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HomeMy WebLinkAbout2005-328f 15� vJ INDIAN RIVER COUNTY GRANT CONTRACT This Grant Contract ("Contract" ) entered into effective this day of October 2005 , by and between Indian River County, a political subdivision of the State of Florida ; 1840 25th Street , Vero Beach , Florida , 32960-3365 ; and Gifford Youth Activity Center ( Recipient) , of: Gifford Youth Activity Center 4875 43`d Avenue Vero Beach , Florida 32967 Summer Cultural Camp Program Background Recitals A. The County has determined that is in the public interest to promote healthy children in a healthy community. B . The County adopted Ordinance 99- 1 on January 19 , 1999 ("Ordinance" ) , and established the Children 's Services Advisory Committee to promote healthy children in a healthy community, and to provide a unified system of planning and delivery within which children 's needs can be identified , targeted , evaluated and addressed . C . The Children 's Services Advisory Committee has issued a request for proposals from individuals and entities that will assist the Children 's Services Advisory Committee in fulfilling its purpose . D . The proposal submitted to the Children 's Services Advisory Committee and the recommendation of the Children 's Services Advisory Committee have been reviewed by the County. E . The Recipient , by submitting a proposal to the Children 's Services Advisory Committee , has applied for a grant of money ("Grant") for the Grant Period (as such term is hereinafter defined ) on the terms and conditions set forth herein . F . The County has agreed to provide such Grant funds to the Recipient for the Grant Period (such term is hereinafter defined ) on the terms and conditions set forth herein . NOW THEREFORE , in consideration of the mutual covenants and promises herein contained , and other good and valuable consideration , the receipt and adequacy of which are hereby acknowledged , the parties agree as follows : 1 . Background Recitals . The background recitals are true and correct and form a material part of this contract. 2 . Purpose of the Grant . The Grant shall be used only for the purposes set forth in the complete proposal submitted by the Recipient , attached hereto as Exhibit "A" and incorporated herein by this reference (such purposes hereinafter referenced as "Grant Purposes") . 3 , Term . The Recipient acknowledges and agrees that the Grant is limited to the fiscal year 2005/2006 ("Grant Period") . The Grant Period commences on October 1 , 2005 and ends on September 30 , 2006 . - 1 - } 4 . Grant Funds and Payment . The approved Grant for the Grant Period is : 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 Management and Budget . The fiscal year will be as reported on the application for funding , and the Recipient agrees to notify the County prior to any change in the fiscal period of Recipient . The Recipient acknowledges that the County may deny funding to any Recipient if an audit required by this Contract for the prior fiscal year is past due and has not been submitted by May 1 . 5 .4 . 1 . The Recipient further acknowledges that , promptly upon receipt of a qualified opinion from its independent auditor, such qualified opinion shall immediately be provided to the Indian River County Office of Management and Budget. The qualified opinion shall thereupon be reported to the Board of Commissioners and funding under this Contract will cease immediately. The foregoing termination right is in addition to any other right of the County to terminate the Contract. 5 .4 . 2 . The Indian River County Office of Management and Budget reserves the right at any time to send a letter to the Recipient requesting clarification if there are any questions regarding a part of the financial statements , audit comments , or notes . 5 . 5 . Insurance Requirements . Recipient shall , no later than September 21 , 2005 provide to Indian River County Risk Management Division a certificate , or certificates , issued by an insurer, or insurers , authorized to conduct business in Florida that is rated not-less-than Category A- :VII by A. M . Best, subject to approval by Indian River County's Risk Manager, of the following types and amounts of insurance : ( i ) Commercial General Liability Insurance in an amount not less than $ 1 , 000 , 000 combined single limit for bodily injury and property - 2 - 5 damage , including coverage for premises/operations , product/completed operations , contractual liability, and independent contractors ; ( ii ) Business Auto Liability Insurance in an amount not less than $ 1 , 000 , 000 per occurrence combined single limit for bodily injury and property damage , including coverage for owned autos and other vehicles , hired autos and other vehicles , non-owned autos and other vehicles ; and ( iii ) Worker's Compensation and Employer's Liability (current Florida statutory limit . ) . 5 . 6 . Insurance Administration . The insurance certificates , evidencing all required insurance coverages shall be fully acceptable to County in both form and content, and shall provide and specify that the related insurance coverage shall not be cancelled without at least thirty (30) calendar days prior written notice having been given the County. In addition , the County may request such other proofs and assurances as it may reasonable require that the insurance is and at all times remains in full force and effect . Recipient agrees that it is the Recipient's sole responsibility to coordinate activities among itself, the County, and the Recipient's insurer(s ) so that the insurance certificates are acceptable to and accepted by County within the time limits set forth in this Contract . The County shall be listed as an additional insured on all insurance coverage required by this Contract, except Worker's Compensation Insurance . The Recipient shall , upon ten ( 10) days prior written request from the County, deliver copies to the County, or make copies available for the County's inspection at Recipient's place of business , of any and all insurance policies that are required in this Contract. If the Recipient fails to deliver or make copies of the policies available to the County; fails to obtain replacement insurance or have previous insurance policies reinstated or renewed upon termination or cancellation of existing required coverages ; or fails in any other regard to obtain coverages sufficient to meet the terms and conditions of this Contract, then the County may, at its sole option , terminate this Contract . 5 . 7 . Indemnification . The Recipient shall indemnify and save harmless the County, its agents , officials , and employees from and against any and all claims , liabilities , losses , damage , or causes of action which may arise from any misconduct, negligent act, or omissions of the Recipient, its agents , officers , or employees in connection with the performance of this Contract. 5 . 8 . Public Records . The Recipient agrees to comply with the provisions of Chapter 119 , Florida Statutes (Public Records Law) in connection with this Contract . 6 . Termination . This Contract may be terminated by either party, without cause , upon thirty (30 ) days prior written notice to the other party. In addition , the County may terminate this Contract for convenience upon ten ( 10 ) days prior written notice to the Recipient if the County determines that such termination is in the public interest . 7 . Availability of Funds . The obligations of the County under this contract are subject to the availability of funds lawfully appropriated for, its purpose by the Board of County Commissioners of Indian River County . 8 , Standard Terms , This Contract is subject to the standard terms attached hereto as Exhibit C and incorporated herein in its entirety by this reference . - 3 - IN WITNESS WHEREOF , County and Recipient have entered into this Contract on the date first above written . INDIAN RIVER COUNTY BOARD OF COMMISSIONERS By: � <: 4 c. Thomas S . Lowther, Chairman BCC Approved : _ &4 4 S� Attest : J . K . Barton , Clerk By: Deputy Glork D' 1h Approved : I ~ i Jose h A. BaPr'd County Administ�alos '. ?b �' . 4•'°' Appr v a o form and legal sufficiency: Marian E . Fell , As y ttorney RECIPIENT : By: Gifford Youth Activity Center - 4 - EXHIBIT A (Copy of complete Request for Proposal ) EXHIBIT - A - The Gifford Youth Activity Center, Inc. — Cummer Cultural Camp Indian River County Children 's Services Advisory Committee PROGRAM COVER PAGE Organization Name : Gifford Youth Activities Center. Executive Director : Michael S . Hubler E-mail : mhubler@gyac . cc Address : 4875 43rd Ave . Telephone : (772) 794- 1005 x22 Vero Beach, FL 32967 Fax : (772) 569 - 5563 Program Director : Paul Baker E-mail : pbaker@gyac . cc Address : 487543 rd Ave . Telephone : (772) 794- 1005 x Vero Beach, FL 32967 Fax : (772) 569-55563 Program Title : Summer Cultural Camp. Priority Need Area Addressed: Mental Wellness ; Childcare Access Brief Description of the Program : Two week summer camp , scheduled in the two weeks prior to the start of the school year, emphasizing the arts through the use of team work and visual , musical and performing arts, reinforcing the six pillars of Character Counts . Held during a time when other options for child care are limited. Culminates in a grand finale, where parents/guardians are invited to participate . SUMMARY REPORT — (Enter Information In The Black Cells Only) Amount Requested from Funder for 2005 / 06 : $ 55 , 549 . 