Backup Documents 09/28/2010 Item #16D 6ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLI16 D 6
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. Original documents should be hand delivered to the Board Office. 'The completed routing slip and original
documents are to be forwarded to the Board Office only after the Board has taken action on the item.)
ROUTING SLIP
Complete routing lines # I through 44 as appropriate for additional signatures, dates, and/or information needed. If the document is already complete with the
A—... I;— th h rooting lines # 1 through #4 complete the checklist. and forward to Sue Filson (line #5).
exception w u,c i.uauuial S a j1a.a.,,, .,,a., a ....
Route to Addressee(s)
_ .. - -�
Office
Initials
Date
(List in routing order)
l.Jennifer White
County Attorney Office
"\AcI
I3o 110
2.
9/28/10
Agenda Item Number
t ��
3.
signed by the Chairman, with the exception of most letters, must be reviewed and signed
4.
Grant Application documents
Number of Original
1
5, Ian Mitchell, BCC Office
Board of County Commissioners
Documents Attached
10
Supervisor
O
6. Minutes and Records
Clerk of Court's Office
2.
All handwritten strike - through and revisions have been initialed by the County Attorney's
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending BCC approval. Normally the primary contact is the person who created/prepared the executive
summary. Primary contact information is needed in the event one of the addressees above, including Sue Filson, need to contact staff for additional or missing
information. All original documents needing the BCC Chairman's signature are to be delivered to the BCC office only after the BCC has acted to approve the
item.)
Name of Primary Staff
Marcy Krumbine /Marlene Foord
Phone Number
252- 2273/252 -4768
Contact
appropriate.
(Initial)
Applicable)
Agenda Date Item was
9/28/10
Agenda Item Number
t ��
Approved by the BCC
signed by the Chairman, with the exception of most letters, must be reviewed and signed
Type of Document
Grant Application documents
Number of Original
1
Attached
I
Documents Attached
INSTRUCTIONS & CHECKLIST
1: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05, Revised 9.18.09
Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is
Yes
N/A (Not
appropriate.
(Initial)
Applicable)
1.
Original document has been signed/initialed for legal sufficiency. (All documents to be
signed by the Chairman, with the exception of most letters, must be reviewed and signed
by the Office of the County Attorney. This includes signature pages from ordinances,
resolutions, etc. signed by the County Attorney's Office and signature pages from
M
contracts, agreements, etc. that have been fully executed by all parties except the BCC
Chairman and Clerk to the Board and possibly State Officials.)
2.
All handwritten strike - through and revisions have been initialed by the County Attorney's
Office and all other parties except the BCC Chairman and the Clerk to the Board
3.
The Chairman's signature line date has been entered as the date of BCC approval of the
y
document or the final negotiated contract date whichever is applicable.
4.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's
signature and initials are required.
M
5.
In most cases (some contracts are an exception), the original document and this routing slip
should be provided to Ian Mitchell in the BCC office within 24 hours of BCC approval.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
(,f`
time frame or the BCC's actions are nullified. Be aware of your deadlines!
6.
The document was approved by the BCC on (enter date) and all changes
made during the meeting have been incorporated in the attached document. The
County Attorney's Office has reviewed the changes, if applicable.
1: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05, Revised 9.18.09
+1.
MEMORANDUM
Date: October 1, 2010
To: Marlene Foord, AICP
Grants Coordinator
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: Application for a Criminal Justice, Mental Health &
Substance Abuse Reinvestment Implementation Grant
from Florida's Department of Children & Families
Attached is the original grant application referenced above (Item # 16D6),
approved by the Board of County Commissioners on September 28, 2010.
The Minutes and Record's Department will hold a copy of the application
in the Board's official records.
If you should have any questions please feel free to call me at 252 -8406.
Thank you.
