Orange County/City of Orlando
Citizens’ Review Panel (CRP)
Funding Proposal
fy: 2014-2015
COVER SHEET & AUTHORIZATION PAGE
Legal Name of Agency:DBA:
Mailing Address:
CEO/President: / Email:
Telephone: / Fax:
Contact Person: / Title:
Telephone: / Email:
Agency Fiscal Year: (mm– mm) / Website:
Funding Panel: / Panel 4 – Supporting Our Seniors
Request for Proposal: / Health & Recreational Programming for Seniors
Authorization
Our signatures certify that to the best of our knowledge the information contained in this proposal is accurate, complete and consistent with our organization’s Mission, Articles of Incorporation and Bylaws and that we have the legal authority to sign below.Chief Volunteer Officer (type or print)
/ Chief Professional Officer (type or print)Chief Volunteer Officer (sign in blue ink) / Chief Professional Officer (sign in blue ink)
Date / Date
Florida has a very broad public records law. As a result, upon request, unless otherwise exempt, any written communication created or received by Orange County and/or the City of Orlando officials and employees will be made available to the public and media. Furthermore, under Florida law, email addresses are public records.
INDEX
Proposal Section / Page #Cover Sheet & Authorization Page
Index
Supporting Documents Checklist
Summary of Funding Request
Agency Overview
Board Governance and Structure
Employee Structure and Compensation
Agency Revenue Comparison
Agency Expenditure Comparison
Agency Budget Explanation
Program Overview – RFP – Health & Recreational Programming for Services
Program Specific Information
Program Demographics
Program Geographic Data
Program Outcomes
Program Revenue Comparison
Program Expenditure Comparison
Program Expenditure Detail
Program Budget Explanation: Orange County– CRP
SUPPORTING DOCUMENTS CHECKLIST
Instructions: In the order listed below, attach the following items to the original and each copy of the proposal. Place an “X” in all boxes indicating included or not included.
/Included
/ /Not
Included
1. 501 (C)(3) Determination Letter from the IRS2. Current Bylaws
3. Audited Financial Statement with Management Letter* (Most Recent)
4. Agency Audited Management Letter for Audit Submitted or Letter from the Auditor stating no Management Letter was issued.
5. Agency’s Response to the Audited Management Letter (if applicable)
6. IRS Form 990 (Most Recent)
7. Any correspondence received from the Internal Revenue Service since January 1, 2012
8. Organization Chart
9. Annual Report
10. Discrimination/EEO Policy
11. Insurance Certificate and Endorsements**
12. Licenses and Certificates
13. Strategic Plan/Planning Document
14. Americans With Disabilities Act (ADA) Policy
15. Letters of Partnerships & Collaborations or Memorandums of Understanding (MOU) from agency partners listed in the Agency Overview Section of the funding proposal.
Please answer the questions below and provide a detailed explanation where necessary.
1. Provide an explanation for any requested documents not attached.
Yes / No2. Is your agency (local chapter) involved in any pending litigation?
(If yes, please explain) (Please use additional sheets of paper if needed)
* Agencies must comply with OMB Circular A-133 Audits of Institutions of Higher Learning.
** Insurance carriers furnishing coverage must be authorized to do business in the State of Florida, and must possess a minimum, current rating of A- Class VIII in the most recent edition of “Best Key Rating Guide”. Insurance Certificates must have all applicable endorsements required by funder.
SUMMARY OF FUNDING REQUEST
ORANGE COUNTY REQUEST FOR PROPOSAL (RFP) ALLOCATION SUMMARY
For any agency applying for funding through the Orange County RFP Process please list if applicable, current and proposed funding amounts in Orange County’s fiscal year (October – September). Note: Table is an embedded spreadsheet with formulas, double click to activate, and then enter information. Calculations are automated. When completed, click outside the spreadsheet to deactivate.
AGENCY OVERVIEW
1. Agency’s History and Mission Statement: Provide a brief agency history and mission statement that includes agency’s goals and objectives. (Not to exceed 1 page)
2. Agency Affiliation: Is your agency a part of a larger organization? If yes, please explain your affiliation. Include information regarding operational oversight, dues, etc.
