03/11/1992_ 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.
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(c) The Grantee shall provide as matching funds for services+under
this Agreement the following amounts:
$ 625.00 CASH
$ -0- IN -KIND
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(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.
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(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.
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(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.
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(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.
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(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. Mertes
230 41st St. Gulf (305) 743-6064
Marathon, FL.- 33050
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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.