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HomeMy WebLinkAbout2003-253J Indian River County Grant Contract This Grant Contract ("Contract" ) entered into effective this 1st day of October 2003 by and between Indian River County, a political subdivision of the State of Florida , 1840 25th Street , Vero Beach FL , 32960 ("County" ) and Cultural Council of Indian River (" Recipient") ; of: (Address ) Cultural Council of Indian River Courthouse Executive Center 214514 th Avenue - Suite 11 Vero Beach , Florida 32960 After School Arts 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 2003/2004 ("Grant Period") . The Grant Period commences on October 1 , 2003 and ends on September 30 , 2004 . - 1 - 4 . Grant Funds and Payment The approved Grant for the Grant Period is Thirty Five Thousand Dollars ( $35 , 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 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 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 23 , 2003 , 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 - 2 - t 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 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. 3 - 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 . IN WITNESS WHEREOF , County and Recipient have entered into this Contract on the date first above written . INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS By: enne . Macht , Chairm n Attest : J . K . Barton , Clerk By : Ap Deputy Clerk Approved : Oaj;�A qwf4 County Administrator Apr a as to form and legal sufficiency : It �. rian e s istan y oun Att , RECIPIENT : Cultural Council of Indian River Courthouse Executive Center 214514 th Avenue - Suite 11 Vero Beach , Florida 32960 IP04PBy : . L Nam Title 4 - 1 EXHIBIT A [Copy of complete proposal/application] - 1 - 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: Mary Jane Kelly, Director Cultural Council of Indian River Courthouse Executive Center 214514 th Avenue - Suite 11 Vero Beach , Florida 32960 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 - 1 - 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. - 2 - ' ESSEX INSURANCE COMPANY mmm COMMERCIAL LIABILITY DECLARATIONS 3 CH4 314 Policy Number Renewal of Number 3 CK3 3 0 8 Item 1 . Named Insured and Mailing Address : a�cPL`�` LI ' Ic`' r,. i irnn;is e t . gown _ r� *' '-.l3GUE2 iGi f ` S SuiiC =< 7 Cultural Council of Indian River Co . , Inc Casseiuerry FL 32707 2145 14th Avenue Ste : 11 Vero Beach , Fl 32960 PRODDAGISid Banack cITv�0 Bo 132 , FL This insurance is d u -jrto the FlonCeSurplus �ine5 � �• so. : insured rwve Item 2 . Policy Period From : 03 / 10 / 2003 To : 03 / 10 / 2004 Term : J!heyeartn of tile F: ., ; .7l-yinsi it ante IIdialSifT7,7 oT'tTe c, � . � tt Ci -.r.y r!ght of 12 : 01 A. M . Standard Time at the address of the Named Insured as stated herein. recovery for the oi,ligat on 01 any in ,olac;nt unlicensed insurer. File # Item 3 . Retroactive Date : Item 4. Business Description : Promotes the arts & cultural activities & programs Item 5 . In return for the payment of the premium , and subject to all the terms of this policy, we agree with you to provide the insurance as stated in this policy. This policy consists of the following coverage parts for which a premium is indicated . Where no premium is shown , there is no coverage . This premium may be subject to adjustment. Coverage Part (s) Form No . and Edition Date Premium Commercial General Liability Coverage Part $ 4 , 2 2 7 . 0 0 Professional Liability Coverage Part g Policy Fee $ 35 . 00 Service Fee $ 12 . 79 Tax $ 213 . 10 $ $ $ Audit Period Annual unless otherwise stated : Total $ 4 , 4 8 7 . 8 9 Item 6 . Forms and endorsements applicable to all Coverage Parts : 011 - 1054 ( 04 - 00 ) , 011 - 1061 ( 08 - 02 ) SHOW NUMBERS Agent Name and Address : Crump Insurance Services of Florida , Inc . 1211 Semoran Blvd , Ste : 227 Casselberry , FL 32707 Agent Number: 104990 Countersigned 03 /25 /2003 kp By DATE r THIS COMMERCIAL LIABILITY DECLARATIONS AND THE SUPPLEMENTAL DECLARATION , OGE TH ER�WiITH THE COMMON POLICY CONDITIONS, COVERAGE FORM (S) AND ENDORSEMENTS COMPLETE THE ABOVE NUMBERED POLICY. 011 - 1056 (9-93) INSURED s , 100 Cultural Council of Indian River County Web site: www.cultural-council.org E-mail: info(a)cultural-councilors Chairman Sheila B. Tucker October 20, 2003 Vice Chairman Richard Stark Treasurer Joyce Johnston-Carlson, Director JaniceBroda Children' s Services Advisory Committee Secretary C/O Human Services Ellen Fisher 1840 25th Street Board Vero Beach, FL 32960-3394 Ray Adams Nancy Bryant Dear Joyce, Jafar Falasiri Barbara Ferrell Peter Ford Philip Flynn This letter is to clarify that the Cultural Council of Indian River County contracts Dorothy Hudson with outside providers for transportation of students in the delivery of the Mazy app Marcia Loewinger Scholarship Program and the Summer Cultural Camp . Therefore, we do not carry Susan K. Mallinson BarbaraIvfiller Business Auto Liability Insurance . James Ostrand Robert L. Richardson Robert L. Temple Thank you for your attention to this matter. Commissioner Ken Macht Madc Wygonik Executive Director Sincerely, Mary Jayne Kelly A X, c.."oY M ' Jayne ne Kell � Y Executive Director Courthouse Executive Center ♦ 2145 W Avenue, Suite 11 ♦ Vero Beach, FL 32960 Phone : (561 ) 770-4857 ♦ Fax : (561 ) 770-3403 This program is sponsored in part by the State of Florida, Department of State, Division of Cultural Affairs, and the Florida Arts Council ' ESSEX INSURANCE COMPANY r ! MARKEL COMMERCIAL GENERAL LIABILITY COVERAGE PART SUPPLEMENTAL DECLARATIONS p, These Supplemental Declarations forma part of policy number 3 CK3 3 0 8 LIMITS OF INSURANCE General Aggregate Limit (other than Products/Completed Operations) $ 2 , 0 0 0 , 0 0 0 Products/Completed Operations Aggregate Limit $ 11000 , 000 Personal and Advertising Injury Limit $ 11000 , 000 Each Occurrence Limit $ 11 0 0 0 , 0 0 0 Damage to Rented Premises $ 501000 Each Occurrence Medical Expense Limit $ 1 , 0 0 0 Any One Perso BUSINESS DESCRIPTION AND LOCATION OF PREMISES COVERED BY THIS POLICY Form of business : El Individual O Joint Venture El Partnership ® Organization (other than Partnership or Joint Venture) Location of all premises you own, rent or occupy: 2145 14th Avenue Vero Beach , F1 32960 PREMIUM Description of Hazards/ Rate Advance Premium Insured Classifications Code No, * Premium Basis PR Co All Other Pr Co All Other Camps - - not - for - profit Including Products & 41422 0 ) 200 Campers Incl Flat $ Incl $ 3 , 738 . 