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Backup Documents 06/10/2014 Item #16D5 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO I 0 5 THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNAT Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later than Monday preceding the Board meeting. **NEW** ROUTING SLIP Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office. Route to Addressee(s) (List in routing order) Office Initials Date - L 2. 3. Colleen Greene County Attorney Office C tnn c , Ji 4. BCC Office Board of County bw N Commissioners /6/ 6\kcAVA 5. Minutes and Records Clerk of Court's Office (phi bit PRIMARY CONTACT INFORMATION 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,may need to contact staff for dditional or missing information. Name of Primary Staff Natali Beta ur Phone Number 239-252- 059 Contact/ Department Agenda Date Item was 06/10/14 Agenda Item Number 16D5 Approved by the BCC Type of Document Agreement --VIN)"\\,--c 'C Number of Original 'r∎ ' ac ,l`_. Attached Documents Attached PO number or account kse� c crK/Cts.- number if document is to be recorded \S ` `,J\-.e3,. ,A`-� INSTRUCTIONS & CHECKLIST Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not appropriate. (Initial) Applicable) 1. Does the document require the chairman's original signature? NB 2. Does the document need to be sent to another agency for additional signatures? If yes, NB See""iOkbe_... provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. 3. Original document has been signed/initialed for legal sufficiency. (All documents to be NB signed by the Chairman,with the exception of most letters,must be reviewed and signed by the Office of the County Attorney. 4. All handwritten strike-through and revisions have been initialed by the County Attorney's .N&- rj/iok Office and all other parties except the BCC Chairman and the Clerk to the Board 5. The Chairman's signature line date has been entered as the date of BCC approval of the NB document or the final negotiated contract date whichever is applicable. 6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's NB signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip N.B-- / should be provided to the County Attorney Office at the time the item is input into SIRE. r 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! 8. The document was approved by the BCC on 06/10/14and all changes made during the NB meeting have been incorporated in the attached document. The County Attorney's Office has reviewed the changes,if applicable. 9. Initials of attorney verifying that the attached document is the version approved by the NB BCC,all changes directed by the BCC have been made,and the document is ready for the Chairman's signature. I:Forms/County Forms!BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12 1605 MEMORANDUM Date: June 11, 2014 To: Natali Betancur, Operations Analyst Park & Recreation Department From: Ann Jennejohn, Deputy Clerk Minutes & Records Department Re: An Agreement with the Early Learning Coalition of Southwest Florida for a School Readiness Education Program Attached for further processing is the original agreement referenced above, (Item #16D5) approved by the Board of County Commissioners on Tuesday, June 10, 2014. After the agreement is signed by the Coalition, if you would please provide our office a fully signed copy of the agreement for the Board's Official Record it would be very appreciated. If you have any questions, please contact me at 252-8406. Thank you. Attachment 1605 EARLY LEARNING COALITION OF SOUTHWEST FLORIDA SCHOOL READINESS PROVIDER CONTRACT FOR July 1, 2014 - June 30, 2015 EARLY LEARNING MEMBER OF ASSOCIATION OF EARLY LEARNING COALITIONS COALITION_ I. PARTIES AND TERMS OF CONTRACT 1. This Provider Contract is entered into between the Early Learning Coalition of Southwest Florida (hereinafter referred to as the"Coalition") and the Provider of School Readiness (SR) Program services, Collier County Parks and Recreation enter program name(hereinafter referred to as the"Provider") with its principal offices located at 15000 Livingston Road Naples, FL 34109 to provide school readiness services for the period of July 1st, 2014 to June 30th, 2015. (Designee"refers to the agency the Coalition may contract with to provide specific school readiness services. If there is no designated contracted agency this field will read N/A.) This is a binding Contract between the Provider, as a School Readiness Program vendor, and the Coalition. This Contract holds the Provider responsible for adhering to the standards outlined in this Contract, induding the Coalition Policies and Procedures and the Coalition Plan, which are hereby incorporated by reference into this Contract. PLEASE NOTE:Florida's Office of Early Learning("OEL'9 has issued a public notice of a proposed administrative rule that would mandate the use by all early learning coalitions of a standard statewide form that must be used by early learning coalitions when contracting with School Readiness Program providers. To the extent any such OEL rule mandating the use by early learning coalitions of a form contract with School Readiness Program providers becomes final or OEL takes any other action which results in a mandate upon early learning coalitions to use a statewide form contract when contracting with School Readiness Program providers, the Coalition shall have the right to terminate this Contract upon sixty(60) days written notice to the Provider. This Contract and the obligations here ser -II be terminated as of the day set forth in the notice from the Coalition to the Provider. Provider Initials 2. The Provider certifies that each location at which the Provider offers the SR program meets all of the qualifications and requirements for offering the SR program established by statute, rule, local Coalition Policy and the terms of this Contract at all times the Provider offers the SR program. 3. In the event the Provider has executed this Contract on behalf of multiple SR sites, and fails to ensure compliance with all qualifications and requirements for offering the SR program at one or more locations listed in Attachment A the Coalition may demonstrate termination of this Contract with respect to that location by striking through the location after following the termination processes outlined in this Contract. This Contract will remain in force and effect as to all locations in Attachment A , which are not stricken. 4. This Contract binds the successors, assignees, and legal representatives of the Provider and of any legal entity that succeeds to the obligations of the Coalition. 5. The Contract is not transferable or assignable to another entity, corporation, and owner without the written approval of the Coalition, which approval is within the sole discretion of the Coalition. A change in corporate ownership shall be deemed a transfer, which requires a new contract. 6. This Contract is only valid to provide services at the location(s) listed. ELCSWF 5R-1004 July 1,2014-June 30,2015 1 ()Provider Initials 1605 II. PROGRAM REQUIREMENTS-The Provider agrees to meet the following minimum standards consistent with the requirements and goals of the SR Program. 7. Utilize an Approved Curriculum that supports the implementation of the Florida Performance Standards (CS/118 7165 Sect/on 1002.82(2)(/)Flor/da Statutes). (This does not apply to school-age only programs, caring for children who have attained the age for school entry). The Provider must identify, report, and implement an approved curriculum. The Provider must utilize a curriculum approved by the Coalition or complete a curriculum approval application and submit the curriculum to the Coalition for review. Approval of the curriculum is at the discretion of the Coalition. 8. Utilize a Character Development Program that supports the implementation of the Florida Performance Standards The Provider is encouraged to identify, report, and implement an approved character development program. A Provider may complete a curriculum approval application and submit another character development program to the Coalition for consideration for review. 9. Complete the Program Assessment Process that supports the implementation of SR requirements in. The Provider is encouraged to participate and cooperate in the Program Assessment Process and to correct identified deficiencies in order to remain in compliance with this Contract. 