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HomeMy WebLinkAbout2005-346A 2 a� INDIAN RIVER COUNTY GRANT CONTRACT This Grant Contract ("Contract") entered into effective this d(I 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 Indian River County Healthy Start Coalition , Inc. ( Recipient) , of: Indian River County Healthy Start Coalition , Inc 1603 10th Avenue Vero Beach , Florida 32960 Healthy Families 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 - 2 a� INDIAN RIVER COUNTY GRANT CONTRACT This Grant Contract ("Contract") entered into effective this d(I 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 Indian River County Healthy Start Coalition , Inc. ( Recipient) , of: Indian River County Healthy Start Coalition , Inc 1603 10th Avenue Vero Beach , Florida 32960 Healthy Families 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 : FORTY NINE THOUSAND , SIX HUNDRED FORTY SIX DOLLARS ($49 , 646 . 00 ) . The County agrees to reimburse the Recipient from such Grant funds for actual documented costs incurred for the Grant Purposes provided in accordance with this Contract . Reimbursement requests may be made no more frequently than monthly. Each reimbursement request shall contain the information , at a minimum , that is set forth in Exhibit " B" , attached hereto and incorporated herein by this reference . All reimbursement requests are subject to audit by the County. In addition , the County may require additional documentation of expenditures , as it deems appropriate . 5 . Additional Obligation of Recipient . 5 . 1 . Records . The Recipient shall maintain adequate internal controls in order to safeguard the Grant . In addition , the Recipient shall maintain adequate records fully to document the use of the Grant funds for at least three ( 3 ) years after the expiration of the Grant Period . The County shall have access to all books , records , and documents as required in this Section for the purpose of inspection or audit during normal business hours at the County's expense , upon five ( 5 ) days prior to written notice . 5 . 2 . Compliance with Laws . The Recipient shall comply at all times with all applicable federal , state , and local laws and regulations . 5 . 3 . Quarterly Performance Reports . The Recipient shall submit quarterly, cumulative , Performance Reports to the Human Services Department of the County, within fifteen ( 15 ) business days following : December 31 , March 31 , June 30 and September 30 . 5 .4 . Audit Requirements . If Recipient receives $25 , 000 , or more in aggregate , from all Indian River County government funding sources , the Recipient is required to have an audit completed by an independent certified public accountant at the end of the Recipient's fiscal year. Within 120 days of the end of the Recipient's fiscal year, the Recipient shall submit the audit to the Indian River County Office of Management and Budget. The fiscal year will be as reported on the application for funding , and the Recipient agrees to notify the County prior to any change in the fiscal period of Recipient . The Recipient acknowledges that the County may deny funding to any Recipient if an audit required by this Contract for the prior fiscal year is past due and has not been submitted by May 1 . 5 .4 . 1 . The Recipient further acknowledges that, promptly upon receipt of a qualified opinion from its independent auditor, such qualified opinion shall immediately be provided to the Indian River County Office of Management and Budget . The qualified opinion shall thereupon be reported to the Board of Commissioners and funding under this Contract will cease immediately. The foregoing termination right is in addition to any other right of the County to terminate the Contract . 5 .4 . 2 . The Indian River County Office of Management and Budget reserves the right at any time to send a letter to the Recipient requesting clarification if there are any questions regarding a part of the financial statements , audit comments , or notes . 5 . 5 . Insurance Requirements . Recipient shall , no later than September 21 , 2005 provide to Indian River County Risk Management Division a certificate , or certificates , issued by an insurer, or insurers , authorized to conduct business in Florida that is rated not-less-than Category A- : VII by A . M . Best, subject to approval by Indian River County's Risk Manager, of the following types and amounts of insurance : - 2 - 4 . Grant Funds and Payment. The approved Grant for the Grant Period is : FORTY NINE THOUSAND , SIX HUNDRED FORTY SIX DOLLARS ($49 , 646 . 00 ) . The County agrees to reimburse the Recipient from such Grant funds for actual documented costs incurred for the Grant Purposes provided in accordance with this Contract . Reimbursement requests may be made no more frequently than monthly. Each reimbursement request shall contain the information , at a minimum , that is set forth in Exhibit " B" , attached hereto and incorporated herein by this reference . All reimbursement requests are subject to audit by the County. In addition , the County may require additional documentation of expenditures , as it deems appropriate . 5 . Additional Obligation of Recipient . 5 . 1 . Records . The Recipient shall maintain adequate internal controls in order to safeguard the Grant . In addition , the Recipient shall maintain adequate records fully to document the use of the Grant funds for at least three ( 3 ) years after the expiration of the Grant Period . The County shall have access to all books , records , and documents as required in this Section for the purpose of inspection or audit during normal business hours at the County's expense , upon five ( 5 ) days prior to written notice . 5 . 2 . Compliance with Laws . The Recipient shall comply at all times with all applicable federal , state , and local laws and regulations . 5 . 3 . Quarterly Performance Reports . The Recipient shall submit quarterly, cumulative , Performance Reports to the Human Services Department of the County, within fifteen ( 15 ) business days following : December 31 , March 31 , June 30 and September 30 . 5 .4 . Audit Requirements . If Recipient receives $25 , 000 , or more in aggregate , from all Indian River County government funding sources , the Recipient is required to have an audit completed by an independent certified public accountant at the end of the Recipient's fiscal year. Within 120 days of the end of the Recipient's fiscal year, the Recipient shall submit the audit to the Indian River County Office of Management and Budget. The fiscal year will be as reported on the application for funding , and the Recipient agrees to notify the County prior to any change in the fiscal period of Recipient . The Recipient acknowledges that the County may deny funding to any Recipient if an audit required by this Contract for the prior fiscal year is past due and has not been submitted by May 1 . 5 .4 . 1 . The Recipient further acknowledges that, promptly upon receipt of a qualified opinion from its independent auditor, such qualified opinion shall immediately be provided to the Indian River County Office of Management and Budget . The qualified opinion shall thereupon be reported to the Board of Commissioners and funding under this Contract will cease immediately. The foregoing termination right is in addition to any other right of the County to terminate the Contract . 5 .4 . 2 . The Indian River County Office of Management and Budget reserves the right at any time to send a letter to the Recipient requesting clarification if there are any questions regarding a part of the financial statements , audit comments , or notes . 5 . 5 . Insurance Requirements . Recipient shall , no later than September 21 , 2005 provide to Indian River County Risk Management Division a certificate , or certificates , issued by an insurer, or insurers , authorized to conduct business in Florida that is rated not-less-than Category A- : VII by A . M . Best, subject to approval by Indian River County's Risk Manager, of the following types and amounts of insurance : - 2 - (i ) Commercial General Liability Insurance in an amount not less than $ 1 , 000 , 000 combined single limit for bodily injury and property damage , including coverage for premises/operations , product/completed operations , contractual liability, and independent contractors ; ( ii ) Business Auto Liability Insurance in an amount not less than $ 1 , 000 , 000 per occurrence combined single limit for bodily injury and property damage , including coverage for owned autos and other vehicles , hired autos and other vehicles , non -owned autos and other vehicles ; and ( iii ) Worker's Compensation and Employer's Liability (current Florida statutory limit. ) . 5 . 6 . Insurance Administration . The insurance certificates , evidencing all required insurance coverages shall be fully acceptable to County in both form and content, and shall provide and specify that the related insurance coverage shall not be cancelled without at least thirty (30 ) calendar days prior written notice having been given the County. In addition , the County may request such other proofs and assurances as it may reasonable require that the insurance is and at all times remains in full force and effect . Recipient agrees that it is the Recipient's sole responsibility to coordinate activities among itself, the County, and the Recipient's insurer(s ) so that the insurance certificates are acceptable to and accepted by County within the time limits set forth in this Contract. The County shall be listed as an additional insured on all insurance coverage required by this Contract, except Worker's Compensation Insurance . The Recipient shall , upon ten ( 10 ) days prior written request from the County, deliver copies to the County, or make copies available for the County's inspection at Recipient's place of business , of any and all insurance policies that are required in this Contract. If the Recipient fails to deliver or make copies of the policies available to the County; fails to obtain replacement insurance or have previous insurance policies reinstated or renewed upon termination or cancellation of existing required coverages ; or fails in any other regard to obtain coverages sufficient to meet the terms and conditions of this Contract, then the County may, at its sole option , terminate this Contract . 5 . 7 . Indemnification . The Recipient shall indemnify and save harmless the County, its agents , officials , and employees from and against any and all claims , liabilities , losses , damage , or causes of action which may arise from any misconduct, negligent act, or omissions of the Recipient, its agents , officers , or employees in connection with the performance of this Contract . 5 . 8 . Public Records . The Recipient agrees to comply with the provisions of Chapter 119 , Florida Statutes ( Public Records Law) in connection with this Contract. 6 . Termination . This Contract may be terminated by either party, without cause , upon thirty (30 ) days prior written notice to the other party. In addition , the County may terminate this Contract for convenience upon ten ( 10 ) days prior written notice to the Recipient if the County determines that such termination is in the public interest . 7 . Availability of Funds . The obligations of the County under this contract are subject to the availability of funds lawfully appropriated for its purpose by the Board of County Commissioners of Indian River County. 8 . Standard Terms . This Contract is subject to the standard terms attached hereto as Exhibit C and incorporated herein in its entirety by this reference . - 3 - IN WITNESS WHEREOF , County and Recipient have entered into this Contract on the date first above written . INDIAN RIVER COUNTY BOARD OF COMMISSIONERS By: ST 5of Thomas S . Lowther, Chairman BCC Approved : Attest: J . K. Barton , Clerk r, By: Deputy Clerk Approved : Joseph A. Baird County Administrator A and legal sufficiency: By- 1st n for REC NT: By: Indian River County Healthy Start Coalition , Inc - 4 - (i ) Commercial General Liability Insurance in an amount not less than $ 1 , 000 , 000 combined single limit for bodily injury and property damage , including coverage for premises/operations , product/completed operations , contractual liability, and independent contractors ; ( ii ) Business Auto Liability Insurance in an amount not less than $ 1 , 000 , 000 per occurrence combined single limit for bodily injury and property damage , including coverage for owned autos and other vehicles , hired autos and other vehicles , non -owned autos and other vehicles ; and ( iii ) Worker's Compensation and Employer's Liability (current Florida statutory limit. ) . 5 . 6 . Insurance Administration . The insurance certificates , evidencing all required insurance coverages shall be fully acceptable to County in both form and content, and shall provide and specify that the related insurance coverage shall not be cancelled without at least thirty (30 ) calendar days prior written notice having been given the County. In addition , the County may request such other proofs and assurances as it may reasonable require that the insurance is and at all times remains in full force and effect . Recipient agrees that it is the Recipient's sole responsibility to coordinate activities among itself, the County, and the Recipient's insurer(s ) so that the insurance certificates are acceptable to and accepted by County within the time limits set forth in this Contract. The County shall be listed as an additional insured on all insurance coverage required by this Contract, except Worker's Compensation Insurance . The Recipient shall , upon ten ( 10 ) days prior written request from the County, deliver copies to the County, or make copies available for the County's inspection at Recipient's place of business , of any and all insurance policies that are required in this Contract. If the Recipient fails to deliver or make copies of the policies available to the County; fails to obtain replacement insurance or have previous insurance policies reinstated or renewed upon termination or cancellation of existing required coverages ; or fails in any other regard to obtain coverages sufficient to meet the terms and conditions of this Contract, then the County may, at its sole option , terminate this Contract . 5 . 7 . Indemnification . The Recipient shall indemnify and save harmless the County, its agents , officials , and employees from and against any and all claims , liabilities , losses , damage , or causes of action which may arise from any misconduct, negligent act, or omissions of the Recipient, its agents , officers , or employees in connection with the performance of this Contract . 5 . 