HomeMy WebLinkAboutReso 2000-187
RESOLUTION NO. 2000-~
A RESOLUTION OF THE CITY COMMISSION OF THE
CITY OF SUNNY ISLES BEACH, FLORIDA, AUTHORIZING
THE CITY MANAGER TO MAKE APPLICATION FOR THE
FLORIDA DEPARTMENT OF JUVENILE JUSTICE
COMBINATION GRANT; PROVIDING FOR AN EFFECTIVE
DATE.
WHEREAS, a Combination Grant from the Florida Department of Juvenile Justice is
available and will further the goals of the organization; and
WHEREAS, a Commission approval is necessary to apply for that grant;
NOW THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE
CITY OF SUNNY ISLES BEACH, FLORIDA, AS FOLLOWS:
1. Authorization to apply for grant. The Chief of Police and/or the City Manager is hereby
authorized to make application for a Combination Grant from the Florida Department of
Juvenile Justice and take all other necessary measures to secure and effectuate same.
2. Effective Date. This Resolution is effective upon passage.
ATTEST:
- ~,~~~~l,l"
. Richard Brown-Morilla, City Clerk
Combination Grant Application - Police Res.
APPROVED AS TO FORM AND
LEGAL SUFFICIENCY
~~
M. DannheIsser, CIty Attorney
Vote:
'1-0-\
Mayor Samson
Vice Mayor Morrow
Commissioner Iglesias
Commissioner Kauffman
Commissioner Turetsky
Combination Grant Application - Police Res.
~(Y es)
V(Y es)
t/ (Yes)
V(Yes)
_(Yes)
Moved by:
Seconded by:
~~~
~'tlMAo- T ~l)_
_(No)
_(No)
_(No)
_(No)
_(No)
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FOR DJJ USE ONLY:
Grant #.
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FLORIDA DEPARTMENT OF JUVENILE JUSTICE
COMBINATION GRANT APPLICATION
Agency Name:
Program Name:
County:
DJJ District:
ONE ORIGINAL AND SIX (6) COPIES OF THIS APPLICATION MUST BE
RECEIVED ON OR BEFORE 5:00 P.M., JANUARY 14,2000, DIRECTED TO:
Florida Department of Juvenile Justice
Attn: Marie A. Boswell, Grants Administrator
3510 Biscayne Boulevard, Suite 302
Miami, Florida 33137
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FLORIDA DEPARTMENT OF JUVENILE JUSTICE
COMBINATION GRANT APPLICATION
PROGRAM INFORMATION:
Grant program name:
Amount of grant funds requested: $ (FY 1999/2000) $ (FY 2000/2001)
Program located in Juvenile Justice District #
Florida county (grant program location):
Grant Category (check only one): 0 Community Juvenile Justice Partnership 0 General Revenue
o Combination 0 Other (List)
GRANT PROVIDER INFORMATION:
~ .
Grant ProviderILead Agency name:
Grant ProviderlLead Agency status: 0 Governmental 0 Private not-for-profit 0 Private for profit
Federal Identification Number:
Authorized Agency Official's name:
Mailing address:
City:
Telephone number: (
Name of fiscal officer:
)
Ext.
, Florida Zip Code
Fax number: (
Telephone number: (
)
)
Ext.
Name of fiscal agency if not Lead Agency:
Grant Program Director's name:
Mailing address:
City:
Telephone number: (
)
Ext.
, Florida Zip Code
Fax number: (
)
CERTIFICATION:
I do hereby certify that all facts, figures, and representations made in the application are true and cor-
rect. Furthermore, all applicable statutes, regulations, and procedures for program compliance and
fiscal control will be implemented to ensure proper accountability of grant funds. I certify that the funds
requested in this application will not supplant funds that would otherwise be used for the purpose set
forth in this project. The Grant Applicant has authorized the filing of this application and I have been
duly authorized to act as the representative of the Applicant in connection with this application.
Authorized Official's Signature
. Date
Authorized Official's Name (typed)
Ext.
