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HomeMy WebLinkAboutAgenda - 09-02-2010 - 4fORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: September 2, 2010 Action Agenda Item No. ~- ' -F SUBJECT• Blue Cross and Blue Shield of North Carolina Foundation Grant Agreement DEPARTMENT: Environment, Agriculture, PUBLIC HEARING: (YIN) No Parks and Recreation ATTACHMENT(S): Preliminary Project Proposal BCBSNC Grant Agreement INFORMATION CONTACT: David Stancil, 919-245-2522 Lori Taft, 919-245-2673 Mark R. Hassig, 919-245-2667 PURPOSE: To consider approving an equipment grant agreement with Blue Cross and Blue Shield of North Carolina (BCBSNC). BACKGROUND: The Department of Environment, Agriculture, Parks and Recreation (DEAPR), through the Parks and Recreation division, has fitness classes that have shown to have a consistent following. Parks and Recreation currently only has "steps" for the classes since storage is limited and little money is allocated for new equipment. The grant funds would be used to purchase equipment and a rack so Parks and Recreation can add diversity to the current programs offered. Because there is such limited space for storage, Parks and Recreation would benefit greatly from also having a rolling rack to store the equipment and for movement between rooms within the Central Recreation Center. The cost of these items would be covered by the grant funds. FINANCIAL IMPACT: This is a one-time grant for $2,500 with a requirement that the funding be used within 12 months of the effective date, which is August 11, 2010. There is no match required with the grant. RECOMMENDATION(S): The Manager recommends that the Board approve the BCBSNC grant and authorize the Chair to sign the grant agreement ~~~3 B1ueCross B1ueShield of North Carolina Foundation Preliminary Project Proposal 2 Submission of a Preliminary Project Proposal is the initial required step for any organization seeking to apply for a grant from the Blue Cross and Blue Shield of North Carolina (BCBSNC) Foundation. After review of the Preliminary Project Proposal, you will be notified by email whether or not your organization has been invited to submit a full grant application. The one exception is equipment-only requests, which will not be asked to complete a full grant proposal. Please note that we are unable to accept grant applications that have not gone through the Preliminary Project Proposal process. INSTRUCTIONS SUBMISSION: The Preliminary Project Proposal must be submitted both electronically and via hard copy (postmarked) by 5 p.m. on or before July 15, 2010. Please note: All proposals MUST be sent using a method that allows for tracking (e.g., return receipt, Fed Ex) in order for you, the applicant, to independently track the receipt status. COMMUNICATION: The only communication you will receive from the BCBSNC Foundation will be regarding a decision on your proposal either accepting or declining your submission. This will be sent via email. EMAIL CONTACTS: • For HVP focus area please email to: katie.e es bcbsncfoundation.org • For HAC focus area, including equipment-only requests, please email to: Jennifer.macdougall(~bcbsncfoundation.org MAILING ADDRESS: A signed original Preliminary Project Proposal must be sent to the mailing address below (please note the different addresses for regular postal service or FedEx/UPS package delivery): Mailing address: BCBSNC Foundation Attention: Jill Mallatratt PO Box 2291 Durham, NC 27702 FedEx/UPS delivery address: BCBSNC Foundation Attention: Jill Mallatratt 5901 Old Chapel Hill Blvd. Durham, NC 27707-0718 BCBSNC Foundation (Rev 5/17/10) 3 ORGANIZATION NAME Orange County Parks and Recreation Department Please check the appropriate box for the Focus Area/grant type (select only one): ^ Health of Vulnerable Populations (HVP) Improving health outcomes for North Carolinians served by health care safety-net organizations ^ Healthy Active Communities (HAC) ®Equipment-only requests Increasing physical activity and access to healthy (Healthy Active Communities only) food for North Carolinians ORGANIZATIONAL PROFILE Legal Name of Requesting Organization: PO Box and/or Street Address: Department of Environment, Agriculture, Parks and PO Box 8181 Recreation De artment DEAPR Hillsborou h NC 27278 City, State, Zip: County: Hillsborou h NC 27278 Oran e Phone Number (Area code): Fax Number (Area code): 919 245-2660 919 644-3042 Executive Director Name: Executive Director Email Lori Taft Address: Itaft@co.oran e.nc.us Grant Request Contact Name: Grant Request Contact Email Mark Hassig Address: mhassi @co.oran e.nc.us Organization Web Site Address: Date of Incorporation http://www.co.orange.nc.us/recparks/recreation.asp ~ (mm/dd/yyyy): 02/05/1979 Tax ID Number: Tax Status (check one): ^ 501 (c)(3) Tax-exempt public charity ® Government entity If invited to submit a grant application you will be required to submit proof of your tax status. Is your organization classified as a supporting organization? Are any Blue Cross and Blue (This should be noted on your IRS tax determination letter): Shield of North Carolina ^ Yes employees associated with ® No your organization as board members, volunteers, etc.? If yes, what type of supporting organization are you? ^ Yes ^ Type I supporting organizations are operated, supervised, or ®NO contra//ed bythe supported organization. If yes, please list names and ^ Type II supporting organizations are supen~ised or contra//ed in their association with your 4 connection with the supported organization. agency: ^ Type III supporting organizations are operated in connection with the supported organization. PRO7 ECT Project Title: Wellness- through Orange County Parks and Recreation programs Proposed Activities -include strategy and evidence that your approach can be effective (response limited to 2000 characters including spaces): Our goal is to add to and enhance the fitness and wellness programs we have established in the past year. We have a step class and power/lo class which has shown to have a stable following. We currently only have steps for the class since our storage is limited and we have little money for new equipment. I would like to use the grant funds to purchase equipment and a rack so we can add diversity to what we currently offer. With the new equipment, we can expand the types of classes we offer. Because we have such limited space for storage, we would benefit greatly from also having a rolling rack to store the equipment and to also be able to use in other rooms in our facility. Equipment Requested -applicable for equipment-only requests (HAC focus area) Resistance bands, steps and risers, jump ropes, dumbells and a mobile dumbell/band rack. Overall Project Budget: $2,500 Geographic Area Served by this Project (list specific counties or communities): Orange County Target Age Groups (check all that apply): Target Gender (check only one): ^ General population (all ages) ®General population ^ Infants & Toddlers (age 0-5) ^ Females only ^ Children (age 6-13) ^ Males only ® Young adults (age 14-18) ® Adults (age 19-64) ^ Seniors (age 65+) Target Ethnic Group (check all that apply): ® General population (all races) ^ African-American ^ Hispanic ^ Native American Grant Request Amount: $2,500 (May not exceed $S, 000 for equipment-on/y For HVP Focus Area Only: Estimate the percentage of individuals who will be served by this project in each category: Uninsured ^ Other Low. income, insured 5 Target Population -please describe in detail the population experiencing the issue your project addresses. Of the total population you are serving, how many people have the problem and how many will your project impact? Tip: This gives us a sense of the nature and degree of the challenge you face. We understand that you may not be providing service to everyone who has this condition or need. (response limited to 1000 characters including spaces): Our fitness program participants currently number between 20-40 adults, depending on the month, between the ages of 18 and 50. They are either low or middle income households. Most of our participants are not members of a local gym and so our programs are attractive to them because there is no membership fee that has to be paid so a long term commitment is not necessary even though many of them do "re-register" for the same program. 6 RESULTS Outcomes -please describe what health gains or behavior changes your target population will achieve as a direct result of this grant. Address how this grant will meet the objectives found in the detailed focus area descriptions for the focus area to which you are applying. Tip: Anticipated health gains are not activities, such as participation in workshops. They are specific verifiable changes in health status made possible by these activities. (response limited to 2000 characters including spaces): After we purchase the equipment needed, we hope to add additional programs directly related to the equipment we purchase. We would also double the amount of potential participants from 24 per week to 48 participants per week. With the addition of the lunchtime fitness program, we would also hope to attract more County employees which would be promoted through our county wellness program. Intensity