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HomeMy WebLinkAbout2005-328o INDIAN RIVER COUNTY - GRANT CONTRACT This Grant Contract ("Contract" ) entered into effective this day of October 2005 , by and between Indian River County, a political subdivision of the State of Florida ; 1840 25th Street , Vero Beach , Florida , 32960-3365 ; and Catholic Charities of the Diocese of Palm Beach , Inc . , ( Recipient) , of: Catholic Charities of the Diocese of Palm Beach , Inc. , P . O . Box 109650 Palm Beach Gardens , Florida 33410-9650 Samaritan Center Background Recitals A. The County has determined that is in the public interest to promote healthy children in a healthy community. B . The County adopted Ordinance 99- 1 on January 19 , 1999 ("Ordinance" ) , and established the Children 's Services Advisory Committee to promote healthy children in a healthy community, and to provide a unified system of planning and delivery within which children 's needs can be identified , targeted , evaluated and addressed . C . The Children 's Services Advisory Committee has issued a request for proposals from individuals and entities that will assist the Children 's Services Advisory Committee in fulfilling its purpose . D . The proposal submitted to the Children 's Services Advisory Committee and the recommendation of the Children 's Services Advisory Committee have been reviewed by the County. E . The Recipient, by submitting a proposal to the Children 's Services Advisory Committee , has applied for a grant of money ("Grant") for the Grant Period (as such term is hereinafter defined ) on the terms and conditions set forth herein . F . The County has agreed to provide such Grant funds to the Recipient for the Grant Period (such term is hereinafter defined ) on the terms and conditions set forth herein . NOW THEREFORE , in consideration of the mutual covenants and promises herein contained , and other good and valuable consideration , the receipt and adequacy of which are hereby acknowledged , the parties agree as follows : 1 . Background Recitals . The background recitals are true and correct and form a material part of this contract. 2 . Purpose of the Grant. The Grant shall be used only for the purposes set forth in the complete proposal submitted by the Recipient , attached hereto as Exhibit "A" and incorporated herein by this reference (such purposes hereinafter referenced as "Grant Purposes") . 3 , Term . The Recipient acknowledges and agrees that the Grant is limited to the fiscal year 2005/2006 ("Grant Period" ) . The Grant Period commences on October 1 , 2005 and ends on September 30 , 2006 . - 1 - INDIAN RIVER COUNTY - GRANT CONTRACT This Grant Contract ("Contract" ) entered into effective this day of October 2005 , by and between Indian River County, a political subdivision of the State of Florida ; 1840 25th Street , Vero Beach , Florida , 32960-3365 ; and Catholic Charities of the Diocese of Palm Beach , Inc . , ( Recipient) , of: Catholic Charities of the Diocese of Palm Beach , Inc. , P . O . Box 109650 Palm Beach Gardens , Florida 33410-9650 Samaritan Center Background Recitals A. The County has determined that is in the public interest to promote healthy children in a healthy community. B . The County adopted Ordinance 99- 1 on January 19 , 1999 ("Ordinance" ) , and established the Children 's Services Advisory Committee to promote healthy children in a healthy community, and to provide a unified system of planning and delivery within which children 's needs can be identified , targeted , evaluated and addressed . C . The Children 's Services Advisory Committee has issued a request for proposals from individuals and entities that will assist the Children 's Services Advisory Committee in fulfilling its purpose . D . The proposal submitted to the Children 's Services Advisory Committee and the recommendation of the Children 's Services Advisory Committee have been reviewed by the County. E . The Recipient, by submitting a proposal to the Children 's Services Advisory Committee , has applied for a grant of money ("Grant") for the Grant Period (as such term is hereinafter defined ) on the terms and conditions set forth herein . F . The County has agreed to provide such Grant funds to the Recipient for the Grant Period (such term is hereinafter defined ) on the terms and conditions set forth herein . NOW THEREFORE , in consideration of the mutual covenants and promises herein contained , and other good and valuable consideration , the receipt and adequacy of which are hereby acknowledged , the parties agree as follows : 1 . Background Recitals . The background recitals are true and correct and form a material part of this contract. 2 . Purpose of the Grant. The Grant shall be used only for the purposes set forth in the complete proposal submitted by the Recipient , attached hereto as Exhibit "A" and incorporated herein by this reference (such purposes hereinafter referenced as "Grant Purposes") . 3 , Term . The Recipient acknowledges and agrees that the Grant is limited to the fiscal year 2005/2006 ("Grant Period" ) . The Grant Period commences on October 1 , 2005 and ends on September 30 , 2006 . - 1 - 4 . Grant Funds and Payment . The approved Grant for the Grant Period is : THIRTY SIX THOUSAND , ONE HUNDRED SIX DOLLARS ($36 , 106 . 00 ) . The County agrees to reimburse the Recipient from such Grant funds for actual documented costs incurred for the Grant Purposes provided in accordance with this Contract. Reimbursement requests may be made no more frequently than monthly. Each reimbursement request shall contain the information , at a minimum , that is set forth in Exhibit "B" , attached hereto and incorporated herein by this reference . All reimbursement requests are subject to audit by the County. In addition , the County may require additional documentation of expenditures , as it deems appropriate . 5 . Additional Obligation of Recipient. 5 . 1 . Records . The Recipient shall maintain adequate internal controls in order to safeguard the Grant. In addition , the Recipient shall maintain adequate records fully to document the use of the Grant funds for at least three (3 ) years after the expiration of the Grant Period . The County shall have access to all books , records , and documents as required in this Section for the purpose of inspection or audit during normal business hours at the County's expense , upon five (5) days prior to written notice . 5 . 2 . Compliance with Laws . The Recipient shall comply at all times with all applicable federal , state , and local laws and regulations . 5 . 3 . Quarterly Performance Reports . The Recipient shall submit quarterly, cumulative , Performance Reports to the Human Services Department of the County, within fifteen ( 15 ) business days following : December 31 , March 31 , June 30 and September 30 . 5 .4 . Audit Requirements , If Recipient receives $25 , 000 , or more in aggregate , from all Indian River County government funding sources , the Recipient is required to have an audit completed by an independent certified public accountant at the end of the Recipient's fiscal year. Within 120 days of the end of the Recipient's fiscal year, the Recipient shall submit the audit to the Indian River County Office of Management and Budget. The fiscal year will be as reported on the application for funding , and the Recipient agrees to notify the County prior to any change in the fiscal period of Recipient . The Recipient acknowledges that the County may deny funding to any Recipient if an audit required by this Contract for the prior fiscal year is past due and has not been submitted by May 1 . 5 .4 . 1 . The Recipient further acknowledges that, promptly upon receipt of a qualified opinion from its independent auditor, such qualified opinion shall immediately be provided to the Indian River County Office of Management and Budget . The qualified opinion shall thereupon be reported to the Board of Commissioners and funding under this Contract will cease immediately. The foregoing termination right is in addition to any other right of the County to terminate the Contract . 5 .4 . 2 . The Indian River County Office of Management and Budget reserves the right at any time to send a letter to the Recipient requesting clarification if there are any questions regarding a part of the financial statements , audit comments , or notes . 5 . 5 . Insurance Requirements . Recipient shall , no later than September 21 , 2005 provide to Indian River County Risk Management Division a certificate , or certificates , issued by an insurer, or insurers , authorized to conduct business in Florida that is rated not-less-than Category A- :VII by A. M . Best, subject to approval by Indian River County' s Risk Manager, of the following types and amounts of insurance : ( i ) Commercial General Liability Insurance in an amount not less than $ 1 , 000 , 000 combined single limit for bodily injury and property - 2 - 4 . Grant Funds and Payment . The approved Grant for the Grant Period is : THIRTY SIX THOUSAND , ONE HUNDRED SIX DOLLARS ($36 , 106 . 00 ) . The County agrees to reimburse the Recipient from such Grant funds for actual documented costs incurred for the Grant Purposes provided in accordance with this Contract. Reimbursement requests may be made no more frequently than monthly. Each reimbursement request shall contain the information , at a minimum , that is set forth in Exhibit "B" , attached hereto and incorporated herein by this reference . All reimbursement requests are subject to audit by the County. In addition , the County may require additional documentation of expenditures , as it deems appropriate . 5 . Additional Obligation of Recipient. 5 . 1 . Records . The Recipient shall maintain adequate internal controls in order to safeguard the Grant. In addition , the Recipient shall maintain adequate records fully to document the use of the Grant funds for at least three (3 ) years after the expiration of the Grant Period . The County shall have access to all books , records , and documents as required in this Section for the purpose of inspection or audit during normal business hours at the County's expense , upon five (5) days prior to written notice . 5 . 2 . Compliance with Laws . The Recipient shall comply at all times with all applicable federal , state , and local laws and regulations . 5 . 3 . Quarterly Performance Reports . The Recipient shall submit quarterly, cumulative , Performance Reports to the Human Services Department of the County, within fifteen ( 15 ) business days following : December 31 , March 31 , June 30 and September 30 . 5 .4 . Audit Requirements , If Recipient receives $25 , 000 , or more in aggregate , from all Indian River County government funding sources , the Recipient is required to have an audit completed by an independent certified public accountant at the end of the Recipient's fiscal year. Within 120 days of the end of the Recipient's fiscal year, the Recipient shall submit the audit to the Indian River County Office of Management and Budget. The fiscal year will be as reported on the application for funding , and the Recipient agrees to notify the County prior to any change in the fiscal period of Recipient . The Recipient acknowledges that the County may deny funding to any Recipient if an audit required by this Contract for the prior fiscal year is past due and has not been submitted by May 1 . 5 .4 . 1 . The Recipient further acknowledges that, promptly upon receipt of a qualified opinion from its independent auditor, such qualified opinion shall immediately be provided to the Indian River County Office of Management and Budget . The qualified opinion shall thereupon be reported to the Board of Commissioners and funding under this Contract will cease immediately. The foregoing termination right is in addition to any other right of the County to terminate the Contract . 5 .4 . 2 . The Indian River County Office of Management and Budget reserves the right at any time to send a letter to the Recipient requesting clarification if there are any questions regarding a part of the financial statements , audit comments , or notes . 5 . 5 . Insurance Requirements . Recipient shall , no later than September 21 , 2005 provide to Indian River County Risk Management Division a certificate , or certificates , issued by an insurer, or insurers , authorized to conduct business in Florida that is rated not-less-than Category A- :VII by A. M . Best, subject to approval by Indian River County' s Risk Manager, of the following types and amounts of insurance : ( i ) Commercial General Liability Insurance in an amount not less than $ 1 , 000 , 000 combined single limit for bodily injury and property - 2 - damage , including coverage for premises/operations , product/completed operations , contractual liability, and independent contractors ; ( ii ) Business Auto Liability Insurance in an amount not less than $ 1 ,000 , 000 per occurrence combined single limit for bodily injury and property damage , including coverage for owned autos and other vehicles , hired autos and other vehicles , non-owned autos and other vehicles ; and (iii ) Worker's Compensation and Employer's Liability (current Florida statutory limit . ) . 5 . 6 . Insurance Administration . The insurance certificates , evidencing all required insurance coverages shall be fully acceptable to County in both form and content, and shall provide and specify that the related insurance coverage shall not be cancelled without at least thirty (30 ) calendar days prior written notice having been given the County. In addition , the County may request such other proofs and assurances as it may reasonable require that the insurance is and at all times remains in full force and effect . Recipient agrees that it is the Recipient's sole responsibility to coordinate activities among itself, the County, and the Recipient's insurer(s ) so that the insurance certificates are acceptable to and accepted by County within the time limits set forth in this Contract. The County shall be listed as an additional insured on all insurance coverage required by this Contract, except Worker's Compensation Insurance . The Recipient shall , upon ten ( 10 ) days prior written request from the County, deliver copies to the County, or make copies available for the County's inspection at Recipient's place of business , of any and all insurance policies that are required in this Contract . If the Recipient fails to deliver or make copies of the policies available to the County; fails to obtain replacement insurance or have previous insurance policies reinstated or renewed upon termination or cancellation of existing required coverages ; or fails in any other regard to obtain coverages sufficient to meet the terms and conditions of this Contract, then the County may, at its sole option , terminate this Contract . 5 . 7 . Indemnification . The Recipient shall indemnify and save harmless the County, its agents , officials , and employees from and against any and all claims , liabilities , losses , damage , or causes of action which may arise from any misconduct, negligent act, or omissions of the Recipient, its agents , officers , or employees in connection with the performance of this Contract . 5 . 8 . Public Records . The Recipient agrees to comply with the provisions of Chapter 119 , Florida Statutes (Public Records Law) in connection with this Contract . 6 . Termination . This Contract may be terminated by either party, without cause , upon thirty (30 ) days prior written notice to the other party. In addition , the County may terminate this Contract for convenience upon ten ( 10 ) days prior written notice to the Recipient if the County determines that such termination is in the public interest. 7 . Availability of Funds . The obligations of the County under this contract are subject to the availability of funds lawfully appropriated for its purpose by the Board of County Commissioners of Indian River County. 8 , Standard Terms . This Contract is subject to the standard terms attached hereto as Exhibit C and incorporated herein in its entirety by this reference . - 3 - IN WITNESS WHEREOF , County and Recipient have entered into this Contract on the date first above written . INDIAN RIVER COUNTY BOARD OF COMMISSIONERS By: S< Thomas S . Lowther, Chairman BCC Approved : / � - `�� ' ' •. _ �. r, Attest: J . K . Barton , Clerk By, r r Deputy Clerk Approved . 1 ( �� Jo ph A. Baird County Administrator )By ed f nd legal sufficiency: arian E . Fell , Assists oun y ttorney RECIPIENT : By: Catholic Charities of the Diocese of Palm Beach , Inc. - 4 - damage , including coverage for premises/operations , product/completed operations , contractual liability, and independent contractors ; ( ii ) Business Auto Liability Insurance in an amount not less than $ 1 ,000 , 000 per occurrence combined single limit for bodily injury and property damage , including coverage for owned autos and other vehicles , hired autos and other vehicles , non-owned autos and other vehicles ; and (iii ) Worker's Compensation and Employer's Liability (current Florida statutory limit . ) . 5 . 