Loading...
Boca Raton's Promise (For BBMHC) - Mayor Taylor 1;. R , R15-055 EXHIBIT "A" COMMUNITY SUPPORT FUNDS REQUEST FORM Part I - Summary of Request (to be completed by City Clerk) Date of Request: f/r/. -°!s" Requested by Mayor/Commissioner: r4-, 4).— Amount Requested: $ o��o__ Recipient/Payee: .& q Ri4r6JK. iv-eoAix5s (cogOBAYY// Description of project, program, or activity to be funded: &tpi/0, 7'Le,c� s Cviumc;L` �. w� ecce Part II -Availability of funds The annual appropriation of funds available to the requesting Member of the Commission listed above is $ L . The balance of funds available for the requesting Member of the Commission is $ .2, r Accordingly: ._, here are funds available as requested ':1' There are insufficient funds available as requested Dated: fA/Aleics" B • �'i - WI P et City Clerk 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 EY-The public purpose is beneficial to the entire community served by such donation Dated: --/ B / R:07 estin•'Mem%••r of the City Commission S:\CC\WP\COMMUNITY INVESTMENT FUNDS\Community_Support_Funs_Policy.2015.doc BOC\ fr 4' 1 s PrOM i5 e. 111 630D AWL =�- on FL 331187 scot - 8G6 - 185o W I raY i Boynton Beach Mental Health Committee (13 :MHC) Budget Narrative On July 1, 2015, the BBMHC completed its first full year of existence and accomplishments. The primary focus has been to build capacity for an Education and Awareness campaign. This involved ' creating a marketing brand, building relationships with Boynton Beach Community High School and community organizations, meeting with community leaders, creating and copying special handouts,conducting community conversations,working on a website,etc. The cost of copying material and buying notebooks, folders and other supplies has been modest during this period. We have appreciated the support of the Boynton Beach Mental Health Initiative (BBMHI) in covering the cost of copying and supplies, as well as support from other organizations who have provided generous in-kind services. Boca Raton's Promise has supported BBMHI as one of the early mental health community grass rootss'efforts. A major focus for year 2 is to expand Education and Awareness outreach to existing and new partners, conduct community conversations and promote Mental Health First Aid (MHFA)training in the community. It is essential for BBMHC to have professional marketing materials and the resources to copy sizeable quantities of educational information to support this effort and purchase basic office supplies. Other funding needs will include hosting MHFA trainings and small groups of community leaders at breakfast or lunch to engage them in our mission and in providing support for events and trainings. 2/poo 2474( • BBMHC is requesting support from the City's Community Support Funds in the amount of We have read and agree to abide by Policy R15-055. As we educate the community about the importance of our vision and mission,we will look to service clubs,individuals and businesses for additional funding and in-kind support. e500 business cards and 500 printed presentation folders for networking, conversations,workshops and events $800.00 • 500 printed letterhead and envelopes 300.00 • Copying and office supplies (cartridges,notebooks,name badges,paper, markers,flip chart and stand,postage etc.) 1,000.00 Food for special gatherings 400.00 o 2 Mental Health First Aid training sessions: 25-30 people,8 hours each @ $750.. . . 0 1,500.00 TOTAL $4,000 • Respectfinlly submitted by f Com=' i' Date 7- 3/-2e/6-- Rev.Woodrow Hay,Chair BB- HC It . • Internal Revenue Service Department al the Treasury P.O.Bos 2588 • Cincinnati,OH 45201 Date: April 20.2006 Person to Contact: Stephanie Swart augh 31-07594 Customer Service Specialist BOCA RATONS PROMISE THE AWANCE Toll Free Telephone Number. FOR YOUTH INC 877-829.5500 %DR MERRItEE MIDDLETON Federal Identification Number: 6300 PARK OF COMMERCE BLVD 65-0878294 L. SOCA RATON FL 33487 • Dear Sir or Madam This is in response to your request of April 20,2006,regarding your organization's tax-exempt status and change of address_ We have updated our records to reflect the information as shown above. In December 1999 we issued a determination letter that recognized your organization as exempt from federal inane tax. Our records indicate that your organization is currently exempt under section 501(c)(3)of the Internal Revenue Code. Our records indicate that your organis also wed as a public charity under sections 509(aX1)arid 170(bx1)(A)(vi)of the Internal Revenue Code. Our records indicate that contributions to your organization are ded Bible under section 170 of the Code,and that you are qualified to receive tax deductible bequests,devises,transfers or gifts ' under section 2055,2106 or 2522 of the Internal Revenue Code. If you have any questions,please call us at the telephone number shown in the heading of this letter. Sincerely, Janna K Skurea,Director,TEJGE • Customer Account Services Form W-9 Request for Taxpayer Give Form to the (Rev.January 2011) Identification Number and Certification . requester.Do not Department of the Treasury send to the IRS. Internal Revenue Service Name(as shown on your income tax mum) • - Business namePoiaregerded entity name.If differem from above CL Cheek appropriate box for federal tax m classification(required): ❑Indtvlduausole proprietor 0 o Corporation 0 a oorparatlen 0 Partnership 0 Trust/mato co e0 0 UmAed liability company,Enter the tax classification(C.,0 corporation.S=S corporation,P=partowshli s•• 0 Exempt Payee g c Com, ^❑ Other(see insbuctlons)► es Address(number.street,and apt.or Suite no.) Requester's name end address(optionaq City,state,and ZIP code tint amount numbor(c)•hero(optional) ' • - • • • Part I Taxpayer Identification Number(TIN) Enter your TIN In the appropriate boX.The TIN provided must match the name given on the'Name"line (Sooel eeourity number to avoid backup withholding.For indNlduels,this Is 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 — — entitles,It Is your employer Identification number(EIN).If you do not have a number,see How to get a , TIN on page 3. Note.If the account is in mere than one name,see the chart on page d for guidelines on whose I Employer identification number number to enter. Part II 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 InternalRevenue 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. I am a U.S.citizen or other U.S.person(defined below). 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 felled to report all Interest and dividends on your tax return:For real estate transactions,kern 2 does not apply.For mortgage interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an Individual retirement arrangement ORA),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 on page rt. Sign signature of /t Here u.s.person l• P/U_/� (//`-. Date o 5 General Instruction Note.If a requester gives you a form other than Form W-9 to request your TIN,you must use the requester's form if it Is substantially similar Section references are to the Internal Revenue Code unless otherwise to this Form W.9. noted. Definition of a V.S.person.For federal tax purposes,you are Purpose of Form considered a U.S.person If you are: A person who is required to file an Information return With the IRS must • Individual who Is a U.S.citizen or U.S.resident ellen, obtain your correct taxpayer Identification number(TIN)to report,for •A partnership,corporation,company,or association created or example,income paid to you,real estate transactions,mortgage Interest organized In the United States or under the laws of the United States, you paid,acquisition or abandonment of secured property,cancellation •An estate(other than a foreign estate),or of debt,or contributions you made to an IRA. •A domestic trust(as defined in Regulations section 301.7701-7). Use Form W-9 only If you are a U.S.person(Including a resident Special rules for partnerships.Partnerships that conduct a trade or alien),to provide your correctto the person requesting it(the business in the United States are generally required to pay a withholding requester)and,when applicable,to: tax on any foreign partners'share of income from such business. 1.Certify that the TIN you are giving Is correct(or you are waiting for a Further,in certain cases where a Form W-9 has not been received,a number to be issued), partnership Is required to presume that a partner Is a foreign person, 2.Certify that you are not subject to backup withholding,or and pay the withholding tax.Therefore,if you we a U.S.person that is a ...scampt Danner in a partnership conducting a trade or business in the United 3.Claim exemption from backup withholding If you are a U.S payee.If applicable,you are also certifying that as a U.S.person,your.provide Form W-9 to the partnership to establish your U.S. allocable share of any partnership Income from a U.S.trade or business status end avoid withholding on your share of partnership income. is not subject to the withholding tax on foreign partners'share of effectively connected Income, Car.No.10231X Form W-9(Rev.1-2011) .014 Pyle, Judith ,... ' ';'From: LaVerriere, Lori Sent: Monday,August 10, 2015 8:51 AM • To: Pyle,Judith Cc: Howard, Tim Subject: FW: Request for Community Support Funds Would you contact Woodrow Hay and ask him to revise their request to match the$2000 limit? As it sits right now there is insufficient funding to fulfill the request. The Mayor would like this on the 8/18/15 agenda. . '07„ Lori LaVerriere, City Manager xr ':'CCity Manager's Office " '' _ City of Boynton Beach 1):7.