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1. 03/11/1992 Agreementi C UNTY joNROE KEY WESTLORIDA 33040 (305)294-4641 M E M O R A N D U M BOARD OF COUNTY COMMISSIONERS MAYOR, Wilhelmina Harvey, District 1 Mayor Pro Tem, Jack London, District 2 Douglas Jones, District 3 A. Earl Cheal, District 4 John Stormont, District 5 TO: Barbara Mertes, Director Grace Jones Community Center - Day Care Program FROM: Deanna S. Lloyd, Grants Manager t— Office of Management and Budget, x4474 DATE: May 4, 1992 SUBJECT: Community Service Block Grant 92SB-69-11-54-01-074 Barbara, attached is the executed contract for the above -mentioned agreement. I have included additional copies of the forms used in the financial and quarterly reports for your use. The financial reports are to be completed monthly and are due to DCA on the following dates: May 21; Aug 21; June 21; Sept 21; July 21; Oct 21. As we did last year, please complete the reports and send to my office in time to meet the DCA deadline. The quarterly reports will begin with the month of April. So, the first quarter includes April, May, and June (report due -July 21st); the second quarter includes July, August, September (report due -October 21st). Once again, please complete and send the reports to me in order to meet DCA's deadline. Call, if you have any questions. Take care Barbara, I'll be calling you within the next week or so. cc: Monroe County Clerk's Office Finance Dept. County Attorney RECYCLED PAPER _ 1992/ii % i CFDA#,.: 93.031 92SB-69-11-54-01-074 (Contract No. to be Assigned by Department) COMMUNITY SERVICES BLOCK GRANT AWARD AGREEMENT THIS AGREEMENT is entered into by and between the State of Florida Department of Community Affairs (hereinafter referred to as the Department), with headquarters in Tallahassee, Florida, and Monroe County Board of County Commissioners (hereinafter referred to as the Grantee). THIS AGREEMENT IS ENTERED INTO BASED ON THE FOLLOWING FACTS: The Department, in furtherance of its duties under the Omnibus Budget Reconciliation Act of 1981 (Public Law 97-35, as amended), has determined that the Grantee has applied and qualifies for a grant under the Community Services Block Grant (CSBG) Program Act. NOW, THEREFORE, the Department and the Grantee do mutually agree as , follows: (1) SCOPE OF WORK The Grantee shall furnish the necessary personnel, materials, services and facilities (except as otherwise provided herein), and shall otherwise do all things necessary for or incidental to the performance of work as set forth in the Grantee's Community Services Block Grant Program Application, attached hereto and incorporated by this reference as Attachment A. (2) INCORPORATION OF LAWS, RULES AND REGULATIONS Both the Grantee and the Department shall be governed by applicable laws and local rules, including, but not limited to: The Omnibus Budget Reconciliation Act of 1981 (P.L. 97-35, as amended), Fla. Admin. Code Chapter 9B-22, and 45 C.F.R. Part 96 (1989). (3) FUNDING (a) The Grantee shall be reimbursed for costs incurred in the satisfactory performance of work hereunder in an amount not to exceed S 3,124.00 for the Department's share, subject to the availability of federal CSBG Program funds to support this amount. (b) The Grantee shall match the CSBG funds identified in Clause (3)(a) by an amount of at least twenty percent (20%) of the funds received. Not less than ten percent (10%) of the match shall be in cash. That is, the Grantee shall supply a cash match equal to at least two percent (2%) of the CSBG funds received. In -kind match sources shall absorb the balance of the overall minimum twenty percent (20%) requirement. i (c) The Grantee shall provide as matching funds for services+under this Agreement the following amounts: $ 625.00 CASH $ -0- IN -KIND 1 (d) Sources of matching funds and expenditures for all funds under this Agreement shall be governed by the CSBG Application in Attachment A of this Agreement. CSBG funds may not be used in part or in whole to meet the (2%) cash match requirement. (e) Any advance payment under this Agreement shall be requested by the Grantee and is subject to s. 216.181(12)(b), Fla. Stat. (1989). The maximum advance allowable is equal to not more than 50% of a 6-month agreement or 3 months of a 12-month agreement. Grantee requests an advance payment and as justification for the advance hereby certifies: (Check one) (1) Previous years' CSBG Agreements establish that $ is necessary in order to cover expense for projected cash needs for the first three (3) months of the Agreement. (2) The Grantee projects that $ is necessary in order to cover expenses for projected cash needs for the first three (3) months of the Agreement. XX (3) No advance payment is required. (f) After the initial advance, payments shall be made on a monthly reimbursement basis. (g) Any expenditures under this contract are subject to compliance with Standards for Grantee Financial Management Systems prescribed in Attachment G of the Federal Office of Management and Budget (OMB) Circular A-102, Revised, or OMB Circular 110, Attachment F; and applicable provisions of 01-IB Circular 87 or OMB Circular A-122. (h) Each reimbursement request shall be on a monthly Financial Status Report form approved by the Department. The Department shall review each reimbursement request prior