00 Completed Operations ( summer ) Camps - - not for profit Including Products & 41422 0 ) 60 Campers Incl Incl Incl Incl Completed Operations ( after - school program Exhibitions - - in buildings - other than 63217 0 ) 2 events Incl 172 . 5 Incl 345 . 00 not - for - profit including products & completed operations Additional insured per ME009 144 . 00 TOTAL ADVANCE * (a) Area , (c) Total Cost , (m) Admission , (p) Payroll , (s) Gross Sales , (u) Units, (o) Other PREMIUM $ 4 , 227 . 00 FORMS AND ENDORSEMENTS other than applicable forms and endorsements shown elsewhere in thepolicy) Forms and endorsements applying to this Coverage Part and made part of this policy at time of issue : 011 - 1054 ( 04 - 00 ) 1 011 - 1095 ( 07 - 01 ) 8 ME - 001 ( 04 - 00 ) , ME - 001A ( 07- 01 ) , ME - 009 ( 04 - 99 ) , ME - 013 ( 05 - 02 ) , ME - 024 ( 09 - 00 ) , ME - 026 ( 10 - 99 ) , ME - 030 ( 04 - 99 ) , ME - 048 ( 04 - 99 ) , ME - 064 ( 04 - 99 ) , ME - 143 ( 04 - 99 ) , ME - 170 ( 08 - 95 ) , ME - 235 ( 08 - 02 ) , CG 00 01 ( 07 - 98 ) , CG 21 69 ( 01 - 02 ) THIS SUPPLEMENTAL DECLARATIONS AND THE COMMERCIAL LIABILITY DECLARATIONS , TOGETHER WITH THE COMMON POLICY CONDITIONS , COVERAGE FORM ( S) AND ENDORSEMENTS COMPLETE THE ABOVE NUMBERED POLICY . 011 - 1061 (8-02) INSURED ESSEX INSURANCE COMPANY MARKEL ADDITIONAL INSURED ENDORSEMENT * Entry optional if shown in the Common Policy Declarations. It no entry is shown, the effective date of the endorsement is the same as the effective date of the policy. *ATTACHED TO AND FORMING *EFFECTIVE DATE *ISSUED TO PART OF POLICY NO. OF ENDORSEMENT 3CK3308 03 / 10 / 2003 Cultural Council of Indian River Co . , Inc 2145 14th Avenue Ste : 11 THIS ENDORSEMENT CHANGES THE POLICY, SECTION II - WHO IS AN INSURED of the Commercial General Liability Form is amended to include: Person or Entity: Board of Indian River County Commissioners 1840 25th St . Vero Beach , Fl 32960 Interest of the Above: Political Entity as an additional insured under this policy, but only as respects negligent acts or omissions of the Named Insured and only for occurrences, claims or coverage not otherwise excluded in the policy. It is further agreed that where no coverage shall apply herein for the Named Insured , no coverage nor defense shall be afforded to the above-identified additional insured . L Moreover, it is agreed that no coverage shall be afforded to the above-identified additional insured for any "bodily injury, " "personal injury, " or "property damage" to any employee of the Named Insured or to any obligation of the additional insured to indemnify another because of damages arising out of such injury. Additional Premium : Incl . AUTHORIZED REPRESENTATIVE DATE M / E-009 (4/99) INSURED R*S OMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC990601A INFORMATION PAGE Insurer : Harbor Specialty Insurance Company Producer : Agent # 722 C/ O AmeriComp Administrators , Inc . Sid Banack Insurance 5951 Cattleridge Blvd . , Suite 200 P . O . Box 130 Sarasota , FL 34232 Vero Beach , FL 32961 ( Carrier Code : 35270 ) 024 Carrier Policy # : 099000004981202 1 . The Insured : Cultural Council of Indian RivereCountyr Policy : NEW Mailing Address : 2145 14 Ave # 11 Type of Business : Corporation Vero Beach , FL 32960 Other workplaces not shown above : Fein : 593299133 NO OTHER WORKPLACES FOR THIS POLICY Risk ID : 2 . The policy period is from 12 : 01 a . m . on 12 / 20 / 2002 to 12 : 01 a . m . on 12 / 20 / 2003 at the insured ' s mailing address . 3 . A . Workers Compensation Insurance : Part One of the policy applies to the Workers Compensation Law of the states listed here : FL B . Employers Liability Insurance : Part Two of the policy applies to work in each state listed in Item 3 . A . The limits of our liability under Part Two are : Bodily Injury by Accident $ 100 , 000 each accident Bodily Injury by Disease $ 5009000 policy limit Bodily Injury by Disease $ 100 , 000 each employee C . Other States Insurance : All states except Nevada , North Dakota , Ohio , Washington , West Virginia , Wyoming and states designated in item 3A D . This policy includes these endorsements and schedules : WCOOOOOOA ( 04 / 92 ) WC000308 ( 04 / 84 ) W0000414 ( 07 / 90 ) WC090606 ( 10 / 98 ) 4 . The premium for this policy will be determined by our Manuals of Rules , Classifications , Rates and Rating Plans . All information required below is subject to verification and change by audit . Classifications Code Premium Basis Rate Per Estimated No . Total Estimated $ 100 of Annual Annual Remuneration Remuneration Premium SEE SCHEDULE OF OPERATIONS Total Estimated Annual Premium $ 2 , 180 . 00 Minimum Premium $ 730 . 00 Ex onst t �' �w .�gO . 00 '� WC 99 06 01 A Countersigned by 1 s Internal Revenue Service Department of the Treasury P . O . Box 2508 Cincinnati , OH 45201 Date : February 15 , 2000 . Person to Contact : Vicki Adams 31 -04011 Customer Service Representative Cultural Council of Indian River County, Inc . TollFree Telephone Number : 214514 th Ave . Ste , . 111 877-829 -5500 Vero Beach , FL 32960-4413 Fax Number : 513-263 -3756 Federal Identification Number: 59 -3299133 Dear Sir or Madam : This letter is in response to our receiving your correspondence concerning your Advanced Ruling period which has been satisfied . Our records have been changed to reflect this . This letter will take the place of the copy you requested . Our records indicate that a determination letter issued in February 1996 granted your organization exemption from federal income tax under section 501 (c) (3) of the Internal Revenue Code . That letter is still in effect . Based on information subsequently submitted , we classified your organization as one that is not a private foundation within the meaning of section 509 (a) of the Code because it is an organization described in section 509 (a) (2) . This classification was based on the assumption that your organization' s operations would continue as stated in the application . If your organization's sources of support, or its character, method of operations , or purposes have changed , please let us know so we can consider the effect of the change on the exempt status and foundation status of your organization . Your organization is required to file Form 990 , Return of Organization Exempt from Income Tax , only if its gross receipts each year are normally more than $ 25 , 000 . If a return is required , it must be filed by the 15th day of the fifth month after the end of the organization's annual _accounting . period . The law imposes a penalty of $ 20 a day , up to a maximum of $ 10 , 000 , when a return is filed late , unless there is reasonable cause for the delay . All exempt organizations (unless specifically excluded) are liable