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Attachment 1
FY 2018/19 Grant Application Summaries Arts, Culture, and Education ATTACHMENT 1 Art Docents Town of Los Gatos FY 2018/19 Community Grant Program Application Summary CLERK EPAR GATOS 2018 MAR - 5 A 143 Project: Project/Program: Art Education Services to Los Gatos Union School District Program Manager: Stefanie Johnston Agency: Name of Agency: Art Docents of Los Gatos Site Address: 17000 Roberts Road Los Gatos, CA 95032 Name of Executive Director: Julie Ferrario Project Description: Provide brief description of agency, agency goals, and agency services. Describe your program briefly, including who benefits from your program. Direct Services: To fulfill the need outlined in the "Memorandum of Understanding" between the Art Docents of Los Gatos and the Los Gatos Union School District, the Art Docents agree to provide: • A comprehensive and sequential visual arts program aligned with the California Public School Art Standards; • Docent -led, hands-on art technique lessons; • Arrangements and payment for the professional guest artist to visit each school in the district; • Production of the Annual District -wide Student Art Show in which the entire Los Gatos community is invited to attend; • Training and continuing education for volunteer docents who provide services How, when, where, services are delivered: Trained docents take the program directly into all K-5 classrooms, and by request into grades 6,7 and 8 classrooms in the LGUSD during school hours throughout the school year. The program consists of: • Print presentations: a mix of digital slides and poster -sized hand-held, mounted prints • Hands-on workshop lessons that use traditional art materials: • The Annual Student Art Show, held once a year over the span of a week, usually in May in the Fisher School multi -purpose room. Each classroom arranges for a tour during school hours, led by Art Docents. The Art Show is also open to the Los Gatos Community and LGUSD Parents. • Sponsored professional guest artist demonstrations at each school location with class visitations. Students may also view the demonstrations during recess and lunch. Why should services be provided: When we educate children in the arts, we provide them with another way to communicate their ideas and comprehend their world. Art links us to other cultures, other times in history, and other neighborhoods. A complete art education teaches students to see clearly, think creatively, and give form to the future. Exposure to art enhances their ability to become flexible, innovative and creative individuals. By providing this service, the Art Docents of Los Gatos are fulfilling the commitment of the Los Gatos Union School District to the visual arts. Program Funding: Provide prior year fiscal year actual budget amounts and proposed amounts for new fiscal year. Program Funding: FY 2017/18 (adopted) FY 2018/19 (requested) Clients: FY 2017/18 (actual) FY 2018/19 (proposed) Town annual funding amount $4000 $4000 Unduplicated annual Los Gatos clients 3216 3216 Total annual program budget (2018/19 proposed) $67,360 $67,360 Total unduplicated annual clients 3216 3216 Town $ as % of annual total 5.9 5.9 Los Gatos clients as % of annual total 100% 100% 2 TOWN OF LOS GATOS & FY 2018/19 APPLICATION FOR COMMUNITY GRANT FUNDING APPLICANT AGENCY/PROGRAM DOCUMENTS CHECKLIST Please submit one copy of each of the documents listed below with your completed application. This page should serve as the cover sheet for that section of your submittal. 1. PROGRAM/PROJECT INFORMATION 0 Fee Schedule, Membership, or other fees II. AGENCY INFORMATION Q Current Board of Directors Articles of Incorporation �] Bylaws El Organizational Chart C] Brochures, Flyers, Promotional Materials III.. FISCAL INFORMATION [] Audit or Financial Statement plus Letter of Auditability [� Organizational Budget [ Internal Revenue Service Ruling Letter (Section 501 c.3) California Revenue Code (Section 23701 d) 3 TOWN OF LOS GATOS 4, FY 2018/19 APPLICATION FOR COMMUNITY GRANT FUNDING GRANT APPLICATION I. PROGRAM/PROJECT INFORMATION A. Contact Information Legal name of organization Art Docents of Los Gatos, Inc. Address of organization 17000 Roberts Road Los Gatos, CA 95032 Organization contact (Name, title, telephone number, email address) Stefanie Johnston Program Coordinator 408-335-2366 artdocents@me.com Program name Art Education Services Site address of program All 5 Schools in Los Gatos Union School District: Fisher Middle School, Louise Van Meter Elementary, Blossom Hill Elementary, Daves Avenue Elementary, Lexington Elementary Program manager (Name, title, telephone number, email address) Julie Ferrario 408-981-3361 jgferrario@gmail.com Annual grant amount requested FY 2018/19 $4000.00 B. Community Need Statement Describe briefly the demonstrated need in the Los Gatos community for the program. Cite data sources as appropriate. The Art Docents of Los Gatos was formed in 1973 to fill a void left by decreased school spending for the Arts. For the past 44 years, the Art Docents program has provided a comprehensive and sequential visual - arts program, unduplicated in the scope or quality by any other school or town program, to over 3000 Los Gatos students in the Los Gatos Union School District. The Art Docents work in collaboration with the one LGUSD art teacher who travels between the four elementary schools. The goal of our cultural/educational program is to meet the Guiding Principles of the Visual Art Standards outlined by the State of California: to introduce art as a tool for creative expression; to develop familiarity with diverse cultures and appreciate one's common heritage: to appreciate and experience the creation of art. The program helps fulfill the arts and cultural needs of our community as outlined in the Town's arts/cultural plan. The program also is continually being evaluated to ensure that it meets the California Visual Art Standards and STEAM focused curriculum as adopted by the school district. 