AGREEMENT BETWEEN THE JUVENILE WELFARE BOARD - AGN274AGREEMENT
Between
THE JUVENILE WELFARE BOARD
and
City of Clearwater (AGN274)
City of Clearwater (COST)
I. PURPOSE
The Juvenile Welfare Board of Pinellas County, hereinafter referred to as "JWB ", and City of Clearwater
(AGN274), hereinafter referred to as "Provider ", enter into this mutual Agreement, including all attachments
referred to herein, for the period commencing October 1, 2015 and extending through September 30, 2016. This
Agreement does not take effect and JWB has no responsibility for any of its obligations hereunder until this
Agreement is executed by all parties to this Agreement.
II. STAFF
Provider agrees to employ staff to execute services provided in accordance with this Agreement. Such
individuals shall not be considered employees of JWB, and are subject to the supervision, personnel practices
and policies of the Provider. Unless otherwise approved by JWB, all staff shall meet qualifications as stated in
the approved job descriptions on file at JWB and any approved revisions which are submitted for FY 15 -16
funding.
III. SERVICES
Provider agrees to deliver services as stated in the currently approved program methodology on file at JWB and
to accomplish performance measures stated in Attachment 2, as determined by JWB, in service areas stated in
Attachment 3, and pursuant to the General Conditions listed in Attachment 1, and any special conditions as
stated in Section I, subsection VIII of this Agreement.
IV. FUNDS
The program budget for both JWB and other funds (if any) for accomplishing the above stated services shall be
as set forth in Attachment 4. JWB agrees to reimburse up to $345,924 for City of Clearwater (COST) for
services rendered pursuant to this Agreement.
V. METHOD OF PAYMENT
1. JWB issues reimbursements in accordance with the schedule listed on Attachment 5 (or on the preceding
working day in case of a holiday). The Provider shall elect to submit a request for payment either every
other week or once a month. Reimbursement requests shall be submitted timely and only for amounts
actually incurred that should properly be reimbursed per this Agreement within reasonably needed
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amounts based on the budget and other funding sources. Request for payment must be accompanied by
the appropriate documentation as prescribed by JWB.
2. Requests for advance funds may be made, consistent with JWB policy.
VI. TERMINATION
1. It is the intent of JWB to ensure a consistent and orderly delivery of children's services. It is the further
intent of JWB to terminate Agreements in those situations where such action is essential to the
protection of its interests and the interests of children, as determined solely by JWB.
2. In the event funds to finance this Agreement become unavailable, JWB may terminate the Agreement
upon no less than twenty -four (24) hours' notice in writing to the Provider. Said notice shall be delivered
by certified mail, return receipt requested, or in person with proof of delivery.
3. JWB shall endeavor, whenever possible and consistent with its legal obligations and principles of
prudent management, to provide thirty (30) days' notice for termination due to lack of funds. JWB shall
be the final authority as to the availability of funds and extension of notice beyond the minimum time
herein stated.
4. In addition to the rights as set forth in paragraph VI. 2 above, this Agreement may be terminated by
JWB for any reason whatsoever upon twenty -four (24) hours written notice. Said notice shall be
delivered by certified mail, return receipt requested, or in person with proof of delivery.
5. Provider shall only be compensated for services performed prior to the termination date. Provider may
only terminate this Agreement upon thirty (30) days written notice to JWB delivered in person, by
facsimile or by US mail, return receipt requested.
6. The above provisions shall not limit JWB's right to remedies at law or to damages.
VII. COMMENCEMENT OF PAYMENT
Unless specifically authorized by JWB, payment shall not be made for services rendered prior to the effective
date of this Agreement.
VIII. SPECIAL CONDITIONS
The following condition(s) applies to the following program(s):
- -- City of Clearwater (COST)
PROGSC 122 - Provider approved COST program shall adhere to the JWB approved Program Service Matrix
Model Program Components for Out of School Time Programming.
PROGSC124- Provider approved COST program site will complete the Florida Afterschool Network Quality
Self - Assessment & Improvement Guide at the beginning of the JWB Fiscal Year and subsequent Program
Improvement Guide as applicable.
PROGSC125 -JWB may report performance information such as, but not limited to: FCAT scores/DSS, GPA, or
school disciplinary information. This data is reported as dashboard, baseline, or pilot information intended to
gain a better understanding of the program's impact on specific community indicators.
PROGSC189 -The Provider shall cooperate with JWB to develop additional performance measures related to
COST and school success, which will be amended into the JWB Agreement by December 30, 2015.
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PROGSC186- Provider approved COST program site shall conduct an ongoing Needs Assessment to identify
and address the needs of program participants.
The following condition(s) applies to the following Agency(AGN274):
- -- City of Clearwater
PROVSC10- General Condition #2E - The last sentence is waived: Provider is not required to submit a
Continuity of Operations Plan to JWB.
PROVSC12- General Condition #3 - Audit and Management Letter are waived.
PROVSC25- General Condition #25 - Indemnification is replaced with "The Provider agrees to be fully
responsible for all claims arising out of its own acts of negligence or its respective employees' acts of
negligence when acting within the scope of their employment and agrees to be liable for any damages
proximately caused thereby; provided, however, that the Provider's liability is subject to the monetary
limitations and defenses imposed by section 768.28, F.S. Nothing herein is intended to serve as a waiver of
sovereign immunity by the Provider, nor shall anything herein be construed as consent by the Provider to be
sued by any third party for any cause or matter arising out of or related to this Agreement except to the extent
provided by 768.28, F.S."
PROVSC133- General Condition #24 - All insurance requirements are waived.
PROVSC11- General Condition #2F - Merit Plan is waived.
PROVSC15- General Condition #11 - Confidential Information- paragraph 4, the sentence that states, "Provider
shall defend, indemnify and hold harmless JWB from any and all damages caused by the improper disclosure of
any confidential information as defined by law including, but not limited to, Protected Health Information under
HIPAA and any and all costs associated with remedying the disclosure." is stricken and replaced with the
following: "Provider shall defend, indemnify, and hold harmless JWB from any and all damages caused by the
provider's improper disclosure of any information including, but not limited to, Protected Health Information
under HIPAA and any and all costs associated with remedying the disclosure subject to the doctrine of
sovereign immunity and limitations set forth in F.S. 768.28."
PROVSC13- General Condition #6 - Board Members, Training, and Financial Review are waived.