Attachment
16D6
Criminal Justice, Mental Health and Substance Abuse Reinvestment Grant
Cover Page For Implementation Grant
Project Title: Collier FIRST/Forensic Intensive Reintegration Support Team
County or Counties: Collier County
GRANT POINT OF CONTACT
Contact Name: Marcy Krumbine
Department:
Housing, Human and Veteran Services
Address Line 1:
3301 East Tamiami Trail
Address Line 2:
Health Building, Suite 211
City:
Naples
State:
Florida
Zip:
34112
Email:
marcykrumbine @colliergov.net
Phone: 239 - 252 -2273
ADDITIONAL CONTACTS
Contact Name (if any):
Fax: 239- 252 -2638
N/A
Organization:
Address Line 1:
Address Line 2:
City:
State:
Zip:
Email:
Phone:
FUNDING REQUEST AND INIATC11ING
1. Total Amount of Grant Funds
Requested:
Fax:
FUNDS
$726,702
2. Total Matching Funds
(Provided by applicant and
project partners):
$743,106
Total Project Cost (Add
amounts in I and 2):
CERTIFVING OFFICIAL
Certifying Official's Signature
$1,469,808
t.j GO. 77, Agenda
Date
Certifying Official's Name
(printed):
Fred W. Coyle Date
Title:
Chairman
Date:
September 28, 2010 Deputy
Approved a3 to form & legai Sufilcienew
Ass ant Coi.inty ���ttr,:r►�:a�
,DWIGHT 9,,J413" bark
ay.
Attak 1f
i �atar'a �'tal..
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e�''r
16U6
Appendix E
COMMITMENT OF MATCH/DONATION FORMS
TO:(name of County)
FROM: Donor Name
ADDRESS: 3 -510
The following $- space, ` equipment, _ goods/supplies, and/or I services, is/are donated
to the County
permanently (title passes to the ounty) Ce u4i
temporarily, for the period 1 to I 1 O (title is retained by the
Description and Basis for Valuation (See neat page)
ckqr-pc
G I. I —amen S
(2) S-4P S14 D- s ka P(anv,"
c r,
` C.15y I. ME Li4a�
Gas
rlt�
�• a.8.1 o�r
Value Corporation USE
c�rnkcztl
sit
avwa lvt
�h•k►nd.
"TOTAL VALUE
The above donation(s) is not currently included as a cost (either direct or matching) of any state
or federal contract or grant, nor has it/they been previously purchased from or used as match for
any state or ederal contract.
(D 1! i _ lure) (Date) (County Designee S ature)_ (Date)
The grant Review Committee will review the valuation of the donated item(s) and has, in the space
provided, indicated the valuation amount acceptable to the department for use in meeting a match
requirement for the Criminal Justice, Mental Health and Substance Abuse Reinvestment Grant program.
Donated items are subject to disallowance should they be found to be a current or previous cost or
matching item of a state or federal grant or contract.
Approved &A To form & Wgai Suf'ielttttr;y
28
3lywa+t:�r��r air_a.
1606
Appendix E
COMMITMENT OF MATCH/DONATION FORMS
TO:(name of County) Collier County
FROM: Tina Gelpi, QTD, QTR/L, Florida Gulf Coast University
ADDRESS: 10501 FGCU Boulevard South, Fort Myers, FL 33965-6565
The following _ space, _ equipment, _ goods/supplies, and/or -X- services, is/are donated to
the County
- permanently (title passes to the County)
A temporarily, for the period Jan 2011 to Jan 2014 (title is retained by the donor)
Description and Basis for Valuation (See next page)
Value Corporation USE
(11 Personnel Services: Annual Salary $78,000
D 11 1 h/312 hours/year x 3 years
-Mil nU -1 1 i
Appre)VAII aS TO 10rm
k2—
C
k
i-oulay esignee
61gjiature)j ate)
-----------
Appre)VAII aS TO 10rm
k2—
16D6
Appendix E
COMMITMENT OF MATCH/DONATION FORMS
TO:(name of County) Collier County
FROM: NAMI of Collier County
ADDRESS: 6216 Trail Blvd, Bldg C, Naples, FL 34108
The following X space, equipment, goods /supplies, and /or _X_ services, are donated to the
County
permanently (title passes to the County)
_X temporarily, for the period Jan 2011 to June 2014 (title is retained by the donor)
Description and Basis for Valuation (See next page)
Value Corporation USE
(1) Personnel Services:` Annual Salary
$75,000 x.10 FTE x 3 years
$ 22,500
(2)_Building/Space
$12 /sq. ft. x 144 square feet x 3 years $62,208
(3) Cash $2,500 /year x 3 years $7,500
TOTAL VALUE $ 92,208
The above donation(s) is not currently included as a cost (either direct or matching) of any state or
federal contract or grant, nor has it/they been previously purchased from or used as match for any
state or federal contract.
