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Home My WebLink About2005-328h 10 , Ale E o � INDIAN RIVER COUNTY ~; , GRANT CONTRACT This Grant Contract ("Contract") entered into effective thiday of October 2005 , by and between Indian River County, a political subdivision of the to of Florida ; 1840 25th Street , Vero Beach , Florida , 32960- 3365 ; and Boys & Girls Clubs of Indian River County, Inc . , ( Recipient) , of: Boys & Girls Clubs of Indian River County , Inc . P . O . Box 643068 Vero Beach , Florida 32964 South County Branch 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 - 10 , Ale E o � INDIAN RIVER COUNTY ~; , GRANT CONTRACT This Grant Contract ("Contract") entered into effective thiday of October 2005 , by and between Indian River County, a political subdivision of the to of Florida ; 1840 25th Street , Vero Beach , Florida , 32960- 3365 ; and Boys & Girls Clubs of Indian River County, Inc . , ( Recipient) , of: Boys & Girls Clubs of Indian River County , Inc . P . O . Box 643068 Vero Beach , Florida 32964 South County Branch 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 - • II 4 . Grant Funds and Payment . The approved Grant for the Grant Period is : TWENTY SEVEN THOUSAND , EIGHTY DOLLARS ($27 , 080 . 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 Manag ment and Budget . The fiscal year will be as reported on the application for fundin , 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 fund ng 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 qualified opinion from its independent auditor, such qualified opinion shall imm diately be provided to the Indian River County Office of Management and Bu get . The qualified opinion shall thereupon be reported to the Board of Commiss oners 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 , onotes . 5 . 5 . Insurance Requirements . Recipient shall , no later than September 21 , 2005 provide to Indian River County Risk Management Division a certificate , or certificates , is ued by an insurer, or insurers , authorized to conduct business in Florida that is rated not-less-than Category A- : VII by A. M . Best , subject to approval by Indian River County's Risk Manager, of the following types and amounts of insurance : (i ) Commercial General Liability Insurance in an amount noless than $ 1 , 000 , 000 combined single limit for bodily injury and property - 2 - • II 4 . Grant Funds and Payment . The approved Grant for the Grant Period is : TWENTY SEVEN THOUSAND , EIGHTY DOLLARS ($27 , 080 . 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 Manag ment and Budget . The fiscal year will be as reported on the application for fundin , 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 fund ng 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 qualified opinion from its independent auditor, such qualified opinion shall imm diately be provided to the Indian River County Office of Management and Bu get . The qualified opinion shall thereupon be reported to the Board of Commiss oners 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 , onotes . 5 . 5 . Insurance Requirements . Recipient shall , no later than September 21 , 2005 provide to Indian River County Risk Management Division a certificate , or certificates , is ued by an insurer, or insurers , authorized to conduct business in Florida that is rated not-less-than Category A- : VII by A. M . Best , subject to approval by Indian River County's Risk Manager, of the following types and amounts of insurance : (i ) Commercial General Liability Insurance in an amount noless than $ 1 , 000 , 000 combined single limit for bodily injury and property - 2 - damage , including coverage for premises/ perations , product/completed operations , contractual liability, and independent contractors ; ( ii ) Business Auto Liability Insurance in an amount notless 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 for 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 