PROVIDE ELDER SERVICES TO THOSE IN NEED
AGREEMENT
This Funds Agreement is made and entered into between the City of Clearwater, hereinafter
referred to as the City, and Neighborly Senior Services, Inc., hereinafter referred to as the
Agency.
WHEREAS, it has been determined to be highly desirable and socially responsible to provide
elder 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 ofthis agreement shall be for a period of 12 months commencing on the 1 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, 2001. 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
d}
jO'O/? L /'
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 ofthis
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
ofthis 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
;I!J
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 of the 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 ofthe provisions ofthis 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. If to Agency, addressed to Neighborly Senior Services, Inc., 13650 Stoneybrook Drive,
Clearwater, FL 33762.
ARTICLE VII. EFFECTIVE DATE
The effective date of this agreement shall be as of the first day of October, 2000.
.IN WITNESS WHEREOF, the parties hereto have set their hands and seals this
~
day of
r
,2001.
CITY OF CLEAR WATER, FLORIDA
Countersigned:
loner
BtfJ!t~..~~....... -q:
ham B. Home II, InterimCity Manager
Approved as to form:
Jili\' Kk' C'
Pame a ,A ill, Ity Attorney
Attest:
Cyn I
Witnesses as to Agency:
)1L. rxJ~
Itz
9A+~
Attest:
~~A~ de~>>' '_~:~-'~""'_/:--
~~U;~ ~wa;d-~xe~~S~~ :,~s~~t-~.n~:'
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-... ....... "- ',-...
-
. ~ -.....
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..----.... .~,
.... ',"':"
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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
Applicant:
(Sponsor/Developer)
Neighborly Senior Services, Inc.
Organization Name:
(If different)
Address:
13650 Stoneybrook Drive
City; State; Zip
Telephone Number:
Clearwater. Florida 33762
(72 7) 573-9444
Contact Person:
Judy Powers
Title:
Vice President, Operations
Telephone Number:
(727) 456-0222 ext. 279
Project Year 2000-2001
Philip E. Dean
Board of Directors Chairperson
Date
"
NOTE:
The City of Clearwater reserves the right to fund applicants at a
level lower than requested.
2
(fJ
B. Activity (Check One)
Adult Crime
Child Abuse
Elderly
xx
Hunger
Juvenile Crime
Physical Illness
Parenting
Adolescents
Substance Abuse
Unsupervised
Children
Youth Development
Other
(Describe Below)
3
C. ANO'DN'1' OF FONDmG CURRENTLY REQUESTED:
(Not to exceed $10,000)
($10,000, to bs used as matching funds. $10,000 of match generates
$90,000 in serVices.
D. SPECIFICALLY FOR WHAT WILL THIS MONEY BE USED.
(Line item budget for this amount)
(Please see attached.)
E. BRIEF DESCRIPTION OF PROJECT YOU WISH TO FOND UTILIZING THIS
GRANT.
Services provided include Adult Day Services, Meals on Wheels, Group Dining,
Transportation, and Community Care for the Elderly, composed of a full array
of home and community-based services designed to maintain independence.
Some of these are Homemaker, Personal Care. Care2iver Relief. Home Health
Aide, Occupational/Physical and Speech Therapy, Mental Health Counseling,
Home Nursing. Emer2encv Alert Response and Chore Services.
F. BRIEF DESCRIPTION OF YOUR OVERALL ORGANIZATION.
(Please see attached.)
4
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G. NUMBER OF CLIENTS SERVED BY THIS PROGRAM.
7,799
H. PERCENTAGE OF THESE CLIENTS WHO ARE CITIZENS OF CLEARWATER.
16.8%
I. CURRENT OVERALL ORGANIZATION BUDGET (PLEASE ATTACH).
Please see attached.
i.e.:
J. IF THIS IS START UP OR MATCHING MONEY, SPECIFY THE DETAILS
WHICH AGENCY OR ORGANIZATION WILL PROVIDE THE MATCH, THE
REQUIREHEN'l'S AND THE AMOUNT OF THE MATCH.
This is match money on a 9:9 basis for Older Americans Act programs:
Adult Day Care, Meals on Wheels, Group Dining and Transportation. It
also matches Florida State Community Care for the Elderly programs on
a 9:9 basis. Clearwater's fair share of match is $174,821.
K. IS YOUR AGENCY A REGISTERED SOl(C) (3) NON-PROFIT AGENCY OR IN
THE PROCESS OF BECOMING ONE.
Yes
Senior Services is a registered SOl(c)(3) non-profit agency.
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.
Yes, all Neighborly Senior Services' facilities have the required
licensure.