95 Total Proposed Program Budget for 2005 / 06 : $ 632180 . 00 Percent of Total Program Budget : 87 . 9 % Current Program Funding ( 2003 / 04 ) : $ 533000 Dollar increase / ( decrease ) in request : $ 25550 Percent increase / ( decrease ) in request * * : 4 . 8 % Unduplicated Number of Children to be served Individually : 300 Unduplicated Number of Adults to be served Individually : - Unduplicated Number to be served via Group settings : - Total Program Cost per Client : 210 . 60 * * If request increased 5 % or more, briefly explain why : If these funds are being used to match another source , name the source and the $ amount : The Organization 's Board of Directors has approved this application on (date) . John Dean Name of President/Chair of the Board Signature Michael S . Hubler Name of Executive Director/CEO Signature 3 The Gifford Youth Activity Center, Inc. — Cummer Cultural Camp ' Indian River County Children 's Services Advisory Committee PROPOSAL NARRATIVE Please respond to each question in the allotted space for each section . In responding to each section of the proposal narrative , please retain the section-label and/or question that you are addressing . Type using 12 pt. font on 8 '/2" X 11 " paper and number each page . These directions and the graphic boxes may be deleted if space is needed . A. ORGANIZATION CAPABILITY (Entire Section A not to exceed one page) 1 . Provide the mission statement and vision of your organization . GYAC Mission Statement is : With God ' s guidance our vision is to establish a partnership among youth, adults and the Gifford- Indian River County area that develops self-esteem, teaches character and encourages each individual to his/her ultimate potential . GYAC Vision is . To provide supplemental educational and character enhancing opportunities to children and families in the Gifford-Indian River Community to enhance their educational and personal development. In doing so , it is the GYAC ' s charge to enhance our children and families ' educational and professional success . 2 . Provide a brief summary of your organization including areas of expertise, accomplishments , and population served . The GYAC was established in 1998 to meet the educational and personal development needs of the Gifford-Indian River Community through supplemental children ' s education and family development opportunities . The GYAC has also established a network of programs to enhance behavioral outcomes of these children . The GYAC employs educational experts and partners with many organizations to provide these services . The GYAC has utilized the expertise of partners including : the Indian River County (IRC) School District, the Indian River Community College , Project Hope , Indian River Library System, the Cultural Counsel , the Vero Beach Museum of Art, the Riverside Children ' s Theater and many more . Successful programs include : Upward Bound, the Freedom School , the Cultural Camp, the After School Program, the Preschool Early Literacy Program and much more . 4 The Gifford Youth Activity Center, Inc. — Cummer Cultural Camp Indian River County Children 's Services Advisory Committee Be PROGRAM NEED STATEMENT (Entire Section B not to exceed one page) 1 . a) What is the unacceptable condition requiring change ? b) Who has the need ? c) Where do they live ? d) Provide local, state, or national trend data , with reference source, that corroborates that this is an area of need . What : Limited number of affordable programs available to working parents in the two weeks prior to the start of school . Who : Children with risk factors such as qualifying for the free or reduced lunch program, living in single parent homes, alcohol tobacco or drug use , symptoms of depression, displaying anti-social behavior or dropping out of school . Many families have single parents or both parents working full time . Many parents find themselves stretched to the limit just trying to provide basic needs . Where : The numbers of school aged children living in Indian River County are located in the western, central and southern ends of the county . The children with the greatest socioeconomic need are centrally located in the county . Summer programs offered in the two weeks prior to school starting and programs for teens are limited. The Summer Cultural Camp offers productive, supervised activities that give children tools for living . The Summer Cultural Camp is held at GYAC , which addresses the need for a central location . From there, field trips and classes are arranged . Data : Figures form the Florida Department of Education indicate a steady increase in students in Indian River County eligible for the free or reduced lunch program . In 1999-200, the percentage was 39% and for 2001 -2002 , the figure rose to 46%, a 7% increase in just one year. This translates into 6 , 856 of the county ' s 14 , 904 students being eligible for the free or reduced lunch program . Data from the needs assessment conducted in 2002 by the Children ' s Services Advisory Committee indicated that the percent growth in impoverished families with children in Indian River County had a 46% rise from 1990-2000 . A subsidized childcare and wait list chart in that same report indicated that there is a capacity for 182 in-school children, but the need is for 250 , revealing a gap of 68 that need a place for childcare after school . Evident in the report was a need for mental wellness for children in our county . Prevention of mental distress and illness was the recommended outcome . The Summer Cultural Camp program gives each child the opportunity to identify a creative act that requires discipline and perseverance in mastering the craft, which gives the child a healthy outlet for expression, increases his or her feelings of self worth and gives the child constructive ways to spend spare time in healthy recreation . All of these skills assist in the prevention of mental distress and illness . 2 . a) Identify similar programs that are currently serving the needs of your targeted population ; b) Explain how these existing programs are under-serving the targeted population of your program . a) No similar programs exist. Most of the children that participate in the Summer Cultural camp participate in the County ' s recreation program, which ends at the end of July. This Summer Cultural Camp gives this particular group of children what could be the only opportunity they may have to be exposed to playing a musical instrument, learning how to paint or learning new steps to a dance . Boys & Girls Clubs and Dasie Bridgewater Hope Center will be operational at this time for day care needs . b) The above mentioned locations are all filled to capacity during these two weeks. 5 The Gifford Youth Activity Center, Inc. — Cummer Cultural Camp Indian River County Children ' s Services Advisory Committee C . PROGRAM DESCRIPTION (Entire Section C, 1 — 6, not to exceed two pages) 1 . List Priority Needs area addressed . Focus Area I . Mental Wellness Issues in Children ages 7- 18 . This program improves the capacity of children in Indian River County to succeed to adulthood in a safe , healthy, and productive manner by meeting the following objectives : Promotes enhanced emotional and social skills ; Provides early intervention screening for children ; Promotes life skills training and effective use of emotional and social skills ; Promotes independent living skills ; Promotes accessible locations for healthy, productive activities . Focus Area II . Childcare Access . This program supports caregivers , a child ' s most important resource, to be and do what is needed to shepherd children to adulthood in a safe, healthy, and productive manner by meeting several stated objectives . Increases the availability of affordable quality childcare ; increases access to affordable extended/after school programs ; increases access to cultural and ethnic activities ; increases tutorial and mentoring programs . 2 . Briefly describe program activities including location of services . The main activities of this program are chosen to provide children and teens with creative tools to help them succeed to adulthood in a safe, healthy and productive manner. Community artists teach the classes in visual , performing and musical arts . The final production involves cooperation and teamwork . Character Counts ! activities are built into the program. Field trips to cultural venues, such as the Environmental Learning Center, McKee Botanical Garden, the Vero Beach Museum of Art, Vero Beach Theatre Guild and Riverside Theatre are part of the enrichment experience . Classes are held in many of these locations , as well as the Gifford Youth Activities Center. Recreational activities, such as swimming and bowling are also a part of the program activities . The anti-drug use message is part of the program , presented by the DATA . 