6 . Insurance Administration . The insurance certificates , evidencing all required insurance coverages shall be fully acceptable to County in both form and content, and shall provide and specify that the related insurance coverage shall not be cancelled without at least thirty (30 ) calendar days prior written notice having been given the County. In addition , the County may request such other proofs and assurances as it may reasonable require that the insurance is and at all times remains in full force and effect . Recipient agrees that it is the Recipient's sole responsibility to coordinate activities among itself, the County, and the Recipient's insurer(s ) so that the insurance certificates are acceptable to and accepted by County within the time limits set forth in this Contract. The County shall be listed as an additional insured on all insurance coverage required by this Contract, except Worker's Compensation Insurance . The Recipient shall , upon ten ( 10 ) days prior written request from the County, deliver copies to the County, or make copies available for the County's inspection at Recipient's place of business , of any and all insurance policies that are required in this Contract . If the Recipient fails to deliver or make copies of the policies available to the County; fails to obtain replacement insurance or have previous insurance policies reinstated or renewed upon termination or cancellation of existing required coverages ; or fails in any other regard to obtain coverages sufficient to meet the terms and conditions of this Contract, then the County may, at its sole option , terminate this Contract . 5 . 7 . Indemnification . The Recipient shall indemnify and save harmless the County, its agents , officials , and employees from and against any and all claims , liabilities , losses , damage , or causes of action which may arise from any misconduct, negligent act, or omissions of the Recipient, its agents , officers , or employees in connection with the performance of this Contract . 5 . 8 . Public Records . The Recipient agrees to comply with the provisions of Chapter 119 , Florida Statutes (Public Records Law) in connection with this Contract . 6 . Termination . This Contract may be terminated by either party, without cause , upon thirty (30 ) days prior written notice to the other party. In addition , the County may terminate this Contract for convenience upon ten ( 10 ) days prior written notice to the Recipient if the County determines that such termination is in the public interest. 7 . Availability of Funds . The obligations of the County under this contract are subject to the availability of funds lawfully appropriated for its purpose by the Board of County Commissioners of Indian River County. 8 , Standard Terms . This Contract is subject to the standard terms attached hereto as Exhibit C and incorporated herein in its entirety by this reference . - 3 - EXHIBIT A (Copy of complete Request for Proposal ) EXHIBIT - A - Catholic Chanties of The Diocese of Palm Beach Samaritan Center PROGRAM COVER PAGE Organization Name : Catholic Charities Executive Director: Thomas A. Bila, PhD E-mail : tbila@diocesep.b.org Address: 9995 N. Military Trail, P.O.Box 109650 Telephone: 561 -775-9561 Palm Beach Gardens, Fl . 33410-9650 Fax: 561 -625-5906 Program Director: Julia Keenan E-mail : samaritancenterl (a y oo.com Address: 3650 41 st Street Telephone : 772-770-3039 Vero Beach, Fl , 32960_ Fax : 772-567-0812 Program Title: The Samaritan Center Priority Need Area Addressed. L) Mental Wellness Issues and 2. ) Parental Support and Education. Brief Description of the Program : Homeless Shelter-BH- 180. 850-Program that provides a temporary place to stay for people who have no permanent housing. Child Abuse Prevention — FN- 150. 190. 15- Programs, often offered in the schools or in other community settings, which attempt to protect children from physical, sexual and/ or emotional abuse or exploitation through a variety of educational interventions which may focus on children of various ages, parents, people who work with children and/ or parents regarding ways of avoiding or handling an abusive situation and / or -information about the indicators and incidence of abuse, requirement for reporting abuse and community resources that are available to children who have been abused and to their families SUMMARY REPORT — (Enter Information In The Black Cells Only) /Yin Amount Requested from Funder for 2005 /06 : $ 719698 . 17 . _ Total Proposed Program Budget for 2005 /06 : $ 655 , 863 . 52 Percent of Total Program Budget : 10 . 9 % Current Program Funding ( 2004 /05 ) : $ 501000 . 00 Dollar increase / ( decrease ) in request : $ 21 , 698 . 00 Percent increase / ( decrease ) in request * * : 43 . 4 % Unduplicated Number of Children to be served Individually : 487 Unduplicated Number of Adults to be served Individually : 22' Unduplicated Number to be served via Group settings : - Total Program Cost per Client : 99369 . 48 * *If request increased 5% or more, briefly explain why: The total cost per client is less in the upcoming budget cycle . However , the cost of Health insurance and other hurricane If these funds are being used to match another source, name the source and the $ amount: related items are expnading The Organization 's Board of Directors has approved this applican (date . 4/ /2005 our costs . Af Nameek President/Cof the Board aSignaturv(rL7 I rI Ud61fi. 3 l L t jam_ Name of Executive Director/CEO Signature 3 IN WITNESS WHEREOF , County and Recipient have entered into this Contract on the date first above written . INDIAN RIVER COUNTY BOARD OF COMMISSIONERS By: S< Thomas S . Lowther, Chairman BCC Approved : / � - `�� ' ' •. _ �. r, Attest: J . K . Barton , Clerk By, r r Deputy Clerk Approved . 1 ( �� Jo ph A. Baird County Administrator )By ed f nd legal sufficiency: arian E . Fell , Assists oun y ttorney RECIPIENT : By: Catholic Charities of the Diocese of Palm Beach , Inc. - 4 - Catholic Charities of The Diocese of Palm Beach Samaritan Center PROPOSAL NARRATIVE Please respond to each question in the allotted space for each section. In responding to each section of the proposal narrative, please retain the section-label and/or question that you are addressing. Type using 12 pt. font on 8 '/2" X 11 " paper and number each page . These directions and the graphic boxes may be deleted if space is needed. A. ORGANIZATION CAPABILITY (Entire Section A not to exceed one page) 1 . Provide the mission statement and vision of your organization. Mission Statement: Catholic Charities of the Diocese of Palm Beach, inspired by God ' s love for all, serves people of all faiths in need, advocates for justice in social structures, and collaborates with others to build just compassionate communities. Vision : Catholic Charities provides a wide range of professional social services to those in need within the five counties comprising the Diocese of Palm Beach (Palm Beach, Martin, St. Lucie, Okeechobee and Indian River). We are accredited by the Council on Accreditation for Families and Children, which assures that we meet the highest standard of practice and management. Our priority is to serve the "poorest of the poor", and we attempt to develop our programs to meet the most current and pressing needs of the communities we serve. 2 . Provide a brief summary of your organization including areas of expertise, accomplishments, and population served. Catholic Charities is a multi-service agency serving the total community. We provide Adoption/Foster Care, pregnancy services, abstinence education, counseling, four out-of- school programs, services to the elderly including case management and guardianship, refugee resettlement, legal immigration services, three group homes for the developmentally challenged, three HUD 202 senior housing facilities, with another scheduled to open this year, a transitional residence for homeless families, emergency assistance (FEMA), and empowerment program for the Glades area in-home counseling/early intervention program in Riviera Beach. The services of Catholic Charities are available to any resident of our service area who qualifies for the particular program, Catholic Charities does not discriminate based on a client' s religion, nor on any other classification protected under applicable federal , state or local discrimination law. 4 Catholic Charities of The Diocese of Palm Beach Samaritan Center Be PROGRAM NEED STATEMENT Entire Section B not to exceed one page) 1 . a) What is the unacceptable condition requiring change? b) Who has the need? c) Where do they live? d) Provide local, state, or national trend data, with reference source, that corroborates that this is an area of need. a) The unacceptable condition requiring change is that of homelessness, a lack of higher education, vocational skills training and parenting skills. In addition, there are typically problems of substance abuse, physical and emotional abuse, financial problems, legal issues, transportation difficulties, mental health issues, and a general lack of adaptive life problem solving skills. b) The need is realized by families that are homeless or living in unacceptable living conditions . Families must consist of at least one adult age 18+ with at least one child age 0- 17 or a pregnant female 18 years or older. c) They must be residents of Indian River County. Most are in the process of being evicted. Some have already been evicted and are living in cars, tents or on someone ' s porch for a limited time. In some cases the court mandates that a parent come into our program in order to be reunified with their child/children. d) Data : The National Mental Health Association reports some facts about families and children who are homeless : I /Families are now the fastest growing segment of the homeless population and account for almost 40 percent of the nation' s homelessness. On any given night, 1 .2 million children are homeless ; 2/Most children become homeless because their mothers and fathers are unable to find affordable housing. Traumatic events such as unemployment, illness, accidents, or violence and abuse further limit their ability to secure decent housing; 3 /The average homeless family is composed of a young, single mother and two children under the age of six; 4/ While one in five school aged children have a major mental disorder, children between the ages of six and 17 years old who are homeless struggle with higher rates of mental health problems; a) Almost half of children who are homeless have anxiety, depression or withdrawal ; b) And more than one in three children who are homeless manifest delinquent and aggressive behavior; 5/ Homeless children are hungry more than twice as often as other children, and 2/3 worry that they won 't have enough to eat; 6/ Homeless children are more often in fair or poor health, are four times likely to have asthma, and are four times more likely to have a low birth weight and need special care right after birth compared to children who are not homeless. 2. a) Identify similar programs that are currently serving the needs of your targeted population; b) Explain how these existing programs are under-serving the targeted population of your program. a) The only local program similar to ours is the Homeless Family Center. They served 33 families consisting of 73 children during the last year. In addition, they turned 30 families away . b) Underserving the targeted population is shown by the number of people turned away by HAC & Samaritan Center. Our records indicated that 120 families applied for residency at S . C . during the last calendar year. This consists of 141 adults, 206 children and 21 unborn children. Of these, one family was not an I .R. C . resident; therefore, not eligible for our program . 5 EXHIBIT A (Copy of complete Request for Proposal ) EXHIBIT - A - Catholic Charities of The Diocese of Palm Beach Samaritan Center C. PROGRAM DESCRIPTION (Entire Section C, 1 — 6, not to exceed two pages) 1 . List Priority Needs area addressed. The romotion & develo ment of family values and family structure . 2 . Briefly describe program activities including location of services. The program activities and services are provided through a Four Tiered Level Program that has been designed to assist residents in moving progressively forward in their life skills development. Very specific objective skills criteria are associated with each level . The goal is for the resident to complete each level before moving to the next. Adequate completion of all four levels maximizes the chances for successful independent community living after leaving our program. It is expected that most will enter the top Level IV approximately 8 months into the program . Included in each training level are such skill areas as : responsible parenting, conflict resolution, money management, organizational training, domestic skills, role modeling, short and long goal planning. Services are provided at the Samaritan Center. 3. Briefly describe how your program addresses the stated need/problem. Describe how your program follows a recognized "best practice" (see definition on page 12 of the Instructions) and provide evidence that indicates proposed strategies are effective with target population. Those families that come into our program and actively participate in our four-tiered level system do reduce the barriers that were described under program need and have become our best practice . Although many families are ready to leave the program while in Level 3 and are able to maintain independence, the families that remain in the program and graduate after completing Level 4 are the most successful when they resume independent living in the community. Level I is the period of adjustment requiring completion of admission packet/assignments, the completion of a short-term case plan with objectives, a family history and medical information and a completion of physicals and T.B . test. These are usually completed the first 30 days. Level II requirements are regular attendance at weekly parenting classes, regular attendance at weekly counseling sessions, attendance at weekly resident meeting that include conflict resolution, attendance at special educational opportunities, both in house and in community. In addition, they must be actively performing P . I .P . hours (Personal Inventory Program, developing and progression with long-term plans and objectives, complete a Domestic Violence evaluation, open a savings account if receiving income & engaged in employment or enrolled in educational program . Level III is the development Level with the purpose of implementation of what has been taught in Level II . The requirements include the continuation of attendance at parenting classes, the weekly counseling sessions that we have recently added as a mandatory educational opportunity . In addition, there are increased P . I.P . responsibilities and privileges. Level IV is the Maintenance Level that prepares resident family towards graduation from the Center. While in this level , they are given the opportunity to maintain their own financial record keeping and banking. They have increased leadership responsibilities, positive role modeling among peers, and special project assistance to staff. They develop with the guidance of the case manager a plan with goals and objectives for living outside the Center. In addition, they continue to attend all of the weekly classes, counseling and educational opportunities as mandated by the Center. 6 Catholic Charities of The Diocese of Palm Beach Samaritan Center In addition, a 24/7 staff provides direct parenting assistance, supervision and intervention. Age appropriate children participate in weekly programs covering ` Health and Safety", "Self- Esteem", and "Character Values" . A comprehensive After Care Program is available to all residents upon leaving Samaritan Center. To participate in our After Care Program residents must sign up either prior to departure or shortly thereafter. The After Care Contract is a commitment to the program . It requires regular follow up contacts from the resident and by our Case Management staff. These contacts allow us to know how each family is progressing, to see if they are using skills taught to them while in our program and to offer helpful advice/guidance as needed. 4. List staffing needed for your program, including required experience and estimated hours per week in program for each staff member and/or volunteers (this section should conform with the information in the Position Listing on the Budget Narrative Worksheet). Samaritan Center Maintains a 24 hour, 7 day per week staffing pattern. While it is desired that all staff have residential experience, this is not always possible. All staff receive a comprehensive formal training at the site level and at the Diocesan level and receive ongoing staff development opportunities. Senior support staff provide 5 shifts of training to all new support employees before they begin working solo . Professional Positions Support Positions One p/t Division Director 4. 5 hr/wk One Ft Adm. Asst./Vol. Coord. 40 hr/wk One Ft Administrator 37 . 5 hr/wk One Ft Clerical Asst. 40 hr/wk One f/t Case Manager 37. 5 hr/wk One p/t Children' s Coord. 