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Agenda 08-01-23The City of Boynton Beach City Commission Agenda Tuesday, August 1, 2023, 6:00 PM City Hall Commission Chambers 100 E. Ocean Avenue Boynton Beach City Commission Ty Penserga, Mayor (At Large) Thomas Turkin, Vice Mayor (District III) Angela Cruz, Commissioner (District 1) Woodrow L Hay, Commissioner (District 11) Aimee Kelley, Commissioner (District IV) Daniel Dugger, City Manager David Tolces, Interim City Attorney Maylee De Jesus, City Clerk City Commission Meeting 6:00 PM *Mission* To create a sustainable community by providing exceptional municipal services, in a financially responsible manner. www.boynton-beach.org Welcome Thank you for attending the City Commission Meeting General Rules & Procedures for Public Participation at City of Boynton Beach Commission Meetings The Agenda: There is an official agenda for every meeting of the City Commissioners, which determines the order of business conducted at the meeting. The City Commission will not take action upon any matter, proposal, or item of business, which is not listed upon the official agenda, unless a majority of the Commission has first consented to the presentation for consideration and action. • Consent Agenda Items: These are items which the Commission does not need to discuss individually and which are voted on as a group. • Regular Agenda Items: These are items which the Commission will discuss individually in the order listed on the agenda. • Voice Vote: A voice vote by the Commission indicates approval of the agenda item. This can be by either a regular voice vote with "Ayes & Nays" or by a roll call vote. Speaking at Commission Meetings: The public is encouraged to offer comment to the Commission at their meetings during Public Hearings, Public Audience, and on any regular agenda item, as hereinafter described. City Commission meetings are business meetings and, as such, the Commission retains the right to impose time limits on the discussion on an issue. • Public Hearings: Any citizen may speak on an official agenda item under the section entitled "Public Hearings." • Public Audience: Any citizen may be heard concerning any matter within the scope of the jurisdiction of the Commission - Time Limit - Three (3) Minutes. Regular Agenda Items: Any citizen may speak on any official agenda item(s) listed on the agenda after a motion has been made and properly seconded, with the exception of Consent Agenda Items that have not been pulled for separate vote, reports, and presentations. - Time Limit - Three (3) Minutes. Addressing the Commission: When addressing the Commission, please step up to either podium and state your name for the record. Decorum: Any person who disrupts the meeting while addressing the Commission may be ordered by the presiding officer to cease further comments and/or to step down from the podium. Failure to discontinue comments or step down when so ordered shall be treated as a continuing disruption of the public meeting. An order by the presiding officer issued to control the decorum of the meeting is binding, unless over -ruled by the majority vote of the Commission members present. Please turn off all cellular phones in the City Commission Chambers while the City 2 Commission Meeting is in session. The City of Boynton Beach encourages interested parties to attend and participate in public meetings either in-person or via communications media technology online. To view and/or participate in the City Commission meeting online you have the following options: 1. Watch the meeting online, but not participate: You may watch the meeting via the GoToWebinar platform. Visit the City's website at www.boynton-beach.org to access the up-to-date link to the meeting. 2. Watch the meeting online and provide public comment during the meeting: To request to speak during the meeting, you can electronically "raise your hand" or type a question using the GoToWebinar platform. The meeting moderator will announce when it is your turn to speak or have your question addressed. Please note that time limits will be enforced so comments must be limited to no more than 3 minutes. For additional information or for special assistance prior to the meeting, please contact Maylee De Jesus, City Clerk at cityclerk@bbfl.us or (561) 742-6061. 1. Openings A. Call to Order - Mayor Ty Penserga Roll Call Invocation by Pastor Amalie Ash, First Presbyterian Church. Pledge of Allegiance to the Flag led by Vice Mayor Turkin. Agenda Approval: 1. Additions, Deletions, Corrections 2. Adoption 2. Other Information Items by members of the City Commission. 3. Announcements, Community and Special Events And Presentations A. Career Online High School Graduates - Certificate of Achievement. Present a Certificate of Achievement from Mayor Ty Penserga to Alejandra Garcia and Rozanna Jeune, for successfully earning a high school diploma from Smart Horizons through the Library's Career Online High School Program. 4. Public Audience Individual Speakers Will Be Limited To 3 Minute Presentations (at the discretion of the Chair, this 3 minute allowance may need to be adjusted depending on the level of business coming before the City Commission). 3 5. Administrative 6. Consent Agenda A. Proposed Resolution No. R23-095- Hampshire Gardens Condo Construction and Access Easement. Authorize the Mayor to sign a Construction and Access Easement Agreement to Hampshire Gardens to construct a replacement seawall. B. Legal Invoices June 2023. Information at the request of the City Commission. No action required. C. Purchases over $10,000 for June 2023. Accept the written report to the Commission for purchases over $10,000 for the month of June 2023. 7. Consent Bids and Purchases over $100,000 A. Vehicles to Purchase- Solid Waste Side Loaders Approve the purchase of two (2) replacement vehicles that were approved in the FY22/23 budget for an estimated amount of $789,356 by utilizing the Florida Sheriff's Association Contract FSA22-VEH20.0. B. Proposed Resolution R23-096- A & Associates Annual Blanket Purchase Order & Piggyback Agreement. Approve a blanket Purchase Order with A & Associates of West Palm Beach, FL with an annual expenditure of $150,000 for general laborers needed at various City departments piggybacking the City of Dallas's Contract #POM -2021-00015158 for the period of the contract which expires on August 10, 2026. The City of Dallas's bid process satisfies the City's competitive bid requirements. C. Bid Extensions and Piggy -Backs Over $100,000 Approve the one-year extension for RFPs/Bids and/ or piggy -backs for the procurement of services and/or commodities over $100,000 as described in the written report for August 1, 2023 - "Request for Extensions and/or Piggybacks." D. Proposed Resolution No. R23-097- Replacement of heating ventilating and air conditioning (HVAC) systems at the Women's Club. Approve & authorize the City Manager to sign the City of Boynton Beach agreement, proposal, quote, and approve the replacement of the cooling system at the Women's Club located at 1010 S Federal Highway utilizing the Omnia / Racine County Contract #3341 in the amount of $140,740. 8. Public Hearing 4 6 P.M. or as soon thereafter as the agenda permits. T he City Commission will conduct these public hearings in its dual capacity as Local Planning Agency and City Commission. A. Proposed Ordinance No. 23-014- Second Reading- Environmental Protection Standards Land Development Regulation Amendment (CDRV 23-005). Approve modifications (CDRV 23-005) amending Part III. Land Development Regulations, Chapter 2, Article II, Section 5. Permit Applications and Chapter 4, Article I. Environmental Protection Standards, to create a landscape permit review and approval process and to modify preservation and mitigation regulations. 9. City Manager's Report 10. Unfinished Business A. Update on in-house City Attorney and direction from Commission. Provide direction to Human Resources on which candidates to include on the short list for interviews with the Commission. 11. New Business A. Proposed Resolution No. R23-098- Community Development Block Grant FY 2023 Annual Action Plan. Approve and adopt the City of Boynton Beach's Community Development Block Grant, Second Year Annual Action Plan for FY 2023; and authorizing the City Manager's execution of the required HUD forms and certifications. 12. Legal A. Proposed Resolution No. R23-084- Declaration of Surplus Property. Declare the City owned vacant property (0.0820 acres) located at NW 7 th Court, PCN #08-43-45-20-08-000-0261, as surplus and direct staff on desired disposition process to follow. B. Proposed Resolution No. R23-099- Landscape Permit application corresponding to Ordinance No. 23-014. Approve a proposed application corresponding to Ordinance No. 23-014 (Amendment to Chapter 2, Article II, Section 5. Permit Applications and Chapter 4, Article I. Environmental Protection Standards, Item ID 345-2023 on this agenda) and to be used for work proposed for the existing tree or palm. 13. Future Agenda Items A. Consider revised local rules for approval. - August 15, 2023 Discussion requested by Mayor Penserga. B. Discussion regarding minimum level of service standards for roadways. — Mobility Workshop scheduled for August 29, 2023 Discussion requested by Vice Mayor Turkin. 5 C. Discussion on best practices in regards to regulating tints for paraphernalia shops. - October 2, 2023 Discussion requested by Vice Mayor Turkin. D. Discussion regarding regulations to support local businesses.- November 7, 2023 Discussion requested by Commissioner Cruz. E. Discussion regarding annexation options and procedures. — December 5, 2023 Requested by Commissioner Hay. F. Discussion regarding existing regional programs and best practices to combat homelessness in the City. - March 19, 2024 Discussion requested by Commissioner Hay. G. Advisory Board Annual Reappointments and Appointments. - Tabled from April 4, 2023.- Pending approval of Advisory Board Ordinance City Commission to reappoint and appoint eligible members of the community to serve in vacant positions on City Advisory Boards. 14. Adjournment Notice If a person decides to appeal to any decision made by the City Commission with respect to any matter considered at this meeting, He/She will need a record of the proceedings and, for such purpose, He/She may need to ensure that a verbatim record of the proceedings is made, which record includes the testimony and evidence upon which the appeal is to be based. (F.S. 286.0105) The City shall furnish appropriate auxiliary aids and services where necessary to afford an individual with a disability an equal opportunity to participate in and enjoy the benefits of a service, program, or activity conducted by the City. Please contact the City Clerk's office, (561) 742-6060 or (TTY) 1-800-955-8771, at least 48 hours prior to the program or activity in order for the City to reasonably accommodate your request. Additional agenda items may be added subsequent to the publication of the agenda on the City's web site. Information regarding items added to the agenda after it is published on the City's web site can be obtained from the office of the City Clerk. 6 Announcements, Community and Special Events And Presentations 08/1/2023 City of Boynton Beach Agenda Item Request Form Commission Meeting Date: 08/ 1/2023 Career Online High School Graduates - Certificate of Achievement. Requested Action by Commission: Present a Certificate of Achievement from Mayor Ty Penserga to Alejandra Garcia and Rozanna Jeune, for successfully earning a high school diploma from Smart Horizons through the Library's Career Online High School Program. Explanation of Request: Celebrating this achievement will help bring awareness of this free program and encourage other potential students to participate in the program. How will this affect city programs or services? This program was paid for with State of Florida funding through the Florida State Division of Library and Information Services. Fiscal Impact: There is no fiscal impact to the budget for this item. 7 6.A Consent Agenda 08/1/2023 City of Boynton Beach Agenda Item Request Form Commission Meeting Date: 08/ 1/2023 Proposed Resolution No. R23-095- Hampshire Gardens Condo Construction and Access Easement. Requested Action by Commission: Authorize the Mayor to sign a Construction and Access Easement Agreement to Hampshire Gardens to construct a replacement seawall. Explanation of Request: Hampshire Gardens boarders Jaycee Park's north property line and both properties front the west side of the Intracoastal Waterway (see Exhibit 1 - Location Map). Hampshire Garden's seawall is failing and seasonal king tides top the seawall to flood Hampshire Garden's parking lot. Hampshire Gardens hired an engineer to design the replacement seawall (see Exhibit 2 — Permitted Seawall Sketches). The replacement seawall extends 75' into an unbuildable area within and along the Jaycee Park's property line (see Exhibit 3 — Site Photos). In October 2021, the City co-sign a US Army Corps of Engineers permit application (Exhibit 4 — USCOE Application). Based upon past actions, Staff recommends that the City continue to support the Hampshire Gardens project and grant a permanent easement (Exhibit 5 — Easement) for Hampshire Gardens to perform the agreed upon work. How will this affect city programs or services? The Hampshire Gardens seawall will prevent eroded materials from the Hampshire Gardens site being deposited with the park. The seawall will be built over a portion of the park that is unusable. The City will require that Hampshire Gardens also apply for a building department permit. Fiscal Impact: There is no fiscal impact to the budget for this item. 0 Attachments: R23-095 Access _Easement_Agreement_with_Hampshire_Gardens-_Reso.pdf Exhibit 5 5E" Easement Exhibit 1 - Location Map Exhibit 2 a€" Permitted Seawall Sketches Exhibit 3 5E" Site Photos Exhibit 4 5E" USCOE Application 0 1 RESOLUTION NO. R23-095 2 A RESOLUTION OF THE CITY OF BOYNTON BEACH, FLORIDA, 3 AUTHORIZING THE MAYOR TO SIGN A CONSTRUCTION AND ACCESS 4 EASEMENT AGREEMENT TO HAMPSHIRE GARDENS TO CONSTRUCT A 5 REPLACEMENT SEAWALL; AND PROVIDING AN EFFECTIVE DATE. 0 7 WHEREAS, Hampshire Gardens boarders Jaycee Park's north property line and both 8 properties front the west side of the Intracoastal Waterway; and 9 WHEREAS, Hampshire Garden's seawall is failing and seasonal king tides top the 10 seawall to flood Hampshire Garden's parking lot; and 11 WHEREAS, Hampshire Gardens hired an engineer to design the replacement seawall 12 which extends 75' into an unbuildable area within and along the Jaycee Park's property line; 13 and 14 WHEREAS, the City Commission of the City of Boynton Beach, Florida, upon the 15 recommendation of staff, deems it to be in the best interests of the City residents to approve 16 and authorize the Mayor to sign a Construction and Access Easement Agreement to 17 Hampshire Gardens to construct a replacement seawall. 18 NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE CITY OF 19 BOYNTON BEACH, FLORIDA, THAT: 20 Section 1. Each Whereas clause set forth above is true and correct and 21 incorporated herein by this reference. 22 Section 2. The City Commission of the City of Boynton Beach, Florida does hereby 23 approve and authorize the Mayor to sign a Construction and Access Easement Agreement to 24 Hampshire Gardens to construct a replacement seawall. A copy of the Easement Agreement 25 is attached hereto as Exhibit "A". 26 Section 3. That this Resolution shall become effective immediately upon 27 passage. S:\CA\RESO\Agreements\Aeeess Easement Agreement With Hampshire Gardens - Reso.Doex 10 28 PASSED AND ADOPTED this 1 st day of August, 2023. 29 CITY OF BOYNTON BEACH, FLORIDA 30 31 YES NO 32 33 Mayor — Ty Penserga 34 35 Vice Mayor — Thomas Turkin 36 37 Commissioner —Angela Cruz 38 39 Commissioner — Woodrow L. Hay 40 41 Commissioner —Aimee Kelley 42 43 VOTE 44 45 46 47 ATTEST: 48 49 50 Maylee De Jes6s, MPA, MMC Ty Penserga 51 City Clerk Mayor 52 53 APPROVED AS TO FORM: 54 (Corporate Seal) 55 56 57 David N. Tolces 58 Interim City Attorney 59 60 S:\CA\RESO\Agreements\Access Easement Agreement With Hampshire Gardens - Reso.Doex 11 PREPARED BY AND RETURN TO: Scott J. Lee, Esq. SJW Law Group, PLLC 12300 South Shore Boulevard, Suite 202 Wellington, Florida 33414 CONSTRUCTION AND ACCESS EASEMENT AGREEMENT THIS CONSTRUCTION AND ACCESS EASEMENT AGREEMENT ("Easement and Access Agreement"), made this IS day of .0 ;-g e , 2023, by the following property owner: Name: City of Boynton Beach, a Florida municipal corporation (herein called the "Owner") granted in favor of Hampshire Gardens, Inc. address: c/o Scott J. Lee, Esq., 12300 South Shore Boulevard, Suite 202, Wellington, Florida 33414 (herein called "Grantee"), and WITNESSETH: That the said Owner, in consideration of the sum of One Dollar ($1.00) and other good and valuable consideration, the receipt of which is hereby acknowledged, hereby grants unto Grantee and its successors, agents, and assigns a non-exclusive permanent easement and rightofway for the purpose of doing everything necessary and incidental as involving that certain construction, reconstruction, and maintenance of the seawall at and on Owner's property including without limitation presently providing access to Owner's Property, together with access over that portion of the Owner's Property reasonably required for Grantee to prepare, perform and do agreed upon work related to that certain construction and reconstruction of the seawall, as well as to maintain such seawall at and on Owner's Property. The Owner's Property is situated and being in the County of Palm Beach and State of Florida, and is further described as follows.. SEE EXHIBIT "A" ATTACHED HERETO. TO HAVE AND TO HOLD THE SAME unto the Grantee, its successors, agents, and assigns a perpetual easement for the purposes expressed herein; The sole purpose of this Easement and Access Agreement is to provide Grantee the right and obligation to prepare, perform and do agreed upon work related to that certain construction and reconstruction of the seawall on Owner's Property as well as to permanently maintain such seawall. The Parties agree further as a part of the consideration of this conveyance that Grantee shall use this easement and access rights in a manner that will in no way hinder or prevent the proper and reasonable access to and from the Owner's Property. As a further condition to the conveyance, Grantee, at Grantee's own cost and expense, shall repair and maintain, any damage done to Owner's Property which are damaged as the result of Grantee preparing and performing certain agreed upon work related to the construction and reconstruction of the seawall, at the perimeter of Owner's property in accordance with the terms of this Easement and Access Agreement; provided as well as to maintain and repair the easement area at Grantee's sole cost and expense. 12 The Grantee agrees to defend at its sole cost and expense (if requested by Grantor), release, indemnify and hold Owner, its subsidiaries, public officials, officers, directors, agents, and employees of each, harmless from and against any and all such claims, suits, judgments, damages, losses and expenses (including reasonable attorneys' fees) or demands, including demands arising from or in any way connected with (i) the use and enjoyment of the Owner's Property by the Grantee and/or any other party claiming by, through or under the Grantee (collectively, the "Grantee Parties"), (ii) any breach of this Agreement by the Grantee and/or any of the Grantee Parties and (iii) injuries or death of persons (including Owner's employees) and damage to property arising out of any negligent acts, errors, omissions or willful misconduct of the Grantee and/or the Grantee Parties. So long as this Easement and Access Agreement remains in effect, all conditions and covenants set forth herein are intended to be and shall be construed as covenants running with the land, binding upon and inuring to the benefit of the Owner or Grantee, as the case may be, and their respective heirs, successors and assigns, including, without limitation, all subsequent owners and/or tenants of the Property and all persons claiming by, through and under them. During the term of this Easement and Access Agreement, the Grantee shall keep and maintain insurance, at Grantee's expense, in such a form and amount as required by the Owner and as may be required by law, prior to entering the Owner's Property. Grantee shall provide the Certificates of Insurance to the Owner prior to entering on the Owner's Property. The terms of this Easement and Access Agreement may be enforced by Owner by injunctive relief and any other available remedies. By way of example, and not limitation, Owner shall be entitled to enjoin any activity or use of the Owner's Property that is inconsistent with the rights granted to the Grantee pursuant hereto. In the event the Grantee breaches the maintenance obligations of this Easement and Access Agreement, the Owner may choose to maintain the Owner's Property and charge the Grantee for the work performed. Payments for said work shall be made by Grantee to Owner within thirty (30) days of receipt of invoice. The Grantee shall inform all parties performing work for it that such parties shall not have the right to file any liens against the Owner's Property, and, if any such liens occur, then the Grantee shall remove any such liens, or the Grantee shall release or transfer to bond any such liens, within ten (10) days of notice thereof. This Easement and Access Agreement may only be terminated by mutual execution by the parties of a termination of easement agreement to be recorded in the public records of Palm Beach County, Florida. In the event the Owner desires to install a seawall or other structure on the Owner's Property, the Grantee shall cooperate with the Owner and the Grantee shall allow connection with either the seawall or other structure. The expense for the construction and design of the seawall or other structure under this paragraph shall be borne by the Owner. Once the connection is made, the Owner is permitted to alter the seawall constructed by the Grantee at the Owner's expense, provided the Owner's alteration does not structurally impair the seawall. IN WITNESS WHEREOF, said Owner and Grantee has hereunto entered into this Easement and Access Agreement as of the date first above written. Signed, sealed and delivered in the presence of: GRANTEE: Hampshire Gardens, Inc. t ( ' niss signature) A2 -_L Print: 6v m' ""'l, (Print name of Witness) `FC] Title:% (Witness signature) ! (Print name of Witness) STATE OF FLORIDA ) )ss: COUNTY OF PALM BEACH HEREBY CERTIFY that on this day, before me, an officer duly authorized in the State and County aforesaid to take acknowledgments, personally appeared'.%kugc 5 to me known to be the persons described in or who have produced as identification and by way of physical presence [ ] or online notarization [ ] who executed the foregoing instrument and acknowledged before me that they executed the same for the purposes therein expressed. WITNESS my hand and official seal in the County and State last aforesaid this day of S-1. , _ , 2023. Notary Public v A Ton! R O'Ccnnell S n.W s ` R�at�lic, State of �' �a [i Ccmrn. 1� 50102`176 n ��._. y ,zslon Expires: Print: M Comrn tedditional signature, witness, and notary on following page] IN WITNESS WHEREOF, said Owner has hereunto entered into this Easement and Access Agreement as of the date first above written. Signed, sealed and delivered in the presence of: OWNER: City of Boynton Beach, a political subdivision of the State of Florida By (Witness signature) (Print name of Witness) (Witness signature) Ty Penserga, Mayor (Print name of Witness) 14 STATE OF FLORIDA ) )SS: COUNTY OF PALM BEACH I HEREBY CERTIFY that on this day, before me, an officer duly authorized in the State and County aforesaid to take acknowledgments, personally appeared Ty Penserga, Mayor, of the City of Boynton Beach on behalf of the City, to me known to be the persons described in or who have produced as identification and by way of physical presence [ ] or online notarization [ ] who executed the foregoing instrument and acknowledged before me that they executed the same for the purposes therein expressed. WITNESS my hand and official seal in the County and State last aforesaid this day of 2023. Notary Public Sign: MY Commission Expires: Print: Page 5 of 5 15 16 W rr J Y4J 1 l I. Gi 1 7 #i (wr t Ih' 0 1000 2000 r � ;! �rlm d j rk. i&�IIfih" SCALE IN FEET 1"=2000' F—do ;(ditk'iP9k2,�'„i��/i'i„1/,/s i k f. i ................ , l ,f LL ASN ': i moi uumi ��� i I J! .�r j i ri l�lr i lir �r,� I.m ...r.. "1-: m ' ��{ ”' ' , fP{9"r1 r C 0 x'v7 (( i 1'I .q„ r In �9 cTYi4"R' raw w"' �J / ;{ i ! ra� f ¢ rif';ri �i r/r lilt r�llir �/i -'h"y a ^:. C , I r ... _r.. 9 iu Xrh"ekI / ^ �i u uk tlR I i✓ ri/ l ri r r p Y� PROJECT ! f f III r SITE ,.rE �,�,..I d a 1 Ilii rk u Irk"4 p I'k S"ld 1 r ! ' rw �wJii� fir'! +! IP, t 1 ( p41 ,k s' Btl (�' %✓.�r��%l/ lr o � � ,' I , i / ,ill r 7 � �"a"vmu" �� f 11, �1��. L L . / /l/ �rrrl�.��,�/ii%%�!,/�i/1. ll � �. � r � l u r„ ,•� r °• I r ), �.. �v � FY d r i i 'ya.. ,,J J� ��� d � uV17�1 9 1 i d r 1 I i I J �bli� p Y P �, a r NJ 1.. t J r r I/f/JF`r✓ d ?fel s r r 1 I � MV F+ ✓ rk / ,/k � �. yy i h 1 r� r i r 4 Y t I 5 l�Ia imv, j1 k1 .iy _. A),.,� 67 '"1. / 9, �i� ( IJ l p f 6 P I V fl �[ �. ��� AI gijJ", {� �., 1{� � M n ' - �.a� � � �_ u� r 4'7t: ✓ " m' ,. ,� ,. Iw �j � , n j �. jr �.+o u n QI,F' '. l'' ;�' TAKEN FROM U.S.G.S. DELRAY BEACH & LAKE WORTH, FLORIDA QUADRANGLES SEC: 33/34 TWP: 45S RGE: 43E VICINITY MAP LAT: 26° 30' 21" N ����$IYNINIIfI�7 ISIMINGER & STUBBS LONG: 080° 03'27" W � '���',�"I D 11,j ��/,r v ENGINEERING, INC. �x.,,SM. 1 . •g' „.. y`�• y�'� COASTAL • ENVIRONMENTAL • MARINE REGISTRATION NUMBER: 8114 This item has been digitally sighed and ^„^ ^ P.O. BOX 14702- NORTH PALM BEACH, FL 33408 -561-881-0003 sealed by Matthew D. Butler, P.E. on y” N0„74039 PROPOSED SEAWALL REPLACEMENT 11/8/2021 using a Digital Signature. 'INTRACOASTAL WATERWAY Printed copies of this document are not = 2500 SOUTH FEDERAL HIGHWAY STATconsidered signed and sealed, and the' CITY OF BOYNTON BEACH, PALM BEACH COUNTY, FL signature must be verified on any{{A"",a w„•"qr APPLICANTS: HAMPSHIRE GARDENS, INC. & CITY OF BOYNTON BEACH electronic copies. ✓ ......... ,^r ,,,W"M DATE 1 11/21 1 DRAWN I MDB CHKD KDB APPRVD I MDB r7 CONAL r—w�N+" DWG NO. 21125A1 SHEET i"�'`�` COMPUTER. FILE NO. 21125A OF 3 1719 APPROX. PROPERTY LINE ICW RIGHT OF WAY --I UPLAND MULTI -FAMILY RESIDENCES EXISTING SEAWALL (MHWL AT FACE) TO BE REPLACED IMMEDIATELY WATERWARD OF ITS EXISTING LOCATION EDGE OF ASPHALT - APPROX. PROPERTY LINE EXISTING LIGHT POLE (TYP.) EXISTING FENCE UPLAND PARK (JAYCEE PARK) NOTE: MANGROVES SOUTH OFFENCE (NOT SHOWN FOR CLARITY) 217'± 400'± AL I I I I 52'± I I I I I I I I I NO SUBMERGED I I RESOURCES ON-SITE I I I I I I I I I I I z I I z I 1A I Z I I U I I � I I U 1 I I I I I I I I 63'± I I I I I I I I I I IT 19'± I I I PROPOSED SEAWALL (749± L.F. TOTAL) I APPROX. I PROPERTY LINE I I . I I NO SUBMERGED I RESOURCES ON-SITE --16'+ 23'+i 1---f I 50 24't� ~r 724 I I I � I I I I APPROX. MHWL I I I EXISTING DOCK TO REMAIN PLAN VIEW N 0 50 100 SCALE IN FEET 1 "=100' 0A%%1 I Iffljjji/// i A ) � //, .`" "1IT 1 N(7, 74039 NATE OF r' XS L 0t , 'et/ t OPV A N' IIIIII This item has been digitally signed and sealed by Matthew D. Butler, P.E. on 11/8/2021 using a Digital Signature. 13IMINGER 4X NTUBBS Q ENGINEERING, INC. Printed copies of this document are not considered signed and NOTES: sealed, and the signature must be Verified On any electronic copies. COASTAL • ENVIRONNIENPAL • MARINE REGISTRATION NUMBER: 8114 P.O. BOX 14702- NORTH PALM BEACH, FL 33408-561-881-0003 PROPOSED SEAWALL REPLACEMENT 1. EXISTING LOCATIONS ARE APPROXIMATE BASED ON SURVEY BY MILLER I NTRACOASTAL WATERWAY LAND SURVEYING, DATED 9/10/20, AND ON-SITE OBSERVATIONS. 2500 SOUTH FEDERAL HIGHWAY 2. RESOURCE INFORMATION BY ISIMINGER & STUBBS ENGINEERING, INC. CITY OF BOYNTON BEACH, PALM BEACH COUNTY, FL FIELD WORK PERFORMED 6/7/21. NO RESOURCES OBSERVED ON-SITE. APPLICANTS: HAMPSHIRE GARDENS, INC. & CITY OF BOYNTON BEACH DATE 11/21 1 DRAWN I MDB CHKD K APPRVD MDB SKETCH SUBMITTED FOR ENVIRONMENTAL PERMIT REVIEW. DWG NO. I 21125A2 SHEET Ift NOT INTENDED FOR CONSTRUCTION OR BUILDING PERMIT REVIEW. COMPUTER FILE NO. 21125A OF 3 1 721 EXISTING SEAWALL (SCHEM.) TO BE REPLACED IMMEDIATELY WATERWARD OF ITS EXISTING LOCATION No,74039 STATE OF rt � OPV AL 111111 NOTES: PROPOSED SEAWALL CAP (SCHEM.) PROPOSED SEAWALL (SCHEM.) PROPOSED BATTER PILE (SCHEM.) MHW = 25± (0.3'± NAVD) PROPOSED KING PILE (SCHEM.) 12"±- 18"± NOTE: THE MEASUREMENT TO BE TAKEN FROM THE WET FACE OF THE EXISTING SEAWALL TO THE WET FACE OF THE NEW SEAWALL PANEL, AT THE MHWL. SECTION A -A 0 2.5 5 SCALE IN FEET 111=5' This item has been digitally signed and sealed by Matthew D. Butler, P.E. on 11/8/2021 using a Digital Signature. Printed copies of this document are not considered signed and sealed, and the signature must be verified on any electronic copies. 1. DATUM IS MLW. MLW = -2.2'± FROM LABINS DATABASE. 2. EXISTING LOCATIONS ARE APPROXIMATE BASED ON SURVEY BY MILLER LAND SURVEYING, DATED 9110/20, AND ON-SITE OBSERVATIONS. 3. SOUNDINGS BY ISIMINGER & STUBBS ENGINEERING, INC. FIELD WORK PERFORMED 617121. SOUNDINGS REDUCED TO MLW BASED ON PREDICTED TIDES ONLY. SKETCH SUBMITTED FOR ENVIRONMENTAL PERMIT REVIEW. NOT INTENDED FOR CONSTRUCTION OR BUILDING PERMIT REVIEW. APPROX. EXISTING GRADE (TYP.) SECTION VIEW ISIMINGER & STUBBS y ENGINEERING, INC. COASTAL • ENVIRONNIENrAL • MARINE REGISTRATION NUMBER: 8114 P.O. BOX 14702- NORTH PALM BEACH, FL 33408-561-881-0003 PROPOSED SEAWALL REPLACEMENT INTRACOASTAL WATERWAY 2500 SOUTH FEDERAL HIGHWAY CITY OF BOYNTON BEACH, PALM BEACH COUNTY, FL APPLICANTS: HAMPSHIRE GARDENS, INC. & CITY OF BOYNTON BEACH DATE 1 11/21 1 DRAWN I MDB CHKD KDB I APPRVD I MDB DWG NO. I 21125A3 SHEET r% COMPUTER. FILE NO. 21125A OF 3-172 a 20 I I 21 cma a) 0 —E a) 2: o0 -2 o 15 z= a) m 0 - 0 .— 0 (D a) cc a) 0 0 0 a- E 0 0 0 M 21 U.S. Army Corps of Engineers (USACE) Form Approved - ,,I A APPLICATION FOR DEPARTMENT OF THE ARMY PERMIT OMB No. 0710-0003 x Expires: 8 01-08-201 33 CFR 325. The proponent agency Is CECW-CO-R. I-Ekly-OWPI), AT11Xq,1wNT' be subject to any penalty for failing to comply with a collection of Information if It does not display a currently valid OMB control number, PRIVACY ACT STATEMENT :'Authorities: Rivers and Harbors Act, Section 10, 33 USC 403; Clean Water Act, Section 404, 33 USC 1344; Marine Protection, Research, and Sanctuaries Act, Section 103, 33 USC 1413; Regulatory Programs of the Corps of Engineers, Final Rule 33 CFR 320-332. Principal Purpose: Information provided on this form will be used in evaluating the application for a permit. Routine Uses: This Information me% be shared with the Dgnartment of Justice and other 1� -locaLgover ment agencies. and the public and may be made avalla 4 =.. is voluntary, however, If information is not provided the permit application cannot be evaluated nor can a permit be Issued. One set of original drawings or good and be submitted to the District Engineer having jurisdiction over the location of the proposed activity. An application that Is not completed In full will be returned. System of Record Notice (SORN). The information received Is entered Into our permit tracking database and a SORN has been completed (SORN #A1 145b) and may be accessed at the following websfte: hUftlX12111,111 iniguirgm i swai 4,, N a I n d extDQ D!w ld e-8 0 R a _J ............... ......... . .............................. ............ .. ........................ 1. APPLICATION NO. FIELD OFFICE CODE 3. DATE RECE[V��ED DATE APPLICATION COMPLETE 1 (ITEMS BELOW TO BE FIUED BYAPPLICANT) 1� 5. APPLICANT'S NAME 8. AUTHORIZED AGENT'S NAME AND TITLE (agent Is not required Vi First - Middle - Last - First - Matthew Middle -D. Last - Butler, P.E. Company - City of Boynton Beach Company - Isiminger & Stubbs Engineering Inc. E-mail Address - Address -tnbutier@coastal-engineers.com 6. APPLIC ADDRESS: 9. AGENTS ADDRESS: Address- P.O. Box 3 10 Address- 649 U.S. Highway 1, Suite 9 City - Boynton Beach State - FL Zip - 33425 Country -USA City - N Palm Beach State - FL Zip - 33408 Country -USA T�iPPLICANT`S PHONE NOs. WAREA CODE 10. AGENTS PHONE NOs. MAREA CODE a. Residence b. Business c. Fax a. Residence b. Business c. Fax 561-881-0003 561-881-8123 STATEMENT OF AUTHORIZATION 11. 1 hereby authorize, IsIminge ,Stubbs E g., Inc. to act in my behalf as my agent In the processing of this application and to furnish, upon request, supplemental inforrRaii—on in support of this permit application. 9ii5iTTT_QRK 70T APPE-16M D_A_YE___'_ NAME, LOCATION, AND DESCRIPTION OF PROJECT OR ACTMTY PROJ CT NAME OR TITLE (see instructions) pshire Gardens Condo Seawall Replacement 113. NAME OF WATERBODY, IF KNOWN (if applicable) 14. PROJECT STREET ADDRESS (if applicable) Intracoastal Waterway Address 2500 South Federal Highway 15. LOCATION OF PROJECT City Boynton Beach State- FL Zip- 33435 Latitude: -N 26 30 21 Longitude: -W 80 03'27" 16. OTHER LOCATION DESCRIPTIONS, IF KNOWN (see Instructions) State Tax Parcel ID 08-43-45-34-00-000-7010 Municipality Boynton Beach Section - 33/34 Township - 45S Range - 43E EFIG FORM 4346, SEP 2017 PREVIOUS EDITIONS ARE OBSOLETE. Page 1 of'F '22 17. DIRECTIONS TO THE SITE From I-95, exit Woolbright Road and head east. Turn right onto South Federal Highway, and the project site is ahead on the left. 1.8. Nature of Activity w., .(Descri_.,ption of project, include all features The proposed project consists of the replacement of the existing, functional seawall within 18"± waterward of its existing location. It is anticipated that the seawall would be constructed with concrete panels, concrete icing piles, concrete batter piles, and a concrete cap. The seawall panels and piles would likely be installed by jetting. 19. Project Purpose (Describe the reason ......W....,� . ........._...._�,.__.�...__.._.._-.....-.............._....�....�..ww-w��-��....��.�..�ww.......,.aaaaw�,...._..._���ww� �_..�w_........ . or purpose of the project, see instructions) The project purpose is shoreline stabilization. ��....,. - USE BLOCKS 20-23 IF DREDGED AND/OR FILL MATERIAL IS TO BE DISCHARGED 20. Reason(s) for Discharge N/A 21. Type(s) of Material Being Discharged and the Amount of Each Type in Cubic Yards: Type Type Type Amount In Cubic Yards Amount in Cubic Yards Amount in Cubic Yards N/A N/A N/A _..— .. ................... _. __.. ....�.M......M..... ....�..w....._ � .w......._.w 22. Surface Area in Acres of Wetlands or Other Waters Filled (see instructions) Acres N/A or Linear Feet N/A s .._.......... 23. Description of Avoidance, Minimization and Compensation (see instructions) �_.._...ww...._. N/A ENG FORM 4345, SEP 2017 Page 2 of 23 24. Is Any Portion of the Work Already Complete? []Yes ®No IF YES, DESCRIBE THE COMPLETED WORK 25. Addresses of Adjoining Property Owners, Lessees, Etc., Whose Property Adjoins the Waterbody lit more than can be entered hare, pleaseattach lisp .._,._...._.... - attach a supplemental lisp. a. Address- 26 Colonial Club Drive City - Boynton Beach State - FL zip - 33435 b. Address- 12455 Tuscany Bay Boulevard City - Boynton Beach State - FL Zip - 33435 c. Address- city - State - Zip - d. Address- city - State - Zip - e. Address- City - State - Zip - �,.._www..,._........... ......... 26. List of Other Certificates or Approvals/Denials received from other Federal, State, or Local Agencies for Work Described in This Application. AGENCY TYPE APPROVAL* IDENTIFICATION DATE APPLIED DATE APPROVED DATE DENIED NUMBER * Would include but Isnot restricted to zoning, building, and flood plain permits _ _ 27. Application Is hereby made for permit or permits to authorize the work described in this application. I certify that this information in this application is complete and accurate. I further certify that I possess the authority to undertake the work described herein or am acting as the duly authorized agent of the applicant. ...... _.... SIGNATURE OF APPLICANT-- -- DATE- SIGNATURE OFAGENT�pm "M---pgTE....... The Application must be signed by the person who desires to undertake the proposed activity (applicant) or it may be signed by a duly authorized agent if the statement in block 11 has been filled out and signed. 18 U.S.C. Section 1001 provides that: Whoever, in any manner within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies, conceals, or covers up any trick, scheme, or disguises a material fact or makes any false, fictitious or fraudulent statements or representations or makes or uses any false writing or document knowing same to contain any false, fictitious or fraudulent statements or entry, shall be fined not more than $10,000 or imprisoned not more than five years or both. ENG FORM 4345, SEP 2017 Page 3 of 24 M. - Consent Consent Agenda 08/1/2023 Legal Invoices June 2023. Requested Action by Commission: Information at the request of the City Commission. No action required. Explanation of Request: Outside counsel invoices received through Risk Management are also included. Goren, Cherof, Doody & Ezrol, P.A. Legal $ 32,317.20 Department Goren, Cherof, Doody & Ezrol, P.A. Risk $ 8,810.00 M Management Outside Counsel $ 9,571.17 TOTAL $ 50,698.37 How will this affect city programs or services? n/a Fiscal Impact: No Fiscal Impact. All items are budgeted. Attachments: Goren Cherof Risk Litigation June 2023 Invoices.pdf Goren Cherof Doody Ezrol June 2023 Invoices.pdf Johnson Anselmo - Smith vs Police Officers - Berben June 2023.pdf Kopelowitz Ostrow - Sohn Arbitration May 2023.pdf Johnson Anselmo - Estate of Davis June 2023.pdf Wydler Law - Smith vs Police Officers June 2023.pdf Olds & Stephens - Smith vs Police Officers - Herny June 2023.pdf Roberts Reynolds - Geraci vs Zeller - June 2023.pdf Roberts Reynolds - Beecher vs Felix June 2023.pdf Roberts Reynolds - Smith vs Police Officers - Sohn (June 2023).pdf Johnson Anselmo - Ultimate Bakery June 2023.pdf Roberts Reynolds - Readon - June 2023.pdf 25 GOREN.CHEROF.00ODY&EZROLP.A. Attorneys at Law 3OB8East Commercial Boulevard Suite 200 Fort Lauderdale, Florida 333O8 Telephone (954)771-45OO CITY OF BOYNTON BEACH 180E.Ocean Avenue Boynton Beach FL 33435 Attn: Lynn Swanson odvMotaChonwodi|no-Homing|nnFedara Lawsuit Billing Category: 18-RLO Claim #19780873 ACCOUNT NO: STATEMENT NO: 06/29/2023 MDC review status of pending cost appeal and prepare update to interim counsel FOR CURRENT SERVICES RENDERED TIMEKEEPER Michael D. Cirullo TOTAL CURRENT WORK BALANCE DUE RECAPITULATION HOURS HOURLY RATE 0.20 $225.00 AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE Poge:1 07/O/2023 306-9905423 48951 HOURS 0.20 020 45.00 TOTAL $45.00 45.00 $45.00 ��� GOREN.CHEROF.DOODY&EZROL.P�� Attorneys at Law 309QEast Commercial Boulevard Suite 200 Fort Lauderdale, Florida 333O8 Telephone (Q54)771'450O CITY OF BOYNTON BEACH 1D0E.Ocean Avenue ACCOUNT NO: Boynton Beach FL 33435 STATEMENT NO: Attn: Lynn Swanson odv. /Acin.Joey (police vehicle accident) Billing Category: 18-RLO Claim #21855649 HOURS 88/08/2023 AGL Receipt and review ofmotion buamend complaint; proposed agreed order onmotion toamend complaint; preparation ofrevision hoproposed order to protect City's interest; preparation of correspondence to Plaintiff counsel regarding changes made hmproposed order 1.00 06/09/202 &GL Receipt and review of correspondence from Plaintiff with attached letter to judge, and agreed order mnmotion boamend answer. 0.20 06/13/2023 AGL Receipt and review ofamended complaint; review ofnotice tocity pursuant to FS Section 768.28;begin preparation ofanswer and affirmative defenses to amended complaint. 2.00 06/14/2023 AGL Continued preparation and completion offinal draft ofanswer and affirmative defenses to amended complaint; preparation of correspondence tnC|ty regarding same and regarding discovery issues. 1.60 06/15/2023 ABL Review Request for Production; Preparation cfemail toCOBB regarding Request; detailing document categories requested and our anticipated responses; Request for documents bmbeprovided. 0.60 06/22/2023 AGL Review cfPlaintiffs Request for Interrogatories; begin preparation nf responses; preparation nfdetailed correspondence toCOBB requesting specific information necessary bmrespond hminterrogatories. 2.20 FOR CURRENT SERVICES RENDERED 7.60 RECAPITULATION TIMEKEEPER HOURS HOURLY RATE TOTAL Adam G. Levine 7.60 $225.00 $1,710.00 TOTAL CURRENT WORK BALANCE DUE AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE Page:1 U7/O/2023 306-9905576 48959 1,710.00 1,710.00 $1,710.00 GOREN.CHEROF.DOODY&EZRDLP�� Attorneys at Law 309QEast Commercial Boulevard Suite 200 Fort Lauderdale, Florida 333O8 Telephone (Q54)771'45OO CITY OfBOYNTONBEACH 0701/2023 1D0E.Ocean Avenue ACCOUNT NO: 306-9005508 Boynton Beooh FL 33435 STATEMENT NO: 48960 Attn: Lynn Swanson adv. PaazU.Danea Billing Category; 18- RLD Claim #21870337 AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE l - � \�~�� HOURS 0801Q023 CU] Drafted Notice ufNon Party Production (7enddeu);begin drafting subpoenas. i�B] CLD Continued drafting non-party subpoenas for production ofrecords. 0.80 06/02/2023 CLD Continued drafting non-party subpoenas for records. 0.40 06/22/2023 AGL Telephone call with state farm to ascertain which state farm entity provided plaintiff with PIP coverage, 0.20 06/26/2023 CU] Drafted, finalized and filed Notice ofNon Party Production and subpoenas aatoShecbanSpine Institute and State Farm. 1.00 FOR CURRENT SERVICES RENDERED 3.90 507.50 RECAPITULATION TIMEKEEPER 7lMBKEEPER HOU�$, HQ0IRLYIRATE TOTAL CynthiaL. Dunn 3.70 S125.00 $462.50 Adam G.Levine 0.20 225.00 45.00 TOTAL CURRENT WORK 507.50 BALANCE DUE s507.50 AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE l - � \�~�� 8OREN.CHEROF.DDODY&EZROLP/A. Attorneys at Law 3099 East Commercial Boulevard Suite 200 Fort Lauderdale, Florida 33308 Telephone (R54)771 -450O CITY OFBDYNTONBEACH 1O0E.Ocean Avenue ACCOUNT NO Boynton Beach FL 33435 STATEMENT NO Attn: Lynn Swanson adv. Wynne, Sharon Billing Category: 18-RLO Claim #21870546 06/30/2023 AGL Receipt and review of correspondence from Tristar requesting myinput ae b/aclaim investigation ofliability; review file inpreparation ofreply; preparation ofreply FOR CURRENT SERVICES RENDERED TIME. -KEEPER Adam G.Levine TOTAL CURRENT WORK BALANCE DUE RECAPITULATION HOURS HOURLYRATE 1.10 $225.00 AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE Page:1 07/01/2023 306-9005599 48961 HOURS ijO 1.10 247.50 TOTAL $247.50 247.50 $247.50 GOREN, CHEROF, DOODY & EZROL, P.A. Attorneys at Law 3099 East Commercial Boulevard Suite 200 Fort Lauderdale, Florida 33308 Telephone (954) 771-4500 CITY OF BOYNTON BEACH 100 E. Ocean Avenue ACCOUNT NO: Boynton Beach FL 33435 STATEMENT NO: Attn: Lynn Swanson adv. Devon Schulte, Staci Schulte, and Tyler Schulte (MVA) Billing Category No. 18 - RLO 06/28/2023 AGL Prepare separate motion to deem admissions admitted for Devon, Staci and Devon as father and guardian of TS; prepare separate motions to compel discovery for Devon, Staci and Devon as father and guardian of TS; receipt and review of request for case evaluation memo from Diana Taylor; begin preparation of case evaluation memo to Diana Taylor 06/30/2023 AGL Continued preparation and finalization of requested first report to Tristar; preparation of correspondence to Tristar regarding first report FOR CURRENT SERVICES RENDERED TIMEKEEPER Adam G. Levine TOTAL CURRENT WORK BALANCE DUE RECAPITULATION HOURS HOURLY RATE 6.30 $225.00 AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE Page: 1 07/01/2023 306-9905639 48964 HOURS 4.40 1.90 6.30 1,417.50 TOTAL $1,417.50 1,417.50 $1,417.50 "430 GOREN, CHEROF, DOODY & EZROL, P.A. Attorneys at Law 3099 East Commercial Boulevard Suite 200 Fort Lauderdale, Florida 33308 Telephone (954) 771-4500 CITY OF BOYNTON BEACH 100.E. Ocean Avenue Boynton Beach FL 33435 Attn: Lynn Swanson adv. Jeffrey Grant Sands Billing Category No. 18 - RLO Claim No. 23902503 ACCOUNT NO STATEMENT NO HOURS 06/01/2023 AGL Research regarding State Farm address and information supporting subpoena duces tecum in preparation for SDT and notice of non party production 1'.00 06/06/2023 AGL Telephone conference call Morgan Chaloupka regarding discovery responses in this matter; preparation of correspondence to city summarizing issues discussed in phone conference; receipt of several email messages from Morgan concerning discovery issues and documents responsive to Plaintiffs requests; continued preparation of answers to interrogatories; continued preparation of responses to request for admissions based on newly provided information 3.50 06/07/2023 AGL continued revisions and edits to Response to request for production and answers to interrogatories based on newly acquired information from city; finalize production and interrogatory responses; review of several correspondence from Morgan Chaloupka as to issues and information to be utilized in responses to plaintiffs discovery requests. 3.80 06/08/2023 AGL Prepared motion for enlargement of time to respond to first interrogatories; preparation of proposed agreed order on motion 1.20 06/09/2023 AGL Receipt and review of correspondence from Plaintiff re: no objection to our Motion for extension regarding the RFA 0.20 06/13/2023 AGL Preparation of email correspondence to Tremain Johnson; Telephone conference call with Tremaine Johnson; Continued preparation and revisions to response to request for admissions; preparation of correspondence to City attaching draft response to request for admissions. 2.20 FOR CURRENT SERVICES RENDERED 11.90 RECAPITULATION TIMEKEEPER HOURS HOURLY RATE TOTAL Adam G. Levine 11.90 $225.00 $2,677.50 Page: 1 07/01/2023 306-9905677 48970 2,677.50 QOREN.CHEROF.00ODY&EZROL.P�� Attorneys at Law 3090East Commercial Boulevard Suite 200 Fort Lauderdale, Florida 333O8 Telephone (Q54)771~45O0 CITY OFBOYNTONBEACH 1O0E.Ocean Avenue ACCOUNT NO: Boynton Beach FL 33435 STATEMENT NO: Attn: Lynn Swanson edv. Katherina Molina (subrogation ofdamages bopolice vehicle #3QUO) Billing Category No. 18-RLO 06/23/2023 AGL Review email history todetermine ifCOBB advised that subrogation check was received; Preparation of correspondence hoCity inquiring whether C|h/ received funds. 06/26/2023 AGL Receipt and review ofupdate email from Diana Taylor; telephone call bo Allstate adjuster handling claim; preparation ofcorrespondence hoCity advising ofsame. FOR CURRENT SERVICES RENDERED RECAPITULATION TIMEKEEPER HOURS HOURLY RATE Adam G.Levine 0.70 $225.00 TOTAL CURRENT WORK AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE Page: 1 O701D023 306'0005884 48971 HOURS 0.30 0.40 0.70 157.50 TOTAL. $157.50 157.50 $157.50 ��� GOREN.CHEROF.DOODY&EZROLP/� Attorneys at Law 3099 East Commercial Boulevard Suite 200 Fort Lauderdale, Florida 333O8 Telephone (Q54)771'45O0 CITY OFBOYNTONBEACH 1UOE.Ocean Avenue ACCOUNT NO Boynton Beach FL 33435 STATEMENT NO Attn: Lynn Swanson adv. Mary Larson (trip and fall nnsidewalk in front ofJaycee Park 'OA3/2O/21) Billing Category No. 1D-RLO 88/07/2023 AGL Receipt and review ofnewly served complaint; review each allegation and begin formulation ofresponses hmeach allegation hobeput into enanswer 06/08/2023 AGL Research concerning 768.28(6)requirement that uclaimant provide 180 days hmallow city ioinvestigate matter; 7G8.28(S)quality ofnotice and specific information hmbeprovided; regarding requirement that Plaintiff allege that City denied claim and waived sovereign immunity, inpreparation for Motion to Dismiss complaint; draft motion todismiss complaint. 06y26/2023 &GL Edit and finalize motion hodismiss complaint FOR CURRENT SERVICES RENDERED TIMEKEEPER Adam G.Levine TOTAL CURRENT WORK BALANCE DUE RECAPITULATION HOURS HOURLY RATE AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE Page 1 U7/O1/2023 300'9905889 48972 HOURS 0.90 4.80 0.90 6.60 1.485.00 TOTAL $1'485.00 1,485.00 $1,485.00 ���� GOREN, CHEROF, DOODY & EZROL, P.A. Attorneys at Law 3099 East Commercial Boulevard Suite 200 Fort Lauderdale, Florida 33308 Telephone (954) 771-4500 CITY OF BOYNTON BEACH 100 E. Ocean Avenue ACCOUNT NO: Boynton Beach FL 33435 STATEMENT NO: Attn: Lynn Swanson adv: Martin Chapman (Trip and Fall on Sidewalk) Billing Category No. 18 - RLO HOURS 06/09/2023 AGL Receipt and review of complaint and attachments; preparation of correspondence to city regarding same; preparation of motion to dismiss complaint. 1.20 06/27/2023 AGL Final review, edit and finalize Motion to Dismiss Complaint FOR CURRENT SERVICES RENDERED TIMEKEEPER Adam G. Levine TOTAL CURRENT WORK BALANCE DUE RECAPITULATION HOURS HOURLY RATE 2.30 $225.00 AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE Page: 1 07/01/2023 306-9905693 48974 1.10 2.30 517.50 TOTAL $517.50 517.50 $517.50 i 34 GOREN, CHEROF, DOODY & EZROL, P.A. Attorneys at Law 3099 East Commercial Boulevard Suite 200 Fort Lauderdale, Florida 33308 Telephone (954) 771-4500 CITY OF BOYNTON BEACH 100 E. Ocean Avenue ACCOUNT NO Boynton Beach FL 33435 STATEMENT NO Attn: Lynn Swanson adv. Minnie Jackson (Slip & Fall) Billing Category No. 18 - RLO 06/06/2023 AGL Receipt and review of new claim regarding a slip and fall; review incident report and various documents FOR CURRENT SERVICES RENDERED TIMEKEEPER Adam G. Levine TOTAL CURRENT WORK BALANCE DUE RECAPITULATION HOURS HOURLY RATE 0.20 $225.00 AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE Page: 1 07/01/2023 306-9905702 48976 HOURS 0.20 0.20 45.00 TOTAL $45.00 45.00 $45.00 �35 GOREN.CHEROFDODDY&EZROL.P�� Attorneys at Law 3OB9East Commercial Boulevard Suite 200 Fort Lauderdale, Florida 333O8 Telephone (Q54)771~15OO CITY OFOOYNTDNBEACH 100 E. Ocean Avenue ACCOUNT NO: Boynton Beach FL 33435 STATEMENT NO: Attn: Lynn Swanson adv. Minnie Jackson (Slip &Fall) Billing Category No. 18'RLO 06/06/2023 A6L Receipt and review ofnew claim regarding aslip and fall; review incident report and various documents FOR CURRENT SERVICES RENDERED TIMEKEEPER Adam G. Levine TOTAL CURRENT WORK BALANCE DUE RECAPITULATION HOURS 0�20 $225.00 AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE HOURS 0.20 0.20 45.00 TOTAL $45.00 45.00 $45.00 ��� 6 36 GOREN.CHEROF.DOODY&EZROLPA- Attorneys at Law 3OSSEast Commercial Boulevard Suite 200 Fort Lauderdale, Florida 333D8 Telephone (g54)771-45DO CITY DF8OYNTONBEACH 100E.Ocean Avenue Boynton Beach FL 33435 Attn: Lynn Swanson 04/18/2023 Messenger Service: Need KNow Delivers South Florida TOTALAD\ANCE8 TOTAL CURRENT WORK BALANCE DUE ACCOUNT NO: STATEMENT NO: Page: 1 O7/U1/2O23 308-9005673 48850 49.60 49.60 AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE Afj 37 GOREN, CHEROF, DOODY & EZROL, P.A. Attorneys at Law 3099 East Commercial Boulevard Suite 200 Fort Lauderdale, Florida 33308 Telephone (954) 771-4500 CITY OF BOYNTON BEACH 100 E. Ocean Avenue Boynton Beach FL 33435 Attn: Lynn Swanson General Matters ACCOUNT NO STATEMENT NO 06/02/2023 MDC call with Lynn Swanson on pending matters, review emails on,pending items, respond to inquiries re: annexation and CRA matters discussed at Commission workshop; review status of contracts; confer,with Quentin Morgan on procurement matters 1.30 QEM Review and evaluation of documents provided by staff re: inquiry for Sand Castle Grant and possible conflict of interest; respond to staff re: matter. 3.60 QEM Work on sunshine presentation documents for taping.session. 1.10 06/04/2023 MDC review agenda materials for 6-6-23 meeting HOURS 06/01/2023 MDC review agenda materials for 6-6-23 workshop and 6-6-23 meeting, review And comment on PBSC MOU and forward to City Manager for -review; meet with Quentin Morgan on procurement inquiries; prepare letter for use of city docks; misc follow up on pending items with Lynn Swanson; review advisory board ordinance; review advisory board ordinance revisions 4.10 QEM Review and discuss conflict of interest issue with Mr. Cirullo; follow-up with 4.10 SMS staff re: information. 1.30 PBH Reviewed HB 1447's preemption of existing Tenant's Bill of Rights 2.50 QEM ordinance. Reviewed existing Tenant's Bill of Right's ordinance and the 0.50 QEM preemption the said ordinance should HB 1447 become law. 0.50 BJS Review and revise drug destruction petition and backup materials 0.60 06/02/2023 MDC call with Lynn Swanson on pending matters, review emails on,pending items, respond to inquiries re: annexation and CRA matters discussed at Commission workshop; review status of contracts; confer,with Quentin Morgan on procurement matters 1.30 QEM Review and evaluation of documents provided by staff re: inquiry for Sand Castle Grant and possible conflict of interest; respond to staff re: matter. 3.60 QEM Work on sunshine presentation documents for taping.session. 1.10 06/04/2023 MDC review agenda materials for 6-6-23 meeting 0.40 06/05/2023 MDC review materials, attend conference call with staff re: 6-6-23 meeting; conference with planning on reasonable accommodation amended agreement and other planning matters; confer with Amanda Radigan to follow up on Commission discussion on CRA and annexation, review contracts and emails relating to procurement, continue reviewing advisory . board ordinance revisions 4.10 SMS Draft/Review Agreement with Club Sports; Review ILA with the County for traffic control devices. 2.50 QEM Review of status update for towing ordinance and franchise procurement. 0.50 QEM Review of updated status re: Sign Letter of Authorization/Consultant Non -Disclosure and Confidentiality Agreement. 0.70 BJS Telephone call with Lynn Swanson and follow up with Dan Cline re: Serial Numbers/Firearms and follow up legal research 0.60 06/06/2023 MDC prepare materials for live local act presentation, review emails on procurement, misc calls on pending matters; review issues on agenda; meet with city staff on pending matters, prepare for and attend City Commission meeting 7.90 QEM Finalize. -sunshine law presentation and forward to staff. 0.50 Page: 1 07/01/2023 306-9001821 48941 38 CITY C}FBOYNTONBEACH 0701/2023 ACCOUNT NO: 306-9001821 STATEMENT NO: 48941 General Matters C)EYW Review and evaluation of RFP-BeaohEquipmendRmntm|Conueasion; 2.00 SMS preparation ofsuggested edits and approve for publishing. 2.40 {jEK8 Coordinate with staff re: Sign Letter ofAuthorization/Consultant 4.00 (]EN1 Non -Disclosure and Confidentiality Agreement. 0.80 OEKA Review and evaluation ofFuel Master Scope documents; coordinate with 1.30 C>EK8 staff re: same. 1.80 HN Review ofTanya Guim'semail re: RenanLaunonaproperty. 0.10 06/07/2023 MDC misofollow upfrom M-8-23meeting, continue review ofAdvisory Board 0.80 SMS ordinance, review nnnai|s and materials re: impact fee ordinance and traffic 0.40 enforcement agreements; continue review ofadvisory board ordinance, call 1.30 with Lynn Swanson onpending matters 1�90 ClEK8 Review and update impact fee ordinance; coordinate with staff re: matter. 2.00 SK88 Review ofCounty ILA for VVoo|bhghtBridge; Review ofBulldog Lease and Amendment. 1.50 BJG Review correspondence re: Return ofFinaorm/Geha( Number resolution 0.30 06/08/2023 MDC review materials, prepare sunshine law, public records and ethics for 2.00 SMS advisory boards; review and approve documents, research annexation, miaureview ofpending matters 4.00 (]EN1 Preparation for and attend taping of Sunshine Lmxv presentation. 3.00 QEKA Review and evaluation ofdocuments provided bystaff re: Assignment 1.30 C>EK8 Agreement from Bi||2Pay. LLC to Caba|ia Payments, LLC; respond to staff 1.30 GK8S re: matter. 230 QEK8 Review and update impact fee ordinance with updated fees. 0.80 SMS Review ofAgreement with the School Board and related Addendum and 0.40 call hudiscuss risk provisions. 1.30 06/09/2023 yNOC review contract inquiries, misocalls onpending items, review agenda items 2.00 SMS for G'2U'33Commission meeting, continue reviewing advisory board ordinance 2.30 QEKU Review and coordinate follow-up items for Bentekand Golf course lake 0.60 C)EyN management agreements. 1.30 C>EK8 Review and comment on3D Printer Quote/Agreement for Library staff. 1.30 GK8S Discussion and review related baHampshire Gardens easement. 0.70 06/ 12/2023 MDC review annexation and CRA materials, call with Amanda Rndi an; 06/13/2023 MDC conference with staff re: short term rental ordinance 2.00 SMS Research onpublic hearing advertisements for Comp Plan Amendments; Review advertisement; Research and review oJPOA. 1.20 C>EKA Review and discuss Bentek contract issues with Mr. Cirullo; follow-up with 0.60 C)EyN Ms. OeComb* re: BenbakAgnaemenL 0.80 C>EK8 Review and evaluation ofImpact Fee agenda item; coordinate with Ms. Swanson re: same. 1.60 C>EKA Begin review ofBrycarAgreement inquiry. 0.70 C)EK8 Review offollow-up from staff re: Library -3dprinter software proposal. 0.40 06/13/2023 MDC review agenda items for 6-2[-23meeting, call with Lynn Swanson on pending matters, review comments hoPBSCK8OU.continue revisions ho Advisory Board ordinance 1.40 C>EK8 Review and update sunshine presentation slides for videographer and staff. 0.60 C)EyN Review and edit updated Impact Fee agenda material; coordinate with staff. 0.90 8K8S Review related boShore drive outfall and related documents; Review ofArt Peterson POA. 1.80 kPl Page: 3 CITY OF BOYNTON BEACH 0701/2023 ACCOUNT NO: 306-9001821 STATEMENT NO: 48941 General Matters 023 MDC review pending matters, review agenda materials for 6/20 meeting,misc 06/22/2023 MDC review pending items with Lynn Swanson, review ernaib)fonwarded by Commission re: parking; confer with Heather NeedcArnanre: 6-27-23 PDB meeting 0.80 {]EK8 Follow-up with staff re: Library -3d printer software proposal. 1.30 BJG Review correspondence from Dan Cline re: Drug Destruction and follow up with Courts and transmittal ofOrder 0.30 PBH Reviewed HB 1575. Began drafting response toCity inquiry. 0.80 SMS Correspondence related toDog Park. 0.30 D6/23/2023 QEM Review of outstanding towing issues; follow-up with staff re: status and needed assistance. 0.50 YW0C review agenda items for 7'18-23Commission meeting, review emai|oon pending matters, nnioccalls buLynn Swanson 0.70 PBH Completed review ofHB1517and drafted summary onHB1G17. 0.40 DJ[] Telephone conference with Taro Duhy, Esq. 0.30 40 calls with Lynn Swanson on pending matters, meet with City Manager, meet with Mayor, meet with ACM W1atoo.review mmailsopadvisory boards 4.20 GWYG Correspondence related bo82SShore Drive; Correspondence related to Hampshire Gardens Easement. 0.80 QEYN Begin review ofFDrevenue share Agreement. 0.80 QEK8 Review ofupdate from staff re: GSA BATT X2 Quote with Trade matter. 0.40 06/15/2023 K8C,C ' review emmikson pending mnotb*re, review agenda for G-21'23workshop, call with TenniUoOeCoateonBenbehagreement 0.90 HN Preparation and attendance ofmonthly chronic nuisance meeting. Phone discussion with Candice Stone. 1.00 Bk88 Review of Existing Lease for LSF and Draft First Amendment. 1.10 06V16/2023 BJG Meeting with K8[}C pe: pending matters and updates on pending projects 0.50 MDC review agenda matters, mioccalls, call onReasonable Aczomodotion; roviowomaiks and meeting at City Hm|| 3`30 <]EK8 Preparation ofnotes for Impact Fee agmnda; discuss vv�hK8r.{�iru||u Z50SIMS(�ornempondanceandrevio^wne|ebadtoHannpahireGandanaEasament Review ofaddendum with County. 0.50 06/19/2023 K8(3C Telephone conference call onagenda items 1.50 06/20/2023 K8QC review materials for commission meeting, call with Lynn Swanson; begin review ofmaterials for transition of CAO; attend vacation rental workshop; attend City Commission meeting 8.30 GKA8 Correspondence related blHampshire Gardens Easement; Review of Facility Use Agreement for Woman's Club. 1.50 06/21/2023 MDC mioucalls and follow upfrom 6-20'23 Commission moeting, review publication, review pending procurement inquiries; confer with Quentin Morgan onfire inquiries 2.80 SMS Review related toCrowder dog Park; Correspondence related b»Hampshire Gardens. 0.50 QEyW Preparation for and attend meeting with, staff re: Fire revenue share/high rise issues. 1.80 C>EYW Review and evaluation ofA-1Air Solutions Agreement inquiry from staff; respond hostaff re: matter. 1.40 06/22/2023 MDC review pending items with Lynn Swanson, review ernaib)fonwarded by Commission re: parking; confer with Heather NeedcArnanre: 6-27-23 PDB meeting 0.80 {]EK8 Follow-up with staff re: Library -3d printer software proposal. 1.30 BJG Review correspondence from Dan Cline re: Drug Destruction and follow up with Courts and transmittal ofOrder 0.30 PBH Reviewed HB 1575. Began drafting response toCity inquiry. 0.80 SMS Correspondence related toDog Park. 0.30 D6/23/2023 QEM Review of outstanding towing issues; follow-up with staff re: status and needed assistance. 0.50 YW0C review agenda items for 7'18-23Commission meeting, review emai|oon pending matters, nnioccalls buLynn Swanson 0.70 PBH Completed review ofHB1517and drafted summary onHB1G17. 0.40 DJ[] Telephone conference with Taro Duhy, Esq. 0.30 40 Page: 4 CITY OF BOYNTON BEACH 07/01/2023 ACCOUNT NO: 306-9001821 STATEMENT NO: 48941 General Matters HOURS BJS Legal Research and draft reponse re: Gated. Communities parking Enforcement/Handicap Parking and draft response to MDC for review 1.50 06/26/2023 MDC misc calls with Lynn on pending matters, call with Chris Stearns on 06/28/2023 MDC review and comment on.sister city agreement per Kathryn Matos; review and provide comments on PBSC MOU per Kathryn Matos review inquiry on CRA advisory board from Kathryn Matas; misc review of transition matters 1.40 SMS Correspondence related to WXEL Easement and approval process. 0.30 06/29/2023 MDC Telephone conference call with Lynn on city attorney matters, transition to interim counsel; review emails on agenda items for 7-18-23 meeting 1.30 SMS Review of WXEL Easement and research on City Commission Approval. 1.50 06/30/2023 MDC misc calls with on pending .CAO matters, transition; call with Lynn Swanson re: millage agenda item for 7-10-23 meeting; review and approve item 0.60 SMS Correspondence and review related to Hampshire Gardens and existing approvals. 0.40 FOR CURRENT SERVICES RENDERED 121.00 21,033.50 Color photocopies Photocopies TOTAL CURRENT WORK 21,033.50 BALANCE DUE $21,033.50 AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE 41 solicitation matter and coordinate forwarding of information to him 0.80 QEM Review and approve Request for Publishing for'Ezell Hester Center Airnasium. 1.80 SMS Review of First Amendment to Lease. 0.20 06/27/2023 MDC review emails on pending matters, respond to inquiries regarding authority to execute documents and procurement, review resolutions for budget meeting and workshop 0.60 HN Preparation for planning and zoning board meeting tonight. Conference with Sean Swartz; attend planning and development board meeting 3.50 QEM Research and evaluation of inquiry from staff re: vendor at City special event; follow-up with staff re: matter. 1.70 QEM Review and respond to inquiry from staff re: HB3. 0.30 06/28/2023 MDC review and comment on.sister city agreement per Kathryn Matos; review and provide comments on PBSC MOU per Kathryn Matos review inquiry on CRA advisory board from Kathryn Matas; misc review of transition matters 1.40 SMS Correspondence related to WXEL Easement and approval process. 0.30 06/29/2023 MDC Telephone conference call with Lynn on city attorney matters, transition to interim counsel; review emails on agenda items for 7-18-23 meeting 1.30 SMS Review of WXEL Easement and research on City Commission Approval. 1.50 06/30/2023 MDC misc calls with on pending .CAO matters, transition; call with Lynn Swanson re: millage agenda item for 7-10-23 meeting; review and approve item 0.60 SMS Correspondence and review related to Hampshire Gardens and existing approvals. 0.40 FOR CURRENT SERVICES RENDERED 121.00 21,033.50 Color photocopies Photocopies TOTAL CURRENT WORK 21,033.50 BALANCE DUE $21,033.50 AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE 41 GOREN, CHEROF, DOODY & EZROL, P.A. Attorneys at Law 3099 East Commercial Boulevard Suite 200 Fort Lauderdale, Florida 33308 Telephone (954) 771-4500 CITY OF BOYNTON BEACH 100 E. Ocean Avenue Boynton Beach FL 33435 Attn: Lynn Swanson 06/02/2023 KLE Follow up re: Endo 06/28/2023 KLE Emails to and from Scott Weisselberg re: Endo bankruptcy, review documents, email to Lynn Swanson re: claim bar date for Endo. FOR CURRENT SERVICES RENDERED TIMEKEEPER Kerry L. Ezrol TOTAL CURRENT WORK BALANCE DUE ACCOUNT NO: STATEMENT NO: RECAPITULATION HOURS H_ O_URLY__RA_TE 0.80 $225.00 Page: 1 07/01/2023 306-9304150 48942 HOURS 0.20 0.60 0.80 180.00 TOTAL $180.00 180.00 $180.00 AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE 42 \ QOREN.CHEROF.DOODY&EZRDLP�� Attorneys at Law 3090East Commercial Boulevard Suite 200 Fort Lauderdale, Florida 33308 Telephone (O54)771 -45O0 CITY OF8OYNTONBEACH 100 E. Ocean Avenue ACCOUNT NO Boynton Beach FL 33435 STATEMENT NO Attn: Lynn Swanson Red Light Cameras 06/02/2023 PBH ReviewedNOhs. 0.50 06/08/2023 PE Sent prose notices toprinter for mailing. Converted boP0F/Aand e0|ed. 3.40 06/19/2023 PE Updated tracking log, updated PBH calendar. Prepared notices for 7/11/2O23for PBH approval. 4.78 06/20/2023 PE Telephone conference call 06/22/2023 PE Sort organized and prepared remaining notices for 7/11/2U23.Looked up attorney information. Communicated with pDregarding returned mail. 4.60 0608/2023 PE Sort organized and prepared notices for 7/11/2O23hearing. 3.70 06D7/2023 K8UC review status ofpending cases, prepare information for transition honew |egm|oounoe| 0.30 06/29/2023 MDC call with Lynn todiscuss hearing schedules; review materials toprovide ho interim counsel 0.30 PBH Reviewed and completed ND|o. 1.30 06/30/2023 PBH Reviewed, revised, and submitted red light camera checklist. 0.50 FOR CURRENT SERVICES RENDERED 19.38 RECAPITULATION TIMEKEEPER HOURS HOURLYRATETOTAL Michael D.QnuUo 0.60 $225.00 $135.00 Paul Hernandez 2.30 225.00 517.50 Patricia Eugene 18.48 125D0 2.060.00 Photocopies TOTAL OUT-OF-POCKETEXPENSES THROUGH 08/3O/2O23 TOTAL CURRENT WORK BALANCE DUE AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE Page: 1 07/01/2U23 306'0808020 48946 2,712.50 26.60 26.60 2,739.10 $2,739.10 /] / Q -D43^ GOREN, CHEROF, DOODY & EZROL, P.A. Attorneys at Law 3099 East Commercial Boulevard Suite 200 Fort Lauderdale, Florida 33308 Telephone (954) 771-4500 CITY OF BOYNTON BEACH 100 E. Ocean Avenue ACCOUNT NO Boynton Beach FL 33435 STATEMENT NO Attn: Lynn Swanson Special Fire Assessment HOURS 06/16/2023 MDC begin preliminary resolution 0.60 06/22/2023 MDC confer with Lynn Swanson on status of data for fire assessment, continue preparing resolution 0.50 06/23/2023 MDC review email on proposed rate structure, continue preparing Preliminary Assessment Resolution, forward to Lynn Swanson to format then deliver to staff for review and comment 1.10 06/30/2023 MDC call with Lynn Swanson, review and revise agenda report and approve item for agenda 0.60 FOR CURRENT SERVICES RENDERED 2.80 RECAPITULATION TIMEKEEPER HOURS HOURLY RATE TOTAL Michael D. Cirullo 2.80 $225.00 $630.00 TOTAL CURRENT WORK BALANCE DUE AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE Page: 1 07/01/2023 306-0005370 48947 630.00 630.00 $630.00 44 GOREN.CHEROF.DOODY&EZROLP/� Attorneys at Law 30QAEast Commercial Boulevard Suite 200 Fort Lauderdale, Florida 3330D Telephone (&54)771-45O0 CITY Of8OYNTONBEACH 1O0E.Ocean Avenue Boynton Beach FL 33435 Attn: Lynn Swanson LABOR -General ACCOUNT NO: STATEMENT NO: 06/01/2023 MDC review status of employment letter phase out with HRdirector 0.30 06/08DY023 MDC review K4azokaaPre-debenn|nationmaterials, related correspondence 0.40 06/13/2023 KAOC review election of rights, related email re: mazakoo 0.20 JFK research re: General Employees' Pension Plan amendment ordinance; correspondence from Bonnie Jensen 0.30 06/208y023 MDC review materials 2nd prepare for pre -determination hearing (PNmzokam)(canoe|edbyemployee) 1.50 06/22/2023 MDC review employment letter processes; review charter for contract matters and prepare and forward delegation toemployment counsel hosign employment letters per charter 0.40 JFK correspondence with Bonnie Jensen re: General Employees' Pension Fund ordinance approval 0.20 FOR CURRENT SERVICES RENDERED 3.30 RECAPITULATION TIMEKEEPER HOURS HOURL TOTAL Michael O.CiruUo 2.80 $225.00 $630.00 K|ohnUu|ieF. 0.50 213.00 106.50 TOTAL CURRENT WORK BALANCE DUE AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE Page: 1 001/202B 306'0603180 48048 736.50 GOREN.CHEROF.DOODY&EZROL.P/� Attorneys at Law 3098East Commercial Boulevard Suite 200 Fort Lauderdale, Florida 333U8 Telephone (954)771-45UO CITY Of8OYNTONBEACH 100E.Ocean Avenue Boynton Beach FL 33435 Attn: Lynn Swanson Litigation Miscellaneous ACCOUNT NO: STATEMENT NO: HOURS 86/07/2023 AGL Receipt and review new claim documents including incident report for new claim and brief reply acknowledging receipt Tuscany nnthe |Ntraooanba|(COB8) 0.20 06/ 13/2023 AGL Receipt and review ofTrial subpoena, arrest affidavit, review email, review criminal docket; telephone call boState Attorney number onthe subpoena, review ofOuhdmbar contact for Assistant State Attorney and preparation of email toASA requesting clarification cfsubpoena; preparation uf correspondence tuC|tyregarding same. 1.00 08/21/2023 &1OC review materials and status nfpending defense litigation 0.30 06823/2023 K80C review letter from counsel re: solicitations and attachments; review city code on solicitations, send letter to City Manager advising of potential litigation and seeking direction onhow boproceed given the transition ofCAO 0.80 06129/2023 'MDC review status ofpending litigation re: transition tointerim counsel 0.30 FOR CURRENT SERVICES RENDERED 2.80 RECAPITULATION T I MEKEEPBR H.OURS HOURLY RATE TOTAL Michael D. Ciru||n 140 $225.00 $315.00 Adam G.Levine 1.20 225.00 270D0 TOTAL CURRENT WORK BALANCE DUE AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE Page: 1 07/O1/2U23 308'0904050 48949 585.00 $585.00 GOREN.CHEROF.DOODY&EZRDL.P�� Attorneys atLaw 3099 East Commercial Boulevard Suite 200 Fort Lauderdale, Florida 333O8 Telephone (&54)771-4500 CITY DFBOYNTONBEACH 1O0E.Ocean Avenue Boynton Beach FL 33435 Attn: Lynn Swanson Mangrove Park - Lease from St. Mark's 06/ 13/2023 SMS Correspondence related bxExchange and removal cfimprovements. 06/29/2023 SMS Initial review related Memo for status offile. 06/30/2023 SMS Review ofOriginal Mangrove Lease for Memorandum. FOR CURRENT SERVICES RENDERED TIMEKEEPER Sean M. Swartz ACCOUNT NO: STATEMENT NO: RECAPITMILATION 1.00 $221.00 AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE Page: 1 07/01/2023 306'0905412 48950 HOURS 0.20 0.40 0.40 1.00 221.00 TOTAL $221.00 221.00 $221.00 GOREN.CHEROF.DOOOY&EZROL.P�� Attorneys at Law 3O00East Commercial Boulevard Suite 200 Fort Lauderdale, Florida 33308 Telephone (854)771-45OO CITY OF8OYNTON8E�CH 100E.OoaonAvenueACCOUNT NO Boynton Beach FL 33435 STATEMENT NO Attn: Lynn Swanson xHo, Benjamin and Karen (Coda/Fomoloauna) 06/27/2023 HN Review ofemail from Adam Temple re: status offoreclosure. Phone discussion with Adam Temple. Email hoAdam Temple with attached 4th DCA opinion. FOR CURRENT SERVICES RENDERED TIMEKEEPER Heather Needelman RECAPITULATION HOURS HOU LYRATE 0.40 $225.00 AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE Page: 1 O7/01/2O23 306'0005433 48052 GOREN, CHEROF, DOODY & EZROL, P.A. Attorneys at Law 3099 East Commercial Boulevard Suite 200 Fort Lauderdale, Florida 33308 Telephone (954) 771-4500 CITY OF BOYNTON BEACH 100 E. Ocean Avenue Boynton Beach FL 33435 Attn: Lynn Swanson adv. Go, Jeanne and Ka Hock (Code/Foreclosure) 06/12/2023 HN Email exchange with Lynn Swanson re: status of subject property and where the City did not foreclose. Discussion with Sean Swartz, FOR CURRENT SERVICES RENDERED TIMEKEEPER Heather Needelman TOTAL CURRENT WORK BALANCE DUE ACCOUNT NO: STATEMENT NO: RECAPITULATION HOURS HOURLY_RATE 0.40 $225.00 AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE Page: 1 07/01/2023 306-9905435 48953 HOURS 0.40 0.40 90.00 TOTAL $90.00 90.00 $90.00 Q'9' 0 GOREN.CHERDF.00ODY&EZROLP.A` Attorneys at Law 3OQQEast Commercial Boulevard Suite 200 Fort Lauderdale, Florida 333O8 Telephone (054)771-45OD CITY OF BOYNTON BEACH 1O0E.Ocean Avenue Boynton Beach FL 33435 Attn: Lynn Swanson adv. Priority Towing ACCOUNT NO STATEMENT NO 06/09/2023 AGL Receipt and review of affidavit and exhibits thereto filed by Plaintiff in opposition to summary judgment; preparation of summary of plaintiffs argument contained in affidavit and preparation of correspondence to city regarding same. 06/12/2023 AGL Receipt and review ofemail from TeniUeDeConberegarding contact person onthis case; preparation ofemail b»Kristen Pinto regarding person with knowledge 0nspeak buregarding RFP process inthis matter; draft email hu A.Temple and yNFrederiksen regarding questions ihave bohelp clarify and argue Motion for Summary Judgment issues 06/13/2023 AGL Prepare and receive series ofcorrespondence with Lynn Swanson regarding scheduling phone conference viUhAdamTemplemnd/orK4oxo Fndehkuon 06/22/2023 AGL Review all emuilscfRFP process provided byRandy Wood bnascertain specific responsive information hmPlaintiffs arguments contained intheir affidavit primarily related bothe number and category oftrucks that Beck's had available ottime ofRFP and contract; Review paper file regarding same; preparation of detailed email to City regarding request for permission tocontact BEck'a.seek bocontinue Motion for Summary Judgment hearing and discussing the P|aitniO`earguments primarily the number and classification oftrucks. 06/23/2023 AGL Review offranchise agreement, addendum 2and RFP regarding vehicle requirements inpreparation ofdetailed email toBeck's towing borequest assistance regarding whether Becks had the necessary vehicles prior bo contract; preparation nfdetailed email hoBecks Towing. AGL Prepare motion to continue special set hearing on K4nUon for Summary Judgment; Receipt ofemail from opposing counsel regarding non objection to motion 00/26/2033 AGL Sevore|amails to/from Stephanie Beck concerning Beck's Towing compliance with minimum vehicle requirements per RFP and Franchise agreement; telephone conference with Stephanie Beck regarding same; preparation of detailed affidavit in support of Motion for Summary Judgment regarding subject matter ofdiscussion with Stephanie Beck; preparation of correspondence |oStephanie Beck requesting review and signature of affidavit; preparation ofcorrespondence inCity regarding affidavit; preparation, review and finalization ofproposed agreed order onmotion to continue Motion for Summary Judgment; receipt and review ufopposing Page 1 07/0M12O23 300'0905458 48054 Page: 2 CITY OF BOYNTON BEACH 07/01/2023 ACCOUNT NO: 306-9905456 STATEMENT NO: 48954 adv. Priority Towing counsel approval of agree order form. FOR CURRENT SERVICES RENDERED TIMEKEEPER Adam G. Levine TOTAL CURRENT WORK BALANCE DUE RECAPITULATION HOURS HOURLY RATE 15.90 $225.00 AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE HOURS 5.60 15.90 3,577.50 TOTAL $3,577.50 3,577:50 $3,577.50 51 GOREN, CHEROF, DOODY & EZROL, P.A. Attorneys at Law 3099 East Commercial Boulevard Suite 200 Fort Lauderdale, Florida 33308 Telephone (954) 771-4500 CITY OF BOYNTON BEACH 100 E. Ocean Avenue Boynton Beach FL 33435 Attn: Lynn Swanson Landfill Closure 06/05/2023 MDC review correspondence and status of notices to government entities 06/15/2023 MDC review correspondence on proof of delivery of notice FOR CURRENT SERVICES RENDERED TIMEKEEPER Michael D. Cirullo TOTAL CURRENT WORK BALANCE DUE ACCOUNT NO: STATEMENT NO: RECAPITULATION HOURS HOURLY RATE 0.40 $225.00 AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE Page: 1 07/01/2023 306-9905475 48955 HOURS 0.20 0.20 0.40 90.00 TOTAL $90.00 90.00 $90.00 n -521 5 GOREN.CHEROF.DOODY&EZROL.P�� Attorneys at Law 3UQQEast Commercial Boulevard Suite 200 Fort Lauderdale, Florida 33308 Telephone (054)771'450O CITY OF8OYNTONBEACH 1UOE.Ocean Avenue Boynton Beach FL 33435 Attn: Lynn Swanson v.JKMBTS Capital, LLC (Declaratory Action) ACCOUNT NO STATEMENT NO 08/08/2023 [NOC review status nfPayment Notice with JKM 06/14/2023 MDC follow uponstatus ofIncentive Payment from JKK4per settlement agreement 06/20/2033 MDC follow uponstatus ofIncentive Payment toCity FOR CURRENT SERVICES RENDERED RECAPITULATION TIMEKEEPER HOURS HOURLY RATE Michael D.OroUo 0.60 $225.00 AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE Pago:1 O7/0d/2O23 306-9905525 48956 HOURS 0.20 0.20 0.20 0.60 135.00 TOTAL $135.00 135.00 $135.00 GOREN, CHEROF, DOODY & EZROL, P.A. Attorneys at Law 3099 East Commercial Boulevard Suite 200 Fort Lauderdale, Florida 33308 Telephone (954) 771-4500 CITY OF BOYNTON BEACH 100 E. Ocean Avenue ACCOUNT NO: Boynton Beach .FL 33435 STATEMENT NO: Attn: Lynn Swanson Canal Maintenance Special Assessment HOURS 06/16/2023 MDC review materials, prepare preliminary assessment resolution 0.90 06/19/2023 MDC review and revise draft preliminary assessment resolution, forward to Lynn Swanson to confirm formatting and then to forward to staff for review 0.40 06/26/2023 MDC review and respond to inquiries regarding preliminary assessment resolution and method of collection 0.40 06/28/2023 MDC review emails on collection method for assessment for FY23-24 0.20 06/30/2023 MDC Telephone conference call with Lynn Swanson, review and revise agenda materials 0.50 - FOR CURRENT SERVICES RENDERED 2.40 RECAPITULATION TIMEKEEPER HOURS HOURLY RATE TOTAL Michael D. Cirullo 2.40 $225.00 $540.00 TOTAL CURRENT WORK BALANCE DUE AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE Page: 1 07/01/2023 306-9905552 48957 540.00 540.00 $540.00 GOREN, CHEROF, DOODY & EZROL, P.A. Attorneys at Law 3099 East Commercial Boulevard Suite 200 Fort Lauderdale, Florida 33308 Telephone (954) 771-4500 CITY OF BOYNTON BEACH 100 E. Ocean Avenue ACCOUNT NO: Boynton Beach FL 33435 STATEMENT NO: Attn: Lynn Swanson adv. Ho, Wing and Ho, Karen (Petition for Preliminary Injunction) 06/14/2023 HN Email exchange with John Kuntzman re: notice of demolition. Phone discussion with John Kuntzman. FOR CURRENT SERVICES RENDERED RECAPITULATION TIMEKEEPER HOURS HOURLY RATE Heather Needelman 0.40 $225.00 TOTAL CURRENT WORK BALANCE DUE Page: 1 07/01/2023 306-9905567 48958 HOURS 0.40 0.40 90.00 TOTAL $90.00 90.00 $90.00 AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE 55 GOREN, CHEROF, DOODY & EZROL, P.A. Attorneys at Law 3099 East Commercial Boulevard Suite 200 Fort Lauderdale, Florida 33308 Telephone (954) 771-4500 CITY OF BOYNTON BEACH 100 E. Ocean Avenue Boynton Beach FL 33435 Attn: Lynn Swanson Wells Landing ARPA Grant Agreement ACCOUNT NO STATEMENT NO HOURS 06/01/2023 SMS Review of documents and correspondence related to 4th Amendment to ILA with CRA for Wells Landing. 0.80 06/02/2023 SMS Correspondence and review of ILA. 0.40 06/06/2023 SMS Correspondence and review of 3rd ILA related to authorization for execution and Exhibit A 0.40 FOR CURRENT SERVICES RENDERED 1.60 RECAPITULATION TIMEKEEPER HOURS HOURLY RATE TOTAL Sean M. Swartz 1.60 $225.00 $360.00 TOTAL CURRENT WORK BALANCE DUE AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE Page: 1 07/01/2023 306-9905604 48962 360.00 $360.00 GOREN, CHEROF, DOODY & EZROL, P.A. Attorneys at Law 3099 East Commercial Boulevard Suite 200 Fort Lauderdale, Florida 33308 Telephone (954) 771-4500 CITY OF BOYNTON BEACH 100 E. Ocean Avenue Boynton Beach FL 33435 Attn: Lynn Swanson adv. Deutsche Bank (Michele Dimon a/k/a Michele Pravata) ACCOUNT NO STATEMENT NO 06/30/2023 _ HN Email exchange with Shelley Maurice, counsel for plaintiff. Email to Lynn Swanson cc Mike Cirullo. Phone call with Lynn Swanson. FOR CURRENT SERVICES RENDERED TIMEKEEPER Heather Needelman TOTAL CURRENT WORK BALANCE DUE RECAPITULATION, HOURS HOURLY RATE 0.50 $225.00 AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE Page: 1 07/01/2023 306-9905630 48963 HOURS 0.50, 0.50 112.50 TOTAL $112.50 112.50 $112.50 A 57 C- \ GOREN.CHEROF.DOODY&EZROLP/� Attorneys at Law 3099 East Commercial Boulevard Suite 200 Fort Lauderdale, Florida 333O8 Telephone (954)771'4500 CITY OFBOYNTONBEACH 1U0E.Ocean Avenue Boynton Beach FL 33435 Attn: Lynn Swanson adv. HSBC Bank (Tekamore.Janque|ino) 06/14/2023 HN Review of status of case and review of notice of sale. FOR CURRENT SERVICES RENDERED TIMEKEEPER Heather Needelman TOTAL CURRENT WORK ACCOUNT NO: STATEMENT NO: RECAPIT4LAT1 Silt HOURS HOURLY RATE 0.30 $225.00 AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE Page: 1 0701/2023 308'0905040 48085 HOURS 0.30 0.30 67.50 TOTAL $87.58 67.50 $67.50 GOREN.CHEROF.DOODY&EZROL.P.A. Attorneys at Law 3D08East Commercial Boulevard Suite 200 Fort Lauderdale, Florida 33308 Telephone (Q54)771-4500 CITY OF8OYNTONBEACH 1U0E.Ocean Avenue Boynton Beach FL 33435 Attn: Lynn Swanson adv. Sohn, Mark (Termination Grievance) 06/29/2023 MDC call with Lynn Swanson to review status ofarbitration toupdate interim counsel re: transition of CAO TIMEKEEPER Michael D. Cirullo I it -11 W-110 15001111 pill ACCOUNT NO STATEMENT NO RECAPITULATION HOURS HOURLY RATE 0.20 $225.00 AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE Page:1 07/O1/2023 306-9905647 48966 HOURS 0.20 0.20 45.00 TOTAL $45.00 45.00 $45.00 ��� GOREN, CHEROF, DOODY & EZROL, P.A. Attorneys at Law 3099 East Commercial Boulevard Suite 200 Fort Lauderdale, Florida 33308 Telephone (954) 771-4500 CITY OF BOYNTON BEACH 100 E. Ocean Avenue Boynton Beach FL 33435 Attn: Lynn Swanson adv. E21- Real Estate Solutions, LLC (Amended Complaint) 06/08/2023 MDC review status of case and related correspondence 06/09/2023 MDC Call with Kathryn Rossmell on status of case ACCOUNT NO: STATEMENT NO: 06/12/2023 MDC review correspondence from Amy Petrick; begin review of Third Amended Complaint 06/13/2023 MDC continue reviewing the Third Amended Complaint, confer with Kathryn Rossmell FOR CURRENT SERVICES RENDERED TIMEKEEPER Michael D. Cirullo Photocopies TOTAL CURRENT WORK BALANCE DUE RECAPITULATION HOURS HOURLY RATE 1.60 $225.00 AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE Page: 1 07/01/2023 306-9905654 48967 HOURS 0.20 0.20 0.30 0.90 1.60 360.00 TOTAL $360.00 360.00 $360.00 60 8OREN.CHEROF.DOODY&EZROLP,A. Attorneys at Law 309QEast Commercial Boulevard Suite 200 Fort Lauderdale, Florida 333O8 Telephone (Q54)771 -45O0 CITY OFBOYNTONBEACH 1O0E.Ocean Avenue Boynton Beach FL 33435 Attn: Lynn Swanson adv. Torounk.Peter (Public Records/Civil Rights Action) 06/01/2023 MDC call with Jeff Hochman to update on status of vacating of premises by mmdm [)EM Review and discuss status with Mr. CimmUoand Mr. Hochman. 06/27/2023 [JEK4 Review ofcorrespondence from Mr. Hochman. FOR CURRENT SERVICES RENDERED TIMEKEEPER Michael D. CimUo Quentin E.Morgan BALANCE DUE ACCOUNT NO STATEMENT NO RECAPITULATION HOURS HOURLY RATE 0.20 ��25OO 1.10 225.00 AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE Page:1 O701C2023 306-0905656 48968 HOURS 0.20 0,50 0.60 1.30 292.50 TOTAL $45.00 247.50 292.50 $292.50 GOREN, CHEROF, DOODY & EZROL, P.A. - Attorneys at Law 3099 East Commercial Boulevard Suite 200 Fort Lauderdale, Florida 33308 Telephone (954) 771-4500 CITY OF BOYNTON BEACH 100 E. Ocean Avenue Boynton Beach FL 33435 Attn: Lynn Swanson adv. 300 Property Owners Association (Robert Emminger Foreclosure) 06/05/2023 HN Review of Final Judgement and foreclosure sale date. FOR CURRENT SERVICES RENDERED RECAPITULATION TIMEKEEPER HOURS Heather Needelman 0.30 TOTAL CURRENT WORK BALANCE DUE ACCOUNT NO: STATEMENT NO: HOURS 0.30 0.30 HOURLY RATE TOTAL $225.00 $67.50 AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE Page: 1 07/01/2023 306-9905659 48969 67.50 67.50 $67.50 [St}REN,CHEROF.DOODY&EZROL,P�\ Attorneys at Law 3099 East Commercial Boulevard Suite 200 Fort Lauderdale, Florida 33308 Telephone (954)771'450U CITY OF BOYNTON BEACH 1OOE.Ocean Avenue Boynton Beach FL 33435 Attn: Lynn Swanson adv. 2OQN.Federal, LLC (Petition for Writ) ACCOUNT NO: STATEMENT NO: 06/09/2023 MDC call with opposing counsel on request for extension oftime, review related correspondence 06/21/2023 MDC miscfollow uponstatus ofcertiorari 06/20/2023 MDC review -status ofcase hmupdate interim counsel FOR CURRENT SERVICES RENDERED TIMEKEEPER Michael D. Cirullo TOTAL CURRENT WORK BALANCE DUE RECAPITULATION HOURS HOURLY RATE 0.70 $225.00 AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE Page: 1 0701/2028 308-0905691 48973 HOURS 0.30 020 0.20 0.70 157.50 TOTAL $157.50 157.50 $157.50 GOREN, CHEROF, DOODY & EZROL, P.A. Attorneys at Law 3099 East Commercial Boulevard Suite 200 Fort Lauderdale, Florida 33308 Telephone (954) 771-4500 CITY OF BOYNTON BEACH 100 E. Ocean Avenue Boynton Beach FL 33435 Attn: Lynn Swanson adv. LHome Mortgage Trust (Design ByStephanieo LLC)(Stephanie Olszewski) ACCOUNT NO: STATEMENT NO: 06/16/2023 HN Review of status of case and review of notice of dropping party filed by plaintiff. FOR CURRENT SERVICES RENDERED TIMEKEEPER Heather Needelman TOTAL CURRENT WORK BALANCE DUE RECAPITULATION HOURS' HOURLY RATE 0.30 $225.00 AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE Page: 1 07/01/2023 306-9905697 48975 HOURS 0.30 0.30 67.50 TOTAL $67.50 67.50 $67.50 GOREN.CHEROFDODDY&EZROL.P�� Attorneys at Law 3OB9East Commercial Boulevard Suite 200 Fort Lauderdale, Florida 333O8 Telephone (Q54)771~15OO CITY OFOOYNTDNBEACH 100 E. Ocean Avenue ACCOUNT NO: Boynton Beach FL 33435 STATEMENT NO: Attn: Lynn Swanson adv. Minnie Jackson (Slip &Fall) Billing Category No. 18'RLO 06/06/2023 A6L Receipt and review ofnew claim regarding aslip and fall; review incident report and various documents FOR CURRENT SERVICES RENDERED TIMEKEEPER Adam G. Levine TOTAL CURRENT WORK BALANCE DUE RECAPITULATION HOURS 0�20 $225.00 AMOUNTS PREVIOUSLY BILLED NOT INCLUDED ABOVE HOURS 0.20 0.20 45.00 TOTAL $45.00 45.00 $45.00 ��� 6 65 Johnson, Anselmo, Murdoch, Burke, Piper & Hochman, P.A. 2455 E. Sunrise Blvd. Suite #1000 Fort Lauderdale, Florida 33304 Tax I.D.#: 65-0220140 July 07, 2023 Billed Through 06/30/2023 Invoice 75305 / MTB 00281 42164 Via: claims@bbfl.us City of Boynton Beach P. O. Box 310 Boynton Beach, FL 33425 Regarding: Joseph Smith vs. Boynton Beach, Shaun James, Mark Sohn, Andrew Berben and Cory Henry (Tristar Claim No. 22891271 and PGCS Claim No. 394052) FOR PROFESSIONAL SERVICES RENDERED: 06/02/2023 SDA Review proposed Joint Motion received from Ann Breeden 0.30 06/02/2023 SDA Prepare correspondence to all defense counsel with suggestions on Joint 0.20 Defense Motion 06/05/2023 MTB Receipt and review of Defendant Mark Sohn's Answer and Defenses to 0.50 Amended Complaint 06/05/2023 MTB Receipt and review of email correspondence from Ann Breeden 0.10 regarding proposed joint motion for extension of time 06/05/2023 SDA Review correspondence from defense counsel to Attorney Nicole 0.20 Sauvola-LaMay regarding position on extending Limine Motion til after disposition of Summary Judgement 06/05/2023 SDA Review correspondence from Attorney Nicole Sauvola-LaMay agreeing 0.20 to extension and request to join for Plaintiff 06/05/2023 SDA Prepare correspondence to all counsel suggesting that Motion be filed 0.30 jointly and applicable to all parties 06/06/2023 SDA Review finalized and filed Motion for Extension (Joint by all parties) 0.20 06/06/2023 SDA Review correspondence to Judge Smith with draft of Order on Motion 0.30 for Extension Total Professional Services: $517.50 Burke, Michael T. 0.60 225.00 $135.00 Alexander, Scott D 1.70 225.00 $382.50 DISBURSEMENTS 0613012023 Printing and Imaging Services 0613012023 WestLaw Research Summary: Total Expenses Advanced: Invoice Number 75305 Page 2 7.70 150.00 Total professional services $517.50 Total expenses incurred +$157.70 Total Amount Billed $675.20 Less Pre -Paid Applied $0.00 Please Pay this Amount $675.20 $157.70 67 LAWYERS Kopelowitz Ostrow Ferguson Weiselberg Gilbert 1 West Las Olas Blvd., Suite 500 Federal Tax I.D. No.: 65-0637822 Fort Lauderdale, FL 33301 www.kolawyers.com City of Boynton Beach c/o City Attorney, Michael Cirullo Jr 100 E. Ocean Avenue Boynton Beach, Florida 33435 RE: City of Boynton Beach - Arbitration of Mark Sohn For Professional Services Rendered Through May 31, 2023 Total Services Total Disbursements Total Current Charges Previous Balance Less Payments Remittance Advice Telephone: 954.525.4100 Facsimile: 954.525.4300 Client: 015589 Matter: 000001 Invoice #: 148361 $2,362.50 $347.12 $2,709.62 $48,559.05 ($48,559.05) Payment is due upon receipt. If payment in full is not received within 30 days, a finance charge of 1.2% (15% annually) may apply. Check Payable To: Wire Transfer: Kopelowitz Ostrow P.A. Receiving Bank: City National Bank of Florida Attn.: Accounts Receivable ABA Routing Number: 066004367 1 West Las Olas Blvd., Suite 500 Beneficiary: Kopelowitz Ostrow P.A. Fort Lauderdale, FL 33301 Account Number: 1954993480 Credit Card: We accept VISA, MasterCard, Discover and American Express or eCheck. To make a secure payment online, pleaseclick here. If paying by credit card, a 2% credit card processing fee will be added to your payment. Please return this remittance page with your payment. Thank you. LAWYERS Kopelowitz Ostrow Ferguson Weiselberg Gilbert 1 West Las Olas Blvd., Suite 500 Federal Tax I.D. No.: 65-0637822 Fort Lauderdale, FL 33301 www.kolawyers.com City of Boynton Beach c/o City Attorney, Michael Cirullo Jr 100 E. Ocean Avenue Boynton Beach, Florida 33435 RE: City of Boynton Beach - Arbitration of Mark Sohn For Professional Services Rendered Through May 31, 2023 Date Person Description of Services 05/01/2023 SDH Organize admitted exhibits and Union exhbits for 225.00 drafting of Closing Brief. 05/07/2023 DLF Worked on closing brief outline. 05/13/2023 DLF Prepared for final hearing. 05/16/2023 DLF Worked on closing brief outline. 05/17/2023 SDH Begin to review Final Hearing Transcript Volume $225.00 1. Begin to draft portions of Closing Brief. Emails 225.00 with opposing counsel regarding deadline to Closing Brief. 05/18/2023 SDH Continue to review Volume 1 Transcipt and outline key passages for Closing Brief. 05/22/2023 SDH Emails to opposing counsel and Arbitrator regarding transcripts and Closing Brief deadline. 05/23/2023 SDH Review continued of Day 1 transcript. Total Professional Services Date Description of Disbursements 05/08/2023 Seth D. Haimovitch- Travel- Tolls 05/08/2023 Seth D. Haimovitch- Travel- Parking - Georges Deposition 05/08/2023 Seth D. Haimovitch- Travel- Mileage (560 @ $0.58) Total Disbursements Telephone: 954.525.4100 Facsimile: 954.525.4300 July 12, 2023 Client: 015589 Matter: 000001 Invoice #: 148361 Page: 1 Hours Rate Amount 1.20 225.00 $270.00 1.00 225.00 $225.00 2.00 225.00 $450.00 1.00 225.00 $225.00 2.50 225.00 $562.50 1.50 225.00 $337.50 0.30 225.00 $67.50 1.00 225.00 $225.00 10.50 $2,362.50 Amount $19.05 $3.27 $324.80 $347.12 19 VA July 12, 2023 21 LAWYERS Client: 015589 Matter: 000001 Invoice #: 148361 Page: 2 Total Services Total Disbursements Total Current Charges Previous Balance Less Payments $2,362.50 $347.12 $2,709.62 $48,559.05 ($48,559.05) DLF David L. Ferguson 4.00 $225.00 $900.00 SDH Seth D. Haimovitch 6.50 $225.00 $1,462.50 70 Johnson, Anselmo, Murdoch, Burke, Piper & Hochman, P.A. 2455 E. Sunrise Blvd. Suite #1000 Fort Lauderdale, Florida 33304 Tax I.D.#: 65-0220140 July 13, 2023 Billed Through 06/30/2023 Invoice 75404 / EBJ 00281 42070 Via: claims@bbfl.us City of Boynton Beach P. O. Box 310 Boynton Beach, FL 33425 Regarding: Shannon Thompson and Stanley Davis, Jr., for Estate of Stanley Davis III vs. City of Boynton Beach (Tristar claim no.: 22874044) FOR PROFESSIONAL SERVICES RENDERED: 06/20/2023 EBJ Review correspondence from Erica Cassalia regarding status 0.20 06/20/2023 EBJ Review file regarding status update to the FMIT 0.30 06/20/2023 EBJ Prepare correspondence to Erica Cassalia regarding status update 0.20 Total Professional Services: $157.50 Johnson, E. Bruce 0.70 225.00 5157.50 DISBURSEMENTS Summary: Total professional services $157.50 Total Amount Billed $157.50 Less Pre -Paid Applied $0.00 Please Pay this Amount $157.50 71 LAW 2600 Douglas Road PH -4 Coral Gables, FL 33134 (305) 445-5528 (305) 446-0995 Fax July 17, 2023 TAX I.D. 92-1828074 Claims/Human Resources and Risk Manageme City of Boynton Beach 100 E. Ocean Avenue Boynton Beaach, FL 33435 In Reference To: Smith, J. v. Shaun James, et al. Claim No.: 22891273 Professional Services 6/2/2023 WL Rec and rev Defendant Sohn's answer and affirmative defenses to amended complaint WL Rec and rev e-mail exchange re joint motion to extend pretrial deadlines 6/5/2023 WL Draft e-mail to Ann Breeden re motion for extension of deadlines; rec and rev response; draft reply For professional services rendered Previous balance 6/22/2023 Payment - Thank You 7/10/2023 Payment - Thank You Total payments and adjustments Balance due Timekeeper Summary Name Lourdes E. Wydler Invoice No. 6244 Hours Amount 0.30 $42.00 0.50 $70.00 0.20 $28.00 Amount $42.00 $70.00 $28.00 1.00 $140.00 $6,113.50 ($4,888.00) ($1,225.50) ($6,113.50) $140.00 Hours Rate 1.00 140.00 72 Claims/Human Resources and Risk Manageme PLEASE MAKE CHECKS PAYABLE TO WYDLER LAW Page 73 OLDS & STEPHENS, P.A. 312 Eleventh Street P. O. Box 4523 West Palm Beach, FL 33401 Invoice submitted to: Tennille DeCoste Human Resources and Risk Management 100 East Ocean Avenue Boynton Beach, FL 33435 July 01, 2023 In Reference To: Client/Insured Claimant: Claim No.: Date/Loss: Invoice # 10289 Boynton Beach Smith TAXPAYER I.D. NO.: 65-0385869 Professional Services 74 Hrs/Rate Amount 6/2/2023 DS Reviewed and responded to email re: Pre-trial 0.30 75.00 Deadlines 250.00/hr DS Receipt and review of Sohn's Answer and 0.40 100.00 Affirmative Defenses 250.00/hr 6/5/2023 DS Receipt and review of emails and attachments re: 0.30 75.00 Motion for Extension of Pre-trial Deadlines 250.00/hr 6/28/2023 DS Analyzed witnesses and exhibits needed for trial 1.50 375.00 250.00/hr 6/29/2023 DS Worked on trial strategy 0.90 225.00 250.00/hr For professional services rendered 3.40 $850.00 Previous balance $1,825.00 74 Tennille DeCoste 6/27/2023 Payment - thank you. Check No. #10281 Total payments and adjustments Balance due User Summary Name DON STEPHENS Page 2 Amount ($1,825.00) ($1,825.00) $850.00 Hours Rate Amount 3.40 250.00 $850.00 75 ROBERTS, REYNOLDS, BEDARD & TUZZIO, PLLC 470 Columbia Drive, Suite C-101 West Palm Beach, Florida 33409 Telephone (561)688-6560 Tax ID No. 65-0004867 City of Boynton Beach July 14, 2023 Attn: claims@bbfl.us Bill No. 74640 100 East Ocean Avenue Boynton Beach, FL 33435 CLIENT: City of Boynton Beach 032 MATTER: Geraci v. Zeller 19132 Adj: Tennille DeCoste BILL FOR FEES AND COSTS THROUGH 06/30/23 PROFESSIONAL SERVICES Date Services Attorney Hours 06/15/23 Receipt and review of e-mail from Tristar Rep. Karen Klein re: LHR 0.20 SHP Sara H. Ptachik, Associate acknowledging Mediation unsuccessful and requesting defense 160.00 192.00 Total Professional Services strategy going forward. $340.00 06/16/23 Preparation of e-mail to Claims Examiner III, Karen Klein, re: SHP 0.60 providing an update on the status of the case in light of the matter not settling at mediation, per her request. 06/20/23 Telephone conference with Asst. Chief Zeller, re: requesting SHP 0.30 the last known addresses and/or contact information for the witnesses to this alleged incident. 06/21/23 Telephone conference with potential defense expert, Dr. John LHR 0.20 Peters, re facts of case and discuss whether able to accept on behalf of Defendant Zeller. 06/21/23 Receipt and review of email and attachments thereto from LHR 0.40 potential defense expert, Dr. John Peters, re CV and Fee Schedule. 06/27/23 Telephone conference with Asst. Chief Zeller, re: following up SHP 0.30 on our prior request for the last known addresses and/or contact information for the witnesses to this alleged incident. PROFESSIONAL SERVICES SUMMARY Code Name Hours Rate Amount LHR Lyman H. Reynolds, Jr., Partner 0.80 185.00 148.00 SHP Sara H. Ptachik, Associate 1.20 160.00 192.00 Total Professional Services 2.00 $340.00 76 Client: City of Boynton Beach Matter: 19132 - Geraci v. Zeller DISBURSEMENTS Date Description 06/02/23 Arbitrators/Mediators #2023.0016D; Mediation Services of Lori Adelson - Approved Dispute Resolution Total Disbursements CURRENT BILL TOTAL AMOUNT DUE Balance Forward: Payments & Adjustments: Total Due: July 14, 2023 Page 2 Amount 1,650.00 $1,650.00 $ 1,990.00 4,882.00 -0.00 $ 6,872.00 77 Please return this page with remittance to Roberts, Reynolds, Bedard & Tuzzio, PLLC 470 Columbia Drive, Suite C-101 West Palm Beach, Florida 33409 Bill Number: 74640 Bill Date: July 14, 2023 Client Code: 032 Client Name: City of Boynton Beach Matter Code: 19132 Matter Name: Geraci v. Zeller Total Professional Services Total Disbursements CURRENT BILL TOTAL AMOUNT DUE Balance Forward: Payments & Adjustments: Total Due: Past Due Balance TOTAL AMOUNT DUE 340.00 1,650.00 $ 1,990.00 4,882.00 -0.00 $ 6,872.00 4,882.00 $6,872.00 78 ROBERTS, REYNOLDS, BEDARD & TUZZIO, PLLC 470 Columbia Drive, Suite C-101 West Palm Beach, Florida 33409 Telephone (561)688-6560 Tax ID No. 65-0004867 City of Boynton Beach Attn: Richard Ignaffo 100 East Ocean Avenue Boynton Beach, FL 33435 CLIENT: City of Boynton Beach MATTER: Beecher v. Felix, Neossaint & City of Boynton Beach Tristar #21870336 BILL FOR FEES AND COSTS THROUGH 06/30/23 PROFESSIONAL SERVICES Date Services July 14, 2023 Bill No. 74641 032 22731 Attorney Hours 06/01/23 Preparation of Notice of Hearing on The City's Motion to Strike SHP Plaintiffs Claims for Lost Wages and Loss of Ability to Earn Money in the Futrure. 06/01/23 Preparation of correspondence to Judge Samantha Schosberg SHP Feuer, re: upcoming UMC Hearing on The City's Motion To Strike Plaintiffs Claims For Lost Wages And Loss Of Ability To Earn Money In The Future. 06/01/23 Preparation of e-mail to Co -Defendant, Glen Levine, agreed SHP upon date and time for UMC hearing on The City's Motion to Strike Plaintiffs Claims for Lost Wages and Loss of Ability to Earn Money in The Future. 06/01/23 Receipt and review of Plaintiffs Notice of Filing Attorney's LHR Affidavit of Compliance 06/01/23 Receipt and review of Plaintiffs Notice of Filing Claimed Mail LHR Pursuant to Florida Statue 48.161 to Defendant, Kathleen Felix 06/02/23 Preparation of e-mail to Co -Defendant's counsel, C. Richard SHP Penalta, re: telephone conference to discuss the defense issues of the case including potentially sharing Dr. Grabel as a joint defense expert. 06/02/23 Receipt and review of e-mail from Co -Defendant's counsel, SHP Rick Penalta, re: upcoming telephone conference. 06/08/23 Preparation for upcoming telephone conference with SHP co -Defendant's counsel, Mr. Penalta, to discuss potentially splitting the cost of experts as well as inquiring as to the amount of co -Defendant's PFS to Plaintiff. 06/09/23 Telephone conference with co-defendant's counsel, Rick SHP Penalta, re: splitting the cost of the CME, and potentially an accident reconstruction ist and surveillance as well as co -Defendant's PFS to Plaintiff. 0.30 0.40 0.30 0.20 0.20 0.30 0.30 0.20 0.30 79 Client: City of Boynton Beach Matter: 22731 - Beecher v. Felix, Neossaint & City of Boynton Beach PROFESSIONAL SERVICES July 14, 2023 Page 2 Date Services Attorney 06/09/23 Receipt and review of e-mail from Co -Defendant's counsel, LHR Richard Penalta, re: status to defense expert, Dr. Jordan Grabel's CME Report pertaining to Plaintiff, Julie Beecher. 06/09/23 Receipt and review of defense expert, Dr. Jordan Grabel's, LHR CME Report pertaining to Plaintiff, Julie Beecher. 06/09/23 Receipt and review of Plaintiffs Notice of Filing Attorney's LHR Affidavit pursuant to Fla. Stat. 48.161. 06/09/23 Receipt and review of Plaintiffs Notice of Filing Claimed Mail LHR Pursuant to Fla. Stat. 48.161. 06/09/23 Receipt and review of e-mail from Co -Defendant's counsel, C. SHP Richard Penalta, providing a copy of Dr. Grabel's CME report regarding Plaintiff, per our prior agreement to share Dr. Grabel as a defense expert. 06/12/23 Preparation of correspondence to Claims Examiner III, Diana LHR Taylor, re: defense expert, Dr. Jordan Grabel's, CME Report pertaining to Plaintiff, Julie Beecher. 06/12/23 Receipt and review of Plaintiff's proposed Alias Summons to LHR Defendant Kathleen McCarthy Felix. 06/14/23 Preparation of e-mail to Claims Examiner III, Diana Taylor, re: SHP detailed discussion of the outcome of the recent telephone conference with counsel for co -Defendant, Mr. Penalta, including the agreement to share Dr. Grabel as a defense expert, the amount of co -Defendant's PFS to Plaintiff, co -Defendant's inquiries related to whether the City would be interested in sharing the cost of an accident reconstruction expert and/or surveillance, and our recommendations related to same. 06/15/23 Receipt and review of e-mail from Claims Examiner III, Diana SHP Taylor, re: inquiries related to our telephone conference with Mr. Penalta. 06/15/23 Preparation of e-mail to Claims Examiner III, Diana Taylor, re: SHP answering Ms. Taylor's inquires related to our telephone conference with Mr. Penalta as well as the defensive and discovery plan of action moving forward. 06/15/23 Receipt and review of e-mail from Claims Examiner III, Diana SHP Taylor, re: acknowledging our answers to her inquires related to the defensive and discovery plan of action. 06/15/23 Receipt and review of e-mail from TriStar Rep. Diana Taylor re: SHP holding on our own surveillance until we know if Co -Defendant's surveillance was successful, agreement to recommendation to wait to decide on splitting cost of ax recon expert until after Plaintiffs deposition, and need for copies of the damage estimate and photos from Co -Defendant as vehicles were in salvage prior to City being advised of claim against them. Hours 0.20 0.50 0.20 0.20 0.40 0.30 0.20 0.60 0.30 0.50 0.30 0.30 80 Client: City of Boynton Beach July 14, 2023 Matter: 22731 - Beecher v. Felix, Neossaint & City of Boynton Beach Page 3 PROFESSIONAL SERVICES Date Services Attorney Hours 06/21/23 Preparation of e-mail to Plaintiffs counsel Levine re: LHR 0.20 depositions of City employees Ben Dexter, Gail Bootz, and Warren Bazemore, former City employee Richard Ignoffo, Defendant Fern Neossaint, and witness Sammie Gillion. 06/28/23 Receipt and review of Plaintiffs Notice of Filing Substitute LHR 0.20 Service of Process on Defendant Felix. PROFESSIONAL SERVICES SUMMARY Code Name Hours Rate Amount LHR Lyman H. Reynolds, Jr., Partner 2.40 185.00 444.00 SHP Sara H. Ptachik, Associate 4.50 160.00 720.00 Total Professional Services 6.90 $1,164.00 SUB TOTAL $ 1,164.00 Prepaid Funds Applied -30.00 Prepaid Funds Remaining: ($30.00) CURRENT BILL TOTAL AMOUNT DUE $ 1,134.00 Balance Forward: 1,664.50 Payments & Adjustments: -1,664.50 Total Due: $ 1,134.00 81 Please return this page with remittance to Roberts, Reynolds, Bedard & Tuzzio, PLLC 470 Columbia Drive, Suite C-101 West Palm Beach, Florida 33409 Bill Number: 74641 Bill Date: July 14, 2023 Client Code: 032 Client Name: City of Boynton Beach Matter Code: 22731 Matter Name: Beecher v. Felix, Neossaint & City of Boynton Beach Total Professional Services Total Disbursements SUB TOTAL Prepaid Funds Applied Prepaid Funds Remaining: ($30.00) CURRENT BILL TOTAL AMOUNT DUE Balance Forward: Payments & Adjustments: Total Due: Past Due Balance TOTAL AMOUNT DUE 1,164.00 0.00 $ 1,164.00 -30.00 $ 1,134.00 1,664.50 -1,664.50 $ 1,134.00 0.00 $1,134.00 82 ROBERTS, REYNOLDS, BEDARD & TUZZIO, PLLC 470 Columbia Drive, Suite C-101 West Palm Beach, Florida 33409 Telephone (561)688-6560 Tax ID No. 65-0004867 City of Boynton Beach July 21, 2023 Attn: Tennille DeCoste Bill No. 74908 100 East Ocean Avenue Boynton Beach, FL 33435 CLIENT: City of Boynton Beach 032 MATTER: Smith (Joseph) v. Sohn et al. 22369 Claim # BILL FOR FEES AND COSTS THROUGH 06/30/23 PROFESSIONAL SERVICES Date Services Attorney Hours 06/01/23 Draft/Revise Answer and Affirmative Defenses to Plaintiff's AGB 3.40 Amended Complaint 06/02/23 Communicate/Other External multiple correspondence with all AGB 0.30 defense counsel re: revisions to Joint Motion to Extend Pretrial Deadlines 06/02/23 Communicate/Other External correspondence to Ms. Lamay re: AGB 0.10 agreement with Joint Motion to Extend Pretrial Deadlines 06/02/23 Communicate/With Client correspondence to Ms. Klein AGB 0.20 regarding Sohn's Answer and affirmative Defenses to Plaintiffs Amended Complaint 06/05/23 Communicate/Other External multiple correspondence with Ms. AGB 0.20 Lamay re: agreement to Joint Motion to Extend Deadlines 06/05/23 Draft/Revise Joint Motion to Extend Pretrial Deadlines to reflect AGB 0.10 Plaintiffs agreement 06/05/23 Draft/Revise proposed order on Joint Motion to Extend AGB 0.20 Deadlines PROFESSIONAL SERVICES SUMMARY Code Name Hours Rate Amount AGB Ann G. Breeden, Associate 4.50 160.00 720.00 Total Professional Services 4.50 $720.00 83 Client: City of Boynton Beach Matter: 22369 - Smith (Joseph) v. Sohn et al. DISBURSEMENTS Date Description 06/29/23 Outside Printing #56706351;Joseph Avrus insurance records from Progressive Ins - Tampa, FL - Claimfox, Inc. 06/29/23 Outside Printing #56553485;Joseph Smith insurance records from Progressive Ins - Tampa, FL - Claimfox, Inc. 06/29/23 Outside Printing #56554862;Joseph Smith insurance records from Progressive Ins, - Tampa, FL - Claimfox, Inc. 06/29/23 Outside Printing #56555356;Joseph Smith insurance records from Progressive Inc - Tampa, FL - Claimfox, Inc. 06/29/23 Outside Printing #56553743;Joseph Smith insurance records from Progressive Ins - Tampa, FL - Claimfox, Inc. 06/29/23 Outside Printing #56554378;Joseph Smith insurance records from Progressive Ins - Tampa, FL - Claimfox, Inc. Total Disbursements CURRENT BILL TOTAL AMOUNT DUE Balance Forward: Payments & Adjustments: Total Due: July 21, 2023 Page 2 Amount 168.00 64.00 65.00 74.00 32.00 318.00 $721.00 $ 1,441.00 2,605.00 -2,214.50 $ 1,831.50 84 Please return this page with remittance to Roberts, Reynolds, Bedard & Tuzzio, PLLC 470 Columbia Drive, Suite C-101 West Palm Beach, Florida 33409 Bill Number: 74908 Bill Date: July 21, 2023 Client Code: 032 Client Name: City of Boynton Beach Matter Code: 22369 Matter Name: Smith (Joseph) v. Sohn et al. Total Professional Services Total Disbursements CURRENT BILL TOTAL AMOUNT DUE Balance Forward: Payments & Adjustments: Total Due: Past Due Balance TOTAL AMOUNT DUE 720.00 721.00 $ 1,441.00 2,605.00 -2,214.50 $ 1,831.50 390.50 $1,831.50 85 Johnson, Anselmo, Murdoch, Burke, Piper & Hochman, P.A. 2455 E. Sunrise Blvd. Suite #1000 Fort Lauderdale, Florida 33304 Tax I.D.#: 65-0220140 July 21, 2023 Billed Through 06/30/2023 Invoice 75504 / JLH 00281 42094 Via: claims@bbfl.us City of Boynton Beach P. O. Box 310 Boynton Beach, FL 33425 Regarding: Ultimate Bakery and Pastry, Inc. vs. City of Boynton Beach (22879963) FOR PROFESSIONAL SERVICES RENDERED: 0.35 06/01/2023 JLH Telephone conference with City attorney regarding performance by 0.70 Ultimate Bakery and Torocsik under settlement agreement and occupancy of premises returned to City; prepare memo to file $337.50 06/07/2023 JLH Letter to City representatives requesting confirmation of return of 0.20 premises $337.85 06/27/2023 JLH Letter to Michael Cirullo and Quentin Morgan regarding completion of 0.60 settlement, conclusion of litigation, and impact of paragraph 9 of settlement agreement on public records request Total Professional Services: $337.50 Hochman, J L 1.50 225.00 $337.50 DISBURSEMENTS 0613012023 Printing and Imaging Services 0.35 Total Expenses Advanced: $0.35 Summary: Total professional services $337.50 Total expenses incurred +$0.35 Total Amount Billed $337.85 Less Pre -Paid Applied $95.00 Please Pay this Amount Invoice Number 75504 $242.85 Page 2 87 ROBERTS, REYNOLDS, BEDARD & TUZZIO, PLLC 470 Columbia Drive, Suite C-101 West Palm Beach, Florida 33409 Telephone (561)688-6560 Tax ID No. 65-0004867 Tristar Risk Management July 21, 2023 Attn: Karen Klein Bill No. 74909 P.O. Box 2805 Clinton, Iowa 52733-2805 CLIENT: Gallagher Bassett Services, Inc. 138 MATTER: Readon v. Boynton Beach 18187 Claim #001470 -000396 -AB -01 BILL FOR FEES AND COSTS THROUGH 06/30/23 PROFESSIONAL SERVICES Date Services Attorney Hours 06/03/23 Communicate/Other External correspondence to Judge AGB 0.20 Cheesman regarding proposed order setting hearing on Defendant, Sohn's Motion for Summary Judgment. 06/14/23 Communicate/Other External Correspondence with David Miller SWK 0.30 and Karen Klein re hearing on our Motion for Summary Judgment. 06/16/23 Receipt and review of Plaintiffs Notice of Filing Deposition SWK 0.10 Transcript of Lex Eugene in Support of Response to Sohn's Motion for Summary Judgment. PROFESSIONAL SERVICES SUMMARY Code Name Hours Rate Amount AGB Ann G. Breeden, Associate 0.20 160.00 32.00 SWK Stephanie W. Kaufer, Partner 0.40 185.00 74.00 Total Professional Services 0.60 $106.00 88 Client: Gallagher Bassett Services, Inc. Matter: 18187 - Readon v. Boynton Beach CURRENT BILL TOTAL AMOUNT DUE Balance Forward: Payments & Adjustments: Total Due: July 21, 2023 Page 2 $ 106.00 1,290.50 -18.50 $ 1,378.00 89 Please return this page with remittance to Roberts, Reynolds, Bedard & Tuzzio, PLLC 470 Columbia Drive, Suite C-101 West Palm Beach, Florida 33409 Bill Number: 74909 Bill Date: July 21, 2023 Client Code: 138 Client Name: Gallagher Bassett Services, Inc. Matter Code: 18187 Matter Name: Readon v. Boynton Beach Total Professional Services Total Disbursements CURRENT BILL TOTAL AMOUNT DUE Balance Forward: Payments & Adjustments: Total Due: Past Due Balance TOTAL AMOUNT DUE 106.00 0.00 $ 106.00 1,290.50 -18.50 $ 1,378.00 1,272.00 $1,378.00 90 6.0 Consent Agenda 08/1/2023 Purchases over $10,000 for June 2023. Requested Action by Commission: Accept the written report to the Commission for purchases over $10,000 for the month of June 2023. Explanation of Request: Per Ordinance No.01-66, Chapter 2, Section 2-56.1 Exceptions to competitive bidding, Paragraph b, which states: Further, the City Manager, or designee is authorized to execute a purchase order on behalf of the City for such purchases under the $49,999 bid threshold for personal property, commodities, and services, or $200,000 for construction. The City Manager shall file a written report with the City Commission at the second Commission meeting of each month listing the purchase orders approved by the City Manager, or designee. All backup documentation is available upon request. Below is a list of the purchases for June 2023: 231395 JOHNSON CONTROLS FIRE $14,582.66 PROTECTIONS 231396 PRO -VISION SOLUTIONS, $37,257.00 LLC 231411 MADSEN/BARR $16,620.00 CORPORATION 231412 MADSEN/BARR $51,837.50 CORPORATION 231415 CKEPUSA $14,643.84 231417 SUNBELT WASTE $239,793.00 EQUIPMTNT 231436 FLUID CONTROL $11,323.00 SPECIALTIES, INC. J.C. WHITE 231438 ARCHITECTURAL INTERIOR $84,220.20 PRODUCTS 231454 ANZCO, INC. $59,395.00 231455 ANZCO, INC. $107,950.00 231457 VTECHIO $37,571.68 231458 CIVICPLUS LLC $27,217.65 91 How will this affect city programs or services? Ordinance No.01-66, Chapter 2, Section 2- 56.1 assists departments in timely procurement of commodities, services, and personal property. Administrative controls are in place with the development of a special processing form titled "Request for Purchases over $10,000" and each purchase request is reviewed and approved by the Department Director, Finance Department, and City Manager, or designee. Fiscal Impact: This Ordinance provides the impact of reducing paperwork by streamlining processes within the organization. This allows administration to maintain internal controls for these purchases, reduce the administrative overhead of processing for approval, and allow for making more timely purchases. Attachments: Purchases over $10k June 2023.pdf 92 ALEXIS KNIGHT 231459 ARCHITECT, INC. $31,785.00 231460 BARNEY'S PUMPS INC. $30,376.00 231461 VECTOR SOLUTIONS $12,862.28 231463 BAKER & TAYLOR $16,176.00 COMPANY 231477 RAFTELIS FINANCIAL $15,000.00 CONSULTANTS 231479 DUVAL FORD $25,852.91 231482 KIMLEY HORN & $22,729.70 ASSOCIATES INC. 231483 HOMRICH CORPORATION $38,900.00 231485 CAROLLO ENGINEERS, INC. $43,005.00 231486 ANZCO, INC. $105,150.00 231487 ANZCO, INC. $24,375.00 231488 AMAZON BUSINESS $15,504.60 231489 STRIPING SERVICE AND $23,290.00 SUPPLY, LLC How will this affect city programs or services? Ordinance No.01-66, Chapter 2, Section 2- 56.1 assists departments in timely procurement of commodities, services, and personal property. Administrative controls are in place with the development of a special processing form titled "Request for Purchases over $10,000" and each purchase request is reviewed and approved by the Department Director, Finance Department, and City Manager, or designee. Fiscal Impact: This Ordinance provides the impact of reducing paperwork by streamlining processes within the organization. This allows administration to maintain internal controls for these purchases, reduce the administrative overhead of processing for approval, and allow for making more timely purchases. Attachments: Purchases over $10k June 2023.pdf 92 CITY OF BOYNTON BEACH APPROVED REQUESTS FOR PURCHASES OVER $10,000 FOR JUNE 2023 1. Vendor: JOHNSON CONTROLS FIRE PROTECTIONS Purchase Amount: $ 14,582.66 Requesting Department: FACILITIES Contact Person: MELVIN STINSON Date: 6/l/2023 Brief Description of Purchase: PAYMENT FOR PAST DUE INVOICES FOR WORK COMPLETED AT VARIOUS FACILITIES IN THE CITY. Source for Purchase: CONFIRMING Fund Source: 001-2511-519.46-91 2. Vendor: PRO -VISION SOLUTIONS, LLC Purchase Amount: $ 37,257.00 Requesting Department: SOLID WASTE Contact Person: PAUL IAIA Date: 6/2/2023 Brief Description of Purchase: PURCHASE HARDWARE AND INSTALLATION FOR SOLID WASTE TRUCK CAMERAS AND CONNECTORS. Source for Purchase: SOLE SOURCE Fund Source: 431-2515-534.64-02 3. Vendor: MADSEN/BARR CORPORATION Purchase Amount: $ 16,620.00 Requesting Department: UTILITIES Contact Person: MARC FILSAIME Date: 6/5/2023 Brief Description of Purchase: INSTALLATION OF 6 INCH LINE STOPS (2 EACH) ON 6 INCH FM IN ORDER TO REPLACE EXISTING VALVES AT LIFT STATIONS 912 AND 210. Source for Purchase: CITY OF BOYNTON BEACH # 019282119 Fund Source: 401-2816-536.46-51 4. Vendor: MADSEN/BARR CORPORATION Purchase Amount: $ 51,837.50 Requesting Department: UTILITIES Contact Person: BRANDON MINGO Date: 6/5/2023 Brief Description of Purchase: THE REPAIR OF 8 INCH WATER MAIN THAT WAS HIT BYA CONTRACTOR WHO WAS DIRECTIONAL DRILLING AT MILITARY TRAIL AND SATIN LEAF. Source for Purchase: CITY OF BOYNTON BEACH # 019282119 Fund Source: 401-2810-536.46-47 5. Vendor: CKEPUSA Purchase Amount: $ 14,643.84 Requesting Department: LIBRARY Contact Person: TIFFANY PAGAN Date: 6/6/2023 Brief Description of Purchase: THE PURCHASE OF KITCHEN EQUIPMENT FOR THE WOMEN'S CLUB. Source for Purchase: PIGGYBACK OMNIA CONTRACT # R18201 Fund Source: 112-4415-559.64-02 PROJECT # - AR2304 6. Vendor: SUNBELT WASTE EQUIPMTNT Purchase Amount: $ 239,793.00 Requesting Department: SOLID WASTE Contact Person: PAUL IAIA Date: 6/6/2023 Brief Description of Purchase: THE PURCHASE OFA PETERBUILT ROLL -OFF TRUCK FOR SOLID WASTE DEPARTMENT. Source for Purchase: EMERGENCY CONFIRMING Fund Source: 501-2516-519.64-33 7. Vendor: FLUID CONTROL SPECIALTIES, INC. Purchase Amount: $ 11,323.00 Requesting Department: UTILITIES Contact Person: DAVID ROLAND Date: 6/13/2023 Brief Description of Purchase: REPLACEMENT OF VALVE AT THE EWTP FOR THE MAIN DRAIN 8" PLUG VALVE REMOVAL AND INSTALL OF NEW PLUG VALVE. Source for Purchase: SOLE SOURCE Fund Source: 401-2811-536.49-17 93 8. Vendor: J.C. WHITE ARCHITECTURAL INTERIOR PR Purchase Amount: $ 84,220.20 Requesting Department: LIBRARY Contact Person: TIFFANY PAGAN Date: 6/13/2023 Brief Description of Purchase: PURCHASE FURNITURE FOR ARTS AND CULTURAL CENTER AS WELL AS WOMEN'S CLUB. Source for Purchase: STATE OF FL CONTRACT # 5610000 -19 -ACS Fund Source: 112-4415-559.64-02 001-2710-572.64-16 001-2710-572.52-20 112-4415-559.52-20 AR2304 9. Vendor: ANZCO, INC. Purchase Amount: $ 59,395.00 Requesting Department: UTILITIES Contact Person: GAIL MOOTZ Date: 6/15/2023 Brief Description of Purchase: MINOR CONSTRUCTION -RENOVATIONS TO EXISTING LIFT STATION #801 Source for Purchase: CITY OF BOYNTON BEACH # 028251120 Fund Source: 403-5000-535.46-51 TASK #U-18-2023 10. Vendor: ANZCO, INC. Purchase Amount: $ 107,950.00 Requesting Department: UTILITIES Contact Person: GAIL MOOTZ Date: 6/15/2023 Brief Description of Purchase: MINOR CONSTRUCTION -RENOVATIONS TO EXISTING LIFT STATION #316 Source for Purchase: CITY OF BOYNTON BEACH # 028251120 Fund Source: 403-5000-535.46-51 TASK # U-17-2023 11. Vendor: VTECHIO Purchase Amount: $ 37,571.68 Requesting Department: POLICE Contact Person: SOPHIA STEWART Date: Brief Description of Purchase: UTILIZE JAG GRANT TO PURCHASE LAPTOPS FOR P.D. Source for Purchase: PIGGYBACK FL CONTRACT # 43211500-WSCA-15- Fund Source: 105-3460-521.64-15 ACS 12. Vendor: ALEXIS KNIGHT ARCHITECT, INC. Purchase Amount: $ 31,785.00 Requesting Department: UTILITIES Contact Person: JOSE HUERTAS Date: 6/15/2023 Brief Description of Purchase: REPLACE APPROXIMATELY 540 LF OF EXISTING 20" FORCE MAIN FROM LIFT STATION #356 TO NORTHEAST 6TH COURT RIGHT OF WAY. Source for Purchase: CITY OF BOYNTON BEACH # 046282117 Fund Source: 403-5000-535.65-04 TASK ORDER # UT -2E-03 13. Vendor: BARNEY'S PUMPS INC. Purchase Amount: $ 30,376.00 Requesting Department: UTILITIES Contact Person: MARC FILSAIME Date: 6/15/2023 Brief Description of Purchase: TWO REPLACEMENT PARTS/ PUMPS FOR LIFT STATION #922 Source for Purchase: CITY OF BOYNTON BEACH # 014282119 Fund Source: 403-5000-535.65-04 94 14. Vendor: VECTOR SOLUTIONS Purchase Amount: $ 12,862.28 Requesting Department: FIRE Contact Person: CHIEF BRUDER Date: 6/15/2023 Brief Description of Purchase: FIRE SCHEDULING -ANNUAL SUBSCRIPTION Source for Purchase: EXEMPT / TRAINING Fund Source: 001-2210-522.46-91 15. Vendor: BAKER & TAYLOR COMPANY Purchase Amount: $ 16,176.00 Requesting Department: LIBRARY Contact Person: TIFFANY PAGAN Date: 6/15/2023 Brief Description of Purchase: BOOK LEASING PROGRAM FROM 01/01/2023 THRU 06/30/2023. Source for Purchase: SINGLE SOURCE Fund Source: 001-2610-571.66-01 691-5000-590.04-41 16. Vendor: RAFTELIS FINANCIAL CONSULTANTS Purchase Amount: $ 15,000.00 Requesting Department: RECREATION AND PARKS Contact Person: KACY YOUNG Date: 6/16/2023 Brief Description of Purchase: CITY COMMISSION REQUESTED RECREATION AND PARKS IMPACT STUDY. Source for Purchase: THREE QUOTES Fund Source: 141-2730-572.49-17 17. Vendor: DUVAL FORD Purchase Amount: $ 25,852.91 Requesting Department: FLEET Contact Person: A. GRECO-ARENCIBIA Date: 6/16/2023 Brief Description of Purchase: PURCHASE 2024 FORD MAVERICK FOR RECREATION & PARKS. Source for Purchase: PIGGYBACK BRADFORD COUNTY # BCSO 22-27-1.0 Fund Source: 501-2516-519.64-33 18. Vendor: KIMLEY HORN & ASSOCIATES INC. Purchase Amount: $ 22,729.70 Requesting Department: ENGINEERING Contact Person: GARY DUNMYER Date: 6/20/2023 Brief Description of Purchase: PAYMENT OF OUTSTANDING INVOICES FOR GRANT WRITING ASSISTANCE. Source for Purchase: CONFIRMING Fund Source: 303-4905-541.49-17 CITY OF BOYNTON BEACH # 046282117 TASK # UT -1 D-08 19. Vendor: HOMRICH CORPORATION Purchase Amount: $ 38,900.00 Requesting Department: FACILITIES Contact Person: KEVIN RAMSEY Date: 6/20/2023 Brief Description of Purchase: MINOR CONSTRUCTION -DEMOLITION OF COMMERCIAL BUILDING LOCATED AT 1101-1103 NORTH FEDERAL HWY. Source for Purchase: CITY OF BOYNTON BEACH # 028251120 Fund Source: 130-2411-524.34-25 TASK ORDER # - F-22-2023 20. Vendor: CAROLLO ENGINEERS, INC. Purchase Amount: $ 43,005.00 Requesting Department: UTILITIES Contact Person: JOEL LACROZE Date: 6/21/2023 Brief Description of Purchase: CONTINUING OF ENGINEERING SERVICES DURING BIDDING AND CONSTRUCTION FOR WELLS 4W AND 5W AND WELLS 7W AND 8W Source for Purchase: CITY OF BOYNTON BEACH # 046282117 Fund Source: 403-5000-533.65-02 TASK ORDER # UT -1A-02 21. Vendor: ANZCO, INC. Purchase Amount: $ 105,150.00 Requesting Department: UTILITIES Contact Person: GAIL MOOTZ Date: 6/21/2023 Brief Description of Purchase: MINOR CONSTRUCTION -RENOVATIONS TO EXISTING LIFT STATION # 319 Source for Purchase: CITY OF BOYNTON BEACH # 028251120 Fund Source: 403-5000-535.46-51 TASK # U-19-2023 95 22. Vendor: ANZCO, INC. Purchase Amount: $ Requesting Department: UTILITIES Contact Person: GAIL MOOTZ Date: 6/21/2023 Brief Description of Purchase: MINOR CONSTRUCTION -RENOVATIONS TO EXISTING LIFT STATION #2113 Source for Purchase: CITY OF BOYNTON BEACH # 028251120 Fund Source: 403-5000-535.46-51 TASK ORDER # U-16-2023 23. Vendor: AMAZON BUSINESS Purchase Amount: $ Requesting Department: WAREHOUSE Contact Person: JEN PACIELLO Date: 6/21/2023 Brief Description of Purchase: PURCHASE OF STREET LIGHTS AND POLES FOR BOYNTON BEACH EXTENSION Source for Purchase: CITY OF BOYNTON BEACH # 043141220 Fund Source: 302-4103-580.63-15 24. Vendor: STRIPING SERVICE AND SUPPLY, LLC Requesting Department: POLICE Brief Description of Purchase: PURCHASE OF MOBILE MESSAGE BOARD Source for Purchase: PIGGYBACK FSA # - FAS20-EQU18.0 Purchase Amount: $ Contact Person: SOPHIA STEWART Date: 6/21/2023 Fund Source: 105-3446-521.64-02 103-2110-521.64-02 24,375.00 15,504.60 23,290.00 96 7.A Consent Bids and Purchases over $100,000 08/1/2023 City of Boynton Beach Agenda Item Request Form Commission Meeting Date: 08/ 1/2023 Vehicles to Purchase- Solid Waste Side Loaders Requested Action by Commission: Approve the purchase of two (2) replacement vehicles that were approved in the FY22/23 budget for an estimated amount of $789,356 by utilizing the Florida Sheriff's Association Contract FSA22-VEH2O.0. Explanation of Request: The Public Works Fleet Division recommends the purchase of two (2) replacement vehicles for Solid Waste which are available for purchase immediately. Commission previously approved purchase order 220556 in the amount of $347,791 and purchase order 230815 in the amount of $376,359 for the replacement of Solid Waste vehicles, but the arrival of the vehicles will not be delivered until the fall of 2024. Which will subsequently increase maintenance on the existing vehicles. The current requested vehicles are in stock and can be delivered in September of 2023. How will this affect city programs or services? These vehicles will be used throughout the City to provide services to our residents and customers. Fiscal Impact: FY 22-23 budget has the funds appropriated for these purchases. 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Box 12519 - Tallahassee, Hodda 32317-2519 fi (850) 878-8665 www.fdsheriffs.org ® 13 NOTICE OF FINAL AWARD FSA22-VEH2O.0: Heavy Trucks and Buses Date: October 1, 2022 To: All Bidders and Purchasers From: Steve Casey, Executive Director Sarrah Glassner, Deputy Executive Director of Administration Hugh Oliver, Cooperative Purchasing Program Manger Re: Notice of Award for Contract FSA22-VEH2O.0: Heavy Trucks and Buses We are pleased to announce that the Florida Sheriffs Association (FSA) has successfully completed its 20th year of the cooperative purchasing contract for heavy trucks and buses. The FSA is issuing a Notice of Award for the contract, that will be effective from October 1, 2022, through September 30, 2023. This year's bid included 152 items offering tactical armored vehicles, conventional and electric buses, refuse trucks, mobile command units, cab and chassis trucks. The competitive process for this award began in April 2022, when stakeholders were surveyed regarding procurement needs. Items were added based on survey results and the Fleet Advisory Committee's review of products. An advertisement for the Invitation to Bid was published in the Florida Administrative Weekly, as well as the State of Florida's Office of Supplier Diversity and the FSA websites. On April 22, 2022, a direct notification was sent to 753 prospective bidders to participate in a voluntary bidder workshop and to register for bid qualification. The three-month ITB advertisement resulted in 79 pre-bid attendees or waivers. Of these respondents, 33 submitted bids and 29 qualified. The Florida Sheriffs Association Cooperative Purchasing Program has followed the Contract Terms and Conditions for this procurement. Bidders that become awarded vendors are governed by their manufacturer agreements and the Contract Terms and Conditions. Contract pricing will be extended and guaranteed to the Florida Sheriffs Association, any unit of local government, political subdivision or agency of the State of Florida, or to other entities approved by manufacturers to buy from this contract, which can include out-of-state sales. Vendors that wish to extend contract pricing to entities other than those defined here are governed by their manufacturer's agreement. All purchasers are bound by state law, local ordinances, rules, and regulations for purchases made under this contract. 101 -K4,IF FSA22-VEH20.0 Item Group Descriptions The following items will be factory installed on the base vehicle/equipment to meet the model number and build codes of the vehicle listed. Item Group: • Buses Electric: 19 To 20 Passenger Capacity Range, Van Type Cutaway Chassis FSA Item Group Description • Motor: 160 kw, 215 hp (minimum); Batteries: 68 kw (minimum) • Charging Rate: NOTE: Charging rate will depend on utilizing chargers from option list, Level II 8 hours, Level III 2 hours • Range: 100 miles (approximate depending on battery size, load, terrain, a/c usage and driving habits) • GVWR: 14,500 Ibs.(approximate, sized to meet passenger capacity) • Wheelbase: 138 in (approximate, sized to meet passenger capacity) • Brakes: Hydraulic brakes w/ ABS, regenerative braking • Suspension: Sized to meet required GVWR • Steering: Power steering • Wheels and Tires: Factory wheels and tires w/wheel covers • Exterior Body: Welded steel cage construction, 96 in wide (approximate), must meet all applicable FMVSS requirements, fiberglass or steel front and rear caps, one piece roof or steel sheets(spanning the full width of roof), electric actuated passenger entry door w/ full length glass, drivers visibility window in front of entry door, passenger windows w/ tempered safety glass and tint, rear center emergency door w/tempered glass and tint, emergency door prop, breakaway mirrors w/ convex, steel rear bumper, rear mud flaps, midship turn /marker lights, backup camera • Interior Body: 74 in (approximate) floor to ceiling height, insulation throughout interior, ceiling grabrail (both sides), plywood floor w/ rubber flooring, modesty panel behind driver, entry grabrail both sides of entry door, safety step nosing, dual a/c and heat system, door activated interior/exterior lighting including entry stepwell, interior finished throughout • Passenger Seating: Seating for 19 passengers, seats w/seatbelts, grab handles on each seat • Drivers Station: Tilt/telescope steering wheel adjustment, backup camera, gauge package, am/fm radio, rear door alarm, tinted sun visor • Color: White 102 LL _ ® C: O r- O i O C: O M CL O 0 pa 0 0 0 LL mCIO co In 00 i U) a. ® ® d d Q U Q0 0 0 O 0 O 0 0 o d N ni N cv C a) -2 M � U w a v �- a. r 0i 61-:� r 6`i 69- r Orn 60- r 6> 60� I - Z w (D Z U U U U C C C C U O O O O o- n n n (n UU) U) U) U) cnw U) (D C O cu C O cu C O m C O m z m w C/) Q cn Q cn Q cn Q U) (n C C O O U i � O 0 co cu m y � a� = ® � r .� U? > L 0 w L 0 w L 0 w L 0 w ® U w 0 N LU NU) 4' � w w w m co E d E d E d E d CD 3 Q N N m Q U LL .o -j v = ®�®�pp U CO w U m V c w NC\j c i n Z c U iA S) -K4,IF FSA22-VEH20.0 Item Group Descriptions The following items will be factory installed on the base vehicle/equipment to meet the model number and build codes of the vehicle listed. Item Group: • Buses Electric: 20 To 52 Passenger Capacity Range, Conventional Type Chassis FSA Item Group Description • Electric Motor: 230 kw, 315 hp • Batteries: 155 KWH batteries capacity (minimum) • CHARGING RATE: NOTE: Charge rate will depend on utilizing chargers from option list, Level II 19.2 KW 6.5 to 11 -hour charging, Level 111 50 KW 2.5-4 hour charging • RANGE: 120 miles (approximate depending on battery size, load, terrain, a/c usage and driving habits) • GVWR: 23,500 Ibs.(approximate, sized to meet passenger capacity) • Wheelbase: 273 in (approximate, sized to meet passenger capacity) • Brakes: Air brakes w/ ABS, and regenerative braking (if available) • Suspension: (Sized to meet required GVWR) Leaf spring front and rear axle, or air ride is acceptable • Steering: Power steering • Wheels and Tires: Factory wheels and tires, painted steel • Exterior Body: Welded steel cage construction, 96 in wide (approximate), must meet all applicable FMVSS requirements, fiberglass or steel front and rear caps, one piece roof or steel sheets(spanning the full width of roof), electric or air actuated passenger entry door w/ full length glass, drivers visibility window in front of entry door, passenger windows w/ tempered safety glass and tint, rear center emergency door or windows w/tempered glass and tint, emergency door prop, breakaway mirrors w/ convex, steel rear bumper, rear mud flaps, midship turn /marker lights, backup camera • Interior Body: 77 in (approximate) floor to ceiling height, insulation throughout interior, ceiling grabrail (both sides), plywood floor w/ rubber flooring, modesty panel behind driver, entry grabrail both sides of entry door, safety step nosing, dual a/c and heat system, door activated interior/exterior lighting including entry stepwell, interior finished throughout • Passenger Seating: Seating for 48 passengers, seats w/seatbelts, grab handles on each seat • Drivers Station: Tilt/telescope steering wheel adjustment, backup camera, gauge package, am/fm radio, rear door alarm, tinted sun visor • Color: White 104 2 E ® m / m § n § m \ » » » M C 0 O O O O 2 E 2 ' 3 y y y m m 3 In 3 U) % U @ a \ c \ o \ c \ o 3 U L E ® 0 w ? a / a ? a ? a CL ) \ / 00 2 z § a 7 00 % 00 % 00 % L » Z O U w O 2 § k § § w — — — — C6 Cli (6 < f f ƒcu f / U) U) U) U) n 3 L Q § _ / § _ / § _ / § _ / 3 @ 3 CO / / / / <§ < ) § § t R R w R # / f f f f f m 3 / q g / § - ƒ ± - g ± - > ± ± C) - 2LL � / k /7 C') m > q / .. / 2 0 ± w wFn -i L b f § LLI 0 � 7 = 2 © 2 k Q § N co • & E 3 % •/ E g ° = \ 2 (13 f & / U •/ & E ° 6 / m 0 CL ry ry -o M Q d i CD (o N 9 N $> N m S, N (n (d) (ed () C: C: C: C: 0 O O O O 0 ® 0 ® 0 IOT LL 0 m 00 U 0 0 0 0 U) Q = U V 4) a. O 6 O CO O 6 O CO LU d J Q O O O d z 0 O O O O O O O O z W > V ico a. O 9- O O co O cle) Z 0 U Lu (D Z � U U U U U z Z Z z d U) � U) U) U D U) LU 0 U U 0 U U 0 U U 0 U U z co U LU CO U) N ® U W O_ J U W O_ J U N W O_ J U N W O_ J �- LO y 0 ® � >I-- h Imo- h h N 0 O = N ® U 0 N W N < LL V _ 0 Q_ U J Lu CO O W i 0 N ELU .7 d O E d O z E d F C U E d O 0 cn -K4,IF FSA22-VEH20.0 Item Group Descriptions The following items will be factory installed on the base vehicle/equipment to meet the model number and build codes of the vehicle listed. Item Group: • Buses Electric: 44 To 80 Passenger Capacity Range, Commercial Type Chassis FSA Item Group Description • Electric Motor: 230 kw, 315hp • Batteries: 155 kw (approximate) • Charging Rate: NOTE: Charge rate will depend on utilizing chargers from option list, Level 11 19.2 KW 6.5 — 11 Hour charging, Level 111 50 kw 2.5-4 Hour charging • Range: 120 miles (approximate depending on battery size, load, terrain, a/c usage, and driving habits) • GVWR: 36,000 Ibs.(approximate, sized to meet passenger capacity) • Wheelbase: 257 in. (approximate, sized to meet passenger capacity) • Brakes: Air brakes w/ABS, and regenerative braking (if available) • Suspension: Conventional type suspension or Air ride suspension (sized to meet required GVWR) • Steering: Power steering • Wheels and tires: Factory wheels and tires, painted steel • Exterior Body: Must meet all applicable FMVSS requirements, welded steel cage construction, 96 in wide (approximate), body length 40 ft (approximate),fiberglass or steel front and rear roof caps, one piece roof or steel sheets(spanning the full width of roof), electric or air actuated passenger entry door w/ full length tempered and tinted safety glass, passenger windows w/ tempered safety glass and tint, emergency exit windows, breakaway mirrors w/ convex (visible through windshield), steel rear bumper, rear mud flaps, midship turn /marker lights, backup camera, steel front and rear bumpers, rear engine compartment lighted and sound insulated w/flip up door held open by gas shocks • Interior Body: 80 in (approximate) floor to ceiling height, insulation throughout interior, ceiling grabrail (both sides), plywood floor w/ rubber flooring, modesty panel behind driver, entry grabrail both sides of entry door, safety step nosing, dual a/c and heat system, door activated interior/exterior lighting including entry stepwell, interior finished throughout • Passenger Seating: Seating for 48 passengers, seats w/seatbelts, grab handles on each seat • Drivers Station: Tilt/telescope steering wheel adjustment, backup camera, gauge package, am/fm radio, door alarm, tinted sun visor • Color: White 107 LL _ ® C: O r- O i O C: O M CL O O pa O O O LL mCIO co In 00 i U) o 0 0 0 U) a. Q U W d o 0 0 0 0 0 0 0 CN ry -6 J Q U .i a. cl (D � N M (.0 � N M co � N C7 co �Of W O U w (D Z U U U U C C C C U O O O O o- n n n (n UU) U) U) U) cnW U) (D C O cu C O cu C O m C O m mZ Y WCL CO Q W co ~ O C (itl O C (w6 O 0- O m O O m F- N _ co ®O W U d i O W O W O W O W O L) O W NW � U LLI Q d d d d CD N (o 3 C\jQ N :2® N m QCO U) W V = U W D m �®�pp V m Q� N L Z (� U iA S) -K4,IF FSA22-VEH2O.0 Item Group Descriptions The following items will be factory installed on the base vehicle/equipment to meet the model number and build codes of the vehicle listed. Item Group: • Buses: 14 To 25 Passenger Capacity Range, Van Type Cutaway Chassis FSA Item Group Description • Engine: Diesel • Transmission: Automatic • GVWR: 10,350 lbs. (approximate, sized to meet passenger capacity) • Wheelbase: 156 in (approximate, sized to meet passenger capacity) • Brakes: Hydraulic brakes w/ ABS • Suspension: Sized to meet required GVWR • Steering: Power steering • Wheels and Tires: Factory wheels and tires, painted steel • Fuel Capacity: 25 gal • Exterior Body: Welded steel cage construction, 86 in wide (approximate),body must meet all applicable FMVSS requirements, fiberglass or steel front and rear caps, one piece roof or steel sheets(spanning the full width of roof), electric actuated passenger entry door w/ full length glass, drivers visibility window in front of entry door, passenger windows w/ tempered safety glass and tint, rear center emergency door w/tempered glass and tint, emergency door prop, breakaway mirrors w/ convex, steel rear bumper, rear mud flaps, midship turn /marker lights, backup camera • Interior Body: 74 in (approximate) floor to ceiling height, insulation throughout interior, ceiling grabrail (both sides), plywood floor w/ rubber flooring, modesty panel behind driver, entry grabrail both sides of entry door, safety step nosing, dual a/c and heat system, door activated interior/exterior lighting including entry stepwell, interior finished throughout • Passenger Seating: Seating for 20 passengers, seats w/seatbelts, grab handles on each seat • Drivers Station: Tilt/telescope steering wheel adjustment, backup camera, gauge package, am/fm radio, rear door alarm, tinted sun visor • Color: White 109 2 2 % « z U2 / ■ a E / « 7 ? ? « 7 f ? 4 7 ? ® \ w m m n m � / § § \ » » » M C 0 O O O O 2 E & 2 3 y y y m m 3 In 3 K k k k k @ \ \ \ \ a c o c o £ ƒ \ 2 % « z U2 / ■ a ? « CN f / « 7 ? ? « 7 f ? 4 7 ? \ w � U 2 & / K k k k k » . . . . 2 J / 2 / / / ± / ± U) U) U) U) n / / g / § / §§ / § / co @ a- « k k k k / / @ � 8 § @ � @ § b R R w R > / 3 � ƒ m ƒ / m \ / m > f ± f ± f ± f ± C2 / / » \ 9 co / (13 / � a-.. C CD \ > q\ / / 0 � 0 E 3 % % g ° k 2 / U E ° / m C: c C: c C: c c C: .F+ <N -N -N -w r LL 0 0 0 0 0 0 0 0 m m m m m m m m m 0 0 0 0 0 0 0 0 ®y 0 0 0 0 0 0 0 0 a o d o o O o 0 0 if U) O Q a) U) 00r = d d d d d d d d "6 U M Q Q Ln D) M C14 LO O) M N LO O 00 d Lf) m 00 t C3 CD Ir --CD ti CD I® CD I`- Q O O O O O O O O a. 69 61) 60- 60. 61) Ef} 69 60 U W a - z W U U U U z U 0 U U cn a) cu cu m cu (n U U) Cl) cn U) (n U) w U) m m=) m=3 m=3 m:3 U m m m m o � UOf C M (13 N c c m > w U) a) U) 2 Q N N m —CU M 0 co 2 O(n c ca E c ca E c ca E c E c LU �— Q d Q d d d Q d Q N � N CO �LU U LL U) N V m Ln r i CO Q = Ir (n` c ®®p Q� N Z U CO N 00 U V S) -K4,IF FSA22-VEH2O.0 Item Group Descriptions The following items will be factory installed on the base vehicle/equipment to meet the model number and build codes of the vehicle listed. Item Group: • Buses: 20 To 52 Passenger Capacity Range, Conventional Truck Type Cutaway Chassis FSA Item Group Description • Engine: 240 hp minimum 6 cyl. diesel • Transmission: Allison (or equivalent) 6 speed automatic • GVWR: 23,500 lbs. (approximate, sized to meet passenger capacity) • Wheelbase: 276 in (approximate, sized to meet passenger capacity) • Brakes: Hydraulic brakes or air brakes w/ ABS • Suspension: Leaf spring, or air ride (sized to meet required GVWR) • Steering: Power steering • Wheels and Tires: Factory wheels and tires, painted steel wheels • Fuel Capacity: 50 gal • Exterior Body: Welded steel cage construction, 96 in wide (approximate), must meet all applicable FMVSS requirements, fiberglass or steel front and rear caps, one piece roof or steel sheets(spanning the full width of roof), electric actuated 36 in passenger entry door w/ full length glass, drivers visibility window in front of entry door, passenger windows w/ tempered safety glass and tint, rear center emergency door w/tempered glass and tint, emergency door prop, breakaway mirrors w/ convex, steel rear bumper, rear mud flaps, midship turn /marker lights, backup camera • Interior Body: 77 in (approximate) floor to ceiling height, insulation throughout interior, ceiling grabrail (both sides), plywood floor w/ rubber flooring, modesty panel behind driver, entry grabrail both sides of entry door, safety step nosing, dual a/c and heat system, door activated interior/exterior lighting including entry stepwell, interior finished throughout • Passenger Seating: Seating for 36 passengers, seats w/seatbelts, grab handles on each seat • Drivers Station: Tilt/telescope steering wheel adjustment, backup camera, gauge package, am/fm radio, rear door alarm, tinted sun visor • Color: White 112 \ ) \ < 2 E ® m / m § n § m \ » » » M C 0 O O O O 2 E 2 3 y y y m m 3 In 3 U) m « $ 3 C:) / o / 0 / 0 / \ a � D U LU ? / ? ? » % ƒ m \ e ƒ £ % o 2 ■ .27 7 7 J / ± a 61-:� � 61) 60- w k Z O � 2 L » 2 / � � / 0 2 J / 2 / / / ± / ± U) U) U) U) n / / g § / § / § / § / co @ a- k k k k « / / @ � 8 § @ � @ § b R R w R # / ƒ z 2 ƒ f ± f ± f ± f ± \ C5 / / r co 7 % 2 / k / .. 0 b m D ¢ a / / g k / E N (8) U) U) V) (n V) (n () C: c C: C: C: i c C: .F+ <N -N -N -w r LL mCIO 03 00 m m CD co m U Q U +r 0 0 0 0 0 0 0 0 ®y 0 0 0 0 0 0 0 0 P- a 6 6 0 0 0 0 0 0 C) U LU C OOOOOOOOr U 00 LO co LO OD LO 00 LO h V cli C6 C5 coo (D (D 0000 co 000 c 0000 0000 mJ Q s -r a. 69- r (11) r ()D- r 60. r 60-6 r r r 60- z O z LU z O U w U U (3 U (D C CC C z Q U U U CJ V U U C) C C C C N T 2? (n () w Cl) (n U) w U) cn U) m d m=) m=) m D m:3 U m m m m � oLU U N m c m z > U U U U >1 >w m U) Q) U) 2 Q C5 ® LO m ( M 0 co (N O `� c ca E c ca E� c ca c ns E c LU �— a) a) > N ¢ d Q d ( d Q d Q cv � cv CO �LU U LL U) CD N V m O i CO N®�®^p Q� N Z U CO N m U V S) � CBi f®2 fAi C!A ® O O O O LL to 00 fn In 00 U) Cl) Q U � j i O Q a. o 0 0 0 F- C) LU o a H Y O d ® d O d O d M Q V L- CD M r CD M r (O M r co M r J a. 69 (f) (A' H> Q Z O H Z W 5 Z O U (A Cn Cn to LLJ Y U -�e U -�e U Y U (7 m m :3 :3 z I- r I- < O Ce _r O Ce _ F Ce O Ce cn a) O O CO O U) C) c c c m 06 U Q - Q N U) a- a) c (3) (D c (D a> (2) a> (1) U H (� z Cn U) i ® i > co U) c CO m cn Cd Cn cu CO c CO m Cn c Cn N U) = CL QCN O C N CO N m W > N C¢ LL ®�®�pp U LO ® N W U) V O O L E d E d Z E d U E d iA -K4,IF FSA22-VEH2O.0 Item Group Descriptions The following items will be factory installed on the base vehicle/equipment to meet the model number and build codes of the vehicle listed. Item Group: • Buses: 33 To 54 Passenger Capacity Range, Commercial Type, Rear Engine Chassis FSA Item Group Description • Engine: 240 HP minimum 6 cyl. diesel • Transmission: Allison (or equivalent) 5 speed automatic • GVWR: 36,000 Ibs.(approximate, sized to meet passenger capacity) • Wheelbase: 257 in. (approximate, sized to meet passenger capacity) • Brakes: Air brakes w/ABS • Suspension: Conventional type suspension or Air ride suspension (sized to meet required GVWR) • Steering: Power steering • Wheels and tires: Factory wheels and tires, painted steel • Fuel Capacity: 60 gal minimum • Exterior Body: Must meet all applicable FMVSS requirements, welded steel cage construction, 96 in wide (approximate), body length 40 ft (approximate),fiberglass or steel front and rear roof caps, one piece roof or steel sheets(spanning the full width of roof), electric or air actuated passenger entry door w/ full length tempered and tinted safety glass, passenger windows w/ tempered safety glass and tint, emergency windows or door, breakaway mirrors w/ convex (visible through windshield), steel rear bumper, rear mud flaps, midship turn /marker lights, backup camera, steel front and rear bumpers, rear engine compartment lighted and sound insulated w/flip up door held open by gas shocks • Interior Body: 80 in (approximate) floor to ceiling height, insulation throughout interior, ceiling grabrail (both sides), plywood floor w/ rubber flooring, modesty panel behind driver, entry grabrail both sides of entry door, safety step nosing, dual a/c and heat system, door activated interior/exterior lighting including entry stepwell, interior finished throughout • Passenger Seating: Seating for 48 passengers, seats w/seatbelts, grab handles Drivers Station: Tilt/telescope steering wheel adjustment, backup camera, gauge package, am/fm radio, door alarm, tinted sun visor • Color: White iI LL _ ® C: O 1= O i O C: O M CL O 0 pa 0 0 0 LL mCIO co In 00 U _ CO Q L ® ® d d = a. U LU Z U zo W v 0) r� 0 00 CY) ti 0 rnW rte' 0 a)a) ��. Q LLI d 61-:� 6r, 61) 61,;� d H J Q U LU 2 2 O U c U c U c U c U W E a) E a) E a) E Q >1 >1 >, >, U) U) U) U) cn ai � U C O cu C O cu c O m c O m m o- Q Q Q w CL 025 (n (n Q (n Y U c cu c w c m c m W H H H H y y (D z w U) U) > c 0 LL c 0 LL c 0 LL c 0 LL _ LU LO ® LU ``) E E E E N M -6 � -a N 3 Q N :2® N m Q U)w LL V = U U) > m � �®^p V m N N Q� N L z U iA S) -K4,IF FSA22-VEH2O.0 Item Group Descriptions The following items will be factory installed on the base vehicle/equipment to meet the model number and build codes of the vehicle listed. Item Group: • Buses: 36 To 52 Passenger Capacity Range, Commercial Type, Front Engine Chassis FSA Item Group Description • Engine: 240 hp minimum 6 cyl diesel • Transmission: Allison (or equivalent) 5 speed automatic • GVWR: 36,000 lbs. (approximate, sized to meet passenger capacity) • Wheelbase: 232 in. (approximate, sized to meet passenger capacity) • Brakes: Air brakes w/ABS • Suspension: Conventional type suspension or Air ride suspension (sized to meet required GVWR) • Steering: Power steering • Wheels and tires: Factory wheels and tires, painted steel • Fuel Capacity: 60 gal minimum • Exterior Body: Must meet all applicable FMVSS requirements, welded steel cage construction, 96 in wide (approximate), body length 40 ft (approximate),fiberglass or steel front and rear roof caps, one piece roof or steel sheets(spanning the full width of roof), electric or air actuated passenger entry door w/ full length tempered and tinted safety glass, passenger windows w/ tempered safety glass and tint, emergency door and or windows, breakaway mirrors w/ convex (visible through windshield), steel rear bumper, rear mud flaps, midship turn /marker lights, backup camera, steel front and rear bumpers, front engine compartment sound insulated w/access door • Interior Body: 77 in (approximate) floor to ceiling height, insulation throughout interior, ceiling grabrail (both sides), plywood floor w/ rubber flooring, modesty panel behind driver, entry grabrail both sides of entry door, safety step nosing, dual a/c and heat system, door activated interior/exterior lighting including entry stepwell, interior finished throughout • Passenger Seating: Seating for 52 passengers, seats w/seatbelts, grab handles on each seat • Drivers Station: Tilt/telescope steering wheel adjustment, backup camera, gauge package, am/fm radio, rear door alarm, tinted sun visor • Color: White 118 LL _ ® r- O 1= O i O C: O M CL O 0 pa 0 0 0 LL mCIO co In 00 CO U i Q L ® ® d d U a. LU �z V z pCL a) ry w z ® w LL 4) .i O 00 m ® 00 LO O 00 LO O 00 LO Q w a. Ef} 69 E1) 613 J Q U LU 2 2 O U c U c U c U c U V) N Cl (6 w E a) E a) E a) E Q >1 >1 >, >, 07 U) U) U) cn ai � U C O cu C O cu c O m c O m m o- Q Q Q w 025 CL (n (n Q (n Y c cu c w c m c m LU H H H H F— y y (D z w U) 0 > co c 0 LL c 0 LL c 0 LL c 0 LL M ® LU N Ln ® LU LL ``) E E E E N ° a n n -a N 3 Q N :2® N m Q U)w LL V = U U) D m � �®�pp V m Ln N Q� c N L Z U iA S) FSA22-VEH2O.0 Item Group Descriptions The following items will be factory installed on the base vehicle/equipment to meet the model number and build codes of the vehicle listed. Item Group: • Cab And Chassis Trucks Electric: 54,000 Lb. GVWR 4x6 Semi Tractor FSA Item Group Description • MOTOR: 340KW (455 hp) electric motor • TRANSMISSION: 2 Speed transmission, differential mounted • BATTERIES: 375 KWH storage capacity, frame mounted • CHARGING SYSTEM: On board charging system,(for emergency use only) NOTE: Daily use charger will need to be selected from truck option list • CHARGING RECEPTACLE: NOTE: Charging receptacle location, size and type should be selected from truck option list to correspond with charger selected • CHARGING RATE: NOTE: Charge rate will depend on utilizing chargers from option list, AC 19.2 KW 7.5-15 hour charging, DC Fast 150 KW 1-2 hour charging • RANGE: 150 miles (approximate depending on mounted truck equipment and driving habits) • FRONT AXLE: 14,000 Ib. GVWR front axle and suspension, shock absorbers • REAR AXLE: 40,000 Ib. GVWR tandem rear axle and suspension, rear differential lock, synthetic lube • FIFTH WHEEL: Fixed fifth wheel set by manufacturer, Holland type (or equivalent) • BRAKES: air brakes; ABS brake system: regenerative braking, disc or drum brakes, air dryer • TIRES AND WHEELS: Manufacturer standard tires and wheels rated for 54,000 Ib. GVWR • CHASSIS, FRAME, CAB: Rear mudflaps and hangers, manufacturers standard front bumper; factory front tow hooks; cab to center of rear axle —138 in (approximate), tractor kit (slide bar, spring hanger, gladhands and light plug holder • COMFORT ITEMS: 2 — Keys and/or fobs; A/C and Heat, Manufacturers standard AM/FM stereo; Heavy duty rubber floor covering, drivers seat air suspension type, manufacturers standard passenger seat, power windows, power door locks (if available), cruise control • SAFETY ITEMS: Dual mount outside mirrors must provide a field of vision for vehicles to 102" width and lower convex mirrors, heated and power adjust mirrors, exterior/interior grab handles, tinted glass, adjustable tilt /telescope steering column, backup alarm, lookdown on passenger door, led lights (turn tail, brake, markers) fire extinguisher, triangle kit • COLOR: White 120 0 O Q N ry -2 M Q IL CD eo N 9 N $> N m S, N (f) V) C: lz ® O O ++ aw yr CL lei! d U- m 00 cn T N T ' N i � 0 0 O U O C6 M (3i 00 I- CDLU M 4 60- 9CDU) (D X m J d O O ® C C LO N (n YY U U U U M m =5w � � m U O 06O LLIL U) L YJ W 0O O� U i V! Y Y y U > > D 2 ® w Z d (D c E E LU = L y U d d N ® � 0 Q Q = U) LL m o Q Y c � U U 0C N (1)o m Q 0 i � 0 C 0 _ O 0 � m N 3:Z U w T N T ' N N N T ' M U- O O O N (n V) U) ® O O O Of o CL i6 Q O 0 0 pry 0 O N LO tq O N LO b9 O N LO EA LL mIn co in W 0 0 80- i ®y C:) O O O O O O Q. O o O O O O O O O CL Of o i6 Q U V 4 O N LO tq O N LO b9 O N LO EA W U) (D x > U U U C C C m N (6 (6 O i C O O O O O LL LL LL LO LO O O O (n N C/) O U) UL O i O i O m U) Y U O U LLI J W (n U U M U U i U U i y'C) 2 = > U) Cl) d U) OC ® = LU > � Q = U 0) ti (OLLL � r_ co E m E cu E N 'a CD N 9 N CO N m N Q U) LL ®�®�pp U Z Q m Q V d Q� N Z U iA 0 O Q N ry N (fid V) U) U) ® O U U U CL M N T � 7 LL O O O O mCIO CIO CIO CIO M N T � 7 O O O O 4) CD ® O O pp a. ® d ® d Of O U O C) O O ~ N N N N IS) V IQ V W V (D (D (�O CSO CSO CD d ffl b9 EA E X LY] J d C) i i ® CU (1) (U C C C C LO U U U U U =5 U U U U Co �— LLI —JO L C (0 C co Cd co C:� (o U W L L- -�3 :3 U X X X X Y ~ > Z Z Z Z y U > D 2 ( 0 N d c EE E E = .7 r L L LU U a_ d d > Z Cv ® > Q co LL Q > c � 0 N Z U (n M N T � 7 FSA22-VEH20.0 Item Group Descriptions The following items will be factory installed on the base vehicle/equipment to meet the model number and build codes of the vehicle listed. Item Group: • Cab And Chassis Trucks Electric: Tilt 26,000 Lb. GVWR (DRW) 42 FSA Item Group Description • Standard Manufacturer Equipment and Specifications, plus the following if not already included in manufacturer standard equipment and base specifications • MOTOR: 250KW (355 hp) electric motor • BATTERIES: 282 KWH storage capacity, frame mounted • CHARGING SYSTEM: On board charging system,(for emergency use only) NOTE: Daily use charger will need to be selected from truck option list • CHARGING RECEPTACLE: NOTE: Charging receptacle location, size and type should be selected from truck option list to correspond with charger selected • CHARGING RATE: NOTE: Charge rate utilizing chargers from option list, AC 19.2 KW 7.5-15 hour charging, DC Fast 150 KW 1-2 hour charging • RANGE: 200 miles (approximate depending on mounted body, truck equipment and driving habits) • FRONT AXLE: 10,000 Ib. GVWR front axle and suspension • REAR AXLE: 16,000 Ib. GVWR rear axle and suspension, rear differential lock, synthetic lube, • COMFORT ITEMS: 2 — Keys and/or fobs; A/C and Heat, Manufacturers standard AM/FM stereo; Heavy duty rubber floor covering, drivers seat air suspension type, passenger seat bench type, power windows, power door locks (if available), cruise control • SAFETY ITEMS: Dual mount outside mirrors must provide a field of vision for vehicles to 102" width and lower convex mirrors, heated and power adjust mirrors, backup alarm, fire extinguisher, triangle kit • BRAKES: air brakes; ABS brake system: regenerative braking, disc front, drum rear • TIRES AND WHEELS: Manufacturer standard tires and wheels rated for 26,000 Ib. GVWR. • CHASSIS, FRAME, CAB: Rear mudflaps and hangers, manufacturers standard steel front bumper; factory front tow hooks; cab to center of rear axle —182 in (approximate), hydraulic cab tilt, 90 degree opening doors • COLOR: White 124 Ln C, 2 U- _ 2 / 0 / 0 \ 0 © CL 0 0 0 0 2 E g 3 S S m 3 m m � \ \ \ a c o 0 ? / ? = o o c o \ q m / k k < < / L- 6G� 69- 69- 2 ± / C m . . . 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Item Group: • Cab And Chassis Trucks: 1 Ton (DRW) 42 FSA Item Group Description • Standard Manufacturer Equipment and Specifications, plus the following if not already included in manufacturer standard equipment and base specifications: • ENGINE: Manufacturer's standard gas engine, alternator, battery and cooling package. • TRANSMISSION/AXLES: Manufacturer's standard automatic transmission; Manufacturer's standard drive axle ratio for engine and transmission combination. • PERFORMANCE ITEMS: Manufacturer's standard power steering; Manufacturer's standard gauges. COMFORT ITEMS: Air conditioning; 2 — keys and/or fobs; Manufacturer's standard AM/FM stereo; Heavy duty rubber floor covering instead of carpet; Manufacturer's standard production seats. Purchaser will select color at time of order. • SAFETY ITEMS: Dual mount outside mirrors to provide field of vision for vehicles to 96" wide; Interior dome lights with left and right door activated switches; Manufacturer's standard air bags. • BRAKES: Four-wheel anti-lock brake ABS system. • TIRES AND WHEELS: Manufacturer's standard tires and wheels. • CHASSIS, FRAME, CAB: Manufacturer's standard bumper; Manufacturer's standard fuel tank; Manufacturer's standard colors, factory painted. Colors to be determined by individual purchasing agencies. 127 0 O Q N ry M Q W(1)En V) U) r_c C c C:0 0 0 0 0 CL 0 0 0 0 0 00 N T � OO M O O U- O O O O r co C) -0 U 0 O -.- O O U J U U L- 0 0 Y :3_ I— yD m Q) M0 r Y ® o LO co 0 > G9 O O O O m 00 cn cn CIO 00 N T � OO M O O O O O O r co C) -0 U 0 O -.- O O U J U U L- 0 0 Y :3_ I— yD m Q) M0 r Y ® o LO co 0 > G9 O O O O a O O O O 00 N T � OO M O O O O O O r co C) -0 U 0 � J i 0 0 0 J U 0 0 J U 0 0 U J U U L- 0 0 Y :3_ I— yD m Q) M0 r Y ® o LO co 0 > G9 N O N M V .1i Izi �4 a. 60-6q 2 W N N 61D60- > N 00 N T � M U EO O 025 N x r ® z O r co C) -0 U 0 � J i 0 0 0 J U 0 0 J U 0 0 U J U U L- 0 0 Y :3_ I— yD m Q) M0 r Y ® o LO co 0 > U) (f) CO U) 2 W N N C) ® Z > N _E d E d E d E d Q U) 0 Q coLL L � U N c Z U � (n 00 N T � 0 O Q N ry M Q W(1)En V) (I) r_c C c C:® 0 0 0 0 CL O ® 0 0 0 rn N T � OO M O O U- O O O O 0 O -.- O O r (D r 6) G9 O O O O m 00 cn cn CIO rn N T � OO M O O O O O O 0 O -.- O O r (D r 6) G9 O O O O a. 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GG. a) M Q D a3 m a3 M L L L L U U U U D o O o 0 0 C7 0 Q Q Q Q ^ _i Q I— a) Q a) Q. a) Q a) (n m p a) m m U) a) ®co a) a) a) U ® C.0Q w Y r J U U U U U cY) co cu m m y D _ m wEu Eu Ez ami U > Q Q Q Q U)M ® D Q Ofco = C: m m m > U a E" E E E N Q `n a Q a n Q Q U) LL m Q CD N CO ®®pp a) N z U CO N m U V FSA22-VEH20.0 Item Group Descriptions The following items will be factory installed on the base vehicle/equipment to meet the model number and build codes of the vehicle listed. Item Group: • Cab And Chassis Trucks: 1 Ton (DRW) 44 FSA Item Group Description • Standard Manufacturer Equipment and Specifications, plus the following if not already included in manufacturer standard equipment and base specifications: Air conditioning; 2 — keys and/or fobs; Limited slip or locking differential. • ENGINE: Manufacturer's standard gas engine, alternator, battery and cooling package. • TRANSMISSION/AXLES: Manufacturer's standard automatic transmission; Manufacturer's standard drive axle ratio for engine and transmission combination; Manufacturer's standard transfer case. • PERFORMANCE ITEMS: Manufacturer's standard power steering; Manufacturer's standard gauges. COMFORT ITEMS: Manufacturer's standard AM/FM stereo; Heavy duty rubber floor covering instead of carpet; Manufacturer's standard production seats. Purchaser will select color at time of order. • SAFETY ITEMS: Dual mount outside mirrors to provide field of vision for vehicles to 96" wide; Interior dome lights with left and right door activated switches; Manufacturer's standard air bags. • BRAKES: Four-wheel anti-lock brake ABS system. • TIRES AND WHEELS: Manufacturer's standard tires and wheels. • CHASSIS, FRAME, CAB: Manufacturer's standard colors, factory painted. Colors to be determined by individual agencies; Manufacturer's standard fuel tank; Manufacturer's standard bumper. 134 0 O Q N ry M Q W(1)En V) U) r_c C c C:0 0 0 0 0 CL 0 0 0 0 0 Ln M T � M N OO M O O U- O O O O ® Y U O -.- O O C) J d•) 00 O 00 49 O O O O m 00 cn cn CIO Ln M T � M N OO M O O O O O O ® Y U O -.- O O C) J d•) 00 O 00 49 O O O O a. 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Item Group: • Cab And Chassis Trucks: 15,000 Lb. GVWR (DRW) 42 FSA Item Group Description • Standard Manufacturer Equipment and Specifications, plus the following if not already included in manufacturer standard equipment and base specifications: • ENGINE: Manufacturer's standard diesel engine; Manufacturer's heavy-duty engine cooling; Heavy duty alternator. • TRANSMISSION/AXLES: Manufacturer's standard automatic transmission. • COMFORT ITEMS: Air conditioning; 2 — keys and/or fobs; Manufacturer's standard AM/FM stereo; Heavy duty rubber floor; Vinyl seating. • SAFETY ITEMS: Dual mount outside mirrors must provide a field of vision for vehicles to 96" width and convex mirrors; Back-up camera, if required by federal standards. BRAKES: 4 -wheel ABS system. • TIRES AND WHEELS: Manufacturer standard tires and wheels rated for 15,000 Ib. GVWR. • CHASSIS, FRAME, CAB: Manufacturer's standard front bumper; Fuel tank capacity, 25 gallons minimum; Cab to center of rear axle - 60" approximately; Minimum 15,000 lbs. 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GVWR (DRW) 44 FSA Item Group Description • Standard Manufacturer Equipment and Specifications, plus the following if not already included in manufacturer standard equipment and base specifications: Limited slip or locking differential, if available. • ENGINE: Manufacturer's standard diesel engine; Manufacturer's heavy-duty engine cooling; Heavy duty alternator. • TRANSMISSION/AXLES: Manufacturer's standard automatic transmission; • COMFORT ITEMS: Air conditioning; 2 — keys and or fobs; Manufacturer's standard AM/FM stereo, Heavy duty rubber floor covering; Vinyl seating. • SAFETY ITEMS: Dual mount outside mirrors must provide a field of vision for vehicles to 96" width and convex mirrors. • BRAKES: 4 -wheel ABS system. • TIRES AND WHEELS: Manufacturer standard tires and wheels rated for 15,000 Ib. GVWR. • CHASSIS, FRAME, CAB: Fuel tank capacity, 25 gallons minimum; Manufacturer's standard front bumper; Cab & chassis only; Minimum 15,000 lbs. 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O o O O Q U) LL V ® U OO � O_ N Q� O O Z O O O O 00 CO o6 o6 C® CO CO CO o V O O O O a. b9 be? ff, 9Ma) 60- M Q co m (B (o x U U U U (10 _ >c O >m b >m b O -a _0 _0 _0 U 5 CD U CD (D Q a) Q (1) � CO 06 U) H y _ m J O O Lf5 Y U � 0') Q U > Q a) U co c Q (D y, U c (1) y, U (v c Q (1) �, U (a Q M ® o LU y NQ = U D 0) 0 a L c co E L1 m . E IL cu E 0- m E 0- -a N 9 N CO N m Q U) LL V ® U Q m Q �®�pp V � O_ N Q� N Z (� U U) FSA22-VEH20.0 Item Group Descriptions The following items will be factory installed on the base vehicle/equipment to meet the model number and build codes of the vehicle listed. Item Group: • Cab And Chassis Trucks: 17,500 Lb. GVWR (DRW) 42 FSA Item Group Description • Standard Manufacturer Equipment and Specifications, plus the following if not already included in manufacturer standard equipment and base specifications: • ENGINE: Diesel engine, minimum 190 HP; Manufacturer's heavy-duty engine cooling; Heavy duty alternator. • TRANSMISSION/AXLES: Manufacturer's standard automatic transmission. • COMFORT ITEMS: Air Conditioning; 2 — keys and/or fobs; Manufacturer's standard AM/FM stereo; Heavy duty rubber floor covering; Vinyl seating. • SAFETY ITEMS: Dual mount outside mirrors must provide a field of vision for vehicles to 96" width, and convex mirrors. • BRAKES: 4 -wheel ABS system; Front brakes disc type, rear brakes may be drum or disc. • TIRES AND WHEELS: Manufacturer standard tires and wheels rated for 17,500 Ib. GVWR. • CHASSIS, FRAME, CAB: Cab to center of rear axle - 60" approximately; Minimum 17,500 lbs. GVWR; Cab & chassis only; Manufacturer's standard front bumper; Fuel tank capacity, 24 gallons minimum. 152 0 O Q N ry M Q W(1)En V) U) r_c C c C:® 0 0 0 0 CL O ® 0 0 0 .f+ OO U- O O O -.- O O O O O O O O m 00 cn cn CIO .f+ OO i O O O -.- O O O O O O O O a. 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LO N LO d LO Q.%L N LO d' LO LZ N LO S2 fl LO aL La a. La O 000 0 0 0 0 0 0 0 0 0 LL M Q mIn M 00 CO co In cn 00 00 00 cn rn i O O O O O O O O O O O O L C) C) C) ® C) C) d C) ® C) C) C) CD C) ® ® ® CD CD ® ® ® ® C) C) a. r (D C) r C) C) f (D ® r C) d C) C) C) O C) O C) O C) C> C) C) C) O C) C) C) O C) C) C) C) C) C) LO 0) 00 N— CO LO 0') 00 N (O r LO 07 00 N (0 r LO (3) 00 N CD r 4) 00 r L() ro r L(7 d r L(') d r LO i N LO d LO I`. LO N LO d LO f`- LO N LO d' LO r- LO N LO d LO fl LO O n a. � 69 6'- 6). 646c). 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C 0> N U> N > N I_- 0> N U> m❑ m m❑ mmmm ❑ ED ❑ m o 2 �5 U) Q 0) a) 2!1 a) 0 0 0 2!' (D 0 a) 0 (D 0 a) 0 2!1 a) N a) 0 W = ULOE O le co c c 0 c c m c c (10 c c 5 N ® LL d Q Q d Q Q d Q Q d Q Q Q U) Q - 'a LL m Q 0 u- CD N (o V CCT a) Fu N :2 0 a) N Z U iA N m U V 00 L T � M LL ca m N (1) V) U) V) U) _O LL _O LL ® O O O O 0 .pr M ZZ CL Q O 0 0 00 0 ® U- Y Y Y U) m In cn In m co mm C ~ C 76 I- U (D O O O O O • � O f0 O C O U)m m CD Qy O O O O O G. ® ® 6 O i ® d ® ® d C N C (6 C: C (B U I— ® i (L) -Q d LO LO d LO d' o V h C4 C4 CO CO N^^L LO LO LO LO LO ry a. > U U U) U a_ _ �— r M Q co ca m N O LL _O LL _O LL 4- 4- 4- 0 O O ® Y Y Y U) j co C mm C ~ C 76 I- U (D 0C (6 0 m • � O f0 O C O U)m m CD i E 06 O Ld') O i Y r C N C (6 C: C (B U I— Y® i (L) -Q (3) -Q (n -Q C U y D � = � ami p' LO > U U U) U a_ _ �— r U) LO LU M U c c co E m E cu E` E Q Q E m C CD N 9 V U CD a) a) N ®�®�pp Q) N Z U CO CO N m U V 0 O Q N ry M Q w r LL m m fn � O O � ® d a. 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EA 613� E!3 E¢} ry C/) [Q O O O O M Q U J co m co M L L L L N U U U U ILD O O O O O ® O O O O C7 0 O W O O O ® i `j O_ I— c- O_ O_ U O C/) [Q O O O O U J p =5 m ® a) N O O 06Q ® U :D Y r � U w U U U LO ®cu Y p ® m m y D _ m w20 L13 -LO ami U > Q Q Q Q U)M Q = co C m m m > U a E" E E E N in `n LO a Q a n N z Q Q U) L.L m Q N 9 V N iQ N ®�®�pp Q) N z U CO N m U V FSA22-VEH20.0 Item Group Descriptions The following items will be factory installed on the base vehicle/equipment to meet the model number and build codes of the vehicle listed. Item Group: • Cab And Chassis Trucks: 17,500 Lb. GVWR (DRW) 44 FSA Item Group Description • Standard Manufacturer Equipment and Specifications, plus the following if not already included in manufacturer standard equipment and base specifications: Limited slip or locking differential, If available. • ENGINE: Diesel engine, minimum 190 HP; Manufacturer's heavy-duty engine cooling; Heavy duty alternator. • TRANSMISSION/AXLES: Manufacturer's standard automatic transmission. • COMFORT ITEMS: Air conditioning; 2 — keys and/or fobs; Manufacturer's standard tinted glass all around; Manufacturer's standard AM/FM stereo; power windows, power door locks, and keyless entry (if available); Heavy duty rubber floor; Vinyl seating. • SAFETY ITEMS: Dual mount outside mirrors must provide a field of vision for vehicles to 96" width, and convex mirrors. BRAKES: 4 -wheel ABS system; Front brakes disc type, rear brakes may be drum or disc. • TIRES AND WHEELS: Manufacturer standard tires and wheels rated for 17,500 Ib. GVWR. • CHASSIS, FRAME, CAB: Cab to center of rear axle - 60" approximately; Minimum 17,500 lbs. GVWR; Cab & chassis only; Manufacturer's standard front bumper; Fuel tank capacity, 25 gallons minimum. E � _ / / \ / 0 0 0 0 0 CL = s c 2 U- — � \ / / m m m m m \ / / / / ■ \ \ \ \ a o o c o \ ) \< \ \ \ \ k / k k G k N 60- U) 60 60- / n / � U C / x \ \ \ ) / / 2 / m ƒ¥ C q / / 7 / U cu K o O ƒ $ o § > @ E 00 ƒ 5 2 ( E ƒ / m E E 0 ƒ 5 CO m E \ ƒ 3 m � > M / 5 / f 2 ._ � / ._ � E ._ a- / ._ c- ƒ 2 / k \ � � / § k / L 0 > / E 3 / g ° / k E ° i O O O O O O O O O O O O L C) C) C) ® C) C) d C) ® C) C) C) CD C) ® ® ® CD (D ® ® ® ® C) C) a. r (D C) r C) C) f (D LL r C) d C) C) C) O C) O C) O N(1) C) C) C) O C) C) C) O C) C) C) C) C) C) r_ 4 C! CD (f) V)CD (f) f,- V) C/) C/) (n (D (n C) ® C ❑ C ❑ C ❑ C ❑ C ❑ C ❑ C ❑ C ❑ C ❑ C ❑ C ❑ C ❑ Ii LO (C LO a LO �(.6 LO LO Q.%L 4 LO (6 LO LZ LO S2 dO LO aL La a. La O 000 0 0 0 0 0 0 000 N LL Q mIn M 00 CO co In cn 00 00 00 cn rn i O O O O O O O O O O O O L C) C) C) ® C) C) d C) ® C) C) C) CD C) ® ® ® CD (D ® ® ® ® C) C) a. r (D C) r C) C) f (D ® r C) d C) C) C) O C) O C) O C) C> C) C) C) O C) C) C) O C) C) C) C) C) C) Edi 0) 4 C! 6 f` (n 0) 4 C) (f) f,- L(7 a) d' C) ((7 I` 6 () 4 C) 6 r- Ii LO (C LO a LO �(.6 LO LO 0 LO 4 LO (6 LO d� LO LO (6 LO dO LO Q a. (�EsA� ��e� �e�r� 696p?46� N Q ECD cCcN_ G CCCcT G G G X o 0 0 0 LL LL LL LL ® ❑ ❑ O ❑ -' a) E a) E a) E a) E co C6 m c a) U m a3 n m ra eo n m n U) J m ® J U❑ J U❑ J U❑ J U❑ �5 L -j -j u, ti H J O F -I J O F O H J O U r LL 70 LL LL -0 LL LL -0 LL LL -0 LL I- Y Ln �- ❑ LL ❑ 2 LL D ❑ 2 LL ❑ 2 LL Of >1 > U Z) x C L U (6 > Q N U C6 > Q N U (B > Q N U N > Q N Q) > m❑ m m❑ mmm ❑ m❑ ED m Z U OQ 2 c Q U) 2!1 a) 0 CD 0 () 0 a) 0 () 0 a) 0 2!1 a) N () 0 LU = ULOE C) le co c c (o c c (13 c c co c c 5 N zLL d Q Q d Q Q d Q Q d Q Q Q U) Q - 'a LL m Q o LL CD N 9 V ❑ i(5 ❑ N :2 ® a) N z U iA N m U �®^p V Ln CD T � i O O O O O O O O O O O O L C) C) C> ® C) C) d C) ® C) C) C) CD C) ® ® ® CD CD ® ® ® ® C) C) a. r (D C) r C) C) f (D LL r C) d C) C) C) O C) O C) O N(1) C) C) C) O C) C) C) O C) C) C) C) C) C) r_ (.D CD (f) V) CD V) C8) C) (n (D (n C) ® c ❑ C ❑ c ❑ C ❑ c ❑ C ❑ c ❑ C ❑ c ❑ C ❑ c ❑ c ❑ N r Ln i Lfl L(7 h-- LO O co Lfl LO r_ LO i?%L L(7 LO h- Edi LZ L6 LO S2 (9 aL La a. La O 000 0 0 0 0 0 0 000 a) LL M Q m In M00 CO co In dpi 00 00 del dpi rn i O O O O O O O O O O O O L C) C) C> ® C) C) d C) ® C) C) C) CD C) ® ® ® CD CD ® ® ® ® C) C) a. r (D C) r C) C) f (D ® r C) d C) C) C) O C) O C) O C) C> C) C) C) O C) C) C) O C) C) C) C) C) C) LO (.D r LO 6 r Ldd") 6 r 6 6 r as (D r LO dt r Ln N r LO N r Ln i Lfl L(7 h-- LO O co Lfl LO r_ LO O (O L(7 LO h- Edi O (D L6 LO r-:O L(") (9 O CL a. (A- 69 6'- 6). 646c). E�} 64 6c> 69 69 69- a) M Q N T (B C_6 X o 0 0 0 LL LL LL LL ® ❑ ❑ O ❑ -' a) E a) E a) E a� E > co o_ o C6 a- m o_ c a) U m a3 n m ra co n m n U) J Co ® J U❑ J U❑ J U❑ J U❑ 06 LQ (n i.: F= O F -I J O F O H J O U r LL 70 LL LL -0 LL LL -0 LL LL -0 LL I- fn i =i L(7 Q O Ll -0 L❑L O L❑L 0 L❑L y C U> Q N L U> Q N L U> QQ N U> N ami Q• 1 as 5 CO db ❑ O m M m S ❑ O m M [o S ❑ O do co db ED ❑ 0 db _ U) ® O Z U) Q U 2!1 0 cO cO cO —co cO 2!1 —co —co LU = U o LO le cOc c co E c c (13 c c (10 c c 5 N ® LL d Q Q d Q Q d Q Q d Q Q Q U) Q - 'a LL db Q U o LL CD N 3 V a) dt5 `!:2Q a� N Z U dA N m U �®�pp V S) m� T � O LO i O O O O O O O O O O O O L C) C) C) ® C) C) d C) ® C) C) C) CD C) ® ® ® ® ® ® ® ® ® C) C) a. r (D C) r d C) r C) LL r C) d C) C) C) O C) O C) O N(1) C) C) C) O C) C) C) O C) C) C) C) C) C) r_ oo CD Cf) C) CD C) C8) C/) (n (/) (!) C) ® C ❑ C ❑ C ❑ C ❑ C ❑ C ❑ C ❑ C ❑ C ❑ C ❑ C ❑ C ❑ 00 r r- r O N LO M LO rl LO N LO C6 LO Q.%L LO cl LO LZ LO S2 r - LO aL La a. La O 000 0 0 0 0 0 0 000 a) LL Q mIn M 00 CO co In cn 00 00 00 cn rn i O O O O O O O O O O O O L C) C) C) ® C) C) d C) ® C) C) C) CD C) ® ® ® ® ® ® ® ® ® C) C) a. r (D C) r d C) r C) ® r C) d C) C) C) O C) O C) O C) C> C) C) C) O C) C) C) O C) C) C) C) C) C) LnL() 0) oo co r- Lii 0') Liz e❑ (a, r-. Lr; o) Li) 00 cry r` 6 w Ln 00 6 r - Q7 C3 N r- r O r- r oO r r- r 00 r r- r O N LO M LO rl LO N LO C6 LO Lf) LO cl LO r- LO LO M LO r - LO CL a. 6G.69 6'- 6). 6). 6). 6c> 64 Er} 69 69 69- a) Q N T D C_6 X o 0 0 0 LL LL LL LL ® ❑ ❑ O ❑ -' a) E a) E a) E a) E > co d d C6 a- m d c a) U m a3 n m ra co n m n U) J m ® J U❑ J U❑ J U❑ J U❑ �5 L -j -j u, r` H J O F -I J O F O H J O r = LL -0 LL LL -E LL LL -E LL LL -0 LL H Y LL � n LL > Z)Co N ULL M N Ny I_- NM U> m❑ m m❑ mmm ❑ m❑ ED m O 2 �5 U Q 0) 2!1 a) 0 CD 0 2!' () 0 a) 0 () 0 a) 0 2!1 a) co () 0 W = ULOE C) le co c c co c c (13 c c co c c 5 N ® LL d Q Q d Q Q d Q Q d Q Q Q U) Q - 'a LL m Q o LL CD N j V r` ❑ i(5 ❑ N :2 ® a) N Z U iA N m U �®�pp V i O O O O O O O O O O O O L C) C) C) ® C) C) d C) ® C) C) C) CD C) ® ® ® CD CD ® ® ® ® C) C) a. r (D C) r C) C) f (D LL r C) d C) C) C) O C) O C) O N(1) C) C) C) O C) C) C) O C) C) C) C) C) C) r_ O r® CD (f) V) CD V) C8) C) (n (D (n C) ® c ❑ C ❑ c ❑ C ❑ c ❑ C ❑ c ❑ C ❑ c ❑ C ❑ c ❑ c ❑ r r-- r L- L(� L(7 Ld7 LO O co Ldi LO (SJ LO i?%L Lr LO (.O Edi LZ LC) LO S2 (9 aL La a. La O 000 0 0 0 0 0 0 0 0 0 LL cz Q m In M00 CO co In dpi 00 00 del dpi rn i O O O O O O O O O O O O L C) C) C) ® C) C) d C) ® C) C) C) CD C) ® ® ® CD CD ® ® ® ® C) C) a. r (D C) r C) C) f (D ® r C) d C) C) C) O C) O C) O C) C> C) C) C) O C) C) C) O C) C) C) C) C) C) LO 0) O r® 00 co LO 0') O re (70 (o 6 CY) O rl. w (Y) 6 (s) C) r- 00 M m LO r- r M rl- r r r- r r r-- r L- L(� L(7 Ld7 LO O co Ldi LO (SJ LO C) (D Lr LO (.O Edi ® (D LC) LO (.0 LO (9 O Q a. (�EsA� ��e� �e�r� 69(f}69- N cz Q ECD cCcN_ G CCCcT G G G X o 0 0 0 LL LL LL LL ® ❑ ❑ ❑ ❑ -' a) E a) E a) E a) E > co d d C6 a- m d cU a) m a3 n m ra eo n m n U) J m ® J U❑ J U❑ J U❑ J U❑ 06 LQ —J J (n r` H J 0 F -I J 0 F O H J 0 r J LL 70 LL LL -E LL LL -E LL- LL -0 LL H Y LLL- ® LL n LL n LL n_ LL > ? C M N U Co N Co N I_- I N U> 000 ❑ m m❑ m db ❑ m m❑ ED m O 2 �5 U Q () 2!1 a) 0 CD 0 2!' () 0 a) 0 () 0 a) 0 2!1 a) N () 0 W = U C) le co c c (o E c c (13 c c co c c 5 N ® LL d Q Q d Q Q d Q Q d Q Q Q U) Q - 'a LL db Q U o LL- CD N (o V a) -Fu N :2 ® a� N Z U dA N m U �®�pp V S) 00 m� T � N LO LL c6 m N _ (1) V) U) V) U) U) ® C: C: i = �= C: O O O O O O M CL Q O 0 0 00 00 0 O O U- ® Y Y Y m In cn In m co co i 0 0 0 0 0 0 O (D CD 0C CU O O O O O O a. O O O O O O O (D O O (S O m O O O O O O C O O r O 0000 O O CY) O fl- h - ®i N N r N 07 C'7 0 V r (� o O d rn Co a (D C A) � ry a.CD61-:� I— y Y D 60- 61) GG 61), .Q � .II � cf) .Q � L m M Q Q_ > co c6 m d O LL _O LL _O LL 4— 4— 4- 0 O O ® Y Y Y Y U) U U) U 76 O (D CD 0C CU 0 m I— ® O C Fo C O m J CD O (D O O (S O m 06 p LQ C C O E E U) U r N (6 C: (B i (� 0 a) a (D C A) � I— y Y D .Q � .II � cf) .Q � L m Q_ > v U � U) v ai n_ � n_ _ �- L r U) LO LU > U c c co E m E cu ` a� E m E co E N ® d d d Q d d Q Q E U) m c CD N 9 V U O a) N ®�®�pp Q) N Z U CO CO N m U V 2, G 2 U- m 2 2 m m m m m / § § / m / = s c CL y y y 0 O O O O 2 LL 2 _0 _0 _0 � m 3 E 2 3 3 / ) = E @ U) t / ƒ E 2 ? e r- / 2 / r o / / = > % % k f « % m % / f « $ % f « $ % / f ƒ « 2 3 ■ \ \ \ \ a c o o c « LL k « U / / / E 3 / E ° / ƒ f $ ƒ ? / ? ? ■ ¥ e £ o 0 C C d C6 LO Lo )CL a � � \ < 3 m 2 2 co m m / y y y 0 -a _0 _0 _0 � » g / 0 3 / ) = E @ U) t / ƒ E 2 ? e r- / 2 / r o / / = > % % k f « % m % / f « $ % f « $ % / f ƒ « 2 3 C) LU / q U) C) U k = 0 o $ ƒ m 2 ._ a 2 ._ E ._ 2 ._ 2 / k \ « LL k « U / / / E 3 / E ° / k E ° FSA22-VEH2O.0 Item Group Descriptions The following items will be factory installed on the base vehicle/equipment to meet the model number and build codes of the vehicle listed. Item Group: • Cab And Chassis Trucks: 25,500 Lb. GVWR (DRW) 42 FSA Item Group Description • Standard Manufacturer Equipment and Specifications, plus the following if not already included in manufacturer standard equipment and base specifications: • ENGINE: Diesel engine, minimum 200 HP. • TRANSMISSION/AXLES: All axles, synthetic lube; Manufacturers standard automatic transmission or approved equivalent (with PTO provision); Front and rear axles and suspension must meet minimum GVWR of 25,500 lbs. • COMFORT ITEMS: Manufacturer's standard AM/FM stereo; Air Conditioning; 2 — Keys and/or fobs; Heavy duty rubber floor covering. • SAFETY ITEMS: Dual mount outside mirrors must provide a field of vision for vehicles to 102" width and convex mirrors. BRAKES: Factory air brakes; ABS brake system. • TIRES AND WHEELS: Manufacturer standard tires and wheels rated for 25,500 Ib. GVWR. • CHASSIS, FRAME, CAB: Minimum 25,500 lbs. GVWR; Cab & chassis only; Manufacturer's standard front bumper; Factory front tow hooks; Fuel tank capacity, 45 gallons minimum; Cab to center of rear axle - 84" approximately. 170 i O O O O O O O O O O O O L C) C) C) ® C) C) d C) ® C) C) C) CD C) ® ® ® CD (D ® ® ® ® C) C) a. r (D C) r C) C) f (D LL r C) d C) C) C) O C) O C) O N(1) C) C) C) O C) C) C) O C) C) C) C) C) C) r_ co 00 CD (f) V)CD C) co V) C/) C/) (n (D (n C) ® C ❑ C ❑ C ❑ C ❑ C ❑ C ❑ C ❑ C ❑ C ❑ C ❑ C ❑ C ❑ LO r cD Ii LO (D LO 4 co 4 LO (D LO Q.%L 4 LO (D LO LZ 4 LO S2 Ii aL La a. La O 000 0 0 0 0 0 0 000 a) w LL Q mIn M 00 CO co In cn 00 00 00 cn rn i O O O O O O O O O O O O L C) C) C) ® C) C) d C) ® C) C) C) CD C) ® ® ® CD (D ® ® ® ® C) C) a. r (D C) r C) C) f (D ® r C) d C) C) C) O C) O C) O C) C> C) C) C) O C) C) C) O C) C) C) C) C) C) (di 0) co 00 C) co (di 0') M C❑ C) co 6 CY) m OD C) (D 6 CY) m OC) C) 00 a) 0') r (D r— r (D LO r (D LO r cD Ii LO (D LO 4 co 4 LO (D LO 4 (D 4 LO (D LO 4 (D 4 LO (D LO Ii p Q a. 6G.69- 69- 6c). 61).6c). 6c>ear � 69 (f} 69- a) w Q ECD cCcN_ G CCCcT G G G X o 0 0 0 LL LL LL LL ® ❑ ❑ O ❑ -' a) E a) E a) E a) E > co d d C6 a- m d c a) U m a3 n m ra eo n m n U) J m ® J U❑ J U❑ J U❑ J U❑ 06 (n —J J (n ui I= —, ® F- —J ® F- ® pi —J (v ® LL -0 LL LL -0 LL LL -0 LL LL -0 LL H Y LL o � LL LL ❑(_q LL® ❑ y Z) U >N >Uo N >NC>N N U> m❑ m m❑ mmm ❑ m❑ ED m O 2 �5 U Q 0) 2!1 a) 0 CD 0 2!' () 0 a) 0 () 0 a) 0 2!1 a) N () 0 W = U C) LO le coc c (o E c c (13 c c co c c 5 N ® LL d Q Q d Q Q d Q Q d Q Q Q U) Q - CD 'a LL m Q o u - 0 3 v m a r 00 a) Q = ®®p a) c N Z c U iA N 00 U V S) 0 O Q N ry M Q d CD (o N 9 N �> N $ N m S) N (P) (B) U) V) U) (n (n f) ® O 0 0 U 0 U U Q CL W 00 0 0 LL O O O O L O o ® oO 0 T 0 ® O 0 r® O 0 O o r O O O o ® r G. o M o co o C'70 co •/y�y . M ey . D . M eq�Dy eppZy+3p epD W lea pD In lea Iaa lea In 00 cn lea 00 0 0 00 O O O O L O o ® oO 0 T 0 ® O 0 r® O 0 O o r O O O o ® r G. o M o co o C'70 co 00 0 0 00 00 00 O O 00 00 o I� o f` o I® o I` ® ® coLO ® CIO ® LO (MO LO LO � Ua� a) a> a) o a7 00 67 G. 601 611 60- 69 69 69 69 69 (V x V i U i U i U i V CU C U C U C U f� a)[� = Y = Y = Y = Y J � U m o f 07 i i i � � �0- 06 ® p� (tf w co LL 03 Y N C J E J E J E J E U i yU > D _ �— ca U o ® (n ® (n N Y co c caC cu (S C = Q c E � r LU = > U ai d Q d Q Q Q m LL Q LL U c � v N Q 00 �+ (n i 0L- 4)N 3:z v CO 0 O Q N ry M Q IL 0 CNN N M N S) lIi U) CO 06 U) Y U y a� 0 cv LU cv cv Q U) LL v f6 i C O V A M. O I.. L i a O O LO N r- 1' - b4 V) i a) C a) U Y U i C X a) z d c � ° U N zw LL (6 m N _ (1) V) U) V) U) ® C: C: i c c O O O O O .pr M ZZ CL Q O 0 0 00 0 ® U- Y Y Y � U) m In cn In m co mm C ~ C 76 I- U (D O O O O O I— O O O C U)m Qy O O O O O G. ® ® 6 O i ® d ® ® d C ®® C: C � C) d U ® 0 00 43 LO LO d LO N o V N r r r r CL i ry a. > b~R? U U ami a_ ® M Q co (6 m N O LL _O LL _O LL 4- 4- 4- 0 O O ® Y Y Y � U) j co C mm C ~ C 76 I- U (D 0C O 0 O I— O O O C U)m i i O m CD O O i 06 Y Ld') N C C C: C U i ® co (L) m (3) m cuC (1) O I— y Y D s� � n = (n -0 � > U U U ami a_ ® m m m w2 > U C .Y c E E cu c E E Q Q m C CD N 9 V U a) a) N ®�®�pp Q) N Z U CO CO N m U V 0 O Q N ry -2 M Q IL E CD (o N 9 N �> N $ N m S) O O O O O O 4) O O O O O O I • • 00 00 0 LL 00 00 O O 4(6 4 CA 4 4 00 a) 00 I' 00 00 m m In m m In m O O O O O O 4) O O O O O O I • • Ln 1- 00 00 LO 00 00 0 0 00 00 O O 4(6 4 CA 4 4 00 a) 00 I' 00 00 V N (C N (fl N N N x Q O O C) C J C J J j J O J O J J 5 � UL) Y cn o m J O cu C O ' 0 0 =5 m O06 O O O O N O O O LQ N co O -2 3: m O "O ?y 03 -2 OS `6 O O O O O O Y > LL Y LL Y LL LL y U > Z) C) _ ~ N U U) C Va 2:1 M � L, = d N r_ E" E( E E = I— y v a Q a Q n N ® � 0 Q Q = U) LL m o Q U Y E c v L L 00 4) ai �+ i V7 C) c9 W N z v CO Ln 1- 00 00 LO 0 O Q N ry M Q M(1)cn V) (n r_c c c c ® 0 U U U O ® 0 0 0 OO U - O O O -.- O -.0- 2 00 6 O O O in O O O O OO O O O -.- O -.0- 2 00 6 O O O a. O O O O OO O O O O O O 00 6 00 6 N N N N d I`a ti � ti V 00 00 00 00 a. 69 69 61D 60- N x p (n V) U) U) a) a) a) a) 5 c c c c U U U U U cn ®) m U) -, Y U Y U Y U Y U m O H H H 06 L i Y LO 0 co co cu m N U = X X X X Y > Z Z Z Z y U > p Q) 2 O cn ® d E E E E LU = cfl d d d c- > U p N ® � Q U LL Q c c V U 00 Q O i 0 c 0 = 0 0 m N Z U co r_ C: c C: C: ® 0 0 0 U O ® 0 LL m O O O O L O O O O O O O O G. O O O O O O O O O O O O v J 0 LO LO LO LO CL LO LO LO CN W N N N c17 6 :J O O O O a. Q 60- b9 ff} 60} CD N 9 N $> N m S) N x �_ v J U U U -J ® N LO Lu S- L L LL O LL O LL LL a) �=5 eco 6 J CD LQ ® qLq,, c // ,, ® pLp`` D �r ,: ® qLq,, a � : l®y V, gro^y U) U I- y m Q) 2 LO N Y U � _ -�e U L M -�e U .� n -�e U .� � n - ® — U) m N N Q U LL 0 Z Q m Q L � d 00 m N W c Z C U � cn FSA22-VEH20.0 Item Group Descriptions The following items will be factory installed on the base vehicle/equipment to meet the model number and build codes of the vehicle listed. Item Group: • Cab And Chassis Trucks: 30,000 Lb. GVWR (DRW) 42 FSA Item Group Description • Standard Manufacturer Equipment and Specifications, plus the following if not already included in manufacturer standard equipment and base specifications: ENGINE: Diesel engine, minimum 200 HP. • TRANSMISSION/AXLES: All axles, synthetic lube; Manufacturers standard automatic transmission or approved equivalent (with PTO provision); Front and rear axles and suspension must meet minimum GVWR of 30,000 lbs. • COMFORT ITEMS: Air Conditioning; 2 — Keys and/or fobs; Manufacturer's standard AM/FM stereo; Heavy duty rubber floor covering. • SAFETY ITEMS: Dual mount outside mirrors must provide a field of vision for vehicles to 102" width and convex mirrors. • BRAKES: Factory air brakes; ABS brake system. • TIRES AND WHEELS: Manufacturer standard tires and wheels rated for 30,000 Ib. GVWR. • CHASSIS, FRAME, CAB: Minimum 30,000 lbs. GVWR; Cab & chassis only; Manufacturer's standard front bumper; Factory front tow hooks; Fuel tank capacity, 45 gallons minimum; Cab to center of rear axle - 84" approximately. 178 i. O O O O O O O O O O O O L o 0 0 0 o C) o 0 0 0 0 0 4) o 0 0 ® o ® o ® o 0 0 0 li d T d r d ® f d LL r ® d 00 0 0 o 0 d Cl NU)(n ® 0 o 0 0 0 0 0 0 0 0 0 0 0 o 0 Ln 6) CO(c) ') a) (n CD (n C8) V) (n (D (n (n ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ r It N i c.0 LO (.6 LO LC) CO (6 LO C4 LO dz%L (6 Loi 6 LO LZ (6 LO S2 Ldp CO aL La Q La O 000 p 69- 00`.,✓ 6c> p�ima-q 000 69 69 000 a) LL M Q m do M 00 CD co CIO do 00 00 00 do 00 i. 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Item Group: • Cab And Chassis Trucks: 52,000 Lb. GVWR 4x6 Semi Tractor FSA Item Group Description • Standard Manufacturer Equipment and Specifications, plus the following if not already included in manufacturer standard equipment and base specifications: • ENGINE: 350 HP 6 -cylinder diesel engine, manufacturer's 11L minimum. • TRANSMISSION & CLUTCH: The following or approved equivalents are acceptable; Fuller 14210B 10 Speed Manual with OD. • ENGINE EQUIPMENT: Air filter restriction monitor— intake mounted. • CAB: Floor covering - black rubber mats; Seating — driver air suspension mid back, passenger fixed mid back; Standard air conditioning & heating. FRAME: Frame — steel construction matched to GVW and mounted body of truck; Wheelbase —187"; Load platform — 161" 56" AF; Front bumper— painted steel; Fuel tank— 70 gallon, minimum; Air dryer— Bendix AD9 heated, or approved equivalent; 5th wheel - stationary with left hand release. • SAFETY: Horn — single air trumpet; Mirrors — West Coast for 102" trailer widths to include 7.5" convex mounted to lower mirror bracket; Daytime running lights; Backup alarm; Electrical plug holder includes glad hand storage; Tractor package to include valves, trailer lines & frame access; Automatic traction and stability control. • FRONT AXLE: Minimum 12,000 Ib.. rated axle and suspension; • REAR AXLE: Minimum 40,000 Ib.. rated axle and suspension; Power divider with warning light and buzzer (includes in cab control). Oil type with synthetic lube. • ELECTRICAL: Hand throttle — electronic hand throttle operated through cruise control when in PTO mode only; Engine protection — engine shut down system monitoring high water temp, low oil pressure, high exhaust temp, high transmission temp. • TIRES and WHEELS: Manufacturer standard tires and wheels rated for 52,000 Ib. GVWR. 187 00 T � CL W O O O LL O O O O O O O O O L ®® O C> O O O O W m In m m In m m m O O O O O O O O O O O O L ®® O C> O O O O G. ce) 0 M Cl CYs C> C7 Cy') 0 O Z N ry M 00 00 00 00 a a ® ® 00 00 6 O L(i O Lfi O O 6 CO m CC) CD CD C') CA co ® v C6 d C6 Lii C6 d' N C7 ~ U G. 69 69 60- 64 69 69 69 69 H LU U) Cfl X � L U L U � U U L J J J J > C: J L J J J ' U a) U a) a) L-7 U W a) L-� C..) 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Item Group: • Cab And Chassis Trucks: 52,000 Lb. GVWR Truck 4x6 FSA Item Group Description • Standard Manufacturer Equipment and Specifications, plus the following if not already included in manufacturer standard equipment and base specifications: • ENGINE: 350 HP 6 -cylinder diesel engine, manufacturer's 11L minimum. • TRANSMISSION & • CLUTCH: The following or approved equivalents are acceptable; Fuller 14210B 10 Speed Manual with OD. • ENGINE EQUIPMENT: Air filter restriction monitor— intake mounted. • CAB: Floor covering - black rubber mats; Seating — driver air suspension mid back, passenger fixed mid back; Standard air conditioning & heating. • FRAME: Frame — steel construction matched to GVW and mounted body of truck; Wheelbase — 187"; Load platform — 161" 56" AF; Front bumper — painted steel; Fuel tank — 70 gallon, minimum; Air dryer — Bendix AD9 heated, or approved equivalent; 5th wheel - stationary with left hand release. • SAFETY: Horn — single air trumpet; Mirrors — West Coast for 102" trailer widths to include 7.5" convex mounted to lower mirror bracket; Daytime running lights; Backup alarm; Electrical plug holder includes glad hand storage; Tractor package to include valves, trailer lines & frame access; Automatic traction and stability control. • FRONT AXLE: Minimum 12,000 Ib.. rated axle and suspension; • REAR AXLE: Minimum 40,000 Ib.. rated axle and suspension; Power divider with warning light and buzzer (includes in cab control). Oil type with synthetic lube. • ELECTRICAL: Hand throttle — electronic hand throttle operated through cruise control when in PTO mode only; Engine protection — engine shut down system monitoring high water temp, low oil pressure, high exhaust temp, high transmission temp. • TIRES and WHEELS: Manufacturer standard tires and wheels rated for 52,000 Ib. GVWR. 196 i C C C C C C C C C C C C ® 0 0 0 U O 0 0 0 U 0 C CL O O OO LL O O tlO OO\ OO O OO O O L 000 O O O 000 000 mCIO In 00 000000 in do cn 00m CIO O O OO O O tlO OO\ OO O OO O O L 000 O O O 000 000 G. 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C: LL O LL LL LL a) 5 co 06 J O ® qLq,, C) ® pLp`` D C) ® qLq,, a U l®y V, o YN U I— y _ C) 2 > CC) Y U Z) U LO cfl � = 1 U L M co E Y U .� n m E Y U .� � ca E n - co E 'a 0 N N m U) LL ® U ¢ Q ®p V ai d W N Z U iA S) E � m m m « m / § § \ CL = s c 2 E 2 ' 3 y y y m m 2 m 3 / / / / C) o o c G q g q q a c o o c \ ) \ f f f f 3 q q q 3 3 % (0 C a ka 69- 69- 619� \ # 2 U D � w @ U) E m ¢ = e @ @ / U Q O U \ E ? 2 2 / L \ / / / / x x x x 2 > k 2 2 k 7 $ 2 » m M m % % / 03 4 \ f f $ E :r 3 m J ƒ » % k / / m > E C\i E g //CD 0 % 0 % 2 U CO CO IV CD N 00v y (ea �a eat ua va (n (n cn CL r W O O O O O O O O O LL L O O O O O O O O a. O co O co O cM O cy') 0 O •/y�y • M •y • D • M •p Z3 •q�Dy •ppZy+3p •pD W lea pD In lea 00 lea 00 cn lea O O O O O O O O O O O O L O O O O O O O O a. O co O co O cM O cy') 0 O Q N ryM 00 00 00 00 Q O O O O O O O O O (6 d O (.O O (D ® O (6 4) v d' d" cs0 .f -r r Ili 0 r O O r 0 0 r 0 0 r r r r r r r (f7 X U D � m a_i 0) C O m CD U LL U LL (1) U LL (1) U LL 06 O ® -0 (B _0 m `a (B `6 w Y N _ � Q. C:0- � a. E r- Q E O I� O I� O I� O I� y Y> U o > Z) 00 M CT ®00 cq 0 (U M 0 M ® CN cq cu ca c ca c c LU U _= d Q _= d <( _= d Q d Q N cv Z < coQ 'a LL Q N V L a) M N �_ ® W N Z U CO N m U �® �pp V S) FSA22-VEH20.0 Item Group Descriptions The following items will be factory installed on the base vehicle/equipment to meet the model number and build codes of the vehicle listed. Item Group: • Cab And Chassis: Tilt (DRW) 4x2 FSA Item Group Description • Standard Manufacturer Equipment and Specifications, plus the following if not already included in manufacturer standard equipment and base specifications: • ENGINE: Manufacturer's standard diesel engine; Heavy duty alternator; Manufacturer's heavy- duty engine cooling. • TRANSMISSION/AXLES: Manufacturer's standard automatic transmission. • COMFORT ITEMS: Air conditioning; 2 — keys and/or fobs; Manufacturer's standard AM/FM stereo; Heavy duty rubber floor covering. • SAFETY ITEMS: Dual mount outside mirrors to provide field of vision for vehicles to 96" wide and convex mirrors; Manufacturer's standard air bags, if available; Manufacturer's standard convex mirrors. BRAKES: Four-wheel ABS system. • TIRES AND WHEELS: Manufacturer standard tires and wheels rated for 12,000 Ib. GVWR. • CHASSIS, FRAME, CAB: Minimum 12,000 Ib. GVWR; Manufacturer's standard bumper; Cab with 45 -degree mechanical tilt with torsion assist; Tilt cab & chassis only. 205 2 U- 0 0 0 _ c / c 0 0 0 0 ©�;_- 0 O O O 2 0 / E 2 2 2 g 3 S 7 m 3 3 2 / 2 [ a � � / \ \ a c o ? ? ? / =5 / _ k k k = w q m E / 0 ƒ § o LO o / z 2 7 a \ m \ @ � \ 0 0 0 c = c C) 0 / 2 2 2 / 2 [ a � � / =5 / _ / w q m E w q n E w q m E / 0 / z 2 \ m \ @ \ m ® > M u ° / ° / ) a k 5 § a / C) / / q « 2 U) \ k « k ¥ ) / / m k � » k a » k ± k ƒ 2 / \ / k � U / U co / E / E / k E I- CD N w 00 N (1) vi cta cn eaa U) Ua eta CL sa r d 00 00 00 00 0 U C LL U C O U C CL ry00 00 00 00 -2 O 0 O O O O O O m co M In En CIO CIO Cil Cil C o 0 0 0 0 0 0 0 O O O O O O O O a. 00 00 00 00 0 U C U C O U C CL ry00 00 00 00 -2 O 0 O O O O O O ®i co 0 M 0 M o C) o v Lf7 C6 LCi G Lfi ai Ln (O X U U a. 69 69 69 69 69 69 69 69 U C U C U C U C C C C C C C C C a X U U U U U U U U U) d Y Y Y Y U Y U Y U Y Y U U mI— ciS `U _0 Ua ® i O C rZ (o C: (B U (lS U C C co U [[) C J X J X J X J X Q U > U ® U Z (1) ® (1) Z U ® (1) Z U U ® Z y J M r LL z a co C: ca c c > v z cv N Q U Q LL `. m U CO C 0 N :2 ® a) N Z U CO N m U V S) 00 0 N 0000 N (1) (n cta cn ea) U) Ua eta _ c ei C: e✓ C: c C: c CL sa r d 00 00 00 00 0 U C LL U C O U C CL CC 00 00 00 00 00 00 00 00 cz O M O M O M 0 C7 (1) m co M In En CIO CIO Cil Cil C o 0 0 0 0 0 0 0 O O O O O O O O a. 00 00 00 00 0 U C U C O U C CL CC 00 00 00 00 00 00 00 00 cz O M O M O M 0 C7 (1) ®i 0 d- 0 d 0 It 0 d V N (d N (O N (D N (fl X U U a. 6S (/3- � � 60- 61-> 6r, 61) (� C U C U C U C (1) aD (1) a) (1) (1) (1) C C C C C C C C a X U U U U U U U U U) d Y U Y U Y U Y U Y U Y U Y Y U U mI— _ ciS `e7 _0 Ua ® i O C rZ cu C: C: m C: m C C co Z ® Z y � � J h � Q) =va eri ® ® U) U) m C) co� a? m c c s = e > v cv N Q U Q LL `. m U h- C 0 Q N :2 = ® a) c N Z c U CO N m U V S) rn 0 N w 00 � a� 0) res rn era ers vi ® 0 0 0 0 0 0 0 Ce C a) LL ®% o -.-0 0 0 0 0 0 C7 '> C) '> > C) CD C) O OCD o O a. 00 0O o0 0 0 J J cn 0 Y mCIO Y U m 00 co CIO CO CIO C a) (1) ®% o -.-0 0 0 0 0 0 C7 '> C) '> > C) CD C) O OCD o O a. 00 0O o0 0 0 J J cn 0 Y n Y U 0 ry Ct cuU ® O O O Cl O O 00 00 O O C 0 0 0 O C: Q � 0 0 � m M � d 6) (C) m 1- O 6) cr7 V N M N C6 ® N N G. 6a 6OR3- (f)- 6rk 61.� 60- 60- (1) a) (1) C7 '> C) '> > C) C) J o U) J® cn ® cn J J cn N— Y Y U Y U U) Ct cuU ® i cu C 0 C: 0 O C: C U> LL Y LL Y Y LL LL i m J o M ~ Y U) a N Q Y .� C co C: E 0 m E e E c E LU y C) tfo w d Q d Q d _� Q N ® � Q U) Q Y IL LL m 00 c c E 0 3 v ra a N Q N :2® = ®p W C N Z c U CO N m U V S) N 0a �s eas ria ® 0 0 0 0 CL O ® 0 ® 0 LL C i O O O O d O O O O a O O O O O O O O O O O O w rn rn 0') o r r r N CL 70 m C co r V I- Ph- h•- 00 Q 70 O M a. Q 69 b9 ff} 60} 70 m C co c Q 70 O L LL O LL O LL O LL L C/3 U N x '4tt O O L O cn O U)`� =5 CO 025 C U C ( U O Y ® U U U F— %` > = ® w Q v ' J U) = N N ® p > r L E E E n Qi h E IL CD N (o 3 N N OD cq LL ® U pp U ®p V L y M W N � Z U co S) FSA22-VEH20.0 Item Group Descriptions The following items will be factory installed on the base vehicle/equipment to meet the model number and build codes of the vehicle listed. Item Group: 0 Mobile Command Unit / Critical Response Unit FSA Item Group Description • Manufacturer standard equipment and specifications, and if not included manufacturer installed power windows, power door locks, key FOB keyless entry. Must meet all FDOT and FMVSS safety standards. 211 N T N 6 rn N d!i C!8 f/i C63 ® 0 d 0 0 d I— LL Z D O O d O m 00 CO In CLi I— i Z D O O d O a. 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R ® ) ¢ / ¢ ¢ / k co m q J E m « 3 cz Cl) « c o 0 0 2 E E L- L- \ \ \ \ � 6P> 69> 60- 0 - L2 D 2 U Q 2 U CO 2 2 2 2 2 0 ® ® /U = co / k co m q J E m « 3 cz Cl) « k E m q ® 2 2 E E E U) / L m 9 E 9 m 9 m 9 > / / w w w w / f O Of U a � > ƒ / O U N k » co » § ± § » q L \ CD@ 2 / »tu \ � / 2 k � 0 L 0 @ m % / Q E f / a) = / -Fu k § 6 -K4,IF FSA22-VEH20.0 Item Group Descriptions The following items will be factory installed on the base vehicle/equipment to meet the model number and build codes of the vehicle listed. Item Group: • Refuse Truck Electric: 60,000 Lb. GVWR Only 46 FSA Item Group Description • Standard Manufacturer Equipment and Specifications, plus the following if not already included in manufacturer standard equipment and base specifications: • Powertrain: electric powered with the OEM recommended electric motor(s) for this application with no less than a 350KW rating. • CAB: Low cab, forward mounted, tilt type; Rubber floor covering ; — 2 keys; Seating — driver air suspension mid back, passenger fixed mid back; Standard air conditioning and heating. • FRAME: Frame — steel construction matched to GVWR and mounted body of truck; Wheelbase — As recommended by the OEM for the body to be mounted; • Batteries — largest available battery pack system for model bid; Electric charging system on the truck must be SAE J1772 compliant; Air dryer — Bendix AD9 heated, or approved equivalent. • SAFETY: Horn — single air trumpet; Mirrors — West Coast to include 7.5" convex mounted to lower mirror bracket; Daytime running lights; Backup alarm. • FRONT AXLE: No less than a 20,OOOIb. front axle and suspension rating; Oil type with synthetic lube. • REAR AXLE: No less than a 40,000 Ib. rear axles and suspension rating; Power divider with warning light and buzzer (includes in cab control);. • TIRES and WHEELS: Manufacturer standard tires and aluminum wheels rated for 60,000 Ib. GVWR. 217 \ ) \ < :22 CD ( /o J / :2 \ m 2 U- _ / / \ 2 0 0 0 © CL 0 O O O 2 E g 3 S 7 m 3 3 2 $ / / / � \ \ \ a c o 0 ? ? ? k ƒ 0') LO £ £ 2/ L- ? / 69- co � 2 O CO < k k k 3 . . . U 0 0 0 @ U 0 U / \ / / f w w w cn o q q q /ED m n m \ / / / C)/ a (0 V) � / � L- ) \ % % b ¢ \ \ c / � C) C) / ƒ / > 2 - o L Q k U s / / k k k $ L m a q 7 CO U) b Fu / / t t = / / 0 k / U) � � ® m m m m / § § \ c = c » m LL 2 2 2 2 3 7 y y m 3 2 2 2 ? R ? ? a a a a CO \ $ $ $ $ 2 ? R ? ? c C C C $ & f q $ 2 $ 2 - ��a. � 2 0 O (n CO $ U) § / U ® ®U Q 2 Q $ z/ / / U ƒ / ƒ § ƒ 2 D 2 C)C)/C) / § U) g g g g / 0 § / ? ) 2 g g g § m Q 0 0 0 0 # ® 2 / / / / 2 > P- C) � ƒ L .g � » » » » / f / 2 E 2 L ._ ._ ._ ._ q L L « CO § / ± 2 ƒ \ / 0 0 % / / 0 \ � 0 % 2 U 0 N N rn ® 0 0 0 0 C .4: LL C o 0 mCIO 0 cn CIO CIO .4: C o 0 0 0 4) O O O O a o d o d 0 O Q N ry Q x O O O O z ® CO L a., bg U) U) Q U 06 [Y] Q U W a) (1) (1) > U a) (1) (1) (1) C/3 ai U)Y =5J m U ro O W U Y U i U Y U i U Y U i06 U U i U9 a� _ ® d :r W ? U w -J W Y Ir h (ti W U � O > C N X z E d (li X z E d (1i X z E W f0 X z E W N � 3 N CO N m N QCO U) W V ®�®�pp U W W LU (If V as N � z U iA \ ) \ < � � U) / / § / f / / / / k LL 2 2 2 3 7 y y m 3 3 2 2 $ Q y y 7 C) o o c e 9 9 9 9 a 0 o 0 0 ? ? ? ? ¢ ƒ % LO 0 0 o C $ a $ 60- $ � t 60- $ � # � 2 O CO U) U) M ® J £ d 3 d 3 C) 2 @ m 2 « f f fU LL 0 ± ± 2 ± a C/3 3 � @ U) ¢ 3 f (D O C) C C)§ U q » 0 / > y y @ m £ f -�e U) ƒ Cl) m : C) -�e § % ¥ @ « 2 / -�e § % ƒ R CO @ 3 ® 2 � m / L % / U / 0 / k » k » k » k » k q LL / 0 2 CO b � / / / / _ E (nt / k t / = FSA22-VEH20.0 Item Group Descriptions The following items will be factory installed on the base vehicle/equipment to meet the model number and build codes of the vehicle listed. Item Group: • Refuse Truck: 60,000 Lb. GVWR Only 46 FSA Item Group Description • Standard Manufacturer Equipment and Specifications, plus the following if not already included in manufacturer standard equipment and base specifications: • ENGINE: 300 HP 6 -cylinder diesel engine, manufacturer's 11L minimum. • TRANSMISISON: Allison 4500 RDS automatic transmission. • ENGINE EQUIPMENT: Air restriction monitor— intake mounted. CAB: Low cab, forward mounted, tilt type; Floor covering — 2 keys and/or fobs; black rubber mats; Seating — driver air suspension mid back, passenger fixed mid back; Standard air conditioning and heating. • FRAME: Frame — steel construction matched to GVWR and mounted body of truck; Wheelbase — 209"; Front bumper — painted steel; Fuel tank — 70 gallon, minimum; Air dryer — Bendix AD9 heated, or approved equivalent. • SAFETY: Horn — single air trumpet; Mirrors — West Coast to include 7.5" convex mounted to lower mirror bracket; Daytime running lights; Backup alarm. • FRONT AXLE: 20,OOOIb. front axle and suspension; Oil type with synthetic lube. • REAR AXLE: 40,000 Ib.. rear axles and suspension; Power divider with warning light and buzzer (includes in cab control). • ELECTRICAL: Hand throttle — electronic hand throttle operated through cruise control when in PTO mode only; Engine protection — engine shut down system monitoring high water temp, low oil pressure, high exhaust temp, high transmission temp. • TIRES and WHEELS: Manufacturer standard tires and wheels rated for 60,000 Ib. GVWR. 222 M N N rn rn d LL N (1) U) En ua en s) Vj ® C: 0 C: 0 C: 0 C: 0 C: 0 C: 0 C: O O 00 00 0 00 LL m m m m CC9 m m m w C o 0 -.-Cl 0 0 0 0 L- O O O O O O O a O o 0 o O o 0 O O O O O O O O O O Cl O O O N N N -M rr T+ V/ - Vrh y®{ 0 V! co V+ VJ pW V/ O a•yyLq . �Tg 11 LTA 69 (Tg v! fir® 61 �Tg 60 �Tg v / �Tg v! Q Na) LL Q U U U Z Z Z U_ U_ x _U Z LU U) LU O U) U� 06 06 06 U) U) CO w w w 2 u u CO U Y Y Y ®) m J J J J U) U J J J J m o U U U06 y. > J d- ® w � w w (13 w M Q) o O X U W Z u1 0 Z u1 ® o Z u1 M ® d > ® CO a o Y co X cv _ U D U > of Q co C: m e ca mC: P � E� E� E E QCO® d a a Q w a Q -a w W Q V i CO N N ®^p ®CD Qs N Z U CO N m U V 2 U- _ / / \ 2 0 0 0 © J CL d 0 O O O 2 3 3 E 2 0 . C) 0 . O . / g U) 3 S 7 m 3 3 2 $ / / / k / k � \ \ \ a c o 0 ? ? ? / \ $ % _ o % = 5 0 c a % / / ? 0 » 2 > £ C) 0 e c c m M 2 \ $ ƒ ) / q / C) / L q k 0 / m 7 a » k a » k 69- \ . \ \ ± k ± LU / J d d ¥ 3 3 3 2 0 . C) 0 . 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O O O O O O O O O O O O J r r r O U O O O O �� O O O cc C a) W co W VJ (n Q Old W V/�, ��y C3 O O O O U U > N CN N C14 CN a. 60- b9 ff} 60} CO X J () z J ® U U U —J �� C C C a) W co W VJ (n Q Old W V/�, ��y co 70 L O LL O qLq�� W V _0 L LL O pLp�� MI rC: V 7 c LL ® a) W rC: V L _o LL 0 VAA,� L r0 U U > N p O O G! U M n � Q � 2 O O ® CO N LO ® LU > CU P O N Q LL v _ 0 w CO LL Q 0 00 r m i N d L U (n U d � 0 z d � C U d 0 cn -K4,IF FSA22-VEH20.0 Item Group Descriptions The following items will be factory installed on the base vehicle/equipment to meet the model number and build codes of the vehicle listed. Item Group: • Refuse Truck: Compact 9.5 Cu Yd Self Loading Refuse Truck FSA Item Group Description • ENGINE: 70 HP Diesel Engine, EPA compliant. • TRANSMISSION: Hydrostatic Transmission; Four-wheel drive. • ENGINE EQUIPMENT: Radiator— aluminum core, or approved equivalent. CAB: Low cab, forward mounted; Floor covering - manufacturer or standard; Seating — driver air suspension; Standard air conditioning and heating; Tilt Wheel • FRAME: Operating weight 7,300 lbs.; Frame — steel construction; GVWR 12,900 lbs.; Wheelbase —108"; Front bumper — painted steel; Fuel tank — 30 gallon, minimum; Articulated joint. • SAFETY: Horn — Electric; Mirrors — West Coast to include 7.5" convex mounted to lower mirror bracket; Brakes — Hydro -static, fail safe parking and emergency brake; Work lights; Strobe lights; DOT compliant lighting; Three Camera system view both sides and rear. • HYDRAULIC SYSTEM: Load arm, grip 55 -90 -gallon containers; Load arm, 500 LB. lift capacity; Load arm, 5 second cycle time. AXLES: Dana Corp 70 series front and rear, or approved equivalent; Front and Rear tires — 36 x 13.50-15 NHS high floatation tires; Hubs — iron, or approved equivalent. • ELECTRICAL: Hand throttle; Engine protection — engine monitoring system for high water temp, low oil pressure, high exhaust temp, high transmission temp. 228 rn N N v 0 d LL ® C: 0 c 0 c 0 c 0 cl a - O O O O O a) LL m w C o 0 0 0 i y O O O O O O O O a O O O O O O O O O O O O OO O O 0 O O O O Q O O O M 2 M M M M L QY a. 60k 64 64 61). U h LU U) D LL W U c c c c z m CL m a- w n m a _ ® E E E E Q U U U U O c c c c LL W U U U U =5 �- C Co co m m m D 06 U Y Ln !E L L L U O i O O O O U m m m m H H H 2 M Imo— = O U I— ® ® U c(i 2!1 L>, 2 of ® r E E E E > N w CO Q o � LL� m V L N 3 � N ®CD ®�pp as N z U iA N m U V FSA22-VEH2O.0 Item Group Descriptions The following items will be factory installed on the base vehicle/equipment to meet the model number and build codes of the vehicle listed. Item Group: • Tactical Armored Vehicles FSA Item Group Description • Engine; 6.7LV-8 Turbo diesel, 330 HP • Transmission 10 speed automatic Torqshift w/od • Drive Axles: 4 -wheel drive electronic • GVWR: GVWR sized to as built vehicle, (19500 lbs. approximate) • Tires and wheels: 225/70R x 19.5 DRW, run flat type tires • Interior: Dual front and rear A/C and Heat, full insulation with headliner, seating for 10 to12, (2 front 8 to 10 rear on benches), all seating position seatbelts, storage under rear bench seats with tie downs, multilevel gunner stand (floor recessed), center console for radios and electrical controls • Body and Glass Ballistic Defeat: Armored body and glass rated for NIJ IV (30.06 M2AP)/UL10(.50CAL M33), Rotating hatch armored with gunport, floor and fuel tank armored to blast, gunports on sides and rear. • Electrical: Strobe lights 2 front 2 rear, siren and pa system with 200 -watt speaker, 8 interior lights with red and white lenses, dual batteries, dual alternators (357 amps), backup camera, AC/DC inverter • Approximate Dimensions and Performance Data: Fuel capacity 40 -gals, Length 255 inches, Height 119 inches turret, Wheelbase 145 inches, turning radius 19.5 ft, 28 -inch fording depth, 13 -inch ground clearance. 230 T M N uo O LL O O O O N O ® O O i (f) V) U) Cl) ® O 0 O 0 C: 0 c O �7 07 67 67 CL O O O O ® 0 0 0 4) b9 69 61) 6f7 LL .i L .E .i CD mCIO cn I5 01 cn C � o0 O 0 0 O O O O e0 O e0 O OO O OO O a r r r r O O O O O Q N O ® O O ry O O O O 6 C O C C �7 07 67 67 Q O O O .L G. b9 69 61) 6f7 U U U U U) N O O O O U_ U_ U_ U_ .i L .E .i CD cn O O O O O U O O O O CD E E E E Y i M Ji W�— i O C co O C m O C m O O f0 N = W O ® W N 0co Q N EE co E m m E Q U � CD N 3 Q N CO N m V = ®�®�pp U ~ V LO r c L a) (n z c U iA NV Consent Bids and Purchases over $100,000 08/1/2023 City of Boynton Beach Agenda Item Request Form Commission Meeting Date: 08/ 1/2023 Proposed Resolution R23-096- A & Associates Annual Blanket Purchase Order & Piggyback Agreement. Requested Action by Commission: Approve a blanket Purchase Order with A & Associates of West Palm Beach, FL with an annual expenditure of $150,000 for general laborers needed at various City departments piggybacking the City of Dallas's Contract #POM -2021-00015158 for the period of the contract which expires on August 10, 2026. The City of Dallas's bid process satisfies the City's competitive bid requirements. Explanation of Request: Piggybacking is a standard practice in procurement whereby government entities can utilize contracts already negotiated by other government entities to exact the same terms and pricing from vendors for goods and services. The City's Purchasing Policy allows for the utilization of this method of procurement. Piggybacked contracts allow multiple government entities to benefit from competitively solicited bids, providing for better buying power and access to products. This method is encouraged when it is determined that it will provide the best product/service at the best price without compromising any of the specifications or quality desired. The City of Dallas's bid process satisfies the City's competitive bid requirements. The Solid Waste Division created an annual blanket in the with A & Associates for general laborers needed to assist with Solid Waste services using the City of Tampa's contract #11110320. The City of Tampa contract is no longer available and therefore we are requesting to utilize the City of Dallas's contract POM -2021-00015158 to piggyback. Due to labor shortages and vacancies, the Division has been utilizing A & Associates to fill positions and assist to complete the solid waste routes. This request is for an annual expenditure of $150,000 to cover for the total yearly expenses to continue utilizing the general laborers when needed. 232 How will this affect city programs or services? The blanket would allow us to continue requesting the assistance of the general laborers and service the customers/residents of the City. Fiscal Impact: Budgeted funding is in Solid Waste account # 431-2515-534-49-17, and other divisions within the Public Works Department, such as Parks and Grounds, Facilities, and Streets. Attachments: R23-096 Piggy-back_Agmts_with_A Associates_Laborers-_Reso.pdf Piggyback Agreement (A & Associates).pdf A & Associates - Letter of Authorization. pdf A & Associates - City of Dallas Contract #POM -2021-00015158 - Exp 08-10-26.pdf 233 1 RESOLUTION NO. R23-096 2 3 4 A RESOLUTION OF THE CITY OF BOYNTON BEACH, FLORIDA APPROVING 5 AND AUTHORIZING THE CITY MANAGER TO SIGN A PIGGY -BACK 6 AGREEMENT UTILIZING THE CITY OF DALLAS'S CONTRACT #POM -2021- 7 00015158 FOR THE PERIOD OF THE CONTRACT WHICH EXPIRES ON 8 AUGUST 10, 2026 AND AUTHORIZING THE CITY MANAGER TO ISSUE A 9 BLANKET PURCHASE ORDER WITH A & ASSOCIATES OF WEST PALM 10 BEACH, FL WITH AN ANNUAL EXPENDITURE OF $150,000 FOR GENERAL 11 LABORERS NEEDED AT VARIOUS CITY DEPARTMENTS; AND PROVIDING 12 AN EFFECTIVE DATE. 13 14 15 WHEREAS, the Solid Waste Division created an annual blanket with A & Associates for 16 general laborers needed to assist with Solid Waste services using the City of Tampa's contract 17 #11110320; however, The City of Tampa contract is no longer available and therefore we are 18 requesting to utilize the City of Dalla's contract POM -2021-00015158 to piggyback; and 19 WHEREAS, due to labor shortages and vacancies, the Division has been utilizing A & 20 Associates to fill positions and assist to complete the solid waste routes; and 21 WHEREAS, the blanket would allow us to continue requesting the assistance of the 22 general laborers and service the customers/residents of the City.; and 23 WHEREAS, the City Commission of the City of Boynton Beach, Florida deems it to be in 24 the best interests of the citizens and residents of the City of Boynton to approve and authorize 25 the City Manager to sign a Piggy -back Agreement utilizing the City of Dallas's Contract #POM - 26 2021-00015158 for the period of the contract which expires on August 10, 2026 and authorizing 27 the City Manager to issue a blanket Purchase Order with A & Associates of West Palm Beach, FL 28 with an annual expenditure of $150,000 for general laborers needed at various City departments. 29 NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE CITY OF 30 BOYNTON BEACH, FLORIDA, THAT: 31 Section 1. The foregoing "Whereas" clauses are hereby ratified and confirmed as 32 being true and correct and are hereby made a specific part of this Resolution upon adoption 33 hereof. 34 S:ACA\RESO\Agreements\Piggy-Back Agmts With A & Associates (Laborers) - Reso.Docx 234 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 62 63 Section 2. The City Commission hereby approves and authorizes the City Manager to sign a Piggy -back Agreement utilizing the City of Dallas's Contract #POM -2021-00015158 for the period of the contract which expires on August 10, 2026 and authorizing the City Manager to issue a blanket Purchase Order with A & Associates of West Palm Beach, FL with an annual expenditure of $150,000 for general laborers needed at various City departments. A copy of the Piggy -back Agreement is attached hereto and incorporated herein by reference as Exhibit „A„ Section 3. This Resolution shall become effective immediately upon passage. PASSED AND ADOPTED this 1 st day of August, 2023. CITY OF BOYNTON BEACH, FLORIDA YES NO Mayor — Ty Penserga Vice Mayor— Thomas Turkin Commissioner — Angela Cruz Commissioner — Woodrow L. Hay Commissioner —Aimee Kelley VOTE ATTEST: Maylee De Jesus, MPA, MMC City Clerk (Corporate Seal) Ty Penserga Mayor APPROVED AS TO FORM: David N. Tolces Interim City Attorney S:ACA\RESO\Agreements\Piggy-Back Agmts With A & Associates (Laborers) - Reso.Docx 235 RE AGREEMENT FOR PURCHASING TEMPORARY LABOR SERVICES - SANITATION INDUSTRIAL AND DAY LABOR This Agreement is made as of this day of 12023 by and between A & ASSOCIATES, INC. with a principal address 951 Sansbury's Way, West Palm Beach, FL 33411 and THE CITY OF BOYNTON BEACH, a municipal corporation organized and existing under the laws of Florida, with a business address of 100 East Ocean Avenue, Boynton Beach, FL 33435, hereinafter referred to as "City". RECITALS WHEREAS, in order to maintain Temporary Labor Services — Sanitation Industrial and Day Labor to the public, the City's Public Works / Solid Waste Department is requesting the City enter into an Agreement with A & Associates, Inc. to provide Temporary Labor Services — Sanitation Industrial and Day Labor; and WHEREAS, A & Associates, Inc. has agreed to allow the City to piggyback the City of Dallas, TX / Temporary Labor Services — Sanitation Industrial and Day Labor Agreement pursuant to Contract No. POM -2021-0015158 to provide Temporary Labor Services — Sanitation Industrial and Day Labor for a five (5) year term commencing August 11, 2021, and terminating on August 10, 2026; and NOW, THEREFORE, in consideration of the mutual covenants contained herein, and for other valuable consideration received, the receipt and sufficiency of which are hereby acknowledged, the parties agree as follows: AGREEMENT Section 1. The foregoing recitals are true and correct and are hereby incorporated in this Agreement. Section 2. The City and A & Associates, Inc. agree that A & Associates, Inc. shall provide Temporary Labor Services — Sanitation Industrial and Day Labor based upon the City of Dallas, TX / Temporary Labor Services — Sanitation Industrial and Day Labor Contract No. POM -2021- 0015158 for a five (5) year term commencing August 11, 2021, a copy of which is attached hereto as Exhibit "A", except as hereinafter provided: A. All references to the City of Dallas, TX / Temporary Labor Services — Sanitation Industrial and Day Labor Contract No. POM -2021-0015158 shall be deemed as references to the City of Boynton Beach. {00533394.1 306-9001821 } Piggyback Contract— A & Associates, Inc. 1 236 B. All Notices to the City shall be sent to: City: Daniel Dugger, City Manager City of Boynton Beach P.O. Box 310 Boynton Beach, Florida 33425 Telephone: (561) 742-6010 / Facsimile: (561) 742-6090 Copy: David N. Tolces, City Attorney Weiss Cerota Helfman Cole + Bierman 2255 Glades Road, Suite 200 E Boca Raton, FL 33431 Telephone: (561) 835-2111 C. The following terms and conditions are hereby incorporated into the Agreement: TAX EXEMPT. Prices applicable to CITY do not include applicable state and local sales, use and related taxes. The CITY is exempt from state and local sales and use taxes and shall not be invoiced for the same. Upon request CITY will provide VENDOR with proof of tax-exempt status. SOVEREIGN IMMUNITY. Nothing contained in Agreement nor contained herein shall be considered nor construed to waive CITY's rights and immunities under the common law or Section 768.28, Florida Statutes, as may be amended. BINDING AUTHORITY. Each person signing this Addendum on behalf of either Party individually warrants that he or she has full legal power to execute the Addendum on behalf of the Party for whom he or she is signing, and to bind and obligate such Party with respect to all provisions contained in this Addendum. ATTORNEY'S FEES. In the event that either Party brings suit for enforcement of the Agreement, each Party shall bear its own attorney's fees and court costs. PUBLIC RECORDS. Sealed documents received by the City in response to an invitation are exempt from public records disclosure until thirty (30) days after the opening of the Bid unless the City announces intent to award sooner, in accordance with Florida Statutes 119.07. The City is a public agency subject to Chapter 119, Florida Statutes. The Vendor shall comply with Florida's Public Records Law. Specifically, the Vendor shall: A. Keep and maintain public records required by the City to perform the service; B. Upon request from the City's custodian of public records, provide the City with a copy of the requested records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided in chapter 119, Fla. Stat. or as otherwise provided by law; {00533394.1 306-9001821 } Piggyback Contract— A & Associates, Inc. 2 237 C. Ensure that public records that are exempt or that are confidential and exempt from public record disclosure requirements are not disclosed except as authorized by law for the duration of the contract term and, following completion of the contract, Vendor shall destroy all copies of such confidential and exempt records remaining in its possession once the Vendor transfers the records in its possession to the City; and D. Upon completion of the contract, Vendor shall transfer to the City, at no cost to the City, all public records in Vendor's possession All records stored electronically by Vendor must be provided to the City, upon request from the City's custodian of public records, in a format that is compatible with the information technology systems of the City. E. IF THE VENDOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE VENDOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS: CITY CLERK OFFICE 100 E. OCEAN AVENUE BOYNTON BEACH, FLORIDA, 33435 561-742-6060 CityCIerk@bbfl.us SCRUTINIZED COMPANIES - 287.135 AND 215.473. By execution of this Agreement, Vendor certifies that Vendor is not participating in a boycott of Israel. The Vendor further certifies that Vendor is not on the Scrutinized Companies that Boycott Israel list, not on the Scrutinized Companies with Activities in Sudan List, and not on the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or has Vendor been engaged in business operations in Syria. Subject to limited exceptions provided in state law, the City will not contract for the provision of goods or services with any scrutinized company referred to above. Submitting a false certification shall be deemed a material breach of contract. The City shall provide notice, in writing, to the Vendor of the City's determination concerning the false certification. The Vendor shall have five (5) days from receipt of notice to refute the false certification allegation. If such false certification is discovered during the active contract term, the Vendor shall have ninety (90) days following receipt of the notice to respond in writing and demonstrate that the determination of false certification was made in error. If the Vendor does not demonstrate that the City's determination of false certification was made in error then the City shall have the right to terminate the contract and seek civil remedies pursuant to Section 287.135, Florida Statutes, as amended from time to time. E -VERIFY. VENDOR certifies that it is aware of and complies with the requirements of Section 448.095, Florida Statutes, as may be amended from time to time and briefly described herein below. 1. Definitions for this Section: 100533394.1 306-9001821 } Piggyback Contract — A & Associates, Inc. 3 238 A. "Contractor" means a person or entity that has entered or is attempting to enter into a contract with a public employer to provide labor, supplies, or services to such employer in exchange for a salary, wages, or other remuneration. "Contractor" includes, but is not limited to, a vendor or consultant. B. "Subcontractor" means a person or entity that provides labor, supplies, or services to or for a contractor or another subcontractor in exchange for a salary, wages, or other remuneration. C. "E -Verify System" means an Internet -based system operated by the United States Department of Homeland Security that allows participating employers to electronically verify the employment eligibility of newly hired employees. 2. Registration Requirement; Termination: Pursuant to Section 448.095, Florida Statutes, effective January 1, 2021, Contractors, shall register with and use the E -Verify System in order to verify the work authorization status of all newly hired employees. Contractor shall register for and utilize the U.S. Department of Homeland Security's E -Verify System to verify the employment eligibility of: A. All persons employed by a Contractor to perforin employment duties within Florida during the term of the contract; and B. All persons (including sub-vendors/sub-consultants/sub-contractors) assigned by Contractor to perform work pursuant to the contract with the City of Boynton Beach. The Contractor acknowledges and agrees that registration and use of the U.S. Department of Homeland Security's E - Verify System during the term of the contract is a condition of the contract with the City of Boynton Beach; and C. The Contractor shall comply with the provisions of Section 448.095, Fla. Stat., "Employment Eligibility," as amended from time to time. This includes, but is not limited to registration and utilization of the E -Verify System to verify the work authorization status of all newly hired employees. Contractor shall also require all subcontractors to provide an affidavit attesting that the subcontractor does not employ, contract with, or subcontract with, an unauthorized alien. The Contractor shall maintain a copy of such affidavit for the duration of the contract. Failure to comply will lead to termination of this Contract, or if a subcontractor knowingly violates the statute, the subcontract must be terminated immediately. Any challenge to termination under this provision must be filed in the Circuit Court no later than twenty (20) calendar days after the date of termination. Termination of this Contract under this Section is not a breach of contract and may not be considered as such. If this contract is terminated for a violation of the statute by the Contractor, the Contractor may not be awarded a public contract for a period of one (1) year after the date of termination. 100533394.1 306-9001821 } Piggyback Contract — A & Associates, Inc. 4 239 DISPUTES. Any disputes that arise between the parties with respect to the performance of this Agreement, which cannot be resolved through negotiations, shall be submitted to a court of competent jurisdiction in Palm Beach County, Florida. This Agreement shall be construed under Florida Law. EXECUTION OF THE AGREEMENT. This Agreement will take effect once signed by both parties. This Agreement may be signed by the parties in counterparts which together shall constitute one and the same agreement among the parties. A facsimile signature shall constitute an original signature for all purposes. TERMINATION FOR CONVENIENCE. This Agreement may be terminated by the City for convenience, upon fourteen (14) days of written notice by the terminating party to the other party for such termination in which event the Vendor shall be paid its compensation for services performed to the termination date, including services reasonably related to termination. In the event that the Vendor abandons the Agreement or causes it to be terminated, the Vendor shall indemnify the City against loss pertaining to this termination. TERMINATION FOR CAUSE. In addition to all other remedies available to City, this Agreement shall be subject to cancellation by City for cause, should Vendor neglect or fail to perform or observe any of the terms, provisions, conditions, or requirements herein contained, if such neglect or failure shall continue for a period of thirty (30) days after receipt by Vendor of written notice of such neglect or failure. INDEMNIFICATION. Vendor shall indemnify and hold harmless the City, its elected and appointed officers, agents, assigns and employees, consultants, separate Vendors, any of their subcontractors, or sub -subcontractors, from and against claims, demands, or causes of action whatsoever, and the resulting losses, damages, costs and expenses, including but not limited to attorneys' fees, including paralegal expenses, liabilities, damages, orders, judgements, or decrees, sustained by the City arising out of or resulting from (A) Vendor's performance or breach of Agreement, (B) acts or omissions, negligence, recklessness, or intentional wrongful conduct by Vendor's, its agents, employees, subcontractors, participants, and volunteers, and (C) Vendor's failure to take out and maintain insurance as required under this Agreement. Vendor's shall pay all claims and losses in connection therewith and shall investigate and defend all claims, suits or actions of any kind or nature in the name of the City, where applicable including appellate proceedings, and shall pay all costs, judgements, and attorneys' fees which may issue thereon. The obligations of this section shall survive indefinitely regardless of termination of Agreement. LIMITATION OF LIABILITY. Notwithstanding any provision of the Agreement to which it is applicable, City shall not be liable or responsible to Vendor beyond the amount remaining due to Vendor under the Agreement., regardless of whether said liability be based in tort, contract, indemnity or otherwise; and in no event shall City be liable to Vendor for punitive or exemplary damages or for lost profits or consequential damages. INDEPENDENT CONTRACTOR. The Agreement does not create an employee/employer relationship between the Parties. It is the intent of the Parties that Contractor is an independent contractor pursuant to the Agreement and shall not be considered the City's employee for any purpose. 100533394.1 306-9001821 } Piggyback Contract — A & Associates, Inc. 5 240 COUNTERPARTS AND EXECUTION. This Addendum may be executed by electronic signature or by hand, in multiple originals or counterparts, each of which shall be deemed to be an original and together shall constitute one and the same agreement. Execution and delivery of this Addendum by the Parties shall be legally binding, valid and effective upon delivery of the executed documents to the other Party through facsimile transmission, email, or other electronic delivery. COMPLIANCE WITH LAWS. Vendor hereby warrants and agrees, that at all times material to the Agreement, Vendor shall perform its obligations in compliance with all applicable federal, state, local laws, rules and regulations, including Section 501.171, Florida Statutes. Non- compliance may constitute a material breach of the Agreement. ASSIGNMENT. In the event Agreement, and any interests granted herein shall be assigned, transferred, or otherwise encumbered, under any circumstances by Vendor, Vendor must gain prior written consent from City thirty (30) days before such transfer. For purposes of Agreement, any change of ownership of Company shall constitute an assignment which requires City's approval. Notwithstanding the foregoing, Vendor may, without City's consent, assign this Agreement in whole or in part as part of a corporate reorganization, consolidation, merger or sale of substantially all of its assets related to this Agreement. Vendor shall provide City written notice of any such corporate reorganization, consolidation, merger or sale of substantially all of its assets related to this Agreement within thirty (30) days of such event. AGREEMENT SUBJECT TO FUNDING. The Agreement shall remain in full force and effect only as long as the expenditures provided for in the Agreement have been appropriated by the City Commission of the City of Boynton Beach in the annual budget for each fiscal year of this Agreement, and is subject to termination based on lack of funding. Early termination by City due to loss of funding shall not obligate Vendor to refund any prepaid fees. Section 1. Entire Agreement. The Agreement and this Addendum, and any subsequent amendments or purchase orders signed by the Parties hereto shall constitute the entire understanding of the Parties. Section 2. Severability. If any provision of this Addendum or application thereof to any person or situation shall to any extent, be held invalid or unenforceable, the remainder of this Addendum, and the application of such provisions to persons or situations other than those as to which it shall have been held invalid or unenforceable, shall not be affected thereby, and shall continue in full force and effect, and be enforced to the fullest extent permitted by law. Section 3. In the event that the A & Associates, Inc. agreement with the City of Dallas, TX is amended, or terminated, A & Associates, Inc. shall notify the City within ten (10) days. In the event the A & Associates, Inc. agreement with the City of Dallas, TX amended or terminated prior to its expiration, this Contract shall remain in full force and effect, and not be deemed amended or terminated until specifically amended or terminated by the parties hereto. Section 4. A & Associates, Inc. agrees that in the event it enters into a Contract for the same (or substantially similar) scope of services with another local government in Florida which contains a term or condition, including fees, charges, or costs, which the City {00533394.1 306-9001821 } Piggyback Contract — A & Associates, Inc. 6 241 deterinines to be more favorable than the terms in this Contract, the parties shall enter into an Addendum to provide those terms to the City. Section 5. The insurance required shall require that the Certificate of Insurance name the City of Boynton Beach as an additional insured. Section 6. In all other aspects, the terms and conditions of the A & Associates, Inc. with the City of Dallas, TX agreement are hereby ratified and shall remain in full force and effect under this Contract, as provided by their terms. Signature Page to follow {00533394.1 306-9001821 } Piggyback Contract— A & Associates, Inc. 7 242 IN WITNESS OF THE FOREGOING, the parties have set their hands and seals the day and year first written above. CITY OF BOYNTON BEACH, FLORIDA A & ASSOCIATES, INC. Daniel Dugger, City Manager (Signature), Company Approved as to Form: David N. Tolces, City Attorney Attested/Authenticated: City Clerk Print Name of Authorized Official Title Attest/Authenticated: (Signature), Witness Print Name (Corporate Seal) {00533394.1 306-9001821 } Piggyback Contract — A & Associates, Inc. 4 243 EXHIBIT A AGREEMENT BETWEEN THE CITY OF DALLAS, TX. AND A & ASSOCIATES, INC. {00533394.1 306-9001821 } Piggyback Contract — A & Associates, Inc. 9 244 AA & Associates, Inc. July 14, 2023 City of Boynton Beach Public Works / Solid Waste 222 NE 9' Avenue Boynton Beach, FL 33435 Subject: Letter of Authorization for Piggyback with the City of Boynton Beach Dear City of Boynton Beach: Please accept this documentation as the Letter of Authorization giving permission to the City of Boynton Beach to piggyback the City of Dallas contract Industrial and Day Temporary Labor RR - 211113 -POM -2844. Please note the contract information below: • Contract Number: POM -2021-00015158 • Contract Title: Industrial and Day Temporary Labor • Contract Term: August 11th, 2021- August 10th, 2026 • Hourly Bill Rate: $20.31 per hour We agree to honor all terms, conditions and pricing listed in the contract for this piggyback arrangement. If you should have a need for more information, please contact our office at 888-402-2950. With Kindest Regards, I Am, qA-'L� *GKQJ Ms. Evelyn Looney A & Associates Corporate Headquarters 951 Sansbury's Way, West Palm Beach, FL 33411 Phone: (561) 533-5303 — Fax: (561) 533-3858 www.AssociateStaffing.com 245 Resolution No. 21- 1263 Contract No. POM -2021-00015158 STATE OF TEXAS § CONTRACT FOR TEMPORARY § LABOR SERVICES — SANITATION COUNTY OF DALLAS § INDUSTRIAL AND DAY LABOR THIS CONTRACT FOR TEMPORARY LABOR SERVICESSANITATION DISPOSAL AND COLLECTION ("Contract") is made and entered into by and between the CITY OF DALLAS, a Texas municipal corporation, located in Dallas County, Texas (hereinafter called "City") and A & Associates, Inc., a Florida corporation, authorized to conduct business in the Stateof Texas, with its principal place of business at 951 Sansbury's Way, West Palm Beach, FL 33411, and its Dallas office located at 4131 North Central Expressway Dallas, TX 75204 (hereinafter called "Contractor"). 1. DESCRIPTION OF WORK A. For the consideration agreed below to be paid to Contractor by City, Contractor shall provide, as needed and when authorized, employees of Contractor to provide temporary laborservices for industrial and day labor for Sanitation Services positions in the City and County of Dallas, Texas, in conformation with the Request for Competitively Sealed Proposals BDZ21- 00015158, hereinafter called the "Services." The Services are to be performed in a good and workmanlike manner and shall conform in every respect to the following: (i) City's Request for Competitively Sealed Proposals (No. BDZ21-00015158); (ii) City's Specifications and Scope of Work for the Services (the "Specifications"); and all addenda thereto, attached as Exhibit A; and (iii) Contractor's Proposal (the "Proposal") attached as Exhibit B. (iv) City's Acknowledgement of Sanitation Vehicle Surveillance attached as Exhibit C. B. All of the documents referred to in subsection A of this paragraph 1 are incorporated by reference and made a part of this Contract for all purposes as though each were written word for word in this Contract; provided, however, that in case of a conflict in the languageof the Request for Competitively Sealed Proposals, the Specifications, the Proposal and this Contract, the terms and conditions of this Contract shall control and are final and binding on bothparties, and the Specifications shall control where they conflict with the Proposal. Contractor and City further agree that should any dispute or questions arise respecting the true construction or meaning of any of these documents, the true meaning shall be decided by City and such decision shall be binding and conclusive upon Contractor. Industrial and Day Temporary Labor — A & Associates, Inc. BD21-00015158 Page 1 of 11 246 2. INSPECTION OF SITE AND COORDINATION Contractor represents that, prior to submitting the Proposal and executing this Contract, Contractor became and remains thoroughly acquainted with all matters relating to the performance of this Contract, including, but not limited to, the existence of external and in -cab video cameras on Department of Sanitation vehicles, and in -cab audio recording, as one way to monitor and encourage safer driving practices, to enhance and improve driver and passenger safety and the safety of the community, public safety, to protect personnel from and reduce financial threats from false allegations of personnel misconduct, to reinforce driver accountability, and for overall service delivery. Contractor agrees to require each person who is engaged by Contractor to provide temporary labor services under this Contract to sign the Acknowledgement Form in Exhibit C and provide a copy of the signed Acknowledgement to the City. Contractor further represents that it is acquainted with all applicable laws and all of the terms and conditions of this Contract. All Services under this Contract shall be coordinated under, and performed to the satisfaction of City's Director of the Department of Sanitation, or the Director's designated representative, hereinafter called "Director." City is authorized to withhold payment of any funds under this Contract until periodic performance of the Services has been inspected, accepted, and approved by the Director. 3. PAYMENT TO CONTRACTOR FOR SERVICES AND CONTRACTOR PAY DUTIESTO TEMPORARY EMPLOYEES A. Upon completion of periodic performance of the Services by Contractor, acceptance of the performed Services by the Director, and receipt and approval of Contractor's invoices, submitted periodically to the Director, City will pay Contractor in accordance with the Specifications and the Proposal. Contractor's periodic and final invoices shall be accompanied bysufficient backup information as required by the Director. Total payments by City during the termof this Contract shall be in the estimated amount of FIFTY-FOUR MILLION SEVENTY SIX THOUSAND SEVEN HUNDRED FIFTY AND 00/100 DOLLARS ($54,076,750.00), subj eetto appropriations. The amount payable pursuant to this service price agreement may exceed the estimated amount but may not exceed the amount of budgetary appropriations for this service price agreement during its term. The estimated amount is intended as guidance rather than a cap on spending under the Contract, so that actual need for the Services combined with the budgeted amount approved by the City Council annually for the Services during the term of the Contract will determine the actual authorized expenditure under this Contract. City may, at its option, offsetany amounts due and payable under this Contract against any debt (including taxes) lawfully dueto City from Contractor, regardless of whether the amount due arises pursuant to the terms of thisContract or otherwise and regardless of whether or not the debt due to City has been reduced to judgment by a court. B. Not later than January 31 of each calendar year during the term of this Contract andwithin thirty (30) days after any Federal minimum wage increase takes effect, Contractor shall provide to City a certified summary for the position category for each Contractor employee assigned to work at the City indicating what wage rate Contractor pays to each temporary employee under this Contract for the balance of the period in question. The summary shall be signed by an officer of the Contractor. C. All temporary employees assigned to perform services under this Contract must beemployees of Contractor, and not independent contractors. Contractor shall pay all Industrial and Day Temporary Labor — A & Associates, Inc. BD21-00015158 Page 2 of 11 247 temporary employees assigned to perform Services under this Contract on a weekly basis and each weekly payment shall be timely made to pay in full all wages and benefits due in accordance with approved time sheets. In accordance with Dallas City Council Resolution 15-2141, Contractor shall pay atleast $15.21 per hour to the temporary employees performing Services on this Contract. If the federal or state minimum wage is increased to exceed $15.21 per hour during the term of this Contract, for those temporary employees receiving the federal or state minimum wage, the Contractor will be allowed to pass on to City the exact amount of the increase in the federal or state minimum wage above $15.21 per hour in accordance with Section 3B above. Contractor shall report and pay the employer's share of applicable state and local taxes, federal taxes, workers' compensation, FICA, federal unemployment insurance, and other required employer payments, with respect to all compensation received by Contractor's employees assigned to perform Services under this Contract. Contractor agrees to indemnify and hold harmless City against any liability for premiums, contributions or taxes payable under any workers' compensation, unemployment compensation, disability benefits, health benefits, retirement benefit or tax withholding laws with respect to all of Contractor's employees assigned to perform Services under this Contract. 4. TERM; SCHEDULE The term of this Contract shall be for a term of five (5) years, commencing on August 11,2021, and terminating on August 10, 2026, unless sooner terminated in accordance with the provisions of this Contract. City may, at its sole discretion and without further City Council action,extend the term of this Contract for an additional six (6) months by filing with the City Secretaiy'sOffice an extension request form signed by the Contractor. Extensions greater than six (6) monthsmust be authorized by City Council resolution. The schedule for completion of the Services shallbe as provided in the Specifications; where the Specifications do not provide for time of completion, the schedule shall be as provided by the Director. Time is of the essence of completionof the performance of the Services. For good cause shown by Contractor, the Director may extendthe time to perform the Services. 5. PERMITS; COMPLIANCE WITH LAWS AND REGULATIONS A. Contractor shall possess or obtain any necessary permits required by City ordinanceor State or Federal law for the performance of the Services prior to commencing the Services. B. This Contract is entered into subject to and controlled by the Charter and ordinances of the City of Dallas and all applicable laws, rules, and regulations of the State of Texas and the Government of the United States of America. Contractor shall, during the course of performance of this Contract, comply with all applicable City codes and ordinances, as amended, and all applicable State and Federal laws, rules and regulations, as amended. C. Contractor will recruit, interview, screen, select, hire and assign temporary employees who, in Contractor's judgment, are best qualified to perform the Services requested bythe Director. As the employer, Contractor will: (i) determine that its employees are eligible to work in the United States; (ii) maintain all necessary personnel and payroll records for its employees; (iii) provide all safety and other training to its employees; (iv) calculate the wages andwithhold taxes and other government mandated charges, if any; (v) remit such taxes and charges to the appropriate government entity; (vi) pay net wages and fringe benefits, if any, Industrial and Day Temporary Labor — A & Associates, Inc. BD21-00015158 Page 3 of 11 248 (e.g., vacationand holiday pay) directly to its employees; (vii) provide for liability and fidelity insurance as specified in Exhibit D of this Contract; (viii) provide workers' compensation insurance coveragein amounts as required by law and by the City; and (ix) comply with all federal and state laws requiring the provision of health care benefits and/or other fringe benefits to its employees as required by law. 6. INDEPENDENT CONTRACTOR (a) Contractor's status shall be that of an independent contractor and not an agent, servant, employee, or representative of City in the performance of the Services. Contractor shall exercise independent judgment in performing Services under this Contract. No term or provisionof this Contract or act of Contractor in the performance of this Contract shall be construed as making Contractor the agent, servant or employee of City, or making Contractor or any of its employees eligible for the fringe benefits, such as retirement and health or life insurance, which City provides its employees. If Contractor is not able to fill an order from the City for temporary employees in a timely manner, Contractor may subcontract with another temporary employment agency, however the Contractor must provide 24 hours advance notice to the City of its intentionto do so, and the subcontractor must be approved by the City, must provide all insurance requirements of this Contract to the City, and must sign a written agreement with Contractor to abide by all of the terms of this Contract and the Specifications. (b) For purposes of this Contract, Contractor, as the supplier of temporary employees to City, is responsible for the training and orientation of its employees. Contractor has the right tocontrol and direct its employees when away from the City work site, and has the right and controlto direct which temporary employees are assigned and what locations they are assigned to, consistent with the requirements of the Specifications, when City requests temporary labor. City has the right to request that a temporary employee who is assigned by Contractor who fails to perform the Services in accordance with the Specifications be removed from the assignment, but this does not in any way require Contractor to terminate the employment of its employee. Contractor is also responsible for making wage payments directly to temporary employees furnished under this Contract and is responsible for all withholding, recordkeeping and reporting of federal taxes and other payroll deductions, if any. Contractor shall, as supplier of temporary labor, furnish and keep in full force and effect at all times during the term of this Contract, coveringall temporary employees furnished under this Contract, workers' compensation insurance with alternate employer endorsements in favor of City. The amount and extent of the workers' compensation insurance coverage shall be as required and provided in Exhibit D -Insurance Requirements. For the purpose of workers' compensation coverage under this Contract, while the Contractor's or any subcontractor's furnished temporary employees work at the City's work site, the worker is an employee of Contractor (or subcontractor) and as a borrowed servant is alsoan employee of the City for worker's compensation purposes, with the Contractor (or its subcontractor) being responsible to provide the workers' compensation insurance coverage for thetemporary employees. CONTRACTOR AGREES TO INDEMNIFY THE CITY AND HOLDCITY HARMLESS FROM AND AGAINST ANY AND ALL PAYMENTS, COSTS AND EXPENSES THE CITY IS REQUIRED TO PAY UNDER THE WORKERS' COMPENSATION STATUTE FOR CLAIMS ARISING FROM THE PROVISION OF SERVICES UNDER THIS CONTRACT. Industrial and Day Temporary Labor — A & Associates, Inc. BD21-00015158 Page 4 of 11 249 7. CONTRACTOR'S INDEMNITY AND WAIVER TO THE FULLEST EXTENT PERMITTED BY LAW, CONTRACTOR AGREES TO PROTECT, DEFEND, INDEMNIFY AND HOLD CITY, ITS OFFICERS, AGENTS AND EMPLOYEES (COLLECTIVELY REFERRED TO AS "INDEMNITEE), FREE AND HARMLESS FROM AND AGAINST ANY AND ALL CLAIMS, DEMANDS, CAUSES OF ACTION, LAWSUITS, JUDGMENTS, OR OTHER LITIGATION OF EVERY KIND AND CHARACTER (INCLUDING ALL COSTS AND EXPENSES AND ATTORNEYS' FEES) WHETHER ASSERTED BY THE CONTRACTOR, AN EMPLOYEE OF CONTRACTOR, OR ANY THIRD PARTY (INCLUDING LABORERS FURNISHED BY CONTRACTOR AND ITS PERMITTED SUBCONTRACTORS) ON ACCOUNT OF BODILY OR PERSONAL INJURY, DEATH, OR DAMAGE TO OR LOSSOF PROPERTY, INCLUDING THE LOSS OF USE THEREOF, OR OTHER HARM FOR WHICH RECOVERY OF DAMAGES IS SOUGHT (COLLECTIVELY REFERRED TO AS "LOSS"), IN ANY WAY OCCURRING, INCIDENT TO, ARISING OUT OF, OR IN CONNECTION WITH (i) CONTRACTOR'S BREACH OF ANY OF THE TERMS OR PROVISIONS OF THIS CONTRACT, OR (ii) THE SERVICES PERFORMED BY CONTRACTOR OR THE WORK PERFORMED BY CONTRACTOR'S EMPLOYEES, AGENTS OR PERMITTED SUBCONTRACTORS; OR (iii) BY ANY NEGLIGENT AND/OR OMISSION OF INDEMNITEE RELATED IN ANY WAY TO THE SERVICES OR WORK OF THE TEMPORARY LABORERS IN THE PERFORMANCE OF THIS CONTRACT, EXCEPT THAT THE INDEMNITY PROVIDED FOR IN THIS PARAGRAPH SHALL NOT APPLY TO ANY LIABILITY RESULTING FROM THE SOLE NEGLIGENCE OR FAULT OF THE CITY, ITS OFFICERS, AGENTS, OR EMPLOYEES AND IN THE EVENT OF JOINT AND CONCURRENT NEGLIGENCE OR FAULT OF THE CONTRACTOR AND CITY, RESPONSIBILITY, AND INDEMNITY, IF ANY, SHALL BE APPORTIONED COMPARATIVELY IN ACCORDANCE WITH THE LAWS OF THE STATE OF TEXAS, WITHOUT WAIVING ANY GOVERNMENTAL IMMUNITY AVAILABLE TO THE CITY UNDER TEXAS LAW AND WITHOUT WAIVING ANY DEFENSES OF THE PARTIES UNDER TEXAS LAW. ANY PAYMENTS BY CONTRACTOR UNDER THIS PARAGRAPH ON BEHALF OF THE INDEMNITEE SHALL BE IN ADDITION TO ANYAND ALL OTHER LEGAL REMEDIES AVAILABLE TO THE INDEMNITEE AND SHALL NOT BE CONSIDERED THE INDEMNITEE'S EXCLUSIVE REMEDY. THE PROVISIONS OF THIS PARAGRAPH ARE SOLELY FOR THE BENEFIT OF THE PARTIES TO THIS CONTRACT AND ARE NOT INTENDED TO CREATE OR GRANT ANY RIGHTS, CONTRACTUAL OR OTHERWISE, TO ANY OTHER PERSON OR ENTITY. CONTRACTOR AND CITY ACKNOWLEDGE AND AGREE THAT THE PROVISIONS OF THIS SECTION 7 SHALL SURVIVE THE TERMINATION OR EXPIRATION OF THE TERM OF THIS CONTRACT. 8. INSURANCE AND BOND REQUIREMENTS A. Contractor shall procure, pay for, and maintain during the term of this Contract, with a company authorized to do business in the State of Texas and otherwise acceptable to City, the minimum insurance coverage contained in Exhibit D -Insurance Requirements, attached to and made a part of this Contract. Contractor shall provide copies Industrial and Day Temporary Labor — A & Associates, Inc. BD21-00015158 Page 5 of 11 250 of all required insurance policiesprior to the execution of the Contract and annually upon renewal or issuance of new policies. Allsubcontractors shall procure and maintain the required insurance and provide copies of policies for all periods when subcontractor employees are on assignment with the City. B. Approval, disapproval or failure to act by City regarding any insurance supplied byContractor or its subcontractors shall not relieve Contractor of full responsibility or liability for damages, errors, omissions or accidents as set forth in this Contract. The bankruptcy or insolvencyof Contractor's insurer or any denial of liability by Contractor's insurer shall not exonerate Contractor from the liability or responsibility of Contractor set forth in this Contract. C. Contractor shall furnish a payment bond and a performance bond each in the amount of 25% of the approved annual contract amount. Bonds shall be written by a corporate surety or sureties authorized to do insurance business in the State of Texas, and licensed to issue surety bonds in Texas. Contractor shall renew these bonds annually by Continuation Certificate or a new bond. Contractor shall promptly mail a written notice to City in the event surety elects not to extend the term of the bond or provide a new bond, and contractor fails to secure new bondswith another surety. 9. TERMINATION If Contractor fails to timely pay the temporary employees or fails to procure and maintainthe required workers' compensation insurance coverage and has not cured the breach within 24 hours of notice by the City, the City may immediately terminate this Contract and move any and all temporary employees to the City payroll or to another contractor without compensation to Contractor. For breaches other than non-payment of temporary employees and failure to procure and maintain workers' compensation insurance coverage, City's Director may, at his/her option and without prejudice to any other remedy City may be entitled to at law, in equity or elsewhere under this Contract, terminate further work under this Contract in whole or in part for cause or forthe convenience of City by giving at least ten (10) days advance written notice of termination to Contractor, with the understanding that all performance being terminated shall cease as of a date to be specified in the notice. City also has the right to request that Contractor assign and transfer to City all of Contractor's rights and obligations under existing subcontracts it has to perform Contract work in the event of termination under this Paragraph. City shall equitably compensate Contractor in accordance with the terms of this Contract for Contract work properly performed prior to the date of termination specified in the notice, following inspection and acceptance of same by City's Director. Contractor shall not, however, be entitled to lost or anticipated profits should City choose to exercise its option to terminate. 10. CONFLICT OF INTEREST A. Contractor and its employees, agents or associates are required to make regular, timely, continual and full disclosures to the Director of all significant outside interests and responsibilities that may give rise to a direct or indirect conflict of interest, including, but not limited to, any and all significant outside interests and responsibilities that could reasonably be expected to impair independence of judgment in Contractor's performance of all of the services under this Contract. Such disclosures must be made no later than ten (10) days following the eventgiving rise to the potential or actual conflict of interest for the Industrial and Day Temporary Labor — A & Associates, Inc. BD21-00015158 Page 6 of 11 251 duration of the Contract term. A potential or actual conflict of interest exists when commitments and obligations to the City or widely recognized professional norms are likely to be compromised in Contractor's performance of its duties under this Contract by the existence of Contractor's other professional relationships, contracts, obligations, or commitments. Failure to disclose such a conflict of interest may result inthe City's immediate termination of this Contract by the City Manager. B. The following section of the Charter of the City of Dallas shall be one of the conditions, and a part of, the consideration of this Contract, to wit: "CHAPTER XXII. Sec. 11. FINANCIAL INTEREST OF EMPLOYEE OR OFFICER PROHIBITED -- (a) No city official or employee shall have any financial interest, direct or indirect, in any contract with the city, or be financially interested, directly or indirectly, in the sale to the cityof any land, materials, supplies or services, except on behalf of the city as a city official or employee. Any violation of this section shall constitute malfeasance in office, and any city officialor employee guilty thereof shall thereby forfeit the city official's or employee's office or positionwith the city. Any violation of this section, with knowledge, express or implied, of the person orcorporation contracting with the city shall render the contract involved voidable by the city manager or the city council. (b) The alleged violations of this section shall be matters to be determined either by thetrial board in the case of employees who have the right to appeal to the trial board, and by the citycouncil in the case of other employees. (c) The prohibitions of this section shall not apply to the participation by city employeesin federally -funded housing programs, to the extent permitted by applicable federal or state law. (d) This section does not apply to an ownership interest in a mutual or common investment fund that holds securities or other assets unless the person owns more than 10 percentof the value of the fund. (e) This section does not apply to non -negotiated, form contracts for general city servicesor benefits if the city services or benefits are made available to the city official or employee on thesame terms that they are made available to the general public. (f) This section does not apply to a nominee or member of a city board or commission, including a city appointee to the Dallas Area Rapid Transit Board. A nominee or member of a cityboard or commission, including a city appointee to the Dallas Area Rapid Transit Board, must comply with any applicable conflict of interest or ethics provisions in the state law and the DallasCity Code." 11. GIFT TO PUBLIC SERVANT City may terminate this Contract immediately if Contractor has offered, or agreed to conferany benefit upon a City employee or official that the City employee or official is prohibited by lawfrom accepting. Industrial and Day Temporary Labor — A & Associates, Inc. BD21-00015158 Page 7 of 11 252 For purposes of this paragraph, "benefit" means anything reasonably regarded as pecuniarygain or pecuniary advantage, including benefit to any other person in whose welfare the beneficiaryhas a direct or substantial interest, but does not include a contribution or expenditure made and reported in accordance with law. Notwithstanding any other legal remedies, City may require Contractor to remove any employee of Contractor from work with this Contract who has violated the restrictions of this paragraph or any similar state or federal law, and obtain reimbursement for any expenditures made as a result of the improper offer, agreement to confer, or conferring of a benefit to a City employeeor official. 12. NOTICE OF CONTRACT CLAIM This Contract is subject to the provisions of Section 2-86 of the Dallas City Code, as amended, relating to requirements for filing a notice of a breach of contract claim against City. Section 2-86 of the Dallas City Code, as amended, is expressly incorporated by reference and madea part of this Contract as if written word for word in this Contract. Contractor is expected to fullycomply with the requirements of this ordinance in the event of a claim, in addition to all other requirements in this Contract related to claims and notice of claims. 13. NOTICES Except as otherwise provided in paragraph 12, any notice, payment, statement, or demandrequired or permitted to be given under this Contract by either party to the other may be effected by personal delivery in writing or by mail, postage prepaid. Mailed notices shall be addressed to the parties at the addresses appearing below, but each party may change its address by written notice in accordance with this paragraph. Mailed notices shall be deemed communicated as of three (3) days after mailing. If intended for City, to: Director Department of Sanitation Services City of Dallas 3112 Canton Street, Suite 200 Dallas, TX 75226 75204With a copy to: Director Office of Procurement ServicesCity of Dallas 1500 Marilla Street, Room 3F NorthDallas, Texas 75201 If intended for Contractor, to: Andrew Luchey President A & Associates, Inc. 4131 North Central Expressway Dallas, TX 14. EQUAL EMPLOYMENT OPPORTUNITY/NONDISCRIMINATION A. Contractor shall not discriminate against any employee or applicant for employment because of race, age, color, ancestry, national origin, place of birth, religion, sex, sexual orientation, gender identity and expression, military or veteran status, genetic Industrial and Day Temporary Labor — A & Associates, Inc. BD21-00015158 Page 8 of 11 253 characteristics, or disability unrelated to job performance. Contractor shall take affirmative action to insure that applicants are employed and that employees are treated during their employment without regard to their race, age, color, ancestry, national origin, place of birth, religion, sex, sexual orientation, gender identity and expression, military or veteran status, genetic characteristics, or disability unrelated to job performance. This action shall include, but not be limited to, the following: employment, upgrading, demotion or transfer, recruitment or recruitmentadvertising; layoff or termination; rates of pay or other forms of compensation; and selection of training, including apprenticeship. Contractor shall also comply with all applicable requirements of the Americans with Disabilities Act, 42 U.S.C.A. §§12101-12213, as amended. Contractor agrees to post in conspicuous places a notice, available to employees and applicants, setting forththe provisions of this non-discrimination clause. B. Contractor shall, in all solicitations or advertisements for employees placed by or on behalf of Contractor, state that all qualified applicants will receive consideration for employment without regard to race, age, color, ancestry, national origin, place of birth, religion, sex, sexual orientation, gender identity and expression, military or veteran status, genetic characteristics, or disability unrelated to job performance. C. Contractor shall furnish all information and reports required by the City Manager or his designee and shall pen -nit the City Manager or his designee to investigate its payrolls and personnel records which pertain to current staffing services contracts with City for purposes of ascertaining compliance with this equal employment opportunity clause. D. Contractor shall file compliance reports with City as may be required by the City Manager or his designee. Compliance reports must be filed within the time, must contain information as to the employment practices, policies, programs, and statistics of Contractor, and must be in the form that the City Manager or his designee prescribes. E. If Contractor fails to comply with the equal employment opportunity provisions ofthis Contract, it is agreed that City at its option may do either or both of the following: (1) Cancel, terminate or suspend this Contract in whole or in part; (2) Declare Contractor ineligible for further City contracts until it is d 15. ASSIGNMENT Contractor shall not sell, assign, transfer or convey this Contract, in whole or in part, without the prior written consent of City's Director. As an express condition of consent to any assignment, Contractor shall remain liable for completion of the Contract work in the event of default by the successor contractor or assignee. 16. RIGHT OF REVIEW AND AUDIT City may review any and all of the services performed by Contractor under this Contract. City is granted the right to audit, at City's election, all of Contractor's records and billings relatingto the performance of this Contract. Contractor agrees to retain such records for a minimum of three (3) years following completion of this Contract. Any payment, settlement, satisfaction, or release provided under this Contract shall be subject to City's rights as may be disclosed by such audit. Industrial and Day Temporary Labor — A & Associates, Inc. BD21-00015158 Page 9 of 11 254 17. VENUE The obligations of the parties to this Contract shall be performable in Dallas County, Texas,and if legal action is necessary in connection with or to enforce rights under this Contract, exclusive venue shall lie in Dallas County, Texas. 18. GOVERNING LAW This Contract shall be governed by and construed in accordance with the laws and court decisions of the State of Texas, without regard to conflict of law or choice of law principles of Texas or of any other state. 19. LEGAL CONSTRUCTION In case any one or more of the provisions contained in this Contract shall for any reason beheld to be invalid, illegal, or unenforceable in any respect, such invalidity, illegality, or unenforceability shall not affect any other provision of this Contract, and this Contract shall be considered as if such invalid, illegal, or unenforceable provision had never been contained in thisContract. 20. COUNTERPARTS This Contract may be executed in any number of counterparts, each of which shall be deemed an original and constitute one and the same instrument. If this Contract is executed in counterparts, then it shall become fully executed only as of the execution of the last such counterpart called for by the terms of this Contract to be executed. 21. CAPTIONS The captions to the various clauses of this Contract are for informational purposes only andshall not alter the substance of the terms and conditions of this Contract. 22. SUCCESSORS AND ASSIGNS This Contract shall be binding upon and inure to the benefit of the parties and theirrespective successors and, except as otherwise provided in this Contract, their assigns. 23. MISCELLANEOUS A. Pursuant to Section 2271, Texas Government Code, the Contractor hereby (i) represents that it does not boycott Israel, and (ii) subject to or as otherwise required by applicablefederal law, including without limitation 50 U.S.C. Section 4607, agrees it will not boycott Israelduring the term of the Agreement. B. The Contractor hereby represents that (i) it does not engage in business with Iran, Sudan or any foreign terrorist organization and (ii) it is not listed by the Texas Comptroller underSection 2252.153, Texas Government Code, as a company known to have contracts with or providesupplies or services to a foreign terrorist organization. As used in the immediately preceding sentence, "foreign terrorist organization" shall have the meaning given such term in Section 2252.151, Texas Government Code. Industrial and Day Temporary Labor — A & Associates, Inc. BD21-00015158 Page 10 of 11 255 24. CERTIFICATION OF EXECUTION The person or persons signing and executing this Contract on behalf of Contractor, or representing themselves as signing and executing this Contract on behalf of Contractor, do herebywarrant and certify that he, she or they have been duly authorized by Contractor to execute this Contract on behalf of Contractor and to validly and legally bind Contractor to all terms, performances and provisions herein set forth. 25. ENTIRE AGREEMENT; NO ORAL MODIFICATIONS This Contract (with all referenced Exhibits, attachments, and provisions incorporated by reference) embodies the entire agreement of both parties, superseding all oral or written previousand contemporary agreements between the parties relating to matters set forth in this Contract. Except as otherwise provided elsewhere in this Contract, this Contract cannot be modified withoutwritten supplemental agreement executed by both parties. EXECUTED this the 17th day of January , 2022, by City, signing by and through its City Manager, duly authorized to execute same by Resolution No. 21-1263 adopted by the City Council on August 11, 2021, and by Contractor, acting through its duly authorized official. APPROVED AS TO FORM: CHRISTOPHER J. CASO City Attorney BY Assistant City Attorney WS CONTRACTOR: A & Associates, Inc., _a Florida corporation BY AME D NAME Mr. Andrew Luchey NAME TITLE C E 0 Industrial and Day Temporary Labor — A & Associates, Inc. BD21-00015158 Page 11 of 11 CITY OF DALLAS T. C. BROADNAX City Manager Assistant City Manager 256 EXHIBIT Imo, 257 .■ E Specifications/Scope of Work Template City of Dallas Request for Competitive Sealed Proposals (RFCSP) Project Title: Temporary Industrial and Day Labor Buyer Solicitation Number: BDZ21-00015158 Page 1 258 31V 0q Scope of Work I. Introduction, Purpose and Intent The City of Dallas is requesting Proposals for a five-year Indefinite Delivery/Indefinite Quantity (ID/IQ) service contract to provide Temporary Industrial and Day Labor for the City of Dallas. These specifications are intended to document, as fully as practicable, the requirements for providing temporary labor hereafter called "temporary employees". An ID/IQ agreement is established when quantities of services and/or delivery schedules cannot be determined. Services under this agreement will be ordered on an as -needed basis for the term of the agreement. The facilities/locations, as specified herein, shall be used by the temporary labor companyhereafter called the "awarded agency" solely for the conduct of activities as described in the specifications, unless otherwise approved by the City's representative. These specifications will become part of the temporary labor contract and will be binding on the parties to the contract. II. Pre -Proposal Meeting Schedule, Questions, and Inquiries During the solicitation process proposers are required to limit their communication regarding this project to the Buyer referenced herein. A preproposal meeting will be held by the City whereby the proposers will have an opportunity to ask the requesting department(s) questions and/or obtain clarification. The preproposal meeting will be the only time when proposers and requesting department(s) will communicate directly, thereafter, all communication associated with thisproject shall be address to the assigned Buyer. Proposers may submit their questions electronicallythrough the City solicitation portal, https://dallascityhall.bonfirehub.com/login. All questions shall be submitted electronically, the City will respond to all questions by way of addendum which willbe posted as part of the solicitation. The City, its agents, and employees shall not be responsible for any information given by way of verbal communication. III. Preferred Qualifications Proposer must submit a letter of demonstrated experience in the field of placement of temporary help. Following are some examples of items that shall be included in the letter: 1. Preferably three (3) years of experience in the field of providing a 150 temporary employees on a daily basis to organizations with 600 or more employees. 2. Current number of proposer staff employees by position to include an organization chart. 3. Preferably three (3) years of experience placing temporary employees in public sector jurisdictions. 4. A listing of at least three clients, with which the proposer is currently providing temporary employee services or has provided temporary employees in the past (3) years successfully including the name and number of the contact person(s). 5. Information about training programs and a copy of the firm's safety handbook for employees. 6. A full description of the firm's hiring and employee screening processes. 7. A full description of firm software used to hire, track and schedule employees and the variety of reports available to the customer. Page 2 259 31V 0q 8. A full description of benefit programs available to employees and other promotional opportunities. 9. Providing opportunities for temporary employees to gain full time employment is important to the City of Dallas. Information should include any benefits or programs that the vendor or vendor contracted partner agency provides to the employees, including ex - offender case management assistance, assistance for ex -offenders and others to clear up or resolve employment barriers such as a suspended license, life skills training, social services resources and/or classes or programs to help employees gain full time employment. IV. Specifications or Scope of Work As stated in Section I this solicitation is intended to secure service contract for two categories of temporary labor. Groups IA and 1B are for temporary industrial labor to assist the City of Dallas' Department of Sanitation Services with day to day operations. Groups 2A and 2B are for temporary day labor and will be utilized by several department throughout the City to assist with various needs. Requirements Common to Industrial and Temporary Day Labor (IA. Sanitation Collections Positions, 1B. Sanitation Disposal Positions, 2A. Title Specific Positions, and 2B. Other Manual or Physical Labor Positions): All temporary employees provided by the awarded agency shall be at least eighteen years of age. All temporary employees provided by the awarded agency must be authorized to work in the United States. Awarded Agency shall use the E -Verify System through the Department of Homeland Security to verify the work status of all temporary employees assigned to work for the City. Awarded agency shall provide certification signed by an officer of agency to the City Representative of the temporary employee's authorization to work in the United States before the temporary employee can report to work. The City of Dallas expects that all temporary employees will be responsible for getting to the job site and/or work location, be punctual, be dressed appropriately with required safety equipment, and will be able to perform the assigned job duties. The individual job sites will vary and may be located throughout the city. Awarded agency will provide temporary employees to the City who are free of drugs and alcohol and who maintain a level of cleanliness consistent with the City staff in the same work environment. In compliance with the requirements of the Federal Drug Free Workplace Act of 1988, all temporary employees are required to refrain from the use of alcohol and/or drugs. City of Dallas rules and regulations prohibit the use or possession of drugs or alcohol while on duty or on City property or in a City vehicle. Temporary employees shall not report for duty or remain on duty with a blood alcohol level of 0.02 or greater or under the influence of any drug. A drug test will be conducted if the City has reasonable suspicion to believe the temporary employee is under the influence of drugs or above the blood alcohol level of 0.02. The drug test will be provided by the awarded agency through an authorized drug testing facility. The results will be reported to the City's representative. Random drug tests may also be required during the term of the Contract. Awarded agency shall provide notice to all temporary employees that both for cause and random Page 3 260 .■ drug testing will be conducted and agency must maintain the appropriate employee paperwork to permit such drug testing. Alcohol - Alcohol or any beverage containing more than one-half of one percent of alcohol by volume, which is capable of use for beverage purposes, either when alone or when diluted. Drug - A controlled substance as defined by Section 1.02 the Texas Controlled Substance Act and/or Section 202, Schedules I through V of the Federal Controlled Substance Act, including but not limited to marijuana, hashish, cocaine, heroin, morphine, codeine, opiates, amphetamines, barbiturates and hallucinogens. Awarded agency shall provide to the City evidence of a negative pre-employment drug screen on all temporary employees provided. The negative results of the tests shall be certified in writing by an officer of the awarded agency as to all temporary employees assigned to work with the City and submitted to the City's representative before the temporary employee can report to work. A weekly report, from the awarded agency, of the drug tests conducted or screenings may be requested by the City's representative. The City has a zero -tolerance for workplace violence. Awarded agency will ensure that all temporary employee's refrain from reporting for duty or having at any time in their possession on City property or in a City vehicle a weapon as classified by the City while performing duties specified herein. The City will not tolerate loud, boisterous, rude and or disrespectful treatment of others. Weapon means an instrument capable of causing bodily injury. Possession of such an instrument is prohibited on City property, unless specifically authorized and work related. Prohibited weapons can include but are not limited to: (a) Any firearm; (b) Any illegal knife, including but not limited to: (c) A knife with a blade over five and one-half inches; (d) A hand instrument designed to cut or stab another by being thrown; (e) A dagger, including but not limited to a dirk, stiletto, or poniard; (f) A bowie knife; (g) A sword; and (h) A spear; (i) A switchblade knife; 0) Any type of club; including but not limited to: (1) A blackjack; (2) A nightstick (3) A mace (4) A tomahawk (k) Any explosive weapon or device; (1) A firearm silencer; (m) Brass knuckles; (n) Ammunition; Page 4 261 31V 0q (o) A zip gun; (p) Any chemical dispensing device; and (q) Any caustic or corrosive liquid, such as acid or lye, capable of causing serious bodily harm. All temporary employees must be fully screened by a criminal background check. Awarded agency shall conduct a criminal background check on all temporary employees. Awarded agency shall provide certification signed by an officer of agency to the designated contact in the Department of Sanitation Services that the employee background checks have been conducted and the employees meet the criteria as listed below before the temporary employee can report for work. Even if a temporary employee was suggested by City management, the awarded agency must do a complete background check as described below. Any of the above violations are grounds for removal of the temporary employee from assignment at all Sanitation locations and City facilities. Awarded agency will ensure temporary employees are trained to communicate with City employees and citizens in a pleasant and professional manner. Awarded agency shall provide temporary employees who are able to understand and follow specific oral and/or written instructions. The complete background check must contain the following search types: • SSN Validation • National Criminal Database Search • 50 State Sex Offender Search • Must include primary (legal) name searches as well as any AKA's The following background check restrictions must be met before assignment to work with the Citv: • No felony conviction of the type on the list below (see Felony list below) within the last 5 years and a one (1) year stable work record • No other felonies and misdemeanors convictions (see Other Felonies and Misdemeanors list below) within the last 3 years and a one (1) year stable work record Felony • Arson • Assault • Bribery • Burglary • Child Molestation • Criminal Conspiracy/Attempt/Solicitation • Domestic Violence • Indecency with a child • Kidnapping • Manslaughter • Murder • Rape Page 5 262 31V 0q • Terroristic Threat Other Felonies and Misdemeanors • Drugs: Cultivation • Drugs: Intent to deliver • Drugs: Delivery • Drug Possession • Child Abandonment/Endangerment • Unlawful Carrying of a Weapon • DWI/DUI • Obscenity • Obstruction • Retaliation • Stalking • Theft • Criminal Mischief • Unlawful Restraint • Fraud • Credit Card Abuse • Embezzlement • Forgery • Misdemeanor: Prostitution • Misdemeanor: Indecent Exposure • Misdemeanor: Public Lewdness • Misdemeanors for charges in the Felony section • Misdemeanor: False alarm report Performance Certificate The City of Dallas has created a pilot program for temporary employees which include a modified criminal background requirement. This allows temporary employees to compete for open positions in Sanitation Services, Street Services, Dallas Water Utilities and Trinity Watershed Management. Temporary employees will have a reduced wait period from their release from prison/jail or date of disposition/conviction of crime, then the standard required by the City for City positions. Awarded agency will review temporary employee performance and work history for the below criteria and issues certificates to qualified temporary employees: a. Worked as a City of Dallas Sanitation Temporary Day Laborer for one (1) year. b. No more than 6 absences annually. c. No more than 9 tardy occurrences annually. d. No preventable accidents/injuries with lost time. e. No significant incidents of unacceptable performance or conduct noted by agency or the City of Dallas supervisory staff. £ Certificates will be valid for 6 months; reviews and re -certification will be conducted by awarded agency every April and October. Page 6 263 31V 0q It is the awarded agency's sole responsibility to handle pay issues with their employees. Any pay issues are to be resolved with awarded agency management or on-site coordinator within 24 hours, but shall be addressed "off the clock" and shall not disrupt daily operations. Awarded Agency shall notify temporary employees that any pay issues must be raised with the Awarded Agency directly and not the City of Dallas or their supervisor/manager with the Department of Sanitation Services. Pay issues not corrected within 24 hours (1 workday) will be considered non-performance. A penalty of $75.00 per day for each occurrence for each employee involved will be deducted from the agency's invoice for non-performance. Repeated instances shall be considered a breach of the contract. Temporary employees may, upon the City's preapproval, regularly work over 40 hours per work week. The City acknowledges that temporary employees working more than 40 hours per week will have all hours over 40 billed at time and a half. It is the awarded agency's responsibility to review and calculate employee's time to account for regular and overtime regardless of work assignments at multiple locations. If a temporary works for more than one supervisor during a week, it is the awarded firm's obligation to notify the second and any subsequent supervisor of the hours already worked, so the temporary is not inadvertently scheduled for more than 40 hours. The City will pay the regular hourly rate for temporary employees who work during these holidays: Thanksgiving, Christmas, and New Year's Day. The City will not pay for laborers who are not working during these holidays. Awarded agency will be responsible for fully complying with all laws and rules applicable to the provision of health insurance for temporary employees. The City will not provide any additional funding for such compliance, and City will not provide City health or any other City benefits to temporary employees. Photo IDs Awarded agency will provide temporary employees with a photo I.D. badge as a means of identification to verify that the temporary employee is employed by the awarded agency. ID card will include the agency company name, the temporary employee's name, and employee number (this number cannot be a Social Security Number). If subcontractors are used the subcontractor employee IDs must be distinguishable by color. Temporary employees without proper identification will not be allowed entry into Sanitation facilities. It will be the responsibility of the awarded agency to replace any temporary employee rejected by the City for lack of proper identification within two (2) hours. A penalty of $75.00 per occurrence assessed for each temporary employee not replaced within the 2 hour limit; the penalty will be deducted from the awarded agency's invoice for non-performance. Repeated instances shall be considered a breach of the contract. Use of City Owned EquipmentNehicles Temporary employees will not be allowed to drive City equipment/vehicles on behalf of the City of Dallas. "City Equipment" includes trucks, backhoes, cranes, bicycles, boats, aircraft, and all Page 7 264 31V 0q automotive equipment, both licensed and non -licensed, on -or off -the -road vehicles whether City - owned, leased, rented, loaned to, or donated to in which the operator or driver may ride upon and drives or controls the equipment and shall also refer to and include privately owned vehicles which are driven in the course and scope of City business. However, temporary employees are authorized to operate on behalf of the City, small non -automotive motorized equipment and hand tools, including but not limited to, push or walk behind lawn mowers, edger's, weed eaters, and hedge trimmers and truck hoppers. Awarded firm's laborers will sign for any equipment provided by the City. In the event awarded firm's laborers loose and or damage equipment, the City reserves the right to recover the cost to replace the equipment from the awarded firm. In the event awarded firm's laborers leave a jobsite and does not return the equipment back to the City, the City reserves the right to charge the awarded firm for the replacement cost of the equipment. Iniuries Awarded agency will provide detailed medical instructions to all temporary employees and its designated on-call company representative, for any medical emergencies and Workers' Compensation related injuries that occur while its employee is assigned to work under a contract. In the event of a temporary employee injury, the City's representative will immediately notify the awarded agency and the user Department's Workers' Compensation representative of the injury. The awarded agency is required to manage all work related injuries once notified of the injury, the awarded agency's designated on-call representative is required to immediately within (1) hour report to the medical facility where the temporary employee is being treated and begin assisting the injured employee with obtaining the correct level of medical care necessary and completing appropriate related documents/forms. The awarded agency will also be required to provide a drug screen on the injured temporary employee and submit the results back to the City's representative. It is the responsibility of the awarded agency to establish the correct legal procedures and paperwork to all assigned employees regarding the requirement for a mandatory post -injury drug screen. Awarded agency will be responsible for any injuries to its personnel, including all state and federal reporting and insurance requirements relating to the injured temporary employee. The City may require the awarded agency to provide updates on injured employees; the awarded agency will within 2 days of request provide written updates to the Sanitation representative. Uniform/Personal Protective Equipment (PPE) Requirements Awarded agency will provide temporary employees that are dressed appropriately for the type of work assigned or as requested by the department. Standard requirements for proper attire include a shirt and pants. Shirts must have sleeves (short or long), be in good condition and cannot contain unacceptable slogans or language that could be deemed hostile or offensive. Pants should come to the ankles (no shorts or capris), be made of durable material (i.e. denim, cotton, polyester or mixed). All clothing should fit the temporary employee properly and cannot be worn in an unacceptable manner. Loose clothing is not acceptable. Footwear shall meet safety standards (as determined by Sanitation Services) for the type of work being performed or as required by the department. Footwear should be closed toed, hard -soled, steel -toed shoes or boots for all temporary employees as required for the department. Tennis or athletic shoes are NOT acceptableat any location. Baseball caps are acceptable but cannot contain unacceptable slogans or languagethat could be deemed hostile or offensive. The City is not responsible for providing and replacing Page 8 265 31V 0q clothing or footwear. Temporary employees are not allowed to wear clothing or hats with the City Logo. The awarded firm shall provide safety related equipment on an "as needed" basis, such as eye and hearing protection, respiration devices, hard hats, gloves, rain gear, and safety appurtenances. In the event such items are needed, the City representative will make this known when placing an order for temporary employees and as otherwise required in this specification. Temporary Employee Assignments There will be no unauthorized access to work sites by temporary employees at any City facility. Awarded agency will provide a contact person(s) that can be reached during the City's business day beginning at 6:00 am for (8 -hour, 10 hour or 12 hour work schedules) for placement needs or issues regarding assigned temporary employees. While temporary employees are employed by the awarded agency, temporary employees will respond to, and receive direction from the City of Dallas managers, supervisors, crew leaders, and truck drivers. Temporary employees are to observe all rules, regulations, instructions, etc. of the City employee designated as their supervisor. If a City department manager or supervisor deems a temporary employee's performance unsatisfactory, the awarded agency will be expected to immediately remove the temporary employee from the worksite and provide a replacement within two (2) hours of notification at no additional cost to the City. All fees and charges are to be included in the proposed rates. The City of Dallas will not pay any additional fees or charges if the City hires a temporary employee any time after twelve (12) consecutive weeks of work as a temporary employee. Start -Up Awarded agency may choose to offer employment to any or all personnel from the current contractor, if applicable, who chose to be employed by the awarded agency with the approval of Sanitation Services, and agency understands that at the conclusion of the term of the contract or the termination of the contract by the City, the same opportunity must be provided to a successor agency without charge for the hiring by the new agency of any temporary employee who elects to continue a temporary assignment with the City. The required hiring process must be followed with regard to all such transition employees. When a Sanitation Department manager or his/her assigned representative places an order for a temporary employee(s), he or she will give the awarded agency the City department and "unit" code that will be used in billing. The City will inform the awarded agency of any special skills or workload requirements for specific tasks. All temporary employees are expected to arrive properly attired. Sub -Contracting Awarded agency may propose the use of subcontractors, if needed, to fulfill the City's Business Inclusion & Development goals. If the awarded agency proposes using a sub -contractor to provide a portion of the Temporary employees, the awarded agency is responsible to the City for ensuring the subcontractor meets all the qualifications and requirements of these specifications. The City Page 9 266 31V 0q expects all temporary employees, whether from awarded agency or a subcontractor, to meet the same prime contractor requirements listed in these specifications, including but not limited to being paid a "living wage", certification of having passed the hearing, background screening, drug screening and authorization to work in the United States, being properly attired, receiving any required safety equipment, following written and oral directions, having received safety training, having received training in the case of a medical emergency, etc. Prior to placing temporary employees through a subcontractor, the awarded agency must insure that the subcontractor provides an insurance certificate that meets the same requirements of the specifications to the City for approval. The City reserves the right to make final determination on the usage of any subcontractor. Subcontractor temporary employees will report to a work location designated by the City Representative. If the awarded agency is unable to fulfill a specific request within the allotted time they will be in breach of contract and the contract may be terminated if the problem is not corrected in the allotted time. The awarded firm must notify the City any time a laborer is placed who is employed by a sub -contractor instead of the awarded firm. The awarded agency remains ultimately responsible for the performance of any and all Temporary employees provided by agency and any approved subcontractor. A contract meeting between the awarded agency and the City may be scheduled to take place once each month from the inception of the contract until completion. Additional meetings between the City and the awarded agency may occur based upon the needs of the City. Contract Awarded agency will be offered a contract for services. The Contract will include the following wording: "Termination: City's Director may, at its option and without prejudice to any other remedy City may be entitled to at law, in equity or elsewhere under this contract, terminate further work under this contract in whole or in part for cause or for the convenience of City by giving at least ten (10) days advance written notice of termination to contractor, with the understanding that all performance being terminated shall cease as of a date to be specified in the notice. City also has the right to request that contractor assign and transfer to City all of contractor's rights and obligations under existing subcontracts it has to perform contract work in the event of termination under this Section. City shall equitably compensate contractor in accordance with the terms of this contract for work properly performed prior to the date of termination specified in the notice, following inspection and acceptance of same by City's Director. Contractor shall not, however, be entitled to lost or anticipated profits should City choose to exercise its option to terminate". Contract will include the following wording: "For the purpose of workers' compensation coverage under this Contract, while the contractor's furnished temporary employees work at the City's work site, the temporary employees are employees of the contractor and the City, with the contractor being responsible to provide the workers' compensation insurance coverage for such employees." See attached sample contract. Invoice Invoices will be submitted weekly to the Sanitation Services department electronically. Separate invoices should be submitted for each "unit" and/or division within the department. Invoices will list all temporary employees working in a given division during the billing period, the Unit code Page 10 267 31V 0q for the assigned work area, and the total hours worked by temporary employees (split by regular, and overtime). Sanitation Services will provide awarded agency a formatted Excel spreadsheet that the agency must complete and attach to each invoice which must contain in alphabetical order the temporary employee's name, actual dates and times worked, and the unit or division where the work was performed. This spread sheet shall be generated for each district and division. A copy of each employee's electronic time card, signed by a City department manager or supervisor, must accompany invoices. A copy of the awarded agency's pay log must also be attached. All modifications to invoices shall have attached to it the explanations as to why modifications were made as well as be signed and dated by the designated awarded agency's representative and the City department manager or supervisor. Invoices will be reviewed and approved by Sanitation Services and then will be forwarded to the City Controller's Office for payment. Payments will be made within 30 days of receipt of undisputed invoices. Sanitation Services will review the awarded agency's weekly "time sheets" for each designated district and division of Sanitation Services, within 48 hours of completion of the work period. The awarded agency is responsible for any corrections to the time sheet and must complete the revisions within 24 hours (workdays) for review and approval by Sanitation Services. This information is to be used for Invoice billing. A. Requirements Specific to Industrial Temporary Labor (IA. Sanitation Collections and 1B. Sanitation Disposal Positions for Industrial Temporary Labor): IA. Sanitation Collections Duties 1. Lift and carry filled garbage bags and other debris from alleys/front yards to garbage trucks. Ride on the back of garbage trucks and get off and on to retrieve bags of garbage, roll carts, and other debris. 2. Operate mechanical compactor mechanism for loading and dumping garbage, refuse, and roll carts. 3. Directing (forward and backward) the movement of Sanitation vehicle to ensure safe operations. 4. Performance of custodial duties such as: a. Sweep, mop, vacuum, wax and/or scrub floors. b. Clean walls, windows and restrooms fixtures. c. Empty, prepare, and clean trash receptacles. d. Pick up litter on facility grounds. 5. Operation of a variety of small power and hand operated lawn maintenance equipment, such as hand mowers, edger's, hedge clippers, weed -eaters, etc. 6. Use of shovels, hoes, pruning shears, rakes, saws, fertilizer spreaders, etc. 7. Plant grass, flowers, trees, shrubs, and prepare color beds for planting. Water lawns, flowers, trees and shrubs etc. S. Perform alley maintenance, including trimming of alleys using a variety of small power and hand operated lawn maintenance equipment. Page 11 268 .■ 9. Assemble and distribute large plastic garbage containers (roll carts). 10. Rake and bag grass clippings and other debris, load and unload filled bags on and off garbage and or dump trucks. 11. Collate packets for door-to-door distribution of Sanitation, Disposal and Recycling education materials. 12. Load, lift and move storeroom inventory, boxes, packets, supplies, filled garbage bags, etc. 13. Contain and clean up environmental spills on City facility parking lots, City streets, or other property as designated by the City. 14. Other duties consistent with the work of the Sanitation Services Department may be included. 1B. Sanitation Disposal Duties 1. Direct City, residential and commercial waste haulers to daily work areas at disposal facilities. 2. Directing (forward and backward) the movement of vehicles to areas for loading and dumping to ensure safe vehicle operations. 3. Performance of custodial duties such as: a. Sweep, mop, vacuum, wax and/or scrub floors. b. Clean walls, windows and restrooms fixtures. c. (Empty, prepare, and clean trash receptacles. d. Pick up litter on facility grounds. 4. Operation of a variety of small power and hand operated lawn maintenance equipment, such as hand mowers, edger's, hedge clippers, weed -eaters, etc. 5. Use of shovels, hoes, pruning shears, rakes, saws, fertilizer spreaders, etc. 6. Plant grass, flowers, trees, shrubs, and prepare color beds for planting. Water lawns, flowers, trees and shrubs etc. 7. Assemble and distribute large plastic garbage containers (roll carts). 8. Rake and bag grass clippings and other debris, load and unload filled bags on and off of garbage and or dump trucks. 9. Collate packets for door-to-door distribution of Sanitation, Disposal and Recycling education materials. 10. Load, lift and move storeroom inventory, boxes, packets, supplies, filled garbage bags, etc. 11. Contain and clean up environmental spills on City facility parking lots, City streets, or other property as designated by the City. 12. Other duties consistent with the work of the Sanitation Services Department may be included. Special Requirements: Awarded Vendor's employees who perform work on City property shall be familiar with the City's environmental policy, especially regarding spill response and proper chemical storage. The City will provide the Awarded Vendor with the necessary information to share with their employees. Physical Requirements: Page 12 269 .■ Temporary employees must be able to: bend, stoop, stand for extended periods of time, walk for extended periods and distances, lift and carry up to (50) pounds, push and or pull up to (90) pounds, work outdoors continuously under all weather conditions and be able to tolerate foul odors. Due to the danger of severe injury or death resulting from an assigned temporary employee not being able to hear an audible warning sound from backing trucks and equipment in the assigned work area or to hear warning calls from other workers, temporary employees must be able to meet standard hearing acuity: perceiving the nature of sounds at normal speaking levels with or without correction, and having the ability to receive detailed information through oral communication, and making fine discriminations in sound. Awarded agency shall provide hearing tests on temporary employees before being assigned to a work location. A statement certified by an officer of the awarded agency affirming that each temporary employee assigned to work at the City has successfully passed the heating screening test shall be submitted to the City Representative before the temporary employee can report to work. Work Locations: Awarded agency will assign all temporary employees to work in specific locations for Sanitation Services. Temporary employees will not be allowed to work outside of their assigned work location without the approval of assigned work location Manager or his/ her assigned representative. Awarded agency will provide trained and qualified temporary employee personnel as requested for scheduled work at the following Sanitation Services facility locations Sanitation Collection Divisions (Group 1A) a. District 1, 2721 A Municipal St, Dallas TX b. District 2, 2423 Valeria, Dallas TX c. District 3, 9811 Harry Hines Blvd, Dallas TX d. District 4, 9811 Harry Hines Blvd, Dallas TX e. District 5, 3112 Canton St, Dallas TX Sanitation Disposal and Transfer Divisions (Group 1B) a. McCormnas Bluff Landfill, 5100 Youngblood, Dallas, TX b. Bachman Transfer Station, 9500 Harry Hines, Dallas, TX c. Fair Oaks Transfer Station, 7677 Fair Oaks, Dallas TX d. Oak Cliff Transfer Station, 4610 S. Westmoreland, Dallas, TX Training Awarded agency will provide temporary employees who are trained and knowledgeable of Sanitation Services operations prior to reporting for duty. An officer of agency will certify that the training has been provided prior to submitting the temporary employee for duty A copy of awarded agency's safety and training manual, including policies and procedures must be made available to the City of Dallas buyer and Sanitation Services representative within 3 days of the contract award. The training manual must include the safety and operation data for the equipmenton which the temporary employee will be assigned. The awarded agency is solely responsible forproviding all required safety equipment for temporary employees, and the awarded agency may Page 13 270 .■ not charge the employee for such safety equipment. Awarded agency will provide updated training to ternporary employees upon request of the Sanitation representative or manager. Training records must be made available to the City of Dallas within 3 days of the written request. Upon request from the City, awarded agency will provide a temporary employee roster in alphabetical order to include employee ID number, assignment date, assigned district/division to all Managers and Sanitation representatives to ensure that only approved temporary employees are assigned and allowed to work at all Sanitation locations. Payroll/Timekeepin� Awarded agency will supply biometric (fingerprint scanning) time clocks to each reporting facility listed in this RFCSP. The awarded agency is responsible for ensuring network connectivity for each time clock utilizing the agency's own network cards or "hotspots". The awarded agency will provide an electronic copy of time clock data to the City's manager at each location for time reporting reconciliation. All Time keeping will be done electronically. Overtime It is the City's goal to minimize overtime hours of Temporary Employees. The Awarded Vendor shall monitor weekly hours, and alert Sanitation representatives of the option to assign alternative Temporary Employees to assignments as each Temporary Employee accumulates 36 hours in a work week with one or more work days remaining in the work week. Temporary Employees may, upon the City's pre -approval, work over 40 hours per work week. The City acknowledges that Temporary Employees working more than 40 hours per week will have all hours over 40 billed at time and a half It is the Awarded Vendor's responsibility to review and calculate employee's time to account for regular and overtime regardless of work assignments at multiple locations. Sanitation Services crews work eight (8), ten (10), and twelve (12) hour days, four (4) days or five (5) days a week. Overtime will be charged only for Temporary Employees working over forty (40) hours in a work week. The work week is Sunday through Saturday. By each Tuesday during the contract term, the awarded vendor shall provide to Sanitation a report of overtime hours worked from the previous week, and a summary of alerts sent to Sanitation representatives regarding impending overtime of Temporary Employees. Failure by the Awarded Vendor to provide such alert will result in a fine equal to the overtime premium paid to Awarded Vendor for each Temporary Employee for which an alert was not provided for the subj ect work week. Failure by the Awarded Vendor to provide an alternative Temporary Employee following an alert and request for such alternative Temporary Employee by a Sanitation representative will result in a fine equal to one-half of the overtime premium paid to the Awarded Vendor for each Temporary Employee for the subject work week. Failure by the Awarded Vendor to provide a weekly overtime report as described above will result in a $75.00 fine for each day the report is past due and may constitute a breach of contract, as determined by the City. Uniform/Personal Protective Equipment (PPE) Requirements Page 14 271 31V 0q Awarded agency will provide temporary employees with a Class II high visibility safety vest with agency Name clearly printed in 3" black letters front and back as a means of identifying the temporary employee as an employee of the agency and a City contractor as specified by the City. The awarded agency will provide safety related equipment on an "as needed" basis, such as: • Eye protection that meet ANSI Z87.1 + standards and or splash proof goggles • Hearing protection • Respiration devices such as 3M brand 8210 or equal • Hard hats o Gloves (appropriate for specific daily jobs)Refuse and recycling collection staff must have the option to have gloves with adjustable wrist straps • Rain suits (Pants and coat with hood) • Back braces • Disposable neoprene gloves (chemical resistant) for the landfill and environmental spill team crews in addition to the other gloves listed above • And any additional personal protection supplies needed. Temporary employees that are not correctly attired or that do not have proper safety equipment or unsuitable equipment will be rejected by the City and not used. It is the responsibility of the awarded agency to replace, within two (2) hours, any temporary employees due to inappropriate attire, lack of proper safety equipment, or refusal to wear safety equipment. The awarded agency shall fill all orders for temporary employees within the 2 hour period. A penalty of $75.00 per occurrence for each temporary employee not replaced within the 2 hour limit will be imposed and, the penalty will be deducted from the agency's invoice for non- performance. Repeated instances shall be considered a breach of the contract. In the event additional safety items are needed, the awarded agency will deliver the supplies to the requesting division/location within 24 hours of request. A penalty of $75.00 per day for each occurrence will be imposed, and the penalty will be deducted from the agency's invoice for non- performance and considered a breach of the contract. The City may at its option, agree to store personal protection supplies for the awarded agency's employees in district offices. Temporary Employee Assignments Sanitation Department Managers will place an order for temporary employees by issuing a delivery order to the awarded agency's office. The awarded agency shall have (2) two hours to fill the order. The City will not be responsible for orders that do not include a delivery order number. Temporary employees that are not correctly dressed or that do not have proper safety equipment will be rejected by the City and not used. It is the responsibility of the awarded agency to replaceany temporary employee due to inappropriate attire or lack of safety equipment within two (2) hours. A penalty of $75.00 per occurrence for each temporary employee not replaced within the two (2) hour limit will be imposed, and the penalty will be deducted from the agency's invoice fornon- performance and considered a breach of the contract. Schedule of Work The successful proposer must be prepared to begin work upon award by City Council, contract execution, an insurance certificate that complies with the requirements, a Texas Ethics Code Form 1295 Disclosure of Interested Parties certified by an officer of proposer, and appropriate bonding Page 15 272 .■ being provided. Any required insurance and/or bonding shall be provided no later than 15 days after Council awards contract. Proposals should include a plan to transition the service from the current agency in order to minimize service disruption. Start -Up Initial placement requests are to be filled within two (2) business days of the request (the two (2) business days applies only to the start of the contract or a newly created division(s) of Sanitation Services). The request will specify the quantity and duration of temporary employee needs. In emergency situations, outside normal daily operational needs, the City may request temporary employees with as little as four hours' notice. The awarded agency will attempt to fill these "short - notice" requests, and if unable to do so, will communicate immediately with the City representative as to how quickly temporary employee (s) will be placed. These time lines apply to only the Initial start-up of the contract and or the creation of a new Sanitation division. Invoice disputes The awarded agency will submit all documentation clearly indicating the reason for the dispute to the Sanitation representative and be available to meet with the Sanitation representative. The City representative will notify agency of the schedule for the meeting a minimum of 5 days prior to the meeting date, unless otherwise agreed to by both parties in writing. The City will charge agency a $25.00 per hour fee for the research/ review of all disputed invoices, which will be deducted from the City's payment to the agency. Awarded agency must make financial records, related to invoicing, available 3 days after written request to the City for review or audit. The City contracts with and pays the awarded agency only. Subcontractors should bill and receive payments from the awarded agency. The City will not pay subcontractors directly. Temporary employees supplied by a subcontractor must use the awarded agency's electronic time clock. Agency will be responsible for providing timely information to its subcontractors to allow timely payment of subcontractor employees. On -Site Coordinator Sanitation requests On-site Coordinators be included as part of the proposal and included in the Temporary Employee hourly rate. Awarded Vendor must schedule coordinators to be on-site at each work location listed in these specifications below for the first two (2) hours of each business day shift (crew -out), and a minimum of three (3) coordinators to be on-call to assist all work locations for the remainder of each business day. The Onsite Coordinators will provide the following services: a. Provide orientation, job and safety training for all temporary employees. b. Assure that the appropriate # of temporary employees report to each work site daily. c. Locate and assign additional temporary employees as required by the City to provide proper staffing levels. d. Meet weekly or upon request with City representatives to discuss work assignments and address any issues. Page 16 273 31V 0q e. Assure that all temporary employees have proper Personal Protective Equipment (PPE) at all times and maintain adequate PPE inventory at each work site. f. Supervise time keeping processes and insure that time keeping is accurate to support efficient payroll process. g. Report for City representative when employees will start earning OT each pay period. h. Manage temporary employee performance and conduct disciplinary actions. i. Conduct frequent field observations and formally address any safety or performance issues. j. Respond to reported incident/injury immediately and manage all post -injury oversight and reporting. k. Address all temporary employee issues in a manner that does not interfere with work assignments (before or after assigned work hours). i. Report hours spent weekly on field observations. Reporting In addition to the certification provided prior to a temporary employee being sent for an assignment, awarded agency will provide a new temporary employee electronic verification report on a monthly basis signed by an authorized representative of the company. The report should include in alphabetical order the employee name and ID number, assignment date, negative drug screening, hearing and background checks and completion of required training. Awarded agency will keep all records regarding temporary employees and make them available upon City's request. B. Requirements Specific to Temporary Day Labor (2A. Title Specific and 2B. Other Manual or Physical Temporary Day Labor): Temporary Employee Assignments Each placement request will be made via email daily (between 8:00 AM — 8:30 AM) to awarded firm and is to be filled within two (2) hours of the request. The awarded firm will attempt to fill these requests on time and if unable to do so, will communicate immediately with the City representative as to how quickly laborer(s) will be placed. Effort should be made to have the fill rate time at 95%. When a City department manager or supervisor places an order for a temporary employee, he or she will give the awarded firm the City department and "org" code and delivery order (DO) number that will be used in billing. The City will inform the awarded firm of any special skills or workload requirements for specific tasks. 2A. Title Specific Positions for • Trades Helper • Mechanic • Mechanic II • Sr. Mechanic • Welder • Sr. Welder • Certified Tech • Fleet Parts Specialist Page 17 274 31V 0q • Sr. Fleet Parts Specialist For title specific positions, the City may request an unlimited federal district searches based on districts the applicant has resided in over the past 7 years, a credit report for financial positions, employment verification as well as education verification. The agency will be asked to prescreen / interview candidates utilizing additional criteria provided by the requesting department. The City of Dallas requesting manager or supervisor reserves the right to screen temporary service employees. In this case, at the time an order is placed for a temporary employee, the awarded agency will immediately provide the requestor with resumes of qualified candidates. The requesting manager or supervisor will review resumes and select the candidate of their choice or conduct interviews to select a candidate. For a complete list of pay rates for each position refer to Exhibit A for a Current City of Dallas Pay Rates for Group 2A. Title Specific Temporary Day Labor. Pay Rate is defined as the temporary employee's pay rate. Bill Rate is the rate charged to the City that includes the pay rate for the temporary employee and the supplier's mark-up. 2B. Manual or Other Physical Temporary Day Labor Temporary employees must be able to: bend, stoop, stand for extended periods of time, walk for extended periods and distances, lift and carry up to (50) pounds, push and or pull up to (90) pounds, work outdoors continuously under all weather conditions and be able to tolerate foul odors. Due to the danger of severe injury or death resulting from an assigned temporary employee not being able to hear an audible warning sound from backing trucks and equipment in the assigned work area or to hear warning calls from other workers, temporary employees must be able to meet standard hearing acuity: perceiving the nature of sounds at normal speaking levels with or without correction, and having the ability to receive detailed information through oral communication, and making fine discriminations in sound. Awarded agency shall provide hearing tests on temporary employees before being assigned to a work location. A statement certified by an officer of the awarded agency affirming that each temporary employee assigned to work at the City has successfully passed the hearing screening test shall be submitted to the City Representative before the temporary employee can report to work. Will be utilized by several departments throughout the City to assist with various needs on a day to day basis. Payroll/Timekeeping Awarded firm shall supply each laborer with a daily time card which includes the contractor's name, address, telephone and fax numbers, the laborer's name, laborer's signature line, assigned Page 18 275 31V 0q location, an area to record actual time worked and a supervisor signature line. This card will provide a signed document for the contractor, laborer and the City representative. V. Exhibits — "Exhibit A - Current City of Dallas Pay Rates for Group 2A. Title Specific Temporary Day Labor". VI. Award Method — The City's intent is to award this solicitation by group, but the City reserves the right to award in the method that is most advantageous to the City. Vendors awarded Groups I and/or 1B will not be awarded Groups 2A or 2B. Should a vendor score highest for all groups the City will make the final determination on which groups to award to that vendor. The City reserves the sole discretion to determine whether a solicitation response is responsive. City reserves the right to reject any or all bids and to waive minor irregularities or discrepancies in any solicitation response as may be in the best interest of City. Late bids will not be considered for award. VII. Location and Invoicing — The City shall pay invoices in 30 days. In order for the City to pay invoices in 30 days, the vendor's invoice must be correct, and reflect the work or goods delivered to the City. The 30 days begin when the City has received a correct invoice reflecting the work or goods delivered. If the City receives an invoice that is not correct and/or reflective of work or goods that have been delivered, the City will request a corrected invoice and the 30 -day period will begin once the correct invoice has been received. All work described in the vendor invoice must have been delivered in compliance with the terms of the contract. Invoices shall be submitted monthly to the City for payment, unless both parties agree to alternative arrangement based on project milestones. Each invoice submitted for payment shall include, at a minimum, the following information: • Name and address of the department for which services were provided • Contact information of City staff who placed order (name, phone number, department) • Date of order or Service • Detailed description of each service • Price good or services (charges for all services covered by this contract are to be separately stated and explained • Total cost of goods/services Submitting invoices without the above information may cause delays in payment processing. Incorrect invoices or invoices sent to the wrong address will delay payment. Vendors who fail to follow this procedure risk having the contract with the City cancelled. A copy of each employee's time card, signed by a City department manager or supervisor, must accompany invoices. If more than 40 hours are worked by any employee, a copy of the City's approval for overtime must be included. Sub -contractors should bill and receive payments from the awarded firm. The City will not pay sub -contractors directly. Laborers supplied by a sub- contractor must use the awarded firm's time cards. VIII. Evaluation Criterion The evaluation criterion is relatively standard, consult with the buyer if changes are required to be made to this section. Note: the BID will mostly always be 15 points. Page 19 276 31V 0q 1. Experience and Capabilities— 35 points 2. Approach — 30 points 3. Pricing — 30 points 4. Local Preference Program- 5 points a) The City of Dallas aims to maximize economic return in the procurement of goods and service with the Local Preference Program. The City's Local Preference Program values the participation of companies who have their principal place of business in the City of Dallas and who hire City of Dallas residents. 5 points will be awarded to those Suppliers that qualify for the Local Preference points on a pass/fail basis. Supplier shall fill out the Local Preference Affidavit to be eligible for Local Preference points. Definitions of Evaluation Criteria: Pricing — 30% Is considered the amount of money proposed for the requested services. Approach to Filling Positions — 20% The necessary steps the agency takes to filling a position. Please list the steps and time taken upon notification of a vacancy to fill. While most vacancies are planned, i.e. retirement, leaving the city for another venue, or through promotions, there will still be a need for unscheduled vacancies. Experience & Capabilities — 20% Proposing agency should have been in the business of providing temporary employment for a minimum of 2 years. Proposals should include a letter of demonstrated experience in the field of placement of temporary employment. Following are some examples of items that may be included in the letter which should be supported by verifiable references: 1. Number of years agency has been in business; 2. Number of years of experience of principals in the field of providing temporary help; 3. Describe experience in placing skilled industrial and day labor level employees with details regarding employee placement and replacement procedures; 4. Describe experienceplacing temporaries with organizations with 5,000 or more employees; 5. Describe experience placing temporaries in Public Sector jurisdictions; 6. Memberships in the local Chamber(s) of Commerce &/or Better Business Bureau; 7. Screening and testing procedures used for prospective employees; 8. Monthly reporting mechanism(s) and types of reports that can be generated. IX. Award Method The City's intent is to award this solicitation by group, but the City reserves the right to award in the method that is most advantageous to the City. Vendors awarded groups IA and/or 1B will not be awarded group 2. Should a vendor score highest for all groups the City will make the final determination on which groups to award to that vendor. The City reserves the sole discretion to determine whether a solicitation response is responsive. City reserves the right to reject any or all bids and to waive minor irregularities or discrepancies Page 20 277 31V 0q in any solicitation response as may be in the best interest of City. Late bids will not be considered for award. X. Transition At the end of the Term or if the Contract is terminated by the City prior to the expiration of the Contract, the Awarded Vendor shall transition the services in a cooperative manner to the successful proposer approved by the City Council at the expiration date of the term of the Contract or on an earlier termination date. The transition shall be seamless without any break in services, and Contractor shall fully cooperate to make certain that this occurs. XVI. Documents Submitted with Proposal or upon Request 1. Business Information Form (OPS -02) 2. Conflict of Interest Policy and Questionnaire (OPS -06, State Form CIQ) 3. Statement of Insurability and Quote (OPS -04) 4. Payment and Performance Bonds (OPS -05) 5. Office of Business Diversity Pre-Bid/Proposal Form (OBD-FRM-623) 6. Office of Business Diversity Workforce Composition Form (OBD-FRM-27) 7. Copy of contractor's internal affirmative action plan or policy S. Living Wage Affidavit (OPS -3) 9. Sample Contract with markups 10. Any other City documents as required X1. Opening of Proposals All proposals shall be in the office of the Office of Procurement Services Department no later than the proposal due date and time shown on the RFCSP Signature Page. Proposals will be opened by the City at 2:00 p.m. the day following the due date to avoid disclosure of contents to competing proposers. Proposer names will be publicly read. It is the responsibility of the proposer to clearly mark and identify all portions of the proposal, which, in the proposer's opinion, contain trade secrets, confidential information and other proprietary information. All proposals are subject to the Texas Open Records Act process. XII. Review of Proposals 1. The City will review and evaluate the proposals submitted to determine if submitted proposals demonstrate the required experience and qualifications to fulfill the obligations of the services identified in this RFCSP. Vendor Presentations are anticipated to take place on March 271H Proposers will be notified by the buyer as to the location and times of presentations. 2. The City may conduct all necessary inquiries or investigations, including but not limited to, contacting references to verify the statements, documents, and information submitted in connection with the Proposal. The City may also seek clarification from the referenced Proposers about any financial and experience issues. Page 21 278 31V 0q 3. Please be aware that the City of Dallas may use sources of information not supplied by the proposer concerning the abilities to perform this work. Such sources may include current or past customers of the organization; current or past suppliers; articles from industry newsletters or other publications or from non -published sources made available to the City of Dallas. XIII. Proposal Pricing 1. Proposed pricing shall be firm for the entire contract. The Contract shall commence on the date of award by the Dallas City Council and upon the execution of the Contract. 2. Costs not included or calculated in the applicable unit prices as -proposed will not be paid by the City, regardless of the intentions of the proposer -when the proposal was submitted and regardless that those costs were actually incurred. XIV. Insurance and Bonding Requirements Insurance: The successful contractor will be required to purchase, within fifteen days of award, and maintain, during the term of the contract, insurance as described in Attachment 1. Bonding: Awarded agency will be required to secure payment bonds in the form required by the City and maintain them for the term of the contract. The performance and payment bonds will be 25 % of the annual amount of the contract. Bonding requirements are the responsibility of the prime contractor. It is the prime contractor's responsibility to obtain and maintain the required bonding throughout the term of the contract. XV. Discussion with Reasonably Qualified Proposals 1. The City reserves the right to engage in discussions or conduct interviews, either oral or written, with the proposers determined by the evaluation criteria to be reasonably viable to being selected for award. If discussions or interviews are held, the buyer may request best and final offers. The request for best and final offers may include: • Notice that this is the opportunity to submit written best and final offers • Notice of the date and time for submission of the best and final offer • Notice that if any modification is submitted, it shall be received by the date and time specified or it will not be considered • Notice of any changes in the Proposal requirements 2. Following evaluation of the best and final offers, purchasing may select for negotiations the offer that is most advantageous to the City, considering price or cost and the evaluation factors in the RFCSP. 3. After the most advantageous proposer(s) has been identified, Contract negotiations may commence. If at any time Contract negotiation activities are judged to be ineffective, Office of Procurement Services will cease all activities with the proposer and begin Contract negotiations with the next highest ranked proposer. This process may continue until either both the proposer and Office of Procurement Services executes a completed Contract or Office of Procurement Services determines that no acceptable alternative proposal exists. 4. The City reserves the right to reject any or all proposals received or to award, without discussions or clarifications, a Contract based on initial proposals received. Therefore, each proposal should contain the Proposer's best terms from a price and technical standpoint. Page 22 279 31V 0q Also, only proposers submitting a proposal will be notified of any communications after the RFCSP closing. XVI. Rejection or Acceptance of Proposals 1. This RFCSP does not commit the City to award any Contract. The City reserves the right to reject any or all proposals, to waive technicalities or irregularities, and to accept any proposal it deems to be in the best interest of the City. The City shall not be liable for any costs incurred by any company responding to this RFCSP. 2. The City will require the recommended proposer to sign the necessary Contract documents prepared by the City Attorney's Office. A sample Contract is included as an attachment. Proposer must take exception to any term of the Contract to which it will not agree in its proposal. XVII. Late and Withdrawn Proposals Proposals are required to be submitted electronically at using the City procurement website https://dallasciUhall.bonfirehub.com/low The system will not accept submittals after the due date and time and hard copy submittals are not permissible. XVIIL Confidentiality Any information deemed confidential, shall be clearly noted as such on each page of thesolicitation response. City cannot guarantee it will not be compelled to disclose all or part of any public record under the Texas Open Record Act. Proposals will be opened by the City to avoid disclosure of contents to competing Respondents and kept secret and confidential during the solicitation process and prior to award. Respondents who include information in a proposal that illegally protected as trade secret or confidential shall clearly indicate the information which constitutes a trade secret or confidential information by marking that part of the proposal "trade secret" or "confidential" at the appropriate place. If a request is made under the Texas Open Records Act to inspect information designated as trade secret or confidential in a proposal, the Proposer shall, upon request, immediately furnish sufficient written reasons and information as towhy the information designated as a trade secret or confidential should be protected fromdisclosure, for the City Attorney to present the matter to the Attorney General of Texas for final determination. XIX. Disqualification of Proposers Proposers may be disqualified for, but not limited to, the following reasons: • Reason to believe collusion exists among the proposers • The proposer is involved in any litigation against the City of Dallas • The proposer is in arrears on an existing contract or has failed to perform on a previous contract with the City of Dallas XX. Permits Required by Law Contractor shall comply with all requirements of federal, state, and local statutory requirements and regulations pertinent to or affecting any phase of this contract. XXL Records and Audit Page 23 280 .■ U The Contractor shall keep accurate records of all components of invoices to the City, including but not limited to times and payroll receipts for hourly personnel utilized by this Contract. These records shall be retained for a minimum of two years after the conclusion of the Contract. The City reserves the right to audit any records it deems necessary for the execution of this Contract. XXII. Assignment of Contract The Contractor shall not assign, transfer, sublet, convey or otherwise dispose of the Contract of any part therein or its right, title or interest therein or its power to execute the same to any other persons, firm, partnership, company or corporation without the prior written consent of the City. Should the Contractor assign, transfer, sublet, convey or otherwise dispose of its right, title or interest or any part thereof in violation of this section, the City may, at its discretion, cancel the Contract and all rights, title and interest of the Contractor shall therein cease and terminate, and the Contractor shall be declared in default. XXIII. Default by Contractor The following events shall be deemed to be events of default by Contractor under the Contract: • Contractor shall become insolvent, or shall make a transfer in fraud of creditors, or shall make an assignment for the benefit of creditors; • Contractor attempts to assign the Contract without the prior written consent of the City; • Contractor shall fail to perform, keep or observe any term, provision or covenant of the Contract; or • Contractor fails to properly and timely pay Contractor personnel, suppliers or other contractors and the failure impacts the City or its Facility in any manner. In the event a default occurs, the Director shall give the Contractor written notice of the default. If the default is not corrected to the satisfaction and approval of the Director within the time specified in such notice, the City may immediately cancel the Contract. At the direction of the Director, the Contractor shall vacate the facility, if applicable, and shall have no right to further operate under the Contract. The Contractor, in accepting the Contract, agrees that the City shall not be liable to prosecution for damages or lost anticipated profits if the City cancels or terminates the Contract. No Waiver: No waiver by the City of any default or breach of any covenant, condition, or stipulation shall be treated as a waiver of any subsequent default or breach of the same or any other covenant, condition, or stipulation. XXIV. Termination The City may terminate this agreement in whole or in part by giving thirty days written notice thereof to Contractor. The City will compensate Contractor in accordance with the terms of the agreement for all goods and services delivered and accepted prior to the effective date of such termination notice. XXV. Miscellaneous 1. After executing the Contract, no consideration will be given to any claim of misunderstanding. Page 24 281 31V 0q 2. Proposers shall submit with the Proposal, the required Contractor's qualification statement with supporting information as stated herein along with all other supporting documentation requested. 3. Proposers shall thoroughly familiarize themselves with the provisions of these Specifications and the Facilities. 4. The City reserves the right to reject all Proposals and to waive any minor irregularities. 5. A Proposal may be disqualified if the corporation or individual Proposer is in arrears or in default to the City for delinquent taxes or assessments or on any debt or Contract, whether as defaulter or bondsman; or who has defaulted upon any obligation to the City by failing to perform satisfactorily any previous agreement or Contract within the past seven years. Also, Proposers may be disqualified for poor prior performance on similar Contracts with other entities. 6. The Contract with the Contractor will be drawn by the City and may contain such other provisions as are deemed necessary to protect the interests of the City. 7. The Contractor agrees to abide by the rules and regulations as prescribed herein. The Contractor will, in all solicitations or advertisements for personnel to perform services under the Contract, state that all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, or national origin. 8. If either party hereto is prevented from completing its obligations under the Contract by act of God, strike, lockout, material or labor restrictions by any governmental authority, civil riot, flood, or any other cause beyond the control of the parties hereto, then such party shall be excused from such performance for such period of time as is reasonably necessary after such occurrence to remedy the effects thereof. 9. The section headings in these Specifications are for convenience in reference and are not intended to define or limit the scope of any of the conditions, terms or provisions of these specifications. 10. Should any question arise as to the proper interpretation of the terms and conditions of these specifications, the decision of the City Attorney or his authorized representative shall be final. XXVL Conflict of Interest CHARTER XXII Sec. 11 FINANCIAL INTEREST OF EMPLOYEE OR OFFICER PROHIBITED (a) No city official or employee shall have any financial interest, direct or indirect, in any contract with the city, or be financially interested, directly or indirectly, in the sale to the city of any land, materials, supplies or services, except on behalf of the city as a city official or employee. Any violation of this section shall constitute malfeasance in office, and any city official or employee guilty thereof shall thereby forfeit the city official's or employee's office or position with the city. Any violation of this section, with knowledge, express or implied, of the person or corporation contracting with the city shall render the contract involved voidable by the city manager or the city council. (b) The alleged violations of this section shall be matters to be determined either by the trial board in the case of employees who have the right to appeal to the trial board, and by the city council in the case of other employees. (c) The prohibitions of this section shall not apply to the participation by city employees in federally -funded housing programs, to the extent permitted by applicable federal or state law. Page 25 282 .■ U (d) This section does not apply to an ownership interest in a mutual or common investment fund that holds securities or other assets unless the person owns more than 10 percent of the value of the fund. (e) This section does not apply to non -negotiated, form contracts for general city services or benefits if the city services or benefits are made available to the city official or employee on the same terms that they are made available to the general public. (f) This section does not apply to a nominee or member of a city board or commission, including a city appointee to the Dallas Area Rapid Transit Board. A nominee or member of a city board or commission, including a city appointee to the Dallas Area Rapid Transit Board, must comply with any applicable conflict of interest or ethics provisions in the state law and the Dallas City Code. (Amend. of 8-12-89, Prop. No. 1; Amend. of 8-12-89, Prop. No. 15; Amend. of 11-4-14, Prop. Nos. 2 and 9) XXVII. Indemnity The selected Proposer agrees to defend, indemnify and hold the City, its officers, agents and employees, harmless against any and all claims, lawsuits, judgments, costs, and expenses for personal injury (including death), property damage or other harm for which recovery of damages is sought, suffered by any person or persons, that may arise out of or be occasioned by the selected Proposer's breach of any of the terms or provisions of the contract, or by any other negligent or strictly liable act or omission of the selected Proposer, its officers, agents, employees, or subcontractors, in the performance of the contract; except that the indemnity provided for in this paragraph shall not apply to any liability resulting from the sole negligence or fault of the City, its officers, agents, or employees and in the event of joint and concurrent negligence or fault of the selected Proposer and City, responsibility, and indemnity, if any, shall be apportioned comparatively in accordance with the laws of the State of Texas, without waiving any governmental immunity available to the City under Texas law and without waiving any defenses of the parties under Texas law. The provisions of this paragraph are solely for the benefit of the parties hereto and are not intended to create or grant any rights, contractual or otherwise, to any other person or entity. XXVIII. Wage Floor Rate Requirement 1. On November 10, 2015, the Dallas City Council passed Resolution 15-2141 which requires prime contractors, awarded general service contracts valued greater than $50,000, and first-tier subcontractors on the contract to pay their employees rendering services on the contract a wage floor of not less than $15.21 per hour. 2. Pursuant to Resolution 15-2141 the wage floor requirement for all general service contracts greater than $50,000 shall be effective immediately on all new contracts awarded after November 10, 2015. Contractors bidding/proposing on general service contracts shall take into consideration such wage floor requirements in their bid/proposal. The wage floor requirement for the City of Dallas' general service contracts shall be derived from the most current Massachusetts Institute of Technology Living Wage publication and shall remain fixed for the term of the respective contract. The City reserves the right to audit such contracts for compliance with the wage floor requirement as mandated by Resolution 15-2141. This requirement does not apply to construction contracts in which prevailing wage of employees is governed by the Davis -Bacon Act as defined in the Texas Local Government Code 2258, Page 26 283 .■ purchase of goods, procurements made with grant funds or procurements made through cooperative and/or inter -local agreements. 3. The purpose of this policy is to promote an acceptable wage floor for working families in the City of Dallas, increase the level of service delivered to the City through specific contracts and reduce turnover in such contracts thus maintaining a continuous and consistent level of service for vested parties. 4. The City Manager shall use the following definitions to administer the benefactors of the "wage floor" for purposes of the referenced resolution: • "City" means the City of Dallas, Texas. • "General Services Contract" means any agreement between the City and any other Person or business to provide general services through an awarded City contract valued greater than $50,000. A General Services Contract for purposes of the Resolution does not include (i) a contract between the City and another governmental entity or public utility, (ii) a contract subject to federal or state laws or regulations that would preclude the application of the application of the wage floor, (iii) or a contract with all services under the contract performed outside of the City of Dallas. • "Subcontractor" means any Person or business that has entered into its own contract with a prime contractor to perform services, in whole or in part, as a result of an awarded City general • "Employee" means any person who performs work on a full-time, part-time, temporary, or seasonal basis, including employees, temporary workers, contracted workers, contingent workers, and persons made available to work through services of a temporary services, staffing or employment agency or similar entity. XXIX. Wage Floor Reporting Requirements Contractors awarded City general services contracts as described in the wage floor rate requirement section of this specification shall be required to provide the buyer the residential zip code and respective number of employees directly impacted by the wage floor requirement ten days after Council approval and on January 1 st. but not later than January 31 st. for the term of the contract. The Contractor shall submit the report to the contract administrator during the established period. XXX. Wage Floor Compliance Requirements Contractors submitting a response to a solicitation for general services must comply with the wage floor requirement to be consider responsive. The City may request that Contractors, at any time during the pre- or post -award process, demonstrate compliance with the wage floor requirement. Contractors not compliant with the wage floor requirement will be deemed nonresponsive and will not be considered for award. Contractors awarded general service contracts must comply with the wage floor policy and reporting requirements for the term of the contract, failure to remain in compliance may result in breach of contract. XXXL Selection Process The internal team will evaluate all proposals received in response to this RFCSP. After reviewing the proposal submissions, consultants may be selected for in-person interviews/oral presentations. Page 27 284 .■ U From those presentations and possible interviews, the proposals will be re-evaluated, and final determination will be made. The City of Dallas will pursue negotiations with the top ranked respondent with the goal of entering into a contract. XXXII. Development Costs Neither City of Dallas nor its representatives shall be liable for any expenses incurred in connection with preparing a response to this RFCSP. Respondents are encouraged to prepare their proposals simply and economically, providing a straightforward and concise description of your firm's ability to meet the requirements of the RFCSP. XXXIII. Contract Award Upon selection of a successful Proposer, the City and the Proposer will negotiate a final contract, based on the terms outlined in this RFCSP. A sample agreement, with the general terins for the final contract, is attached as Sample Contract for Services. By submitting a proposal, the Proposer agrees to be bound by these terms and conditions unless otherwise noted in the Submittal. The final contract is subject to City Council approval. XXXIV. Certificate of Interested Parties (Form 1295) All vendors recommended by City staff for a contract pursuant to this RFCSP will be required to comply with Section 2252.908 of the Texas Government Code. Each vendor shall complete Form 1295 -Certificate of Interested Parties- for every contract for which they're recommended. Vendor will complete the form electronically at the Texas Ethics Commission website, https://www.ethics.state.tx.us/whatsnew/elf_info _forml295.htm , and submit a copy to the buyer before the contract information will be sent to the City Attorney's Office to draft the contract. Once the terms of the contract are fully negotiated; the recommended vendor has signed the contract indicating agreement with the terms of the contract; and the Form 1295 is on file at the Texas Ethics Commission website with a copy provided to the buyer; the staff recommendation will be placed on a City Council agenda to award the contract. Page 28 285 .■ I OFFICE OF PROCUREMENT SERVICES ADDENDUM City of Dallas ADDENDUM NO.2 RFCSP June 21, 2021 The intent of this document is to provide official responses, clarification, and/or notice of change to the referenced solicitation. PROPOSAL NO.: BDZ21-00015158 PROPOSAL TITLE: Temporary Industrial and Day Labor PROPOSAL DUE DATE AND TIME: December 10th, 2020 at 2:OOPM ACTIONS: 1. The pre -proposal attendance sheet and presentation are now available. 2. The Group 2B is now titled "Other Manual or Physical Temporary Day" for clarity in the file titled "BDZ21-00015158, Temporary Industrial and Day Labor - Addendum 1" and the perspective BidTable have been revised. 3. The file titled "Bonding Requirements (OPS -05) - Addendum 2" has been updated to include the bond percentage, bond requirements have not changed. If there are any questions pertaining to this addendum, please login to the Solicitation Portal: www.dallascitvhall.bonfirehub.com Enter your questions under the Messages Tab. OPS -16 6/21/2021 Rev. 0 03/05/2020 Page 1 286 .■ I DH,3 OFFICE OF PROCUREMENT SERVICES BONDING REQUIREMENTS City of Dallas PERFORMANCE AND PAYMENT BONDS Within 15 days of the award of this bid, the successful bidder will be required to post a Performance & Payment Bond in the aggregate amount of 25 % of the annual value of the contract, and the cost of such bond must be absorbed by the bidder. Bonding must be made by a bonding company authorized to do business in the State of Texas, on the Treasury Department's list of approved sureties, and having a designated Resident Agent residing in Dallas County, Texas. SURETY COMPANY INFORMATION (Company providing Performance and Payment bonds forbidder) Legal Name: Address: State of Incorporation: Name of Attorney -in -Fact: Name: Address: Email Address: OPS -05 Rev. 0 — 01/13/2020 RESIDENT AGENT INFORMATION (Must be a name of a natural person residing in Dallas County, Texas) be a street address and not a Post Office box Phone Number: 1/14/2020 Page 1 of' 287 .■ I OFFICE OF PROCUREMENT SERVICES ADDENDUM City of Dallas ADDENDUM NO. 3 RFCSP June 21, 2021 The intent of this document is to provide official responses, clarification, and/or notice of change to the referenced solicitation. PROPOSAL NO.: BDZ21-00015158 PROPOSAL TITLE: Temporary Industrial and Day Labor PROPOSAL DUE DATE AND TIME: December 17th, 2020 at 2:OOPM ACTIONS: 1. The project due date has been extended one (1) week to December 17th, 2020. If there are any questions pertaining to this addendum, please login to the Solicitation Portal: www.dallascitvhall.bonfirehub.com Enter your questions under the Messages Tab. OPS -16 6/21/2021 Rev. 0 03/05/2020 Page 1 288 31V■0q WIT OFFICE OF PROCUREMENT SERVICES ADDENDUM City of Dallas ADDENDUM NO. 4 RFCSP June 21, 2021 The intent of this document is to provide official responses, clarification, and/or notice of change to the referenced solicitation. PROPOSAL NO.: BDZ21-00015158 PROPOSAL TITLE: Temporary Industrial and Day Labor PROPOSAL DUE DATE AND TIME: December 17th, 2020 at 2:OOPM ACTIONS: I. Annual billable hours for each category at the time of award? Refer to the quantity estimates on the perspective Bid Tables. The quantities provided are estimated based on the full term of the agreement and the anticipated need for the 5 -year term, 2. Award date(s)? For tentative award dates pertaining to the new agreement, see the file titled "Pre- Proposal Meeting Presentation". 3. Bid tabulation from current award? See the perspective Bid Tables for BEZ1605 (Groups IA. and 1B.) and POM -2020-00012788 (Groups 2A. and Groups 2B) in the file titled "Bid Tables for Existing Agreements". 4. Current annual billable hours? The quantities provided are estimated based on the full term of the agreement and the anticipated need for the 5 -year term. 5. Current billing rates? See the perspective Bid Tables for BEZ1605 (Groups IA. and 1B.) and POM- 2020- 00012788 (Groups 2A. and Groups 2B) in the file titled "Bid Tables for Existing Agreements". 6. During the evaluation process, are additional points awarded to firms who are or have Minority Business Enterprise (MBE) partners? No points will be awarded for MWBE participation on RFCSPs as of October lst, 2020, see the file titled "Exhibit A - Business Inclusion Policy 2020". 7. Hourly billing rates for each category at the time of award? See the perspective Bid Tables for BEZ1605 (Groups IA. and IB.) and POM -2020-00012788 (Groups 2A. and Groups 2B) in the file titled "Bid Tables for Existing Agreements". 8. How many employees currently work under this contract? IA. Collections — 200 IB, Disposal - 35 2A, Fleet Parts Specialist — 3 employees Trades Helper — 2 employees Mechanic — 2 employees Mechanic 11 — 3 employees The number of employees per position listed above may fluctuate based on need, 2B. Other Manual or Physical Temporary Day Labor positions described in each group are based upon the City's best estimate of anticipated needs. The number of positions actually requested may be more or less than estimated, 9. How many vendors will be awarded as a result of this solicitation? A minimum of 2 contractors will be awarded, see section V. Award Method for more information. 10. How much is intended to be spent once the contract is awarded? The budgeted spend for temporary OPS -16 6/21/2021 Rev. 0 03/05/2020 Page 1 289 N 0q WIT labor positions is subject to annual appropriations and will depend on pricing provided. The City's requirements for temporary labor are to be provided on an as needed basis. 11. How much was spent (dollar value) on this service last year? The spend respective to Groups IA. and Groups 113, was $7,070,616.65 and the spend respective to Groups 2A. and Groups 213. was $3,378,40736, 12. Present vendor(s)? Respective to Groups IA. and Groups IB: Results Staffing, Inc. from 7/01/2016-2/15/2021 Respective to Groups 2A. and Groups 213: Lane Staffing, Inc. from 11/06/2016-2/26/2020 All Temps I Personnel from 2/26/2020-2/25/2021 13. Prevailing/Living wage requirements at time of award? For the current living wage rate see the Living Wage Affidavit (OPS -03) in the file titled "02 - Standard Fonus with Insurance and Bonding". 14. Will the selected vendor be required to provide staffing for all positions or can they choose the positions they are most suited to provide staffing for? The awarded contractors will be responsible for all positions required by the perspective Groups. 15. Can you provide a list of the unspecified positions? There is no list of positions for 2B. Other Manual or Physical Temporary Day Labor). Section B. Requirements Specific to Temporary Day Labor (213. Other Manual or Physical Temporary Day Labor) has been updated with the following description- "Employees must be able to: bend, stoop, stand for extended periods of time, walk for extended periods and distances, lift and carry up to (50) pounds, push and or pull up to (90) pounds, work outdoors continuously under all weather conditions and be able to tolerate foul odors," 16. Can the City provide Job Descriptions for the following? 2A. Title Specific Positions for - Trades Helper • Mechanic • Mechanic 11 • Sr. Mechanic • Welder • Sr. Welder • Certified Tech • Fleet Parts Specialist • Sr. Fleet Parts Specialist See the attached.job descriptions under Files for Title Specification positions. 17. What specifically is being requested as "Documentation to support the Financial Consideration as detailed in the scope" The Proposal Submittal Requirement "Documentation to support the Financial Consideration as detailed in the scope" has been updated to "Docurnentation to support the Preferred Qualifications as detailed in the scope.". IS. Are we required to complete the "Pre -Bid — Pre -Proposal Form" if we are not considered a qualified Minority and Women -Owned Business Enterprise? If we are still required to complete, can you please provide specifics on what you are requesting since we do not qualify? All proposers are required to complete the forms, if a proposer is unable to provide the information required on the form respond with "N/A". 19. Is it possible to bid on one labor group only as opposed to submitting a proposal for both? Yes, contractors are allowed to propose at the Group level, however contractors are required to propose on every line within the perspective Group. 20. If a temporary employee is let go in the middle of the shift is a replacement expected within 2 hours that day? OPS -16 6/21/2021 Rev. 0 03/05/2020 Page 2 290 N 0q WIT Yes, see the Temporary Employee Assignments section in Requirements Common to Industrial and Temporary Day Labor (IA. Sanitation Collections Positions, 113, Sanitation Disposal Positions, 2A. Title Specific Positions, and 2B. Other Manual or Physical Labor Positions) in IV. Specifications or Scope of Work of the specifications for details, 21. Can you please explain the right to terminate the contract for the convenience of the City. Under what circumstances would the city exercise this right and has it ever done so in the past. Termination for convenience clauses provide the City with the option to terminate for or in addition to a reason other than the contractor's default. 22. If an temporary employee has a badge but shows up to work without it, does this count as an occurrence if it is not replaced in 2 hours? Yes, see the Photo IDs section in Requirements Common to Industrial and Temporary Day Labor (IA. Sanitation Collections Positions, 113, Sanitation Disposal Positions, 2A. Title Specific Positions, and 2B. Other Manual or Physical Labor Positions) in IV. Specifications or Scope of Work of the specifications for details, 23. Will there be space at each work location for the onsite coordinators to work? k; Yes, for IA. Sanitation Collections Positions and 113. Sanitation Disposal Positions there is common workspace available at each location for onsite coordinators to work, but no dedicated desk or office space. On-site coordinators are only requested for Groups IA and 113, If there are any questions pertaining to this addendum, please login to the Solicitation Portal: www.dallascitvhall.bonfirehub.com Enter your questions under the Messages Tab. OPS -16 6/21/2021 Rev. 0 03/05/2020 Page 3 291 .■ I 292 Est. Annual Unit Price Line Description Qty (Hours) Extended Price 1 Regular hourly Rate 418,253 $ 14.52 $ 6,073,033.56 Year 1 2 Overtime hourly Rate 31,022 $ 21.78 $ 675,659.16 Year 1 Regular hourly Rate 418,253 $ 14.52 $ 6,073,033.56 3 Year 2 Overtime hourly Rate 31,022 $ 21.78 $ 675,659.16 4 Year 2 Regular hourly Rate 418,253 $ 14.52 $ 6,073,033.56 5 Year 3 Overtime hourly Rate 31,022 $ 21.78 $ 675,659.16 6 Year 3 Regular hourly Rate 418,253 $ 14.52 $ 6,073,033.56 7 Year 4 Overtime hourly Rate 31,022 $ 21.78 $ 675,659.16 8 Year 4 Regular hourly Rate 418,253 $ 14.52 $ 6,073,033.56 9 Year 5 Overtime hourly Rate 31,022 $ 21.78 $ 675,659.16 10 Year 5 Grand Total 1 $ 33,743,463.60 292 .