8 . Public Records . The Recipient agrees to comply with the provisions of Chapter 119 , Florida Statutes ( Public Records Law) in connection with this Contract. 6 . Termination . This Contract may be terminated by either party, without cause , upon thirty (30 ) days prior written notice to the other party. In addition , the County may terminate this Contract for convenience upon ten ( 10 ) days prior written notice to the Recipient if the County determines that such termination is in the public interest . 7 . Availability of Funds . The obligations of the County under this contract are subject to the availability of funds lawfully appropriated for its purpose by the Board of County Commissioners of Indian River County. 8 . Standard Terms . This Contract is subject to the standard terms attached hereto as Exhibit C and incorporated herein in its entirety by this reference . - 3 - EXHIBIT A (Copy of complete Request for Proposal ) EXHIBIT - A - Organization : Indian River County Healthy Start Coalition, Inc. Program: Healthy Families — IRC Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 05-06 Grant Application PROGRAM COVER PAGE Organization Name: Indian River County Healthy Start Coalition, Inc . Executive Director: Leslie Spurlock Email : irchsc(a�aol . com Address : 1603 10th Ave . Telephone : (772) 563 -9118 Vero Beach, Florida 32960 Fax : (772) 563 -9125 Program Director: Dina Kramer Email : dkramer _ ,hfirc . org Address : 1360 US Hwy 1 , Suite 7 Telephone : (772) 778- 1405 Vero B.each�Floridv32 ? Fax : (772) 778 - 1029 Pro ram "!'itle: Health Families - IRC Priority a ; aren in Support an ducatlon as well as Mental Wellness Brief Description of the Program : The taxonomy definition for the Healthy Families-IRC program is PH- 236 . 240 — Family Support Centers . Healthy Families—IRC is a community based, voluntary home visitation program designed to prevent child abuse by promoting positive parent-child interaction and child ff,owth and development which permits children to grow Mp healthy, safe and nurtured. The Health Families-IRC staff provides a wide variety of social services that are designed to promote and support healthy development of families, help families cope towards mental wellness, improve family interaction skills and help at-risk families to resolve problems in the pre-crisis stage before they become unmanageable and child abuse takes place . Mental health and wellness are key components of counseling. SUMMARY REPORT — (Enter Information In The Black Cells - Amount Requested from Funder for 2005 / 06 : $ 5 Total Proposed Program Budget for 2005 / 06 : $ 5; 427771 . 00 Percent of Total Program Budget : 10 . 1 % Current Program Funding ( 2004 / 05 ) : $ 55 , 000 Dollar increase / ( decrease ) in request : $ Percent increase / ( decrease ) in request * * : 0 . 0 % Unduplicated Number of Children to be served Individually : 159 Unduplicated Number of Adults to be served Individually : 147 Unduplicated Number to be served via Group settings : Total Program Cost per Client : 1773 . 76 * *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 State of Florida via Florida Ounce of Prevention — Healthy Families Florida; expected amount : $465 ,985 . 00 The Organization 's Board of Directors has approved this appy atz on (date). / �e Debbie True Name of President/Chair of the Board Sig tore Leslie S urlock 10 Name of Executive Director/CEO Wgn tune 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: ST 5of Thomas S . Lowther, Chairman BCC Approved : Attest: J . K. Barton , Clerk r, By: Deputy Clerk Approved : Joseph A. Baird County Administrator A and legal sufficiency: By- 1st n for REC NT: By: Indian River County Healthy Start Coalition , Inc - 4 - Organization : Indian River County Healthy Start Coalition, Inc . Program: Healthy Families — IRC Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 05-06 Grant Application 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 V" X 11 " paper and number each page. These directions and the graphic boxes may be deleted if space is needed . A. ORGANIZATION CAPABILITY (Entire Section A not to exceed one page) 1 . Provide the mission statement and vision of your organization. The mission of the Indian River County Healthy Start Coalition is to establish a system that guarantees all women have access to prenatal care and that all infants have access to services that promote normal growth and development. The vision is to provide the resources and mechanisms available in Indian River County that lead to healthy birth outcomes and brain development. The Vision/Mission Statement for the HF-IRC program is "To enhance parent' s ability to promote and maintain healthy family life through education and coordinated support which is individualized for each family. " 2 . Provide a brief summary of your organization including areas of expertise, accomplishments, and population served. The Coalition ' s purpose is to provide coordination and build broad-based community support for maternal and child health (MCH) . This is accomplished by establishing a partnership between the private and public sector, state and local government, community alliances and maternal and child health providers to provide coordinated community based care for pregnant women, infants and families with children up to age three for Care Coordination and age five for Healthy Families . Areas of expertise include birth and maternal data analysis, program planning, development, implementation, and addressing gaps in MCH services . Once gaps in service or poor birth outcome trends have been identified, then the necessary steps are taken to improve these gaps in care by building bridges, linkages or adding new services if they currently do not exist to meet the MCH needs in Indian River County. Additional areas of expertise include outreach, providing educational opportunities addressing MCH issues, and ensuring a system is in place for pregnant women, infants and children. The Coalition serves as the lead agency for Healthy Families — IRC in partnership with Family Connections of IRC , Inc . , who is the contracted service agency. The program has provided intensive case management to well over 150 families within the last year, with the primary goal of preventing child abuse in at-risk families . IRCHSC also developed and put in place the TLC Newborn Program in 1998 , which serves more than 1 ,000 infants each year, as well as the parents of the newborns . In addition, the Coalition oversees Healthy Start Care Coordination services in partnership with the Indian River County Health Department, which served over 500 families in the past year. 4 Organization : Indian River County Healthy Start Coalition, Inc . Program: Healthy Families — IRC Funder: IRC Board of County Commissioners — Children' s Services Advisory Committee - 05-06 Grant Application 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. a. What: Pregnancy and raising a child places many new or additional burdens and stressors on a family, including financial, emotional and even physical stress. Along with the joys of parenthood can be the realization of the major responsibilities of raising a child to be healthy and ready to learn by the time they enter their school years . HF focuses on families with risk factors for child abuse by addressing parenting components that improves parent/child interactions and enhances overall brain development. b. Who : Factors associated with increased risk for child abuse, poor birth outcomes and poor infant/child growth and development include : marital status, age of mother, moving three times in one year, alcohol or substance use, high stress level, not wanting the pregnancy, depression, history of mental health counseling, and partner being unemployed. In many cases, these risk factors are more prevalent for low income families . Indian River County residents had 1 ,056 births in 2002 . Of these births , 62 . 8 % were from white mothers, 15 . 3 % black, 19 . 0% Hispanic and 2 . 9% "other" mothers . In 2002, almost half, or 45 % of all births are covered under Medicaid or indigent funding. Of all the births in 2002, 39 . 6 % of babies born were to unwed mothers, with black unwed births at 76 . 5 % . In terms of education status of the newborn ' s mother, 28 . 3 % of the mothers did not have a 12d, grade education or GED . c. Where: Healthy Families — IRC serves families from the entire county, with 53 % served from south county, and 47% from the north county area. d. Corroboration of Area of Need . The HF program is modeled after the highly successful national HF America initiative that is based on critical program elements that have been defined by over 20 years of research and represent best practices in home visitation. 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. Healthy Start Care Coordination provides ongoing case management to high-risk families, placing emphasis on the pregnant woman to help ensure a healthy birth outcome, as well as pregnant women or infants with medical risk factors . The emphasis of the Care Coordinator is the health of the pregnant mom and baby. In contrast, the focus of Healthy Families-IRC staff is to prevent child abuse in a family where there is a pregnant mom. The Healthy Families-IRC program is designed to work on parent/child bonding and interaction with the target child until the child reaches age five . Healthy Families also requires that low caseloads be maintained at an average of 20 families per worker, but no more than 25 . The low caseloads and the extended duration of services greatly enhance the opportunity to positively impact families . Healthy Families-IRC is the only program in Indian River that is designed to stay with families for up to five years . 5 EXHIBIT A (Copy of complete Request for Proposal ) EXHIBIT - A - Organization : Indian River County Healthy Start Coalition, Inc. Program: Healthy Families — IRC Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 05-06 Grant Application C. PROGRAM DESCRIPTION (Entire Section C, 1 — 6, not to exceed two pages) 1 . List Priority Needs area addressed. Parenting Support and Education & Mental Wellness , 2 . Briefly describe program activities including location of services. The primary location of services takes place in the home of the pregnant mom. Healthy Families is a voluntary, intensive home visitation program that occurs on a weekly basis . Family Support Workers (FSW), who are trained paraprofessionals, provide case-management services focusing on parent/child bonding and infant/child growth and development, ensure well baby care and immunization schedule compliance, and support the family by empowering them to set and achieve goals . Family caseloads for the FSW ' s are designed to be kept to fewer than 25 families, to ensure that the intensity of the home- based services are manageable . H caninitiate services either prenatally or up to two weeks after the birth of the target child. HF Florida and the Florida Department of Health have collaborated to develop a Universal Prenatal Screen. The screen is offered to the pregnant woman on her first obstetric (OB) visit with her prenatal care provider and the screens dramatically improve the referral process . HF—IRC receives the screens from the HS Care Coordination office and makes contact with all pregnant mothers who had an initial positive screen for HE Once the positive HF screen is received the FAW conducts a face-to-face two-hour comprehensive assessment to determine if she would be eligible for HF services . HF-IRC encourages and helps families become employed as a number of the families are unemployed. One hundred percent of the families being served have conformed to their well child/EPSTD standards (which includes immunizations), with a significant majority of the families surveyed showing overall satisfaction with services . 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 . HF focuses on families with risk factors for child abuse by addressing parenting components that will improve parent/child interactions and enhance overall brain development. The HF program is modeled after the highly successful national HF America initiative that is based on critical program elements that have been defined by over 20 years of research and represent best practices in home visitation. HF Florida, which is the state-based administrator of all HF programs, contracted with a research and evaluation firm to do overall program evaluation. In a report presented in April 2002 , it found that 98% of all children who participated in HF had no finding of child maltreatment or substantiated child abuse . The national HF initiative has many years of research and has demonstrated that home based case management, parenting education and child development has been the most effective means for addressing parent support and education as well as mental health and wellness . 6 Organization : Indian River County Healthy Start Coalition , Inc. Program: Healthy Families — IRC Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 05-06 Grant Application 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). Project Manager ( 1 Full Time Equivalent - FTE) - Masters degree in social work, psychology, or a related field (or BA with 2 additional years of experience in the field), and/or 2 years experience in direct service delivery and supervision. The primary role is to provide leadership, direction and overall program supervision for all HF— IRC staff. Supervisors ( 1 . 5 FTE ' s) - Masters degree in social work, psychology, or a related field (or BA with 2 additional years of experience in the field) , and 2 years experience in direct service delivery and supervision . Duties are to report to Program Manager, provide direct supervision of FSW ' s and to review caseloads of HF-IRC staff. Family Assessment Worker ( 1 . 5 - FTE ' s) - One-year college credit in a related field, with two years of experience delivering services to children and families . Duties are to review referrals made by OB providers or other sources in the community and to interview/conduct using the eligibility tool with parents to determine eligibility for HF. Family Support Worker (8 FTE ' s) - One-year college credit in a related field, with two years of experience delivering services to children and families. Responsible for initiating and maintaining regular (at least weekly) and long-term contact/support with families . Data Entry Clerk—Admin. Asst. ( 1 FTE) - Accurate and timely information processing ; experience with data entry computer systems . Duties include the review of master copies of documents ; updates HF—IRC database . 