4 c. Direct Services For Human Services and Arts, Culture and Education grant requests, list, describe, and quantify each direct service to be provided annually from July 1, 2018 through June 30, 2019. A Direct Service is a service for which there is an identifiable client. A Participation Agreement (Attachment 2) must be completed by each client receiving the direct services described below. Description of Service FY 2018/19 Number of Services Provided Annually FY 2018/19 Number of Unduplicated Los Gatos Residents served Annually 1. Sequential art Appreciation lessons presented a minimum of five times a year to each student in grades K-5. Lessons vary from 20-75 minutes. 396 1928 Spanish and French language students at Fisher receive one 90-minute lesson per year. 2. Hands-on art technique workshops for grades K- 108 2438 5 consisting of sculpture, still life, collage, abstract composition, face/figure drawing, and digital art. Scientific Illustrations is taught at Fisher Middle School to all 7th graders. In addition, we are currently piloting a new workshop for 6th graders. This lesson is scheduled to be introduced to all 6th grade math students in 15 5 ] 0 November 2018 — focusing on STEAM Curriculum called Big Data 3. One professional guest artist visit per school per year 5 3216 4. Annual Student Art Show displays work in a gallery setting for one week. Approximately 2300 students participate each year. Evening reception and afternoon hours provide viewing hours for the public. I week-long show 3216 5. Community adult program services for docents 6 art tours 90 (continuing education): art tours, lectures, and 6 art lectures/guest docent trainings. speakers 10 trainings Average number of direct services received by each unduplicated client: _9 Average number of direct services received by each unduplicated Los Gatos client: _9_ 5 D. Indirect Services List, describe, and quantify each indirect service to be provided annually from July 1, 2018, through June 30, 2019. An Indirect Service is a service for which there is no identifiable client; for example, information and referral that is given over the phone. Description of Service FY 2018/19 Number of Services Provided Annually I. Informational and referrals to teachers, docents and community members including those who have supported or are considering supporting us. 1 80-90 calls, contacts and presentations 2. The Palette newsletter connects docents to monthly activities and provides information about Art Docents for parents. 9 per year 3. Website. www.artdocents.com On -going and updated monthly 4. Multi -media art resource loan program to teachers and docents 500 approximately F. Demographic Information Provide demographic breakdown of unduplicated Los Gatos residents expected to receive direct services. Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2018/19 Age Under 18 years old 3219 19 — 50 years old 93 51 years old and over 5 Disability Status Disabled Not Disabled Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2018/19 Income 50% of median and below 51% - 100% of median Above 100% of Median Sex Female Male Total Total Los Gatos clients [3317 6 G. Client Participation Requirements Attach appropriate fee schedules, membership requirements, or other fee listings. II. AGENCY INFORMATION A. General lnformation Legal Name of Organization Art Docents of Los Gatos, Inc. Address of Organization 17000 Roberts Road Los Gatos, CA 95032 Name of Executive Director Julie Ferrario, President 2018-2020 Date of Incorporation March 1980 Insurance/Tax Information Federal Employer Tax Number ID# 94-2697299 State Employer Tax Number C0978543 Worker's Compensation Carrier/ Policy Number State Fund: 9200171-17 Liability Insurance Carrier Travelers Insurance Co. Amount of Liability Coverage 2,000,000 Property Damage (combined with liability) 300,000 Combined Single Limit 1,000,000 Policy Period 2/20/2017-2/20/2018 (in process of renewal) B. Staffing Profile Please complete the chart below for your organization as it will be staffed during FY 2018/19. Identify the hours to be devoted to the program for which you are requesting funding, for both employees and volunteers. Position Title Number in Classification Approximate Hourly Rate Hours Worked per Week Percent of Time to Program • Employees Program Coordinator 1 $29,00 27.5 Volunteers Active 68 S0 3 Sustaining 25 $0 .5 7 C. Agency Experience --Describe the experience of your Agency in providing program services. • The Art Docents of Los Gatos have successfully provided art education and enrichment services to the LGUSD since 1973. • To become a docent, one