3 . Briefly describe how your program addresses the stated need/problem . Describe how your program follows a recognized " best practice" (see definition on page 12 of the Instructions) and provide evidence that indicates proposed strategies are effective with target population . Several studies cite the use of the arts as a prevention tool and for positive development of children . A recent report issued to the Florida Senate from the Committee on Criminal Justice in December 2002 , entitled "Review Effectiveness of Juvenile Programs that use a Visual and Performing Arts-Based Intervention Approach" summarized numerous studies that illustrate the positive impact these types of arts programs, especially ones containing mentorship opportunities and relationships to the community, influence at-risk children toward positive goals and behaviors . ( The Arts and Prosocial Impact Study, Rand, 1999 .) Students who have been consistently involved in music and theatre exhibit higher levels of success in math and reading . (Secretary 's Commission on Achieving Necessary Skills, U . S . Department of Labor, 1991 ) A lengthy national project that studied children form low income backgrounds found that those exposed to arts learning were more likely to be class officers, involved with math and science fairs and to be recognized with a writing award. (Community Counts: How Youth Organizations Matter for Youth Development), Shirley Brice Health, Milbrey W . McLaughlin, 2000 . Exposure to arts impacts the developmental growth of children and helps to equalize the learning curve that cuts across diverse socio-economic backgrounds . (UCLA Imagination Project, Americans for the Arts , 1998) By providing arts opportunities and choices at a young Cage , children become motivated and engaged in this healthy outlet for expression. 6 The Gifford Youth Activity Center, Inc. — Cummer Cultural Camp Indian River County Children ' s Services Advisory Committee 4. List staffing needed for your program , including required experience and estimated hours per week in program for each staff member and/or volunteers (this section should conform with the information in the Position Listing on the Budget Narrative Worksheet) . Professional Staff: Camp Director ( 1 ) : Reports to the GYAC Program Director. Experience required with both arts and education. Coordinates and oversees all aspects of Camp operations . Including : Hiring, orienting, training and evaluating staff; represents GYAC within the community, and with students and their parents ; orders supplies and materials to facilitate programs ; tracks attendance ; administers the pre and post test to all participants ; evaluates program and finalizes after-action report for submission to GYAC and IRC-Children ' s Services . Required : Bachelor ' s Degree . Contractual position for 400 hours at $ 16 . 50 per hour as follows : April - 40 hours, May — 50 hours, June — 100 hours , July — 100 , August — 110 hours = $ 6 ,600 . Administrative Counselor ( 1 ) : Reports to the Camp Director. Responsible for program registration ; attendance and food service records . Assist in program and logistics planning ; assists in hiring of Camp staff. 225 hours at $ 11 . 00 per hour = $2 ,475 . Creative Leaders(3 ) : Reports to the Camp Director . Each responsible for one of the three program areas : visual, musical or performing arts . Responsible for the program content and cohesiveness of the overall arts instruction. Oversees Art Instructors . 110 hours at $ 15 each = $4950 . Art Instructors( 16) : Reports to the Creative Leaders and the Camp Director. Develop and execute lessons plans in either visual , musical or performing arts . Required : Experience in teaching arts to children, experience with either visual , musical or performing arts . Contractual position for 30 hours of instruction = $ 17 ,280 . Activity Supervisors ( 16) : Reports to their assigned Creative Leader and the Camp Director. Responsible for assisting with the arts instruction and the overall supervision of the children in their assigned group . 80 hours each at $ 10 = $ 12 , 800 5 . How will the target population be made aware of the program ? First, students that have already participated in the program receive notification by mail . Flyers are distributed to Boys & Girls Clubs and Dasie Bridgewater Hope Center. Spaces are reserved for the collaborative partners . This includes , the Homeless Assistance Center, United for Children : Foster Care Children, Youth Guidance, Hiz Kidz, Gifford Youth Activities Center and the Truancy Prevention Program . Churches and other community organizations receive information by mail . A public notice is published in the newspaper and the county recreation department publishes the information in their summer brochure . Openings usually fill up quickly with this outreach but word of mouth brings more families to inquire . 7 The Gifford Youth Activity Center, Inc. — Cummer Cultural Camp Indian River County Children ' s Services Advisory Committee 6 . How will the program be accessible to target population (i. e. , location , transportation , hours of operation) ? Parents/Guardians will be responsible to bring their children to GYAC . GYAC is centrally located in the county to ease travel concerns . Transportation will be provided for field trips . Hours of operation for the Summer Cultural Camp are 8am to 4pm, Monday through Friday, with aftercare provided until 6pm. 8 The Gifford Youth Activity Center, Inc. — Cummer Cultural Camp Indian River County Children 's Services Advisory Committee D . MEASURABLE OUTCOMES (Description of Intent) Use the Measurable Outcomes form. This description page does not need to be included in the proposal. In order to show the impact that your program is having on the target population and the community, the funders are requiring measurable outcomes . Please review the examples and summaries below to insure your understanding of what is expected . OUTCOMES : Describes what you want to achieve with the target population . Indicates the results of the services you provide, not the services you provide . Outcomes utilize action words such as maintain, increase , decrease , reduce, improve, raise and lower. ACTIVITIES : Describes the tasks that will be accomplished in the program to achieve the results stated in the outcomes . Activities utilize action words such as complete, establish, create, provide , operate , and develop . The activities should reflect the services described in the PROGRAM DESCRIPTION (C2) . Use the following elements to develop your outcomes. All elements must be included.• • Direction of change • Timeframe • Area of change • As measured by • Target population • Baseline : The number that you will be • Degree of chane measuring against Example 1 (Outcome) : To decrease (direction of change) number of unexcused absences (area of change) of enrolled boys and girls (target population) by 75 % (degree of change) in one year (time frame) as reported by the 2003 School Board attendance records (as measured by) . Baseline : 2003 School Board attendance records for enrolled boys and girls . Example 1 (Activity) : To provide anger management classes to enrolled boys and girls 2 times a week for 12 weeks . Example 2 (Outcome) : 75 % (degree of change) of youth (target population) who have participated in the academic enrichment activities (as measured by) for 6 months or more (timeframe), will improve (direction of change) their scores in one or more subject area (area of change) . 25 % of participants in academic enrichment activities will maintain the initial level of performance assessed at entry . Baseline : Pre-test scores from the academic enrichment test. Example 2 (Activity) : 1 ) Provide pre and post-test exercises on the Advanced Learning System software ; 2) Participants will go through the one lesson per week and be graded for 10 weeks . IMPORTANT NOTE : Keep in mind when developing your PROGRAM OUTCOMES , that if funded, this will be what you are held accountable to accomplish. Also , the PROGRAM OUTCOMES should reflect the information described in the PROGRAM NEED STATEMENT (B1 ) . All Program Need Statements should flow from the Mission & Vision . Measurable Outcomes should be based on and measure program needs . Activities are the tasks you do that are going to influence the outcome and impact the unacceptable condition in your Program Need Statement. 9 The Gifford Youth Activity Center, Inc. — Cummer Cultural Camp Indian River County Children ' s Services Advisory Committee D . MEASURABLE OUTCOMES (Entire Section D not to exceed two pages) OUTCOMES ACTIVITIES Add all of the elements for the Measurable Outcome(s) Add the tasks to accomplish the Outcome(s) 1 . 