for taxes under the Federal Insurance Contributions Act (social security taxes) on remuneration of $ 100 or more paid to each employee during a calendar year. Your organization is not liable for the tax imposed under the Federal Unemployment Tax Act ( FUTA) . Organizations that are not private foundations are not subject to the excise taxes under Chapter 42 of the Code . However, these organizations are not automatically exempt from other federal excise taxes . Donors may deduct contributions to your organization as provided in section 170 of the Code . Bequests , legacies , devises , transfers , or gifts to your organization or for its 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 . t -2- Cultural Council of Indian River County Inc. 59 - 3299133 Your organization is not required to file federal income tax returns unless it is subject to the tax on unrelated business income under section 511 of the Code . If your organization is subject to this tax, it must file an income tax return on the Form 990-T, Exempt Organization Business Income Tax Return . In this letter, we are not determining whether any of your organization ' s present or proposed activities are unrelated trade or business as defined in section 513 of the Code . The law requires you to make your organization ' s annual return available for public inspection without charge for three years after the due date of the return . You are also required to make available for public inspection a copy of your organization ' s exemption application , any supporting documents and the exemption letter to any individual who requests such documents in person or in writing . You can charge only a reasonable fee for reproduction and actual postage costs for the copied materials . The law does not require you to provide copies of public inspection documents that are widely available , such as by posting them on the Internet (World Wide Web ) . You may be liable for a penalty of $20 a day for each day you do not make these documents available for public inspection (up to a maximum of $ 10 , 000 in the case of an annual return) . Because this letter could help resolve any questions about your organization's exempt status and foundation status , you should keep it with the organization ' s permanent records . If you have any questions , please call us at the telephone number shown in the heading of this letter. This letter affirms your organization's exempt status . Sincerely, Robert C . Padilla Manager, Customer Service CHILDREN'S SERVICES ADVISORY COMMITTEE C/O Human Services 1840 2e Street Vero Beach, Florida 32960-3394 Phone: 561 -567-8000 (Ext. 467 or 524) Fax: 978-1798 E-Mail: JcarlsongDbcc.00.indian-river.fl.us MmastersonMbw.co.indian-river.fl . us To : Beth Jordan From : Joyce Johnston-Carlson Date : September 30 , 2003 Re : Grant Contracts 2003 -04 The attached is a Children ' s Service Advisory Committee Grant Contract for : Cultural Council of Indian River Please review the insurance certificate and verify that it is adequate by signing on the line below . Contact me if you have any questions . Thank you . , . 7 tt�ljga�c— Beth Jordan Date /o fi - a Cultural Council of Indian River County After School Arts Program Children's Services Advisory Committee - Indian River County PROGRAM COVER PAGE Organization Name : Cultural Council of Indian River County Executive Director : MarJayne Kelly Email : mjkelly@cultural-council . org Address : 2145 14th Avenue, Suite 11 Telephone : (772) 770 -4857 Vero Beach, Florida 32960 Fax : (772) 770-3403 Program Director: Annie Astley Email : info@cultural-council . org Address : 2145 14a' Avenue, Suite 11 Telephone : (772) 770-4857 Fax: (772) 770-3403 Program Title : After School Arts Program Priority Need Area Addressed: Mental Wellness: Parental Education, Childcare Access Brief Description of the Program: The After School Arts Program has been in operation for five years and has had a substantial impact on many youth Indian River County Classes are held after school or on Saturday mornings in Artists ' studios classrooms or community centers We describe offering an instructor at independent after school programs this year, anticipating that more children can be served by bringing the classes to where the ay lready are At the end of the year, students perform at the Children' s Art Festival and exhibit their art in the Carolyn Egeg_rt Children' s Gallery at the Vero Beach Museum of Art . Amount Requested from Funder for 2003 / 04 : $ 353000 Total Proposed Program Budget for 2003 /04 : $ 417795 Percent of Total Program Budget : 83 . 7 % Current Funding . (2002 /03 ) : $ 35 , 000 Dollar increase/(decrease) in request : $ _ Percent increase/( decrease) in request : 0 . 0 % Unduplicated Number of Children to be served Individually : 40 Unduplicated Number of Adults to be served Individually : Unduplicated Number to be served via Group settings : 45 Total Program Cost per Client : 491 . 71 Will these funds be used to match another source ? No If yes , name the source : Amount : $ _ The Organization 's Board of Directors has approved this application on (date). May 22, 2003 Sheila B . Tucker Name of President/Chair of the Board Signalure/ Mary Jayne Kelly Name of Executive Director/CEO Signature ` 3 Cultural Council of Indian River County After School Arts Prograin Children's Services Advisory Committee - Indian River County PROPOSAL NARRATIVE A. ORGANIZATION CAPABILITY (Entire Section A not to exceed one page) 1 . Provide the mission statement and vision of your organization. The mission of the Cultural Council of Indian River County is to nurture a cooperative environment in which cultural and educational organizations and individuals may thrive and thereby, enrich the quality of life in Indian River County for all residents and visitors . The vision of the organization includes being an integral part of the community by being involved, cooperating and collaborating with all entities that desire arts instruction, appreciation, planning or opportunities . 