has to complete a ten -week training program. Also, throughout the school year refresher classes are offered to all docents who wish to hone specific skills relative to our programs. • A curriculum committee, which includes members with education degrees and art experience, ensures the lessons are aligned with the California State Standards for Visual Arts and Common Core Standards. Our curriculum is under constant review and revised as needed per feedback from teachers and docents. • A continuing education committee ensures the volunteer docents receive updated training to stay abreast of current lessons by networking with the greater local community to provide art -related studio tours, museum visits, and classes. D. Staff Experience --Describe the experience of key staff assigned to the program. The Art Docent Program Coordinator provides continuity in the area of support for the volunteer docents and contact with the teachers in the district. The organization is advised by a Board of Directors who meet four times a year and provide guidance in a number of areas. An Executive Board (consisting of a President, VP Programs, VP of Membership, VP of Fundraising, Treasurer, Secretary and Parliamentarian meets once a month and oversees the committees formed to deal with the daily services offered to the students and fundraising, budgetary, and docent issues that arise. The Program Coordinator works directly with the following committees: Training, Art Show, Curriculum, Guest Artist, Fundraising, Hospitality, Publicity, Newsletter, Continuing Education, Website, School Representatives. E. Staffing Plan --Describe any anticipated staffing changes to occur during FY 2018/19. None. 8 III. FISCAL INFORMATION A. Program Budget Please complete the following summary tables to reflect the budget for your organization and program. All amounts should be rounded to the nearest dollar. Alternatively, please attach single page revenue/expense summary sheets for the program for which funds are requested and a separate summary for the organization. Budget Summa Budget Data FY 2018/19 FY 2017/18 Los Gatos grant funding Requested: $4000 Received: $4000 Total Program budget $ $ Los Gatos grant as percentage of total Program budget 5.9% 5.9 % Total Organization budget $ 67360 $ 67360 Cost per year per unduplicated Los Gatos client $ 20 $ 20 Revenue Summa Revenue Source FY 2018/19 Organizational Budget FY 2018/19 Program Budget FY 2017/18 Organizational Budget FY 2017/18 Program Budget Los Gatos grant $ 4000 $ $ 4000 $ Other municipal funding (please specify: City of Monte Sereno ) $ 3000 $ $ 3000 $ County funding (please specify:) $ $ $ $ State funding (please specify:) $ $ $ $ Federal funding (please specify:) $ $ $ $ Other jurisdiction funding (please specify: LGUSD, LGEF, H&S Clubs) $ 62500 $ $ 62500 $ Fees for services: Member Dues $ 3250 $ $ 3250 $ Donations: Business Community, Membership Fundraising $ 6800 $ $ 6800 $ Reserve contingency fund $ 60000 $ $ 60000 $ All other sources (please specify: Service Clubs, Bank Interest, LGCF, SV creates) $ 9250 $ $ 9250 $ Total $ 148800 $ $ 148800 $ 9 Expenditure Surnma Expense Category FY 2018/19 Organizational Budget FY 2018/19 Program Budget FY 2017/18 Organizational Budget FY 2017/18 Program Budget Personnel $ 38400 $ $ 38400 $ Facility $ 3700 $ $ 3700 $ Overhead $ 5360 $ $ 5360 $ Materials/Supplies $ 1700 $ $ 1700 $ Professional Services: Tax prep, copier service $ 2700 $ $ 2700 $ Fundraising $ $ $ $ Capital Projects $ $ $ $ Other (please specify: Program Expenses ) $ 15500 $ $ 15500 $ Total $ 67360 $ $ 67360 $ BUDGET NOTES: 1, Art Docents of Los Gatos has only one program: therefore Organizational and Program budgets are the same. 2. Membership fundraiser - ongoing. 3. New Budget for fiscal year 2018-19 will be adopted in May: estimated to be similar to current year. B. Organization Contracts —Has your organization ever had funds withdrawn or a contract terminated for cause, unsatisfactory performance, or questionable costs on any financial statements or audit? if so, please describe. No. C. Organization Investigations --Is your organization currently on probation or under investigation by any agency which is or was a funding source within the past two years? If so, please describe. No. D. Budget Alternatives --What alternatives will your organization consider if the requested Community Grant funding is not provided, or provided at a reduced level? Describe how a reduction will affect the achievement of stated goals. School expenses will not be affected. Cuts will be made in other areas and/or reserve funds tapped. E. Funding Sources --Describe your organization's efforts in pursuing other funding sources. 1. Apply for yearly grants from Silicon Valley Creates and the City of Monte Sereno 2. Board solicitation of donations from local business community and service clubs 3. Membership Fundraisers to be held in 2018-19: Nicks Next Door Luncheon & Mulch Sale. 10 F. Supplies Disclosure —If any non -expendable supplies with a unit cost of $100 or more are to be purchased with Community Grant funds, please describe. N/A G. Travel Expense Disclosure --If Community Grant funds are to be used for staff travel expenses, please describe. N/A CERTIFICATION The applicant hereby proposes to provide the services as listed in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state, and local regulations, including non- discrimination laws and other assurances as required by the Town of Los Gatos, will be adhered to. Furthermore, as the duly authorized representative of the applicant organization, I certify that the applicant is fully capable of fulfilling its obligation under this proposal as stated herein. This application and the information contained herein are true and correct and complete, to the best of my knowledge. j Date: l f"G+l , 2018 ✓tY'�' ThC_tl t4 s 6 4 LA) s C� S Organization Name xutive Director U.