Name of Agency or Entity
Telephone Number
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A. PROPOSAL SUMMARY. This summary will provide an overview of the program. Do not exceed thi~
page. '. j.~
~
1. What type(s)of services will the proposed program provide? (Refer to Instructions for informa~ ..'
tion on how to properly complete this section.) ,
o Staying in School
o Keeping Busy
o Living Violence Free
o Getting a Job
Alternative/supplemental
education
Law-related education
Other (List)
After-school and/or
weekend activities
Violence reduction/prevention
Peer facilitation
Parent/community training
Individual/family/group counseling
Crisis services
Career & vocational awareness
Career & vocational training
Job development & placement
2. List the program's measurable objectives (no more than five). (Refer to Instructions.)
3. List specific service activities and when each will be provided (hours, days of week/month, fre-
quency, etc.). (Refer to Instructions, Example A.3.)
4. Where will services be provided? (Refer to Instructions, Example A.4.)
5. What is the anticipated time frame a completer is expected to participate in the program? (Refer
to Instructions, example, A.5.)
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A. PROPOSAL SUMMARY - (Continued) Do not exceed this page.
6. Provide the following information: (Refer to Instructions, Example A. 6.)
a) Define Program Enrollee:
(FY 1999/2000)
(FY 2000/2001)
b) Total estimated number of enrollees:
c) Define Program Completer:
d) Total estimated number of completers:
(FY 1999/2000)
(FY 2000/2001)
7. Briefly describe the target population and the major local geographical service areas (i.e., inner
city, rural, high crime, etc.), including zip codes. (Refer to Instructions, Example A. 7.)
8. Estimated percentage of completers identified by Ethnicity, Gender and Age: (Refer to Instructions,
Example A. 8.)
I % White Non- % White % African % Black % Asian % Native % Other
Hispanic Hispanic American Hispanic American
M I F M I F M I F M I F M F M I F M I F
I I I I I I
% of Total
Total
5/CG
B. STATEMENT OF NEED - (What is the problem?) Do not exceed this page.
1. Identify the need or problem that the proposed program intends to address. Include detailed
information about the target population outlined in Program Specific Instructions/Criteria and
the geographic area the program proposes to serve. Include research findings, demographic or
scientific data to support the need, and identify the source and date of this data. Identify existing
community services or resources available to the target population and the gapes) in service
(unmet needs). (Refer to Instructions, Example E.l.)
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C. PROGRAM DESCRIPTION - (What will the program do?) Do not exceed one additional page. Num-
ber additional page 6a.' ,d"
1. Briefly describe the proposed program, and how it will solve the problem or fill the need as stated "
in Section (B). (Refer to Instructions, Example C.].)
2. How does the proposed program complement instead of duplicate already existing services cur-
rently available in the community or neighborhood for the target population? (Refer to Instruc-
tions, Example C.2.)
7/CG
D. PROGRAM IMPLEMENTATION AND OPERATION - (How will the program operate?) Do not
exceed two additional pages. Number additional page(s) 7a, 7b. ,
1. Identify and define the population of juveniles most likely to be involved in the juvenile justice
system who will be the focus of the proposed program. (Refer to Instructions, Example D.l.)
2. What are referral and admission criteria that will be used to accept youth into the program?
Briefly describe the admission/intake process for enrollees. (Refer to Instructions, Example D.2.)
3. How will the program maintain consistent numbers of youth? (Refer to Instructions, Example
D.3.)
4. If the program does not provide transportation, describe how youth will access the proposed
program services. If this question does not apply, briefly state why. Outline and address any
other obstacles to program success. (Refer to Instructions, Example D.4.)
5. Outline specific program components of the proposed program that involve families or other
key members of the youth's support network, and detail that involvement. (Refer to Instruc-
tions, Example D.5.)
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~ D. PROGRAM IMPLEMENTATION AND OPERATION - (Continued)
j
6. Describe the extent to which the project will be managed by local leaders (governmental,
community, civic, youth, grass roots organizations, etc.) and located in the targeted neighbor-
hoods. (Refer to Instructions, Example D.6.)
7. List the social service agencies, drug and alcohol abuse programs, dropout and truancy pre-
vention programs, or other youth-oriented programs that serve the target population or target
neighborhoods and how this program will interact with them. (Refer to Instructions, Example
D.7.)
