agenda item no. 3bb-, 4 palm beach county board of … · 12/7/2010 · 11- ()/ 7~ acct.number...

Agenda Item No. "3B"B-, 4 PALM BEACH COUNTY

BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY

Meeting Date: December 7, 2010 [ x] Consent

Department: Submitted By: Submitted For:

[ ] Ordinance

Palm Beach County Sheriff's Office Palm Beach County Sheriff's Office

I. EXECUTIVE BRIEF

[ ] Regular

[ ] Public Hearing

Motion and Title: Staff recommends motion to approve: a Budget Transfer of $335,382 from the Law Enforcement Trust Fund (LETF) to the Palm Beach County Sheriffs Offjce (PBSO). Summary: Florida Statute 932. 7055 requires that no less than 15% of the LETF's previous year's revenues be used for the support or operation of drug treatment, drug abuse education, drug prevention, crime prevention, safe neighborhood and school resource officer programs of various non-profit organizations. The PBSO's FY 2011 estimated donation requirement will not be finalized until year-end close-out. The funds are requested to aid qualified organizations that meet the requirements set forth in F.S. 932.7055. The PBSO's support of these programs exemplifies its strong commitment to the prevention and reduction of crime throughout the communities it serves and its desire to put money back into these communities to support organizations that provide such services. The current State LETF balance is $2,626~670 Approval of this request will reduce the State Law Enforcement Trust Fund balance to $2,291,288 The year-to-date transfer for all donations after approval of this item is $556,711. The PBSO certifies that the use of these funds is in accordance with F.S. 932.7055. Below is a table indicating the organizations the PBSO seeks to fund and the corresponding amount of funding proposed per respective agency. No new positions are needed and no additional County funds are required. Countywide (OW)

ORGANIZATION AMOUNT Faith Hope Love Charity, Inc. $25,000 Florida Sheriff's Youth Ranches, Inc. $133,100 Gulfstream Council of the Boy Scouts of America, Inc. $10,000 Humane Society of Greater Jupiter Tequesta, Inc. $25,000 Nope Task Force, Inc. $10,000 Palm Beach County P.A.L., Inc. - Shop With A Cop $32,000 Palm Beach County Substance Abuse Coalition, Inc. $10,000 Quantum House, Inc. $10,000 Safety Council of Palm Beach County, Inc. $2,500 The ARC of Palm Beach County Foundation, Inc. $25,000 Urban LeaQue of Palm Beach County, Inc. $53,232

Total Amount of Donations $335,832 Background and Justification: The Palm Beach County Sheriff's Office has a long-standing commitment to the reduction of crime and implementation of crime and drug prevention programs within Palm Beach County. Use of LETF requires approval by the Board in accordance with F.S. 932.7055, upon request of the Sheriff. This Statute requires that no less than 15 % of the last fiscal year's revenues be donated or expended for the support or operation of drug treatment, drug abuse education, drug prevention, crime prevention, safe neighborhood or school resource officer programs. The PBSO certifies that the use of these funds is in accordance with F.S. 932.7055. Attachments:

1. Budget Transfer 2. LETF Donation Applications (11)

------------------------ ·------ - -------------------------------------------------------- --------------------------RECOMMENDED BY: ------rl---,L-....... :c.,.__ _______________ _

DEPARTME RECTOR

APPROVED BY: W-A~ :::--,_, ASSISTANT COUNTY ADMINISTRATOR

DATE

l~ll \10 DATE

(

II. FISCAL IMPACT ANALYSIS

A. Five Year Summary of Fiscal Impact:

Fiscal Years Capital Expenditures Operating Costs

External Revenues Program Income (County) In-Kind Match (County)

Net Fiscal Impact

# Additional FTE Positions

(Cumulative)

2011

$335,832

($335,832)

0

0

0

Is Item Included in Current Budget: YES

2012

---

2013 2014

NO X ----

2015

BudgetAccount No.: Fund ___ Agency ___ Org

Reporting

Object --- ---

Category

B. Recommended Sources of Funds/ Summary of Fiscal Impact: The funds are being requested from the State Law Enforcement Trust Fund. No additional CountyFunds are required.

Ill REVIEW COMMENTS

A. nd/or Contract Administration Comments:

8.

C. Other Department Review:

Department Director

This summary is not to be used as a basis for payment.

11- ()/ 7~

ACCT.NUMBER ACCOUNT NAME Ex_penditures

Transfers 160-1690-9498 Trfr to PBSO Fd 1902

Reserves - New Projects 160-9900-9908 Reserves - New Projects

TOTAL FUND

Palm Beach County Sheriff's Office

INITIATING DEPARTMENT/DIVISION

)>

i Administration/Budget Department Approval n =r i OFMB Department - Posted ~ .... =II:

........

ORIGINAL BUDGET

0

2. ;i'f-1 I StfCJ

Signatures

BOARD OF COUNTY COMMISSIONERS PALM BEACH COUNTY, FLORIDA

BUDGET TRANSFER

FUND 1151 LAW ENFORCEMENT TRUST FUND

CURRENT BUDGET INCREASE DECREASE

220,879 335,382 0

2,b-U., ft-70 0 335,382

$335I382 $335,382

Date

H\~lr;blO _s,J tt/-i,-;/10

Page 1 of 1 pages

ADJUSTED EXPENDED/ REMAINING BUDGET ENCUMBERED BALANCE

$556,261

2,-z...q, z.z·g I

By Board of County Commissioners At Meeting of December 7, 2010

Deputy Clerk to the Board of County Commissioners

PALM BEACH COUNTY SHERIFF'S OFFICE LAW ENFORCEMENT TRUST FUND DONATION

APPLICATION

1. Legal name of Organization: Faith*Hope*Love*Charity, Inc.

Faith*Hope*Love*Charity, Inc.

NAME

2. Address: 3175 S. Congress Avenue - Suite 310 STREET ADDRESS

Palm Springs, FL 33461 CITY, STATE, ZIP

3. Executive Director: Roy J. Foster NAME

.,~ff~ ( 561) 968-1612 [email protected] TELEPHONE NUMBER E-MAIL ADDRESS

FEID #: 65-0464807

4. Fiscal Agent: Marcia Rainford

~ ~ -slGNATLJRE

( 561) 968-1612 [email protected] TELEPHONE NUMBER E-MAIL ADDRESS

5. Date: ~LO

Attachment #

Attachment A

2

-------

PALM BEACH COUNTY SHERIFF'S OFFICE

LAW ENFORCEMENT TRUST FUND DONATION

Attachment A

Organization Name: Faith*Hope*Love*Charity, Inc.

LETF Funding Request (MUST match total on Financial Application): $25,000.00

1. What service will your organization provide through the use of Law Enforcement Trust Funds?

• School Resource Officers • Drug Treatment Program • Crime Prevention • Safe Neighborhood X Drug Abuse Education • Drug Prevention Programs

2. Organization Purpose: Faith*Hope*Love*Charity, Inc. through its program at Stand Down

House provide a multi-tiered program developed to assist and support Veterans who are

struggling with addiction issues, and have become homeless as a result of the struggle.

3. Provide a brief summary of program's activities/services to be funded: Funding is

requested to assist in operational cost such as: emergency housing, food, clothing,

personal hygiene items during their stay. Also, each veteran receives case management,

one-on-one psychological assessment and as group activities include peer-to-peer, AA/NA

meetings (on-site and off-site). In addition. transportation is provided daily to and from

WPB VAMC for medical/mental health appointments and out-patient substance abuse

treatment/classes, anger management, etc.

What results are you committed to achieving?

Our goals are as follow: (1) clients maintaining sobriety- 95%; (2) clients returning to work or

receiving benefits (SSANA} - 90%; (3) clients securing permanent housing- 75%; and (4) clients

completing the program - 60%.