2. Provide a brief summary of your organization including areas of expertise, accomplishments and population served . The Cultural Council of Indian River County has been the county' s designated Local Arts Agency since 1995 . This designation requires this organization to promote cultural opportunities for the community, support cultural organizations and individual artists . It also requires that the Cultural Council work with other entities that desire to include the arts in their programs . This organization' s area of expertise is in collecting and disseminating cultural information to anyone in the County that requests it . We provide technical assistance in finding resources, such as qualified art instructors and supplies . We also work with other organizations to provide cultural experiences that enhance their mission. This organization has done this for many years through an after-school program and a Summer Cultural Camp, both of which emphasize the arts . All of the children are on the free or reduced lunch program, where economic indicators are less than favorable for extras such as arts instruction or opportunities . Instructors serve as positive role models, while teaching skills that can serve as a coping mechanism, career choice or a meaningful activity. The after-school program has retained many students for several years, having started in elementary school, now they are in high school. These students volunteer their time to assist the younger students during the camp. The after-school program has served about 65 children per school year and the summer camp has served over 230 children and teens in any given year. The response from participants and parents has been overwhelmingly positive . However, the program is at a stage where it must evolve for two purposes : to expose more children and teens to the arts and to nurture those students that exhibit exceptional talent . Building on the accomplishments so far, the Cultural Council would like to put arts instruction in locations where children already go after school. We would like to share our experience and expertise with other organizations so they can enhance their programs and we can all enhance the children' s experiences in after school care . It has been demonstrated that learning a skill in the arts helps a child to learn discipline while achieving a goal . A child ' s elf esteem is enhanced when the skill is performed or displayed . 4 Cultural Council of Indian River County After School Arts Program Children's Services Advisory Committee - Indian River County 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 trying to provide just basic needs . Time constraints force us to use the time we have efficiently and wisely. 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 at this time dwindle, programs for teens are limited . The Summer Cultural Camp offers productive, supervised activities that give children tools for living. The Summer Cultural Camp offers transportation to a central location in the morning (GYAC) . From there, field trips and classes are arranged . transportation Data : Figures from the Florida Department of Education indicate a steady increase in students eligible for the Free/Reduced Lunch Program statewide, Indian River County shows 39% of the children in the school system qualify for this program, which translates into 5935 eligible children. Data from the Needs Assessment conducted last year 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 sites and wait list chart in the same report indicated that there is a capacity for 182 in- school children, but the need is for 250, revealing ii gap of 68 needing a place for childcare after school. The Cultural Council is identified as an asset to the community in the service that we currently provide . The focus on the need for mental wellness in our children was evident in the report, especially for programs that prevent mental distress and illness . This program provides such a focus . 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) Boys & Girls Clubs, located in the Southern end of the County and in Sebastian, Gifford Youth Activities Center in Gifford, Dasie Bridgewater Hope Center in Wabasso and Children' s Home Society' s Home on 65 street are all located where the children in need are. b) In conversations with these entities, it was revealed that arts instruction was viewed as a desirable component but basic needs had to be met first . By the time basic needs are met; funds are scarce for including arts instruction. All acknowledged that arts instruction would enhance the program and the children' s experience in after school activities . Some organizations have volunteers that come and provide intermittent services, but not consistently. Consistency and dependability are the cornerstones of providing children with an environment that promotes mental wellness . 5 Cultural Council of Indian River County After School Arts Program Children's Services Advisory Committee - Indian River County C. PROGRAM DESCRIPTION (Entire Section C, 1 — 6, not to exceed two pages) 1 . List Priority Needs area addressed. Mental Wellness Issues Parental Support and Education Childcare Access 2. Briefly describe program activities including location of services . The main activities of this program are chosen to provide children and teens with tools to help them succeed to adulthood in a safe, healthy and productive manner, This program offers p creative classes in music, visual and performance arts in a variety of settings . Instructors for these classes are community artists that want to share their love of their craft with young people . Eligible children have an interest in the arts, participate in the free or reduced lunch program and/or have been referred to the program through the Student Support Specialist at their school . Some classes take place in schools, some in artist studios and others at community centers . Children placed in after school programs such as Gifford Youth Activities Center, Boys & Girls Clubs, Dasie Bridgewater Hope Center and Children' s Home Society have the opportunity to participate in these classes at their sites as well. The Teen Writer' s Workshops, held quarterly, also attract young people in off school hours, engaging them in productive activity. 3. Briefly describe how your program intends to address the stated need/problem . Include reference to any studies or evidence that indicate proposed strategies are effective with target population . Mental Wellness is the most important focus of this program. 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 programs have. 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, 199 1 ) 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 age, children become motivated and engaged in this healthy outlet for expression. 