10.Participate in the SR Child Screening Process designed to identify children in need of further evaluation for spec/al needs 6M-4.720,Florida Statutes.The Provider is required to ensure that all children whose care is funded by SR and who have parental consent receive a developmental screening as required by the Coalition. 11.Partidpate in the pre/post SR Child Assessment Process (CS/HB 7165 Section 1002.82 (2)(k) Florida Statutes).The Provider is encouraged to conduct child assessments as identified by the Coalition. 12.Ensure Special Needs children are provided or referred. Provider agrees to coordinate with the Coalition to ensure that children who have family consent and are identified with special needs are referred to the needed therapeutic services in the children's natural environments. 13.Provide parental access and support family involvement(45 CFR 98.31)Florida Statutes). Parents or guardians must be afforded unlimited access to their children in SR Programs and provided with information and activities that involve them in decisions about their child's growth and development, recognizing them as a child's first teacher. 14.Ensure SR Staff meets all professional development requirements(Section 402.305,Florida Statutes). Directors and staff must meet all training and education requirements. III.PROGRAM ELIGIBILITY AND ADMINISTRATION 15.Meet and maintain state and local(if applicable)health and safety requirements in accordance with federal,state,and local requirements,statutes,and rules pursuant to Section 402.301 Florida Statutes) The Provider must comply with all pertinent state and local health and safety requirements, including, but not limited to, background screening, prevention and control of infectious diseases, childhood immunizations, building and physical premises safety, and minimum health and safety training. These requirements for a"healthy and safe environment"are applicable to all SR Providers, including unlicensed or license-exempt Providers. 16.Provide business information and updates of any changes in a timely manner. The Provider must provide program and business information for inclusion in the Child Care Resource and Referral Network and is responsible for ensuring that the Coalition has up-to-date business and contact(including emergency contact) information. The Provider is required to report any changes in contact or program information within 24 hours. Permanent business closings must be reported at least 10 days prior to changes. Temporary emergency closings must be reported immediately. 17.Maintain a working landline or corded telephone.The Provider is required to have a working landline or corded telephone available to make and/or receive phone calls at all times children are in care. S ELCSWF-SR1004 Julyl,2014—June 31,2015 2 Provider Initials 1605 18.Maintain access to a working email address.The Provider is required to provide open and continuous access to an email address and monitor on a weekly basis for sending and receiving communications from the Coalition. Changes to the email address must be reported to the Coalition within 24 hours of change. 19.Maintain records (6M-4.502)The Provider is required to maintain records for audit purposes for five(5)years and allow Coalition staff and/or representatives access to SR records upon request. In the event that the Provider closes its business, SR records must be maintained for five (5)years for future audit purposes. Parents must be given access to their children's records upon request. 20.Allow access to the SR Program and provide records as requested.The Coalition is responsible for monitoring SR Programs compliance with the requirements of this Contract and must be afforded full access to all areas of the Provider's site. SR records may be audited at any time during regular business hours, and the Provider is responsible for notifying the Coalition if records are maintained at a site other than where the SR Program is provided. 21.Comply with state child abuse and neglect reporting requirements. The Provider is responsible for ensuring staff are knowledgeable and follow guidelines relative to child abuse and neglect reporting. If at any time an employee of the Provider is aware of or suspects that child abuse, neglect, or any other event reportable under Section 39.201, Florida Statutes, (incorporated by reference) has occurred, the employee is required to immediately report the known or suspected abuse or neglect to the Abuse Hotline at(800) 962-2873 via the Child Abuse Registry. The Coalition must be notified of any event of this nature directly impacting the child care facility, staff or children in care, within one (1) hour of reporting to the Child Abuse Registry. 22.Report unusual incidents to the Coalition. The Provider is required to report unusual incidents to the Coalition within the same business day of the incident and to submit a written report to the Coalition within three (3) business days. An unusual incident is any event involving the health and safety of children under the Provider's care that may place the Provider or the Coalition at risk of adverse media attention. Examples of unusual incidents include, but are not limited to: accusations of abuse or neglect against the Provider or the Provider's staff; criminal activity on the part of the Provider or the Provider's staff and serious accidents involving children or staff at the Provider's site or on field trips. 23.Ab/de by provisions of the "Rilya Wilson Act'(Sect/on 39.604,Florida Statutes).A Rilya Wilson child is defined as any child receiving school readiness services as a result of an open abuse and neglect case and the child is three (3) years of age to kindergarten entry. The Provider caring for a child in the Protective Supervision Program must immediately(within 24 hours) notify the local designated staff of the Department of Children and Families (DCF)or community-based care agency of any unexcused absence or seven (7) consecutive days of excused absences. IV. CHILD ELIGIBILITY AND ENROLLMENT 24.Enroll children for the SR Program only with written authorization from the Coalition.The Provider must have enrollment authorization, as outlined in the Coalition Policies, prior to being eligible for reimbursement. 25.Mon/tor eligibility status. The Provider is only paid for children eligible and approved for services and is responsible for monitoring the ending date of eligibility identified by the Coalition. 26.Maintain daily sign-/n and sign-out sheets and submit accurate monthly attendance documentation.The Provider is required to document attendance on a daily basis, accurately document absences, and review and submit monthly attendance to the Coalition. 27. Notify the Coalition of child absences(CS/HB 7165 1002.85(8)Florida Statutes)The Provider is required to notify the Coalition of any child with five (5) consecutive days of absence with no contact by the parent. The Provider is also required to notify the Coalition of the tenth (10th) unexcused absence within a month for any SR child. 28.Protect the confldentiallty of child and family information(CS/HB 71651002.97 Florida Statutes).The Provider must have all staff complete confidentiality agreements and have processes in place to protect the privacy of child and family information. Confidential information associated with the SR Program should only be available to the Provider, the parent/guardian, the Coalition or its representative, the Office of Early Learning, and federal agencies as required for audit and research information. GP ELCSWF-SR1004 Julyl,2014—June 31,2015 3 Provider Initials 1605 29. Comply with nondiscrimination policies(45 Code of Federal Regulations 98.46).The Provider may not refuse to admit a child for enrollment or discriminate against a parent or child based solely on the grounds of race, color, national origin, ethnicity, disability, or religion. V. COMPENSATION AND FUNDING 30.Accept the reimbursement rate established and approved by the Coalition.The Provider is paid based on budget availability, the Provider's current rates, family eligibility, and the reimbursement rate established and approved by the Coalition. Rates may differ for individual children. The Provider is required to provide information concerning its published private child care rates and report any changes in their Gold Seal status. The total payment received by the Provider for a child whose care is funded by SR, including any Gold Seal differential, Coalition-approved parent fees, and subsidy shall not exceed the private rate charged by the Provider for a private pay child. 