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Community Caring Center of Greater Boynton - VM Casello D FORWARD CHECK. CITY OF BOYNTON BEACH DIRECT PAYMENT REQUISITION Please issue a check in the amount of $ 1,000.00 . TO: COMMUNITY CARING CENTER OF GREATER BOYNTON BEACH, INC 145 NE 4TH STREET BOYNTON BEACH FL 33435 FOR: For help with three programs: Senior Veggie Mobile& Home Delivered Meals Program, and the Children's Gardening & Nutrition Education Program, and Cranksgiving &the Holiday Cornupia Projects-Vice Mayor Casello's Community Support Funds Expenditure Requested By: Janet M. Prainito Date: September 22, 2015 Approvals: FUND DEPT BASIC ELE OBJ AMOUNT 001 1110 511 95 47 1,000.00 Div Head _ m 0n • net M. Prainito Finance Dept. Tim Howard City Manager Lori LaVerriere 1,000.00 ,.' ,fid: 5(9! —386—��(& orc�. �� -- 3�q-7a 88LA) R15-055 EXHIBIT "A" COMMUNITY SUPPORT FUNDS REQUEST FORM Part I -Summary of Request (to be completed by City Clerk) Date of Request: /, o"e/6i Requested by Mayor/Commissioner: 00mn7,ss/oNE2 GhSa/o Amount Requested: $ Recipient/Payee: ( iylin4l,o„—y (32A r 6voi Description of project, program,,A.activity to be funded: / ('_CCS g4k oje2 Part II - Availability of funds The annual appropriation of funds available to the requesting Member of the Commission listed above is $4., ' . The balance of funds available for the requesting Member of the Commission is Accordingly: There are funds available as requested q d ❑ There are insufficient funds available as requested Dated: 'P—B-15- Part III-Eligibility Evaluation Public funds will not be used to improve private property unless there is a clear public need, purpose and benefit ! The recipient/payee provides services within the City S/ The public purpose is beneficial to the e tiro co'- uni 1-rved by such donation Dated: / I //g By: =a.. •— — _ Requ:stti g ember of he City Commission S:\CC\WP\COMMUNITY INVESTMENT FUNDS\Community Support_Funs_Policy.2015.doc i Form i r°9 i, .asesW f's!r Tamp yer Give Fonntothe (Rev.December2014).. Ede t ric-i$i.:=r.l Ek!Ia11 'f Er and Certift catEon requester.Do not Department of the Titasury send to the IRS. Internal Revenue Service 1 N (as shown on your income tax 'm).Name Is required on this line;do not Ieave this One blew U4 /71ina4.9rJ !iPiie0 !e� J4e i'ee. `4-`ae� ilv<'. , 2 Business name/disregarded a name,If dlfe(nt from above m 1 _ d bg %de- t>. e a,e4t. 6,44t elh-o.- G',,- G'u/„v,3,ey ����.s���e io,< y.C�_-.. 8 Check appropriate box fur federal tax clesslflcation;check only one s following seven boxes: / 4 Exemptions(codes apply only to a ❑Individual/wile proprietor or Corporation 0 S Corporation 0 Pa tnertthtp 0 Truet/estets instructioncertain s onles'page 3):not vlduelc;sae $ single-member LLC Exempt payee code Of any) ❑Limited liability company.Enter the tax classification(cam corporation,8=S corporation,P=partnership) uExemigNeto.For a single-member LLC that Is disregarded,do not check LUG;check the appro�tmete box In the line above for from FATCA reporting o the tax claeeificatlon of the single-memberer. .5r'/ C3 code DI any) 6 5 [ ther(see instructions)D /�D/c4 i,��{✓j © i WA.), i�J)'/Iv� _ &op.ro od mrtmaeR,awmrco a.us.1 • E b Address(number,sheet,and apt.or su no.) C// Requester's name and address(optional) /�5 /Vc /J ,��e 6 City, e,and 7JP code co ,tf i e,.) 4€14-ed i ,� 3/ 3 13 7 Ust account number(s)here(optional) Part I Taxpayer Identification Number(TIN) Enter your TIN In the,appropriate box.The TIN provided must match the name given on line 1 to avoid I Soctel peauritY number backup withholding.For individuals,this is generally your social security number(SSN).However,for a resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other , - entities,It is your employer identification number(EIN).If you do not have a number,see How to get a 77N on page 3. or Note.If the account Is in more than one name,see the instructions for line 1 and the chart on page 4 for I Employer iderrtlflumticu►number guidelines on whose number to enter. 66- _ o4fie 7 '1 , ® 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. I 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(o)the IRS has notified me that I am no longer subject to backup withholding;and 3. I 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 insbuctIoas.