5. How will the target population be made aware of the program? The primary site for reaching potential HF clients is through the Screening Liaison located at Partners in Women ' s Health. Partners is the primary obstetric Medicaid provider in this county, whose patients would most likely be eligible for Healthy Families. The Screening Liaison provides orientation on the HF program during new client intake days at Partners, which is every Friday. IRMH is also a source for HF program referrals . Because IRCHS is the lead agency for HF-IRC , awareness is also created through The Coalition ' s networking, and it ' s two other programs (Healthy Start Care Coordination and TLC) . Family Connections of IRC , Inc . also assists in marketing the program as well as individuals from the Coalition ' s Board of Directors, partnering agencies and other not-for-profit programs . The Coalition promotes the program through its newsletter, public presentations , bi-monthly Coalition meetings, and at health fairs or other public events. 6. How will the program be accessible to target population (i.e., location, transportation , hours of operation) ? The HF-IRC program serves the entire county. Since HF-IRC is a home-based visitation program, there are few barriers for program participation . The FSWs have flexible hours and can work nights or weekends in order to visit families at their convenience. The FSW ' s can also meet families at their OB or pediatric provider' s offices, WIC or any other convenient location. 7 Organization : Indian River County Healthy Start Coalition, Inc. Program: Healthy Families — IRC Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 05-06 Grant Application PROGRAM COVER PAGE Organization Name: Indian River County Healthy Start Coalition, Inc . Executive Director: Leslie Spurlock Email : irchsc(a�aol . com Address : 1603 10th Ave . Telephone : (772) 563 -9118 Vero Beach, Florida 32960 Fax : (772) 563 -9125 Program Director: Dina Kramer Email : dkramer _ ,hfirc . org Address : 1360 US Hwy 1 , Suite 7 Telephone : (772) 778- 1405 Vero B.each�Floridv32 ? Fax : (772) 778 - 1029 Pro ram "!'itle: Health Families - IRC Priority a ; aren in Support an ducatlon as well as Mental Wellness Brief Description of the Program : The taxonomy definition for the Healthy Families-IRC program is PH- 236 . 240 — Family Support Centers . Healthy Families—IRC is a community based, voluntary home visitation program designed to prevent child abuse by promoting positive parent-child interaction and child ff,owth and development which permits children to grow Mp healthy, safe and nurtured. The Health Families-IRC staff provides a wide variety of social services that are designed to promote and support healthy development of families, help families cope towards mental wellness, improve family interaction skills and help at-risk families to resolve problems in the pre-crisis stage before they become unmanageable and child abuse takes place . Mental health and wellness are key components of counseling. SUMMARY REPORT — (Enter Information In The Black Cells - Amount Requested from Funder for 2005 / 06 : $ 5 Total Proposed Program Budget for 2005 / 06 : $ 5; 427771 . 00 Percent of Total Program Budget : 10 . 1 % Current Program Funding ( 2004 / 05 ) : $ 55 , 000 Dollar increase / ( decrease ) in request : $ Percent increase / ( decrease ) in request * * : 0 . 0 % Unduplicated Number of Children to be served Individually : 159 Unduplicated Number of Adults to be served Individually : 147 Unduplicated Number to be served via Group settings : Total Program Cost per Client : 1773 . 76 * *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 State of Florida via Florida Ounce of Prevention — Healthy Families Florida; expected amount : $465 ,985 . 00 The Organization 's Board of Directors has approved this appy atz on (date). / �e Debbie True Name of President/Chair of the Board Sig tore Leslie S urlock 10 Name of Executive Director/CEO Wgn tune 3 Organization: Indian River County Healthy Start Coalition, Inc . Program: Healthy Families — IRC Funder: IRC Board of County Commissioners — Children ' s Services Advisory Committee - 05-06 Grant Application 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) Note : These outcomes and activities are based on the standard HF Florida and national HF program guidelines and requirements . 1 . Ninety (90) percent of target children will be 1 . FSW ' s will address immunization schedules fully immunized by age two (2) . with family and record usage . 2 . Ninety (90) percent of target children will be 2 . The Well Baby checkups will be monitored, up-to-date with Well-Baby Checks . with the infant ' s medical home established. Families will be encouraged to seek and utilize a pediatrician and/or clinic for ongoing medical care for infant and child. 3 . Ninety (90) percent of the children in 3 . FSW ' s will address proper parenting skills families who participant in HF-IRC for six with the family, as well as Shaken Baby months or longer will have no findings of some Syndrome Education, partner interaction and indications or verified child maltreatment while anger management. receiving Healthy Families services . 4. At least eighty (80) percent of all assessments 4 . The Family Assessment Worker will conduct must occur either prenatally or within the first assessments per referral during the target period two weeks after the birth of the target child. for HF client enrollment. 5 . Ninety (90) percent of families enrolled 90 5 . All FSW ' s will complete a Family Support days or longer will have updated their Individual Plan for enrolled clients, developing mutual Family Support Plan within the previous ninety goals and activities the family will strive to days . obtain . 6 . One hundred ( 100) percent of eligibility 6 . All potential HF clients will be given an assessments will be conducted using a eligibility assessment as part of the enrollment standardized tool . process in Healthy Families . 8 Organization : Indian River County Healthy Start Coalition, Inc . Program: Healthy Families — IRC Funder: IRC Board of County Commissioners — Children's Services Advisory Committee - 05-06 Grant Application E. 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 Indian River County Health * Provides coordination of HS/HF prenatal screen. Department * Communication on potential HF client ' s status . * Medical/nursing based services for HF client on an "as- needed" basis. * WIC and needed health care services at CHD clinics . All these services are provided in-kind Indian River Memorial Hospital * Provides referrals to HF-IRC program from Delivery/ Nursery Department for identified high-risk families . All these services are _provided in-kind. IRC Library — Born to Read * Provides two books to newborn families that are given to Program the family of the newborn . The HF-IRC emphasizes the importance of reading to their infant towards enhancing brain development. All these services are provided in-kind. Visiting Nurses Association of the * Provides home visitation for mothers of newborns Treasure Coast experiencing breastfeeding difficulties or in need of greater breastfeeding education. Partners in Women ' s Health * Primary site for Healthy Families referrals . Partner' s employs, under contract from the Coalition, the Screening Liaison who provides HF-IRC orientation, education, and processing of the Universal Screen. Indian River County Healthy Start * Overall program development, integration and Coalition communication within all three IRCHSC programs. * Fundraising, PR and marketing of HF-IRC program (While the Coalition is the applying * In cooperation/collaboration with the HF-IRC Program agency, many in-kind collaborative Manager, QA/QI, reports . efforts on behalf of the HF-IRC * Provide HF-IRC representation at public events program take place) * Presentations to community groups re : HF-IRC * Development and presentation of HF-IRC Grant(s) * Fiscal oversight and reimbursement requests . All these services are provided in-kind and with no administrative fee. 9 Organization : Indian River County Healthy Start Coalition, Inc . Program: Healthy Families — IRC Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 05-06 Grant Application 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 V" X 11 " paper and number each page. These directions and the graphic boxes may be deleted if space is needed . A. ORGANIZATION CAPABILITY (Entire Section A not to exceed one page) 1 . Provide the mission statement and vision of your organization. The mission of the Indian River County Healthy Start Coalition is to establish a system that guarantees all women have access to prenatal care and that all infants have access to services that promote normal growth and development. The vision is to provide the resources and mechanisms available in Indian River County that lead to healthy birth outcomes and brain development. The Vision/Mission Statement for the HF-IRC program is "To enhance parent' s ability to promote and maintain healthy family life through education and coordinated support which is individualized for each family. " 2 . Provide a brief summary of your organization including areas of expertise, accomplishments, and population served. The Coalition ' s purpose is to provide coordination and build broad-based community support for maternal and child health (MCH) . This is accomplished by establishing a partnership between the private and public sector, state and local government, community alliances and maternal and child health providers to provide coordinated community based care for pregnant women, infants and families with children up to age three for Care Coordination and age five for Healthy Families . Areas of expertise include birth and maternal data analysis, program planning, development, implementation, and addressing gaps in MCH services . Once gaps in service or poor birth outcome trends have been identified, then the necessary steps are taken to improve these gaps in care by building bridges, linkages or adding new services if they currently do not exist to meet the MCH needs in Indian River County. Additional areas of expertise include outreach, providing educational opportunities addressing MCH issues, and ensuring a system is in place for pregnant women, infants and children. The Coalition serves as the lead agency for Healthy Families — IRC in partnership with Family Connections of IRC , Inc . , who is the contracted service agency. The program has provided intensive case management to well over 150 families within the last year, with the primary goal of preventing child abuse in at-risk families . IRCHSC also developed and put in place the TLC Newborn Program in 1998 , which serves more than 1 ,000 infants each year, as well as the parents of the newborns . In addition, the Coalition oversees Healthy Start Care Coordination services in partnership with the Indian River County Health Department, which served over 500 families in the past year. 4 Organization : Indian River County Healthy Start Coalition, Inc . Program: Healthy Families — IRC Funder: IRC Board of County Commissioners — Children' s Services Advisory Committee - 05-06 Grant Application 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. a. What: Pregnancy and raising a child places many new or additional burdens and stressors on a family, including financial, emotional and even physical stress. Along with the joys of parenthood can be the realization of the major responsibilities of raising a child to be healthy and ready to learn by the time they enter their school years . HF focuses on families with risk factors for child abuse by addressing parenting components that improves parent/child interactions and enhances overall brain development. b. Who : Factors associated with increased risk for child abuse, poor birth outcomes and poor infant/child growth and development include : marital status, age of mother, moving three times in one year, alcohol or substance use, high stress level, not wanting the pregnancy, depression, history of mental health counseling, and partner being unemployed. In many cases, these risk factors are more prevalent for low income families . Indian River County residents had 1 ,056 births in 2002 . Of these births , 62 . 8 % were from white mothers, 15 . 3 % black, 19 . 0% Hispanic and 2 . 9% "other" mothers . In 2002, almost half, or 45 % of all births are covered under Medicaid or indigent funding. Of all the births in 2002, 39 . 6 % of babies born were to unwed mothers, with black unwed births at 76 . 5 % . In terms of education status of the newborn ' s mother, 28 . 3 % of the mothers did not have a 12d, grade education or GED . c. Where: Healthy Families — IRC serves families from the entire county, with 53 % served from south county, and 47% from the north county area. d. Corroboration of Area of Need . The HF program is modeled after the highly successful national HF America initiative that is based on critical program elements that have been defined by over 20 years of research and represent best practices in home visitation. 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. Healthy Start Care Coordination provides ongoing case management to high-risk families, placing emphasis on the pregnant woman to help ensure a healthy birth outcome, as well as pregnant women or infants with medical risk factors . The emphasis of the Care Coordinator is the health of the pregnant mom and baby. In contrast, the focus of Healthy Families-IRC staff is to prevent child abuse in a family where there is a pregnant mom. The Healthy Families-IRC program is designed to work on parent/child bonding and interaction with the target child until the child reaches age five . Healthy Families also requires that low caseloads be maintained at an average of 20 families per worker, but no more than 25 . The low caseloads and the extended duration of services greatly enhance the opportunity to positively impact families . Healthy Families-IRC is the only program in Indian River that is designed to stay with families for up to five years . 5 Organization: Indian River County Healthy Start Coalition , Inc. Program: Healthy Families — IRC Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 05-06 Grant Application 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 Comprehensive data on each HF — IRC family who enrolls is entered in a Healthy Families database, developed by Healthy Families Florida. This data includes demographic information. The parent(s) and the Family Support Worker monitor infant developmental stages , with updates documented in the family record. HF — IRC participates in statewide evaluation and provides outcome and performance data in the format and frequency specified by Healthy Families Florida. The HF- Florida database is updated on a weekly basis, with reports also generated on a weekly basis, which is provided to the Project Manager and Supervisor, who then share the general information and/or discrepancies with the appropriate FSW. The Healthy Families Florida Contract manager performs sites reviews on a quarterly basis, as well as Coalition and HF-IRC Advisory Board reviews. 