ertificates 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 % hall , upon ten ( 10 ) days prior written request from the County, deliver copies to the ounty, or make copies available for the County's inspection at Recipient's place of b siness , of any and all insurance policies that are required in this Contract . If the Recip ent 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 ounty, its agents , officials , and employees from and against any and all claims , liabiliti s , 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 sub ' ect to the availability of funds lawfully appropriated for its purpose by the Board f County Commissioners of Indian River County. 8 . Standard Terms . This Contract is subject to the standard terms attached hereto a$ Exhibit C and incorporated herein in its entirety by this reference . IN IN WITNESS WHEREOF , County and Recipient have entered into this Contract n the date first above written . 11 INDIAN RIVER COUNTY BOARD OF COMMISSION RS I By ' Thomas S . Lowther, Chairman BCC Approved : Atter Barton , Clerk By. Deputy Clerk 0 � V4 ' •1, nj i Approved : r,%% Ili t Jose0h A. Baird County Administrator ApprcyledS as to form and legal sufficieng 2By Marian E . Fell , Asstant County Attorney RECIPI By: X Boys & Girls Clubs of Indian River County, Inc . - 4 - damage , including coverage for premises/ perations , product/completed operations , contractual liability, and independent contractors ; ( ii ) Business Auto Liability Insurance in an amount notless 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 for 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 ertificates 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 % hall , upon ten ( 10 ) days prior written request from the County, deliver copies to the ounty, or make copies available for the County's inspection at Recipient's place of b siness , of any and all insurance policies that are required in this Contract . If the Recip ent 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 ounty, its agents , officials , and employees from and against any and all claims , liabiliti s , 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 sub ' ect to the availability of funds lawfully appropriated for its purpose by the Board f County Commissioners of Indian River County. 8 . Standard Terms . This Contract is subject to the standard terms attached hereto a$ Exhibit C and incorporated herein in its entirety by this reference . 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'v 5r. .. f. ., 1'- . , . .�,,. , . y,,,f :.. , ._. .. , .: . r ... : a -:e„ .. .h•u .-.: '», � , a a ten• :" ,s. , n lt3. w br v ' ., .. t,:. t , y rrF , w ar a . . INxrlt•` . , ' . y .( w, i ,. ,. -.a. � 'n :. : ::'FT; l : . x nri : L: . . u .:o. i ' y, '," . y , .Lay 4u 5 x ub yy '�r"" ; +a x,e ,ri �r �>"ae, y rf .: : , , M�':"E" •�+ „wr .. „ n . �1`#. �, +�' k"" +';,, o R^� q ' fin, �I F . .r `yY',^`- t'. Y p f-.�'S.�rY s "1" It : � w;� , '�.•'.� j�i 9 ..,b,' ,-y,IEMr t .y� ,... ti f .. < ,, `.T � : . � q 1 " fi �r r r , , r• p L .'� ,,,, 3 , _.. +. ., . , ,,ad ,U. 'C. . . . ,t kik ;�1. �.. 2aN'F• ' ..riS a :max �. w fa u,� t2 +'�'.a. 11n n ;3 . :V' .�rr're:J IN IN WITNESS WHEREOF , County and Recipient have entered into this Contract n the date first above written . 11 INDIAN RIVER COUNTY BOARD OF COMMISSION RS I By ' Thomas S . Lowther, Chairman BCC Approved : Atter Barton , Clerk By. Deputy Clerk 0 � V4 ' •1, nj i Approved : r,%% Ili t Jose0h A. Baird County Administrator ApprcyledS as to form and legal sufficieng 2By Marian E . Fell , Asstant County Attorney RECIPI By: X Boys & Girls Clubs of Indian River County, Inc . - 4 - Boys & Girls Club of Indian River County, Inc. — South County Branch * Grant Application to the Children's Services Advisory Committee " r ORGANIZATION : Boys & Girls Clubs of Indian River County, Inc. PROGRAM : South County Branch r 2. *� aTY k.fT f TABLE OF CONTENTS for 2005-2006 t* Please "X" the parts of the grant application to indicate that they are included Also, please put the page number where the information can be located. X Section of the Proposal Pa e # r X . COVER PAGE (with signatures) . 