3. Major Agency Activities and Accomplishments during the Past Year: Provide information on major activities such as special events and agency/program achievements. (Not to exceed ½ page)
4. Major Changes during the Past Year: Provide information regarding any major changes that your agency has experienced during the past year (e.g., Board or Staff Changes, Mergers, Location, Policy). (Not to exceed ½ page)
5. Agency Partnerships and/or Collaborations: List any organizations with which your agency has partnerships and/or collaborations. Place an asterisk (*) next to the partners pertaining to this funding proposal. Attach letters of partnership and/or memorandum of agreements (MOU) on partner’s letterhead, from each partner at the end of the funding proposal in the order as listed on the Support Documentation Checklist. (Not to exceed ½ page)
BOARD GOVERNANCE AND STRUCTURE
Please answer the following questions for your last completed fiscal year (12 months) according to your agency’s bylaws.
1. Board Structure:
a) How many total available Board slots does your agency have?b) How many currently seated Board Members does your agency have?
c) How many Board meetings were held during the past year?
d) What is the percentage of Board attendance for the past year?
2. Board Governance Structure:
a) According to your agency’s bylaws, describe the attendance guidelines and requirements for Board and committee meetings.
b) List your Board’s subcommittees, including the responsibilities of each committee and how many times each committee meets per year.
c) What are your agency’s diversity goals for the Board?
d) Discuss any changes/resignation of Board members during the last year that were not related to term expiration.
3. Board’s Role & Responsibilities: Please describe the Board’s role in supervising fiscal matters of the agency.
4. Advisory Board:
a) Does your agency have an Advisory Board? If yes, please answer questions b-f. / Yes / Nob) Describe the role of the Advisory Board.
c) How many current Advisory Board Members does your agency have?
d) How many available Advisory Board slots does your agency have?
e) How many Advisory Board meetings were held during the past year?
f) What is the percentage of Advisory Board attendance during the past year?
4
BOARD INFORMATION FORM
Provide a breakdown of the membership of your organization’s current Board of Directors.
EXECUTIVE COMMITTEEName / Board Position / Business Affiliation
& Title / Mailing Address / Phone &
Email / Areas of
Expertise / Gender / Race/
Ethnicity / # of Continuous Years on Board / Current Term
Expiration
MEMBERS AT-LARGE
Name / Board Position / Business Affiliation
& Title / Areas of
Expertise / Gender / Race/
Ethnicity / # of Continuous Years on Board / Current Term
Expiration
4
EMPLOYEE STRUCTURE AND COMPENSATION
Using the chart below, provide a breakdown of employee compensation for all current agency employees. Salary information should NOT reflect benefits, taxes, or other employee related expenditures. Note: Table is an embedded spreadsheet with formulas, double click to activate, and then enter information. Calculations are automated. When completed, click outside the spreadsheet to deactivate.
Definition of Employee Groups: (Please provide definitions if your agency defines the categories differently.)
· Upper Management – CEO, President, Executive Director, Vice President, Director
· Middle Management – Senior Manager, Manager, Other
· Support Staff – Administrative Assistant, Clerical
· Direct Service – Counselors, Childcare Providers, any staff working directly with clients/customers
· Other Employee group not listed above (please define): ______
1. Does your agency currently have leased employees? If yes, please provide information about your leased employees. Include the name of the leasing company, positions, and total salaries of the group employees (Do not exceed ½ page).
Agency Budget
Review
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Insert
Agency Revenue Comparison Budget
Spreadsheet Here
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Agency Expenditure Comparison Budget Spreadsheet Here
AGENCY BUDGET EXPLANATION
Using the submitted Agency Revenue Comparison and Expenditure Comparison budget spreadsheets as a reference, please answer the questions below. Budgets should only reflect the organization’s operating budget. Below-the-line resources such as in-kind goods and/or services should not be included in the budget. Note: Table is an embedded spreadsheet with formulas, double click to activate, and then enter information. Calculations are automated. When completed, click outside the spreadsheet to deactivate.
1. Total Agency Budget: In agency’s fiscal year, complete the table below.
*Percentage of administrative and fundraising costs as reported in most recent IRS Form 990.
2. Percentage of Administrative and Fundraising Costs More Than 25%: If the percentage of administrative and fundraising costs is more than 25% of your agency’s budget for the Current and/or Proposed fiscal years, provide a breakdown of all included expenses and your plan to lower costs in the future for each year. (Do not exceed ½ page)
3. Agency Fundraising Activities: List and describe fundraising efforts for Past (FYE ‘13), Current (FYE ‘14) and Proposed (FYE ‘15) fiscal years. Include actual costs compared to the net funds raised for each activity. (Not to exceed 1 page)
4. Agency Reserves: Answer the following questions about your agency’s funding reserve.
a) Does your agency currently have a funding reserve?
b) If yes, what is the balance of your agency’s funding reserve?
c) How does your agency fund the funding reserve?
d) Provide your agency’s guidelines for utilizing funds in the funding reserve.
e) If your agency does not have a funding reserve, what is your agency’s contingency plan in the event there is a shortfall in operational funding?
