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2004-229C (2)
lot VWL & 04 ORIGINAL 11 .E bL1022afo Indian River County Grant Contract This Grant Contract ("Contract") entered into effective this 1st day of October 2004 by and between Indian River County, a political subdivision of the State of Florida , 1840 25th Street, Vero Beach FL , 32960 ("County") and Hibiscus Children 's Center (" Recipient" ) ; of: Hibiscus Children 's Center Post Office Box 305 Jensen Beach , Florida 34958 Crisis Nursery Program Background Recitals A. The County has determined that it 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 proposals 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 (as 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 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 2004/2005 ("Grant Period") . The Grant Period commences on October 1 , 2004 and ends on September 30 , 2005 . - 1 - 4 . Grant Funds and Payment The approved Grant for the Grant Period is Twenty Thousand Dollars ($20 ,000 ) . The County agrees to reimburse the Recipient from such Grant funds for actual documented costs incurred for 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 Obligations 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 written notice . 5 . 2 Compliance with Laws . The Recipient shall comply at all times with all applicable federal , state , and local laws , rules , and regulations . 5 . 3 Quarterly Performance Reports , The Recipient shall submit Quarterly 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 the 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 a 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 it's 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 this 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 , 2004 , provide to the 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 , products/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 ) Workers ' 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 to the County. In addition , the County may request such other proofs and assurances as it may reasonably 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 Workers ' 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 COUNTY COMMISSIONERS Caroline D . Ginn , Chai an BCC Approved : Attest : J . K . Barton , Clerk , 6.t B M U Deputy Clerkwv, •�w i 'xsF3 . Yx q\ *� Approved : + Jose h A. Baird County Administrator rov aform and�egal suici ll , offo rney RECIPIgNT : By: A Hibiscus Children 's Center - 4 - EXHIBIT A [Copy of complete proposal/application] - 1 - Hibiscus Children' s Center Crisis Nursery Program Children' s Services Advisory Network Indian River County PROGRAM COVER PAGE Organization Name'. Hibiscus Children's Center Executive Director: Jan S . Huffert E-mail : ' shufferthcc4kids . or Address : Post Office Box 305 Telephone : 772-334-9311 101 Jensen Beach, FL 34958 Fax : 772-334- 1991 Program Director: Lawrence Brooks E-mail : lbrooksna,hcc4kids . org_ Address : Post Office Box 305 Telephone : 772-334-9311 ext. 103 Jensen Beach, FL 34958 Fax : 772-334- 1991 Program Title: `�--- Priority Need Area Addressed: Parental Su ort and Educatio Brief Description of the Program : Child abuse and neglect prevention an crisis intervention program providing voluntary in-home services to families experiencing crisis (Le, unemployment homelessness, domestic violence mental health poverty, etc ) Services may take the form of family sport, accessing therapeutic services coordinating medical needs improving daily livinia skills parentindbarent education addressing educational needs and short term respite care for children SUMMARY REPORT — (Enter Information In The Black Cells Only) A 'm'ount Requested from. ' Funder for 2004 /05 : ;�; 'i:; 232956 . 00 Total Proposed Program Budget for 2004 /05 : $ 384 , 423 . 00 Percent of Total Program Budget : 6 . 2 % Current Program Funding ( 2003 / 04 ) : $ 20 , 250 Dollar increase / ( decrease ) in request : $ 3 706 Percent increase / ( decrease ) in request * * : 18 . 3 % Unduplicated Number of Children to be served Individually : 1 680 Unduplicated Number of Adults to be served Individually : X820 Unduplicated Number to be served via Group settings : _ Total Program Cost per Client : 153 , 77 * *If request increased 5 % or more, briefly explain why: Uncertainty of Department of Children and Families funding. If these funds are being used to match another source, name the source and the $ amount: n/a The Organi.ation 's Board of Directors has approved this application on (date), 7- 19-01 Judith Weber Name of President/Chair of the Board S , tore Jan S. Huffert 1 1 S . 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' , t :e + .r, .�, . .y S Hibiscus Children ' s Center Crisis Nursery Program Children ' s Services Advisory Network Indian River County C. PROGRAM DESCRIPTION (Entire Section C, I — 6, not to exceed two pages) 1. List Priority Needs area addressed. Parental Support and Education, 2. Briefly describe program activities including location of services. Crisis Nursery services are voluntary and available 24 hours a day, 7 days a week. The program is a prevention service provided to families that have no active involvement with child welfare: no current or recent allegations of abuse or neglect. When a family requests services, Family Advocates complete an initial intake and assessment to determine eligibility. This intake can be done at the family' s convenience - in the home, at the office, or a mutually determined location. After eligibility is established, the Program Manager assigns the case based on the family' s needs and case openings. A Family Support Plan, which drives all services provided, is then developed with the family served. The family clearly determines the services to be provided and when the plan is completed, unless other issues occur, the case will close . The services are short term, lasting 4 —6 weeks for most families . Clear and measurable goals and objectives establish what occurs between the family and the program. Services include identification of problematic areas and solutions, formal and informal support systems, resources available within the community, need for fiuther services, and possibly respite services. All services are aimed at stabilizing family crisis, providing tools for family self-sufficiency, and identifying resources within the family and community to enhance and improve family functioning. Coordinated family support services . assist families in accessing a wide variety of services including medical and mental health services, parenting education and information, substance abuse assessment and treatment, employment assistance, help locating housing or assistance with rent/mortgage payments, food, clothing, and transportation. Respite services, where parents voluntarily place their children at Hibiscus Children' s Shelter for short periods of time, provide children all of their basic needs, including, but not limited to therapy and counseling, medical care, educational assessments, and a wide variety of other services as needed. Special conditions have been developed to work collaboratively with law enforcement, health care providers, schools, and a myriad of providers to serve parents in crisis. This approach works hand in hand to resolve the immediate crisis as quickly as possible in a way that is least intrusive and disruptive to the family. Helping families identify not only problems, but solutions, combine to enhance and increase family functioning, working in partnership to assist them in reaching their highest potential. In turn, families learn to resolve their own situations and are better prepared to face the future and every aspect of what it may hold, ' 3. 