31.Review the Monthly Reimbursement Statement. Provider agrees to review the reimbursement summary provided with the monthly reimbursement statement. Provider agrees to immediately report any discrepancy, overpayment, or underpayment. 32. Collect parent fees.The Provider is responsible for collecting any fee from the parent/guardian that is designated by the Coalition to be paid by the parent/guardian. Designated fees are automatically deducted from the Provider's monthly reimbursement payment. 33. Complete direct deposit paperwork.The Provider is required to establish a method of direct deposit in order to receive payments from the Coalition and follow payment procedures. The Provider is required to submit all required attendance records to the Coalition by noon on the 3rd day of each month. 34.Return of funds.The Provider must follow payment procedures adopted by the Coalition and must agree to return to the Coalition any funds received as a result of error and/or overpayment within the required timelines. 35. Follow ELC holiday and approved closing policies: The Provider is required to follow the Coalition-approved holidays and closings, up to 12 days annually, and understands that reimbursement for these dates only applies to qualified children. 36.Maintain a Continuity of Operations Plan(also known as Disaster Plan).The Provider is required to maintain a plan that identifies the steps to be taken in the event of an emergency or natural disaster that may affect the safety of children and staff. The Coalition will provide compensation for closures due to natural declared disasters as recognized by the Office of Early Learning VI. NON-COMPLIANCE AND TERMINATION 337. Allow Inspections for compliance. The Provider is required to allow access and cooperate with the Coalition or its representatives and Office of Early Learning to inspect and monitor the SR Program in accordance with the Coalition Plan and copy records pertaining to the SR Program during all business hours. 38. Comply with terms of this Contract. Provider agrees the Coalition may require corrective action, withhold funds, or terminate this Contract if the Provider fails to comply with the requirements of federal, state, and local laws, federal regulations, Agency rules, regulations and policies, or this Contract. If Provider refuses delivery of the notification (by any method), the Coalition shall document it and may terminate this Contract. Actions taken under this paragraph are subject to dispute resolution as described in this Contract. See Section VII. 39.Agree to termination due to lack of funding.The Provider and the Coalition recognize that federal and state funding is the primary source of support for the SR Program and that this Contract may be terminated due to lack of funding with 24-hour notice. 40.Agree to termination upon mutual consent. The Provider and the Coalition may agree to terminate this Contract by mutual consent. Written notice of termination must be given and alternative arrangements for uninterrupted services for children served under this Contract shall be made at least 30 calendar days before the termination date. (T.( ELCSWF-SR 1004 Julyl,2014—June 31,2015 4 Provider Initials 16D5 41.Comply with Coalition decisions to terminate. The Provider understands that the Coalition has the right to terminate the Contract at any time for Cause."Cause"is defined as: (a)Action, or lack of action, which threatens or potentially threatens the health, safety or welfare of children; (b)The failure to comply with the terms of the Contract or policies, laws, rules, or regulations referenced therein, or the violation of any laws, rules, or regulations regarding SR promulgated by the State of Florida; (c)Acts of fraud or other forms of misconduct that threaten the integrity of the SR Program or Coalition; and/or(d) any other issue that the Coalition deems inconsistent with Coalition policies. Termination for cause as identified as (a) (Action, or lack of action, which threatens or potentially threatens the health, safety or welfare of children) may be made with 24 hour notice. Termination for other cause(b-d) may be made with 10 days notice. 42 Maintain a child care license. The Coalition may immediately terminate this Contract upon denial, suspension/probation/revocation/termination of Provider's licensure or accreditation or under Provider's ability to legally operate, as applicable. 43.Failure to comply with the terms of the Contract. If a Coalition terminates the Provider's Contract for any reason other than intentional misrepresentation (see #44), the Provider is disqualified from receiving SR funding for a minimum period of 12 months unless otherwise noted by the Coalition in writing. 44. Engaging in misrepresentation. Provider agrees that they shall not use their position as a SR Provider to engage in any activity, or be a party to, any form of deception, misrepresentation, falsification, fraudulent or unlawful behavior in order to affect a personal gain, or the personal gain of any relative, friend or business associate. If after investigation the Provider has intentionally misrepresented enrollment or attendance for funds related to the SR programs, the Coalition shall permanently disengage services of that Provider. VII. DISPUTE RESOLUTION 45.Follow procedures regarding the right to appeal.The Provider has the right to appeal after exhausting all possible contract remedies according to the dispute resolution policies of the Coalition. Rights to appeal and the dispute resolution policies and procedure as incorporated by reference and may be accessed at the Coalition website. 46.Agree to litigation venue. The parties acknowledge that this contract shall be construed and enforced in accordance with the laws of the State of Florida. The parties further agree that any litigation brought arising out of this contract will be brought in Lee County, Florida, and not in any other state or county. VII. INDEMNIFICATION AND INSURANCE 47.Accept/lability for actions of agents,employees,and partners.The Provider is fully liable for the actions of its, agents, employees, partners and shall indemnify, defend, and hold harmless the Coalition, the Office of Early Learning, and their officers, agents, employees and sub-contractors from suits, actions, damages, and costs of every name and description, including reasonable attorneys'fees, arising from or relating to personal injury and damage to real or personal tangible property to the extent caused by the Provider, its agents, employees, partners, sub contractors. If the Provider is a county government, public school, or school district, this paragraph is limited to the extent required by section 768.28, Florida Statutes. 48.Maintain child care liability insurance. . The provider agrees to maintain,throughout the entire period of the Provider contract with the Coalition, appropriate liability insurance pursuant to Section 1002.88(1) and (m). F.S. The Provider must obtain and retain an insurance policy that provides a minimum of$100,000 of coverage per occurrence and a minimum of$300,000 general aggregate coverage. The Provider agrees to furnish to the Coalition written evidence of general liability insurance coverage, including coverage of transportation of children (if SR children are transported by the program.) The office of Early Learning may authorize lower limits than the limits referenced in Section 1002.88(1) and (m). F.S. upon request, as appropriate. The Provider must add the Coalition as a named certificate holder and as an additional insured. The Provider must provide the Coalition with a minimum of 10 calendar days'advance written notice of cancellation of or changes to coverage. An informal Providers may, in lieu of general liability insurance, maintain homeowner's liability insurance and, if applicable, a business rider, as provided in Section 1002.88(m, F.S. 49). The provider agrees to obtain and maintain any required workers'compensation insurance under chapter 440, F.S., and any required re-employment assistance or unemployment compensation coverage under chapter 443, F.S. ELCSWF-SR1004 Julyl,2014—June 31,2015 5 Provider Initials 16135 IX. COALITION RESPONSIBILITIES 49.Adhere to fraud reporting requirements. The Coalition and its representatives are required to report to appropriate agency Law Enforcement Agency for further investigation cases where there is sufficient reason to believe that a Provider has knowingly provided or submitted any fraudulent information. 