■ I 293 Est. Annual Unit Price Line Description Extended Price Qty (Hours) 1 Regular hourly Rate 336,916 $ 15.22 $ 5,127,861.52 Year 1 2 Overtime hourly Rate 20,001 $ 22.83 $ 456,622.83 Year 1 Grand Total $ 5,584,484.35 Line Position Bill Rate Interns/Apprenticeship 15.22 5 (Trades Helper) Trades Helper 18.20 6 Mechanic 23.40 7 Service Advisor 26.00 8 Mechanic II 26.00 9 Sernior Mechanic 29.90 10 Certified Technician 33.80 293 31V 0q 77�0) City of Dallas Exhibit A Business Inclusion and Development Policy Business Inclusion and Development (BID) Policy Statement It is the policy of the City of Dallas to involve certified Minority and Women -Owned Business Enterprises (M/WBEs) to the greatest extent feasible on the City's construction, general services, and professional services contracts. It is the policy of the City of Dallas to encourage the growth and development of M/WBEs that can successfully compete for contracting opportunities. The City and its contractors shall not discriminate on the basis of race, age, color, ancestry, national origin, place of birth, religion, sex, sexual orientation, gender identity and expression, military or veteran status, genetic characteristics, or disability unrelated to job performance in the award and performance of contracts. In consideration of this policy, the City of Dallas has adopted the Business Inclusion and Development (BID) Policy for all City of Dallas contracts. Scope of BID Policy The BID Policy shall apply to all contracts for the purchase of goods or services over $50,000 with special emphasis on those contracts with first tier subcontracting opportunities. The provision of the BID Policy takes precedence over any departmental plans or procedures in conflict herewith, except for specific requirements mandated by the terms or conditions of agreements in force between the City and the Federal Government or the State of Texas that require different procedures than those described in the BID Policy. BID Policy Objectives The objectives of the BID Policy are to: • promote inclusion of M/WBEs by providing equal opportunity for participating in City construction, general services and professional services contracts • provide procedures for monitoring, enforcement, and compliance with M/WBE requirements • provide conditions for growth and development of M/WBEs by providing training and access to business resources and opportunities • promote diverse competition through marketing initiatives on all City contracts for the purchase of goods or services over $50,000 Administration of the BID Policy The City Manager will take all usual and legal administrative actions necessary to implement the BID Policy and is ultimately responsible for the administration of the BID Policy. 294 31V 0q The City Manager is designated to serve as the City's M/WBE Liaison Officer for the BID Policy. The Liaison Officer is responsible for implementing, coordinating, and managing the BID Policy. The M/WBE Liaison Officer has designated the Business and Workforce Inclusion (BWI) division of the Office of Economic Development to be responsible for the following: • Developing, managing, implementing, and evaluating the BID Policy • Disseminating information related to business opportunities • Maintaining and providing a directory of certified* M/WBE vendors • Maintaining and providing a directory of registered City of Dallas vendors • Tracking and monitoring M/WBE participation including subcontractor utilization with emphasis on subcontractor utilization post council award • Tracking and monitoring payments to prime contractors from the City and payments from prime contractors to subcontractors with emphasis on prompt payment as outlined in Government Code Section 2251.022 • Granting evaluation points to encourage a meaningful inclusion of M/WBE participation in response to proposals estimated to be more than $250,000. • Advising prospective contractors/proposers on Business Inclusion and Development compliance requirements • Communicating M/WBE goals and BID compliance requirements • Maintaining and submitting accurate and current reports on M/WBE performance • Providing opportunities for networking among contractors and firms • Creating programs that build the capacity of M/WBEs • Creating programs that result in diverse competition on City contracts * The City of Dallas is a member of the North Central Texas Regional Certification Agency (NCTRCA), Dallas Fort Worth Minority Supplier Diversity Council (DFWMSDC), and Women Business Council -Southwest (WBC). BID Policy Procedures to Ensure Equal Opportunity BWI will facilitate participation of M/WBEs in construction, general services and professional services contracts. To ensure compliance with the BID Policy, at a minimum, BWI will: • Conduct outreach functions to communicate contracting and procurement opportunities and procedures • Provide education and assistance services related to starting, maintaining, and growing a business through the Broadening Urban Investment to Leverage Dallas (B.U.I.L.D.) ecosystem 295 31V 0q • Explain Business Inclusion and Development compliance procedures • Encourage prime and subcontracting relationships • Encourage joint ventures and teaming agreements • Communicate the City's M/WBE goals and Business Inclusion and Development requirements • Maintain and distribute a directory of certified and registered M/WBEs • Review Business Inclusion and Development documentation to ensure compliance with the BID Policy • Review specifications for large contracts prior to the issuance of a request for proposal or request for a bid to determine and/or identify unbundling opportunities to increase M/WBE participation • Review project specifications for opportunities to remove barriers and restrictive language • Perform regular site visits based on project type, award amount or stakeholder concerns to ensure compliance with BID Policy • Monitor compliance of prime contractors and subcontractors and recommend measures to deal with prime and sub -contractors deemed to be non-compliant with BID Policy criteria • Develop an owner -controlled insurance policy owned by the City of Dallas • Maintain a public sector group to provide recommendations on industry best practicesfocusing on new programs, small business resources, and contracting opportunities that have historically been overlooked BID Policy Certification of M/WBEs The City of Dallas is a member of the North Central Texas Regional Certification Agency (NCTRCA), Dallas Fort Worth Minority Supplier Diversity Council (DFWMSDC), and Women Business Council -Southwest (WBC). These agencies certify M/WBE ownership and control and provide M/WBE certification services for the City of Dallas. The City reserves the right to accept M/WBE certifications issued by other certifying organizations or agencies that use the same or similar certification criteria as the certification agencies listed above. Self -certification does not meet the City's M/WBE certification requirements. Dallas also recognizes Native American -owned businesses with tribal cards associated with that business as M/WBE. BID Policy Other Provisions In addition to this goal -based policy, it is the preference of the City of Dallas for the workforce of its contractors to be reflective of the diversity of the residents of the City of Dallas. In accordance with Chapter 15B of the Dallas City Code, awardees of construction contracts involving the expenditure of more than $10,000 and awardees for the procurement of goods and services involving an expenditure of more than $50,000 are required to incorporate an equal employment opportunity clause which provides that the contractor shall not discriminate against any employer or applicant for employees because of race, age, color, ancestry, national origin, place of birth, religion, sex, sexual orientation, gender identity and expression, military or veteran status, genetic characteristics, or disability unrelated to job performance. The City reserves the right to request 296 31V 0q a contractor's affirmative action plan or equal opportunity plan. In addition, if the contractor plans to hire additional staff to complete the contract, the City reserves the right to request a local hiring plan. The BID Policy or the diverse workforce preference is not to be construed to require the City of Dallas to award a contract to anyone other than the lowest responsible bidder or most advantageous proposer. The BID Policy is also not to be construed to require contractors/proposers to award subcontracts/sub-proposals to or make significant material purchases from M/WBEs who do not submit the lowest responsible sub -bid. Before award of a contract, the City of Dallas will require bidders/proposers to document good faith efforts to meet established goals. Failure to adequately document a good faith effort to obtain M/WBE participation may result in award to the next -lowest bidder or advantageous proposer. Failure to utilize M/WBEs listed in Business Inclusion and Development forms without properly documenting and explaining the change will be deemed as non-compliant and will result in non- compliance actions and will be considered in future awards. Upon receipt of each payment from the City of Dallas, the awarded vendor is required to report payment data in the City's contract compliance system. Sub -contractors will be prompted to confirm payment data as reported by the prime in the City's contract compliance system. The City of Dallas maintains the option to waive BID Policy criteria where there is no opportunity or availability for M/WBE inclusion. The City Manager's Office is responsible for procedures and processes related to the administration of this Policy. BID Policy Goals Construction 32.00% Architectural & Engineering 34.00% Professional Services 38.00% Other Services N/A Goods 32.00% 297 .■ I DH,3 OFFICE OF PROCUREMENT SERVICES LIVING WAGE AFFIDAVIT City of Dallas VENDOR INFORMATION Business Name: LIVING WAGE REQUIREMENTS Dallas City Council Resolution 15-2141 requires suppliers awarded general service contracts valued greater than $50,000 to pay their employees rendering services on the contract not less than the wage floor (the term employee includes all those performing services on this contract. The relationship of employment is determined by the vendor), no less than the "living wage" rate, as set by the Massachusetts Institute of Technology Living Wage Calculator, or its successor, for Dallas County, Texas. This requirement does not apply to a contract for goods only, professional services, or construction contracts. By signing this affidavit, the contractor agrees to the following: ❑ Pay employees not less than Living Wage rate for the duration of time committed in executing specified services on the contract (current Living Wage rate is $15.21). ❑Provide communication, in writing, to all persons involved in a City of Dallas general service contract, communicated in a similar manner as the attached sample announcement. Any employee under this contract and not receiving a wage floor as specified in the Living Wage policy, shall contact the City of Dallas' Office of Procurement Services office (214-670-3326). ❑To keep records of all employees, and their hourly rates, and will provide this information when requested, as well as allow the City to audit payroll registers, and all other information the City deems necessary to determine compliance of the Living Wage policy. ❑If contract is renegotiated or renewed it is agreed that the Living Wage rate at the time of the renewal will prevail (updated Living Wage rate, if applicable) ❑ Records shall be kept in the following format: No. of Employees on COD Contract I Employee Name I Employee Zip Code I Wage Rate Paid to Employee The signer must be a company officer and authorized to legally bind the business entity referenced herein. Authorized Signature Date Printed Name Title OPS -03 2/4/21 Rev. 2 — 2/4/2021 Page 1 of 1 298 Title: Application: Supplemental/Code: FLSA Status: Position Purpose EXHIBIT City of Dallas Classification Specification Trades Helper Class Code: Career Series Service Maintenance/8 Non Exempt 50007 Pay Grade: B Established: 10/01/94 Revised: 01/01/09 Assists with all routine, standardized trade operations such as plumbing, carpentry, electrical, painting, welding, roofing, building equipment operation, or automotive maintenance and repair to ensure optimum operation and maintenance of city facilities. Essential Functions 1. Assists carpenter with pouring concrete, laying bricks, and building wooden structures to meet the needs of city facilities. 2. Assists painters in preparing and applying protective and decorative coats of paint and related material to interior and exterior of building and structures. 3. Assists plumber in installation and repair of plumbing and fixtures to provide necessary maintenance to city facilities. 4. Assists welder in the repair and maintenance of various metal equipment and strictures to provide necessary maintenance to city facilities. 5. Assists building equipment operator in the operation, maintenance, and repair of air conditioning and heating equipment to ensure optimum operation. 6. Assists electrician in the repair and installation of electrical facilities and equipment to provide necessary service to city facilities. 7. Assists automotive equipment mechanic in disassembling, cleaning, repairing, adjusting various valves to ensure optimum operation of equipment. 8. Assists roofers in tearing out existing systems and installing new systems. 9. Regular, reliable and punctual attendance is an essential function of the job. .■ Class Code: 50007 Knowledge, Skills, and Abilities Required to Perform Work General mechanical knowledge and aptitude necessary to perform a variety of routine trades -related duties. Ability to learn to use hand/power tools and other equipment specific to various trades. Ability to perform manual labor. Ability to understand and follow written and oral instructions. Ability to establish and maintain an effective working relationship with all levels of management, city officials, vendors, other government agencies, other employees and the general public. Working Conditions and Hazards Subject to various working conditions associated with specific trade. Requires standing, walking, bending, climbing, lifting, dragging, and pushing. Subject to minor injury to eyes, feet, hands, and fingers and possible serious injury from falls and power -driven tools and equipment. Subject to electrical shock and related injuries when performing electrical work and plumbing installations. May require working weekends and/or evenings. May be on call 24 hours a day. The above statements are intended to describe the general nature and level of work performed by personnel assigned to this classification and is not necessarily an exhaustive list of all responsibilities, duties and skills required. Title: Mechanic Application: Career Series Supplemental/Code: Skilled Craft/5 FLSA Status: Non -Exempt City of Dallas Classification Specification Class Code: 56001 Pay Grade: C Established: 10/01/94 Revised: 01/01/09 Position Purpose: Assists journey level automotive mechanics, body repairers or plant mechanics in performing preventive maintenance and repair of motorized equipment, vehicles powered by gasoline and diesel engines or maintenance on a variety of equipment at water treatment plants and pumping stations to ensure full operating capacity during routine and emergency conditions. Essential Functions Depending On Assignment: Pulls, labels, cleans, and places into inventory parts from damaged vehicles to be used in repairing other damaged vehicles. 2. Performs preventive/periodic maintenance, inspections and/or repairs to the fuel, ignition, electrical, braking, and other systems in automotive equipment (including tractors and golf electric carts) and power tools to ensure safe and operational equipment. 3. Repairs and maintains hydraulic equipment using hand and special tools or certifiable welds to provide functional equipment at all times. 4. Drives a wrecker to work sites or field locations to repair or retrieve city vehicles or equipment. 5. Inventories, checks out, checks in, and orders parts and routine items for equipment and tools. 6. Sharpens lawn mowing implements and blades and performs minor maintenance to maintain the working condition of mowing equipment. 7. Ass ists in the inspection, dismantling, repair, adjustment, and installation of equipment such as large water pumps, electric motors, and valves under the supervision of a journey -level plant mechanic to ensure water pumping stations and treatment plants are maintained at full operating capacity. 8. Performs scheduled preventive maintenance and inspection of equipment such as routinely checking operating conditions, oil and grease levels, and adjustments to prevent premature breakdown of equipment. 9. Communicates with a variety of employees, divisions, other city departments, and parts vendors to coordinate the repair of equipment and obtain materials. 10. Completes job tickets, work orders and keeps records such as work performed, amount of time required, repairs, parts, and preventive maintenance completed and other paperwork to document work and conditions of equipment. 11. Maintains tools and equipment on assigned vehicle and gathers tools and parts needed for repairs, modifications, and installations. 12. Regular, reliable and punctual attendance is an essential function of the job. 4\ l .■ Class Code: 56001 Knowledge, Skills, and Abilities Required to Perform Work: Knowledge of basic mechanical principles and tool use. Knowledge of pump overhaul requirements per U.S. Army Corps of Engineers operations manual. Automotive employees need basic knowledge of hand, pneumatic, and electric tools used in automotive repair. Ability to diagnose and plan the repair of a wide variety of automotive and diesel mechanical problems. Ability to read and understand automotive and mechanical repair manuals used in the repair of automotive machinery. Ability to communicate both orally and in writing. Ability to establish and maintain an effective working relationship with all levels of management, city officials, vendors, other government agencies, other employees and the general public. Ability to complete apprenticeship training for the maintenance and repair of equipment. Texas "CDL Class A" Driver's License Working Conditions and Hazards: Automotive employees subject to kneeling, stooping, crawling, extended standing, and other strains on the body. Often works in a non -climate controlled environment exposed to noise, petroleum distillates, dust, and dirt. May be exposed to electrical shock hazards and toxic chemicals as well as physical danger associated with automotive repair. May be exposed to dangers from heavy equipment and falls from elevated areas. Plant maintenance employees work both indoors and outdoors and are exposed to inclement weather. May occasionally be exposed to hazardous chemicals such as chlorine and ammonia. Requires climbing stairs and ladders, working in meter vaults, lifting, bending, stooping, squatting, and pulling. The above statements are intended to describe the general nature and level of work performed by personnel assigned to this classification and is not necessarily an exhaustive list of all responsibilities, duties and skills required. 4\ l EXHIBIT City of Dallas Classification Specification Title: Certified Technician Class Code: 52015 Application: Career Series Pay Grade: G Supplemental/Code: Skilled Craft Workers/5 Established: 10/01/94 FLSA Status: Non -Exempt Revised: 01/01/09 Position Purpose: Applies expertise to diagnose automotive equipment problems, coordinates and inspects repair work, and provides training to lower -level mechanics to ensure that automotive repair work is performed properly. Essential Functions: 1. Diagnoses complicated vehicle repair problems using diagnostic equipment and visual inspection. 2. Performs vehicle repair tasks requiring advanced mechanical knowledge and skills. 3. Diagnoses electronic engine control systems and interprets serial data. 4. Performs State safety and emissions testing. 5. Prepares and submits itemized work orders to supervisor based on diagnosis of vehicle problem. 6. Inspects completed repairs of vehicles to ensure that work was performed according to the work order and that the vehicle is running properly. 7. Acts as shift supervisor as required. 8. Regular, reliable and punctual attendance is an essential function of the job. 4\ l .■ Class Code: 52015 Knowledge, Skills, and Abilities Required to Perform Work: Expert knowledge of automotive vehicle and equipment maintenance and repair. Thorough knowledge of advanced diagnostic techniques. Ability to perform complicated automotive repairs. Ability to diagnose electronic engine control systems Ability to interpret serial data. Ability to use electronic scanners. Ability to establish and maintain an effective working relationship with all levels of management, city officials, vendors, other government agencies, other employees and the general public. Ability to communicate effectively both orally and in writing with a wide variety of people. Must have complete set of automotive hand tools. Must possess three Automotive Service Excellence (ASE) certifications and must obtain a total of five ASE certifications within one year of appointment. Must be certified to perform State Safety and Emission testing within six months of appointment. Must have a Texas Commercial Driver's License Class A (or acquire one within six months of appointment). Working Conditions and Hazards: Work is performed in a repair shop. Exposure to drafts, noise, fumes, dirt and grease. Requires standing, stooping and lying on hard surfaces is required to perform work. Lifts objects weighing up to 50 pounds. The above statements are intended to describe the general nature and level of work performed by personnel assigned to this classification and is not necessarily an exhaustive list of all responsibilities, duties and skills required. 4\ l Class Code: 38000 City of Dallas Classification Specification Title: Fleet Part Specialist Class Code: 38000 Application: Career Series Pay Grade: C Supplemental/ Code: Service Maintenance/8 FLSA Status: Non -Exempt Safety Sensitive: LA Established: 10/1/2015 No Revised: Position Purpose Orders, receives, stock storage, and insurance a variety of automotive and diesel related parts, supplies, materials, equipment, and merchandise to ensure effective operation and maintenance of storeroom and warehouse and/or yard. Essential Functions 1. Receives materials and supplies ordered through various sources (e.g., purchasing, outside vendors, other yards) for day-to-day operation and maintenance of an automotive/fleet supply/store room, warehouse or storage yard. 2. Provide support to mechanics involved in automotive repair by storing, shipping, receiving, marking, and pulling automotive parts from the warehouse supplies. 3. Delivers and picks up supplies and materials from various locations to expedite the procurement and disbursement of essential items. 4. Pulls orders, issues materials, and supplies to ensure mechanics are provided with the necessary supplies needed to complete specific jobs. 5. Operates various equipment (i.e., forklift, front-end loader, pallet jack, two wheel dolly, and truck electric jack) to move or transport supplies and materials to other yards, vendors, workstations, or supply rooms. 6. Stocks and stores supplies, materials and equipment in designated areas (bins, on floor, on shelves) for efficient retrieval. 7. Inventories and maintains materials and supplies using a computerized inventory tracking system to ensure proper stock levels and quantities are maintained. 8. Cleans automotive shop and performs general maintenance duties to ensure a clean and safe work area. 9. Pulls tire and wheel assemblies from storage warehouse for delivery to service center. 10. Pulls parts from stock, posts to repair orders, and delivers to mechanics repairing City vehicles. 11. Prepares parts for return to manufacturer (defects/warranty work), receives salvaged or repaired parts into stock, affixes identification labels to parts, performs physical inventory, and other shipping/receiving operations. 12. Delivers parts to other locations, ensures that transfers are documented and accounted for, and makes updates to computer inventory system to reflect the changes. 13. Files completed work orders from mechanics into a permanent file to document work completed and parts used/charged 14. Regular, reliable and punctual attendance is an essential function of the job. .■ Class Code: 38000 Knowledge, Skills and Abilities Required to Perform Work Knowledge of storekeeping/inventory systems, methods, and procedures or the use of computerized tracking system. Knowledge of supply room methods and practices. Ability to keep routine supply room records. Ability to do heavy lifting and carrying. Ability to read, write, and speak English; do simple math. Ability to understand and follow oral and written instructions. Ability to communicate with peers, vendors, and contractors. Ability to use technically oriented parts catalogs and reference manuals. Ability to establish and maintain an effective working relationship with all levels of management, city officials, vendors, other government agencies, other employees and the general public. May require knowledge of petty cash and purchasing policies and procedures. May require knowledge of petty cash and purchasing policies and procedures. Requires a valid State of Texas Class "C" driver's license. Working Conditions and Hazards Require standing, walking, carrying, pushing, lifting, and bending May handle numerous chemical agents in the custody of the department. Works in an automotive shop, warehouse, supply room, or office environment. May be subject to noise, heat, cold, fiimes, lifting and carrying of heavy auto parts. The above statements are intended to describe the general nature and level of work performed by personnel assigned to this classification and is not necessarily an exhaustive list of all responsibilities, duties and skills required. EXHIBIT Class Code: 38016 City of Dallas Classification Specification Title: Senior Fleet Parts Specialist Class Code: 38016 Application: Career Series Pay Grade: E Supplemental/ Code: Service Maintenance/8 FLSA Status: Non -Exempt Safety Sensitive: LA Established: 10/1/2015 CDL: No Revised: Position Purpose Leads and participates in the activities of workers engaged in ordering, issuing, receiving, storing, inventorying, issuing, and delivering automotive related materials (i.e., tools, equipment, parts, uniforms, etc., to ensure efficient and effective operation of an automotive/fleet storeroom, warehouse and/or yard. Essential Functions 1. Plans, schedules, and coordinates the activities of lower fleet part specialists and participates in ordering, receiving, shipping, unpacking, inspecting, storing, issuing and delivery of goods, supplies, equipment and materials used in an automotive storeroom, warehouse and/or yard in accordance with city and departmental guidelines. 2. Monitors and maintains adequate inventory, accurate records and reports for assigned location to ensure proper internal controls and accountability of materials. 3. Inventories and maintains material and supplies using a computerized inventory tracking system to ensure proper stock levels and quantities are maintained. 4. Processes requisitions and price agreement orders to maintain adequate levels of inventory for the efficient operation of a storeroom, warehouse and/or yard. 5. Reviews purchase orders, price agreements, direct pay and office services orders to ensure documents are correct and accurate. 6. Inspects operations and demonstrates proper accounting, receiving, storing, and issuing safety methods to lower level storekeepers according to departmental procedures. 7. Identifies and disposes of obsolete inventory according to municipal controls for disposal. 8. Resolves complaints related to materials and problems with departmental employees, customers and vendors in accordance with departmental guidelines. 9. Recommends changes in policies and procedures for storeroom and warehouse activities. 10. Regular, reliable and punctual attendance is an essential function of the job. n7 .PW .■ Class Code: 38016 Knowledge, Skills and Abilities Required to Perform Work Depending on Location Knowledge of principles of purchasing, quality controls, and quantity of materials needed in the inventory. Knowledge of inventory systems, methods and procedures and the use of computerized tracking system. Ability to perform as a lead worker to other employees and to coordinate activities of routine and complex storeroom duties. Ability to train, direct, and make work assignments. Ability to identify and resolve problems related to storekeeping activities. Ability to maintain accurate inventory and stock records. Ability to establish and maintain an effective working relationship with vendors, buyers, other city employees and the general public. Ability to create and use record keeping systems (e.g., alphabetical, numerical, chronological). Ability to assign, instruct and guide the work of subordinates. Ability to type, write, and understand and follow written and oral instructions. Ability to establish and maintain an effective working relationship with all levels of management, city officials, vendors, other government agencies, other employees and the general public. May require the ability to operate a forklift. Requires a valid State of Texas Class "C" driver's license. Working Conditions and Hazards May handle numerous chemical agents in the custody of the department. Works in property room, warehouse, supply room, or in an office environment. The above statements are intended to describe the general nature and level of work performed by personnel assigned to this classification and is not necessarily an exhaustive list of all responsibilities, duties and skills required .■ I OFFICE OF PROCUREMENT SERVICES ADDENDUM City of Dallas ADDENDUM NO.4 RFCSP June 21, 2021 The intent of this document is to provide official responses, clarification, and/or notice of change to the referenced solicitation. PROPOSAL NO.: BDZ21-00015158 PROPOSAL TITLE: Temporary Industrial and Day Labor PROPOSAL DUE DATE AND TIME: December 10th, 2020 at 2:OOPM ACTIONS: 1. Estimated quantities for the following Bid Tables have been updated: 1A. Sanitation Collections for Industrial Temporary Labor, 1 B. Sanitation Disposal for Industrial Temporary Labor, 2A. Title Specific Positions for Temporary Day Labor, and 2B. Unspecified Positions for Temporary Day Labor. 2. The MWBE list is now available. 3. The Award Method in the file titled "BDZ21-00015158, Temporary Industrial and Day Labor - Addendum I" has been revised. If there are any questions pertaining to this addendum, please login to the Solicitation Portal: www.dallascitvhall.bonfirehub.com Enter your questions under the Messages Tab. OPS -16 6/21/2021 Rev. 0 03/05/2020 Page 1 309 .■ I OFFICE OF PROCUREMENT SERVICES ADDENDUM City of Dallas ADDENDUM NO. 5 RFCSP June 21, 2021 The intent of this document is to provide official responses, clarification, and/or notice of change to the referenced solicitation. PROPOSAL NO.: BDZ21-00015158 PROPOSAL TITLE: Temporary Industrial and Day Labor PROPOSAL DUE DATE AND TIME: December 24th, 2020 at 2:OOPM ACTIONS: 1. The due date has been extended by one week, the project is closing on 12/24/2020. If there are any questions pertaining to this addendum, please login to the Solicitation Portal: www.dallascitvhall.bonfirehub.com Enter your questions under the Messages Tab. OPS -16 6/21/2021 Rev. 0 03/05/2020 Page 1 310 .■ I OFFICE OF PROCUREMENT SERVICES ADDENDUM City of Dallas ADDENDUM NO. 6 RFCSP June 21, 2021 The intent of this document is to provide official responses, clarification, and/or notice of change to the referenced solicitation. PROPOSAL NO.: BDZ21-00015158 PROPOSAL TITLE: Temporary Industrial and Day Labor PROPOSAL DUE DATE AND TIME: January 7th, 2020 at 2:OOPM ACTIONS: 1. The due date has been extended by two weeks, the project due date has been moved from 12/24/2020 to 1/7/2021. If there are any questions pertaining to this addendum, please login to the Solicitation Portal: www.dallascitvhall.bonfirehub.com Enter your questions under the Messages Tab. OPS -16 6/21/2021 Rev. 0 03/05/2020 Page 1 311 .■ I OFFICE OF PROCUREMENT SERVICES ADDENDUM City of Dallas ADDENDUM NO. 7 RFCSP June 21, 2021 The intent of this document is to provide official responses, clarification, and/or notice of change to the referenced solicitation. PROPOSAL NO.: BDZ21-00015158 PROPOSAL TITLE: Temporary Industrial and Day Labor PROPOSAL DUE DATE AND TIME: January 7th, 2020 at 2:OOPM ACTIONS: 1. Changes have been made to the Specifications and Bid Table for Group 2A. Title Specific Positions for Temporary Day Labor. Suppliers should use the most recent version of the Bid Table for 2A. Title Specific Positions for Temporary Day Labor to complete their submission. 2. "Exhibit A - Current City of Dallas Pay Rates for Group 2A. Title Specific Temporary Day Labor" is available for review. If there are any questions pertaining to this addendum, please login to the Solicitation Portal: www.dallascitvhall.bonfirehub.com Enter your questions under the Messages Tab. OPS -16 6/21/2021 Rev. 0 03/05/2020 Page 1 312 .■ I Title of Position Current City of Dallas Pay Rate Trades Helper $13.82 Per Hour Mechanic $18.00 Per Hour Mechanic II $20.00 Per Hour Sr. Mechanic $23.00 Per Hour Welder $18.00 Per Hour Sr. Welder $20.00 Per Hour Certified Tech $26.00 Per Hour Fleet Parts Specialist $13.82 Per Hour Sr. Fleet Parts Specialist $18.00 Per Hour 313 EXHIBIT 314 ST10 01 F. CA & A 4861 South Orange Ave 951 Sansbury's Way Orlando, FL 32806 A&Associates West Palm Beach, FL 33411 Phone: (407) 858-9080 "Quality In Everything We Do" Phone: (561) 533-5303 Fax: (407) 858-9094 Fax: (561) 533-3858 Texas Headquarters 4131 North Central Expressway, Suite 900, Dallas, TX 75204 Phone: (561) 533-5303 — Fax: (561) 533-3858 www.AssociateStaffing.com A & ASSOCIATES RESPONSE TO CITY OF DALLAS REQUEST FOR COMPETITIVE SEALED PROPOSALS FOR TEMPORARY INDUSTRIAL AND DAY LABOR SERVICES BUYER SOLICITATION NUMBER: BDZ21-00015158 FIRM EXPERIENCE AND QUALIFICATIONS TABLE OF CONTENTS: EXECUTIVE SUMMARY.................................................................................................................... 2 STATEMENT OF DEMONSTRATED EXPERIENCE...........................................................................2-7 PREFERRED QUALIFICATIONS....................................................................................................7-22 ATTACHMENT -A: SAFETY HANDBOOK.....................................................................................N/A Page 1 of 22 315 31V on WE: Executive Summa A & Associates is pleased to present the City of Dallas (herein after referred to as the City) with this proposal for Temporary Industrial and Day Labor Services. We understand the personnel and staffing requirements the City faces, and we recognize the unique opportunity to provide affordable solutions. While you assess the contents of our bid, you will recognize that we declare and undeniably aspire to obtain this business. We encompass the dedication and capacity to provide you with world-class services you will be pleased with. We are just the right size to implement and direct your specific staffing program initiatives. Essentially, we have extensive experience providing staffing services to government agencies, waste authorities and national haulers. Our clients include similar organizations, such as: Miami -Dade Solid Waste Authority, The City of Titusville, FCC Environmental Services, Advanced Disposal Services and Palm Beach County who presently trust A & Associates to provide clerical and industrial temporary associates. Organized under professional administration as a monetarily secure corporation; trust the enclosed proposal to confirm with conviction our capacity to provide services to the City. By duly examining your requirements, we are confident that our proposed services will effectively address your needs. Our goal is to fulfill the specific responsibilities outlined in the bid document at a very competitive cost. A & Associates will put your payroll and staffing arrangements into action without wasting time, money, or manpower. We will supply the skilled staff you demand with proficiently qualified, accountable, professionals who execute the functions you expect with a professional approach. Please ponder this response delicately to validate our ability to fulfill the specific items the City is seeking. A & Associates acknowledges each addendum issued by the City with this solicitation. In addition, we agree and will perform in accordance with all terms, conditions, and provisions included in the bid. This proposal is made without collusion with any other person or entity submitting a proposal pursuant to this solicitation. Furthermore, this proposal is valid until the City awards a contract as a result of this solicitation. Statement Of Demonstrated Experience A & Associates would like to provide information for the City to review pertaining to the example inquiries about our experience staffing industrial and day labor government contracts. Please note our responses below: A & Associates has been in business for more than (10) years and has had a physical presence in the State of Texas for over five (5) years. A & Associates can be characterized by our high operating standards, 50+ years of combined temporary staffing experience, flexibility, attention to details, participative management style and problem -solving orientation. Please note the specific number of years each Principal has been providing temporary help: Page 2 of 22 316 31V on WE: Mr. Andrew Luchey, President 20 years Mrs. Gail Luchey, Senior Vice President 17 years Ms. Evelyn Looney, Vice President 13 years Founded in 2003, A & Associates is an American -owned national staffing agency. We currently employ hundreds of temporary employees through our privately held and managed corporation. Our original business model was based on strong core values, a high level of professionalism, and the dedication to providing excellent service. Since commencement of our staffing agency, A & Associates has been focused on developing long-term partnerships with clients like the City. Solid waste departments and national haulers have hired A & Associates to assist with successfully supplementing the permanent workforce with temporary employees. Similar experience, includes, but is not limited to: • Ball Park of the Palm Beaches - Construction Site - A & Associates severed as the sole - source staffing provider for the construction of the Washington Astros and Houston Nationals spring practice facility. We staffed 75 Electricians, 50 Masonry Laborers, 40 Security Officers, and 200 General Laborers for over a year with Hunt Construction. • City of Tampa - A & Associates has been awarded multiple contracts with this City to provide temporary labor for the solid waste residential customers, commercial customers, and the waste -to -energy plant. We staff 10-30 temporary associates daily in harsh environments to fulfill heavy duty laborious task. • City of Titusville — A & Associates provides Day Labor services to this smaller municipality supporting their day -today general labor needs. • FCC Environment — We work with FCC as their Minority Business Enterprise partner for the State of Florida. We actively staff Trash Collectors on sites in Orange County, Volusia County and Palm Beach County on a daily basis for this world-wide hauler. • KBR - Waste -To -Energy Plant - Construction Site - A & Associates worked on this construction site supplying 50+ temporary associates to work in various capacities long-term. • Miami -Dade Department of Waste Management —A & Associates maintains a range of 15 to 50 -day laborers for the Department. Waste Collectors are dispatched at various County locations and are required seven days per week. We provide staff augmentation to ensure the County has a pipeline of temporary employees who can be converted to permanent County employees. Page 3 of 22 317 • Palm Beach County Solid Waste Authority—A & Associates works with this municipality in conjunction with several haulers to place day-to-day and long-term temporary labor. We staff approximately 125-150 associates for various County locations each day. We hold contracts with national haulers like Waste Management and FCC Environmental. We competently and successfully complete projected goals by first taking the time to understand and simplify the complex staffing administration of our client programs. We educate our team regularly and keep them abreast the intimate knowledge of safety methods, technology, and historical human resource -related scenarios for a wide range of individual activities. We also take cost-cutting measures into account, allowing us to make adequate preparations for conducting multiple activities concurrently. Furthermore, we never neglect to account for the impact of weather, labor relations, subcontractor qualifications and productivity, personnel availability, and a host of other factors, as our goal is to reduce the potential risk of having to correct or account for deficits. A & Associates has worked with large government agencies staffing temporary employees. A & Associates employs high quality, professional temps to perform duties in a manner consistent with the highest standards for staffing services prevailing in the industry. As a temporary staffing agency our focus is people. We strive to identify, screen, and support the highest quality of job seekers to then match these individuals with clients in need of personnel. Understanding the City unique business needs and then supplying the City with the right candidate is what sets us apart from the competition. Our staffing services will be tailored to the City and employee needs and include, but is not limited to the following: • Temporary Staffing — A & Associates works hard to identify and meet the temporary staffing needs of the City and local job seekers. We fill assignments for special projects, the seasonal rush, employee vacations, unexpected job vacancies and many other circumstances that permit our assistance. • Temp -to -Hire —The A& Associates temp -to -hire program is a great way to evaluate a candidate before making the final commitment of a new hire. This program allows candidates to experience firsthand the job requirements, environment, and unique culture of a new job opportunity. The candidate remains our employee during the trial period until the customer is ready to extend an offer. • Direct Hire — A & Associates is fully equipped to interview, screen, conduct skill assessments, background checks, and verify references for candidates needed in permanent jobs. Direct Hire is available for the City to fill an opening for a regular full- time employee but does not have the resources to review countless applications and Page 4 of 22 318 31V on WE: resumes. This no risk solution allows you the option to select from a narrow pool of prescreened and qualified candidates and there is never any obligation to hire. • On -Site Management/Support —A & Associates eliminates expenses and frustration with managing a workforce. Our Recruiters and Staffing Managers will work closely with the City to handle the day-to-day management of all temporary employees and keep quality candidates ready to meet your needs. A & Associates is proud to serve as the trusted choice of government agencies and businesses for temporary staffing services throughout the US. With over seventeen (17) years as a recognized industry leader, A & Associates is large enough to satisfy the needs of hundreds of temporary placements, yet small enough to give you the tailored service you expect and deserve. We have experience working with large and small school districts, county, and city municipalities as well as waste management haulers. Experience With Government Agencies: • Broward County • Highland County • Manatee County • Martin County • Miami -Dade County • Orange County • Palm Beach County • Seminole County • The City of Boca Raton • The City of Boynton Beach • The City of Delray Beach • The City of Fort Lauderdale • The City of Homestead • The City of Ocala • The City of Orlando • The City of Palm Beach Gardens • The City of Parkland • The City of Riviera Beach • The City of Titusville • The Town of Lantana • The Town of Palm Beach • Volusia County As you can see, we bring innovation, competency, and extraordinary talent to the table. Page 5 of 22 319 31V on WE: A & Associates holds membership with the Society for Human Resource Management (SHRM). Our SHRM membership provides access to key tools and resources to support our staffing firm. We have included a current copy of Mr. Andrew Luchey's Membership Certification below for City records. CERTIFICATE U' -*'F I P MEMBERSH The Society for Human Resource Management (SHRM) certifies that is a member in good standing with aH the privileges and benefits accorded through Presented by gVVVV Johnny C. Taybr, Jr., SHRM-SCP BETTER WORKPLACES Presucdent & CEO BETTER WORLD"' Screening A & Associates fulfills a large array of pre- and in-service employment screenings on temporary associates. The ability to swiftly find and place candidates is a huge part of our success. Our recruiters fulfill advanced screening evaluations that help A & Associates achieve fast recruiting results. We administer criminal history search, credit reports, education and employment verifications, motor vehicle checks, 1-9 employment verifications, workers compensation history checks, license verifications and drug testing. In addition, A & Associates agrees to comply with the background screening requirements associated with this bid and will ensure all temoorary staff assigned to this contract will have a clearance Page 6 of 22 320 badge prior to assignment into a position and kept on their physical bodies at all times while on duty. Testing A & Associates employs a stringent and mandatory candidate screening system including an in-depth face-to-face behavioral interview, education verification, reference checks, criminal background and National Sex Offender Registry screenings, 1-9 compliance, as well as all knowledge base assessments. To ensure the associates we assign have the knowledge and experience to do the job, A & Associates uses online and in-person skills assessments. Our skills and knowledge assessments test employees to assess their current skill level. We use standard skill test for temporaryjobs, such as: (a) Basic Office Skills, (b) OSHA Safety Training, (c) Paid On -The -Job Training Sessions. Employees are required to qualify on various subjects prior to placement with a client. In cases where staff do not meet the minimum requirements, we use our online and in-person skills testing system to generate a training report so the employee can work on the skills needed to potentially apply again in the future. A & Associates utilizes software for easy creation and submittal of various employee and staffing reports. The functions of our staffing software include resume scanning, job order creation, payroll and invoicing which permits us to be more effective and efficient. We are also able to integrate employee records with client assignments which has proven to be helpful with government agencies utilizing employees under federal grants. The HR division is able to produce a multitude of custom reports which include: • Consumer Reports • Employee Information Reports • Financial/Payroll Reports • Assignment/Order Information Reports • Invoicing Logs • Time/Pay Logs • Workers Compensation Reports (Photography's included) We are able to submit immediatelv and upon request to the Citv. Preferred Qualifications A & Associates has thoroughly reviews the City's preferred vendor qualifications and is providing the following information as a response to the nine (9) line items listed in the RFP. A & Associates has worked with government agencies and elite private entities providing more than 150 temporary employees on a daily basis for organizations with more than 600 employees. Sample projects include: Page 7 of 22 321 ST10 01 V. Solid Waste Authority of Palm Beach County Trash Collectors 125-150 Daily Placements Orange County Public Schools Custodians 100 Daily Placements The School District of Palm Beach County Food Servers 300 Daily Placements National Football League - Super Bowl and Pro Bowl Security Officers 500 Daily Placements University of Central Florida Dorm Helpers 85 Daily Placements Champion Security Security Officers 75 Daily Placements (nationwide Apple Stores All A & Associates consultants are professional with extensive experience in the areas which we recruit and place temporary employees. Our skill in recruiting, screening, placements and, specifically, trash collector staffing, helps ensure a positive outcome for the City. Our success can also be measured by the repeat contracts we have been awarded by government agencies similar in size and service as the City. If awarded this contract, A & Associates would assign a dedicated team to the City account who will maintain substantial involvement in the staffing services. The team will bring a combination of the knowledge and experience needed to successfully staff the critical positions outlined in the bid. If selected for this assignment, Mr. Andrew Luchey will serve as the Account Manager from our firm in charge of the project. Mrs. Gail Luchey and Ms. Evelyn Looney will serve as the Assistant Project Manager. As honorable human resource professionals, they are competent and predominantly capable of implementing and administering a staffing program that will exceed the City expectations. They will be actively involved in managing and directing the services provided to the City. Page 8 of 22 322 Our managerial team is professional and diverse with extensive experience working with government agencies. We assure the team outlined below represents the current team that would be assigned to this account. We will implement a procedure under the bid that requires A & Associates to submit new team members to the City for prior approval before assigning them to the account. All team members will be available to immediately address the City needs upon award of this contract. Other staff members and compliance associates will get involved as needed. A & Associates office staff who provide our staffing services will allot as much time necessary to complete staffing task and placement objectives. Key Management Team - Organization Chart We have a team of managers that will all play an important role in fulfilling our responsibilities for the City under this bid. We have included their name, title, role, and a job description: Mr. Andrew Luch77717 Project Manager Mrs. Gail Luchey PresiAssistant Project Manager Ms. Evelyn Looney ent Assistant Project Manager Ms. Cheryl Jeter Accountant Invoicing and Payroll Ms. Yanira Hodges Bookkeeper Invoicing and Payroll Ms. Jaquita Person Branch Manager Placements and Support Ms. Christine Anderson Staffing Manager Placements and Support Mr. David Robinson Staffing Manager Placements and Support Mr. Terrance McDuffie Recruiting Manager Recruiting and Screening Ms. Ersa Hall Recruiting Manager Recruiting and Screening Ms. Izabela Andres Training Instructor Training and Orientations Ms. Zalha Carrion Office Clerk Administrative Support Ms. McKayla Pham Office Clerk Administrative Support Ms. Rosie McGovern Office Clerk Administrative Support Mr. Peter Rossi Field Supervisor Field Support Mr. Chris McAfee Field Supervisor Field Support Mr. Sebastian Thelisma Field Supervisor Field Support Mr. Warren Martin Field Supervisor Field Support Page 9 of 22 323 w C: Vt 4J N C O Ln L- u u N O E Ln 4 - QJ C O v � M W U O Q _m 2 X `" - C w C: Vt 4J N C O Ln L- u u N O E Ln 4 - QJ 1* N M C > p C ++ 3 N O by OU C rD (1) > bn aJ ut L YCL C � c0 _ rb Ut V N = bA > r6 L O Qi Y Q Q1 Vl a U a•+ (") V7 p • O VI L p Y U L c ro >• L (6 (D bn L N CQ E 4 Q U U O c0 N N L O s O bA C a--� �^ O .41 aJ N to a O� LF kn O-0 p ra O c > �••� U O (..) aJ tw a..! aJ iJ +� 7 a aJ L« c '^ O w-0 O Ln N O O N co bn N io "a O VI 7 In N O a Ou aJ O 4J +� c v O L U O +, Q +, aJ U c u aJ C O N aJ •O N u O O 1 a N .i •� c0J p •� O O .Q N N U to t-0 a aJ 0 f° Lp O bbn +-� -0 m aJ +� a .0 C 0 U O E cuu > ,,; m O a 3 a r0 aJ bA N = aJ a aJ >O 'O a1 O> v O O O aJ s O Vi ti C U r6 C O V C 0 C 7 aJ Q' ro OU U co a1 aJ +� >, Q co L -O ro aJ p +' a LA i m u L aJ >. c0 aJ a .� aJ CL ro N _0 O v O c u v C u v u tuo c `n •U to Ou v p Ln L U O c ca O �_ to N u a Y L O aJ O VI GA O> — aJ u U iJ N ut E E O CL w T Q aJ O p Ln L1 •0 u Q a �' 'a O �_ L O O Ln c U a u E u� N E d CL L a r t+'o L O O N L rC6 a U w0 C N V) aJ U 7 W M v a) p �-- a) ++ L V1 �_ r6 �-• c U � �~ � Vl -o m VI C a U V) O O W U O n u a) a N +� > N +� OJ i C-0 O- N O a aJ C— C O O +� C u 4! 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We intend to hire two additional employees to work in this capacity of awarded this contract. All of the above-mentioned staff will be involved in some phases or task of the staffing services we deliver to the City. On -sight daily operations, however, will be the responsibility of Mr. Andrew Luchey and Ms. Evelyn Looney. Staff will be responsible for general networking and outreach, recruiting, screening, contract development and assisting with placements. A & Associates will assign three (3) Project Managers to the City contract who will be available in the Dallas office Monday to Friday from 7:00 AM to 6:00 PM. The Project Managers will also be available by cell phone 24 hours per day, seven days per week and will return phone calls within the hour after being called by the City. We will provide alternate Supervisory contact information that will be answered in the event the Project Managers are temporarily unable to acknowledge the City, for example, due to illness or vacation. A & Associates will give at least two (2) weeks' notice to the City if the Project Managers will be absent for any reason. The Project Managers assigned to this contract will plan, budget, oversee and document all aspects of services provided to the City. They will work closely with upper management to make sure that the scope and direction of the services provided are timely and surpass the City expectations. They realize the responsibility to coach, support, and impel our temporary employees to achieve their maximum level of professionalism. Mr. Luchey and Ms. Looney are highly motivated, result orientated, and self-starters with a strong professional image. They are able to work well independently and make decisions. Also, they encompass strong leadership and coaching skills, supervisory experience, and knowledge of general industry best practices through experience and education. Being comprised of a paramount managerial team has allowed us to operate in a client satisfaction orientation. A & Associates has over fifteen (15) years' experience staffing temporary employees for the public sector. We have included bid award documentation from other clients as evidence of this claim. THE REMAINDER OF THIS PAGE HAS BEEN LEFT BLANK INTENTIONALLY PLEASE CONTINUE TO THE FOLLOWING PAGE Page 14 of 22 328 x1v on W-1-1 eo..n, ARPROI.TED, P,/fP03 ,;t R5 AGENIT)A ITEM JE�_��A, TEMPORARY ����d�T � F;Ii 11, � :ES�;�� DATE; May 19"2015 DATE ,ADVE `i`ISE D: ATte tr CITEor: JJanluar� iii, 201; (,)A"f EOPENED: tuRESENf'Ef TO BUA D: June 17:,,2015 DTE POSTED, CONTRACT PERIOD; MJwy 1„ 2015 thhror„igh Juno 30,2018 DEPARTMENT, Various FUND: Various t"t,.JN tilllON: Various REQUESTING DEPARWENT, 'carious February , 2016 March 2, 2015 .April 14, 01 Cf;.OtK1 Vwious The ffnanciall irnfpwl to the parlous budg is us not to c;e d $4,200,000. The source of funds is the various depar°trnent budgets. Services to be pfovided include temporary staffing services for non-insta'ur QnaD prasltlons Aoudad for Schools and departments throw hoot th Did-trirpt. V,"END R MINORITY ,. STATUS 2ND Contour"J ro hnolbi , Inc ,A & Also iiatos *2 .Academy Design & Technical Staffing, Inc., areeruUSA;„ Ilnc kk6 a CHFi HA, Inc A. Estiirne & tnitin .As,saciates K y taff, Inc r PESO of Florida Ea'ideskaff, tnc -•- 'A, & Associates is a rninoriity omned bijSine3ss: however, they have exceeded tha,a tacho,ot I rstrict of Palmi Beach Counity guidelines and have gradUated the program "These vendors offered State cer"fification documents certifying thair status as a Women Owfied Business, however, they did not qualify for palms hbw%ed w the itrdustry specific classification for this soliciifatton. Page 15 of 22 329 311' on WE: A 4 ASSOCIATES. INC. EVELYN LOONEY, SMI CE PRESIDENT OF OPERAVONS 8144 DKEECROBEFOLVD, W PALM BEAC 14 F L 33411 Dear'Vondlor, RE,TERMCOWT'RA,CT#,,7 o 11 _QK Forma L This is ter hiform you -that Palm Rfraoh Cmwity Roard of Courity Comurnitsionem, is, enlerfag into a Term i Contract wrffi Vow tounparly for IF—MPOEARY PERS0?jbLEL bas -gid on; [XI SO LIC11"TATION #j,2.Q9§, lL PFUMARY, ITEMS # 2, 4, 6, 7«'8; SECO NDARY:ITEMS # t gra The term of this contract Is 03MV12 through 2,2,2LU, 71he eshmaled defflar vatLJO is $j,"0 InuJusivo of all awarded vendars. The oWisalions of Palm Beach Clrunty under thils coritract are subject to, the avWIabdilty of funds JaWiftflRy appropriated for Its purpose by the State of Florida and the Boar'd of Cotinty Commiss loners- Plallm Beach County Departments will issu& individual hard copy orders agal4w his contract as you r authorizatloin t�o deIlver. AH Lnvpjgpr most reference a unique document number (0,g. C:P=0 680, XY03036500000000001,1111 or CPOrDO 6�8!0 XYD3030,5"1I11). Fallure to ptovld� an, order num mer wth each lirjvo�co will result in a delay in prmessing paymenl. If You have ''a "y cluestions, please, contact 4ky'AL, Senior Bwar 2t 011MA"ll Culmutywide Fill Page 16 of 22 330 311' on W-.-. 441 Orange COLInry BID POST"tNG NOTICE "IWM 4" IFB #Y12-1026-CiG BID TITLE, Temporary Labor - Orange County Convention Center BIDS RECEIVED: 4020,12 PRICE VENDORS (!,Ist all bidders) A & Associates, Inc Zion Employment Solutions Twjian Labor JAG Professicmal Resoorceps Command Cemer. LLT Management Remedy irilefligorl'i"Staffing Levee Resoutces Tampa Service Company, Inc dba Pacesetles Personnel Services Resource Staffing Cieaneveot, USA United Service Companies Ace Staffing Marathon Staffing Services, Inc. Ace Staffing Untlirrifted, Inc are USA Labor HeadylTrue Blue, Inc A & Associates, ine, Zoo 15,mployrnent Solutions, Irojar, I-aborand RECOMMENDED AWARDIFE.- C orn ma,,n4J C,en ter Per Special Terms and Conditions, Item 4, Mulfiple Awards, recomrr*ndafion is, to award C:oRtracts to A& Associates, Inc , Zen Employment Solutions, Trojan Labor aflid Command Center JAG Professional Resources is not recommerWed clue to p*rformance PURCHASING COMMENTS; concemrs SIGNATURE; DATE: Page 17 of 22 331 x1v on WE: 1.1amAl7511:1211M%Am0rrIN-11TraUK Tabulated by: Floc Ralawga., Procurement Analyst There is a considerable amount of customers that use A & Associates as their staffing provider. The number of companies and government agencies that have put their trust in us to create and implement a temporary staffing program is getting longer and longer every day, but we hope this list gives you an idea of the world-class services we provide. The School District of Palm Beach County, FL A & Associates provided a variety of staff to this school district. We employed over four hundred (400) employees on a daily basis in a clerical and industrial capacity. Solid Waste Authority of Palm Beach County A & Associates holds direct contracts with the Authority and with several national haulers to staff over one hundred (100) trash collectors on a daily basis. We manage shifts and overtime, PPE equipment, residential customer service. Page 18 of 22 332 ALL BIDS Aa:EPTED BY THE COUNTY ©F'V©LU"a BA AMIE SUBJECT TO THE CCJUNlYS TERMS AND GCAIDITICrl1S. ANYANDALLADDIPONAL.TERM`✓AND CON4DITOC24 SNBMITTELD'RY THE EWERS ARE REJECTED AND SHALL HAVE NO FORCE AN'D EFFECT RIDS FROM THE VENDORS Lf STED HEREIN ARE THE DNL'r BIDS RECEIVED TChGELY AS OF THE CLC'IBIND GATE AND TIME ALL OTHER B[Gf SUBMITTED IN RESRCMIDE. TO THIS ."vJd.CCITATICaAB, IF ANY, ARE HEREBY Voltl.sld county ROM A REJECTED A`v LATE I - 1 esponse # T espouse # 2 espouse# espouse # 4 Temporary & Leased A & Associates' ALL Staffing Inc. Remedy Intelligent TS Staffing Services, Inc. Employment Services Staffing, Evdyn Howley �k l I y Wiseman Stephen Ills SlIsan Kennedy Closing Date:. 10/07/2014 f11+1 Okeechobee Rk d .7"77 1. AitnatliHnite lh'tl'L�`e 1140 f�k',`,kin I;tay f'I'tlive 1d, 0 Bi oadWrxy, 13th F'h Closing Tinre: 3:00 p.m. wa tit 1' ihn lkG ach, FL 3341 J. A9ta avnrta� `»gr r'iinl;0�. F1,32701 Daytona Rea, It, LL 321.19 New "t oto, NY 10031L €'VE r II4 t,l •'n3rt i'Ite7.,71k1Yr12caYn tWh'VfiC'NV1lX7Caia 4yk'rP.Yflll l7fm;.$`Qk rl'1 {�7f'u Y�V lflrwtir V'a rrYeafl«t'.iY11 CM1'Y NxY 31Ef'4k1iL ff�6f'YSQ'1"rl"d'I.S'4;Y„%➢ 1 133-°'.,.SfP3 x42'�R:i;2117 :!`;r "4i '3fltfS-(1.,11&1."N4 L1L.'!1$Sfl'a {4°;Leased Employment Services n/a f4.{:If""kp H/u itd.4Rl'N, Temporary Employment iricin,� on tab g on Wb 2 fr nicln wvn Yeah 2 I fr Ir1Cln on tab 2 I Iry xServices{+tw ITB: 14-8-165RF Response # S Response # 6 Response # 7 Temporary & Leased Ven LIX d/h/a Tampa Service Co., Inc. dfblx Lalnxr Ready Southeast, Employment Services Daytona Employment Pacesetter Personnel Inc. claire %l riabl(!s Harry IefB,stj Logan Bradley 609S, Ridgewood Ave 110 Box 2146 2743 South Pat k Ave D.iy,en.a Beach IT, 12114 lio nst'on, 4'X 772!;-' 1.nr,f n 1 1-1, 12.771 rsmn,codartuacwunidwy,nrwaaaan Ik, mLm�.y;w; .eotn ka u.rfdteCrru arelrlutar.a: r,m .................................................................................. :4H(s-l'; 3 433'j l l 4'74-111161. ht)'7- ll4 ii1i44 Employment Services n/'a 273. t1t,d3ad, n/a �Leased rnporary Employment pricing on tab 2 pl icin,pa on Lib 2 pi icing on tla1',b2 services Leased Recommendation of Award: TS Staffing Services, Inc. and AUE Staffing, Inc. Tabulated by: Floc Ralawga., Procurement Analyst There is a considerable amount of customers that use A & Associates as their staffing provider. The number of companies and government agencies that have put their trust in us to create and implement a temporary staffing program is getting longer and longer every day, but we hope this list gives you an idea of the world-class services we provide. The School District of Palm Beach County, FL A & Associates provided a variety of staff to this school district. We employed over four hundred (400) employees on a daily basis in a clerical and industrial capacity. Solid Waste Authority of Palm Beach County A & Associates holds direct contracts with the Authority and with several national haulers to staff over one hundred (100) trash collectors on a daily basis. We manage shifts and overtime, PPE equipment, residential customer service. Page 18 of 22 332 31V on WE: Palm Beach County Board of County Commissioners, FL A & Associates has been awarded multiple general labor and clerical temporary staffing contracts with this municipal to staff employees in various County departments, including the Courthouse. Department of Solid Waste - Miami -Dade County, FL A & Associates works with this government agency supplementing the permanent laborious workforce with over thirty (30) temporary associates on a daily basis. We even assist with referring qualified candidates for direct hire within the County. Orange County Public Schools, FL A & Associates employs over two hundred (200) temporary staff members to work as Food Servers, Clerks, Custodians and Security Officers. REFERENCE NO. 1: Company Name: Type of Business: Contact Person: Address: Telephone Number: Email Address: Type of Temporary Associates REFERENCE NO. 2: Company Name: Type of Business: Contact Person: Address: Telephone Number: Email Address: Type of Temporary Associates: REFERENCE NO. 3: Company Name: Type of Business: Contact Person: Address: Telephone Number: Email Address: Type of Temporary Associates The School District of Palm Beach County Educational Institution —Transportation Dept. Patricia Pitre, Transportation IT Manager 3300 Forest Hill Boulevard West Palm Beach, FL 33406 LYe�iQC�i�QC�C3.Yil Patricia. Pitre@Palm BeachSchools.or Clerical/Administrative, Industrial FCC Environmental Solid Waste Hauler Mr. Joseph Sandora, Operations Manager 9901 US -441 Boynton Beach, FL 33472 561-888-3033 Joseph.Sandora@fccenvironmental.com Clerical/Administrative, Refuse Collectors Cigna Corporate Services Healthcare Corporation Ginger Anderson, Supplier Diversity 3500 Piedmont Road, Suite 200 Atlanta, GA 30305 (404) 545-4333 or (860) 226-4550 Ginger.Anderson@Cigna.com Clerical/Administrative, Healthcare Professionals Page 19 of 22 333 REFERENCE NO. 4: Company Name: Type of Business: Contact Person: Address: Telephone Number: Email Address: Type of Temporary Associates REFERENCE NO. 5: Company Name: Type of Business: Contact Person: Address: Telephone Number: Email Address: Type of Temporary Associates 31V on WE: Advanced Disposal Services Solid Waste Hauler Carlos Mangual 5489 Leeper Dr West Palm Beach, FL 33407 561-471-6110 or 561-510-0502 carlos.mangual@advanceddisposal.com Trash Collectors Orange County Public Schools (OCPS) Educational Institution Kevin Ballinger, District Manager 6501 Magic Way, Building 500 Orlando, FL 32809 (757) 450-2777 Kevin.BaIIinger@ocps.net Clerical/Administrative, Custodians, Security Officers, Food Servers A & Associates delivers comprehensive training at all levels so that we may provide fully trained skilled temps who are prepared to handle the daily challenges of the workplace. We believe it is critical to thoroughly prepare an individual prior to site placement and important to develop them through ongoing, continual training. We realize that continuous, effective training is the key to provide a quality service to our customers. We will work extremely hard to have the lowest turnover rate possible through actively monitoring and training professionals via training sessions, informational updates regarding the site, on-site collaboration with management and by abiding the Standard Operating Procedures established for the City. To assure the superiority and receptiveness of A & Associates employees, we require continuous effective in-service training. Employees are given vigorous on-the-job specific guidance as each location specifications may differ. Our staff is carefully taught how to fulfill their responsibilities. They are required to complete training sessions each month with managers and site -supervisors to evaluate their performance for continuous service. In addition, our staff will receive specific training that enhances their interaction with the public in a manner that is professional, friendly, courteous, and diplomatic. Our trainers will focus mainly on the needs of new employees, and make sure that each and every temporary associate is fluent in all things to do with the City to stay compliant. Our main focus during training is to ensure all of temporary associates at the City are prepared to assist. Page 20 of 22 334 Please note we have attached a copy of our Safety Manual as Attachment A to this section of our response. Recruiting at A & Associates is about putting the right candidate in the right job. Our systems are designed around evidence -based hiring practices. We understand a good fit is critical, so we will increase our scrutiny in selecting new candidates. We know they are our product and represent our company, our values, and ultimately, our client. We recognize the importance of not only having enough team members but having enough quality team members. A quality team member would have an attitude focused on customer service. The hiring process includes, benchmarks, such as, pre -qualification for position, completion of application, individual interview, screening, onboarding, and new employee orientation. A & Associates uses a comprehensive staffing agency software named Avionte. It is state-of- the-art technology which helps our business manage the recruiting, sales, operations, and back office functions of our company. Major components of the system include: Candidate Sourcing: Allows for swift candidate sourcing inside and outside our pools of available temporary associates. Job Board/Onboarding: Allows for a positive and seamless candidate experience doing interviews, paperless onboarding, and prompt communication. Time/Attendance and Payroll: Allows for fast, accurate and electronic payroll processing and production. Employees are able to access a web -based employee portal for direct access to payroll records. Invoicing: Allows for automation between payroll and invoicing and eliminates manual invoicing. Page 21 of 22 335 Thanks to our quality services, competitive rates and experienced staff, A & Associates expanded in 2009. Building on our proven business model, we successfully opened branch offices in Florida, New York, and Texas. The success of each office in their respective regional locations led A & Associates to expand for a third time in 2010. We opened a 501c3 (non- profit), A&A Workforce, which has provided clothing and transportation to low-income individuals so they can work. In addition, A&A Workforce provides a myriad of employment services, including, but not limited to, work readiness, food handler training and job placement. Many of the individuals we serve, through this nonprofit, are from underserved communities with limited education and resources. We do this as a give back to our community. Over the years, A & Associates has strengthened its task force and acquired an extensive portfolio of diverse staffing projects including services rendered to school districts, municipalities, elite corporations, and not-for-profit entities. Our management team is phenomenal in keeping careful surveillance and providing adequate support and feedback to staff. Our relationships with local, state, and federal agencies make for a less stressful licensure process as we keep current with the latest regulations with respect to such issues that impact all of our clients. A & Associates has the expertise that encompasses all phases of providing quality staffing services our customers can depend on —from the initial recruiting stage through training, placement and on-going management and development. Page 22 of 22 336 A & ASSOCIATES SAFETY PLAN Table of Contents I. Safety Policy Statement II. Employer Information III. Designation of Safety Responsibilities IV. Employee Reporting and Conduct V. Inspection Procedures VI. Hazard Correction Procedures VII. Accident Investigation VIII. Disciplinary Procedures IX. Employee Training X. Recordkeeping 337 Safety Policy Statement We are pleased that you are a part of A & Associates, Inc (A&A). It is our desire that we establish a sound working relationship based on mutual trust and cooperation. To meet this goal, it is important for you to know, understand and follow established rules and policies that affect you and help keep A&A a strong organization. Accident prevention and safety are high priority items with A&A. You will be expected to read and become knowledgeable about all of the company safety policies and work rules. A&A policy is: • To provide a safe and healthful place of employment for every worker. • To abide accident prevention regulations set forth by the federal, state, and local government. • To provide rules and regulations for the safety of employees and to warn them, under certain conditions, as to the hazards of their position or employment. This includes supervision. • To furnish reasonably safe machinery and equipment. Included is the duty to inspect and repair. • To exercise ordinary care to select careful and competent fellow workers. We are sincerely interested in the safety and welfare of our employees. Accident prevention is essential in maintaining the profitability of A&A. It is our policy that the safety guidelines and rules contained in the following pages should be strictly observed at all times. Although these rules are considered to be very important, it is impossible to publish a rule to cover every circumstance. If a rule that might cover any specific safety hazard condition has been omitted, that shall be no excuse for carelessness or disregard of common sense in the performance of your work. You are urged to cooperate fully. Abuse or disregard of A&A safety rules and guidelines is a violation of company policy and will be treated accordingly. Remember, your help in the prevention of accidents benefits you and your fellow employees. We should strive, at all times, to achieve a record of zero accidents. Employer Information Corporate office information for our company includes but is not limited to: COMPANY NAME: MAILING ADDRESS: Ia:1'611[ek1XIriZa1_ll Ire] 0FTN BID]:]"Is A & Associates, Inc. 951 Sansbury's Way West Palm Beach, FL 33411 951 Sansbury's Way 338 NAICS CODES: West Palm Beach, FL 33411 561320 561612 624310 541214 611691 III. Designation of Safety Coordinator 1. Andrew Luchey is the designated Safety Coordinator for all A&A locations. The safety coordinator's responsibilities include but are not limited to: • The development and maintenance of safety programs and records. • Scheduled safety inspections. • Hazard correction procedures. • Accident investigations. • Communication with employees and management concerning safety topics. • Disciplinary procedures for safety violations. • Conducting the appropriate employee training. IV. Employee reporting and conduct It is the responsibility of every employee at A&A to conduct themselves in a safe and professional manner. Not only do you represent A&A while on the job, but your actions can directly influence the wellbeing of yourself and your co-workers. All employees at A&A must: • Know and understand the rules and guidelines set forth in this safety program. • Be able to recognize and report any hazards or unsafe activity promptly. • Inspect equipment prior to use. • Wear the required personal protective equipment. • Maintain a clean and orderly work area. • Obey all posted signs and rules. • Report all injuries immediately. • Maintain an acceptable level of personal hygiene. • Wear the appropriate clothing for their job and weather conditions. • Use all company machinery and equipment in a safe manner and for the purpose for which it was designed. Employee Reporting: Every employee of A&A is required to comply with all safety regulations implemented by A&A. Any employee that witnesses an unsafe act or an act that is in direct violation of A&A's safety policy is required to report it to their supervisor immediately. If the employee fails to do so they will be reprimanded. 339 V. Inspection Procedures 1. Mr. Andrew Luchey will perform the safety inspections. 2. The frequency of each inspection will be monthly. 3. Mr. Andrew Luchey will document, in writing, all hazards found. 4. The inspector has the authority to halt production and/or tag out machinery if it presents a serious threat to persons or property. Work will not continue until the proper repairs have been made and a follow-up inspection has been performed. 5. We will schedule inspections with outside entities, such as loss control from our insurance company, or by hiring safety consultants. VI. Hazard Correction Procedures 1. The safety coordinator shall submit a written report of deficiencies or hazards found during their inspection to the supervisor responsible for that area. In addition, a copy of the report will also go to upper management. 2. It is the supervisor's responsibility to ensure correction of all deficiencies or hazards found in their work area in an acceptable amount of time. 3. The safety coordinator shall perform follow-up inspections to ensure that all deficiencies are corrected in a timely manner. 4. Records shall be maintained by the safety coordinator of all inspections. Repeat violations occurring in the same work area will result in disciplinary proceedings. Supervisor Responsibilities: All supervisors or persons in management positions at A&A are responsible for providing a workplace free from hazards for their employees. It is the responsibility of supervisors to report all hazards that cannot be immediately corrected to the safety coordinator. Any supervisor found intentionally violating safety protocol will receive severe disciplinary action. VII. Accident Investigation Accident investigation at A&A plays a vital role in the safety program. Accident investigations are conducted to gather information about an incident in an effort to eliminate recurrence. When to investigate: All accidents that result in injury or significant damage to property will be investigated. The more complicated the causes and serious the result, the more detailed the investigation will be. 340 VIII Minor accidents that have the potential to be serious will also be thoroughly investigated. Accidents are to be investigated immediately after their occurrence. The first line supervisor will conduct most of the accident investigations. Accidents that result in serious injury or large- scale damage to property will be investigated by the safety coordinator and members of upper management. How to investigate: When investigating accidents, focus on the following areas: • How was the injury or damage incurred? Exactly what happened and where? • Under what circumstances did the accident occur? In other words, why? • Once the details have been reconstructed, what can be done to prevent a similar accident from recurring? Response procedures: • Respond to the accident quickly and safely. • Survey the scene to ensure it is safe to enter. • Get medical attention for the injured. • Safeguard the accident scene to prevent the destruction of evidence. • Interview any witnesses. • Investigate of the accident scene. This may include taking pictures and measurements. • Complete the accident report and any necessary forms. Disciplinary Procedures All offenses are based on a time period of one calendar year. However, all offenses will remain in that employee's personnel file for the duration of employment. Management reserves the right to review violations on a case-by-case basis and dictate disciplinary action as deemed necessary. Minor Violation: A violation of procedure that will not result in injury or property damage (i.e., tardiness, abuse of phone privileges, etc.). 1st offense Verbal warning. 2nd offense Written warning. 3rd offense One day suspension without pay. 4th offense Upper management will choose punishment or termination of employment. Serious Violation: A violation of a rule or procedure that has the potential to cause injury or property damage. (i.e., smoking outside of designated area, abuse of equipment, etc.). 1st offense 2nd offense One day suspension without pay. One-week suspension without pay. 341 3rd offense Termination of employment. Willful Violation: A violation of a rule or procedure that has the potential to cause serious injury or large-scale property damage. (i.e., speeding on forklift, removing the guard from a machine, etc.) 1st offense Termination of employment. IX. Employee Training At A&A we feel that training is one of the most important elements of our safety program. Training will ensure that all tasks are performed correctly and safely. The employees of A&A are the company's greatest assets, and our goal is to provide a safe work environment for them. What will the training cover? • Occupational hazards found in work areas, generally and specifically those hazards related to individual job assignments. • The methods of minimizing hazards, including safe working conditions, safe work practices and personal protective equipment. • Any new hazards introduced by a change in equipment, process, raw materials, or other factors. • Any new requirements of other applicable OSHA or state standards and environmental regulations. • Specific OSHA standards that require training. • EPA Worker Protection Standard training requirements. When will training take place? • New employee orientation. • To all employees given new job assignments for which training has not been previously received. • Whenever new substances, processes, procedures, or equipment are introduced to the workplace and present a new hazard. • Whenever new personal protective equipment or different work practices are used on existing hazards. • Whenever management is made aware of anew or previously unrecognized hazard. Documentation of trainine: All training done at A&A will be documented. Employees receiving the training will be required to sign material stating that they have attended the training session. The material will then be placed in the appropriate safety and personnel files. Non -English-speaking employees: 342 Federal and state OSHA training standards require that training about safety must be "clearly understood" by employees. Therefore, all training for non -English-speaking employees at A&A will be provided in their native tongue. Who will conduct training? • Safety coordinator. • Human resources personnel. • Managers and supervisors. • Outside entities such as insurance providers and equipment representatives. X. Recordkeeping No operation can be successful without adequate recordkeeping, which enables you to learn from past experience and make corrections for future operations. If accidents and injuries are not recorded, serious hazards may go unnoticed, and worse -- uncorrected. For example, there may be a high incidence of minor hand or finger injuries, but unless records are kept, you may not recognize this to be a significant problem and work to correct it. OSHA Form 300 and 300A The OSHA form 300 is used to maintain a log and cumulative summary of all recordable injuries and illnesses. The back page of the summary portion is to serve as the final summary for the calendar year. It must be completed, signed, and certified by the employers or designated employee. OSHA Form 300A is the back sheet of OSHA Form 300 and is a summary of the OSHA 300. This summation needs to be compiled and then posted no later than February 1 and must remain posted for 90 days and kept on file for five years. In addition to the OSHA Forms 300 and 300A, you must maintain a supplementary record for each recordable occupational injury or illness. The record, OSHA Form 301, must be completed in detail and be available within six working days after receiving information that a recordable case has occurred. These forms should never be posted but must be maintained on file for five years. Postine Reauirements You must post and keep posted the "Safety and Health Protection on the Job". This poster must be displayed prominently in a location that all employees have access to. Copies of this poster can be obtained from your local area OSHA office or the. Emergency phone numbers must be posted in conspicuous locations and show current telephone numbers for quickly obtaining medical assistance, hospital, ambulance, fire department, police, and poison control center. Other Required Records Injury and illness records may not be the only records you need to maintain. OSHA standards concerning toxic substances and hazardous exposures require records of employee exposure to 343 w1v on WE: these substances and sources, physical examination reports, employment records and other information. Three years is a recommended retention period for these types of records. 344 ST10 01 F. CA & A 4861 South Orange Ave 951 Sansbury's Way Orlando, FL. 32806 A&Associates West Palm Beach, FL. 33411 Phone: (407) 858-9080 "Quality In Everything We Do" Phone: (561) 533-5303 Fax: (407) 858-9094 Fax: (561) 533-3858 Texas Headquarters 4131 North Central Expressway, Suite 900, Dallas, TX 75204 Phone: (561) 533-5303— Fax: (561) 533-3858 www.AssociateStaffing.com A & ASSOCIATES RESPONSE TO CITY OF DALLAS REQUEST FOR COMPETITIVE SEALED PROPOSALS FOR TEMPORARY INDUSTRIAL AND DAY LABOR SERVICES BUYER SOLICITATION NUMBER: BDZ21-00015158 PROJECT APPROACH INFORMATION TABLE OF CONTENTS: MANAGEMENT APPROACH............................................................................................................2 TRANSITION PLAN.......................................................................................................................2-3 TRANSITION TIMELINE.................................................................................................................... 4 OUR STAFFING PRACTICES........................................................................................................... 4-6 STAFFING SERVICE DELIVERABLES...............................................................................................6-8 LEVEL OF ASSISTANCE..................................................................................................................... 8 STAFFING TIME OF COMPLETION................................................................................................8-9 Page 1 of 9 345 Methodology A & Associates will provide the City with the quality services the City has come to expect under this contract. To ensure the maximum accuracy and effectives of our staffing services, we employ a well-documented and systematic approach to filling temporary jobs. From interviewing and training to badging and job placement, we adhere to a detailed plan in order to deliver a seamless service on-time and on -budget. We are careful to maintain confidentiality and high levels of communication to ensure clients operations are not negatively impacted by the conversion. Management Approach The goal of approach is to design a transition plan that is fluid and flexible and can be tailored to fit the desired time frame set forth upon award of the contract. We would sit with the City to determine the time frame required or requested. Once that period is agreed upon, we would collectively build our transition implementation schedule to conform to that time frame. Upon identifying the contract start date, we would work backwards; creating a list of critical tasks and events, which need to occur prior to the start date and assign those tasks to the appropriate personnel. Please note this contract conversion period will be executed at no additional cost to the City. Important components of the implementation plan are listed below: Page 2 of 9 346 A & Associates will wait to begin any activity within the Contract Award transition plan until the Board has made an official Notice of Award for this bid to our firm. Complete Transition Plan Pre -contract conference with stakeholders to confirm meeting of expectations in conversion. Assign Project Introduce A & Associates management team to the City and Management Team establish open lines of communication. Re-examine all bid and contract documentation to create and Compliance Assessment outline compliance requirements, like submittal of certificate of insurance. Payroll and Billing A & Associates is implementing a web -based timekeeping Software Set-up system for staffing services delivered to the City. Utilization of sourcing and hiring strategies to advertise and to Recruitment continue to attract a large pool of candidates for the City open job orders. A & Associates will continue to work with candidates and refer Background Clearance for the City badges evidencing clearance of the Level II background check. We will complete other screenings for new staff including a drug test. Training and Orientation Our firm will remain committed to training. Pre- and In -Service On- A & Associates will begin weekly unscheduled inspections to Site the City Visits various City sites to engage with temporary staff and ensure their continuation in the temporary assignment Page 2 of 9 346 This plan focuses on key contract elements, allowing for a successful transition: • Operations—client meetings, mapping client locations, assigning key staff, preparing job advertisements, and establishing a chain of command. • HR/Recruiting and Training — confirming uniforms, determining staffing levels, hosting hiring events, new employee onboarding and incumbent client coordination. • Administrative—form creation, insurance additions, payroll system set-up, billing/invoicing set-up and review of contractual obligations. Page 3 of 9 347 31V on WE: Transition Timeline Jentify Office Space and Office Needs (if pplicable) ransition Team Meeting/Contract Review ransition Team Meets with Client our Sites, Acquire Locations Information eview/Establish Service Expectations stablish/Confirm Client Specific Job teview Emergency Plan, P&P's, and Roles :stablish Administrative Need w/ Corp Office :stablish Team Member Rules/Regulations :stablish Local Office dentify Key Positions (Event/Non-Event Days) teview Appearance Standards dentify Key Training Points ;et Meeting Schedule for Transition Period nitialize Scheduling System (existing staff) dentify Potential Need for Recruiting nitialize Recruiting/Hiring Plan dentify Site Specific Training dentify and Create Training Needs/Plan :onfirm Staffing Request Procedures Irocure Equipment/Uniforms 3egin Hiring Process schedule Training Dates airing Process (Initial & Ongoing) 3egin Training Orientations :onduct Supervisor Training and Orientations Zuality Control Checks ;ontinued New Hire Training and Venue )rientations ;ontinued On-The-Job/Venue Specific Training We hope this plan demonstrates how important new account start-up planning is to the success of our client relationship. With over fifteen (15) years of experience implementing transition plans for new accounts, we manage the process seamlessly. Our Staffing Practices A & Associates employs a professional team of account managers and recruiters who work to understand the City need, campus cultures and job openings. We identify candidates through direct recruiting, online marketing, and job fairs. Through our Applicant Tracking System, A & Associates maintains a detailed profile on each candidate, including screening and assessment Page 4 of 9 348 31V on WE: results on skills, education, and reference checks. Do not mistake A & Associates as a simple resume source. We are natural job coaches and career builders. Our method for service delivery begins with a strong focus on people and recruiting. We leverage resources which are immediately available, such as, a profound database of associates, strong location knowledge, and a professional network of community organizations to attract more candidates and provide the best services to the City. This methodology will allow for a more in-depth staffing process allowing A & Associates to find the right candidate, with the right skill set, for the right job. We will place the right people to help the City carry out operational plans while we closely manage the staffing process. Going beyond expectations is a part of our proven approach. In addition, our infrastructure for the City account will be based on the following staffing practices: Hiring — Recruiting at A & Associates is about putting the right candidate in the right job. Our systems are designed around evidence -based hiring practices. We understand a good fit is critical, so we will increase our scrutiny in selecting new candidates. We know they are our product and represent our company, our values, and ultimately, our client. We recognize the importance of not only having enough team members but having enough quality team members. A quality team member would have an attitude focused on customer service. The hiring process includes, benchmarks, such as, pre -qualification for position, completion of application, individual interview, screening, onboarding, and new employee orientation. Communication - Optimal productivity in the workplace through effective communication that results in successful collaboration is our goal. Communication is even more critical when we have challenging results to share about temporaryjob openings. A & Associates is committed to high levels of verbal and written communication with temporary associates and the City. We speak with each the City Manager every day when there is an open job order. We administer quality assurance calls to make sure temporary associates are performing at client satisfaction levels. • Personnel Conduct — Customer service is a key priority object for A & Associates and as such it is important that all staff follow procedures adopted and agreed by the City. Customer service is an attitude, not a skill and it is the responsibility of all employees to ensure they provide the highest quality of service that resource levels allow. Our customers can count on reliable, efficient services because we strive to meet these demands when and where possible. We will continually strive to improve services, by ensuring good communication and a positive attitude to Managers and students. Our customer care standards will be reviewed regularly, and new standards set so that we can continue to improve services. • Weapon Free Workplace - In order to ensure a safe environment for employees and customers, A & Associates prohibits the wearing, transporting, storage, or presence of firearms or other dangerous weapons in our facilities or on customer property. Any employee in possession of a firearm or other weapon while on our facilities/property or Page 5 of 9 349 31V on WE: while otherwise fulfilling job responsibilities will face disciplinary action including termination. Possession of a valid concealed weapons permit authorized by the State of Texas is not an exemption under this policy. • Knowledge Testing - A & Associates employs a stringent and mandatory candidate screening system including an in-depth face-to-face behavioral interview, education verification, reference checks, criminal background and National Sex Offender Registry screenings, 1-9 compliance, as well as all knowledge base assessments. To ensure the associates we assign have the knowledge and experience to do the job, A & Associates uses online skills assessments. Our skills and knowledge assessments test employees to assess their current skill level. We use standard skill test for Clerical temporary jobs, such as: (a) Basic Office Skills, (b) Interpersonal Skills, (c) Microsoft Application Skills. Employees are required to qualify on various subjects prior to placement with a client. In cases where staff do not meet the minimum requirements, we use our online skills testing system to generate a training report so the employee can work on the skills needed to potentially apply again in the future. • Training Procedures - A & Associates delivers comprehensive training at all levels so that we may provide fully trained skilled temps who are prepared to handle the daily challenges of the workplace. We believe it is critical to thoroughly prepare an individual prior to site placement and important to develop them through ongoing, continual training. We realize that continuous, effective training is the key to provide a quality service to our customers. We will work extremely hard to have the lowest turnover rate possible through actively monitoring and training professionals via training sessions, informational updates regarding the site, on-site collaboration with management and by abiding the Standard Operating Procedures established for the City. To assure the superiority and receptiveness of A & Associates employees, we require continuous effective in-service training. Employees are given vigorous on-the-job specific guidance as each location specifications may differ. Our staff is carefully taught how to fulfill their responsibilities. They are required to complete training sessions each month with managers and site -supervisors to evaluate their performance for continuous service. In addition, our staff will receive specific training that enhances their interaction with the public in a manner that is professional, friendly, courteous, and diplomatic. Our trainers will focus mainly on the needs of new employees, and make sure that each and every temporary associate is fluent in all things to do with the City to stay compliant. Our main focus during training is to ensure all of temporary associates at the City are prepared to assist. Staffing Service Deliverables A & Associates is prepared and equipped to provide a realistic employment program for the City bid for temporary personnel staffing services. We understand and will fulfill all the contractual obligations outlined in the bid. A & Associates has reviewed the City bid for temporary personnel services in detail and agree to meet or exceed the specifications of the project. All stated requests and requirements will be complied with 100 percent. In the following paragraphs, we will outline our service deliverables. We have customized our Page 6 of 9 350 31V on WE: employment solutions to ensure the best possible services are delivered. As a response to your requirements, A & Associates is prepared to: Furnish stable, trained, uniformed employees for the various site locations and to fulfill various job functions. The personnel will be employees of A & Associates. We will pay all wages, expenses, payroll taxes, federal and state unemployment insurance, and other similar expenses for our employees. We will comply with all federal state and local employment laws, rules, regulations, ordinances relative to such employees, including with limitation wage and hour laws, workers compensation laws, immigration laws, equal employment opportunity laws, and occupational health and safety laws. Ensure prior to site assignment, all personnel assigned to this project will possess all personal licenses, certifications, accreditations, and other credentials as required by the City, OSHA, and the State. Skilled associates working under this contract will, at all times, while on duty, have in their possession a valid Picture Identification Card issued by A & Associates. • Make certain skilled associates on duty conduct themselves at all times with a friendly and helpful attitude. • Supply all staff with the support necessary to perform the services required by the contract. Associates will always demonstrate a professional appearance in the designated uniform. • Fulfill complete comprehensive training, to meet or exceed the City requirements, for every staff member, within the 90 -day probationary period. We will use a combination of classroom and on-the-job delivery methods, which will only be conducted by a qualified training instructor. • Provide necessary supervision of employees assigned to work at the various job site locations. • Assign an Account Manager to act as the primary line of communication between A& Associates and the City. The Account Manager will maintain schedules and ensure that all shifts are covered. The Account Manager will work with the City to make scheduling recommendations if the need arises. • Provide ongoing, attentive, and responsive local and corporate management support. The management team that will be responsible for this project and will include, but not be limited to, the President, Vice President, Controller, Account Manager, HR Manager, Training Instructor, Field Supervisors and Office Clerks. Page 7 of 9 351 31V on WE: Maintain appropriate records for all skilled staff assigned to this project. A & Associates will permit the City to review such records whenever required. In collaboration with the City, develop comprehensive policies and procedures, and require that all personnel adhere to and execute the policies and procedures at all times. Once approved, copies of the policies and procedures will be issued to all staff. Level of Assistance A & Associates contains 100% responsibility for supervising and managing temporary staffing services for customers. We will implement the level of management and administrative activity necessary to ensure that each employee is performing duties in a safe and efficient manner and each location is staffed in accordance with the City requirements. The City will never be obligated to exercise supervisory authority over employees. Project Management personnel will make random unannounced inspections at various departments. They will remain keen on deflecting impending issues that have the potential to bubble to the surface and create dispute. Through our high standards of professionalism, Staffing Managers and Recruiters will work to rectify conflicts and correct flaws immediately. A & Associates actively implements measures aimed at improving our premiere staffing program. Our management team has a comprehensive understanding of the principles, practices, and standards of safety, known as industry best practices, that are applied to facilitate successful program execution. With this leverage, rest assured A & Associates can satisfy your needs Staffing Time of Completion A & Associates will provide trained and capable temporary staff in accordance with bid requirements through our large pool of over four hundred (400) temporary associates ready -to - work in the positions outlined in the bid. We are equipped to provide additional staff to fill assignments within one (1) to two (2) hours following the receipt of notification by the City. We can fill over one hundred (100) temporary jobs within 48 -hours of receiving the request. In addition, we will supply additional staff for special or unforeseen projects as they arise. We have the ability to increase staffing levels immediately, by contacting in -reserve badged and trained associates for assignments. We are strategic in recruiting temporary associates within surrounding counties to ensure associates are available for hard -to -fill temporary assignments due to location and transportation. To guard against no shows by temporary employees, A & Associates will determine and added percentage ratio for the daily staffing needs. Staff attrition is carefully monitored by A & Associates managers and based on a variety of factors like weather, holidays, tax return payments, the City permanent hiring needs and special events employees work with other clients. This process helps to ensure we are not short-staffed, and it allows for the swift replacement of temporary associates, when required. A & Associates will work with the City to address both last-minute increases and decreases in staffing levels. The first step to ensure adequate coverage for an account like this, is to expect the need for on-call staff and train such persons to fill this need. All temporary employees are required to be on their assigned location, in complete uniform, at the start of their assigned shift. If a staff is late or cannot arrive for their assigned shift, he or she is required to provide as Page 8 of 9 352 31V on WE: much notice as possible by phone call to our office. This is immediately communicated to managers and lead supervisors so replacements can be assigned same day. A & Associates will ensure each person listed in this bid is available and committed to fulfilling their assigned roles for the City account. Upon receiving a call from the City, the managerial team shall respond within one (1) hour by way of telephone and be on-site at a City location within two (2) hours of the official request. We do not see this project as being one that warrants concerns, but we always take precaution, nevertheless. A & Associates monitors all placements, serving as a strong liaison between the City and the temporary employees. The purpose of monitoring these jobs is to make sure associates show—up when scheduled and managers are pleased with the temporary associate performance. Page 9 of 9 353 X DH,3 OFFICE OF PROCUREMENT SERVICES BUSINESS INFORMATION FORM City of Dallas LEGAL NAME AND ADDRESS OF BUSINESS Business Name: A & ASSOCIATES, INC. Parent Company: N/A Length of time in business: 10+ YEARS Tax Identification No.: 80-0668811 Texas Tax ID No.: SAME Street Address: 4131 N CENTRAL EXPRESSWAY City, State, Zip: DALLAS. TX 75204 Telephone No.: 888-402-2950 E-mail Address: EVELYN @ASSOCIATES FORM OF BUSINESS ENTITY (please check Texas Corporation ❑ Texas General Partnership ❑ Out -of -State Corporation ❑ Out -of -State Partnership ❑ Individual Doing Business As: ❑ Other "Texas Professional Corporation ❑ Texas Limited Partnership State of Incorporation: FL U Texas Non-profit Corporation ❑ Texas Limited Liability Company ❑ Profit X ❑ Non-profit State of Legally Registered Partnership: OFFICER(S) OF THE COMPANY Name: MR. ANDREW LUCHEI Title: PRESIDENT Name: MS. EVELYN LOONEY Title: VICE PRESIDENT Name and title of person(s) legally authorized to sign contracts: Name: MR. ANDREW LUCHE' Title: PRESIDENT Name: MS. EVELYN LOONEY Title: VICE PRESIDENT COOPERATIVE PURCHASING (please check one) Should other governmental entities decide to participate in this contract, would you, the vendor, agree that all terms, conditions, specifications, and pricing would apply? X [:]YES ❑ NO If you checked "YES," the following will apply: • Governmental entities utilizing Inter -Governmental Contracts with the City of Dallas will be eligible, but not obligated, to purchase material/services under a contract(s) awarded as a result of this solicitation. • All purchases by governmental entities, other than the City of Dallas, will be billed directly to that governmental entity, and paid by that governmental entity. • Each governmental entity will order its own material/services, as needed. The City of Dallas will not be responsible for another governmental entity's debts. LOCAL PREFERENCE CONSIDERATION (please check one) This preference is applicable only to Request for Bids (RFB): X ❑YES, I meet the requirements for local preference. ❑ NO, I do not meet the requirements. Please see Section 19 of the General Terms and Conditions for more information. ENVIRONMENTAL POLICY (please check) X LJYES, I acknowledge and agree to comply with the City's Environmental Policy found at the following link: https://dallascityhall.com/departments/OEQ/Pages/contractors.aspx OPS -02 2/27/202(' Rev. 1 - 02/27/2020 Page 1 of - 354 DH,3 OFFICE OF PROCUREMENT SERVICES CONFLICT OF INTEREST POLICY City of Dallas It is the City of Dallas' practice to obtain a conflict of interest form from every individual or business entity that is currently doing business with the City or before being considered for award. This practice is intended to comply with the requirements under chapter 176 of Texas Local Government Code: Conflict of Interest During the 79th Legislative Session, House Bill 914 was approved, which added chapter 176 to the Texas Local Government Code. Chapter 176 mandates the public disclosure of certain information concerning persons doing business or seeking to do business with the City of Dallas, including affiliations and business and financial relationships such persons may have with City of Dallas officers. An explanation ofthe requirements of chapter 176, applicable forms and a complete text of the new law are available at: http://www.ethics.state.tx.us/whatsnew/conflict forms.htm. The vendor acknowledges by doing business or seeking to do business with the City of Dallas that he/she has been notified of the requirements under chapter 176 of the Texas Local Government Code and that he/she is solely responsible for complyingwith the terms and conditions therein. Furthermore, any individual or business entity seeking to do business with the City of Dallas who does not comply with this practice may risk award consideration of any City contract. OPS -07 2/14/2020 Rev. 0 - 02/14/2020 Page 1 of 1 355 CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ For vendor doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who Date Received has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code. A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An Tense under this section is a misdemeanor. 1 Name of vendor who has a business relationship with local governmental entity. D & ASSOCIATES 2 Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated you became aware that the originally filed questionnaire was incomplete or inaccurate.) 3 Name of local government officer about whom the information is being disclosed. Name of Officer 4 Describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer. Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form CIQ as necessary. NONE A. Is the local nment officer or a family member of the officer receiving or likely to receive taxable income, other than inve income, from the vendor? Pt Yes F R-1 No B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer or a family member of the officer AND the taxable income is not received from the local govern m tal ntity? Yes o 5 Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership interest of one percent or more. F-1NONE 6 as des i d in &ctio 176. 0 (2) ), e cluding gifts described in Section 176.003(a-1). 7 Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 356 STIM ON U. Signature of vendor doing business with the governmental entity Date Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 357 CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity A complete copy of Chapter 176 of the Local Government Code may be found at http://www. statutes.Iegis.state.tx.us/ Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form. Local Government Code 4 176.001(1-a): "Business relationship" means a connection between two or more parties based on commercial activity of one of the parties. The term does not include a connection based on: (A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an agency of a federal, state, or local governmental entity; (B) a transaction conducted at a price and subject to terms available to the public; or (C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and that is subject to regular examination by, and reporting to, that agency. Local Government Code & 176.003(a)(2)(A) and (B): (a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if: (2) the vendor: (A) has an employment or other business relationship with the local government officer or a family member of the officer that results in the officer or family member receiving taxable income, other than investment income, that exceeds $2,500 during the 12 -month period preceding the date that the officer becomes aware that (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor; (B) has given to the local government officer or a family member of the officer one or more gifts that have an aggregate value of more than $100 in the 12 -month period preceding the date the officer becomes aware that: (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor. Local Government Code § 176.006(a) and (a-1) (a) A vendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship with a local governmental entity and: (1) has an employment or other business relationship with a local government officer of that local governmental entity, or a family member of the officer, described by Section 176.003(a)(2)(A); (2) has given a local government officer of that local governmental entity, or a family member of the officer, one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B), excluding any gift described by Section 176.003(a-1); or (3) has a family relationship with a local government officer of that local governmental entity. (a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator not later than the seventh business day after the later of: (1) the date that the vendor: (A) begins discussions or negotiations to enter into a contract with the local governmental entity; or (B) submits to the local governmental entity an application, response to a request for proposals or bids, correspondence, or another writing related to a potential contract with the local governmental entity; or (2) the date the vendor becomes aware: (A) of an employment or other business relationship with a local government officer, or a family member of the officer, described by Subsection (a); (B) that the vendor has given one or more gifts described by Subsection (a); or (C) of a family relationship with a local government officer. Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 358 T101 F. DH,3 OFFICE OF PROCUREMENT SERVICES LIVING WAGE AFFIDAVIT City of Dallas VENDOR INFORMATION Business Name: A & ASSOCIATES LIVING WAGE REQUIREMENTS Dallas City Council Resolution 15-2141 requires prime contractors awarded general service contracts, where service is valued to be greater than $50,000, and first-tier subcontractors on the contract, to pay their employees (the term employee includes all those performing services on this contract. The relationship of employment is determined by the vendor), no less than the "living wage" rate, as set by the Massachusetts Institute of Technology Living Wage Calculator, or its successor, for Dallas County, Texas. This requirement does not apply to a contract for goods only, professional services, or construction contracts. By signing this affidavit, the contractor agrees to the following: X❑ Pay employees not less than Living Wage rate for the duration of time committed in executing specified services on the contract (current Living Wage rate is $11.71). X❑Provide communication, in writing, to all persons involved in a City of Dallas general service contract, communicated in a similar manner as the attached sample announcement. Any employee under this contract and not receiving a wage floor as specified in the Living Wage policy, shall contact the City of Dallas' Office of Procurement Services office (214-670-3326). X❑To keep records of all employees, and their hourly rates, and will provide this information when requested, as well as allow the City to audit payroll registers, and all other information the City deems necessary to determine compliance of the Living Wage policy. X❑If contract is renegotiated or renewed it is agreed that the Living Wage rate at the time of the renewal will prevail (updated Living Wage rate, if applicable) X❑ Records shall be kept in the following format: No. of Employees on COD Contract I Employee Name I Employee Zip Code I Wage Rate Paid to Employee The signer must be a company officer and authorized to legally bind the business entity referenced herein. la� iAcGQ,�� 01/07/2021 AuthorVzed S nature Date MS. EVELYN LOONEY VICE PRESIDENT Printed Name Title OPS -03 1/14/2020 Rev. 0 - 12/05/2019 Page 1 of 1 359 I Minority Business Enterprise (MBE) A& ASSOCIATES, INC. DBA A&A A & ASSOCIATES, INC. DBA A&A has filed with the Agency an Affidavit as defined by NCTRCA Minority Business Enterprise (MBE) Policies & Procedures and is hereby certified to provide service(s) in the following areas: NAICS 561320: TEMPORARY STAFFING SERVICES This Certification commences October 27, 2020 and supersedes any registration or listing previously issued. This certification must be updated every two years by submission of an Annual Update Affidavit. At any time there is a change in ownership, control of the firm or operation, notification must be made immediately to the North Central Texas Regional Certification Agency for eligibility evaluation. Certification Expiration: October 31, 2022 Issued Date: October 27, 2020 CERTIFICATION NO. BMM13005831\11022 Certification Administrator 0*f ST10 01 F. D'/ D1 CITY OF DALLAS ETHNIC WORKFORCE COMPOSITION REPORT (Note: Please use the Tab button, mouse or arrows to move from one section to the next. Please DO NOT use the "Enter" key.) Company name: A & ASSOCIATES Address: 4131 NORTH CENTRAL EXPWY Bid #: BDZ21-00015158 Telephone Number: 888 - 402 - 2950 Ext. 100 Email Address: EVELYN@ASSOCIATESTAFFING.COM Please complete the following sections based on the ethnic composition of the (location) entity in the address line above. Employee Classification Total No. Emplo ees White Black Hispanic Other Male Female M F M F M F M F Administrative/ Managerial 8 18 2 2 5 12 0 4 1 0 Professional 30 45 15 5 9 21 5 15 1 4 Technical 0 0 0 0 0 0 0 0 0 0 Office/Clerical 10 65 1 14 6 40 3 11 0 0 Skilled 9 0 4 0 3 0 2 0 0 0 Semiskilled 200 25 35 0 110 18 45 7 10 0 Unskilled 275 50 30 4 145 26 75 35 10 0 Seasonal 80 220 10 25 50 110 15 75 5 10 Totals: 612 423 97 50 328 227 145 147 27 14 # of employees living in Dallas: 0 5 0 1 j 0 j 3 j 0 j 1 j 0 j 0 Total % of employees living in Dallas 0.67 — Officer's Signature MS. EVELYN LOONEY Typed or Printed Name VICE PRESIDENT Title 01/07/2021 Date Revised — 5/13/2020 361 Doc#OBD-FRM-627 S 0 M Success: All data is valid! 362 STIM ON F. 363 1* CD M O o 0 0 0 0 C) LO LQ I -i 00 O r� M M � O O N M EA 64 Q Q. V1 i U1 L L L O 4 Cc 3 O O = y O o� N oma° O O m m cn N > .O O CD Q Q CLf/1 N d V V N N Primary Responses Success: All data is valid! 365 EXHIBIT 4 EXHIBIT C Acknowledgment of Sanitation Vehicle Surveillance I understand that the City of Dallas engages in surveillance activities of its Sanitation fleet vehicles, including in -cab and exterior video and audio recording and live monitoring, for the purposes of encouraging safer driving practices to enhance driver and passenger safety and the safety of the community, to protect employees from and reduce financial threats from false allegations of employee misconduct, to reinforce driver accountability, and for overall service delivery. Audio and video recordings and telematic data are reviewed regularly including, but not limited to, for positive service verification, service complaints, spot checks and following automated alerts and incidents. I acknowledge and understand that I have no expectation of privacy within and in the vicinity of Sanitation fleet vehicles, that my acknowledgment and consent is a condition to operating and/or occupying a Sanitation fleet vehicle, and I consent to the video and audio surveillance. I understand that if I do not sign this form I may not operate, or be a passenger in, Sanitation vehicles and that dismantling, destroying, or altering the view of the camera inside the cab or outside the cab, and any other safety violations or misconduct observed, may result in termination of my temporary work assignment with the City of Dallas Department of Sanitation. Employee Signature Printed Name Date SAN-FRM-001.FLT Effective 5/19/2021 Rev. 2 367 EXHIBIT owl .: EXHIBIT C Insurance Requirements SECTION A. CONTRACTOR shall procure, pay for and maintain the following insurance written by companies approved by the State of Texas and acceptable to CITY. The insurance shall be evidenced by delivery to the CITY, at the address shown in SECTION C (a), certificates of insurance executed by the insurer or its authorized agent stating coverages, limits, expiration dates and compliance with all applicable required provisions. The CITY shall be named as an additional insured by endorsement to the policy and thus will be entitled to notice of cancellation of the policy in accordance with Section 1811 of the Texas Insurance Code. Upon request, the CITY shall be entitled to receive without expense, copies of the policies and all endorsements. CITY HAS NO DUTY TO PAY CONTRACTOR UNTIL SUCH CERTIFICATE HAS BEEN DELIVERED TO THE CITY. SECTION B. The CITY reserves the right to review the insurance requirements of this section during the effective period of the services or work performed by CONTRACTOR and to modify insurance coverages and their limits when deemed necessary and prudent by City's Office of Risk Management based upon changes in statutory law, court decisions or other relevant factors. The CONTRACTOR shall acquire and ensure execution of requests for deletions, revisions or modifications of particular policy terms, conditions, limitations, or exclusions (except where policy provisions are established by law or regulation binding upon either CITY or CONTRACTOR). SECTION C. REQUIRED PROVISIONS The CONTRACTOR agrees, with respect to the required insurance as documented below, all certificate(s) of insurance will contain and state, in writing, the following required provisions: a) The certificate of insurance or policy and endorsements shall be evidenced by delivery to: (i) Office of Procurement Services, Attention: Melissa Anderson, Dallas City Hall, Dallas, Texas 75201 and (ii) Director, Office of Risk Management, 1500 Marilla, 6A -South, Dallas, Texas 75201. b) All certificates of insurance shall identify the service or product being provided, by including the bid number and contract or solicitation name. c) All certificates of insurance shall name the City of Dallas as the Certificate Holder. 11/17/2020 ORM-FRM-505 REVA 10/10/2018 Industrial and Day Temporary Labor BD21-00015158 Page 1 of 5 RR -211113 -POM -2844 369 EXHIBIT C Insurance Requirements SECTION D. INSURANCE COVERAGE REQUIRED Subject to CONTRACTOR'S right to maintain reasonable deductibles, CONTRACTOR shall obtain and maintain in full force and effect for the duration of its engagement with the CITY and any extension hereof, at CONTRACTOR'S sole expense, insurance coverage in the following types) and amounts: WORKERS' COMPENSATION and EMPLOYERS' LIABILITY Workers' Compensation within the regulations of the Texas Workers' Compensation Act. The minimum policy limits for Employers Liability are: Bodily Injury by Accident: $1,000,000.00 Each Accident Bodily Injury by Disease: $1,000,000.00 Each Employee Bodily Injury by Disease: $1,000,000.00 Policy Limit The policy shall include: a) An endorsement to waive subrogation in favor of the City of Dallas, its officers, employees and elected representatives, for bodily injury (including death) or any other loss. b) An endorsement to provide thirty (30) days prior written notice in the event of cancellation to the address as shown in Section C, a (i) and (ii), or in accordance with Section 1811.155 of the Texas Insurance Code, Notice of Cancellation in accordance with the Notice of Insured in the policy for cancellation due to non-payment of premium. NOTES: i. If CONTRACTOR will not be providing services under the contract at a City facility, has no employees and/or is operating as a sole owner and single operator, CONTRACTOR shall provide a signed letter, with the current date, on official letterhead stating such to meet the requirement. ii. If CONTRACTOR is a non -subscriber or is self-insured, CONTRACTOR shall provide a copy of its Certificate of Authority to Self -Insure from the Texas Department of Insurance, Division of Workers' Compensation Self Insurance Regulation Program, evidence of alternative coverage and internal safety and injury coverage policies and procedures. 2. BUSINESS AUTOMOBILE LIABILITY INSURANCE If vehicles will be used in the performance of services under the contract, then Business Automobile Liability Insurance covering owned, hired, and non - owned vehicles, with a minimum combined single limit for bodily injury (including death) and property damage limit of $ 500,000.00 per occurrence. The policy shall include a) An endorsement naming the City of Dallas and its officers, employees and elected representatives as additional insureds. 11/17/2020 Industrial and Day Temporary Labor BD21-00015158 ORM-FRM-505 REV.4 10/10/2018 Page 2 of 5 RR -211113 -POM -2844 370 EXHIBIT C Insurance Requirements b) An endorsement to waive of subrogation in favor of the City of Dallas, its officers and employees, for bodily injury (including death), property damage or any other loss. c) An endorsement to provide thirty (30) days prior written notice in the event of cancellation to the address as shown in Section C, a (i) and (ii), or in accordance with Section 181 1.155 of the Texas Insurance Code, Notice of Cancellation in accordance with the Notice of Insured in the policy for cancellation due to non-payment of premium. d) Provide that CONTRACTOR'S insurance is primary insurance as respects the CITY, its officers, employees and elected representatives. NOTE: i. If CONTRACTOR has no owned, hired and non -owned autos or vehicles and/or no autos or vehicles will not be used in the performance of services under the contract, CONTRACTOR shall provide a letter on official letterhead stating such to meet the requirement for owned autos. 3. COMMERCIAL GENERAL LIABILITY INSURANCE Commercial General Liability Insurance including, but not limited to, Premises/Operations, Personal & Advertising Injury, Products/Completed Operations, Independent Contractors and Contractual Liability with minimum combined bodily injury (including death) and property damage limits of $1,000,000.00 per occurrence, $2,000,000.00 products/completed operations aggregate, $2,000,000.00 general aggregate. The policy shall include: a) An endorsement naming the City of Dallas and its officers, employees and elected representatives as additional insureds. b) An endorsement to waive subrogation in favor of the City of Dallas, its officers and employees, for bodily injury (including death), property damage or any other loss. c) An endorsement to provide thirty (30) days prior written notice in the event of cancellation to the address as shown in Section C, a (i) and (ii), or in accordance with Section 181 1.155 of the Texas Insurance Code, Notice of Cancellation in accordance with the Notice of Insured in the policy for cancellation due to non-payment of premium. d) Provide that CONTRACTOR'S insurance is primary insurance as respects the CITY, its officers, employees and elected representatives. e) If this insurance is written on a claims -made form, coverage shall be continuous (by renewal or extended reporting period) for not less than twenty-four (24) months following completion of the contract and acceptance by the City. Coverage, including any renewals, shall have the same retroactive date as the original policy. 11/17/2020 Industrial and Day Temporary Labor BD21-00015158 ORM-FRM-505 REV.4 10/10/2018 Page 3 of 5 RR -211113 -POM -2844 371 EXHIBIT C Insurance Requirements SECTION E. SUBCONTRACTING LIABILITY (1) Without limiting any of the other obligations or liabilities of the CONTRACTOR, the CONTRACTOR shall require each Subcontractor performing work under the contract, at the Subcontractor's own expense, to maintain during the engagement with the CITY, types and limits of insurance that are appropriate for the work being performed, comply with all applicable laws and are consistent with industry standards. The Subcontractor's liability insurance shall name CONTRACTOR as an additional insured. (2) CONTRACTOR shall obtain and monitor the certificates of insurance from each Subcontractor. CONTRACTOR must retain the certificates of insurance for the duration of the contract and shall have the responsibility of enforcing insurance requirements among its subcontractors. The CITY shall be entitled, upon request and without expense, to receive copies of these certificates. SECTION F. CONTRACTOR LIABILITY Approval, disapproval or failure to act by the CITY regarding any insurance supplied by CONTRACTOR or its subcontractors shall not relieve CONTRACTOR of full responsibility or liability for damages and accidents as set forth in the contract documents. Neither shall the bankruptcy, insolvency nor denial of liability by the insurance company exonerate CONTRACTOR from liability. SECTION G. INDEMNITY CONTRACTOR agrees to defend, indemnify and hold the CITY, its officers, agents and employees, harmless against any and all claims, lawsuits, judgments, costs and expenses for personal injury (including death), property damage or other harm for which recovery of damages is sought, suffered by any person or persons, that may arise out of or be occasioned by CONTRACTOR'S breach of any of the terms or provisions of its engagement with the CITY, or by any negligent or strictly liable act or omission of CONTRACTOR, its officers, agents, employees, or subcontractors, in CONTRACTOR'S performance under its engagement with the CITY; except that the indemnity provided for in this paragraph shall not apply to any liability resulting from the sole negligence or fault of the CITY, its officers, agents or employees and in the event of joint and concurrent negligence or fault of CONTRACTOR and the CITY, responsibility and indemnity, if any, shall be apportioned comparatively in accordance with the laws of the State of Texas, without waiving any governmental immunity available to the CITY under Texas law and without waiving any defenses of the parties under Texas law. The provisions of this paragraph are solely for the benefit of the parties hereto and are not intended to create or grant any rights, contractual or otherwise, to any other person or entity. CONTRACTOR (COMPANY NAME): BY: 11/17/2020 Industrial and Day Temporary Labor BD21-00015158 ORM-FRM-505 REVA 10/10/2018 Page 4 of 5 RR -211113 -POM -2844 372 EXHIBIT C Insurance Requirements Signature of Authorized Representative NAME: Name of Authorized Representative (please print) X7-1111141 11/17/2020 ORM-FRM-505 REVA 10/10/2018 Industrial and Day Temporary Labor BD21-00015158 Page 5 of 5 RR -211113 -POM -2844 373 Memorandum CITY OF DALLAS DATE January 10, 2022 TO Melissa Anderson Office of Procurement Services SUBJECT CERTIFICATE OF INSURANCE Vendor: A & Associates, Inc. Name of Project: Industrial and Day Temporary Labor RR -211113 -POM -2844 Project /Bid Number POM -2021-00015158, BD21-00015158 We have reviewed the certificate(s) of insurance for the project and contractor shown above and have found them to be in compliance with the insurance requirements of the contract. To ensure the accuracy of our records and to ensure appropriate monitoring of this contract, please advise the end date for this project. If the end date changes, please update our office on the changed date to ensure insurance is monitored through the life of the contract. Please call me at 214-243-1137 should you have any questions. '�,- �C--C"._.-� Pamela Parnell Senior Risk Analyst Office of Risk Management "Our Product is Service" Empathy I Ethics I Excellence I Equity 374 CERTIFICATE OF LIABILITY 1 S IICE Q1 X1),3'2(122 THIS CERTIRC,TE IS ISSUED AS A MATTER OF INFORMATrDN ONLY ANDCONFERS NO RIGHTS UPON THIE CERTIFICATE HIOLOSR, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,, EXTFND OR ALTER THE COVERAGE AFFORDED BY THE POLIQ CIES BELOW. THiS CERTIFICATE OF INSURANCE DOES, NOTCONS71TUTE A CONTRACT BETWEEN THE ISSUING INSURER(SI, AUTHORMED REPRESENTATIVE OR:FRODILIOER, AND THE CERTIFICATE HOLDER. - IMPbkTA- -.'-I!j'j7; '(. W' W,e,rtificate Ilolder IS all ADDITIONAL INSURED, the pohcy(ii0�) limowA have ADD14TIONAL INSURED Iprovisions or be, e.115;15.51 11 SUSROGATI ON IS WAIVED, subject to the termts wad con&lioms of V* policyj, ceirlail4t palicips May reqUirig an endorse.-ment. A statemepit on the cel rlificala duos not chafer rights Io the certMczte holder in keu of suc:h RR0,13UTER! GOWA NAIVE %4,EG7,A1N LLJtl,'HF1wl A & A Senvk:eslr,t- bic, AX (kc, No "L, W: SanSbUrysA�'iy FWAIK, A AAVy:SURAM.-,ES,.0O3M SL4te 20,4 09 UIRE _ F- �VJN,6COVIERAGE MOMIG t Fri„n ralan Becaich EVEFIESJ T,0120 Ar ra, MSURER 2��,RE V'INSURAM','E C'OK4PAN 101 9 3 A ASSOC MT E S INC MSURER C E-VER11EST NAT111,C)NA1 014SUR,40,410E COMPAN"Y” 20 o,jsu4i-,,R r) S jtQ2 INIS U PANC E 0 OM PIA, NY 3I a 4? f -S2 9�� I S@nsburw; 'K@y INSURER 6, V`Vt"-!LJf f"alm beach . ............. . .. FL 3J41'1 N SURER F .......... COVERAGES CERTIFICATE NUMIBER.� REVISION NUMBER- �&i7- CFR71FY 7H,A17HF N-`�kJC,�L'-"C0 LfSIED FA,, 1b'SLfl::D �O PiL. ��NZ�URFD NAAAFj,',, A80VI V:C)IR POU,7,e P14,I)IOXTED, NOTAI'� rHSTANDMG: ANY TFRM OR� IDOII�VTON 0,,F CCIVRX�7 �,0R 07HEREXDCLAAE N7 V107H RE$PPF,.,7 1�0 AHli-1i M�s CERTIFICATE LAW/ RF OR Pt)-7,TAAN, �HL ING�RA,'4CL AFRDRD�ID B'( THF,,, PCI, 6C1t13 DL3CR!,EED HFRFB`S IS ZDJEJLC� TO Al -A TH-"-- TFR\V,,,, AND UONDMONS OF SLCH FICIJCiE��- ,-AVTN� IAA P -,/,VL REDUCED EY PM['.J lww ADOL SUM TYPE` OF ON -vVRAJMC E a, ... 06L(c'Y ff EX,P LMITS X EACH X EM, - r'T- 21DD ()C310 . . ...... HIRED AIJT0 LIARIL117Y MP Fxl re 1 0 1)()o A V 19 1 ""'Y,.' 1 X105, 122..21 ZQ G22 I 000.00C .......... ... .. . . 4G[.3REr,! A7F �JN�17 APIPt4F. PPIR nTnTT2, 0 C, ID, icO �,:� o Rill x E"i 15 ZCOAP`: )p p,,,;G s ..................... . .. . ......... FIRE LEGk LIAB111117 y 20C) 000 AUITOPOPALE UASIUrY r FN N S SM_LE-AM T 1,000'0 0 X7,- ......... . X P°, fE Y AQ7�, C11A AUPES Y 3 AUTCS C+dl X, Mr.""'., .-P-, Y' y PIP COVERA(.`�E X uVeR ELLA UAS C EXLL%ss L4AH "Y" 'V C I.A.N), t-(4 OSAZ2022, 000 Ot) RETE I47110N 5 .................. WORKERSX 75R AND 6JMPLljyERFj'L!AP1U7Y ;will RAK 1LfVE,,1Ei`1..,- bll- N,�A, E L s. 1,000 ("K00 )PFV::ER NIEIR,014;Vq,� L AC,044, OCC,01, S Rond4pry In vsil 6,,�,cmbr unclim, G,- CPEG,,A710' S bobml,,-1�111-- ............ a1!tltiNr 10 Ck0 0 13 1-1,1ROF N= S51 CrNAL L 1,413k I Y A GG'Rt-:, G,i;,TF- V 'V ,, I01212,021 C5a222022 Cs C C U R, E N 04-'%k�,Okl P WIGN OF OPERATIONS � LOCATIONS� � V8H1rLZ-!5, u,ACORD 111, AoIeNfibnM Rmmmar'*z mp k)* jP mwo �pvie Is vtobiiimdy. Gini ai �d ss�w s hsuranc a P�Ak;y Nu irr, �ber �J, I riAL. N0,3302-20 I pvcA� (,,y OlNcA�,ve 05, 1 2,12G2 I P6 �oy C E, I 'I 2,202,�, vrkggregatc 3,r,,003,00t) CERT[F1C,A7F, Hs,'.),LDEFO, pS FROM SUSRX'iATI(-)rqj J CERTIFICATE HOLDER I SHOULD ANY IAF THE ABOVE DE GRIMED P01.1KNESIE C&NCEILLED, REFOR1. THE EXPIRAniON DATE THEREOF, 1407CE 'WILL SE DELIVERED M ACCOROANCE WITH THE PoJCy PROVISIONS - CB TY +,'.)F DALLA,-5 15�,)0 MarPa "sI. AVTHT,,RWED REPRS$ENTArV1df Ste 6A Su,,AJ-ii TX 76201 A t"-'2D",AC0'DC0,RP0RAr71ON, AlidgIAS res(� 37 CORD (20 1 W03) 25 The ACOID Rmaniu arW Ijogo airo registered ma s, of A,CQR,D 5 211263, WHEREAS, on June 22, 2016, City Council authorized a three-year contract, with two one-year renewal options, for temporary industrial labor for Sanitation Services with Results Staffing, Inc., in an amount not to exceed $20,246,078.16, by Resolution No. 16- 1049; and WHEREAS, on October 26, 2016, City Council authorized a three-year service contract for temporary day labor with Lane Staffing, Inc., in an amount not to exceed $14,783,392.68, by Resolution No. 16-1721; and WHEREAS, on February 13, 2019, City Council authorized Supplemental Agreement No. 1 to exercise the first of two, one-year renewal options to the service contract with Result Staffing Inc. for temporary industrial labor for the Department of Sanitation Services, in an amount not to exceed $8,101,820.00, by Resolution No. 19-0274; and WHEREAS, on January 22, 2020, City Council authorized Supplemental Agreement No. 2 to exercise the second of two, one-year renewal options to the service contract with Result Staffing, Inc. for temporary industrial labor for the Department of Sanitation Services, in an amount not to exceed $9,000,306.00, by Resolution No. 20-0215; and WHEREAS, on February 26, 2020, City Council authorized a one-year emergency service price agreement for temporary day labor citywide with All Temps 1 Personnel; in the estimated amount of $5,584,484.35; and the ratification of $465,373.69 for temporary day labor citywide with All Temps 1 Personnel, in a total estimated amount of $6,049,858.04, by Resolution No. 20-0356. Now, Therefore, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF DALLAS: SECTION 1. That the City Manager is hereby authorized to execute a service price agreement with A & Associates, Inc. (VC23404) in the estimated amount of $54,076,750.00 and Rushmore Corporation dba ALL TEMPS 1 Personnel (VS0000016991) in the estimated amount of $18,031,559.05, approved as to form by the City Attorney, for temporary industrial and day labor for citywide use for a term of five years, in the total estimated amount of $72,108,309.05. The amount payable pursuant to this service price agreement may exceed the estimated amount, but may not exceed the amount of budgetary appropriations for this service price agreement during its term. Payments made to A & Associates, Inc. and Rushmore Corporation dba ALL TEMPS 1 Personnel shall be based only on the amount of the services directed to be performed by the City and properly performed by A & Associates, Inc. and Rushmore Corporation dba ALL TEMPS 1 Personnel under the service price agreement. The City Manager is further authorized, in the City Manager's sole discretion, to exercise an option to extend the agreement for six months by filing a notice of extension with the City Secretary's Office. 376 August 11 2021 SECTION 2. That the Chief Financial Officer is hereby authorized to disburse funds in an estimated amount of at least $72,108,309.05, but not more than the amount of budgetary appropriations for this service price agreement during its term to A & Associates, Inc. and Rushmore Corporation dba ALL TEMPS 1 Personnel from Service Price Agreement Contract No. POM -2021-00015158. SECTION 3. That this resolution shall take effect immediately from and after its passage in accordance with the provisions of the Charter of the City of Dallas, and it is accordingly so resolved. i �M 377 N,"o, ✓>0a IO ;.r1, COPYConlraci>0(01042021AM015158 CAWAVY OF DAIA00 KNOW AI ,l', NTOW BY lIESE PRESENTS: Thar A & Qsociaw, as Florida local addross is 1341 AVEST SUTTE, 600\` v 11,\IIAS, 'FX 75247, hercinaRur Wed Xhidpi, and YPAD S"FATES PME."INSIURAWCC.)MIPANY -0 a corporation organized and exhi[rig undo the Wo of the atnd tally atrfl-mrized' to amman businns in dw We M'Tex, ,s, as Surny, are held and hrdy bound umm the (7ity of'Da1las., a nlurliicip,al corporaLion organiz-,ci and existing, u.ndor the AWS LT Te SWOO of Oxat herakanev caHed Wgw, and umo aH pw-wnq fin' ,;a, and cmpwoMms who Inay furnish rmlterius tor, or perI,orm labor in Wth the (u cmtrru:'t rcf,(,t-red t,c,, in thea penal Sun', 01 TWO "MILLION SEVEN HIODRED THREE THOUSAND EIGF117 111INDICED THIR,r)7 SEVEN AND 50A00 DOLLARS (S2,703,837.50) in AwRO money of %he 'United States, to be paid in Coun1,­,,,,. TCUS'fi"DT the 172yMen, (lf' whodl sum wAl aml imt, u) be rriade, ­wc bind nurselkes, our heirs, excumors, adridnisymors and successors joindy and svwraQ f,innly by thesc, pn,,�,�sents, This R",)nd L`,. G',IL!Wwed by tho amount of any (Mange Chdor or SuppOrnemal Agreement "Mch inc�rc,,.,,ses the, Contact pncK in no evni shall a Clange Wey or SuppOnontal Agreenont which redmns Ke Onvact PKU OCLOM Q POW SM Cf GS 13OW THE c11,LDJ0, I ION TO PAY SAME is condalnelas Ajowy "Tereaq Aw 114c"al erten ""', Wo a cenin Onaraw, identined by RowhWor Numbcr 21 - I WTI to CA" of Dallas, me Wgee "twh cony"I is dmud Ou 1 10 3,ay oCALq;ust, A -D. 200, a copy of yNhkh is hurso AWK and mmic a pan hemot Q- the provijon of temporary staMng indusNal and day hbor scrvius in the Oq am,.1 Wunty of LOW, Oxis, I&W, THEREFCNIQ We 14nelpa� sha!l wcll, tl%iay and faithiuy pcil`orrn .ts duties and lnzd�',c prompt paynnul M ad persons, firms, subcomramorq corporat3ons and clainumis suMAyby Kbor andbr n­,­Atert ,d irt the- prosecudon of tit, NVnrk provided No in said Contract ar,,d ctl and all d,,ily aui.hcrized modEcadony cf a, ally Clnwav that rual hartafin he mad, C,o tfe Surety is hereby exD'c,_ssly then u'his gal Agmion shall bc WO okenyke it shAl rcmain in WH tree an,J irjaa: w, NUDW)EA) FKATHER, Om 1 anylegal action be Alec', cin, �hI s Bond, venue shall Iia in Dallas Fexas, 1'RCA'1L)ED FURTHER. Am is said Surny, Ir vluc reocived, hereby SOPWaLeS and' 4,ha,no k.harrpe, Cxwnston (m Oniq alwraKn ur addhbn to tn,Conlxactw to Qu Wmk palAmed, ­hcn,,undc,r, of Ohc Spedflahuns acconi pan y iq,,? the same. sowl ! in aqwK allbo As obligmion on TIS Bond, and it dous hucloy wake noke of any sudi clangn uxwndan A Qiv AwrOmi or uddkln Lo thc., ternrDs ofth,_ Connacq cn to ihe Work Do W jwrhrmcd thazurider. A Ass aa.�s C moacct it 1 anyvaT !Wov Serdwro - SATamir KNOW Ond:lq f On! P1 gc 1 ,,< 2 378 Nomithsonding the provismns of the Qmacq the bond WE! appiy/ lf.-Ct�n A,tigust 11, 202'l unci i} 10, 2Q22 and nmy he evan0d hy the Sure!y 6y Cominiminn CeWcme or a new Imn! Me, CA to SUX0, Olds To bond and Jcomimalon cc�Qvmn owed in comocom Tvnwoln ti-�o! be cmimA ani W in no ekml axamd the amoun 2S se! Mh in AN bond m P1 any adMons, riders, or vidorsemem properly "by Chu Silc-,'� a� THE S(.'R-21W SIMLL 60 DAYS ��TITTEN NOTICE TO THE OBLIGEE IN T1111 EVIENT SURETY ELECTS NOT TO EXTEND THE TE IVI OF THIS BOND OR 'PR(')V11-)E, \ NE \V BIOND th��; `3orj nust Vc sought on:0) nvn Q ;can of le larmhatimi 0, I Qic CoMraCl. TV WMAuned and jesivatud azent is herehy, doWnwed !,-,,y Su�%,,ty 1�ercin i4s "'he Agam in Was 03arity to whom any rcquikc n0cvs may he adwerod vmd on Mann savict M ro' Pms m) KU had in momms Ksiny out of S mh sav"f4p, as 1TOWN& # Maim 550303 W Q�, e�"fe,,,,-Ie ,erm fcr this oond is arjary 13, 2022 LM jarmy 9, 2023 ATTES F: . ........ . . A FTES'F� PRINCIPAL, cz A C 1 May; zmpmmkv . ... . ............. 379 F 1q A 379 C(F� (OPY MAQ2211CM1913 An= No STA"IFF", OF C01 FY OF Er,A ALL MEN BY TTURSE PRESENIS: Ra', A & a Florida corT woo wk "hose Q A uddress is 110 WEST NKX:1,[NGIIF:�!RD :-,AN-w� Y,JlI:, 1 x- 75'2,47 hcreinafkr calltd Princ#[ and "'ur thu, thi: C , peratn�)n cirganizc,d lind undu-r thic, !4c- � of "s 'hz� st�ii-� 17 and "Too lully Q in �io, Sr oa� of 'I ex,,s. Lis Marc 1001" a lnl,lnicirzorl)MwOm arTmBed and c0tirig under the laws of Qe Mate A' Tcwv� yvhahcr caked ()Wigsc, in We pcnal syn ,,I TWO MILLION SYVEN HUNDRED TIMEE THOUSAND EIGHT HUNDRED Mium' SEVEN AND 5WI00 DOLLARS 02,703,837,50) p ,; 10 pacem, oC the stated penal suit n as an adlAmal son Df nqs adlditio!1al ccul-� Rob and liquidawd (damagos shshq,, c)ut os' of cunmcclud 'xith the helcm, Awdled CAnnact in OW&I rnonq; Of M 1140d SM04 Q A P±d in DOW Monty. MaIr M palmm of With surn wAl and mo, to ho iniAy we hot, Nrd ourscb,,cs, oin- hcn's, exc,atuns, cnd vWxyrns, YOU, and scvwally, firinl� "by d-,',sc ]-!cscnts, Thls Blar'd ShAl dWOMMAY he MAMSCLI by the WIVU11L of MY Change (Ida m- Syp1noml Agrunnait \V.ich intri,casos, , .,c (,'orlraot price, but & no es,enl, shai� a Clrangu Adar or Supplarnental Agreenim ,xnich ratialces ti -,,e (".Onlrl.,,cr, pricc decrease the penal sLar of this Bond, i a H-. OLIIILA("Jf�a lP)"1\' )'() PA"', MAI is uundibuncd us folico'vs: Whl.,rcLis, t.O-, e!tcred An a cmdr Comm idywAd by MOMMM11 Mmhcr2l�_, "uh Ulu CMY 01 Me, Mc (Mpg., �s Mod Kc 1 1 " day of Aups. AD 202 1, a cop� A &A is hemo ambcd and =L� "'ur thu, thi: A lernpoTary R&MAd and TPAWswoon in Ow Coy and U an proviskyl .y of Count) of Dallas, Texas, NOM% A.d RFUME. it t.ic Pr�ncir,,d sil,-ill lrul', ��rld faiO-iFuAy )cx(,7:4"0. �illd fll c,'Ftho undemalng covevial zenn, conMms and agrearrents A saki coulso Al accordance Mol Ge ipceincalions luld Mnvaa locurnems dwin" thu 'Aginal term th��,Ieo�'c��,J ex"(:rlwion thocol"wilich pay be gmmcd by the MQ , whil x 0 A= noocc m Vc Runj, mid JuAg the MY of any giormay or marwa; ruqulcd jAw- dis Man, and shA An \MH ""und n�Aa all "hic ter .a, conditions and agreemems ch"any and A lathy auMAR moddicaNns ol saij Co11tra4n �hat nniy hioo.-,iftc,,r ho rnado nobn of whOh rnuahikahm io 0c Ono bing AM%, "AQ M! if the &Adpal sill Uh &dnnnip; and sAve harnWy M (Thg" KYU A LOIS and chnages " M h; iwaymi A as w so py f.am Kevin and shan My rohnhuse, and rquj Mpg= A! why and cxpwnse "Mch the Oldigee riny incur in rnaiJn,..! ,t..,,,c)od art%, deffault or LUAU), thun Oks AQuAn shall he MQ wha"ise, it shall innsin in Oki Me and effba. PROVIDED HARTAP11. that it' ary, Qa! azKon be AM upon, ihis 1Bco-,,,.1, exclusivc cnue, �haGl !�L ir Dalla,,,; Counly, S'�,,,c -,,,4 FCNltiS PERiF -,NC,',E 30N'D 380 AMPINE) PROV110i'D that the said Sissy, Or value rece�vd", stipulates and ag,recs ih6 no chail ge. emenlon of Qw. ahcadon or addlon to Me ns of thc Contract or to the, 101A Kark to A pwOrmcd thacu'Cis r or the Speckka6ons acwynparti'inn une, sarne shall in anywise a"-Iect ;n 1) Mgmion on this Bonit and A &as hemn, "wNe no ice of ao, Rwh change, extension of 6nic, tuatimi or JIM Y) We tenns ofthe Ccn"ra'c" or to "hc \V(.rk or to "h: n'dj]'-" �hv prov�s�onsth�" tht� r'ond' sl-uJl appl�'lrum "'T", iths!" 21 a n d nmy b e ,� xi (:r", d cd ��V " h, C S rct 1,7" " C' o r, �' i "ru �Al' i c n C w,":� l(. to tc r a n C c) n d I '11C I pity of "j"V d -'Js ,-Ycmd and ad cmvMhon celfcaes Wood hi comwkm bacwith Ail not be cumdaMe and AM! in tin even! excood the amout as set ;.it..,, in ON NQ ca in any addhions, rider, or endowerriunts prcTwQ/ issunal by the Surety to supplernews thereto. THE S['RETY SHAM. MAIL 60 DAYS WRITTEN NOTICE, TO THE 013LIGEE IN 111F, FXF',N­T SURETY EIXCTS NOT TO EXTEND THE '111�-M OF 'C HS BONI) OR 111MVIDI"', A N11"'W BOND my anion brought under this Bond mum he brought "110 avo (2) yeas MAr the tomAnabon ol' "h' s Contlacl, ]"he u'ncf.—signc.,d and deignand agn, K hemby jusignawd by the Surety herAn as to ReMw' Agan h7 DIM Clawy to "horn wV reydin wims ma; be "ind oll vd'n service C"f i-r(-�Cess niq/ be had in mmwrs adsing out of sudi suwWslky us provided by%c�ion 35503 0,03 of he Insurance Cod(", Tex6,s C:c�'dQs ATTES? B V S ATIEST: BK rhe e11whe to Aw thk hond is January 10. 2022 until JanLMSY 9, 2023 PRTNCIPAL .A alk. '11%'ll,�(,,)(�A'lla-1-1", 'P1111 C" X . ......... -"e, S i, , 'ient, , , SURETY: �-)N ED ST A 7 E S F RE S i R, A ",C E C (D M PA N 'ss�"��a�'s C"nant M A an pw a I !ohm StnAs -- Anne= :nju Ina! an j 10) L- a 1c>. P 1' 0 R V A N C "-, D () - r" g .' '2 o ", '.-" u'ral'i or C*401 o' .. . ....... C`aL",C'ys KEITH, 381 CERTIFICATE OF INTERESTED PARTIES FORM 3.295 10f1 Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2021-764594 A & Associates, Inc. Dallas, TX United States Date Filed: 06/10/2021 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. City of Dallas Date Acknowledged: g Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. POM -2021-00015158 Temporary Industrial and Day Labor 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling I Intermediary McCoy, Bill Dallas, TX United States X Luchey, Gail West Palm Beach, TX United X Luchey, Andrew West Palm Beach, TX United X 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DECLARATION My name is Bill McCoy and my date of birth is 07-31-1969 My address is 2355 Thomas Ave, APT 2006 Dallas TX 75201 USA (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in Palm Beach County, State of Florida on the 1 Othday of June 20 21 (month) (year) Signature of authorized adlent of contracting business entity (Decl rant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.ceffd98 382 Commission Meeting Date: 08/ 1/2023 Bid Extensions and Piggy -Backs Over $100,000 Requested Action by Commission: Approve the one-year extension for RFPs/Bids and/ or piggy -backs for the procurement of services and/or commodities over $100,000 as described in the written report for August 1, 2023 - "Request for Extensions and/or Piggybacks." Explanation of Request: As required, the Finance/Procurement Department submits requests for award to the Commission; requests for approval to enter into contracts and agreements as the result of formal solicitations; and to piggy -back governmental contracts. Options to extend or renew are noted in the "Agenda Request Item" presented to Commission as part of the initial approval process. Procurement seeks to provide an accurate and efficient method to keep the Commission informed of pending renewals and the anticipated expenditure by reducing the paperwork of processing each renewal and/or extension individually and summarizing the information in a monthly report (as required). VENDOR(S) DESCRIPTION OF SOLICITATION SOLICITATION NUMBER RENEWAL TERM AMOUNT Johnson -Davis, Inc.; Gianetti Pre -Qualification City of Boynton Annual Estimated Contracting Corp; of Contractors for Beach Request August 7, 2023 - Expenditure Florida Design Minor Utilities for Qualification August 6, 2024 Drilling Corp.; Construction (RFQ) No. 028- $1,000,000 Centerline Services 2821-19/MFD Utilities, Inc Pre -Qualification of Contractors for City of Boynton Annual Estimated Killebrew, Inc. Pre -Chlorinated Beach Bid No. August 3, 2023 - Expenditure Pipe Bursting of 079-2821-21 August 2, 2024 Potable Water $750,000 Mains 383 How will this affect city programs or services? This renewal report will be used for those solicitations, contracts/agreements and piggy -backs that are renewed/extended with the same terms and conditions and pricing as the initial award. Fiscal Impact: Funds have been budgeted under line items as noted on the attached report. Attachments: $100K Over Request for Bids Extensions August 1 2023.docx Renewal Interest Letter - Johnson -Davis Inc Utilities 2023-2024 Signed.pdf Renewal Interest Letter - Giannetti Contracting Corp Utilities 2023 - 2024 - Executed By Giannetti.pdf Renewal Interest Letter - Centerline Utilities Inc Utilities 2023-2024 Signed.pdf Renewal Interest Letter - Killebrew Inc 2023 - 2024 - Signed.pdf Non -Renewal Interest Letter - Murphy Pipline Contractors 2023 - 2024 Partial 07-05-2023.pdf Renewal Interest Letter - Sages Networks Inc 2023-2024 - Signed.pdf 384 Electronic Plan Review Submittal City of Boynton Estimated Annual Sages Network, and Markup Beach Request September 15, Expenditure Inc Management for Qualification 2023 - September System with No. 034-2410- 14, 2024 $200,000 Mobile Inspection 19/EM Software How will this affect city programs or services? This renewal report will be used for those solicitations, contracts/agreements and piggy -backs that are renewed/extended with the same terms and conditions and pricing as the initial award. Fiscal Impact: Funds have been budgeted under line items as noted on the attached report. Attachments: $100K Over Request for Bids Extensions August 1 2023.docx Renewal Interest Letter - Johnson -Davis Inc Utilities 2023-2024 Signed.pdf Renewal Interest Letter - Giannetti Contracting Corp Utilities 2023 - 2024 - Executed By Giannetti.pdf Renewal Interest Letter - Centerline Utilities Inc Utilities 2023-2024 Signed.pdf Renewal Interest Letter - Killebrew Inc 2023 - 2024 - Signed.pdf Non -Renewal Interest Letter - Murphy Pipline Contractors 2023 - 2024 Partial 07-05-2023.pdf Renewal Interest Letter - Sages Networks Inc 2023-2024 - Signed.pdf 384 REQUESTING DEPARTMENT: UTILITIES DEPARTMENT CONTACT: Tremaine Johnson TERM: August 7, 2023 to August 6, 2024 SOURCE FOR PURCHASE: City of Boynton Beach RFQ No. 028-2821-19IMFD VARIOUS ACCOUNT NUMBER(S): 403-5000-535.65-04 SWR064 403-5000.535.65-04 SW2001 403-5000-535.65-04 SWR102 403-5000-535.65-09 STM031 VENDOR(S): Johnson -Davis, Inc.; Giannetti Contracting Corp.; FL Design Drilling Corp.; Centerline Utilities, Inc. ANNUAL ESTIMATED EXPENDITURE: $1,000,000 DESCRIPTION: On 8/6/2019, City Commission approved the award of the Pre -Qualification of Contractors for Utilities Construction Services contracts to Johnson -Davis, Inc.; Giannetti Contracting Corp.; FL Design Drilling Corp.; and Centerline Utilities, Inc. The initial contract was for one (1) year with an option to renew for four (4) one-year terms. The vendor has agreed to renew the existing agreement with the same terms and conditions for the 4t" renewal August 7, 2023, thru August 6, 2024. REQUESTING DEPARTMENT: UTILITIES DEPARTMENT CONTACT: Tremaine Johnson TERM: August 3, 2023 thru August 2, 2024 SOURCE FOR PURCHASE: City of Boynton Beach Bid No. 079-2821-21 ACCOUNT NUMBER(S): 403-5000-533.65-02 WT1802 VENDOR(S): MuFphy P4peflne GenWaete; Killebrew, Inc. ANNUAL ESTIMATED EXPENDITURE: $750,000 DESCRIPTION: On August 3, 2021, City Commission approved the award of the Pre -Chlorinated Pipe Bursting of Potable Water Mains contracts to two pre -qualified contractors. Murphy Pipeline Contractors for Jacksonville, FL as the Primary vendor and Killebrew, Inc. of Lakeland, FL as the secondary vendor for an initial two (2) year bid term; with an option to renew for three (3) additional one-year renewals with the same terms and conditions subject to vendor acceptance, satisfactory performance and determination that renewal will be in the best interest of the City. Murphy Pipeline Contractors, LLC declined to renew due to the need to increase pricing on several line items of their bid proposal. Utilities staff reviewed Murphy Pipeline Contractors, LLC's request and decided not to move forward with the renewal of the agreement with Murphy Pipeline Contractors, LLC due to the price increase. Utilities staff request the renewal of Killebrew, Inc. as the primary vendor with the same terms, conditions, and pricing for its 1st renewal of August 3, 2023, thru August 2, 2024. REQUESTING DEPARTMENT. DEVELOPMENT DEPARTMENT CONTACT: Adam Temple TERM: September 15, 2023 to September 14, 2024 SOURCE FOR PURCHASE: RFP No. 034-2410-19/EM ACCOUNT NUMBER: 130-2411-524.46-91 VENDOR(S): SAGE NETWORKS, INC. ANNUAL ESTIMATED EXPENDITURE. $200,000.00 DESCRIPTION: At the Commission meeting of September 15, 2020, City Commission awarded the RFP for Electronic Plan Submittal and Markup Management System with Mobile Inspection Software to enhance efficiencies and streamline the permitting processes. The contract initial term was for one (1) year, September 15, 2020 to September 14, 2021 with the option for four (4) one-year renewals exercised separately. The Development Department entered into a contract with Sages Network, Inc. to implement the software in Phases over a period of five (5) years. The Development Department requests to extend the bid term for its 3rd one-year renewal with the same terms, conditions and pricing. Renewal term September 15, 2023 — September 14, 2024. The City of Boynton Beach July 3,2O23 Finmnce/ProouannentJervices I07EOcean Avenue Boynton Beach, FL 33435 R(IBox J20 Boynton Beach, Florida 334JS-O310 Telephone No: /5d1/74Z-6310 Scott J.Johnson, President Johnson -Davis, Inc. OO4HiUbnaihDr. Lantana, FL 33462 VIA EMAIL TRANSMITTAL TO: siohnson(a)iohnsondavis.com 1190119111TAIIII1111ni U1 [Tom The current agreement term for "PRE -QUALIFICATION OF CONTRACTORS FOR UTILITY CONSTRUCTION SERVICES" expires August 6, 2023. The agreement documents allow for four (4) additional one (1) year extensions. The City of Boynton Beach would like to extend the bid for its 4m renewal for an additional one-year period with the same terms and Please indicate your response on the following page and return it to Procurement Services along with the company's update C0 via email to Dratttnbbfl.us at your earliest convenience. If you should have any questione'p|eaoedonotheaitotetocontoctTana|ynPrett.CVntrmctAdministretnrat(581)742-83U8. Sincerely, TondynPratt Contract Administrator 387 Finance/Procurement Services 100 E. Ocean Avenue Boynton Beach, FL 33435 P.O. Box 310 Boynton Beach, Florida 33425-0310 Telephone No: (561) 742-6310 July 3, 2023 BID: PRE -QUALIFICATION OF CONTRACTORS FOR UTILITY MINOR CONSTRUCTION SERVICES Agreement between the City of Boynton Beach and Johnson -Davis Inc. AGREEMENT RENEWAL TERM: AUGUST 7, 2023` —AUGUST 6, 2024 Yes, I agree to renew the existing agreement under the same terms and conditions for an additional one-year term. No, I do not wish to renew the bid for the following reason(s) Johnson -Davis, Inc. 0 J, NAME OF REPRESENTATIVE (please print) 2S z DATE E-Mm,91L ,.SIGNATURE TITLE (AREA CODE) TELEPHONE NUMBER 388 America's Gateway to the Gulf Stream The City of Bounton Beach Finance/Procurement Services 100 E. Ocean Avenue Boynton Beach, FL 33435 P.O. Box 310 Boynton Beach, Florida 33425-0310 Telephone No: (561) 742-6310 July 3, 2023 Richard Gibbs III, President Giannetti Contracting Corporation 1801 NW 181" St. Pompano Beach, FL 33069 VIA EMAIL TRANSMITTAL TO: rich ie _giannetticorp.com BID: PRE -QUALIFICATION OF CONTRACTORS FOR UTILITY MINOR CONSTRUCTION SERVICES BID No.: 028-2821-19/MFD CURRENT AGREEMENT TERM: AUGUST 7,2022— AUGUST 6, 2023 Dear Mr. Gibbs: The current agreement term for "PRE -QUALIFICATION OF CONTRACTORS FOR UTILITY MINOR CONSTRUCTION SERVICES" expires August 6, 2023. The agreement documents allow for four (4) additional one (1) year extensions. The City of Boynton Beach would like to extend the bid for its 41" renewal for an additional one-year period with the same terms and conditions. Please indicate your response on the following page and return it to Procurement Services along with the company's update COI via email to prattU( bbfl.us at your earliest convenience. If you should have any questions, please do not hesitate to contact Taralyn Pratt, Contract Administrator at (561) 742-6308. Sincerely, Taralyn Pratt Contract Administrator America's Gateway to the Gulf Stream 389 The City of Bounton Beach Finance/Procurement Services 100 E. Ocean Avenue Boynton Beach, FL 33435 P.O. Box 310 Boynton Beach, Florida 33425-0310 Telephone No: (561) 742-6310 July 3, 2023 BID: PRE -QUALIFICATION OF CONTRACTORS FOR UTILITY MINOR CONSTRUCTION SERVICES BID No.: 028-2821-19/MFD Agreement between the City of Boynton Beach and Giannetti Contracting Corporation. AGREEMENT RENEWAL TERM: AUGUST 7, 2023 —AUGUST 6, 2024 V Yes, I agree to renew the existing agreement under the same terms and conditions for an additional one-year term. No, I do not wish to renew the bid for the following reason(s) Giannetti Contracting Corporation NAME OF COMPANY Robert Henning III NAME OF REPRESENTATIVE (please print) July 11, 2023 DATE bob@giannetticorp.com E -MAI L RLL /it SIGNATURE Chief Estimator TITLE 954-972-8104 (AREA CODE) TELEPHONE NUMBER America's Gateway to the Gulf Stream 390 The City of Boun on Beach Finance/Procurement Services 100 E. Ocean Avenue Boynton Beach, FL 33435 P.O. Box 310 Boynton Beach, Florida 33425-0310 Telephone No: (561) 742-6310 July 3, 2023 BID: PRE -QUALIFICATION OF CONTRACTORS FOR UTILITY MINOR CONSTRUCTION SERVICES BID No.: 028-2821-19/MFD Agreement between the City of Boynton Beach and Centerline Utilities, Inc. AGREEMENT RENEWAL TERM: AUGUST 7,2023 —AUGUST 6, 2024 Yes, I agree to renew the existing agreement under the same terms and conditions for an additional one-year term. No, I do not wish to renew the bid for the following reason(s) Centerline Utilities, Inc. NAME OF COMPANY ®z NAME O REPRESENTATIVE (please print) DATE ww'."0724-09"WAr " E-MAIL tc,e- ...tom S r r TITLE (AREA CODE) TELEPHONE NUMBER America's Gateway to the Gulf Stream 391 The City of Bounton Beach Finance/Procurement Services 100 E. Ocean Avenue Boynton Beach, FL 33435 P.O. Box 310 Boynton Beach, Florida 33425-0310 Telephone No: (561) 742-6310 July 3, 2023 Adre Poleon Killebrew, Inc. P.O Box Lakeland, Florida 33805 VIA EMAIL TRANSMITTAL TO: adre _killebrewinc.net BID: PRE -CHLORINATED PIPE BURSTING OF POTABLE WATER MAINS BID No.: 079-2821-21 CURRENT AGREEMENT TERM: AUGUST 3,2021 — AUGUST 2, 2023 Dear Mr. Poleon: The current agreement term for "Pre -Chlorinated Pipe Bursting of Potable Water Mains" expires August 2, 2023. The agreement documents allow for three (3) additional one (1) year extensions. The City of Boynton Beach would like to extend the bid for its 1s' renewal for an additional one-year period with the same terms, conditions, and pricing. Please indicate your response on the following page and return it to Procurement Services along with the company's update COI via email to prattt(a-)bbfl.us at your earliest convenience. If you should have any questions, please do not hesitate to contact Taralyn Pratt, Contract Administrator at (561) 742-6308. Sincerely, Taralyn Pratt Contract Administrator America's Gateway to the Gulf Stream 392 The City of Bounton Beach Finance/Procurement Services 100 E. Ocean Avenue Boynton Beach, FL 33435 P.O. Box 310 Boynton Beach, Florida 33425-0310 Telephone No: (561) 742-6310 July 3, 2023 BID: PRE -CHLORINATED PIPE BURSTING OF POTABLE WATER MAINS BID No.: 079-2821-21 Agreement between the City of Boynton Beach and Killebrew, Inc. AGREEMENT RENEWAL TERM: AUGUST 3, 2023 —AUGUST 2, 2024 X Yes, I agree to renew the existing agreement under the same terms, conditions, and pricing for an additional one-year term. No, I do not wish to renew the bid for the following reason(s) Killebrew, Inc. NAME OF COMPANY Richard Bushart NAME OF REPRESENTATIVE (please print) 07/10/23 DATE rich@killebrewinc.net E -MAI L SIGNATURE General ManagerNP TITLE 863 701 0273 (AREA CODE) TELEPHONE NUMBER America's Gateway to the Gulf Stream 393 The City of Bounton Beach Finance/Procurement Services 100 E. Ocean Avenue Boynton Beach, FL 33435 P.O. Box 310 Boynton Beach, Florida 33425-0310 Telephone No: (561) 742-6310 July 3, 2023 Taylor Morris Murphy Pipeline Contractors, LLC 12235 New Berlin Road Jacksonville, Florida 32226 VIA EMAIL TRANSMITTAL TO: taylorm teamipr.com BID: PRE -CHLORINATED PIPE BURSTING OF POTABLE WATER MAINS BID No.: 079-2821-21 CURRENT AGREEMENT TERM: AUGUST 3,2021 — AUGUST 2, 2023 Dear Taylor Morris: The current agreement term for "Pre -Chlorinated Pipe Bursting of Potable Water Mains" expires August 2, 2023. The agreement documents allow for three (3) additional one (1) year extensions. The City of Boynton Beach would like to extend the bid for its 1s' renewal for an additional one-year period with the same terms, conditions, and pricing. Please indicate your response on the following page and return it to Procurement Services along with the company's update COI via email to prattt(a-)bbfl.us at your earliest convenience. If you should have any questions, please do not hesitate to contact Taralyn Pratt, Contract Administrator at (561) 742-6308. Sincerely, Taralyn Pratt Contract Administrator America's Gateway to the Gulf Stream 394 The City of Bounton Beach Finance/Procurement Services 100 E. Ocean Avenue Boynton Beach, FL 33435 P.O. Box 310 Boynton Beach, Florida 33425-0310 Telephone No: (561) 742-6310 July 3, 2023 BID: PRE -CHLORINATED PIPE BURSTING OF POTABLE WATER MAINS BID No.: 079-2821-21 Agreement between the City of Boynton Beach and Murphy Pipeline Contractors, LLC. AGREEMENT RENEWAL TERM: AUGUST 3, 2023 —AUGUST 2, 2024 Yes, I agree to renew the existing agreement under the same terms, conditions, and pricing for an additional one-year term. X No, I do not wish to renew the bid for the following reason(s) Pricing under the current contract was submitted in 2019. Due to national inflation of several cost items MPC request the pricing be adjusted in order to perform the work. This requested adjustment is to reflect current market and inflation costs. Revised pricing Murphy Pipeline Contractors, LLC NAME OF COMPANY Ed Steele NAME OF REPRESENTATIVE (please print) 07-05-2023 DATE eds@murphypipelines.com E -MAI L S GNATURE General Manager TITLE 240-299-2920 (AREA CODE) TELEPHONE NUMBER America's Gateway to the Gulf Stream 395 The City of Bounton Beach Finance/Procurement Services 100 E. Ocean Avenue Boynton Beach, FL 33435 P.O. Box 310 Boynton Beach, Florida 33425-0310 Telephone No: (561) 742-6310 July 5, 2023 Sages Networks, Inc. Attn: Harish Krishna, President 50 Hurt Plaza SE, Suite 1446 Atlanta, GA 30303 VIA EMAIL TRANSMITTAL TO: hkrishnaCcDsagesnetworks.com; payyangar .sapesnetworks.com RFP.: ELECTRONIC PLAN REVIEW SUBMITTAL AND MARKUP MANAGEMENT SYSTEM WITH MOBILE INSPECTION SOFTWARE RFP No.: No. 034-2410-19/EM CURRENT BID TERM: SEPTEMBER 15,2022— SEPTEMBER 14, 2023 Dear Mr. Krishna: The current bid term for "ELECTRONIC PLAN REVIEW SUBMITTAL AND MARKUP MANAGEMENT SYSTEM WITH MOBILE INSPECTION SOFTWARE" expires September 14, 2023. The agreement documents allow for four (4) additional one (1) year extensions. The City of Boynton Beach would like to extend the agreement for its 3rd renewal for an additional one-year period with the same terms, conditions, and pricing. Please indicate your response on the following page and return it to Procurement Services via email to prattt .bbfl.us at your earliest convenience. If you should have any questions, please do not hesitate to contact Taralyn Pratt, Contract Administrator at (561) 742-6308. Sincerely, a"4�w 71"& Taralyn Pratt Contract Administrator America's Gateway to the Gulf Stream 396 The City of Bounton Beach Finance/Procurement Services 100 E. Ocean Avenue Boynton Beach, FL 33435 P.O. Box 310 Boynton Beach, Florida 33425-0310 Telephone No: (561) 742-6310 July 5, 2023 RFP: ELECTRONIC PLAN REVIEW SUBMITTAL AND MARKUP MANAGEMENT SYSTEM WITH MOBILE INSPECTION SOFTWARE RFP No.: 034-2410-19/EM Agreement between the City of Boynton Beach and SAGES NETWORKS, INC. AGREEMENT RENEWAL TERM: SEPTEMBER 15,2023— SEPTEMBER 14, 2024 X Yes, I agree to renew the existing agreement under the same terms, conditions, and pricing for an additional one-year term. No, I do not wish to renew the bid for the following reason(s) SAGES NETWORKS, INC. NAME OF COMPANY HARISH KRISHNA NAME OF REPRESENTATIVE (please print) 7/12/2023 DATE hkrishna@sagesnetworks.com E -MAI L SIGNATURE PRESIDENT TITLE 678-471-7392 (AREA CODE) TELEPHONE NUMBER America's Gateway to the Gulf Stream 397 Consent Bids and Purchases over $100,000 08/1/2023 City of Boynton Beach Agenda Item Request Form Commission Meeting Date: 08/ 1/2023 Proposed Resolution No. R23-097- Replacement of heating ventilating and air conditioning (HVAC) systems at the Women's Club. Requested Action by Commission: Approve & authorize the City Manager to sign the City of Boynton Beach agreement, proposal, quote, and approve the replacement of the cooling system at the Women's Club located at 1010 S Federal Highway utilizing the Omnia / Racine County Contract #3341 in the amount of $140,740. Explanation of Request: The current heating ventilating and air conditioning (HVAC) systems have reached their end - of -life cycle and the maintenance costs are continuing to escalate. Replacing the units would lower the maintenance and monthly electrical expenses. The existing unit will be removed and will be replaced with four (4) air conditioning units, one (1) 7.5 ton single circuit, one (1) ten (10) ton dual circuit, and two (2) five (5) ton split systems. How will this affect city programs or services? The Women's Club will be able to be used for hosting events and rental. Fiscal Impact: The funds have been allocated within the CIP budget and will be reimbursed by the CRA. Attachments: Resolution approving Piggy -back Agmt with Trane (Womens Club AC) Racine Bid Document.pdf Omnia Master Agreement.pdf Over $10K - Trane - $98129.00.pdf Trane - COI ending 4-2024.pdf COBB - Women's Club Replace (4) Split Systems_07.25.23.pdf Equipment Proposal - COBB Women's Club Replace (4) SS 06-12-2023.pdf Piggyback Agreement - Trane U.S. Inc .pdf 398 1 RESOLUTION NO. R23-097 2 3 4 A RESOLUTION OF THE CITY OF BOYNTON BEACH, FLORIDA APPROVING 5 AND AUTHORIZING THE CITY MANAGER TO SIGN A PIGGY -BACK 6 AGREEMENT, PROPOSAL, QUOTE, AND APPROVE THE REPLACEMENT OF 7 THE COOLING SYSTEM AT THE WOMEN'S CLUB LOCATED AT 1010 S 8 FEDERAL HIGHWAY UTILIZING THE OMNIA / RACINE COUNTY 9 CONTRACT #3341 IN THE AMOUNT OF $140,740.00; AND PROVIDING 10 AN EFFECTIVE DATE. 11 12 13 WHEREAS, the current heating ventilating and air conditioning (HVAC) systems at The 14 Women's Club have reached their end -of -life cycle and the maintenance costs are continuing to 15 escalate; and 16 WHEREAS, the existing unit will be removed and will be replaced with four (4) air 17 conditioning units, one (1) 7.5 ton single circuit, one (1) ten (10) ton dual circuit, and two (2) five 18 (5) ton split systems; and 19 WHEREAS, the City Commission of the City of Boynton Beach, Florida deems it to be in 20 the best interests of the citizens and residents of the City of Boynton to approve and authorize 21 the City Manager to sign a Piggy -back Agreement, proposal, quote, and approve the 22 replacement of the cooling system at the Women's Club located at 1010 S Federal Highway 23 utilizing the Omnia / Racine County Contract #3341 in the amount of $140,740.00. 24 NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE CITY OF 25 BOYNTON BEACH, FLORIDA, THAT: 26 Section 1. The foregoing "Whereas" clauses are hereby ratified and confirmed as 27 being true and correct and are hereby made a specific part of this Resolution upon adoption 28 hereof. 29 Section 2. The City Commission hereby approves and authorizes the City Manager 30 to sign a Piggy -back Agreement, proposal, quote, and approve the replacement of the cooling 31 system at the Women's Club located at 1010 S Federal Highway utilizing the Omnia / Racine 32 County Contract #3341 in the amount of $140,740.00. A copy of the Piggy -back Agreement is 33 S:ACA\RESO\Agreements\Piggy-Back Agmts With Trane (Womens Club AC) - Reso.Docx 399 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 attached hereto and incorporated herein by reference as Exhibit "A". Section 3. This Resolution shall become effective immediately upon passage. PASSED AND ADOPTED this 1 st day of August, 2023. CITY OF BOYNTON BEACH, FLORIDA YES NO Mayor — Ty Penserga Vice Mayor— Thomas Turkin Commissioner — Angela Cruz Commissioner — Woodrow L. Hay Commissioner —Aimee Kelley VOTE ATTEST: Maylee De Jesus, MPA, MMC City Clerk (Corporate Seal) Ty Penserga Mayor APPROVED AS TO FORM: David N. Tolces Interim City Attorney S:ACA\RESO\Agreements\Piggy-Back Agmts With Trane (Womens Club AC) - Reso.Docx 400 Purchasing 730 Wisconsin Avenue Racine W[ 53403 Racine County 262-6 6.3700 Ihiane.McKinney@racinecounecounty.com JJ S C' O N S J June 15, 2022 Dear Prospective Bidder: You are invited to submit a bid to provide HVAC Products, Installation, Labor Based Solutions, and Related Products and Services for Racine County and other municipal governments and local public agencies. A copy of this solicitation is available for download at: httos://www.racinecountv.com/departments/finance/Durchasina-rfas-and-bids. Submitted bids are due on or before 1:00 p.m. CST on Thursday July 21, 2022, you must submit electronically online using the DemandStar application at www.DemandStar.com. Late bids will not be accepted. Bids must be submitted electronically online using the DemandStar application at www. DemandStar.com. The terms `Firms', `Suppliers', `Contractors', `Offeror', `Vendor', `Respondent', and/or `Bidder' may be used interchangeably. General questions regarding this solicitation should be directed to Duane McKinney at (262) 636-3700 or via email at I u;u i�e;,,I�cK.iin.n yCo�iraciiiriecouirr� .corn. Technical questions should be submitted via email to Duane McKinney, Purchasing Manager, at Duane. McKinney(a)_racinecounty.com. No other Racine County employee or representative is authorized to provide information or interpret any portion of this solicitation. No contact from a vendor to any Racine County employee or elected official should be made during this process unless authorized by Racine County Finance Department. -Purchasing Division. If your firm chooses not to submit a response for this procurement, please complete Attachment E — No Bid Form. RACINE COUNTY RESERVES THE RIGHT TO ACCEPT OR REJECT ANY OR ALL BIDS; TO WAIVE ANY TECHNICALITY OR ERROR IN ANY BID OR PART THEREIN, AND TO ACCEPT THE SAME OR COMBINATIONS, IN WHOLE OR IN PART, WHICHEVER IS DEEMED TO BE IN THE BEST INTEREST OF RACINE COUNTY IN ITS SOLE AND EXCLUSIVE DISCRETION. Sincerely, Duane McKinney Racine County Purchasing Manager Encl: Bid Package 401 INVITATION FOR BID IFB # RC2022-1001 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES I. PROJECT OVERVIEW Racine County is accepting bids for HVAC Products, Installation, Labor Based Solutions, and Related Products and Services. The Master Agreement will allow government agencies to purchase the products and services defined herein, in indefinite quantities on an as - needed basis. Participating Public Agencies may have different requirements and they may choose to sign supplemental agreements with the Awarded Bidder(s) to conform to their purchasing and contracting requirements. A. STEP -ONE For the first step of the bidding process, Bidders will submit their sealed bid with all requested information, to include Certification of Vendor, and Attachment C — Bid Form by the due date and time outlined in this IFB. After the due date and time, all Bids will be reviewed to determine if they are responsive, responsible, and meet the minimum requirements. Each Bidder determined to be responsive, responsible, and qualified shall be deemed to be a "Responsible Bidder". B. STEP -TWO For the second step of the bidding process, Racine County will distribute to each Responsible Bidder the Sample Project Forms, which have already been prepared and are actual (hypothetical) projects. When completing the Sample Project Form, Responsible Bidders are required to USE THE SAME LINE ITEM PRICING from Attachment C — Bid Form and apply them to the Sample Projects Forms to be supplied upon identification of a Responsible Bidder(s) in the first step; a reduction in price for the sample projects outlined in a Responsible Bidder's Sample Project Form will not be allowable. The final basis for award to the lowest responsible Bidder(s) will result from the lowest total dollar amount of the combined sample projects. II. INSTRUCTION TO BIDDERS A. SCHEDULE Issuance of Bid: Virtual Only Non -Mandatory Pre -Bid Meeting: Deadline for Bidder Questions: Addendum/Questions Answered for Solicitation: Bid Due Date: Wednesday June 15, 2022 Wednesday June 29 at 10am (CST), 2022 Wednesday June 29, 2022 by 5pm (CST) Wednesday July 6, 2022 Thursday July 21, 2022 by 1pm (CST) INVITATION FOR BID - IFB # RC2002-1001 Page 1 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 402 B. BIDDER'S QUESTIONS Bidders are reminded to carefully examine the bid packet and specifications upon receipt. If the Bidder does not fully understand the Invitation for Bid (IFB) or is in doubt as to the County's ideas or intentions concerning any portion of the IFB, any/all questions shall be submitted in writing to Duane McKinney, Purchasing Manager by 5:00 p.m. on Wednesday June 29, 2022, either by fax or e-mail for interpretation or correction of any printed material: Fax: 262-636-3763 E-mail: Duane. McKinney(a-)-racinecounty.com No verbal explanation or instructions will be given in regard to the meaning of the specifications during the response period. If necessary, in Racine County's sole discretion, answers to questions will be provided to all specification holders in the form of an addendum. Any addendum will include a list of each question received and Racine County's response as of the date of the addendum. C. ADDENDA Any changes made to the Invitation to Bid after posting will be issued via addenda to all prospective bidders and if necessary, an extension will be made to the Bid Due Date. The original Invitation to Bid and any addenda will be posted to the Racine County Website Ian; LP .;;//.w.w. r.. iiia aau�irn;�y„com/delpairtirnei�tsCtiiirnairnce/puirclhasiiim irfps and lbiids. Bidders are responsible for checking this website for any future addenda prior to the opening date. All addenda must be signed and returned with your submitted bid as specified in the addenda. Bidders who do not return the addenda may have their bids rejected. If a vendor receives a bid packet from any source or entity other than the Racine County Purchasing Department, the Bidder is responsible for contacting the Racine County Purchasing Department and requesting the firm's name be put on the response list for the project. Failure to do so in no way obligates the County to send out addendum or other information concerning this request to the firm. D. VIRTUAL ONLY NON -MANDATORY PRE-BID MEETING A non -mandatory (virtual only) pre-bid meeting will be held on Wednesday June 29, 2022 at 10am local time held by phone. Due to COVID, Bidders should register for the meeting by Tuesday June 28, 2022 with Duane via above email or (262) 636-3700, to obtain the dial in information. While non -mandatory, it is strongly encouraged for Bidders to attend the pre-bid meeting. Oral statements or discussions during the pre-bid meeting will not be binding. Any questions should be submitted in writing per item B. of this Section. Changes, if any, will only be made in writing via Addenda as described in item C. Addenda. The purpose of this meeting will be to clarify the contents of this IFB in order to prevent any misunderstandings of the IFB. Any doubt as to the requirements of this IFB or any apparent omission or discrepancy should be presented to Racine County at this INVITATION FOR BID - IFB # RC2002-1001 Page 2 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 403 conference. Racine County will then determine the appropriate action necessary, if any, and may issue a written addendum to the IFB. Oral statements or instructions will not constitute an addendum to this IFB. No other Racine County employee or representative is authorized to provide information or interpret any portion of this solicitation. Contact to any Racine County employee or elected official regarding this IFB during this process is prohibited unless authorized by the Racine County Purchasing Manager. E. METHOD OF BID Bidders must submit their bids using the Bid Form documents attached to this IFB and incorporated herein as Attachment C and shall submit all other information and materials required by this IFB. Bids written in pencil or in a format other than the attached forms will be rejected. Erasures or corrections of mistakes on forms submitted shall be initialed or signed by Bidder. Failure to meet any requirements listed in this solicitation document may be cause for disqualification of the bid. Any information considered to be proprietary by a Bidder must be plainly marked as such and may not include pricing. Racine County makes no warranty or representation as to the application of the Wisconsin Public Records Law (Wis. Stat. § 19.31, et seq.)(the "WPRL") to any documents and information submitted in response to this IFB. Each copy of the response shall include the Certification of Vendor page and acknowledgement of addendum(s) if any. A legally authorized representative of the Bidder will sign the Certification of Vendor page. F. INCURRING COSTS Racine County shall not be liable for any costs incurred in replying to this IFB. G. ADDITIONAL DATA WITH BID Bidders may include any additional information deemed advantageous to Racine County. Consideration of additional data and information is to be held optional to Racine County however if an award is made, it will be awarded as outlined in Section D Award under Part V. Award Information. H. DUE DATE You must submit electronically online using the DemandStar application at www.DemandStar.com of your bid is to be received by 1:00 a a (CST) Thursday July 21, 2022, in the offices of the Racine County Purchasing Division. Bids received after 1:00 p.m. central time as dictated by www.time.gov shall be considered late and will not be accepted. Late bids will not be accepted. Faxes will not be accepted. Any Bid received by the County after this date and time will not be accepted. Bidders are responsible for ensuring that the above office receives its Bid before the deadline. All Bids will be reviewed and evaluated as described in Part V. Award Information INVITATION FOR BID - IFB # RC2002-1001 Page 3 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 404 WITHDRAWAL OF BIDS Bids may be withdrawn on written or electronic request received from Bidder prior to time and date fixed for bid opening if the bid contains a mistake, omission, or error. Subject to Wis. Stat. § 66.0901(5), negligence on the part of the Bidder in preparing their bid confers no right for withdrawal of the bid after it has been opened. Bids that are withdrawn prior to the time and date set for bid opening with be returned unopened and the Bidder may not re -submit a bid to this solicitation unless no contract is awarded under this IFB and the IFB is re -advertised. AMENDMENTS TO BIDS Subject and pursuant to Wis. Stat. § 66.0901(5), each Bidder will be allowed a period of forty-eight (48) hours after the time and date set for receipt of responses to notify the County in writing of a material mistake in the bid. However, no changes to the line item prices in Bid Form, included as part of this bid, are permitted after sealed bids are accepted by the due date and time outlined in this IFB. Failure of Bidder to notify the County in the manner and within the time limit specified above will constitute a waiver by the Bidder of all rights and remedies relative to a material mistake. Formal bid amendments thereto or requests for withdrawal of bid received by Racine County after time specified for opening will not be considered. K. BIDS BINDING 90 DAYS Unless otherwise specified, all formal responses submitted shall be binding for ninety (90) calendar days following the bid opening date. II. TERMS AND CONDITIONS A. GENERAL TERMS AND CONDITIONS The successful Bidder(s) (the "Contractor") agrees to all of Racine County's General Terms and Conditions located at https://racinecounty.com/home/showdocument?id=11726 and incorporated by reference herein. B. INSURANCE Requirement Contractor shall procure and maintain in full force and effect for the duration of this Agreement, insurance protecting against claims for injuries to persons or damages to property which may arise from or in connection with performance of the work hereunder by the Contractor, his agents, representatives, employees, or subcontractors. 2. Minimum Limits of Insurance Each vendor shall obtain insurance at the following minimum limits: • General Liability INVITATION FOR BID - IFB # RC2002-1001 Page 4 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 405 o $1,000,000 each occurrence o $1,000,000 personal and advertising injury o $2,000,000 general aggregate o $2,000,000 products and completed operations aggregate Umbrella Liability Insurance on a following form basis o $4,000,000 each occurrence o $4,000,000 aggregate o Any combination of underlying coverage and umbrella equaling $5,000,000 shall be acceptable. Workers Compensation Statutory Limits plus: o $100,000 E.L. Each Accident o $100,000 E.L. Disease Each Employee o $500,000 E.L. Disease Policy Limit The following applies to all policies: • The county is named as an additional insured on the general liability, automobile, and umbrella policies. • All insurance must be placed with an insurance company with a minimum AM Best Rating of A- VII The insurers shall agree under each required policy of insurance to waive all rights of subrogation against the insured parties for losses arising from work performed by the Contractor for Racine County. The making of progress payments to the Contractor shall not be construed as relieving the Contractor or its subcontractors or insurance carriers providing the coverage described herein for responsibility for loss or direct physical loss, damage or destruction occurring prior to final acceptance of the Work. 3. Deductibles and Self -Insured Retention Any deductibles or self-insurance retentions must be declared to and approved by Racine County so that the County may ensure the financial solvency of the Contractor. At the option of the County, either the insurer shall reduce or eliminate such deductibles or self-insured retentions as respects the County, its officers, officials, and employees; or the Contractor shall procure a bond guaranteeing payment of losses and related investigations, claim administration and defense expenses. Contractor shall pay all deductibles and be liable for all claims, losses and damages for which it self -insures. 4. Other Insurance Provisions The policies are to contain, or be endorsed to contain, the following provisions: 1. General Liability, Automobile Liability, and Umbrella/Excess Insurance a. Additional Insured Requirement. Racine County, its elected and appointed officials, officers, boards, commissions, officers, employees, representatives, servants, volunteers and agents (hereinafter referred to as "Insured Party" or "Insured Parties") are to be covered as additional insureds as respects: liability arising out of activities performed by or on behalf of the Contractor; products and completed operations of the Contractor, premises owned, leased, or used by the INVITATION FOR BID - IFB # RC2002-1001 Page 5 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - E Dr. Contractor; and automobiles owned, leased, hired, or borrowed by the Contractor. The coverage shall contain no special limitations on the scope of protection afforded to the Insured Parties. Nothing contained in this section shall be construed to require the Contractor to provide liability insurance coverage to the any Insured Party for claims asserted against such Insured Party for its sole negligence. b. Primary Insurance Requirement. The Contractor's insurance coverage shall be primary and noncontributing insurance as respects to any other insurance or self- insurance available to the Insured Parties. Any insurance or self-insurance maintained by the Insured Parties shall be in excess of the Contractor's insurance and shall not contribute with it. c. Reporting Requirement. Any failure to comply with reporting provisions of the policies shall not affect coverage provided to the Insured Parties. d. Separate Coverage. Coverage shall state that the Contractor's insurance shall apply separately to each Insured Party against whom claim is made or suit is brought. e. Defense Costs/Cross Liability. Coverage shall be provided on a "pay on behalf' basis, with defense costs payable in addition to policy limits. There shall be no cross liability exclusion. 5. Workers' Compensation and Employers Liability Coverage The Contractor shall have and maintain in full force and effect for the duration of this Agreement, insurance protecting against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the Work by the Contractor, its agents, representatives, employees or subcontractors. The insurer shall agree to waive all rights of subrogation against Racine County, and its officers, officials, employees and volunteers for losses arising from the work performed by the Contractor for Racine County. 6. Waiver of Subrogation The insurers shall agree under each policy of insurance required by this Contract to waive all rights of subrogation against the Insured Parties for losses arising from work performed by the Contractor for Racine County. 7. All Coverages 1. Notice Requirement. Each insurance policy required by this Contract shall be endorsed to state that coverage shall not be suspended, voided, canceled, reduced in coverage or in limits except after thirty (30) days' prior written notice by certified mail, return receipt requested, has been given to Racine County Courthouse, Purchasing Department, 730 Wisconsin Avenue, Racine WI 53403. The County reserves the right to accept alternate notice terms and provisions provided they meet the minimum requirements under Wisconsin law. INVITATION FOR BID - IFB # RC2002-1001 Page 6 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 407 2. Acceptability. The insurance to be maintained by Contractor must be issued by a company licensed or approved to transact business in the State of Wisconsin. Such insurance shall be placed with insurers with a Best's Policyholder's Rating of "A" or better and with a financial rating of Class VII or greater, or be otherwise acceptable to Racine County. All policies shall be subject to approval by the Racine County Corporation Counsel as to form and content. 3. Failure of Insurers. The Contractor shall be responsible for any delay resulting from the failure of any insurer to furnish proof of coverage in the prescribed form. 8. Verification of Coverage Prior to execution of the contract, Contractor shall furnish Racine County with certificates of insurance and endorsements to the policies evidencing all coverages required by this Contract. Additionally, the declarations page for each insurance policy listed on the certificate of insurance shall be submitted to the County. The certificates and endorsements for each insurance policy are to be signed by a person authorized by that insurer to bind coverage on its behalf. The certificates shall reference the contract and provide for thirty (30) days advance notice of cancellation or non -renewal during the term of the contract. Racine County reserves the right to require complete, certified copies of all required insurance policies at any time. The contractor shall provide proof that any expiring coverage has been renewed or replaced prior to the expiration of the coverage. 9. Subcontractors Contractor shall include all subcontractors as insureds under its policies or shall furnish separate certificates and endorsements for each subcontractor. All coverage for subcontractors shall be subject to all of the requirements stated in this Agreement, including, but not limited to, naming the Insured Parties as additional insureds. The Contractor shall not allow any subcontractor to commence work until the aforementioned requirements are met. C. USE OF PREMISES The Successful Bidder(s), also referred to as Contractor, shall confine their equipment, the storage of materials and the operations of their work persons to the limits of the work area or in accordance with the directions of the County, laws, ordinances and permits, and shall not unreasonably encumber the premises with their materials. All construction materials, shelter, vehicle parking and storage shall be confined to site. Locations of such storage shall be approved in advance by the County. The Contractor is responsible for any damage done to the building structure, existing hallways, doors etc., that is not part of the scope of work and was damaged during the construction period by the Contractor. INVITATION FOR BID - IFB # RC2002-1001 Page 7 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 1 The County shall have the right to use or occupy the premises and use the whole or any part of the work area as is possible without interference with the work prior to its final acceptance. Such use is not to be taken as an acceptance by the County of the whole or any part of the work performed under this contract. The Contractor is responsible for obtaining any necessary licenses and permits, and for complying with any applicable Federal, State, and municipal laws, codes, and regulations in connection with the prosecution of the work without additional expense. The Contractor is similarly responsible for all damages to persons or property that occurs because of their fault or negligence. The Contractor shall take proper safety and health precautions to protect the work, the workers, the public, and the property of others. The Contractor is also responsible for all materials delivered and work performed until completion and acceptance of the entire construction work, except for any completed unit of construction previously accepted. D. LIEN WAIVERS If Contractor requires multiple payments, all requests will be only for work completed at date of application. Lien Waivers will be provided. All necessary lien waivers are required with each request for payment. Lien waivers for first pay request total may be submitted at time of second pay request only if approved by Owner. Accurate sequencing henceforth will be followed. Final lien waivers will be processed and ready for distribution to Owner prior to final payment being processed. All Lien waivers will contain the following language, clearly typed: "Except for retainage, if applicable, there are no outstanding Claims made against the Owner and/or its lenders and guarantors, or the Project, in connection with the work performed in the construction of the Project through the Period Date, except as set forth in Exhibit A attached hereto, if any, and no such claims set forth on Exhibit A have been included in the Application for Payment dated as of the Application Date." E. BONDS PERFORMANCE & PAYMENT BONDS When required by the Participating Public Agency, the Contractor shall furnish a Performance Bond and Labor and Materials Payment Bond covering the faithful performance of the contract and the payment of all obligations arising there under and complying with the requirements of Wisconsin's law or the applicable state of the Participating Public Agency. Both bonds shall be in the amount of one hundred percent (100%) of the contract amount and shall name the Participating Public Agency as an oblige. Companies issuing bonds must be licensed to write bonds in the state of the Participating Public Agency. The Contractor shall pay premiums for required bonds. Obtaining of bonds by the Contractor shall be a condition precedent to effectuation of the Master Agreement between the Participating Public Agency and Contractor. If additional work is authorized, the amount of the bonds shall be increased to cover the value of the increased contract sum. INVITATION FOR BID - IFB # RC2002-1001 Page 8 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 409 F. PERMITS. CODES AND ORDINANCES Contractor shall, at his own expense, obtain all necessary permits and licenses and comply with municipal and State laws, ordinances, and regulations. Should any change in the plan and scope of work be required to conform to law and /or ordinances, Contractor shall notify the County before submitting his quote. After entering a contract, the Contractor shall be held to complete all work necessary to meet the above local requirements without extra expense to the County. G. STANDARDS AND JOB SITE SAFETY Contractor shall perform all work in accordance with the best present-day practices and conform and test in accordance with the applicable sections of the latest revisions of the codes and standards listed in the scope of work. In the event of a conflict between the referenced codes, standards, scope of work and plans, the one establishing the most stringent requirement will be followed. Contractor shall be totally responsible for initiating, instituting, enforcing, maintaining, and supervising all safety precautions and job site safety programs in connection with the work. The Contractor shall take all reasonable precautions for the safety of all its employees and all other persons who may be on the job site. In that regard, Contractor shall comply with all applicable Federal, State, and local laws, ordinances, rules and regulations and order of any public authority having jurisdiction for the safety of persons or property or to protect them from damage, injury, or loss. Contractor shall erect and maintain as required by existing conditions and the progress of the work, all reasonable safeguards for safety and protection, including posting of danger signs and other warnings against hazard, promulgating safety regulations and notifying owners and users of adjacent utilities. County does require that Contractor comply, at a minimum, with the safety regulations of County as set out in the scope of work for this contract, to protect County's employees who may be on the job site. Enactment of safety precautions and regulations; placement and provision of safety material, barricades, etc.; and use or provision of all required safety equipment shall be the sole responsibility of the Contractor whose employees or subcontractors are exposed to the applicable hazard or whose work endangers surrounding persons, property, equipment, contractors, etc. H. INSPECTION/CLOSE OUT PROCEDURES All materials used and all work completed by the Contractor shall be always subject to the examination, observation, and approval of the County. At their discretion, the County shall have the authority to suspend work that does not comply with plans and scope of work and reject non -complying work and materials provided, however, that the failure of such inspector to reject non -complying work and material shall not constitute a waiver by the County of any rights of the County. For final acceptance, the County shall inspect the work included in the contract as soon as practical after notification by the Contractor that such work has, in their opinion, been completed and final cleanup has been performed. Should the inspection disclose any INVITATION FOR BID - IFB # RC2002-1001 Page 9 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 410 work, in whole or in part, as being unsatisfactory, the County will give the Contractor the necessary instructions for correction of the same, and the Contractor shall immediately comply with and execute such instructions. Upon correction of the work, another inspection will be made which shall constitute the final inspection provided the work has been satisfactorily completed. BIDDER SUPPLIED DOCUMENTATION AND MATERIALS; CONFIDENTIALITY All Bidder -supplied materials, including the Bidder's Bid, become the property of Racine County. Bidder acknowledges that Racine County is an "authority" for the purposes of the WPRL. Any information obtained by Racine County is considered public records and will be subject to disclosure under the WPRL, except for information falling within one of the exemptions therefrom. Racine County is required to and shall comply with the WPRL in relation to any records, documents and information related to its dealings and relationship with the Bidder. Nothing in the Master Agreement shall be deemed or construed as a limitation on Racine County's discretion relating to compliance with the WPRL or other applicable law. Notwithstanding the foregoing, if any of the material a Bidder provides is confidential or is a proprietary trade secret, Bidder may mark that material with a "Confidential" stamp. While Racine County will attempt to keep such information confidential, as an authority, it cannot guaranty that it will remain confidential. Racine County will endeavor to inform Bidders of a public records request to view or obtain such information. Any Bidder may contest such a request at its sole expense. Racine County assumes no responsibility for any liability whatsoever in relation to its compliance with the WPRL. AFFIRMATIVE ACTION; NON-DISCRIMINATION Racine County is committed to fulfilling its role as an Affirmative Action/Equal Opportunity Employer. We request your vigorous support of our Affirmative Action efforts. Our relationship with your agency is based upon your willingness to accept and comply with Executive Order 11246, as amended, and other federal laws requiring equal employment opportunity without regard to race, religion, color, national origin, sex, disability or veteran status. By signing the Certification of Vendor, you indicate your acceptance and compliance. In connection with the performance of work awarded under this IFB, the Contractor agrees not to discriminate against any employee or applicant for employment because of age, race, religion, color, handicap, sex, physical condition, developmental disability as defined in Wis. Stat. § 51.01(5)(a), sexual orientation as provided in Wis. Stat. § 111.36, national origin, or military service as provided in Wis. Stat. § 111.355(1). This provision shall include, but not be limited to the following: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The Contractor further agrees to take affirmative action to ensure equal employment opportunities. The Contractor agrees to post in conspicuous places, available for employees and applicants for employment, notices to be provided by the contracting officer setting forth the provisions of the non-discrimination clause (Wis. Stat. § 16.765 (2))• INVITATION FOR BID - IFB # RC2002-1001 Page 10 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 411 K. NATIONAL CONTRACT Subject to its fiduciary and statutory obligations, Racine County, as the Principal Procurement Agency, defined in Attachment D — National Cooperative Contract to be Administered by OMNIA Partners, has partnered with OMNIA Partners, Public Sector ("OMNIA Partners") to make the resultant contract (also known as the "Master Agreement" in materials distributed by OMNIA Partners) from this solicitation available to other public agencies nationally, including state and local governmental entities, public and private primary, secondary and higher education entities, non-profit entities, and agencies for the public benefit ("Public Agencies"), through OMNIA Partners' cooperative purchasing program. Racine County is acting as the contracting agency for any other Public Agency that elects to utilize the resulting Master Agreement. Use of the Master Agreement by any Public Agency is preceded by their registration with OMNIA Partners (a "Participating Public Agency") and by using the Master Agreement, any such Participating Pubic Agency agrees that it is registered with OMNIA Partners, whether pursuant to the terms of a Master Intergovernmental Cooperative Purchasing Agreement, a form of which is attached hereto on Attachment D — National Cooperative Contract, or as otherwise agreed to. Attachment D — National Cooperative Contract contains additional information about OMNIA Partners and the cooperative purchasing agreement. OMNIA Partners is the largest and most experienced purchasing organization for public and private sector procurement. Through the economies of scale created by OMNIA Partners public sector subsidiaries and affiliates, National IPA and U.S. Communities, our participants now have access to more competitively solicited and publicly awarded cooperative agreements. The lead agency contracting process continues to be the foundation on which we are founded. OMNIA Partners is proud to offer more value and resources to state and local government, higher education, K-12 education and non- profits. OMNIA Partners provides shared services and supply chain optimization to government, education, and the private sector. With corporate, pricing and sales commitments from the Vendor, OMNIA Partners provides marketing and administrative support for the Contractor that directly promotes the Contractor's products and services to Participating Public Agencies though multiple channels, each designed to promote specific products and services to Public Agencies on a national basis. Participating Public Agencies benefit from pricing based on aggregate spend and the convenience of a contract that has already been advertised and publicly competed. The Contractor benefits from a contract that generally allows Participating Public Agencies to directly purchase goods and services without the Contractor's need to respond to additional competitive solicitations. As such, the Contractor must be able to accommodate a nationwide demand for services and to fulfill obligations as a nationwide Contractor and respond to the OMNIA Partners documents (Attachment D). While no minimum volume is guaranteed to the awarded Contractor(s), the estimated annual volume of HVAC Products, Installation, Labor Based Solutions, and Related Products and Services purchased under the Master Agreement through OMNIA Partners is approximately $500M. This projection is based on the current annual volumes among the Racine County and other Participating Public Agencies anticipated to utilize the resulting Master Agreement to be made available to them through OMNIA Partners, and INVITATION FOR BID - IFB # RC2002-1001 Page 11 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 412 volume growth into other Public Agencies through a coordinated marketing approach between the awarded Bidder(s) and OMNIA Partners. The successful Bidder(s) will be required to sign Attachment D — National Cooperative Contract to be Administered by OMNIA Partners, Exhibit B — Administration Agreement. Contractors should have any reviews required to sign the document prior to submitting a response. Notwithstanding the foregoing, Racine County makes no representation or warranty concerning the use of the Master Agreement by any other Participating Public Agency. III. HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES The requirements identified in this section represent the products and services currently being used and are the basis for the resulting contract. The following specifications are minimum acceptable requirements. Bid specifications may not be revised without an official written addendum issued by the Purchasing Coordinator. A. DESCRIPTION OF WORK The expected outcome of this IFB is to enter into a contractual relationship with a business partner(s) who will provide a comprehensive selection of HVAC products and solutions, including complete turn -key services. Vendors are to provide a broad selection of HVAC EQUIPMENT, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES. The intent of this IFB is to provide Participating Public Agencies with products, services and turn -key solutions to meet their various needs. Therefore, the Vendors should have demonstrated experience in providing similar Products and Services as defined in this solicitation, including but not limited to: 1. HVAC Equipment and Products: This includes, but is not limited to, all commercial equipment such as chillers: air-cooled chillers, water-cooled chillers, compressor chillers, ancillary chiller water plant equipment and absorption liquid chillers; unitary systems that combine heating, cooling and fan sections: rooftop systems, split systems, self-contained systems and water source heat pumps; air handling systems: performance air handlers, blower coil air handlers, make-up air gas heating systems, air handler options and air cleaning options; terminal devices: unit heaters, unit ventilators, fan coil units, ventilation fans and variable air volume; ductless variable refrigerant volume units; dedicated outdoor air systems; replacement coils; automation equipment; parts and aftermarket products and any other HVAC products offered by Bidder. 2. Installation and Services: This includes, but is not limited to, any installation of new equipment, maintenance of existing systems, upgrading of existing infrastructure, turn -key services and any other installation and services offered by Bidder. 3. Related Products, Solutions, and Other Services: This includes, but is not limited to, new, and/or retrofitting older products and solutions, HVAC equipment controls, ancillary services, thermostats, sensors, energy programs, design and analysis tools, commissioning, building management and/or certifications, enterprise management, rental and lease services, financial services, training and/or educational services, municipal services, and any other INVITATION FOR BID - IFB # RC2002-1001 Page 12 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 413 related products and services offered by Bidder. B. TERM The term of the Master Agreement will be for five (5) years following the contract award date with the option to review for one (1) additional five (5) year period. The anticipated full term of the contract is ten (10) years. The awarded Bidder(s) shall have the right to enter local "service" agreements with Participating Public Agencies accessing the contract through OMNIA Partners, so long as the effective date of such agreement is prior to the expiration of the Contract. All local agreements may have a full potential term (any combination of initial and renewal periods) subject to the discretion of the Participating Public Agency. Any job orders, project agreements, or maintenance agreements executed against the Master Agreement during the effective term may survive beyond the expiration of the Master Agreement as established and agreed to by both parties. Racine County may terminate the Master Agreement without penalty due to the non - appropriation of funds, or for cause or convenience in accordance with the procedures set forth in the Master Agreement. Participating Agencies commonly require a modification to a term of the Contract (e.g., governing law). The awarded Bidder and Participating Agencies may agree to modify terms on any specific purchase by a Participating Agency without being in conflict with the Contract. C. PRICING Labor rates should be based on regional and national rates. The Awarded Bidder may submit requests for labor rate increases on an annual basis, sixty (60) days prior to the anniversary contract date. Price increase requests are not automatic and must be approved by Racine County. The request for a change in the rate outside of the anniversary contract date shall include: (1) the cause for the adjustment and (2) the amount of the change requested with documentation to support the requested adjustment (i.e.: appropriate Bureau of Labor Statistics index). The pricing structure, or percent discount for product pricing should remain fixed for the term of the contract. The Awarded Bidder agrees to offer all future product and service introductions at similar pricing as that offered through this solicitation and contract. D. ALTERNATIVE COSTING METHOD If a project requires products and services that are not covered on the Bid Form or if a product or service is required that is more appropriate to be custom designed and manufactured to meet an individual project site's conditions and/or provided for a unique application or project, the Contractor may use the alternative costing method as follows: INVITATION FOR BID - IFB # RC2002-1001 Page 13 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 414 The Contractor will be required to: Obtain three (3) written cost proposals from local providers: • Use the most advantageous cost proposals; • Apply the discount as submitted on the Response Form; and • All products and services falling under this category must be submitted in advance and approved by the Participating Public Agency prior to being included in any quote or proposal from the Contractor. E. PRICE LIST FOR ADDITIONAL PRODUCTS The intent is to enter into a Master Agreement for a complete line of HVAC products, installation, labor based solutions, and related products and services. Therefore, in addition to specific line items listed on the pricing schedules, Bidders are encouraged to provide Manufacturer's Price Lists for additional related products including green products as well as current catalogs and price lists. Bidders shall attach to the Bid Form one (1) copy of one (1) price list or retail price sheet, clearly marking the column to which the discount is applied for each item listed. Manufacturer's Price Lists shall be the currently published National Standard Manufacturer's Price Lists. The Bidder's Retail Price Sheets shall be the current Price Sheet at the time of bid submission. Bidders shall quote the percentage of discount from the Manufacturer's Price List or Retail Price Sheet cited above and shall furnish a copy of same with the bid submission. Discounts must be stated as a single percentage. FAILURE TO PROVIDE THE MANUFACTURER'S PRICE LIST OR RETAIL PRICE SHEET MAY BE CAUSE FOR REJECTION OF THE BID. When award is made, current catalogs and price lists provided by the Bidder shall become a part of the contract. The Bidder's name and address shall appear on all catalogs and price lists. Where the price list shows more than one (1) column of prices, Bidder shall clearly mark the column which represents its bid. If a fee or charge is to be made, it should be indicated on the Bid Form. F. SPECIAL OFFERS AND PROMOTIONS In addition to decreasing prices for the balance of the Contract term due to a change in market conditions, Contractor may conduct sales promotions involving price reductions for a specified lesser period. Contractor may offer Participating Agencies competitive pricing which is lower than the not -to -exceed price set forth herein at any time during the Contract term and such lower pricing shall not be applied as a global price reduction under the Contract. IV. BID SUBMITTAL INSTRUCTIONS To adequately review bids uniformly and objectively, all bids should be submitted according to the format detailed below. The bid should be prepared simply and economically, providing straightforward and concise information as requested. Use of existing materials, brochures and other standard preprinted materials containing information responsive to the requests in the solicitation, if available, are encouraged as a method to reduce your response time. However, unnecessary elaborate brochures or other presentations beyond that required to present a complete and effective bid are not desired. Racine County reserves the right to reject any bid not properly formatted. INVITATION FOR BID - IFB # RC2002-1001 Page 14 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 415 A. CERTIFICATION OF VENDOR PAGE Place this page on top of the original and each copy of your complete bid. See page 23. B. TABLE OF CONTENTS Include clear identification of the material to be used. C. EXECUTIVE SUMMARY Limit to one or two pages. Briefly state the Bidder's understanding of the service to be provided and a positive commitment to perform the services as defined in the IFB. D. RESPONSIBLE BIDDER Failure of Bidder to provide the required information, may result in a determination that Bidder is a non-responsive bidder. If Bidder does not adequately demonstrate the minimum qualifications, as outlined throughout this section, Bidder may be deemed not qualified and responsible. Bidders must demonstrate that they have the resources and capability to provide the materials and services described herein. The following minimum criteria shall be met to be eligible for this contract: • Bidders shall demonstrate that they are financially stable; • Bidder shall have been in business providing similar service for at least the last three (3) years; • Bidders should have the capability of providing a combination of products, services, consulting, or other labor -based solutions to accommodate the range of products and services utilized by Participating Public Agencies; and • Bidders shall be properly licensed and incorporated to do business in the State of Wisconsin. Racine County reserves the right to make such additional investigations as it deems necessary to verify a Bidder submitting a bid is qualified and responsible to include investigating Bidder's past work with Racine County and Racine County employees. In addition to the pricing and certification information indicated under item D. Award under V. Award Information, Bidders will submit the following items with their bid: 1. Include a detailed response to Attachment D, Exhibit A, OMNIA Partners Response for National Cooperative contract, to show proof of organizational capacity, equipment, and technical competency. a. Racine County makes no representation or warranty concerning the use of the Master Agreement by any other Participating Public Agency. b. The lowest responsible Bidder(s) will be required to sign Attachment D, Exhibit B, OMNIA Partners Administration Agreement. c. If applicable, provide a sample of additional agreements that Participating Public Agencies may be asked to sign. 2. Provide proof of a positive balance sheet and profitable business operations for two (2) of the last three (3) years. 3. Provide business license and applicable information that Bidder can do business in the State of Wisconsin. List the states where other business or contractor licenses are held. 4. Proof of insurance. INVITATION FOR BID - IFB # RC2002-1001 Page 15 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 5. Describe Bidder's bonding capacity and capability of securing high dollar Performance Bonds. 6. A completed and signed W-9 Request for Taxpayer Identification Number and Certification form. 7. Furnish background of Bidder, including such information as size of the firm, legal status (corporation or partnership, etc.) lines of business, management and technical expertise, financial position, and years in business. Include any unique approaches or techniques developed and used by the firm. 8. Provide a minimum of three (3) comparable references of current work being performed. Information shall include name, phone number, fax number and email address of a person that may be contacted. Ideally, at least two (2) references will be with a government facility of similar size. Also include a brief description of the projects. Bidder's may use the Reference sheets enclosed in this IFB. 9. To further demonstrate similar experience and provide proof of performance: a. Include a detailed description of the Services Bidder can perform, including training, start-up and commissioning services, installation, maintenance, turn -key services, project approach to Indoor Environmental Quality (IEQ), repair services, rentals, leases, equipment upgrades, and any other services provided by the Bidder. • Identify the manufacturer products/brands the Bidder can service and support. • Stipulate the minimum work crew that will be made available at all times, ensuring timely and effective project completion. A project foreman, fluent in English, must be onsite during all construction activities and have authority to act on behalf of the Bidder. Each site work crew must have at least one journeyman assigned. • Describe how Bidder selects sub -contractors for service and/or installation and how Bidder ensures customer satisfaction related to the sub -contractors. • Describe Bidder's company's process for submitting a test and balance report for each piece of equipment installed, including items that will be covered in the test and balance report. • Describe Bidder's company's process for delivering a comprehensive commission plan at least two (2) weeks prior to start-up, including details of what will be covered in the plan. • Describe Bidder's company's scope of work for preventative maintenance work. • Describe and define all scenarios in which additional charges would apply outside of routine preventive maintenance. • Describe Bidder's methodologies for assisting Participating Public Agencies with recommendations on repairs and upgrades from defining the repair/upgrade through the completion of work. • Describe Bidder's firm's process for notifying a Participating Public Agency when personnel are going to be in a facility, arrival and departure time and the work performed. How does Bidder handle requirements for sign -off of work prior to leaving a facility? b. Describe Bidder's ability to provide temporary cooling/chiller units. c. Describe in detail the depth of product and services Bidder provides and any related products or services being offered. Include: INVITATION FOR BID - IFB # RC2002-1001 Page 16 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 417 • A description of the Products, including all related components and parts to be provided by the major product category. • A catalog or brochure type information as applicable. • A matrix breaking out product information on all products, options, accessories such as product type, capacity range, standard warranty information, extended warranty information, estimated lead time/delivery time, etc. • All necessary technical information relating to operation of equipment and systems, along with list of spare parts recommended by manufacturers with part numbers needed to maintain and efficiently run the systems and equipment. d. Describe Bidder's record keeping and processing system for work performed. Include: • Bidder's ability to provide online access to records. • State any options for expediting delivery of product. • State backorder policy. Does Bidder fill or kill order and require Participating Public Agency to reorder if item is backordered? • State restocking procedures for returning products, if applicable. • Describe any special programs offered that will improve customers' ability to access Products and Services, on-time delivery, or other innovative strategies. • Describe the capacity of Bidder to broaden the scope of the contract and keep the product and service offerings current and ensure the latest products, standards and technology for HVAC Products, Installation, Labor Based Solutions, and Related Products and Services. • Describe your Bidder's safety policy and/or program, including how the policy is communicated to employees, whether the employees are evaluated on safety, and if any employees are dedicated to safety. • Describe Bidder's quality control processes. • Describe Bidder's problem escalation process. • Describe how customer complaints are measured and categorized. What processes are in place to know that a problem has been resolved? • Describe Bidder's post -installation support and warranty specifics. Include both product and installation warranty information. • Describe the process for replacement or repair of defective products and warranty related issues. • Describe how Bidder evaluates and determines unit repair versus unit replacement. • Identify all other companies that may be involved in processing, handling, shipping, products and/or services. • Provide the number, size and location of Bidder's distribution facilities, warehouses, and retail network as applicable. • Provide order information to include available ordering methods and available payment terms. • Provide the number and location of support centers (if applicable). INVITATION FOR BID - IFB # RC2002-1001 Page 17 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 418 • Describe Bidder's customer service department staffing levels, hours of operation and other relevant details. • Describe the process for ordering when supply of a unit and installation is involved, specifically addressing whether one purchase order is required for the entire project, or if separate purchase orders are required for ordering the product and securing installation services. • Describe Bidder's internal management system for processing orders from point of customer contact through delivery and billing. Please state if Bidder uses single system or platform for all phases of ordering, processing, delivery, and billing. • Describe the capacity of Bidder to provide management reports, i.e., commodity histories, procurement card histories, green spend, etc. for each Participating Public Agency. E. BID FORM CRITERIA All pricing submitted using the Bid Form (Attachment C) or a document using the same requested information in the same format. The Bid form shall be inclusive of all fees and service/shipping charges. All prices are FOB destination. Additional pages and pricing information may be included. Bidder shall also be responsible for compliance with any federal, state, or local prevailing wage laws. Price/Discounts should remain firm and will include all charges that may be incurred in fulfilling requirements. Invoices may be audited on a random basis along with the necessary supporting documentation. Billing errors will be promptly adjusted. As part of the bid, Bidders shall provide the following: • Details of any proposed additional discounts for volume orders, special offers, minimum order quantity, free goods program, total annual spend. • Comprehensive Product Offering Bidder(s) awarded under this IFB may offer their complete product and service offering/balance of line. Pricing for complete product offering/balance of line items will be determined by a percentage discount from a price list or catalog, or fixed price, or a combination of both with indefinite quantities. Prices listed will be used to establish the extent of a Bidder's product lines, services, warranties, etc. that are available from Bidder and the pricing per item. Multiple percentage discounts are acceptable if, where different percentage discounts apply, the different percentages are specified. Additional pricing and/or discounts may be included. Products and services proposed are to be priced separately with all ineligible items identified. Bidders may elect to limit their bids to any category or categories. Where the price list shows more than one column of prices, Bidder shall clearly mark the column which represents the discounted pricing to Participating Public Agencies. • Federal Funding Pricing Due to products and services potentially being used in bid to an emergency or disaster recovery situation in which federal funding may used, if not already INVITATION FOR BID - IFB # RC2002-1001 Page 18 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 419 incorporated as part of the bid, provide alternative pricing that does not include cost plus a percentage of cost or pricing based on time and materials; if time and materials is necessary, a ceiling price that the contract exceeds at its own risk will be needed. Products and services provided in a situation where an agency is eligible for federal funding, Bidder is subject to and must comply with all federal requirements applicable to the funding including, but not limited to the FEMA Special Conditions section located in the Federal Funds Certifications Exhibit. V. AWARD INFORMATION A. COMPLIANCE WITH IFB Bids submitted must be in strict compliance with the terms of the solicitation. Failure to comply with all provisions of the IFB may result in disqualification. B. CONDITIONS OF AWARD All Bidders, by submission of their respective bids, agree to abide by the rules, regulations, procedures, and decisions of Racine County. C. QUALIFYING BIDDERS Failure of Bidder to provide the required information, may result in a determination that Bidder is a non-responsive Bidder. If Bidder does not adequately demonstrate the necessary qualifications, as outlined throughout Section IV. Bid Submittal Instructions, and submit the information indicated under item D. Responsible Bidder, Bidder may be deemed not qualified and/or responsible. Racine County reserves the right to make such additional investigations as it deems necessary to verify a Bidder may be deemed not qualified and/or responsible. Racine County reserves the right to make such additional investigations as it deems necessary to verify a Bidder submitting a bid is qualified and responsible to include investigating Bidder's past work with Racine County and Racine County employees. D. AWARD Utilizing the two-step process set forth herein, it is the intent of the County to award the Contract to the lowest responsive responsible Bidder provided the bid has been submitted in accordance with the requirements of the Contract Documents, the Bidder is adequately qualified, and the bid does not exceed the funds available. Racine County reserves the right to make an award as deemed in its best interest, which may include awarding to a single bidder or multiple bidders; or to award the whole bid, only part of the bid, or none of the bid to single or multiple bidders, based on its sole discretion of its best interest, together with compliance with applicable law. Intent to award will not be made and a contract will not be executed until Racine County, at its sole discretion, accepts a bid. RACINE COUNTY RESERVES THE RIGHT TO REJECT ANY OR ALL BIDS AND TO WAIVE ANY TECHNICALITY OR ERROR IN ANY BID OR PART THEREIN, AND TO ACCEPT THE SAME OR COMBINATIONS, IN WHOLE OR IN PART, WHICHEVER IS DEEMED TO BE IN THE BEST INTEREST OF RACINE COUNTY IN ITS SOLE AND EXCLUSIVE DISCRETION. While not all inclusive, the following items may be used when determining if a Bidder is considered responsive and responsible: work schedule, INVITATION FOR BID - IFB # RC2002-1001 Page 19 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 420 technical competency, ability to render satisfactory service, past performance, reputation for providing a quality product, timely delivery of products and/or services, financial ability, bonding, experience in performance of similar work, references, equipment, and capacity. For the first step of the bidding process, Bidders will submit their sealed bids with all requested information, to include Certification of Vendor and Attachment C — Bid Form, by the due date and time outlined in this IFB. After the due date and time, all Bidders will be evaluated to determine if they are responsive, responsible, and qualified. Each Bidder determined to be responsive, responsible, and qualified shall be determined to be a "Responsible Bidder." As part of the first step of the bidding process, Racine County may seek additional information or clarification from one or more of the Bidders. If Bidder does not adequately demonstrate the necessary minimum qualifications, Bidder may be deemed not qualified and/or responsible. Racine County reserves the right to make such additional investigations as it deems necessary to verify a Bidder submitting a bid is qualified and responsible to include investigating Bidder's past work with Racine County and Racine County employees. Award may be made without discussion with Bidder, therefore, Bidders are cautioned that Bidders should be submitted initially on the most favorable terms. For the second step of the bidding process, Racine County will distribute to each Responsible Bidder a Sample Project Form to determine which Responsible Bidder(s) constitute the lowest responsible bidder(s) when the bid responses are applied to actual (hypothetical) projects. As indicated in Section I. Project Overview, when responding to the Sample Project Form, Responsible Bidders are required to USE THE SAME LINE ITEM PRICING from Attachment C — Bid Form and apply them to the Sample Projects Form (to be supplied to Responsible Bidders as part of Step -One); a reduction in price for the sample projects outlined in a Responsible Bidder's Sample Project Form will not be allowable. The final basis for award and lowest responsible Bidder(s) will result from the lowest total dollar amount of the combined sample projects. E. TIE BIDS If two (2) or more Bidders submit identical bids, the decision of the County to make award to one or more of such Bidders shall be final. F. NOTICE OF ACCEPTANCE Racine County will notify the lowest responsible and responsive Bidder(s) as soon as practical of the selection. Written notice of award to Bidder(s) in the form of a letter, contract or otherwise, mailed or delivered to the address shown on the Certification of Vendor page will be considered sufficient notice of acceptance of bid. INVITATION FOR BID - IFB # RC2002-1001 Page 20 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 421 REFERENCES HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES List three (3) references for construction services to that requested in this IFB. 1. Company: Address: Contact Person: Email address: Description of project: 2. Company: Address: Contact Person: Email address: Description of project: 3. Company: Address: Contact Person: Email address: Description of project: Phone: Phone: Phone: INVITATION FOR BID - IFB # RC2002-1001 Page 21 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 422 CERTIFICATION OF VENDOR HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES The undersigned, submitting this Bid, hereby agrees with all the terms, conditions, and specifications required by the County in this IFB and declares that the attached Bid is in conformity therewith. The undersigned attests to the following: • 1 have reviewed in detail the IFB and all related attachments and information provided by Racine County before submitting this Bid. • 1 have full authority to make such statements and to submit this Bid as the duly recognized representative of the Bidder. SIGNATURE: PRINT NAME: TITLE: COMPANY: ADDRESS: CITY, STATE, ZIP: TELEPHONE: E-MAIL: DATE: FAX: INVITATION FOR BID - IFB # RC2002-1001 Page 22 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 423 a Community Development Block Grant Addendum Purchases made under this contract may be partially or fully funded with federal grant funds. Funding for this work may include Federal Funding sources, including Community Development Block Grant (CDBG) funds from the U.S. Department of Housing and Urban Development. When such funding is provided, Contractor shall comply with all terms, conditions and requirements enumerated by the grant funding source, as well as requirements of the State statutes for which the contract is utilized, whichever is the more restrictive requirement. When using Federal Funding, Contractor shall comply with all wage and latest reporting provisions of the Federal Davis -Bacon Act. HUD -4010 Labor Provisions also applies to this contract. INVITATION FOR BID - IFB # RC2002-1001 Page 23 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 424 Federal Grant Funding Addendum For more information on Federal Grant Funding for ESSER and GEER, please click on the following link: https://www.hcps.org/departments/docs/BusinessServices/Purchasing/FAQs ESSER GEER.pdf for Frequently Asked Questions on Elementary and Secondary School Emergency Relief (ESSER) Programs Governor's Emergency Education Relief (GEER) Programs (U.S. Department of Education Washington, D.C. 20202, May 2021). For more information on Federal Grant Funding for HEERF, please click on the following link: https://www2.ed.gov/about/offices/list/ope/arpfag.pdf for Higher Education Emergency Relief (HEERF) Fund III Frequently Asked Questions (American Rescue Plan Act of 2021 Published May 11, 2021, updated May 24, 2021). INVITATION FOR BID - IFB # RC2002-1001 Page 24 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 425 Attachment C Bid Form (To be submitted in a sealed envelope or box as indicated) Bid Form documents are provided. A discount percentage or structure must be clearly delineated. The Bid form shall be inclusive of all fees and service/shipping charges. All prices are FOB destination. Additional pages and pricing information may be included. 1. Definitions Labor Wage Classification Definitions - definitions as used herein for establishing labor rates. Participating Public Agencies may choose to establish alternative definitions. LABOR WAGE CLASSIFICATION DEFINITIONS Architect Professional licensed designer providing Architectural drawings. Asbestos Worker Worker who removes and disposes of asbestos materials. Worker who assembles boilers, tanks, vats and pressure vessels. The Boilermaker duties of the boilermaker include welding, acetylene burning, riveting, caulking, rigging, fitting up, grounding, reaming and impact machine operating. Worker who builds wood structures or structures of any material which Carpenter has replaced wood. Includes rough and finish carpentry, hardware and trim. Carpet/Floor Installer Worker who installs carpet and/or floor coverings and vinyl tile. Commissioning Agent Agent who ensures proper installation and operation of technical building systems. Concrete Finisher Worker who floats, trowels, and finishes concrete. Data Communications / Worker who installs data/telephone and television cable and associated Telecommunications Installer equipment and accessories. Delivery Personnel Worker who can deliver materials to other HVAC personnel as well as work as a second man on jobs if necessary. Drafting Worker who provides detail engineering drawings utilizing CADD type documents. Drywall/Ceiling Installer Worker who installs metal framed walls and ceilings, drywall coverings, ceiling grids and ceilings. Worker who cleans air conveyance systems using compressed air tools Duct Cleaner and mechanical agitation devices to dislodge dirt and other contaminants from the ductwork and other HVAC components. Electrician Skilled craftsperson who installs or repairs electrical wiring and devices. Includes fire alarm systems and HVAC electrical controls. LABOR WAGE CLASSIFICATION DEFINITIONS (continued) INVITATION FOR BID - IFB # RC2002-1001 Page 25 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - EK Elevator Mechanic Craftsperson skilled in the installation and maintenance of elevators. Professional licensed engineer. An Engineering Designer is not a requirement of this solicitation but may be beneficial for Participating Engineering Designer Public Agencies to utilize should they choose. In such case, an Engineering Design may lay out HVAC, plumbing, electrical, structural, or civil systems. Fire Proofing Installer Worker who sprays or applies fire proofing materials. Geothermal Well Field Labor Worker who lays coiled pipe and tests and connects to HVAC equipment in earthen trench. Glazier Worker who installs glass, glazing and glass framing. Equipment operator that operates the following, including but not limited Heavy Equipment Operator to, all Cat tractors, all derrick -powered, all power operated cranes, back- hoe, back filler, power operated shovel, winch truck, all trenching machines. HVAC Building Automation Worker who can work on low temperature refrigeration equipment as well Technician as small commercial equipment under 60 tons. HVAC Commercial A/C Technician Worker who can work on large commercial up to 3000 tons. HVAC Light Commercial Worker who can work on small commercial up to 25 tons. HVAC Duct Installer Worker who installs ductwork. Assists with some equipment installation. HVAC Field Supervisor Worker who monitors quality as well as provide technical support to all other HVAC technician skill levels. Worker who changes filters in all types of HVAC equipment as well as HVAC Filter Technician minor maintenance on light commercial equipment such as changing worn belts. HVAC Helper Worker who can assist a commercial or refrigeration technician as well as perform minor analysis and repairs on equipment under 30 tons. HVAC Refrigeration Worker who can work on low temperature refrigeration equipment as well Technician as small commercial equipment under 60 tons. Insulator Worker who applies, sprays or installs insulation. Iron Worker Skilled craftsperson who erects structural steel framing and installs structural concrete rebar. Laborer/Helper Worker qualified for only unskilled or semi -skilled work, including but not limited to, lifting, carrying materials and tools, hauling, digging, clean-up. Lather/Plasterer Worker who installs metal framing and lath. Worker who applies plaster to lathing & installs associated accessories Includes, but is not limited to, operation of air compressors, truck crane Light Equipment Operator driver, flex plane, building elevator, form grader, concrete mixer (less than 14cf), conveyer. Mason, Bricklayer Craftsperson who works with masonry products, stone, brick, block, or any material substituting for those materials and accessories. LABOR WAGE CLASSIFICATION DEFINITIONS (continued) INVITATION FOR BID - IFB # RC2002-1001 Page 26 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 427 Metal Building Assembler Worker who assembles pre -made metal buildings. Millwright Mechanic specializing in the installation of heavy machinery, conveyance, wrenches, dock levelers, hydraulic lifts and align pumps. Painter/Wall Covering Worker who prepares wall surfaces & applies paint and/or wall covering, Installer tape and bedding. Trained worker who installs piping systems, chilled water piping and hot Pipefitter water (boiler) piping, pneumatic tubing controls, chillers, boilers and associated mechanical equipment. Skilled craftsperson who installs domestic hot & cold -water piping, waste Plumber piping, storm system piping, water closets, sinks, urinals, and related work. A Project Engineer is not a requirement but may be beneficial for Participating Public Agencies to utilize should they choose. In such case, Project Engineer a Project Engineer may monitor engineering documents as well as provide technical support regarding the engineering plans and specifications as designed by the Professional Engineer. Worker may be responsible for maintaining project status and reports. Worker who monitors quality as well as provide technical support to all Project Manager other HVAC technician skill levels and is responsible for maintaining project status and reports. Worker who provides administrative support to all technician skill levels Project Administrator and is responsible for all administrative functions of the project such as billings, contracts, work orders, legal requirements, purchase orders, sales tax certificates as well as proper record keeping. Roofer Worker who installs roofing materials, Bitumen (asphalt and coal tar) felts, flashings, all types roofing membranes & associated products. Sheet Metal Worker Worker who installs sheet metal products. Roof metal, flashings and curbs, ductwork, mechanical equipment and associated metals. Sprinkler Fitter Worker who installs fire sprinkler systems and fire protection equipment. Terrazzo Worker Craftsperson who places and finishes Terrazzo. Tile Setter Worker who prepares wall and/or floor surfaces & applies ceramic tiles to these surfaces. Worker who applies water proofing material to buildings. Products include Water Proofer/Caulker sealant, caulk, sheet membrane, liquid membranes, sprayed, rolled, or brushed. Certified technician per AABC or NEBB standards trained to perform Test and Balance Technician water and air balance. Also provides sound and vibration testing and preparing of certified reports. Infrared Technician Worker who utilizes infrared photography to determine location of thermal heat losses. INVITATION FOR BID - IFB # RC2002-1001 Page 27 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 428 LABOR WAGE CLASSIFICATION DEFINITIONS (continued) Certified technician who is trained to evaluate analytical test results on Water Treatment Technician boiler system water, condenser water, and chill water samples and to make appropriate recommendations regarding residual levels, cycles, and feed rates. INVITATION FOR BID - IFB # RC2002-1001 Page 28 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 429 BID FORM Bidder shall include all product pricing using this format as pricing utilized on this form should be consistent with the individual pricing scenarios that are to be distributed to responsive, responsible, and qualified Bidders. Use additional space as necessary. MFG Part Product Name Product Description List Price % Discount off Net Price No. List Price INVITATION FOR BID - IFB # RC2002-1001 Page 29 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 430 INVITATION FOR BID - IFB # RC2002-1001 Page 29 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 430 BID FORM (CONT -D) i r Normal business hours are defined as: Overtime hours are defined as: Holiday hours are defined as: For all applicable Labor Classifications, using the below format, Bidder shall provide labor rates by geographic areas, regions, zones or other means for pricing nationally as sample projects included in Step -Two will be diverse project types including projects from different states and regions outside of Racine County and Wisconsin. Participating Public Agencies may have differing needs and requirements depending on the scope of their project(s); Participating Public Agencies may determine the appropriate Labor Classifications at their discretion. If Bidder is unable to provide one or more of the Labor Classifications below (either as part of their primary staff or as a subcontractor), Bidder should notate that in their response. Pricing utilized on this form will need to be consistent with the individual pricing scenarios provided to responsible, responsive, and qualified Bidders. Hourly Rate Normal Item Labor.. 1 Architect Hours 2 Asbestos worker 3 Boilermaker 4 Concrete finishers 5 Delivery personnel 6 Drafting 7 Drywall and ceiling installers 8 Electricians 9 Engineering design 10 Geothermal well field labor 11 Heavy equipment operators 12 HVAC commercial A/C technician 13 HVAC light commercial 14 HVAC helper 15 HVAC field supervisor INVITATION FOR BID - IFB # RC2002-1001 Page 30 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 431 BID FORM (CONT'D) r r r r , Hourly Rate Item Labor... Business Hours 16 HVAC refrigeration technician 17 HVAC duct installer 18 HVAC filter technician 19 HVAC building automation technician 20 Infrared technician 21 Insulators 22 Laborers 23 Light equipment operators 24 Metal building assembler 25 Millwrights 26 Operating engineer 27 Painters, wall covering installers 28 Pipefitters 29 Plasterers 30 Plumbers 31 Project manager 32 Project administrator 33 Project engineering 34 Roofers 35 Sheet metal workers 36 Test and balance technician 37 Tile setters 38 Water Proofers, caulkers 39 Water treatment technician Use additional space as necessary to add any additional labor categories. INVITATION FOR BID - IFB # RC2002-1001 Page 31 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 432 BID FORM (CONT'D) i r i i INSTRUCTIONS: Bidder shall utilize net product prices and labor rates listed in Sections A and B of this Bid Form to determine cost for installation of new equipment, maintenance of existing systems, upgrading of existing infrastructures, turn -key services and any other installation and services offered. If there are other elements that should also be taken into consideration, Bidder shall list these elements below and any associated pricing. Pricing utilized on this form will need to be consistent with the individual pricing scenarios provided to responsible, responsive, and qualified Bidders. AdditionalAny Upgrades List any other elements to be taken into consideration for installation, maintenance, upgrades and turn -key services INVITATION FOR BID - IFB # RC2002-1001 Page 32 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 433 BID FORM ,CoN.o, Use the below space to provide pricing for any related products and services your company wishes to be considered. Pricing utilized on this form will need to be consistent with the individual pricing scenarios provided to responsible, responsive, and qualified Bidders. Product or Service Cost Use additional space as necessary INVITATION FOR BID - IFB # RC2002-1001 Page 33 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 434 BID FORM (CONT'D) i Insert additional lines as necessary. Pricingutilized on this form will need to be consistent with the individual pricing scenarios provided to responsible, responsive, and qualified Bidders. ADDITIONAL DISCO U NTS/I NCE NTIVES COST Additional Discounts for volume (i.e., price breaks for multiple products/services, etc.) Any additional pricing incentives, discounts, or rebates such as for large volume purchases and services, total spend, etc. Any additional pricing discounts for the purchase of products and services for groups of Participating Public Agencies in a local geographic area that desire to combine requirements, i.e., local city, county, school district, housing authority, transit authority, etc. INVITATION FOR BID - IFB # RC2002-1001 Page 34 of 119 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS, AND RELATED PRODUCTS AND SERVICES - 435 ATTACHMENT D OMNIA P A R T N E R S Requirements for National Cooperative Contract To Be Administered by OMNIA Partners The following documents are used in reviewing and administering national cooperative contracts and are included for Supplier's review and bid. Exhibit A — Response for National Cooperative Contract Exhibit B — Administration Agreement, Example Exhibit C — Master Intergovernmental Cooperative Purchasing Agreement, Example Exhibit D — Principal Procurement Agency Certificate, Example Exhibit E — Contract Sales Reporting Template Exhibit F — Federal Funds Certifications Exhibit G — New Jersey Business Compliance Exhibit H — Advertising Compliance Requirement Version April 12, 2022 436 Exhibit A Response for National Cooperative Contract 1.0 Scope of National Cooperative Contract Capitalized terms not otherwise defined herein shall have the meanings given to them in the Master Agreement or in the Administration Agreement between Vendor (sometimes referred to as `Supplier') and OMNIA Partners. 1.1 Requirement Racine County, Wisconsin (hereinafter defined and referred to as "Principal Procurement Agency"), on behalf of itself and the National Intergovernmental Purchasing Alliance Company, a Delaware corporation d/b/a OMNIA Partners, Public Sector ("OMNIA Partners"), is requesting bids for HVAC Products, Installation, Labor Based Solutions, and Related Products and Services. The intent of this Invitation for Bid is any contract between Principal Procurement Agency and Vendor resulting from this Invitation for Bid ("Master Agreement") be made available to other public agencies nationally, including state and local governmental entities, public and private primary, secondary and higher education entities, non-profit entities, and agencies for the public benefit ("Public Agencies"), through OMNIA Partners' cooperative purchasing program. The Principal Procurement Agency has executed a Principal Procurement Agency Certificate with OMNIA Partners, an example of which is included as Exhibit D, and has agreed to pursue the Master Agreement. Use of the Master Agreement by any Public Agency is preceded by their registration with OMNIA Partners as a Participating Public Agency in OMNIA Partners' cooperative purchasing program. Registration with OMNIA Partners as a Participating Public Agency is accomplished by Public Agencies entering into a Master Intergovernmental Cooperative Purchasing Agreement, an example of which is attached as Exhibit C, and by using the Master Agreement, any such Participating Public Agency agrees that it is registered with OMNIA Partners, whether pursuant to the terms of the Master Intergovernmental Purchasing Cooperative Agreement or as otherwise agreed to. The terms and pricing established in the resulting Master Agreement between the Vendor and the Principal Procurement Agency will be the same as that available to Participating Public Agencies through OMNIA Partners. All transactions, purchase orders, invoices, payments etc., will occur directly between the Vendor and each Participating Public Agency individually, and neither OMNIA Partners, any Principal Procurement Agency nor any Participating Public Agency, including their respective agents, directors, employees or representatives, shall be liable to Vendor for any acts, liabilities, damages, etc., incurred by any other Participating Public Agency. Vendor is responsible for knowing the tax laws in each state. This Exhibit A defines the expectations for qualifying Vendors based on OMNIA Partners' requirements to market the resulting Master Agreement nationally to Public Agencies. Each section in this Exhibit A refers to the capabilities, requirements, obligations, and prohibitions of competing Vendors on a national level in order to serve Participating Public Agencies through OMNIA Partners. Version April 12, 2022 437 These requirements are incorporated into and are considered an integral part of this IFB. OMNIA Partners reserves the right to determine whether to make the Master Agreement awarded by the Principal Procurement Agency available to Participating Public Agencies, in its sole and absolute discretion, and any party submitting a response to this IFB acknowledges that any award by the Principal Procurement Agency does not obligate OMNIA Partners to make the Master Agreement available to Participating Procurement Agencies. 1.2 Marketing, Sales and Administrative Support During the term of the Master Agreement OMNIA Partners intends to provide marketing, sales, partnership development and administrative support for Vendor pursuant to this section that directly promotes the Vendor's products and services to Participating Public Agencies through multiple channels, each designed to promote specific products and services to Public Agencies on a national basis. OMNIA Partners will assign the Vendor a Director of Partner Development who will serve as the main point of contact for the Vendor and will be responsible for managing the overall relationship between the Vendor and OMNIA Partners. The Director of Partner Development will work with the Vendor to develop a comprehensive strategy to promote the Master Agreement and will connect the Vendor with appropriate stakeholders within OMNIA Partners including, Sales, Marketing, Contracting, Training, and Operations & Support. The OMNIA Partners marketing team will work in conjunction with Vendor to promote the Master Agreement to both existing Participating Public Agencies and prospective Public Agencies through channels that may include: A. Marketing collateral (print, electronic, email, presentations) B. Website C. Trade shows/conferences/meetings D. Advertising E. Social Media The OMNIA Partners sales teams will work in conjunction with Vendor to promote the Master Agreement to both existing Participating Public Agencies and prospective Public Agencies through initiatives that may include: A. Individual sales calls B. Joint sales calls C. Communications/customer service D. Training sessions for Public Agency teams E. Training sessions for Vendor teams Version April 12, 2022 438 The OMNIA Partners contracting teams will work in conjunction with Vendor to promote the Master Agreement to both existing Participating Public Agencies and prospective Public Agencies through: A. Serving as the subject matter expert for questions regarding joint powers authority and state statutes and regulations for cooperative purchasing B. Training sessions for Public Agency teams C. Training sessions for Vendor teams D. Regular business reviews to monitor program success E. General contract administration Vendors are required to pay an Administrative Fee of 3% of the greater of the Contract Sales under the Master Agreement and Guaranteed Contract Sales under this Invitation for Bid. Vendor will be required to execute the OMNIA Partners Administration Agreement (Exhibit B). 1.3 Estimated Volume The dollar volume purchased under the Master Agreement is estimated to be approximately S500M annually. While no minimum volume is guaranteed to Vendor, the estimated annual volume is projected based on the current annual volumes among the Principal Procurement Agency, other Participating Public Agencies that are anticipated to utilize the resulting Master Agreement to be made available to them through OMNIA Partners, and volume growth into other Public Agencies through a coordinated marketing approach between Vendor and OMNIA Partners. 1.4 Award Basis The basis of any contract award resulting from this IFB made by Principal Procurement Agency will, at OMNIA Partners' option, be the basis of award on a national level through OMNIA Partners. If multiple Vendors are awarded by Principal Procurement Agency under the Master Agreement, those same Vendors will be required to extend the Master Agreement to Participating Public Agencies through OMNIA Partners. Utilization of the Master Agreement by Participating Public Agencies will be at the discretion of the individual Participating Public Agency. Certain terms of the Master Agreement specifically applicable to the Principal Procurement Agency (e.g., governing law) are subject to modification for each Participating Public Agency as Vendor and such Participating Public Agency may agree without being in conflict with the Master Agreement as a condition of the Participating Agency's purchase and not a modification of the Master Agreement applicable to all Participating Agencies. Participating Agencies may request to enter into a separate supplemental agreement to further define the level of service requirements over and above the minimum defined in the Master Agreement (e.g., governing law, invoice requirements, order requirements, specialized delivery, diversity requirements such as minority and woman owned businesses, historically underutilized business, etc.) ("Supplemental Agreement"). It shall be the responsibility of the Vendor to comply, when applicable, with the prevailing wage Version April 12, 2022 439 legislation in effect in the jurisdiction of the Participating Agency. It shall further be the responsibility of the Vendor to monitor the prevailing wage rates as established by the appropriate department of labor for any increase in rates during the term of the Master Agreement and adjust wage rates accordingly. In instances where supplemental terms and conditions create additional risk and cost for Vendor, Vendor and Participating Public Agency may negotiate additional pricing above and beyond the stated contract not -to -exceed pricing so long as the added price is commensurate with the additional cost incurred by the Vendor. Any supplemental agreement developed as a result of the Master Agreement is exclusively between the Participating Agency and the Vendor (Contract Sales are reported to OMNIA Partners). All signed Supplemental Agreements and purchase orders issued and accepted by the Vendor may survive expiration or termination of the Master Agreement. Participating Agencies' purchase orders may exceed the term of the Master Agreement if the purchase order is issued prior to the expiration of the Master Agreement. Vendor is responsible for reporting all sales and paying the applicable Administrative Fee for sales that use the Master Agreement as the basis for the purchase order, even though Master Agreement may have expired. 1.5 Objectives of Cooperative Program This IFB is intended to achieve the following objectives regarding availability through OMNIA Partners' cooperative program: A. Provide a comprehensive competitively solicited and awarded national agreement offering the Products covered by this solicitation to Participating Public Agencies; B. Establish the Master Agreement as the Vendor's primary go to market strategy to Public Agencies nationwide; C. Achieve cost savings for Vendor and Public Agencies through a single solicitation process that will reduce the Vendor's need to respond to multiple solicitations and Public Agencies need to conduct their own solicitation process; D. Combine the aggregate purchasing volumes of Participating Public Agencies to achieve cost effective pricing. 2.0 REPRESENTATIONS AND COVENANTS As a condition to Vendor entering into the Master Agreement, which would be available to all Public Agencies, Vendor must make certain representations, warranties and covenants to both the Principal Procurement Agency and OMNIA Partners designed to ensure the success of the Master Agreement for all Participating Public Agencies as well as the Vendor. 2.1 Corporate Commitment Vendor commits that (1) the Master Agreement has received all necessary corporate authorizations and support of the Vendor's executive management, (2) the Master Agreement is Vendor's primary "go to market" strategy for Public Agencies, (3) the Master Agreement will be promoted to all Public Agencies, including any existing customers, and Vendor will transition existing customers, upon their request, to the Master Agreement, and (4) that the Vendor has read and agrees to the terms and Version April 12, 2022 440 conditions of the Administration Agreement with OMNIA Partners and will execute such agreement concurrent with and as a condition of its execution of the Master Agreement with the Principal Procurement Agency. Vendor will identify an executive corporate sponsor and a separate national account manager within the IFB response that will be responsible for the overall management of the Master Agreement. 2.2 Pricing Commitment Vendor commits the not -to -exceed pricing provided under the Master Agreement pricing is its lowest available (net to buyer) to Public Agencies nationwide and further commits that if a Participating Public Agency is eligible for lower pricing through a national, state, regional or local or cooperative contract, the Vendor will match such lower pricing to that Participating Public Agency under the Master Agreement. 2.3 Sales Commitment Vendor commits to aggressively market the Master Agreement as its go to market strategy in this defined sector and that its sales force will be trained, engaged and committed to offering the Master Agreement to Public Agencies through OMNIA Partners nationwide. Vendor commits that all Master Agreement sales will be accurately and timely reported to OMNIA Partners in accordance with the OMNIA Partners Administration Agreement. Vendor also commits its sales force will be compensated, including sales incentives, for sales to Public Agencies under the Master Agreement in a consistent or better manner compared to sales to Public Agencies if the Vendor were not awarded the Master Agreement. 3.0 VENDOR BID Vendor must supply the following information for the Principal Procurement Agency to determine if Vendor is qualified and responsible to extend the resulting Master Agreement to Participating Public Agencies through OMNIA Partners. 3.1 Company A. Brief history and description of Vendor to include experience providing similar products and services. B. Total number and location of salespersons and/or project managers employed by Vendor to help support Participating Public Agencies. C. Number and location of support centers (if applicable) and location of corporate office. D. Annual sales for the three previous fiscal years. a. Submit FEIN and Dunn & Bradstreet report. E. Describe any green or environmental initiatives or policies. F. Describe any diversity programs or partners Vendor does business with and how Participating Agencies may use diverse partners through the Master Agreement. Indicate how, if at all, pricing changes when using the diversity program. If there are any diversity programs, provide a list of diversity alliances and a copy of their certifications. Version April 12, 2022 441 G. Indicate if Vendor holds any of the below certifications in any classified areas and include proof of such certification in the response: a. Minority Women Business Enterprise ❑ Yes ❑ No If yes, list certifying agency: b. Small Business Enterprise (SBE) or Disadvantaged Business Enterprise (DBE) ❑ Yes ❑ No If yes, list certifying agency: c. Historically Underutilized Business (HUB) ❑ Yes ❑ No If yes, list certifying agency: d. Historically Underutilized Business Zone Enterprise (HUBZone) ❑ Yes ❑ No If yes, list certifying agency: e. Other recognized diversity certificate holder ❑ Yes ❑ No If yes, list certifying agency: H. List any relationships with subcontractors or affiliates intended to be used when providing services and identify if subcontractors meet minority-owned standards. If any, list which certifications subcontractors hold and certifying agency. I. Describe how Vendor differentiates itself from its competitors. J. Describe any present or past litigation, bankruptcy or reorganization involving Vendor. K. Felony Conviction Notice: Indicate if the Vendor a. is a publicly held corporation and this reporting requirement is not applicable; b. is not owned or operated by anyone who has been convicted of a felony; or c. is owned or operated by and individual(s) who has been convicted of a felony and provide the names and convictions. L. Describe any debarment or suspension actions taken against Vendor 3.2 Distribution, Logistics A. Each offeror awarded under this TFB may offer their complete product and service offering/a balance of line. Describe the full line of products and services offered by Vendor. B. Describe how Vendor proposes to distribute the products/service nationwide. Include any states where products and services will not be offered under the Master Agreement, including U.S. Territories and Outlying Areas. Version April 12, 2022 442 C. Describe how Participating Agencies are ensured they will receive the Master Agreement pricing; include all distribution channels such as direct ordering, retail or in-store locations, through distributors, etc. Describe how Participating Agencies verify and audit pricing to ensure its compliance with the Master Agreement. D. Identify all other companies that will be involved in processing, handling or shipping the products/service to the end user. E. Provide the number, size and location of Vendor's distribution or other operations facilities, warehouses, and/or retail network as applicable. 3.3 Marketing and Sales A. Provide a detailed ninety -day plan beginning from award date of the Master Agreement describing the strategy to immediately implement the Master Agreement as Vendor's primary go to market strategy for Public Agencies to Vendor's teams nationwide, to include, but not limited to: Executive leadership endorsement and sponsorship of the award as the public sector go -to -market strategy within first 10 days ii. Training and education of Vendor's national sales force with participation from the Vendor's executive leadership, along with the OMNIA Partners team within first 90 days B. Provide a detailed ninety -day plan beginning from award date of the Master Agreement describing the strategy to market the Master Agreement to current Participating Public Agencies, existing Public Agency customers of Vendor, as well as to prospective Public Agencies nationwide immediately upon award, to include, but not limited to: Creation and distribution of a co -branded press release to trade publications ii. Announcement, Master Agreement details and contact information published on the Vendor's website within first 90 days iii. Design, publication and distribution of co -branded marketing materials within first 90 days iv. Commitment to attendance and participation with OMNIA Partners at national (i.e. NIGP Annual Forum, NPI Conference, etc.), regional (i.e. Regional NIGP Chapter Meetings, Regional Cooperative Summits, etc.) and supplier -specific trade shows, conferences and meetings throughout the term of the Master Agreement V. Commitment to attend, exhibit and participate at the NIGP Annual Forum in an area reserved by OMNIA Partners for partner Vendors. Booth space will be purchased and staffed by Vendor. In addition, Vendor commits to provide reasonable assistance to the overall promotion and marketing efforts for the NIGP Annual Forum, as directed by OMNIA Partners. Version April 12, 2022 443 vi. Design and publication of national and regional advertising in trade publications throughout the term of the Master Agreement vii. Ongoing marketing and promotion of the Master Agreement throughout its term (case studies, collateral pieces, presentations, promotions, etc.) viii. Dedicated OMNIA Partners internet web -based homepage on Vendor's website with: • OMNIA Partners standard logo; • Copy of original Invitation to Bid; • Copy of Master Agreement and amendments between Principal Procurement Agency and Vendor; • Summary of Products and pricing; • Marketing Materials • Electronic link to OMNIA Partners' website including the online registration page; • A dedicated toll-free number and email address for OMNIA Partners C. Describe how Vendor will transition any existing Public Agency customers' accounts to the Master Agreement available nationally through OMNIA Partners. Include a list of current cooperative contracts (regional and national) Vendor holds and describe how the Master Agreement will be positioned among the other cooperative agreements. D. Acknowledge Vendor agrees to provide its logo(s) to OMNIA Partners and agrees to provide permission for reproduction of such logo in marketing communications and promotions. Acknowledge that use of OMNIA Partners logo will require permission for reproduction, as well. E. Confirm Vendor will be proactive in direct sales of Vendor's goods and services to Public Agencies nationwide and the timely follow up to leads established by OMNIA Partners. All sales materials are to use the OMNIA Partners logo. At a minimum, the Vendor's sales initiatives should communicate: Master Agreement was competitively solicited and publicly awarded by a Principal Procurement Agency ii. Best government pricing iii. No cost to participate iv. Non-exclusive F. Confirm Vendor will train its national sales force on the Master Agreement. At a minimum, sales training should include: i. Key features of Master Agreement ii. Working knowledge of the solicitation process Version April 12, 2022 444 iii. Awareness of the range of Public Agencies that can utilize the Master Agreement through OMNIA Partners iv. Knowledge of benefits of the use of cooperative contracts G. Provide the name, title, email and phone number for the person(s), who will be responsible for: i. Executive Support ii. Marketing iii. Sales iv. Sales Support V. Financial Reporting vi. Accounts Payable vii. Contracts H. Describe in detail how Vendor's national sales force personnel and/or project managers are structured, including contact information for the highest -level executive in charge of the sales and/or project management team. I. Explain in detail how the sales or project management teams will work with the OMNIA Partners team to implement, grow and service the national program. I. Explain in detail how Vendor will manage the overall national program throughout the term of the Master Agreement, including ongoing coordination of marketing and sales efforts, timely new Participating Public Agency account set-up, timely contract administration, etc. J. State the amount of Vendor's Public Agency sales for the previous fiscal year. Provide a list of Vendor's top 3 Public Agency customers, the total purchases for each for the previous fiscal year along with a key contact for each. K. Describe Vendor's information systems capabilities and limitations regarding order management through receipt of payment, including description of multiple platforms that may be used for any of these functions. L. Provide the Contract Sales (as defined in Section 12 of the OMNIA Partners Administration Agreement) that Vendor will guarantee each year under the Master Agreement for the initial three years of the Master Agreement ("Guaranteed Contract Sales"). Version April 12, 2022 445 $ .00 in year one $ .00 in year two $ .00 in year three To the extent Vendor guarantees minimum Contract Sales, the Administrative Fee shall be calculated based on the greater of the actual Contract Sales and the Guaranteed Contract Sales. M. Even though it is anticipated many Public Agencies will be able to utilize the Master Agreement without further formal solicitation, there may be circumstances where Public Agencies will issue their own solicitations. The following options are available when responding to a solicitation for Products covered under the Master Agreement. i. Respond with Master Agreement pricing (Contract Sales reported to OMNIA Partners). ii. If competitive conditions require pricing lower than the standard Master Agreement not -to -exceed pricing, Vendor may respond with lower pricing through the Master Agreement. If Vendor is awarded the contract, the sales are reported as Contract Sales to OMNIA Partners under the Master Agreement. iii. Respond with pricing higher than Master Agreement only in the unlikely event that the Public Agency refuses to utilize Master Agreement (Contract Sales are not reported to OMNIA Partners). iv. If alternative or multiple bid and/or proposals are permitted, respond with pricing higher than Master Agreement, and include Master Agreement as the alternate or additional bid/proposal. Detail Vendor's strategies under these options when responding to a solicitation. Version April 12, 2022 446 Exhibit B Administration Agreement, Example ADMINISTRATION AGREEMENT THIS ADMINISTRATION AGREEMENT (this "Agreement") is made this day of 20_, between National Intergovernmental Purchasing Alliance Company, a Delaware corporation d/b/a OMNIA Partners, Public Sector ("OMNIA Partners"), and ("Supplier"). RECITALS WHEREAS, the (the "Principal Procurement Agency") has entered into a Master Agreement effective , Agreement No , by and between the Principal Procurement Agency and Supplier, (as may be amended from time to time in accordance with the terms thereof, the "Master Agreement"), as attached hereto as Exhibit A and incorporated herein by reference as though fully set forth herein, for the purchase of (the "Product"); WHEREAS, said Master Agreement provides that any or all public agencies, including state and local governmental entities, public and private primary, secondary and higher education entities, non-profit entities, and agencies for the public benefit (collectively, "Public Agencies"), that register (either via registration on the OMNIA Partners website or execution of a Master Intergovernmental Cooperative Purchasing Agreement, attached hereto as Exhibit B) (each, hereinafter referred to as a "Participating Public Agency") may purchase Product at prices stated in the Master Agreement; WHEREAS, Participating Public Agencies may access the Master Agreement which is offered through OMNIA Partners to Public Agencies; WHEREAS, OMNIA Partners serves as the cooperative contract administrator of the Master Agreement on behalf of Principal Procurement Agency; WHEREAS, Principal Procurement Agency desires OMNIA Partners to proceed with administration of the Master Agreement; and WHEREAS, OMNIA Partners and Supplier desire to enter into this Agreement to make available the Master Agreement to Participating Public Agencies and to set forth certain terms and conditions governing the relationship between OMNIA Partners and Supplier. NOW, THEREFORE, in consideration of the payments to be made hereunder and the mutual covenants contained in this Agreement, OMNIA Partners and Supplier hereby agree as follows: DEFINITIONS Capitalized terms used in this Agreement and not otherwise defined herein shall have the meanings given to them in the Master Agreement. Version April 12, 2022 447 TERMS AND CONDITIONS 2. The Master Agreement and the terms and conditions contained therein shall apply to this Agreement except as expressly changed or modified by this Agreement. Supplier acknowledges and agrees that the covenants and agreements of Supplier set forth in the solicitation and Supplier's response thereto resulting in the Master Agreement are incorporated herein and are an integral part hereof. 3. OMNIA Partners shall be afforded all of the rights, privileges and indemnifications afforded to Principal Procurement Agency by or from Supplier under the Master Agreement, and such rights, privileges and indemnifications shall accrue and apply with equal effect to OMNIA Partners, its agents, employees, directors, and representatives under this Agreement including, but not limited to, Supplier's obligation to obtain appropriate insurance. 4. OMNIA Partners shall perform all of its duties, responsibilities and obligations as the cooperative contract administrator of the Master Agreement on behalf of Principal Procurement Agency as set forth herein, and Supplier hereby acknowledges and agrees that all duties, responsibilities and obligations will be undertaken by OMNIA Partners solely in its capacity as the cooperative contract administrator under the Master Agreement. 5. With respect to any purchases by Principal Procurement Agency or any Participating Public Agency pursuant to the Master Agreement, OMNIA Partners shall not be: (i) construed as a dealer, re -marketer, representative, partner or agent of any type of the Supplier, Principal Procurement Agency or any Participating Public Agency; (ii) obligated, liable or responsible for any order for Product made by Principal Procurement Agency or any Participating Public Agency or any employee thereof under the Master Agreement or for any payment required to be made with respect to such order for Product; and (iii) obligated, liable or responsible for any failure by Principal Procurement Agency or any Participating Public Agency to comply with procedures or requirements of applicable law or the Master Agreement or to obtain the due authorization and approval necessary to purchase under the Master Agreement. OMNIA Partners makes no representation or guaranty with respect to any minimum purchases by Principal Procurement Agency or any Participating Public Agency or any employee thereof under this Agreement or the Master Agreement. 6. OMNIA Partners shall not be responsible for Supplier's performance under the Master Agreement, and Supplier shall hold OMNIA Partners harmless from any liability that may arise from the acts or omissions of Supplier in connection with the Master Agreement. 7. Supplier acknowledges that, in connection with its access to OMNIA Partners confidential information and/or supply of data to OMNIA Partners, it has complied with and shall continue to comply with all laws, regulations and standards that may apply to Supplier, including, without limitation: (a) United States federal and state information security and privacy statutes, regulations and/or best practices, including, without limitation, the Gramm -Leach -Bliley Act, the Massachusetts Data Security Regulations (201 C.M.R. 17.00 et. seq.), the Nevada encryption statute (N.R.S. § 603A), the California data security law (Cal. Civil Code § 1798.80 et. seq.) and California Consumer Privacy Act (Cal. Civil Code § 1798.100 et. seq.); and (b) applicable industry and regulatory standards and best practices (collectively, "Data Regulations"). With regard to Personal Information that Supplier collects, receives, or otherwise processes under the Agreement or otherwise in connection with performance of the Agreement, Supplier agrees that it will not: (i) sell, rent, release, disclose, disseminate, make available, transfer, or otherwise Version April 12, 2022 448 communicate orally, in writing, or by electronic or other means, such Personal Information to another business or third party for monetary or other valuable consideration; or (ii) retain, use, or disclose such Personal Information outside of the direct business relationship between Supplier and OMNIA Partners or for any purpose other than for the specific purpose of performance of the Agreement, including retaining, using, or disclosing such Personal Information for a commercial purpose other than for performance of the Agreement. By entering into the Agreement, Supplier certifies that it understands the specific restrictions contained in this Section 7 and will comply with them. For purposes hereof, "Personal Information" means information that identifies, relates to, describes, is reasonably capable of being associated with, or could reasonably be linked, directly or indirectly, with a particular consumer or household, and includes the specific elements of "personal information" as defined under Data Regulations, as defined herein. Supplier will reasonably assist OMNIA Partners in timely responding to any third party "request to know" or "request to delete" (as defined pursuant to Data Regulations) and will promptly provide OMNIA Partners with information reasonably necessary for OMNIA Partners to respond to such requests. Where Supplier collects Personal Information directly from Public Agencies or others on OMNIA Partners' behalf, Supplier will maintain records and the means necessary to enable OMNIA Partners to respond to such requests to know and requests to delete. 8. WITHOUT LIMITING THE GENERALITY OF THE FOREGOING, OMNIA PARTNERS EXPRESSLY DISCLAIMS ALL EXPRESS OR IMPLIED REPRESENTATIONS AND WARRANTIES REGARDING OMNIA PARTNERS' PERFORMANCE AS A CONTRACT ADMINISTRATOR OF THE MASTER AGREEMENT. OMNIA PARTNERS SHALL NOT BE LIABLE IN ANY WAY FOR ANY SPECIAL, INCIDENTAL, INDIRECT, CONSEQUENTIAL, EXEMPLARY, PUNITIVE, OR RELIANCE DAMAGES, EVEN IF OMNIA PARTNERS IS ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. TERM OF AGREEMENT; TERMINATION 9. This Agreement shall be in effect so long as the Master Agreement remains in effect, provided, however, that the provisions of Sections 3 — 8 and 11 — 22, hereof and the indemnifications afforded by the Supplier to OMNIA Partners in the Master Agreement, to the extent such provisions survive any expiration or termination of the Master Agreement, shall survive the expiration or termination of this Agreement. NATIONAL PROMOTION 10. OMNIA Partners and Supplier shall publicize and promote the availability of the Master Agreement's products and services to Public Agencies and such agencies' employees. Supplier shall require each Public Agency to register its participation in the OMNIA Partners program by either registering on the OMNIA Partners website (www.omniapartners.com/publicsector) or executing a Master Intergovernmental Cooperative Purchasing Agreement prior to processing the Participating Public Agency's first sales order. Upon request, Supplier shall make available to interested Public Agencies a copy of the Master Agreement and such price lists or quotes as may be necessary for such Public Agencies to evaluate potential purchases. 11. Supplier shall provide such marketing and administrative support as set forth in the solicitation resulting in the Master Agreement, including assisting in development of marketing materials as reasonably requested by Principal Procurement Agency and OMNIA Partners. Supplier shall be responsible for obtaining permission or license of use and payment of any license fees for all content and images Supplier provides to OMNIA Partners or posts on the OMNIA Partners website. Version April 12, 2022 449 Supplier shall indemnify, defend and hold harmless OMNIA Partners for use of all such content and images including copyright infringement claims. Supplier and OMNIA Partners each hereby grant to the other party a limited, revocable, non -transferable, non-sublicensable right to use such party's logo (each, the "Logo") solely for use in marketing the Master Agreement. Each party shall provide the other party with the standard terms of use of such party's Logo, and such party shall comply with such terms in all material respects. Both parties shall obtain approval from the other party prior to use of such party's Logo. Notwithstanding the foregoing, the parties understand and agree that except as provided herein neither party shall have any right, title or interest in the other party's Logo. Upon termination of this Agreement, each party shall immediately cease use of the other party's Logo. ADMINISTRATIVE FEE, REPORTING & PAYMENT 12. An "Administrative Fee" shall be defined and due to OMNIA Partners from Supplier in the amount of _ percent (_%) ("Administrative Fee Percentage") multiplied by the total purchase amount paid to Supplier, less refunds, credits on returns, rebates and discounts, for the sale of products and/or services to Principal Procurement Agency and Participating Public Agencies pursuant to the Master Agreement (as amended from time to time and including any renewal thereof) ("Contract Sales"). From time to time the parties may mutually agree in writing to a lower Administrative Fee Percentage for a specifically identified Participating Public Agency's Contract Sales. 13. Supplier shall provide OMNIA Partners with an electronic accounting report monthly, in the format prescribed by OMNIA Partners, summarizing all Contract Sales for each calendar month. The Contract Sales reporting format is provided as Exhibit C ("Contract Sales Report"), attached hereto and incorporated herein by reference. Contract Sales Reports for each calendar month shall be provided by Supplier to OMNIA Partners by the l Orh day of the following month. Failure to provide a Contract Sales Report within the time and manner specified herein shall constitute a material breach of this Agreement and if not cured within thirty (30) days of written notice to Supplier shall be deemed a cause for termination of the Master Agreement, at Principal Procurement Agency's sole discretion, and/or this Agreement, at OMNIA Partners' sole discretion. 14. Administrative Fee payments are to be paid by Supplier to OMNIA Partners at the frequency and on the due date stated in Section 13, above, for Supplier's submission of corresponding Contract Sales Reports. Administrative Fee payments are to be made via Automated Clearing House (ACH) to the OMNIA Partners designated financial institution identified in Exhibit D. Failure to provide a payment of the Administrative Fee within the time and manner specified herein shall constitute a material breach of this Agreement and if not cured within thirty (30) days of written notice to Supplier shall be deemed a cause for termination of the Master Agreement, at Principal Procurement Agency's sole discretion, and/or this Agreement, at OMNIA Partners' sole discretion. All Administrative Fees not paid when due shall bear interest at a rate equal to the lesser of one and one-half percent (1 1/2%) per month or the maximum rate permitted by law until paid in full. 15. Supplier shall maintain an accounting of all purchases made by Participating Public Agencies under the Master Agreement. OMNIA Partners, or its designee, in OMNIA Partners' sole discretion, reserves the right to compare Participating Public Agency records with Contract Sales Reports submitted by Supplier for a period of four (4) years from the date OMNIA Partners receives such report. In addition, OMNIA Partners may engage a third party to conduct an independent audit of Supplier's monthly reports. In the event of such an audit, Supplier shall provide all materials reasonably requested relating to such audit by OMNIA Partners at the location designated by OMNIA Partners. In the event an underreporting of Contract Sales and a resulting underpayment of Version April 12, 2022 450 Administrative Fees is revealed, OMNIA Partners will notify the Supplier in writing. Supplier will have thirty (30) days from the date of such notice to resolve the discrepancy to OMNIA Partners' reasonable satisfaction, including payment of any Administrative Fees due and owing, together with interest thereon in accordance with Section 13, and reimbursement of OMNIA Partners' costs and expenses related to such audit. GENERAL PROVISIONS 16. This Agreement, the Master Agreement and the exhibits referenced herein supersede any and all other agreements, either oral or in writing, between the parties hereto with respect to the subject matter hereto and no other agreement, statement, or promise relating to the subject matter of this Agreement which is not contained or incorporated herein shall be valid or binding. In the event of any conflict between the provisions of this Agreement and the Master Agreement, as between OMNIA Partners and Supplier, the provisions of this Agreement shall prevail. 17. If any action at law or in equity is brought to enforce or interpret the provisions of this Agreement or to recover any Administrative Fee and accrued interest, the prevailing party shall be entitled to reasonable attorney's fees and costs in addition to any other relief to which it may be entitled. 18. This Agreement and OMNIA Partners' rights and obligations hereunder may be assigned at OMNIA Partners' sole discretion to an affiliate of OMNIA Partners, any purchaser of any or all or substantially all of the assets of OMNIA Partners, or the successor entity as a result of a merger, reorganization, consolidation, conversion or change of control, whether by operation of law or otherwise. Supplier may not assign its obligations hereunder without the prior written consent of OMNIA Partners. 19. All written communications given hereunder shall be delivered by first-class mail, postage prepaid, or overnight delivery on receipt to the addresses as set forth below. A. OMNIA Partners: OMNIA Partners Attn: President 840 Crescent Centre Drive Suite 600 Franklin, TN 37067 B. Supplier: 20. If any provision of this Agreement shall be deemed to be, or shall in fact be, illegal, inoperative or unenforceable, the same shall not affect any other provision or provisions herein contained or render the same invalid, inoperative or unenforceable to any extent whatever, and this Agreement will be construed by limiting or invalidating such provision to the minimum extent necessary to make such provision valid, legal and enforceable. Version April 12, 2022 451 21. This Agreement may not be amended, changed, modified, or altered without the prior written consent of the parties hereto, and no provision of this Agreement may be discharged or waived, except by a writing signed by the parties. A waiver of any particular provision will not be deemed a waiver of any other provision, nor will a waiver given on one occasion be deemed to apply to any other occasion. 22. This Agreement shall inure to the benefit of and shall be binding upon OMNIA Partners, the Supplier and any respective successor and assign thereto; subject, however, to the limitations contained herein. 23. This Agreement will be construed under and governed by the laws of the State of Delaware, excluding its conflicts of law provisions and any action arising out of or related to this Agreement shall be commenced solely and exclusively in the state or federal courts in Williamson County Tennessee. 24. This Agreement may be executed in counterparts, each of which is an original but all of which, together, shall constitute but one and the same instrument. The exchange of copies of this Agreement and of signature pages by facsimile, or by .pdf or similar electronic transmission, will constitute effective execution and delivery of this Agreement as to the parties and may be used in lieu of the original Agreement for all purposes. Signatures of the parties transmitted by facsimile, or by .pdf or similar electronic transmission, will be deemed to be their original signatures for any purpose whatsoever. [INSERT SUPPLIER ENTITY NAME] Signature Name Title Date NATIONAL INTERGOVERNMENTAL PURCHASING ALLIANCE COMPANY, A DELAWARE CORPORATION D/B/A OMNIA PARTNERS, PUBLIC SECTOR Signature Sarah Vavra Name Sr. Vice President, Public Sector Contracting Title Date Version April 12, 2022 452 Exhibit C Master Intergovernmental Cooperative Purchasing Agreement, Example MASTER INTERGOVERNMENTAL COOPERATIVE PURCHASING AGREEMENT This Master Intergovernmental Cooperative Purchasing Agreement (this "Agreement") is entered into by and between those certain government agencies that execute a Principal Procurement Agency Certificate ("Principal Procurement Agencies") with National Intergovernmental Purchasing Alliance Company, a Delaware corporation d/b/a OMNIA Partners, Public Sector and/or Communities Program Management, LLC, a California limited liability company d/b/a U.S. Communities (collectively, "OMNIA Partners"), in its capacity as the cooperative administrator, to be appended and made a part hereof and such other public agencies ("Participating Public Agencies") who register to participate in the cooperative purchasing programs administered by OMNIA Partners and its affiliates and subsidiaries (collectively, the "OMNIA Partners Parties") by either registering on the OMNIA Partners website (www.omniapartners.com/publicsector or any successor website), or by executing a copy of this Agreement. RECITALS WHEREAS, after a competitive solicitation and selection process by Principal Procurement Agencies, in compliance with their own policies, procedures, rules and regulations, a number of suppliers have entered into "Master Agreements" (herein so called) to provide a variety of goods, products and services ("Products") to the applicable Principal Procurement Agency and the Participating Public Agencies; WHEREAS, Master Agreements are made available by Principal Procurement Agencies through the OMNIA Partners Parties and provide that Participating Public Agencies may purchase Products on the same terms, conditions and pricing as the Principal Procurement Agency, subject to any applicable federal and/or local purchasing ordinances and the laws of the State of purchase; and WHEREAS, in addition to Master Agreements, the OMNIA Partners Parties may from time to time offer Participating Public Agencies the opportunity to acquire Products through other group purchasing agreements. NOW, THEREFORE, in consideration of the mutual promises contained in this Agreement, and of the mutual benefits to result, the parties hereby agree as follows: 1. Each party will facilitate the cooperative procurement of Products. 2. The Participating Public Agencies shall procure Products in accordance with and subject to the relevant federal, state and local statutes, ordinances, rules and regulations that govern Participating Public Agency's procurement practices. The Participating Public Agencies hereby acknowledge and agree that it is the intent of the parties that all provisions of this Agreement and that Principal Procurement Agencies' participation in the program described herein comply with all applicable laws, including but not limited to the requirements of 42 C.F.R. § 1001.9520), as may be amended from time to time. The Participating Public Agencies further acknowledge and agree that they are solely responsible for their compliance with all applicable "safe harbor" regulations, including but not limited to any and all obligations to fully and accurately report discounts and incentives. 453 3. The Participating Public Agency represents and warrants that the Participating Public Agency is not a hospital or other healthcare provider and is not purchasing Products on behalf of a hospital or healthcare provider; provided that the foregoing shall not prohibit Participating Public Agency from furnishing health care services so long as the furnishing of healthcare services is not in furtherance of a primary purpose of the Participating Public Agency. 4. The cooperative use of Master Agreements shall be in accordance with the terms and conditions of the Master Agreements, except as modification of those terms and conditions is otherwise required by applicable federal, state or local law, policies or procedures. 5. The Principal Procurement Agencies will make available, upon reasonable request, Master Agreement information which may assist in improving the procurement of Products by the Participating Public Agencies. 6. The Participating Public Agency agrees the OMNIA Partners Parties may provide access to group purchasing organization ("GPO") agreements directly or indirectly by enrolling the Participating Public Agency in another GPO's purchasing program, provided that the purchase of Products through the OMNIA Partners Parties or any other GPO shall be at the Participating Public Agency's sole discretion. 7. The Participating Public Agencies (each a "Procuring Party") that procure Products through any Master Agreement or GPO Product supply agreement (each a "GPO Contract") will make timely payments to the distributor, manufacturer or other vendor (collectively, "Supplier") for Products received in accordance with the terms and conditions of the Master Agreement or GPO Contract, as applicable. Payment for Products and inspections and acceptance of Products ordered by the Procuring Party shall be the exclusive obligation of such Procuring Party. Disputes between Procuring Party and any Supplier shall be resolved in accordance with the law and venue rules of the State of purchase unless otherwise agreed to by the Procuring Parry and Supplier. 8. The Procuring Parry shall not use this Agreement as a method for obtaining additional concessions or reduced prices for purchase of similar products or services outside of the Master Agreement. Master Agreements may be structured with not -to -exceed pricing, in which cases the Supplier may offer the Procuring Party and the Procuring Party may accept lower pricing or additional concessions for purchase of Products through a Master Agreement. 9. The Procuring Party shall be responsible for the ordering of Products under this Agreement. A non -procuring party shall not be liable in any fashion for any violation by a Procuring Party, and, to the extent permitted by applicable law, the Procuring Party shall hold non -procuring party hannless from any liability that may arise from the acts or omissions of the Procuring Party. 10. WITHOUT LIMITING THE GENERALITY OF THE FOREGOING, THE OMNIA PARTNERS PARTIES EXPRESSLY DISCLAIM ALL EXPRESS OR IMPLIED REPRESENTATIONS AND WARRANTIES REGARDING ANY PRODUCT, MASTER AGREEMENT AND GPO CONTRACT. THE OMNIA PARTNERS PARTIES SHALL NOT BE LIABLE IN ANY WAY FOR ANY SPECIAL, INCIDENTAL, INDIRECT, CONSEQUENTIAL, EXEMPLARY, PUNITIVE, OR RELIANCE DAMAGES, EVEN IF THE OMNIA PARTNERS PARTIES ARE ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. FURTHER, THE PROCURING PARTY ACKNOWLEDGES AND AGREES THAT THE OMNIA PARTNERS PARTIES SHALL HAVE NO LIABILITY FOR ANY ACT OR OMISSION BY A SUPPLIER OR OTHER PARTY UNDER A MASTER AGREEMENT OR GPO CONTRACT. Version April 12, 2022 454 11. This Agreement shall remain in effect until termination by either party giving thirty (30) days' written notice to the other party. The provisions of Paragraphs 6 - 10 hereof shall survive any such termination. 12. This Agreement shall take effect upon (i) execution of the Principal Procurement Agency Certificate, or (ii) registration on the OMNIA Partners website or the execution of this Agreement by a Participating Public Agency, as applicable. Participating Public Agency: Authorized Signature Name Title and Agency Name Date OMNIA Partners, as the cooperative administrator on behalf of Principal Procurement Agencies: NATIONAL INTERGOVERNMENTAL PURCHASING ALLIANCE COMPANY COMMUNITIES PROGRAM MANAGEMENT, LLC Signature Sarah E. Vavra Name Sr. Vice President, Public Sector Contracting Title Date Version April 12, 2022 455 Exhibit D Principal Procurement Agency Certificate, Example PRINCIPAL PROCUREMENT AGENCY CERTIFICATE In its capacity as a Principal Procurement Agency (as defined below) for National Intergovernmental Purchasing Alliance Company, a Delaware corporation d/b/a OMNIA Partners, Public Sector ("OMNIA Partners"), [PPA Name] agrees to pursue Master Agreements for Products as specified in the attached Exhibits to this Principal Procurement Agency Certificate. I hereby acknowledge, in my capacity as of and on behalf of [PPA Name] ("Principal Procurement Agency"), that I have read and hereby agree to the general terms and conditions set forth in the attached Master Intergovernmental Cooperative Purchasing Agreement regulating the use of the Master Agreements and purchase of Products that from time to time are made available by Principal Procurement Agencies to Participating Public Agencies nationwide through OMNIA Partners. I understand that the purchase of one or more Products under the provisions of the Master Intergovernmental Cooperative Purchasing Agreement is at the sole and complete discretion of the Participating Public Agency. Authorized Signature, [PPA Name] Signature Name Title Date 456 Exhibit E Contract Sales Reporting Template Contract Sales Report submitted electronically in Microsoft Excel: 457 Exhibit F Federal Funds Certifications FEDERAL CERTIFICATIONS ADDENDUM FOR AGREEMENT FUNDED BY U.S. FEDERAL GRANT TO WHOM IT MAY CONCERN: Participating Agencies may elect to use federal funds to purchase under the Master Agreement. This form should be completed and returned. DEFINITIONS Contract means a legal instrument by which a non—Federal entity purchases property or services needed to carry out the project or program under a Federal award. The term as used in this part does not include a legal instrument, even if the non—Federal entity considers it a contract, when the substance of the transaction meets the definition of a Federal award or subaward Contractor means an entity that receives a contract as defined in Contract. Cooperative agreement means a legal instrument of financial assistance between a Federal awarding agency or pass-through entity and a non—Federal entity that, consistent with 31 U.S.C. 6302-6305: (a) Is used to enter into a relationship the principal purpose of which is to transfer anything of value from the Federal awarding agency or pass-through entity to the non—Federal entity to carry out a public purpose authorized by a law of the United States (see 31 U.S.C. 6101(3)); and not to acquire property or services for the Federal government or pass-through entity's direct benefit or use; (b) Is distinguished from a grant in that it provides for substantial involvement between the Federal awarding agency or pass-through entity and the non—Federal entity in carrying out the activity contemplated by the Federal award. (c) The term does not include: (1) A cooperative research and development agreement as defined in 15 U.S.C. 3710a; or (2) An agreement that provides only: (i) Direct United States Government cash assistance to an individual; (ii) A subsidy; (iii) A loan; (iv) A loan guarantee; or (v)Insurance. Federal awarding agency means the Federal agency that provides a Federal award directly to a non—Federal entity Federal award has the meaning, depending on the context, in either paragraph (a) or (b) of this section: (a)(1) The Federal financial assistance that a non—Federal entity receives directly from a Federal awarding agency or indirectly from a pass-through entity, as described in § 200.101 Applicability; or (2) The cost -reimbursement contract under the Federal Acquisition Regulations that a non—Federal entity receives directly from a Federal awarding agency or indirectly from a pass-through entity, as described in § 200.101 Applicability. (b) The instrument setting forth the terms and conditions. The instrument is the grant agreement, cooperative agreement, other agreement for assistance covered in paragraph (b) of § 200.40 Federal financial assistance, or the cost -reimbursement contract awarded under the Federal Acquisition Regulations. (c) Federal award does not include other contracts that a Federal agency uses to buy goods or services from a contractor or a contract to operate Federal government owned, contractor operated facilities (GOCOs). (d) See also definitions of Federal financial assistance, grant agreement, and cooperative agreement. Non—Federal entity means a state, local government, Indian tribe, institution of higher education (IHE), or nonprofit organization that carries out a Federal award as a recipient or subrecipient. Version April 12, 2022 458 Nonprofit organization means any corporation, trust, association, cooperative, or other organization, not including IHEs, that: (a) Is operated primarily for scientific, educational, service, charitable, or similar purposes in the public interest; (b) Is not organized primarily for profit; and (c) Uses net proceeds to maintain, improve, or expand the operations of the organization. Obligations means, when used in connection with a non–Federal entity's utilization of funds under a Federal award, orders placed for property and services, contracts and subawards made, and similar transactions during a given period that require payment by the non–Federal entity during the same or a future period. Pass-through entity means a non–Federal entity that provides a subaward to a subrecipient to carry out part of a Federal program. Recipient means a non–Federal entity that receives a Federal award directly from a Federal awarding agency to carry out an activity under a Federal program. The term recipient does not include subrecipients. Simplified acquisition threshold means the dollar amount below which a non–Federal entity may purchase property or services using small purchase methods. Non–Federal entities adopt small purchase procedures in order to expedite the purchase of items costing less than the simplified acquisition threshold. The simplified acquisition threshold is set by the Federal Acquisition Regulation at 48 CFR Subpart 2.1 (Definitions) and in accordance with 41 U.S.C. 1908. As of the publication of this part, the simplified acquisition threshold is $250,000, but this threshold is periodically adjusted for inflation. (Also see definition of § 200.67 Micro -purchase.) Subaward means an award provided by a pass-through entity to a subrecipient for the subrecipient to carry out part of a Federal award received by the pass-through entity. It does not include payments to a contractor or payments to an individual that is a beneficiary of a Federal program. A subaward may be provided through any form of legal agreement, including an agreement that the pass-through entity considers a contract. Subrecipient means a non–Federal entity that receives a subaward from a pass-through entity to carry out part of a Federal program; but does not include an individual that is a beneficiary of such program. A subrecipient may also be a recipient of other Federal awards directly from a Federal awarding agency. Termination means the ending of a Federal award, in whole or in part at any time prior to the planned end of period of performance. The following provisions may be required and apply when Participating Agency expends federal funds for any purchase resulting from this procurement process. Per FAR 52.204-24 and FAR 52.204-25, solicitations and resultant contracts shall contain the following provisions. 52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment (Oct 2020) The Offeror shall not complete the representation at paragraph (d)(1) of this provision if the Offeror has represented that it "does not provide covered telecommunications equipment or services as a part of its offered products or services to the Government in the performance of any contract, subcontract, or other contractual instrument" in paragraph (c)(1) in the provision at 52.204:26,:,, Covered Telecommunications Equipment or Services—Representation, or in paragraph (v)(2)(i) of the provision at 52„.21.2.::3, Offeror Representations and Certifications -Commercial Items. The Offeror shall not complete the representation in paragraph (d)(2) of this provision if the Offeror has represented that it "does not use covered telecommunications equipment or services, or any equipment, system, or service that uses covered telecommunications equipment or services” in paragraph (c)(2) of the provision at 52,,.2,04.-2,6, or in paragraph (v)(2)(ii) of the provision at 5?,.?,12,.:.3. (a) Definitions. As used in this provision— Backhaul,covered telecommunications equipment or services, critical technology, interconnection arrangements, reasonable inquiry, roaming, and substantial or essential component have the meanings provided in the clause 52„204::.25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment. 459 (b) Prohibition. (1) Section 889(a)(1)(A) of the John S. McCain National Defense Authorization Act for Fiscal Year 2019 (Pub. L. 115-232) prohibits the head of an executive agency on or after August 13, 2019, from procuring or obtaining, or extending or renewing a contract to procure or obtain, any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. Nothing in the prohibition shall be construed to— (i) Prohibit the head of an executive agency from procuring with an entity to provide a service that connects to the facilities of a third -party, such as backhaul, roaming, or interconnection arrangements; or (ii) Cover telecommunications equipment that cannot route or redirect user data traffic or cannot permit visibility into any user data or packets that such equipment transmits or otherwise handles. (2) Section 889(a)(1)(B) of the John S. McCain National Defense Authorization Act for Fiscal Year 2019 (Pub. L. 115- 232) prohibits the head of an executive agency on or after August 13, 2020, from entering into a contract or extending or renewing a contract with an entity that uses any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. This prohibition applies to the use of covered telecommunications equipment or services, regardless of whether that use is in performance of work under a Federal contract. Nothing in the prohibition shall be construed to— (i) Prohibit the head of an executive agency from procuring with an entity to provide a service that connects to the facilities of a third -party, such as backhaul, roaming, or interconnection arrangements; or (ii) Cover telecommunications equipment that cannot route or redirect user data traffic or cannot permit visibility into any user data or packets that such equipment transmits or otherwise handles. (c) Procedures. The Offeror shall review the list of excluded parties in the System for Award Management (SAM) (httpa,.1L vuv.sgm,,.ggov) for entities excluded from receiving federal awards for "covered telecommunications equipment or services". (d) Representation. The Offeror represents that— (1) It ❑ will, ❑ will not provide covered telecommunications equipment or services to the Government in the performance of any contract, subcontract or other contractual instrument resulting from this solicitation. The Offeror shall provide the additional disclosure information required at paragraph (e)(1) of this section if the Offeror responds "will' in paragraph (d)(1) of this section; and (2) After conducting a reasonable inquiry, for purposes of this representation, the Offeror represents that— It ❑ does, ❑ does not use covered telecommunications equipment or services, or use any equipment, system, or service that uses covered telecommunications equipment or services. The Offeror shall provide the additional disclosure information required at paragraph (e)(2) of this section if the Offeror responds "does" in paragraph (d)(2) of this section. (e) Disclosures. (1) Disclosure for the representation in paragraph (d)(1) of this provision. If the Offeror has responded "will" in the representation in paragraph (d)(1) of this provision, the Offeror shall provide the following information as part of the offer. (i) For covered equipment— (A) The entity that produced the covered telecommunications equipment (include entity name, unique entity identifier, CAGE code, and whether the entity was the original equipment manufacturer (OEM) or a distributor, if known); (B) A description of all covered telecommunications equipment offered (include brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); and (C) Explanation of the proposed use of covered telecommunications equipment and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(1) of this provision. (ii) For covered services— (A) If the service is related to item maintenance: A description of all covered telecommunications services offered (include on the item being maintained: Brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); or (B) If not associated with maintenance, the Product Service Code (PSC) of the service being provided; and explanation of the proposed use of covered telecommunications services and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(1) of this provision. (2) Disclosure for the representation in paragraph (d)(2) of this provision. If the Offeror has responded "does" in the representation in paragraph (d)(2) of this provision, the Offeror shall provide the following information as part of the offer: (i) For covered equipment— (A) The entity that produced the covered telecommunications equipment (include entity name, unique entity identifier, CAGE code, and whether the entity was the OEM or a distributor, if known); Version April 12, 2022 460 (B) A description of all covered telecommunications equipment offered (include brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); and (C) Explanation of the proposed use of covered telecommunications equipment and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(2) of this provision. (ii) For covered services— (A) If the service is related to item maintenance: A description of all covered telecommunications services offered (include on the item being maintained: Brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); or (B) If not associated with maintenance, the PSC of the service being provided; and explanation of the proposed use of covered telecommunications services and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(2) of this provision. 52.204-25 Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment (Aug 2020). (a) Definitions. As used in this clause— Backhaul means intermediate links between the core network, or backbone network, and the small subnetworks at the edge of the network (e.g., connecting cell phones/towers to the core telephone network). Backhaul can be wireless (e.g., microwave) or wired (e.g., fiber optic, coaxial cable, Ethernet). Covered foreign country means The People's Republic of China. Covered telecommunications equipment or services means– (1) Telecommunications equipment produced by Huawei Technologies Company or ZTE Corporation (or any subsidiary or affiliate of such entities); (2) For the purpose of public safety, security of Government facilities, physical security surveillance of critical infrastructure, and other national security purposes, video surveillance and telecommunications equipment produced by Hytera Communications Corporation, Hangzhou Hikvision Digital Technology Company, or Dahua Technology Company (or any subsidiary or affiliate of such entities); (3) Telecommunications or video surveillance services provided by such entities or using such equipment; or (4) Telecommunications or video surveillance equipment or services produced or provided by an entity that the Secretary of Defense, in consultation with the Director of National Intelligence or the Director of the Federal Bureau of Investigation, reasonably believes to be an entity owned or controlled by, or otherwise connected to, the government of a covered foreign country. Critical technology means– (1) Defense articles or defense services included on the United States Munitions List set forth in the International Traffic in Arms Regulations under subchapter M of chapter I of title 22, Code of Federal Regulations; (2) Items included on the Commerce Control List set forth in Supplement No. 1 to part 774 of the Export Administration Regulations under subchapter C of chapter VII of title 15, Code of Federal Regulations, and controlled - (i) Pursuant to multilateral regimes, including for reasons relating to national security, chemical and biological weapons proliferation, nuclear nonproliferation, or missile technology; or (ii) For reasons relating to regional stability or surreptitious listening; (3) Specially designed and prepared nuclear equipment, parts and components, materials, software, and technology covered by part 810 of title 10, Code of Federal Regulations (relating to assistance to foreign atomic energy activities); (4) Nuclear facilities, equipment, and material covered by part 110 of title 10, Code of Federal Regulations (relating to export and import of nuclear equipment and material); (5) Select agents and toxins covered by part 331 of title 7, Code of Federal Regulations, part 121 of title 9 of such Code, or part 73 of title 42 of such Code; or (6) Emerging and foundational technologies controlled pursuant to section 1758 of the Export Control Reform Act of 2018 (50 U.S.C. 4817). Interconnection arrangements means arrangements governing the physical connection of two or more networks to allow the use of another's network to hand off traffic where it is ultimately delivered (e.g., connection of a customer of telephone provider A to a customer of telephone company B) or sharing data and other information resources. Reasonable inquiry means an inquiry designed to uncover any information in the entity's possession about the identity of the producer or provider of covered telecommunications equipment or services used by the entity that excludes the need to include an internal or third -party audit. Version April 12, 2022 461 Roaming means cellular communications services (e.g., voice, video, data) received from a visited network when unable to connect to the facilities of the home network either because signal coverage is too weak or because traffic is too high. Substantial or essential component means any component necessary for the proper function or performance of a piece of equipment, system, or service. (b) Prohibition. (1) Section 889(a)(1)(A) of the John S. McCain National Defense Authorization Act for Fiscal Year 2019 (Pub. L. 115-232) prohibits the head of an executive agency on or after August 13, 2019, from procuring or obtaining, or extending or renewing a contract to procure or obtain, any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. The Contractor is prohibited from providing to the Government any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system, unless an exception at paragraph (c) of this clause applies or the covered telecommunication equipment or services are covered by a waiver described in FAR 4,2104. ........................... (2) Section 889(a)(1)(B) of the John S. McCain National Defense Authorization Act for Fiscal Year 2019 (Pub. L. 115- 232) prohibits the head of an executive agency on or after August 13, 2020, from entering into a contract, or extending or renewing a contract, with an entity that uses any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system, unless an exception at paragraph (c) of this clause applies or the covered telecommunication equipment or services are covered by a waiver described in FAR 4,2.1.04,. This prohibition applies to the use of covered telecommunications equipment or services, regardless of whether that use is in performance of work under a Federal contract. (c) Exceptions. This clause does not prohibit contractors from providing— (1) A service that connects to the facilities of a third -party, such as backhaul, roaming, or interconnection arrangements; or (2) Telecommunications equipment that cannot route or redirect user data traffic or permit visibility into any user data or packets that such equipment transmits or otherwise handles. (d) Reporting requirement. (1) In the event the Contractor identifies covered telecommunications equipment or services used as a substantial or essential component of any system, or as critical technology as part of any system, during contract performance, or the Contractor is notified of such by a subcontractor at any tier or by any other source, the Contractor shall report the information in paragraph (d)(2) of this clause to the Contracting Officer, unless elsewhere in this contract are established procedures for reporting the information; in the case of the Department of Defense, the Contractor shall report to the website at haps°1/dibnet.dod.mil. For indefinite delivery contracts, the Contractor shall report to the Contracting Officer for the indefinite delivery contract and the Contracting Officer(s) for any affected order or, in the case of the Department of Defense, identify both the indefinite delivery contract and any affected orders in the report provided at https://dibnet,dod,mil. (2) The Contractor shall report the following information pursuant to paragraph (d)(1) of this clause (i) Within one business day from the date of such identification or notification: the contract number; the order number(s), if applicable; supplier name; supplier unique entity identifier (if known); supplier Commercial and Government Entity (CAGE) code (if known); brand; model number (original equipment manufacturer number, manufacturer part number, orwholesaler number); item description; and any readily available information about mitigation actions undertaken or recommended. (ii) Within 10 business days of submitting the information in paragraph (d)(2)(i) of this clause: any further available information about mitigation actions undertaken or recommended. In addition, the Contractor shall describe the efforts it undertook to prevent use or submission of covered telecommunications equipment or services, and any additional efforts that will be incorporated to prevent future use or submission of covered telecommunications equipment or services. (e) Subcontracts. The Contractor shall insert the substance of this clause, including this paragraph (e) and excluding paragraph (b)(2), in all subcontracts and other contractual instruments, including subcontracts for the acquisition of commercial items. The following certifications and provisions may be required and apply when Participating Agency expends federal funds for any purchase resulting from this procurement process. Pursuant to 2 C.F.R. § 200.326, all contracts, including small purchases, awarded by the Participating Agency and the Participating Agency's subcontractors shall contain the procurement provisions of Version April 12, 2022 /,M Appendix II to Part 200, as applicable. APPENDIX II TO 2 CFR PART 200 (A) Contracts for more than the simplified acquisition threshold currently set at $250,000, which is the inflation adjusted amount determined by the Civilian Agency Acquisition Council and the Defense Acquisition Regulations Council (Councils) as authorized by 41 U.S.C. 1908, must address administrative, contractual, or legal remedies in instances where contractors violate or breach contract terms, and provide for such sanctions and penalties as appropriate. Pursuant to Federal Rule (A) above, when a Participating Agency expends federal funds, the Participating Agency reserves all rights and privileges under the applicable laws and regulations with respect to this procurement in the event of breach of contract by either party. Does offeror agree? YES offeror Initials of Authorized Representative of (B) Termination for cause and for convenience by the grantee or subgrantee including the manner by which it will be effected and the basis for settlement. (All contracts in excess of $10,000) Pursuant to Federal Rule (B) above, when a Participating Agency expends federal funds, the Participating Agency reserves the right to immediately terminate any agreement in excess of $10,000 resulting from this procurement process in the event of a breach or default of the agreement by Offeror as detailed in the terms of the contract. Does offeror agree? YES Initials of Authorized Representative of offeror (C) Equal Employment Opportunity. Except as otherwise provided under 41 CFR Part 60, all contracts that meet the definition of "federally assisted construction contract" in 41 CFR Part 60-1.3 must include the equal opportunity clause provided under 41 CFR 60-1.4(b), in accordance with Executive Order 11246, "Equal Employment Opportunity" (30 CFR 12319, 12935, 3 CFR Part, 1964-1965 Comp., p. 339), as amended by Executive Order 11375, "Amending Executive Order 11246 Relating to Equal Employment Opportunity," and implementing regulations at 41 CFR part 60, "Office of Federal Contract Compliance Programs, Equal Employment Opportunity, Department of Labor." Pursuant to Federal Rule (C) above, when a Participating Agency expends federal funds on any federally assisted construction contract, the equal opportunity clause is incorporated by reference herein. Does offeror agree to abide by the above? YES nitials of Authorized Representative of offeror (D) Davis -Bacon Act, as amended (40 U.S.C. 3141-3148). When required by Federal program legislation, all prime construction contracts in excess of $2,000 awarded by non -Federal entities must include a provision for compliance with the Davis -Bacon Act (40 U.S.C. 3141-3144, and 3146-3148) as supplemented by Department of Labor regulations (29 CFR Part 5, "Labor Standards Provisions Applicable to Contracts Covering Federally Financed and Assisted Construction"). In accordance with the statute, contractors must be required to pay wages to laborers and mechanics at a rate not less than the prevailing wages specified in a wage determination made by the Secretary of Labor. In addition, contractors must be required to pay wages not less than once a week. The non -Federal entity must place a copy of the current prevailing wage determination issued by the Department of Labor in each solicitation. The decision to award a contract or subcontract must be conditioned upon the acceptance of the wage determination. The non - Federal entity must report all suspected or reported violations to the Federal awarding agency. The contracts must also include a provision for compliance with the Copeland "Anti -Kickback" Act (40 U.S.C. 3145), as supplemented by Department of Labor regulations (29 CFR Part 3, "Contractors and Subcontractors on Public Building or Public Work Financed in Whole or in Part by Loans or Grants from the United States"). The Act provides that each contractor or subrecipient must be prohibited from inducing, by any means, any person employed in the construction, completion, or repair of public work, to give up any part of the compensation to which he or she is otherwise entitled. The non -Federal entity must report all suspected or reported violations to the Federal awarding agency. Pursuant to Federal Rule (D) above, when a Participating Agency expends federal funds during the term of an award for all contracts and subgrants for construction or repair, offeror will be in compliance with all applicable Davis -Bacon Act provisions. Does offeror agree? YES Initials of Authorized Representative of offeror Version April 12, 2022 463 (E) Contract Work Hours and Safety Standards Act (40 U.S.C. 3701-3708). Where applicable, all contracts awarded by the non -Federal entity in excess of $100,000 that involve the employment of mechanics or laborers must include a provision for compliance with 40 U.S.C. 3702 and 3704, as supplemented by Department of Labor regulations (29 CFR Part 5). Under 40 U.S.C. 3702 of the Act, each contractor must be required to compute the wages of every mechanic and laborer on the basis of a standard work week of 40 hours. Work in excess of the standard work week is permissible provided that the worker is compensated at a rate of not less than one and a half times the basic rate of pay for all hours worked in excess of 40 hours in the work week. The requirements of 40 U.S.C. 3704 are applicable to construction work and provide that no laborer or mechanic must be required to work in surroundings or under working conditions which are unsanitary, hazardous or dangerous. These requirements do not apply to the purchases of supplies or materials or articles ordinarily available on the open market, or contracts for transportation or transmission of intelligence. Pursuant to Federal Rule (E) above, when a Participating Agency expends federal funds, offeror certifies that offeror will be in compliance with all applicable provisions of the Contract Work Hours and Safety Standards Act during the term of an award for all contracts by Participating Agency resulting from this procurement process. Does offeror agree? YES Initials of Authorized Representative of offeror (F) Rights to Inventions Made Under a Contract or Agreement. If the Federal award meets the definition of "funding agreement" under 37 CFR §401.2 (a) and the recipient or subrecipient wishes to enter into a contract with a small business firm or nonprofit organization regarding the substitution of parties, assignment or performance of experimental, developmental, or research work under that "funding agreement," the recipient or subrecipient must comply with the requirements of 37 CFR Part 401, "Rights to Inventions Made by Nonprofit Organizations and Small Business Firms Under Government Grants, Contracts and Cooperative Agreements," and any implementing regulations issued by the awarding agency. Pursuant to Federal Rule (F) above, when federal funds are expended by Participating Agency, the offeror certifies that during the term of an award for all contracts by Participating Agency resulting from this procurement process, the offeror agrees to comply with all applicable requirements as referenced in Federal Rule (F) above. Does offeror agree? YES Initials of Authorized Representative of offeror (G) Clean Air Act (42 U.S.C. 7401-7671q.) and the Federal Water Pollution Control Act (33 U.S.C. 1251-1387), as amended—Contracts and subgrants of amounts in excess of $150,000 must contain a provision that requires the non - Federal award to agree to comply with all applicable standards, orders or regulations issued pursuant to the Clean Air Act (42 U.S.C. 7401-7671q) and the Federal Water Pollution Control Act as amended (33 U.S.C. 1251- 1387). Violations must be reported to the Federal awarding agency and the Regional Office of the Environmental Protection Agency (EPA) Pursuant to Federal Rule (G) above, when federal funds are expended by Participating Agency, the offeror certifies that during the term of an award for all contracts by Participating Agency member resulting from this procurement process, the offeror agrees to comply with all applicable requirements as referenced in Federal Rule (G) above. Does offeror agree? YES Initials of Authorized Representative of offeror (H) Debarment and Suspension (Executive Orders 12549 and 12689)—A contract award (see 2 CFR 180.220) must not be made to parties listed on the government wide exclusions in the System for Award Management (SAM), in accordance with the Executive Office of the President Office of Management and Budget (OMB) guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR part 1986 Comp., p. 189) and 12689 (3 CFR part 1989 Comp., p. 235), "Debarment and Suspension." SAM Exclusions contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other than Executive Order 12549. Pursuant to Federal Rule (H) above, when federal funds are expended by Participating Agency, the offeror certifies that during the term of an award for all contracts by Participating Agency resulting from this procurement process, the offeror certifies that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation by any federal department or agency. If at any time during the term of an award the offeror or its principals Version April 12, 2022 464 becomes debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation by any federal department or agency, the offeror will notify the Participating Agency. Does offeror agree? YES Initials of Authorized Representative of offeror (1) Byrd Anti -Lobbying Amendment (31 U.S.C. 1352)—Contractors that apply or bid for an award exceeding $100,000 must file the required certification. Each tier certifies to the tier above that it will not and has not used Federal appropriated funds to pay any person or organization for influencing or attempting to influence an officer or employee of any agency, a member of Congress, officer or employee of Congress, or an employee of a member of Congress in connection with obtaining any Federal contract, grant or any other award covered by 31 U.S.C. 1352. Each tier must also disclose any lobbying with non -Federal funds that takes place in connection with obtaining any Federal award. Such disclosures are forwarded from tier to tier up to the non -Federal award. Pursuant to Federal Rule (1) above, when federal funds are expended by Participating Agency, the offeror certifies that during the term and after the awarded term of an award for all contracts by Participating Agency resulting from this procurement process, the offeror certifies that it is in compliance with all applicable provisions of the Byrd Anti -Lobbying Amendment (31 U.S.C. 1352). The undersigned further certifies that: (1) No Federal appropriated funds have been paid or will be paid for on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any 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 a Federal contract, the making of a Federal grant, the making of a Federal loan, the entering into a cooperative agreement, and the extension, continuation, renewal, amendment, or modification of a Federal contract, grant, loan, or cooperative 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, an officer or employee of congress, or an employee of a Member of Congress in connection with this Federal grant or cooperative agreement, the undersigned shall complete and submit Standard Form -LLL, "Disclosure Form to Report Lobbying", in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all covered sub -awards exceeding $100,000 in Federal funds at all appropriate tiers and that all subrecipients shall certify and disclose accordingly. Does offeror agree? YES Initials of Authorized Representative of offeror RECORD RETENTION REQUIREMENTS FOR CONTRACTS INVOLVING FEDERAL FUNDS When federal funds are expended by Participating Agency for any contract resulting from this procurement process, offeror certifies that it will comply with the record retention requirements detailed in 2 CFR § 200.333. The offeror further certifies that offeror will retain all records as required by 2 CFR § 200.333 for a period of three years after grantees or subgrantees submit final expenditure reports or quarterly or annual financial reports, as applicable, and all other pending matters are closed. Does offeror agree? YES Initials of Authorized Representative of offeror CERTIFICATION OF COMPLIANCE WITH THE ENERGY POLICY AND CONSERVATION ACT When Participating Agency expends federal funds for any contract resulting from this procurement process, offeror certifies that it will comply with the mandatory standards and policies relating to energy efficiency which are contained in the state energy conservation plan issued in compliance with the Energy Policy and Conservation Act (42 U.S.C. 6321 et seq.; 49 C.F.R. Part 18). Does offeror agree? YES Initials of Authorized Representative of offeror CERTIFICATION OF COMPLIANCE WITH BUY AMERICA PROVISIONS To the extent purchases are made with Federal Highway Administration, Federal Railroad Administration, or Federal Transit Administration funds, offeror certifies that its products comply with all applicable provisions of the Buy America Act and agrees to provide such certification or applicable waiver with respect to specific products to any Participating Agency upon request. Purchases made in accordance with the Buy America Act must still follow the applicable procurement rules calling for free and open competition. Version April 12, 2022 465 Does offeror agree? YES Initials of Authorized Representative of offeror CERTIFICATION OF ACCESS TO RECORDS — 2 C.F.R. § 200.336 Offeror agrees that the Inspector General of the Agency or any of their duly authorized representatives shall have access to any documents, papers, or other records of offeror that are pertinent to offeror's discharge of its obligations under the Contract for the purpose of making audits, examinations, excerpts, and transcriptions. The right also includes timely and reasonable access to offeror's personnel for the purpose of interview and discussion relating to such documents. Does offeror agree? YES Initials of Authorized Representative of offeror CERTIFICATION OF APPLICABILITY TO SUBCONTRACTORS Offeror agrees that all contracts it awards pursuant to the Contract shall be bound by the foregoing terms and conditions. Does offeror agree? YES nitials of Authorized Representative of offeror Offeror agrees to comply with all federal, state, and local laws, rules, regulations and ordinances, as applicable. It is further acknowledged that offeror certifies compliance with all provisions, laws, acts, regulations, etc. as specifically noted above. Offeror's Name: Address, City, State, and Zip Code: Phone Number: Printed Name and Title of Authorized Representative: Email Address: Signature of Authorized Representative: Version April 12, 2022 Fax Number: FEMA SPECIAL CONDITIONS Awarded Supplier(s) may need to respond to events and losses where products and services are needed for the immediate and initial response to emergency situations such as, but not limited to, water damage, fire damage, vandalism cleanup, biohazard cleanup, sewage decontamination, deodorization, and/or wind damage during a disaster or emergency situation. By submitting a bid, the Supplier is accepted these FEMA Special Conditions required by the Federal Emergency Management Agency (FEMA). "Contract" in the below pages under FEMA SPECIAL CONDITIONS is also referred to and defined as the "Master Agreement". "Contractor" in the below pages under FEMA SPECIAL CONDITIONS is also referred to and defined as "Supplier" or "Awarded Supplier". Conflicts of Interest No employee, officer, or agent may participate in the selection, award, or administration of a contract supported by a FEMA award if he or she has a real or apparent conflict of interest. Such a conflict would arise when the employee, officer, or agent, any member of his or her immediate family, his or her partner, or an organization which employs or is about to employ any of these parties, has a financial or other interest in or a tangible personal benefit from a firm considered for award. 2 C.F.R. § 200.318(c)(1); See also Standard Form 424D, ¶ 7; Standard Form 4248, ¶ 3. i. FEMA considers a "financial interest" to be the potential for gain or loss to the employee, officer, or agent, any member of his or her immediate family, his or her partner, or an organization which employs or is about to employ any of these parties as a result of the particular procurement. The prohibited financial interest may arise from ownership of certain financial instruments or investments such as stock, bonds, or real estate, or from a salary, indebtedness, job offer, or similar interest that might be affected by the particular procurement. ii. FEMA considers an "apparent" conflict of interest to exist where an actual conflict does not exist, but where a reasonable person with knowledge of the relevant facts would question the impartiality of the employee, officer, or agent participating in the procurement. c. Gifts. The officers, employees, and agents of the Participating Public Agency nor the Participating Public Agency ("NFE") must neither solicit nor accept gratuities, favors, or anything of monetary value from contractors or parties to subcontracts. However, NFE's may set standards for situations in which the financial interest is de minimus, not substantial, or the gift is an unsolicited item of nominal value. 2 C.F.R. § 200.318(c)(1). d. Violations. The NFE's written standards of conduct must provide for disciplinary actions to be applied for violations of such standards by officers, employees, or agents of the NFE. 2 C.F.R. § 200.318(c)(1). For example, the penalty for a NFE's employee may be dismissal, and the penalty for a contractor might be the termination of the contract. Contractor Integrity A contractor must have a satisfactory record of integrity and business ethics. Contractors that are debarred or suspended, as described in and subject to the debarment and suspension regulations implementing Executive Order 12549, Debarment and Suspension (1986) and Executive Order 12689, Debarment and Suspension (1989) at 2 C.F.R. Part 180 and the Department of Homeland Security's regulations at 2 C.F.R. Part 3000 (Non -procurement Debarment and Suspension), must be rejected and cannot receive contract awards at any level. Public Policy A contractor must comply with the public policies of the Federal Government and state, local government, or tribal government. This includes, among other things, past and current compliance with the: a. Equal opportunity and nondiscrimination laws b. Five affirmative steps described at 2 C.F.R. § 200.321(b) for all subcontracting under contracts supported by FEMA financial assistance; and FEMA Procurement Guidance June 21, 2016 Page IV- 7 c. Applicable prevailing wage laws, regulations, and executive orders Affirmative Steps Version April 12, 2022 /,M For any subcontracting opportunities, Contractor must take the following Affirmative steps: 1. Placing qualified small and minority businesses and women's business enterprises on solicitation lists; 2. Assuring that small and minority businesses, and women's business enterprises are solicited whenever they are potential sources; 3. Dividing total requirements, when economically feasible, into smaller tasks or quantities to permit maximum participation by small and minority businesses, and women's business enterprises; 4. Establishing delivery schedules, where the requirement permits, which encourage participation by small and minority businesses, and women's business enterprises; and 5. Using the services and assistance, as appropriate, of such organizations as the Small Business Administration and the Minority Business Development Agency of the Department of Commerce. Prevailing Wage Requirements When applicable, the awarded Contractor (s) and any and all subcontractor(s) agree to comply with all laws regarding prevailing wage rates including the Davis -Bacon Act, applicable to this solicitation and/or Participating Public Agencies. The Participating Public Agency shall notify the Contractor of the applicable pricing/prevailing wage rates and must apply any local wage rates requested. The Contractor and any subcontractor(s) shall comply with the prevailing wage rates set by the Participating Public Agency. Federal Requirements If products and services are issued in response to an emergency or disaster recovery the items below, located in this FEMA Special Conditions section of the Federal Funds Certifications, are activated and required when federal funding may be utilized. 2 C.F.R. 4 200.326 and 2 C.F.R. Part 200, Appendix II, Required Contract Clauses REMEDIES a. Standard. Contracts for more than the simplified acquisition threshold, currently set at $250,000, must address administrative, contractual, or legal remedies in instances where contractors violate or breach contract terms, and provide for such sanctions and penalties as appropriate. See 2 C.F.R. Part 200, Appendix II(A). b. Applicability. This requirement applies to all FEMA grant and cooperative agreement programs. 2. TERMINATION FOR CAUSE AND CONVENIENCE a. Standard. All contracts in excess of $10,000 must address termination for cause and for convenience by the non -Federal entity, including the manner by which it will be effected and the basis for settlement. See 2 C.F.R. Part 200, Appendix II(B). b. Applicability. This requirement applies to all FEMA grant and cooperative agreement programs. 3. EQUAL EMPLOYMENT OPPORTUNITY When applicable: a. Standard. Except as otherwise provided under 41 C.F.R. Part 60, all contracts that meet the definition of "federally assisted construction contract" in 41 C.F.R. Version April 12, 2022 § 60-1.3 must include the equal opportunity clause provided under 41 C.F.R. § 60- 1.4(b), in accordance with Executive Order 11246, Equal Employment Opportunity (30 Fed. Reg. 12319, 12935, 3 C.F.R. Part, 1964-1965 Comp., p. 339), as amended by Executive Order 11375, Amending Executive Order 11246 Relating to Equal Employment Opportunity, and implementing regulations at 41 C.F.R. Part 60 (Office of Federal Contract Compliance Programs, Equal Employment Opportunity, Department of Labor). See 2 C.F.R. Part 200, Appendix II(C). b. Key Definitions. Federally Assisted Construction Contract. The regulation at 41 C.F.R. § 60- 1.3 defines a "federally assisted construction contract' as any agreement or modification thereof between any applicant and a person for construction work which is paid for in whole or in part with funds obtained from the Government or borrowed on the credit of the Government pursuant to any Federal program involving a grant, contract, loan, insurance, or guarantee, or undertaken pursuant to any Federal program involving such grant, contract, loan, insurance, or guarantee, or any application or modification thereof approved by the Government for a grant, contract, loan, insurance, or guarantee under which the applicant itself participates in the construction work. ii. Construction Work. The regulation at 41 C.F.R. § 60-1.3 defines "construction work" as the construction, rehabilitation, alteration, conversion, extension, demolition or repair of buildings, highways, or other changes or improvements to real property, including facilities providing utility services. The term also includes the supervision, inspection, and other onsite functions incidental to the actual construction. c. Applicability. This requirement applies to all FEMA grant and cooperative agreement programs. d. Required Language. The regulation at 41 C.F.R. Part 60-1.4(b) requires the insertion of the following contract clause. During the performance of this contract, the contractor agrees as follows: (1) The contractor will not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, or national origin. The contractor will take affirmative action to ensure that applicants are employed, and that employees are treated during employment without regard to their race, color, religion, sex, sexual orientation, gender identity, or national origin. Such action shall include, but not be limited to the following: Employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided setting forth the provisions of this nondiscrimination clause. (2) The contractor will, in all solicitations or advertisements for employees placed by or on behalf of the contractor, state that all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or nationalorigin. Version April 12, 2022 469 (3) The contractor will not discharge or in any other manner discriminate against any employee or applicant for employment because such employee or applicant has inquired about, discussed, or disclosed the compensation of the employee or applicant or another employee or applicant. This provision shall not apply to instances in which an employee who has access to the compensation information of other employees or applicants as a part of such employee's essential job functions discloses the compensation of such other employees or applicants to individuals who do not otherwise have access to such information, unless such disclosure is in response to a formal complaintor charge, in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or is consistent with the contractor's legal duty to furnish information. (4) The contractor will send to each labor union or representative of workers with which he has a collective bargaining agreement or other contract or understanding, a notice to be provided advising the said labor union or workers' representatives of the contractor's commitments under this section and shall post copies of the notice in conspicuous places available to employees and applicants for employment. (5) The contractor will comply with all provisions of Executive Order 11246 of September 24, 1965, and of the rules, regulations, and relevant orders of the Secretary of Labor. (6) The contractor will furnish all information and reports required by Executive Order 11246 of September 24, 1965, and by rules, regulations, and orders of the Secretary of Labor, or pursuant thereto, and will permit access to his books, records, and accounts by the administering agency and the Secretary of Labor for purposes of investigation to ascertain compliance with such rules, regulations, and orders. (7) In the event of the contractor's noncompliance with the nondiscrimination clauses of this contract or with any of the said rules, regulations, or orders, this contract may be canceled, terminated, or suspended in whole or in part and the contractor may be declared ineligible for further Government contracts or federally assisted construction contracts in accordance with procedures authorized in Executive Order 11246 of September 24, 1965, and such other sanctions may be imposed and remedies invoked as provided in Executive Order 11246 of September 24, 1965, or by rule, regulation, or order of the Secretary of Labor, or as otherwise provided by law. (8) The contractor will include the portion of the sentence immediately preceding paragraph (1) and the provisions of paragraphs (1) through (8) in every subcontract or purchase order unless exempted by rules, regulations, or orders of the Secretary of Labor issued pursuant to section 204 of Executive Order 11246 of September 24, 1965, so that such provisions will be binding upon each subcontractor or vendor. The contractor will take such action with respect to any subcontract or purchase order as the administering agency may direct as a means of enforcing such provisions, including sanctions for noncompliance: Provided, however, that in the event a contractor becomes involved in, or is threatened with, litigation with a subcontractor or vendor as a result of such direction by the administering agency, the contractor may request the United States to enter into such litigation to protect the interests of the United States. The applicant further agrees that it will be bound by the above equal opportunity clause with respect to its own employment practices when it participates in federally assisted construction work: Provided, That if the applicant so participating is a State or local government, the above equal opportunity clause is not applicable to any agency, instrumentality or subdivision of such government which does not participate in work on or under the contract. Version April 12, 2022 470 The applicant agrees that it will assist and cooperate actively with the administering agency and the Secretary of Labor in obtaining the compliance of contractors and subcontractors with the equal opportunity clause and the rules, regulations, and relevant orders of the Secretary of Labor, that it will furnish the administering agency and the Secretary of Labor such information as they may require for the supervision of such compliance, and that it will otherwise assist the administering agency in the discharge of the agency's primary responsibility for securing compliance. The applicant further agrees that it will refrain from entering into any contract or contract modification subject to Executive Order 11246 of September 24, 1965, with a contractor debarred from, or who has not demonstrated eligibility for, Government contracts and federally assisted construction contracts pursuant to the Executive Order and will carry out such sanctions and penalties for violation of the equal opportunity clause as may be imposed upon contractors and subcontractors by the administering agency or the Secretary of Labor pursuant to Part II, Subpart D of the Executive Order. In addition, the applicant agrees that if it fails or refuses to comply with these undertakings, the administering agency may take any or all of the following actions: Cancel, terminate, or suspend in whole or in part this grant (contract, loan, insurance, guarantee); refrain from extending any further assistance to the applicant under the program with respect to which the failure or refund occurred until satisfactory assurance of future compliance has been received from such applicant; and refer the case to the Department of Justice for appropriate legal proceedings. 