41'.k' y/) 71 ., 0
(Donor Signature) (Date)
(County Designee Sign ,44e) e) (Date)
The grant Review Committee will review the valuation of the donated item(s) and has, in the space
provided, indicated the valuation amount acceptable to the department for use in meeting a match
requirement for the Criminal Justice, Mental Health and Substance Abuse Reinvestment Grant program.
Donated items are subject to disallowance should they be found to be a current or previous cost or
matching item of a state or federal grant or contract.
Approved a3 to form
ti.
e� Ass taut f;rmnty
JS- +�N-\IF-5-2 i� .vet \ \:�!
1i 4 ES a: 3/ 11i i
'3t7 : f
�
ASE" -trim s
li a rs 0 "v4
1606
Appendix E
COMMITMENT OF MATCH/DONATION FORMS
TO:(name of County) Collier County
FROM: David Lawrence Center
ADDRESS: 6075 Bathey Lane, Naples, FL 34116
The following X space, _ equipment, _ goods /supplies, and/or X services, are donated to the
County �
permanently (title passes to the County) (,R i,
X temporarily, for the period Jan 2011 to Jan 2014 (title is retained by the donor)
Description and Basis for Valuation (See next page)
Value Corporation USE
(1)_Personnel Services: Annual Salary
$36,900 x .15 FTE x 3 years
$36,900`
(2)_Personnel Services: Annual Salary
$72,000 x.10 FTE x 3 years $21,600`
(3) Personnel Services: Annual Salary
$65,000 x .05 FTE x 3 _years
$9,750
(4) Building/Space: Fair Rental Value
$12 /sq ft x 196 square feet x 12 months x 3 years
$84,672
(5) Cash $10,000 /year x 3 years $30,000
TOTAL VALUE $182,922
The above donation(s) is not currently included as a cost (either direct or matching) of any state or
federal contract or grant, nor has it/they been previously purchased from or used as match for any
state or federal contract.
(Donor Signature) (Date) (County Designee Signature) 0_ 5 te)
—y
The grant Review Committee will review the valuation of the donated item(s) and has, in the space
provided, indicated the valuation amount acceptable to the department for use in meeting a match
requirement for the Criminal Justice, Mental Health and Substance Abuse Reinvestment Grant program.
Donated items are subject to disallowance should they be found to be a current or previous cost or
matching item of a state or federal grant or contract.
A�a�r,)Vr?tl
iDWIGHT
3y.
Aytist
R
t� l�ti� Kr
fill" I
Appendix F
STATEMENT OF MANDATORY ASSURANCES
Infrastructure: The applicant shall possess equipment and Internet access
Initial
necessary to participate fully in this solicitation.
Site Visits: The applicant will cooperate fully with the Department in
. ti 4-
coordinating site visits, if desired by the Department.
Non - discrimination: The applicant agrees that no person will, on the
basis of race, color, national origin, creed or religion be excluded
from participation in, be refused the benefits of, or be otherwise
subjected to discrimination pursuant to the Act governing these funds
Initial
or any project, program, activity or sub -grant supported by the
requirements of, (a) Title VI of the Civil Rights Act of 1964 which
prohibits discrimination on the basis of race, color or national origin;
(b) Title IX of the Education Amendments of 1972, as amended
which prohibits discrimination the basis of sex; (c) Section 504 of the
Rehabilitation Act of 1973, as amended which prohibits
discrimination in employment or any program or activity that receives
or benefits from federal financial assistance on the basis of handicaps;
(d) Age Discrimination Act 1975, as amended which prohibits
discrimination on the basis of age, (e) Equal Employment
Opportunity Program (EEOP) must meets the requirements of 28
CFR 42.301.
�..
Lobbyin : The applicant is prohibited by Title 31, USC, Section 1352,
entitled "Limitation on use of appropriated funds to influence certain
Initial
Federal contracting and financial transactions," from using Federal
funds for lobbying the Executive or Legislative Branches of the
federal government in connection with a specific grant or cooperative
agreement. Section 1352 also requires that each person who requests
or receives a Federal grant or cooperative agreement must disclose
lobbying undertaken with non - Federal funds if grants and/or
cooperative agreements exceed $100,000 in total costs (45 CFR Part
93).
