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Home My WebLink About2000-216 Grant - RV Manor CITY OF ASHLAND FINANCIAL ASSISTANCE AWARD CONTRACT CITY: CITY OF ASHLAND 20 E Main Street Ashland OR 97520 (541) 488-5300 FAX: (541) 488-5311 GRANTEE: Rogue Valley Manor Community Services Address: 1700 Barnett Road Medford, OR 97504 Telephone: 541-779-5257. Date of this agreement: July 1, 1999 Amount of grant: $3,220 Budget subcommittee: Social Services Contract made the date specified above between the City of Ashland and Grantee named above. RECITAL: City has reviewed Grantee's application for a grant and has determined that the request merits funding and the purpose for which the grant is awarded serveS a public purpose. City and Grantee agree: 1. Amount of Grant. Subject to the terms and conditions of this contract and in reliance upon Grantee's approved application, the City agrees to provide funds in the amount specified above. 2. Use of Grant Funds. The use of grant funds are expressly limited tothe activities in the grant application with modifications, if any, made by the budget subcommittee designated above. 3. Unexpended Funds. Any grant funds held by the Grantee remaining after the purpose for which the grant is awarded or this contract is terminated shall be returned to the City within 30 days of completion or termination. 4. Financial Records and Inspection. Grantee shall maintain a complete set of books and records relating to the purpose for which the grant was awarded in accordance with generally accepted accounting principles. Grantee gives the City and any authorized representative of the City access to and the right to examine all books, records, papers or documents relating to the use of grant funds. 5. Default. If Grantee fails to perform or observe any of the covenants or agreements contained in this contract or fails to expend the grant funds or enter into binding legal agreements to expend the grant funds within twelve months of the date of this contract, the City, by written notice of default to the Grantee, may terminate the whole or any part of this contract and may pursue any remedies available at law or in equity. Such remedies may include, but are not limited to, termination of the contract, stop payment on or return of the grant funds, payment of interest earned on grant funds or declaration of ineligibility for the receipt of future grant awards. 6. Amendments. The terms of this contract will not be waived, altered, modified, supplemented, or amended in any manner except by written instrument signed by the parties. Such written modification will be made a part of this contract and subject to all other contract provisions. 7. Indemnity. Grantee agrees to defend, indemnify and save City, its officers, employees and agents harmless from any and all losses, claims, actions, costs, expenses, judgments, subrogations, or other damages resulting from injury to any person (including injury resulting in death,) or damage (including loss or destruction) to property, of whatsoever nature arising out of or incident to the performance of this agreement by Grantee (including but not limited to, Grantee's employees, agents, and others designated by Grantee to perform work or services attendant to this agreement). Grantee shall not be held responsible for damages caused by the negligence of City. 8. Insurance. Grantee shall, at its own expense, at all times for twelve months from the date of this agreement, maintain in force a comprehensive general liability policy including coverage for contractual liability for obligations assumed under this Contract, blanket contractual liability, products and completed operations, and owner's and contractor's protective insurance. The liability.under each policy shall be a minimum of $500,000 per occurrence (combined single limit for bodily injury and property damage claims) or $500,000 per occurrence for bodily injury and $100,000 per occurrence for property damage. Liability coverage shall be provided on an "occurrence" not "claims" basis. The City of Ashland, its officers, employees and agents shall be named as additional insureds. Certificates of insurance acceptable to the City shall be filed with City's Risk Manager prior to the expenditure of any grant funds. 