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 I and dividends,you are not required to sign the certification,but you must provide your correct TIN.See the instructions on page 3. / Sign Signature of k�G�� n ,, � stet s- o /d` /S Clare u,staeneon la r / General Vnstructio rs ”Form 1098(home mortgage Interost),1098-5(student loan interest),1098-T (tuition) Section references we to the Internal Revenue Code unless otherwise noted. 6 Form 1099-C(canceled debt) Futuro developmcartc.Information about developments affecting Form IN-9(such s Form 1099-A(acquisition or abandonment of secured property) as legislation enactebeltar we+releass tt)is at wwwJrs.govlfw9. Use Form W-9 only If you are a U.S.person(including a resident alon),to Purpose of PoBR4tur'. • provide your correct TIN. An Individual or entity(Fomt.W-9 requester)who is required to file an Information if you do not return Form W-9 to the requester with a TIN,you might be subject return with the IRs must obtain your correct taxpayer Identification number(TN) to backup withholding.See What is beclwp withholding?on page 2. which may be your social security number(SSN),Individual taxpayer Identification By signing the filled-out form,you: number(ITIN),adoption taxpayer Identification number(AT1N),or employer . 1.Certify that the TIN you are giving Is correct(or you are waiting for a number identification number(EIN),to report on art Information return the amount paid to to be Issued), you,or other amount reportable on an information return.Examples of information returns include,but are not limited to,the following: 2.Certify that you are not subject to backup withholding,or Y Form 1099-INT(interest earned or paid) 3.Claim exemption from backup withholding If you are a y.S.aexempt payee.If applicable,you we also certifying that as a U.S.pprgera,tbtil•allocable share of o Form 1099-DN(dividends,Including those from stocks or mutual funds) any partnership Income from a U.S.trade or buslrrre a Is not subject to the *Form 1099-MISC(various types of incomes,prizes,awards,or gross proceeds) withholding tea err foreign partnere'share of effectively connected Income.and •Form 1098-B(stock or mutual fund sales and certain other transactions by 4.Certify that FATCA code(s)entered on this form(If any)Indicating that you we brokers) exempt from the FATCA reporting,is correct.See What Is FATCA reporting?on G Form 1099-S(proceeds from real estate transactions) Page 2 for further Information. •Form 1099-K(merchant card and thlyd,party network transactions) '`"41 a: t i.',`;t ' Cat.No.10231X /:1,. Form W-9(Rev.12-2014) IRS Department of the Treasury 1Tp'bl/i IRS Internal Revenue Service P.O. Box 2508 In reply refer to : 0248467585 Cincinnati OH 45201 Aug. 21 , 2012 LTR 4168C E0 65-0447796 000000 00 00017647 BODC: TE COMMUNITY CARING CENTER OF BOYNTON BEACH INC 145 NE . 4TH RE! BOYNTON BEACH FL 33435-3865 002503 Employer Identification Number: 65-0447796 Person to Contact : Mrs Pamela Skiles Toll Free Telephone Number: 1-877-829-5500 Dear Taxpayer : This is in response to your Aug . 10 , 2012, 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 July 1994. 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) (i) . 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. irs .gov/eo for information regarding filing requirements. Specifically, section 6033(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 2011 . • 0017 T FOOD A DR-14 Consumer's Certificate of Exemption R.04/05 • �l >r!' Issued Pursuant to Chapter 212, Florida Statutes 02/12/10 OF! LN UE 8541012599725C-1 02/28/201C) 02/28/2015 501(C)(3)ORGANIZATION • CertificateN umber Effective Date Expiration Date Exemption Category This ce riifies that COMMUNITY CARING CENTER OF BOYNTON BEA CH INC '445 NE 4TH AVE BOY riTON BEACH FL 33435-3865 • is exernptfrom 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. • LURID A Important Information for Exempt Organizations R 04///05 o MNL1 1. You mustprovide all vendors and suppliers with an exemption certificate before making tax-exempt purchases. See Rule 12A-1.038, Florida Administrative Code(FAC). 2. You r Consumer's Certificate of Exemption is to be used solely by your organization for your organization's customary nonprofit activities. 3. 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 by your organization 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, FAC). 5. Ills 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 necessitate the revocation of this certificate. 