Drug -Free Workplace Requirements: The applicant agrees that it will, or
Initial
will continue to, provide a drug -free workplace in accordance with 45
CFR Part 76.
31
16D6
A!
W G_,d ,
LA) .
t'
16D6
Smoke -Free Workplace Requirements: Public Law 103 -227, Part C-
Environmental Tobacco Smoke, also known as the Pro - Children Act
d
of 1994 (Act), requires that smoking not be permitted in any portion
Initial
of any indoor facility owned or leased or contracted for by an entity
and used routinely or regularly for the provision of health, day care,
education, or library projects to children under the age of 18, if the
projects are funded by Federal programs either directly or through
State or local governments, by Federal grant, contract, loan, or loan
guarantee. The law does not apply to children's projects provided in
private residences, facilities funded solely by Medicare or Medicaid
funds, and portions of facilities used for inpatient drug or alcohol
treatment. Failure to comply with the provisions of the law may
result in the imposition of a civil monetary penalty of up to $1,000
per day and/or the imposition of an administrative compliance order
on the responsible entity.
Comnliance and Performance: The applicant understands that grant funds
t
in Years 2 and 3 for Implementation Grants are contingent upon
compliance with the requirements of this grant program and
Initial
demonstration of performance towards meeting the grant goals and
objectives, as well as availability of funds.
Certification of Non - supplanting: The applicant certifies that funds
&&i
awarded under this solicitation will not be used for programs
currently being paid for by other funds or programs where the funding
has been committed.
�.
Submission of Data: The applicant agrees to provide data and other
- -ry
information requested by the Criminal Justice, Mental Health, and
Initial
Substance Abuse Technical Assistance Center at the Florida Mental
Health Institute to enable the Center to perform the statutory duties
established in the authorizing legislation.
Submission of Reports: The applicant agrees to submit semi- annual
_t�_,,
progress reports and an annual fiscal report, signed by the County
Initial
Administrator, to the Department.
Q._ ( ")
By signing and submitting this agreement, the Applicant certifies that it will comply with
all the above requirements.
9/28/10
Applicant Signature Y.��— Date
Fred W. Coyle, Chairman
ATTEST; 32
CWI(31-O r,' R CK CA-0a<
V. _
*an � may.
(J",
Approved as to form & iegal Sufflcianr-�
Assts ant County Attornexi
16U 6
Ann P. Jennejohn
From: Ann P. Jennejohn
Sent: Friday, October 15, 2010 3:03 PM
To: Foord, Marlene
Subject: RE: 9/28/10 161D6 Criminal Justice Grant
We'll suggest they take over to you.
It's beautiful outside after all!
Ann
From: foord_m [ mailto :MarleneFoord @colliergov.net]
Sent: Friday, October 15, 2010 3:01 PM
To: Ann P. Jennejohn
Subject: RE: 9/28/10 16D6 Criminal Justice Grant
Thanks so much. Colleen Greene or someone from the CA office may be bringing it to you shortly. We just added the
meeting and item number to the top of the ES since I forgot to create another pink transmittal for it. Do you need that
sheet again? Once you do see it, I would greatly appreciate a call to come pick it up unless the person from the CA office
offers to bring it to me.
Marlene . Foord, A.1CP
Grant Coordinator
Administrative Services, Bldg. D.
Collier County Government
3301 Taniiarni Trail East
Naples, Florida 34112
(239) 252 -GRNT (4768)
(239) 252 -8720 (fax)
marlenefoordncolliergoy.net
j.A please consider the environment before printing this email
From: Ann P. Jennejohn [ mailto: Ann.Jennejohn @collierclerk.com]
Sent: Friday, October 15, 2010 2:59 PM
To: foord_m
Subject: RE: 9/28/10 16D6 Criminal Justice Grant
Sure, no problem.
See you soon.
Ann
From: foord_m [mailto :MarleneFoord @colliergov.net]
Sent: Friday, October 15, 2010 2:16 PM
To: Ann P. Jennejohn
Subject: 9/28/10 16D6 Criminal Justice Grant
Hi Ann,
I am walking some signed documents around that are related to the above grant that was approved 9/28. Originals were
already signed and attested to, but the grantor requested some changes. If I bring them by in about 20 minutes, so you
think I could wait for them? Sorry for the rush.