5
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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
NO XX
IF YES, PLEASE EXPLAIN:
Only what is currently being requested.
6
D. SPECIFICALLY FOR WHAT WILL THIS MONEY BE USED
(Line item budget for this amount)
Please see attached Total Agency Budget
Neighborly Senior Services, Inc. receives funds from a variety of sources. The primary
sources of funding, Title ill of the Older Americans Act and the Florida Community Care
for the Elderly Act of 1976, require that NSS provide local matching funds on a
90%/10% basis, i.e., for every nine dollars of federal or state funds received, NSS must
raise one dollar of local matching funds.
NSS provided multiple services to Clearwater residents in 1999, therefore we request the
financial support of your community to ensure the continuation of these vital services
which are designed to meet the basic needs of your most vulnerable elderly and disabled
residents. The number and percent of unduplicated clients in each NSS program who
resided in Clearwater during the latest year for which data are available are indicated in
columns (2) and (3) in the table below.
(4)
(I) (2) (3) (5)
Total Number of Total
Number of Unduplicated Percent Amount "Fair Share"
Unduplicated Clients in of of of
NSS Program Clients Clearwater Total Match Match
Adult Day Care 142 65 45.8% 39,277 $17,988
Community Care
for the Elderlv 852 156 18.3% 525,017 $96.078
Meals on Wheels 2,312 407 17.6% 68,314 $12,023
Group Dinin~ 2,279 291 12.8% 133.670 $17,109
Neighborly
Transportation 2,214 400 18.1% 174,716 $31,623
Total Amount of Match = $940.994
"Fair Share" total = $174.821
However, NSS is only requesting 5.7% of the fair share match.
Measurable Obiectives for 2001-2002
NSS plans to serve 65 Clearwater residents in our Adult Day Services program, 166 with
Care Management services, 703 through our Nutrition services, and 405 through our
Transportation services.
/IJ
F. Brief description of your overall organization.
Neighborly Senior Services, Inc. (NSS) is a private not-for-profit agency chartered in
1966 underthe laws of the State of Florida and is tax exempt under Section 501@(3) of
the Internal Revenue Code. After conducting a needs assessment of the elderly in 1967,
NSS began delivering its first services to Pinellas County Seniors in 1968 through it
Meals on Wheels and Adult Day Care Programs; followed by Group Dining in 1973 and
Transponation in 1977. Now, NSS provides a system of care which not only includes
these early services, but Community Care for the Elderly and a host of other supportive
services as well.
NSS currently has five separate programs and provides more than 25 services through its
service delivery system consisting primarily of 25 group dining sites, 112 meal on wheels
routes, six adult day care centers, 48 vehicles providing transportation services daily, and
25 home and community-based services in the Community Care for the Elderly Program.
These programs and 377 dedicated staff are augmented by 3,292 volunteers, most notably
the 1,609 volunteers in the Meals on Wheels Program. NSS currently serves over 3,000
low income seniors per year in Pinellas County. NSS is the only agency that provides
these services to this target population. NSS has written coordination agreements with
221 other agencies to which referrals are routinely made, and a number of agencies
provide services at sites and centers. NSS programs in this application address the
following 1992 I-COPE need areas.
Communi tv Care for the Elderly
Priority I - Frail and Impaired elderly
Priority I - Hunger and Poor Nutrition
Priority I - Physical lllness
TransDonation
Priority I - Frail and Impaired elderly
Priority I - Hunger and Poor Nutrition
Priority I - Physical lllness
Adult Dav Care
Priority I - Frail and Impaired elderly
Priority I - Hunger and Poor Nutrition
Priority I - Physical Illness
Priority I - Substance Abuse
Meals and More
Priority I - Frail and Impaired elderly
Priority I - Hunger and Poor Nutrition
Priority I - Poverty
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/WI_I, ......... ___-. Inc.
~......
2lID1
ConlrIICI8d FQXl
Conuaaed Food USDA
Meci8 Clipping SeMce
Aullio VISUBl
Interagency ~e
Olher Subcontracred
SUB CON1'RACTs
TOTAL
AGENCY
BUDGET
$ 2,315,752
6.384.756
304.280
138.000
180.000
4.748.516
535.500
1.103.547
38.341
10.000
51.362
39,480
547.659
1,482.261
338.000
545.552
9,000
531,642
$ 19.311.648
$ 7.925.135
2.293.158
10218.293
333.58
267 .283
112,497
58,014
166,511
81,441
13l1.251
131.643
349.335
91.525
18.837
29,512
19.278
84,9ll5
67.666
31.353
1.500
344.566
79.167
78.956
165.464
98.261
108.107
53.651
20,300
178.880
5.275
52.000
231.620
43.681
578.114
59.600
10,000
42.350
10.964
91.487
11.584
57,000
8,732
44.550
2,300
5.000
63.486
82.841
147283
1.000
40,000
4.549
2.370.602
1.147.786
296.280
1.440
10.400
545.552
2.741.478
4.742.936
$ 18.461.616
531.642
$ 18.993258
$ 318.390
AccaunI o.crtllllan
F8dlnI Funds
SlIde Funds
USDA
I.Ill:aI Cash MIlIch
Secaon 5310
MecIcalcI
Mecllcent
Fee lot Service
1.-- Pace
CIty 01 CIeMvater
CIUee 01.....