35 hr/wk One Pt Resident Manager 37 . 5 hr/wk One p/t Kitchen Support 25 hr/wk Support Positions Support Positions Four f/t Support Staff 40 hr/wk Two ph Support 16 hr/wk One p/t Support Staff 32 hr/wk One p/t Support 4 hr/wk Substitutes as needed a rox . 8- 16 hrs. wk . 5. How will the target population be made aware of the program? The target group is made aware of the program through a wide variety of opportunities as follows : Presentations to community civic and church groups Participation / networking with other social service organizations Presentations and bulletin announcements to Churches Law Enforcement agencies Current and former resident word of mouth Labor Force Annual mailings to Churches and Service Providers regarding services provided. Media opportunities including newspaper article, quarterly Samaritan Newsletter, distribution of brochures, fundraising activities, radio & TV talk shows. 7 Catholic Chanties of The Diocese of Palm Beach Samaritan Center PROGRAM COVER PAGE Organization Name : Catholic Charities Executive Director: Thomas A. Bila, PhD E-mail : tbila@diocesep.b.org Address: 9995 N. Military Trail, P.O.Box 109650 Telephone: 561 -775-9561 Palm Beach Gardens, Fl . 33410-9650 Fax: 561 -625-5906 Program Director: Julia Keenan E-mail : samaritancenterl (a y oo.com Address: 3650 41 st Street Telephone : 772-770-3039 Vero Beach, Fl , 32960_ Fax : 772-567-0812 Program Title: The Samaritan Center Priority Need Area Addressed. L) Mental Wellness Issues and 2. ) Parental Support and Education. Brief Description of the Program : Homeless Shelter-BH- 180. 850-Program that provides a temporary place to stay for people who have no permanent housing. Child Abuse Prevention — FN- 150. 190. 15- Programs, often offered in the schools or in other community settings, which attempt to protect children from physical, sexual and/ or emotional abuse or exploitation through a variety of educational interventions which may focus on children of various ages, parents, people who work with children and/ or parents regarding ways of avoiding or handling an abusive situation and / or -information about the indicators and incidence of abuse, requirement for reporting abuse and community resources that are available to children who have been abused and to their families SUMMARY REPORT — (Enter Information In The Black Cells Only) /Yin Amount Requested from Funder for 2005 /06 : $ 719698 . 17 . _ Total Proposed Program Budget for 2005 /06 : $ 655 , 863 . 52 Percent of Total Program Budget : 10 . 9 % Current Program Funding ( 2004 /05 ) : $ 501000 . 00 Dollar increase / ( decrease ) in request : $ 21 , 698 . 00 Percent increase / ( decrease ) in request * * : 43 . 4 % Unduplicated Number of Children to be served Individually : 487 Unduplicated Number of Adults to be served Individually : 22' Unduplicated Number to be served via Group settings : - Total Program Cost per Client : 99369 . 48 * *If request increased 5% or more, briefly explain why: The total cost per client is less in the upcoming budget cycle . However , the cost of Health insurance and other hurricane If these funds are being used to match another source, name the source and the $ amount: related items are expnading The Organization 's Board of Directors has approved this applican (date . 4/ /2005 our costs . Af Nameek President/Cof the Board aSignaturv(rL7 I rI Ud61fi. 3 l L t jam_ Name of Executive Director/CEO Signature 3 Catholic Charities of The Diocese of Palm Beach Samaritan Center 6. How will the program be accessible to target population (i.e., location, transportation, hours of operation)? Samaritan Center holds an orientation/screening for those families seeking shelter. This includes drug testing and background checks for all family members over the age of 18 . This must be completed prior to a family moving into the facility and these are done by appointment. These families are usually able to transport themselves or secure transportation through a family member, friend, etc . On the rare occasion that they are unable to reach us on their own, we will provide transportation via the Center Van. Once a family has moved into the Center, if they do not have their own vehicle, we encourage them to be resourceful in attempts to find transportation through the community bus, or family/friends. If they are unsuccessful, we do provide transportation to their case related appointments (ex . Medical, employment, school, court, off premises educational workshops and Samaritan Center planned Social Activities). We do not provide transport for personal outings . We are very fortunate to periodically have vehicles donated to our program. We in turn, donate the vehicle to a resident that is without transportation to their employment, necessary appointments, groceries, etc. . 8 Catholic Charities of The Diocese of Palm Beach Samaritan Center D. MEASURABLE OUTCOMES (Description of Intent) Use the Measurable Outcomesform. This descrition ggge does not need to be included in the graosal. In order to show the impact that your program is having on the target population and the community, the funders are requiring measurable outcomes. Please review the examples and summaries below to insure your understanding of what is expected. OUTCOMES : Describes what you want to achieve with the target population. Indicates the results of the services you provide, not the services you provide . Outcomes utilize action words such as maintain, increase, decrease, reduce, improve, raise and lower. ACTIVITIES : Describes the tasks that will be accomplished in the program to achieve the results stated in the outcomes . Activities utilize action words such as complete, establish, create, provide, operate, and develop. The activities should reflect the services described in the PROGRAM DESCRIPTION (C2) . Use the following elements to develop your outcomes. All elements must be included: • Direction of change • Time frame • Area of change • As measured by • Target population • Baseline: The number that you will be • Degree o chane measuring against Example 1 (Outcome) : To decrease (direction of change) number of unexcused absences (area of change) of enrolled boys and girls (target population) by 75% (degree of change) in one year (timeframe) as reported by the 2003 School Board attendance records (as measured by). Baseline : 2003 School Board attendance records for enrolled boys and girls. Example 1 (Activity) : To provide anger management classes to enrolled boys and girls 2 times a week for 12 weeks. Example 2 (Outcome) : 75 % (degree of change) of youth (target population) who have participated in the academic enrichment activities (as measured by) for 6 months or more (time frame), will improve (direction of change) their scores in one or more subject area (area of change) . 25 % of participants in academic enrichment activities will maintain the initial level of performance assessed at entry. Baseline : Pre-test scores from the academic enrichment test. Example 2 (Activity) : 1 ) Provide pre and post-test exercises on the Advanced Learning System software; 2) Participants will go through the one lesson per week and be graded for 10 weeks. IMPORTANT NOTE : Keep in mind when developing your PROGRAM OUTCOMES, that if funded, this will be what you are held accountable to accomplish. Also, the PROGRAM OUTCOMES should reflect the information described in the PROGRAM NEED STATEMENT (B 1 ) . All Program Need Statements should flow from the Mission & Vision. Measurable Outcomes should be based on and measure program needs. Activities are the tasks you do that are going to influence the outcome and impact the unacceptable condition in your Program Need Statement. 9 Catholic Charities of The Diocese of Palm Beach Samaritan Center PROPOSAL NARRATIVE Please respond to each question in the allotted space for each section. In responding to each section of the proposal narrative, please retain the section-label and/or question that you are addressing. Type using 12 pt. font on 8 '/2" X 11 " paper and number each page . These directions and the graphic boxes may be deleted if space is needed. A. ORGANIZATION CAPABILITY (Entire Section A not to exceed one page) 1 . Provide the mission statement and vision of your organization. Mission Statement: Catholic Charities of the Diocese of Palm Beach, inspired by God ' s love for all, serves people of all faiths in need, advocates for justice in social structures, and collaborates with others to build just compassionate communities. Vision : Catholic Charities provides a wide range of professional social services to those in need within the five counties comprising the Diocese of Palm Beach (Palm Beach, Martin, St. Lucie, Okeechobee and Indian River). We are accredited by the Council on Accreditation for Families and Children, which assures that we meet the highest standard of practice and management. Our priority is to serve the "poorest of the poor", and we attempt to develop our programs to meet the most current and pressing needs of the communities we serve. 2 . Provide a brief summary of your organization including areas of expertise, accomplishments, and population served. Catholic Charities is a multi-service agency serving the total community. We provide Adoption/Foster Care, pregnancy services, abstinence education, counseling, four out-of- school programs, services to the elderly including case management and guardianship, refugee resettlement, legal immigration services, three group homes for the developmentally challenged, three HUD 202 senior housing facilities, with another scheduled to open this year, a transitional residence for homeless families, emergency assistance (FEMA), and empowerment program for the Glades area in-home counseling/early intervention program in Riviera Beach. The services of Catholic Charities are available to any resident of our service area who qualifies for the particular program, Catholic Charities does not discriminate based on a client' s religion, nor on any other classification protected under applicable federal , state or local discrimination law. 4 Catholic Charities of The Diocese of Palm Beach Samaritan Center Be PROGRAM NEED STATEMENT Entire Section B not to exceed one page) 1 . a) What is the unacceptable condition requiring change? b) Who has the need? c) Where do they live? d) Provide local, state, or national trend data, with reference source, that corroborates that this is an area of need. a) The unacceptable condition requiring change is that of homelessness, a lack of higher education, vocational skills training and parenting skills. In addition, there are typically problems of substance abuse, physical and emotional abuse, financial problems, legal issues, transportation difficulties, mental health issues, and a general lack of adaptive life problem solving skills. b) The need is realized by families that are homeless or living in unacceptable living conditions . Families must consist of at least one adult age 18+ with at least one child age 0- 17 or a pregnant female 18 years or older. c) They must be residents of Indian River County. Most are in the process of being evicted. Some have already been evicted and are living in cars, tents or on someone ' s porch for a limited time. In some cases the court mandates that a parent come into our program in order to be reunified with their child/children. d) Data : The National Mental Health Association reports some facts about families and children who are homeless : I /Families are now the fastest growing segment of the homeless population and account for almost 40 percent of the nation' s homelessness. On any given night, 1 .2 million children are homeless ; 2/Most children become homeless because their mothers and fathers are unable to find affordable housing. Traumatic events such as unemployment, illness, accidents, or violence and abuse further limit their ability to secure decent housing; 3 /The average homeless family is composed of a young, single mother and two children under the age of six; 4/ While one in five school aged children have a major mental disorder, children between the ages of six and 17 years old who are homeless struggle with higher rates of mental health problems; a) Almost half of children who are homeless have anxiety, depression or withdrawal ; b) And more than one in three children who are homeless manifest delinquent and aggressive behavior; 5/ Homeless children are hungry more than twice as often as other children, and 2/3 worry that they won 't have enough to eat; 6/ Homeless children are more often in fair or poor health, are four times likely to have asthma, and are four times more likely to have a low birth weight and need special care right after birth compared to children who are not homeless. 2. a) Identify similar programs that are currently serving the needs of your targeted population; b) Explain how these existing programs are under-serving the targeted population of your program. a) The only local program similar to ours is the Homeless Family Center. They served 33 families consisting of 73 children during the last year. In addition, they turned 30 families away . b) Underserving the targeted population is shown by the number of people turned away by HAC & Samaritan Center. Our records indicated that 120 families applied for residency at S . C . during the last calendar year. This consists of 141 adults, 206 children and 21 unborn children. Of these, one family was not an I .R. C . resident; therefore, not eligible for our program . 5 Catholic Charities of The Diocese of Palm Beach Samaritan Center D. MEASURABLE OUTCOMES (Entire Section D not to exceed two pages) OUTCOMES ACTIVITIES Add all of the elements or the Measurable Outcomes Add the tasks to accomplish the Outcome(s) 1 ) 80% of resident families who leave the All adult residents are required to actively program having improved their life skills to at participate in the four tiered level adaptive life least Level III will move into a stable housing skills training program. The higher level that a situation upon departure as measured by total family completes increases their chances of number of families who depart having entering and remaining in stable housing when achieved a minimum of Level III during the leaving the Samaritan Center program. fiscal year 2005 -2006 . Baseline : Total number of families moving out of the Center in 2004-2005 fiscal year who have achieved Level III or +. 2) Resident children who are age 4 and over Age appropriate children will participate in the will increase their self-esteem by showing an weekly self-esteem module . In addition, 24 average of 5 - 10% increase on the self-esteem hour guidance and encouragement is provided pre/post tests that are given at the end of each 8 to parents to utilize the skills that they are week session. As measured by total number of taught in the weekly parenting classes . By age related children entering the program constant reinforcement of "positive parenting", during the 2005 -2006 fiscal year. Baseline : the children exhibit increased self-esteem and 2005 -2006 resident children who are 4 years improved behaviors. _ old through 17 years . 3 ) 80% of discharged families who have Residents acquire skills for independent achieved Level III or higher will have at least community living including employment one family member involved in a minimum of search, employment training, appropriate attire 35 weekly hours of paid employment as and interviewing techniques as they go through measured by total number of families who the Center' s training program. reached Level III or IV during the 2005 -2006 fiscal year. Baseline : Total discharged families. 4) 75 % of families who have completed the Former residents participate in aftercare program by achieving the minimum of Level services that include home visits, visits at the III will remain in stable housing 12 months Center, telephone contacts, and invitations to after discharge date as measured by total special events or activities . These services are number of families achieving Level III or more provided through the Case Management staff a while in the Center and having moved out minimum of 2 times per month for at least 12 during fiscal year 2004-2005 . Baseline : Total months after moving out. number of families who achieve Level III or higher and moved out of the Center during the 2004-2005 fiscal year. 10 Catholic Charities of The Diocese of Palm Beach Samaritan Center 5 ) Resident children who are age 4 and over Age appropriate children will participate in the will demonstrate a 10 to 15 % improvement in Character Values Program. Children' s behavior learned through the 8 week Character coordinator meets weekly with parent & child Values Program . Behaviors are charted each to share any behavioral problems and together session indicating progression. As measured put a plan together to help child improve . by total number of age related children entering the program during the 2005/2006 fiscal year. 11 Catholic Charities of The Diocese of Palm Beach Samaritan Center C. PROGRAM DESCRIPTION (Entire Section C, 1 — 6, not to exceed two pages) 1 . List Priority Needs area addressed. The romotion & develo ment of family values and family structure . 