•i ice' ybc..{-( D (Print Name) 11 LG Community Concert TOWN OF LOS GATOS Town of Los Gatos CLERK DEPARTMENT CLIVLG FY 2018/19 Community Grant Program Application Summary Nit FEB2 q P 2: 33 Project: Los Gatos Community Concerts Kevin Hayashi, President Agency: Los Gatos Community Concert Association P.O. Box 1116 Los Gatos, CA 95031 Kevin Hayashi, President Project Description: The Los Gatos Community Concert Association is a 501(c)(3) non-profit organization. Our mission is "To provide the community access to live performing arts concerts at an affordable cost." We have provided an annual concert series for the past 70 years consisting of four top quality musical performances presented for the local community at a very affordable cost. In addition, as an outreach program, we also try to arrange for free encore performances by some of our artists, at a local venue for a community group such as students or non -mobile elderly. Program Funding: Provide prior year fiscal year actual budget amounts and proposed amounts for new fiscal year. Program Funding: FY 2017/18 (adopted) FY 2018/19 (requested) Clients: FY 2017/18 (actual) FY 2018/19 (proposed) Town annual funding amount $5,000 $5,000 Unduplicated annual Los Gatos clients 305 305 Total annual program budget $24,975 $25,400 Total unduplicated annual clients 450 450 Town $ as % of annual total 20% 19.6% Los Gatos clients as % of annual total 68% 68% TOWN OF LOS GATOS 4• FY 2018/19 APPLICATION FOR COMMUNITY GRANT FUNDING GRANT APPLICATION I. PROGRAM/PROJECT INFORMATION A. Contact Information Legal name of organization Los Gatos Community Concert Association Address of organization 16250 Shannon Road, Los Gatos, CA 95032 (address of LGCCA president) Organization contact (Name, title, telephone number, email address) Kevin Hayashi, President, 408-204-0674 kevin_hayashi@yahoo.com Program name Los Gatos Community Concerts Site address of program Los Gatos High School Theatre 20 High School Court, Los Gatos, CA Program manager (Name, title, telephone number, email address) See Organization contact above Annual grant amount requested FY 2018/19 $5,000 B. Community Need Statement While the Silicon Valley in general has a wealth of cultural arts entertainment available, it usually comes at a cost: high ticket price and inconvenient venue location/transportation. The elderly population and the residents in general of the Los Gatos community deserve to have quality live musical performances offered locally at a reasonable price. c. Direct Services For Human Services and Arts, Culture and Education grant requests, list, describe, and quantify each direct service to be provided annually from July 1, 2018 through June 30, 2019. A Direct Service is a service for which there is an identifiable client. A Participation Agreement (Attachment 2) must be completed by each client receiving the direct services described below. Description of Service FY 2018/19 Number of Services Provided Annually FY 2018/19 Number of Unduplicated Los Gatos Residents served Annually 1. Musical Concert Performances 4 305 Average number of direct services received by each unduplicated client: 4 Average number of direct services received by each unduplicated Los Gatos client: 4 3 D. Indirect Services List, describe, and quantify each indirect service to be provided annually from July 1, 2018, through June 30, 2019. An Indirect Service is a service for which there is no identifiable client: for example, information and referral that is given over the phone. Description of Service FY 2018/19 Number of Services Provided Annually 1. N/A F. Demographic Information Provide demographic breakdown of unduplicated Los Gatos residents expected to receive direct services. Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2018/19 Age Under 18 years old 20 19 — 50 years old 60 51 years old and over 225 Disability Status Disabled 35 Not Disabled 270 Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2018/19 Income 50% of median and below 51% - 100% of median unknown Above 100% of Median Sex Female unknown Male Total Total Los Gatos clients G. Client Participation Requirements Ticket Prices: Series Subscription of 4 Concerts - $65 Adult/ $60 Senior/ $10 Student/ $140 Family Individual Concert - $30 Adult/ $25 Senior/ $5 Student/$65 Family 4 H. AGENCY INFORMATION A. General Information Legal Name of Organization Los Gatos Community Concert Association Address of Organization 16250 Shannon Road, Los Gatos, CA 95032 (address of LGCCA president) Name of Executive Director Kevin Hayashi Date of Incorporation June 27, 1957 Insurance/Tax Information Federal Employer Tax Number 94-6122399 State Employer Tax Number Entity ID: 0340387 Worker's Compensation Carrier/ Policy Number N/A Liability