PIneII8s~ COWlly
lklIted Way
Contnbulions
Inl8nIB1IInv8elm8nl Appracjatjon
1nl8r Ag8ncy R.......
SeIe8 01 Epuip
IK M81Ch
TOTAl REVENUE
SALARIES
FRINGE BENEFITs
TOTAl PERSONNa.
FTE'S
TRAVEL
R8nt
IIuIIdIng 0eIltBcid0n
BUILDING SPACE
P08l8ge
T-'ephone
UlIIIIIes
COMMUNICATIONS
Prtnting
Ouee & Sub8c:ripttona
OIapoBBls
MedicBt Supp/iea
0II1ce Supptiss
Program Supplies/Art
Small Equip
Copier lXlS18
PAINTING & SUPPUES
Insurance
VBhk:Ie ,_
~
IIuIdIng MlIlnt-.:e
Equip ............
Equip RenlIIl
~Suppli..
Vehicle 0IleratI0ns
Ucense FeBS
Audt
eonsultanl ~
Classified Advertising
Equip Depreciation
VoIunteerl Emp. Recognhlon
Donor Recognllion
Meetings
Extermirlllling Service8
Training & Education
Employee Screening
I.eg8I
WBr8Ilcu8 RenIaJ
Mille ~
ACe Specjst ~
IloMI Aclivitiee
Bed Debll Conlingency
M8IkBIino-Advert FFS
~NSS
He81l1l WBlch ~
Webaite
~P-
OTHER
TOTAl AlLOWABl..E COST
TOTAlIN-KlNO VAlUATION
TOTAl COSTS PLUS IN-KlNO BY SVC
NET INCOME
....lInDOrly _lienI-, Inc:.
AgMcy-WkIe BucIgIIt
, 2001
,-
Vehicla'naurance
Melntenence
BuilIing Meinl--.
Equip MeinIenence
Eq~ Rental
Computer Supplies
Valida Operations
Ucense FMa
Audt
Cansutl8nt Expensa
Cleaailjed Advertising
Equip Oepl8Ciation
Volunteer I Emp. Recognition
Donor Recognition
Meetings
Exterminating Services
Training & Education
Employee Screening
Legal
Warehouse Rental
Mise Expense
ACe Spec;eJ EV8/lls
Bo8Rl AdMtiee
Sad Debll Contingency
M8IIcelino-AdotelI FFS
M8IIceting-Adv8ll NSS
HeeIth Watch Expense
Website
~ p_
OTHER
Conttacted Food
Contracted Foocl USDA
Media Clipping SaNice
Audio VISU8l
Interagency Expense
Other Subconnaclad
SUB CONTRACTS
TOTAL ALLOWABLE COST
TOTAL
AGENCY
BUDGET
$ 2.315.752
8.384,758
304.280
136.000
180.000
4.748.516
535.soo
1.103,647
38.341
10.000
51.362
39.480
647.659
1.482.261
338,000
646,562
9.000
531.642
$ 19.311.848
$ 7.l125.135
2.293.158
10,218.293
333.56
267 .283
112.487
58.014
188.511
81.441
138,251
131.843
349.335
91.525
18.837
29.512
19.278
84.985
67._
31.353
1.500
344.658
79.187
78,956
166.484
98.281
108.107
53.851
20.300
176,880
5.275
52,000
231.620
43,881
578.114
59.&00
10.000
42,350
10.984
91.487
11.584
57.000
8.732
44.550
2.300
5.000
63.488
82.841
147.283
1.000
40.000
4.649
2.370.602
1.147.788
296.280
1.440
10.400
646.552
2.741.476
4,742.936
S 18.461,616
531.642
S 18,993.258
S 318.390
Accounl IlaacrIIIlIOn
F-.m Funds
Slate F....
USDA
Local Cash Match
Section 5310
Madcaid
Medica..
Fee lor SeMca
Intarast Peaca
CIty 01 CI_
CllIea 01.....