4. DAVIS-BACON ACT a. Standard. All prime construction contracts in excess of $2,000 awarded by non- Federal entities must include a provision for compliance with the Davis -Bacon Act (40 U.S.C. §§ 3141- 3144 and 3146-3148) as supplemented by Department of Labor regulations at 29 C.F.R. Part 5 (Labor Standards Provisions Applicable to Contracts Covering Federally Financed and Assisted Construction). See 2 C.F.R. Part 200, Appendix II(D). In accordance with the statute, contractors must be required to pay wages to laborers and mechanics at a rate not less than the prevailing wages specified in a wage determination made by the Secretary of Labor. In addition, contractors must be required to pay wages not less than once a week. b. Applicability. The Davis -Bacon Act applies to the Emergency Management Preparedness Grant Program, Homeland Security Grant Program, Nonprofit Security Grant Program, Tribal Homeland Security Grant Program, Port Security Grant Program, and Transit Security Grant Program. c. Requirements. If applicable, the non-federal entity must do thefollowing: i. The non -Federal entity must place a copy of the current prevailing wage determination issued by the Department of Labor in each solicitation. The decision to award a contract or subcontract must be conditioned upon the acceptance of the wage determination. The non -Federal entity must report all suspected or reported violations to the Federal awarding agency. ii. Additionally, pursuant 2 C.F.R. Part 200, Appendix II(D), contracts subject to the Davis -Bacon Act, must also include a provision for compliancewith the Copeland "Anti -Kickback" Act (40 U.S.C. § 3145), as supplemented by Department of Labor regulations at 29 C.F.R. Part 3 (Contractors and Subcontractors on Public Building or Public Work Financed in Whole or in Part by Loans or Grants from the United States). The Copeland Anti- Kickback Act provides that each contractor or subrecipient must be prohibited from inducing, by any means, any person Version April 12, 2022 471 employed in the construction, completion, or repair of public work, to give up any part of the compensation to which he or she is otherwise entitled. The non - Federal entity must report all suspected or reported violations to FEMA. Include a provision for compliance with the Davis -Bacon Act (40 U.S.C. 3141- 3144, and 3146-3148) as supplemented by Department of Labor regulations (29 CFR Part 5, "Labor Standards Provisions Applicable to Contracts Covering Federally Financed and Assisted Construction"). Suggested Language. The following provides a sample contract clause: Compliance with the Davis -Bacon Act. a. All transactions regarding this contract shall be done in compliance with the Davis -Bacon Act (40 U.S.C. 3141- 3144, and 3146-3148) and the requirements of 29C.F.R. pt. 5 as may be applicable. The contractor shall comply with 40 U.S.C. 3141- 3144, and 3146-3148 and the requirements of 29 C.F.R. pt. 5 as applicable. b. Contractors are required to pay wages to laborers and mechanics at a rate not less than the prevailing wages specified in a wage determination made by the Secretary of Labor. c Additionally, contractors are required to pay wages not less than once a week. S. COPELAND ANTI -KICKBACK ACT a. Standard. Recipient and subrecipient contracts must include a provision for compliance with the Copeland "Anti -Kickback" Act (40 U.S.C. 3145), as supplemented by Department of Labor regulations (29 CFR Part 3, "Contractors and Subcontractors on Public Building or Public Work Financed in Whole or in Part by Loans or Grants from the United States"). b. Applicability. This requirement applies to all contracts for construction or repair work above $2,000 in situations where the Davis -Bacon Act also applies. It DOES NOT apply to the FEMA Public Assistance Program. c. Requirements. If applicable, the non-federal entity must include a provision for compliance with the Copeland "Anti -Kickback" Act (40 U.S.C. § 3145), as supplemented by Department of Labor regulations at 29 C.F.R. Part 3 (Contractors and Subcontractors on Public Building or Public Work Financed in Whole or in Part by Loans or Grants from the United States). Each contractor or subrecipient must be prohibited from inducing, by any means, any person employed in the construction, completion, or repair of public work, to give up any part of the compensation to which he or she is otherwise entitled. The non -Federal entity must report all suspected or reported violations to FEMA. Additionally, in accordance with the regulation, each contractor and subcontractor must furnish each week a statement with respect to the wages paid each of its employees engaged in work covered by the Copeland Anti -Kickback Act and the Davis Bacon Act during the preceding weekly payroll period. The report shall be delivered by the contractor or subcontractor, within seven days after the regular payment date of the payroll period, to a representative of a Federal or State agency in charge at the site of the building or work. Sample Language. The following provides a sample contract clause: Version April 12, 2022 472 Compliance with the Copeland "Anti -Kickback" Act. a. Contractor. The contractor shall comply with 18 U.S.C. §874, 40 U.S.C. § 3145, and the requirements of 29 C.F.R. pt. 3 as may be applicable, which are incorporated by reference into this contract. b. Subcontracts. The contractor or subcontractor shall insert in any subcontracts the clause above and such other clauses as FEMA may by appropriate instructions require, and also a clause requiring the subcontractors to include these clauses in any lower tier subcontracts. The prime contractor shall be responsible for the compliance by any subcontractor or lower tier subcontractor with all of these contract clauses. c Breach. A breach of the contract clauses above may be grounds for termination of the contract, and for debarment as a contractor and subcontractor as provided in 29 C.F.R. §5.12." 6. CONTRACT WORK HOURS AND SAFETY STANDARDSACT a Standard. Where applicable (see 40 U.S.C. §§ 3701-3708), all contracts awarded by the non -Federal entity in excess of $100,000 that involve the employment of mechanics or laborers must include a provision for compliance with 40 U.S.C. §§ 3702 and 3704, as supplemented by Department of Labor regulations at 29 C.F.R. Part 5. See 2 C.F.R. Part 200, Appendix II(E). Under 40 U.S.C. § 3702, each contractor must be required to compute the wages of every mechanic and laborer on the basis of a standard work week of 40 hours. Work in excess of the standard work week is permissible provided that the worker is compensated at a rate of not less than one and a half times the basic rate of pay for all hours worked in excess of 40 hours in the work week. Further, no laborer or mechanic must be required to work in surroundings or under working conditions which are unsanitary, hazardous, or dangerous. b. Applicability. This requirement applies to all FEMA contracts awarded by the non- federal entity in excess of $100,000 under grant and cooperative agreement programs that involve the employment of mechanics or laborers. It is applicable to construction work. These requirements do not apply to the purchase of supplies or materials or articles ordinarily available on the open market, or contracts for transportation or transmission of intelligence. a Suggested Language. The regulation at 29 C.F.R. § 5.5(b) provides contract clause language concerning compliance with the Contract Work Hours and Safety Standards Act. FEMA suggests including the following contract clause: Compliance with the Contract Work Hours and Safety Standards Act. (1) Overtime requirements. No contractor or subcontractor contracting for any part of the contract work which may require or involve the employment of laborers or mechanics shall require or permit any such laborer or mechanic in any workweek in which he or she is employed on such work to work in excess of forty hours in such workweek unless such laborer or mechanic receives compensation at a rate not less than one and one-half times the basic rate of pay for all hours worked in excess of forty hours in suchworkweek. (2) Violation; liability for unpaid wages; liquidated damages. In the event of any violation Version April 12, 2022 473 of the clause set forth in paragraph (b)(1) of this section the contractor and any subcontractor responsible therefor shall be liable for the unpaid wages. In addition, such contractor and subcontractor shall be liable to the United States (in the case of work done under contract for the District of Columbia or a territory, to such District or to such territory), for liquidated damages. Such liquidated damages shall be computed with respect to each individual laborer or mechanic, including watchmen and guards, employed in violation of the clause set forth in paragraph (b)(1) of this section, in the sum of $27 for each calendar day on which such individual was required or permitted to work in excess of the standard workweek of forty hours without payment of the overtime wages required by the clause set forth in paragraph (b)(1) of this section. (3) Withholding for unpaid wages and liquidated damages. The Federal agency or loan/grant recipient shall upon its own action or upon written request of an authorized representative of the Department of Labor withhold or cause to be withheld, from any moneys payable on account of work performed by the contractor or subcontractor under any such contract or any other Federal contract with the same prime contractor, or any other federally -assisted contract subject to the Contract Work Hours and Safety Standards Act, which is held by the same prime contractor, such sums as may be determined to be necessary to satisfy any liabilities of such contractor or subcontractor for unpaid wages and liquidated damages as provided in the clause set forth in paragraph (b)(2) of thissection. (4) Subcontracts. The contractor or subcontractor shall insert in any subcontracts the clauses setforth in paragraph (b)(1) through (4) of thissection and also a clause requiring the subcontractors to include these clauses in any lower tier subcontracts. The prime contractor shall be responsible for compliance by any subcontractor or lower tier subcontractor with the clauses set forth in paragraphs (b)(1) through (4) of thissection. 7. RIGHTS TO INVENTIONS MADE UNDER A CONTRACT ORAGREEMENT a Standard. If the FEMA award meets the definition of "funding agreement' under 37C.F.R. § 401.2(a) and the non -Federal entity wishes to enter into a contract with a small business firm or nonprofit organization regarding the substitution of parties, assignment or performance of experimental, developmental, or research work under that "funding agreement," the non- Federal entity must comply with the requirements of 37 C.F.R. Part 401 (Rights to Inventions Made by Nonprofit Organizations and Small Business Firms Under Government Grants, Contracts and Cooperative Agreements), and any implementing regulations issued by FEMA. See 2 C.F.R. Part 200, Appendix II(F). LL Applicability. This requirement applies to "funding agreements," but it DOES NOT apply to the Public Assistance, Hazard Mitigation Grant Program, Fire Management Assistance Grant Program, Crisis Counseling Assistance and Training Grant Program, Disaster Case Management Grant Program, and Federal Assistance to Individuals and Households — Other Needs Assistance Grant Program, as FEMA awards under these programs do not meet the definition of "funding agreement." a Funding Agreements Definition. The regulation at 37 C.F.R. § 401.2(a) defines "funding agreement' as any contract, grant, or cooperative agreement entered into between any Federal agency, other than the Tennessee Valley Authority, and any contractor for the performance of experimental, developmental, or research work funded in whole or in part by the Federal government. This term also includes any assignment, substitution of parties, or subcontract of any type entered into for the performance of experimental, developmental, or research work under a funding agreement as defined in the first sentence of this paragraph. Version April 12, 2022 474 & CLEAN AIR ACT AND THE FEDERAL WATER POLLUTION CONTROLACT a Standard. If applicable, contracts must contain a provision that requires the contractor to agree to comply with all applicable standards, orders, or regulations issued pursuant to the Clean AirAct (42 U.S.C. §§ 7401-7671 q.) and the Federal Water Pollution Control Act as amended (33 U.S.C. §§ 1251-1387). Violations must be reported to FEMA and the Regional Office of the Environmental Protection Agency. See 2 C.F.R. Part 200, Appendix II(G). b. Applicability. This requirement applies to contracts awarded by a non-federal entity of amounts in excess of $150,000 under a federal grant. a Suggested Language. The following provides a sample contract clause. Clean Air Art 1. The contractor agrees to comply with all applicable standards, orders or regulations issued pursuant to the Clean Air Act, as amended, 42 U.S.C. § 7401 et seq. 2. The contractor agrees to report each violation to the Participating Public Agency and understands and agrees that the Participating Public Agency will, in turn, report each violation as required to assure notification to the Federal Emergency Management Agency, and the appropriate Environmental Protection Agency Regional Office. 3. The contractor agrees to include these requirements in each subcontract exceeding $150,000 financed in whole or in part with Federal assistance provided by FEMA. Federal Water Pollution Control Act 1. The contractor agrees to comply with all applicablestandards, orders, or regulations issued pursuant to the Federal Water Pollution Control Act, as amended, 33 U.S.C. 1251 etseq. 2. The contractor agrees to report each violation to the Participating Public Agency and understands and agrees that the Participating Public Agency will, in turn, report each violation as required to assure notification to the Federal Emergency Management Agency, and the appropriate Environmental Protection Agency Regional Office. 3. The contractor agrees to include these requirements in each subcontract exceeding $150,000 financed in whole or in part with Federal assistance provided by FEMA. 9. DEBARMENT AND SUSPENSION a Standard. Non -Federal entities and contractors are subject to the debarment and suspension regulations implementing Executive Order 12549, Debarment and Version April 12, 2022 475 Suspension (1986) and Executive Order 12689, Debarment and Suspension (1989) at 2 C.F.R. Part 180 and the Department of Homeland Security's regulations at 2 C.F.R. Part 3000 (Non -procurement Debarment and Suspension). b. Applicability. This requirement applies to all FEMA grant and cooperative agreement programs. c Requirements. These regulations restrict awards, subawards, and contracts with certain parties that are debarred, suspended, or otherwise excluded from or ineligible for participation in Federal assistance programs and activities. See 2 C.F.R. Part 200, Appendix II(H); and 2 C.F.R. § 200.213. A contract award must not be made -to parties listed in the SAM Exclusions. SAM Exclusions is the list maintained by the General Services Administration that contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other than Executive Order 12549. SAM exclusions can be accessed at www.sam.gov. See 2 C.F.R. § 180.530. In general, an "excluded" party cannot receive a Federal grant award or a contract within the meaning of a "covered transaction," to include subawards and subcontracts. This includes parties that receive Federal funding indirectly, such as contractors to recipients and subrecipients. The key to the exclusion is whether there is a "covered transaction," which is any non -procurement transaction (unless excepted) at either a "primary" or "secondary" tier. Although "covered transactions" do not include contracts awarded by the Federal Government for purposes of the non -procurement common rule and DHS's implementing regulations, it does include some contracts awarded by recipients and subrecipients. iii. Specifically, a covered transaction includes the following contracts for goods or services: 1. The contract is awarded by a recipient or subrecipient in the amount of at least $25,000. 2. The contract requires the approval of FEMA, regardlessof amount. 3. The contract is for federally -required auditservices. 4. A subcontract is also a covered transaction if it is awarded by the contractor of a recipient or subrecipient and requires either the approval of FEMA or is in excess of$25,000. d Suggested Language. The following provides a debarment and suspension clause. It incorporates an optional method of verifying that contractors are not excluded or disqualified. Suspension and Debarment (1) This contract is a covered transaction for purposes of 2 C.F.R. pt. 180 and 2 C.F.R. pt. 3000. As such, the contractor is required to verify that none of the contractor's principals (defined at 2 C.F.R. § 180.995) or its affiliates (defined at 2 C.F.R. § 180.905) are excluded (defined at 2 C.F.R. § 180.940) or disqualified (defined at 2 Version April 12, 2022 EU C. F. R. § 180.935). (2) The contractor must comply with 2 C.F.R. pt. 180, subpart C and2 C.F.R. pt. 3000, subpart C, and must include a requirement to comply with these regulations in any lower tier covered transaction it enters into. (3) This certification is a material representation of fact relied upon by the Participating Public Agency. If it is later determined that the contractor did not comply with 2 C.F.R. pt. 180, subpart C and 2 C.F.R. pt. 3000, subpart C, in addition to remedies available to the Participating Public Agency, the Federal Government may pursue available remedies, including but not limited to suspension and/or debarment. (4) The bidder or proposer agrees to comply with the requirements of 2 C.F.R. pt. 180, subpart C and 2 C.F.R. pt. 3000, subpart C while this offer is valid and throughout the period of any contract that may arise from this offer. The bidder or proposer further agrees to include a provision requiring such compliance in its lower tier covered transactions. 10. BYRD ANTI -LOBBYING AMENDMENT a Standard. Each tier certifies to the tier above that it will not and has not used Federal appropriated funds to pay any person or organization for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, officer or employee of Congress, or an employee of a Member of Congress in connection with obtaining any Federal contract, grant or any other award covered by 31 U.S.C. § 1352. FEMA's regulation at 44 C.F.R. Part 18 implements the requirements of 31 U.S.C. § 1352 and provides, in Appendix A to Part 18, a copy of the certification that is required to be completed by each entity as described in 31 U.S.C. § 1352. Each tier must also disclose any lobbying with non -Federal funds that takes place in connection with obtaining any Federal award. Such disclosures are forwarded from tier to tier up to the Federal awarding agency. b. Applicability. This requirement applies to all FEMA grant and cooperative agreement programs. Contractors that apply or bid for a contract of $100,000 or more under a federal grant must file the required certification. See 2 C.F.R. Part 200, Appendix II(I); 31 U.S.C. § 1352; and 44 C.F.R. Part 18. G Suggested Language. Byrd Anti -Lobbying Amendment, 31 U.S.C. _ 1352 (as amended) Contractors who apply or bid for an award of $100,000 or more shall file the required certification. Each tier certifies to the tier above that it will not and has not used Federal appropriated funds to pay any person or organization for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, officer or employee of Congress, or an employee of a Member of Congress in connection with obtaining any Federal contract, grant, or any other award covered by 31 U.S.C. § 1352. Each tier shall also disclose any lobbying with non -Federal funds that takes place in connection with obtaining any Federal award. Such disclosures are forwarded from tier to tier up to the recipient who in turn will forward the certification(s) to the awarding agency. Version April 12, 2022 477 d Required Certification. If applicable, contractors must sign and submit to the non-federal entity the following certification. APPENDIX A. 44 C.F.R. PART 18— CERTIFICATION REGARDING LOBBYING Certification for Contracts, Grants, Loans, and Cooperative Agreements The undersigned certifies, to the best of his or her knowledge and belief, that: No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an 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 any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative 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, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form - LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. 3. The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The Contractor, , certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. Chap. 38, Administrative Remedies for False Claims and Statements, apply to this certification and disclosure, if any. Signature of Contractor's Authorized Official Name and Title of Contractor's Authorized Official Date Version April 12, 2022 478 11. PROCUREMENT OF RECOVERED MATERIALS a Standard. A non -Federal entity that is a state agency or agency of a political subdivision of a state and its contractors must comply with Section 6002 of the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act. See 2 C.F.R. Part 200, Appendix II(J); and 2 C.F.R. §200.322. b. Applicability. This requirement applies to all contracts awarded by a non- federal entity under FEMA grant and cooperative agreement programs. a Requirements. The requirements of Section 6002 include procuring only items designated in guidelines of the EPA at 40 C.F.R. Part 247 that contain the highest percentage of recovered materials practicable, consistent with maintaining a satisfactory level of competition, where the purchase price of the item exceeds $10,000 or the value of the quantity acquired by the preceding fiscal year exceeded $10,000; procuring solid waste management services in a manner that maximizes energy and resource recovery; and establishing an affirmative procurement program for procurement of recovered materials identified in the EPA guidelines. d Suggested Language. i. In the performance of this contract, the Contractor shall make maximum use of products containing recovered materials that are EPA -designated items unless the product cannot be acquired— Competitively within a timeframe providing for compliance with the contract performance schedule; Meeting contract performance requirements; or At a reasonable price. ii. Information about this requirement, along with the list of EPA- designated items, is available at EPA's Comprehensive Procurement Guidelines web site, https://www.epa.gov/smm/comprehensive-procurement-quideline-cpg-program. The Contractor also agrees to comply with all other applicable requirements of Section 6002 of the Solid Waste Disposal Act." 12. ACCESS TO RECORDS a. Standard. All recipients, subrecipients, successors, transferees, and assignees must acknowledge and agree to comply with applicable provisions governing DHS access to records, accounts, documents, information, facilities, and staff. Recipients must give DHS/FEMA access to, and the right to examine and copy, records, accounts, and other documents and sources of information related to the federal financial assistance award and permit access to facilities, personnel, and other individuals and information as may be necessary, as required by DHS regulations and other applicable laws or program guidance. See DHS Standard Terms and Conditions: Version 8.1 (2018). Additionally, Section 1225 of the Disaster Recovery Reform Act of 2018 prohibits FEMA from providing reimbursement to any state, local, tribal, or territorial government, or private non-profit for activities made pursuant to a contract that purports to prohibit audits or internal reviews by the FEMA administrator or ComptrollerGeneral. Access to Records. The following access to records requirements apply to this contract: Version April 12, 2022 479 13. CHANGES i.The Contractor agrees to provide Participating Public Agency, the FEMA Administrator, the Comptroller General of the United States, or any of their authorized representatives access to any books, documents, papers, and records of the Contractor which are directly pertinent to this contract for the purposes of making audits, examinations, excerpts, and transcriptions. ii.The Contractor agrees to permit any of the foregoing parties to reproduce by any means whatsoever or to copy excerpts and transcriptions as reasonably needed. iii. The Contractor agrees to provide the FEMA Administrator or his authorized representatives access to construction or other work sites pertaining to the work being completed under the contract. iv.ln compliance with the Disaster Recovery Act of 2018, the Participating Public Agency and the Contractor acknowledge and agree that no language in this contract is intended to prohibit audits or internal reviews by the FEMA Administrator or the Comptroller General of the United States. a. Standard. To be eligible for FEMA assistance under the non -Federal entity's FEMA grant or cooperative agreement, the cost of the change, modification, change order, or constructive change must be allowable, allocable, within the scope of its grant or cooperative agreement, and reasonable for the completion of project scope. b. Applicability. FEMA recommends, therefore, that a non -Federal entity include a changes clause in its contract that describes how, if at all, changes can be made by either party to alter the method, price, or schedule of the work without breaching the contract. The language of the clause may differ depending on the nature of the contract and the end -item procured. 14. DHS SEAL, LOGO, AND FLAGS a. Standard. Recipients must obtain permission prior to using the DHS seal(s), logos, crests, or reproductions of flags or likenesses of DHS agency officials. See DHS Standard Terms and Conditions: Version 8.1 (2018). b. Applicability. FEMA recommends that all non -Federal entities place in their contracts a provision that a contractor shall not use the DHS seal(s), logos, crests, or reproductions of flags or likenesses of DHS agency officials without specific FEMA pre -approval. c. "The contractor shall not use the DHS seal(s), logos, crests, or reproductions of flags or likenesses of DHS agency officials without specific FEMA pre -approval. Version April 12, 2022 480 15. COMPLIANCE WITH FEDERAL LAW, REGULATIONS, AND EXECUTIVE ORDERS a. Standard. The recipient and its contractors are required to comply with all Federal laws, regulations, and executive orders. b. Applicability. FEMA recommends that all non -Federal entities place into their contracts an acknowledgement that FEMA financial assistance will be used to fund the contract along with the requirement that the contractor will comply with all applicable Federal law, regulations, executive orders, and FEMA policies, procedures, and directives. c. "This is an acknowledgement that FEMA financial assistance will be used to fund all or a portion of the contract. The contractor will comply with all applicable Federal law, regulations, executive orders, FEMA policies, procedures, and directives." 16. NO OBLIGATION BY FEDERAL GOVERNMENT a. Standard. FEMA is not a party to any transaction between the recipient and its contractor. FEMA is not subject to any obligations or liable to any party for any matter relating to the contract. b. Applicability. FEMA recommends that the non -Federal entity include a provision in its contract that states that the Federal Government is not a party to the contract and is not subject to any obligations or liabilities to the non -Federal entity, contractor, or any other party pertaining to any matter resulting from the contract. c. "The Federal Government is not a party to this contract and is not subject to any obligations or liabilities to the non -Federal entity, contractor, or any other party pertaining to any matter resulting from the contract." 17. PROGRAM FRAUD AND FALSE OR FRAUDULENT STATEMENTS OR RELATED ACTS a. Standard. Recipients must comply with the requirements of The False Claims Act (31 U.S.C. §§ 3729-3733) which prohibits the submission of false or fraudulent claims for payment to the federal government. See DHS Standard Terms and Conditions: Version 8.1 (2018); and 31 U.S.C. §§ 3801-3812, which details the administrative remedies for false claims and statements made. The non -Federal entity must include a provision in its contract that the contractor acknowledges that 31 U.S.C. Chap. 38 (Administrative Remedies for False Claims and Statements) applies to its actions pertaining to the contract. b. Applicability. FEMA recommends that the non -Federal entity include a provision in its contract that the contractor acknowledges that 31 U.S.C. Chap. 38 (Administrative Remedies for False Claims and Statements) applies to its actions pertaining to the contract. c. "The Contractor acknowledges that 31 U.S.C. Chap. 38 (Administrative Remedies for False Claims and Statements) applies to the Contractor's actions pertaining to this contract." 481 Offeror agrees to comply with all terms and conditions outlined in the FEMA Special Conditions section of this solicitation. Offeror's Name: Address, City, State, and Zip Code: Phone Number: Fax Number: Printed Name and Title of Authorized Representative: Email Address: Signature of Authorized Representative: Date: Version April 12, 2022 482 Exhibit G New Jersey Business Compliance NEW JERSEY BUSINESS COMPLIANCE Suppliers intending to do business in the State of New Jersey must comply with policies and procedures required under New Jersey statues. All offerors submitting proposals must complete the following forms specific to the State of New Jersey. Completed forms should be submitted with the offeror's response to the IFB. Failure to complete the New Jersey packet will impact OMNIA Partners' ability to promote the Master Agreement in the State of New Jersey. DOC #1 Ownership Disclosure Form DOC #2 Non -Collusion Affidavit DOC #3 Affirmative Action Affidavit DOC #4 Political Contribution Disclosure Form DOC #5 Stockholder Disclosure Certification DOC #6 Certification of Non -Involvement in Prohibited Activities in Iran DOC #7 New Jersey Business Registration Certificate DOC #8 EEOAA Evidence DOC #9 MacBride Principals Form New Jersey suppliers are required to comply with the following New Jersey statutes when applicable: all anti -discrimination laws, including those contained in N.J.S.A. 10:2-1 through N.J.S.A. 10:2-14, N.J.S.A. 10:5-1, and N.J.S.A. 10:5-31 through 10:5-38; Prevailing Wage Act, N.J.S.A. 34:11-56.26, for all contracts within the contemplation of the Act; • Public Works Contractor Registration Act, N.J.S.A. 34:11-56.26; and a Bid and Performance Security, as required by the applicable municipal or state statutes. Version April 12, 2022 483 DOC #1 STATEMENT OF OWNERSHIP DISCLOSURE N.J.S.A. 52:25-24.2 (P.L. 1977, c.33, as amended by P.L. 2016, c.43) This statement shall be completed, certified to, and included with all bid and proposal submissions. Failure to submit the required information is cause for automatic rejection of the bid or proposal. Name of Organization: Orcianization Address: Part I Check the box that represents the type of business organization: OSole Proprietorship (skip Parts II and III, execute certification in Part IV) 0 Non -Profit Corporation (skip Parts II and III, execute certification in Part IV) 0 For -Profit Corporation (any type) 0 Limited Liability Company (LLC) 0 Partnership 0 Limited Partnership 0 Limited Liability Partnership (LLP) 0 Other (be specific): Part II 0 The list below contains the names and addresses of all stockholders in the corporation who own 10 percent or more of its stock, of any class, or of all individual partners in the partnership who own a 10 percent or greater interest therein, or of all members in the limited liability company who own a 10 percent or greater interest therein, as the case may be. (COMPLETE THE LIST BELOW IN THIS SECTION) OR 0 No one stockholder in the corporation owns 10 percent or more of its stock, of any class, or no individual partner in the partnership owns a 10 percent or greater interest therein, or no member in the limited liability company owns a 10 percent or greater interest therein, as the case may be. (SKIP TO PART IV) (Please attach additional sheets if more space is needed Name of Individual or Business Entity I Home Address (for Individuals) or Business Address Version April 12, 2022 484 Part III DISCLOSURE OF 10% OR GREATER OWNERSHIP IN THE STOCKHOLDERS, PARTNERS OR LLC MEMBERS LISTED IN PART II If a bidder has a direct or indirect parent entity which is publicly traded, and any person holds a 10 percent or greater beneficial interest in the publicly traded parent entity as of the last annual federal Security and Exchange Commission (SEC) or foreign equivalent filing, ownership disclosure can be met by providing links to the website(s) containing the last annual filing(s) with the federal Securities and Exchange Commission (or foreign equivalent) that contain the name and address of each person holding a 10% or greater beneficial interest in the publicly traded parent entity, along with the relevant page numbers of the filing(s) that contain the information on each such person. Attach additional sheets if more space is needed. Website (URL) containing the last annual SEC (or foreign equivalent) filing Page #'s Please list the names and addresses of each stockholder, partner or member owning a 10 percent or greater interest in any corresponding corporation, partnership and/or limited liability company (LLC) listed in Part II other than for any publicly traded parent entities referenced above. The disclosure shall be continued until names and addresses of every noncorporate stockholder, and individual partner, and member exceeding the 10 percent ownership criteria established pursuant to N.J.S.A. 52:25-24.2 has been listed. Attach additional sheets if more space is needed. Stockholder/Partner/Member and Corresponding Entity Listed in Part II Home Address (for Individuals) or Business Address Part IV Certification I, being duly sworn upon my oath, hereby represent that the foregoing information and any attachments thereto to the best of my knowledge are true and complete. I acknowledge: that I am authorized to execute this certification on behalf of the bidder/proposer; that the <name of contracting unit> is relying on the information contained herein and that I am under a continuing obligation from the date of this certification through the completion of any contracts with <type of contracting unit> to notify the <type of contracting unit> in writing of any changes to the information contained herein; that I am aware that it is a criminal offense to make a false statement or misrepresentation in this certification, and if I do so, I am subject to criminal prosecution under the law and that it will constitute a material breach of my agreement(s) with the, permitting the <type of contracting unit> to declare any contract(s) resulting from this certification void and unenforceable. Full Name (Print): Title: Signature: Date: Version April 12, 2022 485 DOC #2 NON -COLLUSION AFFIDAVIT STANDARD BID DOCUMENT REFERENCE Reference: VII -H Naive of Form: NON -COLLUSION AFFIDAVIT Statutory Reference: No specific statutory reference State Statutory Reference N.J.S.A. 52:34-15 Instructions Reference: Statutory and Other Requirements VII -H The Owner's use of this form is optional. It is used to ensure that Description: the bidder has not participated in any collusion with any other bidder or Owner representative or otherwise taken any action in restraint of free and competitive bidding. Version April 12, 2022 486 State of New Jersey County of I, NON -COLLUSION AFFIDAVIT residing in ss: (name of affiant) (name of municipality) in the County of and State of age, being duly sworn according to law on my oath depose and say that: I am (title or position) entitled of the firm of (name of firm) the bidder making this Proposal for the bid and that I executed the said proposal with of full (title of bid proposal) full authority to do so that said bidder has not, directly or indirectly entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free, competitive bidding in connection with the above named project; and that all statements contained in said proposal and in this affidavit are true and correct, and made with full knowledge that the relies upon the truth of the statements contained in said Proposal (name of contracting unit) and in the statements contained in this affidavit in awarding the contract for the said project. I further warrant that no person or selling agency has been employed or retained to solicit or secure such contract upon an agreement or understanding for a commission, percentage, brokerage, or contingent fee, except bona fide employees or bona fide established commercial or selling agencies maintained by Subscribed and sworn to before me this day Signature ,2 (Type or print name of affiant under signature) Notary public of My Commission expires (Seal) Version April 12, 2022 487 DOC #3 AFFIRMATIVE ACTION AFFIDAVIT (P.L. 1975, C.127) Company Name: Street: City, State, Zip Code: Proposal Certification: Indicate below company's compliance with New Jersey Affirmative Action regulations. Company's proposal will be accepted even if company is not in compliance at this time. No contract and/or purchase order may be issued, however, until all Affirmative Action requirements are met. Required Affirmative Action Evidence: Procurement, Professional & Service Contracts (Exhibit A) Vendors must submit with proposal: 1. A photocopy of a valid letter that the contractor is operating under an existing Federally approved or sanctioned affirmative action program (good for one year from the date of the letter); 2. A photocopy of a Certificate of Employee Information Report approval, issued in accordance with N.J.A.C. 17:27-4; 3. A photocopy of an Employee Information Report (Form AA302) provided by the Division of Contract Compliance and Equal Employment Opportunity in Public Contracts and distributed to the public agency to be completed by the contractor in accordance with N.J.A.C. 17:27-4. Public Work — Over $50,000 Total Proiect Cost: A. No approved Federal or New Jersey Affirmative Action Plan. We will complete Report Form AA201. A project contract ID number will be assigned to your firm upon receipt of the completed Initial Project Workforce Report (AA201) for this contract. B. Approved Federal or New Jersey Plan — certificate enclosed I further certify that the statements and information contained herein, are complete and correct to the best of my knowledge and belief. Date Authorized Signature and Title Version April 12, 2022 488 DOC #3, continued P.L. 1995, c. 127 (N.J.A.C. 17:27) MANDATORY AFFIRMATIVE ACTION LANGUAGE PROCUREMENT, PROFESSIONAL AND SERVICE CONTRACTS During the performance of this contract, the contractor agrees as follows: The contractor or subcontractor, where applicable, will not discriminate against any employee or applicant for employment because of age, race, creed, color, national origin, ancestry, marital status, sex, affectional or sexual orientation. The contractor will take affirmative action to ensure that such applicants are recruited and employed, and that employees are treated during employment, without regard to their age, race, creed, color, national origin, ancestry, marital status, sex, affectional or sexual orientation. Such action shall include, but not be limited to the following: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by the Public Agency Compliance Officer setting forth provisions of this non-discrimination clause. The contractor or subcontractor, where applicable will, in all solicitations or advertisement for employees placed by or on behalf of the contractor, state that all qualified applicants will receive consideration for employment without regard to age, race, creed, color, national origin, ancestry, marital status, sex, affectional or sexual orientation. The contractor or subcontractor, where applicable, will send to each labor union or representative of workers with which it has a collective bargaining agreement or other contract or understanding, a notice, to be provided by the agency contracting officer advising the labor union or workers' representative of the contractor's commitments under this act and shall post copies of the notice in conspicuous places available to employees and applicants for employment. The contractor or subcontractor, where applicable, agrees to comply with any regulations promulgated by the Treasurer pursuant to P.L. 1975, c. 127, as amended and supplemented from time to time and the Americans with Disabilities Act. The contractor or subcontractor agrees to attempt in good faith to employ minority and female workers trade consistent with the applicable county employment goal prescribed by N.J.A.C. 17:27-5.2 promulgated by the Treasurer pursuant to P.L. 1975, C.127, as amended and supplemented from time to time or in accordance with a binding determination of the applicable county employment goals determined by the Affirmative Action Office pursuant to N.J.A.C. 17:27-5.2 promulgated by the Treasurer pursuant to P.L. 1975, C.127, as amended and supplemented from time to time. The contractor or subcontractor agrees to inform in writing appropriate recruitment agencies in the area, including employment agencies, placement bureaus, colleges, universities, labor unions, that it does not discriminate on the basis of age, creed, color, national origin, ancestry, marital status, sex, affectional or sexual orientation, and that it will discontinue the use of any recruitment agency which engages in direct or indirect discriminatory practices. The contractor or subcontractor agrees to revise any of it testing procedures, if necessary, to assure that all personnel testing conforms with the principles of job-related testing, as established by the statutes and court decisions of the state of New Jersey and as established by applicable Federal law and applicable Federal court decisions. The contractor or subcontractor agrees to review all procedures relating to transfer, upgrading, downgrading and lay-off to ensure that all such actions are taken without regard to age, creed, color, national origin, ancestry, marital status, sex, affectional or sexual orientation, and conform with the applicable employment goals, consistent with the statutes and court decisions of the State of New Jersey, and applicable Federal law and applicable Federal court decisions. The contractor and its subcontractors shall furnish such reports or other documents to the Affirmative Action Office as may be requested by the office from time to time in order to carry out the purposes of these regulations, and public agencies shall furnish such information as may be requested by the Affirmative Action Office for conducting a compliance investigation pursuant to Subchapter 10 of the Administrative Code (NJAC 17:27). Signature of Procurement Agent Version April 12, 2022 489 DOC #4 C. 271 POLITICAL CONTRIBUTION DISCLOSURE FORM Public Agency Instructions This page provides guidance to public agencies entering into contracts with business entities that are required to file Political Contribution Disclosure forms with the agency. It is not intended to be provided to contractors. What follows are instructions on the use of form local units can provide to contractors that are required to disclose political contributions pursuant to N.J.S.A. 19:44A-20.26 (P.L. 2005, c. 271, s.2). Additional information on the process is available in Local Finance Notice 2006-1 (http://www.nj_gov/dca/divisions/dlgs/resources/lfns 2006.html). Please refer back to these instructions for the appropriate links, as the Local Finance Notices include links that are no longer operational. 1. The disclosure is required for all contracts in excess of $17,500 that are not awarded pursuant to a "fair and open" process (N.J.S.A. 19:44A-20.7). 2. Due to the potential length of some contractor submissions, the public agency should consider allowing data to be submitted in electronic form (i.e., spreadsheet, pdf file, etc.). Submissions must be kept with the contract documents or in an appropriate computer file and be available for public access. The form is worded to accept this alternate submission. The text should be amended if electronic submission will not be allowed. 3. The submission must be received from the contractor and on file at least 10 days prior to award of the contract. Resolutions of award should reflect that the disclosure has been received and is on file. 4. The contractor must disclose contributions made to candidate and parry committees covering a wide range of public agencies, including all public agencies that have elected officials in the county of the public agency, state legislative positions, and various state entities. The Division of Local Government Services recommends that contractors be provided a list of the affected agencies. This will assist contractors in determining the campaign and political committees of the officials and candidates affected by the disclosure. a. The Division has prepared model disclosure forms for each county. They can be downloaded from the "County PCD Forms" link on the Pay -to -Play web site at http://www.nj_gov/dca/divisions/dl sg /programs/lpcl.html#12. They will be updated from time -to -time as necessary. b. A public agency using these forms should edit them to properly reflect the correct legislative distriet(s). As the forms are county -based, they list all legislative districts in each county. Districts that do not represent the public agency should be removed from the lists. c. Some contractors may find it easier to provide a single list that covers all contributions, regardless of the county. These submissions are appropriate and should be accepted. d. The form may be used "as -is", subject to edits as described herein. e. The "Contractor Instructions" sheet is intended to be provided with the form. It is recommended that the Instructions and the form be printed on the same piece of paper. The form notes that the Instructions are printed on the back of the form; where that is not the case, the text should be edited accordingly. f The form is a Word document and can be edited to meet local needs, and posted for download on web sites, used as an e-mail attachment, or provided as a printed document. It is recommended that the contractor also complete a "Stockholder Disclosure Certification." This will assist the local unit in its obligation to ensure that contractor did not make any prohibited contributions to the committees listed on the Business Entity Disclosure Certification in the 12 months prior to the contract (See Local Finance Notice 2006-7 for additional information on this obligation at http://www.nj.gov/dca/divisions/dlgs/resources/lfns 2006.html). A sample Certification form is part of this package and the instruction to complete it is included in the Contractor Instructions. NOTE: This section is not applicable to Boards of Education. Version April 12, 2022 490 DOC #4, continued C. 271 POLITICAL CONTRIBUTION DISCLOSURE FORM Contractor Instructions Business entities (contractors) receiving contracts from a public agency that are NOT awarded pursuant to a "fair and open" process (defined at N.J.S.A. 19:44A-20.7) are subject to the provisions of P.L. 2005, c. 271, s.2 (N.J.S.A. 19:44A- 20.26). This law provides that 10 days prior to the award of such a contract, the contractor shall disclose contributions to: • any State, county, or municipal committee of a political party • any legislative leadership committee` • any continuing political committee (a.k.a., political action committee) • any candidate committee of a candidate for, or holder of, an elective office: 0 of the public entity awarding the contract 0 of that county in which that public entity is located 0 of another public entity within that county 0 or of a legislative district in which that public entity is located or, when the public entity is a county, of any legislative district which includes all or part of the county The disclosure must list reportable contributions to any of the committees that exceed $300 per election cycle that were made during the 12 months prior to award of the contract. See N.J.S.A. 19:44A-8 and 19:44A-16 for more details on reportable contributions. N.J.S.A. 19:44A-20.26 itemizes the parties from whom contributions must be disclosed when a business entity is not a natural person. This includes the following: • individuals with an "interest" ownership or control of more than 10% of the profits or assets of a business entity or 10% of the stock in the case of a business entity that is a corporation for profit • all principals, partners, officers, or directors of the business entity or their spouses • any subsidiaries directly or indirectly controlled by the business entity • IRS Code Section 527 New Jersey based organizations, directly or indirectly controlled by the business entity and filing as continuing political committees, (PACs). When the business entity is a natural person, "a contribution by that person's spouse or child, residing therewith, shall be deemed to be a contribution by the business entity." N.J.S.A. 19:44A -20.26(b)] The contributor must be listed on the disclosure. Any business entity that fails to comply with the disclosure provisions shall be subject to a fine imposed by ELEC in an amount to be determined by the Commission which may be based upon the amount that the business entity failed to report. The enclosed list of agencies is provided to assist the contractor in identifying those public agencies whose elected official and/or candidate campaign committees are affected by the disclosure requirement. It is the contractor's responsibility to identify the specific committees to which contributions may have been made and need to be disclosed. The disclosed information may exceed the minimum requirement. The enclosed form, a content -consistent facsimile, or an electronic data file containing the required details (along with a signed cover sheet) may be used as the contractor's submission and is disclosable to the public under the Open Public Records Act. The contractor must also complete the attached Stockholder Disclosure Certification. This will assist the agency in meeting its obligations under the law. NOTE: This section does not apply to Board of Education contracts. N.J.S.A. 19:44A -3(s): "The term "legislative leadership committee" means a committee established, authorized to be established, or designated by the President of the Senate, the Minority Leader of the Senate, the Speaker of the General Assembly or the Minority Leader of the General Assembly pursuant to section 16 of P.L.1993, c.65 (C.19:44A-10.1) for the purpose of receiving contributions and making expenditures." Version April 12, 2022 491 DOC #4, continued C. 271 POLITICAL CONTRIBUTION DISCLOSURE FORM Required Pursuant to N.J.S.A. 19:44A-20.26 This form or its permitted facsimile must be submitted to the local unit no later than 10 days prior to the award of the contract. Part I — Vendor Information Vendor Name: Address: City: State: Zip: The undersigned being authorized to certify, hereby certifies that the submission provided herein represents compliance with the provisions of N.J.S.A. 19:44A-20.26 and as represented by the Instructions accompanying this form. Signature Printed Name Title Part II — Contribution Disclosure Disclosure requirement: Pursuant to N.J.S.A. 19:44A-20.26 this disclosure must include all reportable political contributions (more than $300 per election cycle) over the 12 months prior to submission to the committees of the government entities listed on the form provided by the local unit. ❑ Check here if disclosure is provided in electronic form Contributor Name Recipient Name Date Dollar Amount Check here if the information is continued on subsequent page(s) Version April 12, 2022 492 DOC #4, continued List of Agencies with Elected Officials Required for Political Contribution Disclosure N.J. S.A. 19:44A-20.26 County Name: State: Governor, and Legislative Leadership Committees Legislative District #s: State Senator and two members of the General Assembly per district. County: Freeholders County Clerk Sheriff {County Executive} Surrogate Municipalities (Mayor and members of governing body, regardless of title): USERS SHOULD CREATE THEIR OWN FORM, OR DOWNLOAD FROM THE PAY TO PLAY SECTION OF THE DLGS WEBSITE A COUNTY -BASED, CUSTOMIZABLE FORM. Version April 12, 2022 493 DOC #5 STOCKHOLDER DISCLOSURE CERTIFICATION Name of Business: 0 I certify that the list below contains the names and home addresses of all stockholders holding 10% or more of the issued and outstanding stock of the undersigned. OR 0 I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the undersigned. Check the box that represents the type of business organization: 0 Partnership 0 Corporation 0 Sole Proprietorship 0 Limited Partnership 0 Limited Liability Corporation 0 Limited Liability Partnership 0 Subchapter S Corporation Sign and notarize the form below, and, if necessary, complete the stockholder list below. Stockholders: Name: Name: Home Address: Home Address: Name: Name: Home Address: Home Address: Name: Name: Home Address: Home Address: Subscribed and sworn before me this day of 2_. (Affiant) (Notary Public) (Print name & title of affiant) My Commission expires: (Corporate Seal) Version April 12, 2022 494 DOC #6 Certification of Non -Involvement in Prohibited Activities in Iran Pursuant to N.J.S.A. 52:32-58, Offerors must certify that neither the Offeror, nor any of its parents, subsidiaries, and/or affiliates (as defined in N.J.S.A. 52:32 — 56(e) (3)), is listed on the Department of the Treasury's List of Persons or Entities Engaging in Prohibited Investment Activities in Iran and that neither is involved in any of the investment activities set forth in N.J.S.A. 52:32 — 56(f). Offerors wishing to do business in New Jersey through this contract must fill out the Certification of Non -Involvement in Prohibited Activities in Iran here: http://www.state.nj.us/humanservices/dfd/info/standard/fdc/disclosure_ investmentact.pdf. Offerors should submit the above form completed with their proposal. Version April 12, 2022 495 DOC #7 NEW JERSEY BUSINESS REGISTRATION CERTIFICATE (N.J.S.A. 52:32-44) Offerors wishing to do business in New Jersey must submit their State Division of Revenue issued Business Registration Certificate with their proposal here. Failure to do so will disqualify the Offeror from offering products or services in New Jersey through any resulting contract. https://www.njportal.com/DORBusinessRegistration/ Version April 12, 2022 496 DOC #8 EEOAA EVIDENCE Equal Employment Opportunity/Affirmative Action Goods, Professional Services & General Service Projects EEO/AA Evidence Vendors are required to submit evidence of compliance with N.J.S.A. 10:5-31 et seq. and N.J.A.C. 17:27 in order to be considered a responsible vendor. One of the following must be included with submission: • Copy of Letter of Federal Approval • Certificate of Employee Information Report • Fully Executed Form AA302 • Fully Executed EEO -1 Report See the guidelines at: htWs://www.state.nj.us/treasury/contract compliance/documents/bdf/guidelines/pa.pdf for further information. I certify that my bid package includes the required evidence per the above list and State website. Name: Signature: Title: Date: 497 DOC #9 MACBRIDE-PRINCIPLES TATE OF NEW JERSEY DEPARTMENT OF THE TREASURY iIVISION OF PURCHASE AND PROPERTY WEST STATE STREET, P.O. BOX 230 ;ENTON, NEW JERSEY 08625-0230 MACBRIDE PRINCIPALS FORM BID SOLICITATION #: VENDOR/BIDDER: VENDOR'S/BIDDER'S REQUIREMENT TO PROVIDE A CERTIFICATION IN COMPLIANCE WITH THE MACBRIDE PRINCIPALS AND NORTHERN IRELAND ACT OF 1989 Pursuant to Public Law 1995, c. 134, a responsible Vendor/Bidder selected, after public bidding, by the Director of the Division of Purchase and Property, pursuant to N.J.S.A. 52:34-12, must complete the certification below by checking one of the two options listed below and signing where indicated. If a Vendor/Bidder that would otherwise be awarded a purchase, contract or agreement does not complete the certification, then the Director may determine, in accordance with applicable law and rules, that it is in the best interest of the State to award the purchase, contract or agreement to another Vendor/Bidder that has completed the certification and has submitted a bid within five (5) percent of the most advantageous bid. If the Director finds contractors to be in violation of the principals that are the subject of this law, he/she shall take such action as may be appropriate and provided by law, rule or contract, including but not limited to, imposing sanctions, seeking compliance, recovering damages, declaring the parry in default and seeking debarment or suspension of theparty. I, the undersigned, on behalf the Vendor/Bidder, certify pursuant to N.J.S.A. 52:34-12.2 that: ❑ CHECK THE APPROPRIATE BOX The Vendor/Bidder has no business operations in Northern Ireland; or OR ❑ The Vendor/Bidder will take lawful steps in good faith to conduct any business operations it has in Northern Ireland in accordance with the MacBride principals of nondiscrimination in employment as set forth in section 2 of P.L. 1987, c. 177 (N.J.S.A. 52:18A-89.5) and in conformance with the United Kingdom's Fair Employment (Northern Ireland) Act of 1989, and permit independent monitoring of its compliance with those principals. I, the undersigned, certify that I am authorized to execute this certification on behalf of the Vendor/Bidder, that the foregoing information and any attachments hereto, to the best of my knowledge are true and complete. 1 acknowledge that the State of New Jersey is relying on the information contained herein, and that the Vendor/Bidder is under a continuing obli ag tion from the date of this certification through the completion of any contract(s) with the State to notify the State in writing of any changes to the information contained herein; that I am aware that it is a criminal offense to make a false statement or misrepresentation in this certification. If I do so, I will be subject to criminal prosecution under the law, and it will constitute a material breach of my agreement(s) with the State, permitting the State to declare any contract(s) resulting from this certification to be void and unenforceable. Date Name and Title 498 Exhibit H Advertising Compliance Requirement Pursuant to certain state notice provisions, including but not limited to Oregon Revised Statutes Chapter 279A.210, Chapter 279A.220, and other related provisions, the following public agencies and political subdivisions of the referenced public agencies are eligible to register with OMNIA Partners and access the Master Agreement contract award made pursuant to this solicitation, and are hereby given notice of the foregoing request for bids for purposes of complying with the procedural requirements of said statutes: Nationwide: State of Alabama State of Hawaii Commonwealth of Massachusetts State of New Mexico State of South Dakota State of Alaska State of Idaho State of Michigan State of New York State of Tennessee State of Arizona State of Illinois State of Minnesota State of North Carolina State of Texas State of Arkansas State of Indiana State of Mississippi State of North Dakota State of Utah State of California State of Iowa State of Missouri State of Ohio State of Vermont State of Colorado State of Kansas State of Montana State of Oklahoma Commonwealth of Virginia State of Connecticut Commonwealth of Kentucky State of Nebraska State of Oregon State of Washington State of Delaware State of Louisiana State of Nevada Commonwealth of Pennsylvania State of West Virginia State of Florida State of Maine State of New Hampshire State of Rhode Island State of Wisconsin State of Georgia State of Maryland State of New Jersey State of South Carolina State of Wyoming District of Columbia Lists of political subdivisions and local governments in the above referenced states / districts may be found at http://www.usa.gov/Agencies/State and Territories. shtml and https://www.usa.Qov/local-governments. Certain Public Agencies and Political Subdivisions: CITIES, TOWNS, VILLAGES AND BOROUGHS INCLUDING BUT NOT LIMITED TO: BAKER CITY GOLF COURSE, OR CITY OF ADAIR VILLAGE, OR CITY OF ASHLAND, OR CITY OF AUMSVILLE, OR CITY OF AURORA, OR CITY OF BAKER, OR CITY OF BATON ROUGE, LA CITY OF BEAVERTON, OR CITY OF BEND, OR CITY OF BOARDMAN, OR CITY OF BONANAZA, OR CITY OF BOSSIER CITY, LA CITY OF BROOKINGS, OR CITY OF BURNS, OR CITY OF CANBY, OR CITY OF CANYONVILLE, OR CITY OF CLATSKANIE, OR CITY OF COBURG, OR CITY OF CONDON, OR CITY OF COQUILLE, OR CITY OF CORVALLI, OR CITY OF CORVALLIS PARKS AND RECREATION DEPARTMENT, OR CITY OF COTTAGE GROVE, OR CITY OF DONALD, OR CITY OF EUGENE, OR CITY OF FOREST GROVE, OR CITY OF GOLD HILL, OR CITY OF GRANTS PASS, OR CITY OF GRESHAM, OR CITY OF HILLSBORO, OR CITY OF INDEPENDENCE, OR CITY AND COUNTY OF HONOLULU, HI CITY OF KENNER, LA CITY OF LA GRANDE, OR CITY OF LAFAYETTE, LA CITY OF LAKE CHARLES, OR CITY OF LEBANON, OR CITY OF MCMINNVILLE, OR CITY OF MEDFORD, OR CITY OF METAIRIE, LA CITY OF MILL CITY, OR CITY OF MILWAUKIE, OR CITY OF MONROE, LA CITY OF MOSIER, OR CITY OF NEW ORLEANS, LA CITY OF NORTH PLAINS, OR CITY OF OREGON CITY, OR CITY OF PILOT ROCK, OR CITY OF PORTLAND, OR CITY OF POWERS, OR CITY OF PRINEVILLE, OR CITY OF REDMOND, OR CITY OF REEDSPORT, OR CITY OF RIDDLE, OR CITY OF ROGUE RIVER, OR CITY OF ROSEBURG, OR CITY OF SALEM, OR CITY OF SANDY, OR CITY OF SCAPPOOSE, OR CITY OF SHADY COVE, OR CITY OF SHERWOOD, OR CITY OF SHREVEPORT, LA CITY OF SILVERTON, OR CITY OF SPRINGFIELD, OR CITY OF ST. HELENS, OR Version April 12, 2022 499 CITY OF ST. PAUL, OR ENTERPRISE, UT CITY OF SULPHUR, LA EPHRAIM, UT CITY OF TIGARD, OR ESCALANTE, UT CITY OF TROUTDALE, OR EUREKA, UT CITY OF TUALATIN, OR FAIRFIELD, UT CITY OF WALKER, LA FAIRVIEW, UT CITY OF WARRENTON, OR FARMINGTON, UT CITY OF WEST LINN, OR FARR WEST, UT CITY OF WILSONVILLE, OR FAYETTE, UT CITY OF WINSTON, OR FERRON, UT CITY OF WOODBURN, OR FIELDING, UT LEAGUE OF OREGON CITES FILLMORE, UT THE CITY OF HAPPY VALLEY OREGON FOUNTAIN GREEN, UT ALPINE, UT FRANCIS, UT ALTA, UT FRUIT HEIGHTS, UT ALTAMONT, UT GARDEN CITY, UT ALTON, UT GARLAND, UT AMALGA, UT GENOLA, UT AMERICAN FORK CITY, UT GLENDALE, UT ANNABELLA, UT GLENWOOD, UT ANTIMONY, UT GOSHEN, UT APPLE VALLEY, UT GRANTSVILLE, UT AURORA, UT GREEN RIVER, UT BALLARD, UT GUNNISON, UT BEAR RIVER CITY, UT HANKSVILLE, UT BEAVER, UT HARRISVILLE, UT BICKNELL, UT HATCH, UT BIG WATER, UT HEBER CITY CORPORATION, UT BLANDING, UT HELPER, UT BLUFFDALE, UT HENEFER, UT BOULDER, UT HENRIEVILLE, UT CITY OF BOUNTIFUL, UT HERRIMAN, UT BRIAN HEAD, UT HIDEOUT, UT BRIGHAM CITY CORPORATION, UT HIGHLAND, UT BRYCE CANYON CITY, UT HILDALE, UT CANNONVILLE, UT HINCKLEY, UT CASTLE DALE, UT HOLDEN, UT CASTLE VALLEY, UT HOLLADAY, UT CITY OF CEDAR CITY, UT HONEYVILLE, UT CEDAR FORT, UT HOOPER, UT CITY OF CEDAR HILLS, UT HOWELL, UT CENTERFIELD, UT HUNTINGTON, UT CENTERVILLE CITY CORPORATION, UT HUNTSVILLE, UT CENTRAL VALLEY, UT CITY OF HURRICANE, UT CHARLESTON, UT HYDE PARK, UT CIRCLEVILLE, UT HYRUM, UT CLARKSTON, UT INDEPENDENCE, UT CLAWSON, UT IVINS, UT CLEARFIELD, UT JOSEPH, UT CLEVELAND, UT JUNCTION, UT CLINTON CITY CORPORATION, UT KAMAS, UT COALVILLE, UT KANAB, UT CORINNE, UT KANARRAVILLE, UT CORNISH, UT KANOSH, UT COTTONWOOD HEIGHTS, UT KAYSVILLE, UT DANIEL, UT KINGSTON, UT DELTA, UT KOOSHAREM, UT DEWEYVILLE, UT LAKETOWN, UT DRAPER CITY, UT LA VERKIN, UT DUCHESNE,UT LAYTON,UT EAGLE MOUNTAIN, UT LEAMINGTON, UT EAST CARBON, UT LEEDS, UT ELK RIDGE, UT LEHI CITY CORPORATION, UT ELMO, UT LEVAN, UT ELSINORE, UT LEWISTON, UT ELWOOD, UT LINDON, UT EMERY, UT LOA, UT ENOCH, UT LOGAN CITY, UT Version April 12, 2022 500 LYMAN, UT SALEM, UT LYNNDYL, UT SALINA, UT MANILA, UT SALT LAKE CITY CORPORATION, UT MANTI, UT SANDY, UT MANTUA, UT SANTA CLARA, UT MAPLETON, UT SANTAQUIN, UT MARRIOTT-SLATERVILLE, UT SARATOGA SPRINGS, UT MARYSVALE, UT SCIPIO, UT MAYFIELD, UT SCOFIELD, UT MEADOW, UT SIGURD, UT MENDON, UT SMITHFIELD, UT MIDVALE CITY INC., UT SNOWVILLE, UT MIDWAY, UT CITY OF SOUTH JORDAN, UT MILFORD, UT SOUTH OGDEN, UT MILLVILLE, UT CITY OF SOUTH SALT LAKE, UT MINERSVILLE, UT SOUTH WEBER, UT MOAB, UT SPANISH FORK, UT MONA, UT SPRING CITY, UT MONROE, UT SPRINGDALE, UT CITY OF MONTICELLO, UT SPRINGVILLE, UT MORGAN, UT STERLING, UT MORONI, UT STOCKTON, UT MOUNT PLEASANT, UT SUNNYSTDE, UT MURRAY CITY CORPORATION, UT SUNSET CITY CORP, UT MYTON, UT SYRACUSE, UT NAPLES, UT TABIONA, UT NEPHI, UT CITY OF TAYLORSVILLE, UT NEW HARMONY, UT TOOELE CITY CORPORATION, UT NEWTON, UT TOQUERVILLE, UT NIBLEY, UT TORREY, UT NORTH LOGAN, UT TREMONTON CITY, UT NORTH OGDEN, UT TRENTON, UT NORTH SALT LAKE CITY, UT TROPIC, UT OAK CITY, UT UINTAH, UT OAKLEY, UT VERNAL CITY, UT OGDEN CITY CORPORATION, UT VERNON, UT OPHIR, UT VINEYARD, UT ORANGEVILLE, UT VIRGIN, UT ORDERVILLE, UT WALES, UT OREM, UT WALLSBURG, UT PANGUITCH, UT WASHINGTON CITY, UT PARADISE, UT WASHINGTON TERRACE, UT PARAGONAH, UT WELLINGTON, UT PARK CITY, UT WELLSVILLE, UT PAROWAN, UT WENDOVER, UT PAYSON, UT WEST BOUNTIFUL, UT PERRY, UT WEST HAVEN, UT PLAIN CITY, UT WEST JORDAN, UT PLEASANT GROVE CITY, UT WEST POINT, UT PLEASANT VIEW, UT WEST VALLEY CITY, UT PLYMOUTH, UT WILLARD, UT PORTAGE, UT WOODLAND HILLS, UT PRICE, UT WOODRUFF, UT PROVIDENCE, UT WOODS CROSS, UT PROVO,UT RANDOLPH, UT COUNTIES AND PARISHES INCLUDING BUT NOT REDMOND, UT LIMITED TO: RICHFIELD, UT ASCENSION PARISH, LA RICHMOND, UT ASCENSION PARISH, LA, CLEAR OF COURT RIVERDALE, UT CADDO PARISH, LA RIVER HEIGHTS, UT CALCASIEU PARISH, LA RIVERTON CITY, UT CALCASIEU PARISH SHERIFF'S OFFICE, LA ROCKVILLE, UT CITY AND COUNTY OF HONOLULU, HI ROCKY RIDGE, UT CLACKAMAS COUNTY, OR ROOSEVELT CITY CORPORATION, UT CLACKAMAS COUNTY DEPT OF TRANSPORTATION, ROY,UT OR RUSH VALLEY, UT CLATSOP COUNTY, OR CITY OF ST. GEORGE, UT COLUMBIA COUNTY, OR Version April 12, 2022 501 COOS COUNTY, OR COOS COUNTY HIGHWAY DEPARTMENT, OR COUNTY OF HAWAII, OR CROOK COUNTY, OR CROOK COUNTY ROAD DEPARTMENT, OR CURRY COUNTY, OR DESCHUTES COUNTY, OR DOUGLAS COUNTY, OR EAST BATON ROUGE PARISH, LA GILLIAM COUNTY, OR GRANT COUNTY, OR HARNEY COUNTY, OR HARNEY COUNTY SHERIFFS OFFICE, OR HAWAII COUNTY, HI HOOD RIVER COUNTY, OR JACKSON COUNTY, OR JEFFERSON COUNTY, OR JEFFERSON PARISH, LA JOSEPHINE COUNTY GOVERNMENT, OR LAFAYETTE CONSOLIDATED GOVERNMENT, LA LAFAYETTE PARISH, LA LAFAYETTE PARISH CONVENTION & VISITORS COMMISSION LAFOURCHE PARISH, LA KAUAI COUNTY, HI KLAMATH COUNTY, OR LAKE COUNTY, OR LANE COUNTY, OR LINCOLN COUNTY, OR LINN COUNTY, OR LIVINGSTON PARISH, LA MALHEUR COUNTY, OR MAUI COUNTY, HI MARION COUNTY, SALEM, OR MORROW COUNTY, OR MULTNOMAH COUNTY, OR MULTNOMAH COUNTY BUSINESS AND COMMUNITY SERVICES, OR MULTNOMAH COUNTY SHERIFFS OFFICE, OR MULTNOMAH LAW LIBRARY, OR ORLEANS PARISH, LA PLAQUEMINES PARISH, LA POLK COUNTY, OR RAPIDES PARISH, LA SAINT CHARLES PARISH, LA SAINT CHARLES PARISH PUBLIC SCHOOLS, LA SAINT LANDRY PARISH, LA SAINT TAMMANY PARISH, LA SHERMAN COUNTY, OR TERREBONNE PARISH, LA TILLAMOOK COUNTY, OR TILLAMOOK COUNTY SHERIFF'S OFFICE, OR TILLAMOOK COUNTY GENERAL HOSPITAL, OR UMATILLA COUNTY, OR UNION COUNTY, OR WALLOWA COUNTY, OR WASCO COUNTY, OR WASHINGTON COUNTY, OR WEST BATON ROUGE PARISH, LA WHEELER COUNTY, OR YAMHILL COUNTY, OR COUNTY OF BOX ELDER, UT COUNTY OF CACHE, UT COUNTY OF RICH, UT COUNTY OF WEBER, UT COUNTY OF MORGAN, UT COUNTY OF DAVIS, UT COUNTY OF SUMMIT, UT COUNTY OF DAGGETT, UT COUNTY OF SALT LAKE, UT COUNTY OF TOOELE, UT COUNTY OF UTAH, UT COUNTY OF WASATCH, UT COUNTY OF DUCHESNE, UT COUNTY OF UINTAH, UT COUNTY OF CARBON, UT COUNTY OF SANPETE, UT COUNTY OF JUAB, UT COUNTY OF MILLARD, UT COUNTY OF SEVIER, UT COUNTY OF EMERY, UT COUNTY OF GRAND, UT COUNTY OF BEVER, UT COUNTY OF PIUTE, UT COUNTY OF WAYNE, UT COUNTY OF SAN JUAN, UT COUNTY OF GARFIELD, UT COUNTY OF KANE, UT COUNTY OF IRON, UT COUNTY OF WASHINGTON, UT OTHER AGENCIES INCLUDING ASSOCIATIONS BOARDS, DISTRICTS, COMMISSIONS, COUNCILS, PUBLIC CORPORATIONS, PUBLIC DEVELOPMENT AUTHORITIES, RESERVATIONS AND UTILITIES INCLUDING BUT NOT LIMITED TO: ADAIR R.F.P.D., OR ADEL WATER IMPROVEMENT DISTRICT, OR ADRIAN R.F.P.D., OR AGNESS COMMUNITY LIBRARY, OR AGNESS-ILLAHE R.F.P.D., OR AGRICULTURE EDUCATION SERVICE EXTENSION DISTRICT, OR ALDER CREEK-BARLOW WATER DISTRICT NO. 29, OR ALFALFA FIRE DISTRICT, OR ALSEA R.F.P.D., OR ALSEA RIVIERA WATER IMPROVEMENT DISTRICT, OR AMITY FIRE DISTRICT, OR ANTELOPE MEADOWS SPECIAL ROAD DISTRICT, OR APPLE ROGUE DISTRICT IMPROVEMENT COMPANY, OR APPLEGATE VALLEY R.F.P.D. #9, OR ARCH CAPE DOMESTIC WATER SUPPLY DISTRICT, OR ARCH CAPE SANITARY DISTRICT, OR ARNOLD IRRIGATION DISTRICT, OR ASH CREEK WATER CONTROL DISTRICT, OR ATHENA CEMETERY MAINTENANCE DISTRICT, OR AUMSVILLE R.F.P.D., OR AURORA R.F.P.D., OR AZALEA R.F.P.D., OR BADGER IMPROVEMENT DISTRICT, OR BAILEY -SPENCER R.F.P.D., OR BAKER COUNTY LIBRARY DISTRICT, OR BAKER R.F.P.D., OR BAKER RIVERTON ROAD DISTRICT, OR BAKER VALLEY IRRIGATION DISTRICT, OR BAKER VALLEY S.W.C.D., OR BAKER VALLEY VECTOR CONTROL DISTRICT, OR BANDON CRANBERRY WATER CONTROL DISTRICT, OR BANDON R.F.P.D., OR BANKS FIRE DISTRICT, OR BANKS FIRE DISTRICT #13, OR Version April 12, 2022 502 BAR L RANCH ROAD DISTRICT, OR BARLOW WATER IMPROVEMENT DISTRICT, OR BASIN AMBULANCE SERVICE DISTRICT, OR BASIN TRANSIT SERVICE TRANSPORTATION DISTRICT, OR BATON ROUGE WATER COMPANY BAY AREA HEALTH DISTRICT, OR BAYSHORE SPECIAL ROAD DISTRICT, OR BEAR VALLEY SPECIAL ROAD DISTRICT, OR BEAVER CREEK WATER CONTROL DISTRICT, OR BEAVER DRAINAGE IMPROVEMENT COMPANY, INC., OR BEAVER SLOUGH DRAINAGE DISTRICT, OR BEAVER SPECIAL ROAD DISTRICT, OR BEAVER WATER DISTRICT, OR BELLE MER S.LG.L. TRACTS SPECIAL ROAD DISTRICT, OR BEND METRO PARK AND RECREATION DISTRICT BENTON S.W.C.D., OR BERNDT SUBDIVISION WATER IMPROVEMENT DISTRICT, OR BEVERLY BEACH WATER DISTRICT, OR BIENVILLE PARISH FIRE PROTECTION DISTRICT 6, LA BIG BEND IRRIGATION DISTRICT, OR BIGGS SERVICE DISTRICT, OR BLACK BUTTE RANCH DEPARTMENT OF POLICE SERVICES, OR BLACK BUTTE RANCH R.F.P.D., OR BLACK MOUNTAIN WATER DISTRICT, OR BLODGETT-SUMMIT R.F.P.D., OR BLUE MOUNTAIN HOSPITAL DISTRICT, OR BLUE MOUNTAIN TRANSLATOR DISTRICT, OR BLUE RIVER PARK & RECREATION DISTRICT, OR BLUE RIVER WATER DISTRICT, OR BLY R.F.P.D., OR BLY VECTOR CONTROL DISTRICT, OR BLY WATER AND SANITARY DISTRICT, OR BOARDMAN CEMETERY MAINTENANCE DISTRICT, OR BOARDMAN PARK AND RECREATION DISTRICT BOARDMAN R.F.P.D., OR BONANZA BIG SPRINGS PARK & RECREATION DISTRICT, OR BONANZA MEMORIAL PARK CEMETERY DISTRICT, OR BONANZA R.F.P.D., OR BONANZA-LANGELL VALLEY VECTOR CONTROL DISTRICT, OR BORING WATER DISTRICT #24, OR BOULDER CREEK RETREAT SPECIAL ROAD DISTRICT, OR BRIDGE R.F.P.D., OR BROOKS COMMUNITY SERVICE DISTRICT, OR BROWNSVILLE R.F.P.D., OR BUELL-RED PRAIRIE WATER DISTRICT, OR BUNKER HILL R.F.P.D. #I, OR BUNKER HILL SANITARY DISTRICT, OR BURLINGTON WATER DISTRICT, OR BURNT RIVER IRRIGATION DISTRICT, OR BURNT RIVER S.W.C.D., OR CALAPOOIA R.F.P.D., OR CAMAS VALLEY R.F.P.D., OR CAMELLIA PARK SANITARY DISTRICT, OR CAMMANN ROAD DISTRICT, OR CAMP SHERMAN ROAD DISTRICT, OR CANBY AREA TRANSIT, OR CANBY R.F.P.D. 462, OR CANBY UTILITY BOARD, OR CANNON BEACH R.F.P.D., OR CANYONVILLE SOUTH UMPQUA FIRE DISTRICT, OR CAPE FERRELO R.F.P.D., OR CAPE FOULWEATHER SANITARY DISTRICT, OR CARLSON PRIMROSE SPECIAL ROAD DISTRICT, OR CARMEL BEACH WATER DISTRICT, OR CASCADE VIEW ESTATES TRACT 2, OR CEDAR CREST SPECIAL ROAD DISTRICT, OR CEDAR TRAILS SPECIAL ROAD DISTRICT, OR CEDAR VALLEY - NORTH BANK R.F.P.D., OR CENTRAL CASCADES FIRE AND EMS, OR CENTRAL CITY ECONOMIC OPPORTUNITY CORP, LA CENTRAL LINCOLN P.U.D., OR CENTRAL OREGON COAST FIRE & RESCUE DISTRICT, OR CENTRAL OREGON INTERGOVERNMENTAL COUNCIL CENTRAL OREGON IRRIGATION DISTRICT, OR CHAPARRAL WATER CONTROL DISTRICT, OR CHARLESTON FIRE DISTRICT, OR CHARLESTON SANITARY DISTRICT, OR CHARLOTTE ANN WATER DISTRICT, OR CHEHALEM PARK & RECREATION DISTRICT, OR CHEHALEM PARK AND RECREATION DISTRICT CHEMULT R.F.P.D., OR CHENOWITH WATER P.U.D., OR CHERRIOTS, OR CHETCO COMMUNITY PUBLIC LIBRARY DISTRICT, OR CHILOQUIN VECTOR CONTROL DISTRICT, OR CHILOQUIN-AGENCY LAKE R.F.P.D., OR CHINOOK DRIVE SPECIAL ROAD DISTRICT, OR CHR DISTRICT IMPROVEMENT COMPANY, OR CHRISTMAS VALLEY DOMESTIC WATER DISTRICT, OR CHRISTMAS VALLEY PARK & RECREATION DISTRICT, OR CHRISTMAS VALLEY R.F.P.D., OR CITY OF BOGALUSA SCHOOL BOARD, LA CLACKAMAS COUNTY FIRE DISTRICT #1, OR CLACKAMAS COUNTY SERVICE DISTRICT #1, OR CLACKAMAS COUNTY VECTOR CONTROL DISTRICT, OR CLACKAMAS RIVER WATER CLACKAMAS RIVER WATER, OR CLACKAMAS S.W.C.D., OR CLATSKANIE DRAINAGE IMPROVEMENT COMPANY, OR CLATSKANIE LIBRARY DISTRICT, OR CLATSKANIE P.U.D., OR CLATSKANIE PARK & RECREATION DISTRICT, OR CLATSKANIE PEOPLE'S UTILITY DISTRICT CLATSKANIE R.F.P.D., OR CLATSOP CARE CENTER HEALTH DISTRICT, OR CLATSOP COUNTY S.W.C.D., OR CLATSOP DRAINAGE IMPROVEMENT COMPANY #15, INC., OR CLEAN WATER SERVICES CLEAN WATER SERVICES, OR CLOVERDALE R.F.P.D., OR CLOVERDALE SANITARY DISTRICT, OR CLOVERDALE WATER DISTRICT, OR COALEDO DRAINAGE DISTRICT, OR COBURG FIRE DISTRICT, OR COLESTIN RURAL FIRE DISTRICT, OR COLTON R.F.P.D., OR COLTON WATER DISTRICT #11, OR Version April 12, 2022 503 COLUMBIA 911 COMMUNICATIONS DISTRICT, OR COLUMBIA COUNTY 4-H & EXTENSION SERVICE DISTRICT, OR COLUMBIA DRAINAGE VECTOR CONTROL, OR COLUMBIA IMPROVEMENT DISTRICT, OR COLUMBIA R.F.P.D., OR COLUMBIA RIVER FIRE & RESCUE, OR COLUMBIA RIVER PUD, OR COLUMBIA S.W.C.D., OR COLUMBIA S.W.C.D., OR CONFEDERATED TRIBES OF THE UMATILLA INDIAN RESERVATION COOS COUNTY AIRPORT DISTRICT, OR COOS COUNTY AIRPORT DISTRICT, OR COOS COUNTY AREA TRANSIT SERVICE DISTRICT, OR COOS COUNTY AREA TRANSIT SERVICE DISTRICT, OR COOS FOREST PROTECTIVE ASSOCIATION COOS S.W.C.D., OR COQUILLE R.F.P.D., OR COQUILLE VALLEY HOSPITAL DISTRICT, OR CORBETT WATER DISTRICT, OR CORNELIUS R.F.P.D., OR CORP RANCH ROAD WATER IMPROVEMENT, OR CORVALLIS R.F.P.D., OR COUNTRY CLUB ESTATES SPECIAL WATER DISTRICT, OR COUNTRY CLUB WATER DISTRICT, OR COUNTRY ESTATES ROAD DISTRICT, OR COVE CEMETERY MAINTENANCE DISTRICT, OR COVE ORCHARD SEWER SERVICE DISTRICT, OR COVE R.F.P.D., OR CRESCENT R.F.P.D., OR CRESCENT SANITARY DISTRICT, OR CRESCENT WATER SUPPLY AND IMPROVEMENT DISTRICT, OR CROOK COUNTY AGRICULTURE EXTENSION SERVICE DISTRICT, OR CROOK COUNTY CEMETERY DISTRICT, OR CROOK COUNTY FIRE AND RESCUE, OR CROOK COUNTY PARKS & RECREATION DISTRICT, OR CROOK COUNTY S.W.C.D., OR CROOK COUNTY VECTOR CONTROL DISTRICT, OR CROOKED RIVER RANCH R.F.P.D., OR CROOKED RIVER RANCH SPECIAL ROAD DISTRICT, OR CRYSTAL SPRINGS WATER DISTRICT, OR CURRY COUNTY 4-H & EXTENSION SERVICE DISTRICT, OR CURRY COUNTY PUBLIC TRANSIT SERVICE DISTRICT, OR CURRY COUNTY S.W.C.D., OR CURRY HEALTH DISTRICT, OR CURRY PUBLIC LIBRARY DISTRICT, OR DALLAS CEMETERY DISTRICT #4, OR DARLEY DRIVE SPECIAL ROAD DISTRICT, OR DAVID CROCKETT STEAM FIRE COMPANY #1, LA DAYS CREEK R.F.P.D., OR DAYTON FIRE DISTRICT, OR DEAN MINARD WATER DISTRICT, OR DEE IRRIGATION DISTRICT, OR DEER ISLAND DRAINAGE IMPROVEMENT COMPANY, OR DELL BROGAN CEMETERY MAINTENANCE DISTRICT, OR DEPOE BAY R.F.P.D., OR DESCHUTES COUNTY 911 SERVICE DISTRICT, OR DESCHUTES COUNTY R.F.P.D. 42, OR DESCHUTES PUBLIC LIBRARY DISTRICT, OR DESCHUTES S.W.C.D., OR DESCHUTES VALLEY WATER DISTRICT, OR DEVILS LAKE WATER IMPROVEMENT DISTRICT, OR DEXTER R.F.P.D., OR DEXTER SANITARY DISTRICT, OR DORA-SITKUM R.F.P.D., OR DOUGLAS COUNTY FIRE DISTRICT 42, OR DOUGLAS S.W.C.D., OR DRAKES CROSSING R.F.P.D., OR DRRH SPECIAL ROAD DISTRICT #6, OR DRY GULCH DITCH DISTRICT IMPROVEMENT COMPANY, OR DUFUR RECREATION DISTRICT, OR DUMBECK LANE DOMESTIC WATER SUPPLY, OR DUNDEE R.F.P.D., OR DURKEE COMMUNITY BUILDING PRESERVATION DISTRICT, OR EAGLE POINT IRRIGATION DISTRICT, OR EAGLE VALLEY CEMETERY MAINTENANCE DISTRICT, OR EAGLE VALLEY R.F.P.D., OR EAGLE VALLEY S.W.C.D., OR EAST FORK IRRIGATION DISTRICT, OR EAST MULTNOMAH S.W.C.D., OR EAST SALEM SERVICE DISTRICT, OR EAST UMATILLA CHEMICAL CONTROL DISTRICT, OR EAST UMATILLA COUNTY AMBULANCE AREA HEALTH DISTRICT, OR EAST UMATILLA COUNTY R.F.P.D., OR EAST VALLEY WATER DISTRICT, OR ELGIN COMMUNITY PARKS & RECREATION DISTRICT, OR ELGIN HEALTH DISTRICT, OR ELGIN R.F.P.D., OR ELKTON ESTATES PHASE II SPECIAL ROAD DISTRICT, OR ELKTON R.F.P.D., OR EMERALD P.U.D., OR ENTERPRISE IRRIGATION DISTRICT, OR ESTACADA CEMETERY MAINTENANCE DISTRICT, OR ESTACADA R.F.P.D. #69, OR EUGENE R.F.P.D. # 1, OR EUGENE WATER AND ELECTRIC BOARD EVANS VALLEY FIRE DISTRICT #6, OR FAIR OAKS R.F.P.D., OR FAIRVIEW R.F.P.D., OR FAIRVIEW WATER DISTRICT, OR FALCON HEIGHTS WATER AND SEWER, OR FALCON -COVE BEACH WATER DISTRICT, OR FALL RIVER ESTATES SPECIAL ROAD DISTRICT, OR FARGO INTERCHANGE SERVICE DISTRICT, OR FARMERS IRRIGATION DISTRICT, OR FAT ELK DRAINAGE DISTRICT, OR FERN RIDGE PUBLIC LIBRARY DISTRICT, OR FERN VALLEY ESTATES IMPROVEMENT DISTRICT, OR FOR FAR ROAD DISTRICT, OR FOREST GROVE R.F.P.D., OR FOREST VIEW SPECIAL ROAD DISTRICT, OR FORT ROCK -SILVER LAKE S.W.C.D., OR FOUR RIVERS VECTOR CONTROL DISTRICT, OR FOX CEMETERY MAINTENANCE DISTRICT, OR GARDINER R.F.P.D., OR Version April 12, 2022 504 GARDINER SANITARY DISTRICT, OR GARIBALDI R.F.P.D., OR GASTON R.F.P.D., OR GATES R.F.P.D., OR GEARHART R.F.P.D., OR GILLIAM S.W.C.D., OR GLENDALE AMBULANCE DISTRICT, OR GLENDALE R.F.P.D., OR GLENEDEN BEACH SPECIAL ROAD DISTRICT, OR GLENEDEN SANITARY DISTRICT, OR GLENWOOD WATER DISTRICT, OR GLIDE - 1DLEYLD SANITARY DISTRICT, OR GLIDE R.F.P.D., OR GOLD BEACH - WEDDERBURN R.F.P.D., OR GOLD HILL IRRIGATION DISTRICT, OR GOLDFINCH ROAD DISTRICT, OR GOSHEN R.F.P.D., OR GOVERNMENT CAMP ROAD DISTRICT, OR GOVERNMENT CAMP SANITARY DISTRICT, OR GRAND PRAIRIE WATER CONTROL DISTRICT, OR GRAND RONDE SANITARY DISTRICT, OR GRANT COUNTY TRANSPORTATION DISTRICT, OR GRANT S.W.C.D., OR GRANTS PASS IRRIGATION DISTRICT, OR GREATER BOWEN VALLEY R.F.P.D., OR GREATER ST. HELENS PARK & RECREATION DISTRICT, OR GREATER TOLEDO POOL RECREATION DISTRICT, OR GREEN KNOLLS SPECIAL ROAD DISTRICT, OR GREEN SANITARY DISTRICT, OR GREENACRES R.F.P.D., OR GREENBERRY IRRIGATION DISTRICT, OR GREENSPRINGS RURAL FIRE DISTRICT, OR HAHLEN ROAD SPECIAL DISTRICT, OR HAINES CEMETERY MAINTENANCE DISTRICT, OR HAINES FIRE PROTECTION DISTRICT, OR HALSEY-SHEDD R.F.P.D., OR HAMLET R.F.P.D., OR HARBOR R.F.P.D., OR HARBOR SANITARY DISTRICT, OR HARBOR WATER P.U.D., OR HARNEY COUNTY HEALTH DISTRICT, OR HARNEY S.W.C.D., OR HARPER SOUTH SIDE IRRIGATION DISTRICT, OR HARRISBURG FIRE AND RESCUE, OR HAUSER R.F.P.D., OR HAZELDELL RURAL FIRE DISTRICT, OR HEBO JOINT WATER -SANITARY AUTHORITY, OR HECETA WATER P.U.D., OR HELIX CEMETERY MAINTENANCE DISTRICT #4, OR HELIX PARK & RECREATION DISTRICT, OR HELIX R.F.P.D. #7-411, OR HEPPNER CEMETERY MAINTENANCE DISTRICT, OR HEPPNER R.F.P.D., OR HEPPNER WATER CONTROL DISTRICT, OR HEREFORD COMMUNITY HALL RECREATION DISTRICT, OR HERMISTON CEMETERY DISTRICT, OR HERMISTON IRRIGATION DISTRICT, OR HIDDEN VALLEY MOBILE ESTATES IMPROVEMENT DISTRICT, OR HIGH DESERT PARK & RECREATION DISTRICT, OR HIGHLAND SUBDIVISION WATER DISTRICT, OR HONOLULU INTERNATIONAL AIRPORT HOOD RIVER COUNTY LIBRARY DISTRICT, OR HOOD RIVER COUNTY TRANSPORTATION DISTRICT, OR HOOD RIVER S.W.C.D., OR HOOD RIVER VALLEY PARKS & RECREATION DISTRICT, OR HOODLAND FIRE DISTRICT #74 HOODLAND FIRE DISTRICT #74, OR HORSEFLY IRRIGATION DISTRICT, OR HOSKINS-KINGS VALLEY R.F.P.D., OR HOUSING AUTHORITY OF PORTLAND HUBBARD R.F.P.D., OR HUDSON BAY DISTRICT IMPROVEMENT COMPANY, OR I N (KAY) YOUNG DITCH DISTRICT IMPROVEMENT COMPANY, OR ICE FOUNTAIN WATER DISTRICT, OR IDAHO POINT SPECIAL ROAD DISTRICT, OR IDANHA-DETROIT RURAL FIRE PROTECTION DISTRICT, OR ILLINOIS VALLEY FIRE DISTRICT ILLINOIS VALLEY R.F.P.D., OR ILLINOIS VALLEY S.W.C.D., OR IMBLER R.F.P.D., OR INTERLACHEN WATER P.U.D., OR IONS LIBRARY DISTRICT, OR IONE R.F.P.D. #6-604, OR IRONSIDE CEMETERY MAINTENANCE DISTRICT, OR IRONSIDE RURAL ROAD DISTRICT 95, OR IRRIGON PARK & RECREATION DISTRICT, OR IRRIGON R.F.P.D., OR ISLAND CITY AREA SANITATION DISTRICT, OR ISLAND CITY CEMETERY MAINTENANCE DISTRICT, OR JACK PINE VILLAGE SPECIAL ROAD DISTRICT, OR JACKSON COUNTY FIRE DISTRICT #3, OR JACKSON COUNTY FIRE DISTRICT #4, OR JACKSON COUNTY FIRE DISTRICT #5, OR JACKSON COUNTY LIBRARY DISTRICT, OR JACKSON COUNTY VECTOR CONTROL DISTRICT, OR JACKSON S.W.C.D., OR JASPER KNOLLS WATER DISTRICT, OR JEFFERSON COUNTY EMERGENCY MEDICAL SERVICE DISTRICT, OR JEFFERSON COUNTY FIRE DISTRICT #1, OR JEFFERSON COUNTY LIBRARY DISTRICT, OR JEFFERSON COUNTY S.W.C.D., OR JEFFERSON PARK & RECREATION DISTRICT, OR JEFFERSON R.F.P.D., OR JOB'S DRAINAGE DISTRICT, OR JOHN DAY WATER DISTRICT, OR JOHN DAY -CANYON CITY PARKS & RECREATION DISTRICT, OR JOHN DAY-FERNHILL R.F.P.D. #5-108, OR JORDAN VALLEY CEMETERY DISTRICT, OR JORDAN VALLEY IRRIGATION DISTRICT, OR JOSEPHINE COMMUNITY LIBRARY DISTRICT, OR JOSEPHINE COUNTY 4-H & EXTENSION SERVICE DISTRICT, OR JOSEPHINE COUNTY 911 AGENCY, OR JUNCTION CITY R.F.P.D., OR JUNCTION CITY WATER CONTROL DISTRICT, OR JUNIPER BUTTE ROAD DISTRICT, OR JUNIPER CANYON WATER CONTROL DISTRICT, OR JUNIPER FLAT DISTRICT IMPROVEMENT COMPANY, OR JUNIPER FLAT R.F.P.D., OR JUNO NONPROFIT WATER IMPROVEMENT DISTRICT, OR KEATING R.F.P.D., OR KEATING S.W.C.D., OR Version April 12, 2022 505 KEIZER R.F.P.D., OR LEBANON AQUATIC DISTRICT, OR KELLOGG RURAL FIRE DISTRICT, OR LEBANON R.F.P.D., OR KENO IRRIGATION DISTRICT, OR LEWIS & CLARK R.F.P.D., OR KENO PINES ROAD DISTRICT, OR LINCOLN COUNTY LIBRARY DISTRICT, OR KENO R.F.P.D., OR LINCOLN S.W.C.D., OR KENT WATER DISTRICT, OR LINN COUNTY EMERGENCY TELEPHONE AGENCY, KERBY WATER DISTRICT, OR OR K -GB -LB WATER DISTRICT, OR LINN S.W.C.D., OR KILCHIS WATER DISTRICT, OR LITTLE MUDDY CREEK WATER CONTROL, OR KLAMATH 9-1-1 COMMUNICATIONS DISTRICT, OR LITTLE NESTUCCA DRAINAGE DISTRICT, OR KLAMATH BASIN IMPROVEMENT DISTRICT, OR LITTLE SWITZERLAND SPECIAL ROAD DISTRICT, OR KLAMATH COUNTY DRAINAGE SERVICE DISTRICT, LONE PINE IRRIGATION DISTRICT, OR OR LONG PRAIRIE WATER DISTRICT, OR KLAMATH COUNTY EXTENSION SERVICE DISTRICT, LOOKINGGLASS OLALLA WATER CONTROL OR DISTRICT, OR KLAMATH COUNTY FIRE DISTRICT #1, OR LOOKINGGLASS RURAL FIRE DISTRICT, OR KLAMATH COUNTY FIRE DISTRICT #3, OR LORANE R.F.P.D., OR KLAMATH COUNTY FIRE DISTRICT #4, OR LOST & BOULDER DITCH IMPROVEMENT DISTRICT, KLAMATH COUNTY FIRE DISTRICT #5, OR OR KLAMATH COUNTY LIBRARY SERVICE DISTRICT, LOST CREEK PARK SPECIAL ROAD DISTRICT, OR OR LOUISIANA PUBLIC SERVICE COMMISSION, LA KLAMATH COUNTY PREDATORY ANIMAL LOUISIANA WATER WORKS CONTROL DISTRICT, OR LOWELL R.F.P.D., OR KLAMATH DRAINAGE DISTRICT, OR LOWER MCKAY CREEK R.F.P.D., OR KLAMATH FALLS FOREST ESTATES SPECIAL ROAD LOWER MCKAY CREEK WATER CONTROL DISTRICT UNIT #2, OR DISTRICT, OR KLAMATH INTEROPERABILITY RADIO GROUP, OR LOWER POWDER RIVER IRRIGATION DISTRICT, OR KLAMATH IRRIGATION DISTRICT, OR LOWER SILETZ WATER DISTRICT, OR KLAMATH RIVER ACRES SPECIAL ROAD DISTRICT, LOWER UMPQUA HOSPITAL DISTRICT, OR OR LOWER UMPQUA PARK & RECREATION DISTRICT, KLAMATH S.W.C.D., OR OR KLAMATH VECTOR CONTROL DISTRICT, OR LOWER VALLEY WATER IMPROVEMENT DISTRICT, KNAPPA-SVENSEN-BURNSIDE R.F.P.D., OR OR LA GRANDE CEMETERY MAINTENANCE DISTRICT, LUCE LONG DITCH DISTRICT IMPROVEMENT CO., OR OR LA GRANDE R.F.P.D., OR LUSTED WATER DISTRICT, OR LA PINE PARK & RECREATION DISTRICT, OR LYONS R.F.P.D., OR LA PINE R.F.P.D., OR LYONS-MEHAMA WATER DISTRICT, OR LABISH VILLAGE SEWAGE & DRAINAGE, OR MADRAS AQUATIC CENTER DISTRICT, OR LACOMB IRRIGATION DISTRICT, OR MAKAI SPECIAL ROAD DISTRICT, OR LAFAYETTE AIRPORT COMMISSION, LA MALHEUR COUNTY S.W.C.D., OR LAFOURCHE PARISH HEALTH UNIT — DHH-OPH MALHEUR COUNTY VECTOR CONTROL DISTRICT, REGION 3 OR LAIDLAW WATER DISTRICT, OR MALHEUR DISTRICT IMPROVEMENT COMPANY, OR LAKE CHINOOK FIRE & RESCUE, OR MALHEUR DRAINAGE DISTRICT, OR LAKE COUNTY 4-H & EXTENSION SERVICE MALHEUR MEMORIAL HEALTH DISTRICT, OR DISTRICT, OR MALIN COMMUNITY CEMETERY MAINTENANCE LAKE COUNTY LIBRARY DISTRICT, OR DISTRICT, OR LAKE CREEK R.F.P.D. - JACKSON, OR MALIN COMMUNITY PARK & RECREATION LAKE CREEK R.F.P.D. - LANE COUNTY, OR DISTRICT, OR LAKE DISTRICT HOSPITAL, OR MALIN IRRIGATION DISTRICT, OR LAKE GROVE R.F.P.D. NO. 57, OR MALIN R.F.P.D., OR LAKE GROVE WATER DISTRICT, OR MAPLETON FIRE DEPARTMENT, OR LAKE LABISH WATER CONTROL DISTRICT, OR MAPLETON WATER DISTRICT, OR LAKE POINT SPECIAL ROAD DISTRICT, OR MARCOLA WATER DISTRICT, OR LAKESIDE R.F.P.D. #4, OR MARION COUNTY EXTENSION & 4H SERVICE LAKESIDE WATER DISTRICT, OR DISTRICT, OR LAKEVIEW R.F.P.D., OR MARION COUNTY FIRE DISTRICT #1, OR LAKEVIEW S.W.C.D., OR MARION JACK IMPROVEMENT DISTRICT, OR LAMONTAI IMPROVEMENT DISTRICT, OR MARION S.W.C.D., OR LANE FIRE AUTHORITY, OR MARY'S RIVER ESTATES ROAD DISTRICT, OR LANE LIBRARY DISTRICT, OR MCDONALD FOREST ESTATES SPECIAL ROAD LANE TRANSIT DISTRICT, OR DISTRICT, OR LANGELL VALLEY IRRIGATION DISTRICT, OR MCKAY ACRES IMPROVEMENT DISTRICT, OR LANGLOIS PUBLIC LIBRARY, OR MCKAY DAM R.F.P.D. # 7-410, OR LANGLOIS R.F.P.D., OR MCKENZIE FIRE & RESCUE, OR LANGLOIS WATER DISTRICT, OR MCKENZIE PALISADES WATER SUPPLY LAZY RIVER SPECIAL ROAD DISTRICT, OR CORPORATION, OR Version April 12, 2022 506 MCMINNVILLE R.F.P.D., OR NEHALEM BAY WASTEWATER AGENCY, OR MCNULTY WATER P.U.D., OR NESIKA BEACH-OPHIR WATER DISTRICT, OR MEADOWS DRAINAGE DISTRICT, OR NESKOWIN REGIONAL SANITARY AUTHORITY, OR MEDFORD IRRIGATI0N DISTRICT, OR NESKOWIN REGIONAL WATER DISTRICT, OR MEDFORD R.F.P.D. #2, OR NESTUCCA R.F.P.D., OR MEDFORD WATER COMMISSION NETARTS WATER DISTRICT, OR MEDICAL SPRINGS R.F.P.D., OR NETARTS-OCEANSIDE R.F.P.D., OR MELHEUR COUNTY JAIL, OR NETARTS-OCEANSIDE SANITARY DISTRICT, OR MERLIN COMMUNITY PARK DISTRICT, OR NEW BRIDGE WATER SUPPLY DISTRICT, OR MERRILL CEMETERY MAINTENANCE DISTRICT, OR NEW CARLTON FIRE DISTRICT, OR MERRILL PARK DISTRICT, OR NEW ORLEANS REDEVELOPMENT AUTHORITY, LA MERRILL R.F.P.D., OR NEW PINE CREEK R.F.P.D., OR METRO REGIONAL GOVERNMENT NEWBERG R.F.P.D., OR METRO REGIONAL PARKS NEWBERRY ESTATES SPECIAL ROAD DISTRICT, OR METROPOLITAN EXPOSITION RECREATION NEWPORT R.F.P.D., OR COMMISSION NEWT YOUNG DITCH DISTRICT IMPROVEMENT METROPOLITAN SERVICE DISTRICT (METRO) COMPANY, OR MID COUNTY CEMETERY MAINTENANCE DISTRICT, NORTH ALBANY R.F.P.D., OR OR NORTH BAY R.F.P.D. #9, OR MID-COLUMBIA FIRE AND RESCUE, OR NORTH CLACKAMAS PARKS & RECREATION MIDDLE FORK IRRIGATION DISTRICT, OR DISTRICT, OR MIDLAND COMMUNITY PARK, OR NORTH COUNTY RECREATION DISTRICT, OR MIDLAND DRAINAGE IMPROVEMENT DISTRICT, OR NORTH DOUGLAS COUNTY FIRE & EMS, OR MILES CROSSING SANITARY SEWER DISTRICT, OR NORTH DOUGLAS PARK & RECREATION DISTRICT, MILL CITY R.F.P.D. #2-303, OR OR MILL FOUR DRAINAGE DISTRICT, OR NORTH GILLIAM COUNTY HEALTH DISTRICT, OR MILLICOMA RIVER PARK & RECREATION DISTRICT, NORTH GILLIAM COUNTY R.F.P.D., OR OR NORTH LAKE HEALTH DISTRICT, OR MILLINGTON R.F.P.D. 45, OR NORTH LEBANON WATER CONTROL DISTRICT, OR MILO VOLUNTEER FIRE DEPARTMENT, OR NORTH LINCOLN FIRE & RESCUE DISTRICT #1, OR MILTON-FREEWATER AMBULANCE SERVICE AREA NORTH LINCOLN HEALTH DISTRICT, OR HEALTH DISTRICT, OR NORTH MORROW VECTOR CONTROL DISTRICT, OR MILTON-FREEWATER WATER CONTROL DISTRICT, NORTH SHERMAN COUNTY R.F.P.D, OR OR NORTH UNIT IRRIGATION DISTRICT, OR MIROCO SPECIAL ROAD DISTRICT, OR NORTHEAST OREGON HOUSING AUTHORITY, OR MIST-BIRKENFELD R.F.P.D., OR NORTHEAST WHEELER COUNTY HEALTH DISTRICT, MODOC POINT IRRIGATION DISTRICT, OR OR MODOC POINT SANITARY DISTRICT, OR NORTHERN WASCO COUNTY P.U.D., OR MOHAWK VALLEY R.F.P.D., OR NORTHERN WASCO COUNTY PARK & RECREATION MOLALLA AQUATIC DISTRICT, OR DISTRICT, OR MOLALLA R.F.P.D. #73, OR NYE DITCH USERS DISTRICT IMPROVEMENT, OR MONITOR R.F.P.D., OR NYSSA ROAD ASSESSMENT DISTRICT #2, OR MONROE R.F.P.D., OR NYSSA RURAL FIRE DISTRICT, OR MONUMENT CEMETERY MAINTENANCE DISTRICT, NYSSA-ARCADIA DRAINAGE DISTRICT, OR OR OAK LODGE WATER SERVICES, OR MONUMENT S.W.C.D., OR OAKLAND R.F.P.D., OR MOOREA DRIVE SPECIAL ROAD DISTRICT, OR OAKVILLE COMMUNITY CENTER, OR MORO R.F.P.D., OR OCEANSIDE WATER DISTRICT, OR MORROW COUNTY HEALTH DISTRICT, OR OCHOCO IRRIGATION DISTRICT, OR MORROW COUNTY UNIFIED RECREATION OCHOCO WEST WATER AND SANITARY DISTRICT, OR AUTHORITY, OR MORROW S.W.C.D., OR ODELL SANITARY DISTRICT, OR MOSIER FIRE DISTRICT, OR OLD OWYHEE DITCH IMPROVEMENT DISTRICT, OR MOUNTAIN DRIVE SPECIAL ROAD DISTRICT, OR OLNEY-WALLUSKI FIRE & RESCUE DISTRICT, OR MT. ANGEL R.F.P.D., OR ONTARIO LIBRARY DISTRICT, OR MT. HOOD IRRIGATION DISTRICT, OR ONTARIO R.F.P.D., OR MT. LAKI CEMETERY DISTRICT, OR OPHIR R.F.P.D., OR MT. VERNON R.F.P.D., OR OREGON COAST COMMUNITY ACTION MULINO WATER DISTRICT #I, OR OREGON HOUSING AND COMMUNITY SERVICES MULTNOMAH COUNTY DRAINAGE DISTRICT #1, OR OREGON INTERNATIONAL PORT OF COOS BAY, OR MULTNOMAH COUNTY R.F.P.D. #10, OR OREGON LEGISLATIVE ADMINISTRATION MULTNOMAH COUNTY R.F.P.D. #14, OR OREGON OUTBACK R.F.P.D., OR MULTNOMAH EDUCATION SERVICE DISTRICT OREGON POINT, OR MYRTLE CREEK R.F.P.D., OR OREGON TRAIL LIBRARY DISTRICT, OR NEAH-KAH-NIE WATER DISTRICT, OR OTTER ROCK WATER DISTRICT, OR NEDONNA R.F.P.D., OR OWW UNIT #2 SANITARY DISTRICT, OR NEHALEM BAY FIRE AND RESCUE, OR OWYHEE CEMETERY MAINTENANCE DISTRICT, OR NEHALEM BAY HEALTH DISTRICT, OR OWYHEE IRRIGATION DISTRICT, OR Version April 12, 2022 507 PACIFIC CITY JOINT WATER -SANITARY PORT OF UMPQUA, OR AUTHORITY, OR PORT ORFORD CEMETERY MAINTENANCE PACIFIC COMMUNITIES HEALTH DISTRICT, OR DISTRICT, OR PACIFIC RIVIERA #3 SPECIAL ROAD DISTRICT, OR PORT ORFORD PUBLIC LIBRARY DISTRICT, OR PALATINE HILL WATER DISTRICT, OR PORT ORFORD R.F.P.D., OR PALMER CREEK WATER DISTRICT IMPROVEMENT PORTLAND DEVELOPMENT COMMISSION, OR COMPANY, OR PORTLAND FIRE AND RESCUE PANORAMIC ACCESS SPECIAL ROAD DISTRICT, OR PORTLAND HOUSING CENTER, OR PANTHER CREEK ROAD DISTRICT, OR POWDER R.F.P.D., OR PANTHER CREEK WATER DISTRICT, OR POWDER RIVER R.F.P.D., OR PARKDALE R.F.P.D., OR POWDER VALLEY WATER CONTROL DISTRICT, OR PARKDALE SANITARY DISTRICT, OR POWERS HEALTH DISTRICT, OR PENINSULA DRAINAGE DISTRICT 41, OR PRAIRIE CEMETERY MAINTENANCE DISTRICT, OR PENINSULA DRAINAGE DISTRICT 42, OR PRINEVILLE LAKE ACRES SPECIAL ROAD DISTRICT PHILOMATH FIRE AND RESCUE, OR #1, OR PILOT ROCK CEMETERY MAINTENANCE DISTRICT PROSPECT R.F.P.D., OR #5, OR QUAIL VALLEY PARD IMPROVEMENT DISTRICT, OR PILOT ROCK PARK & RECREATION DISTRICT, OR QUEENER IRRIGATION IMPROVEMENT DISTRICT, PILOT ROCK R.F.P.D., OR OR PINE EAGLE HEALTH DISTRICT, OR RAINBOW WATER DISTRICT, OR PINE FLAT DISTRICT IMPROVEMENT COMPANY, OR RAINIER CEMETERY DISTRICT, OR PINE GROVE IRRIGATION DISTRICT, OR RAINIER DRAINAGE IMPROVEMENT COMPANY, OR PINE GROVE WATER DISTRICT-KLAMATH FALLS, RALEIGH WATER DISTRICT, OR OR REDMOND AREA PARK & RECREATION DISTRICT, PINE GROVE WATER DISTRICT-MAUPIN, OR OR PINE VALLEY CEMETERY DISTRICT, OR REDMOND FIRE AND RESCUE, OR PINE VALLEY R.F.P.D., OR RIDDLE FIRE PROTECTION DISTRICT, OR PINEWOOD COUNTRY ESTATES SPECIAL ROAD RIDGEWOOD DISTRICT IMPROVEMENT COMPANY, DISTRICT, OR OR PIONEER DISTRICT IMPROVEMENT COMPANY, OR RIDGEWOOD ROAD DISTRICT, OR PISTOL RIVER CEMETERY MAINTENANCE RIETH SANITARY DISTRICT, OR DISTRICT, OR RIETH WATER DISTRICT, OR PISTOL RIVER FIRE DISTRICT, OR RIMROCK WEST IMPROVEMENT DISTRICT, OR PLEASANT HILL R.F.P.D., OR RINK CREEK WATER DISTRICT, OR PLEASANT HOME WATER DISTRICT, OR RIVER BEND ESTATES SPECIAL ROAD DISTRICT, OR POCAHONTAS MINING AND IRRIGATION DISTRICT, RIVER FOREST ACRES SPECIAL ROAD DISTRICT, OR OR RIVER MEADOWS IMPROVEMENT DISTRICT, OR POE VALLEY IMPROVEMENT DISTRICT, OR RIVER PINES ESTATES SPECIAL ROAD DISTRICT, OR POE VALLEY PARK & RECREATION DISTRICT, OR RIVER ROAD PARK & RECREATION DISTRICT, OR POE VALLEY VECTOR CONTROL DISTRICT, OR RIVER ROAD WATER DISTRICT, OR POLK COUNTY FIRE DISTRICT #1, OR RIVERBEND RIVERBANK WATER IMPROVEMENT POLK S.W.C.D., OR DISTRICT, OR POMPADOUR WATER IMPROVEMENT DISTRICT, OR RIVERDALE R.F.P.D. 11 -JT, OR PONDEROSA PINES EAST SPECIAL ROAD DISTRICT, RIVERGROVE WATER DISTRICT, OR OR RIVERSIDE MISSION WATER CONTROL DISTRICT, PORT OF ALSEA, OR OR PORT OF ARLINGTON, OR RIVERSIDE R.F.P.D. #7406, OR PORT OF ASTORIA, OR RIVERSIDE WATER DISTRICT, OR PORT OF BANDON, OR ROBERTS CREEK WATER DISTRICT, OR PORT OF BRANDON, OR ROCK CREEK DISTRICT IMPROVEMENT, OR PORT OF BROOKINGS HARBOR, OR ROCK CREEK WATER DISTRICT, OR PORT OF CASCADE LOCKS, OR ROCKWOOD WATER P.U.D., OR PORT OF COQUILLE RIVER, OR ROCKY POINT FIRE & EMS, OR PORT OF GARIBALDI, OR ROGUE RIVER R.F.P.D., OR PORT OF GOLD BEACH, OR ROGUE RIVER VALLEY IRRIGATION DISTRICT, OR PORT OF HOOD RIVER, OR ROGUE VALLEY SEWER SERVICES, OR PORT OF MORGAN CITY, LA ROGUE VALLEY SEWER, OR PORT OF MORROW, OR ROGUE VALLEY TRANSPORTATION DISTRICT, OR PORT OF NEHALEM, OR ROSEBURG URBAN SANITARY AUTHORITY, OR PORT OF NEWPORT, OR ROSEWOOD ESTATES ROAD DISTRICT, OR PORT OF PORT ORFORD, OR ROW RIVER VALLEY WATER DISTRICT, OR PORT OF PORTLAND, OR RURAL ROAD ASSESSMENT DISTRICT 43, OR PORT OF SIUSLAW, OR RURAL ROAD ASSESSMENT DISTRICT 44, OR PORT OF ST. HELENS, OR SAINT LANDRY PARISH TOURIST COMMISSION PORT OF THE DALLES, OR SAINT MARY PARISH REC DISTRICT 2 PORT OF TILLAMOOK BAY, OR SAINT MARY PARISH REC DISTRICT 3 PORT OF TOLEDO, OR SAINT TAMMANY FIRE DISTRICT 4, LA PORT OF UMATILLA, OR SALEM AREA MASS TRANSIT DISTRICT, OR Version April 12, 2022 508 SALEM MASS TRANSIT DISTRICT SALEM SUBURBAN R.F.P.D., OR SALISHAN SANITARY DISTRICT, OR SALMON RIVER PARK SPECIAL ROAD DISTRICT, OR SALMON RIVER PARK WATER IMPROVEMENT DISTRICT, OR SALMONBERRY TRAIL INTERGOVERNMENTAL AGENCY,OR SANDPIPER VILLAGE SPECIAL ROAD DISTRICT, OR SANDY DRAINAGE IMPROVEMENT COMPANY, OR SANDY R.F.P.D. #72, OR SANTA CLARA R.F.P.D., OR SANTA CLARA WATER DISTRICT, OR SANTIAM WATER CONTROL DISTRICT, OR SAUVIE ISLAND DRAINAGE IMPROVEMENT COMPANY, OR SAUVIE ISLAND VOLUNTEER FIRE DISTRICT #30J, OR SCAPPOOSE DRAINAGE IMPROVEMENT COMPANY, OR SCAPPOOSE PUBLIC LIBRARY DISTRICT, OR SCAPPOOSE R.F.P.D., OR SCIO R.F.P.D., OR SCOTTSBURG R.F.P.D., OR SEAL ROCK R.F.P.D., OR SEAL ROCK WATER DISTRICT, OR SEWERAGE AND WATER BOARD OF NEW ORLEANS, LA SHANGRI-LA WATER DISTRICT, OR SHASTA VIEW IRRIGATION DISTRICT, OR SHELLEY ROAD CREST ACRES WATER DISTRICT, OR SHERIDAN FIRE DISTRICT, OR SHERMAN COUNTY HEALTH DISTRICT, OR SHERMAN COUNTY S.W.C.D., OR SHORELINE SANITARY DISTRICT, OR SILETZ KEYS SANITARY DISTRICT, OR SILETZ R.F.P.D., OR SILVER FALLS LIBRARY DISTRICT, OR SILVER LAKE IRRIGATION DISTRICT, OR SILVER LAKE R.F.P.D., OR SILVER SANDS SPECIAL ROAD DISTRICT, OR SILVERTON R.F.P.D. NO. 2, OR SISTERS PARKS & RECREATION DISTRICT, OR SISTERS -CAMP SHERMAN R.F.P.D., OR SIUSLAW PUBLIC LIBRARY DISTRICT, OR SIUSLAW S.W.C.D., OR SIUSLAW VALLEY FIRE AND RESCUE, OR SIXES R.F.P.D., OR SKIPANON WATER CONTROL DISTRICT, OR SKYLINE VIEW DISTRICT IMPROVEMENT COMPANY, OR SLEEPY HOLLOW WATER DISTRICT, OR SMITH DITCH DISTRICT IMPROVEMENT COMPANY, OR SOUTH CLACKAMAS TRANSPORTATION DISTRICT, OR SOUTH COUNTY HEALTH DISTRICT, OR SOUTH FORK WATER BOARD, OR SOUTH GILLIAM COUNTY CEMETERY DISTRICT, OR SOUTH GILLIAM COUNTY HEALTH DISTRICT, OR SOUTH GILLIAM COUNTY R.F.P.D. VI -301, OR SOUTH LAFOURCHE LEVEE DISTRICT, LA SOUTH LANE COUNTY FIRE & RESCUE, OR SOUTH SANTIAM RIVER WATER CONTROL DISTRICT, OR SOUTH SHERMAN FIRE DISTRICT, OR SOUTH SUBURBAN SANITARY DISTRICT, OR SOUTH WASCO PARK & RECREATION DISTRICT, OR SOUTHERN COOS HEALTH DISTRICT, OR SOUTHERN CURRY CEMETERY MAINTENANCE DISTRICT, OR SOUTHVIEW IMPROVEMENT DISTRICT, OR SOUTHWEST LINCOLN COUNTY WATER DISTRICT, OR SOUTHWESTERN POLK COUNTY R.F.P.D., OR SOUTHWOOD PARK WATER DISTRICT, OR SPECIAL ROAD DISTRICT 41, OR SPECIAL ROAD DISTRICT 48, OR SPRING RIVER SPECIAL ROAD DISTRICT, OR SPRINGFIELD UTILITY BOARD, OR ST. PAUL R.F.P.D., OR STANFIELD CEMETERY DISTRICT #6, OR STANFIELD IRRIGATION DISTRICT, OR STARR CREEK ROAD DISTRICT, OR STARWOOD SANITARY DISTRICT, OR STAYTON FIRE DISTRICT, OR SUBLIMITY FIRE DISTRICT, OR SUBURBAN EAST SALEM WATER DISTRICT, OR SUBURBAN LIGHTING DISTRICT, OR SUCCOR CREEK DISTRICT IMPROVEMENT COMPANY, OR SUMMER LAKE IRRIGATION DISTRICT, OR SUMMERVILLE CEMETERY MAINTENANCE DISTRICT, OR SUMNER R.F.P.D., OR SUN MOUNTAIN SPECIAL ROAD DISTRICT, OR SUNDOWN SANITATION DISTRICT, OR SUNFOREST ESTATES SPECIAL ROAD DISTRICT, OR SUNNYSIDE IRRIGATION DISTRICT, OR SUNRISE WATER AUTHORITY, OR SUNRIVER SERVICE DISTRICT, OR SUNSET EMPIRE PARK & RECREATION DISTRICT, OR SUNSET EMPIRE TRANSPORTATION DISTRICT, OR SURFLAND ROAD DISTRICT, OR SUTHERLIN VALLEY RECREATION DISTRICT, OR SUTHERLIN WATER CONTROL DISTRICT, OR SWALLEY IRRIGATION DISTRICT, OR SWEET HOME CEMETERY MAINTENANCE DISTRICT, OR SWEET HOME FIRE & AMBULANCE DISTRICT, OR SWISSHOME-DEADWOOD R.F.P.D., OR TABLE ROCK DISTRICT IMPROVEMENT COMPANY, OR TALENT IRRIGATION DISTRICT, OR TANGENT R.F.P.D., OR TENMILE R.F.P.D., OR TERREBONNE DOMESTIC WATER DISTRICT, OR THE DALLES IRRIGATION DISTRICT, OR THOMAS CREEK-WESTSIDE R.F.P.D., OR THREE RIVERS RANCH ROAD DISTRICT, OR THREE SISTERS IRRIGATION DISTRICT, OR TIGARD TUALATIN AQUATIC DISTRICT, OR TIGARD WATER DISTRICT, OR TILLAMOOK BAY FLOOD IMPROVEMENT DISTRICT, OR TILLAMOOK COUNTY EMERGENCY COMMUNICATIONS DISTRICT, OR TILLAMOOK COUNTY S.W.C.D., OR TILLAMOOK COUNTY TRANSPORTATION DISTRICT, OR TILLAMOOK FIRE DISTRICT, OR TILLAMOOK P.U.D., OR TILLER R.F.P.D., OR Version April 12, 2022 509 TOBIN DITCH DISTRICT IMPROVEMENT COMPANY, OR TOLEDO R.F.P.D., OR TONE WATER DISTRICT, OR TOOLEY WATER DISTRICT, OR TRASK DRAINAGE DISTRICT, OR TRI CITY R.F.P.D. #4, OR TRI -CITY WATER & SANITARY AUTHORITY, OR TRI -COUNTY METROPOLITAN TRANSPORTATION DISTRICT OF OREGON TRIMET, OR TUALATIN HILLS PARK & RECREATION DISTRICT TUALATIN HILLS PARK & RECREATION DISTRICT, OR TUALATIN S.W.C.D., OR TUALATIN VALLEY FIRE & RESCUE TUALATIN VALLEY FIRE & RESCUE, OR TUALATIN VALLEY IRRIGATION DISTRICT, OR TUALATIN VALLEY WATER DISTRICT TUALATIN VALLEY WATER DISTRICT, OR TUMALO IRRIGATION DISTRICT, OR TURNER FIRE DISTRICT, OR TWIN ROCKS SANITARY DISTRICT, OR TWO RIVERS NORTH SPECIAL ROAD DISTRICT, OR TWO RIVERS S.W.C.D., OR TWO RIVERS SPECIAL ROAD DISTRICT, OR TYGH VALLEY R.F.P.D., OR TYGH VALLEY WATER DISTRICT, OR UMATILLA COUNTY FIRE DISTRICT #1, OR UMATILLA COUNTY S.W.C.D., OR UMATILLA COUNTY SPECIAL LIBRARY DISTRICT, OR UMATILLA HOSPITAL DISTRICT, OR UMATILLA R.F.P.D. #7405, OR UMATILLA-MORROW RADIO AND DATA DISTRICT, OR UMPQUA S.W.C.D., OR UNION CEMETERY MAINTENANCE DISTRICT, OR UNION COUNTY SOLID WASTE DISPOSAL DISTRICT, OR UNION COUNTY VECTOR CONTROL DISTRICT, OR UNION GAP SANITARY DISTRICT, OR UNION GAP WATER DISTRICT, OR UNION HEALTH DISTRICT, OR UNION R.F.P.D., OR UNION S.W.C.D., OR UNITY COMMUNITY PARK & RECREATION DISTRICT, OR UPPER CLEVELAND RAPIDS ROAD DISTRICT, OR UPPER MCKENZIE R.F.P.D., OR UPPER WILLAMETTE S.W.C.D., OR VALE OREGON IRRIGATION DISTRICT, OR VALE RURAL FIRE PROTECTION DISTRICT, OR VALLEY ACRES SPECIAL ROAD DISTRICT, OR VALLEY VIEW CEMETERY MAINTENANCE DISTRICT, OR VALLEY VIEW WATER DISTRICT, OR VANDEVERT ACRES SPECIAL ROAD DISTRICT, OR VERNONIA R.F.P.D., OR VINEYARD MOUNTAIN PARK & RECREATION DISTRICT, OR VINEYARD MOUNTAIN SPECIAL ROAD DISTRICT, OR WALLA WALLA RIVER IRRIGATION DISTRICT, OR WALLOWA COUNTY HEALTH CARE DISTRICT, OR WALLOWA LAKE COUNTY SERVICE DISTRICT, OR WALLOWA LAKE IRRIGATION DISTRICT, OR WALLOWA LAKE R.F.P.D., OR WALLOWA S.W.C.D., OR WALLOWA VALLEY IMPROVEMENT DISTRICT 41, OR WAMIC R.F.P.D., OR WAMIC WATER & SANITARY AUTHORITY, OR WARMSPRINGS IRRIGATION DISTRICT, OR WASCO COUNTY S.W.C.D., OR WATER ENVIRONMENT SERVICES, OR WATER WONDERLAND IMPROVEMENT DISTRICT, OR WATERBURY & ALLEN DITCH IMPROVEMENT DISTRICT, OR WATSECO-BARVIEW WATER DISTRICT, OR WAUNA WATER DISTRICT, OR WEDDERBURN SANITARY DISTRICT, OR WEST EAGLE VALLEY WATER CONTROL DISTRICT, OR WEST EXTENSION IRRIGATION DISTRICT, OR WEST LABISH DRAINAGE & WATER CONTROL IMPROVEMENT DISTRICT, OR WEST MULTNOMAH S.W.C.D., OR WEST SIDE R.F.P.D., OR WEST SLOPE WATER DISTRICT, OR WEST UMATILLA MOSQUITO CONTROL DISTRICT, OR WEST VALLEY FIRE DISTRICT, OR WESTERN HEIGHTS SPECIAL ROAD DISTRICT, OR WESTERN LANE AMBULANCE DISTRICT, OR WESTLAND IRRIGATION DISTRICT, OR WESTON ATHENA MEMORIAL HALL PARK & RECREATION DISTRICT, OR WESTON CEMETERY DISTRICT #2, OR WESTPORT FIRE AND RESCUE, OR WESTRIDGE WATER SUPPLY CORPORATION, OR WESTWOOD HILLS ROAD DISTRICT, OR WESTWOOD VILLAGE ROAD DISTRICT, OR WHEELER S.W.C.D., OR WHITE RIVER HEALTH DISTRICT, OR WIARD MEMORIAL PARK DISTRICT, OR WICKIUP WATER DISTRICT, OR WILLAKENZIE R.F.P.D., OR WILLAMALANE PARK & RECREATION DISTRICT, OR WILLAMALANE PARK AND RECREATION DISTRICT WILLAMETTE HUMANE SOCIETY WILLAMETTE RIVER WATER COALITION, OR WILLIAMS R.F.P.D., OR WILLOW CREEK PARK DISTRICT, OR WILLOW DALE WATER DISTRICT, OR WILSON RIVER WATER DISTRICT, OR WINCHESTER BAY R.F.P.D., OR WINCHESTER BAY SANITARY DISTRICT, OR WINCHUCK R.F.P.D., OR WINSTON-DILLARD R.F.P.D., OR WINSTON-DILLARD WATER DISTRICT, OR WOLF CREEK R.F.P.D., OR WOOD RIVER DISTRICT IMPROVEMENT COMPANY, OR WOODBURN R.F.P.D. NO. 6, OR WOODLAND PARK SPECIAL ROAD DISTRICT, OR WOODS ROAD DISTRICT, OR WRIGHT CREEK ROAD WATER IMPROVEMENT DISTRICT, OR WY'EAST FIRE DISTRICT, OR YACHATS R.F.P.D., OR YAMHILL COUNTY TRANSIT AREA, OR YAMHILL FIRE PROTECTION DISTRICT, OR YAMHILL SWCD, OR YONCALLA PARK & RECREATION DISTRICT, OR Version April 12, 2022 510 YOUNGS RIVER-LEWIS & CLARK WATER DISTRICT, OR ZUMWALT R.F.P.D., OR K-12 INCLUDING BUT NOT LIMITED TO: ACADIA PARISH SCHOOL BOARD BEAVERTON SCHOOL DISTRICT BEND -LA PINE SCHOOL DISTRICT BOGALUSA HIGH SCHOOL, LA BOSSIER PARISH SCHOOL BOARD BROOKING HARBOR SCHOOL DISTRICT CADDO PARISH SCHOOL DISTRICT CALCASIEU PARISH SCHOOL DISTRICT CANBY SCHOOL DISTRICT CANYONVILLE CHRISTIAN ACADEMY CASCADE SCHOOL DISTRICT CASCADES ACADEMY OF CENTRAL OREGON CENTENNIAL SCHOOL DISTRICT CENTRAL CATHOLIC HIGH SCHOOL CENTRAL POINT SCHOOL DISTRICT NO.6 CENTRAL SCHOOL DISTRICT 13J COOS BAY SCHOOL DISTRICT NO.9 CORVALLIS SCHOOL DISTRICT 509J COUNTY OF YAMHILL SCHOOL DISTRICT 29 CULVER SCHOOL DISTRICT DALLAS SCHOOL DISTRICT NO.2 DAVID DOUGLAS SCHOOL DISTRICT DAYTON SCHOOL DISTRICT NO.8 DE LA SALLE N CATHOLIC HS DESCHUTES COUNTY SCHOOL DISTRICT NO.6 DOUGLAS EDUCATIONAL DISTRICT SERVICE DUFUR SCHOOL DISTRICT NO.29 EAST BATON ROUGE PARISH SCHOOL DISTRICT ESTACADA SCHOOL DISTRICT NO.I OB FOREST GROVE SCHOOL DISTRICT GEORGE MIDDLE SCHOOL GLADSTONE SCHOOL DISTRICT GRANTS PASS SCHOOL DISTRICT 7 GREATER ALBANY PUBLIC SCHOOL DISTRICT GRESHAM BARLOW JOINT SCHOOL DISTRICT HEAD START OF LANE COUNTY HIGH DESERT EDUCATION SERVICE DISTRICT HILLSBORO SCHOOL DISTRICT HOOD RIVER COUNTY SCHOOL DISTRICT JACKSON CO SCHOOL DIST NO.9 JEFFERSON COUNTY SCHOOL DISTRICT 509-J JEFFERSON PARISH SCHOOL DISTRICT JEFFERSON SCHOOL DISTRICT JUNCTION CITY SCHOOLS, OR KLAMATH COUNTY SCHOOL DISTRICT KLAMATH FALLS CITY SCHOOLS LAFAYETTE PARISH SCHOOL DISTRICT LAKE OSWEGO SCHOOL DISTRICT 7J LANE COUNTY SCHOOL DISTRICT 4J LINCOLN COUNTY SCHOOL DISTRICT LINN CO. SCHOOL DIST. 95C LIVINGSTON PARISH SCHOOL DISTRICT LOST RIVER JR/SR HIGH SCHOOL LOWELL SCHOOL DISTRICT NO.71 SALEM-KEIZER PUBLIC SCHOOLS 24J MARION COUNTY SCHOOL DISTRICT 103 MARIST HIGH SCHOOL, OR MCMINNVILLE SCHOOL DISTRICT NOAO MEDFORD SCHOOL DISTRICT 549C MITCH CHARTER SCHOOL MONROE SCHOOL DISTRICT NO. 1J MORROW COUNTY SCHOOL DIST, OR MULTNOMAH EDUCATION SERVICE DISTRICT MULTISENSORY LEARNING ACADEMY MYRTLE PINT SCHOOL DISTRICT 41 NEAH-KAH-N1E DISTRICT NO.56 NEWBERG PUBLIC SCHOOLS NESTUCCA VALLEY SCHOOL DISTRICT NO. 101 NOBEL LEARNING COMMUNITIES NORTH BEND SCHOOL DISTRICT 13 NORTH CLACKAMAS SCHOOL DISTRICT NORTH DOUGLAS SCHOOL DISTRICT NORTH WASCO CITY SCHOOL DISTRICT 21 NORTHWEST REGIONAL EDUCATION SERVICE DISTRICT ONTARIO MIDDLE SCHOOL OREGON TRAIL SCHOOL DISTRICT NOA6 ORLEANS PARISH SCHOOL DISTRICT PHOENIX -TALENT SCHOOL DISTRICT NOA PLEASANT HILL SCHOOL DISTRICT PORTLAND JEWISH ACADEMY PORTLAND PUBLIC SCHOOLS RAPIDES PARISH SCHOOL DISTRICT REDMOND SCHOOL DISTRICT REYNOLDS SCHOOL DISTRICT ROGUE RIVER SCHOOL DISTRICT ROSEBURG PUBLIC SCHOOLS SCAPPOOSE SCHOOL DISTRICT IJ SAINT TAMMANY PARISH SCHOOL BOARD, LA SEASIDE SCHOOL DISTRICT 10 SHERWOOD SCHOOL DISTRICT 88J SILVER FALLS SCHOOL DISTRICT 4.1 SOUTH LANE SCHOOL DISTRICT 45.13 SOUTHERN OREGON EDUCATION SERVICE DISTRICT SPRINGFIELD PUBLIC SCHOOLS SUTHERLIN SCHOOL DISTRICT SWEET HOME SCHOOL DISTRICT NO.55 TERREBONNE PARISH SCHOOL DISTRICT THE CATLIN GABEL SCHOOL TIGARD-TUALATIN SCHOOL DISTRICT UMATILLA MORROW ESD WEST LINN WILSONVILLE SCHOOL DISTRICT WILLAMETTE EDUCATION SERVICE DISTRICT WOODBURN SCHOOL DISTRICT YONCALLA SCHOOL DISTRICT ACADEMY FOR MATH ENGINEERING & SCIENCE (AMES), UT ALIANZA ACADEMY, UT ALPINE DISTRICT, UT AMERICAN LEADERSHIP ACADEMY, UT AMERICAN PREPARATORY ACADEMY, UT BAER CANYON HIGH SCHOOL FOR SPORTS & MEDICAL SCIENCES, UT BEAR RIVER CHARTER SCHOOL, UT BEAVER SCHOOL DISTRICT, UT BEEHIVE SCIENCE & TECHNOLOGY ACADEMY (BSTA) , UT BOX ELDER SCHOOL DISTRICT, UT CBA CENTER, UT CACHE SCHOOL DISTRICT, UT CANYON RIM ACADEMY, UT CANYONS DISTRICT, UT CARBON SCHOOL DISTRICT, UT CHANNING HALL, UT CHARTER SCHOOL LEWIS ACADEMY, UT CITY ACADEMY, UT DAGGETT SCHOOL DISTRICT, UT DAVTNCI ACADEMY, UT DAVIS DISTRICT, UT DUAL IMMERSION ACADEMY, UT Version April 12, 2022 511 DUCHESNE SCHOOL DISTRICT, UT EARLY LIGHT ACADEMY AT DAYBREAK, UT EAST HOLLYWOOD HIGH, UT EDITH BOWEN LABORATORY SCHOOL, UT EMERSON ALCOTT ACADEMY, UT EMERY SCHOOL DISTRICT, UT ENTHEOS ACADEMY, UT EXCELSIOR ACADEMY, UT FAST FORWARD HIGH, UT FREEDOM ACADEMY, UT GARFIELD SCHOOL DISTRICT, UT GATEWAY PREPARATORY ACADEMY, UT GEORGE WASHINGTON ACADEMY, UT GOOD FOUNDATION ACADEMY, UT GRAND SCHOOL DISTRICT, UT GRANITE DISTRICT, UT GUADALUPE SCHOOL, UT HAWTHORN ACADEMY, UT INTECH COLLEGIATE HIGH SCHOOL, UT IRON SCHOOL DISTRICT, UT ITINERIS EARLY COLLEGE HIGH, UT JOHN HANCOCK CHARTER SCHOOL, UT JORDAN DISTRICT, UT JUAB SCHOOL DISTRICT, UT KANE SCHOOL DISTRICT, UT KARL G MAESER PREPARATORY ACADEMY, UT LAKEVIEW ACADEMY, UT LEGACY PREPARATORY ACADEMY, UT LIBERTY ACADEMY, UT LINCOLN ACADEMY, UT LOGAN SCHOOL DISTRICT, UT MARIA MONTESSORI ACADEMY, UT MERIT COLLEGE PREPARATORY ACADEMY, UT MILLARD SCHOOL DISTRICT, UT MOAB CHARTER SCHOOL, UT MONTICELLO ACADEMY, UT MORGAN SCHOOL DISTRICT, UT MOUNTAINVILLE ACADEMY, UT MURRAY SCHOOL DISTRICT, UT NAVIGATOR POINTE ACADEMY, UT NEBO SCHOOL DISTRICT, UT NO UT ACAD FOR MATH ENGINEERING & SCIENCE (NUAMES), UT NOAH WEBSTER ACADEMY, UT NORTH DAVIS PREPARATORY ACADEMY, UT NORTH SANPETE SCHOOL DISTRICT, UT NORTH STAR ACADEMY, UT NORTH SUMMIT SCHOOL DISTRICT, UT ODYSSEY CHARTER SCHOOL, UT OGDEN PREPARATORY ACADEMY, UT OGDEN SCHOOL DISTRICT, UT OPEN CLASSROOM, UT OPEN HIGH SCHOOL OF UTAH, UT OQUIRRH MOUNTAIN CHARTER SCHOOL, UT PARADIGM HIGH SCHOOL, UT PARK CITY SCHOOL DISTRICT, UT PINNACLE CANYON ACADEMY, UT P1UTE SCHOOL DISTRICT, UT PROVIDENCE HALL, UT PROVO SCHOOL DISTRICT, UT QUAIL RUN PRIMARY SCHOOL, UT QUEST ACADEMY, UT RANCHES ACADEMY, UT REAGAN ACADEMY, UT RENAISSANCE ACADEMY, UT RICH SCHOOL DISTRICT, UT ROCKWELL CHARTER HIGH SCHOOL, UT SALT LAKE ARTS ACADEMY, UT SALT LAKE CENTER FOR SCIENCE EDUCATION, UT SALT LAKE SCHOOL DISTRICT, UT SALT LAKE SCHOOL FOR THE PERFORMING ARTS, UT SAN JUAN SCHOOL DISTRICT, UT SEVIER SCHOOL DISTRICT, UT SOLDIER HOLLOW CHARTER SCHOOL, UT SOUTH SANPETE SCHOOL DISTRICT, UT SOUTH SUMMIT SCHOOL DISTRICT, UT SPECTRUM ACADEMY, UT SUCCESS ACADEMY, UT SUCCESS SCHOOL, UT SUMMIT ACADEMY, UT SUMMIT ACADEMY HIGH SCHOOL, UT SYRACUSE ARTS ACADEMY, UT THOMAS EDISON - NORTH, UT TIMPANOGOS ACADEMY, UT TINTIC SCHOOL DISTRICT, UT TOOELE SCHOOL DISTRICT, UT TUACAHN HIGH SCHOOL FOR THE PERFORMING ARTS, UT UINTAH RIVER HIGH, UT UINTAH SCHOOL DISTRICT, UT UTAH CONNECTIONS ACADEMY, UT UTAH COUNTY ACADEMY OF SCIENCE, UT UTAH ELECTRONIC HIGH SCHOOL, UT UTAH SCHOOLS FOR DEAF & BLIND, UT UTAH STATE OFFICE OF EDUCATION, UT UTAH VIRTUAL ACADEMY, UT VENTURE ACADEMY, UT VISTA AT ENTRADA SCHOOL OF PERFORMING ARTS AND TECHNOLOGY, UT WALDEN SCHOOL OF LIBERAL ARTS, UT WASATCH PEAK ACADEMY, UT WASATCH SCHOOL DISTRICT, UT WASHINGTON SCHOOL DISTRICT, UT WAYNE SCHOOL DISTRICT, UT WEBER SCHOOL DISTRICT, UT WEILENMANN SCHOOL OF DISCOVERY, UT HIGHER EDUCATION ARGOSY UNIVERSITY BATON ROUGE COMMUNITY COLLEGE, LA BIRTHINGWAY COLLEGE OF MIDWIFERY BLUE MOUNTAIN COMMUNITY COLLEGE BRIGHAM YOUNG UNIVERSITY - HAWAII CENTRAL OREGON COMMUNITY COLLEGE CENTENARY COLLEGE OF LOUISIANA CHEMEKETA COMMUNITY COLLEGE CLACKAMAS COMMUNITY COLLEGE COLLEGE OF THE MARSHALL ISLANDS COLUMBIA GORGE COMMUNITY COLLEGE CONCORDIA UNIVERSITY GEORGE FOX UNIVERSITY KLAMATH COMMUNITY COLLEGE DISTRICT LANE COMMUNITY COLLEGE LEWIS AND CLARK COLLEGE LINFIELD COLLEGE LINN-BENTON COMMUNITY COLLEGE LOUISIANA COLLEGE, LA LOUISIANA STATE UNIVERSITY LOUISIANA STATE UNIVERSITY HEALTH SERVICES MARYLHURST UNIVERSITY MT. HOOD COMMUNITY COLLEGE MULTNOMAH BIBLE COLLEGE NATIONAL COLLEGE OF NATURAL MEDICINE NORTHWEST CHRISTIAN COLLEGE OREGON HEALTH AND SCIENCE UNIVERSITY Version April 12, 2022 512 OREGON INSTITUTE OF TECHNOLOGY OREGON STATE UNIVERSITY OREGON UNIVERSITY SYSTEM PACIFIC UNIVERSITY PIONEER PACIFIC COLLEGE PORTLAND COMMUNITY COLLEGE PORTLAND STATE UNIVERSITY REED COLLEGE RESEARCH CORPORATION OF THE UNIVERSITY OF HAWAII ROGUE COMMUNITY COLLEGE SOUTHEASTERN LOUISIANA UNIVERSITY SOUTHERN OREGON UNIVERSITY (OREGON UNIVERSITY SYSTEM) SOUTHWESTERN OREGON COMMUNITY COLLEGE TULANE UNIVERSITY TILLAMOOK BAY COMMUNITY COLLEGE UMPQUA COMMUNITY COLLEGE UNIVERSITY OF HAWAII BOARD OF REGENTS UNIVERSITY OF HAWAII -HONOLULU COMMUNITY COLLEGE UNIVERSITY OF OREGON -GRADUATE SCHOOL UNIVERSITY OF PORTLAND UNIVERSITY OF NEW ORLEANS WESTERN OREGON UNIVERSITY WESTERN STATES CHIROPRACTIC COLLEGE WILLAMETTE UNIVERSITY XAVIER UNIVERSITY UTAH SYSTEM OF HIGHER EDUCATION, UT UNIVERSITY OF UTAH, UT UTAH STATE UNIVERSITY, UT WEBER STATE UNIVERSITY, UT SOUTHERN UTAH UNIVERSITY, UT SNOW COLLEGE, UT DIXIE STATE COLLEGE, UT COLLEGE OF EASTERN UTAH, UT UTAH VALLEY UNIVERSITY, UT SALT LAKE COMMUNITY COLLEGE, UT UTAH COLLEGE OF APPLIED TECHNOLOGY, UT STATE AGENCIES ADMIN. SERVICES OFFICE BOARD OF MEDICAL EXAMINERS HAWAII CHILD SUPPORT ENFORCEMENT AGENCY HAWAII DEPARTMENT OF TRANSPORTATION HAWAII HEALTH SYSTEMS CORPORATION OFFICE OF MEDICAL ASSISTANCE PROGRAMS OFFICE OF THE STATE TREASURER OREGON BOARD OF ARCHITECTS OREGON CHILD DEVELOPMENT COALITION OREGON DEPARTMENT OF EDUCATION OREGON DEPARTMENT OF FORESTRY OREGON DEPT OF TRANSPORTATION OREGON DEPT. OF EDUCATION OREGON LOTTERY OREGON OFFICE OF ENERGY OREGON STATE BOARD OF NURSING OREGON STATE DEPT OF CORRECTIONS OREGON STATE POLICE OREGON TOURISM COMMISSION OREGON TRAVEL INFORMATION COUNCIL SANTIAM CANYON COMMUNICATION CENTER SEIU LOCAL 503, OPEU SOH- JUDICIARY CONTRACTS AND PURCH STATE DEPARTMENT OF DEFENSE, STATE OF HAWAII STATE OF HAWAII STATE OF HAWAII, DEPT. OF EDUCATION STATE OF LOUISIANA STATE OF LOUISIANA DEPT. OF EDUCATION STATE OF LOUISIANA, 26TH JUDICIAL DISTRICT ATTORNEY STATE OF UTAH HEART OF APPALACHIA REGION (VIRGINIA) to include: CITIES & TOWNS Bluefield, VA Grundy, VA Norton, VA Town of Tazewell, VA Big Stone Gap, VA Clintwood, VA St. Paul, VA COUNTIES Buchanan County, VA Dickenson County, VA Lee County, VA Russell County, VA Scott County, VA Tazewell County, VA Wise County, VA BLUE RIDGE HIGHLANDS REGION (VIRGINA) to include: CITIES & TOWNS Abingdon, VA Blacksburg, VA Bristol, VA Christiansburg, VA Damascus, VA Galax, VA Marion, VA Pulaski, VA Radford, VA Wytheville, VA COUNTIES Bland County, VA Carroll County, VA Floyd County, VA Giles County, VA Grayson County, VA Montgomery County, VA Patrick County, VA Pulaski County, VA Smyth County, VA Washington County, VA Wythe County, VA Version April 12, 2022 513 CENTRAL VIRGINIA REGION (VIRGINA) to include: CITIES & TOWNS COUNTIES Appomattox, VA Albemarie County, VA Ashland, VA Amelia County, VA Blackstone, VA Amherst County, VA Charlottesville, VA Appomattox County, VA Colonial Heights, VA Buckingham County, VA Chester, VA Campbell County, VA Farmville, VA Chesterfield County, VA Hopewell, VA Cumberland County, VA Lynchburg, VA Dinwiddie County, VA Petersburg, VA Fluvanna County, VA Richmond, VA Goochland County, VA Scottsville, VA Greene County, VA Wintergreen, VA Hanover County, VA Henrico County, VA Louisa County, VA Madison County, VA Nelson County, VA Nottoway County, VA Orange County, VA Powhatan County, VA Prince Edward County, VA Prince George County, VA Sussex County, VA TIDEWATER REGION (WHICH ALSO INCLUDES THE CHESAPEAKE BAY REGION) (VIRGINA) to include: CITIES & TOWNS COUNTIES Kilmarnock, VA Middlesex County, VA Warsaw, VA Lancaster County, VA Urbanna, VA Northumberland County, VA West Point, VA Richmond County, VA Colonial Beach, VA King William County, VA Tappahannock, VA King & Queen County, VA Gloucester, VA Mathews County, VA Irvington, VA Westmoreland County, VA Essex County, VA Gloucester County, VA King George County, VA 514 COASTAL VIRGINIA - EASTERN SHORE REGION (VIRGINA) to include: CITIES & TOWNS Accomac, VA Cape Charles, VA Chincoteague Island, VA Exmore, VA Onanock, VA Tangier Island, VA Wachapreague, VA COUNTIES Northampton County, VA Accomack County, VA Tidewater COASTAL VIRGINIA - HAMPTON ROADS REGION (VIRGINA) to include: CITIES & TOWNS Charles City, VA Chesapeake, VA Franklin, VA Hampton, VA Newport News, VA Norfolk, VA Poquoson, VA Portsmouth, VA Smithfield, VA Suffolk, VA Virginia Beach, VA Williamsburg, VA Yorktown, VA NORTHERN VIRGNIA REGION (VIRGINA) to include: CITIES & TOWNS Alexandria, VA Arlington, VA Centreville, VA Chantilly, VA Clifton, VA Culpeper, VA Dulles, VA Falls Church, VA Fairfax, VA Fredericksburg, VA Herndon, VA Leesburg, VA Lorton, VA Manassas Park, VA Manassas, VA COUNTIES Charles City County, VA Isle of Wight County, VA James City County, VA New Kent County, VA Southampton County, VA Surry County, VA York County, VA COUNTIES Rappanhannock County, VA Fauquier County, VA Stafford County, VA Spotsylvania County, VA Caroline County, VA Prince William County, VA Fairfax County, VA Loudoun County, VA Culpeper County, VA 515 Marshall, VA McLean, VA Middleburg, VA Occoquan, VA Purcellville, VA Reston, VA Spotsylvania, VA Springfield, VA Triangle, VA Vienna, VA Warrenton, VA Woodbridge, VA Washington, VA SHENANDOAH VALLEY REGION (VIRGINA) to include: CITIES & TOWNS COUNTIES Berryville, VA Shenandoah, VA Buena Vista, VA Staunton, VA Front Royal, VA Waynesboro, VA Harrisonburg, VA Winchester, VA Lexington, VA Luray, VA Natural Bridge VA COUNTIES Augusta County, VA Clarke County, VA Frederick County, VA Page County, VA Rockbridge County, VA Rockingham County, VA Shenandoah County, VA Warren County, VA SOUTHERN VIRGINIA (VIRGINA) to include: CITIES & TOWNS COUNTIES Danville, VA Brunswick County, VA Emporia, VA Charlotte County, VA Martinsville, VA Greensville County, VA South Boston, VA Henry County, VA South Hill, VA Halifax County, VA Clarksville, VA Lunenburg County, VA Mecklenburg County, VA Pittsylvania County, VA 516 VIRGINIA MOUNTAINS REGION (VIRGINA) to include: CITIES & TOWNS COUNTIES Bedford, VA Alleghany County, VA Buchanan, VA Bath County, VA Clifton Forge, VA Bedford County, VA Covington, VA Botetourt County, VA Fincastle, VA Craig County, VA Hot Springs, VA Franklin County, VA New Castle, VA Highland County, VA Roanoke, VA Roanoke County, VA Rocky Mount, VA Norfolk Public Schools, VA Salem, VA Northampton County Public Schools, VA Troutville, VA Vinton, VA Warm Springs, VA SCHOOL DISTRICTS (VIRGINA) to include: Manassas Park City Public Schools, VA Accomack County Public Schools, VA Lunenburg County Public Schools, VA Albemarle County Public Schools, VA Lynchburg City Public Schools, VA Alexandria City Public Schools, VA Madison County Public Schools, VA Alleghany County Public Schools, VA Manassas City Public Schools, VA Amelia County Public Schools, VA Manassas Park City Public Schools, VA Amherst County Public Schools, VA Martinsville City Public Schools, VA Appomattox County Public Schools, VA Mathews County Public Schools, VA Arlington Public Schools, VA Mecklenburg County Public Schools, VA Augusta County Public Schools, VA Middlesex County Public Schools, VA Bath County Public Schools, VA Montgomery County Public Schools, VA Bedford City Public Schools, VA Nelson County Public Schools, VA Bedford County Public Schools, VA New Kent County Public Schools, VA Bland County Public Schools, VA Newport News Public Schools, VA Botetourt County Public Schools, VA Norfolk Public Schools, VA Bristol Public Schools, VA Northampton County Public Schools, VA Brunswick County Public Schools, VA Northumberland County Public Schools, VA Buchanan County Public Schools, VA Norton City Schools, VA Buckingham County Public Schools, VA Nottoway County Public Schools, VA Buena Vista City Public Schools, VA Orange County Public Schools, VA Campbell County Public Schools, VA Page County Public Schools, VA Caroline County Public Schools, VA Patrick County Public Schools, VA Carroll County Public Schools, VA Petersburg City Public Schools, VA Charles City County Public Schools, VA Pittsylvania County Public Schools, VA Charlotte County Public Schools, VA Poquoson City Public Schools, VA Charlottesville City Schools, VA Portsmouth Public Schools, VA Chesapeake Public Schools, VA Powhatan County Public Schools, VA 517 Chesterfield County Public Schools, VA Clarke County Public Schools, VA Colonial Beach Public Schools, VA Colonial Heights Public Schools, VA Covington City Public Schools, VA Craig County Public Schools, VA Culpeper County Public Schools, VA Cumberland County Public Schools, VA Danville Public Schools, VA Dickenson County Public Schools, VA Dinwiddie County Public Schools, VA Essex County Public Schools, VA Fairfax County Public Schools, VA Falls Church City Public Schools, VA Fauquier County Public Schools, VA Floyd County Public Schools, VA Fluvanna County Public Schools, VA Franklin City Public Schools, VA Franklin County Public Schools, VA Frederick County Public Schools, VA Fredericksburg City Schools, VA Galax City Public Schools, VA Giles County Public Schools, VA Gloucester County Public Schools, VA Goochland County Public Schools, VA Grayson County Public Schools, VA Greene County Public Schools, VA Greensville County Public Schools, VA Halifax County Public Schools, VA Hampton City Schools, VA Hanover County Public Schools, VA Harrisonburg City Public Schools, VA Henrico County Public Schools, VA Henry County Public Schools, VA Highland County Public Schools, VA Hopewell City Public Schools, VA Isle of Wight County Public Schools, VA King and Queen County Public Schools, VA King George County Public Schools, VA King William County Public Schools, VA Lancaster County Public Schools, VA Lee County Public Schools, VA Lexington City Schools, VA Loudoun County Public Schools, VA Louisa County Public Schools, VA Washington County Public Schools, VA Prince Edward County Public Schools, VA Prince George County Public Schools, VA Prince William County Public Schools, VA Pulaski County Public Schools, VA Radford City Schools, VA Rappahannock County Public Schools, VA Richmond County Public Schools, VA Richmond Public Schools, VA Roanoke City Public Schools, VA Roanoke County Public Schools, VA Rockbridge County Public Schools, VA Rockingham County Public Schools, VA Russell County Public Schools, VA Salem City Schools, VA Scott County Public Schools, VA Shenandoah County Public Schools, VA Smyth County Public Schools, VA Southampton County Public Schools, VA Spotsylvania County Public Schools, VA Stafford County Public Schools, VA Staunton City Public Schools, VA Suffolk Public Schools, VA Sorry County Public Schools, VA Sussex County Public Schools, VA Tazewell County Public Schools, VA Virginia Beach City Public Schools, VA Warren County Public Schools, VA Winchester Public Schools, VA Wise County Public Schools, VA Wythe County Public Schools, VA York County School Division, VA 518 Waynesboro Public Schools, VA Westmoreland County Public Schools, VA West Point Public Schools, VA Williamsburg -James City County Public Schools, VA 519 Attachment E — No Bid Form Contractors who do no wish to bid do not need to return the entire bid package. Simply return this form to Racine County through Duane McKinney, Purchasing Manager at: Duane. McKinney(&-racinecounty.com STATEMENT OF NO BID SEALED BID NUMBER HVAC Products, Installation, Labor Based Solutions, and Related Products and Services I do not wish to submit a bid on this solicitation. Contractor Representative Please indicate the reason(s) for your decision not to bid: 520 Exhibit B Administration Agreement, Example F.1 U Jj 110 P5F 1 THIS ADMINISTRATION AGREEMENT (this "_A=gpLen_') is made this 3 day of July 2p2 between National liftigavernmental Purchasing Alliance Company, a Delaware corporation d/b/a OMNIA Partners, Public Seam %and Tape U.S. Inc. F-W-0-1-TIUK WHEREAS, the(the "urinal DM cival rm-ent AM I has entered into a Master Agreement effective . .... .. .. .... , Agreement No by and between the Principal Procurement Agency and Supplier, (as may be amended from time to time in accordance with the terms thereof, the Mt"M ent and A g AgEWm as attached hereto as Ex incorporated herein by reference as though fully set forth herein, for the purchase of WHEREAS, said Master Agreement provides that any or all public ageticies, including state and local governmental entities, public and private primary, secondary and higher education entities, non-profit entities, and agencies for the public benefit (collectively, "Public that register (either via registration on the ONE41A Partners website or execution of a Master Intergovernmental Cooperative Purchasing Agreement, attached hereto as Exhib&B (each, hereinafter referred to as a. "Partitioaft Egblic Agcy") may purchase Product at prices stated in the Master Agreement; WHEREAS, Participating Public Agencies may access the Master Agreement which is offered through OMNIA Partners to Public Agencies; WHEREAS, OMNIA Partners serves as the cooperative contract administrator of the Master Agreement on behalf of Principal Procurement Agency; WHFP.EAS, Principal Procurement Agency desires OMNIA Partners to proceed with administration of the Master Agreement; and WHEREAS, OMNIA Partners and Supplier desire to enter into this Agreement to make available the Master Agreement to Participating Public Agencies and to set forth certain terms and conditions governing the relationship between ONCZA Partners and Supplier. NOW, MFORE, in consideration of the payments to be made hereunder and tha mutual covenants contained in this Agreement, OMNIA Partners and Supplier hereby agree as follows: I , Capitalized terms used in this Agreement and not otherwise defined herein shall have the meanings given to them in the Master Agrement, � �-11100 521 2. The Master Agreement and the turns and conditions contained therein shall apply to this Agreement except as expressly changed or modified by this Agreement Supplier acknowledges and agrees that the covenants and agreements of Supplier set forth in the solicitation and Supplices response thereto resulting in the Master Agreement are incorporated herein and are an part hereof. 3, OMNIA Partners shall be afforded all of the rights, privileges and indemnifications afforded to Principal Procurement Agency by or from Supplier under the Master Agreement, and such rights, privileges and indemnifications shall accrue and apply with equal effect to OMNIA Partner, its agents, employees, directors, and representatives under this Agreement including, but not limited to, Supplier's obligation to obtain appropriate insurance. 4. ONINIA Partners shall perform all of its duties, responsibilities and obligations as the cooperative contract administrator of the Master Agreement on behalf of Principal Procurement Agency as set forth herein, and Supplier hereby acknowledges and agrees that all duties, responsibilities and obligations will be undertaken by OMNIA Partners solely in its capacity as the cooperative contract administrator under the Master Agreement. 5- With respect to any purchases by Principal Procurement Agency or any Participating Public Agency pursuant to the Master Agreement, OMNIA Partners shall not be: (i) construed as a dealer, re -marketer, representative, partner or agent of any type of the Supplier, plincipalFromIrement Agency or any Participating Public Agency; (u) obligated, liable Or responsible for any Order for Product made by Principal Procurement Agency or any Participating Public Agency or any employee thereof under the Masw Agreement or for any payment required to be made with respect to such order for Product; and (iii) Obligated, liable or responsible for any failure by Principal Procurement Agency or any Participating Public Agency to comply with procedures or requirements of applicable law or the Master Agreement or to obtain the due authorization and approval necessary to purchase under the Master Agreement OA241A Partners makes no representation or guaranty with respect to any minimum purchases by Principal Procurement Agency or any Participating Public Agency or any employee thereof under this Agreement or the Master Agreement 6. OMNIA Partners shall not be responsible for Supplier's performance under the Master Agreement and Supplier shall hold OMNIA Partners harmless from any liability that may arise from the act or omissions of Supplier in connection with the Master Agreernent 7. Supplier acknowledges that, in connection with its access to OMNIA Partners confidential information and/or supply of data to OMNIA. Partners, it has complied with and shall continue to comply with all laws, regulations and standards that may apply to Supplier, including, without limitation: (a) UniW States feclaral and state information security And Privacy statutes, regulations and/or beg practices, including, without limitation, the Gramm-Leacb-Bliley Act the Massachusetts Data Security Regulations (201 CAIR 17.00 et. seq.), the Nevada encryption statute (NXS, § 603A), the California data security law (Cal. Civil Code § 1798-80 et. seq.) and California Consumer Privacy Act (Cal. Civil Code § 1798.100 et seq.)-, and (b) applicable industry and regulatory standards and best practices (collectively, "DBM LMIationf). With regard to Personal Wormation that Supplier collects, receives, or otherwise processes under the Agreement or otherwise in connection with performance of the Agreement, Supplier agrees that it will not (i) sell, rent release, disclose, disseminatemake available, transfer, or othervAse Vemion Apd iZ 2022 522 communicate orally, in writing, or by electronic or other means, such Personal Information to another business or third party for monetary or other valuable consideration; or (ii) retain, use, or disclose such Personal Information outside of the direct business relationship between Supplier and OMNIA Partners or for any purpose other than for the specific purpose of performance of the Agree mOrk. including reitaining, using, or disclosing such Personal Information fat a commercial purpose other than for performance of the Agreement By entering into the Agreement, Supplier oertifies that it understands the specific restrictions, contained in this Section 7 and will comply with them. For purposes hereof, "Z=nal bf gtMdbe means information that identifies, relates to, describes, is reasonably capable of being associated with, or could reasonably be linked, directly of indirectly, with a particular consumer or household, and includes the specific elements of "Personal mfonnatlee as defined under Data Regulations, as defined herein. Supplier will reasonably assist OMNIA Partners in timely responding to any third party "request to know" or "request to delete'" (as defined pursuant to Data Regulations) and will promptly provide OMNIA. Partners with infinmation. reasonably nee,mury for OMNIA Purtn= to respond to such requests. Where Supplier collects Personal Information directly from Public Agencies or others on OMNIA Partners! behalf Supplier will maintain records and the means necessary to enable, OMNIA Partners: to respond to such requests, to know and requests to delete, Vi V V tip 1 01131191 01. 1 N I it 0 1 TERM OF AGRUMM; TERMWATION 9. This Agreement shall be in effect: so long as the Mager Agreement remains in effect, provided, however, that the provisions of Sections 3 — 8 and 11— 22, hereof and the indemnifications afforded by the Supplier to OMNIA Partners in the Master Agreement, to the munt such provisions survive any expiration or termination of the Mager Agreement "I survive the expiration or termination of this Agreement 10, OMNIA Parhuws, and Supplier WWI publicize and promote the availability of the Master Agreement's products and services, to Public Agencies and such agencies' employees. Supplier shall require each Public Agency to register its participation in the OMNIA Partners program by either registering on, the OMNIA Partners website Cw—ww. L i,� W.9 0 o r mecuiing a Master Intergovernmental Cooperative Purchasing Agreement prior to processing the Participating Public Agency's first sales order. Upon request Supplier shall make available to interested Public Agencies a copy of the Master Agreement and such price lists or quotes as may be necessary for such Public Agencies to evaluate potential purchases. 11. Supplier shall provide such marketing and administrative support as set forth in the solicitation result;ing in the Master AgmmeK including "sting in development of marketing materials as reasonably requested by Principal Procurement Agency and OWdA Partners. Supplier shall be responsible for obtaining permission or license of use and payment of any license fees fbr all content and images Supplier provides to OMNIA Partners or posts on the 01-ANIA Partners website, VMIMAPO IZ20 523 Supplier shall indemnify, defend and hold harmless OWUA. Partners for use of all such content and images including copyright ir&ingement claims. Supplier and ONE41A Partners each hereby grant to the other party a limited, revocable, non-tranderable, non-sublicensable right to use such Pam's 1090 (each, the "Ljgjo:) solely for use in marketing the Master Agreement Each party shall provide the other party with the standard terms of use of such party's Logo, and such party shall comply With such term in all material respects. Both parties shall obtain approval from the other party prior to use of such party's Logo. Notwithstanding the foregoing, the parties understand and agree that except as provided herein neither party shall have any right, title or interest in the other party's Logo. Upon termination of this Agreement, each party shall immediately cease use of the other party's Logo. 12, An "Administrative Fee" shall be defined and due to OMNIA Partners from Supplier in the amount of 2 pmmt ( 2%) multiplied by the total purchase amount paid to Supplier, less refunds, credits on returns, rebates and discount, for the sale of products and/or services to Principal Procurement Agency and Participating Public Agencies pursuant to the Master Agreement (as amended from time to time and including any renewal thereof) jMd-Sakes f). From time to time the parties may mutually 49W in writing to a lower Administra ve Fee Percentage for a specifically identified Participating Public Agenqy*s Contract Sales. 13. Supplier shall provide OWLA Partners with an electronic accounting report monthly, in the format prescribed by OMNIA Partners, summanzwg all Contract Sales for each calendar month The Contract Sales reporting format is provided as C ("Contraid Wes RMOKO, attached hereto and incorporated herein by rderence Contact, Sales Reports for each calendar month shall be provided by Supplier to OMNIA Partners by the 109' day of the following month- Failure to provide a Contract S ales Report within the time and manner specified herein "I constitute a material breach of this Agreement and if not cured within thirty (30) days of written notice to Supplier shall be deemed a cause for termination of the Master Agreement at Principal Procurement Agency's sole discretion, and/or this Agreement, at OMNIA Partnere sole discretion. 14. Administrative Fee payments are to be paid by Supplier to OMNIA Partners at the frequency and on the due date stated in Section 13, above, for Supplier's submission of corresponding Contract Sales Reports. Administrative Fee payments are to be made via Automated Clearing House (ACH) to the OMNIA Partners designated financial institution identified in ENWbit D. Failure to provide a payrnerA of the Administrative Fee within the time and manner specified herein shall constitute a material breach of this Agreement and if not cured within thirty (30) days of written notice to Supplier shall be deemed a cause for termination of the Master Agreement at Principal Procurement Agency's sole discretion, and/or this Agteernent, at OMNIA Partners' sole discretion. All Administrative Fees not paid when due shall bear interest at a taw equal to the lesser of one and me -half percent (1 1/2%) per month or the maximum rate permitted by law until POW in full. 15. Supplier shall maintain an accounting of all purchases made by Participating Public Agencies under the Master Agreement OACNIA Partners, or its designee. in OMNIA Partners' sole discretion, reserves the right to compare Pasticipating Public Agency records with Contract Wes Rep" submitted by Supplier for a period of four (4) years from the date OMNIA Partners receives such report In addition, OMNIA Partnea may engage a third party to conduct an independent audit of Supplier's monthly reports. In the event of such an audit, Supplier shall provide all materials reasonably requested relating to such audit by OMNIA Partners at the location designated by ONffdA Partners In the event an underreporting of Contract Saks and a resulting underpayment of Vin Apd 12,2W 524 Administrative Fees is revealed, OUNIA. Partners will notify the Supplier in writing, Supplier will have thirty (30) dayg from the, date of such notice to resolve the discrepancy to OMNIA Partners' reasonable satisfaction, including payment of any Administrative Fees due and owing, together with interest thereon in accordance with Section 13, and reimbursement of OMNIA Partners' costs and expenses related to such audit. GENERAL PROVISIONS 16. This Agreetnetit, the Master Agreement and the exhibits referenced herein supersede any and all other agreements, either oral or in writing, between the parties hereto with respect to the Subject matter hereto and no other agreement, statement or promise relating to the subject matter of this Agreement which is not contained or incorporated herein shall be valid or binding. In the event of any conflict between the provisions of this Agreement and the Master Agreement, as between OMNIA Partners and Supplier, the provisions of this Agreement shall prevail 17. If any action at law or in equity is brought to enforce or interpret the provisions of this Agreement or to recover any Administrative Fee and accrued interest, the prevailing party shall be entitled to reasonable attorney's fees and costs in addition to any other relief to which it may be entitled. 18. This Agreement and OMNIA Partners' rights and obligations hereunder may be assigned at OMNIA Partners' sole discretion to an affiliate of OMNIA Partners, any purchaser of any or all or substantially all of the assets of OMNIA Partners, or the successor entity as a result of a MeTer, reorganization, consolidation, conversion or change of control, whether by operation of law or otherwise. Supplier may not assign its obligations hereunder without the prior written consent of OMMA Partners. 19. All written communications given hereunder shall be delivered by first -elm mail, postage prepaid, or overnight delivery on receipt to the addresses as set forth below. KWONFAUNIGs B. Supplier: Trane U.S. Inc. M—)o RMA-601-0!9-2803Cr69 t, 20. If any provision of this Agreement shall be deemed to be, or shall in fad be, illegal, inoperative or unenforceable, the same shall not affect any other provision or provisions herein cmftined or render the same invalid, inoperative or unenforceable to any extent whatever, and this Agreement will be construed by limiting or invalidating such provision to the minimum extent necessary to make such provision valid, legal and enforceable. VeTsW AM 12, 2122 525 21. This Agreement may not be amended, chwiged, modified, or altered without the prior written consent of the parties hereto, and no prevision of this Agreement may be discharged or waived, except by a writing signed by the parties. A waiver of any particular provision will not be deemed a waiver of any other provision, nor will a waiver given on one occasion be deemed to apply to any other occasion. 22. This Agreement shall inure to the benefit of and shall be binding upon OMWA Partners, the Supplier and any respective successor and assign *ereto, subject, however, to the limitations contained herein. 23. This Agreement will be construed under and governed by the laws of the State of Delaware, excluding its conflicts of law provisions and any action arising out of or related to this Agreement shall be commenced solely and exclusively in the state or federal courts in Williamson County Tennessee. 24. This Agreement may be executed in counterparb6 each of which is an original but all of which, together, shall constitute but one and the same instrument. The exchange of copies of this Agreemwt and of signature pages by facsimile, or by pdf or similar electronic transmission, will constitute effective execution and delivery of this Agreement as to the parties and may be used in lieu of the original Agreement fox all purposes. Signatures of the parties transmitted by fimmile, or by.pelf of similar elechanic transmission, will be domed to be their original siganum for arty purpose whatsoever. TRANE U.S. INC. 7 , 4�4' SSE- nnnnnnnn.. .mm . v mmmim nnnneeeeeen.......................... . Strategic Cooperative Ptvrain Leader Title .................................................................................... . . . . .... Date VempnPpl 12.20 NATIONAL MT=GOVEMMOENTAL PURCHASING ALLIANCE COMPANY, A DFKLAWARE A♦ a - UT -1-111p, VI Y Sipature �Sarahvavm . . ........ . Nam Sr. Vice President Public Sector Tide I M., 526 Date: 6/23/2023 Requesting Department: CITY OF BOYN"rON BEACH REQuEsr FOR PURCHASE OVER, $ 1%000 Facilities Contact Person: Melvin Stinson -PAP Explanation for Purchase: Women's Club - replace four (4) air conditining units. One (1) 7.5 ton single circuit, one 10 ton dual circuit, two (2) 5 ton split systems. Piggyback with Contract 3341, Racine County, Wisconsin with expiration dates of September 1, 2022 to August 31, 2027 ............................ Recommended Vendor Trane vendor # 2957 Dollar Amount of Purchase $98,129.00 Source f or Purchase (check and attach backup materials): Three Written Quotations GSA State Contract PRIDE/RESPECT SNAPS Sole Source Piggy -Back F7 Budgeted Item Emergency Purchase Other Contract Number: Omnia 3341 NOTE: Pricing proposal for purchase must be presented in the same detail contained within the contract. Fund Source for Purchase: 302-4145-580-62-01 / RP 2203 Approvals: Department Head— Purchasing Finance Form Revised 5/12/2022 Date �- 2(- ,-�3 Date Date 527 , i.. o o® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 4/17/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER MARSH & MCLENNAN COMPANIES 1166 Avenue of the Americas New York NY 10036 CONTACT Michaela Grasshoff, ARM NAME: A/CNNo EXt : 212-345-2794 A No): ADDRESS: Michaela.Grasshoff@marsh.com INSURER(S) AFFORDING COVERAGE NAIC # ATTN: 212-345-6000 COMPANY A: Old Republic Insurance Company 24147 INSURED COMPANY B: Travelers Indemnity Co of America 25666 Trane U.S. Inc. COMPANY C: Travelers Property Casualty Cc of Amer 25674 2884 Corporate Way Miramar, FL 33025 $1'000'000'00 United States TIME ELEMENT POLLUTION LIABILITY COVERAGES CERTIFICATE NUMBER: 707110 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL I SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY 317456-23 4/17/2023 4/17/2024 EACH OCCURRENCE $10,000,000.00 CLAIMS -MADE � OCCUR DAMAGE TO PREM SES Ea RENTED $1'000'000'00 X TIME ELEMENT POLLUTION LIABILITY MED EXP (Any one person) $10,000.00 CONTRACTUAL LIABILITY PERSONAL &ADV INJURY $10,000,000.00 X GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $10,000,000'00 POLICY � PRO � LOC JECT PRODUCTS - COMP/OPAGG $10,000,000.00 policy aggregate $20,000,000.00 OTHER: A AUTOMOBILE LIABILITY MWTB 317455-23 4/17/2023 4/17/2024 Ea acccidentSINGLE LIMIT $10,000,000.00 BODILY INJURY (Per person) X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) PROPERTY DAMAGE HIREDNON-OWNED AUTOS ONLY AUTOS ONLY Per accident PHvsICA DAMAGE/SELF INS. APD - Self Insured $ UMBRELLALIAB OCCUR EACH OCCURRENCE AGGREGATE EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ B B C C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY �, / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA UB-8M35413A-23-51-K (AOS) UB -9L048059 -23-51-D (MN) UB -8M370386 -23-51-R (AZ,MA,OR,WI) TWXJ-UB-7434L45A-23 (OH) 4/17/2023 4/17/2023 4/17/2023 4/17/2023 4/17/2024 4/17/2024 4/17/2024 4/17/2024 X PER OTH- STATUTE PER E.L. EACH ACCIDENT $3,000,000.00 E.L. DISEASE- EA EMPLOYEE $3,000,000.00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $3,000,000.00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Please see page 2 for additional information. CERTIFICATE HOLDER CANCELLATION City of Boynton Beach 100 E. Ocean Ave. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Boynton Beach, FL 33435 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN United States ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Marsh USA, Inc. BY: Michaela Grasshoff, ARM � M 0 qr"*� @ 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Requested By:Charyl Ja 5528 ACC)RL> AnnITWINAI RFMARK-q-grwi=III II F AGENCY NAMEDINSURED Trane U.S. Inc. 2884 Corporate Way Miramar, FL 33025 United States EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: City of Boynton Beach is included as Additional Insured where required by contract with respect to General Liability pursuant to applicable endorsement. City of Boynton Beach are included as Additional Insured where required by contract with respect to Automobile Liability pursuant to applicable endorsement. Job Description: HVAC Services For questions regarding this certificate of insurance contact: Charyl Javor Email: charyl.javor@trane.com Phone: 561-681-3379 ACORD 101 (2008/01) @ 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 529 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART/FORM It is agreed that such insurance as is afforded by the policy applies subject to the following provisions: SECTION II - WHO IS AN INSURED is amended to include as an additional insured: 1. Any person or organization to whom you become obligated to include as an additional insured under this policy, as a result of any written contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability to the extent caused by you and arising out of your operations, including both continuing and completed operations, or premises owned by or rented to you; or 2. Any designated person or organization, designated by you in writing to us, but only with respect to liability to the extent caused by you and arising out of your operations or premises owned by or rented to you and provided the "bodily injury", "property damage" or "personal and advertising injury" occurs subsequent to your written request to designate such person or organization as additional insured. However, the insurance provided will not exceed the lesser of: The coverage and/or limits of this policy; or b. The coverage and/or limits required by said contract or agreement. GL 017 003 0423 Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 530 MWZY 317456 23 Trane Technologies Company LLC 04/17/23 - 04/17/24 rl� it I l6 ok. Rh I(�I tlil+ Ir/ 1 G0 BEY0I�D nn /. �� �u i J % l! �I�CI1�II�IOIIV ' /� �I � /i�iii�ll � � [ j( ,Od Trane U.S. Inc. 6965 Vista Parkway North West Palm Beach, Florida 33411 Phone: (561) 683-1521 Oppy# 7212465 July 25, 2023 City of Boynton Beach — Historical Women's Club 1010 S. Federal Hwy Boynton Beach FL, 33435 ATTENTION: Melvin Stinson PROJECT NAME: COBB — Historical Women's Club Replace (4) Split Systems Trane is pleased to offer this proposal to replace the (4) existing Split Systems at the Boynton Beach Historic Women's Club. All equipment except for the 10-T AHU being replaced will go back to existing locations. This proposal reflects a like for like tonnages "Turnkey Installation" and includes the necessary: Installation Labor, Subcontracts, Project Management and Supervision. Start-up of the new split systems will be performed by factory certified technician upon completion with applicable factory warranties. All new equipment will be provided by the City of Boynton Beach. Our pricing and proposal is further defined by the following installation, scope of work. Mechanical Installation Scope: Included: 1. During an agreed upon time period, Trane will shut down and electrically tag -out the existing (4) equipment systems and components to be removed. 2. Mechanically and electrically disconnect the existing split systems being replaced and prepare for removal. 3. Remove and properly dispose of the existing equipment, refrigerant & piping and associated material or debris, per current EPA guidelines. 4. Provide Wind Load Calcs and Tie Down Details for the 7.5 & 10-T CUs. 5. Provide Crane to set and secure new CUs in place as needed. 6. Install (4) new Split Systems- qty (2) 5 ton, qty (1) 7.5 ton & qty (1) 10 ton. 7. Furnish, fabricate and modify duct work as necessary to connect (4) new AHUs being replaced. 8. The new 2nd Floor West 10-T AHU will be relocated from above head to ground level. 9. Furnish and install new drain pans for AHUs. 10. Furnish and install new refrigerant piping insulation where disturbed. 11. Connect and braze all existing refrigerant lines from AHUs and CUs, including new copper fittings as required. 12. Furnish and install new copper refrigerant lines and fittings for the 5-T Kitchen SS, existing lines are undersized. 13. Pressurize and perform hold test on newly installed split systems to ensure system integrity. 14. Reconnect the existing power circuit and wiring to (3) new Split Systems. 15. Provide new breaker and wiring for 5-T Kitchen CU, existing is undersized. 16. Evacuate and charge new systems with virgin refrigerant. 17. Start up and equipment commissioning of new system to be performed by Trane Factory Certified Technician, upon completion of the installation. 18. Furnish and install new Thermostats for the (4) new Split Systems. 19. Standard one year installation warranty 20. Permit acquisition and actual costs for permit fees imposed by municipality. ""1 —R A N = 531 T E C Ff N 0 u..0G1es Not Included: 1. New split system. All new Air handlers & Condenser to be provided by the City of Boynton. 2. Any after hours or premium time labor. All work to be completed during normal business hours. 3. Any fire alarm related controls, piping, wiring, duct, smoke detectors, relays, panels, integration or other components of any kind. (Duct smoke detectors are assumed to be in place and working) 4. Any drywall or patching of bathroom ceiling/ wall where previous unit is removed from. 5. Engineering or drawings of any kind 6. Any electrical upgrade that may not meet existing code. 7. Existing feeder wires are to remain and be reused to the new Unit. 8. Independent test and balance. 9. Roofing of any kind. (Not required in this scope of work) 10. Any changes or additions to the scope of work as described above. PRICING AND ACCEPTANCE: TOTAL PRICE FOR INSTALLATION AS SPECIFIED ABOVE..............$98,129.00 The pricing outlined above is based upon Omnia contract Racine #3341 We appreciate the opportunity to earn your business and look forward to helping you with all of your service needs. Please contact me if you have any questions or concerns. Sincerely, Jerry Shugart Senior Account Manager 5610287-2681 Amar Sukhai Services Turnkey Account Manager 786-423-4196 In addition to any other amounts then due hereunder, if this Agreement is terminated or cancelled prior to its scheduled expiration, Customer shall pay to Company the balance of any amounts billed to but unpaid by Customer and, if a "Service Project" is included in the Agreement, the Cancellation Fee set forth in "Exhibit A" Cancellation Schedule attached hereto and incorporated herein, which Cancellation Fee represents unbilled labor, non -labor expenses and parts materials and components. Subject only to a prior written agreement signed by Trane, payment is due upon receipt of invoice in accordance with Section 6 of the attached Terms and Conditions — Quoted Service. This agreement is subject to Customer's acceptance of the attached Trane Terms and Conditions — Quoted Service. Valid for 30 days from document date June 9, 2023 532 COVID-19 NATIONAL EMERGENCY CLAUSE: The parties agree that they are entering into this Agreement while the nation is in the midst of a national emergency due to the Covid-19 pandemic ("Covid-19 Pandemic"). With the continued existence of Covid-19 Pandemic and the evolving guidelines and executive orders, it is difficult to determine the impact of the Covid-19 Pandemic on Trane's performance under this Agreement. Consequently, the parties agree as follows: 1. Each party shall use commercially reasonable efforts to perform its obligations under the Agreement and to meet the schedule and completion dates, subject to provisions below; 2. Each party will abide by any federal, state or local orders, directives, or advisories regarding the Covid-19 Pandemic with respect to its performance of its obligations under this Agreement and each shall have the sole discretion in determining the appropriate and responsible actions such party shall undertake to so abide or to safeguard its employees, subcontractors, agents and suppliers; 3. Each party shall use commercially reasonable efforts to keep the other party informed of pertinent updates or developments regarding its obligations as the Covid-19 Pandemic situation evolves; and 4. If Trane's performance is delayed or suspended as a result of the Covid-19 Pandemic, Trane shall be entitled to an equitable adjustment to the project schedule and/or the contract price. TERMS AND CONDITIONS — QUOTED SERVICE 1-10.48 (0821) "Company" shall mean Trane U.S. Inc.. To obtain repair service within the scope of Services as defined, contact your local Trane District office identified on the first page of the Agreement by calling the telephone number stated on that page. That Trane District office is responsible for Company's performance of this Agreement. Only Trane authorized personnel may perform service under this Agreement. For Service covered under this Agreement, Company will be responsible for the cost of transporting a part requiring service. 1. Agreement. These terms and conditions are an integral part of Company's offer and form the basis of any agreement (the "Agreement") resulting from Company's proposal (the "Proposal") for the services (the "Services") on equipment listed in the Proposal (the "Covered Equipment"). COMPANY'S TERMS AND CONDITIONS ARE SUBJECT TO PERIODIC CHANGE OR AMENDMENT. 2. Connected Services. In addition to these terms and conditions, the Connected Services Terms of Service ("Connected Services Terms"), available at https://www.trane.com/TraneConnectedServicesTerms, as updated from time to time, are incorporated herein by reference and shall apply to the extent that Company provides Customer with Connected Services, as defined in the Connected Services Terms. 3. Acceptance. The Proposal is subject to acceptance in writing by the party to whom this offer is made or an authorized agent ("Customer") delivered to Company within 30 days from the date of the Proposal. If Customer accepts the Proposal by placing an order, without the addition of any other terms and conditions of sale or any other modification, Customer's order shall be deemed acceptance of the Proposal subject to Company's terms and conditions. If Customer's order is expressly conditioned upon the Company's acceptance or assent to terms and/or conditions other than those expressed herein, return of such order by Company with Company's terms and conditions attached or referenced serves as Company's notice of objection to Customer's terms and as Company's counteroffer to provide Services in accordance with the Proposal. If Customer does not reject or object in writing to Company within 10 days, the Company's counteroffer will be deemed accepted. Customer's acceptance of the Services by Company will in any event constitute an acceptance by Customer of Company's terms and conditions. In the case of a dispute, the applicable terms and conditions will be those in effect at the time of delivery or acceptance of the Services. This Agreement is subject to credit approval by Company. Upon disapproval of credit, Company may delay or suspend performance or, at its option, renegotiate prices and/or terms and conditions with Customer. If Company and Customer are unable to agree on such revisions, this Agreement shall be cancelled without any liability, other than Customer's obligation to pay for Services rendered by Company to the date of cancellation. 4. Cancellation by Customer Prior to Services; Refund. If Customer cancels this Agreement within (a) thirty (30) days of the date this Agreement was mailed to Customer or (b) twenty (20) days of the date this Agreement was delivered to Customer, if it was delivered at the time of sale, and no Services have been provided by Company under this Agreement, the Agreement will be void and Company will refund to Customer, or credit Customer's account, the full Service Fee of this Agreement that Customer paid to Company, if any. A ten percent (10%) penalty per month will be added to a refund that is due but is not paid or credited within forty-five (45) days after return of this Agreement to Company. Customer's right to cancel this Agreement only applies to the original owner of this Agreement and only if no Services have been provided by Company under this Agreement prior to its return to Company. 5. Cancellation by Company. This Agreement may be cancelled by Company for any reason or no reason, upon written notice from Company to Customer no later than 30 days prior to performance of any Services hereunder and Company will refund to Customer, or credit Customer's account, that part of the Service Fee attributable to Services not performed by Company. Customer shall remain liable for and shall pay to Company all amounts due for Services provided by Company and not yet paid. 6. Services Fees and Taxes. Fees for the Services (the "Service Fee(s)") shall be as set forth in the Proposal and are based on performance during regular business hours. Fees for outside Company's regular business hours and any after-hours services shall be billed separately according to the then prevailing overtime or emergency labor/labour rates. In addition to the stated Service Fee, Customer shall pay all taxes not legally required to be paid by Company or, alternatively, shall provide Company with acceptable tax exemption certificates. Customer shall pay all costs (including attorneys' fees) incurred by Company in attempting to collect amounts due. 7. Payment. Payment is due upon receipt of Company's invoice. Company reserves the right to add to any account outstanding for more than 30 days a service charge equal to the lesser of the maximum allowable legal interest rate or 1.5% of the principal amount due at the end of each month. Customer shall pay all costs (including attorneys' fees) incurred by Company in attempting to collect amounts due or otherwise enforcing these terms and conditions. 8. Customer Breach. Each of the following events or conditions shall constitute a breach by Customer and shall give Company the right, without an election of remedies, to terminate this Agreement or suspend performance by delivery of written notice: (1) Any failure by Customer to pay amounts when due; or (2) any general assignment by Customer for the benefit of its creditors, or if Customer becomes bankrupt or insolvent or takes the benefit of any statute for bankrupt or insolvent debtors, or makes or proposes to make any proposal or arrangement with creditors, or if any steps are taken for the winding up or other termination of Customer or the liquidation of its assets, or if a trustee, receiver, or similar person is appointed over any of the assets or interests of Customer; (3) Any representation or warranty furnished by Customer in connection with this Agreement is false or misleading in any material respect when made; or (4) Any failure by Customer to .1 .R 533 perform or comply with any material provision of this Agreement. Customer shall be liable to the Company for all Services furnished to date and all damages sustained by Company (including lost profit and overhead) 9. Performance. Company shall perform the Services in accordance with industry standards generally applicable in the state or province where the Services are performed under similar circumstances as of the time Company performs the Services. Company is not liable for any claims, damages, losses, or expenses, arising from or related to work done by or services provided by individuals or entities that are not employed by or hired by Company. Company may refuse to perform any Services or work where working conditions could endanger property or put at risk the safety of people. Parts used for any repairs made will be those selected by Company as suitable for the repair and may be parts not manufactured by Company. Customer must reimburse Company for services, repairs, and/or replacements performed by Company at Customer's request beyond the scope of Services or otherwise excluded under this Agreement. The reimbursement shall be at the then prevailing applicable regular, overtime, or holiday rates for labor/labour and prices for materials. Prior to Company performing the additional services, repairs, and/or replacements, Customer may request a separate written quote stating the work to be performed and the price to be paid by Customer for the work. 10. Customer Obligations. Customer shall: (a) provide Company reasonable and safe access to the Covered Equipment and areas where Company is to work; and (b) unless otherwise agreed by Customer and Company, at Customer's expense and before the Services begin, Customer will provide any necessary access platforms, catwalks to safely perform the Services in compliance with OSHA, state, or provincial industrial safety regulations or any other applicable industrial safety standards or guidelines. 11. Exclusions. Unless expressly included in the Proposal, the Services do not include, and Company shall not be responsible for or liable to the Customer for, any claims, losses, damages or expenses suffered by the Customer in any way connected with, relating to or arising from any of the following: (a) Any guarantee of room conditions or system performance; (b) Inspection, operation, maintenance, repair, replacement or performance of work or services outside the Services; (c) Damage, repairs or replacement of parts made necessary as a result of the acts or omission of Customer or any Event of Force Majeure; (d) Any claims, damages, losses, or expenses, arising from or related to conditions that existed in, on, or upon the premises before the effective date of this Agreement ("Pre -Existing Conditions") including, without limitation, damages, losses, or expenses involving a Pre -Existing Condition of building envelope issues, mechanical issues, plumbing issues, and/or indoor air quality issues involving mold/mould, bacteria, microbial growth, fungi or other contaminates or airborne biological agents; and (e) Replacement of refrigerant is excluded, unless replacement of refrigerant is expressly stated as included with the Proposal. 12. Limited Warranty. Company warrants that: (a) the material manufactured by Company and provided to the Customer in performance of the Services is free from defects in material and manufacture for a period of 12 months from the earlier of the date of equipment start-up or replacement and (b) the labor/labour portion of the Services is warranted to have been properly performed for a period of 90 days from date of completion (the "Limited Warranty"). Company obligations of equipment start-up, if any are stated in the Proposal, are coterminous with the Limited Warranty period. Defects must be reported to Company within the Limited Warranty period. Company's obligation under the Limited Warranty is limited to repairing or replacing the defective part at its option and to correcting any improperly performed labor/labour. No liability whatsoever shall attach to Company until the Services have been paid for in full. Exclusions from this Limited Warranty include claims, losses, damages, and expenses in any way connected with, related to, or arising from failure or malfunction of equipment due to the following: wear and tear; end of life failure; corrosion; erosion; deterioration; Customer's failure to follow the Company -provided maintenance plan; unauthorized or improper maintenance; unauthorized or improper parts or material; refrigerant not supplied by Company; and modifications made by others to Company's equipment. Company shall not be obligated to pay for the cost of lost refrigerant or lost product. Some components of Company equipment may be warranted directly from the component supplier, in which case this Limited Warranty shall not apply to those components and any warranty of such components shall be the warranty given by the component supplier. Notwithstanding the foregoing, all warranties provided herein terminate upon termination or cancellation of this Agreement. Equipment, material and/or parts that are not manufactured by Company ("Third -Party Product(s)") are not warranted by Company and have such warranties as may be extended by the respective manufacturer. CUSTOMER UNDERSTANDS THAT COMPANY IS NOT THE MANUFACTURER OF ANY THIRD -PARTY PRODUCT(S) AND ANY WARRANTIES, CLAIMS, STATEMENTS, REPRESENTATIONS, OR SPECIFICATIONS ARE THOSE OF THE THIRD -PARTY MANUFACTURER, NOT COMPANY AND CUSTOMER IS NOT RELYING ON ANY WARRANTIES, CLAIMS, STATEMENTS, REPRESENTATIONS, OR SPECIFICATIONS REGARDING THE THIRD -PARTY PRODUCT THAT MAY BE PROVIDED BY COMPANY OR ITS AFFILIATES, WHETHER ORAL OR WRITTEN. THE REMEDIES SET FORTH IN THIS LIMITED WARRANTY ARE THE SOLE AND EXCLUSIVE REMEDIES FOR WARRANTY CLAIMS PROVIDED BY COMPANY TO CUSTOMER UNDER THIS AGREEMENT AND ARE IN LIEU OF ALL OTHER WARRANTIES AND LIABILITIES, LIABILITIES, CONDITIONS AND REMIDIES, WHETHER IN CONTRACT, WARRANTY, STATUTE, OR TORT (INCLUDING NEGLIGENCE), EXPRESS OR IMPLIED, IN LAW OR IN FACT, INCLUDING ANY IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR USE OR FITNESS FOR A PARTICULAR PURPOSE AND/OR OTHERS ARISING FROM COURSE OF DEALING OR TRADE. COMPANY EXPRESSLY DISCLAIMS ANY REPRESENTATIONS OR WARRANTIES, ENDORSEMENTS OR CONDITIONS OF ANY KIND. EXPRESS OR IMPLIED, INCLUDING ANY IMPLIED WARRANTIES OF QUALITY, FITNESS, MERCHANTABILITY, DURABILITY AND/OR OTHERS ARISING FROM COURSE OF DEALING OR TRADE OR REGARDING PREVENTION BY THE SCOPE OF SERVICES, OR ANY COMPONENT THEREOF. COMPANY MAKES NO REPRESENTATION OR WARRANTY OF ANY KIND, INCLUDING WARRANTY OF MERCHANTABILITY OR FITNESS FOR PARTICULAR PURPOSE. ADDITIONALLY, COMPANY MAKES NO REPRESENTATION OR WARRANTY OF ANY KIND REGARDING PREVENTING, ELIMINATING, REDUCING OR INHIBITING ANY MOLD, FUNGUS, BACTERIA, VIRUS, MICROBIAL GROWTH, OR ANY OTHER CONTAMINANTS (INCLUDING COVID-19 OR ANY SIMILAR VIRUS) (COLLECTIVELY, "CONTAMINANTS"), WHETHER INVOLVING OR IN CONNECTION WITH EQUIPMENT, ANY COMPONENT THEREOF, SERVICES OR OTHERWISE. IN NO EVENT SHALL COMPANY HAVE ANY LIABILITY FOR THE PREVENTION, ELIMINATION, REDUCTION OR INHIBITION OF THE GROWTH OR SPREAD OF SUCH CONTAMINANTS INVOLVING OR IN CONNECTION WITH ANY EQUIPMENT, THIRD -PARTY PRODUCT, OR ANY COMPONENT THEREOF, SERVICES OR OTHERWISE AND CUSTOMER HEREBY SPECIFICALLY ACKNOWLDGES AND AGREES THERETO 13. Indemnity. To the maximum extent permitted by law, Company and Customer shall indemnify and hold harmless each other from any and all claims, actions, costs, expenses, damages and liabilities, including reasonable attorneys' fees, resulting from death or bodily injury or damage to real or personal property, to the extent caused by the negligence or misconduct of the indemnifying party, and/or its respective employees or authorized agents in connection with their activities within the scope of this Agreement. Neither party shall indemnify the other against claims, damages, expenses, or liabilities to the extent attributable to the acts or omissions of the other party or third parties. If the parties are both at fault, the obligation to indemnify shall be proportional to their relative fault. The duty to indemnify and hold harmless will continue in full force and effect, notwithstanding the expiration or early termination of this Agreement, with respect to any claims based on facts or conditions that occurred prior to expiration or termination of this Agreement. 14. Limitation of Liability. NOTWITHSTANDING ANYTHING TO THE CONTRARY, NEITHER PARTY SHALL BE LIABLE FOR SPECIAL, INCIDENTAL, INDIRECT, OR CONSEQUENTIAL LOSSES OR DAMAGES OF ANY KIND (INCLUDING WITHOUT LIMITATION REFRIGERANT LOSS, PRODUCT LOSS, LOST REVENUE OR PROFITS, OR LIABILITY TO THIRD PARTIES), INCLUDING CONTAMINANTS LIABILITIES, OR PUNITIVE DAMAGES WHETHER BASED IN CONTRACT, WARRANTY, STATUTE, TORT .1 .R 534 (INCLUDING NEGLIGENCE), STRICT LIABILITY, INDEMNITY OR ANY OTHER LEGAL THEORY OR FACTS. NOTWITHSTANDING ANY OTHER PROVISION OF THIS AGREEMENT, THE TOTAL AND AGGREGATE LIABILITY OF THE COMPANY TO THE CUSTOMER WITH RESPECT TO ANY AND ALL CLAIMS CONNECTED WITH, RELATED TO OR ARISING FROM THE PERFORMANCE OR NON- PERFORMANCE OF THIS AGREEMENT, WHETHER BASED IN CONTRACT, WARRANTY, STATUTE, TORT (INCLUDING NEGLIGENCE), STRICT LIABILITY, INDEMNITY OR ANY OTHER LEGAL THEORY OR FACTS, SHALL NOT EXCEED THE COMPENSATION RECEIVED BY COMPANY UNDER THIS AGREEMENT. IN NO EVENT SHALL SELLER BE LIABLE FOR ANY DAMAGES (WHETHER DIRECT OR INDIRECT) RESULTING FROM MOLD, FUNGUS, BACTERIA, MICROBIAL GROWTH, OR OTHER CONTAMINATES OR AIRBORNE BIOLOGICAL AGENTS. TO THE MAXIMUM EXTENT ALLOWED BY LAW, COMPANY SHALL NOT BE LIABLE FOR ANY OF THE FOLLOWING IN CONNECTION WITH PROVIDING THE ENERGY AND BUILDING PERFORMANCE SERVICES: INTERRUPTION, DELETION, DEFECT, DELAY IN OPERATION OR TRANSMISSION; CUSTOMER'S NETWORK SECURITY; COMPUTER VIRUS; COMMUNICATION FAILURE; THEFT OR DESTRUCTION OF DATA; GAPS IN DATA COLLECTED; AND UNAUTHORIZED ACCESS TO CUSTOMER'S DATA OR COMMUNICATIONS NETWORK. 15. CONTAMINANTS LIABILITY. The transmission of COVID-19 may occur in a variety of ways and circumstances, many of the aspects of which are currently not known. HVAC systems, products, services and other offerings have not been tested for their effectiveness in reducing the spread of COVID-19, including through the air in closed environments. IN NO EVENT WILL COMPANY BE LIABLE UNDER THIS AGREEMENT OR OTHERWISE FOR ANY INDEMNIFICATION, ACTION OR CLAIM, WHETHER BASED ON WARRANTY, CONTRACT, TORT OR OTHERWISE, FOR ANY BODILY INJURY (INCLUDING DEATH), DAMAGE TO PROPERTY, OR ANY OTHER LIABILITIES, DAMAGES OR COSTS RELATED TO CONTAMINANTS (INCLUCING THE SPREAD, TRANSMISSION MITIGATION, ELIMINATION, OR CONTAMINATION THEREOF) (COLLECTIVELY, "CONTAMINANTS LIABILITIES") AND CUSTOMER HEREBY EXPRESSLY RELEASES COMPANY FROM ANY SUCH CONTAMINANT LIABILITIES. 16. Asbestos and Hazardous Materials. The Services expressly exclude any identification, abatement, cleanup, control, disposal, removal or other work connected with asbestos or other hazardous materials (collectively, "Hazardous Materials"). Should Company become aware of or suspect the presence of Hazardous Materials, Company may immediately stop work in the affected area and shall notify Customer. Customer will be responsible for taking any and all action necessary to correct the condition in accordance with all applicable laws and regulations. Customer shall be exclusively responsible for any claims, liability, fees and penalties, and the payment thereof, arising out of or relating to any Hazardous Materials on or about the premises, not brought onto the premises by Company. Company shall be required to resume performance of the Services only when the affected area has been rendered harmless. 17. Insurance. Company agrees to maintain the following insurance during the term of the contract with limits not less than shown below and will, upon request from Customer, provide a Certificate of evidencing the following coverage: Commercial General Liability $2,000,000 per occurrence Automobile Liability $2,000,000 CSL Workers Compensation Statutory Limits If Customer has requested to be named as an additional insured under Company's insurance policy, Company will do so but only subject to Company's manuscript additional insured endorsement under its primary Commercial General Liability policies. In no event does Company or its insurer waive its right of subrogation 18. Force Majeure. Company's duty to perform under this Agreement is contingent upon the non-occurrence of an Event of Force Majeure. If Company shall be unable to carry out any material obligation under this Agreement due to an Event of Force Majeure, this Agreement shall at Company's election (i) remain in effect but Company's obligations shall be suspended until the uncontrollable event terminates or (ii) be terminated upon ten (10) days notice to Customer, in which event Customer shall pay Company for all parts of the Services furnished to the date of termination. An "Event of Force Majeure" shall mean any cause or event beyond the control of Company. Without limiting the foregoing, "Event of Force Majeure" includes: acts of God; acts of terrorism, war or the public enemy; flood; earthquake; lightning; tornado; storm; fire; civil disobedience; pandemic insurrections; riots; labor disputes; labor or material shortages; sabotage; restraint by court order or public authority (whether valid or invalid), and action or non -action by or inability to obtain or keep in force the necessary governmental authorizations, permits, licenses, certificates or approvals if not caused by Company and the requirements of any applicable government in any manner that diverts either the material or the finished product to the direct or indirect benefit of the government. 19. General. Except as provided below, to the maximum extent provided by law, this Agreement is made and shall be interpreted and enforced in accordance with the laws of the state or province in which the Services are performed without regard to choice of law principles which might otherwise call for the application of a different state's or province's law. Any dispute arising under or relating to this Agreement that is not disposed of by agreement shall be decided by litigation in a court of competent jurisdiction located in the state or province in which the Services are performed. Any action or suit arising out of or related to this Agreement must be commenced within one year after the cause of action has accrued. To the extent the premises are owned and/or operated by any agency of the United States Federal Government, determination of any substantive issue of law shall be according to the United States Federal common law of Government contracts as enunciated and applied by Federal judicial bodies and boards of contract appeals of the Federal Government. This Agreement contains all of the agreements, representations and understandings of the parties and supersedes all previous understandings, commitments or agreements, oral or written, related to the Services. No documents shall be incorporated herein by reference except to the extent Company is a signatory thereon. If any term or condition of this Agreement is invalid, illegal or incapable of being enforced by any rule of law, all other terms and conditions of this Agreement will nevertheless remain in full force and effect as long as the economic or legal substance of the transaction contemplated hereby is not affected in a manner adverse to any party hereto. Customer may not assign, transfer, or convey this Agreement, or any part hereof, without the written consent of Company. Subject to the foregoing, this Agreement shall bind and inure to the benefit of the parties hereto and their permitted successors and assigns. This Agreement may be executed in several counterparts, each of which when executed shall be deemed to be an original, but all together shall constitute but one and the same Agreement. A fully executed facsimile copy hereof or the several counterparts shall suffice as an original. No modifications, additions or changes may be made to this Agreement except in a writing signed by Company. No failure or delay by the Company in enforcing any right or exercising any remedy under this Agreement shall be deemed to be a waiver by the Company of any right or remedy. 20. Equal Employment Opportunity/Affirmative Action Clause. Company is a United States federal contractor that complies fully with Executive Order 11246, as amended, and the applicable regulations contained in 41 C.F.R. Parts 60-1 through 60-60, 29 U.S.C. Section 793 and the applicable regulations contained in 41 C.F.R. Part 60-741; and 38 U.S.C. Section 4212 and the applicable regulations contained in 41 C.F.R. Part 60-250; and Executive Order 13496 and Section 29 CFR 471, appendix A to subpart A, regarding the notice of employee rights in the United States and with Canadian Charter of Rights and Freedoms Schedule B to the Canada Act 1982 (U.K.) 1982, c. 11 and applicable Provincial Human Rights Codes and employment law in Canada. 21. U.S. Government Contracts. The following provision applies only to direct sales by Company to the US Government. The Parties acknowledge that all items or services ordered and delivered under this Agreement / Purchase Order are Commercial Items as defined under Part 12 of the Federal Acquisition Regulation (FAR). In particular, Company agrees to be bound only by those Federal contracting clauses that apply to "commercial" suppliers and that are contained in FAR 52.212-5(e)(1). Company complies with 52.219-8 or 52.219-9 in its service and installation contracting business. The following provision applies only to indirect sales by Company to the US Government. As a Commercial Item Subcontractor, Company accepts only the following mandatory flow down provisions: 52.219-8; 52.222-26; 52.222-35; .1 .R 535 52.222-36; 52.222-39; 52.247-64. If the Services are in connection with a U.S. government contract, Customer agrees and hereby certifies that it has provided and will provide current, accurate, and complete information, representations and certifications to all government officials, including but not limited to the contracting officer and officials of the Small Business Administration, on all matters related to the prime contract, including but not limited to all aspects of its ownership, eligibility, and performance. Anything herein notwithstanding, Company will have no obligations to Customer unless and until Customer provides Company with a true, correct and complete executed copy of the prime contract. Upon request, Customer will provide copies to Company of all requested written communications with any government official related to the prime contract prior to or concurrent with the execution thereof, including but not limited to any communications related to contractor's Customer's ownership, eligibility or performance of the prime contract. Customer will obtain written authorization and approval from Company prior to providing any government official any information about Company's performance of the Services that are the subject of this offer or agreement, other than the Proposal or this Agreement. 22. Limited Waiver of Sovereign Immunity. If Customer is an Indian tribe (in the U.S.) or a First Nation or Band Council (in Canada), Customer, whether acting in its capacity as a government, governmental entity, a duly organized corporate entity or otherwise, for itself and for its agents, successors, and assigns: (1) hereby provides this limited waiver of its sovereign immunity as to any damages, claims, lawsuit, or cause of action (herein "Action") brought against Customer by Company and arising or alleged to arise out of the furnishing by Company of any product or service under this Agreement, whether such Action is based in contract, tort, strict liability, civil liability or any other legal theory; (2) agrees that jurisdiction and venue for any such Action shall be proper and valid (a) if Customer is in the U.S., in any state or United States court located in the state in which Company is performing this Agreement or (b) if Customer is in Canada, in the superior court of the province or territory in which the work was performed; (3) expressly consents to such Action, and waives any objection tojurisdiction or venue; (4) waives any requirement of exhaustion of tribal court or administrative remedies for any Action arising out of or related to this Agreement; and (5) expressly acknowledges and agrees that Company is not subject to the jurisdiction of Customer's tribal court or any similar tribal forum, that Customer will not bring any action against Company in tribal court, and that Customer will not avail itself of any ruling or direction of the tribal court permitting or directing it to suspend its payment or other obligations under this Agreement. The individual signing on behalf of Customer warrants and represents that such individual is duly authorized to provide this waiver and enter into this Agreement and that this Agreement constitutes the valid and legally binding obligation of Customer, enforceable in accordance with its terms. 1-10.48 (0821) Supersedes 1-10.48 (0720) .1 .R 536 Proposal 0 TR�IA/E" Proposal is valid for 15 days. Customer must obtain credit approval and release order to production within 60 days of proposal date. PROPRIETARYAND CONFIDENTIAL PROPERTY OF Trane U.S. Inc. DISTRII IJTION ' O OT14ER THAN THE NAMED RECIPIENT IS PROHIBITED Prepared For: City of Boynton Beach Job Name: COBB Women's Club Replace (4) S/S Delivery Terms: Freight Allowed and Prepaid - F.O.B. Factory Date: June 12, 2023 Proposal Number. H4-220443-14841-1 COOP Quote Number. H4-123128-23-005 COOP or Federal Contract ID: OMNIA Racine #3341 Payment Terms: Net 30 Days Trane U.S. Inc. is pleased to provide the following proposal for your review and approval. Tag Data - Odyssey Split System Indoor Unit (Qty: 2) Item Tag(s) Qty Description Model Number Al AHU-2 1 6 - 25 Ton Unitary Split Systems Indoor TWE09043AAA**BD A2 AHU-6 1 6 - 25 Ton Unitary Split Systems Indoor TWE12043BAA**BD Product Data - Odyssey Split System Indoor Unit All Units Air Handler R-41 OA 208-230/60/3 Generation B (2023 DOE) 2 Stage Airflow/SZ VAV-SYMBO condenser Standard Motor Drip panel kits (Field Installed) 7.45/9.96kW (208/230/3/60) (Field Installed) 5 Year Parts and Labor Warranty — whole unit Item: Al Qty: 1 Tag(s): AHU-2 7.5 Ton Single Circuit Item: A2 Qty: 1 Tag(s): AHU-6 10 Tons Dual Circuit Tag Data - Odyssey Split System Outdoor Unit (Qty: 2) Item Tag(s) Qty Description Model Number B1 CU -2 1 6 - 25 Ton Unitary Split Systems Outdoor TTA09043AAA**BS01 B2 CU -6 1 6 - 25 Ton Unitary Split Systems Outdoor TTA12043CAA**BS01 Product Data - Odyssey Split System Outdoor Unit All Units Cooling (TTA) R-41 OA Refrigerant 208-230/60/3 Generation B (2023 DOE) Symbio (Cooling) STD Coil w/ Guards © 2023 Trane Technologies All rights reserved Equipment Proposal - COBB Women's Club Replace (4) SS 06-12-2023.doa 537 COBB Women's Club Replace (4) S/S Service Valve accessory kit (Field Installed) Anti -corrosion coating on condenser coil 5 Year Parts and Labor Warranty — whole unit Item: B1 Qty: 1 Tag(s): CU -2 7.5 Tons Single Compressor/ Single Circuit Item: B2 Qty: 1 Tag(s): CU -6 10 Tons Manifold Compressors / Single Circuit June 12, 2023 NOT INCLUDED: Installation, startup, wiring of any kind, smoke detectors, controls, tie-in to BAS, thermostats, sensors, disconnects, starters, VFDs, dampers, actuators, external vibration isolation, piping, TXVs, refrigerant, any materials or labor not specifically described in this proposal. Tag Data - Split System Air Conditioning Units (Small) (Qty: 2) Item Tag(s) I Qty I Description Model Number C1 AHU/CU-3, AHU/CU-4 1 2 11.5 - 5 Ton Unitary Split Systems (SSC) 4TTR6060N1 / GAM5BOC60M51 E Product Data - Split System Air Conditioning Units (Small) Item: C1 Qty: 2 Tag(s): AHU/CU-3, AHU/CU-4 Split System Cooling Outdoor Unit 5 Ton Nominal Cooling Capacity 200 - 230 Volt 1 Phase 60 Hertz Multi -poise 4 -way 5 Ton air handler Mid EFF Multi -speed 208-230/l/60 Black Epoxy Evaporator Coil Anti -corrosion coating on condenser coil 3.60/4.80 kW Htr w/Ckt Brk 208/240/1 (Field Installed) 5 Year Parts and Labor Warranty — whole unit NOT INCLUDED: Installation, startup, wiring of any kind, smoke detectors, controls, tie-in to BAS, thermostats, sensors, disconnects, starters, VFDs, dampers, actuators, external vibration isolation, piping, TXVs, refrigerant, any materials or labor not specifically described in this proposal. Total Net Price (Excluding Sales Tax) Sincerely, Trane U.S. Inc. 2884 Corporate Way Miramar, FL 33025 Office Phone: (954) 499-6900 $ 42,611 This proposal is subject to your acceptance of the attached Trane terms and conditions. Equipment Proposal Page 2 of 1538 COBB Women's Club Replace (4) S/S June 12, 2023 COVID-19 NATIONAL EMERGENCY CLAUSE The parties agree that they are entering into this Agreement while the nation is in the midst of a national emergency due to the Covid-19 pandemic ("Covid-19 Pandemic"). With the continued existence of Covid-19 Pandemic and the evolving guidelines and executive orders, it is difficult to determine the impact of the Covid-19 Pandemic on Trane's performance under this Agreement. Consequently, the parties agree as follows: 1. Each party shall use commercially reasonable efforts to perform its obligations under the Agreement and to meet the schedule and completion dates, subject to provisions below; 2. Each party will abide by any federal, state (U.S.), provincial (Canada) or local orders, directives, or advisories regarding the Covid-19 Pandemic with respect to its performance of its obligations under this Agreement and each shall have the sole discretion in determining the appropriate and responsible actions such party shall undertake to so abide or to safeguard its employees, subcontractors, agents and suppliers; 3. Each party shall use commercially reasonable efforts to keep the other party informed of pertinent updates or developments regarding its obligations as the Covid-19 Pandemic situation evolves; and 4. If Trane's performance is delayed or suspended as a result of the Covid-19 Pandemic, Trane shall be entitled to an equitable adjustment to the project schedule and/or the contract price. TERMS AND CONDITIONS - COMMERCIAL EQUIPMENT "Company" shall mean Trane U.S. Inc. for sales in the United States and Trane Canada ULC for sales in Canada. 1. Acceptance. These terms and conditions are an integral part of Company's offer and form the basis of any agreement (the "Agreement") resulting from Company's proposal (the "Proposal") for the sale of the described commercial equipment and any ancillary services (the "Equipment"). COMPANY'S TERMS AND CONDITIONS AND EQUIPMENT PRICES ARE SUBJECT TO PERIODIC CHANGE OR AMENDMENT. The Proposal is subject to acceptance in writing by the party to whom this offer is made or an authorized agent ("Customer') delivered to Company within 15 days from the date of the Proposal. Prices in the Proposal are subject to change at any time upon notice to Customer. If Customer accepts the Proposal by placing an order, without the addition of any other terms and conditions of sale or any other modification, Customer's order shall be deemed acceptance of the Proposal subject to Company's terms and conditions. If Customer's order is expressly conditioned upon Company's acceptance or assent to terms and/or conditions other than those expressed herein, return of such order by Company with Company's terms and conditions attached or referenced serves as Company's notice of objection to Customer's terms and as Company's counteroffer to provide Equipment in accordance with the Proposal and the Company's terms and conditions. If Customer does not reject or object in writing to Company within 10 days, Company's counteroffer will be deemed accepted. Notwithstanding anything to the contrary herein, Customer's acceptance of the Equipment will in any event constitute an acceptance by Customer of Company's terms and conditions. This Agreement is subject to credit approval by Company. Upon disapproval of credit, Company may delay or suspend performance or, at its option, renegotiate prices and/or terms and conditions with Customer. If Company and Customer are unable to agree on such revisions, this Agreement shall be cancelled without any liability. 2. Connected Services. In addition to these terms and conditions, the Connected Services Terms of Service ("Connected Services Terms"), available at https://www.trane.com/TraneConnectedServicesTerms, as updated from time to time, are incorporated herein by reference and shall apply to the extent that Company provides Customer with Connected Services, as defined in the Connected Services Terms. 3. Title and Risk of Loss. All Equipment sales with destinations to Canada or the U.S. shall be made as follows: FOB Company's U.S. manufacturing facility or warehouse (full freight allowed). Title and risk of loss or damage to Equipment will pass to Customer upon tender of delivery of such to carrier at Company's U.S. manufacturing facility or warehouse. 4. Pricing and Taxes., Within forty-five (45) days following Customer acceptance of the Proposal without addition of any other terms and conditions of sale or any modification, Customer shall provide notification of release for immediate production at Company's factory. Prices for Equipment are subject to change at any time prior to shipment to reflect any cost increases related to the manufacture, supply, and shipping of Equipment. This includes, but is not limited to, cost increases in raw materials, supplier components, labor, utilities, freight, logistics, wages and benefits, regulatory compliance, or any other event beyond Company's control. If shipment is delayed due to Customer's actions, Company may also charge Customer with storage fees. If a release is not received within 6 months following order acceptance, Company reserves the right to cancel any order. Company shall be entitled to equitable adjustments in the contract price to reflect any cost increases as set forth above and will provide notice to Customer prior to the date for which the increased price is to be in effect for the applicable customer contract. In no event will prices be decreased. The price of Equipment does not include any present or future foreign, federal, state, or local property, license, privilege, sales, use, excise, value added, gross receipts or other like taxes or assessments. Such amounts will be itemized separately to Customer, who will make prompt payment to Company. Company will accept valid exemption documentation for such taxes and assessments from Customer, if applicable. All prices include packaging in accordance with Company's standard procedures. Charges for special packaging, crating or packing are the responsibility of Customer. 5. Delivery and Delays. Delivery dates are approximate and not guaranteed. Company will use commercially reasonable efforts to deliver the Equipment on or before the estimated delivery date, will notify Customer if the estimated delivery dates cannot be honored, and will deliver the Equipment and services as soon as practicable thereafter. In no event will Company be liable for any damages or expenses caused by delays in delivery. 6. Performance. Company shall be obligated to furnish only the Equipment described in the Proposal and in submittal data (if such data is issued in connection with the order). Company may rely on the acceptance of the Proposal and submittal data as acceptance of the suitability of the Equipment for the particular project or location. Unless specifically stated in the Proposal, compliance with any local building codes or other laws or regulations relating to specifications or the location, use or operation of the Equipment is the sole responsibility of Customer. If Equipment is tendered that does not fully comply with the provisions of this Agreement and Equipment is rejected by Customer, Company will have the right to cure within a reasonable time after notice thereof by substituting a conforming tender whether or not the time for performance has passed. 7. Force Majeure. Company's duty to perform under this Agreement and the Equipment prices are contingent upon the non-occurrence of an Event of Force Majeure. If the Company shall be unable to carry out any material obligation under this Agreement due to an Event of Force Majeure, this Agreement shall at Company's election (i) remain in effect but Company's obligations shall be suspended until the uncontrollable event terminates or (ii) be terminated upon 10 days' notice to Customer, in which event Customer shall pay Company for all parts of the Work furnished to the date of termination. An "Event of Force Majeure" shall mean any cause or event beyond the control of Company. Without limiting the foregoing, "Event of Force Majeure" includes: acts of God; acts of terrorism, war or the public enemy; flood; earthquake; tornado; storm; fire; civil disobedience; pandemic insurrections; riots; labor/labour disputes; labor/labour or material shortages; sabotage; restraint by court order or public authority (whether valid or invalid); and action or non -action by or inability to obtain or keep in force the necessary governmental authorizations, permits, licenses, certificates Equipment Proposal Page 3 of 1539 COBB Women's Club Replace (4) S/S June 12, 2023 or approvals if not caused by Company; and the requirements of any applicable government in any manner that diverts either the material or the finished product to the direct or indirect benefit of the government. 8. Limited Warranty. Company warrants the Equipment manufactured by Company for a period of the lesser of 12 months from initial start-up or 18 months from date of shipment, whichever is less, against failure due to defects in material and manufacture and that it has the capacities and ratings set forth in Company's catalogs and bulletins ("Warranty"). Equipment manufactured by Company that includes required start-up and sold in North America will not be warranted by Company unless Company performs the Equipment startup. Exclusions from this Warranty include damage or failure arising from: wear and tear; corrosion, erosion, deterioration; modifications made by others to the Equipment; repairs or alterations by a party other than Company that adversely affects the stability or reliability of the Equipment; vandalism; neglect; accident; adverse weather or environmental conditions; abuse or improper use; improper installation; commissioning by a party other than Company; unusual physical or electrical or mechanical stress; operation with any accessory, equipment or part not specifically approved by Company; refrigerant not supplied by Company; and/or lack of proper maintenance as recommended by Company. Company shall not be obligated to pay for the cost of lost refrigerant or lost product. Company's obligations and liabilities under this Warranty are limited to furnishing replacement equipment or parts, at its option, FCA (Incoterms 2000) factory or warehouse (f.o.b. factory or warehouse for US domestic purposes) at Company -designated shipping point, freight -allowed to Company's warranty agent's stock location, for all non -conforming Company -manufactured Equipment (which have been returned by Customer to Company). Returns must have prior written approval by Company and are subject to restocking charge where applicable. Equipment, material and/or parts that are not manufactured by Company ("Third -Party Product(s)") are not warranted by Company and have such warranties as may be extended by the respective manufacturer. CUSTOMER UNDERSTANDS THAT COMPANY IS NOT THE MANUFACTURER OF ANY THIRD -PARTY PRODUCT(S) AND ANY WARRANTIES, CLAIMS, STATEMENTS, REPRESENTATIONS, OR SPECIFICATIONS ARE THOSE OF THE THIRD - PARTY MANUFACTURER, NOT COMPANY AND CUSTOMER IS NOT RELYING ON ANY WARRANTIES, CLAIMS, STATEMENTS, REPRESENTATIONS, OR SPECIFICATIONS REGARDING THE THIRD -PARTY PRODUCT THAT MAY BE PROVIDED BY COMPANY OR ITS AFFILIATES, WHETHER ORAL OR WRITTEN. COMPANY MAKES NO REPRESENTATION OR WARRANTY OF ANY KIND, INCLUDING WARRANTY OF MERCHANTABILITY OR FITNESS FOR PARTICULAR PURPOSE.ADDITIONALLY, COMPANY MAKES NO REPRESENTATION OR WARRANTY OF ANY KIND REGARDING PREVENTING., ELIMINATING, REDUCING OR INHIBITING ANY MOLD, FUNGUS, BACTERIA, VIRUS, MICROBIAL GROWTH, OR ANY OTHER CONTAMINANTS (INCLUDING COVID-19 OR ANY SIMILAR VIRUS) (COLLECTIVELY, "CONTAMINANTS"), WHETHER INVOLVING OR IN CONNECTION WITH EQUIPMENT, ANY COMPONENT THEREOF, SERVICES OR OTHERWISE. IN NO EVENT SHALL COMPANY HAVE ANY LIABILITY FOR THE PREVENTION, ELIMINATION, REDUCTION OR INHIBITION OF THE GROWTH OR SPREAD OF SUCH CONTAMINANTS INVOLVING OR IN CONNECTION WITH ANY EQUIPMENT, THIRD -PARTY PRODUCT, OR ANY COMPONENT THEREOF, SERVICES OR OTHERWISE AND CUSTOMER HEREBY SPECIFICALLY ACKNOWLDGES AND AGREES THERETO. No warranty liability whatsoever shall attach to Company until Customer's complete order has been paid for in full and Company's liability under this Warranty shall be limited to the purchase price of the Equipment shown to be defective. Additional warranty protection is available on an extra -cost basis and must be in writing and agreed to by an authorized signatory of the Company. EXCEPT FOR COMPANY'S WARRANTY EXPRESSLY SET FORTH HEREIN, COMPANY DOES NOT MAKE, AND HEREBY EXPRESSLY DISCLAIMS, ANY WARRANTIES, EXPRESS OR IMPLIED CONCERNING ITS PRODUCTS, EQUIPMENT OR SERVICES, INCLUDING, WITHOUT LIMITATION, ANY WARRANTY OF DESIGN, MERCHANTABILITY OR OF FITNESS FOR A PARTICULAR PURPOSE, OR OTHERS THAT ARE ALLEGED TO ARISE FROM COURSE OF DEALING OR TRADE. 9. Indemnity. To the fullest extent permitted by law, Company and Customer shall indemnify, defend and hold harmless each other from any and all claims, actions, costs, expenses, damages and liabilities, including reasonable attorneys' fees, resulting from death or bodily injury or damage to real or personal property, to the extent caused by the negligence or misconduct of their respective employees or other authorized agents in connection with their activities within the scope of this Agreement. Neither party shall indemnify the other against claims, damages, expenses or liabilities to the extent attributable to the acts or omissions of the other party. If the parties are both at fault, the obligation to indemnify shall be proportional to their relative fault. The duty to indemnify will continue in full force and effect, notwithstanding the expiration or early termination hereof, with respect to any claims based on facts or conditions that occurred prior to expiration or termination. 10. Insurance. Upon request, Company will furnish evidence of its standard insurance coverage. If Customer has requested to be named as an additional insured under Company's insurance policy, Company will do so but only subject to Company's manuscript additional insured endorsement under its primary Commercial General Liability policies. In no event does Company waive any rights of subrogation. 11. Customer Breach. Each of the following events or conditions shall constitute a breach by Customer and shall give Company the right, without an election of remedies, to terminate this Agreement, require payment prior to shipping, or suspend performance by delivery of written notice: (1) Any failure by Customer to pay amounts when due; (2) any general assignment by Customer for the benefit of its creditors, or if Customer becomes bankrupt or insolvent or takes the benefit of any statute for bankrupt or insolvent debtors, or makes or proposes to make any proposal or arrangement with creditors, or if any steps are taken for the winding up or other termination of Customer or the liquidation of its assets, or if a trustee, receiver, or similar person is appointed over any of the assets or interests of Customer; (3) Any representation or warranty furnished by Customer in connection with this Agreement is false or misleading in any material respect when made; or (4) Any failure by Customer to perform or comply with any material provision of this Agreement. Customer shall be liable to the Company for all Equipment furnished and all damages sustained by Company (including lost profit and overhead). 12. Limitation of Liability. NOTWITHSTANDING ANYTHING TO THE CONTRARY, IN NO EVENT SHALL COMPANY BE LIABLE FOR ANY SPECIAL, INCIDENTAL, INDIRECT CONSEQUENTIAL, PUNITIVE, EXEMPLARY DAMAGES (INCLUDING WITHOUT LIMITATION REFRIGERANT LOSS, BUSINESS INTERRUPTION, LOST DATA, LOST REVENUE, LOST PROFITS),OR CONTAMINANTS LIABILITIES, EVEN IF A PARTY HAS BEEN ADVISED OF SUCH POSSIBLE DAMAGES OR IF SAME WERE REASONABLY FORESEEABLE AND REGARDLESS OF WHETHER THE CAUSE OF ACTION IS FRAMED IN CONTRACT, NEGLIGENCE, ANY OTHER TORT, WARRANTY, STRICT LIABILITY, OR PRODUCT LIABILITY. In no event will Company's liability in connection with the provision of products or services or otherwise under this Agreement exceed the entire amount paid to Company by Customer under this Agreement. 13. CONTAMINANTS LIABILITY The transmission of COVID-19 may occur in a variety of ways and circumstances, many of the aspects of which are currently not known. HVAC systems, products, services and other offerings have not been tested for their effectiveness in reducing the spread of COVID-19, including through the air in closed environments. IN NO EVENT WILL COMPANY BE LIABLE UNDER THIS AGREEMENT OR OTHERWISE FOR ANY INDEMNIFICATION, ACTION, OR CLAIM, WHETHER BASED ON WARRANTY, CONTRACT, TORT OR OTHERWISE, FOR ANY BODILY INJURY (INCLUDING DEATH), DAMAGE TO PROPERTY, OR ANY OTHER LIABILITIES, DAMAGES OR COSTS RELATED TO CONTAMINANTS (INCLUCING THE SPREAD, TRANSMISSION, MITIGATION, ELIMINATION, OR CONTAMINATION THEREOF) (COLLECTIVELY, "CONTAMINANTS LIABILITIES") AND CUSTOMER HEREBY EXPRESSLY RELEASES COMPANY FROM ANY SUCH CONTAMINANTS LIABILITIES. 14. Nuclear Liability. In the event that the Equipment sold hereunder is to be used in a nuclear facility, Customer will, prior to such use, arrange for insurance or governmental indemnity protecting Company against all liability and hereby releases and agrees to indemnify Company and its suppliers for any nuclear damage, including loss of use, in any manner arising out of a nuclear incident, whether alleged to be due, in whole or in part to the negligence or otherwise of Company or its suppliers. 15. Intellectual Property; Patent Indemnity. Company retains all ownership, license and other rights to all patents, trademarks, copyrights, trade secrets and other intellectual property rights related to the Equipment, and, except for the right to use the Equipment sold, Customer obtains no rights to use any such intellectual property. Company agrees to defend any suit or proceeding brought against Customer so far as such suit or proceeding Equipment Proposal Page 4 of 1540 COBB Women's Club Replace (4) S/S June 12, 2023 is solely based upon a claim that the use of the Equipment provided by Company constitutes infringement of any patent of the United States of America, provided Company is promptly notified in writing and given authority, information and assistance for defense of same. Company will, at its option, procure for Customer the right to continue to use said Equipment, or modify it so that it becomes non -infringing, or replace same with non - infringing Equipment, or to remove said Equipment and to refund the purchase price. The foregoing will not be construed to include any Agreement by Company to accept any liability whatsoever in respect to patents for inventions including more than the Equipment furnished hereunder, or in respect of patents for methods and processes to be carried out with the aid of said Equipment. The provision of Equipment by Company does not convey any license, by implication, estoppel, or otherwise, under patent claims covering combinations of said Equipment with other devices or elements. The foregoing states the entire liability of Company with regard to patent infringement. Notwithstanding the provisions of this paragraph, Customer will hold Company harmless against any expense or loss resulting from infringement of patents or trademarks arising from compliance with Customer's designs or specifications or instructions. 16. Cancellation. Equipment is specially manufactured in response to orders. An order placed with and accepted by Company cannot be delayed, canceled, suspended, or extended except with Company's written consent and upon written terms accepted by Company that will reimburse Company for and indemnify Company against loss and provide Company with a reasonable profit for its materials, time, labor, services, use of facilities and otherwise. Customer will be obligated to accept any Equipment shipped, tendered for delivery or delivered by Company pursuant to the order prior to any agreed delay, cancellation, suspension or extension of the order. Any attempt by Customer to unilaterally revoke, delay or suspend acceptance for any reason whatever after it has agreed to delivery of or accepted any shipment shall constitute a breach of this Agreement. For purposes of this paragraph, acceptance occurs by any waiver of inspection, use or possession of Equipment, payment of the invoice, or any indication of exclusive control exercised by Customer. 17. Invoicing and Payment. Unless otherwise agreed to in writing by Company, equipment shall be invoiced to Customer upon tender of delivery thereof to the carrier. Customer shall pay Company's invoices within net 30 days of shipment date. Company reserves the right to add to any account outstanding for more than 30 days a service charge equal to the lesser of the maximum allowable legal interest rate or 1.5% of the principal amount due at the end of each month. Customer shall pay all costs (including attorneys' fees) incurred by Company in attempting to collect amounts due and otherwise enforcing these terms and conditions. If requested, Company will provide appropriate lien waivers upon receipt of payment. Company may at any time decline to ship, make delivery or perform work except upon receipt of cash payment, letter of credit, or security, or upon other terms and conditions satisfactory to Company. Customer agrees that, unless Customer makes payment in advance, Company will have a purchase money security interest in all Equipment to secure payment in full of all amounts due Company and its order for the Equipment, together with these terms and conditions, form a security agreement (as defined by the UCC in the United States and as defined in the Personal Property Security Act in Canada). Customer shall keep the Equipment free of all taxes and encumbrances, shall not remove the Equipment from its original installation point and shall not assign or transfer any interest in the Equipment until all payments due Company have been made. The purchase money security interest granted herein attaches upon Company's acceptance of Customer's order and on receipt of the Equipment described in the accepted Proposal but prior to its installation. The parties have no agreement to postpone the time for attachment unless specifically noted in writing on the accepted order. Customer will have no rights of set off against any amounts, which become payable to Company under this Agreement or otherwise. 18. Claims. Company will consider claims for concealed shortages in shipments or rejections due to failure to conform to an order only if such claims or rejections are made in writing within 15 days of delivery and are accompanied by the packing list and, if applicable, the reasons in detail why the Equipment does not conform to Customer's order. Upon receiving authorization and shipping instructions from authorized personnel of Company, Customer may return rejected Equipment, transportation charges prepaid, for replacement. Company may charge Customer any costs resulting from the testing, handling, and disposition of any Equipment returned by Customer which are not found by Company to be nonconforming. All Equipment damaged during shipment and all claims relating thereto must be made with the freight carrier in accordance with such carrier's policies and procedures. Claims for Equipment damaged during shipment are not covered under the warranty provision stated herein. 19. Export Laws. The obligation of Company to supply Equipment under this Agreement is subject to the ability of Company to supply such items consistent with applicable laws and regulations of the United States and other governments. Company reserves the right to refuse to enter into or perform any order, and to cancel any order, under this Agreement if Company in its sole discretion determines that performance of the transaction to which such order relates would violate any such applicable law or regulation. Customer will pay all handling and other similar costs from Company's factories including the costs of freight, insurance, export clearances, import duties and taxes. Customer will be "exporter of record" with respect to any export from the United States of America and will perform all compliance and logistics functions in connection therewith and will also comply with all applicable laws, rules and regulations. Customer understands that Company and/or the Equipment are subject to laws and regulations of the United States of America which may require licensing or authorization for and/or prohibit export, re-export or diversion of Company's Equipment to certain countries, and agrees it will not knowingly assist or participate in any such diversion or other violation of applicable United States of America laws and regulations. Customer agrees to hold harmless and indemnify Company for any damages resulting to Customer or Company from a breach of this paragraph by Customer. 20. General. Except as provided below, to the maximum extent provided by law, this Agreement is made and shall be interpreted and enforced in accordance with the laws of the state of New York for Equipment shipped to a U.S. location and the laws of the province to which Equipment is shipped within Canada, without regard to its conflict of law principles that might otherwise call for the application of a different state's or province's law, and not including the United Nations Convention on Contracts for the International Sale of Goods. Any action or suit arising out of or related to this Agreement must be commenced within one year after the cause of action has accrued. To the extent the Equipment is being used at a site owned and/or operated by any agency of the Federal Government, determination of any substantive issue of law shall be according to the Federal common law of Government contracts as enunciated and applied by Federal judicial bodies and boards of contract appeals of the Federal Government. This Agreement contains all of the agreements, representations and understandings of the parties and supersedes all previous understandings, commitments or agreements, oral or written, related to the subject matter hereof. This Agreement may not be amended, modified or terminated except by a writing signed by the parties hereto. No documents shall be incorporated herein by reference except to the extent Company is a signatory thereon. If any term or condition of this Agreement is invalid, illegal or incapable of being enforced by any rule of law, all other terms and conditions of this Agreement will nevertheless remain in full force and effect as long as the economic or legal substance of the transaction contemplated hereby is not affected in a manner adverse to any party hereto. Customer may not assign, transfer, or convey this Agreement, or any part hereof, or its right, title or interest herein, without the written consent of the Company. Subject to the foregoing, this Agreement shall be binding upon and inure to the benefit of Customer's permitted successors and assigns. This Agreement may be executed in several counterparts, each of which when executed shall be deemed to be an original, but all together shall constitute but one and the same Agreement. A fully executed facsimile copy hereof or the several counterparts shall suffice as an original. 21. Equal Employment Opportunity/Affirmative Action Clause. Company is a federal contractor that complies fully with Executive Order 11246, as amended, and the applicable regulations contained in 41 C.F.R. Parts 60-1 through 60-60, 29 U.S.C. Section 793 and the applicable regulations contained in 41 C.F.R. Part 60-741; and 38 U.S.C. Section 4212 and the applicable regulations contained in 41 C.F.R. Part 60-250 Executive Order 13496 and Section 29 CFR 471, appendix A to subpart A, regarding the notice of employee rights in the United States and with Canadian Charter of Rights and Freedoms Schedule B to the Canada Act 1982 (U.K.) 1982, c. 11 and applicable Provincial Human Rights Codes and employment law in Canada. 22. U.S. Government Work. The following provision applies only to direct sales by Company to the US Government. The Parties acknowledge that Equipment ordered and delivered under this Agreement are Commercial Items as defined under Part 12 of the Federal Acquisition Regulation (FAR). In particular, Equipment Proposal Page 5 of 1541 COBB Women's Club Replace (4) S/S June 12, 2023 Company agrees to be bound only by those Federal contracting clauses that apply to "commercial" suppliers and that are contained in FAR 52.212- 5(e)(1). The following provision applies only to indirect sales by Company to the US Government. As a Commercial Item Subcontractor, Company accepts only the following mandatory flow down provisions: 52.219-8; 52.222-26; 52.222-35; 52.222-36; 52.222-39; 52.247-64. If the sale of the Equipment is in connection with a U.S. Government contract, Customer certifies that it has provided and will provide current, accurate, and complete information, representations and certifications to all government officials, including but not limited to the contracting officer and officials of the Small Business Administration, on all matters related to the prime contract, including but not limited to all aspects of its ownership, eligibility, and performance. Anything herein notwithstanding, Company will have no obligations to Customer unless and until Customer provides Company with a true, correct and complete executed copy of the prime contract. Upon request, Customer will provide copies to Company of all requested written communications with any government official related to the prime contract prior to or concurrent with the execution thereof, including but not limited to any communications related to Customer's ownership, eligibility or performance of the prime contract. Customer will obtain written authorization and approval from Company prior to providing any government official any information about Company's performance of the work that is the subject of the Proposal or this Agreement, other than the Proposal or this Agreement. 23. Limited Waiver of Sovereign Immunity. If Customer is an Indian tribe (in the U.S.) or a First Nation or Band Council (in Canada), Customer, whether acting in its capacity as a government, governmental entity, a duly organized corporate entity or otherwise, for itself and for its agents, successors, and assigns: (1) hereby provides this limited waiver of its sovereign immunity as to any damages, claims, lawsuit, or cause of action (herein "Action") brought against Customer by Company and arising or alleged to arise out of the furnishing by Company of any product or service under this Agreement, whether such Action is based in contract, tort, strict liability, civil liability or any other legal theory; (2) agrees that jurisdiction and venue for any such Action shall be proper and valid (a) if Customer is in the U.S., in any state or United States court located in the state in which Company is performing this Agreement or (b) if Customer is in Canada, in the superior court of the province or territory in which the work was performed; (3) expressly consents to such Action, and waives any objection to jurisdiction or venue; (4) waives any requirement of exhaustion of tribal court or administrative remedies for any Action arising out of or related to this Agreement; and (5) expressly acknowledges and agrees that Company is not subject to the jurisdiction of Customer's tribal court or any similar tribal forum, that Customer will not bring any action against Company in tribal court, and that Customer will not avail itself of any ruling or direction of the tribal court permitting or directing it to suspend its payment or other obligations under this Agreement. The individual signing on behalf of Customer warrants and represents that such individual is duly authorized to provide this waiver and enter into this Agreement and that this Agreement constitutes the valid and legally binding obligation of Customer, enforceable in accordance with its terms. 1-26.130-4 (0622) Supersedes 1-26.130-4(1221 b) Equipment Proposal Page 6 of 1542 RE AGREEMENT FOR PURCHASE AND INSTALLATION OF HVAC EQUIPMENT This Agreement is made as of this day of 12023 by and between TRANE U.S. INC. with a principal address 6965 Vista Parkway North, West Palm Beach, FL 33411 and THE CITY OF BOYNTON BEACH, a municipal corporation organized and existing under the laws of Florida, with a business address of 100 East Ocean Avenue, Boynton Beach, FL 33435, hereinafter referred to as "City". RECITALS WHEREAS, in order to maintain City facilities, the City's Public Works / Facilities Maintenance Department is requesting the City enter into an Agreement with Trane U.S. Inc. to purchase and the installation of HVAC equipment; and WHEREAS, Trane U.S. Inc. has agreed to allow the City to piggyback the City of Racine, WI / HVAC Products, Installation, Labor Based Solutions and Related Product and Services Contract pursuant to Contract No. 3341 to purchase and installation of HVAC equipment for a term commencing August 2, 2023, and terminating on August 31, 2027; and NOW, THEREFORE, in consideration of the mutual covenants contained herein, and for other valuable consideration received, the receipt and sufficiency of which are hereby acknowledged, the parties agree as follows: AGREEMENT Section 1. The foregoing recitals are true and correct and are hereby incorporated in this Agreement. Section 2. The City and Trane U.S. Inc. agree that Trane U.S. Inc. shall provide HVAC equipment and installation services based upon the City of Racine, WI / HVAC Products, Installation, Labor Based Solutions and Related Product and Services Contract pursuant to Contract No. 3341 to purchase and the installation of HVAC equipment for a term commencing August 2, 2023, a copy of which is attached hereto as Exhibit "A", except as hereinafter provided: A. All references to the City of Racine, WI / HVAC Products, Installation, Labor Based Solutions and Related Product and Services Contract pursuant to Contract No. 3341 shall be deemed as references to the City of Boynton Beach. {00533394.1 306-9001821 } Piggyback Contract— Trane U.S. Inc. 1 543 B. All Notices to the City shall be sent to: City: Daniel Dugger, City Manager City of Boynton Beach P.O. Box 310 Boynton Beach, Florida 33425 Telephone: (561) 742-6010 / Facsimile: (561) 742-6090 Copy: David N. Tolces, City Attorney Weiss Cerota Helfinan Cole + Bierman 2255 Glades Road, Suite 200 E Boca Raton, FL 33431 Telephone: (561) 835-2111 C. The following terms and conditions are hereby incorporated into the Agreement: TAX EXEMPT. Prices applicable to CITY do not include applicable state and local sales, use and related taxes. The CITY is exempt from state and local sales and use taxes and shall not be invoiced for the same. Upon request CITY will provide VENDOR with proof of tax-exempt status. SOVEREIGN IMMUNITY. Nothing contained in Agreement nor contained herein shall be considered nor construed to waive CITY's rights and immunities under the common law or Section 768.28, Florida Statutes, as may be amended. BINDING AUTHORITY. Each person signing this Addendum on behalf of either Party individually warrants that he or she has full legal power to execute the Addendum on behalf of the Party for whom he or she is signing, and to bind and obligate such Party with respect to all provisions contained in this Addendum. ATTORNEY'S FEES. In the event that either Party brings suit for enforcement of the Agreement, each Party shall bear its own attorney's fees and court costs. PUBLIC RECORDS. Sealed documents received by the City in response to an invitation are exempt from public records disclosure until thirty (30) days after the opening of the Bid unless the City announces intent to award sooner, in accordance with Florida Statutes 119.07. The City is a public agency subject to Chapter 119, Florida Statutes. The Vendor shall comply with Florida's Public Records Law. Specifically, the Vendor shall: A. Keep and maintain public records required by the City to perform the service; B. Upon request from the City's custodian of public records, provide the City with a copy of the requested records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided in chapter 119, Fla. Stat. or as otherwise provided by law; C. Ensure that public records that are exempt or that are confidential and exempt from public record disclosure requirements are not disclosed except as authorized by law for the 100533394.1 306-9001821 } Piggyback Contract— Trane U.S. Inc. 2 544 duration of the contract term and, following completion of the contract, Vendor shall destroy all copies of such confidential and exempt records remaining in its possession once the Vendor transfers the records in its possession to the City; and D. Upon completion of the contract, Vendor shall transfer to the City, at no cost to the City, all public records in Vendor's possession All records stored electronically by Vendor must be provided to the City, upon request from the City's custodian of public records, in a format that is compatible with the information technology systems of the City. E. IF THE VENDOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE VENDOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS: CITY CLERK OFFICE 100 E. OCEAN AVENUE BOYNTON BEACH, FLORIDA, 33435 561-742-6060 CityCIerk@bbfl.us SCRUTINIZED COMPANIES - 287.135 AND 215.473. By execution of this Agreement, Vendor certifies that Vendor is not participating in a boycott of Israel. The Vendor further certifies that Vendor is not on the Scrutinized Companies that Boycott Israel list, not on the Scrutinized Companies with Activities in Sudan List, and not on the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or has Vendor been engaged in business operations in Syria. Subject to limited exceptions provided in state law, the City will not contract for the provision of goods or services with any scrutinized company referred to above. Submitting a false certification shall be deemed a material breach of contract. The City shall provide notice, in writing, to the Vendor of the City's determination concerning the false certification. The Vendor shall have five (5) days from receipt of notice to refute the false certification allegation. If such false certification is discovered during the active contract term, the Vendor shall have ninety (90) days following receipt of the notice to respond in writing and demonstrate that the determination of false certification was made in error. If the Vendor does not demonstrate that the City's determination of false certification was made in error then the City shall have the right to terminate the contract and seek civil remedies pursuant to Section 287.135, Florida Statutes, as amended from time to time. E -VERIFY. VENDOR certifies that it is aware of and complies with the requirements of Section 448.095, Florida Statutes, as may be amended from time to time and briefly described herein below. 1. Definitions for this Section: A. "Contractor" means a person or entity that has entered or is attempting to enter into a contract with a public employer to provide labor, supplies, or services to such employer in exchange for a salary, wages, or other 100533394.1 306-9001821 } Piggyback Contract— Trane U.S. Inc. 3 545 remuneration. "Contractor" includes, but is not limited to, a vendor or consultant. B. "Subcontractor" means a person or entity that provides labor, supplies, or services to or for a contractor or another subcontractor in exchange for a salary, wages, or other remuneration. C. "E -Verify System" means an Internet -based system operated by the United States Department of Homeland Security that allows participating employers to electronically verify the employment eligibility of newly hired employees. 2. Registration Requirement; Termination: Pursuant to Section 448.095, Florida Statutes, effective January 1, 2021, Contractors, shall register with and use the E -Verify System in order to verify the work authorization status of all newly hired employees. Contractor shall register for and utilize the U.S. Department of Homeland Security's E -Verify System to verify the employment eligibility of - A. All persons employed by a Contractor to perform employment duties within Florida during the term of the contract; and B. All persons (including sub-vendors/sub-consultants/sub-contractors) assigned by Contractor to perform work pursuant to the contract with the City of Boynton Beach. The Contractor acknowledges and agrees that registration and use of the U.S. Department of Homeland Security's E - Verify System during the term of the contract is a condition of the contract with the City of Boynton Beach; and C. The Contractor shall comply with the provisions of Section 448.095, Fla. Stat., "Employment Eligibility," as amended from time to time. This includes, but is not limited to registration and utilization of the E -Verify System to verify the work authorization status of all newly hired employees. Contractor shall also require all subcontractors to provide an affidavit attesting that the subcontractor does not employ, contract with, or subcontract with, an unauthorized alien. The Contractor shall maintain a copy of such affidavit for the duration of the contract. Failure to comply will lead to termination of this Contract, or if a subcontractor knowingly violates the statute, the subcontract must be terminated immediately. Any challenge to termination under this provision must be filed in the Circuit Court no later than twenty (20) calendar days after the date of termination. Termination of this Contract under this Section is not a breach of contract and may not be considered as such. If this contract is terminated for a violation of the statute by the Contractor, the Contractor may not be awarded a public contract for a period of one (1) year after the date of termination. DISPUTES. Any disputes that arise between the parties with respect to the performance of this Agreement, which cannot be resolved through negotiations, shall be submitted to a court of competent jurisdiction in Palm Beach County, Florida. This Agreement shall be construed under Florida Law. 100533394.1 306-9001821 } Piggyback Contract— Trane U.S. Inc. 4 546 EXECUTION OF THE AGREEMENT. This Agreement will take effect once signed by both parties. This Agreement may be signed by the parties in counterparts which together shall constitute one and the same agreement among the parties. A facsimile signature shall constitute an original signature for all purposes. TERMINATION FOR CONVENIENCE. This Agreement may be terminated by the City for convenience, upon fourteen (14) days of written notice by the terminating party to the other party for such termination in which event the Vendor shall be paid its compensation for services performed to the termination date, including services reasonably related to termination. In the event that the Vendor abandons the Agreement or causes it to be terminated, the Vendor shall indemnify the City against loss pertaining to this termination. TERMINATION FOR CAUSE. In addition to all other remedies available to City, this Agreement shall be subject to cancellation by City for cause, should Vendor neglect or fail to perform or observe any of the terms, provisions, conditions, or requirements herein contained, if such neglect or failure shall continue for a period of thirty (30) days after receipt by Vendor of written notice of such neglect or failure. INDEMNIFICATION. Vendor shall indemnify and hold harmless the City, its elected and appointed officers, agents, assigns and employees, consultants, separate Vendors, any of their subcontractors, or sub -subcontractors, from and against claims, demands, or causes of action whatsoever, and the resulting losses, damages, costs and expenses, including but not limited to attorneys' fees, including paralegal expenses, liabilities, damages, orders, judgements, or decrees, sustained by the City arising out of or resulting from (A) Vendor's performance or breach of Agreement, (B) acts or omissions, negligence, recklessness, or intentional wrongful conduct by Vendor's, its agents, employees, subcontractors, participants, and volunteers, and (C) Vendor's failure to take out and maintain insurance as required under this Agreement. Vendor's shall pay all claims and losses in connection therewith and shall investigate and defend all claims, suits or actions of any kind or nature in the name of the City, where applicable including appellate proceedings, and shall pay all costs, judgements, and attorneys' fees which may issue thereon. The obligations of this section shall survive indefinitely regardless of termination of Agreement. LIMITATION OF LIABILITY. Notwithstanding any provision of the Agreement to which it is applicable, City shall not be liable or responsible to Vendor beyond the amount remaining due to Vendor under the Agreement., regardless of whether said liability be based in tort, contract, indemnity or otherwise; and in no event shall City be liable to Vendor for punitive or exemplary damages or for lost profits or consequential damages. INDEPENDENT CONTRACTOR. The Agreement does not create an employee/employer relationship between the Parties. It is the intent of the Parties that Contractor is an independent contractor pursuant to the Agreement and shall not be considered the City's employee for any purpose. COUNTERPARTS AND EXECUTION. This Addendum may be executed by electronic signature or by hand, in multiple originals or counterparts, each of which shall be deemed to be an original and together shall constitute one and the same agreement. Execution and delivery of this {00533394.1 306-9001821 } Piggyback Contract— Trane U.S. Inc. 5 547 Addendum by the Parties shall be legally binding, valid and effective upon delivery of the executed documents to the other Party through facsimile transmission, email, or other electronic delivery. COMPLIANCE WITH LAWS. Vendor hereby warrants and agrees, that at all times material to the Agreement, Vendor shall perform its obligations in compliance with all applicable federal, state, local laws, rules and regulations, including Section 501.171, Florida Statutes. Non- compliance may constitute a material breach of the Agreement. ASSIGNMENT. In the event Agreement, and any interests granted herein shall be assigned, transferred, or otherwise encumbered, under any circumstances by Vendor, Vendor must gain prior written consent from City thirty (30) days before such transfer. For purposes of Agreement, any change of ownership of Company shall constitute an assignment which requires City's approval. Notwithstanding the foregoing, Vendor may, without City's consent, assign this Agreement in whole or in part as part of a corporate reorganization, consolidation, merger or sale of substantially all of its assets related to this Agreement. Vendor shall provide City written notice of any such corporate reorganization, consolidation, merger or sale of substantially all of its assets related to this Agreement within thirty (30) days of such event. AGREEMENT SUBJECT TO FUNDING. The Agreement shall remain in full force and effect only as long as the expenditures provided for in the Agreement have been appropriated by the City Commission of the City of Boynton Beach in the annual budget for each fiscal year of this Agreement, and is subject to termination based on lack of funding. Early termination by City due to loss of funding shall not obligate Vendor to refund any prepaid fees. Section 1. Entire Agreement. The Agreement and this Addendum, and any subsequent amendments or purchase orders signed by the Parties hereto shall constitute the entire understanding of the Parties. Section 2. Severability. If any provision of this Addendum or application thereof to any person or situation shall to any extent, be held invalid or unenforceable, the remainder of this Addendum, and the application of such provisions to persons or situations other than those as to which it shall have been held invalid or unenforceable, shall not be affected thereby, and shall continue in full force and effect, and be enforced to the fullest extent permitted by law. Signature Page to follow 100533394.1 306-9001821 } Piggyback Contract— Trane U.S. Inc. 6 548 IN WITNESS OF THE FOREGOING, the parties have set their hands and seals the day and year first written above. CITY OF BOYNTON BEACH, FLORIDA Daniel Dugger, City Manager Approved as to Form: David N. Tolces, City Attorney Attested/Authenticated: City Clerk TRANE U.S. INC. (Signature), Company Print Name of Authorized Official Title Attest/Authenticated: (Signature), Witness Print Name (Corporate Seal) {00533394.1 306-9001821 } Piggyback Contract— Trane U.S. Inc. 7 549 EXHIBIT A AGREEMENT BETWEEN THE CITY OF RACINE, WI AND TRANE U.S. INC. {00533394.1 306-9001821 } Piggyback Contract— Trane U.S. Inc. 8 550 OMNIA P A R T N E R S NALI PA US COMMUNITIES" HVAC Products, Installation, Labor Based Solutions, and Related Products and Services Executive Summary Lead Agency: Racine County, Wisconsin Solicitation: RC2022-1001 Solicitation Issued: June 15, 2022 Pre -Bid Date: June 29, 2022 Response Due Date: July 21, 2022 Awarded to: Trane U.S. Inc. Racine County, Wisconsin issued IFB #RC2022-1001 on June 15, 2022, to establish a national cooperative contract for HVAC Products, Installation, Labor Based Solutions, and Related Products and Services. The solicitation included cooperative purchasing language in Section II. INSTRUCTION TO BIDDERS, K. National Contract: Subject to its fiduciary and statutory obligations, Racine County, as the Principal Procurement Agency, defined in Attachment D — National Cooperative Contract to be Administered by OMNIA Partners, has partnered with OMNIA Partners, Public Sector ("OMNIA Partners") to make the resultant contract (also known as the "Master Agreement" in materials distributed by OMNIA Partners) from this solicitation available to other public agencies nationally, including state and local governmental entities, public and private primary, secondary and higher education entities, non-profit entities, and agencies for the public benefit ("Public Agencies"), through OMNIA Partners' cooperative purchasing program. Racine County is acting as the contracting agency for any other Public Agency that elects to utilize the resulting Master Agreement. Use of the Master Agreement by any Public Agency is preceded by their registration with OMNIA Partners (a "Participating Public Agency") and by using the Master Agreement, any such Participating Public Agency agrees that it is registered with OMNIA Partners, whether pursuant to the terms of a Master Intergovernmental Cooperative Purchasing Agreement, a form of which is attached hereto on Attachment D — National Cooperative Contract, or as otherwise agreed to. Attachment D — National Cooperative Contract contains additional information about OMNIA Partners and the cooperative purchasing agreement. Notice of the solicitation was sent to potential offerors, as well as advertised in the following: • Racine County website • OMNIA Partners website • USA Today, nationwide • Arizona Business Gazette, AZ • San Bernardino County Sun, CA • Honolulu Star -Advertiser, HI • The Herald -News —Will County (IL) Version July 14, 2022 551 • The Advocate — New Orleans, LA • The New Jersey Herald, NJ • Albany Times Union, NY • Daily Journal of Commerce, OR • The State, SC • Deseret News, UT • Richmond Times -Dispatch, VA • Seattle Daily Journal of Commerce, WA • Houston Community Newspapers, TX • Helena Independent Record, MT • Las Vegas Sun • Kennebec Journal, ME Socio-economic Outreach: To encourage participation of small businesses, minority owned businesses and women owned businesses, Historically Underutilized Businesses were notified of the Invitation to Bid. On Thursday July 21, 2022, bids were received from the following offerors: • Trane U.S. Inc. Trane U.S. Inc. was the lowest responsive, responsible, and qualified bidder based on the requirements issued in the IFB. The County Executive, who was granted authority on January 11, 2022 by the Racine County Commissioners, approved the contract award. The contract was executed on August 17, 2022 with an effective date of September 1, 2022. Contract includes HVAC Products, Installation, Labor Based Solutions, and Related Products and Services. Trane U.S. Inc. can provide products and services covering the following areas: • Operate, Maintain & Repair o Connectivity and Cloud Services o HVAC System Management o HVAC System Repair o Rental Solutions o Parts and Supplies • Energy & Sustainability o Energy conservation Measures o Energy Monitoring & Analysis o Active Energy Management o Financing & Energy Services Contracting • Design, Upgrade & Modernize o Upgrading Existing Equipment o Building Systems Design and Upgrades o HVAC System Retrofits o Indoor Air Quality (IAQ) • Building Systems and Technologies o Variable Refrigerant Flow (VRF) and Ductless Systems o Chillers o Packages Units and Split Systems Version July 14, 2022 552 o Air Handlers, Terminal Devices, Vav and Fan Coils o Variable Frequency Drives (VFD) o Energy Storage o Precision Cooling • Building Management and Automation o Solutions for Large Buildings and Campuses o Small Building Solutions o Air-Fi° Wireless Communications o Lighting Solutions o Controls Solutions for Light Commercial Contractors • Design and Analysis Software Tools Term: • September 1, 2022 to August 31, 2027 with the option to renew for one (1) additional five (5) year period. The anticipated full term of the contract is ten (10) years. Trane U.S. Inc. has the right to enter local "service" agreements with Participating Public Agencies accessing the contract through OMNIA Partners, so long as the effective date of such agreement is prior to the expiration of the Contract. All local agreements may have a full potential term (any combination of initial and renewal periods) subject to the discretion of the Participating Public Agency. Any job orders, project agreements, or maintenance agreements executed against the Master Agreement during the effective term may survive beyond the expiration of the Master Agreement as established and agreed to by both parties. Pricing/Discount: • Bid Form Available Upon Request. Version July 14, 2022 553 Racine County, Wisconsin for HVAC Products, Installation, Labor Based Solutions and Related Product and Services with Trane US Inc. Effective: September 1, 2022 554 The following documents comprise the executed contract between the Racine County, Wisconsin and Trane U.S. Inc., effective September 1, 2022: I. Vendor Contract and Signature Form II. Supplier's Response to the IFB, incorporated by reference 555 DocuSigrrn Envelope ID: 5AB039C2-2DAF-4AIE-9286-D484OC496111 I Racine County s N 6,_ 1' Purchasing Department 730 Wisconsin Avenue Racine, W[ 53403 262-636-3700 fax: 262-636-3763 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS AND RELATED PRODUCT AND SERVICES CONTRACT 2022 This Contract made and entered into this 16th day of August 2022, by and between Racine County, Wisconsin, 730 Wisconsin Avenue, Racine, Wisconsin 53403 (hereinafter referred to as "COUNTY") and Trane U.S. Inc., 800 Beaty Street, Davidson, North Carolina 28036-6924 (hereinafter referred to as "CONTRACTOR"). WITNESSETH: For good and valuable consideration, the parties agree as follows: 1. WORK: CONTRACTOR shall provide HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS AND RELATED PRODUCT AND SERVICES: The undersigned parties understand and agree to comply with and be bound by the entire contents of Sealed Bid # RC2022-1001: HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS AND RELATED PRODUCT AND SERVICES (aka, the Contractor's Bid Proposal submitted July 21, 2022) which is incorporated herein by reference. CONTRACTOR understands and agrees that the bonds and insurance required by the Project Manual are to be kept current at all times through the length of each term and for 90 Days following completion of each term. Bonds and insurance must be renewed and presented to the COUNTY at the time of each renewal term if COUNTY chooses to renew. Bonds and insurance shall be written by a firm acceptable to the COUNTY as specified in the Project Manual. 2. TERM: September 1, 2022, to August 31, 2027, with full renewal of one (1) additional five (5) year term per the Project Manual. COUNTY shall exercise renewal options by issuance and delivery to CONTRACTOR of a written notice to renew this Agreement. 3. PROJECT: HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS AND RELATED PRODUCT AND SERVICES in accordance with the Project Manual. 4. PRICE: Price as stated for all schedules included in the Project Manual. 556 DocuSign Envelope ID: 5AB039C2-2DAF-4AIE-9286-D484OC496111 5. CANCELLATION: This contract may be cancelled without penalty or obligation of any kind, by COUNTY by, for or on behalf of itself or its agencies, departments, officers, agents or employees immediately upon written notice to all parties that sufficient funds have not been budgeted by the County Board of Supervisors to pay the obligations under this agreement. Either party may terminate the contract on the anniversary date in any subsequent year of the contract by providing the other party with written notice ninety (90) days prior to the anniversary date. If the CONTRACTOR fails to maintain and keep in force required insurance, COUNTY shall have the right to cancel and terminate the contract without notice. Notwithstanding any of the terms and conditions contained herein, the COUNTY and CONTRACTOR reserve the right to terminate the contract at any time for any reason by providing written notice of termination to the other party no less than ninety (90) days in advance of termination. In the event of said termination, CONTRACTOR shall not reduce its activities hereunder unless agreed in advance by COUNTY. The CONTRACTOR will pay according to the contract for services tendered through the date of termination. RACINE COUNTY DocuSigned by: L�'"d cuSigned by: BY: ,�4� Vt u" 8/17/2022 BY: �. ('1hrF 8/17/2022 D�y ocuSigned�by:: � L � pDocuSigned by: BY: Wt,l�t/�� 'SIw&StA& 8/17/2022 BY: k—'em "��`b�'�w 8/16/2022 Trane U13Ssgng6y. BY: V ' "'0 spt,ln'Gv 8/16/2022 557 DocuSign Envelope ID: F348908E-7A95-44F8-BEI2-68B5ABA30B2B Racine County Contract & Contract Amendment Form Attach one copy of the contract to be filed. Attach more copies if required by vendor. Munis Contract #: 3341 Amendment: 6 Yes ❑ No Signed by vendor: F Yes ❑ No ❑ DocuSign Contract Type ❑ Non Encumber Expense ❑ Encumber Expense ❑ HSD PO Expense d Revenue Vendor/Customer#: 3931-2 Vendor Name: TRANE US INC Full Address: 800 E BEATY ST DAVIDSON NC 28036 Department: FIN Sub Department: Brief Description of Services: AMENDMENT BID #RC2022-1001 HVAC PRODUCTS, INSTALLATION Contact/administrator: Duane McKinney Contact Munis ID: 6750dmcklnne Contract Start: 09/01/2022 Contract End: 08/31/2027 If this is a multi year contract - Committee and County Board authorization is needed before the contract can be processed. By completing this form, Procurement Policy has been followed. Accounts Information Account Name: Account Number Amended Amount New Contract Amount Year 13500000.311045 22-27 If additional account lines are necessary, attach a schedule. Total: $ 0.00 - Have you read the agreement: 19 Yes ❑ No Do you understand & agree with the Terms: Yes ❑ No Are there things that you think should be changed in this Contract: ❑ Yes F No If yes, please attach a memo stating the changes you think should be made. Was a resolution passed to authorize the original contract: ❑ Yes F No If yes, indicate the resolution number: 2021-96 (attach a copy of the resolution) Is there a required signature date: ❑ Yes ❑ No If yes, what date: corp Counsel Stamp: County Clerk Stamp: Upon complete execution of this contract, an original copy must be placed on file with the County Clerk along with this cover sheet. 558 This form is to be printed on Pastel Yellow paper. updated 111320 BE DocuSign Envelope ID: F348908E-7A95-44F8-BE12-68135ABA30132B HVAC Products, Installation, Labor Based Solutions and Related Product and Services Contract 2022 AMENDMENT NO. ONE (1) This Amendment No. One (1) is effective January 1, 2023 and is to modify the HVAC Products, Installation, Labor Based Solutions and Related Product and Services Contract 2022 agreed upon by Racine County, Wisconsin, 730 Wisconsin Avenue, Racine, Wisconsin 53403 ("County") and Trane U.S. Inc., 800 Beaty Street, Davidson, North Carolina 28036-6924 ("Contractor") (hereinafter each a "Party" and collectively referred to as "Parties") on August 16, 2022 ("Contract"). The Parties hereby agree to amend the Contract as follows: 1. WORK: To modify pricing as necessary to account for market changes, and labor and material increases.. Details are provided in Attachment A of this Amendment No. 1. 2. PRICE: The County agrees to the revised prices. Details are located in Attachment A. ALL OTHER PROVISIONS OF THE CONTRACT SHALL REMAIN IN THEIR ENTIRETY. RACI N E QUNI : BY: Vt,(,ar Jonathan Delagrave Racine County Executive 1/6/2023 DATE: --DocuSigned by: BY: wUA, (,6Sft,ln SUA, SY3MB'Mistensen Racine County Clerk DATE: 1/6/2023 DocuSigned by: TRANE U.S. INC. Q BY: "' �d SPun'Gt,V' DATE: EDocuSigned by: 1 l(,r�t ald ta"JhV F 36 F9231CFBA8401... 1/5/2023 E�j DocuSigned by: 14A5552654004D4... 12/21/2022 HVAC PRODUCTS, INSTALLATION, LABOR BASED SOLUTIONS AND RELATED Page 1 of 14 PRODUCT AND SERVICES CONTRACT 2022 559 Public Hearing 6 P.M. or as soon thereafter as the agenda permits. The City Commission will conduct these public hearings in its dual capacity as Local Planning Agency and City Commission. 08/1/2023 City of Boynton Beach Agenda Item Request Form Commission Meeting Date: 08/ 1/2023 Proposed Ordinance No. 23-014- Second Reading- Environmental Protection Standards Land Development Regulation Amendment (CDRV 23-005). Requested Action by Commission: Approve modifications (CDRV 23-005) amending Part III. Land Development Regulations, Chapter 2, Article II, Section 5. Permit Applications and Chapter 4, Article I. Environmental Protection Standards, to create a landscape permit review and approval process and to modify preservation and mitigation regulations. Explanation of Request: The City's current Land Development Regulations (LDRs) does not include a procedure for removal of trees or palms nor does it provide mitigation options for replacement, with the exception replacing the tree caliper. The proposed amendments establish the procedure, submittal requirements and review criteria for the Landscape Permit application to remove or replace existing trees and palms. The amendment also proposes to update the City's tree preservation code to contain two additional replacement options for trees and palms including the canopy coverage method and a pay -in lieu of planting method. The additional options allow the City to require mitigation of trees that are removed without approval (canopy replacement) and to allow for infeasible plantings to be supplied in the form of a payment into the Tree Trust Fund. Contributions into this fund can be used to plant trees and palms for City projects. The amendments are designed for the City to create extensive sustainable green infrastructure by promoting tree and palm preservation. The proposed amendments were approved at the Planning & Development Board on June 27th, 2023. How will this affect city programs or services? N/A Fiscal Impact: N/A Attachments: LDR Amendment (Ch 2, and Ch 4) (Permit process and Environmental)(2nd read)- Ordinance.pdf Staff Report.pdf CDRV 23-005 Text Amendment 560 CDRV 23-005 Staff Presentation 561 I 2 ORDINANCE NO. 23-014 3 4 5 AN ORDINANCE OF THE CITY OF BOYNTON BEACH, FLORIDA AMENDING 6 THE LAND DEVELOPMENT REGULATIONS, CHAPTER 2, ARTICLE II, SECTION 7 S. PERMIT APPLICATIONS AND AMENDING CHAPTER 4, ARTICLE I. 8 ENVIRONMENTAL PROTECTION STANDARDS, TO CREATE A LANDSCAPE 9 PERMIT REVIEW AND APPROVAL PROCESS AND TO MODIFY PRESERVATION 10 AND MITIGATION REGULATIONS; PROVIDING FOR CONFLICTS, 11 SEVERABILITY, CODIFICATION AND AN EFFECTIVE DATE. 12 13 14 WHEREAS, the City's current Land Development Regulations (LDR) do not include a 15 procedure for tree and palm removal nor does it provide mitigation options for replacement with 16 the exception replacing the tree caliper; and 17 WHEREAS, the proposed amendments establish the procedure, submittal requirements 18 and review criteria for the Landscape Permit application to modify the existing trees or palms; and 19 WHEREAS, the amendment also proposes to update the City's tree preservation code to 20 contain different replacement options for tree(s) or palm(s) that are removed or to be removed; 21 and 22 WHEREAS, these amendments are designed for the city to create extensive sustainable 23 green infrastructure by promoting tree and palm preservation; and 24 WHEREAS, the City Commission of the City of Boynton Beach has considered the 25 recommendations and has determined that it is in the best interest of the citizens and residents of 26 the City of Boynton Beach, Florida to approve the amendments to the Land Development 27 Regulations as contained herein. 28 NOW THEREFORE, BE IT ORDAINED BY THE CITY COMMISSION OF THE CITY OF 29 BOYNTON BEACH, FLORIDA, THAT: 30 Section 1. The foregoing whereas clauses are true and correct and are now ratified and 31 confirmed by the City Commission. 32 Section 2. City of Boynton Beach Land Development Regulations, Chapter 2, Article II, 33 Section 5. Permit Applications is hereby amended as follows: S:ACA\Ordinances\LDR Changes\LDR Amendment (Ch 2, And Ch 4) (Permit Process And Environmental)(2nd Read)- Ordinance.Doex 562 34 CHAPTER 2. LAND DEVELOPMENT PROCESS 35 36 ARTICLE II. PLANNING AND ZONING DIVISION SERVICES 37 38 Sec. 5. Permit Applications. 39 40 B. Zoning Permit. 41 1. General. 42 a. Purpose and Intent. The purpose and intent of this subsection is to set forth a well - 43 defined application process, review criteria, and uniform procedure for the processing of zoning 44 permits and zoning verification letters, to ensure that certain structures and site improvements 45 comply with the respective requirements and standards described in these Land Development 46 Regulations and the city's Code of Ordinances. 47 b. Applicability. A permit, issued by the Planning and Zoning Division, shall be required 48 for accessory structures and site improvements proposed on any parcel or development unless 49 otherwise specified herein. The following types of requests or improvements do not require a 50 building permit but do require a zoning permit or zoning verification. Such improvements or 51 requests include but are not limited to the following: 52 (1) Accessory structures, limited to a maximum of one (1) open air structure or gazebo 53 less than one hundred (100) square feet and used in connection with a principal residential 54 dwelling or use. Chickee huts are exempt from the above size limitation; 55 (2) Animal enclosures; 56 (3) Fences on residential property (single-family; two-family; and single-family attached 57 if fee -simple ownership) with a maximum height of six (6) feet; unless used as a barrier around a 58 swimming pool, spa, or rooftop equipment; 59 (4) Impervious surfaces that are unenclosed and uncovered, including but not limited to 60 driveways, patios, steps, stoops, terraces, sidewalks, and the like, regardless of proposed surface 61 materials (e.g., pavers, asphalt, concrete, etc.). 62 The zoning permit shall not be applicable to new impervious surfaces and improvements 63 normally administered by other Divisions in the city, such as by the Engineering or Building 64 Divisions. A land development permit (LDP) from the Engineering Division shall be required in 65 lieu of a zoning permit for any proposed driveway, patio, terrace, sidewalk, or the like in excess of 66 eight hundred (800) square feet. Impervious surfaces or improvements that would require a 67 building permit (in lieu of a zoning permit) include reinforced concrete pads connecting with 2 S:ACA\Ordinances\LDR Changes\LDR Amendment (Ch 2, And Ch 4) (Permit Process And Environmental)(2nd Read)- Ordinance.Doex 563 68 existing buildings to be used as a slab for future building additions; required handicapped 69 accessible routes; framed decking improvements; or other similar improvements. 70 It should be noted that any proposed impervious surface and/or site improvement that 71 decreases permeable land area in excess of eight hundred (800) square feet on any given parcel 72 in the city shall be reviewed for compliance with the drainage standards of Chapter 4, Article VIII, 73 Section 3.G:, and/or the Engineering Design Handbook and Construction Standards. This review 74 requires the submittal of a drainage plan prepared by a licensed professional engineer based on 75 the design standards referenced above. 76 (5) Community gardens. See site plan review (Section 2.F. above) for community 77 gardens containing storage and/or agricultural structures that are greater than one hundred 78 (100) square feet. All agricultural structures and storage structures greater than one hundred 79 (100) square feet shall require approval of a building permit in accordance with Chapter 2, Article 80 IV, Section 2. 81 c. Compliance with Florida Building Code. Any proposed structure or improvement that 82 includes an electrical, plumbing, or other similar component which is subject to compliance with 83 the Florida Building Code, shall require a building permit, and the review for such improvement 84 that would have been conducted as part of the zoning permit process, will alternatively occur as 85 part of the review for the building permit. See Chapter 2, Article IV for additional regulations 86 regarding the building permit review process and procedures. 87 2. Submittal Requirements. See Section 1.D. above for the submittal requirements of this 88 application. 89 3. Review Criteria. Each structure or improvement shall comply with the following: 1) all 90 zoning requirements of Chapter 3, including the supplemental regulations of Article V; 2) all 91 applicable site development standards described in Chapter 4; and 3) the applicable regulations 92 of City Code of Ordinances Part II. Notwithstanding compliance with the aforementioned 93 regulations and standards, their specific provisions are referenced as follows: 94 a. Fences. Chapter 3, Article V, Section 2; 95 b. Arbors, trellises, and pergolas. Chapter 3, Article V, Section 3.F.; 96 c. Open air structures and gazebos. Chapter 3, Article V, Section 3.G.; 97 d. Permanent sheds and storage structures. Chapter 3, Article V, Section 3.E.1.; 98 e. Decks, patios, steps, stoops, and terraces (unenclosed and uncovered). Chapter 3, 99 Article V, Section 3.B.; 100 f. Animal enclosure. City Code of Ordinances Part II, Chapter 4, Section 4-4; and 101 g. Driveways for single-family and duplex dwellings. Chapter 4, Article V, Section 2.B. 3 S:ACA\Ordinances\LDR Changes\LDR Amendment (Ch 2, And Ch 4) (Permit Process And Environmental)(2nd Read)- Ordinance.Docx 564 102 4. Approval Process. The application shall be reviewed by staff and action will be taken by 103 the appropriate administrative official. 104 5. Expiration. A zoning permit is valid for a period not to exceed six (6) months from the 105 date of issuance. If construction of the improvement covered by the zoning permit has not 106 commenced within this time period, the permit shall expire and be cancelled with written notice 107 to the applicant. 108 6. Time Extension. An extension of the permit for a period not to exceed ninety (90) days 109 may be requested in writing by the applicant if received by the Division prior to permit 110 expiration. The- fee fer requesting a peFFRit exten-sie—n Shall be appreved by the City Cemmissien 111 and Fnay be .,,, �;�,, ,� frem time to tinz - 112 113 C. Landscape Permit 114 1. General. 115 a. Purpose and Intent. 116 The purpose of this subsection is to set forth uniform procedures, application 117 processes, and information to guide modification to the existing trees, palms, or 118 vegetation located on a property. 119 b. Administration. 120 The Director of Planning and Zoning or designee shall have the authority to interpret 121 and administer this subsection. 122 c. Applicability. 123 Removal, relocation, replacement, or substantial alteration of a tree with a caliper of 124 three (3) inches or greater and a palm with a clear wood of six (6) feet or greater are 125 required to obtain a Landscape Permit, except for exemptions provided below. 126 2. Exemptions. 127 This provision set forth in this subsection shall not apply to the following; 128 a. Single -Family Homes and Duplexes 129 Individually platted lots containing single-family homes or duplexes located within 130 residential zoning districts are exempt, provided that they do not have a plan approved 131 under review of Part III, Chapter 4, Article I and II, or they do not contain specimen 132 trees. A specimen tree is protected in accordance with Chapter 4, Article I, Section 4.13. 133 Preservation Efforts; 134 b. Community Gardens M S:ACA\Ordinances\LDR Changes\LDR Amendment (Ch 2, And Ch 4) (Permit Process And Environmental)(2nd Read)- Ordinance.Docx 565 135 Fruits, vegetables, nuts, and herbs that are planted and growing in a community garden, 136 which is approved by the Citi 137 c. Licensed plant nurseries or tree farms 138 All licensed plant or tree nurseries or tree farms shall be exempt from this subsection 139 only in relation to those plants that are planted and growing on the premises for the 140 sale to the public in the ordinary course of such business; 141 J. Emergencies. 142 The provisions of this article may be waived by the Director of Planning and Zoning or 143 designee during a period of emergency, such as during a hurricane, tropical storm, 144 flood, or any other Act of God; and 145 e. City -owned and operated facilities excluding rights-of-way 146 3. Public Utility Agencies. 147 Public utility agencies may be authorized to remove or trim existing trees or palms that 148 interfere with infrastructure located within easements or rights-of-way, or which 149 otherwise endanger the safety and welfare of the public, without obtaining a landscape 150 permit. However, if the plant material was part of the approved plan, the responsible 151 party or property owner will be required to mitigate removal of the plant material. Trees 152 or palms that are removed or damaged by a public utility agency shall be replaced with 153 comparable material and provided on a tree -for -tree or palm -for -palm basis, as 154 applicable. 155 4. Hazardous and Diseased Trees and Palms. 156 Hazardous and diseased trees and palms may be removed under the supervision of an 157 arborist certified by the International Society of Arboriculture or a Florida licensed 158 landscape architect. The Director of Planning and Zoning or designee shall be notified by 159 the arborist or landscape architect with a condition assessment report and photos prior 160 to removal. Comparable replacement of such trees and palms shall be provided on a tree - 161 for -tree or palm -for -palm basis, as applicable, unless waived by the Director of Planning 162 and Zoning or designee. 163 5. Removal of Invasive Species. 164 Removal of invasive species, as defined in Part III, Chapter 4, Article I, shall be approved 165 with a Landscape Permit, and replacements of such removal are not required. If the 166 invasive species were previouslyapproved as part of or contribution to a landscape plan, 167 or otherwise to comply with the standards of Part III, Chapter 4, Article II, removal of such 168 species shall be replaced on a one-for-one basis. 169 6. Review Criteria. A permit shall comply with the followi S:ACA\Ordinances\LDR Changes\LDR Amendment (Ch 2, And Ch 4) (Permit Process And Environmental)(2nd Read)- Ordinance.Docx 566 170 a. Consistency with characters and materials of the approved master plan or site plan; 171 b. Requirements of the zoning district regulations of Chapter 3, Article III; 172 c. Environmental Protection Standards set forth in Chapter 4, Article I; and 173 d. Landscape Design and Buffering Standards set forth in Chapter 4, Article II. 174 7. Submittal Requirements. 175 See Chapter 2, Article II, Section 1.D for the submittal requirements of this application. 176 8. Approval. 177 The Director of Planning and Zoning or designee shall review a complete application, 178 including submittals, and take action based on the review criteria set forth in this 179 subsection. A Landscape Permit shall be approved upon finding that all applicable 180 standards defined in the Land Development Regulations are met. 181 A Landscape Permit shall be approved after issuance of a Building Permit associated with 182 the site plan and corresponding landscape plan, if applicable. 183 9. Expiration. 184 Approval of a Landscape Permit is valid for a period not to exceed six (6) months from the 185 date of issuance. If the scope of work covered by this permit is not commenced within 186 this time period, the permit shall expire and be automatically cancelled. 187 10. Time Extension. 188 An extension of the permit for a period not to exceed ninety (90) days may be requested 189 in writing by the applicant if received by the Division prior to the permit expiration. 190 191 192 193 Section 3. City of Boynton Beach Land Development Regulations, Chapter 4, Site 194 Development Standards, Article I. Environmental Protection Standards is hereby amended as 195 follows: 196 CHAPTER 4. SITE DEVELOPMENT STANDARDS 197 ... 198 ARTICLE I. ENVIRONMENTAL PROTECTION STANDARDS 199 200 6 S:ACA\Ordinances\LDR Changes\LDR Amendment (Ch 2, And Ch 4) (Permit Process And Environmental)(2nd Read)- Ordinance.Docx 567 201 Sec. 1. General. 202 A. Short Title. This article shall be known and may be cited as the "City Tree Preservation 203 Ordinance." 204 B. Purpose and Intent. The city recognizes the inherent value of trees and other plant material. 205 Healthy vegetation aids in reducing destructive environmental factors to real property, such as 206 wind, noise, and the potential for erosion to the city's soils and beaches. Trees and shrubs 207 contribute towards energy conservation and management by producing oxygen and absorbing 208 carbon dioxide. They have a positive effect ion surface drainage, and help to provide a beautiful 209 and aesthetic environment for residents, businesses, and visitors. The purpose and intent of these 210 Regulations, therefore, is to promote the health, safety, and welfare of the community by 211 establishing rules and regulations governing the protection of trees and vegetation, in 212 conjunction with encouraging the installation and/or proliferation of healthy trees +nand 213fps Ip ants a*din appropriate locations and quantities. 214 C. Administration. The Director of Planning and Zoning or designee shall have the authority to 215 interpret and administer this article. 216 D. Applicability. The provisions of this article shall apply to a4a real property in the Eity that is 217 intended for development or redevelopment, and when c, Eh tree for removal activity that is 218 initiated by the property owner or agent thereof. 219 E. Exemptions. 220 fellewi - The provisions of this article shall not apply to the exemptions identified in Part III. 221 Chapter 2, Article II, Section 5.C.2. Exemptions. 222 223 224 225 . 226 helew 227 2. Community Garden. All fruffits, vegetables, nuts, and her -hs; shall he exempt frern the 228 ffevisiens ef this with FespeEt te these that are planted and grewing en the ffefflises in 229 230 . 231 3. Nurseries and Tree Farm_,;. All liEensed plant er tree nurseries E)F tFee far.m.s sh-all 232 exempt freng the pFevisiens of this aFtiEle E)nly in Felation te these tFees planted and g 233 234 iptepded c -la to the geReFal p blit iR the eFd*1' aFy ce Arco of such b sires 235 4. Public Utility Agepr_-Yes. P-_,_h1*r_- utility ageRGiP_r_ aFP_ al—IthA—FiZed— te Irelmleve er trim exiStiRg 236 S:ACA\Ordinances\LDR Changes\LDR Amendment (Ch 2, And Ch 4) (Permit Process And Environmental)(2nd Read)- Ordinance.Docx 568 .r_E91r_er-r_r_M:r_WWr-eVEM.PMEMS esrOMP-P.P.MnP-9 � P.M�- - -er_� 239 240 , fleed 241 of Ged. 242 5. _er_.,- - .. 245 F. Terms and Definitions. See Chapter 1, Article II for all applicable terms and definitions which 246 pertain to the regulations and standards contained herein. 247 G. Conflict. Whenever the regulations and requirements of this Code conflict with any other 248 lawfully enacted and adopted rules, regulations, ordinances, or laws, the most restrictive shall 249 apply, unless otherwise stated herein. 250 Sec. 2. City Approval Required. 251 No plant material or vegetation shall be cut down, moved or removed, destroyed or effectively 252 damaged without first securing the necessary-(�City approvals-a*d 253 peffflits as previded hereundeF, e)(Eept on instaREes when exempt fFeFn these Regulations in 254 aEEeFdaAEe with SeE ieR 1.E. above. The following processes and permits shall be available to 255 ensure that all EleaFiRg and gF bbing aforementioned activities comply with the standards of this 256 article:. 257 A. Private Property and Public Lands. The property owner or agent shall file the following 258 applications prior to commencement of any of the aforementioned EleaFiRg and grybbiRg 259 activities as applicable: 260 1. Site Plan Review. 261 ExEept for iRdividually platted lets rCeRtaining single family and duplex herner- le-cated- within 262 single -family and +w e family residential z g dim-, „-+�, +The site plan review process shall be 263 required and reviewed in accordance with the procedures set forth in Chapter 2, Article II, Section 264 2.F. r F +„ the *,-;,-;----;;Ar--P- of any IaR d development permit. For the purpose of this subsection, the 265 term "site plan" is construed to include master site plan and technical site plan applications, and 266 to ultimately mean landscape plan review and approval. T#e 267 City FGFeste. ma, , equi, e the submitt-;;I A -f -;; Up -e suwey, tFee management plan, Native PlArid;; 268 , 269 270 pFeseFvatieR eff„r+5; of c„rtieR z R b e*,, 271 272 S:ACA\Ordinances\LDR Changes\LDR Amendment (Ch 2, And Ch 4) (Permit Process And Environmental)(2nd Read)- Ordinance.Docx 569 273 2. Land Development Permit. 274 275 276 .The ILand dDevelopment Permit application shall be PFeEe&seddL quired 277 and reviewed in accordance with the procedures set forth in Chapter 2, Article III, Section 3. T#e 278 City FeFesteF Fnay Fequire the submittal ef a tFee suwey, tFee n9anagement plan, Native FleFida 279 280 , when determined neEessary te identify speEimen trees OF te ensuFe cemplianee with 281 the p a+,^h ^ffA_4S .,f c^, -+;^r _ Q bele..,. The issuance of a land development permit shall 282 not relieve any party from obtaining the necessary permits, which may be required by the various 283 federal, state, or local government agencies, 284 3. Landscape Permit. 285 A Landscape Permit shall be required and reviewed in accordance with the procedure set forth in 286 Chapter 2, Article II, Section S.C. 287 B. Gty Right -5 -of -Way Permit. 288 A (Right-of-wWay Permit application shall be required and reviewed 289 ^I-,nt ..,.,ate ial 46m a Eity Fight ef way in accordance with the procedures set forth in 290 Chapter 2, Article III, Section 4. The -City; )FesteF may req iFe the submittal of a +r^^ ,-„r.,^., +r^^ 291 management plan, Native FleFida Resystem Survey er inventery, er a Eembinatien thereef, as 292 paFt ef the Eity right ef way peFFnit appliEatien, when determined neEessaFy te identify speEingeig 293 tFees .,r to eRSU Fe c-ernpiany +h the . FeseFvat* , effA—Fts ef. C.,.- iA. A. R. R be! ow. 294 Sec. 3. Preservation Principles. 295 A. High Ecological Importance. Areas that are considered to be of high ecological importance 296 should be given the highest priority for protection. These areas include but are not limited to the 297 following: 1) have occurrences of federal and state listed species of flora and fauna; 2) have 298 biological diversity; 3) are located in aquifer recharge zones; and 4) are known to provide habitat 299 for inhabit threatened and endangered species of fauna and flora. Therefore, the 300 natural areas shall be protected as f T, 301 B. Easements and Rights -of -Way. Utilities, stormwater easements, and rights-of-way should 302 avoid preserved areas. 303 C. Contiguity. Areas set aside for preservation should be contiguous parcels of land that are 304 interconnected and considered viable habitat for wildlife to the extent practical. Small 305 fragmented areas of preservation should be avoided when possible. 306 Sec. 4. Standards. 307 The following standards shall be considered in order to ensure the protection of existing 308 vegetation: S:ACA\Ordinances\LDR Changes\LDR Amendment (Ch 2, And Ch 4) (Permit Process And Environmental)(2nd Read)- Ordinance.Docx 570 309 A. General. All proposed developments shall be designed to preserve, perpetuate, and 310 improve the existing natural character of the site. Existing native trees and other landscape 311 features shall, to the maximum extent possible, be preserved in their natural state; and additional 312 landscape features shall be provided to enhance architectural features, to relate structural design 313 to the site, and to conceal unattractive uses. In all instances the -ECity's landscaping requirements 314 and all other applicable regulations shall be fully complied with as minimum standards. Ne tree 315 shall be Femeyed fFem aRy Effity pMpeFty, lands, publiE paFlE, er any aFeas within a Eity Fight E)f 316 pt in aEEeFdaREe with the PFeYi5ieR5of this aFtkl. 317 High-quality areas placed in preservation shall be retained in entirety in their current or 318 improved natural state, and protected iR perpetuffity regardless of ownership. This requirement 319 may be negotiated to create contiguous preserva4&Res among plant communities. During the 320 site plan review process, the applicant shall be required to prove that the highest ecologically 321 valued land is being retained first. If the preservation of the highest ecologically valued land 322 pFeduees U Rd,-^ bi-ird^n ^n the deeey.,1l.Y,. epA renders infeasibility of the site development, it shall 323 be the applicant's responsibility to prove such hardship and provide an acceptable alternative for 324 approval. 325 Rights-of-way and areas determined to be future rights-of-way in the Comprehensive Plan 326 and utility or drainage easements shall not be allowed as designated set-aside areas for 327 preservation purposes. 328 B. Preservation Efforts. 329 1. Beach Dunes. The natural vegetative cover on beach dunes shall be preserved in an 330 undisturbed state of growth as a fragile ecosystem. No beach dune vegetation, grass, sea grape, 331 and tree development shall be altered, removed, or changed except in accordance with federal, 332 state, county, and local regulations. 333 2. Mangrove Areas. Well-documented scientific research has established that mangrove 334 areas are the ecological base of the biological food chain for many important species, including 335 some species of fish that are important for sport and commercial fishing. Mangrove trees, which 336 are of considerable aesthetic value, also serve as protection against storm surgeas well and 337 provide a habitat/shelter for birds and other wildlife. For these reasons, land development and 338 construction thereon, shall be conserved to the maximum extent possible and only altered in 339 accordance with federal, state, county, and local regulations. 340 3. Specimen Tree Designation. The Director of DevelopmentPlanning and Zoning may, by 341 written request to the City Manager, recommend from time to time the official designation of 342 certain trees located within the city as specimen trees. If the City Manager approves such 343 recommendation, the matter shall be presented to the City Commission for final determination. 344 The city shall notify by Eertifieel mail the affected property owner of the proposed hearing 345 certified mail. The City Commission shall accept, modify or deny the staff recommendation. Any 346 proposal to remove a specimen tree shall be mitigated in accordance with Sectien 242. belev.f this 347 Article. io S:ACA\Ordinances\LDR Changes\LDR Amendment (Ch 2, And Ch 4) (Permit Process And Environmental)(2nd Read)- Ordinance.Docx 571 348 4. Environmentally Sensitive Lands. 349 a. General. The purpose and intent of this section is to preserve and protect the values and 350 functions of environmentally sensitive lands from alterations that would result in the loss of these 351 lands or significant degradation of their values and functions. 352 b. Applicability. This subsection applies to all properties that contain environmentally 353 sensitive lands with an "A", "B", or "C" rating as pursuant to Table 22 of the Conservation Element 354 of the Comprehensive Plan. 355 c. Standards. The following standards shall promote the preservation of natural resource 356 sites: 357 (1) If the property proposed for development is greater than ten (10) acres, or is a 358 portion of a larger tract containing ten (10) or more acres of environmentally sensitive lands 359 designated as an "A" rated site, the developer shall be required to preserve a minimum of 360 twenty-five percent (25%) of all native plant communities on the site in one (1) unified preserve. 361 Habitats shall be preserved with intact canopy, understory and ground cover. 362 (2) If the property proposed for development is greater than ten (10) acres and has been 363 designated as a "B" or "C" rated site, the developer shall be required to preserve a minimum of 364 twenty-five percent (25%) of all native plant communities on the site. The preserve areas may be 365 separated into micro preserves. Habitats shall be preserved with intact canopy, understory and 366 ground cover. 367 (3) Natural re-se-urc-se sites identified *A Table 2 Of thP- Q)RservatiE)R EIP-MeRt A -f thP- 368 CempreheRsive Plap aAd- that exe-eeds teR (10) acres shall be sul�eGt te the tweRty-five pereeRt 369 (25%) preserve area set aside subdivide., int^ smaller ricer+c 370 (43) The specific location of the preservation area shall be determined during the review 371 of a master plan or site plan. If no master plan or site plan is required, then such determination 372 shall occur during the review of the prepesed The ultimate area to be preserved shall be 373 indicated on the approved plan mor any corresponding plat. In determining the most 374 appropriate location for the preserve area within the site, the city shall consider factors, which 375 include, but are not limited to the following: proximity of the preserve area to developed and 376 undeveloped property; potential for immediate or future consolidation with environmentally 377 sensitive lands on abutting properties; ability to maintain the preserve area based upon 378 surrounding development and land uses; and the recommendations of staff or any consultants 379 retained by the city. The preserve area shall be maintained in accordance with 380 pFeseFye aFea management p!3- the Conservation Element of the Comprehensive Plan. 381 C. Mitigation of Existing Trees and PalmsrTable ^-1 MitigatieR of Exist*Rg Tro. All existing 382 trees and palms that are not preserved in place or relocated on-site shall be Mitigated 383 384 he based &A aline" dimeRsieR „r type „f tFee mitigated by replacement on-site or payment in - 385 lieu of replacement as indicated in the table he this subsection. The replacement shall be S:ACA\Ordinances\LDR Changes\LDR Amendment (Ch 2, And Ch 4) (Permit Process And Environmental)(2nd Read)- Ordinance.Docx 572 386 provided on-site as indicated in the tables below and comply with the standards defined in Part 387 III, Chapter 4, Article II. Landscape Design and Buffering Standards. 388 1. Replacement. 389 The equivalent replacement for existing trees shall be based on caliper dimension or types of 390 trees based on the condition rating as indicated in the table below. The replacement for existing 391 palms shall be provided on-site as indicated in the table below. 392 393 394 Table 4-1-a Replacement 395 1. Large palms tFees are those species, such as Florida Royal, Canary Island Date, or any 396 other palm species determined by staff, to provide similar or greater shading Eempared 397 te a Eanepy tFee. 398 z, The cumulative caliper inches of existing trees to be removed shall be replaced on-site 399 with an equal or greater number of caliper inches of a replacement tree or trees. 12 S:ACA\Ordinances\LDR Changes\LDR Amendment (Ch 2, And Ch 4) (Permit Process And Environmental)(2nd Read)- Ordinance.Docx 573 400 401 3A ElkisteF E)f thFee (3) small or Fnediung size paing tFees shall be the equivalent 402 403 404 EOR9R9E)R ngathengatoEal Fule ef reunding shall be used when tabulating p 405 406 ° 407 substit-Ae , With palm spec Trees and palms proposed for replacement shall be 408 comparable or same species to the maximum extent possible. Replacement trees for 409 mitigation shall not be substituted by palms; however, replacement of palms for 410 mitigation may be substituted by trees. 411 4. Condition rating shall be determined by an arborist certified by the International Society 412 of Arboriculture or a Florida licensed landscape architect. 413 2. Canopy Replacement. 414 If trees or balms are removed before obtaining approval of a Landscape Permit and calipers of 415 removed trees cannot be determined from any remnants, the number of required replacement 416 trees and palms shall be calculated based on the removed canopy areas in square feet (sq. ft.) 417 determined by using aerial photography; photos; or review of a tree survey. Replacement canopy 418 area credit shall equal the canopy area removed, as provided in the table below. 419 420 Table 4-1-b Canopy Replacement Replacement Type Replacement Canopy Area Credit Tree that spreads a least 30 feet in diameter at maturity 200 sq. ft. Tree that spreads less than 30 feet in diameter at maturity 120 sq. ft. Lar e canopalm 100 sq. ft. Small canopy palm 60 sq. ft. 3. Payment In -Lieu of Replacement. 421 Upon determinina that replacement of removed or to -be -removed trees or palms is not feasible 422 due to the lack of available planting space, the Director of Planning and Zoning may allow the 423 applicant to meet all or part of the replacement for tree or palm by paying into the Tree Canopy 424 Trust Fund an amount of money according to the payment in -lieu schedule set by the City 425 Commission by resolution. The Tree Trust Fund shall be utilized to plant trees and palms, in 426 accordance with the standards in Part III, Chapter 4, Article II. Landscape Design and Buffering 427 Standards, associated with City projects or City Capital Improvement Projects. 428 429 D. Forestry Practices and Procedures. 13 S:ACA\Ordinances\LDR Changes\LDR Amendment (Ch 2, And Ch 4) (Permit Process And Environmental)(2nd Read)- Ordinance.Docx 574 430 1. General. The Director of Planning and Zoning or designee shall use the "Urban 431 Forestry Manual (L) TFees and Cei=154 +;^^", United States Department of Agriculture Forest 432 Service, 200§6 edition or latest supplement thereof as the arboricultural standard when 433 determining which forestry practice or procedure to apply when reviewing the following types of 434 activities: 1) any proposal to relocate, replace, or remove trees that are subject to the standards 435 and permitting processes of this article; 2) any proposal where the grade of the site is to be 436 raised or lowered around an existing plant; 3) where ditching for utilities, foundations, swimming 437 pools, driveways or the like will severely cut root systems; 4) where large paved areas will delete 438 the water supply and aeration necessary for the life of the tree or shrub; or 5) where a change in 439 the grade or drainage of development will seriously harm natural areas to be retained. 440 2. Land Clearing and Construction. 441 a. Vegetation that is set aside for preservation shall be protected from all on-site 442 construction. During the land clearing and construction stage of development, the developer 443 shall erect and maintain protective barriers (to city requirements consistent with best 444 management practices) around all trees or groups of trees to be protected. The developer shall 445 not allow the movement of equipment or the storage of equipment, materials, debris or fill to be 446 placed within the protective barrier. Removal or re -grading of soils within preservation areas is 447 prohibited. Any damaged vegetation located within the set-aside areas shall be replaced wit# 448 vegetatien equivalent to the vegetation deStF,.ye in accordance with this Article. 449 b. During the construction stage of development, the developer shall not allow the 450 cleaning of equipment or material within the drip line of any protected tree or groups of trees. 451 Neither shall the developer allow the disposal of waste materials such as paint, oil solvents, 452 asphalt, concrete, mortar, and the like within the drip line of any tree or groups of trees. 453 c. No attachments or wires other than those of a protective nature shall be attached to 454 any tree. 455 d. If more than one (1) native terrestrial plant community is present on-site, areas 456 representing all existing plant communities shall be preserved on-site unless preserving more 457 e#than one (1) particular community is more ecologically beneficial. 458 E. Seeding and M lEhin^Sod. Properties shall be seeded sodded with drought tolerant grass 459 or other Florida -Friendly landscape material, and FnU'^" within thirty (30) days after any 460 clearing, grubbing, excavating, or filling activity, or prior to request for inspection to close out toe 461 land deve'^p vent a permit, whichever occurs first, eF subseqUent +„ Other m . b ildiR 462 ^'^Y.. elitiOR eF site w eick In the case where other site work is to occur and seeding and mu'Ehin_ 463 will net be peFfeFnged, the other site precautions, such as silt or erosion control fencing as 464 deemed appropriate, protection of storm drains, etc., shall be immediately implemented. Staff 465 shall inspect the seedled and Mu'r-shed-site site work areas to ensure that adequate ground coverage 466 has been obtained. Repeated seediRg and m, lGhiR^ may be required uA i' the tisf +„r„ 467 e^"^ron^ is acce mp!ished 14 S:ACA\Ordinances\LDR Changes\LDR Amendment (Ch 2, And Ch 4) (Permit Process And Environmental)(2nd Read)- Ordinance.Docx 575 469 470 Sec. 5. Fertilizer Regulations. 471 See ARTICLE XII. FERTILIZER USE REGULATIONS of this Chatter for the fertilizer reaulations. .�.r_■w�er_r_sir. eer_�s°- - - :r_rsree�ra�r_nzw_��rser_rs 1111161,111 11 oil ._M-111 I SENIOR 11 12110, 01 W1, � LTJ lel �lli�J■�l�l:�■l.L�l��1:liZ�tiJ■L�1;J�■■IJLJ�L���■lS�■■lR ��■li���■�'.'L�li�J tS�■L�■l��J li�li�L l��l lel` •. �re�rrr�ssr_r.��es����sw_rans�r_Er_ r�ssvr".. rrw. _s 486 feFtilizeF and aFeas ef appliEatie, —F 1-6111—F t8 urban landSEapes within the City, unless SHEh 487 appliEatien is spedkally exempted by SeEtmen 11 ef this aFtiEle. This seEtmE)R shall be pFeSpeEtive 4.. 490 491 IandSGape plaRtS d IF*Hg the prehihited appliGatieR peried erto catsgra+oil ;Ailr 492 493 , 494 495 . 496 D. FeFtilizeF FFee Zones. FeFtilizeF 5hall net be applied within ten (10) feet, E)FthFee (3) feet if a 497 defleEtE)F shield E)F dFE)p spFeaeleF *5 Used, ef any pend, s4eang, wateF body, lake, Eanal, eF wetland 498 defined- by the Florida Department Af Ppy0rApmppt;;1 PrAtpc-t0E)A(ChapteF 62-340). F.AOC. or 499 fFGFn the top ef a seawall A—r lake budkhead. Newly p !anted turf er landSEape plants may be 500 feFtilized on this zene enly fer a sixty (60) day peF*ed beginning thiFty (30) days after plaRtiRg, i 501 needed, te allew the vegetatien te beEeFne well established. CautieFi shall be used te pFevent 502 diFeet depesitie—A .,f fortiii-or i„t„ the iNateF 503 E. [.stili",r CeRteRt and ApplicatieR Rates 15 S:ACA\Ordinances\LDR Changes\LDR Amendment (Ch 2, And Ch 4) (Permit Process And Environmental)(2nd Read)- Ordinance.Docx 576 506 ^!1!iM. _IT-R_� _E requienEy 507 RgaxingtAngs, whiEh YaFy by plant and tuFf types, are feHnd on the labeled feFtiliZeF bag Of 0• _ 509 510 , 511 vegetable gardeRs, and fFHit tFee5 and shFtAbs, unless a sed Ew tissue ElefffiEbeREY has beeR verified 512 by an appFeved test. Muer_r�m_ Department 516 _ .. Rqayame- e applied 517 ;ir-r-tqptdpipr-p With Ri ile SE 1.003(2), 518 F. �eaili-„r AppliEatieR orarstir„s 519 520 521 522 523 524 525 legally applied tE) tHFf er any E)theF legal site, eF FetUFRed te the eriqinal eF etheF appFE)priate 526 E^ 527 528 cterrvm•niator draiRs ditches, eeRye yaRGoc Gr •ni-tor bedies, 529 530 531 532 I IC/TCAS Cleri.d-,_CrieRdly I aR dS.-ape Program 533 534 535 , 536 537 538 Eedes and r „I.,ti„R. 16 S:ACA\Ordinances\LDR Changes\LDR Amendment (Ch 2, And Ch 4) (Permit Process And Environmental)(2nd Read)- Ordinance.Docx 577 543 544 , 545 546*li;zpl: withim the City shall abode by and All Rai appliEatE)FS A -f. 547 SHEEessfully EE)Fnplete the six heuir tr :IM in the Best Management 548 549 550 551 552 553 554 555 MCI 557 EI..� - _ n,r.Ij --- I...-_rsr_s1. - - — .W—_ -9-M__ _r_.s crsr—.uw.�n r�rr_�_,- I ..- �n e - - Ir -•1 appFepFiate Best M • - 64 565 PFieRdly Best MaRagernept ' ' '_ •• - Receipt• -jUly 31, 2019, Department568 EaFFY on their pessessien at all, t ... Anes I.A.fhen applying feFtilizer, e,.,*P-ip-.Pc--P- A -f bt-t4e 569 FIE)r*da 571 572 573 574 575 • �rseir.s�i■ss�r�ss_r.■se�rr�srire�r■rrr_�r�ssr_tsea�rirr.OWN 17 S:ACA\Ordinances\LDR Changes\LDR Amendment (Ch 2, And Ch 4) (Permit Process And Environmental)(2nd Read)- Ordinance.Docx 578 578 aR F. 81 PFE)seEutien ef VOE)IatOE)RS- ef the State - - the aiAhOFity • -' '- Kf'�C? • excee.. .. 589 590 591 592 593 rja a a.ly,�nrrn._ � —.1y _. mss , 596 an appeal shall net - - 597 EFeated befeFe the BeaFd OF SpeEial MasteF. An appeal shall be filed within thiFty (30) days ef the •• exer-sultieR ef the order te be appealed. 599 Sec. 6. Hazardous or Diseased Trees and Palms. 600 ARy dyiRg er dead tree the eity dete....i­ pese a threat, ha2ard, er daRger te the p, blie shall 601 602 603 604 diseased trees er these in a ce—Aditie—A that peteRtially ce_.Atamipate ether trees, ruch ar thp 605 lethal yell,,wing of ,-eEeR„+ palm trees Hazardous or diseased trees or palms shall be reviewed in 606 accordance with the procedures set forth in Part III, Chapter 2, Article II, Section S.C. Landscape 607 Permit. 608 Sec. 7. PFehibitedTFees,E)(etiE, Invasive Species. 609 A. General. Plants classified as a Category I species on the EUFFent PFOhibited list published by 610 the Florida Exotic Pest Plant Council (FLEPPQ ares prohibited within the city. 611 B. wee Removal and Mitigation. AfeePlants classified as a pFehi 4te4Category I species 612 ^P^r this S,,r,s +;^lp shall be removed at the expense of the property owner prior to 613 commencement of construction in accordance with the following: 614 1. Vacant and Undeveloped Property. 18 S:ACA\Ordinances\LDR Changes\LDR Amendment (Ch 2, And Ch 4) (Permit Process And Environmental)(2nd Read)- Ordinance.Docx 579 615 616 617 618 KI 620 affes a land deve'^pm^n+ r,^r ,,;+ A landscape permit shall be required in accordance with the 621 procedures set forth in Chapter2,ArtiEle M, SeEtie„3 Part III, Chapter 2, Article II, Section 5.0 to 622 remove exet+E a -Rd invasive species, ^ pt where exempt under the r, of Sectien 1 � 623 awe. 624 2. Developed Property. On properties that have valid master plan or site plan (landscape 625 plan) approval, ^^develepme^+ perpnit a landscape permit shall be required to remove 626 ^.�Finvasive trees species ci;,i-r5s; the subjec=t trees ., ,r psi„ ap preyed as pa Ft a e+ 627 , 628 AFtiEle 11, LandsEape Design and Bu4eFiRg Standards. in these instaREes, thin nomAwfl Af ;;II C. -r-h 629 in accordance with the 630 procedures set forth in Part III, Chapter 2, Article II, Section 5.C, at the expense of the property 631 owner. Fer the purpose ef this seEtieA, the teFng "site" 632 plan and teEhn*Eal site plan applkatiens, and te ultimately n9ean the pFeEess by WhiEh-a- 633 landSEape p! 634 Sec. 8. Appeals. 635 A. General. Any aggrieved person may appeal a decision of an administrative official in 636 accordance with Chapter 1, AFt+Ele "�SeEtie„T Part II, Chapter 27, Article X. Appeals. 637 B. Environmentally Sensitive Lands. When appealing the provisions of Section -34.6.4. above, 638 the appellant shall address the following: 639 1. Whether the subject property is an environmentally sensitive land or contains 640 endangered, threatened, and rearrare species and/or species of special concern in accordance 641 with the definitions in Chapter 1, Article II; and 642 2. Whether the conditions placed on the development application are reasonable and 643 represent sound environmental practices necessary to mitigate possible harmful impacts upon 644 the subject property and are necessary in order to protect the health, safety, and welfare of the 645 citizens of the city. 646 Sec. 9. Penalties. 647 The city or any other legal authority shall enforce any violation of this article pursuant to the 648 penalty provisions contained in Chapter 1, Article I, Section 7. Penalties of these Land 649 Development Regulations. 1R additieR, +r,^ r -31 of earch tree shall e Pis ttutee a separate 650 e f f e A s e „r„ -^r +h,- ar+,ri^ 651 19 S:ACA\Ordinances\LDR Changes\LDR Amendment (Ch 2, And Ch 4) (Permit Process And Environmental)(2nd Read)- Ordinance.Docx 580 652 653 654 655 656 657 658 659 660 661 662 663 664 665 666 667 668 669 670 671 672 673 674 675 676 677 678 679 680 681 682 683 684 685 686 687 688 Section S. Each and every other provision of the Land Development Regulations not herein specifically amended, shall remain in full force and effect as originally adopted. Section 6. All laws and ordinances applying to the City of Boynton Beach in conflict with any provisions of this ordinance are hereby repealed. Section 7. Should any section or provision of this Ordinance or any portion thereof be declared by a court of competent jurisdiction to be invalid, such decision shall not affect the remainder of this Ordinance. Section 8. Authority is hereby given to codify this Ordinance. Section 9. This Ordinance shall become effective immediately. FIRST READING this 18th day of July, 2023. SECOND, FINAL READING AND PASSAGE this 1st day of August, 2023. CITY OF BOYNTON BEACH, FLORIDA ATTEST: Maylee De Jesus, MPA, MMC City Clerk (Corporate Seal) Mayor — Ty Penserga YES NO Vice -Mayor — Thomas Turkin Commissioner — Angela Cruz Commissioner — Woodrow L. Hay Commissioner —Aimee Kelley VOTE Ty Penserga Mayor APPROVED AS TO FORM: David N. Tolces 20 S:ACA\Ordinances\LDR Changes\LDR Amendment (Ch 2, And Ch 4) (Permit Process And Environmental)(2nd Read)- Ordinance.Docx 581 Interim City Attorney S:ACA\Ordinances\LDR Changes\LDR Amendment (Ch 2, And Ch 4) (Permit Process And Environmental)(2nd Read)- Ordinance.Docx 582 DEVELOPMENT DEPARTMENT PLANNING AND ZONING DIVISION MEMORANDUM NO. PZ 23-023 STAFF REPORT TO: Chair and Members Planning and Development Board THRU: Amanda Radigan, AICP, LEED AP Planning and Zoning Director FROM: Jae Eun Kim, Principal Planner DATE: June 27, 2023 REQUEST: Approve modifications (CDRV 23-005) amending Part III. Land Development Regulations, Chapter 2, Article II, Section 5. Permit Applications and Chapter 4, Article I. Environmental Protection Standards, to create a landscape permit review and approval process and to modify preservation and mitigation regulations. OVERVIEW The City's current Land Development Regulations (LDRs) do not include a procedure for tree and palm removal nor does it provide mitigation options for replacement with the exception replacing the tree caliper. The proposed amendments establish the procedure, submittal requirements and review criteria for the Landscape Permit application to modify the existing trees or palms. The amendment also proposes to update the City's tree preservation code to contain different replacement options for tree(s) or palm(s) that are removed or to be removed. The proposed amendments are designed for the city to create extensive sustainable green infrastructure by promoting tree and palm preservation. EXPLANATION & PROPOSED AMENDMENTS Landscape Permit The current LDRs does not outline or define a review criteria or process when it is necessary to remove trees and palms, or for land clearing. The proposed amendment establishes a Landscape Permit in the LDRs to address such required or necessary removal with respect to the preservation effort. The landscape permit includes three (3) notable points to direct applicants. 1. Exemptions. The exemptions are currently defined to allow tree and palm removal without any replacement and are regulated under Chapter 4, Article I. Environmental Protection Standards. The amendment proposes to relocate the exemptions under a new Landscape Permit procedure and further clarify them to be a user-friendly. 2. Different events. The removal of trees and palms can be necessary to preserve healthy environment and neighborhood, and further public safety, such as tree clearance by a utility company, or removal of invasive species. Under the current regulations, replacement is not required for such removal. The proposed amendment will require replacement with respect to the approved landscape plan and consideration to the existing site conditions. 583 Page 2 Environmental Protection Standards Amendment CDRV 23-005 3. Review criteria and approval process. A Landscape Permit establishes and emphasizes the review criteria that warrant the requested removal of trees and palms being consistent with the LDRs. A Landscape Permit is also designed to regulate the approval process and expiration as it is a permitting tool for tree or palm removal. Environmental Protection Standards The amendment proposes different mitigation options regarding replacement requirements for tree or palm removal, whereas the current LDRs regulate the tree caliper replacement only. This amendment also proposes to remove subsections from Chapter 4, Article I and rewrite them under a Landscape Permit to provide a comprehensive and uniform review process for tree or palm removal while being consistent with other Articles in the LDRs. The amendment for Article I. Environmental Protection Standards can be outlined with three (3) notable points. Reviews and Exemptions • Exemptions to the City approval requirements for a development application pertaining to the existing trees and palms are removed and rewritten under a Landscape Permit. • The subsection referencing invasive species is updated and rewritten for clarification, and the removal process of invasive species is recollected under a Landscape Permit procedure. 2. Mitigations. Three types of mitigations will direct the development applications pertaining to tree or palm removal. • Caliper Replacement: The cumulative caliper inches of existing trees to be removed is required to be replaced on-site with an equal or greater number of caliper inches of replacement canopy tree(s). • Canopy replacement: If trees or palms are removed before obtaining approval of a landscape permit, the number of required replacement trees or palms is based on the removed canopy areas in square feet (sq. ft.). This is determined by using aerial photography; photos; or review of a tree survey. Replacement canopy area credit is required to equal the canopy area removed. • Payment In -lieu of replacement: Upon determining that replacement of removed or to -be - removed trees or palms is not feasible due to the lack of available planting space, the Director of Planning and Zoning may allow the applicant to meet all or part of the replacement for trees and palms by paying into the Tree Canopy Trust Fund an amount of money based on the payment schedule set by the City Commission by resolution. 3. Update and Cleaning up Fertilize regulations are currently defined under both Chapter 4, Article I and Chapter 4, Article XII. This amendment proposes to remove the fertilizer regulations from Article I and refer it to Article XII. Fertilizer Use Regulations, as approved via Ordinance no.11-019. The amendment also proposes to remove redundant verbiages throughout subsections in Article I to be consistent with other parts of LDRs. CONCLUSION/RECOMMENDATION Staff recommends approval of the subject amendments to the Land Development Regulations to establish a procedure for a Landscape Permit and mitigation options to be utilized for development applications pertaining to removal of trees and palms. Attachments 584 PART III. LAND DEVELOPMENT REGULATIONS CHAPTER 2. LAND DEVELOPMENT PROCESS ARTICLE II. PLANNING AND ZONING DIVISION SERVICES Sec. 5. Permit Applications. B. Zoning Permit. 1. General. a. Purpose and Intent. The purpose and intent of this subsection is to set forth a well- defined application process, review criteria, and uniform procedure for the processing of zoning permits and zoning verification letters, to ensure that certain structures and site improvements comply with the respective requirements and standards described in these Land Development Regulations and the city's Code of Ordinances. b. Applicability. A permit, issued by the Planning and Zoning Division, shall be required for accessory structures and site improvements proposed on any parcel or development unless otherwise specified herein. The following types of requests or improvements do not require a building permit but do require a zoning permit or zoning verification. Such improvements or requests include but are not limited to the following: (1) Accessory structures, limited to a maximum of one (1) open air structure or gazebo less than one hundred (100) square feet and used in connection with a principal residential dwelling or use. Chickee huts are exempt from the above size limitation; (2) Animal enclosures; (3) Fences on residential property (single-family; two-family; and single-family attached if fee -simple ownership) with a maximum height of six (6) feet; unless used as a barrier around a swimming pool, spa, or rooftop equipment; (4) Impervious surfaces that are unenclosed and uncovered, including but not limited to driveways, patios, steps, stoops, terraces, sidewalks, and the like, regardless of proposed surface materials (e.g., pavers, asphalt, concrete, etc.). The zoning permit shall not be applicable to new impervious surfaces and improvements normally administered by other Divisions in the city, such as by the Engineering or Building Divisions. A land development permit (LDP) from the Engineering Division shall be required in lieu of a zoning permit for any proposed driveway, patio, terrace, sidewalk, or the like in excess of eight hundred (800) square feet. Impervious surfaces or improvements that would require a building permit (in lieu of a zoning permit) include reinforced concrete pads connecting with existing buildings to be used as a slab for future building additions; required handicapped accessible routes; framed decking improvements; or other similar improvements. It should be noted that any proposed impervious surface and/or site improvement that decreases permeable land area in excess of eight hundred (800) square feet on any given 1 585 parcel in the city shall be reviewed for compliance with the drainage standards of Chapter 4, Article VIII, Section 3.G.„ and/or the Engineering Design Handbook and Construction Standards. This review requires the submittal of a drainage plan prepared by a licensed professional engineer based on the design standards referenced above. (5) Community gardens. See site plan review (Section 2.F. above) for community gardens containing storage and/or agricultural structures that are greater than one hundred (100) square feet. All agricultural structures and storage structures greater than one hundred (100) square feet shall require approval of a building permit in accordance Wtj Iii Chapter 2, Article IV, Section 2. c. Compliance with Florida Building Code. Any proposed structure or improvement that includes an electrical, plumbing, or other similar component which is subject to compliance with the Florida Building Code, shall require a building permit, and the review for such improvement that would have been conducted as part of the zoning permit process, will alternatively occur as part of the review for the building permit. See Chapter 2, Article IV for additional regulations regarding the building permit review process and procedures. 2. Submittal Requirements. See Section I.D. above for the submittal requirements of this application. 3. Review Criteria. Each structure or improvement shall comply with the following: 1) all zoning requirements of Chapter 3, including the supplemental regulations of Article V; 2) all applicable site development standards described in Chapter 4; and 3) the applicable regulations of City Code of Ordinances Part II. Notwithstanding compliance with the aforementioned regulations and standards, their specific provisions are referenced as follows: a. Fences. Chapter 3, Article V, Section 2; b. Arbors, trellises, and pergolas. Chapter 3, Article V, Section 3.F.; c. Open air structures and gazebos. Chapter 3, Article V, Section 3.G.; d. Permanent sheds and storage structures. Chapter 3, Article V, Section 3.E.1.; e. Decks, patios, steps, stoops, and terraces (unenclosed and uncovered). Chapter 3, Article V, Section 3.B.; f. Animal enclosure. City Code of Ordinances Part II, Chapter 4, Section 4-4; and g. Driveways for single-family and duplex dwellings. Chapter 4, Article V, Section 2.B. 4. Approval Process. The application shall be reviewed by staff and action will be taken by the appropriate administrative official. 5. Expiration. A zoning permit is valid for a period not to exceed six (6) months from the date of issuance. If construction of the improvement covered by the zoning permit has not commenced within this time period, the permit shall expire and be cancelled with written notice to the applicant. 6. Time Extension. An extension of the permit for a period not to exceed ninety (90) days may be requested in writing by the applicant if received by the Division prior to permit expiration. be nrlifidrl frnrrs t;-- }n +;__ (Ord. 10-025, passed 12-7-10) 2 586 III ainds�ap"'. 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I 111, Seg tbin I IIIA fair aJhe siiflbilnk:uflI� of fl,ds alpplllucafloini 6J22!'Ow�:!fll he II uuueckhu: r of g[ld ZgEJ11'1�11l�� g��, dg��Viee d'ia�l� rilaviiii: w a g)nip�e!e : Z� inu�:Jiuding iglfwu]]Hlds, aind haklii:'D actligin IlDased oin the ureVew cijt1::Nj,3 slilDf :bidh uuw H'ds S1,fl',)sectbin A II::kinujsicapg II il nflt shdll IN,, app[gygd I.,a.11� wua IlougIiuling jbgj g!111 gp�,.AcdJb staindards deflinecl uuu thui�lp II aind ?eVdbp]12�'!j egLjgjkiins aine niaLl A L:aindscapg iraflt §hdll IID119 isoluaince of a Mth the sk�e p��gll g2d g�lllm2godllqg dsupg! p!ain, 1: applll�cz b1ka rovd1 (A: a II�::iindscai3e 'werri'flt lisvd1ki IIbir a uDeirkA un113a to exii_,,e&ii skx, (6unoint[is froi'n !he ck:ute ofssiluaince f the scc)[22 gf m)rkw oveire(J auya tlhmus rzueinrnut is uuurh coinninieinced 3, waw�:Ns !�inie o., the �dhafl� &'(p�re airid L)e 10 a li I i ii e xte ' ii a i'i"n 588 p� sn oin o�: the Pr2u'r�nu ::ora � gp ii�-d iri�')i U) e) a u�...!Ifli,i et.��...�wu.Q dg u�nIgy bg p.�gg� :���u;�:ted a,.l.. � � �� a u. uun. uu�uun ...11 u �hn h lulu;° nuin� a ..p iirr dw ID Ilu,� �.hn� II �u iIS11 gun Ilcuurn nu �iu..�hnii' a urrnu� uu n�uuuun. r ;W � M � 4ii, L M M i ARTICLE I. ENVIRONMENTAL PROTECTION STANDARDS Sec. 1. General. A. Short Title. This article shall be known and may be cited as the "City Tree Preservation Ordinance." B. Purpose and Intent. The city recognizes the inherent value of trees and other plant material. Healthy vegetation aids in reducing destructive environmental factors to real property, such as wind, noise, and the potential for erosion to the city's soils and beaches. Trees and shrubs contribute towards energy conservation and management by producing oxygen and absorbing carbon dioxide. They have a positive effect +(;,fin surface drainage, and help to provide a beautiful and aesthetic environment for residents, businesses, and visitors. The purpose and intent of these Regulations, therefore, is to promote the health, safety, and welfare of the community by establishing rules and regulations governing the protection of trees and vegetation, in conjunction with encouraging the installation and/or proliferation of healthy trees inand d y IIIA, ip it flirt appropriate locations and quantities. C. Administration. The Director of Planning and Zoning or designee shall have the authority to interpret and administer this article. D. Applicability. The provisions of this article shall apply to aga real property ' ' that is when such tree i.h:: is at intended for development or redevelopment, and °mr removal activity t, initiated by the property owner or agent thereof. E. Exemptions.ai4—permittlng -,F----esses Shall net apply t9 +h^- :. gym:, p2q::0vu§u1311=11S dl ffius auhgn e ����;,n u�ud appt2 ftg gxgu]]pjuii�)ins u�;iun�hullued uiun Iaurh. n:. 5 589 F. Terms and Definitions. See Chapter 1, Article II for all applicable terms and definitions which pertain to the regulations and standards contained herein. G. Conflict. Whenever the regulations and requirements of this Code conflict with any other lawfully enacted and adopted rules, regulations, ordinances, or laws, the most restrictive shall apply, unless otherwise stated herein. (Ord. 10-025, passed 12-7-10) Sec. 2. City Approval Required. No plant material or vegetation shall be cut down, moved or removed, destroyed or effectively .P.d without first securing the necessary G ity approvals empt "Fern these Regula+..;op&+R aGGOrdanGe With 1.E. above. The following processes and permits shall be available to ensure that all Glearing -nnd nru-bbing „; foiiiieiiiiiie.!ii,i�,ILoi!ii,ie'.'!d....activities comply with the standards of this article:. A. Private Property and Public Lands. The property owner or agent shall file the following applications prior to commencement of any of the aforementioned Glearing -nd�� activities s...a..p.Ip.IILR.�....�..�.Il..2u. �.�': 1. Site Plan Review. zen -�:[he site plan review process shall b required and reviewed in accordance with the procedures set forth in Chapter 2, Article 11, Section 2.F. prior to the nf - -I- subsection, the term "site plan" is construeWto include master site plan and technical site pla applications, and to ultimately mean the PFE)Gess by-A41e" landscape plan -e,16tk:::!w aind .. e. ..,,�.,... . ,�. ..; r- a ;. .. �, .,.. a..� .. .. .� 44 r+.� . 2. Land Development Permit. rrr-■e�:rt^ . , .:.... , . .. �+i■.�a.^rr�rrar�;:rr■��:�r�srr.,r�nr,nn. - .. - ,. � . . 6 590 plan, Nativ�� I -heFeof as paF' Of the land developmeiit 1 below.speGimen 'Fees OF to ensufe The issuance of a land development permit shall not relieve any party from obtaining the necessary permits,,„ which may be required by the various federal, state, or local government agencies,, II ands(;app II Ieri, noh: sI[iary 11Ibe...0 eu'pu cured aind u eVoewed in ccoi d linc u:....%Ajtlh th i uu r��. i hu uu .:,'.. SO f orth. „uru , � uin � °h��p.g pf° , �u .p� ri"� ....� � hugu. .:. B. ' Rights-of-Way....III:::`".g.!:i'!LI t. t MT LW"LU Kole] to K-191TIeW.-MATJ Is ArAll 0, =0 I -sit a 11.1 (Ord. 10-025, passed 12-7-10) Sec. 3. Preservation Principles. A. High Ecological Importance. Areas that are considered to be of high ecological importance should be given the highest priority for protection. These areas include but are not limited to the following: 1) have occurrences of federal and state listed species of flora and fauna; 2) have biological diversity, 3 au �,;;�located in aquifer recharge zones; and 4 gp:.!� known to 44 ab#h plbt p ll'�:)r threatened and endangered species of fauna and flora. Therefore, the fe.RewO,g-t[iese natural areas shall be protected B. Easements and Rights -of -Way. Utilities, stormwater easements,, and rights-of-way should avoid preserved areas. C. Contiguity. Areas set aside for preservation should be contiguous parcels of land that are interconnected and considered viable habitat for wildlife to the extent practical. Small fragmented areas of preservation should be avoided when possible. Sec. 4. Standards. The following standards shall be considered in order to ensure the protection of existing vegetation: A. General. All proposed developments shall be designed to preserve, perpetuate, and improve the existing natural character of the site. Existing native trees and other landscape features shall, to the maximum extent possible, be preserved in their natural state; and additional landscape features shall be provided to enhance architectural features, to relate structural design to the site, and to conceal unattractive uses. In all instances the e(; pity's landscaping requirements and all other applicable regulations shall be fully complied with as minimum standards. , 7 591 High-quality areas placed in preservation shall be retained in entirety in their current or improved natural state, and protected regardless of ownership. This requirement may be negotiated to create contiguous preserVa#Gfti,:::,��;j among plant communities. During the site plan review process, the applicant shall be required to prove that the highest ecologically valued land is being retained first. If the preservation of the highest ecological N't valued land ureiii:n.�.�.�. ii..'.�rv....!L!P::.!L( .�.:�: rv.!Lp .!LIIL!I:...of the site ....1..j.�..�:v:6II!...�.II:�.iiT.�.!]j, it shall be the applicant's responsibility to prove such hardship and provide an acceptable alternative for approval. Rights-of-way and areas determined to be future rights-of-way in the Comprehensive Plan and utility or drainage easements shall not be allowed as designated set-aside areas ll'6,, IIS.!L.�::�.!."'..IL.°:�:a:�.!L�'::�.II:Ip.....11.9 !�.!I".IIL�..�."..:I�.• B. Preservation Efforts. 1. Beach Dunes. The natural vegetative cover on beach dunes shall be preserved in an undisturbed state of growth as a fragile ecosystem. No beach dune vegetation, grass, sea grape, and tree development shall be altered, removed, or changed except in accordance with federal, state, county, and local regulations. 2. Mangrove Areas. Well-documented scientific research has established that mangrove areas are the ecological base of the biological food chain for many important species, including some species of fish that are important for sport and commercial fishing. Mangrove trees, which are of considerable aesthetic value, also serve as protection against storm surge ^s wefl ^caii i provide a habitat/shelter for birds and other wildlife. For these reasons, land development and construction thereon, shall be conserved to the maximum extent possible and only altered in accordance with federal, state, county, and local regulations. 3. Specimen Tree Designation. The Director of ".II' .i.IC::q. 1.....!I I:IIJ....21�:� npp iC::!L(,'9. may, by written request to the City Manager, recommend from time to time the official designation of certain trees located within the city as specimen trees. If the City Manager approves such recommendation, the matter shall be presented to the City Commission for final determination. The city shall notify by Gertified mail the affected property owner of the proposed hearing ll2y r eu�.ltlllued p::::.. 'illll. The City Commission shall accept, modify or deny the staff recommendation. Any proposal to remove a specimen tree shall be mitigated in accordance with-® tiGR r ^'^®^` tNis ArtUe 4. Environmentally Sensitive Lands. a. General. The purpose and intent of this section is to preserve and protect the values and functions of environmentally sensitive lands from alterations that would result in the loss of these lands or significant degradation of their values and functions. b. Applicability. This subsection applies to all properties that contain environmentally sensitive lands with an "A", "B", or "C" rating as pursuant to T-, ' ^f the Conservation Element of the Comprehensive Plan. c. Standards. The following standards shall promote the preservation of natural resource sites: (1) If the property proposed for development is greater than ten (10) acres, or is a portion of a larger tract containing ten (10) or more acres of environmentally sensitive lands designated as an "A" rated site, the developer shall be required to preserve a minimum of twenty-five percent (25%) of all native plant communities on the site in one (1) unified preserve. Habitats shall be preserved with intact canopy, understory and ground cover. 8 592 (2) If the property proposed for development is greater than ten (10) acres and has been designated as a "B" or "C" rated site, the developer shall be required to preserve a minimum of twenty-five percent (25%) of all native plant communities on the site. The preserve areas may be separated into micro preserves. Habitats shall be preserved with intact canopy, understory and ground cover. iii:.�ir.iN�.`r��ii. O The specific location of the preservation area shall be determined during the review of a master plan or site plan. If no master plan or site plan is required, then such determination shall occur during the review of the plat. The ultimate area to be preserved shall be indicated on the approved plan ppf any corresponding plat. In determining the most appropriate location for the preserve area within the site, the city shall consider factors, which include, but are not limited to the following: proximity of the preserve area to developed and undeveloped property; potential for immediate or future consolidation with environmentally sensitive lands on abutting properties; ability to maintain the preserve area based upon surrounding development and land uses; and the recommendations of staff or any consultants retained by the city. The preserve area shall be maintained in accordance with ,111CA ruhlr ("Onsill: I ur unhu h.0 w.°"IIuM:u„iii.,• I�, All existing :::” „„ILII r,(T�hlo n_9 nni+ins+inn of Cvic+inn Traac\ C. Mitigation of Existing Trees �,,,, trees ,and II ;;;;;;,';n p��i�� that are not preserved in place or relocated on-site shallbe _-Velopffi—ent peffnit'. The equivalent be based nn GalipeF 4;--ncir)n nr type Of+wnn b"�"I ���, ��1' V Ly Ile„h �Wg ig Ilei°lint, oII I swIt � O Ili � "��u' ��, I"„� Illu& oil: u eh Ill:u en,neirl as indicated in fts Su ub se(boiri I Ilhi g a%!IJ ucernei,1 sIl u41II ,.)e `. 2llOvk:jerh oin U::p.., s Illl��.�ilca�.ed...uirn ffie....ialb[es.11b6k_qw,w ind coi,npllly.. kh U'i s�aq:d auris...delRried uu� 11, u: I['iai)te h. ,rt(e IIIIII aundscallie ID sairll uuu Il:3uuffeiJunci Staindai Js h Il�u��'. � g�::Iuva�ll unh a wp W u. uu n h .: u r u huuur �u 3 Ililw�llllll I,u � .... a Il.prna a 3u )ll )u h.ypg2 g: h h � hlln u�:'".h iuu :�. hn �' �'�� ai����N: d: �,kll � �'...�I� d d:,ull.11„a Il�llil:"all 11 11 rll�llll nil, ..'iii � II II�I�; II„� �➢�u �' ...IIII�I � ��°, ...��� 1 �', urt, �,i+ �D ��� �. II„�I�u 11 ll� ��'ll � (ll'�u. �". 2d II" ]�� b!” 2„II WJIIde.d &."uIn '.,wk:e 0s IIIn6IW aeu. IIID h..hle ta:?...e )eo.:. h abe 4 h a IIC � u�lll ��: Iluur ll�i: ....................................................................................................................................................................................................................................................................................................................................... u ui'�I :u� a �u a lrh: <a uuu�hu'hll�!��uu II ��'hal.un a 1��:„uuu��uuu�:''�.� 9 593 1 Large palms tree -, are those species, auchaaFkohdoRova|.Canory|eJandDate.or I The cumulative caliper inches of existing trees to be removed shall be replaced on- site with an equal or greater number of caliper inches of a replacement or trees. » 4 II h1,� .�; Ilw,;11�1111111 �;111 III � u" .I �'ll 11"11,.11 II II II II II �„� � w rN ....II �""� � �P,�"."II'"III n��."II II , u � II V wll"II.114 ��.,�....a�ll .�.� `p�.' 11�4"`"II"� II�'�w����."�. trees u�nII .,.„ � IIS"'n m m II riot w uw "..ho uh+..,p 1a 11, o avau1401111E� p.�::u'utuu"ni;l.. Pgw g, 1'ie III re( tor ofII "Ill uuunuuui� wlll��� ll�llll�wl il�ll w 2III1110 the u11 h,Wui :uun . u unuiµe:h III �ft r,:ll! moint dull tIIes ull 112wlllllnlIS IlDy Ilw��:��,rll ng IIIc n�r�:.th1 : i 11 (N:3 " u.w "moi Ih du wl set 11D the e u �uu':�.���II�" h.p."uw��tl: III whuw�i �Nul...�nuuu�.�u.h.p�nl r,ll u�1:��r�u����� �iw� w r�u��.11uu� ���..:�Ilu u�,l.W uuw�� int in u��1p u ut C 011 uuilullSS� ()111 Ilp a ��Cwluuhu uiln h Ilii: h Il, h In III'' 1wiird ��11u w111111 IIS uuhnllln Z (h h:w h W wu tl lut uuu h ullluup^° . uin a c oird hug e Wth the in. Iaij 11111111, ('Jh ;h.1121g tl:.,. 8ftje 1111 ain1iJsr,,Eu22 gabu9 a 2q: (I �h�llui'�I�`����Ilr��il��� ���h1..h o1Y:2o11,gtBiQtr g.put61 Illu":quh 11 i i.puul�u ugh: IC "uw�ll'"':' . D. Forestry Practices and Procedures. 1. General. The Director of Planning and Zoning or designee shall lh� Urban use p�^ Forestry Manual ®' ®-Trees and GeRStF Gti^n", United States Department of Agriculture Forest Service, 20056 edition or latest supplement thereof as the arboricultural standard when determining which forestry practice or procedure to apply when reviewing the following types of activities: 1) any proposal to relocate, replace, or remove trees that are subject to the standards and permitting processes of this article; 2) any proposal where the grade of the site is to be raised or lowered around an existing plant; 3) where ditching for utilities, foundations, swimming pools, driveways or the like will severely cut root systems; 4) where large paved areas will delete the water supply and aeration necessary for the life of the tree or shrub; or 5) where a change in the grade or drainage of development will seriously harm natural areas to be retained. 2. Land Clearing and Construction. a. Vegetation that is set aside for preservation shall be protected from all on-site construction. During the land clearing and construction stage of development, the developer shall erect and maintain protective barriers (to city requirements consistent with best management practices) around all trees or groups of trees to be protected. The developer shall not allow the movement of equipment or the storage of equipment, materials, debris or fill to be placed within the protective barrier. Removal or re -grading of soils within preservation areas is prohibited. Any damaged vegetation located within the set-aside areas shall be replacedwith yegetatien equivalent to theyegeIatien destFnye4i n end.'„co dain is::W1h"n fl "nls Aii l fi k,!!'N. b. During the construction stage of development, the developer shall not allow the cleaning of equipment or material within the drip line of any protected tree or groups of trees. Neither shall the developer allow the disposal of waste materials such as paint, oil solvents, asphalt, concrete, mortar, and the like within the drip line of any tree or groups of trees. c. No attachments or wires other than those of a protective nature shall be attached to any tree. d. If more than one (1) native terrestrial plant community is present on-site, areas representing all existing plant communities shall be preserved on-site unless preserving more fi;.Il::p.a.ii: one (1) particular community is more ecologically beneficial. E. eeding and'f °u.. ' �. Properties shall be seed -ed- .oij.;Jigd with drought tolerant grass or other Florida -Friendly landscape material and mulehedwithin thirty (30) days after any clearing, grubbing, excavating, or filling activity, or prior to request for inspection to close out the om,®n+ g permit, whichever occurs first, ^r subsegUeRt +^ n+her. �n^^^li4i^n ^rzi In the case where other site work is to occur m"I^hinn the other site precautions, such as silt or erosion control fencing as deemed appropriate, protection of storm drains, etc., shall be immediately implemented. Staff shall inspect the seeded anw� Bute of 11,1i areas to ensure that adequate ground coverage z al ...Inhn 11 595 (Ord. 10-025, passed 12-7-10; Am. Ord. 11-019, passed 8-2-11; Am. Ord. 12-016, passed 10-2- 12) Sec. 5. Fertilizer Regulations. S e e AII "I IIICII II111111 w 1111111Z -1 SII VIII G -1 III AI IIIA ,IS of: t I i u s C Il, 1 a g t e ii, , c) ii, t h i feiirtullluze ii, Tr IW . I'I I I!.r.W 12 596 ,a M-733 • It . I r w l 4M. i` 'vC '1. 0 .. �. 0 s r s� il rrzMi:. �. e. �� r •�,. r �.:. �.� SIR t. r r �► MR-MV-1� r � ♦ � rr � �t ,r.... r a ,r r r,a �i !'. 1! t. r 13 597 Waft ". a,r rr r 1 t r:. r• rr r. rr r . rr J r w r y w r� r ri r♦ r r r rr ,�� r�:. rr r,� �r ��� w,:... r.,� •r r rr rw ` r ,.rr ,. r • a� r � r r � � � ,. r . . . � r r � � . w :� .r. �. w w � : , �r � � r �� � rr w � rt wr � ,r w rw w � •r � wl � . " .., r s. w r WON! ANN . IN IM WWI �. r ,. r . . . ...........r r. Iw r •,. r^ r, r r r r. • r.: � p. rte. r rr r r. � .r+:. a, 14 598 (Ord. 10-025, passed 12-7-10; Am. Ord. 11-019, passed 8-2-11; Am. Ord. 19-019, passed 7-2- 19) Sec. 8. Appeals. A. General. Any aggrieved person may appeal a decision of an administrative official in C n 1 V d.,� �...Y P� +" . °.,'� „�� W ",".:X: .: i IIS 0 " ';,k„III . accordance with wt r cjga til u B. Environmentally Sensitive Lands. When appealing the provisions of Section 34.13.4. above, the appellant shall address the following: 1. Whether the subject property is an environmentally sensitive land or contains endangered, threatened, and n:ip e species and/or species of special concern in accordance with the definitions in Chapter 1, Article II; and 2. Whether the conditions placed on the development application are reasonable and represent sound environmental practices necessary to mitigate possible harmful impacts upon the subject property and are necessary in order to protect the health, safety, and welfare of the citizens of the city. (Ord. 10-025, passed 12-7-10; Am. Ord. 19-019, passed 7-2-19) Sec. 9. Penalties. The city or any other legal authority shall enforce any violation of this article pursuant to the penalty provisions contained in Chapter 1, Article I, Section 7 of these Land Development Regulations. nff®nse ander this a#inl® (Ord. 10-025, passed 12-7-10; Am. Ord. 19-019, passed 7-2-19) 16 600 T CD CD dor n �,�.°tai �fJlA1i r 'f �r�µ n �r O/ UVJ E ,^ ^u W N a-+ a -- L O (u O O O a) CO •O a cn O w�, W E U N> O O U C C L C6 cn+ W a U (D o w V> N O O +�.+ c E w � E C: C-) N O U U O C: U N O =3 70 L E > O U m O U •� O � Q — ' O N L Q U O U) � w�� W Q •(U L Q� U y� cn N N N O (6 O O U 70 N �O U� O N N cu U (a D > -0 U v> O ? O. O N J O vJ O a .E i a. 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N L QO SQ4-1 ++ -0 cn N :3 p Q (6 Co GD p U E �o'-ON GD C1 NN0-cn > N L m N U N O E�L m N (6 >, p aL-.� Qin co a) N >1 M E O O - O co N +r o U}' U — N (6 (n (n (a N > v (U E O Co •L •QE Qi co N c ■ `� ca C LL -0 m _0 cn ca N O �+ O 2 � � (� pp O 00 ti � II II N N co 0 co o (1) o O a) p a) O �} E4-1II N 4-0 OUO }'N U M 0 + L a) o N: o • L Ec� �_ En cB O� O U L N ED M Q 0L C O� O _� - N E L C: Q) �O�LL L -P-� +r L L N a) Q cn -0 — L O - ' �p O O p U ca �� C a) Q) E c: M LLm. �� a) L N O O +� U cn _0 }, c6 � +rOs=p a)L U tea) acn V N V M a) ��0 O tf~ a) M Q a) N E c_n 000-0 � ca) O� N =a) �O p� (aC:M a) NO p a)Q �E NO O a) > c � .0)a-' a) o .. --= - L �n j -0 � C: � c cn d -Ca)0.-a� -SME � ) � �� �Q �� a�� E� ou UU Q L� Qui O� �O + � o0` C: a) m C) a) L 00 4-0 ,�� 0- c� ��M00 a) }' � �`� o o~ 0 - `no 3-1 c� cM� O—Opp c� ECV �{f} co -C Ef}� � L 110.�� 0 ■ _a) co 4- Io o - m co 0 co m 0 co N U E J N � Q � � N OJ N (D M-0 a-0 L O O U) E a E L- :3 :3 Q O N N E -0 U— C (6 O (� U U) N Co O a) 0 4-1 O 0 U) > 0 O O O i O O O L Q L U m 0 co 0 co Unfinished Business 08/1/2023 Update on in-house City Attorney and direction from Commission. Requested Action by Commission: Provide direction to Human Resources on which candidates to include on the short list for interviews with the Commission. Explanation of Request: The Commission directed Human Resources to begin recruitment for the in-house City Attorney. HR will be providing an update on the recruitment. Attachments: City Attorney Candidates Update.pptx 611 1, M F77 4-0 WC E F77 tllllll�l 4-0 E a) (n U) E o�� co � U) U � ti L.L.I p � Cfl UJ tllllll�l M r C1 N N mu co O N L N � O N r U N n O N 0 >. M Q N I Cr) O N M M co N O N 06 O O C:) O N O N N r N N O N LO N ti r -0 r N r N U U N N C: O O Q C Q Q Q Cn O U O N o co O Qco }' _ CO O cn -co o c� 70 > oO U m a F� U Co (nO Or 0 O 70> (n (n O � Q � o � o o Cm) O . M r N L O Q U m L 70 Q « `- i Q � L a) cuc c 0- a) U }' co r n V !cu u U Lu U U 0- Q .. U E 0 E � n � T" co O W U � U 0 0 O o o >, Ocn ca co c/� n U U � N N O O � L O z .S� C) T" co to T" co ii1111Iw_1 New Business 08/1/2023 City of Boynton Beach Agenda Item Request Form Commission Meeting Date: 08/ 1/2023 Proposed Resolution No. R23-098- Community Development Block Grant FY 2023 Annual Action Plan. Requested Action by Commission: Approve and adopt the City of Boynton Beach's Community Development Block Grant, Second Year Annual Action Plan for FY 2023; and authorizing the City Manager's execution of the required HUD forms and certifications. Explanation of Request: The City of Boynton Beach ("City") is in its Twenty -Seventh year as a federal entitlement community under the U.S. Department of Housing and Urban Development (HUD) Community Development Block Grant (CDBG) Program. Per federal regulations at 24 CFR Part 91 — Consolidated Submissions for Community Planning and Development Programs, the City is required to prepare an Annual Action Plan (the "Plan"). The Plan must identify the City's housing and community development needs, prioritize those needs since funding is limited, establish goals and objectives for the funding based on the priorities, and develop a strategic plan for how the funds will be used each year. The Annual Action Plan is an application for funding for the CDBG Program, which identifies activities that will be undertaken each program year of the five-year Consolidated Plan. HUD published the City's actual CDBG allocation of $550,522 for FY 2023, which is the second year of the five Consolidated Plan period. In addition, the City's CDBG program has $334,011.58 (prior year resources from FY 2021, Housing Rehabilitation Program, 15 -year loan term) that will be reprogram. The CDBG program focus on priorities that are essential to the primary objectives of Title 1 of the Housing and Community Development Act of 1974, as amended. Those objectives are the provision of decent housing, suitable living environments, and the expansion of economic opportunities for its citizens, particularly low -to -moderate income (LMI) persons. Public Services and Housing Rehabilitation activities were solicited from non-profit agencies in the community through a request for proposals (RFP) process. Additionally, two workshops were offered to explain the program, eligibility requirements, and get public input. Seven proposals were submitted. Proposals were reviewed and scored by a committee who evaluated the operation, services, and budget. The following are the scores for the 7 applications submitted. 617 Scores/points were given out of 200 possible points. Public Services Activities Six Applications Submitted 1. Boynton Beach Faith -Based Community Development Corporation, Inc. - Aging in Place - Elder Care Program - 181 Points 2. Pathways to Prosperity, Inc. - CIRCLES Program Boynton Beach - 179 Points 3. Legal Aid Society of Palm Beach County, Inc. - Fair Housing Project - 173 Points 4. Feedings South Florida, Inc. - Culinary Program - 168 Points 5. Feeding South Florida, Inc. - Senior Meal Program - 166 Points 6. Alzheimer's Community Care, Inc. - Nurse Program - 144 Points Housing Rehabilitation Activities Only one Application Submitted 1. Boynton Beach Faith -Based Community Development Corporation, Inc. - Limited Rehabilitation Program - 175 Points Below is a description of the CDBG activities/programs recommended for funding for FY 2023. Boynton Beach Faith -Based Community Development Corporation, Inc. — Aging in Place — Elder Care Program — (Public Services Activity) — The Program will provide 3 basic components to at least 150 LMI Seniors: Food and Nutritional Education; Social Activities; and Basic Essential Social Services. Seniors will be connected to a local network of partners and resources engaging them in managing their wellness, both physical and mental. Applicant Funding Request: $45.000 Staff Recommendation: $40,000 Pathways to Prosperity, Inc. — CIRCLES Program Boynton Beach — (Public Services Activity) — Pathways to Prosperity provides a comprehensive program for people who are willing and ready to move out of poverty. Through a 15-18 weeks Circles Training Class, goals and future plans are mapped out and coupled with tools to secure and retain better jobs. In addition, Pathways to Prosperity assist clients with emergency assistance and/or connect with community resources to meet their need. At least 50 LMI Individuals will be served. Applicant Funding Request: $75,000 Staff Recommendation: $35,000 Legal Aid Society of Palm Beach County, Inc. — Fair Housing Project — (Public Services Activity) — Legal Aid Society will provide fair housing education workshops, outreach, and legal aid assistance to inform the underserved population about fair housing laws and their legal rights. At least 45 LMI individuals will be served through this program. Applicant Funding Request: $10.000 Staff Recommendation: $7,500 Boynton Beach Faith -Based Community Development Corporation, Inc. — Limited 618 Rehabilitation Program – (Housing Activity) – This project provides funding (as a grant) for housing repairs and improvements to elderly and/or disable homeowners (eligible individuals must be at or below 80 percent of Area Median Income). The purpose of the Limited Rehabilitation Program is to stabilize the homeowner's residence by making essential repairs to make the home safe, accessible and livable. At least 18 households will be served. Applicant Funding Request: $535,000 Staff Recommendation: $535,000 Housing Rehabilitation Program – 15 -Year Loan Term – (Housing Activity) – The rehabilitation of existing single-family homes to include roof replacement or repair, installation of energy efficient windows and doors, plumbing repair, electrical upgrade and other repairs in an effort to eliminate slum and blight, and preserve the city's housing stock. The amount recommended for funding for this activity also covers the costs associated with administering rehabilitation program, to include writing work specifications, inspections, daily monitoring of projects, interaction with contractors and sub -contractors. Staff Recommendation: $156,929.58 Planning and Administration – CDBG funds of no more than 20 percent of the allocation will be used to partially funds the costs of managing the program including staffing, program design, agreements, monitoring, technical assistance, and reporting. Funding Recommendation: $110,104 How will this affect city programs or services? Adoption and approval of the CDBG FY 2023 Annual Action Plan promotes the improvement of living environments primarily for low—income households and neighborhoods through public services and housing rehabilitation activities. Fiscal Impact: No. Activity Funding Allocation - FY 2023 - One Year Actual CDBG Program Administration 1 (no more than 20% of annual $ 110,104.00 allocation $110,104.00) 619 Non -budgeted. The City of Boynton Beach's CDBG allocation for FY 2023 is $550,522.00, plus $334,011.58 in prior year resources will be expended to carry out the CDBG program activities for the program year. Attachments: Resolution approving CDBG Second Year Annual Action Plan FY 2023 CDBG FY 2023 Annual Action Plan - Final Draft.pdf Boynton Beach Faith -Based C.D.C., Inc. - Elder Care Program - Complete Application.pdf Pathways to Prosperity, Inc. Complete Application.pdf Legal Aid Society of P.B.C., Inc. Complete Application.pdf Boynton Beach Faith -Based C.D.C., Inc. - Limited Rehabilitation Program - Complete Application.pdf Alzheimer's Community Care, Inc. - Complete Application.pdf Feeding South Florida, Inc. - Culinary Program - Complete Application.pdf 620 CDBG Public Services — Non- profit Organizations (no more than 15% of annual allocation $ 82,500.00) • Boynton Beach Faith - Based Community Development $ 40,000.00 2 Corporation, Inc. — Elder Care Program • Pathways to Prosperity, $ 35,000.00 Inc. — CIRCLES Boynton Beach Legal Aid Society of Palm Beach County, Inc. — Fair $ 7,500.00 Housing Project CDBG Housing Rehabilitation Activities ($ 691,929.88) • Boynton Beach Faith - Based Community 3 Development Corporation, Inc. — $ 535,000.00 Limited Rehabilitation Program $ 156,929.58 City's Housing Rehabilitation Program -15-Year Loan Term CDBG Total Uses $ 884,533.58 CDBG Entitlement Funding $ 550,522.00 CDBG Prior Year Resources $33 011.58 CDBG Total Sources $ 884,533.58 Non -budgeted. The City of Boynton Beach's CDBG allocation for FY 2023 is $550,522.00, plus $334,011.58 in prior year resources will be expended to carry out the CDBG program activities for the program year. Attachments: Resolution approving CDBG Second Year Annual Action Plan FY 2023 CDBG FY 2023 Annual Action Plan - Final Draft.pdf Boynton Beach Faith -Based C.D.C., Inc. - Elder Care Program - Complete Application.pdf Pathways to Prosperity, Inc. Complete Application.pdf Legal Aid Society of P.B.C., Inc. Complete Application.pdf Boynton Beach Faith -Based C.D.C., Inc. - Limited Rehabilitation Program - Complete Application.pdf Alzheimer's Community Care, Inc. - Complete Application.pdf Feeding South Florida, Inc. - Culinary Program - Complete Application.pdf 620 Feeding South Florida, Inc. - Senior Meal Delivery Program - Complete Application.pdf Commission Presentation CDBG FY 2023 Annual Action Plan.pptx 621 1 2 3 4 5 6 7 8 9 to 11 12 13 14 15 �al 17 18 19 20 21 P#a 23 24 25 26 27 28 29 30 31 32 33 34 RESOLUTION NO. R23-098 A RESOLUTION OF THE CITY OF BOYNTON BEACH, FLORIDA, APPROVING AND ADOPTING THE CITY OF BOYNTON BEACH'S COMMUNITY DEVELOPMENT BLOCK GRANT, SECOND YEAR ANNUAL ACTION PLAN FOR FY 2023; AUTHORIZING THE CITY MANAGER TO SIGN THE REQUIRED HUD FORMS AND CERTIFICATIONS; AND PROVIDING AN EFFECTIVE DATE. WHEREAS, The City of Boynton Beach ("City") is in its Twenty -Seventh year as a federal entitlement community under the U.S. Department of Housing and Urban Development (HUD) Community Development Block Grant (CDBG) Program; and WHEREAS, pursuant to Federal regulations at 24 CFR Part 91 — Consolidated Submissions for Community Planning and Development Programs, the City is required to prepare an Annual Action Plan (the "Plan") which Plan must identify the City's housing and community development needs, prioritize those needs since funding is limited, establish goals and objectives for the funding based on the priorities, and develop a strategic plan for how the funds will be used each year; and WHEREAS, the CDBG program focus on priorities that are essential to the primary objectives of Title 1 of the Housing and Community Development Act of 1974, as amended; and WHEREAS, those objectives are the provision of decent housing, suitable living environments, and the expansion of economic opportunities for its citizens, particularly low - to -moderate income (LMI) persons; and WHEREAS, the City Commission of the City of Boynton Beach deems it to be in the best interest of the citizens and residents of the City to approve and adopt the City of Boynton Beach's Community Development Block Grant, Second Year Annual Action Plan for FY 2023; and authorizing the City Manager to sign the required HUD forms and certifications. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE CITY OF BOYNTON BEACH, FLORIDA, THAT: S:ACA\RESO\CDBG Second Year Annual Action Plan FY 2023 - Reso.docx 1 622 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 Section 1. The foregoing "Whereas" clauses are hereby ratified and confirmed as being true and correct and are hereby made a specific part of this Resolution upon adoption hereof. Section 2. The City Commission of the City of Boynton Beach, Florida does hereby approve and adopt the City of Boynton Beach's Community Development Block Grant, Second Year Annual Action Plan for FY 2023; and authorizing the City Manager to sign the required HUD forms and certifications. Section 3. This Resolution will become effective immediately upon passage. PASSED AND ADOPTED this 1st day of August, 2023. CITY OF BOYNTON BEACH, FLORIDA ATTEST: maylee Ue Jesus, IVINA, IVIIVIC. City Clerk (Corporate Seal) Mayor — Ty Penserga Vice Mayor — Thomas Turkin Commissioner —Angela Cruz Commissioner — Woodrow L. Hay Commissioner —Aimee Kelley VOTE Ty Penserga Mayor APPROVED AS TO FORM: David N. Tolces Interim City Attorney S:ACA\RESO\CDBG Second Year Annual Action Plan FY 2023 - Reso.docx 2 YES NO 623 Executive Summary AP -05 Executive Summary - 24 CFR 91.200(c), 91.220(b) 1. Introduction As a requirement of the U. S. Department of Housing and Urban Development (HUD) Community Development Block Grant (CDBG) Program, and per 24 CFR Part 91 — Consolidated Submissions for Community Planning and Development Programs, the City of Boynton Beach ("City") is required to submit an Annual Action Plan. The Annual Action Plan is a component of the City's Five -Year Consolidated Plan for fiscal Year 2022/2026. The City continues its focus on priorities that are essential to the primary objectives of Title 1 of the Housing and Community Development Act of 1974, as amended. Those objectives continue to be the provision of decent housing, suitable living environments, and the expansion of economic opportunities for its citizens, particularly low/moderate income persons. The City of Boynton Beach's objectives plan focuses on the preservation of existing housing stock, providing new affordable housing, homelessness and special needs, and meeting other non -housing and community development needs associated with the reduction of poverty, educational needs and economic development incentives. The Annual Action Plan is an application for funding for the Community Development Block Grant (CDBG) Program, which identifies activities that will be undertaken during the next fiscal year. These activities selected for funding are in accordance with the priorities established by the 2022/2026 Consolidated Plan and are in accordance with the primary objectives of the program. HUD's published allocation of $550,522.00 to the City of Boynton Beach for Program Year (PY) 2023 is the subject of this Annual Action Plan. 2. Summarize the objectives and outcomes identified in the Plan This could be a restatement of items or a table listed elsewhere in the plan or a reference to another location. It may also contain any essential items from the housing and homeless needs assessment, the housing market analysis or the strategic plan. The City of Boynton Beach plans to undertake the activities in part AP -20 (Annual Goals and Objectives of this document.) for FY 2023. Which are: • Rehabilitation of Existing Units • General Public Services 3. Evaluation of past performance This is an evaluation of past performance that helped lead the grantee to choose its goals or projects. The City and the CDBG program committee considered the past performance of the CDBG subrecipients when determining the allocation of CDBG funds to proposed FY 2023 activities. The CDBG program Annual Action Plan 2023 OMB Control No: 2506-0117 (exp. 09/30/2023) 624 committee considered funding requests from nonprofit organizations based upon the proposed benefit to low -to -moderate income residents, their experience in carrying out the proposed activities and meeting the CDBG requirements. CDBG funding was allocated only to activities that address the high priority needs of the 2022/2026 Consolidated Plan which were owner -occupied housing rehabilitation, public services, and neighborhood revitalization of the Heart of Boynton low-income target area. During the first year of this new Consolidated Plan five-year period, the City completed those housing activities that were delayed during the prior year and leveraged its CDBG resources with those provided through the State Housing Initiatives Program (SHIP). Public services subrecipients continued to deliver services directly to beneficiaries, and continued to address the most immediate needs. All CDBG funds were used to address the activities determined as high priority in the City's FY 2022 Annual Action Plan 4. Summary of Citizen Participation Process and consultation process Summary from citizen participation section of plan. The City used numerous strategies to elicit public comments including: The City advertised the availability of CDBG funds on February 27, 2023, and held three public meetings onsite and virtually. The meetings were on 02/27/2023, 02/28/2023, and 08/01/2023. The City solicited input from nonprofit organizations, and encouraged residents to participate in the preparation of the FY 2023 Action Plan. Published information ads in a local newspaper of general circulation. See attached notices and proof of publications. Posted Annual Action Plan information on the City's social media. The Draft of the Action Plan Public was available for Public Comment from Friday, June 23, 2023, through Monday, July 24, 2023. 5. Summary of public comments This could be a brief narrative summary or reference an attached document from the Citizen Participation section of the Con Plan. No public comments were received during the public review period. 6. Summary of comments or views not accepted and the reasons for not accepting them There were no comments or views that were not accepted. 7. Summary The City allocated the CDBG funds to primarily benefit low- and moderate -income households. The CDBG beneficiaries are either income -qualified residents that receive direct services or residents of neighborhoods where at least 51 percent of the population is low and moderate Income. The City expects to receive $550,522.00 for FY 2023 in CDBG funds. Annual Action Plan 2023 OMB Control No: 2506-0117 (exp. 09/30/2023) 625 See Section AP -35 Projects for a detailed description of each activity. Below is a summary of the CDBG activities and allocations: • Program Administration — $110,104.00 in CDBG funds for program administration. Planning and administrative cost must not exceed 20 percent of the grant. • Housing — $357,918.00 (FY 2023) plus $334,011.58 (prior year resources FY 2021) in total $691,929.58 CDBG funds for housing related activities. • Public Services — $82,500.00 in CDBG funds for public services activities. The Public Services allocation must not exceed 15 percent of the grant. The Annual Action Plan was developed by the Department of Financial Services/Division of Community Improvement with the following process: • Consultation with other City departments and governmental entities 05/24/2023 • Consultation with Community organizations and private citizens 02/27/2023 and 02/28/2023 Annual Action Plan 2023 OMB Control No: 2506-0117 (exp. 09/30/2023) O O N r -I 01 I .0 r_ aj Q O a� co m GJ J Ln O 1 CL r4 W U O Ln H GJ +J N Q C � N d � O a U N Q o E Z5 E d J3 m u U C � O C Cti > to \ E 4-1 N O E i N N> fC Q U O Q Q L C Ln U C C Ll t U l0 4J 00 N O c" m z >- m° 0 a U N on f9 C f9 GJ 4J o0C ani u O C Q E Q 7 CE C O U H GJ •U C N Q C � N d � O a U N Q o t a Z5 d J3 m H PrA L a� tin c C 0 .j C N E N O 0- E E C: 7 E E O U a) E m or .. c N E Q N 0 v U N cn U C f6 LL ti C14 CO Ln N r -I ai 0 0 N 0) 0 r -I r -I 01 i 3 O U r -I CL a }I U 3 O C p s i C a O- s tLo i fC V) O bA vi ,a B r6 o of vi > 4-1 E .4.1 h0 � C LnO 'L a U Q Q C r6 L 47 a bA +J U a--� , C C 73 Q +-+ a a s i+ C > ut ai E a L o u o� O a 3 W 0 E° CL o ro 3 o a o L CL C L � s C Q O 'v� o a O +ai v a O M a U U N C > ai M mo > CE Q •> a C L O a M Q m > a a)L O C '> N OL 3 a ° bA s co a m c6 mQ O O om a ap U C -a_ n 4, s Ulto U •s a 4� Q +, 4- c U r6 (o a O> [o � 0 a v O a � Q ma �° (� ° L a L Q V •U y a f6 E 7 r6 O O a + 41 i ca cn C � — a E O +, O a s r6 C a O U O Q O a L •+, Ln C +, a-6 a +' C C a a o +, C O> C O a a U t6 O C s ra +� U X U a O p +, a -0 � _ aj u +s, t6 1 >- >j � E C �..� � a s U 4, r6 ° a U N O V) r6 Q O C C Q ro Q r6 m r6 Lr) ro C O L Q o L O Q �, f6 bo U L O C a O O ry' ut a > c6 s [6 — O rn ¢ v co U v ° +1 m o o U c E v °J +° N a *' v 4-' o E O_0 4-1 o a a— C v >° o>> E ai a 4z = 3 O U o - a O°� s ai �_ E V C ca a E a co E C +, 4- O > ,� ° a > te a 4- ro C i�-I L C ° C m U l.% m a > L a U 3 � O 2 a) N Q +, +S, p0 O C a C ° v>i 0 41 C a 3 .0 l6 a N 41 E .0 � E a +' •N C O a in s s :+, 'a C O dA C rn E U GJto a C + + U bn 0 2 N ro C a a +� a rU6 r bi WVD +_ v 2 oOp mo ro Ln 7 Q) L ut Q) a s s a s +, 4J N O s U O - U +, C a s a E N C 4.1 C O n •L +, E a O pp +, p a C a E n O Y •> OL 4-1 r6U E C a L r6 C C a N C C c -I-- Q Q W a E> N N fU6 41 = r6 a E a) p ° p o0 U f>6 ° +, o +� in c o v C E> a o a) p Q s V, a >> V a V fQ U E Ln a ai m a) s Ln L Lna> s C a r6 L +' '� a C L Ul N a � N i a a U •> o s C r6 E U p '> U L1 _0— Ln C O Val r6 +, L L O L L a o cr a) Q O C a W p 0O ( +�, N Q 0ro Q C o 4� Q +� t U'^ Qj U bA 2 ra 41 7 o a C ° W QJ E r6 -a v C r6 U C }' a s s L O o> a r U E a, O +, C +� ° — N +� E s C. 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The cost of properties in Palm Beach County has become unaffordable because of investor speculation. At the time of submission of this Plan, the City does not own properties that might be used to address the needs in the plan. Discussion The allocation of federal resources and program design will be impacted with more focus on meeting immediate needs. Public services to assist special needs and vulnerable populations and persons who are at risk of homelessness due to job loss will be top priority for resources. There are also opportunities for the City to work with other governmental entities and the private sector to address the needs of Boynton Beach residents. Annual Action Plan 2023 OMB Control No: 2506-0117 (exp. 09/30/2021) 642 N G1 O M c m N fo O 3 a A m C E E D_ 7 C o c0 U N 0 Q o I � t0 � aJ C � Q M t0 �-a J � C N_ i f9 VI N L j S a aj - C a E N D_ T Ln M co v On N > N :3 O 4-1 U 4- n3 Z3 0 O = ai _ I G U C N CU U C7 > QJ L C .. U N to > CL U .C: aCJ " 7E 7 0 Ln O L O D_ t = a z O 0 0 o O NLn O O Li ('i 00 Ol V)- LD c I O O V�1 U C � U i O O .6 O Q C +' C: +J w 7 Q to— C on 4J c9 N aJ aJ .0 n N Vf 7Av L U '> ar Z c 4J L 7 D OU C L U Ln OC aJ = aJ t cm v'i U t L tko a o 3 3 3 Qj u V u to C ro N ca L 73 = c Go b.0 C a1 = O w •� aJ4. 