Insurance Carrier Non Profit's Insurance Alliance Amount of Liability Coverage $2,000,000 Property Damage (combined with liability) $1,500,000 Combined Single Limit $1,000,000 Policy Period 3/26/17 — 3/26/18 B. Staffing Profile Please complete the chart below for your organization as it will be staffed during FY 2018/19. Identify the hours to be devoted to the program for which you are requesting funding, for both employees and volunteers. Position Title Number in Classification Approximate Hourly Rate Hours Worked per Week Percent of Time to Program Employees Volunteers President 1 N/A 4 100% Vice President of Artists and Subscriptions 1 N/A 4 100% Vice President of Publicity 1 N/A 3 100% Treasurer 1 N/A 2 100% Secretary 1 N/A 2 100% Board Members 12 N/A 1 100% 5 C. Agency Experience —Describe the experience of your Agency in providing program services. The Los Gatos Community Concert Association has been producing an annual 4 concert series for 70 years continuously since 1947. D. Staff Experience —Describe the experience of key staff assigned to the program. President — 10 years; 13 years on Board. VP of Artists/Subscriptions-21 years; 25 years on Board. VP of Publicity — 10 years; 15 years on Board. Treasurer — 3 year; 4 years on Board. Secretary — 8 years; 12 years on Board. E. Staffing Plan --Describe any anticipated staffing changes to occur during FY 2018/19. None 6 III. FISCAL INFORMATION A. Program Budget Please complete the following summary tables to reflect the budget for your organization and program. All amounts should be rounded to the nearest dollar. Alternatively, please attach single page revenue/expense summary sheets for the program for which funds are requested and a separate summary for the organization. Budget Summa Budget Data FY 2018/19 FY 2017/18 Los Gatos grant funding Requested: $ 5,000 Received: $ 5,000 Total Program budget $ 25,400 $ 24,975 Los Gatos grant as percentage of total Program budget 19.6% 20% Total Organization budget $ 26,100 $ 25,664 Cost per year per unduplicated Los Gatos client $ 86 $ 84 Revenue Summa Revenue Source FY 2018/19 Organizational Budget FY 2018/19 Program Budget FY 2017/18 Organizational Budget FY 2017/18 Program Budget Los Gatos grant $ 5,000 $ 5,000 $ 5,000 $ 5,000 Other municipal funding (please specify:) $ 1,000 Monte Sereno $ 1,000 Monte Sereno $ 1,000 Monte Sereno $ 1,000 Monte Sereno County funding (please specify:) $ $ $ $ State funding (please specify:) $ $ $ $ Federal funding (please specify:) $ $ $ $ Other jurisdiction funding (please specify;) $ $ $ $ Fees for services $ 13,000 $ 13,000 $ 12,115 $ 12,115 Donations $ 5,000 $ 5,000 $ 5,450 $ 5,450 Reserve contingency fund $ 12,000 $ 12,000 $ 12,000 $ 12,000 All other sources (please specify:) $ 2,100 Program ads $ 2,100 Program ads $ 2,090 Program ads $ 2,090 Program ads Total $ 38,100 $ 38,100 $ 38,655 $ 37,655 Expenditure Sunzrnaz Expense Category FY 2018/19 Organizational Budget FY 2018/19 Program Budget FY 2017/18 Organizational Budget FY 2017/18 Program Budget Personnel $ $ $ $ Facility $ $ $ Overhead $ 1,150 $ 450 $ 1,109 $ 420 Materials/Supplies $ 550 $ 550 $ 540 $ 540 Professional Services $ 24,400 $ 24,400 $ 24,015 $ 24,015 Fundraising $ $ $ $ Capital Projects $ $ $ $ Other (please specify:) $ $ $ $ Total $ 26,100 $ 25,400 $ 25,664 $ 24,975 B. Organization Contracts —Has your organization ever had funds withdrawn or a contract terminated for cause, unsatisfactory performance, or questionable costs on any financial statements or audit? NO. If so, please describe. C. Organization Investigations —Is your organization currently on probation or under investigation by any agency which is or was a funding source within the past two years? NO. If so, please describe. D. Budget Alternatives --What alternatives will your organization consider if the requested Community Grant funding is not provided, or provided at a reduced level? We are continually investigating new funding sources and applying for arts grants. We do have a reserve contingency fund which we use if required. Describe how a reduction will affect the achievement of stated goals. Our goals will be completed in any event, while our contingency fund may be diminished. E. Funding Sources --Describe your organization's efforts in pursuing other funding sources. We actively pursue funding through grants from arts organizations, service clubs, corporations, and government entities, as well as through corporate sponsors, program advertisements, and in -kind donations. F. Supplies Disclosure —If any non -expendable supplies with a unit cost of $100 or more are to be purchased with Community Grant funds, please describe. N/A G. Travel Expense Disclosure --If Community Grant funds are to be used for staff travel expenses, please describe. NIA 8 CERTIFICATION The applicant hereby proposes to provide the services as listed in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state, and local regulations, including non- discrimination laws and other assurances as required by the Town of Los Gatos, will be adhered to. Furthermore, as the duly authorized representative of the applicant organization, I certify that the applicant is fully capable of fulfilling its obligation under this proposal as stated herein. This application and the information contained herein are true and