1 Briefly describe how your program addresses the stated need/problem. Describe how your program follows a recognized "best practice" (see definition on page 12 of the Instructions) and provide evidence that indicates proposed strategies are effective with target population. The Crisis Nursery program is. a nationally recognized program, providing relevant child abuse prevention services in our community. National and state data, media attention, and recognition from the state and federal government support the success of its methodology. It has been cited as a best practice in child abuse prevention. Since October 1994, Hibiscus Crisis Nursery has served 11 ,347 at risk children and families . On average 99% of families served did not become involved in the child welfare system in fiscal year 2002 2003 . ,pa raY r a � , .p. •,; �, s+ .mow t . - . ; n # �;tr r a ' a , 11W.111 < ,. • r- s � . q» r� k� .r t �4+�* 1 .yyrv. i tb' ""a� + °'h'. . Ilk, ix . � S° +' X5;2 vrth'Ei d x + • e `Fr ' a a +.�.;,: t P � PRIM 1101110 11511 ,1`F : t ^ . '. x � Y. " s ' . . ° ,}K' . i '4, • ..'4� xx,'" . � f � 'fl` '� �"' � met. r Pfeu Hibiscus Children' s Center Crisis Nursery Program Children ' s Services Advisory Network Indian River County In alignment with best practice models, services are provided within the child ' s home and are intended to enable the family to stay together, to keep the child living in the child' s home and community, reducing the risk of future crisis and abuse/neglect for children. 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). • Program Director ( 1 ) oversees program functioning. A minimum, of 12 hours per week is designated toward the oversight of this program. The Program Director is required to have or be working toward the completion of a master' s degree in social services or a related field and requires a minimum of 3 years related experience. • Program Manager ( 1 ) provides a high level of supervision to staff members and maintains a small caseload. This is a 40+ hours per week position requiring a degree in social services or a related field and three years of related experience. • Family Advocates (3) provide the bulk of direct service provision. These are para. professional positions that require a high school diploma or GED. Two years of related experience is preferred and these positions are full time (40+ hours per week) positions. • ChildCare Workers and ChildCare Supervisors (4.4) provide direct supervision to the children placed in the Shelter for Respite. When children are in respite, awake supervision is provided 24 hours per day. As defined in the budget narrative, we estimate that this equates to the equivalent of 4 .4 staff members working 40 hours per week throughout the year. A high school diploma or GED is required and 2 years of experience for Supervisors. 5. How will the target population be made aware of the program ? In addition to enjoying statewide and national recognition, the Crisis Nursery Program is well established on the Treasure Coast and has been highlighted in the media, including newsprint and television coverage. The primary referral source for the past five years has been self. referral, which demonstrates the widespread community awareness, acceptance, and need of these valuable services. In addition, Hibiscus Children's Center utilizes an extensive marketing . plan to build awareness for all of its programs . Public Service Announcements are aired across a wide variety of local cable stations and staff participates in TV interviews, newspaper articles, and presentations to church and civic groups . Most of the clients who utilize this service hear about it from a friend or family member who has been helped by the program, 6. How will the program be accessible to target population (i. e., location , transportation, hours of operation) ? This program is available 24 hours a day, seven days a week. Services are provided in the homes of families or at mutually determined locations. The program is readily available through an on- call system that puts program services in the hands of families in need around the clock. Transportation'services are also provided to overcome the obstacles to services many families n face due to' , lackbf "ublie transportation, es ecially after hours 'and on weekends. I PP cc h'. A ' '2 P n.F , s' T ' r"" , yy, > Yi q•* is -c ?s< xg Hibiscus Children' s Center Crisis Nursery Program Children' s Services Advisory Network Indian River County D. MEASURABLE OUTCOMES (Entire Section D not to exceed two pages) OUTCOMES ACTIVITIES Add all of the elements or the Measurable Outcomes Add the tasks to accomplish the Outcome(s) 1 . To maintain at least 951% of families served Outcomes 1 and 2 having no verified reports of abuse or neglect ❖ Maintain list of families served. during services as measured by Department of ❖ Provide list of families served to Children & Families Abuse Screening. Department of Children & Families for Baseline: Our most recent DC&F monitoring identification of families that had verified indicated 100% of families served had no abuse or neglect reports during services and verified reports of abuse or neglect during within 12 months after service provision. service provision. ❖ Receive data back from DC&F and determine percentages. 2 . To increase to 95 % of families served ❖ Review families with verified abuse and having no verified or indicated report of child neglect indicators and determine strategies abuse 12 months after services as measured by to prevent future occurrences. Department of Children & Families Abuse Screening, Baseline : Our most recent DC&F monitoring indicated 91 % of families served had no verified reports of abuse or neglect 12 months after services . (Services were provided to particularly challenging families during this time period and we believe that 95 % is more representative of what the program can achieve.) 