3


FINANCIAL APPLICATION

Period Covered (one year) From: _QL/01 /2011 To: -1l..}....fil_/2011

No. Expense Program LETF Total Reauest

1. Salaries $_141,987.00 $0.00

Employee 2. Benefits/Pavroll Taxes $ 32,657.00 $0.00

3. Professional Fees $ 13,416.00 $0.00

4. Occupancy/Utilities $121,173.00 $10,000.00

5. Telephone $ 11,897.00 $0.00

6. Postaae/Shiccina $ 773.00 $0.00

7. Printina & Publications $ 9,013.00 $0.00

8. Supplies $ 108,492.00 $15,000.00

9. Travel $ 3,786.00 $0.00

10. Meetinas $ 515.00 $0.00

11. Miscellaneous Expenses $ 257.00 $0.00

Total Expenses $ 443,966.00 $25,000.00

Attachment A

LETF

0%

0%

0%

8.2%

0%

0%

0%

13.8%

0%

0%

0%

5.6%

4


Attachment A

Budget Narrative

Provide detailed description for each expense listed on the Financial Application. You may attach additional sheets if necessary.

Salaries (list employees and individual compensation)"-': N"""/"-'A'----------------

Professional Fees (list vendor and type of service provided)·_,N...,./...._A.-... __________ _

Occupancy/Utilities (list utilities): Liability Insurance - $5,000; and Utilities - $5,000

Telephone (provide telephone numbers): NIA -------------------

Printing & Publications (list type of material): N/A ------------------

5


Attachment A

Supplies (list supplies/equipment)::....:.F-=o=od=--....,$....,1=5,...._0o=o.__ _____________ _

Travel (individuals traveling, destination and purpose):;.;.;N;;..;../A..;...._ ____________ _

Meetings (attendees, purpose, items needed for meeting)· ...... N ...... /.L.,A.__ __________ _

Miscellaneous Expense (specify items):__._,,Nu.lA....__ _______________ _

6


APPLICATION CERTIFICATION

Attachment A

I hereby certify that any LETF funds received will be used for the authorized purpose as

indicated on Page 3 of this application. Additionally, I certify that the agency requesting the

funds is a not-for-profit agency or organization, which has been held to be tax exempt under the

provisions of s. 501 of the Internal Revenue Code, and is registered as a Non Profit organization

with the State of Florida, Department of State, Division of Corporations.

Roy J. Foster Name (please print)

NOTARY SECTION:

State of Florida

County of Palm Beach

~ ... gj.~-MJb ary Pu ic/

My Commission Expires:

• -· Comrr.tPOD llllt 5 · • i:::;:.~ 4/18'2011 i "'.r..¥'1 Act.~ NalllyAa., -llle•n••····••:::1:i:a:!:HDHl•HH ...

Executive Director Title (please print)

b bi/18 Dai I

7


APPLICATION

1. Legal name of Organization:

Florida Sheriffs Youth Ranches, Inc.

NAME

2. Address: 2468 Cecil Webb Place STREET ADDRESS

Live Oak, FL 32060 CITY, STATE, ZIP

3. Executive Director: Roger Bouchard

NAME

( 386 ) 842-5501 [email protected]

TELEPHONE NUMBER E-MAIL ADDRESS

FEID #: 23-7303117

4. Fiscal Agent: Wayne Walden

SIGNATURE

( 386 ) 842-5501 [email protected] TELEPHONE NUMBER E-MAIL ADDRESS

5. Date: September 24, 2010 DATE

Attachment A

2


Attachment A

Organization Name: Florida Sheriffs Youth Ranches, Inc.

$133,100 LETF Funding Request (MUST match total on Financial Application): _____ _


• School Resource Officers • Drug Treatment Program )t( Crime Prevention )( Safe Neighborhood • Drug Abuse Education • Drug Prevention Programs

2. Organization Purpose: To prevent delinquency and develop strong, lawful, resilient and

productive citizens who will make a positive contribution to our communities for years to come.

3. Provide a brief summary of program's activities/services to be funded: This request

represents the capital requirements for the Florida Sheriffs Youth Ranches for FY 10-11.

We served thousands of children each year in our camping programs and several

hundred more every year in our year round 24/7 residential care Ranches. As a 53 year

old delinquency and crime prevention agency, our facilities are designed and maintained to

create a safe neighborhood environment for abused, neglected, needy and troubled kids.

We have four residential Ranches and two camping facilities. Each site has specific needs

for capital improvements as outlined in this request. Most are basic items tied to providing

a healthy and safe environment for these at-risk children to grow, learn and succeed.

Please see attached literature for more details.

4. What results are you committed to achieving? The services provided by the Florida

Sheriffs Youth Ranches have proven to be the critical factor in developing young men and

women who are able to face the future with a sense of direction, ability and hope. We

provide the educational and emotional component often missing in their young lives.

Our Alumni have become law enforcement officers, nurses, mechanics, truck drivers and

successful business men and women in our communities.

3



Period Covered (one year) From: 10/01/2010 To: 09/30/2011


1. Salaries $6,519,034. $0

Employee 2. Benefits/Payroll Taxes $2,156,724 $0

3. Professional Fees $254,864 $0

4. Occupancy/Utilities $2,169,459 $0

5. Telephone $244,300 $0

6. Postaqe/Shippinq $345,825 $0

7. Printinq & Publications $545,392 $0

8. Supplies $613,151 $0

9. Travel $390,274 $0

10. Meetinqs $50,600 $0

11. Miscellaneous Expenses $621,300 $133,100

Total Expenses $13,910,923 $133,100

Attachment A

LETF

%

%

%

%

%

%

%

%

%

%

21.4%

0.96%

4


Attachment A

Budget Narrative


Salaries (list employees and individual compensation).:...: ______________ _

Professional Fees (list vendor and type of setvice provided):'---------------

Occupancy/Utilities (list utilities): ____________________ _

Telephone (provide telephone numbers): __________________ _

Printing & Publications (list type of material).:...: ________________ _

5


Attachment A

Supplies (list supplies/equipment):..._ ___________________ _

Travel (individuals traveling, destination and purpose)_: _______________ _

Meetings (attendees, purpose, items needed for meeting):. ______________ _

Miscellaneous Expense (specify items): Boys Ranch ($1021000): Roof Replacement: $32,000, Lift Station

Remodel: $15,000, NC Replacement: $45,000, Flooring: $10,000. Safety Harbor ($31,100): Flooring:

$20,200, Appliances: $5,200, Resurface Athletic Courts: $4,000, Garage Door $1,700.

6


Attachment A


I hereby certify that any LETF funds received will be used for the authorized purpose as indicated on Page 3 of this application. Additionally, I certify that the agency requesting the funds is a not-for-profit agency or organization, which has been held to be tax exempt under the provisions of s. 501 of the Internal Revenue Code, and is registered as a Non Profit organization with the State of Florida, Department of State, Division of Corporations.

Name (please print) • Title (please print)

Signature~~\ Date

NOTARY SECTION:

State of Florida

-·-County of Balm Beacli :::ii.1..u.JQl",(l_et..--

The foregoing Agreement was acknowledged and subscribed before me this .':J 4 .,_i, day of

S ftb nbe..,· , 20j_L_i by ], j\Cle.s-· L"'i, 'b,shd 1Ll vd1 ,\r·, (name of individual) as u . G i--. ~, '-" . +v"t ~jdt.vt+ (title) of i-·lc.v--idc,1,,. <::J,1tr1 n5, 'fOL<Jt') '/-<O,'Jej,tfS (name

of organization/ agency), ~ho is pe_!'son~l!.Y known to_me or who produced ______________ as identification.