1 ` X TABLE OF CONTENTS (check list) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ^PJr t 'S=tll�Sp� R A. ORGANIZATION CAPABILITY (one page maximum) X 1:_ Mission and Vision of organization . . . . . . . . . . . . . . . . 01 , 0000900 * 6 * VOODOO , , , 11 4 z X 2 . Summary of expertise, accomplishments, and population served . , , . . , , , , , 4 Be PROGRAM NEED STATEMENT (one page maximum) t X` 1 . Program Need Statement . . . . . . . . . . . . . , 5 s X 1 . Programs that address need and gaps in service . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 C: ` ;PROGRAM DESCRIPTION (two pages maximum) X 1 . runding priority . . . . . . : . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X 2. Description of program activities . . . . . . . . . . . . . . . . . . . . . . . . . . . too . . . . . . Ole . . . . . . . . . . . . . 6 X 3 . Evidence that program strategy will work , . , , , 6 61 X4. Staffing . . . . . . . . . . . . . . . . . . . 1111 . . . . . . 41 . 19 . . . . . . . . . . . . . . . . . . . . . . . . . . 7 :X` 5 : Awareness of program ' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X ' 6 . Accessibility of program . . . 7 it X D. MEASURABLE OUTCOMES (two pages maximum) 8 r � � X E. COLLABORATION (one page maximum) 10 { R PROGRAM EVALUATION (two pages maximum) X1 . Demographics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X 2 . Measures . 11 * x X 3 . Reporting . . . . 12 r . - X ` G. TIMETABLE (one page maximum) 13 r • 4444 • Ii. . UNDUPLICATED CLIENT COUNT r. X 1 . Projections by Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 2. Projections by Age Group . . . 14 - I: BUDGET FORMS .. X 1 . 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To inspire and enable all young people, especially those from , disadvantaged circumstances to realize their full potential , as productive, responsible and caring x citizens. Vision : To accomplish our mission by establishing neighborhood clubs and outreach services in ' IT -' =A »` Indian River County with quality programs and staff. 2,. Provide a brief summary of your organization including areas of expertise, accomplishments, and population served. 1MS Yy 0'� 4 The Boys & Girls Clubs of Indian River County offers a diverse, affordable program to kids in a Positive atmosphere . Our daily after-school and summer programs offered through our "Club" VI house locations and our outreach services provided through our Youth Volunteer Corps program allows us to provide services to children throughout Indian River County. These program activities attract and sustain young people, ages 6 through 18 , who pay a nominal annual membership fee of $ 35 . 00 (which includes a free Boys & Girls Club t-shirt) . Nowhere in Indian .. . River County can kids or parents find such valuable services offered so inexpensively. While our method of program delivery may change with seasonal activities, or school related endeavors, the core of what and how we conduct daily activities remains much the same . The ioi overall Boys & Girls Club program structure can be divided into "Five Core Service Areas" . 