5. Percentage of Funding: What percentage of the agency’s total revenue is currently funded by:
Orange County – CRP / %City of Orlando – CRP / %
Other / %
Total (should equal 100%) / %
6. Professional Fees/Outside Consultants: Provide a breakdown of all costs included in the line item, Professional Fees/Outside Consultants, reflected on the Agency Expenditure Comparison budget spreadsheet.
7. Budget Variances: Using the submitted Agency Revenue Comparison and Expenditure Comparison budget spreadsheets as a reference, please explain any significant variances in the agency’s budget (losses and/or gains) which equal 15% and greater or at least $5,000 for each line item.
a) Historical Budgeted (FYE ’13) vs. Historical Actual (FYE ’13)
b) Historical Actual (FYE ’13) vs. Current (FYE ’14)
c) Current (FYE ’14) vs. Proposed (FYE ’15)
8. Explanation of Surplus/Deficits: What is your agency’s procedure for handling a surplus or deficit for your agency’s total budget? (Do not exceed ½ page)
9. Using the submitted Agency Revenue Comparison and Expenditure Comparison budget spreadsheets as a reference, please provide an explanation for any surpluses or deficits for your agency’s total budget:
a) Historical Actual (FYE ’13)
b) Current (FYE ’14)
c) Proposed (FYE ’15)
10. Miscellaneous Expenses: If you reported or proposed miscellaneous expenditures which equal 15% or more of the agency’s budget or at least $5,000 on the Agency Expenditure Comparison budget spreadsheet, list and explain specific expenses including dollar amounts.
a) Historical Actual (FYE ’13)
b) Current (FYE ’14)
c) Proposed (FYE ’15)
11. In-Kind Donations: Please provide the amount and description of all in-kind donations reflected on the Agency Revenue Comparison budget spreadsheet.
a) Historical Actual (FYE ’13)
b) Current (FYE ’14)
c) Proposed (FYE ’15)
12. Leveraging: Provide a breakdown of all matching dollars received for all agency revenue.
Funder & Amount of Funding / Match Source / Amount of Match per Dollar / Total Amount of Matched Dollars / Terms & Time Period of MatchIndividual Program
Information
Note: In this section, the program is defined as the request for proposal for which your agency is applying.
Name of Program/RPF:
PROGRAM OVERVIEW
In this section, the program is defined as the request for proposal for which your agency is applying.
1. Brief Program Description: Please provide a brief description of the program. (Not to exceed 50 words)
2. Program Detailed Description and Design: Please provide a detailed description of the program, including the main purpose of the program; types of services provided; agency’s history and experience providing these services; the need for the program; geographic area to be served; partnership with other agencies to provide the program; participant goals and objectives; targeted groups to be served; staffing plan. Please include any data you are using to support that the requested need exists in Orange County. (e.g., agency data, survey information, needs assessment data, other secondary data sources, etc.) (Not to exceed 2 pages)
3. Success Story: Please provide a short program success story from the program’s last fiscal year. (Not to exceed 1 page)
PROGRAM SPECIFIC INFORMATION
1. Cost Efficiency/Return on Investment: Describe the program’s cost efficiency and return on investment to the community. Include cost of services and measurable benefits to the community. (Not to exceed 1 page)
2. Community Support: Describe the current community support for the program. List type of support and how it is provided. (Not to exceed ½ page)
3. Outreach Plan: Describe the outreach plan for the program and strategies used to engage target population. Include how participants are identified, engaged, and retained. (Not to exceed ½ page)
4. Program Changes: If this program has previously received funding, list any significant changes to the program during the past year. Include demographics, staffing, locations, hours, etc. (Do not exceed ½ page)
5. Volunteer Usage: Answer the following questions regarding your program’s use of volunteers.
a) How are volunteers utilized to support this program? Explain your program’s strategy for recruitment, orientation, and training of volunteers.
b) List all background checks and screenings necessary for each volunteer position in your program. Include whether you are currently in compliance with each background check or screening requirement listed.
PROGRAM DEMOGRAPHICS
Orange County Demographic Information
1. Provide the following information about all unduplicated clients served by this program from October 1, 2012 to September 30, 2013. Only include information for clients funded by Orange County.