1 : Each child enrolled in the free or reduced 1 . Provide an increase in affordable arts and lunch program will be informed of the Summer cultural programs for children ages 7- 12 Cultural camp program . enrolled in the free/reduced lunch program by providing one , two-week program as measured 1 . 2 : Each child previously enrolled in the by other affordable programs offered at this Summer Cultural camp will receive time . information in the form of a flyer about the Baseline = 0 program . 2 . Increase appreciation of their own artistic 2 . 1 : Each camper will be given a pre-test on ability by children ages 7 - 12 as shown by an the first day of the program , increase in positive self-reports after the cultural camp experience as measured by a pre- 2 . 2 : Each camper will be given a post-test on test at the start of the program, compared to the the last day of the program . self-report on a post-test at the end of the program. 2 . 3 : Results from the pre-test & post-test will Baseline= pre-test scores be presented in the final report. 3 . Increase the number of positive and trusting 3 . 1 : Professional Art Teachers , in a variety of young adult and adult role models for children disciplines , will be recruited to staff the ages 7- 12 in the free/reduced lunch program as summer cultural camp . shown by self-reports after the cultural camp experience as measured by a pre-test at the 3 . 2 : Experienced Supervisors will be recruited start of the program, compared to the self- to staff the summer cultural camp . report on a post-test at the end of the program . Baseline= pre-test scores 4 . Provide a 100% increase in leadership and 4 . 1 : Expansion of the training program for the service learning through the arts opportunities teen volunteers will include leadership for children ages 13 - 18 during the summer development, character development and cultural camp. service learning through the arts elements . Baseline=0 4 . 2 : Teen volunteers will assist in the evaluation of the summer cultural camp , by providing input from their perspective . 10 The Gifford Youth Activity Center, Inc. — Cummer Cultural Camp Indian River County Children 's Services Advisory Committee OUTCOMES ACTIVITIES Add all of the elements for your Measurable Outcome (s) Add the tasks to accomplish the Outcome(s) 11 The Gifford Youth Activity Center, Inc. — Cummer Cultural Camp Indian River County Children ' s Services Advisory Committee E . COLLABORATION (Entire Section E not to exceed one page) 1 . List your program ' s collaborative partners and the resources that they are providing to the program beyond referrals and support. (See individual funder requirements for inclusion of collaborative a reement letters .) Collaborative Agency Resources provided to the program Cultural Council of Indian River Provide database of previous campers , provide database County of previous staff, identify appropriate arts disciplines, identify appropriate arts teachers . Youth Guidance Referrals of teen volunteers, provides expertise and consulting on teen training and volunteering issues . Indian River County School Assist in identifying appropriate children for the Specialists program Environmental Learning Center Facilities for instruction Instructors Ongoing communication & assessment of project Vero Beach Museum of Art Facilities for Field Trip Docents for tours United for Children : Foster Care Provide children for camp Children Hiz Kidz Provide children for camp Truancy Prevention Program Provide children for camp 12 The Gifford Youth Activity Center, Inc. — Cummer Cultural Camp Indian River County Children ' s Services Advisory Committee F. PROGRAM EVALUATION (Entire Section F not to exceed two pages) 1 . DEMOGRAPHICS : What information (data elements) will you need to collect in order to accurately describe your target population including demographics (age, gender, and ethnic background) required by the funder in Section H ? What are the pieces of information that qualify them for your target population ? How do you document their need for services or their "unacceptable condition requiring change" from Section B19. Necessary data will be collected from registration forms, it will be indicated that the information Will be used for grant reporting purposes only . Children that are participating in the free or reduced lunch program , have an additional risk factor identified by the student support specialist or teacher in a school , indication from a teacher that there is a strong interest in art all qualify students to attend this camp . The presence of risk factors will be documented and shared with staff, as deemed appropriate by the Camp Director . 2 . MEASURES : What data elements will you need to collect to show that you have achieved (or made progress toward) your Measurable Outcomes in Section D ? What tools or items are you using as measures (grades , survey scores , attendance, absences , skill levels) for your program ? Are you getting baseline information from a source on your Collaboration List in Section E ? Are there results from your Activities in Section D that need to be documented ? How often do you need to collect or follow-up on this data ? • Registration for use by instructors , teachers and support specialists . • Database of participating students, including demographic information and indicated risk factors . • Pre-test & Post-test • Identification of children with risk factors • Notify parents/guardians of children with risk factors to appropriate referral sources • Comparison of Pre-test & post test results . 3 . REPORTING : What will you do with this information to show that change has occurred ? How will you use or present these results to the consumer, the funder, the program , and the community ? How will you use this information to improve your program ? The most important information gathered would be the presence of risk factors indicted y the referring entity, instructors during the course of the program or at the end of the program . Parents & guardians will be involved in addressing these risk factors . A final report, including all test results, will be shared with the funder. All final reports are also on file at the GYAC office . C 13 The Gifford Youth Activity Center, Inc. — Cummer Cultural Camp Indian River County Children 's Services Advisory Committee G. TIMETABLE (Section G not to exceed one page) 1 . List the major action steps , activities , or cycles of events that will occur within the program year. New programs should include any start-up planning that may occur outside the funding year. In completing the timetable, review information detailed in prior sections . Month/Period Activities May 2006 • Contact all previous campers, staff, schools and collaborative partners . • Send out informational flyer in the first week of May • Assemble referrals form schools , returning campers and collaborative partners . • Create updated database • Assemble staffing • Secure sites for program June 2006 • Recruit staff for camp, both supervisors and arts instructors . • Start working on supply list. • Start framework for scheduling activities July 2006 • Finalize staffing • Finalize campers • Finalize classes August 2006 . Summer Cultural Camp is conducted in the last two weeks before school starts . • Conduct pre-test & post-test • Identify children with risk factors • Notify parents/guardians of children identified with risk factors to appropriate referral sources . September 2006 Office Wrap -up from program • Prepare final report 14 Number of Unduplicated by Location Vi v � . Tsca ( Sys,_ z , a rj ' ^ [eEiEj � f � 33W • • % r � Rc .,' ih 1^5t Location 3aaY ia;vra I; i Budget s� Z5 asV 1 _ 11 ' I Unduplicated 1 1 1 • 1 iii 1 1 • 1 IndianN. River Countyli 1 1Me ' 1 ' Indian ' 1Total BeachJensen Martin County Tot Co.Port Saint Lucie St. Lucie OtherLocations1 ■ ■ a � I [Lei Wei 51 '11151 1 1 11 Number I I 1 1 Clients 1 y Age �r Y2'� • o.,� ae/Ai +'`� A'. l k yr tS 'i d: , rAC� ��zA, S , �iFL+-r y,� �. ( K T N7 ehi a p 3�d .rt�_ y}V '-G il' all , Elf ti q' s _ i r ap il- ii "Ti ZN Location "' r . M . '.� . _ b n n p 1 to 4 - (Pre-schoo TotalTotal Children Adults Edit this Header. Tyne the organization and program name and the funder for whom it is being completed. The page # is already set at the bottom right of every page. I . BUDGET FORMS - To open the Budget Forms , please double-click on the icon below . " Core Budget Form s " 16 Type the Organization and Program Name UNIFORM GRANT APPLICATION BUDGET NARRATIVE WORKSHEET IMPORTANT: The Budget Narrative should provide details to justify the amount requested in each line item of the budget for you 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 : FUNDER : I CAUTION : Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in place. Gray areas shoult Abe used for calculations and to write information only. RAYAREASFore Pro/dosed Tota'I Pro ram FunderS ie REVENUES REVENUES AGENCY USE ONLY f g p. Total Agency (SHOW DETAIL a CALCULAmoNs) Budget Budget Budget 1 Children's Services Council-St. Lucie 2 Children's Services Council-Martin 3 Advisory Committee-Indian River 63, 180.00 55,549. 