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Up to 20% of the CDBG grant can be expended on Planning and Administration. State of Florida SHIP Program will be leveraged with the CDBG funds for Rehabilitation of substandard housing, and the cost to administer the projects. A limited Rehabilitation Program and Public Services will be awarded through a Request for Proposal process for eligible and qualified community-based non-profit organizations, to provide needed services that will assist in the improvement of the quality of life for our underserved population. No more than 15% of the CDBG grant will be expended on Public Service activities. The projects to be funded below were based on the priorities set by the Consolidated Plan and applications submitted by the non-profit organizations. Projects # Project Name 1 CDBG Administration 2 Housing Rehabilitation 3 Housing Rehabilitation Administration 4 Boynton Beach Faith -Based Community Development Corporation, Inc — Aging in Place—Elder Care Program 5 Legal Aid Society of Palm Beach County, Inc. — Fair Housing Project 6 Pathways to Prosperity, Inc. —Circles Boynton Beach 7 Boynton Beach Faith -Based Community Development Corporation, Inc — Limited Rehabilitation Program Table 7 - Project Information Describe the reasons for allocation priorities and any obstacles to addressing underserved needs Allocation priorities were based on the City's housing and community development needs assessment contained in the Consolidated Plan, feedback from residents and other community stakeholders, funding applications received through a competitive grant applications cycle, and the City Commission. The CDBG application review committee considered funding requests from non-profit agencies based upon the proposed benefit to low- and moderate -income Boynton Beach residents, the agencies demonstrated capacity to carry out the proposed activities, the financial feasibility of the proposed activities, and the amount of funding available. The economic dislocation caused by the COVID-19 pandemic has disproportionally affected low -to -moderate - income households. Housing market conditions related to demand and supply of both affordable rental and homeownership housing and the high costs of vacant land and construction makes it very difficult to serve the housing needs of LMI families. The City is challenged to develop and implement a well -coordinated and integrated outcome -driven service delivery system that meets the City's housing and community development Annual Action Plan 2023 OMB Control No: 2506-0117 (exp. 09/30/2023) 645 needs and goals within the limits of available funding and external conditions. The City will continue to address the affordable housing crisis which was deemed the highest priority in the needs assessment by continue to fund Owner -Occupied Housing Rehabilitation activities. The rehabilitation of existing single-family homes to include roof replacement or repair, installation of energy efficient windows and doors, plumbing repair, electrical upgrade and other repairs in an effort to eliminate slum and blight, and preserve the City's housing. Annual Action Plan 2023 OMB Control No: 2506-0117 (exp. 09/30/2023) 646 AP -38 Project Summary Project Summary Information 1 Project Name CDBG Administration Target Area Citywide Goals Supported Program Administration Needs Addressed Program Administration Funding CDBG: $110, 104.00 Description Administration of the CDBG program to include staff and other related cost of program management, coordination, monitoring reporting, evaluation and oversight. Subject to statutory limitation of 20% of annual allocation. Target Date 9/30/2024 Estimate the number and Not Applicable type of families that will benefit from the proposed activities Location Description Citywide Planned Activities Daily administration of the plan to include monitoring of subrecipients, providing technical assistance, reporting and other administrative duties. 2 Project Name Housing Rehabilitation Program Target Area Citywide Goals Supported Housing Needs Addressed Housing Funding $8S,000.00 Description he rehabilitation of existing single-family homes to include roof replacement or repair, installation of energy efficient windows and doors, plumbing repair, electrical upgrade and other repairs in an effort to eliminate slum and blight, and preserve the city's housing stock. Target Date 9/30/2024 Estimate the number and Estimates three (3) families will benefit from this activity type of families that will benefit from the proposed activities Annual Action Plan 2023 OMB Control No: 2506-0117 (exp. 09/30/2023) 647 Location Description Citywide with emphasis on the Heart of Boynton target area. Annual Action Plan 2023 OMB Control No: 2506-0117 (exp. 09/30/2023) 648 Planned Activities Administered by the City's Community Improvement Division or through a sub -recipient partner, this activity will provide housing assistance to low and moderate -income or elderly homeowners. 3 Project Name Housing Rehabilitation Administration Target Area Citywide Goals Supported Administration of the Housing Rehabilitation program Needs Addressed Housing Funding CDBG: $71,929.58 Description Costs associated with administering rehabilitation to include writing work specifications, inspections, daily monitoring of projects, interaction with contractors and sub -contractors. Target Date 9/30/2024 Estimate the number and 21 families are expected to benefit from this activity. type of families that will benefit from the proposed activities Location Description Citywide with emphasis on the Heart of Boynton target area. Planned Activities Costs associated with administering rehabilitation to include writing work specifications, daily monitoring of projects, interaction with contractors and sub -contractors. 4 Project Name General Public Services — Boynton Beach Faith -Based Community Development Corporation, Inc. — Aging in Place — Elder Care Program Target Area Citywide Goals Supported Public Service Needs Addressed Education, Support and follow up Funding CDBG: $40,000.00 Description The Aging in Place — Elder Care Program will provide 3 basic components to Seniors: Food and Nutritional Education, Social Activities and Basic Essential Social Services. Seniors will be connected to a local network of partners and resources engaging them in managing their wellness, both physical and mental. Annual Action Plan 2023 OMB Control No: 2506-0117 (exp. 09/30/2023) 648 Target Date 9/30/2024 Annual Action Plan 2023 OMB Control No: 2506-0117 (exp. 09/30/2023) 649 Estimate the number and 150 LMI Seniors assisted type of families that will benefit from the proposed activities Location Description Citywide Planned Activities Education, support and follow up 5 Project Name General Public Services — Legal Aid Society, Inc. — Fair Housing Project Target Area Citywide Goals Supported Education and Fair Housing Needs Addressed Education and Outreach to inform the underserved population about air housing laws and their legal rights. Funding CDBG: $7,500.00 Description Fair Housing Education, and legal aid assistance to low, low -moderate income persons/families in Boynton Beach. Target Date 9/30/2024 Estimate the number and 45 low and low to moderate -income persons estimated to benefit type of families that will from this activity. benefit from the proposed activities Location Description Citywide Planned Activities Fair Housing education and complaint follow up. 6 Project Name General Public Services — Pathways to Prosperity, Inc. — Circles Boynton Beach Target Area Citywide Goals Supported Provision of Public Services Needs Addressed Public Services, General Funding CDBG: $35,000.00 Description his activity will benefit low- to moderate -income individuals and households by providing financial literacy training, mentoring, and case management. Target Date 9/30/2024 Annual Action Plan 2023 OMB Control No: 2506-0117 (exp. 09/30/2023) 649 Estimate the number and 50 LMI individuals type of families that will benefit from the proposed activities Location Description Citywide Planned Activities Education, support and follow up Project Name Affordable Housing Activities —Boynton Beach Faith -Based Community Development Corporation, Inc. — Limited Rehabilitation Program Target Area Citywide with emphasis on the Heart of Boynton target area Goals Supported Housing Needs Addressed Housing Funding CDBG: $535,000.00 Description his project provides funding for housing repairs and improvements to eligible low -to -moderate -income (at or below 80 percent of AMI), elderly and/or disable homeowners. The purpose of the Limited Rehabilitation Program is to stabilize the homeowner's residence by making essential repairs to make the home safe, accessible and livable. Target Date 9/30/2024 Estimate the number and type 18 LMI families are expected to benefit from this activity. of families that will benefit from the proposed activities Location Description Citywide with emphasis on the Heart of Boynton target area Planned Activities Through a sub -recipient partner, this activity will provide housing assistance to low and moderate -income or elderly homeowners. This activity will also cover the costs associated with administering rehabilitation to include writing work specifications, daily monitoring of projects, interaction with contractors and sub -contractors. Annual Action Plan 2023 OMB Control No: 2506-0117 (exp. 09/30/2023) 650 AP -50 Geographic Distribution — 91.220(f) Description of the geographic areas of the entitlement (including areas of low-income and minority concentration) where assistance will be directed The City will allocate federal funding on a citywide basis for the 2023 program year, with concentrations within Census tracts 5601, 5701, 5702, 6100, 6201, 6203, and 6300. Housing rehabilitation, however, can be citywide for income eligible homeowners in need of code -related repairs. All projects included in this Annual Action Plan will benefit low- and -moderate income residents throughout the City. Geographic Distribution Target Area Percentage of Funds Low- and Moderate -Income Areas 65 Citywide 35 Table 8 - Geographic Distribution Rationale for the priorities for allocating investments geographically Boynton Beach adheres to all program -specific eligibility requirements when allocating funds. Priorities for allocation of funding have been established through a combination of public feedback, needs analysis, internal and stakeholder feedback and opportunities for leveraging. All the proposed Action Plan projects will serve very low, low, and moderate -income persons and households. All CDBG funds will be geographically allocated citywide, with preferences on the CDBG target area as it is the area with the highest area of minority concentration and lowest of incomes. The City plans to focus its CDBG funds in its census tracts that have a low -to -moderate -income (LMI) population of 51 percent or more including the area called the Heart of Boynton. Discussion See above discussion. Annual Action Plan 2023 OMB Control No: 2506-0117 (exp. 09/30/2023) 651 Affordable Housing AP -55 Affordable Housing — 91.220(g) Introduction Affordable Housing continues to be a priority with the City of Boynton Beach. The City's housing stock is aging and low- and moderate -income homeowners cannot afford to maintain or repair their homes. For this reason, rehabilitation of owner -occupied housing has been determined to be a high priority. The home repair needs of elderly persons and other income eligible households will continue to be addressed under CDBG and the SHIP Home Repair Program. During FY 2023, the City of Boynton Beach will leverage State of Florida SHIP funds to assist 21 non -homeless households with rehabilitation of owner -occupied housing units, production of new housing units, and acquisition of an existing housing unit. One Year Goals for the Number of Households to be Supported Homeless 10 Non -Homeless 21 Special -Needs 0 Total 21 Table 9 - One Year Goals for Affordable Housing by Support Requirement One Year Goals for the Number of Households Supported Through Rental Assistance 10 The Production of New Units Rehab of Existing Units 21 Acquisition of Existing Units 0 Total 21 Table 10 - One Year Goals for Affordable Housing by Support Type Discussion During the second year of this new Consolidated Plan five-year period, the City will focus on completing those housing activities that were delayed during the prior year and leverage its CDBG resources with those provided through the State Housing Initiatives Program (SHIP) to address the second -year priority housing needs. This will include $357,840.00 in CDBG funds from FY2023 and 334,011.58 PY 's 2021 and $1,711,450.00 in SHIP funds from PY's 2022 and 2023. Annual Action Plan 2023 OMB Control No: 2506-0117 (exp. 09/30/2023) 652 AP -60 Public Housing — 91.22O(h) Introduction The City of Boynton Beach does not own or operate a Public Housing Authority or Public Housing Agency within its jurisdiction. However, the Palm Beach County Housing Authority (PBCHA) does own forty-three single- family units in Boynton Beach. Palm Beach County residents are provided with affordable housing options that are free of housing discrimination and architectural barriers according to the PBCHA. Also, the Delray Beach Housing Authority provides Section 8 vouchers to residents in Boynton Beach. These tenants are kept aware of opportunities that become available within the city that will improve their living standards. They are notified whenever job fairs are scheduled as well as the CDBG process. Actions planned during the next year to address the needs to public housing N/A. Actions to encourage public housing residents to become more involved in management and participate in homeownership Outreach efforts are coordinated between the City of Boynton Beach, Palm Beach County and Delray Beach Housing Authorities with regard to informing Section 8 and/or public housing residents of new homebuyer opportunities. This includes notices of all homeownership seminars and workshops being sponsored by the City or its non-profit affordable housing partners. If the PHA is designated as troubled, describe the manner in which financial assistance will be provided or other assistance Not Applicable Discussion See above. Annual Action Plan 2023 OMB Control No: 2506-0117 (exp. 09/30/2023) 653 AP -65 Homeless and Other Special Needs Activities — 91.220(i) Introduction The Homeless and Housing Alliance (HHA) of Palm Beach County (formerly the Continuum of Care) is intended to deliver a comprehensive and coordinated continuum of services for homeless individuals and families. The City of Boynton Beach is under the umbrella of the HHA of Palm Beach County. The system's fundamental components include homeless prevention, outreach and assessment, emergency shelter, transitional housing, supportive services, permanent housing, and permanent supportive housing. The HHA includes community- based membership with representatives from government, business, formerly homeless individuals, law enforcement, banking, housing service providers, faith groups, education, veterans, health care, and concerned individuals. Palm Beach County Division of Human Services (the Division) continues its role as the lead entity for the HHA which began in January 2006. City of Boynton Beach recognizes the need to address the homeless individuals and families, and those persons with special needs. A portion of SHIP funds are set aside for households with members with developmental disabilities. Describe the jurisdictions one-year goals and actions for reducing and ending homelessness including Reaching out to homeless persons (especially unsheltered persons) and assessing their individual needs The City gives priority and allocates CDBG funds to projects benefiting the homeless population whenever it receives applications for CDBG funds. While the City does not receive Emergency Solutions Grant (ESG) funds, the City supports Palm Beach County Continuum of Care strategies to address homelessness. The City actively collaborates with Palm Beach County and other local cities to address homeless related needs. Palm Beach County uses the Service Prioritization Decision Assistance Tool (SPDAT) is the assessment tool used during outreach activities. The tool prioritizes whom to serve and identifies what supportive services should be provided. Palm Beach County's Homeless Outreach Team (HOT), which leads the County's homeless outreach program, utilizes the SPDAT to conduct initial assessments in the field. Individual SPDAT scores are used to determine what programs and services are the most needed by the homeless individual. The HOT Team travels throughout the County to various location where the homeless are known to congregate in order to conduct on-site screenings. The Homeless Coalition of Palm Beach County conducts Homeless Connect events throughout the County. These events allow the homeless population to receive haircuts, toiletries, clothing, and other related items. The Senator Phillip D. Lewis Center is the point of access for the homeless population to obtain housing and/or services in Palm Beach County. Homeless individuals and families are referred to the Lewis Center from the County's Homeless Outreach Team, as well as law enforcement. Annual Action Plan 2023 OMB Control No: 2506-0117 (exp. 09/30/2023) 654 Addressing the emergency shelter and transitional housing needs of homeless persons Palm Beach County's HHA continues to prioritize the emergency shelter component for the County's ESG program. Palm Beach County provides ESG funding to support a transitional housing facility for single homeless men and two emergency shelters for victims of domestic abuse. Palm Beach County operates a temporary emergency homeless shelter, the Lewis Center Annex. This shelter provides beds, showers, meals, medical services, and other supportive services for up to 125 chronically homeless persons. Helping homeless persons (especially chronically homeless individuals and families, families with children, veterans and their families, and unaccompanied youth) make the transition to permanent housing and independent living, including shortening the period of time that individuals and families experience homelessness, facilitating access for homeless individuals and families to affordable housing units, and preventing individuals and families who were recently homeless from becoming homeless again Palm Beach County assists homeless individuals and families to transition into permanent supportive and independent housing. The following actions will be undertaken by the County and its partners to help the homeless population transition into a permanent form of housing: • Palm Beach County will continue to utilize Continuum of Care (CoC) and ESG funding to support three (3) Rapid Rehousing programs. These programs will provide financial assistance to homeless individuals/families to regain stability in permanent housing. The financial assistance will include security deposits, rental assistance, utility deposits, and utility assistance. These households will also continue to receive case management and other supportive services. • HHA has established as a goal for CoC to give funding priority to permanent supportive housing programs that dedicate 100% of their beds for the chronically homeless. • State Housing Initiative Partnership (SHIP) funds will be used by the County to operate a Housing Reentry Assistance (REAP) Program. This homeless prevention program will provide rental security and utility deposits to eligible households whose income is up to 50% AMI. • The County's CoC funding will continue to support permanent supportive housing programs that dedicate 100% of their beds for the chronic homeless population. These programs provide 64 housing and support services to individuals as well to families. • The County will continue the SMART (Support, Marketing, Assistance, Rental, Tenant) campaign which recruits potential landlords to a database to match them with homeless individuals and families who need housing. Persons housed under this program are provided with deposits and monthly rental assistance which vary in length and dollar amounts based on the client's needs. Each household is assigned a case manager who in turn becomes the landlord's point of contact. Annual Action Plan 2023 OMB Control No: 2506-0117 (exp. 09/30/2023) 655 Helping low-income individuals and families avoid becoming homeless, especially extremely low-income individuals and families and those who are: being discharged from publicly funded institutions and systems of care (such as health care facilities, mental health facilities, foster care and other youth facilities, and corrections programs and institutions); or, receiving assistance from public or private agencies that address housing, health, social services, employment, education, or youth needs. Palm Beach County uses local, state, and federal funding to support Homeless Prevention activities that are designed to assist low-income persons and families that find themselves threatened with homelessness: • Palm Beach County provides financial assistance in the form of emergency rent and/or utility payments to households in order to prevent the household from becoming homeless. Homeless prevention funds target those individuals and families who would become homeless without the assistance. • Palm Beach County participates in the Reentry Task Force whose mission is to implement comprehensive re-entry services to ex -offenders from the time of their entry into the prison system through their transition, reintegration, and aftercare in the community. These services will include, among others, case management and housing assistance. The Reentry Task Force partners include Palm Beach County, Criminal Justice Commission and Gulfstream Goodwill Industries. • Palm Beach County makes funding available to agencies that provide housing and support services to youth who have been discharged from the state's foster care program and provides CoC funding to support the "Connecting Youth to Opportunities" program that provides rapid re -housing and support services to unaccompanied youth ages 18 to 24 who have aged out of the foster care system. • The Lewis Center coordinates with area hospitals and mental health facilities to permit discharged patients to receive referrals to the Lewis Center. The referrals will allow for the discharged persons to access the County's homeless services. The County's Division of Human and Veterans Services has oversight of HUD's Youth Homeless Demonstration Program (YHDP). The County awarded 3 nonprofit agencies funding under this program to provide eligible activities that serve youth experiencing homeless, including unaccompanied and pregnant or parenting youth, where no member of the household is older than 24 years of age. Discussion The Homeless and Housing Alliance (HHA) of Palm Beach County, with the support of the members of the CoC within the County, strategically support the needs of persons experiencing homelessness and persons with special needs. The jurisdiction will continue to support the most vulnerable, at -risk community members through housing and supportive services. Annual Action Plan 2023 OMB Control No: 2506-0117 (exp. 09/30/2023) 656 AP -75 Barriers to affordable housing — 91.220(j) Introduction: The City of Boynton Beach remains committed to providing Affordable Housing. The City and its Community Redevelopment Agency conduct housing studies, and adopts plan ordinances to eliminate barriers to affordable housing. The City actively seeks to assist potential homeowners and developers interested in developing in our community. Actions it planned to remove or ameliorate the negative effects of public policies that serve as barriers to affordable housing such as land use controls, tax policies affecting land, zoning ordinances, building codes, fees and charges, growth limitations, and policies affecting the return on residential investment The City's adopted Local Housing Assistance Plan (LHAP) delineates steps taken to eliminate barriers to affordable housing. The City moved to lessen restrictions on development of non -conforming lots. The regulations focused on the Heart of Boynton District, the area with a significant number of such lots. They were previously unbuildable due to lot size and frontage requirements. In order to allow single-family residences to be built on these lots, staff modified development standards including revisions to lot area, lot frontage, setbacks, and minimum livable area. This action furthered the City's goal of increasing the inventory of attainable housing. Community Improvement staff continue to work closely with the City's' Planning Department and is currently strategizing with local affordable housing providers. Staff remains committed to the following: • Explore actions to eliminate land development regulations that impede affordable housing • Continuing supporting traditional lenders who support affordable housing and promote equal housing for all • Educate low and very low-income persons of fair lending rights and policies • Prioritize the provision of housing for very low, low, and moderate -income families with persons with physical or mental disabilities Discussion: The production of affordable housing requires intense collaboration with lenders, developers, community leaders, and local government. It requires many incentives to keep everyone at the table in an effort to eliminate stigmas that may be associated with the production. All involved need to understand what the investment does to the community. Annual Action Plan 2023 OMB Control No: 2506-0117 (exp. 09/30/2023) 657 AP -85 Other Actions — 91.220(k) Introduction: The City of Boynton Beach will undertake a variety of activities aimed at addressing the needs of the low- and moderate -income households. This includes providing affordable housing to the extremely low-income population, addressing homelessness, and providing public services to low income children and families in need. Actions planned to address obstacles to meeting underserved needs The City supports services and projects aimed at addressing homelessness, social services, and housing affordability. The City of Boynton Beach will continue its current initiatives and collaborations with sub grantees, other public, private agencies and social service providers to meet the needs and eliminate the obstacles of its underserved residents. Programs utilizing CDBG funds and other countywide sources, impact numerous families with job searches, suitable housing, and food. The network fosters communication throughout the city. Actions planned to foster and maintain affordable housing The City preserves existing affordable housing stock by help financing rehabilitation of affordable housing projects or negotiating with the new owners of affordable housing projects. The City continually supports the preservation and development of affordable housing to maintain and increase affordable housing supply. Addition incentives offered are expedited permitting, and reduction in building fees. The City will continue efforts of fostering and maintaining existing and new affordable housing by working with our housing partners and potential new developers to expand and increase affordable housing opportunities. Actions planned to reduce lead-based paint hazards Overall, the goal of the City of Boynton Beach is to eliminate lead-based paint hazards and prevent childhood poisoning in our community. This can only be achieved through partnering with our public and private sectors. The City will follow all procedures specified in the applicable program regulations for activities receiving these funds. The City will also provide all contractors/sub-recipient agencies the required notifications to owners and occupants and inspect for defective paint surfaces in pre -1978 properties assisted. Any defective paint conditions found will be included in the project scope of work and treatment provided to the defective areas. All paint inspections, risk assessments and clearance testing of suspect properties will be performed by licensed testing professionals. As a policy, the City provides the HUD required informational pamphlets to homeowners and contractors to ensure that both the lead safe work and the EPS's Renovation Repair, and Painting Rule (RRP) practices are being used for all Federally funded housing activities. Actions planned to reduce the number of poverty -level families The City's Economic Development efforts will provide incentives for business owner that will address the reduction of poverty level families. The City will work to increase the number of higher paying jobs that may in -turn reduce the number of poverty -level families and strive to expand new economic opportunities to build a more equitable business climate in Boynton Beach. Through its partnering agencies and non -profits Annual Action Plan 2023 OMB Control No: 2506-0117 (exp. 09/30/2023) 658 organizations, efforts will continue to support educational opportunities, promote programs that prepare the workforce for new, or career changing paths to financial independence and seek new businesses that will retain young local talented residents. Additionally, our sub grantee Pathways to Prosperity offer services that help develop employability skills for residents, thereby increasing their household incomes. Finally, the City supports applications for CDBG funds for job training and placement for youth and adults. Actions planned to develop institutional structure The City has a strong system of delivering and coordinating its community development goals and objectives internally with its City Departments and externally through its partnerships with lenders, nonprofit developers and social service providers throughout the county that allows for the leveraging of resources. The City undertakes a consultation process each year and invites comments/feedback from stakeholders within the housing and service delivery environs. Actions planned to enhance coordination between public and private housing and social service agencies The City will continue to work with public and private agencies to coordinate the delivery of housing and related services. The City also maintains close relationship with nonprofit organizations that provide social services to the community. The City administers its homeowner programs for existing and new homeowners with CDBG and State funding with its collaboration efforts with lenders, housing providers, and public housing agencies. This delivered with credit counseling, budgeting, and foreclosure prevention. Discussion: Affordable housing development requires multiple funding sources including the City's local funds, State dollars, federal funding, and available redevelopment property amassed by the City. To keep pace with the increasing demand for affordable housing and to balance development to ensure locational choice, continued federal and state funding is needed. Annual Action Plan 2023 OMB Control No: 2506-0117 (exp. 09/30/2023) 659 Program Specific Requirements AP -90 Program Specific Requirements — 91.220(1) (1,2,4) Introduction: Community Development Block Grant Program (CDBG) Reference 24 CFR 91.220(1)(1) Projects planned with all CDBG funds expected to be available during the year are identified in theProjects Table. The following identifies program income that is available for use that is included inprojects to be carried out. 1. The total amount of program income that will have been received before the start of the next program year and that has not yet been reprogrammed $0 2. The amount of proceeds from section 108 loan guarantees that will be used during the year to address the priority needs and specific objectives identified in the grantee's strategic plan. 0 3. The amount of surplus funds from urban renewal settlements 0 4. The amount of any grant funds returned to the line of credit for which the planned use has not been included in a prior statement or plan 0 5. The amount of income from float -funded activities 0 Total Program Income: $0 Other CDBG Requirements 1. The amount of urgent need activities 0 2. The estimated percentage of CDBG funds that will be used for activities that benefit persons of low and moderate income. Overall Benefit - A consecutive period of one, two or three years may be used to determine that a minimum overall benefit of 70% of CDBG funds is used to benefit persons of low and moderate income. Specify the years covered that include this Annual Action Plan. One year. 100.00% Annual Action Plan 2023 OMB Control No: 2506-0117 (exp. 09/30/2023) 660 PAGE INTENTIONALLY LEFT BLANK Annual Action Plan 2023 OMB Control No: 2506-0117 (exp. 09/30/2023) 661 .. i OMB Number. 4040-0004 Expiration Date: 11/3012025 Application for Federal Assistance SF-424 1. Type of Submission: * 2. Type of Application: * If Revision, select appropriate lettegs): -- Preapplication ® New ® Application [:] Continuation * Other (Specify): Changed/Corrected Application Revision * 3. Date Received: 4. Applicant Identifier. ...._.. ....., 5a. Federal Entity Identifier: 5b. Federal Award Identifier: �. ,........ State Use Only. 6. Date Received by State:T State Application Identifier �.... ., 8. APPLICANT INFORMATION: 'a. Legal Name:City of Boynton Beach ... ... -- * b. Employerlfaxpayer Identification Number (EIN/TIN): ` c. U EI: 159-6000282 �FYYMUAVJD.KC6 d. Address: * Streetl: 100 Fast Ocean Avenue Streetl: * City: Baynton Beach . ....... County/Parish: palm Beach * State: �FL: Florida Province: ......... � ......... * Country: t7$A VidlChD 5PA1F,$ mm„ "Zip/Postal Code: 33435 .. 0310 ......... .. ....... .II u e. Organizational Unit: Department Name: Division Name: ............................................. ....... ... ........., Financial Services Department ........... Community 2mprovement Division f. Name and contact information of person to be contacted on matters involving this application: Mr Name .. _w::: Prefix: � � * First 7 „ .. ...,,,, .... , .., ...a7 Middle Name. .,............. „ `Last Name Ramirez ,,,,,. ., ....., ........... ... .... ... .... .......... .. .. Suffix: h Title: Community Improvement Division Manager Organizational Affiliation: *Telephone Number: 561. 14? 6359 Fax Number: _...... *Ernail: rami rezr@bbf i us ...... m— N N .. i Application for Federal Assistance SF -424 * 9. Type of Applicant 1: Select Applicant Type: -���......_..... .............__...t--- .... ---- ...... ICa.,. : City pr .... hip Government Type of Applicant 2: Select Applicant Type: --- Type of Applicant 3: Select Applicant Type: Other (specify): .... ... * 10. Name of Federal Agency: States Department of Housing and Urban Development United 5t m,mm ,,, 11. Catalog of Federal Domestic Assistance Number: CFDA Title: CDBG 12. Funding Opportunity Number: B-23 Mf l2 0043 Tide: Community Development Block Grant 13. Competition Identification Number: Title: _____ .... ...., ..... ............._. .................... ...., ---.............. 14. Areas Affected by Project (Cities, Counties, States, etc.): ...... Arl Attrfrxa �ab'ii� �rllti��ii,/ iUiytlt * 15. Descriptive Title of Applicant's Project:. ...... ................. Community Development Block Grant FY 2023 j ...., ,..... .... ...., ... ...m .. .,, Attach supporting documents as specified in agency instructions. Add Attachmenttf 663 Application for Federal Assistance SF -424 • a. Federal • b. Applicant • c. State • cf. Local • e. Other • I. Program Income * 9. TOTAL b. Program/Project *b.End Date : 09/3.0/2024-1 . ........ .. — 19. to Application Subject to Review By State Under Executive Order 12372 Process? .. ........ ... F-1 a. This application was made available to the State under the Executive Order 12372 Process for review on F-] b. Program is subject to E.O. 12372 but has not been selected by the State for review. M c. Program is not covered by E.O. 12372, 20. Is the Applicant Delinquent On Any Federal Debt? (if "Yes," provide explanation In attachment.) n Yes X No If "Yes", provide explanation and attach . .... . .... . 21. *By signing this application, I certify (1) to the statements contained In the list of certifications— and (2) that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances" and agree to comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 18, Section 1001) M ** I AGREE ** The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency specific instructions. 664 CERTIFICATIONS In accordance with the applicable statutes and the regulations governing the consolidated plan regulations, the jurisdiction certifies that: Affirmatively Further Fair Housing ­'I'llejurisdiction will affirmatively further fair housing. Uniform Relocation Act and Anti -displacement and Relocation Plan -- It will comply with the acquisition and relocation requirements of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, as amended, (42 U.S.C. 4601-4655) and implementing regulations at 49 CFR. Pail 24, It has in effect, and is following a residential anti -displacement and relocation assistance plan required under 24 CFR Pail 42 in connection with any activity assisted with funding under the Community Development Block Grant or HOME programs. Anti -Lobbying --To the best of the jurisdiction's knowledge and belief: 1. No Federal appropriated funds have been paid or will be paid, by or on behalf of it, to any person for influencing or attempting to influence an officer or employee of any 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 any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative 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, an officer or employee of Congress, or all employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, it will complete and submit Standard Form -LLL, "Disclosure Form to Report. Lobbying," in accordance with its instructions; and 3. It will. require that the language of paragraph I and 2 of this anti -lobbying certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. Authority of Jurisdiction --The consolidated plan is authorized under State and local law (as applicable) and the jurisdiction possesses the legal authority to carry out the programs for which it is seeking funding, in accordance with applicable HUD regulations. Consistency with plan --The housing activities to be undertaken with Community Development Block Grant, HOME, Emergency Solutions Grant, and Housing Opportunities for Persons With AIDS funds are consistent with the strategic plan in the jurisdiction's consolidated plan. Section 3 -- It will comply with section 3 of the Housing and Urban Development Act of 1968 (12 U.S.C. 1701u) and implementing regulations at 24 CFR Part 75. Signature of Authorized Official Date City Manager 665 Specific Community Development Block Grant Certifications The Entitlement Community certifies that: Citizen Participation -- It is in full compliance and following a detailed citizen participation plan that satisfies the requirements of 24 CFR 91.105. Community Development Plan -- Its consolidated plan identifies community development and housing needs and specific,,,, both short-term and long-term community development objectives that that have been developed in. accordance with the primary objective of the CDBG program (i.e., the development of viable urban communities, by providing decent housing and expanding economic opportunities, primarily for persons of low and moderate income) and requirements of 24 CFR. Parts 91 and 570. Following a Plan -- It is following a current consolidated plan that has been approved by HIM. Use of Funds -- It has complied with the following criteria: 1. Maximum Feasible Priority. With respect to activities expected to be assisted with CDBG funds, it has developed its Action Plan so as to give maximum feasible priority to activities which benefit low- and moderate -income families or aid in the prevention or elimination of slums or blight. The Action Plan may also include CDBG-assisted activities which the grantee certifies are designed to meet other community development needs having particular urgency because existing conditions pose a serious and immediate threat to the health or welfare of the community, and other financial resources are not available (see Optional CDBG Certification). 2. Overall Benefit. The aggregate use of CDBG funds, including Section 108 guaranteed loans, during program year(s) U,.Y 2 0 2 3 ................ specified by the grantee of o c, _[a period speci f n on c, or three specific consecutive program years], shall principally benefit persons of low and moderate income in a manner that ensures that at least 70 percent of the amount is expended for activities that benefit such persons during the designated period. 3. Sjj I s 0 improvements Assessments. It will not attempt to recover any capita costs f public improve e its ........... -- assisted with CDBG funds, including Section 108 loan. guaranteed funds, by assessing any amount against properties owned and occupied by persons of low and moderate income, including any fee charged or assessment made as a condition of obtaining access to such public improvements. However, if CDBG funds are used to pay the proportion. of a fee or assessment that relates to the capital costs of public improvements (assisted in part with CDBG funds) financed from other revenue sources, an assessment or charge may be made against the property with respect to the public improvements financed by a source other than CDBG funds. In addition, in the case of properties owned and occupied by moderate -income (not low-income) families, an assessment or charge may be made against the property for public improvements financed by a source other than CDBG funds if the jurisdiction certifies that it lacks CDBG funds to cover the assessment. Excessive Force -- It has adopted and is enforcing: 1. A policy prohibiting the use of excessive force by law enforcement agencies within its jurisdiction against any individuals engaged in. non-violent civil rights demonstrations; and 2. A policy of enforcing applicable State and local laws against physically barring entrance to or exit from. a facility or location which is the subject of such non-violent civil rights demonstrations within its jurisdiction. .M Compliance with Anti -discrimination laws --The grant will be conducted and administere(I in conformity with title VI of the Civil Rights Act oft 964 (42, U.S.C, 2000d) and the Fair Housing Act (42 USk"". 3601-3619) and implernenting regulations. Leml-Based Paint -- Its activities concen,iing lead-based paint wi It comply with the requiren-lents of 24 CFR Part, 35, Subparts A, B, J, K and R Compliance with Laws -11. will coniply with applicable laws. Signature ofAuthorized. Official Date City Manager Title 667 APPENDIX TO CERTIFICATIONS INSTRUCTIONS CONCERNING LOBBYING CERTIFICATION: Lobbying Certification This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $ 100,000 for each such failure. March 27, 2023 A -t;ommunity Development CorporationInc. 2191 N Seacrest Blvd Post Office Box 337 Boynton Beach, FL 33426 Phone: 561-752-0303 Fax: 661-244-6049, www.boyntoncdc.org City of Boynton Beach fit 11&Iv11.s1*4ff 2 1,'-0g2J I 120"� N A� Dear Mr. Ramirez: Please accept our grant application for $45,000 to address senior services this year. The timeliness of the grant opportunity could not be better. This is a critical year for our seniors and the need to bring this program Lip to scale, THIS YEAR, is critical —they cannot afford to wait for inflation to come down and our grant writer to achieve funding which would be in another year. I(HN's Judith Graham's SEPTEMBER 7, 2022 article NAVIGATING AGING confirms what we are seeing here in this community. She states that .... I's Becornirug lbo Upeinsive to Uye'�, Ainxlous Wer Adufts Try to Cope Mflth Urnfteol Budgets. Economic insecurity is upending the lives of millions of older adults as soaring housing costs and inflation diminish the value of fixed incomes. Across the country, seniors who until recently successfully managed limited budgets are growing more anxious and distressed. Some lost work during the covid-19 pandemic. Others are encountering unaffordable rent increases and the prospect of losing their homes. Still others are suffering significant sticker shock at grocery stores. As our community ages, serving the elderly has become not only a moral mission, but an economic necessity. The Boynton CDCs home-based services save taxpayers millions. Compared to an average local cost of $4,000/month — or $48,000/year - for institutional care, to about $1,300 per senior per year. The Boynton CDC provides comprehensive support that enables seniors to age in place - for rnany the only place they know - without fear of homelessness and with a network of support care and dignity by leveraging funds to implement the project at scale. Sin K r 'Joseph Executive Director Cc: A COPY OF IHf CWFdOAL Rf."6p5'dRA I WAIAND OYVANCMI. INFORPAAr7ONFOR 00WVrON UFACWMTH 90SED CDCiNC, A YEOffir,)A BASE 'Fa) Cro�irof?AJIJOJV (REWSMATION NO CH12112, MAYBE 08 TAMED FROM THh M750N OF DY (ALUNG'Y-OU-FP' EF 1-800441:0147LA (435 735?) WOHM rHr, 5TA X-C OR VW ONG !'MF' R YVMS�TF, piww -- - -- ------ ---— ------ — Z - a APPROM, OR 501 (C) 7AXEKEMN 0 0971 !,M" tWYNWN &ACHFAN'H VAS�� .0 coc, uvc nC(.'vVzs.CR x"'% (UEACH CONTRIBUOUN, AWP'�M`6 GIVEN 'rOA PR(WE5590NM SONCFMR, 669 Fiscal Year 2023 �111 iq� 11 � 0 k 1 0 vr*Tff�" P •In"Twuram SUBMISSION 1'')EADLINE V ,�y with all attachn';ents to C , '11ty of Boyr;f,,,o,:;)rP Beach Division ,100 East Ocean Avenue Boyriton Beach,, 1 1. 33,43'5 (No applications will be accepted after 5:00 PM, on March 27, 2023) FOR MORE INFORMATION OR QUESTIONS, PLEASE CONTACT: CITY OF BOYNTON RJ Ramirez, Community improvement Division Manager COMMUNITY IMPROVEMENT DIVISION 100 East Ocean Avenue Boynton Beach, FI. 33435 Telephone: 561-742-6359 Email: ramk Boynton-beach.org/community-improvement 670 Agency Name: Boynton Beach Faith Based CDC, Inc_ Project- Aging in Place - Elder Care Program APPLICATION Submit Hard Copy and a Digital/Electronic Application with all attachments ______V Application is signed and dated. By Director, and Board Chairperson 501(c) (3) is attached (No -For -Profit Status) �/ City of Boynton Beach Business Tax Receipt attached (if applicable). Board Member list. Copy of latest audit, All funding sources for this project identified. ADDITIONAL ATTACHMENTS Attachment 1 Agency Articles of Incorporation, Agency By-laws, and Tax Documents submitted to the Internal Revenue Service (IRS). Attachment 2 Copies of current license(s) needed to operate (as applicable to the funded activity) including City of Boynton Beach Business Tax Receipt (if applicable) Attachment 3 Documentation of all additional funding sources for program(s)/project(s) listed in application (if applicable) A description/schedule of fees charged to the targeted yAttachment 4 beneficiaries of the programs/services/facilities to be funded (if applicable) A job description for each position for which funds are being Attachment 5 requested (explain role/responsibilities within each program/project) (if applicable) Attachments 6 Aging in Place Brochures, In Take Application Forms including Income Certification Form, WW CPA Bio, Rental Agreements for Church - Kitchen, St John MBG Social Activities, First Presbyterian Church, "Impact of COVID on the Mental Health of Caregivers," JMF Reports on Elder Care and Family Strengthening's Financial Aid provided to local Seniors, Social Activity Programming, Chronic Meals Menu, CDC's Buyer's Club Affordable Food Flyers. 1 671 Keturah Joseph Print Full Name: Applicant Signature: Executive Director Title: March 27, 2023 Date: 672 I certify that I am authorized to submit this application on behalf of the applicant agency. I affirm that the award and payment of grant funds are subject to the sole and absolute discretion of the City of Boynton Beach City Commission without recourse. By submitting this application, I waive any and all claims related to the City of Boynton Beach CDBG Program and specifically agree to indemnify and hold the City, its employees, officers, agents, and representatives harmless from any and all claims which may be in any way related to any City of Boynton Beach CDBG Program award, payment, and/or denial. I certify that my agency was established and operating in the City of Boynton Beach on or before October 1, 2020. If funded, I affirm the applicant agency will continue service operations in the City of Boynton Beach. I affirm that the tax documents provided in this application are identical to those I have submitted to the Internal Revenue Service. I acknowledge that, funds are distributed by reimbursement onlV. if this grant is approved, any amount my agency receives may be considered taxable income by the Internal Revenue Service. I acknowledge that, if this grant application is approved, the City of Boynton Beach and Representatives of HUD, the Inspector General, and the General Accounting Office shall have access to all books, accounts, records, reports, files, and other papers, or property pertaining to the administration, receipt and use of CDBG funds necessary to facilitate such reviews and audits, as applicable and described under 24 CFR § 570.490(c). I acknowledge that, all records relating to the City of Boynton Beach CDBG Program, including supporting documentation, shall be retained for the greater of three years from closeout of the grant to the City, as applicable and described under 24 CFR § 570.490(d), unless there is litigation, claims, audit, negotiation, or other actions involving the records. The records must be retained until completion of the action and resolution of all issues. I acknowledge that, if this grant application is approved, my name, my agency name, and my grant award amount may be made public by the City of Boynton Beach. I acknowledge that, if this grant application is approved, my agency will be subject to Florida Sunshine Law, FIL State Statute 119.0701 Keturah Joseph Print Full Name: Applicant Signature: Executive Director Title: March 27, 2023 Date: 672 To submit an application, complete A — 1, Attachments 1-5 (if applicable) and any other items requested. Do not include any items that are not requested. Submit a Hard copy and a digital/electronic copy with all attachments to RJ Ramirez, Community Improvement Division Manager Lmn Community Improvement Division, 100 East Ocean Avenue, Boynton Beach, FL 33435 by 5�00 prin, Marck,�( 27, 2(,)21 Please review the "CDBG Subrecipient Information and Guidelines" available at ),for ....... . ...... !'I. L the program reporting requirements, goals and timelines. For assistance, please call the Community Improvement Division at 561-742-6359. Name of Applicant: Boynton Beach Faith Based CDC, Inc. yes No -For-profit Unique Entity ID #GZS6GQlCQFM9 or DUNNS 099722782 Provide copy of your IRS ruling providing tax exempt status under Section 501(c) (3) of the 1986 IRS Code. Per 2CFR Chapter I Part 25 and the Office of Management and Budget guidance on Federal Funding Accountability and Transparency Act (FFATA) Subaward and Executive Compensation Reporting issued on August 27, 2010, each prime grant recipient may make subawards only to entities that have Unique Entity ID Number. 2. Name of Project: Aging in Place - Elder Care Program 3. Area or Location of Project: Greater 8oynton Beach 4. Contact Person/Title: Keturah Joseph, Executive Director (Preferably Executive Directar/PresidentICEO) Email Address: Kjoseph@boyntonbeachcdc.org Additional Contact Person/Title: Sherry Johnson -Frew (Preferably Person responsible for preparing reirobursementsIquarterly repoits) Alternate Email Address: sjohnson@boyntonbeachcdc.org rffi��M 673 S. Grant Request Activity Area (choose one): 11 Homeless Prevention Services Domestic Violence Prevention Public Safety/Crime Prevention Housing Rehabilitation Program XX Senior Services Educational Program Other (please specify): Amount of Funds Requested for Project: $ 45,000 7. Amount of Matching Funds for Project: $ 45,000 Match Type: _ Cash X Other Grants Donations Other Please identify Source of Additional Funding: The match funding is from a local foundation, Jim Moran - Elder Care. The grant begins July 1, 2023 thru June 30, 2024 S. CDBG COST: (a) (b) Total CDBG Funds Requested $45,000 Total Unduplicated units Served 500 (Explain horny determined?) We maintain a data base for all of the seniors that participate in our Eider Ca currently serve 350 participants and with this funding request, we expect to ; ccninrc frnm tha arantar Rmintnn =ran rogram. We another 15C (c) CDBG Average Cost Per Unit (alb) $ 90 per senior which is 13 % of Budget TOTAL PROJECT COST INCLUDING OTHER SOURCE OF FUNDING: (a) Total Project $354,000 (b) Total Unduplicated Units Served 500 (Explain how determined?) We maintain a data base for all of the seniors that participate in our Elder Care Program. We currentiv serve 350 participants and with this funding request, we expect to add another 1St seniors from the greater Boynton Area (c) TOTAL Average Cost Per Unit (a/b) $700per unit El 674 A new service; or quantifiable increase in the level of an existing service which has been providei. by the grantee on its behalf through State or local government funds in the 12 months preceding the submission of the grantee's Consolidated Plan Annual Action Plan Has the applicant received or will receive other Federal, State or local government funds for the proposed project(s) for which the applicant is requesting CDBG funds? Yes XX No If Yes, what is the funding source? City of Boynton Beach CDBG Funding How much? 2021-22 - Public Services, $62,366; 2021-23 CDBG-CV Rental & Utility Assistance $370,645; and CO. Could this project occur without these funds? XX Yes No 11. Will this project continue after CDBG funding ends? XX Yes No J Yes, describe how the applicant will guarantee the sustainability of the troject/program after CDBG funds have been spent. BoyrIL ___ has ei��,eir been�, a mopre ��,:ir,uaal drri�e 'to assist� senlors A 'fixed liricorrms fl -tan 'this p st,-COVID h,'�flatlonair " ( we are now. The timeliness of this CDBG, funding availability for senior care would enable -the expanskil of our services to seniors throughout the great Boynton area at a critical time when seniors a facing soring •prices in food, rental rates, insurance, gas & utilities which have all risen w beyond their ability to provide for their basic essential services. We have a pending ca aci ctu Us I;uu U41 ME MMMM 675 B. PROPOSED PROJECT EXECUTIVE SUMMARY: Please describe in detail the scope of services of the proposed project/activity to be fLinded, including the expected benefits to the community, a plan of action, how the agency will implement the activity (i.e., intake procedures, income certification, collection of required documentation, reimbursement request, progress reports, end of the year report, etc.). (Attach additional sheets if necessary) Our Elder Care program is called "Aging in Place." It consists of 3 basic components: 1) Food & Nutritional Education connecting seniors to local network of partners and resources, and engaging them in managing their wellness, both physical and mental, treatments, and medications through healthy diet and exercising by providing - Healthy & Medically Tailored or Chronic Meals, Fresh Fruits & Vegetables, Buyer's Club Affordable Food Packages at cost bulk wholesale proteins of fish, poultry, meats), Congregate Meals at social activities, and non- perishable Pantry items; 2) Social Activities that address the health impact from senior isolationism — programs are offered at least twice a month and include physical activities, (chair exercising, chair yoga, meditation), arts and crafts, music, cultural celebrations, games, fun & laughter, fashion shows, wellbeing & educational programming, (Nutrition Education, Blood Pressure, Diabetes), presentations by other non -profits offering resources for seniors), guided conversations by mental health therapist, Field Trips for more of the more mobile clients; and, 3) Basis Essential Social Services for financial assistance and housing and emergency me%heges,upplies & transportation, and resources & referrals for end of life, legal, wellness checks, home, hospital and rehab visitations, respite, and repast at end of life celebrations. "Aging in Place" began in 2012 with the Community Caring Center of Palm Beach County, "CCC." By March of 2020, when the CCC merged with Feeding South Florida, the "Aging In Place" model had become a nationally recognized program for elder care serving 800 seniors in PBC, Martin & Broward Counties, promoting and helping to maintain both mental and physical health and wellbeing, increasing longevity, improving health and preventing institutional care - AND THEN THERE WAS THE COVID-19 PANDEMIC - Feeding South Florida, "FSF," immediately implemented their emergency response as a local food bank, and provided outstanding basic food services during times of quarantine. FSF, however, had already indicated prior to the merger that they would not be continuing the "Aging In Place" program other than deliverinz meals. None of the "Aging In Place" staff were hired with the merger and our low-income seniors were thrusted into extreme isolation by the guarantine. COVID swept through the Heart of Boynton. For some, even before it had a name and thought to be influenza, or pneumonia. WE LOST 17 SENIORS BETWEEN 2020 and 2021. Calls for help to CCC's Elder Care staff did not stop. Seniors could not obtain pandemic supplies needed to keep themselves safe — Toilet Paper, Hand Sanitizers, Masks, Gloves, Bleach, Groceries, Laundry, Testing, Vaccinations, Transportation. Former CCC staff began to volunteer with their congregations trying to assist seniors. The Pandemic Crisis made it clear that the program needed to be re-established. The Boynton CDC, wanting to expand their social service department, recognized an opportunity to do so, and offered to help rebuild the program. We intentionally focused on the Heart of Boynton area first as a geographic area to begin to establish the components before we considered expanding to the Greater Boynton Beach area, and Palm Beach County. United Way of PBC and Jim Moran Foundation were the first to provide funding to include staffing, food, and COVID supplies. LePetit Bakery allowed us to use their kitchen Burin the summer of 2020 for meals until a Christmas donation of $17,000 for meals was received from the First Presbyterian Church in Delray, and we Mould contract with St. John MBC for kitchen usage in January of 2021 for meals. �-W Mobile Angel Food PantrV PBA Food Bank — Groceries for Seniors - Holiday Food Baskets —Thanksgiving, Christmas & Easter Thanksgiving Meals from Benvenuto - Meals • Home Delivered or Drive Thru • Congregate Meals at social activities • Monthly Breakfast Bi- monthly Fresh Produce Referrals and Publicity for Mass Food Distribution Dates & Locations Social Activities — See attachment - July 2022 thru January 2023 Social Activity Schedule - Twice a month (First and the Third Monday) Ev - Field Trips I - Online Application Assistance for • SNAP benefits. • Rental Assistance • Utility Assistance —including LIHEAP and EHEAP • Others, ie., SSI, Medicare, Medicaid • Emergency Home Repairs, as well as, Energy Efficiency and Safety, Air Conditioning, Sol] Panels, Impact Windows Discretionary Funding —when available Referrals — Area on Aging, PBC Department of Elder Affairs and Human Resources, Center for Independent Living, and HOB Alliance Members. mmi - - Seniors in our program have self -identified themselves as having at least one of the following conditions and associated dietary restrictions: high blood pressure or heart disease (45%),, diabetes (32%), cancer (25% are living with or are survivors of), and/or arthritis (25%). Our Aging In Place provides wellness checks for dementia, malnutrition, and dehydration. 678 Presentations from other non-profit organizations offering resources for end of life, mental & physical - health care providers — PACE is featured this year as well as Alzheimer's Association. them avoid many ofthe physical, cognitive and emotional difficulties encountered when seniors are isolated. The programming improves senior health by ..... * Reducing stress, which leads to important increases in cardiovascular health and an improved immune * Increasing longevity. * Increasing fitness which leads to a host of physical, mental, and cognitive benefits. Seniors through social interaction are stimulated, keeping them mentally sharp and intellectually engaged. The improvements in these cognitive areas help prevent memory loss, Alzheimer's disease, and other forms of dementia. Increasing the quality of life. * Reduces depression caused by isolation and loneliness. * improves self-esteem and a sense of worth. commonly reported difficulties faced, such as: * Ehj cal ailments. * Loss of a spouse or other loved one * Isolation and/or mobility problems :,I Real or perceived cognitive dechne, p Less availability of family members available to assist with daily chores and transportation In August of 2022, the BoVnton Beach Mental Health Committee provided an event to help measure the impact of COVID on the mental health of caregivers in the 33435 zip code. The Boynton CDC, provided 95% of the participants from their elder care program. The event, called "Cutz & Conversations," used a pre- and post -event survey and a licensed therapist offering a guided conversation on COVID and Mental Health. See Attachment — "Impact of COVID-19 on the Mental Health of Caregivers" - 27% were finding it difficult to rebuild their social life, 68% remained anxious, and fearful, - 80% had their daily routines severely interruptg�, - 90% continue to worrV about the future, and _ - and on the edge 679 CorAhiued - page 6 e are provided to walk-ins and referrals from our partners as needed. Bo nton CIDCIII i's a, member of PBC Client Infor ittee serving on the Nutrition and the Senior Uyp_&er Committe LqDjjgjflj���_R y Committee, & Homeless and Ho, Pa e Alliance. Boy t DC 11 on C� uses a remote Angel Food Pantry and offers sunshine calls, receives requests for pantry items, and provides with their "Groceries for Senior Seniors are rovided with Home Delivered Meals, alongwith fresh produce, meat, and bakery iternsLo provide nutritionally balanced food to the community. The CDBG funding will affect the number of clients we can directiv assist. Therefore, because the program is already open and horneless populations and to avoid duplication services. Thereforge, ija aqd�staff members are skilled at networking arnonglocal service �Rpy _CK_prqj� providers,andtheya get population and assess the needs s ecific to each client _re able to outreach to the tar, we encounter. If we do not have the resources necessary for assistance, program staff makes appropriat referrals. What resources we do have are leveraged with other partners to assist clients to reach sustainability. StrenjgLhening - Financial Assistance, Angel Food Pantry, and Senior Caregiving PrgpTqTs _including home delivered meals and fresh pro I duce rograrns. These are the irograrns to which Boynton CDC--has_qyantffiabI M i 9,11MUA-Mum— ,A - I" to keep the Boynton CDC office open,_programs running to accommodate walk-ins and referrals from our 681 C. STRATEGY: Check the ONE STRATEGY that best describes your project and provide number of units that will be served under this program. Check One Specific Objective Number of Units This Project will Serve Educational Program (Specify) Households/Persons: (please specify which) Public Safety/Crime Prevention Households/Persons: (please specify which) Domestic Violence Prevention Households/Persons: (please specify which) Senior Services Elderly Households/Persons: XX (please specify which) 500 households Youth Programs Children/Youth: Housing Rehabilitation Number of units to be rehabilitated: Other (Specify) Households/Persons: (please specify which) 682 T UMET Wirr, 1. What documentation/data was used to determine the need for this type of program? See Below 2. How do you evaluate the overall effectiveness of the program? See Below 3. How this project relates to the overall organizational structure? See Below 4. Be very specific how the CDBG funds are proposed to be used? See Below 5. How CDBG funds will it impact your current operation? (Attach additional sheets necessary) See Belo 071, M, 701 no -114, MI. iIliTimi III a & Homeless Alliance, United_W" of PBC — Hunger Task Force's Senior Hunger Committe HOB Social Service Alliance's CEO monthly meeting, 211- Interagency Networking in or to sta informed re, arding, at -risk 'populations, and available resources to meet needs of our community. -CurrPttl 3PIN 1101, am. 11M, 0MEN IM! M -I 11 OR, - -- ---- ------ - -- ----- ------- ----------- - ..... .. Kaiser Family Foundation, Food Research & Action Center "FRAC," the City of Bqyn�qn Beaqh, serving over .5,,OOQ,__we listen to the requests for -_ assistance.__KavinR provided CDBG -CV (COVID-19) financial assistance for rent and utilities we have actually document and documented the post-COVI D inflationary impact on this community. U I M FAMOOT 11 L -aggLOAMM, offirwil ITAM91MMIMAP been disastrous. KHN's Judith Graham's SEPTEMBER 7, 2022 article NAVIGATING AGING confirms what we are seei here in this community. She states that .... 0 :o _E x �L V'IISIVE� to Live": ArWous Older Adt,flts T��yto Co,� e With� L,in �dtrnd(, 11"NAcIg MUM WWI MMM"I AM M10 i sug,gests that 54% of older women who live alone have incomes below what's needed to payrw 11 PINISM I 683 Co�i�fflintje 1)g,, 8 a livill 1jj11ll!!!I The BoVnton CDCs home-based services save taxpayers millions. Compared to an average local cost of M, "I'M -9 MI IPM" . , MEI I I! I 1111 rF. without fear of homelessness and with a network of support care and dignity by leveraging fundsto imr'- • r leproat scale. IIIIIIIIII!IIIii log - $Old' MUM 111!, 111111 MR. KH M -M participants added. Sign -in sheets are used for each activity, and staff makes in-home and hospital & rehab W.-MIS•n— jt;.,Ijtjtritio1,-�&4 track se-0grs whQ pecd Ig enjer instittilional care, and w y. Case have been provided to achieve stabilization. 3. Relationship to organizational structure -The organizational structure is already in place for programmatic expansion. It will increase the elder FUUI-.P—[PjI,j, . H 1 w 14, jjJF�jjIKZ[ZIA.v MIPIT.1m" ".1 .101 11"WI. 11MI. "I. PrCy Structure. On the administrative end it will increase workload of existing staff & CPA for data collection & comoliance reilortine. and to maintain financial oversieht. Ow =111M =-11111FITIZIM no - =.A Its, nm���Ewl "Is service; - Food costs to increase congregate meals from 1 day a month for 80 to weekly breakfast/lunch for 200, and increase food costs for HDM from 1 day per week for 110 to 2 daVs per week for 220: a. Number of participants will increase. b. Staffing will move from PT to Full Time. c. Grant Writer to be added to organizational structure - pending application. 684 Where will the program take place and is it within the City of Boynton Beach Municip Boundaries? Who are the targeted beneficiaries (i.e., geographic area, persons servej and how are they selected for the program? 2. Are you working with other organizations in a cooperative effort on the program? yes XX No If yes, please list the other organizations and their role and responsibilities. (Attach additional sheets if necessary) 1. The Aging In Place program has been opened to anyone within the Heart of Boynton area Ea Y -- of 1-95, North to Hypoluxo, South to Woolbright, and East to the beach - There, is a simple «arlic2timi: f4tt Ckin'e"i'l 6 il"tClUdei') rev social security card. The Boynton CDC's Elder Care Program currently serves 351 low-income seniors age 62andabo if disabled, or 70 and over that are living in the "Heart of Boynton Beach." Services are concentrated in Census tracts 57.02, 61, & 62.01 - an area #q��igg as a food deserl by the USDA as both "low income" and "low access". This is a qualified census tracts of the Heart AT.......... fis VM # �*MQjLU1dUMK1Zr-1M3 M I 1111 1 1 �21 11111 Ill OWN •j. IRI& Milli Ill F—UHRISMI Additional pages are attached as Con't pg 9 a - 685 E. LOCATION, TARGET POPULATION AND INCOME CERTIFICATION Collaborative Partners — In additional to collaboration with Palm Beach CountV and county -wide service providers we have created a Heart of Boynton social service alliance. Countywide Providers include 211, Community Action Services, Rental & Utility on-line portals for Air Conditioning, Windows, Solar Panels, especially for LIHEAP and EHEAP, Housing & Homeless Alliance, Elder Care Services, Center for Independent Living, PBC Department of Human Services, Housing Authority, United WaV of PBC Hunger Alliance — Senior Care Committee. Heart of Boynton (HOB) Alliance Team Members: Boca Helping Hands, Gregory Hazle, CEO 561-417-0913, ext. 208, gre ,,ory!-1 . s lek Meal Distribution, Financial Aid, Job Training, includes Culinary, CDL Drivers, Warehouse Equipment, Certified Nursing Assistant, Information Technology, Home Health Kide, Customer Service Representative, Carpentry, Heating Ventilation and Air Conditioning & Refrigeration, & Drafting. 4 Star Rating with Charity Navigato Connection with PB State College Boynton Beach Mental Health Committee, Gerda Klein, Co-chair, 561-704-6419, ge^dak33437 y Resources and Education, provides Mental Health First Aid Training Boynton Beach Coalition of ClergV, Rev. Dames, Chair, 561-503-8244 , ii ­�_ )& Ln a � L co, rn. � B & K Ministry, Pastor Ben Hawkins - Bible Church of God, Bishop SVIvester Banks - Boynton Beach Worship Center, Pastor James Kelly - Community Deliverance, Pastor William Bouie - Grace Fellowship Missionary Baptist Church, Pastor David Wiggins - Grace Fellowship, Pastor Rodney Wilkinson - Greater St Paul AME Church, Pastor Sharon Hobbs - Healing Hands Ministry, Pastor Rae Whitel - Hopewell, MB Church, Pastor Richard Dames - Lighthouse Missionary Baptist Church, Pastor Steven Miller ~ Miracle By Faith, Pastor Albert Polk - New DaV Missionary Baptist Church, WJ Aiken - New Disciples Worship Center, Pastor TommV Brown - New Hope Missionary Baptist Church, Pastor TonV Cato - New Life Zion Church, Bishop Melvin Pinkne - New Life Zion Missionary Baptist Church, Pastor Nate Ward - New Macedonia Missionary Baptist Church, Pastor EJ Maddox - St John MissionarV Baptist Church, Pastor - St. James Missionary Baptist Church, Dr. Tony Drayton - - BoVnton Strong Community Outreach & Training, LLC, Maurice HaVes, CEO, 561-50 - -9808, co created 501 c 3, addressing CommunitV Outreach & Trainin Con"t pg. 9 b Healthier Together Boynton, Ricky Petty, 561-635-8785, r L Lql(-Y-C2bl )b=.�L2[g Family Caregiving, community driven making impactful changes in a critical health issue. Provides Awareness, Education & Health & Wellness — Offers Mini grant opportunities and events celebrating caregivers. Excellent in Community Orgpnizing, and brings the resources available through Palm Healthcare Foundation. Pathways to Prosperity — Kemberly Bush, CEO, 561-856-5551, BRIDGES goal is to ensure that children are: 1) Born healthy, 2) Growing up safe and 3) Ready to learn when they enter school. CirclesO is a community -driven solution that addresses the underlying causes of poverty and supports families in a holistic, long-term pathwaV to economic stabilitV. Non-profit Certification, PBC — FinancialIV Assisted Agency Funding. Experienced with Northend RISE, a Purpose -Built Community model and is currently setting up 2 Circles programs in that community. Brings Valley Bank and Palm Healthcare resources to establishing banking relationships. TrinitV Counseling Center of Florida, Inc. Rae Whitely, CEO, 561-523-2286, rwh��te�y..((O,fa.itl,ii.�-if�o��,�id ior L__g Grass Roots organization, Recovery, Mental Health Women's Circle, Inc. Julen Blankenship, S61-699-8979, jWankensh�p .1��) ornensdrde.gTj.,7 Haitian CommunitV, language skills, job placement. The Heart of BoVnton Neighborhood Association, Inc. Genesis Community Health, DeAnna Warren, CEO 561-806-6835 ext. 7491, Marren L, t�. �i. L. g E g 687 3. The City's CDBG funds must directly benefit low -and -moderate -income individuals (80 Area Median Income (AMI) or below). The City's CDBG program requires non-profit organization to income certify individuals seeking assistance through activities/programs/projects funded with the CDBG funds. Has the organization done income certification of individuals seeking assistance in the past? Yes XX No If yes, please explain the process the organization uses to income certify Individuals?What type documentation is collected? please attach with your application, a copy of the form your organization uses to income certify individuals. _ The org2ni7ation uses the Current Income Lever issued for Palm Beach (`_minty and published in April each year to determinei ieach-household. A copy of our income certification form is attached. Applicants are asked to provide names of household members and forms of income each received. Frrmpioyment verifications are sent to each employer, pay stubs are provided, as well as 6 months of bank statements. If they are self employed, a profit and loss statement is requested. Tax returns are provided as well as benefit letters on letterhead as used as Back up documentation. If no income is determined, thea are asked to sign an Affidavit of Zero Income. Once all of the household income is determined, an Income Certification Form is completed and the adult members of the household attest to having provided all income by signing the statement. A copy of all of our in -take forms can be found in Attachment 6, as well as, the Income Certification Form and a check list of all required documentation. 10 Com' 4. Does the organization charges fees to its clients? Yes_ No XX S. Will program Income be generated from this activity? Yes XX No If yes explain how will the program income be used? Boynton CDC's auger's Club_is a way of purchasing in bulk from local wholesales and _passing the savings back to participants by sell at cost. Each month, meat, poultry, and fish sales are taken advantage of to provide affordable proteins to help keep seniors in stood health. The cost of the package is rounded up to cover the cost of the packaging. The income frim the sales of the monthly packages goes back into the purchase of the following month bulk items. Thus the program is self sustaining- Any extra inventory is either sold next month, or costs are recovered from the meals program as the inventory is move to the kitchen for the meals program. There is no waste. SEE Monthly Flyers in Attachment 6 T. Goals/Objectives/Activity Measures: Descriptive narrative. Tease use separate Goal Sheet far each individual project (if applicable). Project/Program Title: Goal # 1- Increase the number meals served - either HDIVI or Congregate Meals Objective: We are currently providing 110 Home Delivered Meals "HDM" once a week and a Congregate Style Breakfast to 80 once a month - USDA, Nutrition Guidelines only allow meals to contain 2.5 oz of protein (beef, fish, poultry). We use foundation money to purchase food, which_ allows us with limited resources to provide one healthy meals equal to 2 of the same provided by USDA funded non -profits. Increasing 1 more day of kitchen time to provide meals and doubling participants would provide 220 senior with the equivalent of 4 meals a week. Then, add a weekly Breakfast Congregate Meal for for 200 - Walk-in, pick up, deliver - Buffet Style �^ Resources Needed & Available: We already have contracts with the 1st Presbyterian Church and St John MBC for kitchen a Hall rentals - see Attachment 6 - increase to budget $800 ma. Increase costs for food, transportation, chef and volunteer pool of 20 to assist with transportation, delivery and service. Staffing, location and personnel are in place we just need the funding. Start Date & Duration: The program is on-going, the expansion of services would commence with grant approval and begin in October 2023 thru Sept 2024. Coal # 2: Address Inflationary issues so that seniors are able to Age In Place, by offering access to healthy food, social activities, and financial resources - provide at least 2 social activities per month to address health issues related to isolation, - add a weekly congredgate Breakfast/Lunch Oblective: - add an additional weekly healthy meal for PICK UP/Delivery - provide 2 LIHEAP & EHEAP on-site CAP application for LOW INCOME ENERGY ASSISTANCE - provide monthly Buyer's Club packages to minimize the inflationary flood prices at the grocery - increase the number of seniors served from 350 to 500 Resources Needed & Available: All the Resources on in place and on-going. Funding is needed for additional staffing and programmatic costs associated with the expansion The program is on-going, the expansion of services would commence Start Date & Duration: with grant approval and begin in October 2023 thru Sept 2024. 11 689 G. PROJECT BUDGET Please list organization's anticipated expenditures, detailing requested funds and additional funding. Please place C=Cash, I=ln-Kind, O=Other Grants, D=Donations beside each amount under "Other Project Funds" to denote the type of funds being used. If funding request is for multiple programs/projects, please provide a separate PROJECT BUDGET for each program/project Line Item CDBG Funds Requested Other Project Funds Total Project Budget ADMINISTRATION: Personnel (# 3) $10,000 $71,264. 0 $81,264 Payroll Taxes $ 765 $5,445 0 $6,210 Employee Benefits Office Supplies $1,093 0 $1,093 ---- ------- PROGRAM: Copy Supplies $4,178 0 $4,178 Professional Services: Chef $8,200 $18,400 D $26,600 Food $13,920 $23,520 D $37,440 Fresh Produce $20,000 D $20,000 Social Activities $6,000 0 $6,000 Holiday Food Baskets $29,100 Q. 1, Q $29,100 Pantry - $71,000 1 $71,000 Kitchen Rental $7,800 $19,400 D -,U- $27,200 Transportation $4,315 $5,600 0 $9,915 Financial Assistance $30,000 0 $30,000 Other (explain) Other (explain) TOTALS $45,000 $305,000 $350,000 Notes: Sae aHes lncWde only those that are providing fcr direct servces:, Michefle Davi WhiV,Dorlicald Go:Jfrey, Willie Drayton and Chef Eduardo Peirchial - It does nc,'a lrichu,de salaries for Sherry Johnson, - Frew nor Kebirah� Joselph V(JW,ven Rentawokfld incBarr ies adding one more day a viLa,eek and increase $800 a moint[for 8 a-noinths -, There is a sunimer break dtsur ging ,)Ld�y -Ay,,[,&c,M to aHOW fOV' SUMmer Carnp Sessions, and during Nov & Decernt��er several mea�,s are stflbstituted by FloHday Baskets, and congregate n,idea� celebrations, iFhain ksgiM rig MeAs. &a[1 [s --Jni Mwan !-oundaNJok, I"""1eakh�eoyb ton, Pad.ned shp fo�- AgPng in-kJnd- Bamliay PIBC I^ood BaN*, &igeis h-Acfion Donafions -, MonUfly Donm Fimtr I`Inasbytet1an ChUlCh [)kmy, VVe�ls Fwgo Fund IN 690 H. ORGANIZATION CAPACITY (Provide a detail description of each) 1. Is the organization adequately staffed and trained? Yes, see below 2. Explain how this program fits the organization's mission? See Below See Below 3. Please explain the organization's experience with the proposed project? 4. Staffing Capacity: Who works on the project directly and indirectly. See Below 5. Does the organization have written policies and proceduresyes, see below How ften are these policies and procedures updated? Provide a brief list of the topics covered in the organization's policies and procedures. The City of Boynton Beach may request a copy for review during the application and award process or as part of the grant monitoring process. (Attach additional sheets if necessary) See pg 14,phis add[dortial pages 14 a - d 13 691 APPLICANT CAPACITY (cont.) 6. Will all CDBG funds awarded be maintained in a manner that they will be accounted for separately and distinctly from other sources of revenue or funding? Provide a brief description of the organization's policies and procedures that ensure funds will be tracked appropriately. 7. Is the organization's financial management system able to track actual expenditures and outlays with budgeted amounts for each grant or subgrant? Provide a brief summary of the organization's process for tracking expenditures, including tracking budgeted versus actual amounts. S. Does the organization have effective internal controls in place to ensure that federal funds are used solely for authorized purposes? Provide a brief description of the applicant's internal controls that will provide reasonable assurance that the award funds will be managed properly. 9. Does the organization have a documented records retention policy? If so, briefly describe the policy and confirm that the policy complies with federal regulations. Information on Records Retention and Access can be found at 2 C.F.R § 200.333- 200-337. (Attach additional sheets if necessary) 1. adequate staffing and training YES, Keturah Joseph, CEO with BBFBCDC, Inc., is the individual primarily responsible for the fiscal and administrative oversight of the grant, and William Washington along with his firm Thomas & Company, CPA, PA. will be her go -to to resolve fiscal questions and provide auditing reports as required. T Keturah Joseph, CEO for BBFBCDC, Inc. experience includes administered the State of Florida's $10 million SHIP Program, and the Federal DOME $3 million housing program funding for Palm Beach Counly. She served as compliance manager ensuring conformity with state, federal and county regulations and acted as liaison with auditors, monitors, and other regulatory agencies. T ^T Our CPA William Washington and the firm he is Associated with, Thomas & Company, CPA, PA has received a peer review and have been found to be in accordance with the Standards and Reporting according to the American Institute of Certified Public ^^ Accountants standard, in addition they were determined to be in compliance under the Government Auditing Standard under the Single Audit Act. Mr. Washington's resume and a Report on the Firms System of Quality Controls is attached. 2. fit with organizations mission The Boynton CDC Mission is to promote the economic revitalization of the community through homeownership, develop and sustain partnerships for efficient use of resources, improved and increase the delivery of social services in the community to children and families by creating a healthy community through nutrition education, social services and economic development programs. Our mission fits appropriately with the use of CDBG funds for the application. Additional pages are attached as Cont. pg 14 a _d 14 692 Cont. pg. 14 a H. Organization Capacity 3. Experience of the Organization Keturah Joseph, CEO for BBFBCDC, Inc. experience includes administered the State of Florida's $10 million SHIP Program, and the Federal HOME $3 million_ housing, program funding Palm Beach County. She served as compliance manager ensuring conformity With state, federal and county regulations and acted as liaison with auditors, monitors and other regulatory agencies. CPA William Washington and the firm he is Associated with, Thomas & Company, CPA, PA has received a_peer review and have been found to be in accordance with the Standards and Reporting according to the American Institute of Certified Public Accountants standard, in addition they were determined to be in compliance under the Government Auditing Standard under the Singh Audit Act. Mr. Washington's resume and a Report on the Firms System of Quality Controls is attached with the Letters of Support. SherryJohnson, 1999-2020 Executive Director forthe CommunityCaring Center's $1.5 Million in Assets — Economic Develo meat Culina Incubator, 4 Green Markets and Social Service Department including, Home Delivered Meals and Chronic Meals, Affordable Food Program, and EBT Merchant Licenses. Consultant to the Defray Beach. Redevelopment Agency, _promoting economic development in both commercial and residential markets established guidelines, Policy and Procedures for the Affordable Housing and 2nd Mortgage Programs, grant writing and administration including commercial and residential land acquisition and assemblage for community revitalization efforts, developed Requests for Proposals and Requests for Qualifications, accountable for economic Impact regarding residential development federal loans during the pandemic COVID-19 CARES ACT ERA funding and CDBG-CV Contract Management with City of Boynton Beach 4. There are 6 Staff — who works directly with and indirectly: Direct Services - Programmatic Staffing: - Michelle Davis White, Elder Care Program Coordinator - Donald Godfrey, Elder Care Assistant Coordinator - Willie Drayton, Food Coordinator - Eduardo Percival, Chef - Sherry Johnson, In -take and assistance processing 80% of FTE Programmatic Staff Providing Services indirectly: - Sherry Johnson, data, granting,& compliance 20% of FTE - Keturah Joseph, Administrative S. Written Policies & Procedures The organizations general Policy and Procedures Manual is reviewed and u dated eve other year. The following is a list of policies and procedures topics covered: Standards of Conduct, Work Ethics, Job Descriptions, Conflict of interest, Acceptance of Gifts, Benefits and Compensation, Use of Vehicles, 693 Cont. pg. 14 b Probations Period Employment, Competengy Evaluation Disciplinary Action Termination of Employment, Grievances and Complaints, Drug-free Workplace Policy, Sexual Harassment Employment Policy, Guidelines for Staff & Volunteers regarding interaction with client with differing culture or ethnicity, Equal Opuortunily Employer Policy Human „Rig Policy, Credit and Debit Card Usage Policy, Missing Receipt Form, Nepotism Poli Reasonable Accommodations Policy, Whistleblower Protection Policy, Background Che Lawsuits, Claims, or Assessments Policy/Protocol Records Retention & Destruction Policies, HIPPA Compliance, Encryption Policy for Computers and Business Sensitive Data 6. & 7. Describe tracking of funding sources to individually account for expenditures and the Financial Management System — Ability to track budget versus actual Yes, we use a QuickBooks program and create line items budget (sources and uses) or each program/ project, allocate expense according that line item and provide necessary tracking of budgeted versus actual amounts. Monthly financial statements are provided for review by the finance committee and the board. Cashflow Proiections are provided, and expenditures are compared to protections. Variances are noted and actions are taken to address any cash flow deficiencies. 1.27 PM Boynton Beach Faith -Based CDC, Inc. AZM cSaM$ Profit & Loss Budget vs. Actual January 1 through February 2, 2022 Jan I -Feb Z22 Budget SOver Budget %of Budget Ordinary IncomelExpense Income Gross Profit Expense Total Expense Net Ordinary Income Other Inc ometExpense Otherfixpense Ask MyAccoutitant Total other Expense Net Other Income Net Income S. Effective Internal Controls so that federal funds are used for authorized purposes — describe internal control reasonable assurance that award fund will be managed properly. Yes , -A separate bank account will be opened where all deposits and expenditure will be administered a QuickBooks accounting program will be used, a program/protect budget. A Request for Payments 694 Cont. pg. 14 d This is our RECORD RETENTION Policy it is the Policy of BBFBCDC Inc. to retain records as required by law and to destroy them when appropriate. The appropriate Director must approve the destruction of records. The formal records retention policy of BBFBCDC Inc. is as follows: Accounts payable ledgers and schedules 7 Years Accounts receivable ledgers and schedules 7 Years Audit reports Permanent Bank reconciliations 3 Years Bank Statements 3 Years Chart of Accounts Permanently Cancelled Checks 7 Years Contracts, mortgages, notes, and leases Permanently Correspondence with customers and/or vendors 2 Years Deeds mortgages, and bills of sales Permanent) Depreciation schedules Permanently Duplicate deposit slips 3 Year Expense analyses/expense distribution schedule 7. Years Year-end financial statements Permanently General ledgers/year end trial balance Permanent[ Insurance policies (expired) 3 Years Insurance records(policies, claims etc_ Permanentl Internal audit reports 3 Years+ Internal reports 3 Years Invoices (t® customers, from vendors)_7 Years Journals Permanently Payroll records and summaries_ Permanently Property records (incl. depreciation schedules) Permanently Subsidiary ledgers 7 Years Tax returns and worksheets Permanently 695 Cont. pg. 14 c provides for identification of each program and line item in the budget. Appropriate back up documentation roust be attached to substantiate the use of funds according to the Scope of Services and allowable expenditures under the terms and conditions of the grant award. Our CEO has the experience and expertise, pertaining to the use of government funds according to contracts to review documents and authorize Payments. Payment reguests will be approved by signature by the CEO and submitted to the bookkeeper for payment. Our CPA will audit funds annually as required as a single audit. We have a finance committee that requires separation of duties for pregaration of invoices reviews sin off required, check writing, 2 signatures are required for each check, and reconciliation of accounts, limits as to what CEO can approve before it goes to the board. _ BBFBCDC and its subrecipient are expected to use funds effectively, efficiently, a transparently. It is accomplished through a combination of procedures, methods, rules conduct and standards which will be included as a requirement in its agreements w subrecivients. The key characteristics of the financial managementpolicies_ include, but are not limited to: • Transparency and clear accountability at all levels of operation. • All parties_ are held accountable for making sound financial decisions and following all rules and regulations. • Expenditures are planned, then checked against the plan e.., an approved budget). • Costs are reasonable, necessary, allowable, and appropriately allocated to the correct funding source. a Funds do not sit idle and are protected from misuse. • Records are clearly understood by any certified public accountant (CPA); and • Reports generated are helpful to program managers and agency leadership. Topics include: Overview and Responsibilities of Finance Department, Business Conduct Fraud Policy, Security, Control of Chart of Accounts, Journal Entries, Revenue Recognition Policies, Refunds of Revenue Received, Accounting for Contributions and In -Ki Contributions, Billing/Invoicing Policies, Classification of income and Net Asse Procedures for Grant/Contract Billing or Reimbursement Requests, Cash Receipt Reconciliation of Deposits, Accounts Receivable Management (monitoring, collection credits and adiustment, write-off authorization Procedure, reserve for uncollectible accounts, Purchasing Policy and Procedures, Political Intervention, Accounts Paya Management, _Travel and Business Entertainment, Cash Disbursement (check - writing Policies, Cash Management, Accounting Treatment for Prepaid Expenses and Leas Classification of Leases, Accrued Liabilities, Accrued Leave, Frequency of Preparation an Annual Financial Statements, Filing of Government Returns and Public Access Information on Returns Policies relating to Budgeting, Annual Audit Investment, Fix Assets (Capitalization and Depreciation Schedules), Insurance, Record Retention Poli Allocation of General and Administrative Costs. 9. Documented Retention Policy, that complies with 2 CFR 200.333-200-337 Yes, we are in compliance with the government requiring a 7 -year retention of documents for federal review and auditing purposes. 696 1. Conflict of interest Federal law (24 CFR 570.611) prohibits persons who exercise or who have exercised any functions or responsibilities with respect to the above grant—or who are in a position to participate in a decision making process or to gain inside information with regard to such activities, may obtain a financial interest or benefitfrom an assisted activity...eitherforthemselves or those with whom they have family or business ties, during their tenure or for one year thereafter. 1. Is there any member of the applicant's staff, member of the applicant's Board of Directors, or office who currently is or has/have been within one year of the date of this application a City employee, or a member of the Commission? Yes No If yes, please list names: 2. Is there any member of the applicant's staff, member(s) of the Board of Directors, or officer(s) who are business partners or immediate family of a City employee, or a member of the City Commission? Yes 1-- N0 If yes, please list names: 3. Will the funds requested by the applicant be used to pay the salaries of any of the applicant's staff or award a subcontract to any individual who is or has been within one year of the date of this application a City employee, gGa member of the City Commission? Yes No if yes, please list names: 15 697 1:114 llyid prooram, the applition, and City's procurement process, if applicable. MW MUNI IT494TUOUZU 6T­aff (-ittSUr 14,116dU411 #11 tile A. III Me %-WT" 01 AM, 1777"1. dUlIUFdFITLFM'IV;AdrrI M, is not required to verify that entities that have contracted with the applicant have been paid in full, or that such entities have paid any subcontractors in full. Applicant's warranty that all bills related to the Project for which the applicant is directly responsible is sufficient assurance for the City to award to funding. III'M " I i, I iii C L I.I. LUMM111",i UIC d"IltodLl( body of the applicant (if applicable) and that the applicant will comply with all the requirements of this grant if the application is approved. Fame;; Title: KIM - Signature: z/�� Date: Signature: Date: Iry M 698 1 Department of State P. 0. Box 6327 Tallahassee, FL 32314 TRANSMITTAL LETTER SUBJECT: k ED B �IAQH 7111 H B S ITY DEVELOPMII�M CORP. e suf f (PrOPOL colporate COMMUnclud IX) name - 9.01300:30 -?ss'] !9— — P-,.-., , 12/21/99-04007-017 Jill 1111111111 illf, III Fail wif I 13$70.00 Q $78.75 Filing Fee Filing Fee & Ceitificate of Statas E3$78.75 0$87.50 Filing Fee FilingFee, & Certified Copy Certified Copy & Certificate A FROM-, Name (Printed or typed) Daytime Telei���� This corporation is organized pursuant to the Florida Non -Profit Corporation Act, and does not contemplate pecuniary gain or profit to the members thereof and is organized for non-profit purposes. 5. Registered Office.- The initial registered office of the company shall be 428 NW 3 Avenue in Boynton Beach, FL 33435 in the County of Palm Beach. I I I I I I I I I I W I I I Ii I HIM III R I 10. BY -Laws-. The by-laws of the corporation shall be adopted by its Board of Trustees. The power to alter, amend or repeal the by-laws or to adopt new by-laws shall be vested in the Board of Trustees. Name: Courtney Cain Victor Marshall 9 9. Board of Trustees: The number of trustees constituting the organizing Board of Trustees of the corporation is seven (7), and they shall serve in this capacity offly until a full Board of Trustees has been installed in accordance with the by-laws. The names and addresses of the persons who are to serve as the organizing trustees are: Name: _Addreas: Courtney Cain 1900 NE 2 d Lane, Boynton each, FL 33435 Victor Marshall 380 NW 13 Avenue Boynton each, FL Samuel Kendrick 181 NE 19'h Avenue Boynton each, FL 33435 Jeanette Cain 1900 NE 2"d Lane, Boynton each, FL 33435 Elizabeth Jenkins 711 NW Is'Street Boynton each, FL 33435 Debra Marshall 3 80 NW 13 Avenue Boynton Beach, FL Willie Ward 4,28 NW 3"d Avenue Boynton Beach, FL 33435 10. BY -Laws-. The by-laws of the corporation shall be adopted by its Board of Trustees. The power to alter, amend or repeal the by-laws or to adopt new by-laws shall be vested in the Board of Trustees. Name: Courtney Cain Victor Marshall 9 181 NE 19'h Avenue Boynton Beach, FL 33435 711 NW 1"Street Boynton Beach, FL 33435 a28 NW M Avenue Boynton Beach,r 12.PrIndpal Place of Business: The principal place of business of the corporation shall be 428 NW Yd Avenue, Boynton Beach, FL 33435 in the County of Palm Beach. STATE OF FLORIDA ( �(, , t r 19 IN WITNESS WHEREOF,, I HAVE HEREUNTO SET MY HAND AND OFFICLA1 SEAL at Boynton Beach in the State of Florida on this De15aday cember, 1999 of '0 Chris Mummer w COMMMIGN # M027M EXPM. 3, 2001 Notary Public BONDED THRUJune TW FAIN �NSMIXE' IKO. State of Florida My commission expires: 15 12,&el Having been named as registered agent and to accept service Of process for the above stated corporation at the place designated in these articles, I hereby accept the appointment as s rther agree to comply with all sta te relatin t agent and agree to act in this capacity. I RL regi tered ormance of my duties, and am familiar with and accept the obligations of proper and complete perf ta s o the my position as registered agent. Yate F9 Section 1- Name: The name of the corporation is: Boynton Beach Faith Based Community Development Corporation, Inc. Also referred herein as the Corporation. 'Reption 2 — Definition of By -Laws: These by-laws constitute the code of rules adopted by the Boynton each Faith Based Community Development Corporation, Inc., a Florida non-profit corporation, for the regulation and management of its affairs. otion -Principal and BranchOffices. The principal place of business of this organization shall be: 404 NW 13"' Ave Boynton Beach, FL 33436 Or as the Board of Directors may designate from time to time. Section 4.— Fiscal Year: The fiscal year of the corporation shall be the calendar year. The mission of the Boynton. Beach Faith Based Community Development Corporation, Inc. is to Promote the financial revitalization of the community through business and real estate ownership, provision of services, home ownership and improvement, unification of residents, resistance to gentrification. * Develop and sustain partnerships with various groups and agencies in the Boynton Beach Target Neighborhood in order to ensure that development is streamlined and resources are put to the most efficient use. * Increase homeownership opportunities in Boynton Beach. e Reduce the number of vacant lots in the neighborhood and thereby reduce spot blight and crime. The Boynton Beach Target Neighborhood is that geographical area located in the City of Boynton Beach, Florida, that is delineated by NE & W 1 Avenues to the SOUd-4 NE & NW 13 1h AVejUeS to the North, Interstate -95 to the West and the FEC Railroad to the East. Article HI – P:HEpose The pim-pose for which this corporation is organized is to: Atni ns rIfi ticle IV – Lim'fn— 19 The initial membm of the, Corporation are to be selected by the incorporators. IQ ri �°2na t I The Corporation's Board shall consist of not less than 11 and no more than 15 members. The Corporation win attempt to maintain a board composition ratio of three (3) organization members to one I mdividual member. 5ecgqL 2 =jjeeking Conseraus: The Corporation shall seek consensus on all major policy decisions arnong its Board members, after seeking input and consensus from its full inembersWp. Section 4__=_Qq qgniftees. The Corporation's Board may establish such comn-ftees as may be viewed necessary or conver�ient. Section 5 — Officers: ' 7[he Corporation's Board shall elect a President, Vice - President, and a Secretary/Treasurer, and such other officers, as it deems necessary. The Chairperson shall preside at Corporation's Board meetings. Lection 6 — QqnfIentiality: Members shaU treat all non-public information d (either writb�n or oral) as confidential until it is officiaRy publicly released by action of the Corporation"s Board to do so. Otherwise, the President or his or her designee shall be the official spokesperson for the Corporation. Section 7 — Statements on Behalf of the C2M2ratioij. : Corporation members may speak on behalf"of the Corporation only when authorized by the President or the Executive Committee to do so. Article VII — Board MeMbprshin Section I — Selection of Board embers® A nominating committee shall prepare a slate of individual and organizational candidates for Board membership. All organizational candidates must name a designated representative as well as a successor or alternate representative. Section 2 — Functions of Succq�sor Represeiga ives. A successor or altemate representative of a Member organization may take part in all afflairs of the Id Corporation including voting only when the designated representative is unable to do so. Such successor or alternate Member representative does not assume any office held by a member representative he or she is replacing. Section 3 — Terms of #' IE The miltial Board membership "shall be broken into thirds. Approximately one-third of the board members will serve an initial term of three years, one-third will serve an initial term of two -years, and one-third will serve an initial term of one year. At the end of each initial term the board seat will be put up for election for a member to serve a three- year term, This process spreads out the election of board members such tha,i only approximately one-third of the board seats are up for election each year. Section 4 — Election Process: The slate of candidates for Board membership prepared by the nominating committee shall be presented to the Corporation membership prior to the annual meeting. Ballots will be distributed and cast by the current board members whose seats are not up for election at the Corporation's annual meeting. T�e member with the most number of votes wins the seat. In the event of two or more members receiving an equal number of votes, a run-off election will be held. Section 1 - Corporation's Board Meeting Meetings of the Corporate Board shall be held on such days as the representatives shall designate, at such time and place as shall be fixed by the Corporation"s Board and provide in the notice of the meeting. Section 2 - S eeial Meetings: Special meetings of the Corporation's Board may be called at any time by the Chairperson of the Corporation's Board or by a majority of the Corporation's Board Members. Section 3 - Notice of MeetjAW Written notice of any meeting of the Corporation's Board shall be delivered either personally, or by regular first class mail to the address of each Member's Organization and each Individual Board Member appearing on the books of the Corporation for such purpose, not less than 7 days before the date of the meeting. Every such notice shall specify the date, place, day and hour of the meeting, and general nature of the business to be transacted. A waiver of notice of any meeting in writing signed by the Corporation's Board Member entitled to such notice, whether before or after the time stated therein, shall be deemed equivalent to the giving of such notice. R Participation of a Corporation's Board Member in any meeting shall constitute a waiver of notice of such meeting, except where such Corporation Membership representative participates for the sole purpose of objecting to the transaction of any business because the meeting was not lawfully called or convened. Section - 4 Voting: At all meetings of the Corporation's Board, each representative shall have one vote, and may take part and vote only on person or through telephone. Proxy votes will be accepted if approved by a majority of the board. Unless otherwise specifically provided by the Articles of the Corporation or the Bylaws, majorities vote of the Corporation's Board Members present and voting shall govern. However, major policy decisions will require 2/3 vote. A majority vote of the board is necessary in order to designate an issue a major issue. In the event of tie, the issue will be tabled and voted upon again at the next board meeting. If the issue remains locked at the next meeting then the decision of the chairman shall preside. Section 5 — Ouonnn: At a regular or special meeting of the Corporation's Board, quorum shall consist of at least eight (8) board members present. (Present is defined for the purpose of these Bylaws as physically present at the meeting.. Section 6 - Action by Written Consent: Any action which properly may be taken at a meeting of the Corporation's Board shall be taken without a meeting if all Corporation's Board representatives have (1) been notified in writing of a resolution to act; and (2) two-thirds of the Corporation's Board Members entitled to vote consent in writing to the adoption of the resolution authorizmig the action. The resolution and written consents shall be filed with the minutes of the proceedings of the Corporation's Board Members. The Corporation's Board may waiver this requirement at a meeting of the representatives, but only for actions or decisions specified at that meeting, Section I - AuthoriMIg H �tre: The Corporation's Board may hire an Executive Director and such other staff, as they deem appropriate. Section 2 - Duties: The Executive Director shall execute the management alyi] program activities of the Corporation, including hiring of staff, at the direction of the Corporation's Board. N ARTICLE X - FiMMW.Lo a -arid n. pa jciesl subsequent meetmigs, the Corporation's Board shall adopt adequate financial and management policies and procedures sufficient to implement the proper operation of the ori anizatiOM Section 3 -,Annual Audit: All accounts of the Corporation shall be audited, at the direction the Corporation's Board, at least once a year at the' end of each fiscal year by a certified public accountant chosen by the Corporation's Board, and report thereo.n shall be transn�itted to all members in good standing. ARTICLE XI - Ban!�ng ARTICLE X11 .- Dissolution m ARTICLE X111 - it I ��r rrrroy� %liar fru u��lirr�w /u�r � m��iy�„� �1 �r if i »r ow»�ur � rirrrr�u ,�r�r a lr� % � ll� �ain I(sr � �r � � �n ��� 11(raiin�rraiir �i1r�r � � ll%l� Oji ry ' ifnla�i�r / � r r I�( 1�� f � r li u 6 `"r� ruer,,l/� rJ r �w!rntrrutm�r� ke � r ��arrn»irl�r #0656 6751 Forum D&e, Suite 220, Orlando, FL 32821 P (800) 446-0257 F (407) 352-3603 wwwNRPSlcoon I'Jabonal Registry of Food Safety Profession-,& PR SIDENT: LAWRENCE J. LYNCH, CAE ISSUE DATE: OCTOBER 2, 2019 EXPIRATION DATE: OCTOBER 2, 2024 CERTIFIcAm No* 21630688 TEsT FORM: EZS46 "Chis cerCancace is net valid forrnere U.. five y—fr— d.le of is,,e. I ri Ir fLnf JI, _fO ref r, no, NIM lug tlrraH ri Ir fLnf JI, ref r, no, NIM DocuSign Envelope ID: 39589073-4E6D-4464-9BEE-DB9CB5CCE414 State of Florida Department of Children and Families 7 Shevaun L. Harris Secretary Florida Department of Children and Families ESS Program Partner Community Partner Agreement Signature Page ESS Program Partner organization's full leg name: i Partner designated Single Point of Contact (SPOC) name: Partner Signature: rd-TITITMOTOZOTOWTO", "Wro Boynton Beach Faith Based CDC, Inc. sherry Johnson -Frew social service Director Su,v� j6LA,56t/1,-F" 1/9/2023 1 1:40 PM EST 561-752-0303 sjohnson@boyntonbeachcdc.org DCF SPOC name: Casey Penn DCF SPOC title: Assistant secretary of the office of Economic self sufficiency DCF SPOC Signature: Date: 1/10/2023 1 1:14 PM EST DCF SPOC phone number 10161 a-11-016161 NIT 9-M F. 0=6 2415 North Monroe Street, Suite 400, Tallahassee, Florida 32303-4190 Mission: Work in Partnership with Local Communities to Protect the Vulnerable, Promote Strong and Economically Self -Sufficient Families, and Advance Personal and Family Recovery and Resiliency 11 • i gra+ �� ,+ 11 '(".k, "i f i Economic Self -Sufficiency Community Partner Agreement Section I® Parties 1111 1112 1 11111111;11;1111111,11; il!liipiiiierm 11,11, Section II: Background purposesThe mission of the Department is to work in partnership with local communities to protect the vulnerable, promote strong and economically self-sufficient families, and advance personal and family recovery and resiliency. For , the Department in achieving its mission by working with individuals and families to increase Q g A Community Partner serves as an additional access point for individuals who are seeking assistance with applying for food assistance (Supplemental Nutrition Assistance SNAP), cash assistance (Temporary Assistance for Needy Families or TANF), and/or Medicaid. A Community Partner this Section IIIA Definitions 5. Point of Contact - The Community Partner must designate a Point of Contact (POC) to communicate with the Department. The signatory of this document will be deemed the Community Partners POC unless otherwise indicated, T, MEMNIM, M M11,111 !1!1111; 1111 1 1 1 1 1!11 1111111 111 1 1 pil I 1. 'The Community Partner and its employees shall not use or disclose any information concerning ESS customers pursuant to this Agreement or any applicable information or materials for any purpose prohibited by state or federal law or regulations. 2. The Community Partner shall provide the latest Department's security awareness training to its employees who have access to the Department's information. :01 000uSignEnvelope ID: oe580Drn-4E8o-44G4-gBEc-oo9CenCCE^14 of sovereign immunity or consent by the Department or the State of Florida or its subdivisions to suit by third pates. Without limiting this indemnification, the Department may provide the Community Partner (1) written notice of any action or threatened action, (2) the opportunity to take over and settle or defend any such action at the Community Partner's sole expense, and (3) assistance in defending the action at Community Partner's sole expense. The indemnification obligations contained in this paragraph do not apply if Community Partner is a governmental entity that lacks the legal authority to indemnify. Community Partner's indemnification obligations survive termination or expiration of this Agreement. This Agreement will supersede all prior agreements, both verbal and written, related to the services provided pursuant to this Agreement, and become effective based on the Effective Date of the Agreement as shown below. This Agreement shall be effective on the last Party signature date, and shall end at midnight, Eastern time, two years after the date of execution, subject to remaining reporting due for any period during which the contract was effective, This Agreement may be renewed in accordance with Sections 287.057(13) or 287.058(l)(q), F.S., and with federal approval. 1 . This Agreement can be terminated by either Party without cause upon no less than V calendar days, with a notice in writing to the other Party by mail or any other delivery service, unless an earlier time is mutually agreed upon in writing. 2. This Agreement can be terminated immediately for cause by either Party with 24-hour notice. 3. The Community Partner's SPOC shall be responsible for informing the Department -01 performance concerns of which the Community Partner becomes aware that limits or prevents the Community Partner from serving customers, including changes to hours of operation and location, and for providing the Department with documentation required by this Agreement in a timely manner. Re: ESS Partner Network Training Hormation instructions Lenia Diaz <Idiaz@wpharma,com> Wed 2/1/2023 9:54 PM To: HQW.ESS.Partner < HQW.ESS. Partner@ myflfamilies.com > Cc: Ali.Echevarria@miamidade.gov <Ali. Echevarria @ miamidade.gov> Angela Hernstreet <angelahemstreet@goodwillswfl,oi-g>;Bbrr)edicalcenter@yahoo.com <Bbmedicalcen-ter@yahoo.com>;Berioit, Phara <Pbertoit@euchc.org>;Beverlymcclain@fosci.org < Beverlymcclairi@fosci.org >;Denise Fanning <dfanning@ccgnv,org>;Diana Cardona <dcardotia@familiesfirstpbc.org>;Eastacio@feedhopenow.org < Eastacio@feedhopenow.org >;Heather Ferjuste <hferiuste@allfaithsfoodbank.org >;Hillary Gale <Iigale@feedingsouthfiorida.org >;Hines, Eunice <ENHines@chisouthfi.org>;Info@avilahealthgroup.com <info@avilahealthgroLip.coryi>;JUNECONSULTING@YAHOO.COM <JUNECONSULI'ING@yahoo.com>;Jafet Rios <jafet.rios(-Wmytruehealth.org>;Jaf-nes Wixted <jamesw@grit4u.cam>;Jamie.Ferrer@Betterromorrows.org <Jamie.Ferrer@bettertomorrows.org>;Jennifero@mulberrycsc,org <Jennifero@mtilberrycsc.org>;KSHAH@CHILDRENSMEDICALASSOCIATION.COM <KSHAH@childrensmedicalassociation.com>;Karenh@pbcms.org <Karenh@pbcms.org>;Kim.Ross@rossdynasty.com <Kim.Ross@rossdynasty.com> Received, thank you. On Wed, Feb 1, 2023 at 3:45 PM HQW.ESS,Partner <HC %1i,_ESSj1w r Ly 1anjhrns.ccwn> wrote: Welcome aboard Ess Partner Network Community Partner, let's get started!!!! Congratulations on being considered as a top candidate with The Department of Children and Families Office Economic Self-Sufficiency(ESS) ESS Partner Network. We would like to thank you for taking the time to fill out the Partner Interest force and sign The Ess Partner Network Community Partner Agreement. we are contacting you to discuss the next step of the ESS Partner Network enrollment process. Prior to gaining access to the full benefits of the ESS Partner Network, each Ess Partner Network Community Partner Member must complete the following training: * HIPPA hnfornnatJcnn and Action ( Colored red because this is a requirement'for all Community Partners) * Security /1,xvarenesIrairtng ( Colored red because this is a requirement for all Community Partners) * Service Delivery for the Deaf and Hard of Hearing * ACCESS Self -Service Portal Training * ACCESS Going Paperless: E-mail Notifications and Online Notices ® Remote Check-in for Access Notices * Voters Registration Training for Community Partners The link to the Department Training Page can be found I ics.con ren .cial -hrin im, Once each training module is completed, please attach a screenshot, PDF, or a scanned copy of your completion certificate to an e-mail before you send it back to the Partnership and Prevention team at I This will serve as a verification that you completed ESS Partner Network's training prerequisite. Please contact the Partnership and Prevention tearn if you have any additional questions. WEARE A(,',',a 0 U hil A 8 L E V A L tfD E 41k1 P OW E I'? E D " 0 El E t+A d N E D T1 A 14 S P A R 1" ?4 T ,, 0 1 TPA I O C F P4 (3,A (,"w rill - Cit" L 11, 44 8 (')P, AT 6 "UE !DEAL T1�,,,,',,,,AM NLAY07S 243 5 N. N/iM,twir.c I ,.Snte Q0 "R 1 303 Lenia Diaz I MernbersHp Development Supervisor 0:305-220-3600 Ext -10031 F;305-220-81911 M:305-570-6722 A.1_MIW:Alcamedicalcenters.com -3 AIca Medical Center fl 9778 SW 24 ST Miami, 0 33165 Larry James Small Jr, MPA Partnerships and Prevention Economic Self Sufficiency Florida Department of Children and Families off ce: 850-717-4530 HOMELESS & HOUSING ALLIANCE OF PALM BEACH COUNTY New CMIS Project Date: June 2, 2020 Organization,- Boynton Beach Faith Based CDC C'Ornpleted By, Sherry Johnson Enia rryccc@aol.corn Phone: 561-386-426,1 Pa A, - formation Project Name- Emergency Food & Shelter Program Start; Da te: on-going End Date: on-going ------------ Projcct Loca..bon- Adcess of administrative office for project; for single site housirig projects, address of pn..)ject ullfts location Address- 2191 N. Seacrest BM, Geocode- City- Boynton Beach State: FL Zip: 33435 1"'roject Co.-ntact. Sherryk hn son En-iafl: sherr.yccc@aoLcorn Phone: 561-386-4261 .Auto Exit,- Rj yes ED No Er��C'LC�L)P (check one) 0 Street Outreach Nurnber of Days: C fiornelessnes,,,, Prevention 0 PH -- Housing with Services no disability required for entry 0 Safe Haven f�D 'Ype- Housing Type: "I"arget Populatjoj,,. All Frojects, C )l-, Exit 0 EMETgsliCy Shelter 0 Transiticinal Housing H A RA'Aneal�hc­mv PH-R,IpidRehousing m i p[l - Permanent Supportive 1-1ousing aaMity r(X4Uir0d­f01'e3Y LTy 0 P11- Housing Only U Services Only 0 Dav She] ter (D Other 0 Nlight by, Night OSite-based - single site OSite-ba,SE�d DV victirns 0 Persons w f RV/AIDS 07'enant-based - scatteredsite & Not' pmplicPaable ' "Ll V_ __e _- ------- - figibi ily, Project staff, servic(-',,s d expected oLito-mnes Program is designed to help prevent ha rnelessness by provUng renVrnortgage assistance. to MCUde s 3 part-time e case managers, Any one may apply on a first come, first served basis that is de�kjuentwith their rent or past due with a rnortgage payrnent with proper, dOCUrnentafion of the emergency situation, household income, lease agreeffient, househoid idenfification, COVID '19 funding af $3,000 is ftited to fami�les within the Heart gat' Boynton information n.�' ils 2�0i ------- g�r.L 'the (--,ct stat alreacly listed We do provide street Wtreachto a small population that are horneless within the Heart of Boynton as a resuft of menta iMess and refuse housing and find it difficult to live with IOC21 family members, Wealso provide senior care services, and ernergency shefter as funds are available HOMELESS & HOUSINGALLIANCE OFPALM BEACH COUNTY Part, B ­ HOU s_'j �nq,'Tj_, L)LeLk-Ib�--di- U-P:Lt inyf Litary Ive . n.__M!2a.yfhgq sehold and Tvve Be(i Unit Invointory t Oniy 1-4- Child Children Beds 'Units Chronic Honne�ess Youth w I+ Adult I'v/ 0 1+ Adult Ordy W/ Children 14- Ch-i1cf, Children Children 1+ Chilrd Child U nits_.._.,__.__.w.. Part C - Fugdjp&Squ e vrjj.tc "Agency" Grant added to all new projest s' Funding Sotn-cc,,� J)y a.jefauft 'F,'undi j4r_IdL -_Se -vices Fundin,gr Source. COAD "19 Refief & Resources Grant 911 New [I Existing Association Start I )ate.- JWK-) 1, 2020 End Date: Septomber 30, 2020 Funding Source., ESE - Phase 37 & Phase CARES) IMI Nev[DExisting Association Sta.rt [)ate- pendng End Dale: I ---- — ------ H A Part D - Services Referral fOr Services to A nevi project' Servict=s by default Describe service_provided L)y 'LrSject at, direct services to clients and mcoyrd referral servict�s to fl -w prc .... . ..... - - ----- . . ... .... Organizafion weft prov�de RenL and MorIgage finandal asststance according to the ESP Naflonat progrm guedelines for Phase 37 and CARES. &n ad6flon, COVO-49 ReHef & ReSOUIT;es miffl provWe seraior spedaC det rneas, rentimortgage finandal assistance, senior SNAP Beelefits & On4Me shoppng CO IIOLIsehoMs specificafly 90Ce in the Heart. of Boynton targeted are,3, Ej NID LTSER LICENSE -AGREEMENT H H CLIENTMANAGEMENT' INFORMATION OS-YSTEM 'rhe Client Management Jnfox°niatjon System (CMTS) allows sharing of client inforn.lation for the j.)r(:)VISI0]I Of SeITiC(?S in -Palrn Beacti CMtrity through. a networ'ked infrastruchire that establishes electronic cornmunication a.mong Meaiber Agencies. Participation ir� fhe C'MIS enables dae collection arid shariflg ()f uriduplicated countywide aggn-egate data on homeless service deliveq. 'he CNIIS provides a standardized assessm,ent and ofotchent nereds, siripports the creation. of individe alined service j")Ias, and records thu e se of" housin.g her resevices, 11iis document outlines the role and res ponsibili ties of End Users, All Endl-j'sers have a vital role in ensuring the accuracy and quality of at , Member Agency: BOY1 Beach Faith Based CDC er Inf LkpijjgL Sherry,lohnson, Case Manager BB Faitll Based CDC Office — ----- -- . .... .. s h e q�aol.cojjj 561-386-4261 Address 2191 N. Seacrest Blvd., Boynton Beach, FL 33435 i)c ation.Address Above named urser understands and agrees to adfi-ere to all the responsibilities stated belojq- * Read and be fully fiamiliar with the CMIS Policies and Procedures, Manual * Sign an Affidavit of Good Moral Character and rneet background requirernents c)f iyly agerwy * Meet basic azomputer corripetency/ skills to adequately use and navigate CM[S * Cornplete a.11 C'MIS traininc, requirerneras * Comply with all systerrisecurity and corifidenbality policies outfiriedin the CMIS Policies and Prl,,)cedure Manual and in CMIS training (Section 1-i) * Nfaintain the confidentialit " y of assigned User.11) and password * Maintain client confidentially ari.d upbold all chentrigh[s outlined in CMIS Policies and Procedures Nlanu.al (Section 10) * Report suspect security, breaches to my Agency Adininistrator * Ente-r client data fully complyijig witl-i HUD L'Iniversal Data Elements standards * Enter client data in, real-thne adhering0 th.e CMIS Policies andl-'rocedures Manual (Sectio.n 15) * Comply with End User inactivity reqUirernents as outlined in, CTvIIS policies aIjjd Procedures Manual (Secl-iori 11) * Nlairitain. high standards of professional conduct treating clients an.d other Member 0 Agen.cies wiLh rc.spect and fahTWS,5 1. understand fliat a failure to ccamply with the above resI)()nsibs fi ties may result iri fl. -IE' ram oval or suspension of my user lirld4is-e. June 2, 2020 ifs ep,. g,aPre,, j Keturah Joseph tor Signature Ageiicy,?�.cii,.ni.nis..,ator�.,Rrintc-��d.P4ame E"I'd N:. sus Liccme ALI'vement .Rov, 8/20 7 AFFIDAVIT OF GOOD MORAL CHARACTER MINI,; Lir,,J/,%,,, P�kn Se.ch cauntv CLIENT MANAGEMENT INFORMATION'Sys,rEM State of Rodda C' ounty of Palm each Sherry Johnston, Case Manager (Applicant / Ernployee Narne) As an appkant requesfing a User Ncense for the MS systeryl l affirrn and atteSt Under, penafty of per.iLffy that l rneet ffne moral character, requirements for laid out by the Palm Beach Curity COC in that: I have not been arrested with disposition pending or fOUrid gUiity Of, regardiess of adjudication, or entered a piea of nolo contender or gURY to or have been adjuftated definquent arid the record has riot been sealed or expunged for, any offense proMbited under, any of 'the following provisions of the Florida Statutes or under any sirriiiar StatUte of another jurisdiction for any of the offenses listed beiow: ReabL�q_Lq: Section 393,135 Sei.-Hon 394.4593 sexua$ misconduct with certain deveioprnerrtafly disaNed chents and MPU"fing Of SUch se; uai rnisconduct Section 415A 11 SeXUrA misconduct with certain rrierita6 heafth patients and reporting Of SUCh seXUA misconduct 8 Section 741.28 adUft abuse, nEi&Ct, or exploitation of aged persons or cfisabied aduits or faflure to a"GPOft Of SLhch abuse SecUon 782.04 criln'ikmoffenses ffia,t cojstikde dornestic vioience, whether committed in %Hda or another jUrisdictk)n rnurder Section 782.07 rna ns la ug titer, aggravated manslwighter of an ekledy person or disabled aciLdt, or aggravated rnarislaughter of a childSecfian 782.0"71 vehimflar horrilcide Umpte,r 784 Chapter 748.048 aiiSaLdt, battery, and cupabie negfigence, if the Offense was is felony cybenstaiking Sec tion 784.011 a$SaLdt, il" the vicfirn of offense was a minor Section 784.03 battery, V the victkn of offense was a minor Section 787.01 kidnapping Section 787.02 false imprisonment Section 787.025 Wring or entic9ng as ctffld Section 787.04(2) taking, enticing, or removhig a chHd beyond the state fi;nits Vmtf, crirninal 9ntent pending custody proceeding Section 787,04(3) carrying as chiid beyond the state lines with crinninal intent to avo4 d producing an child at a custody hearing or delivering the child to thp designated person S'ection 790,115(l) exhibifing firearms, or weapons withiri 1,000 feet of a school Section 790,115(2) (b) possessing an 9featnc WeaPon or device, dJestr='Vve device, or oV-ier weapon on schooi property Section 794.011 sexual battery Former Section 794,041 prohibited acts of persons in farnflial or mstocflai authority Section 794,05 unlawful semjal activitywfth certain rninors Chapter 796 prostftufion Section 798.02 iewd and iascivious behavior Chapter 800 lewdness avid indecent exposure Section 806.01arson Section 810.02 bUrgiary Section 810.14 voyeurism, if the offense is a felony Section 810.145 video voyeudsrn, if the offense is a felony Cha pter 812 theftand/or robbery and reiated ci-Irnes, if a feiony offense Chapter 815 cornputer reiated chmes Ch4rter 815.06 offenses against computer usrws Chapter 815.034 Fiorida Cornmunicaflons Fraud Act Chapter 847,0135 CORIPUter pornography Section 31 1563 frwduient sale of controHed substances, if the offerise was a felony Section 817.568 crirrd nal Use of personal idenfification inforrriation Secfion 825.102 abuse, aggravated abuse, or neglect of an elderly person or disabled aduit Section 825,1025 Section 825.103 &ewd oriascivious offenses committed upon or in Vie presence of an eidedy person or disabled adUft Section 826.04 expioitation of disabied adufts or eidedy persons, if the offense was as ieqony Section 827.03 incest child abuse, aggravated child abuse, or ne&ct of a child Section 827.04 C01trii)LAling to the deiinqUency or dependency of a child Section 817.034 fraudUlent acts through rnafl, wire, radio, eGectroniagnetic, photo dectraf,1jr.,, or photo opficai systerns Affidavit of Good Moral Character — Rev. 12/2015 '1/2 Section 817.568 criminal use of personal identification infixrnafif.;)n Section 817.60 obtairflng a credit card through fraudulent ineans Section 817,61 fraudWen.t use of credit cards, if ffie ciffense was a felony Section 831.01 forgery Section 831,02 uttering forged instruments Section 831,07 forging bank bills, checks, drafts or prornissory note's Section 831M utt9ring forged bank mills, checks, drafts, or prornissory notes Section 831.30 fraUd in obtaining rnedicinal drugs Section 831,31 the saW-, mantrFacture, deNvery, or possession with Hie intent to se 1, rnwiufacture, defiver any counterfeit controRed substance, if the Offense was a felony. I also affirm that 1 have not been designated as a SeAlal predator pursuant to s. 775.21 ; a career offender pur'suant to s. 775.261; or as sexual offender PWSLIarlt to s. 943.0435, u0ess the requirement to register as a sexual offender tQs been rernoved pursuant to s. 943.04354. I a,rnderstarid that I R)LIst acknoMedge the exlstence of any appficable crh'ninai record relating to the above list's of offenses inciudhig those under any srnflar Statute of anotherjUrisdicfion, regardless of whether or not those records have been sealed or eXpUnged. Further, I understand that, while using as CUS license , W granted, I rnust imrnedlaWy r)Otify my supervisorlernployer of any arrest and any changes in my crirninal record invoMng any of the above fisted provisions of Fiorida StatWeS or annular staftlteS of another jUriscilction whether a misderneanor or felony. This notice must be made within one business (lay of such arrest or charge. Failure to do so could be qmUnds for termination. I attest ffiat I have read the above care�fully ar'rd state that rny attestation here is true and corre�ct ffiat my record does riot Contain any of the above listed offenses. I understand, under penafty of perjury, all users granted CMIS licenses shaH attest to meeting these requirements and agreeng to inforr'n the employer irnryiediately if arrested for any of the disqualifying offenses. I also Understand that it is my responsibiRy to obtain carfficatiorl on anything contained in this affidavat which 1 do not LHIderstand prior to sigrdng. I am aware that any crouse ons, fel sificabons, rnisstaternents or rnisrepresentafions may disqUaNfy me frorn being granted a CWser licenses;. SlGNATURE OF AFFW,I'F: -- Sign Above 09,8eloW, DO NOT Sign Both Lines -- To the best of rrry knowledge and belief, my record contains orwe or more of thp applicable disqUalifying acts or offenses listed above. I have placed a check mark by the offense(s) contained in my record. (Please circle the number which corresponds to the offianse(s) contained in your record.) SIGNATURE OF AFRANT Affidavit of Good Moral Chiracter — Pev. '12121015 2/2 END USER LICENSE AGREEMENT H A CLIENT MANAGEMENT INFORMATION SYSTEM 'PAr!!8NWh CouMy The Client Wfanagement Information System (CMIS) allows sharing orf clieritinfori-naLion for the provision of services in Pal rn Beach Counter Lhroug -i a networked infrastructure that esta Wishes electronic comii.iunication,lil)o.¢igMeriibei-Agericies. Participation intie CMLSenables the collectio andsharin, of undkiplicated Count 9 wide agg-regate data on homeless, service delivery. '11'ie CMIS provides a standardized assessment of chent needs, supports the creation of individualized service plans and records the use of housing and other related services. This document outlines the role and responsibilftks of End Users. All End Users have a vital role in ensuring the accuracy and quality of data en Ery. Member Agency: Boynton each Faith Based CDC U -ser Lnf- 2-t p1ti o n Gloria Goolsby, Case Manager BB Faith Based CDC Office Name of User/ Position or Role Locatian TI -Jame fartheroutrea(��C grnafl.com 561 -600-8925 dress Wor](Phone 2191 N. Seacrest Blvd., BoyntonBeach, FL 33435 Loca tion.Ad dress Above nained user understands and agrees to adhere to all 6.-ae responsibilities stated below- * lZead and be fully fainfliar with the 'MIS Policies and Procedures Manual * Sign an Affidavit of Good Moral Character and inert background requirements of my agency * Meet basic cornputer competency/ skills to adequately use and navigate CMIS * Complete all ("MIS training requirerneits 0 Comply with all system security and confidentiality policies outlined in the CMIS Policies and Procedure Manual and in CM1',.3, training (Section 11) 0 Maintairi the confidentiality of assign.ed User ID and password 0 Mshitain client corffl,dentially arid uphold all client rights outlined in CMIS Policies arid Procedures Manual (Section 10) I.Zeport suspect securitybreaches to my Agency Administrator Enter chent data fully complying wjtl-a HUD Universal Data Elernents standards Enter client data inreal-time adhering the CHIS Policies and'Procedures Manual (Secfion 1,5) COMP137 witli End User inactivity requirements as OLIffined in CMIS Policies and Procedures Manual (Section i. "1) Maffitairhigh standards of professional conduct treating clients and other Merriber Agencies with respect and fairness I understand that as fililUre to coinply wifh the above responsibilities may result in theremoval or, stispension of my user ficerise. June 2, 2020 Date Keturah Joseph Agency Administrator PrintedNarne T',nd User Licemse Agreement -- Rev. 8/2017 1/1 Gloria Goolsby, Case Manager As an applicant requesting to user license for the CMIS system l affirms and attest under penalty of perjury that ! meet the moral character reqUirernents for Raid out by the Palrn Beach County COC in that: I have not been arrested with disposition pending or found guifty of, regardless of adjudication, or entered a plea of nolo contender or guilty to or have been adjudicated delinquent and the record has not been sealed or expunged fOl', any offense prohibited under any of the following provisions of the Florida Statutes or under any similar statute of another, Jurisdiction for any of the offenses listed below: HE= Section 393.135 Section 394.4593 sexual misconduct with certain developmentally disabled clients and reporting of such sexual misconduct Section 415,111 sexual misconduct with certain mentai health patients and repoiling of such sexual rnisconduct adult abuse, neglect, or exploitation of aged or disabled Section 741,28 Section 782.04 persons adults or failure to report of sucti criminal offenses that constitute dornestic vVen, w jurisdictionabuse cehether comFloridaor another mitted in Florid murder Section 782.07 rnansl@Ugriter, aggravaced manslaughter of an elderly person or disabled adult, Oraggmvated manslaughter of a child Section 782,071 vehiCLIiar hornlcide Chapter 784 Chapter 748.048 assault, battery, and culpable negligence, if the offense was a felony cyberstalking Section 784.011 assault, if the victim of offense was a minor Section 784.03 battery, if the victim of offense was a mirror Section 787.01 kidnapping Section 787.02 false irriprisonment Section 787.025 luring or enticing a child Section 787.04(2) taking, enticing, or removing a child beyond the state limits with criminai intent pending custody proceeding Section 787,04(3) carrying a child beyond ffie state flnes with criminal intent to avoid prodUCing a child at a custody hearing or delivering the child to the designated person Section 790.1.1 5(1) exhibiting firearnis or weapons within 1,000 feet of a school Section 790.115(2) (b) Section 794.011 possessing an electric weapon or device, destructive device, or, other weapon on school property sexual battery Former Section 794.041 prohibited acts of persons in farnfliai or custi,.)diai authority Section 794,05 unlawful sexual activity with certain rninors Chapter 796 prostitution Section 798.02 lewd and i8SCMOLJs behavior Chapter 800 lewdness and indecent exposure Seclion 806.01 arson Section 810.02 burglary Section 81 OA 4 voyeurisrn, if the offense is a felony Section 810.145 video VOYeUrisrn, if the offense is a feiony Chapter 812 theft and/or robbery and related crimes, if a felony offense Chapter 815 computer related crimes Chapter 815.06 offenses against computer users Chapter 815.034 Florida Corn al U nicatior is Fraud Act Chapter 847.0135 Computer pornography Section 8117.55'3 frauciLdent sale of controlled substances, if the offense was a felony Section 817,568 criminal Use of personai identification information Section 825,102 Section 825,1025 abuse, aggravated abuse, or neglect of an elderly person or disabiled adult lewd or lascivious offenses committed Section 825.103 upon or in the presence of an elderly person or disabled adult exploitation of disabled adults or elderly persons, if the offense was a felony Section 826,04 incest Section 827.03 child abuse, aggravated child abuse, or neglect of a child Section 827.04 contributing to the delinquency or dependency of a child Section 817,034 fraudulent acts through rilail, wire, radio, eiectrornagnefic, Photo electronic, or photo optical systems Affidavit of, Good Moral Character — Rev, 12/2015 112 Section 817.568 cdrnunM use of personal identffication 4-iforrnation Section 817,60 obtaining a credit card through fraudWisrlt means Section 817.61 fraudulent use of credit cards, of the offense was a feGony Section 831,01 forgery Section 831.02 uttering forged instrUrnents lZection 831.07 forging bank bffls, checks, drafts or promissory iIotes Section 831.09 uttering forged bank Uls, checks, drafts, or promissory notes Section 831.30 fraud in obtaining rned¢cinal drugs Section 831.31 the sale, manufacture, deflvery, or possession with the intent to sell, manufacture, de ever any counterfeit controhed substance, if the offense was a fetony, also affirm that I have not been designated as a sexual predator pursuant to s. 775,21; a career offender pursuant to s. 775.261; or a sexual offender pursuant to s. 943.0-1135, unless the requirement to register as a sexual offender has been removed PUrsuant to & 9,43.04354. b understand that I MUSt acknowledge the exlstence of any aprftaUe crirninal r"er=-d relating to flhue above lists of offenses incUing those under, any sirnflar statute of another iurisdiction, regardless of whether or not those records have been sealed or expunged, Further, I Understand that, while using a CMI S license , if granted, i MUSt irllfflediate9y 110fify my supervisor/ernployer of any arrest and any changes in my crirninal record invoMng ary of the above Hsted provisions of Florida StatLACaS or, similar St2tUtes of another jUris diction whether a misdernearior or felony. This notice mast be made within one business day of such arrest or charge, FaHure to do so cotAcl be grounds for termination. I aftest ffiat V have read the above c,'arefuHy avid state that rny attestation here is true and correct that my record does not Contain any of the above listed offenses. i understand, tinder, penalty of perjury, all users grante)d CMIS licenses shalt/ aftest to rneeting these requirements and agreeing to inforrn the employer inirnediaWy if arrested for any of the disqualifying offenses. f also understand that it is my responsibility to obtain clarification on anytNng confainead in this affidavit which i do, not understand prior to signing. l am aware that any omissions, falsifications, rnisstaternents or rnisrepreSEmtations may disqualify me frown being granted a CMIS user liconse. & S GNATURE OF AFFIANT: -- Sign Above. OR Belo%V, DO NOT Sign Both Unes To the best of may knowledge and belief, my record contains one or more of the applicable disqualffying acts or offenskis listed above. I have placed a check mark by the offense(s) Contained in my record. (please circle the nurnber which corresponds to the offense(s) contained in your record.) SIGNATURE OF AFRANT: Affidavit of Good Mora6 Character — Rev. 12/2015 212 Assist.A.gency Portal Ternis and Conditions 21s.sIslAgKoiry Pbrial prates - revised 0717012019 MY By entering thiswebsite, you are indicating that you have the authority for your.Agency to agrec to these terms and conditions, and that you and your. Agency (Registered Representatives) desire to have, limited access to the Florida Power & Ught Company (herehireferred tons "MIL") Assist Agency We Portal (herein referred to as "Portal") in order to criginate and post conirnitments (payment pledges), view limited cwstomer billing information needed to assess and qualify ibr sa ' id commitmems, and receive e-mail notifications of transactions processed by your Agency through the MUL Access to any of this unfair mation by you and your Agency is confingent on your consent to the ffillowing tel.Ins and conditions: You and your Ageticy will riot disclose anY , FPL -owned infbrination or customer information to as third party without first having obtained the vviftten authorization r..)f FPL. Your Agency shall store arld dispose of tile infonnation you receive tinder this Portal in as secure rr-lanner, limiting access to information Only to other Agency staff on l.'i need to know basisonly, Upan your enrollment, your Agency R Lepresentatives will be given a unique Portal Representative Number that will be used (by, each. representa&6) to register for Flortal access, You and your Registered Representatives are solely responsible for the confidentiality and use ofyour/their ID and password, kind for the trartmotions accomplished by the use of your password. It is also your responsibility to update your Agency's onfine account information immediately upon, any changes to the infornlation, including additions and deletions of'Registered Represnitatives and/or their roles hi the Agency, Sharing of passwords is strictly prohibited, Yowwrill be responsible for any clairns for dainages resulfing from ycair failure to keep your password con.fidential or caused by the misuse of your passwot.d by unauthorized parties. FTIL shall not be responsible for your fifflure to gain access to the Portal or the availability of the Portal clue to events beyond FPL's control or as as result of regular maintenance of tile Portal. You shall be responsiblefor accurately entering both Agency and customer hilbrmation on tile Portal, FPL reserves the right to temikiate your Agencys access to ally information niade available via this Portal if FPL discovers, and in its 9010 jUdgment deterinines, that you have failed to ineet FPII's requirements contained in these terms or have violated any app!cable law or regulation or any of FTL's cyber -security or confidentiality procedures. FPL shall not be held responsible for violations of the law or of these tenns by you. By entering this website, you are incfic�fing that your Agency also agrees that access to oustorrier hilbrimation shall only be I-"c)r the sole purposes of determining whetlier or not a FTI, customer, beingassisted by, the Agency, is eligible for ofifity funding assistance, and .for the purpose of committing such assistance if customer is deenled by Agency to be eligible for the assistanee. Customer hiformation—shall not be used for any otherpurposes not specifically authorized under this Section. By accessing the FPL Prjrttdycrtj jinderstand and acknowledge that prior written consent and pen-nission by FPUs custom.er of record, an authorized party listed on hi(, or her account, or his/laer legal representative mu,,,I, be granted before you are, authorized to access the Portal to view the custorner's data,, FPL reserves the right torequire that your Agency provide ray 'of a customer's written consent. YOUr fMILIM, to promptly provide evidence of customer's prior written consent may result in your termination froin this Poital without recourse, 6 fatal_, pucmlicy strictly prohibits, Registered Representativew s ho have access to the Poruji fyoni using it to perforin payinent assistance transactions on their own FJ�L electric account(s) or any other customer account outside the Agency's payinent assistance process, Such transactions are considered "'unauthorized transactions," Any Registered Representative seeking paymentassistance fbr their FPL account should contfict hishier Agency supervisor,, who may confact the FPL area inanager for direction and information. a The Portal may be niodified in part or discontinued by.FTL at any finie, 1 , licluding revising or updating the hiffirmation provided, or teens of use and the services pr(lded through the Portal. Should the Portal be modified or discontinued, you witi be given 30- days advance notice by e-mail and shall be subject to any modifications until termination of the enrollment by either paily, 6 'I"he Portal will be mrailable 24 hours a day, 7 days a week, with the exception of any three required f.br maintenance of the online systern, In the event of a temporary ordine system outage, reasonable effiort shall be made by F,?L to notify you of'such via broadcast ernail frorn 1,?L, or via as notification on the Portal hornepage, & Your pefticipation and use or the Program does not Convey ally riglits or license to you except as specifically set fbith in these terrrks, and you agree to use and access the information solely for the purposes set lbrth in, these terms, 0 Cancefingyour onffile access to tile Portal will not cancel any pending commitrnents that you have made online, and your Agency will be required to fulfill any coin in itirtunts outstanding at the three of cancellation. & FPL will stf,:)re and protect your onfine identifying ird-brination in the sanie manner Lather personal custorner hiformation is stored and protected, Disclosiare of this inforniaticin shall only be made. when FPL is required to disclose it by law. 6 FPL INFORMATION AND DATA RROVIDED TN THE KXRTAL ARE PROWDED FOR REFERJ--!NCE PURPOSES ONLNr AM) IS PROVIDED TO YOU "AS IS" WITHOUTA24YWARRANTIHS OFANYTYPE, EXPRESS OR TWILFE-1.). FPL DOES NOT WARRA14T, REPRESENT OR,, INFORMATIONORDATA PROVIDED INT.HE, ONLINJ'J""IROGRAMJS CORREC.r, ACCLIRATE OR FITFOR A-NY PAWNCULAR USE OR PURPOSE BY'YOU As OF THE DATETHE INFORMATION IS PROVIDEDTOYOU OR OTHERWISE. "I'lio Assisa Agency Portal is within, the FPL,comwebsite, and as such theAssist Agency Portal is governed by the Teryis and CoLldi the sarne is incorporated by reference herein, hi the event of a conflict between the provisions of these'l"'erins and Conditions and the FPI-comTerrns and Conditions, the provisions most I'avorable to FPL shall govern. * Your consent to these ternis, and condiflonqshall be bindhIg L11,1011 you andyour Registered Representatives, successors and perrnitted assigns. -No other person shall h w e any right against FF1, hereunder. * This Agreement shall be governed by Jaws ofthe State of Florida, * Electronic Consent. By participating in the Assist [Irogram governed by this Agreonie.nt or consenting to this Agreement electi-nnically, you agree to be as bound by this Agreement as if you had executed this Ag reeinent by affixing your signature. ASSIST Partner Organizatiori Applicat1w r -PL Dir_mlpri: To register as a partner organizafion in the FPL. ASM"r Prograffl, please compfete Ws appHcaflon and mall to the address provided on the cover letter, or ernaH to RL SpecW C ormurner Services Area Manager, Upon receipt, the Area Manager wiH contact you to corifirm activation in the prograrn. Fields with an asterisk (*) are required; processing may be delayad if riot provided, , �/ X4 Organization Name * /--,/ )) . , ( ZLA, t_Z12 (as, registered with the Statp, of Flojide) / Q COUnty(s) Organization Type (cherif one) Govt ri FaRh-based o N -p 'OtheTqj ft ca" r D Funding Sourcem (check ail applicabte) LIHEAP o EHEAP rj FEMA r -.r Care'Fo Share c3 Other R-_ FederaIJDNurnber' Telephone NumberF'ax Number Lz WiaffingAddrass* 6-1 Zip E-mail Address E/i 'x! /7 City Operation Hours (chockappfirable) Mon ii— Tues o,")Afed t--r"Thur Fri Hours: Organization Primary Principal Information Pre fi,,r First Name 71,1,41,t Last Mame Title Orgarlization Secondary Principal Information Prefix Hast NarneSt Name La e Title jkZ",J, Employees Authorized to Contact FPL Plaase liet all mpityeas, auihofi?G�J 16 rommunicate "41h FPL paymont assistance �� fijnrt,�, be provided infotmathm, on behalf of ws*gmonc (phmsp Provide lir st and kist narnas). E"inployeos not listed MI/ riot By signature, d confirm aiat all information provided is accurate to the best of my knowledge, acknoMedge reading arid Understanding theAMST AQerroy Commitment Agreement Standards, and agree to cornpiy with them as an ASSIST Partner Organization, I also confirm that inforniation provided by l -"PL wHi be used only for purposes car quatifyijig custorners for payrnent assistance, as stated in the ConfidenUality section of the AS='r Agency Commitment Agreement, Primary Principal Signature and 'Ito; L /Nease return completed form to the tt er"tat orasrarner Services; Manager for your area. Authodzaflan AppltcaUon - 08 11 14.dw, ASSIST Agency Working.Agreement (Revised 711012019-SOO Ovel-VICIV The 1,111, ASSISTPhone Center and Web Poital were established to provide nonprofit and govermiierital agencies assisting FTL CUStOMCrS with utility payments a direct contact point to verify custorner account in-forination andnotify FPL of pending assistance payments, Wbon a participating Agency makes a commitnifnit (promise of a pay sleet;), FRI, notes the customer's account, thereby protecting the accomit and suspending, collection activity for the amount of the commitment. Commitments are made only by the Agency inaking the pqyrnent. A commitnient is not considered valid if the Agency is seeking only to protect the customej-'s account until another Agency carr be found to pay the bill, or until the cus toxner makes the payrnenC 2. Authorized Agencies Non -Profit agencies must be currently registered with the State of Florida (Y�L aqq g) to be considered as an ASSIST Agency, Those agencies that agree to follow the guidelines provided herain will be granted authorization to use the FK, ASSIST'Phone Curter' and/or Web Portal. To maintain the ffitcgrity of both the Agencyand FPL, the Agemey will provide Rpl. with the address (location) of tire Agency, and maintain a list of case workers authorized to comnlit Agenoy funds,ror the respective location(s). FPL will accept commitments only from those locations and workers whose location and -names appear on the list, which have been confirmed by FPL For non-poilal users changes (additions/deletions) to the list of authorized Location/Agency workers must be made in writing on Agency letterhead and signed by the Principal, These ohanges can be &xcd, emailed or inailed to 1413L, Portal Registered Rcpresentativts with the managernwit role will have the ability to make these changes in the. poft-al. Ageney eniployecs, niny not make commitments for each other or for themselves, The Agenray Principal may contact the Area 13pecial Consumer Services managor to request a conimitment :for air .AgenGy worker's accotint, I ConfidentLility By lave, FPL is reqcdred to treat ctistomer and customer payinent inIbmiation as corcride.tifial, and requires that Agency workers and agents take the same degree of care with such confidential information, Conduct whieh jeqpardizes tile confidentiality of records (e.g. Agearcy workersusing the Assist Phone Center and/or Web Portal to obtain infonnation.cera a customer Bor personal reasons�) will result in Agency Agreement suspension and/or tormination. Inib-i'mation provided by FPL can oniy be used for purpo sus of qualifying clients for paynient , -is sigtance. to � 0 Ageneics will not have any obligation with respect to any such cmifidential ffiffirmation which (a) was in the Agency's possessionprior to the time it was disclosed by FPL;(b) is or beconies available to the general public through no fault of the Agency; (c) is disclosed , to Agency without rntriction on disclosure by as tl-tird,party who has the lawfulright to disclosesuch information or; (d) Agency is legally conpclled to disclose. All clients ,Ipplyingf()i-,,tssistance.inust sign ars ,Authori7afion for Release of General and/or Confidential Information application, giving authorization to the Agency to obtain Customer information f'romM., on the clierit's behalf 'I'heAgericyvvorl<eroragent iii-ustlIso sign. the Authorization for Release of General and/Or Confidential Inforynation application and maintain theBorm in local records/files. Ifthe Agency uses an alternative At,ithorization forma as part of its normal intake process, it may be used in lieu of the FPL [brin, upon approval by FPL 4Commitment Guidelines Conunitnients must be paid within 60 calendar days or less fi°om the date the conitnit-nient is made, I Conlinitments must be itemized using an FPL Paym-encrransmfttaf fbini or corrkpitter generated fhesirnile of the FPL Payment Transmittal form FPL Transmittal envelopes should be Used when remitting Agency paynieiit and FPL. Transmittal forms, as appropriate, M sorne cases, agencies may not be able to use the Transmittal flarrn and/or envelope because of their accowiting system and/or the volunie of items being submitted. In sLich cases, Transrnittal envelopes (checks and formas) must be mailed to: FPL - ASSIST P.O� Box. 2S231 Miami FL :f5102-5231 Agencies may not charge the Customer a fee, reqUest a donation, or receive any other form of rernuncrationfbr making a ournmitment on behalf of a customer. 5. Retracting Commitments ShOL11d it become necessary for an Agency to retract (a,aricel) a commitment, the Agency will provide FPL with -written notification of the retracted oornmitinent on Agoncy letterhead or by c' - n -tail, approved by the Principal (President, Vice -President, Director, Manager ., Supervisor or other, as listed), The retraction can be faxed, emailed or mailed to FPL, Notification should frac; lade the custorner's narne, account number, address, the arno tint of the conamitment, and the reason the commitment was retracted. A copy of the written notification provided to the cwstomer by the Agency is to be included in FPL's notification. 6. Ageney Participation Agencies requesting authorization to utilize the FPL ASSISU Phone Center and/or Web Portal must complete and sign an FPL ASSIS'J." Agency Authori7ation Application and return it. to FPL niongwith required docutnentation. Agencies sr brnnting completed applications agree to fbIlow the terms and conditions of the aggreci-nont. All application fieldsare required and will be verified Nvith appropriate governing bodie& Agencies will be denied or delayed if required infbrrnation is incomplete or erroneou.s. ASSIST —A Tjlr�c Agencies are, also required to complete the Authorization fOr celeseof General andYor. Confidential Jhfomiatioij f'crarr® Both the client and the Agem,;3, must sigtt this authorization fbi-ril before any confidential FPL infbiniation is disclosed. The Authori7atioij for Release form should be maintained by the Agency in the applicant's working file, FTL reserves the right to SLISpend and/or terminate the ser vice provided to AAcacias through ffie ASSOTPhone Center and We Portal if the Agency does not comply witil ffic guidefines outfined herei.n. Prior to any suspeasion or termination action, Agencies will be advised of any problems or concerns, and informed of arty corrective actions required to remain active, in writilig by certified mall. Ifthe Agency does not take satisl-a ctory corrective actions, the agreement will be sme pended fibra 60 -day period or until such time asany problems have been resolved. Agreements suspended and not resolved within 60 days will be tenninated, Future agreements form terminated Agencies will not be acceptecl until arly pl-evious infraction has been resolved tc) the satisfaction of FPL and corrective actions have been established to prevent reoccurrence. Um 1.7his agreement has beerx reviewed by the undov,,rigned5 rej)resenting the Agency and FPL. it Agency Princip'alSign.atureffiate FPL Area Manager SigDalure/Date Agency Prinaipal Name (printed) ITI. Area I'vIanager Name (printed) A gency bu Ancy Name Assist Agency Portal User Acknowledgment As an authorized Assist Agency Registered Representative, you are indicating that you agree to these terms and conditions, and that you desire to have, access to the Mor lda Power & Light Company (herein reffarred to as "PPL") Assist Agency Portal (herein referred to as "'Portal") in order to originate and post commitments (payn-Rnt pledges) and view 11mited customer billing information needed to assess and qualify for said commitments. Access to any of this information by you is contingent on your consent to the following: & You will not disclose any FPL -owned information or custorner information to a third party without first having obtained the written authorization of FPL. You will utilize the information you receive under this Portal in a secure rnanner. & Upon your enroliment., you wiH be given a unique Poi'W Representative Number that you will use to register for Portal access. You are solely responsible for the confidentiality and Use of your ID and password, and for the transactions accomplished by the use of your password. Sharing your password is strictiy prohibited. @ You shall be responsible for accurately entering both Agency and customer information on the Portal. FP1. reserves the right to terminate your access to any information made available vla this Portal if FPL discovers, and in its so9e jUdgMent deteralhies, that,you have -failed to meet FPL.'s requirements contained In these terryis or have violated any applicable law or regulation or any of FPL's cyber -security or confidentiality procedures. @ By entering the Portal, you are kidicating that you agree that access to customer information shall only be for the sole purposes of deterinrining whether or not a FPL custorner, being assisted by the Agency, is eligible for utility funding assistance, and for the purpose of committing such assistance if customer is deerned by Agency to be eligible for the assistance. Customer information shall not be used for any other purposes not specifically authodzed under tills Section. o By accessing the Portal, you understand and acknowledge that prior written consent and perrnission by M.'s customer of record, an authorized party listed on his or her account, or his/her legal representative must be granted before you are authorized to access the Portal to view the customer's date, • FPL policy strictly prohibits Registered Representatives who have access to the Portal frorn using it to perform payment assistance transacflons on their own FPL electric account(s) or any other customer account outside the agency's payment assistance process. Stich transactions are considered "Unauthorized transactions." Any Registered Representative seeking payment assistance for their FPL account should contact his/her Agency supervisor, who may contact the FPL area manager for &ectlon. • Your participation and use of the Program does not convey any rights or license to you except as specifically set forth in these tPrms, and you agree to use and access the information solely for the purposes set forth in these terms. • FPL will store and protect your on line ldentlfyft information in the sarrie manner other personal customer Mformation is stored and protected. Disclosure of this 'Info rmatio rn shall only be made when FPL is required to disclose it by iaw. By participating in the Assist Program governed by this Agreement, you agree to be bound by this Agreement based on your signature Wow. cy Portai Use Signat6r' Date Agency Principal Signature Date -P Liner LI' Agency Portal User Printed Name Agency Principal Printed Name Assist Agency Portal User Acknowledgment As an authorized Assist Agency Registered Representative, you are indicating that you agree to these terms and conditions, and that you desire to have access to the Morlda Power & Light Company (herein referred tc) as "FW) Assist Agency Portal (herein referr"ed to as Vortad") in order to originate and Past commitments (payment pledges) and view limited CUStWner Ming information needed to assess and qualify for said COMMitments, Access to any of this information by you is contingent on your consent to the follow lng; 0 YOU will not disclose ally FPL -owned information or custamer information to a third party without first having obtained the written authorization of FPL, You wfll utilize the informatiorl you receive under this Portal in a secure manner. * Upon YOUr enrollment, you will be given a unique Portal Representative Number that you yjj6j use to registerfor Portal access. You are solely responsible for the confidentlaHty and use of your ID and password, and for the transactions, accomplished by the Use of your password, Sharing your password is strictly prohibited, * You shall be responsible for accuratefy entering both Agency and customer Wormiation on the Portal, FPL resenies the right to terminate your assess to any hfformaflon made available via this Portal if FPL discoverers, and in its sole judgment determines, that you have failed to meet FPL's requirements contained in these terms or have violated any applicable is or regulation or any of FPL's cyber-securfty or, confidentiality procedures. * By entering the Poral, you are indicating that you agree that access to customer information shall only be for the sole purposes of deterrnining whether or not a FPL CLISWmer, being assisted by the Agency, is eligible for utility funding assistance, and for the purpose of cornmitting such assistance if customer is deemed by Agency to be eligible for the assistance, Custorner information shall not be used for any other purposes riot specifically authorized under this Section, * By accessing the NxW, you understand and acknowledf, ge that prior written consent and permission by FPL.'s custorner of record, an authorized party listed on his or her account, or hfs/her legal representative must be granted before you are authorized to access the Portal to view the customer's data, * FPL policy strictly prohibits Registered Representatives w1jo have access to the Portal from using it to perform payment assistance transactions on theirown FPL electric account(s) or, any other customer account outside the agencVs payment assistWVCe PI'Ocess- Such transactions are considered 'unauthodzed transactions." Any Registered Representative seeldng payment assistance for their FPL account ShOUld contact his/her Agency Supervisor, who may contact the F131, area manager for cilrection, * Your participation and use of the Program does not convey anV Hghts or license to you except as specifically set forth in these terms, and you agree to Use and access the information solely for the purposes set forth in these terms, * FPL will store and protect your online ldentifying 4-iformation in the sarne rnanner other personal cost orner information is stored and protected. Disclosure of this Information shafl orfly be made wherl FPL is required to disclose it by law, By Participating in the Assist Program governed by this Agreerrient, you agree to be bound by this Agreement based on your signature below, AgencyNklme Agency Portal User Signature y Date ZI _ j Agency Portal User Printed Narne Agency Pdricipal Sigriat ,Ljr? Date '- L/L'+... _—L _z_ 2:�� Agency Principal Printed Nn-ne Public License Information License Number: 23-00016590 Location ID: 000006103 Business Control: 0014478 Business Information Business Name: BOYNTON BEACH FAITH BASED Business Address: 2191 N SEACREST BLVD BB BOYNTON BEACH FL 33435 Mailing Address: COMMUNITY DEVELOPMENT CORP. PO BOX 337 BOYNTON BEACH FL Application Issue 33425 Owner Name: COURTNEY CAIN Date Opened: 06/13/2002 Business Phone: (561) 752-0303 Contractor Flag: Type of Ownership: CP Status: Active Name Title Address Address Email CityState,Zip Phone 1 2 ID COURTNEY CAIN PRESIDENT 33435 Showing I to 1 of 1 entries License Information Classification: CU2 - CERT OF USE & OCC COMM License Status, ACTIVE, 09/09/2022 Date: Application Issue 08/21/2018, 09/09/2022 Date: License Valid Thru 09/30/2023 Date: 09off � �1= Code Description Document Number Expiration Date Showing I to 1 of 1 entries BN BEACH FAITH -BASED COMMUNITY DEVELOPMENT CORPORATION, B0YNR)NB11:.ACHj1, Registration Number:CH12112 Expiration Date : 1/25/2024 Revenue Source : IRS 990 Form (12/31/2021) Total Revenue : $529,466.00 Program Services Expenses : $397,677.00 78% Total Expenses : $612,629,00 Administrative Expenses : $114,952.00 22% Surplus/Deficit: $16,637.00 Fundraising Expenses: $.00 0% 3 R �� $1M Line of Credit, Senior Helpers — Fundraising Social Media — Fundraising "Network Food Good" First Presbyterian Church Delray — Mission Support $5,000 Annually Boynton Angels in Action — Fundraising Events — Tivoli Walk a Thon, Fountains Tennis Monthly/Qtrly Donors - $2,500 Annually Wells Fargo Fund - $50,000 Various Donations through out the year Benvenubƒs Restaurant —217Meals otThanksgiving H/Q[TFoundation — Turkeys for Thanksgiving ChhatFaUovvshipChuroh—ThanksgivinBBasket , Holiday Baskets and Gifts Efreas River Garden Club — Floral Arrangements for seniors at Christmas Boynton Angels in Action — Mobile Pantry Shopping & Delivery for homebound seniors and families Barclay Philanthropic Club — monthly sandwiches and fruit donations PBCFDodBank—GrooeriesforSenionS Programming for Health and Wellness YMCA — Nutrition and Blood Pressure HATTFoundation—DiabehesEduoation DenniaMob|ey-YOGA& Chair Exercised PACE— Resources for Health Care PamBeachHan/eot—FneshFoodPantryitemo Jim Moran Foundation Elder Care — July 1.2022 thmJune 30,2D23for $66.000—Pending renewal April 13 Family Strengthening — July 12O22thruJune 3O,2O23for $58.1DD—pending renewalAoh|13 Discretionary Funds —April 2022 thru April 2023 for $30,000 — pending renewal April 13 Capacity Building Grant Application for $3D.00Opending Healthier Boynton — Mini Grant Grants A, B. &C Mini Grant A.B & C have been completed C finalized on Dec 31, 2022 for $4,000 for senior meals Spring Application has not been issued Partnership for Aging $1.00Ofor senior care Irving |Moskowitz Foundation '$2.5O0for senior Care Lost Tree Charitable Village $11.Q0Ofor Technology addressing senior isolation completed AG&AS Zimmerman Foundation -$1.00Ofor Food City VfBoynton Beach CDBG-CV*37O.G45 Public Services 0O2.00O Senior Rehab -$40O.00U Senior Housing Acquisition $5O4.000 12:44 PM Boynton Beach Faith -Based CDC, Inc. 03126123 Profit & Loss Accrual Basis January 2022 through February 2023 Ordinary Income/Expense Income Direct Public Support Congregational Contributions Corporate Contributions Gifts in Kind - Goods Boynton Angels In Action Boynton Angels In Action - Other Total Boynton Angels In Action Gifts in Kind - Goods - Other Total Gifts in Kind - Goods Individ, Business Contributions Affordable Food Pkg Boynton Angels In Action Angel Bucket Contributions JG & AS Zimmerman Fnd Total Boynton Angels In Action Senior Meals The Barclay Philanthropic Club Wells Fargo Affordable Food Meals Wells Fargo - Other Total Wells Fargo Individ, Business Contributions - 0... Total Individ, Business Contributions Total Direct Public Support Grants City of BB CDBG Housing Rehabilitation Senior Housing Acquisition Total City of BB CDBG ............. . . . . . . . . . . . . ir W 'I", 11 Other Types of Income Miscellaneous Revenue Total Other Types of Income Total Income Gross Profit Net Ordinary Income 5,000.00 -132.00 9,682.54 9,682.54 66,051.08 75,733.62 3,257.40 2,058.21 2,000.00 4,058.21 329.00 375.00 13,000,00 12,000.00 25,000.00 50,000.00 4,801.58 62,821.19 143,422.81 400,000.00 504,000.00 904,000.00 4,000.00 2,500.00 16,000.00 -e-6,000.00 58,100.00 40,000,00 -9,216.00 1'000 00 1,122, 384:00 2,400.00 2,400.00 -356.60 _356.60 1, 267, 850.21 1,267,850.21 1,267,850.21 ima 12:44 PM Boynton Beach Faith -Based CDC, Inc. 03/26123 Profit & Loss Accrual Basis January 2022 through February 2023 1,267,850.21 August 1O.2O22 Iry Kiffin Please sign and return this letter ofcommitment tomeconfirming that Boynton Beach Faith Based Director Community Development Corporation will comply with The Jim Moran Foundation's funding allocation and communications requirements, Lucia Lopez The Foundation's mission is to improve the quality of life for the youth and families of Florida Secretary through the support of innovative programs and opportunities that meet the ever-changing needs of Director the community. With this gnant, we recognize the positive impact you are making by providing home -delivered healthy meals and fresh produce, housing assistance, and social connections to help seniors maintain their independence and we||'being. Michael G. Neam, M.D. Director Melvin lStith, Ph.D.Attachments Founding Director Sincgrely, In accordance with The Jim Moran Foundation, Inc.'s funding and communications requirements stated above, Boynton Beach Faith Based Community Development Corporation agrees to utilize the $66,000.00 grant for the Elder Care - Aging In Place Program. In addition, periodic updates and impact reporting will be provided as requested by The Jim Moran Foundation. KetunahJoaeph. Boynton Beach Faith Based Community Development Corporation M Memory of oz Courtney Cain, President 7 HE Jim Moran Sharon Johnson -Frew, Social Service Director MMER Founder 100 JIM M0R4N BOULEVARD, DEERF|ELD BEACH, FLORIDA 33442 1918-2007 Phone: S5442R2122 wwwjimmomnfounda1|0n.org K4o. KetunahJoaeph Board of Directors Executive Director Boynton Beach Faith Based Community Development Corporation 2191 N. SeacreotBouievond Boynton Beach' FL 33425 Jan Moran Chairman and President Dear Ms. Joseph: Founding Director On behalf of The Jim Moran Foundation, I am happy to notify you that your request to support the Elder Care - Aging |nPlace Program has been approved inthe amount of$BG.00Q.0D.Enclosed ie Tom Blanton the payment according tothe attached budget and expected outcomes. Assistant Treasurer Founding Director Our funding is based on the current status of Boynton Beach Faith Based Community Development Corporation as apublic charity under sections 5O1(o)(3)and GQQ(a)(1)or5O9(a)(2).Consequently, should there be any change tOyour tax status, you are required tOnotify The Foundation Melanie Burgess iODnMediebs}y. /t is also necessary to contact VS with any potential adjustments in program delivery Vice President from what was presented and approved during the grant application process to determine if there are Assistant Secretary funding implications. Founding Director FxocutieDiremto/ We understand the importance of creating cause awareness, as well as acknowledging partnerships invested inserving our community. Should this grant generate anannouncement or recognition (i.e., press release, print ore-nevva|etter. logo uoege, social media. etc.), SuounEooher The Foundation respectfully requires prior review and written approval. |nsuch mentions, please Treasurer refer to us as The Jim Moran Foundation, For further assistance with your communications, or to Director begin the review and approval process, please contact ||isa Finke|mon atg54-3G3-S55Omr Iry Kiffin Please sign and return this letter ofcommitment tomeconfirming that Boynton Beach Faith Based Director Community Development Corporation will comply with The Jim Moran Foundation's funding allocation and communications requirements, Lucia Lopez The Foundation's mission is to improve the quality of life for the youth and families of Florida Secretary through the support of innovative programs and opportunities that meet the ever-changing needs of Director the community. With this gnant, we recognize the positive impact you are making by providing home -delivered healthy meals and fresh produce, housing assistance, and social connections to help seniors maintain their independence and we||'being. Michael G. Neam, M.D. Director Melvin lStith, Ph.D.Attachments Founding Director Sincgrely, In accordance with The Jim Moran Foundation, Inc.'s funding and communications requirements stated above, Boynton Beach Faith Based Community Development Corporation agrees to utilize the $66,000.00 grant for the Elder Care - Aging In Place Program. In addition, periodic updates and impact reporting will be provided as requested by The Jim Moran Foundation. KetunahJoaeph. Boynton Beach Faith Based Community Development Corporation M Memory of oz Courtney Cain, President 7 HE Jim Moran Sharon Johnson -Frew, Social Service Director MMER Founder 100 JIM M0R4N BOULEVARD, DEERF|ELD BEACH, FLORIDA 33442 1918-2007 Phone: S5442R2122 wwwjimmomnfounda1|0n.org (i C5, fs4 � 4�i L Ln aim a Ln 4d, PR s A ce -44 to 4 � . ' . � � C C $pry✓, MyW�11 m, .4 C.5 p g oµ V s Heard about the good work you are doing to help seniors in the Heart of Boynton. This anonymous donation is given in LOVE and this gift to the Boynton Beach Faith Based CDC should only be used to support your senior is program (no administrative or payroll). I am a Facebook follower, so please post photos of the impact this donation is making. Thank you! 0 �r LO 77 L b w � r S R' An 8 VVp i 2 a a- uj e h.. a� crs 7�. 0 :. ;N d av > � -0�^ •'y, CJ. .nom ....... ...... .... . . On behalf of The Jim Moran Foundation, I am happy to enclose a discretionary grant in the amount Ionw Wanton of $30,000,00 for the Senior Support, Program to help elderly residents of Boynton Beach remain in doss sc„',Oa('O rFr a kr r> their hornesor secure safo hous�ng. Once the funds m -e expended, please provide us wth the /-oon"A"Yr jptjrrijj&w' of seatiors whco Were provided Assistance thromih this grant. Our funding is based on the cur�,ejjt status of Boynton Beach Faith Based GOmmUnAY Corporation as a public charity under sections 501(c)(3) and 509(a)(1) or 509(a)(2), GOnsequean'61, should there be any change to your to status, you are required to notify The Foundation immediately. ISS' "'uMlu We understand the importance of creating cause awareness, as well as acknowledging partnerships invested in serving our community, Should this grant generate an announcement or recognition (i.e., press release, print or e -newsletter, logo usage, social media, etc.), g�uires In such mentions, please Susan Eccher The FounL dation respectfully r Thasovr refer to us as The Jim Moran Foundation. For further assistance with YOUr communications, or to Diredoll begin the review and approval process, please contact Kiss Fink elman at 954-363-5550 or ihsa.firs �.ejrhan@jirnrnoranfounda xation asTee"s to Was” and &'Npac.t 6/3/22,1:03 PM Mail - Sherry Johnson - Outlook PFA Commnity Grant Donna Root <Don naRoot@alternativehomehealth.com > Fri 6/3/2022 11:25 AM To: Sherry Johnson <sjohnson@boyntonbeachcdc.org > Cc: Donna Root <Donna Root@ a Iternativeh omehea Ith.com > Thank you for applying for a Grant with us I am pleased to tell you that your organization will receive a grant for $1,000 Congratulations! More to follow regarding the actual check and big check and recognition at one of our general meetings Donna Root, RN, BSN Community Relations Representative Cell 561-307-0331 Office 954-622-0588 donnaroot@alternativehomeheaIth.com www.alternativehomehealth.com Sent from my iPhone https:Houtlook.office.com/mail/inboxlid/AQMkADk4NThkM2Z[LWQxZDgtNG15ZilhNmQzLTE5ZD02MGYOODRhMgBGAAADnile3O6DpEOPT18Q26h8... 1/1 z 0 GmJz 0 U - z M Lr - w CJ NUJ WZLL JWU Lu ZLu 7:m Q) Z < CD =z = Nm C� m -:I M IL 9C q9 0 rm ru CD -0 W ;7 r -u py Ln -a 9C q9 0 rm ru CD -0 W . oo WDouglas Hcy Jr., D.Min., Senior Pastor FIPST PPESBYTEPIAN Greg Rapier, M.Drv., Associate Pastor CHURCH OF DELRAY BEACH Grace Cameron Hood, B.C.E., Director of Children and Family Ministry 99�O VOmMOWY' V&WX, � tIee 95pea Member Congregation of the Presbytery of Tropical Florida April 8, 2022 Sherry Johnson -Frew, Program Director Boynton Beach Faith Based Community Development Corporation 2191 N. Seacrest Blvd. Boynton Beach, FL 33435 Hi Sherry, Thank you so much for your recent update. You continue to provide so much for the seniors in our community with so little. We're pleased to again be able to continue funding your Aging in Place program. We are enclosing a check in the amount of $1,250, the first of four payments totaling $5,000 for your Aging in Place program. Please let us know if you have a donor or donors who will match grants. We will be happy to help you maximize your donations by adjusting our schedule of disbursements. We value our long relationship with you and continue to appreciate the help you offer to those seniors in our community who are often under -served. You continue to offer hope to so many of them who had given up by providing the love, care, and support that they need. Thank you so much for all you have done and all that you continue to do in Boynton Beach. We are blessed to be a small part of your ministry. May God continue to bless you, your staff and your volunteers each and every day for the light you provide to our community. In Christ, Jeanne Heavilin, Chair Mission Outreach Committee 33 Gleason Street, Delray Beach, Florida 33483 9 561-276-6338 - Fax 561.272-8505 - administrator@firstdelray,com www. fi rstclelray.corn Vendor: Boynton Beach Faith Based Community Dev2k-1tpma4S009022 Amount. 1,250.00 INVOICE INVOICE INVOICE INVOICE DIST. DATE NUMBER DESCRIPTION AMOUNT ACCOUNT 03/29/2022 0322 mission 1,250.00 mission 7021 W11 A TO THE ORDER OF BANK OF AMERICA 1001 EAST ATLANTIC AVE. FIRST PRE SBYTERIAN CHURCH DELRAY BEACH, FL 33483 33 GLEASON STREET DELRAY BEACH, FLORIDA 33483 63-858/670 DIST. AMOUNT 3/30/2022 *******1,250.00 ONE THOUSAND TWO HUNDRED FIFTY DOLLARS AND NO CENTS Boynton Beach Faith Based Community Development Ce Attn: Social Services Program Director,--,,",, 2191 N. Seacrest Blvd. Boynton Beach FL 33435 JVP Healthier Boynton Beach 777ration, Inc. Attention: SherryJohnson Address: 2191 N. Seacrest Blvd Boynton Beach, FL 33435 MIT*= =11 E��� ;� — 6 1 "t as s7i7cleTt, your mini grant project proposalTor —our 21YU fiscal year. Your organization will be awarded the amount of $4,000.00. The funds will be disbursed in one payment in May 2022. t,5 t;",;igc-t-he improve health outcomes for family caregivers. The funds made available through the mini -grants will allow local organizations to obtain the needed funds to pilot ideas that will improve our collective community health in one of three focus areas: 1. Promote awareness of family caregiving ummu, s v 3. Promote health and wellness of family caregivers 11 Your Project primarily targets those in the Boynton Beach community (33435 zip code area). 0 Your organization is a local business, civic organization, not-for-profit 501 (c) (3) or you are partnering with one to receive funding. (The check will be written to that organization) 0 You will participate in Healthier Boynton Beach activities/events and like social media pages (Facebook & Instagram) 0 You will provide a calendar and/or dates of project activities by May 11t 2022 E You will provide a Final Report including Impact, Outcomes, Success and Challenges. Pre and post surveys should be a part of your report. Be sure to include photos to share on Healthier Boynton Beach website/social media, Due Date for report December 31't 2022. Please contact Ricky Petty at (561) 635-8785 or via email at 1.11, 1 with any questions you have regarding BBB's mini grant guidelines. Your service to the Boynton Beach community is appreciated, and we are happy to support the great work you provide. Thank you for your partnership! Sherry Johnson - Frew, Social Service Director Printed Name Title Date April 20, 2022 Signature ATTACHMENT Dnou8ignEnvelope ID: EE-DB9CB5CrE414 FREE-FimanciafAssistance On -Line Application Assistance for programs to benefit seniors in Housing, Food, and Financial Ahd—NONE FREE Food Assistance Program Home Delivered Meals Pantry Shopping and Delivery Congregate Meal Mass Food Distributions Fresh Produce Distribution Groceries for Seniors Angel Food Pantry ATCOST'CD['SAffordable Food Buyer's Club Wholesale meat, poultry, and fish is purchased onsale at local wholesalers in bulk quantities and the savings pass to those participating at cost. The cost is rounded up to cover packaging materials. There are nohidden fees, labor, freight, delivery, etc, included. FREE - Social activities are planned for the 1st and 3rd Ofeach month — programming is designed to keep seniors informed regarding resources and community events, provide nutrition and wellness benefits, and always food. Sometimes - We have just begun to offer field trips — Generally for free, however, there may beanexpensive event that Bportion Dfthe ticket might he suggested for consideration. ATTACHMENT Boynton Beach Faith -Based ommunity Development Corporation, Inc. .... .......... The Faith Based CDC (FBCDC) is a 501c3 organization created in 1999 to promote financial revitalization of the community thru business and real estate ownership, provision of services, homeownership and improvement, by increasing homeownership opportunities, and develop and sustain partnerships to ensure that development is streamlined and resources are $,ut to the most efficient use, increase hom-q&-w-nv_�a�, slurR. blight, & cri [Xp#k"iw@Wwn neighborhood. Job Description Senior Caregiving Program Coordinator Annual Salary, Full-time, tbd on exnerieni Position Overview: The Pro(A-,ram Director will be resy,-onsible for the oterational success of the Senior Care,§iving-P-r,,to-g-Am,,tm6n-�LLrpo sPmmAwss__kwm management and development, program delivery, and quality control and evaluation, Responsible for volunteers including recruiting, training, scheduling, and coordinating. The Program Director will be a key external face of the BBFBCDC in the community. Reports directly to the Social Service Program Director. 1010001 WOW day-to-day operation of the Senior Caregiving Programs which includes the following: Fresh Produce, Internet Technology & Training, Home Delivered Meals Program, and Social Activities. Responsibilities: * Delivery of meals to frail and elderly shut ins. * Delivery of FREE vegetables according to route assigned, * Planning of social and educational events for senior clients * Transportation of seniors to and from scheduled social activities. * Shopping for, transportation of, and storage of food and produce products necessary to the preparation of meals and delivery of produce. Assist clients with simple "Honey Do" issues and report directly to supervisor any client needs that are requested or observed as necessary to the safety and welk being of the client. ® Additional duties as required. 90%,1117 rR1X?;Mi= * Maintain & update records as required per contractual agreement. * Provide timely reports as required. * Assist with the set-up and clean-up necessary with each activity. * Maintain a good driving record and valid driver's license. * Any other tasks as deemed needed by the supervisor, 2191 N Seacrest Blvd Post Office Box 337 Boynton Beach, FL 33425 Phone: 561-752-0303 Fax: 561-244-5046 wvery )oy,Lmt nbeachcd(:.org_& �,iovyfjheartof intot �assis7nce,ofg w Must have good communication and social interaction skills with patient, and caring attitude for the elderly and disabled. w Must also have a clean driving record and be able to read maps and/or GPS systems. m Must be able to read, write, speak English fluently, and keep careful records. Fluency in Spanish or Creole highly desired. • Must be able to lift a minimum of 50 pounds bachelor's degree or equivalent experience. • Experience working with volunteers. The FBCDC is an equal opportunity employer and does not discriminate anyone because of their race, color, religion, sex (including gentler identity, sexual orientation, andpregnancy), national origin, age (40 or older), disability or genetic information. 2191 N Seacrest Blvd Post Office Box 337 Boynton Beach, FL33425 Phone: 551'752-0303 Fax". 561-244'5046 Michelle on aauis lu 504 W. Perry:Street.* Lantana, FL 33462 * Cell Phone (561) 275-0379; Horne Phone (561) 249-2923 + Email ray ichelledeviswhitegyahoo.com PROFESSIONAL EXPIERIENCE Case Manager, Community CaHng Center of Greater Boynton each 0 Increases public knowledge of local and county resources and services, * Collaborates with other agencies to address the basic needs of low income families * Provides direct services to local farnHies in a tri -city area in an effort to address the root causes of poverty * Coordinates nutritional assistance to families in need through the centers food pantry Teacher, Palm Beach County School District * Taught 6' and 7" grade Social Studies/Geography to students at Congress Middle School * Re,,sponsible for the welfare and learning activities of 15-20 students in rotating periods * Resnponsible for lesson planning and engaging students and theirfamilies Site Supervisor, Juvenile Transition Center Surnmer Food Program * Supervised the preparation of meals for the city wide summer food program * Mcaff ntained for the welfare and learning activities of 15-20 students in rotating periods * Trained workers and ensured that Safe Sery guidelines were followed for the proper safety and sanitation of food delivery E Q U C A T 1 0 N Bo-thune Cookman University, BA, HistarytPreLaw, Apr'1979 Florida Atlantic University, Continuing Education Courses, Ongoing CIVICSf VOLUNTEER EXPERIENCE "withinAction", recruits, trains, and supports caring volunteers to help their frail and elderly neighbors through friendly relationships. * Community Caring Center of Greater Boynton Beach, coordinates food pantry activities including driving the Waggle Mol)He"to deliver fresh fruits and vegetables to low income families. * "Feed and Praise" through Greater St. Paul AME Church, prepare and deliver fresh meals to local families in need. * Democratic Executive Committee of Pairri Beach County, Zone leader responsible for activating the precinct leaders to encourage voters to participate in local, state, and national elections. * Partnership With Legal Women Voters of Palm Beach County for the restoration of voters' rights. * Member of the Board of Directors for the City of Boynton Beach Democratic Club. * Cook and serve breakfast for "Green Market/Secret Garden Cafe' whose profits are used to fund the "Faith In Action" initiative and assists in keeping a diverse population circulating into the cafe. Elder Care Program Assistant Hourly, Part-time Position Overview: Work effectively ina team environment, assisting other employees and volunteers asneeded, Capture and update information needed for generation ofreports, Maintain office hours atthe BBFBCQCfad|by Report Directly tDthe Program Director to complete daily scheduled assignments, tasks, and routes necessary to implement the day-to-day operation of the Senior Hunger Programs which includes the following: Senior Veggie Mobile Program, Home Delivered Meals Program, and Senior Social Activities. Responsibilities - Delivery of meals to esponm0bNities:DeUveryofnAea/Gto frail and elderly shut-ins; Delivery of FREE vegetables according toroute assigned; Delivery ofAffordable Food Packages Transportation ofseniors hoand from scheduled social activities Shopping for, transportation of, and storage of food and produce products necessary to the preparation of meals and delivery ofproduce Assist clients with simple "Honey Do" issues and report directly to program director any client needs that are requested or observed asnecessary tothe safety and well- being ofthe client, Additional duties as required Provide accurate records mfall client files Maintain & update records asrequired per contractual agreement; Provide timely reports as required Assist with the set-up and clean-up necessary with each activity Maintain agood driving record and valid driver's license Any other tasks as deemed needed bythe program director and executive director Qualifications: 1. Have avalid driver's license. 2. Minimum of high school diploma or equivalent. 3. Good interpersonal communication. 4.Ability toperform minor maintenance projects fOrdien1s 5.Se|f'nlutivated,able totake initiative. 6. Ability to maintain confidentiality. 7. Able towork a flexible schedule. 8.Must beable tVlift aminimum ofSOpounds. 767 MOTANXIMM A. Recipient Information (select one) a. Current homeowner b. Home buyer: [] Existing Dwelling [:] Renter B. Subsidv Use (check all that aoolv) 1:1 Down Payment Assistance 0 Principal Btu y Down F-1 Emergency Rental & Utility Assistance Owner-Occueied Housing Rehab F-1 Closing Cost Assistance Emergency Housing Repair -0 Low -Income Rental Housing El Other C. Household Informa"ti, FM Member Relationship Date of, Birth Head 2 3 4 5 6 MZ'OZPt;LZP. M IIUUbtMUIU I I ICI Y IU 1 NUUUMY 111111U1 Income from Member Asset Description Cash Value I Assets 1 $ 2 $ 3 $ 4 $ 6 Total Cash Value of Assets D(a) $ Total Income from Assets D(b) 0 If line D(a) is greater than $5,000, multiply that amount by the rate specified by HUD D(c) $ (applicable rate 0.06 %) and enter results in D(c), otherwise leave blank. 768 -1111reNt-77 Maly-MT11, =,- 1 111111 IIIIIIJI�11111111 I I� E. Anticipated Annual Income: Includes unearned income and support paid on behalf of minors. Enter total of items E(a) through E(e). This amount is the Annual Anticipated Household Income $ F. RECIPIENT(S) ACKNOWLEDGEMENT AND ATTESTATION: The undersigned expressly acknowledge that the information provided on this form by myself/us is subject to verification by HUD, the City of Boynton Beach, and/or Boynton Beach CDC at any tirne. Further, [/we acknowledge that'ritle 18, Section 1001 of the U.S. Code states that a person is guilty of a felony and program eligibility can be terminated if 1/we knowingly and willingly make a false or fraudulent statement in connection with the representations made above or in connection with any other information provided to Boynton Beach CDC in connection with the application for assistance. NOW, in light of the acknowledgements made above, 1/we knowingly affix our signature below; and by doing so, expressly certify and attest, under penalty of the law recited above or otherwise applicable, that all of the information provided in this form is true and correct according to my/our best knowledge and belief. Should [/we become, or be made aware of the untruthfulness or inaccuracy of any of the information or the representations or information provided above, 1/we will immediately notify Boynton Beach CDC and acknowledge that failure to do so may result in institution of any criminal and/or civil remedies available by law. Signature of Head of Household Date 410NMIXI M -o 1617**=X-oTK0T*79Zr43Tv1 nof: MeM- Tielre Page 2 of 5 769 Wages I Salaries Member (include tips, Benefits I Public Other Income Asset Income commission, Pensions Assistance bonuses and overtime) (Enter the 2 greater of 3 box D (b) 4 or box D(c), 5 above, 6 in box E(e) 7 below) (b) (c) (d) (a) (e) Totals Enter total of items E(a) through E(e). This amount is the Annual Anticipated Household Income $ F. RECIPIENT(S) ACKNOWLEDGEMENT AND ATTESTATION: The undersigned expressly acknowledge that the information provided on this form by myself/us is subject to verification by HUD, the City of Boynton Beach, and/or Boynton Beach CDC at any tirne. Further, [/we acknowledge that'ritle 18, Section 1001 of the U.S. Code states that a person is guilty of a felony and program eligibility can be terminated if 1/we knowingly and willingly make a false or fraudulent statement in connection with the representations made above or in connection with any other information provided to Boynton Beach CDC in connection with the application for assistance. NOW, in light of the acknowledgements made above, 1/we knowingly affix our signature below; and by doing so, expressly certify and attest, under penalty of the law recited above or otherwise applicable, that all of the information provided in this form is true and correct according to my/our best knowledge and belief. Should [/we become, or be made aware of the untruthfulness or inaccuracy of any of the information or the representations or information provided above, 1/we will immediately notify Boynton Beach CDC and acknowledge that failure to do so may result in institution of any criminal and/or civil remedies available by law. Signature of Head of Household Date 410NMIXI M -o 1617**=X-oTK0T*79Zr43Tv1 nof: MeM- Tielre Page 2 of 5 769 m0wmmm0w" Community Development Corporation, Inc. H. Household Data (to be completed by Administrator or designee) RESIDENT/APPLICANT: I do not wish to furnish information regarding ethnicity, race, sex, age and other household composition. (Initials here) Number of Persons By Race I Ethnicity By Age White Black Hispanic Asian American Indian Other 0-25 26-40 41 - 61 62+ I Special Target I Special Needs (Check all that apply) Farm Worker Developmem Disable d tally H omeless T Elderly Other I - Income Certification doc 770 Application - Senior Care PrOgraM5, "Aging In Place' I want to Participate in the following programs: i Meals: —Healthy — Chronic Do you reed — delivery or can you —pick up? Non-Pvofit Market: Monthly Affotclable Food Packaged Fresh Produce groceries for Seniors Social activities Monthly Breakfast Gui4eline5 an4 Activffle5 an4 kequim� Documentation: • Ove�62yeaysofaqe,o�on4i5ability • Atter)4 Social Actfvitie5 at least once a montb • agree to allow any photographs and/or to be interviewed, for the purposes of gaining financial support for the program • Attend and participate in the "Giving Back to our Elders" event (mandatory) Provide. followincl documentation., MI'vt.,n-'i Licen5e, Soc,W Sea.IHIy Cat,(.1, or Green .rrl® 1r)o,,-)rrw (55A, Pen5ion, D, Foo(i Starr -)p, Ur)en)P[aYMej)("icy cle(ern-)ine rnedian income leveL All inlo'nm7tion w111 be p4ced In 7 -Chent FIle-,7ndkept in the offiix amjerlock and key , Date of Birth: Email Ad&e55- SIM Efrican American White Man Native Aeric r) her Ethnicity. _ Hispanic Or Non�-Hi spanic Vete ra n.- Ye5 No signature,.------ Date. ,Any Questions, please contact iNA!ciielle (561) 275-03-79 Boynton Beach Faith -Based CDC, Inc. my Household Income & Expense Budget Application Driver's License / ID Card for applicant only Social Security Cards for applicant and each fainily member rz"Fjz_q1 e agz-of 18 livina at home Release of information City of BB/BBFBCDC PBC Client Tract Proof of Income PayStUbS (2 months, om each emplqver, Screen view is not acceptable) —Tax Return, W-2 Benefit Letters SNAP Benefits Retirement Benefits (SSA, Pensions, etc) Social Security Disability —"Unemployment Benefits Child Support Section 8 Assistance —Bank Statements Dec] aration-0-income (If applicable) Income Certification Form Signed with original or electronically Other 772 Boynton Beach Faith -Based CDC, Inc. Lease Agreement 3 -Day Notification Landlord Verification Form Proof of Residence (Palm each County Only) M Verification of Additional. Funding Sources EXIMMUMMEMM Client Tracking Form Section IV - Landlord Information Vendor Application Sunbiz.org printout W-9 on file Account Ledger Section V - Referrals Referrals (If Applicable) 773 Section'tV - Miscellaneous Documents 774 BOYNTON BEACH FAITH BASED CDC, INC. Application for Services Date: __ /_ /__ In -take Counselor's initials: weekly amount you are receiving, First Name: DOB / City:. State- Zip: Relationship to you mm�=!M . . ....... .. uplumuffglowmagal 1111110,111011" -sea Ap'"Mommal 1 It" -m-10111, M I '� 'M i African American or Black White American Indian or Alaskan LJ Native iian/ Islander Ll other, Citizenship: U.S. Citizen Yes No if no, Birthplace Green Card # Received on __J__J_ Expires on Veteran? Yes No an 2191 IN Seacrest Blvd, or Post Office Box 337, Boynton Beach, FIL 33435 Phone: 561-752-0303 Fax: 561-244-5046 rce,clg, 775 MONTHLY INCOME: $ Income Type: _Unemployment _Employment Disability/Physically Disability/Mentally Benefits Rec'd: SSI/SSD $ Unemployment $ Child Support $ __ Alimony $ _ Food Stamps $ DCF Cash $ _ WIC $ Other $ Health Insurance: Medicaid Medicare None Other 1forise l'iold cc)nsists of Fiow rnany !n!ftE!§grs'? Please list Hotisel-iold Fa,mfl,y �,anjL S'6° Name Relationship DOB Gender School Attending Working Income FOR RENTAL ASSISTANCE APPLICATIONS: funding from any other sources including PBC — ERA — Funds: NO, was YES, if so please provide the, agency, contact person, & indicate the months and amounts and your USER ID and Password for verification: Months: Total Amount Received or Pending $ USER ID: Password: urs derstandthat I am applying for CDBG-r,,V Emergency Rental Assistance, I hereby certify that I participated in completion of the above Application for Services, 2191 N Seacrest Blvd, or Post Office Box 337, Boynton Beach, FL 33435 Phone: 561-752-0303 Fax: 561-244-5046 ±inwvj2oyo)IgL N Am �� anceoi.q q&v mi.he ar Or a� S� ............. . . mi, W 776 Education: Highest level completed: L] 61h grade or less, Marital Status: El Vh — 9th grade LJ io" — lilh grade L3 Married Ll 12" grade diploma/GED/no diploma J Single U College graduate/some college L3 Divorced Q Post -graduate study U Separated LJ Widowed MONTHLY INCOME: $ Income Type: _Unemployment _Employment Disability/Physically Disability/Mentally Benefits Rec'd: SSI/SSD $ Unemployment $ Child Support $ __ Alimony $ _ Food Stamps $ DCF Cash $ _ WIC $ Other $ Health Insurance: Medicaid Medicare None Other 1forise l'iold cc)nsists of Fiow rnany !n!ftE!§grs'? Please list Hotisel-iold Fa,mfl,y �,anjL S'6° Name Relationship DOB Gender School Attending Working Income FOR RENTAL ASSISTANCE APPLICATIONS: funding from any other sources including PBC — ERA — Funds: NO, was YES, if so please provide the, agency, contact person, & indicate the months and amounts and your USER ID and Password for verification: Months: Total Amount Received or Pending $ USER ID: Password: urs derstandthat I am applying for CDBG-r,,V Emergency Rental Assistance, I hereby certify that I participated in completion of the above Application for Services, 2191 N Seacrest Blvd, or Post Office Box 337, Boynton Beach, FL 33435 Phone: 561-752-0303 Fax: 561-244-5046 ±inwvj2oyo)IgL N Am �� anceoi.q q&v mi.he ar Or a� S� ............. . . mi, W 776 NZA] BOYNTON BEACH FAITH BASED CDC, INC. I understand this program provides assistance based on the priority set by the department and/or the funding entity and assistance is based on available -funding. I understand that this application will be denied if l do not submit all required documentation, r" I certify I have not received benefits for the same services and carne time periods from any other funding sources or other entities, further certify that I have read the above information and, to the best of my knowledge and belief, the infon-nation is accurate and has been properly recorded. Additionally, l Understand that I am responsible for the accuracy, of the information provided and that said information gill be used as a basis for determining my eligibility for services, I also understand that any falsification or misrepresentation of this information iSjLJS't cause for denial of services and prosecution for fraud. I attest that the answers on this form are true and reflect My current finances and household information. I understand that a material misstatement fraudulently or negligently made in this form or any Cather statement made by me (us) in connection with an application may constitute a federal violation punishable by a fine and/or denial of my (our) application for assistance, and/or penalties including disqualification from future City of Boynton Beach — CDBG-CV assistance benefits, or, if funds have been released prior to discovery, of the false staternent, immediate recalling of the assistance, which may be in addition to any criminal penalty imposed by law. I authorize the Boynton Beach with Based CDC, Inc. on behalf of the City of Boynton Beach to obtain records of information pertaining to my financial or employment status from any source in order to verify the information provided by rne. I will return any funds made to me by the Boynton Beach with Based CDC, Inc. on behalf of the City of Boynton Beach as a result of misstatement on application, or for any change in circumstances that impacts my eligibility -for services. Client Signature Staff Signature: Intake or Case ManagZ INFORMED CONSENT: By signing this application, I attest that all the information provided is correct. I agree participate in programs, activities andlor services provided by BBFBCDC. i agree to provide any additional information requested by BBFBCDC to determine program eligibility and determination of benefits from applications. I provide permission to release information to any other organization or agency as necessary or required to further my application for assistance. Otherwise, / understand and agree that all information, conversations, records, test results and any other materials related to my participation is confidential and will not be released to any other organization or individual without my permission, EXCEPT if it contains evidence of current or potential child abuse or neglect, harm to others, or me, andlor required as evidence in a court case. CL 2191 N Seacrest Blvd, or Post Office Box 337, Boynton Beach, FL. 33435 Phone: 561-752-0303 Fax: 561-244-5046 &ySra'rw'e or . ........... . W&A 2191 N Seacrest Blvd, or Post Office Box 337, Boynton Beach, Ft. 33435 Phone: 561-752-0303 Fax: 561-244-5046 c c gg & www.the adofbo,L pE pL L2 71 0 778 Boynton Beach Fafth-Based Community Development Corporation,, In c A. Recipient Information (select one) a. El Current homeowner b. F-1 Home buyer: E] Existing Dwelling 1:1 Renter B. Subsidy Use (check all that aDDIv) C. Household Information AM Member Relationship Date of Birth I Head 2 3 4 5 6 ffl%*;b1WLZP. 1"M 11UUbV11U1U FIill' IUClb 1[1U1U4.111IU HINViZ5 Income from Member Asset Description Cash Value I Assets 1 1 $ 2 $ 3 $ 4 $ 5 6 $ Total Cash Value of Assets D(a) Total Income from Assets D(b) 0 If line D(a) is greater than $5,000, multiply that amount by the rate specified by HUD D(c) $ (applicable rate 0.06 % and enter results in D(c), otherwise leave Wank. 779 n Pavment Assistance Principa(Buy Down Emergency Rental & Utility Assistance Owner-Occgied H ab, C■ losin2 Cost Assistance Emergen�y Housing Repair Low-income Ren!�L_ C. Household Information AM Member Relationship Date of Birth I Head 2 3 4 5 6 ffl%*;b1WLZP. 1"M 11UUbV11U1U FIill' IUClb 1[1U1U4.111IU HINViZ5 Income from Member Asset Description Cash Value I Assets 1 1 $ 2 $ 3 $ 4 $ 5 6 $ Total Cash Value of Assets D(a) Total Income from Assets D(b) 0 If line D(a) is greater than $5,000, multiply that amount by the rate specified by HUD D(c) $ (applicable rate 0.06 % and enter results in D(c), otherwise leave Wank. 779 nit,ifs Development Corporation, Inc. 1111111111 1 1 ;� !!Irziiiil I Enter total of items E(a) through E(e). This amount is the Annual Anticipated Household Income F. RECIPIENT(S) ACKNOWLEDGEMENT AND ATTESTATION: The undersigned expressly acknowledge that the information provided on this form by myself/us is subject to verification by HUD, the City of Boynton Beach, and/or Boynton Beach CDC at any tirne. Further, I./we acknowledge that Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony and program eligibility can be terminated if I/we knowingly and willingly make a false or fraudulent statement in connection with the representations made above or in connection with any other information provided to Boynton Beach CDC in connection with the application for assistance. NOW, in light of the acknowledgements made above, I/we knowingly affix our signature below; and by doing so, expressly certify and attest, under penalty of the law recited above or otherwise applicable, that all of the information provided in this form is true and correct according to my/our best knowledge and belief. Should 1/we become, or be made aware of the untruthfulness or inaccuracy of any of the information or the representations or information provided above, 1/we will immediately notify Boynton Beach CDC and acknowledge that failure to do so may result in institution of any criminal and/or civil remedies available by law. U-0011110=490 =10 I Page 2 of 5 780 Wages I Salaries Member (include tips, commission, Benefits I Pensions Public Assistance Other Income Asset Income bonuses and overtime) (Enter the greater of 2 3 box D (b) 4 or box D(c), 5 above, in box E(e) 6 7 below) (a) (b) (c) (d) Totals I Enter total of items E(a) through E(e). This amount is the Annual Anticipated Household Income F. RECIPIENT(S) ACKNOWLEDGEMENT AND ATTESTATION: The undersigned expressly acknowledge that the information provided on this form by myself/us is subject to verification by HUD, the City of Boynton Beach, and/or Boynton Beach CDC at any tirne. Further, I./we acknowledge that Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony and program eligibility can be terminated if I/we knowingly and willingly make a false or fraudulent statement in connection with the representations made above or in connection with any other information provided to Boynton Beach CDC in connection with the application for assistance. NOW, in light of the acknowledgements made above, I/we knowingly affix our signature below; and by doing so, expressly certify and attest, under penalty of the law recited above or otherwise applicable, that all of the information provided in this form is true and correct according to my/our best knowledge and belief. Should 1/we become, or be made aware of the untruthfulness or inaccuracy of any of the information or the representations or information provided above, 1/we will immediately notify Boynton Beach CDC and acknowledge that failure to do so may result in institution of any criminal and/or civil remedies available by law. U-0011110=490 =10 I Page 2 of 5 780 N.MMMMEW Community Development Corporation, Inc. M Signature of Household Member WIM ism SIGNATURE OF HOUSEHOLD MEMBER G. Administrator Statement: Based on the representations herein, and upon the proofs and documentation is/are eligible under the provisions of Chapter 420, Part V, Florida Statutes, the family or individual(s) constitute(s) a-. (check one) Extremely Low Income (ELI) Household means individuals or families whose annual income does not exceed 30% of the area median income as determined by the U. S. Department of Housing and Urban Development with adjustments for household size (Maximum Income Limit � Very Low Income (VLI) Household means individuals or families whose annual income does not exceed 50% of the area median income as determined by the U.S. Department of Housing and Urban Development with adjustments for household size (Maximum Income Lirnit J_). Low Income (LI) Household means individuals or fames whose annual income does not exceed 80% of the area median incorne as determined by the U.S. Department of Housing and Urban Development with adjustments for household size (Maximum Income Limit Moderate Income (MI) Household means individuals or families whose annual income does not exceed 120% of the area median income as determined by the U.S. Department of Housing and Urban Development with adjustments for household size (Maximum Income Limit Based upon the 2022 (year) income limits for Palm Beach Metropolitan Statistical Area (MSA) or County, Florida. OR= SIGNATURE PRINT NAME/TFLE me 781 m Page 4 of 5 782 "q�1111111 1111111�1�1�1q��1;1 inity Development Corporation, Inc. H. Household Data (to be completed by Administrator or designee) RE SID ENT/APPLI CANT: I do not wish to furnish information regarding ethnicity, race, sex, age and other household composition. (initials here) Number of Persons By Race / Ethnicity By Age White Black Hispanic Asian Arner,can Indian Other 0-25 26-40 41 -61 62+ Special Target I Special Needs (Check all that apply) Farm Worker Developmentally Homeless Elderly Other Disabled Income Certification doc 783 11 0 BOYNTON BEACH FAITH BASED CDC, INC. inorder hmdetermine the eligibility of answering the questions below and returning this for to us by Case Name Caaemumbor/CauS*4 for public assistance, please assist maby Office Address / Phone Number: Boynton Beach Faith Based CDC. Inc, 2191 N, Seacrest Blvd. Boynton Beach, FL 33435 561-752-0303 (office) 561-386-4261 (cell) Name ofEmployee: Social Security Number: Add Job of Work Performed: Number mfHours Worked Per Week: Number ofDays Worked Per Week: A. How often is/was the employee paid? nOmy El Week r] Bi -Weekly E] Monthly B. Rate of pay: � [] Other xrInaywmle*. (Explain) Date current employment began: Date previously employed: Does/did employee receive tips? L] Yes E] No (if yes, please show tips ioSection Q/j Is/was employment seasonal? [jYey Fl NV |fyes, season begins:ends: Is/was the employee covered byhealth insurance? E] Yes nNm |fyes, name ofinsurance company: Number ofdependents covered: Does/did the employee participate in any type of payroll savings plan or profit sharing? Yea E]No |fyes, what iathe balance? Does the person perform their job duties: intheir home inyour home N/A | LJ SectionN—LOSS OF INCOME 1 . Date employment ended: 2. Reason for termination: 3. Is the loss of income El Permanent or El Temporary? If temporary, when do you expect the employee to return to work? 4. Date employee received final check: Gross amount- $ (Please list last 4 weeks in Section 111.) 5. Wifl employee receive any vacation pay, retirement refund, or other? El Yes El No If yes, what type? Date received: Amount: $ 6. Is employee eligible for any type of benefits from your company, such as extended insurance coverage, workers' compensation, or other? n Yes E7 No If yes: A. Name of insurance company. - B. Reason for benefits 784 W_. BOYNTON BEACH FAITH BASED CDC, INC. Case Name Case Number/Cat/Seq. List the gross amounts and dates of checks or cash, which were paid for the last four weeks in the space below. —;:; Pay Period Ending Date Pay Received GROSS Earnings o of Regular Worked Rate of ay 7P Na.. of Overtime "o.rs ate of Pay for Overtime Tips $$ Earned Income Credit fflQ If hours or rate of pay has varied in the above period, please state why. What I have written on this form is true to the best of my knowledge. I know that if false information on purpose, I may be subject to prosecution for fraud. M.." . M -ff. w-.. =- Address Employer's Title 785 21911 N. Seacrest Boulevard Post Office Box r 337 Boynton Beach, FL 33425 Phone: 561-752-0303 Fax: 561-244-5046 ahftps:llwww.boyntonbeachcdc.orci/ Zero Income Affidavit Please complete this form if due to the COVID-19 pandernic you are/were unemployed and not receiving unemployment or any other form of income anytime from March 13, 2020 -today or if you cannot show a loss of income due to the COVID-19 pandemic. Appkant's Name: Application Address: Please describe below the financial hardship you experienced or are experiencing because of the COVID-19 pandernic: By signing below, I swear or affirm that the answers are true and reflect my current finances and status regarding COVID-19.1 understand that a material misstatement fraudulently or negligently made in this affidavit or any other statement made by me (us) in connection with an application for assistance may constitute a federal violation punishable by a fine and/or denial of my (our) application for assistance. I Signature of Applicant Date Signature of Applicant Datd REMUEMEEWIT,= Print Name of Applicant a Benefits: SNAP (food stamps, TANF, etc Retirement: *'ension: Disability: Unemployment: N ff 2) 3) 4) '5) Total Household Monthly Income: 1. $ '_ -_� Household Expenses: Rent Utilities: Electric $ Water/Gas $ Phone $ Cable $ Food $ Child Care $ Laundry $ Personal Expenses $ (Soap, toothpaste, etc.) Entertainment $ Cell Phone $ Clothing $ Car Pmt. /insurance $ Gas $ Other 303=1 Total Income Minus Expenses 3. 1 $ IF EXPENSES ARE MORE THAN THE INCOME, PLEASE EXPLAIN HOW YOUR HOUSEHOLD IS MANAGING: (Use additional sheet if necessary) 787 Boynton Beach Faith Based CDC, lnf,,, IM-11MM Client Signature Dated: BBFBCDC to Signature Housing Counselling Provided on 2021 by: Staff Recommendations: Client Signature agree to implement these recommendatiom Z MffWgSJAJ Community Development Corporation, Inc. City of Boynton Beach CDBG-CV Rental Assistance Program Landlord Verification Form Client Information Client Name: Client Address: Lease Agreement was executed on . 2o__and expires on . 20-_ The monthly rent amount according to the lease is s and is due on the — of each month. Landlord has indicated in the lease that payments are to be made to and collected by the property manager Utiftie5 are the responsibility of the tenant, or tenant is required to pay in addition to the rent, other, This is to confirm that rent for ( ) for the property located (name of individual orfamily) (complete address, street number and name, city, state, zip code) with a monthly rent amount of s (rent only, do not include deposits, late fees, or other charges). Additional Charges Due: Legal $ Late Fees s (according to lease agreement terms) Please indicate if you — have, or — have NOT, received rental payments from Palm Beach County's ERA funds on behalf of this individual orfamily. If you have, please indicate the total amount $ Landlord/Agent Name Address: and months/yearwere included in that payment. Phone: (streetlditylstatelzip) I certify that the information provided is accurate to the best of my knowledge, as I have attested with my signature..... I MMMM•� NMI. etuii n dlonq with the fokWng docurnents: k:,:.on account, executed VY -9 form for LandU-d, and a fully execUtE�d lease agM.E!rnenL, and acq-.�y of the evicdon and/or-:,�--day nobce, P�f any 2191 N Seacrest Blvd Post Office Box 337 Boynton Beach, FL 33425 Phone: 561-752-0303 Fax: 561-244-5046 789 Palm Beach County Continuum of Care InIon nned Consent and Release of Information Form 1,r,,,iHA pabn Boach County I understand that partners with other Palm Beach County agencies to help meet my service needs. These agencies are members of a confidential network named the Client Managen-lent Information System (CM.IS). * MIS is a database which allows homeless service agencies to capture and share information about the individuals they serve * This information will help you access the appropriate resources to better rneet your needs. It will also save you time should you access services from another rnernber agency * Only authorized staff in the CMIS system can access your record * All information entered into this database is stored rasing secure technology which protects data from unauthorized users * Non identifying information is used to provide reports for various funding agencies * Any Mformation entered into the database will be maintained for an indefinite timefrarne * You have the right to request a copy of your file * You have the right to refuse to answer any or all questions you consider sensitive * You have right to cancel this release of information for any future data input, however certain financial assistance programs may have statutory mandated information requirements I have received an oral explanation of this fon.-n and hereby grant permission for and authorize the release and sharing of any information regarding myself/children entered into this database to member agencies. Client and/or Legal Guardian Printed Name: Family Member's Names: 2, El S. E. 7. S. Signature: Informed Consent and Release of Inibrination - Rev, 12/2015 Date,: 790 0 Authorization for Release of General and/or Conf€dential lnformation dor l -PL Paymnt Awstance cLualffication FPL. {ievtsed May 14, 2 Note: The Appiicarnt must sign bats form in order for the agwcy to use the Fiortda Puler &t ighght ,FPLI A'�iST process in qualifying tate FPLaccount for payrnerat assistaame. iteft–M-3 to gray this fora, rna-r lead to dj=ug ifigjtioi:, The Applicant may appeal this regatirement by speaking to the agemy Director/Manager, as the agaxy deems appropriate. The agency Director/Manager may opt to contact to discuss any a infidentlaiity concerns the Applicant my have regarding the appUcation/quaDfication proom. FPL ACCOUNT HOLDER (CUSTOMER NAME) - SERVICE ADDRESS FOR FILL (INCL. CffY/ST`/Z[P): FPL ACCOUNT NUMBR: _ – _ – _ _ _ – _.. PHONE FOR FPLA UNT: i hereby authortZe FPL arta this agency to disclose pertinent information to related community agencies. I understand that the reed or purpose of this disclosure is solely to fx:lit.ate the assistance ruartcation PTOC VSs. All information is accurate to the best of my knowledge The agency may verify information cQtrWned in the payment asslstance application, indading the FPL account for which I am seeking assistance. I also confirm that I have not re€:eaved FPL Care To Share urogram assistance in the past twelve mnths from the date of tills appticatian, at this Or other FPL service addre_c& ACCOUNT HOLT: WS SiGNATl RE* - DATE: applicant for payment assistance for the above -referenced FPL account, i hereby con€irm that 1 am not the Account lder with FpL, but I am autl ofted by the Account Holder to imitate t[ft assistance application on ;ti5/her behatf. This ,yr be confirmed at the agency's discretion., €1y contacting the Account Holder. ml information is accurate to the best of my knowledge, The agency may verify my personal information conta€ned in this guthorization, indudfrig the FPL bili ac count for whkh I am seeking assistance. I also confirms that i have not received FPL Care To share Program assisMnce in the past Twelve months from the date of this application, at this Or ny other FPL service address. PPLiC 3"S NAME (NOT ACC:OU14T HOLDERl'. �PPI.tCANVS PHONE NUMBER: LPPLICANVS SIGNATURE: sE O G FOR AGCYUSE € 9 DAT Agoxy must rnrasnitain this form in the appikmes and awake it avolabte to F'pt upw request. for rarcosuftg andaudifirrc,} pages. AG5NCY NAME : AWNCYCASEWORKEFeSNAMr=(P ISEPRftYM: AGENCY CASEWORKER'S SIGNATURE' FPL ASSIST REP NAME* PHONE, DATE. THIS APPLICANT SATtSt M" 1. ALL IrI.IGIBILITY CRITERIA AS O��TL94W IN Tl� FPL CARE TO SHARE PROURikM C3U'DEe.FN S. CHECK MERE: Q 2. THE PAi]CsiiAiS+i'S ENCOPAE EL$GIBIU Y Csi,1IDELME.S aASED ON g HE€t [CRECK oNj-Y_2 OF THE OPTIONS LISTED BELOW): [3 1 <43F POV£RiY LVEL R FIE7iPaNDr-O INCOW UMIT DUE ray SPECIAL CIRC€iMs' AKCES/NE 5 791 BOYNTON BEACH EDIT H BASED CDC, INC. 2191 N. Seacrest Blvd., Boynton Beach, FL 33435 — 561-752-0303 T'' BO , YNI , 'ON CITY OF BOYNTON BEACH D E A C H CDBG-CV RENTAL ASSISTANCE PROGRAM W0=1 "I 11101 I �� 11 1 =11' "I'll I Beach Faith Based CDC, Inc. to verify any of the information provided in my application with landlords, employers, and other agencies in order to help meet my service needs. I also understand that all health information contained in this application with be treated in accordance to the HIPPA law which protects my privacy. 1—JThis agency is a member of the Heart of Boynton Social Service Alliance and a Palm Beach County network called the Client Track Management Information System (CMIS). In order to speed access -to services, I hereby grant permission for and authorize the release and sharing of pertinent information related to my current situation to the partner agencies. I understand the need or purpose for this disclosure is solely to assist in bettering my current situation. I also authorize the use of photographs and stories to be used in order to obtain funding for program continuity and growth, provide research and data to This Agency must maintain your information and make it available to the City of Boynton Beach upon request for accounting and auditing purposes. 1904 M I MW Signature: Name: Print BBFBCDC-CD8G-CV Rev 9129121 792 Date: Program Referred to: "Angel Food Pantry" Shopping & Delivery Program and "Share the Love," if available Applicant Name Head Of Household Social Security Number Address If Available Contact Number Number Of Household Members & Race CMTS Information # Agency Family Being (your agency info goes here) Referred from: Assigning Agency's (your name & email goes here) Case Manager For Family Boynton Beach CDCSherry Johnson, �,,J,�)h kt,,on6Lboy nto n bealched etai g Case Manager 561-386-4261 Contact Information Additional Household Member(s): Name Relationship Date of Birth Social Security Number to HOH Signature of Case Manager for Referral Agency Date -------- - ----------------- ..................... . .. ....... Signature of Case Manager Assigned by BBFBCDC, INC. ---Date Received: 793 017== ME Residents of the Heart of Boynton — Community Town Hall seting— Needs Identified & Prioritized Boynton Beach Clergy Coalition, Boynton Strong Outreach & Training t 11TWIMIJ-0 Safety Boynton Training, Clergy Coalition Economic Stability & Resilience & Food Assistance BBFBCDC Boynton Strong Baca Helping Hands Boca Hmping Hands& or nen' Orde Boynton Strong Outreach & Training so 1"Ontal Heakh Cam"Mittee TrInky cousnefins canter & aIC005 "IC0,01muloy 00to" Clergy K00,41th C08110001 & H00 Neighborhod Assoclafflon Wo Develops the Plan of Action for funding and implementation 0 "91RUJU 720, Homeownership CDC, Inc. BBFBCDC, HOB MOO N Mimi i . . . . . . Genesis Community Health, Trinity Counseling Center, Community, & BBFBCDC 794 con't P& 9 a pro iders we have created a Heart of Boynton social service alliance. "T75.14 Wav of PBC Huneer Alliance — Senior Care Committee. MW Connection with PB State College Ic ucl -5 M*==7 T Resources and Educath il Health First Aid Training NOW Equi m? MIA M- ATAr. I 795 Con't pg. 9 b Healthier Toaether Bqynton, Ricky Petty, 561-635-87KL�clelo�LILtj2LqL2Lg Family Caregiving, community driven making impactful changes in a critical health issue, Provides Awarenes s Of �OW ........... e�gter 5CknjLZLjjj —;j J �'Zjffl:mm 15, IV establishing banking relation2tjRL EMIR I I "- ----- Grass Roots organization, Recovery, Mental Health Sam -1 M -M . ...... -.- . ..... language skLIIsLob_placement. Genesis Communitv Health, DeAnna Warren, CEO 561-806-6835 ext. 7431, gAa 1jj2)j7,gng(D iLLe�!L.jj,.pfg !�]L t _ 796 WW VV1111am Washington Certified Pub is Accountwit P 0. Box 105,15 Riviera Beach, Fbrie a 33419 Phone: (561) 703-5197 E-mail: bfflwashjr@corncast_n9t William Washington, is a graduate of the University of Missouri, Kansas City, Mo. He has worked in accounting and auditing for the past 41 years. His prior experience before establishing William Washington, CPA includes KPMG, and McGladrey CPAs. The firm's most recent peer review report is pass and includes a review of a single audit engagement which is attached. William is a co-founder and member the board of NCCI, a community-based nonprofit to provide leadership in the redevelopment of the Northwest Area of West Palm Beach, FL. He is a past president of Florida Institute of CPAs. He is former chairman of the board of Mental Health Association of PaIrn Beach and former chairman and board member of Good Samaritan Hospital, West Palm Beach, FL. 797 a: 'V C A First Presbyterian Church of Boynton Beach 235 SW 6 th Avenue Boynton Beach, FL 33435 1-732- 774 fR2!�27!21Qn@7_O_LC.Om Church Use Agreement February 2023. February 2024 GMUP: Boynton each Faith Based CDC Contact Person(s): Sherry Johnson -Frew, Socia� Service Coordinator. 61- -42 1 www. boyintonbeac[,icdc. org Michelle Davis. -White, Sr. Program Director 561-275-.0379 wvvw, boy ntonbeachcdc.org Locafion: Prat (FeHowship) HaH and Chassroom #4 for -freezer and linlited storage for speciM food 6tbufion (Rease note that c�assroorn door entrance is 35 inches mfide.) Days: First & Third Monday of each Month — Pratt HaH Additional days may be req..jested with at 9east 2 weeks' notice. Use of CiassrooM #4 MontNy Aniount of cont6bUfiOtI.- $350 per use of Pratt HaH (typ�caHy the first & third Monday of each month) $100 per rnonth for partiM use of Cies srocpm #4. es to the facHity w�H be provded by Event Manager, WHfie Drayton.. Only Boynton Beach Farth IBased CDC personnel 4H have access through -the k�tchen door. AH participants shOWd enter through the east gate. On�y Boynton Beaci,n Faith Based CDC persoririe� waH t-iave access to the katchen restroorn, AH parficpants wiH use the south pubkc and/or handicap restroorns. Set UP the day prior to the event will be pre -arranged with the SeCLArity and Event Technician, WiHie Drayton. -rhe Sem.irfty and Event I-echnician shafl coor6nate with the Campus Manager, Scott &.1sbee, the programming of the A/C systeni for the preparaflon da (s) and the day(s) of the events. 798 Any problems will be reported to the church office at 561-732-3774 or the contacts listed below. In case of emergency, please call: • Cathy McDeavitt, Office Administrator; 561-715-3107 (cell) • Willie Drayton, Security & Event Technician 561-502-0240 (cell) • Scott Busbee, Campos Manager 551-526-5133 (cell) • Rev. Amalie Ash, Pastor 561-635-9926 (cell) First Presbyterian Church will provide the following: • PA system • Tables, • Chairs, • Ice Machine • Limited use of refrigerator the day prior and the day of an event. Boynton Beach Faith Based CDC agrees to provide the following: • All table coverings • Decorations • Paper products and serving utensils • Food and Drinks • Program Supplies • All of the above items should be removed after each event. All items in the refrigerator should be removed after the event. Any damages incurred due to the use of the facility will be the responsibility of Boynton Beach Faith Based CDC. No smoking is permitted in any buildings Alcoholic beverages are not permitted. Permanent signs may not be placed on the church property; however, a temporary sign is allowed for directional and informational purposes. A liability insurance policy of a minimum of $1,000,000 roust be provided to FPC before the first event. First Presbyterian Church of Boynton Beach must be named as the Certificate Holder. In the event of an accident or problem, the Boynton Beach Faith Based CDC agrees to use their liability insurance carrier for coverage. First Presbyterian Church of Boynton Beach 235 SW 6th Avenue Boynton Beach, FL 33435 561-732-3774 799 Indemnification Clause: First Pr(--,�sbyterian Church of Boynton Beach (FP(',) assurnes no responsibility whatsoever for any property, suppHes or eqLkpment piaced 41 or on the fa cHity by Boynton Beach FaWi Based CDC or their i-nernbers or invitees, and FPC is hereby exper es,siy reqeased and discharged frorn any and aH Hability for any ioss, il'IjUry, or darnage to persons, property, eqUipment, or suppHes that may be SLIstained during or by reason of the OCCUpancy ofthe facHity. Boynton Beach Faith Based CDC shaH of rid, indemnify and hoW FPC harrn�ess froM and against any cairn, doss, expense or darnage to any person or property in or LIP011 the fa61ity or any area aHocated to or used by Boynton Beach Faith Based CDC or its agents, ernptray ees or invitees arising out of Boynton Beach Faith Based CDC use or OCCLIpancy of such faciiity or any act or magi of Boynton Beach Fakh Based CDC or its servants, ernpTanya es of, agents or any change (,.w aiteration by Boynton Beach Faith Based CDC to the facility. "t"he iridernnification described herein shaH pertain to the buiiding and all common areas aHocated around the b0ding on the Church grounds, McWing bUt not limited to parking iots, driveway, worship areas, kitchen, haH areas, restrooms, and sidewaks. This agreement is for the one (1) year period of February 1, 2023, thrOUgh Jawary 31, 2024, This agreernent can be terminated by ether party with 30 days' notice. This agreernent can aiso be terminated as a result of -failure of payment. Boynton Beach Faith Based CDC Representative (Print Name and Tit]e) Rrst Presbytedarn ChUrch Representative: &gnature-1 Date: Jainuary 30, 2023 Catba McDeqy:Lttgl!^j� of Session Print il4arne and Tifle First Presbyterian Church of Boynton Beach 235 SW 6th AveMie Boynton Seach, FL 33435 561-732-3774 800 COMMERCIAL LEASE FOR A LDHrED PURPOSE. & COLLABORATION AGREEMENT This Commercial Lease for a Limited Purpose Ss Collaboration. Agreement C Lease") is made by and between St John NVlissionary Baptist Church, Imc., a Florida not for profit mrpoi-ation (hereinafter "Landlord") and Boynton Beach Community .Development Corporation, a Florida. not for profit corporation (hereinafter "Tenant"). landlord and Tenant are collectively referred to herein as the "Parties." Upon execution by both parties, this Lease shall be effective retroactively to January 1, 2422 ("Effective Date"). RECITALS WHEREAS, Landlord awns the commercial real property commonly known as 900 N. Seacrest Boulevard, Boynton Beach, Florida 33435 (the "Property"); and WHEREAS, Tenant is in the business of, among other things, facilitating meals program for seniors in Boynton. Beach, Florida ("Senior Meals Program"), and AREAS, Landlord desires to collaborate on the Senior Meals Program with Tenant by providing the use of the kitchen facility in the Property to Tenant at a reduced rental rate and upon the covenants, conditions and provisions set forth herein; and WBEREA.S, Tenant desires to collaborate on the Senior Meals ]Program -with Landlord by leasing the kitchen facility in the Property from Landlord at a reduced rental rate and upon the covenants, conditions and provisions set forth herein. NOW THEREFORE, in consideration of the mutual promises herein contained and other goad and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties agree as follows: l.. Re_ a The foregoing recitals are trae and correct and incorporated herein by re£emMe. 2. Term_ The term of this Lease shall commence on January 1, 2022 and terminate on December 31, 2022 ("Lease Term7j. I Protrerty Rented. Landlord hereby leases to Tenant approximately five hundred (500) sgwe feet, which comprises the kitchen facility in the Property (the "Premises") during those limited time periods and pursuant to the terms and conditions stated herein. 4. P rmitted Usage Periods of Premises. During the Lease Term, Tenant shall be entitled to use the Premises on Mondays from 10-00 am to 6:00 pm, on I)mv;dsys from 9:00 a-rn to 6:00 Pm and on Wednesdays from 10:00 am to 12:00 pm (" 1'em:titted Usage Periods"). Landlord sball not interfere with. Tenant's use of the Premises during Permitted Usage Periods. 'Tenant shall not have the right to use the Premises at any time outside the Permitted Usage Periods vAthaut obtairmg the prior viten consent of Landlord. The parties agree that Landlord may require. Tenant to gay an additional fee for any use of the Premises not provided for in this paragraph 801 a. I nduLled Mures &- Eau At all times during the Lease Term and any renewals thereof, Tenant shall be entitled, during the Permitted Use Periods and pursuant to the terms and conditions herein, to use the Premises, together with all of the fixtures and equipment (appliances) located on the production lisae of the Premises. Tenant shall be responsible for providing its own pots and pains, utensils, dishes, towels, gJoves, paper products, cleating supplies, etc. and may not use any iterns present in the Premises outside the production line equipment provided for in this paragraph. 6. hdaded Associated Access. Tenant shall have access. to and be permitted to use the restrooans located near the Premises and the parlanrg lot adjacent to the Property dung the Permitted Use Periods. 7. Rent and AsldiilanaI t. Tenant shall ;pay rent for the ]Premises in installments of Eight Hundred Dollars ($800.00) per month C Rental Payment') with the est Rental Payment due in advance on or before the first (I") clay of January, 2022 and each subsequent Rental Payment due on, the Ent (111) day of each month thereaazr alux-04-6 ti:c t.: as-_ pay the rent and any and all other charges respired to be paid winder the provisions of this Lease ("Additional Rend') to Landlord, via cash, check, money order or other certEed funds by hand delivering or sending such payment to: 900 N. Seacrest Boulevard, Boynton Beach, Florida 33435, until such time that S:ablandlord should advise Subtenants that another form or manner of payment is required or acceptable. $. l c►si Advance 4 a aatd ale C1i�r�es. In addition to the Lease Payments described above, Tent shall pay the following. a. Dep ts: (a) Security deposit in the mnount of One Thousand Dollars and 00/100 ($1,0011.00) to be paid upon signing the Lease. Landlord may use the security deposit to offset any amoimt due to Landlord from Tenant under this Lease and Tenant shall have three (5) business days to replenish the security deposit after Landlord serves Tenant with notice demanding the amount required to €ally replenish the security to the amount stated herein. b. Other Charges: (a) Late fee in the amount of $10000 for each day that a Rental Payment is outstanding, winch late fee shall begin to accrue if the Rental Payment is not paid by the fifth (S") clay of the month; (b) Bud check fee in the amount of $100.00 if Tenant makes any Rental Payment with a bac] check. In the event that Tenant snakes a Rental Payment with a bad check, Landlord shall have the -right to require Tenant to make all further Recital Payments with certified funds. 9. riot€see. Whenever notice is required pursuant to the terms of this Agreement, such nation .01.0 hf- by halm deliv ,with proof thereof, or sach notice shall be sent by certified mail or commercial carrier, with return receipt requested, to the addresses listed below, as the parties may change from time to time upon providing written notice to the other party. Such notice shall be effective as of the date the notice is hand delivered or delivered by commercial carrier or, if sent via the United States Postal System, as of the date set forth in such notice, with. five (5) days added for mail time. St. John. lfissionary Baptist Church., Ine- 900 N. Seacrest Boulevard Boynton Bewh, Florida 33435 2 802 Baynton Beach Community Development Corporation 2191. IN. Seacrest Boulevard Boynton Beach, Flora 33435 10. Occmmxman I and Use of Premises. a. Use of Prendses. Tenant shall use the Premises for purposes of operating the Senior Meals Program, only. Tenant acknowledges and agrees that during time Lease Term, the maximum capacity of the Premises shall be Pave (5) people and Tenant shah ensure at all times that not more than five (5) people are present in the Premises at any given time. Tennant shall maintain the Premises m a clean and sanitary condition and comply with all state and local lawns, health. codes, ServSafe protocols, Centers for Disease Prevention and Control (CDC) guidelines and will .follow all other applicable regulations at all tknes when using the same. Tennant shall leave the Premises in a clean and orderly condition at the end of each. Permitted Usage Period. b. Occupancy of Premmes. Test acknowledges and agrees that the Premises have been tendered in, and Tenant has accepted the Premises, in their "AS IS" condition. Tenant shall not perform any acts or Carry on any practices that may injure the Premises, the Property and the MIding thereon or be a nuisance or mm mace to neighbors in and around the building and shall beep time Premises under Term fs control clean and free of rubbish, dirt and other debris at all times. Tenant shah be responsible for all damage to the Premises caused by Tenant, its invitees, guests, or other persons (including trespassers) visithig nr rnmsno to dad- TYPir les At all tixni-c while Tenant has possession of the Premises, Townt shall comply vdth all federal, state and local statues, ordinances, and regulations. Tenant shall perform all terms, responsibilities and obligations required by this Lease. Tenant shall surrender the premises at the expiration or earlier termination of this Lease in the condition in which it was rcccivcd, at the beginning of the lease term, normal year and tear excepted.. 1.1. Maintenance. Landlord. and Tenant agree that outside of the responsibilities and obligations of Tenant stated in this base, Landlord and Landlord's agent(s) shall provide general maintenance for the Premises and shall provide janitorial services for the restrooms and common elements daring the term of the Lease. However, nothing in this section shall. remake Landlord responsible or liable for any condition created or caused by the negligent or intentional act or omission of Tenant, or any other person who is on the Premises with Tenani's consent or due to Temaant's negligence, intentional act, or omission. 12. ITta`lm'ties. T'enant's Rental Payments shall include, all utilities and intemnet service in the Premises. 13. &MaLeWterations. Tenant may only use temporary signage, at Tenant's sole expense, our or about the Property and the Premises after obtaining the prior written consent of the Landlord for the same, at Landlord's sole discretion. Tenant may not make any improvements, alterations or additions to the Premises. Tenant may not install any fixtures in the Premises without the prior written consent of Landlord, which consent may be withheld at Landlord's sole discretion. 14. Landlord's Acmes to Prendsm Landlord or the Agent of Landlord may enter time Promises at reasonable times for time purpose of repairing the Premises, to inspect the Premises, and/or to make necessary or age upon repairs, decorations, alterations, or improvements, to supply agreed services, or to exhibit the Premises to prospective or actaal purchasers, mortgagees, 803 tsnnarnts, workers, or contractors. Landlord may enter the Premises of any time in the case of an emergency. 15. Media Collaboration. T'he parties acknowledge and agree that Landlord is leasing the Premises to Tenant at a reduced Rental Payment as consideration for Landlord and Tenant's agreement to collaborate on the Senior Meals Program In return for the reduced Rental Payment, Tenaiit hereby agrees to publicly credit Landlord as a Selmer Meals Program partner at all times while this Agreemernt is in effect, by including and prominently displaying Landlord's name, logo and contact itnforniation on any and all. Tenant promotional media for the Senior Meal Program including, but in no way limited to, Tenant's website, social media accounts, and all other applicable promotional materials, both physio and digital. Landlord will provide Tenant with digital files of the information to be displayed on behalf ofLandlord. Tenant must obtain the pri omissions by the Tenant or the Tenant's agents, employees, guests, licensees, invitees, Tenants, assignees or successors, or for any cause or reason whatsoever arising out of or by reason of the occupancy of the Tenant andfor on or about the Premises; 3) any failure by Tenant to perform any Of the terms or conditions of this Lease on Tenants part to be performed; 4) any %ailuree of Tenant or Tenant's agents, employees, guests, licensees, invitees, Tenants, assignees or successors to comply with any laws, ordinances, requirements, carders, directions, rales or regulations of any governmental authority. Tenanfs indemnity obligations under this paragraph and elsewhere in this Lease shall survive the expiration or earlier termination of this Lease. 20. Insurance Reguirements. Tenant shall at all times keep in fall force and effect a policy of comprehensive general liability insurance with respect to the Premises and the business operated therein by Tenant with Landlord named as an additional insured thereunder and in which the limits of liability shall not be less than $ i,000,000.00 in respect of bodily injury or death to any one person and $1,000,000.00 per occurrence. All such insmunce policies shall be effected under valid and enforceable policies, shall be issued by insurers that do business in the State of Florida and which are acceptable by Landlord and all said policies shall contain a provision whereby the insures- agrees not to cancel the iuswwce without ddrty (30) days written notice to Landlord Tenant shall also maintain worker's compensations insurance as required by applicable law, 21. Miscellaaueous. a. Further Assurances. The parties agree to promptly execute, acknowledge, deliver, file and record such additional documents, instruments and certificates, and to do all such other acts, as are necessary or desirable to fulfill the terms and conditions of this Agreement. b. No Implied. Waiver. No waiver of any default of the panes hereunder shall be implied from any omission to take any action on account of such default if such default persists or is repeated, and no express waiver shall affect any default other than the default specified in the express waiver and Haat only for the time and to the extent therein. stained. One or more waivers by any of tho parties shall not be construed as a waiver of a subsequent breach of the same covenant, term or condition. c. GoyerWng Lava. This Agreement shall be governed by, construed, and enforced in accordance with the laws of the State of Florida. d. Dispute Resolution. .Any dispute, brew or litigation arising out of or related to this Lease and/or Tenant's tenancy shall be maintained in a state court of competent jurisdiction in Palm Beach County, ]Florida and the parties hereby submit themselves exclusively to the jurisdiction of that Court for purposes of this Lease unless each party to the dispute or litigation agrees in writing to submit to alternate dispute resolution. in the event Haat any disiaute, breach or litigation arises between the parties pursuant to the terms and cozadit ens contained Herein, the prevailing party shah collect from the other arty all reasonable attorney's fees and costs, expenses and damages incurred by the prevailing party. e. Readings, The headings of the paragraphs of this Lease are inserted for 5 805 convenience only and shall not constitute a part thereof- £ Severability. If any provision of lis Lease shall be held invalid by a court of law for any reason, the rernainiing provisions shall remain in full force and effect g. Modification. This Lease .may not be waived, changed, modified, abandoned, arnended or terminated, in whole or in part, except in a written document executed by both parties, h.. No Other Agreements. The parties intend this document to be a fall and complete statement of their agreement tegarding the subject matter hereof, and all prior discussions and agreement regarding the subject matter hereof we superseded by this document. i, interpretation Clause. The parties hereby acknowledge and agree that they have actively negotiated the terns of this Lease and have had the opportunity to have this document reviewed by an attorney, The parties agree that this Lease shall not be interpreted more strictly against the drafting party. j. Binding This ]Lease shall be binding upon, and inure to the benefit of, the parties hereto and the respective legal representatives, successors, and assigns of the parties hereto. The parties agree that the individuals executing this Lease have the full power and authority to bind the respective parties to the Lease to the terms and conditions contained herein. L Counterparts. The parties agree that facsimile and veritable electronic signatures shall be considered original and that this Lease may be executed m any number of couanterparts, each of which shall be an original but all of which together shall constitute one and the same instrument. 1. Obkoation of Good Faith. Landlord and Tenant agree to perforin their obligations under the Lease in good faith. 22. Radon Gas R elosu re. As required by law, Landlord makes the following disclosure. Radon is a naturally occurring radioactive gas that, when it has accurnulated in a building in sufficient quantities, may present health rising to persons who are exposed to it over time. Levels of radon that exceed federal and state guidelines have been found hi buildings in Florida. Additional information regarding radon and radon testing may be obtained from your county health department. [J�Ti TFWIONALLY LEFT BLANK] SIGNATURES ON FOLLOWING PAGE M 806 We, the undersized, have zead, understand and voluntarily accept the terms and conditions provided for in this Commercial Lease for a Limited Purpose and Collaboration Agreement, comm that we have the authority to bind the parties hereto and agree to be bound by sante. Authorized Representative Date St. Jain Missionary Baptist Church, Inc. Authorized Representative bate St John Missionary Baptist Church, Inc. Authorized Representative Hate Boynton Beach Community Development Corporation Authorized Representative Date Boynton Beach Community Development Corporation 7 807 J!� FOUNI)ATION 'T,ff FUTUIRE BELONGS H.)M(.)S�E WHO PnEPARE FOR 617' Type: Progress Report Organization Name: Boynton Beach Faith Based Community Development Corporation Grant Manager: KhaHl Zeinieh Report Year: Year 1 are MW MIM 11 W, I Prograin Name: Farnify Strengthening Grant Term: 12 Grant Payment: Year 1 Grant Payment Arnount: 53„100.00 Grant Period End Date: 06/30/2023 Program Narrative Application ID: 2022-3965 - Boynton Beach Faith Based Community Dev6opnnent Corporation Sherry Johnson Report Daae Date: 01/27/2023 Submitted Date: 03/07/2023 Target Population Statement Approxk-nately 350 families in Boynton Beach will receive Family Strengthening services and support. Please report on the number of adults, children, families and/or seniors you have served to date compared to YOUr initial Target Population. IllUIIIIIIIII FOUND/UION "T 4E FU TURE BELONGS TO THOS E '#V1140 PREPARE P:�ofi �'r.­ Since ,July 1 of 2022 thru January 31, 2023 the Family Strengthening Program has worked to support 727 Households (351 seniors and 376 families) by providing -food, shelter, and financial aid, in addition to referrals for additional assistance through direct & virtual in -take and case managernent by staff and through coordinated collaboration with the Heart of Boynton Social Service Alliance partners as well as other agencies throughout Palm Beach County. Access to Food 1) 31 Seniors and Families benefit from our "Mobile Angel Food Pantry." It is managed by one of our Alliance Partners, "Boynton Angels in Action" and they also include clients from Pathways to Prosperity. The 15 Angel V6unteers call families to let them know what is available from the pantry, bag the groceries, and deliver, special. Thanksgiving Holiday Baskets are provided. Shopping and delivery are provided twice a month. In addition, the current roster of 38 children in these households are included in their program called "Share The Love." This program provides special "Share the Love" Gifts which include backpacks and school supplies, Halioween Gift Buckets, Birthday Cake Packages, for a "rnomrny and me" experience, Santa Bags of Holiday Toys, Easter Baskets, Valentine's Day expressions of Love; and include thoughtful remembrances for parents on Mother's and Father's Day. 2) In August 2022, we implemented an initiativeto address the rising cost of food called our "Affordable Food Program." Each month rneat, -fish, poultry is purchase from wholesale purveyors in bulk and the savings passed on, like a Buyer's Club, to help address the rising cost of food prices at the grocery, this opportunity is available to anyone in the community through our Non -Profit Market "on-line shopping" on our website -https://www.boyntoiibeachcdc.org/non.-profit-market - There are currently 60 participants in this program, including 18 families from Pathways to Prosperity. Packages are generally around $21. -rhe Affordable Food Package program is a self-sustaining program. A donation provided for the purchase of a scale and freezer. 3) In September, we signed a partnership agreement with the PBC Food Bank for their "Groceries for Seniors" Program. They deliver twice a month directly to our social activities on Monday and seniors take the gags of groceries home with them and volunteers will deliver to shut ins. To date, 89 seniors participate. 4) In October, we began a "Third Monday Breakfast." It is a monthly congregate breakfast held at our social activity for our seniors on the 3rd Monday of each month. Approximately 80 to 90 of our seniors come out for this offering of Shrimp & Grits, Scrambled Eggs, Juice, Coffee, Turkey Bacon, Biscuits & Jam, and Georgia sausages. 5) Senior Horne Delivered Program - Healthy Meals are prepared for 110 seniors each week. The Barclay Philanthropic Group donates, once a month, prepared sandwiches and a piece of fruit, like a cutie mandarin. These sandwiches are made with the finest multi -grain breads and selected prime slices of turkey and beef and occasionally egg or tuna salad. 6) Fresh Produce — PaIrn Beach Harvest had been donating fresh produce picked up from Whole Foods until June 2022 at which point, due to transportation costs, ended. We began -to use our donations to purchase 809 T H 11 YK Aro L`�`fl F OUNDNFION '14E FU�URE BELONGS rO P110SE 'ANA0 PFIEPARE FOR, from Rorabeck's Wholesale Produce fresh seasonal local produce and provide it free of charge at least once a month. I can fit in my SUV 17 to 19 cases of produce. It is loaded at Rorabeck's, and the volunteers unload at our distribution site and distribute at the social activities. 7) Holiday Baskets are provided for at Thanksgiving and Christmas - this will be highlighted in more detail in our Elder Care Report. This year we provided 95 20 lb. Turkeys donated by the HATT Foundation, plus several gift cards for turkeys; The City of Boynton provided 13 Thanksgiving Baskets from Christ Fellowship, and Benvenuto's Italian Restaurant donated 217 meals. 8) Staff serves on the United Way Hunger Committee, promotes and distributes information regarding school lunches, nutrition education, SNAP benefits, mass food distribution opportunities for pantry items, produce and meals. Access to Shelter 1) Supportive Housing Opportunities - We currently offer 2 campuses, a 12 -bed men's apartment building, and an 8 -bed single family home for women. Both units are full. Affordable Housing is a major issue for Boynton Beach. Recently, staff, Keturah and 1, have responded to 2 Community Development Block Grant, CDBG, grant opportunities addressing emergency housing rehab for low -income seniors and to provide affordable senior rental units. It was awarded in October 2022 in the arnount of $904,000. It will allow up to $25,000 in emergency repairs for roofing, windows, efficient a/c, etc. for approximately 15 to 20 homes, pay for 1 year of insurance, will not iien on the property if you are over 62 and or disabled and low income, and provide approximately 5 to 6 affordable senior apartment units. Staff has just completed and the city has approved all application documents and the process has just been launched, https://www.boyntonbeachcdc.org/abou,t-3-1 - Access to Financial Aid - This is really where the bulk of time has been spent by staff for the Famfly Strengthening Program, Financiai Aid has been provided via several funding sources: 1) Senior Discretionary Funding $30,000 from your foundation, Jim Moran Foundation -THANK Beach County's Community Action on-line application portal for utility assistance, for low- and elderly energy assistance, or LIHEAP & EHEAP funding; 3) PBC on-line porla� for COVID Rent & Utility Assistance, Eviction/ Relocation Assistance, Non-COVID Rent & 4) D,CF's Emergency Cash Assistance & SNAP benefits; 5) Our Florida had been used the previous year, however, that portal closed in May 2022, and the 6) City of Boynton Beach's $370,64.5 CDBG-CV grant award implemented October 1, 2021 and -then extended October 1, 2022 to February of 2023. Staff had also been awarded by the City of Boynton the CDBG grant for Pubhc Services for period of 10/1 /2021 to 9/30/2022. 1) Senior Discretionary Funding — we spent $30,0154.46 to assist 31 households. 8 families and 23 - Seniors. - Property Taxes — $5,065.61 for 2 senior property owners. We were able to save 2 seniors homes from Tax Deed Certificate Sales, the day before their auction. 1 gentleman owed over $23,000 and had begged, borrowed, and s6d everything possible to raise $20,000. He was a COVID long hauler who had suffered a heart attack as a result of COVID-1 9 and was just beginning to recover from 2 years of illnesses and heart 810 FOLM)ATION '114E UNIRE BELONGS D) THOSE Wkie.) PREPARE FOR J.' surgery only to realize where he was financially. The second was a senior living on fixed income. - Section 8 Deposits for Ernergency Housing Vouchers - $7,077 for 4 Senior Households assisted wi security deposits to use their section 8 voucher for affordable rental housing. i - Rent Assistance — 9 senior households for $12,526.50 - $7,141 for 5 seniors and another $5,385.50 for 4 seniors to paid down the rental increases to their previous rental rates, including one senior who was sharing a vffla/condo and her roommate unexpectantly passed. We paid the roommate portion for I month so that she had time to find another roommate. We also assisted one family ( 2 adults & 5 kids) with I week of motel stay while we were able to get them approved for Relocation COVID Assistance and move into their apartment. COVID had gone thru the family for a period of 2 or 3 months in the fall causing dad to take time from work with COVID and then stifl have to care for his wife and additional kids as it swept thru the fami�y. He had a great Job with a Toyota / Honda Dealership, had been in his apartment for several years, However, the landiord saw an opportunity to raise rent and move quickly towards eviction. I was able to get him approved and into a home in Riviera Beach at an affordable rate. 2) PBC LIHEAP & EHEAP Utility Assistance — 88 households Assisted - During this grant period we were witnessing the most inflationary period in the aftermath of the COVID Pandemic. For many on fixed inicomes rise, and it seerns that everyone bills were increasing from $25 -to $50 month on the average. Because Michelle Davis White sits on the board for our area for Community Action, CAP, we were able to call in a favor and bring the staff of CAP to our social activities for a few days to take 73 applications for LIHEAP and EHEAP utiht�es which amounted to nearly $90,000. We aiso provided online application assistance to another 10 households, and paid FPL with discretionary funding for 15 more households. Altogether assisting 88, household with either LIHEAP, EHEAP, or Discretionary Funds. CAP provided an average of $1,200 Credit for Utility Assistance so seniors didn't need to apply except once a year. 3) PBC on-line portai for COVID Rent & Utility Assistance, Eviction/Relocation Assistance, Non-COVID Rent - 52 households were a ssi stedth rough the PBC COVID Rent & Utility Assistance Program bringing in $473,190 in financial resources to our service area. We were so happy to have this resource, it was open and then closed a few times to allow for clearing log jam of applications and to add: additional funding opportunities. The process was slow and frust�rating in obtaining approvals. Clients needed multiple apphcations to reach self-sustainaNlity. The slow approval process was frustrating to many landlords who began to refuse to work with tenants who needed to access that funding to pay their rent and as rental rate inflation post pandernic to hold landlord who had had to wait to pay their own bills began to evict and raise rental rates. There were to or three landlords that I had to solve their vendor registration errors to get them 811 R I I RJNDNri()�4 "IHE FUTURE BELONGs w. NOSE WHO FIREPAHE FOR VV' paid 4.) Our Florida - we did not do any applications to Our Florida - we did help to solve or find funding for 2 households where the specialist never submitted the applications. 5) City of Boynton Beach, CDBG-CV Assistance - We assisted 75 households and provided $370,645 in Rent, Utility & Relocation Assistance. 22 were seniors, 14 had been evicted and needed relocation assistance; 19 of these househoids required additional funding through PBC and 5 more needed discretionary funding. Our 2 largest landlords were Boynton Bay Apartments with 8 CDBG-CV assists where seniors were still working to supplement their SSA benefits and that loss of income nearly cost thern their apartment and another 11 with Clipper Cove Apartments, a low-income apartment comp�ex. These two �andlords were arnazing in the help they were providingto their tenants: filing out forms, scanning -V !1: 111:11II&AIJIG would begin to add to additional costs for tenants to remedy. Please provide information regarding the progress being made towards your meaSlLirable goals. 812 FOUNLARON "SHE RP"UME BELONGS TO PHOSE WHO PREPARE FOP, H,'' Measurable Goal 1 Eligible families residing in the Heart of Boynton will receive housing stabilization financial assistance and wrap- around services to achieve sustainable housing security. A minimum of 80% of families served will not be evicted as a result of the assistance. How will this goal be measured? Case notes, client database and follow-up mill be used to determine household and financial stabilization. ACTUAL NUMBER OF CLIENTS WHO RELIEVE HOUSING ASSISTANCE TO BE DETERMINED Projected number to be served 0 Number who will achieve this goal 0 Number served to date 197 Number achieved to date, if applicable 197 X""T TOM" 813 FOUNEWFION "IHL FUTURE BELONGS TO MOSE 'A([ f 0 P R E FIA R E F () R Er.,, Measurable Goal 2 Approximately 350 families in the Heart of Boynton will receive wrap-around services include case management, emergency food, shelter, and financial aid. How will this goal be measured? Case management notes and spreadliseets will be used to track the number of families who receive case mangement, emergency food, shelter or rental/mortgage/utilities assistance and other financial aid. Each activity will be reported separately at the end of the grant period. Projected number to be served 350 Number who will achieve this goal 350 Number served to date 726 Number achieved to date, if applicable 726 Comments We still need to follow up to see that folks have been able to maintain - I know of 1 family assisted did loose her home and two of our seniors have passed away, one of them is in the process of foreclosure because of Successes and Challenges ... . . ....... ..................... ------------- Please let us know of any challenges you have encountered to date in delivering the program and how you are addressing them. We also welcome any early success stories you may want to share with us. OMG, where do I begin. Challenges: 1 - Landlords - greed, impatience, frustration, 2- So much handholding to obtain documentation to get them qualified It required a lot of patience - deep breathing and long hours, weekends -to be accessible Page 7 of 9 814 F N OU DATION "THE FUTLIHE BELONGS T'O TI�IOSE WHO FrREPARE FOR, I Line Item Salary - Case Management for family stabilization & economic Mobility "I"JI011, Approved T,JMF Total Other Funds 'Total Biadget, Approved 00'Rer Ftinds Total Widget Speirift Y'TD Spen' t Y"I'9 Spent'VID Variarice Funds 854,000.00 $0,00 $54,000.00 $28,569.52 FICA $4,100.00 $0.00 $4,100.00 $2,185.57 $58,100.00 $0.00 $58,100.00 $30,755.09 Please upload any photos, videos and/or articles. 2022-T'l-niai,�ksgivii,iilg,,,.,Rei)oRt.pp tx 544.4 MB - 03/07/2023 5:20PM Aug ust-2022-Afforda ble-Food-Flyer. pdf 119.7 KB - 03/07/2023 4:28PM Fai'Tiily-Streui!ig-tkie�liii°ig..0lie nt-Data-Ba!se.pdf 845.6 KB - 03/07/2023 5:22PM Noveiniber-.2022 Aifordable...�Focd,-Fiyer.l)c:if 148.2 KB - 03/07/2023 4:29 PM Pai�itry-,BAA,-'F'Iiaiii°il(givirilg,,,-Food-Delivei,ies.jl)g 1,002 KB - 03/07/2023 4:44PM �Pari�'try-Shop,—,,DeV�ivem.-Voltjiiui'teer.jpg 698.1 KB - 03/07/2023 4:44PM "runa ......... . Sal adjPlatter-pg,-3. J PEG 859.6 KB - 03/07/2023 4:45PM $0.00 $28,569.52 $25,430.48 $0.00 $2,185.57 $1,914.43 $0.00 $30,755.09 $27,344.91 Total Files: 7 Page 9 of 9 815 FOLADATION I HE FUNIRL BELONGS rO THOSE WHO PRLPA'RE FOR Ff," Type'. Application ID: 2022-3935 - Boynton Beach Progress Report Faith Based Community Deveaoprnent Corporation Organization Name: Based Community Development Corporation Grant Manager: Khalil Zeinieh Report, Year: Year I IMMUTIPT-Im." Prograrn Name: Elder Care - Aging in Place Grant Amount: $66,000.00 Grant Payment: Year 1 Grant Payment Amount: $66,000.00 Grant Period Start Date: 07/01/2022 Grant Period End Date. 06/30/2023 Program Narrative Primary Contact: Sherry Johnson ReportDue l)ate: 01/27/2023 Submitted Date: 03/09/2023 Please provide us with any senior management or program staffing changes. The Elder Care program has not experienced and senior management changes. There have been changes to the program due to rental rates increases. We've moved our social activities frorn St John Missionary Baptist Church to the First Presbyterian Church and changed from weeHy Monday events to the first and third Monday. For this grant report period we provided 26 Activities, see attachment. We have added a few more field trips to fill in the gaps between events now that it has become a little more safe and our staff is now doing more In Person" visitations. Our schedule looks like this: First Monday - Social Activities Event 11 AM to 2 PM at I st Presbyterian Church Take Orders for Affordable Food Packages about 40 participate Pot Luck Buffet, we provide meat - Leftovers are packaged and taken home L -M; F`0 LJ N L)AT I ON ,rHE FUTURE GELONGS TO THOSE W-40 PREPAFRE FOR VV' PBC Food Pantry delivers Groceries for Seniors - about 30 take pan -try items and rotate so everyone gets a opportunity Fresh Produce is provided - anywhere from 6 to 19 cases - seasonal local wholesaler Tuesday - at St John MBC Chef Prepared Meals - Weekly, 165 participate -110 Meals are prepared - Salad Platters (Tuna, Shrimp, Seafood, Chicken Salad, Egg Salad), SOUPS, Meatioaf, Tilapia 4th Tuesday, Barclay Philanthropic Group, "Sandwich Brigade" delivers 113 sandwiches and fruit to go out with the meals. Wednesday - Meals are picked up 10 AM -to Noon from St John MBC and/or delivered by volunteers to hornebound Boynton Angels In Action volunteers stop by to pick up meal for those that are in the Shop & Deliver Angel Food Pantry Program Thursday & Fridays - staff works on calls & visitations to homes to visually check on status and also nursing homes and hospitais, Also setting up field trips, social activities, and special holidays - We are going to start to do fundraising activities this year for the first tirne. 3rd Monday - Social Activity at I at Presbyterian Church, Monthly Breakfast is provided - at least 3B to 90 attend for the breakfast Affordable Food Packages are handed out PBC Food Bank - Groceries -for Seniors deliver another 30 to 40 pantry grocery bags and the rest of the week We feel we are doing a very good job during this tirne of COV0 Inflationary Crisis at keeping our seniors eating healthy and NOT going hungry! Between the BBA Pantry delivering to our homebound, PBC Food Bank's Groceries for Seniors, i4eafthy Meals, Sandwiches and Fruit, Social Activities congregate feeding, monthly breakfast, monthly Affordable Food Packages, and Fresh Produce. This is an era of one of the biggest struggles to provide housing and food for those on fixed income that I can ever recall in my 30 years of community service. I'll niention it here instead of the successes and challenges section. Pandernic Food Stamps for seniors what one of the best helps. When that ended, our seniors were so disappointed that most have dropped Out of using food stamps because of the recertification requirements, although better, and the smaii arnount of money that they are eligible to receive. Social Security rate increases by 6.5% was remarkable, but the raises were enough to push boarder line seniors over the income eligibility limits. l have not had a senior ask to be placed on food stamps for nearly I year. 817 Y H L� DA FO,,, N 710N "THE FUWRE BELON', rO THOSE WHO FIREVARE 8:Ofl, J," Target Population Statement Approximately 173 low-income seniors residing in Boynton Beach Please report on the number of adults, children, families and/or seniors you have served to data compared to your initial Target Population. We have approximately 351 seniors that have participated in our Elder Care Program. Many have just needed the financial aid program. We have added a few to the monthly Eider Care Program and have lost one or two this year. Co we still hover around the 173 active seniors that are cared for by our Elder Care Staff. We have many more now that have become homebound due to COVID that are called "Long Haulers.® Our biggest attrition in the Elder Care Program is no longer transitioning due to COVID - that first year, 3.020 - 2021, we lost 17 seniors, OMG! - Prograrn attrition is now done to rental rate increases, where many of our seniors have had to relocate, rnany to out of state relatives. The 200 Section 8 Emergency VOUchers for seniors given by the Housing Authority was brfflianV but not nearly enough to meet the need for labra Beach County senior community. l want to sing the praises of the two housing apartment units - Clipper Cove for low-income and Boynton Bay for low incorne seniors - Government needs to provide funding for rnore units like this. The governmental regulations limit rental rate increases by landlords. Government great thinking. Cities and CRA's need to look at this as part of their working with Affordable Housing Deveiopers; ­ We've spoken directly to city and county commissioners regarding this aspect. Once the competition for the project is completed, cities and CRA's simply transfer title to property without paying attention to the fine print in leasing docurnents. They only want to know how many units are set aside for low-incorne. They should impose rental rate limits for a period of time, and read the -fine print regarding how applicants are able to access -the affordable housing rents - One of the newest projects in Boynton Beach, requires that low income applicants have perfect credit rating - Seriously???? After this pandernic, just how is that going to happen? For this reporting period, social activities have been provided weekly on Mondays at St John MBC's RNA Lee Center - an attachment is included detailing those activities, Please provide information regarding the progress being made towards your measurable goals. fi� 1; ALL -1 F0(.J'NI').AI'*J0N' FUl'URE, BELONGS W M0SE WH0 PREPARE FOR �U' Measurable Goal 1 Approximately 173 seniors will be assisted with necessary resources and basic services to allow them to age in place rather than enter institutional care. Flow will this goal be measured? Measurement Of SUccess wffl be a data base excel spreadsheet tracking information on each client, Such as age, years in the program and their level of participation, date, reason and age at transitioning. Numbers of seniors served and outcomes will be tracked and reported for the following services: (1) Home Delivered Healthy Meals - # of seniors receiving home delivered meals, frequency and duration (2) Fresh Produce and Nutrition Education - # of seniors participating (3) Social Activities - # of seniors participating (4) Emergency Food, Shelter & Financiall Serv6ces are available to our low-income and elderly clients, who are assisted with their application for Home Energy Assistance Program funds, (LIHEAP & EHEAP) to pay utilities - # of seniors assisted and services accessed, (5) Emergency Financial Aid funds, when available, are used to assist with rent and mortgage payments - # of seniors and total amount paid in rental and mortgage assistance. Projected number to be served 173 Number who will achieve this goal 173 Number served to date 351 Number achieved to date, if applicable 351 819 -_ZOLNIDATION N U "a, FAIR I IN msl' HE MU'RE BELONGS TO THOSE WHO PREPARE f OF, J," Comments This number is inflated because of the amount of COVID financial aid made available that we were We to access. It wii[ go back down -to the 175 plus or minus until we are on better financial footing to expand the program to the Greater Boynton Area rather than the focus in the Heart of Boynton, which is East of l-95 Lantana to Gulfstrearn Blvd and east to the beach. An attachment is provided detailing participation in areas of food programs and -financial aid funding sources. Measurable Goal 2 Eligible housing inseCUre seniors will receive direct financial assistance for rent, mortgage, utilities, and/or move - in costs through the $30,000.00 grant from The Foundation in May 2022. ACTUAL' UMBER OF SENIORS SERVED TO BE DETERMINED How will this goal be measured? Case management and payrnent records Projected number Ito be served 0 Number who will achieve this goal Number served to date 351 Number achieved to date, if applicable 351 820 1rR,F()LJNI_)ATI ON' "THL FUTURE BELONGS 10 TWJSE INHO PREPARE FOR, kf," Comments Detail was provided in the Family Strengthening Report previously provided - The number was increased dramaticaiiy because for several other funding pools we were able to access. The $30,000 provided financial assistance to 31 households, 23 of which were seniors We were able to assist 2 senior property owners ready to Tose their homes to Tax Deed Certificate Sales; help 4 lucky seniors able to get one of the emergency section 8 vouchers and be approved by Boynton Say to get a great affordable senior apartment by paying their security deposit required to move in and not covered by the section 8 voucher. YEAH!! The rest went to help paydown rental rate increase for those on fixed incomes to allow for a period of adjustment, or pay rent and/or utilities. M=4 Please let us know of any challenges you have encountered to date in delivering the prograrn and how you are addressing them. t also welcome any early success stories you may want to share with us. Safety continues to be one of the challenges - Seniors remain sacred! They are so happy to be able to return to In Person" social activities and feel the need to continue to wear masks. We use round tables for seating so that it allows for additional spacing rather than the long tables. Successes - There are three events this year that are STANDOUTSu!!!!! August 2022 - "Cutz & Conversation" Event -tie partnered with Boynton Beach Mental Health Committee who received a grant from Healthier Together Boynton Beach, a P2P project funded by Palm Health Foundation. It was designed to be an event to measure the effects of COV0 on the mental health of caregivers. 1 serve on the steering committee for both HTBB and BB HC and worked designing the pre & Dost surveys, and provided the statistical data analysis provided in a report - We used Golden Parents Inc. for the program - using a licensed therapist, who provided a guided discussion with 45 of our Elder Care seniors who were caregivers - Within the Mack CUlture, this is generally riot done, however the results were outstanding - Docurnent is attached for Your review - My gest is this: Vve never seen a black man is a group setting get up and begin to cry about who, and how much loss lie suffered and how scared he was - yet, we have 3 of our huge 6'250 lb black men did just that! WOW!!! Bottom line, they want to do more of -these guided conversaUons, they felt safe, the number of seniors who would not have reached OLIt for help with a rnental health person went form 24% in pre -event survey to 84% in post -survey. The results were a fitfle bit scary to me in this respect - These are the elders of this community, they provide the wisdom, strength, the calm patience that is needed for a community - At a time when issues regarding racial equity is at a peak, these seniors who have experienced a lot during the 60's & 70's, will be the ones looked to for advise and guidance. Many have been so impacted by the COVM experience as the results of the study indicate. They are now angry & frustrated by the controversy regarding accurate information, showing less patience with their care recipients, which Could be a leading indicator that our community could become a powder keg. 821 Ot Fff N ME FUIURE, BELOPIGS, TO THOSE WHO PREPMRE FOR We have already had two incidents in this community: a 13 year old black boy killed by a police officer, and a 70 -plus community activist hospitalized by a hit and run driver on the anniversary of the death of that same child. A copy of report called "CO VID-1 9 Mental Health Impact on Caregivers is attached. The other is the Thanksgiving Basket Program we celebrated all month and it began with a Praise and Glory sign -a -long - l had attached that to the Family Strengthening Report - it is a long upload, so l won't duplicate it here. Just a beautiful month of Thanksgiving. The last is the Black History Month Celebration - It is so colorful, I'm attaching photos for you to see. The Fashion Show had a theme of historic black figures: Maya Angelou, Angela Davis, pure fun - A black historian -talked about the black historic home in Boynton, Kwanda Forever! and African Praise Dancer, StoryTelling, including the story of "Brer Rabbit" - Just Beautiful This was held in February, but I'm including some of the pictures here. It will be included in detail with our Final Report. Michelle and her team are just amazing at putting these events together ! _h me Kern Salary - Program Coordinator - PT 24 hr/wk Salary - PT Assistant 24 hr wk Salary -Meal Dehvery * Fresh Produce FTE Salary - Affordable Food Prograrn Butcher & Packaging Salary - Affordable Food Sales & Distribution I'AAF Approved 7,11AF "rotas Other, Fixiids Total Budget Approved Other Funds Total, Budget Sp(�:Int YID S;�ient YTD Spent Y"I'D Variance Finn& $12,000.00 53,000M $15,000.00 $8,251.70 $6,150,76 $14,402,46 $597.54 $12,000.00 $3,000.00 $15,000.00 $8,250.00 $2,923.32 511,17132 $3,826.68 $24,404.50 $16,660.00 $41,064.50 $8,206.00 $2,384.30 $10,590.30 $30,474.20 $0.00 $4,200.00 54,200.00, $0.00 56,048.00 $6,048.00 $0.00 $4,201.99 $4,201.99 ($1.99) $0.00 $928,22 S928.22 $5,119.78 822 T' I I E ,,J N ) F ON TWEE F U I'UR E BELONGS TO I HeDSE WHO PRUARE FOR, 07' Salary - Chef $0.00 $240,000.00 $240,000.00 $0.0,0 $3,510.66 $3,510.66 $236,489.34 for Meals per $0.00 $14,4.00,00 $14,400.00 $0.00 $4,490.00 $4,490,00 $9,910.00 Diern Kitchen Rental $0.00 $12,000.00 $12,000.00 $0.00 $2,500.00 $2,500.00 $9,500.00 Auto - Fuel 580 wk, 2 oil changes $300, $7,000.00 $0,00 $7,000.00 $1,30027 $0.00 $1,300.27 $5,699.73 Repairs 8, Tires $2,540 $0.00 $7,453.00 $7,453.00 MOD $14,54,130 $14,54130 ($7,090.30) Social $6,000.00 MOO $6,000m $1,34195 $0.00 $1,343.95 $4,656,05 Activities $3,595,50 $2,196.00 $5,791.50 $1,890.06 $876.57 $2,766.63 $3,024.87 Fresh Produce $0.00 $240,000.00 $240,000.00 $0.0,0 $3,510.66 $3,510.66 $236,489.34 Pantry Angel Food Pnatry $0.00 $35,000.00 $35,000.00 $0.00 $8,026.79 $8,026.79 $26,973,21 Shopping & Delivery for 25 Office Supplies $1,000,00 $0.00 $1,000.00 $22715 $2,675.62 $2,90237 ($1,902,77) 1--loliday Baskets & $0.00 $7,453.00 $7,453.00 MOD $14,54,130 $14,54130 ($7,090.30) Meals FICA & $3,595,50 $2,196.00 $5,791.50 $1,890.06 $876.57 $2,766.63 $3,024.87 Benefit s $0.00 $30,000.00 $30,000.00 $28,370.52 $202,246,89 $230,617.41 ($200,61741) $66,000.00 $373,957.00 $439,957.00 $5�7,839.65 $255,458.42 $313,298.07 $126,658.93 Page 8 of 10 823 FOt,,,JN 11-TION 1HE FUVURE BELONGS 10 PKI'SL WHO PREPA�"JXNY NP� 14YGf�J 7VrVriV fVVXi" RE FOR M" Please upload any photos, videos and/or articles. 4.1 MB - 03/09/2023 4:23PM 2022-'Thaiilksgivio[ig-Report.2cif 1.8 MB - 03/09/2023 3:15PM 2023,,,,,,,Blacl<,..,�iistory-,P��,ogiam.pdf 3415 KB - 03/09/2023 4:23PM Black-ilis,tory.-F'°asi,iior,i-Show.,.-,-Al:riciaiiri Dancer,,HEEIC 2.6 MB - 03/09/2023 4:24PM Bllacl(,,,,IHistoi;.,,,,,Fashion,-SlicpiAr--"I,I-IEIC 1.9 MB - 03/09/2023 4:23PM EI�der-,("I'a,,,Social,,,A,cm -tivities-,.Iul,y 2022-Ahni .January. 2023.pdf 559.4 KB - 03/09/2023 31 OPM Faii[y,iily,,,,,,,,S,ti,eiig,ti�ieFiiiig_,Client,,,,,,,Data_Base.pdf 845.6 KB - 03/09/2023 3:12PM ��iTipact,,,,,,o,r-COVII)..c)i"t-Cai,egivers,,pdf 1.2 M B - 03/09/2023 12:0 5PM l(warida.,,,Fo�,eveoi��,-,,IBlack,,,.I���listory.,,Sei,iioi,..Iwodels-.pic,-l.jpg 79.6 KB - 03/09/2023 4:26PM l(wai,id�a,,.,Forevei"..Lllaci-,Histoi,y ,,Sen nor„- ode ls.,.pl c-.2-jpg 38.3 KB - 03/09/2023 4:24PM Seni o ii,. -Mea k.-,,%,.Cobb,.,SaIad.j peg 98.5 KB - 03/09/2023 4:25PM Seiiior-,Meals,,,--,,Honey..Glaze(i.,,,,,BBQ_Cl.ilcketi.�wi,tli.Browii_.Rice__Biroccol�i.j��)leg 255.8 KB - 03/09/2023 4:25PM TaW Files: 12 t..M 824 f .1 ,`OUNDAITION " f HE FU rURE BELONGS TO I HOSE WHO FRERMIE FOR � f," Do you approve these photos and stories for publication? Yes Communication -rype: Story with Photo 825 BOYNTON BEACH FAITH BASED CDC, INC. ELDER CARE PROGRAM jim Moran Report on Social Activities Pr6senter - -- ---- ------- - ----- !Organic Market - Produce Distributi( ,'Organic Market - Produce Distribution 'Organic Market - Produce Distribution Field Trip - MOVIES to see "Elvis" Breakfast G ME: "Wheel of Fortune �Boynton Beach Mental Health Committee - " Cutz & Conversations" - COVID-19 Impact on Mental Health for Caregivers - Healthier �Boynton Beach Mini Grant Award Welcome Coffee Field Trip "Saturday, Birthday Breakfastat Palm Dinner" s Luncheon - �COMPASS Presentation affmiTEIiite Line Dancing -Groceriiiiii f i ISeniors, (GFS), 28 Bags Community Action; Program - application assistance for LIHEAP & EHEAP financial aid GFS- 27 bags iCOMPASS Presentation Staff Meeting - Holiday Planning !YMCA - Diabetes - GFS 27 bags �';ACTIVITY: Meditation w/Linda Sheele YMCA - Blood Pressure Screening Program ACTIVITY: "Attitude of Gratitude" praise sing-a- �long w/joshua Harris / GFS 47 bags L 1A IVITY: YMCA- Nutrition Seminar HATT 95 Turkey Drive Thru rt L-�; 827 Thanksgiving Baskett Distribution -via pick up & delivery 17 Walmart Gift Cards for those who didn't get turkeys or requested something different, collard greens Picked up with meals or 21 delivered by volunteers / GFS 20 bags 110 217 Thanksgiving Meals from Benvenutos Italian 23 Restaurant Distributed 217 Breakfast - YMCA - Blood Pressure Screening 28 Program YMCA - Blood Pressure Screening Program / ACTIVITY: Arts & Crafts w/ Ashbury/ GFS 24 Dec 5 bags 42 Pick up Floral Arrangements donated by the 9 Grass River Garden Club & Distribute 100 ACTIVITY: Christmas Celebration -Luncheon, Christmas Carrolling sing -a -long w/Joshua Harris, Solist & Story Telling w/Pastor Sapp, Greater St Paul AMI: - Distribution: Poinsetta, 19 Turkeys. & Hams, or 26 Gift Cards, 400 lbs Fresh Produce incl: potatoes, onions, tomatoes, green beans, celery, lemons, bananas, green peppers, oranges 19 / GFS 24 Bags 45 21 STAFF Holiday Party at Olive Garden 5 26 Holiday -Pio Meeting 0 Jan 2 Holiday -No Meeting 0 Breakfast -YMCA Blood Pressure checks / GFS 9 29 bags 55 16 ML.K Day -fro Meeting 0 Breakfast -YMCA Blood Pressure & Nutrition Seminar # 3 / - GFS 27 hags / Fashion Show 23 rehersal+ 77 30 ACTIVITY: Chair Yoga, Dennis Mobley RELOCATE TO IST Presbyterian Church for Social Activities 827 IA © ' on= _ EM M \ CA 40 CL uj ,ca, ce. . 0 ,M \ / � + m , : w E 0 w® M 1: _ E w uo M/§ '� ®^ �, | MMW UM� , � . \ L-Y-�K 0 c 41 fj)-V' Ul 0 > 4,01) 4- E tn c 0 0� ra z, M -;-- (3) Q) vi 41 c c- (n V, 0 u E u CD > 4- r->, 0 of +1 rnw 41 a OM cc r\j V)Zj Qj C> 41 ul c LA m -0 0 u v E -C 4- Ul as v >as 0 0 0 ai 4-j ul 0 U '1" 0 0 0 V) tA CL o ca — E 0 CL r M Ln Eas cu —V, cos". 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RE Ell MARCH - St Patrick's Day Special * N lindividual Orders - Pick & Choose St Patrick's g Day Vag Pkg 9 y 111100 F, $&00 1 cabbage 6 to 8 Jumbo 6 to 8 Red carrots Potatoes 1 lb 24P21 ct Shrimp, raw, . .. ..... . peeled, tal on 5 $6.00 si"i v� ,/�/ gy w"", gu — /�p 0, gg vg, I - 3 lb Whole Chicken, Halah 1 $6.00 IS'*, 2 lbs Jumbo Chicken Wings, miscuts; 8 $2.00 2 lbs Chicken Thighs, ,j Boneless, Skinless 2 $2.00 10 logs Jumbo Chicken Legs 6 $3.00 1, E 11 11,111,Xl�,,�l�19,11�'�oq,VlI ft" g/sM/Mi I 1-gs"g,". w/r, maw, -g' gg) a a Ir, 2 - 8 oz Center 6 ON MR, 'j, AN but Pork X Chop 6 $2.00 847 abbage, Limbo arrots & Red otatoes Vag ks 16 $6.00 M lb Brisket 16 $19.00 ay Special Item Units Sams Available St Patrick's g Day Vag Pkg 9 y 111100 F, $&00 1 cabbage 6 to 8 Jumbo 6 to 8 Red carrots Potatoes 1 lb 24P21 ct Shrimp, raw, . .. ..... . peeled, tal on 5 $6.00 si"i v� ,/�/ gy w"", gu — /�p 0, gg vg, I - 3 lb Whole Chicken, Halah 1 $6.00 IS'*, 2 lbs Jumbo Chicken Wings, miscuts; 8 $2.00 2 lbs Chicken Thighs, ,j Boneless, Skinless 2 $2.00 10 logs Jumbo Chicken Legs 6 $3.00 1, E 11 11,111,Xl�,,�l�19,11�'�oq,VlI ft" g/sM/Mi I 1-gs"g,". w/r, maw, -g' gg) a a Ir, 2 - 8 oz Center 6 ON MR, 'j, AN but Pork X Chop 6 $2.00 847 3 lb Cut Port Center Roast 2 $6.00 � �i�% l%iii /'Mo i i /M 2 beet patties 2 $3.00 Boynton each FaRb Ba5e4 CommLinity Development Corporation, Inc. )anuary 2023 Affordable Food Package Flyer Poulfty/BeefPackage $14 21b Bonele55, Skinle55)umbo 21b Frozen )umbo Chicken Fine Grir)4 Emma= Re5ta u ra nt Qu a Pure Beef -Burger (S Oz Eacb) RECIPE OF T]HE DAY: Coconut Curry Chicken Chicken thigh, Curry powder, Coconut milk, Coconut Oil, Chopped onions, Canned chopped tomatoes, minced garlic, ginger paste, chicken broth, cayenne pepper, dried coriander INSTRUCTIONS beat up coconut oil on low medium beat, add 6nelycbopped onions and saute Until 50(t and fragrant. Add curry powder, ginger paste, chopped gamic and continue to stir for another minute, this would help release the flavour from the curry powder. Then add the cubed chicken pieces, stir fbr another 2 to 3 minutes or until the chicken is white. Pour the chicken stock over the chicken, stir to combine and 4eglaze the bottom of the pan whilst stirring. A44 chopped t0nlat005, coconut milk, cayenne pepper, salt and stir to combine. Bring the curry to a gentle simmer for another 10 to 15 minutes or until the curry is reduced and thick. Stir to combine, check for 5aft and seasoning and adjust to taste. Take it offthe beat and serve with boiled white rice, coconut rice or naan bread. Place ycin- of -der by '(]"j l5 ar)(Jpick uj,'.> or) the k5l, Moncy of ii,-jonti-1, 849 Boy fon Beach Faith B fnity Developi-nent Corpora -t -fon, Inc, Pecember 2022 Affo4able Foo 4 Package Flyer I 1b Sbrimp 26/30 ct tail Off, Raw, Peele4 & Deveine4, I 1b Imitation Crabmeat 2 - 9 oz Tilapia Fileb Salmon Fileb I RECIPE OF T-IE DAY ' , Honey Garlic Glazed Salmon SALMON 4 (6 oz each) salmon filets,1/2 t5p kosher salt, 1/2 t5p black pepper, 1/2 t5p smoked paprika (or regular paprika), 1/4 bp blackening seasoning (optional), SAUCE 3 Tb5p butter, 2 t5p olive oil, 6 cloves garlic minca 1/2 cup honey, 3 Tb5p water, 3 TbSp Soy Sauce, I Tb5p 5riracha sauce, 2 Tb5p lemon juice INSTRUCTIONS Pat salmon 4ry, then season with salt, pepper, paprika and blackening seasoning (if U5it)g). Set a5i4C. A .' ust ove le?,Qdtiort6n HI�H heat. Once butter is melted, add garlic, water, soy sauce, tomato paste, honeyar)4 lemon juice and cook 30 5eCOr)45 Or 50, Until sauce is heate4 through. Add salmon, skin side down (ifu5ing salmon with skin), and, cook 3 minutes. While salmon cooks, baste frequently with sauce 6om the pan by spooning it over the top of the salmon. Broil salmon for 5-6 minutes, basting with sauce once during the broil, until salmon i5 caramelizecl atA cooke4 to desired 4oneneS5, Pla(",eyouk- oi-ciet, by the'15"'fl"�jmj pick up oi-) he la'( Monclay of'-dr)e rr)oryd-) 850 Boynton Beach Faiths Based Corrimunity 1r. r l nt Corporation, Inc. November 2022 Affordable Food Package Flyer Breakfast Pa("J<aqe $17 per Idz of Large While Eggs r I cup unsalted butter 5oAena4 69 8 OZ Crearn% G 5014 wt the I_ o (2269), / qtanulate4 5ugar (5009),si lemonsusually 2-3 for papery; may be bitter), 5 large e995 room«, 4 2 teaspoonsteaspoon optional, ar wvur (3759), 1 tea5poon baking powder,teaspoon buttermilk 8 Place yout� b«(.! 1 cC' and pkk rvr.,) or) Ole k15i Monday o face i,..nontb, 851 Boynton Beach Faith Base4 Community .l pmCorporation, Inc. ORDER Beeci & Cbicken Package 24 4 2 R) Grour)(i Beef, 2,5 514hlle55 Chicken -Brea5t, I Wliole Chicken, avg 3 1b 4 - All Beef Hamburger 2 N GrOUr)4 Beef, 80/20, Fine Grin4 Paftie5 - 3:1 Halal 2 lbs - Boneless, Skinless Chicken Brens~, ten4er5 Oct, apprOX, 4 to 6 per pkg I Whole Chicken, without Giblets avg. 3 N ea Pick'-Eip or) Monday, Septernbv' �W`;' �jt St )oln') Misisioniry Bapti�j-(: Clw�ch, RAJ, Lee Cen-1-,er, Fellowsl-jip I I a 11, -1, 0 AM to 1 P)`�J, To place an order call either Heather 954-646-8443 or Sheny 561-386-4261 852 "I Boynton Beach Faith Ba5e4 Community Development Corporation, Inc. August 2022 Affor4able Food Package Flyer Fi5b Pac L,age $23 2 Salrnon, I 1h shtirnp, 2 Tdapia, 1111.) 0,abrneal. 2 - 8 9z COHO Sa,lmon I 1b White Shrimp, raw, peele4, �eveine4, t4ik Or) 2 - 719 oz Tilapia Filet Placeyoui, or4et, 1--,�ythe '15'('11, ar)� pick up on'(be last, Mor)4ay off -he ti)ond"). 853 BOYNTON BEACH FAITH BASED COMMUNITY DEVELOPMENT CORPORATION FINANCIAL STATEMENTS DECEMBER 31, 2021 9. TABLE OF CONTENTS PAGE Independent Auditor's Report 1-2 Statement of Financial Position Statement of Activities 4 Statement of Cash Flows Statement of Functional Expenses 6 Notes to the Financial Statements 7-10 Independent Auditor's Report On Internal Control Over Financial Reporting and On Compliance and Other Matters Based On An Audit Of Financial 11-12 Statements Performed In Accordance With Government Auditing Standards WW William Washington Certified Public Accountant INDEPENDENT AUDITOR'S REPORT To the Board of Directors Boynton Beach Faith Based Community Development Corp Report on the Audit of the Financial Statements Opinion P. 0. Box 10515 Riviera Beach, Florida 33419 Phone: (561) 703-5197 E-mail: billwashjr@comcast.net We have audited the accompanying financial statements of Boynton Beach Faith Based Community Development Corp (a nonprofit organization), which comprise the statement of financial position as of December 31, 2021, and the related statements of activities, functional expenses, and cash flows for the year then ended, and the related notes to the financial statements. In our opinion, the financial statements present fairly, in all material respects, the financial position of Boynton Beach Faith Based Community Development Corp as of December 31, 2021, and the changes in its net assets and its cash flows for the year then ended in accordance with accounting principles generally accepted in the United States of America. Basis for Opinion We conducted our audit in accordance with auditing standards generally accepted in the United States of America and the standards applicable to financial audits contained in Government Auditing Standards, issued by the Comptroller General of the United States. Our responsibilities under those standards are further described in the Auditor's Responsibilities for the Audit of the Financial Statements section of our report. We are required to be independent of Boynton Beach Faith Based Community Development Corp and to meet our other ethical responsibilities, in accordance with the relevant ethical requirements relating to our audit. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our audit opinions. Responsibilities of Management for the Financial Statements Management is responsible for the preparation and fair presentation of the financial statements in accordance with accounting principles generally accepted in the United States of America, and for the design, implementation, and maintenance of internal control relevant to the preparation and fair presentation of financial statements that are free from material misstatement, whether due to fraud or error. In preparing the financial statements, management is required to evaluate whether there are conditions or events, considered in the aggregate, that raise substantial doubt about Boynton Beach Faith Based Community Development Corp ability to continue as a going concern within one year after the date that the financial statements are available to be issued. Auditor's Responsibilities for the Audit of the Financial Statements Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor's report that includes our opinion. Reasonable assurance is a high level of assurance but is not absolute assurance and therefore is not a guarantee that an audit conducted in accordance with generally accepted auditing standards and Government Auditing Standards will always detect a material misstatement when it exists. The risk of not detecting a material misstatement resulting from fraud is higher than for one resulting from error, as fraud may involve collusion, forgery, intentional omissions, misrepresentations, or the override of internal control. Misstatements are considered material if there is a substantial likelihood that, individually or in the aggregate, they would influence the judgment made by a reasonable user based on the financial statements. to LO 00 In performing an audit in accordance with generally accepted auditing standards and Government Auditing Standards, we: • Exercise professional judgment and maintain professional skepticism throughout the audit • Identify and assess the risks of material misstatement of the financial statements, whether due to fraud or error, and design and perform audit procedures responsive to those risks. Such procedures include examining, on a test basis, evidence regarding the amounts and disclosures in the financial statements. Obtain an understanding of internal control relevant to the audit in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of Boynton Beach Faith Based Community Development Corp. Accordingly, no such opinion is expressed. • Evaluate the appropriateness of accounting policies used and the reasonableness of significant accounting estimates made by management, as well as evaluate the overall presentation of the financial statements. Conclude whether, in our judgment, there are conditions or events, considered in the aggregate, that raise substantial doubt about Boynton Beach Faith Based Community Development Corp ability to continue as a going concern for a reasonable period of time. We are required to communicate with those charged with governance regarding, among other matters, the planned scope and timing of the audit, significant audit findings, and certain internal control -related matters that we identified during the audit. Other Reporting Required by Government Auditing Standards In accordance with Government Auditing Standards, we have also issued our report dated November 21, 2022, on our consideration of Boynton Beach Faith Based Community Development Cor internal control over financial reporting and on our tests of its compliance with certain provisions of laws, regulations, contracts, and grant agreements and other matters. The purpose of that report is solely to describe the scope of our testing of internal control over financial reporting and compliance and the results of that testing, and not to provide an opinion on the effectiveness of Boynton Beach Faith Based Community Development Corp internal control over financial reporting or on compliance. That report is an integral part of an audit performed in accordance with Government Auditing Standards in considering Boynton Beach Faith Based Community Development Corp internal control over financial reporting and compliance. M/ma. W'UA&W.., eordq Riviera Beach, FL November 21, 2022 BOYNTON BEACH FAITH BASED COMMUNITY DEVELOPMENT CORPORATION STATEMENT OF FINANCIAL POSITION DECEMBER 31, 2021 ASSETS Cash Real estate held for sale Grant receivable Advances Mortgage receivable Real estate held for rental Other Total Assets LIABILITIES Note payable Accrued liabilities Total liabilities NET ASSETS Without Donor Restrictions Total net assets Total Liabilities and Net Assets Without Donor Restrictions $ 317,624 402,216 14,955 66,995 372,738 765,447 10,984 $ 1,950,959 $ 166,035 5,671 171,706 1,779,253 1,779,253 $ 1,950,959 See accompanying notes to financial statements. 9 9. 9. BOYNTON BEACH FAITH BASED COMMUNITY DEVELOPMENT CORPORATION STATEMENT OF ACTIVITIES FOR THE YEAR ENDED DECEMBER 31, 2021 Without REVENUES AND CONTRIBUTIONS Donor Restrictions Grants $ 396,477 Rental income 108,424 Other 2,038 Net realized gain on real estate 135,632 Total 642,571 TOTAL REVENUES AND CONTRIBUTIONS 642,571 Expenses Program Services 522,795 Supporting Services 103,458 Total Expenses 626,253 Change in Net Assets 16,318 Net Assets, Beginning of Year 1,762,935 Net Assets, End of Year $ 1,779,253 See accompanying notes to the financial statements. 0 cfl 00 BOYNTON BEACH FAITH BASED COMMUNITY DEVELOPMENT CORPORATION STATEMENT OF CASH FLOWS FOR THE YEAR ENDED DECEMBER 31, 2021 FINANCING ACTIVITIES: Note payable payments Without Net Cash Provided in (Used in ) Financing Activities Donor OPERATING ACTIVITIES: Restrictions Change in Net Assets $ 16,318 Adjustment to Reconcile Increase $ 317,624 in Net Assets to Net Cash Provided by $ 13,175 ( Used in ) Operating Activities: Depreciation 31,578 Changes in Operating Assets and Liabilities: Advances (24,054) Real Estate Held for Sale 16,811 Grant Receivables 4,158 Mortgage Receivable 17,000 Other (8,484) Accrued Expenses 836 Net Cash Provided by ( Used in ) Operating Activities 54,163 FINANCING ACTIVITIES: Note payable payments (122,188) Net Cash Provided in (Used in ) Financing Activities (122,188) Increase ( Decrease ) in Cash (68,025) Cash at Beginning of Year 385,649 Cash at End of Year $ 317,624 Interest Paid $ 13,175 See accompanying notes to financial statements. 0 cfl 00 BOYNTON BEACH FAITH BASED COMMUNITY DEVELOPMENT CORPORATION STATEMENT OF FUNCTIONAL EXPENSES FOR THE YEAR ENDED DECEMBER 31, 2021 See accompanying notes to financial statements. M PROGRAM SERVICES SUPPORTING SERVICES Neighborhood Development Fund- Management Total and Stabilization raising & General Expenses Salaries and Benefits $ 192,952 $ 82,694 $ 275,646 Professional Fees 16,192 4,048 20,240 Maintenance 35,663 35,663 Utilities 13,693 1,521 15,214 Homeowner Fees 2,940 2,940 Property Taxes 1,423 1,423 Office Expense 7,263 807 8,070 Insurance 15,439 1,527 16,966 Cable 5,134 5,134 Interest 13,175 13,175 Client assistance 134,580 134,580 Program Expenses 1,672 1,672 Other 51,443 12,861 64,303 Depreciation 31,228 31,228 Total $ 522 795 _ 9 nl dr%A it For, Ori See accompanying notes to financial statements. M N W 00 BOYNTON BEACH FAITH BASED COMMUNITY DEVELOPMENT CORPORATION NOTES TO FINANCIAL STATEMENTS DECEMBER 31, 2021 NOTE 1 - SUMMARY OF SIGNIFICANT ACCOUNTING ACTIVITIES Nature of Activities Boynton Beach Faith Based Community Development Corporation ("the CDC") is a nonprofit corporation organized to provide community service, youth programs, and improve the economic conditions of the Boynton Beach, Florida neighborhood through facilitating home ownership for moderate and low income families. The Corporation also provides social services to the neighborhood. Basis of Accountine The Financial Statements of the CDC have been prepared on the accrual basis of accounting and accordingly reflect all significant receivables, payables, and other liabilities. Use of Estimates The preparation of financial statements in conformity with generally accepted accounting principles include the use of estimates that affect the financial statements. Accordingly, actual results could differ from those estimates. Functional Classification of Expenses In the accompanying Statement of Activities, expenses have been reported by their functional classification, a method of grouping expenses according to the purpose for which they were incurred. The primary functional classifications are program services and supporting activities. Program services are the activities that result in services being provided to members that fulfill the purposes or mission for which the CDC exists. Supporting activities are all activities of an organization other than program services and are included in the financial statements as management and general expenses., and are allocated based on time spent. Grants Resources from Government grants are recorded as revenue when the related costs are incurred. All other grants, unless restricted are recorded as revenue when the grant is received. The CDC is dependent on continued financial assistance by federal and local government agencies. Contributions whose restrictions are met in the same reporting period is reported as unrestricted contributions. Concentration of Credit Risk Financial instruments that subject the CDC to concentrations of credit risk include cash. While the CDC attempts to limit its financial exposure, its deposit balances may at times exceed federally insured limits. The CDC has not experienced any losses on such balances. M Cfl 00 BOYNTON BEACH FAITH BASED COMMUNITY DEVELOPMENT CORPORATION NOTES TO FINANCIAL STATEMENTS DECEMBER 31, 2021 NOTE 1 - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Contd.) Contributed Services The CDC does not recognize any support, revenue or expense from services contributed by volunteers, because they do not meet the criteria for measurement. Availability and Liquidity: Financial assets of cash $317,624, grant receivables $14,955 , financial assets available of $332,579 to meet expenses over next twelve months. Income Tax Status The CDC is exempt from federal income tax as an organization described in Section 501 (c)(3) of the Internal Revenue Code. CDC believes it is no longer subject to examinations of returns for tax years ended December 31, 2018. There are no examinations for any tax periods currently in progress. Contributions Contributions received are recorded as net assets without donor restrictions or net assets with donor restrictions depending on the existence and/or nature of any donor restrictions. Contributions that is restricted by the donor is reported as an increase in net assets without donor restrictions if the restriction expires in the reporting period in which the contribution is recognized. All other donor -restricted support is reported as an increase in net assets with donor restrictions, depending on the nature of the restriction. When a restriction expires(that is, when a stipulated time restriction ends or purpose restriction is accomplished), net assets with donor restrictions are reclassified to net assets without donor restrictions and reported in the Statement of Activities as net assets released from restrictions. The CDC has cash of $317,624 real estate held for sale or rental $1,167,663, and mortgage receivable of $372,738 at December 31, 2021, which are recorded as net assets without donor restrictions, however, those assets must be used in compliance with the grant agreements. Real Estate Held for Sale The CDC has purchased and renovated certain properties held for sale to eligible home buyers. These properties are valued at lower of cost or fair market value. Fair market value is based on recent market sale prices. Propegy and Equipment Property and equipment are stated at cost less accumulated depreciation. Depreciation is being provided by use of the straight-line method over the estimated useful lives of the related assets as follows: Office equipment, 5 years life. cfl 00 BOYNTON BEACH FAITH BASED COMMUNITY DEVELOPMENT CORPORATION NOTES TO FINANCIAL STATEMENTS DECEMBER 31, 2021 NOTE 1 - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Cont'd.) Fair Value Measurements The following fair value hierarchy measure fair value: Level 1- unadjusted quoted prices. Level 2 - Observable inputs. Level 3- significant unobservable inputs which are supported by little or no market activity. Level 2 include real estate held for sale. Fair value is the price CDC would receive to sell an asset in an orderly transaction between participants at measurement date. The carrying value of all other assets and liabilities approximate fair value due to their short maturity. NOTE 2 - PROPERTY AND EQUIPMENT At December 31, 2021, Property and Equipment consisted of the following: Office equipment, $18,349 less accumulated depreciation of $18,349. NOTE 3— MORTGAGE RECEIVABLE The CDC purchased real estate that will be renovated and sold to eligible home buyers as part of the neighborhood stabilization and improvement program. Proceeds from the homes that were sold during the year ended December 31, 2021 are recorded in the financial statements. Net proceed from any sale must be used in compliance with the grant agreement. The CDC provided second mortgage financing which is an interest free deferred payment loan and the loan will be paid upon the sale of the property if sold short of the term of fifteen years from the closing date of the first mortgage or upon mortgagor's default. Mortgage receivable will be forgiven if the homeowner remains in the home the required period. NOTE 4 - LEASE OBLIGATION The CDC uses offices provided by the City of Boynton Beach in the neighborhood in which it operates, for a nominal fee of $12 per year. The market value of this space is not included in the financial statements. NOTE 5 — Program Income Program income includes gross sales of real estate of $620,000, and rental income from real estate not sold of $108,424. The net gain on sale of real estate is reported in the statement of activities. The CDC is required to use program income in compliance with grant rules and regulations. L0 W 00 BOYNTON BEACH FAITH BASED COMMUNITY DEVELOPMENT CORPORATION NOTES TO FINANCIAL STATEMENTS DECEMBER 31, 2021 NOTE 6 — CONTINGENCIES AND SUBSEQUENT EVENTS The Corporation receives financial assistance from federal, state, municipal and other local non- governmental agencies in the form of grants. The disbursement of funds received under this program generally requires compliance with the terms and conditions specified in the grant agreements and are subject to audit by the grantor agencies. Any disallowed claims resulting from audits could become a liability of the CDC. The date to which events occurring after December 31, 2021, the date of the most recent statement of financial position, have been evaluated for possible adjustment to the financial statements is November 21, 2022, which is the date the financial statements were available to be issued. Grants from governmental agencies totaled 26% of total revenue at December 31, 2021. As a result off COVID -19, economic uncertainties have risen though such potential impact is unknown at this time. Note 7- LINE OF CREDIT CDC obtained a revolving line of credit to develop residential single family homes in low and moderate income communities in Boynton Beach, Florida. The terms are as follows: maximum principal amount of loan $1,000,000, interest rate of five and one quarter percent, maturity date of two years from the date of loan closing, security property of first mortgages on residential parcels and the improvements located thereon at scattered sites within the Project, and repayment terms commencing on the last day of the month following the loan closing date, monthly payments of interest are due and payable on the last day of each month, with the principal balance of the loan , if not sooner paid, together with any unpaid interest and fees, due and payable in full on the maturity date. Borrowings are outstanding at December 31, 2021 of $166,035. Note 8 — NEW ACCOUNTING PRONOUNCEMENT On August 18, 2016, FASB issued ASU 2016-14, Not -for -Profit Entities (Topic 958) — Presentation of Financial Statements of Not for -Profit Entities. The update addresses the complexity and understandability of net asset classification, deficiencies in information about liquidity and availability of resources, and the lack of consistency in the type of information provided about expenses and investment return. NOTE 9 — REAL ESTATE HELD FOR RENTAL As of December 31, 2021, certain real estate held for sale was converted for rental property as part of its affordable homes program. The properties are depreciated over 27 Years, and accumulated depreciation of $31,228. U cfl cfl 00 WW William Washington Certified Public Accountant P. O. Box 10515 Riviera Beach, Florida 33419 Phone: (561) 703-5197 E-mail: billwashjr@comcast.not INDEPENDENT AUDITOR'S REPORT ON INTERNAL CONTROL OVER FINANCIAL REPORTING AND ON COMPLIANCE AND OTHER MATTERS BASED ON AN AUDIT OF FINANCIAL STATEMENTS PERFORMED IN ACCORDANCE WITH GOVERNMENT AUDITING STANDARDS To the Board of Directors Boynton Beach Faith Based Community Development Corporation Boynton Beach, Florida I have audited in accordance with the auditing standards generally accepted in the United States of America and the standards applicable to financial audits contained in Government Auditing Standards issued by the Comptroller General of the United States, the financial statements of Boynton Beach Faith Based Community Development Corporation (" CDC" ) (a nonprofit organization), which comprise the statement of financial position as of December 31, 2021, and the related statements of activities, functional expenses and cash flows for the year then ended, and the related notes to the financial statements, and have issued my report thereon dated November 21, 2022. Internal Control over Financial Reporting In planning and performing my audit of the financial statements, I considered CDC's internal control over financial reporting (internal control) to determine the audit procedures that are appropriate in the circumstances for the purpose of expressing my opinion on the financial statements, but not for the purpose of expressing an opinion on the effectiveness of CDC's internal control. Accordingly, 1 do not express an opinion on the effectiveness of the Organization's internal control. A deficiency in internal control exists when the design or operation of a control does not allow management or employees, in the normal course of performing their assigned functions, to prevent, or detect and correct, misstatements on a timely basis. A material weakness is a deficiency, or a combination of deficiencies, in internal control, such that there is a reasonable possibility that a material misstatement of the entity's financial statements will not be prevented, or detected and corrected on a timely basis. A significant deficiency is a deficiency, or a combination of deficiencies, in internal control that is less severe than a material weakness, yet important enough to merit attention by those charged with governance. My consideration of internal control was for the limited purpose described in the first paragraph of this section and was not designed to identify all deficiencies in internal control that might be material weaknesses or significant deficiencies. Given these limitations, during my audit I did not identify any deficiencies in internal control that I consider to be material weaknesses. However, material weaknesses may exist that have not been identified. Compliance and Other Matters As part of obtaining reasonable assurance about whether CDC's financial statements are free from material misstatement, l performed tests of its compliance with certain provisions of laws, regulations, contracts, and grant agreements, noncompliance with which could have a direct and material effect on the determination of financial statement amounts. However, providing an opinion on compliance with those provisions was not an objective of my audit, and accordingly, ) do not express such an opinion. The results of my tests disclosed no instances of noncompliance or other matters that are required to be reported under Government Auditing Standards. Purpose of this Report The purpose of this report is solely to describe the scope of my testing of internal control and compliance and the results of that testing, and not to provide an opinion on the effectiveness of the CDC's internal control or on compliance. This report is an integral part of an audit performed in accordance with Government Auditing Standards in considering the CDC's internal control and compliance. Accordingly, this communication is not suitable for any other purpose. William WasA %%ton, DoE Riviera Beach, FL November 21, 2022 IN ti Co 00 650971,509 11110`31220022 8:55 PM Form V7 V Department of the Treasury intemd Revenue Service Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) ► Do not enter social security numbers on this form as it may be made public. It, Go to wwwJrs.gov1Form990 for instructions and the latest infnrrnatinn 2021 an to Public A For the 2021 calendar year, or tax year beginning and endin i Current Year B Check V applicable: C Name of organization BOYNTON BEACH FRITH BASED COMMUNITY 216,268 124,977 D Employer identification number 706,357 529,466 0 Address change DEVELOPMENT . CORPORATION 0 428,780 233,865 Doing business as 117,382 16,837 Name change 65-0971509 Number and street (cr P.O. box if mail is not delivered to street address) RCOF5uite E Taiephone number tnitial return 2191 N SEACREST BLVD 561-752-0303 ❑Final retuml City or town, state or province, country, and ZIP orforeign postal code terminated BOYNTON BEACH FL 33435 Amended return 1 G Gmssrecei ts$ 1,124, 913 F Mama and address of principal officer, Application pending COURTNEY CAIN H(a) Is this a group return for subordinates? Yes F;5;1 No 2191 N SEACREST BLVD H(b) Are all subordinates included? F] Yes F7NO BOYNTON BEACH FL 33435 If "No," attach a list. See instrucrcns I Tax-exempt status: X 501(c)(3) 71 501(c) ) A(insert no) 4947(a)(1)or 527 J Website: ► N/A H(c) Group exemption number 111- K K Form of or aniza5on:X Co oration Trust Association Other ► Year of formation: 19 9 9 1 m State of legal domicile: FL Part I SummarV 1 Briefly describe the organization's mission or most significant activities: TO DEVELOP SUSTAINABLE COMMUNITIES THROUGH SERVICES THAT INCLUDE HOME ..... .......— —..................................................... OWNERSHIP AND FINANCIAL EDUCATION RESULTING IN SPRITUAL AND ECONOMIC ............ L ..................................................................................................... 2 Check this box ► If the organization discontinued its operations or disposed of more than 25% of its net assets. t0a� 3 Humber of voting members of the governing body (Part VI, line 1 a) 3 10 m . 4 Number of independent voting members of the governing body (Part VI, line 1b) 4 10 .5 5 Total number of individuals employed in calendar year 2021 (Part V, line 2a) 5 8 a 6 Total number of volunteers estimate if necessa ( ry)6 0 ......................... . 7a Total unrelated business revenue from Part Vill, column (C), line 12 7a 0 b Net unrelated business taxable income from Form 990-T, Part 1, line 11 . . . ........ . ... . ..... . . . . . . .. 7b 0 m N C m a X 1U `o 8 Contributions and grants (Part VIII, line 1h) .............. 9 Program service revenue (Part VIII, line 2g) 10 Investment income (Part VIII, column (A), lines 3, 4, and 7d) .. 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 1le) 12 Total revenue — add lines 8 through 11 must equal Part VIII, column A line 12 13 Grants and similar amounts paid (Part IX, column (A), lines 1--3) 14 Benefits paid to or for members (Part IX, column (A), line 4) 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) 16a Professional fundraising fees (Part IX, column (A), line Ile) b Total fundraising expenses (Part 1X, column (D), line 25) 10,0 ............... 17 Other expenses (Part IX, column (A), lines 11a -11d, 11f --24e) 18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) 19 Revenue less expenses. Subtract line 18 from line 12 , ..... ,nor Year i Current Year 390 469 396 477 0 216,268 124,977 99,620 8,012 706,357 529,466 0 0 160,19 278,764 0 428,780 233,865 588,975 512,629 117,382 16,837 H 20 Total assets (Part X, line 16) .......... ................. .......... 2,055,821 1 950 959 am 21 Total liabilities (Part X, line 26) 293,057 171 706 wn 22 Net assets or fund balances. Subtract line 21 from line 20 ............ . ....... . . . ..... . . . 1,762,764 1779 253 Part U Si nature Block Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge. Sign / Signature of officer Date Here ' COURTNEY CAIN PRESIDENT Type or print name and title Printfrype preparers name Preparers signature tate Check ❑g if PTIN Paid Massih Saadat nand 11/03/22 self-employed P00387382 Prepare,Firm's name 11, Massih Saadatmand PA Firm's FIN I► 27-1223636— Use only 7059 Aliso Ave Firm's address ► WeSt Palm Beach, FL 33413 Phone no. 561-640-2983 May the IRS discuss this return with the preparer shown above? See instructions n Yes X No For Paperwork Reduction Act Notice, see the separate instruction DAA p s' Form 990(-868 Application f Dr Automatic Extensmim of Thvw To Rio an Exen" Orgmbmdon Retum OMfkk. 1545-ON7 fortm I fifta ff Type or Name ofexer Mptorganbabon ora#wfilw. we in res. COM &yM#. -!f no" BeeeeAf toc-al 14 ITaxpayer iden�nn rxat r [TSF} A 65-Oq2j5Oq PrW 4�- Rebylhe (dumber. streek and roan orsuft as Ifa MD. box, eeelw�� dmdaftliv mJ ex 6R f -6 -f - firing y City. tMM Orpost oWnw- sWe. and 23P codik ForatxeWaddress. see baftudkm �B-' zl� I lez- 3.3 " -T- Erder#* PseftmOode for the rstum#Wlisapplk:aflon is for W a separate appkabm for each retum) . . . . . . Appffcafim Psatwn 'Appftiftn Rot" Is For Oade\- is For Code Form 990 or Form M -U (01 F=*u,1041-A 08 Form 4720 A2SMLfAg Form 4720 (odw#m Odvkk;4 09 Fbrm 99D -PF 04 Ran 527 10 Form SM -T (sec. "I or4OBWtust) 05 Fbnn SM I I -Forrn SWT est OOW#= 21qTM9 08 Fann 8M 12 Far 990-T i7fPRIM` sTtreb aMin#WCMOfo- 'Ciao /, Tie W Jo- (&&)1 -7 Sa -jg-Fax W W- • If the organbuUm does not have an Ofte or Place of bu*mm in the Wiled Stag m che& this box - - - - - - - - - D.- 0 • If this is far a Circup, Reuxnthe orgw&agwf$ four di* GrDW EKw4ftn I*m*w (GENQ - ff ff4s is for the whole group, do* ttft box . . . 0- [3 - if it is for part of the Woup, dwA#ft box 0- E] acrd atter a fist with the names mid TM of aff mernbem the adension is for. I IrO*mestantic &vwrdhmderW=offirers UW--,A/Oi/ 1.'j: , 20CRI. to file fteMfflpt OrgWfiUMM return for the aarnzatim nanied abovp- The wMm-am isibrthe organ maws return w. *[ffcaJerWaryear2D,2j_err 10- 0 twc yewbegkming 20._, aid enckg -,20 2 If the tax year enhwed in RM I is 1br few Chart 12 ffoaft, dw-k reamm 0 k" -W MWM 0 Rnal raWM 0 Change in acaXinling period 33 If 1ho application is for Fam 990 -PF, 99D -T. 4720. or WK enw tte uff*abvp- W kss aW n=Wundable credite. Sm ki3bilcoons b If thW WM;cafion is for Fmw 9W-pF. 990-T. 47 or 6M, elft mW Mk=Uge Mecft and 3a aMforr"d tar, RaWwft made. Include MLpmr]M T2pnM!W affowed as a aedL 3b 0 EkdanM dw- SUbtraOt Fine 3b *= lim 3. kidkde yow payawd wgh ttft AMM U EFTPS 91m6wic FederW Tax MT2!m ng!Et See by if required, by S!29 t Sc j$ Cauum if you are gomg to max-- an 49MOMfiffWS WWAMNd kwbUCHOM. do" wM this Form 88M am ram 8453 -TE aid Form a87g-rE w payment FbrftmcyAct ander Reftftw Avt Nodca, aft mWudmm Cat. No. 279M FbFM 8W F-ev. i -MM 869 65097'2509 111031202.2 8;55 PM Form 990 (2021) BOYNTON BEACH FAITH BASED COMMUNITY 65-0971509 page 2 Part 111 Statement of Program Service Accomplishments _ Check if Schedule O contains a response or note to any line in this Part III ............ . .. . ......................... . ❑ 1 Briefly describe the organization's mission: TO DEVELOP SUSTAINABLE COMMUNITIES THROUGH SERVICES THAT INCLUDE HOME ...................... ........................... .................. OWNERSHIP AND FINANCIAL EDUCATION RESULTING IN SPRITUAL AND ECONOMIC. ............................................................................................................................................................... ......................................................................................................................................................... 2 Did the organization undertake any significant program services during the year which were not listed on the prior Form 990 or 990 -EZ? Yes ® No vices If "Yes," describe these new seron Schedule Q. 3 Did the organization cease conducting, or make significant changes in how it conducts, any program services? ❑ Yes ❑q No If "Yes," describe these changes on Schedule O. 4 Describe the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported. 654971409 1110312022 6:55 PM form 990 (2021) BOYNTON BEACH FAITH BASED COMMUNITY 65-097:L509 Page 3 Part IV Checklist of Required Schedules 1 Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes, Yes No complete Schedule A ...... 1 X 2 is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? 2 X 3 Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes,"complete Schedule C, Part 1 3 X 4 Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Fart ll 4 X 5 Is the organization a section 501(c)(4), 601(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Rev. Proc. 98-19? if 'Yes, "complete Schedule C, Part 111 5 X Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes"complete Schedule D, Part 1 6 X 7 Did the organization receive or hold a conservation easement, including easements to preserve open space, the environment, historic land areas, or historic structures? If 'Yes," complete Schedule D, Part 11 7 X Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes, complete Schedule D, Part 111 8 X 9 Did the organization report an amount in Part X, line 21, for escrow or custodial account liability, serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? if "Yes,"complete Schedule D, Part iV 9 X 10 Did the organization, directly or through a related organization, hold assets in donor -restricted endowments or in quasi endowments? If "Yes,"complete Schedule D, Part V 10 X the organization's answer to any of the following questions is "Yes,' then complete Schedule D, Parts VI, VI I, VI ll, IX, or X, as applicable. a Did the organization report an amount for land, buildings, and equipment In Part X, line 10? if "Yes," complete Schedule D, Part VI 11a X b Did the organization report an amount for investments --other securities in Part X, line 12, that is 5% or more of its total assets reported in Part X, line 16? if "Yes, "complete Schedule D, Part VII 11b X c Did the organization report an amount for investments—program related in fart X, line 13, that is 5% or more Of its total assets reported in Part X, line 16? If "Yes, " complete Schedule D, Part ViR 11c X d Did the organization report an amount for other assets in Part X, line 15, that is 5% or more of its totaE assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IX 11d X e Did the organization report an amount for other liabilities in Part X, line 25? If "Yes, " complete Schedule D, Part lie X Did the organization's separate or consolidated financial statements for the tax year include a footnote that addresses the organization's liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes, " complete Schedule D, Part 11f X 2a Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes,"complete Schedule D, Parts XI and X11 , .... .1 - ............ .............. .............. . ............... 2a X b Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes,"and if the organization answered "No'to line 12a, then completing Schedule D, Parts XI and XII is optional 12b X 13 Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes,' complete Schedule E 13 X 4a Did the organization maintain an office, employees, or agents outside of the United States? 14a X Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts 1 and IV 14b X 5 .............................. Did the organization report on Part iX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? 1f "Yes,"complete Schedule F, Parts 11 and IV 16 Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If "Yes, " complete Schedule F, Parts 111 and IV 18 X 17 Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part 1X, column (A), lines 6 and I Ie? if'Yes,"complete Schedule G, Part I. See instructions 17 X 18 Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes,"complete Schedule G, Part 11 18 X 19 Did the organization report more than $15,000 of gross income from gaming activities on Part Vlll, line 9a? If "Yes, " complete Schedule G, Part i/I ............ 19 X 202 Did the organization operate one or more hospital facilities? if "Yes,"complete Schedule H 20a X b If es" to line 20a, did the organization attach a copy of its audited financial statements to this return? 20b 21 Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX column (A), line 1? If "Yes," complete Schedule 1, Parts I and 11 ... . . . .... . ...... . ............. 21 X DAA Form 990 (2 871 65097 ,509 11 1=022 8:55 PM Form 990 2021 BOYNTON BEACH FAITH BASED COMMUNITY 65-0971509 Pae 4 Part IV Checklist of Required Schedules continued 22 Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If "Yes,"Complete Schedule 1, Parts 1 and 1l! ...-.. 23 Did the organization answer "Yes" to Part ViI, Section A, line 3, 4, or 5 about compensation of the 22 organization's current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J .............. .......... 24a Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than 23 $100,000 as of the last day of the year, that was issued after December 31, 2002? If "Yes,"answerffnes 24b through 24d and complete Schedule K If "No," go to line 25a24a .._ b Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception? 24b G Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease any tax-exempt bonds? d Did the organization act as an "on behalf of issuer for bonds outstanding at any time during the year? 24c 24d 25a Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? if 'Yes,' complete Schedule L, Part! 25a b Is the organization aware that it engaged in an excess benefit transaction with a disqualified p erson in a p�nor _ year, and that the transaction has not been reported on any of the organization's prior Forms 990 or 990 -EZ? If 'Yes, 'complete Schedule L, Part .......................... 26 did the organization report any amount on Part X, line 5 or 22, for receivables from or payables to any current 5b or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons? if "Yes," complete Schedule L, Part 11 26 27 Did the organization provide a grantor other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons? If "Yes," complete Schedule L, Part I!! 28 Was the organization a party to a business transaction with one of the following parties (see the Schedule L, Part IV, instructions for applicable filing thresholds, conditions, and exceptions): a A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If 'Yes,"complete Schedule L, Part IV .............................................................. b A family member of any individual described in line 28a? !f °Yes,"complete Schedule L, Part 28a c A 35% controlled entity of one or more individuals and/or organizations described in line 28a or tab? !f 28b 'Yes," complete Schedule L, Pari IV ... ......................................... 29 Did the organization receive more than $25,000 in non-cash contributions? if "Yes,"complete Schedule M 28c 29 30 Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified _ conservation contributions? !f "Yes,"complote Schedule M 31 Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part 1 30 X 31 32 Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If 'Yes, _ -- .. complete Schedule N, Pail 11 .an .. .... 33 Did the organization own 100% of entity disregarded as separate from the organization under Regulations 32 sections 301.7701-2 and 301.7701-3? If 'yes," complete Schedule R, Part 1 34 Was the organization related to any tax-exempt or taxable entity? If "Yes,"complete Schedule R, Part 11, 111, 33 or !V, and Part V. line I .................... 35a Did the organization have a controlled entity within the meaning of section 512(b)(13)? 34 b If "Yes" to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If Yes,"complete Schedule 1, Part V, line 2 35b 36 Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non -charitable related organization? !f "Yes,"complete Schedule R, Part V, line 2 37 Did the organization conduct more than 5% of its activities through an entity that is not a related organization 36 and that is treated as a partnership for federal income tax purposes? if "Yes,"complete Schedule R, Part VI 37 38 Did the organization complete Schedule O and provide explanations on Schedule O for Part VI, lines I Ib and 19? Note. All Form 990 filers are required to complete Schedule O. X Part V Statements Regarding Other IRS Filings and Tax Compliance 38 Check if Schedule O contains a response or note to any line in this Part V 1a Enter the number reported in box 3 of Form 1096. Enter -0- if not applicable I 1a 7 Enter the number of Forms W -2G included on line 1a. Enter -0- if not applicable 1b 0 c Did the organization comply with backup withholding rules for reportable payments to vendors and re ortable amin ambling) winnings to prize winners? . DAA L4 ►L X X X X X X X No 1 IX Form 990 (2o 872 65097t5o9 1110312922 8:55 PM Form 990 (202.1) BOYNTON BEACH FAITH BASED COMMUNITY 65-0971509 Page 5 Part V Statements Regarding Other IRS Filings and Tax Compliance continued Yes No 2a Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements, fled for the calendar year ending with or within the year covered by this return L2a 1 8 b If at least one is reported on line 2a, did the organization file all required federal employment tax returns? 2b X ............................ Note: If the sum of lines 1a and 2a is greater than 250, you may be required to a -file. See instructions. 3a Did the organization have unrelated business gross income of $1,000 or more during the year? ...................................... 3a X b if "Yes," has it filed a Form 990-T for this year? If "No" to line 3b, provide an explanation on Schedule O 3b 4a ......................... At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? 4a X b If "Yes," enter the name of the foreign country ► .................................... ......... ........................ . See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR). 5a Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? 5a X b .................................. Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction? 5b X c If "Yes" to line 5a or 5b, did the organization file Form 8886-T? ............... .................... Sc 6a .................. - - ..... Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? 6a X b If "Yes," did the organization include with every solicitation an express statement that such cent r':bution s or gifts were not tax deductible? 6b 7 Organizations that may receive deductible contributions under section 170(c). a Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? 7a b if "Yes," did the organization notify the donor of the value of the goods or services provided? ......................................... 7b c Did the organization sell, exchange, or otherwise dispose of tangible personal. property for which it was required to file Form 8282?.. . ................ ................. . ........ ......... 7c d * . ............. If "Yes," indicate the number fForms 8282 fleuring the year e Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? 7e f ....................... Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? g If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? #7h h If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? 8 Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? 8 9 Sponsoring organizations maintaining donor advised funds. a Did the sponsoring organization make any taxable distributions under section 4966?9a b .............._ ......... Did the sponsoring organization make a distribution to a donor, donor advisor, or related person? gb 10 Section 501(c)(7) organizations. Enter: a Initiation fees and capital contributions included on Part VIII, line 12 10a b Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities 10b 11 Section 501(c)(12) organizations. Enter: a Gross income from members or shareholders Ila b Gross income from other sources. (Do not net amounts due or paid to other sources against amounts due or received from them.) 11b 12a Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 10417 b If "Yes," enter the amount of tax-exempt interest received or accrued during the year ........ . . . . . .. 12b 12a 13 Section 501(c)(29) qualified nonprofit health insurance issuers. a is the organization licensed to issue qualified health plans in more than one state? ................................................... 13a Note: See the instructions for additional information the organization must report on Schedule O. b Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans I 13b c Enter the amount of reserves on hand ................................. 14a Did the organization receive any payments for indoor tanning services during the tax year? 14a X b If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation on Schedule O 14b 15 Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? 15 X If "Yes," see instructions and file Form 4720, Schedule N. 16 Is the organization an educational institution subject to the section 4968 excise tax on net investment income? 16 X If "Yes,' complete Form 4720, Schedule O. 17 Section 501(c)(21) organizations. Did the trust, any disqualified person, or mine operator engage in activities that would result in the imposition of an excise tax under section 4951, 4952 or 4953? 17 If "Yes " complete Form 6069. DAA Form 990 ( 873 850971509 11103!2022 8:55 PM Form 990 2021 BOYNTON BEACH FAITH BASED COMMUNITY 65-0971509 Pae 6 Part VI Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to line 8a, 8b, or IOb below, describe the circumstances, processes, or changes on Schedule O. See Instructions. Check if Schedule O contains a response or note to any line in this fart VI ..... _ ... Section A. Governing Body and Management la Enter the number of voting members of the governing body at the end of the tax year. 1a 10 If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain on Schedule O. b Enter the number of voting members included on line 1a, above, who are independent 1b 10 2 Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? 3 Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors, trustees, or key employees to a management company or other person? 4 Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? 5 Did the organization become aware during the year of a significant diversion of the organization's assets? ............. Did the organization have members or stockholders? .... ......... 7a Did the organization have members, stockholders, or other persons who had the power to elector appoint one or more members of the governing body? .............. . ........................................... b Are any governance decisions of the organization reserved to (or subject to .approv..al . . by member..s, ........ ...... stockholders, or persons other than the governing body? 8 Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following: a The governing body? ................................. .. ..._ .. ...................................... ....... ...... ......... . b Each committee with authority to act on behalf of the governing body? 9 Is there any officer, director, trustee, or key employee listed in Part VfI, Section A, who cannot be reached at the organization's mailing address? !f "Yes." provide the names and addresses on Schedule O .. . ........... . . . Section B. Policies This Section B requests information about policies not required by the Internal Revenue C. 10a Did the organization have local chapters, branches, or affiliates? b if "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? a Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? b Describe on Schedule O the process, if any, used by the organization to review this Form 990. 12a Did the organization have a written conflict of interest policy? If 'No,"go to line 13 Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? c Did the organization regularly and consistently monitor and enforce compliance with the policy? if `Yes," describe on Schedule O how this was done ...... 13 Did the organization have a written whistleblower policy? ............................. . " . . . . . . . . . .' ' . 14 Did the organization have a written document retention and destruction policy? . . . 15 Did the process for determining compensation of the followin . .'' g persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision? a The organization's CEO, Executive Director, or top management official b Other officers or key employees of the organization ..... .......... ........... If "Yes" to line 15a or 15b, describe the process on Schedule O. See instructions. . . . . . . . . . . 16a Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ..................... _ __ _ _ b if "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the or anization's exempt status with res ect to such arran ements? Yes I No 13 X 4 X 5 X s X 7a X 7b X 8a X 8b X 9 X fe. Yes No 102 X 10b Ila X 12a X 12b X 12c X 13 X 14 X 15a X 15b X Section C. Disclosure 16a I I X . ....................... ........................................ 17 List the states with which a copy of this Form 990 is required to be filed P FL 18 Section 6104 requires an organization to make its Forms 1023 (1024 or 1024-A, if applicable), 990, and 990-T (section 501(c) (3)s only) available for public inspection. Indicate how you made these available. Check all that apply. U Own website [_] Another's website ❑X upon request [] Other (explain on Schedule O) 19 Describe on Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year. 20 State the name, address, and telephone number of the person who possesses the organization's books and records 0- MILIND CHOKOSHI 2191 N SEACREST BLVD BOYNTON BEACH FL 33435 561-752-0303 DAA Form 990 {2o 874 65097.1509 11/0812022 5:55 PM Form 990 (2021) BOYNTON BEACH FAITH BASED COMMUNITY 65-0971509 Page 7 Part VII Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors Check if Schedule O contains a response or note to any fine in this Part Vll . . . . . ....... . .. . . ...... . .. ❑ Section A. Officers, Directors: Trustees, Key Employees and Highest Compensated Employees la Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization's tax year. * List all of the organization's current officers, directors, trustees (whether individuals or organizations), regardless of amount of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid. • List all of the organization's current key employees, if any. See instructions for definition of "key employee." • List the organization's five current highest compensated employees (other than an officer, director, trustee, or key employee) who received reportable compensation (box 5 of Form W-2, Form 1099-MISC, andlor box 1 of Form 1099 -NEC) of more than $100,000 from the organization and any related organizations. • List all of the organization's former officers, key employees, and highest compensated employees who received more than $100,000 of reportable compensation from the organization and any related organizations. • List all of the organization's former directors or trustees that received, in the capacity as a former director or trustee of the organization, more than $10,000 of reportable compensation from the organization and any related organizations. See the instructions for the order in which to list the persons above. ❑ Check this box if neither the organization nor any related organization compensated am, rrirrant nifirar rliran+nr nr+—f— (A) Name and title ($) Average g hours per week list ( any hours for (do box, officer not unless and Position check person a (c) more director/trustee) than is both one an (D) Reportable compensation from the organization (W-2! 1099-MISC! (E) Reportable compensation from related organizations (W-2! 1099-MISCI {t=) Estimated amount of other compensation from the ° 5 a K 5 w - o � n' z � z �� m o related a o' S T ? o 3 Y y mm � � 1099-NECJ 1099 -NEC) organization and related organizations organizations m K below m dotted line) m �' CD m (i)KETURAH JOSEPH 50.00 EXECUTIVE DIRECTOR 0.00 X 671`500 0 6,988 (2) EVERLENE BAYER 5.00 DIRECTOR 0'_ bb- X 0 0 0 (3)COURTNEY CAIN .............................. 5.00 PRESIDENT 0.00 X 0 0 0 (4)ALEXANDRE EDMO S 5.00 VICE PRESIDENT O .O O X 0 0 0 (s)CARLENE ELLIOTT 5.00 TREASURER 0. dd xi 0 0 0 (6)SHARON FREW 5.00 SOCIAL SERVICE DIREC 0.00 X 0 0 0 (7) GLORIA GOOLSBY ..................... 5_.00 DIRECTOR 0.00 X 0 0 0 (s) EARL HEATH 5.00 DIRECTOR 0.00 X 0 0 0 (s)MARGARET JOHNSON .................. 5.00 SECRETARY 0.0 0 X 0 0 0 10)HUBERT MCINTOSH ............. 5.00 DIRECTOR 0.00 X 0 0 0 11)YVONNE ODOM 5.00 ]IRECTOR 0. 06" X 0 0 0 FormDAA 990 (2021) 875 65097.150<311/0312022 8-55 PM f=orm 990 (2021) BOYNTON BEACH FAITH BASED COMMUNITY 65-0971509 _ Page 8 Part VII Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Emolovees Icontinuedl A r ozal number or individua€s (inc€uding but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization ► 0 Yes No 3 Did the organization list any former officer, director, trustee, key employee, or highest compensated employee on line 1 a? if "Yes," complete Schedule J for such individual , . , _ _ _ 3 X 4 For any individual listed on line 1 a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? if "Yes,"complete Schedule J for such individual . a X 5 Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? if'Yes,"com lete Schedule J for such joerson . _ ..... .. _ . 5 X .................... Section B. Independent contractors 1 Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization's tax vaar A m Nae and business address Descripio�ofservioes (c) Position (A) (S) (do not check more than one (b) (E) (F} Name and title Average box, unless person is both an Repertab€e Reportable Estimated amount hours officer and a directodtrustee) compensation compensation of other per weeko from the from related compensatfen _ _ (list any a a N 3m o organization (VV -2J organizations (W-21 from the hours m e 5 m 3 aN 1099-MISC! 1099-MISCI organization and related o m 0 ' 8 1099 -NEC) 1099 -NEC) related organizations organizations c m ° N below m dotted fine) m w m n ....................................................... ....................................................... ....................................................... ....................................................... 1b Subtotal ................ ................. ............... ► 67,500 6,988 c Total from continuation sheets to Part VII, Section A . , ... ► d Total add lines Ib and Ic................ ............. ► 67,500 6,988 A r ozal number or individua€s (inc€uding but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization ► 0 Yes No 3 Did the organization list any former officer, director, trustee, key employee, or highest compensated employee on line 1 a? if "Yes," complete Schedule J for such individual , . , _ _ _ 3 X 4 For any individual listed on line 1 a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? if "Yes,"complete Schedule J for such individual . a X 5 Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? if'Yes,"com lete Schedule J for such joerson . _ ..... .. _ . 5 X .................... Section B. Independent contractors 1 Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization's tax vaar A m Nae and business address Descripio�ofservioes Com e nsation 2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization ► 0 871 Form 990 (2021) 650971509 1110312Q22 8:55 PM Form 990 (2021) BOYNTON BEACH FAITH BASED COMMUNITY 65-0971509 Pam Part VIII Statement of Revenue Check if Schedule O contains a response or note to anv line in this Part Vlll i-1 DAA Fort„ 990 (2021) 877 (A) (e) (c) (D) Total revenue Related or exempt Unrelated Revenue excluded function revenue business revenue from tax under sections 512514 1a Federated campaigns 1a o b Membership dues 1113 Qc Fundraising events 1c 1d i5.2 d Related organizations 1 e 180,364 tr�E e Govemment grants (contributions) q f All other ouriJbuiions, gifts, grants, tand similar amounts not included above ........ 1f 216,113 �0 g Noncash contribufions included in ='o lines la -1f ........ .... Ig $ 0ca h Total. Add lines ria—if .. . ........... 396,477 ....... -........ ► Business Code 2a mb .............. .............. .......... . .................... ................. G E CD ............... ............. d 2e CL................................................. f All other program service revenue ..... . ...... . .. . . . . Total. Add lines 2a -2f ................... . .................... ► 3 Investment income (including dividends, interest, and other similar amounts) ► ....................................... 4 Income from investment of tax-exempt bond proceeds Do - 5 5 Royalties..................................................... ► (i) Real (ii) Personal 6a Gross rents 6a 108,424 b Less: rental expenses 6b 100,424 C Rental !no. or (loss) 6c 8,000 d Net rental incomeor(loss .__.................... „_... ► 8,000 8,000 7a Gross amountfmm (i) Securities (ii) Other sales of assets other than inventory 7a 620,000 b Less: cost or other basis and sales exps. 7b 495,023 c Gain or (lass) I 7c 124,977 s d Net gain or loss ........... ► 124,977 124,977 p $a Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 8a b Less: direct expenses 8b c Net income or (loss) from fundraising events ........... . .. . . ► 9a Gross income from gaming activities. See Part IV, line 19 9a b Less: direct expenses 9b c Net income or (loss) from gaming activities ...... . .......... . ► 10a Gross sales of inventory, less returns and allowances 10a b Less: cost of goods sold 10b c Net income or loss from sales of inventory .............. lo- w w Business Code m 3 1 is Miscellaneous ...._..... I2 12 ................ b U d ................... ................ C N>r .................. ................. d All other revenue ... . ...... . . .. . .................. e Total. Add lines 112-11 d .... _ ............. . .... . ► 12 12 Total revenue. See instructions ..... ... ........... ► 529,466 132 , .9-7-71 12 DAA Fort„ 990 (2021) 877 65097150911103/2022 8:55 PM Form 990 (2021) BOYNTON BEACH FAITH BASED COMMUNITY 65-0971509 Page 10 Part IK Statement of Functional Expenses _ Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) Check if Schedule O contains a response or note to any line in this Part IX n _ Do not include amounts reported on lines &b, 7b, $b, 9b, and 10b of Part Vlll. t Total expenses Program service expenses .............................. Management and Fundraising general expenses expenses 1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 2 Grants and other assistance to domestic individuals. See Part IV, line 22 ............. 3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16 4 Benefits paid to or for members 5 Compensation of current officers, directors, trustees, and key employees 6 Compensation not included above to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) 7 Other salaries and wages 8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) 9 Other employee benefits........... ......... 10 Payroll taxes. 11 Fees for services (nonemployees): a Management ................................ b Legal c Accounting. _ ........ .... .... d Lobbying ..................................... e Professional fundraising services. See Part IV, line 17 f Investment management fees ............... g Other. (If line lig amaunt exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule 0.) 12 Advertising and promotion ..........- 13 Office expenses ......................... 14 Information technology 15 Royalties ............ 16 Occupancy ................ 17 Travel3,466 18 Payments of travel or entertainment expenses for any federal, state, or local public officials 19 Conferences, conventions, and meetings 20 Interest 21 Payments to affiliates ........................ 22 Depreciation, depletion, and amortization 23 Insurance 24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses on line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule 0.) a CLIENT ASSISTANCE b OTHER C ................. .................. _ d ................... .............. . e All other expenses 25 Total functional expenses. Add lines 1 through 24e , , ... 67 500 13 t 500 54 000 178,422 142 e 738 35,684 12,464 6,232 6f232 20 378 16,302 4,076 20,240 16,192 4,048 10,198 8 158 2,040 5,530 4,424 1f106 3466 13,175 13,175 16,966 16,966 134,580 134,580 29,710 25,410 4,300 512,6291 397,677 114 952 0 26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here ► if following SOP 98 2 ASC 958-720). — ....... Form 990 (:878 65OS715M 11/0312022 3:56 PM f=orm 990 (2021) BOYNTON BEACH FAITH BASER COMMUNITY 65-0971509 Page 11 Part X Balance Sheet - Check if Schedule O contains a rPsnnnca nr nntP to an.. line in thee Part Y Farm 990 (2021) DAA 879 (A) (�) ..... Beginning of year End of year 1 Cash—non-interest-bearing .................. ...... .......... ... 385,649 1 317,625 2 Savings and temporary cash investments 2 3 Pledges and grants receivable, net 4 Accounts receivable, net 42 940 4 14,955 5 Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons5 .............................. 8 Loans and other receivables from other disqualified persons (as defined m under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) 6 w 7 Notes and loans receivable, net389 ........................................... 738 7 3'72 73$ 8 Inventories for sale or use 8 9 Prepaid expenses and deferred charges 10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 11 367 b Less: accumulated depreciation 10b 11,367 10c 11 investments—publicly traded securities 11 12 Investments—other securities. See Part IV, line 11 ..................................... 12 13 Investments—program-related. See Part IV, line 11 13 66,995 14 Intangible assets 14 15 Other assets. See Part IV, line 111,237,494 ...................................................... 15 1,178,646 16 Total assets. Add lines 1 through 15 must equal line 33 ........................ . ..... 2,055,821 16 1F950,959 17 Accounts payable and accrued expenses 4,834 17 1,434 18 Grants payable .............................. 18 19 Deferred revenue...................................................................... 19... 24 Tax-exempt bond liabilities 20 21 Escrow or custodial account liability. Complete Part IV of Schedule D .................. 21 m 22 Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons 22 23 Secured mortgages and notes payable to unrelated third parties ........................ 23 24 Unsecured notes and loans payable to unrelated third parties 24 25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D .......... 288,223 25 170,272 26 Total liabilities. Add lines 17 throe h 25 . ............... ............... 293,057 26 171,706 Organizations that follow FASB ASC 958, check here ► ❑X U and complete lines 27, 28, 32, and 33. c 27 Net assets without donor restrictions1,762,764 ................................................... z7 1,779,253 m 28 Net assets with donor restrictions 28 Organizations that do not follow FASB ASC 958, check here ON -Ll U. and complete lines 29 through 33. L ° 29 Capital stock or trust principal, or current funds29 .............. ............................ 30 m 30 Paid -in or capital surplus, or land, building, or equipment fund .......................... Q 31 Retained earnings, endowment, accumulated income, or other funds 81 V32 Total net assets or fund balances .............................................. 1,762,764 32 1,779,253 33 Total liabilities and net assets/fund balances ................... 2,055,821 33 1,950,959' Farm 990 (2021) DAA 879 65097`5091110312Q22 8:56 PM Form 990 (2021) BOYNTON BEACH FAITH BASED COMMUNITY 65-0971509 Page 12 Part XI Reconciliation of Net Assets Check if Schedule O contains a response or note to any line in this Part A ..... n 1 2 3 4 5 S 7 8 9 10 Total revenue (must equal Part VIII, column (A), line 12) Total expenses (must equal Part IX, column (A), line 25) Revenue less expenses. Subtract line 2 from line 1 Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ............................. Net unrealized gains (losses) on investments ..................................... . . ............ Donated services and use of facilities6 .......................... ....................... Investment expenses Prior period adjustments ......................... ......................... ........................... Other changes in net assets or fund balances (explain on Schedule O) ............... ........................ Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column 13 ............ . .................... .I .................... . .1 ..................... 1 529,466 2 512,629 3 16,837 4 1,762,764 5 Schedule O. 7 8 2a Were the organization's financial statements compiled or reviewed by an independent accountant? .................................. 9 —348 10 1 r 779r25 Part XII Financial Statements and Reporting Check if Schedule O contains a response or note to an line in this Part X]] ....... - . ............. . ..... . .... . . . . ...... F1 1 Accounting method used to prepare the Form 990: F]Cash ❑X Accrual F7Other Yes No If the organization changed its method of accounting from a prior year or checked "Other," explain on Schedule O. 2a Were the organization's financial statements compiled or reviewed by an independent accountant? .................................. 2a X If "Yes," check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both: ❑ Separate basis ❑ Consolidated basis I] Both consolidated and separate basis b Were the organization's financial statements audited by an independent accountant? ......................................... If "Yes," check a box below to indicate whether the financial statements for the year were audited on a 2b X separate basis, consolidated basis, or both: ❑ Separate basis ❑ Consolidated basis Both consolidated and separate basis c If "Yes" to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?2c ....................... ..... If the organization changed either its oversight process or selection process during the tax year, explain on Schedule O. 3a As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? b If "Yes,' did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why on Schedule O and describe any steps taken to undergo such audits .............. 3b Form 990 (2021) DAA 880 650971509 1110312022 8:56 PM SCHEDULE A Public Charity Status and Public Support OMB No. 1545-0447 (Form 990) 2 02 1 Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust Department of the Treasury ► Attach to Form 990 or Form 990 -EZ. Open to Public Revenue Service ► Go to www.irs. ov/Form990 for instructions and the latest information. I Inspection Name of the organization BOYNTON BEACH FAITH BASED COMMUNITY Employer identification number DEVELOPMENT CORPORATION 165-0971509 Part i Reason for Public Charity Status. All or anizations must complete this art. See instructions. The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.) 1 A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i). 2 n A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Fomn 990).) 3 L��i A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii), 4 A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(M). Enter the hospital's name, city, and state: 5 An organization operated fortho benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part 11.) 6 A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v). 7 X An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part 1i.) 8 n A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.) 