2 . Briefly describe program activities including location of services. The program activities and services are provided through a Four Tiered Level Program that has been designed to assist residents in moving progressively forward in their life skills development. Very specific objective skills criteria are associated with each level . The goal is for the resident to complete each level before moving to the next. Adequate completion of all four levels maximizes the chances for successful independent community living after leaving our program. It is expected that most will enter the top Level IV approximately 8 months into the program . Included in each training level are such skill areas as : responsible parenting, conflict resolution, money management, organizational training, domestic skills, role modeling, short and long goal planning. Services are provided at the Samaritan Center. 3. Briefly describe how your program addresses the stated need/problem. Describe how your program follows a recognized "best practice" (see definition on page 12 of the Instructions) and provide evidence that indicates proposed strategies are effective with target population. Those families that come into our program and actively participate in our four-tiered level system do reduce the barriers that were described under program need and have become our best practice . Although many families are ready to leave the program while in Level 3 and are able to maintain independence, the families that remain in the program and graduate after completing Level 4 are the most successful when they resume independent living in the community. Level I is the period of adjustment requiring completion of admission packet/assignments, the completion of a short-term case plan with objectives, a family history and medical information and a completion of physicals and T.B . test. These are usually completed the first 30 days. Level II requirements are regular attendance at weekly parenting classes, regular attendance at weekly counseling sessions, attendance at weekly resident meeting that include conflict resolution, attendance at special educational opportunities, both in house and in community. In addition, they must be actively performing P . I .P . hours (Personal Inventory Program, developing and progression with long-term plans and objectives, complete a Domestic Violence evaluation, open a savings account if receiving income & engaged in employment or enrolled in educational program . Level III is the development Level with the purpose of implementation of what has been taught in Level II . The requirements include the continuation of attendance at parenting classes, the weekly counseling sessions that we have recently added as a mandatory educational opportunity . In addition, there are increased P . I.P . responsibilities and privileges. Level IV is the Maintenance Level that prepares resident family towards graduation from the Center. While in this level , they are given the opportunity to maintain their own financial record keeping and banking. They have increased leadership responsibilities, positive role modeling among peers, and special project assistance to staff. They develop with the guidance of the case manager a plan with goals and objectives for living outside the Center. In addition, they continue to attend all of the weekly classes, counseling and educational opportunities as mandated by the Center. 6 Catholic Charities of The Diocese of Palm Beach Samaritan Center In addition, a 24/7 staff provides direct parenting assistance, supervision and intervention. Age appropriate children participate in weekly programs covering ` Health and Safety", "Self- Esteem", and "Character Values" . A comprehensive After Care Program is available to all residents upon leaving Samaritan Center. To participate in our After Care Program residents must sign up either prior to departure or shortly thereafter. The After Care Contract is a commitment to the program . It requires regular follow up contacts from the resident and by our Case Management staff. These contacts allow us to know how each family is progressing, to see if they are using skills taught to them while in our program and to offer helpful advice/guidance as needed. 4. List staffing needed for your program, including required experience and estimated hours per week in program for each staff member and/or volunteers (this section should conform with the information in the Position Listing on the Budget Narrative Worksheet). Samaritan Center Maintains a 24 hour, 7 day per week staffing pattern. While it is desired that all staff have residential experience, this is not always possible. All staff receive a comprehensive formal training at the site level and at the Diocesan level and receive ongoing staff development opportunities. Senior support staff provide 5 shifts of training to all new support employees before they begin working solo . Professional Positions Support Positions One p/t Division Director 4. 5 hr/wk One Ft Adm. Asst./Vol. Coord. 40 hr/wk One Ft Administrator 37 . 5 hr/wk One Ft Clerical Asst. 40 hr/wk One f/t Case Manager 37. 5 hr/wk One p/t Children' s Coord. 35 hr/wk One Pt Resident Manager 37 . 5 hr/wk One p/t Kitchen Support 25 hr/wk Support Positions Support Positions Four f/t Support Staff 40 hr/wk Two ph Support 16 hr/wk One p/t Support Staff 32 hr/wk One p/t Support 4 hr/wk Substitutes as needed a rox . 8- 16 hrs. wk . 5. How will the target population be made aware of the program? The target group is made aware of the program through a wide variety of opportunities as follows : Presentations to community civic and church groups Participation / networking with other social service organizations Presentations and bulletin announcements to Churches Law Enforcement agencies Current and former resident word of mouth Labor Force Annual mailings to Churches and Service Providers regarding services provided. Media opportunities including newspaper article, quarterly Samaritan Newsletter, distribution of brochures, fundraising activities, radio & TV talk shows. 7 Catholic Charities of The Diocese of Palm Beach Samaritan Center E. COLLABORATION (Entire Section E not to exceed one page) 1 . List your program ' s collaborative partners and the resources that they are providing to the program beyond referrals and support. (See individual funder requirements for inclusion of collaborative agreement letters. Collaborative Agency Resources provided to the program The Mental Health Association and The Child Witness Program, a 12 week session held at Exchange Club of I .R.C . S . C . & conducted by a M . H.A. counselor, is designed for children having witnessed domestic violence. For adults, a weekly support group is offered offsite that resident adults may attend. I . R.C . Human Services They provide temporary housing up to 3 nights at the Citrus Motel upon referral from S . C . . This process is used mostly when a family is "out on the street" and being accepted into S . C . contingent on results of background screening. Indian River Thrift Store They accept donations of furniture, household items, clothing & miscellaneous items in the name of S .C . . When items are sold, a credit is placed on our account to be used by our program/clients as needed for reasons such as clothing for employment or employment search; furniture & household items when moving into their own housing. Indian River Health Dept . Hold meetings/workshops at S .C . as our census changes on the topics of "Pregnancy Prevention", Aids Prevention", and general information about the prevention and treatment of sexually transmitted disease. Hold workshops at S . C . for it' s employees on HIV issues. Provides testing at S .C . for HIV for it' s residents. Homeless Family Center A MIS system called "Service Point" is in place to network with agencies participating in the Homeless Continuum of Care. H .F . C . & S .C . are two of the priority programs . The focus of MIS covers I & R, service coordination, case planning & assessment data. The two agencies also work closely sharing donated items of clothing and food, along with providing referrals to each other. Habitat for Humanity JA representative from Habitat comes to S . C . to present the requirements for acquiring a Habitat home . They also work with interested families on financial guidance * Carenet Pregnancy Center Workshops covering abstinence and STD prevention are help onsite for our adult and teen residents. Gifford Youth Activities Center A 9 week parenting class, facilitated by GYAC staff is held on-site. City of Vero Beach Police Dept. When needed, the police department will assist parents with car seat installation. This is done at S .C . and for individuals at the Police Department. 12 Catholic Charities of The Diocese of Palm Beach Samaritan Center F. PROGRAM EVALUATION (Entire Section F not to exceed two pages) 1 . DEMOGRAPHICS : What information (data elements) will you need to collect in order to accurately describe your target population including demographics (age, gender, and ethnic background) required by the funder in Section H? What are the pieces of information that qualify them for your target population ? How do you document their need for services or their "unacceptable condition requiring change" from Section B19 The Data elements collected for our target population are on our "Program Beneficiary Statistic" form. The information collected is 1 ) Unduplicated count of program beneficiaries; 2) Age group ; 3 ) Sex ; 4) Ethnic background; 5) Program beneficiary characteristics (ex . Single parent, w/o GED or diploma, Veteran, Victim of rape/incest/domestic violence ; physically disabled); 6) Income level; 7) Geographic residence in IRC; 8) Unit of service including census days, special programs, transportation, legal & miscellaneous ; 9) Religion. In addition, a monthly census form is kept by day on families that are in residence. This information is carried over to the above form at the end of each month. This information is collected and entered into the data form once they enter the program. The pieces of information that qualify them for our target population and their need is documented before entering the program. A telephone intake is the first step in assessing their need. If it appears that they qualify for our program, an appointment is scheduled to fully explain the program to them and to have them complete the following forms: 1 ) Samaritan Center Personal Inventory that is designed to obtain information about a wide range of possible problems areas; 2) Subjective questionnaire (personal information including behaviors, mental health issues, drug/alcohol issues, etc. ) 3 ) A Statement regarding reason(s) or homelessness; 4) Written assignment (why they think they are a good candidate for the program; goals that they would like to accomplish and personal description of self. Once this information has been completed, a determination can be made if this family fits into our target population, and the depth of their need. 2 . MEASURES : What data elements will you need to collect to show that you have achieved (or made progress toward) your Measurable Outcomes in Section D? What tools or items are you using as measures (grades, survey scores, attendance, absences, skill levels) for your program? Are you getting baseline information from a source on your Collaboration List in Section E ? Are there results from your Activities in Section D that need to be documented ? How often do you need to collect or follow-up on this data? The data elements needed to collect to show achievements/progress toward Measurable Outcomes are located in our "Master Stats" which include : the information in above form in addition to dates each family achieved a new Level, Level at time of exit, discharge information, forwarding address, phone and contact, 6 month contact information, 12 months contact information, rent/own home and whether employed. The tools/items used are pre-post test, school grades, school attendance, counseling & parenting class attendance and the Level system. 13 Catholic Charities of The Diocese of Palm Beach Samaritan Center 6. How will the program be accessible to target population (i.e., location, transportation, hours of operation)? Samaritan Center holds an orientation/screening for those families seeking shelter. This includes drug testing and background checks for all family members over the age of 18 . This must be completed prior to a family moving into the facility and these are done by appointment. These families are usually able to transport themselves or secure transportation through a family member, friend, etc . On the rare occasion that they are unable to reach us on their own, we will provide transportation via the Center Van. Once a family has moved into the Center, if they do not have their own vehicle, we encourage them to be resourceful in attempts to find transportation through the community bus, or family/friends. If they are unsuccessful, we do provide transportation to their case related appointments (ex . Medical, employment, school, court, off premises educational workshops and Samaritan Center planned Social Activities). We do not provide transport for personal outings . We are very fortunate to periodically have vehicles donated to our program. We in turn, donate the vehicle to a resident that is without transportation to their employment, necessary appointments, groceries, etc. . 8 Catholic Charities of The Diocese of Palm Beach Samaritan Center D. MEASURABLE OUTCOMES (Description of Intent) Use the Measurable Outcomesform. This descrition ggge does not need to be included in the graosal. In order to show the impact that your program is having on the target population and the community, the funders are requiring measurable outcomes. Please review the examples and summaries below to insure your understanding of what is expected. OUTCOMES : Describes what you want to achieve with the target population. Indicates the results of the services you provide, not the services you provide . Outcomes utilize action words such as maintain, increase, decrease, reduce, improve, raise and lower. ACTIVITIES : Describes the tasks that will be accomplished in the program to achieve the results stated in the outcomes . Activities utilize action words such as complete, establish, create, provide, operate, and develop. The activities should reflect the services described in the PROGRAM DESCRIPTION (C2) . Use the following elements to develop your outcomes. All elements must be included: • Direction of change • Time frame • Area of change • As measured by • Target population • Baseline: The number that you will be • Degree o chane measuring against Example 1 (Outcome) : To decrease (direction of change) number of unexcused absences (area of change) of enrolled boys and girls (target population) by 75% (degree of change) in one year (timeframe) as reported by the 2003 School Board attendance records (as measured by). Baseline : 2003 School Board attendance records for enrolled boys and girls. Example 1 (Activity) : To provide anger management classes to enrolled boys and girls 2 times a week for 12 weeks. Example 2 (Outcome) : 75 % (degree of change) of youth (target population) who have participated in the academic enrichment activities (as measured by) for 6 months or more (time frame), will improve (direction of change) their scores in one or more subject area (area of change) . 25 % of participants in academic enrichment activities will maintain the initial level of performance assessed at entry. Baseline : Pre-test scores from the academic enrichment test. Example 2 (Activity) : 1 ) Provide pre and post-test exercises on the Advanced Learning System software; 2) Participants will go through the one lesson per week and be graded for 10 weeks. IMPORTANT NOTE : Keep in mind when developing your PROGRAM OUTCOMES, that if funded, this will be what you are held accountable to accomplish. Also, the PROGRAM OUTCOMES should reflect the information described in the PROGRAM NEED STATEMENT (B 1 ) . All Program Need Statements should flow from the Mission & Vision. Measurable Outcomes should be based on and measure program needs. Activities are the tasks you do that are going to influence the outcome and impact the unacceptable condition in your Program Need Statement. 9 Catholic Charities of The Diocese of Palm Beach Samaritan Center We have requested baseline information from one of our collaborative sources but have not received it. We will be requesting baseline information from all those sources who conduct workshops for our clients. All activities are documented. Information is turned into our Resident Manager who inputs the statistical information. This information is kept current and entered as clients enter a new Level and as test results are completed . 