8. Complete the timeline. List specific program activities (planning, hire/train staff, admitting
youth, program evaluation, community meetings, special events, etc.) and place an "X" in the
box for the appropriate month these activities will occur. Add any other activities specific to
your program.
Activity Year 2000 Year 2001
Month: 03 .04 07 08 09 10 11 12 01 02 03 04 05 06
Program Planning I. .
RecruitlHirerrrain Program Staff
Admit Youth to Program
Provide Services to Youth
Submit Reimbursement Requests
Collect Data for Quarterly Reports
Collect Program-Specific Data for Evaluation
. ,
. ,
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I' 1
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,
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E. PROPOSAL OUTCOME OBJECTIVES AND STRATEGIES - (How will the program reach ~!~ mijor
goals?) Do not exceed one additional page. Number additional page 9a. -
E.!. To reach the program's major goals (i.e., Keeping Busy, Living Violence Free, Staying in School,
or Getting a Job), describe the program's objectives (no more than five) in measurable terms. '.
Under each objective, list specific strategies (activities) that will produce the desired outcome in
each objective. Utilize the performance-based examples given in the Instructions (Example E.!).
Each objective must be: ~pecific, Measurable, Achievable, Responsible, and Time Certain
(SMART). (Refer to Instructions, Example E.)
10/ea
F. EVALUATION PLAN - (What will prove the program works?) Do not exceed one additional p~g~.
Number additional page lOa. ((.~~:...
1. Identify the program-specific data elements that will be collected to support the measurement of'
each program objective. Briefly list each objective (Section E, page 8), identify the specific data
element(s), and indicate where the data elements can be obtained (data source). (Refer to Instruc-
tions for minimum data collection requirements, and to Example F.l.)
2. Describe your ongoing plan for measuring program effectiveness. Include information about
when and how often program evaluation will occur, the types of data required, who will collect the
data and from what source, who will analyze the data, how the results of the analysis will be used
to modify and improve the program, and how this information will be documented. (Refer to
Instructions, Example F.2.)
ll/CG
G. PROGRAM DESIGN AND CONTINUATION - Do not exceed one additional page. Number aqdi-
tional page 11 a. ., ......: .. .
1. Is the proposed program a (check only one): (Refer to Instructionsfor definitions.)
o New Program 0 Expansion of Existing Program 0 Enhancement of Existing Program
o Continuing Program
2. List all proposed positions directly related to the program. Fill in every blank to the right of each
position. List all staff positions included as part of the match. (Refer to Instructions, Example G. 2.)
Number of Hours % of Total Funding Source(s) for
Program Position(s) Per week on This Salary to be Paid Remainder of Salary (if
Program with DJJ Grant applicable)
Funds
~
1.
2.
3.
4.
5.
6.
. Attach a brief position description with minimum qualifications (education, experience) for each
position listed above (Appendix F).
3. List any other funds you are currently receiving or expect to receive for this program (grants or
contracts), and give grant or contract number. (Refer to Instructions, Example G.3.)
4. Indicate whether the grant program anticipates generating any income and if so, how much or at
what rate, and from what source. (Refer to Instructions, Example G.4.)
5. Identify other services the agency currently provides to youth (if applicable) and how the pro-
posed program will interact with those services. (Refer to Instructions, Example G. 5.)
6. Describe the plan to continue funding the project with other resources and funding after the DJJ
grant funding cycle ends. NOTE: While future year planning does not commit an applicant to a
specified direction, it does provide evidence to reviewers of the commitment to long-term imple-
mentation and planning for project development. (Refer to Instructions, Example G.6.)
12/CG
~ H. FY 1999/2000 PROGRAM BUDGET SUMMARY
H.1. Budget Categories (Refer to Instructions)
. . .....-.,:T"t<~~:':.;:::~:...x :'~., /_. "
t
Employees/Staff Salaries & Benefits
Contractual Staff or Services
Equipment Over $999 (Property)
Equipment Under $1,000
Field Trips
Materials/Supplies
Postage
Printing/Copying
Rent/TelephonelUtilities '
Training/Seminars
Staff Travel
Other:
Other:
*Local match contribution mav be cash or in-kind, and is required to be at least 25% of the total amount of
1!rant funds requested (Column B above).