Notary Public


7


APPLICATION

Attachment A

1. Legal name of Organization: Gulf Stream Council of the Boy Scouts of America, Inc

2. Address:

3. Executive Director:

4. Fiscal Agent:

5. Date:

Learning for Life Exploring Program

NAME

8335 N. Military Trail, Ste. 100 STREET ADDRESS

Palm Beach Gardens, FL 33410 CITY, STATE, ZIP

Jeff Isaac

( 561 ) 694-8585 TELEPHONE NUMBER ,

Jeff. [email protected]

FEID #: 59-0624407

Same as above NAME

SIGNATURE

TELEPHONE NUMBER

June 22, 2010 DATE

E-MAIL ADDRESS

E-MAIL ADDRESS

2


Attachment A

Organization Name: Gulf Stream Council, Inc. Learning for Life

LETF Funding Request (MUST match total on Financial Application): $10,000


• School Resource Officers • Drug Treatment Program Iii Crime Prevention Iii Safe Neighborhood • Drug Abuse Education Iii Drug Prevention Programs

2. Organization Purpose: The mission of Learning for Life is to enable young people to become

responsible individuals by teaching positive character traits, career development, leadership and life skills so they can make ethical choices and achieve their fun potential

3. Provide a brief summary of program's activities/services to be funded: Exploring is

Learning for Life's worksite-based career education program for young men and women io high school The Gulf Stream Council seeks funding for three activities that provide added programming for over 320 youth participating in 18 Exploring posts sponsored by law enforcement agencies in the Council's service area. Those activities are: 1) The Law Enforcement Challenge, a competitive event allowing youth to demonstrate career skills learned in Exploring; 2} the Law enforcement Recognition Luncheon, an opportunity to publicly recognize exemplary youth, adult leaders and partner organizations; and 3) the Law Enforcement Explorer Academy, a one-week residential program Explorers a hands-on opportunity to learn about law enforcement in a disciplined environment similar to a police training academy. These activities provide low cost, supplemental programming for Explorer posts that further expose participants to career opportunities, character development, leadership experience, life skills training and citizenship.

4. What results are you committed to achieving? 1) 100 Explorers will participate io the Law Enforcement Challenge; 2) 200 Explorers, agency representatives and parents will participate in the Law Enforcement Recognition Luncheon; 3) 50 Explorers will participate in the Law Enforcement Exploring Academy; 4) 90% of Law Enforcement Exploring posts will renew commit to continue Delivering the Exploring program by renewing their charters by December 31, 2011.

3



Attachment A

Period Covered (one year) From: 01 / 01 / 2011 To: 12 / 31 / 2011

No. Expense Program LETF LETF Total Reauest

1. Salaries $ 41,000 $ -0- %

Employee 2. Benefits/Payroll Taxes $ 6,240 $ -0- %

3. Professional Fees $ - 0 - $ -0- %

4. Occuoancv/Utilities $ 3,700 $ 2,000 54%

5. Telephone $ 6,000 $ -0- %

6. Postaae/Shiooina $ 100 $ -0- %

7. Printina & Publications $ 275 $ - 0 - %

8. Supplies $ 20,965 $ 8,000 38%

9. Travel $ 6,000 $ -0- %

10. Meetinas $ 100 $ -0- o/o

11. Miscellaneous Expenses $ -0- $ -0- %

Total Expenses $ 84,380 $ 10,000 12%

4


Attachment A

Supplies (list supplies/equipment): ____________________ _

Awards for Law Enforcement Challenge (trophies, medals, etc.) $700.00

Uniform T-shirts, uniform caps, water bottles and other program supplies for the Law Enforcement

Exploring Academy $1,300.00

Food for the Law Enforcement Exploring Academy (three meals per day for six days for 130 Explorers

and adult leaders) and to offset food expense for the Law Enforcement Recognition Luncheon $6,000.00

Travel (individuals traveling, destination and purpose): -----------------


Miscellaneous Expense (specify items): ---------------------

6


Attachment A

Supplies (list supplies/equipment):~-------------------Awards for Law Enforcement Challenge (trophies, medals, etc.) $700.00 Uniform T-shirts, uniform caps and water bottles and other program supplies for the Law Enforcement Exploring Academy $1,300.00 Food for the Law Enforcement Exploring Academy (three meals per day for six days for 130 Explorers and adult leaders) and to offset food expense for the Law Enforcement Recognition Luncheon $6,000.00

Travel (individuals traveling, destination and purpose):'-------------------

Meetings (attendees, purpose, items needed for meeting):'----------------

Miscellaneous Expense (specify items): ____________________ _

6



Attachment A


Jeff Isaac Name (please print)

~~ NOTARY SECTION:

State of Florida


Chief Executive Officer Title (please print)

or/41)

The foregoing Agreement was acknowledged and subscribed before me this ~ day of

~: , .20J.12. by -~ [se,,.,;_ (name ofi divklu~I) as ' {wJ;ui {);o - (title) of • . ,, d (name

of o ani tion ~ency), who is personally kno to me er whe produce-a

0 /~ / 10/ ;i013

7


APPLICATION

1. Legal name of Organization: Humane Society of Greater Jupiter Tequesta, Inc.

dba Safe Harbor Animal Sanctuary & Hospital

NAME

2. Address: 185 E. Indiantown Rd., #205 STREET ADDRESS

Jupiter, FL 33477 CITY, STATE, ZIP



FEID #: ____ 59__,-2:::.;1;..;,1 .... 12 ... 7=3 ___ _

4. Fiscal Agent: Terry Meyer, Accounting NAME

(_ 2- ~• •r • I SIGNATURE ._


5. Date: June 29, 2010 DATE

Attachment A

2

~. PALM BEACH COUNTY SHERIFF'S OFFICE Attachment A

~~ LAW ENFORCEMENT TRUST FUND DONATION tll·~~~. ,l ·',l

Organization Name: Humane Society of Greater Jupiter Tequesta, Inc. dba Safe Harbor

LETF Funding Request (MUST match total on Financial Application): $251000


o School Resource Officers o Drug Treatment Program o Crime Prevention X Safe Neighborhood o Drug Abuse Education • Drug Prevention Programs

2. Organization Purpose: Our mission is to rescue homeless animals in need, Those that are injured neglected and abused take tap pdocity Safe HarhQc additiananv recognizes tbat pet averpapulation creates an atroaspbece favorable ta aniroal crnelty, neglect, and owner ircespnnsibility Safe Hacbac believes that pet sterilization is an effective way to address oyerpopulation w;th its attendant animal and public safety issues including abandoned. loose and/or aggressive. biting dogs.

Provide a brief summary of program's activitiesJse[Yices to be funded· Safe Ha[bot's Safe Neighborhood Program is dedicated to reducing the number of unwanted. loose and abandoned animals as well as addressing the public safety issue of dog bites through our low cost sterilization efforts. According to the American Society for the Prevention of Cruelty to Animals (ASPCA). • .. more than 70% of all dog bite cases involve unsterilized male dogs, and that an unneutered male dog is 2.6 times more likely to bite than a neutered dog.· Safe Harbor is a leader in low cost sterilization having opened the second Spay/ Neuter Clinic in the State of Florida in 1985. Safe Harbor sterilized 2.630 cats and dogs In 2009 alone. Our Safe Harbor Safe Neighborhood Program is rooted in our low cost spay/neuter program.

What results are you committed to achieving? By regycjng the number pt unwanted pets we are committed to achieving a reduction in free roaming animals as well as a corresponding reduction in animals bites. According the the Humane Society of the United States. "The Centers for Disease Control and Prevention in Atlanta. GA, estimates that nearly 2% of the U.S. population is bitten by a dog each year. This translates to more than 4. 7 million people per year, most of whom are children." According to Palm Beach County Animal Care & Control. in six years, one female dog and her offspring can theoretically produce 67,000 dogs. Using this formula, Safe Harbor prevented the birth of 58,806,000 puppies in 2009 alone (818 female dogs x 67,000). Pet sterilization works. Please help us to continue this very important work by awarding Safe Harbor the LE Trust Fund Donation.

3



Period Covered (one year) From: 01 / 01 / 11 To: 12/31 /11


1. Salaries $0 $0

Employee 2. Benefits/Payroll Taxes $0 $0

3. Professional Fees $25,000 $25.000

4. Occupancy/Utilities $0 $0

5. Telephone $0 $0

6. Postaae/Shiooina $0 $0

7. Printing & Publications $0 $0

8. Supplies $0 $0

9. Travel $0 $0

10. Meetinas $0 $0

11. Miscellaneous Exoenses $0 $0

Total Expenses $25,000 $25,000

Attachment A

LETF

0%

0%

100%

0%

0%

0%

0%

0%

0%

0%

0%

100%

4


Attachment A

Budget Narrative

Provide detailed description for each expense listed on the Financial Application. You may attach additional shee1s if necessary.

Salaries (list employees and individual compensation)_: ______________ _

Professional Fees (list vendor and type of service provided):. ____________ _

James Manning, DVM - Contract Surgical Veterinarian performing Program duties of spay/neuter.