50.Uphold regulation standards. The Coalition and its representatives will report any identified regulation deficiencies to the appropriate Law Enforcement Agency, local licensing authorities, accrediting bodies, or related state or federal agencies. 51.Support the provision of quality SR services.The Coalition supports all licensed and license-exempt public and private centers, family child care homes and informal child care providers in the provision of quality SR services. The Coalition will provide training, technical assistance, and other means of support to any Provider who would like help in meeting these quality standards as funding is available and according to Coalition Plan priorities. 52.Uphold this Contract. The Coalition and its representatives will monitor compliance of all requirements of this Contract, and contingent upon funding, will provide information and assistance as specified in this Contract. 53. Understand and agree to Coalition's right to monitor. The Provider understands and agrees the Coalition has the right to monitor the Provider's compliance with the Provider Contract, legal requirements and Coalition policies. The Coalition will review the Provider's compliance and evaluate the Provider's past and present performance when considering renewal. X. ADDITIONAL TERMS AND CONDITIONS 54.Severability. If any provision of this Contract is held to be unenforceable by a court of competent jurisdiction, the remaining terms and conditions remain in full force and effect. 55. Contacting the Coalition. The representative for the Coalition or designee for this Contract is Gayla Thompson, Chief Quality Officer Early Learning Coalition of Southwest Florida, Inc. 2675 Winkler Avenue, Suite 300 Fort Myers, Florida 33901 Telephone: 239-935-6189 Email: Gayla.Thompson @elcofswfl.org The representative of the Provider responsible for the administration of the program under this Contract is: Name Jeanine McPherson Address 15000 Livingston Road Naples, FL 34109 Telephone 239-252-4000 Email JeanineMcpherson @colliergov.net In the event that either party designates different representatives after execution of this Contract, notice of the name and contact information of the new representative will be rendered in writing to the other party within 10 business days of change and said notification attached to originals of this Contract. Changes for Providers will require a new application and Contract to be completed within 10 days of the change. ELCSWF-SR1004 Julyl,2014—June 31,2015 6 GQ+ Provider Initials 1605 56.Failure to exercise.The failure of the Coalition to exercise any of its rights or to enforce any of the provisions of this Contract on any occasion shall not be a waiver of such right or provision, nor affect the Coalition's rights thereafter to enforce each and every provision of this Contract. 57.Acting as an Independent contractor. Each party acknowledges that it is acting as an independent contractor. Neither party, nor any of their respective representatives, employees or agents shall be construed to be the agent, employee, servant or representative of the other, and neither party shall have the power and authority to act on behalf of or bind the other party. 58.Execution of Contract.This Contract may be executed in counterparts, each of which shall be deemed an original, but all of which shall constitute one and the same instrument. 59.This Contract constitutes the only Contract, and supersedes all prior Contracts and understandings both written and oral, among the parties with respect to the subject matter herein. All Attachments hereto are a material part of this Contract and are incorporated by reference. This Contract, including any Attachments hereto, may not be amended or modified, except in writing and signed by all parties to this Contract. XI. COMMITMENT OF INTENT The Provider agrees to tell the truth on all information. Provider acknowledges that providing information in order to obtain benefits, payments or reimbursement to which they are not entitled, or to increase the benefits, payments or reimbursements, is unlawful. Provider understands that if they knowingly provide false information, omit requested information, sign inaccurate attendance documents or fail to promptly report changes which could directly affect eligibility as a school readiness provider,the following could occur: (a) Provider may be required to pay back unauthorized payments and/or denied further participation in the program; and (b) Provider may be referred to the Department of Finance, Public Assistance Fraud Division for further investigation. It is understood that by signing this Contract, the Provider acknowledges they are in full compliance with all applicable laws, rules, and policies of the Coalition. The Provider or Provider's authorized representative hereby acknowledges that he/she has read and understands the Provider Contract and that the Provider agrees to comply with the terms and conditions for provision of SR services as provided herein and in any referenced materials and attachments. This Contract is not transferable and non- assignable upon sale or assignment of the Provider's business.SR Services must be provided at the identified address(es). IN WITNESS THEREOF, the parties have caused this 9 page Contract including accompanying Attachment 1 to be executed by their undersigned officials as duly authorized. Tom Heir ing Chairman Name of • :vider(pH.-*print) Title 01111► bA Vol Signature of Provider or Auth•,ip•d Representative Date AST DWIGHT.E.BRCCK, Clerk Provider Social Security or Federal Identification number: Wr� �� /1 11. ign atur• •nly. Gayla Thompson Chief Quality Officer = .pr vcd.as to font and legality Coalition (print name) Title %"o/ Assistant County A • y Signature of Coalition CEO designee Date ELCSWF-SR1004 Julyl,2014-June 31,2015 7 ovider Initials 1605 Attachment 1 GENERAL ASSURANCECER7IFICA7ION The Office of Early Learning and the Coalition are mandated to provide oversight and establish policies for SR funding. Pertinent rules and regulations that SR Providers are required to adhere to under this Contract may be accessed at the following websites and the following are incorporated by reference: Federal Child Care Development Funds Laws(45 Code of Federal Regulations 98): http://www.access.goo.gov/nara/cfr/waisidx 02/45cfr98 02.html CS/HB 7165 From 1001.213 F.S. to 1002.91 F.S. Child Care Licensing Standards and Information (Chapter 402.26-402.319, Florida Statutes; Chapter 65C-22, Florida Administrative Code, for centers and Chapter 65C-20, Florida Administrative Code, for family child care homes), as applicable: http://www.dcf.state.fl.us/childcare//laws.shtml Local Child Care Licensing Standards and Information, as applicable. License exempt programs are expected to comply with all licensing requirements including the use of age appropriate discipline. Rilya Wilson Act(Section 39.604, Florida Statutes) Local Coalition Plan —School Readiness (also referred to as Early Learning) Laws charge the Coalition with development of a local plan to establish priorities and services based on a local needs assessment. An addendum to this Contract may be attached that details the Coalition Plan priorities and services reflecting local needs and resources. The Coalition Plan and its corresponding policies are incorporated by reference. Adult and Child Care Food Program —Providers participating in this program must comply with all provisions: http://www.fns.usda.gov/cnd/Care/Regs-Policy/Regulations.htm ELCSWF-SR1004 Julyl,2014—June 31,2015 8 Provider Initials 605 EARLY LEARNING COALITION ACKNOWLEDGEMENT OF UNDERSTANDING Intentional Program Violation: is defined as a false or misleading action,omission or statement made in order for an Owner or person primarily responsible for the operation of a child care facility/program to qualify as a provider or recipient in the Voluntary Prekindergarten(VPK)and/or