The URL can be used to link to this page

Home My WebLink About2005-328g lo • � ` 0s� INDIAN RIVER COUNTY GRANT CONTRACT �Ir This Grant Contract ("Contract" ) entered into effective this 11 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 Homeless Family Center . ( Recipient) , of: Homeless Family Center 7154 th Place Vero Beach , Florida 32962 Assets Build Futures Program 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 - lo • � ` 0s� INDIAN RIVER COUNTY GRANT CONTRACT �Ir This Grant Contract ("Contract" ) entered into effective this 11 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 Homeless Family Center . ( Recipient) , of: Homeless Family Center 7154 th Place Vero Beach , Florida 32962 Assets Build Futures Program 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 : THIRTEEN THOUSAND , FIVE HUNDRED FORTY DOLLARS ($ 13 , 540 . 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 : - 2 - Y 4 . Grant Funds and Payment. The approved Grant for the Grant Period is : THIRTEEN THOUSAND , FIVE HUNDRED FORTY DOLLARS ($ 13 , 540 . 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 : - 2 - (i) Commercial General Liability Insurance in an amount not less than $ 1 , 000 , 000 combined single limit for bodily injury and property 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 BC �, Y: Thomas S . Lowther, Chairman BCC Approved : 05 Att arton , Clerk By Deputy Clerk '' m Approved : Jos h A . Baird County Administrator {rt Approved �s to form and legal sufficiency: / , / By: >> ff, arian E . Fell , Assistant Count orney RECD NT : Y B : J Homeless Family ( nt r - 4 - (i) Commercial General Liability Insurance in an amount not less than $ 1 , 000 , 000 combined single limit for bodily injury and property 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 - Homeless Family Center Assets Build Futures Indian River Advisory Committee PROGRAM COVER PAGE Organization Name : Homeless Family Center Executive Director : Roberto Ortiz E-mail : rortiz hfc@bellsouth . net Address : 715 4a' Place Telephone : 772 67-2766 Vero Beach FL 32962 Fax: _ (772) 567- 1454 Program Director: Roberto Ortiz E-mail : (Same) Address : (Same) Telephone : Fax : Program Tit] . Assets Build Futures" ' I ( ^/{� �i Priority Need Are essed. Mental Wellness I ' uesJPar`ental Support & Education Brief Description of the Program : . To provide child development classes (PH 610 510) and parenting skills development (P .::610 . 680) for children of homeless families residing in a homeless shelter H- 180 . 850) and family transitional unit (BY 180 . 950) striving to build a positive self identity for and with their children. The child development specialist provides parenting skills training and self —esteem trainingto children and their parents who are homeless with a focus on buildin personal strengths and assets in children SUMMARY REPORT — (Enter Information In The Black Cells On Amount Requested from Funder for 2005 /06 : $ 5 0 Total Proposed Program Budget for 2005 /06 : $ 3 , 5 Percent of Total Program Budget : Current Program Funding ( 2004 / 05 ) : 63 . 6 % $ 15 , 000 Dollar increase /( decrease ) in request : $ Percent increase/ ( decrease ) in request Unduplicated Number of Children to be served Individually : 0 . 0 % Unduplicated Number of Adults to be served Individually : Unduplicated Number to be served via Group settings : 6 82 Total Program Cost per Client . 267 . 95 * * If request increased 5% or more, briefly explain why : If these funds are being used to match another source, name the source and the $ amount : The OgA,`yr / a�n�/ A � i�1zation 's Board of Directors has approved this applicatio (date). Name of President/Chair _-of�/the Board�— e�o 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 BC �, Y: Thomas S . Lowther, Chairman BCC Approved : 05 Att arton , Clerk By Deputy Clerk '' m Approved : Jos h A . Baird County Administrator {rt Approved �s to form and legal sufficiency: / , / By: >> ff, arian E . Fell , Assistant Count orney RECD NT : Y B : J Homeless Family ( nt r - 4 - Homeless Family Center Assets Build Futures Indian River Advisory Committee 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. The mission of the Homeless Family Center, Inc . (HFC) is to provide opportunities for homeless families and individuals to end their homelessness by achieving self- sufficiency through education, living wages, and permanent housing. The vision is that each homeless family will achieve their short-term and long-term goals in building and establishing relationships in the community towards obtaining and maintaining stability and resources to end their homelessness . F2. Provide a brief summary of your organization including areas of expertise, accomplishments, and population served. The Homeless Family Center has developed from a grassroots organization incorporated in 1992, to an organization, which provides emergency, and transitional housing for homeless families and individuals. The following highlight some of the organizations accomplishments during July 04 thru March 05 . • During these first three quarters, the center provided emergency shelter to 84 singles and transitional housing to 46 families (including 94 children and 59 parents) for a total of 237 different homeless individuals receiving assistance and services . • An average of 4 parent session per month were provided to an average of 8 adult participants. For the children an average of 5 group sessions per month to an average of 5 participants were provided . • The damages to the center ' s building caused by the hurricanes have been completed 90% . The educational workstation will be completed by end of 2005 . 4 Homeless Family Center Assets Build Futures Indian River Advisory Committee B. 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. Prolonged daily living in "fractured families" consumed with the stress of poverty, in a homeless center, dealing with unemployment and/or low wages, and the uncertainty of the future causes hopelessness, fear, insecurity, and anxiety in children . These families often do not have the energy nor the resources to provide positive reinforcement and developmental experiences which builds self-esteem and resiliency in their children. The 2000 "Homeless Education Program", sponsored by the Broward County School District, was able to document that children who are homeless display low self-esteem; are either withdrawn and listless, or hostile and aggressive; are emotionally needy; are old beyond their years ; feel unsafe in their environments ; and feel shame at where they live . In addition to educational setbacks there are developmental delays which augment the child ' s feelings of failure. Homelessness for children is often an extended period of time in their young life which is fraught with educational and emotional setbacks that lasts for years. Approximately 47% suffer depression, anxiety, display aggressive behaviors and are taunted by their peers for being homeless . ( 1 ) In an annual report titled Homeless Conditions in Florida Fiscal Year 2002 -2003 by the Department of Children and Families, Office of Homelessness the daily homeless population of Florida was estimated at 76, 675 . "Of that estimate it is clear that more and more families with children are becoming homeless for the first time, and that first-time homeless episodes are increasing . " (2) For homeless families, research indicates that 84% are single mothers with children. (3 ) In Indian River County, it is estimated there are over 450 homeless daily of which 45 % are families . Many Florida children live on the brink : 4% live in households without a telephone while 17% reside in households without a vehicle. (4) There remains therefore a large area for continued efforts to address the unmet needs of children who are homeless within our community and the potential for the issues to get worse before improving without proper resources . 1 ) 1999 study of "Homeless in America: A Children ' s Story" conducted by The Institute for Children & Poverty 2) Annual report on Homeless Conditions in Florida Fiscal Year 2002-2003 Florida Department of Children and Families, Office of Homelessness, Tom Pierce, June 2004 pg 1 3 ) Ibid pg. 2 4 Children at Risk : State Trends 1990 — 2000, Annie E . Casey Foundation, 2002 5 EXHIBIT A (Copy of complete Request for Proposal ) EXHIBIT - A - Homeless Family Center Assets Build Futures Indian River Advisory Committee 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 . Other local programs providing services to homeless families include the Samaritan Center, a local transitional housing program and Safe Space, a shelter for victims of domestic violence . However, reports on homelessness, such as those conducted by the Treasure Coast Homeless Services Council and Florida Department of Children and Families Office of Homelessness, verifies that the need for services for these children and their families is far greater than the availability of services to meet their needs . HFC programs provide more capacity for much needed services. 6 Homeless Family Center Assets Build Futures Indian River Advisory Committee C. PROGRAM DESCRIPTION (Entire Section C. 1 — 6, not to exceed two pages) F List Priority Needs area addressed. ental Wellness Issues and Parental Support & Education F describe program activities including location of services. ccur at the residential facilities. The hours of services provided by the child nt specialist include parenting groups, individual family consultation, and educational groups for elementary age, middle school and teens . Sessions are focused on : building mutual respect; managing difficult behaviors ; developing boundaries ; reinforcement focused on building self- esteem; communication; and developing positive parent/child relationships . Through individual assessments and family discussions the families and children are made aware of the program and the benefits of their active participation. Progress is monitored via staff and case management in the house with each respective individual and reflected with on-going sessions and communications with family members. Case management meetings and supervisory sessions assured program objectives and family and children needs are being met . On-going Follow-up is provided to families residing in the transitional housing program; family consultations continue as needs arise and children may continue to participate in the activities . 7target describe how your program addresses the stated need/problem . Describe how rogram follows a recognized ` best practice" (see definition on page 12 of the tions) and provide evidence that indicates proposed strategies are effective with population , Since 1990, the Search Institute has focused on the development of "healthy communities, healthy youth" through their research and implementation of programs they have promoted the 40 developmental assets of children . These assets, which include building external assets (support, empowerment, boundaries & expectations, constructive use of time) and internal assets (commitment to learning, positive values, social competencies, positive identity) are the building developmental blocks of young people to grow up healthy, caring and responsible. The HRC program for homeless families is designed to impact the internal asset of developing a positive self identity in children through achieving personal power, self-esteem, a sense of purpose and a positive view of one ' s future. 7 Homeless Family Center Assets Build Futures Indian River Advisory Committee PROGRAM COVER PAGE Organization Name : Homeless Family Center Executive Director : Roberto Ortiz E-mail : rortiz hfc@bellsouth . net Address : 715 4a' Place Telephone : 772 67-2766 Vero Beach FL 32962 Fax: _ (772) 567- 1454 Program Director: Roberto Ortiz E-mail : (Same) Address : (Same) Telephone : Fax : Program Tit] . Assets Build Futures" ' I ( ^/{� �i Priority Need Are essed. Mental Wellness I ' uesJPar`ental Support & Education Brief Description of the Program : . To provide child development classes (PH 610 510) and parenting skills development (P .::610 . 