4r Together, these core service areas provide a diverse base of activities designed to meet the needs k and interests of every member. The following Five Core program areas represent the Club ' s ¢' service offerings to its membership : - • Education and Career Development . enables youth to become proficient in basic ' TIT., educational disciplines, apply learning to everyday situations and embrace technology to achieve success in a career and life in general. • Character and Leadership Development . . . empowers youth to support and influence their fi Club and community, sustain meaningful relationships with others, develop a positive self- x s aa image, participate in the democratic process and respect their own and others ' cultural b identities. N }4 • Health and Life Skills . . . develops young people ' s capacity to engage in positive behaviors that nurture their own well-being, set personal goals and live successfully as self-sufficient x�x ' • The Arts . . . enables youth to develop their creativity and cultural awareness through knowledge and appreciation of the visual arts , crafts, performing arts and creative writing . t � ` • < 'Sports, Fitness and Recreation . . . develops fitness , positive use of leisure time, skills for stress management, appreciation for the environment and social skills . 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PROGRAM : South County Branch r 2. *� aTY k.fT f TABLE OF CONTENTS for 2005-2006 t* Please "X" the parts of the grant application to indicate that they are included Also, please put the page number where the information can be located. X Section of the Proposal Pa e # r X . COVER PAGE (with signatures) . 1 ` X TABLE OF CONTENTS (check list) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ^PJr t 'S=tll�Sp� R A. ORGANIZATION CAPABILITY (one page maximum) X 1:_ Mission and Vision of organization . . . . . . . . . . . . . . . . 01 , 0000900 * 6 * VOODOO , , , 11 4 z X 2 . Summary of expertise, accomplishments, and population served . , , . . , , , , , 4 Be PROGRAM NEED STATEMENT (one page maximum) t X` 1 . Program Need Statement . . . . . . . . . . . . . , 5 s X 1 . Programs that address need and gaps in service . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 C: ` ;PROGRAM DESCRIPTION (two pages maximum) X 1 . runding priority . . . . . . : . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X 2. Description of program activities . . . . . . . . . . . . . . . . . . . . . . . . . . . too . . . . . . Ole . . . . . . . . . . . . . 6 X 3 . Evidence that program strategy will work , . , , , 6 61 X4. Staffing . . . . . . . . . . . . . . . . . . . 1111 . . . . . . 41 . 19 . . . . . . . . . . . . . . . . . . . . . . . . . . 7 :X` 5 : Awareness of program ' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X ' 6 . Accessibility of program . . . 7 it X D. MEASURABLE OUTCOMES (two pages maximum) 8 r � � X E. COLLABORATION (one page maximum) 10 { R PROGRAM EVALUATION (two pages maximum) X1 . Demographics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X 2 . Measures . 11 * x X 3 . Reporting . . . . 12 r . - X ` G. TIMETABLE (one page maximum) 13 r • 4444 • Ii. . UNDUPLICATED CLIENT COUNT r. X 1 . Projections by Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 2. Projections by Age Group . . . 14 - I: BUDGET FORMS .. X 1 . Financial Budget Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 - --I� 2 � G b •� . g F f a� M M Cgs O --k O d qtt (ogg% : O a, 4. 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Provide the mission statement and vision of your organization. � Mission Statement. To inspire and enable all young people, especially those from , disadvantaged circumstances to realize their full potential , as productive, responsible and caring x citizens. Vision : To accomplish our mission by establishing neighborhood clubs and outreach services in ' IT -' =A »` Indian River County with quality programs and staff. 2,. Provide a brief summary of your organization including areas of expertise, accomplishments, and population served. 1MS Yy 0'� 4 The Boys & Girls Clubs of Indian River County offers a diverse, affordable program to kids in a Positive atmosphere . Our daily after-school and summer programs offered through our "Club" VI house locations and our outreach services provided through our Youth Volunteer Corps program allows us to provide services to children throughout Indian River County. These program activities attract and sustain young people, ages 6 through 18 , who pay a nominal annual membership fee of $ 35 . 