Occupancy/Utilities(listutilities):...:.N.::..:/A;..:._ __________________ _

Telephone (provide telephone numbers): ~Nl;.;...A;..._ ________________ _

Printing & Publications (list type of material) __ : N __ / __ A _______________ _

5


Attachment A

Supplies (list supplies/equipment):'--'-"Nl.:..:A'-------------------

Travel (individuals traveling, destination and purpose):..:: N=/A;..;._ ____________ _

Meetings (attendees, purpose, items needed for meeting)· .... N_../....,A.__ __________ _

Miscellaneous Expense (specify items):-N....,/._.A ________________ _

6


Attachment A







Linda Kender Name (please print)

~~ Signature '

NOTARY SECTION:

State of Florida


Administrative Manager Title (please print)

June 29, 2010 Date

The foregoing Agreement was acknowledged and subscribed before me this 29th day of June,

2010 by Linda Kender (name of individual) as Administrative Manager (title) of Humane

Society of Greater Jupiter Tequesta, Inc. dba Safe Harbor Animal Sanctuary & Hospital (name

of organization/ agency), who i~rsonally known ~r has produced _____ as

Notary Public


7


APPLICATION

1. Legal name of Organization: NOPE Task Force, Inc.

2. Address:

3. Executive Director;

4. Fiscal Agent:

5. Date:

Narcotics Overdose Prevention & Education

NAME

3233 Commerce Place Suite A STREET ADDRESS

West Palm Beach, Fl 33407 CITY, $TATE, ZIP

Karen H. Perry

( 561 ) 478-1055x1 TELEPHONE NUMBER

FEID #: 20-1289080

NAME

SIGNATURE

TELEPHONE NUMBER

6/23/2010 DATE

E·MAILAODRESS

E-MAIL ADDRESS

Attachment A

2


Attachment A

Organization Name:-;,.;N..:.;O:;.P...,E=...:.Ta.:;.S:,:k,;..:F:..,O;;.:.f.;:.Ce _________________ _

LETF Funding Request (MUST match total on Financial Application): $ l O , 0 0 0


CJ School Resource Officers a Drug Treatment Program • Crime Prevention • Safe Neighborhood • Drug Abuse Education

✓ Drug Prevention Programs

2. Organization Purpose: To edycate youth and families about consequences of drug and alcohol apuse; to reduce the number of overdose and drug related deaths; to reduce the number of students who first use alcohol and other substances at an early age

3. Provide a brief summary of program's activities/services to be funded: NOPE projects to serve approximately 28.000 students and parents in Palm Beach County in 2011. NOPE will provide a 60 minute presentation to middle and high school students in Pa.Im Beach County designed to educate students about addiction, drug abuse. la,w enforcement and the importance of asking for help. NOPE will also provide a 90 minute interactive presentation

for parents and communities about the reality our nation faces regarding youth drug abuse and offer suggestions for parenting strategies to combat the issues.

4. What results are you committed to achieving? '3eYWs# tt,e 11pmw, of middle and high school students who exgeriment with drugs for the first time. Increase the number of middle and high school students who will not use drugs in the future. from the group that has previously useg drugs at leatzt once. Increase the number of middle and high school students that seek help from the grouQ who are addicted to drugs or know someone who is addiged to drugs. Reduce the number of drug overdose deaths among the student gopu1ation who have cornpletM the NOPE program. Bring awareness and educ§te parems about the dangers our youth face today with drug and aJcohol abuse. inform and encourage posjtive parenting. (The Palm Beach County Sheriff's Office Overdose SUQpression Proiect pffers a comprehensive strategy to reduce the number qf ovgrdose deaths In our county. The overall olan involves a nqm,ber qt established strat,egic alliances, including th§ Narcotics, Overdose Prevention and Education Task force,,l

3



Period Covered (one year) From: 1/1/.2011 To: 12/31/2011


1. Salaries $70.000.00 $00.00

Employee 2. Benefits/Payroll Taxes $ 6,223.00 $00.00

3. Professional Fees $13,500.00 $00.00

4. Oooupancv/Utilities $37,573.16 $00.00

5. Teleohone $5,000.00 $00.00

6. Postage/Shipping $9;000.00 $00.00

7. Prlntina & Publications $75,000.00 $5,000.00

8. Supplies $27,500.00 $5,000.00

9. Travel $10,000.00 $00.00

10. Meetinas $10,000.00 $00.00

11. Miscellaneous Exoenses $80,000.00 $00.00

Total Expenses $343. 796.16 $10,000.00

Attachment A

LETF

00%

00%

00%

00%

00%

00%

6.7%

18%

00'%

000/o

00%

2.9%

4


Attachment A

Budget Narrative Provide detailed description for each expense listed on the Financial Application. You may attach additional sheets if necessary.

Salaries (list employees and individual compensation): FTE Program Coordinator-Laura Guelzow 40,000 FTE Administrative Assistant Kristin Cantwell 30,000

Professional Fees (list vendor and type of service provided): Accountant, Website story manag.er

Occupancy/Utllities (list utilities): 451h street partners (lease}, 1.600 sg ft. furnished office space; FPL

Maintenancei cleaning service

Telephone (provide telephone numbers); 561·478-1055 1866-612-NOPE 1-561-689-2440

Printing & Publlcations (list type of material): website , training video1 memorial video, vigil guides and materials.NOPE Training manual. NOPE presentation brochures and hand outs; Just one time can kill. ttuth and consequences what every parent must kQQW. sometimes llOU never sleep it off ... what evel)! gollege student must ~now. after the loss.usupport for families who lost k>yed ones. medication log book, About us, information packets. Partnership for a drug free America media tapes and annual fee. NOPE Task Force Is Requesting: 30,000 One Time Can Kill Student Brochures @ $3,500; 10,000 Parent Information Booklets @ $9,000.00; 5,000 After the Lou booklets @ 5,200.00

Supplies (list supplies/equipment): Office supplies. copier.computers. phones.fax,toner. Travel (individuals traveling. destination and purpose): presentations1 conferences, meetings

Travel: 90 locations PBC attending Law Enforcement; NOPE Representatives, Parents. Trainings, Conference Travel Expenses

Meetings (attendees, purpose, items needed for meeting): aoard sub committees, Appreciation Dinner. Coalition meetings;

Miscellaneous Expense (specify items): Insurance- Generalllabllityand Olrectorsj Thomson CompuMarkTrade mark watch; Bank Charges, Fees, Car, Conference exhibit and personnel registration material shipping expenses including: ACHA, Florida Prevention Conference, Florida Police Chiefs Conference, Florida Sherriffs Association Conference, Florida School Resource Officer's Conference, Southern College Health Conference, attending: NOPE Executive Director, Program Coordinator, law Enforcement Official.

5


Attachment A


I hereby certify that any LETF funds received will be used for the authorized purpose as indicated on Page 3 of this application. Additionally, I certify that the agency requesting the funds is·a not-for-profit agency or organization, which has been held to be tax exempt under the provisions of s. 501 of the Internal Revenue Code, and is registered as a Non Profit organization with the State of Florida, Department of State, Division of Corporations.

k'acen J-1 (}~ Name (please print)

NOTARY SECTION:

State of Florida


Title (please print)

t; - 25-/o Date

The foregoing ·Agreement was acknowledged and subscribed before me this a day of WI\ e ' 20Q:S by 'ttir-:tb H ' J>err1 (n~e of individual) as f;{:f:tkcb\l < 1)r-e cm (title) of ~pPt:: I as~ fux:t.:e (name

of organization/ agency), who is ~ersonally known to me or who produced ____________ as identification.

rl-titUJ 4Ac,t J.UJA l J Notary Public ·

My Commission Expires: H4-f ~ ,l),C, 11

... ~~t"•,, ARIELLE ERICKSON Commission#DD67830Z

·expiles: MAY24, 20ft WWW.AAAONNotN!Y.CQm

6


Attachment A

APPLICATION

1. Legal name of Organization: Palm Beach County P.A.L., Inc./ Shop With A Cop

2. Address:


4. Fiscal Agent:

5. Date:

NAME

3228 Gun Club Road STREET ADDRESS

West Palm Beach, FL 33406 CITY, STATE, ZIP

Scott Scrivner

( ) [email protected] TELEPHONE NUMBER E-MAIL ADDRESS

FEID#: 65-0461384

NAME

( 561 } 346-5893 TELEPHONE NUMBER

DATE

[email protected] E-MAIL ADDRESS

2


Attachment A

Organization Name: P.A.L. (Police Athletic League)



• School Resource Officers ~ Drug Treatment Program ~ Crime Prevention • Safe Neighborhood • Drug Abuse Education • Drug Prevention Programs

2. Organization Purpose: Palm Beach County PAL will team with PBSO districts and

Community Policing Sites to offer FREE recreational activities in a safe and supervised

setting. PAL will assist to bridge the gap between law enforcement and community youth,

reduce juvenile crime thus reducing call to service.