to payment to verify that the costs claimed are allowable under the provisions of this Agreement and applicable cost principles. (i) Any CSBG funds paid to the Grantee by the Department and not expended for the contracted service shall be considered Department funds, and shall be returned by the Grantee to the Department. (j) Any CSBG funds expended in violation of this Agreement shall be refunded in full by the Grantee to the Department or, if this Agreement is still in force, shall be withheld by the Department from any subsequent request for payment. (k) The Grantee shall submit a final Close-out Report on forms approved by the Department within 60 days of termination of this Agreement. Any non -accrued expenses or residual funds remaining at the termination of this Agreement shall revert to the Department and shall be due and payable on such date of termination and shall be paid no later than 60 days thereafter. (1) Provision of funding under this Agreement shall not be construed as a guarantee of future or subsequent funding to the Grantee under the CSBG Program or any other program administered by the Department. (4) PROGRAM INCOME (a) The Grantee may temporarily invest CSBG grant funds, but any interest income shall either be returned to the Department or be applied against the Department's obligation to pay the contract amount. E (b) Any interest income earned by the temporary investment of these CSBG grant funds that are not applied against the Department's obligation to pay shall be returned to the Department at the time of submission of the final Close-out Report. (c) Grantee may apply program income, excluding interest income, to meet matching requirements, or may reprogram it for eligible program activities in accordance with Fla. Admin. Code Chapter 9B-22. The amount of program income and its disposition must be reported to the Department at the time of submission of the final Close-out Report. (5) PROCUREMENT STANDARDS Grantee shall comply with procurement standards equivalent, at a minimum, to OMB Circular A-102, Attachment O or OMB Circular A-110, Attachment 0, and relevant State and local laws applicable to the procurement of supplies, equipment, and services. (6) PROPERTY MANAGEMENT STANDARDS Grantee shall comply with property management standards for non - expendable property equivalent, at a minimum, to OMB Circular A-102, Attachment N, or OMB Circular A-110, Attachment N. (7) AUDIT (a) Grantee shall submit an annual financial audit which meets the requirements of 11.45 and 216.349, Fla. Stat. (1990), and Chapter 10.550 of the Rules of the Auditor General. (b) when applicable, the scope of the audit should encompass the additional activities necessary to establish compliance with the Single Audit Act of 1984, P.L. 98-502, OMB Circulars A-128 and A-133 and other applicable federal lay.s. The audit will be due seven months after the end of the local fiscal year. A copy of the audit will be provided to the Department by: April 30, 1993 (specify month/day/year no later than seven months after the end of the grantee's fiscal year). (c) The audit report must be complete including all management letters and recipients resporise to all findings, including corrective action to be taken. Incomplete reports will not be accepted as meeting contract requirements and may be returned to the grantee. (d) The audit report must include a schedule of financial assistance specifically identifying all contracts and grant revenue by sponsoring agency and contract number. (e) The Department may undertake such further or additional audits as determined necessary or appropriate including, but not limited to, past or current organization -wide audits. Such audits may be necessary to determine the adequacy, accuracy, and reliability of the Grantee's internal controls, fiscal data, and management systems established to safeguard the Grantee's assets and to ensure compliance with this Agreement. (f) If this Agreement is closed -out without an audit, the Department reserves the right to recover any disallowed costs identified in an audit after such close-out. (8) RECORDKEEPING (a) Grantee shall maintain records and supporting documents, as prescribed in OMB Circular A-110, Attachment C, or OMB Circular A-102, Attachment C. 3 (b) All records pertinent to this Agreement shall be retained by the Grantee for three (3) years following receipt by the Department of the Grantee's final monthly Financial Status Report, with the following exception: if any litigation, claim or audit is started before the expiration date of the three year period, the records will be maintained until all litigation, claims or audit findings involving the records have been resolved. (c) All records shall be sufficient to determine compliance with the requirements and objectives of this Agreement, the CSBG Program, and all other applicable laws and regulations. The Grantee is responsible for maintaining and storing all records pertinent to this Agreement in an orderly fashion in a readily accessible, permanent and secured location. (d) The Grantee shall allow access to its records at reasonable times to the Department, its employees and agents, and to the U.S. Department of Health and Human Services (H.H.S.), its employees and agents. "Reasonable" shall be construed according to the