00 (which includes a free Boys & Girls Club t-shirt) . Nowhere in Indian .. . River County can kids or parents find such valuable services offered so inexpensively. While our method of program delivery may change with seasonal activities, or school related endeavors, the core of what and how we conduct daily activities remains much the same . The ioi overall Boys & Girls Club program structure can be divided into "Five Core Service Areas" . 4r Together, these core service areas provide a diverse base of activities designed to meet the needs k and interests of every member. The following Five Core program areas represent the Club ' s ¢' service offerings to its membership : - • Education and Career Development . enables youth to become proficient in basic ' TIT., educational disciplines, apply learning to everyday situations and embrace technology to achieve success in a career and life in general. • Character and Leadership Development . . . empowers youth to support and influence their fi Club and community, sustain meaningful relationships with others, develop a positive self- x s aa image, participate in the democratic process and respect their own and others ' cultural b identities. N }4 • Health and Life Skills . . . develops young people ' s capacity to engage in positive behaviors that nurture their own well-being, set personal goals and live successfully as self-sufficient x�x ' • The Arts . . . enables youth to develop their creativity and cultural awareness through knowledge and appreciation of the visual arts , crafts, performing arts and creative writing . t � ` • < 'Sports, Fitness and Recreation . . . develops fitness , positive use of leisure time, skills for stress management, appreciation for the environment and social skills . 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L.` . 4 / r r IF. 1 fi.. . . 15 J ,,: .. , 'a >r .r . ; , ,., :.,% ., s. ., _ ,. , ;Y�, :"• 1 n- . w^ ! _ - t ,�.w , &�{ . r° .kv ^.s r>r E $ u xN . .: ., ,. J r t ^. .., , T. .".xr^''?'n ,= . r r °tt 'P { ,.t,+ " ,ra FfN .t ;r ' ,, a . . . 'w.„mat 9 f, .0 , .: .. ^3 I"8cI I, i3I"”' f +'1 -c4 ". A " ° ai., Twi, u '} .iy' di Pw .,.,� 4 � w, . , -.,war, .{ :, , .. ,. . rw .:.t v ,. ..'�J1a, . . ., a . . .. -.. _ .a . a . . .x .,S.. .. , a. . J w 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 basks 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 ma yf 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 th10 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 expendNture 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 tollsa 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 - O ; O O O " . ; O O OO i Se 91 ere 9 le le M # 8rstr ' ell _ I�rcq <� v � ; N]§ n a < r " n I � y2le lV eq t0)L X41 t ,yr(LiiDIle-Fl rt _ T vl o-I Ar , y a I, d'N e jmu & .r� , 1 . 8 i eY F't , "W $ 3�ler . 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O 4N7 0 0 0 t0 O 0 t0 W O N O O C O O C O G O 0 0 0 OO O N O th OV/ V O A O •tOo .000 co w O It f w �� O 000 Op p O OO p O -1 m � � C7 O 0 0 0 0 0 0 0ggggg 0ggggg 0o ? 4 4 0 0 0 0 0 0 0 CCA O O O O O O O O O O C ; O O O O O O O O O O O C O 0 0 0 0 0 0 0 `� gggggggggg0 0 0 0 0 0 0 0 0 0 0 0 0 0 { 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0ggggg 0 0 0 0 0 0 0 0 0 0 # # Z Nee X C 3e 7 cvv C # # # �#k # i n ? w m � w o o w w N N tit of j _< v v v v v A Z S 0 0 0 N O A V W N W W i N to r W N N N 0 {► O O G G G G G G ' C t^ ju N 4 0 0 to ggg' O V O O Af 00 A V 0 <!t Cf W Of W O r+ — •— W t"t O O –a p p C G tD m 2 en e A o ae o ao V w a� N atOo ooi N ttOit tOit to o .