9. Merger. This contract constitutes the entire agreement between the parties. There are no understandings, agreements or representations, oral or written, not specified in this (iontract regarding this contract. Grantee, by the signature below of its authorized representative, acknowledges that it has read this contract, understands it, and agrees to be bound by its terms and conditions. GRANTEE CITY OF ASHLAND Its Director of'lRnanca BY,. Content review by: ~ It Department Head Form review by: ~ (City Attorney) Coding: (for City u. se only) PAGE 2-GRANT AGREEMENT CITY OF ASHLAND CITY HALL ASHLANO, OREGON 97520 June 29, 1999 Becky Snyder & George Gilman Rogue Valley Manor Community Services 1700 Barnett Road Medford, OR 97504 Dear Ms. Snyder & Mr. Gilman: The City of Ashland Budget for the 1999-2000 fiscal year was approved by the City Council on June 15. Your grant of $3000 is included in this budget. The payment will be made following the City's receipt of the enclosed contract with signature. The City requires grant recipients to supply a certificate of insurance indicating liability coverage of not less than $500,000 per occurrence. The City, its officers, and employees must be named as additional insureds. Please sign the enclosed contract and return it to the City as soon as possible. Once the signed contract is on file, the payment schedule can be implemented. Sincerely, Director of Finance kg Enclosure G:~BUDGET~Social Services~Vlail Merge forms~granteeltr, doc ....... 03/13a PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Bratrud Middletonlnsurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Brokers Inc. - Tacoma Div ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. O. Box 11205 COMPANIES AFFORDING COVERAGE Tacoma, WA 98411-0205 COMPANY A Transportation Insurance Co. INSURED COMPANY Rogue Valley Manor Community B Fidelity & Deposit Co. of MD Service, Inc. COMPANY 1200 Mira Mar Avenue C Medford, OR 97504 COMPANy I JAP D THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OFINSURANCE POUCY NUMBER POUCY EFFECTIVE POMCY EXPIRATION; LTR DATE (MM/DD/YY) DATE (M M/DD/YY) LIMITS A GENERAL UAB,L,W LHH1089002158 lO/el/00 10/01/01 GENERAL AGGREGATE $ 3,000,000 X ' COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/UP AGG $ 3~000~000 I CLAIMS MADE ~J OCCUR PERSONAL&ADVINJURY $ OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ 1,~0~0.~0~) X Prof. Liability I FIRE DAMAGE (Any one fire) $ 50~000 X Empl. Ben. Liab MHD EXP (Any one person) $ 51000 AUTOMOBILE EABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ EACH ACCIDENT $ AGGREGATE $ A EXcess LIABILITY CUP1089002192 10/01/00 10/01/01 EACH OCCURRENCE $ 1,000~000 X UMBRELLA FORM AGGREGATE $ 1,000)000 OTHER THAN UMBRELLA FORM $ WC S fATU- WOR.E, COMFENSATION AND I TORY.MI','S EMPLOYERS~ LIABILITY EL EACH ACCIDENT $ THEpARTNERS/EXECUTivEPROPRIETOR/ [~ INCL EL DISEASE - POLICY LIMIT $ OFFICERS ARE:I I EXCL EL DISEASE. EA EMPLOYEE $ B OTHER CRIME CCP0036038 10/01/00 10/01/01 $450,000 LIMIT $2,500 DEDUCTIBLE DESCRIPTION OF OPERATIONS/LOCATION~/VEHICLE~/SPEClAL ITEMS RE: OPERATIONS OF THE NAMED INSURED THE CITY OF ASHLAND, IT'S OFFICIALS, EMPLOYEES AND AGENTS ARE ADDED AS ADDITIONAL INSUREDS. SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE CITY OF ASHLAND 20 EAST MAIN STREET EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL ASHLAND, OR 97520 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, INSURED: Rogue Valley Manor Community 158564 JAP OTHER COVERAGES - (Continued): CO LTR TYPE OF rNSURANCE POLICY NUMBER A BLKT BLDGS/BUS LHH1089002158 PERS. PROP/B&M POLICY EFFECTIVE POLICY EXPIRATION DATE DATE LIMITS 10/01/00 10/01/01 $224,695,717. LIMIT $5,000 DEDUCTIBLE POLICY NUMBER: LHH1089002158 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON or ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Name of Person or Organization: CITY OF ASHLAND 20 EAST MAIN STREET ASHLAND, OR 97520 SCHEDULE RE: OPERATIONS OF THE NAMED INSURED THE CITY OF ASHLAND, IT'S OFFICIALS, EMPLOYEES AND AGENTS ARE ADDED AS ADDITIONAL INSUREDS. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your operations or premises owned by or rented to you. CG 20 26 11 85 Copyright, Insurance Service Office, Inc., 1984 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION BratrudMiddleton Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Brokers Inc. - Tacoma Div ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. O. Box 11205 COMPANIES AFFORDING COVERAGE Tacoma, WA 98411-0205 COMPANY A Transportation Insurance Co. INSU RED COMPANY Pacific Retirement Serv Inc. B and Rogue Valley Manor 1200~Iira Mar Avenue-" COMPANY c Medford, OR 97504 COMPANY THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION UMITS LTR DATE (MM/DD/YY) DATE (MM/DD,r(Y) A GENERAL LIABILITY LHH1089002158 10101/00 10/01/01 GENERAL AGGREGATE S 3,000,000 X COMMERCIALGENERAL LIABILITY PRODUCTS- COMP/OPAGG $ 3,000,000 i: CLAIMS MADE OCCUR PERSONAL & ADV INJURY $ 1~000~000 ! OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ l?000,000 X Prof. Liability FIRE DAMAGE (Any CnG fire) $ X Employee Ben. MED EXP (Any one person) $ 51000 A ALITOMOB~LE LIABILITY X ANYAUTO BUA1089002175 10/01/00 10/01/01 COMBINED SINGLE LIMIT $ 1,000,000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ X i HIRED AUTOS BODILY INJURY $ X i NON-OWNED AUTOS (Per accident) I PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: __ EACH ACCIDENT $ AGGREGATE $ A EXCESS LIABILITY CUP1089002192 10/01/00 10/01/01 EACH OCCURRENCE $ 1,000,000 X UMBRELLA FORM AGGREGATE $ 1_,000,000 OTHER THAN UMBRELLA FORM $ WC STATU- ' WORKERS COMPENSATION AND I TORY LIMITS I ?E-~- EMPLOYERB' LIABILITY EL EACH ACCIDENT $ THE PROPRIETOR/ ~ INCL EL DISEASE - POLICY LIMIT $ PARTNERS/EXECUTIVE OFFICERS ARE: EXCL EL DISEASE- EA EMPLOYEE $ OTHER I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS RE: OPERATIONS OF THE NAMED INSURED THE CITY OF ASHLAND, IT'S OFFICERS, EMPLOYEES AND AGENTS ARE ADDED AS ADDITIONAL INSUREDS. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CITY OF ASHLAND EXPIRATION DATE THEREOF, THE ISSUING COMPANY WiLL ENDEAVOR TO MAIL CITY HALL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ASHLAND, OR 97520 SUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGAT~ON OR LIABILITY oP ANY KI,D TH _ REPRBSENTATIVES. .., .......................... POLICY NUMBER: LHH1089002158 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON or ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Name of Person or Organization: CITY OF ASHLAND CITY HALL ASHLAND, OR 97520 SCHEDULE RE: OPERATIONS OF THE NAMED INSURED THE CITY OF ASHLAND, IT'S OFFICERS, EMPLOYEES AND AGENTS ARE ADDED AS ADDITIONAL INSUREDS. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your operations or premises owned by or rented to you. CG 20 26 11 85 Copyright, Insurance Service Office, Inc., 1984 PRODUCER 94737 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Willis Corroon Corporation of Portland ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. Box 8699 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Portland OR 97207 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (503) 224-4155 COMPANIES AFFORDING COVERAGE COMPANY Agricultural Insurance Co. Michelle Nutting A INSURED COMPANY B Rogue Valley Manor Community Services COMPANY 1200 Mira Mar Ave C Medford OR 97504 COMPANY THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POMCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POECIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD~YY) DATE (M M/DD~fY) LIMITS A GENERALUABILITY PAC138691210 01-0CT-1999 01-0CT-2000 GENERALAGGREGATE $ :3,000,000 X COMMERCIAL GENERAL LIABILITY PROOUCTS-CONIP/O{= AGG $ I, 000,000 I CLAIMSMADE ~ OCCUR PERSONAL&ADVINJURY $ 1,000,000 OVVNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ I , 0 0 0,0 0 0 FIRE DAMAGE (Any one fire) $ 100,000 MED EXP (Any one personI ~ 10,000 AUTOMOSlLE LIABILITY COMBINED SINGLE LIMIT ANY AUTO ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NONq:)WNED AUTOS (Per accident) PROPERTY DAMAGE GARAOE EABIETY AUTO ONLY - EA ACCIOENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE OTHER THAN UMBRELLA FORM WC STATU- WORKERS COMPENSATION AND J TORY LIMITS I I~RTM EMPLOYERS' LIABILITY EL EACH ACCIDENT THE PROPRIETOR/ PARTNERS/EXECUTiVE INCL EL DISEASE~OLICY LIMIT $ OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE OTHER DESCRIPTION OF OPERATIONS~LOCATIONS~VEH ICLES/SP ECIAL II~MS Certificate holder is named as an additional insured as respects General Liability insurance in regards to grant funds provided to the named insured. SHOULD ANY OF THE ABOVE DESCRIBED POUCIES SE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL City Of Ashland, Its Officers, Employees, & Agents 30 __ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Attn: Kathy Griffith BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Main Street OF ANY KIN~/UPON THE COMPAHY~ ITS AGENTS OR REPRESENTATIVES. Ashland OR 97520 A U TH 0 RIZ E D~ E N T~;~]]U~ I . ACORD,. :: E IEI TL ELI BIEI : :INSUR I 2 EP ............................................ :::::::::::::::::::::::::::::::::::::::::::::::::::::: ................... ::::::::::::::::::::::: .............. :::::::::::::::::::::::::::::::::: ...................................... ~: ............................ .~.:.!~ i;~ ;:~!~:~:! - PROOBCER 92681 THIS CERTIFICATE IS ISSUED AS A MA~ ~-R OF INFORMATION Willis Corroon Corporation o~ Portland ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. Box 8699 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Portland OR 97207 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (503) 22~. ~. 