3. Provide a brief summary of program's activities/services to be funded: The event will start

with children eating with the deputy who recommended them for the program. They will

receive a backpack which will contain Crime Prevention material as well as information

which will be age appropriate for Gang Pressure Prevention tips. In addition, the backpack

will have information for their parents to guide them with the "red flags" of gang

participation.

During the event, the Sheriff will give each child their badge of courage which will be a

sticker that says "I wear my own badge of courage No Gangs".

At that staging area, will be a deputy assigned to Crime Prevention booth to address parent

concerns. In addition, all children will be asked to write an essay as to why they should not

join a gang, 40 of the best essays will be awarded a bicycle & helmet as well as pamphlets of bicycle safety.

They will shop with a deputy sheriff and communicate their interests. The deputies will then accompany the children shopping.

4. What results are you committed to achieving? To initiate a bond between the deputies and

the child during this event, perhaps instilling in the child importance of turning toward law

enforcement and refraining from gang participation on any level.

3

I "

II

II

ii I I




Period Covered (one year) From: Dec/1/201 O To: Dec/17/2010

No. Expense Program LETF Total Request

1. Salaries $ $

. Employee 2. Benefits/Payroll Taxes $ $

3. Professional Fees $ $

4. Occuoancv/Utilities $ $

5. Telephone $ $

6. Postaae/Shiooina $ $ I

7. Printing & Publications $ $

8. Supplies $ 30000.00 $30000.00

9. Travel $ $ I I

10. Meetings ·$ $

11. Miscellaneous Expenses $2000.00 $2000.00

Total Expenses $32,000.00 $32,000.00

Attachment A

LETF

%

I

%

%

%

%!I

%

I

%

100% i i

%

%1 i

100%

100%

4



Attachment A

Budget Narrative


Salaries (list employees and individual compensation): NIA

Professional Fees (list vendor and type of service provided): N/A

Occupancy/Utilities (list utilities): NIA

Telephone (provide telephone numbers):

Printing & Publications {list type of material): NIA

5


Supplies (list supplies/equipment): 150 backbacks

150-$125 gift card, food, soda, candy, water 40 bicycles and helmets

Travel (individuals traveling, destination and purpose):N/A

Meetings (attendees, purpose, items needed for meeting): N/A

Miscellaneous Expense (specify items): Decorations, rental and security of the hall.

Colored safety t-shirts


Attachment A

6


Attachment A

I hereby certify that any LETF funds received will be used for the authorized purpose as indicated on Page 3 of this application. Additionally, I certify that the agency requesting the funds is a not-for-profit agency or organization, which has been held to be tax exempt under the provisions of s. 501 of the Internal Revenue Code, and is registered as a Non Profit organization with the State of Florida, Department of State, and Division of Corporations.

Name (please print)

----~ Sign~ ,....--1--

NOTARY SECTION:

State of Florida


Title (please print)

('·o/..J-) D

Date

The foregoing Agreement was acknowledged and subscribed before me this __5_ day of \\)Ov~(Ytb-e< 20\b by S.C.o\-\-~,,vf\er (nameofindividual)as

Ji) ,'<'-e.e-1:Q( (title) of \) .\\,-L- :::!:. nc · (name

of organization/ agency), who is personally known to me or who produced

\J .. ~ · as identification.


7


APPLICATION

1. Legal name of Organization: Palm Beach Count Substance Abuse Coalition, Inc.

NAME

2. Address: 933 45th Street STREET ADDRESS

West Palm Beach, Fl. 33407

CITY, STATE, ZIP

3. Executive Director: Jan Cairnes, Interim Executive Director

SIGNATURE

( 561 844-5952 [email protected] TELEPHONE NUMBER E-MAIL ADDRESS

FEID #:_80-0501520 _________ _

4. Fiscal Agent: Palm Beach Count Substance Abuse Coalition, Inc.

SIGNATURE

( 561 ) 844-5952 TELEPHONE NUMBER


5. Date: 8/17/10

DATE

Attacihment A

2


Attachment A

Organization Name: Palm Beach County Substance Abuse Coalition



• School Resource Officers • Drug Treatment Program • Crime Prevention • Safe Neighborhood

✓ Drug Abuse Education • Drug Prevention Programs

2. Organization Purpose: This organization is organized and shall he operated exc]usiveJy for charitable purposes as a tax exempt entity under Section 501 (c) 3 of the Internal Revenue Code of 1986 as amended and in accordance with Florida Statutes Chapter 617, for the following purposes:

(a)

(b)

(c)

(d)

(e)

(f)

Reduce demand for illegal drugs and illegal use of alcohol and tobacco and other substances, particularly among the youth and high use populations of Palm Beach County and South Florida;

Sponsor and promote research, awareness and prevention aimed at the broad spectrum of societal consequences arising from use of illegal drugs, alcohol and other chemical substances, with particular focus on evidence based strategies to include "at risk" youth and community consequences;

Organize and coordinate activities with representatives from government, law enforcement agencies, private industry, the school system, other human service agencies, media, Civic groups, youth and youth serving agencies, businesses, state agencies, healthcare, charitable and community based organizations, concerned parents and other private individuals to encourage and support healthy drug-free activities for youth and families throughout the community, as well as healthy drug-free lifestyles among all segments of the community including "at risk" youth;

Organize, sponsor and promote research, educational programs and environmental strategies focused on prevention, awareness, rehabilitation, and early identification training for counselors, teachers, youth group leaders, parents and other concerned citizens; and

Support other drug-free lifestyles, drug use prevention, recovery and other anti-drug events, policies and programs. Establish and strengthen collaboration among communities, private nonprofit agencies, and Federal, State, local, and tribal governments to

3


Attachment A

support the efforts of the coalition to prevent and reduce substance abuse among youth and other high risk populations;

(g) Reduce substance abuse among youth and, over time, among adults by addressing the factors in a community that increase the risk of substance abuse and promoting the factors that minimize the risk of substance abuse. (Substances include, but are not limited to, narcotics, depressants, stimulants, hallucinogens, cannabis, inhalants, alcohol, and tobacco, where their use is prohibited by Federal, State, or local law.)

3. Provide a brief summary of program's activities/services to be funded:

Prescription Drug Abuse Conference Targeting Physicians Dentists, ARNP, Pharmacists,

Law Enforcement Health Care and Treatment Professionals, Prevention Professionals

offering CEU's, CME's, PDH's and

4. What results are you committed to achieving? As a result of the conference participants will:

Recognize the silent epidemic of prescription drug abuse

Comprehend the legal consequences for patients and physicians

Understand polysubstance abuse

Understand co-morbidities of drug addiction and pain management patients

Understand the impact on families

Understand best practice for prescribing methods

4



Period Covered (one year) From: 1/1/2010 To: 12/31/2010

No. Expense Program LETF Total Request

1. Salaries $0 $0

Employee 2. Benefits/Payroll Taxes $0 $0

3. Professional Fees $0 $0

4. Occupancy/Utilities $0 $0

5. Telephone $0 $0

6. Postage/Shipping $400 $116

7. Printing & Publications $4,000 $1,160

8. Suoolies $4,000 $1,160

9. Travel $750 $233

10. Meetinos $21,280 $6,171

11. Miscellaneous Expenses $4,000 $1,160

Total Expenses $34,430 $10,000

Attachment A

LETF

0%

0%

0%

0%

0%

29%

29%

29%

31%

29%

29%

29.2857%

5


Attachment J.,

Budget Narrative


Salaries (list employees and individual compensation).:....:: N:...:.:l.:...:A~-------------

Professional Fees (list vendor and type of service provided)·._,NL...2J/<L.A~------------

Occupancy/Utilities (list utilities): -'--Nc..;../A-'----------------------

Telephone (provide telephone numbers): NIA --------------------

Printing & Publications (list type of material): Conference materials for attendees, promotional printing of sponsor materials and applications, conference signage.