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? The outcomes are based on data needed by HF Florida (HFF) as well as HF-IRC , which are compiled and entered into the HFF database at regularly scheduled intervals . Based on strict HFF criteria, families develop goals based on their assets and needs, and must achieve these through the program to "graduate" to higher levels, which means less intensity of services, which empowers the family to become self-sufficient . The required data and outcomes are monitored by HFF, as well as locally by the HF-IRC Program Manager and the Coalition. These measures are based on 30 years of research by Healthy Families America, 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? Database is compiled and updated on a weekly basis , with reports also generated on a weekly basis that the FSW and Supervisor review . Monthly reports are provided to the HF-IRC Advisory Board, and quarterly reports are submitted to the Coalition and CSAC . 10 Organization : Indian River County Healthy Start Coalition, Inc . Program: Healthy Families — IRC Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 05-06 Grant Application Data and programmatic reports are submitted to the HF-IRC Advisory Board on a monthly basis, the Coalition Executive Director and Board of Directors on a quarterly basis, the HFF Contract Manager on a monthly basis , who also conducts on-site QA/QI every three months . Reports are provided at the public Coalition meetings bi-monthly. All of the QA/QI partners, which include Healthy Families Florida, the Advisory Board and the Coalition address program outcomes from a global sense and work towards strategies and solutions that can be shared with the HF-IRC service staff, who then apply the action steps to benefit the families they serve. 11 Organization : Indian River County Healthy Start Coalition, Inc. Program: Healthy Families — IRC Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 05-06 Grant Application C. PROGRAM DESCRIPTION (Entire Section C, 1 — 6, not to exceed two pages) 1 . List Priority Needs area addressed. Parenting Support and Education & Mental Wellness , 2 . Briefly describe program activities including location of services. The primary location of services takes place in the home of the pregnant mom. Healthy Families is a voluntary, intensive home visitation program that occurs on a weekly basis . Family Support Workers (FSW), who are trained paraprofessionals, provide case-management services focusing on parent/child bonding and infant/child growth and development, ensure well baby care and immunization schedule compliance, and support the family by empowering them to set and achieve goals . Family caseloads for the FSW ' s are designed to be kept to fewer than 25 families, to ensure that the intensity of the home- based services are manageable . H caninitiate services either prenatally or up to two weeks after the birth of the target child. HF Florida and the Florida Department of Health have collaborated to develop a Universal Prenatal Screen. The screen is offered to the pregnant woman on her first obstetric (OB) visit with her prenatal care provider and the screens dramatically improve the referral process . HF—IRC receives the screens from the HS Care Coordination office and makes contact with all pregnant mothers who had an initial positive screen for HE Once the positive HF screen is received the FAW conducts a face-to-face two-hour comprehensive assessment to determine if she would be eligible for HF services . HF-IRC encourages and helps families become employed as a number of the families are unemployed. One hundred percent of the families being served have conformed to their well child/EPSTD standards (which includes immunizations), with a significant majority of the families surveyed showing overall satisfaction with services . 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 . HF focuses on families with risk factors for child abuse by addressing parenting components that will improve parent/child interactions and enhance overall brain development. The HF program is modeled after the highly successful national HF America initiative that is based on critical program elements that have been defined by over 20 years of research and represent best practices in home visitation. HF Florida, which is the state-based administrator of all HF programs, contracted with a research and evaluation firm to do overall program evaluation. In a report presented in April 2002 , it found that 98% of all children who participated in HF had no finding of child maltreatment or substantiated child abuse . The national HF initiative has many years of research and has demonstrated that home based case management, parenting education and child development has been the most effective means for addressing parent support and education as well as mental health and wellness . 6 Organization : Indian River County Healthy Start Coalition , Inc. Program: Healthy Families — IRC Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 05-06 Grant Application 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). Project Manager ( 1 Full Time Equivalent - FTE) - Masters degree in social work, psychology, or a related field (or BA with 2 additional years of experience in the field), and/or 2 years experience in direct service delivery and supervision. The primary role is to provide leadership, direction and overall program supervision for all HF— IRC staff. Supervisors ( 1 . 5 FTE ' s) - Masters degree in social work, psychology, or a related field (or BA with 2 additional years of experience in the field) , and 2 years experience in direct service delivery and supervision . Duties are to report to Program Manager, provide direct supervision of FSW ' s and to review caseloads of HF-IRC staff. Family Assessment Worker ( 1 . 5 - FTE ' s) - One-year college credit in a related field, with two years of experience delivering services to children and families . Duties are to review referrals made by OB providers or other sources in the community and to interview/conduct using the eligibility tool with parents to determine eligibility for HF. Family Support Worker (8 FTE ' s) - One-year college credit in a related field, with two years of experience delivering services to children and families. Responsible for initiating and maintaining regular (at least weekly) and long-term contact/support with families . Data Entry Clerk—Admin. Asst. ( 1 FTE) - Accurate and timely information processing ; experience with data entry computer systems . Duties include the review of master copies of documents ; updates HF—IRC database . 5. How will the target population be made aware of the program? The primary site for reaching potential HF clients is through the Screening Liaison located at Partners in Women ' s Health. Partners is the primary obstetric Medicaid provider in this county, whose patients would most likely be eligible for Healthy Families. The Screening Liaison provides orientation on the HF program during new client intake days at Partners, which is every Friday. IRMH is also a source for HF program referrals . Because IRCHS is the lead agency for HF-IRC , awareness is also created through The Coalition ' s networking, and it ' s two other programs (Healthy Start Care Coordination and TLC) . Family Connections of IRC , Inc . also assists in marketing the program as well as individuals from the Coalition ' s Board of Directors, partnering agencies and other not-for-profit programs . The Coalition promotes the program through its newsletter, public presentations , bi-monthly Coalition meetings, and at health fairs or other public events. 6. How will the program be accessible to target population (i.e., location, transportation , hours of operation) ? The HF-IRC program serves the entire county. Since HF-IRC is a home-based visitation program, there are few barriers for program participation . The FSWs have flexible hours and can work nights or weekends in order to visit families at their convenience. The FSW ' s can also meet families at their OB or pediatric provider' s offices, WIC or any other convenient location. 7 Organization : Indian River County Healthy Start Coalition, Inc. Program: Healthy Families — IRC Funder: IRC Board of County Commissioners — Children ' s Services Advisory Committee - 05-06 Grant Application 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 com l ting the timetable, review information detailed in prior sections. Month/ Activities Period The major steps for the overall program are : Pregnant women are offered the universal screen by the Screening Liaison at Partners in Women ' s Health. The voluntary screen looks at risks for child abuse . A consent form is also signed by the client if they have a positive score for Healthy Families on the universal HS/HF screen . Referrals can also come from the social worker at Indian River Memorial Weekly Hospital at the time of birth. Additional referrals can come from any agency in the community. Families can be eligible for assessment during pregnancy or up to two weeks after the birth of their child. The screen is sent to the Healthy Start Care Coordination office for processing . All screens are then forwarded to the Healthy Families Family Assessment Worker (FAW) for a face- to-face assessment to determine if they are eligible for Healthy Families . The FAW communicates with the HS Care Coordination team to determine the potential HF client' s status prior to performing the assessment. After the assessment, if the family is eligible for Healthy Families, and is interested in On-going participation, the Program Manager reviews the case with the FAW. The case (family) then goes to the HF Supervisor, who reviews the family' s needs and determines the best Family Support Worker (FSW) for case management assignment. The family is then assigned to a FSW. Phone contact must be attempted within 72 hours by the FSW. A subsequent home visit attempt must be completed within 5 days . Once contact is made with the family, initial goal(s) setting is done within one month of opening case . Supervision is conducted weekly with all FSW ' s for a minimum of two hours, who review all cases assigned to the FSW. Goals are reviewed and updated with the family and Supervisor every 90 days . These goals can be modified during 90 days if needed . For pregnant women, the determination of weekly or bi-weekly visits during pregnancy is made . After birth, visits are weekly for a minimum of 6 months . Bi-weekly visits can be done if the mom returns to work, with phone contacts in between . Six to eight months after birth, the Supervisor and FSW will determine if the family can move to level two , which are bi-weekly visits . This determination would be based on the family' s progress in meeting their goals and well as overall family needs . The Ages and Stages child assessment tool is conducted every four months and goes all the way to 60 months . The Parent Child Assessment/Observation tool is done at one month, then every six months . Home Safety checks at one month then six months . The family and target child have goals and levels to achieve for program graduation . 12 Organization : Indian River County Healthy Start Coalition, Inc. Program: Healthy Families — IRC Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 05-06 Grant Application H. PROJECTIONS FOR UNDUPLICATED CLIENTS Number of Unduplicated Clients by Location Last Fiscal Year Current Fiscal Year Next Fiscal Year Location Actual 2003/2004 Budget 2004/05 Projections 2005/06 Unduplicated Clients Unduplicated Clients Unduplicated Clients N. Indian River County* 159 171 198 S. Indian River County* 99 193 108 Indian River Co. Total 258 364 306 TOTAL SERVED 258 364 306 *Counts infant/child and mother ( 182 families) ( 182 families) * * Does not count father or partner Number of Unduplicated Clients by Age Last Fiscal Year Current Fiscal Year Next Fiscal Year Location Actual 2003/2004 Budget 2004/05 Projections 2005/06 Individuals Group ; Individuals Group Individuals Group 0 to 4 - (Pre-school) 113 - 182 - 120 - 5 to 10 - (Elementary) 30 - - - 30 - 11 to 14 - (Middle) 7 - - - 7 - 15 to 18 - (High School) 1 - 12 - 2 - Total Children 151 - 194 - 159 - 19 to 59 - (Adults) 107 - 170 - 147 - L60 + (Seniors)Total Adults 107 - 170 - 147OTAL SERVED 258 - 364 - 306 - 13 Organization: Indian River County Healthy Start Coalition, Inc . Program: Healthy Families — IRC Funder: IRC Board of County Commissioners — Children ' s Services Advisory Committee - 05-06 Grant Application 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) Note : These outcomes and activities are based on the standard HF Florida and national HF program guidelines and requirements . 1 . Ninety (90) percent of target children will be 1 . FSW ' s will address immunization schedules fully immunized by age two (2) . with family and record usage . 2 . Ninety (90) percent of target children will be 2 . The Well Baby checkups will be monitored, up-to-date with Well-Baby Checks . with the infant ' s medical home established. Families will be encouraged to seek and utilize a pediatrician and/or clinic for ongoing medical care for infant and child. 3 . Ninety (90) percent of the children in 3 . FSW ' s will address proper parenting skills families who participant in HF-IRC for six with the family, as well as Shaken Baby months or longer will have no findings of some Syndrome Education, partner interaction and indications or verified child maltreatment while anger management. receiving Healthy Families services . 4. At least eighty (80) percent of all assessments 4 . The Family Assessment Worker will conduct must occur either prenatally or within the first assessments per referral during the target period two weeks after the birth of the target child. for HF client enrollment. 5 . Ninety (90) percent of families enrolled 90 5 . All FSW ' s will complete a Family Support days or longer will have updated their Individual Plan for enrolled clients, developing mutual Family Support Plan within the previous ninety goals and activities the family will strive to days . obtain . 6 . One hundred ( 100) percent of eligibility 6 . All potential HF clients will be given an assessments will be conducted using a eligibility assessment as part of the enrollment standardized tool . process in Healthy Families . 8 Organization : Indian River County Healthy Start Coalition, Inc . Program: Healthy Families — IRC Funder: IRC Board of County Commissioners — Children's Services Advisory Committee - 05-06 Grant Application E. 