680) for children of homeless families residing in a homeless shelter H- 180 . 850) and family transitional unit (BY 180 . 950) striving to build a positive self identity for and with their children. The child development specialist provides parenting skills training and self —esteem trainingto children and their parents who are homeless with a focus on buildin personal strengths and assets in children SUMMARY REPORT — (Enter Information In The Black Cells On Amount Requested from Funder for 2005 /06 : $ 5 0 Total Proposed Program Budget for 2005 /06 : $ 3 , 5 Percent of Total Program Budget : Current Program Funding ( 2004 / 05 ) : 63 . 6 % $ 15 , 000 Dollar increase /( decrease ) in request : $ Percent increase/ ( decrease ) in request Unduplicated Number of Children to be served Individually : 0 . 0 % Unduplicated Number of Adults to be served Individually : Unduplicated Number to be served via Group settings : 6 82 Total Program Cost per Client . 267 . 95 * * If request increased 5% or more, briefly explain why : If these funds are being used to match another source, name the source and the $ amount : The OgA,`yr / a�n�/ A � i�1zation 's Board of Directors has approved this applicatio (date). Name of President/Chair _-of�/the Board�— e�o Name of Executive Director/CEO Signature 3 Homeless Family Center Assets Build Futures Indian River Advisory Committee 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). Staffing required for program implementation include : The child development specialist, Beverly Whitely, has a PD . D in Education and has extensive experience in conducting mental health educational groups. Roberto Ortiz, M. A. , the Executive Director/Program Director, has several years of prior experience in the mental health field providing family and individual therapy, provides on-going supervision to the staff and monitors program activities . 5. How will the target population be made aware of the program ? Homeless families are referred to HFC either through self4eferral or local community agencies . Families entering the program meet eligibility criteria, complete a comprehensive assessment and individual case plan, which identifies specific goals and objectives based on the family needs. Common need areas identified include : employment, mental health, substance abuse, debt, legal issues, transportation, family support and housing. Additional areas of concern include : parenting issues, special needs of children, school and relationships within the family. As families enter residential programs they receive an orientation to the program as a part of their assessment and plan development process . Families, as such are made aware of, and required to participate in the available family program identified in this proposal . 6. How will the program be accessible to target population (i. e. , location, transportation , hours of operation) ? Homeless families reside at the facility where the program is conducted . Group activities for children are available after school, with parent activities available on evenings, weekends and throughout the day as scheduled . No transportation is required for this program. 8 Homeless Family Center Assets Build Futures Indian River Advisory Committee D. D. MEASURABLE OUTCOMES (Entire Section D not to exceed two pages) OUTCOMES ACTIVITIES FAddall o the elements or the Measurable Outcome(s) Add the tasks to accomplish the Outcome(s) Increase knowledge of parenting techniques * Participation in weekly parenting skills for 42 parents residing at the Homeless Family training classes conducted by the Child Center by 75 % during the grant period as Developmental Specialist . measure by the parenting skills pre-test/post- * Provide individual family consultation and test . counseling services to parents and their children regarding identified specific parenting and/or behavior issues in the family unit . *Provide pre and post test 2 . Improve knowledge of positive behaviors * Youth ages 5 - 10, 11 - 14 and 15- 18 will and coping skills which promote self-esteem participate in age appropriate groups focused for 46 homeless children ages 5 to 18 residing on communication skills, conflict resolution, at the Homeless Family Center by 75 % during empowerment, and related topics focused on the grant period as measured by the "About self esteem building . Me" pre-test/post-test. *Provide pre and post test 9 Homeless Family Center Assets Build Futures Indian River Advisory Committee 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. The mission of the Homeless Family Center, Inc . (HFC) is to provide opportunities for homeless families and individuals to end their homelessness by achieving self- sufficiency through education, living wages, and permanent housing. The vision is that each homeless family will achieve their short-term and long-term goals in building and establishing relationships in the community towards obtaining and maintaining stability and resources to end their homelessness . F2. Provide a brief summary of your organization including areas of expertise, accomplishments, and population served. The Homeless Family Center has developed from a grassroots organization incorporated in 1992, to an organization, which provides emergency, and transitional housing for homeless families and individuals. The following highlight some of the organizations accomplishments during July 04 thru March 05 . • During these first three quarters, the center provided emergency shelter to 84 singles and transitional housing to 46 families (including 94 children and 59 parents) for a total of 237 different homeless individuals receiving assistance and services . • An average of 4 parent session per month were provided to an average of 8 adult participants. For the children an average of 5 group sessions per month to an average of 5 participants were provided . • The damages to the center ' s building caused by the hurricanes have been completed 90% . The educational workstation will be completed by end of 2005 . 4 Homeless Family Center Assets Build Futures Indian River Advisory Committee B. 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. Prolonged daily living in "fractured families" consumed with the stress of poverty, in a homeless center, dealing with unemployment and/or low wages, and the uncertainty of the future causes hopelessness, fear, insecurity, and anxiety in children . These families often do not have the energy nor the resources to provide positive reinforcement and developmental experiences which builds self-esteem and resiliency in their children. The 2000 "Homeless Education Program", sponsored by the Broward County School District, was able to document that children who are homeless display low self-esteem; are either withdrawn and listless, or hostile and aggressive; are emotionally needy; are old beyond their years ; feel unsafe in their environments ; and feel shame at where they live . In addition to educational setbacks there are developmental delays which augment the child ' s feelings of failure. Homelessness for children is often an extended period of time in their young life which is fraught with educational and emotional setbacks that lasts for years. Approximately 47% suffer depression, anxiety, display aggressive behaviors and are taunted by their peers for being homeless . ( 1 ) In an annual report titled Homeless Conditions in Florida Fiscal Year 2002 -2003 by the Department of Children and Families, Office of Homelessness the daily homeless population of Florida was estimated at 76, 675 . "Of that estimate it is clear that more and more families with children are becoming homeless for the first time, and that first-time homeless episodes are increasing . " (2) For homeless families, research indicates that 84% are single mothers with children. (3 ) In Indian River County, it is estimated there are over 450 homeless daily of which 45 % are families . Many Florida children live on the brink : 4% live in households without a telephone while 17% reside in households without a vehicle. (4) There remains therefore a large area for continued efforts to address the unmet needs of children who are homeless within our community and the potential for the issues to get worse before improving without proper resources . 1 ) 1999 study of "Homeless in America: A Children ' s Story" conducted by The Institute for Children & Poverty 2) Annual report on Homeless Conditions in Florida Fiscal Year 2002-2003 Florida Department of Children and Families, Office of Homelessness, Tom Pierce, June 2004 pg 1 3 ) Ibid pg. 2 4 Children at Risk : State Trends 1990 — 2000, Annie E . Casey Foundation, 2002 5 Homeless Family Center Assets Build Futures Indian River Advisory Committee 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 a reement letters. Collaborative Agency Resources provided to the program Through the school liaison for homelessness, they Indian River County School District provide school supplies, assistance with school enrollments or transfers, assist with obtaining free and/or reduced lunch programs, provide transportation and serve as a resource for solving other problems which arise with homeless children in the school . Provides food and snacks for children and families at the Treasure Coast Food Bank Center. Share a management information system (MIS ), Treasure Coast Homeless Services collaborate on grants, projects the annual needs Council assessment process for the homeless 10 Homeless Family Center Assets Build Futures Indian River Advisory Committee F. PROGRAM EVALUATION (Entire Section F not to exceed two pages) F GRAPHICS : What information (data elements) will you need to collect in order rately describe your target population including demographics (age, gender, and background) required by the funder in Section H? What are the pieces of ation that qualify them for your target population ? How do you document their need for services or their "unacceptable condition requiring change" from Section B19 Program experience during prior years has demonstrated that nearly every child residing in the homeless shelter environment displays some of the emotional and/or behavioral issues previously discussed in section B . Parents appear to welcome any support and guidance staff can offer regarding parenting issues . * * * * See #2 (Below) for data collection 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 ? ITEM MEASURES FREQUENCY Child name, age, sex, race Enrollment Forms Upon intake Gender, school, county Parenting Skills Development Pre-Post Test Beginning & End of Groups Problem Behavior(s) Behavior Issues Checklist I " week in residence Behavior Management Observations & Progress Weekly Notes Participation Levels Attendance Logs Each class meetings Self-esteem issues "About Me" Assessment Beginning & End Groups 11 Homeless Family Center Assets Build Futures Indian River Advisory Committee 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 . Other local programs providing services to homeless families include the Samaritan Center, a local transitional housing program and Safe Space, a shelter for victims of domestic violence . However, reports on homelessness, such as those conducted by the Treasure Coast Homeless Services Council and Florida Department of Children and Families Office of Homelessness, verifies that the need for services for these children and their families is far greater than the availability of services to meet their needs . HFC programs provide more capacity for much needed services. 