PROVIDE HEALTH SERVICES TO THOSE IN NEED
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AGREEMENT
This Funds Agreement is made and entered into between the City of Clearwater, hereinafter
referred to as the City, and Greenwood Community Health Resource Center, Inc., hereinafter
referred to as the Agency.
WHEREAS, it has been determined to be highly desirable and socially responsible to provide
health services to those who would not otherwise have a means to fill these needs; and
WHEREAS, the City desires to help those in need by providing funding for the above services;
and
WHEREAS, the Agency provides such services and operates in the City;
NOW, THERFORE, the parties agree as follows:
ARTICLE I. TERM
The term of this agreement shall be for a period of 12 months commencing on the I st day of
October, 2000 and continuing through the 30th day of September, 2001 (the Termination Date)
unless earlier terminated under the terms of this agreement.
ARTICLE II. RESPONSIBILITIES OF THE AGENCY
1. Services to be Provided: The Agency shall provide the above stated service in
accordance with the proposal submitted by the Agency and approved by the City, which
is attached and incorporated herein by reference.
2. Area to be Served: Services rendered through this agreement shall be provided within
the corporate limits of the City as it now exists and as its boundaries may be changed
during he term of this agreement.
3. Scheduled Reports of Agency Activities: The Agency shall furnish the City Human
Relations Department, Grants Coordinator, with an annual report of activities conducted
under the provisions of this agreement by October 31, 200 I. Each report is to identify the
number of clients served, the costs of such service, and commentary on the viability,
effectiveness, results of measurable goals and objectives as set out in the agency's
proposal, and trends affecting the program. The agency will also provide a copy of its
most recent independent financial audit.
4. Use and Disposition of Funds Received: Funds received by the Agency from the City
shall be used to pay for the above services as further described in the grant proposal
submitted by the Agency to the City. Funds existing and not used for this purpose at the
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end of this agreement term shall be deemed excess to the intended purpose and shall be
returned to the City.
5. Creation, Use, and Maintenance of Financial Records:
a) Creation of Records: Agency shall create and maintain financial and accounting
records, books, documents, policies, practices, procedures and any information
necessary to reflect fully the financial activities of the Agency. Such records shall
be available and accessible at all times for inspection, review, or audit by
authorized City representatives.
b) Use of Records: Agency shall produce such reports and analyses that may be
required by the City and other duly authorized agencies to document the proper
and prudent stewardship and use of the monies received through this agreement.
c) Maintenance of Records: All records created hereby are to be retained and
maintained for a period not less than five (5) years from the termination of this
agreement.
6. Non-discrimination: Notwithstanding any other provisions of this agreement during the
term of this agreement, the Agency for itself, agents and representatives, as part of the
consideration for this agreement, does covenant and agree that:
a) No Exclusion from Use: No person shall be excluded from participation in,
denied the benefits of, or otherwise be subjected to discrimination in the operation
of this program on the grounds of race, color, religion, sex, age, national origin, or
disability.
b) No Exclusion from Hire: In the management, operation, or provision of the
program activities authorized and enabled by this agreement, no person shall be
excluded from participation in or denied the benefits of or otherwise be subject to
discrimination on the grounds of or otherwise be subjected to discrimination on
the grounds of race, color, religion, sex, age, national origin, or disability.
c) Inclusion in Subcontracts: The Agency agrees to include the requirement to
adhere to Title VI and Title VII of the Civil Rights Act of 1964 in all approved
sub-contracts.
d) Breach of Nondiscrimination Covenants: In the event of conclusive evidenced
of a breach of any of the above non-discrimination covenants, the City shall have
the right to terminate this agreement.
7. Liability and Indemnification: The Agency shall act as an independent contractor and
agrees to assume all risks of providing the program activities and services herein agreed
and all liability therefore, and shall defend, indemnify, and hold harmless the City, its
officers, agents, and employees from and against any and all claims of loss, liability, and
damages of whatever nature, to persons and property, including, without limiting the
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generality of the foregoing, death of any person and loss of the use of any property, except
claims arising from the negligence or willful misconduct ofthe City or City's agents or
employees. This includes, but is not limited to matters arising out of or claimed to have
been caused by or in any manner related to the Agency's activities or those of any
approved or unapproved invitee, contractor, subcontractor, or other person approved,
authorized, or permitted by the Agency in or about its premises whether or not based on
negligence
ARTICLE III. RESPONSIBILITIES OF THE CITY
1. Grant of Funds: The City agrees to provide a total grant of $7,000.00 to fund the
program in accordance with this agreement and subject to City Commission budget
approval.
2. Payments: The total amount requested will be paid by the City to the Agency within 30
days after execution of this agreement by the City and the Agency but no earlier than
October 1 of the budget year for which the funds are authorized.
ARTICLE IV. DISCLAIMER OF WARRANTIES
This Agreement constitutes the entire Agreement of the parties on the subject hereof and may not
be changed, modified, or discharged except by written Amendment duly executed by both
parties. No representations or warranties by either party shall be binding unless expressed herein
or in a duly executed Amendment hereof.