95 63, 180 . 4 United Way-St. Lucie County 5 United Way-Martin County 6 United Way-Indian River County 7 Department of Children & Families 8 County Funds 9 Contributions-Cash 10 Program Fees 11 Fund Raising Events-Net 12 Sales to Public it, Net 13 Membership Dues 14 Investment Income ... . . . . .. : . : . . . . 15 Miscellaneous 16 Legacies & Bequests 17 Funds from Other Sources 18 Reserve Funds Used for Operating 19 In -Kind Donations (Not included In total) 20 TOTAL REVENUES (doesn't include line 19) $63, 180. 00 $55,549.95 $63, 180 A D B C EXPENDITURES ' :'1 1Z GRAY AREAS FOR Proposed To#al Program FuntlerSpeclfic TotalA eric r ' . . AGENCY d5E ONLY _ g - y (SHOIVCALCULATIbNs) Budget Budget Bud of 21 Salaries - (must complete chart on next page) 44 , 105.00 44 , 105.00 44 , 105 o: Salary 22 FICA - Total salaries x 0. 07657 .65% 694.24 Retirement - Annual pension or qua I -e 23 staff 0.00 l e eat - e Ica enta ort-term 24 Disab. 0.00 Workers Compensation - # employees x 25 rate 375 .71 Florida Unemployment - # projected 26 employees x $7 , 000 x UCT-6 rate 0.00 A . p AL ARIS, GrAnnual B SEoss C % of:Gross A ?OSITIFON LISTING. Portion of Salary on Proposed nnq Salary Funder Specrfic'Budgei . ; Salary 'Program Posrt�on +Title}/ Total Hrs/wk (Agency) 9 9Requesfed(C/A) Example ?' Executn eDuector%40hrs 70, 000. 00 9 100000.00. 5;000.00 74.. 5/1 8/2005 sa Type the Organization and Program Name Camp Director ( 1 ) 6, 600. 00 6,600 . 00 61600. 00 100.0( Administrative Counselor ( 1 ) 2 , 475 . 00 21475.00 21475. 00 100 . 0( Creative Leaders (3) - Contractual 4 ) 950 . 00 41950.00 41950.00 100.0( Art Instructors ( 16) - Contractual 17, 280 . 00 17, 280 . 00 17,280. 00 100 . 0( Activity Supervisors ( 16) - Contractual 121800 . 00 12, 800 . 00 12 , 800. 00 100.0( #DIV/01 #DIV/01 #DIV/01 #DIV/01 #DIV/01 #DIV/0 ! #DIV/01 #DIV/0! #DIV/O! #DIV/01 #DIV/01 #DIV/O! #DIV/01 #DIV/0! #DIV/01 Remaining positions throughout the agency Total Salaries $440105.00 $44 ,105. 00 $44, 105.00 100.01 FRINGE BENEFITS DETAIL q (Funder SpecWc Budget Funder e c n e F G Specific FICA 7. 65% Pension yealfh Ins. . , Workers Mnemployme Totaf Fnnges Fund Cp/u111» :C Only, from line 22' to 27) (q X ' ) Compens nt Compens, Specific. Budget Posilioii71tle / Total HrsLwk Example .,- C'Qn ,Manager/ 40 rs . 5;000.00 382:50. 200.00 ; 50000' 414: 00_ 200:00 1,G9§ Camp Director ( 1 ) 60600 .00 504.90 273.24 778 Administrative Counselor (1 ) 21475.00 189.34 102.47 291 Creative Leaders (3) - Contractual 41950 .00 0.00 0 Art Instructors ( 16) - Contractual 179280 .00 0.00 0 Activity Supervisors ( 16) - Contractual 12, 800.00 0.00 1 0 0 0 .00 0.00 0 0 0 .00 0.00 0 0 0.00 0 .00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 1 0 0 0.00 0 .00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0.00 0 0 0.00 0 .00 0 0 0.00 0 .00 1 0 0 0.00 0.00 0 0 0. 001 0.00 0 Total Funder Request Fringe Benefits $44ol05.001 $694.24 $0.00 $0.00 $375 .711 $0.001 $ 1 ,069 A B C Q EXPENDlT. .URES . ' crurneEAs Foa Proposed Total. Program Funder Specific . To..tal A enc .::. AGENCY USE ONLY TO 6 ' _. g I . zsNown�rwi Budget ;Budget ;Budget•: , 27 Travel-Daily - Bus Transportation 5,600.00 4,200.00 51600 # of Staff x average # of miles/wk x 50 wks x $ = Estimated Daily Travel/Mileage Reimb. 28 TraveUConferences/Training 0. 00 0 . 001 0 S1 sn00s a-i Type the Organization and Program Name National Conference (cost per staff) Training/Seminar (cost per staff) Other Trainings (cost of travel , lodging , registration , food) 29 Office Supplies - Art Supplies 21500 . 00 21500.00 29500 . ( • Office supplies (monthly average x 12 months = estimated cost of office supplies based on present history. 30 Telephone 525 . 00 0.00 525 . ( # Phone lines x average cost per month x 12 months = local phone cost • Average long distance calls x 12 months = Estimated cost of long distance 31 Postage/Shipping 400.00 400. 00 400 . ( • Quarterly Mailing of Newsletter • Special events, etc. • Bulk mailings - appeals 32 Utilities 41400 .00 0.00 41400. 1 • Electricity ($ x 12 months) • Water/Sewer ($ x 12 months) • Garbage ($ x 12 months) 33 Occupancy ( Building & Grounds) 0.00 0.00 0 . 1 • Mortgage/Rent ($ x 12 months) • Janitorial ($ x 12 months) • Grounds Maint. ($ x 12 months) • Real Estate Taxes 34 Printing & Publications 400 . 00 400.00 400. • Quarterly Newsletter ($ x 4) • Letterheads, Envelopes, etc. • Fundraising materials • Other 35 Subscription/Dues/Memberships 0.00 0.00 0. Membership to National Organization • Dues • Subscriptions to Newspapers/magazines, etc. 36 Insura nce 11650. 00 0.00 11650. Directors/Officers Liab. Commercial/General Insurance Bond Ins. Auto Insurance 37 Equipment: Rental & Maintenance 0. 00 0.00 0. • Copier lease ( $ x 12 months) • Meter lease ($ x 12 months) • Copier Maintenance ($ x 12 months) Computer Maintenance ( $ x 12 months) Other 38 Advertising 400.00 400.00 400. Newspaper ads Fundraising ads/promotions Other (vacancies) 39 Equipment Purchases: Capital Expense 0 .00 0. 00 0 Computer/monitor (# x $) Laser Printer 40 Professional Fees ( Legal, Consulting ) 0 .00 0.00 0 • Legal advice ( estimated #hrs x $) • Consultant fees Other 41 Books/Educational Materials 0.00 0. 00 0 • Books/videos • Materials ($ x staff) 5/1W005 B-1 Type the Organization and Program Name 42 Food & Nutrition 0.00 0 . 00 0. • Meals ( # meals x clients x 5days x 50 wks) • Snacks 43 Administrative Costs 3, 000 . 00 0 .00 3 , 000. Admin . Cost ( % of total budget) 44 Audit Expense 200. 00 0.00 200 . Independent Audit Review 45 Specific Assistance to Individuals 0.00 0 .00 0. • Medical assistance • Meals/Food • Rent Assistance • Other 46 Other/Miscellaneous 0.00 2 ,475.00 0. • Background check/drug test • Other 47 Other/Contract 0. 00 0 . 00 0. Sub-contract for program services 48 TOTAL EXPENSES $639180.00 $55 .549 . 95 $63, 180 . 5/18/2005 B-1 Type D e OMMbafu " Pr°°ram Name UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET =REVENUES FY 03/04 FY 04/05 FY 05106 % INCREASE HE �E FYE CURRENT VS. NEXT FY BUDGET A B C O ACTUAL TOTAL PROPOSED Ic01. Cc01. BYcoL B BUDGETED BUDGETED 1 Children's Services Council-St. Lucie 0.00 #DIV/01 2 Children's Services Council-Martin 0.00 #DIV/01 3 Advisory Committee-Indian River 70 000.00 30 000.00 16, 097. 00 46.34% 4 United Way-St Lucie County0.00 #DIV/01 5 United Way-Martin County0.00 #DIV101 6 United Way-Indian River County0.00 #DIV/O! 7 Department of Children 8. Families 0.00 #DIV/01 8 County Funds 120 513 .00 122 443.00 1261000.00 2.91 % s Contributions-Cash 45 000.00136 750.00 165,000.00 20.66% 10 Program Fees 0.00 #DIVlOI 11 Fund Raising Events-Net 57500. 00 7 000.00 6,000.00 -14.29% 12 Sales to Public-Net 0.00 #DIV/01 13 Membership- Dues 21000.001 71500.00 61000.00 -20.00% 14 Investment Income 100 000.00 31000.00 -97.00% 15 Miscellaneous 0.00 #DIV/01 16 Legacies & Bequests 0.00 #DIV/01 17 Funds from Other Sources 274 545.00 199 500.00 267,303.00 33.99% 18 Reserve Funds Used for Operating 0.00 #DIV/01 19 In-Kind Donations (Mot Included 1n total) 0.00 #DIV/01 20 TOTAL 517 558.00 603193005 589,400.00 2.29% EXPENDITURES 21 Salaries 242 058.00294 226.00 312,000.00 6.04% 22 FICA 22 508.00 221919.00 23,000.00 0.35% 23 Retirement 8 827.00 8988.001 91000.00 0. 13% 24 Life/Health 27p363.001 28% 184.00 30 000.00 6.44% 25 Workers Com ensation12 626.00 12 853.00 13,000.00 1 ,14% 26 Florida Unemployment 11182.001 1 194.00 1 , 150.00 -3.69% 27 Travel-Dail 51738.001 11 358.00 2 000.00 -82.39% 28 Travel/Conferences/Trainin 3, 000.00 #DIV/0! 29 Office Supplies 14 508.00 18 002.00 181050.00 0,27% 30 Telephone 17 052.00 18 002.00 9,000.00 -50.01 % 31 Posta a/Shi in 3 300.003 501 .00 3,700.00 5.68% 32 Utilities 36 000.00 37 900.00 35,000.00 -7.65% 33 Occupancy (Building & Grounds 25 800.00 2790000 61500.00 -76.70% 34 Printing & Publications 0.00 #DIVI01 35 Subscription/Dues/Memberships 21t404.00 35 654.00 37,500.00 5.18% 36 Insurance 0.00 #DIV/01 37 E ui ment:Rental & Maintenance 0.00 #DIV/01 38 Advertising 0.00 #DIV/01 39 Equipment Purchases :Ca ital Expense 0.00 #DIV/01 40 Professional Fees (Legal, Consulting) 0.00 #DIV101 41 Books/Educational Materials 500.00 #DIV/01 42 Food & Nutrition #DIV/0l 43 Administrative Costs 61 087.00 81 ,000.00 32.60% 44 Audit Expense 4 650.00 650000 50000.01 -23.08% 45 Specific Assistance to Individuals 9,086.00 0.00 #DIV/01 46 Other/M iscel lane 0 ous 8j815.001 8 815.00 0.00 -100.00% 47 Other/Contract 0. 00 #DIV/OI 48 TOTAL 460 917.00 597 083.00 589 400.00 -1 .29% 49 REVENUES OVER/ UNDER EXPENDITURES 56 641 .00 6, 110 00 0. 