circumstances but ordinarily shall mean during normal business hours of 8:00 a.m. to 5:00 p.m. on Monday through Friday. "Agents" shall include, but not be limited to, auditors retained by the Department or H.H.S. (9) PERFORMANCE REPORTS (a) The Grantee shall provide the Department with a monthly Financial Status Report within twenty-one (21) calendar days after the end of each month that this Agreement is in force. These reports shall be submitted on forms provided by the Department. (b) The Grantee shall provide the Department with quarterly Program Activity Reports within twenty-one (211 calendar days after the end of each quarter that this Agreement is in force. These reports shall be submitted on forms provided by the Department. (c) Reports not received by the date due shall be considered delinquent, and may be considered by the Department as sufficient cause to suspend CSBG payments. (d) Upon reasonable notice, the Grantee shall provide such additional program reports or information as required by the Department. (e) The Grantee shall provide the Department with a Final Grant Close-out Report describing the services provided, and a summary of all financial transactions on forms to be provided by the Department. The Final Grant Close-out Report is due sixty (60) days after the termination of this Agreement. (10) MONITORING, EVALUATION, AND TECHNICAL ASSISTANCE (a) Grantee shall constantly monitor its performance under this Agreement to ensure that time schedules are being met, projected program activities are being accomplished within specified time periods, and other performance goals are being achieved. This review shall be made for each program, function, or activity set forth in Attachment A. (b) Training and technical assistance shall be provided by the Department, within limits of staff time and budget, upon request by the Grantee and/or upon a determination by the Department of Grantee need. (c) The Grantee shall allow the Department to carry out monitoring, evaluation and technical assistance and shall ensure the cooperation of its employees, and of any Subgrantees with whom the Grantee contracts to carry out CSBG program activities. (11) SUBGRANTEES (a) Grantee may delegate to other agencies responsibility for the performance of activities and service under this Agreement. Such subgrantees shall be identified in Attachment A. 4 (b) With the exception of the board structure requirements set forth in the Assurances in Clause (17) of this Agreement, Subgrantees undertaking or carrying out CSBG activities under this Agreement shall do so in conformance with the terms and conditions of this Agreement, Fla. Admin. Code Chapter 9B-22, and all applicable State and Federal laws, rules, regulations, guidelines, and OMB Standards. (c) The Grantee shall be responsible for the program and fiscal performance of its Subgrantees and shall monitor their activities accordingly. In the event of a Subgrantee's non-compliance with the program or fiscal activities under this Agreement, the Grantee agrees to reimburse to the Department any and all grant funds misused by the Grantee or its Subgrantee(s). (12) LIABILITY The Grantee shall be solely responsible to parties with whom it shall deal in carrying out the terms of this Agreement and shall hold the Department harmless against all claims of whatever nature by third parties arising out of the performance of work under this Agreement. (13) PERIOD OF AGREEMENT (a) This Agreement shall begin on April 1, 1992 or upon date of signing by the Department if executed after April 1, 1992. This Agreement shall end on September 30, 1992, unless terminated earlier in accordance with the provisions of Clause (14). (14) SUSPENSION OR TERMINATION OF FUNDS (a) The Department reserves the right to withhold or suspend payments to the Grantee when the reports required in Clause (9) of this Agreement are delinquent, or when the grantee fails to comply with the terms and conditions of this Agreement. (b) The Department may terminate this Agreement for cause upon such written notice as is reasonable under the circumstances. Cause shall include, but not be limited to: misuse of funds; fraud; non-compliance with applicable rules, laws, regulations, and OMB Standards; failure to perform the program or fiscal activities under this Agreement; and failure to comply with the Assurances set forth in Clause (17) or the Special Conditions required in Clause (18) of this Agreement. (c) It is expressly understood that the Department shall have the right to terminate this Agreement for discriminatory practices by the Grantee. (d) The Department reserves the right to exercise corrective remedial actions including, but not limited to: requesting additional information from the Grantee to determine the reasons for, or extent of non- compliance or lack of performance; issuing a written warning advising that suspension or termination may be initiated if the situation is not remedied; advising the Grantee to suspend, discontinue, or not incur costs on activities in question; or requiring the Grantee to reimburse the Department for the amount of costs incurred for any items or activities determined ineligible or disallowed. (15) MODIFICATIONS (a) As provided in Fla. Admin. Code Chapter 9B-22.09, the Department or the Grantee may request modifications to