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IX. SIGNATURES
See attached City signature page
D, Marcie A. Biddleman
Executive Director, Juvenile Welfare Board
Authorized Representative, Provider
of Pinellas County
Dr. Marcie A. Biddleman
Please Print or Type Name Please Print or Type Name
Date Date
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City Signature Page for Agreement between
The Juvenile Welfare Board and City of Clearwater
For Period Commencing October 1, 2015
Countersigned:
--C,erOfkt(\(rt\StVos
George N. Cretekos
Mayor
Approved as to form:
ew M. `6 ith
Assistant City Attorney
CITY OF CLEARWATER, FLORIDA
By: Watitizt,citiataLid
William B. Horne, II
City Manager
Attest:
Toe: Rosemarie Call
City Clerk
Attachment 1
General Conditions of the Agreement
1. Agreement Revisions
This Agreement and its attachments constitute the contractual relationship between the Provider and JWB. If
there is any discrepancy between program- related documents, this agreement preempts all other documents. No
amendment to this Agreement or its attachments may be made without the prior written approval of JWB and
Provider, except as may be provided in General Condition #4.
2. Fiscal Responsibility
a. Provider agrees to maintain books, records and documents in accordance with generally accepted
accounting principles and practices which accurately and appropriately reflect all expenditures of funds
listed in Attachment 4.
b. Provider agrees that all financial records and supporting documentation shall be subject at all times to
inspection, review, or audit by JWB personnel or its duly authorized agent.
c. Provider agrees to maintain and file with JWB in a timely fashion reports related to services provided
under this Agreement.
d. Provider agrees to retain all financial records, supporting documentation, statistical records, and any
other documents pertinent to this Agreement for a period of five (5) years after termination of this
Agreement. If an audit has been initiated and audit findings have not been resolved at the end of five (5)
years, all records shall be retained until resolution of audit findings.
e. Payments during Disaster Recovery: JWB agrees to support funded programs that are unable to provide
normal services for a period of at least sixty (60) days after a disaster has been declared, provided the
program agrees to comply with requests of JWB and Recover Pinellas. This period may be extended at
the discretion of the Board upon recommendation of the Executive Director. Provider must file an
insurance and FEMA claim and shall reimburse JWB for any amounts received from FEMA and
insurance that have previously been funded by JWB. The Provider must submit to JWB a copy of the
Provider's Continuity of Operations Plan (see Attachment 6 for an outline of all document submittals)
within thirty (30) days of the effective date of this Agreement.
f. The Provider agrees to provide prior to their budget submission or subsequent amendment, Board
meeting minutes that show explanation and approval of a compensation plan, if JWB funds are to be
utilized to pay merit increases, cost of living adjustments bonuses, incentives or retention payments of
any kind, or if annualized salary or benefit changes may impact future budgets. JWB shall not reimburse
more than two weeks of accrued leave for terminating employees. JWB shall not reimburse expenses not
previously approved by JWB.
3. Audit and Management Letter
The Provider agrees to submit to JWB an independent audit of the financial statements of the entity in its
entirety and any accompanying management letter(s) immediately upon receipt by the Provider's board, but
within a period not to exceed one hundred and fifty (150) calendar days of the close of the Provider's fiscal year.
The audit must be performed by a firm licensed to perform audits in the State of Florida and conducted in
accordance with generally accepted auditing standards and standards established by the American Institute of
Certified Public Accountants.
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The Provider's auditor shall not provide any non -audit service to an issuer contemporaneously with the audit,
including:
(1) bookkeeping or other services related to the accounting records or financial statements of the audit client;
(2) financial information systems design and implementation; (3) appraisal or valuation services, fairness
opinions, or contribution -in -kind reports; (4) actuarial services; (5) internal audit outsourcing services; (6)
management functions or human resources; (7) broker or dealer, investment adviser, or investment banking
services; (8) legal services and expert services unrelated to the audit.
The Provider is required to engage an audit firm that follows Government /Non -Profit Audit Standards when
conducting the financial audit and that shows evidence of a peer review report completed every three years. The
audit will separately identify JWB revenues, fees and donations, and expenditures by program.
4. Other Financial Support
a. Provider shall report within ninety (90) calendar days any major changes in non -JWB revenue which
would impact contracted service levels in JWB funded programs during the fiscal year.
b. JWB funds shall not be used for expenditures also funded by other sources. JWB funds shall not be used
to supplant other sources of revenue.
c. Generally, JWB encourages use of its funds as financial match for securing funds from other sources.
However, in such instances, Provider is required to obtain prior written approval to submit an
application with JWB committed funds.
d. Revenues earned in a JWB funded program must remain in that program as a condition of funding.
5. Program Monitoring
Provider agrees to submit progress reports and other information in such format and at such times as may be
prescribed by JWB (including JWB Databases, SharePoint and Provider specific data collection systems), and
to cooperate in site visits and other on -site monitoring (including, but not limited to, access to sites, staff, fiscal
and participant records, and logs and the provision of related information). Provider agrees to cooperate with
Monitoring JWB Funded Program policy and procedures. Provider agrees to provide JWB representatives
access, without presence of the Provider supervisor, to staff or program participants during any monitoring with
or without advance notice. Programs charging a fee for services supported by JWB funding must forward a
copy of the fee schedule to JWB. Lead agencies are responsible for monitoring subcontracts funded by JWB
unless otherwise specified in a Special Condition of this Agreement. Governmental entities are exempt from
fiscal and personnel file review.
Program staff shall adhere to JWB's Data Business Rules and Fiscal Guidelines for Funded Programs, and all
staff who have any responsibility (supervisory or direct) for data entry shall be trained within thirty (30)
calendar days of hire. The Provider is responsible for maintaining written policies and procedures for providing
data to JWB in a timely manner. The Provider is responsible for reviewing JWB Database and JWB SharePoint
User Access to ensure that all users are active employees with access to appropriate data systems and modules.
The Provider shall notify support@mosaic - network.com for GEMS support and help @jwbpinellas.org for
SharePoint support. Provider shall notify JWB within two (2) business days whenever a Provider staff person's
access must be inactivated due to the reasons outlined in JWB's Data Business Rules. The Provider is
responsible for implementing appropriate procedures into their data policies to protect data and prevent
accidental or malicious disclosure of participant information. The Provider is responsible for maintaining fiscal
workflow approval prior to creation of a program budget.
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6. Board Members, Training, and Financial Review
Within thirty (30) calendar days of approval or a change of Board composition, Provider shall submit to JWB
an updated list of Board Members to include member addresses and places of employment.
Submission of Provider policies and procedures regarding Board review of Provider finances shall be required
within thirty (30) calendar days of this Agreement and upon revision and approval by the Provider's Board.
Training of new board members by an external trainer is required prior to issuance of a funding contract or by
August 1st of the current fiscal year, whichever occurs first. Training must consist of the following topics: non-
profit governance, fiduciary risks, and liabilities. Documentation of this training shall include an outline of
topics covered, the Board members in attendance and who provided the training. Providers that are
governmental entities, higher education institutions, and hospitals are exempt from this policy.
7. Nondiscrimination
Providers receiving funding from JWB shall not discriminate against an employee, volunteer, or participant of
the Provider on the basis of race, color, gender, religion, national origin, citizenship, disability, marital status,
age, veteran status, sexual orientation or any other legally protected category except that programs may target
services for specific participant groups as defined in the application. Additionally, Providers receiving funds
shall demonstrate the standards, policies, and practices necessary to render services in a manner that respects the
worth of the individual and protects and preserves the dignity of people of diverse cultures, classes, races,
religions, and ethnic backgrounds.