6 Homeless Family Center Assets Build Futures Indian River Advisory Committee C. PROGRAM DESCRIPTION (Entire Section C. 1 — 6, not to exceed two pages) F List Priority Needs area addressed. ental Wellness Issues and Parental Support & Education F describe program activities including location of services. ccur at the residential facilities. The hours of services provided by the child nt specialist include parenting groups, individual family consultation, and educational groups for elementary age, middle school and teens . Sessions are focused on : building mutual respect; managing difficult behaviors ; developing boundaries ; reinforcement focused on building self- esteem; communication; and developing positive parent/child relationships . Through individual assessments and family discussions the families and children are made aware of the program and the benefits of their active participation. Progress is monitored via staff and case management in the house with each respective individual and reflected with on-going sessions and communications with family members. Case management meetings and supervisory sessions assured program objectives and family and children needs are being met . On-going Follow-up is provided to families residing in the transitional housing program; family consultations continue as needs arise and children may continue to participate in the activities . 7target describe how your program addresses the stated need/problem . Describe how rogram follows a recognized ` best practice" (see definition on page 12 of the tions) and provide evidence that indicates proposed strategies are effective with population , Since 1990, the Search Institute has focused on the development of "healthy communities, healthy youth" through their research and implementation of programs they have promoted the 40 developmental assets of children . These assets, which include building external assets (support, empowerment, boundaries & expectations, constructive use of time) and internal assets (commitment to learning, positive values, social competencies, positive identity) are the building developmental blocks of young people to grow up healthy, caring and responsible. The HRC program for homeless families is designed to impact the internal asset of developing a positive self identity in children through achieving personal power, self-esteem, a sense of purpose and a positive view of one ' s future. 7 Homeless Family Center Assets Build Futures Indian River Advisory Committee 3. REPORTG: What will you do with this i INnformation 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 ? Results of the program are shared with the funder through the monitoring and reporting process . A final report will be shared with the staff and Board of Directors which shows the results and outcomes learned from grant implementation . On-going information is shared with parents as part of their involvement in the process . The experiences and results of the program are used to continue to develop and/or improve services to homeless children and their families during their stay in residence. Learned healthy interaction by parents and their children improve the overall health, strength and functioning of the family as a support system. 12 Homeless Family Center Assets Build Futures Indian River Advisory Committee G. TBIETABLE (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 October-December Series # 1 — Parenting Skills & Child Development Classes Parent/Child Assessment completed with needs identified Pre-Test Administered for Parenting Classes "About Me" Assessments with Children Post-Tests Series #2 — Parenting Skills & Child Development Classes January — March Parent/Child Assessment completed with needs identified Pre-Test Administered for Parenting Classes "About Me" Assessments with Children Post-Tests Series # 3— Parenting Skills & Child Development Classes Parent/Child Assessment completed with needs identified April — June Pre-Test Administered for Parenting Classes "About Me" Assessments with Children Post-Tests Series #4— Parenting Skills & Child Development Classes Parent/Child Assessment completed with needs identified Pre-Test Administered for Parenting Classes July — September "About Me" Assessments with Children Post-Tests 13 Homeless Family Center Assets Build Futures Indian River Advisory Committee 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). Staffing required for program implementation include : The child development specialist, Beverly Whitely, has a PD . D in Education and has extensive experience in conducting mental health educational groups. Roberto Ortiz, M. A. , the Executive Director/Program Director, has several years of prior experience in the mental health field providing family and individual therapy, provides on-going supervision to the staff and monitors program activities . 5. How will the target population be made aware of the program ? Homeless families are referred to HFC either through self4eferral or local community agencies . Families entering the program meet eligibility criteria, complete a comprehensive assessment and individual case plan, which identifies specific goals and objectives based on the family needs. Common need areas identified include : employment, mental health, substance abuse, debt, legal issues, transportation, family support and housing. Additional areas of concern include : parenting issues, special needs of children, school and relationships within the family. As families enter residential programs they receive an orientation to the program as a part of their assessment and plan development process . Families, as such are made aware of, and required to participate in the available family program identified in this proposal . 6. How will the program be accessible to target population (i. e. , location, transportation , hours of operation) ? Homeless families reside at the facility where the program is conducted . Group activities for children are available after school, with parent activities available on evenings, weekends and throughout the day as scheduled . No transportation is required for this program. 8 Homeless Family Center Assets Build Futures Indian River Advisory Committee D. D. MEASURABLE OUTCOMES (Entire Section D not to exceed two pages) OUTCOMES ACTIVITIES FAddall o the elements or the Measurable Outcome(s) Add the tasks to accomplish the Outcome(s) Increase knowledge of parenting techniques * Participation in weekly parenting skills for 42 parents residing at the Homeless Family training classes conducted by the Child Center by 75 % during the grant period as Developmental Specialist . measure by the parenting skills pre-test/post- * Provide individual family consultation and test . counseling services to parents and their children regarding identified specific parenting and/or behavior issues in the family unit . *Provide pre and post test 2 . Improve knowledge of positive behaviors * Youth ages 5 - 10, 11 - 14 and 15- 18 will and coping skills which promote self-esteem participate in age appropriate groups focused for 46 homeless children ages 5 to 18 residing on communication skills, conflict resolution, at the Homeless Family Center by 75 % during empowerment, and related topics focused on the grant period as measured by the "About self esteem building . Me" pre-test/post-test. *Provide pre and post test 9 Homeless Family Center Assets Build Futures Indian River Advisory Committee H. PROJECTIONS FOR UNDUPLICATED CLIENTS . �. . . . Cu n rre t Fiscal Year > > >' ei <:: < :gar . . . . . . "cation ► .; # .:::;.>: Budget 2004/05 "'` ± t�... . :: .. . . . . . ::. . . . Unduplicated Clients Unduplicated Clients Unduplicated Clients N. Indian River County 6 5 5 S. Indian River County 39 60 60 Indian River Co. Total 45 65 65 Greater Stuart 9 4 4 Hobe Sound Indiantovm Jensen Beach Palm City Martin County Total 9 4 4 Fort Pierce 19 19 19 Port Saint Lucie St. Lucie Co. Total 19 19 19 Other Locations TOTAL SERVED 73 88 88 Current . . . . . . . . . . Fiscal Year ;::. :: . . . . . . . . .: . . .. Location cati n 0 i0 < <> Budget 2004/05 V. Individuals Group ::::::. . . . . . . . . . . . . . . . . . . . 0 to 4 - (Pre-school) 5 to 10 - (Elementary) - 17 - 18 - 18 11 to 14 - (Middle) - 15 - 18 - 186 15 to 18 - (High School) - 9 - 10 - 10 0fj Total Children - 41 - 46 - 46 19 to 59 - (Adults) 4 28 6 36 6 36 60 + (Seniors) Total Adults 4 28 6 36 6 36 TOTAL SERVED 4 69 6 82 6 82 14 Type the Organization and Program Name 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 Specific Budget Forms. AGENCY/PROGRAM NAME : Homeless Family Center FUNDER : Indian River County Advisory Committee CAUT/ON : Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in place. Gray areas should 1 b used for calculations and to write information only,4ppp 'l I z } ^ : Ry M1,. " y,Ih Jki` 4 YA "1' ; 'fit`. iTT" OEM,I! l-oposes�l ,To>�a/ P/ o raM Funder gyp, c�fic 0{ �/ /age Cy Y 3sHg gt r0 Btl2f 9t 3 •� f "t rh. i x , r v � r r Ca1.cULAilON6 1 Children's Services Council-St. Luciery 2 Children 's Services Council•Martintx`�; rr 3 Advisory Committee-Indian River iris , r� ; , 150000.00 15, 000, 00 15, 000. 00 4 United Wa -St. Lucie County _ =rE � r3fi 50, 000. 00 S United Way-Martin County ,.y�;�rwk n 6 United Way-Indian River County tndni rtment of Children & Families 8 Funds epi ry Fav Ah 55, 000. 00 9ibutions-Cash �„ 8, 580.00 400 ,000.00 10am fees * <, ; 11Raisin Events-Net n 20 , 000. 00 12 to Public - Net 11013ershi Dues `p 1.n W ITIM14tment Income d 15llaneous16ies & Be nests17 from Other Sources U,. IMA 18,000.00 18 Reserve Funds Used for Operating � �s ,' 113 ,412. 00 19 In-Kind Donations (Not included In total) �, 20 TOTAL REVENUES *- , (doesn't include line 19) 1. E er ? $23, 580.00 $ 15, 000. 00 $671 ,412 . 00 - r a5 `•`, ' i yfiwf ,a ,y YY rk rt Tfnm, N 2..,r a£>3F . k R �a . :i- "� l a" '� .l IV .55 xx` ° ""c eFi r•+ 2... . .. aE ,, frL��SNA" . .. .�f ..tk��.av ?..:.. ,k ms T 'ay?".4 `s r y .eP ,i:� 1 2 x w 'v sJ '. ,; r v, --T .. . ` fi 5 c 1 '"flr a v "r t 0 -Pa x, ' n .�.,. ,: s ifi �,: ARES w [ x nwr » l?%posed otal pro f+4m " Find r S etc fJ - � �� °'�sty . . t 'v�.:.'., tk4 ! SS c.h ^r E(:� Jii"R i" 3-TW' .�'•J r s '.{'`4 'n' - 1 I 5 Salaries �f udg,+Q� � . -�" ' , ' . >l:+ " 9 Mdge.� i ,; ^P �/ •• k : 21 es (must complete chart on next page 4 000 00 0. 00 431 r707. 00 y"N's .sKX6T SSS y -.�, .StArt 'vnf -F{. tom' y7, )X P' ilf , f ,f db.�. � ��1" � �a�I''Fy+J. . lr 22 FICA - Total salaries x 0. 0765 , . T. . man . cY�":.. l i P4f e remen - Annualpension or qua ie `� ��`�i- � � , 0 . 00 31 , 005 . 00 23 Staffs warm ; 0 . 00 4 , 500. OD i ea a Ica en o - erm 24 Disab. ZZZ Ill. � a Knt r5C j. "` ` 0 .00 48, 500. 00 25 rate Workers ompensa on - emp oyees x ayw �� by akar � � 0. 00 13,500.00 or anemp oymen - prole e r= y f 26 employees x $7,000 x UCT-6 rate r D. DD >, ';jR,1.FV +~M YX.''61Cx ttLt^ 7/^��.Y,� i ' aw c w x vu +, �{,,. a .Y _ y� �• k Y,z xA'E. .c�'^ji. s.,' „ z• rn '4 4 , tF'p' z'�e 'srn.S`^` I wfspy " ./ fy. / ," r' ^� _ �_ e� � l'adlon ofSa/ptyo�►P oposetlfi r` �/�. ; , , /�, _ XAnnutOl PV�V1l., 7 � lRlRt 3i { � Yti 4 � S hf = F .. �� m.'2 "" > �t�nYAl ,pe�.I1i�•i �u a't of x,�+�a- 'M w `@' .�h� A a� L t 'r e1z, cG' '. < r t{( t x L s•,.*..y,-, r h ?< ti aj j i vt --fi- '^assYu .;s .....;� t �3e' - �S . 5 a 7ws. '4ai s u I, is _ __ "OFYY♦ICO'yv � R W!^7 / � 1 ,GWS .ry •n r a a .,yw.v. a .- . , E .n. .