3 . To maintain at least 95 % of families, Outcome 3 completing services, showing improvement in ❖ Administer and score AAPI as part of one domain of their parenting abilities through intake/assessment process for each the use of the Adult Adolescent Parenting family. Inventory (AAPI) as a pre and post (45+ days ❖ Administer and score an AAPI post-test after service implementation) test. for families who complete services (a Baseline : Data for this objective wasminimum of 45 days). ' established in 2002-2003 . During that time ❖ Individual data to be maintained in period, the program met the outcome at the client files and collapsed into the 100% level. quarterly Peer Record Reports. ❖ If percentages are not achieved, a IN corrective action plan will be developed in response to the quarterly Peer Review and monitored through the next peer review cycle.NON ' X 1 w urA. 4U4 9�k'ry P'� 'hkill� i to,r y a ti I. r yr ' a. ••, x A, k. , axt tR • V n'M F- K 1 • . 1 � • t 1 1 1 'J 11 1 1 i 1 i 11 the resources1 1 1 1 1 1 ' 1 11 1 ' 11 1 1 1 1re erra an tsupport. midm'dual funder11 11 1 t inclusion 1collaborativfe�_Weement letters.) Collaborative Agenc IndianCounty HumanReferral for food, medication, travel / • t payments and reciprocal services. • • tl • / • t • t • t • t • • t t / • •- . • ' t • • • • • • vouchers. Indian Homeless Collaboration on shared cases including mutual referral , Shelter for homeless families. h � OF 3 + t F �'�, 't' S. m h x� ,�' .. / � .. . }tS. ' r ^�,'� �',�yx+•�..f�'��xx fI � ° etre# _ , y . , roti gp p w..� si 13M,� � ti. . , o w . s�• �f ����L �t . ;'J, �. "'"�''"�n N4- • 1 • 1 t t • • tl t • 1 • • • _ • 1 • , 1 • • 1 1AIII • ' 1EMOGRAPHICS .w What (data11 1willyou need to collectI order 1accurately describe your population *including demographics • gender, 1 1 ethnic background) 1 / 1 thefunder 1Section t What are thepieces 1 information 1 qualify1 11 for your targetpopulation? i l " do you document t1 need for services 1 heir "unacceptable condition requirmgy change" Section 13192 ProgramThe : Crisis Nursery Program collects client data in many different ways, *in order to meet a variety of funder requirements. Client data 'including age, gender, race, economic level, education lev6l,, parenting situation (i . e. single, dual, grandparents, guardian etc.) is collected on every family served. The information is compiled on a monthly basis and put into a data spreadsheet that is used for reporting to funders. Monthly, quarterly, and year-end reports are provided upon request based on the specific requirements of each fander. All families complete an intake/assessment process to deten-nine the level of their crisis and the ability of the Crisis Nursery services is clearly documented • 1 the intake form and incorporated 1 • the Family SupportPlan — The Program is a primary prevention program • • tt • services before abuseor neglect• takesplace., - - • / " universal qualification • t make .a family ineligible • • screening,be verified abuseand/or neglect prior to service implementation based on the DC&F background' 1 1 1 1 1 1 1 1 1 11 II 1 1 1 1 1 1 1 1 1 1 1 1 II 1 1 i l ' 1 1 1 1 1 1 • ' 1 1 1 1 1 1 • 1 1 1 1 1 . small 1 _ 1 • - • • _ • t • t _ _ • • • _ t _ _ _ • • " • • • • • 1 I • 1831 • • / 1 • t • _ _ • • TV 1 • REPORTING: hat will you do with this information to show thatchange 1 . occurred ? 1 ' will youor present 1 1 the consumer, the 1 1 1 program, 1 1 the community ? 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Hibiscus Children' s Center Crisis Nursery Program Children' s Services Advisory Network Indian River County Data is maintained in client records, monthly Risk Management Reports, quarterly Peer Record Reviews, and MIS spreadsheets. Hibiscus utilizes a Continuous Quality Improvement Committee comprised of a broad spectrum of stakeholders (staff, board members, funders, former clients, volunteers, other agency representatives, etc.) to discuss internal and external monitoring results . This group is also instrumental in ensuring that the agency maintains a "big picture" perspective on all of its services. Goals and Benchmarks are established for each program and service offered through Hibiscus Children's Center. Each program establishes "Functional Team" goals to ensure that they assist the agency in meeting its strategic plan and funding requirements. These goals along with contractual outcomes, are tracked quarterly through Peer Record Reviews . The Operating Board of Directors of Hibiscus Children's Center has also established Risk Management benchmarks for each program. This allows our board to remain informed of "high risk" situations . Risk issues are tracked through the monthly Risk Management meeting and then reported to the Board on a monthly basis. An example of a benchmark for the Crisis -Nursery program would be a family who is reported to the abuse hotline for abusing or neglecting their children while we are providing Crisis Nursery services. Clients are informed in writing of our Continuous Quality Improvement processes and are allowed access to reports generated upon request. These reports are also available to funders upon request. Additionally, Hibiscus maintains an adequate MIS to comply with all funders requests for documenting and sharing data elements . Change in the family' s situation is most clearly documented through the completion of the Family Support Plan. This documentation is maintained in the individual family' s record. The systemic change of preventing and reducing child abuse is documented through our annual monitoring by DC &F. The Department of Children & Families will report outcomes on abuse and/or neglect that occur during services . Prior to service initiation, families are screened through the Department of Children & Families to determine if there is an open case of abuse or neglect. This information is verified by the Department and maintained in client records. At all times during services, from initiation to termination, Family Advocates are working with the families they serve to collect accurate data. Data is collected and compiled on a monthly basis by the Family Advocates and presented to the Program Director. The Program Director reviews all program data for accuracy in reporting. It is compiled by county and rolled up into a report that is provided to all funding entities based on their requirements individually and in full to the Department of Children & Families . This data is included in the agency ' s annual report, is utilized in brochures and other agency materials, and is available upon request. r ` v � a - x's"� e ge • 1 • 1 1 _ • as • ' • • • 1 II 1 1 1 1 1es 1 events thatoccur within 1 ' de any1 plannMig that may occur outside 1 1 1 1 ' year. 1 complefing the timetable, " informadon detaRed in prior 1 1 1 1 1 r I • tt • tt " " t " • ' 1 " • 1 " " • ra _ • 1 • _ • • _ . • • • / r _ • • 1 • t . ' " It " 1 • It 1 a r t • " • • Ir 1 • / • r • • •J • • t _ • . 1 • r • ' 11 a � 3} vy 81 ^ " ,. � v � . � . k .'� t � ^4' f q , � � •i t FR ��Rj'3'�".^ tl d'S�' '. y'�w .:,�r 'i c4• vj }f d �..+s �� F i . "3'�'� °� � � :. 1 iti'1 i b } aArA4.e �- s'�' T .`. n r s{ "scS x 'a '.,� 54 •4 � .[. - " k • y:.✓ .4 x4 :� � ..