School Readiness(SR)Program to receive program benefits or reimbursement. Examples of Intentional Program Violations include,but are not limited to the following: • Providing false or misleading information or withholding information in order to participate or receive payments under the SR/VPK Program; • Concealing information to obtain SR/VPK payments; • Failing to maintain attendance records required for SR/VPK Programs and/or refusing to allow an inspection of those records during business hours; • Falsifying attendance records to reflect higher amounts of time that a child was in care; • Falsifying or altering authorization documents to obtain SR/VPK payments to which he/she is not entitled; • Failing to comply with any repayment plan or to cooperate with the establishment of such plan; or • Failing to cooperate with the Coalition or their designees for purposes of determining compliance with the SR/VPK program requirements. • Assisting or aiding any person in committing any of the above acts. I understand and agree that as an Owner/Director/Principal, I am responsible for any Intentional Program Violation and the reimbursement of any improper payment even if the management of the facility has been delegated to an employee or other agent. I understand and agree that the Coalition or designee has a right to investigate any allegations or concerns of program violations,whether intentional or unintentional,as it relates to my delivery of services and my eligibility as a SR/VPK Provider. I understand and agree that such investigation may include the sharing of information between any federal,state, and/or local agencies relevant to determining my eligibility as a SR/VPK provider such as,but not limited to, Department of Children and Families(DCF),USDA Food Program, Division of Financial Services(DFS)or law enforcement. I further understand that I can be sanctioned by e Coalitio/f program violations warrant. Tom Henning, Chairman _ \■0`,A Printed Name of Person signing and title ignature Date Collier County Parks and Recreation 15000 Livingston Road Naples, 34109 Name of Facility Address,city,zip a,. Approv ' as to form and legality ' /1 III IA/I ATTEST.; Asitit f b&MY'Ati•ri4it's DWIGHT E. BROCK. Clerk By: � a „'� •�. � . eSatt ► r. .1 1605 Attachment A Immokalee Community Park Vendor#:1205W Contact:Annie Alvarez Address:321 North 1st Street Immokalee, FL Phone#:239-252-4449 Email:Anniealvarez(Wcolliergov.net Max Hasse Community Park Vendor#:1262W Contact: Sid Kittila Address: 3390 Golden Gate Blvd. West Naples, FL Phone#: 239-348-7500 Email:Sidkittila @colliergov.net Golden Gate Community Center Vendor#:1153W Contact:Vickie Wilson Address:4701 Golden Gate Pkwy. Naples, FL Phone#:239-252-4180 Email:Vickiewilson@colliergov.net East Naples Community Park Vendor#:1118W Contact: Kathy Topoleski Address:3500 Thomasson Drive Naples, FL Phone#: 239-793-4414 Email:KathvtopoleskiCc@colliergov.net Vineyards Community Park Vendor#:1467W Contact: Laurie Johnson Address: 6231 Arbor Blvd. Naples, FL Phone#: 239-353-9669 Email:Laurieiohnson @colliergov.net 160 ; , .. . • • . . . . .„ ft_ • flp) SCHOOL READINESS CHILD CARE PROVIDER llf *O/N4ttorney 2014-2015 EARN(EARNING COALITION APPLICANT CONTACT INFORMATION AoDlicatiort: Facility Tvoe: (check one) O New Application @Licensed Child Care Facility °Religious Exempt Child Care Facility or Public School program O Updated application @Large Family Child Care Home °Licensed Family Child OAnnual Renewal Care Home °Registered Family Child Care Home °Informal provider ()Private School ()Public School ()Charter School Name of Provider, Corporation or School: East Naples Community Park Business Name (doing business as): Phone: Cell Phone: E-mail: Fax: 239-793-4414 cierrawillis@colliergov.net 239-793-7358 Physical Address: 3500 Thomasson Dr. County:Collier City: Naples Zip Code:34112 Mailing address (if different): Zip Code: Director:Clerra Willis Employer ID number (EIN) or SS#:59-60005580 Ages Served: Capacity: DCF license# or name of accrediting agency if religious exempt - 4-12yrs. 100 C20009927 OCA# - OWNERSHIP INFORMATION Legal Owner: Collier County Board of County Commissioners Address:3299 Tamiami Trait E. City:Naples ZIP Code:34112 Telephone:239-252-4000 Fax:239-252-3602 E-mail: --- FACILITY Days of Operation - Check all that apply: Additional Services: ❑ Monday ❑ Friday ❑ Full day ❑ Weekend Care ❑ Tuesday ❑Saturday ❑ Half day ❑ Night care ❑ Wednesday ❑ Sunday ❑ Drop in care ❑Infant care (0-12 mos) ❑ Thursday ❑ Part time care ❑Toddler (13 - 36 mos) 7:15 ❑ Before School ❑ Transportation Daily OPENING Time ❑ AM ❑PM ❑ After School ❑ Food served Daily CLOSING time 6:00 DAM ❑ PM VPK provider: ❑ Yes ❑ No ELC-SR 1001 2014-15(3 2014) 0 16D5 For Family Child Care Homes - Please list name of substitute(s): CURRICULM Name each Name of Publisher (unless curriculum Check if developmentally designed by the provider or school) curriculum appropriate curriculum designed by used in your programs. provider. A. - B. I I ❑ Does your curriculum include a character development plan? Yes 1 No ❑ If no, describe how you address character development: Gold Seal Accreditation Information; Yes — I am gold seal accredited. Name of Gold Seal accrediting agency: Expiration date: ❑ No — I am NOT gold seal El I'd like more information on how to get accredited. accredited. t,01.91 CERTIFICATION{ I certify that: • I may not discriminate against a parent or child, including the refusal to admit a child for enrollment on the grounds of race, religion, color, ethnicity or national origin. • I understand that in order to receive school readiness funding, I must either be licensed or legally exempt from licensure pursuant to Chapter 402.302 — 319, Florida Statutes. o Developmentally appropriate; o Have a character development plan o Are designed to prepare students for early literacy; o Enhance the age-appropriate progress of students in attaining the performance standards adopted by the Office of Early Learning and the Department of Education; o Prepare students to be ready for school. • I understand that I must maintain a healthy and safe environment for children. • I understand that I must allow access to any parent of a child I have in care. • I understand that I will be required to sign and comply with the School Readiness Provider Agreement. • I understand that I will be monitored for compliance by coalition designated staff. • I have examined this application and,to the best of my knowledge and belief,the information provided is true and correct. • If any of this information changes, I understand that I must submit an updated application that reflects the ch. ges Signature: .i�; 'm a jolt����� Date: \k..v.i-k Print Name: Leo Ochs ' Title: County Manger Please check if applicable rx—i -r Direc4P1. 1941801 fO 'lidooilelsttict Staff Other • ssistant Co my Attorney ELC-5R 1001 2014-15 (3-2014) , 1605 N Holiday List EARLY LEARNING Program Year: 2014-2015 COALITION Early Learning Coalition of Southwest Florida 2675 Winkler Ave, Suite 300, Fort Myers, FL 33901 Provider Name: East Naples Community Park Address: 3500 Thomasson Drive City, State, Zip Code: Naples, FL 34112 Phone Number: 239-793-4414 Each Child Care Provider will be paid for the following holidays. These are days the provider will be closed, but eligible for School Readiness payments. 1. Independence Day: (07/04/14) Friday 2. Labor Day: (09/01/14) Monday 3. Thanksgiving Day: (11/27/14)Thursday 4. Day after Thanksgiving: (11/28/14) Friday 5. Christmas Eve: (12/24/14)Wednesday 6. Christmas Day: (12/25/14)Thursday 7. New Year's Eve: (12/31/14)Wednesday 8. New Year's Day: (01/01/15)Thursday 9. Memorial Day: (05/25/15) Monday In addition, each provider may choose a maximum of three (3) holidays. These are days the provider will be closed, but eligible for School Readiness payments. Please document only the dates that your program will be closed. Please specify the actual age you will be closed. OPTIONAL Holidays you wish to be reimbursed for in addition to the holidays listed above: 1.01/19/15 2. 