8. Publicizing of JWB Support — Endorsements
Requests for endorsements that require a commitment of JWB resources shall be submitted to the JWB Board
for its consideration. However, endorsements, which do not require JWB resources may be given to those
Providers that support the focus and priorities of the JWB Board, at the discretion of the JWB Executive
Director. JWB's logo must be present on the following Provider materials as an acknowledgement of support:
• Annual Report
• Program Brochures
• Stationery
JWB's logo may not be used on any other publications requiring JWB resources without JWB approval.
However, if a publication does not require a monetary commitment or indicate sponsorship, use of the JWB
logo may be authorized at the sole discretion of the JWB Executive Director.
9. Publications
Provider agrees to supply JWB, without charge, up to three (3) copies of any publication developed in
connection with implementation of programs addressed by this Agreement. Such publications will state that the
program is supported by JWB. Provider agrees that JWB will have unlimited use of copyrighted materials
developed under this Agreement.
10. Assignments and Subcontracts
Provider shall not assign the responsibility of this Agreement to another party nor subcontract for any of the
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work contemplated under this Agreement, unless so specified in Attachment 4, without prior written approval of
JWB. No such approval by JWB of any assignment or subcontract shall be deemed in any event or in any
manner to provide for the incurrence of any obligation by JWB in addition to the total dollar amount stated in
this Agreement. All such assignments or subcontracts shall be subject to the conditions of this Agreement and to
any conditions of approval that JWB shall deem necessary.
11. Confidential Information
Provider must follow all laws regarding confidentiality of information including, but not limited to, HIPAA.
Provider shall not use or disclose any information which specifically identifies a recipient of services under this
Agreement, and shall adopt appropriate procedures for employees' handling of confidential data with the
following exceptions: a) such information may be revealed as may be necessary to conform to Fiscal
Responsibility and Program Monitoring requirements as stated in the General Conditions of this agreement; b)
such information may be revealed as may be necessary pursuant to applicable federal, state, or local law and
related regulations; and c) such information may be revealed with the written consent (authorization) of the
recipient, or the recipient's responsible parent or guardian, where authorized by law. Provider is responsible to
adopt appropriate policies, notifications, authorizations, and other relevant information that allows for the
sharing of confidential information with JWB.
Providers shall adhere to JWB's written statement of purpose for collection of confidential data in compliance
with Section 119.071(5), Florida Statutes. Provider must distribute a copy of this statement to recipients of
JWB - funded programs and services and obtain the signature of the recipient or recipient's responsible parent or
guardian. A copy of this signed statement must be maintained in case files for each participant for whom
confidential data is collected. Once executed, this signed statement does not require subsequent renewal.
The Provider shall also maintain in participant files a completed copy of a JWB- approved form for authorizing
client consent to release information for each participant receiving services. As allowed by law and Provider
policy, the Provider shall add JWB to consent forms including HIPAA consent forms to facilitate data sharing
and implement the Fiscal Responsibility and Program Monitoring requirements as stated in the General
Conditions of this agreement and advise JWB within two (2) business days if a participant has withdrawn
consent to share data and note this withdrawal of consent in the case file. In no event should participant
identifying information ever be emailed or faxed to JWB.
In the event of an improper disclosure of participant information by Provider, Provider shall inform JWB of the
improper disclosure and extent thereof within two (2) business days of becoming aware of the improper
disclosure. In accordance with JWB Breach Procedures, Provider shall cooperate fully with JWB and take all
necessary steps to correct and remedy any damage caused by the Provider's improper disclosure and to prevent
future improper disclosure. Provider shall defend, indemnify and hold harmless JWB from any and all damages
caused by the improper disclosure of any confidential information as defined by law including, but not limited
to, Protected Health Information under HIPAA and any and all costs associated with remedying the disclosure.
Provider will indemnify and hold harmless JWB from any and all damages caused by the improper disclosure as
defined by law of any information including but not limited to personally identifiable information (PII) and
protected health information (PHI) as required under HIPAA, HITECH and FIPA regulations or other
information that is confidential and/or exempt from disclosure per F.S. 119. This provision shall survive the
termination of this Agreement.
Likewise, in the event of an improper disclosure of Provider's participant information by JWB, JWB shall
inform Provider of the improper disclosure and extent thereof within two (2) business days of becoming aware
of the improper disclosure. In accordance with JWB Breach Procedures, JWB shall cooperate fully with
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Provider and take all necessary steps to correct and remedy any damage caused by JWB's improper disclosure
and to prevent future improper disclosure. JWB shall defend, indemnify and hold harmless Provider from any
and all damages caused by the improper disclosure and any and all costs associated with remedying the
disclosure subject to the doctrine of sovereign immunity and limitations set forth in F.S. 768.28.
12. Public Records
JWB is a public entity subject to Florida's Public Records Law, which includes provisions relating to records
retention, production and confidentiality. Pursuant to 119.0701(2) any contractor acting on behalf of JWB must
comply with the Public Records Law (F.S. 119) to the same extent that the law applies to JWB. Contractors
acting on behalf of JWB must comply with 119.0701(2) and should be aware that social security numbers are
confidential and exempt from disclosure (119.071(5)) and personal identifying information of a child or the
parent or guardian of the child held by JWB or service provider under contract with JWB is exempt from
disclosure (125.901(11)). However, for all Providers, any and all contracts between JWB and Provider, program
methodology, budgets, requests for reimbursements, emails, other written correspondence and any other
documents exchanged between the Provider and JWB are public records and will be disclosed in the sole
discretion of JWB and must be retained in accordance with Florida's record retention policy. Providers should
not provide any documents to JWB containing Trade Secrets (as defined by F.S. 812.081) or Confidential
and/or Exempt information to JWB without specifically marking such document. By submitting any documents
or information whatsoever to JWB, Provider agrees that JWB may use and disclose all information and
documents submitted for any purpose JWB sees fit and that it is within JWB's sole discretion to determine if
any information submitted is exempt from disclosure.
Any Provider who receives a Public Records request for records pertaining to JWB or services funded by JWB,
Provider must advise JWB within two (2) business days of the records request and JWB and Provider will work
together to respond to any such request. This provision shall survive termination of this Agreement.
13. Return of Funds
Provider agrees to return to JWB any overpayment due to costs not incurred or costs disallowed pursuant to the
terms of this Agreement and such funds shall be considered JWB funds and shall be refunded to JWB in
accordance with its instructions. Should Provider fail to return said funds, Provider shall be responsible for all
costs and fees of collection incurred by JWB - including, but not limited to attorney fees and court costs
including any pre -suit collections fees and costs. This provision survives termination of this Agreement and
return of funds for overpayment or disallowance will be required even if the overpayment or disallowance is
discovered after this Agreement is terminated.