H.2. For each budget category in Column C, indicate the source of the Local Match Contribution.
Budf(et Catef(ory
Source of Local Match Contribution
Employees/Staff Salaries & Benefits
Contractual Staff or Services
Equipment Over $999 (Property)
Equipment Under $1,000
Field Trips
Materials/Supplies
Postage
Printing/Copying
Rent/T elephonelU tilities
Training/Seminars
Staff Travel
Other:
Other:
H.3. Estimated Number of Youth to Complete Program by 06/30/00:
(Refer to Instructions)
H.4. Cost Per Youth with Grant Funds: $ (Divide Total of Column B by Estimated
Number of Youth to Complete Program by 06/30/00) (Refer to Instructions)
13/CG
I. FY 1999/2000 BUDGET NARRATIVE - Use as much space as necessary. Number additional pages 14a,
14h, etc.
1. Using the budget categories in Section H.1, 1999/2000 Budget Summary, describe in detail the items
or services directly related to the program necessary for program implementation. Specifically
describe how you arrived at each total (i.e., show your formula or calculations). If a Budget Category
does not apply, enter zero in the Total columns. (Refer to Instructions, Example II.)
Employee/Staff Salaries & Benefits
Position Title Monthly Retire- FICA Health Life Other Total Annual Total Total
Salary ment Ins. Ins. Fringe Sal. + Salary for Salary for
Bens. Bens. Grant Local
Funds Match
,
TOTALS $ $
Contractual Staff or Services:
Amount Paid with Amount Paid with
Position Title or Service Performed Rate of Pay Grant Funds Local Match
TOTALS $ $
Amount Paid with Amount Paid with
Grant Funds Local Match
Equipment Over $999 (Property): Itemize non-expendable items
to be purchased or leased with grant funds (tangible property having a use-
fullife of more than one year). Describe if the property or equipment will
be purchased or leased.
Equipment Under $1,000: Itemize non-expendable items to be pur-
chased or leased with grant funds (tangible property having a useful life of
more than one year). Describe if the property or equipment will be pur-
chased or leased.
Field Trips: Itemize any educational or community-service related
field trips necessary for program implementation. Include costs associated
with transportation, food, admission fees, etc.
14/CG
FY 1999/2000 Continued
Materials/Supplies: Itemize program-related materials and supplies
by type (office supplies, copy paper, books, etc.) that are expendable or
consumed during the course of the program.
Postage: Itemize the purpose and cost of postage directly related to the
program.
PrintinwCopying: Itemize the purpose and cost of printing and/or
copying directly related to the-program.
RentffelephonelUtiljties: Itemize program-specific costs to imple-
ment the program for pro-rata share or applicable percentage of the total
costs of these items. Show the formula used to arrive at total program
costs.
Rent:
Telephone:
Utilities:
TraininwSeminars: Itemize costs associated with required or antici-
pated staff training or seminars by purpose, and include any associated
costs (Le., mileage, per diem, meals, hotel, registration fees, etc.).
Staff Travel: Itemize costs associated with anticipated program-related
staff travel (i.e., home visits, community meetings, etc.)
Other: List and describe expenses not specifically listed above.
Other: List and describe expenses not specifically listed above.
Amount Paid with
Grant Funds
Amount Paid with
Lo~~l Match
,,,. -,.
':~ -".'.l
15/CG
I
, J. FY 2000/2001 PROGRAM BUDGET SUMMARY
J.t. Budget Categories (Refer to Instructions, Example Jl.)
Employees/Staff Salaries & Benefits
Contractual Staff or Services
Equipment Over $999 (Property)
Equipment Under $1,000
Field Trips
Materials/Supplies
Postage
Printing/Copying
Rent/Te1ephonelUtilities '
Training/Seminars
Staff Travel
Other:
Other:
*Local match contribution mav be cash or in-kind, and is required to be at least 25% of the total amount of
grant funds requested (Column B above).
J.2. For each budget category in Column C, indicate the source of the Local Match Contribution.