00 -100.00% W ar. 05 9-2 I y°e die Organ®tion and Prtgr Name UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME : FY 03104 FY 04/05 FY 05106 % INCREASE FYE �E �E CURRENT VS_ NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED Icol. C-col. Bycol. B REVENUES BUDGETED BUDGETED 1 Children's Services Council-St Lucie 0.00 #DIV/01 2 Children's Services Council-Martin 0.00 #DIV101 3 Advisory Committee-Indian River 50 500.00 53 000.00 55 , 549.95 4.81 % 4 United Way-St Lucie County #DIV10l 5 United Way-Martin CountV 0.00 #DIV101 6 United Way-Indian River County- 0.00 #DIV/01 7 De artment of Children 8, Families 0.00 #DIV/01 8 County Funds 0.00 #DIV/Ol 9 Contributions-Cash 10 Program Fees 0.00 #DIV/010.00 #DIV/01 11 Fund Raisin Events-Net 0.00 #DIV/01 12 Sales to Public-Net 0.00 #DIV/01 13 MembershipDues 0.00 #DIV/01 14 Investment Income 0.00 #DIV/01 15 Miscellaneous 0.00 #DIV/01 16 Legacies & Bequests 0.00 #DIV/01 17 Funds from Other Sources 15 052.69 0.00 71630.05 #DIV/Ol 18 Reserve Funds Used for Operatinq 0.00 #DIV/01 19In-Kind Donations (Notincluded Intotal) 0.00 #DIV/0! 20 TOTAL 65 552.69 53 000.00 63, 180.00 19.21 % EXPENDITURES 21 Salaries 375.00 375.00 44, 105.00 11661 .33% 22 FICA 28. 69 28.69 0.00 -100.00% 23 Retirement 24 Life/Health 0.00 #DIV/DI 0.00 #DIV/01 25 Workers Compensation 0.00 #DIV/01 26 Florida Unemployment 0.00 #DIV/01 27 Travel-Dail 41000.001 4 000.00 59600.00 40,00% 28 TraveUConferenceslTrainin 29 Office Su 0.00 #DIV/Ol lies 100.00 80.00 2 500.00 3025.00% 30 Telephone 1 140.00 11140.00 525.00 -53.95% 31 Postage/Shipping 148.00 148.00 400.00 170.27% 32 Utilities 33 Occupancy (Building & Grounds 49400.00 #DIY/01 1 111 .00 1 111 .00 0.00 -100.00% 34 Printing & Publications 90.00 90.00 400.00 344.44% 35 Subscri tion/Dues/Membershi s 70.00 0.00 #DIV/Ot 36 Insurance 91000.00 51000.00 1 , 650.007.00% 6 37 E ui ment:Rental & Maintenance 0.00 #DIV-6 38 Advertising 01 400.00 #DIV/01 39 Equipment Purchases : Ca ital Expense 0.00 #DIV/01 40 Professional Fees (Legal, Consultin 22 537.00 22, 537.00 0.00 -100.00% 41 Books/Educational Materials 41750.00 21286.31 0.00 -100.00% 42 Food & Nutrition 0.00 #DIV/01 43 Administrative Costs 61528.001 0.003, 000.00 #DIV/01 44 Audit Expense 1 250.00 1 250.00 200. 00 84.00°/d 45 Specific Assistance to Individuals 0. 00 #DIV/01 46 Other/Miscellaneous 47 Other/Contract 14 425.00 0.00 #DIV/01 14 425.00 0.00 -100.00% 48 TOTAL 65o552. 69 52 471 .00 63, 180. 00 20.41 % 49 REVENUES OVER/ UNDER EXPENDITURES 0. 00 529. 00 0.00 -100.00% snanoas ea Type the Organization and Program Name UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME : FUNDER : A B C FY 04105 FY 04/05 % OF TOTAL FUNDER TOTAL VS . PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET (col. B/col. A) EXPENDITURES 21 Salaries 44, 105. 00 44, 105 . 00 100.00 % 22 FICA 0 . 00 694. 24 #DIV/01 23 Retirement 0 . 00 0 .00 #DIV/01 24 Life/Health 0 . 00 0 . 00 #DIV/01 25 Workers Compensation 0 . 00 375 .71 #DIV/Ot 26 Florida Unemployment 0 . 00 0 . 00 #DIV/01 27 Travel -Daily5, 600 . 00 4, 200 . 00 75. 00 % 28 Travel/Conferences/Training 0 . 00 0 .00 #DIV/01 29 Office Supplies 2, 500 . 00 21500 .00 100 . 00 % 30 Telephone 525 . 00 0 .00 0. 00% 31 Postage/Shipping400. 00 400 .00 100. 00% 32 Utilities 41400 . 00 0 .00 0 . 00% 33 Occu anc ( Building & Grounds 0 . 00 0 .00 #0IV/01 34 Printing & Publications 400. 00 400.00 100 .00% 35 Subscription/Dues/Memberships 0 . 00 0 .00 # DIV/0 ! 36 Insurance 11650. 00 0 .00 0 . 00% 37 E ui ment: Rental 8r. Maintenance 0. 00 0.00 #DIV/01 38 Advertising 400 . 00 400.00 100 . 00% 39 Equipment Purchases : Capital Expense 0 .00 0 . 00 #DIV/01 40 Professional Fees ( Legal , Consulting) 0 . 00 0.00 #DIV/01 41 Books/Educational Materials 0.00 0 .00 #DIV/Ol 42 Food & Nutrition 0. 00 0.00 #DIV/O ! 43 Administrative Costs 31000 . 00 0 . 00 0 .00% 44 Audit Expense 200. 00 0 .00 0 .00% 45 Specific Assistance to Individuals 0 . 00 0. 00 #DIV10I 46 Other/Miscellaneous 0 . 00 2 ,475. 00 #DIV/0 ! 47 Other/Contract 0 . 00 0 . 00 #DIV/01 48 TOTAL $63 , 180 . 00 $ 559549. 95 87,92%0 5/18!2005 _ B-4 Type Ne Otganizadan and Program Name UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: FUNDER : WWWWROL, ' �ir "rt ryY" vtf _i '�.:i)5f'1�, Y �. i+14y� 4 C t g 1' r rS G"i1""" _ • y"; ten^ + #DIV/0l #DIV/OI #DIV/0 ! #DIVI01 #DIV/01 #DIV/0! #DIV/01 #DIV/01 #DIV/OI #DIV/01 #DIV/01 #DIV/01 #DIV/01 #DIV/0! #DN/0l #DIV/01 #DIV/Of #DIV/01 Previously paid staff all as contractual, will begin paying partial staff as hired staff, contractual instructors are also incorporated in this Salaries total. #DIV/0l #DIV/OI #DIV/0! #DIVlOI Travel-Daily Daily bus transportation to take children to various programmatic instructional aspects of the progFam. #DIV/01 Office Su Iles Includes art supplies for children's use in the program. Calculated basaed upon number of children previously attended being sent information and sending confirmation letters to those Postage/Shipping accepted in the program. #DIVIOI Printing & Publications Cost of paper and toner to make promotional flyers. #DIV101 #DN/01 #DIV10l #DIV/0f #DIV/01 #DIV/Of #DIV/0l #DN/OI 51182005 B-5 TYPO the organization and Program Name UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE FUNDER SPECIFIC BUDGET AGENCYIPROGRAM NAME : FUNDER: ' st"/l1IEe'4JEIYl sw' �tcf'� ?" r FORsV ANA �:. - � i4�RIA'A/C Previously paid staff all as contractual, will begin paying partial staff as hired staff, contractual instructors are also incorporated in this Salaries total. #DIVIOI #DIVIOI #DIV/0l #DIVIOI #DIVIOI Travel-Daily Daily bus transportation to take children to various programmatic instructional aspects of the program. #DIVIOI Office Supplies Includes art supplies for children's use in the program- Calculated basaed upon number of children previously attended being sent information and sending confirmation letters to those Postage/Shipping accepted in the program. #DIVIOI Printinq & Publications Cost of paper and toner to make promotional flyers. #DIVI01 #DIVIOI Advertising Cost of add in the local IRC newspaper. #DIV/0l #DIVIOI #DIVIO! #DIVIOI #DIV10I #DIVIOI #DIVIOI Sn82005 63 INTERN4; REVENUE sE2v10E DH2aRTMEZIT OF THE TRS?_SiJP ` ? - O . BOX 2508 - CINCINNATI , off 44201 Date : OCT V 82002 Employer Lcenti � _ cation Number : 43 - 195091 ' DLN : 17053266015032 GIFFORD YOUTH ACTIVITY CENTER INC Contact Person : 4875 4 3RD AVE DALE T S CH_aBERu ' VERO BEACH , FL 32967 ID ,� 31175 Contact Telephone Number : ( 877 ) 829 - 5500 Accounting Period Ending : December 31 Foundation Status Classification : 509 ( a ) ( 1 ) Advance Ruling Period Begins : December 27 , 2001 Advance Ruling Period Ends : December 31 , 2005 Addendum Applies : No Dear ADPlicant : Based on information _Jou supplied , and assuming your operations will be as stated in your application for recognition of exemption , we have determined you are exempt from federal income tax under section 501 ( a ) of the Internal Revenue Code as an organization described in section 501 ( c ) ( 3 ) Because you are a newly created organization , we are not now making a final determination of your foundation status under section 509 ( a ) of the Code . However , we have determined that you can reasonably e_Vpect to be a publicly supported organization described in sections 509 ( a ) ( 1 ) and 170 ( b ) ( 1 ) ( A ) ( vi ) . Accordingly , during an advance ruling -period you will be treated as a publicly supported organization , and not as a private foundation . This advance ruling period begins and ends on the dates shown above . Within 90 days after the end of your advance ruling period , you must Scn� us the i= ori-riation needed to determi_e whether you ^ ave met the req„ „-o _ ments of the applicable support test during the advance ruling period . If you establish that you have been - a publicly supported organization , we will classi - fy you as a section 509 ( a ) ( 1 ) or 509 ( a ) ( 2 ) organization as long as you continue to meet the recuirements of the applicable support test . If you do not meet the public support requirements during the advance ruling period , we will classify you as a private foundation for future periods . Also , if we classify You as a private foundation , we will treat- you as a private foundation from Your beginning date for purposes of section 507 ( d ) and 4940 . Grantors and contributors may rely on our determination that you are not a Private foundation until 90 days after the end of _your advance rulinggperiod . If you send us the required information within the 90 days , grantors and contributors may continue to rely on the advance determination until we make Letze-r 1045 ( DO / C� ) GIFFORD POUT$ aCTIVITY ClEiNr7ER IF•TC a final determination of your foundation_ status . If we publish a notice in the Internal Revenue Bulletin stating that we will no longer treat you as a publicly supported organization , grantors and contributors may not rely on this determination after the date we publish the notice . In addition , if _you lose your status as a publicly supported organi - zation , and a grantor or contributor was responsible for , or was aware of , - the act or failure to act , that resulted in hour loss of such status , that person may notrely on this determination from the date of the act or failure to act . Also , if a grantor or contributor learned that we had given notice that you would be removed from classification as a publicly supported organization , then that person may not rely on this determination as of the date . he or she acquired such knowledge . If you change your sources of support , your purposes , character , or method of operation , please let us know so we can consider the effect of the change on your exempt status and foundation status . If you amend your organizational document or bylaws , please send us a copy of the amended document or bylaws . Also , let us know all changes in your name or address . - AS-0-f— rY°ter � �lable = or social security taxes under the Federal Insurance Contributions Act on amounts of $ 100 or more you pay to each of your employees during a calendar year . You are not liable for the tax imposed under the Federal Unemployment Tax Act ( FLTTA ) Organizations that are not private foundations are not subject to the pri - vate foundation excise taxes under Chapter 42 of the Internal Revenue Code . However , you are not automatically exempt from other federal excise taxes . If you have any Questions about excise , employment , or other federal taxes , please let us know . Donors may deduct contributions to you as provided in section 170 of the Internal Revenue Code . Bequests , legacies , devises , transfers , or gifts to you or for your use are deductible for Federal estate and gift tax purposes if they meet the applicable provisions of sections 2055 , 2106 , and 2522 of the Code . Donors may deduct contributions to you only o the extnt contributions are gifts , with no consideration received . Ticketrpurchases and similar payments in conjunction with fundraising events may not necessarily qualify as deductible contributions , depending on the circumstances . Revenue Ruling 67 - 246 , published in Cumulative Bulletin 1967 - 2 , on page 104 , gives guidelines regarding when taxpayers may deduct payments for admission to , or other participation in , fundraising activities for charity_ . You are not required to file Form 990Return Income Tax , if your gross receipts each year are normallga$25 , 000nor Iess .Exmptj + If if receive a Form 990 package in the mail , simply attach check the box in the heading to indicate that your annual gross lapel provided , normally $ 25 , 000 or less , and signt . 9- ss be t=pes are a public charity for return fiii the return . , Because you will be treated as Ing Purposes during Your ent period , you should file Form 990 re advance ruiinc for each _rear is your advance ruling period letter i0 " c QiC� ) GIFFORD YOUTH ACTIVITY CENTER INC that you exceed the $ 25 , 000 filing threshold even if your sources of support do not satisf_r the public support tesc specified in the heading of this letter . If a return is required it must be filed by the 15th day of the fifth month after the end of your annual accounting period . A penalty of $ 20 a day is charged when a return is filed lace . , unless there is reasonable cause for the delay . However , the maximum penalty charged cannot exceed $ 10 , 000 or 5 percent of your gross receipts for the year , whichever is less . For organizations with gross receipts exceeding $ 1 , 000 , 000 in any year , the penalty is $ 100 per day per return , unless there is reasonable cause for the delay . The maximum penalty for an organization with gross receipts exceeding $ 1 , 000 , 000 shall not exceed $ 50 , 000 . This penalty may also be charged if a return is not complete . So , please be sure your return is complete before you file it . You are not required to file federal income tax returns unless you are subject to the tax on unrelated business income under section 511 of the Code . = f _Icu are sup.:, j ec " to this tax , you Must Lite an income tax return on Form 990 - T , Exempt Organization Business Income Tax Return . In t'lis letter we are not determining whether any of your present or proposed activities are unre - a"ted-grade—ar—buus-rnesz—as—de£in on b13 o t e Code . You are required ' to make your annual information return , r^orn 990 or Form 990 - EZ , available for public inspection for three years after the later of the due date of the return or the date the return is filed . You are also required to make available for public inspection your exemption application , any supporting documents , and your exemption letter . Copies of these documents are also required to be provided to any individual upon written or in person recruest without charge other than reasonable fees for copying and postage . You may fulfill this requirement by placing these documents on the Internet . Penalties may be imposed for failure to comply with these requirements . Additional information is available in Publication 557 , Tax - Exempt Status for Your Organization , or you may call our toll free number shown above . You need an employer identification number even if you have no employees . If an employer identification number was not entered on your applia cation , e will assign a number to you and advise you of it . Please use that number on all returns - you file and in all correspondence with the Internal Revenue Service . If we said in the heading of this letter that an addendum applies , the addendum enclosed is an integral part of this letter Because this letter could help , us resolve any questions about _your exempt status and foundation status , ,you should keep it in your permanent records . . We have sent a copy of this letter to your representative as indicated in your power of attornev . fetter 20 = 5 i %C ,. ! .` l GIFFORD YOUTH ACTIV-. . Y C= INC If you have any questicns , please contact the person whose name and telephone number are shown in the heading of this letter . Sincerely _yours , Lois G . Lerner Ir Director , Exempt Organizations Enclosure ( s ) : i Form 872 - C Lecte _ 1. 045 ( DO / CG , EXHIBIT B ( From policy adopted by Indian River County Board of county Commissioners on February 19 , 2002 ) " D . Nonprofit Agency Responsibilities After Award Funding Indian River County provides funding to all nonprofit agencies on a reimbursement basis only. All reimbursable expenses must be documented by an invoice and/or a copy of the canceled check . Any expense not documented properly to the satisfaction of the Office of Management & Budget and/or the County Administrator may not be reimbursed . If an agency repeatedly fails to provide adequate documentation , this may be reported to the Board of Commissioners . In the event an agency provides inadequate documentation on a consistent basis , funding may be discontinued immediately. Additionally, this may adversely affect future funding requests . Expenditures may only be reimbursed from the fiscal year for which funding was awarded . For example , no expenditures prior to October Vt may be reimbursed with funds from the following year. Additionally, if any funds are unexpended at the end of a fiscal year, these funds are not carried over to the next year unless expressly authorized by the Board of Commissioners. All requests for reimbursement at fiscal year and (September 301h) must be submitted on a timely basis . Each year, the Office of Management and Budget will send a letter to all nonprofit agencies advising of the deadline for reimbursement requests for the fiscal year . This deadline is typically early to mid October, since the Finance Department does not process checks for the prior fiscal year beyond that point . Each reimbursement request must include a summary of expense by type . These summaries should be broken down into salaries , benefit, supplies , contractual services , etc . If Indian River County is reimbursing an agency for only a portion of an expense (e . g . salary of an employee ) , then the method for this portion should be disclosed on the summary. The Office of Management & Budget has summary forms available . Indian River County will not reimburse certain types of expenditures . These expenditure types are listed below. a ) Travel expenses for travel outside the County including but not limited to : mileage reimbursement , hotel rooms , meals , meal allowances , per diem , and tolls . Mileage reimbursement for local travel (within Indian River County) is allowable . b ) Sick or Vacation payments for employees . Since agencies may have various sick and vacation pay policies , these must be provided from other sources . c) Any expenses not associated with the provision of the program for which the County has awarded funding . d ) Any expense not outlined in the agency's funding application . The County reserves the right to decline reimbursement for any expense as deemed necessary." EXHIBIT - B - EXHIBIT C STANDARD TERMS FOR GRANT CONTRACT 1 . Notices . Any notice , request, demand , consent, approval , or other communication required or permitted by this Contract shall be given , or made in writing , by any of the following methods : facsimile transmission ; hand delivery to the other party; delivery by commercial overnight courier service; or mailed by registered or certified mail (postage prepaid ) , return receipt requested at the addresses of the parties shown below: County: Joyce Johnston -Carlson , Director Indian River County Human Services 1840 25th Street Vero Beach , Florida 32960-3365 Recipient : Gifford Youth Activity Center 4875 43rd Avenue Vero Beach , FL 32967 Attention : Michael Hubler, Executive Director 2 . Venue : Choice of Law . The validity, interpretation , construction , and effect of this Contract shall be in accordance with and governed by the laws of the State of Florida only. The location for settlement of any and all claims , controversies , or disputes , arising out of or relating to any part of this Contract, or any breach hereof, as well as any litigation between the parties , shall be Indian River county, Florida for claims brought in state court , and the Southern District of Florida for those claims justifiable in federal court . 