14. Special Situations and Incidents
Provider agrees to inform JWB within one (1) business day of any circumstances or events which may
reasonably be considered to jeopardize its capability to continue to meet its obligations under the terms of this
Agreement. Participant incidents are required to be reported for situations that occur only while under the
Provider's care and includes anything that may reflect negatively or critically upon JWB. Certain personnel are
mandated by law to report their suspicions of child abuse, neglect, or abandonment to the Florida Abuse Hotline
(1- 800 -96- ABUSE). All concerns regarding suspected abuse, neglect, or abandonment of a child or vulnerable
adult by the Provider shall first be reported to the Florida Abuse Hotline and then reported to JWB. Incident
reporting does not preclude mandated reporting requirements.
Critical Incidents are defined as follows:
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Abduction - An incident in which an individual who does not have care and custody of a child has taken the
child. Concerns of child abductions shall immediately be reported to the appropriate law enforcement personnel.
Abuse or Neglect - Reasonable cause to suspect that a child has been harmed or is believed to be threatened
with harm from a person responsible for the care of the child.
Participant Death - The death of any participant receiving JWB services, regardless if the death occurred while
under Provider's care.
Media Coverage or Public Inquiry - Media coverage or public reaction that may have an impact on the Provider
or JWB's ability to protect and serve its participants, or other significant effect on the Provider or JWB.
Investigation or Lawsuit -Any formal investigation or legal action brought against Provider which relates to the
services funded by JWB or which may reasonably be considered to jeopardize its capability to continue to meet
its obligations under the terms of this Agreement.
Participant Illness - An illness of a participant receiving services determined by a licensed health care
professional to be life - threatening or the result of apparent abuse or neglect.
Participant Injury - A medical condition of a participant determined by a licensed health care professional to be
life - threatening or the result of apparent abuse or neglect.
Employee Arrest - Employee conduct or activity that results in potential liability to the Provider or JWB; death
or harm to a participant; or results in a law violation, including falsification of official records. If an arrest is
made for a potentially disqualifying offense under Level 2 background screening requirements, or if the arrest
occurred while in the performance of an employee's official duties, the incident should be reported immediately.
Suicide Attempt - An act which clearly reflects the physical attempt by an active participant to cause his or her
own death, which results in bodily injury requiring medical treatment by a licensed health care professional.
Sexual Battery - An allegation of sexual battery involving a participant or employee as evidenced by medical
evidence or law enforcement involvement. Sexual battery includes participant on participant incidents,
employee on participant, and participant on employee.
In addition, the Provider shall notify JWB immediately upon knowledge of any action or incident involving
Provider staff or volunteers that could potentially jeopardize the terms of this Agreement which includes
misconduct, malfeasance during working hours, or any conduct that results in the arrest of a staff member or
volunteer after hours.
Within one (1) business day, the Provider must submit electronically a completed Incident Report to
IRreviewteam @jwbpinellas.org with full details and disposition of the incident, excluding identifying
information such as name, date of birth, and address. In the event of a participant death please contact by phone
the JWB Chief Operating Officer within three (3) hours of notification of the incident. All e-mail
communications made or received by JWB members or staff are considered public records and are retained and,
upon request, made available to the public and media in accordance with Chapter 119, Florida Statutes.
Provider must adhere to the reporting requirements hereunder after the termination of this Agreement if
Provider becomes aware of a Critical Incident after the termination of the Agreement if the Critical Incident
occurred during the term of the Agreement and/or relates to the services funded by JWB.
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15. Provider Staff Membership on Board
Provider agrees that Provider staff shall not serve as members of the Provider's governing board.
16. Waiver
JWB reserves the right to waive requirements of this Agreement and General Conditions where warranted by
special circumstances. Any waiver shall be in writing and signed by JWB.
17. Provider & Program Data Maintained In 2 -1 -1 Database
Provider agrees to maintain accurate and up -to -date Provider and program data in the 2 -1 -1 Tampa Bay Cares
database. The Provider will review and update (as necessary) this data at least once annually. The Provider will
list data for newly funded program(s) within thirty (30) calendar days of the date that JWB funds the program.
This requirement applies to all programs accepting 2 -1 -1 referrals.
18. Provider Staff Background Checks
All program and Provider staff (including employees, independent contractors and staff of subcontractors),
volunteers and those who may have access to youth participants supported through JWB funding are required to
undergo and pass a national Level 2 background check that complies with the standards set forth in F.S. 435.
Those individuals must have no disqualifying offenses listed in Florida Statute 435.04. for which they have not
received an exemption in accordance with Florida law. All staff and volunteers must continue to qualify to pass
a Level 2 screening at all times and must notify their employer if at any time they no longer qualify to pass a
Level 2 screening. Proof of Level 2 background clearance, including current executed affidavits /attestations of
good moral character, must be maintained at all times in the appropriate files and the screening repeated every
five (5) years or more often in accordance with law or as requested by JWB. This requirement applies to
employees regardless of the funder supporting the position and all volunteers who may have access to youth. A
volunteer who assists on an intermittent basis for less than ten (10) hours per month does not have to be
screened if a person who meets the screening requirement of this section is always present and has the volunteer
within his or her line of sight. The Provider is required to clearly document which volunteers meet the criteria
for a Level 2 background screening and affidavits of good moral character, and which are exempt according to
the terms of this Agreement. The Provider's policy and practice for background screening must provide for
adequate protection and must comply with all applicable laws and implementing regulations including, but not
limited to F.S. 435. Should a Provider not be statutorily authorized to receive a national Level 2 background
check in accordance with F.S. 435, the Provider must still comply with the standards set forth in F.S. 435
through VECHS background screening. The Florida Department of Children and Families provides an
exemption process under this statute. JWB does not provide an exemption or waiver process.
19. Attendance
Provider is required to keep attendance records. If Attachment 2 requires a program to track participant
attendance, attendance may be tracked in the JWB Database or other approved data system.
20. Link to JWB's Websites
Provider website shall include links to the JWB website (www.jwbpinellas.org) and include the JWB logo.
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21. Drug -Free Workplace
The Provider shall comply with the Drug -Free Workplace Act, Section 440.101, Florida Statutes.
22. Public Entity Crimes
Per Section 287.133, Florida Statutes, a person or affiliate who has been placed on the convicted vendor list
following a conviction for a public entity crime may not submit a bid on a contract to provide any goods or
services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair
of a public building or public work, may not submit bids on leases of real property to a public entity, may not be
awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with a public
entity, and may not transact business with a public entity in excess of the threshold amount provided in Section
287.017, for CATEGORY TWO for a period of thirty six (36) months from the date of being placed on the
convicted vendor list.