Budf(et Catef(ory
Source of Local Match Contribution
Employees/Staff Salaries & Benefits
Contractual Staff or Services
Equipment Over $999 (Property)
Equipment Under $1,000
Field Trips
Materials/Supplies
Postage
Printing/Copying
Rent/T elephonelUtilities
Training/Seminars
Staff Travel
Other:
Other:
J.3. Estimated Number of Youth to Complete Program for FY 2000/2001: _ (Refer to Instructions)
J.4. Cost Per Youth with Grant Funds: $ (Divide Total of Column B by Estimated
Number of Youth to Complete Program for FY 2000/2001) (Refer to Instructions)
16/CG
K. FY 2000/2001 BUDGET NARRATIVE - Use as much space as necessary. Number additional pages
17a, 17b, etc."T?~::.;:
1. Using the budget categories in Section J.t., 2000/2001 Budget Summary, describe in detail the items ~
or services directly related to the program necessary for program implementation. Specifically'
describe how you arrived at each total (i.e., show your formula or calculations). If a Budget Category
does not apply, enter zero in the Total columns. (Refer to Instructions, Example 11.)
Employee/Staff Salaries & Benefits
Position Title Monthly Retire- FICA Health Life Other Total Annual Total Total
Salary ment Ins. Ins. Fringe Sa!. + Salary for Salary for
Bens. Bens. Grant Local
Funds Match
,
TOTALS $ $
Contractual Staff or Services:
Amount Paid with Amount Paid with
Position Title or Service Performed Rate of Pay Grant Funds Local Match
TOTALS $ $
Amount Paid with Amount Paid with
Grant Funds Local Match
Equipment Over $999 (Property): Itemize non-expendable items
to be purchased or leased with grant funds (tangible property having a use-
fullife of more than one year). Describe if the property or equipment will
be purchased or leased.
Equipment Under $1,000: Itemize non-expendable items to be pur-
chased or leased with grant funds (tangible property having a useful life of
more than one year). Describe if the property 6r equipment will be pur-
chased or leased.
Field Trips: Itemize any educational or community-service related
field trips necessary for program implementation. Include costs associated
with transportation, food, admission fees, etc.
17/CG
FY 2000/2001 Continued Amount Paid with Amount Paid with
Grant Funds Local Match .-
,,--'- '
Materials/Supplies: Itemize program-related materials and supplies ."'" ..'
by type (office supplies, copy paper, books, etc.) that are expendable or
consumed during the course of the program.
Postage: Itemize the purpose and cost of postage directly related to the
program.
PrintinwCopying: Itemize the purpose and cost of printing and/or
copying directly related to the.program.
RentffelephonefUtilities: Itemize program-specific costs to imple-
ment the program for pro-rata share or applicable percentage of the total
costs of these items. Show the formula used to arrive at total program
costs.
Rent:
Telephone:
Utilities:
TraininWSeminars: Itemize costs associated with required or antici-
pated staff training or seminars by purpose, and include any associated
costs (i.e., mileage, per diem, meals, hotel, registration fees, etc.).
Staff Travel: Itemize costs associated with anticipated program-related
staff travel (i.e., home visits, community meetings, etc.)
Other: List and describe expenses not specifically listed above.
Other: List and describe expenses not specifically listed above.
18/CG
~ L. DISALLOWED EXPENDITURES
,\,~'."-
t
.'
1. The following is a list of disallowed costs: These items or services may not be purchased with
grant funds. If these items are incorporated in the budget, they will be disallowed.
. Audit Expense
. Awards
. Beepers
. Cellular or Mobile Tele-
phones
. Construction
. Costumes
. Decorative Items for
Office or Home
.. Drinks
. Dues or Membership Fees
. Employment Subsidies for
Participants or Staff
. Entertainment for Guests/
Dignitaries
. Frames for Awards or
Certificates
. Incentives for Test,
Participation, etc.
. Insurance
. Lobbying
. Meals (except onfield
trips or approved student
day program)
· Memorabilia (bags,
pencils, pens, rings, etc.)
2. Expenditures Limitations
. Out-of-state travel
. Prizes
. Program Evaluation
. Refreshments (except
nutritious snack for youth)
. Remodeling
. Telegrams
. Trophies
. T-shirts
. Uniforms
. Vehicles
. Weapons
a Travel expenditures are limited for reimbursement as authorized in Section 112.061, Florida Statutes.
a. Meals while traveling (i.e., outside of the city or town (a minimum of 50 miles) of official head-
quarters:
~ $3.00 breakfast (depart before 6:00 a.m. and return before 10:00 a.m.)