3 . REPORTING : What will you do with this information to show that change has occurred ? How will you use or present these results to the consumer, the funder, the program, and the community? How will you use this information to improve your program? The data is collected as described in the above sections. The information becomes a permanent part of our records and is shared with those funding sources that seek that information. The "Program Beneficiary Statistical" form is the standard form that is required by Catholic Charities . This report is sent to them on a monthly basis . The outcomes are sent to Catholic Charities for review and to evaluate how our program is doing. Some of the outcomes are shared in the community when making presentations and occasionally have been used in our newsletter that is mailed to approximately 4500 area residents and businesses . We always strive to improve our program and the outcomes are used when our treatment team meets for regular evaluation of clients and the program as a whole. 14 Catholic Charities of The Diocese of Palm Beach Samaritan Center G. TIMETABLE (Section G not to exceed one page) 1 . List the major action steps, activities, or cycles of events that will occur within the program year. New programs should include any start-up planning that may occur outside the funding year. In completing the timetable, review information detailed in prior sections. Month/Period Activities Children Ongoing year round Tuesday evening activity night — family sports, art & crafts, music, movies, etc . — To teach families how to spend quality time without spending money. Ages 4- 17 one session per week for 8 weeks of Self-Esteem Classes . Quarterly Ages 4- 17 one session per week for 8 weeks of Character Values. Quarterly Between above sessions — classes on Health & Safety are conducted by Quarterly Children' s Coordinator. A 12 week — Child Witness Program — conducted by the Mental Health As new age Association. appropriate children enter program Family outings that are staff supervised are held to teach and ensure Monthly quality time between parents & child(ren). Events are held at the Brevard Zoo, area recreational parks, Royal Palm Fountain, local beaches, etc. Adults Quarterly 3X 8 week Parenting Classes conducted by Center Case Manager (Monday Evenings) . May, June, July 12 week Parenting Class conducted by Gifford Community Center. In between Parenting 8 week classes on Domestic Violence conducted by Mental Health Classes Association. As time allows Various classes on Budget & Financial planning, Anger Management & other educational opportunities. 15 Catholic Charities of The Diocese of Palm Beach Samaritan Center D. MEASURABLE OUTCOMES (Entire Section D not to exceed two pages) OUTCOMES ACTIVITIES Add all of the elements or the Measurable Outcomes Add the tasks to accomplish the Outcome(s) 1 ) 80% of resident families who leave the All adult residents are required to actively program having improved their life skills to at participate in the four tiered level adaptive life least Level III will move into a stable housing skills training program. The higher level that a situation upon departure as measured by total family completes increases their chances of number of families who depart having entering and remaining in stable housing when achieved a minimum of Level III during the leaving the Samaritan Center program. fiscal year 2005 -2006 . Baseline : Total number of families moving out of the Center in 2004-2005 fiscal year who have achieved Level III or +. 2) Resident children who are age 4 and over Age appropriate children will participate in the will increase their self-esteem by showing an weekly self-esteem module . In addition, 24 average of 5 - 10% increase on the self-esteem hour guidance and encouragement is provided pre/post tests that are given at the end of each 8 to parents to utilize the skills that they are week session. As measured by total number of taught in the weekly parenting classes . By age related children entering the program constant reinforcement of "positive parenting", during the 2005 -2006 fiscal year. Baseline : the children exhibit increased self-esteem and 2005 -2006 resident children who are 4 years improved behaviors. _ old through 17 years . 3 ) 80% of discharged families who have Residents acquire skills for independent achieved Level III or higher will have at least community living including employment one family member involved in a minimum of search, employment training, appropriate attire 35 weekly hours of paid employment as and interviewing techniques as they go through measured by total number of families who the Center' s training program. reached Level III or IV during the 2005 -2006 fiscal year. Baseline : Total discharged families. 4) 75 % of families who have completed the Former residents participate in aftercare program by achieving the minimum of Level services that include home visits, visits at the III will remain in stable housing 12 months Center, telephone contacts, and invitations to after discharge date as measured by total special events or activities . These services are number of families achieving Level III or more provided through the Case Management staff a while in the Center and having moved out minimum of 2 times per month for at least 12 during fiscal year 2004-2005 . Baseline : Total months after moving out. number of families who achieve Level III or higher and moved out of the Center during the 2004-2005 fiscal year. 10 Catholic Charities of The Diocese of Palm Beach Samaritan Center 5 ) Resident children who are age 4 and over Age appropriate children will participate in the will demonstrate a 10 to 15 % improvement in Character Values Program. Children' s behavior learned through the 8 week Character coordinator meets weekly with parent & child Values Program . Behaviors are charted each to share any behavioral problems and together session indicating progression. As measured put a plan together to help child improve . by total number of age related children entering the program during the 2005/2006 fiscal year. 11 r W 00 N N 4 r� N. rn rL: � 3 xx •-+ ,-� d N N t� WE" A W P. Tx . ee POEM PC OWN PC PC W o moo •C a o INS U 00 p .-. C*s O O C*A O O art d M M t` fir ~ .M1 0 . � a� U o :. V �' . � d � � • - � � ',ted ' off � � �. � W 00. ►� C� 0 S w° V. 0 o n � � °` � U C/) x Edit this Header. Tyi)e the organization and program name and the funder for whom it is being completed. The page # is already set at the bottom right of every page. I. BUDGET FORMS - To open the Budget Forms, please double-click on the icon below. : .gin:- " Core Budget Forms " 17 Catholic Charities of The Diocese of Palm Beach Samaritan Center E. COLLABORATION (Entire Section E not to exceed one page) 1 . List your program ' s collaborative partners and the resources that they are providing to the program beyond referrals and support. (See individual funder requirements for inclusion of collaborative agreement letters. Collaborative Agency Resources provided to the program The Mental Health Association and The Child Witness Program, a 12 week session held at Exchange Club of I .R.C . S . C . & conducted by a M . H.A. counselor, is designed for children having witnessed domestic violence. For adults, a weekly support group is offered offsite that resident adults may attend. I . R.C . Human Services They provide temporary housing up to 3 nights at the Citrus Motel upon referral from S . C . . This process is used mostly when a family is "out on the street" and being accepted into S . C . contingent on results of background screening. Indian River Thrift Store They accept donations of furniture, household items, clothing & miscellaneous items in the name of S .C . . When items are sold, a credit is placed on our account to be used by our program/clients as needed for reasons such as clothing for employment or employment search; furniture & household items when moving into their own housing. Indian River Health Dept . Hold meetings/workshops at S .C . as our census changes on the topics of "Pregnancy Prevention", Aids Prevention", and general information about the prevention and treatment of sexually transmitted disease. Hold workshops at S . C . for it' s employees on HIV issues. Provides testing at S .C . for HIV for it' s residents. Homeless Family Center A MIS system called "Service Point" is in place to network with agencies participating in the Homeless Continuum of Care. H .F . C . & S .C . are two of the priority programs . The focus of MIS covers I & R, service coordination, case planning & assessment data. The two agencies also work closely sharing donated items of clothing and food, along with providing referrals to each other. Habitat for Humanity JA representative from Habitat comes to S . C . to present the requirements for acquiring a Habitat home . They also work with interested families on financial guidance * Carenet Pregnancy Center Workshops covering abstinence and STD prevention are help onsite for our adult and teen residents. Gifford Youth Activities Center A 9 week parenting class, facilitated by GYAC staff is held on-site. City of Vero Beach Police Dept. When needed, the police department will assist parents with car seat installation. This is done at S .C . and for individuals at the Police Department. 12 Catholic Charities of The Diocese of Palm Beach Samaritan Center F. PROGRAM EVALUATION (Entire Section F not to exceed two pages) 1 . DEMOGRAPHICS : What information (data elements) will you need to collect in order to accurately describe your target population including demographics (age, gender, and ethnic background) required by the funder in Section H? What are the pieces of information that qualify them for your target population ? How do you document their need for services or their "unacceptable condition requiring change" from Section B19 The Data elements collected for our target population are on our "Program Beneficiary Statistic" form. The information collected is 1 ) Unduplicated count of program beneficiaries; 2) Age group ; 3 ) Sex ; 4) Ethnic background; 5) Program beneficiary characteristics (ex . Single parent, w/o GED or diploma, Veteran, Victim of rape/incest/domestic violence ; physically disabled); 6) Income level; 7) Geographic residence in IRC; 8) Unit of service including census days, special programs, transportation, legal & miscellaneous ; 9) Religion. In addition, a monthly census form is kept by day on families that are in residence. This information is carried over to the above form at the end of each month. This information is collected and entered into the data form once they enter the program. The pieces of information that qualify them for our target population and their need is documented before entering the program. A telephone intake is the first step in assessing their need. If it appears that they qualify for our program, an appointment is scheduled to fully explain the program to them and to have them complete the following forms: 1 ) Samaritan Center Personal Inventory that is designed to obtain information about a wide range of possible problems areas; 2) Subjective questionnaire (personal information including behaviors, mental health issues, drug/alcohol issues, etc. ) 3 ) A Statement regarding reason(s) or homelessness; 4) Written assignment (why they think they are a good candidate for the program; goals that they would like to accomplish and personal description of self. Once this information has been completed, a determination can be made if this family fits into our target population, and the depth of their need. 2 . MEASURES : What data elements will you need to collect to show that you have achieved (or made progress toward) your Measurable Outcomes in Section D? What tools or items are you using as measures (grades, survey scores, attendance, absences, skill levels) for your program? Are you getting baseline information from a source on your Collaboration List in Section E ? Are there results from your Activities in Section D that need to be documented ? How often do you need to collect or follow-up on this data? The data elements needed to collect to show achievements/progress toward Measurable Outcomes are located in our "Master Stats" which include : the information in above form in addition to dates each family achieved a new Level, Level at time of exit, discharge information, forwarding address, phone and contact, 6 month contact information, 12 months contact information, rent/own home and whether employed. The tools/items used are pre-post test, school grades, school attendance, counseling & parenting class attendance and the Level system. 13 Catholic Charities of The Diocese of Palm Beach / The Samaritan Center UNIFORM GRANT APPLICATION BUDGET NARRATIVE WORKSHEET IMPORTANT, The Budget Narrative should provide details to justify the amount requested in each line item of the budget for your program. From this worksheet, your figures will be linked to the Total Agency Budget, Total Program Budget and Funder Speck Budget Forms. AGENCY/PROGRAM NAME : Catholic Charities of The Diocese of Palm Beach/Samaritan Center FUNDER: Children 's Services Advisory Committee CAUTION : Do not enter any figures where a cell is colored in dark blue = Formulas and/or links are in place. Gray areas should i Ibe used for calculations and to write information only, MAY AMM FM Proposed Total Program Funder Speck Total Agency REVENUES IoM L& Budget Budget Budget CALC"Monsl 181 ,961 . 1 Children's Services Council-St Lucie 0 2 Children's Services Council-Martin 71 697 9 71 ,697.9 3 Adviso Committee4ndian River 71 ,697.93 6,000.0 4 United Wa -St Lucie County17,500. 5 United Wa -Martin County80,000. 6 United Wa andian River County �'�'� O.cq 7 Department of Children & Families 66, 150,001 8 County Funds 454,877-001 9 Contributions-Cash 189,331 .49 1 ,146.00 534,964.UUI 10 Program Fees 280,875.001 11 Fund Raising Events-Net 118'997'00 750.00 21 ,000,001 12 Sales to Public - Net 0.uuJ 13 Membership Dues 155,862. 14 tnvesbnent Income 15,000.00 45, 182.00 254.146. 15 Miscellaneous 1319250.00 16 Legacies & Bequests 4,010,479.0 17 Funds from Other Sources 133,759. 10 0.00 6379665. 18 Reserve Funds Used for Operatin 0.0(1 19 in-Kind Donations (Not included in total 20 TOTAL REVENUES 55 863.52 71 697.93 8 904 427.00 doesn't include line 19 A B C D EXPENDITURESMAY AIWM "M Proposed Total Program Funder Specific Total Agency AGO= USE ONLY Budget Budget Budcjet Y1 Salaries - (must complete chart on next page 314,778.00 51 ,084 .0 31138,575.00 Salary 7.65% 249080.52 3 22 FICA - Total salaries x 0.0765 907 .93 240, 101 . e remen - Annual pension for qualified 22,034.00 3 2199700. 23 staff .07 x 314,778 =Utieffl576.00 ea - MICa1113entaVbhort-taffn 6,024 x 12.12613,363.00 24 Disab. FTS 731011 .00 12 108.00 Workers Compensation - # employees x 31 .386, 25 rate 314177. 8 X .01 = 39148.00 511 .00 on nemp oymen - Prole 31 ,386.00 26 employees x $7,000 x UCT-6 rate 3140778 X .01 = 3,148.00 511 .00 D SALARIES A B C of Gross Annual Gross Annual Portion of may on Proposed Funder Specific Budget Salary POSITION LISTING Salary Program RequestwKCIA) Position rd/e / Total Hrsrwk (Agency) Example: Executive Director/ 40 hrs 70,000.00 10, 00 5,000.00 7.44% in1 Catholic Charities of The Diocese of Palm Beach / The Samaritan Center Program Admin ./ J . Keenan 45,865.00 45,865.00 0.00° Case Manager/ J . Mulanax (68°x6) 280840.00 289840.00 199611 .00 68.00 Clerical Assistant/ P. Forbes 22,000.00 19,860.00 0.00°/ Support Staff/ N . Covera 21 ,874.00 21 ,874.00 0.00 OA Support Staff/ L. Morrison (P.T.) 15,358.00 15,358.00 0.00° Resident Manager/ T. Niebel (33%) 28,500.00 29,705.00 99803.00 34 .40° Support Staff/ A. Moore 20,267. 20,267.00 0 .00° Support Staff/M. Rabuck 229859. 22,859.00 0.00° Support Staff/ M. Purvis-Forbes 191860.00 19,860.00 0.00 Substitutes - On Call averse 16hrs per wk) 71696.00 7,696.00 0.00 Support Staff/ Y. Lemke (P.T.) 79696.00 71696.00 0.00 Support Staff/ L. Lutrell (P.T. ) 71696.00 79696.00 0.00° Children's Program Coordrr. Craig 21 ,670.00 219670.00 21 ,670.00 100.00 Cook Support/ 1 . Woodside 12,386.00 12,386.00 0.00 Adm. Asst/Vol. Cood ./ J . Thatcher 229425.00 25,130.00 0.00° Divison Director/ 4.5 hrs per wk 48,801 .00 51856.00 0.00° Support Staff/ D. Oliver (P.T.) 3,930.00 21160.00 0.00° *DIV/0! #DIV/0! #DIV/0! lRemaining positions throughout agency en Total Salaries $357,723.0 $3141718.00 $51 ,084. "1428 FRINGE BENEFITS DETAIL a (Funder Speck Budget FunderB p,�fo„ D W~Es , Lkwwployme Total'Frir� Funder Column C only, from line 22 to 27) Rodger Specific FICA 76530 (A x %) Hea ' bm Comperes at Comperes ` SpecHlc Position ride / Total Hrsfwk EMMPA Cass MAGWW/40 hrs 51000.00 382.50 200.00 500.00 300.00 200.00 1,582 50 Program Admin ./ J . Keenan 0.00 0.00 _ 0.00 Case Manager/ J . Mulanax 68% 19,611 .00 1500.24 1 ,373.00 41096.00 196.00 196.00 71361 .2 Clerical Assistant/ P. Forbes 0.00 0.00 0• Su rt Staff/ N . Cover) 0.00 0.00 0. Support Staff/ L. Morrison P.T. 0.00 0.00 0. Resident Manager/ T. Niebel 33% 91803.0 749.93 686.00 1 ,988.00 98. 98. 3,619.9 Support Staff/ A. Moore 0.0 0. 00 0. Support Staff/M . Rabuck 0.00 0.00 0. Support Staff! M. Purvis-Forbes 0.00 0.00 0• Substitutes - On Call averse 16hrs per wk 0.00 0.00 0.0 Support Staff/ Y: Lemke P.T. 0. 0.00 0• Support Staff/ L. Lutrell P .T. 0.0 0.00 0.0 Children's Program CoordrT. Craig21 ,670.00 19657. 76 11517.00 69024.00 217. 