155 COMPANIES AFFORDING COVERAGE COMPANY Agricultural Insurance Co. Michelle Nutting A INSURED COMRANY B Rogue Valley Manor Community Services C/O Pacific Retirement COMPANY 1200 Mira Mar Ave C Medford OR 97504 COMPANY I D THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AU- THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POLICY EXPIRATION CO TYPE OF INSURANCE POLICY NUMBER DATE (M M/DD/VY) UMITS LTI:I DATE (M M/DD/YY) A GENERAL LIABILITY F'AC138691209 01-0CT-1998 01-0CT-1999 GENERALAGGREGATE $ 3,000,000 X COMMERCIALGENERAL LIABILITY PRCOUCTS~OMP/OP AGG $ I o 000.000 ] CLAIMSMADE JXI OCCUR PERSONAL&ADVINJURY $ I o000,000 OWNER'S & CC~TRACTOR'S PROT EACH OCCURRENCE $ 1, 000. 000 FIRE DAMAGE (Any one fire) $ 100 . 000 MED EXP (Any one pe~on} ~ 5 , 0 0 0 AUTOMOBILE UABIUTY COMBINED SINGLE UMIT $ ANY AUTO ALL OWNED AUTOS BOOILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BOOiLY INJURY $ NON~WNED AUTOS (Per accident) PROPERTY DAMAGE GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE EXCESS LIABIETY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM WC STATU- WORNERSCOMPENBA.ON ANU I TOSY UMITS I I EMPLOYERS' LIABILITY EL EACH ACCIDENT $ THE PROPRIETOR/ PARTNERS/EXECUTIVE INCL EL DISEASE-POLICY LIMIT $ OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS Certificate holder is named as an additional insured as respects General Liability insurance in regards to grant funds provided to the named insured. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City Of Ashland EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL Its officers, employees, 30 __ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. and agents BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR EABILITY Main Street OF ANY KIN~'~UPON THE COMPANYI ITS AGENTS OR REPRESENTATIVES. Ashland OR 97520 A U TH 0 R IZ E D R~E N T~T,~ I Agency Application Forms (revised 11/30/98) For applications to City of Medford, City of Ashland, Jackson County and United Way. This application submitted to: __ City ofMedford X City of Ashland Jackson County __ United Way Agency Name: Mailing Address: Street Address: City/State/Zip: Agency Application Form Section I - Agency Information Rogue Valley Manor Community Services 1700 Barnett Road 1700 Barnett Road Medford, OR 97504 Director's Name/Title: George L. Gilman, Director of the Foster Grandparent Program Becky A. Snyder, Director of the Retired and Senior Volunteer Program Phone: 541-779-5257 Fax: 541-779-4883 Email: rvmcsC~_,mind.net IRS Classification: 501-(C)3 Federal Tax ID~: 93-0892261 Agency mission statement (found in your bylaws, articles of incorporation or subsequent board adopted mission statements): Rogue Valley Manor Community Services, Inc. provides meaningful volunteer opportunities for seniors to enrich the lives of people in their communities. Funding application summary Information (list only those programs for which you are seeking funding): Program Title Foster Grandparent Program Retired and Senior Volunteer Program Funding Amount $ 2.000 $ 2,000 Total (if more space is needed for specific programs attached a separate listing but grand total must appear here): $ 4,000 C. General description of agency services (be brief and use only the space provided): The primary purpose of the Foster Grandparent Program is to provide opportunities for seniors age 60 and older to serve as mentors, tutors and care givers for at-risk children and youth. Foster Grandparents meet income eligibility requirements, serve 20 hours per week at sites throughout our community and receive small stipends to augment their income. The Retired and Senior Volunteer Program provides meaningful volunteer opportunities to individuals age 55 and over to help meet the needs of the community. In addition to placing volunteers with 112 non-profit organizations, RSVP directly coordinates the following services: Airport Information Booth, Call-A-Ride medical transportation, Senior Respite Services, SHIBA / Senior Health Insurance Benefits Assistance, and CARE, mentorship for family child care providers. D. Administration and overhead expenses (expressed as percent of total budget - also known as management and general, that portion of your expenses not dedicated solely to program or services. Different agencies have different ways of calculating this figure and you are free to use your own formula. If asked, be able to explain it. If applying for United Way funding, use the administrative expense taken directly from your 990): 7.1 % E. Describe interagency collaboration (briefly descdbe other agencies which you share or cosponsor services or