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 Indian River County Health * Provides coordination of HS/HF prenatal screen. Department * Communication on potential HF client ' s status . * Medical/nursing based services for HF client on an "as- needed" basis. * WIC and needed health care services at CHD clinics . All these services are provided in-kind Indian River Memorial Hospital * Provides referrals to HF-IRC program from Delivery/ Nursery Department for identified high-risk families . All these services are _provided in-kind. IRC Library — Born to Read * Provides two books to newborn families that are given to Program the family of the newborn . The HF-IRC emphasizes the importance of reading to their infant towards enhancing brain development. All these services are provided in-kind. Visiting Nurses Association of the * Provides home visitation for mothers of newborns Treasure Coast experiencing breastfeeding difficulties or in need of greater breastfeeding education. Partners in Women ' s Health * Primary site for Healthy Families referrals . Partner' s employs, under contract from the Coalition, the Screening Liaison who provides HF-IRC orientation, education, and processing of the Universal Screen. Indian River County Healthy Start * Overall program development, integration and Coalition communication within all three IRCHSC programs. * Fundraising, PR and marketing of HF-IRC program (While the Coalition is the applying * In cooperation/collaboration with the HF-IRC Program agency, many in-kind collaborative Manager, QA/QI, reports . efforts on behalf of the HF-IRC * Provide HF-IRC representation at public events program take place) * Presentations to community groups re : HF-IRC * Development and presentation of HF-IRC Grant(s) * Fiscal oversight and reimbursement requests . All these services are provided in-kind and with no administrative fee. 9 Edit this Header. Type 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. 14 IRCHSC/HF-IRC 05-06 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 : Indian River County Healthy Start Coalition , Inc ./Healthy Families -IRC FUNDER : IRC BOCC Children 's Service Advisory Committee = 05 -06 I CAUTION : Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in place. Gray areas should Abe used for calculations and to write information only. GRAY AREAS FOR Proposed REVENUES AGENCY USE ONLY sed Total Program Funder Specific Total Agency " gCALG;� Budget Budget Budget 1 Children's Services Council-St, Lucie 2 Children's Services CounciWartin 3 Advisory Committee-Indian River 55,000.00 559000.00 75,000 . 00 4 United Way=St. Lucie County 5 United Way-Martin County 6 United Way-Indian River County 46,000.00 7 DOH-0unce of Prevention 488,085.00 945,315.00 8 County Funds 9 Contributions-Cash 12 ,500.00 10 Program Fees 11 Fund Raising Events-Net 12,500.00 12 Sales to Public • Net 13 Membership Dues 14 Investment Income 15 Miscellaneous 50 ,000.00 16 Legacies & Bequests 17 Funds from Other Sources 12 ,500.00 18 Reserve Funds Used for Operating 19 In•Kind Donations (Not included in total) 20 TOTAL REVENUES (doesn't include line 19) $543,085.00 $55,000. 001 $ 1 , 153,815. 00 A B C D EXPENDITURES GRAY AREAS FOR Proposed Total Program Funder Specific Total Agency AGENCY USE ONLY (SHOW CALCULAMNS) Budget Budget Budget 21 Salaries - (must complete chart on next page) 3302581 .00 55,000 .00 773,281 . 00 Salary 22 FICA . Total salaries x 0. 0765 7.65% 25,290 . 00 47207.50 59, 156 .00 e firemen - Annual pension tor qualm &k 23 staff ( note: this includes WC, UC and 0 . 00 88,000.00 Life/Health - Medical/Dental/Short-term 24 Disab. 41 ,000.00 0 . 00 Workers Compensation - # employees x 25 rate 4,200 .00 0 .00 Honda unemployment - pro)ec e 26 employees x $7,000 x UCT-6 rate 49000.00 0 . 00 SALARIES A a D Gross Annual c % of Gross Annual POSITION LISTING Salary Portion of Salary Proposed Funder Specific Budget Salary Position Title / Total Hrs/wk (Agency) Programm Requested(CIA) Example: Executive Director/ 40 hrs 70,000. 00 10,000.00 5, 000.00 7. 14% 5/13/2005 B-1 Organization: Indian River County Healthy Start Coalition , Inc. Program: Healthy Families — IRC Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 05-06 Grant Application 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 Comprehensive data on each HF — IRC family who enrolls is entered in a Healthy Families database, developed by Healthy Families Florida. This data includes demographic information. The parent(s) and the Family Support Worker monitor infant developmental stages , with updates documented in the family record. HF — IRC participates in statewide evaluation and provides outcome and performance data in the format and frequency specified by Healthy Families Florida. The HF- Florida database is updated on a weekly basis, with reports also generated on a weekly basis, which is provided to the Project Manager and Supervisor, who then share the general information and/or discrepancies with the appropriate FSW. The Healthy Families Florida Contract manager performs sites reviews on a quarterly basis, as well as Coalition and HF-IRC Advisory Board reviews. 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? The outcomes are based on data needed by HF Florida (HFF) as well as HF-IRC , which are compiled and entered into the HFF database at regularly scheduled intervals . Based on strict HFF criteria, families develop goals based on their assets and needs, and must achieve these through the program to "graduate" to higher levels, which means less intensity of services, which empowers the family to become self-sufficient . The required data and outcomes are monitored by HFF, as well as locally by the HF-IRC Program Manager and the Coalition. These measures are based on 30 years of research by Healthy Families America, 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? Database is compiled and updated on a weekly basis , with reports also generated on a weekly basis that the FSW and Supervisor review . Monthly reports are provided to the HF-IRC Advisory Board, and quarterly reports are submitted to the Coalition and CSAC . 10 Organization : Indian River County Healthy Start Coalition, Inc . Program: Healthy Families — IRC Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 05-06 Grant Application Data and programmatic reports are submitted to the HF-IRC Advisory Board on a monthly basis, the Coalition Executive Director and Board of Directors on a quarterly basis, the HFF Contract Manager on a monthly basis , who also conducts on-site QA/QI every three months . Reports are provided at the public Coalition meetings bi-monthly. All of the QA/QI partners, which include Healthy Families Florida, the Advisory Board and the Coalition address program outcomes from a global sense and work towards strategies and solutions that can be shared with the HF-IRC service staff, who then apply the action steps to benefit the families they serve. 11 IRCHSC/HF-IRC 05-06 Program Manager 45, 150 . 00 45, 150 .00 ja Supervisor/FAW 36,278 .00 36 ,278.00 Supervisor 299201 .00 29,201 . 00 FAW 24 , 595. 00 24,595.00 8 FSW 173,327.00 173 ,327.00 55,000.00 Data entry clerk 22,030.00 22,030.00 0. 00°i° #DIV/0! #DIV/0 ! #DIV/0 ! Remaining Positions outside Healthy Families #DIV/01 TLC (total annual ) 69,700. 00 0. 00% Care Coordination 2419000.00 0 .00% IRCHSC 132 ,000 . 00 0. 00% #DIV/0 ! #DIV/0! #DIV/0 ! #DIV/0! #DIV/0 ! #DIV/0! #DIV/0 ! Remaining positions throughout the agency Total Salaries 1 $773,281 .001 $330,581 . 00 $559000.00 7. 11 FRINGE BENEFITS DETAIL A (Funder Specific Budget Funder B C p E F G Pension Worker's Unemployme Total Fringes Funder Column C only, from line 22 to 27) Specific FICA 7. 65% IA x Yo) Health ins. Compens. nt Compens. Specific Position Title / Total Hrs/wk Budget Example: Case Manager / 40 his 5,000.00 382.50 200.00 500.00 300.00 200.00 1, 582.50 Program Manager 0 .00 0 . 00 0 . 0 Supervisor/FAW 0. 00 0. 00 0. 0 Supervisor 0. 00 0. 00 0. 0 FAW 0 . 00 0 . 00 0 . 0 8 FSW 55,000 .00 41207 . 50 41207 . 50 Data entry clerk 0. 00 0. 00 1 0 . 0 0 0.00 0 .00 0 . 0 0 0 .00 0 .00 0.0 0 0. 00 0. 00 0. 0 Remaining Positions outside Healthy Families 0. 00 0 . 00 0 . 0 TLC (total annual ) 0. 00 0 .00 0. 0 Care Coordination 0.00 0. 00 0 . 0 IRCHSC 0 . 00 0. 00 1 0. 0 0 0. 00 0.00 0 . 0 0 0. 00 0 . 00 0 . 0 0 0. 00 0. 00 0. 0 0 0. 00 0.00 0 . 0 0 0. 00 0. 00 0. 0 0 0. 00 0 . 001 1 0. 0 0 1 0. 001 0. 001 1 1 1 1 0 . 0 Total Funder Request Fringe Benefits 1 $55,000 . 001 $4 ,207. 50 -$0.0-0-r- $0.001 $0.0q $0. 001 $4 ,207. 5 A B C D EXPENDITURES GRAY AREAS FOR Proposed Total Program Funder Specific Total Agency AGES OW USETo Budget Budget Budget 27 Travel-Daily 18,000.00 24,000.00 # of Staff x average # of miles/wk x 50 wks x $ = Estimated Daily Travel/Mileage Reimb. 28 Travel/conferencesrTraining 6, 500.001 14 ,000.00 5/131200s B-1 IRCHSC/HF-IRC 05-06 • National Conference (cost per staff) • Training/Seminar (cost per staff) • Other Trainings (cost of travel , lodging, registration , food) 29 Office Supplies 91500. 00 12, 500.00 • Office supplies (monthly average x 12 months = estimated cost of office supplies based on present history. 30 Telephone 7,200 . 00 18 ,000. 00 • # 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 300.00 10 ,000. 00 • Quarterly Mailing of Newsletter • Special events, etc. • Bulk mailings - appeals 32 Utilities 3 ,800.00 6 ,000. 00 • Electricity ($ x 12 months) • Water/Sewer ($ x 12 months) • Garbage ($ x 12 months) 33 Occupancy (Building & Grounds) 249000 .00 36,000 . 00 • Mortgage/Rent ($ x 12 months) • Janitorial ($ x 12 months) • Grounds Maint. ($ x 12 months) • Real Estate Taxes 34 Printing & Publications 600. 00 65000 .00 Quarterly Newsletter ($ x 4) Letterheads , Envelopes, etc. Fundraising materials Other 35 Subscription/Dues/Memberships 21500. 00 • Membership to National Organization • Dues • Subscriptions to Newspapers/magazines , etc. 36 Insurance 31500.00 41500. 00 • Directors/Officers Liab. • Commercial/General Insurance Bond Ins. Auto Insurance 37 Equipment: Rental & Maintenance 41500.00 51500. 00 • Copier lease ($ x 12 months) • Meter lease ($ x 12 months) • Copier Maintenance ($ x 12 months) • Computer Maintenance ( $ x 12 months) • Other 38 Advertising 800.00 3 ,000 . 00 • Newspaper ads • Fundraising ads/promotions • Other (vacancies) 39 Equipment Purchases : Capital Expense 21000.00 31000 .00 • Computer/monitor (# x $) • Laser Printer 40 Professional Fees (Legal, Consulting) 61000.00 12,000.00 • Legal advice ( estimated #hrs x $) • Consultant fees • Other 41 Books/Educational Materials 1 ,500.00 3,300. 00 • Books/videos • Materials ($ x staff) 42 Food & Nutrition 5/13/2005 B-1 Organization : Indian River County Healthy Start Coalition, Inc. Program: Healthy Families — IRC Funder: IRC Board of County Commissioners — Children ' s Services Advisory Committee - 05-06 Grant Application 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 com l ting the timetable, review information detailed in prior sections. Month/ Activities Period The major steps for the overall program are : Pregnant women are offered the universal screen by the Screening Liaison at Partners in Women ' s Health. The voluntary screen looks at risks for child abuse . A consent form is also signed by the client if they have a positive score for Healthy Families on the universal HS/HF screen . Referrals can also come from the social worker at Indian River Memorial Weekly Hospital at the time of birth. Additional referrals can come from any agency in the community. Families can be eligible for assessment during pregnancy or up to two weeks after the birth of their child. The screen is sent to the Healthy Start Care Coordination office for processing . All screens are then forwarded to the Healthy Families Family Assessment Worker (FAW) for a face- to-face assessment to determine if they are eligible for Healthy Families . The FAW communicates with the HS Care Coordination team to determine the potential HF client' s status prior to performing the assessment. After the assessment, if the family is eligible for Healthy Families, and is interested in On-going participation, the Program Manager reviews the case with the FAW. The case (family) then goes to the HF Supervisor, who reviews the family' s needs and determines the best Family Support Worker (FSW) for case management assignment. The family is then assigned to a FSW. Phone contact must be attempted within 72 hours by the FSW. A subsequent home visit attempt must be completed within 5 days . Once contact is made with the family, initial goal(s) setting is done within one month of opening case . Supervision is conducted weekly with all FSW ' s for a minimum of two hours, who review all cases assigned to the FSW. Goals are reviewed and updated with the family and Supervisor every 90 days . These goals can be modified during 90 days if needed . For pregnant women, the determination of weekly or bi-weekly visits during pregnancy is made . After birth, visits are weekly for a minimum of 6 months . Bi-weekly visits can be done if the mom returns to work, with phone contacts in between . Six to eight months after birth, the Supervisor and FSW will determine if the family can move to level two , which are bi-weekly visits . This determination would be based on the family' s progress in meeting their goals and well as overall family needs . The Ages and Stages child assessment tool is conducted every four months and goes all the way to 60 months . The Parent Child Assessment/Observation tool is done at one month, then every six months . Home Safety checks at one month then six months . The family and target child have goals and levels to achieve for program graduation . 12 Organization : Indian River County Healthy Start Coalition, Inc. Program: Healthy Families — IRC Funder: IRC Board of County Commissioners — Children 's Services Advisory Committee - 05-06 Grant Application H. PROJECTIONS FOR UNDUPLICATED CLIENTS Number of Unduplicated Clients by Location Last Fiscal Year Current Fiscal Year Next Fiscal Year Location Actual 2003/2004 Budget 2004/05 Projections 2005/06 Unduplicated Clients Unduplicated Clients Unduplicated Clients N. Indian River County* 159 171 198 S. Indian River County* 99 193 108 Indian River Co. Total 258 364 306 TOTAL SERVED 258 364 306 *Counts infant/child and mother ( 182 families) ( 182 families) * * Does not count father or partner Number of Unduplicated Clients by Age Last Fiscal Year Current Fiscal Year Next Fiscal Year Location Actual 2003/2004 Budget 2004/05 Projections 2005/06 Individuals Group ; Individuals Group Individuals Group 0 to 4 - (Pre-school) 113 - 182 - 120 - 5 to 10 - (Elementary) 30 - - - 30 - 11 to 14 - (Middle) 7 - - - 7 - 15 to 18 - (High School) 1 - 12 - 2 - Total Children 151 - 194 - 159 - 19 to 59 - (Adults) 107 - 170 - 147 - L60 + (Seniors)Total Adults 107 - 170 - 147OTAL SERVED 258 - 364 - 306 - 13 IRCHSC/HF-IRC 05-06 • Meals ( # meals x clients x 5days x 50 wks) • Snacks 43 Administrative Costs 35,000. 