� ao oN� W N — - ? - — m - o 4 Ort. et a e e e e e e -'. O O N Cf O 3' a. O to to e C O m e c O7 -m•1 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 , byjany 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 : Boys & Girls Clubs of Indian River County P . O . Box 643068 Vero Beach , Florida 32964 Attention : Ronnie Hewett , President , CEO 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 claimsl, 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 - ACORgR ) CERTIFICATE OF INSURANCEISSUE (MM/DD/YY) 09- 26- 2005 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS Markel Insurance Company NO RIGHTS UPON THE CERTIFICATE HOLDER . THIS CERTIFICATE DOES NOT AMEND , P . O . BOX 3870 EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Glen Allen , VA 23058 -3870 COMPANIES AFFORDING COIVERAGE COMPANY CODE SUB-CODE LETTER A MARKEL INSURANCE COMPANY COMPANY INSURED B LETTER ' Boys & Girls Club of Indian River County, Inc . COMPANY C PO Box 3068 LETTER Vero Beach, FL 32964 COMPANY D LETTER COMPANY E LETTER COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NA ED 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 . LIMITS SHOWN MAY HAVE BEEN REDUCED BY _ �AID CLAIMS , O POLICY EFFECTIVE POLICY EXPIRATION TR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY1 LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ 3 , 000, 000 A X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OPS AGGREGATE $ 1 ,0001000 CLAIMS MADE 0 OCCUR . 8502CY220128- 5 09- 13 - 2005 09- 13- 2006 PERSONAL & A VERTISING INJURY $ 10000, 000 OWNERS & CONTRACTOR'S PROT . EACH OCCURRE CE $ 1 , 000, 000 FIRE DAMAGE (/any one fire) $ 100,000 MEDICAL EXPENSE (Any one person) $ 5 , 000 A AUTOMOBILE LIABILITY COMBINED SINGLE X ANY AUTO LIMIT $ 1 , 000, 000 X ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Person) $ X HIRED AUTOS 8502CY220128- 5 09- 13- 2005 09- 13- 2006 BODILY INJURY X NON-OWNED AUTOS (Per accident) $ GARAGE LIABILITY PROPERTY DAMAGE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM STATUTORY LIMITS `.YORKER 'S COMPENSATION AND EACH ACCIDENT $ EMPLOYERS' LIABILITY DISEASE - POLICY LI Fj 3 47 DISEASE - EACH A�61PL0YEE S' A OTHER Inland Marine Property 8502CY220128- 5 09- 13 - 2005 09- 13 - 2006 ^' DESCRIPTION OF OPERATION S/LOCATIONSNEHICLES/SPECIAL ITEMS �. ul Certificate holder is included as additional insured for operations conducted by the named insured . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES ' BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO Indian River County MAIL__IQ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION Board of County Commissioners OR LIABILITY OF ANY KIND UPON THE COMPANY , ITS AGENTS OR 1840 25th Street REPRESENTATIVES . Vero Beach , FL 32960 AUTHORIZED REPRESENTATIVE 00 t4ww', wA I( r Cie 14 Bruce A . Kay JPO ACORD 25-S ( 7 /90) ( c) ' CORD CORPORATION 1990 '' 9e( 01Ytr.. .Y. Tfl^n✓mn5f'#y. . R i :>•a/Y 'v 6� ?M1- ,,9 ..5•; .+w ,. , . Ao-, at, .. Y .r. -,.. +i '". . r Ea+ >, x . r . a ... , .: ^a` ,2; .f r . . ..... . .w .. s :ti� . ' , .,, : *,ta r . ; " ^`dt : , i : . ..Y . . , ,A « .. ..». .. : :,. . .a sr ... x. . , .^sx rt. , ..t, ,, r ' . :r y� .R. . v n.... ,a , r_ ra . .. r. .._ ✓� rR., . . . ' 1.. ,t, m .. 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" Gill " Kundrat, Jr., C'hpilrurrut 4F C ;eUrgL' Sandcrer, Vier Cin.1 i6Urrnr John U. 1 Linselm ;m Nis Nksur ArlmbriaiercvlAy3r,r,ru11 N111cc 1979 Thorwm S - NICOfr 13,p. 13ax 988 • L7kchnd , 1. 1, 33802 .,0988 urrresumrnitlt �IdingY• Coll' ('harles R . VVillU, Tcicphnnc ( 903 ) 66 :5. 6060 or 1 -800-282-7648 • ras (863) 666- 1958 C� 1-t�ificate of InSW ranee RE : 0520 - 25864 ISSUED T0 : Indian River County Board or County Commissioners 1840 25th St Vero Beach , FL 32960 - 3365 This is to certify that boys girls G.11�b of IndLrl _Rjver_�ounty , In R., �,� c�306 $ �(ero Beach ,�l.3296 } , being subject to the provisions of the Florida Workers ' Compensation Law, has secured the payment of any workers ' compensation benefits due by insuring their risk with the Florida Retail Federation Self Insurers Fund . POLICY NUMBER : 052_0_2 664 Statutory Limits - -State of Florida Employers liability EFFECTIVE DATE ; $ept€.nber-I3.