~ $6.00 lunch (depart before 11 :00 a.m. and return after 2:00 p.m.)
~ $12.00 dinner (depart before 6:00p.m. and return after 8:00 p.m.)
b. Mileage is reimbursed at $.29 per mile
c. Reasonable accommodation costs
d. All conference travel must be requested and approved in writing by the DJJ Headquarters (Talla-
hassee) in advance.
I, , certify that I have read the above disallowed costs, expenditure limi-
tations and travel costs, and will comply with these rules and regulations. If disallowed items are charged
to the grant, the agency must reimburse the State of Florida for the disallowed expenditures. The
Department of Juvenile Justice is entitled to offset future reimbursements against the amount of
disallowed expenditures until the Department is fully reimbursed. Additionally, I understand that if
these items are included in the budget, they will be disallowed.
Signature of Authorized Representative
Date
19/CG
CERTIFICATION OF ASSURANCES
Florida Department of Juvenile Justice
2000/2001 Grant Programs
."
.,.
The Department of Juvenile Justice requires that Grant recipients make certain legally enforceable
promises to the Department of Juvenile Justice regarding their programs. The recipients must comply
with the promises to receive and maintain grant awards. Assurance is hereby given:
1. That the FY 1999/2000 grant period begins on March 1,2000, and continues through June 30, 2000; and
that the FY 2000/2001 grant period begins on July 1,2000, and continues through June 30, 2001. That the
total costs incurred will not exceed the grant award. That the grant recipient will maintain all records and
provide any information as required by the Department of Juvenile Justice to ensure fiscal and program
accountability. That documentation shall be maintained at the grant recipient's office for a period of five
years from the termination or completion of the grant period, or until an audit has been conducted and any
findings resolved, whichever is later.
2. For amounts received in excess of $25,000, a financial audit of the grant-funded program shall be com-
pleted in accordance' with the Rules of the Auditor General, Chapter 10.600 Audits of State Grants and
Aids Appropriations, promulgated pursuant to Section 11.45, Florida Statutes. If the amounts received do
not exceed $25,000, a sworn affidavit from the agency head must be submitted stating the program has
complied with the provisions of the grant. A copy of the audit or sworn affidavit must be received by the
Department of Juvenile Justice no later than November 30, 2001. The Department of Juvenile Justice
reserves the right to require a financial audit on any grant-funded program. Failure to comply with audit
requirements may disqualify the agency from further grant opportunities. I
3. That all property and equipment in excess of $999 requires three written competitive bids and that this
documentation will be kept on file. That all property and equipment will meet and not exceed Department
of Juvenile Justice Information Technology Standards. That all property and equipment purchased with
grant funds will be properly identified and a record of such property and equipment will be sent to the
Grant Manager. That all property and equipment purchased with grant funds will remain the property and
equipment of the State of Florida, Department of Juvenile Justice, and will be returned to the Department
upon termination of the grant. That all travel will be performed in accordance with Section 112.061, F.S.
That funds will not be used for lobbying as stated in Section 216.347, F.S.
4. That any change in the grant after the Grant Award must be requested and approved in writing by the
grant administrator prior to the change(s) taking place or the grant may be revoked for cause. That the
grant recipient and the state may change the grant only by mutual agreement and in writing. That the
Department of Juvenile Justice is entitled to offset future reimbursements against the amount of
disallowed expenditures until the Department of Juvenile Justice is fully reimbursed. That the grant
recipient understands and agrees that the state may terminate this grant for convenience or cause without
further liability to the state for expenses incurred after the termination date.
5. That the grant recipient agrees not to commingle grant funds with other personal or business accounts.
That the grant recipient may transfer between approved line items up to ten percent (10%) or $1,000,
whichever is greater, of any budget category without prior approval, and that that this transfer may be exe-
cuted only once. That a budget amendment may be requested with appropriate justification and approved
in writing by the Department of Juvenile Justice grant administrator without affecting this transfer provi-
sion, and that this method of budget amendment must be in writing and approved prior to the expenditure.