• •1 Homeless Family Center Assets Build Futures Indian River Advisory Committee 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 a reement letters. Collaborative Agency Resources provided to the program Through the school liaison for homelessness, they Indian River County School District provide school supplies, assistance with school enrollments or transfers, assist with obtaining free and/or reduced lunch programs, provide transportation and serve as a resource for solving other problems which arise with homeless children in the school . Provides food and snacks for children and families at the Treasure Coast Food Bank Center. Share a management information system (MIS ), Treasure Coast Homeless Services collaborate on grants, projects the annual needs Council assessment process for the homeless 10 Homeless Family Center Assets Build Futures Indian River Advisory Committee F. PROGRAM EVALUATION (Entire Section F not to exceed two pages) F GRAPHICS : What information (data elements) will you need to collect in order rately describe your target population including demographics (age, gender, and background) required by the funder in Section H? What are the pieces of ation that qualify them for your target population ? How do you document their need for services or their "unacceptable condition requiring change" from Section B19 Program experience during prior years has demonstrated that nearly every child residing in the homeless shelter environment displays some of the emotional and/or behavioral issues previously discussed in section B . Parents appear to welcome any support and guidance staff can offer regarding parenting issues . * * * * See #2 (Below) for data collection 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 ? ITEM MEASURES FREQUENCY Child name, age, sex, race Enrollment Forms Upon intake Gender, school, county Parenting Skills Development Pre-Post Test Beginning & End of Groups Problem Behavior(s) Behavior Issues Checklist I " week in residence Behavior Management Observations & Progress Weekly Notes Participation Levels Attendance Logs Each class meetings Self-esteem issues "About Me" Assessment Beginning & End Groups 11 Type the Organization and Program Name Executive Director 50,000 4,000.00 0. 00° Accountant/Budgeting 32 ,000 0 . 000/c Development Coordinator 50, 000 0 . 00 % Residential Mgr. 32,000 0 . 00% Residential Support Staff (1 ) 18,746 0 . 00% Residential Support Staff (2) 18,746 0. 00% Residential Case Mgr. 30,000 0 . 00% Cook 19,448 0 . 00% Administrative Assistant 20,800 0. 00% PT Residential Support (80%) 141144 0. 00% PT Residential Support (60%) 10,680 0. 00% PT Residential Support (20%) 7,072 0 .00% HUD Housing Spec. (FT) 309000 0 . 00% HUD Housing Spec. (PT) 20, 925 0 . 00% Follow Up Case Manager 30,000 0 . 00% PT Residential Support (60%) 10,680 0. 00% PT Residential Support (50%) 10,066 0 . 000 0 Employment Specialist 26,400 0 .000 0 #DIV/0 ! #DIV/0 ! Remaining positions throughout agency en Total Salaries $431 ,707.001 $4 ,000.00 $0.00 0. 00% (��x'�F` Yz BRW n.O. , 1 ']� y.�,» nn 'sx^.R�v"...k ate''�•-G +J.:£L* +?` ; lx, q�, � .. so�� . ..� � V k�Pp.47i �J' h viF., ,... �� rmn} y `f m ��fi:Ai S � .�.� ) '.:: � -J�� 4 l� �_ ; t �Y _-4, �h !+ � hx J�yY.".l I.il rigs 15 ,]f }y � t °' Yf ^ ' ��.a f• h 'y y ,��' s � y°kc . '' ?, ire is ��S .s'xAi t �'f4.C`c . �`YF* ,:. n nW�g. O .. �i 3 >..�Fk 0.^�<^'� �r . f= . `'iS£r .. • .... '. t�+`PP'� -v:: k�^v�.�'S� ,Ji�".va. N. - 5 rJ^ .�t✓��1"4'� £•, Cyt v y "t � 5 - � ��` �`�i�� ✓ '�� . 4• . y �y r c` ` ki.p Bey' 4f.'Fr sd. J �SG ylNj ` AXk sv e iF.:w'.. sd�j �L"r /-�/�/(. KM /W/� s �V.'seGryry+� 4ze" `� .. .5 . . .. . _.._.. 1 .;W. . T'Tf Rau. .i .F:"wEW, , .Mi`: .Y,Crs , .?,:. 1.�.,u ..�. Executive Director 0 .001 0 . 00 0. 0 Accountant/Budgeting 0. 001 0. 00 0. 0 Development Coordinator 0. 001 0.00 0.0 Residential Mgr. 0. 001 0. 00 0. 0 Residential Support Staff ( 1 ) 0. 001 0.00 0 .0 Residential Support Staff 2) . 0. 001 0. 00 0 . 0 Residential Case Mgr. 0 .00 0. 00 0 . 0 Cook 0 .00 0. 00 0. 0 Administrative Assistant 0 . 00 0 . 00 0. 0 PT Residential Support (80%) 0 .00 0 . 00 0 . 0 PT Residential Support (60%) 0. 00 0. 00 0 .0 PT Residential Support (20%) 0 . 00 0. 00 0.0 HUD Housing Spec. (FT) 0. 00 0. 00 0. 0 HUD Housing Spec. (PT) 0. 00 0. 00 0. 0 Follow Up Case Manager 0.00 0. 00 0. 0 PT Residential Support (60%) 0. 00 0 . 00 0 . 0 PT Residential Support (50% ) 0. 00 0. 00 0. 0 Employment Specialist 0 .001 0 .00 0 . 0 0 0 . 001 0 . 001 0 .0 0 0 . 001 0 . 001 0 .0 Total Funder Request Fringe Benefits $0. 001 _ $0.001 $0. 00 $0. 001 $0. 001 $0. 001 s. �•✓�,i* �"� .5e^N , r`sns'� x � � � _ 5 i�`3z :iY ��o-, f�5. s, ' isrh"w ,'i'Y"` a"'' � t :aS '^~< £'. c � RYyr~.`' `.l :.a AJt. yipWM +aR./rJ0. ,>_ -rye 27 Travel-Daily 900 .00 # of Staff x average # of miles/wk x 50 wks x � x � h f G 3 f �y ''z' +t', "��, ' +, w` C.'#' fA�$ �v` ��'ad( s' }„1 3aku � '�1�''t�s•' 7 , v 'f".��" F �� ea{>r'{. F9 "fix xy. i�.�s�xy�t-,,.r� "r3'y1 z $ = Estimated Dail TravellMileage Reimb Y 9 28 TraveUconferencearrrainin 9 . ., .. .. 11500.00 s1l7rzoos a-I 0 0 0o c o o L; Oo Oo o p 0 0 0 O o o o > o , o o o 0 o r�i o 0 0 o o w 4 o o o IIi4 ' o0 6 N (O " ; , b fit . Cliff r e- i F f`') t f✓ 3 r t i:y IIIIIIIIIIIIIIIaW / 47 N civ. ` - p ' � f to °T a1x�n x' > 5 E � e _ v v r_ t ie Y` m ! - � y s � ,. tib y FF t,t rY✓ ( � L } - 1 F i > i5 � pO 4 s 1y '. fi tit ^� � 'ra ; � /r 4 O p ' FIJFI : iIII v p t G s IIIIIIIIIIIIfIIIIInIIIIIIIIIIIIIIIIIIIIIItIO n } xE t O O i a , P' i s 1 1 r ". 4 r y ;4 if y rr1. O ' . «— moi- '•, Via---- � ..w..-. .. .: � i f I21 1 III i I : i S v ^ Y !r �•- 1 f ' ( ! F Cl t 1 ! I L 4 � 1 W. � k lItIIIIFIIIIf (Fj IIIIIIIIIIIitItIIIIIIFL.ILL ILL'It 1 f T � 1 15 It, y , a i ifII W ! f Y• t P Sl J 1 �tC C _ 1 . { ' �' YV tIitIIIItII ' I O O O O x S b Y., '^ > C Y, ^'.. :,'tea,. , FI It-t 'r iCtt > , s r y� { f Tw fFlq 14 I p Y '� IT x e z s ter, 9 .x. t + ' H i r 4f L s O � O " ; -� s' s v, i � .. O r p � =3a �IIIIII 'LL O - O t �� p � i" F � u < ', k' ,� y O r � H , a .� � Y ✓v., p s e ,,Y �,[ ✓: r�:. c a w .r z: r N I � L N 14 y ✓ p . rye Y ..Y' � r eIII � rs v ,u i�` Y.; 4 � �tM1!'-�i O GAr .n d1 t IISjt F F _ 1.., p s, sl> k w >Y n r t , ,::y Y 4µt � k• J, .�y:M 1 p x. , �: 4 s <y � tr a � > x ` F CO 4 a � s Ea t^,a= O IIi > ;:' Y r r ! t a r r N r 19 v t J : xIII ..... v _: � : s r < art� d t ' P 0 9 Op gca i Y 1 rr L - t : ! F 4 �F Y:' � tvx E t o 1 �l .t q e i � t a :F 44 ,� . e:I.' � v#r t _ i #II 1 5 C, i +' i� '7 ic'Ik" �, s . r 1 _ _ v fIItyIIIti is � k , � p � ::2fY � ��' yde t3..> t " tix, � �.Y; E ! .l sr tnq > � 4 [Ss 4 -ti?' 7k 3 ! M'.� � �! g�. _: . a u �,4d F � � � v � � � uc s , .� r::L � ' � x? ° v'#' ,� � ` 3 e z v s t i y: 1 5. , ,u ' '�II1 IIIr i ' t sS 41,' �YS IIIItIIIIII �✓ d , f i;': e t} I'll ry t c e ` ✓ ( ' ,y 4� 11 vry F � �tx �s v °aStf a t 6 e '" + ? ' rF .j. s �. nY^. F11 a f 1 . ,.> y [ `{ y f•r t 1 'q6` is yt i # ! t � `s'Tr As t � ytr vTLtyev r' F7: W t i i e T _ Y F 5 4J t z F; ♦ } - " �� > ':? ..{:. i �k:.. ! : i4 ay � s f {j � y :x QrF s� itde F r T 3:. ..a�: �;..:>, :�. 'sY ,. > � x�',.. 3i", ,wt ^' t t� , x,: � .. p ,( .: ` i # y v ' ]'':" � ai ( a {LJ,y, i., _.. ,�_. .:. .. ..:..r . , , '. :�; :F= r , , rs . ., i rt ! -...n, + r e i,. Pn*e' J 'fvi -.:, y t ... 5 . :. i ;, k �,� q r .. nl .n: F '.. 4 t 4.: . . : . n? x • a+ < 4 !"�. > tY�:^.A i ..g 4�+ i I, F! Y r '. ". , , ': ;.. . � .,,. . .�, � e .+ t .,:: :....: Y '_�, � . `'ct ✓tvA F,I, 1Q �-i x::., 4k w w, ff a T i�;t" x:�. } t 4 r- ; £ r ,i's`G',+a C.e a - 5 a. <F� l (r%r Y4 X"1J T ::li7 � Jr is , i n a. L sI 'zf t t Y 4t ;4 lr:'. yi' � , Q k : ( n it}i •� +ti"F . 1 ., 4s .3 � sr v ,` Y ,v' S*: , r .ri �` - t -, i? •ci;: J* 1 SA? W, . 't i• 5, : ' �" ri � e 0 - } / x � v -. ✓ A , � : , I ., a a . �9 y i �;� � aR� v `+Lt i� +�anj }✓N � � > 5 Y r� 4 1u 1 ,t aEFv } ti , t ryr , t °� r:: � i „✓ �s.e +. a: � . �� / ,/ .. xk ' #� ttifw� II "I Ia -tF 1 5. '., r x '. ✓ W i.,t�L i „r2✓. ryn.$F N. (1`i xi rRr fRY ' 3 "GL 5'._'a ` w w � r � u:3 .xit '`i8!'.vY I '�, �C1F r r y Y ? r >�3. � r -,1; �{ i f s .>; , v h n } a< we,v 'vt , 5.u • a''t`. <: , ._. .; ! :. � �y� � ,_ .,.y' a a , f -_'.fes _^t rtlXe. .3-:,..,1.+�..y�l•1.5,:. :1i. .: o l % '.a i st aw rvt3 � � e . '` T .is > 8� # ��.. yia -..: ( >..�.. &.. y+ } ,.:•..a .., _: . ,...:: > . � . , a s�. '.4 a.. ,... . . : ., ., ....:c .. . ,. . ...I.- ti ',� � .,. a:.. . .. .... .. . . .. _ . ;:. , . ..,, ht ✓` . ,4t . <. . . .. -> .,Sa A . . : , � s r , . u:- . . ._. . .Yi. ' 0 1. .. F_. F. Fild .. . . . _ . . .. ,...: , . .. _.. .�. � . , � , : , . _ ” . . ..,". ... N n. "2' . ,f [ F ... k'3•. n f� t..' . , . r1 '. e .. . . . . �fA.' eJ. a '' / 5 . . .. . . so . , . . c . ,:: :.,... �._ - .. ;. . r rx s £a� ..... .. . ,. .. . _. .. 4 . . 'f . . i . ,{ - r {. a t . . .. 5X •�4 . .i'i✓ t ! -. : . . ..,. . , ...: . . . . . . .. .. . .. . ., - ... . , ,. .v ..,,. ... ,i. ., saw ,. .. t � � . ,a :. �. _ , . .y Fr• :. . ':: .� . . : . wx�..a . t. 2. . .. .. . . .. . .. . . . ... . .... ..: ... , . . : ... . .., A . K .rn, s R . . k3 Sv-... . C u S S . . ., 5 ! o . t . .... J ... . ..!'. _.. . .:, .., .. ...: ...: ;. a.'- .... -s... . � .,. , ,,. . . . . . ..4., :. ... r } " , � . u !_ . ". a. • • v . •. 3.. .. '. . l , A vv } 'i.i ,+� sy ".. n. « o:'. _ . ♦ , . , . .., . . . ., 1� . 'y. • [ ILL.. ..... .. ... . . .. . . .. ., a . . . ,., 5 _.. . . �., .. .. ._. 1 . .,. . :d: . . .�✓ A n' ,F� .v;7� .7 r•Y ,"� L .. . . .. .. .. . .. ... ... . ,. .).a i. vn "... af. a,. . f, a � t .a . . . a t J .F „ R '. .a.: ! . ..: ! : . '(. .:: %..[�. . • �". 1'l1 . . . _. ;. . . , , . .. �:. . ,. -,: . . .. ? <. _ . , .: � 4. '.. a. a ..v :. : ,. 1 am,.: - R•'+ . .. . tt '. Y k„ jxY` a E}F.,. m f .... . . .: .... .1. . . . 3Y r..- N .. ..v. 1. i.: • ) . . ' � ). . :,., .. . .; .. . ._ .. .. , ..e . Ar., i . � �. 'Y4 . _Y . Al . .. �t . • . rrrv. 1-% .s. 4 . :. , l . .• . r. . I Y2��. 1 . :..n .. y . :'t r , o. °' „ -, `� e b .. �., ✓ : .: ^f . 4 y:.. -04 . . .x .. ..,. . ,, _ . .rT. ,. ., r . . .a .3. ., ... 1. •37 t .. . . ... .: .. ..- � . .4 . . >Y . ,, [P. s,r . fx. _(. . .. . . F ._. . .. ... . _ , ,.. ,, e ...: ,. . . r '. :d ' fi . . ,._ . ,. . �k .. e::. n � t at r .... . , 1 k ^n `YG ?s,.�?;:• � < ,y 2k y F :. .L.. . ., ..: .. . .. : .. . _ . .S t .,. ..... ' s ., -v. - as 4 sAy, $$ H ak1., F. .• Y -.x�. yr 5 L . a + , :_ a . { �. .. . _ ... _, ... . . .,;. _.. ti< -. -... . � ,... r ... . ✓. , ,. . _._ _ .. . .. . _ , r n . .. . . , . ...,.. ,. .t _ . . e. . . . 1. Y ... ,., ... _,.. .>£ .. . . . .v< . .�.. . �. , v.,<� : -s; .,.... . �:rr �• . ,§- w a z � at„�':. , .. , ..v:...,e. . . .:_ . . '< ... `Z ., eyx ..n.. : . .. < iv '� k . ✓ki -.�. . . d . : &.... s . .,. . ,...., r '.r n .: y , 1 . . _. . y} � ,:- >, . _ / h t. � �� + f . . , Yl . > Er' sti _ . �?. Rrs �. . 1, is } : �.� ✓ uw"� p „( .. :v::r., ] A , � +�a asir I ' � xs4Y � _ r - .mss,_ �' �, E�� `ti r >•+z� , rn x r: m to � N N �-. O' O O C H � 'C x y E E C •N ^ +•� C w O m � � O IO a Oil .- a ^ ^ O. N � v cE k ^ a � > > 0 x °ra m ^ t w = c E c o9 ccN W = E» �o o —'' y Z+ waO CLni `� 3 ” y E w E x m O a `�° to y � � � a �j r a U W $ .O-. O U O) Z U) C E w N w Vol C � N E a H •� C x ... CO m ^ r U m � 8 OVL > 0 otic Ego e `- ox c `moy m o 3 me E0 0> o qx �' mm � � :: .. m (p aw c w0) m NxE �° � E � m R ymc � c�'a Z -a `�° '� � N � m o � � J � w 'C O U) m C x U O C .- fA N .... N V W > .m. m Z L" C �-- C C �O' o f O E c co dmEm mo a = - ' 3 .. .- } cm a .'9x m rn :_ o f 'e � m c or a m c y x x m c x .c a 3 W O o _ m a ds x c c a 0 m 0 = o rA C � Ucn • a ah � c u o o m rn vs m r. m � 3 m E � y � U c� d �-- � m • v v . � c m m '� o w m c a m a m _ o r > c 3 �, a9 m a Z w r a c c a m .. m m m r o w m ;, o iD p) O 3 O c N f/1 >. m — m V `� "'� C C L O g; m .0 Of �Cmp m vm 0 x C F- "a N b 11 CO C w ` N ,�+` (n m C y —`�''• l0 •y :.:. V tyC tl) f0 m C U d .. m .. V O643, 91 o ' ym t ocm � w 1° E w � � w �smcam worm c �' ° L' `- yy corm m � a •- mc � cc � c om .. m t3 N U L C t O N m0. W L c0 m 'C m e m m .. N m 'C 'O 7 l6 @ ar3 .H V C m m d m E m m Y m U .m. 'e 3 r O C c0 m y ` V EO U c w E C E ` 7 W O• m .>.. 3 �. W '� W > y Z ZF- O awiC Eal-® �tNQW dUo' tom' = w m m v ° `° E m c ' � tiO � ' d a l LD 4) toE c S °• 'am •aE °) m � 0 06 a) a m y � Y Y � eli N M N � U M � � (7 � a 0 rn QU m c OU () 0WU � 000 Qzii0 ctj � QUO om°O � o° � ) � ) e� C4 m W d m W in M M M M N Homeless Family Center Assets Build Futures Indian River Advisory Committee 3. REPORTG: What will you do with this i INnformation 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 ? Results of the program are shared with the funder through the monitoring and reporting process . A final report will be shared with the staff and Board of Directors which shows the results and outcomes learned from grant implementation . On-going information is shared with parents as part of their involvement in the process . The experiences and results of the program are used to continue to develop and/or improve services to homeless children and their families during their stay in residence. Learned healthy interaction by parents and their children improve the overall health, strength and functioning of the family as a support system. 