�';. �, rf`A. Y ,y . -! . o y f � � • . • Hibiscus Children' s Center Crisis Nursery Program Children' s Services Advisory Network Indian River County EL PROJECTIONS FOR UNDUPLICATED CLIENTS Number ofUnduplicated Clients by Location Current Fiscal Yeara Location Budget 2003/04 Unduplicated Clients Unduplicated Clients Unduplicated Clients N. Indian River County 31 15 35 S . Indian River County 28 13 25 Indian River Co . Total 59 28 60 Greater Stuart 73 90 92 Hobe Sound 2 7 4 Indiantown 14 10 10 Jensen Beach 31 42 42 Palm City 5 4 5 Martin County Total 125 153 153 Fort Pierce 178 230 230 Port Saint Lucie 102 120 125 St. Lucie Co . Total 280 350 355 Other Locations 24 44 32 TOTAL SERVED 488 575 600 *Client is identified as family Number of Unduplicated Clients by Age * * a a Current Fiscal Year Location Budget 2003/04ecti of Mau ,amu Individua Group M ua 0 to 4 - (Pre-school) 417 - 554 - 560 - 5 to 10 - (Elementary) 295 550 - 55b - 11 to 14 - (Middle) 315 - 450 - 450 . - 15 to 18 - (High School) 130 - 101 - 120 - Total Children 15157 . - 1 , 655 - 1 , 680 - 19 to 59 - (Adults) 587 - 800 - 770 - 60 + (Seniors) 63 - 20 - 50 - Total Adults 650 - 820 - 820 - TOTAL SERVED 1 ,80711 2,475 - 2,500 - * * Client is defined as individual &I yl fr k1 1 �YT* :r;. y +wF ; . t 1 Yr : 1 � a 3t. FM • .%F 4 ��.. i . . •�gl.�i�^� s i m�-' d ;�` . it'i^ tai ki ::�rnyy } ;'� k dy ' ? >yi�° : yar k tw " } y vu . aTyfy, '�"`s'4�, E�� . � � • • 5 � ` �• U sY 1 yte sr Hibiso Children's Center, Inc./ Crisis Nursery Program , 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 : Hibiscus Children 's Center, Inc ./Crisis Nursery FUNDER : Children 's Services Advisory Committee of Indian River County I CAUTION ; Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in place. Gray areas should t Abe used for calculations and to write infonnafion only. III 1 a;111 , 111 101 , ,ro osed' a gram unrlifl ency REI�EN(!ES : S�+d�+� _ Budget �u ge uget 1 Children's Services Council-St Lucie _ ,� 141 , 817.00 186 ,582.00 2 Children's Services Council-Martin 61 1087.00 81 ,071 .00 3 Advisory Committee-Indian River 23 ,956.00 23 , 956 .00 339549.0 4 United Way-St Lucie County coma== 68 ,273.00 68,273.00 5 United Way-Martin County 299408.00 29,408.00 6 United Way-Indian River County 119533. 00 11 ,533.00 7 Department of Children & Families 29234,804,0p 8 CountyFunds 9 Contributions-Cash 10 Program Fees 11 Fund Raising Events-Net 12 Sales to Public - Net 225,000.00 13 Membership Dues 14 investment Income 51000. 00 15 Miscellaneous 16 Legacies & Bequests " dre ' . Setvaees vun t7 ee o"bee C-ounty_ s s Chiidrera 17 Funds from Other Sources ih a6o 48, 349. 00 11597,494.00 18 Reserve Funds Used for Operating 19 In-Kind Donations (Not included in total) 32 ,000.00 i 400 , 000.00 20 TOTAL REVENUES (doesn't include line 19) ;. : .,.; $384 ,423.00 $231956.00 $4 ,472 ,714.00 C ' M-D, oi: unTtG��SE �r� � 21 Salaries - (must complete chart on next page) 210, 313.00 19,036.00 211513,903.00 Ilk Salare .. 22 FICA - Total salaries x 0.0765 7T5'/o 16 , 089 .00 11,456.25 192,314.00 Ketirement - Annual pension or qua i ie 23 staff :. , Dlo 3, 155.00 180.75 37,709.00 Lileffleafth - e Ica enta ort-term 24 Disab. 32,077.00 29903.0 259.559.00 Workers ompensa on - emp oyees x- 25 rate 1 * _ o 4` 's 52Jn 'I • , S 3,197 DD t ti+ ; °•7 ' ° 290.00 67,702.0 onanempoymen . prosee ` s V "} ' v< l ' . '` ' a • 12,067.004 9990 0.026 employees x $7000 x UCT-6re " � � rhe 3 f�x kxg � m:' � , -. d �, y •.« .. Hibiscus Children's Center, Inc./ Crisis Nursery Program y Y �t 'iGiassAnnualGross nua1 ��� $ � � a a! f'orbon of prly �ioposed nd r>S eet c 3�ndge G Ras o �fu q'Uta1 Agenc #3eqursfed CYAj F Exam e, Fxeeu6ve a . . K. �--W:-7�err, 7.4 % ' Program Manager/40 Hours - 100% 329148.00 32, 148.00 41650.00 14AF/ Family Advocate/40 Hours - 100% 20,610.00 20,610.00 21360.00 11 .45°/ Family Advocate/40Hours - 100% 24,401 .00 24 ,401 .00 6,900.00 28.28% Program Director/40 Hours - 30% 45,320.00 13,596.00 0.00% Family Advocate/40 Hours - 100% 20,600.00 20,600.00 29364. 11 .48% Child Care Supervisor/40 Hours - 100% 24,516.00 24,516 .00 0.00% Child Care Worker/40 Hours - 40% 16,004.00 6,401 .00 0 .00% Team Leader/40 Hours- 100% 25,750.00 259750.00 0 .00% Child Care Worker/40 Hours - 100% 20,289.00 209289. 00 0 . 00°/ Child Care Worker/40 Hours - 100% 22,002.00 22,002.00 2,762.00 12 .55% #DIV/DI #DIV/DI #DIV/01 #DN/oi #DIV/Ol #DIV/01 #DIV/Ol #DIV/01 #DIV/01 #DIV/OI Remaining positions throughout the agency 21262,263.00 Total Salaries $ t5131903.001 $210,313.00 $ 19,036.00 0.76°/ k Nita SE EFl7'SS �E nde j Specrfic Pension Y 1Yorkei's Unempioyme Tnfal Fnnges Fundec spec" / ea7th lns - .a - Golurnn GoL frorn< rile 7?D 7' YA orri 'ens � .ntCom ens.Speci> c udgef �roa r ixample g Case Manager 4 rs DDi7D0 h 382 5Q, 200:00 500 UD.: Ot7 D0, 20000 31,582.5A Program Manager/40 Hours - 100% 4 ,650.00 355.73 70.00 709.00 71 .00 22.00 1 ,227.7 Family Advocate/40 Hours - 100% 21360.00 180. 54 35.00 360. 00 36.00 11 .00 622 . 54 Family Advocate/40Hours - 100% 61900.00 527. 85 75.75 11052.00 105.00 33.00 11793 .6 Program Director/40 Hours - 30 % 0.00 0. 00 0.00 0.00 0.00 0.00 0. 0 Family Advocate/40 Hours - 100% 21364.00 180.85 O.DO 361 .00 36.001 11 .00 588. 8 Child Care Supervisor/40 Hours - 100% 0.00 0.00 0. 00 0. 00 0. 00 0.00 0. 0 Child Care Worker/40 Hours - 40 % 0.00 0.00 0 . 00 0. 00 0.00 0.00 0.0 Team Leader/40 Hours- 100% 0.00 0.00 0.00 0. 00 0.00 i 0.00 0.00 Child Care Worker/40 Hours - 100% 0.00 0 . 00 0.00 0.00 0.00 0.00 0 . 0 Child Care Worker140 Hours - 100% 2,762.00 211 .29 0.00 421 .001 42.00 13.00 687 .2 0 : . 0.00 0.00 0.0 0 ` 0.00 0.00 0. 0 0 0. 00 0.00 0.0 0 0.00 0.00 0. 0 0 0.00 0. 00 0.00 0 0.00 0.00 0. 0 0 - 0.00 0.00 0. 0 0 0.001 0.00 0. 0 o O. C)01 0.00 0. 0 O.Oq 0. 00 0. 0 y TofaIFunder Request Fringe 6enefits $ 19,036.001 $ 19456.25 $ 180,75117, $2j903.00 l $290.001 . $90.00 $4,920.00 a a � � i'X* l� �` mR §n . vl a ° 'C# �(,�"et ` •x } i �. y � uc..yv - , °a.r 3� ,;_y . B3 �� i; •.fin _ g'�j�,3 b ': 1 T"' i �" o- . Hibiscus Children's Center, Inc./ ` Crisis Nursery Program TC W 6 M -� %° • � � .. ,� vn >A ,. p ccs-�:_ otal�Ig cy fudge Budgets` `' "Budges ' 27 Travel-Dai hr � . = 89000 .00 0. 00 831000. 00 # of Staff x average # of miles/wk x 50 wks x t8 ilei der eel MIA $ = Estimated Daily TraveUMileage Reimb. " � ' '" _' ' 28 Travel/Conferencew7raining Z000 . 01C 0.0c 309000.00 • National Conference (cost per staff) • Training/Seminar (cost per staff) + r - • Other Trainings (cost of travel, lodging, • .amtlySu � ,raanmg , or .3 �eople registration, food) 29 Office Supplies 3 ,000. 00 0.00 41 ,250.00 • Office supplies (monthly average x12 t, months = estimated cost of office supplies ` based on present history. ° * ' - $250 �errnotayeJ?9: a �or2 months . , 4 s . 30 Telephone - 81000. 00 0.00 108 ,750. 00 • # Phone lines x average cost per month x � 61 IT . 12 months = local phone cost e71 ov8D R • Average long distance calls z 12 months = eta9e7Ge11 p on $ e „ ontfl : .. ave ge I.W.distance $80er Estimated cost of long distancemonth av ra 31 Postage/Shipping 300. 