02/16/15 3. Date Date Date Leo Ochs 1118W Provider's Printed Name Vendor ID it ■ \ ■o\ Provider's Signaturq Date 1LC-SR-1003 3/2015 U,Q' 1605 Child Care Provider EARLY LEARNING Rate Schedule for 2014-2015 COALITION 01 S(0 *INI�T 11(,11111., Early Learning Coalition of Southwest Florida 2675 Winkler Ave, Suite 300, Attn: Reimbursement, Ft. Myers, FL 33901 Provider Name: East Naples Community Park Vendor Number: 1118W Please enter your DAILY rates for full time and part time care for each care level (age)that you intend to serve. These rates will be used for School Readiness reimbursement purposes for the contract year 2014-2015. FT PT Daily Daily Care Level Age Full Time Rates Part Time Rates 6to11hrs 3to6hrs INF Infant Up to 12 months TOD 12 to 23 Toddler months 2YR 24 to 35 2 year old months PR3 36 to 47 3 year old months PR3 36 to 47 3 year old months VPK Wrap Care PR4 48 to 59 4 year old months PR4 48 to 59 4 year old months VPK Wrap Care PR5 60 to 72 5 year old months $21 .60 $16.20 PR5 60 to 72 5 year old months VPK Wrap Care SCH Over 60 School Age months $18.20 $13.65 Signature: �r.r . �� Date: b / . b / t, 4 Printed Name: Leo Ochs 1605 c SCHOOL READINESS CHILD CARE PROVIDER APPLICATION 1 2014-2015 EARLY LEARNING COALITION APPLICANT CONTACT INFORMATION ADDlicatioq: Facility Tvoe: (check one) O New Application @Licensed Child Care Facility °Religious Exempt Child Care Facility or Public School program O Updated application °Large Family Child Care Home °Licensed Family Child © Annual Renewal Care Home °Registered Family Child Care Home °Informal provider °Private School ()Public School °Charter School Name of Provider, Corporation or School: Vine ards Community Park v v Business Name (doing business as): Phone: Cell Phone: E-mail: Fax: 239-353-9669 Physical Address: 6231 Arbor Blvd. W. County:Collier City: Naples Zip Code:34119 Mailing address (if different): Zip Code: Director: Employer ID number (El N) or SS#: Susan Satow 596000558 Ages Served: Capacity: DCF license# or name of accrediting agency if religious exempt - C20009930 4-12yrs. 113 OCA# - OWNERSHIP INFORMATION Legal Owner: Collier County Board of County Commissioners Address:3299 Tamiami Trail E. City:Naples ZIP Code:34112 Telephone:239-252-40001 Fax: E-mail: FACILITY Days of Operation - Check all that apply: Additional Services: ❑ Monday ❑ Friday El Full day ❑ Weekend Care ❑ Tuesday ❑Saturday ❑ Half day ❑ Night care ❑ Wednesday ❑ Sunday ❑ Drop in care ❑Infant care (0-12 mos) ❑ Thursday ❑ Part time care ❑Toddler (13 - 36 mos) 7:15 ❑ Before School ❑ Transportation Daily OPENING Time ❑ AM ❑ PM ❑ After School ❑ Food served Daily CLOSING time 6.00 ❑AM ❑ PM VPK provider: ❑ Yes ❑ No ELC•SR 1001 2014-15(3-2014) 0 1605 For Family Child Care Homes - Please list name of substitute(sl: CURRICULM Name each Name of Publisher (unless curriculum Check if developmentally designed by the provider or school) curriculum appropriate curriculum designed by used in your programs. provider. A. � B. I I ❑ ,. Does your curriculum include a character development plan? Yes ' No ❑ If no, describe how you address character development: Gold Seal Accreditation Information: Yes — I am gold seal accredited. Name of Gold Seal accrediting agency: Expiration date: ❑ No — I am NOT gold seal I'd like more information on how to get accredited. accredited. CERTIFICATION I certify that: • I may not discriminate against a parent or child, including the refusal to admit a child for enrollment on the grounds of race, religion, color, ethnicity or national origin. • I understand that in order to receive school readiness funding, I must either be licensed or legally exempt from licensure pursuant to Chapter 402.302 —319, Florida Statutes. o Developmentally appropriate; o Have a character development plan o Are designed to prepare students for early literacy; o Enhance the age-appropriate progress of students in attaining the performance standards adopted by the Office of Early Learning and the Department of Education; o Prepare students to be ready for school. • I understand that I must maintain a healthy and safe environment for children. • I understand that I must allow access to any parent of a child I have in care. • I understand that I will be required to sign and comply with the School Readiness Provider Agreement. • I understand that I will be monitored for compliance by coalition designated staff. • I have examined this application and,to the best of my knowledge and belief,the information provided is true and correct. • If any of this information changes, I understand that I must submit an updated application that reflects the chap Signature: 7 9 �-p_ Date: ‘=,\, Print Name: Leo Ochs Title: County Manager Approved as to form and legality Please check if applicable n Pr Owner r]Director ❑ ncipal ❑Schesol Distr)c'Staff ❑Other It ff. �1! Assistant Coun Attorney ELC-SR 1001 2019.15(3.2014) CA 1605 0.t.._ firChild Care Provider EARLY LEARNING Rate Schedule for 2014-2015 COALITION Early Learning Coalition of Southwest Florida 2675 Winkler Ave, Suite 300, Attn: Reimbursement, Ft. Myers, FL 33901 Provider Name: Vineyards Community Park Vendor Number: 1467W Please enter your DAILY rates for full time and part time care for each care level (age) that you intend to serve. These rates will be used for School Readiness reimbursement purposes for the contract year 2014-2015. FT PT Qai& Daily Care Level Age Full Time Rates Part Time Rates 6 to 11 hrs 3 to 6 hrs INF Infant Up to 12 months TOD 12 to 23 Toddler months 2YR 24 to 35 2 year old months PR3 36 to 47 3 year old months PR3 36 to 47 3 year old months VPK Wrap Care PR4 48 to 59 4 year old months PR4 48 to 59 4 year old months VPK Wrap Care PR5 60 to 72 5 year old $21 .60 $16.20 months PR5 60 to 72 5 year old months VPK Wrap Care SCH Over 60 School Age months $18.20 $13.65 Signature: Date: L / 1.C, / \A 7 ' Printed Name: Leo Ochs CA, 1605 Holiday List EARLY I[ARMING Program Year 2014-2015 C:OAI I LION Early Learning Coalition of Southwest Florida 2675 Winkler Ave, Suite 300, Fort Myers, FL 33901 Provider Name: Vineyards Community Park Address: 6231 Arbor Blvd. City, State, Zip Code: Naples, FL 34120 Phone Number: 239-353-9669 Each Child Care Provider will be paid for the following holidays. These are days the provider will be closed, but eligible for School Readiness payments. 1. Independence Day: (07/04/14) Friday 2. Labor Day: (09/01/14) Monday 3. Thanksgiving Day: (11/27/14)Thursday 4. Day after Thanksgiving: (11/28/14) Friday 5. Christmas Eve: (12/24/14)Wednesday 6. Christmas Day: (12/25/14)Thursday 7. New Year's Eve: (12/31/14)Wednesday 8. New Year's Day: (01/01/15)Thursday 9. Memorial Day: (05/25/15) Monday In addition, each provider may choose a maximum of three(3) holidays. These are days the provider will be closed, but eligible for School Readiness payments. Please document only the dates that your program will be closed. Please specify the actual datg you will be closed. OPTIONAL Holidays you wish to be reimbursed for in addition to the holidays listed above: 1 01/19/15 2. 02/16/15 3. Date Date Date Leo Ochs 1467W Provider's Printed Name Vendor ID Provider's Signature Date FI C-SR-1003 3/2015 1605 c firSCHOOL READINESS CHILD CARE PROVIDER APPLICATION 2014-2015 EARLY LEARNING COALITION APPLICANT CONTACT INFORMATION I Annlicatioq: Facility Tyne: (check one) I O New Application @Licensed Child Care Facility °Religious Exempt Child Care Facility or Public School program O Updated application °Large Family Child Care Home °Licensed Family Child 0 Annual Renewal Care Home °Registered Family Child Care Home ()Informal provider @Private School 0Public School °Charter School Name of Provider, Corporation or School: Max Hasse Community Park Business Name (doing business as): Phone: Cell Phone: E-mail: Fax: 239-348-7500 239-348-7503 Physical Address:3390 Golden Gate Blvd. West County:Collier City: Naples Zip Code:34116 Mailing address (if different): Zip Code: Director: Melody Zikursh Employer ID number (EIN) or SS#:59-60005580 Ages Served: Capacity: DCF license # or name of accrediting agency if religious exempt - C20006610 4-12yrs. 120 OCA#- OWNERSHIP INFORMATION Legal owner: Collier County Board of County Commissioners Address:3299 Tamiami Trail E. City:Naples ZIP Code:34112 Telephone:239-252-40001 Fax:239-252-3602 E-mail: FACILITY 1 Days of Operation - Check all that apply: Additional Services: ❑ Monday ❑ Friday ❑ Full day ❑ Weekend Care ❑ Tuesday ❑Saturday ❑ Half day ❑ Night care ❑ Wednesday ❑ Sunday ❑ Drop in care ❑Infant care (0-12 mos) ❑ Thursday ❑ Part time care ❑Toddler (13 - 36 mos) 7:15 ❑ Before School ❑ Transportation Daily OPENING Time ❑ AM ❑ PM ❑ After School ❑ Food served Daily