00 40,000.00 Admin. Cost (% of total budget) 44 Audit Expense 60000.00 20 ,000.00 Independent Audit Review 45 Specific Assistance to Individuals 2,500 .00 51000.00 • Medical assistance • Meals/Food • Rent Assistance • Other 46 Other/Miscellaneous 61000.00 8,000 . 00 • Background check/drug test • Other 47 Other/Contract • Sub-contract for program services 48 TOTAL EXPENSES $542,771 .00 $59,207.50 $ 1 , 1539737.00 5/13/2005 B.1 IRCHSCMF-IRC 0506 UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCY/PROGRAM NAME: Indian River County Healthy Start Coalition, In ./Healthy Families-IRC FY 03/04 FY 04/05 FY 05106 %, INCREASE FYE FYE FYE CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (col. C-eol. Byeol. B REVENUES BUDGETED BUDGETED 1 Children's Services Council-St Lucie 0.00 #DIV/O! 2 Children's Services Council-Martin 0.00 #DIV/0! 3 Advisory Committee4ndian River 709000.00 74 500.00 759000. 00 0. 67% 4 United Way-St Lucie County 0. 00 #DIV/01 5 United Way-Martin County 0.00 #DIV/0! 6 United Way-Indian River County 45 000.00 46 000.00 46 000. 00 0. 00% 7 DOH - Ounce of Prevention 366 963.00 3669963.00 945 315. 00 157. 60% 8 County Funds 32 500.00 20 500. 00 0.00 -100. 00% 9 Contributions-Cash 5705.00 129500. 00 #DIV/01 10 Program Fees 7830.00 10 250.00 0.00 0100.00% 11 Fund Raising Events-Net 22,222.00 24 250.00 129500. 00 -48.45% 12 Sales to Public-Net 0. 00 #DIV/0! 13 Membership Dues 0.00 #DIV/01 14 Investment Income 0. 00 #DIV/01 15 Miscellaneous 112 905.60 135198.00 50,000.00 -63.02% 1s Legacies & Bequests 0. 00 #DIV/01 17 Funds from Other Sources 386,040.00 443 985.00 12,500. 00 -97. 18% 18 Reserve Funds Used for Operating 239000.00 0.00 0100. 00% 19 In-Kind Donations (Not Included in toad 0. 00 #DIV/0! 20 TOTAL 190499165.60 19144,646.00 1 , 1533815.00 0. 80% EXPENDITURES 21 Salaries 629 674. 12 756 306.00 773,281 . 00 2.240 22 FICA 48 170.07 57A57.00 59, 156. 00 2.25% 23 Retirement rLines 23-26 are combinedl 91 966.01 809599.26 88,000. 00 9. 18% 24 Life/Health 0.00 #DIV/01 25 Workers Compensation 0. 00 #DIV/0! 26 Florida Unemployment 0.00 #DIV/01 27 Travel-Daily 17 107.23 21 706.00 249000.00 10.57% 28 Travel/Conferences/Training 14,944.4712 500.00 14,000.00 12.00% 29 Office Supplies 99168.44 109700.00 12 500.00 16.82% 30 Telephone 159636. 10 17 200.00 187000.00 4.65% 31 Postage/Shipping 89241 .87 81384.00 107000.00 19.27% 32 Utilities 79651 ,71 5156.00 61000.00 16.37% 33 Occupancy (Building & Grounds 30 509.00 37,299.00 36,000.00 3.48% 34 Printing & Publications 61633.66 5,700.00 6 000.00 5.26% 35 Subscription/Dues/Memberships 29436.00 19500.00 27500.00 66.67% 36 Insurance 89469.00 4100.00 4500.00 9.76% 37 E ui ment: Rental & Maintenance 82050.00 40935.00 55500.00 11 .45% 38 Advertising 19211 .48 49800.00 31000.00 -37.50% 39 Equipment Purchases:Ca ital Expense 562.00 29500.00 39000.00 20.00% 40 Professional Fees (Legal, Consulting) 399319.56 11 350.00 122000.00 5.73% 41 Books/Educational Materials 4857.41 31300.00 39300. 00 0.00% 42 Food & Nutrition 29988.00 19300.00 0.00 -100. 00% 43 Administrative Costs 31 988.00 62 398. 50 40,000.00 -35.90% 44 Audit Expense 71975.00 18x840.00 20 000.00 6. 16% 45 Specific Assistance to Individuals 5,271 .46 10,500.00 5,000.00 -52.38% 46 Other/Miscellaneous 359375.33 7o846.00 82000.00 1 .96% 47 Other/Contract 10 953.95 0.00 #DIV/0! 48 TOTAL 12039159.87 1 , 146 776.76 19153,737.00 0.61 % 49 REVENUES OVER/ UNDER EXPENDITURES 10 005.73 -21130.76 78.00 -103. 66% 5/172005 94 Edit this Header. Type 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. 14 IRCHSC/HF-IRC 05-06 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 : Indian River County Healthy Start Coalition , Inc ./Healthy Families -IRC FUNDER : IRC BOCC Children 's Service Advisory Committee = 05 -06 I CAUTION : Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in place. Gray areas should Abe used for calculations and to write information only. GRAY AREAS FOR Proposed REVENUES AGENCY USE ONLY sed Total Program Funder Specific Total Agency " gCALG;� Budget Budget Budget 1 Children's Services Council-St, Lucie 2 Children's Services CounciWartin 3 Advisory Committee-Indian River 55,000.00 559000.00 75,000 . 00 4 United Way=St. Lucie County 5 United Way-Martin County 6 United Way-Indian River County 46,000.00 7 DOH-0unce of Prevention 488,085.00 945,315.00 8 County Funds 9 Contributions-Cash 12 ,500.00 10 Program Fees 11 Fund Raising Events-Net 12,500.00 12 Sales to Public • Net 13 Membership Dues 14 Investment Income 15 Miscellaneous 50 ,000.00 16 Legacies & Bequests 17 Funds from Other Sources 12 ,500.00 18 Reserve Funds Used for Operating 19 In•Kind Donations (Not included in total) 20 TOTAL REVENUES (doesn't include line 19) $543,085.00 $55,000. 001 $ 1 , 153,815. 00 A B C D EXPENDITURES GRAY AREAS FOR Proposed Total Program Funder Specific Total Agency AGENCY USE ONLY (SHOW CALCULAMNS) Budget Budget Budget 21 Salaries - (must complete chart on next page) 3302581 .00 55,000 .00 773,281 . 00 Salary 22 FICA . Total salaries x 0. 0765 7.65% 25,290 . 00 47207.50 59, 156 .00 e firemen - Annual pension tor qualm &k 23 staff ( note: this includes WC, UC and 0 . 00 88,000.00 Life/Health - Medical/Dental/Short-term 24 Disab. 41 ,000.00 0 . 00 Workers Compensation - # employees x 25 rate 4,200 .00 0 .00 Honda unemployment - pro)ec e 26 employees x $7,000 x UCT-6 rate 49000.00 0 . 00 SALARIES A a D Gross Annual c % of Gross Annual POSITION LISTING Salary Portion of Salary Proposed Funder Specific Budget Salary Position Title / Total Hrs/wk (Agency) Programm Requested(CIA) Example: Executive Director/ 40 hrs 70,000. 00 10,000.00 5, 000.00 7. 14% 5/13/2005 B-1 IRCHSCMFIRC 0506 UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: Indian River County Healthy Start Coalition , Inc./Health Families-IRC 05-06 FY 03/04 FY 04105 FY 05/06 % INCREASE FYE FYE FYE CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (col. C<ol. Bycol. B REVENUES BUDGETED BUDGETED 1 Children's Services Council-St. Lucie 0. 00 #DIV/0! 2 Children's Services Council-Martin 0. 00 #DIV/01 3 Advisory Committee-Indian River 55 000.00 55,000.00 55 000.00 0. 00% 4 United Wa .St. Lucie County 0. 00 #DIV/01 5 United Way-Martin County 0.00 #DIV/01 6 United Way-Indian River County 0. 00 #DIV/01 7 DOH-Ounce of Prevention 373,761 .00 466 085.00 488,085.00 4.72% e CountyFunds 0.00 #DIV/01 9 Contributions-Cash 700.00 0. 00 #DIV/01 10 Program Fees 0.00 #DIV/0! 11 Fund Raising Events-Net 0.00 #DIV/01 12 Sales to Public-Net 0.00 #DIV/01 13 Membership Dues 0. 00 #DIV/01 14 Investment Income 0.00 #DIV/01 15 Miscellaneous 0. 00 #DIWOI 16 Legacies & Bequests 0.00 #DIV/0! 17 Funds from Other Sources 0. 00 #DIV/O! 1s Reserve Funds Used for Operating 0.00 #DIV/0! to In-Kind Donations (Not included in total) 0. 00 #DIV/01 20 TOTAL 429v461 . 00 521 085.00 543,085.00 4.22% EXPENDITURES 21 Salaries 2939015.00 314y838.00 330,581 .00 5.00% 22 FICA 22,416.00 24 085.00 25 290.00 5.00% 23 Retirement 0.00 #DIV/01 24 Life/Health 31 340.00 36 085.00 417000.00 13.62% 25 Workers Compensation 2,873.00 41200. 00 #DIV/01 26 Florida Unemployment 49000.00 #DIV/01 27 Travel-Daily 14,987.00 15,500.00 18,000.00 16. 13% 2e Travel/Conferencesrrrainin 4$007.00 69500.00 6,500.00 0.00% 29 Office Supplies 89209.00 11 500.00 99500.00 -17.39% 3o Tele hone 6 806.00 6,200.00 7 200.00 16. 13% 31 Postage/Shipping 1 ,006.00 300.00 300.001 0.00% 32 Utilities 61120.00 365600 380000 3.94% 33 Occupancy (Building & Grounds 18 295.00 21 812.00 2400000 10.03% 34 Printing & Publications 400.00 800.00 600.00 -25.00% 35 SubscritionlDues/Membershi s 594.00 0.00 #DIV/01 36 Insurance 2,500.00 3,000.00 3 500. 00 16.67% 37 Equipment: Rental & Maintenance 3o274,00 69435.00 40500.001 -30.07% 38 Advertising 17211 ,00 800.00 800. 00 0.00% 39 Equipment Purchases:Ca ital Expense 192.00 27500,00 29000.00 -20.00% 40 Professional Fees (Legal, Consulting) 12 326.00 5,600.00 69000.00 7. 14% 41 Books/Educational Materials 11825.00 11500.00 1 500.00 0.00% 42 Food & Nutrition 0.00 #DIV/01 43 Administrative Costs 16 841 .00 329703.00 35 000.00 7.02% 4a Audit Expense 3920.00 6,000.00 6000.00 0. 00% 45 Specific Assistance to Individuals 5,271 .00 2 500.00 2500L=00 0.00% 46 Other/Miscellaneous 1714.00 67300.00 600000 -4.76% 47 Other/Contract 99"2.00 9 750.00 0.00 -100.00% 48 TOTAL 468 584.00 5189364.001 5427771 .00 4.71 % 4s REVENUES OVER/ UNDER EXPENDITURES .391123.001 29721 .00 314.00 -88.46% 'Li32(p5 BJ IRCHSC/HF-IRC 05-06 UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME : Indian River County Healthy Start Coalition , Inc./Healthy Families FUNDER : IRC BOCC Children's Service Ad , A B C FY 05/06 FY 05/06 % OF TOTAL FUNDER TOTAL VS. PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET (col. B/col. A) EXPENDITURES 21 Salaries 330 ,581 . 00 55 ,000 , 00 16 .64% 22 FICA 25 ,290 .00 41207 .50 16 . 64% 23 Retirement 0 . 00 0 .00 #DIV/0 ! 24 Life/Health 41 ,000 . 00 0 . 00 0 .00 % 25 Workers Compensation 41200 .00 0 , 00 0 .00% 26 Florida Unemployment 40000 .00 0 , 00 0 . 00 % 27 Travel =Daily 18 ,000 . 00 0 .00 0 . 00 % 28 Travel/Conferences/Training 61500 . 00 0 .00 0 , 00% 29 Office Supplies 9 ,500 .00 0 . 00 0 , 00 % 30 Telephone 77200 . 00 0 , 00 0 .00 % 31 Postage/Shipping 300 .00 0 .00 0 , 00% 32 Utilities 39800 . 00 0 , 00 0 .00 % 33 Occupancy ( Building & Grounds 24,000 .00 0 .00 0 .00% 34 Printing & Publications 600 . 00 0 , 00 0 , 00% 35 Subscri tion/Dues/Memberships 0 . 00 0 .00 #DIV/01 36 Insurance 31500 , 00 0 .00 0 , 00% 37 Equipment: Rental & Maintenance 41500 . 00 0 .00 0 . 00 % 38 Advertising 800 .00 0 .00 0 .00% 39 Equipment Purchases : Ca ital Expense 21000 .00 0 ,00 0 .00% 40 Professional Fees ( Legal , Consulting ) 6 ,000 . 00 0 .00 0 , 00% 41 Books/Educational Materials 13500 . 00 0 . 00 0 , 00 % 42 Food & Nutrition 0 , 00 0 , 00 #DIV/01 43 Administrative Costs 359000 .00 0 .00 0 , 00% 44 Audit Expense 6 ,000 . 00 0 , 00 0 . 00 % 45 Specific Assistance to Individuals 29500 . 00 0 . 00 0 , 00 % 46 Other/Miscellaneous 61000 . 00 0 , 00 0 . 00 % 47 Other/Contract 0 .00 0 .00 #DIV/01 48 TOTAL $542 ,771 . 00 $ 59 ,207 . 50 1 10 . 91 % 5113/2005 B-4 IRCHSC/HF-IRC 05-06 Program Manager 45, 150 . 00 45, 150 .00 ja Supervisor/FAW 36,278 .00 36 ,278.00 Supervisor 299201 .00 29,201 . 00 FAW 24 , 595. 00 24,595.00 8 FSW 173,327.00 173 ,327.00 55,000.00 Data entry clerk 22,030.00 22,030.00 0. 00°i° #DIV/0! #DIV/0 ! #DIV/0 ! Remaining Positions outside Healthy Families #DIV/01 TLC (total annual ) 69,700. 00 0. 00% Care Coordination 2419000.00 0 .00% IRCHSC 132 ,000 . 00 0. 00% #DIV/0 ! #DIV/0! #DIV/0 ! #DIV/0! #DIV/0 ! #DIV/0! #DIV/0 ! Remaining positions throughout the agency Total Salaries 1 $773,281 .001 $330,581 . 00 $559000.00 7. 11 FRINGE BENEFITS DETAIL A (Funder Specific Budget Funder B C p E F G Pension Worker's Unemployme Total Fringes Funder Column C only, from line 22 to 27) Specific FICA 7. 65% IA x Yo) Health ins. Compens. nt Compens. Specific Position Title / Total Hrs/wk Budget Example: Case Manager / 40 his 5,000.00 382.50 200.00 500.00 300.00 200.00 1, 582.50 Program Manager 0 .00 0 . 00 0 . 0 Supervisor/FAW 0. 00 0. 00 0. 0 Supervisor 0. 00 0. 00 0. 0 FAW 0 . 00 0 . 00 0 . 0 8 FSW 55,000 .00 41207 . 50 41207 . 50 Data entry clerk 0. 00 0. 00 1 0 . 0 0 0.00 0 .00 0 . 0 0 0 .00 0 .00 0.0 0 0. 00 0. 00 0. 0 Remaining Positions outside Healthy Families 0. 00 0 . 00 0 . 0 TLC (total annual ) 0. 00 0 .00 0. 0 Care Coordination 0.00 0. 00 0 . 0 IRCHSC 0 . 00 0. 00 1 0. 0 0 0. 00 0.00 0 . 0 0 0. 00 0 . 00 0 . 0 0 0. 00 0. 00 0. 0 0 0. 00 0.00 0 . 0 0 0. 00 0. 00 0. 0 0 0. 00 0 . 001 1 0. 0 0 1 0. 001 0. 001 1 1 1 1 0 . 0 Total Funder Request Fringe Benefits 1 $55,000 . 001 $4 ,207. 50 -$0.0-0-r- $0.001 $0.0q $0. 001 $4 ,207. 5 A B C D EXPENDITURES GRAY AREAS FOR Proposed Total Program Funder Specific Total Agency AGES OW USETo Budget Budget Budget 27 Travel-Daily 18,000.00 24,000.00 # of Staff x average # of miles/wk x 50 wks x $ = Estimated Daily Travel/Mileage Reimb. 28 Travel/conferencesrTraining 6, 500.001 14 ,000.00 5/131200s B-1 IRCHSC/HF-IRC 05-06 • National Conference (cost per staff) • Training/Seminar (cost per staff) • Other Trainings (cost of travel , lodging, registration , food) 29 Office Supplies 91500. 00 12, 500.00 • Office supplies (monthly average x 12 months = estimated cost of office supplies based on present history. 30 Telephone 7,200 . 00 18 ,000. 00 • # 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 300.00 10 ,000. 00 • Quarterly Mailing of Newsletter • Special events, etc. • Bulk mailings - appeals 32 Utilities 3 ,800.00 6 ,000. 00 • Electricity ($ x 12 months) • Water/Sewer ($ x 12 months) • Garbage ($ x 12 months) 33 Occupancy (Building & Grounds) 249000 .00 36,000 . 00 • Mortgage/Rent ($ x 12 months) • Janitorial ($ x 12 months) • Grounds Maint. ($ x 12 months) • Real Estate Taxes 34 Printing & Publications 600. 00 65000 .00 Quarterly Newsletter ($ x 4) Letterheads , Envelopes, etc. Fundraising materials Other 35 Subscription/Dues/Memberships 21500. 00 • Membership to National Organization • Dues • Subscriptions to Newspapers/magazines , etc. 36 Insurance 31500.00 41500. 00 • Directors/Officers Liab. • Commercial/General Insurance Bond Ins. Auto Insurance 37 Equipment: Rental & Maintenance 41500.00 51500. 00 • Copier lease ($ x 12 months) • Meter lease ($ x 12 months) • Copier Maintenance ($ x 12 months) • Computer Maintenance ( $ x 12 months) • Other 38 Advertising 800.00 3 ,000 . 00 • Newspaper ads • Fundraising ads/promotions • Other (vacancies) 39 Equipment Purchases : Capital Expense 21000.00 31000 .00 • Computer/monitor (# x $) • Laser Printer 40 Professional Fees (Legal, Consulting) 61000.00 12,000.00 • Legal advice ( estimated #hrs x $) • Consultant fees • Other 41 Books/Educational Materials 1 ,500.00 3,300. 