9 iLJi An agricultural research organization described in section 170(b)(1)(A)(Ix) operated in conjunction with a land-grant college or university or a non -land-grant college of agriculture (see instructions)_ Enter the name, city, and state of the college or university: ............................................................................................................................................ 10 An organization that normally receives (1) more than 33 113% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions, subject to certain exceptions; and (2) no more than 33113% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part 111.) 11 An organization organized and operated exclusively to test for public safety. See section 509(a)(4). 12 F] An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g. a Type 1. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B. to Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C. c ❑ Type HI functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E. d Type III non -functionally integrated. A supporting organization operated in connection with its supported organization($) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V. e Check this box if the organization received a written determination from the IFAS that it is a Type 1, Type 11, Type III functionally integrated, or Type 111 non -functionally integrated supporting organization. f Enter the number of supported organizations .... g Provide the following information about the supported organization(s). (i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1-10 above (see instructions)) (iv) is the organization listed in your gnveming documenv (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions) Yes No (A) (B) (C) (D) (E) Total Or raverworx KeducPOn Act Notice, see the instructions for Form 990 or 990 -EZ. Schedule A (Form 990) 2021 DAA 881 6509-1509 11 103f2= 6:56 PM 5cheduleA (Form 990) 2021 BOYNTON BEACH FAITH BASED COMMUNITY 65-0971509 Page 2 Part fl Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or S of Part I or if the organization failed to qualify under Part III_ If the organization fails to qualify under the tests listed below, please complete Part III ) Section A. Public Sunnort Calendar year (or fiscal year beginning in) ► (a) 2017 (b) 2018 (c) 2019 (d) 2020 (e) 2021 (f) Total 108,128 211,374 390,469 396,477 1,251,618 23,650 1 Gifts, grants, contributions, and membership fees received. (Do not 216,268 124,977 424,291 organization test-2020. If the organization did not check a box on Hne 13, 16a, 16b, or 17a, and line inc€udeany "unusual grants.") 145,170 108,1281 211,374 390,469 396,477 1,251,618 121 52.212 instructions 2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf 3 The value of services or facilities furnished by a governmental unit to the organization without charge 4 Total. Add lines 1 through ......... 5 The portion of total contributions by 145,170 108,128 211.,374 390,469 396,477 1,251 618 each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) 6 Public support. Subtract line 5 from line 4 .. 1,251,618 Calendar year (or fiscal year beginning in) ► 7 Amounts from line 4 8 Gross income from interest, dividends, payments received on securities loans, rents, royalties, and income from similar sources .......................... 9 Net income from unrelated business activities, whether or not the business is regularly carried on . .. . .. . . . .. . . . 10 11 12 13 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) . .............. Total support Add lines 7 through 10 (a) 2017 (b) 2018 (c) 2019 (d) 2020 (e) 2021 (f) Total 145,170 108,128 211,374 390,469 396,477 1,251,618 23,650 26,568 32,82 216,268 124,977 424,291 organization test-2020. If the organization did not check a box on Hne 13, 16a, 16b, or 17a, and line 15 is 10% or more, and if the organization meets the facts -and -circumstances test, check this box and stop here. Explain 50,700 1,500 121 52.212 instructions 1,728 121 Gross receipts from related activities, etc. (see instructions) First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 509 (c)(3) organization: check this box and stop here ion C. Computation of Public Support Percentage 1 12 1 430,408 71 14 Public support percentage for 2021 (line 6, column (f) divided by line 11, column (f)) _ _ _ 14 72.43% 15 Public support percentage from 2020 Schedule A, Part II, line 14 15 81.21% 16a 33 113% support test -2021. If the organization did not check the box on line 13, and line 14 is 33 113 or more, check this /o box and stop here. The organization qualifies as a publicly supported organization b 33 113% support test -2020. If the organization did not check a box on line 13 or 16a, and line 15 is 33 113% or more, check this box and stop here. The organization qualifies as a publicly supported organization ► 17a 10% facts -and -circumstances test -2021. If the organization did not check a box on fine 13, 16a, or 16b, and line 14 is 10% or more, and if the organization meets the facts -and -circumstances test, check this box and stop here. Explain in Part VI how the organization meets the facts -and -circumstances test. The organization qualifies as a publicly supported organization test-2020. If the organization did not check a box on Hne 13, 16a, 16b, or 17a, and line 15 is 10% or more, and if the organization meets the facts -and -circumstances test, check this box and stop here. Explain in Part Vi how the organization meets the facts -and -circumstances test. The organization qualifies as a publicly supported organization 18 Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see instructions Schedule A (Form 990) 2021 DAA 882 6599715491 IM/2022 8:56 PM Schedule A f=orm 990 2021 BOYNTON BEACH FAITH BASED COMMUNITY 65-0971509 Pae 3 Part III Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part 11. If the organization fails to qualify under the tests listed below, please complete Part II_) Section A. Public Support Calendar year (or fiscal year beginning in) ► (a) 2017 (b) 2018 (c) 2019 (d) 2020 (e) 2021 (f) Total 1 Lits, grants, contributions, and membership fees received. (do not include any "unusual grants.') 2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax exempt purpose ... • , • ... . 3 Gross receipts from activities that are not an unrelated trade or business under section 513 4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf ...... 5 The value of services or facilities furnished by a governmental unit to the organization without charge 6 Total. Add lines 1 through 5 7a Amounts included on lines 1, 2, and 3 received from disqualified persons b Amounfs included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1 % of the amount on line 13 for the year c Add lines 7a and 7b ..................... 8 Public support. (Subtract line 7c from line 6.) ................................... Section B. Total Support Calendar year (or fiscal year beginning in) ► (a) 2017 (b) 2018 (c) 2019 (d) 2020 (e) 2021 (f) Total 9 Amounts from line 6 10a Gross income from interest, dividends, payments received on securities loans, rents, royalties, and income from similar sources ... b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975 c Add lines 1 oa and 10b 11 Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on 12 Other income_ Do not include gain or loss from the sale of capital assets (Explain in Part VI.) 13 Total support. (Add Ines 9','16c, 11, and 12.) 14 First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here .... Section C. Computation of Public Support Percentage 15 Public support percentage for 2021 (line 8, column (f), divided by line 13, column (f))15 o7u ......................................... Public support percentage from 2020 Schedule A, Part 111, line 15 .... , . _ . 16 % Section D. Computation of Investment Income Percentage 17 Investment income percentage for 2021 (line 1 oc, column (t), divided by line 13, column (0)H17 % 18 Investment income percentage from 2020 Schedule A, Part Ill, line 17 19a 33 113% support tests -2021_ If the organization did not check the box on lin ............................................. n ........ e 14, and line 15 is more than 33 113 /o, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization . - _ .. _ . ► ❑ b 33 113% support tests -2020. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 113%, and line 18 is not more than 33 113%, check this box and stop here. The organization qualifies as a publicly supported organization ............ . . . ► ❑ 20 Private foundation If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions ... _ .. - . ► ❑ Schedule A (Form 990) 2021 DAA 883 650971-50911103120 2 8:55 PM Schedule A (form 990) 2021 BOYNTON BEACH FAITH BASED COMMUNITY 65-0971509 Pae 4 Part iV Supporting Organizations (Complete only if you checked a box in line 12 on Part I. If you checked box 12a, Part i, complete Sections A and B. If you checked box 12b, Part I, complete Sections A and C. If you checked box 12c, Part 1, complete Sections A, D, and E. If you checked box 12d, Part 1, coml)lete Sections A and D_ and rrimniptp p:r+v 1 Section A. AH Su ns 1 Are all of the organization's supported organizations listed by name in the organization's governing documents? If 'No, " describe in Part Vt how the supported organizations are designated If designated by class or purpose, describe the designation. If historic and continuing relationship, explain - 2 Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes, " explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2). 3a Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes,"answer lines 3b and 3c below. b Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes, " describe in Part VI when and how the organization made the determination_ c Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes, " explain in Part V1 what controls the organization put in place to ensure such use_ 4a Was any supported organization not organized in the United States ("foreign supported organization")? If "Yes, " and if you checked box 12a or 12b in Part 1, answer lines 4b and 4c below. b Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If "Yes,"describe in Part V1 how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations. c Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If "Yes," explain in Part Vi what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes_ 5a Did the organization add, substitute, or remove any supported organizations during the tax year? If "Yes," answer lines 5b and 5c below (if applicable). Also, provide detail in Part V1, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document). b Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document? c substitutions only. Was the substitution the result of an event beyond the organization's control? S Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization's supported organizations? If `Yes, "provide detail in Part VL 7 Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (as defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If "Yes,"complete Part I of Schedule L (Form 990). 8 Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? if "Yes, " complete Pall I of Schedule L (Form 990). 9a Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If "Yes,"provide detail in Part V1. b Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If 'Yes,"provide detail in Part Vl. c Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? if "Yes,"provide detail in Part Vt. 10a Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type 11 supporting organizations, and all Type III non -functionally integrated supporting organizations)? If "Yes," answer line 10b below. b Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings-) Yes I No 3a 3b 4a 4b 4c 5a 5b 5c 10a _bbl I Schedule A (Form 990) 2021 °"A 884 6509715091110312022 5:56 PM Schedule Form 990 2021 BOYNTON BEACH FAITH BASED COMMUNITY 55--0971509 Page 5 Part IV Sunnortincr Ornani7atinn4t frnnfinwrcrll 11 Has the organization accepted a gift or contribution from any of the following persons? Yes a A person who directly or indirectly controls, either alone or together with persons described on lines 11 b and 11 c below, the governing body of a supported organization? Ila b A family member of a person described on line 11 a above? 11b c A 35% controlled entity of a person described on line 11 a or 11 b above? if 'Yes" to line Ila, 11b, or 11c, provide detail in Part VI_ 11c ection B. Type I Supporting Organizations Did the governing body, members of the governing body, officers acting in their official capacity, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization's officers, directors, or trustees at all times during the tax year? If "No,"describe in Part V1 how the supported organization(s) ofiectively operated, supervised, or controlled the organization's activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove officers, directors, or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year. Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If "Yes," explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised, or controlled the Supporting organization. in C. Type II Sunnorflna OrQ2111i7afinnc 2 No Yes No 1 Were a majority of the organization's directors or trustees during the tax year also a majority of the directors or trustees of each of the organization's supported organization(s)? If'No,"describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed Section D. All Type IiI 1 Did the organization provide to each of its supported organizations, by the last day of the frfth month of the Yes NO organization's tax year, (i) a written notice describing the type and amount of support provided during the prior tax Year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization's governing documents in effect on the date of notification, to the extent not previously provided? 1 2 Were any of the organization's officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? if No,"explain in Part V1 how the organization maintained a close and continuous working relationship with the supported organizatien(s). 2 3 By reason of the relationship described on line 2, above, did the organization's supported organizations have a significant voice in the organization's investment policies and in directing the use of the organization's income or assets at all times during the tax year? If "Yes,"describe in Part V1 the role the organization's supported o anizations played in this regard Section E. Type III Functionally Integrated Supporting Organizations 3 1 Check the box next to the method that the organization used to satisfy the integral Part Test during the year (see instructions). a The organization satisfied the Activities Test. Complete line 2 below. b The organization is the parent of each of its supported organizations. Complete line 3 below. c The organization supported a governmental entity. Describe in Part VI how you supported a governmental entity (see instructions). 2 Activities Test. Answer lines 2a and 2b below. a Did substantially all of the organization's activities during the tax year directly further the exempt purposes of Yes No the supported organization(s) to which the organization was responsive? If "Yes,"then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities. 2a b Did the activities described on line 2a, above, constitute activities that, but for the organization's involvement, one or more of the organization's supported organization(s) would have been engaged in? If "Yes, "explain is Part VI the reasons for the organization's position that its supported organization(s) would have engaged in these activities but for the organization's involvement 2b 3 Parent of Supported Organizations. Answer lines 3a and 3b below. a Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? If "Yes" or "No,"provide details in Part Vl. 3a b Did the organization exercise a substantial degree of direction over the policies, programs, and activities of each ona of its supported organizations? If "Yes,"describe in Part Vi the role pla ed by the organization in this regard. 3b Schedule A (Form 990) 885 6509? 9 509 W03120226:56 PM ScheduieA Form 990 2021 BOYNTON BEACH FAITH BASED COMMUNITY 65-0971509 Page 6 Part V Type Ill Non -Functional) Integrated 509(a)(3) Supportiniql Organizations 1 L Check here if the organization satisfied the Integral Part Test as a trust Nov. qualifying on 20, 1970 (explain in Part VI. See instructions. All other Type III non -functionally integrated supporting organization must COm lete Sections A throu h E. Section A --Adjusted Net Income (A) Prior Year (B) Current Year 1 Net short-term capital gain (optional)1 2 Recoveries of prior -year distributions 2 3 Other cross income see instructions 3 4 Add lines 1 through 3. 4 5 Deareciation and depletion 5 6 Portion of operating expenses paid or incurred for production or collection of gross income orfor management, conservation, or maintenance of property held for production of income see instructions 6 7 Other expenses isee instructions 7 8 Adjusted Net Income subtract lines 5, 6, and 7 from line 4 8 Section B — Minimum Asset Amount (B) Current Year (A) Prior Year 1 Aggregate fair market value of all non -exempt -use assets (see (optional) instructions for short tax year or assets held for part of year): a Average monthly value of securities 1a b Average monthly cash balances 1b C Fair market value of other non -exam use assets d Total add lines 1 a 9 b, and 1 c qc Id e Discount claimed for blockage or other factors (explain in detail in Part : Vl 2 Acquisition indebtedness applicable to non -exempt -use assets 2 3 Subtract line 2 from line 1d. 3 4 Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). 4 5 Net value of non -exempt -use assets subtract line 4 from line 3 5 6 Multiply line 5 by 0.035. 6 7 Recoveries of prior -year distributions 7 S Minimum Asset Amount add line 7 to line 6 8 Section C — Distributable Amount Current Year 1 Adjusted net income for prior Year from Section A, line 8, column A 2 I=nter 0.85 of line 1. 3 Minimum asset amount for prior Year from Section B, line 8, column A 4 Enter greater of line 2 or line 3. V4" 5 Income tax im osed in rior ear 6 Distributable Amount. Subtract line 5 from line 4, unless subject to emer en tem ora reuction see instructions . 7 ❑ Check here if the current year is the organization's first as a non -functionally integrated Type III supporting organization see instructions . Schedule A (Form 990) 2021 DAA 886 850974509 11!0312022 8:56 PM Schedule A Form 990 2021 BOYNTON BEACH FAITH BASED COMMUNI'T'Y 65-0971509 Pae 7 Part V Type III Non -Functional) Integrated 509(a)(3) Supporting Organizations continued Section D – Distributions DAA 887 Current Year 1 Amounts paid to supported organizations to accomplish exempt pur oses 2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity 3 Administrative expenses paid to accomplish exempt purposes of supported organizations 4 Amounts paid to acquire exempt -use assets 5 Qualified set-aside amounts(prior IRS approval required—provide details in Part 6 Other distributions describe in Part V . See instructions. 7 Total annual distributions. Add lines 1 through 6. 8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part n. See instructions. 9 Distributable amount for 2021 from Section C, line 6 10 Line 8 amount divided bv fine 9 amount (i) Section E – Distribution Allocations (see instructions) Excess Distributions (ii1 (iii) Underdistributions Distributable 1 Distributable amount for 2021 from Section C, line 6 Pre -2021 Amount for 2021 2 Underdistributions, if any, for years prior to 2021 (reasonable cause required–explain in Part V!). See instructions. 3 Excess distributions carryover, if any,to 2021 a From 2016 .................................. b From 2017........... c f=rom 2018 .................................. d From 2019...._..._. ......................... e From 2020........... ........................ f Total of lines 3a through 3e Applied to underdistributions of prior years h Applied to 2421 distributable amount i Carryover from 2016 not aeplied see instructions . Remainder. Subtract lines 3 , 3h, and 3i from line 3f. 4 Distributio ns for 2021 from Section D. line 7: $ a Applied to underdistributions of prior years b Applied to 2021 distributable amount c Remainder. Subtract lines 4a and 4b from line 4. 5 Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. For result greater than zero, explain in Part VI. See instructions. 6 Remaining underdistributions for 2021 Subtract lines 3h and 4b from line 1. For result greater than zero, explain in Pari VI. See instructions. 7 Excess distributions carryover to 2022. Add lines 3j and 4c. 8 Breakdown of line 7: a Excess from 2017 ......................... b Excess from 2018 ..... .................... . c Excess from 2019 d Excess from 2020 e Excess from 2021 Schedule A (Form 990) 2021 DAA 887 6509Z1 509 1 1/03/2022 8:56 PM Schedule Form 990 2021 BOYNTON BEACH FAITH BASED COMMUNITY 55-0971509 Page 8 Part VII Supplemental Information. Provide the explanations required by Part 11, line 10; Part 11, line 17a or 17b; Part 111, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a, and 3b; Part V, line 1; Part V, Section B, line 1 e; Part V, Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. See instructions. Part II, Line 10 — Other Income Detail DEVELOPMENT FEES ..52 , 200 nrw Schedule A (Form 990) $$$ 65097VK911103/2022 8:56 PM SCHEDULE D (Form 990) Department cf the Treasury Internal Revenue Service Name of the organization BOYNTON BEACH DEVELOPMENT C, Supplemental Financia! Statements ► Complete if the organization answered "Yes" on Form 990, Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b. ► Attach to Form 990. FAITH BASED CONMUNITY RPORATION OMS No. 1545-0047 1 2021 Employer identification number 65-4971r%na Part I Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6. (a) Donor advised funds I (b) Funds and other accounts I Total number at end of year ................................. 2 Aggregate value of contributions to (during year) ........... 3 Aggregate value of grants from (during year) ............ 4 Aggregate value at end of year 6 Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization's property, subject to the organization's exclusive legal control? ❑ Yes ❑ No 6 Did the organization inform all grantees, donors, and donor advisors in writing that grant fund's can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible erivate benefit?❑ ❑ No .......... ........... ............. Yes benefit?........Part II Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7. 1 Purpose(s) of conservation easements held by the organization (check all that apply). ❑ Preservation of land for public use (for example, recreation or education) ❑ Preservation of a historically important land area ❑ Protection of natural habitat ❑ Preservation of a certified historic structure ❑ Preservation of open space 2 Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year. Held at the End of the lax Year a Total number of conservation easements b Total acreage restricted by conservation easements c Number of conservation easements on a certified historic structure included in (a) 2c d Number of conservation easements included in (c) acquired after 7125/06, and not on a historic structure listed in the National Register ... 2d 3 Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the tax year 0- 4 4 Number of states where property subject to conservation easement is located 10- 5 5 Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ❑ Yes ❑ No 6 Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year 7 Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year ►$ 8 Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(13)(i) and section 170(h)(4)(B)(ii)? ........ ................................ Yes ❑ No 9 In Part Xill, describe how the organization reports conservation easements in its revenue and expense statement and balance sheet, and include, if applicable, the text of the footnote to the organization's financial statements that describes the organization's accounting for conservation easements. Part III Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets. Complete if the organization answered "Yes" on Form 990, Part IV, line 8. 1a If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide in Pari XII1 the text of the footnote to its financial statements that describes these items. b If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items: (i) Revenue included on Form 990, Part Vlll, line 1 (ii) Assets included in Form 990, Part X $ ................... . .► .......................... .... .. $ -_.... 2 If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the following amounts required to be reported under FASB ASC 958 relating to these items: a Revenue included on Form 990, Part Vill, line 1 ► $ Assets included in Form 990 Part X .. _ ..... ► $ For Paperwork Reduction Act Notice, see the Instructions for Form 990. DAA Schedule D (Form 990) 2889 6509F1509 11103/422 8:55 PM Schedule D Form 990 2021 BOYNTON BEACH FAITH BASED COMMUNITY 65-0971509 Pae 2 Part Ill Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets continued 3 Using the organization's acquisition, accession, and other records, check any of the following that make significant use of its collection items (check all that apply): a Public exhibition d 0 Loan or exchange program n Scholarly research e Other Cb .......................... c Preservation for future generations ............. .."............ 4 Provide a description of the organization's collections and explain how they further the organization's exempt purpose in Part XIII 5 During the year, did the organization solicit or receive donations of art, historical treasures, or other similar assets to be sold to raise funds rather than to be maintained as part of the or anization's collection?".. El Yes No Part iV Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, fine 21. 1a Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not included on Form 990, Part X? 'Yes," L]Yes � No b If explain the arrangement in Part XIII and complete the following table: Amount c Beginning balance.......................................1 c d Additions during the year 1d ....................... e Distributions during the year. Ending balance.................................................................1f. 2a Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? Ll Yes No b es," explain the arrangement in PartXIII. Check here if the explanation has been provided on Part XI II .... " . , Part Endowment l=ands. Complete if the or anization answered "Yes" on Form 990 Part IV, fine 10. (a) Current year [b) Prior year (c) Two years back (d) Three years back is Beginning of year balance ............... (e) Four years back b Contributions ............................ c Net investment earnings, gains, and losses .............................. ..... d Grants or scholarships . ........... e Other expenditures for facilities and programs .......... f Administrative expenses ................ g End of year balance 2 Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as: a Board designated or quasi -endowment ► b Permanent endowment ► % c Term endowment ► /o The percentages on lines 2a, 2b, and 2c should equal 100%. 3a Are there endowment funds not in the possession of the organization that are held and administered for the organization by: Yes No (i) Unrelated organizations ........................ .......................................................... ......................... 11 Related organizations 3a i ............................................ _ b If Yes" on fine 3a(ii), are the related organizations listed as required on Schedule R? 3a li .................. Describe in Part KIi[ the intended uses of the or anization's endowment funds. 3b Part VI Land, Buildings, and Equipment. Com fete if the organization answered "Yes" on Form 990 Part lV fine 11 a. See Form 990 Part X line f 0. (c) Accumulated Description of property (a) Cost or other basisM11 (d) Book value (investment)depreciation la Land b Buildings c Leasehold improvements .. ....... d Equipment 11 367 e Other Total. Add lines 1 a through 1 e. (Column (d) must equal Form 990, Part X, column (B), line 100 Schedule D (Form 990) 2021 DAA 890 6509311509 11/0312722 a:57 PM Schedule D (Form 990) 2021 BOYNTON BEACH FAITH BASED COMMUNITY 65-0971509 Page3 Part VII Investments — Other Securities. Complete if the organization answered "Yes" on Form 990, Part IV, line 11 b_ See Form 990, Part X, line 12. (a) Description of security or category (b) Book value (c) Method of valuation: (including name of security) I I r— ------- —.......... (1) Financial derivatives ..................................................... (2) Closely held equity interests .......................................... (3) Other ........................................................... (A) (B) (D) ................. ............... ................. ................ ....... ...(q) .. ................. ...(H) ........................... Total. (Column (b) must equal Form 990, Part X, col. (B) line 12_) .. ► Part VIII Investments— Program Related. Complete if the organization answered "Yes" on Form 990, Part IV, fine 11c. See Form 990, PartX, line 13. (a) Description of investment (b) Book value (c) Method of valuation: Cost or end-cf-year market value Total. (Column (b) must equal Form 990, Part X, col. (8) line 13.) . _ ► Part IX Other Assets. Complete if the or anization answered "Yes" on Form 990, Part IV, line 11 d_ See Form 990, Part X, line 15. (a) Description (b) Book value (1) REAL ESTATE FIELD FOR RENTAL 1,176,146 (2) DEPOSITS 2,500 (3) (4) (3) (6) (7) ($) (9) Total. (Column b must equal Form 990, Part X, col- (8) line 15.) ........... . ....... ............ .............. ........ ► 1r178,646 Part X Other Liabilities. Complete if the organization answered "Yes" on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25_ 1. (a) Description of liabil ty (b) Book value (1) Federal income taxes (2) NOTES PAYABLE 142,000 (3) LT Debt SBA Doan 24,035 (4) Other Payable 4,237 (5) (6) (7) (8) (9) Total. (Column (b) must equal Form 990, Part X, col. (B) line 25.) ► 170,272 2_ Liability for Uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the or antation's liability for uncertain tax positions under FASB ASC 740. Check here if the text of the footnote has been provided in Part Xfl! .. n DAA Schedule D (Form 990) 891 650971509 11/03/2022 8:57 PM Schedule -D (Form 990) 2021 BOYNTON BEACH FAITH BASED COMMUNITY 65-0971509 Page 4 Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered "Yes" on Form 990, Part IV, fine 12a. 1 Total revenue, gains, and other support per audited financial statements1 .......... 529,466 2 Amounts included on fine 1 but not on Form 990, Part VI 11, line 12: a Net unrealized gains (losses) on investments2a .......................................... b Donated services and use of facilities2b ................... I ............. ................. c Recoveries of prior year grants 2C d Other (Describe in Part XIII.) 2d ......................................................... e Add lines 2a through 2d .. ........... .................... .................. ................... 2e . . .......... 3 Subtract line 2e from fine 1 ............... ... 3 529 466 ......... 4 Amounts included on Form 990, Part VIII, fine 12, but not on line 1: a Investment expenses not included on Form 990, Part VI [I, line 7b 4a b Other (Describe in Part XII[.) 41b ._......... I ...... c Add lines 4a and 4b ....... ....................... .... 5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Fart 1, line 12.} - .. _ ........ ........ ........ 5 529,4697 Part X11 Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered "Yes" on Form 990, ] art IV, line 12a. 1 Tota[ expenses and losses per audited financial statements 1 512,629 2 Amounts included on line 1 but not on Form 990, Part [X, line 25: a Donated services and use of facilities b Prior year adjustments.. ............................................................... c Other losses.......................................................................... 2c d Other (Describe in Part XI II.) 2d e Add lines 2a through 2d 3 Subtract line 2e from line 7 ....................................... ..............._ 3 512,629 4 Amounts included on Form 990, Part IX, line 25, but not on line 1; a Investment expenses not included on Form 994, Part Vlll, line 7b 4a .................... b Other (Describe in Part XIII.) 415 c Add lines 4a and 41b 5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part 1, line 18.) ...... 5 512,629 Part X111 Supplemental Information. Provide the descriptions required for Part [l, lines 3, 5, and 9; Part [ll, lines 1 a and 4; Part IV, lines 1 b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information. ......... ............... . I................ ....... ................. .................. .............. -----...... ... Schedule D (Form 990) 2021 DAA 892 65097?5091110312022 8:57 PM Schedule D (Form 990)2021 BOYNTON BEACH FAITH BASED COMMUNITY 65-0971509 Page 5 Part XIII Supplemental Information (continued) Schedule 0 (Form 990) 2021 DAA 893 65097','309 1110312= 8:57 PM Schedule M (Form 990) 2021 BOYNTON BEACH FAITH BASED COMMUNITY 55-0971509 Page 2 Part Il Supplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part i, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information. Schedule M (Form 990) 2021 DAA 894 650975509 11103120;32 8:57 PM SCHEDULE O (Form 990) Department of the Treasury Internal Revenue Service Name of the organization Supplemental Information to Form 990 or 990 -EZ Complete to provide information for responses to specific questions on Form 990 or 990 -EZ or to provide any additional information. ► Attach to Form 990 or Form 990 -EZ. ► Go to www.irs.gav/Form990 for the latest information. BOYNTON BEACH FAITH BASED COMMUNITY DEVELOPMENT CORPORATION OMB No. 1545-0047 202' Open to Public Inspection :mployer identification number 65-0971509 Form 990, Part VI, Line 11b - Organization's Process to Review Form 990 A COPY OF FORM 990 PROVIDED TO EACH BOARD MEMBER PRIOR TO SUBMISSION. ................ ................... -1................. .................--....... ......... I..- --.................. ................ Form 990 Part VI, Line 19 - Governing Documents Disclosure Ealplanation FORM 990 IS AVAILABLE TO THE PUBLIC UPON REQUEST. ... ....................... .I.................- .......... -I-. ............................. .................... ..-................. . Form 990, Part XI, Line 9 - Other Changes in Net Assets Explanation .................................... Adjustmen.t.................................. $-348 .................................. . For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990 -EZ. Schedule O (Form 990) : 895 DAA 65097:509 11/03/2022 8:55 pM Form 8879 -TE IRS a -fele Signature Authorization for a Tax Exempt Entity 0M8Nc.1545-c047 For calendar year 2021, orfiscal year beginning ... _ , .... , 2021, and ending. _ .. _ _ ... _ , , 20 Department of the Treasury )',Do not send to the IRS. Keep for your records. 2021 Internal Revenue Service ► Go to www.frs. ov/Fbrm8879TEfor the latest information. Nameoffiler BOYNTON BEACH FAITH BASED COMMUNITYDEVELOPMENT CORPORATION 165-0971509 ElNorssN Name and title of officer or person subject to tax �+OURTNEY CAIN PRESIDENT Part I Type of Return and Return Information Check the box for the return for which you are using this Form 8879 -TE and enter the applicable amount, if any, from the return. Form 8038 - CP and Form 5330 filers may enter dollars and cents. For all other forms, enter whole dollars only. If you check the box on line la, 2a, 3a, 4a, 52, 6a, 7a, 8a, 9a, or 10a below, and the amount on that line for the return being filed with this form was blank, then leave line 1b, 2b, 3b, 4b, 5b, 6b, 7b, 8b, 9b, or 10b, whichever is applicable, blank (do not enter -0-). But, if you entered -0- on the return, then enter -0- on the applicable line below. Do not complete more than one line in Part 1. 1a Form 990 check here ► b Total revenue, if any (Form 990, Part Vill, column (A), line 12) 1b 529,466 2a Form 990 -EZ check here _ 10-b Total revenue, if any (Form 990 -EZ, line 9) 2b 3a Form 1120-POL check here ► b Total tax Form 1120-POL, line 22) 3b 4a Form 990 -PF check here ► b Tax based on investment income (Form 990 -PF, Part Vl, line 5) 4b 5a Form 8868 check here ► b Balance due (Form 8868, line 3c) .......... 6a Form 990-T check here ..... _ . ► b Total tax (Form 990-T, Part 111, line 4) . . ... . .. .... ............... . .... . 7a Form 472D check here _ ► b Total tax (Form 4720, Part III, line 1 . ... ' ... 6b ............ 8a Form 5227 check here ► b FMV of assets at end of tax year. (Fort 5227, Item D) ..... . . . . . ...... . 8b 9a Form 5330 check here ► b Tax due (Farm 5330, Part Il, line 19) ...... . . .... . . .... 9b 10a Form 8038 -CP check here .... ► b Amount of credit a rent re uested Form 803$ -CP Part Ill; line 22 10b Part Il Declaration and Si nature Authorization of Officer or Person Subject to Tax Under penalties of perjury, I declare that LXJ 1 am an officer of the above entity or I am a person subject to tax with respect to (name of entity) , (EIN) and that I have examined a copy of the 2021 electronic return and accompanying schedules and statements, and, to the best of my knowledge and belief, they are true, correct, and complete. 1 further declare that the amount in Part I above is the amount shown on the copy of the electronic return. I consent to allow my intermediate service provider, transmitter, or electronic return originator (ERO) to send the return to the IRS and to receive from the IRS (a) an acknowledgement of receipt or reason for rejection of the transmission, (b) the reason for any delay in processing the return or refund, and (c) the date of any refund. If applicable, I authorize the U.S_ Treasury and its designated Financial Agent to initiate an electronic funds withdrawal (direct debit) entry to the financial institution account indicated in the tax preparation software for payment of the federal taxes owed on this return, and the financial institution to debit the entry to this account. To revoke a payment, I must contact the U -S. Treasury Financial Agent at 1-888-353-4537 no later than 2 business days prior to the payment (settlement) date. I also authorize the financial institutions involved in the processing of the electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payment. I have selected a personal identification number (PIN) as my signature for the electronic return and, if applicable, the consent to electronic funds withdrawal. PIN: check one box only ❑ 1 authorize ERO firm name to enter my PIN as my signature Enter titre numbers, but do not enter all zeros on the tax year 2021 electronically filed return_ if I have indicated within this return that a copy of the return is being filed with a state agency(ies) regulating charities as part of the IRS Fed/State program, I also authorize the aforementioned ERO to enter my PIN on the return's disclosure consent screen. As an officer or person subject to tax with respect to the entity, I will enter my PIN as my signature on the tax year 2021 electronically filed return. If I have indicated within this return that a copy of the return is being filed with a state agency(ies) regulating charities as part of the IRS Fed/State program, I will enter my PIN on the return's disclosure consent screen. Signature of ot£cer or person sub ect to tax I' Date F 11/03/22 Part III Certification and Authentication ERO's EFIN/PIN. Enter your six -digit electronic filing identification number (EFIN) followed by your five -digit self-selected PIN. 65$] ].611Q 59 Do not enter all zeros 1 certify that the above numeric entry is my PIN, which is my signature on the 2021 electronically filed return indicated above. I confirm that am submitting this return in accordance with the requirements of Pub. 4163, Modernized e -File (MeF) Information for Authorized IRS e -fife Providers for Business Returns. ERO's signature 1 Date ll, 11/03/22 ERO Must Retain This Form — See Instructions Do Not Submit This Form to the IRS Unless Requested To Do So For Privacy Act and Paperwork Reduction Act Notice, see back of form. DAA Form 8879 -TE (20'896 INTERNAL REVENUE SERVICE P. 0, BOX 2508 CINCINNATI, OH 45201 �Jpj I 1) 6 tj Date ; �Oalj- BOYNTON REACH FAITH BASED COMMUNITY DEV CORP PO BOX 337 BOYNTON BEACH, FL 33425--0000 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: 65-0971509 DLN.- Ilb53073775004 Contact Person: SANDRA MAK ID# 95023 Contact Telephone Number: (877) 829-5500 Public Charity Status: 170(b)(1)(A)(Vi.) our letter dated October 2000, stated you would be exempt from Federal income tax under section 501(c)(3) of the Internal Revenue Code, and you would be treated as a public charity, rather than as a private foundation, during an advance ruling period. Based on the information you submitted, you are classified as a public charity under the Code section listed in the heading of this letter. since your exempt status was not under consideration, you continue to be classified as an organization exempt from Federal income tax under section 501(c)(3) of the Code. Publication 557, Tax -Exempt Status for Your Organization, provides detailed information about your rights and responsibilities as an exempt organization. You may request a copy by calling the toll-free number for forms, (800) 829-3676. Information is also available on our Internet Web Site at www.irs.gov. If you have general questions about exempt organizations, please call our toll-free number shown in the heading between 8:00 a.m. - 6:30 p.m. Eastern time., Please keep this letter in your permanent records. Sincerely yours, I "o Lois G!" Lerner Director, Exempt Organizations Rulings anti. Agreements Letter 1050 (DO/CG) 101,420 IRSDepartment of the Treasufy Ifileril"d Revenue Sorvice P,,O. Box 2508 In reply refer to: 0248574153 Cincinnati OH 45201 Apr. 13, 2011 LTR 41680 EO 65-0971509 000000 00 00017038 BODC, TE BOYNTON BEACH FAITH BASED COMMUNITY DEV CORP X COURTNEY C CAIN PO BOX 337 BOYNTON BEACH FL 33425-0337 Employer Identification Number: 65-0971509 Person to Contact! 14S. J(11 KERS Toll Free Telephone Number. 1-877-829-5500 MIMMMMUQK�� This is in response to your Apr. 04, 2011, request for information regarding Your tax-exempt status our records indicate that you were recognized as exempt under section 501(c)(3) of the Internal Revenue Code in a determination letter issued in OCTOBER 2000. our records also indicate that you are not a private foundation within the meaning of section 509(a) of the Code because you are described in section(s) 509(a)(1) and 170(b)(1)(A)(vi). Donors may deduct contributions to YOU as provided in section 170 of the Code. BeQuests, legacies, devises, transfers, or gifts to you or for your use are deductible for Federal estate and gift tax Purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. Please refer to our website www.irsegov/eo for information regarding filing requirements, SpecificallYy, section 6033(3) of -the Code provides that failure to file an annual information return for three consecutive Years results in revocation of tax-exempt status as Of the filing due date of the third return for organizations required to file. We will publish a list of organizations whose tax-exempt status was revoked Under section 6033(1) of the Code on our website beginning in early 2011. 0248574153 Apr. 13, 2011 LTR 4168C EO 65-0971509 000000 no 00017039 BOY14TON BEACH FAITH BASED COMMUNITY DEV CORP X COURTNEY C CAIN PO BOX 337 BOYNTON BEACH FL 33425-0337 If VOLI have any questions, please call us at the telephone 11LImber shown in the heading of this letter. S. A. Martin, Operations Manager Accounts Management Operations Public License Iriforrnation License Number: 23-00016590 Location ID: 000006103 Business Control: 00'14478 Business lnformation Business Name: BOYNTON BEACH FAITH BASED Business Address: 2191 N SEACREST BLVD BB BOYNTON BEACH Fl- 33435 Mailing Address: COMMUNITY DEVELOPMENT' CORP. PO BOX 337 BOYNTON BEACH FL Application Issue 33425 Owner Name: COURTNEY CAIN Date Opened: 06/13/2002 Business Phone: (561) 752-0303 Contractor Flag: Type of Ownership: CP Status: Active Name Title Address Address Email 0tyState,Zip Phone 1 2 ID COURTNEY CAIN PRESIDENT 33435 Showing 1 to 1 of l entries License Wormation Classification: CU2 - CERT OF USE & OCC COMM License Status, ACTIVE, 09/09/2022 Date: Application Issue 0812112.018, 09/09/2022 Date: License Valid Thru 09/30/2023 Date: AdditionA Requirements Code Description Docurnent Number Expiration Date Showing 1 to 1 of 1 entries Public License Information License Number: 23-00014969 Location ID: 000006103 Business Control: 0014478 Business Information Business Name: BOYNTON BEACH FAITH BASED Business Address: 2191 N SFACREST BLVD 813 BOYNTON BEACH FL 33435 Mailing Address: COMMUNITY DEVELOPMENT CORP. PO BOX 337 BOYNTON BEACH FL Application Issue 33425 Owner Name; COURTNEY CAIN Date Opened: 06/13/2002 Business Phone: (561) 752-0303 Contractor Flag: Type of Ownership: CP Status: Active Name Title Address Address Eunall Clty'state'zip Phn oe 1 2 ID COURTNEY PRESIDENT 33435 CAIN Showing 1 to 1 of 1 entries License Information Classification: 561110 - OFFICES EXECUTIVE &. ADMINISTRATIVE License Status, ACTIVE, 03/16/2023 Date: Application Issue 08/31/2022, 09/01/2022 Date: License Valid ThrU 09310/2023 Date: Code Description Document Number Expiration Date SL DBPR CERTIRCATION na Showing 1 to 1 of I entries O O Q 1,5 Q ai Q 21 IM 43 41 lo 7o 70 wt O O ��� OM Line of Credit, Senior Helpers - Fundraising 'iocial Media - Fundraising "Network Food Good" First Presbyterian Church Delray - Mission Support $5,000 Annually Boynton Angels in Action - Fundraising Events - Tivoli Walk a Thon, Fountains Ten Monthly/Qtrly Donors - $2,500 Annually Wells Fargo Fund - $50,000 Various Donations through out the year BenvenutosRestaurant -217Meals adThanksgiving HATTFoundebuO-TurheysforThanhogk/ing Christ Fellowship Churoh-ThGnkeQiving Baskets, Holiday Baskets and Gifts Grass River Garden Club - F|ons| Arrangements for seniors at Chhpdnnaa Boynton Angels in Action - Mobile Pantry Shopping & Delivery for homebound seniors and families Barclay Philanthropic Club - monthly sandwiches and fruit donations PBC Food Bank - Groceries for Seniors Programming for Health and Wellness YWYCA-NutritionandB|oodpnossuna HAJ-FFoundadon-DiabetemEducgUon Dennis Mobley -YDGA & Chair Exercised PACE-ResouncesforHealthCana PemBeaohHameet-FreshFoodPentryitems Jim Moran Foundation Elder Care - July 1.2O22thnuJune 3O.2O23for $06.ODO-Pending renewal April 13 Family Strengthening - July 12O22thruJune 3O.2023for $58.1OO-pending renewal April 13 Discretionary Funds - April 2O22thnuApril 2O23for $30.00O - pending renewal April 13 Capacity Building Grant Application for $3O.00Opending Healthier Boynton - Mini Grant Grants A, B. & C Mini Grant A.B&Chave been completed C finalized onDec 31.2O22for $4'DO0for senior meals Spring Application has not been issued Partnership for Aging $1.ODOfor senior care Irving | Moskowitz Foundation - $2.500 for senior Care Lost Tree Charitable Village - $11,900 for Technology addressing senior isolation completed AG &ASZimmerman Foundation -$1.00Ofor Food City of Boynton Beach C[}BG-CV$37O.G45 Public Services $02.00O Senior Rehab -$4DO.00O Senior Housing Acquisition $504'000 12:44 PM Boynton Beach Faith -Based CDC, Inc. 03126123 Profit & Loss Accrual Basis January 2022 through February 2023 Ordinary Income/Expense Income Direct Public Support Congregational Contributions Corporate Contributions Gifts in Kind - Goods Boynton Angels In Action Boynton Angels In Action - Other Total Boynton Angels In Action Gifts in Kind - Goods - Other Total Gifts in Kind - Goods Individ, Business Contributions Affordable Food Pkg Boynton Angels In Action Angel Bucket Contributions JG & AS Zimmerman Fnd Total Boynton Angels In Action Senior Meals The Barclay Philanthropic Club Wells Fargo Affordable Food Meals Wells Fargo - Other Total Wells Fargo Individ, Business Contributions - 0... Total Individ, Business Contributions Total Direct Public Support Grants City of BB CDBG Housing Rehabilitation Senior Housing Acquisition Total City of BB CDBG Healthier Boynton Mini Grant C Irving 1. Moskowitz Foundation Jim Moran Fnd - Elder Care C Jim Moran Fnd - Elder Care D Jim Moran Fnd - Fam Strength C JMF - Senior Discretionary Fund Lost Tree Village Charitable Fn Partnership on Aging Total Grants Indirect Public Support St.John Missionary Baptist Chur Total Indirect Public Support Other Types of Income Miscellaneous Revenue qFr1V*4E;a1'11*] 5,000.00 -132.00 9,682.54 9,682.54 66,051.08 75,733.62 3,257.40 2,058.21 2,000.00 mIli, 111 11 50,000.00 4,801.58 62,821.19 143,422.81 904,000.00 4,000.00 2,500.00 66,000.00 66,000.00 58,100.00 30,000.00 -9,216.00 1,000.00 1,122,384.00 2,400.00 2,400.00 -356.60 Total Other Types of Income -356.60 Total Income 1,267,850.21 Gross Profit 1,267,850.21 Net Ordinary Income 1,267,850.21 =1 12:44 PM Boynton Beach Faith -Based CDC, Inc. .13/26/23 Profit & Loss Accrual Basis January 2022 through February 2023 1,267,850.21 z= Public License Information License Number: 23-00014969 Location ID: 000006103 Business Control: 0014478 Business Information Business Name: BOYNTON BEACH FAITH BASED Business Address: 2191 N SEACREST BLVD BB BOYNTON BEACH FL 33435 Mailing Address: COMMUNITY DEVELOPMENT CORP, P0 BOX 337 BOYNTON BEACH FL Application issue 33425 Owner Name: COURTNEY CAIN Date Opened: 06/13/2002 Business Phone: (561 } 752-0303 Contractor Flag; Type of Ownership: CP Status: Active I I I Narne Titie Address Address Emalt 1 2 city'stale'zip Phone ID COURTNEY CAIN PRESIDENT 33435 Showing 'I to I of 1 entries License Ir Darla Classification: 561110 -OFFICES EXECUTIVE& ADMINISTRATIVE License Status, ACTIVE, 03/16/2023 Date: Application issue 08/31/2022, 09/01/2022 Date: License Valid Three 09/S0/2023 Date: AdditionM Requirements Code Description Document Number Expiration Date SL DBPR CERTIRCATION na Showing 1 to 1 of 1 entries E W LA v a° N L- O av v,EL ° v °o =+ _ -0 0 v 4-, •> � U QJ U te a, O O O L U p o f LnC: Q p (O a o g _ U-0 a O a-+_ 4-1 Q U QJ C U O a O 'r- a a� a QJ Ln toM Q N a� w 0- •� a -- a L Q a a W 0- U _\ Q v Q +� a Q +� m= X a p E O a--� i6 �� Q: Q: N > > is N QL1 O �--� Q) N +� U (B ; vi a� +� > _ a c c C L Q) oca w O) O L U 0 bA U O a 4-1 m Q +� O f6 '�' O U— +, L m — N 3 � +, L a O U (� a a W Q a p Q v u� a > O ° L a a a? 0 +-, a +� C7 0 a M .0 U O t > O +� > `� CO + bA 7; O a � a.1 VI (6 U v L Q M M O .L U 0 inW '� Q1 VI L Q� a W U +� a Q .a +� U x E VI a a L Q u U 4.1 � U `� U a 4- C `n a Q 4- O L C O E c QJ a"' Q QJ QJ ° t +-� O w Q O Q Q) a +� a-0 o +� p O C_ C L Q +s QJ > 3 U i a Q a v Q (O +� +� O a pCL 4-> 4.1 Eto N N M a Q ° U U O .� � a M Q) 4- O_ +- O a o E a a a� 3 0 i= v a a bA o 4- 0 F--0 Q) X Qj C M C v a t a� w s +, �j F- � Q L O L Q C 3 m ._ L L r VI % +- m a� > cn ' � U a S S cv a ai Ln � a �F a E a u n_ 3 L � . 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L N O a a +' Q C n3 .0 — aJ Q > O 4- C — O a U C U L L E U L L (6 .� C O v � O a) f6 L L 4' v O O -0 .a } aaj O C n3 C Q aJ p- a a N Q aa in O a O a) in H> L a) a E L a� } to f6 tw Ln aJ a) O QJ C C U n3Ln C L p U 4- C6 N U N O N O iJ L a -j b1J ++ " `^ VI L) -a v ca s C a. - m n3 nA U v co s a a- U U a a N `L' L a o N a -0 Q ,} — Q a *' C-0 a) O> D `� C a ca a) Q C O a p a•� U O a) a) Q n3 cn L t (6 � N +' N > Q .� a u '+� a L _0 �i a L O O O 4— a .Ln aJ N� — Q (� a) L (9 (9 C 41 a L bA dA .'^ co a cLa t E U C co +� Ln N n3 n3 � C O } vi C O (B L a"' a C � � E co � a N a f° a••+ a a a a--� M + O > O D C Q a> > a Lin of O u O 0 Q C L- Lu O C)E a) a) EQ a QL a a) a L s Cv0 Q Ct -C C Q o U D U a C D Q� [6 4— N m 4— m O a) a- m C O a� A m O N .a M N 3 O CL O Co d to U � O May 26, 2023 Keturah Joseph, Executive Director Boynton Beach Faith -Based Community Development Corporation, Inc. 2191 N. Seacrest Blvd. Boynton Beach, FL 33435 Re: Community Development Block Grant (CDBG) Funding FY2023/2024 Dear Mrs. Joseph: This letter is in regards to your application for CDBG funds for the Fiscal Year 2023/2024. The CDBG Application Review Committee assessed your application for Public Services — Aging in Place — Elder Care Program and based on their scoring, funding recommendations has been forwarded to the City Commissioners for approval, for the amount of $40,000.00. Final recommendation approval will be at the regular City Commission Meeting on August 1, 2023, at 6:00 pm. The City Commission meeting will be held at 100 E. Ocean Ave., Boynton Beach, FL 33425, We recommend you or a representative attend the meeting to address any questions that may arise regarding your organization and/or services. Thank you and we look forward to working with you. Sincerely, RJ Ra mi rez Community Improvement Division Manager 911 Fiscal Year 2023 (October 1, 2023 to September 30, 2024) COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) Not -For -Profit Subrecipient Grant Application March 27, 2023, 5.-00 PM Hard &Electronk , ;chments (No applications will be accepted after 5:00 PM, on March 27, 2023) FOR MORE INFORMATION OR QUESTIONS, PLEASE CONTACT: CITY OF BOYNTON RJ Ramirez, Community Improvement Division Manager COMMUNITY IMPROVEMENT DIVISION 100 East Ocean Avenue Boynton Beach, FL 33435 Telephone: 561-742-6359 Email: ramirezr@bbfLus boynton-beach.org/com m u n ity-i m prove ment 912 Agency Name: Pathways to Prosperity, Inc. Project: Circles Palm Beach County AFFULA I IUN Submit Hard Copy and a Digital/Electronic Application with all attachments Application is signed and dated. By Director, and Board Chairperson 501(c) (3) is attached (No -For -Profit Status) City of Boynton Beach Business Tax Receipt attached (if applicable). Board Member list. Copy of latest audit. All funding sources for this project identified. ADDITIONAL ATTACHMENTS Attachment 1 Agency Articles of Incorporation, Agency By-laws, and Tax Documents submitted to the Internal Revenue Service (IRS). Attachment 2 Copies of current license(s) needed to operate (as applicable to the funded activity) including City of Boynton Beach Business Tax Receipt (if applicable) Attachment 3 Documentation of all additional funding sources for program(s)/project(s) listed in application (if applicable) A description/schedule of fees charged to the targeted Attachment 4 beneficiaries of the programs/services/facilities to be funded (if applicable) A job description for each position for which funds are being Attachment 5 requested (explain role/responsibilities within each program/project) (if applicable) 913 Certifications and Affirmations Print Full Name: KOribcrly B y1sh Applicant Signature: L")4 Title: 0 ("EO Q Date: 3 /Ca3 I 914 I certify that I am authorized to submit this application on behalf of the applicant agency. I affirm that the award and payment of grant funds are subject to the sole and absolute discretion of the City of Boynton Beach City Commission without recourse. By submitting this application, I waive any and all claims related to the City of Boynton Beach CDBG Program and specifically agree to indemnify and hold the City, its employees, officers, agents, and representatives harmless from any and all claims which may be in any way related to any City of Boynton Beach CDBG Program award, payment, and/or denial. I certify that my agency was established and operating in the City of Boynton Beach on or before October 1, 2020. If funded, I affirm the applicant agency will continue service operations in the City of Boynton Beach. I affirm that the tax documents provided in this application are identical to those I have submitted to the Internal Revenue Service. I acknowledge that, funds are distributed by reimbursement only. if this grant is approved, any amount my agency receives may be considered taxable income by the Internal Revenue Service. I acknowledge that, if this grant application is approved, the City of Boynton Beach and Representatives of HUD, the Inspector General, and the General Accounting Office shall have access to all books, accounts, records, reports, files, and other papers, or property pertaining to the administration, receipt and use of CDBG funds necessary to facilitate such reviews and audits, as applicable and described under 24 CFR § 570.490(c). I acknowledge that, all records relating to the City of Boynton Beach CDBG Program, including supporting documentation, shall be retained for the greater of three years from closeout of the grant to the City, as applicable and described under 24 CFR § 570.490(d), unless there is litigation, claims, audit, negotiation, or other actions involving the records. The records must be retained until completion of the action and resolution of all issues. I acknowledge that, if this grant application is approved, my name, my agency name, and my grant award amount may be made public by the City of Boynton Beach. I acknowledge that, if this grant application is approved, my agency will be subject to Florida Sunshine Law, FL State Statute 119.0701 Print Full Name: KOribcrly B y1sh Applicant Signature: L")4 Title: 0 ("EO Q Date: 3 /Ca3 I 914 FY 2023 Funding Request To submit an application, complete A — I, Attachments 1-5 (if applicable) and any other items requested. Do not include any items that are not requested. Submit a Hard copy and a digital/electronic copy with all attachments to RJ Ramirez, Community Improvement Division Manager (ramirezr@bbRus) Community Improvement Division, 100 East Ocean Avenue, Boynton Beach, FL 33435 by 5:00 prn, March 27, 2023. Please review the "CDBG Subrecipient Information and Guidelines" available at CDBG I City of Boynton Beach (boynton-beach.org) for the program reporting requirements, goals and timelines. For assistance, please call the Community Improvement Division at 561-742-6359. A. GENERAL INFORMATION 1. Name of Applicant: Pathways to Prosperity, Inc. X No -For-profit Unique Entity ID # EH5XLFEQ5C95 Provide copy of your IRS ruling providing tax exempt status under Section 501(c) (3) of the 1986 IRS Code. Per 2CFR Chapter I Part 25 and the Office of Management and Budget guidance on Federal Funding Accountability and Transparency Act (FFATA) Subaward and Executive Compensation Reporting issued on August 27, 2010, each prime grant recipient may make subawards only to entities that have Unique Entity ID Number. 1. Name of Project: Circles Boynton Beach 2. Area or Location of Project: Boynton Beach, with a special focus on Heart of Boynton Beach. Census Tract 61, 33435 3. Contact Person/Title: Kemberly Bush/Executive Director (Preferably Executive Director/President/CEO) Email Address: kbush@p2ppbc.org Mailing Address/Zip: 639 East Ocean Avenue Suite 101, Boynton Beach, Florida 33435 Telephone: 561-856-5551 Fax: NA Additional Contact Person/Title: Deja Hasness, Grant Writer_ (Preferably Person responsible for preparing reimbursements/quarterly reports) Alternate Email Address: grants@p2ppbc.ore Mailing Address/Zip: 639 East Ocean Avenue Suite 101, Boynton Beach, Florida, 33435 Telephone: 561-903-7743 Fax: NA 3 915 4. Grant Request Activity Area (choose one): Homeless Prevention Services Domestic Violence Prevention Public Safety/Crime Prevention Housing Rehabilitation Program Senior Services Educational Program X Other (please specify): Financial Literacy/Family Stabilization 5. Amount of Funds Requested for Project: $75,000 Amount of Matching Funds for Project: $492,718 Match Type: _ Cash X Other Grants X Donations Other Please Identify Source of Additional Funding: Children's Services Council $122,476 approved, Palm Beach Countv FAA 570.000.00 aDDroved. Truist Foundation 810.000.00 approved. Thomas Charitable Trust $10,000.00 approved, New York Community Bank $5,000.00 approved, The Jim Moran Foundation $40,000 approved, Quantum Foundation $50,000 approved, Palm Beach County CDBG $28,390 approved, The Community Foundation for Palm Beach & Martin Counties $74,800 pending, Agency revenues, other grants, fundraising & donations $82,052 pending 7. CDBG COST: (a) Total CDBG Funds Requested $75,000 (b) Total Unduplicated Units Served 105 individuals (or 30 households) (c) (Explain how determined?) Circles leaders from 30 households. Each individual member of the Boynton Beach, income - certified household served = 1 unit. Average Boynton Beach household size = 3.5 individuals. (https://www.towncharts.com/Florida/Demographics/Boynton-Beach-city-FLDemographics- data.html (d) CDBG Average Cost Per Unit (a/b) $714 per individual served ($2,500 per family served) TOTAL PROJECT COST INCLUDING OTHER SOURCE OF FUNDING: (a) Total Project $ 567,718.00 (b) Total Unduplicated Units Served 290 individuals (or 100 families) 4 916 (c) (Explain how determined?) Each individual member of a Palm Beach County, income -certified family served = 1 unit. Average Palm Beach County household = 2.9 individuals.https://www.towncharts.com/Florida/Demographics/Boynton- Beach-Delray-Beach-CCD-FL-Demographics-data.html (d) TOTAL Average Cost Per Unit (a/b) $1,957.65 per individual served 917 (e) Is this project: A new service; or X A quantifiable increase in the level of an existing service which has been provided by the grantee on its behalf through State or local government funds in the 12 months preceding the submission of the grantee's Consolidated Plan Annual Action Plan Has the applicant received or will receive other Federal, State or local government funds for the proposed project(s) for which the applicant is requesting CDBG funds? Yes No If Yes, what is the funding source? Palm Beach County FAA Securing Our Futures Initiative (SOFT), Children's Services Council of Palm Beach County, Palm Beach County CDBG How much? $270,866 8. Could this project occur without these funds? X Yes No 9. Will this project continue after CDBG funding ends? X Yes _ No If Yes, describe how the applicant will guarantee the sustainability of the project/program after CDBG funds have been spent. Pathways to Prosperity is committed to success in this city. Our Board of Directors is engaged and dedicated to the sustainability of our programs and to the residents of Boynton Beach, and 100% of our Board of Directors donates to Pathways to Prosperity, giving us a base for unfunded expenses each year. A comprehensive 5 -year strategic plan serves as a road map for future activities to strengthen our agency's fiscal security, including diversifying funds and increasing unrestricted revenue streams. Over the past decade we have built a vast network of service partners and many dedicated funders including Palm Beach County FAA, Palm Beach County CDBG, The Quantum Foundation, Children's Services Council of Palm Beach County, and a number of other local and regional funding partners. In 2016, when Palm Health Foundation was looking for a Boynton Beach home for their Healthier Together Palm Beach County initiative, Pathways to Prosperity was the agency they trusted to execute their vision. As Pathways to Prosperity and Circles Palm Beach County move forward together in our shared effort to reduce poverty by 10% in the next 10 years, we are broadening our search for funding partners. Like many nonprofits today, we have been forced to stretch expenses, as revenues have been severely affected by COVID-19 and recent economic instabilities. We are an Accredited Nonprofit Agency, receiving the highest level for 10 consecutive years, and our development team consistently identifies and cultivates new funding partners. They diligently work to develop ongoing funding for this growing program. Our long-term strategy for funding this initiative includes continued grant writing, fundraising events and promotion of Povertv Awareness Week. 6 918 B. PROPOSED PROJECT EXECUTIVE SUMMARY: Please describe in detail the scope of services of the proposed project/activity to be funded, including the expected benefits to the community, a plan of action, how the agency will implement the activity (i.e., intake procedures, income certification, collection of required documentation, reimbursement request, progress reports, end of the year report, etc.). (Attach additional sheets if necessary) Circles Palm Beach County has a goal of reducing the number of families in poverty by 10% in 10 years and is based on a model that empowers people in poverty to build intentional relationships across income and class lines. Circles is a nationwide, proven anti -poverty strategy recognizing a family's upward mobility is inextricably linked to the economic & social capital of their personal and professional "circles". Circles' unique, comprehensive curriculum identifies and addresses barriers keeping people in poverty. Circles matches people living in poverty, or "Circle Leaders", with middle- to upper-income volunteers, called "Allies", to establish relationships across class lines, create multidimensional support systems, access new ways of thinking and possibilities. Circles staff, or "Coaches", provide financial literacy, case management, transitional services, guide goal -setting and match Circle Leaders with an Ally who supports them in reaching their goals: increasing savings or skills. Rettine a iob or a better one, makine sound financial and other life decisions. Circles groups are conducted in cohorts of between 15-20, with typically 3 to 4 cohorts per year across Palm Beach County (with cohorts meeting in South, Central and North Palm Beach County). Circles participants are recruited through word-of-mouth, through local iob fairs or other community convenings, or by referral from other Pathways to Prosperity programs or one of our partner agencies. Interested participants are pre -qualified before entering the program to ascertain if they are ready and able to complete our program. Program requirements include being 18 years of age or older, working or in school (or must enroll in school within 30 days), having reliable transportation, and being highly motivated to make a change in their life and willing to commit to the program for a minimum of 18 months. Additionally, Circles participants are income certified: they must have a household income at or below 200% of the federal poverty guidelines, with a special emphasis on those at or below 100% of the federal poverty guidelines. During the first few months of Circle Leader training, participants assess their current relationships, resources and reason or purpose for making the necessary changes to escape from poverty permanently. It is during this time that Allies, who are middle- to upper- income community volunteers, are also attending training sessions that increase awareness of poverty issues within the families they will be matched with as well as issues that affect the community as a whole. Both the Circle Leader and Ally training curricula teach participants to better understand the "hidden rules" or "social norms" associated with class in the United States as well as how to build a long-term vision for their future, individually as well as collectively to contribute to community change. Looking at poverty in a more holistic manner is necessary for both Circle Leaders and Allies once thev are matched in an intentional team for a minimum of 18 months. 7 919 Helping each family set and achieve goals unique to their own needs is the responsibility of Circle Allies. Leaders and Allies meet monthly to build relationships, review established goals, discuss and problem solve barriers to reaching those goals, such as improving self- sufficiency, expanding social networks, and enhancing academic performance and skills levels of both children and parents. Moving forward, weekly Community Meetings gather Circle Leaders, Circle Allies, Circles Coaches, and other interested community members to provide support and networking opportunities. Big View Meetings are held once per month and feature a far-raneiniz discussion of the causes of Dovertv in the communitv and how to address them for the long term, in the process removing systemic barriers. We also provide dinner, childcare, and support with transportation to reduce obstacles to participation. Instead of just playing games or watching movies while their parents attend meetings, children of Circle Leaders and Allies are introduced to financial literacy education through our Circles for Youth program, where they, too, create Dream Boards, set SMART goals, open bank accounts, and participate in savings challenges much like the adult participants. Financial literacy for both children and adults is provided through our partnership with AmTrust Bank, a division of New York Community Bank, and supported by the Truist Foundation. Instilling healthy financial habits at an early age can shift generational relationships with money and wealth and empower young people to make smart financial decisions, which will allow more financial freedom and security later in life, breaking the revolving cycle of poverty. Our staff also provide case management and wrap- around support such as obtaining government IDs, safe/stable housing, food security, healthcare access, emergency financial support when needed, parenting and childcare resources, and more. Circles participants receive a number of benefits from participating in the program. The Circles model supports families in poverty by building intentional relationships, actively listening, asking questions, sharing knowledge and resources, helping participants set goals, and working together to dismantle barriers that prevent people from moving out of Poverty, while simultaneously increasing higher income individuals' understanding of and empathy for those dealing with the challenges of living in poverty. Circle Leaders receive peer support from each other (known as "bonding social capital") as well as the support of their Circle Allies (known as "bridging social capital"). Through our program, which fosters unstructured social connectedness, Circle Leaders can lift themselves out of poverty and learn skills that encourage further financial stability. Circle Leaders gain knowledge on how to create a new relationship with money and with life choices. As part of the training curriculum, Circle Leaders learn how to make decisions that will be beneficial to them and their families. Circles is a highly effective program: among current Circles participants, all increased their income within the first 3 months, and 66% of participants doubled their income or more since starting the program. Our most recent program data report shows participants' income increased by 10% by the end of their financial literacy training, by 26% after 6 months, and the median increase after 12 months was 106%. Every year, Pathways to 0 920 Prosperity, through Circles, empowers hundreds of people living in poverty with tools and new relationships that support them in achieving financial self-sufficiency, independence, and promising futures. We review and record metrics, including changes in income, upon graduation of Circles Leader Training, which typically occurs 3 to 4 months after joining the program, and then again after 6. 12. 18 months of participation in the program. Results are documented upon withdrawal for participants exiting the program before the 18 -month mark. Some graduates remain active in the orogram oast the 18 -month mark for onaoin coaching, case management and support from their Allies, and to offer peer support to current program participants. We maintain contact with all participants as able, monitoring household income and other results up through 36 months from the date of enrollment in the Circles program. 0 921 C. STRATEGY: Check the ONE STRATEGY that best describes your project and provide number of units that will be served under this program. Check One Specific Objective Number of Units This Project Will Serve Educational Program (Specify) Households/Persons: (please specify which) Public Safety/Crime Prevention Households/Persons: (please specify which) Domestic Violence Prevention Households/Persons: (please specify which) Senior Services Elderly Households/Persons: (please specify which) Youth Programs Children/Youth: Housing Rehabilitation Number of units to be rehabilitated: 30 Other (Specify) Households/Persons: Family stabilization & (please specify which) Financial literacy 30 households (105 persons) 10 922 D. COMMUNITY NEED/JUSTIFICATION What documentation/data was used to determine the need for this type of program? 2. How do you evaluate the overall effectiveness of the program? 3. How this project relates to the overall organizational structure? 4. Be very specific how the CDBG funds are proposed to be used? 5. How CDBG funds will it impact your current operation? (Attach additional sheets if necessary) 1. According to the 2020-2024 Palm Beach Countv Consolidated Plan. the Countv's median income for a household of four increased from $67,600 in 2009 to $74,500 in 2019, a stunning growth of 10.2% (Palm Beach County FY 2020-2024 Consolidated Plan and Action Plan, 2020). More recent data from Palm Beach County suggests that as of 2022, the median family income in Palm Beach County has increased to $90,300, indicating a growth of over 21% in the past 3 years (Florida Housing Finance Corporation, 2022). There is a demonstrable economic shift happening in Palm Beach County, partially driven by the influx of financial firms and other high- profile investors to the area which has occurred in the wake of the pandemic, earning our Countv the moniker "The Wall Street South". The end result is a skvrocketine cost of livine. with many long-time residents being priced out of our communities. Despite being home to some of the wealthiest families in the country, 12% of residents in Palm Beach County live in poverty. Poverty disproportionately impacts Latinx and Black residents in Palm Beach County; 67% of low income citizens are People of Color. 80% of program participants in Circles Palm Beach County have dependent children in the home, and a median household income equal to or below 100% of the federal poverty level of $27,700 for a family of 4. Inadequate access to healthcare, childcare, food, housing, and transportation are ever- present barriers. Especially since the pandemic, families who were already challenged are now struggling with the increased cost of living. The average rent of a 2 -bedroom apartment In Palm Beach County is $2,200/month, or $27,000/year, and the average starting household annual gross income of Circle Leaders is $15,084 (compared to the median family income in Palm Beach County of $68,874). For years Pathways to Prosperity has provided emergency financial assistance to our Boynton Beach neighbors. On average, the agency provides $20,000/year in financial assistance. However, as an organization, we wanted to offer a path to sustainability for our families, beyond offering the temporary solution of emergency support. We researched various program models and anti -poverty strategies. CirclesUSA was the appropriate choice as it provides people the long-term support they need to lift themselves out of poverty and create financial stability for themselves. Now with increasing economic destabilization, our community is facing skyrocketing rent, electricity, food and gas costs, increasing stress and compromising mental health. As the economic crisis worsens. our clients face even steeber barriers to achieving their izoals. We 11 923 have expanded our program to include citizens returning from incarceration; in doing so we realized that these individuals require additional hands-on case management and higher-level coaching support in order to find employment, housing, access to healthcare, food security, mental health and other resources necessary to create stability, reconnect with family and remain in the community. The acuity of our clients' needs has grown exponentially in the past year, and as a community-based organization with a mission to meet the needs of Boynton Beach residents, we are working tirelessly to provide the coaching and wrap-around case management support they require. In 2023 we are committed to meeting the increasing needs of our Circles clients by hiring a new full-time Case Manager and enhancing our service delivery in meaningful ways that ensure participants' success. 2. We look at the number of program participants reaching their own personal goals, improvements in income. increased savings. debt -reduction. educational attainmen vocational certifications and employability skills, increased credit scores, increased community engagement, and reaching a family income of 200% of federal poverty level or greater. We monitor family income and track improvements over time, upon completion of the program and for up to 18 months afterwards, for a total of 36 months. We aggregate participant data to determine if agency program goals and objectives have been met, and if our funder and program partners' goals have been met. We collect and provide data to Palm Beach County uploaded into the HMIS system and also share our local data with CirclesUSA. We also compare local outcomes with national brogram outcomes as a measure of overall effectiveness of the program. Circles participants are assessed for their financial literacy knowledge both before and after Circle Leader training utilizing a pre/post test developed in partnership with our financial literacy partner, New York Community Bank. Circle Leaders are evaluated on their understanding of the banking system, interest rates, savings, home ownership/mortgages, budgeting, and more. We also assess participants' understanding of and ability to set SMART goals (Specific, Measurable, Achievable, Relevant, and Time -Bound) both pre- and post - completion of their Circle Leader training. Soft skills including communication, active listening, time management, problem -solving, adaptability, teamwork and leadership are assessed through self-evaluation, group feedback, and Coach's notes. The most important "skill" our Circle Leaders gain is the ability to authentically generate new relationships and networks which enhance their social capital. This process happens organically, over a period of time, and is challenging to evaluate objectively. We are developing new data collection methodologies and to capture this metric, as it is an essential and truly unique component of Circles which makes this program a success. 3. Pathways to Prosperity is dedicated to strengthening communities across Palm Beach County by improving outcomes for children and families through education and social services. Our goal is to ensure that our families have what they require to not only survive, but thrive. The agency features a range of programs and initiatives to uplift individuals and families out of economic hardship through education, parenting support, food assistance, healthcare, and other social services. Pathways to Prosperity, through Circles, helps hundreds of people every year reach their goals of financial self-sufficiency and independence. Our programs include 12 924 BRIDGES at Boynton Beach, a community hub concept developed by the Children's Services Council of Palm Beach County to meet the daily and long-term needs of local families. The ultimate goal is to ensure that children are born healthy, grow up safe, and are ready to learn when they enter school. Our community -led initiative, Healthier Boynton Beach, exists to inspire, support, and improve the lives of caregivers in the Boynton Beach Community. In addition to these flagship programs, Pathways to Prosperity also offers a community food Pantry and emergency financial assistance to Boynton Beach residents seeking stabilization and support. Given our agency's mission, the scope of our programming, and our existing rapport with the Boynton Beach community, Pathways to Prosperity was approached in 2014 by the Town of Palm Beach United Way and introduced to the CirclesUSA model. Being that the missions of both Pathways to Prosperity and CirclesUSA are so closely aligned, incorporating Circles into our family of community-based initiatives was a logical choice. We accepted the challenge to become the lead agency to bring Circles to Palm Beach County and launched the program. Hundreds of Boynton Beach families have lifted themselves out of poverty with Circles. Circles is our strategy to support families on their Pathways to Prosperity. 4. CDBG funds will be used to support the Circles Coordinator position, which oversees recruitment and income verification of Circle Leaders and Allies, training for Circle Leaders and Allies, educational sessions for Circle Leaders, Allies and their children, and support our Case Manager who will provide ongoing case management for Circle Leaders. In particular, there is an increased need for employment and social determinants of health support for Circle Leaders and family members who are formerly incarcerated returning citizens, as key components of economic stability, mobility and emergence from poverty. 5. CDBG funds will secure the funding required to fully staff the Circles Program for next year, leaving a manageable gap that can be addressed with one new funding source or with agency reserves as necessary. This will allow the program staff to develop as a team, and facilitate leadership transfer from the Program Director to the Program Coordinator, grooming staff for growing responsibilities. It will also free up our Programs Director to spend more energy on data tracking, program evaluation, and future directions. 13 925 E. LOCATION, TARGET POPULATION AND INCOME CERTIFICATION 1. Where will the program take place and is it within the City of Boynton Beach Municipal Boundaries? Who are the targeted beneficiaries (i.e., geographic area, persons served, etc.), and how are they selected for the program? 2. Are you working with other organizations in a cooperative effort on the program? YesX No If yes, please list the other organizations and their role and responsibilities. (Attach additional sheets if necessary) 1. We will host classes at our offices located at 639 East Ocean Avenue in Boynton Beach and/or we will utilize the Carolyn Sims Center which we have done in the past. Both facilities are within municipal boundaries and Circles families covered under these grant funds live within the municipal boundaries of Boynton Beach. Boynton Beach residents may also attend classes we host in other locations outside the Boynton Beach municipal boundaries, such as Delray Beach, Palm Sarines. Lake Worth. Lantana. etc. 86% of clients served live in Birth to 22 Alliance identified high risk zip codes. 98% are People of Color. 83% of Circle Leaders are single moms. 80% have dependent children in the home, and a median household income equal or below 100% the federal poverty level of $27,700 for a family of 4, income certified upon intake. Participants are referred to Circles through one of our other programs, one of our community partners, or self -referral as more families and their relatives learn about the program. A 6 - person Steering Committee of local professionals supports recruitment of Allies and community-based resources. 8 BRIDGES programs across South Florida refer families to Circles. The school district paraprofessionals office refers families to Circles. Boynton Beach Faith - Based CDC provides emergency assistance, housing, and education/tuition for our clients, and refer their clients to Circles. Boynton Strong works with our citizens returning from incarceration, and they refer returning citizens to us for Circles as they don't have a structured program for mob placements. Riviera Beach Reentry Center also refers clients to Circles. 2. We work with several partner organizations and programs including Genesis Community Health, our partner in healthcare who provides health screenings, and for those who are uninsured or without a medical home, referrals are made to Genesis for free or sliding scale healthcare. Genesis also provides twice monthly workshops at our agency, with topics including mental health, diabetes management, nutrition and fitness, as well as understanding the links between health, wellness and economic sustainability. Another of our partners, CareerSource, helps Circle Leaders to identify their skillsets, successfully market those skills, and create standout profiles for mob searches on the CareerSource website. Through our partnership with CareerSource and Palm Beach County FAA Securing Our Futures Initiative (SOFI), Circle Leaders are prioritized for available employment opportunities for which they qualify. AmTrust, a division of New York Community Bank, is our financial literacy partner. Local banker and 14 926 AmTrust employee Audrey Davis, who is an esteemed member of our Board of Directors, Provides weekly financial education for both Circles Leaders and their children. AmTrust also provides bank accounts to Circles Leaders free of charge. Additionally, we partner with a number of local faith-based organizations. Churches are a wonderful source of recruitment and referrals for Circles. St. John's Missionary Baptist Church has been a long-standing source of support for Pathways to Prosperity, and many of our Circles Allies are recruited from their congregation. Christ Fellowship Church is another one of our faith-based partners, always willing and eager to support in any way necessary. When our families are in need of backpacks and supplies for back-to-school, or toys for children during the holidays, Christ Fellowship answers the call. We recently joined with the newly formed Boynton Beach Faith-Based Alliance, which is composed of several local agencies whose goal is to work together to address the needs of families residing in the Heart of Boynton. Children of Inmates provides emergency financial assistance, education, access to care and case management for citizens newly returning from the criminal justice system and refer them for stability and support through our Circles program. Boca Helping Hands provides employment training to Circles participants. Community Partners Mental Health Counseling and Boynton Beach Mental Health Coalition provide mental and behavioral health resources to Circles participants who face untreated mental health struggles. Our volunteer Circles Allies are among our greatest partners with their wealth of networking opportunities, professional insight and guidance to enhance and expand the work of Circles Palm Beach Countv. 15 927 3. The City's CDBG funds must directly benefit low -and -moderate -income individuals (80% Area Median Income (AMI) or below). The City's CDBG program requires non-profit organization to income certify individuals seeking assistance through activities/programs/projects funded with the CDBG funds. Has the organization done income certification of individuals seeking assistance in the past? Yes X No If yes, please explain the process the organization uses to income certify Individuals? What type documentation is collected? Please attach with your application, a copy of the form your organization uses to income certify individuals. A minimum of 80% of clients enrolled have family income equal to or below 100% of the federal poverty guidelines. Our process for income certification includes utilizing Palm Beach County's Online System for Community Access to Resources and Social Services (OSCARSS) as a guide for annual household income limits. We then determine if a household qualifies as Extremely Low Income, Very Low Income, Low Income, Moderate Income, or Higher Moderate Income based on the household income and number of persons in the household (see attachment "Annual Income Limits for West Palm Beach and Boca Raton Metropolitan Statistical Area (MSA)"). This information is documented on our Circles Income verification form (attached) and logged internally on our intake forms and Case Notes. Fluctuations in household income limits are monitored and reassessed every 6 months via progress reports (see attachment "Circle Leader Progress Report"). 16 928 4. Does the organization charges fees to its clients? Yes No X 5. Will program Income be generated from this activity? Yes_ No X If yes explain how will the program income be used? F. Goals/Objectives/Activity Measures: Descriptive narrative. Please use separate Goal Sheet for each individual project (if applicable). Project/Program Title: Circles Boynton Beach Goal # 1: Reduce the number of families in poverty in Boynton Beach by 10% over 10 years. Objective: 80% of Circle Leaders will experience an increase in family income after 6 months of participation. Resources Needed & Available: We currently report data to our funders but do not have an internal data management system. We have hired a development firm to assist us in doing a historical data analysis of our program and set up a new tracking system to facilitate future data collection and analysis by staff. Start Date & Duration: 10/1/2023 & 12 months Goal # 2: Reduce the number of families in poverty in Boynton Beach by 10% over 10 years. Objective: 66% of Circle Leaders will double their family income increase by at least 100% after 18 months of participation. Resources Needed & Available: Typically cohorts of Circle Leaders start every few months about 4 cohorts ear and participate for 18 months. Circles graduates often choose to stay involved for a subsequent 18 months supporting new Circle Leaders and continuing to work on goals. Outcomes are currently assessed at the 18 and 36 -month marks per the CirclesUSA program model. With an internal data system, we will be able to better track outcomes at the 12 -month mark. Start Date & Duration: 10/1/2023 & 12 months 17 929 G. PROJECT BUDGET Please list organization's anticipated expenditures, detailing requested funds and additional funding. Please place C=Cash, 1=In-Kind, O=Other Grants, D=Donations beside each amount under "Other Project Funds" to denote the type of funds being used. If funding request is for multiple programs/projects, please provide a separate PROJECT BUDGET for each program/project Line Itern tDBG Funds Requested Other"Proj;ect Funds Total'Project' Budget ADMINISTRATION: Personnel (#) $ 68000 $234,630 $302,630 Payroll Taxes $7,000 $20,188 $27,188 Employee Benefits $33,522 $33,522 Office Supplies $5,796 $5,796 Copy Supplies $6,220 $6,220 Professional Services fee $54,666 $54,666 Other (Postage) $1,015 $1,015 Other (Telephone) $1,114 $1,114 Other (Insurance) $2600 $2600 Other ((Facility) $8197 $8197 Other (Travel/ Transportation) $3,084 $3,084 Other (Admin 10%) $51,611 $51,611 PROGRAM: Other (Program Supplies) $35075 $35075 Other (Conference/ professional development) $18,000 $18,000 Other (Sponsored events, -License, Fees, certifications etc ) $17,000 $17,000 TOTALS $75,000 $492,718 $567,718 Notes: 1. Professional fees include Bookkeeping, accounting, social media, website, IT tech support, program evaluation. 2. Other expenses include insurance -2,600, Facility -$8,197, Admin -$51,611. 3. Program expenses include Program supplies -35,075, Conference/professional development -$18,000, Sponsored events $12,000 + Misc.-License, Fees, certifications etc -5,000. 18 930 H. ORGANIZATION CAPACITY (Provide a detail description of each) 1. Is the organization adequately staffed and trained? 2. Explain how this program fits the organization's mission? 3. Please explain the organization's experience with the proposed project? 4. Staffing Capacity: Who works on the project directly and indirectly? 5. Does the organization have written policies and procedures? How often are these policies and procedures updated? Provide a brief list of the topics covered in the organization's policies and procedures. The City of Boynton Beach may request a copy for review during the application and award process or as part of the grant monitoring process. (Attach additional sheets if necessary) 1. Our organization as a whole is adequately staffed. We have 13 full-time employees and 4 part- time employees; we average over 5,000 volunteer hours annually. All our full-time program staff hold a minimum of a Bachelor's Degree, except our Family Support Specialist and our Child Watch Team. All those in leadership positions hold Master's Degrees. Our team is diverse and committed to our community. The Circles Program, in particular, is staffed by a full-time Program Coordinator, a full-time Recruitment & Data Management Specialist and a newly hired full-time Case Manager, set to begin in April, with oversight and support from our Program Coordinator. Currently, the Recruitment & Data Management position is unfilled. We ensure that all of our staff are continuously trained in their respective domain areas. We are an Accredited agency by Nonprofits First, receiving the highest level for 10 consecutive years. In 2021, Pathways to Prosperity received the Best of Boynton Beach Award in the Community & Social Services category by the Boynton Beach Award Program. In 2015, Pathways To Prosperity was awarded "Nonprofit of the Year" from the Greater Boynton Beach Chamber of Commerce. For the past 12 years, this agency has continuously and consistently delivered the high-quality programming we are known for in the Boynton Beach community. 2. Pathways to Prosperity's mission is to strengthen the community by improving the social, mental, spiritual, economic and emotional well-being of children and families through education and social services. The Circles model understands that the strength of the community as a whole is dependent on the stability of the families and households in the community. Circles uses a combination of education, social services, social connections and emotional wellbeing to support people on a path out of poverty. Our other programs support people in their lives today, but Circles is unique in that it helps "transition" people beyond poverty, into sustainability and long-term success. It is a transformative experience. It is, indeed, a Pathway to Prosperity. 3. Pathways to Prosperity, Inc. (132P) was established in September 2010 and in 2014 was invited by the Town of Palm Beach United Way to pursue the Circles model as a path to self- sufficiency. P2P accepted the challenge to be the lead agency to bring Circles to Palm Beach County. We partnered with CSC's BRIDGES of Palm Beach County initiatives to recruit Circle Leaders and launch the program. We have held a contract with the Children's Services Council of Palm Beach County for the past 13 years and they have consistently provided funding for the 19 931 Circles Program. In July, we will be starting our 7th year under contract with Palm Beach County Financially Assisted Agencies (FAA), and our 4th year as an FAA Securing Our Future Initiative (SOFI) provider under contract with Palm Beach County Community Services Division to bring the Circles model specifically to families with children at home under 18 years old whose income is, at most, 80% of the federal poverty level. Over the years, we have developed a responsive program, a solid team, supportive funding partners, trusting community members and volunteers, and an expansive network of partners and resources. We have successfully administered this Drogram for almost a decade. serving 100 families each vear. with consistent results. Recently, P2P's CEO Kemberly Bush was invited to serve as moderator/panelist at the Securing Our Future Palm Beach County Economic Mobility Summit in December, alongside CirclesUSA Executive Director Kamatara Johnson. Their session was titled "Intentional Relationships: Improving Pathways to Upward Mobility for Low -Earning Workers." The session was well attended and responsiveness from attendees was overwhelmingly positive. The exposure garnered from this experience brought attention and accolades to the Circles model, which is strongly supported by emerging research in the economic mobility sector, presented by Dr. Rai Chetty of Harvard University and Dr. Camille Bussette of Brookings Institute, among others. As a result, P2P is currently engaged in conversations with a number of new potential program partners in Palm Beach County who have expressed interest in and excitement about bringing the Circles program to additional under -served families living in poverty. Undoubtedly, P2P is seen as an emerging leader in the local nonprofit sector, with both the experience and results to demonstrate the agency's capacity to execute high-quality programming which promotes uaward economic mobilitv. 4. Kemberly Bush (CEO) - As the Executive Director and Co -Founder of Pathways to Prosperity, Ms. Bush is charged with the agency's mission to strengthen the community by improving social, mental, spiritual, economic, and emotional well-being of children and families in Palm Beach County. She is a native of Palm Beach County and has worked in the field of social work for over 30 years. She is committed to serving in her community, and is an active board member of the Transitional Outreach Program. Genesis Communitv Health. Co-founder of From the Ground Up Consulting Group, Boynton Beach Chamber of Commerce, and the Black Chamber of Commerce of Palm Beach County. Kemberly's vision is to develop Pathways to Prosperity into a model program that is embraced by the community and ensures that children and families reach their full potential. Kemberly provides general oversight and leadership for the Circles initiative. She provides staff supervision and evaluation as well as reviews program outcomes and participant evaluations, oversees budgeting and program development. Tara Hails (COO) - Tara provides administrative support to the Executive Director and the Board of Directors, including planning, research, communications, personnel, recordkeeping, property management, and bookkeeping. She provides oversight of the Circles program, ensuring deliverables are met, verifying, gathering and disseminating data and outcomes to funders and other stakeholders, and facilitates marketing, recruitment and hiring of Circles staff. Tara monitors and tracks program expenditures, submitting for reimbursement and allocating funds to appropriate and allowable programs based on funder requirements. Tara joined P2P in 2011 20 932 under our BRIDGES program after an extensive career in the banking and insurance industries. She has served on the administrative team for the past 8 years. Kwankila Corbin (Program Coordinator) - Kwankila loins the Circles team as the Program Coordinator after serving as Pathways to Prosperity's BRIDGES Site Administrator for two years. She holds a Bachelor's of Science in Social Science from Mercer University in Georgia, and has had a dedicated career in the recovery and community service arena for the last 8 years. As the Circles Coordinator, Kwankila's primary role is to work outwardly with the community. Her responsibilities include marketing, sharing the Circles Program and success stories, building relationships with prospective funders, and working with different volunteer groups. She is responsible for recruiting, organizing, managing and supporting the leadership of the volunteer groups. Kwankila believes in the Circles program and has seen first-hand how it builds up families on a path to self-sufficiency by meeting them where they are and helping them achieve the next level of eenerational growth. OPEN POSITION (Recruitment & Data Management Specialist) - The Circles Recruitment & Data Management Specialist manages data entry and reports for Circles, is responsible for recruitment and scheduling of Circles Leaders and Allies, and supports with other activities as needed. Ontario (OJ) Johnson (Coach) - After graduating from the Art Institute of Fort Lauderdale, OJ worked as a Certified Practitioner of Financial Capability specializing in helping low-income households and individuals as they made their way from financial crisis to stability. He is a licensed real estate agent and small business owner, currently also working as a Community Organizer and Resident Services Manager for a nonprofit real estate development firm. OJ serves as a member of the Mayor's Task Force for Racial and Ethnic Equality for the City of West Palm Beach and is a special strategic advisor to the Urban Institute in the areas of poverty and economic mobility. Cameron Simmons (Coach) - Cameron grew up in Boynton Beach, left to go to college, but returned to the community after graduation to provide assistance to the residents. Cameron is a full time teacher for the School District and a football coach for the Bovnton Beach Bulldogs. Randi Marks (Coach) - Randi is a Circles graduate from 2014. She accomplished all of the SMART goals that she established as a Circles Leader. Craig Davis was her Circles Ally and she credits him with holding her accountable to complete her education and receive a Bachelor's Degree in Legal Studies. Randi is currently employed full-time with the Federal Government Court Svstems and works cart -time with Circles as a Coach. Gerard McKently (Outreach) - Gerard has endless contacts within Palm Beach County. He has established a Circles Steering Committee, composed of local leaders to ensure that we continue to market the initiative and highlight its many successes. Gerard formerly worked with South County Mental Health providing case management services throughout Palm Beach County. He has a Bachelor's Degree in Music Education. 21 933 Alcoia Bush (Family Care Specialist) - Alcoia has consistently volunteered for P2P at various events, offering her services as a licensed Cosmetologist to participants going on gob interviews and providing services for students during our annual Back to School Health Fair. Alcoia goined the Circles movement as a Circle Leader in the 2017 class. One of her goals was to open her own Hair Salon which she accomplished. She is a full-time Family Support Specialist, assisting with the youth component of Circles. When she is not working with the youth, she performs administrative duties and is contacting former Circles graduates while working to create an alumni group. 5. Yes. Policies and procedures are reviewed annually by the full board of directors at the annual board meetine. held on the last Thursdav of November. Some topics covered include: Responsibility Individual Personnel Files NonDiscrimination Employee Status and Benefits Eligibility Compensation Benefits Employee Development Code of Conduct/Termination of Employment Office Security E-mail Health and Safety Outside Employment Personal Mail Personal Telephone Calls Daily Attendance & Tardiness Drug Free Workplace Whistleblower Policy Confidentiality Policy Workplace Violence Communications with the Media 22 934 23 935 APPLICANT CAPACITY (cont.) 6. Will all CDBG funds awarded be maintained in a manner that they will be accounted for separately and distinctly from other sources of revenue or funding? Provide a brief description of the organization's policies and procedures that ensure funds will be tracked appropriately. 7. Is the organization's financial management system able to track actual expenditures and outlays with budgeted amounts for each grant or subgrant? Provide a brief summary of the organization's process for tracking expenditures, including tracking budgeted versus actual amounts. 8. Does the organization have effective internal controls in place to ensure that federal funds are used solely for authorized purposes? Provide a brief description of the applicant's internal controls that will provide reasonable assurance that the award funds will be managed properly. 9. Does the organization have a documented records retention policy? If so, briefly describe the policy and confirm that the policy complies with federal regulations. Information on Records Retention and Access can be found at 2 C.F.R § 200.333- 200-337. (Attach additional sheets if necessary) 6. Yes. Each grant is set up with its own account and grant -related expenditures are all tracked as such. We use Quickbooks Plus to manage all revenues and expenses. QuickBooks provides for separate, self -balancing sets of accounts, in accordance with Generally Accepted Accounting Principles and Procedures (GAPP) for Nonprofits. An Independent Audit is performed annually. We hold multiple government contracts and have held and successfully executed multiple contracts with the City of Boynton Beach. We are accredited by NonProfits First with a rating of "Excellence"; and a rating of "Give with Confidence" and a score of 100 out of 100 by Charity Navigator. 7. Yes. Office expenditures requested by staff are presented in writing with a vendor's quote, then reviewed and approved by the Programs Director first. We submit check requests weekly to the bookkeeper for reimbursements. The CEO signs off on checks produced. Financial statements are produced monthly and provide a breakdown of income and expenses by programs that follow revenue and disbursements, prepared in accordance with GAAP and standards of accounting and reporting established specifically for non-profit organizations. The general ledger is used to accumulate all financial transactions and is supported by subsidiary ledgers that provide details for certain accounts in the general ledger. Budgeted amounts per line item are recorded. Monthly reports of budgeted v actual are provided to the Board of Directors. Quarterly financial updates are reviewed with management -level program staff to review allowable program expenditures. 8. Yes. We have internal controls to serve as checks and balances to reduce the risks of misuse and misappropriation of assets, including strong physical controls, separation of duties, 24 transparency and periodic/ surprise reviews. Internal controls address individuals in 4 areas: those with access to assets; those with access to accounting systems & accounting records; those in management or control positions; and those exercising independent oversight, including our Board of Directors. Some internal control policies include requiring two signatures on all checks, advance approval for expenditures and reimbursements, two people count cash, background checks are conducted for anyone with money handling responsibilities. Cash and financial documents are kept in a locked drawer in a locked office. Procedures are specified for how to handle an alleization of misuse or misaaaroariation of assets. Yes. To provide an accurate and auditable record of all financial transactions. the organization's books, records, and accounts are maintained in conformity with Generally Accepted Accounting Principles and Procedures (GAPP). Records will be maintained for the periods sufficient to satisfy IRS regulations and other legal needs as may be determined. Record retention reauirements are reviewed annuallv with lee -al counsel and independent auditors to determine any necessary changes. 25 937 H. Conflict of Interest Federal law (24 CFR 570.611) prohibits persons who exercise or who have exercised any functions or responsibilities with respect to the above grant ... or who are in a position to participate in a decision making process or to gain inside information with regard to such activities, may obtain a financial interest or benefit from an assisted activity... either for themselves or those with whom they have family or business ties, during their tenure or for one year thereafter. a. Is there any member of the applicant's staff, member of the applicant's Board of Directors, or office who currently is or has/have been within one year of the date of this application a City employee, or a member of the City Commission? Yes X No If yes, please list names: b. Is there any member of the applicant's staff, member(s) of the Board of Directors, or officer(s) who are business partners or immediate family of a City employee, or a member of the City Commission? Yes X No If yes, please list names: c.Will the funds requested by the applicant be used to pay the salaries of any of the applicant's staff or award a subcontract to any individual who is or has been within one year of the date of this application a City employee, or a member of the City Commission? Yes X No If yes, please list names: 26 938 REPAYMENT: Funding from this grant program is subject to federal, state and local audit. If a determination is made that these grant funds were used in a manner inconsistent with program guidelines, for an ineligible expense or for expenses reimbursed by another federal, state or local grant/loan program then the awarded entity will reimburse the City of Boynton Beach these funds. SUBMISSION OFAN APPLICATION IS NOT AGUARANTEE 0FFUNDING It6sthe responsibility mfthe applicant to READ AND UNDERSTAND all aspects ufthe CDBG grant program, the application, and City's procurement process, if applicable. NOTICE TOTHIRD PARTIES: The CD8G grant application program does not create any rights for any parties, including parties that performed work onthe project. NorshaUiasuanceofaCOBG grant result in any obligation on the part of the City of Boynton Beach to any third party. The City is not required to verify that entities that have contracted with the applicant have been paid in full, or that such entities have paid any subcontractors in full. Applicant's warranty that all bills related tothe Project forvvhichtheapp|icantisdirect|yresponsib|eissufficientassurancefmrthe City toaward loan funding. The applicant certifies to the best of his/her knowledge and belief that the data in this application is true and correct and that the filing of the application has been duly authorized by the governing body of the applicant (if applicable) and that the applicant will comply with all the requirements ofthis grant ifthe application isapproved. Title: (IB( Name:— Maguerie Cadet Title: Board President Attachments - 501(c)(3) (No -For -Profit Status) City of Boynton Beach Business Tax Receipts Attached (if applicable) - Board Members List - Copy of Master Audit All funding sources for this project identified. (Backup documentation provided in Additional Attachments 3). - Forms used to income certify individuals nij PATHWAYS TO PRGS?Fi�xry INC C/O ZRNORA KERR WARD 5725 c()RPO-,qAT2 wxY STI,� 20r, W-Er,T PIdM UIEACF, F -I �1107 'UezIr Applicant' � Eftjpjayej -,tie ,atjfjcjtiosi rumber: 27-3550271 DLN� 17053236363011 Cr,��ntac-t j�erson� 'R.,RN P ,R RAILEY NORTON 311,12 Cont,act ',velephone I-htuue-f: (OV77) 829--F,500 Accourltlzvq. Pel,101,'I Fending: 10 -,',ub1ic Cliarity SLEItua,', 170(b) (1) tA(vi) -qtj Yy S Effecti,ve DaLc of BXeMPtIOM RTv SepLead)-r' 18, 2010 upon arepj to inforra u� of r p icatioll for taX CXeMnt SV f Fe�leral aZ:Ut7, tWe haVe detCrT�'Iined that you are �xempt �ccm 1 inccme tax uecti.O,r 53j(cY C34 n� the Interrail Revenue Cadv?, C�-,nL7.r*ihw:kticns to You etre t'D rece ve undcr seat� -on 170 of the Code. YOU Ar,2� o -'SO Tl,-Llific�d -,ins -ax <Ied'uctibie bequdstc-, revs es" t,t, fer's or gifts undea. aertj�n o 20 S, 2522 at the Code.- Becaur;e �'aL-b 1ULLOr could ht�,Ip resolve a"Y gUenti0r'-O n-.atga,rding ycluf exemptautzrz, 5!:Ouj.da p it. ),vkA pf��;m.ment records. oz-ganizat-Jons, exp: -Pt UT'der section 501,tC) (3) Of �-ec, coctc� arf, fuxthcr classified eather public C'narit-.jes or private foundarions. We deLalwined thaz You are a pubjj.(- chziriLy unnef tnr� Cod�' sectLon(sl listed in tbp hcwfting of this letter T51'-zjsr' See .'Lclosed Pub, ication. 422L -1'C' C'Omplizalae G.U."'de for C3!AIC Charatie's, for some heInzji aa.)out your Pxemp- Lett-IeY 917 DDICG) 941 City of Boynton Beach Development Services 100 E. Ocean Ave, Boynton Beach, FL 33435-0190 0 **SINGLE -PIECE 1 SGL. 129099A2L-A-1 11 1 SP 0 530 PATHWAYS TO PROSPERITY iNC 900 N SEACREST BLVD BOYNTON BEACH FL 33435-3002 NDear Boynton Beach Business and Property Owners: We appreciate your continued participation in supporting economic growth and viability of our City by maintaining your Certificate of Use and Occupancy & Local Business Tax, In accordance with Chapter 13 of the City of Boynton Beach Municipal Ordinance, the document(s) below must be posted in a conspicuous place at your business or property, Should assistance be needed please contact the Development Services Department at (561)742-6350 or visit Our website at www.boyriton-beach.org, + DETACH THE DOCUMENT BELOW ACONSPCUOUSLY AT IYPLACE OF BUSINESS 4 0 - - - - - - - - - - - - - - - - - . . . . AND POST . . . . . . . . . . . . . . . . . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - .. City of Boynton Beach Certificate of Use/Business Tax Receipt Business Control Number: 0032488 Date Issued: 01/26/22 Business Name: Pathways To Prosperity Inc Business Location: 900 N Seacrest Blvd Any changes in narne, address, suite, ownership, etc, will require a new application, 22-00038288 624190 INDIVIDUAL & FAMILY SOCIAL SERVICES NON PROFIT 4N $01 City of Boynton Beach 100 E. Ocean Ave. * Boynton Beach, FL 33435-0190 at, Board of Directors 2022-2023 a C� W NAME TITLE PROFESSIONAL AFFIUATI 0N COMPLETE MAI UNG ADDRESS Maguene D. Cadet Board Chair Attorney 1501 Siena Lane Boynton Beach, FL 33436 Valencia Spells Anderson Vice Chair Administrator 210 NW 7th Ave Boynton Beach, FL 33435 Audrey Davis Secretary Bank Regional Manager 917 NW 37th Ave Delray Beach, FL 33445 Octavia Bell Treasurer Daycare Owner 512 NW 13th Ave Boynton Beach, FL 33435 Revia Lee Board Member Retired School Principal 507 N W 8th Ave Boynton Beach, FL 33435 Dr. Barbara Carey -Shuler Board Member Retired Business Owner 12881 Cocoa Pine Dr Boynton Beach, FL 33436 MariIane Chaney Board Member Social Security Admin 4312 Porn elo Blvd Boynton Beach, FL 33436 DeAnna Warren Board Member CEO -Genesis 7069 Chesapeake Cir Boynton Beach, FL 33436 Terrance Kearney Board Member Pastor 3481 Chickasaw Cir Greenacres, FL 33467 Page 1 of 1 943 PATHWAYS TO PROSPERITY, INC. INDEPENDENT AUDITOR'S REPORT AND FINANCIAL STATEMENTS FOR THE YEARS ENDED SEPTEMBER 30, 2021 AND 2020 MARK ESCOFFERY, P.A. CERTIFIED PUBLIC ACCOUNTANT 944 PATHWAYS TO PROSPERITY, INC. TABLE OF CONTENTS PAGE INDEPENDENT AUDITOR'S REPORT 1-2 STATEMENTS OF FINANCIAL POSITION STATEMENTS OF ACTIVITIES STATEMENTS OF FUNCTIONAL EXPENSES STATEMENTS OF CASH FLOWS NOTES TO FINANCIAL STATEMENTS 7-12 REPORT ON INTERNAL CONTROL OVER FINANCIAL REPORTING AND ON COMPLIANCE AND OTHER MATTERS BASED ON AN AUDIT OF FINANCIAL STATEMENTS PERFORMED IN ACCORDANCE WITH GOVERNMENT AUDITING STANDARDS 13-14 MANAGEMENT LETTER 15 945 8645 N. Military Trail Suite 503 Palm Beach Gardens, FL 33410 Mark Escoffery, P.A. Certified Public Accountant INDEPENDENT AUDITOR'S REPORT To the Board of Directors Pathways to Prosperity, Inc. Boynton Beach, Florida Tel (561) 627-1404 Fax (561) 627-3844 I have audited the accompanying Financial Statements of Pathways to Prosperity, Inc. ("the Organization") (a non-profit organization) which comprise the Statements of Financial Position as of September 30, 2021, and 2020 the related Statements of Activities, Functional Expenses and Cash Flows for the year then ended and the related notes to the financial statements. Management's Responsibility for the Financial Statements Management is responsible for the preparation and fair presentation of these financial statements in accordance with accounting principles generally accepted in the United States of America; this includes the design, implementation, and maintenance of internal control relevant to the preparation and fair presentation of financial statements that are free from material misstatements, whether due to fraud or error. Auditor's Responsibility My responsibility is to express an opinion of these financial statements based on my audit. I conducted my audit in accordance with auditing standards generally accepted in the United States of America. Those standards require that I plan and perform the audit to obtain reasonable assurance about whether the financial statements are free from material misstatement. An audit involves performing procedures to obtain audit evidence about the amounts and disclosures in the financial statements. The procedures selected depend on the auditor's judgment, including the assessment of the risks of material misstatement of the financial statements, whether due to fraud or error. In making those risk assessments, the auditor considers internal control relevant to the entity's preparation and fair presentation of the financial statements in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the entity's internal control. Accordingly, I express no such opinion. An audit also includes evaluating the appropriateness of accounting policies used and the reasonableness of significant accounting estimates made by management, as well as evaluating the overall presentation of the financial statements. I believe that the audit evidence I have obtained is sufficient and appropriate to provide a basis for my audit opinion. MEMBER: AMERICAN INSTITUTE OF CERTIFIED PUBLIC ACCOUNTANTS AND FLORIDA INSTITUTE OF CERTIFIED PUBLIC ACCOUNTANTS 946 Opinion In my opinion, the financial statements referred to above present fairly, in all material respects, the financial position of the Organization as of September 30, 2021 and 2020, and the changes in its net assets and cash flows for the year then ended in conformity with accounting principles generally accepted in the United States of America. Other Reporting Required by Government Auditing Standards In accordance with Government Auditing Standards, I have also issued my report dated March 22, 2022, on my consideration of the Organization's internal control over financial reporting and my tests of its compliance with certain provisions of laws, regulations, contracts, and grants. The purpose of that report is to describe the scope of my testing of internal control over financial reporting and compliance and the results of that testing and not to provide an opinion on the internal control over financial reporting or on compliance. That report is an integral part of an audit performed in accordance with Government Auditing Standards and should be read in conjunction with this report in considering the results of my audit. Palm Beach Gardens Florida March 22, 2022 2 947 PATHWAYS TO PROSPERITY, INC. STATEMENT OF FINANCIAL POSITION SEPTEMBER 30, 2021 AND 2020 Without Donor With Donor 2021 Restrictions Restrictions Total 2020 Assets: Cash Grants Receivable Prepayments Property and Equipment, Net Deposits Total assets Liabilities and net assets: Accounts Payable and accrued liabilities Payroll liabilities Note Payable Total liabilities Net assets: Without donor restrictions With donor restrictions Total net assets Total liabilities and net assets $ 169,971 $ 193,757 $ 363,728 $ 293,351 169,893 - 169,893 96,900 8,049 8,049 2,685 4,501 - 4,501 1,434 3,600 3,600 6,000 $ 356,014 $ 193,757 $ 549,771 $ 400,370 $ 28,894 $ - $ 28,894 $ 22,707 2,383 - 2,383 8,245 298,618 - 298,618 149,900 329,895 - 329,895 180,852 $ 26,119 26,119 (39,379) 193,757 193,757 258,897 26,119 193,757 219,876 219,518 $ 356,014 $ 193,757 $ 549,771 $ 400,370 See Accompanying Notes to Financial Statements 3 948 PATHWAYS TO PROSPERITY, INC. STATEMENT OF ACTIVITIES FOR THE YEARS ENDED SEPTEMBER 30, 2021 and 2020 Net Assets Net Assets Without With 2021 2020 Restrictions Restrictions Total Total REVENUE AND OTHER SUPPORT Governmental Grants $588,943 $588,943 $889,055 Private Grants 75,940 241,592 317,532 58,392 Other Revenue 41,904 41,904 83,710 Fundraising 16,100 16,100 1,450 Net Assets Released from Restrictions 306,732 (306,732) Total Revenue and Other Support 1,029,619 (65,140) 964,479 1,032,607 EXPENSES Program Sei vices 904,929 904,929 892,795 Supporting Services 58,329 58,329 81,308 Fundraising 863 863 Total Expenses 964,121 964,121 974,103 Increase/(Decrease) in Net Assets 65,498 (65,140) 358 58,504 Net Assets, Beginning of Year (39,379) 258,897 219,518 161,014 Net Assets, End of Year $193,757 $219,518 $26,119 $219,876 See Accompanying Notes to Financial Statements 4 949 PATHWAYS TO PROSPERITY, INC. STATEMENTS OF FUNCTIONAL EXPENSES FOR THE YEARS ENDED SEPTEMBER 30, 2021 AND 2020 SUPPORTING PROGRAM MANAGEMENT SERVICES SERVICES & GENERAL FUNDRAISING Salaries $514,110 $269 Program Expenses 30,000 37,500 Payroll Taxes 39,809 15 Occupancy 64,243 2,265 Grant Awards 30,000 501 Fring Benefits 69,118 4,858 Specific Assistance 27,380 24,231 Sponsored Events 20,484 291 Professional Fees 38,748 2,000 Conferences 8,075 501 Office Supplies 20,801 1,761 Marketing/promotion 19,690 1,624 Office expenses 20,557 9,425 Food 3,562 358 Communication 19,152 660 Staff development 9,193 920 Relief and Recovery 8,075 Depreciation 220 1,020 Travel insurance 5,638 Equipment Rental 2,124 56 Memberships 100 2021 2020 7,958 39,824 39,089 66,508 83,497 30,000 37,500 73,976 75,114 51,611 82,603 372 21,147 28,352 40,748 37,904 501 11,050 22,562 8,112 21,314 17,455 491 30,473 15,863 3,920 5,643 19,812 15,231 10,113 3,983 8,075 1,240 659 2,303 5,638 5,106 2,180 4,016 $904,929 $58,329 $863 $964,121 $974,103 See Accompanying Notes to Financial Statements 5 950 PATHWAYS TO PROSPERITY, INC. STATEMENTS OF CASH FLOW FOR THE YEARS ENDED SEPTEMBER 30, 2021 AND 2020 2021 2020 CASH FLOWS FROM OPERATING ACTIVITIES Change in net assets Adjustments to reconcile change in net assets to net assets provided by operating activities: Decrease (increase) in operating assets: Grants Receivable Prepaid Expenses Deposits Increase (decrease) in operating liabilities: Accounts Payable Payroll Liabilities Net cash provided by operating activities CASH FLOWS FROM INVESTING ACTIVITIES Purchase of Property and Equipment Net cash provided by Investing activities CASH FLOWS FROM FINANCING ACTIVITIES Proceeds from Note Payable Payments on note payable Net cash flows from financing activities Net increase in cash Cash, beginning of year Cash, end of year $ 358 $ 58,504 1,240 659 (72,993) (12,550) (5,364) (142) 2,400 6,186 9,827 (5,862) (8,249) (74,035) 48,049 (4,306) (1,014) (4,306) (1,014) 150,000 149,900 (1,282) 148,718 149,900 70,377 196,935 293,351 96,416 $ 363,728 S 293,351 See Accompanying Notes to Financial Statements 6 951 PATHWAYS TO PROSPERITY, INC. NOTES TO FINANCIAL STATEMENTS SEPTEMBER 30, 2021 AND 2020 NOTE 1 — SIGNIFICANT ACCOUNTING POLICIES Nature of Activities Pathways to Prosperity, Inc. ("the Organization") is a nonprofit community based organization whose mission is to improve the social, spiritual, economic and emotional well being of children and families through education and social services. The Organization is located in Boynton Beach, Florida. The primary program of the Organization is The Bridges, which is committed to connecting families to community resources so more children are born healthy, remain free from abuse and neglect and are ready for kindergarten and other appropriate grade levels. The Organization also has other programs, which focus on social services and education as follows: Circles Palm Beach County focuses on ways to eliminate poverty by helping families through education and community partnerships. Healthy Boynton Beach (HBB) assist families with assessment and linkage to healthcare providers, health insurance and other social services. Basis of Accountin! The accounting and reporting policies of the Organization conform to accounting principles generally accepted in the United States of America and are in accordance with Financial Accounting Standards Board (FASB). In August 2016, the FASB issued Update 2016-14 to Accounting Standards Codification 958 Not -for -Profit Entities. These financial statements are prepared on the accrual basis of accounting and report information regarding financial position and activities according to two classes of net assets: net assets without donor restrictions and net assets with donor restrictions. Income Taxes The Organization is exempt for federal income tax purposes under Section 501(c)(3) of the Internal Revenue Code. The Organization's Form 990, Return of Organization Exempt from Income Tax, for the years ended 2019, 2020 and 2021 are subject to examination by the Internal Revenue Service (IRS), generally for three years after they are filed. There are no current examinations in progress by the IRS. Contributions All contributions are considered to be available for unrestricted use unless specifically restricted by the donor. Amounts designated for future periods or restricted by the donor for specific purposes are reported as net assets with donor restrictions. 7 952 PATHWAYS TO PROSPERITY, INC. NOTES TO FINANCIAL STATEMENTS (Continued) SEPTEMBER 30, 2021 AND 2020 NOTE 1— SIGNIFICANT ACCOUNTING POLICIES (Cont'd.) Contributions (Cont'd.) Contributions are recognized when the donor makes a promise to give to the Organization that is, in substance, unconditional. Contributions that are restricted by the donor are reported as increases in net assets without donor restrictions if the restrictions expire in the fiscal year in which the contributions are recognized. All other donor -restricted contributions are reported as increases in net assets with donor restrictions. When a restriction expires, net assets with donor restrictions are reclassified to net assets without donor restrictions. Grants Revenues from reimbursable grants are recorded when the related costs are incurred. All other grants, unless restricted are recorded as revenue when the grant is received. The Organization is dependent on continued financial assistance from grants. Use of Estimates The preparation of financial statements in conformity with generally accepted accounting principles include the use of estimates that affect the financial statements. Accordingly, actual results could differ from those estimates. Functional Classification of Expenses In the accompanying Statements of Activities, expenses have been reported by their functional classification, a method of grouping expenses according to the purpose for which they were incurred. The primary functional classifications are Program Services and Supporting Activities. Program Services are the activities that result in services being provided to members that fulfill the purposes or mission for which the Organization exists. Supporting Activities are all activities other than program services and are included in the financial statements as Management and General Expenses. Contributed Services The Organization does not recognize any support, revenue or expense from services contributed by volunteers, because they do not meet the criterion for measurement. Accounts Receivable Accounts receivable are primarily due from grantors and are carried at the amount of the commitment expected to be recovered. Receivables are written off when deemed uncollectible. Recoveries of receivables previously written off are recorded when received. Management does not believe an allowance for bad debts is necessary and none is provided. 8 953 PATHWAYS TO PROSPERITY, INC. NOTES TO FINANCIAL STATEMENTS (Continued) SEPTEMBER 30, 2021 AND 2020 NOTE 1— SIGNIFICANT ACCOUNTING POLICIES (Cont'd.) Property and Equipment The Organization capitalizes assets with a cost of $500. Repairs and maintenance costs that do not add to the asset value or materially extend the useful lives of the assets are not capitalized. Property and equipment are stated at cost less accumulated depreciation. Depreciation is being provided by use of the straight-line method over the estimated useful lives of the related assets as follows: Assets Method Life Furniture & Fixtures SL 5 Years Equipment SL 5 Years NOTE 2 — ACCOUNTS RECEIVABLE At September 30, 2021 and 2020, the organization had an account receivable balance of $169,893 and $96,900 due primarily from the City of Boynton Beach, Children Services Council of Palm Beach County and Palm Beach County -FAA. NOTE 3 — PROPERTY AND EQUIPMENT At September 30, 2021 and 2020 property and equipment consisted of the following: Equipment Furniture & Fixtures Less: Accumulated Depreciation Total Property & Equipment 2021 2020 $ 15,790 $ 12,210 7,651 6,008 23,441 18,218 18,940 17,140 $ 4,501 $ 1,078 Depreciation expense for the years ended September 30, 2021 and 2020 was $1,240 and $659, respectively. lu 954 PATHWAYS TO PROSPERITY, INC. NOTES TO FINANCIAL STATEMENTS (Continued) SEPTEMBER 30, 2021 AND 2020 NOTE 4 — OPERATING LEASES The Organization leases office space under a non -cancelable operating lease that expired in January 2023. The rent expense of approximately $59,000 for the year ended September 30, 2021, is included in Occupancy in the Statement of Functional Expenses. Future minimum lease payments, assuming the Organization will renew the lease annually, are as follows: Year Amount 2022 $ 43,200 2023 44,500 2024 45,800 2025 47,200 2026 48,600 $ 229,300 NOTE 5 — REVENUE CONCENTRATION The Organization receives the majority of its funding from quasi governmental sources and is, therefore, dependent upon the availability of grants and awards for its continued existence. The Organization received approximately 47% and 44% of its funding from the Children's Services Council of Palm Beach County (CSC) for the years ended September 30, 2021 and 2020. NOTE 6 — FAIR VALUE MEASUREMENT The Fair Value Measurement Topic of the FASB Accounting Standards Codification defines fair value, establishes a consistent framework for measuring fair value and expands disclosure requirements for fair value measurements. The Organization measures the fair value of assets and liabilities as the price that would be received to sell an asset or paid to transfer a liability in the principal or most advantageous market in an orderly transaction between market participants at the measurement date. The fair value hierarchy distinguishes between independent observable inputs and unobservable inputs used to measure fair value as follows: Level 1: Quoted prices (unadjusted) in active markets for identical assets or liabilities that the reporting entity has the ability to access at the measurement date. Level 2: Inputs other than quoted market prices included within Level I that are observable for an asset or liability, either directly or indirectly. Level 3: Unobservable inputs for an asset or liability. Level 3 inputs should be used to measure fair value to the extent that observable Level 1 or 2 inputs are not available. 10 955 PATHWAY TO PROSPERITY, INC. NOTES TO FINANCIAL STATEMENTS (Continued) SEPTEMBER 30, 2021 AND 2020 NOTE 6 — FAIR VALUE MEASUREMENT (Cont'd.) Generally accepted accounting principles require disclosure of an estimate of fair value of certain financial instruments. The organization's significant financial instruments are cash, accounts receivable, and accounts payable. For these financial instruments, carrying values approximate fair value because of the short maturity of these instruments. NOTE 7 — TEMPORARILY RESTRICTED NET ASSETS Temporarily restricted net assets are grants received that have a time restriction which had not expired by September 30, 2021. Temporarily restricted net were composed of the following at September 30, 2021: Palm Health Care Foundation $ 137,288 DeLuca Foundation 21,250 Quantum Foundation 35,219 $ 193,757 NOTE 8 — CONTINGENCIES The Organization receives financial assistance from agencies in the form of grants. The disbursement of funds received under those programs generally requires compliance with the terms and conditions specified in the grant agreement and is subject to audit by the grantor agencies. Any disallowed claims resulting from audits could become a liability of the Organization. NOTE 9 -- LIQUIDITY AND AVAILABILITY OF FINANCIAL ASSETS Financial assets available for general expenditure, that is, without donor or other restrictions limiting their use, within one year of the statement of financial position date, comprise the following: Cash and Cash Equivalents $363,728 Grants receivable 169,893 533,621 Less net assets with donor restrictions 193,757 Total financial assets available to meet general expenditures Over the next twelve months $339,864 NOTE 10 — RISKS AND UNCERTAINTIES Risks and uncertainties could significantly affect the amounts reported in the financial statements in the near term of the Organization. The risks and uncertainties addressed can stem from the organization's operations, the use of significant estimates and revenue. 11 956 PATHWAY TO PROSPERITY, INC. NOTES TO FINANCIAL STATEMENTS (Continued) SEPTEMBER 30, 2021 AND 2020 NOTE 11 — SMALL BUSINESS ADMINISTRATION LOAN On June 14, 2020, the organization received loan proceeds from the Small Business Administration (SBA) in the amount of $149,900 under Section 7(b) of the Small Business Act. On August 19, 2021, the organization received an additional loan from the SBA in the amount of $150,000. The loans are collateralized by all assets of the Organization. The Organization will be required to pay interest on the SBA loan at a rate of 2.75% per annum. The loan is for thirty years with principal and interest of $1,328 monthly and will begin on June 14, 2022. NOTE 12 — SUBSEQUENT EVENTS Management has evaluated events that occurred subsequent to the year end for potential recognition or disclosure in the financial statements, through the date on which the financial statements were available to be issued. The date when the financial statements were available to be issued was March 22, 2022. On March 15, 2022, the SBA extended the deferment period from 24 months to 30 months. The organization loan payments will begin on December 14, 2022. 12 957 Mark Escoffery, P.A. Certified Public Accountant 8645 N. Military Trail Suite 503 Palm Beach Gardens, FL 33410 REPORT ON INTERNAL CONTROL OVER FINANCIAL REPORTING AND ON COMPLIANCE AND OTHER MATTERS BASED ON AN AUDIT OF FINANCIAL STATEMENTS PERFORMED IN ACCORDANCE WITH GOVERNMENT A UDITING STANDARDS To the Board of Directors Pathways to Prosperity, Inc. Boynton Beach, Florida Tel (561) 627-1404 Fax (561) 627-3844 I have audited the financial statements of Pathways to Prosperity, Inc., ("the Organization")(a nonprofit organization) as of and for the year ended September 30, 2021, and have issued my report thereon dated March 22, 2022. I conducted my audit in accordance with auditing standards generally accepted in the United States of America and the standards applicable to financial audits contained in Government Auditing Standards, issued by the Comptroller General of the United States. Internal Control Over Financial Reporting In planning and performing my audit, I considered the Organization's internal control over financial reporting as a basis for designing my auditing procedures for the purpose of expressing my opinion on the financial statements, but not for the purpose of expressing an opinion on the effectiveness of the Organization's internal control over financial reporting. Accordingly, I do not express an opinion on the effectiveness of the Organization's internal control over financial reporting. A deficiency in internal control exists when the design or operation of a control does not allow management or employees, in the normal course of performing their assigned functions, to prevent or detect and correct misstatements on a timely basis. A material weakness is a deficiency, or a combination of deficiencies, in internal control such that there is a reasonable possibility that a material misstatement of the entity's financial statements will not be prevented or detected and corrected on a timely basis. My consideration of internal control over financial reporting was for the limited purpose described in the first paragraph of this section and was not designed to identify all deficiencies in internal control over financial reporting that might be significant deficiencies, or material weaknesses. I did not identify any deficiencies in internal control over financial reporting that I consider to be material weaknesses, as defined above. Compliance and Other Matters As part of obtaining reasonable assurance about whether the Organization's financial statements are free of material misstatements, I performed tests of its compliance with certain provisions of laws, regulations, contracts and grant agreements, noncompliance with which could have a direct and material effect on the determination of financial statement amounts. 13 MEMBER: AMERICAN INSTITUTE OF CERTIFIED PUBLIC ACCOUNTANTS AND FLORIDA INSTITUTE OF CERTIFIED PUBLIC ACCOUNTANTS 958 To the Board of Directors Pathways to Prosperity, Inc. Boynton Beach, Florida Page 2 However, providing an opinion on compliance with those provisions was not an objective of my audit, and accordingly, I do not express such an opinion This report is intended solely for the information and use of the Board of Directors, Management, Children's Services Council of Palm Beach County and is not intended to be and should not be used by anyone other than these specified parties. Palm Beach Gardens Florida March 22, 2022 14 959 Mark Escoffery, P.A. Certified Public Accountant 8645 N. Military Trail Suite 503 Palm Beach Gardens, FL 33410 MANAGEMENT LETTER To the Board of Directors Pathways to Prosperity, Inc. Boynton Beach, Florida Tel (561) 627-1404 Fax(561)627-3844 I have audited the financial statements of the Organization as of and for the year ended September 30, 2021 and have issued my report thereon dated March 22, 2022. In planning and performing my audit of the financial statements of the Organization for the year ended September 30, 2021, I considered its internal control structure to determine my auditing procedures for the purpose of expressing an opinion on the financial statements and not to provide assurance on the internal control structure. However, during my audit I did not become aware of any matter that created an opportunity for strengthening internal control and operating efficiency. This letter does not affect my report dated March 22, 2022, on the financial statements of the Organization. This report is intended solely for the information and use of the Board of Directors, Management, Children's Services Council of Palm Beach County, and is not intended to be and should not be used by anyone other than these specified parties. Palm Beach Gardens Florida March 22, 2022 15 MEMBER: AMERICAN INSTITUTE OF CERTIFIED PUBLIC ACCOUNTANTS AND FLORIDA INSTITUTE OF CERTIFIED PUBLIC ACCOUNTANTS 960 Annual Income Limits for West Palm Beach and Boca Raton Metropolitan Statistical Area (MSA) FY 2022 Area Median Family Income $90,300 (HOME up to 80%; SHIP up to 140%) Number of Persons in Household Extremely Low Income (30%) Very Low Income (50%) Low Income (80%) Moderate Income (120%) Moderate Income (140%) 1 $19,350 $32,200 $51,500 $77,280 $90,160 2 $22,100 $36,800 $58,900 $88,320 $103,040 3 $24,850 $41,400 $66,250 $99,360 $115,920 4 $27,750 $46,000 $73,600 $110,400 $128,800 5 $32,470 $49,700 $79,500 $119,280 $139,160 6 $37,190 $53,400 $85,400 $128,160 $149,520 7 $41,910 $57,050 $91,300 $136,920 $159,740 8 $46,630 $60,750 $97,200 $145,800 $170,100 9 Referto HUD $64,400 $103,040 $154,560 $180,320 10 $68,080 $108,928 $163,392 $190,624 The maximum sales price for a property is $352,371 HUD Released 4/18/2022; Florida Housing Finance Corporation Posted 4/27/2022); *Effective by Palm Beach County April 27, 2022 April 27, 2022 2:00 PM 961 CIRCLES Palri? Beach Coonty Client Name: Income Source: (Employment, Social Security, SSI/SSRI, Child Support, Relative Caregiver Benefits, Cash Assistance & No Income Verification.) Number of Household Members: Income is based on the Federal Poverty Guidelines at 125 % of the client's gross income. Total the income for all house hold members. Calculation of Gross Income Income : $ Multiply X Payments: (Circle One: Weekly, Bi weekly, Bi Monthly, Monthly, or Daily) TOTAL $ Formula Used to calculate income I 1. Weekly- Take the average gross income x 52 weeks. Total payments for a 1 week. 2. Bl weekly- Take the average gross income x 26 weeks 3. Semi- monthly -(2 times a month, Take the average gross income x 24 weeks), 4. Monthly- average gross salary for the month x 12 months. 5. Daily- Add the number of days to get weekly total x 52 (example $50 a day, 3 days=150 x's 52 weeks (Client paid daily, but get paid inconsistent during the month (one paid, one week without pay i.e.), add the number of days paid in the entire month x's 12.) (Example: Total pay for Week I is $45) Total pay for Week 2 is $0; Total pay for Week 4 is $25, (Add all for weeks and multiple by 12). This will give you the annual income. 6. 9 month employees receive 22 pays a year. Gross x 22 weeks. 7. Self- employed- First page of the 1040 tax form should be used. 8. Child Support Income calculation the last 9 days of income. if dates and amounts within the last 3 months are inconsistent, add all the amounts within the last 90 days, divide it by 3 to get the average, and x 12. (n+n+n /3) x12.) 9. Unemployment will be calculated for 26 pays if biweekly amount is given and 52 if the weekly amount is given, Qa lICIRCLES" CIRCLE LEADER PROGRESS REPORT Updated 9/2022 Full Name: Address: Phone: E-mail: Place of Employment Name: Work Phone: Job Title: Job Start Date (MM/DD/YYYY): Aualability Pleasewrite "Yes" irrthe boxes corres ondin to" hen . ou are available, 71 Yes 71 No Monday Tuesday Wednesday Thursday Friday Saturday Sunday Morning 71 Yes 71 No Employment status: 71 Part-time 71 Full-time 71 Self-employed 71 Unemployed Matched to Allies? 71 Yes 71 No If yes, how many? Name(s) How many people can you count on for support? Afternoon Evening Housing, Transportation, Education, Employment, and support. Safe housing for next 3 months: 71 Yes 71 No Housing status: I Rent (Amount $: ) 71 Own 71 Other: Reliable transportation: 71 Yes 71 No Education completed: 71 High school 71 Some college 71 4 -year degree 71 GED 71 2 -year degree 71 Graduate degree 71 Certification/Technical training 71 N/A Have you signed up through www.em to florida.com? 71 Yes 71 No Employment status: 71 Part-time 71 Full-time 71 Self-employed 71 Unemployed Matched to Allies? 71 Yes 71 No If yes, how many? Name(s) How many people can you count on for support? lICIRCLES" Beac -' I,aA ru4 h`i.�rs�f",� Monthly Household Iftco' me'Over the Last 30 Days Do not include TANF SNAP foans received or unem to ment benefits Circle Leader's gross earned income: $ 2nd Circle Leader gross earned income: $ Other adult (18+) earned income: $ Child support received: $ Social Security benefits received: $ Military pension or VA benefits received: $ Any other income: $ TOTAL INCOME LAST 30 DAYS >>> $ M2 Cash Assets Checking account(s) balance (current): $ Savings account(s) balance (current): $ Cash on Hand: $ Investments: $ TOTAL CASH ASSETS >>> $ M2 Debt Credit Cards: $ Medical: $ Student Loans: $ Other Debt (ex. mortgage): $ TOTAL DEBT >>> $ M2 Benefits Do you receive housing benefits? 71 Yes 71 No If yes, how much? $ Do you receive food benefits? 71 Yes 71 No If yes, how much? $ Do you receive healthcare benefits? 71 Yes 71 No If yes, how much? $ Do you receive financial assistance benefits? 71 Yes 71 No If yes, how much? $ Do you receive the Earned Income Tax Credit? 71 Yes 71 No If yes, how much? $ M2 lICIRCLES" Number of adults (18+) in household: Number of children in household (list below): Names of Children Date of Birth SSN (optional) School attended Circle Leader Signature: * Initial/Intake * Training completion * 6 months Date of data collection: Date: For Office Use On/y; 71 12 months 71 18 months 71 24 months Date entered into Circles database: Date entered into Client Track: Staff Member Print and Sign: Additional Staff Notes: 71 30 months 71 36 months 7142 months Circles #: HMIS #: 7148 months 71 52 months 71 60 months .: Additional Attachments 1 Articles of Incorporation Agency By -Laws 990 FY 2019 �j M. Electronic Articles of Incorporation For PATHWAYS TO PROSPERITY, INC. N10000008831 FILED September 20, 2010 Sec. Of State cgolden The undersigned incorporator, for the purpose of forming a Florida not-for- profit corporation, hereby adopts the following Articles of Incorporation: Article I The name of the corporation is: PATHWAYS TO PROSPERITY, INC. Article II The principal place of business address: 223 N.E. 12 AVENUE BOYNTON BEACH, FL. 33435 The mailing address of the corporation is: 900 N. SEACREST BLVD BOYNTON BEACH, FL. 33435 Article III The specific purpose for which this corporation is organized is: TO STRENGTHEN THE COMMUNITY BY IMPROVING THE SOCIAL, MENTAL, 1111 SPIRITUAL, ECONOMIC AND EMOTIONAL WELL-BEING OF CHILDREN AND ❑ ❑ FAMILIES THROUGH EDUCATION AND SOCIAL SERVICES. Article IV The manner in which directors are elected or appointed is: AS PROVIDED FOR IN THE BYLAWS. Article V The name and Florida street address of the registered agent is: ST JOHN MISSIONARY BAPTIST CHURCH, INC 900 N. SEACREST BLVD. BOYNTON BEACH, FL. 33435 I certify that I am familiar with and accept the responsibilities of registered agent. Registered Agent Signature: LANCE CHANEY Article VI The name and address of the incorporator is: REV LANCE CHANEY 4312 POMELO BLVD BOYNTON BEACH, FL 33436 Incorporator Signature: LANCE CHANEY Article VII The initial officer(s) and/or director(s) of the corporation is/are- Title: C LANCE CHANEY REV 4312 POMELO BLVD BOYNTON BEACH, FL. 33436 US Title: VC LEE S REVIA 507 N.W. 8TH AVE BOYNTON BEACH, FL. 33435 US Title: S MARK KARAGEORGE 240 A MAIN BLVD BOYNTON BEACH, FL. 33435 Title: M RUBY ALLEN 4536 WOKKER DRIVE LAKE WORTH, FL. 33467 Article VIII The effective date for this corporation shall be: 09/18/2010 N10000008831 FILED September 20, 2010 Sec. Of State cgolden 969 rr w//%if r r ltsw PATHWAYS TO PROSPERITY, INC. BYLAWS ARTICLE I - NAME & PURPOSE SECTION 1: The name of the organization is called Pathways to Prosperity, Inc. SECTION 2: Pathways to Prosperity program shall operate as a program of St. John Missionary Baptist Church and is a 5010 organization whose sole purpose is to provide services to communities which include, but are not limited to: case management, adult and youth education, life skills training, employment placement and retention training, budgeting and finance classes, youth after school programs and other social activities. ARTICLE II - BOARD MEMBERS SECTION 1: The Board of Directors shall have the right to deny, or terminate, the membership of another board member according to the Board policies. SECTION 2: Each voting member of Pathways to Prosperity Board of Directors has one vote per scheduled meeting. ARTICLE III - MEETINGS OF BOARD OF DIRECTORS SECTION 1: The Board will meet 6 times per year. The dates of the meetings shall be set by the Board of Directors who shall also set the time and place. SECTION 2: Special meetings. Special meetings may be called by the chairperson, the Executive committee, or a simple majority of the Board of Directors. SECTION 3: Notice. Notice of each meeting shall be given to each voting member by mail and/or email. Each Board Member is distributed an annual calendar of scheduled meetings for each year. Read ahead documents will be forwarded via e-mail to each Board Member within 48 hours of upcoming Board meeting. ARTICLE IV - BOARD OF DIRECTORS SECTION 1: Board role, size, composition. The Board is responsible for overall policy and direction of Pathways to Prosperity programs, and delegate responsibility day to day operations P2P BYLAWS AMENDED 08/27/20 970 to the CEO/ Executive Director and staff. The Board shall have up to 12, and no less than five members. The Board receives no compensation other than reasonable expenses. SECTION 2: Meetings. The Board shall meet at least 6 times during the year at an agreed upon time and place. SECTION 3: Board Elections. Elections shall be held at the end of every year in accordance with the Board members term. SECTION 4: Board Governance Committee. A Board Governance Committee shall be appointed by the Board to represent diverse aspects of the organization as needed. The Board Governance Committee shall meet as necessary. The Board Governance Committee shall be responsible for Board training and leadership development. SECTION 5: Board Fund Development Committee. A Board Fund Development Committee shall meet as necessary and is responsible for researching and presenting to Board of Directors suggestions for Activities and Events to generate funding for the agency. SECTION 6: Election Procedures. The Board of Directors will vote on potential Board members, Officers and Committee members on the recommendation of the Board Governance Committee. The election will be held in accordance with the election procedures established by the Board of Directors. SECTION 7: Terms. All Board members shall serve three year terms, but are eligible for re- election. However, no Board member shall serve more than (3) three year terms, unless agreed upon by full Board. SECTION 8: Quorum. A quorum must be attended by at least 60 percent of the Board members before business can be transacted or motions made or passed. SECTION 9: Notice. Notice of each meeting shall be given to each voting member by mail and/ or e-mail. Each Board Member will be distributed an annual calendar of scheduled meetings for each year. Read ahead board documents will be forwarded vial e-mail to each Board Member within 48 hours of upcoming meeting. SECTION 10: Officers and Duties. There shall be four officers of the Board consisting of a Chair, Vice—chair, Secretary, and Treasurer. The Chair shall convene regularly scheduled Board meetings, shall preside or arrange for other members of the Executive committee to preside at each meeting in the following order: Vice—chair, Secretary or Treasurer. The Vice—chair will chair committees on special subjects as designated by the Board. The Secretary shall be responsible for keeping records of Board actions, including overseeing the taking of minutes at P2P BYLAWS AMENDED 08/27/20 971 all Board meetings, sending out meeting announcements, distributing copies of minutes and the agenda to each Board member, and assuring that corporate records are maintained. The Treasurer shall make a report at each Board meeting. The Treasurer shall chair the finance committee, assist in the preparation of the budget, help develop fund raising plans, and make financial information available to Board members. SECTION 11: Vacancies. When a vacancy on the Board exists, nominations for new members may be received from the Board Governance Committee two weeks in advance of a Board meeting. These nominations shall be sent out through the Board Governance Committee to Board members with the regular Board meeting announcement to be voted upon at the next meeting. All vacancies will be filled only to the end of the particular Board member's term. SECTION 12: Resignation, Termination, and Absences. Resignation from the Board must be in writing and received by Secretary. A Board member can be dropped for excess absences from the Board if he or she has three unexcused absences from Board meetings in a year. A Board member may be removed for other reasons by a majority vote of the remaining directors. SECTION 13: Special Meetings. Special meetings of the Board shall be called upon the request of the chair or one-third of the Board. Notices of special meetings shall be sent out by the Secretary to each Board member post marked two weeks in advance or as early as possible. ARTICLE V - COMMITTEES SECTION 1: The Board may create committees as needed. There shall be four standing committees — Executive, Fund Development, Finance/Audit, and Governance Committees. The Board chair appoints all committee chairs. Committee chairs must be members of the Board. SECTION 2: The four officers serve as the members of the Executive Committee. The Executive Committee shall review the performance of the Executive Director. Except for the power to amend the Articles of Incorporation and Bylaws, the Executive Committee shall have all of the powers and authority of the Board of Directors in the intervals between meetings of the Board of Directors, subject to the direction and control of the Board of Directors. SECTION 3: Finance/Audit Committee. The Treasurer shall serve on the Finance Committee, which includes two other Board members. The Finance Committee is responsible for developing and reviewing fiscal procedures, and annual budget, and all expenditures must be within the budget. Any major change in the budget must be approved by the Board or the Executive Committee. The fiscal year shall be October to September. Quarterly reports are required to be submitted to the Board showing income, expenditures and pending income. P2P BYLAWS AMENDED 08/27/20 972 SECTION 4: Executive Committee and Hiring Policy. The Executive Board is responsible for hiring the Executive Director. The Executive Director is responsible for hiring and supervising other staff. The Executive Committee shall operate as a grievance committee, and is responsible for developing a personnel policy. SECTION 5: Board Governance Committee. The Board Governance Committee responsibilities are spelled out according to Article IV Section 4. ARTICLE VI - DIRECTOR AND STAFF Section 1: Executive Director. The Executive Director is hired by the Board Executive Committee. The Executive Director has day to day responsibility for the organization including carrying out the organization's goals and Board policy. The Executive Director will attend all Board meetings, report on the progress of the organization, answer questions of Board members and carry out the duties described in the job description. The Board can designate other duties as necessary. ARTICLE VII - AMENDMENTS SECTION 1: These Bylaws may be amended when necessary by the majority of the Board of Directors. Proposed amendments must be submitted to the Secretary to be sent out with regular Board announcements. These Bylaws will be reviewed at least every 3 years by the Board of Directors. P2P BYLAWS AMENDED 08/27/20 973 Form 990 Return of Organization Exempt From Income Tux (Rev. January 2020) Under section 60i(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) Department of the Treasury ► Do not enter social security numbers on this form as it may be made public. Internal Revenue Service 1 0* Go to wwwJrs.gov1Form990 for instructions and the latest information. OMB No. 1545-0047 ti 2019 A For the 2019 calendar year, or tax year beginning 10-01 2019, and ending 09-30 , 2020 S' Check if appficable: C Name of organizationPATHWAYS TO PROSPERITY INC. Signature of officer D Employer identification number ❑ Address change 1 Doing business as ECONOMIC AND 27-3550271 ❑ Name change EMOTIONAL WELL BEING OF CHILDREN AND FAMILIES THROUGH EDUCATION AND SOCIAL SERVICES. Number and street (or P.O. box if mail is not delivered to street address)77Room/suite c R Date E Telephone number ❑ Initial return Pair 00 N SEACREST BLVD . ( c (561)736-1111 ❑ Final retum/terminated City or town, state or province, country, and ZIP or foreign postal code G Gross receipts ❑ Amended return YNTON BEACH FL 33435 $ 1&032,607 ❑ Application pending F Name and address of principal officer: REVIA LEE H(a) Is this a group return for subordinates? Li Yes W No AME AS C ABOVE H(b) Are all subordinates included? ❑ Yes ❑ No Tax-exempt status: 501(c)(3) ❑ 501 M ( ) (insert no.) ❑ 4947(a)(1) or ❑ 527 If "No," attach a list. (see instructions) J Website: l" N/A H(c) Group exemption number 01 K Fnrm of oroani7atinn- n ^ n Comnrafinn I I Trust I I Assnriafinn F] Other L Year of formatinn, gni 0 I M State of larval domicile, FT. t r REVIA LEE ummary Sign Signature of officer Date Here 1 Briefly describe the organization's mission or most significant activities: TO IMPROVE THE SOCIAL SPIRITUAL ECONOMIC AND m EMOTIONAL WELL BEING OF CHILDREN AND FAMILIES THROUGH EDUCATION AND SOCIAL SERVICES. c R Date Check ❑ if PTIN Pair Zenora. Kerr 'Ward CPA . ( c self employed P00961711 Proparer Firm's name 111' WARD AND OMPANY PA Firm's EIN Use Only Firm's n's address �' 5725 CORPORATE WAY SUITE 106 Phone no. WEST PALM BEACH FL 33407 0 2 Check this box ► ❑ if the organization discontinued its operations or disposed of more than 25% of its net assets. 0 3 Number of voting members of the goveming body (Part VI, line 1a) • • • • • • • • • • • • • • • • • • • • • 3 10 06 4 10 4 Number of independent voting members of the governing body (Part VI, line 1 b) • • • • • • • • • • • • • • • CDU) 5 15 > 5 Total number of individuals employed in calendar year 2019 (Part V, line 2a) 6 Total number of volunteers (estimate if necessary) • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 6 150 a 7a Total unrelated business revenue from Part VIII, column (C), line 12 • • • • • • • • • • • • • • • • • • • • • 7a 0 7b 0 b Net unrelated business taxable income from Form 990-T line 39 • • • • • • • • • • • • • • • • • • • • • Prior Year Current Year 861,313. 1,032,607 8 Contributions and grants (Part VIII, line 1h) • • • • • • • • • • • • • • • , • • • • • • • • 9 Program service revenue (Part Vlll, line 2g) • • • • • • • • • • • • • • • • • • • • • • 0 c 10 Investment income (Part VIII, column (A), lines 3, 4, and 7d) . • • • • • • • • • • • • • • • 0 0 11 Other revenue (Part VI l 1, column (A), lines 5, 6d, 8c, 9c, 10c, and 11 e) • • • • • • • • • • • 861,313 11032,607 12 Total revenue - add lines 8 through 11 (must equal Part VIII, column (A), line 12) • • • • • 13 Grants and similar amounts paid (Part IX, column (A), lines 1-3) • • • • • • • • • • • • • • 33,000 37,500 0 14 Benefits paid to or for members (Part IX, column (A), line 4) • • • • • • • • • • • • • • • • 566,110 606,868 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) • • • • • H 16a Professional fundraising fees (Part IX, column (A), line 11 e) • • • • • • • • • • • • • • 0 c b Total fundraising expenses (Part IX, column (D), line 25) 1* 0 a C0 X 17 Other expenses (Part IX, column (A), lines 11a-11 d, 11f -24e) • • • • • • • • • • • • • • • 318,328 329,735 917,438 974,103 18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) • • • • • • • (56,125) 58,504 19 Revenue less expenses. Subtract line 18 from line 12 • • • • . • • • • • • • • • • • • • 04) Beginning of Current Year End of Year 190,388 400,370 m� 20 Total assets (Part X, line 16) • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • ¢"9 21 Total liabilities (Part X, line 26) • • • • • • • • • • • • • . • • • • • • • • • • • • • • • • 29,374 180L852 zLL 22 Net assets or fund balances. Subtract line 21 from line 20 • • • • • • • • • • • • • • • • • 161,014 219,518 Part 11 igneture Bloch Under penalties of perjury, I declare that I have exar fined this return, including accompanying schedules and statements, and to the best of my, knowledge and belief, it is true, coned, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge. May the IRS discuss this return with the preparer shown above? (see instructions) • • • • • • • • • • • • • • • • • • • • • • • • • • • U Yes Xj No For Paperwork Reduction Act Notice, see the separate instructions. Form 990 (2019) EEA REVIA LEE Sign Signature of officer Date Here REVIA LEE, CHAIRPERSO?C Type or print name and title Printlrype preparer's name Preparer's signature Date Check ❑ if PTIN Pair Zenora. Kerr 'Ward CPA . ( 9-22-2021 self employed P00961711 Proparer Firm's name 111' WARD AND OMPANY PA Firm's EIN Use Only Firm's n's address �' 5725 CORPORATE WAY SUITE 106 Phone no. WEST PALM BEACH FL 33407 561-697-9468 May the IRS discuss this return with the preparer shown above? (see instructions) • • • • • • • • • • • • • • • • • • • • • • • • • • • U Yes Xj No For Paperwork Reduction Act Notice, see the separate instructions. Form 990 (2019) EEA in Form 990 (2019) PATHWAYS TO PROSPERITY INC. 27-3550271 Page, I" 'M� rt Statement of Program Service Accomplishments Check if Schedule O contains a response or note to any line in this Part III • • • • • • • • • • • • • • • • • • • . • • • . • • • . • ❑ 1 Briefly describe the organization's mission: TO IMPROVE THE SOCIAL SPIRITUAL ECONOMIC AND EMOTIONAL WELL BEING OF CHILDREN AND FAMILIES THROUGH EDUCATION AND SOCIAL SERVICES. 2 Did the organization undertake any significant program services during the year which were not listed on the priorForm 990 or 990 -EZ? • • • • • • • • • • • . • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • . • • ❑ Yes to If "Yes," describe these new services on Schedule O. 3 Did the organization cease conducting, or make significant changes in how it conducts, any program services? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes No If "Yes," describe these changes on Schedule O. 4 Describe the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported. 4a (Code: ) (Expenses $ 892,795 including grants of $ 37,500 ) (Revenue $ ) See SERVICES page for a description of this program service. 44b (Code: ) (Expenses $ 4c (Code: ) (Expenses $ including grants of $ including grants of $ ) (Revenue $ ) (Revenue $ 4d Other program services (Describe on Schedule O.) (Expenses $ including grants of $ ) (Revenue $ ) 4e Total program service expenses ► 892,795 EEA Form 990 (2019) W Form 990 (2019) PATHWAYS TO PROSPERITY INC. 27-3550271 Page; I- eft Checklist o Required' Schedul Yes No 1 Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," completeSchedule A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 X 2 2 Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? • • • • • • • • • • • • • • . X 3 Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? 11 "Yes,"complete Schedule C, Part I • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 3 X 4 Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If 'Yes, "complete Schedule C, Part 11 • • • • • • • • • • • • • • • • • • • • • • • • - 4 X 5 Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes,"complete Schedule C, Part III • • • • • • 5 6 Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part ••••••••••••••••••........................... 6 X 7 Did the organization receive or hold a conservation easement, including easements to preserve open space, the environment, historic land areas, or historic structures? If "Yes,"complete Schedule D, Part 1l • • • • • • • • • • • • • 7 X 8 Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part 111 . . . . . . . • . . . . . . . . • . . . . . . . . . . • • • • • • • • • • • • • • • • • • • • 8 X 9 Did the organization report an amount in Part X, line 21, for escrow or custodial account liability, serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes,"complete Schedule D, Part IV • • • • • • • • • • • • • • • • • • • • • • • • • • • • 9 X 10 Did the organization, directly or through a related organization, hold assets in donor -restricted endowments or in quasi endowments? If "Yes,"complete Schedule D, Part V • • • • • • • • • • • • • • • • • • • • • • • • • • • • 10 X 11 If the organization's answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable. a Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete Schedule D, Part VI • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Ila X b Did the organization report an amount for investments - other securities in Part X, line 12, that is 5% or more of its total assets reported in Part X, line 16? If 'Yes, "complete Schedule D, Part VII • • • • • • • • • • • • • • • • • • • • • • • 11b X c Did the organization report an amount for investments - program related in Part X, line 13, that is 5% or more of its total assets reported in Part X, line 16? If "Yes,"complete Schedule D, Part VIII • • • • • • • • • • • • • • • • • • • • • • 11c X d Did the organization report an amount for other assets in Part X, line 15, that is 5% or more of its total assets reported in Part X, line 16? If 'Yes, "complete Schedule D, Part IX • . • • • • • • • • • • • • • • • • • • • • • • • • • • • 11d X 11e e Did the organization report an amount for other liabilities in Part X, line 25? If "Yes,"complete Schedule D, PartX • • • • • • • X f Did the organization's separate or consolidated financial statements for the tax year include a footnote that addresses the organization's liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes,"complete Schedule D, PartX • • • • • • • 11f X 12a Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes,"complete Schedule D, Parts X1 and XII • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • . . • • • • • • • • • • 12a X b Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes, " and if the organization answered 'No" to line 12a, then completing Schedule D, Parts XI and X11 is optional • . . . . . . . . . 12b X 13 13 Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes,"complete Schedule E . • • • • • • • • • • • • • • • X 14a 14a Did the organization maintain an office, employees, or agents outside of the United States? • • • • • • • • • • • • • • • • • • • • X b Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If 'Yes, "complete Schedule F, Parts I and IV • • • • • • • • • • • • • • • • 14b X 15 Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If 'Yes, "complete Schedule F, Parts 11 and IV . . . • • . . • • • • • • • • • • • • • • • • • • • 15 X 16 Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If 'Yes, "complete Schedule F, Parts 111 and IV . . . . • . . . . • . . . • • • • • • • • 16 X 17 Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 1le? If 'Yes, "complete Schedule G, Part I (see instructions) • • • • • • • • • • • • • • • 17 X 18 Did the organization report more than $15,000 total of fundraising event gross income and contributions on PartVIII, lines lc and 8a? If "Yes,"complete Schedule G, Part II • . • • • • • • • • • • • • • • • • • • • . • • • • • • • • 18 X 19 Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes,"complete Schedule G, Part 111 • • • • • • • • • • • • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • 19 X 20a 20 a Did the organization operate one or more hospital facilities? If "Yes,"complete Schedule H • • • • • • • • • • • • • • • • • • • X 20b b If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? • • • • • • • • • • • • • • • 21 Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If "Yes,"complete Schedule I, Parts I and II . • • • • • • • • • • • • • • 21 X EEA Form 990 (2019) II,_ Form 990 (2019) PATHWAYS AYS TO PROSPERITY INC. 27-3550271 Page � Part IV Checklist of Required Schedules (continued) Yes No 22 Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If 'Yes, "complete Schedule/, Parts I and 111 . • • . • • • • • • • • • • • • • • • • • • • • • 22 X 23 Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization's current and former officers, directors, trustees, key employees, and highest compensated employees? If 'Yes, "complete Schedule J • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 23 X 24a Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If "Yes, "answer lines 24b through 24d and complete Schedule K. If 'No, "go to line 25a • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 24a X 24b b Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception? • • • • • • • • • • • • • • c Did the organization maintain an escrow account other than a refunding escrow at any time during the year todefease any tax-exempt bonds? • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 24c 24d d Did the organization act as an "on behalf of issuer for bonds outstanding at any time during the year? • • • • • • • • • • • • • • 25a Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes,"complete Schedule L, Part I • • • • • • • • • • • • • • • • • • 25a X b Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization's prior Forms 990 or 990 -EZ? If "Yes,"complete Schedule L, Part I • • • • • • • • • • • • • • .. • • . • • • • • • • • • • • • • • • • • • • • • • • • • 25b X 26 Did the organization report any amount on Part X, line 5 or 22, for receivables from or payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member or any of these persons? If "Yes, "complete Schedule L, Part ll . • • • • • • • • • • • • 26 X 27 Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons? If "Yes," complete Schedule L, Part III • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 27 X 28 Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions, for applicable filing thresholds, conditions, and exceptions): a A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If "Yes, " complete Schedule L, Part IV • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 28a X 28b b A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV . . • • • • • . • • • • • • • • . X c A 35% controlled entity of one or more individuals and/or organizations described in lines 28a or 28b? If "Yes," complete Schedule L, Part IV • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 28c X 29 29 Did the organization receive more than $25,000 in non-cash contributions? If 'Yes," complete Schedule M • • • • • • • • • • X 30 Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If 'Yes," complete Schedule M • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 30 X 31 31 Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes,"complete Schedule N, Part I • • • • • • • X 32 Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes, " complete Schedule N, Part 11 • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 32 X 33 Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes,"complete Schedule R, Part I • • • • • • • • • • • • • • • • • • • • • • • • • 33 X 34 Was the organization related to any tax-exempt or taxable entity?. If "Yes,"complete Schedule R, Part ll, lll, or IV, and Part V, line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 X 36a 35a Did the organization have a controlled entity within the meaning of section 512(b)(13)? • • • • • • • • • • • • • • • • • • • • X b If "Yes" to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If 'Yes, "complete Schedule R, Part V, line 2 • • . • • • • . • • • . • 36b X 36 Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non -charitable related organization?ff 'Yes," complete Schedule R, Part V, line 2 • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 36 X 37 Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes,"complete Schedule R, Part VI • • • • • • • • • 37 X 38 Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 b and 19? Note: All Form 990 filers are required to complete Schedule O. 38 X P 11 Statements Regarding Other IRS Filings and Tax Compliance Check if Schedule O contains a response or note to any line in this Part V .................... n Yes I No 1a Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable • • • • • • • • • • • • • • • la g b Enter the number of Form W -2G included in line 1 a. Enter -0- if not applicable • • • • • • • • • • • • • • lb 0 c Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners. 0 • • • • • . • • • • • • • • • • • • • • • • • • • • • • • • • • • • • I IL. I x EEA Form 990 (2019) Form 990 (201 27-3550271 00 m � rar't v'{ btatementS K09af"oin CAtner" 1Kb 1-11111 5 SI" a I nt uompiia is (continued) Yes No 2a Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements, filed for the calendar year ending with or within the year covered by this return • • • • • • 2a 15 b If at least one is reported on line 2a, did the organization file all required federal employment tax returns? • • • • • • • • • • • • • • 2b X Note: If the sum of lines 1 a and 2a is greater than 250, you may be required to a -file (see instructions) • • • • • • • • • • • • 3a Did the organization have unrelated business gross income of $1,000 or more during the year? • . . . . . . . • • • • • • • • • • 3a X 3b b If "Yes," has it filed a Form 990-T for this year? If No" to line 3b, provide an explanation in Schedule 0 • • • • • • • • • • • • 4a At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? • • • • • • • • 4a X b If "Yes," enter the name of the foreign country ► See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR). 5a Was the organization a parry to a prohibited tax shelter transaction at any time during the tax year? • • • • • • • • • • • • • • • • • 5a X 5b X b Did any taxable party notify the organization that it was or is a parry to a prohibited tax shelter transaction? • • • • • • • • • • • • • Sc c If "Yes" to line 5a or 5b, did the organization file Form 8886-T? • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 6a Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? • • • • • • • • • • • • • • • • • • 6a X b If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 6b 7 Organizations that may receive deductible contributions under section 170(c). a Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods . and services provided to the payor? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7a_ X 7b b If "Yes," did the organization notify the donor of the value of the goods or services provided? • • • • • • • • • • • • • • • • • • • c Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . 7c X d If "Yes," indicate the number of Forms 8282 filed during the year • • • • • • • • • • • • • • • • • • • • • • 7d 7e X e Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? • • • • • • • • • 7f X f Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? • • • • • • • • • • • • 7g X g If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? • • • 7h X h If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-c? • • • • • • • • • 8 Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? • • • • • • • • • • • • • • • • • • • • • • 8 9 Sponsoring organizations maintaining donor advised funds. a Did the sponsoring organization make any taxable distributions under section 4966? • • • • • • • • • • • • • • • • • • • • • • • 9a 9b b Did the sponsoring organization make a distribution to a donor, donor advisor, or related person? • • • • • • • • • • • • • • • • 10 Section 501(c)(7) organizations. Enter: a Initiation fees and capital contributions included on Part VIII, line 12 . • • • • • • • • • • • • • • • • • • • • • 10a b Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities • • • • • • • • • • • • 10b 11 Section 501(c)(12) organizations. Enter: a Gross income from members or shareholders • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 11a b Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) • . • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 11b 12a Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041? • . . • . • . . . . . 12a b If "Yes," enter the amount of tax-exempt interest received or accrued during the year • • • • • • • • • • • 12b 13 Section 501(c)(29) qualified nonprofit health insurance issuers. a Is the organization licensed to issue qualified health plans in more than one state? • • • • • • • • • • • • • • • • • • • • • • • 13a Note: See the instructions for additional information the organization must report on Schedule O. b Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans • • • • • • • • • • • • • • • • • • • • • • • • • 13b cEnter the amount of reserves on hand • • • • . • • • • • • • • • • • • • • • • • • • • • • • • • • • • 13c 14a X 14a Did the organization receive any payments for indoor tanning services during the tax year? • • • • • • • • • • • • • • • • • • • 14b b If "Yes," has it filed a Form 720 to report these payments? If "No, "provide an explanation on Schedule 0 • • • • • • • • • • • • • 15 Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excessparachute payment(s) during the year? • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 15 X If "Yes," see instructions and file Form 4720, Schedule N. 16 Is the organization an educational institution subject to the section 4968 excise tax on net investment income? • • • • • • • • • • • 16 X If "Yes," complete Form 4720, Schedule O. EEA Form 990 (2019) a) Form 990 (2019) PATHWAYS TO PROSPERITY INC. 27-3550271 Page f I" l rt t governance, Management, and Disclosure For each "Yes"response to lines 2 through 7b below, and for a "No" response to line 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions. Check if Schedule O contains a response or note to any line in this Part VI . . • • • • • • • • • • • • • • • • • • • • • • • • • • n Yes I No 1a Enter the number of voting members of the governing body at the end of the tax year • • • • • • • • • 1a 10 Yes No If there are material differences in voting rights among members of the governing body, or X 10a Did the organization have local chapters, branches, or affiliates? • • • • • • • • • • • • • • • • • • • • • • • • • • • • • if the governing body delegated broad authority to an executive committee or similar b If "Yes," did the organization have written policies and procedures governing the activities of such chapters, committee, explain on Schedule O. 10b b Enter the number of voting members included in line 1 a, above, who are independent • • • • • • • • • 1 b 10 X 11a Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? 2 Did any officer, director, trustee, or key employee have a family relationship or a business relationship with b Describe in Schedule O the process, if any, used by the organization to review this Form 990. any other officer, director, trustee, or key employee? • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 2 X R 12b X 3 Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors, or trustees, or key employees to a management company or other person? . • • . • • . • 3 X 4 12c X 4 Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? • • • • 5 X X 5 Did the organization become aware during the year of a significant diversion of the organization's assets? • • • • • • • • 6 X X 6 Did the organization have members or stockholders? • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 7a Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 7a X a The organization's CEO, Executive Director, or top management official • • • • • • • • • • • • • • • • • • • • • • • • • • • • 15a X b Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 7b X 8 Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following: aThe governing body? . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16a X i8aX X b Each committee with authority to act on behalf of the governing body? • • • • • • • • • • • • • • • • • • • • • • • • • • participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the 9 Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the or anization's mailing address? If "Yes, "provide the names and addresses on Schedule O • • • • • • • • • • • • • • • 9 X Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.) 17 List the states with which a copy of this Form 990 is required to be filed ► 18 Section 6104 requires an organization to make its Forms 1023 (1024 or 1024-A if applicable), 990, and 990-T (Section 501(c) (3)s only) available for public inspection. Indicate how you made these available. Check all that apply. ❑ Own website ❑ Another's website © upon request ❑ Other (explain on Schedule O) 19 Describe on Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year. 20 State the name, address, and telephone number of the person who possesses the organization's books and records M KEMBERLY BUSH (561)736-1111, 900 N SEACREST BLVD, BOYNTON BEACH, FL 33435 EEA Form 990 (2019) Yes No 10a X 10a Did the organization have local chapters, branches, or affiliates? • • • • • • • • • • • • • • • • • • • • • • • • • • • • • b If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? • • • • • • • • • • 10b 11a X 11a Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? b Describe in Schedule O the process, if any, used by the organization to review this Form 990. 12a Did the organization have a written conflict of interest policy? If 'No, "go to line 13 • • • • • • • • • • • • • • • • • • • • • • 12a X 12b X b Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? c Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 12c X 13 X 13 Did the organization have a written whistleblower policy? • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 14 X 14 Did the organization have a written document retention and destruction policy? • • • • • • • • • • • • • • • • • • • • • 15 Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision? a The organization's CEO, Executive Director, or top management official • • • • • • • • • • • • • • • • • • • • • • • • • • • • 15a X 15b X b Other officers or key employees of the organization • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions). 16a Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? • • • . . • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 16a X b If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization's exempt status with respect to such arrangements? • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 16b Section C. Disclosure 17 List the states with which a copy of this Form 990 is required to be filed ► 18 Section 6104 requires an organization to make its Forms 1023 (1024 or 1024-A if applicable), 990, and 990-T (Section 501(c) (3)s only) available for public inspection. Indicate how you made these available. Check all that apply. ❑ Own website ❑ Another's website © upon request ❑ Other (explain on Schedule O) 19 Describe on Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year. 20 State the name, address, and telephone number of the person who possesses the organization's books and records M KEMBERLY BUSH (561)736-1111, 900 N SEACREST BLVD, BOYNTON BEACH, FL 33435 EEA Form 990 (2019) 0 Form 990 (2019) PATHWAYS TO PROSPERITY INC. 27-3550271 Page, 00 sac Compensatioin--of OffiCen, Directors, Trustees, Key Employees, Highest Compensated Employees, and °) Independent Contractors Check if Schedule O contains a response or note to any line in this Part VII . • • • . • • • • • • • • • • • • • • • • • • • • • • • ❑ Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees 1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization's tax year. • List all of the organization's current officers, directors, trustees (whether individuals or organizations), regardless of amount of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid. • List all of the organization's current key employees, if any. See instructions for definition of "key employee." + List the organization's five current highest compensated employees (other than an officer, director, trustee, or key employee) who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the organization and any related organizations. e List all of the organization's former officers, key employees, and highest compensated employees who received more than $100,000 of reportable compensation from the organization and any related organizations. i List all of the organization's former directors or trustees that received, in the capacity as a former director or trustee of the organization, more than $10,000 of reportable compensation from the organization and any related organizations. See instructions for the order in which to list the persons above. R] Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee. EEA Form 990 (2019) (c) A () 6 ( ) Position D () E () F ( ) (do not check more than one Name and lige Average box, unless person is both an Reportable Reportable Estimated amount hours officer and a director/trustee) compensation compensation of other per week from the from related compensation (list any organization organizations from the hours for o H 3 0 m o (W-2/1099-MISC) (W-2/1099-MISC) organization and related n a a o CD 3 o related organizations organizations a m S m 3 below 2 dotted line) m m m a (1) REVIA LEE1.00 ___________________ _____ CHAIRPERSON X X 0 0 0 (2) MAGUENE CADET 1.00 VICE CHAIRMAN X X 0 0 0 (3) OCTAVIA BELL 1.00 TREASURER X X 0 0 0— (4) AUDREY DAVIS ---------------------------- 2.00 ----- SECRETARY X X 0 0 0 (5) - --- - - - - - - - - - - - - - - - - - - - - - - -- - - - -- (6) ---------------------------- ----- (7) - --- - - - - - - - - - - - - - - - - - - - - - - -- ----- (6) - --- - - - - - - - - - - - - - - - - - - - - - - -- - - - -- (9) (10) - --- - - - - - - - - - - - - - - - - - - - - - - -- - - - -- (11) __________________________ _____ (12) - --- - - - - - - - - - - - - - - - - - - - - - - -- - - - -- (13) - --- - - - - - - - - - - - - - - - - - - - - - - -- - - - -- (14) EEA Form 990 (2019) V - Form 990 (2019) PATHWAYS TO PROSPERITY INC. 27-3550271 Page t 00 2 Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization ► 0 Yes No 3 Did the organization list any former officer, director, trustee, key employee, or highest compensated employee on line 1a? If "Yes,"complete Schedule J for such individual • • • • • • • • • • • • • • • • • • . • • • • • • • 3 X 4 For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes,"complete Schedule J for such individual......................................................... 4 X 5 Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes,"complete Schedule J for such person • • • . . • • • • • • . • • • • • 5 X Section B. Independent Contractors 1 Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization's tax year. (A) (B) (c) Name and business address Description of services Compensation 2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization ► EEA Form 990 (2019) (c) (A) (B) Position (D) (E) (F) (do not check more than one Name and title Average box, unless person is both an Reportable Reportable Estimated amount hours officer and a directorttrustee) compensation compensation of other per week from the from related compensation (list any organization organizations from the hours for a 2 m = m (W-2/1099-MISC) (W-2/1099-MISC) organization and related S° ° �n related organizations ° organizations q below M ig dotted line) B (15) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (16) - --- - - - - - - - - - - - - - - - - - - - - - - -- - - - -- (17) (18) (19) - --- - - - - - - - - - - - - - - - - - - - - - - -- ----- (20) ---------------------------- ----- (21) - --- - - - - - - - - - - - - - - - - - - - - - - -- ----- (22) ---------------------------- ----- (23) ---------------------------- ----- (24) ---------------------------- ----- (25) ---------------------------- ----- 1b Subtotal . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . ► c Total from continuation sheets to Part VII, Section A . . . . . . . . . • . • . • ► 0 0 0 d Total (add lines 1b and 1c) • • • • • • . . • . . .. . . . . . . . . . . • • • • • ► 2 Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization ► 0 Yes No 3 Did the organization list any former officer, director, trustee, key employee, or highest compensated employee on line 1a? If "Yes,"complete Schedule J for such individual • • • • • • • • • • • • • • • • • • . • • • • • • • 3 X 4 For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes,"complete Schedule J for such individual......................................................... 4 X 5 Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes,"complete Schedule J for such person • • • . . • • • • • • . • • • • • 5 X Section B. Independent Contractors 1 Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization's tax year. (A) (B) (c) Name and business address Description of services Compensation 2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization ► EEA Form 990 (2019) N Form 990 (2019) PATHWAYS TO PROSPERITY INC. 27-3550271 Page E 00 et Statement O Revenue Check if Schedule O contains a resnonse or note to anv line in this Part VIII . . . . . . • . . . . . • • • • • • • • • • • • • • • • n EEA Form 990 (2019) (A) (B) (C) (o) Total revenue Related or exempt Unrelated Revenue excluded function revenue business revenue from tax under sections 512-514 1a Federated campaigns • • • • • • • • 1a 11b '442 to 0 00 b Membership dues • • • • • • • • • • c Fundraising events • • • • • • • • • d Related organizations • • • • • • • • a Government grants (contributions) 1c 1d 1e 889,055 1f 143,552 a� f All other contributions, gifts, grants, and similar amounts not included above g Noncash contributions included in .,.., c lines 1a -1f . . . . . . • • • • • • • h Total. Add lines 1a -1f • • • • • • • • 1g $ 1,032,607 • • • • • • • • • • ► Business Code d c 2a C LVd li d e f All other program service revenue • • • • • • • • • • • • r. g Total. Add lines 2a -2f • • • • • • • • • • • • 3 Investment income (including dividends, interest, and other similar amounts) • • • • • • • • • • • • • • • • • • • 0, 4 Income from investment of tax-exempt bond proceeds • • • ► 5 Royalties . . . . . . . . . . . . . . . . . . . . . . . . • ► (i) Real (ii) Personal 6a Gross rents • • • • • • 6a b Less: rental expenses 6b c Rental income or (loss) 6c d Net rental income or (loss) • • • • • • • • • • • • • • • • ► 7a Gross amount from (i) Securities (ii) other sales of assets c y otherthan inventory 7a b Less: cost or other basis and sales expenses 7b" c Gain or (loss) . . . . . 7c d Net gain or (loss) • • • • • • • • • • • • • • • • • • • • • 110- , 8a 8a Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 • • • • • • • • 8a b Less: direct expenses • • • • • • • • • 8b c Net income or (loss) from fundraising events • • • • • . ►° 9a Gross income from gaming activities, See Part IV, line 19 • • • • • 9a b Less: direct expenses • • • • • • • • • 9b% c Net income or (loss) from gaming activities . • • • • • • • ► 10a Gross sales of inventory, less returns and allowances • • • • • • • • • 10a b Less: cost of goods sold • • • • • • • • 10b c Net income or (loss) from sales of inventory • • • • • • • • ► Business Code U) OW c 11a b c d All other revenue • • • • • • • • • • e Total. Add lines 11 a-11 d • • • . . . • . . • • . . . . • ► 12 Total revenue. See instructions . • • • . . • . • . • . . • ► 1,032,607 0 1 01 0 EEA Form 990 (2019) M Form 990 (2019) PAThVAYS TO PROSPERITY INC. 27-3550271 Page 1i 00 Part IX I Statement of Functional Expenses Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A). Check if Schedule O contains a response or note to any line in this Part IX . . . . . . . . • • • . • . . . • • • • • • . • . . . . . Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part Vlll. (A) Total expenses (B) Program service expenses (c) Management and general expenses (D) Fundraising expenses 1 2 3 4 5 6 7 8 9 10 11 aManagement bLegal c d e f g 12 13 14 15 16 17 18 19 20 21 22 23 24 a Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 Grants and other assistance to domestic individuals. See Part IV, line 22 • • . • • • • • . . . . Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16 • • • • Benefits paid to or for members • • • • • • • • • • • Compensation of current officers, directors, trustees, and key employees • • • • • • • • • • • • • Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) • • • • • Other salaries and wages • • • • • • • • • • • • • • Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) Other employee benefits • • • • • • • • • • • • • • • Payroll taxes • • • • • • • • • • • . . . • • . . . . . Fees for services (nonemployees): ......••••••.......•• ......................... Accounting . . . . . . . . . . . . • . . . . . . . • • Lobbying . . . . . . . . . . . . . . . . . . . . . . . Professional fundraising services. See Part IV, line 17 - Investment management fees • • • • • • • • • • • • • Other. (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O.) • • Advertising and promotion • • • • • • • • • . . . . . Office expenses • • • • • • • • • • • • • • . • . . . Information technology • • • • • • • • • • • • • • • Royalties . . . . . . . . . .. . . . . . . . • • • • • Occupancy •••••••••••••••••••••• Travel ••••...•........•..••... Payments of travel or entertainment expenses for any federal, state, or local public officials • • • • • Conferences, conventions, and meetings • • • • • • • Interest • • • • • • • • • • • • • • • • • • • • • • • Payments to affiliates • • • • • • • • • • • • • • • • Depreciation, depletion, and amortization • . • . . . . Insurance . . . . . . . . . . . . . . . . . . • • • • Other expenses. Itemize expenses not covered above (List miscellaneous expenses on line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.) SPECIFIC ASSISTANCE 37,500 37,500 492,665 484,523 8,142 75,114 73,152 1,962 39,089 38,468 621 26,500 26,500 11,404 11,260 144 17,455 17,455 15,863 12r959 2 904 81,664 1,833 .83,497 2,303 1,357 946 11,050 8 027 3,023 659 220 439 5,106 5 106 82,603 32,994 49,609 b PROGRAM EXPENSES 7,958 6 419 1,539 c SPONSORED EVENTS 28,352 23,450 4 902 d OFFICE SUPPLIES 8,112 5,995 2 117 e 26 All other expenses Total functional expenses. Add lines 1 through 24e• . . 28,873 25,746 3,127 974,103 892,795 81,308 0 26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here No. ❑ if following SOP 98-2 (ASC 958-720) • • • • • • • • • • EEA Form 990 (2019) Iq Form 990 (2019) PATHWAYS TO PROSPERITY INC. 27-3550271 Pagel, 00 Balance Sheet Check if Sr_hedule O contains a resnonse or note to anv line in this Pad X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . n EEA Form 990 (2019) (A) (B) Beginning of year End of year 1 Cash - non-interest-bearing • • • • • • • • • • • • • • • • • • • • • • • • • 96,416 1 293,351 2 2 Savings and temporary cash investments • • • • • • • • • • • • • • • • • • • 84,350 3 96,900 3 Pledges and grants receivable, net • • • • • • • • • • • • • • • • • • • • • • 4 4 Accounts receivable, net . . . . . . . . . . . . . . . . . . . . . . . . • • • 5 Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons • • • • • • • • • • • • 5 6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) • • • • • 6 7 y Q 7 Notes and loans receivable, net . . . . . . • . . . . . . . . . . . . . • • • 8 Inventories for sale or use • • • • • • • • • • • • • • • • • • • • • • • • • • 9 Prepaid expenses and deferred charges • • • • • • • • • • • • • • • • • • • 8 2,544 9 2,685 10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D • • • • • • • 10a 13,126 b Less: accumulated depreciation • • • • • • • • • • • 10b 11,692 1,078 10c 1,434 11 11 Investments - publicly traded securities • • • • • • • • • • • • • • • • • • • • 12 12 Investments - other securities. See Part IV, line 11 • • • • • • • • • • • • • • 13 13 Investments - program -related. See Part IV, line 11 • • • • • • • • • • • • • • 14 14 Intangible assets • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 6,000 15 6,000 15 Other assets. See Part IV, line 11 • . . . . . . . . . . . . . . • • • . . • . . 190,388 16 400,370 16 Total assets. Add lines 1 through 15 (must equal line 33) . . . . . . . . . . . 17 Accounts payable and accrued expenses • • • • • • • • • • • • • • • • • • • 29,374 17 180,852 18 18 Grants payable • • • • • • . . . . . . . . . . . . . . . . . . . . . . . . • • 19 19 Deferred revenue . . . . . . . . . . . . . . . . . . . . . . . . • • • • • • 20 20 Tax-exempt bond liabilities . . . . . . . . . . . . . . . . . . . . . . . . • • 21 21 Escrow or custodial account liability. Complete Part IV of Schedule D • • • • • 22 Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons • • • • • • • • • • • • 22 23 Secured mortgages and notes payable to unrelated third parties • • • • • • • 23 24 24 Unsecured notes and loans payable to unrelated third parties • • • • • • • • • 25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 25 29,374 26 180,852 26 Total liabilities. Add lines 17 through 25 • • • • • • • • • • • • • • • • • • • Organizations that follow FASB ASC 958, check here ► El 0 e and complete lines 27, 28, 32, and 33. 27 Net assets without donor restrictions • • • • • • • • • • • • • • • • • • • • • (47,920) 27 (39,379) 208,934 28 258,897 28 Net assets with donor restrictions • • • • • • • • • • • • • • • • • • • • • • LL Organizations that do not follow FASB ASC 958, check here ► ❑ and complete lines 29 through 33. 0 29 Capital stock or trust principal, or current funds • • • • • • • • • • • • • • • • • • 29 f a 30 Paid -in or capital surplus, or land, building, or equipment fund • • • • • • • • 31 Retained earnings, endowment, accumulated income, or other funds • • • • • 30 31 161 014 32 219,518 32 Total net assets or fund balances • • • • • • • • • • • • • • • • • • • • • • • 33 Total liabilities and net assets/fund balances • . . . . • • • • . . • • • • • • 190,388 33 400,370 EEA Form 990 (2019) Ln Form 990 (2019) PATHWAYS TO PROSPERITY INC. 27-3550271 Page 1; 00 a ` I Reconciliation of Not as Check if Schedule O contains a response or note to any line in this Part XI • • • • • • • • • • • • • • • • • • • • • • • • • • • • ❑ 1 Total revenue (must equal Part VIII, column (A), line 12) • • • • . . • • • • • • • • • • • • • • • • • • • • • • 1 1 1,032.607 2 Total expenses (must equal Part IX, column (A), line 25) • • • • • • • • • • • • • • • • • • • • • • • • • • • 3 Revenue less expenses. Subtract line 2 from line 1 • • • • • • . • • • • • • • • • • • • • • • • • • • • • • • • • 4 Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) • • • • • • • • • • • • • 5 Net unrealized gains (losses) on investments • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 6 Donated services and use of facilities • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 7 Investment expenses • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 8 Prior period adjustments • .. . . . . . . . . . . . . . . • • . . . . . . • • • . . . . . . . . . . . . . • • • • 9 Other changes in net assets or fund balances (explain on Schedule O) • • • • • • • • • • • • • • • • • • • • • 10 Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B)) . . . . . .. . .. . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . 58 l attXll Financial Statements and Reporting Check if Schedule O contains a response or note to anv line in this Part XII . • • • • • • • • • • • • • • • • • • • • • • • . . . • n 1 Accounting method used to prepare the Form 990: ❑ Cash ® Accrual ❑ Other If the organization changed its method of accounting from a prior year or checked "Other," explain in Schedule O. 2a Were the organization's financial statements compiled or reviewed by an independent accountant? • • • • • • • • • • • • • • If "Yes," check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both: ® Separate basis ❑ Consolidated basis ❑ Both consolidated and separate basis b Were the organization's financial statements audited by an independent accountant? • • • • • • • • • • • • • • • • • • • • • If "Yes," check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both: ® Separate basis ❑ Consolidated basis ❑ Both consolidated and separate basis c If "Yes" to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? • • • • • • • • • If the organization changed either its oversight process or selection process during the tax year, explain on Schedule O. 3a As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-1 33? • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • b If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why on Schedule O and describe any steps taken to undergo such audits • • • • • • • • • • • EEA No Form 990 (2019) SCHEDULEA Public Charity Status and Public Support OMB No. 1545-0047 (Form 990 or 1390-EZ) Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust. 2019 Department of the Treasury Ili Attach to Form 990 or Form 990-EZ. Open to PUMIC Internal Revenue Service to Go to www.ft.gov/Porm990 for instructions and the latest information. Inspection Name of the organization Employer identification number PATHWAYS TO PROSPERITY INC. 27-3550271 " Ftft91fton for Pub fie Char)t1P Status (All OrazinizatiOnS must COmr)lete this Dart.) See instructions. The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.) 1 ❑ A church, convention of churches, or association of churches described in section 170(b)(1)(A)(1). 2 ❑ A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990 -EZ).) 3 ❑ A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii). 4 ❑ A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state: 5 ❑ An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.) 6 ❑ A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v). 7 ® An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.) 8 ❑ A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.) 9 ❑ An agricultural research organization described in section 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non -land-grant college of agriculture (see instructions). Enter the name, city, and state of the college or university: 10 ❑ An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions - subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.) 11 ❑ An organization organized and operated exclusively to test for public safety. See section 50%a)(4). 12 ❑ An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g. a ❑ Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B. b ❑ Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C. c ❑ Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E. d ❑ Type III non -functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V. e ❑ Check this box if the organization received a written determination from the IRS that it is a Type I, Type ll, Type III functionally integrated, or Type III non -functionally integrated supporting organization. f Enter the number of supported organizations • • . • • • • • • • • • • • • • • • • • . • • • • • . • • • • • • • • • • • • • . 0 g Provide the following information about the supported organization(s). (i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1-10 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions) Yes No (A) (e) (C) (D) (E) Total For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990 -EZ. Schedule A (Form 990 or 990 -EZ) 2019 EEA W 00 M I- 00 rn Schedule A (Form 990 or 990 -EZ) 2019 PATHWAYS TO PROSPERITY INC. 27-3550271 Pagel Part If Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 1 0(b)(1)( )(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part 111. If the organization fails to qualify under the tests listed below, please complete Part III.) Section A. Public SUDoort Calendar year (or fiscal year beginning in) o, (a) 2015 (b) 2016 (c) 2017 (d) 2018 (e) 2019 ( Total 1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . . .. . . 634,986 984,238 882,35 861,31 1,031,157 4 394 053 2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf ...... . 3 The value of services or facilities furnished by a governmental unit to the organization without charge ...... . 634,986 984,2381 882,359 861,313 1,031,157 4 394 053 4 Total. Add lines 1 through 3 . • • .... 5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) ...... . 4,394,053 6 Public support. Subtract line 5 from line 4 ection cs. (oxai : upporr Calendar year (or fiscal year beginning in)oo, (a) 2015 (b) 2016 c) 2017 d) 2018 (e) 2019 f) Total 7 Amounts from line 4 .. . .. . . . .. . . 634,986 984,238 882,35 861,31 1,031,157 4 394053 8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources ..... . • ...... . 9 Net income from unrelated business activities, whether or not the business is regularly carried on .. ........ . 10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ........... . 11 Total support Add lines 7 through 10 . 4 394 053 4 12 Gross receipts from related activities, etc. (see instructions) . ...... • ......... • . . • 12 13 First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here . .. . . • . • . • . • • • • . • • • • • • • • • • • . • • • • • • • • • • • . 14 Public support percentage for 2019 (line 6, column (f) divided byline 11, column (f)) ......... 141 100.00 % 15 Public support percentage from 2018 Schedule A, Part 11, line 14 ......... • ......... 15 1 100.00 % 16a 33 1/3% support test - 2019. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box and stop here. The organization qualifies as a publicly supported organization .................. ..... w► b 33 1/3% support test - 2018. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this box and stop here. The organization qualifies as a publicly supported organization ........... • ... ..... El 17a 10% -facts -and -circumstances test - 2019. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more, and if the organization meets the "facts -and -circumstances" test, check this box and stop here. Explain in Part VI how the organization meets the "facts -and -circumstances" test. The organization qualifies as a publicly supported organization............................................................. ❑ b 10% -facts -and -circumstances test - 2018. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or more, and if the organization meets the "facts -and -circumstances" test, check this box and stop here. Explain in Part VI how the organization meets the "facts -and -circumstances" test. The organization qualifies as a publicly supported organization ....................................................... ❑ 18 Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see instructions............................................................. ► fl EEA Schedule A (Form 990 or 990 -EZ) 2019 00 co M Schedule A (Form 990 or 990 -EZ) 2019 PATHWAYS TO PROSPERITY INC. 27-3550271 Page's Part (Il Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box On line 10 of Part I or if the organization failed to qualify under Part 11. If the organization fails to qualify under the tests listed below, please complete Part II.) Section A. Public Sunnort Calendar year (or fiscal year beginnings in)► (a) 2015 (b) 2016 (c) 2017 (d) 2018 e) 2019 (f) Total 9 Amounts from line 6 .. .. • • .... . 10a Gross income from interest, dividends, 1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") royalties, and income from similar sources b Unrelated business taxable income (less section 511 taxes) from businesses 2 Gross receipts from admissions, merchandise sold or services performed, or facilities acquired after June 30, 1975 ..... . furnished in any activity that is related to the c Add lines 10a and 10b ......... . 11 Net income from unrelated business activities not included in line 10b, whether organization's tax-exempt purpose or not the business is regularly carried on 12 Other income. Do not include gain or loss from the sale of capital assets 3 Gross receipts from activities that are not an unrelated trade or business under section 513 . (Explain in Part VI.) ... ........ . 13 Total support (Add lines 9, 10c, 11, and 12.) ................. 4 Tax revenues levied for the organization's benefit and either paid to 14 First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth organization, check this box and stop here • . • . • ... • • . • . • • • . • .. • • • • • • • • • • • • • • • • • • • • • • • • • ► ❑ Section C. Computation of Public Support Percentage 15 Public support percentage for 2019 (line 8, column (f),divided byline 13, column (f)) or expended on its behalf ....... . 16 % 16 Public support percentage from 2018 Schedule A, Part III, line 15 ..... • • . • • • • • ...... Section D. Computation of Investment Income Percentage 17 Investment income percentage for 2019 (line 10c, column (f), divided byline 13, column (f))...... 17 % 18 Investment income percentage from 2018 Schedule A, Part III, line 17............ • . • • • • 18 % 19a 33 1/3% support tests - 2019. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization . ► ❑ b 33 1/3% support tests - 2018. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3%, and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ► ❑ 20 Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions. ... ► ❑ 5 The value of services or facilities furnished by a governmental unit to the organization without charge • ... • . . 6 Total. Add lines 1 through 5 ...... . 7a Amounts included on lines 1, 2, and 3 received from disqualified persons . • . b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1 % of the amount on line 13 for the year c Add lines 7a and 7b .. ........ . 8 Public support. (Subtract line 7c from line 6.) ....... ... ........ . becTion ts. ioxai buppori Calendar year (or fiscal year beginning in)► (a) 2015 (b) 2016 (c) 2017 (d) 2018 e) 2019 f) Total 9 Amounts from line 6 .. .. • • .... . 10a Gross income from interest, dividends, payments received on securities loans, rents, royalties, and income from similar sources b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975 ..... . c Add lines 10a and 10b ......... . 11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on 12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ... ........ . 13 Total support (Add lines 9, 10c, 11, and 12.) ................. tax year as a section 501(c)(3) 14 First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth organization, check this box and stop here • . • . • ... • • . • . • • • . • .. • • • • • • • • • • • • • • • • • • • • • • • • • ► ❑ Section C. Computation of Public Support Percentage 15 Public support percentage for 2019 (line 8, column (f),divided byline 13, column (f)) 15 16 % 16 Public support percentage from 2018 Schedule A, Part III, line 15 ..... • • . • • • • • ...... Section D. Computation of Investment Income Percentage 17 Investment income percentage for 2019 (line 10c, column (f), divided byline 13, column (f))...... 17 % 18 Investment income percentage from 2018 Schedule A, Part III, line 17............ • . • • • • 18 % 19a 33 1/3% support tests - 2019. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization . ► ❑ b 33 1/3% support tests - 2018. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3%, and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ► ❑ 20 Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions. ... ► ❑ EEA Schedule A (Form 990 or 990 -EZ) 2019 a) Schedule A (Form 990 or 990 -EZ) 2019 PATHWAYS TO PROSPERITY INC. 27-3550271 Page 00 Part 1 SupportingOrganizations anizations (Complete only if you checked a box in line 12 on Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.) 1 Are all of the organization's supported organizations listed by name in the organization's governing documents? If "No, " describe in Part VI how the supported organizations are designated. If designated by class or purpose, describe the designation. If historic and continuing relationship, explain. 2 Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes,"explain in Part V1 how the organization determined that the supported organization was described in section 509(a)(1) or (2). 3a Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes,"answer (b) and (c) below. b Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes,"describe in Part V1 when and how the organization made the determination. c Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes, " explain in Part V1 what controls the organization put in place to ensure such use. 4a Was any supported organization not organized in the United States ("foreign supported organization")? If "Yes," and if you checked 12a or 12b in Part 1, answer (b) and (c) below. b Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If "Yes, " describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations. c Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If "Yes,"explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes. 6a Did the organization add, substitute, or remove any supported organizations during the tax year? If "Yes," answer (b) and (c) below (if applicable). Also, provide detail in Part Vt including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document). b Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document? c Substitutions only. Was the substitution the result of an event beyond the organization's control? 6 Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization's supported organizations? If 'Yes," provide detail in Part Vt. 7 Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (as defined in section 4958(c)(3)(13)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If "Yes, " complete Part I of Schedule L (Form 990 or 990 -EZ). 8 Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If "Yes, " complete Part I of Schedule L (Form 990 or 990 -EZ). 9a Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If "Yes, "provide detail in Part Vl. b Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If "Yes,"provide detail in Part Vt. c Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If "Yes, "provide detail in Part Vl. 10a Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non -functionally integrated supporting organizations)? If "Yes,"answer 10b below. b Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings.) EEA MM Schedule A (Form 990 or 990 -EZ) 2019 or 990 -EZ) 2019 PATHWAYS "F« AYS TO PROSPERITY. INC. 11 Has the organization accepted a gift or contribution from any of the following persons? a A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization? b A family member of a person described in (a) above? c A 35% controlled entity of a person described in (a) or (b) above? If "Yes" to a, b, or c, provide detail in Part Vl. 0 5 � 0) M 1 Did the directors, trustees, or membership of one or more supported organizations have the power to JYesJ hlo regularly appoint or elect at least a majority of the organization's directors or trustees at all times during the tax year? If 'No, " describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization's activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year. 2 Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If "Yes, " explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised, or controlled the supporting organization. 7M, 1 Were a majority of the organization's directors or trustees during the tax year also a majority of the directors or trustees of each of the organization's supported organization(s)? If "No, " describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s). M, 1 Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization's tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization's governing documents in effect on the date of notification, to the extent not previously provided? 2 Were any of the organization's officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No,"explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s). 3 By reason of the relationship described in (2), did the organization's supported organizations have a significant voice in the organization's investment policies and in directing the use of the organization's income or assets at all times during the tax year? If "Yes, " describe in Part VI the role the organization's supported organizations played in this regard. n 1 Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions). a ❑ The organization satisfied the Activities Test. Complete line 2 below. b ❑ The organization is the parent of each of its supported organizations. Complete line 3 below. c ❑ The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions) 2 Activities Test. Answer (a) and (b) below. Yes i~to a Did substantially all of the organization's activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes, " then in Part Vl identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities. 2a b Did the activities described in (a) constitute activities that, but for the organization's involvement, one or more of the organization's supported organization(s) would have been engaged in? If "Yes, " explain in Part VI the reasons for the organization's position that its supported organization(s) would have engaged in these activities but for the organization's involvement. 2b 3 Parent of Supported Organizations. Answer (a) and (b) below. a Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part Vl. 3a b Did the organization exercise a substantial degree of direction over the policies, programs, and activities of each of its supported organizations? If "Yes, " describe in Part W the role played by the organization in this regard. 3b EEA Schedule A (Forrn 990 or 990 -EZ) 2019 V_ 990 or 990 -EZ) 2019 PATHWAYS AYS TO PROSPERITY, INC. �. 27-3550271 Page( CD 1 LJ Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other TVDe III non -functionally integrated suDDortina organizations must comDlete Sections A throuah E. Section A - Adjusted Net Income (A) Prior Year (B) Current Year (optional) 1 Net short-term capital gain 1 c Fair market value of other non -exempt -use assets 2 Recoveries of prior -year distributions 2 1d 3 Other gross income (see instructions) 3 2 Acquisition indebtedness applicable to non -exempt -use assets 4 Add lines 1 through 3. 4 3 5 Depreciation and depletion 5 5 Net value of non -exempt -use assets (subtract line 4 from line 3) 6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6 6 7 Other expenses (see instructions) 7 8 Minimum Asset Amount (add line 7 to line 6) 8 Adjusted Net Inco (subtract lines 5, 6, and 7 from line 4) 8 Section B - M'ini'mum Asset Amount (A) Prior Year (B) Current Year (optional) 1 Anareaate fair market value of all non-exemnt-Ilse assets (see instructions for short tax year or assets held for part of year): a Average monthly value of securities 1a b Average monthly cash balances 1 b c Fair market value of other non -exempt -use assets 1c d Total (add lines 1 a, 1b, and 1c) 1d e Discount claimed for blockage or other factors (explain in detail in Part VI): 2 Acquisition indebtedness applicable to non -exempt -use assets 2 3 Subtract line 2 from line 1d. 3 4 Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). 4 5 Net value of non -exempt -use assets (subtract line 4 from line 3) 5 6 Multiply line 5 by .035. 6 7 Recoveries of prior -year distributions 7 8 Minimum Asset Amount (add line 7 to line 6) 8 Section C - Distributable Amount Current Year 1 Adjusted net income for prior year (from Section A, line 8, Column A) 1 2 Enter 85% of line 1. 2 3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3 4 Enter greater of line 2 or line 3. 4 5 Income tax imposed in prior year 5 6 Distributable Amount Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions). 1 61- 7 ❑ Check here if the current year is the organization's first as a non -functionally integrated Type III supporting organization (see instructions). EEA Schedule A (Form 990 or 990 -EZ) 2019 N Schedule A (Form 990 or 990 -EZ) 2019 PATHWAYS TO PROSPERITY INC. 27-3550271 Page i CD Part V Tvoe III Non -Function liv Integrated 509(a)(3) Sutmorting Orcianizations (continued) Section D - Distributions Current Year 1 Amounts paid to supported organizations to accomplish exempt purposes 2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity 3 Administrative expenses paid to accomplish exempt purposes of supported organizations 4 Amounts paid to acquire exempt -use assets 5 Qualified set-aside amounts (prior IRS approval required) 6 Other distributions (describe in Part VI). See instructions. 7 Total annual distributions. Add lines 1 through 6. 8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions. 9 Distributable amount for 2019 from Section C, line 6 10 Line 8 amount divided by line 9 amount Section E - Distribution /Vocations (see instructions) Excess Distributions Underdistributions Pre -2019 Distributable ,Amount for 2019 1 Distributable amount for 2019 from Section C, line 6 2 Underdistributions, if any, for years prior to 2019 (reasonable cause required - explain in Part VI). See instructions. 3 Excess distributions carryover, if any, to 2019 a From 2014 .... .... . b From 2015 ...... • c From 2016 d From 2017 ....... • e From 2018 .•••• f Total of lines 3a through e g Applied to underdistributions of prior years h Applied to 2019 distributable amount i Carryover from 2014 not applied (see instructions) j Remainder. Subtract lines 3g, 3h, and 3i from 3f. 4 Distributions for 2019 from Section D, line 7: $ a Applied to underdistributions of prior years b Applied to 2019 distributable amount ' c Remainder. Subtract lines 4a and 4b from 4. 5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. For result greater than zero, explain in Part VI. See instructions. 6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. For result greater than zero, explain in Part VI. See instructions. 7 Excess distributions carryover to 2020. Add lines 3j and 4c. 8 Breakdown of line 7: a Excess from 2015° b Excess from 2016 c Excess from 2017 d Excess from 2018 e Excess from 2019 EEA Schedule A (Form 990 or 990 -EZ) 2019 M ScheduleA(Form 990or990-E2)2019 Page! � Supplemental Informm)atlon. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part 111, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11 a, 11 b, and 11 c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a, and 3b; Part V, line 1; Part V, Section B, line 1 e; Part V, Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions.) EEA Schedule A (Form 990 or 990 -EZ) 2019 iiiiijillillill�ill�ill�l�ill��I I: (Form 990)I Do,Complete if the organization answered "Yes" on Form 990, Part IV, line 6, 7, 8, 9, 10, 110, 11b, 11c, 11d, 11e, 11f, 12a, or 12b. Department of the Treasury 00, Attach to Form 990. Internal Revenue Service I ► Go to wwwJrs.gov/Form990 for instructions and the latest information. DMB No. 1545-0047 Name of the organization Employer identification number PATHWAYS TO PROSPERITY, INC. 1 27-3550271 Fort Organizations Maintaining ning Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6. (a) Donor advised funds (b) Funds and other accounts 1 Total number at end of year • • • • • • • • • • • • • 2 Aggregate value of contributions to (during year) • • 3 Aggregate value of grants from (during year) 4 Aggregate value at end of year • • • • • • • 5 Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization's property, subject to the organization's exclusive legal control? • • • • • • • • • • • • • • • • • ❑ Yes ❑ No 6 Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • ❑ Yes ❑ No Complete if the organization answered "Yes" on Form 990, Part IV, line 7. 1 Purpose(s) of conservation easements held by the organization (check all that apply). ❑ Preservation of land for public use (e.g., recreation or education) ❑ Preservation of a historically important land area ❑ Protection of natural habitat ❑ Preservation of a certified historic structure ❑ Preservation of open space 2 Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year. a Total number of conservation easements • • • • • • • • • • • • • • • • • • • • • • b Total acreage restricted by conservation easements • • • • • • • • • • • • • • • • c Number of conservation easements on a certified historic structure included in (a) • • • • • • d Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register • • • • • • • • • • • • • • • • • • • 3 Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the tax year ► 4 Number of states where property subject to conservation easement is located 0, 5 Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? • • • • • • • • • • • • • • • • • • • • • • • • . • • ❑ Yes ❑ No 6 Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year 10, 7 Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year ■$ 8 Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(13)(1) and section 170(h)(4)(B)(ii)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No 9 In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and balance sheet, and include, if applicable, the text of the footnote to the organization's financial statements that describes the or anization's accounting for conservation easements. Part III Organizations Maintaining Collections of Art, Historical Treasures, or Other gimilar Assets. Complete if the organization answered "Yes" on Form 990, Part IV, line 8. 1a If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII the text of the footnote to its financial statements that describes these items. b If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items: (1) Revenue included on Form 990, Part VIII, line 1 • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • ► $ (ii) Assets included in Form 990, Part X • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • ► $ 2 If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the following amounts required to be reported under FASB ASC 958 relating to these items: a Revenue included on Form 990, Part VIII, line 1 • • . • • • • • • . • • • • • • • • • • • • • • • • • • • • • • ► $ b Assets included in Form 990, Part X • • • • • • • • • • • • • • • • • • • • • • • • • • • • • ► $ For Paperwork Reduction Act Notice, see the Instructions for Form 990. schedule D (For, 990) 2019 EEA LO Schedule D (Form 990) 2019 PATHWAYS TO PROSPERITY INC. 27-3550271 Page 2 Pad iil 1r anizations Maintaining Collections of Art, Historical Treasures, or Other Similar ,assets (continued) 3 Using the organization's acquisition, accession, and other records, check any of the following that make significant use of its collection items (check all that apply): a ❑ Public exhibition d ❑ Loan or exchange programs b ❑ Scholarly research e ❑ Other c ❑ Preservation for future generations 4 Provide a description of the organization's collections and explain how they further the organization's exempt purpose in Part XIII. 5 During the year, did the organization solicit or receive donations of art, historical treasures, or other similar assets to be sold to raise funds rather than to be maintained as part of the organization's collection? . • . . • • • • • • • • • • ❑ Yes ❑ No Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21. la Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not included on Form 990, Part X? • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • ❑ Yes ❑ No b If "Yes," explain the arrangement in Part XIII and complete the following table: C d e f 2a b Amount Beginning balance • • • • • • • • • • • • . . . . . . . . . . . . . . . . . . . . . . . . • • 1c Additions during the year • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 1d Distributions during the year . . • . . . . . . . • . . . . . . . . . . . . . . • • • • • • • • le Endingbalance • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 1f Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? • • • • • • • • Yes No If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided on Part XIII • • • • • • • • ❑ Complete if the organization answered "Yes" on Form 990, Part IV, line 10. (a) Current year (b) Prior year (c) Two years back (d) Three years back (e) Four years back 2 Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as: a Board designated or quasi -endowment II► % b Permanent endowment ► % c Term endowment ► % The percentages on lines 2a, 2b, and 2c should equal 100%. 3a Are there endowment funds not in the possession of the organization that are held and administered for the organization by: Yes No (1) Unrelated organizations • • • • • • • • • • • • • • • • 3a(i) (ii) Related organizations • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 3a(ii) b If "Yes" on line 3a(ii), are the related organizations listed as required on Schedule R? • • • • • • • • • • • • • • • • • • • • • 3b 4 Describe in Part XIII the intended uses of the organization's endowment funds. rt Land, Buildings, and Equipment. Complete if the organization answered "Yes" on Form 990, Part IV, line 11 a. See Form 990, Part X, line 10. Description of property (a) Cost or other basis (b) Cost or other basis (c) Accumulated (d) Book value (investment) (other) depreciation laLand . . . . . . . . . . . . . . . . . . . . b Buildings • • • . .. . .. ... . . . . • • c Leasehold improvements • • • • • • • • • • d Equipment • • • • • • • • • • • • • • • • • 13,126 11,692 1,434 eOther .. . . . . .. . .. ... . . . .. . Total. Add lines 1 a through le. (Column (d) must equal Form 990, Part X, column (B), line 10c.) • • • • • • • • • • • • • • • ► 1,434 EEA Schedule D (Form 990) 2019 1a Beginning of year balance • • • • • • b Contributions . . . . . . . . . . . . • c Net investment earnings, gains, and losses• • • • • • • • • • • • • • • • • d Grants or scholarships • • • • • • • • e Other expenditures for facilities and programs . . . . . . . . . . . . • • • f Administrative expenses • • • • • • • g End of year balance • • • • • • • • • W Sdiedule D (Form 990) 2019 PATHWAYS TO PROSPERITY INC. 27-3550271 Page Investments d ) -Otter Securities. � Complete if the organization answered "Yes" On Form 990, Part IV, line 11 b. See Form 990, Part X, line 12. (a) Description of security or category (b) Book value (c) Method of valuation: (including name of security) Cost or end -of -year market value (1) Financial derivatives • • • • • . • • . . . . . . . • • • • . • • . • • • (2) Closely -held equity interests • • • • • • • • • . • • • • • • . (3) Other Total. (Column (b) must equal Form 990, Part X, col. (8) line 12.) . . . . . . IN- Part ►P rt Vill Investments - Program Related. Complete if the organization answered "Yes" on Form 990, Part IV, line 11 c. See Form 990, Part X, line 13. (a) Description of investment (b) Book value (c) Method of valuation: Cost or end -of -year market value Total. (Column (b) must equal Form 990, PartX, col. (t3) line 13.) Complete if the organization answered "Yes" on Form 990, Part IV, line 11d. See Form 990, Part X, line 15. (a) Description (b) Book value MECURITY DEPOSITS 6,000 Total. (Column (b) must equal Form 990, PartX, col. (8) line 15.) . . . . . . . . . . . . • . • • • • • • • • • . • • ► 1 6,000 ' P ilrt X Other Liabilities. Complete if the organization answered "Yes" on Form 990, Part IV, line 11e or 11 f. See Form 990, Part X, line 25. 2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FASB ASC 740. Check here if the text of the footnote has been provided in Part XIII • • • • • . ❑ EEA Schedule D (Forth 990) 2019 ti Srheduleo Form 990)2019 PATHWAYS TO PROSPERITY INC. 27-3550271 Page art Reconciliation of Revenue Per audited Financial statements With hu Revenue per return. Complete if the organization answered "Yes" on Form 990, Part IV, line 12a. 1 2 a b c d e 3 4 a b c 5 Total revenue, gains, and other support per audited financial statements • • • • • • • . • • • • • • • • • • • • • Amounts included on line 1 but not on Form 990, Part VIII, line 12: Net unrealized gains (losses) on investments • • • • . • • • • . . • • • • • • • • 2a Donated services and use of facilities • • • • • • • • • • • • • • • • • • • • . • 2b Recoveries of prior year grants • . • • . • • • • • • • • • • • . • • . • . • • . 2c Other (Describe in Part XIII.) • • . • • • • • • • • . • • • • • • • • . • • • • • 2d Add lines 2a through 2d .. .. . .. . .. . . . . . . . . . . . .. . .. . .. .. . .. . . . .. . . . . Subtract line 2e from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . • . . . • • • • • • • • • • • • Amounts included on Form 990, Part VIII, line 12, but not on line 1: Investment expenses not included on Form 990, Part VIII, line 7b • • • . • • • • 4a Other (Describe in Part XIII.) . • • • • • • • • • • . • • • . • . • • • • • • • • 4b Add lines 4a and 4b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .. . . . . . . . . . Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part 1, line 12.) • • • . • • • • • • • • • • • • • • 1 1 032 607 11032,607 1,032,607 2e 3 4c . 5 FFaH Reconciliation of Expenses per Audited Financial tatements 1911ith Expenses pereturn. Complete if the organization answered "Yes" on Form 990, Part IV, line 12a. 1 2 a b cOther d e 3 4 a b c 5 Total expenses and losses per audited financial statements • • • • • • • • • • • • • . • • . • . • • . • • • • Amounts included on line 1 but not on Form 990, Part IX, line 25: Donated services and use of facilities . • • • • • . • • • • . • • • • • • • • • • 2a Prior year adjustments • • • • • • • • • • . . • • • • • • • • • • • • • • • • • 2b losses • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 2c Other (Describe in Part XIII.) • • • • • • • • • . . • • • • • • • • • • • . • • • 2d Add lines 2a through 2d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . • . . . . . . . • . . Subtract line 2e from line 1 • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • . • • • . • • • • • Amounts included on Form 990, Part IX, line 25, but not on line 1: Investment expenses not included on Form 990, Part VIII, line 7b • . • • • • • • • 4a Other (Describe in Part XIII.) • • • • • • • • • • • • • • • • • • • • . . • • • • 4b Add lines 4a and 4b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part 1, line 18.) • • • • • . • . • • • • • • • . • 1 974,103 2e., 3 974,103 974,103 4c. 5 ai Supplemental Information. Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines la and 4; Part IV, lines lb and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information. EEA Schedule D (Form 990) 2019 SCHEDULE o Supplemental Information to Form 991 or 90 -EZ (Form 990 or 990 -EZ) Complete to provide information for responses to specific questions on Form 990 or 990 -EZ or to provide any additional information. Department of the Treasury Ib Attach to Form 990 or 990 -EZ. Internal Revenue Service 0. Go to www.1rs.gov1Form990 for the latest information. Name of the organization 01. Form 990 governing body review (Part VI, line 11) 00 OMB No. 1545-0047 CD 2019 Opon to Public Inspection Employer Identification number 27-3550271 FORM 990 IS DISTRIBUTED TO THE BOARD OF DIRECTORS FOR REVIEW PRIOR TO IRS FILING. 02. Conflict of interest policy compliance (Part VI, line 12c) TO COMPLY WITH THE CONFLICT OF INTEREST POLICY EACH BOARD MEMBER SIGNS AN ANNUAL STATEMENT OF ANY KNOWN CONFLICTS OF INTEREST. SHOULD ANY INDIVIDUAL CONFLICT ISSUES OCCUR DURING MEETINGS THE MEMBER WITH THE CONFLICT WILL NOT VOTE ON THE ISSUE. 03. CEO, executive director, top management co (Part VI, line 15a) THE EXECUTIVE DIRECTOR HOLDS THE TOP MANAGEMENT POSITION WITHIN THE ORGANIZATION. THE SALARY FOR THAT POSITION IS DETERMINED BASED ON COMPARATIVE DATA PROVIDED FOR THE NONPROFIT INDUSTRY. 04. Other officer or key employee compensation (Part VI, line 15b NO OTHER OFFICERS OR KEY EMPLOYEES HIRED DURING THE TAX YEAR. 05. Governing documents, etc, available to public (Part VI, line 19) THE GOVERNING DOCUMENTS ARE AVAILABLE FOR PUBLIC INSPECTION ON SITE AT THE AGENCY UPON REQUEST. 06. Significant program services not listed on prior year return (Part III, line 2) WE PARTNERED WITH A LOCAL COMMUNITY HEALTH CENTER AND HOSTED A COVID-19 TESTING SITE FOR 4 WEEKS WHERE WE TESTED OVER 500 LOCAL RESIDENTS. ADDITIONALLY WE INCLUDED IN ALL OF OUR VIRTUAL CLASSES A MENTAL HEALTH COMPONENT TO ASSIST OUR CLIENTS IN COPING WITH THE PANDEMIC. WE ALSO PARTNERED WITH THE LOCAL CABLE COMPANY TO PROVIDE INTERNET SERVICES IN For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990 -EZ. Schedule O (Form 990 or 990 -EZ) (2019) EEA CD Schedule O (Form 990 or 990 -EZ) (2019) Page 2 Name of the organization Employer identification number THE HOMES OF STUDENTS IN OUR COMMUNITY BECAUSE THEY WERE OUT OF SCHOOL AND NEEDED INTERNET IN ORDER TO PARTICIPATE IN THE VIRTUAL LEARNING PLATFORM OFFERED BY THE SCHOOL DISTRICT. WE REDIRECTED (WITH PERMISSION FROM OUR FUNDER) DOLLARS TO ALLOW US TO PAY FOR THAT SERVICE FOR THE FAMILIES. 07. General explanation attachment PATHWAYS TO PROSPERITY IS A TAX EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE HOWEVER INCOME FROM CERTAIN ACTIVITIES NOT DIRECTLY RELATED TO THE ORGANIZATION'S TAX EXEMPT PURPOSE IS SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. THERE WAS NO SUCH INCOME FOR THE YEAR ENDED 9/30/20. THEREFORE, NO TAX IS DUE AND THERE IS NO PROVISION FOR TAXES IN THESE FINANCIAL STATEMENTS. EEA Schedule 0 (Form 990 or 990-EZ)(2019) M O CL aM M eh f CU CL p IL C O LL c O 0 C c o N 0 .� O d w CU Q U ■ T c` O d z y mm Lf),o y to p � rn O o a' m U m v N a) c dv r1 U O M U w c w � CD v ^m LL 'p o C) O c v •W Fo O L r O �q U- U C: C O d (n � o a) a J cn E :_ m C: N O rl O N Z. s CV m aw N r O 1 Ln L a �O +- � x m .°8 U H E 1 rn O 10 `o H H ul U r Z W M W a m M M E a a a as w c m CCS EH W � u 4 Q d N O x z h � O E4 0 0 Z y 01 W v w M a M7. m z c CSS T c` O d z _ YaN y Lf),o y to m o y, o a' m v N c dv r1 U O U w In 7 a CD v 'p o E O r �q U v d � o a E N rl O CV N O 1 Ln �O � x .°8 U H m rn 10 `o H H ul r Z W M W a m M M E a a a as w m EH W Z u 4 N O x z h � O E4 0 0 y 01 v w M a M7. 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L L C O 2 .0 orn rn c @ C m mrn Z5 p o O 2''p H CO CO l0 � N EE C L N •C O 2 O) m N m s} L w m a) a) a) m p a) E O O w m N .C.. N N) E E Q Q) N �i � .Z o n E m aBIi ami i p p cc T O O. O. O p N O a) N N N H h O. Q N C X C U U 01 _ C 0) C E N m m d = .�.. O O N Y N O O f00 � N O p N V U w m Q E - E O C C 0 o 00 .. o fU0 N a) of w o ."r. N ccC O 0 O 2 2 E a m m c M o0 0 E E c c a n c Q) a) c c 4)) v u0i o o c e E E U c o o o > m 0 x m ami m m r t a) 'D C7 C7 , J a U)o w -jJ a a cn u> Y 0 ma Uv Z , 0 IM ._., x_ E c o ac N N C , O C O N co .N C O O y m m � m E O (D ani CL O O Q O. 0 0 V U O O w w C C m m 0 0 w )` 0 N W N O O T > 0 c C E m :d m d d d m 0 C1 c 0 E C O_ ul � l0 C N N F- .2 2' l0 d E m Z W N O O T U) 16 2 � cc E k 7 ; � $ CL ƒ k k E 7; �)k bm� .0 0E� ■ � ±k(\ ^()}\ \Ea , 2 2 {§ ■ � §® / M \| E2 co 2 \`®0 u ca c04 _ E Sig ID C �_® 2 _ \{0 \ / Z G 3 I k K § 0 0 Names) as shown on return Your Social Security Number PATHWAYS TO PROSPERITY, INC. 1 27-3550271 FORM 990—PART III(A) statement #4 Statement of Service A222TE!!!hM2ELt PROGRAM SERVICE CODE PROGRAM SERVICE EXPENSES $$92795 GRANTS AND ALLOCATIONS INCLUDED IN ABOVE EXPENSE $37500 PROGRAM SERVICES REVS $0 ASSISTED FAMILIES OVERCOME BARRIERS THAT KEEP THEM LOCKED INTO THE CYCLE OF POVERTY. OUR CIRCLE OF PALM BEACH COUNTY INITIATIVE PROVIDES 12-1$ WEEKS OF EDUCATIONAL TRAINING ON DECISION MAKING BUDGETING, RELATIONSHIPS, MASLOW'S HIERARCHY OF NEEDS AND SETTING S.M.A.R.T. GOALS. BRIDGES INITIATIVES SUPPORT FAMILIES WITH YOUNG CHILDREN FOCUSING ON AWARENESS, EDUCATION AND SUPPORT CENTERED AROUND PARENTING AND EARLY CHILDHOOD DEVELOPMENT IN CRITICAL GEOGRAPHIC AREAS. BRIDGES FACILITATE FAMILY ENGAGEMENT, STRENGTHEN AND BUILD COMMUNITY CAPACITY AND RESILIENCE, OFFERS TI AND WORKSHOPS FOR PARENTS, INFORMATION ON HEALTHY WAYS TO HELP CHILDREN GROW AND LEARN, FAMILY EVENTS, ASSISTANCE CONNECTING TO COMMUNITY RESOURCES. THE HEALTH EDUCATION AND LINKAGE INITLATI' PROVIDES CERTIFIED APPLICATION COUNSELORS TO ASSIST WITH HEALTH CARE APPLICATIONS. WE OFFER DIRECT REFERRALS TO PARTNERS FOR HEALTHCARE NEEDS, EDUCATION ON MANAGING AND PREVENTING CONDITIONS COMMON TO LOW INCOME COMMUNITIES. OUR STABILIZATION PROGRAM INCLUDES OUR FOOD PANTRY IN PARTNERSHIP WITH LOCAL FOOD BANKS. WE PROVIDED OVER 900,000 POUNDS OF FOOD TO MORE THAN 19,0 FAMILIES IN THE COMMUNITY. DUE TO THE COVID-19 PANDEMIC, WE ADJUSTED OUR OPERATIONS TO ACCOMMODATE OUR CLIENTS VIRTUALLY. WE RAISED FUNDS AND WERE ABLE TO ASSIST CLIENTS WITH FOOD, RENT, UTILITIES, AND OTHER EXPENSES. WE ASSISTED A TOTAL OF 96 HOUSEHOLDS FOR A TOTAL OF $50,55 WE OFFER MINI GRANTS RANGING FROM $1500 — $5000 TO 14 DIFFERENT CHURCHES, AGENCIES AND ORGANIZATIONS IN OUR COMMUNITY TO DEVELOP PROGRAMMING FOR INDIVIDUALS PROVIDING CAREGIVING TO LOVED ONES AND CREATED A CAREGIVERS CLUB THROUGH OUR HEALTHIER BOYNTON BEACH INITIATIVE WHICH I FUNDED BY THE PALM HEALTHCARE FOUNDATION. STM.LD LO 0 0 990 Overflow Statement Pacfe 1 r Name(s) as shown on ratum FEIN PATHWAYS TO PROSPERITY INC. 27-3550271 OTHER EXPENSES PROGRAM Description _ Amount___ _FOOD _ $ _ 3,874 COMMUNICATION _ _ _— _ 14,198 _STAFF DEVELOPMENT 3, 978 EQUIPMENT RENTAL — 3,696 — - - -- Total:25746 OTHER EXPENSES MGMT & GENERAL Description _ _ _ _ Amount__ FOOD $ 1,769 - -- ----- --- -- --- --- COMMUNICATION _ _ 1,033 STAFF DEVELOPMENT 5 EQIPMENT RENTAL _ — 320 — -- -----Total: $ --__3 27 OVERFLOWID OVERFLOWID Additional Attachments 2 Copies of current license(s) needed to operate; City of Boynton Beach Business Tax Receipt City of Boynton Beach Development Services 100 E. Ocean Ave, Boynton Beach, FL 33435-0190 0 **SINGLE -PIECE 1 SGL. 129099A2L-A-1 11 1 SP 0 530 PATHWAYS TO PROSPERITY iNC 900 N SEACREST BLVD BOYNTON BEACH FL 33435-3002 NDear Boynton Beach Business and Property Owners: We appreciate your continued participation in supporting economic growth and viability of our City by maintaining your Certificate of Use and Occupancy & Local Business Tax, In accordance with Chapter 13 of the City of Boynton Beach Municipal Ordinance, the document(s) below must be posted in a conspicuous place at your business or property, Should assistance be needed please contact the Development Services Department at (561)742-6350 or visit Our website at www.boyriton-beach.org, + DETACH THE DOCUMENT BELOW ACONSPCUOUSLY AT IYPLACE OF BUSINESS 4 0 - - - - - - - - - - - - - - - - - . . . . AND POST . . . . . . . . . . . . . . . . . . . . . . . . . - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - .. City of Boynton Beach Certificate of Use/Business Tax Receipt Business Control Number: 0032488 Date Issued: 01/26/22 Business Name: Pathways To Prosperity Inc Business Location: 900 N Seacrest Blvd Any changes in narne, address, suite, ownership, etc, will require a new application, 22-00038288 624190 INDIVIDUAL & FAMILY SOCIAL SERVICES NON PROFIT 4N $01 City of Boynton Beach 100 E. Ocean Ave. * Boynton Beach, FL 33435-0190 1007 Additional Attachments 3 Documentation of all additional funding sources for program listed in application 1008 BOARD OF DIRECTORS The Late Rev. Lance Chaney Visionary & Founder Kernberly Bush CEO & Executive Director Maguene Cadet, Esq President Valencia Spells -Anderson Vice President Audrey Davis Secretary Octavia Bell Treasurer Dr. Barbara Carey -Shuler Board Member Marilane Chaney Board Member Rev. Terrence Kearney Board Member Revia Lee Board Member DeAnna Warren Board Member Additional Program Funding Sources • Children's Services Council $122,476 approved • Palm Beach County FAA $70,000.00 approved • Truist Foundation $10,000.00 approved • Thomas Charitable Trust $10,000.00 approved • New York Community Bank $5,000.00 approved • The Jim Moran Foundation $40,000 approved • Quantum Foundation $50,000 approved • Palm Beach County CDBG $28,390 approved • The Community Foundation for Palm Beach & Martin Counties $74,800 pending 0 639 E. Ocean Avenue, Suite 101, Boynton Beach, FL 33435 - 561.903.7743 www.�Y�Wsbovmtoworg-- Contributions benefit Pathways to Prosperity, Inc., a not-for-profit, tax-exempt organization. A COPY OF THE OFFICIAL REGISTRATION AND FI"'"""" INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES AT www.FloridaConsumerHelp.com OR BY CALLING TOLL- 1009 435- 7352) WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE. Registratir-.. , __ 16 DocuSign Envelope ID: 87AE63F7-DBA6-41 D5-83B3-COCC1 DA8D443 r iChildinem's Servivocoas Counc P µ L M w . Healthy. Safe. • y . i April 12, 2022 Kemberly Bush Pathways to Prosperity, Inc. P2P BRIDGES - 699 639 E Ocean Ave Ste 101 Boynton Beach, FL 33435 Dear Ms. Bush: 2300 High Ridge R•.r Boynton Beach,rw Tek 561.740.7000 561.8,3 6 Children's Services Council of Palm Beach County (CSC) thanks you for your agency's work in helping Palm Beach County's children grow up healthy, safe and strong. CSC has developed the 2022 — 2023 allocation amounts incorporating the following principles: 1) The program's allocation for October 1, 2022 — September 30, 2023 is based on historical information regarding spending patterns. 2) COST DRIVERS: a. Salaries: The allocation includes up to a maximum of a 5% increase in CSC funded salaries and the corresponding payroll taxes. CSC recognizes the ultra -competitive labor market and the consequential and unprecedented amount of staff turnover and long duration of vacancies Provider agencies are experiencing. This is occurring especially in direct service positions and those that provide administrative/data entry support for programs. The data on these two metrics and the impact they have on Palm Beach County children and families being waitlisted and not receiving services for an increasingly amount of time and in greater numbers are clear. After hearing concerns from our Providers, in order to stabilize the CSC Provider workforce and fill vacant positions, CSC has determined increasing salaries will be a way to help mitigate some of those concerns. The expectation is to distribute the 5% salary cost driver pool in a strategically meaningful way that makes the best use of the dollars. A thoughtful and targeted approach to allocate funds where substantive turnover and vacancies are occurring will help mitigate this challenging dilemma. www.cscpbc.org 1010 DocuSign Envelope ID: 87AE63F7-DBA6-41 D5-83B3-COCC1 DA8D443 r iChildinem's Servivocoas Counc P µ L M w . Healthy. Safe. • y . i 2300 High Ridge R•.r Boynton Beach,rw Tek 561.740.7000 561.8,3 6 Currently vacant positions must receive 5% cost driver at minimum if the salary is less than market value and/or to the extent possible to increase to a competitive salary. All positions and increases are subject to review by CSC. b. Health Insurance: The allocation includes up to a maximum of a 10% increase in health insurance. These additional dollars are intended to fund the specific cost drivers only: salaries, payroll taxes and health insurance. The allocation is also inclusive of any discussions during the allocation development process. 3) The CSC mileage reimbursement rate reflects the IRS mileage rate for 2022 currently set at 0.56 per mile. 4) Indirect/Administrative Costs cannot exceed 15% of all other expenses for the Program. Your proposed October 1, 2022 — September 30, 2023 program allocation from Children's Services Council of Palm Beach County is $742,285.00 Please note this allocation is contingent on approval by the Council. The proposed allocation may be subject to change based on approval of the Council via the annual TRIM process. Budgets are to be submitted into SAMIS (if applicable for your agency) and received by the Budget Specialist no later than May 10, 2022. If you find a need for a virtual meeting or a phone call to discuss the allocation or your program/budget, please feel free to contact your Budget Specialist or Program Officer. FAILURE TO MEET THIS DEADLINE MAY RESULT IN THE TERMINATION OF CSC'S FUNDING OF YOUR PROGRAM EFFECTIVE OCTOBER 1, 2022. Once submitted, FINAL APPROVAL of the 2022-2023 budget is subject to sensitive timelines. Please ensure your agency staff is available and responsive to CSC staff during the Annual Contract Renewal process so there are no delays due to vacation, illness, etc. Here are some tips for entering your budget in SAMIS, if applicable to your agency: www.cscpbc.org 1011 DocuSign Envelope ID: 87AE63F7-DBA6-41 D5-83B3-COCC1 DA8D443 • 2300 High Ridge Road Childim,-%ns Servitc-Et:s Co � Boynton Beach, 0 33426 PA L MB E A H 0 U N T `d Te1:561.740.700 Healthy. Safe. Strong Fax: 561.835.1056 • The maximum indirect cost percentage to be reimbursed by CSC is 15%. Please make sure to separate all direct costs from indirect costs. The indirect costs should be transferred to the indirect cost worksheet. • Necessary budget forms, such as the Budget Summary, Disclosure of Other Agency Funders, Form C, and the Indirect Cost Worksheet are due at the same time as the budget. Please ensure the SAMIS budget and all forms balance with one another. Templates of the forms mentioned above can be found at the SAMIS Fiscal Reference Files link via the SAMIS information icon at https://palmbeach.samis.io/modules/samis/default.cfm. The fiscal guidelines are also there to reference. Please change the fiscal years on the forms, as necessary. If you have any general questions regarding the contract renewal process, please contact your Budget Specialist or Charice Robinson, Director of Program Budget, at (561) 740-7000. Your CSC Program Officer and Budget Specialist look forward to working with you on your 2022- 2023 budget. Sincerely, Debra Heim Chief Financial Officer 5 DocuSigned by: 2586D1B35C3F421... 4/13/2022 www.cscpbc.org 1012 CONTRACT FOR PROVISION OF SERVICES This Contract is made as of day of , 20_, by and between Palm Beach County, a Political Subdivision of the State of Florida, by and through its Board of County Commissioners, hereinafter referred to as the COUNTY, and Pathways to Prosperity, Inc., hereinafter referred to as the AGENCY, a not-for-profit corporation authorized to do business in the State of Florida, whose Federal Tax I.D. is 27-3550271. WHEREAS, on December 27, 2020, the Emergency Rental Assistance Program (ERA - COVID-19) was established into law through section 501, Division N, Consolidated Appropriations Act 2021, Public Law No. 116-260 to assist households that are unable to pay rent and utilities due to the COVID-19 pandemic; and WHEREAS, on January 21, 2021, Palm Beach County received funding to implement ERA - COVI D-19; and WHEREAS, Community Services Department, hereinafter referred to as the DEPARTMENT, will implement ERA - COVID-19 on behalf of the COUNTY; and WHEREAS, the DEPARTMENT will engage nonprofit agencies to assist with providing rental and utility assistance to Palm Beach County households experiencing loss of income due to COVI D-19; and WHEREAS, the AGENCY has agreed to assure access to funded services for COUNTY departments, divisions and/or programs; and to assure that individuals referred from COUNTY departments, divisions and/or programs will receive services on a timely basis. NOW THEREFORE, in consideration of the mutual promises contained herein, the COUNTY and the AGENCY agree as follows: ARTICLE 1 INCORPORATION OF RECITALS The foregoing recitals are true and correct and incorporated herein by reference. ARTICLE 2 FUNDED SERVICES The AGENCY agrees to provide services under Emergency Rental Assistance Program (ERA - COVID-19) services to residents experiencing loss of income as result of COVID-19 of Palm Beach County as set forth in the EXHIBIT A - SCOPE OF WORK AND SERVICES. The AGENCY also agrees to provide deliverables, including reports, as specified in ARTICLE 19 - AGENCY'S PROGRAMMATIC REQUIREMENTS. No changes in the scope of work or services are to be conducted without the written approval of the Palm Beach County Community Services Department (the DEPARTMENT). The AGENCY receiving funds must be an agency within Palm Beach County and the AGENCY'S services, with these contracted funds, are limited to meeting the needs of Palm Beach County residents. No part of the funding is intended to benefit any specific individual or recipient. All funding is intended for the overall benefit of all recipients of the services provided by the programs being funded herein. ARTICLE 3 ORDER OF PRECEDENCE Page 1 1013 Conflicting provisions hereof, if any, shall prevail in the following descending order of precedence: (1) Laws passed by Congress, which are codified in provisions of the United States Code (U.S.C.) applicable to the funding source for this Contract; (2) Rules or regulations adopted by a federal agency, which are codified in the Code of Federal Regulations (C.F.R) and applicable to the funding source for this Contract; (3) the federal award or funding document for this Contract; (4) the provisions of the Contract, including EXHIBIT A and EXHIBIT B; and (5) all other documents, if any, cited herein or incorporated herein by reference. ARTICLE 4 SCHEDULE The term of this Contract shall be for one (1) year, starting January 1, 2022 (initial term) and the Contract will automatically renew for two (2) additional one (1) year term(s) (renewal terms), unless either party notifies the other prior to the expiration of the initial term or any renewal term of its intent not to renew in accordance with the time parameters stated herein. The parties shall amend this Contract if there is a change to the Scope of Work/Implementation Plan, funding, and/or federal, state, and local laws or policies affecting this Contract. Monthly billing, reports and other items shall be delivered or completed in accordance with the detailed schedule set forth in EXHIBIT A, EXHIBIT B, and the AGENCY'S PROGRAMMATIC REQUIREMENTS. ARTICLE 5 PAYMENTS TO AGENCY The total amount to be paid by the COUNTY under this Contract for all services and materials shall not exceed a total Contract amount of ONE HUNDRED AND FIFTY THOUSAND DOLLARS AND ZERO CENTS ($150,000.00) OVER A THREE-YEAR PERIOD, OF WHICH FIFTY THOUSAND DOLLARS AND ZERO CENTS ($50,000.00) IS BUDGETED IN FISCAL YEAR 2022 WITH AN ANTICIPATED ANNUAL ALLOCATION OF FIFTY THOUSAND DOLLARS AND ZERO CENTS ($50,000.00) TO BE BUDGETED IN EACH SUBSEQUENT FISCAL YEAR FOR THE TERM OF THIS CONTRACT. The AGENCY will bill the COUNTY on a monthly basis, or as otherwise provided, at the amounts set forth in EXHIBIT B for services rendered toward the completion of the Scope of Work. Where incremental billings for partially completed items are permitted, the total billings shall not exceed the estimated percentage of completion as of the billing date. The program and unit cost definitions for this Contract year are set forth in EXHIBIT B. All requests for payments of this Contract shall include an original cover memo on AGENCY letterhead signed by the Chief Executive Officer, Chief Financial Officer or their designee. The AGENCY is obligated to provide the COUNTY with the properly completed requests for all funds to be paid relative to this Contract. Any amounts not submitted by AGENCY shall remain the COUNTY'S and the COUNTY shall have no further obligation with respect to such amounts. Payment of invoices shall be contingent on timely receipt of all required reports. Invoices received from the AGENCY pursuant to this Contract will be submitted through the Services and Activities Management Information System (SAMIS) website, reviewed and approved by Page 2 1014 the COUNTY'S representative, to verify that services have been rendered in conformity with the Contract. Approved invoices will then be sent to the Finance Department for payment. Invoices will normally be paid within thirty (30) days following the COUNTY representative's approval. Any payment due by COUNTY under the terms of this Contract shall be withheld until all reports due from the AGENCY and necessary adjustments have been approved by the COUNTY. In the event that the AGENCY has drawn down all possible funds prior to the end of the fiscal year and does not comply with all reporting requirements, the COUNTY will take this into consideration during the next funding year. COUNTY funding can be used to match grants from non -COUNTY sources; however, the grantee cannot submit reimbursement requests for the same expenses to more than one funding source or under more than one COUNTY funded program. Final Invoice: In order for both parties herein to close their books and records, the AGENCY will clearly state "final invoice" on the AGENCY'S final/last billing to the COUNTY. This shall constitute AGENCY'S certification that all services have been properly performed and all charges and costs have been invoiced to Palm Beach County. Any other charges not properly included on this final invoice are waived by the AGENCY. In order to do business with Palm Beach County, agencies are required to create a Vendor Registration Account OR activate an existing Vendor Registration Account through the Purchasing Department's Vendor Self Service (VSS) system, which can be accessed at https://pbcvssp.co.palm-beach.fl.us/webapp/vssp/AltSelfService. If AGENCY intends to use subagencies, AGENCY must also ensure that all subagencies are registered as agencies in VSS. All subcontractor agreements must include a contractual provision requiring that the subagency register in VSS. COUNTY will not finalize a contract award until the COUNTY has verified that the AGENCY and all of its subagencies are registered in VSS. ARTICLE 6 AVAILABILITY OF FUNDS The obligations of the COUNTY under this Contract for the current or any subsequent grant year are subject to the availability of funds lawfully appropriated for its purpose by the Board of County Commissioners of Palm Beach County, and received from the United States Government under the United States Treasury Department. ARTICLE 7 TRUTH -IN -NEGOTIATION CERTIFICATE Signature of this Contract by the AGENCY shall also act as the execution of a truth -in - negotiation certificate certifying that the wage rates, over -head charges, and other costs used to determine the compensation provided for in this Contract are accurate, complete and current as of the date of the Contract and no higher than those charged to the AGENCY'S most favored customer for the same or substantially similar service. The said rates and costs shall be adjusted to exclude any significant sums should the COUNTY determine that the rates and costs were increased due to inaccurate, incomplete or noncurrent wage rates or due to inaccurate representations of fees paid to outside agencies. The COUNTY shall exercise its rights under this Article within three (3) years following final payment. ARTICLE 8 AMENDMENTS TO FUNDING LEVELS Page 3 1015 This Contract may be amended to decrease and/or increase funds for the delivery of services depending upon the utilization and rate of expenditure of funds. AGENCY shall be subject to decrease of funds if funds are not utilized at the anticipated rate of expenditures. The anticipated rate of expenditures is determined by dividing the Contract service amount by the months in the Contract unless otherwise provided for in this Contract. A 10% increase over the monthly expenditure rate must be pre -approved by the COUNTY. The anticipated rate of expenditure will be figured on a per service basis. The formula for reduction of funds shall be as follows: At one quarter of the service period the AGENCY shall have provided at a minimum twenty percent (20%) of their anticipated services. If the minimum has not been reached ten percent (10%) of the unspent funds allocated for that service period may be reduced. At one half of the service period the AGENCY shall have provided at a minimum forty percent (40%) of their anticipated services. If the minimum has not been reached fifty percent (50%) of the unspent funds allocated for that service period may be reduced. At three quarters of the service period the AGENCY shall have provided at a minimum seventy-five percent (75%) of their anticipated services. If the minimum has not been reached one hundred percent (100%) of the unspent funds allocated for that service period may be reduced. In the event that funds become available due to other agencies budgets being decreased, a currently funded AGENCY may apply for those funds. AGENCY may become eligible for an increase in funding if they have spent their funds at the anticipated rate and can present a proposal for the utilization of additional funds by delivering additional units of service. Any increase or decrease of funding for any of the AGENCY'S contracted programs of up to 10% may be approved by the Director of Community Services or Designee. Any increase or decrease of funding over 10% must be approved by the Board of County Commissioners. ARTICLE 9 INSURANCE The AGENCY shall maintain at its sole expense, in force and effect at all times during the term of this Contract, insurance coverage and limits (including endorsements) as described herein. Failure to maintain at least the required insurance shall be considered default of the Contract. The requirements contained herein, as well as COUNTY'S review or acceptance of insurance maintained by AGENCY, are not intended to and shall not in any manner limit or qualify the liabilities and obligations assumed by AGENCY under the Contract. AGENCY agrees to notify the COUNTY at least ten (10) days prior to cancellation, non -renewal or material change to the required insurance coverage. Where the policy allows, coverage shall apply on a primary and non-contributory basis. A. Commercial General Liability: AGENCY shall maintain Commercial General Liability at a limit of liability not less than $500,000 combined single limit for bodily injury and property damage each occurrence. Coverage shall not contain any endorsement(s) excluding Contractual Liability or Cross Liability. B. Additional Insured Endorsement: The Commercial General Liability policy shall be endorsed to include, "Palm Beach County Board of County Commissioners, a Political Page 4 1016 Subdivision of the State of Florida, its Officers, Employees, and Agents" as an Additional Insured. A copy of the endorsement shall be provided to COUNTY upon request. C. Workers' Compensation Insurance & Employer's Liability: AGENCY shall maintain Workers' Compensation & Employer's Liability in accordance with Chapter 440 of the Florida Statutes. D. Professional Liability: AGENCY shall maintain Professional Liability, or equivalent Errors & Omissions Liability, at a limit of liability not less than $1,000,000 each occurrence, and $2,000,000 per aggregate. When a self-insured retention (SIR) or deductible exceeds $10,000, COUNTY reserves the right, but not the obligation, to review and request a copy of AGENCY'S most recent annual report or audited financial statement. For policies written on a "claims -made" basis, AGENCY warrants the Retroactive Date equals or precedes the effective date of this Contract. In the event the policy is canceled, non -renewed, switched to an Occurrence Form, retroactive date advanced, or any other event triggering the right to purchase a Supplement Extended Reporting Period (SERP) during the term of this Contract, AGENCY shall purchase a SERP with a minimum reporting period not less than three (3) years after the expiration of the Contract term. The requirement to purchase a SERP shall not relieve the AGENCY of the obligation to provide replacement coverage. The Certificate of Insurance providing evidence of the purchase of this coverage shall clearly indicate whether coverage is provided on an "occurrence" or "claims -made" form. If coverage is provided on a "claims -made" form the Certificate of Insurance must also clearly indicate the "retroactive date" of coverage. E. Waiver of Subrogation: Except where prohibited by law, AGENCY hereby waives any and all rights of Subrogation against the COUNTY, its officers, employees and agents for each required policy except Professional Liability. When required by the insurer, or should a policy condition not permit an insured to enter into a pre -loss agreement to waive subrogation without an endorsement, then AGENCY shall notify the insurer and request the policy be endorsed with a Waiver of Transfer of Rights of Recovery Against Others, or its equivalent. This Waiver of Subrogation requirement shall not apply to any policy that includes a condition to the policy specifically prohibiting such an endorsement or voids coverage should AGENCY enter into such an agreement on a pre -loss basis. F. Certificates of Insurance: On execution of this Contract, renewal, within forty-eight (48) hours of a request by COUNTY, and upon expiration of any of the required coverage throughout the term of this Contract, the AGENCY shall deliver to the COUNTY or COUNTY'S designated representative a signed Certificate(s) of Insurance evidencing that all types and minimum limits of insurance coverage required by this Contract have been obtained and are in force and effect. Certificates shall be issued to: Palm Beach County Board of Commissioners and may be addressed: c/o Community Services Department 810 Datura Street West Palm Beach, FL 33401 ATTN: Contracts Manager F. Right to Revise or Reject: COUNTY, by and through its Risk Management Department in cooperation with the contracting/monitoring department, reserves the right to review, Page 5 1017 modify, reject, or accept any required policies of insurance, including limits, coverage, or endorsements. ARTICLE 10 INDEMNIFICATION AGENCY shall protect, defend, reimburse, indemnify, save and hold the COUNTY, its agents, employees, officers and elected officials harmless from and against any and all claims, liability, expense, loss, cost, damages or causes of action of every kind or character, including attorney's fees and costs, whether at trial or appellate levels or otherwise, arising during and as a result of their performance of the terms of this Contract or due to the acts or omissions of AGENCY. AGENCY will hold the COUNTY harmless and will indemnify the COUNTY for any funds that the COUNTY is obligated to refund the Federal Government based on the AGENCY'S provision of services, or failure to provide services, pursuant to this Contract. The AGENCY also agrees that funds made available pursuant to this Contract shall not be used by the AGENCY for the purpose of initiating or pursuing litigation against the COUNTY. ARTICLE 11 SUCCESSORS AND ASSIGNS The COUNTY and the AGENCY each binds itself and its partners, successors, executors, administrators and assigns to the other party and to the partners, successors, executors, administrators and assigns of such other party, in respect to all covenants of this Contract. Except as above, neither the COUNTY nor the AGENCY shall assign, sublet, convey or transfer its interest in this Contract without the prior written consent of the other. ARTICLE 12 WARRANTIES AND LICENSING REQUIREMENTS The AGENCY represents and warrants that it has and will continue to maintain all licenses and approvals required to conduct its business, and that it will at all times conduct its business activities in a reputable manner. Proof of such licenses and approvals shall be submitted to the COUNTY'S representative upon request. The AGENCY shall comply with all laws, ordinances and regulations applicable to the services contemplated herein, to include those applicable to conflict of interest and collusion. The AGENCY is presumed to be familiar with all federal, state, and local laws, ordinances, codes and regulations that may in any way affect the services offered. The AGENCY represents and warrants that it is governed by a Board, or other appropriate body, whose members have no monetary conflict of interest. Further, the members must also serve the AGENCY without compensation, and the composition of the governing body must reasonably reflect Palm Beach County and/or client demographics. The AGENCY shall comply with all legal criminal history record check regulations required for the population they serve. AGENCY will have and comply with policy that requires them to conduct a Level 1 or Level 2 Criminal Background Check as appropriate on applicants and volunteers being considered for positions that will provide services or will be around children, the elderly and other vulnerable adult populations, prior to start date. AGENCY may hire employees prior to obtaining the Level 2 background check results, the employees are only permitted to attend training and orientation during this period while they are waiting for their background check results. They are not allowed to have any contact with the clients during Page 6 1018 this period. Live Scan Screening proof must be provided that shows the scan was completed prior to an employee's start date. All criminal background checks shall be done at the expense of the AGENCY. ARTICLE 13 PERSONNEL The AGENCY warrants that all services shall be performed by skilled and competent personnel to the highest professional standards in the field. Any changes or substitutions in the AGENCY'S key personnel, or any personnel turnover which could adversely impact the AGENCY'S ability to provide services as may be listed herein must be made known to the COUNTY'S representative within five (5) working days of the change. AGENCY shall establish and consistently utilize an allocation methodology for personnel costs for program activities supported by multiple sources. All of the services required hereinunder shall be performed by the AGENCY or under its supervision. The AGENCY further represents that it has, or will secure at its own expense, all necessary personnel required to perform the services under this Contract, and that they shall be fully qualified and, if required, authorized, permitted, and/or licensed under State and local law to perform such services. Such personnel shall not be employees of or have any contractual relationship with the COUNTY. All of the AGENCY'S personnel (and all subcontractors), while on COUNTY premises, will comply with all COUNTY requirements governing conduct, safety and security. ARTICLE 14 NONDISCRIMINATION The COUNTY is committed to assuring equal opportunity in the award of contracts and complies with all laws prohibiting discrimination. Pursuant to Palm Beach County Resolution R2017-1770, as may be amended, the AGENCY warrants and represents that throughout the term of the Contract, including any renewals thereof, if applicable, all of its employees are treated equally during employment without regard to race, color, religion, disability, sex, age, national origin, ancestry, marital status, familial status, sexual orientation, gender identity or expression, or genetic information. Failure to meet this requirement shall be considered default of the Contract. As a condition of entering into this Contract, the AGENCY represents and warrants that it will comply with the COUNTY'S Commercial Nondiscrimination Policy as described in Resolution 2017-1770, as amended. As part of such compliance, the AGENCY shall not discriminate on the basis of race, color, national origin, religion, ancestry, sex, age, marital status, familial status, sexual orientation, gender identity or expression, disability, or genetic information in the solicitation, selection, hiring or commercial treatment of subcontractors, vendors, suppliers, or commercial customers, nor shall the AGENCY retaliate against any person for reporting instances of such discrimination. The AGENCY shall provide equal opportunity for subcontractors, vendors and suppliers to participate in all of its public sector and private sector subcontracting and supply opportunities, provided that nothing contained in this clause shall prohibit or limit otherwise lawful efforts to remedy the effects of marketplace discrimination that have occurred or are occurring in the COUNTY'S relevant marketplace in Palm Beach County. AGENCY shall comply with all applicable Federal statutes relating to nondiscrimination. These include but are not limited to: (a) 42 U.SC. § 2000d et seq., Title VI, Civil Rights Act of 1964 Page 7 1019 which prohibits discrimination on the basis of race, color or national origin; (b) 20 U.S.C. § 1681 et seq., Title IX of the Education Amendments of 1972, as amended, which prohibits discrimination on the basis of sex; (c) 29 U.S.C. § 701 et seq., Section 504 of the Rehabilitation Act of 1973, as amended, which prohibits discrimination on the basis of disability; (d) 42 U.S.C. § 6101 et seq., the Age Discrimination Act of 1975, as amended, which prohibits discrimination on the basis of age; (e) Public Law 92-255, the Drug Abuse Office and Treatment Act of 1972, as amended, relating to nondiscrimination on the basis of drug abuse; (f) Public Law 91-616, the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970, as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) 42 U.S.C. § 201 et seq., the Public Health Service Act of 1912, as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) 42 U.S.C. § 3601 et seq., Title VIII of the Civil Rights Act of 1968, as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the statute(s) under which this Contract that uses Federal assistance is being made; and (j) the requirements of any other nondiscrimination statute(s) which may apply to this Contract. Vendor shall comply with the Drug Free Workforce Act of 1988. The AGENCY understands and agrees that a material violation of this clause shall be considered a material breach of this Contract and may result in termination of this Contract, disqualification or debarment of the company from participating in COUNTY contracts, or other sanctions. This clause is not enforceable by or for the benefit of, and creates no obligation to, any third party. AGENCY shall include this language in its subcontracts. ARTICLE 15 SUBCONTRACTING The COUNTY reserves the right to accept the use of a subcontractor, or to reject the selection of a particular subcontractor, and to inspect all facilities of any subcontractors in order to make a determination as to the capability of the subcontractor to perform properly under this Contract. If a subcontractor fails to perform or make progress, as required by this Contract, and it is necessary to replace the subcontractor to complete the work in a timely fashion, the AGENCY shall promptly do so, subject to acceptance of the new subcontractor by the COUNTY. ARTICLE 16 REMEDIES This Contract shall be governed by the laws of the State of Florida. Any legal action necessary to enforce the Contract will be held in a court of competent jurisdiction located in Palm Beach County, Florida. No remedy herein conferred upon any party is intended to be exclusive of any other remedy, and each and every such remedy shall be cumulative and shall be in addition to every other remedy given hereunder or now or hereafter existing at law or in equity, by statute or otherwise. No single or partial exercise by any party of any right, power, or remedy hereunder shall preclude any other or further exercise thereof. No provision of this Contract is intended to, or shall be construed to, create any third party beneficiary or to provide any rights to any person or entity not a party to this Contract, including but not limited to any citizen or employees of the COUNTY and/or AGENCY. ARTICLE 17 CONTRACTING WITH SMALL AND MINORITY BUSINESSES, WOMEN'S BUSINESS ENTERPRISES, LABOR SURPLUS FIRMS Page 8 1020 A. The COUNTY has made all necessary affirmative steps to assure that small and minority businesses, women's business enterprises, and labor surplus area firms are used when possible. The AGENCY, if prime sub -contracts are to be let, shall take the Affirmative Steps listed below in paragraphs 1) through 5) of this Article. B. AFFIRMATIVE STEPS must include: 1. Placing qualified small and minority businesses and women's business enterprises on solicitation lists; 2. Assuring that small and minority businesses, and women's business enterprises are solicited whenever they are potential sources; 3. Dividing total requirements, when economically feasible, into smaller tasks or quantities to permit maximum participation by small and minority businesses, and women's business enterprises; 4. Establishing delivery schedules, where the requirement permits, which encourage participation by small and minority businesses, and women's business enterprises; 5. Using the services and assistance, as appropriate, of such organizations as the Small Business Administration and the Minority Business Development Agency of the Department of Commerce. ARTICLE 18 HIRING OF MECHANICS OR LABORERS For those solicitations and contracts including the employment of mechanics or laborers, the Contract must provide for compliance with 40 U.S.0 § 3702, as supplemented by Department of Labor regulations (29 C.F.R. 5). Specifically, AGENCY shall be required to compute the wages of every mechanic and laborer based on a standard work week of 40 hours. Work in excess of the standard work week is permissible provided that the worker is compensated at a rate of not less than one and a half (11/Z) times the basic rate of pay for all hours worked in excess of 40 hours in the work week. ARTICLE 19 AGENCY'S PROGRAMMATIC REQUIREMENTS Failure to provide or adhere to the following information or activity in a timely fashion and in the format required will constitute a material breach of this Contract and may result in termination of this Contract. In addition to its other obligations hereunder, the AGENCY agrees to comply with the following: 1. AGENCY must maintain separate financial records for ERA - COVID-19 funds and account for all receipts and expenditures including direct and indirect cost allocations in accordance with Generally Accepted Accounting Principles (GAAP), by individual service categories, by administration and program costs ERA - COVID-19 fund cost allocations are to be completed and posted by service category, delineating program and administrative costs, to the general ledger on a monthly basis. 2. AGENCY shall be chartered or registered with the Florida Department of State, have been incorporated for at least one AGENCY fiscal year and have provided services for at least six months. If approved for funding, a formal contract shall be executed, and payment will be made by reimbursement of documented expenses. 3. AGENCY shall promptly reimburse the COUNTY for any funds which are misused, misspent, unspent, or are for any reason deemed by the COUNTY to have been spent on Page 9 1021 ineligible expenses. This will be calculated based on payment schedule as determined by the COUNTY. 4. AGENCY must allow the DEPARTMENT to monitor AGENCY to assure that goals and conduct as outlined in the EXHIBIT A - SCOPE OF WORK, are adhered to. Non- compliance may impact future contract awards and/or funding level. 5. AGENCY must comply with the Health Insurance Portability Accountability Act (HIPAA). 6. AGENCY must attend all meetings, as required by COUNTY staff and other funded agencies, to develop their respective programs. 7. AGENCY must maintain books, records, documents, and other evidence which sufficiently and properly reflects all costs and provisions of services to individuals of any nature expended in the performance of this Contract for a period of not less than seven (7) years. 8. AGENCY must submit any and all reports to the COUNTY for each individual service as requested; including Recipient databases reports, as well as any AGENCY database reports that might contain ERA - COVID-19 client level data and/or ERA - COVID-19 fiscal data. All reports are subject to on-site verification and audit of AGENCY'S records. Copies of the required forms will be supplied to the AGENCY. Failure to submit completed reports will constitute a material breach of this Contract and may result in termination of this Contract. Agencies must be able to respond to Recipient inquiries. Data Reports will be monitored during monitoring phase. 9. AGENCY must not expend ERA - COVID-19 funds received pursuant to this Contract with any for-profit entity if there is a nonprofit entity available to provide quality service. Expenditure with a for-profit entity will require documentation that there were no nonprofit entities available to provide the quality service. 10. AGENCY agrees to the sharing of all data collected pursuant to this Contract, and must execute a Data Sharing Agreement that provides for sharing all data within the ERA - COVID-19 client database, the Online System for Community Access to Resources and Social Services (OSCARRS) system. 11. AGENCIES must attend OSCARRS training within one month of Contract award. 12. AGENCY must have policies in place to monitor any subagency providing services on behalf of the AGENCY paid with ERA - COVID-19 funds. Subagency contracts shall be documented between an AGENCY and subagency with a signed contract detailing the services to be rendered, length of contract and payment amounts. 13. AGENCY must sign and submit the following attachments: a. EXHIBIT D - CASH FLOW COMMITMENT STATEMENT along with the following financial statements: i. Statement of Cash Flows ii. Statement of Revenues, Expenditures and Changes in Fund Balance iii. Balance Sheet Statement 14. AGENCY must comply with all of the provisions of 2 C.F.R. 200 - Uniform Administrative Requirements, Cost Principles and Audit Requirements for Federal Awards (Super Circular) for CARES Act Rent and Utilities Assistance Program. 15. Funds provided to AGENCY pursuant to this Contract shall not be used to make payments for international travel. 16. AGENCY must comply with the information contained in EXHIBIT F - CERTIFICATION REGARDING LOBBYING BYRD ANTI -LOBBYING AMENDMENT and EXHIBIT G - CERTIFICATION DEBARMENT AND SUSPENSION. Page 10 1022 17. In accordance with section 119.0721(2), Florida Statutes, Social Security Numbers (SSN) may be disclosed to another governmental entity or its agents, employees, or contractors, if disclosure is necessary for the receiving entity to perform its duties and responsibilities. The receiving governmental entity, and its agents, employees, and contractors shall maintain the confidential and exempt status of such numbers. 18. Any publications produced with funds from the ERA - COVID-19 award must display the following language: This project is supported, in whole or in part, by federal award number 21.023, awarded to Palm Beach County by the U.S. Department of the Treasury. 19. AGENCY shall meet the requirements of the DEPARTMENT'S Emergency Rental and Utilities Assistance Program (ERA Program) Policy and Procedures Memorandum (PPM) #CS -E-005, located on the DEPARTMENT'S website at: https:Hdiscover.pbcgov.org/communityservices/humanservices/Pages/CoC-Grant- Apps.aspx ARTICLE 20 ACCESS AND AUDITS The AGENCY shall maintain adequate records to justify all charges, expenses, and costs incurred in estimating and performing the work for at least seven (7) years after completion of this Contract, or until resolution of any audit findings and/or recommendations. The COUNTY shall have access to such books, records, and documents as required in this section for the purpose of inspection or audit during normal business hours, at the AGENCY'S place of business. The AGENCY will provide a final close out report and Financial Reconciliation Statement as set forth in EXHIBIT C on accounting for all funds expended hereunder no later than 30 days from the Contract end date. The AGENCY shall provide the COUNTY with an annual financial audit report, which meets the requirements of sections 11.45 and 216.349, Florida Statutes, and Chapter 10.550 and 10.650, Rules of the Auditor General, and, to the extend applicable, the Single Audit Act of 1984, 31 U.S.C. § 7501-7507, OMB Circular A-128 for the purposes of auditing and monitoring the funds awarded under this Contract. a. The annual financial audit report shall include all management letters and the AGENCY'S response to all findings, including corrective actions to be taken. b. The annual financial audit report shall include a schedule of financial assistance specifically identifying all contracts, agreements and grant revenue by sponsoring agency and contract/agreement grant number. C. The complete financial audit report, including all items specified herein, shall be sent directly to: Fiscal Manager Palm Beach County Community Services Department 810 Datura Street West Palm Beach, FL 33401 Page 11 1023 Electronic submission via email is acceptable. Please submit audit reports to the Fiscal Manager and Financial Analyst. d. The AGENCY shall have all audits completed by an independent certified public accountant (IPA) who shall either be a certified public accountant or a public accountant licensed under Chapter 473, Florida Statutes. The IPA shall state that the audit complied with the applicable provisions noted above. e. The audit is due within 30 days after receipt of the financial audited report from the IPA or PA within nine (9) months after the close of the AGENCY'S fiscal year. f. A copy of all grant audits and monitoring reports by other funding entities are required to be provided to the COUNTY. g. AGENCY shall establish policies and procedures and provide a statement, stating that the accounting system or systems established by the AGENCY, has appropriate internal controls, checking the accuracy and reliability of accounting data, and promoting operating efficiency. ARTICLE 21 CONFLICT OF INTEREST The AGENCY represents that it presently has no interest and shall acquire no interest, either direct or indirect, which would conflict in any manner with the performance of services required hereunder, as provided for in Chapter 112, Part III, Florida Statutes, and Palm Beach County Code of Ethics. The AGENCY further represents that no person having any such conflict of interest shall be employed for said performance of services. The AGENCY shall promptly notify the COUNTY'S representative, in writing, by certified mail, of all potential conflicts of interest of any prospective business association, interest or other circumstance which may influence or appear to influence the AGENCY'S judgment or quality of services being provided hereunder. Such written notification shall identify the prospective business association, interest or circumstance, the nature of work that the AGENCY may undertake and request an opinion of the COUNTY as to whether the association, interest or circumstance would, in the opinion of the COUNTY, constitute a conflict of interest if entered into by the AGENCY. The COUNTY agrees to notify the AGENCY of its opinion by certified mail within thirty (30) days of receipt of notification by the AGENCY. If, in the opinion of the COUNTY, the prospective business association, interest or circumstance would not constitute a conflict of interest by the AGENCY, the COUNTY shall so state in the notification and the AGENCY shall, at its option, enter into said association, interest or circumstance and it shall be deemed not in conflict of interest with respect to services provided to the COUNTY by the AGENCY under the terms of this Contract. ARTICLE 22 DRUG-FREE WORKPLACE The AGENCY shall implement and maintain a drug-free workplace program of at least the following items: 1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. Page 12 1024 2. Inform employees about the dangers of drug abuse in the workplace, the AGENCY'S policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3. Give each employee engaged in providing the services that are under Contract a copy of the statement specified in Item Number 1 above. 4. In the statement specified in Item Number 1 above, notify the employees that, as a condition of working on the Contract services, the employee will abide by the terms of the statement and will notify the AGENCY of any conviction of, or plea of guilty nolo contendere to, any violation of Chapter 893, Florida Statutes, or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction or plea. 5. Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community, by any employee who is so convicted or so pleads. 6. Make a good faith effort to continue to maintain a drug-free workplace through implementation of section 287.087, Florida Statutes. ARTICLE 23 AMERICANS WITH DISABILITIES ACT (ADA) The AGENCY shall meet all the requirements of the Americans With Disabilities Act (ADA), which shall include, but not be limited to, posting a notice informing service recipients and employees that they can file any complaints of ADA violations directly with the Equal Employment Opportunity Commission (EEOC), One Northeast First Street, Sixth Floor, Miami, Florida 33132. ARTICLE 24 INDEPENDENT CONTRACTOR RELATIONSHIP The AGENCY is, and shall be, in the performance of all work services and activities under this Contract, an Independent Contractor, and not an employee, agent, or servant of the COUNTY. All persons engaged in any of the work or services performed pursuant to this Contract shall at all times, and in all places, be subject to the AGENCY'S sole direction, supervision, and control. The AGENCY shall exercise control over the means and manner in which it and its employees perform the work, and in all respects the AGENCY'S relationship and the relationship of its employees to the COUNTY shall be that of an Independent Contractor and not as employees or agents of the COUNTY. The AGENCY does not have the power or authority to bind the COUNTY in any promise, contract or representation other than specifically provided for in this Contract. ARTICLE 25 CONTINGENT FEES The AGENCY warrants that it has not employed or retained any company or person, other than a bona fide employee working solely for the AGENCY to solicit or secure this Contract and that it has not paid or agreed to pay any person, company, corporation, individual, or firm, other than a bona fide employee working solely for the AGENCY, any fee, commission, percentage, gift, or any other consideration contingent upon or resulting from the award or making of this Contract. Page 13 1025 ARTICLE 26 PUBLIC ENTITY CRIMES As provided in section 287.132-133, Florida Statutes, by entering into this Contract or performing any work in furtherance hereof, the AGENCY certifies that it, its affiliates, suppliers, subcontractors and AGENCY who will perform hereunder, have not been placed on the convicted vendor list maintained by the State of Florida Department of Management Services within the 36 months immediately preceding the date hereof. This notice is required by section 287.133(3)(a), Florida Statutes. ARTICLE 27 EXCUSABLE DELAYS The AGENCY shall not be considered in default by reason of any failure in performance if such failure arises out of causes reasonably beyond the control of the AGENCY or its subcontractors and without their fault or negligence. Such causes include, but are not limited to: acts of God; natural or public health emergencies; labor disputes; freight embargoes; and abnormally severe and unusual weather conditions. AGENCY acknowledges that Palm Beach County and the Country are currently experiencing a pandemic, specifically COVID-19, and agrees that COVID-19 is not an excusable delay under this Contract. Upon the AGENCY'S request, the COUNTY shall consider the facts and extent of any failure to perform the work and, if the AGENCY'S failure to perform was without it or its subcontractor's fault or negligence, the Contract Schedule and/or any other affected provision of this Contract shall be revised accordingly; subject to the COUNTY'S rights to change, terminate, or stop any or all of the work at any time. ARTICLE 28 ARREARS The AGENCY shall not pledge the COUNTY'S credit or make it a guarantor of payment or surety for any contract, debt, obligation, judgment, lien, or any form of indebtedness. The AGENCY further warrants and represents that it has no obligation or indebtedness that would impair its ability to fulfill the terms of this Contract. ARTICLE 29 DISCLOSURE AND OWNERSHIP OF DOCUMENTS The AGENCY shall deliver to the COUNTY'S representative for approval and acceptance, and before being eligible for final payment of any amounts due, all documents and materials prepared by and for the COUNTY under this Contract. The AGENCY agrees that copies of any and all property, work product, documentation, reports, computer systems and software, schedules, graphs, outlines, books, manuals, logs, files, deliverables, photographs, videos, tape recordings or data relating to the Contract which have been created as a part of the AGENCY'S services or authorized by the COUNTY as a reimbursable expense, whether generated directly by the AGENCY, or by or in conjunction or consultation with any other party whether or not a party to the Contract, whether or not in privity of contract with the COUNTY or the AGENCY, and wherever located shall be the property of the COUNTY. To the extent allowed by Chapter 119, Florida Statutes, all written and oral information not in the public domain or not previously known, and all information and data obtained, developed, Page 14 1026 or supplied by the COUNTY, or at its expense, will be kept confidential by the AGENCY and will not be disclosed to any other party, directly or indirectly, without the COUNTY'S prior written consent, unless required by a lawful court order. All drawings, maps, sketches, programs, data bases, reports and other data developed or purchased under this Contract for the COUNTY, or at the COUNTY'S expense, shall be and remain the COUNTY'S property and may be reproduced and reused at the discretion of the COUNTY. All covenants, agreements, representations and warranties made herein, or otherwise made in writing by any party pursuant hereto, including but not limited to any representations made herein relating to disclosure or ownership of documents, shall survive the execution and delivery of this Contract and the consummation of the transactions contemplated hereby. Notwithstanding any other provision in this Contract, all documents, records, reports and any other materials produced hereunder shall be subject to disclosure, inspection and audit, pursuant to the Palm Beach County Office of the Inspector General in Palm Beach County Code, Section 2-421 - 2-440 as amended. ARTICLE 30 TERMINATION This Contract may be terminated by the AGENCY upon sixty (60) days' prior written notice to the COUNTY in the event of substantial failure by the COUNTY to perform in accordance with the terms of this Contract through no fault of the AGENCY. It may also be terminated, in whole or in part, by the COUNTY, with cause upon five (5) business days written notice to the AGENCY or without cause upon ten (10) business days written notice to the AGENCY. Unless the AGENCY is in breach of this Contract, the AGENCY shall be paid for services rendered to the COUNTY'S satisfaction through the date of termination. After receipt of a Termination Notice, except as otherwise directed by the COUNTY, in writing, the AGENCY shall: • Stop work on the date and to the extent specified. • Terminate and settle all orders and subcontracts relating to the performance of the terminated work. • Transfer all work in process, completed work, and other materials related to the terminated work to the COUNTY. • Continue and complete all parts of the work that have not been terminated. In the event the grant to the COUNTY under the Emergency Rental Assistance Program (ERA - COVID-19) is suspended or terminated, this CONTRACT shall be immediately terminated effective on the date the Federal Government notifies the COUNTY of the suspension or termination. ARTICLE 31 SEVERABILITY If any term or provision of this Contract or the application thereof to any person or circumstances shall, to any extent, be held invalid or unenforceable, the remainder of this Contract, or the application of such terms or provision to persons or circumstances other than those as to which it is held invalid or unenforceable, shall not be affected, and every other term and provision of this Contract shall be deemed valid and enforceable to the extent permitted by law. ARTICLE 32 NOTICES Page 15 1027 All notices required in this Contract shall be sent by certified mail, return receipt requested, hand delivery or other delivery service requiring signed acceptance. If sent to the COUNTY, notices shall be addressed to: Taruna Malhotra, Assistant Department Director Palm Beach County Community Services Department 810 Datura Street West Palm Beach, FL 33401 and if sent to the AGENCY, shall be mailed to: Kemberly Bush, Chief Executive Officer Pathways to Prosperity, Inc. 900 N. Seacrest Boulevard Boynton Beach, FL 33435 ARTICLE 33 STANDARDS OF CONDUCT FOR EMPLOYEES The AGENCY must establish safeguards to prevent employees, agencies or members of governing bodies from using their positions for purposes that are, or give the appearance of being, motivated by a desire for private financial gain for themselves or others such as those with whom they have family, business, or other ties. Therefore, each institution receiving financial support must have written policy guidelines on conflict of interest and the avoidance thereof. These guidelines should reflect State and local laws and must cover financial interests, gifts, gratuities and favors, nepotism, and other areas such as political participation and bribery. These rules must also indicate the conditions under which outside activities, relationships, or financial interest are proper or improper, and provide for notification of these kinds of activities, relationships, or financial interests to a responsible and objective institution official. For the requirements of code of conduct applicable to procurement under grants, see the procurement standards prescribed by 45 C.F.R. Part 74, Subpart P and 45 C.F.R. Part 92.36. The rules of conduct must contain a provision for prompt notification of violations to a responsible and objective AGENCY official and must specify the type of administrative action that may be taken against an individual for violations. Administrative actions, which would be in addition to any legal penalty(ies), may include oral admonishment, written reprimand, reassignment, demotion, suspension, or separation. Suspension or separation of a key official must be reported promptly to the COUNTY. The AGENCY shall provide a copy of the rules of conduct to each officer, employee, board member, and sub -agency who are working on the grant supported project or activity and the rules must be enforced to the extent permissible under State and local law or to the extent to which the COUNTY determines it has legal and practical enforcement capacity. The rules need not be formally submitted to and approved by the COUNTY; however, they must be made available for a review upon request, for example, during a site visit. ARTICLE 34 SCRUTINIZED COMPANIES A. As provided in section 287.135, Florida Statutes, by entering into this Contract or performing any work in furtherance hereof, the AGENCY certifies that it, its affiliates, Page 16 1028 suppliers, subagencies and AGENCY who will perform hereunder, have not been placed on the Scrutinized Companies that boycott Israel List, or is engaged in a boycott of Israel, pursuant to section 215.4725, Florida Statutes. Pursuant to section 287.135(3)(b), Florida Statutes, if AGENCY is found to have been placed on the Scrutinized Companies that Boycott Israel List or is engaged in a boycott of Israel, this Contract may be terminated at the option of the COUNTY. B. When contract value is greater than $1 million: As provided in section 287.135, Florida Statutes, by entering into this Contract or performing any work in furtherance hereof, the AGENCY certifies that it, its affiliates, suppliers, subcontractors and AGENCY who will perform hereunder, have not been placed on the Scrutinized Companies With Activities in Sudan List or Scrutinized Companies With Activities in The Iran Petroleum Energy Sector List created pursuant to section 215.473, Florida Statutes, or is engaged in business operations in Cuba or Syria. If the COUNTY determines, using credible information available to the public, that a false certification has been submitted by AGENCY, this Contract may be terminated and a civil penalty equal to the greater of $2 million or twice the amount of this Contract shall be imposed, pursuant to section 287.135, Florida Statutes. Said certification must also be submitted at the time of Contract renewal, if applicable. ARTICLE 35 PUBLIC RECORDS Notwithstanding anything contained herein, as provided under section 119.0701, Florida Statutes, if the AGENCY: (i) provides a service; and (ii) acts on behalf of the COUNTY as provided under section 119.011(2), Florida Statutes, the AGENCY shall comply with the requirements of section 119.0701, Florida Statutes, as it may be amended from time to time The AGENCY is specifically required to: A. Keep and maintain public records required by the COUNTY to perform services as provided under this Contract. B. Upon request from the COUNTY'S Custodian of Public Records, provide the COUNTY with a copy of the requested records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided in Chapter 119 or as otherwise provided by law. The AGENCY further agrees that all fees, charges and expenses shall be determined in accordance with Palm Beach County PPM CW -F-002, Fees Associated with Public Records Requests, as it may be amended or replaced from time to time. C. Ensure that public records that are exempt, or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law for the duration of the Contract term and following completion of the Contract, if the AGENCY does not transfer the records to the public agency. D. Upon completion of the Contract the AGENCY shall transfer, at no cost to the COUNTY, all public records in possession of the AGENCY unless notified by COUNTY'S representative/liaison, on behalf of the COUNTY'S Custodian of Public Records, to keep and maintain public records required by the COUNTY to perform the service. If the AGENCY transfers all public records to the COUNTY upon completion of the Contract, the AGENCY shall destroy any duplicate public records that are exempt, or confidential and exempt from public records disclosure requirements. If the AGENCY keeps and maintains public records upon Page 17 1029 completion of the Contract, the AGENCY shall meet all applicable requirements for retaining public records. All records stored electronically by the AGENCY must be provided to COUNTY, upon request of the COUNTY'S Custodian of Public Records, in a format that is compatible with the information technology systems of COUNTY, at no cost to COUNTY. Failure of the AGENCY to comply with the requirements of this Article shall be a material breach of this Contract. COUNTY shall have the right to exercise any and all remedies available to it, including but not limited to, the right to terminate for cause. AGENCY acknowledges that it has familiarized itself with the requirements of Chapter 119, Florida Statutes, and other requirements of state law applicable to public records not specifically set forth herein. IF THE AGENCY HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE AGENCY'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, PLEASE CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT RECORDS REQUEST, PALM BEACH COUNTY PUBLIC AFFAIRS DEPARTMENT, and 301 N. OLIVE AVENUE, WEST PALM BEACH, FL 33401, BY E-MAIL AT RECORDS REQUEST@PBCGOV.ORG OR BY TELEPHONE AT 561-355-6680. ARTICLE 36 CRIMINAL HISTORY RECORDS CHECK The AGENCY, AGENCY'S employees, subcontractors of AGENCY and employees of subcontractors shall comply with Palm Beach County Code, Section 2-371 - 2-377, the Palm Beach County Criminal History Records Check Ordinance ("Ordinance"), for unescorted access to critical facilities ("Critical Facilities") or criminal justice information facilities ("CJI Facilities") as identified in Resolutions R2013-1470 and R2015-0572, as amended. The AGENCY is solely responsible for the financial, schedule, and/or staffing implications of this Ordinance. Further, the AGENCY acknowledges that its Contract price includes any and all direct or indirect costs associated with compliance with this Ordinance, except for the applicable FDLE/FBI fees that shall be paid by the COUNTY. This Contract may include sites and/or buildings which have been designated as either "critical facilities" or "criminal justice information facilities" pursuant to the Ordinance and Resolutions, as amended. COUNTY staff representing the DEPARTMENT will contact the AGENCY(IES) and provide specific instructions for meeting the requirements of this Ordinance. Individuals passing the background check will be issued a badge. The AGENCY shall make every effort to collect the badges of its employees and its subcontractors' employees upon conclusion of the Contract and return them to the COUNTY. If the AGENCY or its subcontractor(s) terminates an employee who has been issued a badge, the AGENCY must notify the COUNTY within two (2) hours. At the time of termination, the AGENCY shall retrieve the badge and shall return it to the COUNTY in a timely manner. The COUNTY reserves the right to suspend the AGENCY if the AGENCY 1) does not comply with the requirements of COUNTY Code Section 2-371 - 2-377, as amended; 2) does not contact the COUNTY regarding a terminated AGENCY employee or subcontractor employee within the stated time; or 3) fails to make a good faith effort in attempting to comply with the badge retrieval policy. ARTICLE 37 PALM BEACH COUNTY OFFICE OF INSPECTOR GENERAL Page 18 1030 Palm Beach County has established the Office of the Inspector General in Palm Beach County Code 2-421 through 2-440, as may be amended, which is authorized and empowered to review past, present and proposed COUNTY contracts, transactions, accounts and records. The Inspector General has the power to subpoena witnesses, administer oaths and require the production of records, and audit, investigate, monitor, and inspect the activities of the AGENCY, its officers, agents, employees, and lobbyists in order to ensure compliance with Contract requirements and detect corruption and fraud. Failure to cooperate with the Inspector General or interference or impeding any investigation shall be in violation of Palm Beach County Code Section 2-421 through 2-440, and punished pursuant to section 125.69, Florida Statutes, in the same manner as a second degree misdemeanor. ARTICLE 38 AUTHORITY TO PRACTICE The AGENCY hereby represents and warrants that it has and will continue to maintain all licenses and approvals required to conduct its business, and that it will at all times conduct its business activities in a reputable manner. Proof of such licenses and approvals shall be submitted to the COUNTY'S representative upon request. ARTICLE 39 DISCRIMINATORY VENDOR LIST An entity or affiliate who has been placed on the discriminatory vendor list may not: contract to provide goods or services to a public entity; contract with a public entity for the construction or repair of a public building or public work; lease real property to a public entity; award or perform work as a vendor, supplier, sub -contractor, or agency under contract with any public entity; nor transact business with any public entity. The Florida Department of Management Services is responsible for maintaining the Discriminatory Vendor List and intends to post the list on its website. Questions regarding the discriminatory vendor list may be directed to the Florida Department of Management Services, Office of Supplier Diversity at (850) 487-0915. ARTICLE 40 FEDERAL AND STATE TAX The COUNTY is exempt from payment of Florida State Sales and Use Taxes. The COUNTY will sign an exemption certificate submitted by the AGENCY. The AGENCY shall not be exempted from paying sales tax to its suppliers for materials used to fulfill contractual obligations with the COUNTY, nor is the AGENCY authorized to use the COUNTY'S Tax Exemption Number in securing such materials. The AGENCY shall be responsible for payment of its own and its share of its employees' payroll, payroll taxes and benefits with respect to this Contract. ARTICLE 41 DEBARMENT AND SUSPENSION A completed "Certification Regarding Debarment and Suspension" (EXHIBIT 1) is required at time of contract execution. Upon request, the AGENCY agrees to provide the COUNTY with subsequent certification(s) for it and/or its suppliers, sub -recipients and sub -agencies after Contract award. This Contract is a covered transaction for purposes of 2 C.F.R. 180 and 2 C.F.R. 3000. As such the AGENCY is required to verify that none of the AGENCY, its principals (defined at 2 C.F.R. Page 19 1031 180.995), or its affiliates (defined at 2 C.F.R. 180.905) are excluded (defined at 2 C.F.R. 180.935). The AGENCY must comply with 2 C.F.R. 180, subpart C and 2 C.F.R. 3000, subpart C and must include a requirement to comply with these regulations in any lower tier covered transaction it enters into. This certification is a material representation of fact relied upon by the COUNTY. If it is later determined that the AGENCY did not comply with 2 C.F.R. 180, subpart C and 2 C.F.R. 3000, subpart C, in addition to remedies available to the Federal Government serving as Grantor and COUNTY as Recipient, the Federal Government may pursue available remedies, including but not limited to suspension and/or debarment. The AGENCY must comply with the requirements of 2 C.F.R. 180, subpart C and 2 C.F.R. 3000, subpart C while this offer is valid and throughout the period of any contract that may arise from this offer. The AGENCY further agrees to include a provision requiring such compliance in its lower tier covered transactions. ARTICLE 42 FEDERAL SYSTEM FOR AWARD MANAGEMENT A contract award shall not be made to parties listed on the government -wide exclusions set forth in the System for Award Management ("SAM") (found at www.sam.gov), which contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority. ARTICLE 43 FACILITIES / OFFICE SPACE The COUNTY shall grant the AGENCY the right, revocable license and privilege of accessing and using room(s) (the Premises), contingent on availability, at the following COUNTY locations: 810 Datura Street West Palm Beach, FL 33401 6415 Indiantown Road Jupiter, FL 33450 1440 Martin Luther King Boulevard Riviera Beach, FL 33404 1699 Wingfield Street Lake Worth, FL 33460 38754 State Road #80, Room #216 Belle Glade, FL 33430 The room shall be used solely and exclusively for general office purposes and meeting their obligations under the terms of this Contract. Additional provisions on the license, use and restrictions regarding the Premises are detailed in EXHIBIT F, which is attached hereto and incorporated herein. ARTICLE 44 CLEAN AIR ACT AND THE FEDERAL WATER POLLUTION CONTROL ACT Page 20 1032 AGENCY agrees to comply with all applicable standards, orders or regulations issued pursuant to the Clean Air Act, as amended (42 U.S.C. 7401-7671) and the Federal Water Pollution Control Act, as amended (33 U.S.C. 1251-1387). The AGENCY agrees to report each violation to the COUNTY, and understands and agrees that the COUNTY will, in turn, report each violation as required by the federal awarding agency and the appropriate Environmental Protection Agency Regional Office. The AGENCY agrees to include these requirements in each sub -contract exceeding $100,000 financed in whole or in part with Federal assistance money. ARTICLE 45 SCIENTIFIC RESEARCH AND DEVELOPMENT AND COPYRIGHT AND PATENT RIGHTS Those solicitations or contracts providing federal funds in support of scientific research and development must comply with the requirements of 37 C.F.R. 401 - Rights to Inventions Made by Nonprofit Organizations and Small Business Firms Under Government Grants, Contracts and Cooperative Agreements, and any implementing regulations issued by the awarding agency. COUNTY shall be the exclusive owner of any patent rights arising as a result of any discovery or invention that arises or is developed in the course of or under this Contract. The COUNTY shall hold the copyright to works produced or purchased under this Contract. FEMA and the Federal Government hold a royalty -free, non-exclusive and irrevocable license to produce, publish, or to otherwise authorize others to use, for Federal Government purposes, copyrighted material that was developed under a Federal award or purchased under a Federal award. ARTICLE 46 MANDATORY STANDARDS AND POLICIES RELATING TO ENERGY EFFICIENCY AGENCY is required to comply with mandatory standards and policies related to energy efficiency that are contained in the State energy conservation plan issued in accordance with the Energy Policy and Conservation Act (Pub. L. 94-163, 89 Stat. 871) (42 U.S.C. 6201). ARTICLE 47 PROCUREMENT OF RECOVERED MATERIALS AGENCY is to provide COUNTY with those goods designated by the Environmental Protection Agency (EPA), at 40 C.F.R. 247 - 247.17, that contain the highest percentage of recovered materials practicable while maintaining a satisfactory level of competition for goods valued above $10,000 or where the value of the goods procured during the preceding fiscal year exceeded $10,000. Categories of goods with the highest percentage of recovered materials include construction products; landscaping products; miscellaneous products; non -paper office products; paper and paper products; park and recreation products; transportation products; and vehicular products. ARTICLE 48 PROGRAM FRAUD AND FALSE OR FRAUDULENT OR RELATED ACTS The AGENCY acknowledges that 31 U.S.C. 38 - Administrative Remedies for False Claims and Statements applies to the AGENCY's actions pertaining to this contract. (31 U.S.C. Chapter 38). Page 21 1033 ARTICLE 49 FEDERAL CRIMINAL LAW/FALSE STATEMENTS ACT The False Statement Act sets forth liability for, among other things, any person who knowingly submits a false claim to the Federal Government or causes another to submit a false claim to the government or knowingly makes a false record or statement to get a false claim paid by the government. For example, a false claim could include false billing documentation submitted by the COUNTY received from an agency or subrecipient under the Contract. (31 U.S.C. 3729). ARTICLE 50 E -VERIFY - EMPLOYMENT ELIGIBILITY AGENCY warrants and represents that it is in compliance with section 448.095, Florida Statutes, as may be amended, and that it: (1) is registered with the E -Verify System (E- Verify.gov), and beginning January 1, 2021, uses the E -Verify System to electronically verify the employment eligibility of all newly hired workers; and (2) has verified that all of AGENCY'S subcontractors performing the duties and obligations of this Contract are registered with the E -Verify System, and beginning January 1, 2021, use the E -Verify System to electronically verify the employment eligibility of all newly hired workers. AGENCY shall obtain from each of its subcontractors an affidavit stating that the subcontractor does not employ, contract with, or subcontract with an Unauthorized Alien, as that term is defined in section 448.095(1)(k), Florida Statutes, as may be amended. AGENCY shall maintain a copy of any such affidavit from a subcontractor for, at a minimum, the duration of the subcontract and any extension thereof. This provision shall not supersede any provision of this Contract which requires a longer retention period. COUNTY shall terminate this Contract if it has a good faith belief that AGENCY has knowingly violated Section 448.09(1), Florida Statutes, as may be amended. If COUNTY has a good faith belief that AGNECY'S subcontractor has knowingly violated Section 448.09(1), Florida Statutes, as may be amended, COUNTY shall notify AGENCY to terminate its contract with the subcontractor and AGENCY shall immediately terminate its contract with the subcontractor. If COUNTY terminates this Contract pursuant to the above, AGENCY shall be barred from being awarded a future contract by COUNTY for a period of one (1) year from the date on which this Contract was terminated. In the event of such contract termination, AGENCY shall also be liable for any additional costs incurred by COUNTY as a result of the termination. ARTICLE 51 COUNTERPARTS This Contract, including the exhibits referenced herein, may be executed in one or more counterparts, all of which shall constitute collectively but one and the same Contract. The COUNTY may execute the Contract through electronic or manual means. ARTICLE 52 ENTIRETY OF CONTRACTUAL CONTRACT The AGENCY agrees that the Scope of Work has been developed from the AGENCY's funding application and that the COUNTY expects performance by the AGENCY in accordance with such application. In the event of a conflict between the application and this Contract, this Contract shall control. The COUNTY and the AGENCY both further agree that this Contract sets forth the entire Contract between the parties, and that there are no promises or understandings other than Page 22 1034 those stated herein. None of the provisions, terms and conditions contained in this Contract may be added to, modified, superseded or otherwise altered, except by written instrument executed by the parties hereto. REMAINDER OF PAGE LEFT BLANK INTENTIONALLY Page 23 1035 IN WITNESS WHEREOF, the Board of County Commissioners of Palm Beach County, Florida has made and executed this Contract on behalf of the COUNTY and AGENCY has hereunto set his/her hand the day and year above written. ATTEST Joseph Abruzzo Clerk of the Circuit Court & Comptroller Palm Beach County Cv Deputy Clerk APPROVED AS TO FORM AND LEGAL SUFFICIENCY BY: Assistant County Attorney PALM BEACH COUNTY, FLORIDA, a Political Subdivision of the State of Florida BOARD OF COUNTY COMMISSIONERS Mayor AGENCY: Pathways to Prosperity, Inc. BY: Authorized Signature Kemberly Bush AGENCY'S Signatory Name Typed APPROVED AS TO TERMS AND CONDITIONS Community Services Department Department Director Page 24 1036 'L61' Authorized Signature Kemberly Bush AGENCY'S Signatory Name Typed APPROVED AS TO TERMS AND CONDITIONS Community Services Department Department Director Page 24 1036 EXHIBIT A 2022 EMERGENCY RENTAL ASSISTANCE PROGRAM (ERA - COVID-19) SCOPE OF WORK AND SERVICES AGENCY: PATHWAYS TO PROSPERITY, INC. PROGRAM NAME: NAVIGATION SERVICES Number Served: 400 Unduplicated Clients The Emergency Rental Assistance Program (ERA — COVID-19) provides rental and utility assistance to eligible Palm Beach County residents who are eighteen years of age or older, eligible for unemployment, have experienced a reduction of household income, incurred significant costs, annual income is at or below eighty percent (80%) Area Median Income (AMI), or experienced financial hardship due to COVID-19. AGENCY shall perform services on behalf of the Palm Beach County Community Services Department (DEPARTMENT), providing Palm Beach County residents affected by the COVID-19 pandemic with application submittal assistance for ERA- COVID-19. Scope of Services AGENCY shall provide RREAP services to clients suffering negative financial impact from the COVID-19 pandemic. RREAP services are intended to mediate disagreements between tenants and property owners, to construct payment plans, temporary rent reductions, deferred payments or other creative solutions to prevent evictions and ultimately homelessness. AGENCY shall: Application Review Services for all clients with annual incomes at or below eighty percent (80%) Area Median Income (AMI) who have submitted applications through the DEPARTMENT'S OSCARRS portal, including, but are not limited to: o Review of client applications to screen for eligibility and completeness; and o Approved applications will be processed by the DEPARTMENT. • Application Navigation Services for clients with incomes at or below eighty percent (80%) AMI to submit applications through the OSCARRS portal, including, but are not limited to: o Providing limited technical assistance, scanning services, and/or computer access to clients applying for services; o Assisting clients with submitting all required documents; o Providing Application Review Services once the applications are submitted; o Assisting client in checking the status of submitted application; o Referring clients to other assistance agencies when necessary; o Assisting landlords with the portal and providing them with technical assistance; o Seeing clients in person; o Helping clients with scanning/computer; o Assisting clients with completing applications thru OSCARSS; o Scheduling appointments; Page 25 1037 EXHIBIT A o Utilizing AGENCY facility and equipment; o Helping clients obtain any documents that are needed; o Initial screening of the application by AGENCY; o Forwarding screened application to the DEPARTMENT; and o Approved applications will be processed by the DEPARTMENT. AGENCY shall not charge a fee to the Client for Navigation Services provided under this Contract. AGENCY responsibilities shall also include, but not be limited to: • Participation in MANDATORY DEPARTMENT -provided training and technical assistance for AGENCIES. Failure to participate in training will render AGENCY ineligible to provide services to Palm Beach County residents; • Clients shall be assisted in the order in which they apply; and • Meet the requirements of CSD's Emergency Rental and Utilities Assistance Program (ERA Program) Policy and Procedures Memorandum (PPM) # CS -E-005, located on the CSD website at: https://discover. pbcgov.org/co m m u n ityservices/h u ma nse rvices/Pages/CoC-Grant-Apps.aspx AGENCY will assist Clients who meet the following criteria: • Reside within the limits of Palm Beach County; • Meet gross annual incomes at or below eighty percent (80%) AMI limits prior to COVID-19; • Provide documentation to evidence eligible for unemployment, have experienced a reduction of household income, incurred significant costs, or experienced financial hardship due to the COVID-19 pandemic that contributed to the missed rental payments; • Not have received any other financial assistance for rent and/or utilities for the period payment is requested and must be willing to certify that other assistance has not been obtained; • Have a lease and utilities in the name of an adult household member; • Apply for unemployment benefits and provide support documentation; and • Other restrictions may apply. Assistance may be provided for up to 12 months on a first come first serve basis. Additional benefits may be allowed for an additional three (3) months with the DEPARTMENT's approval. Payment of existing housing -related arrears that could result in eviction of an eligible household is prioritized. Assistance will be provided to reduce an eligible household's rental arrears before the household may receive assistance for future rent payments. Once a household's rental arrears are reduced, the DEPARTMENT will only commit to providing future assistance for up to three (3) months at a time. Households may reapply for additional assistance at the end of the three-month period if needed, provided that the overall time limit for assistance is not exceeded. An application for rental assistance may be submitted by either an eligible household or by a landlord on behalf of that eligible household. Page 26 1038 EXHIBIT B 2022 EMERGENCY RENTAL ASSISTANCE PROGRAM (ERA - COVID-19) UNITS OF SERVICE RATE AND DEFINITION AGENCY: PATHWAYS TO PROSPERTIY, INC. PROGRAM: NAVIGATION SERVICES Number Served: 400 Unduplicated Clients Total Payments: Not to exceed $50,000 The Scope of Work to be completed by AGENCY as defined in EXHIBIT A shall be billed on a monthly basis, and upon submission of invoices to the COUNTY of said "deliverables" as expressly indicated below. Invoices will normally be paid within thirty (30) days following the COUNTY representative's approval. Request for Payment must be accompanied by detailed report listing client names, date of service, type of service (application review or client assistance) and OSCARSS application number. Reimbursement shall only be made for unduplicated services, that is, reimbursement shall not be made more than once for provision of the same service to the same Client household. Navigation Services is Unit Rate = $125.00 $50,000 $50,000 $50,000 $150,000 defined as providing eligible per Client household Client household with eligible Navigation Services as described in EXHIBIT A - SCOPE OF WORK. One Unit is defined as a completed service to Client household(s) as evidenced by a client's approved and paid application in OSCARSS. TOTAL AGREEMENT $50,000 $50,000 $50,000 $150,000 AMOUNT Page 27 1039 EXHIBIT C FINANCIAL RECONCILIATION STATEMENT As required by the provisions of the Agreement/Contract between Palm Beach County ("the County") and Agency Name ("Agency") [Contract Number] effective 202_, for [describe subject of Agreement/Contract], attached is a final financial reconciliation of the funds provided by County. As shown in the attached (mark applicable box): •a ❑ All funds provided by Palm Beach County were spent in accordance with the provisions of the Agreement/Contract; and total administrative expenses did not exceed fifteen percent (15%) ❑ There were under expenditures in the amount of $ which pursuant to the Contract/Agreement, will be returned to Palm Beach County by [date]; all other funds were spent in accordance with the provisions of the Agreement/Contract. The undersigned states that he/she is the CFO or other individual dually authorized as stipulated in the contract to sign this type of document. The information attached is a true and accurate representation of the expenditure of Palm Beach County funds under the Agreement/Contract. Signature Print Name Date Page 28 1040 EXHIBIT D CASH FLOW COMMITMENT STATEMENT As the authorized representative of the applicant agency, I hereby certify that our agency has adequate cash available (or access to a credit line) to cover up to three (3) months cash expenses. AGENCY NAME Authorized Representative Date Attachments: a. Statement of Cash flows b. Statement of Activities C. Statement of Financial Position Page 29 1041 EXHIBIT E USE OF AND RESTRICTIONS REGARDING THE PREMISES 1. License for Premises: In addition to the availability of the room in the buildings mentioned in Facilities/Office Space article of this Contract/Agreement and once requested and approved by the DEPARTMENT, the AGENCY shall have the non-exclusive license over, upon and across the Premises, together with the common areas to allow AGENCY access and use of the Premises. The AGENCY shall be entitled to use the Premises without charge. The COUNTY will provide the AGENCY with office furniture and equipment, including a desk, chairs, a file cabinet and a telephone. The AGENCY accepts the Premises in "as is" condition. The AGENCY shall establish procedures with regard to space utilization and permitted uses. Said procedures shall include, but not be limited to, coordination between the COUNTY and the AGENCY of said use. The AGENCY shall, at AGENCY'S sole cost and expense, comply with all regulations of federal, state, county, municipal and other applicable governmental authorities, now in force or which may hereafter be in force, pertaining to the AGENCY or its use of the Premises, and shall faithfully observe in the use of the Premises all municipal and county ordinances and state and federal statutes now in force or which may hereafter be in force. 2. Additional Uses: The AGENCY shall not use, permit or suffer the use of the Premises or any other part of the premises for any other business or purpose whatsoever, except as specifically set forth in this Contract/Agreement and this exhibit without the prior written approval of the Director of the COUNTY'S Department of Facilities Development & Operations. 3. Improvements, Maintenance, Repairs and Utilities: The COUNTY shall maintain, repair and keep the Premises in good condition and repair at COUNTY'S sole cost and expense; provided however, in the event the AGENCY damages the Premises, COUNTY shall complete the necessary repairs and the AGENCY shall reimburse COUNTY for all expenses incurred by COUNTY in doing so. Furthermore, COUNTY shall provide utilities and janitorial services to the Premises that are necessary for the Premises to be used for general office purposes. In no event shall COUNTY be liable for an interruption or failure in the supply of any utilities to the Premises. No improvements, alterations or additions to the Premises shall be performed by the AGENCY. 4. Waste and Nuisance: The AGENCY shall not commit or suffer to be committed any waste or nuisance or other act or thing which may result in damage or depreciation of value of the Premises or which may affect COUNTY'S fee interest in the Premises. The AGENCY shall not store or dispose of any contaminants including, but not limited to, hazardous or toxic substances, chemicals or other agents on the Premises. 5. COUNTY'S Right to Enter: COUNTY shall have the right to enter the Premises at any time necessary, without notice, to implement its responsibilities pursuant to this Contract/Agreement and for purposes of inspection of the Premises generally. 6. Revocation of License: Notwithstanding anything to the contrary contained in this Contract/Agreement, the rights to use COUNTY property granted to the AGENCY in this Contract/Agreement and this exhibit amount only to a license to use the Premises, which license is expressly revocable by COUNTY for any reason whatsoever upon notice to the AGENCY. Upon AGENCY'S receipt of notice from COUNTY of the revocation of the license granted hereby, the AGENCY shall vacate the Premises within thirty (30) days, whereupon the AGENCY'S rights of use pursuant to this Contract/Agreement and this exhibit shall terminate and COUNTY shall be relieved of all further obligations hereunder accruing subsequent to the date of such tennination. Page 30 1042 EXHIBIT E 7. Surrender of Premises: Upon expiration or earlier termination of the AGENCY'S license to use the Premises, the AGENCY, at its sole cost and expense, shall remove all of its personal property from the Premises and shall surrender the Premises to the COUNTY in at least the same condition the Premises were in as of the date of this Contract/Agreement, reasonable wear and tear excepted. Indemnity: To the extent permitted by law, AGENCY shall indemnify, defend and save COUNTY, its agents, officers, and employees harmless from and against any and all claims, actions, damages, liability and expense, whether at trial or appellate level or otherwise, in connection with loss of life, personal injury and/or damage to or destruction of property arising from or out of the occupancy or use by AGENCY of the Premises or any part thereof, or any act, error or omission of AGENCY, its agents, contractors, employees, volunteers or invitees. In case COUNTY shall be made a party to any litigation commenced against AGENCY or by AGENCY against any third party, then AGENCY shall protect and hold COUNTY, its agents, officers, and employees harmless and pay all costs and attorney's fees incurred by COUNTY in connection with such litigation, whether at trial or appellate level or otherwise. This Section shall survive termination or expiration of this Contract/Agreement. Nothing herein shall be construed as a waiver of sovereign immunity or the statutory limits of liability set forth in section 768.28, Florida Statutes. Page 31 1043 EXHIBIT F CERTIFICATION REGARDING LOBBYING BYRD ANTI -LOBBYING AMENDMENT This Required Certification MUST be Submitted The undersigned Vendor certifies, to the best of his or her knowledge, that: 1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an 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 any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative 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, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form -LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. 3. The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31, U.S.C. § 1352 (as amended by the Lobbying Disclosure Act of 1995). Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The Vendor, , certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. § 3801 et seq., apply to this certification and disclosure, if any. Signature of Vendor's Authorized Official CEO Name and Title of Vendor's Authorized Official 11/9/2021 Date Page 32 1044 EXHIBIT G CERTIFICATION DEBARMENT AND SUSPENSION The Vendor certifies that: a. This contract is a covered transaction for purposes of 2 C.F.R. 180 and 2 C.F.R. 3000. As such the contractor is required to verify that none of the contractor, its principals (defined at 2 C.F.R. 80.995), or its affiliates (defined at 2 C.F.R. 180.905) are excluded (defined at 2 C.F.R. § 180.940) or disqualified (defined at 2 C.F.R. 180.935). b. The contractor must comply with 2 C.F.R. 180, subpart C and 2 C.F.R. 3000, subpart C and must include a requirement to comply with these regulations in any lower tier covered transaction it enters into. c. This certification is a material representation of fact relied upon by County (subgrantee). If it is later determined that the contractor did not comply with 2 C.F.R. 180, subpart C and 2 C.F.R. 3000, subpart C, in addition to remedies available to County, the Federal Government may pursue available remedies, including but not limited to suspension and/or debarment. d. The Vendor agrees to comply with the requirements of 2 C.F.R. 180, subpart C and 2 C.F.R. 3000, subpart C while this offer is valid and throughout the period of any contract that may arise from this offer. The vendor further agrees to include a provision requiring such compliance in its lower tier covered transactions. COMPANY NAME: Pathways to Prosperity, Inc. ADDRESS: COMPANY'S AUTHORIZED OFFICIAL: CEO Name and Title Signature 11/91202/ Date Page 33 1045 DocuSign Envelope ID: 476C46A8-7A80-4EB8-B72D-6D6794A1E634 EXHIBIT H TO: All Community Services Employees FROM: Julie Dowe, Director of Finance and Support Services PREPARED BY: Julie Dowe, Director of Finance and Support Services SUBJECT: Covid-19 Rental and Utility Assistance PPM#: CS -E-005 ISSUE DATE EFFECTIVE DATE March 10, 2021 March 10, 2021 PURPOSE: To establish policies and procedures to process client rental and utility assistance applications through the US Treasury Emergency Rental Assistance Program for Palm Beach County residents experiencing crisis due to COVID-19. UPDATES: Future updates to this PPM shall be the responsibility of the Assistant Department Director. AUTHORITY U.S. Department of Treasury Emergency Rental Assistance (ERA) Program BCC Agenda Item from March 9th, 2021 POLICY - On March 9, 2021, the Board of County Commissioners (BCC) approved ERA funding to assist Palm Beach County residents affected by COVID-19 with rental and utility assistance. Eligible Palm Beach County households is a renter household in which at least one or more individuals meets all of the following criteria: i. qualifies for unemployment or experienced a reduction of household income, incurred significant costs, or experienced other financial hardships due to COVID-19; ii. demonstrates a risk of homelessness or housing instability; and iii. Has a household income at or below 80% of the area median. Households may receive up to 12 months of assistance, plus an additional 3 months if the grantee determines the extra months are needed to ensure housing stability and grantee funds are available. Payment of existing housing -related arrears that could result in eviction of an eligible Page 1 of 7 Page 34 1046 DocuSign Envelope ID: 476C46A8-7A80-4EB8-B72D-6D6794A1E634 EXHIBIT H household is prioritized. Assistance must be provided to reduce an eligible household's rental arrears before the household may receive assistance for future rent payments. Once a household's rental arrears are reduced, grantees may only commit to providing future assistance for up to three months at a time. Households may reapply for additional assistance at the end of the three-month period if needed and the overall time limit for assistance is not exceeded. An application for assistance may be submitted by either an eligible household or by a landlord on behalf of that eligible household. Utilities assistance is for electric, water, gas, sewer, trash removal and energy costs. ERA Application Requirements A household may be eligible if they meet the following criteria: 1. One or more household members experience a financial crisis directly or indirectly caused by the COVID-19 Pandemic. Examples may include but are not limited to: Directly Related to COVID-19: a. Reduction or loss of Income b. Lost Employment c. Qualified for Unemployment Indirectly Related to COVID-19: a. Increase in expenses due to COVID-19 b. Responsible for caring for children/grandchildren at home c. Caring for or being a high risk individual 2. One or more household members can demonstrate a risk of homelessness or housing instability. Examples of proof of risk are: a. Eviction notice b. Past due rent notice c. Past due utility bill d. Utility disconnect notice 3. Total household income must be at or below 80% of Area Median Income (AMI), with priority given to households with 50% or less of Area Median Income a. Income < 30% AMI (Highest Priority) b. Income 31% to 50% AMI (High Priority) c. Income 51% to 80% AMI (Regular Priority) NOTE: Priority shall also be given to households with at least one individual unemployed for 90 or more days. Household Partial Eli ig'bility Households receiving funding or subsidy under any other federally funded rental assistance program i.e. Section 8, HUD Housing, Public Housing may be eligible for ERA assistance. However, households shall need to provide: Page 2 of 7 Page 35 1047 DocuSign Envelope ID: 476C46A8-7A80-4EB8-B72D-6D6794A1E634 EXHIBIT H 1. Proof of assistance received from such programs (new tenant portion identified) 2. Proof of rental reduction request to its Housing Authority Staff shall confirin that no other entity using federal dollars has already paid for the rental payment requested in the application. Household Income Income for all adult household members ages 18 and over shall be collected to determine income eligibility (see above income limits and priorities). Income may be collected in the following manner: • Total household income for 2020 (Adjusted Gross Income under IRS form 1040 series) or • Total household income for the two months prior to the submission of the application. Income and household composition must be recertified for each 3 -month period after the initial assistance application. Benefit Maximum There is not a maximum amount of assistance per household with ERA funding. However, assistance paid may not exceed 12 months. Rental assistance can be paid up to three (3) months in advance, and income must be recertified for each three (3) month period. Required Documentation All Clients must present the following documentation in order to apply for services: • Evidence of COVID-19 direct impact (see examples above) or • Evidence of COVID-19 indirect impact (see examples above) • Evidence of risk of homelessness or housing instability (see examples above) o For Rental Assistance- Current Lease Agreement and Balance Statement completed by Landlord must be submitted o For Utility Assistance—copy of past due bill or disconnection notice must be submitted • Evidence of Income Eligibility: o For determining 2020 income, at the time of application, potential households may submit: wage statement, interest statement, unemployment compensation statement or a copy of Form 1040 as filed with the IRS for the household. o Monthly Income: income from the past two months prior to the submission of the application (paystubs, tax returns, unemployment income, etc.) • Valid government issued ID • Most recent utility bill to verify residency • Social Security Numbers for all household members. Applicant will have to provide copy of social security card. Household members may need to provide copy if deemed necessary by the Case Manager. For rental assistance, landlords must be registered as vendors with Palm Beach County. Landlords who have not yet registered shall receive a link to register. Page 3 of 7 Page 36 1048 DocuSign Envelope ID: 476C46A8-7A80-4EB8-B72D-6D6794A1E634 EXHIBIT H PROCEDURE: Clients submitting applications on behalf of themselves: • Clients shall apply for services using the Online System for Community Access to Resources and Social Services (OSCARSS) and upload required documentation. • OSCARSS shall pre-screen applicants to determine initial eligibility. Landlords/Property Owners/Agency Staff submitting applications on behalf of tenants/clients: • Clients shall provide all required information and supporting documents to the person/entity applying on their behalf • Clients shall provide an Attestation Statement granting approval to the person/entity creating/submitting/managing their OSCARSS application. • Tenant/Client's Attestation Form and Electronic Signature must be included in the OSCARSS application • Person/entity creating/submitting/managing OSCARSS application on tenant/client's behalf shall provide application document to tenant/client. Program/Supervisory Staff. 1. Program staff shall review OSCARSS COVID-19 ERA applications and screen for eligibility. 2. Program staff shall review supporting documents. 3. Program staff shall review and confirm vendor code in application. If vendor is not registered with Palm Beach County, program staff shall follow up with vendor to register and provide vendor code. 4. For rental assistance, staff shall confirm through Palm Beach County's Property Appraisers Website that landlord owns home being rented. 5. Once client is deemed eligible for services and vendor code is included in application, program staff shall approve application at Level 1. 6. Supervisors shall review and approve applications at Level 2. Approved applications shall be merged with OSCARSS Financials Web -based System and generate invoice. 7. Fiscal Staff shall review invoice generated from the approved application. NOTE: Applications that are incomplete or include incorrect information shall be returned to the client for correction. Clients shall resubmit applications in OSCARSS after corrections are made. Fiscal Staff.- Fiscal Specialist or Financial Analyst shall retrieve approved applications for utility and rental assistance from the OSCARSS System and review to ensure: a. Invoice has been approved by Supervisor b. Supporting documentation attached i. Client Application, which must include statement of how the household was directly or indirectly impacted by COVID-19 ii. Evidence of COVID-19 direct or indirect impact iii. Rental Assistance—lease and balance sheet Page 4 of 7 Page 37 1049 DocuSign Envelope ID: 476C46A8-7A80-4EB8-B72D-6D6794A1E634 EXHIBIT H iv. Utilities—copy of past due bill supporting amount requested c. Supporting documentation matches invoice and all service dates falls within ERA funding requirements. i. Client Application—name of client matches name on invoices and on all supporting documentation (note: utilities may be in another household member's name); Client COVID-19 statement is present and is related to COVID-19; application is complete and includes client certification statement. ii. Evidence of COVID-19 direct or indirect impact—is for the client or member of household iii. Rental Assistance—Lease: current active lease; payee name matches; client name matches; client address (including apartment number) and payee address matches; monthly rent amount matches lease amount (could be less if Case Manager pro -rates rent) iv. Rental Assistance—Balance Sheet—amount requested on invoice is equal to or less than amount on Balance Sheet and includes the months the client is requesting v. Utility bill—past due bill/statement; Client name, account number, and service address (including apartment number) matches on invoice and utility bill (or is in the name of a household member); Utility bill may be in the name of any household member. d. Invoice includes active vendor code and: i. name in Advantage Financial System matches the payee name of the invoice and supporting documentation ii. payment address in Advantage Financial System matches the address on the invoice and supporting documentation 2. If not all the criteria above are met, Fiscal Specialist or Financial Analyst shall reject invoice. If all the criteria is met, Fiscal Specialist or Financial Analyst shall approve invoice. Approved invoices shall be forwarded by the system to Fiscal Manager. 3. Financial Manager shall review all invoices for proper documentation and budgetary sufficiency and shall approve or reject invoices. Rejected invoice shall go back to Fiscal Specialist or Financial Analyst to review. Approved invoices shall be electronically interfaced to the Clerk & Comptroller's department for final approval. Invoices sent to the Clerk shall include the following: a. Human Service's Authorization and Billing Invoice b. Copy of OSCARSS Client Application Landlord/Vendor Registration Landlord/vendor shall have 21 days to register as a vendor with Palm Beach County. If vendor does not comply with the established timeframe, the application shall be returned to the client. Agency staff shall make reasonable efforts to obtain the cooperation of landlords/vendors. Requests for participation shall be made in writing, by certified mail, to the landlords/vendors or a minimum of three (3) documented attempts made by phone or email requesting participation. HMIS Once application processing is complete, client data shall be transmitted to HMIS. Page 5 of 7 Page 38 1050 DocuSign Envelope ID: 476C46A8-7A80-4EB8-B72D-6D6794A1E634 EXHIBIT H ERA Funding_ Reporting Requirements The Secretary of Treasury in consultation with the Secretary of Housing and Urban Development must provide Quarterly Public Reports on the use of funds, including the following information on the program: 1. Name address, Social Security Number (SSN) for household members 2. Tax ID number for landlords/vendor 3. Amount and percentage of monthly rent covered by ERA 4. The number of Eligible Households who receive assistance 5. The Acceptance Rate of Applications for assistance 6. The Type(s) of assistance provided to each household 7. Amount of outstanding rental arears for each household 8. The Average Amount of Funding provided to Each Household 9. Income of Eligible Households by Income Tier a. 30% and Below AMI b. 31 % to 50% AMI c. 51 % to 80% AMI 10. The Average Number of Monthly Rental and Utility Payments 11. The data listed above must be disaggregated by the applicant's: a. Gender i. Male ii. Female iii. Transgendered b. Race i. White ii. Black or African American iii. American Indian and Alaska Native iv. Asian v. Native Hawaiian and Other Pacific Islander vi. Client Doesn't Know vii. Client Refused viii. Data Not Collected c. Ethnicity i. Hispanic or Latino ii. Not Hispanic or Latino iii. Client Doesn't know ERA FundingPrivacy and Security Requirements Data privacy and security requirements for ERA funding shall be listed on CSD website or application. Page 6 of 7 Page 39 1051 DocuSign Envelope ID: 476C46A8-7A80-4EB8-B72D-6D6794A1E634 docume EXHIBIT H Dooccu�uSigned by: . 