23. JWB Policies and Procedures
Provider agrees to follow all JWB policies and procedures which can be located on the JWB website at
www.jwbpinellas.org/ and which are incorporated into this Agreement in their entirety. Said policies include,
but are not limited to, all Board policies, funding policies, Fiscal Guidelines for Funded Programs, JWB Breach
Procedures, research policies, security policies, JWB Data Business Rules and policies that may be promulgated
by JWB within its sole discretion from time to time. JWB reserves the right to change these policies from time
to time within its sole discretion. JWB will provide a minimum of thirty (30) calendar days' notice to the
Provider and it is the responsibility of the Provider to be in compliance will all policies and procedures at all
times.
Provider is encouraged to provide certification of current accreditation by a recognized national accrediting
body appropriate to the programming funded by JWB.
Regardless of accreditation, the Provider must meet the highest professional standards established through its
specific field.
24. Insurance, Public Liability, Bodily Injury, and Property Damage
The Provider will procure, pay for, and maintain, throughout the period of this Agreement, on behalf of the
Provider and JWB, the following MINIMUM limits of insurance coverage with responsible companies, eligible
to do business in the State of Florida, which maintain a rating of A -IX or higher with AM Best.
Commercial General Liability
Each occurrence $1,000,000
Personal Injury $1,000,000
General Aggregate $1,000,000
Property Damage $1,000,000
Products & Completed Operations $1,000,000
Fire Legal Liability $50,000
Agency: City of Clearwater (AGN274) 08/31/2015 11:33:28 AM
Page 12 of 30
Professional Liability
Each occurrence $1,000,000
Sexual Abuse and Molestation:
Each occurrence $1,000,000
Automobile (to include owned, hired and non -owned autos):
Bodily Injury and Property damage $500,000
Directors and Officers Liability
with Employment Practices Liability Insurance: $1,000,000
Workers Compensation $500,000
Recommended, but not presently required coverage:
CyberLiability $1,000,000
JWB must be listed as an additional insured for the operations of the Provider on all coverage except Directors
and Officers Liability. The Provider shall submit to JWB a certificate of insurance which describes the
insurance maintained by the Provider. Provider will give JWB written notice within three (3) business days of it
becoming aware that any of its insurance coverage will be cancelled, decreased or changed in any way.
25. Indemnification
Provider shall defend, indemnify, and hold harmless JWB, its agents, and employees from and against any and
all liabilities, claims, judgments, or actions including court costs and attorney's fees that may hereafter at any
time be made or brought by any person or entity on account of any claim including but not limited to, personal
injury, property damage, loss of monies, civil rights violation, or discrimination allegedly caused in whole or
part by any act or omission, including but not limited to, breach of contract, negligent act, wrongful act,
intentional act, omission, and any acts of fraud or defalcation, of the Provider, its agents, employees, or
subcontractors, arising out of or relating to its performance of this Agreement or for Provider's improper
disclosure of confidential and/or exempt information, or failure to comply with F.S. 119 or any other applicable
law, rule or regulation. In no event will the Provider be liable for or have any obligation to defend JWB against
such liability, claims, judgments, or actions, including costs and attorney's fees, arising out of the sole negligent
acts of JWB. This provision survives termination of the Agreement.
Agency: City of Clearwater (AGN274) 08/31/2015 11:33:28 AM
Page 13 of 30
Attachment 2
City of Clearwater (AGN274)
City of Clearwater (COST) (PROG478)
Performance Measurements & Service Levels
FY 2015 -2016
Participant Level Performance Measurements
All Primary Participants will be measured through the Performance Measurement reporting module in GEMS
within the contract period. Measured is defined as each participant having all the appropriate administration
points required during the fiscal year based on the language of each Performance Measurement.
Targets Information for PROG478
TargetDefinitionld
Target(Measurable): Annual participation - child
TRGT1211
ShortTargetTitle
Annual participation - child
TargetText
Number of Participants who continue in the afterschool program for more than one year.
(Baseline)
TargetType
Milestone Based Target
ProjectedValue
ProjectedValue
ProjectedStartDate
10/01/2015
ProjectedEndDate
09/30/2016
Notes
Baseline
Ta
c et(Measurabie): Number of children receiving OST Survey
TargetDefinitionld
TRGT932
ShortTargetTitle
Number of children receiving OST Survey
TargetText
Number of currently enrolled participants will be given the OST Survey during the administration
windows (October 2015 and May 2016) and captured with JWB database milestone. (Baseline)
TargetType
Milestone Based Target
ProjectedValue
ProjectedStartDate
10/01/2015
ProjectedEndDate
09/30/2016
Notes
Baseline
TargetDefinitionld
ShortTargetTitle
Target(Measurable): Percent of days attended
TRGT945
Percent of days attended
Agency: City of Clearwater (AGN274)
Page 14 of 30
08/31/2015 11:33:28 AM
TargetText
The program will have 70% of the youth attend 70% of the program days tracked on a monthly
basis as demonstrated by JWB database attendance report. (Baseline)
TargetType
Other (Custom) Target
ProjectedValue
ProjectedStartDate
10/01/2015
ProjectedEndDate
09/30/2016
Notes
Baseline
Services Not Associated with Any Targets In Program's SOW
Milestones Not Associated with Any Targets in Program's SOW
R & R Definitions Information for PROG478
Agency: City of Clearwater (AGN274) 08/31/2015 11:33:28 AM
Page 15 of 30
Attachment 3
Geographical Service Area
Provider agrees whenever possible to maintain service sites which are accessible by public transportation and
convenient to the target participant group. Provider will advise JWB of any changes made in service sites.
The geographical service area for this agreement is as follows:
Program Name
City of Clearwater (COST)
Services will be provided less than countywide.
Service Will be Provided Services will be provided in the following zip
Countywide codes or the following geographical areas
(list all zip codes of the target area or describe the geographical area)
33755,33756
Agency: City of Clearwater (AGN274)
Page 16 of 30
08/31/2015 11:33:28 AM
Attachment 4: BUDGET(S)
The provider will deliver services according to the budget(s) following this page.
Revised budgets should be submitted by the provider in accordance with JWB policies and procedures.
Provider may make budget amendments during the fiscal year according to the Fiscal Guidelines for Funded
Programs found on the JWB website at www.jwbpinellas.org.
For all amendments, the following guidelines apply:
A. Funded programs shall make adjustments in accordance with forms and procedures as established by
JWB staff.
B. Equipment purchased will be considered the inventory of the Provider. Equipment purchased will be
accounted for and controlled by the Provider. Inventory reports shall be made available to JWB upon
request. JWB may physically inspect equipment at their discretion. Once equipment is fully depreciated
it becomes the property of the Provider. JWB will accept the depreciation schedule of the Provider's
auditor.
C. Any adjustments made by funded agencies which are not in accordance with JWB policy shall be
reimbursed at the discretion of JWB.
No adjustment may be made after the budget amendment closing date.