this Agreement. Changes in the approved Work Plan may be made by a Grantee only after formal modification to the contract is approved in writing by the Department. (b) The Department shall not be obligated to reimburse a Grantee for outlays in excess of the funded amount of the grant Agreement unless and until the Department officially approves such expenditures by executing a written modification to the original contractual Agreement. R (c) All requests for modifications in excess of ten percent (10%) of the line item or the total budget must be submitted to the Department for approval thirty (30) days prior to the anticipated implementation date. The Grantee must include a description of the proposed changes and their effect upon the approved work plan. Failure to meet this time frame may result in reimbursement delays. (d) Changes within individual budget line items may be made at the discretion of the Grantee, without Department approval, if the cumulative effect of such changes does not exceed ten percent (10%) of the line item total, and if the cumulative effect of the number of such changes does not exceed ten percent (10%) of the total approved grant amount, provided that: 1. only unobligated funds are transferred from one line item to another line item; 2. the Grantee notifies the Department in writing prior to effecting a budget change within the limitations set forth in this Section and in Fla. Admin. Code Chapter 9B-22; and 3. budget changes do not result in overexpenditure of the total approved grant amount or expenditures in excess of the administrative or secondary administrative expense limits. (16) CLIENT ELIGIBILITY AND CLIENT RECORDS (a) The Grantee shall certify each client receiving CSBG funded services as income eligible at 125% or less of the current Office of Management and Budget Poverty Guidelines as required by CSBG law and rule. In order to certify each client, the Grantee shall be required to maintain current (less than one year old) source documentation of income eligibility. In the event that the client cannot provide income documentation, the Grantee shall require the client to provide a signed certification of eligibility to attest to the client's verbal declaration. This certification must specify the reasons that no current documentation could be provided by the client. (b) Grantee will maintain a separate record for each CSBG client which includes at least the following data: client name, address, sex, race, age, income amount and method of verification, date client was interviewed, services performed for the client and documentation of any denial of client services. (c) Grantees are required to have written client appeal procedures for any client denied services using CSBG funds. (17) ASSURANCES (a) Interest of Certain Federal Officials. No member of or delegate to the Congress of the United States, and no Resident Commissioner, shall be admitted to any share or part of this Agreement or to any benefit to arise from the same. (b) Interest of Members Officers or Employees of Recipient Members of Local Governing Body, or Other Public Officials. No member, officer, or employee of the Grantee, or its designees or agents, no member of the governing body of the locality in which the program is situated, and no other public official of such locality or localities who exercises any functions or responsibilities with respect to the program during his tenure or for one year thereafter, shall have any interest direct or indirect, in any contract or subcontract, or the proceeds thereof, for work to be performed in connection with the program assisted under this Agreement. The Grantee shall incorporate or cause to be incorporated in all such Agreements, a provision prohibiting such interest pursuant to the purposes of this subsection. (c) Nepotism. The Grantee agrees to abide by the provision of s. 112.3135, Fla. Stat. (1989), pertaining to nepotism in their performance under this Agreement. 2 (d) In compliance with section 1352, title 31, U.S. Code, the Subgrantee certifies, to the best of his or her knowledge and belief that: (1) No federal appropriated funds have been paid or will be paid, by or on behalf of the Subgrantee, to any person for influencing or attempting to influence an officer or employee of any State or Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of this Agreement, the making of this Agreement, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of this agreement. (2) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, or an officer or employee of Congress, or an employee of a Member of Congress in connection with this Agreement, the Subgrantee shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (e) Notwithstanding subsection (17)(d)(2) above, none of the funds, materials, property, or services contributed by the Department or the Subcontractor under this Contract shall be used in the performance of this Contract for any partisan political activity, or to further the election or defeat of any candidate for public office, or for the purpose of lobbying the Legislature or a state agency. (f) CSBG Assurances. The Grantee hereby assures and certifies as a condition of receipt of Community Services Block Grant funds, that it and its Subgrantees will comply with the applicable requirements of Federal and State laws, rules, regulations, and guidelines. As part of its acceptance and use of CSBG funds, the Grantee assures and certifies that: 1. The Grantee possesses the legal authority to apply for the grant, and that the application has been approved by the Grantee's governing body, including all assurances contained herein. 