00 0. 00 7 ,650.00 • Quarterly Mailing of Newsletter , :: • Special events, etc. . age . osta a esr aversoage..D $25 - • Bulk mailings - appeals o '� 32 Utilities 3 ,000. 00 0. 00 103 ,000.00 • Electricity ($ x 12 months) a nc = 7 0` er onth g „ vera ater Sewer 22;50 er • Water/Sewer ($ x 12 months) D tta ave ag� age 3i) er • Garbage ($ x 12 months) 'rnnnth avers , p 33 Occupancy (Building & Grounds) 80000. 00 0. 0c 109 ,000. 00 • Mortgage/Rent ($ x 12 months) • Janitorial ($ x 12 months) • Grounds Maint $ 12 months) x $� ( • Real Estate Taxes al tenance $2[)p� noratl �" 34 Printing & Publications 1 ,000.00 0. 00 71500.00 • Quarterly Newsletter ($ x 4) . • Letterheads , Envelopes, etc. ; • Fundraising materials • Other 9 � -N =1; n 83 x3 Ver mont verage5 . 35 Subscription/Dues/Memberships 21000.00 0. 00 14 ,300. 00 • Membership to National Organization 01fairfeP�gue � _ . • Dues 46 er onthi'D es Rr �'=t;abrd: Dllncl 3: er .x - • Subscriptions to Newspapers/magazines, o 'tt Sti ssxap on ewspapers k etc. #admagazines 6 . 36 Insurance 3,000. 00 0. 0NI 100 ,000. 00 • Directors/Officers Liab. « • Commercial/General Insurance s F = r °pe� nsura ce • Bond Ins. n �Genera�ablll nsurance � • Auto Insurance 37 Equipment: Rental & Maintenance 51000.00 0. 00 70,000.00 • opier lease x 12 months) wK w e1 �N 220 3 er • Meter lease ($ x 12 months) $ „� � onth/Nleter easeIN $ Lfi�03er ,�•, , i`= £ • Copier Maintenance ($ x 12 months) . ' { . r - a o Copier arntenan X77 • .. peronth/5e��ares p ort 790238Computer Maintenance ( $ x 12 months) = iTHM012 � F 1 Y-IF a ,r � t • Other -. .. s t .tm':i?."x£ �*' `' ? € `�z t� � r `y3 *� s.4 i a::F�nvF �y,,r:•, �� 4-7;ri _.:. iv.: :. e. der mDntr IN 38 Advertisingasa ;a 0.00 32.000.00 150.00 � , e, ,, •; Newspaper ads � :, t r 4' ? f r a `4:w'4,xxs' .. f L . u � ' � . Fundraising adsp o otions x � ? �?(` aF t Wi Ej . ;p,.. k: i a•7 �i � 3 tT% " Othet .vacancies sr . h. k r a e g t, . s ,* *lewspaper ads as needed ytm � • � , - r li; r _ '° ,. x • r - :_ rt , . ri .qi * J� , ' f yi ✓' y� � t� f sti ?`p t�� � � M� r= ep " s h ' IN i. c .meq : y :'' y y�� 'k + C y+,,3 5 Vii: p tom•�,- y��.p4.yy i ! � . . x �. +i�y�•3�A 'Na" ' S } ^.'1aC,°� §' v.Yi '11 . Y J • x . • `F Hibiscus Children's Center, IncJ • Crisis Nursery Program 39 Equipment Purchases:Ca ital Expense 0.0c 0.00 • Computer/monitor (# x $) � p�i� * y • Laser Printer . . ....M 40 l WIN7 40 Professional Fees (Legal, Consulting) 0. 0 0.00 • Legal advice estimated #hrs x $ "" • Consultant fees • Other 41 Books/Educational Materials - 0.00 4,300.0 • Bookstvideos 4 k • Materials ($ x staff) _ � tt < .d a � . _ x 42 Food & Nutrition 2,701 .00 0.00 92,000.00 • Meals ( # meals x clients x 5days x 50 wks) �� `*# �- eaTsday eek o • Snacks l ren der�2°wee IX < . . . 2-o91: 43 Administrative Costs 38,442.00 0. 0 406,610.00 . "4:64 dafi "ES � �L 07COCf 0 ;„ r clary 1COX nge5 • Admin. Cost (% of total budget) "ala `� 474g 44 Audit Expense 1 ,300.00 0.00 17- ,200. 00 • Independent Audit Review - tr�dE endent Audikev euu Y 45 Specific Assistance to Individuals s 319500.00 0.00 138 ,400.00 • Medical assistance . z « .. .. • Meals/Food , + • Rent Assistancen vin c coca 6 _ onthave. e�b6 sststa , . • Other _ 46 Other/Miscellaneous 1 ,200.00 0. 00 249500.00 • Background check/drug test _ k • Other s ` roun�fiecks/nrok In m- aWsa mya kta'� S .S yT 47 Other/Contract 0.00 0. 00 • Sub-contract for program services - UNKNOWN, w"Tr 48 TOTAL EXPENSES $384,423.00 $23, 956.00 $4 ,472 ,714 .00 i 1 16 1 • i5j 4' 5 Y ) Y �5. 4S X f.✓Y X NEbN CNIM ? cam"t CI Nummy PrWam UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCY/PROGRAM NAME: Hibiscus Children's Center, IncJCrisis Nursery FY 02/03 FY 03/D4 FY 04105 % INCREASE FYE_6/30/03 FYE_06/30/04 FYEL. CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (COL C-I Bye*. B REVENUES BUDGETED BUDGETED 1 Children's Services Council-St Lucie 41 ,067.17 105,000.00 1869582.00 77.70% 2 Children's Services Council-Martin 34 545.52 25,000.DD 81 ,071 .00 224.28% 3 Advisory Committee4ndian River 25 000.00 20,250.00 33,549.00 65.67% 4 United Wa St Lucie County 20,D00.04 5 OOO.OD 68 273.00 1265.46% 6 United Way-Martin County 12,531 .28 151,000.00 29,408.00 96.05% 6 United Way-Indian River County 111,533.00 #DIV/01 7 Department of Children & Families 1 ,371 ,286.81 2,024,606.00 2,234,804.00 10.38% 6 County Funds 0.001 #DIV/01 9 Contributions-Cash 221188.15 0.0D #DIV/O! 10 Program Fees O.OD #DIV/01 11 Fund Raising Events-Net O.OD #DIV/01 12 Sales to Public-Net 2231,512.16 2061,756.01) 2251,000.001 8.82% 13 Membership Dues 0.0D #DIV/01 14 Investment Income 2,279.68 9,397.00 511000.00 -46.79% 1s Miscellaneous O.OD #DIV I 16 Legacies 8, Bequests 0.00 #DIV/01 1T Funds from Other Sources 192179584.01 191281,499.00 1 ,597,494.00 41 .56% 16 Reserve Funds Used for Operating 0.00 #DIV/01 19 In-Kind Donations (Not Included Intohl) 461 754.00 391 ,714.00 400,000.00 2. 12% 20 TOTAL 2,969,994.82 3,5399508.00 40472,714.00 26.37% EXPENDITURES 21 Salaries 11741 ,623.90 2;0601,200.00 21,513,903.0D 22.02% 22 FICA 148,288.62 177,075.00 1929314.00 8.61 % 23 Retirement 71,148.12 221,090.00 37,709.00 70.71 % 24 Life/Health 1131,834.56 207,647.00 259,559.00 25.00% 25 Workers Compensation 501,204.50 84,627.00 671 -20.00% 26 Florida Unemployment 12,329.94 14,332.00 12,067.00 -15.80% 27 Travel-Daily 51 ,039.34 65,406.00 839000.00 26.90% 28 Travel/Conferences/Training 14,331 .21 25,493.00 _ 30,000.OD 17.68% 29 Office Supplies 29,550.37 35,560.00 41 ,250.00 16.00% 30 Telephone 53,921 .62 63,231 .00 108,750.00 71 .99% 31 PostagetShipping 71143.18 7,127.00 7,650.DD 7.34% 32 Utilities 36,220.01 389770.00 1037000.00 165 .67% 33 Occupancy (Building & Grounds 100, 114.71 109,881 .00 109,000.00 -0. 80% 34 Printina & Publications 79030.43 7, 198.00 7,500.00 4.20% 35 Subscription/Dues/Memberships 12,817.69 12,535.00 14,300.00 14.08% 36 Insurance 42,157.17 48,126.00 100,000.00 107.79% 3T E ui ment:Rental & Maintenance 431,013.67 47,201 .00 70,000.00 48.30% 38 Advertising 24,941 .34 . 13, 160.00 32,000.00 143. 16% 39 Equipment Purchases:Ca ital Expense 58,265.82 48,000.00 0.00 -100.00% 4o Professional Fees (Legal, Consulting) 41390.00 500.00 0.0D -100.00% 41 Books/Educational Materials 3,099.27 11477.00 4,300.00 191 .13% 42 Food & Nutrition 25 471 .20 18,350.00 92,000.00 401 .36% 43 Administrative Costs 2499388.00 300,000.00 406,610.00 35.54% 44 Audit Expense 11p024.00 10,500.00 17,200.00 63.81 % 4s Specific Assistance to Individuals 649773.07 86 ,653.00 1381400.001 ':111111, 59.72% 46 Other/Miscellaneous 17,924.43 20,779.00 24,500.00 17.91 % 47 Other/Contract 15,360.00 137590.00 0.00 100100% 48 TOTAL 2r945,406,17 3,539,508.00 414721,714.00 26.37% 49 REVENUES OVER/ UNDER EXPENDITURES 24,588.65 0.00 O.D01 #DIV/01 �l P� A � { � n 3 b Fly+ J • f f •• "_w r� � ! ,yyK"i �?A f jd a. � TRl.Y r�a,� �� "k M�`r=3+r+ . l r � +'� +` rS h ~ �FX✓ didt = T +'iM� �r� s s t ply s : �tl� y 6. .4 •5 (. t � �� Y' M k. f` � L v1" FL(�.