PIneI'ea County/Mana!ea County
U1ited Way
CornrIbutions
Intanls1IlflV8llmlnt Appraciation
1nl8t Agency R.....
Sales ol Epujp
.KMall:ll
TOTAL REVENUE
SAlARIES
FRINGE BENEFITS
TOTAL PERSONNEl
FTE'S
TRAVEL
Ram
BuIlfJng Oeprecjalion
BUILDING SPACE
Postage
T8/ephona
UlIIttles
COMMUNICATlONS
Prlntlng
Duaa & Subscriptions
OlaposaJa
MadicaI Supplies
0IIIca Supplies
Program Suppllea/Arl
Smal. Equip
Copiar coals
PRINTING & SUPPUES
TOTALI~~NDVALUATlON
TOTAL COSTS PLUS I~~ND BY SVC
NET INCOME
lINIFLED FIJNDQfG APPLICATION
To: (funder): City of Clearwater
For time period of: Project Year 2000-2001
Applicant Information (print or tvDe):
Legal Name of Organization: Neighborly Senior Services, Inc.
Complete Address: 13650 Stoneybrook Drive
Clearwater, Florida 33762
Phone ( ) (727)573-9444 Fax ( ) (27)572-8214
E-Mail Jpowers@neiehborlv.ore
Federal Tax Identification Number: 59-1218100
Contact Person:
Judy Powers
Title:
Vice PreSident, Operations
Organization Type: _Public _Private ~ Non-profit _ Other
Sernce Area: _ County _ City of
2 Other Pinellas and Manatee Counti~s
Agency currently funded by ( check all that apply):
..!-. St. Petersburg _ Florida Dept. of Children & Families
~ Clearwater _ Florida Dept. of J~tice
- Largo _ Pinellas County Foundation
-L Pinellas County _ Allegany Franciscan Foundation
-L Area Agency on Aging _ Eckerd Family Foundation
- Juvenile Welfare Bd. ~ Other: Manatee County, contributions
2... United Way
CertificatioDS: (1) ICrequiredto register for solicitation offunds, is tbe Agency currently
registered witb tbe State? -K. Yes _ No ~e County? _ Yes _ No
j
(2) lCincorporated, bas tbe Agency Annual Report been med witb tbe Florida
Secretary of State? -X.. Yes_No
Name and Title of Agency Representative submitting this funding request:
Fredric Buchholtz
President/CEO
r (senior staff member) or Board Chair:
Date:
01/25/2001
.eived in funder's office by:
Date:
iJ i''At
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BOARD OF DffiECTORS -# reauired in Bv Laws = Minimum 12, maximum 18
'JAMElOFFICER
'.;;;lly M. Braun I Secretary
Franesco G. Cotronea M.D.
Philip E. Dean/Chair
LeAnn 1. Elliott
Lisa A. Gorge, CPA, CV A,
CFE
William E. Hale. M.D.
Roderic A. Johnson
Nancy S. Kaylor
Odalys Z. Lara
OCCUPA TION
Corporate Attorney
OUlback Sleakhouse. Inc.
Physician. retired
Public Relations. formerly with Florida
Power
Community Economic Development
Programs, Corporate Training Services.
Sl Petersburg Junior College
Certified Public Accountant
Perzel & Lara. P A. CP As
Physician. specializing in Geriatric care
Vice President. Municipal Trading.
American Municipal Securities
Editor
CCH. Inc. (Publishers)
Panner
Perzel & Lara. CP As
Attorney
In private practice
Professor of Gerontology
University of South Florida
Debra L. Mitchell. RN. BSN Administrator
~ ..:.. E. Mahoney, Esq.
Wiley P. Mangum. Ph.D.
I Vice Chair
Richard M. Orlan. M.D.
Owen C. Schlaug, Jr.
WilJiall! F. Tremper I
Treasurer
Gloria Watkins I Immediate
Past Chair
Children's Orthopadic &
Scoleosis Surgery Associates, LLP
Medical Director. Older Adult Services
Sl Anthony's Bayfront Health System
Retired Associate Actuary
Meidinge & Associates
Retired Military, Retired Director of
Transponation and Communications
Systems
Lead Program Administrator'
Honeywell. Inc.
AREA OF EXPERTISE
Law
Psychiatry
Public Relations
Business
CPA
Medicine
Financial
Marketing
Financial
Attorney
Gerontology
Business
Physician. specializing in
Gerontology
Actuarial
Management
Business Development!
Administration
RACE/GENDER
Cau/F
Cau/M
Cau/M
NIF
Cau/F
Cau/M
Cau/M
Cau/F
HispanicIF
Cau/F
Cau/M
Cau/F
Cau/M
Cau/M
Cau/M
BIF