Beverly Walker, Commissioner
Steve Love, Acting Division Director
Georgia Department of Human Resources Division of Family and Children Services Social Services Section Family Violence Program Two Peachtree Street NW Suite 18-454 Atlanta, GA 30303-3180 (404) 657-3413 FAX (404) 463-0192
TO:Family Violence Agencies
DHR Family Violence Unit Chief
DATE:March 14, 2005
In order to coordinate the processing of our contracts for the coming year, we are asking that, like last year, you submit your information to us in two parts. Please send in the following information by April 4, 2005 at 5:00 p.m. Once the legislative session is complete we will email your cover page, budget forms, etc. for you to complete. As you know, we must wait until the legislature closes to determine the amount of money available for your contracts. By reviewing your current budget needs and your service projections now, it will speed the process for you when you receive the budget packet.
The process for the proposals is pretty much the same as last year. If you have it saved on your computer, it should be easy to update your information.
Please send your:
- Resolutions to enter contract (with agency seal), 5 signed originals with corporate seals (sample attached)
- Certified Assurances, 5 originals (blank form attached)
- List of board members, their phone numbers and addresses (identify officers and their terms, identify law enforcement and list the number of formerly battered, ethnicity breakdown and English spoken as a second language)
- Copy of 501(c)(3)
- Annual corporate registration with the Secretary of State, copy of bill, check or internet confirmation
- Current agency budget
- Year end financial statement
- Most recent 990
- Letters of support from law enforcement
- Documentation of 10% board training for FY2005 (guidelines attached)
- Core Services Projections (the form can be found on your stats program and must be emailed)
All documents and the completed checklist (attached) should be sent by regular mail. Please do not fed-ex or overnight—it will only delay delivery. Please send to:
DHR Family Violence Unit
2 Peachtree Street, NW, 18th Floor
Atlanta, Georgia 30303
All documents should be received no later than 5:00 p.m. on April 4, 2005 with the following exceptions:
If you are not able to get your resolutions and certified assurances in by the April 4th deadline, you can submit the other documents. However, all documents must be received by April 30th to process your contract.
You will find the form for your “Core Services Projections” on your stat program. Click on the “Core Projections” button. Click on the “Instructions” button to display information on how to complete the form. After you have completed the form, send your stats program in the same way you submit your monthly stats but note in the email that you are sending your core projections.
If you have any questions, please contact your consultant.
DHR FY2005 Contract Proposal Attachments
Please include 5 copies of the resolution to enter contract, all with original signatures and the agency’s corporate seal. Include 5 copies of the certified assurances. Include one copy of all other attachments.
___ Copy of latest annual corporation registration with Secretary of State
___ Copy of 501(c) 3
___ Copy of most recent 990
___ Year end statement for last completed fiscal year showing year-to-date expenses and income
___ Resolution to Enter Contract (5 original copies)
___ Certified Assurances (5 copies)
___ Letters of support from local law enforcement
___ Letters of support from local government (for previously unserved counties only)
___ Up-dated list of Board of Directors including phone numbers and mailing addresses; identifying officers and terms; specifying # of formerly battered women; # of ethnic/racial minorities and # of English as a second language members.
__ 10% Board training documentation (FY2005)
__ Core services projections (must be emailed)
- Minimum of 80% of adult victims served are victims of domestic violence.
- Minimum of 25% of the total agency/program budget is from local sources other than state and federal funds.
- To ensure that a minimum of 10% of Contractor board members complete DHR approved family violence training during the contract period. Should this not be met, that agency share of funding will be reduced by 10% during the next contract period.
- To provide required core services for family violence victims and their dependents.
- Safe, confidential shelter staffed 24 hours a day, 7 days per week
- 24-hour crisis line answered by staff or trained individual. Answering machines cannot be used at any time.
- Linkages with community agencies, referrals for supportive services
- Children’s services, structured activities should be available for children
- Emotional support, individual and support groups, which should be led by a trained leader using structured activities and offered at least twice monthly for adult victims. Individual support should be available 24 hours per day. Counseling/support may be provided by the agency or referred out.
- Community education and awareness must be available to address prevention, agency services and referral procedures, dynamics of abuse.
- Legal and social services advocacy
H.Household establishment assistance
I.Follow up services
- To be incorporated as a 501© (3) organization.
- To receive annual written endorsement from local law enforcement agencies.
The ______(Board chairperson, vice chairperson or executive officer) certifies that the information contained in this proposal is true and accurate and can be confirmed by agency records and/or audits and that all of the above certified assurances are met by the agency.
Signature of Board Chairperson, Vice Date
Chairperson or Executive Officer
S A M P L E
DO NOT COMPLETE THIS FORM - IT IS A SAMPLE TO FOLLOW.
ACTUAL RESOLUTION SHOULD BE TYPED ON CORPORATE
RESOLUTION TO ENTER CONTRACT
At the meeting of ______
(regular OR called) (legal name of corporation)
on , the following resolution was presented, seconded, and passed
(unanimously OR by majority vote)
WHEREAS:The desires to
(legal name of corporation)
provide services, and
WHEREAS:Said corporation desires to enter a contractual arrangement with the Georgia Department of Human Resources for the provision of said services; be it therefore
(legal name of corporation)
Agrees to enter a written contract with the Georgia Department of Human Resources, ______, for the provision of ______
services for the period beginning and ending ,
and be it further
RESOLVED,That the ______(President, Vice President, OR Chief Executive Officer)
AND THE are duly authorized to
(Secretary OR Assistant Secretary)
execute said contract on behalf of this corporation.
Certified true and correct
Signature of Corporate SecretaryTyped Name of Corporate Secretary
Typed Name of Corporation
Imprint Seal of Corporation Here