6 Cultural Council of Indian River County After School Arts Program Children's Services Advisory Committee - Indian River County 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: Experience required with arts and education, organizes classes and locations of classes, represents Cultural Council with instructors, parents and students . Assists parents with locations and transportation. Coordinates evaluation administration and collects required documentation from instructors and students . Required : Bachelor' s Degree; Contracted Position for 10 hours per week. Arts Instructors : Provides weekly lessons in a specific discipline such as sculpture, piano, voice, painting. Assists with administering evaluations, required documentation and reports . Determines need for supplies and materials within the budgetary guidelines . Responsible to Program Director and to keep the Cultural Council informed of any concerns or changes in their schedules . Assists with year end display and participation in the Children' s Art Festival. Required : Experience teaching art to children, experience with a specific artistic skill. Contracted Position for 1 . 5 Hours per week. Program Evaluator: Administers evaluation of program, interprets findings and screens for potential mental health risk factors for referral. Required : Bachelor' s degree in Psychology or related field, Advanced Degree in Counseling, Registered Art Therapist . Contracted Position for 40 Hours Total . Bookkeeper: Responsible for organization of records and administration of payments to contracted personnel and program related expenses . Keeps records pertaining to all grant expenditures, prepares request for reimbursements and quarterly reports . 3 % of time (5hours per month) 5. How will the target population be made aware of the program ? The targeted population will be made aware of the program in several ways . First, students currently enrolled in the program that have a desire and motivation to continue will be allowed to do so . Students that attend the Summer Cultural Camp will be made aware of the availability of the program. Schools Support Specialists will receive a memo in the Fall explaining the program and in what locations classes are available. All collaborative partners will receive memos explaining the program and what instructors are available for their site, so they can select what works best for their group . 6. How will the program be accessible to target population (i. e. location, transportation, hours of operation) ? The program is accessible to the target population at sites that are located throughout the County. Children will either take a bus to their location and parents/guardians will pick them up, or parents/guardians provide transportation. Classes take place immediately after school or on Saturday Mornings . 7 Cultural Council of Indian River County After School Arts Program Children's Services Advisory Committee - Indian River County D. MEASURABLE OUTCOMES (Description of Intent) OUTCOMES ACTIVITIES Add all the elements or the Measurable Outcome (s) Add the tasks to accomplish the Outcome (s) To increase the number of opportunities for Contact all independent after school programs arts classes or field trips for children enrolled to assess interest and scheduling of arts classes in independent after school programs by 50% and/or field trips . in one funding year as reported by the after school program records . Baseline : 2002 — 1 . 2 : 2003 funding year records of arts classes or Document 2002 —2003 funding year arts field trips in independent after school classes and field trips from program records . programs. 1 . 3 : Maintain records of arts classes and field trips for 2003 —2004 funding year for each participating program. 1 . 4 : Compare records of 2002 —2003 to 2003 — 2004 . 2 . 2 . 1 : To increase post test scores for children Administer Silver Drawing Test as pre-test to participating in arts classes by 10% in one participants in program in the first month of funding year as reported by the Silver Drawing program being operational . Test of Cognition and Emotion. Baseline : Pre-Test Scores on the Silver 2 . 2 : Drawing Test of Cognition and Emotion. Administer Silver Drawing Test as post-test to participants in the last month of program being operational. 2 . 3 : Identify children with risk factors indicated by test results . 2 . 4 : Notify parents/guardians of children identified with risk factors to appropriate referral sources . 2 . 5 : Compare Pre & Post Test Results 8 Cultural Council of Indian River County After School Arts Program Children's Services Advisory Committee - Indian River County 3 . 3 . 1 : To retain students already enrolled in the After Identify returning students enrolled in the After School Arts Program by 60% in one funding School Arts Program. year as indicated by the 2002 — 2003 funding year records . 3 . 2 . Baseline : 2002 — 2003 List of students for the Identify returning students that complete the after school program. program for the 2003 — 2004 funding year. 3 . 3 : Compare the beginning and end of year names to determine retention. 9 Cultural Council of Indian River County Atter School Arts Program Children's Services Advisory Committee - Indian River County D. COLLABORATION Entire Section E not to exceed one page) 1 . List your program ' s collaborative partners and the resources they are providing to the program beyond referrals and support. (See individual funder requirements for inclusion of collaborative agreement letters. Collaborative Agency Resources provided to the program Gifford Youth Activities Center Facilities for instruction Ongoing communication & assessment Participation in evaluation Boy' s & Girls Clubs Facilities for instruction Ongoing communication & assessment Participation in evaluation Dasie Bridgewater Hope Center Facilities for instruction Ongoing communication & assessment Participation in evaluation Children' s Home Society Facilities for instruction Ongoing communication & assessment Participation in evaluation Indian River County School District Facilities for instruction Ongoing communication & assessment Assistance with transportation Laura Riding Jackson Foundation Facilities for instruction Ongoing communication & assessment Participation in evaluation 10 Cultural Council of Indian River County After School Arts Program Children's Services Advisory Committee - Indian River County 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 Bl ? Necessary data elements will be collected from referral 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 or have an additional risk factor identified by the student support specialist or teacher from the school and indicate that there is an interest in learning about the arts qualifies them for the program. The presence of any of these risk factors indicates the need for services and the indicated risk factors will be documented for reference in the database. This information will be shared with the appropriate staff, which will take it under advisement . 