2. The Grantee will utilize all CSBG funds to provide a range of services and activities having measurable and potentially major impact on causes of poverty in the community where poverty is a particularly acute problem. 3. In the case of a Community Action Agency or non-profit private organization, the Grantee assures and provides documentation that its Board of Directors is constituted so that: a. One-third of the members of the Board are elected officials currently holding office or their representatives, except that if the number of elected officials reasonably available and willing to serve is less than one-third of the membership of the Board, membership on the Board of appointive public officials may be counted in meeting such one-third requirement. b. At least one-third of the members of the Board are persons chosen in accordance with democratic selection procedures adequate to assure that they are representatives of the poor in the area served. C. The remainder of the representatives of the Board are officials or members of business, labor, industry, religious, welfare, education or other major groups and interests in the community. 4. In the case of a limited purpose agency, the Grantee assures and provides documentation that the Board is composed of at least one-third representatives of the poor or an advisory committee of at least a majority of which are democratically selected representatives of the poor. 5. In the case of a migrant and seasonal farmworker organization, the Grantee assures and provides documentation that the Board of Directors consists of at least 51% representatives of migrant and seasonal 7 farmworkers, and that the organization provided direct services to a target population of migrant and seasonal farmworkers during federal fiscal years 19E3 to the present. 6. The Grantee will provide for coordination among antipoverty programs in each community and, where appropriate, with emergency energy crisis intervention programs under Title XXVI of the Low -Income Home Energy Assistance Act conducted in each community. 7. The Grantee possesses the sound fiscal controls and fund accounting procedures necessary to adequately safeguard the assets of the agency, check the accuracy and reliability of accounting data, promote operating efficiency and maintain compliance with prescribed management policies of the agency. 8. The Grantee will permit and cooperate with Federal and State investigations designed to evaluate compliance with the law. 9. The Grantee will give the Department, the Auditor General or any authorized representative, complete access to examine all records, b:�:,,ks, papers or documents related to all fiscal and program operations of the grant, including those of any Subgrantee. 10. The Grantee will comply with non-discrimination provisions, in accordance with Florida Statutes; section 677 of P.L. 97-35; Titles VI and II of the Civil Rights Act of 1964; and 45 C.F.R. Parts 84, 86 and 90 (199) 11. The Grantee will comply with the match requirements of this agreement and maintain verification of type and source. 12. The Grantee will comply with section 680 of Public Law 97-35, as amended, which prohibits use of CSBG funds for purchase or improvement of land, or the purchase, construction, or permanent improvement �cther than, low-cost residential weatherization or other energy related home repairs) of any building or other facility. 13. The Grantee will comply with Fla. Admin. Code Chapter 93-22, which provides that CSBG administrative expenses shall not exceed fifteen percent (15%) of the, total CSBG funded contract amount. 14. If the Grantee administers a transportation program, it will comply with Chapter 427, Fla. Stat. (1989), so that it will coordinate :,:ith the appropriate transportation provider(s). 15. If requesting Secondary Administrative Expenses, the Grantee will provide substantial documentation that these expenses are .,ustified and support eligible CSBG activities. 16. The CSBG application and all its attachments, including budget data, are true and correct. 17. This Agreement has been approved by the Grantee's governin'- bcdy by official action, and the officer who signs it is duly authorized to sign this Agreement. (18) SPECIAL CONDITIONS (a) The Grantee and its Subgrantees shall comply with the following special conditions: NUNE (b) Failure of the Grantee or its Subgrantees to comply with the special conditions under this Agreement shall be cause for the immediate suspension of payments, and may be cause for the immediate termination of this Agreement. 