�l ti' pyF4 �� ti „• : Y 9 ` HEbeu C ~6 C~. ftj or" "Wa" PMF" UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: Hibiscus Children's Center, IncJCrisis Nurse Program FY 02103 FY 03104 FY 04!05 %. INCREASE FYE 6!30103 FYE 6130104LLLLLL, FYE 6!30105 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (eoL C-COL Byeol B REVENUES BUDGETED BUDGETED 1 Children's Services Council-St Lucie 2611250.00 70,000.00 141 ,817.00 102.600/a 2 Children's Services Council-Martin 24,363.00 25,000.00 61 ,087.00 144.35% 3 Advisory Committee4ndian River 25,000.00 20,250.00 23,956.00 18.30% 4 United Way-St Lucie County 20,000.00 59000.00 66,273.00 1265.46% 5 United Way-Martin County 12,531.00 15,000.00 29,408.00 96.05% 6 United Way-Indian River County 11 ,533.00 #DN/DI 7 Department of Children & Families 171 000.00 1719000.00 0.000100.OD% a County Funds 0.00 #DIV/01 9 Contributions-Cash 5,378.00 O.DO #DN/01 10 Program Fees 0.00 #DN/Ol 11 Fund Raising Events-Net 0.00 #DN/Ol 12 Sales to Public-Net 0.00 #DIV/01 13 Membership Dues 0.00 #DN/01 14 Investment Income 0.00 #DN/01 15 Miscellaneous O.OD #DIV/01 16 Legacies & Bequests 0.00 #DIV/0l 17 Funds from Other Sources 7,000.00 74,882.00 41 -35.43% i6 Reserve Funds Used for Operating 0.00 #DIV/01 19 In49nd Donations (Not tneludedintotaq 47,652.00 31 ,117.00 3211000.00 2.84% 20 TOTAL 291 ,522.00 381 ,132.00 384 423.00 0.86% EXPENDITURES 21 Salaries 201 212,989.00 210,313.00 -1 .26% 22 FICA 14,485.00 16,984.00 16,089.00 -5.27% 23 Retirement 321 .00 111720.00 3, 155.00 83.43% 24 Life/Health 7,312.00 171, 114.00 32,077.00 87.43% 25 Workers Compensation 7,272:00 9,792.00 3111197.00 -67.35% 26 Florida Unemployment 479.00 11118.00 999.00 -10.64% 27 Travel-Daily 7,557.00 9,500.00 8,000.00 -15.79% 28 Travel/Conferences/Training 1 ,689.00 2,000.00 2,D00.00 0.070/0 29 Office Supplies 21686.00 3,000.00 3,000.00 0.00% 30 Telephone 7,873.00 8,276.00 8,000.00 -3.33% 31 Postage/Shipping 248.00 300.00 300.00 O.DO% 32 Utilities 21897.00 2,976.00 3,DO0.00 0.81 % 33 Occupancy (Building & Grounds 7,314.00 7,590.00 . 8,000.00 5.40% 34 Printing & Publications 794.00 1 ,000.00 19000.00 0.00% 35 Subscri tion/Dues/Membershi s 1 ,889.00 2,OD0.00 2,000.00 0.00% 36 Insurance 3,004.00 3,209.00 3,000.00 -6.51 % 37 E ui mentRental & Maintenance 4,901 .00 6,500.00 5,000.00 -23.08% 38 Advertising 128.00 150.00 150.00 0.00% 39 Equipment Purchases:Ca ital Expense 311604.00 0.00 #DIV/01 40 Professional Fees (Legal, Consulting) 0.00 #DIV/01 41 Books/Educational Materials 0.00 #DIV/0l 42 Food & Nutrition 29701 .00 2,701 .00 21701 .00 0.00% 43 Administrative Costs 3411947.00 38,113.00 38t442.00 0.86% 44 Audit Expense 111213.00 1 ,300.00 17300.00 0.00% 45 Specific Assistance to Individuals 31 ,OO9.00 31 ,500.00 31 ,500.00 0.00% 46 Other/Miscellaneous 19191 .00 1 ,300.00 10200.00 -7.69% ' 47 Other/Contract 0.00 #DIV/01 43 TOTAL 350,072.00 381 ,132.00 384,423.00 0.86% 49 REVENUES OVER/ UNDER EXPENDITURES -581550.00 0.00 0.00 #DIVI01 It OIL, F i Y " RLI, `VILL ems. Ff" T t ' i" ..: - y. M r4: r 'v w k y .« _ r j n n. 1w , 041011' z • • • • • • • • AGENCY/PROGRAM • HibiscusChildren's Children'sAdvisory • FY 04105 04/05 OF TOTAL • • PROGRAM • A BUDGET • EXPENDITURES MR -- 1 11 1 11 1 ' / 1 : 1 Workers • • • i 1 1 1 t 1 Florida • • • • I111 11 1 11 1 11 ' , ; Office • • Elam I � Postage/Shipping Utilities 111 11 1 11 . 1 ! 1 ' , Occupancy (13tAlding & Grounds) Printin g & Publications 11 ! 11 1 11 i 1f ' , Equ ipm Advertising 1 11 1 11 t 11 ' , • • mmMPioirchases * Capital Expense 1Professional Fees (Legal , Consulting ) Books/Edu' cational Materials • • • & Nutrition Administrative Costs- - - Audit • Specific • Individuals 101 1 11 11 ® 1 11 1 11 ' • • c • Other/Coritract1 11 ® 1 11 1 o 777 M 1 r 2 ! 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"Fr s .IycS � : 3 w � Cx`: x . ::7,•. fiIRE . • ., y .� ;»:# .' & os„S . . ,;. .,n...< �fi` wM DepartmentMIIFJX �� No Department of Children & Families funding available._ �, = No Department of Children & Families funding available. Department of Children & Families funding available. No • available.• • 1 r am, 1 • • 1 • 1 • • 1 • I • • 1 • 1 • • 1 • • 1 - _ 1 • _ _ • • _ _ _ _ _ _ _ _ • - • - • • - . • _ _ • • - _ - • ■ 1 • I � • 1 7., 4r y �•�v, .. 5+ ,�.t 'Y.b t , !F. q � � - + 'w �a'�A.Sr .;a, � �w � 3 x: t ti31C.• _ { `" d F ` { fife: T' .'^- 111 111111111111 11111 111!1 :1111 11111111 111: 111 RON 11111111 111 11111C11 III I �i•"-4 ° 3r iia i a �A i a y '�.r R br:' r �. ,yl x %.� �y 6; •{ a j „ A ,, � ?� F�'"�'t 'f,.� +o�'�Se � '- } . ' . �'j dk,Ka �"! sn�s� tx�ilcx:t '�,SµsY '"a.'rY u�-hP'" y `•.h.-1 d'.N`Y 'S.e`�' '�+dm�- �;�' do s q ir��'t xX� v4�4� 'w��:�r�. "� � `�'�''�;.�- "`°a 'fa'S! . +5`_ :r �u. r .ta R`� "^ k*d i F' r ��4 '• • zE�� � � w � .; XK txa 4 ':� r' � fw t rl t'r'frsf.4^, +t�' am. '•'„,,. a - € *a, >;. �`�Y ... , " . i� �3.. -• w � �,; �»� rl 7 :, r�.+.r'�'��� , i'� :: X 3£ � q. ,�, �✓ ml �y = ''fih `� ,$.P,"'i� tfms '{ , . . ,:S.h' s•v' ffj .}d f �N � a �+�+r . 9 .ds .nu ,. a! Y �4�k i` . r .� y y Act' ": �"a � � v.Ai . > ;+ , 57� -�' „' r ';. r .� u . --.�i�g X td ,�,'�i7{ �`R•�,`t' s . . � ,v x' Sq'• ..,k �' �= " 4a t:•1� k.r�.�� .,,�t �+.#a. $.�': ate" u�y,�;• t �n=. m a, �.. �a 3'' � eFL' a..., . �:. :`f " C o a 0. �S•. :v.: �, v �e �. »�.`.., rr .� � a ��"" ,:.� a�Y�, v 7 „ u!2'Cya`,�''� S i t ,4 .,+ h �` +. 7 ;�rwu•�}+ ,"u1.c,�it`�A+'�`+p`.r�gf z .�r waN�rA•t, 6i;�la 'M uF . :°'"d%o' .. > :'a :n��a f'atn6-,i.�d'afa x r. r . t 't�' .r y,1•� �-1 + � � ;er..'%#=�`�Sri�•gy -Lg 3 . ytEr^p N i.e. ..¢ >� �3 F afi� �T rr �Pu �.t" ;:,?z;,�.� .q.'� q ... '�3<��T�x hf'�'; �y :,"`r 3' � �"x�r;�r �.�';°�c �y�z��° �,�r ` �> � � ,y,��'mrx :u$,,�rt + ' 4 �^x� • � t. x ;. r*'P" i* ;;« a'Ay `�r �3 ,• �"�`4�i '.'i'�''� ' h s . � � , w +4 k •k+ r b .a i i .a« ^°a Ya^ '*. "�" b. e . '?g� r < a t 1 at rc _..� FR K5 h .H', ,,. ,Jn4F Y ek •` s D y �°�f"`� � � ,i, x ru'3' r'i`iz <"'✓! f � 'b .�yy � K u NOT FOR PROFIT AGENCY CERTIFICATION The County of Indian River requires , as a matter of policy, that any Consultant or firm receiving a contract or award resulting from the Request for Qualifications issued by the County of Indian River, Florida , shall make certification as below. Receipt of such certification , under oath , shall be a prerequisite to the award of contract and payment thereof. I (we) hereby certify that if the contract is awarded to me, our firm , partnership , or corporation , that no members of the elected governing body of Indian River County, nor any professional management, administrative official - oremployee of the County, nor members of his or her immediate family, including spouse, parents , or children , nor any person representing or purporting to represent any member or members of the elected governing body or other official , has solicited , has received or has been promised , directly or indirectly, any financial benefit, including but not limited to a fee , commission , finder's fee , political contribution , goods or services in return for favorable review of any Proposal submitted in response to the Request for Qualifications or in return for execution of a contract for performance or provision of services for which Proposals are herein sought. The undersigned certifies that he/she is a principal or officer of the firm applying for consideration and is authorized to make the above acknowledgments and certifications for and on behalf of the applicant. The undersigned certifies that the Applicant has not been convicted of a public entity crime within the past 36 months , as set forth in Section 287 . 