2/16/2�21E�BF34EF22BFDF492 James Green, Department Director Department of Community Services Page 7 of 7 Page 40 1052 30ARD OF DIRECTORS The Late Rev. Lance Chaney Visionary & Founder Kemberly Bush CEO & Executive Director Maguene Cadet, Esq President Valencia Spells -Anderson Vice President Audrey Davis Secretary Octavia Bell Treasurer Dr. Barbara Carey -Shuler Board Member Marilane Chaney Board Member Rev. Terrence Kearney Board Member Revia Lee Board Member DeAnna Warren Board Member .I 00 December 5, 2022 Lynette Bell, President Truist Foundation 214 N. Tyron St. Charlotte, NC 28202 Re: grant ID 111725 Dear Ms. Bell, It is with warm gratitude that we accept Truist Foundation's grant of $10,000 (Check #810733387, Date: 11/18/22) for Pathway to Prosperity's anti -poverty program, Circles. We are grateful for your support of our organization, and it is invaluable to all we serve. Pathways to Prosperity is dedicated to strengthening the community by improving the social, mental, spiritual, economic, and emotional well-being of children and families through education and social services. Our mission is to have a positive, meaningful, and empowering impact in the lives of the people in our community and ensure they have what they need to thrive. With the support of funders like Truist Foundation, we can continue to provide programs that uplift individuals and families across Palm Beach County. We are thankful for your support and commitment to helping our community. It truly makes a difference in breaking the cycle of poverty our families are facing. We look forward to growing this partnership with you throughout the grant term, and are excited to share our program results with you! Warm regfirds, Kem`berly Bush, CEO 639 E. Ocean Avenue, Suite 101, Boynton Beach, FL 33435 « 561.903.774", www.pathwaysboynton.oeV Contributions benefit Pathways to Prosperity, Inc., a not-for-profit, tax-exempt organization. A COPY OF THE OFFICIAL REGISTRATION AND FIS TNF(1R MATTM MAV RF ORTATNFh F1Z(1M THF r1T\/TCTn1N nF MNG0 ]MFR CFR\/TCFS AT IAAAAAI F1nrir1A( rn zj im rHdn rnm ()R RY ("A] I TNn; Tn I -FRFF f. 10. From: Antonio Sangio mail@grantapplication.com Q Subject: Re: Bank of America, N.A., Co-Trustee of the William and Helen Thomas Charitable Trust Date: December 30, 2022 at 10:29 AM To: grants@p2ppbc.org Bank of America Private Bank, Philanthropic Solutions Online Grant Application Determination Rachel B Waterman Grant Writer Pathways to Prosperity, Inc. 639 E. Ocean Avenue, Suite 101 Boynton Beach, FL 33435 Dear Waterman: It is our pleasure to advise you that the Trustees for the William and Helen Thomas Charitable Trust have awarded a grant in the amount of $10,000.00 to Pathways to Prosperity, Inc.. This one-year grant was made in support of the following: Circles Palm Beach County. Bank of America, N.A., as Co-Trustee of the William and Helen Thomas Charitable Trust, is responsible for the management of the Fund's assets and administration of its grantmaking program and ensures that the philanthropic intentions of the donor are honored. A Grant Agreement Terms and Conditions document is attached for your review to ensure that you are familiar with the terms of the grant. A check in the full payment of this award will be mailed under separate cover to the address listed above. The grantee organization's deposit, negotiation, or endorsement of the check (arriving under separate cover) constitutes its agreement to the Grant Terms and Conditions document. In addition, please be advised that a grant report is due within 1 year of the grant award date. The grant report requirement and due date will be published on your MyAccount page in the Requirements Tab: www.grantrequest.com/SID_1116?SA=AM. Please do not attach materials beyond what is requested to the report forms, unless specifically discussed in advance. We request all correspondence to be conducted electronically; however, please do not add our contact email addresses to your organization's general newsletter or annual report mailing lists. We are proud to have the opportunity to partner with your organization and look forward to learning more about your continuing success. If you have any questions about this grant, or its conditions, please do not hesitate to contact me at paige.bernard@bofa.com, or Andrew Davis, Philanthropic Client Manager, at andrew.g.davis@bofa.com Best wishes for much success. Paige Bernard Philanthropic Administrator For the Trustees of the William and Helen Thomas Charitable Trust Bank of America Private Bank CONFIDENTIAL & PRIVILEGED "This communication is confidential and intended only for the addressee. If you are not the intended recipient, you may not copy, disclose, or distribute this message to anyone else; any such actions may be unlawful. If you have received this communication in error, please contact the sender of the message to inform him or her of the error. Regular Internet e-mail is not secure. We ask that you do not send personal or company information of a sensitive or confidential nature through unsecured e-mail. For questions concerning your account relationship with Bank of America, you may contact us by phone or US mail." n 6500173754ed4 26781... O.docx 1054 Um FO ���� ��������������I���� ~THE FUTURE BELONGS TO THOSE WHO PREPARE FOR IT." February 22.2O23 Board of Directors Mrs. NembedyBush CE{} Jan Moran Pathways to Prosperity, Inc. an�Pen�*/ 039E Ocean Ave, Suite 101 }oundt gUi� eom/ Boynton Beech, FL33435 Dear Mrs. Bush-, Torn Blanton Onbehalf ofThe Jim Moran Foundadon.|amhappy hono�^ �you that your request toouppodthe An�� o�D� �am/ Fhun��D�cm/ Circles Program in Palm Beach County has been approved in the amount of $40,000.00. Enclosed is the payment according to the attached budget and expected outcomes, Our funding is based on the current status of Pathways to Prosperity as a public charity under Melanie Burgess sections 5O1(c)(3)and 5OQ(a)(1)or5OQ(o)(2).Consequently, should there beany change toyour Vicm11reside«/ tax status, you are required tonotify The Foundation immediately. |tisalso necessary tocontact A»sl»m«rSeo*taty uswith any potential adivatmentainprogram delivery hnmwhat was presented and approved ������� ' Beou8veDkaco/ during the grant application process to determine if there are funding implications, VVe understand the importance of creating cause awareness, as well as acknowledging partnerships invested in serving our community. Should this grant generate an announcement or SusanEcchur recognition (ie, press release, print ore-news|etter. logo usaga, social media, etc.), Ireasorer respectfully T� Foundation |� In such mentions, p�� D�r� refer to us as The Jim Moran Foundation, For further assistance with your communications, or to begin the review and approval pnzoeso, please contact ||isa Finko|men at 954-363-5550 or |mKiffin Dkecxm Please sign and return this letter of commitment to me confirming that Pathways to Prosperity will comply with The Jim Moran Foundation's funding allocation and communications requirements. Lucia Lopez The Foundation's mission is to improve the quality of life for the youth and families of Florida J*ontaiT through the support of innovative programs and opportunities that meet the ever-changing needs D»mco/ of the community.VVith this grant, we recognize the positive impact you are making by providing motivated families with volunteer mentors who guide them on their journey to self-sufficiency. Sincerely, �|o�o|G.�am.MD. Attachments Melvin T.Stith, Ph.D. --------'----------'----------- FoundingDkector In accordance with The Jim Moran Foundation, Inc.'s funding and communications requirements stated abova. Pathways to Prosperity. Inc., agrees to utilize the $40.000.00 grant for the Circles Program inP181m BeachCounty, In addition, periodic updates and impactreporting will be provid s requested y The Jim Moran Foundation. In Memory of Kemberly h, Pathways to Prosperity, Inc, CC" PWagueneCadet, Board Chair Jim Moran M MIT" Founder 100 JIM MDRAN BOULEVARD. nEERF|ELD BEACH F1 OR|DA33442 19/8 2007 � Phone: 9544292122 wwwjimmu/anfoundaUon,org `____-1055 3/27/23, 9:35 AM Fwd: Grant Update - sunnygds07@gmail.com - Gmail From: Qon Armstead <cjonquantumfnd.org> Sent: Friday, March 17, 2023 9:58:04 AM To: Kemberly Bush <kbush @p2ppbc.org> Subject: Grant Update Hi Kern, I wanted to update you that our Board of Trustees has approved your grant request of $50,000 over 12 months. I will be sending more information in the beginning of next week. Congratulations Sincerely, II",,J AJll'°°RJI%4S""'III""' I["������'�NI':' I Program Officer 0: 561-832-7497 D: 561-623-2116 https://mail.google.com/mail/u/0/#inbox/FMfcgzGslkkkkWpmZGNBLXHpKhrxIBCP 1056 Department of Housing & Economic Development Strategic Planning Division 100 Australian AMILIC - Suite 500 Weir Palm Beach, 171, 33406 ('561)233-3600 4114M.pIx,g(w. com/hed Pahn Reach County Board of County Commissioners Gregg K. Weiss, Mayor Maria Sachs, Vice Mayor Maria G. Marino Michael A. Barnett Marci Woodward Sara Baxter Mack Bernard County Administrator Verden ia C. Baker "An Equal Opportunity ,,$ffirinalhw Action Employer March 7, 2023 Ms. Kemberly Bush, Chief Executive Officer Pathways to Prosperity 639 E. Ocean Avenue, Suite 101 Boynton Beach, FL 33435 AE: RFP HED.2023.1 — Community Development Block Grant (CDBG) Public Services FY 2023-2024 Funding Recommendations FNITTY.-M&MMM On March 6, 2023, the Selection Committee for RFP HED.2023.1 made funding recommendations for FY 2023-2024 CDBG Public Services during a publically held meet�ing. The Selection Committee recommended funding for Pathways to Prosperity for the Circles — Palm Beach County Program in the amount of $28,390. The funding recommendation will be presented at a Board of County Commissioners (BCC) meeting for approval on April 18, 2023. BCC meetings begin at 9:30 am and are located at the PBC Governmental Center, 301 N. Olive Avenue, 6th Floor Commission Chambers, West Palm Beach, FL 33401. Should you wish to protest the recommendation, you must submit a written protest via hand delivery, mail or email within three (3) business days following receipt of this letter. The written protest must be submitted to the designated RFP contact person and must contain identification of the RFP and the protestor, as well as a factual summary of the basis of the protest. The written protest is considered filed when it is received and date/time stamped. Only the issues submitted in writing within the period specified for the protest will be considered. The HED Department Director, or designee, will make a determination as to the validity of the protest, and has the authority to: 1 . Deny the protest, based on the findings of the review; 2. Uphold the protest, and recommend award to the next highest ranked proposer; provided however if the RFP is awarded to the next highest ranked proposer, new notice and protest provisions defined in the RFP shall apply; or 3. Cancel the RFP. Be advised that the Palm Beach County Lobbyist Registration nance Ordi(PamlBeach County Code Section 2-351 to 2-357) remains in effect and prohibits any non -written communication regard»® ©* RFP between a Respondent or a Respondent's representative and any member of the Board of County Commissioners, Commissioner's staff, or any member of the Selection Committee. This prohibon on non -written communication extends until the time at which the Board of County Commissioners makes a funding award, or until cancellation of the RFP. Cc: Sherry Howard, Deputy Director, HED Carlos Serrano, SPO Director, HED �# M � Additional Attachments 4 Description/Schedule of Fees Charged to Targeted Beneficiaries (N/A) 1059 Additional Attachments 5 Job description for each position that funds are being requested 1060 Title: Salary Range: FLSA Status: Date Revised: Job Summary: Pathways to Prosperity 639 E. Ocean Ave. Stet 101 Boynton Beach, FL. 33435 Circles Coordinator $48,000 - $68,000 Exe m pt 10/01/19 Job Description The Program Director provides administrative support to the Executive Director and the Board of Directors, including: planning, research, communications, personnel, recordkeeping, property management, and bookkeeping. He or she also acts as the Executive Director in his or her absence. Essential Job Functions / Responsibilities: • Maintains the oversight and facilitation of program space including coordination of space and effective delivery of work orders. • Coordinates data collection among P2P staff, service partners and programs. • Supports the facilitation of activities and facility scheduling for meetings/trainings/events. • Entry and filtering of data in appropriate programs (Excel and / or Access). • Develops and facilitates the data collection of linkage verifications and compiles report. • Responsible for P2P staff supervision, staff development, and effective budget management. • File and retrieve organizational documents, records and reports. • Coordinate and direct office services such as records, budget preparation personnel and housekeeping. • Create and modify documents such as invoices, reports, memos, letters and financial statements using word processing, spreadsheet, database and/or other presentation software such as Microsoft Office, QuickBooks or other programs. 1061 • Arrange for the repair and maintenance of office equipment. • Supports staff in assigned project -based work. • Assists in special events, such as fundraising activities and the annual meeting. • Supports all programs of P2P as needed. • Perform other duties as assigned by the Executive Director Qualifications: -Bachelor's degree preferred -May exchange years of education for years of experience -Minimum 2 years experience in related responsibilities -Bilingual, as needed for the community Additional Requirement: -Random drug testing throughout employment 1062 Title: Salary Range: FLSA Status: Date Revised: Job Summary: Pathways to Prosperity (P2P) 639 E. Ocean Ave. Ste. 101 Boynton Beach, FL 33435 Job Description Circles Case Manager $41,000 - $51,500 Full Time Exempt 12/18/2022 Circles is a community-based initiative that creates relationships across class and race lines, matching people with low-income with people of middle- and upper-income Allies. The primary role of the person in this position is to provide case management along with service and resource coordination in a human services environment, particularly with clients that are low-income and in crisis or emergency situations. 1. Conducts assessments and in-person appointments. Manages documentation for organizational purposes, as well as management and reporting for federal and non-federal grants. 2. Counsels clients and/or their families to facilitate achieving service plan goals, developing life skills, and/or sustaining financial stability, conducts activities and monitors the service environment in a manner to maximize client success and well-being. 3. Attends community meetings that pertain to resources specific to P2P services. • Works with community partners to maximize the assistance for clients. • Advocates on behalf of clients and families for services, basic needs, and other related issues. • Composes or prepares correspondence, case notes, narrative and technical reports, notifications, and related documents using computer-based applications. • Conduct comprehensive, client -centered social work activities in accordance with best practices. • Stays abreast of community resources and procedures for referring clients to appropriate resources. 1063 • Performs other duties and assumes other responsibilities as assigned by supervisor. • Due to the leadership role Pathways to Prosperity is called upon to play in the community, particularly during times of crisis, it is the expectation that all P2P staff will be fully engaged in the organization's crisis plan and response efforts. • Leads assigned community teams & assist recruitment for the team to ensure the efficacy & viability of the Circles model recruitment and Community Teams in tasks / Outreach efforts. • Maintains accurate records, files and complete required reports, including Intake documents. • Complete initial Matrix to assess Circle Leader at intake, quarterly or as needed thereafter to determine Circle Leader progression • Regularly attends and provides leadership in team meetings and community meetings. • Demonstrates strong organizational skills in managing complex tasks with autonomy. • Ability to identify own personal and professional challenges and implement learning feedback into work performance. • Excellent verbal and written communication skills. • Ability to work flexible schedule. • Bachelors' degree preferred with major course work in social work, psychology or another field closely related field. • At least two (2) years of experience in social case work, counseling, eligibility determination, social service or community resource referral, or closely related work. • Ability to communicate effectively with a diverse audience. • Knowledge of general interviewing practices and/or techniques; knowledge of social work and counseling practices and techniques, including crisis prevention and intervention. • Must have experience with Microsoft Office Suite & ability to work in online platforms. 1*11N1911 Mission -Focused: Catalyze others' commitment to mission to create real social change that leads to better lives and healthier communities. This drives their performance and professional motivations. Relationship -Oriented: Understands that people come before process and is astute in cultivating and managing relationships toward a common goal. 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L N O a a +' Q C n3 .0 — aJ Q > O 4- C — O a U 3 C U C L L E U L L (6 .� C 0 v � 0 a) f6 L L 4' v O O -0 .`^ p .a n3 O n3 'Q N Q } 0 aaj C 3 L) O ca C to C O_ aJ p- C a a N Q aa in O a O a) in H> L a) a E L a� } to f6 tw Ln aJ a) O QJ C C U n3Ln C L p U 4- C6 N U N O N O iJ L a -j b1J C ++ C " `^ N ��,, aJ 3 L) -a v ca s C a. - m n3 nA U v co s a a- U U a a N `L' L a o N a -0 Q ,} - Q a *' C-0 a) O> D `� C a ca a) Q C O a p a•� U O a) a) Q n3 cn L t (6 � N +' N > Q .� a u '+� a L _0 �i a L O O O 4— a .Ln aJ N� — Q (� a) L C (9 (9 C 41 C a L bA dA .'^ co a cLa t E U C co +� Ln N n3 n3 � C O } vi C O (B a"' L a C � � E co � a N a f° a••+ a a a a--� 3 + O > O 3 C Q a> > a Lin of O u O 0 Q C L- Lu O C)E a) a) EQ a QL a a) a L s Cv0 Q Ct -C C Q o U D U a C D Q� [6 4— N m 4— m O a) a- m C O m CoLA dLn C�uD U O M w 0 T- May 26, 2023 Kemberly Bush, CEO Pathways to Prosperity, Inc. 639 East Ocean Avenue, Suite 101 Boynton Beach, FL 33435 Re: Community Development Block Grant (CDBG) Funding FY2023/2024 Dear Mrs. Bush: This letter is in regards to your application for CDBG funds for the Fiscal Year 2023/2024. The CDBG Application Review Committee assessed your application for Public Services — CIRCLES of Boynton Beach Program and based on their scoring, funding recommendations has been forwarded to the City Commissioners for approval, for the amount of $35,000.00. Final recommendation approval will be at the regular City Commission Meeting on August 1, 2023, at 6:00 pm. The City Commission meeting will be held at 100 E. Ocean Ave., Boynton Beach, FL 33425. We recommend you or a representative attend the meeting to address any questions that may arise regarding your organization and/or services. Sincerely, ... ... . ........ ... . .. .. ....... .... - RJ Rainirez Community Improvement Division Manager 1070 Fiscal Year 2023 (October 1, 2023 to September 30, 2024) COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) Not -For -Profit Subrecipient Grant Application March 77, %' Hard cjiLflectronic Co wit a attachments (No applications will be accepted after 5:00 PM, on March 27, 2023) FOR MORE INFORMATION OR QUESTIONS, PLEASE CONTACT: [a]11W[97A-19]1►11 to] ►1 RJ Ramirez, Community Improvement Division Manager COMMUNITY IMPROVEMENT DIVISION 100 East Ocean Avenue Boynton Beach, FL 33435 Telephone: 561-742-6359 Email: ramirezr@bbfl.us boynton-beach.org/community-improvement 1071 Agency Name: Legal Aid Society of Palm Beach County, Inc. Project: Fair Housing Project APPLICATION ✓ Submit Hard Copy and a Digital/Electronic Application with all attachments ✓ Application is signed and dated. By Director, and Board Chairperson ✓ 501(c) (3) is attached (No -For -Profit Status) n a City of Boynton Beach Business Tax Receipt attached (if applicable). ✓ Board Member list. ✓ Copy of latest audit. ✓ All funding sources for this project identified. ADDITIONAL ATTACHMENTS ✓ Attachment 1 Agency Articles of Incorporation, Agency By-laws, and Tax Documents submitted to the Internal Revenue Service (IRS). ✓ Attachment 2 Copies of current license(s) needed to operate (as applicable to the funded activity) including City of Boynton Beach Business Tax Receipt (if applicable) ✓ Attachment 3 Documentation of all additional funding sources for program(s)/project(s) listed in application (if applicable) A description/schedule of fees charged to the targeted n a Attachment 4 beneficiaries of the programs/services/facilities to be funded (if applicable) A job description for each position for which funds are being ✓ Attachment 5 requested (explain role/responsibilities within each program/project) (if applicable) 1072 Certifications and Affirmations Print Full Name: Robert A. Bertisch, Esq. Applicant Signature Title: Executive Director Date: March 24, 2023 1073 I certify that I am authorized to submit this application on behalf of the applicant agency. I affirm that the award and payment of grant funds are subject to the sole and absolute discretion of the City of Boynton Beach City Commission without recourse. By submitting this application, I waive any and all claims related to the City of Boynton Beach CDBG Program and specifically agree to indemnify and hold the City, its employees, officers, agents, and representatives harmless from any and all claims which may be in any way related to any City of Boynton Beach CDBG Program award, payment, and/or denial. I certify that my agency was established and operating in the City of Boynton Beach on or before October 1, 2020. If funded, I affirm the applicant agency will continue service operations in the City of Boynton Beach. I affirm that the tax documents provided in this application are identical to those I have submitted to the Internal Revenue Service. I acknowledge that, funds are distributed by reimbursement only. if this grant is approved, any amount my agency receives may be considered taxable income by the Internal Revenue Service. I acknowledge that, if this grant application is approved, the City of Boynton Beach and Representatives of HUD, the Inspector General, and the General Accounting Office shall have access to all books, accounts, records, reports, files, and other papers, or property pertaining to the administration, receipt and use of CDBG funds necessary to facilitate such reviews and audits, as applicable and described under 24 CFR § 570.490(c). I acknowledge that, all records relating to the City of Boynton Beach CDBG Program, including supporting documentation, shall be retained for the greater of three years from closeout of the grant to the City, as applicable and described under 24 CFR § 570.490(d), unless there is litigation, claims, audit, negotiation, or other actions involving the records. The records must be retained until completion of the action and resolution of all issues. I acknowledge that, if this grant application is approved, my name, my agency name, and my grant award amount may be made public by the City of Boynton Beach. I acknowledge that, if this grant application is approved, my agency will be subject to Florida Sunshine Law, FL State Statute 119.0701 Print Full Name: Robert A. Bertisch, Esq. Applicant Signature Title: Executive Director Date: March 24, 2023 1073 FY 2023 Funding Request To submit an application, complete A — I, Attachments 1-5 (if applicable) and any other items requested. Do not include any items that are not requested. Submit a Hard copy and a digital/electronic copy with all attachments to RJ Ramirez, Community Improvement Division Manager (ramirezr@bbfl.us) Community Improvement Division, 100 East Ocean Avenue, Boynton Beach, FL 33435 arch 27, 2023. Please review the "CDBG Subrecipient Information and Guidelines" available at CDBG I City of Boynton Beach (boynton-beach.org) for the program reporting requirements, goals and timelines. For assistance, please call the Community Improvement Division at 561-742-6359. A. GENERAL INFORMATION 1. Name of Applicant: Legal Aid Society of Palm Beach County. Inc. ✓ No -For-profit Unique Entity ID # 59-6046994 Provide copy of your IRS ruling providing tax exempt status under Section 501(c) (3) of the 1986 IRS Code. Per 2CFR Chapter I Part 25 and the Office of Management and Budget guidance on Federal Funding Accountability and Transparency Act (FFATA) Subaward and Executive Compensation Reporting issued on August 27, 2010, each prime grant recipient may make subawards only to entities that have Unique Entity ID Number. 2. Name of Project: Fair Housing Project 3. Area or Location of Project: Boynton Beach, FL 4. Contact Person/Title: Robert A. Bertisch, Esq., Executive Director (Preferably Executive Director/President/CEO) Email Address: rbertisch@legalaidpbc.or Mailing Address/Zip: 423 Fern Street, Suite 200, West Palm Beach, FL 33401 Telephone: (561) 655-8944 Ext. 247 Fax: (561) 655-5269 Additional Contact Person/Title: Tequisha Y. Myles, Esq., Supervising Attorney (Preferably Person responsible for preparing reimbursements/quarterly reports) Alternate Email Address: tmyles@legalaidpbc.org Mailing Address/Zip: 423 Fern Street, Suite 200, West Palm Beach, FL 33401 Telephone: (561) 655-8944 Ext. 296 Fax: (561) 655-5269 3 1074 5. Grant Request Activity Area (choose one): _ Homeless Prevention Services Domestic Violence Prevention Public Safety/Crime Prevention Housing Rehabilitation Program Senior Services Educational Program ✓ Other (please specify): Public Services 6. Amount of Funds Requested for Project: $10,000.00 7. Amount of Matching Funds for Project: $5,696.00 Match Type: _ Cash ✓ Other Grants Donations Other Please Identify Source of Additional Funding: U.S. Department of HUD PEI-MYFC 8. CDBG COST: (a) Total CDBG Funds Requested $10,000.00 (b) Total Unduplicated Units Served 61 (Explain how determined?) Total Unduplicated Units Served: Fifteen (15) individuals will attend each of three (3) fair housing seminars and outreach events for a total of forty-five (45) individuals at $400 per event ($1,200.00). Sixteen (16) clients will be represented through enforcement/discrimination activities at $550 per case ($8,800.00). (Explain how determined?) This information is based on historical data. (c) CDBG Average Cost Per Unit (a/b) $10,000.00/61 individuals = $163.93 TOTAL PROJECT COST INCLUDING OTHER SOURCE OF FUNDING: (a) Total Project $435,000.00 (b) Total Unduplicated Units Served 182 (Explain how determined?) Total Unduplicated Units Served: Per the Legal Aid Society's contract with HUD, the following unduplicated units are to be delivered: ■ Conduct at least 10 outreach and education activities. • Conduct annual Fair Housing Month events. ■ Perform 92 fair housing tests for administrative and judicial enforcement. ■ Open at least 80 cases each year. (Explain how determined?) This information is based on historical data. 11 1075 (c) TOTAL Average Cost Per Unit (a/b) $2,390.10 (however this is not how the HUD budget units of service are calculated) 9. Is this project: A new service; or ✓ A quantifiable increase in the level of an existing service which has been provided by the grantee on its behalf through State or local government funds in the 12 months preceding the submission of the grantee's Consolidated Plan Annual Action Plan Has the applicant received or will receive other Federal, State or local government funds for the proposed project(s) for which the applicant is requesting CDBG funds? Yes No ✓ If Yes, what is the funding source? How much? n/a 10. Could this project occur without these funds? ✓ Yes No 11. Will this project continue after CDBG funding ends? ✓ Yes No If Yes, describe how the applicant will guarantee the sustainability of the project/program after CDBG funds have been spent. Historically the Fair Housing Project has been funded through a combination of resources including Palm Beach County CDBG funds, HUD Fair Housing Initiatives Program (FHIP) grants, funding from private foundations such as the Florida Bar Foundation, Bank of America and Wells Fargo, and general operating funds. If CDBG funds are not available in the future, the Legal Aid Society will continue to pursue the above mentioned as well as other funding sources. B. PROPOSED PROJECT EXECUTIVE SUMMARY: Please describe in detail the scope of services of the proposed project/activity to be funded, including the expected benefits to the community, a plan of action, how the agency will implement the activity (i.e., intake procedures, income certification, collection of required documentation, reimbursement request, progress reports, end of the year report, etc.). (Attach additional sheets if necessary) The Legal Aid Society of Palm Beach County's Fair Housing Project proposes to protect the fair housing rights of the low/moderate-income residents in the City of Boynton Beach by ensuring that local housing practices comply with the Federal Civil Rights Act of 1968 and the Fair Housing Amendments Act of 1988, as well as local, more inclusive, fair housing ordinances. To achieve these important goals, the Fair Housing Project will continue to offer two types of core services: 1) education and outreach activities that include informing the general public and underserved 5 1076 populations of their rights under federal and local substantially equivalent fair housing laws and procedures for filing claims, and 2) fair housing enforcement activities that include conducting investigations to determine compliance with accessibility requirements and identifying and remedying discrimination in the real estate market. In addition, the Fair Housing Project will continue offering eviction prevention and defense services by educating, representing, and defending protected individuals. Specific deliverables include: fifteen (15) individuals will attend each of three (3) fair housing seminars and outreach events for a total of forty-five (45) individuals, and ten (10) clients will be represented through enforcement/discrimination activities. Legal Aid's Fair Housing Project will serve residents within the City of Boynton Beach's target areas of Census Tract 57.01 and Census Tract 61. Fair Housing Project staff will conduct intakes through which information about the client is compiled and assessed and cases of alleged fair housing violations are investigated. All clients served with City of Boynton Beach CDBG funding will be residents of Boynton Beach and at least 51% will be low-income according to federal guidelines. Preference will be given to individuals who are low-income, victims of abuse, elderly, disabled, homeless, illiterate, or migrant farm workers. However, the merit of their case ultimately determines whether the client is served. Clients will be asked to self -certify their income through a client intake questionnaire. This information will be inputted into Legal Aid's case management system, LegalServer, which automatically calculates the percentage of the Federal Poverty Guidelines as defined by the Department of Health and Human Services (HHS). If awarded funding, Legal Aid's Fair Housing Project staff will submit all required reimbursement requests, progress reports and end of year reports as stipulated by the City of Boynton Beach in the executed agreement. C. STRATEGY: Check the ONE STRATEGY that best describes your project and provide number of units that will be served under this program. Check One Specific Objective Number of Units This Project Will Serve Educational Program (Specify) Households/Persons: (please specify which) Public Safety/Crime Prevention Households/Persons: (please specify which) Domestic Violence Prevention Households/Persons: (please specify which) Senior Services Elderly Households/Persons: (please specify which) Youth Programs Children/Youth: Housing Rehabilitation Number of units to be rehabilitated: 1077 ✓ Other (Specify): Public Services Households/Persons: 61 persons (please specify which) D. COMMUNITY NEED/JUSTIFICATION 1. What documentation/data was used to determine the need for this type of program? 2. How do you evaluate the overall effectiveness of the program? 3. How this project relates to the overall organizational structure? 4. Be very specific how the CDBG funds are proposed to be used? 5. How CDBG funds will it impact your current operation? (Attach additional sheets if necessary) The City of Boynton Beach clearly recognizes the need to protect its most vulnerable residents from fair housing discrimination violations and to assist individuals with landlord -tenant matters. In preparing this application for funding, the Legal Aid Society examined the most recent City of Boynton Beach FY2022-2026 Consolidated Plan/FY 2022 Annual Action Plan, which describes two of the City's priorities as being tied directly to fair housing activities currently being provided by Legal Aid's Fair Housing Project: 1) the "Increased Public Services" priority that has the objective "to improve and expand public services that address ... fair housing counseling and ... tenant/landlord counseling...", and 2) the "Fair Housing Services" priority that has the associated goals of, "fair housing counseling, fair housing education, fair housing enforcement and fair housing testing." While the plan documents indicate that the City is in the process of updating its Analysis of Impediments, it nevertheless cited known fair housing impediments to be inadequate fair housing knowledge, lending disparities and a segregated housing market. The activities proposed by Legal Aid's Fair Housing Project directly respond to these needs and to the City's most recent plan of action to address its identified impediments to fair housing choice and include targeted outreach, education and enforcement activities that the Legal Aid Society's Fair Housing Project has provided in the past: ■ Fair housing outreach programs conducted at various public events throughout the City of Boynton Beach; ■ Provision of enforcement and counseling services to persons who lodge housing discrimination complaints; ■ Conducting of fair housing workshops to various citizens and professional groups throughout the City of Boynton Beach; ■ Presentations targeting school children, attorneys, realtors, builders, community association boards and property managers regarding what fair housing is and their rights and obligations provided by fair housing laws; ■ Representation for clients in discrimination and eviction cases; ■ Anti -predatory and fair lending education and support seminars for community based organizations, civic and faith -based groups and condo/homeowner associations; and ■ Housing counseling concerning affordable housing opportunities. 7 1078 The community outreach, education, advocacy and enforcement of housing laws proposed by the Legal Aid Society's Fair Housing Project will ensure that no City of Boynton Beach resident is denied access to housing based on his or her race, color, religion, national origin, sex, disability, marital status, familial status, age, sexual orientation, and/or gender identity and expression. All clients seeking services from the Legal Aid Society's Fair Housing Project complete an application for services which captures client demographics, financial information, and brief details of their legal issues. A copy of the application for services is attached to this proposal. To track metrics and ensure that the Project's established goals and objectives are met, Fair Housing Project staff will enter all client and case -related data into LegalServer, the Legal Aid Society's secure, confidential case management system that is protected by user name and password access. This web -based database allows staff to track all client demographic information and case notes, as well as information on cases that are referred to the Department of Housing and Urban Development (HUD), Palm Beach County's Office of Equal Opportunity (OEO) or to other Legal Aid projects. Through the LegalServer case management system, Fair Housing staff will also track education and outreach events, including the number of participants who attend each event, the demographics of the participants, and the name and number of brochures that are distributed. Detailed reports will then be run by Fair Housing Project staff for reporting purposes and to track patterns and trends. This data is regularly analyzed and evaluated by Fair Housing Project staff, and strategies and approaches are adjusted to ensure that all proposed goals and objectives are being met. The Legal Aid Society of Palm Beach County is one of the largest legal aid organizations in the State of Florida and since 1949 has provided free civil legal services to economically and socially disadvantaged individuals and families throughout all of Palm Beach County. The Legal Aid Society addresses a broad range of legal needs through the following program areas: Family Advocacy, Children's Advocacy, Individual Rights Advocacy, Elder Advocacy, Health Advocacy, and Community Outreach. In addition, Legal Aid provides services to over 2,000 individuals each year through outreach and education programming such as eviction prevention clinics, immigration outreach seminars, fair housing rights presentations, and elder abuse and exploitation prevention workshops. The Fair Housing Project is part of Legal Aid's Individual Rights Advocacy practice area which aims to improve a family's opportunities and living conditions through the provision of high quality civil legal advice, consultation, representation and outreach at no cost to participants and clients. Through this proposal for funding, City of Boynton Beach residents will benefit from the full spectrum of legal services provided by Legal Aid's 21 various projects. When appropriate, Boynton Beach residents seeking fair housing assistance will receive referrals and have access to advice, consultation and representation for a variety of legal matters, including but not limited to: representation at restraining order hearings for victims of domestic violence, sexual assault and stalking; investigation of cases of abuse, neglect and exploitation of frail and vulnerable seniors; assistance with immigration matters, particularly for victims of domestic violence and 1079 juveniles in the dependency system; and the filing of appeals for individuals with HIV/AIDS who have been wrongfully denied disability benefits. Requested Community Development Block Grant funds from the City of Boynton Beach will be used to provide fair housing education, outreach and enforcement activities for residents of the City of Boynton Beach. All activities will be presented by staff attorneys and paralegals from the Legal Aid Society's Fair Housing Project. Attorneys will be licensed and will have experience in fair housing, real property, landlord -tenant, consumer, mortgage foreclosure and housing law. All services will be offered free of charge and will be in support of the proposed eligible activities only. The attorney will organize and conduct fair housing workshops and legal presentations for the general public and for social service providers and representatives from the banking and realty sectors. The attorney will also represent victims of unlawful discrimination in cases regarding the provision of housing services in state/federal courts, and before administrative agencies in cases seeking affirmative relief and counterclaims for damages and injunctive relief. Accordingly, he/she will file administrative discrimination complaints with HUD, the Palm Beach County Office of Equal Opportunity, and other appropriate agencies. The attorney will work with community partners to facilitate referrals, to identify additional resources for fair housing clients, and to arrange cross -training sessions and community outreach and education activities. In addition, he/she will actively recruit other experienced attorneys to accept pro bono referrals of housing discrimination complaints and foreclosure cases, as there is currently an overwhelming demand for these legal services. Without legal assistance, many low- income, disadvantaged individuals and families in the City of Boynton Beach will likely end up homeless or living in substandard housing. E. LOCATION, TARGET POPULATION AND INCOME CERTIFICATION 1. Where will the program take place and is it within the City of Boynton Beach Municipal Boundaries? Who are the targeted beneficiaries (i.e., geographic area, persons served, etc.), and how are they selected for the program? 2. Are you working with other organizations in a cooperative effort on the program? Yes_ No ✓ If yes, please list the other organizations and their role and responsibilities. (Attach additional sheets if necessary) The Legal Aid Society's Fair Housing Project services will serve residents within the City of Boynton Beach's target areas of Census Tract 57.01 and Census Tract 61. Potential clients learn about Legal Aid's Fair Housing Project services through outreach activities and via referrals from local social service agencies. Clients are accepted on a complaint basis. Fair Housing Project staff conduct intakes through which information about the client is compiled and assessed and cases of alleged fair housing violations are investigated. All clients served with City 9 1080 of Boynton Beach CDBG funding will be residents of Boynton Beach and at least 51% will be low- income according to federal guidelines. Preference will be given to individuals who are low- income, victims of abuse, elderly, disabled, homeless, illiterate, or migrant farm workers. However, the merit of their case ultimately determines whether the client is served. 3. The City's CDBG funds must directly benefit low -and -moderate -income individuals (80% Area Median Income (AMI) or below). The City's CDBG program requires non-profit organization to income certify individuals seeking assistance through activities/programs/projects funded with the CDBG funds. Has the organization done income certification of individuals seeking assistance in the past? Yes✓ No If yes, please explain the process the organization uses to income certify Individuals? What type documentation is collected? Please attach with your application, a copy of the form your organization uses to income certify individuals. The Legal Aid Society proposes that a minimum of 70% of its clients who receive direct civil legal representation through the Fair Housing Project will be low -and -moderate -income individuals. Legal Aid defines low -and -moderate -income as those individuals who are at or below 150% of the Federal Poverty Guidelines as defined by the Department of Health and Human Services (HHS). The Legal Aid Society is currently utilizing the 2023 HHS poverty guidelines, which were published in the Federal Register on January 19, 2023. When a client first comes to Legal Aid's office seeking assistance, they are asked to self -certify their income through a client intake questionnaire. As many Fair Housing Project clients are heads of household with extended families, Legal Aid factors both household size and total income to determine the percentage of the federal poverty guideline. Generally, in order to be eligible for free legal assistance from the Legal Aid Society of Palm Beach County, an individual's income cannot exceed 150% (or one and one-half times) the 2023 Federal Poverty Guidelines. This is how the Legal Aid Society defines "low -and -moderate income." For a single individual this translates to $ 21,870.00 per year, or $ 45,000.00 for a family of four. Presently the average percentage of poverty of our current clients, as calculated by Legal Aid's case management system, is 137% of the Federal Poverty Guidelines. When individuals come to the Legal Aid Society seeking assistance with eviction cases, they are asked to fill out a one-page "Application for Legal Assistance," which instructs them to self -certify their income by completing a chart describing their own monthly income, as well as their spouses' month income, if applicable. Types of income listed include employment, Social Security, pension, veterans' benefits, workers compensation, etc. They are also asked to list the total number of individuals residing in their household. Fair Housing Project staff then enter this information in Legal Aid's case management system, LegalServer, along with other client demographics such as date of birth, race, ethnicity, marital status, etc. Once the monthly income information is entered, LegalServer automatically calculates the percentage of the Federal Poverty Guidelines as defined by the Department of Health and Human Services (HHS). The Legal Aid Society is currently utilizing the 2023 HHS poverty guidelines which were published in the 10 1081 Federal Register on January 19, 2023. Legal Aid's Fair Housing Project will also incorporate an additional intake form modeled off of the City of Boca Raton's CDBG Program to certify income information. 4. Does the organization charges fees to its clients? Yes_ No ✓ 5. Will program Income be generated from this activity? Yes_ No ✓_ If yes explain how will the program income be used? F. Goals/Objectives/Activity Measures: Descriptive narrative. Please use separate Goal Sheet for each individual project (if applicable). Project/Program Title: Fair Housing Project Goal # 1: To provide Fair Housing information and resources to protected classes in the City of Boynton Beach. Objective #1: To conduct a minimum of three (3) fair housing seminars or outreach events annually for Boynton Beach residents, housing industry groups (including lenders, property managers, and realtors), community groups, civic associations and/or schools. Objective #2 —To implement an outreach campaign to inform persons with disabilities, their support organizations, and service providers of their rights under local, state and federal fair housing laws. Objective #3 — As required by HUD, to collect and maintain statistics on the race, ethnicity and income of the households served by Legal Aid's fair housing education seminars. Resources Needed & Available: All necessary resources will be provided and/or arranged by the Legal Aid Society's Fair Housing Project. Start Date & Duration: Proposed services will commence on October 1, 2023 and will continue through September 30, 2024. Goal 2: To provide fair housing enforcement activities to the residents of the City of Boynton Beach. Objective #1—To provide a minimum of sixteen (16) units of unduplicated fair housing enforcement, landlord tenant counseling, foreclosure representation and heirs property representation services for Boynton Beach residents. Objective #2 —To operate a telephone hotline that will provide the public with: a) Information for victims of housing discrimination 11 1082 b) Referral services to file complaints and seek redress; and c) Affordable housing and housing related referrals. Objective #3 — As required by HUD, to collect and maintain statistics on the race, ethnicity and income of the households served by Legal Aid's fair housing enforcement, landlord tenant counseling, foreclosure representation and heirs property legal assistance programs. Resources Needed & Available: All necessary resources will be provided and/or arranged by the Legal Aid Society's Fair Housing Project. Start Date & Duration: Proposed services will commence on October 1, 2023 and will continue through September 30, 2024. G. PROJECT BUDGET Please list organization's anticipated expenditures, detailing requested funds and additional funding. Please place C=Cash, 1=In-I<ind, O=Other Grants, D=Donations beside each amount under "Other Project Funds" to denote the type of funds being used. If funding request is for multiple programs/projects, please provide a separate PROJECT BUDGET for each program/project Line Item CDBG Funds Requested Other Project Funds Total Project'Budget ADMINISTRATION: Personnel (# ) Payroll Taxes Employee Benefits Office Supplies Copy Supplies Professional Services fee Other (explain) Other (explain) Other (explain) Other (explain) Other (explain) PROGRAM: Other (explain) Other grants $10,000.00 $425,000.00 (Other grants) $435,000.00 Other (explain) Other (explain) 12 1083 $10,000.00 $425,000.00 435,000.00 TOTALS (Other grants) Notes: H. ORGANIZATION CAPACITY (Provide a detail description of each) 1. Is the organization adequately staffed and trained? 2. Explain how this program fits the organization's mission? 3. Please explain the organization's experience with the proposed project? 4. Staffing Capacity: Who works on the project directly and indirectly? 5. Does the organization have written policies and procedures? How often are these policies and procedures updated? Provide a brief list of the topics covered in the organization's policies and procedures. The City of Boynton Beach may request a copy for review during the application and award process or as part of the grant monitoring process. (Attach additional sheets if necessary) The Legal Aid Society of Palm Beach County, Inc., a nonprofit charitable law firm, was chartered in 1949 and has been recognized by the IRS as a 501(c)(3) non-profit corporation since 1970. Through its mission of providing high quality civil legal advice, representation and education to disadvantaged persons in Palm Beach County, Legal Aid presently operates 21 projects, employs a staff over 140 and manages a budget of $12.7 million. Legal Aid positively impacts the lives of more than 8,000 clients and their families each year by protecting their personal safety, improving their opportunities and living conditions, and promoting self-sufficiency. Legal Aid's 21 diverse projects are designed to give the underserved in our community a voice in the judicial system, whereby ensuring equal access to justice for our county's most vulnerable residents, including families in crisis, elderly individuals, individuals with disabilities, persons living with HIV/AIDS, victims of domestic violence, the homeless, the working poor, undocumented immigrants, military veterans, indigent individuals with no local family, individuals caring for minor relatives, victims of wage dispute, and foster children and youth. Depending on their legal needs, we offer clients a full range of advocacy strategies, which can include legal information, advice and referrals; limited or full legal representation; community legal education; individual, affirmative and strategic litigation; administrative advocacy and other methods. We are also fortunate to continue our strong partnership with the Palm Beach County and South Palm Beach County Bar Associations and with voluntary private bar associations, and currently have over 2,500 private attorneys throughout the county who assist Legal Aid's Pro Bono Project in providing free legal services to low-income individuals. The Legal Aid Society recognizes the vital importance of ongoing training and education for all of its staff members and is committed to ensuring that staff, law clerks and volunteers receive appropriate training that will enhance their ability to serve clients in the most effective manner possible. All program staff will be provided with housing and other related legal training and will 13 1084 regularly participate in regional and national trainings throughout the year. Project attorneys will also complete CLE trainings as part of their ongoing professional development. The mission of the Legal Aid Society of Palm Beach County is to provide high quality civil legal advice, representation and education to the disadvantaged children, families, elders and individuals residing in Palm Beach County so as to protect their personal safety, enhance their opportunities and living conditions and promote self-sufficiency. The Fair Housing Project contributes directly to the Legal Aid Society's overall mission of improving a family's opportunities and living conditions by providing high quality civil legal services free of charge that address local discriminatory housing practices through enforcing compliance with the Federal Fair Housing Act and equivalent state and local fair housing laws. These activities are specifically targeted to protected individuals in order to heighten awareness of their housing -related civil legal rights, to enhance their capacity to stand up for their rights, and to increase the likelihood that they will seek justice when those rights are violated. This includes information and education as to their legal options and procedures for filing claims in cases where they believe that their rights have been violated. This knowledge will permit individuals to exercise their rights under the law and have access to safe, equitable, affordable housing. In addition, Fair Housing Project staff will provide legal representation for individuals and families facing foreclosure. The purpose of the representation is to save the individual or family home and to have the mortgage loan reduced to a reasonably affordable amount. Legal Aid's Fair Housing Project was established in October 1999 through a Community Development Block Grant awarded by Palm Beach County to provide education, outreach and enforcement services to all areas of the County. Over the past 23 years, the Fair Housing Project has provided fair housing training to over 9,000 individuals and has investigated 2,233 fair housing complaints, including testing for discriminatory practices. Through the Fair Housing Project's participation in community fairs and expos, over 55,000 individuals have received educational information, brochures and booklets explaining their rights under the Fair Housing Act, how to exercise these rights, and where to tum if they feel their fair housing rights have been violated. The Fair Housing Project has litigated lawsuits in federal and state court against municipalities, mobile home parks, landlords, public housing authorities, and condominium and homeowners associations. In the past six years, the Legal Aid Society's Fair Housing Project has successfully litigated discrimination cases resulting in close to $1 million in settlements for its clients. Based on our mission and experience in providing civil legal services to very low-income persons, Legal Aid has the ability to pursue timely remedies for individual clients. The Legal Aid Society's Fair Housing Project has significant experience in outreach methods and activities designed to make people aware of their civil rights and to advise and/or represent them to protect those rights. Fair Housing Project staff employ a variety of training methods in order to effectively disseminate information to the community, including workshops, symposiums, one-on-one consultations, online materials, an active presence on social media platforms such as Facebook, Instagram and Twitter, a YouTube channel, webinars, electronic newsletters, videos, brochure distribution, public service announcements and newspaper advertising. For 23 14 1085 years, staff have forged close relationships with community service providers, businesses, municipalities, homeowner associations, realtors, banks and landlords to provide trainings on fair housing law and the promotion of equal access to fair housing choice for all. Through its excellent administration of numerous and concurrent HUD and CDBG grants over the past 23 years, Legal Aid has demonstrated its proven capability to manage, operate and maintain activities, performance requirements and timetables for multiple grants. With its dedicated and experienced staff and committed partners in the community, Legal Aid's Fair Housing Project will successfully carry out its proposed activities, ensuring that the rights of individuals in the City of Boynton Beach are protected as guaranteed under the Fair Housing Act. Requested Community Development Block Grant funds from the City of Boynton Beach will be used to pay for a portion of an attorney's salary and related project expenses (i.e., limited travel to investigate fair housing allegations, informational materials, etc.). The CDBG-funded attorney will provide services in support of the proposed eligible activities only. The attorney will organize and conduct fair housing workshops and legal presentations for the general public and for social service providers and representatives from the banking and realty sectors. The attorney will also represent victims of unlawful discrimination in cases regarding the provision of housing services in state/federal courts, and before administrative agencies in affirmative action and counterclaims for damages and injunctive relief. Accordingly, he/she will file administrative discrimination complaints with HUD, the Palm Beach County Office of Equal Opportunity, and other appropriate agencies. The attorney will also represent clients in foreclosure and tenants whose landlord is in foreclosure. The attorney will work with community partners to facilitate referrals, to identify additional resources for fair housing clients, and to arrange cross -training sessions and community outreach and education activities. In addition, he/she will actively recruit other experienced attorneys to accept pro bono referrals of housing discrimination complaints and foreclosure cases, as there is currently an overwhelming demand for these legal services. Without legal assistance, many low- income, disadvantaged individuals and families in the Boynton Beach CDBG target area will likely end up homeless or living in substandard housing. The Legal Aid Society maintains policies and procedures manuals including an employee manual, financial policies and procedures, administrative policies and procedures and a disaster preparedness and business continuity plan. These are updated as needed and reviewed annually. Legal Aid also uses its annual accreditation process to ensure that its policies and procedures are legally compliant and that its rules, standards, values, culture, and benefits are clearly outlined. Since 2007 Legal Aid has been certified by Nonprofits First of Palm Beach County for sound nonprofit management, a designation that is quickly becoming a requisite standard for funding agencies in Palm Beach County. In 2012 Legal Aid applied for and was awarded gold status, the highest level of certification offered by Nonprofits First, and has been recertified at this same level each year since. The annual accreditation process includes an in-depth review of Legal Aid's board governance policies, strategic planning processes, risk management procedures, 15 1086 fundraising strategies, human resources policies and financial management systems to ensure that Legal Aid is implementing best practices for sound nonprofit management and continually striving to achieve maximum efficiency while providing the highest quality level of service to our clients. 6. Will all CDBG funds awarded be maintained in a manner that they will be accounted for separately and distinctly from other sources of revenue or funding? Provide a brief description of the organization's policies and procedures that ensure funds will be tracked appropriately. 7. Is the organization's financial management system able to track actual expenditures and outlays with budgeted amounts for each grant or subgrant? Provide a brief summary of the organization's process for tracking expenditures, including tracking budgeted versus actual amounts. 8. Does the organization have effective internal controls in place to ensure that federal funds are used solely for authorized purposes? Provide a brief description of the applicant's internal controls that will provide reasonable assurance that the award funds will be managed properly. 9. Does the organization have a documented records retention policy? If so, briefly describe the policy and confirm that the policy complies with federal regulations. Information on Records Retention and Access can be found at 2 C.F.R § 200.333- 200-337. (Attach additional sheets if necessary) The Legal Aid Society is a fiscally sound agency that has a long and successful history of administering federal, state and local government grants, as well as grants from private foundations and charitable organizations such as local United Ways. Legal Aid's financial statements are prepared monthly and separate sources of revenue through General Ledger classification specific to each program, maintaining distinction between all other sources of revenue/funding. The monthly financials further break down income and expenses by program to follow revenue and disbursements. The financial statements are presented monthly to the Board of Directors for their review and approval. The Legal Aid Society's Finance Department is overseen and supervised by the Director of Finance and Administration and is comprised of a Chief Financial Officer, one Senior Accountant, one Accountant, and one Financial Assistant. Finance personnel are responsible for all grants billing and fiscal administration, including payments to third parties, contractors and service providers. Internal control procedures dictate the segregation of duties between finance department personnel, and all procedures are outlined in the agency's Financial Accounting Policies and Procedures Manual. The Legal Aid Society uses U.S GAAP accrual basis of accounting and utilizes Abila MIP Fund Accounting 2022 (version 22.1.0.0) to record all transactions including revenues, expenses, fixed assets, accounts payable/receivable, accrued and prepaid expenses. Expenses are allocated and coded to grants on MIP Fund Accounting using program code, funding code, and other code 16 1087 features. Grant coding is recorded in accordance with individual grant contract line item budgets. Expenses are allocated to the programs according to the cost allocation method. Legal Aid's procurement, purchasing and expenditures policies follow adequate accounting and internal control procedures and are outlined in the financial policies manual. The Director of Finance and Administration, Chief Financial Officer, or the Executive Director reviews and authorizes all requests for supplies, program materials and services outside of those cited in the established Blanket Invoice Approval. Contracts for work or services over $2,000 require a written estimate that must be provided prior to work being done or service performed, and contracts over $10,000 are required to have written estimates from three (3) separate vendors that are reviewed and authorized prior to the selection of the vendor and require Board approval. Legal Aid maintains financial records to account for the receipt, obligation and expenditure of all funds, and assures all other internal controls are in place, including but not limited to: proper inventory control of blank and voided checks; effective control over and accountability for capital property; monthly bank reconciliations; surprise counts and audits of petty cash funds; and following strict authorized check signing protocol. The Legal Aid Society is audited annually by Holyfield and Thomas, LLP, Certified Public Accounting and Advisers firm, who ensure Legal Aid's compliance with the Federal Single Audit Act and OMB Circular A-133. A copy of the audited financial statements and Legal Aid's management letter are sent to each granting agency once the yearly audit is complete. In addition, any recommendations and findings made by the independent auditing firm are incorporated into Legal Aid's Financial Accounting Policies and Procedures Manual. Legal Aid's procurement, purchasing and expenditures policies follow adequate accounting and internal control procedures and are outlined in detail in its Financial Policies Manual. The following is Legal Aid's record retention policy that complies with federal regulations as outlined in its Policies and Procedures Manual (last revised October 2022). Record Years (Legal Years (Strongly Requirement) Recommended) Hiring Records 1 year 5 years (Keep EEO information separate) Job applications, resumes, records Federal contractors relating to refusal to hire, advertisement should keep these about openings, promotions or training records for at least 2 opportunities years Basic Employee Information 3 years after hire or 1 5 years (Keep I -9s separate) year after As long as possible 1-9 for all, work permits for minors termination, Background checks, harassment whichever is later investigations Payroll Records 4 years As long as possible 17 1088 Name, address, SSN, DOB, job classification, occupation, daily schedules, pay rate, weekly pay, amounts and dates of payments, daily and weekly hours, overtime hours and pay, annuity/pension payments, benefits, deductions/add Employment Actions 1 year from date of Maintain all records of Hires, separations, rehires, promotions, action current employees, and demotions, transfers, layoffs, recalls, for 3 years after training, employment test results termination Health, medical, safety data (keep in Varies separate, locked file cabinet) Job related illnesses and injuries 5 years 5 years at a minimum Requests for accommodation of disability 1 year 5 years at a minimum FMLA 3 years 5 years at a minimum Client case files 7 years 7 years I. Conflict of Interest Federal law (24 CFR 570.611) prohibits persons who exercise or who have exercised any functions or responsibilities with respect to the above grant ... or who are in a position to participate in a decision making process or to gain inside information with regard to such activities, may obtain a financial interest or benefit from an assisted activity... either for themselves or those with whom they have family or business ties, during their tenure or for one year thereafter. 1. Is there any member of the applicant's staff, member of the applicant's Board of Directors, or office who currently is or has/have been within one year of the date of this application a City employee, or a member of the City Commission? Yes ✓ No If yes, please list names: 2. Is there any member of the applicant's staff, member(s) of the Board of Directors, or officer(s) who are business partners or immediate family of a City employee, or a member of the City Commission? Yes ✓ No If yes, please list names: N/A 1089 3. Will the funds requested by the applicant be used to pay the salaries of any of the applicant's staff or award a subcontract to any individual who is or has been within one year of the date of this application a City employee, or a member of the City Commission? Yes ✓ No If yes, please list names: N/A REPAYMENT: Funding from this grant program is subject to federal, state and local audit. If a determination is made that these grant funds were used in a manner inconsistent with program guidelines, for an ineligible expense or for expenses reimbursed by another federal, state or local grant/loan program then the awarded entity will reimburse the City of Boynton Beach these funds. SUBMISSION OF AN APPLICATION IS NOT A GUARANTEE OF FUNDING It is the responsibility of the applicant to READ AND UNDERSTAND all aspects of the CDBG grant program, the application, and City's procurement process, if applicable. NOTICE TO THIRD PARTIES: The CDBG grant application program does not create any rights for any parties, including parties that performed work on the project. Nor shall issuance of a CDBG grant result in any obligation on the part of the City of Boynton Beach to any third party. The City is not required to verify that entities that have contracted with the applicant have been paid in full, or that such entities have paid any subcontractors in full. Applicant's warranty that all bills related to the Project for which the applicant is directly responsible is sufficient assurance for the City to award loan funding. The applicant certifies to the best of his/her knowledge and belief that the data in this application is true and correct and that the filing of the application has been duly authorized by the governing body of the applicant (if applicable) and that the applicant will comply with all the requirements of this grant if the application is approved. Name: Robert A. Bertisch, Esq. Title: Executive Director Name: Michelle R. Suskauer, Esq. Title: President, Board of Directors 19 Signature Date: March 24, 2023 Signature: Date: March 24, 2023 1090 Department of the Treasury District Director DATE: 'M i— K 0 Im LEGAL AID SOCIETY OF PALM BEACH COUNTY INC 423 FERN ST STE 200 WEST PALM BEACH, FL 33401 Internal Revenue Service 401 W. Peachtree St., NW Room 1109 - Stop 520-D Atlanta, GA 30365 Date of Inquiry: 06/27/95 Person to Contact: Kim Artis Telephone Number: 404 331-4967 EIN: 59-6046994 Dear Taxpayer: This is in response to your request for confirmation of your exemption from Federal income tax. Our records indicate your organization was granted exemption from Federal income tax under section 501(c)(3) of the Internal Revenue Code by our Letter dated May 1969. You were further determined not to be a private foundation within the meaning of section 509(x) of the Code because you are an organization described in section 509(a)(2). Contributions to you are deductible as provided in section 170 of the Code. The tax exempt status recognized by our letter referred to above is currently in effect and will remain in effect until terminated, modified or revoked by the Internal Revenue Service. Any change in your purposes, character, or method of operation must ' be reported to us so we may consider the effect of the change on your exempt status. You must also report any change in your name and address. Thank you for your cooperation. Sincerely, Exempt Organizations Coordinator TPA4401tr 1091 P: a: Box 737, Atlanta, Georgia 30301 �,- Address any reply to: 275 Peachtree St. NE., Atlanta, Ga. 30303 Internal Revenue Service Date: In reply refer to: JA�1 2 6 1971 411-1-3 : RAM p Legal Aid Society of Palm Beach County, Inc. 506 Citizens Building West Palm Beach, Florida Purpose: Charitable Accounting Period Ending: Dec. 31 Based on information supplied, and assuming your operations will be as stated in your exemption application, we have determined that you are exempt from Federal income tax under section 501(c)(3) of the Internal Revenue Code. Any change in your purposes, character, or method of operation must be reported to us so we may consider the effect of the change on your exempt status. You must also report any change in your name and address. Pending issuance of regulations under section 509 of the Code, we are unable to make a determination as to whether you are a private founda- tion as defined in that section. Upon issuance of the regulations we will evaluate your application, make a determination as to your status under section 509 of the Code, and notify you of our decision. If upon issuance of the regulations we determine that you are a private foundation, you will be required to comply with the provisions of section 508(e), which specifies that a private foundation is not exempt unless its governing instrument includes certain provisions set forth in that section and the regulations thereunder. Failure to comply with the requirements of section 508(e) will result in retroactive revocation of this determination. For years beginning prior to January 10 1970, you are required to file the annual information return, Form 990-A; For each subsequent year, please refer to the instructions accompanying the Form 990 for that particular year to determine whether you are required to file. If filing is required, you must file the Form 990 by the 15th day of the fifth month after the end of your annual accounting period. 171,,A J 1092 -2- Legal 2-Legal. Aid Society of Palm Beach County, Inc.: You are not required to file Federal income tax returns unless you are subject to the tax on unrelated business income under section 511 of the Code. If you are subject to this tax, you must file an income tax return on Form 990-T-- In this letter we are not determining whether any of your present or proposed activities are an unrelated trade or business as defined in section 513 of the Code. You are not liable for Federal Unemployment taxes. You are liable for Social Security Taxes only if you have filed waiver of exemption certi- ficates as provided in the Federal Insurance Contributions Act. Contributions made to you are deductible by donors as provided in section 170 of the Code. Bequests, legacies, devises, transfers or gifts to you or for your use are deductible for Federal estate and gift tax purposes under the provisions of section 2055, 2106, and 2522 of the Code. Every exempt organization is required to have an Employer Identification Number, regardless of whether it has any employees. This number should be entered in the designated space on all Federal returns which should be filed with the Mid -.Atlantic Service Center in Philadephia, Pennsylvania, and referred to on all correspondence which should be addressed to the District Director in Atlanta, Georgia. If you do not have such a number, our Service Center will assign one to you in the near future and notify you of the number assigned. This is a determination letter. Sincerely yours, i„l .1.. 2aal) A: C: Ross District Director CC: Robert 0. Rogers 1093 LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC. BOARD OF DIRECTORS FISCAL YEAR 2022-2023 President— Michelle Suskauer First Vice President— Lawrence Rochefort Second Vice President— Robert Friedman Secretary— Scott Murray Treasurer — Jerry Beer Immediate Past President — Miriam Acosta-Castriz Board of Trustees David Ackerman, Esq. + Claire Arnold + F. Greg Barnhart, Esq. + Bill Bone, Esq. Patrick J. Casey, Esq. + Jeffrey Devore, Esq. + Garry Glickman, Esq. + Carey Haughwout, Esq. Jane Kreusler-Walsh, Esq. + Richard Lubin, Esq. + Rafael J. Roca, Esq. Michael Salnick, Esq. + Gary Woodfield Carla Tharp Brown Leslie Artsis Adams Palm Beach County Bar Association Morgan Stanley Smith Barney PO Box 17726 777 S. Flagler Drive, Suite 900 West Palm Beach, FL 33416 West Palm Beach, FL 33401 Phone: (561) 687-2800 + Fax: (561) 687-9007 Phone: (561) 838-8900 + Fax: (561) 838-8970 E-mail: ctbrown@palmbeachbar.org E-mail: Leslie.Adams@MSSB.com Jerald S. Beer, Esq. Jerald Beer Consulting PLLC 19 Carrick Rd., Palm Beach Gardens, FL 33418 Email: jbeer@beerlawfl.com Richard M. Benrubi, Esq. Benrubi Law 1401 Forum Way, Suite 600 West Palm Beach, FL 33401 Phone: (561) 478-2500 E-mail: rbenrubi@benrubilaw.com Bridget Berry, Esq. Greenberg Traurig, P.A. 777 South Flagler Drive, Suite 300 E West Palm Beach, FL 33401 Phone: (561) 650-7912 + Fax: (561) 655-6222 E-mail: berryb@gtlaw.com Robin Bresky, Esq. Schwartz Sladkus Reich Greenberg Atlas 2424 N Federal Hwy Ste 456 Boca Raton, Florida 33431 Phone: (561) 769-5600+ Fax: (561) 769-5660 E-mail: rbresky@ssrga.com Sarah Cortvriend, Esq. Email: scortvriend@gmail.com Vincent F. Cuomo 16184 76th Trail North Palm Beach Gardens, FL 33418 Phone: (561) 504-5026 E-mail: Vincent.Cuomo@hotmail.com Amy Devore c/o Devore Law Group, P.A. 4100 RCA Boulevard, Suite 110 Palm Beach Gardens, FL 33410 Phone: (561) 478-5353 + Fax: (561) 228-8330 E-mail: adevore@devorelawgroup.com Howard D. DuBosar, Esq. Weiss Serota Helfman Cole + Bierman 2255 Glades Rd Ste 200E Boca Raton, FL 33431 Phone: (561) 835-2111 + Fax: (561) 544-8988 Email: HDuBosar@wsh-law.com Karis Engle, M.S. The Glades Initiative, Inc. 141 S.E. Avenue C Belle Glade, FL 33430 Phone: (561) 996-3310 + Fax: (561) 996-3349 E-mail: kengle@gladesinitiative.org 1094 Dwinette J. Feemster, Esq. Carrier Corporation 13995 Pasteur Blvd. Palm Beach Gardens, FL 33418 Phone: (561) 365-1141 + Fax: (860) 660-0116 E-mail: dwinette.feemster@carrier.com Robert H. Friedman, Esq. Friedman P.A. 340 Royal Poinciana Way, Suite 317-202 Palm Beach, FL 33480 Phone: (561) 800-2110 E-mail: rob@friedmanpa.com Joseph G. Galardi, Esq. Atherton Galardi Mullen & Reeder PA 224 Datura St., Suite 815 West Palm Beach, FL 33401 Phone: (561) 283-8323 + Fax: (561) 293-2593 E-mail: jgalardi@athertonlg.com Richard D. Greenfield 529 S Flagler Dr, Apt 16G West Palm Beach, FL 33401 Phone: (917) 495-4446 + Fax: (561) 653-9977 24579 Deep Neck Road Royal Oak, MD 21662 Phone: (410) 745-4149 + Fax: (561) 514-4801 Email: rdg@twowhitehats.com Jack P. Hill, Esq. Searcy Denney Scarola Barnhart & Shipley, PA 2139 Palm Beach Lakes Boulevard West Palm Beach, FL 33409 Phone: (561) 686-6300 + Fax: (561) 383-9424 E-mail: jph@searcylaw.com Denise Rappaport Isaacs, Esq. 2300 Glades Road, Suite 203 E Boca Raton, FL 33431 Phone: (561) 361-8300 + Fax: (561) 361-9865 E-mail: denise@isaacsfamlawgroup.com Wilnar Julmiste Julmiste Legal 5301 N Federal Hwy, Suite 110 Boca Raton, FL 33487-4914 Phone: (561) 210-0234+ Fax: (561) 210-0222 E-mail: wjulmiste@julmistelegal.com W. Hampton Keen, Esq. Keen Law Group 500 S Australian Ave Ste 532 West Palm Beach, FL 33401-6223 Phone: (561) 331-6515 + Fax: (561) 801-7738 Email: hkeen@keenlawgroup.com Nancy Lambrecht E-mail: Lambrecht143@aol.com Jason Lazarus, Esq. Pankauski Hauser PLLC 415 South Olive Avenue West Palm Beach, FL 33401 Phone: (561) 475-2099 Ext. 109 Email: jason@phflorida.com Daniel Lustig, Esq. Pike & Lustig, LLP 1209 N. Olive Avenue West Palm Beach, FL 33401 Phone: (561) 855-7585 + Fax: (561) 855-7710 Email: Daniel@bigfirmalternative.com Ellen S. Malasky, Esq. Managing Attorney Florida Power & Light Company 700 Universe Boulevard Juno Beach, FL 33408 Phone: (561) 691-7321 + Fax: (561) 691-7103 E-mail: ellen.malasky@fpl.com Scott C. Murray, Esq. Murray & Guari, P.L. 1525 North Flagler Drive West Palm Beach, FL 33401 Phone: (561) 366-9099 + Fax: (561) 366-9098 E-mail: smurray@murrayguari.com James Grier Pressly III, Esq. Pressly, Pressly, Randolph & Pressly, P.A. Plaza Center 251 Royal Palm Way, Suite 300 Palm Beach, FL 33480 Phone: (561) 659-4040 + Fax: (561) 655-6006 E-mail: grier@pprplaw.com 1095 Heather Ries, Esq. Fox Rothschild LLP 777 South Flagler Drive Suite 1700 West Tower West Palm Beach, FL 33401 Phone: (561) 804-4419 + (561) 835-9602 Email: HRies@foxrothschild.com Lawrence P. Rochefort, Esq. Akerman 777 South Flagler Drive Suite 1100 West Tower West Palm Beach, FL 33401 Phone: (561) 671-3603 + Fax: (561) 659-6313 E-mail: Irochefort@akerman.com Peter A. Sachs, Esq. Jones Foster Flagler Center Tower 505 South Flagler Drive, Suite 1100 West Palm Beach, Florida 33401 Phone: (561) 650-0476 + Fax: (561) 650-5300 Email: psachs@jonesfoster.com Matthew Sackel, Esq. Shutts & Bowen, LLP 525 Okeechobee Blvd, Suite 1100 West Palm Beach, FL 33401 Phone: (561) 650-8545 + Fax: (561) 822-5503 E-mail: msackel@shutts.com Robert M. W. Shalhoub, Esq. Robert M. W. Shalhoub, P.A. 1011 North Olive Avenue West Palm Beach, FL 33401 Phone: (561) 835-1102 + Fax: (561) 835-1777 E-mail: bob@robertmshalhoub.com Grasford W. Smith, Esq. Akerman LLP 777 South Flagler Drive, Suite 1100 West Tower West Palm Beach, FL 33401 Phone: (561) 671-3617 Email: grasford.smith@akerman.com Michelle R. Suskauer, Esq. Dimond Kaplan & Rothstein, P.A. 515 N Flagler Drive Ste P300 West Palm Beach, FL 33401-4326 Phone: (561) 671-1920 + Fax: (561) 671-1951 E-mail: michelle@dkrpa.com Rebecca Mercier Vargas, Esq. Kreusler-Walsh, Vargas and Serafin, P.A. 501 South Flagler Drive, Suite 503 West Palm Beach, FL 33401 Phone: (561) 659-5455 + Fax: (561) 820-8762 E-mail: rvargas@kwvsaapeals.com Matthew Zimmerman, Esq. Holland & Knight LLP 777 South Flagler Drive Suite 1900, West Tower West Palm Beach, Florida 33401 Phone: (561) 650-8331 + Fax: (561) 650.8399 Email: matthew.zimmerman@hklaw.com Board of Trustees David P. Ackerman, Esq. Akerman LLP 777 South Flagler Drive, Suite 1100 West Palm Beach, FL 33401 Phone: (561) 273-5567 + Fax: (561) 651-1555 E-mail: david.ackerman@akerman.com Miriam Acosta Castriz, Esq. Acosta & Fraga Law PLLC 530 N Federal Hwy Lake Worth, FL 33460 Phone: (561) 582-1888 + Fax: (561) 625-1107 E-mail: AFLAW@Immigrationwpb.com Claire Arnold E-mail: carnold246@aol.com F. Gregory Barnhart, Esq. Searcy Denney Scarola Barnhart & Shipley 2139 Palm Beach Lakes Blvd. P.O. Drawer 3626 (33402) West Palm Beach, FL 33409 Phone: (561) 686-6300 + Fax: (561) 684-5707 E-mail: fgb@searcylaw.com Bill Bone, Esq. 550 South Quadrille Blvd., Suite 200 West Palm Beach, FL 33401 Mailing Address: P.O. Box 1900 West Palm Beach, FL 33402-1900 Phone: (561) 832-9400 + Fax: (561) 832-9445 E-mail: bb@billbone.com 1096 Patrick J. Casey, Esq. Patrick J. Casey, PLLC P. O. Box 1207 Port Salerno, FL 34992 Phone: (561) 373-9780 + Fax: (561) 694-6098 Email: pcasey33@comcast.net Jeffrey A. Devore, Esq. Devore Law Group, P.A. 4100 RCA Boulevard, Suite 110 Palm Beach Gardens, FL 33410 Phone: (561) 478-5353 + Fax: (561) 478-2144 Toll Free (800) 840-0053 E-mail: jdevore@devorelawgroup.com Mariano Garcia, Esq. Searcy Denney 2139 Palm Beach Lakes Blvd. West Palm Beach, FL 33409 Phone: (561) 686-6300 + Fax: (561) 383-9463 E-mail: MXG@SearcyLaw.com Garry Glickman, Esq. 1601 Forum Place, Suite 1101 West Palm Beach, FL 33401 Phone: (561) 478-1111 + Fax: (561) 478-2433 E-mail: gglickman@gwmlawyers.com Carey Haughwout, Esq. Office of the Public Defender 421 Third Street West Palm Beach, FL 33401 Phone: (561) 355-7651 + Fax: (561) 355-7737 E-mail: careypd@pd15.state.fl.us Jane Kreusler-Walsh, Esq. Kreusler-Walsh, Vargas and Serafin, P.A. 501 South Flagler Drive, Suite 503 West Palm Beach, FL 33401 Phone: (561) 659-5455 + Fax: (561) 820-8762 E-mail: janewalsh@kwvsappeals.com Richard Lubin, Esq. Richard G. Lubin, P.A. 1217 South Flagler Drive, 2nd floor West Palm Beach, FL 33401-6717 Phone: (561) 655-2040 + Fax: (561) 655-2182 E-mail: rich@lubinlaw.com Rafael J. Roca, Esq. Law Offices of Craig Goldenfarb, P.A. 1800 South Australian Ave, Suite 400 West Palm Beach, FL 33409 Phone: (561) 697-4400 E-mail: rroca@800goldlaw.com Michael Salnick, Esq. Salnick, Fuchs & Bertisch, P.A. 250 Australian Avenue, #1203 West Palm Beach, FL 33401 Phone: (561) 471-1000 + Fax: (561) 659-0793 E-mail: salnicklaw@aol.com Gary Woodfield, Esq. Nason Yeager Gerson Harris & Fumero, P.A 3001 PGA Boulevard Palm Beach Gardens, FL 33410 Phone: (561) 686-3307 + Fax: (561) 686-5442 E-mail: gwoodfield@nasonyeager.com (Last update 3/27/23) 1097 LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC. REPORT ON AUDIT OF FINANCIAL STATEMENTS For the Year Ended September 30, 2022 (with comparable totals for 2021) 1098 TABLE OF CONTENTS PAGE INDEPENDENT AUDITOR'S REPORT 1-3 FINANCIAL STATEMENTS Statement of Financial Position 4 Statement of Activities 5 Statement of Cash Flows 6-7 Statement of Functional Expenses 8 NOTES TO FINANCIAL STATEMENTS 9-18 INTERNAL ACCOUNTING AND ADMINISTRATIVE CONTROL AND COMPLIANCE Independent Auditor's Report on Internal Control Over Financial Reporting and on Compliance and Other Matters Based on an Audit of Financial Statements Performed in Accordance with Government Auditing Standards 19-20 Independent Auditor's Report on Compliance for Each Major Program and on Internal Control Over Compliance Required by the Uniform Guidance 21-23 Schedule of Findings and Questioned Costs 24-25 Corrective Action Plan 26 SUPPLEMENTARY INFORMATION Schedule of Expenditures of Federal Awards 27-28 Notes to Schedule of Expenditures of Federal Awards 29 1099 Holyfield & Thomas, LLC Certified Public Accountants & Advisors 125 Butler Street • West Palm Beach, FL 33407 (561) 689-6000 • Fax (561) 689-6001 • www.hol)dieldandthomas.com INDEPENDENT AUDITOR'S REPORT To the Board of Directors of Legal Aid Society of Palm Beach County, Inc. West Palm Beach, Florida Report on the Audit of the Financial Statements Opinion We have audited the accompanying financial statements of Legal Aid Society of Palm Beach County, Inc. (a non-profit organization), which comprise the statement of financial position as of September 30, 2022, and the related statements of activities, cash flows, and functional expenses for the year then ended, and the related notes to the financial statements. In our opinion, the financial statements present fairly, in all material respects, the financial position of Legal Aid Society of Palm Beach County, Inc. as of September 30, 2022, and the changes in its net assets and its cash flows for the year then ended in accordance with accounting principles generally accepted in the United States of America. Basis for Opinion We conducted our audit in accordance with auditing standards generally accepted in the United States of America and the standards applicable to financial audits contained in Government Auditing Standards, issued by the Comptroller General of the United States. Our responsibilities under those standards are further described in the Auditor's Responsibilities for the Audit of the Financial Statements section of our report. We are required to be independent of Legal Aid Society of Palm Beach County, Inc. and to meet our other ethical responsibilities, in accordance with the relevant ethical requirements relating to our audit. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our audit opinions. Responsibilities of Management for the Financial Statements Management is responsible for the preparation and fair presentation of the financial statements in accordance with accounting principles generally accepted in the United States of America, and for the design, implementation, and maintenance of internal control relevant to the preparation and fair presentation of financial statements that are free from material misstatement, whether due to fraud or error. In preparing the financial statements, management is required to evaluate whether there are conditions or events, considered in the aggregate, that raise substantial doubt about Legal Aid Society of Palm Beach County, Inc.'s ability to continue as a going concern within one year after the date that the financial statements are available to be issued. 1100 Auditor's Responsibilities for the Audit of the Financial Statements Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor's report that includes our opinion. Reasonable assurance is a high level of assurance but is not absolute assurance and therefore is not a guarantee that an audit conducted in accordance with generally accepted auditing standards and Government Auditing Standards will always detect a material misstatement when it exists. The risk of not detecting a material misstatement resulting from fraud is higher than for one resulting from error, as fraud may involve collusion, forgery, intentional omissions, misrepresentations, or the override of internal control. Misstatements are considered material if there is a substantial likelihood that, individually or in the aggregate, they would influence the judgment made by a reasonable user based on the financial statements. In performing an audit in accordance with generally accepted auditing standards and Government Auditing Standards, we: • Exercise professional judgment and maintain professional skepticism throughout the audit. • Identify and assess the risks of material misstatement of the financial statements, whether due to fraud or error, and design and perform audit procedures responsive to those risks. Such procedures include examining, on a test basis, evidence regarding the amounts and disclosures in the financial statements. • Obtain an understanding of internal control relevant to the audit in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of Legal Aid Society of Palm Beach County, Inc.'s internal control. Accordingly, no such opinion is expressed. • Evaluate the appropriateness of accounting policies used and the reasonableness of significant accounting estimates made by management, as well as evaluate the overall presentation of the financial statements. • Conclude whether, in our judgment, there are conditions or events, considered in the aggregate, that raise substantial doubt about Legal Aid Society of Palm Beach County, Inc.'s ability to continue as a going concern for a reasonable period of time. We are required to communicate with those charged with governance regarding, among other matters, the planned scope and timing of the audit, significant audit findings, and certain internal control -related matters that we identified during the audit. Supplementary Information Our audit was conducted for the purpose of forming an opinion on the financial statements as a whole. The accompanying schedule of expenditures of federal awards, as required by Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, is presented for purposes of additional analysis and is not a required part of the financial statements. Such information is the responsibility of management and was derived from and relates directly to the underlying accounting and other records used to prepare the financial statements. The information has been subjected to the auditing procedures applied in the audit of the financial statements and certain additional procedures, including comparing and reconciling such information directly to the underlying accounting and other records used to prepare the financial statements or to the financial statements themselves, and other additional procedures in accordance with auditing standards generally accepted in the United States of America. In our opinion, the schedule of expenditures of federal awards is fairly stated, in all material respects, in relation to the financial statements as a whole. 1101 Other Reporting Required by Government Auditing Standards In accordance with Government Auditing Standards, we have also issued our report dated February 24, 2023, on our consideration of Legal Aid Society of Palm Beach County, Inc.'s internal control over financial reporting and on our tests of its compliance with certain provisions of laws, regulations, contracts, and grant agreements and other matters. The purpose of that report is solely to describe the scope of our testing of internal control over financial reporting and compliance and the results of that testing, and not to provide an opinion on the effectiveness of Legal Aid Society of Palm Beach County, Inc.'s internal control over financial reporting or on compliance. That report is an integral part of an audit performed in accordance with Government Auditing Standards in considering Legal Aid Society of Palm Beach County, Inc.'s internal control over financial reporting and compliance. Report on Summarized Comparative Information We have previously audited Legal Aid Society of Palm Beach County, Inc.'s September 30, 2021 financial statements, and we expressed an unmodified audit opinion on those audited financial statements in our report dated March 25, 2022. In our opinion, the summarized comparative information presented herein as of and for the year ended September 30, 2021, is consistent, in all material respects, with the audited financial statements from which it has been derived. West Palm Beach, Florida February 24, 2023 1102 LEGAL AID SOCIETY OF STATEMENT OF FINANCIAL POSITION PALM BEACH COUNTY, INC. As of September 30, 2022 (with comparable totals for 2021) Without Donor With Donor 2022 2021 Restrictions Restrictions Totals Totals ASSETS Cash and cash equivalents $ 3,843,919 $ - $ 3,843,919 $ 4,158,340 Investments 547,235 - 547,235 655,215 Accounts receivable 1,694,675 48,750 1,743,425 1,433,583 Other receivable 752 - 752 14,504 Prepaid expenses 78,358 - 78,358 101,650 Total current assets 6,164,939 48,750 6,213,689 6,363,292 Cash - designated 3,065,466 - 3,065,466 2,563,213 Deposits 4,750 - 4,750 4,750 Beneficial interest in trust - 64,297 64,297 74,068 Furniture and equipment, net 25,390 - 25,390 38,493 Total assets $ 9,260,545 $ 113,047 $ 9,373,592 $ 9,043,816 LIABILITIES AND NET ASSETS Accounts payable $ 123,404 $ - $ 123,404 $ 105,920 Accrued salaries 163,911 - 163,911 124,345 Accrued compensated absences 345,248 - 345,248 368,682 Deferred revenues 41,999 - 41,999 238,978 Refundable advances 311,575 - 311,575 380,349 Total current liabilities 986,137 - 986,137 1,218,274 Trust account 180,220 - 180,220 17,556 Public guardianship account 2,885,246 - 2,885,246 2,545,657 Total liabilities 4,051,603 - 4,051,603 3,781,487 Net assets: Without donor restrictions 5,208,942 - 5,208,942 5,139,511 With donor restrictions - 113,047 113,047 122,818 Total net assets 5,208,942 113,047 5,321,989 5,262,329 Total liabilities and net assets $ 9,260,545 $ 113,047 $ 9,373,592 $ 9,043,816 See accompanying notes to financial statements. In 1103 LEGAL AID SOCIETY OF 11,815,264 - 11,815,264 STATEMENT OF ACTIVITIES PALM BEACH COUNTY, INC. 636,883 - 636,883 590,882 Fundraising For the Year Ended September 30, 2022 (with comparable totals for 2021) 326,953 Total expenses 12,779,111 Without Donor With Donor 2022 2021 (9,771) 59,660 Restrictions Restrictions Totals Totals 3,758,050 Net assets, end of year $ 5,208,942 $ 113,047 $ 5,321,989 Support and revenues: Governmental grants $ 10,678,189 $ - $ 10,678,189 $ 10,246,824 Foundation grants 601,548 - 601,548 679,361 Other grants 306,053 65,000 371,053 335,229 Contributions 759,825 - 759,825 655,810 Program service revenue 165,611 - 165,611 185,693 Special events and activities 370,454 - 370,454 273,821 Investment income 15,640 - 15,640 15,594 Change in unrealized gain on investments (119,977) - (119,977) 84,417 Change in value of beneficial interest in trust - (9,771) (9,771) 14,799 PPP loan forgivenesss - - - 1,305,402 Other 6,199 - 6,199 51,750 Total support and revenues 12,783,542 55,229 12,838,771 13,848,700 Net assets released from restrictions 65,000 (65,000) - - Expenses: Program 11,815,264 - 11,815,264 11,426,586 Management and general 636,883 - 636,883 590,882 Fundraising 326,964 - 326,964 326,953 Total expenses 12,779,111 - 12,779,111 12,344,421 Change in net assets 69,431 (9,771) 59,660 1,504,279 Net assets, beginning of year 5,139,511 122,818 5,262,329 3,758,050 Net assets, end of year $ 5,208,942 $ 113,047 $ 5,321,989 $ 5,262,329 See accompanying notes to financial statements. -5- 1104 LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC. STATEMENT OF CASH FLOWS For the Year Ended September 30, 2022 (with comparable totals for 2021) 2022 2021 Totals Totals Cash flows from operating activities: Cash received from contributors and grantors $ 12,028,537 $ 12,382,013 Cash received from client agencies 165,611 185,693 Cash received from fundraising events 173,475 340,076 Investment income 15,640 15,594 Other cash received 23,363 61,004 Cash paid to employees (10,205,847) (10,047,280) Cash paid for goods and services (2,503,202) (2,511,058) Net cash provided by (used in) operating activities (302,423) 426,042 Cash flows from investing activities: Proceeds from sale of investments - 750 Purchase of investments (11,997) (4,905) Purchase of furniture and equipment - (32,351) Net cash used in investing activities (11,997) (36,506) Cash flows from financing activities: Advances under agency transactions 502,252 367,825 Net cash provided by financing activities 502,252 367,825 Net change in cash and cash equivalents 187,832 757,361 Cash and cash equivalents, beginning of year 6,721,553 5,964,192 Cash and cash equivalents, end of year $ 6,909,385 $ 6,721,553 Cash and cash equivalents $ 3,843,919 $ 4,158,340 Cash - designated 3,065,466 2,563,213 $ 6,909,385 $ 6,721,553 See accompanying notes to financial statements. 02 1105 LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC. STATEMENT OF CASH FLOWS For the Year Ended September 30, 2022 (with comparable totals for 2021) Reconciliation of change in net assets to net cash provided by (used in) operating activities: Change in net assets Adjustments to reconcile change in net assets to net cash provided by (used in) operating activities: Depreciation Change in unrealized gain on investments Change in value of beneficial interest in trust PPP loan forgiveness Decrease (increase) in: Accounts receivable Other receivable Prepaid expenses Increase (decrease) in: Accounts payable Accrued salaries Accrued compensated absences Deferred revenues Refundable advances Net cash provided by (used in) operating activities 2022 2021 Totals Totals $ 59,660 $ 1,504,279 13,103 15,730 119,977 (84,417) 9,771 (14,799) - (1,305,402) (309,842) 167,252 13,752 13,940 23,292 (10,756) 17,484 27,589 39,566 (254,371) (23,434) 3,205 (196,979) 66,255 (68,773) 297,537 $ (302,423) $ 426,042 See accompanying notes to financial statements. -7- 1106 LEGAL AID SOCIETY OF STATEMENT OF FUNCTIONAL EXPENSES PALM BEACH COUNTY, INC. For the Year Ended September 30, 2022 (with comparable totals for 2021) Program Salaries $ 7,537,940 Payroll taxes 555,497 Employee benefits 1,459,005 Total personnel expenses 9,552,442 Management anti C-,anaral $ 462,920 32,552 38,230 533,702 Fundraising $ 106,886 6,822 22,127 135,835 2022 2021 Totals Totals $ 8,107,746 594,871 1,519,362 10,221,979 $ 7,811,574 554,818 1,429,722 9,796,114 Bank charges - 14,881 2,930 17,811 14,764 Bar functions 4,921 7,714 557 13,192 1,190 Dues and licenses ------------------32,303 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4,713 - - - - - - - - - - - - - - - - - - - - - - - 11 - - - - - - - - - - - - - - - - - - - - - - - 37,027 - - - - - - - - - - - - - - - - - - - - - - - 61-,-104-- - - - - - - - - - - - - - - - - - Equipment rental and maintenance 108,559 4,351 1,441 114,351 77,775 Fundraising event costs 620 - 165,816 166,436 71,918 Insurance 52,304 1,310 281 53,895 48,942 _Library------------------------------------- 31,011---------------3,749----------------- 122-------------34,882-------------34,495-- Litigation costs 73,367 - - 73,367 73,271 Miscellaneous expense 6,763 1,007 6 7,776 6,546 Other project expenses 46,508 - 880 47,388 36,146 ParkinR..................................... 15,153----------------- 207-------------------- 6-------------15,366-------------39,060-- Postage and shipping 29,347 901 204 30,452 23,410 Printing 17,474 47 2,493 20,014 8,076 Pro bono expenses - - - - 120 Professional fees 195,354 12,570 4,496 212,420 168,660 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Public relations - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 35 Recruiting 28,890 - - 28,890 14,410 Rent and utilities 611,035 19,720 10,000 640,755 625,859 Specific assistance to individuals 769,308 769,308 995,575 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Staff development - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ------------------------------------------ - 1,702 - - - - - - - - - - - - - ------------ 1,702 - - - - - - - - - - - - 2,030 Sub -grants 23,698 - - 23,698 25,451 Supplies 93,531 12,570 1,545 107,646 103,125 Telephone and communications - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 34,182 - - - - - - - - - - - - - - - - - - - - - - - - 2,500 - - - - - - - - - - - - - - - - - - - - - - - 272 - - - - - -------------------------------------------------------------- 36,954 34,987 Training and education 28,251 2,701 69 31,021 33,940 Travel 59,369 309 - 59,678 31,688 Depreciation 874 12,229 - 13,103 15,730 Total expenses $11,815,264 $ 636,883 $ 326,964 $12,779,111 $12,344,421 See accompanying notes to financial statements. 1107 LEGAL AID SOCIETY OF NOTES TO FINANCIAL STATEMENTS PALM BEACH COUNTY, INC. For the Year Ended September 30, 2022 Summary of Significant Accounting Policies Organization and Nature of Activities Legal Aid Society of Palm Beach County, Inc. (the "Society"), is a Florida not-for-profit corporation organized on November 18, 1970 for the purpose of providing high quality civil legal advice, representation, and education to the disadvantaged of Palm Beach County in order to protect their personal safety, enhance their opportunities and living conditions, and promote self-sufficiency. Basis of Accounting The financial statements of the Society have been prepared on the accrual basis of accounting in accordance with accounting principles generally accepted in the United States of America. Support is recognized when received, revenues are recognized when earned, and expenses are recognized when incurred. The significant accounting policies followed by the Society are described below to enhance the usefulness of the financial statements to the reader. Financial Statement Presentation The Society follows FASB Accounting Standards Codification (FASB ASC) 958-205, Presentation of Financial Statements. The standard requires that the Society present information regarding its financial position and activities according to two classes of net assets, described as follows: Net assets without donor restrictions: this classification includes those net assets whose use is not restricted by donors, even though their use may be limited in other respects, such as by contract or by board designation. Changes in net assets arising from exchange transaction (except income and gains on assets that are restricted by donors or by law) are included in net assets without donor restrictions. Net assets with donor restrictions: this classification includes those net assets whose use by the Society has been limited by donors to either later periods of time, or after specified dates, or for a specified purpose. When a donor restriction expires, that is, when a stipulated time restriction ends or purpose restriction is accomplished, the restricted amounts are reclassified to net assets without donor restrictions. This classification also includes those net assets that must be maintained by the Society in perpetuity. These are contributions for which donor -imposed restrictions limiting the Society's use of an asset or its economic benefits neither expire with the passage of time nor can be removed by the Society meeting certain requirements. Estimates The preparation of financial statements in conformity with accounting principles generally accepted in the United States of America requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates. I ai 1108 LEGAL AID SOCIETY OF NOTES TO FINANCIAL STATEMENTS PALM BEACH COUNTY, INC. For the Year Ended September 30, 2022 Summary of Significant Accounting Policies, continued Fair Value of Financial Instruments The Society follows FASB ASC 820-10, Fair Value Measurement and Disclosures, which provides a common definition of fair value, establishes a framework to measure fair value within accounting principles generally accepted in the United States of America, and expands the disclosures about fair value measurements. The standard does not create any new fair value measurements. Instead, it applies under existing accounting pronouncements that require or permit fair value measurements. For assets and liabilities measured at fair value on a recurring basis, entities should disclose information that allows financial statement users to assess (1) the inputs used to develop such measurements, such as Level 1 (i.e., quoted price in an active market for an identical asset or liability), Level 2 (i.e., quoted price for similar assets or liabilities in active markets), or Level 3 (i.e., unobservable inputs); and (2) the effect on changes in net assets of recurring measurements that use significant unobservable (Level 3) inputs. Prior Year Summarized Information The financial statements include certain prior -year summarized comparative information in total but not by net asset class. Such information does not include sufficient detail to constitute a presentation in conformity with accounting principles generally accepted in the United States of America. Accordingly, such information should be read in conjunction with the Society's financial statements for the year ended September 30, 2021, from which the summarized information was derived. Certain 2021 amounts have been reclassified to conform to 2022 classifications. Such reclassifications have no effect on the change in net assets as previously reported. Cash and Cash Equivalents, Cash - Designated For purposes of the statement of cash flows, the Society considers designated cash and all highly liquid investments available for current use with an initial maturity of three months or less to be cash equivalents. In connection with its Public Guardianship Program (PGP) and its legal practice, the Society maintains designated cash funds that are held in separate accounts for the benefit of wards and clients. These accounts are reported as non-current assets under the caption "cash - designated," and as non-current liabilities under the captions of "trust account" and "public guardianship account." Investments Investments of the Society are stated at fair value based on quoted prices on a national stock exchange, with the resulting realized and change in unrealized gains and losses included in the Statement of Activities. Investments as of September 30, 2022 consist primarily of mutual funds that are presented in the financial statement at fair value, with the resulting realized and change in unrealized gains and losses included in the Statement of Activities. Investment transactions and related expenses are accounted for on a trade date basis. Cash and cash equivalents accounts maintained by the Society's investment portfolio are part of the Society's long-term investment policy and are classified as investments. -10- 1109 LEGAL AID SOCIETY OF NOTES TO FINANCIAL STATEMENTS PALM BEACH COUNTY, INC. For the Year Ended September 30, 2022 1. Summary of Significant Accounting Policies, continued Accounts Receivable Accounts receivable consist of amounts due to the Society under various federal, state, and local grants and promises to give from United Way and other agencies. Because the amounts are considered to be fully collectible, there is no provision for doubtful accounts as of September 30, 2022. Furniture and Equipment Furniture and equipment is stated at cost, or if donated, at the approximate fair value at the date of the donation. Individual items costing less than $1,500 are expensed. Expenditures for repairs and maintenance are charged to expense as incurred. Major improvements are capitalized. Depreciation is computed by the straight-line method over the estimated useful lives of the assets, which range from 5 to 39 years. Compensated Absences Full-time employees of the Society accrue vacation at varying rates depending upon the length of service. A maximum of 20 vacation days may be accumulated at any time during the year. Refundable Advances The Society has reimbursement arrangements with various grantors whereby the Society receives funds ahead of the expenditures. In accordance with the terms of these arrangements, any funds that are not spent within the contract period must be refunded to the grantors. Contributions In accordance with FASB ASC 958-605, Revenue Recognition, contributions received, including unconditional promises, are recognized as revenues when the donor's commitment is received. All contributions are considered to be without donor restrictions unless specifically restricted by the donor. Amounts received that are designated for future periods or restricted by the donor for specific purposes are reported as with donor restriction support that increase the net asset with donor restriction class. When the restriction expires, net assets with donor restrictions are reclassified to net assets without donor restrictions and reported in the Statement of Activities as net assets released from restrictions. Special events revenue is recognized as revenue at the time of the event. Tickets sold prior to the event are recorded as deferred revenue. Functional Allocation of Expenses The costs of providing the various programs and other activities have been summarized on a functional basis in the Statement of Activities and according to natural classification in the Statement of Functional Expenses. Accordingly, certain costs have been allocated among the programs and activities benefited. Advertising The Society expenses advertising costs as incurred and includes such expenses in the public relations category in the Statement of Functional Expenses. -11- 1110 LEGAL AID SOCIETY OF NOTES TO FINANCIAL STATEMENTS PALM BEACH COUNTY, INC. For the Year Ended September 30, 2022 Summary of Significant Accounting Policies, continued Income taxes The Society is exempt from federal income tax under Section 501(c)(3) of the Internal Revenue Code. However, income from certain activities not directly related to the Society's tax-exempt purpose would be subject to taxation as unrelated business income. There were no such unrelated activities for the year ended September 30, 2022. The Society follows FASB ASC 740-10, Accounting for Uncertainty in Income Taxes. This pronouncement seeks to reduce the diversity in practice associated with certain aspects of measurement and recognition in accounting for income taxes. It prescribes a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position that an entity takes or expects to take in a tax return. An entity may only recognize or continue to recognize tax positions that meet a "more likely than not" threshold. The Society assesses its income tax positions based on management's evaluation of the facts, circumstances and information available at the reporting date. The Society uses the prescribed more likely than not threshold when making its assessment. For the year ended September 30, 2022, the Society did not accrue any interest expense or penalties related to its tax positions. Furthermore, there are currently no open Federal or State tax years under audit. Recent Accounting Pronouncements In February 2016, the FASB issued ASU No. 2016-02, Leases (Topic 842). ASU 2016-02 replaces existing leasing rules with a comprehensive lease measurement and recognition standard and expanded disclosure requirements. ASU 2016-02 will require lessees to recognize most leases on their statement of financial position as liabilities, with corresponding "right -of -use" assets. The standard is effective for annual reporting periods in fiscal years that begin after December 15, 2021. Management is currently evaluating the magnitude and other potential impacts on the Society's financial statements. 2. Liquidity and Availability of Resources Financial assets available for general expenditure within one year, that is, without donor restrictions or other restrictions limiting their use within one year of the Statement of Financial Position date, comprise the following: Cash and cash equivalents $ 3,843,919 Investments 547,235 Accounts receivable 1,743,425 Other receivable 752 Total financial assets available to meet general expenditures over the next 12 months $ 6,135,331 The Society is substantially supported by contributions without donor and with donor restrictions. Because a donor's restriction requires resources to be used in a particular manner or in a future period, the Society must maintain sufficient resources to meet those responsibilities to its donors. Some of the Society's net assets with donor restrictions are available for general expenditure within one year of September 30, 2022 because the restrictions on the net assets are expected to be met by conducting the normal program activities of the Society in the coming year. -12- LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC. For the Year Ended September 30, 2022 2. Liquidity and Availability of Resources, continued NOTES TO FINANCIAL STATEMENTS Accordingly, the related resources have been included in the quantitative information detailing the financial assets available to meet general expenditures within one year. Furthermore, the Society has a $350,000 line of credit of which management may draw upon in the event of unanticipated financial distress or an immediate liquidity need (see Note 9). The Society forecasts its future cash flows and monitors liquidity on a monthly basis. 3. Fair Value Measurements FASB ASC 820-10 establishes a framework for measuring fair value. That framework provides a fair value hierarchy that prioritizes the inputs to valuation techniques used to measure fair value. The hierarchy gives the highest priority to unadjusted quoted prices in active markets for identical assets or liabilities (Level 1 measurement) and the lowest priority to unobservable inputs (Level 3 measurement). The three levels of the fair value hierarchy under FASB ASC 820-10 are described below: Level 1— Inputs to the valuation methodology are unadjusted quoted prices for identical assets or liabilities in active markets that the Society has the ability to access. Level 2— Inputs to the valuation methodology include: quoted prices for similar assets or liabilities in active markets; quoted prices for identical or similar assets or liabilities in inactive markets; Inputs other than quoted prices that are observable for the asset or liability; Inputs that are derived principally from or corroborated by observable market data by correlation or other means. Level 3 — Inputs to the valuation methodology are unobservable and significant to the fair value measurement. The asset's or liability's fair value measurement level within the fair value hierarchy is based on the lowest level of any input that is significant to the fair value measurement. Valuation techniques used need to maximize the use of observable inputs and minimize the use of unobservable inputs. Fair Value of Financial Instruments: The following methods and assumptions were used by the Society in estimating fair value of financial instruments that are not disclosed under ASC 820. Cash, Cash Equivalents and Cash - Designated: The carrying amount reported approximates fair value. Accounts and Other Receivable: The carrying amount approximates fair value due to the relative size, timing and amounts to be collected. Accounts Payable, Accrued Salaries and Compensated Absences: The carrying amount reported approximates fair value due to the short-term duration of the instruments. Loan Payable: The carrying amount reported approximates fair value as the stated interest rates approximate market rates. -13- 1112 LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC. For the Year Ended September 30, 2022 3. Fair Value Measurements, continued NOTES TO FINANCIAL STATEMENTS Items Measured at Fair Value on a Recurring Basis: The following is a description of the valuation methodologies used for assets measured at fair value. There have been no changes in the methodologies used as of September 30, 2022. Investments: Valued at net asset value (NAV) by the custodian as of the close of business at year end September 30, 2022. Beneficial Interest in Trust: Valued by the 3rd party custodian at the current fair value of underlying investment assets in the account, which provides a perpetual stream of income to the Society. The following table sets forth by level, within the fair value hierarchy, the Society's assets at fair value as of September 30, 2022: Investments Beneficial interest in trust Total Assets at Fair Value Level Level Level Total $ 547,235 $ 64,297 $ 547,235 64,297 547,235 $ -64-297 $ 611,532 The table below sets forth a summary of changes in the fair value of the beneficial interest in trust for the year ended September 30, 2022. Balance, beginning of year $ 74,068 Issuances/contributions - Settlements/collections - Change in value (9,771) Balance, end of year $ 64,297 4. Investments Investments in mutual funds are presented in the financial statement at fair value, with the resulting realized and change in unrealized gains and losses included in the Statement of Activities. Investment transactions and related expenses are accounted for on a trade date basis. Investments consist of the following as of September 30, 2022: Money market funds $ 8,073 Fixed income mutual funds 266,184 Common stock mutual funds 272,978 Total investments at fair market value 547,235 Total investments at cost 376,658 Unrealized gains 170,577 Less beginning balance of unrealized gains 290,554 Total change in unrealized gain $ (119,997) -14- 1113 LEGAL AID SOCIETY OF NOTES TO FINANCIAL STATEMENTS PALM BEACH COUNTY, INC. For the Year Ended September 30, 2022 5. Accounts Receivable Accounts receivable consisted of the following as of September 30, 2022: Federal and state grants $ 1,109,076 Local government grants 417,671 Other grants 167,928 United Way Allocation 48,750 $ 1,743,425 6. Prepaid Expenses Prepaid expenses consisted of prepaid insurance, software licenses, IT services and future events as of September 30, 2022: 7. Furniture and Equipment Furniture and equipment consisted of the following as of September 30, 2022: Furniture and fixtures $ 105,994 Computer equipment 140,508 Software 81,982 Other assets 242,066 570,550 Less accumulated depreciation 545,160 Furniture and equipment, net $ 25,390 8. Beneficial Interest in Trust The Society is the income beneficiary of a perpetual trust, whose assets are held by the Community Foundation for Palm Beach and Martin Counties, Inc. (the "Foundation") as an endowed component fund ("Fund"). Under the terms of the Fund, the Foundation's Board of Directors has a variance power to modify any restriction or condition on the distribution of funds for any specific charitable purpose or to specified organizations, if in their sole judgement (without the approval of any trustee, custodian, or agent), such restriction or conditions becomes, in effect, unnecessary, incapable of fulfillment or inconsistent with the charitable needs of the community or the area served by the Foundation. The Fund is subject to the Foundation's investment and spending policies. During the year ended September 30, 2022, the Society did not receive any distributions from the Fund. 9. Line of Credit The Society has a $350,000 line of credit with interest at the bank's prime rate (5.50% as of September 30, 2022), that is secured by accounts receivable and other business assets. No amount was outstanding as of September 30, 2022. -15- 1114 LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC. For the Year Ended September 30, 2022 10. Net Assets with Donor Restrictions NOTES TO FINANCIAL STATEMENTS Net assets with donor restrictions as of September 30, 2022 consisted of the following: Subject to the passage of time: Town of Palm Beach United Way Allocation $ 48,750 Beneficial interest in trust 14,297 Total time restrictions 63,047 Perpetual in nature: Beneficial interest in trust 50,000 Total net assets with donor restrictions $ 113,047 11. Government Grants Government grants consist of $3,314,705 from various federal government agencies, $1,093,404 from state government agencies, and $6,270,080 from local government agencies. Grants from local government agencies include $4,795,810 from Children's Services Council, and $1,474,270 from Palm Beach County. Children's Services Council funds the following programs: Non-profit legal assistance project $ 64,000 Children's Advocacy Project 4,318,443 Project DULCE 379,332 Other 34,035 $ 4,795,810 Palm Beach County funds the following projects: Domestic violence $ 113,646 Guardian advocacy 92,245 Guardianship program for elder citizens 152,542 Wage dispute project 141,100 Community Id program 75,000 Other legal assistance 899.737 $ 1,474,270 12. Other Grants Other grants received during the year amounted to $371,053, of which approximately $277,800 was awarded from Town of Palm Beach United Way and United Way of Palm Beach County. -16- 1115 LEGAL AID SOCIETY OF NOTES TO FINANCIAL STATEMENTS PALM BEACH COUNTY, INC. For the Year Ended September 30, 2022 13. Operating Lease Commitment The Society leases its office space under two non -cancelable leases extending through February 2026. For the year ended September 30, 2022, rent expense for office space was $640,755, and is included in the rent and utilities category in the Statement of Functional Expenses. A schedule of future minimum rental payments under the leases as of September 30 is as follows: 2023 $ 642,200 2024 661,467 2025 681,311 2026 287.367 $ 2,272,345 The Society is also lessee under operating lease agreements extending through July 2027, for the use of various items of office equipment. For the year ended September 30, 2022, equipment rental expense totaled approximately $36,740, and is included in equipment rental and maintenance expense in the Statement of Functional Expenses. Minimum expected future lease payments for office equipment as of September 30, are as follows: 2023 $ 31,987 2024 23,336 2025 6,415 2026 709 2027 532 $ 62,979 14. Concentration of Credit Risk The Society maintains cash deposits at different banks, which the Society periodically evaluates and believes to be in sound financial condition. Deposits located at banks are insured by the Federal Deposit Insurance Corporation (FDIC) up to $250,000. As of September 30, 2022, the uninsured portion of deposits aggregated to approximately $2,864,500. The Society has not experienced any loss on such accounts and management believes it is not exposed to any significant credit risk arising from such balances. 15. Retirement Plan The Society maintains a 401(k) profit sharing plan for all eligible employees, as more fully described in the plan documents. The Society makes match contributions in an amount equal to 100% of the participant's elective contribution not in excess of 2% of the participant's compensation for the plan year. The Society also has the option to make discretionary contributions to the plan. The Society's contribution to the plan for the year ended September 30, 2022 was $109,519, and is included in employee benefits expense in the Statement of Functional Expenses. -17- 1116 LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC. For the Year Ended September 30, 2022 16. Subsequent Events NOTES TO FINANCIAL STATEMENTS The Society's management has evaluated subsequent events through February 24, 2023, the date on which the financial statements were available to be issued, and determined there were no further disclosures required to be presented in these financial statements. 9"; 1117 Holyfield & Thomas, LLC Certified Public Accountants & Advisors 125 Butler Street • West Palm Beach, FL 33407 (561) 689-6000 • Fax (561) 689-6001 • www.hol)dieldandthomas.com INDEPENDENT AUDITOR'S REPORT ON INTERNAL CONTROL OVER FINANCIAL REPORTING AND ON COMPLIANCE AND OTHER MATTERS BASED ON AN AUDIT OF FINANCIAL STATEMENTS PERFORMED IN ACCORDANCE WITH GOVERNMENT AUDITING STANDARDS To the Board of Directors of Legal Aid Society of Palm Beach County, Inc. West Palm Beach, Florida We have audited, in accordance with the auditing standards generally accepted in the United States of America and the standards applicable to financial audits contained in Government Auditing Standards issued by the Comptroller General of the United States , the financial statements of Legal Aid Society of Palm Beach County, Inc. (a non-profit organization), which comprise the statement of financial position as of September 30, 2022, and the related statements of activities, cash flows, and functional expenses for the year then ended, and the related notes to the financial statements, and have issued our report thereon dated February 24, 2023. Report on Internal Control over Financial Reporting In planning and performing our audit of the financial statements, we considered Legal Aid Society of Palm Beach County, Inc.'s internal control over financial reporting (internal control) as a basis for designing audit procedures that are appropriate in the circumstances for the purpose of expressing our opinion on the financial statements, but not for the purpose of expressing an opinion on the effectiveness of Legal Aid Society of Palm Beach County, Inc.'s internal control. Accordingly, we do not express an opinion on the effectiveness of Legal Aid Society of Palm Beach County, Inc.'s internal control. A deficiency in internal control exists when the design or operation of a control does not allow management or employees, in the normal course of performing their assigned functions, to prevent, or detect and correct, misstatements, on a timely basis. A material weakness is a deficiency, or a combination of deficiencies, in internal control, such that there is a reasonable possibility that a material misstatement of the entity's financial statements will not be prevented, or detected and corrected, on a timely basis. A significant deficiency is a deficiency, or a combination of deficiencies, in internal control that is less severe than a material weakness, yet important enough to merit attention by those charged with governance. Our consideration of the internal control was for the limited purpose described in the first paragraph of this section and was not designed to identify all deficiencies in internal control that might be material weaknesses or significant deficiencies and therefore, material weaknesses or significant deficiencies may exist that were not identified. Given these limitations, during our audit we did not identify any deficiencies in internal control that we consider to be material weaknesses. We identified a deficiency in internal control, described in the accompanying schedule of findings and questioned costs as item 2022-01, that we consider to be a significant deficiency. -19- 1118 Report on Compliance and Other Matters As part of obtaining reasonable assurance about whether Legal Aid Society of Palm Beach County, Inc.'s financial statements are free from material misstatement, we performed tests of its compliance with certain provisions of laws, regulations, contracts, and grant agreements, noncompliance with which could have a direct and material effect on the financial statements. However, providing an opinion on compliance with those provisions was not an objective of our audit, and accordingly, we do not express such an opinion. The results of our tests disclosed an instance of noncompliance or other matter that is required to be reported under Government Auditing Standards and which are described in the accompanying schedule of findings and questioned costs as item 2022-01. Legal Aid Society of Palm Beach County, Inc.'s Response to Findings Government Auditing Standards requires the auditor to perform limited procedures on Legal Aid Society of Palm Beach County, Inc.'s response to the finding identified in our audit and described in the accompanying schedule of findings and questioned costs. Legal Aid Society of Palm Beach County, Inc.'s response was not subjected to the other auditing procedures applied in the audit of the financial statements and, accordingly, we express no opinion on the response. Purpose of This Report The purpose of this report is solely to describe the scope of our testing of internal control and compliance and the results of that testing, and not to provide an opinion on the effectiveness of Legal Aid Society of Palm Beach County, Inc.'s internal control or on compliance. This report is an integral part of an audit performed in accordance with Government Auditing Standards in considering Legal Aid Society of Palm Beach County, Inc.'s internal control and compliance. Accordingly, this communication is not suitable for any other purpose. West Palm Beach, Florida February 24, 2023 -20- 1119 Holyfield & Thomas, LLC Certified Public Accountants & Advisors 125 Butler Street • West Palm Beach, FL 33407 (561) 689-6000 • Fax (561) 689-6001 • www.hol)dieldandthomas.com INDEPENDENT AUDITOR'S REPORT ON COMPLIANCE FOR EACH MAJOR PROGRAM AND ON INTERNAL CONTROL OVER COMPLIANCE REQUIRED BY THE UNIFORM GUIDANCE To the Board of Directors of Legal Aid Society of Palm Beach County, Inc. West Palm Beach, Florida Report on Compliance for Each Major Federal Program Opinion on Each Major Federal Program We have audited Legal Aid Society of Palm Beach County, Inc.'s compliance with the types of compliance requirements identified as subject to audit in the OMB Compliance Supplement that could have a direct and material effect on each of Legal Aid Society of Palm Beach County, Inc.'s major federal programs for the year ended September 30, 2022. Legal Aid Society of Palm Beach County, Inc.'s major federal programs are identified in the summary of auditor's results section of the accompanying schedule of findings and questioned costs. In our opinion, Legal Aid Society of Palm Beach County, Inc. complied, in all material respects, with the types of compliance requirements referred to above that could have a direct and material effect on each of its major federal programs for the year ended September 30, 2022. Basis for Opinion on Each Major Federal Program We conducted our audit of compliance in accordance with auditing standards generally accepted in the United States of America; the standards applicable to financial audits contained in Government Auditing Standards, issued by the Comptroller General of the United States; and the audit requirements of Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). Our responsibilities under those standards and the Uniform Guidance are further described in the Auditor's Responsibilities for the Audit of Compliance section of our report. We are required to be independent of Legal Aid Society of Palm Beach County, Inc. and to meet our other ethical responsibilities, in accordance with relevant ethical requirements relating to our audit. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion on compliance for each major federal program. Our audit does not provide a legal determination of Legal Aid Society of Palm Beach County, Inc.'s compliance with the compliance requirements referred to above. Responsibilities of Management for Compliance Management is responsible for compliance with the requirements referred to above and for the design, implementation, and maintenance of effective internal control over compliance with the requirements of laws, statutes, regulations, rules, and provisions of contracts or grant agreements applicable to Legal Aid Society of Palm Beach County, Inc.'s federal programs. -21- 1120 Auditor's Responsibilities for the Audit of Compliance Our objectives are to obtain reasonable assurance about whether material noncompliance with the compliance requirements referred to above occurred, whether due to fraud or error, and express an opinion on Legal Aid Society of Palm Beach County, Inc.'s compliance based on our audit. Reasonable assurance is a high level of assurance but is not absolute assurance and therefore is not a guarantee that an audit conducted in accordance with generally accepted auditing standards, Government Auditing Standards, and the Uniform Guidance will always detect material noncompliance when it exists. The risk of not detecting material noncompliance resulting from fraud is higher than for that resulting from error, as fraud may involve collusion, forgery, intentional omissions, misrepresentations, or the override of internal control. Noncompliance with the compliance requirements referred to above is considered material if there is a substantial likelihood that, individually or in the aggregate, it would influence the judgment made by a reasonable user of the report on compliance about Legal Aid Society of Palm Beach County, Inc.'s compliance with the requirements of each major federal program as a whole. In performing an audit in accordance with generally accepted auditing standards, Government Auditing Standards, and the Uniform Guidance, we: • Exercise professional judgment and maintain professional skepticism throughout the audit. Identify and assess the risks of material noncompliance, whether due to fraud or error, and design and perform audit procedures responsive to those risks. Such procedures include examining, on a test basis, evidence regarding Legal Aid Society of Palm Beach County, Inc.'s compliance with the compliance requirements referred to above and performing such other procedures as we considered necessary in the circumstances. • Obtain an understanding of Legal Aid Society of Palm Beach County, Inc.'s internal control over compliance relevant to the audit in order to design audit procedures that are appropriate in the circumstances and to test and report on internal control over compliance in accordance with the Uniform Guidance, but not for the purpose of expressing an opinion on the effectiveness of Legal Aid Society of Palm Beach County, Inc.'s internal control over compliance. Accordingly, no such opinion is expressed. We are required to communicate with those charged with governance regarding, among other matters, the planned scope and timing of the audit and any significant deficiencies and material weaknesses in internal control over compliance that we identified during the audit. Report on Internal Control over Compliance A deficiency in internal control over compliance exists when the design or operation of a control over compliance does not allow management or employees, in the normal course of performing their assigned functions, to prevent, or detect and correct, noncompliance with a type of compliance requirement of a federal program on a timely basis. A material weakness in internal control over compliance is a deficiency, or a combination of deficiencies, in internal control over compliance, such that there is a reasonable possibility that material noncompliance with a type of compliance requirement of a federal program will not be prevented, or detected and corrected, on a timely basis. A significant deficiency in internal control over compliance is a deficiency, or a combination of deficiencies, in internal control over compliance with a type of compliance requirement of a federal program that is less severe than a material weakness in internal control over compliance, yet important enough to merit attention by those charged with governance. -22- 1121 Our consideration of internal control over compliance was for the limited purpose described in the Auditor's Responsibilities for the Audit of Compliance section above and was not designed to identify all deficiencies in internal control over compliance that might be material weaknesses or significant deficiencies in internal control over compliance. Given these limitations, during our audit we did not identify any deficiencies in internal control over compliance that we consider to be material weaknesses, as defined above. However, material weaknesses or significant deficiencies in internal control over compliance may exist that were not identified. Our audit was not designed for the purpose of expressing an opinion on the effectiveness of internal control over compliance. Accordingly, no such opinion is expressed. The purpose of this report on internal control over compliance is solely to describe the scope of our testing of internal control over compliance and the results of that testing based on the requirements of the Uniform Guidance. Accordingly, this report is not suitable for any other purpose. i .i West Palm Beach, Florida February 24, 2023 -23- 1122 LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC. For the Year Ended September 30, 2022 SECTION I — SUMMARY OF AUDITOR'S RESULTS Financial Statements Type of auditor's report issued: Internal control over financial reporting: Material weakness identified? Significant deficiency(ies) identified that are not considered to be material weaknesses? Noncompliance material to financial statements noted? Federal Awards Internal control over major programs: Material weakness(es) identified? Significant deficiency(ies) identified that are not considered to be material weaknesses? Type of auditor's report issued on compliance on major programs Any audit findings disclosed that are required to be reported in accordance with 2 CFR 200.516(a)? Major programs: CFDA Number Name of Federal Program or Cluster: Dollar Threshold used to distinguish between type A and type B programs: Auditee qualified as a low-risk auditee? -24- SCHEDULE OF FINDINGS AND QUESTIONED COSTS Unmodified No Yes No No None reported Unmodified No 16.575 U.S. Department of Justice — Crime Victim Assistance $ 750,000 Yes 1123 LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC. For the Year Ended September 30, 2022 SECTION H — FINANCIAL STATEMENT FINDINGS Finding 2022-01: Revenue/Receivable Reconciliation SCHEDULE OF FINDINGS AND QUESTIONED COSTS Condition Grants revenue were not reconciled with the grant agreements, and grants receivable were not reviewed to ensure collection or correction. Criteria Internal controls should be in place to ensure amounts billed under each grant are in accordance with the terms of the grant agreement. Cause There are no procedures in place to require the reconciliation of grant revenue and receivables with the grant agreement. Effect Because no reconciliation was done through the year, grants revenue recorded in the books exceeded the amount allowed under the grant agreement. These amounts remained as outstanding receivable. Recommendation We recommend that management develop a system to track the progress of each grant to ensure that amounts are recorded in accordance with the agreements, and to make sure funds under the grants are properly utilized. In addition, such system would assist management to determine that funds are collected on a timely manner and that proper adjustments to the billings are made when necessary. Management's We have developed a report mechanism within our accounting system that response will report grant revenue in relation to the grant amount, regardless of fiscal periods involved. We have also initiated an internal reconciliation checklist and have specific staff assigned to each of the reconciliations to assure that grants revenue and our receivables are being reconciled on a monthly basis. SECTION I/1— FEDERAL AWARD FINDINGS AND QUESTIONED COSTS There are no findings or questioned costs reported for the year ended September 30, 2022, relative to federal awards for Legal Aid Society of Palm Beach County, Inc. PRIOR YEAR FINDINGS There were no prior audit findings for the year ended September 30, 2021, relative to federal awards requiring action on the part of Legal Aid Society of Palm Beach County, Inc. -25- 1124 Executive Director Robert A. Bertisch, Esq. Adniinistrator Michael Spillane Director of Development Dana K. Brookes Board of Trustees David. Ackerman, Esq. Claire Arnold F. Greg Barnhart, Esq. Bill Bone, Esq. Patrick J. Casey, Esq. Jeffrey A. Devore, Esq. Mariano Garcia, Esq. Garry Glickman, Esq. Carey Ilatighwout, Esq. ,Jane Krensler-Walsh, Esq. Richard Lubin, Esq. Rafael ,1. Roca, Esq. Michael Salnick, Esq. Gary Woodfield, Esq. Board of Directors President Michelle R. Sitskaner, Esq. Inninediate Past Pres. Miriam Acosta-Castriz, Esq. First Vice -President Lawrence 1). Rochefort, Esq. Second Vice-111resident Robert 11. Friedinan, Esq. Secretary Scott C. Murray, Esq. ,treasurer ,Jerald S. Beer, Esq. Board of Directors Leslie Artsis Adams Richard M. Benrnbi, Esq. Bridget A. Berry, Esq. Robin Bresky, Esq. CarlaTharp Brown Sarah Cof-Nriend, Esq. Vincent F. Cnoino Amy Devore Howard 1.). Dtfflosar, Esq. Kai -is Engle DwineLte,l. FeeinsLer, Esq. ,Joseph G. Galardi, Esq. Richard 1.). Greenfield ,lack 1). Hill, Esq. Denise Rappaport Isaacs, Esq. Wilnar,J.,Jnhniste, Esq. W. Hampton Keen, Esq. Nancy Lambrecht ,Jason 1.). Lazarus, Esq. Daniel ImAig, Esq. Ellen S. Malasky, Esq. J. Grier Pressly, 111, Esq. Heather L. Ries, Esq. peter A. Sachs, Esq. MaRliew Sackel, Esq. Robert M.W. Shalliont), Esq. Grasford W. Smiffi, Esq. Rebecca Mercier Vat -gas, Esq. Matthew Zimmerman, Esq. Legal Aid Society ofPalm Beach County, Inc. 423 Fern Street, Suite 200, West.Palm. Beach, FL 33401 Phone: (561) 655-8944 * Fax: (561) 655-5269 * Toll -Free t-800-403-935 tvww.1ega1a1dpbc.org I Corrective Action Plan For the Year Ended September 30, 2022 Legal Aid Society of Palm Beach County, Inc. respectfully submits the following corrective action plan for the year ended September 30, 2022. Name and address of independent public accounting firm: Holyfield & Thomas, LLC 125 Butler Street West Palm Beach, FL 33407 Audit period: September 30, 2022 The findings from the September 30, 2022 schedule of findings and questioned costs are discussed below. The finding is numbered consistently with the number assigned in the schedule of the audit report dated February 24, 2023. FINDINGS—FINANCIAL STATEMENT AUDIT 2022-01: Revenue/Receivable Reconciliation Recommendation: Auditors recommend that management develop a system to track the progress of each grant to ensure that amounts are recorded in accordance with the agreements, and to make sure funds under the grants are properly utilized. In addition, such system would assist management to determine that funds are collected on a timely manner and that proper adjustments to the billings are made when necessary. Action taken: We have developed a report mechanism within our accounting system that will report grant revenue in relation to the grant amount, regardless of fiscal periods involved. This will alert us to the occurrence of a grant billed for funds in excess of the permissible amounts. We have also initiated an internal reconciliation checklist and have specific staff assigned to each of the reconciliations to assure that grants revenue and our receivables are being reconciled on a monthly basis. For questions regarding this plan, please call Robert Bertisch, Executive Director at (561) 655-8944. Sincerely yours, Legal Aid Society of Palm Beach County, Inc. By: Robert Bertisch, Esq., Executive Director February 24, 2023 Children's Services Council 1; - , , Healthy. Safe. Strong. Nwn of Pan Beach Unked Way United Way of Pa irn Beach County Additional Funding Provided by Pah, Bead, Co"-" SUPPLEMENTARY INFORMATION i `pil LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC. SCHEDULE OF EXPENDITURES OF FEDERAL AWARDS For the Year Ended September 30, 2022 Federal Grantor Pass-through Entity CFDA Award Federal Federal Program Title Period Number Number Expenditures U.S. Department of Housing and Urban Development Fair Housing Initiative Program 04/01/21 - 03/31/22 14.418 FPE120046 $ 180,000 Fair Housing Initiative Program 04/01/22 - 03/31/23 14.418 FPE120046 185,000 Fair Housing Initiative Program 06/01/22 - 05/31/23 14.418 FPE2122055 81,250 Fair Housing Initiative Program 06/01/21 - 05/31/22 14.416 FE0120027 78,805 Fair Housing Initiative Program 06/01/22 - 05/31/23 14.416 FE01210068 41,667 566,722 Passed through from Palm Beach County, Florida: Community Development Block Grants 10/01/21 - 09/30/22 14.218 R2021-1511 58,621 Emergency Solutions Grant Program 03/01/21 -09/30/22 14.231 R2021-0998 247,646 Emergency Solutions Grant Program 03/01/21 -09/30/22 14.231 R2022-0922 350,000 Passed through from City of Boca Raton, Florida: Community Development Block Grants 10/01/21 -09/30/22 14.218 FY2021-2022CDBG 4,100 Passed through from City of Boynton Beach, Florida: Community Development Block Grants 10/01/21 -09/30/22 14.218 FY2021-2022CDBG 5,760 Passed through from City of Delray, Florida: Community Development Block Grants 10/01/21 -09/30/22 14.218 FY2021-2022CDBG 9,500 Passed through from City of Jacksonville, Florida: Eviction Protection Grant Program: Florida Legal Aid Eviction Protection Proj 02/01/22 - 02/01/24 14.537 EP -21 -FL -001 108,831 Total U.S. Department of Housing and Urban Development 1,351,180 U.S. Department of Justice: Passed through from Florida Office of the Attorney General: VOLA -2021 -Legal Aid Crime Victim Assistance 10/01/21 - 09/30/22 16.575 Society of Palm -00559 829,463 Passed through from Office on Violence Against Women: Legal Assistance for Victims 10/01/16 - 09/30/22 16.524 2016 -WL -AX -0058 206,360 Passed through from Office for Victims of Crime, Equal Justice Works: Crime Victim Assistance/Discretionary 06/15/20 - 08/31/22 16.582 2020-OVC-EJP-009 100,317 Total U.S. Department of Justice 1,136,140 (continued on next page) See independent auditor's report and accompanying notes to Schedule of Expenditures of Federal Awards. -27- 1127 LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC. For the Year Ended September 30, 2022 Federal Grantor Pass-through Entity Federal Program Title Period (continued from previous page) U.S. Department of Treasury SCHEDULE OF EXPENDITURES OF FEDERAL AWARDS CFDA Number Award Number Federal Expenditures Low Income Taxpayer Clinics 01/01/21 - 12/31/21 21.008 21-LITC0457-02-00 $ 22,500 Low Income Taxpayer Clinics 01/01/22 - 12/31/22 21.008 21-LITC0457-03-00 67,500 90,000 Passed through from City of Lake Worth, Florida: American Rescue Plan Act of 2021 10/01/21 - 09/30/22 21.027 Y5177 32,900 Total U.S. Department of Treasury 122,900 U.S. Department of Health and Human Services: Older Americans Act, Title III B and 01/01/21 - 12/31/21 93.044/.052 IA 021-9001 002 138,180 Title III E - Support Services 01/01/22 - 12/31/22 93.044/.052 IA 021-9001 003 291,906 430,086 Passed through from Palm Beach County, Florida: HIV Emergency Relief Project 03/01/20 - 02/28/21 93.914 R2019-0585 109,629 HIV Emergency Relief Project 03/01/21 - 02/28/24 93.914 R2021-0308 164,770 274,399 Total U.S. Department of Health and Human Services 704,485 Total expenditures of federal awards $ 3,314,705 See independent auditor's report and accompanying notes to Schedule of Expenditures of Federal Awards. -28- 1128 LEGAL AID SOCIETY OF NOTES TO SCHEDULE OF EXPENDITURES PALM BEACH COUNTY, INC. OF FEDERAL AWARDS For the Year Ended September 30, 2022 Basis of Presentation The accompanying schedule of expenditures of federal awards (the "Schedule") includes the federal award activity of Legal Aid Society of Palm Beach County, Inc. under programs of the federal government for the year ended September 30, 2022. The information in this Schedule is presented in accordance with the requirements of Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). Because the Schedule presents only a selected portion of the operations of Legal Aid Society of Palm Beach County, Inc., it is not intended to and does not present the financial position, changes in net assets, or cash flows of Legal Aid Society of Palm Beach County, Inc. 2. Summary of Significant Accounting Policies Expenditures reported on the Schedule are reported on the accrual basis of accounting. Such expenditures are recognized following the cost principles contained in the Uniform Guidance, wherein certain types of expenditures are not allowable or are limited as to reimbursement. 3. Scope of Audit Pursuant to Uniform Guidance All federal grant operations of Legal Aid Society of Palm Beach County, Inc. are included in the scope of the Uniform Guidance. Programs tested as major federal programs included awards from the U.S. Department of Justice with fiscal year 2022 expenditures totaling $829,463. Programs tested ensure coverage of at least 20 percent of federally granted funds. Actual coverage is approximately 25 percent of total federal award program expenditures. See independent auditor's report. -29- 1129 �r °rtba BrVa'rtmpnt of fttp I certify from the records of this office that LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC. is a corporation organized under the laws of the State of Florida, filed on November 18, 1970. The document number of this corporation is 719708. I further certify that said corporation has paid all fees due this office through December 31, 2021, that its most recent annual report/uniform business report was filed on January 4, 2021, and its status is active. I further certify that said corporation has not filed Articles of Dissolution. CR2E022 (01-11) *aww- Laurefw'. Lee Secretary of State M r r :43epartmerit of #tatp I certify the attached is a true and correct copy of the Amended and Restated Articles of Incorporation, filed on February 17, 2021, for LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC., a Florida corporation, as shown by the records of this office. The document number of this corporation is 719708. • 5 HE - • # N." CR2EO22 (01-11) Secretary of State Articles of Amendment to Articles of Incorporation of Legal Aid Society of Palin Beach County, Inc. (Name of Cor voration as currently filed with the Florida Dent. of State) 719708 (Document Number of Corporation (if known) Pursuant to the provisions of section 617.1006, Florida Statutes, this Florida Not For Profit Corporation adopts the following amendment(s) to its Articles of Incorporation: A. If amending name, enter the new name of thecor oration: n/a new must be distinguishable and contain the word "corporation or�"incorporated " or the abbr Warne m peviction "Corp. " or `Inc. " "Com any"or "Co."mav not be used in the name. B. Enter new DrinciDal office address. if a licable: n/a (Principal office address MUST BE A STREET ADDRESS) n/a n/a C. Enter new mailing address, if a nlicable: n/a (Mailing address MAY BEA POST OFFICE BOX) n/a n/a D. If amending the registered agent and/or registered office address in Florida, enter the name of the new registered aLyent and/or the new re istered office address: Nance ofNeiv Re istered Agent: n/a n/a NeN�,Tru,,gietermed Office Address: (Florida street address) n/a Florida n/a �. (Cit),) ..._...........��... (Zip Code) New Re istered Agent's Signature. if changing Registered Agent - 1 hereby accept the appointment as registered agent I am familiar with and accept the obligations of the position Signature of New Registered Agent, if changing N M r r If amending the Officers and/or Directors, enter the title and name of each officer/director being removed and title, name, and address of each Officer and/or Director being added: (Attach additional sheets, if necessary) Please note the officer/director title by the first letter of the office title. P = President; V= Vice President; T— Treasurer; S= Secretary; D= Director; TR= Trustee; C = Chairman or Clerk; CEO = Chief Executive Officer; CFO =Chief Financial Off cer. If an officer/director holds more than one title, list the first letter of each office held. President, Treasurer, Director would be PTD. Changes should be noted in the following manner. Currently John Doe is listed as the PST and tLlike Jones is listed as the V There is a change, Alike Jones leaves the corporation, Sally Snaith is named the V and S These should be noted as John Doe, PT as a Change, Alike Jones, V as Remove, and Sally Smith, SV as an Add. Example: X Change PT John Doe X Remove V Mike Jones X Add SV Sallv Smith Type of Action Title Name (Check One) 1) Change Add Remove 2) Change Add Remove 3) Change. Add Remove 4) Change Add Remove S) Change Add Remove 6) Change Add Remove E. If amending or adding additional Articles, enter change(s) here: (attach additional sheets, if necessar)). (Be specific) Address The Le al Aid Society of Palm Beach County amended "Article IV: Membership" of its Articles of Incorporation to state: -- "The g Y County, is not a membership organization." _ "The Le al Aid Society of Palm Beach -Coon Inc., " _ �zation." M r r p The date of each amendments adoption: October 27, 2020 if other than the date this document was signed. Effective date if applicable: (no more than 90 days after amendment file date) Note: if the date inserted in this block does not meet the applicable statutory filing requirements, this date will not be listed as the document's effective date on the Department of State's records. Adoption of Amendment(s) (CHECK ONE) 8 The amendment(s) was/were adopted by the members and the number of votes cast for the amendment(s) was/were sufficient for approval. LO M r r ❑ There are no members or members entitled to vote on the amendment(s). The amendment(s) was/were adopted by the board of directors. November 30, 2020 Dated Signature (By the chairman or vice chairman of the board, president or other officer -if directors have not been selected, by an incorporator — if in the hands of a receiver, trustee, or other court appointed fiduciary by that fiduciary) Michelle R. Suskauer (Typed or printed name of person signing) President, Legal Aid Society of Palm Beach County Board of Directors (Title of person signing) FLORIDA DEPARTMENT OF STATE Division of Corporations April 13, 2021 ROBERT A BERTISCH, EXECUTIVE DIRECTOR LEGAL AID SOCIETY OF PALM BEACH COUNTY 423 FERN STREET STE 200 WEST PALM BEACH, FL 33401 Re: Document Number 719708 The Amended and Restated Articles of Incorporation for LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC., a Florida corporation, were filed on February 17, 2021. The certification you requested is enclosed. Should you have any questions concerning this matter, please telephone (850) 245- 6050, the Amendment Filing Section. Shelia S Young Regulatory Specialist III Division of Corporations Letter Number: 021A00007578 www.sunbiz.org Division of Corporations - P.O. BOX 6327 -Tallahassee, Florida 32314 ARTICLES OF AMENDMENT LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC., The undersigned being the President and Registered Agent of the LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC., a Florida not-for-profit corporation, hereby subscribes to, acknowledges, and files the following Articles of Amendment: ARTICLE I NAME OF CORPORATION The name of the Corporation is the LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC. ARTICLE II AMENDMENTS ADOPTED The Amendments adopted are incorporated in the Amended and Restated Articles of Incorporation, an original of which is affixed hereto and incorporated herein by reference. ARTICLE III DATE OF ADOPTION This Amendment was adopted by the Board of Directors of the Corporation on October 27, 2020. This Amendment was adopted by and approved by the members of the Corporation at a meeting thereof on October 27, 2020, and the number of votes cast was sufficient for approval. 00 M r r IN WITNESS WHEREOF, the undersigned have herein set their hands and seals this 30 day of November ,.,.,,.,, 20 20 LEGAL AID SOCIETY COUNTY, INC., a corporation By: , MICH Attest: ROBE STATE OF FLORIDA COUNTY OF PALM BEACH OF PALM BEACH Florida not-for-profit ISTERED AGENT BEFORE ME, the undersigned authority, personally appeared to me MICHELLE R. SUSKAUER and ROBERT A. BERTISCH, to me well known to be the President and Registered Agent respectively of the LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC., and executed the foregoing Articles of Amendment and acknowledged before me that they executed the same for the purposes therein expressed. Sworn to (or affirmed) and subscribed before me by means of .❑ Physical Presence, —OR - 0 Online Notarization, this �'"_ day of2020, by Name of Person Swearing or Affirming Signaure,bf Notary Public — State of Florida Name of Notary Typed, Printed or Stamped p MY I HH CUM E Personally Known Nwnbsr 17,2U4, ❑ Produced Identification Type of Identification Produced: M r r LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC. AMENDED AND RESTATED ARTICLES OF INCORPORATION The undersigned, being the President and Registered Agent of the LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC., hereby subscribe to, acknowledge, and file the following Amended and Restated Articles of Incorporation: ARTICLE NAME AND ADDRESS The name of the Corporation is the LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC., and the principal office and mailing address of the Corporation is 423 Fern Street, Suite 200, West Palm Beach, Florida 33401. ARTICLE II • The Corporation commenced existence on May 6, 1949 and was reincorporated in accordance with Florida Statutes November 18, 1970. The Corporation shall exist perpetually unless sooner dissolved according to law. ARTICLE I II PURPOSES The general nature and object of the Corporation is benevolent and charitable, and organized to render legal aid gratuitously, if necessary, to all persons appearing worthy of such aid who shall be unable to procure legal assistance elsewhere, to assist persons without means in the pursuit of any civil remedy and in the protection of their person or 0 property, and to promote measures for the protection of indigent persons. The Corporation may also do everything necessary, proper or convenient for the accomplishment of its purpose as set forth herein, and every other act which is not forbidden under the laws of the United States of America, State of Florida (specifically Chapter 617) or by the provisions of these Amended and Restated Articles of Incorporation. The Corporation has and intends to continue to qualify for exemption from federal income taxes under Section 501(c) (3) of the Internal Revenue Code of 1986, as amended, and these Amended and Restated Articles of Incorporation shall be construed consistently with the requirements thereof. ARTICLE IV MEMBERSHIP The Legal Aid Society of Palm Beach County, Inc., is not a membership organization. ARTICLE V MANAGEMENT OF CORPORATE AFFAIRS The powers of this Corporation shall be exercised, its properties controlled, and its affairs conducted by a Board of Directors. The Corporation shall have at least ten (10) directors. A majority of directors shall be members of the Palm Beach County Bar Association. The term of office for each director shall be three (3) years, exclusive of time served as an officer or until a director's successor is elected or appointed, whichever shall occur last. The directors shall be elected annually by a majority vote of the then directors in accordance with the Bylaws of the Corporation. ARTICLE VI LOCATION OF REGISTERED AGENT The street address of the Corporation's registered office is 423 Fern Street, Suite 200, West Palm Beach, Florida 33401. The registered agent at that address is Robert A. Bertisch. ARTICLE VII BYLAWS The Bylaws of the Corporation may be amended, altered, rescinded or appealed, in whole or in part, by the Board of Directors in the manner provided therein. Any amendments to the Bylaws shall be binding on all members of this Corporation. ARTICLE VIII AMENDMENTS TO ARTICLES Amendments to these Amended and Restated Articles of Incorporation shall be made pursuant to law. ARTICLE IX INDEMNIFICATION AND LIMITATION OF LIABILITY The Corporation shall indemnify any officer or director, or any former officer or director of the Corporation, to the full extent permitted by law. The private property of any member shall not, unless otherwise provided by law, be subject to payment of the Corporation's debts to any extent whatsoever. ARTICLE X DISSOLUTION In the event the Corporation desires to dissolve and wind up its affairs within the State of Florida and ceases to exist for the stated purposes, Articles of Dissolution shall be filed with the Secretary of State according to the Florida Statutes for dissolving a not-for- profit corporation, and the assets of the Corporation after payment of all costs and expense of such dissolution, shall be distributed to organizations which have qualified for exemption under Section 501(c)(3) of the Internal Revenue Code of 1986, as amended, or to the federal government, or to the state or local governments for a public purpose, and none of the assets shall be distributable to any member, director, officer or trustee of this Corporation. ARTICLE XI STATEMENT OF NON -DISCREPANCY Any amendments included in the Amended and Restated Articles of Incorporation have been adopted pursuant to section 617.1007(4), Florida Statutes, and there is no discrepancy between the Corporation's Articles of Incorporation as therefore amended and the provisions of the restated Articles of Incorporation other than the inclusion of these Amendments and the omission of matters of historical interest. IN WITNESS WHEREOF, the undersigned have herein set their hands and seals this 30 day of November ,_, 20 20 LEGAL AID SOCIETY COUNTY, INC., a corporation ELLE R. Attest: _ ROBERT STATE OF FLORIDA COUNTY OF PALM BEACH OF PALM BEACH Florida not-for-profit D AGENT BEFORE ME, the undersigned authority, personally appeared to me MICHELLE R. SUSKAUER and ROBERT A. BERTISCH, to me well known to be the President and Registered Agent respectively of the LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC., and executed the foregoing Articles of Amendment and acknowledged before me that they executed the same for the purposes therein expressed. Sworn to (or affirmed) and subscribed before me by means of P=Physical Presence, —OR - 0 Online Notarization, this da of �, y 2020, by Name of Person Swearing or Signa ure%of Notary Public — State of Florida Name of Notary Typed, Printed or Stamped •'� JENNIFER L. ROTHMAN ` Personally Known MY COMMISSION # HH 033408 'o' EXPIRES: December 17,2024 SWW rnn, Novy wbik Und El Produced Identification ► t,, Type of Identification Produced: ADDENDUM TO AMENDED AND RESTATED ARTICLES OF INCORPORATION The undersigned being the President and Secretary of the LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC., a Florida not-for-profit corporation, hereby subscribed to, acknowledges, and files the following Addendum to the Amended and Restated Articles of Incorporation dated September 24, 1997: ARTICLE XI STATEMENT OF NON -DISCREPANCY Any amendments included in the Amended and Restated Articles of Incorporation have been adopted pursuant to section 617.1007(4), Florida Statutes, and there is no discrepancy between the Corporation's Articles of Incorporation as therefore amended and the provisions of the restated Articles of Incorporation other than the inclusion of these Amendments and the omission of matters of historical interest. IN WITNESS WHEREOF, the undersigned have herein set their hands and seals this -9'/1V- day of 19 97. LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC., a Florida not-for-profit corporation Fav AZ STATE OF FLORIDA COUNTY OF PALM BEACH BEFORE ME, the undersigned authority, personally appeared to me DAVID P. ACKERMAN and ROBERT A. BERTISCH, to me well known to be the President and Secretary respectively of the LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC., and executed the foregoing Amended and Restated Articles of Incorporation and acknowledged before me that they executed the same for the purposes therein expressed. IN WITNESS WHEREOF, I Dere unto affix m hand and seal at West Palm Beach, Florida this #day of 50 „ IA NOTARY PUBLIC, State of Florida at Large My Commission Expires: My Commission Number: E lic!i ,racy°, YSG �o'�z fT JOUN x�° o a.o�a P::ax�a:�a. ��. W LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC. AMENDED AND RESTATED ARTICLES OF INCORPORATION The undersigned, being the President and Secretary of the LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC., hereby subscribe to, acknowledge, and file the following Amended and Restated Articles of Incorporation: ARTICLE I NAME AND ADDRESS The name of the Corporation is the LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC., and the principal office and mailing address of the Corporation is 423 Fern Street, Suite 200, West Palm Beach, Florida 33401. ARTICLE II DURATION The Corporation commenced existence on May 6, 1949 and was reincorporated in accordance with Florida Statutes November 18, 1970. The Corporation shall exist perpetually unless sooner dissolved according to law. ARTICLE III PURPOSES The general nature and object of the Corporation is benevolent and charitable, and organized to render legal aid gratuitously, if necessary, to all persons appearing worthy of such aid who shall be unable to procure legal assistance elsewhere, to assist persons without means in the pursuit of any civil remedy and in the protection of their person or property, and to promote measures for the protection of indigent persons. The Corporation may also do everything necessary, proper or convenient for the accomplishment of its purpose as set forth herein, and every other act which is not forbidden under the laws of the United States of America, State of Florida (specifically Chapter 617) or by the provisions of these Amended and Restated Articles of Incorporation. The Corporation has and intends to continue to qualify for exemption from federal income taxes under Section 501(c) (3) of the Internal Revenue Code of 1986, as amended, and these Amended and Restated Articles of Incorporation shall be construed consistently with the requirements thereof. ARTICLE IV MEMBERSHIP This Corporation is organized on a non -stock basis an shall not issue shares of stock. All attorneys -at -law who are members in good standing of the Palm Beach County Bar Association shall be members of this Corporation. The authorized number, qualifications, and manner of admission of persons who are not members of the Palm Beach County Bar Association, the different classes of membership, if any, and other rights and privileges of members, the liability of members for dues or assessments and the method of collection thereof, and the termination and transfer of membership shall be as set forth in the Bylaws of this Corporation. ARTICLE V MANAGEMENT OF CORPORATE AFFAIRS The powers of this Corporation shall be exercised, its properties controlled, and its affairs conducted by a Board of Directors. The Corporation shall have at least ten (10) directors. A majority of directors shall be members of the Palm Beach County Bar Association. The term of office for each director shall be three (3) years, exclusive of time served as an officer or until a director's successor is elected or appointed, whichever shall occur last. The directors shall be elected annually by a majority vote of the then directors in accordance with the Bylaws of the Corporation. ARTICLE VI LOCATION OF REGISTERED AGENT The street address of the Corporation's registered office is 423 Fern Street, Suite 200, West Palm Beach, Florida 33401. The registered agent at that address is Robert A. Bertisch. ARTICLE VII BYLAWS The Bylaws of the Corporation may be amended, altered, rescinded or appealed, in whole or in part, by the Board of Directors in the manner provided therein. Any amendments to the Bylaws shall be binding on all members of this Corporation. ARTICLE VIII AMENDMENTS TO ARTICLES Amendments to these Amended and Restated Articles of Incorporation shall be made pursuant to law. ARTICLE IX INDEMNIFICATION AND LIMITATION OF LIABILITY The Corporation shall indemnify any officer or director, or any former officer or director of the Corporation, to the full extent permitted by law. The private property of any member shall not, unless otherwise provided by law, be subject to payment of the Corporation's debts to any extent whatsoever. ARTICLE X DISSOLUTION In the event the Corporation desires to dissolve and wind up its affairs within the State of Florida and ceases to exist for the stated purposes, Articles of Dissolution shall be filed with the Secretary of State according to the Florida Statutes for dissolving a not-for- profit corporation, and the assets of the Corporation after payment of all costs and expense of such dissolution, shall be distributed to organizations which have qualified for exemption under Section 501(c)(3) of the Internal Revenue Code of 1986, as amended, or to the federal government, or to the state or local governments for a public purpose, and none of the assets shall be distributable to any member, director, officer or trustee of this Corporation. 0 L0 IN WITNESS WHEREOF the President and Secretary herein before named for the purposes of amending and restating the Articles of Incorporation for purposes of amending and restating the Articles of Incorporation for purposes of operating within and without the State of Florida, hereby certify that the foregoing is a true and correct copy of the Amended and Restated Articles of Incorporation, this X1/9 day of - �� t , 1912. LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC., a Florida not-for-profit corporation Yoe DAV P. ACKIz N. re e Attest: STATE OF FLORIDA COUNTY OF PALM BEACH , Secretary BEFORE ME, the undersigned authority, personally appeared to me DAVID P. ACKERMAN and ROBERT A. BERTISCH, to me well known to be the President and Secretary respectively of the LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC., and executed the foregoing Amended and Restated Articles of Incorporation and acknowledged before me that they executed the same for the purposes therein expressed. IN WIZI9ESS WHEREOF, I here unto affix Env hand and seal at West Palm Beach, Florida this N day of �.A , 1911 NOTARY PUBLIC, State of Florida at Large My Commission Expires: My Commission Number: �N� 0 M I lo� i III lil u�i ARTICLES OF AMENDMENT LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC., The undersigned being the President and Secretary of the LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC., a Florida not-for-profit corporation, hereby subscribes to, acknowledges, and files the following Articles of Amendment: ARTICLE I NAME OF CORPORATION The name of the Corporation is the LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC. ARTICLE II AMENDMENTS ADOPTED The Amendments adopted are incorporated in the Amended and Restated Articles of Incorporation, an original of which is affixed hereto and incorporated herein by reference. ARTICLE III DATE OF ADOPTION This Amendment was adopted by the Board of Directors of the Corporation on September 24, 1997. This Amendment was adopted by and approved by the members of the Corporation at a meeting thereof on September 24, 1997 and the number of votes cast was sufficient for approval. IN WITNESS WHEREOF, the undersigned have herein set their hands and seals this JY day 1997. LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC., a Florida not-for-profit corporation By DA Aft RC STATE OF FLORIDA COUNTY OF PALM BEACH BEFORE ME, the undersigned authority, personally appeared to me DAVID P. ACKERMAN and ROBERT A. BERTISCH, to me well known to be the President and Secretary respectively of the LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC., and executed the foregoing Articles of Amendment and acknowledged before me that they executed the same for the purposes therein expressed. IN WITNESS WHEREOF, I here unto affix my hand and seal at West Palm Beach, Florida this Z" day of _ 194 . NOTARY PUBLIC, State of Florida at Large My Commission Expires: My Commission Number: UM ST J014 co M55WN NO. cC52477 M to r r �i FLORIDA DEPARTMENT OF STATE Jim Smith Secretary or State March 16, 1992 LEGAL AID SOCIETY OF PALM BCH. COUNTY 224 DATURA ST., SUITE 301 W. PALM BEACH, FL. 33401 Re: Document Number 719708 Dear SIR: This will acknowledge receipt of your Amended and Restated Articles of Incorporation for LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC., which were filed on March 11, 1992. Your remittance totaling $35.00 has been received. Should you have any questions regarding this matter, please telephone (904) 487-6050, the Amendment Filing Section. VELMA SHEPARD Division of Corporations Division of Corporations, PO Box 6327, Tallahassee, Florida 32314 It W) ARTICLES OF AMENDMENT FILED LEGAL AID SOCIETY OF PALM BEACH COUNTR MW PH 1: S8 SEC r. v iALC �P" OSg F OF The undersigned being the President and Secretary of the LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC., a Florida not for profit corporation hereby subscribes to, acknowledges and files the following Articles of Amendment: ARTICLE I NAME OF CORPORATION The name of the Corporation is the LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC. ARTICLE II AMENDMENTS ADOPTED The Amendments adopted are incorporated in the Amended and Restated Articles of Incorporation, an original of which is affixed hereto and incorporated herein by reference. ARTICLE III DATE OF ADOPTION This Amendment was adopted by the Board of Directors of the Corporation on November 20, 1991. This Amendment was adopted by and approved by the members of the Corporation at a meeting thereof on December 12 , 1991 and the number of votes cast was sufficient for approval. ADDENDUM TO AMENDED AND RESTATED ARTICLES OF INCORPORATION The undersigned being the President and Secretary of the LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC. a Florida not for profit corpora- ticn hereby subscribed to, acknowledges and files the following Addendum to the Amended and Restated Articles of Incorporation dated December 12, 1991. ARTICLE XI STATEMENT OF NON -DISCREPANCY Any amendments included in the Amended and Restated Articles of Incorporation have been adopted pursuant to section 617.1007(4), Florida Statutes, and there is no discrepancy between the corporations articles of incorporation as therefore amended and the provisions of the restated articles of incorporation other than the inclusion of these amendments and the em fission of matters of historical interest. IN WITNESS WHEREOF, the undersigned have herein set their hands and seals this c,Zla day of iy' i�yl�y� 1992. LEGAL AID SOCIETY OF PALM INC. a Florida not for PALit kzeim Attest: STATE OF FLORIDA COUNTY OF PALM BEACH BEFORE ME, the undersigned authority, personally appeared to me RICHARD J. LUBIN and ROBEFQ A. BERTISCH to me well known to be the President and Secretary respectively of the LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC. and executed the foregoing Amended and Restated Addendum to A Bed And Restated Articles of In- corporation P. 2 Articles of Incorporation and acknowledged before me that they executed the same for the purposes therein expressed. IN WIMESS WHEREOF, I hi�see unto aff' my and and seal at West Palm Beach, Florida, this ,�,1¢t4y' of _VL�� 1992. JBTSC, State. of Florida At Targe CD U) r My Conmission Expires: , "OTAAw MIC STATE OF FURI 4 Few ISSkAA EMA.l4,,3to Mgm THAU CCACNAL 4 . My: :ssion, :,. �S4�Z� LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC. AMENDED AND RESTATED ARTICLES OF INCORPORATION The undersigned, being the President and Secretary of the Legal Aid Society of Palm Beach County, Inc., hereby subscribe to, acknowledge and file the following Amended and Restated Articles of Incorporation. ARTICLE I I NAME AND ADDRESS The name of the corporation is LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC., and the principal office and mailing address of the corporation is 224 Datura Street, Suite 301, West Palm Beach, Florida 33401. ARTICLE II DURATION The corporation commenced existence on May 6, 1949 and was reincorporated in accordance with Florida Statutes November is, 1970. The corporation shall exist perpetually unless sooner dissolved according to law. ARTICLE III PURPOSES The general nature and object of the corporation is benevolent and charitable, and organized to render legal aid gratuitously, if necessary, to all persons appearing worthy of such aid who shall be unable to procure legal assistance elsewhere, to assist persons without means in the pursuit of any civil remedy and in the protection of their person or property, and to promote measures for the protection of indigent persons. The corporation may also do everything necessary, proper or convenient for the accomplishment of its purpose as set forth herein, and every other act which is not forbidden under the laws of the United States of America, State of Florida (specifically Chapter 617) or by the provisions of these Amended and Restated Articles of Incorporation. The corporation has and intends to continue to qualify for exemption from federal income taxes under Section 501(c)(3) of the Internal Revenue Code of 1986, as amended, and these Amended and Restated Articles of Incorporation shall be construed consistently with the requirements thereof. ARTICLE IV MEMBERSHIP This corporation is organized on a non -stock basis and shall not issue shares of stock. All attorneys -at -law who are members in good standing of the Palm Beach County Bar Association shall be members of this corporation. The authorized number, qualifications, and manner of admission of persons who are not members of the Palm Beach County Bar Association, the different classes of membership, if any, the voting and other rights and privileges of members, the liability of members for dues or assessments and the method of collection thereof, and the 2 termination and transfer of membership shall be as set forth in the bylaws of this corporation. ARTICLE V MANAGEMENT OF CORPORATE AFFAIRS The powers of this corporation shall be exercised, its properties controlled, and its affairs conducted by a Board of Directors. The corporation shall have at least ten (10) directors. A majority of directors shall be members of thI Palm Beach County Bar Association. The term of office for each director shall be three (3) years, exclusive of time served as an officer or until a director's successor is elected or appointed, whichever shall occur last. The directors shall be elected annually by a majority vote of the then directors in accordance with the bylaws of the corporation. ARTICLE VI LOCATION OF REGISTERED AGENT The street address of the corporation's registered office is 224 Datura Street, Suite 301, West Palm Beach, Florida 33401. The registered agent at that address is Robert A. Bertisch. ARTICLE VII BYLAWS The bylaws of the corporation may be amended, altered, rescinded or appealed, in whole or in part, by the Board of 3 Directors in the manner provided therein. Any amendments to the bylaws shall be binding on all members of this corporation. ARTICLE VIII AMENDMENTS TO ARTICLES Amendments to these Amended and Restated Articles of Incorporation shall be made pursuant to law. ARTICLE IX INDEMNIFICATION AND LIMITATION OF LIABILITY The corporation shall indemnify any officer or director, or any former officer or director of the corporation, to the full extent permitted by law. The private property of any member shall not, unless otherwise provided by law, be subject to payment of the corporation's debts to any extent whatsoever. ARTICLE X DISSOLUTION In the event the corporation desires to dissolve and wind up its affairs within the State of Florida and ceases to exist for the stated purposes, Articles of Dissolution shall be filed with the Secretary of State according to the Florida Statutes for dissolving a not-for-profit corporation, and the assets of the corporation after payment of all costs and expenses of such dissolution, shall be distributed to organizations which have qualified for exemption under Section 501(c)(3) of the Internal 4 Revenue Code of 1986, as amended, or to the federal government, or to the state or local governments for a public purpose, and none of the assets shall be distributable to any member, director, officer or trustee of this corporation. IN WITNESS WHEREOF the President and Secretary hereinbefore named for the purposes of amending and restating the Articles of Incorporation for purposes of operating within and without the State of Florida, hereby certify that the foregoing is a true and correct copy of the Amended and Restated Article of Incorporation, this i�Ce1»ber IQ , 1991. LEGAL AID SOCIETY OF PALM REACH COUNTY, 'INC, a Florida noX,for profit. coAtion LTE STATE OF FLORIDA COUNTY OF PALM BEACH ecretary r BEFORE ME, the undersigned authority, personally appeared to me RICHARD J. LUBIN and ROBERT A. BERTISCH to me well known to be the President and Secretary respectively of the Legal Aid Society of Palm Beach County, Inc. and executed the foregoing Amended and Restated Articles of Incorporation and acknowledged before me that they executed the same for the purposes therein expressed. IN WITNESS WHEREOF, I here �nto ama:: atWest Palm Beach, Florida this day . NOTARY PUBLIC, State of Florida at Large My Commission Expires: NOIAA► PUBLIC SLATE OF FLORIDA NT COMMISSION EXP. MR. 14,1963 5 6ONDED THRU GIMUL INS. M. ,4f - - s i 3 IN WITNESS WHEREOF, the undersigned have herein set their hands and seals this 12 day of December , 1991. LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC., a Florida not for profit corporation IL �) —K--- — ay: RICHARD J. LUBIN, President Attest:,d _� 2r ' rRT A. ERTISCH, cretary STATE OF FLORIDA COUNTY OF PALM BEACH BEFORE ME, the undersigned authority, personally appeared to me RICHARD J. LUBIN and ROBERT A. BERTISCH to me well known to be the President and Secretary respectively of the Legal Aid Society of Palm Beach County, Inc. and executed the foregoing Articles of Amendment and acknowledged before me that they executed the same for the purposes therein expressed. IN WITNESS WHEREOF, I here unto affix y hand and seal at West Palm Beach, Florida this �_ day of �, 1991. L14 -- NOTARY PUBLIC, State of Florida at Large My Commission Expires: NOTARY PUBLIC STATE RF FLORIDA NY COMMISSION EXP. HAR.24,1993 DONDEO THRII GENERAL INS. UND. M to r �r Jaa.: o: Dorney.', ..' ALIon IF.: araakstt Johnson' Pal a. 'Liao Th1a the Ijth Bay. cif'Apr1l, 1949.• Jos. D. Parish. ?r.. few@" Pals 00sch'countr. Par Lssoalatlob ORDER Or.JPPAOYAL' Thq foregbing prppojgd otYartsr of LT I AID sOCIC1I••Ol! PALD,'B'UCH COgM IDO.,'•1` having been this day pr}sentsd for,appr"l, and•it ppppsring lhat sans i♦ in proper form' j and the onjoat thereof isauthorized by the"lfw or, the state ot'Plorida,; IT Is NOW OSD—M AND ♦DJODO;D that the said proposed ahFrtar is hsrsby approTed' and ' tho' said L QL,L IID QOOICTI OF PALS BTaOH COOM, 'ISO.•. le hereby incorporated ae a oorporatlon not for profit, with #hp porsrs and privllsg*s set torth in a a' , and,. it is bsreby griniod and'rerted 'rith all •the righpo, povsrs, pririlLgea; duties; obllgatlone, rVatriotigcs.and 11altatlons oocflrrrsd and Imposed wpOp'auoA ogpporati4n� bp' ' time Ian, of aRba� ;tatt of riao"a , Bone and-OrOorea. at 'Vogt Wls Belch, 'rlorlda, thla tho 6 day pf )ky,, '15 . rirt+ :. 0 C On1l1t th oust Jae(4�k�urida, 4atabn f Dir ut„t er „� .. .. . ,Beapb OPU40. del tl�raoordsdh, 49"o ,ota2;.5 D4. N.. �ALW !acedy UAW NW4Y FL PIA !fMk May f lqa �5. laver, to- arwam ewe of Page 01A-racauo of k J. l ,. C6 YI of Cirou6t Court. 12, . Nil . Dy s Bi cfl I •• :. .; ,:. .. bow. Lar . ]1►3dE ' ,• , Pnotas b. ORLR M L AM 610 EW Or PAIN UCR• OODMTI • IMO. The uniltrrtgaad aambeve .of ;tbe Legis; A44 ComodUss of, tbs Pair $eaob Own" Mar Aseoolat"a'* pursuant to the gatbar}ty and'dlriotloA, or the said Ase000tion,.as ebovA by'e duly oertlfied bopy or.e rssoluti6c and a osrtlfloats or the Secretary at said Agscgilation , . bessto attwobed: and .wad• a pert• bersof,.•da berwbq aneoais;s ourselves togathsr roe t" . purpose at lAaarpgrwtiag legs} Aid pogl�ty of #eels Asroh Qougtj,'IAQ.,,&a. a ou paration' Aot far puaotit,' aad propose the fallawigg :aj 4" charter tlgratort 2bs:.p+u@Cor.'tbi ooi�parpwtion shell Vol Lx L. AID d00I1M1< br. rKiiM S ►C,M Cp11My;, Ilea;, aa� its' Pri,noipsl= ofr14s• shall Dw to ;hO Olt or Mast Palo oil cb, rl,u IdR, the gsnsral nature and objOot or tba 9orporation-are benevolent and oholtable, that is to say'. it As .orgaalsird.;to reader, legal aid Sksultauslk:;, if asgessary,':to all poreoas appiRariAg warthy.of suoh aid who shall"bs unable to'.proouz:4 legal asaletaAow elaawh s,wol-'to:assist persons'without weans in tba pursuit of &Ay'olwil remedy and In. the, protection or'their'persaw or property, and to promote Asasurss for lbs, pratootloo or i ladlpAt parsons. r. the FwPaa of rdtd opFporOtica "ic- yroaa�` the ti . it. 1a era shall b..fi4`ths . neq&sear . to Z aoats in equipping and,aaintaiping an offsos and paying the, eoapgaention of, on.yffsee.attsodpot.So Lip and a&elst in randsrin$ Vagal &aiiatanss ae:• • '. III. . jShe qu*llfieaiioo of �laaberi and the aaangr pts 1 l"lr:ladalerlon ehah`ba as Any og ecosi a iiiiber. my pg`�dglfted bi'a twd-third penop daelri ' to b soti.of the 'Directors at.aag.of their. as 1144. Sbb aorporatlon shall'.exist until •It.sball be dissolve;'aobprying,to"lar; Sh}.'wias and 'r"Wimnoss pf the subinribers airs as follsws L. A.. HODRI' , , Wast gals bsaab,• )1L. . ` • JaOF '0..TOH11BC1 • ;Balls. Olads, ria. IIAWOIB I IDIF lake worth, Jia.. ' '..JtB[4oID 1.: Jd00B Ialce worth, Fla. WRIL MaoII1UAX'. Italrag Beach, ]la. :. JAMFQ Q. "•90wi1I •. 'is t` Pala Beach, 'Ola.' . MAN T. B84Q[tit.. Wast P&L,Baaoh, lla. Y J.•JCpWBOW Wiet•Rals Beach, rla. AOHCA! 1: AtWISS. Vast Paws Beach Fla. BSI. g.,. IVte vast'.pala Beach, ru' ' Tba affairs of the porporation are to be gsysrped and manage0' by a Hoard of not 1ue 40 five &ane tbaq.thirtssq..who •bail be elected egooally by, the, Baa* 'County .bar Assopiation, Sha'firit,.Board of Directors 'or said: corporation.to_consigt,of tb 'i gubiorlbero hereto; as and oonetituting tbs Iwgal did "Qoaaittas of the PalR Hsaob 0ountg bas dsacciatlon, and. as say .ee three other&, to'bs,appolntsd b7 the PraalOsat of the i , . P of the "Id Board Psls beaob'Count Bar Assoolatson..•2q any and all events a.aa orlf .Of Dlrsotgre^qubali, her newborn io go$d.btagding of. the pals Beacp Qountl Sar A&ioplation... i. �. 900,'W-laws' 5!r the oorpofstion are Rc bi' sadi, _altered or. resoinded by 4 `. aajoritt iota of %be'Boarc of DirPotora. • PIIS .. ' The otflosrs of'tha society sha11 be a president, Vise Preeidant, lecr'jarF, f and Treasurer. rho ehsil be-Bleated and shell hold offlaa'until their successors; ars, elected and qualify-and have aooepted: The'highsst aaouat of lhdebtadness or liability to which the corporation my' t .at any ties spbjlat'itbelf shall be a sus equal to two-third• of the valus of the property ti cfl RueMM OX BE It REBOIAtb, by ,thr.•Pa1m each 4.0unty war. AesociatIOA, that the legal #1d Oommiitae of,t¢e Pala Beach County par'Aaeooiation Is'hsraby authors;id and diseoted to tako such step* as It shall Aees.proper to sgSablish a formal, cheritabli_and noq-profit. corporation, to be "own -as the Lmgal Aid society of Pala Beach County, pursuant ti.q ths'provieions of the Lir of the Etats of•Florida•for benevolent and charitable purpose*, ` to render leggl aid gratuitouely,, if neosesary, to all appearing rop07, of the ears and ri •ball be unable to procure legal assistance vleerhere. So aeslat psreone !without means. tm that puireuit'of- any civil rawdy'and 1n'thd protection of their piiioo cr'property, mad to promots.8saeurae for the protection of indigent persons; and BS ;! FURTHER RIEOLYED, that said ocrporation *hall b� govornsd .by a Board of Dirsotcr• of not Les than five nor. aore•than thirteen, conflating of•attornsye, bueinpeme Judges, clergy and "proaentati►es of welfare agsnoias, to be slanted by the Palm Beach Oounty liar Assoolation, the first Bwrd of Directore of said corporation'to Ccgeiet o,! the member• of the pr*sent Ligal Aid CCmaittee.of the Pals Beach Qounty Bar.As*ociatiom and ii eieny as three othirp. to bi appointed by the President of thi Afsociition,.but in all avant it majority of. said Board#hall be. "eb'sre of 'the Pala beach -Oounty Biu' Aesoolatiom; and, • BE I! FORreIM HieOLTED, that, tbe' present• Iagal Aid Ooasitte* Of this Assoclition Is directed to take all gteps.required;an4 Incidental to.oreating laid Corporation and to 4PP17 to and "Oo1va from. the OCrOmunity Ohpet of the. FalM00eachee c. any' other aBency Cr ipdiviAual finanelal aeeiet%noe dngidental•to the Operation of such legal'aid aootety, PAI]; BEACH 00ONtY BAR ABBOCIATION West Palm Beach, Florida ; I Flp"Ur CERTIFY •th►t the foregoing resolution is ••true and .902-2 at Copy -of that resolution- unanimously adopted by the Pa Is Beach County Bar Association at its' regular mon'thly'mestlng,•hold April 11th, 1949,,at West Wm Deboh, Florida. Tble,tke 1;tti day of April, 194. ' Joe. D: lkrieh, Jr..sag reter ... pal Beeo4 C. t Bar Aeeooiatioo t . i PALM BEACH. COUNTY BAR, ASSOM21ON Nest Pal Beach, Florida I WWRY'MtIFY that the following named members 4f the Pali beads county Bar Association ase the duly appointed members of the Legal Aid Ooaaittise for th's year 19491 P L. A: Moo.tey, Chairman Jack 0. Johnaon "ocii It. Lowe Jerrold F. Joepb Nell NaoNil.lan State of Florida Department of State Great Seal of the State of Florida I, Tom Adams, Secretary of State of the State of Florida, Do Hereby Certify That the following is a true and correct copy of Original: charter LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC. filed in the Circuit Court of Palm Beach County, Florida on the 6th day of May, A. D., 1949, coming in by Amendment under the same name LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC., a corporation not for profit, organized and exist- ing under the Laws of the State of Florida, filed on the 18th day of November, A. D., 1970, as shown by the records of this office, Given under my hand and the Great Seal of the State of Florida at Tallahassee, the Capital, this the 23rd day of November, A.D. 19 70. s/ Tom Adams Secretary of State Great Seal of the State of Florida 00 W AFFIDAVIT OF PRESIDENT OF LEGAL AID SOCIETYOFPALM BEACH COUNTY, INC. TO: HONORABLE TOM ADAMS SECRETARY OF STATE TALLAHASSEE, FLORIDA I, the President of Legal Aid Society of Palm Beach County, Inc., a Florida corporation not for profit, do hereby certify that the document attached hereto as Exhibit A is a certified copy of the Charter of said corporation. IN WITNESS WHEREOF, I, the undersigned President, have hereunto set my hand and seal this„ day of ,1970. I. C. Smith President STATE OF FLORIDA ) SS. COUNTY OF PALM BEACH) SUBSCRIBED and sworn to before me, the undersigned authority, this 4th day of November 1970 (NOTARIAL SEAL) Marjorie J. Kelly Notary Public in and for the County and State Aforesaid My Commission Expires: Notary Public, State of Florida at large My Commission expires Jan. 8, 1974 FIRST AMENDMENT TO THE CHARTER OF LEGAL AID SOCIETY OF PALM, BEACH COUNTY. INC. WHEREAS, The Board of Directors of Legal Aid Society of Palm Beach County, Inc., a Florida corporation not for profit approved by the Circuit Judge in Palm Beach County, Florida, on May 6, 1949, has approved, subject to approval thereof by the Secretary of State of the State of Florida, amending its Charter as hereinafter provided: NOW THEREFORE, it is provided that such Charter be amended by adding thereto the following: XI. Upon dissolution of this corporation, all of its remain- ing assets, after payment of all costs and expenses of such dissolution, shall be distributable to organizations which have qualified for exempt- ion under Section 501 (c)(3) of the Internal Revenue Code, or to the Federal Government,or to the State or local governments for a public purpose, and none of the assets shall be distributable to any member, director, officer or trustee of this organization. IN WITNESS WHEREOF, we, the undersigned, President and Secretary; have hereunto set our hands and seals this 4th da of November 1970. . ATTEST: By; Ballard R. Donnell. BALLARD R. DONNELL SECRETARY (SEAL) LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC. B ... . I. C. SMITH, PRESIDENT 0 ti STATE OF FLORIDA ) SS. COUN'T'Y OF PALM BEACH) SUBSCRIBED and sworn to before me, the undersigned authority, this 4th Y �da of November 1970. ..._..___m.,. ...�............._w (NOTARIAL SEAL) Marjorie J. Kelly Notary Public in and for the County and State Aforesaid My Commission Expires: Notary Public, State of Florida at Large My Commission expires Jan. 8, 1974 State of Florida Department of State Great Seal of the State of Florida I, Tom Adams, Secretary of State of the State of Florida, Do Hereby Certify That the following is a true and correct copy of Original charter LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC_ filed in the Circuit Court of Palm Beach County, Florida on the 6th day of May, A. D., 1949, coming in by Amendment under the same name LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC., a corporation not for profit, organized and exist- ing under the Laws of the State of Florida, filed on the 18th day of November, A. D., 1970, as shown by the records of this office, Given under my hand and the Great Seal of the State of Florida at Tallahassee, the Capital, this the 23rd day of November, A.D. 19 70. Great Seal of the State of Florida s/ Tom Adams Secretary of State AFFIDAVIT OF PRESIDENT OF LEGAL AID SOCIETY OF PALM BEACH COUNTYL INC, To: HONORABLE TOM ADAMS SECRETARY OF STATE TALLAHASSEE, FLORIDA I, the President of Legal Aid Society of Palm Beach County, Inc., a Florida corporation not for profit, do hzreby certify that the document attached hereto as Exhibit A is a certified copy of the Charter of said corporation. IN WITNESS WHEREOF, I, the undersigned President, have hereunto set my hand and seal this_ 4±h _ day I. C. Smith President STATE OF FLORIDA ) SS. COUNTY OF PALM BEACH) SUBSCRIBED and sworn to before me, the undersigned authority, this 4th day of November 1970 (NOTARIAL SEAL) Marjorie J. Kelly Notary Public in and for the County and State Aforesaid My Commission Expires: Notary Public, State of Florida at large My Commission expires Jan. $, 1974 FIRST AMENDMENT TO THE CHARTER OF LEGAL AID SOCIETY OF PALM BEACH COUNTYINC. WHEREAS, The Board of Directors of Legal Aid Society of Palm Beach County, Inc., a Florida corporation not for profit approved by the Circuit Judge in Palm Beach County, Florida, on May 6, 1949, has approved, subject to approval thereof by the Secretary of State of the State of Florida, amending its Charter as hereinafter provided: NOW THEREFORE, it is provided that such Charter be amended by adding thereto the following: XI. Upon dissolution of this corporation, all of its remain- ing assets, after payment of all costs and expenses of such dissolution, shall be distributable to organizations which have qualified for exempt- ion under Section 501 (c)(3) of the Internal Revenue Code, or to the Federal Government,or to the State or local governments for a public purpose, and none of the assets shall be distributable to any member, director, officer or trustee of this organization. IN WITNESS WHEREOF, we, the undersigned, President and Secretary, have hereunto set our hands and seals this 4th day of November , 1970. ATTEST: By: Ballard R. Donnell BALLARD R. DONNELL SECRETARY (SEAL) LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC. gy, _I. C. Smith I. C. SMITH, PRESIDENT STATE OF FLORIDA SS. COUNTY OF PALM BEACH) I SUBSCRIBED and sworn to before me, the undersigned authority, this 4th —day of November -1 1970. (NOTARIAL SEAL) Marjorie J. Kelly Notary Public in and for the County and State Aforesaid My Commission Expires: Notary Public, State of Florida at Large My Commission expires Jan. 8, 1974 I ROBE$T O. ROGEBs ATTOBNSY THE 400 BUIL.�ING 400 ROYAL PALM WAY PALU BnAcH, BLoluD.d 33490 TELEPHONE 833-4595 October 14, 1970 Ballard R. Donnell, Esq. Legal Aid Society of Palm Beach County, Inc. . 506 Citizens Building West Palm Beach, Florida Dear Mr. Donnell: Enclosed herewith Is a completed Exemption Application, Form 1023, for the Legal Aid Society. The various exhibits referred to in the attach- ment to the Form 1023, as previously provided by you, are not enclosed with the exception of Exhibit B, a proposed charter amendment. As you may recall, it is necessary that the corporate charter provide for disposition of the assets to an exempt organization upon its disso- lution. The current charter of the Legal Aid Society does not meet this standard Imposed by the regulations. Accordingly, it will be necessary that the corporate charter be amended. In the meantime, however, it is suggested that the Farm 1023 be filed with a request that the Internal Revgnue Service make its deter- mination subject to proper amendment being made in the future, in view of the complexities involved in obtaining such an amendment. I have also included a Statement that the Legal Aid Society is not a "private foundation" as defined in the Code. The Tax Reform Act has imposed stricter requirements on organizations that are "private foundations" or fail to state and show they are not. This Statement and the Form 1023 will serve to notify the Service as to the nonprivate foundation status of the Legal Aid Society. If you have no objection to the contents of the form nor to the language of the proposed charter amendment, please see that the Form 1023, as well as the enclosed Power of Attorney, are properly executed, impressed with the corporate seal, and returned to me for filing with the Internal Revenue Ballard R. Donnell, Esq. Page 2 October 14, 1970 Service. Also, please see that the Statement is executed where indicated and returned with the other documents. ROR:clt Enclosures as stated *AMENDED AND RESTATED BYLAWS OF LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC. (A CORPORATION NOT FOR PROFIT) ARTICLE I NAME, OBJECT, AND ORGANIZATION Section 1. NAME: The name of this Corporation is the LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC. Section 2. OBJECTS: The general nature, objects and purposes of this Corporation are: To provide or help provide legal services for economically or otherwise disadvantaged persons and groups in Palm Beach County, Florida; To promote compliance with the fulfillment of the attorney's Rules of Professional Conduct by soliciting and encouraging the support of local attorneys; To ensure that no qualified applicant will be denied legal counsel and/or representation in civil legal matters solely because of inability to pay for such services; To establish, conduct, manage, promote, and otherwise support projects which will increase community understanding of individual legal rights, remedies, and responsibilities, and to publicize the availability of legal services by any and all methods consistent with high ethical standards of the legal profession; To provide or help provide legal assistance to non-profit 501(c)(3) organizations in Palm Beach County, Florida, which primarily serve the low-income community; Amends revised Bylaws dated Jul 20, 1978 and subsequent amendments dated February 28, 1979, May 21, 1981, December 12, 1991 April 27, 1998, August 25, 1999 September 29 1999. November 14 2001, September 15, 2008, February 22, M11, October 30, 20f2, May 24, 2016, May 26, 2620, and October 27, X020. 1178 To accept and seek financial and other forms of support from agencies of Federal, State, and/or Local Governments, or from corporations, trusts, partnerships, or persons, in order to carry- out the objects of the Corporation; To have and exercise all of the corporate powers enumerated in Section 617.021, Florida Statutes, and all other powers consistent therewith, including all powers implicit in the objects outlined in this article, necessary and proper to the operation of this Corporation. Section 3. POWERS: The Corporation shall have the power, either directly or indirectly, either alone or in conjunction or cooperation with others, to do any and all lawful acts and things to engage in any and all lawful activities which may be necessary, or convenient to effect any or all of the objects for which the Corporation is organized, and to aid or assist other organizations whose activities are such as to further accomplish, foster, or attain any of such purposes. The powers of the Corporation shall include, but not be limited to, the acceptance of contributions from both the public and private sectors, whether financial or in-kind contributions. Notwithstanding anything herein to the contrary, the Corporation shall exercise its powers only in furtherance of exempt purposes as such terms are defined in Section [501(c)(3)] of the Code and the regulations promulgated thereunder. Section 4. ORGANIZATION: This organization is a non-profit, non-political and nonpartisan corporation existing under and by virtue of a Charter granted by the Circuit Court in and for Palm Beach County, Florida on May 6, 1949 and incorporated under the laws of the State of Florida on November 4, 1970. Section 5. NON-PROFIT STATUS: The Corporation is a non-profit organization, and no part of the net earnings of the Corporation shall inure to the benefit of or be distributable to, any Director, officer, or other private person, except that the Corporation shall be authorized and 2 1179 empowered to pay reasonable compensation for services rendered and to make payments and distributions in furtherance of the purposes set forth in the Articles of Incorporation and these Bylaws. In the event of any liquidation or dissolution of the Corporation, the Board of Directors shall distribute all of the assets of the Corporation for one or more exempt purposes within the meaning of Section 501(c)(3) of the Code, or to the United States of America, any State thereof, or any political subdivision of any State, for exclusively public purposes, as the Board of Directors of the Corporation shall determine. ARTICLE II MEMBERSHIP The Legal Aid Society of Palm Beach County, Inc., is not a membership organization. ARTICLE III DIRECTORS Section 1. QUALIFICATIONS: Directors shall be selected from: a. Attorneys practicing in Palm Beach County who are in good standing with the Florida Bar, b. Such other persons and organizations who are interested in the delivery of civil legal assistance to economically, or otherwise disadvantaged persons, and who are residents of or have their principal offices in Palm Beach County, Florida. Section 2. BOARD OF DIRECTORS: The property, affairs and business of the Corporation shall be managed and its corporate powers exercised by a board of not more than thirty-five (35) Directors. A majority of the Directors shall practice law in Palm Beach County and at least four (4) directors shall be non -attorneys. Of the total board, at least one (1) director shall reside or have his or her principal office in each of the following areas: South County area (south 3 1180 of Lantana Road), North County area (north of Blue Heron Boulevard) and the West County area (west of State Road #7 [441]). The board shall include one (1) member with substantial financial management and/or accounting experience. One (1) of the thirty-five (35) directors shall include the Executive Director of the Palm Beach County Bar Association or a member of its Board of Directors. In essence, the composition of the Board should be representative of the diverse segments of the Palm Beach County Community. Section 3. ELECTION: Directors shall be elected by a majority vote of the Board of Directors of the Corporation upon recommendation of the Board's Nominating Committee. Nominations may be submitted by any person qualified for election as a Director, in accordance with the provisions of Section 1 of this Article. Section 4. TERM OF OFFICE: The term of office for each Director shall be three (3) years, or until his or her successor is elected or appointed. However, if a Director becomes an officer at any time during his or her term, that Director's term shall be tolled during the time they serve as an officer. Directors can serve for three (3) consecutive terms and shall be eligible to reapply for a Director position after having been off the board for a minimum of one year. Upon recommendation of the Nominating Committee, the Board of Directors by a two-thirds (2/3) vote of those present may waive the term limit requirement for a board member. Section 5. DUTIES OF THE BOARD OF DIRECTORS: The Board of Directors shall have control and general management of the affairs and business of the Corporation, shall determine the policies of the Corporation, and shall adopt rules, regulations and guidelines which it deems necessary and proper to carry out its policies and its duties, but not inconsistent with these Bylaws, nor with the Laws of the State of Florida. The Board has the fiduciary responsibility for the Corporation, and its duties include, but are not limited to, the hiring of the Executive Director, 4 1181 election and removal of officers, approval of financial policies, approval of the annual budget, approval of the selection of the independent auditor and review and acceptance of the annual audit, the appointment of legal counsel and the meeting of the required conflict of interest standards. In particular the Board of Directors shall: a. Promulgate and publicize clear standards and procedures for determining the financial eligibility of applicants, taking into account relevant factors such as net income, assets, obligations, family size, health, cost of living standards, and the availability of private attorneys to handle the matter; b. Not interfere in any way with the attorney in carrying out his or her professional responsibility to clients as established in the Rules of Professional Conduct of the Florida Bar; C. Impose no arbitrary restrictions that limit civil legal assistance either by forum or parties, although the Board may determine, because of limited resources and personnel, to implement a rational system of case load control; d. Carry out those other functions as are contained elsewhere in these Bylaws. Section 6. DIRECTORS MEETINGS: Meetings of the Board of Directors shall be held at least six (6) times per year. Special meetings of the Board of Directors may be called by the President or Executive Director at any time and shall be called by the President, Executive Director, or Secretary upon the written request of five (5) Directors. Section 7. NOTICE OF MEETINGS: Notice of regular meetings shall be given by regular mail, postage prepaid to the post office address of each Director, or by email via an email address provided by the Director, or by other such method as the Board may determine from time to time, at least three (3) days before the date designated for such meeting. Special meeting notices 5 1182 shall be given by regular mail, postage prepaid to the post office address of each Director at least two (2) days before the date designated for such meeting. The notice shall specify the time and place of such meeting, and the business to be brought before the meeting. A statement contained in the minutes of any meeting of the Directors over the signature of the Secretary to the effect that due notice of such meeting has been given shall be conclusive evidence that proper notice of such meeting has been given in one of the ways provided herein. Any meeting of the Board of Directors may be held by means of a telephone conference circuit, and connection to such circuit shall constitute attendance at such meeting. Section 8. QUORUM: The presence of twelve (12) of the members of the Board of Directors then serving shall be necessary at any meeting of the Board to constitute a quorum to transact business. The act of a majority of Directors present at a meeting when a quorum is present shall be the act of the Board of Directors. In the absence of a quorum, a majority of the Directors present may adjourn any meeting from time to time until there is a quorum. Notice of any adjourned meeting need not be given. The Directors shall act only as a Board and the individual Directors shall have no power as such. Section 9. VOTING: At all meetings of the Board of Directors each director shall have one (1) vote on each issue voted upon. Unless otherwise provided by the Bylaws, or by resolution of the Board, all elections shall be held and all questions decided by a majority vote of the directors present. Section 10. RESIGNATION: Any Director of the Corporation may resign at any time by giving written notice to the Board of Directors, the President, or the Secretary of the Corporation. The resignation of any Director shall take effect at the time specified therein; and, unless otherwise specified therein, the acceptance of such resignation shall not be necessary to make it effective. 6 1183 Section 11. VACANCIES: Vacancies on the Board occurring between annual elections shall be filled for the unexpired portion of the teen by election by the Board. Section 12. REMOVAL OF DIRECTORS AND OFFICERS: Any Director or officer may be removed from office or from the Board by the affirmative vote of a majority of the directors wherever, in the Board's judgment, the best interests of the Corporation would be served thereby. Any such director or officer proposed to be removed shall be entitled to at least five (5) days notice in writing by mail of the meeting at which such removal is to be voted upon and shall be entitled to appear before and be heard at such meeting, at which time said director may present witnesses on his or her behalf and present defenses as he or she shall deem advisable. Failure to attend three (3) consecutive meetings or 50% of meetings within any fiscal year, absent extraordinary circumstances as determined by the Board, shall constitute cause for removal of a Director. Section 13. STANDING COMMITTEES: The Board of Directors shall establish such committees as may be needed to run the corporation. Such standing committees shall be as follows: A. The Executive Committee. The Executive Committee shall be composed of all officers and other Board members deemed necessary by the President, who shall have and exercise the authority of the Board of Directors, in the management of the business of the Corporation between meetings of the board and subject to the limitations imposed by the Florida Not -for -Profit Corporation Act; B. The Audit Committee shall be responsible for selecting the agency's auditor and shall meet a minimum of one time per year to review the audit and present it to the full board for review and acceptance. One member of the Audit Committee shall not be a member of the Board of Directors. 7 1184 C. The Finance Committee shall be chaired by the Treasurer and responsible for the financial operation and continued solvency of the Corporation; D. Personnel Committee, which shall include, but not be limited to, reviewing and approving personnel policies and changes to existing policies and reviewing all personnel related materials so as to assure the Corporation's compliance with all state and federal labor and employment laws; E. Nominating Committee, which shall review all applications for nomination of individuals to the Board of Directors and make recommendations to the Board of such persons as the majority of the Nominating Committee selects and present a slate of officers to the Board of Directors at its annual meeting; F. Resource Development Committee, which shall oversee all fundraising activities, resource and asset procurement, and work directly with the Development Director and staff; and G. Long -Term Planning Committee, which shall review and update the five year plan outlining the goals and objectives of the Corporation; the projected capital, personnel and equipment related long term needs of the Corporation; and how those goals and objectives will be achieved for the continued fiscal viability of the Corporation. In order that no action is taken without the acknowledgment of the Board of Directors, all actions of the committees shall be deemed recommendations only and shall take effect only upon the approval of a majority of members of the Board of Directors at any meeting where such recommendations are presented. The Board of Directors shall have the authority to establish such other committees which they deem necessary for the successful operation of the corporation. All committee members and 8 1185 their chairpersons shall be appointed by the President of the Board of Directors following each annual meeting and thereafter as the President or a majority of the Board of Directors deems fit. Section 14. GENERAL STANDARDS FOR DIRECTORS: A Director shall discharge his or her duties as a Director, including his or her duties as a member of a committee: (a) in good faith; (b) with the care an ordinarily prudent person in a like position would exercise under similar circumstances; and (c) in a manner he or she reasonably believes to be in the best interest of the Corporation. In discharging his or her duties, a Director may rely on information, opinions, reports, or statements, including financial statements and other financial data, if prepared or presented by (a) one or more officers or employees of the Corporation whom the Director reasonably believes to be reliable and competent in the matters presented; (b) legal counsel, public accountants, or other persons as to matters the director reasonably believes are within the person's professional or expert competence; or (c) a committee of the Board of Directors of which he or she is not a member if the Director reasonably believes the committee merits confidence. A Director is not acting in good faith if he or she has knowledge concerning the matter in question that makes reliance otherwise permitted unwarranted. A Director is not liable for any action taken as a Director, or any failure to take any action, if he or she performed the duties of his or her office in compliance with this section. Section 15. DIRECTOR CONFLICTS OF INTEREST: No contract or other transaction between the Corporation and one or more of its Directors or any other corporation, firm, association, or entity in which one or more of its Directors are directors or officers or are financially interested, shall be either void or voidable because of such relationship or interest, because such Director or Directors are present at the meeting of the Board of Directors or a committee thereof 9 1186 which authorizes, approves, or ratifies such contract or transaction, or because his or her or their vote(s) are counted for such purpose, if (a) the fact of such relationship or interest is disclosed or known to the Board of Directors or committee which authorizes, approves, or ratifies the contract by a vote or consents of such interested Directors; (b) the fact of such relationship or interest is disclosed or known to the directors entitled to vote on such contract or transaction, if any, and they authorize, approve, or ratify if by vote or written consent; or (c) the contract or transaction is fair and reasonable to the Corporation at the time it is authorized by the board. Common or interested Directors may be counted in determining the presence of a quorum at a meeting of the Board of Directors or a committee thereof which authorizes, approves, or ratifies such contract or transaction. Section 16. BOARD OF TRUSTEES: The Corporation shall have a Board of Trustees consisting of all past Board Chairs and those Directors of the Corporation who have been elected to the Board of Trustees by the Board of Directors. The functions of the Trustees shall be to assist in such business of the Corporation as requested by the President of the Board of Directors and/or the Board of Directors and to support the events and policies of the Corporation. The President of the Board of Directors shall also serve as the presiding officer over the Board of Trustees. The Board of Trustees shall serve in an advisory capacity only and shall have no fiduciary powers, voting or other rights of a Director. The Board of Directors shall have the power to remove any Trustee from the Board of Trustees for any reason. The Trustees shall be expected to attend the Corporation's Annual Meeting. 10 1187 ARTICLE IV WAIVER OF NOTICE; UNANIMOUS CONSENT Section 1. WAIVER OF NOTICE: Notice of the time, place and purpose of any meeting of the Board of Directors of the Corporation may be waived in writing by any Director of the Corporation either before or after such meeting; and attendance in person at a meeting of the Board of Directors shall be equivalent to having waived notice thereof. Section 2. UNANIMOUS CONSENT OF DIRECTORS: Insofar as permitted by law and unless otherwise restricted by the Articles of Incorporation or these Bylaws, any action required or permitted to be taken at any meeting of the Board of Directors of the Corporation may be taken without a meeting if prior to such action a written consent thereto is signed by all Directors and such written consent is filed with the records of the Corporation. ARTICLE V OFFICERS Section 1. OFFICERS: The officers of this Corporation shall be Directors and shall consist of the President, Immediate Past President, Vice President, Secretary, and Treasurer and such other officers and employees as the Board may deem necessary. Section 2. ELECTION OF OFFICERS: The Board of Directors, at its annual meeting, shall elect a President, a Vice President, a Secretary and a Treasurer from a slate of candidates offered by the Board's Nominating Committee. Nominations shall also be taken from the floor. The Board shall have the power to appoint such other officers as it deems necessary and fill any vacancy in any office, occurring for any reason whatsoever. The annual meeting to elect officers of the Board of Directors shall take place the last month of the fiscal year or at such other time as the Board of Directors designates. 11 1188 Section 3. TERM OF OFFICE: Officers shall serve one (1) year terms and may be re- elected for additional terms of office so long as they do not serve the same office more than two (2) consecutive one (1) year terms, unless otherwise approved by a two-thirds (2/3) vote of the Board of Directors. Officers can be removed as provided in Article Ill, Section 12. Section 4. PRESIDENT: The President, or his or her designee, shall preside at all meetings of the Board of Directors and shall be the administrative head of this organization, exercising the general supervision of its affairs. The President shall act as the Corporations' spokesperson and representative in any matters pertaining to the activities of the Corporation. He or she shall enforce the Bylaws and perform all duties incident to the position and office, and which are required by law. The President may delegate to the Executive Director whichever of such duties are deemed suitable. Section 5. IMMEDIATE PAST PRESIDENT: The Immediate Past President shall give counsel and advice to the President and Board of Directors and serve as a member of the Executive Committee. Section 6. VICE PRESIDENT: During the absence or inability of the President to render and perform his or her duties or exercise said powers, as set forth in these Bylaws, the Vice President shall have all the powers and be subject to all the responsibility herein given to and imposed upon the President. Section 7. SECRETARY: The Secretary shall be responsible for seeing the minutes of the meetings of the Board of Directors are kept and all notices of the Corporation are served. The Secretary shall be the custodian of the records and of the seal, affix the seal when required, shall present to the Board of Directors at its meetings all communications addressed to the Corporation, and shall attend to all correspondence and perform all of the duties incident to the office of 12 1189 Secretary. The Executive Director employed by this Corporation shall assist the Secretary with all of the aforesaid duties. Section 8. TREASURER: The Treasurer shall work with the Executive Director and other appropriate staff to develop and monitor financial policies and procedures and the annual budget and to perform such other duties as are prescribed by the Board of Directors or President. ARTICLE VI EXECUTIVE DIRECTOR Section 1. EXECUTIVE DIRECTOR: The Board of Directors is authorized and empowered to employ an Executive Director, who shall be an attorney who is licensed to practice law in the State of Florida and who has practiced law in any state for a minimum of five (5) years and who shall carry out the duties herein prescribed. The Board of Directors shall pay the Executive Director such reasonable compensation as it, within its discretion, deems advisable. Section 2. DUTIES: The Executive Director shall perform the following duties: a. Assist all officers of the Corporation, and shall attend all meetings of the Board of Directors, and shall perform such duties as the President of the Corporation may delegate to him or her. b. Notify all parties concerned of meetings of the Board of Directors in writing, as prescribed elsewhere in these Bylaws. C. Hire and supervise all staff personnel for the purpose of providing legal assistance to the qualified applicants. d. Manage and direct all offices which the Corporation may open and utilize for the screening of legal aid applicants and the dispensing of legal assistance to the qualified applicants. 13 1190 e. Serve as publicity representative of the Corporation, and shall be charged with securing suitable publicity concerning the activities of the Corporation and the availability of legal services to be provided by the Corporation to qualified applicants. f. It shall be the policy of the Corporation not to: 1. Provide legal assistance with respect to any case generating an attorney fee from the opposing parry where a private attorney is willing to represent that individual. However, in the event two (2) private attorneys reject the individual's case, or in those circumstances when the case is not of the type taken by private attorneys in the community, then the Corporation can accept representation and attorney's fees; 2. Provide criminal legal defense with respect to individuals charged with crimes. g. Ensure that applicants who are not eligible for legal assistance by this Corporation are informed of the Lawyer Referral Service of the Palm Beach County Bar Association. The Corporation shall cooperate with the Palm Beach County Bar Association in the promotion and referral of clients to the Lawyer Referral Service. h. Ensure that no recipient of legal services from the Corporation shall be charged any fee for the services provided, except that recipients are encouraged to absorb expenses incident to the conduct of their legal affairs, including but not limited to, court costs, service of process costs, discovery costs, and long distance telephone expenses. 14 1191 Manage and direct the screening of applicants for legal aid services in compliance with the client eligibility guidelines, rules, and regulations established by the Board of Directors. j. Ensure the monitoring and evaluation of the caseload of staff attorneys to ensure that qualified applicants receive quality legal assistance and maintain a pro bono program to handle eligible clients whose legal problems cannot be handled by staff attorneys. k. Ensure the maintenance of the records of the legal services provided by the Corporation which indicates the number of persons interviewed; final disposition of each client, whether handled by a staff attorney or referred to a pro bono attorney, and shall submit a monthly report in writing to the Board of Directors covering the information. Progress dockets shall be maintained on all active cases, and will include an application form signed by the client for legal aid services. ARTICLE VII REMUNERATION AND ATTORNEY'S FEES Section 1. The directors and officers of this Corporation shall perform their duties without compensation or remuneration for their services as such. Section 2. The Executive Director and all other staff personnel shall receive reasonable compensation for their services to be paid by the Corporation. Section 3. Neither the Executive Director, staff attorneys, nor any other staff person shall at any time charge a legal aid client a fee for services rendered to the client. This shall not be construed to inhibit or prohibit staff attorneys from requesting that a Court award attorney's fees 15 1192 in a given legal aid case, but said award shall be handled in accordance with the provisions of Section 5 of this Article. Section 4. Attorneys who practice law in Palm Beach County shall donate their services or make a financial contribution to the Corporation as a public service to economically, or otherwise disadvantaged persons residing in or having legal affairs pending in Palm Beach County. Attorneys shall not charge legal aid clients for legal services. This shall not be construed to inhibit or prohibit attorneys from requesting that a Court award attorney's fees in a given legal aid case, but said award shall be handled in accordance with the provisions of Section 5 of this Article. Section 5. In any cause undertaken by this Corporation on behalf of a client for legal aid services, where an award is made by the Court requiring a party other than the legal aid client to pay attorney's fees, the legal aid staff attorney shall immediately upon collection of said fee, remit it to the Executive Director of the Corporation who shall deposit such monies to the general credit of the Corporation for the furtherance of its work, When an attorney from the private bar collects a court awarded fee, he or she, shall be entitled to keep the fee, however, he or she shall notify the Legal Aid Society's office upon receipt of the fee. Upon collection of a fee for such a case, the private attorney shall not be given credit for representing a legal aid client, unless said fee is returned to the Corporation. Section 6. Nothing herein shall prohibit a Legal Aid attorney, whether staff attorney or pro bono attorney, from encouraging reimbursement for expenses incident to litigation such as court costs, service of process costs, and discovery costs from the legal aid client on a voluntary basis. 16 1193 ARTICLE VIII LOANS TO DIRECTORS AND OFFICERS Loans may not be made by the Corporation to its Directors or officers, or to any other corporation, firm association, or other entity in which one or more of its Directors, officers, or employees is a director, officer or employee or holds a substantial financial interest. A loan made in violation of this section is a violation of the duty to the Corporation of the Directors or officers authorizing it or participating in it, but the obligation of the borrower with respect to the loan may not be affected thereby. ARTICLE IX INDEMNIFICATION The Corporation will, pursuant to Section 617.0831 of the Florida Not -For -Profit Corporation Act or any successor indemnification provision, and to the extent legally permissible and only to the extent that the status of the Corporation as a corporation exempt under Section 501(c)(3) of the Code is not affected thereby, indemnify any person who was or is a party or is threatened to be made a party to any threatened, pending or completed action, suit or proceeding, whether civil, criminal, administrative or investigative by reason of the fact that he or she is or was a Director, committee members, officer, employee or agent of the Corporation (or is or was serving at the request of the Corporation as a trustee, director, officer, partner, employee or agent of another corporation, partnership, joint venture, trust or other enterprise), against all liabilities and expenses (including attorneys' fees), judgments, penalties, fines, settlements and reasonable expenses actually incurred by the person in connection with any such action, suit or proceeding. Expenses, including counsel fees, reasonably incurred by any such Director, committee members, officer, employee or agent in connection with the defense or disposition of any such action, suit or other 17 1194 proceeding may be paid from time to time by the Corporation in advance of the final disposition thereof upon receipt of an undertaking by such Director, committee members, officer, agent or employee to repay the amounts so paid to the Corporation if it is ultimately determined that indemnification is not authorized hereunder. The right of indemnification hereby provided shall not be exclusive of or affect any other rights to which any Director, committee members, officer, employee or agent may be entitled. Nothing contained herein shall affect any rights to indemnification to which corporate personnel other than Directors or officers may be entitled by contract or otherwise under law. As used in this paragraph, the terms "Director" and "officer" include their respective heirs, executors and administrators, and a "disinterested" director is one against whom in such capacity the proceeding in question or another proceeding of the same or similar grounds is not then pending. The Board of Directors of the Corporation may authorize the Corporation to purchase and maintain insurance on behalf of any person who is or was a Director, committee members, officer, employee or agent of the Corporation, or is or was serving at the request of the Corporation as a trustee, director, officer, partner, employee or agent of another foreign or domestic corporation, partnership, joint venture, trust or other enterprise, against any liability asserted against such person and incurred by such person in any such capacity or arising out of his or her status as such. No Director or officer of the Corporation shall be liable to the Corporation for monetary damages for breach of fiduciary duty as a Director or officer, except to the extent such exemption from liability or limitation thereof is not permitted under the Florida Statutes as the same exist or may hereafter be amended. As used in this paragraph, the terms "Director" and "officer" include their respective heirs, executors and administrators. 18 1195 ARTICLE X FISCAL YEAR The Fiscal Year of the Corporation shall commence on the first day of October and end on the last day of September. ARTICLE XI RULES OF ORDER "ROBERT'S RULES OF ORDER" latest revised edition, shall be parliamentary authority for all meetings and matters not specifically covered by these Bylaws. ARTICLE XII SEAL The seal of the Corporation shall contain the words: LEGAL AID SOCIETY OF PALM BEACH COUNTY, INCORPORATED FLORIDA 1949. The words shall be suitably arranged upon a circular seal, as prescribed by law, and said seal shall be in the charge of the Secretary. ARTICLE XIII AMENDMENTS TO BYLAWS The Board of Directors may make, amend, alter, revise, or rescind these Bylaws, from time to time, in whole or in part, by a majority vote of the Board of Directors of the Corporation present at any meeting of the Board duly called and convened, at which a quorum is present. [See Next Page for Signatures] 19 1196 We the undersigned do hereby certify that the foregoing AMENDED and RESTATED BYLAWS were duly adopted by the Corporation at a meeting duly held and called on the day of October 27, 2020. LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC. By: MICHELLE R. SUSKAUER, President Attest: ROBERT A. BERTISCH, Executive Director (SEAL) 20 1197 PUBLIC DISCLOSURE COPY ( Not for IRS Filing ) 1198 PUBLIC DISCLOSURE COPY — STATE REGISTRATION NO. CH187 Form 990 Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) ON1e No t5545-0047 2020 County, Inc. L) Department of the Treasury Internal Revenue Service ► Do not enter social security numbers on this form as it may be made public. No, Go to www.irs.gov/Form990 for instructions and the latest information. Doing business as nidal return Number and street (or P.O. box if mail is not delivered to street address) Open to Public Inspection A For the 2020 calendar year, or tax year beginning OCT 1, 2020 and ending SEP 30 , 2021 B cheek if C Name of organization D Employer identification number I bl app ca e. Legal Aid Society of Palm Beach Briefly describe the organization's mission or most significant activities: To provide Address change County, Inc. L) �Nhange 59-6046994 Doing business as nidal return Number and street (or P.O. box if mail is not delivered to street address) Room/suite E Telephone number [::]return/423 Fern Street 200 ( 561) 655-8944 termin- ated City or town, state or province, country, and ZIP or foreign postal code G Gross receipts $ 13,770,392. �re uended West Palm Beach, FL 33401 H(a) Is this a group return for subordinates?DYes X No Ao plica- FNameandaddressofprincipalofficer:Robert A. Bertisch, Esq. pending same as C above H(b) Are all subordinates included? E]Yes = No If "No," attach a list. See instructions H c Group exemption number ► Tax-exempt status: EXI 501 (c)(3) 501 c insert no. 4947(a)(1) or 527 J Website: 10o, www. le alaid be . or K Form of organization: X Corporation = Trust = Association = Other ► L Year of formation: 19 7 01 M State of legal domicile: FL Part l`I Summary rare n -I orgnature miocK Under penalties of perjury, I dec e t�I h e e mined is ree rn, Inclu -g accompanying schedules and statements, and to the best of my knowledge and belief, it is true.._ r.nrract_ and cmmnlete_ D`.IarlSnn nrp fa ar t1h nff,ficar hacerl nn all infnrmatinn of Whirh nrpnarpr hac ami knnwlarina Sign 9 1 Briefly describe the organization's mission or most significant activities: To provide high quality civil L) Director legal advice, representation, and education to the disadvantaged of E2 Check this box ► [:::]if the organization discontinued its operations or disposed of more than 25% of its net assets. 0 3 Number of voting members of the governing body (Part VI, line 1a) ......................... .. PaidScott 3 34 4 34 0 4 Number of independent voting members of the governing body (Part VI, line 1b) ca-- 5 Total number of individuals employed in calendar year 2020 (Part V, line 2a) 5 -- 15 5 6 ................................................ Total number of volunteers (estimate if necessary) ..... West Palm Beach, FL 33407 6 1300 7a 0. 7 a Total unrelated business revenue from Part VIII, column (C), line 12 b Net unrelated business taxable income from Form 990-T, Part I, line 11 7b 0 . Prior Year Current Year 9, 931 , 270 13,537 , 269 m 8 Contributions and grants (Part VIII, line 1 h) 253 , 336 . 185 , 693 . r_ 9 Program service revenue (Part VIII, line 2g) 'y 10 ...... ......... . . Investment income (Part VIII, column (A), lines 3, 4, and 7d) ....................................... 38 , 047. 21 , 703 . cc 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 1 Oc, and 11 e)..... ................... —33 , 781 . -46 , 191 . 12 Total revenue - add lines 8 through 11 must equal Part VIII, column (A), line 12 ......... 10,188 , 872 . 13, 698 , 474 . 13 Grants and similar amounts paid (Part IX, column (A), lines 1-3) 190 , 755 . 1, 021 , 026 . 14 Benefits paid to or for members (Part IX, column (A), line 4) 0 . 0 . 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) 9, 051 10 5 . 9, 796 ,114 . CD ......... 16a Professional fundraising fees (Part IX, column (A), line 11 e) . 0 . 0 . a b Total fundraising expenses (Part IX, column (D), line 25) ► 255 , 035. 1,433 , 809 . 1 , 461 , 472 . Lu 17 Other expenses (Part IX, column (A), lines 11a-11 d, 11f -24e) ................ ... ......... . 18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) ..................... 10,675 , 669. 12, 278 , 612 . —486 , 797 . 1 , 419 , 862 . 19 Revenue less expenses. Subtract line 18 from line 12 ................................................ o Be innin of Current Year End of Year 9 , 0 4 3 , 816 . N 20 Total assets (Part X, line 16)8,336,899. a 21 Total liabilities (Part X, line 26) .............................................. ................................... 4,578,849. 3,781,487. Z 22 Net assets or fund balances. Subtract line 21 from line 20 .......................................... 3 , 7 5,262,329 . rare n -I orgnature miocK Under penalties of perjury, I dec e t�I h e e mined is ree rn, Inclu -g accompanying schedules and statements, and to the best of my knowledge and belief, it is true.._ r.nrract_ and cmmnlete_ D`.IarlSnn nrp fa ar t1h nff,ficar hacerl nn all infnrmatinn of Whirh nrpnarpr hac ami knnwlarina Sign 9 Signa ur or Date — Here Robert A. Bertisch, Esq., Executive Director ' Type or print name and title Print/Type preparer's name Prepar 's signatt r . Date check a PTIN PaidScott Y. Haynes 7-26-2022 self-employed 01366363 Preparer Firm's name Hol field & Thomas, LL Firm'sEIN 65-1083521 Use Only Firm's address ► 125 Butler Street West Palm Beach, FL 33407 Phoneno.(561) 689-6000 May the IRS discuss this return with the Preparer shown above? See instructions __...........__ ........................_. _ .. X Yes No 032001 12-23-20 LHA For Paperwork Reduction Act Notice, see the separate instructions. Form 990 (2020) See Schedule 0 for Organization Mission Statement Continuation 1199 Legal Aid Society of Palm Beach Form 990 2020 County, Inc. 59-6046994 Page 2 Part III Statement of Program Service Accomplishments Check if Schedule O contains a response or note to any line in this Part III.................................................................................... OX 1 Briefly describe the organization's mission: To provide high quality civil legal advice, representation, and education to the disadvantaged of Palm Beach County so as to protect their personal safety, improve their lifestyle, living conditions and promote self-sufficiency. 2 Did the organization undertake any significant program services during the year which were not listed on the prior Form 990 or 990 -EZ? ..................................... If "Yes," describe these new services on Schedule O. 0 Yes 0 No 3 Did the organization cease conducting, or make significant changes in how it conducts, any program services?0 Yes 0 No .................. If "Yes," describe these changes on Schedule O. 4 Describe the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported. 4a (Code: ) (Expenses $ 3 , 8 8 9 , 616 . including grants of $ 6,358. ) (Revenue $ 19,921. ) The Foster Children's Project - The Children Advocacy represents children from birth to age 12 and their siblings who are placed in licensed custody of the State of Florida. Following appointment by the Juvenile Court, Foster Children's Project attorneys represent children in all court and administrative proceedings to keep them safe from abuse and neglect and to ensure that they reach permanent placement either with their biological parents or adoptive parents within a 12 -month timeframe. During FY 2020-2021, Foster Children's Project attorneys represented 498 clients in foster care. 4b (Code: ) (Expenses $ 2,928,596. including grants of $ 929,605. ) (Revenue $ 22,147. ) The Fair Housing Project - The Invidivual Rights Advocacy project provides community outreach, education, advocacy and enforcement activities with regard to fair housing laws to ensure that no one in Palm Beach, Martin, Okeechobee, Hendry and St. Lucie counties is denied housing on the basis of race, sex, color, religion, national origin, handicap, familial status, sexual orientation, age, marital status, or gender identity and expression. In addition to representing victims of fair housing discrimination, the Fair Housing Project also represents tenants facing eviction to ensure their rights provided under the Florida Landlord Tenant Act are enforced. In FY 2020-21, Legal Aid's Fair Housing Project staff served 1,075 clients. 4c (Code: ) (Expenses $ 1,868,925. ncluding grants of $ 2,500. ) (Revenue $ ) The Elder Law Project - Elder Advocacy provides legal advice, consultation, education and representation to economically and socially disadvantaged seniors (55+) in the areas of elderly abuse and exploitation, housing law, real property law, consumer law, guardianship matters, family law, and government benefits (Social Security, Supplemental Security Income [SSI] Medicare and Medicaid). In FY 2020-2021, Legal Aid's Elder Law Project staff served 1,387 socially and economically disadvantaged seniors in our community. 4d Other program services (Describe on Schedule O.) O (Expenses $ 2,739,449. including grants of $ 8 2 , 563. ) (Revenue $ 143,625.) 4e Total program service expenses ► 11,426,586. Form 990 (2020) 032002 12-23-20 3 1200 14270725 784176 0400900 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,vvi Legal Aid Society of Palm Beach Form 990 2020 County, Inc. 59-6046994 Page 3 Part IV I Checklist of Required Schedules Yes No 1 Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If"Yes, , complete Schedule A............................................................................................................................................. 1 X 2 X 2 Is the organization required to complete Schedule B, Schedule of Contributors?.................................................................. 3 Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes, , complete Schedule C, Part I............................................................................................................ 3 X 4 Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes, " complete Schedule C, Part 11................................................................................................... 4 X 5 Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part III .......................................... 5 X 6 Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part 1 6 X 7 Did the organization receive or hold a conservation easement, including easements to preserve open space, the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part II .......................................... 7 X 8 Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete ScheduleD, Part 111............................................................................................................................................................ 8 X 9 Did the organization report an amount in Part X, line 21, for escrow or custodial account liability, serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes, , complete Schedule D, Part IV................................................................................................................................. 9 X 10 Did the organization, directly or through a related organization, hold assets in donor -restricted endowments or in quasi endowments? If "yes," complete Schedule D, Part V.......................................................................................... 10 X 11 If the organization's answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable. a Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes, " complete Schedule D, PartVI.............................................................................................................................................................................. 11a X b Did the organization report an amount for investments - other securities in Part X, line 12, that is 5% or more of its total assets reported in Part X, line 16? If "Yes, " complete Schedule D, Part V11........................................................................... iib X c Did the organization report an amount for investments - program related in Part X, line 13, that is 5% or more of its total assets reported in Part X, line 16? If "yes," complete Schedule D, Part V111........................................................................... 11c X d Did the organization report an amount for other assets in Part X, line 15, that is 5% or more of its total assets reported in Part X, line 16? if "Yes, , complete Schedule D, Part IX......................................................................................................... 11d X iie X e Did the organization report an amount for other liabilities in Part X, line 25? 1f "Yes," complete Schedule D, Part .................. f Did the organization's separate or consolidated financial statements for the tax year include a footnote that addresses the organization's liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part ............ iif X 12a Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete ScheduleD, Parts Xl and X11................................................................................................................................................ 12a X b Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes, " and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and X11 is optional ............... 12b X 13 13 Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E .......................................... X 14a Did the organization maintain an office, employees, or agents outside of the United States?14a ................................................ X b Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes, , complete Schedule F, Parts I and IV......................................................................................................... 14b X 15 Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? 1f "Yes," complete Schedule F, Parts 11 and IV.................................................................................... 15 X 16 Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If "Yes, " complete Schedule F, Parts 111 and IV.............................................................................. 16 X 17 Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11 e? If "Yes," complete Schedule G, Part I....................................................................................... 17 X 18 Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1 c and 8a? If "Yes, , complete Schedule G, Part II............................................................................................................... 18 X 19 Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? if "Yes," completeSchedule G, Part III............................................................................................................................................. 19 X 20a 20a Did the organization operate one or more hospital facilities? 1f °Yes," complete Schedule H ................................................... X 20b b If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? ____________________________ _F 21 Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If "Yes " complete Schedule I Parts I and II 21 X 032003 12-23-20 Form 990 (2020) 4 1201 14270725 784176 0400900 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,vui Legal Aid Society of Palm Beach Form 990 2020 County, Inc. 59-6046994 Page 4 Part IV I Checklist of Required Schedules continued Yes No 22 Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If "Yes," complete Schedule 1, Parts I and III.............................................................................. 22 X 23 Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization's current and former officers, directors, trustees, key employees, and highest compensated employees? If "yes," complete ScheduleJ........................................................................................................................................................................ 23 X 24a Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If "Yes, " answer lines 24b through 24d and complete Schedule K. If "No " go to line 25a....................................................................................................................................... 24a X 24b b Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception? c Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease any tax-exempt bonds?24c ..................................................................................................................................................... . 24d d Did the organization act as an "on behalf of issuer for bonds outstanding at anytime during the year?_________ 25a Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes, " complete Schedule L, Part I................................................ 25a X b Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization's prior Forms 990 or 990-EZ? If "Yes," complete ScheduleL, Part I............................................................................................................................................................ 25b X 26 Did the organization report any amount on Part X, line 5 or 22, for receivables from or payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part ll....................................... 26 X 27 Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons? If "Yes, " complete Schedule L, Part 111......... 27 X 28 Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions, for applicable filing thresholds, conditions, and exceptions): a A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If "Yes, , complete Schedule L, Part IV.................................................................................................................................... 28a X 28b X b A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV............................................. c A 35% controlled entity of one or more individuals and/or organizations described in lines 28a or 28b? If "Yes, , complete Schedule L, Part IV.................................................................................................................................... 28c X 29 X 29 Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M ........................... 30 Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes, , complete Schedule M..................................................................................................................... 30 X 31 X 31 Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I .................. 32 Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes, " complete ScheduleN, Part II............................................................................................................................................................ 32 X 33 Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes, " complete Schedule R, Part I........................................................................ 33 X 34 Was the organization related to any tax-exempt or taxable entity? If "Yes, " complete Schedule R, Part II, III, or IV, and PartV, line 1..................................................................................................................................................................... 34 X 35a X 35a Did the organization have a controlled entity within the meaning of section 512(b)(13)?...................................................... b If "Yes" to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes, " complete Schedule R, Part V, line 2......................................................... 35b 36 Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes, , complete Schedule R, Part V, line 2........................................................................................................................ 36 X 37 Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VI ........................ 37 X 38 Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 b and 19? Note: All Form 990 filers are required to complete Schedule O............................................................................................. 38 X Part V Statements Regarding Other IRS Filings and Tax Compliance Check if Schedule O contains a response or note to anv line in this Part V n is Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable _________________________________ is 264 b Enter the number of Forms W -2G included in line 1a. Enter -0- if not applicable ib 0 C Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners?................................................................................................................................. is X 032004 12-23-20 Form 990 (2020) 5 1202 14270725 784176 0400900 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,vui Legal Aid Society of Palm Beach Form 990 2020 County, Inc. 59-6046994 Page 5 Part V I Statements Regarding Other IRS Filings and Tax Compliance continued Yes No 2a Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements, I filed for the calendar year ending with or within the year covered by this return ______________________________ 2a 155 b If at least one is reported on line 2a, did the organization file all required federal employment tax returns?2b .............................. X Note: If the sum of lines 1 a and 2a is greater than 250, you may be required to a-file (see instructions)................................. 3a Did the organization have unrelated business gross income of $1,000 or more during the year?_______________________________ 3a X 3b b If "Yes," has it filed a Form 990-T for this year? If "No" to line 3b, provide an explanation on Schedule O .............................. 4a At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? 4a X b If "Yes," enter the name of the foreign country 110- See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR). 5a Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? 5a 5b X b Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction? ___________________________ 5c c If "Yes" to line 5a or 5b, did the organization file Form 8886-T? 6a Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? 6a b If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?6b .................................................................................................................................................. . 7 Organizations that may receive deductible contributions under section 170(c). a Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? 7a X 7b X b If "Yes," did the organization notify the donor of the value of the goods or services provided?___________________________________________ c Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required tofile Form 8282?............................................................................................................................................................ 7c X d If "Yes," indicate the number of Forms 8282 filed during the year I 7d e Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?.............. ....... 7f X f Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? _________________________ 7 g If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? __. 7h h If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? 8 Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at anytime during the year?_______________________________________________________ 8 9 Sponsoring organizations maintaining donor advised funds. a Did the sponsoring organization make any taxable distributions under section 4966?_______________________________________________________ 9a 9b b Did the sponsoring organization make a distribution to a donor, donor advisor, or related person? 10 Section 501(c)(7) organizations. Enter: a Initiation fees and capital contributions included on Part VIII, line 1210a b Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities __________________ 10b 11 Section 501(c)(12) organizations. Enter: a Gross income from members or shareholdersiia .............................................................................. b Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.)_______________ iib 12a Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041? 12a b If "Yes," enter the amount of tax-exempt interest received or accrued during the year .................. 12b 13 Section 501(c)(29) qualified nonprofit health insurance issuers. 13a a Is the organization licensed to issue qualified health plans in more than one state? Note: See the instructions for additional information the organization must report on Schedule 0. b Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans__________________________________________________________________ 13b c Enter the amount of reserves on hand13c 14a X 14a Did the organization receive any payments for indoor tanning services during the tax year? 14b b If "Yes," has it filed a Form 720 to report these payments? If "No, " provide an explanation on Schedule O ........................... 15 Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year?..................................................................................................................... 15 X If "Yes," see instructions and file Form 4720, Schedule N. 16 Is the organization an educational institution subject to the section 4968 excise tax on net investment income? ________________ 16 X If "Yes," complete Form 4720, Schedule 0. 032005 12-23-20 14270725 784176 0400900 Form 990 (2020) 6 1203 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,vui Legal Aid Society of Palm Beach Form 990 2020 County, Inc. 59-6046994 Page 6 PartVl Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to line 8a, 8b, or 10b below, describe the circumstances, processes, or changes on Schedule O. See instructions. Check if Schedule O contains a response or note to any line in this Part VI................................................................................. OX Section A. Governing Body and Management is Enter the number of voting members of the governing body at the end of the tax year .................. is 34 If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain on Schedule 0. b Enter the number of voting members included on line 1a, above, who are independent __________________ ib 34 2 Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? 2 X 3 Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors, trustees, or key employees to a management company or other person? 3 X 4 X 4 Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? _______________ 5 X 5 Did the organization become aware during the year of a significant diversion of the organization's assets? _________________________ 6 X 6 Did the organization have members or stockholders?_________________________________________________________________________________________________________ 7a Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or moremembers of the governing body?.............................................................................................................................. 7a X b Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? 7b X 8 Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following: aThe governing body?......................................................................................................................................................... 8a X 8b X b Each committee with authority to act on behalf of the governing body? 9 Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization's mailing address? ................................................... 9 LX Section B. Policies (This Section B reguests information about policiesnot reQuired by theInternal Revenue Yes No 10a X 10a Did the organization have local chapters, branches, or affiliates?__________________________________________________________________________________________ b If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? 10b iia X iia Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? b Describe in Schedule O the process, if any, used by the organization to review this Form 990. 12a Did the organization have a written conflict of interest policy? If "No," go to line 13............................................................... 12a X 12b X b Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? .................. c Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe inSchedule O how this was done....................................................................................................................................... 12c X 13 X 13 Did the organization have a written whistleblower policy? 14 X 14 Did the organization have a written document retention and destruction policy? ..... 15 Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision? a The organization's CEO, Executive Director, or top management official 15a X 15b X b Other officers or key employees of the organization If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions). 16a Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? 16a X b If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization's exempt status with respect to such arrangements? ............................................................................................................ I 16b Section C. Disclosure 17 List the states with which a copy of this Form 990 is required to be filed 100 -FL 18 Section 6104 requires an organization to make its Forms 1023 (1024 or 1024-A, if applicable), 990, and 990-T (Section 501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply. 0 Own website 0 Another's website OX Upon request 0 Other (explain on Schedule O) 19 Describe on Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year. 20 State the name, address, and telephone number of the person who possesses the organization's books and records ► Robert A. Bertisch - (561) 655-8944 423 Fern St., West Palm Beach, FL 33401 032006 12-23-20 Farm 990 (2020) 7 1204 14270725 784176 0400900 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,vui Legal Aid Society of Palm Beach Form 990 2020 County, Inc. 59-6046994 Page 7 Part VII Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors Check if Schedule O contains a response or note to any line in this Part VII __________________ 0 Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees is Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization's tax year. • List all of the organization's current officers, directors, trustees (whether individuals or organizations), regardless of amount of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid. • List all of the organization's current key employees, if any. See instructions for definition of "key employee." • List the organization's five current highest compensated employees (other than an officer, director, trustee, or key employee) who received report- able compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the organization and any related organizations. • List all of the organization's former officers, key employees, and highest compensated employees who received more than $100,000 of reportable compensation from the organization and any related organizations. • List all of the organization's former directors or trustees that received, in the capacity as a former director or trustee of the organization, more than $10,000 of reportable compensation from the organization and any related organizations. See instructions for the order in which to list the persons above. 0 Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee (A) Name and title (B) Average hours per week (list any hours for related organizations below line) (C) Position(do not check more than one box, unless person is both an officer and a director/trustee) (D) Reportable compensation from the organization (W-2/1099-MISC) (E) Reportable compensation from related organizations (W-2/1099-MISC) (F) Estimated amount of other compensation from the organization and related organizations - _ __ _- - - 121 0 a f, o E 2 (1) Robert Bertisch Executive Director 40.00 X 155,476. 0 . 13,481. (2) John Walsh Supervising Attorney 40.00 X 100,823. 0. 16,803. (3) James Walsh Supervising Attorney 40,00 X 104,979. 0. 12,590. (4) Michael Spillane Dir, of Finance & Admin, 40.00 X 101, 414. 0 . 12,402. (5) Rena Taylor Supervising Attorney 40.00 X 95,991. 0. 12,478. (6) Michelle R. Suskauer, Esq, President 7,00 X Ix 0. 0. 0. (7) Lawrence P. Rochefort, Esq, First Vice President 12.00 X X 0. 0. 0. (8) Robert H. Friedman, Esq, Second Vice President 16.00 X X 0. 0. 0. (9) Scott C. Murray, Esq, Secretary 10.00 X X 0. 0. 0. (10) Jerald S. Beer, Esq, Treasurer 17.00 X X 0. 0. 0. (11) Miriam Acosta Castriz, Esq, Immediate Past President 2,00 X 0 , 0 , 0 , (12) Jeffery Devore, Esq, Member -Board of Trustees 2,00 X 0 , 0 , 0 , (13) David P. Ackerman, Esq, Member -Board of Trustees 2,00 X 0 , 0 , 0 , (14) Claire Arnold Member -Board of Trustees 2.00 X 0 , 0 , 0 , (15) F. Gregory Barnhart, Esq, Member -Board of Trustees 2,00 X 0 , 0 , 0 , (16) Bill Bone, Esq, Member -Board of Trustees 2.00 X 0 , 0 , 0 , (17) Patrick J. Casey, Esq, Member -Board of Trustees 2.00 X 0.1 0.1 0 , 032007 12-23-20 Form 990 (2020) 8 1205 14270725 784176 0400900 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,vvi Legal Aid Society of Palm Beach Form 990 2020 County, Inc. 59-6046994 Page Part VII �__. (A) Name and title (B) Average hours per week (list any hours for related organizations below line) (C) Position (do not check more than one box, unless person is both an officer and a director/trustee) (p) Reportable compensation from organization (W-2/1099-MISC) (E) Reportable compensation from related organizations (W-2/1099-MISC) (F) Estimated amount of other compensation from the organization and related organizations 8the - - _ - - - 0 a o (18) Melinda Penney Gamot, Esq, (Dec Member -Board of Trustees 2,00 X 2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization ► 0 0 • 0 • 0 , (19) Mariano Garcia, Exq, Member -Board of Trustees 2,00 X 0 • 0 • 0 • (20) Garry Glickman, Esq, Member -Board of Trustees 2.00 X 0 • 0 • 0 • (21) Carey Haughwout, Esq, Member -Board of Trustees 2.00 X 0 • 0 • 0 • (22) Jane Kreusler-Walsh, Esq, Member -Board of Trustees 2.00 X 0 , 0 , 0 , (23) Richard Lubin, Esq, Member -Board of Trustees 2.00 X 0 , 0 , 0 , (24) Rafael J. Roca, Esq, Member -Board of Trustees 2,00 X 0 • 0 • 0 • (25) Michael Salnick, Esq, Member -Board of Trustees 2.00 X 0 • 0 • 0 , (26) Gary Woodfield, Esq, Member -Board of Trustees 2,00 X 0 • 0 • 0 , ib Subtotal► ................................................................................................... c Total from continuation sheets to Part VII, Section A .................... ► .......... d Total add lines ib and 1c........................................................................ IN. 558, 683. 0. 67,754. 0 • 0 • 0 558,683.1 0.1 67,754. 2 Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization ► 4 Yes No 3 Did the organization list any former officer, director, trustee, key employee, or highest compensated employee on line 1 a? If "Yes, " complete Schedule J for such individual................................................................................................... 3 X 4 For any individual listed on line 1 a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes, " complete Schedule J for such individual ....................................... 4 X 5 Did any person listed on line 1 a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? 5 Section B. Independent Contractors 1 Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the nrnnni7stion_ Rpnnrt cmmnpncatinn fnr the calpndnr vpar pnriinn with nr within the nrnsni7ntinn's tax vaar_ (A) Name and business address NONE (B) Description of services (C) Compensation 2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization ► 0 See Part VII, Section A Continuation sheets Form 990 (2020) 032008 12-23-20 9 1206 14270725 784176 0400900 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,vuj- Legal Aid Society of Palm Beach Form 990 County, Inc. 59-6046994 Part VII I Scr4inn A (lffirnrc Ilir—M— lr—c+aac Kau P-1—aac and 14inhac4 (`mmnancafcrl Fmnln—ac 1—+;--41 (A) Name and title (B) Average hours per week (list any hours for related organizations below22 line) (C) Position (check all that apply) (D) Reportable compensation from the organization (W-2/1099-MISC) (E) Reportable compensation from related organizations (W-2/1099-MISC) (F) Estimated amount of other compensation from the organization and related organizations - _Sg — - - T 9 o - (27) Leslie Artsis Adams Member 8,00 X 0 , 0 , 0 , (28) Richard M. Benrubi , Esq, Member 6.00 X 0 , 0 , 0 , (29) Robin Bresky, Esq, Member 8.00 X 0 , 0 , 0 , (30) Vincent F. Cuomo Member 8.00 X 0 , 0 , 0 , (31) Joseph G. Galardi, Esq, Member 2,00 X 0 , 0 , 0 , (32) Richard D. Greenfield Member 2,00 X 0 , 0 , 0 , (33) Denise Rappaport Isaacs, Esq, Member 7,00 X 0 , 0 , 0 , (34) W. Hampton Keen, Esq, Member 10.00 X 0 , 0 , 0 , (35) Sarah Cortvriend, Esq, Member 10.00 X 0 , 0 , 0 , (36) Nancy Lambrecht Member 7.00 X 0 , 0 , 0 , (37) James Grier Pressly III, Esq, Member 11.00 X 0 , 0 , 0 , (38) Lawrence P. Rochefort, Esq, Member 11,00 X 0 , 0 , 0 , (39) Matthew Sackel, Esq, Member 8,00 X 0 , 0 , 0 , (40) Peter A. Sachs, Esq, Member 8. 00 X 0 , 0 , 0 , (41) Robert M. W. Shalhoub, Esq, Member 12.00 X 0 , 0 , 0 , (42) Grasford W. Smith, Esq, Member 2.00 X 0 , 0 , 0 , (43) Karis Engle, M.S. Member 11,00 X 0 , 0 , 0 , (44) Rebecca Mercier Vargas, Esq, Member 7,00 X 0 , 0 , 0 , (45) Jack P. Hill, Esq, Member 55,00 X 0 , 0 , 0 , (46) Ellen S. Malasky, Esq, Member 2.00 X 0. 0 , 0 , Total to Part VII, Section A, line 1 c........................................................................... 032201 04-01-20 10 1207 14270725 784176 0400900 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,vvi Legal Aid Society of Palm Beach Form 990 County, Inc. 59-6046994 Part VII I Scr4inn A (lffirnrc Ilir—M— lr—c+aac Kau P-1—aac and 14inhac4 (`mmnancafcrl P-1—aac 1—+;--41 (A) Name and title (B) Average hours per week (list any hours for related organizations below22 line) (C) Position (check all that apply) (D) Reportable compensation from the organization (W-2/1099-MISC) (E) Reportable compensation from related organizations (W-2/1099-MISC) (F) Estimated amount of other compensation from the organization and related organizations - _Sg — - - T 9 o - (47) Howard D. DuBosar, Esq, Member 4.00 X 0 , 0 , 0 , (48) Bridget A. Berry, Esq, Member 13.00 X 0 , 0 , 0 , (49) Carla T. Brown Member 8.00 X 0 , 0 , 0 , (50) wilnar J. Julmiste, Esq, Member 10,00 X 0 , 0 , 0 , (51) Jason D. Lazarus, Esq. Member 5.00 X 0 , 0 , 0 , (52) Amy Devore Member 10.00 X 0 , 0 , 0 , (53) Daniel Lustig, Esq, Member 5.00 X 0 , 0 , 0 , (54) Matthew Zimmerman, Esq,rj Member .0 0 X 0 , 0 , 0 , (55) Heather L. Ries, Esq, Member 4.00 X 0 , 0 , 0 , Total to Part VII, Section A, line 1 c........................................................................... 032201 04-01-20 11 1208 14270725 784176 0400900 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,vvi Legal Aid Society of Palm Beach Form 990 2020 County, Inc. 59-6046994 Page Part VIII Statement of Revenue Chock if Rnhariula n cnntninc s racnnnsa nr nnta to anv lino in thic Part VIII n 032009 12-23-20 Farm 990 (2020) 12 1209 14270725 784176 0400900 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,vvi (A) ......... ......... ......... (B) ......... .................. (C) (D) Total revenue Related or exempt Unrelated Revenue excluded function revenue business revenue from tax under sections 512 - 514 1 a Federated campaigns is 188,874, c R b Membership dues ib I-7 c Fundraising events is 268,300, (6 ..................... d Related organizations id y e Government grants (contributions) ie 11,552,226. o f All other contributions, gifts, grants, and P similar amounts not included above __. if 1,527,869. C g Noncash contributions included in lines 1a -1f i $ h Total. Add lines ia-1 f ................................................... 1110. 13,537,269, Business Code a) 2 a Legal Assistance Project 900099 143 625, 143 625, V L b Attorney Fees 900099 38,268. 38,268. CD U) C Other Services 900099 3,800, 3,800. to L d Im 0 e L a f All other program service revenue ............... 185, 693. Total. Add lines 2a -2f ................................................... 00. 3 Investment income (including dividends, interest, and other similar amounts)_................ .................................. 00. 21,703. 21,703, 4 Income from investment of tax-exempt bond proceeds 00. 5 Royalties..................................................................... 00� (i) Real (ii) Personal 6 a Gross rents 6a b Less: rental expenses __. 6b c Rental income or (loss) 6c d Net rental income or (loss) .......................................... jl� 7 a Gross amount from sales of (i) Securities (ii) Other assets other than inventory 7a b Less: cost or other basis 3 and sales expenses ......... 7b c Gain or (loss)7c cc d ............... Net gain or (loss)......................................................... 00. I 8 a Gross income from fundraising events (not p including$ 268 300, of contributions reported on line 1 c). See Part IV, line 18 8a .................................... 5,521.. b Less: direct expenses 8b 71,918, -66,397. -66,397. c Net income or (loss) from fundraising events ............... 11110. 9 a Gross income from gaming activities. See Part IV, line 19 93 .................................... b Less: direct expenses 9b c Net income or (loss) from gaming activities .................. 10. 10 a Gross sales of inventory, less returns and allowances10a b Less: cost of goods sold 10b c Net income or loss from sales of invento 01 Business Code N 3 0 11 a Bene. Interest in Trust 900099 14,799. 14,799. 5,407. 0, 5,407. b Other Misc, Revenue 900099 m NC V d All other revenue ....................................... 20,206, e Total. Add lines 11 a -11d 12 Total revenue. See instructions 13,698,474.1 185,693, 1 0, -24,488, 032009 12-23-20 Farm 990 (2020) 12 1209 14270725 784176 0400900 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,vvi Legal Aid Society of Palm Beach Form 990 2020 CountX, Inc. 59-6046994 Page 10 Part IX I Statement of Functional Expenses Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A). Check if Schedule O contains a response or note to anv line in this Part IX n Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part Vlll. (A) Total expenses ... ......... (B) Program service expenses ......... ......... ......... (C) Management and general expenses .................. (D) Fundraising expenses 1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 2 Grants and other assistance to domestic individuals. See Part IV, line 22 ..................... 3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16 4 Benefits paid to or for members ..................... 5 Compensation of current officers, directors, trustees, and key employees 6 Compensation not included above to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) 7 Other salaries and wages .............................. 8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) 9 Other employee benefits ______________________________ 10 Payroll taxes ................................................ 11 Fees for services (nonemployees): a Management ................................................ bLegal............................................................ c Accounting ................................................... dLobbying...................................................... e Professional fundraising services. See Part IV, line 17 f Investment management fees ........................ g Other. (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Sch 0.) 12 Advertising and promotion......... .................. 13 Office expenses ............................................. 14 Information technology 15 Royalties...................................................... 16 Occupancy ................................................... 17 Travel ......................................................... 18 Payments of travel or entertainment expenses for any federal, state, or local public officials ... 19 Conferences, conventions, and meetings _ _.. _ _ 20 Interest...................................................... 21 Payments to affiliates .................................... 22 Depreciation, depletion, and amortization _ _.. _ _ 23 Insurance ................................................... 24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses on line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule 0.) a Litigation Expenses b Projects Expenses c Library Fund d Misc. Expenses e All other expenses 25 Total functional expenses. Add lines 1 through 24e 25,451. 25,451. 995,575. 995,575. 617,879. 570,205. 32,883. 14,791. 7,263,866. 6,689,377. 397,783. 176,706. 103,110. 96,709. 4,246. 2,155. 1,256,441. 1,178,443. 51,738. 26,260. 554,818. 519,804. 22,145. 12,869. 26,700. 25,257. 1,158. 285. 6,109. 6,109. 141,960 . 134,287. 6,160. 1,513. 35 . 35. 373,621 . 310, 850. 55,097. 7,674. 664,919. 641,197. 12,148. 11,574. 31,688. 31,688. 1,190. 365. 825. 15,730. 13, 387. 1 , 965. 378. 48,942. 47,329. 1,128. 485. 73,271. 73,271. 36,146. 35,061. 1,039. 46. 34,495. 32,305. 1,897. 293. 6,546. 5,870. 670. 6. 120. 120. 12,278,612. 11,426, 586. 596,991. 255,035. 26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here j► = if following SOP 98-2 (ASC 958-720) 032010 12-23-20 Form 990 (2020) 13 1210 14270725 784176 0400900 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,vui Legal Aid Society of Palm Beach Form 990 (2020) County, Inc. 59-6046994 Page 11 ---- ---- - ---. __-------- -- - - --- - --- - -- --- ---- -- ----- - ---- ......... ......... ......... ......... (A) ......... ......... ......... (B) Beginning of year End of year 1 Cash - non-interest-bearing........................................................................... 400. 1 400. 2 Savings and temporary cash investments ______ _________ ..____ ..______..__ 5,963,792. 2 6,721,153. 3 Pledges and grants receivable, net 1,600,835. 3 1,433,583. 28,444. 4 14,504. 4 Accounts receivable, net .............................................................................. 5 Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons 5 6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) 6 7 y N a 7 Notes and loans receivable, net 8 Inventories for sale or use 9 expenses Prepaid ex and deferred charges p p g 8 90,894. 9 101,650. 10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 570,550. b Less: accumulated depreciation ________________ 10b 532,057. 21,872. loc. 38,493. 566, 643. 11 655, 215. 11 Investments -publicly traded securities_________________________________________________________ 12 12 Investments - other securities. See Part IV, line 11 .......................................... 13 13 Investments - program -related. See Part IV, line 11 _______________________________________ 14 14 Intangible assets.......................................................................................... 15 Other assets. See Part IV, line 11 .................................................................. 64,019. 15 78,818. 8,336,899. 16 9,043,816. 16 Total assets. Add lines 1 through 15 must equal line 33 .............................. 17 Accounts payable and accrued expenses 822, 524. 17 598, 947. 18 18 Grants payable............................................................................................. 172,723. 19 238,978. 19 Deferred revenue .......................................................................................... 20 20 Tax-exempt bond liabilities 2,195,387. 21 2,563,213. 21 Escrow or custodial account liability. Complete Part IV of Schedule D w m 22 Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% m controlled entity or family member of any of these persons 23 Secured mortgages and notes payable to unrelated third parties 22 23 1,305,402. 24 24 Unsecured notes and loans payable to unrelated third parties ........................ 25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D ............................................................................................. 82,813. 25 380,349. 4,578,849. 26 3,781,487. 26 Total liabilities. Add lines 17 through 25 ...................................................... Organizations that follow FASB ASC 958, check here 00- OX m c 3 LL and complete lines 27, 28, 32, and 33. 27 Net assets without donor restrictions________________________________________________________ 28 Net assets with donor restrictions _ _.. _ Organizations that do not follow FASB ASC 958, check here 000. 0 and complete lines 29 through 33. 3,578,781. 27 5,139,511. 179,269. 28 122,818. 0 y............................................. N Q 29 Capital stock or trust principal, or current funds 30 Paid -in or capital surplus, or land, building, or equipment fund________________________ 31 Retained earnings, endowment, accumulated income, or other funds ............ 29 30 31 3,758,050. 32 5,262,329. Z 32 Total net assets or fund balances.................................................................. 33 Total liabilities and net assets/fund balances 8,336,899. 33 9,043,816. 032011 12-23-20 14270725 784176 0400900 Form 990 (2020) 14 1211 2020.06000 LEGAL AID SOCIETY OF PALM 0406-7vv-L Legal Aid Society of Palm Beach Form 990 2020 County, Inc. 59-6046994 Page 12 Part XI Reconciliation of Net Assets Check if Schedule O contains a response or note to any line in this Part XI.................................................................................... 0 1 2 3 4 5 6 7 8 9 10 Total revenue (must equal Part VIII, column (A), line 12).............................................................................. Total expenses (must equal Part IX, column (A), line 25) .._____ ____ _________ ._______..__ Revenue less expenses. Subtract line 2 from line 1 Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) Net unrealized gains (losses) on investments Donated services and use of facilities ......................................................................................................... Investment expenses................................................................................................................................. Prior period adjustments........................................................................................................................... Other changes in net assets or fund balances (explain on Schedule O) Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, columnB................................................................................................................................................ 1 13,698,474. 2 12,278,612. 3 1,419,862. 4 3,758,050. 5 84,417. 6 7 8 9 0. 10 5, 262, 329. Part XII Financial Statements and Reporting Check if Schedule O contains a response or note to any line in this Part XII................................................................................. 0 Yes I No 1 Accounting method used to prepare the Form 990: 0 Cash OX Accrual 0 Other If the organization changed its method of accounting from a prior year or checked "Other," explain in Schedule O. 2a Were the organization's financial statements compiled or reviewed by an independent accountant? ............................ If "Yes," check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both: 0 Separate basis 0 Consolidated basis 0 Both consolidated and separate basis b Were the organization's financial statements audited by an independent accountant? ................................................. If "Yes," check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both: OX Separate basis 0 Consolidated basis 0 Both consolidated and separate basis c If "Yes" to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? ..................................... If the organization changed either its oversight process or selection process during the tax year, explain on Schedule O. 3a As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ...................................................................................................................................... b If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit 032012 12-23-20 14270725 784176 0400900 X X 2c I X X 3b I X I Form 990 (2020) 15 1212 2020.06000 LEGAL AID SOCIETY OF PALM 0406-7vv-L SCHEDULE A Public Charity Status and Public Support (Form 990 or 990 -EZ) Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust. Department of the Treasury 110- Attach to Form 990 or Form 990 -EZ. Internal Revenue Service lloo- Go to www.irs.gov/Form990 for instructions and the latest information. OMB No. 1545-0047 2020 Open to Public Inspection Name of the organization Legal Aid Society of Palm Beach Employer identification number County, Inc. 1 59-6046994 Part I I Reason for Public Charity Status. (All organizations must complete this part.) See instructions. The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.) 1 0 A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i). 2 0 A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990 -EZ).) 3 0 A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii). 4 0 A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state: 5 0 An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.) 6 0 A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v). 7 OX An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.) 8 0 A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.) 9 0 An agricultural research organization described in section 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non -land-grant college of agriculture (see instructions). Enter the name, city, and state of the college or university: 10 0 An organization that normally receives (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions, subject to certain exceptions; and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.) 11 0 An organization organized and operated exclusively to test for public safety. See section 509(a)(4). 12 0 An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g. a 0 Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B. b 0 Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C. C 0 Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E. d 0 Type III non -functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V. e 0 Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non -functionally integrated supporting organization. f Enter the number of supported organizations g Provide the following information about the supported organization(s). (i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1-10 above see instructions Iv s fne orgamza ion iistea in our qoverninc document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions) Yes No Total LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990 -EZ. 032021 01-25-21 Schedule A (Form 990 or 990 -EZ) 2020 16 1213 14270725 784176 0400900 2020.06000 LEGAL AID SOCIETY OF PALM 0406_,uuj_ Legal Aid Society of Palm Beach Schedule A Form 990 or 990 -EZ 2020 County, Inc. 59-6046994 Pa e 2 Part II Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.) Section A. Public Support Calendar year (or fiscal year beginning in) 11110- a 2016 b 2017 c 2018 d 2019 e 2020 f Total 7 Amounts from line ..................... 8605937. 9360441. 9924331. 9931270. 1 Gifts, grants, contributions, and membership fees received. (Do not 8 Gross income from interest, include any"unusual grants.") 8605937. 9360441. 9924331. 9931270. 3537269. 1359248. securities loans, rents, royalties, 2 Tax revenues levied for the organ- ization's benefit and either paid to and income from similar sources 14,584. or expended on its behalf 19,933. 38,047. 21,703. 109, 973. 9 Net income from unrelated business 3 The value of services or facilities furnished by a governmental unit to the organization without charge business is regularly carried on 8605937. 9360441. 9924331. 9931270. 3537269. 1359248. 4 Total. Add lines through or loss from the sale of capital 5 The portion of total contributions by each person (other than a assets (Explain in Part VI.) 1 86,476.1248,281.1185,714.1 governmental unit or publicly -4,603. 5,407. 521,275. 11 Total support. Add lines 7 through 10 supported organization) included 1990496. 12 Gross receipts from related activities, etc. (see instructions) on line 1 that exceeds 2% of the 12 1,009,592. 13 First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here....................................................................................................................................... amount shown on line 11, 0 Section C. Computation of Public Support Percentage column (f) .................................... O 1 3 5 9 2 4 8. 6 Public support. Subtract line 5 from line 4. Section B. Total 5u Calendar year (or fiscal year beginning in) 00- a 2016 b 2017 c 2018 d 2019 e 2020 f Total 7 Amounts from line ..................... 8605937. 9360441. 9924331. 9931270. 3537269. 1359248. 8 Gross income from interest, dividends, payments received on securities loans, rents, royalties, and income from similar sources 14,584. 15,706. 19,933. 38,047. 21,703. 109, 973. 9 Net income from unrelated business activities, whether or not the business is regularly carried on 10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) 1 86,476.1248,281.1185,714.1 -4,603. 5,407. 521,275. 11 Total support. Add lines 7 through 10 1990496. 12 Gross receipts from related activities, etc. (see instructions) 12 1,009,592. 13 First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here....................................................................................................................................... 0 Section C. Computation of Public Support Percentage 14 Public support percentage for 2020 (line 6, column (f), divided byline 11, column (f)) ____________________________________ 1 141 98.79 % 15 Public support percentage from 2019 Schedule A, Part II, line 14............................................................... 1 151 98.57 % 16a 33 1/3% support test - 2020. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box and stop here. The organization qualifies as a publicly supported organization________________________________________________________________________________________ oo. OX b 33 1/3% support test - 2019. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this box and stop here. The organization qualifies as a publicly supported organization� 0 .................................................................................... 17a 10% -facts-and-circumstances test - 2020. If the organization did not check a box online 13,16a, or 16b, and line 14 is 10% or more, and if the organization meets the facts -and -circumstances test, check this box and stop here. Explain in Part VI how the organization meets the facts -and -circumstances test. The organization qualifies as a publicly supported organization ___________________________________________ lo. 0 b 10% -facts-and-circumstances test - 2019. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or more, and if the organization meets the facts -and -circumstances test, check this box and stop here. Explain in Part VI how the organization meets the facts -and -circumstances test. The organization qualifies as a publicly supported organization ______________________ IN. 0 18 Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see instructions . Mo. 0 Schedule A (Form 990 or 990 -EZ) 2020 032022 01-25-21 17 1214 14270725 784176 0400900 2020.06000 LEGAL AID SOCIETY OF PALM 0406-7vvi- Legal Aid Society of Palm Beach Schedule A Form 990 or 990 -EZ 2020 County, Inc. 59-6046994 Pa e 3 Part III Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.) Section A. Public Support Calendar year (or fiscal year beginning in) 00- a 2016 b 2017 c 2018 d 2019 e 2020 f Total 1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") 2 Gross receipts from admissions, merchandise sold or services per- formed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose 3 Gross receipts from activities that are not an unrelated trade or bus- iness under section 513 ............... 4 Tax revenues levied for the organ- ization's benefit and either paid to or expended on its behalf 5 The value of services or facilities furnished by a governmental unit to the organization without charge 6 Total. Add lines 1 through 5 ......... 7a Amounts included on lines 1, 2, and 3 received from disqualified persons b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year c Add lines 7a and 7b 8 Public support. Subtract line 7c from line 6. Section B. Total Support Calendar year (or fiscal year beginning in) jo� 9 Amounts from line 6 ..................... 10a Gross income from interest, dividends, payments received on securities loans, rents, royalties, and income from similar sources b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975 c Add lines 10a and 10b .................. 11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on ..................... 12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) 13 Total support. (Add lines 9, 10c, 11, and 12.) a 2016 b 2017 c 2018 d 2019 e 2020 f Total 14 First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and Section C. Comnu Section D. Computation of Investment Income Percentage 17 Investment income percentage for 2020 (line 10c, column (f), divided by line 13, column (f)) 18 Investment income percentage from 2019 Schedule A, Part III, line 17 1 181 19a 33 1/3% support tests - 2020. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization POP, 0 b 33 1/3% support tests - 2019. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3%, and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization 00. 0 20 Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions ........................ 00- 032023 0032023 01-25-21 Schedule A (Form 990 or 990 -EZ) 2020 18 1215 14270725 784176 0400900 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,vvj- Legal Aid Society of Palm Beach Schedule A Form 990 or 990 -EZ 2020 County, Inc. 59-6046994 Pa e 4 Part IV Supporting Organizations (Complete only if you checked a box in line 12 on Part I. If you checked box 12a, Part I, complete Sections A and B. If you checked box 12b, Part I, complete Sections A and C. If you checked box 12c, Part I, complete Sections A, D, and E. If you checked box 12d, Part I, complete Sections A and D, and complete Part V. an 1 Are all of the organization's supported organizations listed by name in the organization's governing documents? If "No, " describe in Part VI how the supported organizations are designated. If designated by class or purpose, describe the designation. If historic and continuing relationship, explain. 2 Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2). 3a Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes, " answer lines 3b and 3c below. b Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If °Yes," describe in Part VI when and how the organization made the determination. c Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "yes," explain in Part VI what controls the organization put in place to ensure such use. 4a Was any supported organization not organized in the United States ("foreign supported organization")? If "Yes, " and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below. b Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If "Yes, " describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations. c Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If "yes," explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes. 5a Did the organization add, substitute, or remove any supported organizations during the tax year? If "Yes," answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (fi) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document). b Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document? c Substitutions only. Was the substitution the result of an event beyond the organization's control? 6 Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization's supported organizations? If "Yes," provide detail in Part VI. 7 Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (as defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If "Yes, " complete Part I of Schedule L (Form 990 or 990 -EZ). 8 Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If "Yes, " complete Part I of Schedule L (Form 990 or 990 -EZ). 9a Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If "Yes, " provide detail in Part VI. b Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If "Yes," provide detail in Part VI. c Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If "Yes," provide detail in Part VI. 10a Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non -functionally integrated supporting organizations)? If "Yes," answer line 10b below. b Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to 032024 01-25-21 Schedule A (Form 990 or 990 -EZ) 2020 19 1216 14270725 784176 0400900 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,vvi Legal Aid Society of Palm Beach Schedule A Form 990 or 990 -EZ 2020 County, Inc. 59-6046994 Pa e 5 Part IV I SuDDortina Oraanizations t nnfinttarh 11 Has the organization accepted a gift or contribution from any of the following persons? a A person who directly or indirectly controls, either alone or together with persons described in lines 11 b and 11 c below, the governing body of a supported organization? b A family member of a person described in line 11 a above? c A 35% controlled entity of a person described in line 11 a or 11b above? If "Yes" to line 11a, 11b, or 11c, provide 1 Did the governing body, members of the governing body, officers acting in their official capacity, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization's officers, directors, or trustees at all times during the tax year? If "No, " describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization's activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove officers, directors, or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year. 2 Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If "Yes," explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, Section C. Type II Supporting Organizations 1 Were a majority of the organization's directors or trustees during the tax year also a majority of the directors or trustees of each of the organization's supported organization(s)? If "No, " describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed Section D. All Type III Supporting Organizations 1 Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization's tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization's governing documents in effect on the date of notification, to the extent not previously provided? 2 Were any of the organization's officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s). 3 By reason of the relationship described in line 2, above, did the organization's supported organizations have a significant voice in the organization's investment policies and in directing the use of the organization's income or assets at all times during the tax year? If "Yes, " describe in Part VI the role the organization's nteg rg 1 Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions). a 0 The organization satisfied the Activities Test. Complete line 2 below. b 0 The organization is the parent of each of its supported organizations. Complete line 3 below. C 0 The organization supported a governmental entity. Describe in Part VI how you supported a governmental entity (see ins 2 Activities Test. Answer lines 2a and 2b below. a Did substantially all of the organization's activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities. b Did the activities described in line 2a, above, constitute activities that, but for the organization's involvement, one or more of the organization's supported organization(s) would have been engaged in? If "Yes, " explain in Part VI the reasons for the organization's position that its supported organization(s) would have engaged in these activities but for the organization's involvement. 3 Parent of Supported Organizations. Answer lines 3a and 3b below. a Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? If "Yes" or "No" provide details in Part VI. b Did the organization exercise a substantial degree of direction over the policies, programs, and activities of each 032025 01-25-21 14270725 784176 0400900 11 Yes I No No Schedule A (Form 990 or 990 -EZ) 2020 20 1217 2020.06000 LEGAL AID SOCIETY OF PALM 0406-7v, Legal Aid Society of Palm Beach Schedule A Form 990 or 990 -EZ 2020 County, Inc. 59-6046994 Pa e 6 Part V I Type III Non -Functionally Integrated 509(a)(3) Supporting Organizations 1 0 Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 ( explain in Part VI). See instructions. All other Type III non -functionally integrated supporting organizations must complete Sections A throu h E. Section A - Adjusted Net Income (A) Prior Year (B) Current Year (optional) 1 Net short-term capital gain 1 2 Recoveries of prior -year distributions 2 3 Other gross income see instructions 3 4 Add lines 1 through 3. 4 5 Depreciation and depletion 5 6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income see instructions 6 7 Other expenses see instructions 7 8 Adjusted Net Income subtract lines 5, 6, and 7 from line 4 8 Section B - Minimum Asset Amount (A) Prior Year (B) Current Year (optional) 1 Aggregate fair market value of all non -exempt -use assets (see instructions for short tax year or assets held for part of year): a Average monthly value of securities is b Average monthly cash balances ib c Fair market value of other non -exempt -use assets is d Total add lines 1 a, 1 b, and 1 c id e Discount claimed for blockage or other factors x 1 in in detail in Part VI): 2 Acquisition indebtedness applicable to non -exempt -use assets 2 3 Subtract line 2 from line 1 d. 3 4 Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). 4 5 Net value of non -exempt -use assets subtract line 4 from line 3 5 6 Multiply line 5 by 0.035. 6 7 Recoveries of prior -year distributions 7 8 Minimum Asset Amount add line 7 to line 6 8 Section C - Distributable Amount Current Year 1 Adjusted net income for prior year from Section A, line 8, column A 1 2 Enter 0.85 of line 1. 2 3 Minimum asset amount for prior year from Section B, line 8, column A 3 4 Enter greater of line 2 or line 3. 4 5 Income tax im osed in prior year 5 6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction see instructions . 6 7 0 Check here if the current year is the organization's first as a non -functionally integrated Type III supporting organization (see instructions). Schedule A (Form 990 or 990 -EZ) 2020 032026 01-25-21 21 1218 14270725 784176 0400900 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,vvi Legal Aid Society of Palm Beach Schedule A Form 990 or 990 -EZ 2020 County, Inc. 59-6046994 Pa e 7 PartV I Type III Non -Functionally Integrated 509(a)(3) Supporting Organizations (continued) Section D - Distributions Current Year 1 Amounts paid to supported organizations to accomplish exempt purposes 1 2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity 2 3 Administrative expenses paid to accomplish exempt purposes of supported organizations 3 4 Amounts paid to acquire exempt -use assets 4 5 Qualified set-aside amounts(prior IRS approval required provide it in Part VI 5 6 Other distributions(describe in Part VI). See instructions. 6 7 Total annual distributions. Add lines 1 through 6. 7 8 Distributions to attentive supported organizations to which the organization is responsive (Qrovide detailsin Part VI). See instructions. 8 9 Distributable amount for 2020 from Section C, line 6 9 10 Line 8 amount divided by line 9 amount 10 Section E - Distribution Allocations (see instructions) (i) Excess Distributions (ii) Underdistributions Pre -2020 (iii) Distributable Amount for 2020 1 Distributable amount for 2020 from Section C, line 6 2 Underdistributions, if any, for years prior to 2020 (reason- able cause required - explain in Part VI). See instructions. 3 Excess distributions carryover, if any, to 2020 a From 2015 b From 2016 c From 2017 d From 2018 e From 2019 If Total of lines 3a through 3e Applied to underdistributions of prior years h Applied to 2020 distributable amount i Carryover from 2015 not applied see instructions Remainder. Subtract lines 3q, 3h, and 3i from line 3f. 4 Distributions for 2020 from Section D, line 7: $ a Applied to underdistributions of prior years b Applied to 2020 distributable amount c Remainder. Subtract lines 4a and 4b from line 4. 5 Remaining underdistributions for years prior to 2020, if any. Subtract lines 3g and 4a from line 2. For result greater than zero, g4Qjain in Part VI. See instructions. 6 Remaining underdistributions for 2020. Subtract lines 3h and 4b from line 1. For result greater than zero, explain in Part VI. See instructions. 7 Excess distributions carryover to 2021. Add lines 3j and 4c. 8 Breakdown of line 7: a Excess from 2016 b Excess from 2017 c Excess from 2018 d Excess from 2019 e Excess from 2020 Schedule A (Form 990 or 990 -EZ) 2020 032027 01-25-21 22 1219 14270725 784176 0400900 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,vui Legal Aid Society of Palm Beach Schedule A Form 990 or 990 -EZ 2020 County, Inc. 59-6046994 Pa e 8 Part VI Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11 a, 11 b, and 11 c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a, and 3b; Part V, line 1; Part V, Section B, line 1e; Part V, Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions.) 032028 01-25-21 Schedule A (Form 990 or 990 -EZ) 2020 23 1220 14270725 784176 0400900 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,vvi ** PUBLIC DISCLOSURE COPY ** Schedule B Schedule of Contributors (Form 990,990 -EZ, Attach to Form 990, Form 990 -EZ, or Form 990-13F. or 990 -PF) 00- Go to www.irs.gov/Form990 for the latest information. Department of the Treasury Internal Revenue Service OMB No. 1545-0047 2020 Name of the organization Employer identification number Legal Aid Society of Palm Beach 0mini•-Kr Tnn r.Q-9nA9QQA Organization type (check one): Filers of: Section: Form 990 or 990 -EZ 0 501(c)( 3 ) (enter number) organization 0 4947(a)(1) nonexempt charitable trust not treated as a private foundation 0 527 political organization Form 990 -PF 0 501(c)(3) exempt private foundation 0 4947(a)(1) nonexempt charitable trust treated as a private foundation 0 501(c)(3) taxable private foundation Check if your organization is covered by the General Rule or a Special Rule. Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions. General Rule 0 For an organization filing Form 990, 990 -EZ, or 990 -PF that received, during the year, contributions totaling $5,000 or more (in money or property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions. Special Rules OX For an organization described in section 501(c)(3) filing Form 990 or 990 -EZ that met the 33 1/3% support test of the regulations under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990 -EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000; or (2) 2% of the amount on (i) Form 990, Part VIII, line 1 h; or (ii) Form 990 -EZ, line 1. Complete Parts I and II. 0 For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990 -EZ that received from any one contributor, during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I (entering "N/A" in column (b) instead of the contributor name and address), II, and III. 0 For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990 -EZ that received from any one contributor, during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year10. $ Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990, 990 -EZ, or 990 -PF), but it must answer "No" on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990 -EZ or on its Form 990 -PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990, 990 -EZ, or 990 -PF). LHA For Paperwork Reduction Act Notice, see the instructions for Form 990, 990 -EZ, or 990 -PF Schedule B (Form 990, 990 -EZ, or 990 -PF) (2020) 023451 11-25-20 1221 Schedule B (Form 990, 990 -EZ, or 990 -PF) (2020) Page 2 Name of organization Employer identification number Legal Aid Society of Palm Beach County, Inc. 59-6046994 Part I Contributors (see instructions). Use duplicate copies of Part I if additional space is needed. (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution 1 $ 4,315,487. Person OX Payroll 0 Noncash 0 (Complete Part II for noncash contributions.) (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution 2 $ 1,022,029. Person OX Payroll 0 Noncash 0 (Complete Part II for noncash contributions.) (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution 3 $ 330,205. Person OX Payroll 0 Noncash 0 (Complete Part II for noncash contributions.) (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution 4 $ 514,326. Person OX Payroll 0 Noncash 0 (Complete Part II for noncash contributions.) (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution 5 $ 2,837,542. Person OX Payroll 0 Noncash 0 (Complete Part II for noncash contributions.) (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution 6 $ 826,889. Person OX Payroll 0 Noncash 0 (Complete Part II for noncash contributions.) 023452 11-25-20 14270725 784176 0400900 Schedule B (Form 990, 990 -EZ, or 990 -PF) (2020) 25 1222 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,vvi- Schedule B (Form 990, 990 -EZ, or 990 -PF) (2020) Page 3 Name of organization Employer identification number Legal Aid Society of Palm Beach County, Inc. 59-6046994 Part II Noncash Property (see instructions). Use duplicate copies of Part 11 if additional space is needed. (a) No. from Part 1 (b) Description of noncash property given (c) FMV (or estimate) (See instructions.) (d) Date received (a) No. from Part I (b) Description of noncash property given (c) FMV (or estimate) (See instructions.) (d) Date received (a) No. from Part 1 (b) Description of noncash property given (c) FMV (or estimate) (See instructions.) (d) Date received (a) No. from Part I (b) Description of noncash property given (c) FMV (or estimate) (See instructions.) (d) Date received (a) No. from Part 1 (b) Description of noncash property given (c) FMV (or estimate) (See instructions.) (d) Date received (a) No. from Part I (b) Description of noncash property given (c) FMV (or estimate) (See instructions.) (d) Date received 023453 11-25-20 14270725 784176 0400900 Schedule B (Form 990, 990 -EZ, or 990 -PF) (2020) 26 1223 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,uuj- Schedule B (Form 990, 990-1 or 990 -PF) (2020) Page 4 Name of organization Employer identification number Legal Aid Society of Palm Beach County, Inc. 59-6046994 Fart III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this info. once.) Pop, $ Use duplicate copies of Pali III if additional space is needed. (a) No. from Part I (b) Purpose of gift (c) Use of gift (d) Description of how gift is held (e) Transfer of gift Transferee's name address and ZIP + 4 Relationship of transferor to transferee (a) No. from Part I (b) Purpose of gift (c) Use of gift (d) Description of how gift is held (e) Transfer of gift Transferee's name address and ZIP + 4 Relationship of transferor to transferee (a) No. from Part I (b) Purpose of gift (c) Use of gift (d) Description of how gift is held (e) Transfer of gift Transferee's name address and ZIP + 4 Relationship of transferor to transferee (a) No. from Part I (b) Purpose of gift (c) Use of gift (d) Description of how gift is held (e) Transfer of gift Transferee's name address and ZIP + 4 Relationship of transferor to transferee 023454 11-25-20 14270725 784176 0400900 Schedule B (Form 990, 990 -EZ, or 990 -PF) (2020) 27 1224 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,vvi- SCHEDULE D Supplemental Financial Statements UMb No. 1545-UU4/ (Form 990) Pilo- Complete if the organization answered "Yes" on Form 990, 2020 Part IV, line 6, 7, 8, 9, 10, Ila, 11b, 11c, 1 id, 1 ie, 11f, 12a, or 12b. Open to Public Department of the Treasury I110� Attach to Form 990. Internal Revenue Service Go to www.irs.gov/Form990 for instructions and the latest information. Inspection Name of the organization Legal Aid Society of Palm Beach Employer identification number County, Inc. 1 59-6046994 Part I Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the answered "Yes" on Form 990, Part IV, line 6. (a) Donor advised funds i (b) Funds and other accounts 1 Total number at end of year _____________________________________________ 2 Aggregate value of contributions to (during year) ............ 3 Aggregate value of grants from (during year) ________________ 4 Aggregate value at end of year 5 Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization's property, subject to the organization's exclusive legal control? 0 Yes ...................................................... 0 No 6 Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit?0 Yes .................................................................................................................................... 0 No Part II 1 Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7. 1 Purpose(s) of conservation easements held by the organization (check all that apply). 0 Preservation of land for public use (for example, recreation or education) 0 Preservation of a historically important land area 0 Protection of natural habitat 0 Preservation of a certified historic structure 0 Preservation of open space 2 Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year. Held at the End of the Tax Year a Total number of conservation easements 2a ................................................................................................ b Total acreage restricted by conservation easements 2b c Number of conservation easements on a certified historic structure included in (a)2c d Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listedin the National Register.................................................................................................................. I 2d 3 Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the tax year 110� 4 Number of states where property subject to conservation easement is located 10� 5 Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? 0 Yes ........................................................................... 0 No 6 Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year I111l. 7 Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year I110� $ 8 Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? _ 0 Yes ......................................................................................................................................... 0 No 9 In Part All, describe how the organization reports conservation easements in its revenue and expense statement and balance sheet, and include, if applicable, the text of the footnote to the organization's financial statements that describes the organization's accounting for conservation easements. Part III Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets. Complete if the organization answered "Yes" on Form 990, Part IV, line 8. is If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide in Part XIII the text of the footnote to its financial statements that describes these items. b If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items: (i) Revenue included on Form 990, Part VIII, line 1 $ .................................................................................... (ii) Assets included in Form 990, Part X $ 2 If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the following amounts required to be reported under FASB ASC 958 relating to these items: a Revenue included on Form 990, Part VIII, line 1 110. $ .......................................................................................... b Assets included in Form 990, Part X......................................................................................................... 00� $ LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule D (Form 990) 2020 032051 12-01-20 14270725 784176 0400900 28 1225 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,uuj- Legal Aid Society of Palm Beach Schedule D Form 990 2020 County, Inc. 59-6046994 Pae 2 Part III I Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued,) 3 Using the organization's acquisition, accession, and other records, check any of the following that make significant use of its collection items (check all that apply): a 0 Public exhibition d 0 Loan or exchange program b 0 Scholarly research e 0 Other C 0 Preservation for future generations 4 Provide a description of the organization's collections and explain how they further the organization's exempt purpose in Part XIII. 5 During the year, did the organization solicit or receive donations of art, historical treasures, or other similar assets to be sold to raise funds rather than to be maintained as part of the organization's collection? .................................... 0 Yes 0 No Part IV Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21. is Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not included on Form 990, Part X?0 Yes 0 No .................................................................................................................................................. . b If "Yes," explain the arrangement in Part XIII and complete the following table: c Beginning balance ................................................................................................................................. dAdditions during the year........................................................................................................................ eDistributions during the year.................................................................................................................. f Ending balance ....................................................................................................................................... 2a Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? Part V I Endowment Funds. Complete if the organization answered "Yes" on Form 990, Part IV, line 10. a Current year b Prior year c Two years back d Three years back a Four years back is Beginning of year balance ..................... b Contributions .......................................... c Net investment earnings, gains, and losses d Grants or scholarships e Other expenditures for facilities and programs ....................................... f Administrative expenses g End of year balance 2 Provide the estimated percentage of the current year end balance (line 1 g, column (a)) held as: a Board designated or quasi -endowment 00� % b Permanent endowment 10- % c Term endowment llll� % The percentages on lines 2a, 2b, and 2c should equal 100%. 3a Are there endowment funds not in the possession of the organization that are held and administered for the organization by: Yes No (i) Unrelated organizations................................................................................................................................................ 3a i (ii) Related organizations................................................................................................................................................... 3a ii b If "Yes" on line 3a(ii), are the related organizations listed as required on Schedule R?____________________________________________________________ 3b 4 Describe in Part XIII the intended uses of the organization's endowment funds. Part VI Land, Buildings, and Equipment. Complete if the organization answered "Yes" on Form 990, Part IV, line 11 a. See Form 990, Part X, line 10. Description of property (a) Cost or other (b) Cost or other (c) Accumulated I I (d) Book value basis (investment) basis (other) depreciation is Land ............................................................ bBuildings...................................................... c Leasehold improvements .............................. d Equipment ................................................... 140,508. 140,508. 0. e Other 430,042. 391, 549. 38,493. 032052 12-01-20 14270725 784176 0400900 Schedule D (Form 990) 2020 29 1226 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,vui Legal Aid Society of Palm Beach Schedule D Form 990 2020 County, Inc. 59-6046994 Pae 3 Part VII Investments - Other Securities. Complete if the organization answered "Yes" on Form 990, Part IV, line 11 b. See Form 990, Part X, line 12. (a) Description of security or category (Including name of security) (b) Book value (c) Method of valuation: Cost or end -of -year market value (1) Financial derivatives ............................................. (2) Closely held equity interests (3) Other Investments - Program Related. Complete if the orqanization answered "Yes" on Form 990, Part IV, line 11 d. See Form 990, Part X, line 15. (a) Description I (b) Book value .................................................................................... Part X Other Liabilities. Complete if the organization answered "Yes" on Form 990, Part IV, line 11 e or 11 f. See Form 990, Part X, line 25. 1. (a) Description of liability (b) Book value 1 Federal income taxes (21 Refundable Advances 380,349. I VLM (UOlumn (o) must eaua/ corm yyu, cart x. COI. (LI une Yb.l .................... P- I . v v , J Z J . 2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FASB ASC 740. Check here if the text of the footnote has been provided in Part XIII ... OX Schedule D (Form 990) 2020 032053 12-01-20 30 1227 14270725 784176 0400900 2020.06000 LEGAL AID SOCIETY OF PALM 0406-7vvi- Nal rt xll l Reconciliation of Expenses per Audited Financial Statements with Expenses per Return. Complete if the organization answered "Yes" on Form 990, Part IV, line 12a. 1 Total expenses and losses per audited financial statements______________________________________________________________________________ 1 12,344,421. 2 Amounts included on line 1 but not on Form 990, Part IX, line 25: a Donated services and use of facilities 2a .................................................................. bPrior year adjustments....................................................................................... 2b cOther losses...................................................................................................... 2c d Other (Describe in Part XIII.).............................................................................. 2d 71,918. eAdd lines 2a through 2d................................................................................................................................. 2e 71,918. 3 Subtract line 2e from line 1 3 12,272,503. .............................................................................................................................. 4 Amounts included on Form 990, Part IX, line 25, but not on line 1: a Investment expenses not included on Form 990, Part VIII, line 7b 4, b Other (Describe in Part XIII.) 4b 6 , 10 9 . c Add lines 4a and 4b 4c 6 , 10 9 . ....................................................................................................................................... 5 Total expenses. Add lines 3 and 4c. (1 -his must eQual Form 990. P 1 line 1 51 12,278,612. Part XIIII Supplemental Information. Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines la and 4; Part IV, lines lb and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information. Part IV, line 1b: In connection with its Public Guardianship Program (PGP) and its legal practice, the Society maintains designated cash funds that are held in separate accounts for the benefits of wards and clients. Part X, Line 2: The Society is a not-for-profit organization, other than a private foundation, pursuant to Internal Revenue Code Section 501(c)(3) and, as such, is not required to pay income taxes on its exempt function income. On October 1, 2009, the Society adopted FASB ASC 740-10-00, "Accounting for Uncertainty in Income Taxes." This pronouncement seeks to reduce the 032054 12-01-20 Schedule D (Form 990) 2020 31 1228 14270725 784176 0400900 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,vvi Legal Aid Society of Palm Beach Schedule D Form 990 2020 County, Inc. 59-6046994 Pa e 4 Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered "Yes" on Form 990, Part IV, line 12a. 1 Total revenue, gains, and other support per audited financial statements_______________________________________________________ 1 13,848,700. 2 Amounts included on line 1 but not on Form 990, Part VIII, line 12: a Net unrealized gains (losses) on investments____________________________________________________ 2a 84,417. b Donated services and use of facilities .................................................................. 2b c Recoveries of prior year grants 2c d Other (Describe in Part XIII.)......................................................................... 2d 71,918. eAdd lines 2a through 2d................................................................................................................................. 2e 156,335. 3 Subtract line 2e from line 1 .............................................................................................................................. 3 13,692,365. 4 Amounts included on Form 990, Part VIII, line 12, but not on line 1: a Investment expenses not included on Form 990, Part VIII, line 7b 4a b Other (Describe in Part XIII.) .................. 4b 6,109. c Add lines 4a and 4b ....................................................................................................................................... 4c 6,109. 5 Total revenue. Add lines 3 and 4c_ mhic --f --i g:i— aon parr i ii— 19 1 5 13.698.474. Nal rt xll l Reconciliation of Expenses per Audited Financial Statements with Expenses per Return. Complete if the organization answered "Yes" on Form 990, Part IV, line 12a. 1 Total expenses and losses per audited financial statements______________________________________________________________________________ 1 12,344,421. 2 Amounts included on line 1 but not on Form 990, Part IX, line 25: a Donated services and use of facilities 2a .................................................................. bPrior year adjustments....................................................................................... 2b cOther losses...................................................................................................... 2c d Other (Describe in Part XIII.).............................................................................. 2d 71,918. eAdd lines 2a through 2d................................................................................................................................. 2e 71,918. 3 Subtract line 2e from line 1 3 12,272,503. .............................................................................................................................. 4 Amounts included on Form 990, Part IX, line 25, but not on line 1: a Investment expenses not included on Form 990, Part VIII, line 7b 4, b Other (Describe in Part XIII.) 4b 6 , 10 9 . c Add lines 4a and 4b 4c 6 , 10 9 . ....................................................................................................................................... 5 Total expenses. Add lines 3 and 4c. (1 -his must eQual Form 990. P 1 line 1 51 12,278,612. Part XIIII Supplemental Information. Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines la and 4; Part IV, lines lb and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information. Part IV, line 1b: In connection with its Public Guardianship Program (PGP) and its legal practice, the Society maintains designated cash funds that are held in separate accounts for the benefits of wards and clients. Part X, Line 2: The Society is a not-for-profit organization, other than a private foundation, pursuant to Internal Revenue Code Section 501(c)(3) and, as such, is not required to pay income taxes on its exempt function income. On October 1, 2009, the Society adopted FASB ASC 740-10-00, "Accounting for Uncertainty in Income Taxes." This pronouncement seeks to reduce the 032054 12-01-20 Schedule D (Form 990) 2020 31 1228 14270725 784176 0400900 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,vvi Legal Aid Society of Palm Beach Schedule D Form 990 2020 County, Inc. 59-6046994 Pa e 5 Part XIII I Supplemental Information (continued) diversity in practice associated with certain aspects of measurement and recognition in accounting for income taxes. It prescribes a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position that an entity takes or expects to take in a tax return. An entity may only recognize or continue to recognize tax positions that meet a "more likely than not" threshold. The Society assesses its income tax positions based on management's evaluation of the facts, circumstances and information available at the reporting date. The Society uses the prescribed "more likely than not" threshold when making its assessment. At adoption, the Society did not record any cumulative effect adjustment, and the Society did not accrue any interest expense or penalties related to tax positions for the vear ended September 30, 2021, and there are currently no open Federal or State tax years under audit. Part XI, Line 2d - Other Adjustments: Special Fundraising Expenses 71,918. Part XI, Line 4b - Other Adjustments: Investment Management Fee 6,109. Part XII, Line 2d - Other Adjustments: Special Fundraising Events 71,918. Part XII, Line 4b - Other Adjustments: Investment Management Fee 6,109. Schedule D (Form 990) 2020 032055 12-01-20 32 1229 14270725 784176 0400900 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,vvi SCHEDULE G (Form 990 or 990 -EZ) Department of the Treasury Internal Revenue Service Supplemental Information Regarding Fundraising or Gaming Activities I OMB No. 1545-0047 Complete if the organization answered "Yes" on Form 990, Part IV, line 17, 18, or 19, or if the 0 organization entered more than $15,000 on Form 990 -EZ, line 6a. L 2oLL I► Attach to Form 990 or Form 990 -EZ. Open to Public I► Go to www.irs.gov/Form990 for instructions and the latest information. Inspection Name of the organization Legal Aid Society of Palm Beach Employer identification number Countv, Inc. 159-6046994 Part Fundraising Activities. Complete if the organization answered "Yes" on Form 990, Part IV, line 17. Form 990 -EZ filers are not required to complete this part. 1 Indicate whether the organization raised funds through any of the following activities. Check all that apply. a 0 Mail solicitations e 0 Solicitation of non-government grants b 0 Internet and email solicitations f 0 Solicitation of government grants c 0 Phone solicitations g 0 Special fundraising events d 0 In-person solicitations 2 a Did the organization have a written or oral agreement with any individual (including officers, directors, trustees, or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services? 0 Yes 0 No b If "Yes," list the 10 highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is to be compensated at least $5,000 by the organization. (i) Name and address of individual or entity (fundraiser) (ii) Activity (iii) Did havedcus raiser or control of contributions? (iv) Gross receipts from activity (v) Amount paid to (or retained by) fundraiser listed In COI. (I) (vi) Amount paid to (or retained by) organization Yes No Total ............ I► 3 List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing. LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990 -EZ. 032081 11-25-20 14270725 784176 0400900 Schedule G (Form 990 or 990 -EZ) 2020 33 1230 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,uuj- Legal Aid Society of Palm Beach Schedule G Form 990 or 990 -EZ 2020 County, Inc. 59-6046994 Pa e 2 Part II Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990 -EZ, lines 1 and 6b. List events with gross receipts greater than $5,000. (a) Event #1 (b) Event #2 (c) Other events (d) Total events Pro Bono (add col. (a) through 7 Food and beverages Event arbe ue 1 col. (c)) (event type) (event type) (total number) 8 Entertainment .......................................... 71,918. 9 Other direct expenses ..............................i 12,939.1 1,164.1 57,815 71,918. 10 Direct expense summary. Add lines 4 through 9 in column (d) 1110. ........................................................................ —66,397. 1 Gross receipts .......................................... 251,250. 5,521. 17,050. 273,821. Ir (b) Pull tabs/instant (c) Other gaming (d) Total gaming (add 2 Less: Contributions 251,250. 17,050. 268,300. Ir 3 Gross income (line 1 minus line 2) _ 5,521.1 5,521. 4 Cash prizes 2 Cash prizes c a 3 Noncash prizes X '21 4 Rent/facility costs 0 1 5 Other direct exper 0 Yes % 1= Yes % 1= Yes % 6 Volunteer labor 7 Direct expense summary. Add lines 2 through 5 in column (d).................. � ...................................................... 8 Net aamina income summarv. Subtract line 7 from line 1, column (d) ............................................................... ► 9 Enter the state(s) in which the organization conducts gaming activities: a Is the organization licensed to conduct gaming activities in each of these states?0 Yes 0 No ............................................................ b If "No," explain: 10a Were any of the organization's gaming licenses revoked, suspended, or terminated during the tax year? ___________________________ 0 Yes 0 No b If "Yes," explain: 032082 11-25-20 Schedule G (Form 990 or 990 -EZ) 2020 34 1231 14270725 784176 0400900 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,vvi 5 Noncash prizes ....................................... 6 Rent/facility costs .................................... CL X LU t 7 Food and beverages 0 8 Entertainment .......................................... 71,918. 9 Other direct expenses ..............................i 12,939.1 1,164.1 57,815 71,918. 10 Direct expense summary. Add lines 4 through 9 in column (d) 1110. ........................................................................ —66,397. 11 Net income summary. Subtract line 10 from line 3, column d........................................................................ Part III Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990 -EZ, line 6a. (a) Bingo (b) Pull tabs/instant (c) Other gaming (d) Total gaming (add bingo/progressive bingo col. (a) through col. (c)) Q) Ir 1 Gross revenue .......................................... 2 Cash prizes c a 3 Noncash prizes X '21 4 Rent/facility costs 0 1 5 Other direct exper 0 Yes % 1= Yes % 1= Yes % 6 Volunteer labor 7 Direct expense summary. Add lines 2 through 5 in column (d).................. � ...................................................... 8 Net aamina income summarv. Subtract line 7 from line 1, column (d) ............................................................... ► 9 Enter the state(s) in which the organization conducts gaming activities: a Is the organization licensed to conduct gaming activities in each of these states?0 Yes 0 No ............................................................ b If "No," explain: 10a Were any of the organization's gaming licenses revoked, suspended, or terminated during the tax year? ___________________________ 0 Yes 0 No b If "Yes," explain: 032082 11-25-20 Schedule G (Form 990 or 990 -EZ) 2020 34 1231 14270725 784176 0400900 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,vvi Legal Aid Society of Palm Beach Schedule G (Form 990 or 990-EZ) 2020 County, Inc. 59-6046994 Page 3 11 Does the organization conduct gaming activities with nonmembers? 0 Yes 0 No 12 Is the organization a grantor, beneficiary or trustee of a trust, or a member of a partnership or other entity formed to administer charitable gaming?.................................................................................................................................... 0 Yes 0 No 13 Indicate the percentage of gaming activity conducted in: a The organization's facility ............................................................................................................................................. 13a % bAn outside facility......................................................................................................................................................... I 13b % 14 Enter the name and address of the person who prepares the organization's gaming/special events books and records: Name 10� Address 11� 15a Does the organization have a contract with a third party from whom the organization receives gaming revenue?0 Yes 0 No .................. b If "Yes," enter the amount of gaming revenue received by the organization 11� $ of gaming revenue retained by the third party ► $ c If "Yes," enter name and address of the third party: Name Oo- Address 1110- 16 16 Gaming manager information: Name 1111l. Gaming manager compensation ON- $ Description of services provided 10� 0 Director/officer 0 Employee 0 Independent contractor and the amount 17 Mandatory distributions: a Is the organization required under state law to make charitable distributions from the gaming proceeds to retain the state gaming license? 0 Yes 0 No ....................................................................................................................................... b Enter the amount of distributions required under state law to be distributed to other exempt organizations or spent in the organization's own exempt activities during the tax year 00- $ Part IV Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 91b, 10b, 151b, 15c, 16, and 17b, as applicable. Also provide any additional information. See instructions. 032083 11-25-20 14270725 784176 0400900 Schedule G (Form 990 or 990 -EZ) 2020 35 1232 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,vvi Legal Aid Society of Palm Beach Schedule G Form 990 or 990 -EZ County, Inc. 59-6046994 Pa e 4 Part IV I Supplemental Information (continued) Schedule G (Form 990 or 990 -EZ) 032084 04-01-20 36 1233 14270725 784176 0400900 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,vvi i 7 W. y Q O z 0 " O U 7 � a� Na(D o 0 =_ C� �� N - w 0 o O ° Q :p CD Z s= N V l0 N o 4J U O s �4 4J LO .y >. ❑ r) N O H q C E N O U W o .c O N U N N to N U a N � cuC � U (U U � q O C C N N CV N U) co o o - a �c2 �/� N 4 � T C C O O a) NN zt 7 2 V o •� C-0 C E j LL � a o O fU 0 O)M O L CD 0) c N C N U s= O -W0 am uii ro �•— r y O rn s y (n QO U) S (Q (U SL C) ra C N ._ + O vii .N 2 V N� y Q C y o LL Q -�;0 N C O 0) • U) O co 7 aifa i C O y N O 3 O N +y+ m 3 � U O 0 C +O. rm 0 ai O E fu O rl 0 N y +� r ♦ a+ O 0 L d a) M 44 E O C R A N V o U CL f1 O c O 'C O U O U N c a -I in N c6 N U fn N f 3, Q • N 4 U 7 s N I (U o O co rn n fn Q Sa a ccn n @ O U O O N U �i O O 'H O O O O N a O N W �D a E-Fo E r E o 0 i o E is N (a 3 ra y cu 2) y a, O a o ami> C N m O co rn� :F J U) Z) U O O7 W 0 > p ¢ O 4:O N -H a M JJ M = L U o a �3 E ca fi N NLV o = z i 7 W. CSI 2 J 0 0 0 a q* M N T_ a� �� N - w N a o 4J U s �4 4J r) N H q N O U .c O N Q N U N � � U � q O C a o0(aO - -'C- - a �c2 2- 6 p zt 7 2 V j LL O fU 0 C N U s= O U N QO U) S ra O vii O 0) N E -r- < U) � U O N N .V M U CL f1 _ O U fLL-.1 a -I in z w `O 00 LU 3, s N I O co Sa .c q M U O 'H O N W �D E r O a 00 % CU o g ao O a O p N m O co O 3~ fu E -H a M JJ M (a z U a > a) w V U r r U 5 PQ CSI 2 J 0 0 0 a q* M N T_ N A U N pC F r -I P4 44 0 N N N N cu a3 a 0 rn rn E O LL O N N } a) N 3 N C ai C O N 21 O a) CLE 0 U _N Wa 7 N a a .� a0i c � N U a) ++ U N aY N Q E _ 0 0 O .O a+ N -O U C N a) N � Q .0 tQ �+ -0 o N a-0 CC:M CO 0 i CO o a N U a3 N N N a3 ro m O L (d a) -.-I b G q ro N m m U 9 H 0 O - 1 1J rl ?4 -rl O a) m•H 04 4J FJ S4 7, ri ¢i N U 0 4 0 m O N q) N m •m 0 Q m O to >, -H FJ r -i a) U to ¢, ro O U Ri x 0 N ro ro m q -rl U ro a) m O) Q ri 4J -H lJ ri 4� t7/ fi U1 m -m 4J H o H -u -Col m -b N o q m >, m 0 +1 O a) m -H -H O m � L 90 t m m a) ro 3N a) a) U U ro to ro ro _>E O m cn m N N O Q a) m m 0 N N m m a) LL LL a] U3 U -60 -W V ra ro ro w w -H S4 �4 O -1 -1 Id a) a) a) a) a) 41 ON 0 V O o O It1 eo Ln m o N ri W C•) o c -I N 7N O 0 L Q U) -6 U O 0 0 0 0 0 C � O EL Qcz V U O.1 c -I T N co o LO U) U) :Q z a, E N U C aY Mn N aY O C p1 ri ro 71 ~ W W 0 G G G ( 4� U m m q m a) ro m O U m F N G U N q iJ 0 S4 O m q a) r m O i (d m U r� a) m a) W U m 4 co OO M SCHEDULE J I Compensation Information (Form 990) For certain Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees Olo- Complete if the organization answered "Yes" on Form 990, Part IV, line 23. Department of the Treasury I Attach to Form 990. Internal Revenue Service ► Go to www.irs.aov/Form990 for instructions and the latest information. OMB No. 1545-0047 2020 Open to Public Inspection Name of the organization Legal Aid Society Of Palm Beach Employer identification number Countv. Inc. 1 59-6046994 Part I I Questions Regarding Compensation is Check the appropriate box(es) if the organization provided any of the following to or for a person listed on Form 990, Part VII, Section A, line 1 a. Complete Part III to provide any relevant information regarding these items. 0 First-class or charter travel 0 Housing allowance or residence for personal use 0 Travel for companions 0 Payments for business use of personal residence 0 Tax indemnification and gross -up payments 0 Health or social club dues or initiation fees 0 Discretionary spending account 0 Personal services (such as maid, chauffeur, chef) b If any of the boxes on line 1 a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain 2 Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all directors, trustees, and officers, including the CEO/Executive Director, regarding the items checked on line 1 a? 3 Indicate which, if any, of the following the organization used to establish the compensation of the organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III. 0 Compensation committee 0 Written employment contract 0 Independent compensation consultant 0 Compensation survey or study 0 Form 990 of other organizations X Approval by the board or compensation committee 4 During the year, did any person listed on Form 990, Part VII, Section A, line 1 a, with respect to the filing organization or a related organization: a Receive a severance payment or change -of -control payment?____________________________________________________________________________ 4a X 4b X b Participate in or receive payment from a supplemental nonqualified retirement plan? 4c X c Participate in or receive payment from an equity -based compensation arrangement? .. If "Yes" to any of lines 4a -c, list the persons and provide the applicable amounts for each item in Part III. Only section 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9. 5 For persons listed on Form 990, Part VII, Section A, line 1 a, did the organization pay or accrue any compensation contingent on the revenues of: aThe organization?............................................................................................................................................................... 5a X 5b X bAny related organization?................................................................................................................................................... If "Yes" on line 5a or 5b, describe in Part III. 6 For persons listed on Form 990, Part VII, Section A, line 1 a, did the organization pay or accrue any compensation contingent on the net earnings of: aThe organization?............................................................................................................................................................... 6a X 6b X bAny related organization?................................................................................................................................................... If "Yes" on line 6a or 6b, describe in Part III. 7 For persons listed on Form 990, Part VII, Section A, line 1 a, did the organization provide any nonfixed payments not described on lines 5 and 6? If "Yes," describe in Part III ................................................................................................... 7 X 8 Were any amounts reported on Form 990, Part VII, paid or accrued pursuant to a contract that was subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe in Part III _______________________________ 8 X 1 9 If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulationssection 53.4958-6(c)? ....................................................................................................................................... 9 LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule J (Form 990) 2020 032111 12-07-20 14270725 784176 0400900 39 1236 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,uuj- N J, y� I � u N _N CL O U N co U Q 3 N A Vf U N _O W a E LU rzl r -I m � v P4 w 44 0. o E 7 c L _O N C 3 O E W ca C C E 3 O U _N Q m U Q 0- m m L6 N C Q C O U N cucu 0- C) 0 A U pC F r -I P4 44 O C C 0 .. 0 E 0 c Q C& LOQ C6 LO U Q C6 M Q N N C ca ca a _o a a� 6 a> 0 0 .Q U N N 0 0 c CL x a 0 E 0 t m a O 0- 00 M N T r -I SCHEDULE O Supplemental Information to Form 990 or 990 -EZ UMb No. 1545-UU4/ (Form 990 or 990 -EZ) Complete to provide information for responses to specific questions on 2020 Form 990 or 990 -EZ or to provide any additional information. Department of the Treasury I Attach to Form 990 or 990 -EZ. Open to Public ., ',...__ n..........., c,......... `,... ... ......... ..... ....../L.....r. n,]/1 i...iM.. I..i....i :..i.....r... i:.... Incnnn+inn Name of the organization Legal Aid Society of Palm Beach Employer identification number CountV, Inc. 1 59-6046994 Form 990, Part I, Line 1, Description of Organization Mission: Palm Beach County so as to protect their personal safety, improve their lifestyle and living conditions and promote self-sufficiency. Form 990, Part III, Line 4d, Other Program Services: The Domestic Violence Project provides survivors of abuse with legal advice, consultation, and assistance in filing injunctions for rotection (restraining orders) and legal representation at hearings on injunctions for protection. The Project strives to ensure that clients are protected from further violence while also promoting stability by establishing parenting plans and securing financial support for survivors as appropriate. To further promote stability, The Domestic Violence Project provides holistic legal services including assistance in related family law matters. The Project not only assists in navigating the legal system but provides referrals to communit resources to help survivors access personalized safety planni support groups, transitional housing and financial resources. The Domestic Violence Project served 2,220 clients in FY 2020-2021. Expenses $ 1,526,695. including grants of $ 25,611. Revenue $ 0. Other legal counseling services - During FY 2020-2021 other legal counseling services were provided to 5,934 individuals. Expenses $ 1,212,754. including grants of $ 56,952. Revenue $ 143,625. Form 990, Part VI, Section B, line 11b: A draft copy of Form 990 is presented to the members of the board of LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990 -EZ. Schedule O (Form 990 or 990 -EZ) 2020 032211 11-20-20 42 1239 14270725 784176 0400900 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,uuj- Schedule O (Form 990 or 990 -EZ) 2020 Name of the organization Legal Aid Society of Palm Beach Employer identification number County, Inc. 1 59-6046994 directors for approval prior to filing. Form 990, Part VI, Section B, Line 12c: An annual, signed document is submitted by members of the board and key employees disclosing potential conflicts of interest. Form 990, Part VI, Section B, Line 15a: The board of directors requested the administrator obtain a salary survey and provide recommendations to the board from which the executive director's salary is set. Form 990, Part VI, Section C, Line 19: The Organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Part XII Line 2C The audit report is reviewed annually at the audit report review meeting as 'presented by the inde-Dendent auditor. 032212 11-20-20 Schedule O (Form 990 or 990 -EZ) 2020 43 1240 14270725 784176 0400900 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,vvi Form 8868 I Application for Automatic Extension of Time To File and (Rev. January 2020) Exempt Organization Return OMB No. 1545-0047 Department of the Treasury ► File a separate application for each return. Internal Revenue Service ► Go to www.irs.gov/Form8868 for the latest information. Electronic filing (e -file). You can electronically file Form 8868 to request a 6 -month automatic extension of time to file any of the forms listed below with the exception of Form 8870, Information Return for Transfers Associated With Certain Personal Benefit Contracts, for which an extension request must be sent to the IRS in paper format (see instructions). For more details on the electronic filing of this form, visit www_irs.gov/e-file-providers/e-file-for-charities-and-non-profits. Automatic 6 -Month Extension of Time. Only submit original (no copies needed). All corporations required to file an income tax return other than Form 990-T (including 1120-C filers), partnerships, REMICs, and trusts must use Form 7004 to request an extension of time to file income tax returns. Type or Name of exempt organization or other filer, see instructions. Taxpayer identification number (TIN) print Legal Aid Society of Palm Beach County, Inc. 59-6046994 File by the due date for Number, street, and room or suite no. If a P.O. box, see instructions. filing your See 423 Fern Street, No. 200 return. instructions. City, town or post office, state, and ZIP code. For a foreign address, see instructions. West Palm Beach, FL 33401 Enter the Return Code for the return that this application is for (file a separate application for each return).......... ......................................... 0 1 Application Return Application Return Is For Code Is For Code Form 990 or Form 990 -EZ 01 Form 990-T (corporation) 07 Form 990 -BL 02 Form 1041-A 08 Form 990 -PF 04 Form 5227 10 Form 990-T sec. 401 a or 408(a) trust 05 Form 6069 11 Form 990-T trust other than above 06 Form 8870 12 Robert A. Bertisch • The books are inthe careof ► 423 Fern St. - West Palm Beach, FL 33401 Telephone No. ► (5 61) 655-8944 Fax No. ► • If the organization does not have an office or place of business in the United States, check this box ► 0 • If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN) . If this is for the whole group, check this box ► 0 . If it is for part of the group, check this box ► 0 and attach a list with the names and TINS of all members the extension is for. I request an automatic 6 -month extension of time until August 15, 2022 to file the exempt organization return for the organization named above. The extension is for the organization's return for: ► 0 calendar year or ► OX tax year beginning OCT 1, 2020 , and ending SEP 30, 2021 2 If the tax year entered in line 1 is for less than 12 months, check reason: 0 Initial return 0 Final return 0 Change in accounting period 3a If this application is for Forms 990 -BL, 990 -PF, 990-T, 4720, or 6069, enter the tentative tax, less any nonrefundable credits. See instructions. 