correct and complete, to the best of my knowledge, Date: 12n_Ao. zl-, 2018 Los (syvvIANP' Organization Name Executi ., ‘efor keV i tut : - (Print Name) 1,644 eL-0 T -- 9 TOWN OF LOS GATOS ❖ FY 2018/19 APPLICATION FOR COMMUNITY GRANT FUNDING APPLICANT AGENCY/PROGRAM DOCUMENTS CHECKLIST Please submit one copy of each of the documents listed below with your completed application. This page should serve as the cover sheet for that section of your submittal. I. PROGRAM/PROJECT INFORMATION ❑ Fee Schedule, Membership, or other fees II. AGENCY INFORMATION ❑ Current Board of Directors O Articles of Incorporation ❑ Bylaws ❑ Organizational Chart ❑ Brochures, Flyers, Promotional Materials III. FISCAL INFORMATION ❑ Audit or Financial Statement plus Letter of Auditability O Organizational Budget ❑ Internal Revenue Service Ruling Letter (Section 501 c.3) O California Revenue Code (Section 23701 d) 2 Town of Los Gatos FY 2018/19 Community Grant Program Application Summary Project: Project/Program: Museum Explorer Program Program Manager: Maritza Lara-Martinez NUMU (Explorer Program) TOWN OF E03 GATOS CLERK DEPARTMENT RECEIVED 2018 IAA R- 5 A II: 31 Agency: Name of Agency: Los Gatos Museum Association (New Museum Los Gatos) Site Address: 106 E. Main Street, Los Gatos, CA 95030 Name of Executive Director: Lisa Coscino Project Description: Provide brief description of agency, agency goals, and agency services. Describe your program briefly, including who benefits from your program. The Mission of New Museum Los Gatos (NUMU): Engaging community at the intersection of art, history and education through innovative, locally connected and globally relevant exhibits, programs and experiences. Program Funding: Provide prior year fiscal year actual budget amounts and proposed amounts for new fiscal year. Program Funding: FY 2017/18 (adopted) FY 2018/19 (requested) Clients: FY 2017/18 (actual) FY 2018/I9 (proposed) Town annual funding amount $6,500 7,000 Unduplicated annual Los Gatos clients 958 1,250 Total annual program budget $30,522.00 $34,122.00 Total unduplicated annual clients 2,276 2,800 Town $ as % of annual total 21.29% 20,5 l % Los Gatos clients as of annual total 42.1% 44.6° TOWN OF LOS GATOS ❖ FY 2018/19 APPLICATION FOR COMMUNITY GRANT FUNDING APPLICANT AGENCY/PROGRAM DOCUMENTS CHECKLIST Please submit one copy of each of the documents listed below with your completed application. This page should serve as the cover sheet for that section of your submittal. I. PROGRAM/PROJECT INFORMATION • Fee Schedule, Membership, or other fees II. AGENCY INFORMATION • Current Board of Directors • Articles of Incorporation • Bylaws • Organizational Chart • Brochures, Flyers, Promotional Materials III. FISCAL INFORMATION • Audit or Financial Statement plus Letter of Auditability • Organizational Budget Internal Revenue Service Ruling Letter (Section 50] c.3) California Revenue Code (Section 23701 d) TOWN OF LOS GATOS •:• FY 2017/18 2 APPLICATION FOR COMMUNITY GRANT FUNDING GRANT APPLICATION I. PROGRAM/PROJECT INFORMATION A. Contact Information Legal name of organization Los Gatos Museum Association Address of organization 106 E. Main Street Los Gatos, CA 95030 Organization contact (Name, title, telephone number, email address) Lisa Coscino, Executive Director Phone: 408.354.264E E-mail: ed@numulosgatos.org Program name Museum Explorer Program Site address of program 106 E. Main Street Los Gatos, CA 95030 Program manager (Name, title, telephone number, email address) Maritza Lara-Martinez, Education & Programs Coordinator Phone; 408.354.2646 Email: mlaraga,numulosgatos.org Annual grant amount requested FY 2017/18 $7,000 B. Community Need Statement Describe briefly the demonstrated need in the Los Gatos community for the program. Cite data sources as appropriate. As the cultural backbone for Los Gatos and its surrounding communities, the Los Gatos Museum Association has been serving the Los Gatos community for over fifty years. As stated by the Town of Los Gatos, the museum is an important resource that makes the Town of Los Gatos an excellent place to live and raise a family. As New Museum Los Gatos, we now provide the community with extensive exhibition space and a dedicated Education Studio, allowing us to offer fresh perspectives on Bay Area history, art, and the innovation of our times. The museum's education programs provide opportunities for adults, youth and children; however, this Community Grant proposal will focus on programs for children. The Museum's current education program serving elementary age school students is the Museum Explorer Program. The Museum Explorer Program includes school tours for elementary school students, kindergarten through fifth grade. At present, Explorer is offered on various dates throughout the school year, beginning in October, and ending in May. Explorer is designed to introduce elementary school students to art and history themes in an age -appropriate manner within the context of a museum setting. Children from Los Gatos schools participate in large numbers, as do children from the surrounding Santa Clara County communities. The programs provide many children with their first exposure to a museum. Smithsonian research has shown that museum enrichment experiences have a significant positive impact on child development. While art and history