3 . Entirety of Agreement . This Contract incorporates and includes all prior and contemporaneous negotiations , correspondence , conversations , agreements , and understandings applicable to the matters contained herein and the parties agree that there are no commitments , agreements , or understandings concerning the subject matter of this Contract that are not contained herein . Accordingly, it is agreed that no deviation from the terms hereof shall be predicated upon any prior representations or agreements , whether oral or written . It is further agreed that no modification , amendment or alteration in the terms and conditions contained herein shall be effective unless contained in a written document signed by both parties . 4 . Severability. In the event any provision of this Contract is determined to be unenforceable or invalid , such unenforceability or invalidity shall not affect the remaining provisions of this Contract, and every other provision and term of this Contract shall be deemed valid and enforceable to the extent permitted by law . To that extent , this Contract is deemed severable . 5 . Captions and Interpretations . Captions in this Contract are included for convenience only and are not to be considered in any construction or interpretation of this Contract or any of its provisions . Unless context indicates otherwise , words importing the singular number include the plural number, and vise versa . Words of any gender include the correlative words of the other genders , unless the sense indicates otherwise . 6 . Independent Contractor. The Recipient is and shall be an independent contractor for all purposes under this Contract. The Recipient is not an agent or employee of the County, and any and all persons engaged in any of the services or activities funded in whole or in part performed pursuant to this Contract shall at all times and in all places be subject to the Recipient's sole direction , supervision and control . 7 . Assignment . This Contract may not be assigned by the Recipient without the prior written consent of the County. EXHIBIT - C - 11 / 04 ' 2005 09 : 24 FAX 772 562 3466 SID BANACK INS , 12 001 sm N ' ACORD DATE (MWDDmry0l TM. CERTIFICATE OF LIABILITY INSURANCE Nava os PRODUCER 4TRIS CERTIFICATE Ia ISSUED A$ A MATTER OF INFORMATION 2 0435Ui0(3AL S HOBBS OF FLA INC /SID BANACK INS. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 2TN AVE. HOLDER. THOS CERTIFICATE DOES NOT AMEND, EXTEND OR P O BOX 130 ALTER THE E AFFORDED BY THE POLICIES IsEL OW, VERO BEACH FL 3296E INSURERS AFFORDING COVERAGE MAIC III INSURED ( INSURER A GRANITE STATE IN3-d-6— GIFFORD YOUTH ACTIVITY CENTER INSURER g: Progressive American Insurance Co. 24252 4875 43RD AVE I _ . ,_ VERO BEACH FL U96T INSURER C: � `- INSURER D: - - INSURER E COVERAGES THE POUCIES OF INSURANCE LISTEO OELOW NAVE BEEN 103UED TO THE INSURED NAMED ABOVE FOR THE POLICYPQFt*D INDICATED. NOTWTMSTANDING ANY AEUMM5 ENT, TERM OR CONDITION OF ANY CONTRACT OR OTTER DOCUMENT WITH RESPECT TOWHICH THIg CERTIFICATE MAY BE 135011) OR MAY PERTAK THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED 1{BRFW IS SUBJECT TO ALITHE TERMS, EXCLUSIONS AND CONDITIONS Of SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE PEEN REDUCED BY MID CLAW, LTRNEE OF WSUMNCE POLICY NUMBER POLICY EFFBCTWE roucYMpIRATIOM 1 LIMITS LTR I DATE DAn1 GENERA- LIMILITY 024.X-0489330.0/000 MAY 15 05 MAY 73 06 EACH OCCURRENCE S 1 , 00 1000 X COMMERCIAL GENE LIABIUT� BOE TO ft7M3 S 100 000 CL/UMS MADE( X OCCUR MEO. EXP (My one pown) S 3004() A I I PER30W I ADV IWURY 11000,000 GENERAL AGGREGATE Is 31000/GOO GEML AGGREGATE LIMIT' APPLIES PER, ,P UCTSCONPIOP AGG I g 1 00000000 POLICY NOJECT LOC . .. _..'"- --- - AUTOMOBILE LABILITY 02626305-1 APR 23 05 X ANY AUTO APR 23 06 IFO�MONEDISINGLE LIMIT i s 11000,000 ALL OWNED AUTOS ---111 BODILT INJURY SCHEDULED AUTOS I I ! Iry Deraw) g X {I HIRED AUTOS NON•CWNEDA�UTOS X I I BODILY INJURY SRY :x (Pw v0dent PROPERTY DAMAGE g per mcr*rE) GARAGE 1U01NTV ANY AUTO I AUTO�LI=EA ACCiOEN—T — I�3--- OTHER THAN EA ACC 1 s AUTO ONLY; —S EXCESS I UMBRELt�LIAt1UTY EACH OCCURRENCE S J OCCUR i�JI CLAIMS MADEAG REG GA7E g — OEOUCYIELE I - S _ . . RETENTION g - ; g WORKERS COMPENSATION AND I WDaTATU- O ER sMPLOYll" LM!UTY ca_ j ANY ►ROFM 0WARTN9Kq ECYTNE Elm WH ACCIDENT g OFFICER&WmX EML0907 E.L. DISE.45EFA ENPlOYEE I — e yolkaarnea unor _ . ,_ _ MECIAL frgYiEgIN bMw E.L. DISEASE-POLICY LIMIT 13 OTHER: I DESCRIPTION OF OPERATIONSiOCATIONSNEH(CLESIEXCLUSIONS ADDED DY ENDORSEMENT) SPECIAL PROVISIONS $ 1 ,000 DEDUCT18LE BODILY INJURY AND PROPERTY DAMAGE COMBINED PER OCCURRENCE INDIAN RIVER COUNTY IS NAMED AS AN ADDITIONAL INSURED WITH REGARDS TO THE GENERAL LIABILITY AND AUTO POLICIES WITH RESPECTS TO THE OPERATIONS OF THE NAMED INSURED, CERTIFICATE HOLDER —CANCELLATION SHOULD ANY OF TH9 A6QVE DESCRIBED POLICIES BE CANCELLED BEFORE TME EXPIRATION DATE THEREOF, THF ISSUING COMPANY WILL ENDEAVOR YO MAIL 10 DAYS MITTEN NOTICE TO THE CERTIFICATE NOLD%R NAMED TO THE LEFT, BUT FAILURE TO DO SO SNAUL W106E NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INDIAN RIVER COUNTY INSURER, ITS AGENTS OR REFRESENTATIVES. 11340 25TH STREET AUTHORIZi'D REPRESENTAT;VE VERO !BEACH, FL. 32960 Attention: woo Idney M a a�0!� � ACORD 25 (2001108) Certificate # 90774 ® ACORD CORPORATION 1988 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE OCT11705 w PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PAT O'CONNELL IN:'URANCE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1148 VISTA ROYALE %,QUARE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR VERO BEACH FL 329.:2 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PHONE : 772567.7774 FAX: 772-567.01 _ AQencLiC#: 4194679 66 INSURERS AFFORDING COVERAGE NAIC # _ —_ y INSURED i NSURER A: Westport Insurance — GIFFORD YOUTH ACTIVI-; Y CENTER , INC . ( INSURER B : P O BOX 339 1 INSURER C: VERO BEACH FL 32961 — INSURER D: INSURER E : — COVERAGES THE POLICIES OF INSURANCE LISTED BL '.OW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD WDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITIOk OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICh THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE A.FFORDEL BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY iAVE BEEN REDUCED BY PAID CLAIMS. �r TYPE OF INSURANCE I POLICY NUMBER Poucr EFFECTIVE I poucY EXPIRATION OMITS ILT DATE NOMDNY I DATE M,DDlYY lT GENERAL LIABILITY I EACH OCCURRENCE _ _$ FDAM4CE TO RENTED LIABILITY - i-- r� I I ! COMMERCIAL GENERALI $ �F 1i 1,5 .e rPa nruvencel _ CLAIMS MADE '� OCCUR I f MED. EXP (Any One Penson ) IS ---- -- - — -- _- I- { -- - —a ------ - t � PERSONALB ADV INJURY $ GENERAL .AGGREGATE $ — - GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/DP AGG . $ POLICY ' 1 AUTOMOBILE LIABILITY _ COMBINED SINGLE LIMIT � ANY AUTO I (Ea awdert) ALL OWNED AUTOS rSODR�TWJURY X SCHEDULEDAUTOS erson) -- HIREDAUTOS BODILY INJURY I $ i NON-OWNED ALTOS i I (Per acudenq f -- -- — i PROPERTY DAMAGE $ i GARAGE LIABILITY ! ! AUTO ONLY • EA ACCIDENT II5 ANY AUTO I OTHER THAN -- cA ACC I s — I •�` I , AUTO ONLY: AGG S IEXCESSIUMBERELLALIABILITY i I EACH OCCURRENCE _ S FL OCCUR I CLAIMS MADE AGGREGATE $ I 1 — — -- r I DEDUCTIBLE --il, RETENI.1014 S ( ~ S WORKERS CCMPENSATION AND VLfL 'X.79T2H1 I JAN 4 015 JAN 4 06 X wC STATJ- i OTHE2 EMPLOYERS' LIABILITY I A iANY PROPRIETOR+PARTNERIEXEWTIVE I ( EL EACH ACCIDENT : $ 'I UU,QOU OFFICENMeMBEREXCLUDE07 E.L. DISEASE•EA. EMPLOYE.E S 100 ,000 It yet, della t o Under SPECIAL PROVISIONS Mlaw , E.L DISEASE-POLICY LIMIT 500,000 ( OTHER: DESCRIPTION OF OPERATIONS/ LOC TIONIVEHICLESlEXCLUSIONS ADDED ENDORSEMENT/ SPECIAL PROVISIONS T.... CERTIFICATE HOLDER ADDITIGn LINSURED; INSURER LETTER : CANCELLATION INDIAN RIVER COUNTY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE BOARD OF COUNTY COIiHi`aSIO d FJWiRAT10N DATE THEREOF, THE ISSUING COMPANY VNILL ENDEAVOR TO MAIL 10 DAYS J/RITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT 11840 25TH STREET FAILURE TO DO SO SHALL IMPOSE NO OBL'GATION OR LIABILITY OF ANY KIND UPON THE VERO BEACH, FL 32960 INSURER, I•f'S AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Attention : ACORD 25 (2001 /06) Certificate # 1144 David O' Connell