ARTICLE V. TERMINATION
1. For Cause: Failure to adhere to any of the provisions of this agreement as determined by
the City shall constitute cause for termination. This agreement may by terminated with 5
days notice without any further obligation by City.
2. Disposition of Fund Monies: In the event of termination for any reason, monies made
available to the Agency but not expended in accordance with this agreement shall be
returned to the City.
ARTICLE VI. NOTICE
Any notice required or permitted to be given by the provisions of this agreement shall be
conclusively deemed to have been received by a party hereto on the date it is hand-delivered to
such party at the address indicated below (or at such other address as such party shall specify to
the other party in writing), or if sent by registered or certified mail (postage prepaid), on the fifth
(5th) business day after the day on which such notice is mailed and properly addressed.
1. If to City, addressed to Grants Coordinator, Human Relations Department, P.O Box 4748,
Clearwater, FL 33758
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2. Ifto Agency, addressed to Greenwood Community Health Resource Center, Inc., 1108
North Greenwood Avenue, Clearwater, FL 33755.
ARTICLE VII. EFFECTIVE DATE
The effective date ofthis agreement shall be as ofthe first day of October, 2000.
.IN WITNESS WHEREOF, the parties hereto have set their hands and seals this
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day of
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, 2001.
CITY OF CLEARWATER, FLORIDA
Countersigned:
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Approved as to form:
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Pamela K. Akin, City Attorney
Attest:
Witnesses as to Agency:
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CITY OF CLEARWATER
SOCIAL SERVICES GRANT
PROJECT APPLICATION FORM
Phone:
(727) 562-4060 for assistance
Due: January 26, 2001
A. Application Infor.mation
Organization Name:
(If different)
Willa L. Carson, President/CEO
Greenwood Community Health Resource
Center, Inc.
Applicant:
(Sponsor/Developer)
Address:
1108 North Greenwood Avenue
City; State; Zip
Telephone Number:
Clearwater, Florida 33755
(727) 467-9411
Contact Person:
Willa L. Carson
Title:
President/CEO & Board of Directors
Telephone Number:
(727) 447-6993
Period for which funds
are being requested:
October 1, 2000 - September 30, 2001
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Signature Willa L. Carson Willa L. Carson
Board of Directors Chairperson
Date
January 25, 2001
NOTE:
The City of Clearwater reserves the right to fund applicants at a
level lower than requested.
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B. Activity (Check One)
Adult Crime
Child Abuse
Elderly
x
Hunger
Juvenile Crime
Physical Illness
x
Parenting
Adolescents
Substance Abuse
Unsupervised
Children
Youth Development
Other
(Describe Below)
Elderly and citizens in the North Greenwood Community
The Greenwood Community Health Resource Center (GCHRC) is a free health clinic
(center) that offers health education, health physicals and support services
to the elderly and sick children. GCHRC is in the heart of the lowest
economical section of Clearwater. It is in walking distance for most clients.
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AMOUNT OF FUNDING CURRENTLY REQUESTED:
(Not to exceed $10,000)
$10,000.00
D. SPECIFICALLY FOR WHAT WILL THIS MONEY BE USED.
(Line item budget for this amount)
Funding will be used to assist in paying for utilities, education
(health), medical supplies and medication for those who are less
fortunate. Education books for counseling, teaching, telephones
and other services are also needed in this area.
E. BRIEF DESCRIPTION OF PROJECT YOU WISH TO FUND UTILIZING THIS
GRANT.
GCHRC needs funding for daily operation as this is a free clinic. Health
programs are needed to advise the community to good healthy habits.
F. BRIEF DESCRIPTION OF YOUR OVERALL ORGANIZATION.
GCHRC is a free health center supported from grants, donations, volunteers
and several paid staff. It also is composed of a volunteer Board of
Directors, Community Board, medical doctors, nurses and many volunteers
assistance.
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~. NUMBER OF CLIENTS SERVED BY THIS PROGRAM.
1513 from 1/1/00 - 12/31/00
H. PERCENTAGE OF THESE CLIENTS WHO ARE CITIZENS OF CLEARWATER.
99%
I. CURRENT OVERALL ORGANIZATION BUDGET (PLEASE ATTACH) .
See attached
J. IF THIS IS START UP OR MATCHING MONEY, SPECIFY THE DETAILS
i.e.:
WHICH AGENCY OR ORGANIZATION WILL PROVIDE THE MATCH, THE
REQUIREMENTS AND THE AMOUNT OF THE MATCH.
No
K. IS YOUR AGENCY A REGISTERED 501 (C) (3) NON-PROFIT AGENCY OR IN
THE PROCESS OF BECOMING ONE.
Yes registered
L. DOES YOUR FACILITY HAVE OR IS IT IN THE PROCESS OF ACQUIRING
THE APPROPRIATE LICENSURE FOR THE DELIVERY OF THE SERVICES
DESCRIBED IN THIS APPLICATION.