6


Attachment A

Supplies (list supplies/equipment): Promotional items, room decorations, speaker welcome baskets,

name tags.

Travel (individuals traveling, destination and purpose): hotel rooms, travel, meals for out of town

S eakers.

Meetings (attendees, purpose, items needed for meeting): meeting rooms, setup, tables, chairs,

Miscellaneous Expense (specify items): rental of equipment including projectors, screens Microphones, needed for presentations.

7


Attachment A


I hereby certify that any LETF funds received will be used for the authorized purpose as indicated on Page 3 of this application. Additionally, I certify that the agency requesting the funds is a not-for-profit agency or organization, which has been held to be tax exempt under the



_ Janice L. Cairnes _____ _ _Interim Executive Director ____ _ Naz:rinti~ Title (please print)

'i?/17/10 Signature Date

NOTARY SECTION:

State of Florida


The foregoing Agreement was acknowledged and subscribed before me this / 7 i\day of

~,20LQ by\-- lo.A1ica.. C0t,cnes (nameofindividual)as i;.;Ve;.: Exec. b'7;... (title) ofthlm 6roc.h Co ,'5,.66-bnce Ahli.Sf (name of organization/ agency), who is personally known to me or who produced t oa.J,f,~ -,.p,.,1-4\~..;i.L>,,,........-""""::!=---L..1.L>-.. _____ as identification.

My Commission Expires: 0/ /to/ t1

8


APPLICATION

1. Legal name of Organization: Quantum House, Inc.

2. Address:


901 45th Street STREET ADDRESS


Roberta Jurney

NAME

1!::f!1i~o/ ( 561 ) 494-0515 TELEPHONE NUMBER

FEID #: 65-0898326

4. Fiscal Agent: N/A

NAME

SIGNATURE

( ) TELEPHONE NUMBER

5. Date: 5/5/10

DATE


E-MAIL ADDRESS

Attachment A

2



Organization Name: Quantum House

LETF Funding Request (MUST match total on Financial Application): $1 O , O O O

Attachment A


• School Resource Officers • Drug Treatment Program • Crime Prevention • (X) Safe Neighborhood • (X) Drug Abuse Education • (X) Drug Prevention Programs

2. Organization Purpose: Quantum House, a hospital hospitality house in West Palm Beach, provides "a caring place to call home" for families while their children are receiving treatments for serious medical conditions in Palm Beach County. Quantum House is the only facility of its kind between Orlando and Ft. Lauderdale.

3. Provide a brief summary of program's activities/services to be funded: For a variety of medical reasons, many residents staying at Quantum House are often prescribed pain, anxiety & depression medications during their rehabilitation/recuperation. Quantum House staff has become extremely concerned with the number of prescription medications and the lack of safe storage available, thus creating the need for the "Safe" Prescription Program. Quantum House would like to install medical safes in each guest room where prescriptions can be stored and are only accessible by the family staying in that room. Informational packets will be provided to each family during the check in process describing drug disposal instructions and safety precautions. With the existing pandemic in Palm Beach County regarding prescription medication addiction, Quantum House would like to do its part toward drug education and prevention.

Crucial pieces to the --safe" Prescription Program include informational dinner seminars with valuable community partners whose experience and knowledge can contribute to the program. Quantum House will partner with St. Mary's Medical Center, Walgreens Pharmacy and the Sheriff's Office to provide speakers for quarterly informative seminars at Quantum House. These speakers will present topics to patients and families about such issues as drug abuse and drug prevention. The seminars will provide valuable information to raise awareness within Quantum House and the community at large. Walgreens pharmacists will contribute to the program by delivering prescriptions to Quantum House and providing detailed information to the families about their specific prescriptions. The Sheriff's Office will be highlighted and acknowledged on all associated Quantum House materials and on the medical storage safes. In order to reach a larger audience, the program information will also be listed on the Quantum House website so that all families have access to the informative materials.

3


Attachment A

4. What results are you committed to achieving?

The "Safe" Prescription Program will teach parents and children how to safely handle prescription drug use and storage both during their stay at Quantum House and in their homes. Children that are on medications and their caregivers will understand the drug's significance, potential risks and proper usage. Quantum House will be able to carry out its mission and provide a safe environment for families during a medical crisis and provide sense of comfort in their time of need. Since opening in May, 2001, Quantum House has never experienced a negative incident regarding prescription drugs. It is the goal of the House to maintain this positive record and continue to provide the safest, healthiest environment possible for the families and children who are guests of the House. Statistics show that a "proactive" position rather than a "reactive" position regarding drug abuse awareness will have significantly more successful results. Addressing the issue "head-on" in an open, informative forum, will achieve this success.

4



Attachment A

Period Covered (one year) From: _.Q1_/__Q1._1__11._ To: _12.._I ..l.L/ ---1.L


1. Salaries $10,000 $6,750 67.5%

Employee 2. Benefits/Pavroll Taxes $1,650 $0 %

3. Professional Fees $ $ %

4. Occupancy/Utilities $ $ %

5. Teleohone $ $ %

6. Postaae/Shippina $ $ %

7. Printina & Publications $500 $250 50 %

8. Suoolies $2,500 $2,500 100 %

9. Travel $ $ %

10. Meetinas $1,500 $500 33 %

11. Miscellaneous Expenses $500 $0 %

Total Expenses $16,650 $10,000 60 %


Budget Narrative

Attachment A


Salaries (list employees and individual compensation),.:..: _______________ _

Operations Manager-$5,625 Outreach Coordinator-$4,375

The Operations Manager {OM), who oversees the management of the facility itself, will work

with hospital staff in order to research and purchase the appropriate prescription storage

devices and will coordinate the installation process in the guest rooms at Quantum House. The

OM will also update and revise Quantum House Policies & Procedures regarding the Safe

Prescription Program and see that each guest reads and understands them upon check-in. The

OM, along with the Outreach Coordinator, will coordinate with local Walgreen's Pharmacies to

schedule prescription deliveries and opportunities for the families to meet with the Walgreen's

staff for consultation. The Outreach Coordinator {OC) who interacts daily with the families, will

reach out, providing them with the appropriate information about how to handle their prescription

medications and see that any requests/concerns regarding drug use will be directed to

appropriate agency for assistance. The Coordinator will also organize the quarterly

dinner/seminars by scheduling speakers, spreading awareness to families and providing

collateral materials. The OC will also be responsible for seeing that the program information is

posted and regularly updated on the Quantum House website for easy access for the families.

Professional Fees (list vendor and type of service provided): ______________ _

Occupancy/Utilities (list utilities): -----------------------


Attachment A

Telephone (provide telephone numbers): ___________________ _

Printing & Publications (list type of material).:..: __________________ _

Prescription Drug Packet including pain chart, pill identification chart. drug disposal information.

Walgreens delivery information and all of Quantum House Policies & Procedures for

prescription drugs.

Supplies (list supplies/equipment):. ____________________ _

Ten wall-mount prescription safes including installation

Travel (individuals traveling, destination and purpose):...: _______________ _


Initial check-in to Quantum House will include a review of Drug Policies & Procedures for guests. The Outreach Coordinator and/or Operations Manager will see that each family reads and understands these systems for the House.

Quarterly informative seminars at Quantum House will feature professional speakers who will talk with parents and patients about the use and abuse of prescription drugs, answer questions and provide associated materials. Dinner will be provided to all attendees who will include parents and pediatric patients (20-40). (Dinner meetings are suggested as this is historically the time of day when quests have returned to the House from a day of therapy, treatment and /or hospital visits resulting in the highest attendance.)

Miscellaneous Expense (specify items):. ____________________ _

This includes additional office supplies, transportation costs for families and informational books that will be added to the Quantum House Family Resource Center.