CLOSING time 6.00 y DAM ❑ PM VPK provider: 0 Yes ❑ No ELC-SR 1001 2014-15 (3-2014) 7r 1613 5 For Family Child Care Homes - Please list name of substitute(sl: CURRICULM Name each Name of Publisher (unless curriculum Check if developmentally designed by the provider or school) curriculum appropriate curriculum designed by used in your programs. provider. A. ❑ B. I ❑ 1 Does your curriculum include a character development plan? Yes Li i No ❑ If no, describe how you address character development: is Gold Seal Accreditation Information: 0 Yes — I am gold seal accredited. Name of Gold Seal accrediting agency: Expiration date: D No — I am NOT gold seal 0 I'd like more information on how to get accredited. accredited. CERTIFICATION I certify that: • I may not discriminate against a parent or child, including the refusal to admit a child for enrollment on the grounds of race, religion, color, ethnicity or national origin. • I understand that in order to receive school readiness funding, I must either be licensed or legally exempt from licensure pursuant to Chapter 402.302 — 319, Florida Statutes. o Developmentally appropriate; o Have a character development plan o Are designed to prepare students for early literacy; o Enhance the age-appropriate progress of students in attaining the performance standards adopted by the Office of Early Learning and the Department of Education; o Prepare students to be ready for school. • I understand that I must maintain a healthy and safe environment for children. • I understand that I must allow access to any parent of a child I have in care. • I understand that I will be required to sign and comply with the School Readiness Provider Agreement. • I understand that I will be monitored for compliance by coalition designated staff. • I have examined this application and,to the best of my knowledge and belief,the information provided is true and correct. • If any of this information changes, I understand that I must submit an updated application that reflects the c ange . Signature: _ Date: \czA OV4-k Print Name: Leo Ochs Title: County Manager A rove as to form and legaltty Please check if applicable rd Owner n Directory , F'nncipa •Schc5 i District Staff nOther � ' ,)� I Assistant Co my Attorney ELC-SR 1001 2014.15(3.2014) 1605 Holiday List EARLY LEARNING Program Year: 2014-2015 COALITION Early Learning Coalition of Southwest Florida 2675 Winkler Ave, Suite 300, Fort Myers, FL 33901 Provider Name: Max Hasse Community Park Address: 3390 Golden Gate Blvd W City, State, Zip Code: Naples, FL 34120 Phone Number: 239-348-7500 Each Child Care Provider will be paid for the following holidays. These are days the provider will be closed, but eligible for School Readiness payments. 1. Independence Day: (07/04/14) Friday 2. Labor Day: (09/01/14) Monday 3. Thanksgiving Day: (11/27/14)Thursday 4. Day after Thanksgiving: (11/28/14) Friday 5. Christmas Eve: (12/24/14)Wednesday 6. Christmas Day: (12/25/14)Thursday 7. New Year's Eve: (12/31/14)Wednesday 8. New Year's Day: (01/01/15)Thursday 9. Memorial Day: (05/25/15) Monday In addition, each provider may choose a maximum of three(3) holidays. These are days the provider will be closed, but eligible for School Readiness payments. Please document only the dates,that your program will be closed. Please specify the actual Agfg you will be closed. OPTIONAL Holidays you wish to be reimbursed forin addition to the holidays listed above: 1.01/19/15 2. 02/16/15 3. Date Date Date Leo Ochs 1262W Provider's Printed Name Vendor ID ;� ' OtAVAIllita VC'\.�L\ Provider's Signature Date 1LC-SR-1003 3/2015 16D5 Child Care Provider EARLY LEARNING Rate Schedule for 2014-2015 COALITION Early Learning Coalition of Southwest Florida 2675 Winkler Ave, Suite 300, Attn: Reimbursement, Ft. Myers, FL 33901 Provider Name: Max Hasse Community Park Vendor Number: 1262W Please enter your DAILY rates for full time and part time care for each care level (age)that you intend to serve. These rates will be used for School Readiness reimbursement purposes for the contract year 2014-2015. FT PT Daily Daily Care Level Age Full Time Rates Part Time Rates 6 to 11 hrs 3 to 6 hrs INF Infant Up to 12 months TOD 12 to 23 Toddler months 2YR 24 to 35 2 year old months PR3 36 to 47 3 year old months PR3 36 to 47 3 year old months VPK Wrap Care PR4 48 to 59 4 year old months PR4 48 to 59 4 year old months VPK Wrap Care PR5 60 to 72 5 year old months $21 .60 $16.20 PR5 60 to 72 5 year old months VPK Wrap Care SCH Over 60 School Age months $18.20 $13.65 Signature: c Date: / O / l A Printed Name: Leo Ochs CP 16D5 SCHOOL READINESS CHILD CARE PROVIDER APPLICATION 2014-2015 EARLY LEARNING COALITION APPLICANT CONTACT INFORMATION Aoolicatiorl: Facility Tvoe: (check one) O New Application ()Licensed Child Care Facility °Religious Exempt Child Care Facility or Public School program O Updated application °Large Family Child Care Home ()Licensed Family Child OAnnual Renewal Care Home °Registered Family Child Care Home °Informal provider °Private School °Public School °Charter School Name of Provider, Corporation or School:Golden Gate Community Center Business Name (doing business as): Phone: Cell Phone: E-mail: Fax: 239-252-4180 239-793-7358 Physical Address:4701 Golden Gate Parkway county:Collier City:Naples Zip Code:34116 Mailing address (if different): Zip Code: Director:Julie Allen Employer ID number (EIN) or SS#:59-60005580 Ages Served: Capacity: DCF license # or name of accrediting agency if 4-12yrs. 105 religious exempt - C20009928 OCA# - 08086326Z OWNERSHIP INFORMATION Legal Owner: Collier County Board of County Commissioners Address:3299 Tamiami Trail E. City:Naples ZIP Code:34112 Telephone:239-252-40001 Fax:239-252-3602 E-mail: FACILITY Days of Operation - Check all that apply: Additional Services: ❑ Monday ❑ Friday ❑ Full day ❑ Weekend Care ❑ Tuesday ❑Saturday ❑ Half day ❑ Night care ❑ Wednesday ❑ Sunday ❑ Drop in care ❑Infant care (0-12 mos) ❑ Thursday [' Part time care ❑Toddler (13 - 36 mos) 7:15 ❑ Before School ❑ Transportation Daily OPENING Time ❑ AM ❑PM ❑ After School ❑ Food served Daily CLOSING time 6.00 ❑AM ❑ PM VPK provider: ❑ Yes ❑ No ELC-SR 1001 2014-15(3-2014) 1605 For Family Child Care Homes - Please list name of substitute(s): CURRICULM Name each Name of Publisher (unless curriculum Check if developmentally designed by the provider or school) curriculum appropriate curriculum designed by 1 used in your programs. provider. A. I I ❑ ,1 B. I I o Does your curriculum include a character development plan? Yes No D 1 If no, describe how you address character development: Gold Seal Accreditation Information: Yes — I am gold seal accredited. Name of Gold Seal accrediting agency: Expiration date: No — I am NOT gold seal Ei I'd like more information on how to get accredited. accredited. CERTIFICATION. I certify that: • I may not discriminate against a parent or child, including the refusal to admit a child for enrollment on the grounds of race, religion, color, ethnicity or national origin. • I understand that in order to receive school readiness funding, I must either be licensed or legally exempt from licensure pursuant to Chapter 402.302 —319, Florida Statutes. o Developmentally appropriate; o Have a character development plan o Are designed to prepare students for early literacy; o Enhance the age-appropriate progress of students in attaining the performance standards adopted by the Office of Early Learning and the Department of Education; o Prepare students to be ready for school. • I understand that I must maintain a healthy and safe environment for children. • I understand that I must allow access to any parent of a child I have in care. • I understand that I will be required to sign and comply with the School Readiness Provider Agreement. • I understand that I will be monitored for compliance by coalition designated staff. • I have examined this application and,to the best of my knowledge and belief,the information provided is true and correct. • If any of this information changes, I understand that I must submit an updated application that reflects the changes,.... / f Signature: _, � Date: k , Print Name: Leo Ochs Title: County Manager A .roved as to f and legality Please check if applicable n Owner fl Director n Principal n Sca►of L'strict SQtaf •Dmer Assistant Co my Attorney E1C-511 1001 2014.15(3-2014) ibv s 1 0 5 Child Care Provider EARLY