217.0 9,632 .7 Cook Su oN I . W oodside 0.00 0.00 0 • Adm . Asst/Vol. Cood./ J . Thatcher 0.00 0.00 1 0• Davison Director/ 4. 5 hrs r wk 0.00 0.00 0 Support Staff/ D. Oliver P.T. 0.001 0.00 0• 0 0.001 0.00 0.0 0 0.00 0 .00 0.0 0 0.001 0.001 0• Total Funder Request FdngeBenefits $511084.0 $3,907.93 $3t5-16 .001 $ 12, 108.00 $511 .0 $511 .0 $209613.9 B C D EXPENDITURES OMYMWASFM Proposed Total Program Funder Speck Total Agency AGENCY UM awr ro SHM MTML Budget Budget °Budget 27 Travel-Daily Ve 3J96.00 0.00 82,400. 00 miles per mo x # of Staff x average # of miles/wk x 50 wks x 12 mos ;375 $ = Estimated Daily Travel/Mileage Reimb. 1 ,575. + gas for 28 Travel/Conferences/Training Training 19200. 0.001 34,712.00 5/112005 6-1 Catholic Charities of The Diocese of Palm Beach Samaritan Center We have requested baseline information from one of our collaborative sources but have not received it. We will be requesting baseline information from all those sources who conduct workshops for our clients. All activities are documented. Information is turned into our Resident Manager who inputs the statistical information. This information is kept current and entered as clients enter a new Level and as test results are completed . 3 . REPORTING : What will you do with this information to show that change has occurred ? How will you use or present these results to the consumer, the funder, the program, and the community? How will you use this information to improve your program? The data is collected as described in the above sections. The information becomes a permanent part of our records and is shared with those funding sources that seek that information. The "Program Beneficiary Statistical" form is the standard form that is required by Catholic Charities . This report is sent to them on a monthly basis . The outcomes are sent to Catholic Charities for review and to evaluate how our program is doing. Some of the outcomes are shared in the community when making presentations and occasionally have been used in our newsletter that is mailed to approximately 4500 area residents and businesses . We always strive to improve our program and the outcomes are used when our treatment team meets for regular evaluation of clients and the program as a whole. 14 Catholic Charities of The Diocese of Palm Beach Samaritan Center G. TIMETABLE (Section G not to exceed one page) 1 . List the major action steps, activities, or cycles of events that will occur within the program year. New programs should include any start-up planning that may occur outside the funding year. In completing the timetable, review information detailed in prior sections. Month/Period Activities Children Ongoing year round Tuesday evening activity night — family sports, art & crafts, music, movies, etc . — To teach families how to spend quality time without spending money. Ages 4- 17 one session per week for 8 weeks of Self-Esteem Classes . Quarterly Ages 4- 17 one session per week for 8 weeks of Character Values. Quarterly Between above sessions — classes on Health & Safety are conducted by Quarterly Children' s Coordinator. A 12 week — Child Witness Program — conducted by the Mental Health As new age Association. appropriate children enter program Family outings that are staff supervised are held to teach and ensure Monthly quality time between parents & child(ren). Events are held at the Brevard Zoo, area recreational parks, Royal Palm Fountain, local beaches, etc. Adults Quarterly 3X 8 week Parenting Classes conducted by Center Case Manager (Monday Evenings) . May, June, July 12 week Parenting Class conducted by Gifford Community Center. In between Parenting 8 week classes on Domestic Violence conducted by Mental Health Classes Association. As time allows Various classes on Budget & Financial planning, Anger Management & other educational opportunities. 15 Catholic Charities of The Diocese of P81m Beach / The Samaritan Center seminars • National Conference (cost per staff) conference for 6 • Training/Seminar (cost per staff) staff member • Other Trainings (cost of travel, lodging, 150 x 9 =900 + registration, food) registration of0 0 6::::3,860. 29 Office Supplies 4,500.0 Office supplies (monthly average x 12 months = estimated cost of office supplies 375 per mo. X based on present history. 12 mos = 4,500 0.00 97,850. 30 Telephone egu ar, oca 71500.00 phone serv. Is Is # Phone lines x average cost per month x 547 a mo. X 12 12 months = local phone cost mos. x,564. + • Average long distance calls x 12 months = long distant of Estimated cost of long distance 936• 20,600.00 n. ar u►g 41000.0 0.00 31 Postage/Shipping news • Quarterly Mailing of Newsletter Ietters/brochure • Special events, etc. 2,000 per yr. + • Bulk mailings - appeals regular and 17,500. 0. 75, 190-00 32 Utilities • Electricity ($ x 12 months) 1 ,458 permo. X • WatedSewer ($ x 12 months) 12 mos • Garbage ($ x 12 months) =17,500 4,890.17 per 58,682.000.0 500.940.00 33 Occupancy (Building 8 Grounds) in X 12 mos = Mortgage/Rent ($ x 12 months) 58,E includes • Janitorial ($ x 12 months) exterminating Grounds Maint. ($ x 12 months) and building Real Estate Taxes maint 31750. 0.00 22•� 34 Printing & Publications • Quarterly Newsletter ($ x 4) Stationary 2;< • Letterheads, Envelopes, etc. pubixation, ads • Fundraising materials 312.50 per mo x • Other 12 mos = 31750 0 13,905-00 100.00 3 M SubscriptionlDuee emberships • Membership to National Organization Membership to • Dues local • Subscriptions to Newspaperstmagazines, organization etc. 100 per year. 30,000.0 41500-00 0. 36 Insurance • Directors/Officers Liab. Van insur. • CommerciallGeneral Insurance 1 ,000 a yr plus • Bond Ins. prop Gab is In Auto Insurance 3,500. 3 EquipnnentRental S Maintenance 4,500. 0.0039,140. • Copier lease ($ x 12 months) 375 per mo x 12 • Meter lease ($ x 12 months) mos =4;500 - • Copier Maintenance ($ x 12 months) copier, • Computer Maintenance ( $ x 12 months) telephone, and • Other computers. 147.500.0 1s500-000.0 38 Advertising Promo costs • Newspaper ads and ads 125 per • Fundraising ads/promotions mo. X 12 mos ' • Other (vacancies) =1 ,500 00 39 Equipment Purchases:Capital Expense 0.00 0.00 37,595. • Computer/monitor (# x $) • Laser Printer N/A 131 , 120-00 12,SQ0.00 0.00 40 Professional Fees (Legal, Consulting) Consultants, • Legal advice ( estimated #hrs x $) Contrail • Consultant fees Workers - • Other APPROX 0.00 67,000. 41 BookslEducational Materials 4,500.0 imolp: lies - • Bookstvideos prox.375 per • Materials ($ x staff) 12 mos B-1 511 irm Catholic Charities of The Diocese of Palm Beach / The Samaritan Center 42 Food & NutritionApprox. $49.32 189000.00 0. 93,596. 00 • Meals ( # meals x clients x 5days x 50 wks) per day X365 • Snacks days = 18,000 43 Administrative Costs 10.2% = 609694. 0.00 473,800.0 • Admin. Cost (% of total budget) 60,694. 44 Audit Expense 22,500 x ,033 = 743.00 0.00 22,500. 00 • Independent Audit Review 743. 45 Specific Assistance to Individuals Car. repaus Tor 7Y500.00 0.00 670,708. 00 • Medical assistance donated cars of • approx. 1 ,500 Meals/Food and; direct • Rent Assistance assistance to • Other clients 6,000. Other/Miscellaneous and drugs 500.00 0. 59000. 00 • Background check/drug test testing 500 • Other annuall. 47Other/Contract 0.00 0. • Sub-contract for program services NIA 48 TOTAL EXPENSES $688863.52 $71 ,697.9 $6,904,427.00 5/11 r2005 s-� r W 00 N N 4 r� N. rn rL: � 3 xx •-+ ,-� d N N t� WE" A W P. Tx . ee POEM PC OWN PC PC W o moo •C a o INS U 00 p .-. C*s O O C*A O O art d M M t` fir ~ .M1 0 . � a� U o :. V �' . � d � � • - � � ',ted ' off � � �. � W 00. ►� C� 0 S w° V. 0 o n � � °` � U C/) x Edit this Header. Tyi)e the organization and program name and the funder for whom it is being completed. The page # is already set at the bottom right of every page. I. BUDGET FORMS - To open the Budget Forms, please double-click on the icon below. : .gin:- " Core Budget Forms " 17 1 1 IK I 1 1 : I • 1 1 1 1 •�. 111 aim _ • .. 1 I 11 1 11 1 lal ;: . 1 ': • r_lj Committee-liudian River1 I 1 1 IJ I 1 . 11 11 1 'a. 1 1 1 1 1 I 19 I�l11 1 1 ,a. � 1' •. 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Ijl1i1MORE! 1 1 1 • . . . 1 . 1 1 1 1 1 1 1 11111 1.1 �t'All•/al 1 , 11 1 1 I 1 — .11 . l/l 1 1 11 1 11 .lil IT1 • 1 : : • .: I 1 1 I 1 1 �lil 111 ;� . jl •� . 11 .: 1 . . 1 1 1 I I 1 , ,1, .1, � , 1914 • Catholic Charities of The Diocese of Palm Beach / The Samaritan Center UNIFORM GRANT APPLICATION BUDGET NARRATIVE WORKSHEET IMPORTANT, The Budget Narrative should provide details to justify the amount requested in each line item of the budget for your program. From this worksheet, your figures will be linked to the Total Agency Budget, Total Program Budget and Funder Speck Budget Forms. AGENCY/PROGRAM NAME : Catholic Charities of The Diocese of Palm Beach/Samaritan Center FUNDER: Children 's Services Advisory Committee CAUTION : Do not enter any figures where a cell is colored in dark blue = Formulas and/or links are in place. Gray areas should i Ibe used for calculations and to write information only, MAY AMM FM Proposed Total Program Funder Speck Total Agency REVENUES IoM L& Budget Budget Budget CALC"Monsl 181 ,961 . 1 Children's Services Council-St Lucie 0 2 Children's Services Council-Martin 71 697 9 71 ,697.9 3 Adviso Committee4ndian River 71 ,697.93 6,000.0 4 United Wa -St Lucie County17,500. 5 United Wa -Martin County80,000. 6 United Wa andian River County �'�'� O.cq 7 Department of Children & Families 66, 150,001 8 County Funds 454,877-001 9 Contributions-Cash 189,331 .49 1 ,146.00 534,964.UUI 10 Program Fees 280,875.001 11 Fund Raising Events-Net 118'997'00 750.00 21 ,000,001 12 Sales to Public - Net 0.uuJ 13 Membership Dues 155,862. 14 tnvesbnent Income 15,000.00 45, 182.00 254.146. 15 Miscellaneous 1319250.00 16 Legacies & Bequests 4,010,479.0 17 Funds from Other Sources 133,759. 10 0.00 6379665. 18 Reserve Funds Used for Operatin 0.0(1 19 in-Kind Donations (Not included in total 20 TOTAL REVENUES 55 863.52 71 697.93 8 904 427.00 doesn't include line 19 A B C D EXPENDITURESMAY AIWM "M Proposed Total Program Funder Specific Total Agency AGO= USE ONLY Budget Budget Budcjet Y1 Salaries - (must complete chart on next page 314,778.00 51 ,084 .0 31138,575.00 Salary 7.65% 249080.52 3 22 FICA - Total salaries x 0.0765 907 .93 240, 101 . e remen - Annual pension for qualified 22,034.00 3 2199700. 23 staff .07 x 314,778 =Utieffl576.00 ea - MICa1113entaVbhort-taffn 6,024 x 12.12613,363.00 24 Disab. FTS 731011 .00 12 108.00 Workers Compensation - # employees x 31 .386, 25 rate 314177. 8 X .01 = 39148.00 511 .00 on nemp oymen - Prole 31 ,386.00 26 employees x $7,000 x UCT-6 rate 3140778 X .01 = 3,148.00 511 .00 D SALARIES A B C of Gross Annual Gross Annual Portion of may on Proposed Funder Specific Budget Salary POSITION LISTING Salary Program RequestwKCIA) Position rd/e / Total Hrsrwk (Agency) Example: Executive Director/ 40 hrs 70,000.00 10, 00 5,000.00 7.44% in1 Catholic Charities of The Diocese of Palm Beach / The Samaritan Center Program Admin ./ J . Keenan 45,865.00 45,865.00 0.00° Case Manager/ J . Mulanax (68°x6) 280840.00 289840.00 199611 .00 68.00 Clerical Assistant/ P. Forbes 22,000.00 19,860.00 0.00°/ Support Staff/ N . Covera 21 ,874.00 21 ,874.00 0.00 OA Support Staff/ L. Morrison (P.T.) 15,358.00 15,358.00 0.00° Resident Manager/ T. Niebel (33%) 28,500.00 29,705.00 99803.00 34 .40° Support Staff/ A. Moore 20,267. 20,267.00 0 .00° Support Staff/M. Rabuck 229859. 22,859.00 0.00° Support Staff/ M. Purvis-Forbes 191860.00 19,860.00 0.00 Substitutes - On Call averse 16hrs per wk) 71696.00 7,696.00 0.00 Support Staff/ Y. Lemke (P.T.) 79696.00 71696.00 0.00 Support Staff/ L. Lutrell (P.T. ) 71696.00 79696.00 0.00° Children's Program Coordrr. Craig 21 ,670.00 219670.00 21 ,670.00 100.00 Cook Support/ 1 . Woodside 12,386.00 12,386.00 0.00 Adm. Asst/Vol. Cood ./ J . Thatcher 229425.00 25,130.00 0.00° Divison Director/ 4.5 hrs per wk 48,801 .00 51856.00 0.00° Support Staff/ D. Oliver (P.T.) 3,930.00 21160.00 0.00° *DIV/0! #DIV/0! #DIV/0! lRemaining positions throughout agency en Total Salaries $357,723.0 $3141718.00 $51 ,084. "1428 FRINGE BENEFITS DETAIL a (Funder Speck Budget FunderB p,�fo„ D W~Es , Lkwwployme Total'Frir� Funder Column C only, from line 22 to 27) Rodger Specific FICA 76530 (A x %) Hea ' bm Comperes at Comperes ` SpecHlc Position ride / Total Hrsfwk EMMPA Cass MAGWW/40 hrs 51000.00 382.50 200.00 500.00 300.00 200.00 1,582 50 Program Admin ./ J . Keenan 0.00 0.00 _ 0.00 Case Manager/ J . Mulanax 68% 19,611 .00 1500.24 1 ,373.00 41096.00 196.00 196.00 71361 .2 Clerical Assistant/ P. Forbes 0.00 0.00 0• Su rt Staff/ N . Cover) 0.00 0.00 0. Support Staff/ L. Morrison P.T. 0.00 0.00 0. Resident Manager/ T. Niebel 33% 91803.0 749.93 686.00 1 ,988.00 98. 98. 3,619.9 Support Staff/ A. Moore 0.0 0. 00 0. Support Staff/M . Rabuck 0.00 0.00 0. Support Staff! M. Purvis-Forbes 0.00 0.00 0• Substitutes - On Call averse 16hrs per wk 0.00 0.00 0.0 Support Staff/ Y: Lemke P.T. 0. 0.00 0• Support Staff/ L. Lutrell P .T. 0.0 0.00 0.0 Children's Program CoordrT. Craig21 ,670.00 19657. 76 11517.00 69024.00 217. 217.0 9,632 .7 Cook Su oN I . W oodside 0.00 0.00 0 • Adm . Asst/Vol. Cood./ J . Thatcher 0.00 0.00 1 0• Davison Director/ 4. 5 hrs r wk 0.00 0.00 0 Support Staff/ D. Oliver P.T. 0.001 0.00 0• 0 0.001 0.00 0.0 0 0.00 0 .00 0.0 0 0.001 0.001 0• Total Funder Request FdngeBenefits $511084.0 $3,907.93 $3t5-16 .001 $ 12, 108.00 $511 .0 $511 .0 $209613.9 B C D EXPENDITURES OMYMWASFM Proposed Total Program Funder Speck Total Agency AGENCY UM awr ro SHM MTML Budget Budget °Budget 27 Travel-Daily Ve 3J96.00 0.00 82,400. 00 miles per mo x # of Staff x average # of miles/wk x 50 wks x 12 mos ;375 $ = Estimated Daily Travel/Mileage Reimb. 1 ,575. + gas for 28 Travel/Conferences/Training Training 19200. 0.001 34,712.00 5/112005 6-1 Type Cie OnganaaCcn and Pn V= Name UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME : FUNDER: A B C FY 04/05 FY 04/05 % OF TOTAL FUNDER TOTAL VS. PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET col. B/col. A EXPENDITURES 21 Salaries 314 778 .00 51 s084A0 16.23% 22 FICA 24 080 .52 3 907.93 16.23% 23 Retirement 22 034.00 3 576.00 16.23% 24 Life/Health 73 011 .00 12108.00 16.58% 25 Workers Compensation 3148.00 511 .00 16.23% 26 Florida Unemployment 3148.00 511 .00 16.23% 27 TravelwDaily 3195.00 0.00 0.00% 28 Travel/Conferences/Training 1 200.00 0.00 0.00% 29 Office Supplies 4,600a00 0.00 0.00% 3o Telephone - 7 500.00 0.00 0.00% 31 PostagelShipping 4 000.00 0.00 0.00% 32 Utilities 17 500.00 0.00 0.00% 33 Occupancy (Building & Grounds 58 682.00 0.00 0.00% 34 Printing & Publications 3760000 0.00 0.00% 35 Subscription/Dues/Memberships Subscription/Dues/Memberships100.00 0.00 0.00% 36 Insurance 4 500.00 0.00 0.00% 37 E ui ment: Rental & Maintenance 4 500 .00 0.00 0 .00°k 38 Advertisin 1 500.00 0.00 0.00% 39 Equipment Purchases : Ca ital Expense 0.00 0.00 #DIV/0! 40 Professional Fees (Legal, Consulting) 12j800,00 0.00 0.00% 41 Books/Educational Materials 4,600s00 0.00 0.00% 42 Food & Nutrition 1840008 0.00 0.00% 43 Administrative Costs 60 694.00 0.00 0.00% 44 Audit Expense 743.00 0.00 0 .00% 45 Specific Assistance to Individuals 7,600w 0.00 0.001 46 Other/Miscellaneous 500 .00 0.00 0.00% 47 Other/Contract 0 .00 0.00 #DIV101 48 TOTAL $655,863 ,52 71 o697w93 10 .93% E" 5/11/2005 ' • Type tlu omwankn eM Ptawn Name UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET AGENCYIPROGRAM NAME: FUNDER: 77777777777, 77,_ _ _ . .. ddalmm/of77777 77 ow/ol CatlmGc Charities is requesting a $21 ,697.93 increase. This breaks down to a $59.45 increase per day. We need these dollars to rel m Comittee-Indian River maintain our stability in a grovAng and expanding community. ivolvro! Unified andlan River County Additional dollars requested to met rasing costs. #W18l SWIM ddrnvrol dhVALUE1 ow/of rel LifeMealth This will be the second year in a row in which Catholic Charities will experience a 15% increase. Over the last two years the total is 30%. Anticipate increases in ccet due to last year's hurricanes. Insurance companies are requesting an increase in payment to rebuild their Insurance reserve. Food i Nutrttion The cost of food has increase since last s hurricane. Anticipate that costs will continue to increase. rel S mrot MUMS B ti Catholic Charities of The Diocese of P81m Beach / The Samaritan Center seminars • National Conference (cost per staff) conference for 6 • Training/Seminar (cost per staff) staff member • Other Trainings (cost of travel, lodging, 150 x 9 =900 + registration, food) registration of0 0 6::::3,860. 29 Office Supplies 4,500.0 Office supplies (monthly average x 12 months = estimated cost of office supplies 375 per mo. X based on present history. 12 mos = 4,500 0.00 97,850. 30 Telephone egu ar, oca 71500.00 phone serv. Is Is # Phone lines x average cost per month x 547 a mo. X 12 12 months = local phone cost mos. x,564. + • Average long distance calls x 12 months = long distant of Estimated cost of long distance 936• 20,600.00 n. ar u►g 41000.0 0.00 31 Postage/Shipping news • Quarterly Mailing of Newsletter Ietters/brochure • Special events, etc. 2,000 per yr. + • Bulk mailings - appeals regular and 17,500. 0. 