6{.' If you have questions regarding your exemption certificate,please contact the Exemption Unit of Central Registration at 850-487-4130. The mailing address is PO BOX 6480,Tallahassee, FL 32314-6480. Request for Funding from Discretionary Funds Background Information Community Caring Center serves approximately 2,500 families annually. Our primary target is in the Heart of Boynton Beach. It offers both social services and economic development services by providing homeless outreach,frail and elderly volunteer care giving,financial assistance,food pantry, USDA product distribution, affordable food distribution programs,emergency shelter, hurricane recovery and mitigation,food stamp on-line applications, medication and prescription drug assistance programs,and healthcare on-line applications for Medicaid, Palm Beach County Healthcare District,senior veggie mobile program, home delivered meals to shut-ins,vegan green market,and culinary incubator program creating jobs and small business development. In 2000,CCC began a 7-year study to determine some of the root causes of poverty and published in 2007 a concept paper called "Creating a Healthier Community" Initiative.CCC determined that when people lacked access to healthy affordable food there was a direct economic impact on a community measured in loss Of productivity,increased costs of health care,and increase demand for social services. With respect to CCC clients that requested financial aid,55%of them were debilitated by health related issues and 28%of those issues were nutrition related diseases like diabetes, high cholesterol, blood pressure, cancer and heart disease.CCC determined that the perception of a food pantry needed to change so that it became a community resource for social change, health prevention and an economic stimulus by"Creating Healthier Communities." CCC began to help bring awareness to the plight of hungry children,the perception of how a food pantry needs to address those issues,and what we all can do to help create a "Healthier Community." CCC developed a strategy which includes the creation of a non-profit grocery store, a"working"small business incubator,a community nutrition education program, an urban farming project,and a green market program,thus, launching a "NEW" Economic Development Department.The 2004/05,the children's nutrition education program,called"5 A Day,"was CCC's first program in its "Creating a Healthier Community" Initiative. It was designed as a prevention initiative to respond to an identified need &an attempt to alter the health-course of the next generation and hopefully influence their parents into making changes in attitudes and behaviors. Senior Executive for Produce for Better Health Foundation indicated that"educating children about healthful eating is critical to developing the skills they must have to lead healthy, productive lives, but more must be done to address the significant shortage of fruits and vegetables in children's diets." Since diabetes is one of the leading health concerns within the minority community and one of the larger health issues CCC has experienced,CCC felt that designing a program that could provide information on how to eat healthier by including more fresh fruit and vegetables in diets might have a significant impact in nutrition-related disease prevention.CCC conducted nine 6-weeks series of the Easy Garden Gourmet nutrition cooking classes, helping 90 men and women to reduce their sugar and salt intake by using locally grown fruits and vegetables, primarily from our own Urban Farming Project. We are happy to see that this idea has begun to catch on largely due to the emphasis placed on the subject by First Lady, Michele Obama. It certainly underlined the fact that our organization had been moving in the right direction in addressing"root" causes of poverty. "Creating A Healthier Community"Initiative. • kik ' [1272;ir:gef In year 2009/10, it was decided that a 2nd strategic planning process was needed. It helped to move the organization from a charitable hand-out posture to a self-sustaining model addressing a major root cause of poverty.The organization added its second department for economic development,and revised its by-laws and mission statement, "to address the root causes of poverty by an innovative integration of social services programs,economic development (through small business incubation), nutrition education, and access to a healthy sustainable food center," and increased its programmatic activities to include a