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? • Referral Form for use by Instructors, Teachers and Student Support Specialists . • Information Sheet for Participating After School Programs • Database of participating students, including demographic information and indicated risk factors . • Records of arts classes and field trips held at participating independent after school programs, for baseline information and reporting information. • Silver Drawing Test of Cognition and Emotion: This test measures self-concept and provides visual indicators of risk factors . A Registered Art Therapist, with a Masters Level Education, scores the test. • Data collection and refinement will be ongoing. 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 indicated by the referring entity, instructors during the course of the program or at the end of the program. Parents and Guardians will be involved in addressing these risk factors . A final report will be shared with the funder and the community will have access to the results . The Silver Drawing Test results will be pooled with the researcher' s national data. All final reports are open to the public for review. 11 Cultural Council of Indian River County After School Arts Program Children's Services Advisory Committee - Indian River County 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 October 2003 • Contact all independent after school programs to assess interest and scheduling of arts classes and/or field trips . • Assemble referrals from schools, returning students and cultural camp attendees . • Document 2002 —2003 funding year arts classes and field trips from Participating independent after school program records . • Match students with appropriate sites and classes . • Set up records of arts classes and field trips for 2003 —2004 funding year for each participating program. November 2003 • Administer Silver Drawing Test as pre-test to participants in program in the first month of program being operational • Identify returning students enrolled in the After School Arts Program. October 2003 — May 2004 • Conduct classes and field trips . • Administer Silver Drawing Test as post-test to participants in the last month of program being operational . May 2004 • Program classes cease • Compare arts classes and field trip records of 2002 —2003 to 2003 — 2004 . • Identify children with risk factors indicated by test results . • Notify parents/guardians of children identified with risk factors to appropriate referral sources . • Compare Pre & Post Test Results June 2004 • Identify returning students that complete the program for the 2003 — 2004 funding year. • Compare the beginning and end of year names to determine retention. July 2004 • Prepare Final Report 12 £ i Sti Ob - LS - V9 GaAH3S 'IVIOZ - - (sroluaS) + 09 (sl inPV) - 69 0161 - (toorlo S tPH) - 81 0191 ZZ SZ - S £ - 8Z (aIPPTL) ' bi 03 11 £Z 91 - ZZ - 9E (A.rrluauralg) ' 0 i of S - (Ioogos-a rd) - tr of 0 dnoa s tjn eu ::dam"> � liI . I P. . 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V. . . M1 . . :V•• .:1�`V;:�VI .CJ4'}�':''�, ::M1 ' 4�M1M1 � f{•,.,:;:M1:;iihN• �• • M1M1M1`4l{IV4'.:M1M1•::.V.4:•.M1M1•:::.:�:• '•q•{{;:�;:•:•�y;:•�:: {{:'{•f.?•: i. ::• ��v / f/. '{ • •:::M1 44 •: �•:: .:. : , <Lti•:M1M1v •:.{tt"itn{Ci}:}:::Uir.;: if;::::•:{•i •i'•:iL:}}}::i:• i'nti:•> mils:::t��tif:•M1.::i��irh,•ltiltitiM1ti . l}\M1M1':ti;:'•h'•••::{`• �M1M1}:'•N•,1 L11��•�f:.4M1M1}•t: :•f.Y�.�{h::::: V1I•:•�.;,•h�•::: .:':: 4 :{{vtt}:v{nit•M1.i . .,viii{};;1::;: ii'h✓••.' . . . . . . .0Lx.... iir Y.v::•i::•M1.iYi::•jY3{ii::H:::; M1�'i:•i: :,{• :<,l?it? �: i:^:i i :'r,{:: ': : : :ytl{ •.;!..n{.; ;.'j, . .{y{}i4.}t�.,r>.. .4�.:'t::ty ii:};4M1.i M1.'•4.: :.M1M1 . .: . • Y{::{t�•'i':'}r .. . . . . . . . .l :;;::{:::,.•v Current Fiscal Year 1148. rr �yy}:'j%�{ �:a• - ::::4•:tt' . `j . .tt.T::{ . :: 1i {i`•'''if• (t >ti: ;::.4 .41 '. •' :lTT ::l ' ` T''f :: :':{: :.;!„; :;: nx;..:;2;%titt>.':<t:;itf,.;::tt. :t`.2�;^::t,: rt ;{t:tttt.'.;•::.M1•.;•: •: 4M1 M1••.;:•.::::::. YOU 44440446%: 'y{' :: A:•:•4.1.4.;. .�� .M1•t��:;t•:•h�:;?•{M'{;4•••ff:i:{•:{M1f�:::t�:•:1n:::tf1:::M1ti:f.\ > 1 < x` Budget 2002/03 _ ' hies ::`. Individuals . . . .. . . . . . . . . . . Familiesuts: .4::�4:::: ::: 1\::::vt�t: :: :::•.:•::::h::.:.M1•:::.:•::::: ::. Families Served 64 51 57 48 85 71 Single Parent - 44 - 39 - 56 Two Parent - 7 - 9 - 15 Teen Parents Served Ethnicity/Race White 19 23 25 19 30 25 Black/African American 29 18 18 17 30 25 Asian/Pacific Islander 3 1 5 3 American Indian Hispanic 16 10 11 11 20 18 Haitain Other Subtotal 64 51 57 48 85 71 14 Cultural Council of Indian River County/ After School Arts Program Children's Services Committee - Indian River 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 : Cultural Council of Indian River County/After School Arts Program FUNDER : Children's Advisory Committee = Indian River County CAUTION : Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in place. Gray areas should be used for calculations and to write information only. I r613 r 1 Children's Services Council-St. Lucie 0.00 2 Children's Services Council-Martin 0.00 3 Children's Services Council-Okeechobee 0.00 4 Advisory Committee-Indian River 35,000.00 359000 .00 88,000.00 5 United Way-St, Lucie County 0.00 6 United Way-Martin County 0.00 7 United Way-Okeechobee Coun 0. 00 8 United Way-Indian River County 0. 00 9 Department of Children & Families 0 .00 10 County Funds 126, 114 . 00 11 Contributions-Cash 31000 . 00 12 Program Fees 11000 .00 13 Fund Raising Events-Net 15,000 .00 14 Sales to Public - Net - 0.00 15 Membership Dues 9,000 .00 16 Investment Income 250 . 00 17 Miscellaneous - License Plate Funds 91000 .00 18 Le acies & Bequests 0 .00 19 Funds from Other Sources 61785 .00 7 ,000.00 20a Reserve Funds Used for O erating 0.00 20b In-Kind Donations (Not Included in total) "` 0.00 21 TOTAL REVENUES (doesn't include line 20b) $41 ,785.00 $35,000.00 $258,364.00 5 22 Salaries - (must complete chart on next page) 840.00 840 .00 73 ,000 .00 23 FICA - Total salaries x 0.0765 64 .26 91600. 00 e iremen - Annual pension tor qua i e 24 staff 0.00 Life/Health - e ica en o - erm 25 Disab. 0.00 7 ,000.00 Workers Compensation - emp oyees x 26 rate 0.00 Florida Unemployment - # projected 2T employees x $7,000 x UCT-6 rate 0.00 5/28/2003 15 s O O O �' " N O O O O O Q O 0 0 0 0 0 0 0 0 0 0 0 0 N ri o r 5C1;1 o c o o o o 0 c?, 0 0 0 CD 0 0 x ,�^� it ik # ik ik � # ik � ik # # # ik # ik 7k # � ` � •- E k C? 