8 (19) STANDARD CONDITIONS The Grantee agrees to be bound by the provisions included in the Standard Conditions attached to and incorporated by reference in this agreement as follows: (a) Bills for any travel expenses must be submitted in accordance with s. 112.061, Fla. Stat. (1989). (b) Bills for fees or other compensation for services or expenses must be submitted in detail sufficient for a proper preaudit and postaudit thereof, as required in s. 287.058(1)(a), Fla. Stat. (1989). (c) As provided in s. 287.0582, Fla. Stat. (1989), the State of Florida's performance and obligation to pay under this Agreement is contingent upon an annual appropriation by the Legislature. (d) Extension of a contract for contractual services shall be in writing for a period not to exceed six months and shall be subject to the same terms and conditions set forth in this initial contract. There shall be only one extension for the contract unless the failure to meet criteria set forth in the contract for completion of the contract is due to events beyond the control of the grantee. (e) The Department may unilaterally cancel this Agreement for refusal by the Grantee to allow public access to all documents, papers, letters or other materials subject to the provisions of Chapter 119, Fla. Stat. (1989), and made or received by the Grantee in conjunction with the Agreement. THIS AGREEMENT AND %'Tri .ktT`IACHMENTS EMBODY THE ENTIRE AGREEMENT OF THE PARTIES. IN WITNESS WF2REOF, THE PARTIES HERETO HAVE DULY EXECUTED THIS AGREEMENT. STATE OF FLORIDA GRANTEE DEPARTMENT OF COMMUNITY AFFAIRS BY � � BY ` (Signature) (Signature) Wilhe]mina Harvey Maypr/ChaJrnian Pat Pepper, Director (Type Name and Title) Division of Housing and Community Develo ment DATE Clerk DATE 6 /� 7 ATTEST 4-�Zz, ' &, _' 59-Fnnn749 Federal Identification Number A. ..;Y. ev — -- •-7 Da±o 9 ATTACHMENT B 92SB-69-11-54-01-074 Contract No. to be assigned by Department FLORIDA DEPARTMENT OF COMMUNITY AFFAIRS COMMUNITY SERVICES BLOCK GRANT SIGNATURE AUTHORIZATION FORM - FFY 1992 Monroe County Board of County Commissioners GRANTEE NAME � AS SIGNED BY THE GRANTEE h ON THE ORIGINAL AGREEMENT I ATURE PAGE 9 OF 10 (SEAL) Wilh_lmina Har= ATTEST: Danny L. Kolhage Clerk 1NAME By: I� _Xuar /Mai rman TITLE The signature of the person(s) shown below are designated and authorized to sign fiscal reports on be contract listed above: Thornas W. Brown NAME • r •. •u• • NAME TITLE SIGNATURE app FORM AND EFFIENC BY Y. Attomeys Office Date�- 10 Page 1 of 7 ATTACHMENT A Florida Department of Community Affairs COMMUNITY SERVICES BLOCK GRANT APPLICATION Federal Fiscal Year 1992 APPLICATION SUBMISSION FORM SUBMITTED BY: Monroe County Board o-17 Commissioners (APPLICANT) Application is hereby made for funding through the Community Services Block Grant under the Community Services Block Grant Act of 1981 (PL 97-35), as amended, and the Community Services Block Grant Program Rule 9B-22, Florida Administrative Code. THE APPLICANT CERTIFIES THAT THE DATA IN THIS APPLICATION AND ITS VARIOUS SECTIONS, INCLUDING BUDGET DATA, ARE TRUE AND CORRECT TO THE BEST OF HIS OR HER KNOWLEDGE AND THAT THE FILING OF THIS APPLICATION HAS BEEN DULY AUTHORIZED AND UNDERSTANDS THAT IT WILL BECOME PART OF THE AGREEMENT BETWEEN THE DEPARTMENT AND THE APPLICANT. Thomas Brown Name (typed) Countv Administrator Title Wi.iVness Signature Date Date APPLICATIONS MUST BE POSTMARKED BY THE DUE DATE, FEBRUARY 3, 1992 AND RECEIVED NO LATER THAN CLOSE OF BUSINESS (5:00 p.m.) ON FEBRUARY 10, 1992 TO BE CONSIDERED FOR FUNDING. r Page 2 of 7 Florida Department of Community Affairs COMMUNITY SERVICES BLOCK GRANT APPLICATION FEDERAL FISCAL YEAR 2992 CONTRACT PERIOD: 4-01-92 to 9-30-92 2 TR DCA USE ONLY �} POSTMARK DATE: ' 3 CONTRACT NO: / ,9 S /_ �1 / "� �� DATE RECEIVED: 90% [ J SX [ j D t [ REVISION REC'D: DCA CONSULTANT:-=12.I9%I INSTRUCTIONS: Please complete all parts in this Application.which are applicable to your organization. If any part does not apply, write "N/A". Do not use white -out (correction fluid) on any part of this application. sssxa.ssxssssassssassssssssssssssssssssssasssssaszsszssxxssxaxssszsssssssxsssxx I. APPLICANT CATEGORY: [ J Eligible Entity [Xj Local Government [ J Migrant/Seasonal Farmworker Organization II. GENERAL ADMINISTRATIVE INFORMATION a. Name of Applicant: Public Service Bldg., Wing II b. Applicant's Address: 5100 College Rd. City: Stock Island, FL Zip Code: 33040 Telephone: (305 ) 292-4474 County: Monroe c. Applicant's Mailing Address (if different from above): Zip Code d. Chief Official or Executive Director's Name: Wilhelminn Harvey Title: mayor• Chairman of 14onroe County Board of Commissioners e. Name and Title of Official to Receive State Warrant: Danny I:olhage,Clerk of Court Address::.. Key West, FL Zip Code 33040 f. Contact Person: Hennna S_ Lloyd Title: Grants Manager Mailing Address:puhl i e Service Bldg. , Wing II 5100 College Rd. Stoc_l: TGland, FL. Zip Code: 33040 Telephone: ( 303 ?9?-4474 Fax: (305 292-4401 g. Federal ID #: 99-6000749 ****************************************************************************** III. SUBGRANTEE INFORMATION a. These funds will be transferred to: [;;j _]_ subgrantee(s) [ ) None b. Give the names of subgrantees included in this application: Name and address of suborantee(s) Contact flerson & Telephone Grace Jones Community Center Barbara J. 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I I 1 I 1 1 1 I I 1 1 1 tU O+ I 11 I II N II dS II II 11 1 1 1 1 1 1 1 I 1 1 I I I 1 i 1 1 I 1 1 1 I 1 I 1 1 1 1 1 1 ro W 1 11 I 11 p 11 11 1 1 1 1 I I ! 