3a $ 0 b If this application is for Forms 990 -PF, 990-T, 4720, or 6069, enter any refundable credits and estimated tax payments made. Include any prior year overpayment allowed as a credit. 3b $ 0 c Balance due. Subtract line 3b from line 3a. Include your payment with this form, if required, by using EFTPS Electronic Federal Tax Payment System). See instructions. 3c I $ 0 Caution: If you are going to make an electronic funds withdrawal (direct debit) with this Form 8868, see Form 8453 -EO and Form 8879 -EO for payment instructions. LHA For Privacy Act and Paperwork Reduction Act Notice, see instructions. Form 8868 (Rev. 1-2020) 023841 04-01-20 14270725 784176 0400900 1 1241 2020.06000 LEGAL AID SOCIETY OF PALM 0406-,vvi- Member Profile — Tequisha Yvette Myles — The Florida Bar MEMBER PROFILE Tea u i s h a Yvette My es 8 a ! N U.Tn L,e r (_; /F_l _) � I UI a I I Ad,S ress: https: //-,vww.floridabar. org/directories/find-mbr/profile/?num=6765 51 Member in Good Standing Eligible to Practice Law in Florida 2egsl Ald ` i:ly of Palm Heath cloy, -)Ly 423 Fern St Ste 20-1 '/Vest Palm Death, FF33%01-5830 Off ice: 561-e`5-844 Fax 561-655-52( =mall: tn�yl, < c�l,c� alsicl k c.crg -Iersonal Czar URF: htt�_/��,,,,ti.florioaoarorc�/rrry/-,r�r�tile;r=X76351 1242 1 of 3 3/27/2023, 12:33 PM Member Profile — Tequisha Yvette Myles — The Florida Bar Ca rd: M CO u n tv: Pain"1 Beach .IrculL Ad m I L_ed U/07%DSU F)- 'car D'Iscmhne. HIsL:7ry None F -mda Statr Lniv-�s t,; Collr,qc of Lav,, 2003 ;�o rn ni ittees: CommiLLee 2 of 3 https: //-,vww.floridabar. org/directories/find-mbr/profile/?num=6765 51 tucer t EcLC,�ti(-r <�nd AM sior- -o th ' <ar Cornrn ttee(CM) �;e�tlons: D ri e r La \A/ Real Property, Probate & Trust Oder Ecual Oppeiri�ies =ederal Courts: S. "cart )fAepealsfe Eleventrcuit L.S. District Ccu,t, District of Elcriea -i rm: LL -gal Aid Society of Palr-n Beach OsL,'rty -irrn Sizo: Of"f"ice I er— Vice Cr;,ir 06/30/2023 1243 3/27/2023, 12:33 PM Member Profile — Tequisha Yvette Myles — The Florida Bar ?1-50 -Am IVebso alaiccbccrg https: //-,vww.floridabar. org/directories/find-mbr/profile/?num=6765 51 -hc=inouA,^,-,cr,_tar;npD"Vc ass p..A:,a,cc-to =lcrcvDoi 7sntu "Amac_i_ `omuicnAcutlamcr lrv-ndt Pc-iccin -'hq4-( gin re scdwr .. ,;rh h jorc-r A. sctrrl,�-t; rr"J a:lr,"nw.e-r1 11�v njhPR ii a!ar aTl -ainrlipl rsl tw,r Sd P ral i �nul I ci ,- r II fi r c;C DWI, ,ger R -Alpre K ."Alae r 1 P, -A Hp`k VSW:;�Wl v of vs rnx r . (� v n - `­ ( ,( � y anc I i, R n_ s , , ,,[ I,I , I h 1u <-1 1,211-c. 111 l,b idu �hrw A ad j j "_rel Wx ircunco,arc Wnuntc" alV_ t -auw , �dvha" -tcrul -"V-3 c- PICKa othwm4canA -,-m��,r- Ci,cjs, r _lt_; r _houn� li nj r� �tcn i_li� in�i J� �-,ct���_ �rt�c I� cc l r " now a - w^, c,rn_ Unauv� my use _t _his data P c e,i iIt it u"iI , . cqrryn l e Q s V e --d & &XV, jw, -, r, _c 'Ash.,e ee ral,;7r,c:e 1244 3 of 3 3/27/2023, 1233 PM Assistance Award/Amendment U.S. Department of Housing and Urban Development Office of Administration 1. Assistance Instrument 2. Type of Action Amount ❑ Cooperative Agreement ® Grant ❑ Award ® Amendment Obligated in 3. Instrument Number 4. Amendment Number 5. Effective Date of this Action 6. Control Number FPE120046 3 59-6046994 7. Name and Address of Recipient 8. HUD Administering Office Total Legal Aid Society of Palm Beach County, Inc. U. S. Department of HUD/FHEO 423 Fern Street, Suite 200 Five Points Plaza, 16`' Floor West Palm Beach, FL 33401 UEI: VMT7 RKRM U3X3 DUNS No: 101937779 40 Marietta Street Atlanta, GA 30303-2806 8a. Name of Administrator 8b. Telephone Number Carlos Ose ueda 678-732-2905 10. Recipient Project Manager 9. HUD Government Technical Representative Te uisha Miles 361 655-8944 Darryl Foster 202 230-8707 11. Assistance 12. Payment Method 13. HUD Payment Office Arrangement ❑ Treasury Check Reimbursement Fort Worth Field Accounting ❑ Cost Reimbursement ❑ Advance Check P. O. Box 2905 ❑ Cost Sharing ® Automated Clearinghouse Fort Worth, TX 76113-2905 ® Fixed Price 14. Assistance Amount 15, HUD Accounting and Appropriation Data Previous HUD Amount $735,000.00 .................................................................................................................................................................... 15a. Appropriation Number 15b. Reservation number HUD Amount this action $425,000.00 .................................................................................................................................................................... 86 22/23 0144 FPEI20046 Total.HUD.Amount.................................$1.,160,000.00..................................... Amount. PreviouslyObligated.................$735.,000:00...................................... Recipient Amount $0.00 .......................................................................................................................Obligation.bv.. this.action........................... .$425.,000:00...................................... Total Instrument Amount $1,160,000.00 Total Obligation $1,160,000.00 16. Description Fund Description Amount Code Obligated in this Action PE3 Private Enforcement $425,000.00 Initiative Total $425,000.00 THIS GRANT INSTRUMENT IS TO AMEND AN AWARD UNDER THE FAIR HOUSING INITIATIVES PROGRAM (FHIP) — NOFA 2020. THIS GRANT AGREEMENT CONSISTS OF THE BASIC AGREEMENTS AND THE FOLLOWING ATTACHMENTS WHICH ARE APPENDED HERE AND MADE A PART HEREOF: Attachment A — Schedule of Articles Attachment B - Addendum to the Schedule of Articles Attachment C - Special Conditions (if applicable) Attachment D - Grantee Declarations Attachment E - Additional Assurances Attachment F - Final Statement of Work Attachment G - Payment Schell ale Attachment H - Applicant Assurances Final Negotiated Budget The period of perfonnance is April 1, 2023 — March 30, 2024 (Year 3) The grant expiration date is now July 31, 2024. The Grant Officer/Administrator is Carlos Osegueda The Government Technical Monitor (GTM) is now Kirk Ashmeade The Government Technical Representative (GTR) is now Darryl Foster 17. ® Recipient is required to sign and return three (3) copies 18. ❑ Recipient is not required to sign this document. of this document to the HUD Administering Office 19. Recipient (By Name) 20. HUD (By Name) Robert Bertisch Carlos Osegueda, Regional Director Region IV, Office of FHEO/CAO Signature & Title Date Signature & Title Date (mm/dd/yyyy) (mm dd/yyyy) 3/24/2023 3/23/2023 Robert A. Bertisch, Executive Director form HUD -1044 (8/90) 1245 JOB SUMMARY: LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC. JOB TITLE: PROJECT: CLASSIFICATION: REPORTS TO: REVISION DATE: Attorney Fair Housing Project Full-time, exempt Supervising Attorney January 2023 The Fair Housing Project staff attorney position involves a high degree of professionalism, advocacy, compassion, independence, and personal initiative. The successful candidate will provide a full range of high-quality legal services to individual clients and to client groups, including representation and administrative proceedings. The attorney will practice in state and federal courts as well as before administrative agencies on behalf of victims of housing discrimination. Conducts civil lawsuits, draws up legal documents, advises clients as to legal rights, and practices other phases of fair housing law. Assists the Project Director with the implementation of a local and regional fair housing enforcement program. The work schedule is generally Monday through Friday, 9:00 a.m. 5:00 p.m., with occasional evening or weekend work. Travel in Palm Beach, Martin, Okeechobee, St. Lucie and Hendry counties required. ESSENTIAL DUTIES AND RESPONSIBILITIES: • Represents clients before administrative and judicial tribunals in a full range of civil legal matters. • Conducts interviews of clients at the office, at outreach events or through virtual platforms. • Investigates and develops cases, including conducting necessary interviews and consulting appropriate agencies and resources. • Counsels and advises clients in legal matters. • Negotiates on behalf of clients. • Drafts letters, memos, pleadings, briefs, and other legal documents and written materials. • Manages grant deliverables and reporting requirements as required. • Analyzes facts divulged by clients to identify legal issues presented and make appropriate referrals. • Performs legal research and remains current on new developments in the law which affects clients. • Oversees the fair housing testing program. • Conducts site visits to properties being investigated and collect documents. • Maintains accurate and complete records and files regarding cases. • Makes referrals and follows up referrals of clients to appropriate alternative or additional sources of assistance. • Develops and maintains relationships with social service agencies. 1246 • Plans and participates in Fair Housing Month Activities. • Provides community trainings on fair housing issues and lending discrimination. • Assists local funding jurisdictions and municipalities in fulfilling their obligations to affinnatively further fair housing. • Serves on community, bar association, and county committees where feasible. • Attends staff and other meetings in the community as assigned. • Maintains confidentiality of all information handled. • Complies with all agency policies and procedures. • Works with other staff members to form a positive, supportive team atmosphere. • Must work the days and hours to perform all assigned responsibilities and tasks, and be punctual and timely in meeting all performance requirements, including but not limited to, attendance standards and work deadlines. • Must maintain courteous, professional and effective working relationships with employees and clients of the organization. • Assists the Executive Director and/or supervisor with special projects, assignments and any additional duties as deemed appropriate or as needed. SUPERVISES: Paralegal/support staff. POSITION RELATIONSHIPS: The position requires daily contact with unit attorneys and paralegals, the executive director, and clients on a frequent basis and with other staff members on a frequent to daily basis. POSITION REQUIREMENTS: • Doctor of Jurisprudence (J.D.) from A.B.A. accredited law school. • Member of the Florida Bar. • Must have 3-5 years legal experience. • Excellent verbal and written skills. • Must have a professional attitude and pleasant manner with the public. • Knowledge of the Florida and Federal Rules of Civil Procedure. • Excellent computer and word processing skills. Proficient in using MS Outlook, MS PowerPoint, MS Word, Excel software. Experience with a case management system is a plus. • Experience with community outreach and planning and delivering public presentations. • Commitment to going above and beyond to meet all contractual deadlines. • Outstanding project management skills; ability to set priorities, manage multiple tasks, and meet deadlines. • Working to eradicate housing discrimination and help build inclusive communities through education, outreach, advocacy, and enforcement. • Must have a demonstrable commitment to understanding the issues of low-income constituents and be able to appreciate and work with a culturally and demographically diverse population. • Demonstrated commitment to fair housing and civil rights. 1247 • Occasional out of area travel and overnight stays may be required. SPECIAL REQUIREMENTS AND PHYSICAL DEMANDS: Requires safely lifting or moving up to 10 lbs on an occasional basis, for example movement of materials, files or texts. Regular requirement to stand, and sit for long periods of time, with some walking, occasional bending, stooping, squatting, pushing and pulling. Noise level is usually quiet to moderate. EQUIPMENT: Computer, scanner, telephone, fax, copy machine. SALARY RANGE: Salary: Commensurate with experience. Continued employment is dependent on availability of funding resources. NON-DISCRIMINATION STATEMENT The Legal Aid Society does not discriminate against employees or clients on the basis of race, color, religion, gender, sexual orientation, national origin, age, disability, marital status, familial status or any other characteristic protected by Federal, State or local law or ordinance. A non- discrimination clause concerning employment opportunity is incorporated in the Employee Policy and Procedure Manual. The agency will make reasonable accommodations in compliance with the Americans with Disabilities Act of 1990. This job description may not be all-inclusive and employees are expected to perform all other duties as assigned and directed by management. Job descriptions will be reviewed periodically as duties and responsibilities change with business necessity. Essential and marginal job functions are subject to modification. I have read and understand the job responsibilities, standards and requirements for this position. Employee Name Date Robert Bertisch, Executive Director 1248 0) It 04 T - FAIR HOUSING COMPLAINI_QUETIONNAIRE Legal Aid Society of Painipeach County, Inc. 423 Ferri Street, Suite 200 West Palm Beach, Florida 33401 Telephone: (561) 655-8944/ Fax: (5 61) 655-5269 Last First Name Social Security No. State Zip Code Ph—one Contact Person Name &Phone Age: Birth Date: Male Female Marital Status: Single Married Separated Divorced Widowed Spouse's Name: How many people live in your home? — Adults Children Primary Language: English Spanish J Creole ( ] Ethnicity: [ ] White Hispanic Black Asian/Pacific Islander Other: REFERRED BY: Please list list all—the income received — by -- you and the people living with TYPT—Ofincome Amount Hovy often is it paid? weekly [ every two weeks [ monthly [ ] yearly weekly [ every two weeks [ monthly [ ] yearly weekly [ every two weeks [ monthly [ ] yearly weekly [ every two weeks [ monthly [ ] yearly LEGAL WPROBLEM- Briefly state the nature of your problem: L Affl4LC—A U—EILTIrICATIQN _ _ The answers and information given above by me are true and I ask the Legal Aid Society to rely on them when deciding whether I am eligible for their legal services. Signature rim SY nature Ta -i -e 0 LO 04 V_ .. .... .... .... 1, , authorize Legal Aid Society of Palm Beach County, Inc. (LASPBC), and any attorneys associated with them to represent me either through in-house staff or on a pro bono basis and to do all things necessary or desirable including initiating litigation in connection with my fair housing issue. • • OMIM612011 0 11 - ------ I understand that LASPBC represents low-income clients only and that LASPBC does not charge an attorney's fee for its services. I understand that the attorney • paralegal with me at any Court or Administrative hearing may not be the same person who initially interviewed me. I agree, however, to pay all necessary costs connected with my representation unless it is agreed by LASPBC that I am unable to pay those costs. I agree to reimburse LASPBC for any costs paid on my • 2. 1 agree to keep all appointments or promptly notify LASPBC of the need to change an appointment, truthfully give all information requested, and promptly notify LASPBC about any changes in information in my case, any new developments in my case, and any changes in my address or my financial situation. 3. If deemed to •^ in the best interest of my case, LASPBC may require that I make a monthly deposit of funds into its trust account. These deposits will be held for my benefit, so that I will have the necessary funds available should a settlement/loan modification be reached in my case. 4. LASPBC shall keep all information provided by me confidential, request my participation in all decisions concerning resolution of my problem, and make no settlement of my claims without my consent. I understand that my participation depends upon keeping LASPBC informed of my whereabouts. I understand that information regarding my personal finances may be disclosed during the litigation process as a means of settling my dispute. Any financial disclosures will be limited to those individuals/organizations which have authority to settle this matter. 5 1 hereby waive the aftorney-client privilege with respect to any knowledge obtained by my attorney through the attorney-client relationship concerning my income and assets, should the attorney file a Motion to Withdraw from my representation based upon my financial ineligibility. 6. 1 agree to permit LASPBC to seek and retain attorney's fees, whether authorized by statute or otherwise, as may be assessed against any opposing party by any court or through settlement. Further, I understand that LASPBC has limited funds and can continue to take cases like mine only if it is regularly able to obtain attorney's fees from the opposing party. I therefore agree that LASPBC may reject, on my behalf, any settlement offer which requires LASPBC to give up its right to seek a reasonable attorney's fee from the opposing party, ��Mhat LASPBC will no RJJ T- LC) 04 TM higher court or other body. An appeal by LASPBC will be taken only after consultation with I-ASPBC's Executive Director or designee and consideration of the merits of the appeal, program resources, and my continued • eligibility for LASPBC services. 8. 1 further understand that if I have been provided with free legal services, and it is discovered that I was not eligible for them that I will pay a reasonable fee, plus expenses, for all services rendered by LASPBC or the private attorney which was furnished to me, LASPBC, or the private attorney whom it furnishes to me, may ask the judge handling my case to decide the amount of any fee or expense that I might owe. 9. 1 further understand that if I qualify for representation, LASPBC, at its discretion and without stating a reason, may assign my case to one of its staff attorneys, or may refer the matter to a private pro bono attorney. Such referral may occur at any point in the representation. I understand that the opposing party involved in this legal matter may request or may have requested assistance from LASPBC in this legal matter and that the opposing party may also be eligible for LASPBC's services. In such a case, LASPBC will attempt to obtain private pro bono representation for one or both parties, or may provide representation to one of the parties through a LASPBC staff attorney. 10. 1 understand that if I fail to comply with any of the foregoing, LASPBC may withdraw its representation. 11. This retainer becomes effective as of the date signed below. LASPBC representation will terminate upon a final disposition being reached in my case, settlement of my case, or the LASPBC staff attorney's withdrawal from the case. This Retainer Agreement will also pertain to the services of a Pro Bono Project attorney, should I be referred through LASPBC, subject to the above terms. By signing below, I hereby acknowledge and agree to the terms of this Retainer Agreement. In addition, I acknowledge that a copy of this Retainer Agreement was provided to me. Client Signature Date Client Signature Date This agreement is not effective unless and until signed below by a LASPBC attorney or paralegal. LASPBC Attorney/Paralegal Signature pate Legal Aid Society of Palm Beach County, Inc. Fair Housing Project Client Rights & Responsibilities and Grievance Procedure Individuals enrolled in the Fair Housing Project have the following rights and responsibilities: I. CLIENT RIGHTS You have the right to choose whether or not to accept civil legal representation from the attorneys and paralegals of the Legal Aid Society of Palm Beach County, Inc. You have the right to receive representation from an attorney or paralegal who is knowledgeable in the area of law affecting your legal problem. You have the right to know about your attorneys/paralegals education, training and experience. If you ask, the attorney/paralegal should tell you about their actual experience dealing with cases similar to yours. If you ask, the attorney/paralegal should provide information about special training or knowledge and give you this information in writing if you request it. You have the right to be told by your attorney of possible adverse consequences should you lose your case. Those adverse consequences may include money that you might have to pay for costs and attorney's fees to the other side. You have the right to have your telephone calls returned promptly. You have the right to ask your attorney at reasonable intervals how the case is progressing and have any questions answer to the best of your attorney ability. You have the right to make the final decision regarding settlement of your case. Your attorney must notify you of all offers of settlement before and after the trial. Offers during the trial must immediately be communicated and you should consult with your attorney regarding whether to accept a settlement. You have the right to file a grievance regarding Legal Aid decisions, actions and the implementation thereof. H. RESPONSIBLITIES The following are the responsibilities expected of you as a client of the Legal Aid Society of Palm Beach County, Inc. You are responsible for assisting the Legal Aid Staff in any and all aspects of your legal representation, including, but not limited to, requests for information in a timely manner and with providing accurate and truthful information regarding your case. You are responsible for keeping all scheduled appointments, including attending any trials, final hearings necessary court and/or administrative hearings, depositions, etc., and with keeping the Legal Aid staff advised of any changes in your address, telephone number or other pertinent personal information, etc. You are responsible for demonstrating behavior that is cooperative and respectful of others, and for following any instructions to the best of your ability. You are responsible for notifying the attorney representing you when you have problems obtaining services or when you are dissatisfied with the services provided to you. M LO N V— Any individual may file a grievance regarding Legal Aid decisions, actions, and implementation thereof that has adversely impacted them in a substantive manner. This complaint/grievance must be in written form in order to be considered. Step 1 Complaints will be addressed by Robert A. Bertisch, Executive Director of the Legal Aid Society of Palm Beach County, Inc. the Executive Director or other designated staff members under the Executive Director's supervision will have fifteen (15) calendar days to research the complain and submit a written response to the complainant. if a response cannot be submitted within fifteen (15) calendar days, the complainant will be notified in writing of the anticipated response date. The Statement of the Complaint/Grievance must address the following: The specific date and nature of the event or action in question. A brief statement of the facts surrounding the event or action as perceived by the complainant and in what manner this has adversely impacted the complainant. Redress sought by the complainant. step 2 If the complainant is not satisfied with the response obtained in step 1, he/she may follow the same steps as above addressing the Chairperson of the Personnel Committee of the Board of Directors of Legal Aid Society of Palm Beach County, sending along with his/her complaint a copy of the Executive Director's response. This must be done within ten (10) working days of receipt of the above response. The Chairperson of the Personnel Committee of the Board of Directors will review said complaint with the committee and respond to the complaint or will discuss the matter at the next Board or Directors meeting, if necessary, and the notify the complainant of the final decision. I hereby acknowledge receipt of a copy of the Client Rights & Responsibilities and Grievance Procedure. Signature Date It L0 04 V - Palm Beach County Office of Equal Opportunity 301 North Olive Avenue, 10th Floor— West Palm Beach, FL 33401 Telephone: (561) 355-4883 / FAX: (561) 365-4932 / TDD: (561) 355-:1517 h It I P:./J,, W M a C. P, h q 9 P -V- —Cq . -rol M" I u p (a Art! 1 D A y iMP'&—RTANT-kOT CE 0 POTENTIAL COMPLAINANT: Completion of this form is necessary in order for the Office of Equal Opportunity (OEO)to determine if you have sufficient legal grounds to initiate the filing of a complaint of housing discrimination. Completion and submission of this Questionnaire does notconstitute the filing of a complaintof discrimination. Upon receipt of this completed Questionnaire, we will determine if you have stated sufficient factual allegations to proceed further. If the facts are not sufficient, we will either contact you for further information or notify you of our determination that the facts are not sufficient. If the facts are sufficient, a complaint will be prepared for you to sign and return to OEO for filing and investigation. You m ust return the signed, notarized complaint form so that it is received byOEOwithin one (1) year of the date of the most recent act of alleged discrimination. When completing this form, please print legibly or use typewriter. Please do not write on the back of the page. Use additional sheets if necessary. PERSONAL INFORMATION: i. My name is: (First) (Middle Nanneor Initial) (Last) 2. My date of birth 3. My gender is and my racial identity is 4. 1 reside at in the City of State of County of pr�]= 6. My day time telephone number, including the area code 6. My evening telephone number, including the area code is: 7. The name of a person who will know how to reach me is: Their telephone number (including area code) is: What is the name of the housing provider, landlord, condominium association, homeowner's association, realtor, etc., that you believe discriminated against you? Revised 03/06/2008 Housing Questionnaire 1 of 6 What is the address of the house or property that is involved in your discrimination claim? - — — -------- - In what Florida County is this property located? Were you residing at the above address at the time of the alleged discrimination? - - ----- - S,-1 (Yes) .......... . ... . . (No). If you answered yes to the above question, when did you first move to this How many units are located at this address? Is the subject property: (a)_ n_multi-family (apartment/condominium); or (b) single family. Please indicate the basis upon which you believe you were discriminated against. (Check and respond only to those that are applicable to your case.) Race. If your claim is based on race, what is your race? Color. If your claim is based on color, what is your color? National Origin. If your claim is based on national origin, what is your national origin? ❑ Sex. If your claim is based on sex (or gender), what is your sex (gender)? ;YesIf your claim is based on sexual harassment, did you report the alleged harassment to the housing provider.) - es % )No. If yes, what actions did the housing provider take based upon your report? Age. If your claim is based on age, what is your age? Religion. If your claim is based on religion, what is your religion? —Did you request an accommodation for a religious practice or belief? ---aYes --allo. If yes, what was the housing provider's response to your request? 1:1 Familial Status. If your claim is based on familial status, please indicate the number and ages of your dependent child(ren): ElDisability. If your claim is based on disability, what is your disability?. —MO—TE.. iF Yf7l1R rl, MIS RAID ON DISABILITY PLEASE COMPLETE THE A7TACHF,P DLSABILITY IRE -1 Did you request an accommodation or modification for your disability? ;Yes No. If yes, what accommodation or modification did your request? What was the property owner's/housing provider's response to your request for an accommodation or modification? Marital Status. If your claim is based on marital status, please indicate whether you are.oingle; kjmarried; divorced; .0 other (please Sexual Orientation, If your claim is based on sexual orientation, what is your sexual orientation? Gender Identity or Revised 03/06/2008 Housing Questionnaire 2 of 6 L0 W) 04 T - W L0 04 V - The most recent act of discrimination took place on (Month) (Day) (Year) BRIEF STATEMENT REGARDING YOUR DISCRIMINATION CLAIM. (Briefly describe the action that was taken against you that you believe to be discriminatory. Indicate what harm, if any, was caused to you or others in your household or family, as a result of this alleged action. For example: Were your refused rentaljleasing? Were you subjected to different terms and conditions? Was housing falsely denied as being available? Were you harassed? Were you denied a mortgage/insurance/financing?, etc.) LLS.ft-IoLtignal sheets if ne—...- Please do not vqriteon,,Lhe _.revs &.e side What reason, if any, did the housing provider give for the alleged discriminatory treatment? Why do you believe that the action taken against you was discriminatory? Revised 03/06/2008 Housing Questionnaire 3 of 6 The names, addresses and telephone numbers for all persons who have knowledge about the alleged discriminatory treatment are listed below. I have also given a summary of what each person knows about this matter. WHAT RELIEF ARE YOU SEEKING IN THIS MATTER? ARE YOU WILLING TO PARTICIPATE IN MEDIATION TO SEEK AN EARLY RESOLUTION OF YOUR CLAIM(S)? rl� Yes. No. AAVE YOU SOUGHT ASSISTANCE FROM ANY OTHER AGENCY, ATTORNEY, ETC10 If so, What is the name of the source of assistance? Date of assistance:----_.-..-_ Results, if any: HAVE YOU PREVIOUSLY FILED A COMPLAINT WITH OEO or HUD ? Yes No. If yes, when did you file: Complaint No. (If known). A. I have been advised by a representative of the Palm Beach County Office of Equal Opportunity (OEO) that completion of this Questionnaire is necessary in order for the Office of Equal Opportunity to determine if I have sufficient legal grounds to initiate the filing of a complaint of housing discrimination. I understand that completion and submission of this Questionnaire does not constitute the filing of a complaint of discrimination and that upon receipt and review of this completed QuestioffMrore, OEO will determine if I have stated sufficient factual allegations to proceed with the actual filing of a complaint of discrimination. B. I understand that to be timely filed a complaint of discrimination must be received by OEO within one (1) year of the date of the most recent act of alleged discrimination. Under penalty of perjury, I declare that I have read the entire contents of this Questionnaire and that my answers and statements contained herein are true and correct. 61173M Printed Name: Date Signed: Revised 03/06/2008 Housing Questionnaire 4 of 6 r. - L0 04 T— 00 LO 04 T- mm - (Continuation Sheet) a) •U V) Rl M LO N T cn a O L to C +, a N L O a O � v L v C a a bA � C + U a U a� a-+ U p a 0 o L— U_ Q E N O } +� ra a +� Q Q u U� a -C M O C U N o a o 'O C L o O a-.+ N fB L Q 0 O _ i a -0 fB .� a � a dA 0 -- aa +�•,d a a v) d UU U' � L m LQ CU a U CU -� C of Q 6 Q � +' a io Q} 4- M t x a O N CL 4'0 +- O; a 4- M :� a s N > 7 > �J O +� a +' U C Ou m � N v) a� O +� > c� _ a C C N Ln a L C C a L a o Ln O L i p > N p C 'L U O bn p a Q '4- + -0 E p C6 +, o U +, =) L N p N o 4- C O O L a a+ of a +� (J O -0 a ca .0 U C Vf O N +-' >� C o U Ln a +1 O > Q� Ln CO p +� C .p .O aj t]A L C a s O a a .0 4 � N (6 U W L p_ > (6 a (6 Q 'L U G � v V) a � L � Q a Q a � U +� � a o O � � +' " � �, � � � Ln a j a L Q (6 U +� U �^ u 3 a } `~ C `� H a Q a + Q L C o C E� a +' a a p +� O a cn O Q C Q a +J C a-0 p +1 C C o C t C p O Q _ �•++N��+ aUaQ > UaC aa _p> 0- m p s a U E iQ +.+ Q UO (9 N raa C o U 9 O U0 4 0 o E 0a i a bn -0 +O x A a + t Q o Q C C 3 a� •� N 3 C o O +' U > O m o > m a E a u Q u L D . 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Bertisch, Esq., Executive Director Legal Aid Society of Palm Beach County, Inc. 423 Fern Street, Suite 200 West Palm Beach, FL 33401 Re: Community Development Block Grant (CDBG) Funding FY2023/2024 Dear Mr. Bertisch: This letter is in regards to your application for CDBG funds for the Fiscal Year 2023/2024. The CDBG Application Review Committee assessed your application for Public Services — Fair Housing Project and based on their scoring, funding recommendations has been forwarded to the City Commissioners for approval, for the amount of $7,500.00. Final recommendation approval will be at the regular City Commission Meeting on August 1, 2023, at 6:00 pm. The City Commission meeting will be held at 100 E. Ocean Ave., Boynton Beach, FL 33425. We recommend you or a representative attend the meeting to address any questions that may arise regarding your organization and/or services. Thank you and we look forward to working with you. Sincerely, . ............... . . ­­­­�', RJ ,amirez Community Improvement Division Manager 1263 B 0 ynton Beach Faith -Based ity Development Corporation, 2191 N Seacrest Blvd Post Office Box 337 Boynton Beach, FL 33425 Phone: 561-752-0303 Fax: 561-244-5046 M w—Mboyntonedc."r March 27, 2023 City of Boynton Beach RJ Ramirez, Community Improvement Division Manager 100 East Ocean Avenue Boynton Beach, FI 33435 Dear Mr. Ramirez: Please find our application for the CDBG grant referenced above, You will find included one complete application and attached a UBS Jump Drive as our electronic version requested, Vile feel that the housing is the highest need in the post-COVID pandemic and COVID inflationary period of soaring rents, taxes and insurance cost that have become unbearable with seniors on fixed incomes particularly, . ere'l Keturah J sep Executive Director Cc: Courtney Cain, Board President File–Grants: 2023 CDBG Grant Application for Rehab A COPO EJEI HEF 0,h FEEC fAt &N?E'P'.,;IE 7o�ATONSND ,FIN'ANCilkE. HWORNIA 70A/i OR BOYNTONSEACHFAITH BASEL) CP, CI'� UVC _ALOQ �fii()A BASED 04.1211,,?), 0 t Vi 5 P C �/V 0C" (1 0 NS LAPO E R .`FECES C E 5 133 C A L �I NG TO I t -F R E E I - & X) I E I f F LA h' 4 3 5 ­ S3 52) 08 7 � H I N T H E 5 TAT E OR W 1, f T7 N 6 T1 i ER �pVf 05 / 7 F, W til W d i 0 R C VA C QNS U N1 ER F � Et P, Co %A EJC. G C S TR A T1 0 N D 0 ES V 0 7' f fVTPLY EN 0 C R :5 E NI E N.E. APPROVA I Of? RE C0&,TA4EN1.')A E [ON BY S FA TE, 501 (C) I AX EWAIIF'r 65. 0971,509 BOYN TON UEA CH F11, R 7 BASED CDCfl��T, RECTIVES) 1,00 k,,01: WTH 09�. GWENTO, A PROFESSa'ONALSC'00TOR 1264 Fiscal Year 2023 October 1, City of Boynton Bea ch Community Improvement DIM 11 , I IsWirl 100 I-Wst Ocean Avertue Boynton Beach,, FL 3.34,3115 roiff&] RJ Ramirez, Community Improvement Division Manager COMMUNITY IMPROVEMENT DIVISION 100 East Ocean Avenue Boynton Beach, FL 33435 Telephone: 561-742-6359 Email,.rq reKtEkbfL , ML —.uE boynton-beach.org/community-improvement 1265 MOM X Submit UaAd %V pil .111 IM Ill IFINIP WITIO 11 p lispill; X Board Member list. X Copy of latest audit. ADDITIOIAL ATTACHMENTS ....... . . . . . . . ... .. .. .. .. . .. . ................ .... ------------ - ---- . ........ ---------- X Attachment I Agency Articles of Incorporation, Agency By-laws, and Tax Documents submitted to the Internal Revenue Service (IRS). 701' G&Fies Pf current lice-rIll naer,,Le,4�-" *jvil (,2s apvticable to the funded activity) including City of Boynton Beach Business Tax . ....................... .......... . Attach m ent 3 Documentation of all additional funding sources for � program(s)lproject(s) listed in application �if applicable) . ....... . . . . ..... . . .... .. . ........................ . Attachment 4 A job description for each position for which funds are being X -Attachment 5 requested (explain role/responsibilities within each P!Ol (if lic« #Ie) L X Attachment6 Intake Forms N Moo 0 1266 WIM, I certify that I am authorized to submit this application on behalf of the applicant agency. —J I affirm that the award and payment of grant funds are subject to the sole and absolute discretion of the City of Boynton Beach City Commission without recourse. By submitting this application, I waive any and all claims related to the City of Boynton Beach CDBG Program and specifically agree to indemnify and hold the City, its employees, officers, agents, and representatives harmless from any and all claims which may be in any way related to any City of Boynton Beach CDBG Program award, payment, and/or denial. I certify that my agency was established and operating in the City of Boynton Beach on or before October 1, ................ . 20M .. . .. .......... If funded, I affirm the applicant agency will continue service operations in the City of Boynton Beach, ................ I affirm that the tax documents provided in this application a have submitted to the Internal Revenue Service, ......... . . . . . . . . . . . . . . ................... I acknowledge that, funds are distributed by reimburs,,e,,M,,ent_qn1)L. if this grant is approved, any amount my agency receives may be considered taxable income by the Internal Revenue Service. .............. ............... I acknowledge that, if this grant application is approved, the City of Boynton Beach and Representatives ofthe Inspector General, and the General Accounting Office shall have access to all books, accounts, records, reports, files, and other papers, or property pertaining to the administration, receipt and use of CDBG funds necessary to facilitate such reviews and audits, as applicable and described under 24 CFR § 570.490(c). . ....... . . �T_acknowledge that, all records relatingto the City of Boynton Beach CDBG Program, including supporting documentation, shall be retained for the greater of three years from closeout of the grant to the City, as applicable and described under 24 CFR § 570.490(d), unless there is litigation, claims, audit, negotiation, or other actions involving the records. The records must be retained until completion of the action and resolution of all issues. . . . . ....... . ........ I I acknowledge that, if this grant application is approved, my name, my agency name, and my grant award amount maybe made public by the Cit of ton Beach. I acknowledge that,if this grant application is approved, my agency will be subject to Florida Sunshine Law, FL State Statute 119.0701 .......... . .. . .. .. .............................. .. .... ­­­ . ....... Print Full Name: Kettwab-Joseph Applicant Signature: Title: -.1xecutive Director Date: — 327L2023 1267 91M =-= M To submit an application, complete A — 1, Attachments 1-5 (if applicable) and any other items requested. Do not include any items that are not requested. Submit a Hard copy and a digital/electronic copy with all attachments to RJ Ramirez, Community Improvement Division Manager (ra irezrc�bbftus) community Improvement Division, 100 East Ocean Avenue, Boynton Beach, FL 33435 by S Please review the "CDBG Subrecipient I nf o rm ation an d G ui de [I n es" ava i [a b I e at CDBG C ly-sj �115 �,vatq YPPA�ZW �N) Jkm:11g�L g r the program reporting requirements, goals and timelines. For assistance, Please call the Community Improvement Division at 561-742-6359. Per 2CFR Chapter I Part 25 and the Office of Management and Budget guidance on Federal Funding Accountability and Transparency Act (FFATA) Subaward and Executive Compensation Reporting Issued on August 27, 2010, each prime grant recipient may make subawards only to entities that have Unique Entity ID Number. 2. Name of Project: Limited Owner -Occupied EmeEgency Reha�ilitation & N,gW Housin Pgyglopment 4. Contact PersonMtle: Keturah,,Joseo�b,/',Ex,,e,(;,u,,t,,Ive Direct—or . .............. - (Preferably Executive Director/PresidenilCEQ) Email Add ress:,kLo-s-e-pt,,@,�,9,yriW,,u.���hcdc-o�r Telephone: 561-752-0303 Fax: 561-244-5046 Additional Contact Person/Title: Sharon Frew/Social Service Director (Preferably Person responsiblefor preparing reirnbursementsIquarterly reports) ......... . .... . ... . .............. . . . . ........ Mailing Address/Zip: PO BpX,aR, 1311111111o, ntoln Beac 1,, FL ........... Telephone: 561-752-0303 --- Fax: 561-244-5046 I 1268 MBWMMM�� Homeless Prevention Service,� Public Safety/crime Prevent Senior Services Other (please specify): Domestic Violence Prevention X Housing Rehabilitation Program — Educational Program 7. Amount of Matching Funds for Project: r2,64�?J . ........ __ MatchType., X Cash — Other Grants — Donations X Other IIIIIIIIII 111111111111111111 � I rl 111111111111111 1!!I� (a) Total CDBG Funds Requested (a) Total Project�l,,IL9,6.8.1 (b) Total Unduplicated Units Served -., 20 . -- (Explain how determined?) ... . ............... . . . . . . . . ...... .............. ... .. .............. construction of 2 new housingVnits o,,p,,pcant lots. El 1269 9. Is this project: A new service; or X A quantifiable increase in the level of an existing service which has been provided by the grantee on its behalf through State or local government funds in the 12 months preceding the submission of the grantee's Consolidated Plan Annual Action Plan Has the applicant received or will receive other Federal® State or local government funds for the proposed project(s) for which the applicant is requesting CDBG funds? Yes to if Yes, what is the funding source? 41A How much? 10. Could this project occur without these funds? Yes X No project/program after CDBG funds have been spent. Laic U�41 AND A 1 REF114 1M, ;RMNAIRAWAGAURIJ "Of 1270 WWO, NMI am'' 1"I 11"WAINN 110'0"'00101! 0 request, progress reports, end of the year report, etc.). (Attach additional sheets if necessary) p .,ynl!Q,o fleach Faith Based Community Developm iB _qy nlqa Beach MJ willcontinue ur neighborhood revitalization activitieselig:ibleunder 24CFRI!j__, "Sgggjg���EQO d it �jncor �gratts two disti, , vities. 1), Ho 'n __Ogt ggti g" Develorlment/New Home Construction, and 2) Limited Qwner-O��gypjqdEnjgEggncy' Rehabilitation. Housing Development Ourhousin dev lop ent qgQMftyKpMIdes various hou op to el mL low jiA– -vp[tunit i bLe and moderate-incomefamilies.,.,Ibep mqU ctive of this activity J� jo crqq, te safe and, clecent.housin that lower-income individuals and families can afford and is intended to improve and revita,lize,,the HOB tanget communit�L,The,,ho,u,sin,g,,developmenllqiy� th''11,111"I's—prq Ule-farnfly homes on vacant sites in the HOB communftjj�M, m i s s i o rin affordable homeownershi � op ........................................................................ to-lolwlllland moderate iIncome residents. The homes will be attractive in design and will rap&q ih _go sq. ft. to 1800 s . ft. Recent Housing Development Accomplishment - e c e n t "I 1,131 new home redevelopment Prolect that was partly �ponsorecl �y the City -in the HOB... Th"e"I"Cit'lly clona f the thirteen lots, and the CQC.qP ba ted nine -(9) o ------------ Ittl MI, MUM — ----- Ignal w''CUMMMUI UWANAMMIM1011111111, 1271 4n;UUPjU6_IT7j propci as Lneir pnmary residence for the loan term.. However, the loan is repayable if the home is sold, ownership is transferred, or the owner ceases to occupy the home as their primary residence during the loan term. Sadly, many low and middle-income home owners are unable to afford home improvement/repairs to address home maintenance issues and correct health and safety hau, rds. Boynton Beach CDC created the Limited Owner -Occupied Emergency Rehabilitation Program to assist these homeowners with :f..... home rerairs. The Droiect vill III 1 1 1�! 1 11 V! 1111, 11 Ilk i,il mom== u*114-Itt'lun, dul, IL wim anow 17,7777-ro,'como 17TIUM7,7777 To MaTT777,15777 nom77`nCTSb1p status in a city/community they have likely called home for decades. Eligible 9 1272 7. Applicants' must be current on any obligation owed to or insured by the Feder Government including student loans and child support payments, i Maximum.,F nd" 1. The maximum award is $25,000 per household and the amount of the award will be based on the amount necessary to cure existing substandard conditions or accessibility. 2. Qualifying homeowners with at least one household member 62 years or older will receive financing through a grant that will not need to be repaid. 3, Eligible non -elderly applicants will receive a zero -interests deferred loan will have no monthly payments. The loan is forgivable if the homeowner occupies the property as their primary residence for the loan term. The loan is repayable if the home is sold, ownership is transferred, or the owner ceases to occupy the home as their primary residence during the loan term. 4. For homeowners with deferred loans only, when transfer of title is caused by the deat of the recipient, the heirs to the property may assume the obligation of the original recipient under the terms of the repayment agreement with no immediate repayment of the funds required. In order to do this, heirs must meet the eligibility requirements the program, and use the property as their primary and principal place 1M•'•• residence. Limited Owner -Occupied Emergency Rehabilitation loans are not assumable. 1273 M OMMSM7M zmzm=<v% 2 2 «> SHMEMM mo FA ,douseholds/Persons: 9ouseholds/4ersom.— (plea\\\/.«.\\ich\ 1274 L What documentation/data was used to determine the need for this type of program? See D-2, below 2. How do you evaluate the overall effectiveness of the program? - See Continued Pg. $(a) 3. How this project relates to the overall organizational structure? - See Cointi ntled Pg. 8(a) & 8(b) 4. Be very specific how the CDBG funds are proposed to be used? - See Continued Pg. 8(b) 5. How CDBG funds will it impact your current operation? (Attach additional sheets if necessary) - See. Continued Pg. 8(c) D-1: The documentation/data used to determine the need for the project came from the following sources: A. The City, of Boynton Beach published Consolidated Plan identifies, U rehabilitation and greservation of e Owner-Orcu, ,,Rehabilitation p,,LogCpm wiLl address a need identified as, a "'high priorit -!&the Cit ,ABynton Qeach. IWA . . ......... . M M Tin pArate 2 21 2 Florida International Universitv MULHOB ComMun' ..... ....... . . . . ........... .......... . _it .y_AssessmentZ Pillar # 5 -"Housing: reports similar findings. One of the fivg specific,!_ousing" recommendatJons-of,the ELU rep -p C s" maintenan [tin, [We Providing rehabilit@jjg�j assistance for older homes,� of which 97.5% @Le ver 22 y a o D. Boynton Beach CDC's two -months marketing efforts [rgLJd-Jaqy,g[jJq rn�l -MarLbl resulted d_ in more than 40 interested agglicants contactinp,_g "rkJpe.fqr ram Jnformation �flcan ne-gdjQ-r1bg-PrQKr—am. J1JJJT,.M4Q*AMZ I "M L WIN I M'., I its UONAMM -1—IMMEM110, their homes into co Hance. 1275 -1141-14 "WMIFF1111 q'iMARTUNT 7 If !k The success/effectiveness of the program will be measured by the following - 1. Number of applications received and the completeness of the applications. Completeness means every required document is included in the application package. If the application is not complete, success is measured on the timeliness/expediency of the follow up calls/ emails to obtain the missing documentation 2. omplete application turn -around time (no more than 14 business days), A complete application is submitted with all the required/supplemental documentation. if the application is complete at initial receipt, the application should be submitted for final review within 14 business days allowing time to receive the Verification of Employment (VOE) 3. Number of homeowners assisted - the total number of homeowners assisted should not be less that the proposed "total unduplicated units"' 4. Expenditure timeliness — whether all funds are expended in a timely manner as stipulated in the agreement 5, Number of applicants' complaints received. A large number of complaints is a clear indication that the administration/implementation process needs to be reviewed and/or improved. 6For the new housing development activity, success/effectiveness is based on the date the Certification of Occupancy (CO) is issued and the sale date. Additionally, we maintain an excel spreadsheet on all participants of our programs. The collected information stores name, address, phone number, service requested and received, date service was rendered. Everyone that comes into the office signs in. The sign -in sheet captures pertinent contact information and reason for the visit for future reference and follow-up. I T= 1!; 1 � � � � i I i � 1! P, 1 1:111 1' 11 =1 The organization structure was established more than twenty-two years ago when the citizens who came together to address crime, decay, neglect, and blight in the Heart of Boynton (HOB). Our primary mission is to promote the economic revitalization of our mission is to address slum and blight and improve the deteriorating housing stock of the HOB. The objective is to increase the permanent supply of affordable housing in the HM That objective is accomplished though our housing development activity. We create, sustain, and promote access to safe, decent affordable housing for low/moderate-income individuals and families, the vast majority with household incomes below 80 percent of AM 1. 1276 The Limited Owner-occupied Rehabilitation program is a continuation of the CDCs primary mission to improve and revitalize neighborhoods and aligns perfectly with our or",nizational existing homes), and it allows us the opportunity to broaden our mission of "sustaining" housing for low/ moderate-income homeowners as well as improving the existing older housing stock, The goal is to increase the quality of the older housing stock by addressing health, safety and deferred maintenance issues and preserving homeownership for lower- wage individuals and families. The project/initiative will continue our comprehensive neighborhood revitalization activities eligible under 24 CFR 570.204, "Special Activities" by Community Based Development Organizations (CBDO). BBFBCDC. Our current housing activities include the following: 1. New home construction on vacant lots that are either donated or purchased. 2. Acquire, renovate, and sell or rent distressed/abandoned homes to eliminate 3. blight (neighborhood revitalization). 4. Affordable rental housing. 5. Supportive housing opportunities for at -risk single individuals. 6. We recently completed (2/28/23) an emergency rental assistance program that provided rental assistance to more than seventy (70) individuals that experiencec, financial hardship due to COVID-19. Although the limited owner -occupied rehabilitation project is a new program recently and the program's concept and implementation process is not new to us, It allows us to serve a broader base of residents we did not previously serve. However, the program's �To'&, 01AMM(Mise2 The application and eligibility determination and certification process are similar to the first-time buyer/down-payment assistance and the emergency rental assistance programs. Staff is very knowledgeable and experienced with the income determination and certification process and have all the necessary skills. The rehab I litat !on/re n ovation process of the residences is similar to the renovation activity we undertake when we purchase distressed/abandoned homes for renovation. We don't anticipate any lag time with Implementing the home renovation aspect of this program. We are ready, wng and able to implement this activity immediately. D-4 Specific Use of Funds The total requested amount is $535,000. If granted, eighty-five percent (85%) will be used to directly fund (pay for) renovation/repair cost and related expenses to correct emergency health and safety hazards and code -related issues for eighteen (1 8) eligible low/middle-income homeowners at $25,000 each. The remaining fifteen percent (15%) will fund the related activity delivery costs to implement the program and will pay a portion of staffs salary. 1. Requested Amount: $535,000 2. Less Activity Delivery Cost @ 15%: $80,250 1 Max Available for Pr og Expenditure $454,750/$25,000 4. Total Number of Clients to be assisted -1 ($454,750/$25,000 =1 .1 clients) 1277 ZMHM�� • Expand the Owner -occupied Emergency Rehab Program • Number of homeowners assisted will double • Owner -Occupied Rehabilitation initiative will expand or neighborhood revitalization efforts • Provide a broader base of experience to apply for additional funding (state/federal) to continue the program. The "Project" will continue and expand our newly created Limited Owner -Occupied Emergency Rehabilitation Program that serves eligible low/middle-income residents, We I a u n c homeowners. Within two months, we have accumulated a list of 42 interested applicants, but we can only serve 13 homeowners at $25,000 each. The program is in high demand, but the current funding is limited. The funds will allow us to expand the program and provide dollars to assist eighteen (18) additional low/middle-income homeowners who have expressed an interest in the program but do not have the money to pay for the renovation/repairs themselves. It will also significantly increase the number of residents we assist, Additionally, it will assist the CDC with documentingthe program experience needed to seek state and federal funding to expand the program further and help more homeowners. 10 1278 1. Where will the program take place and is it within the City of Boynton Beach Municipal Boundaries? Who are the targeted beneficiaries (i.e., geographic area, persons served, etc.), and how are they selected for the program7 MMI n. I'm Amed-0-0-41"Mg,, ed basis. 2. Are you working with other organizations in a cooperative effort on the program? Yes No X If Yes, please list the other organizations and their role and responsibilities. (Attach additional sheets if necessary) -NIZA . . . . ............. - ------- . ....................... . . . —'-- . . . . ...... M 1279 3. The City's CDBG funds must directly benefit low -and -moderate -income individuals (80% Area Median Income (AMI) or below). The City's CDBG program requires non-profit organization to income certify individuals seeking assistance through activities/programs/projects funded with the CDBG funds. Has the organization done income certification of individuals seeking assistance in the past? Yes X No If yes, please explain the process the organization uses to income certify Individuals? What type documentation is collected? Please attach with your application, a copy of the form your organization uses to income certify individuals. REM - ------ - - V AVA I Emm- statements for all checkin e,r,p rall r,,zvinP4z _quired, most recent 2 rw*�jiths fn , 1 111111 a ' 9110ift I er& most recent rs x returns, if self-employed,, most recent-2yegEs tax returns includiagAll schedules and yggr-to-date Profit and I ­< �ztp- nt. The income m nje m the Inco e Certificatj —OULU •- ------- al fair Tr -- --------- -- 11M bers 18 and over are also ,rgquilred SeeAttachment6–lntake 'arn, Ful 1280 4. Does the organization charges fees to its clients? Yes_ — X S. Will program Income be generated from this activity? Yes_ No If Yes explain how will the program income be used? . ................. ... ... .... . ................. ... F. Goal s/Objectives/Activity Measures, Project/P wArmfor !qWj Ob"ective. pq urces Needed & Available: ER gn.dg-merR I I'll, I'll, I'll 11 -, BERM ................. -r,r,r,-r,r,r,r. ! ............. . Effff= Is 1281 Please list organization's anticipated expenditures, detailing requested funds and additional funding, Please place C=Cash, Hn-Kind, O=Other Grants, D=Donations beside each amount under "Other Project Funds," to denote the type of funds being used. If funding request is for multiple programs/projects, please provide a separate PROJECT BUDGET for each program/project 9,750 $128,250 VF7!r T ................. — ------ PayrollTaxes5,240 4,571 9,811 . . . .................................................. ....... . . . .. - .'�Lat .' enefits 3,216 3,038 6,254 ..................... . . ..... . .. - - ---- --- ----------­--- - - - -------- . ............................. ...................... . .............. .. . . . . ....... .. ................. . . . . .......... . . Office Supplies . . . . ........................... . . .. .. .... ... . .... . ..... , . ....... o­ysu—'lies — - - -------- .... .. Professlonal Services fee 3,294 8,022 11,316 .... ........ . . . . . . . .. ........................ ........ . . ........ ... ......... . . ....... Other (explain) .......................... . Other ex Iain ............ . . . ..... . ............. Iter (exple�n . ................ ....... . . . Other (explain) ........ ............ Other (ex l -.i..1 ...... . . .. . ................... — ---------- ........................ ............... . . �PRO GRAIIIM'1111: I — -------- Other (explain) Housi Rehabilitation 45 ,7 $454,750 n_r" _91 — -- ---------- . . ......... .. .. Other (explain) J$560,000 -- -------- — - — - - - - - - - - ------------------- . ..... her (explain) ........................ . ........ . . TOTALS $535r,999 �WABI $1,197,881 . ............... .............................. Notes. $535,000 CD8G funding —will fund the Limited Owner -Occupied Rehab prog $568,000 CDC funding — will fund construction of 2 new single-family homes . . .......... .............. — -------------------------- - — --------------------------- - ------- . . . ................. 0 1282 1Is the organization aM equately staffed and trained? See # 1, below 2. Explain how this program fits the organization's mission? See # 2 �bielow 3. Please explain the organization's experience with the proposed project? S Continued. pg. 14(a) 4. Staffing Capacity: Who works on the project directly and indirectly? See # 4 beic 5 S. Does the organization have written policies and procedures? How often are thel! policies and procedures updated? Provide a brief list of the topics covered in t[ organization's policies and procedures. The City of Boynton Beach may request copy for review during the application and award proce ass or as part of the gr at monitoring process, (Attach additional sheets if necessary) See Continued I 14(a) in 11� 111 ill . 1111 H-2: Explain how this program fits the organization'smission .... . ..... " -Beach--S L,)_Q revitaURation ofMqua `ties and 111,111hborlill,111,111 nershi and sustairLp �qrges,,-and_�nAovp p,11C ij1py se delivery � ,rn —9f-,5o6a1 terMjkqa__jR_ the emmpw�),, he infited D-M�-r -�:Dccup -Rshabifitatio ied is cqM �QLat iLAR1—prtb,.,ervL ho—niw,wo,piip ahilq ,-s-1ur4sgpd b1ijzl, it Aq-d-immo—yjDSJhe dgl� ora iT.12 will _--g 4�tai st t9 Vit i% QQ and neighk rhtst ds. Additlor .—M@4are attached as ontin 13 -P H-4: Staffing Capacity: Who works on the project directly and indirectly? The followtn,j� �hreej!�Lpff 1, tLdirectly in iggLLhe ro Eq _OftL_ __p I m. james Horn p2fl_aLerry J1reW . . ...... 5p!Jal servicg§ ire _Q:_ctor nd �Leturah JMep Horne will be the _pf (Mar ta�ctg,rigi.—He is r ns ible for intake, receh�lng 11 ApPk n�., and condulpfing 11 follo\q- , __g_ -Vp _L ,,_ah9LryJ Frew Will--pLovide idministratLye suRpog. IN 1283 A sign Ificant component of Boynton Beach CDC's mission is to promote the economic revitalization of the communities/neighborhoods through homeownership, A w©afunction of that mission is to address slums and blight by improving the deteriorating' housing stock in the neighborhoods/communities' including creating/maintaining safe, decent housing for lower-income families. Remaining faithful to our core mission while continuing to expand our redevelopment efforts, we developed and commenced a new program -the Limited Owner - Occupied Emergency Rehabilitation program - to complement our housing activities, This unique program aligns squarely with the CDC's mission. This program/project is an all- encompassing program that addresses several core principles of our mission - blight ,safety, slums, deterioration, affordable housing, and housing preservation. No other program overs many different areas of our mission. The assistance provided through this program can be applied to the "deteriorating" housing issue directly. it offers eligible homeowners a zero -interest deferred loan or grant of up to $25,000 for home improvement and incidental expenses that correct emergency health and safety hazards, code -related issues, and/or deferred maintenance and repairs. The funds pay the cost of the repairs directly, For example, program funds can be used to repair/replace roofs, windows, electrical, plumbin& bathrooms, etc. - items that contribute to the deterioration if left undone because the homeowner cannot pay the repair cost. 1284 Keturah Jo,%jjtj, fb�r Bp3mton,Bea,,q,h Faith Based CDC e e .. . . .. .... . . . . ........ . . . p��,enc� UR -9 �O—aln-JaAdlh§--Federal RQME —$3rWJlhan—hgmsJ" ,rogim Beach Countv. She L as coMp i4qge manAgprO�u confonnit"w. thgtatefedera andmm mt,i.msart( kg1p igiggg found to mect aid„jbg dsand-,,Aqcordin&Lg-tbqAmerican InsfiLut_epf _%g g_ fi R4W tin ant Standard,jp addition,. iL er de . ...... . . ... �tenU �Jj T gtb ,is with the GovemmentAc tine, Standard ................ ........ m AS9 _—As As _—As As Pr- A_c _ 14 1285 Boynton Beach CDC has been actively involved in the creation of homeownership opportunities for hundreds of low/mod-income families and has leveraged various funding sources including private loans, private foundations, City CDBG and SHIP funds, and CRA funds to successfully develop housing opportunities for lower -wage individuals and families, When needed, we have also provided secondary financing to ensure affordability for eligible buyers, Keturah Joseph, CEO for BBFBCDC, Inc, experience includes administered the State of Florida's $10 million SHIP Program, and the Federal HOME $3 million housing prognam funding Palm Beach County. She served as compliance manager ensuring conformity with state, federal a county regulations and acted as liaison with auditors, monitors and other regulatory agencies. I 1W I 9k r L I RAN individuals, Every unit purchased was fully rehabilltated/renovated. Rehabilitation incorporated "green" features to the extent possible and included upgrading major components of the home such as electrical, heating and cooling, plumbing, and roofing upgrades; appliances as well as kitchen, bathroom, and floor upgrades, etc. H-5 - Written Policies & Procedures The organizations general Policy and Procedures Manual is reviewed and updated every other year. The following is a list of policies and procedures topics covered: Standards of Conduct, Work Ethics, Job Descriptions, Conflict of Interest, Acceptance of Gifts, Benefits and Compensation, Use of Vehicles, i Actinn Twminnfinn nf 1286 V Financial Management System —Ability to track budget versus actual Yes, we use a QuickBooks program and create line items budget (sources and uses) or each programl project, allocate expense according that line item and provide necessary tracking of budgeted versus actual amounts. Monthly financial statements are provided for review by the finance committee and the board, Cashfiow Projections are provided and expenditures are compared to projections, Variances are noted and actions are taken to address any cash flow deficiencie& KWJJFQ� ardinwy Inca mn!�r Ncorne Gro" ftf* eve"Se Tvtgg rxpl!"S6 NetOnOrmy1nopme other rmomeiExpernit otherExpenAop Ask MyAceou"tant Total Other &Pense tm C*h6t he Net fncom6 pl;omt & Loss audget vs. AaWal ,January I theough FebrUArYr2, 74= Jan I -fob 2, 22 Budget 0,#Wr Budget 16 of Budget ffmmlffi�N� MWANIMMMM � � We use QuickBooks accounting program to track all program expenses,/expenditures, A budget will be created for each project[homeowner based on the accepted bid amount and all spending will be administered, approved and tracked as itemized on each project budget. A Request for Payments provides for Identification of each program and line Item in the budget. Appropriate back up documentation must be attached to substantiate the use of funds ,;rnnigg f* W, Srw6"lces vrid -ey-Deidilures under the terms and conditions of the arant illowable '57731-7-M , authorize payments. Payments are approved by the signature of theOur CPA performs an annual audit including a single audit If required. We have a finance committee that requires separation of duties for preparation of invoices, reviews, sign off required, reconcillation of accounts and check wdting. Two signatures o ' for each check and limb are set as to the amount the CEO can approve without board approval/consent. accomplished through a combinaton of procedures, methods, rules conduct, and standards. The Key characteristics of the financial management policies include, but not limited to: • Transparency and clear accountability at all levels of operation • All parties are held accountable for making sound financial decisions and following all rules and regulations. • Expenditures are planned, then checked against the plan (e.g. an approved budget) 9 1287 Costs are reasonable, necessary, allowable, and appropriately allocated to the correct funding SOOMP" A, (Capitalization and Depreciation Schedules), Insurance, Record Retention, and Allocation of General and Ad documents for federal review and auditing purposes, Record Retention Poll c" K il I t� -5�171cy —of 1313'�BCDC, Inc. to retain records as required by law and to destroy them when appropdate. The appropriate Director must approve the destruction of records. The fon-nal records retention policy of BBFBCDC, Inc, is as follows: Accounts payable ledgers and schedules 7 Years Audit reports Permanently Bank reconciliations 3 Years Bank Statements 3 Years Chart of Accounts Permanently Cancelled Checks 7 Years Contracts, mortgages, notes, and leases Permanently Correspondence vft customers and/or vendors 2 Years Deeds, mortgages, and bills of sales Permanently Depreciation schedules Permanently Duplicate deposit slips 3 Year Expense analyses/expense distribution schedule 7 Years Year-end financial statements Permanently General ledgerstyear end trial balance Permanently Insurance policies (expired) 3 Years Insurance records (policies, claims, etc,) Permanently Internal audit reports 3 Years+ Internal reports 3 Years Invoices (to customers, from vendors) 7 Years Journals Permanently Payroll records and summaries Pennanently Property records (Incl, depreciation schedules) Permanently Subsidiary ledgers 7 Years Tax returns and worksheets Permanently 10 1288 CFR 57S.611)yrohMts yerstn—swhq exercise Q-r--vA-9 k7-ve exercised any-funeti-vris or responsibilities with respect to the above grant ... or who are in a position to participate in a decision making process or to gain inside information with regard to such actives, may obtain '"W1111 rin a fina es r F;11 1:111 11 1111 V A W- wil 1. Is there any member of the applicant's staff, member of the applicants Board o? -MW"Ut6y �s application a City employee, or a member of the City Commission? Yes X No If yes, please list names: . . . .................mm... ........... of the City Commission? Yes X No If yes, please list names: . ......... . . . . . 1 Will the funds requested by the applicant be used to pay the salaries of any of the r�rI I fill UAW 1: 111 1 1 1 U I If yes, please list names: 09 1289 IMH®RLSVP Ip w frectly responsible is sufficient assurance for the City to award loan funding. Ii ' EMMA nin body of the applicant (if applicable) and that the applicant will comply with all the requiremen of this grant if the application is approved, -------- Name: Ketqrah Josqph Signature: Title:,, Wtlye 2 Lrector Na m Title: Date:.-3Z2V202 3— Signature:— Date: In 1290 REPAYMENT: Funding from this grant program is subject to federal, state and local audit. If a determination is ineligible expense or for expenses reimbursed by another federal, state or local grant/loan program then the awarded entity will reimburse the City of Boynton Beach these funds, SUBMISSION OF AN APPLICATION IS NOT A GUARANTEE OF FUNDING program, the application, and City's procurement process, if applicable. NOTICE TO THIRD PARTIES: The CDBG grant application program does not create any rights for any parties, including parties that performed work on the project. Nor shall issuance of a CDBG grant result in any obligation on the part of the City of Boynton Beach to any third party. The City is not required to verify that entities that have contracted with the applicant have been paid in full, or that such entities have paid any subcontractors in full. Applicant's warranty that all bills City to award loan funding. of this grant if the application is approved. z Name:Signature:, ......... . . . ........... Title: Date: Name: Signature:. . ...... "M mm [a 1291 INTERNAL REVENUE SERVICE P. 0, BOX 250B CINCINNATI, ON 4S201 Date: mv U 0 '1994 BOINTON BEACH FAITH BASED COMMUNITY DEV CORP PO BOX 337 BOYVTON BEACH, FL 33425-0000 Dear Applicant a 119, DEPARTMENT OF THE TREASURY Employer Identificati-on Number: 65-0971509 DLN: ilbS3073775004 Contact Person: SANDRA MAK ID4 95023 Conta6t Telephone Number - (S771 S29-5500 Public Charity Status: 170(b)(I)fA)(vi) Our letter dated October 2000, stated you would be exempt from Federal, income tax under section 501(c)(3) of the Internal Revenue Code, and you would be treated as a public charity, rather than as a private foundation, during an advance ruling period. Based on the information you submitted, you are classified as a public charity under the Code section listed in the heading of this letter. Since your exempt status was not under consideration, you continue to be classified as an organization exempt from Federal income tax under section 501(c)(3) of the Code. Publication 557, Tax -Exempt Status for Your Organization, provides detailed information about your rights and responsibilities as an exempt organization, You may request a copy by calling the toil -free number for forms, (800) 829-3676. information is also available on our Internet Web Site at www.irs.gov. If you have general questions about exempt organizaLions, please call our toll -tree number shown in the heading between 8:00 a.m, - 6:30 p.m, RasLervj time. Please keep this letter in your permanent records. Sincerely yours, leis G!'Lerner Director, Exempt Organizations Rulings and Agreements Letter 1050 fDO/CG) 1292 05420 IRS P'O. Box 2508 Cincinnati OH 45201 BOYNTON BEACH DEV CORP X COURTNEY C PO BOX 337 BOYNTON BEACH FAITH BASED COMMUNITY Awom"', FL 33425-0337 In reply refer to; 0248574153 Apr. 13o 2011 LTR 4168C EO 65-097150? 000000 00 00017038 BO Cs TE Employer Identification Numberi 65-0971509 Person to Contact: MS. JOCKERS Tall Free Telephone Number; 1-877-829-5500 Dear TAXPAYFRt This is in response to your Apr. 04P 2011, request for information regardino Your tax-exempt status. Our records indicate that you were recognized as exempt under section 501(c)(3) of the Internal Revenue Code in a determination letter issued in OCTOBER 2000. Our records also indicate that you are not a private foundation within the meaning of section 509(a) of the Code because you are described in section(s) 509(a)(1) and 170(b)(1)(A)(vi). Donors may deduct contributions to you as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to you or for your use are deductible for Federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. Blease refer to our website www.irs.gov/ea for information regarding filing reouirements. Specifically, section 60 330) of the Code provides that failure to file an annual information return for three consecutive years results in revocation of tax-exempt status as of the filing due date of the third return for organizations rid ouired to file. We will publish a list of oroanizations whose tax-exempt status was revoked Under section 6033(j) of the Code on our website beginning in early 2011. 1293 0248574153 Apr. 13, 2011 LTR 4168C EO 65-0971509 000000 00 00017039 BOYNTON BEACH FAITH BASED COMMUNITY DEV CORP % COURTNEY C CAIN PO BOX 337 BOYNTON BEACH FL 33425-0337 If you have any nUestions, please call us at the telephone number shown in the heading of this letter. Sincerely yoursp C A. Hartint operations Manager Accounts Management Operations 1294 PUblic License Inforrination License Number 23-00016590 Location ID: OW006103 Business Control: 0014476 Busriness Information Rusiness Wow BOYNTON BEACH FA IT11 BASED Bminesq Address: 2191 N SEACRES7 BLVD 813 BOYNTON BFACH F1 33435 Mailing Address: COMMUNITY DEVELOPMENT CORP. PO BOX 337 BOYNTON BEACH FL 13425 Owner Name: COIJUNEY CAIN Data Opened; 06/13/2002 I Business Phone; (561) 752-00 Contractor Flag: Typp, of Owners4lp: CP Status: Adivp Business officer's Addiess Address Eonad Nwme TWe atystate,zip 1 Phone lD COURTNEY CAIN PRESIDEN 33435 Showing 1 to I c-4 I entries Ucen%e hifon-nation Classificatiow CU2 - CERT OF USE& OCC COMM License Statex, A(TIVL, 0910912022 Data: Application Issue 08/21/2018, 09/09/2022 DaW License Valid Thru 09/30/20?3 Date ... .... . ... ... . .... . -- . .. . ... ..... .. AddRlimA Re(jUireirnents Code Desqjlpt�on 1, Docuwnevrt Nuivwdpew I Expiration Date Showing I to I of I entrion 1295 Public License Information License Nurnbm 23-00014969 Location ICc 000006103 Business Control: 0014478 Busliness �Information Business Narna: BOYNTON 13LACH MITH BASED Business Addiess: MI M SEACREST BLVD Elf GOYNION BEACH H. 33435 Mailing Address: COMMUNITY DR(O-OPIVINTCORP, PO BOX 33 f BOYN rON BEACH rL 3305 Owner Name: COURTNEY CAN Date Opened: 06/1.3/20W Business Pham (561) 752,0303 Contractur Pag: Type of Ownerships: CP Status; Active. Hume hiftwirmnafion Chssification: 561110 - OFF ICES EXECUTIVE & ADMINilTRATfVF License Status, ACTIVE, 03/16/2023 Date: Application issue 0813112022, 09/01/2022 License ViRd Thru 09/30/2023 Date; Additional Requirements Code DescrlptWn Document Number 1 Fxp�iratkn Date 9 DRPR MCNACANON OR Showing I to 1 ofI cnlks 1296 m 1297 . . ..... ... . - ----- -Pll as 'o 12 1.5 vx ..... ..... . . ........... ....................... , > .. . .............. ........................ . . .............. ......... . ................. .... . . Y+ rt of aY( MJ ........... . ..... L9 6i rl 4t) 4 Ol 40 i0 MCJ 1-0 m 1297 7'\`\ � J/ « `,\.\°��) /\,,}•{ ,\\../�). 1298 TABLE OF am Independent Auditor's Report 1-2 Statement of Financial Position Statement of Activities 4 Statement of Cash Flows Statement of Functional Expenses 6 Notes to the Financial Statements 7-10 Independent Auditor's Report On Internal Control Over Financial Reporting and On Compliance and Other Matters Based On An Audit Of Financial 11-12 Statements Performed In Accordance With Goven nniew Auditing Standards 1299 q,XM Carded PubHo Accountant ii9[YEI,PElq[I)Eiq'r AUCHTOFf"S RI F)ORT To the Board of Directors Boynton BeactFaith Based CorrinrwrRy Deveioprrient Corp Report on the Audit of the Financial Statements Q;Miinn R O� Box 105 1 IS Mvleira Beach, IRMida 334 114 Pli (561) 703-5197 E-maflu WhArasl iojrOn corricastrekt, We, hiave audited the accornpanykiig flinairiciai staterner iits of Boynton Beach Faith Based Conn'llunit y Development Corp (aa nonprofit organization),, wMch comphae the state.,ment of firtaincial posifion as of Decerr"Oer 31, 2021, and the rdated st8telrrlerft DfaCfi%`Ri1(-S, functional experises, and cash flows for, fl,we year, U'ren arded, aridthe relate Inotraas to the financW staterrients, in ouir opirrion, the firmrmW statements piresent fairly, in aii rnaterW respects, the financiai position of Boynton Beach Faith Based Community Development Corp as of December 31, 2021, and the changes in ft inet assets and its cash flovifs for the year then eiY iided in accoirdance with accouriting principles generaily accepted in the I Mited States of Arnerica, Basi's for OpInIon We cond=ted our audit in acClOrdarrce witl°i aulditing standairds generMly accepted in trie 1.1rifted States of Arrierica and thaw stanidards appbaa aWe to financW audits contained in GovernmentAuditing StandaIVS, issued by the (1'1O"omptroiier General of ttw,a Unfted,Ststes. Our responsibiNties under these standards are further descrilred ki the AUditor's Respoinsit4Wes for the AUdit of, the F:Inw idal Staternents section Of IDUil' re;wrt, We are required to be independent of Bqynton Beach F'aith Based C'cirrimuri DeIvOopnlent (,orp arrid to nwet our other sittyJ!cW respori�sibiiitres, in accordance Mh the reievant ethicW requirerinelir 4s relating to our audit. VVP beHeve ftt the aiudit evd(!rince Niue have obtafirted Iia SUfficient ard ai�)pircipriate to proviide ia basis for our audit opir0ons. Rens ponspilMitles of Manapemient for the Rnancap' al Stalentents Managernent is respionsVe for the preparatkrn and fair presentstioirof the firrandai statements in accordance with accounNig prindpVes generaiiy accepted h'i the, L.inited States of Arnedica, arid for the desdqn, h nplen'terrtatioi r, and rnaintenance of kiternW controi r0evarit to the preparation and fair presentaUori of finandai statements that are free frorr; niatedad n,irsstaternent, whether due to fraud or error. in pwepariing the finarn:W steateMents, rnanagernerit is reqWri:W to ev,uMuatewhether there are contiftions or events, considered in the aggregate, 0W raise SLibcotantral doubt about lel oyntion Beach Faith Based Community Development Ce abMty to coritinue as a going coricern vwithlra one year aftcar the date ftt the finandai statementsaware avaflable to be iwued Auditor's Rlimponssibliffies for the Audit of the Financial Statemetits Our objectives are to obtaiin reasonable assurance i whetimir the financial staternents as, a sthole are flee ffom, rnatierrial rnisstatement, whether dlLie to fraU(I or error, and to issue an audtor"s report that hiciudes our opniion. Reasonak)de assn krance is a high ttevpl of assurance but iss not absotute MSUrancie and ttreirefore is not a guiaranteei that amo audkcor4 uicted in accordarice Mh gienerafly accepted ftdiflrug staindards, and Govornment Audiffing 54andards wfli +gyalways dclrtect a rnateriai r6sstaterrrieint when it exists, The risk of not detecting a materiW misstaterrient resultir'from fratid is Ngtier tharr for one re.sultnQ frorn error, as fraud may involve colluifiori, forgely, inter rtional ornissions, rnisrepiresentatrons, or the override of Werinaf controi, Nfisistaternei rts are coirusidered rnated,W if there is a substanfiW fikehhood that, iiridividivaHy or in the aggregato, V'rey wouid Whic"ince ffie judgment rriade by as reasonabie user baseld on ti'm M iandai statements, 1300 In performing ars audit In accordance with generally accepted auditing standards and a ovemment Auditing Standards, we: 0 Exercise professional judgment and maintain professional skepticism throughout the audit financialObtain an understanding of internal control relevant to the audit in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of Boynton Beach Faith Based Community Development Corp. Accordingly, no such opinion is expressed. Evaluate the appropriateness of accounting policies used and the reasonableness of significant accounting estimates made by management, as well as evaluate the overall presentation of the complianceConclude whether, in our judgment, there are conditions or events, considered in the aggregate, that raise substantial doubt about Boynton Beach Faith Based Community Development Corp ability to continue as a going concern for a reasonable period of time, We are req uired to communicate with those charged with 4 overnance regardinq, amonq other matters, the that we identified during the audit. Other Reporting Required by Government Auditing Standards In accordance with Government Auditing Standards, we have also issued our report dated November 21, 2022, on our consideration of Boynton Beach Faith Based Community Development COr internal control over financial reporting and on our tests of its financialcontracts, and grant agreements and other matters. The purpose of that report is solely to describe the scope of our testing of internal control over financial reporting and compliance and the results of that testing, and not to provide an opinion on the effectiveness of Boynton Beach Faith Based Community Development Corp internal control over part of an audit performed in accordance with Government Auditing Standards in considering Boynton Beach Faith Based Community Development Corp internal control over financial reporting and ;r. Riviera Beach, FL November 21, 2022 1301 BOYNTON BEACH IT BASED COMMUNITY DEVELOPMENT CORPORATION STATEMENT OF FINANCIAL POSITION DECEMBER 31, 2021 Cash Real estate held for sale Grant receivable Advances Mortgage receivable Other Total Assets LIABILITIES Note payable NET ASSETS MahT#M Total net assets See accompanying notes to financial statements, Without Donor Restrictions $ 317,624 402,216 14,955 66,995 372,738 765,447 11 0 984 166,035 671 171,706 ,,779,253 1302 BOYNTON BEACH FAITH BASED COMMUNITY DEVELOPMENT CORPORATION STATEMENT OF ACTIVITIES FOR THE YEAR ENDED DECEMBER 31, 2021 Without REVENUES AND CONTRIBUTIONS Donor Restrictions Grants 396,477 Rental income 108,424 Other 2,038 Net realized gain on real estate 135,632 Total 642,571 TOTAL REVENUES AND CONTRIBUTIONS 42571 ........... Expenses Program Services 522,795 Supporting Services 103,458 Total Expenses 626,253 Change in Net Assets 16,318 Net Assets, Beginning of Year 1,762,935 Net Assets, End of Year 1,7 `9,253 11111111111 IRIIII 111111111!111!111111 !11!111 111!1! R�= I M 1303 BOYNTON BEACH FAITH BASED COMMUNITY DEVELOPMENT CORPORATION STATEMENT OF CASH FLO'WS FOR THE YEAR ENDED DECEMBER 31, 2021 nnn I . ..... . ..... FINANCING ACTIVITIES: Note payable payments Net Cash Provided in (Used in ) Financing Activities . . I . I . ....................................I22,_I ",tSt Increase (Decrease) in Cash (68,025) Cash at Beginning of Year 385,649 Cash at End of Year . . . ......... -,--3-17"-'6 . ... . ...... 2............ 4 ............. Interest Paid 13,175 See accompanying notes to financial statements. 1304 Without Donor OPERATING ACTIVITIES: Restrictions Change in Net Assets 318 Adjustment to Reconcile Increase in Net Assets to Net Cash Provided by ( Used in ) Operating Activities: Depreciation 31,578 Changes in Operating Assets and Liabilities: Advances (24,054) Rea( Estate Held for Sale 16,811 Grant Receivables 4,158 Mortgage Receivable 17,000 Other (8,484) Accrued Expenses 836 Net Cash Provided by ( Used in ) Operating Activities . . , . . , , I . ......... I 54,163 FINANCING ACTIVITIES: Note payable payments Net Cash Provided in (Used in ) Financing Activities . . I . I . ....................................I22,_I ",tSt Increase (Decrease) in Cash (68,025) Cash at Beginning of Year 385,649 Cash at End of Year . . . ......... -,--3-17"-'6 . ... . ...... 2............ 4 ............. Interest Paid 13,175 See accompanying notes to financial statements. 1304 BOAT ON BEACH FAITH BASED COMMUNITY DEVELOPMENT CORPORATION STATEMENT OF FUNCTIONAL EXPENSES FOR THE YEAR ENDED DECEMBER 31, 2021 See accompanying notes to financial statements. 9 1305 PROGRAM SIER., t99L 9"WER.9JELTINKLA Et Neighborhood Development Fund- Management Total and Stabilization ra,snn General . . .... . Exan Saiaries and Benefits $ 192,952 $ 82,694 $ 275,646 Professional Fees 16,192 4,048 20,240 Maintenance 35,663 35,663 Utilities 13,693 1,521 15,214 Homeowner Fees 2,940 2,940 Property Taxes 1,423 1,423 Office Expense 7,263 807 8,070 Insurance 15,439 1,527 16,966 Cable 5,134 5,134 Interest 13,175 13,175 Client assistance 134,580 134,580 Program Expenses 1672 11672 Other 51,443 '12,861 64,303 Depreciation wrvnnmmmmmwmmuumni 31 31,228 Total ........................ It inq AAA . ...... . . . ft See accompanying notes to financial statements. 9 1305 BOYNTON BEACH FAITH BASED COMMUNITY DEVELOPMENT CORPORATION NOTES TO FINANCIAL STATEMENTS DECEMBER 31, 2021 NOTE I - SUMMARY OF SIGNIFICANTACCOUNTING ACTIVITIES Xatqpq,.q( - Activities ........... — Boynton Beach Faith Based Community Development Corporation ("the CDC") is a nonprofit corporation organi 7ed to provide community service, youth programs, and improve the economic conditions of tile Boynton Beach, Florida neighborhood through facilitating home ownership for moderate and low income families, The Corporation also provides social services to the neighborhood. The Financial Statements of the CDC have been prepared on the accrual basis of accounting and accordingly reflect all significant receivables, payables, and other liabilities. Q§g,ff Eqirnates The preparation of financial statements in conformity with generally accepted accounting principles include the use ofestimates that affect the financial statements,, Accordingly, actual results could differ frorn those estimates, funetkag]4CLssificg tj 'x _ _Lon of E _Mnses In the accompanying Statement of Activities, expenses have been reported by their functional classification, a method of grouping expenses according to the purpose for which they were incurred. The primary functional classifications are program services and supporting activities. Program services are the activities that result in services being provided to mernbers that fulfill the purposes or mission for which the, CDC exists, Supporting activities are all activities of an organization other than program services and are included in the financial statements as management anal general expenses., and are allocated based on time spent, Grants Resources from Government grants are recorded as revenue when the related costs are incurred. All other grants, Unless restricteA are recorded as revenue when the grant is received. The CDC is dependent on continued financial assistance by federal and local government agencies. Contributions whose restrictions are met in the same reporting period is reported as unrestricted contributions, Co,.ncl,eti.t.r,lat.i.on_gif:jrqdi,t.Ris,k Financial instruments that subject the CDCto concentrations of credit risk include cash. While the CDC attempts to limit its financial exposure, its deposit balances may at times exceed federally insured limits. The CDC has not experienced any losses on such balances, a 1306 BOYNTON BEACH FAITH BASED COMMUNITY DEVELOPMENT CORPORATION NOTES TO FINANC�AL STATEMENTS DECEMBER 31, 2021 NOTE I - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Cont'd,) Contributed SgoLiqc�s The CDC does not recognize any support, revenue or expense from services contributed by volunteers, because they do not meet the criteria for measurement. Availability and Liquidity: Financial assets of cash $317,624, grant receivables $14,955 , financial assets available of $3328579 to meet expenses over next twelve months. la-CLpaielmer 1OW5 The CDC is exempt from federal income tax as an organi7ation described in Section 501 (c)(3) of the Internal Revenue Code. CDC believes it is no longer subject to examinations of returns for tax years ended December 31, 2018. There are no examinations for any &,m periods currently in progress, CpadbAm Contributions received are recorded as net assets without donor restrictions or net assets with donor restrictions depending on the existence and/or nature of any donor restrictions, Contributions that is restricted by the donor is reported as an increase in net assets without donor restrictions if the restriction expires in the reporting period in which the contribution is recognized. All other donor -restricted support is reported as an increase in net assets with donor restrictions, depending on the nature of the restriction, When a restriction expires(that is, when a stipulated time restriction ends or purpose restriction is accomplished), net assets with donor restrictions are reclassified to net assets without donor restrictions and reported in the Statement of Activities as net assets released from restrictions, The CDC has cash of $317,624 real estate held for sale or rental $1,167,663, and mortgage receivable of $372,738 at December 31, 2021, which are recorded as net assets without donor restrictions, however, those assets must be used in compliance with the grant agreemenis, Real Estatc-JigW_ yr Sale The CDC has purchased and renovated certain properties held for sale to eligible home buyers, These properties are valued at lower of cost or fair market value. Fair market value is based on recent market sale prices. ftw Arty - all idl%p,Vmqmt Property and equipment are stated at cost less accumulated depreciation. Depreciation is being provided by use of the straight-line method over the estimated useful lives of the related assets as follows: Office equipment, 5 years life. 11 1307 BOYNTON BEACH FAITH BASED COMMUNITY DEVELOPMENT CORPORATION NOTES TO FINANCIAL STATEMENTS DECEMBER 31,2021 . . .. . ............... _,, ......... . ....... . . . . . . . ..... . ................................................... . .. . . ....... . ...... .... . . . . . .......... . . ....... ��­,� . ........... NOTE I - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Contd.) E&r,ya,b&'Measx1n Rents The following fair value hierarchy measure fair value: Level I- unadjusted quoted prices. Level 2 - Observable inputs, Level 3- significant unobservable inputs which are supported by little or no market activity, Level 2 include real estate held for sale. Fair value is the price CDC would receive to sell an asset in an orderly transaction between participants at measurement date. The carrying value of all other assets and liabilities approximate fair value due to their short maturity. NOTE 2 - PROPERTY AND EQUIPMENT At December 31, 2021, Property and Equipment consisted of the following: Office equipment, $18,349 less accumulated depreciation of$18,349, NOTE 3— MORTGAGE RECEIVABLE The CDC purchased real estate that will be renovated and sold to eligible home buyers as part of the neighborhood stabilization and improvement program, Proceeds from the homes that were sold during the year ended December 31, 2021 are recorded in the financial statements, Net proceed fi-orn any sale must be used in compliance with the grant agreement, The CDC provided second mortgage financing which is an interest free deferred payment loan and the loan will be paid upon the sale of the property if sold short of the term of fifteen years from the closing date of the first mortgage or upon mortgagor's default. Mortgage receivable will be forgiven if the homeowner remains in the home the required period. NOTE 4 - LEASE OBLICT'ATION The CDC uses offices provided by the City of Boynton Beach in the neighborhood in which it operates, fbr a nominal fee of $12 per year. The market value of this space is not included in the financial statements. NOTE 5 — Program Income Program income includes gross sales of real estate of $620,000, and rental income from real estate not sold of $108,424. The net gain on sale of real estate is reported in the statement of activities, The CDC is required to use program income in compliance with grant rules and regulations, a 1308 BOYNTON BEACH FAITH BASED COMMUNITY DEVELOPMENT CORPORATION NOTES TO FINANCIAL STATEMENTS DECEMBER 31 o 2021 The Corporation receives financial assistance from federal, state, municipal and other local no governmental agencies in the forin of grants. The disbursement of funds received under this program generally requires compliance with the terms and conditions specified in the grant agreements and are subject to audit by the grantor agencies. Any disallowed claims resulting from audits could become a liability of the CDC. `rho date to which events occurring after December 31, 2021, the date of the most recent statement of financial position, have been evaluated for possible adjustment to the financial statements is November 21, 2022, which is the date the financial statements were available to be issued. Grants from governmental agencies totaled 26% of Costal revenue at December 31, 2021. As a result off COVID -19, economic uncertainties have risen though such potential impact is unknown at this time, CDC obtained a revolving line of credit to develop residential single family homes in low and moderate income communities in Boynton Beach, Florida. "rho terms are as follows: maximurn principal amount of' loan $ 1,000,000, interest rate of five and one quarter percent, maturity date of two years from the date of loan closing, security property of first mortgages on residential parcels and the improvements located thereon at scattered sites within the Prqject, and repayment terns s commencing on the last day of the month following the loan closing date, monthly payments of interest are due and payable on the last day of each rrionth, with the principal balance of the loan , if not sooner paid, together with any unpaid interest and fees, due and payable in full on the maturity date, Borrowings are outstanding at December 31, 2021 of $ 166,035. I WONN MMINWAMMNMN!W,@,,l#NMwiim W, NOTE 9 — REAL ESTATE HELD FOR RENTAL As of December 3 1, 202 1, certain real estate held for sale was converted for rental property as part of its affordable homes program. The properties are depreciated over 27 Years, and accumulated depreciation of $31,228. 1309 To the Board of Directors Boynton Beach Faith Based Community Development Corporation Boynton Beach, Florida I have audited in accordance with the auditing standards generally accepted in the United States of'America and the standards applicable to financial audits contained in Government.4uditing Standards issued by the Comptroller General of the United States, the financial statements of Boynton Beach Faith Based Community Development Corporation (" CDC" ) (a nonprofit organization), which comprise the statement of financial position as of December 31, 2021, and the related statements of activities, functional expenses and cash flows for the year then ended, and the related notes to the financial statements, and have issued my report thereon dated November 21, 2021 Internal Control over Financial Reporting In planning and performing my audit of the financial statements, I considered CDC's internal control over financial reporting (internal control) to determine the audit procedures that are appropriate in the circumstances for the purpose of expressing my opinion on the financial statements, but not for the purpose of expressing an opinion on the effectiveness of CDCs internal control. Accordingly, I do not express an opinion on the effectiveness of the Organization's internal control. A cle/IciencY in internal control exists when the design or operation of a control does riot allow management or employees, in the normal course of performing their assigned functions, to prevent, or detect and correct, misstatements on a timely basis. A material weakness is a deficiency, or a combination of deficiencies, in internal control, such that there is a reasonable possibility that a material misstatement of the entity's financial statements will not be prevented, or detected and corrected on a timely basis. A significant deficiency is a deficiency, or a combination of deficiencies, in internal control that is less severe than a material weakness, yet important enough to merit attention by those charged with governance. My consideration of internal control was for the limited purpose described in the first paragraph of this section and was not designed to identify all deficiencies in internal control that might be material weaknesses or, significant deficiencies. Given these limitations, during my audit I did not identify any deficiencies in internal control that I consider to be material weaknesses. However, material weaknesses may exist that have not been identified. 1310 Compliance and Other Matters As part of obtaining reasonable assurance about whether CDCs financial statements are free from material misstatement, I performed tests of its compliance with certain provisions of laws, regulations, contracts, and grant agreements, noncompliance with which could have a direct and material effect on the determination of financial statement amounts. However, providing an opinion on compliance with those provisions was not an objective of my audit, and accordingly, I do not express such an opinion„ The results of my tests disclosed no instances of noncompliance or other matters that are required to be reported under Government Auditing L9andards, Purpose of this Report The purpose of this report is solely to describe the scope of my testing of interval control and compliance and the results of that testing, and not to provide an opinion on the effectiveness of the CBC's internal control or on compliance. This report is an integral part of an audit performed in accordance with GovernmentAuditing Standards in considering the CDC's internal control and compliance, Accordingly, this communication is not suitable for any other put -pose, Riviera Beach, FL November 21, 2022 N 1311 I V. DepaAment of State Division of Corporations P 0. 13ox 6327 TaRahassee, FL 32314 CORP. cOrPc)r'atO 12ame - roust include SEHIR IpS 12/21/89- 0 -100? --017 SO so Enclosed is an Original and one(l) cOPY of the articles of incorporation and a check for 13$70.00 El $78.75 U$7835 Filing Fee Fi$87.50 ling Fee & Filing Fee Filing Fee, Certificate of & Cerdfied Copy Certffied Copy Status & Cerdficate ADDMONAL COPY RFQUMD FROM: (PH i ti -d�sped)­"'-- r d --A-V—& - A j d Te—s—s — -- �Cityl _fl, D'WI(IMPTelephone n -15e�r ARTICLES of INCORPORATION OF BOYNTON'BEACH FAITH BASED COMMUNITY DEVELOP i NT CORPORATION We, the undersigned natural persons of the age of eighteen (18) years err more, at least two (2) of whom are citizens of the State of Florida, acting as- Incorporators of a corporation under the Florida Non -Profit Corporation Act, do hereby adopt the following Articles of Incorporation for such corporation: 1. Name: The name of the corporation is Boynton each Faith Based Cojjimnnity Development Corporation. 2. Non -Profit Corporation-, 1he corporation is a non profit -corporation. 3. Duration: The corporation is said to have perpetual existence. 4. Purposes: The purpose for which this corporation is organized is to.- • Promote the financial revitalization of the community through business and real estate ownership, provision of services, home ownership and improvement, urAfication of residents, resistance to gentrification. • Develop and sustain partnerships with various groups and agencies in, the Boynton Beach Target Neighborhood in order to ensure that development is streamlined and resources are put to the most efficient use. • Increase homeownership opportunities in Boynton Beach. • Reduce the number of vacant lots in the neighborhood and thereby reduce spot blight and crime. • Improve and increase the delivery of social services to the neighborhood. 17he Boynton Beach Target Neighborhood is that geographical area located in the City of Boynton Beacl-4 Flrida, that is delineated by NE & NW 6"' Avenues to fliz South, NE & NW 13"Avenues to the North, interstate 95 to the West and the FEC Railroad to tile East. The foregoing statement of purposes shall be construed as a statement of both purpose and powers, and the purpose and powers stated in each clause shall, except where otherwise expressed, be in no way limited or restricted by any reference to or inference from the terms or provisions of any other clauses, but shall be regarded as independent purposes and powers. n 1313 NotMthstanding any other provisions of these Articles of Incorporation, the corporation shall not conduct or carry on any activities not permitted to be conducted or carried on by an organization exempt from taxation under Section 501 (c) (3) of the Internal Revenue Code and its regulations as they now exist or as they may be hereafter be amended, or by an organization, contributions to which are deductible under Section 170 (c) (2) of the Internal Revenue Code and Regulations as they now exist or as they may hereafter be amended. This corporation is organized pursuant to the Florida Non -Profit Corporation A ct' does not contemplate pecuniary gain or profit to the members thereof andl organized for non-profit purposes. 5 I . Registered Office: The initial registered office of the company shall be 428 NW 3d Avenue in Boynton Beach, FL 33435 in the County of Palm each. 6. Registered Agent: The registered agent of the company shall be Willie Ward. S. Dissolution: Upon the dissolution of the corporation, the Board of Trustees shal after paying or maldng provisions for the payment of all the liabilities and obliga tior of the corporation, dispose of any and all of the assets of the corporation exclusivel for charitable, educational, or scienti-fic yarposes as shall at the time qualify as a� exempt organization or organizations under Section 501 (c) (3) of the Intern Internw: Revenue Service of 1954 (or the corresponding provision of any future United State Internal Revenue Law) as the Board of Trustees shall determine. Any such assets nc so disposed of shall disposed of by the Court having jurisdiction in the county I which the principal office of the corporation is then located, exclusively for sucl purposes or to such organization, as said Court shall determine, which are organizei and operated exclusively for such purpose. 1314 . .. .. . . . 9. . Board of Trustees. The nun:iber of trustees constituting the Organizing Board of Trustees Of Ole cOrPOration is seven (7), and they shall serve in this capacity only until a fall Board of Trustees has been installed in accordance with the by-laws, The names and addresses of the persons who are to serve as the organizing trustees are: 10. "By -Laws: The by-laws of -the corporation shall be adopted by its Board of Trustees. The power to alter, amend or repeal the 'by-laws or to adopt now by-laws shall be vested in the Board of Trustees. U. Incorporators-. The names and addresses of each incorporator is - Courtney Cain Victor Marshall A ft e _ss: 1900 NE 2 d Lane, Boynton Beach, FL 33435 380 NW 13 Avenue Boynton Beach, FL I 1315 Addre, Courtney Cain 1900 NE Z,d Lane, Boynton Beach, FL 33435 Victor Marshall 380 NW 13 Avenue Boynton Beach, FL Samuel Kendrick 181 NE 19'h Avenue Boynton Beach, FL 33435 Jeanette Cain 1900 NE 2'd Lane, Boynton .beach, FL 33435 Elizabeth Jenkins 711 NW I" Street -Boynton Beach, FL 33435 Debra Marshall 380 NW 13 Avenue Boynton Beach, FL Willie Ward 428 NW YdAvenue Boynton Beach, FL 33435 10. "By -Laws: The by-laws of -the corporation shall be adopted by its Board of Trustees. The power to alter, amend or repeal the 'by-laws or to adopt now by-laws shall be vested in the Board of Trustees. U. Incorporators-. The names and addresses of each incorporator is - Courtney Cain Victor Marshall A ft e _ss: 1900 NE 2 d Lane, Boynton Beach, FL 33435 380 NW 13 Avenue Boynton Beach, FL I 1315 Samuel Kendrick Elizabeth Jenknis 181 NE 19'h Avenue Boynton Beach, FL 33435 711 NW I" Street Boynton Beach, FL 33435 428 NW 3 d Avenue Boynton Beach, FL 33435 K2. -Principal Place of Business: The principal place of business of tile corporation shall be 428 NW 3"d Avenue, Boynton Beach, FL 33435 in the . County of Palm, Beach, IN WITNESS WHEREOF, we the undersigned incorporators have hereto seta hands on this 15t" day of December 1999. per Coujb',!; 1.1""aln Victor Marshall Willie Ward P, . . .... .... El1q,fieth Jenkins STATE OF FLOREDA COUNTY OF PALM BEACH BEFORE me, the undersigned authority, personally appeared before me Courtney Cain, Victor Marsh , Willie Ward, Samuel Kendrick and Elizabeth Jenkins on December 15,1999, who are personally known by me, and who subscribed the above Arficles of Incorporation, and they did freely and vol-Luitarily aclaiowledge before me according to law that they made and subscribed the same for the uses and purposes therein mentioned. E 1316 INWITNESS WMRZOF'1.1-IAVF-I-I-up,.VUNFOS OFFICIAL h SEAL at.B.,,,,, ET My HAND AND l3ecenber, 19.99 8""'u the State of Florida on this i5th day of 01% Plummer NOtrY Public PAY COW State of Florida ISSIOU �rsaExpfl 2M WNUhEaftJung a, I My FAIR . . . . . ......... ssion expires: 6 /9 been named as registered agent and to acr-�Pt service of PrOceSs for the s cOrPOration at the place designated in these articles, 0 agent and agree to act in j&q capacity. I hereby accept t1le appoin, ab ve tat d Proper and complete performaace I filrther agree to tMent as registered Comply with ail statutes relating to the Of my duties, and au, f i My arn liar With and accept the obligations of Pos't'on as re9f Stered agent. Registered A gen"-' Ili e Ward Date 11 ...........1317 '07 D b 5 TELEPHONE LOCAL INITlATIVES SUPPORT CORP, 00 AUG 24 PH 3: 17 _16,55 PALM BEACH LAKES BLVD STE 1500 WEST PALM BEACH offilce Use ("WY colipoRA'110-N NAME(S) a DOCUME NT NUKUR(S), Cif knom"u): -7ff)�' 3, . . .......... lil.t . ...... . . 7 — — 0 lCoiporatioa Nan1c) ,Is. 00 4, (Docurnent 6,0"rPon'tion Name) 0 Walk in Ll Pick tip time Certified Co.py J Mail out 1:3 \Vill wzdt LJ Photocopy Certificate of Status NE XMING Ll Profit A.meTidi-nent Not for Profit Besign ation of R.A., OIfer/Director Lj J,imited Liability J Cb .g of Registered Agent Domestication J Dissolution/Withdrawal Ll Other Merger OTEffiRwa RFQ'j$MAU UALIFICAnON A' nnuaf F.epart, Foreign Fictftious Name Limited Partnership Q keins,taternent LJ Trademark L) wier ...... .. .. [_Exarniner's Initials . ............ CR2E031 ("7197) 1318 ARnCLE,A ,I. E, tiE ARTICL 'to 00 AM 24 "OFINCORPORATION of F L 0 R I D A Pai�on Beach Faith Based CoIrjMullit%,e �J)evejo��,!j or,,,�, P 1 tu "'V't 4f rl t ire "71 e P r 0 1) is 10 IS 0 'S e,'Ct 10 1� 617, 100 j-, FIC nonprqfli corp kalutes, Ille, 1"Inclersi - "17ey'l ,j()TtS the fiOI101447?g Cjjn(,n(j g �, 171L It to ,� ollieles 0j, incof7wr(alm '.P if, IIATRST: Anlelldmont(s) adopted: ONIN( ATE, ARTICLE MJMBER (3) BER, (DR DHIETLti)) '70 AM-J� 3 11)1,,y) q, ADDED See Attached. THIRD: Adoption Q Th d ani endj.uent(s) �vaqwe).,-e,) adopted by the members and the nuinber of vote's cast f6r the amendment wa,,,), sufficl.ent for approval, The c, are no 1.110,11bers or rnembors entitled to vote On the al"le was(wen) adopted by tfiol)ojrtj of directors, Ieach F I 1" , aft -i, Basf,,d Co.in-n-,n i fi,, , .3 Signalmrcof Clairman, � i(-'e"'Cl-mirman, President or odl e,, r 0 fl, -J (,- 0r w 1319 ANWENDMENT'110 L -ES Oy fjNC0.R -r -130YUtOn each F21th Based r , yo AT_10N _ojjjjnuIIj.�Y Devejr)ptnent C30riwatior Article 7 - Said is OrEl .Ea'lized (�,,c(,jjjsiVej educatiorial, religio,,,, or sc y Ic PtIrt)oses, wij.jjij'.j th" arftal)R�, FOF 0111 of Of the ffilemal R.e.,v6j-i,,je �-Oj, (or o, cdctlrar fedexal tura cod llsponding s(�-ctiotl o.Cany NO P(31't of' the 116t earnings of' the CoTc'Vttion shall inure to tlie drstrxiwr at a.l :l to Its tzrr jt of S, directors, '0 0 ()t' Ot)lc�r PriVato, persons, C,"(capt SlIa.11 70 authorized and (�MPOWeted 10 PaY reasonable COMpensation for Services renderrad and to rrjakc Pyr encs distn�llj.jtjons i filift'heranco of Seotiotj 501 (r,) (3) pu"PO,'Ies, NO substantial par -t the 11 the corporation shall be th.e carrybl' C , activities of , 311 ()f propagaada, or otTjerwis�, influence JP�gislation, and -[110 coj�j")Oration, shall not participate , . attempting, to 011cludin8l the publishit'lB Or distribution of state ft,' in, or intervene in behalf of or ill opposf1io" 111011'tO �ITIY P01iticil caq)aign oil 11 to any calldidate fbrpt,jj)jic OffIce, �'I"Otwithstanding any Oth-er Provision of these Based (- the -Boyntoij C0Ynrj-II'II*Y r)eve'01?nlent Cr 1poratioli shall a -Yl arty ".Ct"'v't'as 110t Pel-I'llitft,d to be car 110 t c ri d 01, (,1) by a c. ) 1 a Y 0 er �rjp orp. oratioll exempt fkm federil irlcOnl(� tax under Section 50163) (3) of tIl(,- ITIt6imal Ravemi.e Code (or- corresponcling section of a"Y Ii -1-111M federaf tax, C, 0.de) or (b) by a cOlporation, coiltlibl"tIolls to 1v"'ch "M d0ductiblo under Secti Revei.2ne Cad(a (01., corrt,,spond, oil 170 (c) (2) Of� tlIC' Infernal T sect,( an ofajay f jItIlre f6deral 1320 RY-LAWS OF CH r BOYNTONREA DEVELOPMF' TITBASED COMM.IYMTY NT coRPORATION, INc. Nk a 150 e llanle of tile co rporatio-n is. Bynton Beach FaiBased rM th Communi�v Development corporation, o COrPoration, -Inc- Also .. referred herein as the D . qt ipn of B,,,� adopted by the BOYnton B These by -haws constitute the code of rule Corporation, Inc., each Faith Based Com s a. Florida' nol-j-profi 11-11111ity Devel opluet n1allage.c. t Of its affairs. t corporation, for the regulation and OVA, id BralicbLMM'. this organization shall be U' - - The prin. cipal place of business of 2.191N Seacre-vt Blvd Sub OfWce.- 404 ArW 13t1',4,, Boynton each, 17L 33435 BOY"Iton Beach, 334-35 Or as 'he Board of Directors May designate from tirfle to tinle.. qPtiorl — 4 isl year. The fiscal year of th e corporation, shall be the calendar ��L Z MhNio II The M.ss'01.1, 4 the Boynton Beach ' Faith Based CorlunlIrlity Development R Corpora -Li on, Inc, is to Prornote the f ",incial revitalization. thrOUgh busine,&s and real estate ownership, supportive Of the community Provision, of services, borne housing for the elderly, alld improvement residents, resist Ownership ' a'lce to gentlification. Imificatioll of Develop and sustain Partnership,<; with V, BOY"ItOn Beaclj various grollps and agenci' -11ined and resources es in th strean Target Neighborhood. in. order to ensure that de ' - e are put to velopment is • Provide decent 1�10-u,,3ing that - the I'lost efficient use. • People. is affordable to low and.mod epjte_income R-edllce the 'n"Ibll (If vacant 1()t Spot bligi-ttand crime. s ill the neighborhood and the,--reby reduce b"Pro-ve ' m,d increase the delivery Of Social SerViCeS to the n ghbOrhood. 1321 the BOYnton Beacli Target the City of 130YItoll each, Neighborhood is that geographical area located ill to the South, Gate , Morida, that is clelineat ,4 by -Boynton Railroad t way -Blvd to the North 'Inter, Beach 13!vd 0 the East. state 95 to the West and the FEC AMkL(--,.,jjLZ, se The PUrPose for which this co . . ....... . - rporat'011 is Organized is to: Develop and sustain partnerships with various groups and ag Boynton Beach Target Neighborhood M order encies in the is streal-Willed and resources are ptit to the to ens that developmellt Increase homeownership eft-icieut use. R-educc the opportunit, ies f ,or residen reduce Mber of vacallt lots ill the , . ts of �BoyutOn Beach, ,spot blight and cri ne'9111�10rhood and thereb Improve the econolnic . n3e- y Ond"'Ons of the beighbOrhood tbxo�ugh eillplOYMent and business development training - and opport-u- In-Trove and illereas e� the delivery of ,3 niiies. -prornote supportive, Ocial services to the nei iborhood. 110'usillg for the elderly. 91 I'he colporat'011:,Sllall be subject to the following litnit, A. No Part of ti, Itlons: to tile 661" yet fl t Of or be di, e, ' net e'a-minof the c Orporati of"'ers) Cont6butor stributed to its ulernb ion shall intre , or � i-ndividual ens, 1-10under, t,.-Llstecs5 authorized and I except that the cor entpoWered to Pay reasonable co P rendered and to rua1ce PaYnients rapensation for services orat'on Shall be and d P11rPOse set forth in Article III istributi' 13'bercof ons in f1l,rtherance of the Pollacal be to --MAZ173 No part of the activities of t, CP, M, Or intervelle distribution Of states lientq) in (includin le corporation shall ..g the Publishing or any Political campai&,n 01, eandidate.:for public Office. behalf of these b Notwithstanding anY other provision of y laws� the cOrporatioll Shall not Carry on Permitted* to be carried on `1,11Y other activities Ilot 111come 1- �", 1 (1) by a cOrPoration exenipt 1954 Wider Section 50 1 (c) (3) TOR, Federal (or the corresponding provision, I of the Tnte-mal leee.Code of 11ternal Revenue Law); or by a orpor 2 Of any future United atio*n cOntributioll,,. _, to are deductible under Section 170 (c). (2) of the Mlicl., c Mates tes Internal Revenue Code of 1322 1954 (o� r the corresponding provisions Internal, Revenue Law). of any -tuture 'IJIlited States One class of Inemb r, Which is ar, M�'M-11 shki: ThiScor,atio. e designated as General 1\4er Meinbership shall b y1b Will have and representa 0 individuals or Organizations that OTs. General tive of botli the coinmun are actively involved in z Pleasant City V�460ut regard itY and the faith based org�,uj ,,tins in disability. The to race, religion3 creed' national, 0 � - set.forth in members must affl rigill sex, age or A-rticle 11 and if r1a that they share the Mission and Purposes andstaterne j. All members. shall Submit a si " nt Of cOnfidentiality. gned affinnation ,rhe initial membel"s of the.COTPOration are to be selected by tile t%n2 incOr Adi Porators. fbilows: "'t "Mel e -,"Admissio A. t, Of membership shall be as QEJ,',,9n.47,qt !zZ*11115'ers- An organization the p rovision of eligible for membership tinder kSoctiOn and WhichAesires t Corporation shall submit to the See , o become a and s' * f , retary'or acting Member Of the Igned application, on a 'Orn 'Secretary a wr, e application shall be conside I approved by the 13oard tt Of Directors at its . regular , red bor approval or di and each meetinj, sappr'Oval by the _Board An organizatior, shall sub' , g or at any special meeting Of the Board. -following: a statement of Mit ail application which shall Purpose, th, include tile Members, -a descnption of nan-es of its its P 0 tcers and board -Board resolUtiOn. indicatin rograrn. and activities 'f the � Boyn � g their &LIPport of the r ., and a copy of a ton Beach Faitjj B ni 1-nc-. Additionally., e�very sed Community Develssloti and purpose of designated representative organization shall opme"t Corporation, R &(1-'-K1�ftLqU[eMhers and one alternate. 'submit the names of One Provision OF--- - -I-- : An individual Cligible'for menibe' Corporation Sect"Ou I and �h�� desires to b rshil) tinder the Corporation. shall complete n appli e.QOMe a member of the C. A ca'iOTI fOrt-a available fron, tile ),n approved �� Me !)-OZT�-' Application bY a m for Genera C ajority vote of the C0rPoratioII9l'Menb",b.ip must be orporat'01�1 TuaY specif 8 Board of Directors. organi7atiOn represet y the !lumber V.Plicatioll to-,- rn6m -itative or individual Of meetings that an s 'Drdivi(jual den bershi- "Itl t attend be -fore their ,ied 1) will 1)e considered' Any' organizati.or, membership nlaY,'Ippearl in Writing to the Board , 1323 ITLC pptr, t th.r� z� mAX. hzdrrls zzz.tzzs r"�t��zr '�vitzrt .sszzrrr�r� the rz%s �r ash t off` Membership, may. i Y car e- �' i Men si sthrough zrsib%Iit s application process zrtli tions Members. and the, b ha I t to attend z t zr s d t rr. b m - 1" BQ�Q�tg-I'Afemherish. rz rrzb rs 1I zzcrt ri rrrr d d. bar the Mrd, 1.rb dor" �. year, rr��ab zr.LW: General rn�rp sh. b �"r�r Corp � ar�tr�z�� I�r itlz t�S�r�t �`chzs dt Period 'csz�c� mend r zzt cr ` these.. t a s rya h r z �" W. thr p zz such ter BY -Laws r . c 0 r irrzzs Mrd, b it shall d t r estab, additional s s� y rye. membership moved rz rr a zs r OrlltiOti Board Members ofE MY el, Directors forjust z�s y "a o-thir( �r�t c� t��. s ifi .d . May b The d s c the' -Board C OTPor ,t zr. s Mrd s bitr.d:t";m oar d of t' xz ._ a � mpg y{� { S{ d $may 'the , .nor co yg. }8��y g�p�ay� �gy�g .k..9.�JW&tJ.4edA. C..z6�z,�, C�LN ��t984gn��,gg r.i� 4,LA'4.ft-.@. 1J...d,.4rd9..,9.4.8&✓.S. .�,9..d.S.E may_ i a ', sting r sigstio shall be, der 'rPor t'Oil resign with considered ��"�tir� �n�. d� r.ziwhereupon `.ttrz rz�r. rrzb r" Or� s.nizat z. ps h r up n such shall include the ya � resp of a ..ptarzt. Pursuant.t Article qrepresentative tirr r sign ti rr of its r pr s zz tz _,ti. t tl C Or°p r tz l's rrd�r._.. TPolicies and r le, dations �zc,l member rr czxrr�tts the r arrivedpinch r �h rye bar r;s rct bindingz�trrrd individual crtrzbzs.rdrt stzrr rcidrs� sz� retaintheir .ris ther arbiter their hcPosition �zRsz distinct Policies, art pro axrrs. is thra.. .iwcs.r; and no' z�c�rc� t:h�.zz. 1 � z ���hz° rl�r4�.��rrr�'s � Members � rz st reside xthi the r �d shall consist cad not s 4 Crr t�z%z°d thecar nizat�r. zz s target Organizations board ted �ar�a:rrzzzzzit. rzr r per[z�; d c iszc� s � spbS, `�'h COrI) ration shall r s rr.srrs : c its f"ll " s �,z rt.s oard rii-errb rs � secc►zzs rl,s as z"r. �ril zrrrsirip4 der skirzg . rxrpUt and ,_.,_Carr D c�isr.cr r , the poli cy positrons of the ar rrratrc� The Car ar tzcrrr 13 Programs to frrlcrrrerrted l tlro and the directiarr and Oard shall astrrlish Possible, the � purpose off" the Article Vill.ora drr s Corporation. f consensus orl � . issue is rr.at Board shall ural decision s by a vote as iudica:ted in `59� Comm carrrzrrrttee as be i rhe Corporation's Bay tte , viewed ne ssa y or convenient. d air establish such Pres ... iderrt, a d� a secret � surer n s acrd shall �elect a President necessary. Thai /"l re surer, grad Such. ether- off , Vice- rpersarr shall preside t or orations , as it deems �crl .-11-. paidceti.rrs. 'rxrrtr�rl.: °4 (either , ltterr ar Oral) _.b ,' etrzhers shall treat all "On -Public cif the far yrs �.011-fidentza, -r�tl.l zt is cr ci larr lic iia Corporation, °rrtion. her des r�ee shall % the c c l oard. to do s pnbl cl. rele&rse h Cher e y p person dr the Corporation.d erlt or his rs ar 4 n Inaspeak�� �tcrnnts a _ lel�behalf.l f „�" the .. , car the mm_, _,...tttrrrd : crrtia.tioD erre corporationcar* � a � Ott s�i �-vh�x a�th hers e to d 'so. Olized by� the president °,. c cti p l .°lcr.ow°.�,w smm l ti Prepare �; slafe.. of rindivdual __� rear era ire � c r�errrl�r �hi,p. All m seed � o.t aarritt shall 0 represerr.tative swell Organizational candidates rrrfir.al candidates Inst rra:rrr for .d j s sr.rccessar or alternate ate r r designated � cti0 representative. re... rescrattr ..,` ca we far rr .ilarrs p ve of .. l cr leer. r�ritrr spt successor ar orad. rr it r reludin l r��ay take r alternate to da sda vat%rr any Where the designated :part in all affairs of the Ch, srrcc6ssor car alternate re Y Office held b pre ea�tat%ire i� unable err her relareserrt�rtive her representative. does zest asstrrrre orshe is re 6 &tral�... replacing. .. ers bro eo sal tO thudsxs rsh%.t�.a: e initial. : Alan �.a �rO im-at lBoard rllcz hcrslli. zrzrtia.I ter -ill of three ears one -third sere-tlzrrd. �' the lard rrrerr�r.l�ers .l� shall be and Orl-°tldr°d will serve ' ter"I the bo �rve air. initial tern -r lire rv� 'In initial tear- at` crWil� seer board kse�rt vrzl he pert up dor � year. A t the end ye<ri s, .V election for a each Initial ne,rrr.her to se e a tlzt ee- 1325 Year terunb :l"liis Process spreads �,�t the election oat appro"u'u telt' orle-tlird : the b of" beard We bers such ru-d, seats 17 a �° each year, tbat �ee�. t��� r��s,w„ '�" Int Of ci by the r�.oruat: c�arrultteo shall candidates for c�arcl rueuabef �uember°s ip Prior to the be presented to the Cho the current board ruernbe�sav�l� segs oratlo�� Ballots will be distributed orpuratiou,s �r Dual a ect rr , eats 'are not u and cast by p for election. us the seat. �e rueruber th the most r�rrxrbe, the :� the event �" two r car rleu�rber Of votes, cru-offe election i:I[ be eid; rtes receiving :� equal num ecti��rr l.. 7 C°ca� � shall be held ousuch da � ._ cera _ a B aid Wetrr Meetings the and place as "shall be ed b he'.e reseuta:tives shall c i ,orate hoard of'th.e eetiu m � the C` O'rPoratior�t$s Board an proms at such time the notice be c,-Illed at Special meetings s o `the C" rp�r-ati�r any time by the C h' er� � s Board inay �rrajrarity of the Corps r� of the Cor �ora�i�au�s ward or ratri s Board ewer. by a _,� C" _ etru arporatro'yard Wri eu notice f`. a�n ba.l1 be any ���ceti�a. C delivered. either g the class grail to the acld�`ess �� cacti. Beard 3:ezubr a 11ernl�ers pesoual.i.y or by rerxlar drat less than appear On tl-� books o the Cor�� attl.1 and each Individual days b or e th.e date f the rr eetiuEvery tl�e date poratir� :l`r�r s�rrch prr.rpoo Trot place, da y cud lr ur f the uleetir�. such 1r t ce shall specify V t � transacted � and er�eral nature Of the b Waiver of notice o any meeting C`o Orations 3 d e rtsfuess tin ti . e stated caber entitled to sI.Ich notice, whether signed by the 'the .n, shall be deer ed e cre or after the Participation o a Corporations -. c{ariya ent toth a waiver of -n tit e ofsrrc.h rr� Boar ° .�. of such. :l�!%Tr�.b�z~ i:ri an notice. � representative Meeting,. ' Meeting shall con stitate ,. except rla re such Ci r Participates for the solePurposef 1 "cctl: or do - any business because tl-re r eetin�erubership J to the transact%ora. of was t la dully called or convened.At all I tact,. m mctxxa� representative shall have One v meet%u � f the, C"rpt�raticsrr %s tlaz:c a la. tel.el),10 Proxy vote, auc:l may t�.�l�e part aratl vote . Board, each the b�aard. y trcates will be ecce ate d if . til ss ctth. a. Iy on �ersorr or pcta tti r ctt 'se specifically iovidecapproved:by in,,- Corcrit tla.e vote he y of yl.a rs, 111a rtes y t tiles f t:lte til: �.r�r�,�,�-�,�;�. �. � 1326 Members present and voting shall gove n_ However M . will reqUire 2/3 'vote. A majority �vote major Policy decisions designate an ISSue a major issue. Of the board Is necessary in order to In. the event of fie -1 voted'upon again at the next boar' ,the issue will be tabled and next meetin d meeting, g then the decisio If the issue will locked at the 11 Of the cliairmat, shall Preside. 019T411K At a regular Or special ni n Doard) quOnim shall consist of at least eig ceti. .9 of the Corporation,s lit (8) board embers me ti. ... (Presen tis defined for the pulpose of these Bylmpresent. aws as physically present at the ng ,$ecftSAqion,, th, Any actio taken at a mectilig-of e Corporation 11 which properly n V be if all Corp il 's Board shall be t,,,Ike,,n without a rneeti.-ng oratio''n card representatives have (1) beerl'notified in reso!ution to , s BO, entitled to act; and (2) two-thirds of the writi'19 of a vote consent in writing Corporario-n's Board Members the action.. rh' to the adoption of the resolution. authOriZlii Of the proceed e resol"6011 aild.wijttert dents shall be filed with the 9 ings of the Corporation's Board Mernber Minutes Board may Waiver this' for actions or dec' requirement ata Mee ting 0 rhe CorPoratioll's f the representatives, but only Section 7 — Isi-ons specifie&at that Meeting. . att; Tbc organization iS created to serve moderate incot'ne lics; therefore, lOw-illeorrie Program bene low and advise the organiz 0 developnlent, all 'tti011 in all 'f its decisions regardin f-rciaries shall d in �g the desigu�� lOCatiOD, anageme"t of afCor projects engaged in by the cGrPoratio:n dable housing proiects , aid all other to the Public. I17h, _ Allregularboard , m Opportuili e agenda of all regulceting shall be open tY for any 1-nerriber of the p, lar board meetings shall � Organization alld its progran.,s. liblic to comm . ent on . include, all specific c Additionally the ally aspect of the Oulm e organization shall hold project .:Unity mectilIgs regarding affordable 11011sing dev�elopmellt - limial Meeting t Projects, and hold an A 0 give resideut�s an Opp comment oil the orgailization and its Progras. ortunity to A . r+. ect'or), Aufhori ty tq, f. Corl? ')"rector aildsUch, oth . er. staff, 01"I�tio`n-'s Board rylay hire "'In Executive a, they do appropriate. 'S 'gct� 2-- F-) prograin a'c- "1'1. Ex e ecutive. Director shall exe t'v't'es of the Corf)olation, il"cluding hir- cute the mallagement and of the C01poration,,q Board. ' tng of staff, at the direction 1327 ARTICL rV, x . ......... se re14,14 Ang -ration's Board shall adopt a At "" 4!p and man nt inectings, the Corp6 sufficient to im doquate F 'agement Policies mid, procedures �pj manciaj operation of file Organization. el -Rent the proper �5qdQX!JL_-,,S6ntra.cP,,: Pay-nlent that N"'nancial contract exceeds tile , commitment or agreemerit for behalf ofthe C' anlount of $5%00 shall be mad'e at any time on contract, OrPoratiOn Or to obligate tile Corporation in any way'n'llesS such Corporati commitment or agreement shall first have recei On's Board, ved tile approval of the 59ction 3x._. arrc : All accounts 0,f the Corpor, the diection the Co�rpo atio Board 'Jul ration,,s n shall be , di ed at I -c , at least Once a Year at the end Of each fiscal Year by, erfified public accountant chosen by the C and report thereon'shall be transrnitted to all Members in'' orporations DO�r(l good stailding. 41ANOtes valuableassets of the Corpora , t , ioll sl nle nloneYs, securities and other not to exceed ($500.00) whiell 'all be deposited, except for such petty cash requirements the board considers necessary for Illinlediate lay f-ron, time to tides the Corporation5s 130 n such depositories'a ,me sinate. All depos sits sh ard representatives �crrypr�atin.® Checks� notes, drafts - i all be made in the name, Of the under tajcin bills gs, or other mstrume Of exchangel acceptarisigned by t Uts or orders fior the cos, two Officers or agents as the Corporation Payment Of moneyshall be Brite to time designate. 'S Board Member's I -nay from 41��NTj!14M)P_ndeqt An 'ection lndeP!eP_0eTlt At!, in-clVerident erg aniz - I ­­� N'I' _Tbe 6179,1nizatioll shall at all time remain a ation arid ' to controlled -by or receive direction f'rOM individuals or entities Se shall not 11 the 0 eking Profit flOrn the organization. Addition rg"tilization shall alway's remain free fIII veid(:)r(s) of its O'An choosin' tO centract fjor goods all d s ally, all state, federal, 9 provided the method con,fo ervice's or local regulations tjja�t rt, service providej,-,s. _ight goveril tare rms With any and le selectio:tj Of good or 1328 the event � r f disso reinarrr.ing assets f the C✓ ratics:rr shall tiO- or final liquidation, the Al lzabtlltles crbll�atlars f the Carer atlrr ed d distributed fllr��vs. dlschaxed, cr�: provision shall be mads theref shall be laid, satisfied, and condition their be re -turned, ed, transferred car c rr e re a erre; an seats held or, the disposed o: accordance � Upon dissolution shall be nature its ever, regnir�ern.ent; all re airriri assets of ear description shall be die lrx.ted relil;iorrs, educational, soi.enti c r liter le to any charitable. ander the rcr�isi�arr of Section Ol organizationswhich then q ali 19 as amended, or %ls srtccesssar l�rwevisiorr�. of cry" the rt . al,Revenue Code *tion2,....-1; rd thebook, d records of the opal ffice of the Corporation r'poraticrn shall. he sept at des% rats. �aratio�r, cr at srrch plaace a the C ol.- orad n gra X11: bcrc�ls:s and records of the' Corporation �. lccatir rr where arr. representatives h yin a be inspected at the arr r reasonable,p pose uponproper V ting .rights, or thein atto 1 to rr notice 7ceep them. ears, for { s decd 1 acrrerr.ded or rep .. healed, or rreirf these as air be altered the proposed arrrerr lags may e adopted to la after t€ro . errt at separate Corporation ward readin s an of anati e vote ofaof Majority ority f the C orporatin 's 130, 6tirj s followed b rr.oNce Cif each eetin ashall state the substance . ended, repealed, rad apted. � of the la Provided tc� that fire e altered, 1329 We affim I that these 13y -jaws as Presented were forniallyadopted ard by a qnorum of the Boof Directors of the Boyt Development Corp oraYnon,f3e4ch Faith Based,Coinmlmi tion O'n tb"s day Jar Ilary 10, 200.1. ty ..4 collrtneY Cain (Presiee-nij- ,,Fgaret JOhnSi, , P(Secretary) 1330 6sog"1'-'0C' , 1/03,2= e,:55 PfA 9 Return of Organization Exempt From Income Tax -2 M " 1M Form 90, Under setnion 541(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) stent of fho TragouryOil Do not enter socia I security numbers on this form as it maybe made public, open P 8 Ice (30 to n= A pot the2021 nd ending, . ............ B Check ffspplfcabfe� B07NTON BEACH FAITH BASED COb24UNITY 1) Eirnialoyer idamificatran number ElAddress charge IfsPMANT COR20RATIO111 buciressm lVui 65-0971509 .. ...... .. —1-111111.111111111 ........... nbor and streat (or ;715td� Ll i4amachange vered to street sddnass,� T&30nvsuRe . ........ 2191 N SEACREST BLVD ---- - - ............. _561-752-0303 0 Irilid return Filial returN City or trwri, state or pmvJnr*, o0imtty, and ZIP or faraigr pglst��fl code ...... . . ..... BOYNTON BEACH FL 33435 17. k 1,124,913 Arno dad retura Name and address of prindpal cfflwr Applicgifon pending COURTNEY CAIN HP) is this a group return forsubordinatmm? 11 Yea FRI No 2191 N .Si Tr BLVD H(b) Are all suborcanat" induripd? 0 Yes 130YNTON BEACH FL 33435 If"NO." attach a Ist See insi"myons 77 - - -------- - - ---------- LARK . .... nqjrj_... . . .... 5�y WA mm _Fit O� 'I wv' ll'� TL Year of fouriation: Oil is Form of ananizati I L . . . . . . . . . ............................................................. . . . . . ......... . ....... .. .. FL I Sumrnga, .............. . . . .............. - — ------ 1 Briefly describe the organizatfidn's mission or most significant activities: � I ....... - r-.--.-'.. -.1-- ---, -1. ... --- i * ................ ........ ............. TO DEVELOP SUSTAINABLE COMMITIRS THROUGH S CES THAT OWNERSHIP AND FINANCIAL EDUCATION RESULTING I N SPR: E T UAL A , ND zC 1 ON , C ........ ........... ...... > ....... ...................... .... ... .... ................................ ................. ..... .......... 0 2 if the organization discontinued its operations or disposed of more than 25% of its net assets, (3 1 3 Number of voting members of the governing body (Part VI, line 1a) ........... 3 10 -- — — - - - ----------- 4 Number of independent voting member,,; of the governing body (Part V), line 1b) 10 > & Toanumber of employed In calendar year 2021 (Part V, line 2a) '43 tl bf Ii 6 Total number of volunteers (estimate if necessary) 6 0 ......... . .... ............. ......... 7a Total unrelated business revenue from Part V1 11, column (C), line 12 .................................. is 0 b Met unrelatq fn�q2 E2rT - 7b T� Park I fine 11 Fqrory — ------ 8 Contributions and grants (Part Vill, line 1 h), 3 9 . . . . ............ --- Cx!!---Mye&r 469 396 4 "77 In a 9 Program service (Part Vill, 2) -- — _ 0 10 vestment income revenue (Part Vill, column (line 9 , an nes A), lines 3, 4d 7d) 21— 6 v -- ad 'i 2 68 124 977 11 Other revenue (Part Vill, column (A), lines 5, 6d, 80, go, 10c, and 1 le) — -------- ---- 8 012 12 Total revenue— add lines 8 th uQ r to q_�)Nj, column �,M, rine 1�� ... 6 2 6 6 . . .... . . ....... 70 13 Grants and similar amounts paid (Part fX, column (A), lines 1-3) . ..... 14 Benefits paid to or for members (Part IX, column (A), line 4) 0 sa column (A), lines 5-10) 16 Salaries, other compensation, employee benefits (Part tX, colu 0 ............ ? 7,? jff Q 1 Sa Is rofession a I fundraising fees ees (Part IX, column (A), line 11 e) lu_ , .,_ , ._'_ ... _— 11.1— ... .... . .......... 0, 0-1 b Total fundraising expenses (Part fX, column (D), line 25) Ille'. 0 X� .. . ........ 17 Other expenses (Part rX, column (A), lines 11a --11d, 1If-249) . ...... ...... 428233 18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) 17,49 ..... . . ........... 588 .975 19 Revenue les Subtra s9 manseline 18 from line 12 117 --,382 pa,�ur9sah our ty End of Year 20 Tots I assets (Part X, line 16) < 21 Total liabilities (Part X, line 26) ...... ....... 93,�0571 171,706 5—j ..... ... . . 22 Netasset orfund lancqs. _kq_ frqM E4, 1 zyq,.z��3 Part 11 _ §y�nqji 11— . ......... . ... . qptyre Block Under penalties of perjury, I declare that I have examined this retum, induding accompanying schedules and statements, and to the beat of my knowledge and belief, it is true, correct, and complete, Declaration of pp (other than officer) is based on ap information of which Preparer has any knowledge, Sign JV Siqna!ure of affimr Date Here COURTWEY CAIN ... ......... Jypa or print narrio and trite .............. ............... Fi irdnyoo prepacei's marrip F'r rrr r rotatune Leto. . . .. ....... ......... Paid Check ,tK*aeli-h Saaldataand --------- -- ifi 111441/1, 3/22t . ........ . . Pre. ........ - — ----- ....... . ............. 0 . . . . . . .... P003B7382 parer 1 11, Massih Saadatmand PA 27-1223636 Use Only Xiiso Av", e' . . .. .. . . ............................ West PalM Beach, FL 33413 — —, 11.11, 1 1 . — -11 � -- — � --- - --- ILP�n�e'q!"'� 561-640-2983 Maythe IRS discussthis returnwith the prepairershown above? see instructions 'F n'" er-w—ork R—eduWon —Act Notic e—,sceth—es—eparate illn'llslltr—u""""el""",UIll""Ioll,"Inllllls--- J, Form 90 (2021) 1331 The boois am In the cam of lo. i y , �.;�,„Y„ ,,,' .. ,� 5 �ivX' .r° ^ 12F 4 K, r' 5C'.. A(b"w; x '"HY+ 4W 'MC^, � *t, i, '>r„ ♦, y,h 'W S M'+- � 1332 660971,509111T3/20Z2 6,65 PM Ecanrr 990 ,Lo?�j -- _40YNTPN BEACH FAITH BASED COMMUNITY 65-0971509 ........... .................. —Servi Part Ili Statement of Pr' o—g r am c e A c'-c—omplis,h--ments Check if Schedule 0 contains a r@§j,,,,pqsg . . ....... jinqin this Part M I Briefly describe the organization's mission-. TO DEVELOP SUSTAINABLE COMMUNITIES IRROUCM SEaVICES THAT INCLUDE Hmv, ............ ...... --- ...... ...... OWNERSHIP AND FINANCIAL EDUCATION RESULTING IN SPRITUAL AND ECONOMIC. .......... .......... .............. 2 Did the organization undertake any significant program services during the year which were not listed on the prior Form 990 or 990-EZ? .... X Yes L] NO If "Yes," describe these new services on Schedule 0. 3 Did the organization cease conducting, or make significant changes in how it conducts, any program services? ........ ....... ..... . Yes rA No If "Yes," describe these changes on Schedule 0. 4 Describe the organIzaton's program service accomplishments for each of Its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, If any, for each program service reported, ............................. . . .... . . _, . . .. .............. . ..... 4a (Code: ...... (Expenses $ 3 97, 67 - 7 ' including grants of (Revenue $ 396 ,�X77 ORGANIZATION ASSISTED FAMIL"I"E'S IN ACS 7G HOMES .............. ..... ... ......... ......... ............ ...... ...... ........... ........... . - - -------- . . ...... . ........ . . .... ......... . . ..... . . ...... 4b (Code,- (Expenses ........ Including grants of $ (Revenue $ ........ N/A .............. ........... .......... ...... ............. ........ ........ ............ ...... ........ ....... .................. ...... . . .. . ...................... ................. .......... . 4o (Code: )(Expenses ....... Including grants of $ $ .............. ......... ...(Revenue N....... ........... ........... ...... ......... ........ .......... ...... - ..... ........... ...... ............ ...... 65G9PV%4 11103=22 6: 55 PM EFormp?.CLI?_0212 BOYNT,,0N BEACH FAITH BASED COMMUNITY 65-0971509 P e3 1 Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule A .... ....... ......... ............ ....... I ........... X 2 Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? 2 3 Did the organization engage In direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes."complete Schedule C, Part 1 3 4 Section 601(c)(3) organizations. Did the organization engage in lobbying activit'[es,'or have 's'section '501'(h') ... .. .......... election in effect during the tax year? If 'Yes, " complete Schedule p, part 11 4 X 5 Is the organization a section 501(c)(4), 601(c)(5), or 501 (c)(6) organization that receives me'rnbership, dues, ................. ... . assessments, or similar amounts as defined in Rev. Proc. 98-197 If 'Yes,"G:orriplete Schedule Q, Part III 6 Did the organization maintain any donor advised funds or any similar funds or accounts for which donors ...... ........ have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If 'Yes,' complete Schedule D, Part 1 6 X 7 Did the organtz-ation receive, or hold a conservation easement, including easements to preserve open space, . .... the environment, historic land areas, or historic structures? If 'YPS," complete Srhedule D, Part 11 7 X 8 Did the organIzationmaintaln collections of works of art, historical treasures, or other similar assets? lfrY'e-s .... .......... complete Scf7adule, 0, Part /11 B X 9 Did the organization report an amount in Part X, line 21, for escrow or custodial account liability, serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? ffYes,'compiefe Schedule 0, Part IV 9 X 10 Did the organization, directly or through a related organization, hold 'assets 'in'donor-restricted 'e'ri'do'wme-ntq* ............ ..... ....... or in quasi endowments? If 'Yes, 'complete Schedule D, part v 10 X 11 It the organization's answer to any of the following questions is 'Yes,"'then 'complete 'Schedule 'D',, Parts' Vl',' '' . . ................ . VII, Vill, IX, or X, as applicable, a Did the organization report an amount for land, buildings, and equipment In Part X, line 10? If "Yes;" complete Schedule Q Part V/ 11a X ...... . . ...... * .......... ................ ............ .. ......... * . ......... ..... * ...... b Did the organization report an amount for investments --other securities in Part X, line 12, that is 5% or more of Its total assets reported in Part X, line 16? If 'Yes, "complete Schedule D, Part V11 Ill h. a Did the organization report an amount for investmenL%--program related in Part X, line 13, is'5%'or'more ............ ...... of its total assets reported in Part X, line 16? If "Yes, " complete Schedule 0, Part Vill 111C d Did the organization report an amount for other assets in Part X, line,., 15, that is 5% orM'O"re"0'*f'its "t'ot'a'l'as's'e't's* ...... ............. reported in Part X, line 16? If "Yes,'Compte-te Schedule D, Part IX Ild X e Did the organization report an amount for other liabilities in Part X, line 25? if "Yes, "complete Schedule L), Pert lie X f Did the organization's separate or consolidated financial statements for the tax year include a footnote that addresses ....... the organization's liability for uncertain tax positions under FIN 48 (ASC 740)? If "YP,%'cornplete Schedule D, Part X lit , X 12a Did the organization obtain separate, independent audited financial statements for the tax year? 11"Yes,"Cornplote ­- .. Schedule D, Parts X1 and A _ _ _ . . .............. ........ _ ........ ...... . 12a X b Was the organization Included in consolidated, independent audited financial statements for the tax year? If 'Yes,' and if the organization answered 'No' to line 12e, lien completing Schedule D, Parts XI and XII is optional 12b 13 Is the organization a school described in section 170(b)(1)(A)(H)? If"Yes,'completo Schedule E ...... ... . ...... 1 13 X 14a Did the organization maintain an office, employees, or agents outside of the United States? b Did theorgianization have aggregate revenues or expenses of more than $10,000 from granimki I a . n I g, 1-11-1- 14a- -X fundraising, business, investment, and program service activities outside the United States, of aggregate foreign Investments valued at $100,000 or more? It"Yes,' corriplete Schedule F, Parts I and tV 146 15 Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance . I . o I or X - for any foreign organization? If "Iles, "complete Schedule F, Parts 11 and IV 16 Did the organization report on Part IX, column (A), [file 3, more than $5,000 of aggregate grants or other ..... assistance to or for foreign individuals? 11"Yes,'complote Schedule F, Parts /it and IV Did the organization report a total of more than $15,000 ofexpenses for Professional fundiaising'ser'vices ori'' 17 16 X Part K column (A), lines 6 and I Ie'? If 'Yes, " complete Schedule G, Part 1. See instructions 17 18 Did the organization report rnore than $15,000 total of, fundraising event gross income and coninblit'l'o'ns"o'n' ..... .... ..... .. ..... Part VIII, 11 ne5 1c and Ba? If "Yes, ' comple le Schedule G, Part 11 X 19 Did the organization report more than $155,000 of gross inccme from gaming activities can Pa rt V] 11, If ne go? If"YeS, "complete SQ170dolP G, Part Ill_ .......... ........ 19 X 20a Did the organization operate one or more hospital facilities? If 'Ybs,'coj7jpjota Schedule H 20a X b if "Yes'to line 20a, did the organization attach a copy of its audited financial staternents to this return? .. . ........ . ..... ....... 20b 21 Did the organization report rnore than $5,000 of grants or other assistance to any domestic organizatlon'or ..... ........... ... domestic n2!Lt2fl me I? DAA rarro 990 (2021) 1334 S5rk9710i I I/O. "=2 &115 PM For qqo�gg?j,,��_ YNTON BEACH FAITH BASED COMMITY 65-0971509 _M­­����..... . . . . ............ . .. . ......... Part IV Checpt_9iL � q!M4 . . . . .................................. . Dara 4 oQt�!YPOT __ — � ___ . . ....... . . .. ... . .. kilt ... .. ... . . .... . 22 Did the organization report more than $5,000 of grants Or Othor assistance to or for domestic individuals on Part X, column (A), line 2? If 'Yes, I complete, Schedule 1, Parts I and M X ' ' ' ........... * ... * ................. ........ . 23 Did the organization answer "Yes' to Part VII, Sectinn A, line 3, 4, or 5 about compensation of the . ..... organization's current and former officers, directors, trustees, key employees, and highest compensated enipfoyees? If "Yes, ' complete Schedule J ,of 23 X 24a Did the organization have a tax-exempt band issue with an outstanding principal amount more than * ............. ........ .. . ... $100,000 as of the last day of the year, that was Issued after December 31, 2002? If "`Yes, "answerflnos 24b through 24d and complete Schedule K If go to line 256 X b Did the organization invest any proceeds of tax -exempt bonds beyond a temporary period exception? 24b a Did the organization maintainmaintaintain an escrorwaccount other than a refunding escrow at any time during the 'ye'ar ................ ........ . to defease ally tax-exempt bonds? ......................... . ..................... .......... d Did the organization act as an 'on behalf of Issuer for bonds outstanding at any time during the year? 24c 250 Section 601(c)(3), 501(c)(4), and 601(c)(29) organizations. Did the organization engage in an excess benefit ............. .. 24d transaction with a disqualified person during the year? If 'Yes-," complete Schedule L, Part ............ b Is the organization aware that it 25a L engaged In an excess benefit transaction with a disqualified p'e'r's'iin`in'a'pdo'r year, and that the transaction has not been reported on any of the organization :s prior Forms 990 or 990 -EZ? 11"Yes, ' complete Schedule L, Part I ...2 . ..... . .. .... . ... . 6 Did the organization report any arnount'on'P`art"X", line' 5 or 22, for,receivatl[eq, from any current ................... 25b X or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity a r family member of any of these persons? If "Yes, "carnplate Schedule L, Part 11 26 X 27 Did the organization provide a grant or other assistance to any current or former officer, director, tr*ust'e'e­,'ke'y' ............ . .......... employee, creator or founder, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof} orfamlly member of any of these persons? If "Yes, " complate Schedule L, Part H/ 28 Was the organization a party to a business transa'cVon'wi'tl'l'o'ne'of'th'efo'il'ow'lng"p"arties'(se*e"the Schedule L, . .......... 27 X . . ..... Part IV, instructions for applicable filing thresholds, conditions, and exceptions) - a A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? if "YeS,'COMPlete Schedule L, Part IV b A family member of any individual described in Part IV ... * ...................... .... 2 28b c A 35% controlled entity of one or more individuals andfor organizations described in line 28a or 28b? If 'Yes,' complete Schedule L, Port IV ...... . ...... . ..... 29 Did the organization receive more than 25„000 in non-cash contributions? If 'Yes,"Complera .Schedule M 29 X 30 Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified * ........ ........ ....... conservation contributions? It "Yes,"complote Schedule M. .. ..... 31 Did the organization liquidate, terminate, ordissofve and cease operations? ff'YeS,' Complete SchoduleN, Pare lX 30 31 X 32 Did the organization sell, exchange, dispose of, or transfer more than 25% of As net assets? If "Ye,, complete Schedule N, Part 11 .... .... 33 Did the organization own 100% of an entity disregarded as separate from the organization under Regulations 32 X Sections 301.7701-2 and 301,7701-3? It"Yes,complete Schedule R, Part 1 ' '' '­ .. .. ...... . ....... ...... 34 Was the organization related to any tax-exempt or taxabfeentity? ff 'Yes, I complete Schedule R Part 11, Ifl, 33 X or IV, and Part V, line I 36a Did thea have a Controlled entity within the meaning of section 512(b)(i 3)? "Yes” X Xation b If to line 350, did the oaniz receive any payment from or engage., Ir any transaction with a _rg controlled entity within the rneaning of section 512(b)(13)? lf'yes,"compA-,te Schedule f?, Part V, fine 2 36 Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non -charitable ......... ....... ........ . 35b related organization? li"Yes,"coniplefe Srhodule R, Palt V fine 2 an entity that i ........ 37 Old the organization conduct more than 5% of its activities through ... .......... a not a related organization X , and that is treated as a partnership for federal income tax purposes? If "Yes,,, complete Schedule R, Part Vir 37 X 38 Did the 0 rg a n Lzation complete Schedule 0 and provide explanations on Schedule 0 for Part VI, lines I Ib and 19? Note. All Form 990 filers are r uired to com rlete Schedule 0. P�iii'T - - — . . . ....... Regarding Other IRS Filings and Tax Compliance heck if Schedule 0 contains a r , e�pll onse or note to env line in this Part V Ila Enter lie number reported in box 3 of Form 1096. Enter .0- if not applicable -2G included an line Ia. Enter -0- if not applicable b Enter the number of Forms W Ia 7 c Did the on;pnization c0roplywith backup withholding rules for reportable payments t I o, , v I and . ors at . rd I DAA............ L -LC A Nrm 990 (702,1) 1335 65097166 1110312922 6:55 PM For BOYNTON BEACH FAITH BASED COMMUNITY 65-0971509 . ........................ . ............... . . ..................... Part V Statements RegArdinij Other IRS Filings and Tax Gompiflwrce (coi0ifirtind) 2a Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements, filed for the calendar year ending with or within the year covered by this return b If at least one is reported on line 2a, did the organization file all required federal employment tax returnsl ............... Note: If thenof lines Is and 2a is greater than 250, you may be required to e -6/s, See instructions, 3a Did the organization have unrelated business gross Income of $1,000 or more during the year? ...... 3a b ..... ...... If "Yes," has It filed a Form 990-T for this year? ff 'No" to fine 3b, provide an explonolion on Sched'uIe"O 3L 4a ............. . . At any time during the calendar year, did the organization have an Interest in, or a signature or other authority 'over, ..... a financial account in a foreign country (such as a bank account, securities account, or other financial account)? 4a b If 'Yes," enterthe name of the foreign country O .......... ....... ..... ... ___ . .. ... .................... .. See instructions for filing requirements for FInCEN Form 114, Report of Foreign Bank and Financial Accounts (FEAR). 5a Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? Sa b Did any taxable party notify the organization that it was or is a party in a prohibited tax shelter transaction? ...................... 56. C If "Yes* to line So or 5b, did the organization file Form 8886-7? Sa Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ..... ........ Ge Is ............ ....... . If "Yes,' old the organization include with every solicitation an express statement that such contributions or . , gifts were not tax deductible? ................... ........... .......... 6b 7 . ............ Organizations that may receive deductible contributions under section 170(c). . a Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payer? ........... ... ... . ........ ..... ..... ... .... * , -, * .......... 7a b . ........... If "Yes,' did the organization notiffy the donor of the value of the goods or services provided? ...... 715 c ....................... Did the organization sell, exchange, or otherwise dispose of tangible personal prop". for which' it was* required to rile Form 8282? . . ............ ___ .......... . .. ........ .................. 7c d If 'Yes," indicate the number of Forms 8282 filed during the year Qi 7d.. I e .... . .......... * " ' Old the organization receive any funds, directly or indirectly, to Pay Premiums on a personal benefit contract? 7e f Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ....... .. 7f 9 If the organization received a contribution of qualified intellectual property, did the organization file Form 8899'a's'required? ' h if the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?' 7h 8 Sponsoring organizations maintaining donor advised funds, Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? 9 Sponsoring organizations maintaliting donor advised funds. a Did the sponsoring organization make any taxable distributions under section 4966? 9a In Did the sponsoring organization make a distribution to a donor, donor advisor, or related 'person?............. ..... ....... ....... 9b 10 Section 601(c)(7) Organizations, Enter. a Initiation fess and capital contributions included on Part VIII, line 1210a .. . b ............... * .. ...... Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities 10bl, 11 Section 601(0)(12) organizations, Enter: ........... . a Gross Income from members or shareholders 111a b . . . ............. Gross income from other sources. (Do not net amounts duo or paid to other sources against amounts due or received from them.) 116 12a Section 4947(a)(1) non-exempt charitable trusts. Is the organization -riling Form 990 in lieu of Form 1041? 12a to . .......... ...... if "Yes," enter the amount of -exempt interest received or accrued during the year 13 ........ Section 501(c)(29) qualified nonprofit health insurance Issuers. a Is the organization licensed to issue qualified health plans in more than one state? "Ci. ... 111. 3 .a ............ ....... Note: See the instructions for additional information the organization must report on'Schedule b Enter the amount of reserves the organization is required to maintain by the states in which c the organization is licensed to issue qualified health plans 31 . . . ......... . ................. Enter the amount of reserves on hand — 13 13 b 14a Did the organization receive any payments for indoor tanning services during the tax year? 14a b If"Ye," has it filed a Form 720 to report these payments? if No "provide an explanation on'Schodula*o ..... ....... 146 15 Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuncra, rion or excess parachute payment(s) during the year? mm 15 If "Yes," see instructions and file Form 4720, Schedule N. 16 Is the organization an educational Institution subject to the ser -lion 4968 excise tax on net investment income? 16 If 'Yes,' complete Form 4720, Schedule 0. . ......... -- 17 Section 501(c)(21) organizations. Did the trust, any disqualified person, or mine operator engage in activities that would result in the imposition of an excise tax under section 4951, 4952 or 4951? V VIA 91 DAA Fonn 990 (2021) 1336 65097150911AY412W.2 8:55 PM Formg9V2021`� BOYNTON BEACH FAITH BASED COMWITY -097 -i3�� . ......... 409 V1 Governance, Management, and Disc IOSUre For each "Yes" response to lines' -2 faro'—Ugh'--- 7bPari below, and for a "No response to line 8a, 8b, or I Ob below, describe the circumstances, processes, or changes on Schedale See instrucfions, ------ qheck SchedqltQ_c t 2D§�Lqr—ngtg !r D I%rle in this22q A.— .. ........ S� QPA Ppypplin 'A an . ................ of the governing body at the end Of the t la Enter the number of voting members y eax year 10 Yes No If there are material differences in voting rights among members of the governing body, 'or* ....... .... if the governing body delegated broad authority to an executive committee or similar committee, explain on Schedule 0. to Enterthe number ofvotlng members included on line Is, above, who are independent Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? supervision of officers, directors, trustees, or key employees to a management Company or other person? icant Chan Did the organization make any signif X 3 Did the organization delegate control over management duties Customarily performed by or under the direct 4 changes to its governing documents since the prior Form 990 was filed?X 6 Did the organization become aware during the year of a sigriffIcant diversion of the organization's assets" . ........ 6 Did the organization have members or stockholders? X 6 X 7a Did the organization have members, stockholders, or other 'pers'Or"Is'who 'toad the pawner to elector appoint ..................... one or more members of the governing body? .. ....... 7a J X b Are any governance decisions of the organization reseryed to (or subject to approval b9mb . ... ... stockholders, or persons other than the governing body? y) m 8 Did the organization contemporaneously document the meetings . held. . or written . actions I undertaken . dt . iri n g Ilse , yea . r b , y the - following - . 7b -[X a The governing body? ........ _ .......... ..... ___ ...... .. . ..... X to Each committee with authority to act on behalf of the governing be d y7 , trustee, or key employee listed in Part Vlf, �Sectlon'A', who Cannot be"reached 'at ....... ......... 9 Is there any Officer, direc,tor8b, X L9.101 PP' reS NC 10a Did the organization have local chapters, branches, or affiliates? p X b If "Yes,' did the organization have written policies and procedures governing the activities of such chapte N_ affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?10b Ila Has the organization provided a complete copy of this Form 990 to all members of its governing body before ''fill'n'gthe f'o'r'm? Ila b Describe on Schedule 0 the process, if any, used by the organization to review this Form 990. 12a Did the organization have a written conflict of Interest pollcy0 If `Nc,'go to fine 13 , and key employees required to disclose, annually 'interests 'that 'c'ould'give 'rise to'cenfikts?' 12b X b Were officers, directors, or trustees 12a X c Did the organization regularly and consistently monitor and enforce cof r i pHance with thea y f p Ile ? I "yos, describe on Schedule 0 how ulis was done .......... . ..... . X 13 Did the organization have a written whistleblower policy? .......... .. ........... 14 X 14 Did the organization have a written document retention and destruction policy? .. ......... ............. 13 X 15 Did the process for determining compensation of the foilowfrig persons include a' review and*approval'by . .......... ............ .. ------- independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision? a The organization'sCE-0, Executive Director, or top management official .... Ise X as of the organization . . ........ . Is Other officers or key employee X If "Yes" to fine 15a or 15b, describe the process on Schedule 0. See instructions. . . ......... . ........ . .......... ...... - 15b .. ....... 16a Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? b If"Yes," did the organ' ion follow wr'llilten"policy ,or prock-'dure'requ"lri'ng'the 'orga ' n! ' zatio ' n ' to ' a ' v ' a[uato ' its .......... ..... .......... I - 6a X participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the . . . .. ............... . ... Section C. Disclosure mm. ----------- - - 17 List the states with which a copy of this Form 990 is required to be filed 1114- FL .. ........ .. ...... ...... .... ......... .. IS Section 6104 requires an organization to make b Forrns 1023 (1024 or 1 02'4­-A'Jf a'opl'ic'a­b'Io), 990, and 990-T (section 501 (c) (3)s only) available for public inspection, Indicate how you made these available. Cherk all that apply. [J Own wobske � Anothees website X Upon request D Other (expla,r,,,,Schedulao) 19 Describe on Schedule 0 whether (and if so, how) the organization made Its governing documents, conflict of interest policy, and financial statements available to the public during the tax year, 20 Staba the name, address, and telephone number of the person who Possesses the organization's books and records 0- MILIND CHONOSEX 21.91. N SEACREST BLVD BOYNTON BEACH FL 33435 DAA -- — - --------- 561,-752-0303 990 1337 65097150911103f'022 BISS PM Form 990,,go 1 15 2), BOYNTON BEACH FA-TTH BASED COM14UNITY 6 -097,1509 Pall Fir—Vll 6 o m . ..... . .. . .. p e . ......... n s-a-t"i o---n—o-f "0—f rj"c-e-r's' ....... D -ii a c"i-o m —Tr—ustees, Key E m-p-i-oy-e-es, -H! . ................................................ -------- — A Independent Contractors ghost Compensated Employees, and Check if Schedule 0 contains a r2S;jon�§ or no to n . ............ Y. - - ---- Section A. Office Dire rslrtLs pq�, es and mmPnn,, , , "'.."m L -.Kgy-F , go np!u Is Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization's tax year. 0 List all of the organization's current officers, directors, trustees (whether individuals or organizations), regardless of amount of compensation. Enter -0- In columns (0), (E), and (F) if no compensation was pald. • List all of the organization's current key employees, if any. See instructions for definition of "key empkilyee." •List the organizat[on's five current highest compensated employees (other than an officer, director, trustee, or key employee) Who received reportable compensation (box. 6 of Form W-2, Form 1099-MISC, andJor box I of Form 1099 -NEC) of more than $100,000 from the organization and any related organizations. 0 List all or the organization's former officers, key employees, and highest compensated employees who received more than 100,000 of reportable compensation from the organization and any related organizations. * List all of the organization's former directors or trustees that received, in the capacity as a former director or trustee of the organization, more than V0,000 of reportable compensation from the organization and any related organizations, See the instructions for the order In which to list the persons above, Check this box if neftheir the organization nor any related organization compensated any current officer, director, or trustee, ,,, ----------- . ........................... ........... (A) Posifion Name and 6fle Average (do not check Knowe Mari one (F) huunj box. unless rersc� [a both an Reportable Repatt,-Ne Fstknatedl amcKxt pay wook Officer and a cilrentorltrustee) clyaperisW10 I nompensation of uther -.— I . ........ - from the from related compefronsafion (list any R 5 5 0 organization W -2j p.drganizwqvr�s (W.V m the 1Q!3- ISCI i o ganihan and related P 'ILlaled organizatlons organizations109-,NEC) below c1citied fine) as l - - — ---------- -- - — ---- (1)KETURAE JOSEPH — 50.00 L=CUTIVE DIRECTOR 0.00 X 67 500 0 6, (2) EVERLEVE BAKER DIRECTOR 00 X (3) COURTNEY CAIN .. ................... I 5.00 ................... 0-.' 4 ALEXANDRE EDM ON S 5.00 zap ,00 X"], 0 00 (5) CARLENE ELLIOTT 5.00 TREASURER 0.00 X . . .... —11111�������� ............... - -- 0 01 (6)SHARON FRLV 5.00 ,SOCIAL SWMCE D 0 0 0X 0 0, 0 GL (7) ORIA GOOLSB Y5.0'46. ....... .. -0'. b 6' ................. . A 0 0 5.00 - (s)EARL HEATH M—AIIEGT JOHNSO�' --- . . ....... . Of 0, 0 blAR 5400 .0 0- . "CECW,TARY 0.00 , X 0 . . . . ................. 0 (10)HUBERT MCINTOSH 5.00 DIRECTOR 0.00 X ............. (11)YVONNE ODOM 5.00 D REC7 R 0.00 X 0 0 OAA 990 (2021) 1338 6509715�9 11/0312022 a�5,5 PM Formgp ILBOYNTON BEACH FAITH BASED COMMUNITY 65-0971509 1b Subtotal_ ... ..... ........... ay ...,., ' c Total from d 'I"ol add tidos Iia and 1c" Section � ion to Part _ 2 of number of individualsibrncludira but Holt mmd .. 6 .m 8 8 (including to those listed above) who rec ived more than $100,000 of re ortable co ensation from eau niza ion O" 0 3 Did the organ[zation list any fon-ner officer, director, trustee, key employee, or highest compensated employee on line 1a? if"Yes,"carry/ale#e Schedule Jfor such rrrcfrvrd(.is/ 4 For any individual listed on lima 1a, is the sum of reportable compens-.itlon acic Cather compensation from the .... , ........ organization and related organizations greater than $150,000? If 'Yes, 'complete 13chodule .J far such individual 5 Did any+ person listed on lime la receive or accrue compensation from any unrelated organization or individual former rendgred to the or anization . kf "Ye corno�Iete ,Scf�r�rle J farsucfr JYorse�n 5 __ .. ectR, t3,.ulnrla anr3�sa.-s�ratr#�tcs .....�. �...�..,. 1 complete tFaia table for your five highest oorx�ipensate d independent conRractorS that rer.�.lverl mere than :�~bnta nnri :`,f ..�..,........,.,.,. 1339 R Foaifon (A) (B) (do not checkmore tl, vnw €oD (E) (F) Nam+y and title Average box, urksa ppr.,orn i> body an rdep rtatx Reraartebfe Fstimoked amount Flours aErimrand ;adiracAmkrustre) camperr,abon COmpenaation or other Per We0k� fir, -n p «� ;� C7 ,ro ri the frOm related CXAfliperlsat{an (list any a 0 n �N organlzatean(W-2/ organLm6or>s(W-2/ from the hturrafor c 1099MISCd 10199 1SC/ orgaMZ90nend ei red r a 9t7 WFC) 1099-NdEC) related organtmvons a'args1nizatiorae <; ''.. w ,.e ,;{ below 2 dotted lute) m w. 1b Subtotal_ ... ..... ........... ay ...,., ' c Total from d 'I"ol add tidos Iia and 1c" Section � ion to Part _ 2 of number of individualsibrncludira but Holt mmd .. 6 .m 8 8 (including to those listed above) who rec ived more than $100,000 of re ortable co ensation from eau niza ion O" 0 3 Did the organ[zation list any fon-ner officer, director, trustee, key employee, or highest compensated employee on line 1a? if"Yes,"carry/ale#e Schedule Jfor such rrrcfrvrd(.is/ 4 For any individual listed on lima 1a, is the sum of reportable compens-.itlon acic Cather compensation from the .... , ........ organization and related organizations greater than $150,000? If 'Yes, 'complete 13chodule .J far such individual 5 Did any+ person listed on lime la receive or accrue compensation from any unrelated organization or individual former rendgred to the or anization . kf "Ye corno�Iete ,Scf�r�rle J farsucfr JYorse�n 5 __ .. ectR, t3,.ulnrla anr3�sa.-s�ratr#�tcs .....�. �...�..,. 1 complete tFaia table for your five highest oorx�ipensate d independent conRractorS that rer.�.lverl mere than :�~bnta nnri :`,f ..�..,........,.,.,. 1339 6,90971-509 11/aw_QZ2 8:5b PM 65-0971509 Pam Revenue Check if Schedule 0 contains response or note to any Une in this Part ` ill �.......,.. [� Iota[ irAvenuo t�al�£F ionexempt �rrerxae�ied Revanuo�nxalude4 fwLlfon re'venue bU3*ff11 _S roVorUe (roan fax under setxfonaa 5t2 -59a 1a Federated campaigns 1a V a% b Membership dues lit „�„„o <, c Fundraising events . �, Related organizations Id df us ,. C vvern 1 6 oMacawngrats s=in ants ,, 8 and similaramounts not Included above ........ 1f 23.6 . l 9 Noflcash rontdbuYtons included in lines la4f d m h Total A�d6dlinesIa-1f..... , _., ......_. ............... ,,, �"� ,,,.,396 �4i"7,..�.�.� ���......_ [�usirauss �i � 2a r _�., .. a 4f .. .nue � f All other ro cam service revenue .., ........ p g T®tat. Add it �„ 2a�2f . .,.��. .. _ ,,,,,,,,, 3 Investment income (Including dividends, Interest, and Bather similar amounts) ........ .................... ..... .... ... -, 4 Income from investment of tax-exempt bond proceeds ..... ., ...,,,.� ..., ..... ,..,a�, ....,.......... 5 Royalties ..... , . fnj For ryn it � , Gross rents b Less: ran> e ses 6b 16 .�. ..............._ ._.�, .. m,.., c Rental Inc. or (bis) 6c 8,000 ......... d Net rental income or i�lass __� 1� 0 CI a Oil... 7a C,ras^anr�untfxm �- (�➢ SerouMt�e E t Other�` ����.. __� solo$ of asserts _.... � ,.. other than 9mwbry 7a wo a 620, 000 b lass: Cost or other basis and sales exps. its 495 c Gain or (loss) c 7..., ..................... � 4 977 ... 977 , ............. d Not gain or lass z�...�.:._4 '',, 977J „977 Be Cross income from fundraising events (not including $ ...... . of contributions reported on line 1c), See Part IV, line 16 8a Is Less: direct expenses , 4 b c Not income or (less) from fundraising events 9a Grass income from gaming l activities. See Pari IV, line 19 9a b Less: direct expenses c Net income or (loss) from gaming activities_ 14a. Gross sales of inventory, less returns and allowances Ica b Less: cost of quads sold 1 City rmy c Net income or Ileases from sales of tnvento .. .... 1 ......ri:. ...., �., .,� ..iv„... ® ........ un t Business Coma o.1 Ila mi.slien 12 I w .. , . ... _ . . ...... . . .. .. . . ..... ..... . .. .. .. .... . . _ .. ,.. __,_._,_.....__..... ..,� .... ,..mn ,. d All other revenue .... _._._. . m e TotailAdd Innes, 11a --11d 12 1.2 _Too revenue See rnsturtions ....... 529,466 13 ,9'77 Mi M CLI -1— 12 Foryn 990 (2021) 1340 S�zOJf 45iiJ 'l'r(fiafn`Q`'"�.. £r.55 PhA OYNTON F onmrt "021 t,wBEACH T� _.m.WT'65-0971509 1 taMMMM„,�_._ � rto n Cnaf � ,, ^If d rtd-5CJ9!c f�^Jgrai�nest CQ7;,Netto all columns A l,rather �arjgrrrz�lpr�ns rr�u�t c c?na la q ccriztrnrr PF!” ectiora 7 Check rF Schedule 0 contains a response or nate to any line in this Fart I T ......................ro nnnn .... _ 9,ma.. K:... Do not include .amounts reg�erried on litres 6b,...7br} C�i 4a) (c) ta3 Taial cxpennei Program snrrrre Manapemnt and Fundraising 6b, 9b, arra 10b ofPart W11 .. ................ expana pp'rrar expenses arts 1 Crania and other assistmm Ser der estc oNaniza fbns _. and dorra%Dc grnernrrrent.. Sea Pot IV, line 21 ... ....... ......... 2 Grants and Cather assistance to domestic individuals. See Curt IV, line 22 3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Fart IV, Einem 15 and 16 4 Benefits paid to or for members Compensation of current officers, directors, trustees, and key employees 13I 6 Compensation rias included above to disqualified persons (as defined under section 4955(fj(1)) and persons described ars section 4958(cj(3)(fi) Other salaries and wages „ x.70 4,22x,42 r 719 .... .. 8 Pension plan accruals and contributions (irrcCude " seciian 401(k) arx! 403(b) employer contributions) .w.. 9 C�thererrdplayrebenefits .............. ., 23-2 ,,,,.,�.....a3 y .......,.,. _ 0 w 378 -1 30 1 4 0715 tl F'a roll taxes 11 Fees for services (nonemployees): I a Management 0 to Legal ®„ Accounting 20 240 44 of Lobbying ................. . ............... —� e Professional furldraisilag services. See Part 1V, line 17 f investment management fees Utier. (If line 11q am(intexcceds TY. orline 25, column (N Hiram, liat I'm 119 expense. on Schodulo 0) 12 Advertising and promotion 13 Office expenses . m, r _. t240 14 Information technology .. ,, __ ", i e 3.. , 424 10 6, 16 Royalties 16 occupancy .... 17 Travel 466 r466, 16 Paymentscsf travel or entertainment expenses � for any federal, state, or local public officials ie Conferences, conventions, and meetings ��_..... 20 Interest.... ......... _—�--- ..... 21 Payments to affiliates 22 Depreciation, depletion, and amortization 23 Insurance r 6I - ses. Itemize expenses not covered above (List miscellaneous expenses on line 24e, if Pine 24e amourit exceeds 10% of line 25, column A (A) amount, list line 24e expenses on Schedule 0.) _ a CLIENT ASSISTANCE 134,580 13 4r °i1 ,,,,,,,,„ , _ _. . 300 e All other expo I Hees 2 S "Tom seM 51 „r,..-- 6 11 0 26 Joint costs. Csaln}alefa this titre only if the organization reported in column (B)joint oasts traria a cornbiriedi edum lonal campaignand nd tuncirassdng solicitation, Check here [ It foffowi,r,j §Q ° E 2,LA,9C pM710 B raaA Foon 990 (7021) 1341 Form 990',,Zo�j B(� BEACH FA_TTH BASED COMMUNITY 65-0971509 sallance Sheet Check if Schedule 0 contains a Beginning of year 2 Savings and temporary cash investments _A_ . ...... . 6 ' 25 5 Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial ox)ntribUtor, or 35% controlled entity orfarrily member of any of these persons 6 Loans and other receivables from other disquaNfled persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) 6 372 3 9 Prepaid expenses and deferred charges ... _ _ .... ... - cost or other 10a Land, buildings, and equipment basis. Complete Part VI of Schedule D 12 Investments --other securities. See 12 494' 15 15 Other assets. See Part. FV, line I I 17 Accounts payable and accrued expenses 18 Grants payable 34 17 20 Tax-exempt bond liabilities ­­ f ­ _'­mmm 20 21 Escrow or custodial account liability. Complete Part IV of Schedule D 21 w 22 Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family Member of any of these persons 22 23 Secured mortgages and notes payable to unrelated thlrd parties 24 Unsecured notes and loans payable to unrelated third parties 24 26 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X 26 ToW liabillitles. Add lines 17 t hr 25 293 57 171 706 ok Organizations that fellow FASB ASC 968, che re and colnplete lines 27, 28, 32, and 33. 27 Net assets Without donor restrictions 28 Net assets with donor restrictions 28 Organizations that do not follow FASB ASC 958, check here ill and complete lines 29 through 33. 29 Capital stock or trust principal, or current funds 30 Pajd4n or capital surplus, or land, building, or eq"uiprne'n't'fun'd ........ . t 30 31 Retained earnings, endowment, accumulated fricorne, or other funds . ....... ... 0) 32 Total net assets or fund balances 821[ 990 RM 6501W'5013 I I)IJ312Q22 8'.56 PM Foim,g —7 .q_,q g_j_�_BOYNTON BEACH FAITH BASED COMMUNITY 65 091509 .1-1- ,p ...........mm .. . .......... Part X1 Reconciliation of Net Assets Check if Schedule 0 contains a re f,)20§q, or flqtq�gLa —py Lin Rjhi Psrt.U, X I Total revenue (must equal Part Vill, coIumn (A), line 12) ............ ................ 52-9, 2 Total expenses (Must eqUal Pan IX, column (A), line 25) 512, 2" 3 Revenue less expenses. Subtract line 2 from line I ........... A3.71 4 Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) q. J.dL7 62 Jg4, 5 Net unrealized gains ([oases) on investments . ........ . 6 Donated services and use of facilities . . ............ ........... . . . .. 6 7 Investment expenses 8 Prior period adjustments ... ..... ................ ................ . ........ 8 .............. . 9 Other changes in net assets or fund balances (explain on Schedule 0) . .. .. .... * .. . ..... .... ...... 9 —348 ....... ..... 10 Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32 AL . ... . .. . ... . ... . ... . .. . . ..... - 2. 5 3 Part X11 Financial Statements and Reporting Check if Schedule 0 contains a re . . Schedule ............... M-,�)onse or nate to gpyj err taws Part X11 ........ 1 Accounting method used to prepare the Form 990: LJ Cash X Accrual Other Yes — No - If the organization changed Its method of accountfrig from a prior year or chocked 'Other,' explain on Schedule O. 2a Were the organization's financial statements compiled or reviewed by an independent accountant? ... ... . .............. 2a X If "Yes," check a box below to indicate whether the financial statements for the year were complied or ......... ..... . .... reviewed on a separate basis, consolidated basis, or both: El Separate basis [] Consolidated basis E] Both consolidated and separate basis In Were the organization's financial statements audited by an Independent accountant?, . ..... 2b If "Yes," check a box below to indicate whether the financial statements for the year I were audited on a separate basis, consolidated basis, or both: Separate basis [] Consolidated basis Both consolidated and separate basis c If 'Yes'to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? 2c If the organization changed either its oversight process or selection process during the tax year, explain on ....... Schedule 0. 3a As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB CirculiqrA-1 33? ' * ..... ..... .... . .... ... .......... * ....... ........ 3a b lf'Yes,'did the organization undergo the required audit or audits? If the organization did not undergo the ...... ....... . .............. .. .. . . req,,,wired audit or I in Lon Schedule 0 and describe any ........ . ... . . . . ......... Auqhai�qL ,, 3b EM ru Form 990 (20:>1) 1343 ssos*q 11/31om." Rr'u PM Dapartrnerl of the Treasury Internal Revenue Service imp rit complato If the organization is a section 501(c)(3) organ vidian or a sacdon 4947(a)(1) nonexempt ckjaritablF, trust 0, Attach to Form 900 or Form 99a -EZ. Marne of 0* organization BOYNTON BEACH F A -IT H -B"—A S E_ D . . ........................ E-6—M-RU—NITY DEVELOPMENT CORPORATION .. ....................... . . - _ ­. .... . .. The organization is not a private foundation because it i$: (For lines 1 through 12, check only one box.) I A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i). 2 A school described in section 170(b)(1)(A)(Il), (Attach Schedule E (Form 990).) 3 A hospital or a cooperative hospital service organization described insection 170(b)(I)(A)(ill). 4 A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(W) 0 111111111111 111 1 ' 1 11 Enter the hospital's name, city, and state - 5 ta led for the benefit ............. . .. . ........ An organization o'lpa' ................... of a college or university owned or operated by a governmental unit described In section 170(b)(1)(A)(Iv), (Complete Part ll.) 6 A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v), 7 Art organization that normally receives a substantial part of Its support from a governmental unit or from the general public described in section 17D(b)(1)(A)(vl). (Complete Part 11.) 8 A community trust described in section 170(b)(11)(A)(vl). (Complete Part 11.) 9 An agricultural research organization described In section 170(b)(1)(A)([x) operated in conjunction with a land-grant college or university or a non -land-grant college of agriculture (see Instructions). Enter the name, city, and state of the college or University: 10 An organization that normally receives 1 more titan 33 1 13% of Its support from contributions„ membership fees, and , gross receipts from activities related to its exempt functions, subject to certain exceptions; and (2) no more than 33113% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975, See section 509(a)(2). (Complete Part III-) , 11 An organization organized and operated exclusively to test. for public safety. See section 609(a)(4). 12 LJ An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described In section 609(a)(1) or section 509(x 2). See section 509(a)(3). Check the box on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g. Type 1, A supporting organizatIon operated, supervised, or controlled by Its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization, You must complete Part IV, Sections A and B. b Type 11. Asupportfng organization supervised or controlled In connection wth its supported organization($), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C. c Type III functionally integrated, A supporting organization operated in connection with, and functionally Integrated with, its supported organization(&) (see instructions). You must complete Part IV, Sections A, D, and E. d Type III non -functionally "integrated, A supporting organization operated in connection with Its supported organ ization(s) that is not functionally integrated, The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions), You must complete Part IV, Sections A and D, and Part V, a Check this box H the organization received a written determination from the IRS that It is a Type 1, Type 11, Type III functionally integrated, or Type III non -functionally Integrated supporting organization. f Enter the number of supported organizations g Provide the following information about the supported organization(s). .. ......... (1) r4 me of Auppeead (ii) EuN QH) Type or orVarrization (lv) Is the organ`17atJon (v) Amount of monetary (vi) Anrcurd of or,Wnizatlon (described on lines 1-10 loted in your govem!rrj support (see other support (see above (see trisinxVorls)) tlMYrmPnt7 Ira#rucdons) ansfrucfions) yx oda (A) I Total For Peirrerwork Reduction Act Notice, see the Instructions for Fo0 o rnn 99r 990 -EZ. Schedule A (Form 990) 2021 ffs 1344 6509115CO 11/33/204 8:65 PM . . .......... . . . ......... Calendar year (or fiscal year beginning in) I Gifts, grants, contributions, and membership fees received. (Do not Include any "unusuaf grants.") ....... 145,170 108,128' 211 374 90,46 -- ............ ................ q 396,47 2 Tax revenues levied for the organization's benefit and either paid to or expended on As behalf ........................................... . ---------------- . . .... 3 Tho value of services or facilities furnished by a governmental unit to the organization without charge 4 Total. Add lines I through 3 ... 145,270 108 128� 211-374 390 a69 396,477 6 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included an line I that exceeds 2% of the amount shown on line 11, oalumn (f) . ... .... .... ..... . 6 Publiesu, ,ort,. Subtract line 5 frorn line 4 p ,,L_ .. . . ................... �auH— -.----- —. ----------- - - - - Total Sulp . . . . ....... ... Calendar yaa­r-(-o­r­fisc"a'I year beginning in) A- -- ------- 017 .. . .......... - — ------ - 2621 (a) 2 (b) 2018 (c) 2019 (d) 2020 7 Amounts from line 4 . ... . ... . .. 39Cb 469. 396 r 4171 ............... . 8 Gross income from interest dividends, payments received on securities loans, rents, royalties, and income from similar sources23 660 L- --, . . ............... 216,269� 124, 977� 9 Net income from unrelated business activities, whether or not the business is regularly carried on ............. . . . ....... .. 10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VL) 50 700 11 Total support Add lines 7through 10 mm 12 Gross receipts from related activities, etc. (see instructions) . ...... ... ... ... ... , * ..... .. 13 First 6 years. If the Form 990 is for the organization's first, seco'n'dj hIrd,'fourth, orfifthtax,year, as 'a'section,501(0)(3.). 01(o)(3'). M Section C.Compyl; .Rf—P—Ukr1q,§qp rt JL - !"Re ............ 14 Public support percentage for 2021 (line 6, column (f) divided by line 11, column (f)) 72.43% Public support percentage from 2020 Schedule A, Part 11, line 14 15 % ... .................... . 2:L ............ ........ ... 16a 33 M% support test -2021. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this" box and stop here. The organization qualifies as a publicly supported organization b 33 113% support test -2020. If the organization did not check a box on line 13 or 16a, and line 15 is 33 113% or more, check this box and stop here, The organization qualities as a publicly supported organization 17a M-facts-and-circurnstances; test -2021. If the organization did not check a box on line 113, 160, 4r i ab„ and line 1q is 10% or More, and if the organization meets the facts -and -circumstances test, check this box and stop hore, Explain in Part VI how the organization meets the facts -and -circumstances test. The organization qualifies as a publicly supported organization pp b 1 00/6-facts-and-oIrcumstances test -2020. If the organization did not check a box on line 13, 16a lab, or 17a, and fine 16 Is 10% or more, and if the organization meets the facts -and -circumstances test, check this box and stop here. Explain in Part VI how the organization meets the facts-and-circurnstances test. The organization quakes as a publicly supported organization on, If the organization did not check a box on line 13, 16a, 16b, 170, or 17b, check this box a,nd"sse, .. ........... ... . 18 Private foundatj* ' ­­­ .... ...... . ............................. . ... ... * ........... * ................. instructions ......... .. ..... .. . . .... . .......................... El .. ............ . . ......... .. . ---- Schedule A (Form 990) 2021 MM 1345 550971500 111rY3 022 8,56 PM ScJleduleAll�'Fo,ff,,n,pgq��,,,,,, ... BOYNTON BEACH FAITH BASED COMMUNITY,,, §�7 9 +rw ; M 'Section (Complete only if you checked the box on fine 10 of Part I or if the organization failed to qualify under Part 11. 1f,the ogrpnization fails to, ted be com Part ��er the tests lis st Y Y 9. M a, inning in) atendGt, grants, fees ia(2U17 (b) 2018 _ .." 2019 X4721 ictal I g Ea .. recelvod,(Do not iniudaarty°unurualgrants') 2 Grass receipts from admissions, merchandise scald or services performed, or facii1tfes furnished in any activity that Is related to the organization's tax, .exempt purpose ...... n�� ... . ...�, , , �. ....... __ ... Grass receipts from activities that are not an unrelated trade or business under section 5113 ; 4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf 5 The value of .services or facilities furnished by a governmental unit to the organr'zatfon without charge Total. Add lines 1 through a 7a Amounts included on fines 1., 2, and 3 received from disqualified persons Amounts included on lines 2 and 3 received from aider than disqualified persons that exceed the greater of $5,000 or 1% of the aarnaunt on Brie 13 fear the year C Add Braes 7a and iia 8 Public support (Subtract line 7c from line 6.4 11 Net irrcr me frorn unrelated businessI activities not included on lene 10b, whether or nutthe business is regularly carried on . � .,........ � „ 12 Other Income. ria n include.. gain or ..,. loss from the sale of capital assets (Explain in Fart WI.) 13 Total support. (Add Ines J, 10c, 11 lop ,.„. - �.. h �.... 14 ... � _ll ... I orm ���,,,�.... First 6 yeas. if the Form 990 is for the o organization's first, second, third, fourth, or fifth tax year as a section 501 (c)(3) organization, is kA x are s ere � � �yN^�,p;.¢�. 6 l�k8I11Tn �nnzm 5S9+p.Ss .-. _._._ d E:d� � 15 t'ratalisu� ort percentage for 6, a:ol Pia P g ( (fj by line 13column (f)) 1 16 p t schedule Faart Ift line 15 elf In�t2t7 ,. tCIIrSasCCorr 7t9tt �,. tr1T Ilnco�zra Pa01rr, 17 1S Investment incorne percentage for 2021 (line 10c, column (f), divided by lime 13, column (f? Investarrent rncorne from 2020 Schedule .., ......18 [.- ...... _ percentage A, Part 4f1; line 17 19a 331.13% support tests --2021- If the organization did not check the box online 14„ and line 15 is more than 3:3 113%, and line %.. 17 is not men, than 33 1!301., check: this box and stop Frere. The organization qualifies as a publicly supported organization „ ........ b 33 113% arkppo 20217. If the organization did not check a box on line 14 or line 1 ga, and line 16 is more than 33113' o and line 18 is not more than 33 113%, check this box and steep here. The organization qualities as a publicly supported organization,,.,20 g b Private foundation. if the organization not check a box on line 14 19a or 1gcheck this box and see instructions ._ m. � Schedule A (Farm 990) 21721 OAA 1346 GW97',1X911/03r2122 8:56 PM schedule A (Form 990'� 2021 BOYNTON BEACH FAITH BASED COMMUXITY ... ....... .. ........ --i'mi . ... ................ ...... 65-0971509 Supporting Organizations -- _Lq,22A (Complete only if you checked a box in line 12 on Part 1. If you checked box 12a, Part 1, cornplete, Sections, A and B. If you checked box 12b, Part 1, complete Sections A and C. If you checked box 12c, Part 1, complete 5PP99P§A.P.,-?fld �,-,,Jf-122,,,checked box 12d, .,Part J,,,99ffjL!ttt�aepPqnS,,A and D,, and com Part V 1 Are all of the organization's supported organizations listed by name in the organization's governing documents? If "No,'oescribc in Part V1 how Mo supported organizations are designated. ff designated by class or purpose, describe the designation. If historic and continuing relationship, explain. 2 Did the organization have anysuppored organization that does not have an IRS datermfnatfon of status under section 509(a)(1) or (2)? IF "Yes, "explain in Part W how the organization determined that the supported organization was described in section 509(a)(1) or (2). 3a Dirt the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yds,," answer lines 3b and 3c below. b Did the organization confirm that each Supported organization qualified under section 501 (C)(4), (6), or (6) and satisfied the public -support tests under section 509(2)(2)? If "Yes,'* describe it? Part V1 when and how the organization made the detentyinaflon. c Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(8) purposes? If 'Yes, " explain in Part of what controls the organization put in place to ensure such use - 4a Was any supported organization not organized in the United States ("foreign supported organization)? If "Yes,'" and if you Checked boy 129 or 12b in Part /, answer lines 4b and 4c below, b Did the organization have uItimate, control and discretion in deciding whether to make grants to the foreign supported organization? If 'Yes, 'descifbe in Part W how the onjani7stion had such control and discretion despite boing controlled or supervised by or in connerffon with its supported organizations, c Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If 'Yes,'explain iry Part V1 what controls the organization used to ensure Mat ail support to the foreign supPc`rfecf organization was used exclusively forsection 170(c)(2)(B) purposes, 6a Did the organization add, substitute, or remove any supported organizations during the tax year? If 'Yes, answer lines 5b and 5o below (if applicable). Also, provide detail in Part W, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (Y) Ilya reasons rear aeoll such action; (iji) the authority carder the organization's organizing document authorizing such action; and (iv) how the action was,acrornplishod (sucll as by amendivent to the organizing document). b Type I or Type 11 only. Was any added or substituted supported organization part of a class already designated In the organization's organizing document? c substitutions only. Was the substitution the result of an event beyond the organization's control? 6 Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone otherr than (1) b supported organizations, (H) indMduals that are part of the charitable class benefited by one or more of its supported organizations, or (ill) other supporting organizations that also support or benefit one or more of the filing organization's supported organizations? If 'Yes,'provide detail in Part V1. 7 Did the organization prcyvide a grant, loan, compensaVon, or other similar payment to a substantial contributor (as defined in section 4956(c)(3)(0)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If 'Yies,'cocrypiete Part I of Schedule L (Form 9907). 8 Did the organization make a loan to a disqualffied person (as defined in sooflon 4958) not described on line 7' ? If 'Yes, " complete Part I of Schedule L (Form 990). 9a Was the organization controlled directly or incirectiy at any time during the tax year by One or more disqualified persons, as defined in seutfon 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If 'Yes,"provide detail in Part V1. b Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If `Yes, "provide detail in Part K c Did a disqualified person (as defined an line 9a) have an ownership Interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If 'Yes, "provide detail in Part V1, 1 Oa Was the organization sub*t to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type It supporting organizations, and all Type Ill non-functIonally integrated supporting organizations)? If 'Yes, "answerline 101) below. b Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to - - - datenryine whether Ilia omarrizaticify had excess businp,,Lq hnielinepo,, ) M Schedule A (Form 990) 2021 1347 650?'V"!49 I I IC012022 3-16 NO 0rrm"60 2021 0 ''TON 13FAC! PAITH, BASED COMMUNITY0)T1 9 § .. . . ............. PP 1 Organiz d n 11 11sis the cpIrgan4zatIlon ac�.nepted ,:� g[il or irwitribuvoiri fjr)rrr EMY Of tile folloviling persons? a A person mtho directly, clr, indirectlly controls, elitheralorle Or togeAher with pemons des"the d on fines 11b anid @'f c below, the goV0,111hig tx),dy of 2 supported r.n9anizaflon'? it A far00Y rnernN.)r of a peystm desioribr,,,ld rin Une 11 as above? c A 35% conliroflr.A enVky of a pemon doscobed o: n Ine I la or I 1b abovcl? If 'Yes" to jjrrrm t1a, I 1b, or I jce, 1 ..,; ection I DkJ the grivernuiq body, riiernbers of the,� q JW C,412elty,, or trierribership of orlic! Or goverr*lrj body, officers aiI in Vjel� �hjjr�, Mau-, supported organlIzatl(mis flawsIhe power in mguli`WHY appokit air etect at l a majority afthe orgarization's afflh;rjy,:,, 6rectors, of trustees Lit. ah times di.aing the tax year? Vft, 11 (,fFSCdbl-) in Part IN how the �,,,lipportm 0,rfecUvely operativid, suporvirsed, 0), Cosibrofledffie oyganizativr7,�,;, 474qr7j) ation had rnote than prit) &Ipt,nOrteej ort golnization, desr,,Hfte tkotv Me parr ram. tri appoint andlor mmlmre Offi4-rcrS, dku-CtXS, C)" trustees wery,a e4ormled airrorig tile I.,,,upparted otganimsfions ay'RY Wflat cf..)nCiffloos of mstfiinx)ns, irarly, aj,"IptiOd fQ Such Power,,; during the ta)r� 2 DlId the orgaritraWn aparme frac the benefit Of aIny Supportod organlizafiriin qAher than the Supported organlization(s) that Opelrate vt super%nsed, or co,ntroHed the supporfing 4irganIi If `YP,4,, 'explain [jq Part V1 how jrovkffi�q &Ach berletif carrier.] out userprirl,eo.qeS of tfnc Supported c)rganization(s) thal opeoete'd, ��ed or confrofird thn smrmnrP!;rwv fw-iry .0 mqa^ons I Were a rraJority of the organizabon's dircctors, or trLiStPps diurtrig the tax year aiso as rridjorftyof fti &ectors ar trusts-ees of eacll of the 0q,.,TamzaiIIoirvssuprx)rto.,j orqa bq , , b0n(SP It "NCi, °" dai 'Wrbe 17 1Part h 4 Jaowv c,(y'gfr)l , Il Or MWYaVeMPM Of tjjC .Djjppodmg oqiandation was vestr-x-f h7 the S0177xa P&Mans that cy)nfrolled or, i naaaegea ,f D. All "rvpe in pt, suPpu'Aed orgarkz�#mm;, by the Jast d: ay of the fl rhollthofthe organ katjon's tax year, (j) as vvrdlen notIce descrNing typekind WrlOunt Of Support proWded durflig the prior tax Year, (iG) a copy Of the Forrn 990 that vlras nrost irecentllYffled as, Of thEl date of iI,n, and (N) Copiels of the Organa dam's gavernhig documents ln effegt orw Ijita�j�'i 0 Of'nCAffiCJfioT1, tx) the tmtent not pTqVjCiWy ProvWed? 2 Were, any of the organization's offI dlm(tom,, or tmuitmmns c, thee- ([) 1ppointad or elected by the sUpportc,,d Orgjarflzation(s) or (fi) surving on the governfing biAy of a supported orgwftatbn? " explaii-i in P-rtVj,how thO mainfilhiod a close and ccnth,wous working reh'itionshifs iqith thp sjupporlLri orgonkrabonfr), 3 By reason of thie, ropatoA,jshllp &-,scribe�,d oil line 2, above, dId the organizabon's SVPPMt6Xi 0rqanli7.,,,-',fflonS have a SIiqr1iI voice in flie organ [7afion'% investment pOUas and in dlrlaa�ng thee Use OF tire oigairib.ation's incor rre m, misets at all I tr,rscs d I rj rig the teix yezar? ff dbScUrIbe In Pan' V1 the mi/e the cert ratarrmtdcrk"�� °!ep""a 2lgtELCLL��,Jrll 1A2ns r"glamJ in ulis rox mfioxi E. TVpe 111 II11-Funiciii)"n" altlnte-a� mted St.mII till I # e )Pmc* Ihe..,, box aaxt to the methrld Mar the ear ghers zaflan USed to safisd Me rarataa rand rt 7est during Ole yeey, 1rnSf#-jgjr,,-,t a .p...tr crp aaraz akreas%,atlsried the A.(,Ijlv' itles TO%t- Comi'Vete fine 2 bekjw, to I he argm,Ozafion pr, the PzNerlt Of each of lits Supported orgairwzahons. 3 belcm. C 1j, I ho oMaripzatfori &.jppert&d a govelriiI enjit.y, rlesclibe irl Ran V/ ar�jjj f,,wPPo61k'mJ .'l egovemmental Curgity ('sVe Ostd-m AcAMMes 'est, Answer flnes 2a afrd 2b bolo as DkI sub stwifiMiy aH of the orga'I acAhfftiea during tPjc,,, 9t,�x year d4vxlty further the axrompt pwpoa 7,cas cif thR SUPPOited orgarjlxaatjojj(s) to smpnie ft the organlizatbrt was irespauara,uwrc? jul"Iyes, thcj,in Pmf 16 ldenff& those suppwfed clNanim thans 4and exp1ain how these ac,,I dilecitye fivribeted Meiir homl the organizution mes rr'-VOOSA(6� R) th()SO suPP010d arganizations, and how the 4)1,gOri�zation dohwrrtfnacj that the an acfivides constituted substanfiafpy all aNIS ablivides, b Did the authfitIes descrR)od on Frie 2a, "Ib011e, C'MISIRLde acfivltks that, but for the ojr�,jani7aflojj1S krvouverntrnt, DrIe or more. (,If the urgan�zaflon's saipported orgarilization(q) woWd fitave, been engaged in""', if 19"(p1j'air) irk Palf V1 ffie reasms fbi, sqpfya.rrtcd orge zd6ary(s) wmild h"we engage ed In bcse, 0clivilivs but for thic cirfxjnizi�td171a�m jjpvrajaj &1apt 3 Pamit of Supported OigarI Answerlrrysms 3a and 3b beimm as D id the orgavirzation liave Ule power to regirjIII appoint og majority of the afficc-Ils, d4(,x,1crs, ur frustees of each of the s Upported orr,panizafiolris? If' `h`(,`` 01' `PVo,'pn,ivkh, detadi O,Ne t iVI. b I.Nd the cxeri.rse a sutmtantiad degrea of dh)ec1J0n caster tire Poilick's, p'liroqrams, and aclivrhf��c, of eaf,)l us L) 1 h �i ",op o fa . L,? N,�,-ra L�f2-z� ale A (Fomns;a(ij[ 2oz r 1348 6W9,11 5c* 11 /0312022 8:56 PM Schedule A INIZI 9M, BOYNTON BEACH FAITH BASED CCOMM !K . .............. TYPPAKN—OR-f I Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov, 20, 1970 (pxplaln In Part VpSee in potions, All other [alqte Sections A th!qqpp F. Section A - Adjusted Not Income .(A) Prior Year . . ........... 6un�'—'t Year . ... . . . ... . . . 6 Ponion of operating expenses paid or incurred for production or collection of gross income or for managervient, conservation, or maintenance of --- LIEO-i'_e"!YJjqd ford,rq of ricome ($c'e lnstructlons'N, 7instruction 7 _q N!st LncejR tract Nrn 6A and 7 from Jane r 'rtm Section B - Minimum Asset Amount (A) Prior Year (B) Current Year 1 Aggregate fair market value of all non-exempt-useassets (see FE V 4-10-ta! "add lines I a I b and -is", . ........ e Discount claimed for blockage or other factors Subtract line 2 from line Id. . . . ........ . .. . ........ - . ......... 4 Cash deemed held for,. use. Enter 0,015 of line 3 (for greater amount, see instructfogL . ............... - — — - - ----------- - . ..... 4 6 Net value of norl::� ) -y§ x4� a assets (subtract line 4 from line 3u r Recoveries ref mor -1r distributions 7 .. . . . .......... Section C-. Distributable Amount . ....... Current Year I A usted net income for '�nor r . - - - —Yl-- L- . . .. . ....... 2 Enter 0.85 of line 1, Minimum asset amount for garifrcrrrrSectNonf3lied column.� n' 4 Enter ogre"ater of line 2 or line 3- ............... . . ............ 4 5 income tax in J �qp fn,L tqr_y 6 DistributableArnount Subtract line 5 from line 4, unless subject to t_ ItT pedu tructiop�)/,_'// .. ......... . . ..... ... 7 L i Check here if the current year is the organization's first a non-functonally integrated Type Ill supporting organization MM 1349 ,,klie,du e A 21 BOYNTON BEAC,31 FAITH IASED ,mow CC TY 6 5 D . . . ......... . .... . .T7 III Non-Funict lyll !Q �F llizat 10 1011a . 1% --# ns. Section D - Distributions Current Ywir 2 Ain-vounti, pa W to pmforrn aclMty that direcCy furthers exernpt pwposes of supported 8 Dshibuflons to atterftW supporled CigalliZatilDnq, to wNch the organizatiorl �a resp unsive .. ... . . .............. . . . . . ........ .. . ........... . . . ............ . . . .... . 9 DstdbutaWe aff*Mt for,2021 fravill Secdary G, 'ID Urm 8 arnmmt divided 0) Section F MstribuflonMorationsi, (sea, irmtructions) Excess IstribiRions lea' derdistributicin-g Dislrkxutable .......... Ne -2021 A 11OUnt for 2W 1 DusWkdabie amount for 2021 frorni Section C, fine, C� . . ....... - -- - -------- ''I'll. — .. ........ . . . ........ 2 UnderdistribWJons, of arly, for Years prior po 2021 (re ewer cause req uired-ewpikiin in Part W). Sea m lb Firwn2017,,,, ic Frcm2018- e Il rorn2020, Ir ToW of Kanas 3a Lhrwah art !12 2, L) i (�2t RQ i dSee instructions IL E:Mgirider, SubbaActt finc-I 3 , 3h, arid 3i h-orn kis at, Distdbvjtk)ns fbi, 2021 from m _.r (line - 4a avid 4b from kne 4� !�jn;�btr I . . . ........ . ...... --- . . .... - . . ... .... 5 Rem2in�ng tmderd: istriblutiom,'4 for years prior to 202?1, K any. Snbtracl liries 3g and 4z fronv ifine 2. F�oirr vl(., U 6 FiemaivOng ars derdistributiorrs for 20:21 SlUlbtiact lim-7 3h and 4b from fine 1. Fbi, resul greater thary zoro, explain ill Part 1101. See knstnxtkwrs . . ........ . . ........... 7 Exce4m, distribuflons carryover to 20,22, Add Hnes 3j arid4c,, ............. 8 Breakdovin of Hine 7, Exclor's from Exrc,ess from U,RA 2017 11 . .......... 2018 , � - .......... tu-�(JUFC 41% (Form 990) 2021 1350 h: Zi,5C 1 I1IWM2L 6:56 PM Schad We A °art r rr r N Information,I ) °-- C 3 CCS65-0971509P a'; . N Provide the explanations required by Part 11, line 10; Part 11, Ilse 17a or 17b; Part III, lime 12; Part IV, Section A, Imes 1, 2,3b, 3c, 4b, 4c, 5a, 6,9a, 9b, 9c, 11a, 11b, and 11c; Fart IV, Section 13, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, Imes 2 and 3; Part IV, Section E, lines 1 c, 2a, 2b, 3a, and 3b; Part V, lime 1; Fart V, Section 13, line ie; Furl V, Section D, Imes 5, 5, and 5; and Part V, Section P, nline 2 5 and 5. ,Also compjete this i n fcsr rs� additional informabon ��, e rnstr�acfions,� Part 11, Line 10—tither Tacoma Detail ,DEV., ..... .. FEES ,,... , 52,200 _. ��� , .rr._..... ., ��,�... . .................. Schede e A Torm 990)-"21021 1351 850971-139 1 V03020,22 8:63 Pm Supplemental Financial Statements OMB No, 15454A7 0, Complete If the organization answered "Yes" on Form 990, Part IV, line6, 7, 9, 9, 10, Ila, Ilb, 11c, Ild, Ile, llf, 12a, orl2b. 2 0 Ad% 1 01 Attach to Forrn 990. Open to Publi J t Arctwiry El Ing i ction la).Domr adviaW funds (b3runft arid other "*=un 1 Total number at end of year . . ........... 2 Aggregate value of contributions to (during year) 3 Aggregate value of grants from (during year) 4 Aggregate value at end of year. .... .. . . . . .......... . ................ . . .. ........... 6 Did the organization inform all donors and donor advisors in writing that the assets held In donor advised funds are the organization's property, subject to the organization's exclusive legal control? .. ......... Yes No 6 Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not forthe benefit of the donor or donor advisor, or for any other purpose . . .. . . .. . . . No Pa rt 11 Conserr ion Easements. Complete if the organization answered "YW on Form 990, Part IV, line 7. . . . ....... .............. . ........ . ...... . . . . . ............. 1 Purpose(s) of conservation easements held by the organization (check all that apply), Preservation of land for public use (for example, recreation or education) Preservation of a historically important land area Protection of natural habitat Preservation of a certified historic structure Preservation of open space 2 Complete lines 2a through 2d if the organization held a qualified conservation contribution In the form of a conservation easementon the last day of the tax year, old t End of the Tax Year a Total number of conservation easements 2a b Total acreage restricted by conservati .................. on easements 2b toric structure included in . ......... . . ..... ... ......... c Number of conservation easements on a certiflod his 2c d Number of conservation easements included In (c) acquired after 7/25/06, and not on a historic structure listed in the National Register 3 N um bar of ca nservatio n easements modified, transferred, released, extinguished, car termin ated by the orga n lzatio n during the . . . ... tax year 4 Number of states where property subject to conservation easement Is located 10. 6 Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............................. * ........ * ........ .......... —1- []Yes E] No 6 Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year ll� ........... * .... 7 Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year )i s ................... ... 8 Does each conservation easement reported an line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) avid section 1170(h)(4)(B)(i)?. .......... ........... Yes [] No 9 In PartAll, describe how the organization reports conservation easements in its revenue and expense statement and balance sheet, and include, if applicable, the text ofthe footnote to the organization's financial statements that describes the organization's accounu!9 L�L ns!!2!ion easements, ... ........ ........... ........ ... art U11 Organizations Maintaining Collections of Art Historical Treasures, or Other Similar Assets, Complete if the organization answered 'Yes" can Farre) 990, . .......... — . . . . . . ........... Part IV, line 8. . . ................... . .. . . . ..... . . ...... la If the organization elected, as permitted undeFASB ASC 958, not to report in its revenue statement and balance sheet work of art, historical treasures, or other similar assets field for public exhibition, education, or research in furtherance of public service, provide in Part Xill the text of the footnote to its financial statements that describes these items, b If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these sterns: (i) Revenue im-Auded on Form 990, Part Bill, line I (H) Assets included in Form 990, Part X $ $ 2 If the organization received or held works of art, historic*[ treasures, or other similar assets for financial gain, provide the following amounts required to be reported under FASB ASC 958 relating to these items: a Revenue included on Form 990, Part Vill, line I b Assets included in Form 9 , P ............. ............ For Pa n Act Notice, see the Instructions for Form 990. OAA (rearm iso) zo2z 1352 6509T*1 WJ I I /Wizp= 8 56 PM §11ch9duleD_±Qn.2aUQ2j BOYNTON BEACH FAITH BASED COMMUNITY 65-0971509 0 iia—ri III ni"n........................... . ....... .. .. . ....... . ofHistorical TreaSurM, ,or,Other Similar Assets,(a�ntar�tra ,l 3 Using the organization's acquisition, accession, and other records, check any of the following that make significant use of ifs collection items (check all that apply): a Public exhibition d Loan or exchange program b Scholarly research e Other C Preservation for future generations 4 Provide a description of the organization's collections and explain how they further the organization's exempt purpose in part X111. 6 During the year, did the organization solicit or receive donations of art, historical treasures, or other similar assets to be sold to raise funds rather than to be maintained as No collectio, ....... .. ... `i a c —ro w a -,n- , d" 'C', u -s -to -d-, `Ia' I Arrangements. ..­__111111mmmm ................... -'L L Complete if the organization answered "Yes" on Form 990, PW IV, line 9, or reported an amount on Forrrj Dart X line 21. . ................. . . . . ................ . . ....... la Is the organization an agent, tfUSt80, Custodian or other intermediary for contributions or other assets not included on Form 990, Part X? nt In Part a,nd,co,miolate th'e, following' table: .... . ................. .. .................. ....... E] Yes b If 'Yes,* explain the arrangement ... No Amount c Beginning balance ....... . ........ ........ ... .... .. .. . . ............ d Additions during the year e Distributions during the year ....... . le f Ending balance' 28 on Part xlil Did the organization include an amount on Form 990 Part X ince 2 1 for as c row o r ou s to , dial account flabiflty? ..... .... . �0 b if Yes eXj!l!I_arW r7!�qj in Part X111, Check here I Ute,±J­Ian� Z_ - _ _ 'L q Part V Endowment FunWi. . ... . ..... t1pte'lf theI cq,� aniZation answered "Yes' on Form 00 Pqrt 1\1 fing. In 4ai Carr Jnr year W Pdor year (0) Two yaars ba (d) Three, years back ......... (0) Fow years back Ila Beginning of year balance b Contributions .. . ............ c Net investment eam[rigs, gains, and losses d Grants 'car 'schola'is'hips .......... ...... .... . ...... _,_ . .................... e Other expenditures for facilities and programs . ........ . ............ f Administrative expenses ......... . . .. — ----- .. ........ . 9 End of year balance ...... . .... 2 Provide the estimated percentage of the current year end balance (line 19, column (a)) held as: a Board designated or quasi -endowment % ..... ........ b Permanent endowment % c Term endowment % The percentages on lines 2a, 2b, and 2c should equal 100%, 3a Are there endowment funds not in the possession of the organization that are held and administered for the organization by: i 6509M1,09 I I M20228:51 PM Schedule D (Form 990'1! 2021 BOYNTON BEACH FAITH BASED C014HUNITY 65-0971509 Par, 3 .............. WWRIEMMU-I"IM (a) Dasvpl;on of swurity or cateVaiy (including nam of secvrity) NUMMM (1) Financial derivatives (2) Closely held equity interests (3) Other .......... ..... . .......... ........... ................. .... ... .... . .. . .. . .. . .. . .. . ... - — - - ----------- Tot !aifCofumg must equal Form 990, part,X,-c Pali " i—F", J`hvest m­"e-n—ts - —Progr-aii Related. Complete if the ol�gg n answered "Yes' on Form �0, R�r . �� -.11,11,111-11, - — — —, 9 1l)y (a) Desulption of inve&IMPrd 7 "M000kwilue opr' F rt X, line I (c) Method of vafua3an, Cost ry rnd-of-year rrrdrket value 11 c. See Form 990 Part X, fine 13, Cost or end -of -year mwkel value Tota ZqQan .-I - - ------ PiR IX Other Assets. ............ .......... . ........... ToU. (Column (?,�) Must equal Form 0 part> co!, (B) line — — ----------- - 1 70 ,2 72 2. Liablifty for uncertain tax positions. In Part XI H, provide the taxt of the footnote, to the organization's finanriaj statements that reports the 2M�nizafion's Ha�!iiNja[ uq2�rtajin, tax l',ositions under FA,13B ASC 740. Check here; if the text of the footrtot . . ....... e halyra,!222n,,��q A i"P Qgll DAA Sehodulo D (Found 990) 2U21 1354 ^ |05D971'5T2 I 1103,0C22 85[ PMScheduieDTorrn991 2021 BOYNTON BEACH FAITH BASED COMMUNITY 65-0971509Part X1 Reconciliation of Revenue per Audited Financial Statements With Revenue per Return.Com,,,lete if the MM�zaflon answered "Yes�'on Form 900- Part IV, line 12a,I Totai revenue, gains, and other support per audited financial statoments 529,_A_2 Amounts included on line I but not on Form 990, Part Vill, line 12:a Net unrealized gains (losses) on investments'.h Donated services and use of facilitiesd Other (Describe in Part XIII.) 2d3 Subtract line 29 from line 1 5 2 94 Amounts Included on Form 990, Part Vill, fine 12, but not on line 1:a Investment expenses not included on Form 990, Part Vill, fine 7bb Other (Describe In Part X11 1.)c Add lines4a and 4b 4cAudited Financial StaternentS With Expenses per Return . .......Comr4ete if the.q�g���!t� ".2n Form 990, Part IV, fine 12a,1 Total expenses and losses per audited financial statements 512 292 Amounts included on line I but not on Form 990, Part fX, line 25'b Prior year adjustmentsc Other lossesd Other (Describe in Part XllL)4 Amount-, Included on Form 990, Part IX, fine 25, but not on line I --L9A -a Investment expenses not included on Form 990, Part Mil, [hie 7b ..' L4ac Add lines 4a and 4bas, Add lines 3 and 4c. (This must a 990, part 1, line 18'�Provide the descriptions required for Part 11, lines 3, 6, and 9� Part 111, lines I a and 4; Part IV, lines I band 2b; Part V, line 4; Part X, line2; Part XI, lines 2d and 4b; and Part X11, lines 2d and 4b. Also complete this part to provide any additional information. DAA Em Schedule D (Form 990) 2021 1356 650971=9 "i'{ft7MC'n?2 &57 PM Scch, dLtl 1M1....,.,.,.,Fu m 99900�.....l.Q.29 H BASED COMMUNITY 65-0971509 �Page . ,, .____- w ��� mental Information Provideh inform information required by fart I, fines 30b, 32b, and 33 and whether the organization is reporting in Dart i, column (b)q the number of eontribubon , the r]Llmber of items received, _.,rr.� g�lete thin p ��art for an,, dd� �n�l info etion ere combination cr both AJse � .. m. .._ _. ®� , �.� . _ ....._._ DAA ChOduru l49(Form 9,90 2021 1357 e6097T509 I 1M17W— 8:57 PM SCHEDULEO Supplemental Information to Form 990 or 990 -EZ (Form 990) Complete to provide Information for responses to specific questions on Form 990 or 990 -EZ or to provide any additional information. Departnwnl of U* Treasury 0, Attach to Foffn 990 or Form 990 -EZ. Internal Revenue Service 00, Go to jy����2 latest Information. 6509715n9 11/0W2022 &55 PM na rlrnent of ttu: Treasury Irrterrra4 rtcx✓enurr aerutraa Elaine offflerm For Calendar yaor2021,orracelyearbeQirirrinp..... . ...P021,andendiT49- .... ......, 2U 10, Do not serifs to tura IRS. Keep for your records, OMD No. 1546-0047 NOM w� �rra�rrs�s���sa�–C)1Q stibied to tax C OLTRTi� .,,`.�° CAI Check return for which you .are casing this Farm 8879 -TC and cerci the applicable amatsrrt If any, from the return. F'an's 8038_ CP and Farm 5330 filers may enter dollars and cents. For all other farms, enter whole dollars Only- If you check the box on line la, 2a 3a, 4a, 6a, 6a, 7a, ala, 9a, or 1 Oa below, and the amount ori that line for the return being filed with this farm was blank, them leave line 1 b, 2b, 3b, Oka, 6b, 6b, 7b, 8b, 9b, or 10b, whichever is applicable, blank (do not enter •U-), But, iF you entered -0- on the return, then enter -0- on the applicable line below. Do not complete more than one line in Park 1. 1a Farm 990 check here ......b Total revenue, if any (Form 990, Dart Hili, column (F4), litre 12) 1b 529466 2a Form 990 -EZ check here b Total revenue, if an Farre 990 , line 9) 2 r 3a Form 11217 -POO check here "l"catal tax (Perm 1120-PC7C_, Brie 22) , Ufa Farm 990 -PF check here b 'fax based on investment income (F , ..r99 .....0 -PF, Part�I. , Cine . .5 , .). • ........ Ota ol7r 6a Form 8863 check herrn 10, b Balance due (Farre 8868, line 30) ........ , . 5b ... .............. ........... a Form 990 -T -i check here ...... .... Eta era b Total lace (Form '99Q -i, Part lB(, line 4) , ° a trrrrr X7"20 check here , ... , .. �` b Total tai (Form 4720, Part Ill, line 1) ................. 7b $a Form 522? check here I b FEND' of assets at end of year (Fa rs 5227, Item D) 5 . . 9a Form 5;330 check here � b T due (Form 5330, Pert 11, line 1'9) • ...... , , , , � Yiyallcerorversonuu cttoTax Under penalties of perjury, ! declare That I 1 am an officer oaf the above fe�Fl ; � I em a � �� d that have tax with respect to (name. 2021 of entity) return and accompanying schedules and stat rnents, and, to the best of my knowledge and belief',, they are true, examined oro e Dopy of the complete. I further declare that the amount in Part I above is the amount shown on the appy of the electronic return. I consent to allow my and intermediate service provider, transmitter, or electronic return originator (ER€0) to send the return to the IRS and to receive from the IRS (a) an acknowledgement of receipt or reason for rejection of tile transmission, (b) the reason for any delay in processing the return or refund, and (c) the date of any refund. If applicable, I authorize the U.S. Treasury and its designated Financial Agent to initiate an electronic funds withdrawal (direct debit) entry to the financial institution account: indicated in the tax preparation software for payment of the federal taxes owed on this return, and the financial institution to debit the ontry to this account, To revoke a payment, I roust contact the U.S. Treasury Financial Agent at 1-888-353-4537 no later than 2 business bays prior to the payment (settlement) date, I also authorize the financial institutions involved in the processing of the electronic payment of taxes to receive confidential inforrrrahon necessary to answer inquiries and resolve issues related to the payment, I have selected a personal identification number (PIN) as my signature for the electronic return and, if applicable, the consent to electronic funds withdrawal. aaczzM .= Ll1 authorize to enter any PISS o lura, name as my signature Enter five numbem, but +'fee not emcr all zerog on the tax year 2021 electronically filed return. 1f I have indicated within this return that a copy of the return is being filed with a state agency(ies) regulating charities as part of the IRS Fed/State program, I also authorize the aforementioned ERR to enter my PIN on the return's disclosure consent screen. 19 As an officer or person subject to tax with respect to the entity, I will enter my PIN as my signature on the tax year 2021 electronically filed return. If I have indicated within this return that a copy of the return is being filed with a state agency(les) regulatingcharities as part of tiro IFAS Fed/State program, I will enter my PIN on the return's disclosure consent screen. tax REI's FIN/PIN. Enter your six -digit electronic filing identlfi C 2'tion number (EFIN) hollowed by your five -digit self-selected PIfs. ERO'S siptature, 11. r Mill 11111� M1111- Date 1, 1,.1/03/22 Rte Must Retain This Form —See ill tru tlort ... it This Form to the 1: braless R U sled To Cies o For Privacy Act and Paperwork Reduction Actl_otice see:::, „_____1 _.� ...� , � � t,ti�rrllt'Th1 taaegk of form, """".","._ .��`.�� F it 8879 -TE �_..,M....._ op�a2fY21 y 5 State of Fiorida Department of State The document number of this corporation is N99000007620, I further certify that said corporation has paid all fees due this office through December 31, 2023, that its most recent ai-tritial report/unifonn basiness report was filed on January 30, 2023, and that its status is active. 1. further certify that said corporation has not filed Articles of Dissolution, Given under my hand and the at Tallahassee, the Capital, this the Thirtieth day of'.1anuary, 2023 Tracking Number: 278179937OCC To authenticate this certificatc,visit the following site,enter this number, and then follow the instructions displayed. ltttl)s://services.suiibiz.or�,F/Filiiigs/Certiricate0t*,S'tatus/(`,'ertifi.cateAutlientication 1360 in **SINGLE -PIECE 1 SGL 1118T48A01-A-1, 10 1 SP 0.57D BOYNTON BEACH FAITH BASED COMMUNITY DEVELOPMENT CORP, PO BOX 337 BOYNTON BEACH Ft, 33425-0337 INDear Boynton Beach BLISitleSS and Property Owners: We appreciate your continued participation in Supporting economic growth and vlabiliLy of our City by maintaining your Certificate of Use and Occupancy & Local Business Tax. In accordance with Chapter 13 of the City of Boynton Beach Municipal Ordinance, the E!OGUrnent(s) below must be posted in a conspicuous place at your business or property. Should assistance be needed please contact the Development Services Department at (561)742-6350 or visit our website at www,boyiiton-beacti.org. 40 DE TACH DOC UMENT BELOW AND POST CON SPICUOUSLYAT' YOUR PLACE OF BUSINESS 41 ........ - -------------------------- — ------------- ----------------------------------------------------- City of Boynton Beach Certificate of U�se/Business Tax Receipt �Expires on September 30, 2023 Business Control Number: 0014478 Date Issued: 09/01/22 Business Name: Boynton Beach Faith Lased Business Location. 2191 N Seacrost Blvd Any changes in naine, address, suite, ownership, etc. will require a now application. Classification Code Classification Add ItIonai'l nforniatloh 23-00014969 561110 OFFICES EXECUTIVE &ADMINISTRATIVE NON PROFIT COMMUNITY DEVELOPMENT CORP City of Boynton Beach 100 E. Ocean Ave. e Boynton Beach, FL 33435-0190 1361 City of Boynton Beach Development Services 100 E. Ocean Ave. Boynton Beach, FL 33435-0190 in **SINGLE -PIECE 1 SGL 1118T48A01-A-1, 10 1 SP 0.57D BOYNTON BEACH FAITH BASED COMMUNITY DEVELOPMENT CORP, PO BOX 337 BOYNTON BEACH Ft, 33425-0337 INDear Boynton Beach BLISitleSS and Property Owners: We appreciate your continued participation in Supporting economic growth and vlabiliLy of our City by maintaining your Certificate of Use and Occupancy & Local Business Tax. In accordance with Chapter 13 of the City of Boynton Beach Municipal Ordinance, the E!OGUrnent(s) below must be posted in a conspicuous place at your business or property. Should assistance be needed please contact the Development Services Department at (561)742-6350 or visit our website at www,boyiiton-beacti.org. 40 DE TACH DOC UMENT BELOW AND POST CON SPICUOUSLYAT' YOUR PLACE OF BUSINESS 41 ........ - -------------------------- — ------------- ----------------------------------------------------- City of Boynton Beach Certificate of U�se/Business Tax Receipt �Expires on September 30, 2023 Business Control Number: 0014478 Date Issued: 09/01/22 Business Name: Boynton Beach Faith Lased Business Location. 2191 N Seacrost Blvd Any changes in naine, address, suite, ownership, etc. will require a now application. Classification Code Classification Add ItIonai'l nforniatloh 23-00014969 561110 OFFICES EXECUTIVE &ADMINISTRATIVE NON PROFIT COMMUNITY DEVELOPMENT CORP City of Boynton Beach 100 E. Ocean Ave. e Boynton Beach, FL 33435-0190 1361 0000009 I(7/2021 um FLORIDA 85-8012675927C-8 111111mammgmsm eras I1 of Exeml )n Issued Pursuant to Chapter 212, Florida Statutes 09/15/2021 ff#ective Date BOYNTON BEACH FAITH BASED COMMUNITY DEVELOPMENT CORPORATION 2191 N SEACREST BLVD BOYNTON BEACH FL 33435-2289 09/30/2026 Expiration Date 501(C)(3) ORGANIZATION x e mpfion Categ o r y is exempt from the payment of Florida sales and use tax on real property rented, transient rental property rented, tangible personal property purchased or rented, or services purchased. '11 Important Information for Exempt Organizatil You must provide all vendors and suppliers with an exemption certificate before making tax-exempt purchases, See Rule 12A-1.038, Florida Administrative Code (F.A.C.). Your Consumer's Certificate of Exemption is to be used solely by your organization for Your organization's customary nonprofit activities. Purchases made by an individual on behalf of the organization are taxable, even if the individual will be reimbursed by the organization, 4. This exemption applies only to purchases your organization makes. The sale or lease to others of tangible personal property, sleeping accommodations, or other real property is taxable. Your organization must register, and collect and remit sales and use tax on such taxable transactions. Note: Churches are exempt from this requirement except when they are the lessor of real property (Rule 12A-1.070, :A.C.). 5. It is a criminal offense to fraudulently present this certificate to evade the payment of sales tax. Under no circumstances should this certificate be used for the personal benefit of any individual, Violators will be liable for payment of the sales tax plus a penalty of 200% of the tax, and may be subject to conviction of a third-degree felony. Any violation will require the revocation of this certificate. 6. If you have questions about your exemption certificate, please call Taxpayer Services at 850-488-6800. The mailing address is PO Box 6480, Tallahassee, FL 32314-6480. 1362 1363 FLORIDA RIVISU COMMUNITYKA EXPERTISE- AND CAPITAL TO HELP YOUR PROJECT SUCCEED, LOAN FUND111 PROOFOFFUNDS March 1s, 2023 Ms, Keturah Joseph Boynton Beach Foa th Based CDC 2191 N, Scacrest Boulevard, Boynton Beach, FL 33435 Re: St0tUS of revolving LOC with FCLF Dear Ms, Joseph: Thank you for being a valued client of Florida Community Loan Fund ("FCLF'), Currently you hove a revolving LOC with FCLF in the amount of $1,000,000.00 at 0 rate of 5.25% with $858,000.00 in current availability. The line matures April 15, 2025, Mike Jones ComMunity Development Loon Officer (321) 217-2792 Mdn Offire: 501 N, Mcqnolio Ave. Suite 100 0 Orlando, K 32801-1,364 07,246OV,b 0 fi 407.24&0856 a wwwJc1l.orq Odand a # JacksonviHe 0 Sarasota n Tampa 0, Fort Laudprdale 1364 1365 -Based Boynton Beach Faith Community Development Corporation, Inc. of the community thru business and real estate ownership, provision of services, homeownership and improvement, by increasing homeownership opportunities, and develop and sustain partnerships to ensure that development is streamlined and resources are put to the most efficient use, increase homeownership with in -fill housing to reduce slum, blight, & crime, improve and increase the delivery of social services to the residents of the Heart of Boynton neighborhood. J iII3 I ILS CR � P'T � 0 N S Executive Director Annual Salary, FLI 11 -time position A. The Executive Director is responsible to the Board of Directors for all activities related to the management, administration and operation of the Organization's programs and services, in accordance with the bylaws of the Organization. B. The responsibilities and compensation for the position of Executive Director are established by the Board of Directors and included in a written contract signed by the Executive Director. L hiMJO'ti, A. Administrative 1. The Executive Director oversees the administrative operations of the organization, including the day-to-day operation of the office, correspondence, and the development and maintenance of files and records. 2. The Executive Director recruits, trains, supervises and evaluates all paid staff (and volunteer staff as necessary in the absence of a volunteer coordinator). Job descriptions and salary ranges are subject to board approval and budget constraints. Any position not provided for within the approved budget is Subject to board approval prior to the hiring of any individual to fill that position. Otherwise, the hiring of any paid staff member is the responsibility of the Executive Director, and all staff and volunteers report directly to the Executive Director unless otherwise stipulated, 3. The releasing of any ernployee after all policies and procedures for resolution has been exhausted is at the discretion of the Executive Director. The Executive Director shall approve all compensation packages with the Board of Directors and any legal opinion required by the board prior to termination. 4. The Executive Director recruit's representatives to serve on the Board of Directors; oversees maintenance of meeting minutes and records of service; prepares agendas for monthly, annual, and special meetings; prepares Executive Directors reports and related correspondence; and prepares notices of termination of service as determined by policies set by the Board of Directors. 2191 N Seacrest Blvd Post Office Box 337 Boynton Beach® FL 33425 Phone: 561-752-0303 Fax: 561-244-5046 k(natantic go_OLO._i �iah3t err, & vroAN ark g.... r�, 1366 5. The Executive Director recruits' representatives to serve on the Advisory Committee, prepares agendas for committee meetings, oversees maintenance of meeting minutes and records of service, and performs other related responsibilities as determined by policies set by the Board of Directors. 6. The Executive Director works with the Treasurer and any financial or budget committee to develop fundraising strategy with the Board that aSSUres adequate revenue to sustain operation of the organization, ensures proper fiscal accounting and controls in accordance with the guidelines of funding Sources and with sound accounting practices, and maintains the fiscal solvency of the 7. Coordinative 1. The Executive Director coordinates with other nonprofit and for-profit organizations, governmen agencies, businesses, and other entities regarding the mission and activities of the Organization, 2. The Executive Director maintains a multi -disciplinary working relationship with local, county, regional, and state agencies to develop and support programs, legislation, and collaborative activiti that are consistent with the mission of the Organization and further its goals and objectives. 3. The Executive Director, promotes cooperation among the member congregations of the organization through participation in the programs and activit�ies of the organization. I C. Programmatic 1. The Executive Director oversees the development and implementation of the programs of the organization, according to the guidelines established by the Board of Directors. 2. The Executive Director oversees the planning, coordination, and evaluation of all fundralsing and other events sponsored bvthe organization. ]. The Executive Director reports periodically tothe Board of Directors unthe functional and financial status ofall programs, program initiatives and program planning, and presents am/htten year-end report tothe Board atthe annual meeting ofthe organization. D. Developmental 1, The Executive Director oversees planning and development of individual programs and budgets, implementation of programs, and grant preparation, compliance, and reporting, and develops program evaluation and tracking procedures with staff, working collaboratively with the program director and relevant staff and/or Volunteers. J.The Executive Director works with the Board ofDirectors and the Advisory Committee iothe areas of strategic planning and board development to provide for long-range planning and visioning for the organization, including assessment mfprograms in partnership with staff members and the Board of Directors. 3. The Executive Director ensures that the personnel policies of the organization are adhered to in all hiring and employment practices, proposes changes in policy to the Board of Directors, and provides for staff development activities that upgrade employee skills and motivate performance. 4.The Executive Director research new funding sources, supervises donor campaigns and fundraising events, and meets with funders, and prospective donors in collaboration with Board members and marketing staff. E. Public Information and Outreach 1, The Executive Director serves as the spokesperson for the organization, is the primary point contact for the organization with the media, and reviews and approves all informational materl 2191 N Seacrest Blvd Post Office Box 337 Boynton Beach, FL33425 Phone: 561-752-0303 Fax: 5$1-244-5040 related to the organization and its activities prior to their distribution or publication, including press releases, newsletters, brochures, and reports 2. The Executive Director oversees the development, updating and distribution of publications and public information materials on the mission, programs, and activities of the organization, 3. The Executive Director oversees the presentation of information on the organization and its programs and activities to interested groups and organizations. Qualifications: • Transparent and high integrity leadership • Advanced degree, five or more years senior nonprofit management experience • Solid, hands-on, budget management skills, including budget preparation, analysis, decision- rnaking, and reporting. • Strong organizational abilities including planning, delegating, program development and task facilitation. • Ability to convey a vision of the Boynton Beach Faith Based CDC, Inc.'s strategic future to staff, board, volunteers and donors. • Knowledge of fundraising strategies and donor relations unique to nonprofit sector, excellent grant writing skills • Skills to collaborate with and motivate board members and other volunteers, • Strong written and oral communication skills • Ability to interface and engage diverse volunteer and donor groups, • Demonstrated ability to oversee and collaborate with staff. • Strong public speaking ability • Knowledge, Experience, or Background in Construction and Housing Development TheFBCDC is an equal opportunity employer and does not discriminate anyone because of'their race, color, relig P jon, sex (inchiding gender identity, sexual orientation, andpregnancy), national oriAin, age (40 or older), disability or genetic information. 2191 N Seacrest Blvd Post Office Box 337 Boynton Beach, FL 33425 Phone: 561-752-0303 Fax: 561-244-5046 w �fw Padof vnw u� h , I)o na u Jnr .p "I'll'', ........ . .. — ------ L 1368 Boynton Beach FaithBasp d CDC The Faith Based CDC. (FCDC is a 501 c3 organization created in 1999 to promote financial revitalization of the community thru business and real estate ownership, provision of services, borneco vaiershipand improvement, by increasing homeownership opportututies, and develop and sustain partnerships to ensure that development is streamlined and resources are put to the most efficient use, increase homeownership with in -fill housing to reduce slurn, blight, & crime, improve and increase the delivery of social services to the neighborhood, provides social services. JOB SC PT - Social Service PEPILram Director Annual salary, full-time position The Assistant Director will report to and work closely with the Executive I)ircctor and will be responsible for all aspects ofthe social service department,, including the food pantry, benefits (SNAP, Medicaid, SSUSSID) intake, operations and progran-i martagement,administration, and human resources and will strengthen existing and create new community partnerships in support of Faith Based CRC's mission. The Program Director oversees the coordinationand administration ofall aspects of an ongoing program including planning, organizing, staffing, leading, and controlling prograin activities. I'rhnary.Duties and .lac The Program Manager performs a wide range of duties including some or all of the following: Plan the program * Plan the delivery of the overall program arid its activities in accordance with the mission and the goals of the organization * Develop new initiatives to support the strategic direction of the organization. * Develop and implement long-term goals and objectives to achieve the successful outcome of the program • Develop an annual budget and operating plan to support the prograrn • Develop a program evaluation framework to assess the strengths of the prograrn and to identify areas for improvement • Develop funding proposals for the program to ensure the continuous delivery of services Organize the program Ensure that program activities operate within the policies and procedures of the organization • 1,nsure that prograrn activities comply with all relevant legislation and professional standards, • Develop forins and records to document program activities • Oversee the collection and mainterlance of'records on the clients of the prograrn for statistical purposes according to the confidentiality/privacy policy of the organization 1369 BopitonBeach Faith Based CDC ,9qff the program • In consultation with the Executive Director, recruit, interview and select well -qua] i fled, program staff and volunteers • Implement the human resources policies, procedures and practices of the organization • Ensure that personnel files for the program are properly maintained and kept confidential • Establish and implement a performance management process flor all program staff • Engage volunteers for appropriate program activities using established volunteer management practices • Ensure that all program. staff receive an appropnate orientation to the organization and. the programs Lead the program 'Ensure all staff members receive orientation and appropriate training in accordance with organizational standards • Supervise program staff by providing direction, input and feedback • Communicate with clients and other stakeholders to gain community support for the program and to solicit, input to improve the program • Liaise with other managers to ensure the, effective and efficient program delivery • Coordinate the delivery of services among different program activities to increase effectiveness and efficiency Control the pr ograrn • Write reports on the program for management and for 13unders • (,ornmunicate with funders as outlined in funding agreements • Ensure that the program operate within the approved budget • Monitor and approve all budgeted program expenditures • Monitor cash flow projections and report actual cash flow and variance to the Executive Director on a regular basis (monthly/birriontlily) • Manage all project funds according to established accounting policies and procedures • I'Aisure that all -financial records :for the program are up to date • Ensure financial reports and supporting documentation for ftinders are prepared as outlined in fUnding agreements • Provide required information to have invoices generated and submitted to funders according to the established timelines • Identify and evaluate the risks associated with program, activities and take appropriate action to control the risks • Monitor the program activities on a. regular basis and conduct an. annual evaluation according to the program evaluation firamework, • Report evaluation findings to the E.xecutive Director and recommend changes to enhance the program, as appropriate 2 111 a g, c 1370 0 University degree it) a. related subject, and or 10 years similar fiield experience work Knowledge, skills and abilities 0 Knowledge of program management 0 Knowledge of client groups and/or issues related to the progrwn area llrqficiency in the use (?f'rornj)utersfi)r,-' • Word processing • Simple accounting • DataNises 9 Spreadsheets 0 E-maril 0 Inteniet I)ersonal characteristics The T'rograniManager should demonstrate competence in sonic or all of the fir)] lowing: Beliave Ethically. L)nderstand ethical behavior arid business practices, and ensure that own behavior amd the behavior of others is consistent withthese standards and aligns with the values of the organization • Build Relationships. 1,,.stablish and maintain positive working relationships with others, both internally and externally, to actrieve the goals of the organization. • Communicate Effectively: Speak, listen and write in as clear, thorough arid timely manner using appropriate and effective corninwiication tools and techniques. • Creativity/ffinovation: Develop newand unique ways to irriprove operations ofthe organization and to create new opportunities. • Focus on Client Needs. Anticipate, understand, and respond to the needs of internal and cxterntial clients to meet or exceed their expectations with. in the organi zational parameters. Faster'ftaniwork: Work cooperatively and effectively with others to set goals, resolve problems, and make decisions that enhance organizational effectiveness, Lead: Positively influence others to achieve results tbatare in the best interest of the organization. Make Decisions. Assess situations to determine the importance, urgency and risks, and rnake clear decisions, which are timely and in the best interests of the organization. Organize: Set priorities, develop as work schedule, monitor progress towards goals, and track details, data, information and activities. Plan: Detemfine strategies to inove the ear gani7ation forward, set goals, createand implcin.ent actions plans, ,md evaltuate the process zmd results, Solve Problems: Assess problem situations to identify causes, gather and process relevant information, generate possible solutions, and -make recommendations and/or resolve the problem, 1371 Boynton Beach Faith Based CDC OperationsUanagement Improve cfficienqy and effectiveness of all inwrnal operations. - Enhance agency infrastructure to better support agency programming. .- Manage inforrnati0r) technology, including ongoing maintenance and updating of systems, hardware, and software. - Oversee building maintenance by contracting services and repairs as needed. ,4(iministration Administer grants, including government, local fiaith community, private foundation, and corporate grants... Serve as the lead oTi agency use of the ClientTrack system (CMIS), Implement data, collection systerns to streamline reporting on outputs and outcomes in all program areas. - Manage program aspccts of the annual budget in coqjunction with prograty) directors mid the Executi ve Director, C'ommunity Partnerships - Strengthen relationships with other, service providers to irnprove service delivery to clients, - Serve on community committees and boards as directed by the Executive Director. Other Along with the Executive Dir ectormend senior staff', provide gtaff"support and guidance to the Board of Directors end serve as staff liaison to relevant subcommittees of the Board. - Provide programmatic input to the Executive Director in strategic planning. - Represent the agency at private and public functions as needed. The.FBCDC iv an equal opportunity employer and does not discriminate anyone because qftheir race, color, religion, se.x (including gender idenfi6r,se x,ual orientation, andpregnane nalionaloril.,xin,aige(40ort,)Ider),di�,aorge bilityneti,(.-iiijinrmati(,)n. .Y) 4 1 P a e 1372 Sharon Frew Boynton Beach, FL lullnorized to work in the (JS for any employer Work Experie�'ice Executive Director/CEO NON PitOFFF Oia,GAN2Nl`laq - Boynton Beach, FL. May '1999 to Present • GrantWritlirng • Fuarndraisurng w Donor Development • Accounting B QUickbooks • Human Resources Payroll Management • Programmatic Dveiopment including Culinary Ilrncuulaataar • Marketing, website d vela irrnernt„ social ani dia ramnagernent. • Office Suite, Word, Excel, Power r Point • Catering Experience, Food Manager's License • Organic Gardening & Nutrition Education Education Banking Cash Management in Accountingand Bank Management Banking lrnstituate of Arnerica - Local Bron card CoU g - Fart Lauderdale, EN_ :1970 'taw 1982 Associate In Secondary Education Western Michigan University - Kalamazoo, Ml Septeinrnber 1.964 Lo Aprfl 1.96 SecondaryAssociate in Ka�arnazoo, MI • Budgeting (10+ years) • Microsoft Powerpoint (10+ years) • Marketing (10+ years) • Microsoft soft Ward (3.0+ years) • Strategic Planning (10-4- year,) • Retail Sales (10.4- years) • Training (10+ years) 1373 mm a J, Cer,tificatic��r�s/I.-�ceiris,es Food Manager Certification May 20(')9 to Pre�,,�e�'A 1374 Certificate of Attendance Implementing the New Financial. Statement Presentation Standard - Accounting Stxxidards Update (ASU) 201.6-14 Attendee Name - resent tion e- resentation Date: klay.30, 2019 "I"ime: 9 00a --,11:00arn Location: Community Partners Delivery Method: Group Beld of Study; Acaninting & Auditing Hc uns of Recommendrerd CPE Credit: 2,0 CTE credits have fx,en granted based on a,50 minurc limr. Please raani this document k)r you records, ilii--lolyfl6k.''i & Thornas, 1 f V ITII-r-,t-rrrCcIdific,J Djdk,kgounrrits & Acl',Wil sor� Davk,l] Nbnaging Parmer 000 , Fux61 "v"", Holyfield &TIhomas, LLC 1375 561-94S-6091 AtIjame,s40@yahoo,com, IMMEM PROFILE: 18 years of experience ia providing hordeownership education and counseliAg, for First Tirrie Flomebuyers. Provide one on one counselmg,low to moderate income families Successfiffly counseled clients to become new horneowaeTs Construction programs, to simeting, property acquisition, and development. Kn owledge of Commm�ity Development block Grant and State Housing Initiatives partner sip, NCHEC Homeownership Counseling Certification NCHEC Post -Purchase Educator Certification HUD approved Hosing Counseling, Agency NC °C: Pre -Purchase Educator Certification NCHEC; -:Farr closure Intervention and Default Counseling, Certification Facilitating and conducting first TimeHoinebuyer Workshop. - Partzrorship with City of Boynton each. Di -vision of Qmnraunity Redevelopinent - Knowledge of government insured loan FRA and Conventional Mortgage Loan. F ,by,[ COUNSELOR & PRE -PURCHASE EDUCATOR XOMMOVEM Pre -Purchase One on One counseling: Mewtage tho day to flay operation of the First Tfine Homebuy= progra, m, Provide individijaHzed ono on one Credit Counseling services and Rmt-")Nme Homebuyer Suninar Conduct detail credit analyses with clients and provide: advice and diredion on how to repair credit an&or improve credit score. KK GUidQ client fti repairing credit issues. . Monitor client's pro�gTcss toward mortgage readiness . Maintnin ongoing Contact wid, clic ravia phone, face u) face, and emalt- AssisMing client wilt cornmunioating with, tine City of plcAtOn Beaell and ,ne State Honsingh)idatives Partnership Program, Palm Beach CxAmty, and 1376 Review and ojalu,Mc ORMW s rca(MOS5 ".1 v""o' <1 Evajoato credit report, financjul statements, and tax returns preparing juonfhly beneficiary reports to runding sources, City of BoYntOn Beacjj State I JOLJSirrg Initiatn'eq PaftnejShip Program and Boynton Beach CommuTlity Ite4jovelopinent Agency. - Aftenca'S, all city of Boyaton Beach Corarnunity RcdevGloptneDt Agency and Falm Beach County inonthly Treetings. Ensures tilit clients mortgage readiness file is wnipleted and wbraitted to lender-, in a timely n-tattor. Review sales conizacLs, borne, inq)ection reports, appruisal reports, and addendunis. Discuss and review with clients, loan officer, and inortgage advisor the Mortgage loan docuincats, and Loan ostimate Attend closing with, Oient, lenders, attomey, and title company. New construction In.-FAI Single Families 14011'es DevelOPIn"t- Assist land acquisition! Assist project PlUlning and development Assist process to include design dcvelopment permitting, approval', solicitation., bids and proposals from contractor and consultants. Assist obtaiWng,variances, and all other pre -development activities Assist finance disbursements zmd draws by contractor • M.onitoring the new construction of single 111 -Fill farafly 1101110 • Assist chent through the new honic purchasin&r process. • Connnarlicajed Cb,,eflt,,- preferences to contractor or builder. (Floor plans design) Administm, tive suppoM * Ans 'ng FirstT saris,wer Potential clierg's, inquiry and questions regardi HoTnebuyer Program. * Provide homeownership regrtirernents for city of Boynton Beach SHIP, Pairn Beach County SHIP, and Boynton Beach CRA. * IvIa-Intain up to date information on lending and boniebuyer down payment assistance programs * Refer cliel.it to Bank Lenders Maintain client confidentiality pa e pat's Inot1thly reports to City of Boynton Beach Community Doi,ok)pment Block CT r ant Prepare reports as necessary for the HIM Housing Counseling PrOg"'An's Corrunul-deato critical problems to Executive Director Pre -Purchase Homebuyer Education 6 Hoerr $ Senn nar: 9 Coordinate 1,1t):Rjebuyer pro -purchase, 6 -hour Workshop . Sligtained. a Ilomeboiyer Edacation Pipeline. 1377 * flava to qualify for a morLgage and, a-=ixinlate funds for down payments * How to resolve credit difficulties I Howto budget and save or a dovn payment ad unexpected ex crises P How to shop for and negotiate a quality affordable home Adequately preparing client for closing, 'rips to avoid Predatoiy Lending EDUCATION: PALM BEACH STATE COLLEGE 20114ndustrial operation Led GreenAssociate CERTWICATIONS 2009 -Mortgage Broke State of Florida required Pre -License course 1 2009 -Real FsLate Sales Associate Agent, Pre- Livense course & Passed Pre - Exam 2005- present US Department of Housing and Urban DeveRopment and Neighbor work Homeownership and EducationalTi-aining Insfitate HUD Approved Professional Certifications NCH.EC Certified Horneownership Counselor I NCHEC Cerdfiefforcclosure Interventionand Doffilalt Counsolor NCHEC Cewfifled Pre-Parobaft Bomeolxrnemhs"p Mucation NCHEC Cordfied Education Understanding the Income Qualification • Foruolos-ure Prevention. Trainin-o Enhancing your Housing Suategies Floxnebuyer Couwsding Training I Pre-MweInpmeat Process Income Qualfflmtion Training Cli'nic Workshop INT ollicr"osofi;w,.)rd-Lxcel* Pow eri-loint-i- cce�;s 1378 1379 (NCHEC) Foreclosure Intervention and Default Counseling certification status Issuance Date Expiration Date NCHEC CE External CE Total CE Confirmed 12/22/2020 12/22/2023 13.50 0.00 13.50 Course ID/Course Name Course Type NWA LocationlExternal Provider Test Required? Passed? CE mmmmi� �wx=—Mmmuw �yMV.—MMM'. .....> MIffi H0002 Housing Affordability: ELEARNING E -LEARNING No N/A 1.50 Building Competency in Housing Counseling - Interactive Webinar Trainlm�� . . . . . ....... . . . . ...... H0003 Fair Housing: Building ELEARNING E -LEARNING No N/A 1.50 Competency in Housing Counseling - Interactive Webinar Trainin, LI . —.2, . . . ........................ .......... H0004 Financial Management: ELEARNING E -LEARNING No WA 1,50 Building Competency in Housing Counseling - Interactive Webinar H0005 Tenancy: Building ELEARNING E -LEARNING No N/A 1.50 Competency in Housing Counseling - Interactive Webinar Traifil;L— ... ......... . .. . –.— . ........ . . . . . . .................. H0006 Avoiding Foreclosure: ELEARNING E -LEARNING No N/A 1.50 Building Competency in Housing Counseling - Interactive Webinar jrainLn2__ .... ..... . . ...... . ..... H0017 Using Financial ELEARNING E -LEARNING No N/A 1.50 Coaching Techniques to Engage and Motivate Clients - Interactive Webinar Trainin!L . .................... H0028 Time's Running Out! ELEARNING E -LEARNING No N/A 1.50 Tips, Tools and Techniques for Taking the HUD Exam - Interactive WebinarTral H0033 Protecting Credit and ELEARNING E -LEARNING No N/A 1,50 Avoiding Scams During the COVID-19 Financial Crisis — - — — — ------- F10038 Government Loan ELEARNING E -LEARNING No N/A 1,50 Basics for Housing Counselors 1380 participant NCHEC Certification History „JamesL.Horne (NCHEC) Homeownership Counseling certification status �Issuance Date Expiration Gate NCHEC CE External CE fetal C Confirmed 05/13/2020 0511312023 22.50 0.00 22.50 Course I� eine arse T e ynlosure m . . .� , ,M ..... NWA Location/External Provider Test RePassed? CEC3tCourse ���HG001 Tunesu Forec p - ELEARNiNG EAF NTNG NoN/A 1.50interactive Webinar Training Ired H0002 Housing Affordability: ELEARNING E -LEARNING NoNIA 1.50Building Competency in Housing Counseling - InteractiveWebinarTraininti::i � � ..� mmnH07003 Fair Housing: Building ELEARNING E -LEARNING No N/A ,a Competency in Housing Counseling - interactive WebinarTraitm H0004 Financial Management: ELEARNING E -LEARNING No NIA 1.50 Building Competency in Housing Counseling - Interactive Webinar Trainim H0005 Tenancy: Building ELEARNING E -LEARNING No NIA 1.50 Competency In Housing Counseling - interactive Webinar Tralni ��.�ti ��. �w�„ �����..w����.rv,w _ �.. H0006 Avoiding Foreclosure: ELEARNING E -LEARNING No N/A 1.50 Building Competency in Housing Counseling - �.. Inter nrive Webinar Trainin�� ���������.. Ht0007 Homeownership: ELEARNING E -LEARNING N0 N/A 1„ 50 Building Competency in Housing Counseling - Interactive Webinar Trainindy,,,,. ��.mm H0016 HECM Default and ELEARNiNG E -LEARNING No NIA 150 Foreclosure - Interactive f Webinar Training H0017 Using Financial ELEARNING E -LEARNING No NIA 1.50 Coaching Techniques to Engage and Motivate Clients - interactive Webinar Traeninta H4g023 Foreclosure ELEARNING E -LEARNING No NIA 1.50 Intervention Services During Disaster Recovery _ Interactive WebinarTraenin� No NIA 1.50 H0028 Time's Running Out! ELEARNING E -LEARNING Tips, Tools and Techniques for Taking the HUD Exam - 1381 Participant NCHEC Certification History - JamesL.Horne NWA Location/External Provider 1-10001 Foreclosure Tune-up - ELEARNING H0029 Remote ELEARNING E -LEARNING No N/A 1.50 Homeownership Counseling E -LEARNING Building Competency in amid the COVID-1 9 Crisis - interactive WebinarTra interactive Webinar Traini H0003 Fair Housing: Building ELEARNING E -LEARNING Competency in Housing H0031 Rental Counseling & ELEARNING &LEARNING No I N/A 1.50 Eviction Preventions Amid the H0004 Financial Management 11 ELEARNING COVID-19 Crisis .......... . Housing Counseling - H0033 Protecting Credit and ELEARNING E -LEARNING No N/A 1.50 Avoiding Scams During the ELEARNING E -LEARNING Competency in Housing COVID-19 Financial Crisis Counseling - Interactive Web . n r Trai H0038 Government Loan ELEARNING E -LEARNING No . . N/A ..... ...... . . ...... 1.50 Basics for Housing Counselors . . . . ......... . ........................................ . . . ........................ (NCHEC) Post Purchase Homeownership Education certification status Issuance Date Expiration Date NCHEC CE External CE Total CE Confirmed 05114/2020 05/14/2023 26.52 OM 26.52 Course ID/Course Name Course Type NWA Location/External Provider 1-10001 Foreclosure Tune-up - ELEARNING Nflififififi E -LEARNING interactive Webinar Training H0002 Housing Affordability: ELEARNING E -LEARNING Building Competency in Housing Counseling - interactive WebinarTra H0003 Fair Housing: Building ELEARNING E -LEARNING Competency in Housing Counseling - Interactive Webinar Trarnrnc H0004 Financial Management 11 ELEARNING E -LEARNING Building Competency in Housing Counseling - Interactive Webinar " . . . . ....... H0005 Tenancy: Building ELEARNING E -LEARNING Competency in Housing Counseling - Interactive Web . n r Trai Building Competency In Housing Counseling - Interactive Webinar Tralnintl Building Competency in Housing Counseling - Interactive Webinar Traininri Test Required? Passed? CE CE No N/A I 1.50 No I N/A 1 1.50 No I N/A � 1.50 No I N/A 1 1.50 No If N/A 1 1.50 No I N/A I 1,50 No I NIA 1 1.50 1382 1-10016 HECK Default and mmmiW ELEARNING E -LEARNING IN o N/A 1.50 Foreclosure - Interactive Webinar Training . .. . ... H0017 Using Financial ELEARNING E -LEARNING No N/A 1.50 Coaching Techniques to Engage and Motivate Clients - Interactive We�lnarjr—, NIA 1,50 H0023 Foreclosure ELEARNING E -LEARNING No Intervention Services During I Disaster Recovery - interactive Webinar Tr No N/A 1,50 H0028 Time's Running Out! ELEARNING &LEARNING Tips, Tools and Techniques for Taking the HUD Exam - Intoractiv Webinar Trainrnil NIA 1.50 I H0029 Remote ELEARNING E -LEARNING No Homeownership Counseling amid the COVID-1 9 Crisis - Interactive Webinar Traintj., NIA 1,50 H0031 Rental Counseling & ELEARNING E -LEARNING No Eviction Preventions Amid the COVID-1 9 Crisis H0033 Protecting Credit and ELEARNING E. -LEARNING No N/A 'I �50 Avoiding Scams During the COVID-19 Financial Crisis ............. — — — ------- .- H0038 Governrnent Loan ELEARNING mm E -LEARNING No N/A 1.50 Basics for Housing Counselors j H01 09 Foreclosure Basics for ELEARNING E -LEARNING No N/A 4.02 Homeownership Counselors -ation certification NWA Location/External Provider Course ID/Course Name Course Type HO001 Foreclosure Tune-up - ELEARNING E -LEARNING Interactive Webinar Training 3e H0002 Housing AffOrclability: ELEARNING &LEARNING Building Competency in Housing Counseling - Interactive Webinar Tr Test Required? Passed? CE No NIA 1,50 . .......... .... . . . . ...... No N/A 1,50 1383 Participant NCHEC Certification History - Jarnest..Horne H0003 Fair Housing: Building ELEARNING E -LEARNING No N/A 1,50 Competency in Housing ELEARNING E -LEARNING No N/A 1.50 Counseling - Interactive WebinarTra' ........................................................... ............ H0004 Financial Management: ELEARNING E -LEARNING No NIA 1.50 Building Competency in ELEARNING E -LEARNING No N/A 1,50 Housing Counseling - ,jriteractive Webinar Training . . . . . ........ . H0005 Tenancy: Building ELEARNING E -LEARNING No N/A 1.60 Competency in [dousing ELEARNING E -LEARNING No N/A 1.507 Counseling - Interactive Webinar Training �nnnnnnn s.. H0006 Avoiding Foreclosure: ELEARNING E -LEARNING No N/A 1.50 Building Competency in ELEARNING E -LEARNING No N/A 1,50 Housing Counseling - Interactive Webinar I ----.1.1.1111111111111 ................ . . ....... H0007 Homeownership: ELEARNING E -LEARNING No N/A 1.50 Building Competency in ELEARNING E -LEARNING No N/A 1.50 Housing Counseling - Interactive Webinar TraiqLn,,,"� — . . ............. ...................... . .. . . . ...... H 00 16 H EC M Default and ELEARNING -LEARNING Nca NIA 1.50 Foreclosure - interactive F Webinar Training — - — - — — ----------- . ...... . ........................................ 1384 HOO,17 Using Financial ELEARNING E -LEARNING No N/A 1.50 Coaching Techniques to Engage and Motivate Clients - interactive Webinar Trainin,, .......... H0023 Foreclosure ELEARNING E -LEARNING No N/A 1,50 Intervention Services During Disaster Recovery - Interactive WebinarTrai H0028 Time's Running Out! ELEARNING E -LEARNING No N/A 1.507 Tips, Tools and Techniques for Taking the HUD Exam - Interactive Webinar Trainin;,.,,,,, ........... . . . . . .................... . . . . ........ H0029 Remote ELEARNING E -LEARNING No N/A 1,50 Homeownership Counseling amid the COVID-19 Crisis - Interactive Webinar Trainirmf, H0031 Rental Counseling & ELEARNING E -LEARNING No N/A 1.50 Eviction Preventions Amid the COVID-19 Crisis H0033 Protecting Credit and ELEARNING E -LEARNING No N/A 1.50 Avoiding Scams During the COVID-19 Financial Crisis — - — - — — ----------- . ...... . ........................................ H0038 Government Loan ELEARNING E -LEARNING No N/A 1.50 Basics for Housing Counselors FIOI 09 Foreclosure Basics for E-LEARN[NG E -LEARNING No N/A 4,12 Homeownership Counselors .............. I','ll""..",""� . ........... 1384 1385 p , ., O rst'nme'Hwrie� Program, x e��e for ou**oh n `uVi rewons r El softam 1. 1386 'M if ar gjCWgf 'lam • Mvilll�EHMZWWAM �- Stallm answer quevions fiam customers, ruaivft� 1387 or aWeements ldw„ sent,--., wyers. cmwnetor's With t tr=; Obtaftis sppropriate pmjee '%w W"' de"'qxTs, wnfrwtors, and ffie and4eqws,9 I for vatiameS frOM esUb II 9W st,4,ds cleux, MInafm PmPexty,hmpectba to & ond' "Vah'M'O=g'n"iOuconddON SMisl feaWtes, and edbivatr' develop SOOP"'. VmpaM com estimates, 907mrmnt ft9l9aflow; supft-Vise prt" conviedon Of au'pr*0 ac,6wes; Prepam 'noathly rVOtb &T the McOwtvc dhm-ar tIj the dimaor.' 1388 JOB DESCPJMON Category: Exempt, Management Reporting Relationship: Reports to the Board of Directors with direct supervision by the Executive Committee (consisting of all officers and one at -large member) General Aes,��� 'Hh­cEie� ive Director diTects and coordinates all the operations of the organization. Prepares budget in consultation with program coordinators and the board of directors to allocate funds,, control costs, and maintain operations at level consistent with the organization's policies and procedures. Recommends new policies and procedures to the organization's governing board, Represents the organization to the public and responsible for articulating the organization's vision and compliance with its mission. If the position is occupied by a consultant, it, will be considered as a non-employee compensated (form 1099) position - 5 _Duties Under the supervision of the Board of Directors, the Executive Director Vill be responsible for assisting the organization to manage real estate development projects of the organization and to implement other initiatives as requested. Planning/Grant and Program Management 1. Review and prepare all operational or administrative documents to ensure compliance with federal, state and local regulations. 2. Act as CDC board liaison and make presentations to suff and officials of private and government entities, and assist in CDC negotiations. 3. Coordinate the research of grant sources, grant applications and other fund raising activities through the CDC fundraising working committee.. 4. Coordinate the development, revision and implementation, where necessary, of CDC fiscal and administrative policies and procedures. 5. Coordinate strategic planning meetings with the board of directors, develop strategic plans with clearly defmcd goals, objectives and activities and have plan approved by board. 6. Establish and/or strengthen financial and program management functions of the organization. 1389 8. Develop and coordinate all organizational activities in conjunction with board of directors, staff and consultants; 9Assist with the negotiations necessary to gain a variety of public and private development resources for the organization's programs and prqjccts; 10. Supervise organization's staff, reemits and select all personnel and consultants & evaluates employee performance. 11. Actively establish, maintain, and strengthen relationships and networks that support the goals of the organization. 12. Monitor the financial position of the organization and develop the organization's budget - 13. Assist the board in developing and implementing a multi-year fund raising plan and marketing campaign to promote the organization and to build capacity and be sustainable. 14. Act as staff to the board and responsible for coordinating board governance activities, 15. Present regular oral and written report-; to the board of directors, as requested but not less frequently than monthly. 16. Coordinate leadership development activities to develop the capacity of the board members. Project/Program Implementation 1. linplement strategic plan as developed by board and staff. L. Coordinate research and property acquisition in accordance with applicable local, federal regulations including appraisals, environmental review, title insurance, etc. 3. Develop and administer required RFP process for selecton of service contractors and consultants. ® Process expenditures for approval by the CDC board and funding sources and assist the CDC in the selection of vendors and services. 5. Monitor all contractors and subcontractors to ensure compliance regarding permits, insurance, federal, state and local codes and regulations including Davis on and Section 3 requirements. 6. Monitor all, construction activities, and coordinate necessary inspections through working committee of the CDC board. 7. Coordinate all service delivery activities that will compliment the real estate and community development activities of the organization. 9, Train existing staff and recruit new staff to carry out the activities of the organization W, 1390 Chlaw )cations The selected candidate must be a proven leader with a demonstrated record of building capacity and raising funds (through grant writing and solicitation). Leadership and experience with non- profit organizations vital; real estate development and homeownership experience preferred. Experience overseeing or conducting daily non-profit organization's operations require& Bachelor's degree or 5 years plus experience in community development required; advanced degree or relevant professional certification a plus. Strength needed in administration, or anization collaboration. coordination- and WN TVXLU J)"Zilva _10f UUWUVUHIVUk, UtwuU011 Lo Getau, avility R Wme, Effies, knowledge of community development high energy and ethics, good writing skills, and great verbal skills. The candidate should display an entrepreneurial approach to management of non- profit organizations. RMLCDC offers a competitive salary and benefits package. MI RAR,CDC is an Equal Opporlunity Employer and an Equal Opportunity flowing Provider K 1391 Vf , 1392 amu rBOV'NTON E A C H ATTACHMENT# 6 BOYNTON BEACH FAITH BASED CDC, INC. APPLICATI.ON FOR SERVICES Ir I IRWIN 11111111 111 �ii� F 171 ,ffigm, i I ill I I I'll i 11 1, 1:, i I "I I rcm In -take Counselor's Initials: How can we help YOU? Please provide a brief description of your situation and the services you are requesting: ­­,,,,,,, ............ . . . . .......... ...... . . . . ADD ADDITIONAL LINES IF INEEDED PLEASE PRINT ALL INFORMATION Applicant's Name: First MiddleLast Date of Birth:._,SoI Security #,...— � � .. .... ... . ....... Current Address: Street City, State, Zip Code Home Phone: _ ­ .__,,,,,,,_Work Phone: -11111111111111 ........... .- . ............. —Cell Phone:'—,,,,—, Marital Status: Married ri Unmarried 0 Divorced 0 Widow/Widower 0 Separated r., U.S. Citizen? Yes 0 No o If No, Valid Permanent Resident Cardholder: 'yes, N o Do you own Rent Other Explaiw How long have you lived at this address? Monthly Housing Payment Landlord]Lender Name & Address� Co-Applicant/Spouse Name: .............. I First Middle Last Date of Security ............ .. EMAIL: Current Address: Street City, State, Zip Code Home Phone: ... . ... ..... _ Work Phone:, 'Cell Phoney Marital Status: Married ci Unmarried Ij Divorced rj Widow/Widower c., Separated 0 U.S. Citizen? Yes a No 0 If No, Valid Permanent Resident Cardholder Yes 0 No I-1 Do you own Lj, Rent r) Other u Explain: ..... ......... How long have you lived at this address?,.,,,,,, _,Monthly Housing Payment: $ Landlord I Lender Name & Address: Applicant's Employer;—.—",.,.,., ---,------",Address: 2 K 1393 SalarY:,,— ,,How Long?, Job Title:_. PEV 12= ----Main Other Ernployers:­­ APP11cantlSpouse Address, SalarY ..HowLonge Job TItle-­11.1 Main Other Emp[oyers, LIST ALL PERSONS WHO VALL RESIDE IN THE PROPERTY NTH YOU AND CO-APPUC ANt FULL LEGAL NAME RELATIONSHIP AGE SOCIAL SECURITY 1Are A Household Members U.S. Cftizen? Yes E] No El If No, Permanent Resident Cardholder., Yes [:] NoE] I Does any Imernber ofyour household meetthe fbilowing definition of special need? Definifion of Persons with Special Needs per Florida Statutes S.420.0004: ,An adult person requiring Independent living services in order to maintain housing or develop independent livingskil.is and has a disabling condition 420.0004 (7) Flodda Statutes. E] A young adult formerly in foster care who is eligible for services under 8.409,1451 (5). E] A survivor of domestic violence as defined in S.741,28; or A person receiving benefb under the Social Security.Disability insurance o; l) program or the Supplemental Security or from Veterans' Disability Benefits. HOUSEHOLD INCOME (Must provide proof) WAGE /SALARIES - PER OVERTIME - ............ - PER EIONUS PER COMMISSION PER CHILD SUPPORTIALINIONY PEIi UNEMPLOYMENT ------ PER OTHER REGULAR CONTPJBUTJONSPER­- - OTHER INCOME PER SOCIAL SECURnr PER -- DISABILITY PER VETERAN BENEFITS PER- RETIREMEN FIPENSION PER---_ 19 1394 0' � SAVJNGSACCOUNT: YES[:] N,[:] RANKJINs'n-nfrK)N.- CHECKING ACCOUNT: Yrs 0 No BANKANgTITUTION: SAVJNGSACCOUNT: YES[:] N,[:] RANKJINs'n-nfrK)N.- INVESTMENTS*. y E.SED OE] FIRMhNsTrrnom RETIREMENT: YE a EI NoE] FIRWINs-nTu-nON: REAL ESTATE: TYPE OR USE DO YOU RECEIVE INCOME FROM REAL ESTATE?YES E3NO0 IF YES, AMOUNT[]MQa= DANNUALLY LABILMES AQUELL 9QNluLX-mymEm ELECTRIC ---------e. TELEPHONE --------- TELEPHONE . .... . ........ .""– WATER $r«,,,, ..... GAS....... . ... ..... .. ...... . ........ — WLEX . . ........ . . ...mow ..... . . ... .. .moi. . CHILD CARE tuIEDJGAL IN . . ........ L(w<s) K;AR I om $ .................................... —, DO YOU ANCA/OR THE CO -APPLICANT OWN PROPERTY IN ANY OTHER 0OUNT1 WITH!N Tl --IE UNITED STATES? YES NoD DO YOU OWN AND OCCUPY THE PROPERTY FOR WHICI I YOU ARE REQUESTING REPAIRS? YES IINOIJ FIAVE YOU ASA HOMEOWNER PREVIOUSLY RECEIVED ASSISTANCE FROM THE CITY OF BOYNTON BEACH FOR HOME REPAIRS? YES D NO D IFYES, PLEASE DESCRIBE ASSISTANCE----------------------------------------------------------------------------------- BRIEFLY LIST THE TYPE OF REPAIRS YOU WISH TO MAKE ON YOUR HOME OR REQUESTING. USE THE BACK oFTHIS PAGE IF NEEDED, . ..................... . ---- . . ........ .. . . . .......... ............. ........ . ..... --- .. .. ......... . . . . . . . . . . . .................................... ARE ANY OF THE ABOVE REPAJ RS THE RESULT OF HURRICANE DAMAGE? 'YES® NOE] IF YES, DID YOU RECEIVE INSURANCE ANWOR FEMA FUNDS? YES AMOUNT RECEIVED 11 11 ME 1395 A C H 7110 following information is requested, in order, to monisor compliance with Equal Credit Opportunity and Fair Housing Laws, You are not required to ftirnish this information. If you do not wish to furnish the inforination below, please check die appropriate box. 11 Mate fl Female EULW= 13 HISPANIC OR LA"T"INO 11 NOT HISPANIC OR LAn No U IEras NOT WSIITex FURNISH ¢NFORMATION ALASKA 14ATIVE Cl NATIVE AM R1 CAN 13 ASIAN 11 BLACK OR AFRICAN AMERICAN LJ NATivE HAmvN 0 OTHER PACIFY GIBILANDER W11TE OTHFR. . . . . . . ................ . . ..... 'I M NOT WSH 'TO FURNISH INFORMATION 0 Mate El Fernale Eniw= El HISPANIC OR LATINO 0 NOT HISPANIC OR LATINO F -I I DO NOT VWSH TO FURN[SI-j INFORMATION =2 El AiAsKA NATm- El NATIVEAMEMCAN ❑ ASIAN ❑ BLACK OR AFRICAN AMEMCAN LJ NAnvr FIA wAim, 13 OTHER PACIFIC ISLANDER 1-7 WHITE 0 OTHER I. 1 DO NOT W31 I TO FURNISH IINFORMAMON ALGREENENTIONDERSTANDING (IMPORTANT- (READ BEFORE SlGXrNG) It is your resporlsibility to Corriplets the application and provide all the information requested. Failure to do so %mil result In the cancellation of your applicaflon. L/We understand that providing fates information on this application regarding marital status, household size and income M11 result in automatic denial of the application for funding. IfWe understand the Florida Statute 914 provides that willml false statements or misrepresentationconcerning, income, asset, or liability information relating to financial conditions is a rmemearior of the first degree, punishable by fames and unprisonmeat provided under FL Starates 775.082 or 775.08.1. UWo comfy & A the application information provided is true and complete to the best of my/our low),led ae. Me agree to provide any documentation needed, to assist in determiningeligibility and are awue that ail information and documents provided are a matter of public record, !/We consent to disclose all information for telae purposes of income verification related to ruaking a determination of my/cater eligibility for program assistance,. I/We understand that funds provided ftNigh all proexarns are considered a conditional loan and may reciaire TrAy/out signature on 9. Mori ge and Prcmissory Note. I understand that the 1`13C.IX-'and City of Boynton l3each reserves the right to check any information pmvidod as a part of, this appl i ratiom Kpplicanl-signature:_ . . ............. . ... .. .. ............ Dated � iso- Applicant/Syou ce Dated - W 1396 gm 1397 1398 S4 ite Control Property Detail Location Address NW 13TH AVE Munlclpalfty BOYNTON BEACH Parcel Control Number 08.43-45-21-33-000-0070 Subdivision KNOLLWOOD SUR IN Official Records Book 29538 Page 1412 Salo Date NOV-2017 Legal DescripVon KNOLLWOOD SUB LT 7 Owner Information owners Mailing address BOYNTON BCH FAITH BASED CM NTY DEV CORP 2191 N SEACRESTBLVD BOYNTON BEACH rL 33435 2289 'Sales Information 2022 Exemption Information $0 Sales Date Price ORB k/Mage Sale Type Owner NOV-2017 $]a 29538 /01412 WARRANTY DEED BOY BCH FAITH BASED CM NTY DFV CORP JAN -2016 $10 28098 / 00672 COUNTY DEED CITY OF BOYNTON BEACH NOV-2015 Slo 27925 / 00598 TAX DEED PALM BEACH COUNTY FER-) 996 $100 09173 / 00196 QUIT" CLAIM PALM BEACH COUNTY JAN -1971 $1,300 olgil /00550 2022 Exemption Information $0 Applicant/Owner Year Detail Total tax 2023 Property Information Number of Units 0 *'katal Square Feet 0 Acres 4.1768 Use Code 0000 - VACANT Zoning R2 - R2 DUPLEX, 10 DU/AC 08-BOYNTON REACH Appraisals Tax Year 2022 Improvement Value $o Land Value $60,289 Total Market Value $60,289 All values are as of January I st each year Assessed and Taxable Values Tax Year 2022 Assessed Value $27,951 Exemption Amount $27,951 Taxable VaRje $o �1 2021 $25,410 $25,410 $0 2021 $0 $50 $50 Tax Year 2022 Ad Valorem $0 Non Ad Valorem $50 Total tax $50 Dorothy 3ackg, CPAt AAS PALM EACH COUNTY PROPERTY APPRAISER wwwpbcgov.org/PAPA 2020 1 $23,100 323,100 $o 1399 Site Control # 2 EBB= :1. SELLER agrees to sell and convey to pURCHA= and PURCHASER agrees to purchase and acquire from SgLLEK an the terms and condnons hereinafter set forth, the real Property legally described in Exhibit vA# attached hereto (hem4nafter the 'Property*). The Partfas Intend that the, purchase and sale and enso"s redevWboment of the Proverly wi i W IWILI�-'��Qlil��� toll" WOO T*#W low to moderatoo Income cotegories (W120% of the West Patm Beach and Soto Rzton Metropoittan Statistical Area Median Incerne) (&oe "projecr). 2- M-RO 7he Purchase Price for the Propertyshag be SMY THOUSAND DOLLARS AND 00/100 DOLLARS j$#0,Q00.00j to be paid in M at ClosjrW, SELLER has c=pKed wfth Section 163-390, f lorlda Statutes, In proceeding vdth the sale of the Property to PuitcitAsek M''M 1 1— 11TWIR5111111111111 1A I'll, "I'll" I'll -, I'll I S. The purchase -md sale transaction contemplated herein shjj close no sooner tha��e i oanrp nf "i", M- IM P—M�Wt!��MD. At Clostng, SELLER shag cxmveyto PURCHASER, by5pecial 1400 11111 IF III i 1,11,511 -mil, FIVI fails to objed, or which PURCHASER agrees to accept. investigations, Which P R ER m deem necessary. During the FeaslblI Period, PURCHASER may elect, in PURCHASEWS sole and absolute discretion, to terndnateI this damage to persons or property arlsIng out of PURCHASEWS InvestlI of the Pmperty. F wy, 7.1 ae fler�s Diocurnggs, SELLER shall deliver to PURCKkSM the iblimire documents and instrc�rnents wfthin five (5) days of the Effective Date of This Agreement- argy aY existing tAle polickIs, appraisals, copies c�f any reports or studies (Including enviroorriIental" en&eerin& virveyssoT k*rIngS �7prf pt4jer pfi",- 1cgi M,#oM) �4, SEaf;r1S, possesqo"I, co, d i th "Ajital jff the [!QDM*VT�j)1, WA rlf—Q, Olw" F55uau V -j k7UVVC(jr1rfTzF1"-V%-a; rTOV!;,T OT -11 I h-er-f q�mwcy-u� Au 4 14 Y tAxs III, tM?-V1 I uwi discloses clalms, aflegatfons oradverse Information regarding the Property or SELLER *ft respect to the Property. ilillli!:! 11111111! 1171 IFIF III 1401 counsel, as closing agent for the tramction contemplated herelm (the OMsIng Agene) shali obtatm, at the SELLFAS expense, from a lItle Company chosen by SOJER (hereinafter 071M Company"), a Tide Commitment covering the Property and proposing to finwre PURMASER in the amount of the Purchase Price subject only to the Permitted Exceptions, together with ExAtha le mrnitrnentPU 1 min arising from the Title Update sholl be the same as 0 'ectton-5 to items appearing to the Titte, Commitment, subject to the provisions ofthIs Secdon. 7.3 PURCHASER, at PURCHASEWS expeme, may obtain a current boundary survey (the **Survey) of the Property� indicating the number of acres ��, ,y „s - �-klc�- „02 C �—'- *n the Prooeftv or that tmoravernerift located thereon encroach on &Wback Ifne-S. provisions af Section 7.2 concerning t1de objections. 1402 PURCHASE AND DEMOPMEW A19REEMENT Page 4 of 14 8-1 ft2WM=9M--An—dW-q-nW_tieS. All of the repremtotions ane warranties of SELLER contaMed 10 this Agreement $hall be true and carrect as of closjn& 81 fta&qL-ELqceqdJng, At ClosinF, there shall be no ftavon CW admintst"Ve aft -n Property or the SELLM pending or threatened, which has not been dls�sW, prior to cJo-,hIZ and accepted by PUMOSM 8-8 The Property shalt be in comptlance vAth all appifoble federal, state and kwal laws, ordInan requirements, Ilcenses, permlts and authorizartions as of the date of Clwft 8.4 The SEUER vAll cooperate with the Agent and the Ode Company may requIre. 92 !iV-IJ9tJAMdqV-_fts- SELLER shall furnIsh to PURCHASER an ownees ammAt attesting that, to the best of th knowfedge, no Individual or entftV has MY cfaim against the Property under the applicable construction Ilan fai% that the SELLER Will not record or enter into documents affectingthe Property afterth0est eftctiye date on the Titte Commitment, and dtat there are no parues In postpsslon of the Property otherthan SEUM SULER shah also fur"Ishto PURCHASER a rwrt-forftn affldavtt v4tb respect to the Property. in the event SELLER Ls unableto deliver Its affidavfts referenced above, the some shall be deemed an unmredTftle Objection. 9.3 Qq"n A cJcpsing statement setting forth the Purchase PrIc6, 1403 74 IIT�' to be paid at ® and the net .:»:a« »« SELLER, which SMJXR shall also \, ,a deriver at Closing. 9.5 A44kfoo���. Such other 4ocumentsas PURCHASER or the Tide Company may reagonab�y raques» that SEUR execute and defiver, and any other documenU required by this Agreement or reasonably necessary Ip order to close this transaWo" and tffectuate the terms of tW Agreement la 99"MAR"i 10,1 9M—raJLOMTaxes for the Property shall he prorated through the &y 10,2 O2Ang_Q2StA. SEIIZR shah pay for documentary stamps on the deed, eVenses. Each party shall be responsible for theIr respectiw attorneys' fees, io.3 .99sing-krocedu v n. �PURCHASER shaft fund the Purchase Price subject to tile credits, offsets and prorations set forth herein. SELLER and PURCHASER (as applicable) shali execute and evert the Closing Agent the Closing Document!L The Closing. Agent shall, at Closing; (1) disburse the sale proceeds to SELLER; G.,2«- the Closing Dowynents and a AMC appikable to and encumberin.«.»e<» 11- &PjO_f_NYAT_IONS CQjT-NANT$.AN0 WA SELLER hereby represents, covenants and warrarytt to PURCHASM as of the Effective Date and as of the Closing Clete, as MWOMW 1404 11A Av jbgpty$F . The executirm and delivery of this Agreement by LLEfk and .11-2 _Utfte, SELLER Is and will be on the Closing Date, the owner of valid, good, marketable and Insurable fee simple tMe to the property, free and dear of an ftens� vt the Perm fted-FXrewaiiiiiiiii" 11.3 Mggg_tion. 'There are no actions, suits, proceedings or investigat0io, pending or threatened against Setter or the Property affectirig any portion of ther Prop Induding but not limited to condemnation actions. 11.4 EAqLesLn_Possessfq here am no parties other than SELLER in possession 0 T or with a rJ& to plosseWotj of any porttn of the Property. ILs &qLAffggfia& P Lop=. From and after the Effective Date, SULER 1, I refrain from (a) performing any Sradirn& excavation, construction, or making any other (;han, AI airrint WAWW" i i or InturrInWra NOW"- MHRM��i 12,1 EURQ:o EF�S Default, In the event that this transal falls to close A -Z 112 In the event that SELLER fails to fully and timely to perform any of its obligations and covenants hereunder or if SELLER Is In breach of any representations her f4n, PURCHAStR may, at ft oPtion, (i) th-cle SELLER in default under this 1405 and neither party shall have any further r1khts hereunder. 15-3 NqUgLqf _Defauft, Prior to declaring a default and exercising the remedies cried firaift. , determine the action necessary to cure the defauft. The defaulting Party shaft havefifteen 1151 d from d0ve-ry of the notice during which OCaUrl 15.4 �yll The provisions of this Section 15 shall survive the termination of this ACreement. FUMM receipf requeneo, or perSo,-,aj delivill the following addresses; if to Seller Thuy Sli Executive fArector Boynton Beach Community Redevelopment Agency 100 E. Ocean Avenue, 4th Floor Boynton Beack FL 33435 With a copy to: Kenneth Dodge, Es"Ire Lewis, Longman & Walker, PA 360 Rosemary Avenue, Suite 11 West Palm Beach, FL 33401 1 If to Purchaser., Keturah Joseph, EXecUtNe Director Boynton Beach Fad eased CommUnTry Development Corp. 2191 N. Seacrest Boulevard Boynton Beach, FL 33425 Ifflth a copy to: ------- PURCHASER's Initials., SELLE R's Initlials: & 1406 PURCHASE AND DEVELOPMENT AGREEMENT Page 9 of 14, 13. The terms and conditions ofthis AEVeeovnt are hereby made b1nding on., and shA Inure to the benefit of, the succe=rt and perrni—,� assigns of the Parties hereto. SEU�ER may Wt assign its hiferest In this AVeement without the priar written conseotal'PURCHASER, which shall not be fiowvver, that SELLER may assign its lntere!vt to the city of sovoton seach without the pdcw wfdten consent of PLJRCHkSEK This Agreerment way be, freek assigned by PURCHASER to a ................ .............. -------------------- within fifteen (IS) days after, receipt by PURCHASER of the notice from SELLER. SELLER heFeby to have been made by either Party or an its behalf with any broker or finder in connection with this Agreement. However, SELLEW-S indemnification obligations shztl not exceed the staft4m limits pravided within Section 768,20, floi 'ift Statutes, and SELLER does not otherwise waive fts savereign Immunity rights, The provislons of this SWIon shalf survive Closing or termfnabon of this Agreement. 01 1407 PURCHASE AND DEVELMMENT AGREEMENT Page 9 of 14 16. To t�he best of SELLMS knowledge, the p"L-rty applicable zonIng and o"ronmental Laws and regulations. 17. SEUIR and PliRcHAsIER, to the CRA staff for review pAorto submIssion'to the City for approval, I& The following events must be documented In wrMW and%rmAded to the SEUER u$iw completion of each action 1,collectivety the a) Submission of application to the CIty for site p48n approval withir, b) Achlewment of site plan approval from the City by c) SubmIssion of construction documents to the (3ty for a building permit -by Proof of permit applkation fees paid W# be pmAded to the' SELLER upon submission to the City. Upon Oty 6-suance of the building permit a copy will W provided to SELLER. d) Temporary Or'permapentcertificate of occupancy to he provided wAin _Lk�K__ Cf� mon*s follovAng building permit issuance. If one or more of, the required W911 #b 1408 PURCkASE AND DEVELOPMENT AGREEMENT Page 10 of 14 shelf he terminated, and SELLER shall be released from any and all obrWations und'er JhLs eemerit and (b) if such events are wntem ift agree that tinmWe is of the essern�xce. 19- 19.1 OAMMI. This Agreement, an:d anY amendmdnt hereto, rnay be execuW In n which ends on a &-aturday, Sund y or legal holiday shall extend to 5.00 p.m. on the next f"ll busir"s d ay. Time. is of the mence In the performance of a 11 obligations under WN AgreerneryL 71me periods commencing with the Effect?ve Date shall not lndude the Effective Date in the calcuWon thereof. 1409 PURCHASE AND DEVELOPM ENT AGREEMENr Page 11 of 14 19.4 The Parties to this Agreement, througfj counsel, have parttelpated freeN To the negqtlatlon and preparation hereof Neither this Agreement nor any amendment hereto shall be more strIctfy construed against vnv , p require. Provisfonsof this Agreement that expressly provide that they survive the O*an&sftafj not merge Into the Deed. !tj. If arty provision of this Agreement or the applic tto th f shall for an reason and to an extent be Invafid or unenfo bf n 19-10 NnlmrrdiThis Agreement shall not be recorded In the Publieftewrds of Palm Beach county, Florida wkh6ut the PrIor approval Of.both parties, 19,11 5-un-AY4 The covenants, 'warranties, representations, Indemnitler, and undertakings of MLER set forth In this Agreement, shall survlve aw Cbsing, the defNery and recording ofthe Deed and PURCHASEWS possession of the Property. 19.12 PURCHASER acknow4edges and agrees that PURCHASER shall be resporisible for its own attorneyse fetes end all 03SU, ifafty., incur -red by PURCHASER In connecClon with the tiaasacWn contemplated by this AV-eement. 10.13 Eu SELLE R it a public, agency subject to Chapter 119, Florida Statutes. The "CHASER shall comply with Florida's Public Records Law. Spedficalty� the PURCHMER shaM b. Provide the Public Wfth access to such Public rewtds on the same terms and conditions that the SELLER would prm4de the records and at a cost that does oot exceed that provided In cf iapter 119, Fla- Start., or as Otherwise provided by taw; r- Ensure that public records that are exempt or that am Confidential and exemot hem oublic record reguirernow::: Arp n d. Meet all requirements for retaining and providing public records and tran r the Sr -L k*,-r:prrv-V- r SELLER shaft, upon request, provide 8uldance to PURC"ASER as to the public records keeping and reporting duties that are imposed upon PURCH ' AStR as provided above and shaft take alf steps reasonably required to assist PUR04A.SER in not violating them. The failure c# PU RCHAS ER to ccrayly with % ��- � and Breach of this Agreement. ff PURL14ASER fags to cure the default within seven (7) daW notice ftom the SELLER the SELLER may terminate the Agreemea, IN VATNESS WHEREOF, the Parties have executed thIs Agreement as of the Eftcove, date. BOYNTON BEACH PAffm sAsED COMMUNITY DEVELOPMENT CORPORATJO� Printed tpi'm`e: TV Penserga 1411 PURCHASE AN' D DEVELOPMENT ACRS ENS" Ploge 13 of 14 'ntle: ta=1mg i e lDste: WIT,y�s; T M'41 Printed Name� --=1 TfUe. Chair Date, �-11111111 . . ....... . ....... . . ... Printed Name. Apprwed as to form and legal suffi6ency-,." c" ov PUS CHASEW,s Initials - SELLER'S Initials-, 4f 1412 LEGAL DESCRIPTION tasXWOngsald North erty Lot Une�' for a diStance of 24.23feetto the poln' tof k-Onnim and 404 IN W 1. Avenue, SOYntOn BeaCh, FL 334.35 PNC #W-4345-21-14�0011-4140 LIM W, Mrzm. MO ml -Z 1413 1414 7' sir Beach Faith -Based Community Development Corporation, Inc. . .......... Effective A- Recipient Information (select one) & Current homeowner b. Home buyer 0 Existing Dwelling Z Renter 91 C. Household Information . ..... .... . Member RelationshIp Date of Birth .................. . Head 43/1976 2 . . .............. ...................... . ....... . . . . . . ............. . ..... ... . . ....... . . .......................................................... . . . . . . . . . . . ................... .. . . . ............................. - - - — - - - - - ---------- .... ........ _....m. . . .............. Assets: All household mernbe rncludin minors Income from Member Asset Descript] on Cash Value Assets 1� ............... .. ... . . . .. . $ 2 $ m... . ....... 3 $ . .. . ....... 4 --- - --- ------ . . . . ......... 6 f ............ futal Income from Assets D(b) ............... .......... ............. ...... . . if line D(a) Is greater than $5,000, muftipty that amount by the rate specAted by HUD (applicable rate _kQ6 j D(c) and enter results in O(c), otherwise leave blank. ...... . . . ..... 0 1415 4' Wag" I Salaries (include tips, commission, bonusesend overtime) Tow, 1 lllllq�l Enter WWI of Items Ell through E(e). T a m n u n f is t 61maill E��m� icome and s4mo!Ip'-'a-�q'On beh - — - - — ---------- ........ . . . . . . . alf of mino rs. public Other I Assistance � income Asset income I I 3 a 1i, " rsigned expressL acknowledge that the information provided on this form by myself/us is subject to verification HUD, the City of Boynton Beach, and/or Boynton Beacb CDC at any time. Further, I/we acknowledge that Title 18, Section 1001 of the U. S . Code states that a person is guilty of a felo and progam, eligibility cart be terminated if Vwe knowingly and willingly make a false or fi-audulent 9tatement in connection with the representations made above or in connection With other information provided to Boynton Beach CDC in connection with the application for assistAnce, NOW, in light of the acknowledgements made above, I/we knowingly affix our signature below; and by doing so, expressly certify and attcs� under penalty of the law recited above or otherwise Rpplicable, that all of the information p -to deAffithkilb n"' —atur-e--"of'Hof H— - ouselh-o-1— Date Id p—ouse or--C-1c1""1-1`6P66e6a--d oDa usehld i UMMM 1416 ))gr W ,.,y Dal Signature of Household Member i Dat -p Signature of Household Member .................. Date Signature of Household Member G. Administrator Statement: Based on the re resentations herein islare eligible under the provisions of Chapter 420, Part V, Horde Statutes, the family or individual(s) con-stitute(s) a: (check one) Extremely Low Income (ELI) Household means individuals or families whose annual income does not exceed 30% of the area median income as determined by the U. S, Department of Housing and Urban Development with adjustments for household size (Maximum income Limit Very Low Income (VLQ Household means individuals or families whose annual income does not exceed 50% of the: area median income as determined Development with adjustments for household size (Maximum Income Limit 1J. Low Income (LI) Household means individuals or families whose annual income does not exceed 80% of the area median income as determined by the U.S. Department of Housing and Urban Development with adjustments for household size (Maximum Income Limit JJ % of AMI Moderate Income JMIJ Yous tp& tig-2i's or me area median income as determined by the U.S. Department of Housing and Urban Development with adjustments for household size (Maximum Income Limit'l, . . .......... Based upon the 2022 (year) income limits for EPalm Beach Metropolitan Statistical Area (MSA) or �ounly, Florida. . . . . . .. ....... 11 . . . ................ j��.qq...,,,, ... --" -- I ... . ........ — ",, 1417 K Household Data (to be completed by AdminIstralor or designee) The City of Boynton Beach requests this information in order to comply with HUD's required reporti requirements, Although The City would appreciate receiving tbis information, you may choose not to furnish You may not be discriminated against on the basis of this information, or on whether or not you choose furnish ft. If you do not Wsh to furnish this infbrmation, Please initial below. RESIDENVAPPLICANT� I do not wish to furnish information regarding ethnicity, race, sex, age and oth household composition. (Initials here),--- I WAS Black HMien 0-25 26 40 41-61 62+ X ......... . . . Special Target I SPOCIal Needa . . ...... (Check all that apply) FQVM Worko D"OMMudly I OftabW HOMVW" Fjftmy Ool. WLexarNCDBM2022-23 Application DpoVinal Docs Zincome Certification (4),doc Page 4 Df 4 1418 low 1419 � ami �ry y � „' p , ✓ r Iwo numrawi����u�rgllmmq�nwlllu V � l .Y �,, OVIVWI'kAINNBmIN%UPN'IU4Wb wrluwu"owww�iuilm� )cz W r lyly i. 4. fi p 3 Q.1 V^..i,. ( �mIIII �IIIW r iw pa$ ��.f! A f I.� 4..7 Illi ob 0.o 1 w„;co �. �q p w.,. Qu u c 0s CZ 0 cW •, .... """""iri 3: 4� To- -CnD c :E E 0 , @ C) e 06 4—J w® ��qq v,„,mr y�ga"*U wa spy c F„„aX p E3 Ln „„Vb ZD0 cA 2 �m 1419 1420 1421 1422 Homesteaded Owner -Occupied Rehabilitation Program Scope of Services The Homesteaded Owner -Occupied Limited Rehabilitation Program for qualifying households will serve low -to -very low-income residents who own and homestead their residence. The program will offer a grant for home improvement/rehabilitation and incidental expenses that correct emergency health and safety hazards, and code related issues. The maximum award $30,000.00 per household. ELIGIBLE APPLICANTS Applicant's gross household income (income from all sources before taxes and withholding for every household member, age 18 and over) may not exceed 80% of the area median income, as determined by the U.S. Department of Housing and Urban Development (HUD). The following apply: • To qualify for grant funding, at least one homeowner residing in the residence must be an Elderly as defined by F.S. 420.0004 (8) and/or have a member of the household that has a documented disability as defined by F.S. 420.0004 (7). • The applicant must be the homeowner and occupy the home for at least twelve months before the date of application. • The applicant shall not own any other real estate. • Absentee owners are not eligible. • Applicants must have 100% ownership interest in the residence to be improved • Applicants must have clear title to the subject property as evidenced by a title search or deed • Must have home repair needs that threaten the homeowner's safety, energy efficiency, habitability, and accessibility. • Payments on all mortgages on the property must be current. If the mortgage payment is delinquent, it must be brought current before application and remain current through the closing. • Must not have received housing rehabilitation assistance under any program administered by the City of Boynton Beach in the last 15 years. • Property taxes must be current. • Must be current on obligations owed to or insured by any body of government, including, but not limited to code violation liens, income tax liens, child support, and student loans. If the loan has been charged off, the owner will be required to contact the lender and arrange to pay the past due amount. • If a payment arrangement is made, payment must be current at the time of loan application and approval. If the loan has been forgiven, written proof must be obtained. OCCUPANCY REQUIREMENTS Homeowner must have owned the property and Homesteaded the property as his/her principal residence for at least one year prior to applying for assistance. The homeowner must intend to reside in the property for at least one year after the rehabilitation. 1423 INCOME CERTIFICATION REQUIREMENTS Gross annual household income included but is not limited to the gross annual projected income of all household members age 18 and over that reside in the household before taxes or withholdings. The following income sources must be included in the income calculation: • Salaries, overtime earnings, commissions, bonuses, full-time and part-time earnings, seasonal employee earnings, tips • Unemployment compensation • Social Security benefits • Public assistance • Net rental income • Pensions • Alimony and child support • Net income from business activities • Interest and dividend income • Capital gains • Imputed income • Partnership income • Partnership income • Bank accounts (i.e. checking, savings and CDs) • Prepaid debits cards (i.e. Green Dot, Prepaidify, Payoneer, Bluebird) • Brokerage accounts (i.e. stocks, bonds) • IRAs, 401 -Ks, 457s, ELIGIBLE PROPERTIES: • Properties that are being repaired must be the sole and primary residence of the owner. • Homesteaded Owner -Occupied Single-family properties (Mobile Homes are not eligible) • Must be the applicant's Homesteaded property • The property to be improved must not have a lien as a result of code violations. • The property must be located within city limits (property control number beginning with 08). TITLE VERIFICATION Boynton Beach Faith -Based Community Development Corporation, Inc. (FAITH -BASED CDC) will verify the following: • The legal description of the subject property • The owner's ownership interest by conducting or facilitating a title search/investigation • Existing liens, if any on the property ELIGIBLE IMPROVEMENTS Improvements include but not limited to: • Electrical • Plumbing • Air Conditioning Replacement • Insulation 1424 • Single families detached dwellings are also eligible for: o Roof Replacement o Exterior Doors Replacement o Windows Replacement • Accessibility Improvements for occupant(s) with disabilities • Repairs incidental to any of the above (i.e. drywall, caulking and painting) • Other conditions that could cause the home to be or become uninhabitable will be considered on a case by case basis. Each improvement must be made and in compliance with all applicable health, fire prevention, building and housing codes standards, and product approvals. APPLICATION PROCESS • Funding is awarded on a first come, first qualified basis • FAITH -BASED CDC will assist applicant with the application process • FAITH -BASED CDC will review the applications and supporting documentation to ensure all eligibility criteria are met • Applications must be signed by all homeowners • All forms in the application package must be signed and dated by all household members over 18 • Income Certifications must be signed and dated by all household members over 18 • FAITH -BASED CDC will perform visual home inspection to identify required improvements and write specifications • FAITH -BASED CDC will review with homeowner proposed improvements • FAITH -BASED CDC will send work specifications to City's Community Improvement Division for review and approval. The approval of funds to complete rehabilitation is contingent upon the availability of funds • FAITH -BASED CDC will prepare bids, receive bids from contractors, and selects contractor • Owner/contractor agreement must be signed before work begins on home • FAITH -BASED CDC will oversee the rehabilitation work through periodic inspections, review of construction payment requests, and issuance of payments to contractors • FAITH -BASED CDC will not release final payment to contractor until home passes the final inspection PROPERTY INSPECTION • FAITH -BASED CDC will conduct an Environmental Review that is categorically excluded subject to Section 58.5 pursuant to 24 CFR 58.35(a). • FAITH -BASED CDC will submit all necessary documentation and certification to the Florida State Historic Preservation Officer for properties 45 years or older • If required and depending on work specification, the FAITH -BASED CDC will conduct a Lead Paint Inspection in accordance with the Lead Based Paint Poisoning Preventive Act and assessment on properties built before 1978 • FAITH -BASED CDC will complete visual home inspection to itemize required repairs and write specifications 1425 • FAITH -BASED CDC will develop and prepare work specifications for the needed improvements for bidding purposes. • FAITH -BASED CDC will take and save photos of pre -construction condition All homes to be rehabilitated must undergo an environmental review and the file documented prior to any commitment of funds. An environmental review consists of a statutory checklist of required review items and a request to the Florida State Historic Preservation Officer (SHPO) for a review of historical significance and its impact on the rehabilitation of houses that are 45 years old or more. FAITH -BASED CDC will submit a description, maps, and photographs of the house to the SHPO. Properties with environmental conditions will not be permitted to proceed unless the conditions are corrected. The Community Improvement Division will review all documents of the environmental review checklist. No funds can be committed to a rehabilitation project, or work can start, until the environmental review is completed and approved. Each improvement must be a permanent general improvement that correct defects or deficiencies in the property directly affecting the structural integrity, the safety, habitability, or energy consumption of the property. The homeowner will be responsible for moving his/her belongings to perform the improvements. REHABILITATION REQUIREMENTS Rehabilitation must satisfy the following requirements: • Prior to start of rehabilitation, the property must be inspected by the FAITH - BASED CDC to determine eligibility under the program. • All proposed rehabilitation must be outlined in the specifications and must address the deficiencies and/or accessibility improvements noted on the inspection report. • FAITH -BASED CDC will procure bids from currently licensed contractors based on the specifications, and in accordance with 2 CFR 200.320 and select the lowest responsive and responsible bid. • All improvements must be completed by a currently licensed contractor for their respective trade. Any contractor who is excluded from the federal procurement, or is on the HUD's list of Debarred Contractors, is not eligible for to participate in the program. • A written construction contract will be prepared by the FAITH -BASED CDC and executed between the contractor and homeowner. • A Notice of Commencement will be filed for all projects. • The contractor will notify the City's Community Improvement Construction Coordinator when application for permit has been made so the permit review can be expedited. • Property improvements will conform to all applicable zoning ordinances and all appropriate permits must be obtained. • Each rehabilitated property assisted with CDBG funds for single family rehabilitation must be a permanent improvement completed in compliance with applicable state, county and municipal health, housing, building, fire prevention and housing maintenance codes. 1426 • Lien waivers must be collected from all contractors and sub -contractors upon completion of rehabilitation CHANGE ORDERS Change orders are not permitted after the contract documents have been executed unless unanticipated deficiencies identified during the rehabilitation process will cause further damage to the home if not addressed Any changes in the scope of work, including the reason for the change must be documented in the file In the event that a change order occurs, grant amount will be adjusted INDIVIDUAL GRANT • The maximum grant award allocated for this activity is $30,000.00 per household • The amount of the award might increase if other source of funding is available. The increase will be based on the amount necessary to cure existing substandard conditions or accessibility. If the rehabilitation cost exceeds the maximum grant award the project will be referred to the City's Housing Rehabilitation Program which will require a deferred mortgage of 15 years. 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C C U aJ } L L! +� C O > aJ aJ N OU +' U C n3 .� — O Q > L O +' O .N E Q w c > — NO aJ U C U L L E U L L ro .ai W C p p aJ to L L 4' •� v O s O w .`^ N p .O n3 O O n3 Q N Q N C N LJ O Q coco � Q aJ p � - O WaJ N Q aJ OJ O N O aJ O aJ L 4.1 N H> O L O E} L �' N q0 N QJ QJ C U N O N U O N O N — bA C +� C N .E aJ iJ aJ WN N O .E +j QJ L) CD u U i to aJ U U aJ N `L' aJ E N U Q '> Q aJ *' -0 aJ !7 O `� aJ to GJ Q Q Q O O C 4-1 U > O Q) aJ O Q (o -0 N L i-0 M N L-^ �"� N Q .f:A QJ U '+� fo Ln aJ � L ul � O L O O 4 O aJ 4- L- -I-- v N — Q co aJ v L co co C +� O H Cyp txA .� +� cLa t E c co N L N ca E w p C 4 - E E a aJ + QJ +O >O O C Q a > >OC Q N N O Q QJ O 0E U a aJ O E C a N OL 0 N Q L U U a C D Q N Q Q Co Co O aJ Q (o C ++ N +' N M 001 CO a bb U a O O }' 4• ro L U E 7 Q O ate+ 0O a cn 4p U _0 a) W U > L N a1 i a..' aJ O `n qfJ L N > Q N N O = aJ O +N 4- O L O O -0 O 00 L .0 > E a, a 4 -Ln C a (6 O 4J L 4 L O+1 UA � c`no O -0 Ln O QJ '� 4- bn aJ > 3 U -a N I v 4O N O O O Na.., -r- v v v +, �bn Ln =5 o O C V O O U a --i U O O vi 4� U M O Q O iii aJ +' Q O L O L � aj Ln m O.E O a-+ U v� p LnO E NO a m Ln _0 N -Q N � +J 41 -0 O O 4-1 aJ (o Ln ON O L U � U :, •Q -C U L v*' aJ � 00 � X U � � >..L 4� Q 4- -a i Q U Q aJ Q (o i U C � � C a LL O + > E C aJ E m O N o �D� aJ u 0 4, -0 i u May 26, 2023 Keturah Joseph, Executive Director Boynton Beach Faith -Based Community Development Corporation, Inc. 2191 N. Seacrest Blvd. Boynton Beach, FL 33435 Re: Community Development Block Grant (CDBG) Funding FY2023/2024 Dear Mrs. Joseph: This letter is in regards to your application for CDBG funds for the Fiscal Year 2023/2024. The CDBG Application Review Committee assessed your application for Housing Rehabilitation Activities — Limited Owner -Occupied Rehabilitation Program and based on their scoring, funding recommendations has been forwarded to the City Commissioners for approval, for the amount of $535,000.00. Final recommendation approval will be at the regular City Commission Meeting on August 1, 2023, at 6:00 pm. The City Commission meeting will be held at 100 E. Ocean Ave,, Boynton Beach, FL 33425. We recommend you or a representative attend the meeting to address any questions that may arise regarding your organization and/or services. Thank you and we look forward to working with you. Sincerely, .... . .. . RJ Ramirez Community Improvement Division Manager 1432 Fiscal Year 2023 (October 1, 2023 to September 30, 2024) Not -For -Profit SUBMISSION DEADLINE Morch,27,, 2023,, 5000 PM Hard a s ,.!�q�Witchmen h all attat to City of Boynton Reach Community Improvement Division 100 Fast Ocean Avenue (No applications will be accepted after 5:00 PM, on March 27, 2023) FOR MORE INFORMATION OR QUESTIONS, PLEASE CONTACT: CITY OF BOYNTON RJ Ramirez, Community Improvement Division Manager COMMUNITY IMPROVEMENT DIVISION 100 East Ocean Avenue Boynton Beach, FL 33435 Telephone: 561-742-6359 Email: ra-m-irggr@bIlfi.� boynton-beach.org/community-improvement 1433 Agency Name: Alzhei.mefs Community Care Project, Family Nurse Navigator and ID Locator Programs U 0111IX-A&K ^X Submit Hard Copy and a Digital/Electronic Application with all attachments X Application is signed and dated. By Director, and Board Chairperson X 501(c) (3) is attached (No -For -Profit Status) NA City of Boynton Beach Business Tax Receipt attached (if applicable). X Board Member list. X Copy of latest audit. X All funding sources for this project identified. ADDITIONAL ATTACHMENTS X Attachment I Agency Articles of Incorporation, Agency By-laws, and Tax Documents submitted to the Internal Revenue Service (IRS). lI X Attachment 2 Copies of current license(s) needed to operate (as applicable to the funded activity) including City of Boynton Beach Business Tax Receipt (if applicable) X Attachment 3 Documentation of all additional funding sources for program(s)/project(s) listed in application (if applicable) A description/schedule of fees charged to the targeted X Attachment 4 beneficiaries of the programs/services/facilities to be funded (if applicable) ............. A job description for each position for which funds are being X Attachment 5 requested (explain role/responsibilities within each program/project) (if applicable) 1434 Certifications and Affirmations Print Full Name: Christine DelGuzzi Applicant Signature: a"I. f Title. Director of Grants Date- March 27, 2023 1435 . . .................. I certify that I am authorized to submit this application on behalf of the applicant agency. I affirm that the award and payment of grant funds are subject to the sole and absolute discretion of the City of Boynton Beach City Commission without recourse. By submitting this application, I waive any and all claims related to the City of Boynton Beach CDBG Program and specifically agree to indemnify and hold the City, its employees, officers, agents, and representatives harmless from any and all claims which may be in any way related to any City of Boynton Beach CDBG Program award, payment, and/or denial. I certify that my agency was established and operating in the City of Boynton Beach on or before October 1, 2020. If funded, I affirm the applicant agency will continue service operations in the City of Boynton Beach. I affirm that the tax documents provided in this application are identical to those I have submitted to the Internal Revenue Service. I acknowledge that, funds are distributed by reimbursement only. if this grant is approved, any amount my agency receives may be considered taxable income by the Internal Revenue Service. I acknowledge that, if this grant application is approved, the City of Boynton Beach and Representatives of HUD, the Inspector General, and the General Accounting Office shall have access to all books, accounts, records, reports, files, and other papers, or property pertaining to the administration, receipt and use of CDBG funds necessary to facilitate such reviews and audits, as applicable and described under 24 CFR § 570.490(c). I acknowledge that, all records relating to the City of Boynton Beach CDBG Program, including supporting documentation, shall be retained for the greater of three years from closeout of the grant to the City, as applicable and described under 24 CFR § 570.490(d), unless there is litigation, claims, audit, negotiation, or other actions involving the records. The records must be retained until completion of the action and resolution of all issues. 1 acknowledge that, if this grant application is approved, my name, my agency name, and my grant award amount may be made public by the City of Boynton Beach. I acknowledge that, if this grant application is approved, my agency will be subject to Florida Sunshine Law, FL State Statute 119.0701 Print Full Name: Christine DelGuzzi Applicant Signature: a"I. f Title. Director of Grants Date- March 27, 2023 1435 FY 2023 Funding Request To submit an application, complete A — 1, Attachments 1-5 (if applicable) and any other items requested. Do not include any items that are not requested. Submit a Hard copy and a digital/electronic copy with all attachments to RJ Ramirez, Community Improvement Division Manager (Kqmirezr bbfl.us) community Improvement Division, 100 East Ocean Avenue, Boynton Beach, FL 33435 by 5:00 pryi, M,arcli 2'1, 2023. Please review the "CDBG Subrecipient Information and Guidelines" available at CQBQ Cit ' of Boynton Beach (bo iton-beacli.oW for the program reporting requirements, goals and timelines. For assistance, please call the Community Improvement Division at 561-742-6359. A. GENERAL INFORMATION 1. Name of Applicant: Alzheimer's Community Care X No -For-profit Unique Entity ID # VAC8DQFK57L3 Provide copy of your IRS ruling providing tax exempt status under Section 501(c) (3) of the 1986 IRS Code, Per 2CFR Chapter I Part 25 and the Office of Management and Budget guidance on Federal Funding Accountability and Transparency Act (FFATA) Subaward and Executive Compensation Reporting issued on August 27, 2010, each prime grant recipient may make subawards only to entities that have Unique Entity iD Number. 1 Name of'Project: Family Nurse Navigator& ID Locator Service 3. Area or Location of Project: Benton Beach 4. Contact Person/Title: Michael Jessup, President & CEO (Preferably Executive Director/President/CEO) Email Address: miessupPalzcare.org Mailing Address/Zip:800 Northpoint Pkwy, Ste 101-5, West Palm Bch., FL 33407 Telephone: 561-683-2700 Fax: 561-683-7600 Additional Contact Person/Title: Christine De.]Guzzi, Director of Grants (Preferably Person responsible for preparing reimbursements/quarterly reports) Alternate Email Address: cdelguzzi@alzcare.org Mailing Address/Zip: 800 Northpoint Pkwy, Ste 101-B, West Palm Bch., FL 33407 Telephone: 561-683-2700 Fax: 561-683-7600 i El 11:11 0 11i Grant Request Activity Area (choose one): Homeless Prevention Services Public Safety/Crime Prevention X Senior Services — Other (please specify): Amount of Funds Requested for Project: $25,000 Amount of Matching Funds for Project: $285,000 Domestic Violence Prevention Housing Rehabilitation Program Educational Program MatchType:—Cash X Other Grants Donations Other Please Identify Source of Additional Funding: Private Foundations, Unqed Vl�ay, Individual Donations 8. CDBG COST: (a) Total CDBG Funds Requested $25,000 (b) Total Unduplicated Units Served 300 (Explain how determined?) 'rhe Family Nurse Navigator program will provide services to 230 individuals residing in. Boynton Beach (1. 15 Patients/115 caregivers). The ID Locator Service will provide 70 individuals (35 patients/35 t-d1C61V'Z1bJ lUbHU-tir, U1 DUYUL011 (c) CDBG Average Cost Per Unit (a/b) $83.33 (a) Total Project 5916,565 (b) Total Unduplicated Units Served 3480 (Explain how determined?) Patients to be served: 1815 Caregivers to be served- 1665 (c) TOTAL Average Cost Per Unit (a/b) $263-38 4 1437 9. Is this project: A new service; or X A quantifiable increase in the level of an existing service which has been provided by the grantee on its behalf through State or local government funds in the 12 months preceding the submission of the grantee's Consolidated Plan Annual Action Plan Has the applicant received or will receive other Federal, State or local government funds for the proposed project(s) for which the applicant is requesting CDBG funds? Yes X No If Yes, what is the funding source? State of Florida, Department of justice How much? $2,3850,000 (if State Budget is signed without changes) 10. Could this project occur without these funds? Yes X No 11. Will this project continue after CDBG funding ends? X Yes - No If Yes, describe how the applicant will guarantee the sustainability of the project/program after CDBG funds have been spent. Funding will be sourced via grants from private foundations and through government 1438 B. PROPOSED PROJECT EXECUTIVE SUMMARY: Please describe in detail the scope of services of the proposed project/activity to be funded, including the expected benefits to the community, a plan of action, how the agency will implement the activity (i.e., intake procedures, income certification, collection of required documentation, reimbursement request, progress reports, end of the year report, etc.). (Attach additional sheets if necessary) -n-1p FM14Nurse Navigntnr (ENN) program is the portal thr which familiess access dcmentia-spf=ifIL- services and resources and is an essential compienent of a comEjehensive, famil centered model of care for caregivers and patients living With Alzheimer's disease. FINNs, licensed nurses with specialized dementia - specific Training, provide intervention. an -specslic care, or both-the—patient and-t1we caregiver. FNNs work directl with caregivers and patients, providing emotional support, disease education, practical guidance and connections to community resources throughout all stages of the disease. For patients at risk ofwafiticring, I s ink families to Alzheimer's Community Care's ID Locator Services, a complementary - SUMM thfff MIMS oil IfN&Ingtirvices WUFIT by patients UfftrUoilctinated searcmand resciltel Ze! rus J n wllvi n a I nLv _communis ,thus avaidin cosh nursin Home placement. Intake procedures include intake forms (attached) that require income verification of both the patient and caregiver, Which areTntered into IFFElectronic Heath Records (EHR) system. Through this EHR, the organization is able to collect the necessary information for progress and end of the year reports. The benefit to the community is that families are able to remain together in the home and in the community, with safety and security, thereby delaying or avoiding costly nursing home placement for those Mat are financially challeen-g-c-d5ow income Within that community. Durini,y the initial visit, the FNN completes an evaluation of both the patient and the caregiver. A compre- hensive review of medical histories, current medications, financial status, and any relevant legal -d arrangements, like the -power of attorney an d/ or healthcare proxy, is can u cted FNNs link families to the organization's ID Locator Services to help revent wandering episodes and ensure timely rescues should an elopement occur. 1439 Consent and Authorization to Receive & Release Care giver- Information This document is intended to provide you Nvith information regarding our disclosure of confidential information contained in your client record. 1, (Print Caregiver Name/Responsible Party): . hereby consent to and give authorization to Alzheimer's Community Care, Inc. to release either orally, written, or by electronic transfer confidential information, both within Alzheimer's Community Care and to outside organizations, including information, if patient will be utilizing state or federal funding for services if and/or caregiver is financially obligated for care received by patient. Consent and authorization are further granted to financial representatives as well as health and human service organizations to release confidential above -referenced information deemed necessary by Alzheimer's Community Care to coordinate or receive services. I understand I have the right to withdraw consent at any time and I will inform Alzheimer's Community Care in writing of intent to do so. Alzheimer's Community Care participates in the Health Information Exchange (HIE). This allows the Organization to electronically share information with the patient's other health providers. Signing this document means that you consent to allow the Organization to share your information. If you wish to opt out, check the box below. Lj I do not consent for Alzheimer's Community Care to receive/release the patient's health information from/to other providers. The following information is required by many of our funders. This information is used for reporting purposes only. Your name is never disclosed with this information. Date of Birth: Gender: ❑ Female ❑ male ❑ Transgencler Veteran: ❑ Yes ❑ o Race: Please Check One White/Caucasian ❑ Black/African American ❑ Two or More Races Asian/Pacific Islander ❑ American Indian/Alaskan Native ❑ Decline Ethnicity: Please Check One ❑ Non -Hispanic White ❑ Non -Hispanic Black/African American ❑ Non -Hispanic Other [] Non -Hispanic Multiracial ❑ Hispanic/Latino/Mexican/Other ❑ Decline lmome:,$.,_ —, D Monthly D Yeady Sig,14t�igt of otogiver/Responsible Party: Date: Relationship to Patient: Witness: —Date: This authorization expires upon termination of services or change in responsible party Revised October 2022 1440 ALZHEIMER'S 14, CommuIw^ y Thindocument provide you with inh,rma�onre�nUmmour dhal�upeo{conNden�a| CARE' This v . �� / +.~,`',,*^~/,~ information contained inyour client record. |, (Print Caregiver Name/Responsible Party)' I hereby consent toand give authorization to Alzheimer's CommunityCare, Inc. to release either orally, written, or by electronic transfer confidential information concerning indusivcofthefo(|ovxin8authorizations'' (Patient): A. For confidential patient information to be shared by the Organization's departments, asdetermined 6vpatient needs; D. For the patient to be transported to the nearest hospital in the event of emergency or acute i|\nessamdetermined by paramedics; C. To any physician, hospital, clinic, medical services provider, service agency for the release of medical, financial and/or other confidential information on patient to the Organization; to the Organization for the release of information, including medical, financial, and/or confidential information for patient to agencies and/or medical providers in order toobtain appropriate health services for patient; D. |naccordance with Florida Statute I19,Alzheimer's Community Care, Inc. collects Social Security Numbers (SSN)ofall recipients ofservices provided by Alzheimer's Community Care for the following purposes: To determine eligibility and to assist individuals with applications for publicly funded programs and services; * if applicable, to share information with any Florida State Agency or Office that requires BNto offer its services. E. I understand that I have the right to withdraw this consent and authorization at any time with written notice to the program. F. I consent for Organization staff to share confidential information and leave voicemail, text,oremail with the following: Name' Relationship: Phone: Email: _________________ Name' Relationship: Phone: Email: _________________ Name: Relationship: —Phone:— Email: _________-_______ Alzheimer's CumunouityCare participates inde8eu|th�� Information Exchange (HI8).This allows th�c0r8mzi�ioutoelectronically share information with the patient's otherhealth providers. Signing this document means that you consent toallow the Organization {u share the patient's information, which will include your contact information. if you wish to opt out, check the box below. The following information is required by many of our funders. This information is used for reporting purposes only. Patient and Caregiver names are never disclosed with this information. |sthe patient mVeteran? M Yes [_\ No Patient's Income: F1m^poo.^."wYOve�"r' Race- Please Check One FlVVhite/Coucasian nBlack/African 4mehcam ElTwo nrMore Races [lAsian/Pacific Islander MAmerican Indian/Alaskan Native E] Decline Ethnicity Please Check One Fl Non -Hispanic White F-1 Non -Hispanic Black/African American F] Non -Hispanic Other Non -Hispanic Multiracial r-1 Hispanic/Latino/Mexican/other | |Dec|ine THE PALM BEACH COUNTY FINANCIALLY ASSISTED AGENCIES (FAA) CONSENT I The Financially Assisted Agencies (FAA) is committed to ensuring that the information maintained in our client records �` I�FF' remains confidential, secure, and can be accessed only by individuals authorized to do so. Your information will be maintained securely and is only shared with your consent, by signing this form. The Financially Assisted Agencies (FAA) service providers will disclose to authorized staff of Alzheimer's Community Care the required database demographic and Personal Health Information (PHUabout you. Disclosure isfor the purpose ofcoordinating payment for care and to demonstrate that the quality of care provided is in accordance with accepted standards. Information entered into the database will bemaintained for anindefinite timeframe. You have the right to request a copy of your file. You have the right to refuse to answer any of all questions you consider sensitive. You have the right to cancel this release of information for any future data input; however certain programs may have statutory mandated information requirements. Please initial: OReceived a copy of this form ODecnned acopy ot trus torm Signature of Caregiver/Responsible, Party, Date: Relationship to Patient: Witness Date: This authorization expires upon termination of services or change in responsible party 1441 Revised October 2022 C. STRATEGY: Check the ONE STRATEGY that best describes your project and provide number of units that will be served under this program. Check One Specific Objective Number of Units This Project Will Serve ------------------------------ --- Educational Program (Specify) Households/Persons: (please specify which) Public Safety/Crime Prevention Households/Persons: (please specify which) Domestic Violence Prevention Households/Persons: (please specify which) Senior Services Elderly Households/Persons x (please specify which) Persons - 300 Youth Programs Children/Youth: --------------------------- Housing Rehabilitation — ---------------------------------- Number of units to be rehabilitated: Other (Specify) Households/Persons: (please specify which) 1442 1. What documentation/data was used to determine the need for this type of program? 2. How do you evaluate the overall effectiveness of the program? 3. Now this project relates to the overall organizational structure? 4. Be very specific how the CDBG funds are proposed to be used? 5. How CDBG funds will it impact your current operation? (Attach additional sheets if necessary) The Family Nurse Navigator (FIMN) gathers needed data uponenrollment, entering it into Alzheimer's Community Care's Electronic Medical Records System (EIIR). Vocurnic-nna-rran used to determme The need or MIR type of program Inc ludes me an ur en whieh is administered by the i dttf-fing the ial . isit with tl- fi—i4y to +hestfesss level of the This same test, the Zarit Burden Interview is also administered again at the annual meeting with the family to ensure fhat stress levels are sf-aFilized or reduced, ie ping to determine the overall effectiveness of Me— pingrant. Additiolmally, ill I aMIUM a] Innyllwas r-3!UgIVUI bUIVUY Ib �VUUU�L�U UPensuir th at the 1"Lludly NUINV a4igator' 11) boca�Q;:' and Day family. The project relates to the overall organizational structure in that our mission of placing a safety net around M-Memier's pati -c -a -Ms an Meir caregivers, providing t - neril WIM tie and riope, is being liprie!a. CL RG funds will be used to laravide fending for a portion rdthe calory for one Lan0IzNnrsP Consultant who provides services in Boynton Beach. Alzheimer's Community Care will cover fringe benefits, and the remainder of the salary will be covered by other grants received. With CDBG funding, the Family Nurse Navigator will provide a determined number 61 hours of service based on the grant affi-o-u-n-UA portion of the gi arit will also bU Used ft)i the it) tmcatui staff'ser Vicing t! iat ai Cm Over 75% offamilies served are earning a low to moderate -income This information is gathered at intake and recorded in the Electronic f1ealth Records system. CDBG funds will impact our current operation in that it will allow for the organization to serve additional underserved patients in that region. H., 1443 1. Where will the program take place and is it within the City of Boynton Beach Municipal Boundaries? Who are the targeted beneficiaries (i.e., geographic area, persons served, etc.), and how are they selected for the program? 2. Are you working with other organizations in a cooperative effort on the program? Yes x No If yes, please list the other organizations and their role and responsibilities. (Attach additional sheets if necessary) The FINNI Program takes place within Palm Beach County, and the City of Boynton Beach Municipal Boundaries are within the countyparametersthat are served. The ID Locator Program also serves all of Palm Beach Countv inchmibe of the City of B=ton Beach Municipal Boundaries. 11) Locator staff.mt2ets with the family in the home or at the nearest Alzheimer's Community Care Specialized Day Service Center site (Delray Beach, Lake Worth, or Boca Raton) for monthly batteLy changes. While the FNN and ID Locator Service programs do not target a specific neighborhood in Boynton Beach, most services (75%) have been and will be for families who reside in economically disadvantaged neighbor- hoods for Larnilies whose earned income is well below the natj2aL14)overtv level. Responding to the, challenges facing individuals and families living with Alzheimer's disease (A2) requires a community wide response. For 24 years, Alzheimer's Community Care has been a catalyst for building community-based partnerships and proudly collaborates with numerous public and private entities to strengthen trie sae ty-net for pa rens and caregivers. service partners include Palm be County Division of Senior Services that provides financial assistance for families to access community-based care; 211 Palm Beach Couwfy;-serving as a partner for the Alzheimer's 24 -1 -lour Crisis Line; Palm H—ea-cYT--ounty Sheriffs Department, assisting with rescue efforts with Alzheimer's Community Care's 11) Locator Services and Florida's Silver Alert program; Area Agency on Aging, providing referrals and financial support for families in need of community-based support; Meals on Wheels, bringing meals to vulnerable families living with Alvbeimer's disease-, Veteran's Administration, providing funding for Day Care services to veterans aMicteZI wiln.M. 1. ne Organization atso works closely- witti farmly physicians to coordinate care plans for patients and caregivers. Working together, we are bringing help and hope to hundreds of families as they navigate through the heartbreaking pro—gression of AD, surrounding them with essential resources to live safMy!Ti the community and delay or efurunate the need for nursing home ptarement. 9 1444 3. The City's CDBG funds must directly benefit low -and -moderate -income individuals (80% Area Median Income (AMI) or below). The City's CDBG program requires non-profit organization to income certify Individuals seeking assistance through activities/programs/projects funded with the CDBG funds. Has the organization done income certification of individuals seeking assistance in the past? Yes X No If yes, please explain the process the organization uses to income certify Individuals? What type documentation is collected? Please attach with your application, a copy of the form your organization uses to income certify individuals. "The organization certifies income of both the patient and caregiver through the initial intake assessment forms, on which the income is requested and the caregiver signs for confirmation/verification. This intake form, with the income verification areashighlighted, are included in this application. 1445 4. Does the organization charges fees to its clients? Yes— No X 5. Will program Income be generated from this activity? Yes_ No X if yes explain how will the program income be used? F. Goals/Objectives/Activity Measures: Descriptive narrative. Please use separate Goal Sheet for each individual Project (if applicable). Project/Program Title: Goal #l: Safety and security Ob" J-eCtive- No less than 95% ofAtz.heimer's patients equipped with ID Locator Bracelets who elope from their safe location will be found in a timely manner and suffer no injuries. Resources Needed & Available: ID Locator Service staff, ID Locator Service devices Start Date& Duration: 7/t/2023-6/30/2024 Goal # 2: Dignity and Integrity Ob'JeCCIVe. 85% of caregivers working with the Family Nurse Navigator will report that they are _ likely to continue caring for their loved one at home (measured on assessment form at the time of reassessment), Resources Needed &Available: Family Nurse Navigator staffing Start Date & Duration: 7/1/2023-6130/2024 IN i E, E, 11 Please list organization's anticipated expenditures, detailing requested funds and additional funding. Please place C=Cash, I=ln-Kind, O=Other Grants, D=Donations beside each amount under "Other Project Funds" to denote the type of funds being used. If funding request is for multiple programs/projects, please provide a separate PROJECT BUDGET for each program/project Une'AW" s'- Reques"feci, tfier,0rq1qc Fujids T, ta ect o fl, - P/r ol Budget ADMINISTRATION: Personnel (# j $25,000 $605,504 $630,504 Payroll Taxes $48,233 $48,233 Employee Benefits Office Supplies $106,618 $4300 $106,618 54300 — - ------------------ ------------ ----- Copy Supplies $850 $850 Professional Services fee 0 0 Other (explain) Telephone $14,450 $14,450 Other (explain) misc.. $111,610 $111,610 Other (explain) Other (explain) Other (explain) PROGRAM: Other (explain) Other (explain) Other (explain) TOTALS$916,565 S916,565 . . ... .... . ........... ....................... ...... . Notes: 12 1447 H. ORGANIZATION CAPACITY (Provide a detail description of each) 1. is the organization adequately staffed and trained? 2. Explain how this program fits the organization's mission? 3. Please explain the organization's experience with the proposed project? 4. Staffing Capacity: Who works on the project directly and indirectly? S. Does the organization have written policies and procedures? How often are these policies and procedures updated? Provide a brief list of the topics covered in the organization's policies and procedures. The City of Boynton Beach may request a copy for review during the application and award process or as part of the grant monitoring process. (Attach additional sheets if necessary) The organization is adequately staffed for the need of the program and. the community. Alzheimer's Community Care emvloys approximately% dementia -specific trained staff and is supported by 125 community V volunteers. The hallmark of Alzheimer',,,; Community Care's Model of care is the equal focus on the needs of both the -Alzheimer's patient and the fam4 caregiycr.-The guidance and sLippgrt provided by the FainilyNtirse Navigator program ensures that every family, regardless of income, has a trusted guide to help them navigate .the disease, The organization has been in existence since 1996, providing comill 11 ni!y- based, family - centered care for patients living with a neurocognitive disorder and their caregivers. Of primary importance has always been preserving the safety of both the patient and the caregiver throughout the disease -pro gression. From its incepti u—the organization's Family Nurse Navigators-liaye worked closely with families to develop I)ersonahzed care plans to address ever-changing issues, including patient wanderingand ensure family safety and Nvellbeing, Family Nurse Navigators will provide person -centered assessments for wandering risk of patients and safety training f.r caregivers. A director of Family Nurse Nayigators supports the Nurses. AdditionallytheFamily Nurse Navigators work closely with ID Locator Assistants, who, regularly monitor the safety of Mzheinier's patients at high risk for wandering Nyho are equipped with electronic locator/tracking devices. The 11) Locator Team is also responsible for educating caregivers, program partners, and the community about preventing and mitigating the wandering of patients with Alzheimer's disease. The organization has a written Policies and Procedures Manual that is updated regularly in accordance with any changes in corporate policies or procedures. A brief list of the topics included in the Policies and procedures Manual are: National Patient Safety Goals, infection Control, Records of Care,Treament, and Services, Accreditation Participation Requirements, Environment of Care, Medication Management, Emeraency Management, and Rights and Responsibilities of the Individual, 13 1448 6. Will all CDBG funds awarded be maintained in a manner that they will be accounted for separately and distinctly from other sources of revenue or funding? Provide a brief description of the organization's policies and procedures that ensure funds will be tracked appropriately. 7. Is the organization's financial management system able to track actual expenditures and outlays with budgeted amounts for each grant or Subgrant? Provide a brief summary of the organization's process for tracking expenditures, including tracking budgeted versus actual amounts. 8. Does the organization have effective internal controls in place to ensure that federal funds are used solely for authorized purposes? Provide a brief description of the applicant's internal controls that will provide reasonable assurance that the award funds will be managed properly. 9. Does the organization have a documented records retention policy? If so, briefly describe the policy and confirm that the policy complies with federal regulations. Information on Records Retention and Access can be found at 2 C.F.R § 200.333- 200-337. (Attach additional sheets if necessary) All CDBG funds awarded will be maintained so that they are accounted for separately and distinctly from other sources of revenue or funding. Once funds are received, they are coded to the authorized purpose, ensuring the grant is allotted to the appropriate program. The organization's financial management systei is able to track actual expenditures and outlays with the budgeted amounts for each grant, which provides the basis for the annual organizational and prggLam budgets. Internal controls are in place to ensure that federal funds are used solely for authorized purposes, and these revenues are monitored with the corresponding program expenses to ensure the funds are fully utilized. The organization has a documented Records Rctential Policy, with all records being kept for at least 10 years. Corporate documentation and financial reports are permanently retained. 1449 1. Conflict of Interest Federal law (24 CFR 570.611) prohibits persons who exercise or who have exercised any functions or responsibilities with respect to the above grant ... or who are in a position to participate in a decision making process or to gain inside information with regard to such activities, may obtain a financial interest or benefit from an assisted activity... either for themselves or those with whom they have family or business ties, during their tenure or for one year thereafter. 1. is there any member of the applicant's staff, member of the applicant's Board of Directors, or office who currently is or has/have been within one year of the date of this application a City employee, or a member of the City Commission? Yes X No If yes, please list names: 2. Is there any member of the applicant's staff, member(s) of the Board of Directors, or officer(s) who are business partners or immediate family of a City employee, or a member of the City Commission? X Yes No If yes, please list names: 3. Will the funds requested by the applicant be used to pay the salaries of any of the applicant's staff or award a subcontract to any individual who is or has been within one year of the date of this application a City employee, or a member of the City Commission? Yes x No If yes, please list names: IR 1450 REPAYMENT: Funding from this grant program is subject to federal, state and local audit, if a determination is made that these grant funds were used in a manner inconsistent with program guidelines, for an ineligible expense or for expenses reimbursed by another federal, state or local grant/loan program then the awarded entity will reimburse the City of Boynton Beach these funds. SUBMISSION OF AN APPLICATION IS NOT A GUARANTEE OF FUNDING it Is the responsibility of the applicant to READ AND UNDERSTAND, all aspects of the CD OG grant program, the application, and City's procurement process, If applicable. NOTICE TO THIRD PARTIES: The CDBG grant application program does not create any rights for any parties, including parties that performed work on the project. Nor shall issuance of a CDBG grant result in any obligation on the part of the City of Boynton Beach to any third party. The City is not required to verify that entities that have contracted with the applicant have been paid in full, or that such entities have paid any subcontractors in full. Applicant's warranty that all bills related to the Project for which the applicant is directly responsible is sufficient assurance for the City to award loan funding. The applicant certifies to the best of his/her knowledge and belief that the data in this application is true and correct and that the filing of the application has been duly authorized by the governing body of the applicant (if applicable) and that the applicant will comply with all the requirements of this grant if the application is approved. .... . ...... . . Name: Michael Signature: 77— Title: President &CEO Date: March 27, 2023 Name: G.MarkShaUoway Signature: Title: Chair, Board of Directors Date: March 27, 2023 16 1451 E 0 (/) L E N 0 V) c 0 f6 U 20 so N LO T Ln C vI N +' O L C a a) N co L O Q) > a) -0 C:L _0 0O(9 C aJ N bA �° +J •> M v v aJ U aJ v O N O o O a) +� [6 U_ C Q O L N O Q p} +� (O v C O Q U Q) S O N O Q m aJ Y O C L O O +� N-0 ' C m L D-° 0 QJ ate-+ a) Q C a) dA 0 U N ° O aJ 0- tn qp O O ++O •� U a) �•d v '� ~ O O > ° O aJ Q) U dJ (� 47 _\ Q N 0- Q -0} C a Q +1 m x O E�^ O; N > O v 0 E U :' C u O O N O +� > t� C — U O C C _0 a) a L a) a) .- C N L a E� ° (n O L i p-> a) O O `n 'L U O hA ° Q) a) a) c6 } � -0 E O i� U— +�'� L > C N 3 O p vUi+' O Q Q41a--� VI Q1 41 O _0 a) (O .0 U LeiL O L >� O U U)+- > ON o CO a' l]a C i 47 a) `n p aj 4J C +, 4-a) ° > C6 Q C6 p U Cw in L a a) V v aJ O + ai p OL C OE a) a" Q ° O p O+' C W -0 p p O C C L U s > Q U o o o _ >" L N _ Q Q _ 4- CCc6o +� p a) Ln U E QO4- '+-)+ �taN1 Q .N_ cnn L U U Q) Q +- W ° E a, a O v a o+a� +m O)XOq +c0n a>ON +OtUoJ O Q m C .� 4� N 3 ° C O + U C to QJ t U (6 a) C6 of > O >• � V O C m 0 O a) t +_+ ca a E a, u n .� 3 .E 0- m o C) 41 0) _ U a C 0 aC) QC i +1 C E 4- UU tUi1 N U a O O� -Z Oc fiC ECw - mCm_O V- O U,- O�OA U+, U O W p L V) C a) v a) a) 'E +� �C C O V1 o a O C- f6 c O v LA Q '- Ln a E u0 °; +J a) a) p u U a) C 0 0 O to t O n3 L L Q. 4 x O 4-� j v C a E E � L N p O-0 Ln O x -I-, a 0 a) � U C20 +� L 4. •C N Q x a) C C i C a) > j O Q +1 `� C p +� O C +mi a) N N N N O L (9 aJ .0 +� Q O O a) 'a +J +� C6 'O > v ate-+ aJ m � >, N Qj Q) C > � = _ cu U � v v v Q v o v o o 4- {n Q) Q L a) — N p ° u Q) L N V Q > ra •° n u C> � o ° v o U .� [U6 aJ �° c U L O M� c U L .� - vi .Q- � 4� N .Q O N QLJ m aJ .Q +J (LO C O O L (0 N 7 Cu U U Q (]Jcijs Q) aJ aJ t : p m O_ 4- 4- m U Q f0 .� U f0 47 •�E O � ioca � O i "0 E Zc 41 ++ ° a 4 +- O E as '� c a +_ u c +� o c H 'O i O ri U O ++ a O H tC Q a) a= E U o v a E J a x O W U N LO T M LO r 4- N N O (9 Q) a) L E +- C -C aJ 3 L 4 O N d�A p '� vii N aJ C s _A 4-1 (a 41 L O L O O= Q Q t O: U 4 J O aJ ' C +� Q a) p ON N + p Q U 4• O x aJ C } a) v L + C6 L a aJ > O '}� a) N a) � Ln aJ O u N Ln (L6 Q 4 O O .0 4- aJ C •N 7 a) ate-•+ U f6 L a- E a) CL 0 a) N Ca j N N a) '0 OU L OA O a) aJ L OL X a) N v v ca ra U~ Ca .� V N O Q •- w c Q 4 t tLa Q v 73 +J ra LnY •� Q nA Q G C 4' m a) L i ca — •L L N O 4 i U L Q •f6 fa a) 4� O Q) p X N O C C N L •Q N Q� cu O 4J .0 CII a) 1 f6 N O L CL 4. 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CDp O +, Ln Q) U � +� a Q a T O 'u N a� �., a L a s i dA a O L Q� a i O v O_r a- 0 0 co .- i i t Q N c F- m� i Q Q to s a� O a u ra a 4-(3) (3) C7 a N r0 O-0 a L O m -00 r6 r6L •f�B 4- a O 40 3 u _v =3c p ..+' o V � a °- Oro °C: O Q N a G 0 C- 0- -0 a a 0 0 >C -Co E te a-, NN �sS L Q O a- nU E '^ Y a- aJ +' N Ln a c ra O N c U .� ro O O O a L• Q a� •+, aj cr a c U •L a +- i L! a-- N O a s N L U .� O L O LO aJ NO Q > +' C — a✓ Ov a Q N U a 0 r6 a c J U 0 r6 a� L L E U i i r0 .� p .a a L +� Ln O O N .`^ N p r6 O c� Q N C)- } N aai c LJ O co (.0 aJ O- O a a N-0 Q a s O N O a O O L 41 N H> a L a a E `� rL6 i +J N bA N a M s ro N - O 4- +� r6 a O C U N U U NO NL J O mN M 4-j � _" OJ J O i +, OJ a -a a N *L .- v U+ U a-0 L a a-+ M a N VaNN aj O a } > - QQ O Qa a Q Q O O c 4-1 U O N s- M > QN-0 a u a O 0)a v a Q •te a a _0 41 a4- bA a• C c N E 6 p p Ln Ea"' E M a•+a ac - M > O D c Q a> a f° > a N N O >a LO u a i C)E° Q a E a a C U 0 N a �C t L -CO c Q U D U a c D CL r6 N H H Q m 4- m O a Q m 0 LA m c N •M V c CoLn to m U O N 4� v_ N L a v a v > 4- N v O X Q QJ V N � O N a� a � U O Q > -0 r6 r6 ai 0 V CA 0 LO LO 3 MR -101W Mr. Michael Jessup, President and CEO Alzheimer's Community Care, Inc. 800 Northpoint Pkwy, Ste., 101-B West Palm Beach, FL 33407 Re: Community Development Block Grant (CDBG) Funding FY 2023/2024 Dear Mr. Jessup: This letter is in regards to your application for CDBG funds for the Fiscal Year 2023/2024, The CDBG Application Review Committee assessed your application forfunding for Public Services — Family Nurse Navigator and ID Locator Programs and based on their scoring and funding availability, I regret to inform you that your application was not recommended for funding at this time. I encourage your organization to reapply next year. A Notice of Funding Opportunity will be advertised on the City's website next year. Thank you for taking the time to apply. Very Respectfully, ........... RJ Ramirez Community Improvement Manager 1456 Fiscal Year 2023 (October 1, 2023 to September 30, 2024) COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) Not -For -Profit Subrecipient Grant Application March 27, 2023, 5:00 PM Hard copy and a Digital/Electronic Copy with all attachments to City of Boynton Beach Community Improvement Division 100 East Ocean Avenue Boynton Beach, FL 33435 (No applications will be accepted after 5:00 PM, on March 27, 2023) FOR MORE INFORMATION OR QUESTIONS, PLEASE CONTACT: CITY OF BOYNTON RJ Ramirez, Community Improvement Division Manager COMMUNITY IMPROVEMENT DIVISION 100 East Ocean Avenue Boynton Beach, FL 33435 Telephone: 561-742-6359 Email: ramirezr@bbfl.us boynton-beach.org/community-improvement 1457 Agency Name: Feeding South Florida Project: Culinary Training Program APPLICATION X__. Submit Hard Copy and a Digital/Electronic Application with all attachments X Application iasigned and dated. BvDirector, and Board Chairperson )( 5O1(c)(3)iaattached /No-For-ProftStatus) X City ofBoynton Beach Business Tax Receipt attached (if app|icab|e). X Board Member list. X Copy oflatest audit. X All funding sources for this project identified. ADDITIONAL ATTACHMENTS X —Attachment I Agency Articles of Incorporation, Agency By-laws, and Tax Documents submitted to the Internal Revenue Service (IRS). X —Attachment 2 Copies of current license(s) needed to operate (as applicable to the funded activity) including City of Boynton Beach Business Tax Receipt (if applicable) X —Attachment 3 Documentation of all additional funding sources for program(s)/project(s) listed in application (if applicable) A description/schedule of fees charged to the targeted X —Attachment4 beneficiaries of the programs/services/facilities to be funded (if A job description for each position for which funds are being X —Attachment5 requested (explain role/responsibilities within each program/project) (if applicable) Certifications and Affirmations Print Full Name: Allyson Vaulx Applicant Signature: C\\/�.,,� Title: AVP of Philanthropy Date: March 24, 2023 1459 I certify that I am authorized to submit this application on behalf of the applicant agency. I affirm that the award and payment of grant funds are subject to the sole and absolute discretion of the City of Boynton Beach City Commission without recourse. By submitting this application, I waive any and all claims related to the City of Boynton Beach CDBG Program and specifically agree to indemnify and hold the City, its employees, officers, agents, and representatives harmless from any and all claims which may be in any way related to any City of Boynton Beach CDBG Program award, payment, and/or denial. I certify that my agency was established and operating in the City of Boynton Beach on or before October 1, 2020. If funded, I affirm the applicant agency will continue service operations in the City of Boynton Beach. I affirm that the tax documents provided in this application are identical to those I have submitted to the Internal Revenue Service. I acknowledge that, funds are distributed by reimbursement only. if this grant is approved, any amount my agency receives may be considered taxable income by the Internal Revenue Service. I acknowledge that, if this grant application is approved, the City of Boynton Beach and Representatives of HUD, the Inspector General, and the General Accounting Office shall have access to all books, accounts, records, reports, files, and other papers, or property pertaining to the administration, receipt and use of CDBG funds necessary to facilitate such reviews and audits, as applicable and described under 24 CFR § 570.490(c). I acknowledge that, all records relating to the City of Boynton Beach CDBG Program, including supporting documentation, shall be retained for the greater of three years from closeout of the grant to the City, as applicable and described under 24 CFR § 570.490(d), unless there is litigation, claims, audit, negotiation, or other actions involving the records. The records must be retained until completion of the action and resolution of all issues. I acknowledge that, if this grant application is approved, my name, my agency name, and my grant award amount may be made public by the City of Boynton Beach. I acknowledge that, if this grant application is approved, my agency will be subject to Florida Sunshine Law, FL State Statute 119.0701 Print Full Name: Allyson Vaulx Applicant Signature: C\\/�.,,� Title: AVP of Philanthropy Date: March 24, 2023 1459 FY 2023 Funding Request To submit an application, complete A— |, Attachments 1'5 /if applicable) and any other items requested. Do not include any items that are not requested. Submit a Hard copy and a digital/electronic copy with all attachments to RJ Ramirez, Community Improvement Division Manager / \ Community Improvement Division, 100 East Ocean Avenue, Boynton Beach, FL 33435 by 5;08 pm, March 27, 2023. Please review the "CDBG Suhredpient Information and Guidelines" available at for the program reporting requirements, goals and timelines. For assistance, please call the Community Improvement Division at5S1-742-6359. A. GENERAL INFORMATION Name of Applicant: Feeding South Florida _X No -For-profit Unique Entity |D # Z6MBJ8KL9MX1 Provide copy of your IRS ruling providing tax exempt status under Section 501(c) (3) of the 1986 IRS Code. Per 2cFnChapter | Part 7sand the Office ofManagement and Budget guidance unFederal Funding Accountability and Transparency Act (pFArA) Svhawand and Executive Compensation Reporting issued on August 27, aou\ each prime grant recipient may make subawards only to entities that have Unique Entity ID Number. 2. Name nfProject: Culinary Training 3. Area orLocation ofProject: 4825Park Ridge Blvd. Boynton Beach, FL 33426 4. Contact Person/Title: Allyson Vaulx, AVP of Philanthropy (Preferably Executive Email Address: aveu|x@feedingsouthfluhdu.org Moi|ingAddress/Zip: 25O1SV32Terrace, Pembroke Park, FL 33023 S545181818 Additional Contact person/Tit|e: Lisa Devine, Grants Manager (Preferably Person responsible for preparing reimbuoemrnts/quo'te,lyreports) Alternate Email Address: K4oi|ingAddress/Zip: 2501 SW 32nd Terrace, Pembroke Park, FIL 33023 5. R., VA Grant Request Activity Area (choose one): Homeless Prevention Services Public Safety/Crime Prevention Senior Services Other (please specify): __. Domestic Violence Prevention Housing Rehabilitation Program X Educational Program Amount ofFunds Requested for Project: $SUOOO Amount ofMatching Funds for Project: N/A Match Type: ___Cash Other Grants Donations Please Identify Source ofAdditional Funding: 8. CDBG COST: (a) Total [DBGFunds Requested /6\ Total Unduplicated Units Served 6 (Explain how deternlined7) We will recruit approximately 20% of program participants from the City of Boynton Beach (c) CD8BAverage Cost Per Unit (a/b) $1U.O0Uper student TOTAL PROJECT COST INCLUDING OTHER SOURCE OF FUNDING: (a) Total Project $240.000 (b) Total Unduplicated Units Served 24 (Explain how detennined?) We can host approximately 6 students per training session, up to training sessions /r\ TOTAL Average Cost Per Unit (a/b) $10,000 per student 9. Is this project: X_Anew service; or — A quantifiable increase in the level of an existing service which has been provided bythe grantee onits behalf through State Orlocal government funds inthe I2months preceding the submission of the grantee's Consolidated Plan Annual Action Plan Has the applicant received or will receive other Federal, State or local government funds for the proposed project(s) for which the applicant is requesting [DBG funds? Yes No )( If Yes, what is the funding source? How much? 10. Could this project occur without these funds? >( Yes No 11. Will this project montinueafter[O0Gfundingends? » YesNo If Yes, describe how the applicant will guarantee the sustainability ofthe project/program after CDBG funds have been spent. In line with our vision to move families from a place of dependency to self-sufficiency, we are committed to the sustainability f our workforce development initiatives. We will continue to grow our programs and reach additional families and individuals, as well as include expanded curriculum tracks. With the rt of grants, individual, phvabe and government funding, i Program is supported by Feeding South Florida's annual budget and is included in the_ organization's long-term strategy plan. 5 B. Please describe indetail the scope of services ofthe proposed project/activity tobefunded,indudingtheexpectedbenefbsto the community, a plan of action, how the agency will implement the activity (i.e., intake procedures, income certification, collection of required documentation, reimbursement request, progress reports, end of the year report, etc.). (Attach additional sheets if necessary) With a curriculum designed by James Beard Award -nominated Chef Lindsay Autry, our Culinary Training Program is offered at no cost to qualified candidates and gives students the skills necessary to place them in jobs with our hospitality partners. Hosted in our 5000 square foot, state-of-the-art Cit Kitchen, studentsparticipate in 360 hours of training including knife skills,kitchen f t equipment, cooking techniques and previousTo qualify potential candidates, we move through an application process that assesses | t transportation,housing i iexperience of financial h during the last 12 months. Feeding South Florida utilizes a case management software to collect and report on required demographic information and data All students are individuals services to overcome barriers that may inhibit thfrom nteh d completing the mm. Alongside e writing, interview skills, computer literacy and financial literacy. Upon completion of the students are placed in livable wage/benefits positions based on experiencelevel C. STRATEGY: Check the ONE STRATEGY that best describes your project and provide number of units that will be served under this program. Check One Specific Objective Number of Units This Project Will Serve Educational Program (Specify) Households/Persons: X (please specify which) 24 persons Public Safety/Crime Prevention Households/Persons: (please specify which) Domestic Violence Prevention Households/Persons: (please specify which) Senior Services Elderly Households/Persons: (please specify which) Youth Programs Children/Youth: Housing Rehabilitation Number of units to be rehabilitated: Other (Specify) Households/Persons: (please specify which) 1464 D. COMMUNITY NEED/JUSTIFICATION I. What documentation/data was used to determine the need for this type of program? 2. How doyou evaluate the overall effectiveness ofthe program? 3. How this project relates to the overall organizational structure? 4. 8every specific how the COBGfunds are proposed tobeused? num/CuuuTunas will itimpact your current operation? (Attach additional sheets if 1. Feeding South Flhd launched employmentstart of the pro gram, we have graduated eighteen students. Over 801/o of the proqram -graduates are employed a d have maintained employment. For more than a year, the hospitality industry has had a 13.7% increase in job growth, adding 11, 100 jobs in the past year. According to the Bureau of Labor and Statistic�, overall of cooks is projected to grow 16% by 2031, compared to a 5% average for all other occupations. 2. FEeedina South Florida will measure the success of the Culinary Trainina Proaram by tracking the number of Program applicants, number of government benefits aDplications enabled for Program candidates, number of program graduateesnumber of financial benefits secured through case management assistance and employment statistics such as increased wages and new ositions retained. With research -driven experience and technology, Feeding South Florida leverages multiple tools to evaluate and measure our program outcomes. The Client Services team utilizes a case management software, Oasis Insight, to collect demographic and service data from clients enrolled in our programs. This allows Feedinn §outh Florida to assess the needs of the entire household and track services and progress towards self-sufficiency. The Culinafy Training Manager will report weekly on evaluation metrics and assessments in a program dashboard to analyze the pE2.2ression of students. The Workforce Training Manager will report monthly on outcome metrics and collect feedback surveys thro�!ghout the program for overall program evaluation. 3. Targeting m 19ioalized pQpulations. Feeding South Florida a, arriers to education, training, empigyment and increased ingome. We understand tha hunger is a symptom of a larger, systemic problem. The Culinary raining program seeks to break the cycle of hunger and poverty by transforming lives through economic mobility. By providing job training and life skills education, individuals build their confidence, gain employment and increase their mental and physical health and well-being, reducing their overall budget shortfall and increasing their own self-sufficiencv. 