12 Homeless Family Center Assets Build Futures Indian River Advisory Committee G. TBIETABLE (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 October-December Series # 1 — Parenting Skills & Child Development Classes Parent/Child Assessment completed with needs identified Pre-Test Administered for Parenting Classes "About Me" Assessments with Children Post-Tests Series #2 — Parenting Skills & Child Development Classes January — March Parent/Child Assessment completed with needs identified Pre-Test Administered for Parenting Classes "About Me" Assessments with Children Post-Tests Series # 3— Parenting Skills & Child Development Classes Parent/Child Assessment completed with needs identified April — June Pre-Test Administered for Parenting Classes "About Me" Assessments with Children Post-Tests Series #4— Parenting Skills & Child Development Classes Parent/Child Assessment completed with needs identified Pre-Test Administered for Parenting Classes July — September "About Me" Assessments with Children Post-Tests 13 CAO V OAI � {► W Cl) m S m m m 'Q a Q a � �' � m �' � m � maom :.• 33dm 8 = C �O : 7 K c 0 23 CL ac OL O E, 0 d y m D rn DCD A c r- o o a o, 00 x U3 0 6 jr m to c < fir (D m 3 Q `D x Z N < G tto fmB Z a W m �^ x 0 f t to gpY '�y ,;NYF� rt"r K}v .-,e* 3r }4 ii x�y'nt yr 4 .,tr 7777-1Yr } ty' az~ rr� .kl'*5: y , � gra s ITf §Y . 1ds� nP Bf'fi¢5 rf � r' i w5xytfr�p5;� 'v y> �� yrsi� a d`> Y ; 1s r } ) aA kYtyp # osx�''y'' F:: ' l3li jk1 ASA G ) NYI y f I't9 £}' : Ft} �r 2Eh". rrr3 { 4r`: "b 4 7N d iias%y �r�; Ald Ifr r N rt a . i V ITJ Wr S✓, ai t. i.t. h _ i 1 i s A Y x r ti ;�R V� }Pi r 4LLf( zy± ! > rc a:. IT fA n i ; tP O 1 / v t EKi } LL rLL r F t11 �i t iU ; 1 1I S J!v { � 111 � i fA r Q ! Srl 6 � 1 • { 1 J I 1 P fi 1 ,i i TT- rl2 ; :LZI a., O TYR Ow awftow ww Pmpw N.me UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCY/PROGRAM NAME: Homeless mily Center - Assets Build Futures FY 10/03 FY 10/04 FY 10/05 % INCREASE FYE 9/30/04 FYE 9/30/05 FYE 9/30/06 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (col. Ceol. sycoa. a REVENUES BUDGETED BUDGETED 1 Children's Services Council-St. Lucie I0.00 #DIV/01 2 Children's Services Council-Martin 0.00 #DIV/01 3 AdvisoryCommittee4ndian River 13 703.58 15 000.00 15 000.00 0.00% 4 United We St Lucie County50 000.00 #DIV/Ol 5 United Wa •Martin County0.00 #DIV/0! 6 United Way-Indian River County0.00 #DIV/01 7 De artment of Children & Families 61 #103.04 0.00 0. 00 #DIV/O! 8 Coun Funds 61 105.25 55 336.00 55 000. 00 0.61 9 Contributions-Cash 665 419.57 402 700.00 400 000. 00 0.67% 10 Pro ram Fees 662.25 0. 00 #DIV/01 11 Fund Raisin Events-Net 7 846.72 25 000.00 20 000. 00 20.00% 12 Sales to Public-Net 0.00 #DIV/01 13 Membershi Dues 0. 00 #DIV/01 14 Investment Income 0. 00 #DIV/01 15 Miscellaneous 899.11 0. 00 #DIV/0I 1s Le acies & Bequests 21 925.00 0. 00 #DIVl01 17 Funds from Other Sources 23 039.87 18 632.00 18 000. 00 -6.31 11 Reserve Funds Used for Operating 112 168.00 113y412.00 1 . 11 % 19 In-Kind Donations (Not included Intotal) 0.00 #DIVl01 20 TOTAL 855.804.39 6291836,00 67141200 M f n %^,'#.. 7, ..n• :: c rx'fiRu. .;gf.i, -Lf"�'.L ee'NK: .a S:cl l.. '�T� ..:-ran S V�, 60°IO peg", ".77,77 7-17777777, 7771777 77 7L' j7 7 , 7777,77� EXPENDITURES 21 Salaries 254 674.07 319 847.00 431p707. 00 34. 97% 22 FICA 20 701 .38 2446800 31005.00 26,72°/, z3 Retirement 1500,00 3 500.00 450000 28.57% 24 Life/Health 28A71 .80 38 431 .00 48 500. 00 26.20% 25 Workers Com enation 21 475.00 10 800.00 13,600.0025. 00% 26 Florida Unem to ment 20.67 0. 00 #DIVl01 27 Travel-0ail 2 286.22 31000,0 900.00 -70.00% 28 Travel/Conferences/Training1 ,50000 #DIV/Ol 29 Office Su lies 2,688,44 21800,00 3 000.00 7. 14% 30 Tele hone 12192.80 10000.00 1000000a#DIVIOf 31 Posta e/Shi in 1458.16 3,800,00 31800.00 32 Utilities 22 875.39 26 000.00 24 000.00 33 Occu an Buildin 0 Grounds 12147.69 12 000.00 12 000.00 34 Printin & Publications 6 000.00 35 Subscri on/Dues/Memberships 624.69 11 ,000.01) 1 000. 00 0.00% 36 insurance 8102.83 17 632.00 18 000.00 2.09% 37 E ui ment:Rental & Maintenance 450.00 3 500.00 3 500.00 0.00% 36 Advertisin 6763.911 4,500,001 41000. 00 39 E ui ment Purchases: Capitol Ex nse 307 692.04 0.00 0.00 #DIV/0 ! 40 Professional Fees (Legal, Consulting) 13 091 .16 105 820.00 12 600. 00 88. 09% 41 Books/Educational Materials 8438.00 1 000.00 88. 15% 42 Food & Nutrition 6 361 .76 8600,00 109500.00 23. 53% 43 Administrative Costs 0. 00 #DIVlOI 4a Audit Ex nse 7 250.00 10 800.00 109800.00 0. 000% 46 S cific Assistance to Individuals 68 522.60 0.00 0. 00 #DIV/01 46 Other/Miscellaneous 15 000.00 7.500.00 -50.00% 47 Other/Contract 12 100.00 #DIV/01 48 TOTAL 802350.61 629 836.003 671 412 00 6.60% _r. -. ..... #.. .� mF ..ls,:e :. kr)PYa,4xn ': i 7749 REVENUES OVER/ UNDER 3g EXPENDITURES 53 453.78 0.00 0.00 #D!V/01 smrmos w Homeless Family Center Assets Build Futures Indian River Advisory Committee H. PROJECTIONS FOR UNDUPLICATED CLIENTS . �. . . . Cu n rre t Fiscal Year > > >' ei <:: < :gar . . . . . . "cation ► .; # .:::;.>: Budget 2004/05 "'` ± t�... . :: .. . . . . . ::. . . . Unduplicated Clients Unduplicated Clients Unduplicated Clients N. Indian River County 6 5 5 S. Indian River County 39 60 60 Indian River Co. Total 45 65 65 Greater Stuart 9 4 4 Hobe Sound Indiantovm Jensen Beach Palm City Martin County Total 9 4 4 Fort Pierce 19 19 19 Port Saint Lucie St. Lucie Co. Total 19 19 19 Other Locations TOTAL SERVED 73 88 88 Current . . . . . . . . . . Fiscal Year ;::. :: . . . . . . . . .: . . .. Location cati n 0 i0 < <> Budget 2004/05 V. Individuals Group ::::::. . . . . . . . . . . . . . . . . . . . 0 to 4 - (Pre-school) 5 to 10 - (Elementary) - 17 - 18 - 18 11 to 14 - (Middle) - 15 - 18 - 186 15 to 18 - (High School) - 9 - 10 - 10 0fj Total Children - 41 - 46 - 46 19 to 59 - (Adults) 4 28 6 36 6 36 60 + (Seniors) Total Adults 4 28 6 36 6 36 TOTAL SERVED 4 69 6 82 6 82 14 Type the Organization and Program Name 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 Specific Budget Forms. AGENCY/PROGRAM NAME : Homeless Family Center FUNDER : Indian River County Advisory Committee CAUT/ON : Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in place. Gray areas should 1 b used for calculations and to write information only,4ppp 'l I z } ^ : Ry M1,. " y,Ih Jki` 4 YA "1' ; 'fit`. iTT" OEM,I! l-oposes�l ,To>�a/ P/ o raM Funder gyp, c�fic 0{ �/ /age Cy Y 3sHg gt r0 Btl2f 9t 3 •� f "t rh. i x , r v � r r Ca1.cULAilON6 1 Children's Services Council-St. Luciery 2 Children 's Services Council•Martintx`�; rr 3 Advisory Committee-Indian River iris , r� ; , 150000.00 15, 000, 00 15, 000. 00 4 United Wa -St. Lucie County _ =rE � r3fi 50, 000. 00 S United Way-Martin County ,.y�;�rwk n 6 United Way-Indian River County tndni rtment of Children & Families 8 Funds epi ry Fav Ah 55, 000. 00 9ibutions-Cash �„ 8, 580.00 400 ,000.00 10am fees * <, ; 11Raisin Events-Net n 20 , 000. 00 12 to Public - Net 11013ershi Dues `p 1.n W ITIM14tment Income d 15llaneous16ies & Be nests17 from Other Sources U,. IMA 18,000.00 18 Reserve Funds Used for Operating � �s ,' 113 ,412. 00 19 In-Kind Donations (Not included In total) �, 20 TOTAL REVENUES *- , (doesn't include line 19) 1. E er ? $23, 580.00 $ 15, 000. 00 $671 ,412 . 00 - r a5 `•`, ' i yfiwf ,a ,y YY rk rt Tfnm, N 2..,r a£>3F . k R �a . :i- "� l a" '� .l IV .55 xx` ° ""c eFi r•+ 2... . .. aE ,, frL��SNA" . .. .�f ..tk��.av ?..:.. ,k ms T 'ay?".4 `s r y .eP ,i:� 1 2 x w 'v sJ '. ,; r v, --T .. . ` fi 5 c 1 '"flr a v "r t 0 -Pa x, ' n .�.,. ,: s ifi �,: ARES w [ x nwr » l?%posed otal pro f+4m " Find r S etc fJ - � �� °'�sty . . t 'v�.:.'., tk4 ! SS c.h ^r E(:� Jii"R i" 3-TW' .�'•J r s '.{'`4 'n' - 1 I 5 Salaries �f udg,+Q� � . -�" ' , ' . >l:+ " 9 Mdge.� i ,; ^P �/ •• k : 21 es (must complete chart on next page 4 000 00 0. 00 431 r707. 00 y"N's .sKX6T SSS y -.�, .StArt 'vnf -F{. tom' y7, )X P' ilf , f ,f db.�. � ��1" � �a�I''Fy+J. . lr 22 FICA - Total salaries x 0. 0765 , . T. . man . cY�":.. l i P4f e remen - Annualpension or qua ie `� ��`�i- � � , 0 . 00 31 , 005 . 00 23 Staffs warm ; 0 . 00 4 , 500. OD i ea a Ica en o - erm 24 Disab. ZZZ Ill. � a Knt r5C j. "` ` 0 .00 48, 500. 00 25 rate Workers ompensa on - emp oyees x ayw �� by akar � � 0. 00 13,500.00 or anemp oymen - prole e r= y f 26 employees x $7,000 x UCT-6 rate r D. DD >, ';jR,1.FV +~M YX.''61Cx ttLt^ 7/^��.Y,� i ' aw c w x vu +, �{,,. a .Y _ y� �• k Y,z xA'E. .c�'^ji. s.,' „ z• rn '4 4 , tF'p' z'�e 'srn.S`^` I wfspy " ./ fy. / ," r' ^� _ �_ e� � l'adlon ofSa/ptyo�►P oposetlfi r` �/�. ; , , /�, _ XAnnutOl PV�V1l., 7 � lRlRt 3i { � Yti 4 � S hf = F .. �� m.'2 "" > �t�nYAl ,pe�.I1i�•i �u a't of x,�+�a- 'M w `@' .�h� A a� L t 'r e1z, cG' '. < r t{( t x L s•,.*..y,-, r h ?< ti aj j i vt --fi- '^assYu .;s .....;� t �3e' - �S . 5 a 7ws. '4ai s u I, is _ __ "OFYY♦ICO'yv � R W!^7 / � 1 ,GWS .ry •n r a a .,yw.v. a .- . , E .n. .• •1 MENOMONEE Two " ws proww No" UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: Homeless F Ily Center/Assets Build Futures FY 10103 FY 10/04 FY 10/0 % W CREASE FYE 9/30/04 FYE 8/30105 FYE 9/30106 CURRENT VS. NEXT FY BUDGET A C D ACTUAL TOTAL PROPOSED (COL C•eaL 13peo1. 8 REVENUES BUDGETED BUDGETED 1 Children's Services CounelkSt, Lucie 0. 00 #DIV/01 2 Children's Services Council-Martin 0.00 #DIV/01 3 Adviso Committeo4ndian River 13 703.58 1500000 15 000. 000.00% 4 United Wa -St. Lucie County0.00 #DIV/o! 5 United Way-Martin County0.00 #DIV/01 6 United Way-Indian River County0.00 #DIV/O! 7 De artment of Children & Families 0. 00 #DIV/O! a County Funds 0.00 #DIV/01 9 Contrlbutions-Cash 81654,66 81580.00 0.86% 10 Pro ram Fees 0.00 #DIV/01 11 Fund Raisin Events-Net 0.00 #DIV/01 12 Sales to Public-Net 0.00 #DIV/O! 13 Membersh! Dues 0.00 #DIV/01 14 Investment Income 0.00 #DIV/01 16 Miscel neous 0.00 #DIV/01 16 Le aces & Beauests 0.00 #DIV/Ol 17 Funds from Other Sources 0.00 #DIV/01 18 Reserve Funds Used for Operating 0.00 #DIV/Ol 19 In-Kind Donations (Not Inckuded In total) 0.00 #DIV/D! 20 TOTAL 13 703.58 2S 664.56 23t580.00 -0. 32% PENDITURES 21 Salaries 4 000.00 4 000.00 4 000.00 0.00% 22 FICA 0.00 #DIV/01 23 Retirement 0.00 #DIV/01 24 LlfeMealth 0.00 #DIV/01 25 Workers Compenation 0.00 #DIV/D! 26 Florida Unemployment 0.00 #DIV/OI 27 Travel-Daily0.00 #DIV/01 28 TraveUConferences/Trainin 0.00 #DIV/0! 29 Office Supplies 216.08 224.00240.00 7. 14% 30 Tele no 969.62 800.00 800.00 0. 00% 31 hippin0.00 #DIV/01 s2 t!Ilties 1830.03 2 080.00 1 920.00 -7.69% 33 Occu an (Building & Grounds 971 .82 960,001960. 00 0.00% 34 Printin & Publications 0. 00 #DIV/01 36 Subscr! tlordDues/Membersh! 0.00 #DIV/01 381nauranc0 728.23 1410.56 1440.00 . 09% .09 37 E ui ment:R9ntal & Maintenance 36.00 280.00 280.00 2 2 % 3ng 0.00 #DIV/01 39 E ul ment Purchasee :Ca !tal Expense 0. 00 #DIV/01 40 Prof tonal Fees (Legal, Consulting) 0.00 #DIV/01 41 Books/Educat!onai Materials 0.00 1 OD0.00 1 000.00 0.00% 42 Food & Nutrition 508.88 800.00 840.00 5.00% 43 Administrative Costs 0.00 #DIV/01 44 Audit Expense 0. 00 #DIV/Ol 46 S if!c Assistance to individuals 0. 00 #DIV/01 46 Other/Miscellaneous 0.00 #DIV/01 47 Other/Contract 4 443.93 12. 1 00.00 12 100. 00 0.00% 48 TOTAL 13 703.66 23 654.56 23 580.00 -0.32% 49 REVENUES OVER/ UNDER EXPENDITURES 0.00 0.001 0.00 #DIV/01 °nrrmos w Type the OrgerdzaWn and Program Name UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME : Homeless Family Center /Assets Build Futures FUNDER : Indian River County Advisory A B C FY 05106 FY 05/06 % OF TOTAL FUNDER TOTAL VS. PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET col. B/col. A EXPENDITURES 21 Salaries 4, 000 . 