-?S05 $ 500 , 000 ( Each Accident) $ 500 , 000 (Disease - - Each Employee) EXPIRA'T'ION DATE : Septernber 13 , 7ti006 $ 500, 000 ( Disease - - Policy', Limit) This certificate is not a policy and of itself does not afford any insurance . Nothing contained in thlsj certificate shall be construed as amending , extending , or altering coverage not afforded by the policy shown above or affording Insurance to any Insured not named above . period indicated . Notwithstanding The policy of insurance listed above has been issued to the named insured for the policy p any requirement , term or condition of any contract or other document to which this certificate may pertain , the Insurance made available by the described policy in this certificate is subject to only the terms , exclusions and Conditions of such policy . Paid claims may have reduced the shown limits , re the expiration date indicated , the issuing company will attempt to mail 30 If the policy described above is cancelled befo days ' written notice to the certificate holder named above, although if cancellation is for nonpayment of premium , then the Issuing company will attempt to mail 10 days ' written notice to the certificate holder . In any event, the issuing company , its agents , and representatives accept no obligation or liability of any kind for failure to mail such notice . Date 10/ 17/ 2005 1l Summit, ndministraior Florida Retail ku'doration Self Insurers F "I' d j ?sA rn cri N 'O O r; � N a N L_ O O a N 07 L U O C a .0 t ui C U cO m C N O Q p � :ag � U m `e Q W V u. C9 � W 0 0 a f0 = N o IL Luts Li � zLL = o a � Z w w 3 � $ -> y o m � o V . . 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J l w 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 basks 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 ma yf 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 th10 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 expendNture 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 tollsa Mileage reimbursement for local travel (within Indian River County) is allowable . b ) Sick or Vacation payments for employees . Since agencies may have various sick and vacation pay policies , these must be provided from other sources . c) Any expenses not associated with the provision of the program for which the County has awarded funding . d ) Any expense not outlined in the agency's funding application . The County reserves the right to decline reimbursement for any expense as deemed necessary . " EXHIBIT - B - EXHIBIT C STANDARD TERMS FOR GRANT CONTRACT 1 . Notices . Any notice , request, demand , consent , approval , or other communication required or permitted by this Contract shall be given , or made in writing , byjany 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 : Boys & Girls Clubs of Indian River County P . O . Box 643068 Vero Beach , Florida 32964 Attention : Ronnie Hewett , President , CEO 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 claimsl, 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 - ACORgR ) CERTIFICATE OF INSURANCEISSUE (MM/DD/YY) 09- 26- 2005 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS Markel Insurance Company NO RIGHTS UPON THE CERTIFICATE HOLDER . THIS CERTIFICATE DOES NOT AMEND , P . O . BOX 3870 EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Glen Allen , VA 23058 -3870 COMPANIES AFFORDING COIVERAGE COMPANY CODE SUB-CODE LETTER A MARKEL INSURANCE COMPANY COMPANY INSURED B LETTER ' Boys & Girls Club of Indian River County, Inc . COMPANY C PO Box 3068 LETTER Vero Beach, FL 32964 COMPANY D LETTER COMPANY E LETTER COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NA ED 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 . LIMITS SHOWN MAY HAVE BEEN REDUCED BY _ �AID CLAIMS , O POLICY EFFECTIVE POLICY EXPIRATION TR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY1 LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ 3 , 000, 000 A X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OPS AGGREGATE $ 1 ,0001000 CLAIMS MADE 0 OCCUR . 