1 1 I I 1 I 1 I I 11 II 11 II II 1 t I I I 1 I 1 1 I 1 I 1 t I 1 1 1 1 1 1 1 1 I 1 1 I 1 1 1 R ro l a 11 t RC II II 11 GL II a 11 I I I 1 I I I 1 1 1 1 1 1 1 1 1 1 1 I 1 1 1 1 I 1 1 1 I L 1 4-1 I E U 1 0 11 11 11 11 11 t:9 II IC II 1 1 u 1 I I 1 I I I I 1 1 I 1 1 1 I 1 1 1 1 1 1 1 1 I 1 1 1 1 1 1 1 d I E tt l 11 11 to II 1 1 1 1 1 I I 1 I I 1 I I 1 I 1 1 1 I 1 I 1 I 1 1 I 1 11 O I A II t z 11 11 II U II II U I I 1 I I I 1 1 1 1 I I 1 I 1 I 1 I 1 I I I I 1 I I I 1 I 1 E 1� 11 1 It II II II II 11 II I I p l 1 1 1 I 1 I 1 1 1 1 1 I 1 1 1 1 1 1 1 1 I 1 I I t 1 I I 1 1 I I w 1-I 1 C9 II I II II II i"1 I I I 1 1 1 1 1 1 1 I 1 1 1 1 1 1 I I I 1 1 1 1� I 1 11 I 11 U 11 U II Q, 1 1 I I I I I I I 1 1 I 1 1 I 1 11 W I 1 1 1 1 I I 1 1 I 1 1 1 1 I E I II II II II II I I 1 1 1 1 I I 1 1 I I 1 1 1 1 I 1 I I 1 I 1 1 1 I 1 1 1 I 0 E 1 II 1 II W W II � II t 1 I 1 I I 1 I I 1 I 1 1 I I W I 11 �II II O W II p4 CY, U I I 1 I 1 1 I 1 1 I I 1 1 I I I 1 I 1 1 1 I I 1 1 1 1 I 1� l a 1 II l 11 0G C9 II a 11 1 1 1 1 I I I 1 1 I 1 I I 1 1 I II u Page 5 of 7 CSBG BUDGET SUMMARY NAME OF APPLICANT: Monroe County Board of Commissioners TAX EXEMPT NUMBER: 5 9 6000749 (If none, attach copy of Certificate of Incorporation.) I REVENUE SOURCES I PERCENT I MATCH I TOTAL AMOUNT I NOTES: 1 1---------------------------------- 1--------------- 1---------------- 1------------------ 1 - Round d figures upward 1 1. CSBG Grant Funds.............Iilllllllllllllllllllllllllllillll $ 3 1 2 4.0 0 1 to nearest dollar. 1 1---------------------------------- 1 2. 1--------------- 1---------------- Cash Match Funds.............1 20 % 1 $ 625.00 1------------------ 11111111111111111111 1 - Provide: 1 1---------------------------------- 1--------------- 1---------------- 1----------------- -1 c Min Cash Match 2% 1 1 3. In -kind Match................1 % 1 - 0- IIIIIIIIIIIIIIIIIIII Min. Total Match 20% 1 i---------------------------------- 1 4. 1---------------1---------------- TOTAL MATCH (Lines 2 + 3)....1 20 X IIIIIIIIIilillllll 1------------------1 625.00 1 - DO NOT UNDER MATCH. 1 1---------------------------------- 1--------------- 1---------------- 1------------------ 1 1.99% cash ca match is 1 1 5. TOTAL FUNDS (Lines 1+ 4).... IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII $ 3 7 4 9. 0 0 1 not acceptable. 1 1 CSBG FUNDED PROGRAMS ONLY 1 (1) CSBG 1 (2) CASH 1 (3) IN -KIND I I EXPENSE CATEGORAY 1 FUNDS ( MATCH 1 MATCH 1 (4) TOTAL 1 1--------------------------------------------------- 1 GRANTEE 1--------------- ADMINISTRATIVE EXPENSE: I 1--------------- 1--------------- I I 1---------------1 I I 1 6. Salaries including fringe.....................1 I I I I 1--------------------------------------------------- 1 7. 1--------------- Rent and Utilities ............................I 1--------------- 1--------------- I I 1---------------1 I I 1--------------------------------------------------- 1 8. 1--------------- Travel........................................I 1--------------- 1--------------- I I 1---------------1 I I 1--------------------------------------------------- 1 9. 1--------------- ot:ier.........................................I 1--------------- 1--------------- I I 1---------------1 I I 1------------------------------------------- 1 10. -------1---------------1---------------1---------------1---------------1 SUBTOTAL (Lines 6 thru 9).....................I I I I I 1 SUBGRANTEE ADMINISTRATIVE EXPENSE: I I I --------------- I I 1 11. 1--------------------------------------------------- Salaries including fringe.....................1 1 12. 1--------------- Rent and Utilities ............................i 1--------------- 1--------------- I I 1---------------1 I I 1--------------------------------------------------- i13. 1--------------- Travel........................................1 1--------------- 1--------------- I I 1---------------1 I I 1--------------------------------------------------- 1 14. 1--------------- Other.........................................1 1--------------- 1--------------- I I 1---------------1 I I 1------------------------------------------------•--i 1 15. SUBTOTAL (Lines 11 thru 14)...................1 -------•- - - - - - -1 -------------- ------------- -1- I I -------------- -1 -1 I I 1 16. TOTAL ADMINISTRATIVE EXPENSE (Lines 10 + 15)..1 --------------- I I ----------- I I 1-------------------------------------------------- 1 17. -1- ADMINISTRATIVE EXPENSE PERCENT................1 ------- - - - - - - -1• % ---------------------------- 1 IIIIIII (not to exceed ------------- -1- -1 15% of line 1) 111111111 1 GRANTEE PROGRAM EXPENSE: 1 --------------- 1 1 ------------- I I 1 18. 1--------------------------------------------------- Salaries including fringe.....................1 1 I I 1 19. 1--------------- Rent and Utilities ............................i i--------------- 1--------------- 1---------------1 1-------------------------------------------------- 1 20. -1 -------------- Travel........................................1 -1 -1- -------------- ------------- I I -1- 1 -------------- I I 1-------------------------------------------------- 1 21. -I- Other.........................................I --------------I- ------------- ------------- -I- I I ------------ -I- -I I I 1-----•-------------------------------------------- 1 22. -1 -------------- SUBTOTAL (Lines 18 thru 21)...................1 -1- ------------- ------------- -1- 1 I -------------- -1 -1 I I 1 SUBGRANTEE PROGRAM EXPENSE: 1 1 1 I I 1 23. 