-i-:': ,�<4-,.,�v.', 100 E. Boynton Beach Blvd. I Boynton Beach, Florida 33435 16,-,,-.0. o: 561-742-6010 I f: 561-742-6011 NUP- LaVerriereL®bbfl.us I www.boynton-beach.org America's Gateway to the Gulfstream Please be advised that Florida has a broad public records law and all correspondence to me via email may be subject to disclosure.Under Florida records law,email addresses are public records. Therefore,your e-mail communication and your e-mail address may be subject to public disclosure. From: Taylor, Jerry Sent: Sunday, August 09, 2015 2:49 PM To: LaVerriere, Lori Subject: Re: Request for Community Support Funds Lori, please place this request on the next city agenda. Thanks. Mayor On Aug 4, 2015 11:31 AM, "LaVerriere, Lori" <LaVerriereL cr bbfl.us>wrote: Please see the attached letter of request from the Mental Health Committee. Per the resolution the request must be submitted by an elected official. Please coordinate this with Mayor Taylor. Also advise him that the amount of funds available to him is$2,000. They are requesting$4,000. Once you have the information completed we will need to place this on our next city commission agenda. From: Bizhub Sent: Tuesday, August 04, 2015 12:20 PM To: LaVerriere, Lori Subject: Message from KMBT_C360 R15-055 CITY OF BOYNTON BEACH COMMUNITY SUPPORT FUNDS POLICY PURPOSE: The purpose of the Community Support Funds (CSF) is to provide a source of discretionary funding to support projects, programs and activities in the City which are accessible and beneficial to the citizens of the City. Due to the broad and diverse nature of programs or projects that may be eligible for funding from the Community Support Funds, no specific list of eligible projects, programs, or activities is appropriate. SCOPE: This policy recognizes that there is a specific line item in the City Commission portion of the City's annual budget. Each year, in the annual budget adoption process, the City Commission shall consider an appropriation for Community Support Funds. The Commission is not required to appropriate Community Support Funds but when it does, the amount appropriated, if any, shall be available for distribution by the Mayor and City Commissioners in equal amounts only for qualified programs or projects. By way of example: If the Commission budgets $10,000, the Mayor and each Commissioner may request distributions up to $2,000 for the year that the funds are appropriated. CRITERIA FOR ELIGIBILITY: Eligibility for funding shall be conditioned on a finding by the City Commission that: 1. Public funds should not be used to improve private property unless there is a clear public need, purpose and benefit; and 2. The recipient/payee will use 100% of the funds to provide services within the City; and 3. The public purpose is beneficial to the entire community served by such donation and to the City as a whole; and 4. Proper safeguards shall be implemented by the City administration to assure that the funds will be used for the stated purpose, such as: a. Prior to receiving any funds, the recipient must complete a W-9 Request for Taxpayer Identification Number Form in order to be added to the City's vendor list. b. Within 60 days of receipt of funds, the recipient must provide the Finance Director appropriate backup documentation demonstrating the funds were used for the stated purpose approved by the Commission. c. Should the recipient fail to submit the appropriate documentation within the allotted time, the City Commission may dee m the recipient ineligible for any future funding. • The findings of the City Commission as to each of these required elements shall be inferred from the Commission's approval or disapproval of the requested distribution without the need for separate findings. PROCEDURE FOR CONSIDERATION OF EXPENDITURES: The procedures for expenditures from the Community Support Funds are as follows: 1. The Mayor or any member of the City Commission shall make a request to the City Clerk for the expenditure of funds. The requesting member of the City i R15-055 Commission must have a written request from the entity seeking funds. The written request must contain a narrative explanation indicating how the funds will be used and an affirmative acknowledgement that the requestor understands and will comply with the above listed conditions for eligibility and use. The written request will be forwarded to the City Commission along with Exhibit "A" (see Step 2). 2. The City Clerk shall complete a Community Support Fund Request Form (form attached as Exhibit "A") and confirm the funds are available with the Finance Director. 3. If the appropriate funds are available the City Clerk will schedule the matter to be considered by the City Commission at the next scheduled City Commission meeting under New Business. 4. The City Commission shall act on the request for expenditure by approving or disapproving the agenda item. A majority vote is required for approval of the expenditure. DISCRETIONARY NATURE OF COMMISSION ACTION: The decision of the City Commission to approve or disapprove a requested distribution of Community Support Funds is discretionary and is not subject to appeal, review or challenge.