and Duration -please define how long and how many times participants will need to engage in this project in order to achieve the desired results (response limited to 1000 characters including spaces): We would add two additional 60 minute classes to supplement the 60 minute Monday and Wednesday programs we already offer to the public. This would double our fitness opportunites. A Saturday morning class as well as a lunchtime fitness program would be added, which would increase the amount of time available through our programs from the current 120 minutes to 240 minutes per week. CERTIFICATION We certify to the best of our knowledge that all the information contained in this proposal is accurate and complete. Organization's Executive Director: Signature: Date: Lori Taft ~ 7-9-10 Project/Program Director: Signature: Date: Mark Hassi4 _ 7-9-10 7 REQUIRED ATTACHMENTS Please make sure ONE copy of the following items is attached. The preliminary project proposal will not be reviewed without these items. 1. Current List of Board of Directors and/or Principal Officers. 2. Complete the project budget form located in the Excel document posted on the BCBSNC Foundation Web site. Note that a sample project budget is provided as a worksheet in the Excel document to help you complete the form accurately. You wi//have an opportunity to revise the budget if you are asked to submit a fu// proposa/. 8 BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA FOUNDATION GRANT AGREEMENT THIS GRANT AGREEMENT (the "Grant Agreement") is effective as of the date indicated below (the "Effective Date"), by and between the Blue Cross and Blue Shield of North Carolina Foundation, (the "BCBSNC Foundation"), and Grantee (as defined below). This Grant Agreement documents the BCBSNC Foundation's support of the proposal submitted by Grantee to the BCBSNC Foundation as set forth in Schedule A (the "Project"). Grantee: Department of Environment, Agriculture, Parks and Recreation ("Grantee" or "you") Project Title: Wellness through Orange County Parks and Recreation Programs Brief Project Description: Increase physical activity for 401ow-income adults in Orange County through the provision of exercise equipment. (the "Project") Grant Amount: $2,500.00 over 12 months (the "Grant"). The Grant is the sole amount that the BCBSNC Foundation is obligated to pay to Grantee and is subject to the conditions set forth below. Term: 12 months from the Effective Date. Effective Date: August 11, 2010 Use of the Grant: •Iri consideration of its right to receive the Grant, Grantee agrees to use the Grant in accordance with this Grant Agreement and solely as set forth in the description of the Project (Schedule A). Grantee shall establish and operate the Project and all of the Project's activities in compliance with all applicable federal, state, and local laws, rules, and regulations. Grantee shall oversee and be responsible for all activities of the Project, and shall be solely responsible for Grantee's compliance with all obligations of Grantee listed below. (initial here) 9 A. Funding Terms. Funding by the BCBSNC Foundation is guaranteed for one time only. The BCBSNC Foundation has no obligation to provide any other funding or support to the Grantee. Funding is further conditioned upon: The execution and return of this Grant Agreement. Please initial each page of the Grant Agreement and sign the fmal page. Please keep a copy of this executed Grant Agreement for your records. The BCBSNC Foundation will keep the originally executed Grant Agreement for its records. Confirmation that the Internal Revenue Service has recognized the Grantee as a tax- exempt governmental unit or as an organization described in Section 501(c)(3) of the Internal Revenue Code and classified as a nonprivate foundation under Section 509(a). Further, Grantee confirms that its determination letter from the Internal Revenue Service remains valid as to its nonprivate foundation status and its status under IRC Section 501(c)(3) and that it has not undergone any material change in its character, purposes, activities, method of operation or sources of support that would be inconsistent with that status. Grantee agrees to notify the BCBSNC Foundation immediately if there is any change in its nonprivate foundation status or its status under IRC Section 501(c)(3). Grantee's agreement to use the Grant for charitable, educational, or scientific purposes only. Grantee's agreement to timely submission of project information and reports, as reasonably requested by the BCBSNC Foundation, certifying compliance with the terms of this Grant Agreement and documenting