learning opportunities can be found in our local schools, galleries, and studios, a museum provides a unique venue for such exploration. The museum educates, lends inspiration, and offers exposure to a range of cultural perspectives with unparalleled resources including historical artifacts and original artwork. As our museum develops in its new location, we would like to continue to expand our educational offerings to the children of our community. The Museum requests Community Grant funding to continue offering the Museum Explorer program year-round, and add additional dates to our program. In addition, we would like to offer a transportation stipend to pay for bus rental, thus enabling more schools' participation, particularly Title 1 schools. The Explorer program speaks to the nature of the Los Gatos community, providing important cultural and learning opportunities to its residents of all ages. For better-resourced schools in Los Gatos and the surrounding communities, the Explorer program is a curriculum supplement. We are working directly with the Los Gatos School district and their elementary school teachers to create lessons complementing classroom curriculum. NUMU meets grade specific curriculum standards, and each program is designed specifically for each visiting class and the topics they have covered thus far. For schools with fewer resources, Explorer is a vital part of classroom planning and often provides an introductory museum experience for many students. For Los Gatos students who come from families with fewer resources, the Museum's educational programming provides key educational and cultural opportunities. c. Direct Services For Human Services and Arts, Culture and Education grant requests, list, describe, and quantify each direct service to be provided annually from July 1, 2017 through June 30, 2018. A Direct Service is a service for which there is an identifiable client. A Participation Agreement (Attachment 2) must be completed by each client receiving the direct services described below. FY 2017/18 FY 2017/18 Description of Service Number of Services Provided Number of Unduplicated Los Gatos Annually Residents served Annually 1. E-newsletters to all elementary teachers 9 e-newsletters 260 teachers within the are sent out to Los Gatos Schools each teacher. (Private & Public Schools) 4 2. Program Tours for Art and History 55 Tours 30 Tours 25-45 students per tour 1,000 children 200 parents Average number of direct services received by each unduplicated client: 9 Average number of direct services received by each unduplicated Los Gatos client: D. Indirect Services List, describe, and quantify each indirect service to be provided annually from July 1, 2017, through June 30, 2018. An Indirect Service is a service for which there is no identifiable client; for example, information and referral that is given over the phone. Description of Service FY 2017/18 Number of Services Provided Annually 1. Emails and phone conversations 250 2. Website announcements and applications 100% available clients to 3. Marketing — Outreach to local businesses, outreach through LGUSD newsletters and elementary Home and School Clubs, 450 F. Demographic Information Provide demographic breakdown of unduplicated Los Gatos residents expected to receive direct services. Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2018/19 Age Under 18 years old 1,000 19 — 50 years old 200 51 years old and over 50 Disability Status Disabled No data Not Disabled No data Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2018/19 Income 50% of median and below No Data 51% - 100% of median No Data Above 100% of Median No Data Sex Female 625 Male 625 Total Total Los Gatos clients 1,250 5 G. Client Participation Requirements Attach appropriate fee schedules, membership requirements, or other fee listings. See attachment. II. AGENCY INFORMATION A. General Information Legal Name of Organization Los Gatos Museum Association Address of Organization Name of Executive Director Date of Incorporation Insurance/Tax Information Federal Employer Tax Number State Employer Tax Number 106 E. Main Street, Los Gatos, CA 95030 Lisa Coscino 1965 94-1619601 3649433-4 Worker's Compensation Carrier/ Policy Number AP Intego (Employers) Policy #EIG207701401 Liability Insurance Carrier Amount of Liability Coverage Property Damage (combined with liability) Combined Single Limit Policy Period The Hartford 1 million per occurrence 2 Million aggregate of annual claims 1 Million January 12, 2018 — January 12, 2019 6 B. Staffing Profile Please complete the chart below for your organization as it will be staffed during FY 2018/19. identify the hours to be devoted to the program for which you are requesting funding, for both employees and volunteers. Position Title Number in Classification Approximat e Hourly Rate Hours Worked per Week Percent of Time to Program Employees Executive Director 1 Salary 40 + 3% Art Curator I $28 12 4% Operations & Membership Manager 1 Salary 40 3% Education Coordinator 1 $17 25 70% Graphic Designer 1 Salary 40 1% History Curator 1 $28 40 4% Community Outreach Coordinator 1 $17 30 8% Contracted storyteller 1 $200 per session N/A 100% Bookkeeper 1 $35 per hour 10 1% C. Agency Experience --Describe the experience of your Agency in providing program services. The Los Gatos Museum