00 0 . 00 0 . 00 % 22 FICA 0 .00 0 . 00 #DIV/01 23 Retirement 0 .00 0 . 00 #DIV/01 24 Life/Health 0 . 00 0 . 00 #DIV/01 25 Workers Compensation 0 . 00 0 . 00 #DIV/01 26 Florida Unemployment 0 . 00 0 . 00 #DIV/0 ! 27 Travel-Dail 0 . 00 0. 00 #DIV/0 ! 28 wwftNwEwwNMwMw�Travel/Conferences/Training0 . 00 0 . 00 ' #DIV/O ! 29 Office Supplies 240. 00 0 . 00 0 . 00% 3o Telephone 800 .00 0 . 00 0 .00 °/a 31 Posta a/Shi in 0 . 00 0200 #DIV/0 ! 32 Utilities 1 , 920. 00 1 , 000 . 00 52 , 08% 33 Occupancy (Building & Grounds 960. 00 500 . 00 52 . 08 % 34 Printing & Publications 0. 00 0 . 00 #DIV/01 35 Subscription/Dues/Memberships 0 . 00 0 . 00 #DIV/0 ! 361nsurance 1 , 440 . 00 400 . 00 27, 78 % 37 Equipment: Rental & Maintenance 280 . 00 0 . 00 0 . 00°/a 38 Advertisin 0 . 00 0 . 00 #DIV/01 39 Equipment Purchases : Capital Expense 0 . 00 0 . 00 #DIV/0 ! 40 Professional Fees (Legal , consulting ) 0 . 00 0 . 00 #DIV/O1 41 Books/Educational Materials 17000. 00 11000 . 00 100. 00 °/a 42 Food & Nutrition 840 . 00 0 . 00 0 . 00 % 43 Administrative Costs 0 . 00 0. 00 #DIV/0 ! 44 Audit Expense_ 0600 0 . 00 #DIV/O ! 45 Specific Assistance to Individuals 0 .00 0 . 00 #DIV/01 46 Other/Miscellaneous 0 .00 0 . 00 #DIV/O ! 47 Other/Contract 12 , 100 . 00 12, 100. 00 100. 00°/a 48 TOTAL $23 , 580 . 00 $ 15, 000 .00 63 . 61 % 5rnrnoo5 Type the Organization and Program Name Executive Director 50,000 4,000.00 0. 00° Accountant/Budgeting 32 ,000 0 . 000/c Development Coordinator 50, 000 0 . 00 % Residential Mgr. 32,000 0 . 00% Residential Support Staff (1 ) 18,746 0 . 00% Residential Support Staff (2) 18,746 0. 00% Residential Case Mgr. 30,000 0 . 00% Cook 19,448 0 . 00% Administrative Assistant 20,800 0. 00% PT Residential Support (80%) 141144 0. 00% PT Residential Support (60%) 10,680 0. 00% PT Residential Support (20%) 7,072 0 .00% HUD Housing Spec. (FT) 309000 0 . 00% HUD Housing Spec. (PT) 20, 925 0 . 00% Follow Up Case Manager 30,000 0 . 00% PT Residential Support (60%) 10,680 0. 00% PT Residential Support (50%) 10,066 0 . 000 0 Employment Specialist 26,400 0 .000 0 #DIV/0 ! #DIV/0 ! Remaining positions throughout agency en Total Salaries $431 ,707.001 $4 ,000.00 $0.00 0. 00% (��x'�F` Yz BRW n.O. , 1 ']� y.�,» nn 'sx^.R�v"...k ate''�•-G +J.:£L* +?` ; lx, q�, � .. so�� . ..� � V k�Pp.47i �J' h viF., ,... �� rmn} y `f m ��fi:Ai S � .�.� ) '.:: � -J�� 4 l� �_ ; t �Y _-4, �h !+ � hx J�yY.".l I.il rigs 15 ,]f }y � t °' Yf ^ ' ��.a f• h 'y y ,��' s � y°kc . '' ?, ire is ��S .s'xAi t �'f4.C`c . �`YF* ,:. n nW�g. O .. �i 3 >..�Fk 0.^�<^'� �r . f= . `'iS£r .. • .... '. t�+`PP'� -v:: k�^v�.�'S� ,Ji�".va. N. - 5 rJ^ .�t✓��1"4'� £•, Cyt v y "t � 5 - � ��` �`�i�� ✓ '�� . 4• . y �y r c` ` ki.p Bey' 4f.'Fr sd. J �SG ylNj ` AXk sv e iF.:w'.. sd�j �L"r /-�/�/(. KM /W/� s �V.'seGryry+� 4ze" `� .. .5 . . .. . _.._.. 1 .;W. . T'Tf Rau. .i .F:"wEW, , .Mi`: .Y,Crs , .?,:. 1.�.,u ..�. Executive Director 0 .001 0 . 00 0. 0 Accountant/Budgeting 0. 001 0. 00 0. 0 Development Coordinator 0. 001 0.00 0.0 Residential Mgr. 0. 001 0. 00 0. 0 Residential Support Staff ( 1 ) 0. 001 0.00 0 .0 Residential Support Staff 2) . 0. 001 0. 00 0 . 0 Residential Case Mgr. 0 .00 0. 00 0 . 0 Cook 0 .00 0. 00 0. 0 Administrative Assistant 0 . 00 0 . 00 0. 0 PT Residential Support (80%) 0 .00 0 . 00 0 . 0 PT Residential Support (60%) 0. 00 0. 00 0 .0 PT Residential Support (20%) 0 . 00 0. 00 0.0 HUD Housing Spec. (FT) 0. 00 0. 00 0. 0 HUD Housing Spec. (PT) 0. 00 0. 00 0. 0 Follow Up Case Manager 0.00 0. 00 0. 0 PT Residential Support (60%) 0. 00 0 . 00 0 . 0 PT Residential Support (50% ) 0. 00 0. 00 0. 0 Employment Specialist 0 .001 0 .00 0 . 0 0 0 . 001 0 . 001 0 .0 0 0 . 001 0 . 001 0 .0 Total Funder Request Fringe Benefits $0. 001 _ $0.001 $0. 00 $0. 001 $0. 001 $0. 001 s. �•✓�,i* �"� .5e^N , r`sns'� x � � � _ 5 i�`3z :iY ��o-, f�5. s, ' isrh"w ,'i'Y"` a"'' � t :aS '^~< £'. c � RYyr~.`' `.l :.a AJt. yipWM +aR./rJ0. ,>_ -rye 27 Travel-Daily 900 .00 # of Staff x average # of miles/wk x 50 wks x � x � h f G 3 f �y ''z' +t', "��, ' +, w` C.'#' fA�$ �v` ��'ad( s' }„1 3aku � '�1�''t�s•' 7 , v 'f".��" F �� ea{>r'{. F9 "fix xy. i�.�s�xy�t-,,.r� "r3'y1 z $ = Estimated Dail TravellMileage Reimb Y 9 28 TraveUconferencearrrainin 9 . ., .. .. 11500.00 s1l7rzoos a-I 0 0 0o c o o L; Oo Oo o p 0 0 0 O o o o > o , o o o 0 o r�i o 0 0 o o w 4 o o o IIi4 ' o0 6 N (O " ; , b fit . Cliff r e- i F f`') t f✓ 3 r t i:y IIIIIIIIIIIIIIIaW / 47 N civ. ` - p ' � f to °T a1x�n x' > 5 E � e _ v v r_ t ie Y` m ! - � y s � ,. tib y FF t,t rY✓ ( � L } - 1 F i > i5 � pO 4 s 1y '. fi tit ^� � 'ra ; � /r 4 O p ' FIJFI : iIII v p t G s IIIIIIIIIIIIfIIIIInIIIIIIIIIIIIIIIIIIIIIItIO n } xE t O O i a , P' i s 1 1 r ". 4 r y ;4 if y rr1. O ' . «— moi- '•, Via---- � ..w..-. .. .: � i f I21 1 III i I : i S v ^ Y !r �•- 1 f ' ( ! F Cl t 1 ! I L 4 � 1 W. � k lItIIIIFIIIIf (Fj IIIIIIIIIIIitItIIIIIIFL.ILL ILL'It 1 f T � 1 15 It, y , a i ifII W ! f Y• t P Sl J 1 �tC C _ 1 . { ' �' YV tIitIIIItII ' I O O O O x S b Y., '^ > C Y, ^'.. :,'tea,. , FI It-t 'r iCtt > , s r y� { f Tw fFlq 14 I p Y '� IT x e z s ter, 9 .x. t + ' H i r 4f L s O � O " ; -� s' s v, i � .. O r p � =3a �IIIIII 'LL O - O t �� p � i" F � u < ', k' ,� y O r � H , a .� � Y ✓v., p s e ,,Y �,[ ✓: r�:. c a w .r z: r N I � L N 14 y ✓ p . rye Y ..Y' � r eIII � rs v ,u i�` Y.; 4 � �tM1!'-�i O GAr .n d1 t IISjt F F _ 1.., p s, sl> k w >Y n r t , ,::y Y 4µt � k• J, .�y:M 1 p x. , �: 4 s <y � tr a � > x ` F CO 4 a � s Ea t^,a= O IIi > ;:' Y r r ! t a r r N r 19 v t J : xIII ..... v _: � : s r < art� d t ' P 0 9 Op gca i Y 1 rr L - t : ! F 4 �F Y:' � tvx E t o 1 �l .t q e i � t a :F 44 ,� . e:I.' � v#r t _ i #II 1 5 C, i +' i� '7 ic'Ik" �, s . r 1 _ _ v fIItyIIIti is � k , � p � ::2fY � ��' yde t3..> t " tix, � �.Y; E ! .l sr tnq > � 4 [Ss 4 -ti?' 7k 3 ! M'.� � �! g�. _: . a u �,4d F � � � v � � � uc s , .� r::L � ' � x? ° v'#' ,� � ` 3 e z v s t i y: 1 5. , ,u ' '�II1 IIIr i ' t sS 41,' �YS IIIItIIIIII �✓ d , f i;': e t} I'll ry t c e ` ✓ ( ' ,y 4� 11 vry F � �tx �s v °aStf a t 6 e '" + ? ' rF .j. s �. nY^. F11 a f 1 . ,.> y [ `{ y f•r t 1 'q6` is yt i # ! t � `s'Tr As t � ytr vTLtyev r' F7: W t i i e T _ Y F 5 4J t z F; ♦ } - " �� > ':? ..{:. i �k:.. ! : i4 ay � s f {j � y :x QrF s� itde F r T 3:. ..a�: �;..:>, :�. 'sY ,. > � x�',.. 3i", ,wt ^' t t� , x,: � .. p ,( .: ` i # y v ' ]'':" � ai ( a {LJ,y, i., _.. ,�_. .:. .. ..:..r . , , '. :�; :F= r , , rs . ., i rt ! -...n, + r e i,. Pn*e' J 'fvi -.:, y t ... 5 . :. i ;, k �,� q r .. nl .n: F '.. 4 t 4.: . . : . n? x • a+ < 4 !"�. > tY�:^.A i ..g 4�+ i I, F! Y r '. ". , , ': ;.. . � .,,. . .�, � e .+ t .,:: :....: Y '_�, � . `'ct ✓tvA F,I, 1Q �-i x::., 4k w w, ff a T i�;t" x:�. } t 4 r- ; £ r ,i's`G',+a C.e a - 5 a. <F� l (r%r Y4 X"1J T ::li7 � Jr is , i n a. L sI 'zf t t Y 4t ;4 lr:'. yi' � , Q k : ( n it}i •� +ti"F . 1 ., 4s .3 � sr v ,` Y ,v' S*: , r .ri �` - t -, i? •ci;: J* 1 SA? W, . 't i• 5, : ' �" ri � e 0 - } / x � v -. ✓ A , � : , I ., a a . �9 y i �;� � aR� v `+Lt i� +�anj }✓N � � > 5 Y r� 4 1u 1 ,t aEFv } ti , t ryr , t °� r:: � i „✓ �s.e +. a: � . �� / ,/ .. xk ' #� ttifw� II "I Ia -tF 1 5. '., r x '. ✓ W i.,t�L i „r2✓. ryn.$F N. (1`i xi rRr fRY ' 3 "GL 5'._'a ` w w � r � u:3 .xit '`i8!'.vY I '�, �C1F r r y Y ? r >�3. � r -,1; �{ i f s .>; , v h n } a< we,v 'vt , 5.u • a''t`. <: , ._. .; ! :. � �y� � ,_ .,.y' a a , f -_'.fes _^t rtlXe. .3-:,..,1.+�..y�l•1.5,:. :1i. .: o l % '.a i st aw rvt3 � � e . '` T .is > 8� # ��.. yia -..: ( >..�.. &.. y+ } ,.:•..a .., _: . ,...:: > . � . , a s�. '.4 a.. ,... . . : ., ., ....:c .. . ,. . ...I.- ti ',� � .,. a:.. . .. .... .. . . .. _ . ;:. , . ..,, ht ✓` . ,4t . <. . . .. -> .,Sa A . . : , � s r , . u:- . . ._. . .Yi. ' 0 1. .. F_. F. Fild .. . . . _ . . .. ,...: , . .. _.. .�. � . , � , : , . _ ” . . ..,". ... N n. "2' . ,f [ F ... k'3•. n f� t..' . , . r1 '. e .. . . . . �fA.' eJ. a '' / 5 . . .. . . so . , . . c . ,:: :.,... �._ - .. ;. . r rx s £a� ..... .. . ,. .. . _. .. 4 . . 'f . . i . ,{ - r {. a t . . .. 5X •�4 . .i'i✓ t ! -. : . . ..,. . , ...: . . . . . . .. .. . .. . ., - ... . , ,. .v ..,,. ... ,i. ., saw ,. .. t � � . ,a :. �. _ , . .y Fr• :. . ':: .� . . : . wx�..a . t. 2. . .. .. . . .. . .. . . . ... . .... ..: ... , . . : ... . .., A . K .rn, s R . . k3 Sv-... . C u S S . . ., 5 ! o . t . .... J ... . ..!'. _.. . .:, .., .. ...: ...: ;. a.'- .... -s... . � .,. , ,,. . . . . . ..4., :. ... r } " , � . u !_ . ". a. • • v . •. 3.. .. '. . l , A vv } 'i.i ,+� sy ".. n. « o:'. _ . ♦ , . , . .., . . . ., 1� . 'y. • [ ILL.. ..... .. ... . . .. . . .. ., a . . . ,., 5 _.. . . �., .. .. ._. 1 . .,. . :d: . . .�✓ A n' ,F� .v;7� .7 r•Y ,"� L .. . . .. .. .. . .. ... ... . ,. .).a i. vn "... af. a,. . f, a � t .a . . . a t J .F „ R '. .a.: ! . ..: ! : . '(. .:: %..[�. . • �". 1'l1 . . . _. ;. . . , , . .. �:. . ,. -,: . . .. ? <. _ . , .: � 4. '.. a. a ..v :. : ,. 1 am,.: - R•'+ . .. . tt '. Y k„ jxY` a E}F.,. m f .... . . .: .... .1. . . . 3Y r..- N .. ..v. 1. i.: • ) . . ' � ). . :,., .. . .; .. . ._ .. .. , ..e . Ar., i . � �. 'Y4 . _Y . Al . .. �t . • . rrrv. 1-% .s. 4 . :. , l . .• . r. . I Y2��. 1 . :..n .. y . :'t r , o. °' „ -, `� e b .. �., ✓ : .: ^f . 4 y:.. -04 . . .x .. ..,. . ,, _ . .rT. ,. ., r . . .a .3. ., ... 1. •37 t .. . . ... .: .. ..- � . .4 . . >Y . ,, [P. s,r . fx. _(. . .. . . F ._. . .. ... . _ , ,.. ,, e ...: ,. . . r '. :d ' fi . . ,._ . ,. . �k .. e::. n � t at r .... . , 1 k ^n `YG ?s,.�?;:• � < ,y 2k y F :. .L.. . ., ..: .. . .. : .. . _ . .S t .,. ..... ' s ., -v. - as 4 sAy, $$ H ak1., F. .• Y -.x�. yr 5 L . a + , :_ a . { �. .. . _ ... _, ... . . .,;. _.. ti< -. -... . � ,... r ... . ✓. , ,. . _._ _ .. . .. . _ , r n . .. . . , . ...,.. ,. .t _ . . e. . . . 1. Y ... ,., ... _,.. .>£ .. . . . .v< . .�.. . �. , v.,<� : -s; .,.... . �:rr �• . ,§- w a z � at„�':. , .. , ..v:...,e. . . .:_ . . '< ... `Z ., eyx ..n.. : . .. < iv '� k . ✓ki -.�. . . d . : &.... s . .,. . ,...., r '.r n .: y , 1 . . _. . y} � ,:- >, . _ / h t. � �� + f . . , Yl . > Er' sti _ . �?. Rrs �. . 1, is } : �.� ✓ uw"� p „( .. :v::r., ] A , � +�a asir I ' � xs4Y � _ r - .mss,_ �' �, E�� `ti r >•+z� , rn x r: m to � N N �-. O' O O C H � 'C x y E E C •N ^ +•� C w O m � � O IO a Oil .- a ^ ^ O. N � v cE k ^ a � > > 0 x °ra m ^ t w = c E c o9 ccN W = E» �o o —'' y Z+ waO CLni `� 3 ” y E w E x m O a `�° to y � � � a �j r a U W $ .O-. O U O) Z U) C E w N w Vol C � N E a H •� C x ... CO m ^ r U m � 8 OVL > 0 otic Ego e `- ox c `moy m o 3 me E0 0> o qx �' mm � � :: .. m (p aw c w0) m NxE �° � E � m R ymc � c�'a Z -a `�° '� � N � m o � � J � w 'C O U) m C x U O C .- fA N .... N V W > .m. m Z L" C �-- C C �O' o f O E c co dmEm mo a = - ' 3 .. .- } cm a .'9x m rn :_ o f 'e � m c or a m c y x x m c x .c a 3 W O o _ m a ds x c c a 0 m 0 = o rA C � Ucn • a ah � c u o o m rn vs m r. m � 3 m E � y � U c� d �-- � m • v v . � c m m '� o w m c a m a m _ o r > c 3 �, a9 m a Z w r a c c a m .. m m m r o w m ;, o iD p) O 3 O c N f/1 >. m — m V `� "'� C C L O g; m .0 Of �Cmp m vm 0 x C F- "a N b 11 CO C w ` N ,�+` (n m C y —`�''• l0 •y :.:. V tyC tl) f0 m C U d .. m .. V O643, 91 o ' ym t ocm � w 1° E w � � w �smcam worm c �' ° L' `- yy corm m � a •- mc � cc � c om .. m t3 N U L C t O N m0. W L c0 m 'C m e m m .. N m 'C 'O 7 l6 @ ar3 .H V C m m d m E m m Y m U .m. 'e 3 r O C c0 m y ` V EO U c w E C E ` 7 W O• m .>.. 3 �. W '� W > y Z ZF- O awiC Eal-® �tNQW dUo' tom' = w m m v ° `° E m c ' � tiO � ' d a l LD 4) toE c S °• 'am •aE °) m � 0 06 a) a m y � Y Y � eli N M N � U M � � (7 � a 0 rn QU m c OU () 0WU � 000 Qzii0 ctj � QUO om°O � o° � ) � ) e� C4 m W d m W in M M M M N TYPO " Ofgw&adon vW PMOMM NO + EXPLANATION FOR VARIANCES OF 15% OR MORE FUNDER SPECIFIC BUDGET AGENCYIPROGRAM NAME: Homeless Family Center - Assets Build Futures FUNDER: Indian River County Advisory Committee i 1 I i N I 1 I I n (Building ds 8% of the total location is used s y for this project:, therefore, 8% of the expenses where attributed to thisram, 8% of the total location is used s HY for this project, therefore, 8% of the exAmnses where attributed to this program. 