programs. May include sharing of staff, facilities, equipment or program materials.): The FGP and RSVP comprise Rogue Valley Manor Community Services, and as such, share office space, supplies, equipment, staff and office duties. In addition to this close collaboration, each of the programs enjoys good working relationships with those organizations in which they place volunteers. Staff from both programs are in regular affendance at monthly, or quarterly, meetings of: Commission on Children and Families, Interagency Council, Jackson County Child Care Task Force, Jackson County Human Services Consortium, Oregon Coalition of Community Non-Profits, Oregon Community Service Commission, Oregon Senior Service Corps Association, Public Pdvate Partnership for a Safe & Healthy Community, RVCOG Senior and Disabled Services Advisory Council, Special Transportation Advisory Committee, and United Way. Please attach the followina: 1. Current agency board of directors roster 2. Most recent agency audit or financial review 3. Agency self-evaluation 4. Current and projected budget: agency and program/s requesting funding G. Environmental scan: Descdbe number of people in Jackson County who need this service, their specific needs, other similar programs serving the same population. This is your opportunity to descdbe the environment in which you offer your service. Offer any information on best practices. Current estimates indicate 5,038 seniors, age 60 and older, in Jackson County are eligible to participate in the Foster Grandparent Program. Financial eligibility for the FGP is 125% of the federal poverty level. The great number of youth in Jackson County in need of this special one-on-one assistance is staggering. We have countless requests for additional Foster Grandparents to fill never-ending slots at our placement sites. Funding has been the only limiting factor to the growth of the program. The specific needs of FGP's service range from helping our senior citizens population become self sufficient, worthwhile, contributing citizens in the county, to building better lives for our youth 2 by bettering their education, their mental and emotional health, and giving them a chance to succeed. The ability to address the specific needs of each individual is what makes this program so invaluable. Each Foster Grandparent provides a tailor-made program for each child depending on their specific needs. Presently, more than 750 individuals age 55 and above are registered with the Retired and Senior Volunteer Program, keeping them engaged in the life of their community. Not only do RSVP volunteers help meet needs for residents of all ages through their volunteering with the non-profit organizations with which RSVP is associated, they offer essential services for homebound, isolated seniors. Environmental scan continued: Describe also other agencies serving the same population with similar service, including name of agency, location, and number of clients served. When considering the Foster Grandparent Program, please realize that no other volunteer opportunity exists in Ashland for seniors to receive additional, non taxable income. Few programs can provide the one-on-one assistance for children on an ongoing, consistent basis (20 hours per week) which enables a personal bonding relationship of trust to develop. The inter-generational friendships that evolve are unique to this program. Although there are other programs which might appear similar to the Retired and Senior Volunteer Program, in particular the Community Service Volunteer Program, they are not of the same configuration. RSVP is distinct in its target population, those age 55 and above, and in its extensive association with other non-profit organizations. A national organization, RSVP is locally associated with more than 100 non-profit organizations who comprise its 'volunteer station' roster. CSVP is considered a volunteer station, and as such, RSVP offers the benefits of volunteer recruitment to CSVP, in addition to mileage reimbursement, supplemental'insurance coverage, and volunteer recognition events to its volunteers registered with RSVP. CSVP itself does not provide these benefits to its volunteers. Clientele served by RSVP's in-house programs are not duplicated. H. Authorization (executive director and board president signatures are both required, authorized by the agency's board of directors): The undersigned certify that authority to submit this application was properly provided by the agency's board of directors. Foster Grandparent Program Date Exe~cufiv~-l~rector, Becky 5' Snyder Retired and Senior Volunteer Program Date 3