00 • Books/videos • Materials ($ x staff) 42 Food & Nutrition 5/13/2005 B-1 IRCHSCMF-IRC OSOB UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: Indian River County Healthy Start Coalition, Inc./Healthy Families-IRC FUNDER : IRC BOCC Children's Service Advisory Committee 05-06 LINE ITEM EXPLANATION FOR VARIANCE #DN/0! #DNIO! #DN/Ol #DN/0! #DN/0! #DN/O! #DN/Ol #DN/O! #DN/0! #DN/0! #DN/O! #DN/Ol #DNIO! #DN/Ol #DN/0! #DN/01 #DNIO! #DN/0! #DNIO! #DN/0! Due to the increase in staff and the substantial increase in gas prices this category had to be increased especially in light of the fact that Travel4)aily staff are always on the road doing constant home visitations with the clients. This item was underbudgeted in the last fiscal year, there has been an increase in staff to be able to serve more families to the maximum capacity permitted which resulted in more phone lines being installed. Tele hone #DN/O! Insurance We have had an increase in insurance premiums due to the fact our staff performs frequent home visitations on at-risk families. #DN/O! &13/2005 es III iiiiiiiiiiiiiiiiiiiiiillillillillillillilliilillill� IRCHSCMFIRC 05-06 UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE FUNDER SPECIFIC BUDGET AGENCY/PROGRAM NAME : FUNDER : LINE ITEM EXPLANATION FOR VARIANCE This is not reall y an increase as we are still using the $55,000 to pay a portion of the FSW salaries. It is just that we are excluding FICA. However, the program does not permit us to exclude FICA. If FICA must be included we can reduce the $55,000 to $519091 .50 Salaries and add FICA in the amount of $3,908.50 for a total still of $55,000. FICA See above #DIV/0! ;DIV/01 ;DN/0! #DN/0! 511312005 B-5 IRCHSC/HF-IRC 05-06 • Meals ( # meals x clients x 5days x 50 wks) • Snacks 43 Administrative Costs 35,000. 00 40,000.00 Admin. Cost (% of total budget) 44 Audit Expense 60000.00 20 ,000.00 Independent Audit Review 45 Specific Assistance to Individuals 2,500 .00 51000.00 • Medical assistance • Meals/Food • Rent Assistance • Other 46 Other/Miscellaneous 61000.00 8,000 . 00 • Background check/drug test • Other 47 Other/Contract • Sub-contract for program services 48 TOTAL EXPENSES $542,771 .00 $59,207.50 $ 1 , 1539737.00 5/13/2005 B.1 IRCHSCMF-IRC 0506 UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCY/PROGRAM NAME: Indian River County Healthy Start Coalition, In ./Healthy Families-IRC FY 03/04 FY 04/05 FY 05106 %, INCREASE FYE FYE FYE CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (col. C-eol. Byeol. B REVENUES BUDGETED BUDGETED 1 Children's Services Council-St Lucie 0.00 #DIV/O! 2 Children's Services Council-Martin 0.00 #DIV/0! 3 Advisory Committee4ndian River 709000.00 74 500.00 759000. 00 0. 67% 4 United Way-St Lucie County 0. 00 #DIV/01 5 United Way-Martin County 0.00 #DIV/0! 6 United Way-Indian River County 45 000.00 46 000.00 46 000. 00 0. 00% 7 DOH - Ounce of Prevention 366 963.00 3669963.00 945 315. 00 157. 60% 8 County Funds 32 500.00 20 500. 00 0.00 -100. 00% 9 Contributions-Cash 5705.00 129500. 00 #DIV/01 10 Program Fees 7830.00 10 250.00 0.00 0100.00% 11 Fund Raising Events-Net 22,222.00 24 250.00 129500. 00 -48.45% 12 Sales to Public-Net 0. 00 #DIV/0! 13 Membership Dues 0.00 #DIV/01 14 Investment Income 0. 00 #DIV/01 15 Miscellaneous 112 905.60 135198.00 50,000.00 -63.02% 1s Legacies & Bequests 0. 00 #DIV/01 17 Funds from Other Sources 386,040.00 443 985.00 12,500. 00 -97. 18% 18 Reserve Funds Used for Operating 239000.00 0.00 0100. 00% 19 In-Kind Donations (Not Included in toad 0. 00 #DIV/0! 20 TOTAL 190499165.60 19144,646.00 1 , 1533815.00 0. 80% EXPENDITURES 21 Salaries 629 674. 12 756 306.00 773,281 . 00 2.240 22 FICA 48 170.07 57A57.00 59, 156. 00 2.25% 23 Retirement rLines 23-26 are combinedl 91 966.01 809599.26 88,000. 00 9. 18% 24 Life/Health 0.00 #DIV/01 25 Workers Compensation 0. 00 #DIV/0! 26 Florida Unemployment 0.00 #DIV/01 27 Travel-Daily 17 107.23 21 706.00 249000.00 10.57% 28 Travel/Conferences/Training 14,944.4712 500.00 14,000.00 12.00% 29 Office Supplies 99168.44 109700.00 12 500.00 16.82% 30 Telephone 159636. 10 17 200.00 187000.00 4.65% 31 Postage/Shipping 89241 .87 81384.00 107000.00 19.27% 32 Utilities 79651 ,71 5156.00 61000.00 16.37% 33 Occupancy (Building & Grounds 30 509.00 37,299.00 36,000.00 3.48% 34 Printing & Publications 61633.66 5,700.00 6 000.00 5.26% 35 Subscription/Dues/Memberships 29436.00 19500.00 27500.00 66.67% 36 Insurance 89469.00 4100.00 4500.00 9.76% 37 E ui ment: Rental & Maintenance 82050.00 40935.00 55500.00 11 .45% 38 Advertising 19211 .48 49800.00 31000.00 -37.50% 39 Equipment Purchases:Ca ital Expense 562.00 29500.00 39000.00 20.00% 40 Professional Fees (Legal, Consulting) 399319.56 11 350.00 122000.00 5.73% 41 Books/Educational Materials 4857.41 31300.00 39300. 00 0.00% 42 Food & Nutrition 29988.00 19300.00 0.00 -100. 00% 43 Administrative Costs 31 988.00 62 398. 50 40,000.00 -35.90% 44 Audit Expense 71975.00 18x840.00 20 000.00 6. 16% 45 Specific Assistance to Individuals 5,271 .46 10,500.00 5,000.00 -52.38% 46 Other/Miscellaneous 359375.33 7o846.00 82000.00 1 .96% 47 Other/Contract 10 953.95 0.00 #DIV/0! 48 TOTAL 12039159.87 1 , 146 776.76 19153,737.00 0.61 % 49 REVENUES OVER/ UNDER EXPENDITURES 10 005.73 -21130.76 78.00 -103. 66% 5/172005 94 SUPPORTING DOCUMENTS CHECKLIST RFP 7052 ./ Cover Page ./ Application ✓ List of current officers and directors Latest Financial Audit Report & Management Letter that conforms with the AICPA Audit Guide Most recent IRS Form 990, including all schedules J Most recent Internal Financial Statement (i . e. : Balance Sheet and Operating Budget ✓ Staff Organizational Chart NA Most Recent Annual Report (if available) 501 (C)(3 ) IRS Exemption Letter Articles of Incorporation Agency' s Bylaws V Agency' s written policy regarding Affirmative Action Nepotism Statement XV Organization : Indian River County Healthy Start Coalition, Inc. Program: Healthy Families — IRC Funder: IRC Board of County Commissioners — Children ' s Services Advisory Committee - 05-06 Grant Application ORGANIZATION : Indian River Healthy Start Coalition, Inc . PROGRAM : Healthy Families - Indian River County TABLE OF CONTENTS Please `X" the parts of the grant application to indicate that they are included. Also, please put the page number where the information can be located. X I Section of the Proposal Pa e # ✓ TABLE OF CONTENTS (check list) 1 ✓ COVER PAGE (with signatures) . . I 1 0 6 1 1 1 1 1 1 1 1 0 1 of 0 . . . fee . . . . . . 0 a 0 e a 0 a 0 a * a a 0 v * . . . . . . . . 0 3 A. ORGANIZATION CAPABILITY (one page maximum) ✓ 1 . Mission and Vision of organization . , . , off 1 110 off , 4 2 . Summary of expertise, accomplishments, and population served . . . . . . . . . . . . . . . . 4 B. PROGRAM NEED STATEMENT (one page maximum) ✓ 1 . Program Need Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 V2 . Programs that address need and gaps in service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 C . PROGRAM DESCRIPTION (two pages maximum) 1 . Funding priority, I I I I I I I I * I . I I I I 1 0 1 1 1 1 1 1 1 1 1 1 1 1 * 4 0 0 a 0 0 6 a & a 0 & 0 a . . . . . . . . . . . . . . 0 . . . . . . . . . 6 2 . Description of program activities . , , , , , . , . , . 00 1 6 3 . Evidence that program strategy will work . . . . . . . . . . . . . . . . . . . . . . . . . v4 . Staffing . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . 0 0 0 9 0 . 0 0 6 5 . Awareness of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 ✓ 6 . Accessibility of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 D. MEASURABLE OUTCOMES (two pages maximum) . , . . . , , 8 E . COLLABORATION (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 F. PROGRAM EVALUATION (two pages maximum) V 1 . Demographics . , . . , . . . . . 1110190 * 9 9 * 0 00 * 40 off * 0 . 1 $ * a 6600 & 0 a * * * 86 * 011 * . 4 ISO # 10 - V 2 . Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 ✓ 3 . Reporting " , " . , 1 10 , 11 . 10 off 10 G. TIMETABLE (one page maximum) 0040 . . . . . . . . . . . . . . . . . . . . . . . 12 H. UNDUPLICATED CLIENT COUNT 1 . Projections by Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2 . Projections by Age Group " . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . 0 0 0 . . . . . . . . . . . . . . . . . 13 1 IRCHSCMFIRC 0506 UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: Indian River County Healthy Start Coalition , Inc./Health Families-IRC 05-06 FY 03/04 FY 04105 FY 05/06 % INCREASE FYE FYE FYE CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (col. C<ol. Bycol. B REVENUES BUDGETED BUDGETED 1 Children's Services Council-St. Lucie 0. 00 #DIV/0! 2 Children's Services Council-Martin 0. 00 #DIV/01 3 Advisory Committee-Indian River 55 000.00 55,000.00 55 000.00 0. 00% 4 United Wa .St. Lucie County 0. 00 #DIV/01 5 United Way-Martin County 0.00 #DIV/01 6 United Way-Indian River County 0. 00 #DIV/01 7 DOH-Ounce of Prevention 373,761 .00 466 085.00 488,085.00 4.72% e CountyFunds 0.00 #DIV/01 9 Contributions-Cash 700.00 0. 00 #DIV/01 10 Program Fees 0.00 #DIV/0! 11 Fund Raising Events-Net 0.00 #DIV/01 12 Sales to Public-Net 0.00 #DIV/01 13 Membership Dues 0. 00 #DIV/01 14 Investment Income 0.00 #DIV/01 15 Miscellaneous 0. 00 #DIWOI 16 Legacies & Bequests 0.00 #DIV/0! 17 Funds from Other Sources 0. 00 #DIV/O! 1s Reserve Funds Used for Operating 0.00 #DIV/0! to In-Kind Donations (Not included in total) 0. 00 #DIV/01 20 TOTAL 429v461 . 00 521 085.00 543,085.00 4.22% EXPENDITURES 21 Salaries 2939015.00 314y838.00 330,581 .00 5.00% 22 FICA 22,416.00 24 085.00 25 290.00 5.00% 23 Retirement 0.00 #DIV/01 24 Life/Health 31 340.00 36 085.00 417000.00 13.62% 25 Workers Compensation 2,873.00 41200. 00 #DIV/01 26 Florida Unemployment 49000.00 #DIV/01 27 Travel-Daily 14,987.00 15,500.00 18,000.00 16. 13% 2e Travel/Conferencesrrrainin 4$007.00 69500.00 6,500.00 0.00% 29 Office Supplies 89209.00 11 500.00 99500.00 -17.39% 3o Tele hone 6 806.00 6,200.00 7 200.00 16. 13% 31 Postage/Shipping 1 ,006.00 300.00 300.001 0.00% 32 Utilities 61120.00 365600 380000 3.94% 33 Occupancy (Building & Grounds 18 295.00 21 812.00 2400000 10.03% 34 Printing & Publications 400.00 800.00 600.00 -25.00% 35 SubscritionlDues/Membershi s 594.00 0.00 #DIV/01 36 Insurance 2,500.00 3,000.00 3 500. 00 16.67% 37 Equipment: Rental & Maintenance 3o274,00 69435.00 40500.001 -30.07% 38 Advertising 17211 ,00 800.00 800. 00 0.00% 39 Equipment Purchases:Ca ital Expense 192.00 27500,00 29000.00 -20.00% 40 Professional Fees (Legal, Consulting) 12 326.00 5,600.00 69000.00 7. 14% 41 Books/Educational Materials 11825.00 11500.00 1 500.00 0.00% 42 Food & Nutrition 0.00 #DIV/01 43 Administrative Costs 16 841 .00 329703.00 35 000.00 7.02% 4a Audit Expense 3920.00 6,000.00 6000.00 0. 00% 45 Specific Assistance to Individuals 5,271 .00 2 500.00 2500L=00 0.00% 46 Other/Miscellaneous 1714.00 67300.00 600000 -4.76% 47 Other/Contract 99"2.00 9 750.00 0.00 -100.00% 48 TOTAL 468 584.00 5189364.001 5427771 .00 4.71 % 4s REVENUES OVER/ UNDER EXPENDITURES .391123.001 29721 .00 314.00 -88.46% 'Li32(p5 BJ IRCHSC/HF-IRC 05-06 UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME : Indian River County Healthy Start Coalition , Inc./Healthy Families FUNDER : IRC BOCC Children's Service Ad , A B C FY 05/06 FY 05/06 % OF TOTAL FUNDER TOTAL VS. PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET (col. B/col. A) EXPENDITURES 21 Salaries 330 ,581 . 00 55 ,000 , 00 16 .64% 22 FICA 25 ,290 .00 41207 .50 16 . 64% 23 Retirement 0 . 00 0 .00 #DIV/0 ! 24 Life/Health 41 ,000 . 00 0 . 00 0 .00 % 25 Workers Compensation 41200 .00 0 , 00 0 .00% 26 Florida Unemployment 40000 .00 0 , 00 0 . 00 % 27 Travel =Daily 18 ,000 . 00 0 .00 0 . 00 % 28 Travel/Conferences/Training 61500 . 00 0 .00 0 , 00% 29 Office Supplies 9 ,500 .00 0 . 00 0 , 00 % 30 Telephone 77200 . 00 0 , 00 0 .00 % 31 Postage/Shipping 300 .00 0 .00 0 , 00% 32 Utilities 39800 . 00 0 , 00 0 .00 % 33 Occupancy ( Building & Grounds 24,000 .00 0 .00 0 .00% 34 Printing & Publications 600 . 00 0 , 00 0 , 00% 35 Subscri tion/Dues/Memberships 0 . 00 0 .00 #DIV/01 36 Insurance 31500 , 00 0 .00 0 , 00% 37 Equipment: Rental & Maintenance 41500 . 00 0 .00 0 . 00 % 38 Advertising 800 .00 0 .00 0 .00% 39 Equipment Purchases : Ca ital Expense 21000 .00 0 ,00 0 .00% 40 Professional Fees ( Legal , Consulting ) 6 ,000 . 00 0 .00 0 , 00% 41 Books/Educational Materials 13500 . 00 0 . 00 0 , 00 % 42 Food & Nutrition 0 , 00 0 , 00 #DIV/01 43 Administrative Costs 359000 .00 0 .00 0 , 00% 44 Audit Expense 6 ,000 . 00 0 , 00 0 . 00 % 45 Specific Assistance to Individuals 29500 . 00 0 . 00 0 , 00 % 46 Other/Miscellaneous 61000 . 00 0 , 00 0 . 00 % 47 Other/Contract 0 .00 0 .00 #DIV/01 48 TOTAL $542 ,771 . 00 $ 59 ,207 . 50 1 10 . 91 % 5113/2005 B-4 Organization: Indian River County Healthy Start Coalition, Inc . Program: Healthy Families — IRC Funder: IRC Board of County Commissioners — Children ' s Services Advisory Committee - 05-06 Grant Application I. BUDGET FORMS 4 1 . Financial Budget Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 or J. FUNDER SPECIFIC/ADDITIONAL SHEETS .� K, APPENDIX 2 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 18t may be reimbursed with funds from the following year . Additionally, if any funds are unexpended at the end of a fiscal year, these funds are not carried over to the next year unless expressly authorized by the Board of Commissioners . All requests for reimbursement at fiscal year and ( September 30th) must be submitted on a timely basis . Each year, the Office of Management and Budget will send a letter to all nonprofit agencies advising of the deadline for reimbursement requests for the fiscal year. This deadline is typically early to mid October, since the Finance Department does not process checks for the prior fiscal year beyond that point . Each reimbursement request must include a summary of expense by type . These summaries should be broken down into salaries , benefit, supplies , contractual services , etc . If Indian River County is reimbursing an agency for only a portion of an expense (e . g . salary of an employee ) , then the method for this portion should be disclosed on the summary. The Office of Management & Budget has summary forms available . Indian River County will not reimburse certain types of expenditures . These expenditure types are listed below. a) Travel expenses for travel outside the County including but not limited to : mileage reimbursement, hotel rooms , meals , meal allowances , per diem , and tolls . Mileage reimbursement for local travel (within Indian River County) is allowable . b ) Sick or Vacation payments for employees . Since agencies may have various sick and vacation pay policies , these must be provided from other sources . c) Any expenses not associated with the provision of the program for which the County has awarded funding . d ) Any expense not outlined in the agency's funding application . The County reserves the right to decline reimbursement for any expense as deemed necessary. " EXHIBIT - B - IRCHSCMF-IRC OSOB UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: Indian River County Healthy Start Coalition, Inc./Healthy Families-IRC FUNDER : IRC BOCC Children's Service Advisory Committee 05-06 LINE ITEM EXPLANATION FOR VARIANCE #DN/0! #DNIO! #DN/Ol #DN/0! #DN/0! #DN/O! #DN/Ol #DN/O! #DN/0! #DN/0! #DN/O! #DN/Ol #DNIO! #DN/Ol #DN/0! #DN/01 #DNIO! #DN/0! #DNIO! #DN/0! Due to the increase in staff and the substantial increase in gas prices this category had to be increased especially in light of the fact that Travel4)aily staff are always on the road doing constant home visitations with the clients. This item was underbudgeted in the last fiscal year, there has been an increase in staff to be able to serve more families to the maximum capacity permitted which resulted in more phone lines being installed. Tele hone #DN/O! Insurance We have had an increase in insurance premiums due to the fact our staff performs frequent home visitations on at-risk families. #DN/O! &13/2005 es III iiiiiiiiiiiiiiiiiiiiiillillillillillillilliilillill� IRCHSCMFIRC 05-06 UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE FUNDER SPECIFIC BUDGET AGENCY/PROGRAM NAME : FUNDER : LINE ITEM EXPLANATION FOR VARIANCE This is not reall y an increase as we are still using the $55,000 to pay a portion of the FSW salaries. It is just that we are excluding FICA. However, the program does not permit us to exclude FICA. If FICA must be included we can reduce the $55,000 to $519091 .50 Salaries and add FICA in the amount of $3,908.50 for a total still of $55,000. FICA See above #DIV/0! ;DIV/01 ;DN/0! #DN/0! 