1 1 k n Books and Educational materials are specificanyused for this ram i rel The inclMduals providing the program se (art therapy and child development) are providing bme um for this program 5/1Trzoos 84 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 1St 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 - CAO V OAI � {► W Cl) m S m m m 'Q a Q a � �' � m �' � m � maom :.• 33dm 8 = C �O : 7 K c 0 23 CL ac OL O E, 0 d y m D rn DCD A c r- o o a o, 00 x U3 0 6 jr m to c < fir (D m 3 Q `D x Z N < G tto fmB Z a W m �^ x 0 f t to gpY '�y ,;NYF� rt"r K}v .-,e* 3r }4 ii x�y'nt yr 4 .,tr 7777-1Yr } ty' az~ rr� .kl'*5: y , � gra s ITf §Y . 1ds� nP Bf'fi¢5 rf � r' i w5xytfr�p5;� 'v y> �� yrsi� a d`> Y ; 1s r } ) aA kYtyp # osx�''y'' F:: ' l3li jk1 ASA G ) NYI y f I't9 £}' : Ft} �r 2Eh". rrr3 { 4r`: "b 4 7N d iias%y �r�; Ald Ifr r N rt a . i V ITJ Wr S✓, ai t. i.t. h _ i 1 i s A Y x r ti ;�R V� }Pi r 4LLf( zy± ! > rc a:. IT fA n i ; tP O 1 / v t EKi } LL rLL r F t11 �i t iU ; 1 1I S J!v { � 111 � i fA r Q ! Srl 6 � 1 • { 1 J I 1 P fi 1 ,i i TT- rl2 ; :LZI a., O TYR Ow awftow ww Pmpw N.me UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCY/PROGRAM NAME: Homeless mily Center - Assets Build Futures FY 10/03 FY 10/04 FY 10/05 % INCREASE FYE 9/30/04 FYE 9/30/05 FYE 9/30/06 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (col. Ceol. sycoa. a REVENUES BUDGETED BUDGETED 1 Children's Services Council-St. Lucie I0.00 #DIV/01 2 Children's Services Council-Martin 0.00 #DIV/01 3 AdvisoryCommittee4ndian River 13 703.58 15 000.00 15 000.00 0.00% 4 United We St Lucie County50 000.00 #DIV/Ol 5 United Wa •Martin County0.00 #DIV/0! 6 United Way-Indian River County0.00 #DIV/01 7 De artment of Children & Families 61 #103.04 0.00 0. 00 #DIV/O! 8 Coun Funds 61 105.25 55 336.00 55 000. 00 0.61 9 Contributions-Cash 665 419.57 402 700.00 400 000. 00 0.67% 10 Pro ram Fees 662.25 0. 00 #DIV/01 11 Fund Raisin Events-Net 7 846.72 25 000.00 20 000. 00 20.00% 12 Sales to Public-Net 0.00 #DIV/01 13 Membershi Dues 0. 00 #DIV/01 14 Investment Income 0. 00 #DIV/01 15 Miscellaneous 899.11 0. 00 #DIV/0I 1s Le acies & Bequests 21 925.00 0. 00 #DIVl01 17 Funds from Other Sources 23 039.87 18 632.00 18 000. 00 -6.31 11 Reserve Funds Used for Operating 112 168.00 113y412.00 1 . 11 % 19 In-Kind Donations (Not included Intotal) 0.00 #DIVl01 20 TOTAL 855.804.39 6291836,00 67141200 M f n %^,'#.. 7, ..n• :: c rx'fiRu. .;gf.i, -Lf"�'.L ee'NK: .a S:cl l.. '�T� ..:-ran S V�, 60°IO peg", ".77,77 7-17777777, 7771777 77 7L' j7 7 , 7777,77� EXPENDITURES 21 Salaries 254 674.07 319 847.00 431p707. 00 34. 97% 22 FICA 20 701 .38 2446800 31005.00 26,72°/, z3 Retirement 1500,00 3 500.00 450000 28.57% 24 Life/Health 28A71 .80 38 431 .00 48 500. 00 26.20% 25 Workers Com enation 21 475.00 10 800.00 13,600.0025. 00% 26 Florida Unem to ment 20.67 0. 00 #DIVl01 27 Travel-0ail 2 286.22 31000,0 900.00 -70.00% 28 Travel/Conferences/Training1 ,50000 #DIV/Ol 29 Office Su lies 2,688,44 21800,00 3 000.00 7. 14% 30 Tele hone 12192.80 10000.00 1000000a#DIVIOf 31 Posta e/Shi in 1458.16 3,800,00 31800.00 32 Utilities 22 875.39 26 000.00 24 000.00 33 Occu an Buildin 0 Grounds 12147.69 12 000.00 12 000.00 34 Printin & Publications 6 000.00 35 Subscri on/Dues/Memberships 624.69 11 ,000.01) 1 000. 00 0.00% 36 insurance 8102.83 17 632.00 18 000.00 2.09% 37 E ui ment:Rental & Maintenance 450.00 3 500.00 3 500.00 0.00% 36 Advertisin 6763.911 4,500,001 41000. 00 39 E ui ment Purchases: Capitol Ex nse 307 692.04 0.00 0.00 #DIV/0 ! 40 Professional Fees (Legal, Consulting) 13 091 .16 105 820.00 12 600. 00 88. 09% 41 Books/Educational Materials 8438.00 1 000.00 88. 15% 42 Food & Nutrition 6 361 .76 8600,00 109500.00 23. 53% 43 Administrative Costs 0. 00 #DIVlOI 4a Audit Ex nse 7 250.00 10 800.00 109800.00 0. 000% 46 S cific Assistance to Individuals 68 522.60 0.00 0. 00 #DIV/01 46 Other/Miscellaneous 15 000.00 7.500.00 -50.00% 47 Other/Contract 12 100.00 #DIV/01 48 TOTAL 802350.61 629 836.003 671 412 00 6.60% _r. -. ..... #.. .� mF ..ls,:e :. kr)PYa,4xn ': i 7749 REVENUES OVER/ UNDER 3g EXPENDITURES 53 453.78 0.00 0.00 #D!V/01 smrmos w 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 184025 th Street Vero Beach , Florida 32960-3365 Recipient : Homeless Family Center 7154 th Place Vero Beach , Florida 32962 Attention : Roberto Ortiz, Executive Director 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 - Date : 5 / 13 / 2005 Time : 2 : 31 PM To : @ 567 - 1454 Page : 001 - 002 DRQ CERTIFICATE OF LIABILITY INSURANCE DATE iiz o PRODUCER ( 772) S67 - 1188 FAX ( 772) 778- 1416 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION SCHLITT INSURANCE SERVICES INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1717 INDIAN RIVER BLVD HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, SUITE 300 VERO BEACH , FL 32960 INSURERS AFFORDING COVERAGE NAIC # INSURED Homeless Family Center , Inc . INSURER A: American States Ins . Co . 715 4th Place INSURER B: Vero Beach , FL 32962 INSURER C: INSURER D: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDOL TYPE OF INSURANCE POLICY NUMBER POLICYEFFECTNE POLICY EXPIRATION LIMITS GENERAL LIABILITY 01CG70087710 01/09/2006 01/09/2006 EACH OCCURRENCE $ 110009000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100 r 00 CLAIMS MADE a OCCUR MED EXP (Any one person) $ 5 r 00 A PERSONAL & ADV INJURY $ 11 000 , OO GENERAL AGGREGATE $ 3 , 000 , OO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ INCLUDE POLICY QCT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY. AGG $ EXCE331UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND ORS TIA S 1T EMPLOYERS' LIABILITY A . ER ANY PROPRIETORIPARTNERFXECUTIVE E.L. EACH ACCIDENT $ OFRCERIMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ Is, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMrr S OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL .,Q. DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Indian River County BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 1840 2 5th Street OF ANY KIND UPON THE INSURER, ITS AGENT'S OR REPRESENTATIVES. Vero Beach , FL 32960 AUTHORIZED REPRE SOENTATFVE n 7A J 7effre Schl itt CPCU LAR ACORD 25 (2001 /08) OACORD CORPORATION 1888 05 - 13 - 2005 13 : 33 HFC 7725671454 PAGE1 MENOMONEE Two " ws proww No" UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: Homeless F Ily Center/Assets Build Futures FY 10103 FY 10/04 FY 10/0 % W CREASE FYE 9/30/04 FYE 8/30105 FYE 9/30106 CURRENT VS. NEXT FY BUDGET A C D ACTUAL TOTAL PROPOSED (COL C•eaL 13peo1. 8 REVENUES BUDGETED BUDGETED 1 Children's Services CounelkSt, Lucie 0. 00 #DIV/01 2 Children's Services Council-Martin 0.00 #DIV/01 3 Adviso Committeo4ndian River 13 703.58 1500000 15 000. 000.00% 4 United Wa -St. Lucie County0.00 #DIV/o! 5 United Way-Martin County0.00 #DIV/01 6 United Way-Indian River County0.00 #DIV/O! 7 De artment of Children & Families 0. 00 #DIV/O! a County Funds 0.00 #DIV/01 9 Contrlbutions-Cash 81654,66 81580.00 0.86% 10 Pro ram Fees 0.00 #DIV/01 11 Fund Raisin Events-Net 0.00 #DIV/01 12 Sales to Public-Net 0.00 #DIV/O! 13 Membersh! Dues 0.00 #DIV/01 14 Investment Income 0.00 #DIV/01 16 Miscel neous 0.00 #DIV/01 16 Le aces & Beauests 0.00 #DIV/Ol 17 Funds from Other Sources 0.00 #DIV/01 18 Reserve Funds Used for Operating 0.00 #DIV/Ol 19 In-Kind Donations (Not Inckuded In total) 0.00 #DIV/D! 20 TOTAL 13 703.58 2S 664.56 23t580.00 -0. 32% PENDITURES 21 Salaries 4 000.00 4 000.00 4 000.00 0.00% 22 FICA 0.00 #DIV/01 23 Retirement 0.00 #DIV/01 24 LlfeMealth 0.00 #DIV/01 25 Workers Compenation 0.00 #DIV/D! 26 Florida Unemployment 0.00 #DIV/OI 27 Travel-Daily0.00 #DIV/01 28 TraveUConferences/Trainin 0.00 #DIV/0! 29 Office Supplies 216.08 224.00240.00 7. 14% 30 Tele no 969.62 800.00 800.00 0. 00% 31 hippin0.00 #DIV/01 s2 t!Ilties 1830.03 2 080.00 1 920.00 -7.69% 33 Occu an (Building & Grounds 971 .82 960,001960. 00 0.00% 34 Printin & Publications 0. 00 #DIV/01 36 Subscr! tlordDues/Membersh! 0.00 #DIV/01 381nauranc0 728.23 1410.56 1440.00 . 09% .09 37 E ui ment:R9ntal & Maintenance 36.00 280.00 280.00 2 2 % 3ng 0.00 #DIV/01 39 E ul ment Purchasee :Ca !tal Expense 0. 00 #DIV/01 40 Prof tonal Fees (Legal, Consulting) 0.00 #DIV/01 41 Books/Educat!onai Materials 0.00 1 OD0.00 1 000.00 0.00% 42 Food & Nutrition 508.88 800.00 840.00 5.00% 43 Administrative Costs 0.00 #DIV/01 44 Audit Expense 0. 00 #DIV/Ol 46 S if!c Assistance to individuals 0. 00 #DIV/01 46 Other/Miscellaneous 0.00 #DIV/01 47 Other/Contract 4 443.93 12. 1 00.00 12 100. 00 0.00% 48 TOTAL 13 703.66 23 654.56 23 580.00 -0.32% 49 REVENUES OVER/ UNDER EXPENDITURES 0.00 0.001 0.00 #DIV/01 °nrrmos w Type the OrgerdzaWn and Program Name UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME : Homeless Family Center /Assets Build Futures FUNDER : Indian River County Advisory A B C FY 05106 FY 05/06 % OF TOTAL FUNDER TOTAL VS. PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET col. B/col. A EXPENDITURES 21 Salaries 4, 000 . 00 0 . 00 0 . 00 % 22 FICA 0 .00 0 . 00 #DIV/01 23 Retirement 0 .00 0 . 00 #DIV/01 24 Life/Health 0 . 00 0 . 00 #DIV/01 25 Workers Compensation 0 . 00 0 . 00 #DIV/01 26 Florida Unemployment 0 . 00 0 . 00 #DIV/0 ! 27 Travel-Dail 0 . 00 0. 00 #DIV/0 ! 28 wwftNwEwwNMwMw�Travel/Conferences/Training0 . 00 0 . 00 ' #DIV/O ! 29 Office Supplies 240. 00 0 . 00 0 . 00% 3o Telephone 800 .00 0 . 00 0 .00 °/a 31 Posta a/Shi in 0 . 00 0200 #DIV/0 ! 32 Utilities 1 , 920. 00 1 , 000 . 00 52 , 08% 33 Occupancy (Building & Grounds 960. 00 500 . 00 52 . 08 % 34 Printing & Publications 0. 00 0 . 00 #DIV/01 35 Subscription/Dues/Memberships 0 . 00 0 . 00 #DIV/0 ! 361nsurance 1 , 440 . 00 400 . 00 27, 78 % 37 Equipment: Rental & Maintenance 280 . 00 0 . 00 0 . 00°/a 38 Advertisin 0 . 00 0 . 00 #DIV/01 39 Equipment Purchases : Capital Expense 0 . 00 0 . 00 #DIV/0 ! 40 Professional Fees (Legal , consulting ) 0 . 00 0 . 00 #DIV/O1 41 Books/Educational Materials 17000. 00 11000 . 00 100. 00 °/a 42 Food & Nutrition 840 . 00 0 . 00 0 . 00 % 43 Administrative Costs 0 . 00 0. 00 #DIV/0 ! 44 Audit Expense_ 0600 0 . 00 #DIV/O ! 45 Specific Assistance to Individuals 0 .00 0 . 00 #DIV/01 46 Other/Miscellaneous 0 .00 0 . 00 #DIV/O ! 47 Other/Contract 12 , 100 . 00 12, 100. 00 100. 00°/a 48 TOTAL $23 , 580 . 00 $ 15, 000 .00 63 . 61 % 5rnrnoo5 FW A FLORIDA W111ERS' COMPENSATION JOINT UNDERWRITING ASSOCIATION, INC. WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER : ( 6FR1 3UB - 798BB04 - 4 - 05 ) RENEWAL OF ( GFR13UB - 7988B04 - 4 - 04 ) INSURER : FLORIDA W . C . JUA 1 NCCI CO CODE : 80179 INSURED : PRODUCER : HOMELESS FAMILY CENTER INC SCHLITT INS SVCS INC 715 4TH PLACE 1717 INDIAN RIV BLVD 300 VERO BEACH FL 32962 VERO BCH FL 32960 Insured is A CORPORATION Other work places and identification numbers are shown in the schedule (s) attached . 2 . The policy period is from 07 - 29 - 05 to 07 - 29 - 06 12 : 01 A. M . at the insured ' s mailing address . 