LEARNING Rate Schedule for 2014-2015 COALITION Ilf LI1 '.t•111{ I IIt14 vt1A Early Learning Coalition of Southwest Florida 2675 Winkler Ave, Suite 300, Attn: Reimbursement, Ft. Myers, FL 33901 Provider Name: Golden Gate Community Center Vendor Number: 1153W Please enter your DAILY, rates for full time and part time care for each care level (age)that you intend to serve. These rates will be used for School Readiness reimbursement purposes for the contract year 2014-2015. FT PT Da t Daily Care Level Age Full Time Rates Part Time Rates 6 to 11 hrs 3 to 6 hrs INF Infant Up to 12 months TOD 12 to 23 Toddler months 2YR 24 to 35 2 year old months PR3 36 to 47 3 year old months PR3 36 to 47 3 year old months VPK Wrap Care PR4 48 to 59 4 year old months PR4 48 to 59 4 year old months VPK Wrap Care PR5 60 to 72 5 year old months $21 .60 $16.20 PR5 60 to 72 5 year old months VPK Wrap Care SCH Over 60 School Age months $18.20 $13.65 Signature: Date: c / \0 / 1i-k Printed Name: Leo Ochs GP 1605 -.,. Holiday List EARLY LEARNING Program Year: 2014-2015 COALITION fl.illlll Early Learning Coalition of Southwest Florida 2675 Winkler Ave, Suite 300, Fort Myers, FL 33901 Provider Name: Golden Gate Community Center Address: 4704 Golden Gate Parkway City, State, Zip Code: Naples, FL 34116 Phone Number: 239-252-4180 Each Child Care Provider will be paid for the following holidays. These are days the provider will be closed, but eligible for School Readiness payments. 1. Independence Day: (07/04/14) Friday 2. Labor Day: (09/01/14) Monday 3. Thanksgiving Day: (11/27/14)Thursday 4. Day after Thanksgiving: (11/28/14) Friday 5. Christmas Eve: (12/24/14)Wednesday 6. Christmas Day: (12/25/14)Thursday 7. New Year's Eve: (12/31/14)Wednesday 8. New Year's Day: (01/01/15)Thursday 9. Memorial Day: (05/25/15) Monday In addition, each provider may choose a maximum of three(3) holidays. These are days the provider will be closed, but eligible for School Readiness payments. Please document only the dates,that your program will be closet(. Please specify the actual gisitg you will be closed. OPTIONAL Holidays you wish to be reimbursed for in addition to the holidays listed above: 1.01/19/15 2. 02/16/15 3. Date Date Date Leo Ochs 1153W Provider's Printed Name Vendor ID Provider's Signature Date 11(7-SR-IOW 3/2015 C;)) 1605 .. c OP SCHOOL READINESS CHILD CARE PROVIDER APPLICATION 2014-2015 EARLY LEARNING COALITION APPLICANT CONTACT INFORMATION Annlicatior>l: Facility Tyne: (check one) O New Application @Licensed Child Care Facility ()Religious Exempt Child Care Facility or Public School program O Updated application ()Large Family Child Care Home @Licensed Family Child 0 Annual Renewal Care Home °Registered Family Child Care Home °Informal provider I ()Private School 0 Public School ()Charter School Name of Provider, Corporation or school Immokalee Community Park Business Name (doing business as): Phone: Cell Phone: E-mail: Fax: 239-252-4449 239-580-9120 Ieonormontelongo@colliergov.net 239-657-5511 Physical Address:321 N. 1st Street County:Collier City: Immokalee Zip code:34142 Mailing address (if different): Zip Code: Director:Leonor Montelongo Employer ID number (EIN) or SS#:596000558 Ages Served: Capacity: DCF license #or name of accrediting agency if religious exempt - C20008163 4-12yrs. 135 OCA# - OWNERSHIP INFORMATION Legal Owner: Collier County Board of County Commissioners Address:3299 Tamiami Trail E. City:Naples ZIP Code:34112 Telephone:239-252-40001 Fax: E-mail: FACILITY Days of Operation - Check all that apply: Additional Services: ❑ Monday ❑ Friday ❑ Full day ❑ Weekend Care ❑ Tuesday ❑Saturday ❑ Half day ❑ Night care ❑ Wednesday ❑ Sunday ❑ Drop in care ['Infant care (0-12 mos) ❑ Thursday ❑ Part time care ['Toddler (13 - 36 mos) 7:15 ❑ Before School ❑ Transportation Daily OPENING Time ❑ AM ❑ PM ❑ After School ❑ Food served Daily CLOSING time 6.00 ❑AM ❑ PM VPK provider: ❑ Yes ❑ No ELC-SR 1001 2014-15(3-2014) 7 1605 For Family Child Care Homes - Please list name of substitute(s): 4 CURRICULM Name each Name of Publisher (unless curriculum Check if developmentally designed by the provider or school) curriculum appropriate curriculum designed by used in your programs. provider. A. I I ❑ El jDoes your curriculum include a character development plan? Yes t No ❑ If no, describe how you address character development: Gold Seal Accreditation Information: Yes — I am gold seal accredited. Name of Gold Seal accrediting agency: Expiration date: p No — I am NOT gold seal ❑ I'd like more information on how to get accredited. accredited. CERTIFICATION I certify that: • I may not discriminate against a parent or child, including the refusal to admit a child for enrollment on the grounds of race, religion, color, ethnicity or national origin. • I understand that in order to receive school readiness funding, I must either be licensed or legally exempt from licensure pursuant to Chapter 402.302 — 319, Florida Statutes. o Developmentally appropriate; o Have a character development plan o Are designed to prepare students for early literacy; o Enhance the age-appropriate progress of students in attaining the performance standards adopted by the Office of Early Learning and the Department of Education; o Prepare students to be ready for school. • I understand that I must maintain a healthy and safe environment for children. • I understand that I must allow access to any parent of a child I have in care. • I understand that I will be required to sign and comply with the School Readiness Provider Agreement. • I understand that I will be monitored for compliance by coalition designated staff. • I have examined this application and, to the best of my knowledge and belief,the information provided is true and correct. • If any of this information changes, I understand that I must submit an updated application that reflects the c anges. Signature: Date: l 10\,144 Print Name: Leo Ochs Title: County Manager A•'roved a to form I aliW Please check if applicable n Owner Director n Pri •ai 1wbch•1il District tatf DOther " N,t! i • Assistant Co ty Attorney ELC-SR 1001 2014-15(3-2014) 1605 Holiday List EARLY LEARNING Program Year: 2014-2015 COALITION Early Learning Coalition of Southwest Florida 2675 Winkler Ave, Suite 300, Fort Myers, FL 33901 Provider Name: Immokalee Community Park Address: 321 North 1st Street City, State, Zip Code: Immokalee, FL 34142 Phone Number: 239-252-4449 Each Child Care Provider will be paid for the following holidays. These are days the provider will be closed, but eligible for School Readiness payments. 1. Independence Day: (07/04/14) Friday 2. Labor Day: (09/01/14) Monday 3. Thanksgiving Day: (11/27/14)Thursday 4. Day after Thanksgiving: (11/28/14) Friday 5. Christmas Eve: (12/24/14)Wednesday 6. Christmas Day: (12/25/14)Thursday 7. New Year's Eve: (12/31/14)Wednesday 8. New Year's Day: (01/01/15)Thursday 9. Memorial Day: (05/25/15) Monday In addition, each provider may choose a maximum of three (3) holidays. These are days the provider will be closed, but eligible for School Readiness payments. Please document only the dates that your program will be closed. Please specify the actual you will be closed. OPTIONAL Holidays you wish to be reimbursed for in addition to the holidays listed above: 1.01/19/15 2. 02/16/15 3. Date Date Date Leo Ochs 1205W Provider's Printed Name Vendor ID Provider's Signature Date it C-SR-1003 3/2015 1605 Child Care Provider, EARLY LEARNING Rate Schedule for 2014-2015 COALITION Early Learning Coalition of Southwest Florida 2675 Winkler Ave, Suite 300, Attn: Reimbursement, Ft. Myers, FL 33901 Provider Name: Immokalee Community Park Vendor Number: 1205W Please enter your DAILY rates for full time and part time care for each care level (age)that you intend to serve. These rates will be used for School Readiness reimbursement purposes for the contract year 2014-2015. FT PT Daily J2�iix Care Level Age Full Time Rates Part Time Rates 6 to 11 hrs 3 to 6 hrs INF Infant Up to 12 months TOD 12 to 23 Toddler months 2YR 24 to 35 2 year old months PR3 36 to 47 3 year old months PR3 36 to 47 3 year old months VPK Wrap Care PR4 48 to 59 4 year old months PR4 48 to 59 4 year old months VPK Wrap Care PR5 60 to 72 5 year old months $21 .60 $16.20 PR5 60 to 72 5 year old months VPK Wrap Care SCH Over 60 School Age months $18.20 $1 3.65 Signature: - — /� Date: (v / o / Printed Name: Leo Ochs