160 6
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. Original documents should be hand delivered to the Board Office. The completed routing slip and original
documents are to be forwarded to the Board Office only after the Board has taken action on the item.)
ROUTING SLIP
Complete routing lines # 1 through #4 as appropriate for additional signatures, dates, and/or information needed. If the document is already complete with the
o.we flu.; ..e ,I -i .. ,.... A— . line th—ch � 11tino lines # t thTmnah #4. cmmnlete the checklist. and forward to Sue Filson (line #5).
CACO UVL Vl I1lV �LLW1 -- o u. .uaw v, wu.. r u..v ru..— ..-
Route to Addressee(s)
List in routing order
. —.--- - .. - -.. - - --- -- - - -. - - -- - - -- - - -
Office
Initials
Date
1.
Initial
Applicable)
2.
September 28, 2010
Agenda Item Number
16 -D -6
3.
Chairman, with the exception of most letters, must be reviewed and signed by the Office of the
4 Colleen M. Greene, Assistant County
Attorney
County Attorney
C.MEr
0- Iy_ 10
5. Ian Mitchell, BCC Office Supervisor
Board of County Commissioners
Documents Attached
6. Minutes and Records
Clerk of Court's Office
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending BCC approval. Normally the primary contact is the person who created/prepared the executive
summary. Primary contact information is needed in the event one of the addressees above, including Sue Filson, need to contact staff for additional or missing
information. All original documents needing the BCC Chairman's signature are to be delivered to the BCC office only after the BCC has acted to approve the
item 1
Name of Primary Staff
Marlene Foord
Phone Number
252 -4768
Contact
Initial
Applicable)
Agenda Date Item was
September 28, 2010
Agenda Item Number
16 -D -6
Approved by the BCC
Chairman, with the exception of most letters, must be reviewed and signed by the Office of the
Type of Document
Criminal Justice, Mental Health and
Number of Original
1
Attached
Substance Abuse Reinvestment Grant
Documents Attached
INSTRUCTIONS & CHECKLIST
* *M &R: Please call Marlene Foord upon completion of processing. The document is
needed today. Thank you.
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
amatter _ numben>/ «document number»
Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is appropriate.
Yes
N/A (Not
Initial
Applicable)
1.
Original document has been signed/initialed for legal sufficiency. (All documents to be signed by the
CMG
Chairman, with the exception of most letters, must be reviewed and signed by the Office of the
County Attorney. This includes signature pages from ordinances, resolutions, etc. signed by the
County Attorney's Office and signature pages from contracts, agreements, etc. that have been fully
executed by all parties except the BCC Chairman and Clerk to the Board and possibly State
Officials.
2.
All handwritten strike - through and revisions have been initialed by the County Attorney's Office and
N/A
all other parties except the BCC Chairman and the Clerk to the Board
3.
The Chairman's signature line date has been entered as the date of BCC approval of the document or
CMG
the final ne otiated contract date whichever is applicable.
4.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's signature and
CMG
initials are required.
5.
In most cases (some contracts are an exception), the original document and this routing slip should be
N/A
provided to Ian Mitchell in the BCC office within 24 hours of BCC approval. Some documents are
time sensitive and require forwarding to Tallahassee within a certain time frame or the BCC's actions
are nullified. Be aware of your deadlines!
6.
The document was approved by the BCC on 06/08/10 and all changes made during the meeting
CMG
have been incorporated in the attached document. The County Attorney's Office has reviewed
the changes, if applicable.
* *M &R: Please call Marlene Foord upon completion of processing. The document is
needed today. Thank you.
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
amatter _ numben>/ «document number»
160 6
MEMORANDUM
Date: October 15, 2010
To: Marlene Foord, AICP
Grants Coordinator
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: Application (revision) for a Criminal Justice, Mental
Health & Substance Abuse Reinvestment Implementation
Grant from Florida's Department of Children & Families
Attached is the original grant application revision referenced above
(Item # 16D6), approved by the Board of County Commissioners September 28, 2010.
The Minutes and Record's Department will hold a copy of the revised application
in the Official Records of the Board.
If you have any questions please feel free to call me at 252 -8406.
Thank you.