4. program candidates. Program exp �1 it it for em, iecnnology, equipment andsba# salaries dulinary Training Manager, Director of Client Services and Director of Culinary Services, 5. Receiving CDBG support from the City of Boynton Beach will allow us to scale the prog am and increase the number of students we enroll. N. E. LOCATION, TARGET POPULATION AND INCOME CERTIFICATION 1. Where will the program take place and |s itwithin the City of BoyntonBeach Municipal Boundaries? Who are the targeted beneficiaries (i.e., geographic area, persons served, eto.),and how are they selected for the program? 2. Are you working with other organizations in a cooperative effort on the program? Yes XNo___ |fyes,p|ease|isttheotherorganiz8tionsendtheirro|eandresponsibi|ities. (Attach additional sheets ifnecessary) Feeding South Florida's Culinary Training is held at the Feedinq Palm Beach County located in Boynton Beach. The pro ram serves residents of Palpast graduates and programmatic goals for our current fiscal year, we anticipate that approximately 20% of all program participants will be Boynton Beach residents. Culinary students are recruited through our client services department, partner agencies, municipalities and community partners. All students are individuals who have experienced financial hip (unemployment, underemployment, government assistance, etc.) during the last 12 months and screen for food insecurity. We account for structural inequity and cultural differences in program planning to target marginalized populations and applicants that experience systemic barriers to accessing services. While some students learn of the program after seeking food assistance, many are new clients, reaching out for help for the first time. Feeding Palm Beach can host 4 training sessions with an average of 6 students per session. 2. Feedinci Palm Beach County works with a network of community partners as a referral pathway for Prospective candidates to ensure immediate access of nutritious food and provide P- d services forth eekhoare, employment and education. These partnerships are the cornerstone of our recruitment efforts as Vita Nova, Habitat for Humanity Greater Palm Beach County, Place of Hope, Riviera Beach Community Outreach, Farmworker Coordinating Council, Securing our Future Initiative Agencies (Dress for Success, Pathways to Prosperity, CarerSource PBC, West Palm Beach The City's CDBG funds must directly benefit low -and -moderate -income individuals (80% Area Median Income (AMI) or below). The City's CDBG program requires non-profit organization to income certify individuals seeking assistance through activities/programs/projects funded with the CDBG funds. Has the organization done income certification of individuals seeking assistance in the past? Yes X No If yes, please explain the process the organization uses to income certify Individuals? What type documentation is collected? Please attach with your application, a copy of the form your organization uses to income certify individuals. Feeding South Florida is a community partner of the Department of Children and Families and holds government contracts including the Commodity Supplemental Food Program, and the Emergency Food Assistance Program. We have received CDBG and ARPA funding in the past and have utilized our case management software to collect, document and report on income certification. While our food assistance initiatives rely on only self - declaration of need, we have an intake form that requests household income and the ability to store supporting documentation in our case management software. **Client Intake Form is included in this application packet. IN 1467 Today's Date: Client First Name: Client Street Address: Telephone Number: 67 F E E11frJ1 SOUTH FLORIDA CLIENT SERVICES INTAKE FORM Please answer all questions sothat wemay better serve you. This information is for reporting purposes only and is not shared with any other entity. Completion cfthis form isnot required to receive food assistance. Last Name: Date mfbirth: /____/___ Gender: ___ State: Zip Code: County: Client : May aFeeding South Florida team member contact you to share your experience and feedback? El Yes 11 No Referred by: O DCF El DOH O Friend/Family USenior Site El School O Partner Agency OOther Are you or any members of your family currently receiving: [I WIC (Women, Infants & Children) 11 SNAP (Supplemental Nutrition Assistance Program) 0 Medicaid OSSI (Supplemental Security |ncome/Dbabi|ity) OFlorida K|DCARE OTCA (Temporary Cash Assistance) Household Income: OWeekly OBiweekly [] Monthly []Annually Employment Status: OCurrently Employed Full -Time OCurrently Employed Part -Time OUnemployed O Disabled OStudent • Retired Health Insurance: [] Household Insured [] Household Uninsured [] Some members ofhousehold insured and some uninsured Housing: ORent OOwn OShelter/Temporary Housing/Hotel OResiding with afriend/family member O Homeless/in need of housing OHUD/Section 8 OSupported Housing/[arrfour Education: OSome High School O High School Diploma/GED OSome College 1:1 Vocational OAssodates El Bachelors Ok8asters ODoctorate Revised Novemb~'`»I« Race/Ethnicity: (Check All That Apply): ❑ American Indian or Alaskan Native ❑ Asian ❑ Hispanic or Latino ❑ Black or African American ❑ Caucasian ❑ Caribbean ❑ Native Hawaiian or Pacific Islander ❑ Multiracial ❑ Other: Veteran Status: ❑ Active Military ❑ Veteran (1 or more day of service) ❑ Disabled Veteran ❑ Not a Veteran Other member(s) of the household: "Within the past 30 days, l/we worried whether our food would run out before we got money to buy more." (Select One): ❑ Often True ❑ Sometimes True ❑ Never True "Within the past 30 days, the food I/we bought just didn't last and we didn't have money to buy more." (Select One): ❑ Often True ❑ Sometimes True ❑ Never True Thinking about your physical health, which includes physical illness and injury, how many days during the past 30 days was your physical health not good?: Days Thinking about your mental health, which includes stress, depression or problems with emotions, how many days during the past 30 days was your mental health not good?: Days First and Last Name Age Date of Birth Relationship Altering or modirying this document is prohibited. In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident. Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible Agency or USDA's TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English. To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD -3027, found online at How to File a Program Discrimination Complaint and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov. USDA is an equal opportunity provider, employer, and lender. Revised November 202- 1469 4. Does the organization charges fees toits clients? Yes___No_X_ 5. Will program Income begenerated from this activity? Yes___No )( |fyes explain how will the program income beused? F. Goa Is/Objectives/Activity Measures: Descriptive narrative. Please use separate Goal Sheetfbreach individual project (if [itle: Resources Needed & Available: °°PLEASESEE ATTACHED GOAL/OBJECTIVE ATTACHMENT Start Date & Duration: Resources Needed & Available: Start Date & Duration: 11 F. Goals/Objectives/Activity Measures: Project/Program Title: Culinary Training Program Goal #1: Increase awareness and participation of the Culinary Training Program Objective: Increase program participation from 12 students to 24 students Resources Needed & Available: Staff, supplies (food, binders, equipment, uniforms) Start Date & Duration: October 2023 — October 2024 Goal #2: Increase benefits enrolment of Culinary Training students Objective: Assist students enrolled in Culinary Training program with enrollment in government benefits programs and other wrap around services Resources Needed & Available: Staff, technology and Community Partners (i.e. — WIC) Start Date & Duration: October 2023 — October 2024 Goal #3: Increase the number of Boynton Beach residents securing jobs in the culinary and hospitality industry Objective: Graduate and place all participants in minimum of $15 per hour wage jobs Resources Needed & Available: Staff, technology, Employment partners Start Date & Duration: October 2023 — October 2024 1471 G. PROJECT BUDGET Please list organization's anticipated expenditures, detailing requested funds and additional funding. Please place C=Cash, 1=ln-Kind, O=Other Grants, D=Donations beside each amount under "Other Project Funds" to denote the type of funds being used. If funding request is for multiple programs/projects, please provide a separate PROJECT BUDGET for each program/project Line Item CDBG Funds Requested Other Project Funds Total Project Budget ADMINISTRATION: Personnel (# ) $39,250 $117,750 $157,000 Payroll Taxes Employee Benefits Office Supplies Copy Supplies Professional Services fee Other (explain) Telephone $67 $202 $269 Other (explain) Marketing $45 $136 $181 Other (explain) Technology $563 $1,687 $2,250 Other (explain) Utilities $10,162 $7,988 $18,150 Other (explain) PROGRAM: Other (explain) Transportati n $22,500 $22,500 Other (explain) Program Supplies $9,913 $29,737 $39,650 Other (explain) TOTALS $60,000 $180,000 $240,000 Notes: 12 1472 H. ORGANIZATION CAPACITY (Provide adetail description nfeach) 1. |sthe organization adequately staffed and trained? I. Explain how this program fits the organization's mission? 3. Please explain the organization's experience with the proposed project? 4. Staffing Capacity: Who works onthe project directly and indirectly? S. Does the organization have written policies and procedures? How often are these policies and procedures updated? Provide abrief list ofthe topics covered inthe organization's policies and procedures. The City ofBoynton Beach may request a copy for review during the application and award process or as part of the grant monitoring process. (Attach additional sheets ifnecessary) 1. Feeding South Flhd ' team offood bankers includes 109 full-time | enond 1 part-time employee,dedicated to ending hunger in South Florida by providingimmediate to nutritious food leading hunger and poverty advocacy efforts d transforming lives through innovative i d education. All team members| tacivil rights training, FEMA Disaster Response training, food safety training and subject matter specific training such as OSHA Warehouse Safety. 2. Feeding South Flhd ' mission is to endh in South Flhdimmediate access to nutritious food leading hunger and poverty advocacy efforts transforming lives through innovative programming. By providing food for today, Feeding South Florida helps to empower families for a better tomorrow. The Culinary Training program aims to pod local individuals in breaking the | of hunger d poverty through economic self- sufficiencyning and life ahiUo education, they build confidence,min employment, increase their ta| and physical health and well-being, reduce their overall budget shortfall, increase self-sufficiency and improve the local economy. 3. The Workforce Development Initiative launched in April 2021 and has graduated 18 Culinary .Training participants. This program is 1 of 26 "ob training programs within the Feeding America network and gives Feeding South Florida the opportunity to share insight with other food banks. Feedinci South Florida's experience with serving vulnerable popul tions, as U as our expertisein food production and culinary arts,makes uniquely itkoned tolead this innovative program. Byleveraging our network ofover 3O0community program.partners, Feeding South Florida is able to support recruitment, retention, wrap-aroun services and job placement opportunities for graduates of the Culinary Training 4. The Culinary Training Program is supported by 2 key team members and 3 supportingteam members."PLEASE S. Feeding South Florida does provide an Employee Handbook that covers policies and procedures. "PLEASE SEE ATTACHMENT WITH TABLE OF CONTENTS Policies are updated as needed and or required by law or when the organization mak s changes or develops new policies. Feeding South Florida typically reviews and updates Ahese policies on an annual basis. 13 N EMPLOYEE HANDBOOK Created: July 2015 Revision: December 2022 1474 Table of Contents 1. EMPLOYMENT Nature ofEmployment .--'—_--_------------''—'---------------.9 TeamMember Relations ............................................................................................................................... g EqualEmployment Opportunity ................................................................................................................... 9 Business Ethics and Conduct .----------_-------'-----_--'-----lO HiringofRelatives ........................................................................................................................................ 11 Immigration Law Compliance .......................................................................................................... 11 Conflicts ofInterest ----------.------.------------.-----------.12 Non -Disclosure ................................................................................................................................. 12 DisabilityAccommodation ................................................................................................................ 13 JobPosting ....................................................................................................................................... l3 11. EMPLOYMENT STATUS AND RECORDS EmploymentCategories ............................................................................................................................... 14 PersonalData Changes ..................................................................................................................... 5 IntroductoryPeriod ........................................................................................................................... 1S Employment Reference Checks ......................................................................................................... lS Performance Evaluations .................................................................................................................. 16 Ill. TEAM MEMBER BENEFIT PROGRAMS TeamMember Benefits ................................................................................................................... 16 Holidays............................................................................................................................................ 16 PaidTime Off (PTO).......................................................................................................................... l7 WorkersCompensation ................................................................................................................... 1y DomesticViolence ........................................................................................................................... 19 JuryDuty .......................................................................................................................................... 2O LeavesofAbsence ............................................................................................................................ 2O PregnancyRelated Absence ............................................................................................................. S MilitaryLeave ................................................................................................................................... 26 BereavementLeave.......................................................................................................................26 Benefits Continuation (COBRA).....................................................................................................26 Timekeeping............................................................................. ...27 PayDays.........................................................................................................................................27 EmploymentTermination..............................................................................................................27 PayAdvances.................................................................................................................................28 Administrative Pay Corrections.....................................................................................................28 PayDeductions..............................................................................................................................28 IV. WORK CONDITIONS AND HOURS Safety.............................................................................................................................................28 WorkSchedules.............................................................................................................................29 Use of Phone and Mail Systems.....................................................................................................29 Smoking..........................................................................................................................................29 MealPeriods...................................................................................................................................29 Overtime........................................................................................................................................30 Useof Equipment..........................................................................................................................30 EmergencyClosings.......................................................................................................................30 BusinessTravel...............................................................................................................................31 Visitorsin the Workplace...............................................................................................................31 Computerand Email Usage............................................................................................................32 InternetUsage...............................................................................................................................32 WorkplaceMonitoring...................................................................................................................34 SocialMedia...................................................................................................................................34 Workplace Violence Prevention.....................................................................................................36 CellPhone Usage...........................................................................................................................37 V. TEAM MEMBER CONDUCT AND DISCIPLINARY ACTION Team Member Conduct and Work Rules.......................................................................................39 Drugand Alcohol Use.....................................................................................................................40 Harassment and Discrimination.....................................................................................................40 3 1476 Attendance and Punctuality...........................................................................................................41 Personal Appearance......................................................................................................................42 Returnof Property..........................................................................................................................42 Resignation............................................................................................................................. ....42 SecurityInspections.........................................................................................................................43 Solicitation............................................................................................................... ........................ 43 ProgressiveDiscipline......................................................................................................................44 ProblemResolution..........................................................................................................................44 WorkplaceEtiquette........................................................................................................................45 Whistleblower..................................................................................................................................47 Team Member Acknowledgement Form .........................................................................................48 "I 1477 APPLICANT CAPACITY (cont.) 6. Will all CO8G funds awarded be maintained in a manner that they will be accounted for separately and distinctly from other sources of revenue or funding? Provide a brief description of the organization's policies and procedures that ensure funds will betracked appropriately. 7. Is the organization's financial management system able to track actual expenditures and outlays with budgeted amounts for each grant oryubQranL? Provide a brief summary of the organization's process for tracking expenditures, including tracking budgeted versus actual amounts. 8. Does the organization have effective internal controls in place to ensure that federal funds are used solely for authorized purposes? Provide a brief description of the applicant's internal controls that will provide reasonable assurance that the award funds will bemanaged properly. 9. Does the organization have adocumented records retention policy? |fso, briefly describe the policy and confirm that the policy complies with federal regulations. Information on Records Retention and Access can be found at C.F.R § 200.333- 200-337. (Attach additional sheets if necessary) 6. The Finance Department at Feeding South Florida creates classifications within its general ledger system to capture revenue and expenses related to funding where distinct accountability and progress reporting is required. 7' Snod in which one tab contains the original budget and then a progress tab showing how much of the budget has already been absorbed, as well as the fund balance. 8. On all federal grants, the food supply chain department maintains an inventory, matching the requirements of the grant. On non -inventory related grants, a purchase order is immediately - placed when outside services are proculed. "Inside" services such as payroll for staff dedicated to the proJert are allocated directIV to the corresponding grant, 9. In accordance with Federal, State, Local and Feeding America member guidelines, Feeding South Florida follows a seven-year records retention policy. 14 |. Conflict of Interest Federal law (24 CIFIR 570.611) prohibits persons who exercise or who have exercised any functions or responsibilities with respect to the above grant ... oFwho are in 3 position to participate in a decision making process or to gain inside information with regard to such activities, may obtain a financial interest or benefit from an assisted activity ... either for themselves or those with whom they have family or business ties, during their tenure or for one year thereafter. I. Is there any member of the applicant's staff, member of the applicant's Board of Directors, or office who currently is or has/have been within one year of the date of this application aCity employee, oramember ofthe City Commission? Yes X No If yes, please list names: 2. Is there any member of the applicant's staff, member(s) of the Board of Directors, or officer(s) who are business partners or immediate family of a City employee, or a member ofthe City Commission? Yes X No If yes, please list names: 3. Will the funds requested by the applicant be used to pay the salaries of any of the applicant's staff or award a subcontract to any individual who is or has been within one year of the date of this application a City employee, or a member of the City Commission? Yes X No If yes, please list names: 15 REPAYMENT: Funding from this grant program is subject tofederal, state and local audit. If determination is made that these grant funds were used in a manner inconsistent with program guidelines, for an ineligible expense or for expenses reimbursed by another federal, state or lOC3| grant/loan program then the awarded entity will reimburse the City of Boynton Beach these funds. SUBMISSION OF AN APPLICATION IS NOT A GUARANTEE OF FUNDING It is the responsibility of the applicanttmREAD AND UNDERSTAND all aspects «f the CDBG grant program, the application, and City's procurement process, if applicable. NOTICE TO THIRD PARTIES: The[DBG grant application program does not create any rights for any parties, including parties that performed work onthe project. NurshaUissuanceofa[DBG grant result in any obligation on the part of the City of Boynton Beach to any third party. The City is not required to verify that entities that have contracted with the applicant have been paid in full, or that such entities have paid any subcontractors in full. Applicant's warranty that all bills related tothe Project forvvhichtheapp|icantisdinec±|ynesponsib|eissufficientassunanceforthe City to award loan funding. The applicant certifies tothe best ofhis/her knowledge and belief that the data inthis application is true and correct and that the filing of the application has been duly authorized by the governing body of the applicant (if applicable) and that the applicant will comply with all the requirements of this grant ifthe application isapproved. Name: -Allyson VauIx Title: AVP of Philanthropy Name: Title: Signature: Date' March 24, 2023 Signature: 16 BYLAWS OF FEEDING SOUTH FLORIDA, INC. a Florida Not for Profit Corporation 1481 BYLAWS OF FEEDING SOUTH FLORIDA, INC. a Florida Not for Profit Corporation Article I NAME AND PURPOSE Section 1.1 Name. The name of the corporation is Feeding South Florida, Inc. (the Corporation ). Section 1.2 Purposes. The purposes of the Corporation are those stated in its Articles of Incorporation. 1 Article II OFFICES Section 2.1 Registered Office. The location of the registered office of the Corporation shall be at 2501 S.W. 32nd Terrace, Pembroke Park, Florida, 33023-7707, which location may be changed from time to time by the Board of Directors. Section 2.2 Other Offices. The Corporation may also have offices or branches at such other places, both within and without the State of Florida, as the Board of Directors may from time to time determine or as the business of the Corporation may require. Article III MEMBERSHIP The Corporation will not have members .2 Article IV DIRECTORS Section 4.1 Responsibilities of the Board. All power and authority regarding the property, affairs and management of the Corporation shall be vested in and controlled by the Board of Directors. The Board of Directors shall establish policies and directives governing the business of the Corporation, and may delegate to the Chair of the Corporation or to a Committee of the 1482 Corporation, subject to the provisions of these Bylaws, authority and responsibility to ensure that the policies and directives are implemented by the Board of Directors, Committees, and Officers. The Board of Directors shall have no authority to take any action contrary to, or inconsistent with, the Articles of Incorporation, these Bylaws or the provisions of the Florida Not For Profit Corporation Act, as amended (the Act ). Each Director shall contribute to the Corporation least $2,500 annually and shall cause to be contributed by others funding, goods or services having a value (as determined by the Board) of minimum $_[25,000] annually. Section 4.2 Number And Qualifications. The Board of Directors shall be composed of no less than three (3) Directors. Membership on the Board of Directors shall be nondiscriminatory with regard to age, race, gender, sexual orientation, religion, ethnicity or creed. Section 4.3 Nominations. Nominations to the Board of Directors shall be made in accordance with the policies and procedures developed and implemented by the Board of Directors. Section 4.4. Election. The Directors shall be elected at the annual meeting of the Board of Directors by a majority vote of Directors present at such meeting. Section 4.5. Term. Directors shall be elected for such term as determined by the Board of Directors. Which term shall be the same for each Director or applicable class of Director, but absent such determination -each Director shall be elected for a three-year term. No Director shall be elected for more than two 3 -year terms. Newly elected Directors shall assume office, and terms of Directors that are expiring shall expire, as of the date of the annual meeting of the Board of Directors or at any other time as designated by the Board. Directors that are appointed to fill a vacancy shall take office immediately and hold office for the unexpired portion of the term of the vacating Director. Unless removed in accordance with the provisions of these Bylaws, each Director shall hold office for the term for which she or he is elected or appointed and until her or his successor shall have been duly elected or appointed. Section 4.6 Vacancies. A vacancy shall be declared in any seat on the Board of Directors upon the death, resignation, or removal of the occupant thereof, or upon the disability of any occupant rendering him or her permanently incapable of participating in the management and affairs of the Corporation. Vacancies on the Board may be filled at any time, as they arise, at a duly called meeting of the Board of Directors by the affirmative vote of a majority of the Directors present at such meeting. Section 4.7. Resignation. A Director may resign by written notice to the Corporation. The resignation is effective upon its delivery to the Corporation or a subsequent time as set forth in the notice of resignation. If a resignation is made effective at a later date, the Board of Directors may fill the pending vacancy before the effective date if the Board of Directors provides that the successor does not take office until the effective date. 1483 Section 4.8 Removal. Any Director may be removed at any time, with or without cause, by a majority vote of the total number of Directors at a duly called meeting of the Board of Directors. Removal of a Director shall result in a vacancy of the removed Director's board seat. A proposed removal of a Director at a meeting shall require a separate vote for each Director whose removal is sought. Where removal is sought by written consent, a separate consent is required for each Director to be removed. If removal is effected at a meeting, any vacancies created shall be filled by the Directors eligible to vote for the removal. Any Director who is removed from the Board is not eligible to stand for reelection until the next annual meeting at which Directors are elected. Any Director removed from office shall turn over to the Board within 72 hours any and all records of the Corporation in his or her possession. If a Director who is removed does not relinquish his or her office or tum over records as required under this section, the circuit court in the county where the Corporation s principal office is located may summarily order the Director to relinquish his or her office and tum over corporate records upon application of any Director. Section 4.9 Absence of Director. Any Director unable to attend a meeting shall inform the President or Chair in advance of the meeting, stating the reason for his or her absence. The President or Chair shall have the power in his or her sole and absolute discretion to excuse such absence. If a Director has two or more consecutive unexcused absences, the Directors resignation shall be deemed to have been tendered and accepted. Section 4.10 Chair. The Chair shall provide the leadership required to ensure the adequate performance of duties assigned to the Board of Directors, Officers and any Committees established by the Board. The Chair shall preside at all meetings of the Board of Directors. The Chair shall be an ex -officio voting member of all standing and special Committees. In general, the Chair shall perform all duties incident to the office of Chair and have such other powers and duties as may from time to time be prescribed pursuant to resolutions duly adopted by the Board of Directors. The Chair shall chair the Executive Committee. The Chair shall appoint Chairpersons and members of all Board Committees, and the Chair shall have the authority to appoint Directors to undertake specific tasks as needed. Section 4.11 Absence of Chair; Vacancy. In the absence of the Chair or in the event of the Chair's inability or refusal to act, the Treasurer shall perform the duties of the Chair, and when so acting shall have all the power of and be subject to all of the restrictions upon the Chair. In the event of a vacancy of the office of Chair, the Treasurer shall become acting Chair until the vacancy is filled by action of the Board of Directors. The Treasurer shall communicate with the Chair and the Directors and shall assist the Chair in performing his or her duties, as requested by the Chair. Article V MEETINGS OF THE BOARD OF DIRECTORS Section 5.1 Place of Meetings. Meetings of the Board of Directors may be held either within or without the State of Florida. Section 5.2 Regular Meetings. Regular meetings of the Board of Directors may be held at such time and at such place as shall from time to time be determined by the Chair or the vote of the Board of Directors. Any notice given of a regular meeting need not specify the business to be transacted or the purpose of the meeting. Section 5.3 Saecial Meetings. Special meetings of the Board of Directors may be called by the Chair and shall be called by the Secretary on the written request of any two Directors. The 1484 person authorized to call special meetings of the Board of Directors may fix any place, either within or without the State of Florida, as the place for holding any special meeting of the Board of Directors called by her or him. Written notice of any special meeting shall be given to all Directors at least 48 hours prior to such special meeting. Notice of any special meeting need not specify the business to be transacted or the purpose of the meeting. Section 5.4 Annual Meetings. The annual meeting of the Board of Directors will be held at such time and place as designated by a majority of the Board of Directors. Section 5.5 Attendance as Waiver of Notice. Attendance of a Director at any meeting shall constitute a waiver of notice of such meeting, except where a Director attends for the express purpose of objecting to the transaction of any business on the ground that the meeting is not lawfully called or convened. Section 5.6 Quorum of Directors: Majority Vote. At all meetings of the Board of Directors, the presence (whether in person or by electronic medium that allows immediate, contemporaneous exchange) of a majority of Directors then in office shall constitute a quorum for the transaction of business, and the act of the majority of the Directors present (whether in person, by telephone, or by proxy) at any meeting at which a quorum is present shall be the act of the Board of Directors, unless the act of a greater number is required by the Act, the Articles of Incorporation or these Bylaws. If a quorum is not present at any meeting of Directors, the Directors present in person may adjourn the meeting from time to time, without notice other than announcement at the meeting, until a quorum is present. Section 5.7 Action Without a Meeting. Any action required to be taken at a meeting of Directors, or any action which may be taken at a meeting of the Directors or any Committee, may be taken without a meeting if consent in writing (including electronic media), setting forth the action to be taken, shall have been signed by all of the Directors or Committee members. Such consent shall have the same force and effect as a unanimous vote at a meeting. Section 5.8 Electronic Presences at a Meeting. Subject to the provisions of the Act and these Bylaws concerning notice of meetings and unless otherwise restricted by the Articles of Incorporation or these Bylaws, members of the Board of Directors, or members of any Committee, may participate in and hold a meeting of such Board of Directors or Committee by any means that provides immediate, contemporaneous verbal exchange by which all Directors participating may hear each other simultaneously during the meeting, and such participation shall constitute presence in person at such meeting, except where a person participates in the meeting for the express purpose of objecting to the transaction of any business on the ground that the meeting is not lawfully called or convened. 1485 Section 5.9 Compensation. Directors as such shall not receive any compensation for their services as Directors, but no Director shall be precluded from serving the Corporation in any other capacity and receiving compensation therefore and Directors may, by resolution, authorize reimbursement of expenses incurred in the performance of their duties. Article VI NOTICES Section 6.1 Delivery of Notices. Whenever, under the provisions of the Act or of the Articles of Incorporation or of these Bylaws, written notice is required to be given to any Director or Committee member, such notice shall be given in writing by personal delivery, facsimile, email, overnight delivery service or by mail (registered, certified or other first class mail) addressed to such Director or Committee member at his or her address as it appears on the records of the Corporation, with postage thereon prepaid. Such notice shall be deemed to be given upon the date emailed, upon confirmation of receipt, if sent by personal delivery or facsimile, one day after delivery to a recognized overnight delivery service, or three days after the notice shall be deposited in a post office or official depository under the exclusive care and custody of the United States postal service. Section 6.2 Waiver of Notice. Whenever any notice is required to be given under the provisions of the Act or of the Articles of Incorporation or these Bylaws, a waiver thereof in writing, signed by the person or persons entitled to said notice, whether before or after the time stated therein, shall be deemed equivalent thereto. Neither the business to be transacted at, nor the purpose of, any regular or special meeting of the Directors or a committee need be specified in any written waiver of notice. Article VII OFFICERS Section 7.1 Elective Officers. Elective Officers of the Corporation shall be elected each year by the Board of Directors at the annual meeting of the Board of Directors. Any such election shall be held by open voting unless a Director moves to have such election held by ballot and two other Directors second such motion, in which case the election shall be held by ballot. A majority of the votes cast shall cant' the election. The Board of Directors may elect such additional officers or assistant officers as it may from time to time determine. 1486 Section 7.2 Term of Officers. Each elective officer shall take office immediately upon his or her election and shall serve for a term of one year and until his or her successor is duly elected and qualified. Section 7.3 Vacancy: Removal; and Resignation. Any Officer elected or appointed may be removed, with or without cause, by the persons authorized to elect or appoint such Officer whenever in their judgment the best interests of the Corporation will be served thereby. A vacancy occurring in any office of the Corporation by death, resignation, removal or otherwise shall be filled by the Board of Directors. An Officer may resign by written notice to the Corporation. The resignation is effective upon its delivery to the Corporation or a subsequent time as set forth in the notice of resignation. If a resignation is made effective at a later date and the Corporation accepts the future effective date, the Board of Directors may fill the pending vacancy before the effective date if the Board of Directors provides that the successor does not take office until the effective date of the pending vacancy._ Section 7.4 Vacancy in Officer Position. Vacancies in any office may be filled for the balance of the term thereof by the Directors at any regular or special meeting. Section 7.5 Chief Executive Officer. The CEO shall report to the Board of Directors on operations and all matters material to the business of the Corporation, and shall perform such other duties as are necessarily incident to the office or as may be prescribed by the Board of Directors. The CEO shall participate in the active management of the affairs of the Corporation, and shall be responsible for overseeing the implementation and operation of the Corporation's charitable and educational programs. The CEO is an ex -officio, non-voting member of the Board. Section 7.6 Treasurer. The Treasurer shall be responsible for: monitoring the control, receipt, and custody of all assets of the Corporation; monitoring disbursements as authorized by the Board of Directors; and reporting receipt, use and disbursements of all assets of the Corporation. The Treasurer shall exercise the powers and perform such other duties usually incident to the office of Treasurer. Section 7.7 Secretary. The Secretary shall be responsible for seeing that notices are issued for all meetings of the Board of Directors, and shall see that the minutes of such meetings are kept. The Secretary shall be responsible for the custody of corporate books, records and files, and shall exercise the powers of the office of Secretary. The Secretary shall be responsible for authenticating records of the Corporation. Section 7.8 Other Officers. To the extent the powers and duties of any Officers are not provided in these Bylaws or from time to time by resolution or other directive of the Board of Directors, the Officers shall have all powers and shall discharge the duties customarily and usually held and performed by like officers of corporations similar in organization and business purposes to the Corporation. Article VIII 1487 COMMITTEES OF THE BOARD OF DIRECTORS Section 8.0 Committees. (a) The Board of Directors, by resolution adopted by a majority of the full Board, may designate from among its members an Executive Committee and one or more other committees (a Committee ) each of which, to the extent provided in such shall have and may exercise all the authority of the Board, except that no such Committee shall have the authority to fill vacancies on the Board or any Committee thereof or adopt, amend, or repeal these Bylaws. b) The meeting, notice and waiver of notice, and quorum and voting requirements of the Board of Directors shall apply to Committees and their members. (c) Each Committee must have two or more Directors who serve at the pleasure of the Board. The Board, by resolution adopted in accordance with Section 8.0(a) hereof, may designate one or more Directors as alternate members of any such Committee who may act in the place instead of any absent member or members at any meeting of such Committee. (d) Neither the designation of any such Committee, the delegation thereto of authority, nor action by such Committee pursuant to such authority shall alone constitute compliance by any Director who is not a member of the Committee in question with his or her responsibility to act in good faith, in a manner he or she reasonably believes to be in the best interests of the Corporation, and with such care as an ordinarily prudent person in a like position would use under similar circumstances. Section 8.1 Advisory Committees. The Board of Directors may, from time to time, create honorary and/or advisory Committees to support and promote the activities of the Corporation. Such Committees shall have such purposes, powers and procedures as shall be determined from time to time by the Board of Directors. Section 8.2 Vacancies. Vacancies in the membership of any Committee may be filled by appointments made in the same manner as provided in the case of the original appointments. Section 8.3 Reports. Each Committee shall report findings and recommendations to the Board of Directors as required to keep the Board of Directors reasonably informed of such Committee s findings and recommendations. Article IX DUTIES OF DIRECTORS AND OFFICERS Section 9.1 Duty of Directors and Officers. Directors and Officers shall discharge the duties of their respective positions in good faith and with that degree of diligence, care, and skill which ordinarily prudent persons would exercise under similar circumstances in like positions. In the administration of the powers to make and retain investments, to appropriate appreciation, and to delegate investment management of institutional funds, as provided by law, the Board of Directors shall consider among other relevant considerations the long and short-term needs of the Corporation in carrying out its purposes, its present and anticipated financial requirements, expected total return on its investments, price level trends and general economic conditions. In discharging their duties, Directors and Officers, when acting in good faith, may rely upon financial statements of the Corporation represented to them to be correct by the Chair, or the Officer of the 1488 Corporation having charge of its books of accounts, or stated in a written report by a certified public accountant or firm fairly to reflect the financial condition of the Corporation. Section 9.2 Conflict of Interest. Directors and Officers serve the Corporation in a fiduciary capacity and as such owe a duty of loyalty to the purposes of the Corporation. Any possible conflict between the interests of the Corporation and the personal or business interests of a Director, an Officer, or member of their families, shall be disclosed to the Board and made a record through an annual procedure and also when the interest becomes a matter of Board action. Any Director having a duality of interest or a possible conflict of interest on any matter shall not vote or use personal influence on the matter. The minutes of the meeting shall reflect that a disclosure was made and the abstention from voting. This conflict of interest policy shall not be construed as preventing a Director or Officer from stating his position in the matter or from answering pertinent questions since his knowledge may be of great assistance to the voting Directors. Article X INDEMNIFICATION AND EXCULPATION Section 10.1 Indemnification. The Corporation, to the fullest extent authorized or permitted by the provisions of the Act, shall indemnify against liability, and advance expenses to, any person, and his or her heirs, executors, administrators and legal representatives, who is or was a party to any proceeding by reason of the fact that such person is or was a Director or Officer of the Corporation or is or was serving as a director or officer of another corporation, partnership, joint venture, trust or other enterprise at the request of the Corporation. Officers and Directors who are so entitled to be indemnified shall be paid their expenses in advance of a final disposition of the proceeding to the maximum extent authorized or permitted by the provisions of the Act. Section 10.2 Insurance. The Corporation shall have the power to purchase and maintain insurance to indemnify the Corporation and its Directors and Officers whether or not the Corporation would have the power to indemnify its Directors and Officers against such liability. Section 10.3 Private Foundations and Other Limitations. In no case shall the Corporation indemnify, reimburse, or insure any person for any taxes imposed on such person under chapter 42 of the Code. Furthermore, (a) if at any time the Corporation is a private foundation within the meaning of section 509(a) of the Code, then during such time no payment shall be made under this Article if such payment would constitute an act of self-dealing or taxable expenditure as defined in section 4941(d) or section 4945(d), respectively, of the Code and (b) if at any time the Corporation is not a private foundation within the meaning of section 509 of the Code, then during such time no payment shall be made under this Article if such payment would constitute an excess benefit transaction as defined in section 4958 of the Code. Section 10.4 Exculpation. A Director shall not be personally liable to the Corporation or any person for monetary damages for failure to perform his or her duties as a Director, unless such failure to perform constitutes (a) a violation of the criminal law, unless the Director had reasonable cause to believe his or her conduct was lawful or had no reasonable cause to believe his or her conduct was unlawful (b) a transaction from which the Director derived an improper personal benefit, directly or indirectly, or (c) recklessness or an act or omission that was committed in bad faith or with malicious purpose or in a manner exhibiting wanton and willful disregard of human rights, safety or property. If the Act hereafter is amended to authorize the further elimination or limitation of the liability of directors, then the liability of Directors of this Corporation shall be 1489 eliminated or limited to the full extent authorized by such amendment. Section 10.5 Amendment or Repeal. Any repeal or modification of the foregoing provisions of this Article shall not adversely affect any right or protection hereunder of any person in respect of any act or omission occurring prior to the time of such repeal or modification. The rights provided hereunder shall inure to the benefit of any indemnified person and such person s heirs, executors and administrators. Section 10.6 Severability. If any part of this Article shall be found in any action, suit, or proceeding to be invalid or ineffective, the validity and the effectiveness of the remaining parts shall not be affected. Article XI GENERAL PROVISIONS Section 11.1 Contracts. The Board of Directors may authorize any Officer or Officers, agent or agents of the Corporation, in addition to the Officers so authorized by these Bylaws, to enter into any contract or execute and deliver any instrument in the name of and on behalf of the Corporation, provided that such contract or instrument is in alignment with the mission and direction of the organization, and is not in violation of the Articles of Incorporation, these Bylaws or applicable law. Such authority may be general or confined to specific instances. 1490 Section 11.2 Contn�Contributions, bequests and gifts to the Corporation shall be accepted or collected only as authorized by the Board of Directors. Guidelines for accepting contributions shall be established by the Board of Directors. Section 11.3 Checks and Drafts. All checks, drafts, or orders for the payment of money, notes, or other evidences of indebtedness issued in the name of the Corporation shall be signed by such Officer or Officers, agent or agents of the Corporation and in such manner as shall from time to time be determined by resolution of the Board of Directors. The Board Chair shall countersign all authorizations for payments of bills, except the payment of normal, routine, and recurring bills in an amount not exceeding $25,000. Section 11.4 PAP -0 -sits. All funds of the Corporation shall be deposited from time to time to the credit of the Corporation in such banks, trust companies, or other depositories as the Board of Directors may select. Section 11.5 Financial Report A summary report of the financial operations of the Corporation shall be made available to the public annually, in such form as the Board of Directors shall provide. Within 60 days following the end of the fiscal or calendar year or annually on such date as is otherwise provided by the Board, the Executive Committee shall provide to each Director a complete financial report of actual receipts and expenditures for the previous 12 months. The report shall show the amounts of receipts by accounts and receipt classifications and shall show the amounts of expenses by accounts and expense classifications. Section 11.6 Fiscal Year. The fiscal year of the Corporation shall be fixed from time to time by resolution of the Board of Directors, but shall begin on July list and end June 30"' , if not otherwise fixed by the Board of Directors. Section 11.7 Seal. The Board of Directors may provide for a corporate seal in such form as it prescribes. The corporate seal shall have inscribed thereon the name of the Corporation and the words "Corporate Seal, Florida." The seal may be used by causing it or a facsimile thereof to be impressed or affixed or reproduced or otherwise. Except as otherwise provided by law, the failure to affix the seal of the Corporation to a document shall not affect the validity thereof. Section 11.8 Books and Records. The Corporation shall keep correct and complete books and records of account, shall keep minutes of the proceedings of its Board of Directors and Committees having any authority of the Board of Directors. Section 11.9 Nondiscrimination Policy . The Corporation shall, in the conduct of its business, programs and activities, admit program participants of any race, color, religion, national origin, disability, gender, sexual orientation, age and ethnic origin to all the rights, programs, and activities generally accorded or made available to participants in the Corporation s programs. The Corporation shall not discriminate on the foregoing basis in administration of its educational policies, admission policies, and other Corporation -administered programs. 1491 Section 11.1 o Confirm I!W Except as required by applicable law, legal process or agreements to which the Corporation is a party, each Director and Officer and his or herconfirespective espe ti e agents shall keep secret and confidential, and agrees to keepsecret refrred to as information acquired relating to the following (all he financ'al ll such Gond tioin and ormaton her informat onerelating to Confidential Business Information ): (a) the business of he Corporation, including without limitation, its rates so stemsc s, its operations s and arrangements; (b) and contracts, and its business planY services, marketing sales, administration and management procedures, trade relations or practices, techniques and practices heretofore or hereafter acquired, developedonors, andor used suppliebs, the Corporation; and (c) the Corporations providers, clients, customers, vendors, lenders, independent contractors and payers and the provisions and terms of any agreements or proposed agreements between the Corporation and any of such individual or not on shl entities; provide that nCoDi Directorion already ial Officer shall atsiness tiany time disclosed Confidential Business publically available. Information to any person, firm, corporation, association or other entity, or use the same in any manner other than in connection with the business and affairs of the Corporation. Directors and Officers shall under no circumstances use Confidential Business Information in any way reasonably perceived as detrimental to the Corporation. aff Section 11:11 B1ts tiaws shall govern the internal ent with law and he ArArticlesof Incorporat one Corporation, but only tohe extent they are cons Article XII AMENDMENTS These Bylaws may be amended or repealed, or new Bylaws may be adopted, at a duly called meeting of the Board of Directors - by the affirmative vote of two-thirds of the Directors present at such meeting. 1492 a?� �5 ARTICI ES DF 1NCORPORATIo.E , 7564 ` OF wa DAILY BREAD•C0: Mjj1TY F'OOD.HAN'K , * ±,pr�l } t T�14 - (a'Florida Corporation Not for Profit) VE, the undersigned avbsczibers. to these Articles E of Incorporation, being natural.persona competent to contract, do L Y - - i hereby associate ourselves in the ,formation'of a corporation not for profit under the laws of the State of Florida, pursuant to Tyr: the provisions of Chapter 617;'Florida Statute$,�� t{ Y! ARTICLE 1.'....> CORPORATE Z4R IE The name of :he Corporation shail'be: DAILY isR£AD_COMMUNITY FOOL] BANK, ll;C,. ARTICLE II a r='�!' PURPOS"S. Ft� i The purposes of 'which this Curpniation.fs organized :'LtiL are', _ ts, 1. To feed the hungry through the procurement and distribution ofsal,vogeable'and'surplus food and to :operate. and mainiain Community Food•Bank facflitie9. aid u ' 2. To collect,.store,' warehouse and distribute.salvage- able and surplus food to'social and charitable, agencies and other' rti€ organizations chatqualify under Section 501(c)(3) of the Interna! Revenue'Code'ef-1954,'as tax, exempt organizations;, l 3. TO.Opetate exclusively for such charitable and educational'puzposes that will qualify ,.this Corporation as a tax s exempt organization under Section '501(c) t3) of. the" ,Internol Revenue 6. % Fz " Code of 1954, or' the:correspondiiig_�provision-'of any subsequent lntepta! kevenua.:Cpde or t4x law, t •' , - _ ,fir l = W4LTOULANTAFF KMROKOER CJRSON, - - 1' r` - VOALFp LC .O W9N1 ■IILG116,V Wllowr0 ,]]r]I, TLLtI„V w[rA!LR CG]E )011 ]7;L 5a ,' L♦h r' 1493 h3 AIM- ­®Rnl, ARTICLE III j� �'l. ALIFICATIOP� OF HiEbIBER3 AHD' MANNER OF THEIR ADMISSION Ufa Any person interested in feeding the hungry and dedicated to the purposes and ob'jOctiYea specified in these aY. _ Articles. of Inrorporatian'is qualified,and eligible far Membership �Si F in this carporetlon, The mariner. of admission to membership shalt i be evidenced by a Certificate of Meu,bership issued by the Corpora - tion. to each sciabar. Each member shall be 'subject to kha rights, privileges and duties set forth in ehe''Sy-Laws. ' ARTICLE IV TERM This Corporation- shall have perpetual existence. --. ARTICLE- V NAMES AND RESIDENCES OF SUSCRIHERS The names and residences of the Subscribers are. 1,1ILLIA!•1 J. GRAY 6030 S. hr. 8th Street Plantation, Fldrida 33317 `NiC110LAS E. CHRISTIN 15521 S. {,: 74th Avenue., f Miami,. Florida 33157 fi' '9 5 GEORGE CHEBR041 ` t 1230 So, Alhambra Circle Coral Gables, Florida -33146 iZ���R ARTICLE Vi t�t -w5�t� OFFICERS AND THEIR ELECTION OR APPOINTMENT. i:, The affairs of this Cb_rporation are to be managed by .gra' , . .. • n r� a President one ar.more Vice+Presidents, a Secretary and a Treasurer. Those Officers be elected shall or appointed at the k`f annual meeting .of the members of the Corporation. , 5. - - iYAITON VE!% ELAXTAFF$CHa00 ER CARSON:. - ice•irweo c.-ot,a,au,o.+o. urF�-rvewio i7rrrnre rwrir mnE iosra an'. .`aa�" 1494 b + 777777777 ARTICLE VII FIRST OFFICERS .` The. name's of -tho- officers who are CO serve until thc. !i. first eieCtl0n or appointment under these Articles of corporation 't are, ,a Ha me Office WILLIAM J. GRAY President 3cf�'f ` FJ, RICHOLAS E, CHRISTYta. .p: Vice President > OEDRC6 CIIESRp'A Secretary and Treasurer sis ARTICLE VIII t+ FIRST BOARD OF DIRECTORS 7. The The affairs of this Corporation shy+11 be conducted by j es! a Board of Directors of at feast three members. The names and addreases of the personn.uho areto serve as Directors until the 7> ^" first election thereof are: ' 1 Address . WILLIM-1 3 GRAY 0 �,- 6430 5, k• 8th Street Plantation, Florida ..333[7 NICHOLAS E..CHitISTIN 15521 S. W. 79th Avenue: 's Nfami' Florida 331,,u ��t g GEORGE CHESR014 1230 S. AlhambYa Circle Coral Cables,. Florida 33146. -"i Vis} t'�'Fru ARTICLE iR f x>aF. The B p By-Laws this Corporation are to he made, altered, ame1nded or rescinded by a two-thirds vote of all of the members of ?,L the Board of Directors, at a meeting duly called for that specific 1 purpose. -A meeting hereunder is duly called if:it-is called by any . -1 Director or the President of the.Cor oration at an regular or' ' P Y 8 Ispecial meeting field prior to the meeting provided.for herein. ARTICLE }: ' AMENDMENTS To ARTICLES of 'INCORPORATION C Amendments to these Artie Jigs of Incorporation may be' Piop"osed,by any member. of the Board of Directors and sdapted by ' - WACFOr/ RAA7wFF3gssojoe6 CARi07f _ �9?6l �FpJ. OuaUT�V+LO.LG, NYI,H p�ORIC6 IIf71. I,LLFiryO vl iwll[A CODA' SM. i1l6.., WIP 1495 y n . 5_ To hold. invOst, reinvest. and nanrkge money and property and to use the principal and ineor:e thereof. s - i 6. To borron money anti execuce ,and issue urornissory nvtes, bonds, dubentures, and other evidm)ce of Indebtedness, fron time r"o—Ime, for any 1as.•fu2 carprate purpose and'to mortgave, Pledge and othenrise-charge any and all of its property and other assets to secure the payment thereof: 7. To do ail and everyr"hing necessary and proper £or. i the accomp:inh=ent of any of the objects or purposes enumerated'irt k} Chess Articles of Incorporation or any amendment thereto, or in ; the furtherance thei-eof or necessary or incidental to the protectiolt and benefit of the Corporation, and In general, either alone o>: " in association gl th other charitable corporations, organizations, associat'ons, partnerships, firms or individuals, to carry on any. law€ul.'pursuit necessary or: incidental to the acconPlishmen[ of the purposes or khe attainment of, the objectives or the furtherance of such purposes or objectives for which this corporation 'La _formed , i and to have -all of. the:po-.4ers conferred'upon this Corporation by .`' the.lawa of "the State of rlorida, or of any other state or country, F and not prohibited by. the Corporations Not fur Profit Act. a VIAL -VON LANVAFF SC/iRMEp a CAMON roll i.lrpSU i.Ower/1n18:v0"4�Ane,f�dll'0�. J/nl.lr�!!»y,l f��,[�e4oiwS. ]SPN11 1 . 3r . 1496 a cc.o-thirds voce os all She""directors at say c3ering duly called .,T.y. For Chac s -7c if c ir" purpa.e. ��s' RF JL 14 a means of accomplishing the purposes sel; forth in ,lrticla II harem, 'Chis. Corporacion shall have the following .� Pavers '•: �<;: To raise fu;,ds by solicitations, business entcrgrises, or borrix.;,ing, i ' v 2. Accept and receive donari(pns and contributions of services and money and property of every kind and description by gift, subscription, devise, bequeat; or other.Jtse, Buy, build, lease, sell, mortgage, manage or otherwise cleat with real, or personal property. 4. Enter into contracts or agreemonts of an k'id y n . 5_ To hold. invOst, reinvest. and nanrkge money and property and to use the principal and ineor:e thereof. s - i 6. To borron money anti execuce ,and issue urornissory nvtes, bonds, dubentures, and other evidm)ce of Indebtedness, fron time r"o—Ime, for any 1as.•fu2 carprate purpose and'to mortgave, Pledge and othenrise-charge any and all of its property and other assets to secure the payment thereof: 7. To do ail and everyr"hing necessary and proper £or. i the accomp:inh=ent of any of the objects or purposes enumerated'irt k} Chess Articles of Incorporation or any amendment thereto, or in ; the furtherance thei-eof or necessary or incidental to the protectiolt and benefit of the Corporation, and In general, either alone o>: " in association gl th other charitable corporations, organizations, associat'ons, partnerships, firms or individuals, to carry on any. law€ul.'pursuit necessary or: incidental to the acconPlishmen[ of the purposes or khe attainment of, the objectives or the furtherance of such purposes or objectives for which this corporation 'La _formed , i and to have -all of. the:po-.4ers conferred'upon this Corporation by .`' the.lawa of "the State of rlorida, or of any other state or country, F and not prohibited by. the Corporations Not fur Profit Act. a VIAL -VON LANVAFF SC/iRMEp a CAMON roll i.lrpSU i.Ower/1n18:v0"4�Ane,f�dll'0�. J/nl.lr�!!»y,l f��,[�e4oiwS. ]SPN11 1 . 3r . 1496 1497 The .objects and purposes specified ..irk the',foregairig ��a s ft clauses of.thie'Article; unkess expressly lfmited, shall not he _ - a l.imited'gr restricted by reforence to, or inference ft'gn,'any . }` ^ �. provision In this or any.orher Article of thasc,Articjes of Incorporation, shall be regarded as independent objects and pur=.' ' 15 sr c+r poses and shnll be carlsti�eed'as po r_Cs as kekl. as objects and purposes, ali as permitted by law. XRTICLF. X1.1 CHARITABLE RESTRICTIONS AND LIMITATIONS I t - `' The purposes and operatibna of this Corporation. shall be specifically restricted and 'limited tis follows. go part of 'the net earnings of the Corporation F shall iriurc to the benefit of or - be distributable tc its members,-- directors,=officers, or other private persons,' except that the 1`'t � ��.��'•�,". '- CorpDYACidll shall be authorized and empowered to pay reasonable - (. a compannation for services rendered and to make payments.and ` -distributions in furtherance ofthepurposes set forth in Article' S lI hereof. r 2, iio subs.tantiaL part of the activities of the - Corporation shall, consist of carrying on propaganda, or. otharuiso N Ti•�tY .. tai ,- attempting to influence legislation except as Otherwise provided- :, in -Section 501(h) of the Internal Revenue Code of 1954, or the curresponding provision of any subsequent Internal Revenue -Code z; �tr �:+ ; or tax law. The Corporation shall net p�rtieipate in; ar'-zntorven.g : tr f3e i� in (including the publishirr'or distributing of statemen_ts), any political cam ai Y' public p gn Ori behalf', aF an candidate for 3'. The CorparatiOn.shall not operate for the purpose of -carrying pn a trade'ox business for grofit, or engage fn any prohlbtted,transacrion described in -Section 503 of the internal' - Revenue Code of 1454, tor the corresponding: provision of any subse- 1 sy quent Internal Revenue Code or tax ,law. ,zfs y rw, ITALTUN LANTA14 CWgOEDER 6 SAflSgq' . .. '. 'iso 3:lF11�61.OHt0'.T lY,40 �O: MrAM1,I IOA•1a1� 11C1 .O+C1+11l�LOtlC ]0 xTO S>f11 - rliw- {:: - at 1497 1498 be the Perions known.by me CO b chose names .Aescrib'e';j executed the for4gol'i:� .Articles ur incorp orati:on. an(, . [tiei acln&.rled&ed to me chat they cxecli zo the same ss.the!jr free voluntary act and deed and for tho uses' AnA pufpo..AstheFeAn act forth and expressed. iN 141TUESS �i,':IEREOF. i have harcu.no.;Set. PIV hand Am' Fl ill Bf f ixed my official seal. on aruJ yea;� :f toli, al wtit ..ir,-Cr ._T -j. U - 'nr STATF OF FLORIDA COUNTY OF RADE'_ J "HEREBY CE-RTIFY- thatFebif6 .'on A appeared before me, the, undbrsiineld au h' GRAY - t orii7y tiTtnini AV. F; rltmvQT­ be the Perions known.by me CO b chose names .Aescrib'e';j executed the for4gol'i:� .Articles ur incorp orati:on. an(, . [tiei acln&.rled&ed to me chat they cxecli zo the same ss.the!jr free voluntary act and deed and for tho uses' AnA pufpo..AstheFeAn act forth and expressed. iN 141TUESS �i,':IEREOF. i have harcu.no.;Set. PIV hand Am' Fl ill Bf f ixed my official seal. on aruJ yea;� :f toli, al wtit ..ir,-Cr ._T U - 'nr My Commission Expires4 i. jj Z, .- 4 ;1 I. t ACKNOWLEDMUNT OF RES MEN ACbi HAving been named to accept service of Proces's for DAILY BREAD COMIUNITY FOOD BANK Mr., 8L tfie.pl"e designated ,4L In Article'XIII of. the attached Artli:les of 111rorporaribin, I hereby accept to act in this capacity, 4rw agree to coqply...rich the provision at Section -48,09L, Florida St' 'rutes , relatf ve to keeping, open the resLde'nt'oMc6. 4 ($EAL') 11 Al V !A WAL70ij LANTAill. SCHROEMR &'CARSwi 1499 at Jam, i I fItED ARTICLESaFAfaENDi•fENl' :Ttl 7HR: �Ai I� i6 ARTICLES OF INCORPORATION OF 5-0 Of StAIE ' 7�r�;-t• - - '.'' . - .. - - ,. -'. U�U111-�SSEEtt4AiDA DAILY 'DREAD. CO;LYUNITY._FOOD- BANk. INC.. a V �*v {A Florida Corporacion Noe for Profit} ee 5 FgrsuanG. to -the pxovisio-a3 of Section 617 02 of- the k t Florida SCatutes, the undersigned corporation adopts the following SVP �1;r iY rte• Articlos of Amendment to.its 'Articles of Incorporation, filed .4 - rJI s 4 s�i'fJ9 February 17; :}.481,:: _�� � •s�,<ks� mgt 1-- The Board of birectors of said corporation ae a meeting called and held.on: %lay 6, 1981, adopted the follow'.nr, .. resolutiolt y #" f',�w #sr ` RESOLVED that Article III of the Articles of Incorporation �i hereby completely is: Y emended as follo�rs: �x •� �.;; ;u; ARTICLE IIl -QUALIFICATION OF MEMBERS ANIL �;{r� MANNER OF .THEIR ADMISS30157 x } The members of the corporation shall consisC of the t�fy c I persons signing the Articlrs of ,,tcvrpgration and such otr,er personjm 4 -? - or persons or organization or. organizations as the Board AF Directors may elect,:6y vote of a majority of the membersof the Board of Air, !Directors of the corporation, at any Annual or Special Meeting of Y the Board of Directors . i} i,,f�°�1 a,•I { 2. The Board of Directors of such corporation ata 7 itteacfng: duly , called and held on May 6. 1991 adopted said resolution A- Zt t amendnR Che Articles, of Incorporation as aforesaid,'no shares of`s�' stock having been issued,:nor permitted under general lair. o?'a sS� IN wITNESS..WHBREOF,:the undersigned -Directors have (ixecuted these Articles of,Amendmene'.this'llth day of May, J981 DAILY BREAD COr'IWHTY FDQp' BANK, INC. `= ISEALIWILLIMI >Ft. d By `'. HI�H oras E. 629ftaw j �1�.s�,si•'�ild - 1500 STATE OF.FLORIVA COUNTY OF DAVE On this day:personlly'appeared before me, the undersigned officer duly authorized:by the laws of the''State of Florida to take acknowledgements WILLIAM J. GRAY, NICHDLAS E. CHRISTM , and. GEORGE CRESIi0l+1, DireotarS of Daily Bread.Community Fool- dank,.' In£;, a Florida.corporation, and they acknowledged that they executed the herein and foregoing Articles of Amendment as such Directors for and -.on behalf. of said. Corporation after having been duty authoxi2ed to do so. WITNESS my hand and affict4l seal at Miami, Dade county, Florida, this day of May, 1981. ~otary 'u ic'2`, Sttate o Ir or a at arae My Commission Expires: MY VA A7 l,I,r., - _ - v ocy: s uwar ts, i iai ..2.. t�1 1501 1! r e 1501 LA ARTICLES; 4F AMENDMENT TO ARTICLES OF INCORPORATION DAILY BREAD COMMUNITY.FOOD BANK INC Pursuant, to the pravi$iot:s of, Section 617, 018, Florida Statutes, the undersigned. "Corporation adopts the following Articles.of Amendment to its Articles of Incorpoiat ion, filed rebivary 17, 1981., FIRST: The nate of the corporation is: DAILY BREAD COMUNITY'FOOD BANK, INC. SECOND:" The following Amendment of the Articles of in- corporation was adapted by' the Corporation: �ARTICLE I: CORPORATE NAME DAILY BREAD Dated: September 2 BANK, INC," - was. adopted unanimously by the Board Ji day of septekbar 1986 at -a meeting. urpose:." 6 DAILY, BREAD COMMUNITY FOOD BANK, INC. By osep Scior:Lnno, res ent - /f By icrhar Wa ter, ecretary 1502 1503 To: The Flarida Dept of State SubWt 000177.111388 From: Ashley Smlm Friday, September 4, 2008 4730 PM Page: 3 of 3 H09000208I52 3 ARTICLES OF AMENDMENT TO THE x Vim► CP ARTICLES OF INCORPORATION 0 14- . DAILY DREAD FOOD RAMC INC. Pursuant to the applicable provisions of the Florrda Slatules, this Florida not for /,`oSlfl rorparallon adopts the following articles of amendment io its articles of irrcarporation - I. The name of the corporation is DAILY BREAD FOOD BANK, INC. (the "Corp*ralioti ). 2. The Amendment set forth below was adopted on March 26, 2009 by unanimous consent of all of the members entitled to vote on the board of directors of the Corporation. 3. Article I of the Articles of Incorporation of the Corpration shat I be deleted irk its entirety E and replaced with the Following: ARTICLE 1 The name of the Corporation shall be: FEEDING SOUTH FLORIDA, INC., a Florida not for profit corporulion ' 4. All of the provisions of the Articles of Incorporation not amended herein tut hemby ratified, confirmed and shall remain undmngcd. IN WITNESS WHEREOF, the undemiped has CYCCULed 111t:se Articles ofAUnendment to the Articles of Encorporation. D tD FOOD K. INC., a Florida no for profi Iti i 8y, Brmc J. Berman, President and Chaitmnn of the Board of Directors f r 1 l MIA rsxsor-r.o.:.axP i H09000208152 3 1504 Articles of Amendment to - !F'� a 1 u Articles or Incorporallen a , of (Name of C r6pration 35 currentlyfile/ with the F o ' t. t 44f.�4r�%. (Document Number of Corporation (if known) Pursuant to this provisions of section 617.1 OD6, Florida Statutes, this Florida Not For Profit Corporation adapts the following amendment(s) to its Articles of Incorporation: A. If aMlIWIP2 name,enter tht new name of the cot oration: The new name must be distinguishable and contain the word "corpornrfan " or "incorporated" " or the abbreviation "Corp. " or "Inc. " "4•" =411x" or "CO.' may trot be used in the name, S. Enter new principal office address if applicable - (Principal office address 11fUST BE A ST'REETADDRESS ) C. Y.nte w madiny address, if a (Mailing address MAY BEi &_osr oEncE goX D, If simeadJOP the regislorgd a epi and/or reelstered office,adgfeas in Florida_ enter the game ofthe at!L—reglstered aegnt and/or the new rmillered 9fte address: Nam e e New Re&iered A gen r; e Z. 25'0 I 3.z "= Tel', -A ee (Florida rant address) New Registered Q 1Pc'e Address: —&M1'-OKe _ &L L„ , Florida 3 3o 2_e {Zip Code) 1 hereby accept the appoinrmenr as regisre a e llat(t Jamil' r with and accept the obligations of the position, Sign rare ofew Regisrerwd Agent, if changing Page 1 of 4 1505 i If amending the Officers nod/or Directors, enter the title and name of each of;..er/director being removed sad title, name, and address of each Officer andtor Director being added: (Attach additional sheets, if necessary) Please note the off5rerldirector n..'ti � Aefirst letter of the office title: P — President; Y= Vice President; T= Treasurer: S= Secretary; D= Director; TR— Trusree; C = Chairman or Clerk; CEO = Chic Executive Officer: CFO = Chief Financial Officer. !fan o,fficerldirector holds more than one title, list the first letter of each opt -cc held. President. Treasurer, Director would be PTD. Changes should be noted in rhe following manner. Currently John Doe is listed as the PST and Mike Jones is listed as the V, There is a change. Mike Jorres leaves the corporation, Sally Smith is named the Y and S. These should be noted as John Doe, PT as a Cha nge, Mike Jones, Y as Remove, and Sally Smith. SV as an Add. Exampic: 2LChange V1 Mn Doc X Remove V Mike Jones X Add 5—V Sally Smith "Fyffe of Action Titl,g am Ac�r�r s (Check One) 1) Change V f 0 G 25-0 1 SV 3 /rl�CG. Add pfYl j C Q '3 F Remove 33oZ 2) —Change Add —yRemovc 3 ) _Change Add Reprove 4) �� Change Add Remove 5) Change Add Remove 6) _Change Add Remove P-' MMAAE1., Page 2 of 4 &d d!'Q]cr „1�zfzk 'ne , 102'? 1506 �. It aMtntling or addlos additional Art cI s than e s here: 014th additional sheets, ifnecessap)). (Be specifrc) Page 3 o r 4 1507 The dote of each stmendment(s)adoption: _ (a �`a O y _�� if other the this document was.sigxed. Effective date if appl a51e: (no more than 90 days afrer axlei:(lmerrr file dale) Adopdan of Atntendrnent(s$ (CHLQ ONY1 © The amendrnent(s) was/were adopted by the members and the number of votes cast for the anxndment(s) was/were sufficient for approval. ❑ There are no members or members entitled to vote on the amendmenl(s). The amendmeal(s) was/were adopted by the board of dircclors. Dated TV 5 ignatttre ($y the chai}manor ice chairman or the board, president or other officer -if directors have rot been selec d, by an incorporator— if in the hands of a receiver, trustee, or other court appoin fiduciary by that fiduciary) Df VelCQ ' Lt- _ Typed or printed a of person signing) (Title of person signing) Page 4 of 4 1508 Articles of Amendment to Articles of Incorporation FIED of Fl on hUG 7 PM 1= k2 (Negi of Corpomflas as coirrentlyfilld Wilb fbe floridoDept. of State `, t ii'( t• MRIDA (Document Number of Corporation (if known) Pursuant to the provisions of section 617.1006, Florida Statutes, this Florida Not For Profit Corporation adopts the fol lowing amcndmem(s) to its Articles of Incorporation: A. If amendin4 name, eater t6C new name of the cornnratiao: The new name must be distinguishable and contain the word "corporation '• or 'Incorporated " or the abbreviation "Corp, " or "Inc. " "C "Co. " M not he used in the B. Enter new Principal ofte addr i— li le: (Principal office add*js MUS T a A S rREErA ) C. Enter new addre (Mailiarg address MA V BE A POST OFFICE BOX) D. If amendilg theim ist n resixtead 9TKe address in Florida. t ter Ike new registered agent and/or the new registered oMet address, Name of Nfw Registered Agent: kAAJC4.SLQ. VEL -C-2- (Florida rmeet addrerrJ New rered D e P� P Florida z. (City) (Zip Code) New Re stered A is SignatureL If clianizing Rghtgrld Agent: 1 hereby accept the appointment as registered agent. f am familiar with pnd accept the ligarh ns_ �fhe position. of New Page I o(4 Rgea if changing 1509 If amending the Officers and/or Director,% enter tie title and Dome of each officer/director being removed add titk, Dante, a ad Address of each Officer sodlor Director being added: �Asiach additional sheers. Vnecessary] Please note the ofJlcerfdirector title by the first letter of the office title: P - President; V= Vice President; T- Treasurer; S- Secretary,- D- Director; TR- Trustee; C = Chairman or Clerk; CE p Chief Fxecu ive Officer; CFO - Chief Financial Officer. If an officer/director holds more than one title, list the first letter of each office held President, Treasurer, Director would be PTD. Changes should he noted in the following manner, Currently John Doe is listed as rhe PST and Mike Jones is listed as the V There is a change, Mike Jones leaves the corporation, Sally Smith is named the V and S These should be noted as John Doe. PT as a Change. Mike Jones, leas Remove, and Safly Smith, SV as an Add. Example: X Change PT LQbD-Q-W- X Remove V Mike Jones X Add SV S�IIX.$mith Tvne of Action Title Name Mdmp (Check One) i) Change Add Remove 2) —Change Add Remove 3 ) _Change Change Add Remove 4) Change Add _ Remove 5) —Change Acid Remove d) Change Add Remove fLgAMCd(A VEX -67- 2 5101 5WG c JC*qA A4 333 A4 C' V4f C2- Page 2 of 4 1510 EIf amendings here: (attach additional sheets, ifnecessary). (Be specific) Page 3 of 4 1511 The date of each arneltdmettl(s) adoptioe: if other than the date this document was signed. Effective date It antslicable: (no more than 40 days after amendment file date) Nola: If the date inserted in this block does not meet the applicable statutory filing requirements, this date will not be listed as the document's effective date on the Department of State's records. Adoption or Atmendtmealls) (CHECK ONEI Q The arnendrnent(s) was/were adopted by the members and the nwnber of votes cast for the amendment(s) waslviere sufficient for approval. There are no members or members entitled to vote on the amendment(s). The amendment(s) wasi%%rrc adopted by the board of directors. Dated Signature (By the chainiu6 or vice chairm have not been selected, by an it other court appointed fiduciary Zv 1"4--0,t e board, president or other officer -if directors aor — if in the hands of a receiver, trustee, or fiduciary) (Typed or printed name of person signing) � S cc Fs z (Title of person signing) Page 4 of 4 1512 Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid social security number backup withholding. For individuals, this is generally your social security number (SSNHowever, for a — m resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a F M___ TIN, later. or Note: If the account is in more than one name, see the instructions for' line 1. Also see What Name and Employer identification number Number To Give the Requester for guidelines on whose number to enter. M�J -2097f20 Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later. bign Signature of Here I U.S. person 10 - General General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Form 1099 -INT (interest earned or paid) Cat. No. 10231X Date► Z-ZO 2.3i_ • Form 1099 -DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. if you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Form W-9 (Rev. 10-2018) 1513 Request for Taxpayer Give Form to the Form (Rev. October 2018) Identification Number and Certification requester. Do not Department of the Treasury send to the IRS. Internal Revenue Service ► Go to www.irs.gov/Form1V9 for instructions and the latest information. 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. �.Gd't Saute 1 o f+da 'fir, iL 2 Business name/disregardejentity name, if different from above ch 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to mfollowing seven boxes. certain entities, not individuals; see a a F-1 Individual/sole proprietor or ElC Corporation ElS Corporation ElPartnership ElTrust/estate instructions on page 3): c single -member LLC Exempt payee code (if any) 0.0 ❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ► `p Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check Exemption from FATCA reporting + wLLC c if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is from for code ( if any) a ois-disregarded another LLC that is not disregarded the owner U.S. federal tax purposes. Otherwise, a single -member LLC that from the owner should check the a propriate box for the tax classification of its owner. aoi Other (see instructions) ► C' 3 (Applies to accountY maintained outside the U.S.) 5 Address (number, street, and apt. or suite no.) See instructions. Requester's name and address (optional) SU rU/ 3 2- V rr-a C -C 6 City, state, and ZIP code firt-4 t, 33023 ,.Ice il'�c�K 7 List account number(s) here (optional) IMM Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid social security number backup withholding. For individuals, this is generally your social security number (SSNHowever, for a — m resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a F M___ TIN, later. or Note: If the account is in more than one name, see the instructions for' line 1. Also see What Name and Employer identification number Number To Give the Requester for guidelines on whose number to enter. M�J -2097f20 Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later. bign Signature of Here I U.S. person 10 - General General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Form 1099 -INT (interest earned or paid) Cat. No. 10231X Date► Z-ZO 2.3i_ • Form 1099 -DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. if you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Form W-9 (Rev. 10-2018) 1513 City of Boynton Beach Development Services 100 E. Ocean Ave. Boynton Beach, FL 33435-0190 0 **AUTO**SCH 5 -DIGIT 33436 1 PS5 133298BA29-A-1 74 1 AV 0.452 IIIII II�I���'I'IIIII�I�II���II��I'�hI���I�II�I�I��I��III��IIJII FEEDING SOUTH FLORIDA INC 4925 PARK RIDGE BLVD BOYNTON BEACH FL 33426-8317 Dear Boynton Beach Business and Property Owners: We appreciate your continued participation in supporting economic growth and viability of our City by maintaining your Certificate of Use and Occupancy & Local Business Tax. In accordance with Chapter 13 of the City of Boynton Beach Municipal Ordinance, the document(s) below must be posted in a conspicuous place at your business or property. Should assistance be needed please contact the Development Services Department at (561)742-6350 or visit our website at www.boynton-beach.org. + DETACH THE DOCUMENT BELOW AND POST CONSPICUOUSLY AT YOUR PLACE OF BUSINESS -y ------------------ City of Boynton Beach Certificate of Use/Business Tax Receipt Expires on September 30, 2023 Business Control Number: 0032057 Date Issued: 07/29/22 Business Name: Feeding South Florida Inc Business Location: 4925 Park Ridge Blvd Any changes in name, address, suite, ownership, etc. will require a new application. 23-00036979 561110 OFFICES EXECUTIVE & ADMINISTRATIVE OFFICE ADMINISTRATOR City of Boynton Beach 100 E. Ocean Ave. • Boynton Beach, FL 33435-0190 1514 City of Boynton Beach Development Services 100 E. Ocean Ave. Boynton Beach, FL 33435-0190 Nzk W **AUTO**SCH 5 -DIGIT 33436 1 PS5 133298BA29-A-1 73 1 AV 0.452 FEEDING SOUTH FLORIDA INC 4925 PARK RIDGE BLVD BOYNTON BEACH FL 33426-8317 Dear Boynton Beach Business and Property Owners: We appreciate your continued participation in supporting economic growth and viability of our City by maintaining your Certificate of Use and Occupancy & Local Business Tax. In accordance with Chapter 13 of the City of Boynton Beach Municipal Ordinance, the document(s) below must be posted in a conspicuous place at your business or property. Should assistance be needed please contact the Development Services Department at (561)742-6350 or visit our website at www.boynton-beach.org. + DETACH THE DOCUMENT BELOW AND POST CONSPICUOUSLY AT YOUR PLACE OF BUSINESS -y ------------------ City of Boynton Beach Certificate of Use/Business Tax Receipt Expires on September 30, 2023 Business Control Number: 0032057 Date Issued: 07/29/22 Business Name: Feeding South Florida Inc Business Location: 4925 Park Ridge Blvd Any changes in name, address, suite, ownership, etc. will require a new application. 23-00036978 493110 GENERAL WAREHOUSE/STORAGE STORAGE OF FOOD City of Boynton Beach 100 E. Ocean Ave. • Boynton Beach, FL 33435-0190 1515 City of Boynton Beach Development Services 100 E. Ocean Ave. Boynton Beach, FL 33435-0190 IN **AUTO**SCH 5 -DIGIT 33436 1 PS5 133298BA29-A-1 72 1 AV 0.452 IilrrililirillillilhillPlhh�llllilrlulr�rliiiirl��iirllllli FEEDING SOUTH FLORIDA INC 4925 PARK RIDGE BLVD BOYNTON BEACH FL 33426-8317 W. Dear Boynton Beach Business and Property Owners: We appreciate your continued participation in supporting economic growth and viability of our City by maintaining your Certificate of Use and Occupancy & Local Business Tax. In accordance with Chapter 13 of the City of Boynton Beach Municipal Ordinance, the document(s) below must be posted in a conspicuous place at your business or property. Should assistance be needed please contact the Development Services Department at (561)742-6350 or visit our website at www.boynton-beach.org. + DETACH THE DOCUMENT BELOW AND POST CONSPICUOUSLY AT YOUR PLACE OF BUSINESS + ---------------------------------------------------------------------------------------------------------------------- City of Boynton Beach Certificate of Use/Business Tax Receipt Expires on September 30, 2023 Business Control Number: 0032057 Date Issued: 07/29/22 Business Name: Feeding South Florida Inc Business Location: 4925 Park Ridge Blvd Any changes in name, address, suite, ownership, etc. will require a new application. ,..�;.,v.:.�...�a...v: ';3- •-�.�oz.. ,. --: �4�":ai r. � �.o`��i-+�-. r��� F.c�.. 3;..'jrs^�r+ .4, r7^��?x'"aq�, 3'T;.,s .0 tt-'t•.,, ... '�7*-a Via. �.ws. S. �-T':F dr5''„�taa^."ia3 qtr-...^-um�' 4 C��: 23-00034733 CU2 CERT OF USE & OCC COMM NON PROFIT FOOD WAREHOUSE I�I City of Boynton Beach 100 E. Ocean Ave. • Boynton Beach, FL 33435-0190 1516 Funding Sources for Culinary Training include: 1. General Operating funds 2. Regions Bank 1517 All services offered through Feeding South Florida are free to all clients, regardless of income or employment status. HILLARY GALE Fl U E3 I 1I C 11. ll::.:: A I f I I P 1\1 0 IN Fl Ifs 0 1:::: 1I F Fl IR: 0 G Ifs A IM Il A A 1\4 A G 1::.::: FZ Boynton Beach, FL hillarygalel@gmaiLcom 561.281.5191 PROFESSIONAL PROFILE Solutions-orlented, corrununity-driven, 1,,.ji oject imainager providing transforrnadonall iimIr.)act on strategy and emission execution through (zollaboration, EDUCATION MASI E.::IR 01:::: F'UIBI 1(..., 1 fl::::AI FI i L.Jiniversity of South Florida 1 2014.2016 BIACI il::.::l OIR (')I:::: SClI::.::INCI: Chemistry / Sociology Florida State University 1 20,10-2013 SKILLS • Prololern Solving • [)ata Collection i- Analysis • Microsoft FlowerFloint • MicrosoftWord p 1::.::xcell • CriticM FI-ilinkling WORK EXPERIENCE P IIS 0 Ift A IM IM A IN A G IEIR F:eeding South IFlloidda 1I 113oynton l3each, 1=1 2018 IPiresenrnt EXPERTISE • Flroject Management • Community 1::.::i,igageiqieiqt • IPrograim limplernentation • limpact E.::valuation • Strategic FlIanning I eads collaloorative commUllity SOIUtifflS LO lorealk the cyclle of hunger and loovertythrough research, technology, and innovative initiatives tl,"iat.. strengthen the South F:1orida food system. Addi,(..,sses food insecurity as a sociA determiriarit of health with a hurnan -centered aloloroach. * Manages healthy eqUity initiatives and direct service lorograrns from strategic planning throi.igh design, 11711olernentation, evaluation, and relaorting to internA and extennA stakeholders. * 131,.jilds rneaningft.d and interitionA relationshilos with locA rm..jinicilpA leaders, comirni,.jinity -based organizations (030s), stakeholders and residents, L-widging the galo between strategy, policy, arid lorograms.. * Con(Jucts comirm..jinity needs assessiments, 1,,..)ollicy scans, data collection and imaloloing to jorovide a clear syiiol,,..)sis of tine current food systern and how to best strengthen it with an eqi,.jital,,)le lens, through sustainalole, collective iiinl,,.)a(.,:t and solutions, Flarticiloates in the development of iml,..)roved toolls and methodologies for food systems analysis. * F'rovides (lirect supervision to a tear of Case Managers responsible for data collection and advocacy efforts, serving families to transition from a place of deloendency to self-suffic[ency. Supports oloerationA excellence as it relates to KIF)ls, with core values at the forefront of our work. 11 11E.:All III HCAIRIE.: SIEIRVIlCli:..:S C001RIDIIINA.-T-0111 1I 20,1-7 2018 Served as the liaison for cornrnunity health stakeholders and f=eeding Arnerica I Winger p I Health initiatives. 0 1 ead research initiatives studying the impact of food insecurity on health outcornes, Frain and oversee tearn mernbers reslmrisilole for data collection. F:nrolled and provided ongoing case management SUIDIDortto 750 program participants to identify lbarrier.s to healthy food access. 0 Assisted in the cultivation and stewardshilo of current and jorosjoective healdhcare donors through our Food i.s Adedicine initiatives. R 1R 11 IM A lid Y ..H..IH F.:R A Ifs 11 S I Recovery IRestairt 1I I13oyrntoin l3each, F1 2014 2017 Conducted therapy sessions relating to healthy relationships, 031, effective comirriunication, impulse control, cnloiiqg skills, relalose prevention, family dynarnics, traurria, stress reduction, anger managernent., and substance alL.)USe education. • R(..,sloonsible for fa(.-ilitatinggroups at multilolelewds of care inc.'Juding inpatierit., 1::)1 jl::) arid outpatient. Managed acc.-urate clocurne.intation within the ele.coronic rne.dicM record software to ensure corrijoliance, and reporting. • Advocated on of.dhalf of clients and facilitated communication between clients and families, or community resource - including employment, housing, and legM concerns. 1519 "I'l��IUSA��""""",,,,,,,,,,,,,,� . .......... AV�'111 ��M S , �EyCUf V 0 1����� pRF}11 1� 5msamisadymamicIeaderwith avast knoMedgeof giobaicmisine. She has �� 3l2Zl�l779 wirittencurricuiefor eduits atkirge,asvveUascollege programs, and �� suaznt�e���maiioom deve[opedrecipes for two cookbooks. ler avvardwinning menusare ve�n��o�a[�inspire��Shro�the NSF1nsining pumn creab�^ cvv i�ean��ua BoyntonBe�ch,Fiohda and SOP3fOr Off site C@teringduring[OV|DfOrth�AuS1inGOOg[e team. 01 ler love for food issurpassedonbbyher passion toeUminate food and p[asticvvaste, and shededicoted hermas1er's1hesistothe bopic, )[�AT1[N EyP�I \'I �—. NC'E MS, Hospitality Management Rooseveltuniversity, [hicago^|L DIRECTOR (}FCULINARY SERVICES Fbod FEED|N5SOUTHFLOR|DA !BDYN[ON BEAU H ! 2021. PRESENT Waste in the Hosf)/ta0�y/nobs&rY � Directproduc1ionarid menuengineeririg for lO,000monthiyfWen meaisfor Ce,tif/cate,GircuKair, Economy aind oeniors,fb||ovvingstrict dietaryguidelines; manogestaff and vo|unteersl� SmmtahnabLleStrategies' developed a||SDPs,budget`purchasing and ana(ydcsfor four week menu Cambridge University'2O2l rotation across diversecultural demographic Certificate, Pastry Arts � Deveiopedoff pemiseaummerbreakspot. cat.eringand USDAchi(dren'smea( French Pas1rySchool, Chica�o.|L Prognam'delivering GOO+mea(sdally liltLeading�oodwasteaction pianand imp|ementadon AA. CuhmaryArts lilt �enuideadonandieadforfu||semicecateringprognam [H|[, Le[ur�on B|eu,[hico�o, |L eCormeUL EXECUTIVE KITCHEN SYNC CHEF [erd8cate PiantBasedN trition , u GUCKENHE|WER.ON3|TE@)GUOG|E ! AU3T|N ! 3EPT20l8 2022 BA, English Literature Opened the fiagshiPteaching kitchenonsiteatGoogieAUS, morethan l.00O experientio|use�a�en ed|iveandvi�uaic|assesw �huniquerecipes. TheUniveoityof|||inoi� [hicaQo |L ' ' (transitionedfromin-per-son todigitAengagementand video), Coordinated and moderated Food Waste Taik ^^510.yAbuutFbocl 01bste~ essemb(eda paneiof KI national subject irriatter exper-ts to discuss history, impIiclations and stakitions For food waste'attended bymore thanl5Opeople � �enu[ngineerin� � RecipeDeveiopment EXECUTIVE CHEF � TrainingandLeodership GUCKENHE|MiER, ONS|TE<�PGDOG|E ! AU3T|N ! 2019 2020 � Dudgets`Furecasting � Producedfood vvastec|assesand docks with Gtechsustainabi|ityteom � DiQitail::�ngagement � Produced glove reduchonvideosarid decksforG(�,�)Gg(oba(team � FoodVVastoSubject � Executivechefforoffaitecatering,4OOpreparedmea|s,sevendaysavveek, maintained budget and purchasingfor uni��desi�nedmenu,trained sta#and lilt Goo�|e�uite deve|opedSOPs � I\d5OfficeSui � Reengineeredmenusand |edcatering teamforall holiday events,Doc. 2Dl9 U 1 VVrotecomprehensiveNSF tcaininf.t,deck and conducted staff training 1.1""""""",",'I'l",,�ll,�'�,� . ... . . . . . . . . . .......... AV S M S � �XECUTI\/[ CI IEF CHEF/OWNER c� en?y c� ce Academy �� dem�£�e�� SVYEET[ASSAVAU[! [H|CAGO ! 2302-2Ol8 R��o/en�HaVrer[o8e�e2[D8 Boutiquecamrerforprivateandcorporotedients;planned events fromplanning to producdon,featuring gioba|or�znicmenus,frnm2D-pe�onsitdowndinnersto ���[����[6��No/���oo� 35O-personhuiidayevents;reduced food waste 5O96in2years Thun,btac�2Ol�an�28l� Providedpreparedmea(servicethrou�houtChicago|and;4DO-5DDseekiyoven readymea|s,often vvorhingvvIhin ytriUdietaryconstrainLs C E FIT II'd CATI 0N S/ ���������I N LJ[TI NI('i ' � LLu men udeveiopafbrGFcnsckeriinz^seven SKUs, prod uc1ion2O2l SemSafe.Manager/Proc1or2O24 � �F�000hess G/een�2O2� cookbookeditor,contributor,consuitant A[[, Member � BeIc�our[(.)okboo�.2O27-recipeeditorand contributor CAFE'1\4ember - Sandal ResmMs,Ja/na��WIC'st/nuYer-designedmenusart conducted James Beard, Member trainingfor resorLarid privatevi((a staffinc(uding trainingmanuais - Chkago PubUc 5dmoKs vvrowand standordizedthree yen highKhoo[ I AK][,[1ACd cuiinarycurricuium � NadmmaKEiiWiromnmemtaKAust; &k.,liFloss on[hfleonSea Bass, coordinated English Chkago and MAN campaln to Ascawareness of the plight of dw overlOnd Spanish Patagoniontoothfish TI �I I I N[� ' �ll lairperComnmmmin[ty CoKKege,Chicago, |L2Ol42Ol&TaughtPunchasing; � Ta|kingtoStranQers OPenadonsAnaiysNGarde MangnaPWry; |ntmto hospitality; Menu Pianning; |ntemadona|[uisine' �[iassica|Cuiyine�^ inducted into Academic Excellence Levei|| � The � OnFood and Cuuking Sur Lo11W.Chicago`UL2011-2OlG, Savory and RaytryChef |nstrucor � The Awakening GKemmme&ak lDktHot.Giencoe'|L2003-2Ol5,Deveiopedsevem|pnogc*msfor � So|aris chiidnen'teensand aduits � Frankenstein DaMamCmmmmmmmUty College Afflammefor 11 earmflmg,Chicago, |LZOO7-2Ol7. � TheMushnoomat. theEnd ofthe Developed broad range ofcookingclasses for continuing educa1ionpmgram World UmstEmlemf AO. Chicago'|L2DO42OO5.AcUunct[hetInstructor - - OMC,�eCoMomBKem.[hicago,|L2000 2002,[1nefl|nstruct01r Food, CompostingTravei,Film, BB&AEno, Dimadorof Business DeveKmj,-jmme��,[hk:ago,UL. l889-ZOOl. Reading, Music' Dressage Developed identity and markehngmaterio(sfor new company; targeted now markets and wrote pmpoao(sand webcontent.;managedstaff offburand preparedbudgets and hzecast,workingc(oseiywith engineernand architec1s �������oc �omn�m ��� mm����/oteum/ Revenue Service P.O. Box 2508 Cincinnati OH 45201 In reply refer to: 0248182382 Oct. 19, 20I5 LTR 4188C O 59-2097620 000000 00 00013885 8OOC: TE FEEDING SOUTH FLORIDA INC y< PACO VELEZ 2501 8W 32ND TER PEMBROKE PARK FL 33023 Employer Identification Number: 59-2097520 Person to Contact: Mr. McQueen Toll Free Telephone Number; 1-877-829-5500 Dear Taxpayer: This is in response to your Oct. 07' 2015, request for information regarding your tax-exempt status. Our records indicate that you were recognized as exempt under section 50I(c)(3) of the Internal Revenue Code in a determination letter issued in July 198I. Our records also indicate that you are not a private foundation within the meaning of section 509(a) of the Code because you are described in section(s) 509(a)(1) and 170[b](I)(A)(vi). Donors may deduct contributions to You as provided in section I70 of the Code. Bequests, legacies, devises, transfers, or gifts to you or for your use are deductible for Federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2108, and 2522 of the Code. Please refer to our website www,irs.gov/eo for information regarding filing requirements. Specifically, section 8033(j) of the Code provides that failure to file an annual information return for three consecutive Years results in revocation of tax-exempt status as of the filing due date of the third return for organizations required to file. We will publish a list of organizations whose tax-exempt status was revoked under section 6033(j) of the Code on our website beginning in early 201I. ��\����� rm�u ���/mm~�/�/n�m^/uov^vu*o,nic, P.O. Box zsoa Cincinnati ox *5201 002718.605723.110489.26184 1 AT 0.416 san FEEDING SOUTH FLORIDA INC % PACO VELEZ 2501 SW 32ND TER ---- PEMBROKE PARK FL 33023 oourm CUT OUT AND RETURN THE VOUCHER AT THE BOTTOM OF THIS PAGE IF YOU ARE MAKING A PAYMENT' EVEN IF YOU ALSO HAVE AN INQUIRY. he IRS address must appear in the window. 0248162362 DUDCD-TE INTERNAL REVENUE SERVICE P.O. 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N Q NQ a C N-- LJ O n3 Q aJ p N Q a) a) N O a) O OJ L N H > L OJ N E `� (L6 i +� s N fa bn N N OJ O OJ C v f6 N L O U 4- C6 N U N O N O iJ L a -j b1J ++ N VI L) 'O v H" ca s C +, - m n3 nA U `� a) N 4-;(9 N L o aJ E - C O p p a-1 U O N Q n3 -0 N L t (6 N N a� N > Q .� a) U '+� a) L _0 vi 4J L O O `� O aJ +- L1 W— N� Q (a wL (9 (9 C 41 Q) H to dA .� M a••+ � t U � C CC6 +� N V N � � p � a� N C p (O a"' L> aJ C CC C � C f0 Q a) N aJ a••+ aJ a-' Q a) 4- M a O O D C Q aJ > > aJ LNO N u OQ N C L> O Q) C =5 C) a) C Q a QL N a) a Ls C 0 Q La) -C C Q O U D U a C D Q=;C [6 4- N m 4- m O a) Q m C O LA m 3 O Cfa C. p an d N V O N O 4A fC 4l E Q _O a1 N U E O O O u W co N LO T— 7"he y QfBoyntort Beorch May 26, 2023 Mrs. Allyson Vaulx, AVP of Philanthropy Feeding South Florida, Inc. 2501 SW 32 Terrace Pembroke, FL 33023 Re: Community Development Block Grant (CDBG) Funding FY 2023/2024 Dear Mr. Jessup: This letter is in regards to your application for CDBG funds for the Fiscal Year 2023/2024. The CDBG Application Review Committee assessed your application for funding for Public Services — Culinary Training Program and based on their scoring and funding availability, I regret to inform you that your application was not recommended for funding at this time. I encourage your organization to reapply next year. A Notice of Funding Opportunity will be advertised on the City's website next year. Thank you for taking the time to apply. Very Respectfully, RJ Ramirez Community Improvement Manager 1529 Fiscal Year 2023 (October 1, 2023 to September 30, 2024) COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) Not -For -Profit Subrecipient Grant Application SUBMISSION DEADLINE March 27, 2023, 5:00 PM Hard copy and a Digital/Electronic Copy with all attachments to City of Boynton Beach Community Improvement Division 100 East Ocean Avenue Boynton Beach, FL 33435 (No applications will be accepted after 5:00 PM, on March 27, 2023) FOR MORE INFORMATION OR QUESTIONS, PLEASE CONTACT: CITY OF BOYNTON RJ Ramirez, Community Improvement Division Manager COMMUNITY IMPROVEMENT DIVISION 100 East Ocean Avenue Baynton Beach, FL 33435 Telephone: 561-742-6359 Email: ramirezr@bbfl.us boynton-beach.org/community-improvement 1530 Agency Name: Feeding South Florida Project: Senior Meal Delivery Program APPLICATION X Submit Hard Copy and a Digital/Electronic Application with all attachments X Application is signed and dated. By Director, and Board Chairperson X 501(c) (3) is attached (No -For -Profit Status) X City of Boynton Beach Business Tax Receipt attached (if applicable). X Board Member list. X Copy of latest audit. X All funding sources for this project identified. ADDITIONAL ATTACHMENTS X —Attachment 1 Agency Articles of Incorporation, Agency By-laws, and Tax Documents submitted to the Internal Revenue Service (IRS). X —Attachment2 Copies of current license(s) needed to operate (as applicable to the funded activity) including City of Boynton Beach Business Tax Receipt (if applicable) X —Attachment 3 Documentation of all additional funding sources for program(s)/project(s) listed in application (if applicable) A description/schedule of fees charged to the targeted X Attachment 4 beneficiaries of the programs/services/facilities to be funded (if applicable) A job description for each position for which funds are being X —Attachment5 requested (explain role/responsibilities within each program/project) (if applicable) 1531 Certifications and Affirmations Print Full Name: Applicant Signature: AVP ofPhilanthropy Date: March 24.2023 I certify that I am authorized to submit this application on behalf of the applicant I affirm that the award and payment of grant funds are subject to the sole and absolute discretion of the City of Boynton Beach City Commission without recourse. By submitting this application, I waive any and all claims related to the City of Boynton Beach CDBG Program and specifically agree to indemnify and hold the City, its employees, officers, agents, and representatives harmless from any and all claims which may be in any way related to any City of Boynton Beach CDBG Program award, payment, and/or denial. I certify that my agency was established and operating in the City of Boynton Beach on or before October 1, 2020. If funded, I affirm the applicant agency will continue service operations in the City of Boynton Beach. I affirm that the tax documents provided in this application are identical to those I have submitted to the Internal Revenue Service. I acknowledge that, funds are distributed by reimbursement onIV. if this grant is approved, any amount my agency receives may be considered taxable income by the Internal Revenue Service. I acknowledge that, if this grant application is approved, the City of Boynton Beach and Representatives of HUD, the Inspector General, and the General Accounting Office shall have access to all books, accounts, records, reports, files, and other papers, or property pertaining to the administration, receipt and use of CDBG funds necessary to facilitate such reviews and audits, as applicable and described under 24 CFR § I acknowledge that, all records relating to the City of Boynton Beach CDBG Program, including supporting documentation, shall be retained for the greater of three years from closeout of the grant to the City, as applicable and described under 24 CFR § 570.490(d), unless there is litigation, claims, audit, negotiation, or other actions involving the records. The records must be retained until completion of the action and resolution of all issues. I acknowledge that, if this grant application is approved, my name, my agency name, and my grant award amount may be made public by the City of Boynton Beach. I acknowledge that, if this grant application is approved, my agency will be subject to Florida Sunshine Law, FL State Statute 119.0701 Print Full Name: Applicant Signature: AVP ofPhilanthropy Date: March 24.2023 FY 2023 Funding Request To submit an application, complete A — I, Attachments 1-5 (if applicable) and any other items requested. Do not include any items that are not requested. Submit a Hard copy and a digital/electronic copy with all attachments to RJ Ramirez, Community Improvement Division Manager (ramirezr@bbfi.us) Community Improvement Division, 100 East Ocean Avenue, Boynton Beach, FL 33435 by 5:00 pm, March 27, 2023. Please review the "CDBG Subrecipient Information and Guidelines" available at CDBG I Cit o�ynton Beach (boynton-beach.org) for the program reporting requirements, goals and timelines. For assistance, please call the Community Improvement Division at 561-742-6359. A. GENERAL INFORMATION Name of Applicant: Feeding South Florida X No -For-profit Unique Entity ID # Z6MBJ8KL9MX1 Provide copy of your IRS ruling providing tax exempt status under Section 501(c) (3) of the 1986 IRS Code. Per 2CFR Chapter I Part 25 and the Office of Management and Budget guidance on Federal Funding Accountability and Transparency Act (FFATA) Subaward and Executive Compensation Reporting issued on August 27, 2010, each prime grant recipient may make subawards only to entities that have Unique Entity ID Number. 2. Name of Project: Senior Meal Delivery Program 3. Area or Location of Project: 4925 Park Ridge Blvd. Boynton Beach, FL 33426 4. Contact Person/Title: Allyson Vaulx, AVP of Philanthropy (Preferably Executive Director/President/CEO) Email Address: avaulx@feedingsouthflorida.org Mailing Address/Zip: 2501 SW 32 Terrace, Pembroke Park, FL 33023 Telephone: 954-518-1818 Fax: Additional Contact Person/Title: Lisa Devine, Grants Manager (Preferably Person responsible for preparing reimbursements/quarterly reports) Alternate Email Address: grants@feedingsouthflorida.org Mailing Address/Zip: 2501 SW 32 Terrace, Pembroke Park, FL 33023 Telephone: 954-518-1818 Fax: 3 1533 5. Grant Request Activity Area (choose one): R VA Homeless Prevention Services Domestic Violence Prevention Public Safety/Crime Prevention Housing Rehabilitation Program Other (please soecUy): Amount ofFunds Requested for Project: Amount ofMatching Funds for Project: N/A Match Type: ___ Cash Other Grants Donations Please Identify Source ofAdditional Funding: 8. CDBG COST: /a\ (b) Total CDBG Funds Requested Total Unduplicated Units Served 50 (Explain how deternnined7\ Feeding South Florida will provide 50 seniors with 13,000 meals. /6 CDBGAverage Cost Per Unit 6/b\$18824O per senior per year at $7.24 a meal TOTAL PROJECT COST INCLUDING OTHER SOURCE OFFUNDING: /a\ Total P $448,011.20 'O11 '20 (b) Total Unduplicated Units Served 238 (Explain how deternnined?) With full program funding, Feeding South Florida can provide 23Oseniors with G1.88Omeals. (r) TOTAL Average Cost Per Unit (a/b) $1882.40 per senior per year at $7.24 a nx»a El 9. |sthis project: X Anew service; or — A quantifiable increase in the level of an existing service which has been provided by the grantee on its behalf through State or local government funds in the 12 months preceding the submission of the grantee's Consolidated Plan Annual Action Plan Has the applicant received or will receive other Federal, State or local government funds for the proposed project(s) for which the applicant is requesting CIDBG funds? Yes No X If Yes, what is the funding source? How much? 10. Could this project occur without these funds? X Yes No 11. Will this project continue after [DBGfunding ends? X Yes No If Yes, describe how the applicant will guarantee the sustainability ofthe project/program after CDBG funds have been spent. We are committed to the sustainability of our Senior Meal Delivery Program. We will continue to grow our programs and reach additional families and individuals. With the support of gra . B. Please describe indetail the scope of services ofthe proposed project/activity tobefunded,indudingtheexpeotedbenefbsto the community, a plan nfaction, how the agency will implement the activity U.e, intake procedures, income certification, collection of required documentation, reimbursement request progress reports, end ofthe year report, etci(Attach additional sheets if necessary) The goal of the Senior Meal Delivery Program is to help low-income older adults achieve stability by addressing the underlying obstacles of access to nutritious food, which tend to fuel poor health outcomes. Feedina South Florida currently serves 42 Boynton Beach seniors through our Senior Meal DeliveU Program. We are requesting CDBG funds to maintain support for those 42 residents and increase our program to serve an increase of approximatel Feeding South Florida's Senior Meal Delivery Program addresses two main concerns facing ne of South Florida's most vulnerable populations today: health through increased access to nutritious food and social isolation. Seniors often face barriers to food access due to mobility, transportation, and financial security. Feedina South Florida launched this program in 2020, after merging with the Communily Cari g Center, and during a time of high -need as COVID-1 9 further perpetuated barriers to food access. We have sustained and grown the program as part of our ongoing strategic plan to end hunger in South Florida. To enroll in the Senior Meal Delivery Program, clients reach out to a Feeding South Florida Benefits Assistance Coordinator by phone or email. A referral can also be completed on the Feeding South Flhd bnite by a case manager, social service organization, family membe , or healthcare worker to request Feeding South Florida to contact the client directly. Our Client Services Team will compete a full intake to better d rota d demographics, including incom. household needs, transportation, social isolation and the ability to cook and prepare meals. Feeding South Florida iU assist with governmentbenefits applications,including SNAP (food stamps) and collect any necessary documentation such as pay stubs or social security income documentation. Feedinci South Florida also assesses existing resources the client may alrea yoe receivina to ensure we are not duplicating services in the community. Once enrolled, clients will C. STRATEGY: Check the ONE STRATEGY that best describes your project and provide number of units that will be served under this program. Check One Specific Objective Number of Units This Project Will Serve Educational Program (Specify) Households/Persons: (please specify which) Public Safety/Crime Prevention Households/Persons: (please specify which) Domestic Violence Prevention Households/Persons: (please specify which) Senior Services Elderly Households/Persons: (please specify which) X 50 seniors Youth Programs Children/Youth: Housing Rehabilitation Number of units to be rehabilitated: Other (Specify) Households/Persons: (please specify which) 1537 1. What documentation/data was used todetermine the need for this type of program? 2. How doyou evaluate the overall effectiveness ofthe program? 3. How this project relates tothe overall organizational structure? 4. Bevery specific how the CD8Gfunds are proposed tobeused? 5, How [D8Gfunds will itimpact your current operation? (Attach additional sheets if necessary) 1.Nor Hunger,well as other publications to identify . Data has shown that inadequate nutrition is a self-perpetuating problPm because it can be both a cause and a consequence of poor health and poverty, Census data forecasts that the senior population is expected to grow to 25% of the population by 2040, with Florida having the highest percentage of residents aged 65 and older. 2. Feeding South Florida utilizes a case managementoofbwo Oasis Insight, to monitor the number of clients in the program, the demographics of our client population, and track programs and services they b|izi We evaluateth effectiveness of the i d post metrics accessing food insecurity and self-report health. We also assess client satisfaction on a quarterly basis through a feedback survey that captures qualitative and quantitative data on food preferences, dietary restrictions, satisfaction on the quantity of meals, delivery process, enrollment process, communication and quality of meals. 3. Feeding South Florida's Si Meal Delivery Program is built it i strategy t address the needs of a vulnerable population. In line with our mission and vision to end hunger in South Florida, our Senior Meal Delivery Program seeks to fill gaps in the community and increase food access for homebound and socially isolated seniors. 4.COB m. as well as the food and labor costs associated with meal production and delivery. The program expenses include staff costs, utility costs for the Community Kitchen, food purchases, outreach efforts including the printing of materials, software, equipment and repairs, supplies and 5. Receiving CDB(] supporthn the City ofBoynton Beach will allow us to maintain and scale the program to increase the number of Boynton Beach seniors we serve. Hl- LOCATION, TARGET POPULATION AND INCOME CERTIFICATION 1. Where will the program take place and iSitwithin the City of BoyntonBeach Municipal Boundaries? Who are the targeted beneficiaries (i.e., geographic area, persons served, etc),and how are they selected for the program? 2. Are you working with other organizations in a cooperative effort on the program? YesX�No___ If yes, please list the other organizations and their role and responsibilities. (Attach additional sheets ifnecessary) 1. Feedinci South Florida's Senior Meal Delive[y Program serves the tri -county area. City of Boynton Beach CDBG funding would support the City of Boynton Beach residents currently enrolled in the program, as well as an estimated growth of 20%. Seniors are selected for the program through a referral pathway and client intake process. Seniors are screened for food insecurity, transportation and social isolation. 2. Feeding Palm Beach County works with a network of community partners as a referral pathway to ensure immediate access to nutritious food and provide wrap-around services for our Senior Meal Delivery Program. These partnerships include over 300 of our food pantry partners (60+ in Palm Beach County), senior centers, healthcare partners and C130's such as Kat for Humanity Greater Palm Beach County, Area Agency on Aging, Securing our Future Initiative Agencies (Dress for Success, Pathways to Prosperity, CareerSource PBC, West \ Beach Housing Authority, aun' 3. The City's CDBG funds must directly benefit low -and -moderate -income individuals (80% Area Median Income (AMI) or below). The City's CDBG program requires non-profit organization to income certify individuals seeking assistance through activities/programs/projects funded with the CDBG funds. Has the organization done income certification of individuals seeking assistance in the past? Yes X No If yes, please explain the process the organization uses to income certify Individuals? What type documentation is collected? Please attach with your application, a copy of the form your organization uses to income certify individuals. Feeding South Florida is a community partner of the Department of Children and Families and holds government contracts includinq the Commodity Supplemental Food Program and the Emergency Food Assistance Program. We have received CDBG and ARPA funding in the past and have utilized our case management software to collect, document and report on income certification. While our food assistance initiatives rely on only self -declaration of need, we have an intake form that requests household income and the ability to store supporting documentation in our case management software. "PLEASE SEE ATTACHED OUR CLIENT INTAKE FORM" 10 1540 Today's Date: Client First Name: Client Street Address: Telephone Number: 07 0������ 0�0m��^SOUTH FLORIDA CLIENT SERVICES INTAKE FORM Please answer all questions sothat we may better serve you. This information |sfor reporting purposes only and is not shared with any other entity. Completion of this form is not required to receive food assistance. Last Name: Date mfbirth: / /____ Gender Zip County; Client May aFeeding South Florida team member contact you to share your experience and feedback? OYes 171 No Referred by: OD[F El DOH OFhend/Fami|y OSenior Site OSchoo| OPartner Agency OCxher Are you or any members of your family currently receiving: OWIC (Women,Infants & Children) OSNAP (Supplemental Nutrition Assistance Program) El Medicaid n SSI (Supplemental Security Income/Disability) El Florida KIDCARE 0 TCA (Temporary Cash Assistance) Household Income: EJ Weekly [] Biweekly []Monthly El Annually Employment Status: OCurrently Employed Full -Time O Currently Employed Part -Time OUnemp|oyed O Disabled O Student ORetined Health Insurance: [] Household Insured [] Household Uninsured [] Some members ofhousehold insured and some uninsured Housing: ORent OOwn OShelter/Temporary Housing/Hotel OResiding with afriend/family member O Homeless/In need of housing O HDO/Section8 OSupported Housin8/Carrfour Education: OSome High School OHigh School Diploma/GED OSome College El Vocational El Associates O8oche|ory 11 Masters ODoctorate Revised November 2020 Race/Ethnicity: (Check All That Apply): ❑ American Indian or Alaskan Native ❑ Asian ❑ Hispanic or Latino ❑ Black or African American ❑ Caucasian ❑ Caribbean ❑ Native Hawaiian or Pacific Islander ❑ Multiracial ❑ Other: Veteran Status: ❑ Active Military ❑ Veteran (I or more day of service) ❑ Disabled Veteran ❑ Not a Veteran Other member(s) of the household: "Within the past 30 days, I/we worried whether our food would run out before we got money to buy more." (Select One): ❑ Often True ❑ Sometimes True ❑ Never True "Within the past 30 days, the food I/we bought just didn't last and we didn't have money to buy more." (Select One): ❑ Often True ❑ Sometimes True ❑ Never True Thinking about your physical health, which includes physical illness and injury, how many days during the past 30 days was your physical health not good?: Days Thinking about your mental health, which includes stress, depression or problems with emotions, how many days during the past 30 days was your mental health not good?: - Days First and Last Name Age Date of Birth Relationship Altering or modifying this document is prohibited. In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident. Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible Agency or USDA's TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English. To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD -3027, found online at How to File a Program Discrimination Complaint and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: program.intal(e@usda.gov. USDA is an equal opportunity provider, employer, and lender. Revised November 2020 1542 4. Does the organization charges fees toits clients? Yes ___No X U 5. VNppo0rarn|ncomnebe8enenatedfronnthisaciivbv?Yes____No X |fyes explain how will the program income be used? F. Goa Is/Objectives/Activity Measures: Descriptive narrative. Please use separate Goal Sheet/or each individual project (if applicable). mmTitle: Goal 4 1: Increase awareness about Feeding South F|oha'oSenior Meal Delivery Program Increase enrollment ofBoynton Beach Senior inthe Senior Meal Delivery Program by2O% Resources Needed & Available: -Staff -Delivery Van -Community Kitchen -.""" Start Date & Duration: October 2O23 - October 2O24 Goal ±L2: Increase access tohealthy, nutritious food for Boynton Beach seniors. SO%ofseniors enrolled inFeeding South Florida's Senior Meal Delivery Program will experience anincreased access tnhealthy, nutritious food. Resources Needed & Available: -staff -Community Kitchen -Delivery Van -Food Start Date & Duration: October 2023'October 2U24 ll G. PROJECT BUDGET Please list organization's anticipated expenditures, detailing requested funds and additional funding. Please place C=Cash,|=|n-Kind,O=OtherGrants, D=Donationsbeside each amount under "Other Project Funds"todenotethetypeoffundsbeingused. If funding request is for multiple prognarns/p 'ects,p|easeprovideasepanatePROJECT BUDGET for each program/project Line Item CDBG Funds Requ'ested Other Project Total Project Budget Funds Personnel (# Payroll Taxes Employee Benefits Office Supplies Copy Supplies Professional Services fee Other (explain) Other (explain) Other (explain) Other (explain) Other (explain) Other (explain) Other (explain) Other (explain) TOTALS "PLEASE SEE BUDGET SHEET ON NEXT PAGE 12 G. PROJECTBUDGET Please list organization's anticipated expenditures, detailing requested funds and additional funding. Please place C=Cash,|=|n-Kind,O=OtherGrants, D=Donationsbeside each amount under "Other Project Funds" to denote the type of funds being used. If funding request is for multiple programs/projects, please provide a separate PROJECT BUDGET for each program/project Une Item CDBG Funds Requested i Other Project Funds Total Project Budget Personnel $46,746.70 $175,767.59 $222,514.29 Payroll Taxes Employee Benefits Office Supplies Copy Supplies Professional Services fee Electricity $1,477.28 $5,554.88 $7,031.86 Pest Control $246.53 $926.96 $1,173.50 Security $117.20 $440.68 $557.88 Water and Sewer $128.35 $482.61 $610.96 Permits $787.99 $3,750.83 Food Purchases $32,503.25 $122,212.22 $154,715.47 Outreach Efforts $276.90 $1.041.14 $1,318.04 Software $416.00 $1,564.16 $1,980.16 Repairs $190.67 $716.91 $907.67 Supplies $10,029.49 $37,710.88 $47,740.37 Sanitation $536.88 $2,018.67 $2,555.44 Equipment Lease $570.89 $2,146.55 $2,717.44 Equipment Repairs $91.87 $345.42 $437.29 TOTALS $94,120 $353,891.20 $448,011.20 12 H. ORGANIZATION CAPACITY (Provide adetail description ofeach) 1. |sthe organization adequately staffed and trained? 2. Explain how this program fits the organization's mission? I Please explain the organization's experience with the proposed project? 4. Staffing Capacity: Who works onthe project directly and indirect|y? 6. Does the organization have written policies and procedures? How often are these policies and procedures updated? Provide abrief list ofthe topics covered inthe organization's policies and procedures. The City ofBoynton Beach may request a copy for review during the application and award process or as part of the grant monitoring process. (Attach additional sheets ifnecessary) 1. Feeding South Florida's team of friendly food bankers includes over 109 full-time employees and 1 part-time employee dedicated to our mission and core values. including service above all else. All team members complete civil rights training, FEMA Disaster Response training, food safety training and subject matter specific training such as OSHA Warehouse Safety. 2. Feeding South Florida's mission is to end hunger in South Florida by providing immediate access to nutritious food, leading huncler and poverty advocacy efforts, and transforming lives through innovative programming. We believe in providing food for today and also empowering families for a better tomorrow. Our Senior Meal Delivery Program addresses food access needs for one of South Florida's most vulnerable populations. 3. Feeding 25% of the entire state's food insecure population. We are one of over 200 food banks in the Feeding America Network and work closely with our state association, Feeding Florida. Leading the network's work in the healthcare and Food is Medicine intersection, Feeding South Florida partnered to publish a Senior Home Delive[y Playbook alonaside Feeding America, Feeding Tampa Bay and Humana. Our workh for Feeding America food banks to expandtheir own home delivery nd increase food 000eosfor homebound mnd socially isolated seniors. VVolaunched our Senior Meal D|iveProgram during the peak ofC{}V|O-19and have operated d expandedth the t3 years. To date, we have preparedand delivered- nearly over 6000 meals per monthfo Senior Meal Delivery Program. 4. The Senior Meal Delivery Program is supported by general food banking staff including 4 key team members and seven supporting team members. **PLEASE SEE ATTACIVIENT OF JOB DESCRIPTIONS 5. Feedina South Florida does provide an Employee Handbook that covers policies and procedu es. **PLEASEE SEE ATTACHMENT WITH TABLE OF CONTENTS Policies are updated as required by law, when needed or when the organization makes changes or develops new policies. Feeding South Florida typically reviews and updates these w|icjeaonanannual basis. 13 SOUTH FLORIDA" Created: July 2015 Revision: December 2022 1547 Table of Contents NatureofEmployment ---_—'--... ................... ......................................... ..................................... 9 TeamMember Relations ............................................................................................................................... 9 EqualEmployment Opportunity ................................................................................................................... 9 Business Ethics and Conduct -----_-----------'—'—_------------1U HiringofRelatives ........................................................................................................................................ 11 ImmigrationLaw Compliance .......................................................................................................... 1l Conflicts ofInterest .—.--------------------------------------.12 Non -Disclosure ................................................................................................................................. 12 DisabilityAccommodation ................................................................................................................ l3 JobPosting ....................................................................................................................................... 13 Ill. EMPLOYMENT STATUS AND RECORDS Employment Categories _.._..........-_'--..........--.---'—..-----.--_..__l4 PersonalData Changes ..................................................................................................................... 15 IntroductoryPeriod ........................................................................................................................... 15 EmploymentReference Checks ......................................................................................................... l5 Performance Evaluations .................................................................................................................. 1G W|.TEAM MEMBER BENEFIT PROGRAMS TeamMember Benefits ................................................................................................................... 16 Holidays............................................................................................................................................. 16 PaidTime Off (PTO).......................................................................................................................... 17 Workers Compensation ................................................................................................................... 19 DomesticViolence ........................................................................................................................... l9 JuryDuty .......................................................................................................................................... 2U LeavesofAbsence ............................................................................................................................ 2O Pregnancy Related Absence ------------------------------------25 MilitaryLeave ................................................................................................................................... 26 4 BereavementLeave.......................................................................................................................26 Benefits Continuation (COBRA) ............................. ................26 ........................................................ Timekeeping........................................................................ ...27 ........................................................ PayDays.........................................................................................................................................27 EmploymentTermination..............................................................................................................27 Pay Advances..................................................................... ........28 .................................................... Administrative Pay Corrections.....................................................................................................28 PayDeductions..............................................................................................................................28 IV. WORK CONDITIONS AND HOURS Safety.............................................................................................................................................28 WorkSchedules.............................................................................................................................29 Use of Phone and Mail Systems.....................................................................................................29 Smoking..........................................................................................................................................29 MealPeriods...................................................................................................................................29 Overtime........................................................................................................................................30 Useof Equipment..........................................................................................................................30 EmergencyClosings.......................................................................................................................30 BusinessTravel...............................................................................................................................31 Visitorsin the Workplace...............................................................................................................31 Computerand Email Usage............................................................................................................32 InternetUsage...............................................................................................................................32 WorkplaceMonitoring...................................................................................................................34 SocialMedia...................................................................................................................................34 Workplace Violence Prevention.....................................................................................................36 CellPhone Usage...........................................................................................................................37 V. TEAM MEMBER CONDUCT AND DISCIPLINARY ACTION Team Member Conduct and Work Rules.......................................................................................39 Drugand Alcohol Use........................................................................................... Harassment and Discrimination.....................................................................................................40 3 1549 Attendanceand Punctuality ........................................................................................................... 41 PersonalAppearance ...................................................................................................................... 42 ReturnofProperty .......................................................................................................................... 42 Resignadon--------------------------------------------. 42 SecurityInspections ......................................................................................................................... 0 5o|khation--------------------------------------------... 43 ProgressiveDiujp|ine---------------------------------------. 44 ProblemResolution .......................................................................................................................... 44 WorkplaceEtiquette ........................................................................................................................ 45 VVhisdeb|owec------------------------------------------.. 47 "I APPLICANT CAPACITY (cont.) 5. Will all [DBG hJDdS 8vvanjed be maintained in 8 manner that they will be accounted for separately and distinctly from other sources of revenue or funding? Provide a brief description of the organization's policies and procedures that ensure funds will betracked appropriately. 7. Is the organization's financial management system able to track actual expenditures and outlays with budgeted amounts for each grant orsubgnanL? Provide abrief summary ofthe organization's process for tracking expenditures, including tracking budgeted versus actual amounts. Q. Does the organization have effective internal controls in place to ensure that federal funds are used solely for authorized purposes? Provide abrief description of the applicant's internal controls that will provide reasonable assurance that the award funds will bemanaged properly. 9. Does the organization have a documented records retention policy? If so, briefly describe the policy and confirm that the policy complies with federal regulations. Information onRecords Retention and Access can befound at2[.F.R§2OO.333' 200-337.(ALtachadditiona|aheetsifnecesaary) 0. The Finance Department at Feeding South Florida creates classifications within its general ledger system to capture revenue and expenses related to funding where distinct accountability and progress reporting is required. 7. Supplement maintained in which one tab contains the original budget and then a progress tab showing how muchofthe budget has already 8. On all federal grants, the food supply chain department maintains an inventory, matching the requirements of the grant. On non -inventory related grants, a purchase order is immediately placed when outside services are proculed. "Inside" services such as payroll for staff dedicated to the project are allocated directly to the corresponding grant. _ In accordance with Federal, State, Local and Feeding America member guidelines, Feeding South Florida followsrecords retention 14 |. Conflict of Interest Federal law (24CFR 570.611) pro hi bits persons who exercise or who have exercised any functions or responsibilities with respect iOthe above grant ... Vrwho are in B pO5hiDO to participate in a decision making process or1ogain inside information with regard to such activities, may obtain a financial interest or benefit from an assisted activity ... either for themselves or those with whom they have family or business ties, during their tenure or for one year thereafter. I. Is there any member of the applicant's s1off, member of the applicant's Board of Directors, or office who currently is or has/have been within one year of the date of this application aCity employee, or member ofthe City Commission? Yes X No If yes, please list names: 2. Is there any member ofthe applicant's staff, member(s)ofthe Board of Directors, or officer(s) who are business partners or immediate family of a City employee, oromember ofthe City Commission? Yes « No If yes, please list names: 3. Will the funds requested by the applicant be used to pay the salaries of any of the applicant's staff oraward a subcontract to any individual who is or has been within one year of the date of this application a City employee, or a member of the City Commission? Yes X No If yes, please list names: 15 Funding from this grant program is subject to federal, state and local audit. If a determination is made that these grant funds were used in a manner inconsistent with program guidelines, for an ineligible expense or for expenses reimbursed by another federal, state or |OC8| gr8D1/lO8D program then the awarded entity will reimburse the City of Boynton Beach these funds. SUBMISSION OF AN APPLICATION IS NOTA GUARANTEE OF FUNDING It is the responsibility of the applicant to READ AND UNDERSTAND all aspects mf the CDBG grant program, the application, and City's procurement process, if applicable. NOTICE TO THIRD PARTIES: The COBG grant application program does not create any rights for any parties, including parties that performed work onthe project. NorshaUiasuanceofaCD8G grant result in any obligation on the part of the City of Boynton Beach to any third party. The City is not required to verify that entities that have contracted with the applicant have been paid in full, or that such entities have paid any subcontractors in full. Applicant's warranty that all bills related tothe Project forvvhichtheapp|icantisdireut|ynesponsib|eissufMcientassuranceforthe City to award loan funding. The applicant certifies to the best of his/her knowledge and belief that the data in this application is true and correct and that the filing of the application has been duly authorized by the governing body of the applicant (if applicable) and that the applicant will comply with all the requirements ofthis grant ifthe application isapproved. Name' Allyson VauIx Title: AVP of Philanthropy Signaturk=� Date: March 24, 2023 Name: Signature: Title: Date: 16 BYLAWS OF FEEDING SOUTH FLORIDA, INC. a Florida Not for Profit Corporation 1554 BYLAWS OF FEEDING SOUTH FLORIDA, INC. a Florida Not for Profit Corporation Article I NAME AND PURPOSE Section 1.1 Name. The name of the corporation is Feeding South Florida, Inc. (the Corporation ). Section 1.2 Purposes. The purposes of the Corporation are those stated in its Articles of Incorporation. 1 Article II OFFICES Section 2.1 Registered Office. The location of the registered office of the Corporation shall be at 2501 S.W. 32nd Terrace, Pembroke Park, Florida, 33023-7707, which location may be changed from time to time by the Board of Directors. Section 2.2 Other Offices. The Corporation may also have offices or branches at such other places, both within and without the State of Florida, as the Board of Directors may from time to time determine or as the business of the Corporation may require. Article III MEMBERSHIP The Corporation will not have members .2 Article IV DIRECTORS Section 4.1 Responsibilities of the Board. All power and authority regarding the property, affairs and management of the Corporation shall be vested in and controlled by the Board of Directors. The Board of Directors shall establish policies and directives governing the business of the Corporation, and may delegate to the Chair of the Corporation or to a Committee of the 1555 Corporation, subject to the provisions of these Bylaws, authority and responsibility to ensure that the policies and directives are implemented by the Board of Directors, Committees, and Officers. The Board of Directors shall have no authority to take any action contrary to, or inconsistent with, the Articles of Incorporation, these Bylaws or the provisions of the Florida Not For Profit Corporation Act, as amended (the Act ). Each Director shall contribute to the Corporation least $2,500 annually and shall cause to be contributed by others funding, goods or services having a value (as determined by the Board) of minimum $_[25,000] annually. Section 4.2 Number And Qualifications. The Board of Directors shall be composed of no less than three (3) Directors. Membership on the Board of Directors shall be nondiscriminatory with regard to age, race, gender, sexual orientation, religion, ethnicity or creed. Section 4.3 Nominations. Nominations to the Board of Directors shall be made in accordance with the policies and procedures developed and implemented by the Board of Directors. Section 4.4. Election. The Directors shall be elected at the annual meeting of the Board of Directors by a majority vote of Directors present at such meeting. Section 4.5. Term. Directors shall be elected for such term as determined by the Board of Directors. Which term shall be the same for each Director or applicable class of Director, but absent such determination -each Director shall be elected for a three-year term. No Director shall be elected for more than two 3 -year terms. Newly elected Directors shall assume office, and terms of Directors that are expiring shall expire, as of the date of the annual meeting of the Board of Directors or at any other time as designated by the Board. Directors that are appointed to fill a vacancy shall take office immediately and hold office for the unexpired portion of the term of the vacating Director. Unless removed in accordance with the provisions of these Bylaws, each Director shall hold office for the term for which she or he is elected or appointed and until her or his successor shall have been duly elected or appointed. Section 4.6 Vacancies. A vacancy shall be declared in any seat on the Board of Directors upon the death, resignation, or removal of the occupant thereof, or upon the disability of any occupant rendering him or her permanently incapable of participating in the management and affairs of the Corporation. Vacancies on the Board may be filled at any time, as they arise, at a duly called meeting of the Board of Directors by the affirmative vote of a majority of the Directors present at such meeting. Section 4.7. Resignation. A Director may resign by written notice to the Corporation. The resignation is effective upon its delivery to the Corporation or a subsequent time as set forth in the notice of resignation. If a resignation is made effective at a later date, the Board of Directors may fill the pending vacancy before the effective date if the Board of Directors provides that the successor does not take office until the effective date. 1556 Section 4.8 Removal. Any Director may be removed at any time, with or without cause, by a majority vote of the total number of Directors at a duly called meeting of the Board of Directors. Removal of a Director shall result in a vacancy of the removed Director's board seat. A proposed removal of a Director at a meeting shall require a separate vote for each Director whose removal is sought. Where removal is sought by written consent, a separate consent is required for each Director to be removed. If removal is effected at a meeting, any vacancies created shall be filled by the Directors eligible to vote for the removal. Any Director who is removed from the Board is not eligible to stand for reelection until the next annual meeting at which Directors are elected. Any Director removed from office shall turn over to the Board within 72 hours any and all records of the Corporation in his or her possession. If a Director who is removed does not relinquish his or her office or tum over records as required under this section, the circuit court in the county where the Corporation s principal office is located may summarily order the Director to relinquish his or her office and tum over corporate records upon application of any Director. Section 4.9 Absence of Director. Any Director unable to attend a meeting shall inform the President or Chair in advance of the meeting, stating the reason for his or her absence. The President or Chair shall have the power in his or her sole and absolute discretion to excuse such absence. If a Director has two or more consecutive unexcused absences, the Directors resignation shall be deemed to have been tendered and accepted. Section 4.10 Chair. The Chair shall provide the leadership required to ensure the adequate performance of duties assigned to the Board of Directors, Officers and any Committees established by the Board. The Chair shall preside at all meetings of the Board of Directors. The Chair shall be an ex -officio voting member of all standing and special Committees. In general, the Chair shall perform all duties incident to the office of Chair and have such other powers and duties as may from time to time be prescribed pursuant to resolutions duly adopted by the Board of Directors. The Chair shall chair the Executive Committee. The Chair shall appoint Chairpersons and members of all Board Committees, and the Chair shall have the authority to appoint Directors to undertake specific tasks as needed. Section 4.11 Absence of Chair; Vacancy. In the absence of the Chair or in the event of the Chair's inability or refusal to act, the Treasurer shall perform the duties of the Chair, and when so acting shall have all the power of and be subject to all of the restrictions upon the Chair. In the event of a vacancy of the office of Chair, the Treasurer shall become acting Chair until the vacancy is filled by action of the Board of Directors. The Treasurer shall communicate with the Chair and the Directors and shall assist the Chair in performing his or her duties, as requested by the Chair. Article V MEETINGS OF THE BOARD OF DIRECTORS Section 5.1 Place of Meetings. Meetings of the Board of Directors may be held either within or without the State of Florida. Section 5.2 Regular Meetings. Regular meetings of the Board of Directors may be held at such time and at such place as shall from time to time be determined by the Chair or the vote of the Board of Directors. Any notice given of a regular meeting need not specify the business to be transacted or the purpose of the meeting. Section 5.3 Saecial Meetings. Special meetings of the Board of Directors may be called by the Chair and shall be called by the Secretary on the written request of any two Directors. The 1557 person authorized to call special meetings of the Board of Directors may fix any place, either within or without the State of Florida, as the place for holding any special meeting of the Board of Directors called by her or him. Written notice of any special meeting shall be given to all Directors at least 48 hours prior to such special meeting. Notice of any special meeting need not specify the business to be transacted or the purpose of the meeting. Section 5.4 Annual Meetings. The annual meeting of the Board of Directors will be held at such time and place as designated by a majority of the Board of Directors. Section 5.5 Attendance as Waiver of Notice. Attendance of a Director at any meeting shall constitute a waiver of notice of such meeting, except where a Director attends for the express purpose of objecting to the transaction of any business on the ground that the meeting is not lawfully called or convened. Section 5.6 Quorum of Directors: Majority Vote. At all meetings of the Board of Directors, the presence (whether in person or by electronic medium that allows immediate, contemporaneous exchange) of a majority of Directors then in office shall constitute a quorum for the transaction of business, and the act of the majority of the Directors present (whether in person, by telephone, or by proxy) at any meeting at which a quorum is present shall be the act of the Board of Directors, unless the act of a greater number is required by the Act, the Articles of Incorporation or these Bylaws. If a quorum is not present at any meeting of Directors, the Directors present in person may adjourn the meeting from time to time, without notice other than announcement at the meeting, until a quorum is present. Section 5.7 Action Without a Meeting. Any action required to be taken at a meeting of Directors, or any action which may be taken at a meeting of the Directors or any Committee, may be taken without a meeting if consent in writing (including electronic media), setting forth the action to be taken, shall have been signed by all of the Directors or Committee members. Such consent shall have the same force and effect as a unanimous vote at a meeting. Section 5.8 Electronic Presences at a Meeting. Subject to the provisions of the Act and these Bylaws concerning notice of meetings and unless otherwise restricted by the Articles of Incorporation or these Bylaws, members of the Board of Directors, or members of any Committee, may participate in and hold a meeting of such Board of Directors or Committee by any means that provides immediate, contemporaneous verbal exchange by which all Directors participating may hear each other simultaneously during the meeting, and such participation shall constitute presence in person at such meeting, except where a person participates in the meeting for the express purpose of objecting to the transaction of any business on the ground that the meeting is not lawfully called or convened. 1558 Section 5.9 Compensation. Directors as such shall not receive any compensation for their services as Directors, but no Director shall be precluded from serving the Corporation in any other capacity and receiving compensation therefore and Directors may, by resolution, authorize reimbursement of expenses incurred in the performance of their duties. Article VI NOTICES Section 6.1 Delivery of Notices. Whenever, under the provisions of the Act or of the Articles of Incorporation or of these Bylaws, written notice is required to be given to any Director or Committee member, such notice shall be given in writing by personal delivery, facsimile, email, overnight delivery service or by mail (registered, certified or other first class mail) addressed to such Director or Committee member at his or her address as it appears on the records of the Corporation, with postage thereon prepaid. Such notice shall be deemed to be given upon the date emailed, upon confirmation of receipt, if sent by personal delivery or facsimile, one day after delivery to a recognized overnight delivery service, or three days after the notice shall be deposited in a post office or official depository under the exclusive care and custody of the United States postal service. Section 6.2 Waiver of Notice. Whenever any notice is required to be given under the provisions of the Act or of the Articles of Incorporation or these Bylaws, a waiver thereof in writing, signed by the person or persons entitled to said notice, whether before or after the time stated therein, shall be deemed equivalent thereto. Neither the business to be transacted at, nor the purpose of, any regular or special meeting of the Directors or a committee need be specified in any written waiver of notice. Article VII OFFICERS Section 7.1 Elective Officers. Elective Officers of the Corporation shall be elected each year by the Board of Directors at the annual meeting of the Board of Directors. Any such election shall be held by open voting unless a Director moves to have such election held by ballot and two other Directors second such motion, in which case the election shall be held by ballot. A majority of the votes cast shall cant' the election. The Board of Directors may elect such additional officers or assistant officers as it may from time to time determine. 1559 Section 7.2 Term of Officers. Each elective officer shall take office immediately upon his or her election and shall serve for a term of one year and until his or her successor is duly elected and qualified. Section 7.3 Vacancy: Removal; and Resignation. Any Officer elected or appointed may be removed, with or without cause, by the persons authorized to elect or appoint such Officer whenever in their judgment the best interests of the Corporation will be served thereby. A vacancy occurring in any office of the Corporation by death, resignation, removal or otherwise shall be filled by the Board of Directors. An Officer may resign by written notice to the Corporation. The resignation is effective upon its delivery to the Corporation or a subsequent time as set forth in the notice of resignation. If a resignation is made effective at a later date and the Corporation accepts the future effective date, the Board of Directors may fill the pending vacancy before the effective date if the Board of Directors provides that the successor does not take office until the effective date of the pending vacancy._ Section 7.4 Vacancy in Officer Position. Vacancies in any office may be filled for the balance of the term thereof by the Directors at any regular or special meeting. Section 7.5 Chief Executive Officer. The CEO shall report to the Board of Directors on operations and all matters material to the business of the Corporation, and shall perform such other duties as are necessarily incident to the office or as may be prescribed by the Board of Directors. The CEO shall participate in the active management of the affairs of the Corporation, and shall be responsible for overseeing the implementation and operation of the Corporation's charitable and educational programs. The CEO is an ex -officio, non-voting member of the Board. Section 7.6 Treasurer. The Treasurer shall be responsible for: monitoring the control, receipt, and custody of all assets of the Corporation; monitoring disbursements as authorized by the Board of Directors; and reporting receipt, use and disbursements of all assets of the Corporation. The Treasurer shall exercise the powers and perform such other duties usually incident to the office of Treasurer. Section 7.7 Secretary. The Secretary shall be responsible for seeing that notices are issued for all meetings of the Board of Directors, and shall see that the minutes of such meetings are kept. The Secretary shall be responsible for the custody of corporate books, records and files, and shall exercise the powers of the office of Secretary. The Secretary shall be responsible for authenticating records of the Corporation. Section 7.8 Other Officers. To the extent the powers and duties of any Officers are not provided in these Bylaws or from time to time by resolution or other directive of the Board of Directors, the Officers shall have all powers and shall discharge the duties customarily and usually held and performed by like officers of corporations similar in organization and business purposes to the Corporation. Article VIII 1560 COMMITTEES OF THE BOARD OF DIRECTORS Section 8.0 Committees. (a) The Board of Directors, by resolution adopted by a majority of the full Board, may designate from among its members an Executive Committee and one or more other committees (a Committee ) each of which, to the extent provided in such shall have and may exercise all the authority of the Board, except that no such Committee shall have the authority to fill vacancies on the Board or any Committee thereof or adopt, amend, or repeal these Bylaws. b) The meeting, notice and waiver of notice, and quorum and voting requirements of the Board of Directors shall apply to Committees and their members. (c) Each Committee must have two or more Directors who serve at the pleasure of the Board. The Board, by resolution adopted in accordance with Section 8.0(a) hereof, may designate one or more Directors as alternate members of any such Committee who may act in the place instead of any absent member or members at any meeting of such Committee. (d) Neither the designation of any such Committee, the delegation thereto of authority, nor action by such Committee pursuant to such authority shall alone constitute compliance by any Director who is not a member of the Committee in question with his or her responsibility to act in good faith, in a manner he or she reasonably believes to be in the best interests of the Corporation, and with such care as an ordinarily prudent person in a like position would use under similar circumstances. Section 8.1 Advisory Committees. The Board of Directors may, from time to time, create honorary and/or advisory Committees to support and promote the activities of the Corporation. Such Committees shall have such purposes, powers and procedures as shall be determined from time to time by the Board of Directors. Section 8.2 Vacancies. Vacancies in the membership of any Committee may be filled by appointments made in the same manner as provided in the case of the original appointments. Section 8.3 Reports. Each Committee shall report findings and recommendations to the Board of Directors as required to keep the Board of Directors reasonably informed of such Committee s findings and recommendations. Article IX DUTIES OF DIRECTORS AND OFFICERS Section 9.1 Duty of Directors and Officers. Directors and Officers shall discharge the duties of their respective positions in good faith and with that degree of diligence, care, and skill which ordinarily prudent persons would exercise under similar circumstances in like positions. In the administration of the powers to make and retain investments, to appropriate appreciation, and to delegate investment management of institutional funds, as provided by law, the Board of Directors shall consider among other relevant considerations the long and short-term needs of the Corporation in carrying out its purposes, its present and anticipated financial requirements, expected total return on its investments, price level trends and general economic conditions. In discharging their duties, Directors and Officers, when acting in good faith, may rely upon financial statements of the Corporation represented to them to be correct by the Chair, or the Officer of the 1561 Corporation having charge of its books of accounts, or stated in a written report by a certified public accountant or firm fairly to reflect the financial condition of the Corporation. Section 9.2 Conflict of Interest. Directors and Officers serve the Corporation in a fiduciary capacity and as such owe a duty of loyalty to the purposes of the Corporation. Any possible conflict between the interests of the Corporation and the personal or business interests of a Director, an Officer, or member of their families, shall be disclosed to the Board and made a record through an annual procedure and also when the interest becomes a matter of Board action. Any Director having a duality of interest or a possible conflict of interest on any matter shall not vote or use personal influence on the matter. The minutes of the meeting shall reflect that a disclosure was made and the abstention from voting. This conflict of interest policy shall not be construed as preventing a Director or Officer from stating his position in the matter or from answering pertinent questions since his knowledge may be of great assistance to the voting Directors. Article X INDEMNIFICATION AND EXCULPATION Section 10.1 Indemnification. The Corporation, to the fullest extent authorized or permitted by the provisions of the Act, shall indemnify against liability, and advance expenses to, any person, and his or her heirs, executors, administrators and legal representatives, who is or was a party to any proceeding by reason of the fact that such person is or was a Director or Officer of the Corporation or is or was serving as a director or officer of another corporation, partnership, joint venture, trust or other enterprise at the request of the Corporation. Officers and Directors who are so entitled to be indemnified shall be paid their expenses in advance of a final disposition of the proceeding to the maximum extent authorized or permitted by the provisions of the Act. Section 10.2 Insurance. The Corporation shall have the power to purchase and maintain insurance to indemnify the Corporation and its Directors and Officers whether or not the Corporation would have the power to indemnify its Directors and Officers against such liability. Section 10.3 Private Foundations and Other Limitations. In no case shall the Corporation indemnify, reimburse, or insure any person for any taxes imposed on such person under chapter 42 of the Code. Furthermore, (a) if at any time the Corporation is a private foundation within the meaning of section 509(a) of the Code, then during such time no payment shall be made under this Article if such payment would constitute an act of self-dealing or taxable expenditure as defined in section 4941(d) or section 4945(d), respectively, of the Code and (b) if at any time the Corporation is not a private foundation within the meaning of section 509 of the Code, then during such time no payment shall be made under this Article if such payment would constitute an excess benefit transaction as defined in section 4958 of the Code. Section 10.4 Exculpation. A Director shall not be personally liable to the Corporation or any person for monetary damages for failure to perform his or her duties as a Director, unless such failure to perform constitutes (a) a violation of the criminal law, unless the Director had reasonable cause to believe his or her conduct was lawful or had no reasonable cause to believe his or her conduct was unlawful (b) a transaction from which the Director derived an improper personal benefit, directly or indirectly, or (c) recklessness or an act or omission that was committed in bad faith or with malicious purpose or in a manner exhibiting wanton and willful disregard of human rights, safety or property. If the Act hereafter is amended to authorize the further elimination or limitation of the liability of directors, then the liability of Directors of this Corporation shall be 1562 eliminated or limited to the full extent authorized by such amendment. Section 10.5 Amendment or Repeal. Any repeal or modification of the foregoing provisions of this Article shall not adversely affect any right or protection hereunder of any person in respect of any act or omission occurring prior to the time of such repeal or modification. The rights provided hereunder shall inure to the benefit of any indemnified person and such person s heirs, executors and administrators. Section 10.6 Severability. If any part of this Article shall be found in any action, suit, or proceeding to be invalid or ineffective, the validity and the effectiveness of the remaining parts shall not be affected. Article XI GENERAL PROVISIONS Section 11.1 Contracts. The Board of Directors may authorize any Officer or Officers, agent or agents of the Corporation, in addition to the Officers so authorized by these Bylaws, to enter into any contract or execute and deliver any instrument in the name of and on behalf of the Corporation, provided that such contract or instrument is in alignment with the mission and direction of the organization, and is not in violation of the Articles of Incorporation, these Bylaws or applicable law. Such authority may be general or confined to specific instances. 1563 Section 11.2 Contn�Contributions, bequests and gifts to the Corporation shall be accepted or collected only as authorized by the Board of Directors. Guidelines for accepting contributions shall be established by the Board of Directors. Section 11.3 Checks and Drafts. All checks, drafts, or orders for the payment of money, notes, or other evidences of indebtedness issued in the name of the Corporation shall be signed by such Officer or Officers, agent or agents of the Corporation and in such manner as shall from time to time be determined by resolution of the Board of Directors. The Board Chair shall countersign all authorizations for payments of bills, except the payment of normal, routine, and recurring bills in an amount not exceeding $25,000. Section 11.4 PAP -0 -sits. All funds of the Corporation shall be deposited from time to time to the credit of the Corporation in such banks, trust companies, or other depositories as the Board of Directors may select. Section 11.5 Financial Report A summary report of the financial operations of the Corporation shall be made available to the public annually, in such form as the Board of Directors shall provide. Within 60 days following the end of the fiscal or calendar year or annually on such date as is otherwise provided by the Board, the Executive Committee shall provide to each Director a complete financial report of actual receipts and expenditures for the previous 12 months. The report shall show the amounts of receipts by accounts and receipt classifications and shall show the amounts of expenses by accounts and expense classifications. Section 11.6 Fiscal Year. The fiscal year of the Corporation shall be fixed from time to time by resolution of the Board of Directors, but shall begin on July list and end June 30"' , if not otherwise fixed by the Board of Directors. Section 11.7 Seal. The Board of Directors may provide for a corporate seal in such form as it prescribes. The corporate seal shall have inscribed thereon the name of the Corporation and the words "Corporate Seal, Florida." The seal may be used by causing it or a facsimile thereof to be impressed or affixed or reproduced or otherwise. Except as otherwise provided by law, the failure to affix the seal of the Corporation to a document shall not affect the validity thereof. Section 11.8 Books and Records. The Corporation shall keep correct and complete books and records of account, shall keep minutes of the proceedings of its Board of Directors and Committees having any authority of the Board of Directors. Section 11.9 Nondiscrimination Policy . The Corporation shall, in the conduct of its business, programs and activities, admit program participants of any race, color, religion, national origin, disability, gender, sexual orientation, age and ethnic origin to all the rights, programs, and activities generally accorded or made available to participants in the Corporation s programs. The Corporation shall not discriminate on the foregoing basis in administration of its educational policies, admission policies, and other Corporation -administered programs. 1564 Section 11.1 o Confirm I!W Except as required by applicable law, legal process or agreements to which the Corporation is a party, each Director and Officer and his or herconfirespective espe ti e agents shall keep secret and confidential, and agrees to keepsecret refrred to as information acquired relating to the following (all he financ'al ll such Gond tioin and ormaton her informat onerelating to Confidential Business Information ): (a) the business of he Corporation, including without limitation, its rates so stemsc s, its operations s and arrangements; (b) and contracts, and its business planY services, marketing sales, administration and management procedures, trade relations or practices, techniques and practices heretofore or hereafter acquired, developedonors, andor used suppliebs, the Corporation; and (c) the Corporations providers, clients, customers, vendors, lenders, independent contractors and payers and the provisions and terms of any agreements or proposed agreements between the Corporation and any of such individual or not on shl entities; provide that nCoDi Directorion already ial Officer shall atsiness tiany time disclosed Confidential Business publically available. Information to any person, firm, corporation, association or other entity, or use the same in any manner other than in connection with the business and affairs of the Corporation. Directors and Officers shall under no circumstances use Confidential Business Information in any way reasonably perceived as detrimental to the Corporation. aff Section 11:11 B1ts tiaws shall govern the internal ent with law and he ArArticlesof Incorporat one Corporation, but only tohe extent they are cons Article XII AMENDMENTS These Bylaws may be amended or repealed, or new Bylaws may be adopted, at a duly called meeting of the Board of Directors - by the affirmative vote of two-thirds of the Directors present at such meeting. 1565 a?� �5 ARTICI ES DF 1NCORPORATIo.E , ` OF wa DAILY BREAD•C0: Mjj1TY F'OOD.HAN'K , * ±,pr�l } t T�14 - (a'Florida Corporation Not for Profit) VE, the undersigned avbsczibers. to these Articles E of Incorporation, being natural.persona competent to contract, do L Y - - i hereby associate ourselves in the ,formation'of a corporation not for profit under the laws of the State of Florida, pursuant to Tyr: the provisions of Chapter 617;'Florida Statute$,�� t{ Y! ARTICLE 1.'....> CORPORATE Z4R IE The name of :he Corporation shail'be: DAILY isR£AD_COMMUNITY FOOL] BANK, ll;C,. ARTICLE II a r='�!' PURPOS"S. Ft� i The purposes of 'which this Curpniation.fs organized :'LtiL are', _ ts, 1. To feed the hungry through the procurement and distribution ofsal,vogeable'and'surplus food and to :operate. and mainiain Community Food•Bank facflitie9. aid u ' 2. To collect,.store,' warehouse and distribute.salvage- able and surplus food to'social and charitable, agencies and other' rti€ organizations chatqualify under Section 501(c)(3) of the Interna! Revenue'Code'ef-1954,'as tax, exempt organizations;, l 3. TO.Opetate exclusively for such charitable and educational'puzposes that will qualify ,.this Corporation as a tax s exempt organization under Section '501(c) t3) of. the" ,Internol Revenue 6. % Fz " Code of 1954, or' the:correspondiiig_�provision-'of any subsequent lntepta! kevenua.:Cpde or t4x law, t •' , - _ ,fir l = W4LTOULANTAFF KMROKOER CJRSON, - - 1' r` - VOALFp LC .O W9N1 ■IILG116,V Wllowr0 ,]]r]I, TLLtI„V w[rA!LR CG]E )011 ]7;L 5a ,' L♦h r' 1566 h3 AIM- ­®Rnl, ARTICLE III j� �'l. ALIFICATIOP� OF HiEbIBER3 AHD' MANNER OF THEIR ADMISSION Ufa Any person interested in feeding the hungry and dedicated to the purposes and ob'jOctiYea specified in these aY. _ Articles. of Inrorporatian'is qualified,and eligible far Membership �Si F in this carporetlon, The mariner. of admission to membership shalt i be evidenced by a Certificate of Meu,bership issued by the Corpora - tion. to each sciabar. Each member shall be 'subject to kha rights, privileges and duties set forth in ehe''Sy-Laws. ' ARTICLE IV TERM This Corporation- shall have perpetual existence. --. ARTICLE- V NAMES AND RESIDENCES OF SUSCRIHERS The names and residences of the Subscribers are. 1,1ILLIA!•1 J. GRAY 6030 S. hr. 8th Street Plantation, Fldrida 33317 `NiC110LAS E. CHRISTIN 15521 S. {,: 74th Avenue., f Miami,. Florida 33157 fi' '9 5 GEORGE CHEBR041 ` t 1230 So, Alhambra Circle Coral Gables, Florida -33146 iZ���R ARTICLE Vi t�t -w5�t� OFFICERS AND THEIR ELECTION OR APPOINTMENT. i:, The affairs of this Cb_rporation are to be managed by .gra' , . .. • n r� a President one ar.more Vice+Presidents, a Secretary and a Treasurer. Those Officers be elected shall or appointed at the k`f annual meeting .of the members of the Corporation. , 5. - - iYAITON VE!% ELAXTAFF$CHa00 ER CARSON:. - ice•irweo c.-ot,a,au,o.+o. urF�-rvewio i7rrrnre rwrir mnE iosra an'. .`aa�" 1567 b + 777777777 ARTICLE VII FIRST OFFICERS .` The. name's of -tho- officers who are CO serve until thc. !i. first eieCtl0n or appointment under these Articles of corporation 't are, ,a Ha me Office WILLIAM J. GRAY President 3cf�'f ` FJ, RICHOLAS E, CHRISTYta. .p: Vice President > OEDRC6 CIIESRp'A Secretary and Treasurer sis ARTICLE VIII t+ FIRST BOARD OF DIRECTORS 7. The The affairs of this Corporation shy+11 be conducted by j es! a Board of Directors of at feast three members. The names and addreases of the personn.uho areto serve as Directors until the 7> ^" first election thereof are: ' 1 Address . WILLIM-1 3 GRAY 0 �,- 6430 5, k• 8th Street Plantation, Florida ..333[7 NICHOLAS E..CHitISTIN 15521 S. W. 79th Avenue: 's Nfami' Florida 331,,u ��t g GEORGE CHESR014 1230 S. AlhambYa Circle Coral Cables,. Florida 33146. -"i Vis} t'�'Fru ARTICLE iR f x>aF. The B p By-Laws this Corporation are to he made, altered, ame1nded or rescinded by a two-thirds vote of all of the members of ?,L the Board of Directors, at a meeting duly called for that specific 1 purpose. -A meeting hereunder is duly called if:it-is called by any . -1 Director or the President of the.Cor oration at an regular or' ' P Y 8 Ispecial meeting field prior to the meeting provided.for herein. ARTICLE }: ' AMENDMENTS To ARTICLES of 'INCORPORATION C Amendments to these Artie Jigs of Incorporation may be' Piop"osed,by any member. of the Board of Directors and sdapted by ' - WACFOr/ RAA7wFF3gssojoe6 CARi07f _ �9?6l �FpJ. OuaUT�V+LO.LG, NYI,H p�ORIC6 IIf71. I,LLFiryO vl iwll[A CODA' SM. i1l6.., WIP 1568 y n . 5_ To hold. invOst, reinvest. and nanrkge money and property and to use the principal and ineor:e thereof. s - i 6. To borron money anti execuce ,and issue urornissory nvtes, bonds, dubentures, and other evidm)ce of Indebtedness, fron time r"o—Ime, for any 1as.•fu2 carprate purpose and'to mortgave, Pledge and othenrise-charge any and all of its property and other assets to secure the payment thereof: 7. To do ail and everyr"hing necessary and proper £or. i the accomp:inh=ent of any of the objects or purposes enumerated'irt k} Chess Articles of Incorporation or any amendment thereto, or in ; the furtherance thei-eof or necessary or incidental to the protectiolt and benefit of the Corporation, and In general, either alone o>: " in association gl th other charitable corporations, organizations, associat'ons, partnerships, firms or individuals, to carry on any. law€ul.'pursuit necessary or: incidental to the acconPlishmen[ of the purposes or khe attainment of, the objectives or the furtherance of such purposes or objectives for which this corporation 'La _formed , i and to have -all of. the:po-.4ers conferred'upon this Corporation by .`' the.lawa of "the State of rlorida, or of any other state or country, F and not prohibited by. the Corporations Not fur Profit Act. a VIAL -VON LANVAFF SC/iRMEp a CAMON roll i.lrpSU i.Ower/1n18:v0"4�Ane,f�dll'0�. J/nl.lr�!!»y,l f��,[�e4oiwS. ]SPN11 1 . 3r . 1569 a cc.o-thirds voce os all She""directors at say c3ering duly called .,T.y. For Chac s -7c if c ir" purpa.e. ��s' RF JL 14 a means of accomplishing the purposes sel; forth in ,lrticla II harem, 'Chis. Corporacion shall have the following .� Pavers '•: �<;: To raise fu;,ds by solicitations, business entcrgrises, or borrix.;,ing, i ' v 2. Accept and receive donari(pns and contributions of services and money and property of every kind and description by gift, subscription, devise, bequeat; or other.Jtse, Buy, build, lease, sell, mortgage, manage or otherwise cleat with real, or personal property. 4. Enter into contracts or agreemonts of an k'id y n . 5_ To hold. invOst, reinvest. and nanrkge money and property and to use the principal and ineor:e thereof. s - i 6. To borron money anti execuce ,and issue urornissory nvtes, bonds, dubentures, and other evidm)ce of Indebtedness, fron time r"o—Ime, for any 1as.•fu2 carprate purpose and'to mortgave, Pledge and othenrise-charge any and all of its property and other assets to secure the payment thereof: 7. To do ail and everyr"hing necessary and proper £or. i the accomp:inh=ent of any of the objects or purposes enumerated'irt k} Chess Articles of Incorporation or any amendment thereto, or in ; the furtherance thei-eof or necessary or incidental to the protectiolt and benefit of the Corporation, and In general, either alone o>: " in association gl th other charitable corporations, organizations, associat'ons, partnerships, firms or individuals, to carry on any. law€ul.'pursuit necessary or: incidental to the acconPlishmen[ of the purposes or khe attainment of, the objectives or the furtherance of such purposes or objectives for which this corporation 'La _formed , i and to have -all of. the:po-.4ers conferred'upon this Corporation by .`' the.lawa of "the State of rlorida, or of any other state or country, F and not prohibited by. the Corporations Not fur Profit Act. a VIAL -VON LANVAFF SC/iRMEp a CAMON roll i.lrpSU i.Ower/1n18:v0"4�Ane,f�dll'0�. J/nl.lr�!!»y,l f��,[�e4oiwS. ]SPN11 1 . 3r . 1569 1570 The .objects and purposes specified ..irk the',foregairig ��a s ft clauses of.thie'Article; unkess expressly lfmited, shall not he _ - a l.imited'gr restricted by reforence to, or inference ft'gn,'any . }` ^ �. provision In this or any.orher Article of thasc,Articjes of Incorporation, shall be regarded as independent objects and pur=.' ' 15 sr c+r poses and shnll be carlsti�eed'as po r_Cs as kekl. as objects and purposes, ali as permitted by law. XRTICLF. X1.1 CHARITABLE RESTRICTIONS AND LIMITATIONS I t - `' The purposes and operatibna of this Corporation. shall be specifically restricted and 'limited tis follows. go part of 'the net earnings of the Corporation F shall iriurc to the benefit of or - be distributable tc its members,-- directors,=officers, or other private persons,' except that the 1`'t � ��.��'•�,". '- CorpDYACidll shall be authorized and empowered to pay reasonable - (. a compannation for services rendered and to make payments.and ` -distributions in furtherance ofthepurposes set forth in Article' S lI hereof. r 2, iio subs.tantiaL part of the activities of the - Corporation shall, consist of carrying on propaganda, or. otharuiso N Ti•�tY .. tai ,- attempting to influence legislation except as Otherwise provided- :, in -Section 501(h) of the Internal Revenue Code of 1954, or the curresponding provision of any subsequent Internal Revenue -Code z; �tr �:+ ; or tax law. The Corporation shall net p�rtieipate in; ar'-zntorven.g : tr f3e i� in (including the publishirr'or distributing of statemen_ts), any political cam ai Y' public p gn Ori behalf', aF an candidate for 3'. The CorparatiOn.shall not operate for the purpose of -carrying pn a trade'ox business for grofit, or engage fn any prohlbtted,transacrion described in -Section 503 of the internal' - Revenue Code of 1454, tor the corresponding: provision of any subse- 1 sy quent Internal Revenue Code or tax ,law. ,zfs y rw, ITALTUN LANTA14 CWgOEDER 6 SAflSgq' . .. '. 'iso 3:lF11�61.OHt0'.T lY,40 �O: MrAM1,I IOA•1a1� 11C1 .O+C1+11l�LOtlC ]0 xTO S>f11 - rliw- {:: - at 1570 1571 be the Perions known.by me CO b chose names .Aescrib'e';j executed the for4gol'i:� .Articles ur incorp orati:on. an(, . [tiei acln&.rled&ed to me chat they cxecli zo the same ss.the!jr free voluntary act and deed and for tho uses' AnA pufpo..AstheFeAn act forth and expressed. iN 141TUESS �i,':IEREOF. i have harcu.no.;Set. PIV hand Am' Fl ill Bf f ixed my official seal. on aruJ yea;� :f toli, al wtit ..ir,-Cr ._T -j. U - 'nr STATF OF FLORIDA COUNTY OF RADE'_ J "HEREBY CE-RTIFY- thatFebif6 .'on A appeared before me, the, undbrsiineld au h' GRAY - t orii7y tiTtnini AV. F; rltmvQT­ be the Perions known.by me CO b chose names .Aescrib'e';j executed the for4gol'i:� .Articles ur incorp orati:on. an(, . [tiei acln&.rled&ed to me chat they cxecli zo the same ss.the!jr free voluntary act and deed and for tho uses' AnA pufpo..AstheFeAn act forth and expressed. iN 141TUESS �i,':IEREOF. i have harcu.no.;Set. PIV hand Am' Fl ill Bf f ixed my official seal. on aruJ yea;� :f toli, al wtit ..ir,-Cr ._T U - 'nr My Commission Expires4 i. jj Z, .- 4 ;1 I. t ACKNOWLEDMUNT OF RES MEN ACbi HAving been named to accept service of Proces's for DAILY BREAD COMIUNITY FOOD BANK Mr., 8L tfie.pl"e designated ,4L In Article'XIII of. the attached Artli:les of 111rorporaribin, I hereby accept to act in this capacity, 4rw agree to coqply...rich the provision at Section -48,09L, Florida St' 'rutes , relatf ve to keeping, open the resLde'nt'oMc6. 4 ($EAL') 11 Al V !A WAL70ij LANTAill. SCHROEMR &'CARSwi 1572 at Jam, i I fItED ARTICLESaFAfaENDi•fENl' :Ttl 7HR: �Ai I� i6 ARTICLES OF INCORPORATION OF 5-0 Of StAIE ' 7�r�;-t• - - '.'' . - .. - - ,. -'. U�U111-�SSEEtt4AiDA DAILY 'DREAD. CO;LYUNITY._FOOD- BANk. INC.. a V �*v {A Florida Corporacion Noe for Profit} ee 5 FgrsuanG. to -the pxovisio-a3 of Section 617 02 of- the k t Florida SCatutes, the undersigned corporation adopts the following SVP �1;r iY rte• Articlos of Amendment to.its 'Articles of Incorporation, filed .4 - rJI s 4 s�i'fJ9 February 17; :}.481,:: _�� � •s�,<ks� mgt 1-- The Board of birectors of said corporation ae a meeting called and held.on: %lay 6, 1981, adopted the follow'.nr, .. resolutiolt y #" f',�w #sr ` RESOLVED that Article III of the Articles of Incorporation �i hereby completely is: Y emended as follo�rs: �x •� �.;; ;u; ARTICLE IIl -QUALIFICATION OF MEMBERS ANIL �;{r� MANNER OF .THEIR ADMISS30157 x } The members of the corporation shall consisC of the t�fy c I persons signing the Articlrs of ,,tcvrpgration and such otr,er personjm 4 -? - or persons or organization or. organizations as the Board AF Directors may elect,:6y vote of a majority of the membersof the Board of Air, !Directors of the corporation, at any Annual or Special Meeting of Y the Board of Directors . i} i,,f�°�1 a,•I { 2. The Board of Directors of such corporation ata 7 itteacfng: duly , called and held on May 6. 1991 adopted said resolution A- Zt t amendnR Che Articles, of Incorporation as aforesaid,'no shares of`s�' stock having been issued,:nor permitted under general lair. o?'a sS� IN wITNESS..WHBREOF,:the undersigned -Directors have (ixecuted these Articles of,Amendmene'.this'llth day of May, J981 DAILY BREAD COr'IWHTY FDQp' BANK, INC. `= ISEALIWILLIMI >Ft. d By `'. HI�H oras E. 629ftaw j �1�.s�,si•'�ild - 1573 STATE OF.FLORIVA COUNTY OF DAVE On this day:personlly'appeared before me, the undersigned officer duly authorized:by the laws of the''State of Florida to take acknowledgements WILLIAM J. GRAY, NICHDLAS E. CHRISTM , and. GEORGE CRESIi0l+1, DireotarS of Daily Bread.Community Fool- dank,.' In£;, a Florida.corporation, and they acknowledged that they executed the herein and foregoing Articles of Amendment as such Directors for and -.on behalf. of said. Corporation after having been duty authoxi2ed to do so. WITNESS my hand and affict4l seal at Miami, Dade county, Florida, this day of May, 1981. ~otary 'u ic'2`, Sttate o Ir or a at arae My Commission Expires: MY VA A7 l,I,r., - _ - v ocy: s uwar ts, i iai ..2.. t�1 1574 1! r e 1574 LA ARTICLES; 4F AMENDMENT TO ARTICLES OF INCORPORATION DAILY BREAD COMMUNITY.FOOD BANK INC Pursuant, to the pravi$iot:s of, Section 617, 018, Florida Statutes, the undersigned. "Corporation adopts the following Articles.of Amendment to its Articles of Incorpoiat ion, filed rebivary 17, 1981., FIRST: The nate of the corporation is: DAILY BREAD COMUNITY'FOOD BANK, INC. SECOND:" The following Amendment of the Articles of in- corporation was adapted by' the Corporation: �ARTICLE I: CORPORATE NAME DAILY BREAD Dated: September 2 BANK, INC," - was. adopted unanimously by the Board Ji day of septekbar 1986 at -a meeting. urpose:." 6 DAILY, BREAD COMMUNITY FOOD BANK, INC. By osep Scior:Lnno, res ent - /f By icrhar Wa ter, ecretary 1575 1576 To: The Flarida Dept of State SubWt 000177.111388 From: Ashley Smlm Friday, September 4, 2008 4730 PM Page: 3 of 3 H09000208I52 3 ARTICLES OF AMENDMENT TO THE x Vim► CP ARTICLES OF INCORPORATION 0 14- . DAILY DREAD FOOD RAMC INC. Pursuant to the applicable provisions of the Florrda Slatules, this Florida not for /,`oSlfl rorparallon adopts the following articles of amendment io its articles of irrcarporation - I. The name of the corporation is DAILY BREAD FOOD BANK, INC. (the "Corp*ralioti ). 2. The Amendment set forth below was adopted on March 26, 2009 by unanimous consent of all of the members entitled to vote on the board of directors of the Corporation. 3. Article I of the Articles of Incorporation of the Corpration shat I be deleted irk its entirety E and replaced with the Following: ARTICLE 1 The name of the Corporation shall be: FEEDING SOUTH FLORIDA, INC., a Florida not for profit corporulion ' 4. All of the provisions of the Articles of Incorporation not amended herein tut hemby ratified, confirmed and shall remain undmngcd. IN WITNESS WHEREOF, the undemiped has CYCCULed 111t:se Articles ofAUnendment to the Articles of Encorporation. D tD FOOD K. INC., a Florida no for profi Iti i 8y, Brmc J. Berman, President and Chaitmnn of the Board of Directors f r 1 l MIA rsxsor-r.o.:.axP i H09000208152 3 1577 Articles of Amendment to - !F'� a 1 u Articles or Incorporallen a , of (Name of C r6pration 35 currentlyfile/ with the F o ' t. t 44f.�4r�%. (Document Number of Corporation (if known) Pursuant to this provisions of section 617.1 OD6, Florida Statutes, this Florida Not For Profit Corporation adapts the following amendment(s) to its Articles of Incorporation: A. If aMlIWIP2 name,enter tht new name of the cot oration: The new name must be distinguishable and contain the word "corpornrfan " or "incorporated" " or the abbreviation "Corp. " or "Inc. " !Q=411w" or "CO.' may trot be used in the name, S. Enter new principal office address if applicable - (Principal office address 11fUST BE A ST'REETADDRESS ) C. Y.nte w madiny address, if a (Mailing address MAY BEi &_osr oEncE goX D, If simeadJOP the regislorgd a epi and/or reelstered office,adgfeas in Florida_ enter the game ofthe at!L—reglstered aegnt and/or the new rmillered 9fte address: Nam e e New Re&iered A gen r; e Z. 25'0 I 3.z "= Tel', -A ee (Florida rant address) New Registered Q 1Pc'e Address: —&M1'-OKe _ &L L„ , Florida 3 3o 2_e {Zip Code) 1 hereby accept the appoinrmenr as regisre a e llat(t Jamil' r with and accept the obligations of the position, Sign rare ofew Regisrerwd Agent, if changing Page 1 of 4 1578 i If amending the Officers nod/or Directors, enter the title and name of each of;..er/director being removed sad title, name, and address of each Officer andtor Director being added: (Attach additional sheets, if necessary) Please note the off5rerldirector n..'ti � Aefirst letter of the office title: P — President; Y= Vice President; T= Treasurer: S= Secretary; D= Director; TR— Trusree; C = Chairman or Clerk; CEO = Chic Executive Officer: CFO = Chief Financial Officer. !fan o,fficerldirector holds more than one title, list the first letter of each opt -cc held. President. Treasurer, Director would be PTD. Changes should be noted in rhe following manner. Currently John Doe is listed as the PST and Mike Jones is listed as the V, There is a change. Mike Jorres leaves the corporation, Sally Smith is named the Y and S. These should be noted as John Doe, PT as a Cha nge, Mike Jones, Y as Remove, and Sally Smith. SV as an Add. Exampic: 2LChange V1 Mn Doc X Remove V Mike Jones X Add 5—V Sally Smith "Fyffe of Action Titl,g am Ac�r�r s (Check One) 1) Change V f 0 G 25-0 1 SV 3 /rl�CG. Add pfYl j C Q '3 F Remove 33oZ 2) —Change Add —yRemovc 3 ) _Change Add Reprove 4) �� Change Add Remove 5) Change Add Remove 6) _Change Add Remove P-' MMAAE1., Page 2 of 4 &d d!'Q]cr „1�zfzk 'ne , 102'? 1579 �. It aMtntling or addlos additional Art cI s than e s here: 014th additional sheets, ifnecessap)). (Be specifrc) Page 3 o r 4 1580 The dote of each stmendment(s)adoption: _ (a �`a O y _�� if other the this document was.sigxed. Effective date if appl a51e: (no more than 90 days afrer axlei:(lmerrr file dale) Adopdan of Atntendrnent(s$ (CHLQ ONY1 © The amendrnent(s) was/were adopted by the members and the number of votes cast for the anxndment(s) was/were sufficient for approval. ❑ There are no members or members entitled to vote on the amendmenl(s). The amendmeal(s) was/were adopted by the board of dircclors. Dated TV 5 ignatttre ($y the chai}manor ice chairman or the board, president or other officer -if directors have rot been selec d, by an incorporator— if in the hands of a receiver, trustee, or other court appoin fiduciary by that fiduciary) Df VelCQ ' Lt- _ Typed or printed a of person signing) (Title of person signing) Page 4 of 4 1581 Articles of Amendment to Articles of Incorporation FIED of Fl on hUG 7 PM 1= k2 (Negi of Corpomflas as coirrentlyfilld Wilb fbe floridoDept. of State `, t ii'( t• MRIDA (Document Number of Corporation (if known) Pursuant to the provisions of section 617.1006, Florida Statutes, this Florida Not For Profit Corporation adopts the fol lowing amcndmem(s) to its Articles of Incorporation: A. If amendin4 name, eater t6C new name of the cornnratiao: The new name must be distinguishable and contain the word "corporation '• or 'Incorporated " or the abbreviation "Corp, " or "Inc. " "C "Co. " M not he used in the B. Enter new Principal ofte addr i— li le: (Principal office add*js MUS T a A S rREErA ) C. Enter new addre (Mailiarg address MA V BE A POST OFFICE BOX) D. If amendilg theim ist n resixtead 9TKe address in Florida. t ter Ike new registered agent and/or the new registered oMet address, Name of Nfw Registered Agent: kAAJC4.SLQ. VEL -C-2- (Florida rmeet addrerrJ New rered D e P� P Florida z. (City) (Zip Code) New Re stered A is SignatureL If clianizing Rghtgrld Agent: 1 hereby accept the appointment as registered agent. f am familiar with pnd accept the ligarh ns_ �fhe position. of New Page I o(4 Rgea if changing 1582 If amending the Officers and/or Director,% enter tie title and Dome of each officer/director being removed add titk, Dante, a ad Address of each Officer sodlor Director being added: �Asiach additional sheers. Vnecessary] Please note the ofJlcerfdirector title by the first letter of the office title: P - President; V= Vice President; T- Treasurer; S- Secretary,- D- Director; TR- Trustee; C = Chairman or Clerk; CE p Chief Fxecu ive Officer; CFO - Chief Financial Officer. If an officer/director holds more than one title, list the first letter of each office held President, Treasurer, Director would be PTD. Changes should he noted in the following manner, Currently John Doe is listed as rhe PST and Mike Jones is listed as the V There is a change, Mike Jones leaves the corporation, Sally Smith is named the V and S These should be noted as John Doe. PT as a Change. Mike Jones, leas Remove, and Safly Smith, SV as an Add. Example: X Change PT LQbD-Q-W- X Remove V Mike Jones X Add SV S�IIX.$mith Tvne of Action Title Name Mdmp (Check One) i) Change Add Remove 2) —Change Add Remove 3 ) _Change Change Add Remove 4) Change Add _ Remove 5) —Change Acid Remove d) Change Add Remove fLgAMCd(A VEX -67- 2 5101 5WG c JC*qA A4 333 A4 C' V4f C2- Page 2 of 4 1583 EIf amendings here: (attach additional sheets, ifnecessary). (Be specific) Page 3 of 4 1584 The date of each arneltdmettl(s) adoptioe: if other than the date this document was signed. Effective date It antslicable: (no more than 40 days after amendment file date) Nola: If the date inserted in this block does not meet the applicable statutory filing requirements, this date will not be listed as the document's effective date on the Department of State's records. Adoption or Atmendtmealls) (CHECK ONEI Q The arnendrnent(s) was/were adopted by the members and the nwnber of votes cast for the amendment(s) waslviere sufficient for approval. There are no members or members entitled to vote on the amendment(s). The amendment(s) wasi%%rrc adopted by the board of directors. Dated Signature (By the chainiu6 or vice chairm have not been selected, by an it other court appointed fiduciary Zv 1"4--0,t e board, president or other officer -if directors aor — if in the hands of a receiver, trustee, or fiduciary) (Typed or printed name of person signing) � S cc Fs z (Title of person signing) Page 4 of 4 1585 Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid social security number backup withholding. For individuals, this is generally your social security number (SSNHowever, for a — m resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a F M___ TIN, later. or Note: If the account is in more than one name, see the instructions for' line 1. Also see What Name and Employer identification number Number To Give the Requester for guidelines on whose number to enter. M�J -2097f20 Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later. bign Signature of Here I U.S. person 10 - General General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Form 1099 -INT (interest earned or paid) Cat. No. 10231X Date► Z-ZO 2.3i_ • Form 1099 -DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. if you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Form W-9 (Rev. 10-2018) 1586 Request for Taxpayer Give Form to the Form (Rev. October 2018) Identification Number and Certification requester. Do not Department of the Treasury send to the IRS. Internal Revenue Service ► Go to www.irs.gov/Form1V9 for instructions and the latest information. 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. �.Gd't Saute 1 o f+da 'fir, iL 2 Business name/disregardejentity name, if different from above ch 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to mfollowing seven boxes. certain entities, not individuals; see a a F-1 Individual/sole proprietor or ElC Corporation ElS Corporation ElPartnership ElTrust/estate instructions on page 3): c single -member LLC Exempt payee code (if any) 0.0 ❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ► `p Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check Exemption from FATCA reporting + wLLC c if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is from for code ( if any) a ois-disregarded another LLC that is not disregarded the owner U.S. federal tax purposes. Otherwise, a single -member LLC that from the owner should check the a propriate box for the tax classification of its owner. aoi Other (see instructions) ► C' 3 (Applies to accountY maintained outside the U.S.) 5 Address (number, street, and apt. or suite no.) See instructions. Requester's name and address (optional) SU rU/ 3 2- V rr-a C -C 6 City, state, and ZIP code firt-4 t, 33023 ,.Ice il'�c�K 7 List account number(s) here (optional) IMM Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid social security number backup withholding. For individuals, this is generally your social security number (SSNHowever, for a — m resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a F M___ TIN, later. or Note: If the account is in more than one name, see the instructions for' line 1. Also see What Name and Employer identification number Number To Give the Requester for guidelines on whose number to enter. M�J -2097f20 Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later. bign Signature of Here I U.S. person 10 - General General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Form 1099 -INT (interest earned or paid) Cat. No. 10231X Date► Z-ZO 2.3i_ • Form 1099 -DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. if you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Form W-9 (Rev. 10-2018) 1586 City of Boynton Beach Development Services 100 E. Ocean Ave. Boynton Beach, FL 33435-0190 0 **AUTO**SCH 5 -DIGIT 33436 1 PS5 133298BA29-A-1 74 1 AV 0.452 IIIII II�I���'I'IIIII�I�II���II��I'�hI���I�II�I�I��I��III��IIJII FEEDING SOUTH FLORIDA INC 4925 PARK RIDGE BLVD BOYNTON BEACH FL 33426-8317 Dear Boynton Beach Business and Property Owners: We appreciate your continued participation in supporting economic growth and viability of our City by maintaining your Certificate of Use and Occupancy & Local Business Tax. In accordance with Chapter 13 of the City of Boynton Beach Municipal Ordinance, the document(s) below must be posted in a conspicuous place at your business or property. Should assistance be needed please contact the Development Services Department at (561)742-6350 or visit our website at www.boynton-beach.org. + DETACH THE DOCUMENT BELOW AND POST CONSPICUOUSLY AT YOUR PLACE OF BUSINESS -y ------------------ City of Boynton Beach Certificate of Use/Business Tax Receipt Expires on September 30, 2023 Business Control Number: 0032057 Date Issued: 07/29/22 Business Name: Feeding South Florida Inc Business Location: 4925 Park Ridge Blvd Any changes in name, address, suite, ownership, etc. will require a new application. 23-00036979 561110 OFFICES EXECUTIVE & ADMINISTRATIVE OFFICE ADMINISTRATOR City of Boynton Beach 100 E. Ocean Ave. • Boynton Beach, FL 33435-0190 1587 City of Boynton Beach Development Services 100 E. Ocean Ave. Boynton Beach, FL 33435-0190 Nzk W **AUTO**SCH 5 -DIGIT 33436 1 PS5 133298BA29-A-1 73 1 AV 0.452 FEEDING SOUTH FLORIDA INC 4925 PARK RIDGE BLVD BOYNTON BEACH FL 33426-8317 Dear Boynton Beach Business and Property Owners: We appreciate your continued participation in supporting economic growth and viability of our City by maintaining your Certificate of Use and Occupancy & Local Business Tax. In accordance with Chapter 13 of the City of Boynton Beach Municipal Ordinance, the document(s) below must be posted in a conspicuous place at your business or property. Should assistance be needed please contact the Development Services Department at (561)742-6350 or visit our website at www.boynton-beach.org. + DETACH THE DOCUMENT BELOW AND POST CONSPICUOUSLY AT YOUR PLACE OF BUSINESS -y ------------------ City of Boynton Beach Certificate of Use/Business Tax Receipt Expires on September 30, 2023 Business Control Number: 0032057 Date Issued: 07/29/22 Business Name: Feeding South Florida Inc Business Location: 4925 Park Ridge Blvd Any changes in name, address, suite, ownership, etc. will require a new application. 23-00036978 493110 GENERAL WAREHOUSE/STORAGE STORAGE OF FOOD City of Boynton Beach 100 E. Ocean Ave. • Boynton Beach, FL 33435-0190 1588 City of Boynton Beach Development Services 100 E. Ocean Ave. Boynton Beach, FL 33435-0190 IN **AUTO**SCH 5 -DIGIT 33436 1 PS5 133298BA29-A-1 72 1 AV 0.452 IilrrililirillillilhillPlhh�llllilrlulr�rliiiirl��iirllllli FEEDING SOUTH FLORIDA INC 4925 PARK RIDGE BLVD BOYNTON BEACH FL 33426-8317 W. Dear Boynton Beach Business and Property Owners: We appreciate your continued participation in supporting economic growth and viability of our City by maintaining your Certificate of Use and Occupancy & Local Business Tax. In accordance with Chapter 13 of the City of Boynton Beach Municipal Ordinance, the document(s) below must be posted in a conspicuous place at your business or property. Should assistance be needed please contact the Development Services Department at (561)742-6350 or visit our website at www.boynton-beach.org. + DETACH THE DOCUMENT BELOW AND POST CONSPICUOUSLY AT YOUR PLACE OF BUSINESS + ---------------------------------------------------------------------------------------------------------------------- City of Boynton Beach Certificate of Use/Business Tax Receipt Expires on September 30, 2023 Business Control Number: 0032057 Date Issued: 07/29/22 Business Name: Feeding South Florida Inc Business Location: 4925 Park Ridge Blvd Any changes in name, address, suite, ownership, etc. will require a new application. ,..�;.,v.:.�...�a...v: ';3- •-�.�oz.. ,. --: �4�":ai r. � �.o`��i-+�-. r��� F.c�.. 3;..'jrs^�r+ .4, r7^��?x'"aq�, 3'T;.,s .0 tt-'t•.,, ... '�7*-a Via. �.ws. S. �-T':F dr5''„�taa^."ia3 qtr-...^-um�' 4 C��: 23-00034733 CU2 CERT OF USE & OCC COMM NON PROFIT FOOD WAREHOUSE I�I City of Boynton Beach 100 E. Ocean Ave. • Boynton Beach, FL 33435-0190 1589 Fundine Sources for Senior Meal Delivery Proeram: 1. General Operating Funds 2. Wellmed Charitable Foundation 1590 All services offered through Feeding South Florida are free to all clients, regardless of income or employment status. HILLARY GALE Fl U E3 I 1I C 11. ll::.:: A I f I I P 1\1 0 IN Fl Ifs 0 1:::: 1I F Fl IR: 0 G Ifs A IM Il A A 1\4 A G 1::.::: FZ Boynton Beach, FL hillarygalel@gmaiLcom 561.281.5191 PROFESSIONAL PROFILE Solutions-orlented, corrununity-driven, 1,,.ji oject imainager providing transforrnadonall iimIr.)act on strategy and emission execution through (zollaboration, EDUCATION MASI E.::IR 01:::: F'UIBI 1(..., 1 fl::::AI FI i L.Jiniversity of South Florida 1 2014.2016 BIACI il::.::l OIR (')I:::: SClI::.::INCI: Chemistry / Sociology Florida State University 1 20,10-2013 SKILLS • Prololern Solving • [)ata Collection i- Analysis • Microsoft FlowerFloint • MicrosoftWord p 1::.::xcell • CriticM FI-ilinkling WORK EXPERIENCE P IIS 0 Ift A IM IM A IN A G IEIR F:eeding South IFlloidda 1I 113oynton l3each, 1=1 2018 IPiresenrnt EXPERTISE • Flroject Management • Community 1::.::i,igageiqieiqt • IPrograim limplernentation • limpact E.::valuation • Strategic FlIanning I eads collaloorative commUllity SOIUtifflS LO lorealk the cyclle of hunger and loovertythrough research, technology, and innovative initiatives tl,"iat.. strengthen the South F:1orida food system. Addi,(..,sses food insecurity as a sociA determiriarit of health with a hurnan -centered aloloroach. * Manages healthy eqUity initiatives and direct service lorograrns from strategic planning throi.igh design, 11711olernentation, evaluation, and relaorting to internA and extennA stakeholders. * 131,.jilds rneaningft.d and interitionA relationshilos with locA rm..jinicilpA leaders, comirni,.jinity -based organizations (030s), stakeholders and residents, L-widging the galo between strategy, policy, arid lorograms.. * Con(Jucts comirm..jinity needs assessiments, 1,,..)ollicy scans, data collection and imaloloing to jorovide a clear syiiol,,..)sis of tine current food systern and how to best strengthen it with an eqi,.jital,,)le lens, through sustainalole, collective iiinl,,.)a(.,:t and solutions, Flarticiloates in the development of iml,..)roved toolls and methodologies for food systems analysis. * F'rovides (lirect supervision to a tear of Case Managers responsible for data collection and advocacy efforts, serving families to transition from a place of deloendency to self-suffic[ency. Supports oloerationA excellence as it relates to KIF)ls, with core values at the forefront of our work. 11 11E.:All III HCAIRIE.: SIEIRVIlCli:..:S C001RIDIIINA.-T-0111 1I 20,1-7 2018 Served as the liaison for cornrnunity health stakeholders and f=eeding Arnerica I Winger p I Health initiatives. 0 1 ead research initiatives studying the impact of food insecurity on health outcornes, Frain and oversee tearn mernbers reslmrisilole for data collection. F:nrolled and provided ongoing case management SUIDIDortto 750 program participants to identify lbarrier.s to healthy food access. 0 Assisted in the cultivation and stewardshilo of current and jorosjoective healdhcare donors through our Food i.s Adedicine initiatives. R 1R 11 IM A lid Y ..H..IH F.:R A Ifs 11 S I Recovery IRestairt 1I I13oyrntoin l3each, F1 2014 2017 Conducted therapy sessions relating to healthy relationships, 031, effective comirriunication, impulse control, cnloiiqg skills, relalose prevention, family dynarnics, traurria, stress reduction, anger managernent., and substance alL.)USe education. • R(..,sloonsible for fa(.-ilitatinggroups at multilolelewds of care inc.'Juding inpatierit., 1::)1 jl::) arid outpatient. Managed acc.-urate clocurne.intation within the ele.coronic rne.dicM record software to ensure corrijoliance, and reporting. • Advocated on of.dhalf of clients and facilitated communication between clients and families, or community resource - including employment, housing, and legM concerns. 1592 "I'l��IUSA��""""",,,,,,,,,,,,,,� . .......... AV�'111 ��M S , �EyCUf V 0 1����� pRF}11 1� 5msamisadymamicIeaderwith avast knoMedgeof giobaicmisine. She has �� 3l2Zl�l779 wirittencurricuiefor eduits atkirge,asvveUascollege programs, and �� suaznt�e���maiioom deve[opedrecipes for two cookbooks. ler avvardwinning menusare ve�n��o�a[�inspire��Shro�the NSF1nsining pumn creab�^ cvv i�ean��ua BoyntonBe�ch,Fiohda and SOP3fOr Off site C@teringduring[OV|DfOrth�AuS1inGOOg[e team. 01 ler love for food issurpassedonbbyher passion toeUminate food and p[asticvvaste, and shededicoted hermas1er's1hesistothe bopic, )[�AT1[N EyP�I \'I �—. NC'E MS, Hospitality Management Rooseveltuniversity, [hicago^|L DIRECTOR (}FCULINARY SERVICES Fbod FEED|N5SOUTHFLOR|DA !BDYN[ON BEAU H ! 2021. PRESENT Waste in the Hosf)/ta0�y/nobs&rY � Directproduc1ionarid menuengineeririg for lO,000monthiyfWen meaisfor Ce,tif/cate,GircuKair, Economy aind oeniors,fb||ovvingstrict dietaryguidelines; manogestaff and vo|unteersl� SmmtahnabLleStrategies' developed a||SDPs,budget`purchasing and ana(ydcsfor four week menu Cambridge University'2O2l rotation across diversecultural demographic Certificate, Pastry Arts � Deveiopedoff pemiseaummerbreakspot. cat.eringand USDAchi(dren'smea( French Pas1rySchool, Chica�o.|L Prognam'delivering GOO+mea(sdally liltLeading�oodwasteaction pianand imp|ementadon AA. CuhmaryArts lilt �enuideadonandieadforfu||semicecateringprognam [H|[, Le[ur�on B|eu,[hico�o, |L eCormeUL EXECUTIVE KITCHEN SYNC CHEF [erd8cate PiantBasedN trition , u GUCKENHE|WER.ON3|TE@)GUOG|E ! AU3T|N ! 3EPT20l8 2022 BA, English Literature Opened the fiagshiPteaching kitchenonsiteatGoogieAUS, morethan l.00O experientio|use�a�en ed|iveandvi�uaic|assesw �huniquerecipes. TheUniveoityof|||inoi� [hicaQo |L ' ' (transitionedfromin-per-son todigitAengagementand video), Coordinated and moderated Food Waste Taik ^^510.yAbuutFbocl 01bste~ essemb(eda paneiof KI national subject irriatter exper-ts to discuss history, impIiclations and stakitions For food waste'attended bymore thanl5Opeople � �enu[ngineerin� � RecipeDeveiopment EXECUTIVE CHEF � TrainingandLeodership GUCKENHE|MiER, ONS|TE<�PGDOG|E ! AU3T|N ! 2019 2020 � Dudgets`Furecasting � Producedfood vvastec|assesand docks with Gtechsustainabi|ityteom � DiQitail::�ngagement � Produced glove reduchonvideosarid decksforG(�,�)Gg(oba(team � FoodVVastoSubject � Executivechefforoffaitecatering,4OOpreparedmea|s,sevendaysavveek, maintained budget and purchasingfor uni��desi�nedmenu,trained sta#and lilt Goo�|e�uite deve|opedSOPs � I\d5OfficeSui � Reengineeredmenusand |edcatering teamforall holiday events,Doc. 2Dl9 U 1 VVrotecomprehensiveNSF tcaininf.t,deck and conducted staff training 1.1""""""",",'I'l",,�ll,�'�,� . ... . . . . . . . . . .......... AV S M S � �XECUTI\/[ CI IEF CHEF/OWNER c� en?y c� ce Academy �� dem�£�e�� SVYEET[ASSAVAU[! [H|CAGO ! 2302-2Ol8 R��o/en�HaVrer[o8e�e2[D8 Boutiquecamrerforprivateandcorporotedients;planned events fromplanning to producdon,featuring gioba|or�znicmenus,frnm2D-pe�onsitdowndinnersto ���[����[6��No/���oo� 35O-personhuiidayevents;reduced food waste 5O96in2years Thun,btac�2Ol�an�28l� Providedpreparedmea(servicethrou�houtChicago|and;4DO-5DDseekiyoven readymea|s,often vvorhingvvIhin ytriUdietaryconstrainLs C E FIT II'd CATI 0N S/ ���������I N LJ[TI NI('i ' � LLu men udeveiopafbrGFcnsckeriinz^seven SKUs, prod uc1ion2O2l SemSafe.Manager/Proc1or2O24 � �F�000hess G/een�2O2� cookbookeditor,contributor,consuitant A[[, Member � BeIc�our[(.)okboo�.2O27-recipeeditorand contributor CAFE'1\4ember - Sandal ResmMs,Ja/na��WIC'st/nuYer-designedmenusart conducted James Beard, Member trainingfor resorLarid privatevi((a staffinc(uding trainingmanuais - Chkago PubUc 5dmoKs vvrowand standordizedthree yen highKhoo[ I AK][,[1ACd cuiinarycurricuium � NadmmaKEiiWiromnmemtaKAust; &k.,liFloss on[hfleonSea Bass, coordinated English Chkago and MAN campaln to Ascawareness of the plight of dw overlOnd Spanish Patagoniontoothfish TI �I I I N[� ' �ll lairperComnmmmin[ty CoKKege,Chicago, |L2Ol42Ol&TaughtPunchasing; � Ta|kingtoStranQers OPenadonsAnaiysNGarde MangnaPWry; |ntmto hospitality; Menu Pianning; |ntemadona|[uisine' �[iassica|Cuiyine�^ inducted into Academic Excellence Levei|| � The � OnFood and Cuuking Sur Lo11W.Chicago`UL2011-2OlG, Savory and RaytryChef |nstrucor � The Awakening GKemmme&ak lDktHot.Giencoe'|L2003-2Ol5,Deveiopedsevem|pnogc*msfor � So|aris chiidnen'teensand aduits � Frankenstein DaMamCmmmmmmmUty College Afflammefor 11 earmflmg,Chicago, |LZOO7-2Ol7. � TheMushnoomat. theEnd ofthe Developed broad range ofcookingclasses for continuing educa1ionpmgram World UmstEmlemf AO. Chicago'|L2DO42OO5.AcUunct[hetInstructor - - OMC,�eCoMomBKem.[hicago,|L2000 2002,[1nefl|nstruct01r Food, CompostingTravei,Film, BB&AEno, Dimadorof Business DeveKmj,-jmme��,[hk:ago,UL. l889-ZOOl. Reading, Music' Dressage Developed identity and markehngmaterio(sfor new company; targeted now markets and wrote pmpoao(sand webcontent.;managedstaff offburand preparedbudgets and hzecast,workingc(oseiywith engineernand architec1s �������oc �omn�m ��� mm����/oteum/ Revenue Service P.O. Box 2508 Cincinnati OH 45201 In reply refer to: 0248182382 Oct. 19, 20I5 LTR 4188C O 59-2097620 000000 00 00013885 8OOC: TE FEEDING SOUTH FLORIDA INC y< PACO VELEZ 2501 8W 32ND TER PEMBROKE PARK FL 33023 Employer Identification Number: 59-2097520 Person to Contact: Mr. McQueen Toll Free Telephone Number; 1-877-829-5500 Dear Taxpayer: This is in response to your Oct. 07' 2015, request for information regarding your tax-exempt status. Our records indicate that you were recognized as exempt under section 50I(c)(3) of the Internal Revenue Code in a determination letter issued in July 198I. Our records also indicate that you are not a private foundation within the meaning of section 509(a) of the Code because you are described in section(s) 509(a)(1) and 170[b](I)(A)(vi). Donors may deduct contributions to You as provided in section I70 of the Code. Bequests, legacies, devises, transfers, or gifts to you or for your use are deductible for Federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2108, and 2522 of the Code. Please refer to our website www,irs.gov/eo for information regarding filing requirements. Specifically, section 8033(j) of the Code provides that failure to file an annual information return for three consecutive Years results in revocation of tax-exempt status as of the filing due date of the third return for organizations required to file. We will publish a list of organizations whose tax-exempt status was revoked under section 6033(j) of the Code on our website beginning in early 201I. ��\����� rm�u ���/mm~�/�/n�m^/uov^vu*o,nic, P.O. Box zsoa Cincinnati ox *5201 002718.605723.110489.26184 1 AT 0.416 san FEEDING SOUTH FLORIDA INC % PACO VELEZ 2501 SW 32ND TER ---- PEMBROKE PARK FL 33023 oourm CUT OUT AND RETURN THE VOUCHER AT THE BOTTOM OF THIS PAGE IF YOU ARE MAKING A PAYMENT' EVEN IF YOU ALSO HAVE AN INQUIRY. he IRS address must appear in the window. 0248162362 DUDCD-TE INTERNAL REVENUE SERVICE P.O. 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L N O a a +' Q C to .0 — ai Q > O 4- c — O v U 0 (a a NO — a a✓ U u a UOca Q N CEQL a� E [LaJ .�Q C � . a � 0'Z4c1 ap ai Na ^ .vc N p -0 u Q — NQ No O to c vp cU a a N-0 Q a a a N O a O a L 41 M N�� H a > L a a E `� i} +� N fa tin N a a O a i C U ca N C L O U 4- J �„ U Ln NO NL —O bc1J a " vJ a N N .+�C_0 a L 'O Uc+ aa aUO-+ a UN L O } � - QQ -0 a O D ` a Qa Q O a c} U > O a QN L M N '+� a O O + a— N Q to a L �F C to to c 41 c a L t Ln U c C6 N N (a E (a c p vi c O (a E QLN O p C > > N O (Qa U N �c Ua L C)E° OL a a o C U 0E C -C Q o U D U a c D Q� 4- N m 4- m O a Q m O aJ LA a••' a••' dA C RTC N U � C 0 C. Co to U O N 4- E E E O U T- CD CD May 26, 2023 Mrs, Allyson Vaulx, AVP of Philanthropy Feeding South Florida, Inc. 2501 SW 32 Terrace Pembroke, FL 33023 Re: Community Development Block Grant (CDBG) Funding FY 2023/2024 Dear Mr. Jessup: This letter is in regards to your application for CDBG funds for the Fiscal Year 2023/2024. The CDBG Application Review Committee assessed your application for funding for Public Services — Senior Meal Delivery Program and based on their scoring and funding availability, I regret to inform you that your application was not recommended for funding at this time. I encourage your organization to reapply next year. A Notice of Funding Opportunity will be advertised on the City's website next year. Thank you for taking the time to apply. Very Respectfully, RJ R, mirez Community Improvement Manager 1602 olllt� JOY,qY . . . ....... . t'? g gg ...... ... . .. .. ..... . .......... 91 R A A 1,21f 'lln"I" N E Q� co — N LL + 0 o Qco L U > C O O cn co L (cu N (n L •E , n V E U p O O M L L L L F r L EM 0 0 p o �--+ U � > � } o QQ cci LL co a L w O m — N m p m E U -0 N Q U-1-1 Q m -0 c) LO 0� ° ( L N ° m 0)c oQ CU 75U O `N > L oU cl)CU L / ' �Q) L U > OL >> °U�n o o c a� N > OUr > �• M� W Q U m ca Q O U L U' ca Q O 70 ��n O 4.1 Uro U N N E cn M m c: ca O) i= a o o p c �= O � cary Q U 70 m � -0 O 2 U m Q Q o N Q- NQ c N 0 = / E = o m E \ f E _f \k 0E E @ � . > = \\' L)0ƒ o = c m . 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Requested Action by Commission: Declare the City owned vacant property (0.0820 acres) located at NW 7 th Court, PCN #08-43- 45-20-08-000-0261, as surplus and direct staff on desired disposition process to follow. Explanation of Request: The City has received a written offer on the following vacant property. Parcel Id: #08-43-45-20-08-000-0261 Location: NW 7th Court Size: 0.0820 Acres PBC Assessed Value: $25.00 Offer By: Yoany Dulzaides Carvajal Offer Amount: $1,500 According to Chapter 2, Article IV, Section 2-56 (c) of the City of Boynton Beach Code of Ordinances, the City Commission can sell property, which is determined to be in the best interest of the City: An advertisement for public hearing was placed in the Palm Beach Post on July 22, 2023. It is recommended that the City Commission authorize disposition of the property through negotiated sale with the sender of the Letter of Interest, Yoany Dulzaides Carvajal. No action 1611 is being taken on the Letter of Interest today. Section 2-56 (c) Disposal of City real property. (1) Power to sell. The City Commission may authorize by Resolution the sale, transfer, and swap any real property, improved or unimproved, now owned or hereafter acquired by or owned by the City, as provided herein. These procedures supplement any other procedures that may now or in the future be applicable as provided by law or regulation. (2) Disposal of property which is sufficient in size and of such character as to comprise an independent building site and which will involve a conveyance of the City's fee simple interest. These parcels typically enjoy access to a public right-of-way, and are developable as building sites. (a) Resolution declaring surplus. Before any improved or unimproved property owned by the City shall be sold or otherwise disposed of pursuant to this subsection (b), the governing body shall adopt a resolution declaring same surplus. (b) Determination concerning surplus. a. The City governing body shall review and consider the following: 1. The legal description (by reference to a recorded plat or government survey); 2. The property address by street number, if there be any; 3. A description of all improvements located upon the land; 4. How said land has been used since same has belonged to the City; 5. The current use of the property; 6. How the property was acquired and financed; 7. The needs of the City; 8. Whether disposal is consistent with the City comprehensive plan; 9. The estimated property value; 10. Any relevant property history; 11. The property's title; and 12. Whether the disposal of the property is precluded by grant provisions of other agencies. (c) Public hearing. The City governing body shall hold one (1) public hearing prior to adopting a resolution declaring property as surplus. An advertisement for such public hearing 1612 shall appear once in a newspaper of general circulation at least ten (10) days prior to the hearing. The advertisement will contain the resolution title and the date, time and place of the hearing. The City Clerk shall advertise the proposed resolution for public hearing by placing it on the City Council agenda and posting such agenda at least three (3) business days prior to the City Council Meeting. (d) When appraisals are needed. a. Any real property that the City proposes to sell or otherwise dispose of pursuant to this subsection (b) must be appraised by two (2) independent appraisers, who are designated members of the Appraisal Institute, if the property is estimated to have a value that exceeds one million dollars ($1,000,000.00). b. Any real property that the City proposes to sell or otherwise dispose of pursuant to this subsection (b) must be appraised by one (1) independent appraiser, who is a designated member of the Appraisal Institute, if the property is estimated to have a value between one hundred thousand dollars ($100,000.00) and one million dollars ($1,000,000.00). c. Any real property that the City proposes to sell or otherwise dispose of pursuant to this subsection (b) with an estimated value below one hundred thousand dollars ($100,000.00) shall not require an appraisal. d. Notwithstanding subparagraphs a., b., and c. above, no appraisal shall be needed: 1. Where the City acquired the property from Palm Beach County as a result of the tax sale process and is returning such asset to the former owner or its successors and assigns; 2. Where the City transfers the property to another governmental entity or agency; or 3. Where the City is exchanging such real property with the private sector for a replacement parcel determined by the City governing body to have similar utility and where the public interests would be served. (e) Methods of disposal. a. Methods. The City may dispose of property pursuant to this subsection (b) utilizing 1613 the following methods: negotiation, trade with other governmental entities or agencies, request for letters of intent, sealed bids, or request for proposals. The City may retain professional real estate services to aid in the disposal of property. 1. Negotiation. The City may negotiate the sale of real property with a particular person or entity, and no further advertising will be needed to effect a transfer. 2. Sealed bids, requests for letters of intent, and request for proposals. At any time no more than ninety (90) days after adoption of resolution declaring the property surplus, the land may be offered for public disposition, and a notice shall be published by the City in a newspaper of general circulation in the City once not less than ten (10) days before sealed bids, letters of intent, or proposals are due. The notice shall state, at a minimum, the date when sealed bids, letters of intent, or proposals shall be received and whether the sale is with or without reservation. Sealed bids, letters of intent, and proposals shall be received accompanied by cashier's checks or certified checks payable to the City in an amount equal to at least ten (10) percent of the disposition price. 3. Transfer to governmental agencies. The City may sell or transfer any of its property to any other governmental agency, if the City governing body determines that: i. A transfer of the property to the other governmental agency shall provide a benefit to the City; and ii. That the terms received by the City are fair and equitable. 4. Land swap with any private or public land owner provided the properties are appraised at substantially the same value. In determining substantial value the City may take into consideration the potential increase in value following the swap. (f) Proceeds from sale or transfer. Any proceeds derived from the sale of any land, as authorized in this subsection (b), shall be deposited in the general fund of the City, or such other fund or account of the City as is determined by the Finance Director. (g) Conveyance. In order to convey property pursuant to this subsection (b) the City governing body shall be required to adopt a resolution authorizing the conveyance. Notwithstanding anything possibly to the contrary, the City may reject any and all offers, bids, letters of intent, or proposals, or terminate negotiations at any time and choose not to dispose 1614 of property, and nothing shall obligate the City governing body to adopt any necessary resolution. How will this affect city programs or services? There will be no impacts to City programs or services. Fiscal Impact: By declaring this parcel surplus and completing the disposition process it will return the parcel to the City tax rolls. Attachments: R23-084 Declaring_City_owned_property_on_NW_7th_Court_as_Surplus_property_- _Reso. pdf Residential- Pu rchase-Letter-of-I ntent-NW7thCt. pdf Prope rtyDetail-NW7thCt. pdf Prope rtyAerialPhoto-NW7thCt. pdf 1615 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 RESOLUTION NO. R23-84 A RESOLUTION OF THE CITY OF BOYNTON BEACH, FLORIDA DECLARING THE CITY OWNED VACANT PROPERTY (0.0820 ACRES) LOCATED AT NW 7TH COURT, PCN #08-43-45-20-08-000-0261, AS SURPLUS; AND PROVIDING AN EFFECTIVE DATE. WHEREAS, The City has received a written offer from Yoany Dulzaides Carvajal in the amount of $1,500.00 for the following vacant property: Parcel Id: #08-43-45-20-08-000-0261, located at NW 7t" Court, Size: 0.0820 Acres, PBC Assessed Value: $25.00; and WHEREAS, according to Chapter 2, Article IV, Section 2-56 (c) of the City of Boynton Beach Code of Ordinances, the City Commission can sell property, which is determined to be in the best interest of the City; and WHEREAS, before any improved or unimproved property owned by the City can be sold, the City Commission must first declare the property to be surplus; and WHEREAS, the City Commission, upon recommendation of staff, declares the City owned vacant property (0.0820 acres) located at NW 7th Court, PCN #08-43-45-20-08-000- 0261, as surplus. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE CITY OF BOYNTON BEACH, FLORIDA AS FOLLOWS: Section 1: Each Whereas clause set forth above is true and correct and incorporated herein by this reference. Section 2: The City Commission of the City of Boynton Beach declares the City owned vacant property (0.0820 acres) located at NW 7t" Court, PCN #08-43-45-20-08-000- 0261, as surplus. S:ACA\RESO\Declaring City owned property on NW 7th Court as Surplus property - Reso.docx 1616 Section 3. This Resolution shall become effective immediately upon passage. 40 PASSED AND ADOPTED this 1 st day of August, 2023. 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 CITY OF BOYNTON BEACH, FLORIDA Mayor — Ty Penserga Vice Mayor — Thomas Turkin Commissioner —Angela Cruz Commissioner — Woodrow L. Hay Commissioner —Aimee Kelley ATTEST: VOTE Maylee De Jesus, MPA, MMC Ty Penserga City Clerk Mayor (Corporate Seal) YES NO APPROVED AS TO FORM: David N. Tolces Interim City Attorney S:ACA\RESO\Declaring City owned property on NW 7th Court as Surplus property - Reso.docx 1617 LETTER OF INTENT Effective Date: MAY 19T", 2023 TO: DEPUTY CITY OF BOYNTON BEACH MANAGER ANDREW MACK 100 EAST OCEAN AVENUE, BOYNTON BEACH, FL 33435 FROM: YOANY DULZAIDES CARVAJAL 814 NW 4T" AVE, BOYNTON BEACH, FL 33426 RE: Intent to Purchase Parcel next to my property This letter of intent represents the request of the buyer Yoany Dulzaides Carvajal to purchase the parcel next to his property in order to extend the limits of his current property for personal use. The buyer agrees to make proper and permitted use of this parcel as well as pay the taxes related to it. Find the details of the property below. The Buyer: Yoany Dulzaides Carvajal. The Seller City of Boynton Beach. Property Address: NW 7TH CT, BOYNTON BEACH, FL 33426. Parcel Control Number: 08-43-45-20-08-000-0261 Legal Description: LAUREL HILLS 2ND ADD E 1/2 OF LT 26 (K/A SURPLUS PROPERTY) Purchase Price: The Buyer shall purchase the Property for One Thousand and Five Hundred Dollars ($1500) (the "Purchase Price"). TERMS: This is a CASH TRANSACTION with no financing contingency. All costs associated with the Closing shall be the responsibility of THE SELLER Following the execution of this Letter of Intent, and until the Closing, the Seller shall not engage in negotiations for the sale of the Property with any other party unless either the Buyer and Seller agree in writing to terminate this Letter of Intent. BUYER Buyer's Signature Date May 19, 2023 Print Name Yoany Dulzaides Carvajal Page 1 of 1 1618 PAPA Banner JI 1rc11t11mmu A11u1.mx;ss NW 7TH CT Mu:mlvtcllpmaxlity BOYNTON BEACH Parcel C'ontmxul lVm: rnbcur 08-43-45-20-08-000-0261 SuNtivlsisun LAUREL HILLS 2ND ADD IN tt111lici[a1l 1Records Ill,00k Page Sale Date lll: !j° LAUREL HILLS 2ND ADD E 1/2 OF LT 26 (K/A SURPLUS 1 amt Dexu°rAl�utaau�ucr PROPERTY) Mailing address Ow ers PO BOX 310 BOYNTON BEACH CITY OF BOYNTON BEACH FL 33425 0310 No Sales Information Available. Ex:eucrlifl uum Aplplicant/Owneui- Fear JIID'etail BOYNTON BEACH CITY OF 2023 FULL: MUNICIPAL GOVERNMENT uml Totalt INuuniber ofiJuits 0 Acus 0.0820 Square V 8900 - RIA- RIA SINGLE FAMILY, 6 DU/AC t..J'se C::."rmute MUNICIPALmuDI11i 08-BOYNTON BEACH) 1'ax dear 2022 2021 2020, 11vproven,wfit;Value $0 $0 $0 L'an11 Value, $25 $25 $25 Il'ot l Madwt Va 11 uie $25 $25 $25 All values are as of January 1 st each year Fax Wallr, 2022 21121 20211 Assessed Valllriue. $25 $25 $25 llh'Nempptuaon Al witint $25 $25 $25 "Ira1;able. Value $0 $0 $0 'IraN Fear 20 22 20,21 2020 Ad Vallllu1 ini $0 $0 $0 Non Ad Valumrr na $0 $0 $0 ll'otaI ta..x $0 $0 $0 1619 08434520080000261 June 27, 2023 1:576 0.00475 0.0095 0.019 mi 1620 0.0075 0.015 0.03 km 12.13 Legal 08/1/2023 City of Boynton Beach Agenda Item Request Form Commission Meeting Date: 08/ 1/2023 Proposed Resolution No. R23-099- Landscape Permit application corresponding to Ordinance No. 23-014. Requested Action by Commission: Approve a proposed application corresponding to Ordinance No. 23-014 (Amendment to Chapter 2, Article II, Section 5. Permit Applications and Chapter 4, Article I. Environmental Protection Standards, Item ID 345-2023 on this agenda) and to be used for work proposed for the existing tree or palm. Explanation of Request: As proposed in Ordinance No. 23-014 (Amendment to Chapter 2, Article II, Section 5. Permit Applications and Chapter 4, Article I. Environmental Protection Standards), Item ID 368-2023 on this agenda, this new Landscape Permit application is required to review and inspect the proposed work to the existing trees and palms, including removal and relocation. The following are the purposes and functions of this new Landscape Permit application: • It will provide an overview of the replacement requirements for the removed trees and palms in accordance with the Environmental Protection Standards in the Land Development Regulations. • The applicant will be able to plan the project and prepare the property in compliance, based on the information and direction provided in the application. • It is designed for the applicant to prepare the necessary documents and plans for staff review, determination, and inspection; and • It is designed to acquire necessary information between the property owner and authorized agent. How will this affect city programs or services? This item will not affect City programs or services. 1621 Fiscal Impact: N/A Attachments: Resolution approving Landscape Permit Application Landscape Permit Application.pdf 1622 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 RESOLUTION NO. R23-099 A RESOLUTION OF THE CITY OF BOYNTON BEACH, FLORIDA, APPROVING THE APPLICATION CORRESPONDING TO ORDINANCE NO. 23-014 TO BE USED FOR WORK PROPOSED FOR THE EXISTING TREE OR PALM; PROVIDING AN EFFECTIVE DATE. WHEREAS, as proposed in Ordinance No. 23 -014, this new Landscape Permit application is required to review and inspect the proposed work to the existing trees and palms, including removal and relocation; and WHEREAS, the Landscape Permit application will provide an overview of the replacement requirements for the removed trees and palms in accordance with the Environmental Protection Standards in the Land Development Regulations; will allow the applicant to plan the project and prepare the property in compliance, based on the information and direction provided in the application; will permit the applicant to prepare the necessary documents and plans for staff review, determination, and inspection; and permits necessary information between the property owner and authorized agent; and WHEREAS, upon the recommendation of staff, the City Commission deems it to be in the best interests of the citizens and residents of the City of Boynton Beach to approve the application corresponding to Ordinance No. 23-014 to be used for work proposed for the existing tree or palm. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE CITY 28 OF BOYNTON BEACH, FLORIDA, THAT: 29 Section 1. The foregoing "Whereas" clauses are true and correct and are hereby S:\CA\RESO\Landscape permit Application - Reso.docx 1623 30 ratified and confirmed by the City Commission. 31 Section 2. The City Commission of the City of Boynton Beach, Florida, hereby 32 approves the application, a copy of which is attached hereto and incorporated herein by 33 reference as Exhibit "A", corresponding to Ordinance No. 23-014 to be used for work 34 proposed for the existing tree or palm. 35 Section 3. This Resolution shall become effective immediately on adoption. 36 PASSED AND ADOPTED this 1 st day of August, 2023. 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 ATTEST: 53 54 55 56 Maylee De Jes6s, MPA, MMC 57 City Clerk 58 59 60 (Corporate Seal) 61 62 63 64 65 66 CITY OF BOYNTON BEACH, FLORIDA YES NO Mayor — Ty Penserga Vice -Mayor — Thomas Turkin Commissioner —Angela Cruz Commissioner — Woodrow L. Hay Commissioner —Aimee Kelley VOTE Ty Penserga Mayor APPROVED AS TO FORM: David N. Tolces Interim City Attorney S:\CA\RESO\Landscape permit Application - Reso.docx 1624 CITY OF BOYNTON BEACH DEVELOPMENT DEPARTMENT I PLANNING & ZONING DIVISION 100 E. Ocean Avenue • Boynton Beach, FL 33435 • (561)742-6369 • PZMailbox@bbfl.us LANDSCAPE PERMIT APPLICATION FORM Application Date: 'I. PROPERTY OWNER INFORMATION 2. WORK LOCATION Owner's Name: Job Address: Address: Subdivision: City: State Zip Parcel ID #: Phone: Fax: Email: 3. APPLICATION TYPE & DESCRIPTION OF WORK Tree and Palm ❑ Relocation ❑ Removal ❑ Replacement ❑ Canopy Replacement ❑ Payment In -Lieu of Replacement Reason for this Application: Description of Work: 4. APPLICATION CERTIFICATION AND ACKNOWLEDGEMENT Application is hereby made to obtain a permit to perform work and installation as indicated. Applicant certifies that no work or installation has commenced prior to issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit does not assure compliance with Homeowners Association's rules, regulation and/or deed restrictions. Applicant is advised to obtain approval from the Homeowners Association before improving any property. NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities, such as water management districts, state agencies, or federal agencies. WARNING TO OWNER: Failure to record a notice of commencement may result in paying additional fee for improvements to the subject property. A notice of commencement must be recorded and posted on the job site prior to inspection. If intent on obtaining financing, consult with a lender or attorney before commencing work or recording your notice of commencement. FEE: $50 application fee plus $25 per removal of each tree or palm and $25 per relocation of each tree or palm. Fees are due prior to permit issuance, non-refundable or non -transferable. 5. AGENT / APPLICANT / CONTRACTOR INFORMATION Agent / Applicant: License No.: Company Name: Address: City: State Zip Phone: Email: 6. AGENT AUTHORIZATION FORM & OWNER CONSENT FORM Please provide original signed forms 7. AGENT / APPLICANT / CONTRACTOR SIGNATURE Name (Print): Signature: Date: S:APlanning\SHARED\WP\SPECPROJ\CODE REVIEW\CDRV 23-005 Tree Preservation & Mitigation\Landscape Permit Application\Landscape Permit ,� ��� Application_Final.docx 1 of 3 S:APlanning\SHARED\WP\SPECPROJ\CODE REVIEW\CDRV 23-005 Tree Preservation & Mitigation\Landscape Permit Application\Landscape Permit 1 ��� Application_Final.docx 2 of 3 8. LIST TO BE COMPLETED BY APPLICANT Tree/Palm # Identified on Plan/Survey Botanical Name Common Name Caliper in inches for Tree / Clear Wood or Clear Trunk in feet for Palm Relocated Removed Protected * Please add a separate list as needed. 9. SUBMITTAL REQUIREMENTS • A tree survey, tree management plan, mitigation plan, condition assessment including photos (good, fair, and poor), or combination thereof, as part of an application submission shall be provided. Such submittals shall be prepared by an arborist certified by the International Society of Arboriculture or a Florida licensed landscape architect. • A signed and sealed landscape plan is required unless it is waived by the Director of Planning and Zoning. • If irrigation work is required, a Building Permit shall be submitted to the Building Division in conjunction with this application. 14. REPLACEMENT Replacements shall be provided on-site, or payment in -lieu made to the Tree Canopy Trust Fund, as defined in Table 4-1-a Replacement, Table 4-1-b Canopy Replacement, or 3. Payment In -Lieu of Replacement of Part III, Chapter 4, Article I, Section 4.C. Mitigation of Existing Trees and Palms. 11. EXPIRATION and INSPECTION Approval of the Landscape Permit is valid for a period not to exceed six (6) months from the date of issuance. If the scope of work covered by this permit is not commenced within this time period, the permit shall expire and be automatically cancelled. Inspection shall be approved prior to expiration (Part III, Chapter 2, Article II, Section 5.C.9. Expiration). 13. PAYMENT IN -LIEU OF REPLACEMENT Upon determining that replacement of removed or to be removed trees or palms is not feasible due to the lack of available planting space, the Director of Planning and Zoning may allow the applicant to meet all or part of the replacement for trees or palms by paying into the Tree Canopy Trust Fund an amount of money according to the payment in -lieu schedule as defined in this application. The payment shall be made prior to permit approval. S:APlanning\SHARED\WP\SPECPROJ\CODE REVIEW\CDRV 23-005 Tree Preservation & Mitigation\Landscape Permit Application\Landscape Permit 1 ��� Application_Final.docx 2 of 3 a. A payment in -lieu of replacement for tree removal shall be calculated based on caliper measurements, as provided in the table below. Tree with a condition rating scale equal to or greater than fair: $250 per caliper inch ■ Example 1: Payment for a tree with 8.5 caliper inches is $2,125 (8.5 X $250). ■ Example 2: Payment for a tree with 21 caliper inches is $5,250 (21 X $250). Trees with a condition rating scale of poor: A payment in -lieu of replacement shall be calculated at 80% of the above scale. b. A payment in -lieu of replacement for palm removal shall be calculated based on determination of palm canopy, as provided in the table below. Palm with a condition rating scale equal to or greater than fair: $600 for a small canopy palm and $1,200 for a large canopy palm. ■ Example 1: Payment in -lieu of removed canary island date or royal palm: $1,200 ■ Example 2: Payment for cabbage palm or Montgomery palm is $600. Palm with a condition rating scale poor: A payment in -lieu of replacement shall be calculated at 80% of the above escalating scale. c. If trees are removed before obtaining authorization for removal, and the value of the removed tree(s) or palm(s) cannot be determined from any remnants, such value shall be calculated based on canopy areas in square feet (sq.ft.) determined by using aerial photography; photos; or review of a tree survey. A payment in -lieu of replacement for removed trees and palms shall be calculated, as provided in the table below. Table 4-1-d Payment In -Lieu of Replacement for Removed Trees and Palm(s) Removed tree(s): $750 per 100 sq. ft. of a tree canopy area but no less than $750 per a tree ■ Example 1: Payment for 452 sq. ft. of a tree canopy area is $3,390 (4.52 X $750) ■ Example 1: Payment for 78.5 sq. ft. of a tree canopy area is $750 Removed palm(s): $600 per 60 sq. ft. of a palm canopy area but no less than $600 per a palm ■ Example 1: Payment for 218 sq. ft. of a palm canopy area is $2160 (3.6 X $600) ■ Example 1: Payment for 62 sq. ft. of a palm canopy area is $600 d. A payment in -lieu of replacement for a specimen tree shall be calculated, as provided in the table below. Table 4-1-e Payment In -Lieu of Replacement of Removed Specimen Tree $500 per caliper inch, or $750 per 100 sq. ft. of the tree canopy removed, and additional payment $1,000 per tree in addition to mitigation or to a payment in -lieu for a removed specimen tree. S:APlanning\SHARED\WP\SPECPROJ\CODE REVIEW\CDRV 23-005 Tree Preservation & Mitigation\Landscape Permit Application\Landscape Permit ,� ��� Application_Final.docx 3 of 3 Advisory Board Vacancies as of May 02, 2023 Art Advisory Board Regular member 2 (2 year) terms Alternate Member 2 (1 year) terms Vice Mayor Turkin II Hay IV Kelley Regular 2 -year term Regular 2 -year term Alternate 1 -year term Applicants: Ace Tilton Ratcliff — Current Regular member seeking reappointment. Completed one term. Building Board of Adjustment and Appeals Regular member 2 (2 year) terms Alternate Member 2 (1 year) terms Mayor Penserga Regular 2 -year term Vice Mayor Turkin Regular 2 -year term I Cruz Regular 2 -year term II Hay Regular 2 -year term IV Kelley Regular 2 -year term Mayor Penserga Alternate 1 -year term Applicants: None Community Redevelopment Agency Advisory Board 2 Year staggered terms Mayor Penserga Regular 2 -year term Vice Mayor Turkin Regular 2 -year term I Cruz Regular 2 -year term II Hay Regular 2 -year term Applicants: Naomi Cobb - Current Regular member seeking reappointment. Completed two terms. Chevette Gadson Golene Gordon - Current Regular member seeking reappointment. Completed two terms. Gregory Hartmann Mark Jackowiak Ellen Jones Alexandria Lopresto Noelle McIntyre Heather Posta Lesha Roundtree 1628 Advisory Board Vacancies as of May 02, 2023 Education and Youth Advisory Board 2 -Year term Regular member 2 (2 year) terms 2 -year term Alternate/Student Member 2 (1 year) terms 2 -year term Mayor Penserga Regular 2 -year term Vice Mayor Turkin Regular 2 -year term I Cruz Regular 1 -year term II Hay Student 1 -year term IV Kelley Student 1 -year term Mayor Penserga Student 1 -year term Applicants: Francois Calixte-Dieuvil - Current Regular member seeking reappointment. Completed one term. Nicolas Giacolne Dr. Teresa Kasey-McClendon Valorie Valcourt - Current Regular member seeking reappointment. Completed one term. Historic Resources Preservation Board — Quasi-judicial Regular member 2 (2 year) terms Alternate Member 2 (1 year) terms Mayor Penserga Regular 2 -year term Vice Mayor Turkin Alternate 1 -year term Applicant: Bradley Jackson Library Board Regular member 2 (2 year) terms Alternate Member 2 (1 year) terms I Cruz II Hay IV Kelley Mayor Penserga Vice Mayor Turkin Regular 2 -Year term Regular 2 -year term Regular 2 -year term Alternate 1 -year term Alternate 1 -year term Applicants: Ellen Jones Lindsay Karten - Current Regular member seeking reappointment. Completed one term. Marcia Levine - Current Regular member seeking reappointment. Completed one term. Ace Tilton Ratcliff - Current Regular member seeking reappointment. Completed one term. 1629 Advisory Board Vacancies as of May 02, 2023 Planning & Development Board - Quasi-judicial Regular member 2 (2 year) terms Alternate Member 2 (1 year) terms Mayor Penserga Regular Vice Mayor Turkin Regular I Cruz Regular II Hay Atlernate Applicants: Vanessa Belmonte Ellen Jones Alexandria Lopresto Lesha Roundtree Nicholas Tunno Recreation and Parks Board Regular member 2 (2 year) terms Alternate Member 2 (1 year) terms IV Kelley Mayor Penserga Vice Mayor Turkin 2 -year term 2 -year term 1 -year term 2 -year term Regular 2 -year term Regular 2 -year term Regular 2 -year term Applicants: Sarah Beveridge Geoff Campbell — Current Alternate member seeking reappointment. Completed one term. Julie Mondello - Current Regular member seeking reappointment. Completed one term. Frando Patterson - Current Regular member seeking reappointment. Completed one term. Senior Advisory Board Regular member 2 (2 year) terms Alternate Member 2 (1 year) terms Mayor Penserga Regular 2 -year term 1630 Stanzioine,, Tammy From- ace < i~ or r-epal yt"�)123fornil)uiider-.com> Sent: TLIesday, March 14, 2023 2:44 PM To- City Gerk Subject: Advisory Board Appointment application Attachments: ATR-resurne-2023.pdf Today's date 03/14/2023 Name Ace Tilton Ra:tcliff phone number 561-376-3640 Address 142 SW 13th Avenue Boynton Beach FL 33435 United States Email ace@staywejrdbekjnd.corn Current occupation or, if retired, prior Self-employed artist and writer occupation Education BA in Pofifica0 Science from UCF Are you a registered Y voter? I Do you reside withiin the Boynton �Beach Y' city limits? Dio you own/mainage If "yes", name of Harper's PrOrni5e, CUirrently on hiatus business. Are you currently serving on a City Y bolaird? I Have you served on a City bard in the Yes past? If "yes", which, Yes, I am a vnernber of the Library Board as well as the Art Board, My terrn on the Art Board has bolaird(s,) and whn? come to an end but I am efigibIle to re -apply. Have you ever, been, �No P? If "yes", when and N/A where? 1631 OEM= If appointed by the City Commission to 7f7 - willing to serve in thiis capacity?' ZGEMMSEEM Yes Personal i ani a working artist who makes my living as a rrietalworker', mixed -acedia artist, photographer, Qua:lificaitionis and author. I have grown UP in Boynton Beach and though 1: left for some time to live in California, I returned in 2019 because I wanted to be in my hornetown. I attended Dreyfoos High School of the Arts and graduated in 20,05. 1 have been an active arid excited'i rriernber of the Art Advisory Board and believe that serving, another two years to complete my tenure will be useful for my personal growth and for the Board. Professional City of Boynton Beach Library Advisory Board, Member Memberships IAAHPC Member Feel free to a,ttaich/upload a:in d=38,0b8a7l].04aie843,9le6c5el22526cObel ) extra, sheet or resume. Certification 1, the applicant, hereby certify that the statements and answers provided herein are true and accurate. I understand that, if appointed, any false statements, may be cause for removal from a board. The mesa, e has been serrt from 185,20,3.219,28 (,United States) at 20 I1 14 13*4135 on Chrome 1()9,0,0,0 Entry 0: 606 Referrer: httasjLwwA,.bc)ltitori-bcacti.o[U Form Host: 8-321A/�i �aa: hgaLdLilzig Llut n, men t - auml Lcat tic 1632 m„�WI��� ''lll��llo sMVli �V^Nti V� ac N�UIVu�„ IU�Wr � N�µJ oM'V'ft� u�'V%�, w�n� (IV �Ndlo*'�Yd�. "�Nw a "�ll�lwo�^^ w., 1�4� w Gu„ ��'Id;«, E, Y&VO I Nil fF' 00WITY -0 a missaim, They[Thern Pronouns ryluillw1by"Iludly alrrssl ullube UUM qTaPPWb %14'1111 IFIC U1l5UV4eTj Ul bell MiTyff) Ille wellenuebi ulat knaMN-141' U411 chitchat, but damn good art, Will W i- ..INN milli Robinette Kowal and Alix Harrow, They have an AS in funera I siervices; six years experience as a funeral 5; Promise_a_v_PterinaQlpractice focused on in-home pet euthanasia and'! end -of -life care, Ace is a metalsmith who also works in fibers and watercolors. They're a Photographer who shoots digital and film. Ace is a sucker for the literal undierdog� they live with four dogs and three cats, alt abandoned' street animalsi. Ttm)��d-cwrwtraldzr V -MK#*& kv their scooter to the beach to read, El"'XPEMENCE & SIU" US CEO, Stay Weird, Be Kind Studios I December, 20,11 - Present Ace's work as a freelance writer has spanned topics from deathcare to disability and beyond. Ace is represented by their agent, Stacia Decker, at Dunow, Carlson & Lerner Literary Agency. Their first book, "The Little Book of Dog Care: Expert Advice on Giving Your Dog Their Best Life" is forthcoming in j Illy, 2023 from Simon & Schuster. Ace has bylines at places like Gizmodo, Popular Science, log, fluffington Post, Eater, and many more. Ace Eras made a name for themself writing about living life as a disabled person in an inaccessible world, but has also had fiction published in places like Fireside Fiction, Phobos Magazine, and Glittership, Ace's voice as a disability activist has been featured in ,rhe Economist, the Guardian, and Upworthy Videos, Ace has been a panelist at The Next Page Conference in partnership with Kickstarter, Worldcon `76, and the North American Scierice Fiction Convention 2,020, Ace has been featured on a number of podcasts, including Maximum Fun's Reading Glasses, WNYC's Note to pelf, and Andrew Gurza's Disability After Dark. As a sensitivity reader,, Ace focuses on topics related to disability, working with writers like Hugo Award winners Mary Robinette Kowal and Alix Harrow, plus publishing houses -such as Penguin Random House, Toy, and Rosen Publishing, Ace has been awarded the D, Franklin Defying Doomsday Award and nominated for a pushcart Prize 1633 Ace possesses a dedicated group of almost of amazing Twitter followers and makes nearly 2.5, million Impressions there on a monthly basis. Ace and their followers focus on community -care, raising thousands of dollars for places like local abortion funds or Fiyah Magazine, in order to sponsor disabled BIPOC to attend FIYAHCON. fro- ottn er, Dhcare Advisor Harper's Promise, LLC I January, 2oi8 - Present Harper's Promise is air in- home pet euthanasia, hospice and palliative care practice devoted ,tohelping, families throughout South Florida provide the best possible end of life experience. In 2017,,Ace co-founded the practice with their partner, Dr. Derek Calhoun (a veterinarian), after the death of their ctilhualtua, Harper — the best -worst dog ever. Ace applies years of funeral industry expertise to working in conjunction with Derek to enhance quality of life, for chronically ill pets while providing dignity, comfort, and!, control through the final stages of incurable illness for those that are terminally ill. Ace and f erek keep Harpers Promise by helping, provide pets a good death, which is air integral part of a good fife. Funeral Director, Embabner, & Crernatory Operator Paren t- Sorensen Mortuary & Crematory. I January, 2014 - August, 2015 Wilson & Kratzer Mortuaries I October, 2012 — January, 2014 Smith & Witter Funeral Home I January, 2012 — AUgUSt 1, 2012 Boynton Memoriol'Chopet I May, 2010 - August, 2010 Ace had direct responsibility for administrative and organizational management in addition to fast- paced event planning and production with extremely tight deadlines. She has superlative customer relation skills under demanding and stressful circumstances. She coordinated legal paperwork at a county, state, and national level, with a focus on calendar, budget and contract management, She flexibly worked between three office locations in addition to remote, after-hours telephone work. She provided necessary support to a tightly knit team when riot working independently. She conceptualized funerals for thousands of families from a mu ;titude of ethnic and cultural backgrounds after in-depth, personal phone and onsite interviews and conferences. She completed a rigorous and extremely demanding two-year embalming apprenticeship. Nominum,' Inc, Ace worked with the documentations team to streamline existing technical documentation and produce new documentation for end, -users - typically system administrators, Site standardized content across platforms, revised documents, and clarified instructions to make documentation easier to use. She is proficient in lira software for ticketing systems and Madcap Flare for docurnent creation. She is willing and able to learn any new software or programs required. un et Inc. Ace was a combination event -coordinator, customer service representative, and salesperson, providing innovative service by using over 14 -years of experience in situational analysis to create repeat -customer loyalty,. They were in charge of all advertising and social media campaigns, including all written 1634 communications released by the company. Ace implemented multiple lel gli-level, marketing -oriented processes and procedures, witIr a strong focus on social rnedi a maintenance across multilaic major platforms. ACII VOTHES &, 0RG)4,NLZI' TIONS City of Boynton each Art Advisory Board, Member City of Boynton Beach Library Advisory Board, Mernber IAAI I PC Member EN )UCATV'J American River College, Sacramento, (A - AS., Funeral Servi(eS 201-2 University of Central Florida, Orlando, FL, -- BA., Politicol ScienCe 201.0 1635 Stanzione, Tammy From. Oty Clerk Sent: 1 uesday, March 14, 2023 5:53 PM To- De Jem.rs, Maylee; Stan zione, Tanirvy Subject: FW: Advisory Board Appointryient application From: drnrcobb <i,ioreply@,123fori"nbuiilder.coTi> Sent: Tuesday, March 14, 2023 5:52 PIM To: City Clerk <CityCIerk@bbfI,us> Subject: Advisory Board Appointment appilication, =iw Name Phorn e number Address MM Education 013/14/2023 Naoirni Cobb 95�4-6916�-18,33 10,07 SE 3rd Street Boynton Beach FL ' 435 United States drnrcoLtLa)_&qj�Li�x..om W232M= MOE Do you res�ide within the Y Boynton Beaich CISI ity limits? Do you own/manage a busiiness within City limits? T1 29031��� Are you currently serving on a Yes City board? Have you ser,ved on a City Yes board In thfast`? If "yes", which board(s) and CRA when? Haveyou ev been convicted Yes, of a crime? If "Yes", when, and where? Georgia 1982 Advisory Board Community Redevellopment Agency Advisory Board i U.M.1 aM w� M M Personal Qualifications Currently serve as Chair if CRA Advisory Board FOrfflelt° Pub�lic Administrator Currently employed as a Risk Manager for a non profit acrd have over 40 years as a public employee Professional IMemberships SHRM Feel free to, attach/upload an extra shieetear resume. Certification 1, the applicant, hereby certify that the state rne rits and answers provided hereirl are true and accurate. I understand that, if appointed, awry false statements may be cause for reirnoval from a board. The rnessage has been sent from 66. .0,10 (United States) at 2023-03,14 16:5MI on Chronie 11 .01,0, ErM'y ID,: 608 Referrer. h s, W,Ab�dnton-bg�ad .1tp,J1 n 'i � ci r Forn'i ldost: ry-hoaLd �L J Liqjent al )n L)8.32 4La.Jyjs 0 _2_ L �pi) L �aUL_ 1637 Stanzione, Tammy 0, -Now WM- From. City Clerk Sent-. Tuesday, April 18, 2023 10:19 AM To: Stanzione, 1"arnrny Subject: FW Advisory Board Appointment application Attachments,. CGadsonResurne-,2022.pdf From: CM&adson4 �-,noireply@1forryibui,G(ler,coni��, Sent: TLIesday, April 18, 2023 10 10 AM To- City Clerk <CityClerk@bbfI.us> Subject. Advisory Board Appointment application Today's date O /18/2023 Name Chevette, Gadson Phone number 561-702-9973 Address 1480 NO. 3rd Street BOYNTON BEACH FL 33435-2622 Netherlands Email Current occupation or, if retired, prior Manager, Clint of School Programs occupation Education master of Science, Counseling Psychology Are you a regilst�ered y voter? I Do you reside within the Boynton Beach Y City firnits? Doyou own/manage Are you current�ly servi ng on a City Y1 boa,rd? Have you served on a City boarUII d in the it III past? I 1638 if "'Yes", which Education and Youth Advisory, Board - currently serving now boaird(s) and wheO IIS If "yes", when and where? Advisory Board Community Redevelopment Agency, Advisory Board J appointed by the City Commission to ;erve as Board Chair No or Vice Chair are ISI �II you willing to serve in this "ty? capad Personal I have beeni long-standing resident of Boynton Beach for 40+ years. Qualifications I have a B,A, degree in Finance. I have been a member of the Education and Youth, Advisory Board since Septernber 2019. 1 served as chapter president for the South Palm Beach, County Alurninae Chapter of Delta Sigma Theta, Sorority, Inc, for four years which included overseeing community prograrns and projects. I arri currently a Manager in the Departaient of Extended Learning with the RaIrri Beach County School District where, I oversee and support 40+ middle school afterschool pro rams with over a $2,00 ,01010 budget, I arum passionate and eager to serve the Boynton Beach community, professional Palm Beach School Counseling Association Memberships, Delta Sigma Theta Sorority, Inc. (Life rnernber) University of South Florida Alumni Association (Life mernber) Feel free to attach/upload aner (01�1&.L)L(Lad Ild 11 -,yc gt�j: 4!,, Od, I c extra sheet or 144d34 �ttps,Lfo n112YSLr�nLld, bu j_ resume. Certification 1, the applicant, hereby certify that the statements and answers provided herein are true and aCCUrate. I understand that, if appointed, any false statements may be cause for removal from a board. The rnessage has been sent frorn 127.01.0.1 (Neffiedands) at 2023-04-18 09:10;26 on Chrome 110.0.0,0 Entry ID: 622 Referrer: Form Host: I_1t-1j?2-:/In,..I1-foar nbuld'Ider,corn/5,3LA/9�y�gly g4 d.. ointen -Pp!Ilc.a.. .....o n 1639 Starizione, TarnintX From: City Clerk Sent: Thursday, April 13, 2023 8:46 AM To: Stanzione, Tammy Subject: FW: Advisory Board Appointment application From: glouis129 <noreply@123formbuilder.com> Sent: Thursday, April 13, 2023 8:29 AM To: City Clerk <CityClerk@bbfl.uis> Subje,ct: Advisory Board Appointment applicatNoni Name Phone number Address EM n 04/13/20,23 GO,LENE GORDON 230 LAKE MONTEREY CIR BOYNTON BEACH Fl. 33426 United States &Lo3Js129@gmafl..gom Real estate agent, financial specialist and life insurance broker Are you a registered voter? Yes Do you reside within the Yes Boynton Beach City limits? Dooui own/manaU a business it's w 'thin City li'miits? 1 1 1 1 If "Yes"', name of business: GORDON SOLUTION LLC Are you currently serving oni a Yes City board? Have you served on a City Yes be in the Past? if "Yes", whiich board(s) andl CURRENTILT SERVING AS A MEMBER OF CRAAB, FORMER ART COMMISSION BOARD when? AND FORMER F&D BOARD Have you ever been convicted No of a crime? if "Yes"', when and where? Advisory BoardCommunity Redevelopment Agency Advisory Board 1640 if appointed by the City Commission to serve as Board Yes Chair or Vice Chair are you willing to serve in this capacity? personal Qualifications MY MANY YEARS OF SERWNG THE COMMUNITY Professional Memberships MATERS OF lSMESS ADMIMSTRATION' Feel free to attach/upload an extra sheet or resume. Certification 1, the applicant, hereby certify that the statements and answers provided herein are true and accurate. I understand that, if appointed, any faise staternents may be cause for removal from a board. The rnessage has been sent frorn 69.18,0,113, 28 (Ulniited States at 20,23 04-13, 07:29-1019 on Chrome 111ff0,0 Entry ID: 617 ReferrerhtjpL-,jj bgLy_n_LQq-bp_4�,th'ggz -- _NyA�y _ Fc Host� htt :� fon,n.123foirrnbLdIder,ccon 32L4Za0visq oard-!prLqi 9t_ment-appflcation 1641 Stanzione, Tammy From: ogre harts en,or,eply(�i)123foirmbui�ldler,,com> Sent- Thursday, March 3,01, 2023 3:57 PM To: City Clerk Subject- Advisory Board Appointment application Today's date 03/30/2023 Name Gregory Hartmann Phone number 954-258-3236 Address 1083 SW 25 PL Boynton Beach FL 33426 United States Em,all gregliairts@'prtotiinai�.co�rii Current occupation or, if Motion Graphic Artist/Business, owner retired, prior occupation Education ConnECfiCUt School of Broadcasting, Do you reside within the Yes Boynton Beach City llimits? Doyou own/manage a buisi�ness Yes within City lini If "yes", naime of business: Modern Animal LLC Are you currently serving of a Yes it board? Have you served on a City Yes board in the paist? If "yes"", wphich board(s) and whenArts AdvisoBo ry ard ? Have you ever bieein convicted No xif a crime? if appointed by the City C,omm,ilssilon to serve as Board Yes Chair, or Vice Chair are you willing to, serve in this capacity? Personal Quail Ifications; My qualifications to, be on the CRA advisory board are that of a srnalt business owner and engaged conistrtuenit who wants to bring their lousiness and life experience to the board. VI also serve the city on the Arts Advisory Board, I have volunteered and engaged I 1642 the local community over the years, & have the understanding needed to help move the CRA and city in a positive direction, Professional Memberships Defray Beach P,BA =- 1707mr. MM Ytt oir resumei, Certification 1, the applicant, hereby certify that the staternents, and answers provided herein are true and accurate. I understand that, if appointed, any false staternents may be cause for removal from, a, board. The message has, been sent from 9,35.29.1.59 (Unfted 5tates) at 2023 013.30 14:57.-08 on Safari 15kl Entry ID: 613 Referrer: hit s: g, iLonzbe, rL/ yL Forni Host:iLttRs.diorrrij.123fon ,mbuide -COD)5 3LIAbAy-qL�20 yjsorko oigtrTignL- i d6on, _ _ -- 1643 From: City Clerk Sent: Monday, April 17,2023&03 AM T+o: Stanzione, Tarnmy; De Jesus, Maylee Subject, FW: Advisory Board Appointrnent application Attachments: Mairk-,Jackowiaik.-Re$Llltne-04112023.pdf From-, rnjackowiak <noreply@123forTTibLilderconi> Sent: Friday, April 14, 2023 4:55 PM To: City Clerk <Cit,yClerk@bbfl.us> Subject: Advisory Board Appointnient application 04/14/2023 561-374-.0031 Address 3156 N Greenleaf Circle Boynton Beach FL 33426 United States Email�7gj�V_�P!)jt QW.�,L� (X�) - wYLaj-C�h . COM _C Current occupation or, If retired, prior CEO and Founder occupation Education Depaul University - Bachelor Degree of Arts in Business Management and Entrepreneurship, Are you a registered Yes voter? Do you reside within the Boynton Beach Yes i City, ilmlits? Do you own/manage a business within City Yes limits? If "Yes,", name of Ze,lta Home match business: Are you currently serving on a City No board? 0 1644 If "Yes", which Cornsurner Protection Commission -teak Forest, IL 2004 board(s) and when? Have you ever been No convicted of a crinne? if "yes", when and where? Advisory Board Community Redevelopment Agency Advisory Board lf,appointled by the C-Ity Commission to serve as Board Chair Yes or Vice, Chair are you willing to sierve in this, capacity? Personal My career in sales has given the ability to effectively comrnUni4cate and build strong Qualifications relationships. I served on the Consurners Protection Commi:sion, whichm I acted as a liaison between the community and businesses in the community, I currently olwin a home watch business in Boynton Beach and watch homes in Palm Beach County. I am serving as an Ambassador (Business Mentor) for the Dell,ray Beach Charnber of Commerce, 11, am bonded, Insured) and background checked with the National Horne Watch Association. I an') licensed a FlISAA Football and Baseball official. I have overall rating of 4.8. Professional National Horne Watch Association Memberships Delray Beach Chamber of Commerce - Arnbassador Committee Florida High School Athletic Association Feel free, to attach/upload anp �htt sILfoi,rn,123formbLJilder,.corTr 51L� extra, sheet or resuime. Certification 1, the applicant, hereby certify that the statements ands answers provided herein are true and accurate. I understand that, ifr appoh'ited, any false statements may be cause for renioval from a board. ThE! messwee has been: sent from 68.91.221,102 (United States) at 2023-04 14 15:55:21 on Chrorne 1.12,0.0.0 Entry ID: 619 Referrer tttiA.5!Lmv—wtoo yrLtgLl-b—LiLr!'i-o—rgZ Form Host: h 11,5� forni 1l �u LHder san-I L.51N t4 ns f k 1lrc fpjqULjjL-. e .p.pjjqatjon 1645 MARK AAACKOWIAK Boynton Beach, I'L, 1 561.374,0031 CAREER SUMMARY Accotripi i shed bUShICSS entrepreneur and sales professional experienced irr niaxiinizing, business -to -business sale%within highly competitive markets. Expert closer committed to a soWflon-biised sales apl'.)roach and as Cu stomer-cent ered focus. J',",'xceptimial aabdity to build and im,'dntahi relatiorisilips with key decision makers. I"roven track record ol"exceeding indlion-doHar annual sales qw)tas. U'Atraordinary conitnunication and organizational skills. 0 Ncxv BUSiness Development Territory NIanagerilent Cl -Level Sales Relationships 11 KI'll LIGHTS Prospecting an(] Cold Calling COIISUltatiVe & S(flUtion Sales New Account Acquisition • Client Relationship Management • Key Account Management • Ucadershnp & Team Building PR(I WESSIONAL EXPERIENCE ZELTA HOME, WTCH — Boynton Beach, Fl, Dec 2022 to Current CE0 and 14'oander— Conduct vissual inspection, of a horne or property, looking for obvious issues. Ideatify water, inold and pest problems, or with various outside contractors to repair or service tile properties. Word ofmouth referrals and niat-ket affluent communities to secure an(] protect their hornes. Member ofthe National Home Watch Association -- insured, bonded and critri ina I background check I Nleniber ofthe Delray Beach Chamber of Commerce -- Accepted as an Arnbassador. Affiliation atid strong reiationship with All Trades Consiruction Company for Pr(Ject Management Top 10�% Home Watch Businesses in Paint Beach County, FL MONEY MAILER OF GREATER ORLAND — Frankfort, 11, Apr 2017 to Apr 202'2' f'runchise Responsible for day-to-day operations, monthly` profn and loss reporting, help businessesand nianagenieni create strategic plans to, niarket their prodUcis and services through direct rnail, rnobile and digital niarketing, • I nereased profit margins over 63% year over year • C lensed over 2,,469 spots ofadvertising in 20 19 • ANvartled Special Achievenient Award for increasing 1,573 spots� • Received the Dianumid ( I lub Member for being recognized of Outstanding Actdevenient of 501,4 montfis MAIIJACK EN'T"ERPRISE S, LLC — Oak Forest, IL Mar 2005 to Dec 2'018 ,Real Eslate Investor/Properq, Almutger — 1""UrChased real estate propertiesand land in ( 4eorgia, f1orida, Illinois, and 'rennesm,e, Managed and, operated rental properties in Illinois, Responsible I"or tic; day-to-day, activities in, the upkeepand inairocriance schedules with all vendors and contractors. * Negotiated reduced rates with triaintenance coinpanies, saving 10',N� annually * Screened applicants, coridticted background checks, dralled lease documents and collected rent checks 0, Coordiruitcd d, tender for tie", maintenance suppliers, successfully, saving the bUSiness 75% of the budget i 1.11 1.1 NIAWA.JA(1X0W1AK l"ACK41.1 — Oak Forest, IL Jan 2016 to Jul 2017 Rqriotud,'Yales Director- S,old autornared solutions to retail and long -terns care pharmacies fiv slailup verAure. Cover seven states, in Midwest Region, Develop strategic relationships vvilli pharinaccutical whoesalers, automation providers and software vendors to build pipeline. * Ck)scd firms' first pliarniacy deal in Indiana, converting client llroni rnanual process 1.0 OL11'automated solutiom: client realized cost savings of$30,000 * Generated 191 leads and 10 new opportUllitieS, in I'lorida,'I"exas and Illinois * (,`,onsult with pliarmacies aboUl tfic R01 ofliatient-specific compliance packaging CINTAS (Fornierly Zee Medioil) — Chicago South, It., Jan 2015 to Dee 2016 Sqjtv andT'irs1Ait,1,Sa1es Consultant— Rcspovisible for the sale of in': aid supplies, training prog)ams, ernergency first - responder products andi personal protection equiptitent. Developed solution -based sales relationships by identifying potential probleirt areas in workplace safety. • Altained (.wer 130% ofquota in first quarter of 2015 • Ranked in the top 5% ofsales organization based on year-to-date sales revenue • Added 25 new accounts in municipal, industrial, retail and transportation segments AVIS BUD(YET CAR RE'NTAI-, GR(')tJP— Western Suburbs, [L MaY 2012 to Dee 2014 liulef)endentAgenc,j) Operalor—Maintafited as bminess plan airvied at developing rent -a -u ar business in local area. 1)eveloped and used internal relationships to ensure NO was niaJ wai tied and available. Responsibifitics included: budgethig, payroll, and ernployee numagenient. Hired, tvihvd, arrrcl motivated as tcan'r ()Henlal Associates, # l locatiori in counter sales revenue at 121% in January 2014 for Western Region Managed (lay to day operations of as $500,000 location, 10% revenue growth over, YTD 2013 Attained 1(.t10% ofmonthly counter sales incentive prograin for 200 WOLTERS KLIJWER FINANCIAL SERVICES, — Headquar(cred in St. Cloud, NIN Jan 2011 to Mez 2012 Y Account Executive - Sold compliance, audit and risk nianagernenj S0j'tjVrarc solutions to C01nfl1Uni1Y banks niortgage lenders and insurance organizations, Collaborated with sales, retention speciaNsts and support partners to nicetchanging custonier needs. Attained l 00IN of'S] .4 nidli011 arlt'IMII SUbscriplion inventory quota i`xceedcd annual softwatre quota by 150011 C0111dUCted groul:)software demo, closed three out offive altendees, produced $60,000 in new sales DEPAUL UNIVERSITY - Chicago, Illinois Bachelor of its in Business Managerrient EDUCATION ASSOCIATIONS NATIONAL 1:10ME WA'1`01 ASSOCIATION - NUWA I)ELRAY BENCH (TIAMBER OF COMMERCE --AC" 'BASSA ORS COMMITTEE 1647 11,111111111311nm 1111mmilIT1111 IF IF MM32E= Thaiink you for your interest in Serving on one of the City's Advisory Boards and for taking the t�ime to, fill out this aippl�ication. If inistructilons allre not followed or the application is not filled out in its entirety, the application will be returned for clanfication. EMAIL DISCLAIMER, Pleaise be advised that under Florida law, e-mail adpublic records. If you I do not want your e-mail address released in reisponse to a pubiic-records re�quest, do not send electronic mail. instead', contact the City Clerk's office by phone or in writing - Mailing address: P.O. Box 310, Boynton Beach, FIL 33435-0310 Phone: (561) 742-6060 I FAX:: (561) 742-6098 Name s Telephone # MR IN < 4� Date of Birth:� Emafl: I J Current occupation or prior occupation: LIVC-1 A4 U / �Ir Education N� 44AZ I �A Are you a registered voter? V/` Yes No Do you reside within the Boynton Beach City limits? jzYes No 111 Do you own/manage a business within the City limits:� Yes No If yes, name of business Have you ever been convicted of a crime? IV' Yes No If yes, when Where Areyou currently servings on a City board? V Yes No Have you served on a City board in the past? Yes No 2, S.r\CC\W'P\BOARDS\Applicatdoiiis\Advsory Board Application 2023,doc OHE .7x 1648 If so, which board(s) and when? Please indicate which advisory board you are seeking appointment. For board listing, requiremenff,- responsibilitles, and meeting times and dates, see attached. Arts Commiission Building Board of Adjustment & Appeals v"Community Redevelopment Agency Advisory Boa!li Education and Youth: Advisory Board EmployeesPension Board f9refiq*t5� Pension Trust Fund .. . . ........ ..... .. . . . Historic Resources Preservation Board Library Board Planning & Development Board Police Officers' Retirement Trust Fund' Recreation & Parks Board If appointed are you willing to serve as Chair or Vice Chair? S No y� 04, CX4 i' What personal qualifications do you possess (i.e., profession, previous experience, branch of military service or organization) which you feel would make you a good candidate for this board? Please be specific. I MT-311M.w r w w -am Signature: D�ate:A, / ......... . - "I S:\CC\WPNBOARDS\Applica'dons' Adv�sory Board Applicabon 2023,doc M 1649 Stan"Mone, Tamill From: City Gei,k Sent: Wednesday, April! 19, 2023 433 PM To: Stainzione, Tarnniy„ De Jesus, Mayleel Subject. FW: Advisory Board Appointnrient application Attachiments: Ali Lol-,)resto . Resunie-2021(focx From-, aml9889 <tiiorepty@)1123for-ryibtjilder.com> Sent: Wednesday, April 19, 2023 4:29 PM To: City Clerk < ityCle r k @ bbfl. us> Subject, Advisory Bolard Appolintinent application Today's date04/19/2023, Name Alexandria I_ rests Phiolne number 561-704-1718 Address 578 SW 25th Ave Boyntoln, Beach Florida 33435 United States Email aW9889 uain(iSICL) Tio Current occupation or, if retired, prior Medical Sales Representative occupation Education Florida International University Are you a registered Yes voter'? Do you reside within the Boynilton Beach Ye, s city limits? Do you own/manage ail business within City No limiits? Are you currently serving on a City No board? Haveyou served on a No City board in the paist7 i If.1yes", which, b0ard(s), and whein? 1650 IN ffl�� if "yes", when and where? Advisory Board Cornrnunity Redeveloprrient Agency Advisory Board If appointed by the City Commiis'sion to serve as Board Chair Yes or Vice Chair are you willing to serve! in this capaicity? Personal I am a resident of Boynton Beach arid currently live in, Chapel Hilli. I am very interested in getting Qualifications involved in the city, l am extremely professional, passionate about this city and would love to be involved with this committee because 11 am fascinated by how it has changed over, the years. l ani, born and raised in Boynton Beach and probably will never leave this gorgeous area except for vacation. I also volunteer with the George Snow Scholarship Fund in Boca Raton in my spare time to review college applicants for scholarships, Il am always looking to give back to my cominnunity and think my knowledge of the area and being a young person, in business will make me an, asset to this board. Feel free to attach upload' an LiqpL.JLLogTi L2 d�,)h�)?.fi�c-id=3c7cc3,6,4c5260846e3d6cclb82c8302Wit; qforr,ribuilder,com extra sheet or resume. Certification 1, the applicant, hereby certify that the statements and answers provided herelln, are true and accurate, I understand that, if appointed, any false staternents r -nay be cause for removal from a board. The message has been sent from 75-301,2,29-2018 (United States) at 2023-04,1915:29:03 on Safari 14,0 Entry ID3 Referrer Form Heist h psj L-� -1 L�r—t42�sp i�,!_CLIAAqy—sojY--bo—ard _qj!InL,wLLrif2u 1651 Alexandria M. Lopresto Cell phone: 561-704-1718 578 SW 25'�'Ave Boynton Beach, FL 33435 AML -2 2UN !3AII(Q),Q —W t D Education Florida International University, Miami, F1 Bachelor of Science in Hospitality M,anagertient, Minor inGlobial C"onmtini cati oils Graduated May 2013 GPA� 3.0 Work Exoerience Azurity Pharmaceuticals (Pre'viously-Arbor Pharn'raccuticals)- South 11orida March 2021) -Present Hospital Sales Repares enlativc • Sales and Marketing for five brandcd pharmaccutical products, (Giliadel, 'Trip(odur, Nyinalize, Firvanq, l`]cqsuvy) • Call points include Neurosurgeons, Neuro -oncologists, Hospitals, R U, OR, Pediatric F-ndocrinologists, Nursing Staff, f1hannacy Buyersand Clinical Nurse Educators. • Fostered relationships and perfurmed 111 -Services with Pharmacy Buyers, Neuro -K.' I U Nursing staff', Operating RoStaff a om Stand odier call points within (lie hospital s),Meni. • Leveraged relationships wi Ih key physicians and phartnacy personnel to get product, reviewed b�y P&TConimittee so that it call he added io the fficifity formulary list. • Tenriiory- South Florida- Ew Coast Vero Beach to the Keys and West Coast fi-on't Bradenton soulli to Naples I Fired at the beginuing of, the COV[D- 19 Pandemic navigated virtual selling envirolinlent utiliziiig NIS Teanis, Outlook and (wer the plione conversations to generale and exceed sales goals. • Institutions I %,ork ch)sely vvith- Boca Regional, Delray Medical Center, JFK Medical Center, Sarasota Meirwrial, Giulf C'oast Medical Center, Cape Coral, St. Mary's, Broward General, Memorial Regional—Tackson J-leahh ;way stenn, University of'Miami Neuroscience Institute, Grew total territory allnual sales 15rc)m $1 .5 million in March 2020 to over $5,8 millioll prusent 2022. President's Oub 2020- Winner ranked 21"1 fil the nation President's C'ircle of Excellence 22021- Winner ranked I "°' in the nation Arbor StarAward 2020 Top 'Friptodur Sales A ward 2020 & 2021 fflo'�Delivery Sciences- West Pahn Beach, t'lorida March 2019- March 2022O Ten-itory Manager • Sales and Marketing for two branded pharmacculicall products (Belbuca & Symproic) • Ca 11 points in Pain Managenient, Internal Medicine and Neurology. • Created strong reationships with Pain imanagernell Practices in illy territory to grow the baseline ofBelbuca fifins. 4P FIducated lillysicialis and stal"fon clinical benefits ol,' bloth Nanded products as well as assisted with managed care pull through and, prior authorizations. • My first full quarter with BDSl 14 2 2019) 1 exceeded voh.ime fol-TRx in, any previous quarter in the Itistory of the lerhtory. • Managed a territory wilb the geography of Boca Raton to Vero Beach, 1652 Pernix 'rherapeutics —West I'ahn Beach, F lorida Ociober 2014. -February 2019 Phartitaccutical S,pecialty Sales Representative • Sales and Marketing of four Branded PhannaceUtical Drugs (Zohydro F'R, Silenor, "Freximet, lc hedez1a) to Physicians in, tile following specially fields: Internal Medicine, Psychiatry, Primary ("are & Neurologists, • Analyzed call and sales, reports to establish morc of and effective strategy • Persuasive conimunication and interpersonal skills, adept with developing strong and successful relationships'with clients • Able to communicate sciernific data clearly and concisely to all audiences, including MAs, nurses, nurse practitioners and physicians • I leld as l0-+- call per day schedule with pharmacy visits • Fxceeded quarterly sales goals air(] demonstrated product growth widrin my terriiory • Four quarters, in as row exceeded goal of I OW,() to plan on all three products • Since joining Pernix have Ireld 30"' in the company or better on national sales rankings based off as sales force of2()O reps • FN" 20117- Ranked Q2 out 78 reps, in the company FY 2016- Ranked 06 out ol'34 reps in the company FY 2015- Rariked 0-29 out 200 reps in the coinpany C orlsistently grew sales through acccaunt management for four products in the speciahics of Internal Medicine, Pain Management, Primary ('are & Neurology, • Managed as lcn,ilory 1'rom North Fort Lauderdale to "I"itusville, F loricla. • Nicniber ofthe Pernix Advisory COUITCH, a board coarprised cif 12 employees selected 1wy the CFO [c) represent dift'ererit areas ol'the company at quarterly meetings. Pronova 'orporation ­ Bro\vard & Pahn Beach County, Florida July 201 y-Ocu) tier 2014 Manag'er. Sales and N4arkefing offour Branded Phannaceutical Drugs (Ilemax, Obtrex, (..)btrex DYIA, Digex NF) to Physicians in the l'ollowing Specialty fields! OB/GYN, I-lenIatology/Oncology, (Jastroenrcrology & Nephrology Almlyzed call and sales reports to establisb MOTV CfliCielll and efl&five strategy Persuasive conri,nunicafion and interpersonal skills, adept with developing stroilg and smccessful relationships %vith clients Able to comatturicate scietliffic dala clearly and concisely to all audiences, including MAs, 11LU-SeS, nurse practitionerx and physicians FY 2013 -Ranked 02 out of'25 Reps in the c�,mmpany FY 2014 -Ranked #2 out of'25 Reps in the company Held a 10', call per day schedule with pliarmacy visits Exceeded quanerly and yearly sales goalsand denionstraled product growth wilhin my terntory grew sales in four Products in the specialties oT(I')B/GYN, FlematologyX)ncology, ("jasiroenterology, and Nephrology Held and mainwined the second largest territory within Pronova t...'orporalilon Community Se,rvice & L,ars idershjp Roles Pr eOdenl Delray Beach'Youth Council, 2006-20108 ,aoccer Btah'llyl Captait), Boca Raton Top Soccer Association, 2006- Present Teain Captain, Atlantic ("ollim tinnily I'ligh School "lomen's Goll"Temn, 2004-2008 1653 Stanzione. Tammy . ...... From: City Clerk Sent, W I ednesday, February 01, 2023 12:12 PM, To: De Jesurs, Maylee, Stanzione, Tarnmy Subject: FVV': Advisory Board Appointment application Attachments: Noelle.docx From. nmcir)tyre82 <noT°eply@123fornibluider,COfTl> Sent: Wednesday, February 1, 2023 11:15 AM To: City Clerk <CityClerk@bbfI,us> Subject: Advisory Board Appointment application Today's date 02/01/2023 Name, Noelle McIntyre Phone number 561-703-3759 Address 910 SW 27th Avenue Boynton Beach Florida 33435 United States Email, !I RIc Yr�u y Current occupation or, if retired, prior Self Employed occupation Education Some college Are you a registered Yes voter? Do you reside within the Boyntoin Beach Yes city limits? Do you own/manage a bulsiness, within CityNo Urnits? If "'yes"', name of business: Are you cu!rrently serving on a City No boaird? Have youser ved on a ,City board in the No past? If "Yes", which board(s) and wheni? I 1654 1655 Have you ever been No wiff"U "I I if "yes", when and where? Advisory Board Community Redevelopment Agency Advisory Board if aippointed by t�he City Commission to serve as Board Chair Y or Vice Chair are you willing to serve in this capacity? Personal, see attachment Qualifications Professional Memberships Feel free to attach/upload an h t tpsA, _5259a1152 form,12 3formbuilder,coML extra sheet or — resume. Certification 1, the applicant, hereby certify that the statements and answers provided herein are true and accurate, 1, understand that, if appointed, any false statements, may be cause for reniioval from a board, The message has been, sent from 73,57,19.1.90 (United States,) at 2023-02-011,114:42 on Chrome 109.0 0,0 Entry IID: 587 Referrer: ht p -,/L 'a t -019LI: IUItLRMI nt lication Form HoW L I 1656 1657 AMMAR wo V 1858 1659 From: City Clerk Sent: Monday, April 24, 20,23 -7:44 AM To: Stanzione, Tarnmy Subject: FW Advis,ory Board AppoirmMent application From. hirurzun <noreply@123fora bluider.com> Sent: Saturday, April 22, 2023 3,:58 PM To: City Nark <CityClerk@bbflAJS> Subject: Advisory, Board, Appointment application Today's date 04/22/2023 Name Heather Posta Phone number 561-6,35-0114 Address 2555 SW 14 th Stree Boynton Beach Florida Florida 42 Reserved Email Liirurzun@ Current occupation or,, if Delray Beach Ocean ReSCLJe Lieutenant retired, prior occupation Education Hi school diplorna Are you a registered voteir? Yes Do you reside within the Yes Boynton Beach City 11mits? within City limits? if 11yes", na,mie of business - Are you currently serving on a No City boarid? Haive you serived on a City No board in the paist? IL;��sWclti board(s) and when? Have you ever been convicted No of a crime? if "Yes", when, and where? Advisory Board Community Redevelopment Agency Advisory Board 1660 If appointed by the City Commission to serve as Board Yes Chair or Vice Chair are you willing to serve in this capacity? Personal Qualifications As an Ocean Rescue Lieutenant for City of Delray Beach over the past 28 years, I have had a great deal of experience in representing the Ocean Rescue/ Fire Rescue Division in many different facets. I have received several different proclamations from our cities mayor on behalf of our Lifeguard Competition Tearn, spoken on behalf of several employees receiving their service awards in front of all of our department heads, and presented at several of our local schools for our Ocean Awareness Program. I have participated in ongoing, community Outreach by teaching CPR classes to Our city employees , as well as being the lead instructor of our Junior Lifeguard Prograrn, Professional Memberships I have been a nnernber in good standing of the United States life-saving Association as well as The international Association of firefighters, for the past 28 years. . W i 11 li z-xt�ra sheet or resume. Certification 1, the applicant, hereby certify that the statements and answers provided herein are true and accurate. I understand that, if appointed, any false statements may be cause for reirnoval from a board. The message has, been sent frorn 174,228.1,64,52 (Reserved) at 2023-04-22 '14,,58:16 on lPhone 15.6 Entry M 625 -opplication Form Host: h s: J11- Y-!?,�NL4- U cal -e L 1661 From: lesharOUndtireell <nor y.&Jt22, f o tjr CO , n > �aL)ujlder,, I Sent: Wednesday, March 291, 2023 2:47 PM To: City Clerk <01y Lejj,@—bkj-ft.Lj–s> Subject: Advisory Board Appointment application Today's date 03/29/2023 Name Lesiva Rouncitree phone number Address 805 N.E 2nd Ct, Boynton Beach FL 334,35 Netherlands Email m,�T-t Current occupation or, if retired, prior occupation Education Master Degree Are you a registered Yes voter? Do, you reside within the Boynton Beach, City yes limits? Do you own/manage a business within City limits? if "yes", name of buisines,s- LCAE AR nterprises Are you currently serving Yes on a, City board? Have you served on a Yes City board in the past? i If "yes", which boair�dl(s) Parks and Recreation and when? Education Advisory CornmUnity Relations Library Advisory Have you ever been N10 convicted of a crime. If "yes", when and where? Advisory Board please select... If appointed by the City Commission, to serve as Yes Board Chair or Vice Chair I 1662 are, you willing to serve in this capacity? Personal Qualifications Professional Mie�mb�erships Feel free to attach/uPloadi an extra sheet or resume. Certification 1, the aipplicant, hereby certify that the statements and, answers provided herein are true and accurate, I understand that, if appointed, any false staternents may be cause for removal frorn aboard. The message has been senit frot'n 127.0,01 (Netherlands) at 2023-03-291 BA7:29 on Chrorne 110.0, .0 Entry IID612 Referrer: h ' ti ' IITI I Form HosV h t i� ff A iio( p2din e t" L�L)!Lcatjon 1663 Stanizione, Tamp] Y Fronn: Lesha ROUncitree <esliarouridt�i,e,ell@gTnaill.coi-n> Sent- I"u,esday, April 04, 2023 11: O AM To: Stanz�ione, Tammy Subject: Re: FVV: Advisory Board Appointment appfication Hello - I apWWd Rw two boardL I air very interested in the CRA Advisory Board. On Tue, Apr 4, 2023 at 8.21 AM Stanzione, Tarniny <StanziorIeIR[LbfUs> wrote: Thank YOU, M have reodved your AdviWory Board Appohm,nent alipfication. Y'OLU appIkation mill Cre subalned to tk CRy CornmKon for consideratIon of appointment at the April :18, 2023 Cornrnission iirieeitng, e� 7 '[a'urmry Sr'anzror�e' Cr"'IC Deputy Cly CO'k, CRY Uerk's' Olk("' hAaHing Address: HI Box 310 � B,,.ov,nton BeaO,, Fk'-aida 33425 P[rvskal Address; 100 E. Ocean Ave. I Boynton Reach Fladda 33435 k. SE',0742 6062 fia StanQneT(qi,Db[iR us I PInse be advNed tho HOW has as bmad puNic recork, R,,i,�vvcmd all wqxWexe to rrr(-Ai aenrfll rnay he SUbjr,,,,(I U), Nor% records law, emaH addresws me puWk awords. Thoekm, your e maH corrununkWon and your einaH addrox may be suboct to pubUc dhNsum, From- City, Clerk <gity�g1kL@ bbtl, up Sent: Wednesday, March 2% 2123 392 PM To: Stan zione, Tarnmy De Jesus, Mayl:ee <Debf I-Le-sL)L ..-I. —us > Subject: FW: Ad,visolry Board Appointment application 1664 From: City Clerk Sent: Wednesday, March 08, 2023 3:41 PM To: Stanzione, Tarnmy Subject: FW': Advisory Board Appointment application From: calixtefranoels e <noreply@123fo�,tnbLilder.comi> Sent: Wednesday, March 08, 20239:15 AM To: City Clerk <CityC1erk@bbfl.us> Subject: Advisory Board Apip ontinent application Today's date 031/08/2023 Name Fraincoise Calixte-Dieuvfl Phone number Address Email calixtefraincoisecwznlLgil�Com Current occupation or, if Esol Coordinator retired, prior oiccuipation Education Ks Are you a registered voter? Yes Doi you reside within the Yes Boynton Beach City li�mit�s? Do you own/manaige a, businesis NO within City limits? if ""yes", name of business: Are you cu rre ntly seirvi nig on a Y'eis City board? Have you served on a City yes board in the piast? If "yes", which board(s) and when? Education & YouA th dvisory Board for the past four-plus years, Have you ever been convicted No of a crime? If "yes", when and where". Advisory Board Education and Youth Advs,ory Bio and 1665 If appointed by the City Personal Qualifications Palmer Beach Atiandc University Master's in organizational leadership Palm Beach State College Bachelor's in management & Supervision Associated of Art in Health Sciences Graduated with an honor PaIrn Beach Maritirne Academy Secondary sol Coordinator) 2022 — Present City of Delray Beach (Finance UTB), 2019 -2022 Perform general administrative management duties Collect services fee Create a spreadsheet for the collection fee Promote poisitive ei'Tipioyee relations and employee morale daiily. South County Drug Abuse Foundation Inc. 20,16- 2019 Health Behavior Educator/Counseling/HN advocate Keep appointment calendars, and schedule Professional Memberships F&R Immigration and Notary services 2007-2016 Provide administrative and StaffAssistant to the whole staff. Help with translation File paperwork Monitor daily Payroll sheet Church volunteer 2005 -Present Counsel and coach people with different needs Teach Sunday schoo I for all age g,ro u ps Assist with planning youth activities A971TOM. I extra sheet or resumei. Certification 1, the applicant, hereby certify that the statements and answers provided herein are true and accurate. I understand that, if appointed, any false statements may be cause for rernoval frorni a board. The niessage has been sent frorn, 5x0.23 a'.1 8.186 (United! States) at 2023,03-018 09.14161 ()nj ClIq'rorne 110,0,0,0 Entry 110; 61015 Referrer11tps JjWww,boynton-beach.p�rgj Form Host; h tforn 1,123fornibuilde co Lg, as EY:k�EA-4PPR LU t, ffigIll- j1p 1666 Stainizionle, Tammy From: it Clerk Sent: 'Tuesday, February 21, 2023 8:23 AM To: Stanzione, I'arnmy; Die Jesus, Maylee Subject: FW: Advisory Board Appointment applliicaition Attachments: Nkola s.-Giacalone-LoR.picif From: nicolasgiacaloo e <noreplly@123fori,nbuilldet,com> Sent: Saturday, February 18, 2023 1:28 PM To: City Clerk <CityCierk@bbfLUl5> Subject: Advisory Board Appointment appfication Today's date 02/18/2023 �Namie Nicoiias Giacalone Phone number 561-699-3466i Address 4170 Key Unie Blvd Boynton Beach FL 33436 United States Email mica las. giacalon Current occupation or, if retired, Iprior Marco, Rubio for Senate occuption Education College Student Are you a regi�stered voter? Yes Do you resiIUII de within the Boynton Beach Yes city, limits? Do you oiwni/manaige if "yes", name of business. Are you currently cerving on ai City No board? naive you servied on a City board in the No past? If "yes", which board(s) and when? 1667 If "yes", when and where? Advisory Board Education and youth Advisory Board If appointed by the City Cornmission to serve as Board Chair Yes or Vice Chair are you willing to, serve in this capacity? Personal I am 19 years old and started my career in public service in middle school at Franklin Acaderny in Qualifications Boynton Beach, Florida, I served as a student council representative and won mern ber of the year, II went on to serve as President of the Jr. Class of 2022 and Chairman of FUndraising for the Student Government Association at Sornerset Academy Canyons High School in Boynton Beach, Florida, In 12th gracile, l was, elected to served as the President of Student Gov erni"nent Association, ^which I governed the middle -high school, II now am attending Lynn University, 11 know, the education system well, as I hived in it and have been around for it practically my whole life. Professional A committeeman at the Republican Executive Committee of Palm Beach County. Memberships Intern, and IPalrn Beach County Administrative Liaison for Marco Rubio's 2022Re-election Carnpaign, Feel free to attach/upload an d=29�6�lcad 6�8c6bb,Olt��J.0134f7'7085e736352 extra sheet or resume. Certification 1, the applicant, hereby certify that the stat ernents and answers provided herein are true and accurate,. I understand that, if appointed, any false staternents may be cause for removal froiru a, board, The nnessape has been sent from 9,9,210,19:8,,214 (Ur'Oted States), at 20,23- 18 13 27A2 on Whone 16,2 Entry 11D: 592' Refenvrhnl;!iILWvvA,,LcMEitgn,-beacL]..o_rgZ Form Host: h tL 5 14 ad jg:L�zLrL­@p ohlLaltal- _g )Ljfirgtjj[on _p_ _ _ 1668 December V, 2022 I am pleased to have the opportunity to write a letter of recommendation on behalf of Wicol;;w Nicolas' declicvtion to kis acadernics and leaders'tivil will make him an M=jjjjMMMjjj= 11 E Nicolas has been alct�ively engaged in piolitics, interning with, my South Florida campaign tea As a Campaign Intern, Nicolas, hais taiken an act�ive role in engaging with Florida voters, whiile di�scus,sing issues that matter most to them. Nicolas has also demonstrated his commitment to his coimmuniity by having completed oiver 4,00 hopast four years. I I am proud that Nicolas' experience working with my campaign has inspiired him to further his leadership, and I have no doubt he will thrive alt his next opportunity, Nicolas' passion for academics, as well as his understanding of politics, ensures he will be a great aisset to you. Thank you for your th-ne ainid consideration in this matter. To discuss Nicolas' recommendation further please contact my Political Director, Matt Grucla, ait 305-613-6651. MOM Marco, Rubio United States Senator 1669 Stanzione, Tammy I from: City Clerk Sent: Monday, March 20, 2023 2:07 P,M To: Stanzione, Tammy; De Jesus, Ma lee Subject: FW Advisory Board Appointment application Attachiments: Resume Te�resa M-3-23,clocx From: Damcclendon, <i,io�repill y@1foi,milbit,iilder.coni> Sent- Monday, March 201, 20,23 12J3 PM To: City perk <GtyCler k@bbfl.us> Subject: Advisory Board Appointment application Today's date 08/16/1963 Name Dr Teresa Kase y -Mc Clend oin Phone number 561-577-9272 Address 7228 Chesapeake Circie Boynton Beach Florida 33436 United States Emaill DrtmiccliendoLift, fl.corn Current occupation or, if'Executive Director Early Childhood Education reti�red�, pricer occupation Doctrine of Divinity yes Do you reside within the Boynton Beach City Yes limits? -mo you own/manage a 'i�uslness within City Y" ]limits?, If "yes", name of Little Cubz Learning enter buisiness� Are you currently No serving on a City board? Have you served on a No City board in the past? If "yes"', which board(s) and when? Have you ever been No, convicted of a crime? 1670 If "Yes", when; and where? Advisory oard Education and Youth Advisory Board If appointed by the City Commission to serve as Bioa rd Cha I r or Vice No Personal Qualifications Asa Pastor and cornmUnity leader Ministering to, low-incorne fat'nilies On a consistent bas'i's. As an Experienced Childcare Provider Serving area farnihes and seeing the needs of the people firsthand, and hearing their COrnplaints and hearing their struggles. During the Pandemic serving our community by opening a food pantry, giving away clothing. Shoes and assisting, with: ministry finances. Professional Way of Life Family Worship Center Memberships Children Services Council StrongMinds Prevention Central of South Florida American Heeart Association National Chaplain Association Florida Association of Childcare Management NAACP �Feel free to attach/upload an, extra htjpsj f�oral-n.123forriiibLi�dc%rcos' )IL!lp (Ldid i Li-Mleid=58bl,findW.396f5ff7afe8c6da, cfed78 sheet or resume. Ce�irtification 1, the applicant, hereby certify that the statements andl answers provided herein pare true and accurate. I understaind that, if appointed,, any false statements may be cause for removal from a board. The niessage has been sent fron,,j 166,2'05.159.62 (United States), at 20,23 03-20 11:12:51 on Whone 163 Entry ID,. 609 Referrer LittpZtwbqy oq,,jlg_a� Lk&g ,ILL g/ Forni Host; tit orrn.123formbudder.,con jajZ141 Jj �E )i),E I -a r t .9 n rnc� t 1671 OMM11wrom 1079MVIONSTMEIZOI 7228 Chesapeake Circle - Boynton Beach, FL 33436 Cell (561) 577-9272 Email - Liv2livagin@Paola ,com Patrick, Henry High - Ranoke, VA 06/1981 National Bus. College Salem, VA 10/ 1983 Fashion Merchandizing Palm beach State College Lake Worth,, FI -8/2015 Director; Degree Faith Christian University School 5/20109 Doctorate Leadership Tabernacle Bible College & Sieminary Doctorate Divinity *Work Experience: Way of Life Ministry B I 'oynton Beach, Fl. 2020 Executive Administratoir/Pas�tor Instructor - Mentor: Manage Administrative Sitaff, Correspondence, Typing, Dat E�ntry, Reicorld- keeping, Filing, Meeting Scheduling. Mana- &Train Volunteers Alternative Unlimited Plantation, FI 01/210iO6-05/2008 1672 Administrative Assistant Office, Administration, Registration, Data Entry, Scheduling, Appointment Setting, Filing, Reporting, Teacher Assistant Manage & Train New Hires Portsmouth Redevelopment & Housing Authority - Administrative Assistant: Chesapleiake, VA - 07/1999- Oil/2OiO2. Typing, Filing, Meeting Scheduling, Office Management, Data Ent�ry, Report Updates & Filing, Electronic Billing, Customer Service, Traffic Calls, Accounts Payable, Sort &, Distribute Mail, Accounts Payable & Receivable. R & R Transportation,, Inc. Oi2/2000 - 01.5/2001, Suff6lk, VA Marketing/Advertisileiment & Custom,er Service Marketing & Advertisement, Transporter, Appointment Setting�, Quote Preparation, Data Entry, Customer Service, Data E�ntry, Matrix Updating, Manage & e-ui [Harrison Museum of African. Culture 0 Itirector Assistant American 08/1.997'- 01/2000 Roanoke) Vj-X,. #ffice Management, Payroll, Accounts P�ayabile & Receivable, lWata Entry, Manage &Train Volunteers Trigon BC/BS - 11/1.987'-07/1997 Roanoke, VA Customer Service Claims S�plecialist/Prolvider Service, Retention, Benefits Analysis,, 1673 Claims Entry & Processor, Coding, Billing, Medical Claims Assistant , Roanoke Virginia 05/1983 - Assistant Dietary Director /Dining Rooim Assistant Assistant to Dietar , y Director, Manage Administrative Staff, Correispiondencei, Typing Record -keeping, Filing, Meeting, Scheduling, Data Entry, Menu Preparation, Manage Evenin I` Staff Waitress, Assist Coiolks Skills: Administration Operator/Reco ptio�nis�t Office Management Dis�patch, Data Entry Volunteer Coordinator Mentoiring, /Business Machines Certified Effective Supervision Licensed Parenting Instructor Licensed Minister/ Noutic Counseling Medical Billing/'Claims Filing Insurance Benefits/P,r,ovider & Broker Service Nursing Home Dietary Food Preparation/ Training Medical Term inoloigy Microfilm & Microfiche "Tele mrktin ,Fundra i sing 1674 Pam Canon -Lead Secretary Portsmouth Redevelopment & Housing Authority 80�O High Street Poirtsimouth, VA 237015 (757) 39i9-5261 Felicia Walker Regional Director 28001 Oakland Blvd Fo�rt Lauderdale 33311,4 (1754) 32:1-7050 Tierra Kasey - CEO Prevention Central Fort Lauderdale, Fl 33336 (954) 599-2267 94EM., I=MNwM Michael J.r. McClendon - Pas�tor Ramsey Coins�ultant�s A1TV.7T Gwixtwticatiovs V17 0 W, WI M To, 105 = Tammy Autrey Marriott Richmond, V 5611225-3527 1 1675 Stanzione, TaIMIMIX . . . ............ From: City Clerk Sent: Wednesday, March 01, 2023 12:25 PM To: Stanzione, Tammy,- De Jesus, Mayllee Subject: FW: Advisory Board Appointment application Sent: Wednesday, March 1, 2023 12.018 PM To: City Clerk <CityClerk@bbfl.us> Subject- Advisory Board Appointment application Today's date 03/01/2023 Name Vall,erie Valcourt Phone nuim,ber 561-293-6591 Address 410 IN W 16th Ave Boynton Beach Florida 33435 Netherlands Fm iaill vafeerie.vall qjLiL bjLdlLi2!,±),ach.$)n!j2qLAcam, Current occupation or, Jif retired, prior occupation Educator Education Doctorate in Educational Leadership Are you a registered voter? Yes Do you reside within I i the Yes Boynton Beach City limits? Do you own/manage a business iW ,within City limits? if ""yes"', name of business: Areyou currently serving on a: Yes, City board? Have you served on a City Yes board in the past? If "yes", which boiard(s) and I am currently the chairperson for the Education & Youth Advisory Boar* when? Have you ever been convicted No of a, crime? if "yes", when and where? Advisory Board Education and Youth Advisory Board r. 1676 If appointed by the City Commission to serve as Board Yes Chair or Vice Chair are you willing to serve in this capacIty? Personal Qualifications I have been, on the Education & Youth Advisory Board since 2020. 1 have served as, the chairperson the last 2 years. I am also an Assistant Principal for the' cho l District of Palm Beach County. I have graduate degrees in Educational Leadership, Professional Memberships Feel free to attach/upload an extra sheet or resume., Certification 1, the applicant, hereby certify that the statements and answers provided herein are true and accurate. I understand that, if appointed, any false statements may be cause for removal from a board. The message has been sent from 127.01.01.1 (Netherlands) at 20,23-03-01 12:08J6 on Chromie 108.0.0.0 Entry ID: 5,98, Referrer: !"i t qg�jj'VLWfflW�tg) MLQn .LN'Ai-11, Lai Form Host', ht s,,) j.Lq!n_ I�Jf2Lr -12__ _ru 1677 From: City Clerk SentFriday, March 31, 2023 428 PM 'To: Stanzione, Tarnrny; De JeSILIS, Ma to Subject: W Advisory Board Appointi[nent application Attachments, Brad -Jackson -12022 'Resiuime,docx From: bjackson <�nioreply@,1,23fortnbluildeir.co�"n> Sunt® Friday, March 31, 2023 3:30 PM To. pity Clerk <CityClerk@bbfl.us> Subject: Advisory Board Appointrrient application Today's date 03/3,1/2023 Name Bradley Jackson, Phone number 561-2' -5791 Address 815 W. Boynton Beach, Blvd., Apt 15-103 Boynton, Beach FL 33426, United States Emaill bac kson Ccqer Current occupation or, if retired, prior Marketing Director for Engineering & SUrveying Firrn occupation Education Bachelors Degree froini FSU in Business/Hospitafity Management Aire you a registered Yes voter? Do you resiide withiin the Boynton Beach Y'e s City limits? Do you oiwn/manailge If "yes", name of business: Are you currently serving on, a City No board''17 Have youi served on a No City, board in the past? If "Yes", which board(s) and when? 1678 Have you ever been Yes convictO of a, cri-tte? If "'Yes", when and 2014, Driving Under Influence where? If appointed by the City Commission to serve as Board Chair Yes or Vice Chair are you wi Ming to serve in this capacity? Personal I work in the,, architeCtUre, engineering, and construction industry and hawse knowledge and Qualifications appreciation for our historic buildings and resources in the City and the important of preserving there from being erased through overdevelopiment or redevelopment. I have previous, experience volunteering at the South Florida Fair in their yesteryear village (YYV) park to help spread information and awareness about the historic structures being preserved there so that people of all ages can learn, about history in Palm Beach County, I serve on the Young Professionals, SponsorsWp, and Hospitality Committees at the Fair which help prornote YYV throughout the Community, Professional Society of Marketing Professional Services, (SNIPS) South Florida Chapter Memberships AEC Trendsetter's of: Florida Leadership Painij Beach County Rusty Gordon LQ+ Democratic Caucus, Urban Land Institute (MLI) Southeast Florida Chapter Florida Engineering Society American Society of Civil Engineers Feel free to attach/uploa,di an c1a6eb7aedb9527bcO17f2f extra sheet or Mutt ms: forrru.;�forrmmi�au�IMpr comm fug load did, Ir resurne,, Certification, 1, the applicant, hereby certify that the statements and answers provided herein are true and accurate. I understand that, if appointed, any, false state me rits may be cause for removal from a board. The niessage has bleen sent from, 501.244.140,133 (United States) at 2023-01,31, 1.4:30:20 on Chrome 111,0,0,0 Entry ID,., 614 Referrec htfjps w%Lw boyn Form Host-, u or sJL httjj m.123forrnLi r.&Loj-DJj�. �UAL�Ld oi�oty-bg�a rd -a ppoi Lit m eqjjjj?2icat"qn, _ _ _jdc 1_ _ 1679 Bradley Jackson # I-5 W- [,o--y-n-t"o—riA-pil. 151()3, Boyraon 13eadl, FL 33426 1 (561) 252-579 1 1 To be considered for a seat on the Boynton Beach Historic Resources Preservation oar to serve the residents as, a member of the coninnunity committed to preserving the rich history of the buildings and architecture in the City. Skills Excellent Communicator and Coordinator • Highly adept at marketing research and organization of company functions • Convey leadership qualities in managing organizations and business responsibilities • Pai-ticipating in community activism and engagirigi with local leader's to, enhance the environt-neat and well- being for our neighbors Edu atron BS Business/Hospitality Managerrient � May 2013 � Florida Mate University (Leadership Boot Carnp, College of Business � October- 201,81 Florida AtIa ntic University 4W Current.job E2=6enice Dir. of Marketfi,ig & Business Development I Engenuity GWUP, lnc, I March 2oi.3- Present 0 Manage and at times pregame all RFQJRFP responses, for public sector, work * Manage, prepare, and post content for company website,social rnedia 0 Manage and prepare conterit for company newsletter through Coristant Contacts 0 Prepaire and review reSUmes and project experience cut sheets for marketing 0 Coordiriate and manage teaming opportunities for private and Public sector, projects 0 Attend networking events to socialize wei various groups of people to learn and develop new business connections for the company 0 Research and develop ri-iiarketing, strategies, firma -wide 0 Manage admilinistrative staff to ensure quality control of day to day tasks VOIL nteg u-!qj i e in ic, e, 0 Society of Marketing Professional Services (SMPS) South Floriida Chapter: Past President 2020-2,022, President 2019-2020, President Elect 2018-20ag, Programs ilair 2017-2018 0 AEC T"rrendsetter's of Florida� Viice President 2020-2022, Board Mernber 2017-2020 0 Leadership Palm Beach County Class of 20: 2,2. Current Alurnini serviing on HohdayBe.akfast, Focus, & Forward Committees 0 Rusty Gordon L.GBT0+ Democratic Caucus: Secretary & Endorsements Chair 2021,. -Current: # South Florida Fair & Exposiitions- 'Beyond the Falr'Young Professionals Class Of 20'21, Serving on Sponsorships, Youngi Leaders, & Hospitality CommitteeS, 2023- Current 0 Compass: Stonewall Ball Host Cornmittee Menibel" 2022- Current 0 Sunfest. dates Comirnittee Member 2022 -Current Urban, Land Institute (UU) Southeast Florida Chapter_ Palm Beach County Young Le�aders Steering Comr-nittee Member' 2018 -Current Florida Engineering Sobiety:"volunteer yearly for MATHCOUNTS & Engineer It! COMpetitionswhich, engage elementary & mididdile schroolers with rriath and science American Society of Civil Engineers: VOilUnteer yearly for Bowl -a - Thor) Scholarship event Volunteered on i different local Ipoliitical carripaiigns 1680 1681 11,111111111311nm 1111mmilIT1111 IF IF MM32E= Thaiink you for your interest in Serving on one of the City's Advisory Boards and for taking the t�ime to, fill out this aippl�ication. If inistructilons allre not followed or the application is not filled out in its entirety, the application will be returned for clanfication. EMAIL DISCLAIMER, Pleaise be advised that under Florida law, e-mail adpublic records. If you I do not want your e-mail address released in reisponse to a pubiic-records re�quest, do not send electronic mail. instead', contact the City Clerk's office by phone or in writing - Mailing address: P.O. Box 310, Boynton Beach, FIL 33435-0310 Phone: (561) 742-6060 I FAX:: (561) 742-6098 Name s Telephone # MR IN < 4� Date of Birth:� Emafl: I J Current occupation or prior occupation: LIVC-1 A4 U / �Ir Education N� 44AZ I �A Are you a registered voter? V/` Yes No Do you reside within the Boynton Beach City limits? jzYes No 111 Do you own/manage a business within the City limits:� Yes No If yes, name of business Have you ever been convicted of a crime? IV' Yes No If yes, when Where Areyou currently servings on a City board? V Yes No Have you served on a City board in the past? Yes No 2, S.r\CC\W'P\BOARDS\Applicatdoiiis\Advsory Board Application 2023,doc OHE .7x 1682 If so, which board(s) and when? Please indicate which advisory board you are seeking appointment. For board listing, requiremenff,- responsibilitles, and meeting times and dates, see attached. Arts Commiission Building Board of Adjustment & Appeals v"Community Redevelopment Agency Advisory Boa!li Education and Youth: Advisory Board EmployeesPension Board f9refiq*t5� Pension Trust Fund .. . . ........ ..... .. . . . Historic Resources Preservation Board Library Board Planning & Development Board Police Officers' Retirement Trust Fund' Recreation & Parks Board If appointed are you willing to serve as Chair or Vice Chair? S No y� 04, CX4 i' What personal qualifications do you possess (i.e., profession, previous experience, branch of military service or organization) which you feel would make you a good candidate for this board? Please be specific. I MT-311M.w r w w -am Signature: D�ate:A, / ......... . - "I S:\CC\WPNBOARDS\Applica'dons' Adv�sory Board Applicabon 2023,doc M 1683 Starizione, Tammy Fromi- City Clerk Sent- Thursday, March 02', 2023 218 PM To: Stanzione, Tammy Subject: FW: Advisory Board Appointment application From, lindsaykarten <iioreply@123fortn,builder.coni> Sent: Thursday, March 2, 2023 8:41 AM To. City Clerk <0tyClerk@bbf1,us> Subject., Advisory Board Appointment appfication Address 3386 CHURCHILL DR BOYNTON BEACH FL 33435 United States Email l"ndsavkarterii(o')Rniaill.corTi Z Do you reside within the Yes Boynton Beach City limits? Do you own/manaige a business No within City 11imits? Are, you currently serving on a No City board? Have you served on a City No board, In the past? 14 bis-o2rd( Have you ever been convicted No of a crimO, If "Yes"', when and where? ,Advisory Board Library Boa:rd If appointed by the City Yes Commission to serve as Board .1 1684 Chair or Vice Chair are you willling to serve In this capacity? Personal Qualifications, Professional Memberships Feel free to attach/upload an extra sheet or resume. Certification 1, the applicant, hereby certify that the statements and answers proided herein are true and accurate. I understand that, if apointed, any failse statements may be cause for rernoval frorn a board. 'Th:e rnes5age has been sem from 1.7 .55,112,230 (United States) at 20123-013 02 08AOA7 ori Chrome 11 .0.01.0 Eritry ID: GOI Referre,rht�pi,-11w.ter w )yjL tgq-bg Li4,CTd Form Flost: ht( s,/ forrii.12�3foriiiibuiilclt,,rcoinLM3�q4lild i boardcrpp i �a I i 0 r, 1685 '3 Stanzione, Tammy From: Clity Clerk Sent: Wednesday, (March 08, 2023 7:43 AM To: Stanizione, Tarnrny; De JeSUS, Maylee Subjt: FW: Advisory Board Appointment application Attachments: Marcia Levine RestA,nii(�iiciit-ch-23,doc From: marcialorHevine <noreply@123forrnbuilder.corn> Sent: Tuesday, March 7, 20,23 7:40 PM To: City Clerk <CityCierk@ bbf L LIS> Suibject: Adviisory Board App6ntrnent application Today's date /07/2023 Name niarcia IeOne A 0 a * A It 14 4 Address, 6,25 casa Lorria blvd' apt 8018, Boynton Beach FL 33435 United States Email Current occupation or, if retired, prior DJ occupation Education College Graduate Are you a registered Yes voter? Do you reside within ts? Do you own/manage a business within City No 111fits? Are you currently Yes serving on a City board? H�ave you served on a Y'es City board in the piaslt? if" ns", winich board(s) I arn currently: and when Library Board Mernber terrTi expires 3/31/23 This is a request for renewall of that position Senjor Advisory Board Mernber (start Data; 2022), 1686 If"yes", when and where,? Advisory Boiard Library Board If apt by the City Commission to serve as Board Chair or Vice Yes Thank you for asking me to renew my application/Library Advisory Board Member, I WOUld be honored to be able to continue for another terni. It's difficult for rne to express my positive qualifies as I like to practice hUrnility in all aspects of rny life, but I ani, a service oriented, cornirnunity minded and involved resident of The City of Boynton each. My whole fan'-dly loves libraries and the majority, of rny farrifly mernbers, are avid reaiders , I not only love to read, but I llolve the concept of the library as an important fabric and glue of the cornmunity, I love the work that Mr. Craig Clark and the tearn are doing and 11 want to he able to help,with the endeavors going forward. Professional Wornen For Excellience ­ Worrier's Leadership Group Memberships Wornen in Developimenit-Wornen who are the fundraising area DL Franchise Record Pool-Dj Networking G rrO U P Feel free to attach,/u!pload an extra Littps 23foi"r'vi�buildeL.C(—)ry-)AIPLO—ad-110stip?fileLct=t7da(i6cdfl3f3l)lf29,33523f43bfd334 sheet or resume. Certification, 1, the applicant, hereby certify that the staternents and answers provided herein are true and accurate. I understand that, if appointed, any fallse statements may be cause for, removal froni a board, The niessage Ihas been sera frorn 206.214,134.18 (United States) at 20123-03,017 1939:50 On: Chroflle JJ01010.0 Entry IM 604 Referrer: I, L L) qy i kq!h L - gfj RUP L be _ _4Z Forrn Host: .11 ... Ni de -1.1—L 1687 Boynton Beach, Florida (917) 693-4729 marcialorilevine@gmiaip.com SUMMARY I am a tl'IOUght-foul, and creaitive business professional, with a successful career prin'larily within the media/ marketing and sales arena. II have an established track record of cultivating strong internal/externaI partnerships. II am adept marketer and facilitator. I believe my experiences will allow rile the opportunity to, join, a tearn, and to not only personally flourish, taunt also to help Iflake a difference on the team (s) I join VIDEO CONFERENCE PRODUCER, Virtual, 2019-Presenl Set -Up and Adrn inister/Faciltate Techni,cal Support for Virtual SeIrinars/Trainings, Recovery Workshops and Professional Conferences, Manage all in rneefing operations, including instructions on how to participate via computer or pahone-in options, muting/un -I'll LJ ting features, polling, breakout roorns, screen sl")aring, and whiteboard/ with attendee participation. P,rovi:lde help with, set -Up Of Ineeting (s), registration with correct in- meeling controls/ functions, to Insure, smooth, orderly and successful conference/workshops for stake -holders,... OLD SCHOOL SQUAREICORNELL ART MUSEUM:, Delray Beac1i, Fl. 2018-20,20 Assistant Museum Operations Director Assist �irector of OperationS/CLffator' Duties include: opening and closing rnuseUrn, Wrating, operating and irraintaining Museurn Stoire, placing media buys for Art Shows at OSS/driving revenue to Old School Square. Manage, reception desk adn'0ssions/donations through Square Register operating system, Greet guests With working kirlowledge, of Old Scl,ioot Square and Cornell Art Miiuse u m_W rite all press releases. Engage and tour visitors through the exhibits. THE HEALTH CHANNEL/South Florida PBS, Miami -Da de- Pali n Beach Counfy 2017-20,18 Account Execlutive (one year contract) Relocated to Florida to join team to develop/taunch The Health Channel properties, and ,Nww,allhe4fly Jv websile, Responsibilities includeDevelopment of all marketing materials, generating leads, daily prospecting and lead generation, outreach into local cornimunity to create partner relationships, presentations virtually and in-person. Successfully worked togettier with Baptist/ Bethesda Soufll Ploidda's marketing group and with aFP S creative, marketing and ad sales divisions. VIVENTIUM SOFTWARE, New York, N.Y. 2o 1 6_201 7 Nationall Sales Account Executive (Outside and Inside Sales) N I was recruited to develop NYC territory and assist the (launch, of Viventiurn Software, Responsibillties Include: Developmerit of leacls, daily prospecting, virtual arid in person selling/closing, cold call arid lead generation for all HCM (Hurnari Capital Management /Payroll, Onboarding, HR,) products, Led the launcl'itearr in new bUSIness !sales, meeting and exceeding rnonthly arid yearly goals, $250,000 Gross Revenue A+E TELEVISION NETWORKS, New York, N. Y. 19,99 -20,15 Account Executive, New Business Developrnent Specialist, A&E, Biography, History Channel 01 Researched/venerated new bUSlness opportunifies;, prospected on a daily baisis. Identified customer needs, set Up client rneefings/presented to senior level decision makers. Closed high percentage of new lbusiness,; met and exceeded, yearly sales, goals; Grew, sales list revenue frorn $10 million to $100 rnillflon over tine course of 14 years. VOLUNTEER & COMMUNITY SERVICE ACTIVITIES Boynton Beach Art In Public Places„ Vice Chair, Boynton each Library Advisoiry Board Member, Boynton Beach Senior. Advisory Board Member, Vice-Char Overeaters Anonymous PaIrn Beach Counity Board of Directors , Reading VOILInteer Mestchester Mordessorl! School & Carlarsle Childcare Development Center; IDeveloped Therapeutic Music Program for Children oil the Autistic Spectrum; EXTRA -CURRICULAR ACTIVITRES Professional DJ for the past 20 years, I go by the mane, "01 Marsh" II have had over 25,01 D,J jobs In various locations. I specialize In varied playlists that satisfy all age ranges. I transitioned to virtual D'ing during COVID, but I arn currently back to live OJing- EDUCATION B.A., Hunter College, New York, N,Y. 1688 1689 From. are <n:oreply@1:123tor,iiibL,Iil,der",com> Sent: TUesday, IMarch 14, 2023 2:47 PM To: City, Gerk Subject: Advismy Board Appointment application Attachments: ATR-resurne-2023,pcif Today's, date 03/14/2023 Name Ace Till!ton Ratcfiff Phone number 561-376-3640 Address 142 SW 13th, Avenue Boynton Beach Fl. 33435, United States Email ace@staVweirdbekindcom Current occupation or,, if retired, prior Self-employed artist, photographer,, and writer occupation Education BA in, political science from UCF Are you a registered voter? Yes, Do you reside within, the Boynton Keach Y'e s City limits? Do olid owin/manage a business withiin, City Yes limits? If Oyes",, name of Harper's Promise, currenfly on hiatus business: Are, you currently serving on a City Yes board? Have you served on a City board in the Yes past? If "Yes", which 11 have served on the Art Advisory Board and the Library Board for one tenn each. board(s) and whien7 Have you ever been No convicted of a crime? If "yes"',, when and where? Advisory Board Llbrary Board 1690 If appointed by the, City Commission to serve as Board Chair Yes or Vice Chair are you willing to serve in this capacity? Personal I arn almost a lifelong resident of Boynton Beach. Though I left for a period to live in, California, I Qualifications returned: to my hornetown to buy a house and create a life here. I have served in ryly capacity on the Library Board for one term and I am interested inanother, I! arn am author with rny first book forthcoming from Simon & Schuster. Also II LOVE our library!! Professional City of Boynton Beach Art Advisory Board, Member Membership City, of Boynton Beach Library Advisory Board, Member Feel'l free to attach/upload an ()Lmbui LderLoniZup Ll,.�.p-?f-.'iLc��d=6cldl630le328le7'4(�;2ld5,53a29ee7cc548 extra sheet or resume. Certification 11, the applicant, hereby certify that the statements, and answers provided herein are true and accurate. i understand that, if appointed, any false staten'ients may be cause for removal from, a board, The message has Ihernrr sent frorn185,203,218.28 (United States) at 2023-03-14 13A6�55 on Chrorne 10 9.0.0,0 Entry ID, 607 Referrer: httjL�'w A ,N�qyljjavg. a,Jl, Form HoW htt.j s boa d-appointryie t pj2LLg gr! J,I�UrLq�123fq�'nibuflde,c nj 21 - r ni -a LLqg 1691 Ace possesses a dedicated group of almost 20K amazing Witter followers and makes nearly 2-5, million impressions there on a monthly basis. Ace and their followers focus on connnunity .-care, raising thousands of dollars for places like local, abortion funds or Fiyah Magazine, in order to sponsor disabled BIPOC to attend FIYAHCON. Co -founder, Deathcare Advisor Harper's Promise, LLC I January, 2018 ­ Present Harper"s Promise is an in-horne pet euthanasia, hospice and palliative care practice n ice devoted to helpig families throughout South Florida provide the best possible end of life experience, In 2017, Ace co-founded the practice with their partner, Dr, Derek Calhoun (a veterinarian), after the death of their chilwah ua, Harper ..— the best -worst dog ever. Ace applies years of funeral industry expertise to working in conjunction with Derek to enhance quality of life for chronically ill pets while providing dignity, cornfort, and control, through the final stages of incurable illness for those that are terminally ill. Ace and Derek keep Harper's Promise by helping provide pets a good death, which is an, integral part of a good life. Funeral Director, Embalmer, & Crematory Operator Parent-Soretisen Mortuary & Crernatoryl January,, 2014 - 1'Y 2015 Wilson & Kratzer Mortuaries I October2012 — January, 2014 Smith & Witter Funerail Home I January, 2012 — August, 2012 Boynton Memorial Chapel I May, 20110 - Augusto 20,10 Ace had direct responsibility for administrative arid organizational management in addition to fast -paced event planning and production with extremely tight deadlines. She has superlative custorner relation skills under demanding and stressful circumstances. She coordinated legal paperwork at a county, state, and national level, with a focus on calendar, budget and contract management. Sheflexibly worked between three office locations in addition to remote, after-hours teleptione work. She provided necessary support to a tightly Icnit team when not working independently. She conceptualized funerals, for thousands of families from a multitude of ethnic and cultural backgrounds after in. -depth, personal phone and onsite interviews and conferences. She completed a rigorous and extremely dernanding two-year ernbalming apprenticeship. Norninum, Inc. Ace worked with the documentations team to streamline existing technical documentation and produce new documentation for end-users - typically systern administrators. She standardized, content across platforms, revised docurnents, and clarified instructions, to make docurnentation easier to use. She is proficient in lira software for ticketing systems and Madcap Flare for document creation. She is willing and able to learn any new software or programs required. Sunfed,, Inc' Ace was a combination event -coordinator, customer service representative, and salesperson, providing innovative service by using over 14 -years of experience in situational analysis to create repeat -customer loyalty. They were in charge of all advertising and social media campaigns, including all written 1693 communications released by the company. Ace implemented multiple high-level, marketing -oriented processes and procedures, with a strong focus, on social inedia maintenance across multiple major platforms. ACTWHOES & City ofBoynton Beach Art Advisory Board, Member City of Boynton Reach Library Advisory Board, Member IAAI IPC Meniber EDIU(,,,/k Ir KN American River College, Sacramento, CA .- A.S., Furwral Services 2012 University of Central Florida,, Orlando, FL - BA, POHOW1 SC'ifflte 2010 1694 Stanzionejaimmy Frorn: City Clerk Senit: Monday, January 23, 2023 7121 AM To: Starizione, Tarnmy Subj,ect: FW: Ad� sory Board Appointryient application Attachments, Vaiies,sa-IBeNi,nont-,Resume-copy.pdf From: vanessabelmonte <rioreply@123foriiibLlillder,cort'ii> Sent: Saturday, January 21,, 2023 :22 PM Toy: City clerk <GtyCIerk@bbfl.us> Subject: Advisory, Board App6sitment application Today's date 01/21/2023 Name Vanessa, Belimonte phone number 407-913-9563 Address 100 NE 6th Street Apt 6,017 Boynton Beach Florida 33435 United States Email v,airiessabeir-non,I@L2En2a�il,(�ori� xmmmm��� if retired, prior Marketing ConSWtaflt occuipation Education Bachelors Degree, University of Central Florida 2008 Are you a registered Yes voter? Do you reside within the �Boynton Beach Yes City limits? Do you own/maniaige a business within City No, I i TI -it's? if "yes",, name of business: Are you currently serving on a City No ho, w2 H�ave yoilu served on a No C4 board in the past? i 1695 Have ' you ever been, Yes convicted *,f a c:r' If "yes", when and 2004, misderneanor for possession, of niarijuana at a college party where? Advisory Board Pianning & Developirient Board If appointed by the City Cornimission to .serve as Board Chalr2LMI, Vice Chair are you, willing to serve in this capacity? Personal QualificationsI'mi passionate about the intersection of technology and culture, For the past 1.2 years I've helped cireatives, startLIPS, SM Es & entrepreneurs ideate and execute on their visions & projects through 1"narkefing, communications, events and business operations andl more recently in creative consulting & transformational coaching. I have 5 years of experience with digital transformation, and corrimunity building. My experience both working with small businesses building communities for start1ups makes rile a great candidate, for the Planning & Development Board, I have, innovative approaches yet and grounded in sustainable growth and thriving community, Professional Professional Memberships: Memberships OperiExO Arnbassador Certified OpenExO Trainer, Advisor and Consultant Certified Internship, Mentor with Boston Ext Feel free to attach/upload an ext�raLittps.,LforrTi.123frriibuildgrcorriZ.ypj!2 f Certification, 1, the appficant, hereby certify that the statements and answers provided herein are true and accurate. I understand that, if appointed, any false statements may be cause for removall from a board. The message has been, sent from 206.214.134.162 (United! States) at 2023-01-21 17:2130 on Chronie 107ffO,O Entry M; 584 Form Host; htIpL.11 .123fornibuilder,co nLf)L3�IALa(4,��s ry - 4j2Q2jO1MgnL-1pV I i c .. . .......... —i— _ _g_ _Lqg�2_ & 1696 Broad,based background with over 12 years' hands on experiolce in the areas of digitall rnarketing, brand develollillent, social rnedia, and online development. InsighlifuiJ and result -driven professional with a profound ability to conceptuahze, devellop and CIOCUte markefing ca ill paigns tlamt bURd strong and rner-norabte brands. dnnovative leader with, wide -ranging experience delivering resu Its by creating and linsfigatingsn"ategic and tactical 50iiAiOnS that advances productsawareiless; with a proven track record of work iiigc�'oss-funictdoriallytOeXOCLuto new Projects, direct MLilfi,Site Operations, in')prove, productivity and profitability, and ein1hiance the custoiner's experience, • Community Relations • Strategic Market Planning • Budget Managerneril • Project Managennerit • Event Managerrent 0, Chent Development 0 EXPERIENCE ...... .......... Branding Development Social Media Management Market & Cornipetitor Research • Commuinication &: Storytelling • Creative Team, I eaclership • Customer Engagement Optimization Ch,lef Creative Officer 20,110 .2022. Culture Climax -A Creative Agency Fooncied ("uhure Cliniox to helps smoflbushiosses growthrough branding development andcreative, morAefing, as improved brand awareness and helped cheints connect with potential custorners by developing creative communityoutreach canipaigns and advocated brand on r'nultiple social media c hannels • Cultivated community and connection withsponsored events • Inueased sales and custonwr engagen'ient for 30,-a chents by developing g[ owth strate&s and creating uptirnized social rnedia designs and content • Strean-ilincd all facets of operifloins, of ever)ts, marketing carnpaigns and Launch Of over 50 busiriesses • Ensured the s0'ategic vision of agencies and 40+ clients were in line with the brand development and content creation, indluding graphlic, desrgn, filhning, and photography Community Manager 2019-2020 OpenExO - Global Transformation Ecosystern & Marketplace * Increased efficiency by autornating community oribuarding process, einail marketing and sales fUnnels utiibzing HubSpot * Spearheaded engagernent campaigns, ordine partnerships, vMue generation and growth, strategies to heip build and inianage a 50001 mernbei comnumity * Coordinated ri,per 'sawn and virtual evflits on a weekly and monthly basis for 100+ people * Managed and led Oper'atjoln$ fC ',' live Certification programs, inchi&ig doveiop processes, research and inilAecent tools, strearinfine onboarding, manage logistics, content and CoIllaterall Marketing Director 20,17 - 20,19 ExO Works - Digital Transformation Consultancy, Pioneei,ed the innovation of creative marketing canipaigris, N andkig, and content creation that led to 24% im, rease in sales and boosted revenue generation ■ Oversaw marketing operations and optirnized KPIS for partnerships with Accenture and Hoit Business School Documented and supported outcomes of ExO innovation sprint for Fortune 500 Ccrnpank-,s Contributed to the ExponentiM Tr insforirnitioin book, and launched campaigns and events for hook promotion Oversaw, organiza d arld shaped company image by implementing processes dor corriparly, offerings, press and partnersllips Booking Manager 2015-2017 ExCr Speakers - Speakers Burreau for Digital Transformation, Speakers • Spearheaded con tracts, booking, marketing and traveI for high profile keynote speaker s and ulthors, • Coordinated contracts for 15-1 global speaking engagernents peir inionti"i • Managed client correspondence and trained and oversaw 2 eirnployees • Negotiated cw&acts fw spealking E�ngagernentq, increasing rev"'lue by 30% 1697 1698 11,111111111311nm 1111mmilIT1111 IF IF MM32E= Thaiink you for your interest in Serving on one of the City's Advisory Boards and for taking the t�ime to, fill out this aippl�ication. If inistructilons allre not followed or the application is not filled out in its entirety, the application will be returned for clanfication. EMAIL DISCLAIMER, Pleaise be advised that under Florida law, e-mail adpublic records. If you I do not want your e-mail address released in reisponse to a pubiic-records re�quest, do not send electronic mail. instead', contact the City Clerk's office by phone or in writing - Mailing address: P.O. Box 310, Boynton Beach, FIL 33435-0310 Phone: (561) 742-6060 I FAX:: (561) 742-6098 Name s Telephone # MR IN < 4� Date of Birth:� Emafl: I J Current occupation or prior occupation: LIVC-1 A4 U / �Ir Education N� 44AZ I �A Are you a registered voter? V/` Yes No Do you reside within the Boynton Beach City limits? jzYes No 111 Do you own/manage a business within the City limits:� Yes No If yes, name of business Have you ever been convicted of a crime? IV' Yes No If yes, when Where Areyou currently servings on a City board? V Yes No Have you served on a City board in the past? Yes No 2, S.r\CC\W'P\BOARDS\Applicatdoiiis\Advsory Board Application 2023,doc OHE .7x 1699 If so, which board(s) and when? Please indicate which advisory board you are seeking appointment. For board listing, requiremenff,- responsibilitles, and meeting times and dates, see attached. Arts Commiission Building Board of Adjustment & Appeals v"Community Redevelopment Agency Advisory Boa!li Education and Youth: Advisory Board EmployeesPension Board f9refiq*t5� Pension Trust Fund .. . . ........ ..... .. . . . Historic Resources Preservation Board Library Board Planning & Development Board Police Officers' Retirement Trust Fund' Recreation & Parks Board If appointed are you willing to serve as Chair or Vice Chair? S No y� 04, CX4 i' What personal qualifications do you possess (i.e., profession, previous experience, branch of military service or organization) which you feel would make you a good candidate for this board? Please be specific. I MT-311M.w r w w -am Signature: D�ate:A, / ......... . - "I S:\CC\WPNBOARDS\Applica'dons' Adv�sory Board Applicabon 2023,doc M 1700 Sitanizioniei, From: It Clerk Sent: wednesday, AprH 19, 2023 5:20 P'M To: Stanzione, Tamniy; De Jesus, Maylee Subject: FW: Advisory Board Appointment application Attachments: Ali-Loper esto,-Resuinie-2023,docx From., arn19889! <i,ioreply@123fort,nbLlildei,,cotn> Sent-, Wednesday, Aprd 19, 2023 4:45 PM To. City Clerk <CityClerk@bbf1.us> Subject: Advisory Board Appointment applicatlon Today's date 04/19/2023 Name, Alexandria Lopesto phone number 561-704-1718 Address 578 SW' Stew Av Boynton Beach Florida 3343S, United States Email PM yAh 00 99 -r -n Current occupation or, if retired, prior Medical Sales Representative occupation Education Florida International University Are you a registered Yes voter?' Do you: reside within the Boynton Beach Yes City limits? Do you own/manage a business within City N,o limits? If "Yes"', name of business - Are you currently serving on a City No boa,rd? Haveyou, , served on a City board in; the No past? if ""Yes""', which, board(s) and when? I 1701 Have you ever been No convicted of a crime? If "yes", when aindl where? Advisory Board Planning Development Board 'f appointed by the City Commission to q.e,rve as Board Chair ir Vice Chalir are you YqE willing toserve in t'hiis capacity? Personal I am 32 years old and have lived in Boynton Beach my whole fife. I love this city and am amazed Qualifications by how much it has grown and changed over the years. i am always looking to get involved in the community and think this would be a great opportunity for me. Il currently volunteer for some other local charities and scholarship committees. I am very interested in the new development of our city and the opportunity for these projects to benefit our residents. I enjoy riding my bike to Downtown Boynton, Beach and also taking part in the Iholiday festivities. I currently live in Chapel Hill and love how rnuch the downtown area has evolved and would love to be a part of the future of Boynton Beach, Professional Memberships Feell free to attach/upload an hup -qd47551f(,),5b28d7ed35a6cO9d7'1'74722 extra sheet or LeW� resume., Certification 1, the applilcant, hereby certify that the staterrients and answers provided herein are true and accurate, I understand that, if appointed, any false staternents may be cauise for removal from a hoard. The niessage has been sent from 75,30.229.208 (United States) at 2023-04-19 15A4:33 on Safari 14.0 Entry ID: 624 Referrer � tq bea .21111-_cg_nIjrnittees Form Host; h a rd a poLiLLtq3Di�� 1?1 i n �Yornnbufliderx f 1702 Stanzione, Tammy From: leshag-OU ncitreell <nloi,eply@123�fon'i-nl)uilder,coi-n> Sent: Wednesday, March 29,2023 2A2 PM To': City Clerk Subject- Advisory BoardAppointrnent appkation Today's, date 03/29/2023 Name Leshai Roundtree Phone n!uim,ber Address 805 NE 2nd Ct, Boynton Beach FL 33435 Netherlands Emall lesharoundltree,ll@lgtaill.co,ii-i Current occupation or, if Edcatoir retired, �pri�o�r oc!cuipatio�n Education pMaster Degree Do you reside within the Yes BoBeach City firnits? If "yes,"', name of business: L Enterpin'ses Are you currently serving on a No City board? Have you served on a: City Yes board in the past? If "yu s", which board(s) and Education Advis:o:ry Board wheu ni? Library Adviscry Community Relations Parks aind Recreation Have you ever been convicted No #4 a crime? if "yes,"', when and where?' If appointeid by the City Commission to serve as Board Chair or Vice Chair are you Planning & Development Board 1703 I W.M*T1qMM'W extra sheet or resume., Certification 1, the applicant, hereby certify that the statements and answers provided herein are trio e and' acclu rate. 11 Understand that, if appointed, any false state mints ma:ly be carse for removal from a board. The message has been sent frorn 127.0.0.1 (Nethedairids) at 2023,03-29 13,:42:11 on Chrome 11 .0.0,0 Entry ID: 61.1 ReferrerI .2 MI Form Host: !LqL)s1�1LoLrn.,123f ornibuflder.gm 3 32.j a _vjs_o[yLcqr_ :ApRL a ( au _ 1704 From: City Clerk S,en t Friday, March 03, 20,23 1213 PM To: Staern zform e, Tammy; De JeSUIS, Haylee Subject: FW Advisory Board Appointment applicafion From: n,ick "-tunno <riorply@123formbtjilder.coni> Sent!. Fridlay, March 3, 2023 11:45 AM To: it Clerk <0tyClerk@bbfLu:s> Subject- Advisory Board Appoiritrnent application Today's clato /03/2023 Name Nicholas TUnno Phone number 561-862-7240 Address 4 Nottingharn PI Boynton Beach City limits? Bo,yntoin, Beach FL 33426 Do you olwin/imaniage, a business United States Email Li �k k Lu o 6�y 1 jjg () c o 13 �� !_ _.a_ L Current occu �pation or, if I Sales Manager revired, Prior occupation Education Bachelors Are you a registered voter? Y'e,s Do you residewithin, the Yes Boynton Beach City limits? Do you olwin/imaniage, a business within City limits? No if "yes", name of business - Are you! clurrentl:y serving on a No City board? Have you served on a City No, board iin the past? If "Yes,"', which board (s) and whein? Rave you ever been convictied No, of a crimie? if "yes", when, and where? Advisory Board Planning & Development Board 1705 If appointed by the City Commission to serve as Board yes Chair or Vice Chair are you willing to, serve in this capacity? personal Qualifications Hello. I have been a board member of SIARM PaIrn Beach County for many years working closely with businesses, and business professionals in OUr con'-irnunity. I'mi very passionate about serv'ing oin boards that allow me to rnake an impact in my local cornniunity. I'ni seeking a new challenge and arn confident 1 can rnake a real impact in hat vier role t take, I also serve as a sales manager for a large hisurance consulting firm. I nianage 13 offices and over 50 professionals. 1'rn a great coach and mentor in this capacity, professional Memberships SHRM Palm Beach County Board of Director, Surru'rier Search Norr Profit Junior Board mernber. Feel free to attach/upload an extra sheet or resume. Certification 1, the applicant, hereby certify that the statements and answers provided herein are. true and accurate. 11 understand that, if appointed, any false statements may be cause for rernoval born a board, The message has been sent froini 731,106,23 (United States) at 2023-013 03 DA5:00 on Chronle 110,0,0.0 Entry 0: 602 Forum H�ost: htjps,:J oj,..jL23formbudder.cp[ji j 3L dvis'qMj�d j - o t , ent-:,4—atLj®r1 _ rn P 1706 From: City Clerk Sent: Thursday, February 23, 20,23 229 PM To: Stanzione, Tammy; De Jesus, Maylee Subject: FM Advisory Board Appointment application From, beveridge,n,sarah <noreply@123fornibtiilder.corii> Sent: Thursday, February 23, 20, 23 2:44 PM T : City Clerk <CityClerk@bbfl1.us> Subject. Advisory Board Appointment application Today's date 02/23/2023 Name Sarah Beveridige Phone number Address 3681 WOLF RUN LN BOYNTON BEACH FL 33435 Ulnited States Email Current occupation or, If Stay at home mother, previOUSly a teacher retired,, prior occupation Education Bachelors Do you reside witIII w hin the Yes Boynton Beach City limits? Do you own/manage a business No within City limits? Are you currently serving on a No City board? Have you served on a City No board in the past? J0 i ic"Nioardis) and whien? Have you ever been convicted No of a crime? if "yes", when and where? Advisory Board Recreation & Parks Board 0 1707 1708 If appointed by the City Commission to serve as Board, No Chair or Vice Chair are you willing to serve in this capacity? Personal Qualifications As, a another and a previous educator I feel I have a connection to what is needed in our community. Feel free to attach/lupilloadi an extra sheet or resume. Certification 1, the applicant, hereby certify that the statements and answers, provided herein are true and accurate. I understand that, if appointed, any false statements may be cause for removal from a board, The messige has been sent from 73.2�04,57,247 (United States) at 20,23-02-23 M44:19 on Chrome 110.0,5481.83 Entry ID,: 595 Referrer bIAL)sJ:jAApyLi Lrjq:t PacL�LrE/ MLnj:�Pp Form Host: r4-g1mgLq ' -!j ation 1709 1710 From: camgeoff <noreply@123fornibuild:ler.cory)> Sent: Tuesday, March 28, 2023 11:1 ' AM To,: City Clerk Subject: Advisory Board Appointment application Today's date 03/28/2023 Name Geoff Campbell Phone number 864-320-6712 Address 221 SE 5th Ave. Apt. B Boynton each Florida 33435 United States Email, camgeoff@gmaii,com Current occupation or, if Landscape Architect retired, prior occupation Education Bachelors Are you a registered voter? Yes Do you reside, within the Yes Boynton Beaich City limits? Do you own/mianage a business No within City limi�ts? If "Yes", name of business- KEITH Are you currently serving on a Yes City boa;rid? Have you served on a City Yes board 'in the past? if "'Yes", which board(s) and Recreation and Parks when? DZINEEMEMMM Advisory Board Recreation & Parks Boare if appointed by the City Commission to serve as Board Yes Chair or Vice Chair are you wil Ii ng to serve in thl s capacity? Personal Qualifications Practicing landscape Architect well versed in site and park design,, maintenance and construction. Lifelong athlete, former Boynton Beach Tennis League participant, 0 1711 I'll 11 11 1 1A extra sihieeit or resume., Certification 1, the applicant, hereby certify that the stat eren ents and answers provided herein are true and accurate. I understand that, if a,pppint ed, any false stat ernents rnay be cause for removal from a board. The message has been sent from 64-152.141,146 (Unfted States) it 2023-03-28 10:11:39 on Chrome 111.0.0.0 Entry D 10 Refpirrer Form Host: hq —f gr LB� 2 L4 _p ��.j Aqvi jL(ja[d�,UL)qLinqnent- p,�C I —2 ory 1712 Stanzione, Tammy From: City Clerk Sent: Wednesday, March 01, 2023 2:05 PM To: Stanzione, Tarnmy, De Jesus, Mia lee Subject: FW: Advisory Board Appointment application Sent: Wedinesday, March 1, 2023 1:31 PM To: City Clerk <CityClerk@bbfLus> I SubAdvisory Board! Appointment application Today's date 03/011/2023 Name Julie Mondello Phone number 561-346-,9466 Address 122 Lancaster Road Boynton IBeach FL 33426 United States EmailLtLh-ejri—Le-Le1(o-2yALnr-qpnn Current occupation or, If Technology Project Mianager retired, prior occupation Education, MBA Are you a registered voter? Yes Do you reside within the Yes Boynton Beach City limits? Do you own/mainage a business within, City limit's? if "yes", name of business, Are you currently serving on a Yes City board? Have you served) on a City Yes, board in the past? if "yes"', which board(s) and I have been serving on the Recreation and Parks, board for the last 10 years or so. when? Have you ever been convicted No Bmf a crime? if "yes,"', when and where? Advisory Board Recreation & Parks Board t. 1713 If appointed by the City Commission to serve as Board Yes Chair or Vice Chair are you willing to serve in this capacity? Personal Qualifications I have a daughter in high school and she ha grown up going to parks, park events and city of Boynton Beach event. Are parks are beautiful and important to childen's lives, important to everyone's lives especially since the paniclemic, I am, currently the chair of I the board and I think all of or board members are doing a great job. Professional M" emberships Project Management Professional' (PMP) Six Sigma Green Belt Feel free to attach/upload an extra sheet or resume. Certification, 1, the applicant, hereby certify that the staternents and answers, provided herein are true and: accurate. 11 understand that, if appointed, any false statements may be cause for rernoval from a board. The message has been sent from 73,46,25.173 (Un:ited States) at 2023,-03-01 13:31:06 on Chrome 108-01.0.0 Entry ID: 599 Deferrer Form Most: 3214 adv oard-a: p9intn L, p gj&� --m—(MAA 1714 Havei you serve on a City board ini thie 'Yes past? If "'Yes", whiich Youth and Education and Recreation and Parks Boards board(s) aind when? ull If "yes",'when and where? Advisory Board Recreation & Parks Board If appointed by the City Commission to serve as BoardChair Yes or Vice Chia! r are you willing to serve ini thiis Capacity? Personal I am presently serving oin this board ,Qualifications Professional Member of Kappa Alpha Psi Memberships Feel free to attach/uptoad an 11!.Vs: orm. 23forrnbuil co t�4�a 911 & 2�9,ta i� �a j.1---a.....--1..-1--M1e1 I �oa d _�J-Il�d, L �Oi&bfLZt5,L63 extra sheet or resume. Certification 1, the applicant, hereby certify that the statements and answers provided herein are true and accurate. I understand t�hait, if appointed, any failse staternents may be cause for removal from a board. The message has been sent from 131,91.7.200 (United States) at 2023-02-28 12:1034 on Chrome 110.0,0.0 Entry ID: 596 Referrer IIt Form Host:.h j1,2 j�gAjjgn ......... . ....... . ... . .... --gn— RP 1715 Stanizione, Tammy To: City Clerk Subject: RE: Advisory Board Appointment application From: City Clerk <CityClerk@bbfl�.us> Sent: Tuesday, February 28, 2023, 1218 PM To: Stanzione Tarnmt<Stanzion T'- bblif Sent: Tuesday, February 28i, 2023 12:11 PM To: City Clerk <Qy us> Today's date 02/28/2023 Name, Franido Patterson Phone number Address I I I I RWIVIII United States Current occupation or, if retired, prior Director of Testing and Certification occupation Education Master Degree Are your a registered Yes voter? Do you reside withiin, the Boynton Beach Yes City limits? Do you own/miainage a business within City No linnits? if "yes,', name of business: Are you currently serving on a City Yes boardl? 1716 Frando LPattemon, Boynton Beach, Fl, 33,426 Objective: A visionary and proactive individual who is seeking a position where my skills, abilities, and experience will benefit tile organizations goals and objectives. Education: Golden Gate Un&ersitj, San Francisco, CA Master of Science Hunian Resources Educational emphasis Personnel Management ;lune 1991 TennevseeState Universitji Nashville, TN Master of Education Curriculum and Instruction Educational emphasis Business Education (.',onipleted 33, hour toward teaching certification Tennessee State Universil Y Bachelor of Business Admin Educational emphasis Marketing CCA F Associated Degree Nashville, TN May1983 Maxwell AFB Education and 'I"raining Management Work llistot%y: Florida Atlantic Universitj, Boca Raton, FL Director of Testing and Certification Dec 2007 to tile Present Director of Testing Preparation Responsibilities - Department manager for all activities in the center which includes overseeing Budget, Revenue and Expenses, Additional responsibilities include employee relations (personnel policies, ernPloyment, hiring and staff development) and marketing of tile services offered by the departnient. Point of contact torr all academic and professional test administration, record keeping and scheduling of pencil and paper tests, computer-based tests, and internet- based tests (national, state, local), Test center manager for PROM TRIC APTC, PEARSON VUE, PS] centers, Priniary manager for administer functions for the test Prep departnient. lZellresent the department or the university at various functions or committees, as needed. 1717 Tennessee State 0,tiversity Nashville, TN Testing Supervisor Jail 4993 to Nov 2007 Respons ibili ties - Supervised and administer cornputer-based and paper and pencil exams, These exams included GRE, MAT, CASTLEWORLD, CLEP, PSI, GED ACC LP PLACER, MCATand Praxis series test. Supervised and trained graduate assistants and contractual test proctors on administering test for the department. Advise university personnel, students, and the public on testing requirements. Military History: Air Force Reserve Marietta, (jA a 4"' Wing'Training Manager Jan 2013 to June 2015 45"' Aerospace Evacuation Squadron June 2015 to Jan 2017 Wing Training Manager/ Unit'Irraining Manager Responsibilities,- -Worked as the OPR for training programs for units serviced by tine l'orce Support Squadron, In my capacity as a Wing Training Manager, I ensured programs were in place to inanage upgrade, qualification, in-ganison, and ancillary training, Irriplenient and manage training prograrris, policies, and procedures as directed by higher headquarter, Review and coordinate wing and unit -level training publications, supplements, and operating instructions, and provide reconimendations to the appropriate OPRs. Tennessee Air National Guard Nashville, T N T'rai ni ng Manager 11, 8"' AES July 1 91 to Jan 2013 Resl.)onsihifities- Advise the Unit Commander oil all training issues Develops, delivers, and evaluates education and trairring progranis Apply instructional system development process for job standards Advise Air National C.,suard 4NO CFM oil training issues Advise niernbers as 'school dates using'FEAM Award members skill level using Milpds Advise AN Readiness ("enter concerning training issues Super -User for tile ANCi Medical Communities for AFTR Senior Instructor tarn tile Express Train Class (Class for newly appointed) U l, M and units that are 12 months out from a HSI) Instructor for Supervisor Involvement Course ANG Field Rep for AI TR United State Air Force July1987 to July 1199 Computer Skills: MicrosofiWords, PowerPoint, Excel, Banner and Access Organization: Member ATP-NCTA ORP Standard workgroup Rel'erence: Available on Request 1718 W rr J Y4J 1 l I. Gi 1 7 #i (wr t Ih' 0 1000 2000 r � ;! �rlm d j rk. i&�IIfih" SCALE IN FEET 1"=2000' F—do ;(ditk'iP9k2,�'„i��/i'i„1/,/s i k f. i ................ , l ,f LL ASN ': i moi uumi ��� i I J! .�r j i ri l�lr i lir �r,� I.m ...r.. "1-: m ' ��{ ”' ' , fP{9"r1 r C 0 x'v7 (( i 1'I .q„ r In �9 cTYi4"R' raw w"' �J / ;{ i ! ra� f ¢ rif';ri �i r/r lilt r�llir �/i -'h"y a ^:. C , I r ... _r.. 9 iu Xrh"ekI / ^ �i u uk tlR I i✓ ri/ l ri r r p Y� PROJECT ! f f III r SITE ,.rE �,�,..I d a 1 Ilii rk u Irk"4 p I'k S"ld 1 r ! ' rw �wJii� fir'! +! IP, t 1 ( p41 ,k s' Btl (�' %✓.�r��%l/ lr o � � ,' I , i / ,ill r 7 � �"a"vmu" �� f 11, �1��. L L . / /l/ �rrrl�.��,�/ii%%�!,/�i/1. ll � �. � r � l u r„ ,•� r °• I r ), �.. �v � FY d r i i 'ya.. ,,J J� ��� d � uV17�1 9 1 i d r 1 I i I J �bli� p Y P �, a r NJ 1.. t J r r I/f/JF`r✓ d ?fel s r r 1 I � MV F+ ✓ rk / ,/k � �. yy i h 1 r� r i r 4 Y t I 5 l�Ia imv, j1 k1 .iy _. A),.,� 67 '"1. / 9, �i� ( IJ l p f 6 P I V fl �[ �. ��� AI gijJ", {� �., 1{� � M n ' - �.a� � � �_ u� r 4'7t: ✓ " m' ,. ,� ,. Iw �j � , n j �. jr �.+o u n QI,F' '. l'' ;�' TAKEN FROM U.S.G.S. DELRAY BEACH & LAKE WORTH, FLORIDA QUADRANGLES SEC: 33/34 TWP: 45S RGE: 43E VICINITY MAP LAT: 26° 30' 21" N ����$IYNINIIfI�7 ISIMINGER & STUBBS LONG: 080° 03'27" W � '���',�"I D 11,j ��/,r v ENGINEERING, INC. �x.,,SM. 1 . •g' „.. y`�• y�'� COASTAL • ENVIRONMENTAL • MARINE REGISTRATION NUMBER: 8114 This item has been digitally sighed and ^„^ ^ P.O. BOX 14702- NORTH PALM BEACH, FL 33408 -561-881-0003 sealed by Matthew D. Butler, P.E. on y” N0„74039 PROPOSED SEAWALL REPLACEMENT 11/8/2021 using a Digital Signature. 'INTRACOASTAL WATERWAY Printed copies of this document are not = 2500 SOUTH FEDERAL HIGHWAY STATconsidered signed and sealed, and the' CITY OF BOYNTON BEACH, PALM BEACH COUNTY, FL signature must be verified on any{{A"",a w„•"qr APPLICANTS: HAMPSHIRE GARDENS, INC. & CITY OF BOYNTON BEACH electronic copies. ✓ ......... ,^r ,,,W"M DATE 1 11/21 1 DRAWN I MDB CHKD KDB APPRVD I MDB r7 CONAL r—w�N+" DWG NO. 21125A1 SHEET i"�'`�` COMPUTER. FILE NO. 21125A OF 3 1719 APPROX. PROPERTY LINE ICW RIGHT OF WAY --I UPLAND MULTI -FAMILY RESIDENCES EXISTING SEAWALL (MHWL AT FACE) TO BE REPLACED IMMEDIATELY WATERWARD OF ITS EXISTING LOCATION EDGE OF ASPHALT - APPROX. PROPERTY LINE EXISTING LIGHT POLE (TYP.) EXISTING FENCE UPLAND PARK (JAYCEE PARK) NOTE: MANGROVES SOUTH OFFENCE (NOT SHOWN FOR CLARITY) 217'± 400'± AL I I I I 52'± I I I I I I I I I NO SUBMERGED I I RESOURCES ON-SITE I I I I I I I I I I I z I I z I 1A I Z I I U I I � I I U 1 I I I I I I I I 63'± I I I I I I I I I I IT 19'± I I I PROPOSED SEAWALL (749± L.F. TOTAL) I APPROX. I PROPERTY LINE I I . I I NO SUBMERGED I RESOURCES ON-SITE --16'+ 23'+i 1---f I 50 24't� ~r 724 I I I � I I I I APPROX. MHWL I I I EXISTING DOCK TO REMAIN PLAN VIEW N 0 50 100 SCALE IN FEET 1 "=100' 0A%%1 I Iffljjji/// i A ) � //, .`" "1IT 1 N(7, 74039 NATE OF r' XS L 0t , 'et/ t OPV A N' IIIIII This item has been digitally signed and sealed by Matthew D. Butler, P.E. on 11/8/2021 using a Digital Signature. 13IMINGER 4X NTUBBS Q ENGINEERING, INC. Printed copies of this document are not considered signed and NOTES: sealed, and the signature must be Verified On any electronic copies. COASTAL • ENVIRONNIENPAL • MARINE REGISTRATION NUMBER: 8114 P.O. BOX 14702- NORTH PALM BEACH, FL 33408-561-881-0003 PROPOSED SEAWALL REPLACEMENT 1. EXISTING LOCATIONS ARE APPROXIMATE BASED ON SURVEY BY MILLER I NTRACOASTAL WATERWAY LAND SURVEYING, DATED 9/10/20, AND ON-SITE OBSERVATIONS. 2500 SOUTH FEDERAL HIGHWAY 2. RESOURCE INFORMATION BY ISIMINGER & STUBBS ENGINEERING, INC. CITY OF BOYNTON BEACH, PALM BEACH COUNTY, FL FIELD WORK PERFORMED 6/7/21. NO RESOURCES OBSERVED ON-SITE. APPLICANTS: HAMPSHIRE GARDENS, INC. & CITY OF BOYNTON BEACH DATE 11/21 1 DRAWN I MDB CHKD K APPRVD MDB SKETCH SUBMITTED FOR ENVIRONMENTAL PERMIT REVIEW. DWG NO. I 21125A2 SHEET Ift NOT INTENDED FOR CONSTRUCTION OR BUILDING PERMIT REVIEW. COMPUTER FILE NO. 21125A OF 3 1 721 EXISTING SEAWALL (SCHEM.) TO BE REPLACED IMMEDIATELY WATERWARD OF ITS EXISTING LOCATION No,74039 STATE OF rt � OPV AL 111111 NOTES: PROPOSED SEAWALL CAP (SCHEM.) PROPOSED SEAWALL (SCHEM.) PROPOSED BATTER PILE (SCHEM.) MHW = 25± (0.3'± NAVD) PROPOSED KING PILE (SCHEM.) 12"±- 18"± NOTE: THE MEASUREMENT TO BE TAKEN FROM THE WET FACE OF THE EXISTING SEAWALL TO THE WET FACE OF THE NEW SEAWALL PANEL, AT THE MHWL. SECTION A -A 0 2.5 5 SCALE IN FEET 111=5' This item has been digitally signed and sealed by Matthew D. Butler, P.E. on 11/8/2021 using a Digital Signature. Printed copies of this document are not considered signed and sealed, and the signature must be verified on any electronic copies. 1. DATUM IS MLW. MLW = -2.2'± FROM LABINS DATABASE. 2. EXISTING LOCATIONS ARE APPROXIMATE BASED ON SURVEY BY MILLER LAND SURVEYING, DATED 9110/20, AND ON-SITE OBSERVATIONS. 3. SOUNDINGS BY ISIMINGER & STUBBS ENGINEERING, INC. FIELD WORK PERFORMED 617121. SOUNDINGS REDUCED TO MLW BASED ON PREDICTED TIDES ONLY. SKETCH SUBMITTED FOR ENVIRONMENTAL PERMIT REVIEW. NOT INTENDED FOR CONSTRUCTION OR BUILDING PERMIT REVIEW. APPROX. EXISTING GRADE (TYP.) SECTION VIEW ISIMINGER & STUBBS y ENGINEERING, INC. COASTAL • ENVIRONNIENrAL • MARINE REGISTRATION NUMBER: 8114 P.O. BOX 14702- NORTH PALM BEACH, FL 33408-561-881-0003 PROPOSED SEAWALL REPLACEMENT INTRACOASTAL WATERWAY 2500 SOUTH FEDERAL HIGHWAY CITY OF BOYNTON BEACH, PALM BEACH COUNTY, FL APPLICANTS: HAMPSHIRE GARDENS, INC. & CITY OF BOYNTON BEACH DATE 1 11/21 1 DRAWN I MDB CHKD KDB I APPRVD I MDB DWG NO. I 21125A3 SHEET r% COMPUTER. FILE NO. 21125A OF 3-172