Agency: City of Clearwater (AGN274) 08/31/2015 11:33:28 AM
Page 17 of 30
Form 1
City of Clearwater (COST) (PROG478)
Current & Proposed Operating Budget
Category
Salaries
Subcategory
Salaries
Prior
Fiscal
Year
$168 2
Total
Current
Fiscal
Year
$254,733
Program Budget
Difference
from Prior
Year ($)
$86,461
Difference
from Prior
Year (%)
51.382%
Prior
Fiscal
Year
$0
JWB
Current
Fiscal
Year
$125,623
Budget
Difference
from Prior
Year ($)
$125,623
Difference
from Prior
Year (%)
100%
Subtotal
Salaries
$168,2
72
$254,733
$86,461
51.382%
$0
$125,623
$125,623
100%
Benefits
FICA
$6,155
$8,889
$2,734
44.419%
$0
$6,006
$6,006
100%
Retirement
$26'006
$32,477
$6,471
24.883%
$0
$11,041
$11,041
--
Group
Insurance
$25,21
1
$42,782
$17,571
69.696%
$0
$17,682
$17,682
-
Workers
Comp
$0
$0
$0
--
$0
$0
$0
-
Unemploymen
t Comp
$0
$0
$0
--
$0
$0
$0
-
Subtotal
Benefits
$57,37
2
$84,148
$26,776
46.671%
$0
$34,729
$34,729
100%
Total Salary and Benefits
$225'6
$338,881
$113,237
50.184%
$0
$160,352
$160,352
100%
Professio
nal
Professional
$81,10
$75,822
$ -5,278
- 6.508%
$25 60
$75,822
$50,222
196.18%
Services
Services
0
0
Audit/Accounti
ng
$0
$0
$0
--
$0
$0
$0
--
Court/Legal
Services
$0
$0
$0
-
$0
$0
$0
--
Other
Services
$0
$0
$0
-
$0
$0
$0
-
Investigations
$0
$0
$0
-
$0
$0
$0
-
Subtotal
Professional
$81'100
$75,822
$ -5,278
- 6.508%
$25,60
$75,822
$50,222
196.18%
Services
Rent
Expense
Rental &
Leases
$0
$27,535
$27,535
100%
$0
$0
$0
--
Subtotal Rent
Expense
$0
$27,535
$27,535
100%
$0
$0
$0
--
Repairs /M
aintenanc
e
Repairs &
Maintenance
$0
$0
$0
--
$0
$0
$0
--
Subtotal
Repairs /Main
tenance
$0
$0
$0
--
$0
$0
50
--
Utilities
Communicatio
ns
$0
$0
$0
--
$0
$0
$0
--
Utilities
$0
$0
$0
--
$0
$0
$0
--
Agency: City of Clearwater (AGN274)
Page 18 of 30
08/31/2015 11:33:28 AM
Category
Subcategory
Subtotal
Utilities
Prior
Fiscal
Year
$0
Total
Current
Fiscal
Year
$0
Program Budget
Difference
from Prior
Year ($)
$0
Difference
from Prior
Year ( %)
--
Prior
Fiscal
Year
$0
Current
Fiscal
Year
$0
JWB Budget
Difference
from Prior
Year ($)
$0
Difference
from Prior
Year ( %)
--
Operating
Expenses
Freight and
Postage
$0
$0
$0
--
$0
$0
$0
--
Printing &
Binding
$0
$0
$0
--
$0
$0
$0
--
Advertising
$0
$0
$0
--
$0
$0
$0
--
Office
Supplies
$2,200
$0
$ -2,200
- 100%
$0
$0
$0
--
Operating
Supplies
$49,47
2
$0
$- 49,472
- 100%
$0
$0
$0
--
Subtotal
Operating
Expenses
$51,67
2
$0
$- 51,672
- 100%
$0
$0
$0
—
Participa
nt
Expenses
Participant
Transportation
$21,80
0
$9,000
$- 12,800
0
-58.716%
$0
$9,000
$9,000
100 /o
100%
Participant
Expense
$67,55
0
$80,800
$13,250
19.615%
$0
$76,800
$76,800
100%
Participant
Food &
Nutrition
$56,45
0
$80,272
$23,822
42.2%
$0
$23,950
$23,950
100%
Participant
Books
$0
$0
$0
--
$0
$0
$0
—
Participant
Educ.
Materials
$10,00
0
$0
$- 10,000
-100%
$0
$0
$0
Subtotal
Participant
Expenses
$155,8
00
$170,072
$14,272
9.16%
$0
$109,750
$109,750
100%
Educatio
nal
Books,
Subscriptions
Dues &
Memberships
$0
$0
$0
--
$0
$0
$0
--
Training
$2,500
$0
$ -2,500
- 100%
$0
$0
$0
--
Subtotal
Educational
$2 ' 500
$0
$ -2,500
- 100%
$0
$0
$0
--
Travel /Co
nference
Travel & Per
Diem
$0
$0
$0
--
$0
$0
$0
—
Conference
$0
$0
$0
--
$0
$0
$0
—
Subtotal
Travel /Confer
ence
$0
$0
$0
—
$0
$0
$0
—
Promotio
nal
Promotional
$0
$0
$0
--
$0
$0
$0
--
Subtotal
Promotional
$0
$0
$0
--
$0
$0
$0
—
Administr
ative Cost
Administrative
Cost
$27,57
2
$0
$- 27,572
- 100%
$0
$0
$0
- -
Agency: City of Clearwater (AGN274)
Page 19 of 30
08/31/2015 11:33:28 AM
Category
Subcategory
Subtotal
Administrativ
e Cost
Prior
Fiscal
Year
$27,57
2
Total
Current
Fiscal
Year
$0
Program Budget
Difference
from Prior
Year($)
Difference
from Prior
Year( %)
-100%
Prior
Fiscal
Year
$0
JWB
Current
Fiscal
Year
$0
Budget
Difference
from Prior
Year($)
$0
Difference
from Prior
Year( %)
--
$- 27,572
Depreciat
ion
Depreciation
Expense
$0
$0
$0
—
$0
$0
$0
—
Subtotal
Depreciation
$0
$0
$0
--
$0
$0
$0
--
Insurance
Insurance
Expense
$0
$0
$0
--
$0
$0
$0
--
Subtotal
Insurance
$0
$0
$0
—
$0
$0
$0
--
Miscellan
sous
Bank Service
$0
$0
$0
--
$0
$0
$0
--
Other /Miscella
neous
$0
$0
$0
--
$0
$0
$0
—
Subtotal
Miscellaneou
s
$0
$0
$0
--
$0
$0
$0
--
Capital
Machinery &
Equipment-
Capital
$0
$0
$0
--
$0
$0
$0
--
Subtotal
Capital
$0
$0
$0
--
$0
$0
$0
--
Unit of
Costs
Residential