133 , Florida Statutes . Failure to si n this form will result in discivalfficaffon. Handwritten Signature of Authofriiz-ed. Principal(s): DATE: 51 sloq NAME: Cx ✓1 � TITLE: ^cbe .Ls NAME OF FIRM/PARTNERSHIP/CORPORATION : , "ren FOR DON BEHALF OF THE APPLICANT: Sworn to and subscribed to me, a NotaryP lic, this qday of 2004. - Br. Jan S . Huffert , CEO (SEAL) (TYPE NAME & TITLE) Indian River Board of County Commissioners 1840 25t!' Street + t f. V/ero Beach ; FL 32960 j �� A°'�� TRA s,:AvcrR j x . q COMMmSION +I� DD 02571 y n M8 .fir 'A r a r . {'� ♦ � k 4 f�� i'� � a yrW >,,,t� ; `vv.� ? Y13+vOTARV' . FL N01ery Service d {.. AA LFA"74f � `6 Y t3� s ' +ss t '�. " - �i','.`'�wF� � may; �;� 'p�`' 71�� , . •"�,: ` .a. '. . r r' ' M1 w. �� A • RAWArAf IF IF IF ' i y4 t }p"� r L` <lt "• t Y �• v ,,,Y +".,: `s'^� k� r xf �+ ` a a Y 3Wn*kvI' n' r Jru '� ft P } F m INNN • 'es " yy us �. , . K,«s � I �' rp�ip „� :#& ' _ � � °s �:K. yi ^ak, ' °d � ., Y i � ' �•is"a #�r � .xYi +� 1 �4 i Y`-%. '' ) s•,p f 4 �a� n� r ��ir�+ a 'yY �'"i.av3 a e:�a t v Lr p a. ` x z �x #'� a • � s :2�c. ` k; �;Yr � i 'rb,yjrH< ,t'� :7++ ;a�Ia"- �' •<vt+C. St ,; '`,�• .' k"o4" a t x i Pn :.,.z 5 „1 1 i 'Y�Gat , n S, • . <. �! s +5+ �' tiP�' '` AY. � s r 'd-? k': .. r �"`�� �, �3$' G'x'�M b ��<" � �� , , �.ti °'�' � ' " � �� S�y. � � ''"�� , °,kr+°Y,° .: `?� w #`a, ,+� �'R rt V3;l y� � d,•2,. .y �y.. 5 .'N,,:z':-., n. e-, _�.�rt * � ' ra �; . • - • Igo r I • HIM WN MEN IVII t ` (+5 '�>N,�¢+° ""LL�yiy'tLL�Fn �}19'—T�",� Y{t1}i.- h;3 jr.si'nM1```�' ( �. .W� PT.� �.( 9' �$� + �.f�"'yxwp•RieS�s,tY b{ rAM �wT'i ') � +1,TF,.kk't`1AyV'S.pYit M1"yPl"yTp a rPy ,f2V4 e* ;A •�' ,s f P . 8t ccJ et. s i G,,.,3 � .�t,\iksr{` .a ,$�,,�Y? M�i�;�t � : � ? £_srxS z�+` fx,3.;rj:�ig`, ki7y1.p,�'x,'[�,,;t,r �s ^` 5�aPe .<.qY:'_ sY5tae-`e 3t vial j.in;..p'.Y.y,'ya+tcti✓.. . .x:`:�,' saz'r+. rd".S .E.< Y,'?�a 1 'v w #Fv;�4. ,"�SaZru as'b.X`,Rr "a}.✓E"p{T` ,'{�.�yM,4B::-rtiA:�'CA.h i Sy�ahY�.T.ne.°1µ{3�x',",+<'.`yr,xr' MR t.;'.N�rv„yA�f£ay��dtisroz ,z r{v'ktra �>5� 5i 'Sr ' (F 50 1 understand that the relationship with a County Commissioner or County employee that must be disclosed as follows: Father, mother, son , daughter, brother, sister, uncle, aunt, first cousin , nephew, niece, husband , wife , father-in-law, mother-in-law, daughter- in4aw, son4n-law, brother-in-law, sister-in-law, stepfather, stepmother, stepson ,, stepdaughter, stepbrother, stepsister, half brother, half sister, grandparent, or grandchild . 6 . Based on information and belief, the statement, which I have marked below is true in relation to the entity submitting this sworn statement. [Please indicate which statement applies . ] X Neither the entity submitting this sworn statement, nor any officers , directors , executives , partners , shareholders , employees , members , or agents who are active in management of the entity, have any relationships as defined in section 105 . 08 , Indian River County Code , with any County Commissioner or County employee . The entity submitting this sworn statement, or one or more of the officers , directors , executives , partners , shareholders , employees , members , or agents , who are active in management of the entity have the following relationships with a County Commissioner or County employee: Name of Affiliate Name of County Commissioner Relationship or enti or employee (signature) 5 -2S- d %4 (date) f STATE OF GNU COUNTY OF The foregoing instrumentMas ack owledge eforg -me this c ZS day of 2004 , by aD ho is p onally known me or who has produced r 0zom as identification . NOTARY PUgklC , SIGN : t PRINT: State of Florida at Lq!o My Commission Expires : (Seal) � T A°BGc TRACY L SLAUGHTER � N(YCOMMISSION #' DD025716 �?'OFF�� Service 8 Borang, ik 'l jij, r Hibiscus Children' s Center Crisis Nursery Program Children' s Services Advisory Network Indian River County I. BUDGET FORMS X 1 . Financial Budget Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-21 J. FUNDER SPECIFIC/ADDITIONAL SHEETS X 1 . Not For Profit Agency Certification, . . * 0 0000 a 00 see 66600006 22 X 2. Authorization For Release Of Information . . . 23 X 3 . Sworn Statement Under Section 105 . 08, IRC Code, On Disclosure of 24-26 Relationships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . K. APPENDIX X 1 . List of current officers and directors X 2. Latest Financial Audit Report & Management Letter X 3 . IRS Form 990 X 4. Internal Financial Statement X 5 . Staff Organizational Chart X 6 . Annual Report X 7. 501 (c)(3 ) IRS Exemption Letter X 8 . Articles of Incorporation X 9. Agency' s Bylaws X 10. Agency' s written policy regarding Affirmation Action X 11 . Nepotism Statement w , . at1, e ^eYrF� fr ae tis. . TSS 'S 3 w c NW41 =.r r t g3� gt ' 3 ^ r ' •.V Hibiscus Children' s Center Crisis Nursery Program Children' s Services Advisory Network Indian River County ORGANIZATION: Hibiscus Children' s Center PROGRAM: Crisis Nursery Program TABLE OF CONTENTS Please "X the parts of the grant application to indicate that they are included Also, please put the page number where the information can be located. X I Section of the Proposal Pa e # X TABLE OF CONTENTS check list 1 -2 X COVER PAGE (with signatures) . . 609000 3 A. ORGANIZATION CAPABILITY (one page maximum) X 1 . Mission and Vision of organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 0 0 6 0 0 0 4 X 2 . Summary of expertise, accomplishments, and population served . . . . , . . . . 0 000 4 B. PROGRAM NEED STATEMENT (one page maximum) X 1 . Program Need Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 . . . . . . . . . . . . . . . . . . . . . . 00 . . 5 X 2. Programs that address need and gaps in service , . . * * woe we 90 0 * 000000 5 C. PROGRAM DESCRIPTION (two pages maximum) X1 . Funding priority . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . 00 , 019 . . . : 00 * 06e & Ilow , Is 6 X 2. Description of program activities . . 11 so so 0000 0 * 0 80066be 6 * 9 * we 0 woo 0 so * * , * 6 X 3 . Evidence that program strategy will work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-7 X4. Staffing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :. . . . . . . . . . . . . . . Do * 000 so a 000 son 000 7 X5 . Awareness of program . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . aa600so0 & * * so * 7 X6. Accessibility of program , , , , , , , , , , , , , , 0900 . . . . . . . . . . . . . . . . . . . . . 