Writable PDF - FY 25.pdf

Is your organization involved in any active litigation? [ ] No[ ] Yes

Is your company currently involved in any mergers or acquisitions? [ ] No[ ] Yes

Have you included all items listed on the required documents checklist? [ ] No[ ] Yes

I hereby certify that to the best of my knowledge all information contained in this proposal is accurate and complete, that this is a valid proposal and that I am legally authorized to sign and to represent this organization.

Signature Date

ATTACHMENT A: PROPOSAL COVER SHEET

Organization Information

Organization Name:

Address:

Website:

Contact Person: Title:

Phone: Email:

Organization Type: [ ] Non-Profit [ ] Government [ ] Private for Profit [ ] Other

Proposal Information

Project Name

Proposed number of enrollments (July 1, 2024 – June 30, 2025)

Total funding amount requested $

Estimated cost per participant $

Additional funds (cash or in-kind) that will support this project $

Organization’s total annual operating budget $

Requested project is % of organization’s total budget

Category

Personnel

Operating Expenses

Travel

Contractual Services

Equipment

Other Direct Cost

ATTACHMENT B: BUDGET

infringement;

5. Entertainment costs;

6. Incentive compensation for employees, as follows: a. That does not involve all sources of funding; b. That is not based on job performance, a written job appraisal or some other documented, measurable criteria; c. That is not available to all employees within the same class; d. That is not part of a defined benefit plan; e. Does not increase an employee’s salary and/or to circumvent payroll limitations;

and/or f. That is not issued pursuant to an agreement or an established plan entered into in good faith between the organization and the employees before the services were rendered.

9. Assets, goods or services for personal use;

10. Interest on borrowed capital/lines of credit;

Funding will not be approved for unallowable costs including, but not limited to:

1. Alcoholic beverages;

2. Bad debts;

3. Contributions and donations to charitable organizations not in support of a defined activity;

4. Defense and prosecution of criminal and civil proceedings, claims, appeals and patent

15. Renovation/remodeling and capital projects;

7. Personal use by employees of organization-furnished automobiles (including transportation to and from work) and other assets;

8. Fines and penalties and interest on fines and penalties;

14. Losses on other awards;

11. Costs of organized fundraising;

12. Costs of investment counsel/management;

13. Lobbying;

This category is reserved for office equipment needed to operate the program.

This category is reserved for expenses that do not meet the existing categories. Some examples of “other” may be: Training Materials needed to implement program, Program

Supplies, Professional Dues/Publications/Subscriptions, Office Supplies, and Food.

This category is reserved for line items for Trainings, Consultants, Legal, and/or

Accounting/Auditing.

Allowable costs include all reasonable direct costs incurred to carry out the activities allowed in the grant award.

Typical direct costs chargeable to this grant source are:

a. Compensation of employees for the time devoted and identified specifically to the project;

b. Cost of materials acquired, consumed, or expended specifically for the purpose of the project;

c. Equipment and other approved fixed assets purchased specifically to carry out the purpose of the project; and/or,

d. Travel expenses incurred specifically to carry out the purpose of the project.

Complete the budget form with narrative explanation of the basis for the cost projection.

Intended use

This category is reserved for staff that would utilize salary and benefits which may include health insurance, taxes, social security. Use salary line item only for salary; place fringe costs on the fringe line item. Salary may only be charged for actual hours worked on the grant project. Fringe may be allocated based on that salary percentage.

This category is reserved for line items associated with costs needed for operating the program.

This category is reserved for line items associated with Mileage (allowable cost is current

IRS mileage rate), Registration Fees, Hotel, and Conferences/Conventions.

24. For fee-for-service contracts, vendor staff vacation, sick leave and other leave time during which services were not provided.

25. Trinkets/promotional/giveaway items (e.g., pens, notepads, hats, mugs, portfolios, t-shirts, coins, gift bags, etc., whether or not they include the Board/program/vendor name and/or logo).

18. Costs of training/technical assistance;

19. Any plaque or item presented to a speaker, official, legislator, vendor, or other person in recognition of service provided with a value in excess of $50;

20. Any expenses relating to the establishment, maintenance or liquidation of foundation or other accounts that the Board utilizes for the purpose of maintaining earned reinvestment and other State funds, to the extent that the Board does not receive prior approval for the expenses;

21. Investment fees and losses;

22. Flex fund expenditures;

23. Gift card expenditures (in any form or format), except for incentives for participants attending meetings/focus groups/forums where:

a. The grentee purchases only the number of gift cards necessary based on the number of participants; b. The grantee does not establish or maintain an inventory of gift cards; and, c. The participants are families and/or children/youth.