1--------------------------------- Salaries including fringe.....................1 ------ $3124.00 -------------- 1 $ 625.001 --=----------------------- -0- I $3749.00 1 =------------- 1 24. Rent and Utilities ............................1 I I I I 1--------------------------------------------------- 1 25. 1--------------- Travel........................................1 1--------------- 1--------------- I I 1---------------1 I I 1-------------------------------------------------- 1 26. -1- Other.........................................1 ------------- -1- --------------------•------ -1 I I ------------- -1- -1 I I 1---------------------------------------------------1 1 27. -------------- SUBTOTAL (Lines 23 thru 26).................. 1 • $3124.00 - ---------- -------------- 1 $ 625.001 ------------ -0- 1$3749.00 1 1 28. TOTAL PROGRAM EXPENSE: (Lines 22 + 27).......1 $3124.00 1 $ 625.001 I I -0- h3749.00 I 1 29. SECONDARY ADMINISTRATIVE EXPENSE............ i l l l l l l l i l l l l l l l i l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l i l l l l l l l l l l l 1 30. --------------- GRAND TOTAL EXPENSE: (Lines 16 + 28 + 29)....1 $3124.00 1 ----------------------------- $625.00 1 --------------- -0- 0749.00 1 Page 6 of 7 CSBG SUBGRANTEE BUDGET (Each Subgrantee must complete this page. Omit this page if there is no subgrantee.) NAME OF APPLICANT: Monroe County Board of Commissioners NAME OF SUBGRANTEE: Grace Jones Community Center MAILING ADDRESS OF SUBGRANTEE: 230 41st St. Gulf, Marathon, FL 33050 TAX EXEMPT NUMBER OF SUBGRANTEE: 06003420054 (If none, attach a copy of the certificate of incorporation) CONTACT PERSON: TITLE: Barbara J. Mertes Director TELEPHONE: (305)743-6064 NOTE: The following line items (11-15 and 23-27) must correspond to the CSBG BUDGET SUMMARY of the applicant. If there is more than one subgrantee, it is the applicant's responsibility to ensure that the total of all sugbrantee budgets add correctly. This form requires original signatures. --------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- 1 CSBG FUNDED PROGRAMS ONLY 1 (1) CSBG i (2) CASH I (3) IN -KIND I I EXPENSE CATEGORY --------------------------------------------------- 1 FUNDS 1 MATCH 1 MATCH 1 (4) TOTAL 1 I SUBGRANTEE ADMINISTRATIVE EXPENSE: 1--------------- I 1--------------- I 1--------------- I 1---------------1 I I 1 11. Salaries including fringe.....................1 1--------------------------------------------------- 1 12. Rent and Utilities ............................I 1--------------- 1--------------- I 1--------------- I I---------------1 I I -------1 13. Travel........................................I --------------- 1--------------- I 1--------------- I 1---------------1 I I 1--------------------------------------------------- 14. Other.........................................I 1--------------- I--------------- I 1--------------- I 1---------------1 I 1--------------------------------------------------- 15. SUBTOTAL (Lines 11 thru 14)...................1 --------------------------------------------------- 1--------------- 1--------------- 1 I--------------- I ---1--------------- I ---------------I I 1 1 SUBGRANTEE PROGRAM EXPENSE: 1--------------- 1 1------------ I I 1---------------I I I 1 23. Salaries including fringe .....................1$3124.00 1--------------------------------------------------- 1 $ 625.001 -0- 1 $3749.00 1 24. Rent and Utilities ............................i 1--------------- I--------------- I 1--------------- I 1---------------I I 1 1--------------------------------------------------- 1 25. Travel........................................I i--------------- 1--------------- I I--------------- I 1---------------I I I 1--------------------------------------------------- 1 26. Other ......................................... --------------------------------------------------- 1--------------- I I--------------- I 1--------------- I 1---------------1 I I 1 27. SUBTOTAL (Lines 23 thru 26)................... 1--------------------------------------------------- 1--------------- I $3124. --------------- 00 1--------------- 1 $ 625.001 1--------------- -0- I---------------1 1 $3749.001 1 TOTAL EXPENSE: (Lines 15 * 27)...................1 I $3124. 00 I --------------- 1 $ 625.001 I --------------- -0- I --------------- 1 $3749.001 i The subgrantee certifies that the data included in the Sugbrantee Budget and the Subgrantee Work Plan are true and correct. The subgrantee agrees to comply with all rules and regulations relating to the Community Services Block Grant and understands that this budget and work plan will become a part of the Agreement between the Applicant and the Department of Community Affairs. Approved by: Jae (e b (President of the Board) Signature Dat Attested by: Name nature DaWe Page 7 of 7 RAME l LINE ITEM NO. 23 23 CSBG BUDGET DETAIL )F APPLICANT: Monroe Countv Board of Con .=x=x==cx=xxxxxxxxxaxxxxaxxaaass=xxxxxaxxxaaaa EXPENDITURE DETAIL Round up line item totals to dollars. Do not use cents and decimals in totals. -------------------------------------------- Cash Match Documentation Suhgrantee Program Expenses - Salari Source: 11onroe County General Fund � Teacher's Aide - 113.6 hrs n 55.50/hr CSBG Funds Teacher's Aide - 568 hrs. a $5.50/hr unissioners CSBG CASH FUNDS MATCH -------- -------- :s $625.00 3124.0 IN -KIND MATCH Explain sources of cash & in -kind match.