0 , 119 . . . . . . be & - - - ato * 00 7 X D. MEASURABLE OUTCOMES (two pages maximum) , , , , , , . . . . . . . , 0 0 , 0 * * * so 8 X , E. COLLABORATION (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 F. PROGRAM EVALUATION (two pages maximum) X 1 Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . go age & 60000000 , 10 X 2 . Measures . . . . . . woo woo 10 X 3 . Reporting . . . . .. . . . . . . . . . . . : . . : . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . : 0000 . . . 11 X G. TIMETABLE (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : 0000 12 H. UNDUPLICATED CLIENT COUNT X 1 . Projections by Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 ' X 2. Projections by Age Group 00 : 00 0000 . . . . . . . . . . . . . . . . . . . . . . . 13 r et * eta , , ✓ , 4 , `^ .� a a o ' :i FiA + :`v - 4th t9r � .. w' N 7 . . v r � .M. `§ x !+ tX + f`• f I � � ' is 3N •�¢" try, '�• a �' * ( Y h , x fdtt � �' "°�n' 'E'°"� :, ,. ;' '�"` I �s� yy Lh EXHIBIT B [From policy adopted by Indian River County Board Of County Commissioners on February 19 , 2002] " D . Nonprofit Agency Responsibilities After Award of 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 end (September 30th) must be submitted on a timely basis . Each year, the Office of Management & 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 expenses by type . These summaries should be broken down into salaries , benefits , 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." - 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 , 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 : Hibiscus Children 's Center Post Office Box 305 Jensen Beach , Florida 34958 Attention : Jan S . Huffert, 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 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 term and provision 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 the context indicates otherwise , words importing the singular number include the plural number, and vice 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. - 1 - Internal Revenue Service Department of the Treasury Elm el - - -- Director P . O . Box 13163 , Room 1550 Baltimore , MD 21203 FEBRUARY 5 , 1999 Employer Identification Number : 59- 2632361 HIBISCUS HOUSE , INC . Person to Contact : D/B /A HIBISCUS HOUSE EP / EO Tax Examiner PO BOX 305 JENSEN BEACH , FL 34958 Telephone Number $ ( 410 ) 962- 6058 • Dear Sir /Madam : This is in response to your inquiry dated JANUARY 4 , 1999 , requesting a copy of the letter which granted tax exempt status to the above named organization . Our records show that the organization was granted exemption from Federal Income Tax under section 501 ( c ) ( 3 ) of the Internal Revenue Code effective MARCH , 1987 . We have also determined that the organization is not a private foundation because it is described in section ( s ) 509 ( a ) ( 1 ) and 170 ( b ) ( 1 ) ( A ) ( vi ) . Donors may deduct contributions to you under section 170 of the Code . As of January 1 , 1984 , you are liable for taxes under . the Federal Insurance Contributions Act ( social security taxes ) on remuneration of $ 100 or more you pay to each of your employees during the calendar year . You are not liable for the tax imposed under the Federal Unemployment Tax Act ( FUTA ) . You are required to file Form 990 , Return of Organization Exempt from Income Tax , only if your gross receipts each year are normally more than $ 25 , 000 . However , if you receive a Form 990 package in the mail , please file the return even if you do not exceed the gross receipts test . If you are not required to file , simply attach the label provided , check the box in the heading to indicate that your annual gross receipts are normally $ 25 , 000 or less , and sign the return . A copy of our letter certifying the status of the organization is not available , however , this letter may be used to verify your tax-exempt status . Because this letter could help resolve any questions about your exempt status , it should be kept in your permanent records . Sincerely yours , w • Paul M . Harr gton District 'Director AMR—D. CERTIFICATE OF LIABILITY INSURANCE OP ID L DATE (MM/DDIYYYY) HIBIS - 2 10 / L5 / 04 ORODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE R . V . Johnson Agency , Inc . HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR _A1 TFR THE rn)LI=RArpl= _ - _ ------- - _ Stuart FL 34996 Phone : 772 - 287 - 3366 Fax : 772 - 287 - 4255 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Landmark Insurance Company_ Hibiscus Childrens Center Inc . INSURER B: Markel International &Hibiscus Childrens Foundation INSURER C: Bridgefield Employers Insuranc P 0 BOX 305 INSURER D : Jensen Beach FL 34958 INSURER E : COVERAGES 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. POLICY EFFECTIVE POLICY EXPIRATION LTR INSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 r 000 r 000 AGETO RENT Ems- -- -- — -- B X COMMERCIAL GENERAL LIABILITY 3602SS255610 - 0 07 / 12 / 04 07 / 12 / 05 PREMISES ( E aoccurence) $ 200 , 000 4s3CLAIMS MADE , Fx ] OCCUR MED EXP (Any one person) $ 15000 X Abuse / PERSONAL & ADV INJURY $ 110001000 Molestation $ 1 , 00O , Ooo / $3 , 000 , 000 GENERAL AGGREGATE , 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 3 , 0 0 0 r 0 0 0 POLICY PRO- JECT I I Loc Emp Ben . $ 1M/ $ 3M AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 11000 , 000 1002SS255617 - 0 07 / 12 / 04 07 / 12 / 05 B X ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTOEA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE s2 , 000 , 000 B X OCCUR EICLAIMSMADE 4602SS255623 - 0 07 / 12 / 04 07 / 12 / 05 AGGREGATE s2 , 000 , 000 RDEDUCTIBLE X RETENTION $ 10F000 $ WORKERS COMPENSATION AND TORY LIMITS X ER C EMP LOYERS' LIABILITY 0830 - 28580 02 / 22 / 04 02 22 ANY PROPP,IETOR/PARTNEPJEXECUTIVE / / O5 E.L. EACH ACCIDENT $ 500000 OFFICER/MEMBEREXCLUDED? E. L. DISEASE - EA EMPLOYEE $ 500000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500000 OTHER A Property Section LHD066474 07 / 12 / 04 07 / 12 / 05 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS 30 days notice of cancellation for workers compensation coverage . Companies have the option to cancel 10 days for non -payment . CERTIFICATE HOLDER CANCELLATION IND IA31 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 * DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 1840 25TH STREET REPRESENTATIVES. VERO BEACH FL 32960 AUT z PR NT I ACORD 25 ( 2001 /08) © ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED , the policy ( ies ) must be endorsed . A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s ) . If SUBROGATION IS WAIVED , subject to the terms and conditions of the policy , certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s ) . DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer( s ) , authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend , extend or alter the coverage afforded by the policies listed thereon . ACORD 25 ( 2001108 )