Per Diem
Units
$0
$0
$0
--
$0
$0
$0
--
Day Program
Per Diem
Units
$0
$0
$0
—
$0
$0
$0
--
Parent
Education
Units
$0
$0
$0
--
$0
$0
$0
—
Case
Management
Units
$0
$0
$0
—
$0
$0
$0
—
Unit Costs
(New System
Units)
$0
$0
$0
—
$0
$0
$0
—
Health
Assessment/S
creening Units
$0
$0
$0
--
$0
$0
$0
--
Out of School
Time (OST)
$0
$0
—
$376,8
42
$0
$- 376,842
-100%
Support
Group Units
$0
$0
$0
—
$0
$0
$0
--
After Care
Units
$0
$0
$0
--
$0
$0
$0
--
Home
Visitation
$0
$0
$0
--
$0
$0
$0
--
Consultation
$0
$0
$0
--
$0
$0
$0
--
Agency: City of Clearwater (AGN274)
Page 20 of 30
08/31/2015 11:33:28 AM
Category
Subcategory
Information
and Referral
Prior
Fiscal
Year
$0
Total
Current
Fiscal
Year
$0
Program Budget
Difference
from Prior
Year ($)
$0
Difference
from Prior
Year (%)
--
Prior
Fiscal
Year
$0
Current
Fiscal
Year
$0
JWB Budget
Difference
from Prior
Year ($)
$0
Difference
from Prior
Year (%)
--
Case
Consultation/
Clinical
Supervision
$0
$0
$0
--
$0
$0
$0
--
-Behavioral
Assessment
Modification
$0
$0
$0
--
$0
$0
$0
--
$0
$0
$0
--
$0
$0
$0
--
Tutoring
—In -Home
Counseling
—Subtotal Unit
of Costs
$0
$0
$0
--
$0
$0
$0
--
$0
$0
$0
--
$0
$0
$0
--
$0
$0
$0
—
$376,8
42
$0
$- 376,842
-100%
Grand Total
$544,2
88
$612,310
$68,022
12.497%
$402,4
42
$345,924
'
$- 56,518
- 14.044%
Agency: City of Clearwater (AGN274) 08/31/2015 11:33:28 AM
Page 21 of 30
Form 2
City of Clearwater (COST) (PROG478)
Salary and Fringe Preparation
FY 2015 -2016
Position
POS1709 -
Rec
Coordinator
Staff
PRSNL192
4 - Kathy
LaTerza
FTE
P
o
s
1
Staff
0.1
Salaries
PRG
$18,453
JWB
$0
FICA
PRG
$268
JWB
$0
Retirement
PRG
$3,506
JWB
$0
Group Insurance
PRG
$2,875
JWB
$0
Workers
Comp
PRG
$0
JWB
$0
Unemp
Comp
PRG
$0
oyment
JWB
$0
Total
& Benefits
PRG
$25,102
Salary
JWB
$0
POS1725 -
Recreation
Leader
PRSNL193
8 - Jalisa
Stone
1
1
$24,368
$0
$353
$0
$4,630
$0
$8,861
$0
$0
$0
$0
$0
$38,212
$0
POS2267 -
Recreation
Leader
PRSNL268
5 - ng
seasonal
0.2
0.2
$5,121
$5,121
$392
$392
$0
$0
$0
$0
$0
$0
$0
$0
$5,513
$5,513
POS1729 -
Recreation
Leader
PRSNL194
2 - Marcia
Terry
0.6
0.6
$15,365
$15,365
$1 ' 17
5
$1,17
5
$0
$0
$0
$0
$0
$0
$0
$0
$16,540
$16,540
POS2265 -
Recreation
Leader
$5,121
$0
$392
$0
$0
$0
$0
$0
$0
$0
$0
$0
$5,513
$0
POS2264 -
Recreation
Leader lw
$5,121
$0
$392
$0
$0
$0
$0
$0
$0
$0
$0
$0
$5,513
$0
POS2262 -
Recreation
Leader RN
ppt
$15,365
$15,365
$1,17
5
$1,17
5
$0
$0
$0
$0
$0
$0
$0
$0
$16,540
$16,540
POS2263 -
Recreation
Leader seas
Iw
$6,052
$0
$463
$0
$0
$0
$0
$0
$0
$0
$0
$0
$6,515
$0
POS1732 -
Recreation
Leader-lw
PRSNL194
3 - vacant
0.2
5
0.25
$6,053
$6,053
$463
$463
$0
$0
$0
$0
$0
$0
$0
$0
$6,516
$6,516
Agency: City of Clearwater (AGN274)
Page 22 of 30
08/31/2015 11:33:28 AM
Position
POS1731 -
Recreation
Leader -PPT
Staff
PRSNL194
7 - Daniel St
Clair
FTE
P
o
s
1
Staff
1
Salaries
PRG
$24,368
JWB
$24,368
FICA
PRG
$353
JWB
$353
Retirement
PRG
$4,630
JWB
$4,630
Group Insurance
PRG
$8,861
JWB
$8,861
Workers
Comp
PRG
$0
JWB
$0
Unemployment
Comp
PRG
$0
JWB
$0
Total
& Benefits
PRG
$38,212
Salary
JWB
$38,212
POS1730 -
Recreation
Leader -PPT
PRSNL194
5 - Nick
Robinson
0.6
0.6
$15,365
$15,365
$1,17
5
$1,17
5
$0
$0
$0
$0
$0
$0
$0
$0
$16,540
$16,540
POS1734 -
Recreation
Leader -
seas
PRSNL194
6 - vacant
mseas
0.2
0.2
$5,121
$5,121
$392
$392
$0
$0
$0
$0
$0
$0
$0
$0
$5,513
$5,513
POS1733 -
Recreation
Leader -
seas
PRSNL194
4 - vacant
ngseas
0.2
0.2
$5,121
$5,121
$392
$392
$0
$0
$0
$0
$0
$0
$0
$0
$5,513
$5,513
POS1727 -
Recreation
Programme
r
PRSNL194
0 - Freda
Dixon
1
1
$33,744
$33,744
$489
$489
$6,411
$6,411
$8,821
$8,821
$0
$0
$0
$0
$49,465
$49,465
POS1726 -
Recreation
Specialist
PRSNL193
9 - Kevin
Whitlow
1
0.8
$41,708
$0
$605
$0
$7,925
$0
$8,890
$0
$0
$0
$0
$0
$59,128
$0
POS1728 -
Recreation
Supervisor
PRSNL194
1 _vacant
1
0.3
$28,287
$0
$410
$0
$5,375
$0
$4,474
$0
$0
$0
$0
$0
$38,546
$0
TOTAL
$254,73
3
$125,62
3
$8,88
9
$6,00
6
$32,47
7
$11,04
1
$42,78
2
$17,68
2
$0
$0
$0
$0
$338,88
1
5160,35
2
Agency: City of Clearwater (AGN274)
Page 23 of 30
08/31/2015 11:33:28 AM
Form 3
City of Clearwater (COST) (PROG478)
Operational Narratives
Category Subcategory Line Items Amount
Position Narratives
Narrative
Professional
Services
Professional
Services
Professional
services
$75,822
$75,800 for two centers' enrichment overlay programs.