not-for-profit grocer offering both an organic and an affordable monthly food& vegetable package to replace SHARE and Angel Food Ministries that left Florida,and a culinary incubator program for small business development in which we identify potential incubator clients,offer technical assistance with marketing and business plan development, operate a green market,teach nutrition education and food preservation, operate an urban farm,and sell our community supported agriculture packages and support a senior veggie mobile&mini"Meals on Wheels" programs all moving in a direction of providing a healthy sustainable food center. We believe that we have a unique model that deserves to be replicated on a national level--Note:to date Alachua County, Lake County, and the State of Florida's Department of Health have asked to come and study our model and requested that we serve on State board as an adviser. In the last year or two, CCC has been going through a second cycle of growth.The Strategic Planning Process has solidified and energized the board and they have adopted a plan of action for 1) Building the Organizations Infrastructure, and 2) Fundraising and Development. Helping to make sure that our Mission Statement is in line with the direction the organization is going in providing Health and Human Services as a faith- based organization,at the same time providing Hope and Help through our Economic Development programs,tying them together by caring for the poor,frail and elderly in the Heart of Boynton and insuring that the CCC moves toward self-sufficiency for its long-term survival. Use of Funds For the purposes of the request we would like to ask for$2,000 to 10,000 in financial support to help in three of our programs: 1. Senior Veggie Mobile &Home Delivered Meals Program, and the 2. Children's Gardening and Nutrition Education Program, and 3. Cranksgiving and the Holiday Cornucopia Projects All of these programs help to feed low-income families her in Boynton Beach. The Children's Garden and Nutrition Education program help children learn how to grown a garden and the nutritional value of the food they are eating.The garden produce is used in the senior veggie mobile program and also the vegetables used in the home delivered meals we provide to 274 frail and elderly shut-ins in the Heart of Boynton Beach. We have developed a 15-wk curriculum that meets the core curriculum for Palm Beach County.The funds would be used to purchase seeds,seedlings,soil,composter,and pay a stipend to a teacher. N The senior Veggie Mobile&Home Delivered Meals Program not only provides FREE vegetables weekly and 200 meals weekly to 274 shut-in seniors, but it addresses the health affects a "Creating A Healthier Community"Initiative f • € , - e '3 ,. a y ' g� ter BSD ,t ra Becirc �m u� t Gari; � �exiter��f ���ea }F. tor _ �3 �� �}�, m e = attributed to isolationism one of the major illnesses senior face. CCC plans several activities and tries to make sure that each senior participates in at least one or two events throughout the year. They include: Faulk Foundation Play"No Sex Please,We're retired," Kravis Center's "Motown the Musical," Mother's Day, Father's Day, New Years Breakfast, "You Pick"Your Own &Hayride, "Holiday Cheers w/Roy Davis"Love Me Tender" Easter Celebration,Gratitude Social with Adrianna for Thanksgiving. Funds would be used to cover costs of tickets,transportation and food. Cranksgiving is a new fundraising event to help fill the 250 Cornucopia Thanksgiving baskets we provide to the community. Baskets include:Turkeys,stuffing, rice and potatoes,canned green beans and cranberry sauce, pumpkin pie shells,fresh produce like celery,onions,sweet potatoes.The event is a bicycle race scavenger hunt to purchase food for the event. Participating stores include both Publix Stores at Woolbright and Congress,Winn Dixie on Federal in Lantana and WalMart on South Federal. Funds would be used to purchase t-shirts for the race, insurance,water, ice,and make up any shortage of turkeys&food required to complete the 250 baskets given away prior to Thanksgiving. We affirm that these funds applied for will be used for the specific items requested and that all invoicing and proper documentation will be provided in a written report. Thank you for giving this request your sincere consideration, Sherry Johnson Val/90/MOSse Executive Director Attachments crs Q) a. "Creating A Healthier Community"Initiative