6. That the grant recipient will comply with the Department of Juvenile Justice background screening
requirements. That proof of grant employee screening by DJJ is required. That reimbursements for
payment will not be made to an agency for an employee who has not received a favorable preliminary
screening and a favorable final screening within six (6) months.
20/CG
7. That the program will be monitored for compliance. That the Department of Juvenile Justic~,Q.as access
without notice to the program and all records and information necessary to ensure c()tnpliance. That the
grant recipient will submit quarterly' reports and data. That reimbursements may be withheld if reports are
not received by the due date. That the grant recipient will comply with the policy and procedure packet
distributed upon award of funds.
8. That the grant is a cost-reimbursable grant. That the grant recipient will submit monthly reimbursement
requests within 30 days after the end of each month. That late monthly reimbursement requests may not
be honored for payment. That funds made available under this grant shall not be used to supplant current
(existing) resources. _
9. That the grant recipient shall provide adequate insurance coverage on a comprehensive basis and will hold
such liability insurance at all times during the existence of this grant. That state agencies shall comply
with Section 768.28, Florida Statutes, and verification of liability insurance shall be provided upon request
to the Department.
10. That the grant recipient shall indemnify and hold harmless the Department of Juvenile Justice, upon notice
for any liabilities caused by the grant recipient or its employees' or agents' negligent or tortious acts or
omissions within the'scope of this grant to the limits of sovereign immunity, pursuant to Section 768.28,
Florida Statutes.
11. That the grant recipient will send a representative to any technical assistance training as required provided
by the Department of Juvenile Justice.
12. That the grant recipient will provide specific data and reports to the Department of Juvenile Justice
pursuant to the directive of the Florida Legislature, for the purposes of accountability and in accordance
with established performance-based budgeting standards.
13. That if the grant recipient is a private not-for-profit agency, it will maintain a current and active secular-
based (non-religious) 501(c)(3) Internal Revenue Service designation during the grant period.
14. That the grant recipient shall comply with Chapter 415, Florida Statutes, relating to the reporting of abuse,
neglect and exploitation. That the grant recipient shall comply with the Department of Juvenile Justice,
Inspector General's Statewide Incident Reporting Procedures.
15. That the grant recipient will not use or disclose any information concerning a recipient of services under
this grant for any purpose not in conformity with state statutes and any applicable federal regulations (45
CFR, Part 205.50) except upon written consent of the recipient, or his/her responsible parent or guardian
when authorized by law.
16. That any publication produced under this grant shall contain the following or similar wording: This publi-
cation is funded/partially funded by grant funds awarded by the Florida Department of Juvenile Justice.
17. That the grant recipient will comply with all Department of Juvenile Justice policy memoranda.
I, (print name), certify that this agency will comply with the
assurances given above, and that I am the authorized official of the agency.
(Print) Legal Name of Applicant (Agency)
Signature of Authorized Official
Date
211CG
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FLORIDA DEPARTMENT OF JUVENILE JUSTICE
Combination Grant Application
Technical Review Checklist
. Jt'-
J ITEM Appendix
(if applicable)
Completed Grant Application (one signed original and six copies)
Signed Certification on Page 2
Signed Disallowed Expenditures (Section L, Page 18)
Signed Certification of Assurances (Pages 19 & 20)
Local Criteria (if applicable) Appendix A
Written and Signed Collaborative Agreement Appendix B
Copy of compliance monitoring and/or site visit report (required only
if applicant is currently receiving funding or has received funding within Appendix C
the last three years from the Department of Juvenile Justice). Do not in-
clude confidential or identifying information on juveniles.
A description of the agency or organization (for non-governmental Appendix D
agencies or organizations)
A copy of the agency or organization's current operating budget (for Appendix E
non-governmental agencies or organizations)
A list of the agency or organization's board of directors (for non-gov-
ernmental agencies or organizations) for private not-for-profit, or list of Appendix F
corporate officers for private for-profit organizations
Copies of program-related position descriptions and minimum Appendix G
requirements (education, experience)
Copy of the agency or organization's current secular-based (non-
religious) 501(c)(3) Internal Revenue Service designation (for non- Appendix H
governmental agencies or organizations)
22/CG