8502CY220128- 5 09- 13 - 2005 09- 13- 2006 PERSONAL & A VERTISING INJURY $ 10000, 000 OWNERS & CONTRACTOR'S PROT . EACH OCCURRE CE $ 1 , 000, 000 FIRE DAMAGE (/any one fire) $ 100,000 MEDICAL EXPENSE (Any one person) $ 5 , 000 A AUTOMOBILE LIABILITY COMBINED SINGLE X ANY AUTO LIMIT $ 1 , 000, 000 X ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Person) $ X HIRED AUTOS 8502CY220128- 5 09- 13- 2005 09- 13- 2006 BODILY INJURY X NON-OWNED AUTOS (Per accident) $ GARAGE LIABILITY PROPERTY DAMAGE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM STATUTORY LIMITS `.YORKER 'S COMPENSATION AND EACH ACCIDENT $ EMPLOYERS' LIABILITY DISEASE - POLICY LI Fj 3 47 DISEASE - EACH A�61PL0YEE S' A OTHER Inland Marine Property 8502CY220128- 5 09- 13 - 2005 09- 13 - 2006 ^' DESCRIPTION OF OPERATION S/LOCATIONSNEHICLES/SPECIAL ITEMS �. ul Certificate holder is included as additional insured for operations conducted by the named insured . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES ' BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO Indian River County MAIL__IQ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION Board of County Commissioners OR LIABILITY OF ANY KIND UPON THE COMPANY , ITS AGENTS OR 1840 25th Street REPRESENTATIVES . Vero Beach , FL 32960 AUTHORIZED REPRESENTATIVE 00 t4ww', wA I( r Cie 14 Bruce A . Kay JPO ACORD 25-S ( 7 /90) ( c) ' CORD CORPORATION 1990 OCT- 17 - 2005 MON 02 , 44 PM WM , DAY , INC , FAX NO, 772 546 5772 P . 04 Florida Retail Federation t3oarrl of Truxrees Self Insurers W. " Gill " Kundrat, Jr., C'hpilrurrut 4F C ;eUrgL' Sandcrer, Vier Cin.1 i6Urrnr John U. 1 Linselm ;m Nis Nksur ArlmbriaiercvlAy3r,r,ru11 N111cc 1979 Thorwm S - NICOfr 13,p. 13ax 988 • L7kchnd , 1. 1, 33802 .,0988 urrresumrnitlt �IdingY• Coll' ('harles R . VVillU, Tcicphnnc ( 903 ) 66 :5. 6060 or 1 -800-282-7648 • ras (863) 666- 1958 C� 1-t�ificate of InSW ranee RE : 0520 - 25864 ISSUED T0 : Indian River County Board or County Commissioners 1840 25th St Vero Beach , FL 32960 - 3365 This is to certify that boys girls G.11�b of IndLrl _Rjver_�ounty , In R., �,� c�306 $ �(ero Beach ,�l.3296 } , being subject to the provisions of the Florida Workers ' Compensation Law, has secured the payment of any workers ' compensation benefits due by insuring their risk with the Florida Retail Federation Self Insurers Fund . POLICY NUMBER : 052_0_2 664 Statutory Limits - -State of Florida Employers liability EFFECTIVE DATE ; $ept€.nber-I3.-?S05 $ 500 , 000 ( Each Accident) $ 500 , 000 (Disease - - Each Employee) EXPIRA'T'ION DATE : Septernber 13 , 7ti006 $ 500, 000 ( Disease - - Policy', Limit) This certificate is not a policy and of itself does not afford any insurance . Nothing contained in thlsj certificate shall be construed as amending , extending , or altering coverage not afforded by the policy shown above or affording Insurance to any Insured not named above . period indicated . Notwithstanding The policy of insurance listed above has been issued to the named insured for the policy p any requirement , term or condition of any contract or other document to which this certificate may pertain , the Insurance made available by the described policy in this certificate is subject to only the terms , exclusions and Conditions of such policy . Paid claims may have reduced the shown limits , re the expiration date indicated , the issuing company will attempt to mail 30 If the policy described above is cancelled befo days ' written notice to the certificate holder named above, although if cancellation is for nonpayment of premium , then the Issuing company will attempt to mail 10 days ' written notice to the certificate holder . In any event, the issuing company , its agents , and representatives accept no obligation or liability of any kind for failure to mail such notice . Date 10/ 17/ 2005 1l Summit, ndministraior Florida Retail ku'doration Self Insurers F "I' d x