Attachment
Ap
Colleen Greene,
Assistant County Attomey
16D 6
Criminal Justice, Mental Health and Substance Abuse Reinvestment Grant
Cover Page For Implementation Grant
PROPOSAL INFORINIATION
Project Title: Collier FIRST /Forensic Intensive Reintegration Support Team
County or Counties: Collier County
GRANT POINTOF CONTACT
Contact Name: Marcy Krumbine
Department:
Housing, Human and Veteran Services
Address Line 1:
3301 East Tamiami Trail
Address Line 2:
Health Building, Suite 211
City:
Naples
e:
e:
Florida
Zip:
34112
Email:
marcykrumbine @colliergov.net
Phone: 239 - 252 -2273
ADDITIONAL, CONTACTS
Contact Name (if any):
Fax: 239 - 252 -2638
PAS (2J Qkt r
Organization:
C t Ct f
Address Line 1:
Q,�
Address Line 2:
City: ley
State: V— to (td
Zip: 34 t kko
Email: amp—. b% d\ G V\�
Phone: �,3q 35 &4 - I L461 Fax:
FUNDING FUNDS
1. Total Amount of Grant Funds Requested: $548,490
2. Total Matching Funds (Provided by applicant
and project partners):
$548,547
Total Project Cost (Add amounts in 1 and 2):
$1,097,037
CERTIFYING. OFFICIAL
Certifying Official's Signature
A,�"e y�
Certifying Official's Name (printed):
Fred W. Coyle -
Title:
Chairman
Date:
o form & le al sufficiency
September 28, 2010
.ATTEST.
DWIGHT E.� 130( , Cklik
- s
: f nw •�•.ww
.,i1 6
16D 6
Appendix E
COMMITMENT OF MATCH/DONATION FORMS
TO: (name of County) p i kn
FROM: Donor Name COkk,ft- CZ.A-hT(A er`i 1
ADDRESS: 3 O k �0.mn0. 71 -
0.
The following -Y—\ space, _ equipment, _ goods /supplies, and/or '�k services, is /are donated
to the County
permanently (title passes to the County) Cots
temporarily, for the period 1 0 tQ to 0 l (title is retained by the deeef)
Description and Basis for Valuation (See next page)
(1)OQQce sNu &w ' t r u
Na 7Y 4-19
no�nl�
(2) o-o gLk- +: e NLY11W SOL" i Ser
2r , o VT . e - Vtw) s
(3 '
Cursi ca 40 4- akv\ CC.SQ vt" V1 C 1i'.
r� Mv; Cos yAkayies ) Wd
6�4CC.S � x �� x ll X �lOhr � 3�rg
.� T N
�tb d 1, r ear
Value Corporation USE
$515.060-t
$VAq Age
$ X4000
$ !)0t, 6n (5L TOTAL VALUE
The above donation(s) is not currently included as a cost (either direct or matching) of any state
or federal contract or grant, nor has it/they been previously- cha ed from o used match for
a&tate r federal contract. t (A) .
. --4c rj—G
(Donor Signature) (Date) (County Designee Signature) (Date)
The grant Review Committee will review the valuation of the donated item(s) and has, in the space
provided, indicated the valuation amount acceptable to the department for use in meeting a match
requirement for the Criminal Justice, Mental Health and Substance Abuse Reinvestment Grant program.
Donated items are subject to disallowance should they be found to be a current or previous cost or
matching item of a state or federal grant or contract.
Approved as to torm at iegai swnavi Y
L
Colleen Greene,
Assistant County Attorney
ATTEST. `
0W1GHT �.� 14bCK,' Gler:k
28
far. S�
rai.+j&l.ry SAV.r
BASIS OF VALUATION
Building /Space
160 6
1. Donor retains title:
a. Fair rental value - Substantiated in provider's records by written
confirmation(s) of fair rental value by qualified individuals, e.g., Realtors, property
managers, etc. /
b. (1) Established monthly rental of space $ 0 %
(2) Number of months donated during the contract J�
Value to the project [b.(1) X b.(2)] $
2. Title passes to the County:
Depreciation
a. Cost of Fair Market Value (FMV) at acquisition (excluding land) $
b. Estimated useful life at date of acquisition yrs.
c. Annual depreciation (a./b.) $
d. Total square footage sq. ft.
e. Number of square feet to be used on the grant program. sq. ft.
f. Percentage of time during contract period the project will occupy the building/space
g. Value to project (e. /d. X f. X c.) $
Use Allowance
a. To be used in the absence of depreciation schedule (i.e., when the item is not
normally depreciated in the County's accounting records)
b. May include an allowance for space as well as the normal cost of upkeep, such as
repairs and maintenance, insurance, etc.