75, 190-00 32 Utilities • Electricity ($ x 12 months) 1 ,458 permo. X • WatedSewer ($ x 12 months) 12 mos • Garbage ($ x 12 months) =17,500 4,890.17 per 58,682.000.0 500.940.00 33 Occupancy (Building 8 Grounds) in X 12 mos = Mortgage/Rent ($ x 12 months) 58,E includes • Janitorial ($ x 12 months) exterminating Grounds Maint. ($ x 12 months) and building Real Estate Taxes maint 31750. 0.00 22•� 34 Printing & Publications • Quarterly Newsletter ($ x 4) Stationary 2;< • Letterheads, Envelopes, etc. pubixation, ads • Fundraising materials 312.50 per mo x • Other 12 mos = 31750 0 13,905-00 100.00 3 M SubscriptionlDuee emberships • Membership to National Organization Membership to • Dues local • Subscriptions to Newspaperstmagazines, organization etc. 100 per year. 30,000.0 41500-00 0. 36 Insurance • Directors/Officers Liab. Van insur. • CommerciallGeneral Insurance 1 ,000 a yr plus • Bond Ins. prop Gab is In Auto Insurance 3,500. 3 EquipnnentRental S Maintenance 4,500. 0.0039,140. • Copier lease ($ x 12 months) 375 per mo x 12 • Meter lease ($ x 12 months) mos =4;500 - • Copier Maintenance ($ x 12 months) copier, • Computer Maintenance ( $ x 12 months) telephone, and • Other computers. 147.500.0 1s500-000.0 38 Advertising Promo costs • Newspaper ads and ads 125 per • Fundraising ads/promotions mo. X 12 mos ' • Other (vacancies) =1 ,500 00 39 Equipment Purchases:Capital Expense 0.00 0.00 37,595. • Computer/monitor (# x $) • Laser Printer N/A 131 , 120-00 12,SQ0.00 0.00 40 Professional Fees (Legal, Consulting) Consultants, • Legal advice ( estimated #hrs x $) Contrail • Consultant fees Workers - • Other APPROX 0.00 67,000. 41 BookslEducational Materials 4,500.0 imolp: lies - • Bookstvideos prox.375 per • Materials ($ x staff) 12 mos B-1 511 irm Catholic Charities of The Diocese of Palm Beach / The Samaritan Center 42 Food & NutritionApprox. $49.32 189000.00 0. 93,596. 00 • Meals ( # meals x clients x 5days x 50 wks) per day X365 • Snacks days = 18,000 43 Administrative Costs 10.2% = 609694. 0.00 473,800.0 • Admin. Cost (% of total budget) 60,694. 44 Audit Expense 22,500 x ,033 = 743.00 0.00 22,500. 00 • Independent Audit Review 743. 45 Specific Assistance to Individuals Car. repaus Tor 7Y500.00 0.00 670,708. 00 • Medical assistance donated cars of • approx. 1 ,500 Meals/Food and; direct • Rent Assistance assistance to • Other clients 6,000. Other/Miscellaneous and drugs 500.00 0. 59000. 00 • Background check/drug test testing 500 • Other annuall. 47Other/Contract 0.00 0. • Sub-contract for program services NIA 48 TOTAL EXPENSES $688863.52 $71 ,697.9 $6,904,427.00 5/11 r2005 s-� Type du oVwwWon and NOW= Num UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE FUNDER SPECIFIC BUDGET AGENCYIPROGRAM NAME: FUNDER: ---w yYs n Salaries A 3 to 4 % increase is . Other doAars relate to increase haus worked over lam year FICA Function of salary se Re*omnt Function of salary expense Health insurance will increase W Ju 2005 by 15% Workers Compefoatkm Function of saiary expense Unemokmainot Function of salary expense mmol rot a-� 5111f2 os Catholic Charities of The Diocese of Palm Beach Samaritan Center ORGANIZATION: Catholic Charities PROGRAM : Samaritan Center TABLE OF CONTENTS Please "X" the parts of the grant application to indicate that they are included Also, please put the page number where the information can be located. X I Section of the Proposal Page # TABLE OF CONTENTS (check list) COVER PAGE (with signatures) . 0 9 . 0 . 0 . . . . . . . . . . A. ORGANIZATION CAPABILITY (one page maximum) 1 . Mission and Vision of organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . Summary of expertise, accomplishments, and population served . . . . . . . . . . . . . . . . B. PROGRAM NEED STATEMENT (one page maximum) 1 . Program Need Statement . , . , , , , , , , , , 2 . Programs that address need and gaps in service . , , " I ' ll , log 000 0 * 0 * we 06 a 0004 so ' e " o C. PROGRAM DESCRIPTION (two pages maximum) 1 . Funding priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . Description of program activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 . Evidence that program strategy will work . 10 * 00 . 006 . 1 . . . . . . . . . . . . . . . . . . . . . . 4. Staffing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 . Awareness of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 . Accessibility of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D. MEASURABLE OUTCOMES (two pages maximum) . . . . . . . . . . . : . . . . . . . . . . . . . E. COLLABORATION (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F. PROGRAM EVALUATION (two pages maximum) 1 . Demographics . . . . . . . . . 2 . Measures , . a a , a a a a a a 9 a a . . . a a . . . . . . . . 3 . Reporting . . . . . . . . . . . . . . . . moo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a . . . . . . . . . . . . . . . . . . . . . . . . . . . . G. TIMETABLE (one page maximum) H. UNDUPLICATED CLIENT COUNT 1 . Projections by Location . . , . . . . . . 2 . Projections by Age Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1 1 IK I 1 1 : I • 1 1 1 1 •�. 111 aim _ • .. 1 I 11 1 11 1 lal ;: . 1 ': • r_lj Committee-liudian River1 I 1 1 IJ I 1 . 11 11 1 'a. 1 1 1 1 1 I 19 I�l11 1 1 ,a. � 1' •. United WayAllartin County r • 1 1 / 111 11 1 1111 11 r • III ra• : • t i 11 1 . 1 ■ 111 I 1 1 Mil 111 1 1 . 1 ■ 1 1 1 1 111 • 1 • 1 111 11 1 111 11 . . yl 1�1 1 t Coun Funds I 1 1 1 1 1 Id 11 :�1 lil M : ' a• r -T'114 • . 11 , : 1111 11 : : 111 11 1 111 11 11 � • ., - • . • 1 1 1 1 I 1 1 1 I c • • • 19 1 1144A 1i1 FN � yz11j1 . 1 11 1 1 1 11 •11� IjIJ : 1n - • : : 1 I ( L.: �' 111 — Workers • 1 11 /�: 1 11 11 1 1 111 w 1 : , L 1 � I ' 19 ( L,. 111 • : e 1 11 11 i�l Compensation • r - 1 1 1 " : : 1 1 L.•. 111 • : , 1 1 1 1 1 1 1 1 . = 1 ILi ISI ' a, rep 1 1 1 I i l 1 1AlFrUILELLON 1 : IJ 1 1 1 1 1 : . 1 ILt 111 ' a, • 1 , . , 1 1 I 1 1 1 111 � 111 ; , 1 _ : • • - 1 , al 1 1 1 I 1 '11 :�I11 I11J 111 v • • 1 1 . 1 11I 11 'il I11 1111111111111111111MITI I K . - • • 1 1 I 1 1 1�1 - 1 Int 1 • , is 1 1 1 I 1 1 'it 1�1 lil _ IG 1 1 1 I I 1 1 L�1 I�lal lil C:I JLI&I a. 11 IJ 1 11 I -1411A, 1 : T . r • � 1 1 1 1 1 1 lil ( 1�1 ' - I 1 1 1 1 1 i t 11111 /il 4c 11 111 11 � .a• lil .: ' a. 11 - 1 111 1111 11 11 p 1 I 11 ■ 1 1 IJ lal 111 1 111 0 • . . 1 1 ! 1 1 1 1 ! 111 1,1 a - . —.■ ■_I■■- 1 lil � � �I . / . : i i 1 11111 11 II 11 1:1 'i. • w il w • AGENCYIPROGRAM I Children's _ _ 1 1 1 1 1 I lil ifi 'l�'/l'li 1 • • �� � � United Way-Martin County . 1 119 11 1 111 11 1 111,1 111 . i • • i . •Lai lil re I j al Fund RaWng Events-Net - - Investment . 1 1 hl 1 1 1 lith 1,1 1 lit . LAI • 1 : 1 1 111 I lil �� Funds from f : � . 1 1 1 IJ ® I I 1 ' 1 1 . � . . - � . •. ���� yyyyA��.••��� --�,ww� �� ��1ww; •1�� 1 , 1 1 lit ;: . 1 1 • _�CaLCiitiJ 1 1 I . t`.MENIF . r. .r . . 1i1 MENEI 1K I 1 , :.l - t1'. 1 :77T , , 1110 JIM = . 1 1 1 i 1 it 7`. `: . . ` _ ■ 1 1 : : 1 . 1 . : 111 t`'o • : 1 1 1 f Ill • _ , � . II ill 1�1 1 1 1 � -. . . 1 1 1 1 1 1 il;l I,t 1 lilr• J . ■ 1 1 11 1 11 1111 1,1 1 Ilir�, • � i .• - � � 1 11 � 11 11 �I,1 Ill 1 lit � • 1 1 1 � � 1 1 ,il r7, i . . _ INNER= lili.t ommmune "IT 11 11 11 I�1 11 rexill " ■� 1 1 1 1 ilyl 1MOMENT . ,, - � _ 1 1 1 1 1 1 11 1 lil 111 . lil 1 I - 1 = 1 1 :.lalit . . , . V 7MM I 1 1 1 1 Il . Ijl1i1MORE! 1 1 1 • . . . 1 . 1 1 1 1 1 1 1 11111 1.1 �t'All•/al 1 , 11 1 1 I 1 — .11 . l/l 1 1 11 1 11 .lil IT1 • 1 : : • .: I 1 1 I 1 1 �lil 111 ;� . jl •� . 11 .: 1 . . 1 1 1 I I 1 , ,1, .1, � , 1914 • Catholic Charities of The Diocese of Palm Beach Samaritan Center L BUDGET FORMS 1 . Financial Budget Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J. FUNDER SPECIFIC/ADDITIONAL SHEETS K. APPENDIX 2 EXHIBIT B ( From policy adopted by Indian River County Board of county Commissioners on February 19 , 2002 ) " D . Nonprofit Agency Responsibilities After Award Funding Indian River County provides funding to all nonprofit agencies on a reimbursement basis only. All reimbursable expenses must be documented by an invoice and/or a copy of the canceled check . Any expense not documented properly to the satisfaction of the Office of Management & Budget and/or the County Administrator may not be reimbursed . If an agency repeatedly fails to provide adequate documentation , this may be reported to the Board of Commissioners . In the event an agency provides inadequate documentation on a consistent basis , funding may be discontinued immediately. Additionally, this may adversely affect future funding requests . Expenditures may only be reimbursed from the fiscal year for which funding was awarded . For example , no expenditures prior to October 18t may be reimbursed with funds from the following year. Additionally, if any funds are unexpended at the end of a fiscal year, these funds are not carried over to the next year unless expressly authorized by the Board of Commissioners . All requests for reimbursement at fiscal year and (September 30th) must be submitted on a timely basis . Each year, the Office of Management and Budget will send a letter to all nonprofit agencies advising of the deadline for reimbursement requests for the fiscal year. This deadline is typically early to mid October, since the Finance Department does not process checks for the prior fiscal year beyond that point . Each reimbursement request must include a summary of expense by type . These summaries should be broken down into salaries , benefit, supplies , contractual services , etc . If Indian River County is reimbursing an agency for only a portion of an expense (e . g . salary of an employee) , then the method for this portion should be disclosed on the summary. The Office of Management & Budget has summary forms available . Indian River County will not reimburse certain types of expenditures . These expenditure types are listed below. a ) Travel expenses for travel outside the County including but not limited to : mileage reimbursement, hotel rooms , meals , meal allowances , per diem , and tolls . Mileage reimbursement for local travel (within Indian River County) is allowable . b) Sick or Vacation payments for employees . Since agencies may have various sick and vacation pay policies , these must be provided from other sources . c) Any expenses not associated with the provision of the program for which the County has awarded funding . d ) Any expense not outlined in the agency's funding application . The County reserves the right to decline reimbursement for any expense as deemed necessary." EXHIBIT - B - Type Cie OnganaaCcn and Pn V= Name UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME : FUNDER: A B C FY 04/05 FY 04/05 % OF TOTAL FUNDER TOTAL VS. PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET col. B/col. A EXPENDITURES 21 Salaries 314 778 .00 51 s084A0 16.23% 22 FICA 24 080 .52 3 907.93 16.23% 23 Retirement 22 034.00 3 576.00 16.23% 24 Life/Health 73 011 .00 12108.00 16.58% 25 Workers Compensation 3148.00 511 .00 16.23% 26 Florida Unemployment 3148.00 511 .00 16.23% 27 TravelwDaily 3195.00 0.00 0.00% 28 Travel/Conferences/Training 1 200.00 0.00 0.00% 29 Office Supplies 4,600a00 0.00 0.00% 3o Telephone - 7 500.00 0.00 0.00% 31 PostagelShipping 4 000.00 0.00 0.00% 32 Utilities 17 500.00 0.00 0.00% 33 Occupancy (Building & Grounds 58 682.00 0.00 0.00% 34 Printing & Publications 3760000 0.00 0.00% 35 Subscription/Dues/Memberships Subscription/Dues/Memberships100.00 0.00 0.00% 36 Insurance 4 500.00 0.00 0.00% 37 E ui ment: Rental & Maintenance 4 500 .00 0.00 0 .00°k 38 Advertisin 1 500.00 0.00 0.00% 39 Equipment Purchases : Ca ital Expense 0.00 0.00 #DIV/0! 40 Professional Fees (Legal, Consulting) 12j800,00 0.00 0.00% 41 Books/Educational Materials 4,600s00 0.00 0.00% 42 Food & Nutrition 1840008 0.00 0.00% 43 Administrative Costs 60 694.00 0.00 0.00% 44 Audit Expense 743.00 0.00 0 .00% 45 Specific Assistance to Individuals 7,600w 0.00 0.001 46 Other/Miscellaneous 500 .00 0.00 0.00% 47 Other/Contract 0 .00 0.00 #DIV101 48 TOTAL $655,863 ,52 71 o697w93 10 .93% E" 5/11/2005 ' • Type tlu omwankn eM Ptawn Name UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET AGENCYIPROGRAM NAME: FUNDER: 77777777777, 77,_ _ _ . .. ddalmm/of77777 77 ow/ol CatlmGc Charities is requesting a $21 ,697.93 increase. This breaks down to a $59.45 increase per day. We need these dollars to rel m Comittee-Indian River maintain our stability in a grovAng and expanding community. ivolvro! Unified andlan River County Additional dollars requested to met rasing costs. #W18l SWIM ddrnvrol dhVALUE1 ow/of rel LifeMealth This will be the second year in a row in which Catholic Charities will experience a 15% increase. Over the last two years the total is 30%. Anticipate increases in ccet due to last year's hurricanes. Insurance companies are requesting an increase in payment to rebuild their Insurance reserve. Food i Nutrttion The cost of food has increase since last s hurricane. Anticipate that costs will continue to increase. rel S mrot MUMS B ti EXHIBIT C STANDARD TERMS FOR GRANT CONTRACT 1 . Notices . Any notice , request, demand , consent , approval , or other communication required or permitted by this Contract shall be given , or made in writing , by any of the following methods : facsimile transmission ; hand delivery to the other party; delivery by commercial overnight courier service ; or mailed by registered or certified mail (postage prepaid ) , return receipt requested at the addresses of the parties shown below: County: Joyce Johnston -Carlson , Director Indian River County Human Services 1840 25th Street Vero Beach , Florida 32960-3365 Recipient : Catholic Charities/Samaritan Center 3650 41 st Street Vero Beach , Florida 32960 Attention : Julia Keenan , Administrator 2 . Venue : Choice of Law. The validity, interpretation , construction , and effect of this Contract shall be in accordance with and governed by the laws of the State of Florida only. The location for settlement of any and all claims , controversies , or disputes , arising out of or relating to any part of this Contract , or any breach hereof, as well as any litigation between the parties , shall be Indian River county, Florida for claims brought in state court, and the Southern District of Florida for those claims justifiable in federal court . 3 . Entirety of Agreement . This Contract incorporates and includes all prior and contemporaneous negotiations , correspondence , conversations , agreements , and understandings applicable to the matters contained herein and the parties agree that there are no commitments , agreements , or understandings concerning the subject matter of this Contract that are not contained herein . Accordingly, it is agreed that no deviation from the terms hereof shall be predicated upon any prior representations or agreements , whether oral or written . It is further agreed that no modification , amendment or alteration in the terms and conditions contained herein shall be effective unless contained in a written document signed by both parties . 4 . Severability. In the event any provision of this Contract is determined to be unenforceable or invalid , such unenforceability or invalidity shall not affect the remaining provisions of this Contract, and every other provision and term of this Contract shall be deemed valid and enforceable to the extent permitted by law. To that extent, this Contract is deemed severable . 5 . Captions and Interpretations Captions in this Contract are included for convenience only and are not to be considered in any construction or interpretation of this Contract or any of its provisions . Unless context indicates otherwise , words importing the singular number include the plural number, and vise versa . Words of any gender include the correlative words of the other genders , unless the sense indicates otherwise . 6 . Independent Contractor. The Recipient is and shall be an independent contractor for all purposes under this Contract. The Recipient is not an agent or employee of the County, and any and all persons engaged in any of the services or activities funded in whole or in part performed pursuant to this Contract shall at all times and in all places be subject to the Recipient's sole direction , supervision and control . 7 . Assignment . This Contract may not be assigned by the Recipient without the prior written consent of the County. EXHIBIT - C - NU1.i- 1b—i'L' UZ> 00 ; HK I HUK UHLLHUHtK 30:X ( 1b1.)d73 re 01 ARD. CERTIFICATE OF LIABILITY INSURANCE "1— I 1/ 9/as ' DRnnucER 5 . 59 - bQ IHIS CERTIFICATE IS 133UrD Ah�A MATTEROFI141loUItMATION1 Arthvi J • l;allagzer a Cv . Miami ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER . THIS CERTIFICATE UUt$ NOT AMEND, EXTEND Ott 9Z4o ) . W . 4140 9traaR I ALTER THIt COVERAGE AFFORDED EY The rOLICI92 YELQW. Suite : uu t >ilwwl : PL : 5166 I NALCI Aneoaia E AhRllE - AVOV� ud INSURERS AFFORDING COVERAGE eleurKn _ NWFIOAA. rS`Iinc tM 7rNRR A SLIQ S L_aer 1"* 10706 DIr r�OCt9a OP Fi4LM EE+1CR �wQ1IRFR3: c7AT1C'AIAlr CA.Tu01YC nnc 110093 CAT901, 7HARTTIES OP rAIA ZZACR . 