511312005 B-5 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 : Indian River County Healthy Start Coalition , Inc. 160310 th Avenue Vero Beach , Florida 32960 Attention : Leslie Spurlock , 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 14 : 54 FAX 772 562 .5466 SID BANACK INS . 10001 ; 001 did ACORD Ttd. CERTIFICATE OF LIABILITY INSURANCE DATE (MWDDhWY) NOV 4 05 PRCDUCER e HILB ROGAL b HOBBS OF FLA INC !SID BANACK INS. TUN CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 204514TH AVE ONLY AND CONFERS NO RIGTITS UPON THE CERTIFICATE P O 80X 130 ►OLDER. TTOS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER E AFFORDED BY THEPgLIQI93 BELOW. VERO BEACH FL 32961 1 INSURERS AFFORDING COVERAGE MAIC 4 INSURED INSURER A: AUT04MNERS INSURANCEbUMPANY INDIAN RIVER COUNTY HEALTHY START, INC. I INSURER B_ HARTFORD UNDERWRITERS INSURANCE 10TH COMP VER Y AVS. I Ii _ LITY INSURANCE COMP VERO BEACH FL 32960 INSURER C: UN[TD STATESLIABI INSURER D: ( INSURER E: COVERAGES THE POLICIES OF; INSURANCE LISPED BELOW NAA! BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NorWm,STANDING ANY REQUIREMENT, rm TERM OR colr10N OF ANY CONTRACT OR OTHER DOCUMENT MTN RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED on MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L� Ip TY►E OF INSURANCE7—'POLICY NUMBER POLICY 0 THE Fmyl � iX►/ULigNIllwoLBIITS - GENERAL LIABILITY NDOIUU5446 I AUG 9 05 AU43100 EACH OCcU NCE s 1 ,000,000 --� co ORCULLGENERAL LIABILI aAy1,,CE � A� -� N S (Ear�•=• Iit i.WM6 MADE OCCUR I INED. EXP (Arty DAG pomm) 5 0no � C H -- I PERSONAL t ADV INJURY S 11000, 000_ GENERAL AGGREGATE S 1 ,000,000 GENLAGGREGATE LBeIrAPPLr58 PERPROCUCTS%CONPIOP AGG. S 110001000 POLICY WC 1 -- AUTotare.E LY(BILITY COMBINE%34NGLE LNIT AVY AUTO (ft accidranu I I� ALL GINNED AVY03 BODILY INJURY �—{ SCHEDUtEDAUTOS (PsrparaDn) HIREDAUTOi --f NON-OWNIM A=$ I i BODILY INJURY i k_.-I (Per adanJ $ .. I F ERTY OAMAOEr4arva GARAGE UABlLr7Y AUONLY - EA ACCIDENT I ANY AUTO TOOTHER THIN EA ACC i ! ALTO ONLY; • ' S EXCESS I LWOREl1A LABILITY iI EACH OCCURRENCE _ OCCUR F7 CLAIMS MADE AGGREGATE i I I DEDUCTIBLE i • i� - - -- I RETENTION S S WoRKERB COMPENSATION AND 21 WEC G07700 PLMAY 3 OS MAY 306 v� arAty pYMM EMOygw LNBI-ITY IuDa B ANY nmPWIURWARTtl1VFJIEtvnvEI EL EACNACCIDENT $ - - 0"IttKNOIDA [AAAeLUDW 100,000 IO rm, Maae wdwi SEI L.01SEWE-EA EMPLOYEE S 100, 000 aNt �ao� rNov E.L. DISEASEPOLICY LBUT S 5000000 OTHER: DIRlCTOR$ ANO OFFICER$ NDOIOO6544G AUG 0 OS AUG806 0/ C 31 ,000,000 i DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLU$IONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS CERITIFICATE HOLDER NAMED AS AN ADDITIONAL INSURED WITH RESPECTS TO GENERAL LIABILITY AS PER POLICY FORM AND PROVISIONS CERTIFICA _ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUGES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, 'HE ISSUING COMPANY WILL ENDEAVOR TO MNL ) o DAYS WRITTEN NaKE TO THE CERTIFICATE HOLDER NAMED TO THE LOFT, BUT INDIAN RIVER COUNTY INSURER s AGENTS OR R90 SHALL PR SEENNTAY IVas, OR LIABILRY OF ANY KIND SON THE 1940 25TH STREET VERO REACH FL 32960 AUTHORIZED REPRESHNTA AttalUon: 979.1790 Idndy a c , r, / ' ACORD 25 (2001109) CeRiACate 4 90782 V ACORO CORPORATION 1998 SUPPORTING DOCUMENTS CHECKLIST RFP 7052 ./ Cover Page ./ Application ✓ List of current officers and directors Latest Financial Audit Report & Management Letter that conforms with the AICPA Audit Guide Most recent IRS Form 990, including all schedules J Most recent Internal Financial Statement (i . e. : Balance Sheet and Operating Budget ✓ Staff Organizational Chart NA Most Recent Annual Report (if available) 501 (C)(3 ) IRS Exemption Letter Articles of Incorporation Agency' s Bylaws V Agency' s written policy regarding Affirmative Action Nepotism Statement XV Organization : Indian River County Healthy Start Coalition, Inc. Program: Healthy Families — IRC Funder: IRC Board of County Commissioners — Children ' s Services Advisory Committee - 05-06 Grant Application ORGANIZATION : Indian River Healthy Start Coalition, Inc . PROGRAM : Healthy Families - Indian River County TABLE OF CONTENTS Please `X" the parts of the grant application to indicate that they are included. Also, please put the page number where the information can be located. X I Section of the Proposal Pa e # ✓ TABLE OF CONTENTS (check list) 1 ✓ COVER PAGE (with signatures) . . I 1 0 6 1 1 1 1 1 1 1 1 0 1 of 0 . . . fee . . . . . . 0 a 0 e a 0 a 0 a * a a 0 v * . . . . . . . . 0 3 A. ORGANIZATION CAPABILITY (one page maximum) ✓ 1 . Mission and Vision of organization . , . , off 1 110 off , 4 2 . Summary of expertise, accomplishments, and population served . . . . . . . . . . . . . . . . 4 B. PROGRAM NEED STATEMENT (one page maximum) ✓ 1 . Program Need Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 V2 . Programs that address need and gaps in service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 C . PROGRAM DESCRIPTION (two pages maximum) 1 . Funding priority, I I I I I I I I * I . I I I I 1 0 1 1 1 1 1 1 1 1 1 1 1 1 * 4 0 0 a 0 0 6 a & a 0 & 0 a . . . . . . . . . . . . . . 0 . . . . . . . . . 6 2 . Description of program activities . , , , , , . , . , . 00 1 6 3 . Evidence that program strategy will work . . . . . . . . . . . . . . . . . . . . . . . . . v4 . Staffing . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . 0 0 0 9 0 . 0 0 6 5 . Awareness of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 ✓ 6 . Accessibility of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 D. MEASURABLE OUTCOMES (two pages maximum) . , . . . , , 8 E . COLLABORATION (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 F. PROGRAM EVALUATION (two pages maximum) V 1 . Demographics . , . . , . . . . . 1110190 * 9 9 * 0 00 * 40 off * 0 . 1 $ * a 6600 & 0 a * * * 86 * 011 * . 4 ISO # 10 - V 2 . Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 ✓ 3 . Reporting " , " . , 1 10 , 11 . 10 off 10 G. TIMETABLE (one page maximum) 0040 . . . . . . . . . . . . . . . . . . . . . . . 12 H. UNDUPLICATED CLIENT COUNT 1 . Projections by Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2 . Projections by Age Group " . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . 0 0 0 . . . . . . . . . . . . . . . . . 13 1 11 / 07 % 2003 HON 18 : 41 FAX 561 563 9125 IRC HEALTHY START 1Z001 / 001 �v Cr 1A`.; 2 Indian River County Healthy Start Coalition, Inc . 1603 100 Avenue,, Vero BeachFloridaori 32960 li� ,; dv. T } Phone 772. 563 . 9118 Fax 772 . 563 . 9125 Email : Info irchealthysta^ rt oro Web address : wwWWjrchealthy rt ora kI VL November 7 , 2005 Children 's Services Advisory Committee Indian River County Human Services 1840 25 " Street Vero Beach , FL 32960 - 3365 , Attention : Marion Masterson Re : Transportation Dear Ms . Masterson , I am writing per request to inform you that neither of our children 's programs Healthy Families IRC nor TLC Newborn Is required to transport children Thank you for the opportunity to provide services to the families of Indian River County , Sincerely , (4)Jo c k . Leslie Spurlock, Executive Director "The Mission of the Indian River County Healthy Start Coalition is to establish a system that guarantees all women have access to prenatal care and that all infants have access to services that promote normal growth and development. Organization: Indian River County Healthy Start Coalition, Inc . Program: Healthy Families — IRC Funder: IRC Board of County Commissioners — Children ' s Services Advisory Committee - 05-06 Grant Application I. BUDGET FORMS 4 1 . Financial Budget Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 or J. FUNDER SPECIFIC/ADDITIONAL SHEETS .� K, APPENDIX 2 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 18t may be reimbursed with funds from the following year . Additionally, if any funds are unexpended at the end of a fiscal year, these funds are not carried over to the next year unless expressly authorized by the Board of Commissioners . All requests for reimbursement at fiscal year and ( September 30th) must be submitted on a timely basis . Each year, the Office of Management and Budget will send a letter to all nonprofit agencies advising of the deadline for reimbursement requests for the fiscal year. This deadline is typically early to mid October, since the Finance Department does not process checks for the prior fiscal year beyond that point . Each reimbursement request must include a summary of expense by type . These summaries should be broken down into salaries , benefit, supplies , contractual services , etc . If Indian River County is reimbursing an agency for only a portion of an expense (e . g . salary of an employee ) , then the method for this portion should be disclosed on the summary. The Office of Management & Budget has summary forms available . Indian River County will not reimburse certain types of expenditures . These expenditure types are listed below. a) Travel expenses for travel outside the County including but not limited to : mileage reimbursement, hotel rooms , meals , meal allowances , per diem , and tolls . Mileage reimbursement for local travel (within Indian River County) is allowable . b ) Sick or Vacation payments for employees . Since agencies may have various sick and vacation pay policies , these must be provided from other sources . c) Any expenses not associated with the provision of the program for which the County has awarded funding . d ) Any expense not outlined in the agency's funding application . The County reserves the right to decline reimbursement for any expense as deemed necessary. " EXHIBIT - B - 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 : Indian River County Healthy Start Coalition , Inc. 160310 th Avenue Vero Beach , Florida 32960 Attention : Leslie Spurlock , 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 14 : 54 FAX 772 562 .5466 SID BANACK INS . 10001 ; 001 did ACORD Ttd. CERTIFICATE OF LIABILITY INSURANCE DATE (MWDDhWY) NOV 4 05 PRCDUCER e HILB ROGAL b HOBBS OF FLA INC !SID BANACK INS. TUN CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 204514TH AVE ONLY AND CONFERS NO RIGTITS UPON THE CERTIFICATE P O 80X 130 ►OLDER. TTOS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER E AFFORDED BY THEPgLIQI93 BELOW. VERO BEACH FL 32961 1 INSURERS AFFORDING COVERAGE MAIC 4 INSURED INSURER A: AUT04MNERS INSURANCEbUMPANY INDIAN RIVER COUNTY HEALTHY START, INC. I INSURER B_ HARTFORD UNDERWRITERS INSURANCE 10TH COMP VER Y AVS. I Ii _ LITY INSURANCE COMP VERO BEACH FL 32960 INSURER C: UN[TD STATESLIABI INSURER D: ( INSURER E: COVERAGES THE POLICIES OF; INSURANCE LISPED BELOW NAA! BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NorWm,STANDING ANY REQUIREMENT, rm TERM OR colr10N OF ANY CONTRACT OR OTHER DOCUMENT MTN RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED on MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L� Ip TY►E OF INSURANCE7—'POLICY NUMBER POLICY 0 THE Fmyl � iX►/ULigNIllwoLBIITS - GENERAL LIABILITY NDOIUU5446 I AUG 9 05 AU43100 EACH OCcU NCE s 1 ,000,000 --� co ORCULLGENERAL LIABILI aAy1,,CE � A� -� N S (Ear�•=• Iit i.WM6 MADE OCCUR I INED. EXP (Arty DAG pomm) 5 0no � C H -- I PERSONAL t ADV INJURY S 11000, 000_ GENERAL AGGREGATE S 1 ,000,000 GENLAGGREGATE LBeIrAPPLr58 PERPROCUCTS%CONPIOP AGG. S 110001000 POLICY WC 1 -- AUTotare.E LY(BILITY COMBINE%34NGLE LNIT AVY AUTO (ft accidranu I I� ALL GINNED AVY03 BODILY INJURY �—{ SCHEDUtEDAUTOS (PsrparaDn) HIREDAUTOi --f NON-OWNIM A=$ I i BODILY INJURY i k_.-I (Per adanJ $ .. I F ERTY OAMAOEr4arva GARAGE UABlLr7Y AUONLY - EA ACCIDENT I ANY AUTO TOOTHER THIN EA ACC i ! ALTO ONLY; • ' S EXCESS I LWOREl1A LABILITY iI EACH OCCURRENCE _ OCCUR F7 CLAIMS MADE AGGREGATE i I I DEDUCTIBLE i • i� - - -- I RETENTION S S WoRKERB COMPENSATION AND 21 WEC G07700 PLMAY 3 OS MAY 306 v� arAty pYMM EMOygw LNBI-ITY IuDa B ANY nmPWIURWARTtl1VFJIEtvnvEI EL EACNACCIDENT $ - - 0"IttKNOIDA [AAAeLUDW 100,000 IO rm, Maae wdwi SEI L.01SEWE-EA EMPLOYEE S 100, 000 aNt �ao� rNov E.L. DISEASEPOLICY LBUT S 5000000 OTHER: DIRlCTOR$ ANO OFFICER$ NDOIOO6544G AUG 0 OS AUG806 0/ C 31 ,000,000 i DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLU$IONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS CERITIFICATE HOLDER NAMED AS AN ADDITIONAL INSURED WITH RESPECTS TO GENERAL LIABILITY AS PER POLICY FORM AND PROVISIONS CERTIFICA _ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUGES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, 'HE ISSUING COMPANY WILL ENDEAVOR TO MNL ) o DAYS WRITTEN NaKE TO THE CERTIFICATE HOLDER NAMED TO THE LOFT, BUT INDIAN RIVER COUNTY INSURER s AGENTS OR R90 SHALL PR SEENNTAY IVas, OR LIABILRY OF ANY KIND SON THE 1940 25TH STREET VERO REACH FL 32960 AUTHORIZED REPRESHNTA AttalUon: 979.1790 Idndy a c , r, / ' ACORD 25 (2001109) CeRiACate 4 90782 V ACORO CORPORATION 1998 11 / 07 % 2003 HON 18 : 41 FAX 561 563 9125 IRC HEALTHY START 1Z001 / 001 �v Cr 1A`.; 2 Indian River County Healthy Start Coalition, Inc . 1603 100 Avenue,, Vero BeachFloridaori 32960 li� ,; dv. T } Phone 772. 563 . 9118 Fax 772 . 563 . 9125 Email : Info irchealthysta^ rt oro Web address : wwWWjrchealthy rt ora kI VL November 7 , 2005 Children 's Services Advisory Committee Indian River County Human Services 1840 25 " Street Vero Beach , FL 32960 - 3365 , Attention : Marion Masterson Re : Transportation Dear Ms . Masterson , I am writing per request to inform you that neither of our children 's programs Healthy Families IRC nor TLC Newborn Is required to transport children Thank you for the opportunity to provide services to the families of Indian River County , Sincerely , (4)Jo c k . Leslie Spurlock, Executive Director "The Mission of the Indian River County Healthy Start Coalition is to establish a system that guarantees all women have access to prenatal care and that all infants have access to services that promote normal growth and development.