3 . A . WORKERS COMPENSATION INSURANCE : Part One of the policy applies to the Workers Compensation Law of the state (s) listed here : FL a_ B . EMPLOYERS LIABILITY INSURANCE : Part Two of the policy applies to work in each state listed in m item 3 . A . The limits of our liability under Part Two are : Bodily Injury by Accident : $ 100000 Each Accident Bodily Injury by Disease : $ 500000 Policy Limit Bodily Injury by Disease : $ 100000 Each Employee C . OTHER STATES INSURANCE : Part Three of the policy applies to the states , if any , listed here : SEE ENDORSEMENT FWCJUA 03 01 N m 0 D . This policy includes these endorsements and schedules : o SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE 0 4 . The premium for this policy will be determined by our Manuals of Rules , Classifications , Rates and Rating W— Plans . All required information is subject to verification and change by audit to be made ANNUALLY . DATE OF ISSUE : 08 - 01 - 05 SR ST ASSIGN : FL OFFICE : FLORIDA WC JUA 821 PRODUCER : SCHLITT INS SVCS INC 22WDC 008174 FW� A FLORIDA WORKERS' COMPENSATION JOINT UNDERWRITING ASSOCIATION, INC. WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A ) POLICY NUMBER : ( 6FR1 3UB - 7988B04 - 4 - 05 ) CLASSIFICATION SCHEDULE : PREMIUM BASIS ESTIMATED RATES ESTIMATED TOTAL ANNUAL PER $ 100 OF ANNUAL CLASSIFICATIONS CODE NO REMUNERATION REMUNERATION PREMIUM SEE EXTENSION OF INFORMATION PAGE - SCHEDULE ( S ) SIC- CODE : 8399 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - F ARD TOTAL ESTIMATED ANNUAL STANDARD PREMIUM $ STAN8D046 FLAT ASSIGNED RISK SURCHARGE 475 PREMIUM DISCOUNT NONE 0900 - 09 EXPENSE CONSTANT 200 TERRORISM RISK INS ACT 2002 110; TOTAL ESTIMATED PREMIUM 10921 DEPOSIT AMOUNT DUE 10921 A /R ( FWCJUA ) # Minimum Premium : $ 2500 ST ASSIGN : FL DATE OF ISSUE : 08 - 01 - 05 SR OFFICE : FLORIDA WC JUA 821 PRODUCER : SCHLITT INS SVCS INC 22WDC TYPO " Ofgw&adon vW PMOMM NO + EXPLANATION FOR VARIANCES OF 15% OR MORE FUNDER SPECIFIC BUDGET AGENCYIPROGRAM NAME: Homeless Family Center - Assets Build Futures FUNDER: Indian River County Advisory Committee i 1 I i N I 1 I I n (Building ds 8% of the total location is used s y for this project:, therefore, 8% of the expenses where attributed to thisram, 8% of the total location is used s HY for this project, therefore, 8% of the exAmnses where attributed to this program. 1 1 k n Books and Educational materials are specificanyused for this ram i rel The inclMduals providing the program se (art therapy and child development) are providing bme um for this program 5/1Trzoos 84 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 1St 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 - Fl� A FLORIDA WORKERS' COMPENSATION JOINT UNDERWRITING ASSOCIATION, INC. WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY EXTENSION OF INFO PAGE — SCHEDULE WC 00 00 01 ( A ) POLICY NUMBER : ( GFR1 3UB - 7988B04 - 4 - 05 ) INSURER : FLORIDA W . C . JUA 80179 — FL INSURED ' S NAME : HOMELESS FAMILY CENTER INC RATE BUREAU ID : 091317621 EXP . MOD . EFFECTIVE DATE : 07 - 29 - 05 PREMIUM BASIS ESTIMATED RATES ESTIMATED TOTAL ANNUAL PER $ 100 OF ANNUAL CLASSIFICATION CODE REMUNERATION REMUNERATION PREMIUM LOCATION 001 01 FEIN 593129752 ENTITY CD 001 HOMELESS FAMILY CENTER INC 715 4TH PLACE VERO BEACH , FL 32962 CHARITABLE OR WELFARE ORGANIZATION — PROFESSIONAL EMPLOYEES & CLERICAL 8861 337922 1 . 68 5677 a WELFARE OR CHARITABLE ORGANIZATION : ALL OTHER EMPLOYEES & DRIVERS 9110 22347 9 . 38 2096 LOCATION 002 01 FEIN 593129752 ENTITY CD 001 0 HOMELESS FAMILY CENTER INC 720 4TH STREET VERO BEACH , FL 32962 N m O O� O W� a � DATE OF ISSUE : 08 - 01 - 05 SR ST ASSIGN : FL SCHEDULE NO : 1 OF MORE 008175 FW A FLORIDA WORKERS' COMPENSATION WORKERS COMPENSATION JOINT UNDERWRITING ASSOCIATION$ INC. AND EMPLOYERS LIABILITY POLICY EXTENSION OF INFO PAGE - SCHEDULE WC 00 00 01 ( A ) POLICY NUMBER : ( GFR1 3UB - 7988B04 - 4 - 05 ) PREMIUM BASIS ESTIMATED RATES ESTIMATED TOTAL ANNUAL PER $ 100 OF ANNUAL CLASSIFICATION CODE REMUNERATION REMUNERATION PREMIUM LOCATION 002 01 ( CONT ' D ) CHARITABLE OR WELFARE ORGANIZATION - PROFESSIONAL EMPLOYEES & CLERICAL 8861 IF ANY 1 . 68 WELFARE OR CHARITABLE ORGANIZATION : ALL OTHER EMPLOYEES & DRIVERS 9110 7435 9 . 38 697 r - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - TOTAL PREMIUM SUBJECT TO EXPERIENCE MODIFICATION $ 8470 TENTATIVE EXP MOD : 95 MODIFIED PREMIUM 8046 TOTAL ESTIMATED ANNUAL STANDARD PREMIUM 8046 TIER 1 SURCHARGE 2090 EXPENSE CONSTANT ( 0900 ) 200 0 . 0000 TERRORISM RISK INS ACT 2002 ( 9740 ) 110 ASSIGNED RISK FLAT SURCHARGE ( 9601 ) 475 TOTAL ESTIMATED PREMIUM 10921 DEPOSIT AMOUNT DUE 10921 DATE OF ISSUE : 08 - 01 - 05 SR ST ASSIGN : FL SCHEDULE NO : 2 OF LAST 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 184025 th Street Vero Beach , Florida 32960-3365 Recipient : Homeless Family Center 7154 th Place Vero Beach , Florida 32962 Attention : Roberto Ortiz, Executive Director 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 - • OFFICERS October 12, 2005 Frank P. Fagan President Tom Tierney Children ' s Services Advisory Committee 1st Vice President 1840 25`h Street Brennan Egan Vero Beach, FL 32960 2nd Vice President Dear Joyce Johnston-Carlson: Richard J . Fava Treasurer The Homeless Family Center does not transport children in the Agency vehicle Elizabeth Thomas for our programs, therefore we have not enclosed proof of vehicle insurance . Secretary If you have any questions regarding this, please feel free to contact me , BOARD OF DIRECTORS Sincerely, Michael Catanzaro Don Evers Jr. Gt Roberto Ortiz Rosalie Hakker Executive Director Robert E. Healy Don Murray Ferguson Peters Jr. Richard Schlitt Sue Rux, MSW, MS Executive Director 715 4th Place , Vero Beach , FL 32962 • (772) 567-2766 • Fax (772) 567- 1454 Date : 5 / 13 / 2005 Time : 2 : 31 PM To : @ 567 - 1454 Page : 001 - 002 DRQ CERTIFICATE OF LIABILITY INSURANCE DATE iiz o PRODUCER ( 772) S67 - 1188 FAX ( 772) 778- 1416 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION SCHLITT INSURANCE SERVICES INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1717 INDIAN RIVER BLVD HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, SUITE 300 VERO BEACH , FL 32960 INSURERS AFFORDING COVERAGE NAIC # INSURED Homeless Family Center , Inc . INSURER A: American States Ins . Co . 715 4th Place INSURER B: Vero Beach , FL 32962 INSURER C: INSURER D: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDOL TYPE OF INSURANCE POLICY NUMBER POLICYEFFECTNE POLICY EXPIRATION LIMITS GENERAL LIABILITY 01CG70087710 01/09/2006 01/09/2006 EACH OCCURRENCE $ 110009000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100 r 00 CLAIMS MADE a OCCUR MED EXP (Any one person) $ 5 r 00 A PERSONAL & ADV INJURY $ 11 000 , OO GENERAL AGGREGATE $ 3 , 000 , OO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ INCLUDE POLICY QCT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY. AGG $ EXCE331UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND ORS TIA S 1T EMPLOYERS' LIABILITY A . ER ANY PROPRIETORIPARTNERFXECUTIVE E.L. EACH ACCIDENT $ OFRCERIMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ Is, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMrr S OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL .,Q. DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Indian River County BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 1840 2 5th Street OF ANY KIND UPON THE INSURER, ITS AGENT'S OR REPRESENTATIVES. Vero Beach , FL 32960 AUTHORIZED REPRE SOENTATFVE n 7A J 7effre Schl itt CPCU LAR ACORD 25 (2001 /08) OACORD CORPORATION 1888 05 - 13 - 2005 13 : 33 HFC 7725671454 PAGE1 FW A FLORIDA W111ERS' COMPENSATION JOINT UNDERWRITING ASSOCIATION, INC. WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER : ( 6FR1 3UB - 798BB04 - 4 - 05 ) RENEWAL OF ( GFR13UB - 7988B04 - 4 - 04 ) INSURER : FLORIDA W . C . JUA 1 NCCI CO CODE : 80179 INSURED : PRODUCER : HOMELESS FAMILY CENTER INC SCHLITT INS SVCS INC 715 4TH PLACE 1717 INDIAN RIV BLVD 300 VERO BEACH FL 32962 VERO BCH FL 32960 Insured is A CORPORATION Other work places and identification numbers are shown in the schedule (s) attached . 2 . The policy period is from 07 - 29 - 05 to 07 - 29 - 06 12 : 01 A. M . at the insured ' s mailing address . 3 . A . WORKERS COMPENSATION INSURANCE : Part One of the policy applies to the Workers Compensation Law of the state (s) listed here : FL a_ B . EMPLOYERS LIABILITY INSURANCE : Part Two of the policy applies to work in each state listed in m item 3 . A . The limits of our liability under Part Two are : Bodily Injury by Accident : $ 100000 Each Accident Bodily Injury by Disease : $ 500000 Policy Limit Bodily Injury by Disease : $ 100000 Each Employee C . OTHER STATES INSURANCE : Part Three of the policy applies to the states , if any , listed here : SEE ENDORSEMENT FWCJUA 03 01 N m 0 D . This policy includes these endorsements and schedules : o SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE 0 4 . The premium for this policy will be determined by our Manuals of Rules , Classifications , Rates and Rating W— Plans . All required information is subject to verification and change by audit to be made ANNUALLY . DATE OF ISSUE : 08 - 01 - 05 SR ST ASSIGN : FL OFFICE : FLORIDA WC JUA 821 PRODUCER : SCHLITT INS SVCS INC 22WDC 008174 FW� A FLORIDA WORKERS' COMPENSATION JOINT UNDERWRITING ASSOCIATION, INC. WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A ) POLICY NUMBER : ( 6FR1 3UB - 7988B04 - 4 - 05 ) CLASSIFICATION SCHEDULE : PREMIUM BASIS ESTIMATED RATES ESTIMATED TOTAL ANNUAL PER $ 100 OF ANNUAL CLASSIFICATIONS CODE NO REMUNERATION REMUNERATION PREMIUM SEE EXTENSION OF INFORMATION PAGE - SCHEDULE ( S ) SIC- CODE : 8399 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - F ARD TOTAL ESTIMATED ANNUAL STANDARD PREMIUM $ STAN8D046 FLAT ASSIGNED RISK SURCHARGE 475 PREMIUM DISCOUNT NONE 0900 - 09 EXPENSE CONSTANT 200 TERRORISM RISK INS ACT 2002 110; TOTAL ESTIMATED PREMIUM 10921 DEPOSIT AMOUNT DUE 10921 A /R ( FWCJUA ) # Minimum Premium : $ 2500 ST ASSIGN : FL DATE OF ISSUE : 08 - 01 - 05 SR OFFICE : FLORIDA WC JUA 821 PRODUCER : SCHLITT INS SVCS INC 22WDC Fl� A FLORIDA WORKERS' COMPENSATION JOINT UNDERWRITING ASSOCIATION, INC. WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY EXTENSION OF INFO PAGE — SCHEDULE WC 00 00 01 ( A ) POLICY NUMBER : ( GFR1 3UB - 7988B04 - 4 - 05 ) INSURER : FLORIDA W . C . JUA 80179 — FL INSURED ' S NAME : HOMELESS FAMILY CENTER INC RATE BUREAU ID : 091317621 EXP . MOD . EFFECTIVE DATE : 07 - 29 - 05 PREMIUM BASIS ESTIMATED RATES ESTIMATED TOTAL ANNUAL PER $ 100 OF ANNUAL CLASSIFICATION CODE REMUNERATION REMUNERATION PREMIUM LOCATION 001 01 FEIN 593129752 ENTITY CD 001 HOMELESS FAMILY CENTER INC 715 4TH PLACE VERO BEACH , FL 32962 CHARITABLE OR WELFARE ORGANIZATION — PROFESSIONAL EMPLOYEES & CLERICAL 8861 337922 1 . 68 5677 a WELFARE OR CHARITABLE ORGANIZATION : ALL OTHER EMPLOYEES & DRIVERS 9110 22347 9 . 38 2096 LOCATION 002 01 FEIN 593129752 ENTITY CD 001 0 HOMELESS FAMILY CENTER INC 720 4TH STREET VERO BEACH , FL 32962 N m O O� O W� a � DATE OF ISSUE : 08 - 01 - 05 SR ST ASSIGN : FL SCHEDULE NO : 1 OF MORE 008175 FW A FLORIDA WORKERS' COMPENSATION WORKERS COMPENSATION JOINT UNDERWRITING ASSOCIATION$ INC. AND EMPLOYERS LIABILITY POLICY EXTENSION OF INFO PAGE - SCHEDULE WC 00 00 01 ( A ) POLICY NUMBER : ( GFR1 3UB - 7988B04 - 4 - 05 ) PREMIUM BASIS ESTIMATED RATES ESTIMATED TOTAL ANNUAL PER $ 100 OF ANNUAL CLASSIFICATION CODE REMUNERATION REMUNERATION PREMIUM LOCATION 002 01 ( CONT ' D ) CHARITABLE OR WELFARE ORGANIZATION - PROFESSIONAL EMPLOYEES & CLERICAL 8861 IF ANY 1 . 68 WELFARE OR CHARITABLE ORGANIZATION : ALL OTHER EMPLOYEES & DRIVERS 9110 7435 9 . 38 697 r - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - TOTAL PREMIUM SUBJECT TO EXPERIENCE MODIFICATION $ 8470 TENTATIVE EXP MOD : 95 MODIFIED PREMIUM 8046 TOTAL ESTIMATED ANNUAL STANDARD PREMIUM 8046 TIER 1 SURCHARGE 2090 EXPENSE CONSTANT ( 0900 ) 200 0 . 0000 TERRORISM RISK INS ACT 2002 ( 9740 ) 110 ASSIGNED RISK FLAT SURCHARGE ( 9601 ) 475 TOTAL ESTIMATED PREMIUM 10921 DEPOSIT AMOUNT DUE 10921 DATE OF ISSUE : 08 - 01 - 05 SR ST ASSIGN : FL SCHEDULE NO : 2 OF LAST • OFFICERS October 12, 2005 Frank P. Fagan President Tom Tierney Children ' s Services Advisory Committee 1st Vice President 1840 25`h Street Brennan Egan Vero Beach, FL 32960 2nd Vice President Dear Joyce Johnston-Carlson: Richard J . Fava Treasurer The Homeless Family Center does not transport children in the Agency vehicle Elizabeth Thomas for our programs, therefore we have not enclosed proof of vehicle insurance . Secretary If you have any questions regarding this, please feel free to contact me , BOARD OF DIRECTORS Sincerely, Michael Catanzaro Don Evers Jr. Gt Roberto Ortiz Rosalie Hakker Executive Director Robert E. Healy Don Murray Ferguson Peters Jr. Richard Schlitt Sue Rux, MSW, MS Executive Director 715 4th Place , Vero Beach , FL 32962 • (772) 567-2766 • Fax (772) 567- 1454