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L hour = $4500; Program Evaluator $20 per hour; 40 hours total $20 x 40 = $800 49 TOTAL EXPENSES $41 ,785.00 $34,482 .26 $258 , 364.00 5/28/2003 18 Cultural Council of Indian River County/ Mer School Arts Program Children's Services Committee - Indian River UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCY/PROGRAM NAME: Cultural Council of Indian River Count /After School Arts Pro ram FY 01/02 FY 02/03 FY 03/04 % INCREASE FYE_09/30/02_ FYE_09/30/03_ FYE_09/30/04 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (Col. C-Col. sycol. a REVENUES BUDGETED BUDGETED 1 Children's Services Council-St Lucie 0.00 0.00 0.00 #DIV/01 2 Children's Services Council Martin 0.00 0.00 0.00 #DIV/01 3 Children's Services Council-Okeechobee 0.00 0.00 0.00 #DIV/O! 4 Advisory Committee-Indian River 24 500.00 88 000.00 88 000.00 0.00% --- 5 United Way-St. Lucie County 0.00 0.00 0.00 #DIV/01 6 United Way-Martin County 0.00 0.00 0.00 #DIV/01 7 United Wa -Okeechobee County 0.00 0.00 0.00 #DIV/01 8 United Way-Indian River County 0.00 0.00 0.00 #DIV/01 9 Department of Children & Families 0.00 0.00 0.00 #DIV/O! 10 County Funds 68 591 .00 108 020.00 126 114.00 16.75% 11 Contributions-Cash 4 250.00 5,000,00 , 3.000.00 40.00% 12 Program Fees 940.00 1 000.001 000.00 0.00% 13 Fund Raisin Events-Net 17 500.00 3000000 15 000.00 -50.007 14 Sales to Public-Net 0.00 0.00 0.00 #DIV/0! 15 Membership Dues 89000,00 8 000.00 91000 .00 12.50% 16 Investment Income 106.00 200.00 250.00 25.00% 17 Miscellaneous - License Plate Funds 59524.001 80000.00 900000 12.50% 18 Legacies & Bequests 0.00 0.00 0.00 #DIV/OI 19 Funds from Other Sources 60400,001 7 000.00 71000,000.00% 20a Reserve Funds Used for Operating 0.00 0.00 0.00 #DIV/01 201b In-Kind Donations (Not Included in total) 0.00 #DIV/O! 21 TOTAL 135 811 .00 255 220.00 258 364.00 1 .23% „ w EXPENDITURES 22 Salaries 65 930.00 90 920.00 73 000.00 -19.71 % 23 FICA 5 040.00 14 400.00 9,600.00 -33.33% 24 Retirement 0.00 0.00 0.00 #DIV/01 25 Life/Health 41825.001 91000.00 71000.00 -22.22% 26 Workers Compensation 0.00 0.00 0.00 #DIV/O! 27 Florida Unemployment 0.00 0.00 0.00 #DIV/O! 28 Travel-Daily 172.00 5,000.00 5 000.00 0.00% 29 Travel/Conferences/Trainin 1 505.00 21000.00 2 000.00 0.00% 30 Office Supplies 1 773.00 2,000.00 250000 25.00% 31 Telephone 2 257.00 31500.00 31500,00 0.00% 32 Postage/Shipping 2p356.0 21000.00 2000,00 0.00% 33 Utilities 0.00 0.00 0.00 #DIV/O! 34 Occupancy (Building & Grounds 6 224.00 10 000.00 10 000.00 0.00% 35 Printing & Publications 7t294.00 10 000.0015 000.00 50.00% 36 Subscri tion/Dues/Membershi s 1 125.00 2100000 200000 0.00% 37 Insurance 91050.00 12 000.00 12 000.00 0.00% 38 E ui ment:Rental & Maintenance 11978,00 200000 2 800.00 40.00% 39 Advertising 1 ,684.00 300000 1 700.00 -43.33% 40 Equipment Purchases :Ca ital Expense 0.00 0.00 2 000.00 #OIV/0! 41 Professional Fees (Legal, Consulting) 11000.00342900.00- 35 764.00 2.48% 42 Books/Educational Materials 3 804.00 12 500.00 1250000 0.00% 43 Food & Nutrition 2 800.00 500000- - 000.00 0.00°k 44 Administrative Costs 0.00 0.00 0.00 #DIV/01 45 Audit Expense 4,000.00 51000.00 5 000.00 0.00% 46 Specific Assistance to Individuals 0.00 0.00 0.00 #DIV/01 47 Other/Miscellaneous 0.000.00 Other/Contract 0.00 #DIV/01 48 13 000.00 1 30 000.00 50 000.00 66.67% 49 TOTAL 135 817.00 255 220.00 258 364.00 1 .23% 5o REVENUES OVER/ UNDER EXPENDITURES 1 -6.001 0.00 0.00 #DIV/OI srzeaoa{ 19 Guttural Council of Indian River County/Mer School Ms Program Children's Services Advisory Committee - Indian River UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: FY 01102 FY 02103 FY 03/04 % INCREASE FYE_09130/03_ 4_09/30/03_ FYE_09/30/04 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (Col. Ctol. Bycol. e REVENUES BUDGETED BUDGETED 1 Children's Services Council-St Lucie0.00 0.0010.00 #DIV/01 2 Children's Services Council-Martin 0.00 0.00 0.00 #DIV/01 3 Children's Services Council-Okeechobee 0.00 0.00 0.00 #DIV/O! -. -- 4 Advisory Committee-Indian River 23157.00 35 000.00 35 000.00 0.00°k 5 United Wa St Lucie Coun 0.00 0.00 0.00 #DIV/01 6 United Way-Martin County 0.00 0.00 0.00 #DIV/01 7 United Way-Okeechobee County 0.00 0.00 0.00 #DIV/01 8 United Way-Indian River County 0.00 0.00 0.00 #DIV/O! 9 Department of Children & Families 0.00 0.00 0.00 #DIV/01 10 County Funds 0.00 0.00 0.00 #DIV/Ol 11 Contributions-Cash 0.00 0.00 0.00 #DIV/01 12 Pro ram Fees 0.000.00 0.00 #DIV/01 13 Fund Raisin Events-Net 0.00 0.00 0.00 #DIV/01 14 Sales to Public-Net 0.00 0.00 0.00 #DIV/01 15 Membership Dues 0.00 0.00 0.00 #DIV/01 16 Investment Income 0.00 0.00 0.00 #DIV/01 17 Miscellaneous 0.00 0.00 0.00 #DIV/01 18 Legacies & Bequests 0.00 0.00 0.00 #DIV/01 19 Funds from Other Sources 69000,00 766000 61785,00 -11 .42% 20a Reserve Funds Used for Operating 0.00 0.00 0.00 #DIV/01 20b In-Kind Donations (Not Included In total) 0.00 0.00 0.00 #DIV/01 21 TOTAL 29157.00 42 660.00 41 785.00 -2.05% EXPENDITURES 22 Salaries 0.002 560.00 840.00 9% -67.1 23 FICA 0.00 0.00 0.00 #DIV/O! 24 Retirement 0.00 0.00 0.00 #DIV/01 25 Life/Health 0.00 0.00 0.00 #DIV/01 26 Workers Compensation 0.00 0.00 0.00 #DIV/01 27 Florida Unemployment 0.00 0.00 0.00 #DIV/Ol 28 Travel-Daily425.00 0.00 750.00 #DIV/01 29 Travel/Conferencesrrrainin 0.00 0.00 0.00 #DIV/01 30 Office Supplies 155.00 250.00 160.00 -36.00% 31 Telephone 0.001 630.00 762.00 -53.25°k 32 Posta a/Shi in 135.00 240.00140.00 .41 .67% 33 Utilities 0.00 0.00 0.00 #DIV/01 34 Occupancy (Building & Grounds 35.00 300000 2 224.00 -25.87% 35 Printing & Publications 0.00 200.00 168.00 -16.00% 36 Subscri tion/Dues/Membershi s 0.00 300.00 70.00 -76.67% 37 Insurance 2,258.001 70350,00 79321 .0- 13' -0.39% 38 E ui ment:Rental & Maintenance 0.00 0.00 0.00 #DIV/01 39 Advertising4.00 0.00 0.00 #DIV/01 40 Equipment Purchases :Ca ital Expense 0.00 0.00 0.00 #DIV/01 41 Professional Fees (Legal, Consulting) 18 515.00 13 430.00 %300.00 13.92% 42 Books/Educational Materials 4104.007 500.00 750000 0.00°� 43 Food & Nutrition 0.0010.00 0.00 #DIV/0! 44 Administrative Costs 0.00 0.00 0.00 #DIV/01 45 Audit Expense 11000.001 19200.00 125000 4. 17% 46 Specific Assistance to Individuals 0.00 0.00 0.00 #DIV/01 47 Other/Miscellaneous 0.00 0.00 0.00 #DIV/01 48 Other/Contract 2,530,00 5 000.00 5 3O0.00 6.00% 49 TOTAL 29 157.00 4266000 41 785.00 -2.05% 50 REVENUES OVER/ UNDER EXPENDITURESif 0.00 0.001 01001 #DIV/01 srzerm°a 20 Cultural Council of Indian River County/After School Arts Program Children's Serivices Advisory Committee - Indian River UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME : Cultural Council of Indian River County /After School Arts Program FUNDER : Children's Services Advisory - Indian River A B C FY 03/04 FY 03/04 % INCREASE TOTAL FUNDER TOTAL VS . PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET col. B/col. A EXPENDITURES 22 Salaries 840.00 840.00 100 .00% 23 FICA 0 .00 64. 