Equipment
1. Donor retains title: Fair Rental Value
2. Title passes to County:
a. FMV at time of donation $ , or
b. Annual value to project (not to exceed 6 2/3% X a.) _ $
Goods /Supplies
FMV at time of donation
Personnel Services DSO T ` �� �� S3,1��0��
1. Staff of another agency /organization. { or
Annual Salary Numb r of hours 208k X to be provided = $ (`
O,000 .IS = a \ &Vrs = q,oOQ
gg b8o f o
�FT . = n t = Wa,bB`F
oS
2. Vo unteer
Comparable annual salary $
Annual salary Number of hours 2080 X to be provided = $
C 1T So.\ar t +1 U-S b�\Cc-SO (Atxv -iv,�C tT4r
hh. A clo.W,, v1 x 40 �vr W�- -1 aye. \'a-i avC r
� e(xr .
29
0A
sk-le-0
160 6
Appendix E
COMMITMENT OF MATCR/DONATION FORMS
TO:(name of County) Collier County
FROM: NAMI of Collier County
ADDRESS: 6216 Trail Blvd, Bldg C, Naples, FL 34108
The following 2L-space, _equipment,_ goods /supplies, and /or X services, are donated to the
County
permanently (title passes to the County)
_ XX temporarily, for the period Jan 2011 to June 2014 (title is retained by the donor)
Description and Basis for Valuation (See next page)
(1) Personnel Services: Annual Salary
$75,000 x .10 FTE x 3 years
Value Corporation USE
$ 22,500
(2) Building/Space
$12 /sq. ft. x 144 square feet x 3 years $5,184.00
(3 ) Cash $2 500 /year x 3 years $7,500
TOTAL VALUE $ 35,184
The above donation(s) is not currently included as a cost (either direct or matching) of any state or
federal contract or grant, nor has it/they been previously purchased from or used as match for any
state or federal contract.
(Donor Signature) (Date) (County Designee Signature) ( ate)
The grant Review Committee will review the valuation of the donated item(s) and has, in the space
provided, indicated the valuation amount acceptable to the department for use in meeting a match
requirement for the Criminal Justice, Mental Health and Substance Abuse Reinvestment Grant program.
Donated items are subject to disallowance should they be found to be a current or previous cost or
matching item of a state or federal grant or contract.
Approved as to form & legal sufficiency
C
Colleen 6reene,
Assistant County Attorney
AT T EST`
DWIGHT E 81FIdOK 091.1 K
sy. _ .
C-
160 6
Appendix E
COMMITMENT OF MATCH/DONATION FORMS
TO:(name of County) Collier County_
FROM: David Lawrence Center
ADDRESS: 6075 Bathey Lane, Naples, FL 34116
e o owing _space, , equipment, X goods/supplies, and/or X services, are donated to the
County
permanently (title passes to the County)
X temporarily, for the period Jan 2011 to June 2014 (title is retained by the donor)
Description and Basis for Valuation (See next page)
Value Corporation USE
(l) Personnel Services: Annual Salary
$36,900 x .33FTE x3 years
$ 36.900_
(2) Personnel Services: Annual Salary
$72,000 x A0 FTE x 3 years
$ 21,600
(3) Personnel Services: Annual Salary
$65,000 x .15 FTE x 3 years
$29,250
(4) Goods /Supplies
$455 /year x 3 years
$ 1,365
(5) Building Space
$12 /sg foot x 196 sa feet x 3 years $ 7,056
(6) Cash $10,000 /year x 3 years $30,000
TOTAL VALUE 1126,171
'The above donation(s) is not currently included as a cost (either direct or matching) of any state or
federal contract or grant, nor has it/they been previously purchased from or used as match for any
state or federal contract.
Gel G'
(Donor Signature) (:Date) (County Designee Signature} Date)
The grant Review Committee will review the valuation of the donated item(s) and has, in the space
provided, indicated the valuation amount acceptable to the department for use in meeting a match
requirement for the Criminal Justice, Mental Health and Substance Abuse Reinvestment Grant program.