Attachment A







~ob~ J. <Juv ~ Name (please print)

~tft1!~ Title (please print)

J!:# tJi!~ c30 I rJ Date

NOTARY SECTION:

State of Florida

County of Palm Beach ~ /.aiA.I.-Jf 6.ivl4,l).j _ The foregoing Agreement was acknowledged and subscribed before me this M day of

~ , _2ow by \_, &!... T Q< \no ~)(name of individu I) as

__ l 1::\-i\Ll,_J)ut,1 tr'{ title of vtM.. (name

of organization/ agency) who is personally known to m

My Commission Expires: :s ~ ~ ,'2..0 \ &

9


APPLICATION

1. Legal name of Organization: Safety Council of Palm Beach County Inc.

Toni Burrows

NAME

2. Address: 4152 W. Blue Heron Blvd Suite 110 STREET ADDRESS

Riviera Beach, FL 33404 Cl1Y, STATE, ZIP

3. Executive Director: Toni Burrows

SIGNATURE

( 561 ) 845-8233 [email protected]

TELEPHONE NUMBER E-MAIL ADDRESS

Attachment A

FEID #:_59-1168121 ____________ _

4. Fiscal Agent: Safety Council of Palm Beach County Inc. NAME

SIGNATURE

(561-) 845-8233 [email protected] TELEPHONE NUMBER E-MAIL ADDRESS

5. Date: L, I ( I I d-.O I 0 DATE


Organization Name: Safety Council of Palm Beach County Inc.


Attachment A


• School Resource Officers • Drug Treatment Program • Crime Prevention X Safe Neighborhood • Drug Abuse Education • Drug Prevention Programs

2. Organization Purpose: ...,M=o=b..,,il,...e_.E.._y...,e..,,s"-'P_,r=og-a:a,.;,ra..,_m.,_._ ________________ _

3. Provide a brief summary of program's activities/services to be funded: ______ _ The Mornte Eyes program combats impaired driving k>¥ enlisting the help of Palm Beach County citizens Since 2004 the Traffic Safety Committee of the Palm Reaches has implemented tbe Mobile Eyes program in our county. When a citizen sees what seems to be an impaired driver they call 911 and rePOrt it to the POiice. The communications center dispatches the appropriate POiice agency. If an arrest is made then the person who made the phone call receives a $100.00 reward. The arresting agency must code the call as a Mobile Eyes call and fax the information sheet to the Safety Council. 100% of your donation goes to fund the rewards.

4. What results are you committed to achieving?

We know that Mobile Eyes will reduce the amount of drunk drivers on the road and discourage people from wanting to take the chance of driving intoxicated. The ultimate goal of Mobile Eyes is to increase the impaired driver's paranoia and make him or her reluctant to drive, because the driver behind him will most likely have a cell phone. The single greatest deterrent to impaired driving is the threat of a apprehension. Mobile Eves maximizes that threat while helping law enforcement.



Period Covered (one year) From: _1 / 1 / 11 To 12 / 31 / 11_


1. Salaries $ $

Employee 2. Benefits/Payroll Taxes $ $

3. Professional Fees $ $

4. Occupancy/Utilities $ $

5. Telephone $ $

6. Postage/Shiooing $ $

7. Printina & Publications $ $

8. Supplies $ $

9. Travel $ $

10. Meetings $ $ 25- $100.00 Mobile Eyes Rewards

11. Miscellaneous Exoenses $2,500.00 $2,500.00

Total Expenses $2,500.00 $ 2,500.00

Attachment A

LETF

%

%

%

%

%

%

%

%

%

%

100%

100%

A


Budget Narrative

Attachment A


Salaries (list employees and individual compensation).:..:: N;.:.;o::...s=-=a:.:.;:la;;.;.:ri~es::;_.. __________ _

Professional Fees (list vendor and type of service provided): _____________ _ No Professional Fees

Occupancy/Utilities (list utilities): _____________________ _

NIA

Telephone (provide telephone numbers): __________________ _ N/A

Printing & Publications (list type of material).:...: _________________ _ N/A


Attachment A

Supplies (list supplies/equipment):'--'-N=o....,S=u:cpzpl=ies=-----------------We do print the form for the Police agencies. However, the Safety Council provides one copy to each agency that they may duplicate.

Travel (individuals traveling, destination and purpose)·:_· _______________ _

Meetings (attendees, purpose, items needed for meeting): _______________ _

Miscellaneous Expense (specify items): Mobile Eyes Rewards With this $2,500 00 we wm be able to give 25 $100.00 rewards to people who call and report impaired drivers. The responding police agency must witness the impaired driving for the caller to be eligible for the reward.


Attachment A



-,;n., Bur-~ouJS ~x~c_u_-\-\VL \J ,?. Name (please print) Title (please print)

- ,;: ~ e,f 11l1<J Signature Date

NOTARY SECTION:

State of Florida

County of Palm Beach tl The foregoing Agreement was acknowledged and subscribed before me this lr day of

-:S-"'-~ c. , 20 \ o by\o ~, 6 u.. rr a \,,':) !:. (name of individual) as

~'-'c.c.""--\\vc.. \/, c.-c,;?n;.!.\de;n'.T(title) of'So... ~c:.1' l C.(\v-n~~ a~ 've:,c.. """J:;c. (name of organization/ agency), ~ersonally know~-who produced

-,--------------as identification.

~kt()~ \b-Notary Public P

My Commission Expires: o ~ I a S J ' \

...----........ ------· ·----

Q). :::·~- LESLIE MCKENNA {•: :-~ MY co•~MISSI0N # 00655252

• ,. EXPIRES March 25. 2011 t 111 \

14011398-0153 FlondaNotaryServJGe.com

.,.


APPLICATION

1. Legal name of Organization: The Arc of Palm Beach County, Inc.

2. Address:


4. Fiscal Agent:

5. Date:

The Arc of Palm Beach County

NAME

1201 Australian Ave STREET ADDRESS

Riviera Beach, FL 33404 CITY, STATE, ZIP

Michael Papa

(561) 842-3213 TELEPHONE NUMBER

Tax ID#: 59-0883386

(561) 842-3213 TELEPHONE NUMBER

Db-t'f-;-viD DATE

E-MAIL ADDRESS


Attachment A

2



Attachment A

Organization Name: The Arc of Palm Beach County. Inc.



• School Resource Officers • Drug Treatment Program • Crime Prevention Cl Safe Neighborhood • Drug Abuse Education • Drug Prevention Programs

2. Organization Purpose: To provide positive recreational activities to children and adults

with disabilities who would otherwise have no access to structured activities during non

school hours and during the day. People with disabilities are at risk for being both victimized

due to their disability as well as at risk for negative behaviors due to lack of structured

activities.

3. Provide a brief summary of program's activities/services to be funded: Special events

and programs. A scholarship fund for persons who can not afford the program fees for

camps. Staff payroll to Disney's Animal Kingdom trip, class instructions, programs and

special event during out of school time during the year. Supplies for activities, instructional

classes, and field trips. Recreational services will offer opportunities to children and adults

persons with special needs in a self-contained setting or integrating them into existing other

city sponsored programs during non school days and or the weekends.

4. What results are you committed to achieving? Keeping people with disabilities safe

during school days out, during the day for adults who are not in a sheltered work shop and

down time on the weekends. Programs will provide positive activities and teach

participants safe social skills while they are out in the community. This will also help in

preventing crime towards people with disabilities by offering them a supervised safe

alternative during these time frames in which many would have no were else to go or be

home unsupervised.

4



Attachment A

Period Covered (one year) From: _1_/_QL/_1_1 To: _12_!--3..L/_11_

No. Expense Program LETF LETF Total Request

1. Salaries $ 155,170.00 $4,000.00 3%

Employee 2. Benefits/Payroll Taxes $26,500.00 $800.00 3%

3. Professional Fees $ 650.00 $0 0%

4. Occuoancv/Utilities $33,920.00 $0 0%

5. Telephone $2,100.00 $ 600.00 29%

6. Postage/Shiooing $1,140.00 $0 0%

7. Printing & Publications $ 600.00 $0 0%

8. Supplies $12,500.00 $5,000.00 40%

9. Travel $20,481.00 $1,245.00 6%

10. Meetings $600.00 $ 600.00 100%

11. Miscellaneous Expenses $16,460.00 $12,755.00 77%

Total Expenses $270,121.00 $25,000.00 9%

5


Attachment A

Budget Narrative


Salaries (list employees and individual compensation): Direct care staff of which a list will be attached as paid on payroll for the following - Disney's Animal Kingdom, special events and day programs during the year.