We will hire professionals to facilitate educational
learning experiences in such areas as:
Summer Instructors 36,322 for 190 youth =
$36,322/190= $191.17 per youth
Fitness, Youth development, Hygiene /etiquette, STEM,
Nutrition, Speakers
Afterschool $39,500 for 100 youth = $39,500/100 =
$395 per youth
Fitness, Journaling/spoken word, Step /dance, STEM,
Gender specific, Sports instruction, Misc speakers
Rent
Expense
Rental & Leases
Facility usage
$27,535
Amount of rent charged to previous North Greenwood facility partner
who programmed middle school OST program. They canceled their
agreement and the City assumed operations of this program.
Participant
Expenses
Participant
Transportation
Transportation
$9,000
Participant bus transportation for field trips 13 trips x 2
sites x $345 per trip for 190 youth = $9,000
Participant
Expense
Participant
expenses
$80,800
$45,800/100 = $458 per youth represents participant
expenses such as sports & fitness equipment, t- shirts,
storage equipment, overlay materials, and art supplies
for 2 City of Clearwater sites.
Approximately 190 youth will participate in 13
culminating activity exposure trips planned in
conjunction with curriculum lesson plans that provide
sequential learning opportunities for youth. Trips
include Weeki Wachee, MOSI, and spectator sporting
events, skating, kayaking/watersports, museums,
theater productions, and sports activities for a total of
$31,000/190 = $163.16 per youth or $12.55 average per
trip.
SOR -Teen youth sports leagues registration 5 leagues x
$800 each = $4,000 (Paid by city)
Agency: City of Clearwater (AGN274)
Page 24 of 30
08/31/2015 11:33:28 AM
Category Subcategory Line Items Amount Narrative
Participant
Food &
Nutrition
Food and
nutrition
$80,272 Educational parent nights $200 x 12 months x 2 sites =
$4,800
July 4 family cookout 190 kids + 2 guests x $4 each =
$2280
PowerAde mix $75 per cooler x 45 =$3370
Summer Parent banquet 150 kids + 2 guests ea x $7.78=
$3500
$10,000 for Lunch and snack for school out days when
school lunches are not available
$10,000/20 days x 100 kids = $5per youth
SOR Summer lunches and snack $4.44 x 45 days x 190
children = $37,962
SOR Afterschool snacks $0.85 x 216 days x 100 kids =
$18,360
$37,962 + 18,360 = $56,322 provided by FL Dept of
Agriculture
SOR -Teen sports league dinner 35 days x 20 kids x $5.71
each = $4,000 (paid for by the City)
Total
Operating
Cost
$273,429
Agency: City of Clearwater (AGN274) 08/31/2015 11:33:28 AM
Page 25 of 30
Funder Type / Funder
Form 4
City of Clearwater (COST) (PROG478)
Other Program Funding
Other Program Funding Fiscal Year Comparison
FY 2014 -2015 Total
FY 2015 -2016 Total
% Increase /Decrease
City Government (in Pinellas)
$141,846
$210,064
48.093%
State - General (all other departments)
$0
$56,322
100%
Grand Total
$141,846
$266,386
87.799%
Total Budget Summary
Total JWB Allocations
$345,924
Total Other Funding
$266,386
Total Program Funding:
$612,310
Total Program Budget
$612,310
Difference
$0
Agency: City of Clearwater (AGN274)
Page 26 of 30
08/31/2015 11:33:28 AM
Form 5
City of Clearwater (COST) (PROG478)
Other Program Funding Narrative
Funding Amount: Other Funding Source: Narrative:
$210,064 City Government (in
Pinellas)
City of Clearwater contribution to program. Parks and Recreation Dept budget is
primarily from the General Fund which comes from Ad Velorem taxes. Includes
salary & benefits, facility use, transportation, food, participant expenses
$56,322
State - General (all other
departments)
SOR Summer lunches and snack $4.44 x 45 days x 190 children = $37,962 SOR
Afterschool snacks $0.85 x 216 days x 100 kids = $18,360 $37,962 + 18,360 =
$56,322 provided by FL Dept of Agriculture
Agency: City of Clearwater (AGN274) 08/31/2015 11:33:28 AM
Page 27 of 30
END OF PROGRAM BUDGET FOR
City of Clearwater (COST) (PROG478)
Agency: City of Clearwater (AGN274) 08/31/2015 11:33:28 AM
Page 28 of 30
Attachment 5
JWB Reimbursement Schedule
Payl>
Juvenile
Accounts
Submission
Due Date
Welfare Board
FY 2015 -2016
Payable Schedule
Reimbursement
Date
1
10/02/15
10/09/15
2
10/16/15
10/23/15
3
10/30/15
11/06/15
4
11/13/15
11/20/15
5
11/27/15
12/04/15
6
12/11/15
12/18/15
7
12/25/15
01/01/16
8
01/08/16
01/15/16
9
01/22/16
01/29/16
10
02/05/16
02/12/16
11
02/19/16
02/26/16
12
03/04/16
03/11/16
13
03/18/16
03/25/16
14
04/01/16
04/08/16
15
04/15/16
04/22/16
16
04/29/16
05/06/16
17
05/13/16
05/20/16
18
05/27/16
06/03/16
19
06/10/16
06/17/16
20
06/24/16
07/01/16
21
07/08/16
07/15/16
22
07/22/16
07/29/16
23
08/05/16
08/12/16
24
08/19/16
08/26/16
25
09/02/16
09/09/16
26
09/16/16
09/23/16
27
09/30/16
10 /06 /16(September business)
28
10/14/16
10 /20 /16(September business)
Agency: City of Clearwater (AGN274) 08/31/2015 11:33:28 AM
Page 29 of 30
Attachment 6
Document Submittal Chart
Provider Document
COOP
Time Frame
Within thirty (30) days of effective date of agreement
Submit To
Waived
Most Recent Audit
Immediately upon receipt by the Provider's Board or not to
exceed 150 days of the close of the Provider's fiscal year
Waived
Board Member List
Within thirty (30) calendar days of approval or a change of
Board composition
Waived
Policy and procedure regarding Board
review of Provider finances
Within thirty (30) calendar days of effective date of
agreement and upon revision and approval by the
Provider's board
Waived
Board Approved Merit Compensation
Plan
(Board minutes showing approval)
If applicable, then prior to budget submission or subsequent
amendment
Waived
Board Training
(Outline of topics, members in
attendance and who provided training)
For new board members, prior to issuance of subsequent
year's contract or August 1st of current fiscal year,
whichever occurs first
Waived
Incident Reports
Within one (1) business day of occurrence
IRreviewteam @jwbpinellas.org
Liability Insurance Documentation
Throughout the period of the agreement.
Waived
User Access
Notify within two (2) business days when a staff person's
access must be inactivated
support@mosaic- network.com
Agency: City of Clearwater (AGN274) 08/31/2015 11:33:28 AM
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