We have necessary license for operation
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M. HAS YOUR ORGANIZATION RECEIVED OR IS IT EXPECTING TO RECEIVE
FUNDING (WHETHER CASH OR IN-KIND CONTRIBUTIONS) FROM THE CITY
OF CLEARWATER DURING THE FISCAL YEAR FROM OCTOBER 1, 2000
THROUGH SEPTEMBER 30, 2001?
YES X
NO
IF YES, PLEASE EXPLAIN:
We are applying for funding from the City of Clearwater at this time for
October I, 2000 through September 30, 2001
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GREENWOOD COMMUNI1Y REALm RESOURCE CENTER. INC.,
PROJECI'ED BUDGET YEAR 2001-2002
Account #I Title
3610 Inten:st
3690 Clearwater Social
Service Grant
Clearwater Community
Foundation
Dr. Scholl FOlUldation
Donations
Fund Raisin8
CEHAB Grant
Alleghany Foundation
Projected T oral Income
Expenses: Administration
4110 Salaries
Center Administrator
Assistant Administrator
Outreach Worker
Receptionist
FICA
Payroll Tax
Workman Compo
Legal
InsUl'8.llCO-OutreWorker
Unemployment Compensation
4140 Printing! Promotion
4150 Training &; Travel
4170 AuditlAlYYlImting
4180 Travel
4190 Medical Supplies
4190.1Office Supplies
4190.2 Posta@e
4190.4 Telephone
Utilities:
4310 Waklr/Sewer
4320 Electricity
Maintenance:! Labor! Building
4410.1 Labor
4410 Materials
4420 Contracts
Insurance:
4510 Liability! Fire
4510.1 Liability! Board &; Volunteers
5100 Reserve
Amount
$ 200.00
10,000.00.
12,000.00
20,000.00
20,500.00
20,000.00
15,000.00
_ 50,000.00
$ 143,700..00
( Community EnvironmentalRealth Advisory Board)
32,000.00
20,000.00
19,893.00
12,078.00
6,1IJ.00
3,528.00
927.00
1,500.00
1,200.00
784.00
2,500.00
1,500.00
2,500.00
1,000.00
3,500.00
3,000.00
1,576.00
1,500.00
2,000.00
2,000.00
2,000.00
2,500.00
1,000.00
2,000.00
2.000.00
3,000.00
T oral Projected Expenses
$ 143,099.00
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To: (funder):
~lJf1ED FUNDIN~ICATION
City of Clearwater For time period of: I" - / - ~ -k:- 'J'~ j 6/
Applicant Information (print or ~pe):
Legal Name of Organization: GREENWOOD COMMUNITY HEALTH RESOURCE CENTER. INC.
Complete Address:
1108 North Greenwood Avenue
Clearwater, Florida 33755
Phone ( ) 727-467-9411 Fax ( ) 727-467-2771
E-Mail N / A
Federal Tax Identification Number: EIN-65-0743078
Contact Person: Willa L. Carson
1itle: President/CEO & Board of Directors
Organization Type: _Public _Private.!..... Non-profit _ Other
Service Area:..!.... County ~ City of Clearwater
Other
Agency currently funded by ( check all that apply):
_ St. Petersburg _ Florida Dept. of Children & Families
JL Clearwater _ Florida Dept. of Justice
_ Largo 2 Pinellas County Foundation
_ Pinellas County ~ Allegany Franciscan. Foundation
_ Area Agency on Aging _ Eckerd Family Foundation
Juvenile Welfare Bd. Other:
_ United Way
Certifications: (1) H required to register for solicitation of funds, is the Agency cDrrendy
registered with the State? ..!... Yes _ No The County? _ Yes _ No
(2) If incorporated, has the Agency Annual Report been filed with the Florida
Secretary of State? ....!. Yes _ No
Name and Tide of Agency Representative submitting this funding request:
Willa L. Carson
President Board of Directors
Signature of Agency Director (senior stBfr member) or Board Chair:
Willa L. Carson
Date: 1-25-01
Received in funder's office by:
Date:
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BOARD OF DlRECTORS---Required in BY-LAWS
NAME/OFFICER OCCUPATION AREA OF EXPERTISE RACE/GENDER
Willa L. Carson Retired Registered Nursing B F
President Nurse
Janice Johnson Asst. Office Manager Secretarial W F
Secretary
James Ayer Retired N. Y. State Em- Accounting B M
Treasurer ployer
Deborah French Pediatrician Medicine B F
Medical Director
Joseph E.Heastie Marketing Supervisor Marketing B M
Advisor
Jeannie Renfrow V.P. Peoples Bank Banking W F
Advisor
Gregory Showers Attorney (Esq.) Legal B M
Legal Advisor
Rev. William F.Shennan Pastor, Mt. Carmel Religion B M
Advisor Baptist Church
Beth Goodgame Community Community W F
Fundraising Consultant
Beatrice Lewis Retired Teacher Community B F
Assist. to Treasurer
Gregory Dean B M
Muha mmad Abden-Rahim B M
Dr. Theresa Goss B F
Annette Faison B F
Carle Seale B M