Professional Fees (list vendor and type of service provided): Auditor (within current funder budget)

Occupancy/Utilities (list utilities): Recreation building and office space, FPL, Bellsouth, Janitor, Park maintenance, insurance, and W.P.B. water - $33,920.00 (not requesting funds from LETF)

Telephone (provide telephone number): 561-252-8891- $600.00 ------'----------------December* January * April * June * July * August Busy program months.

Printing & Publications (list type of material);..: __________________ _

6


Attachment A

Supplies (list supplies/equipment): Cooking accessories, sports equipment, supplies for all programs & camps offered, photos material, office supplies, t-shirts for staff and participants, communication devices, etc. A list and receipts of all purchases made will be provided)

Travel (individuals traveling, destination and purpose): Charter bus cost $1,245.00,

Meetings (attendees, purpose, items needed for meeting): Professional staff instructional class offered to all recreation employees $600.00

Miscellaneous Expense (specify items): Camp fee scholarships - $5,300.00 (for day camps which will be provided to children of working parents), storage facility - $2,000.00, food and beverages - $599.00, theme park entrance for staff ticket costs x 10-12 staff, food & beverage stipend= $1,956.00

various field trips & special guests - $2,900.00 (log of all trips/ guests receipts will be provided).

12,755.00

7


Attachment A



indicated on Page 3 of this application. Additionally, I certify that the agency requesting the funds is a not-for-profit agency or organization, which has been held to be tax exempt under the

provisions of s. 501 of the Internal Revenue Code, and is registered as a Non Profit organization with the State of Florida, Department of State, Division of Corporations.

Julie Lobdell Name (please print)

b ' ~~ bd&K igture

NOTARY SECTION:

State of Florida


Director of Recreation Title (please print)

Co-t5-l6 Date

The foregoing Agreement was acknowledged and subscribed before me this /6-/.J....,day of t~ , 20./J) by -J....J,~ wdeJ / (name ol,lpdividual) as If , , ~® or R,w-{/4-1:t"" c1it1e> ot-tk- /ML or- 1-tilm ISeuJ... l0ml/11"ame

of o~ nization/ agency), who is personally known to me or who produced

e ~ Iii t0tJ as identification.

JL o/~ Notary Public


•

HEUI ..... ..,,.... ...... .... .,c... ...... 11,1114 C•1111111 ii DD-11

""' IIOllllldTlnllllllllDllll....,Ane.

8


APPLICATION

1. Legal name of Organization:

Urban League Of Palm Beach County, Inc.

NAME

2. Address: 1700 N. Australian Ave. STREET ADDRESS


3. Executive Director: Patrick J. Franklin

! 561 ) 833-1461 TELEPHONE NUMBER

FEID #:_59-1533710 _________ _

4. Fiscal Agent:

SIGNATURE

561 833-1461 TELEPHONE NUMBER

5. Date:

Attachment A

2


Attachment A

Organization Name: Urban League Of Palm Beach County, Inc.



• School Resource Officers • Drug Treatment Program x Crime Prevention • Safe Neighborhood • Drug Abuse Education • Drug Prevention Programs

2. Organization Purpose: The purpose of the organization is to provide programs and services to the youth in Palm Beach County that would assist them in staying Crime and Drug free. In addition our program partners with a number of Law Enforcement agencies to provide these same youth with enhance life skills, self esteem building, conflict resolution training, and anger management training. Opportunities are also provided to do joint community service projects.

3. Provide a brief summary of program's activities/services to be funded: The event to be funded is the trip to the 26th Annual Preventing Crime in The Black Community Conference. The date of the Conference is May 25-28, 2011 in Miami, Florida. 100 youth, from all over Palm Beach County, escorted by 27 chaperons will have the opportunity to receive training from law enforcement and community experts from all over the county, on the best practices to prevent crime in the black community. They will also have the chance to see other positive teens across the county and review other model programs.

4. What results are you committed to achieving? We wm create community ambassadors of crime free living. Last year, the program took 100 youth from all over Palm Beach County who are now setting the standard in community service and crime prevention. Based on the positive effects of last year's trip, the Urban League has increased its youth group participation. We partner and mentor other youth groups as well. The youth have been very active in crime prevention activities like stop the violence marches, crime prevention basketball shoot outs, door to door crime prevention campaigns, serving senior citizens, and community clean-ups. These youth are located In West Palm Beach, Riviera Beach, Belle Glade, North Lake, Lake Worth, Boynton, Boca Raton, South Bay and Delray. Once these youth are better trained they then plan and participate in more community service and crime prevention programs that benefit the Palm Beach Community.

3



Attachment A

Period Covered {one year) From: _01_/_01_/_11_ To: _12_/_31_/_11_


1. Salaries $ $ %

Employee 2. Benefits/Payroll Taxes $ $ %

3. Professional Fees $ $ %

4. Occuoancv/Utilities $ $ %

5. Telephone $ $ %

6. Postage/Shiooina $ $ %

7. Printina & Publications $ $ ' . %

8. Supplies $1,905.00 $1,905.00 100%

9. Travel $33,410.00 $33,410.00 100%

10. Meetinas $17,480.00 $17,480.00 100%

11. Miscellaneous Expenses $437.00 $437.00 100%

Total Expenses $53,232.00 $53,232.00 100%

4


Budget Narrative

Attachment A

Provide detailed description for each expense listed on the Financial Application. You may attach additional sheets if necessary. ·

Salaries (list employees and individual compensation).;.._: ______________ _

Professional Fees (list vendor and type of service provided): _____________ _

Occupancy/Utilities (list utilities): _____________________ _

Telephone (provide telephone numbers): __________________ _

Printing & Publications (list type of material): ------------------

5


Attachment A

Supplies (list supplies/equipment): Polo collared shirts: 127 x $15 = $ $1,905.00

Travel (individuals traveling, destination, and purpose},..;..: _______________ _ Capri's Charter (Coach USA}: 3 - 49 passenger buses @ $3,800 per day x 3 days= $11,400.00

Transport 100 teens and 27 chaperons from West Palm Beach, FL to attend the 26th Annual Preventing Crime in the Black Community Conference. The date of the conference is May 25-28, 2011 In Miami, FL 3 Rooms for 3 drivers@ $100 x 3 rooms x 3 days= $900.00; 25 Rooms for 100 Teens @$100 x 25 rooms x 3 days= $7,500.00; 15 Rooms for 27 chaperons@ $100 x 15 rooms x 3 days= $4,500.00; Per-diem for 100 teens@ $19.667 x 3 days x 100 teens= $5,900.00; Per-diem for 27 chaperons@ $35 per day x 3 days x 27 chaperons= $2,835.00; Gratuity for 3 drivers@ $125 x 3 days= $375.00

Meetings (attendees, purpose, items needed for meeting}: ---------------Registration for 100 teens@$110 x 100 teens= $11,000.00; Registration for 27 chaperons @ $240 x 27 chaperons = $6,480.00

Miscellaneous Expense (specify items}: Snacks and drinks for bus ride to and from conference $437.00

6


Attachment A



~<-t'--~ f-..t,Wr tc.EZ> Na e{J)iease print) Title (please print)

NOTARY SECTION:

State of Florida


The foregoing Agreement was acknowledged and subscribed before me this 3- 0 day of ~ , 201,P by~~d<....1,\:t~~n (name of indivi al) as QI(' .rr;; A~ v C c;:_~ . (title) of • °'"' \,J.. & ~~ ~~ame

of organization/ agency), who is personally known to me or who produ ------"'."""""----:-_______ as identification.


-~v~. EMANUEL RIDGEWAY €•: ~•~ MY COMMISSION # 00920875 • ~ EXPIRES August 27, 2013

FlorldaNolllrySeivlce.com

7

agenda item no. 3bb-, 4 palm beach county board of … · 12/7/2010 · 11- ()/ 7~ acct.number...

Documents