Donated items are subject to disallowance should they be found to be a current or previous cost or
matching item of a state or federal grant or contract. , -1 �
Approved as to form & legal sufficiency
ATTEST:
DWIGHT E SrROCK bletk.
Colleen Greene,
Assistant County Attorney SY,
f swatr�
Collier County 160 6
Criminal Justice, Mental Health and Substance Abuse Reinvestment Grant
Budget
Budget Worksheet
Budget Worksheet Summary
Fundin Cate o
Grant Funds. Re uested:
.`, Mate hin ` unOS and Other
in. Kind, Cgntributl6t
Amount
Amount
Source of Funds
Collier Coun "Housin Human & Veteran Sarvicos'
Salaries:
$0.00
$0.00
Administration:
$18,000.00
$0.00
Equipment:
$0.00
$0.00
Travel:
$0.00
$0.00
Contractual:
$131,730.00
$182,849.00
Partner agencies
Supplies:
$0.00
$0.00
Rent/Utilities:
$0.00
$0.00
Other Expenses:
Enhancements
$33,100.00
$0.00
Housing, medication,
etc
-transportation,
Totals:
$182,830.00
$182,849.00
Total Project Cost:
$365,679.00
Matching Percentage:
100%
Breakdown of Contractual
Fundin Gated
Grant Fund*, uestsd
, , " Matchin "Fu(04aind Othe to Kind Contributions.:y
Contract 1 Dav d'Lawrence
Gunter
Salaries:
1 Case Manager 1.0 FTE
$31,900.00
$0.00
2 MA Counselor 0.50 FTE
$16,500.00
$0.00
3 Forensic Supervisor .3
$0.00
$12,300.00
DLC
4 Clinical Supervision .1
$0.00
$7,200.00
DLC
5 Project Coord /Eval .15
$0.00
$9,750.00
DLC
Fringe Benefits @ 24.71 %
1 Case Manager
$7,636.00
$0.00
2 MA Counselor
$4,077.00
$0.00
Equipment
Travel:
Local travel 2 positions
$1,282.00
$0.00
Supplies:
$455.00
Rent/Utilities:
$0.00
$2,352.00
DLC
Other: Cash
$0.00
$10,000.00
DLC
SubtotaF
$61,196.00
$42,057.00,
D'.
Fundin Cate o -
Grant Funds Requested,,
Matchin =Funds and Other in Kind Contributions,,
Contract 2- CCSO
Salaries:
1 Discharge Planner 1.0
$30,000.00
$0.00
2 D/C Plan Supervisor .15
$0.00
$9,000.00
CCSO
(3) Grant Coord /Mtgs (.05)
$0.00
$2,684.00
CCSO
Page 1 of 2
Collier County 160 6
Criminal Justice, Mental Health and Substance Abuse Reinvestment Grant
Budget
Fringe Benefits 26.04
1 Discharge Planner
$7,812.00
$0.00
Equipment (computer)
$0.00
$0.00
Travel: n/a
$0.00
$0.00
Supplies:
$455.00
$0.00
Rent/Utilities:
$0.00
$2,448.00
CCSO
Other: Cash
$0.00
$10,000.00
CCSO
CIT Training
$76,432.00
CCSO
SubTota%" "
$38 267.00
i ` $100 A 4.00
IBM
7!ndtn
Cate o `
Grant Funds Ra nested
M, tir :' tin ndP` .
'eir In Kind Confri "utltls:.
Contract -3' NAMI
N,
Salaries
1 Peer Counselor 2 .50
$28,000.00
$0.00
2 NAMI Director 0.10
$0.00
$7,500.00
NAMI
Fringe Benefits @ 9.95 %
1 Peer Counselors
$2,786.00
$0.00
Equipment: n/a
$0.00
$0.00
Travel
Local Travel
$1,282.00
$0.00
Supplies: n/a
$0.00
$0.00
RenWtilities
$0.00
$1,728.00
NAMI
Other: Cash
$0.00
$2,500.00
NAMI
S`uGtotal:
" tf 720.00"
Funding. Cat o - :
Qrant Funds Requested .
lWatchintil Funds and Other In Kind Contributions
Contract 4: Ftorida Gulf Coast
University',,
Salaries
1 EdD Coordinator 0.15
$0.00
$11,700.00
FGCU
2 Volunteer/ Interns .60
$0.00
$16,800.00
FGCU
Page 2 of 2