26 #DIV/01 24 Retirement 0 .00 0 .00 #DIV/01 25 Life/Health 0 .00 0 .00 #DIV/0 ! 26 Workers Compensation 0 .00 0 .00 #DIV/01 27 mmvw�Florida Unemployment 0. 00 0 .00 #DIV/01 28 Travel-Dail 750.00 750 .00 100. 00% 29 Travel/Conferences/Training 0 . 00 0 .00 #DIV/01 30 Office Supplies 160 .00 150 .00 93 .75% 31 Telephone 762 .00 200 . 00 26 .25% 32 Postage/Shipping 140 .00 140.00 100.00% 33 Utilities 0.00 0. 00 #DIV/0 ! 34 Occupancy (Building & Grounds) 2, 224.00 19000. 00 44. 96% 35 Printing & Publications 168 .00 . 168e00 100 .00% 36 Subscri tion/Dues/Membershi s70.00 70 .00 100 .00% 371nsurance 79321 .00 49000 .00 54. 64% 38 Eq ui ment: Rental & Maintenance 0 .00 0 .00 #DIV/01 39 Advertising0.00 0 .00 #DIV/0 ! 4o Equipment Purchases : Ca ital Expense 0 .00 0 .00 #DIV/01 41 Professional Fees (Legal , Consulting ) 15, 300 .00 15 ,300 .00 100 .00% 42 Books/Educational Materials 79500 .00 5 , 250.00 70 .00% 43 Food & Nutrition 0 .00 0.00 #DIV/0 ! 44 Administrative Costs 0.00 0 .00 #DIV/01 45 Audit Expense 1 ,250. 00 15250 .00 100 .00% 46 Specific Assistance to Individuals 0 .00 0.00 #DIV/01 47 Other/Miscellaneous 0 .00 0 .00 #DIV/O ! 48 Other/Contract 5,300 .00 5, 300 .00 100.00% 49 TOTAL $41 , 785 .00 $34,482. 26 $0. 83 5/28/2003 21 Ctdkral Couicll of Indan River Cougy/ After School Arts Program Chiklren's Services Advisory Committee UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME : Cultural Council of Indian River County /After School Arts Program FUNDER: Children's Services Advisory Council - Indian River ` k £ "WJ50 AIANCr v � tr� y. #DIV/O! #DIV/O ! #DIV/0! #DIV/O! #DIV/0! #DIVlO! #DIV/01 #DIV/O! #DIV/O! #DIVIO! #DIV/0! #DIV/0 ! #DIV/0! #DIV/01 #DIV/O ! #DIV/0! #DN/01 #DIV/O! #DIV/O! #DIV/0! #DIV/01 #DIV/0 ! #DIV/O! #DIV/0! #DIV/O! #DIV/01 #DIV/O! #DIVIO ! #DIV/O! #DIV/0 ! #DIV/O! 5262663 22 Cultural Council of Indian River County After School Arts Program Children's Services Advisory Committee - Indian River County ORGANIZATION, Cultural Council of Indian River County PROGRAM: After School Arts Program TABLE OF CONTENTS Please `X" the parts of the grant application to indicate they are included. Also, please put the page number where the information can be located. X Section of the Pro osalPa e a X TABLE OF CONTENTS (Check list) X COVER PAGE (with signatures) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 A. ORGANIZATION CAPABILITY (one page maximum) X 1 . Mission and Vision of organization . I I . . I . . I . . . I . . 1 . . 0 . . . * . . . 0 . . . 0 . . . . . . . . . . . . . . . . . . . 4 X 2 . Summary of expertise, accomplishments, and population served . . . . . . . . . . . . . . . . 4 Be PROGRAM NEED STATEMENT (one page maximum) X 1 . Program Need Statement . , . . . . . . . 5 X 2 . Programs that address need and gaps in service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 C. PROGRAM DESCRIPTION (two pages maximum) X 1 . Funding priority , . I . . . . . . . I . . . I . . . 0 . . 0 . . . . 6 X 2 . Description of program activities . . . . . . . . . . . . . . . . . . . . . . . . I . . I . . . . . . . . . . . . . . . . . . . . . . . . . 6 X 3 . Evidence that program strategy will work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . 6 X4 . Staffing , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X 5 . Awareness of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X 6 . Accessibility of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X D . MEASURABLE OUTCOMES (two pages maximum) . . . . . . I . . . . . . . . . . . . . . . . . . & 9 X E. COLLABORATION (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 F. PROGRAM EVALUATION (two pages maximum) XI . Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 X2 . Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 X3 . Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . II X G. TIMETABLE (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 H. UNDUPLICATED CLIENT COUNT X 1 . Projections by Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . 0 . . . . . . . . . 13 X 2 . Projections by Age Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . I . . . 13 X 3 . Demographic Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . 14 1 Cultural Council of Indian River County After School Arts Program Children's Services Advisory Committee - Indian River County I. BUDGET FORMS X 1 . Budget Narrative Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . 15 - 18 X 2 . Total Agency Budget , . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 X 3 . Total Program Budget. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 X 4 . Funder Specific Budget. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 X 5 . Explanation for Variances — Total Program Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 X 6 . Explanation for Variances — Funder Specific Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 J. FUNDER SPECIFIC/ADDITIONAL SHEETS X Authorization for Release of Information , . . . . . . . . . . . . . . . . . * . * . . . . . . . . . . . . . . . . . 24 X Sworn Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 -27 X Not for Profit Agency Certification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 K. APPENDIX List of Current Board of Directors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 AuditReport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30-40 ManagementLetter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . * . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4142 IRS Form 990 . . . . . . . . . . . . . . . . . . . . . . . . . . I . . " , . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . 43 -64 Most Recent Financial Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 OperatingBudget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . 66 Staff Organizational Chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Most Recent Annual Report (not available) 501 (c) (3 ) IRS Exemption . . , . . . . . 1 1 . 1 1 . 1 . . * * . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 -69 Articles of Incorporation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . 70-74 Agency' s ByLaws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . 75 - 81 Agency' s Written Policy Regarding Affirmative Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Proof of Liability Insurance . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . 11 . . . . . . . . . . . . . . . 83 - 84 Proof of Goals & Outcomes Workshop Attendance . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . 85 2