17. Food and beverages, except for: a. Those incurred by employees traveling overnight on official business; b. Bulk drinking water for coolers where tap water is not potable; c. Those routine expenses for the operation of a program serving children and youth (e.g., snacks served to children on a regular basis at an out-of-school time program ); d. Meetings/focus groups/forums where the majority of attendees expected are family and/or youth; and/or, e. Special events where the majority of attendees are not Board members or staff or State/local

Agency representatives.

16. Gifts for Board members and/or Board employees;

Proposed Budget Budget Narrative

Grant Funds In-Kind Match Funds Cash Match Total For each line item where a change is proposed , enter below a description of the expense and the calculations that show how the expense was derived.

Organization Name:

Personnel

Salaries

Fringe Costs

Operating Expenses

Communications

Postage

Utilities

Advertising

Office Supplies

Insurance

Rent/Mortgage

Printing/Duplication

Information System Repair/Maintenance

Vehicle Operating (other than Insurance)

Travel

Business Travel

Conferences/Conventions

Contractual Services

Training

Consultant (other than Legal & Accounting/Auditing)

Legal

Accounting/Auditing

Equipment

Office Equipment

Other

Vehicle purchase and lease

Program Supplies

Professional Dues/Publications/Subscriptions

Food

Other (specify)

Other (specify)

TOTAL BUDGET

*Cash is funding that comes from other sources which will support the proposed project.

**In-kind contributions are the value of goods or services to support the project but which do not come from a direct funding source.

DESCRIPTION

ATTACHMENT B: BUDGET

Fiscal Year 2025 Complete this form and include it with your proposal package.

ATTACHMENT C: PERFORMANCE MEASURES

Organization Name:

Performance Measure (Subject to change per state contract)

Numerator and Denominator (NUM/DEM) Your projections

(number)

What/How Much We Do:

Number of referrals received N/A

Number of children who complete assessment N/A

Number of parents/caregivers who enroll in the parenting/attachment workshops

N/A

How Well We Do It:

Number of children who complete the recommended services

NUM: # of children who complete the program

DEN: total # of children who enroll in the program

Number of parents/caregivers who complete parenting/attachment workshops

NUM: # of parents/caregivers who complete the parenting/ attachment workshops

DEN: parents/caregivers who enroll in the parenting/ attachment workshops

Is Anyone Better Off?

Number of children who show improvement as measured by the follow-up assessment

NUM: # of children who show improvement as measured by the follow-up assessment

DEN: # of children who complete the follow-up assessment

Number/percent of parents/caregivers reporting that the services improved behaviors in the child

NUM: # of parents/caregivers reporting that the services improved behaviors in the child

DEN: # of parents/caregivers who complete the survey

Who will be responsible for gathering the evaluation data for your organization?

Describe the process for gathering data for the project.

ATTACHMENT D: REFERENCES

Please list three references from whom you have received a grant and/or for whom you have performed similar work in the last five years.

Reference #1

Company/Organization Name:

Address:

City, State, Zip

Contact Person:

Phone Number:

Email:

Type of Project:

Dates of contract/work performed:

Reference #2

Company/Organization Name:

Address:

City, State, Zip

Contact Person:

Phone Number:

Email:

Reference #3

Company/Organization Name:

Address:

City, State, Zip

Contact Person:

Phone Number:

Email:

ATTACHMENT E: CONFLICT OF INTEREST AFFIDAVIT AND DISCLOSURE

A conflict of interest is a set of circumstances that creates a risk that professional judgement or actions regarding a primary interest will be unduly influenced by a secondary interest. Conflicts of interest, whether real, perceived, or potential, must be disclosed. Disclosure of a potential conflict of interest does not make it an actual conflict and disclosure of an actual conflict of interest does not remove the conflict but allows the Local Management Board to transparently approach and manage the conflict.

A. “Conflict of interest" means that because of activities or relationships with other persons/organizations 1) a person/organization is unable or potentially unable to render impartial assistance or advice to the Local Management Board, or 2) the person's/organization’s objectivity in performing the contract work is or might be otherwise impaired, or 3) a person/organization has an unfair competitive advantage.

B. The bidder warrants that, except as disclosed in D below, there are no relevant facts or circumstances now giving rise or which could, in the future, give rise to a real, perceived or potential conflict of interest.

C. The following facts or circumstances give rise or could in the future give rise to a real, perceived or potential conflict of interest (explain in detail; if none, write N/A):

D. The bidder agrees that if an actual or potential conflict of interest arises after the date of this affidavit, the bidder will immediately make a full disclosure in writing to the Local Management

Board of all relevant facts and circumstances. This disclosure shall include a description of actions which the bidder has taken and proposes to take to avoid, mitigate, or neutralize the actual or potential conflict of interest.

I do solemnly declare and affirm under the penalties of perjury that the contents of this affidavit are true and correct to the best of my knowledge, information and belief.

Signature Date

Print Name and Title

FY23 RFP_Early Childhood ACEs_Performance Form