the use of the Grant and the progress of the Project. All such certification and expenditure reports shall be delivered by Grantee to the BCBSNC Foundation at least once per year, using the .templates provided by the BCBSNC Foundation. Grantee agrees that it will return to the BCBSNC Foundation any monies contributed by the BCBSNC Foundation that are not used for the purposes set forth in the Grant Agreement. B. Reporting. All reports required to be submitted by the Grant Agreement shall be sent to: Jennifer MacDougall (or other approved representative) Blue Cross and Blue Shield of North Carolina Foundation PO Box 2291 Durham, NC 27702 Jennifer MacDougall is your primary contact for this grant and may be reached at(919) 765- 2128 or e-mail jennifer.macdougall@bcbsncfoundation.org. (initial here) 10 C. BCBSNC Foundation Logo and Name Usage. Please be aware that the BCBSNC Foundation must approve all items on which our name and/or logo are included prior to the item(s) production. Please note that approval from the BCBSNC Foundation is not a grant of a license or a sublicense to any Blue Cross and/or Blue Shield trademarks or service marks. If the Grantee does not secure the proper approvals from the BCBSNC Foundation, the Grantee may be held responsible for the unauthorized use of the BCBSNC Foundation logo and name as well as for the reprinting of any unapproved items at the Grantee's expense. The following standards must be followed when using our name and/or logo: • When written in text, all words in the name must be completely spelled out and written as follows: Blue Cross and Blue Shield of North Carolina Foundation. If you are producing a long text document (for example, a newspaper article) it may be written as BCBSNC Foundation in secondary mentions. • The BCBSNC Foundation logo can not be altered without BCBSNC Foundation's prior written approval. Use of the BCBSNC Foundation logo requires the following tagline: "Blue Cross and Blue Shield of North Carolina (BCBSNC) and Blue Cross and Blue Shield of North Carolina Foundation are independent licensees of the Blue Cross and Blue Shield Association (BCBSA)." In cases where this or a similar statement is already included in the logo graphics file, it is not necessary to add the tagline. • In cases where another entity's mark or logo appears with a legend identifying that other entity as the owner of that logo or mark, the legend must also include ownership of marks by either Blue Cross and Blue Shield Association and/or BCBSNC Foundation. These statements may be placed anywhere on the piece. The type must be at least 6 points in size and must remain legible and relatively independent of other copy or graphics. • The BCBSNC Foundation logo can only appear in white, black or cyan. • Electronic files of the logo maybe downloaded from the "grantees only" section of our Web site. Please contact Jennifer MacDougall at (919) 765-2128 if you have difficulty accessing the logos or need them in a different format. • You may fax or a-mail items needing approval to Jennifer MacDougall or approved representative at (919) 765-7288 at least two business days prior to due date. • Please provide final copies of all items on which the BCBSNC Foundation logo and/or names appear. (initial here) 11 D. Publicity. Grantee may not share any information about the Grant Agreement with the public or any third parry (by way of a press release or otherwise) until the Grant Agreement is executed, and the BCBSNC Foundation has provided its approval of the proposed announcement. Thereafter, any announcements related to this initiative need to be coordinated (in advance and with 30 days of planning time) directly with the BCBSNC Foundation. The BCBSNC Foundation must approve any press releases, banners or any other publicity materials containing its name and/or the mention of this grant. If the Grantee does not secure the proper approvals from the BCBSNC Foundation, the Grantee may be held responsible for the unauthorized use of the BCBSNC Foundation logo and name as well as for the reprinting of any unapproved items at the Grantee's expense. Thank you for working with us to adhere to this Grant Agreement. The partnership between the BCBSNC Foundation and Department of Environment, Agriculture, Parks and Recreation is important to us, as is the success of this initiative. Grantee: Signature of Executive Director or Authorizing Agent Date Name: Title: Signature of Board Chair Date Name: Title: (initial here) 12 SCHEDULE A [Your grant proposal, currently on file at the Foundation, serves as schedule A to this agreement.] (initial here)