1;rC , - l+ v5 a , MILITARY TRAIL IN . amo vontlAcnGal Cat vU PARrN on&o t CARDED) ; rL 37 ,110 , !NSlINcn - . ._ INCunEn € L!;0V—F- RAGie3 - T -4 OOLICiES 4 = MIST IRAPRa L!S i tV bELO'JU YANE BEEN 101UCD TO THE INSURFC NAMED ASOVf- 1•< Mt l'HE PgUCY PERIOD INDICATCG, NOTWITHSTANDING AN" mt:QJIREbICNY , TERM OR CONDrION OF ANY CONTRACT r.1W 01NfIK QOGUMENT WITH RB3PCCT TO V+441CN Toil % CER.TIFICATF MAY !It ISSUEU VR IVAY PCFITAINr TWE INS'JCANCE AFF,?Iar Ir I I HY 714E POLICIES m50NDCD I IChE@: I$ SUBJECT TO ALL '.IlI HF TFRMS, :XGL613!GN5 AND CONG!TION: Or CUCa UA I t L1,1017S SHOWN MAY I-XJC DCCT: REDUCED Sy PAID CLAIMS LA o ;:RML --_ • . - .. . ...-r--... . . .._ on! FE ECT— f �u% EXP!RhTWN CET ,y 0 r !uRR, 1 . W)U ,r . , , . t rr IN 4P �nN1-" ¢ANCC rOwcy uUMeER OATC�urtE t K wYEXPUUlrr , ICS LNYIuri ItTZ - A7 - F.7G - 04o001i40 0 / 07 / INC I U9iVl / Of kAt:Mtltr 174R- WG; • 000 , 000 _ir-- � RTtr.) a � c • le 04 / 01 / OS ! 44 / n ) / INA P �EMlO[G (G �.cg(eM SLnC1LL6e1 a S< 1 c:'�prr,�eRGII SC!aEfL4L LU501.rri � .9�— _'• .- ✓-J CL1R•tC U•V1F L� O:I:UM i I I, mEo ap cMry wre W tarn; . . evil .. $ 1 , 000 , 000 I� i IrCNERpL AGGRCWTE C �/ A -.. I ` 1 ; 040 ; 000 1OC1+'IhGG!1CO,1', ELWITA00LIESPERI I � OROOICT+ • r'•nl!PR'TPACiG ' PCLCY Pon- 77,rWC I .. .. . A AO---T{{{ot+oalLGlvnuiv 13: -A1 - aX • 4000oi544 j 44 / 0110i t ue / a1 / o6 LVNOIhCG3t+OtEIIMiT ` 53 , 400 . 004 b If � ANYAUIU { aRc1050 . OA us % u1 / 05 6e / Oli Oi � Ita raho€n�1 1- ALL O'.IR�: A /TOS I OOD4YIWURY tPara!acnl i el'MwV:,EOA.rros � - �-•• - 1 LX fSIRFDAVipa I GOOILY INJUM" 1 t NEr A iCCI!11r111 r• n0r[nTvDMAGC trot acmes ! � cw2ACELIS nu ITV I AUTU,UNLY - t:A AGi,iD 7T To . . .. �� ArvrAJTO i AA1.Rn nNHvl'i ! A00 4 I e%C60O/VGrOMCLIA lNW4Tv I EACw f.Y:•^.I IR RFNCE 5 rxruk ❑ ,ILAWSV009 I AoaftstlATc I ! RE"Umo►. S � ?. AWO "K ) L:VaiPINEATMUM10, I (�4 - A1 - • 0000019UU j Vi / 4' 1 / 05 0 < JOli 04 X y7ATw.!J7s1 I eR- r IC,/MLOYERS' LIAOILITY 06 � 01 / OlI w1 : i9692GL uG / V1 / Oi ]IAt4lUtNY Ann . Ann I wVPRODP.IETrIMAQrNFR/E%EUJIIVt INu I ! FI 4AtT. OFFICCR+MGwOC'tEkCLVOCM Fxr.Il i f :1.. MCEA£E EAI;MpLOYEE S 1 . V00 , 000 • , N� ppo�4eoseri6o�rdv I - FI DIS'kA.it - YV�TrY !MR � •l ! 00a 000 OPECIAL F1111 ICIoNE "low .. .._ OTHGR i j1 i I I OCdGRIPTION Or OKnATiDNa r LOGATION41 vEwM l Ft l F.XC W WONS ADDED 8T ENOUHJtMCrI1 a SPEGIK PAOrI&70N0 rft:esv � r : lusur� c A 10 0Utn% , 9250 . onn RAJt R)eure'1 RotCUtivw 44 Lnclwdsd within k}• linits Tia ^rRTiRSrATU NUL SR AND 110YAP RIV31 CoVNTY r.Ro MATED ADDTTTrWAT, rNSURED R95PFV1:3 :v TRz 0XV39 Ui LLA01"TY UNMA TRE CATUOLTC CAARSIXIC DRO40.1IN T,RC:ATRD AT : VAMAZTAE CDNT$ RA 1040 41 C'TRESTr YallO eSACIIr MORIDA : 2040 . CERTIFICATE IIOLDFR CANCELLATION -- ��• SHOVLO ANY OT THE *SI nFsmllrcD POLICIES SE I:ANI.266ED eEFORC TMC 9XFIRATRM I ' bTD_TAF ifTVRR r'C:UD?'iY UAYa II1CnCOI, Ti10 gOwNO INSUniR WILL LNOF�IVnr TM WAtI 3G DAY` 7YR!TTEN I • NnTIrF TO THE CERTIFICATE HOLDEN KANtu IU TNR LRT, Guy FAILUIIA TO 00 CO CHALI. LVI; RC IRRDOE NO OOw6AT10N OR ♦;AOILRY OF ANV KININ IIPOP THE INiUHtll IIY WANT4 074 HLACDI , t6 b = 9ae i VSA AUTMQRt="Ir49*ENTATTl 00PL ge'' 'l - /! - ACORD 25 f2G41J'0flj b0ebro0 Q'� ACORD CnRpnRA I ! ON 1988 354911 Pwcr1 � �` Ce."tNiO�tctNow"° Type du oVwwWon and NOW= Num UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE FUNDER SPECIFIC BUDGET AGENCYIPROGRAM NAME: FUNDER: ---w yYs n Salaries A 3 to 4 % increase is . Other doAars relate to increase haus worked over lam year FICA Function of salary se Re*omnt Function of salary expense Health insurance will increase W Ju 2005 by 15% Workers Compefoatkm Function of saiary expense Unemokmainot Function of salary expense mmol rot a-� 5111f2 os Catholic Charities of The Diocese of Palm Beach Samaritan Center ORGANIZATION: Catholic Charities PROGRAM : Samaritan Center TABLE OF CONTENTS Please "X" the parts of the grant application to indicate that they are included Also, please put the page number where the information can be located. X I Section of the Proposal Page # TABLE OF CONTENTS (check list) COVER PAGE (with signatures) . 0 9 . 0 . 0 . . . . . . . . . . A. ORGANIZATION CAPABILITY (one page maximum) 1 . Mission and Vision of organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . Summary of expertise, accomplishments, and population served . . . . . . . . . . . . . . . . B. PROGRAM NEED STATEMENT (one page maximum) 1 . Program Need Statement . , . , , , , , , , , , 2 . Programs that address need and gaps in service . , , " I ' ll , log 000 0 * 0 * we 06 a 0004 so ' e " o C. PROGRAM DESCRIPTION (two pages maximum) 1 . Funding priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . Description of program activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 . Evidence that program strategy will work . 10 * 00 . 006 . 1 . . . . . . . . . . . . . . . . . . . . . . 4. Staffing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 . Awareness of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 . Accessibility of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D. MEASURABLE OUTCOMES (two pages maximum) . . . . . . . . . . . : . . . . . . . . . . . . . E. COLLABORATION (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F. PROGRAM EVALUATION (two pages maximum) 1 . Demographics . . . . . . . . . 2 . Measures , . a a , a a a a a a 9 a a . . . a a . . . . . . . . 3 . Reporting . . . . . . . . . . . . . . . . moo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a . . . . . . . . . . . . . . . . . . . . . . . . . . . . G. TIMETABLE (one page maximum) H. UNDUPLICATED CLIENT COUNT 1 . Projections by Location . . , . . . . . . 2 . Projections by Age Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NOk,t- 16-2005 00 : 56 ARTHUR GALLAGHER 3057163293 Pa02 MINIMUM IMPORTANT if the certificate holder is an ADDITIONAL INSURE [) , the policy(ies ) must be endorsed , A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) . if SUBROGATION IS WAIVED , subject to the terms and conditions of the policy, certain policies may require an endorsement , A statement on this certificate dors not confer rights to the certificate holder in lieu of such endorsement(s ), DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a oontract tetween the issingr producer , and t�e affirmativelyfor negatnsurer(sively `amend extsnd ora ter horized reresentative othe coverage afforded by�the policies listed r thereondoes ` ACORD 25 (2001 !08) TOTAL P . e2 Catholic Charities of The Diocese of Palm Beach Samaritan Center L BUDGET FORMS 1 . Financial Budget Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J. FUNDER SPECIFIC/ADDITIONAL SHEETS K. APPENDIX 2 EXHIBIT B ( From policy adopted by Indian River County Board of county Commissioners on February 19 , 2002 ) " D . Nonprofit Agency Responsibilities After Award Funding Indian River County provides funding to all nonprofit agencies on a reimbursement basis only. All reimbursable expenses must be documented by an invoice and/or a copy of the canceled check . Any expense not documented properly to the satisfaction of the Office of Management & Budget and/or the County Administrator may not be reimbursed . If an agency repeatedly fails to provide adequate documentation , this may be reported to the Board of Commissioners . In the event an agency provides inadequate documentation on a consistent basis , funding may be discontinued immediately. Additionally, this may adversely affect future funding requests . Expenditures may only be reimbursed from the fiscal year for which funding was awarded . For example , no expenditures prior to October 18t may be reimbursed with funds from the following year. Additionally, if any funds are unexpended at the end of a fiscal year, these funds are not carried over to the next year unless expressly authorized by the Board of Commissioners . All requests for reimbursement at fiscal year and (September 30th) must be submitted on a timely basis . Each year, the Office of Management and Budget will send a letter to all nonprofit agencies advising of the deadline for reimbursement requests for the fiscal year. This deadline is typically early to mid October, since the Finance Department does not process checks for the prior fiscal year beyond that point . Each reimbursement request must include a summary of expense by type . These summaries should be broken down into salaries , benefit, supplies , contractual services , etc . If Indian River County is reimbursing an agency for only a portion of an expense (e . g . salary of an employee) , then the method for this portion should be disclosed on the summary. The Office of Management & Budget has summary forms available . Indian River County will not reimburse certain types of expenditures . These expenditure types are listed below. a ) Travel expenses for travel outside the County including but not limited to : mileage reimbursement, hotel rooms , meals , meal allowances , per diem , and tolls . Mileage reimbursement for local travel (within Indian River County) is allowable . b) Sick or Vacation payments for employees . Since agencies may have various sick and vacation pay policies , these must be provided from other sources . c) Any expenses not associated with the provision of the program for which the County has awarded funding . d ) Any expense not outlined in the agency's funding application . The County reserves the right to decline reimbursement for any expense as deemed necessary." EXHIBIT - B - EXHIBIT C STANDARD TERMS FOR GRANT CONTRACT 1 . Notices . Any notice , request, demand , consent , approval , or other communication required or permitted by this Contract shall be given , or made in writing , by any of the following methods : facsimile transmission ; hand delivery to the other party; delivery by commercial overnight courier service ; or mailed by registered or certified mail (postage prepaid ) , return receipt requested at the addresses of the parties shown below: County: Joyce Johnston -Carlson , Director Indian River County Human Services 1840 25th Street Vero Beach , Florida 32960-3365 Recipient : Catholic Charities/Samaritan Center 3650 41 st Street Vero Beach , Florida 32960 Attention : Julia Keenan , Administrator 2 . Venue : Choice of Law. The validity, interpretation , construction , and effect of this Contract shall be in accordance with and governed by the laws of the State of Florida only. The location for settlement of any and all claims , controversies , or disputes , arising out of or relating to any part of this Contract , or any breach hereof, as well as any litigation between the parties , shall be Indian River county, Florida for claims brought in state court, and the Southern District of Florida for those claims justifiable in federal court . 3 . Entirety of Agreement . This Contract incorporates and includes all prior and contemporaneous negotiations , correspondence , conversations , agreements , and understandings applicable to the matters contained herein and the parties agree that there are no commitments , agreements , or understandings concerning the subject matter of this Contract that are not contained herein . Accordingly, it is agreed that no deviation from the terms hereof shall be predicated upon any prior representations or agreements , whether oral or written . It is further agreed that no modification , amendment or alteration in the terms and conditions contained herein shall be effective unless contained in a written document signed by both parties . 4 . Severability. In the event any provision of this Contract is determined to be unenforceable or invalid , such unenforceability or invalidity shall not affect the remaining provisions of this Contract, and every other provision and term of this Contract shall be deemed valid and enforceable to the extent permitted by law. To that extent, this Contract is deemed severable . 5 . Captions and Interpretations Captions in this Contract are included for convenience only and are not to be considered in any construction or interpretation of this Contract or any of its provisions . Unless context indicates otherwise , words importing the singular number include the plural number, and vise versa . Words of any gender include the correlative words of the other genders , unless the sense indicates otherwise . 6 . Independent Contractor. The Recipient is and shall be an independent contractor for all purposes under this Contract. The Recipient is not an agent or employee of the County, and any and all persons engaged in any of the services or activities funded in whole or in part performed pursuant to this Contract shall at all times and in all places be subject to the Recipient's sole direction , supervision and control . 7 . Assignment . This Contract may not be assigned by the Recipient without the prior written consent of the County. EXHIBIT - C - NU1.i- 1b—i'L' UZ> 00 ; HK I HUK UHLLHUHtK 30:X ( 1b1.)d73 re 01 ARD. CERTIFICATE OF LIABILITY INSURANCE "1— I 1/ 9/as ' DRnnucER 5 . 59 - bQ IHIS CERTIFICATE IS 133UrD Ah�A MATTEROFI141loUItMATION1 Arthvi J • l;allagzer a Cv . Miami ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER . THIS CERTIFICATE UUt$ NOT AMEND, EXTEND Ott 9Z4o ) . W . 4140 9traaR I ALTER THIt COVERAGE AFFORDED EY The rOLICI92 YELQW. Suite : uu t >ilwwl : PL : 5166 I NALCI Aneoaia E AhRllE - AVOV� ud INSURERS AFFORDING COVERAGE eleurKn _ NWFIOAA. rS`Iinc tM 7rNRR A SLIQ S L_aer 1"* 10706 DIr r�OCt9a OP Fi4LM EE+1CR �wQ1IRFR3: c7AT1C'AIAlr CA.Tu01YC nnc 110093 CAT901, 7HARTTIES OP rAIA ZZACR . 1;rC , - l+ v5 a , MILITARY TRAIL IN . amo vontlAcnGal Cat vU PARrN on&o t CARDED) ; rL 37 ,110 , !NSlINcn - . ._ INCunEn € L!;0V—F- RAGie3 - T -4 OOLICiES 4 = MIST IRAPRa L!S i tV bELO'JU YANE BEEN 101UCD TO THE INSURFC NAMED ASOVf- 1•< Mt l'HE PgUCY PERIOD INDICATCG, NOTWITHSTANDING AN" mt:QJIREbICNY , TERM OR CONDrION OF ANY CONTRACT r.1W 01NfIK QOGUMENT WITH RB3PCCT TO V+441CN Toil % CER.TIFICATF MAY !It ISSUEU VR IVAY PCFITAINr TWE INS'JCANCE AFF,?Iar Ir I I HY 714E POLICIES m50NDCD I IChE@: I$ SUBJECT TO ALL '.IlI HF TFRMS, :XGL613!GN5 AND CONG!TION: Or CUCa UA I t L1,1017S SHOWN MAY I-XJC DCCT: REDUCED Sy PAID CLAIMS LA o ;:RML --_ • . - .. . ...-r--... . . .._ on! FE ECT— f �u% EXP!RhTWN CET ,y 0 r !uRR, 1 . W)U ,r . , , . t rr IN 4P �nN1-" ¢ANCC rOwcy uUMeER OATC�urtE t K wYEXPUUlrr , ICS LNYIuri ItTZ - A7 - F.7G - 04o001i40 0 / 07 / INC I U9iVl / Of kAt:Mtltr 174R- WG; • 000 , 000 _ir-- � RTtr.) a � c • le 04 / 01 / OS ! 44 / n ) / INA P �EMlO[G (G �.cg(eM SLnC1LL6e1 a S< 1 c:'�prr,�eRGII SC!aEfL4L LU501.rri � .9�— _'• .- ✓-J CL1R•tC U•V1F L� O:I:UM i I I, mEo ap cMry wre W tarn; . . evil .. $ 1 , 000 , 000 I� i IrCNERpL AGGRCWTE C �/ A -.. I ` 1 ; 040 ; 000 1OC1+'IhGG!1CO,1', ELWITA00LIESPERI I � OROOICT+ • r'•nl!PR'TPACiG ' PCLCY Pon- 77,rWC I .. .. . A AO---T{{{ot+oalLGlvnuiv 13: -A1 - aX • 4000oi544 j 44 / 0110i t ue / a1 / o6 LVNOIhCG3t+OtEIIMiT ` 53 , 400 . 004 b If � ANYAUIU { aRc1050 . OA us % u1 / 05 6e / Oli Oi � Ita raho€n�1 1- ALL O'.IR�: A /TOS I OOD4YIWURY tPara!acnl i el'MwV:,EOA.rros � - �-•• - 1 LX fSIRFDAVipa I GOOILY INJUM" 1 t NEr A iCCI!11r111 r• n0r[nTvDMAGC trot acmes ! � cw2ACELIS nu ITV I AUTU,UNLY - t:A AGi,iD 7T To . . .. �� ArvrAJTO i AA1.Rn nNHvl'i ! A00 4 I e%C60O/VGrOMCLIA lNW4Tv I EACw f.Y:•^.I IR RFNCE 5 rxruk ❑ ,ILAWSV009 I AoaftstlATc I ! RE"Umo►. S � ?. AWO "K ) L:VaiPINEATMUM10, I (�4 - A1 - • 0000019UU j Vi / 4' 1 / 05 0 < JOli 04 X y7ATw.!J7s1 I eR- r IC,/MLOYERS' LIAOILITY 06 � 01 / OlI w1 : i9692GL uG / V1 / Oi ]IAt4lUtNY Ann . Ann I wVPRODP.IETrIMAQrNFR/E%EUJIIVt INu I ! FI 4AtT. OFFICCR+MGwOC'tEkCLVOCM Fxr.Il i f :1.. MCEA£E EAI;MpLOYEE S 1 . V00 , 000 • , N� ppo�4eoseri6o�rdv I - FI DIS'kA.it - YV�TrY !MR � •l ! 00a 000 OPECIAL F1111 ICIoNE "low .. .._ OTHGR i j1 i I I OCdGRIPTION Or OKnATiDNa r LOGATION41 vEwM l Ft l F.XC W WONS ADDED 8T ENOUHJtMCrI1 a SPEGIK PAOrI&70N0 rft:esv � r : lusur� c A 10 0Utn% , 9250 . onn RAJt R)eure'1 RotCUtivw 44 Lnclwdsd within k}• linits Tia ^rRTiRSrATU NUL SR AND 110YAP RIV31 CoVNTY r.Ro MATED ADDTTTrWAT, rNSURED R95PFV1:3 :v TRz 0XV39 Ui LLA01"TY UNMA TRE CATUOLTC CAARSIXIC DRO40.1IN T,RC:ATRD AT : VAMAZTAE CDNT$ RA 1040 41 C'TRESTr YallO eSACIIr MORIDA : 2040 . CERTIFICATE IIOLDFR CANCELLATION -- ��• SHOVLO ANY OT THE *SI nFsmllrcD POLICIES SE I:ANI.266ED eEFORC TMC 9XFIRATRM I ' bTD_TAF ifTVRR r'C:UD?'iY UAYa II1CnCOI, Ti10 gOwNO INSUniR WILL LNOF�IVnr TM WAtI 3G DAY` 7YR!TTEN I • NnTIrF TO THE CERTIFICATE HOLDEN KANtu IU TNR LRT, Guy FAILUIIA TO 00 CO CHALI. LVI; RC IRRDOE NO OOw6AT10N OR ♦;AOILRY OF ANV KININ IIPOP THE INiUHtll IIY WANT4 074 HLACDI , t6 b = 9ae i VSA AUTMQRt="Ir49*ENTATTl 00PL ge'' 'l - /! - ACORD 25 f2G41J'0flj b0ebro0 Q'� ACORD CnRpnRA I ! ON 1988 354911 Pwcr1 � �` Ce."tNiO�tctNow"° NOk,t- 16-2005 00 : 56 ARTHUR GALLAGHER 3057163293 Pa02 MINIMUM IMPORTANT if the certificate holder is an ADDITIONAL INSURE [) , the policy(ies ) must be endorsed , A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) . if SUBROGATION IS WAIVED , subject to the terms and conditions of the policy, certain policies may require an endorsement , A statement on this certificate dors not confer rights to the certificate holder in lieu of such endorsement(s ), DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a oontract tetween the issingr producer , and t�e affirmativelyfor negatnsurer(sively `amend extsnd ora ter horized reresentative othe coverage afforded by�the policies listed r thereondoes ` ACORD 25 (2001 !08) TOTAL P . e2