Association has delivered educational programs as part of its core mission since its founding in 1965. A variety of education programs have been offered over the past 50 years, all focused on providing children and youth with outstanding learning experiences. The current Explorer program has been in place for 9 years. All Museum Education programs use a combination of trained staff, experienced volunteers, and professional consultants to deliver exceptional learning experiences for student participants. Planning for Explorer generally begins a year in advance in order to allow time to develop program content, communicate with the classroom teachers, and obtain external funding. It is a measure of the excellence of these programs that the Museum has been successful in obtaining the needed financial support for both. Consultants are interviewed and carefully selected to ensure excellent delivery, creative and imaginative curriculum planning, in addition to teaching credentials. D. Staff Experience --Describe the experience of key staff assigned to the program. Maritza Lara-Martinez is our Education & Programs Coordinator. She received her Bachelor's in Human Communications from California State University, Monterey Bay, with a minor in Human Development. She has four years of experience working with students inside the classroom, grades K-10. Ms. Lara currently designs, coordinated, schedules the Explorer program and is part of the Explorer teaching team. She has been working with the Museum since August, 2017. Education Consultant Jerry Falek is part of the Explorer teaching team at the Museum. Mr. Falek is well known throughout the region as an outstanding practitioner of teaching through the imaginative use of story, music, puppets and theater in schools, universities, and community centers. He has an M. Ed in special education and his work has taken him to such diverse places as Soledad Prison and rural Alaska. He provides a wide range of programs for audiences of all ages, from medieval tales of King Arthur, to the writing of Beatrix Potter, to programs of Jewish culture. Mr. Falek is a frequent guest presenter at the Children's Discovery Museum of San Jose. He is on the artist roster for Young Audiences of Northern California and the Alaska State Council of the Arts, and is a regional instructor for the California Arts Project. An important focus of his work has been the social and emotional needs of at -risk children. Art Curator, Marianne McGrath, M.A. has more than 18 years of experience in developing and delivering art education programming in a variety of contexts. From 2008-2011 she served as the Museum's Education Curator, managing and originating many of the core features of the Explorer Program. Under her leadership, the Explorer Program grew to include many teachers both in Los Gatos and the surrounding communities that incorporated the program into their curriculum planning. Mrs. McGrath has also served in other positions in the Museum and has been Art Curator since 2013. Julie Ho is NUMU's graphic and exhibit designer. She has a B.F.A. in Painting and a Graduate's Certificate in Science Illustration. Julie has an extensive background in graphic design for museums and will create the collateral materials for Museum Explorer. Kimberly Snyder, Operations and Membership Manager, holds B.A. degrees in both History of Art and Visual Culture and Business Management Economics with an emphasis on accounting. Ms. Snyder handles the invoicing for Museum Explorer as well as all general operations for the Museum. She has been with the Museum since the beginning of 2014. Leslie Sanchez is the Community Outreach Coordinator. She holds an Associate's in Biology and a minor in Interior Design. Ms. Sanchez will work with Ms. Lara to connect directly with Los Gatos schools and organizations, informing parents and teachers of our program opportunities, and marketing the program to a wider audience. E. Staffing Plan --Describe any anticipated staffing changes to occur during FY 2018/19. No staffing changes are anticipated. 8 III. FISCAL INFORMATION A. Program Budget Please complete the following summary tables to reflect the budget for your organization and program. All amounts should be rounded to the nearest dollar. Alternatively, please attach single page revenue/expense summary sheets for the program for which funds are requested and a separate summary for the organization. Budget Summar Budget Data FY 2018/19 FY 2017/18 Los Gatos grant funding Requested: $7,000 Received: $6,500 Total Program budget $34,122 $30,522.00 Los Gatos grant as percentage of total Program budget 20.5% 21.3% Total Organization budget FY18/19 Budget is approved in June $695,349.00 Cost per year per unduplicated Los Gatos client $12.19 $13.41 Revenue Summary Revenue Source FY 2018/19 Organizational Budget FY 2018/19 Program Budget FY 2017/18 Organizational Budget FY 2017/18 Program Budget Los Gatos grant $13,000 $7,000 $9,300 $6,500 Other municipal funding (please specify: ) $ N/A $N/A $N/A $N/A County funding (please specify:) $ N/A $N/A $N/A $N/A State funding (please specify:) $ N/A $N/A $N/A $N/A Federal funding (please specify:) $ N/A $N/A $N/A $N/A Other jurisdiction funding (please specify:) $ N/A $N/A $N/A $N/A Fees for services $N/A $14,000 $ 214,445.00 $10,000 Donations $N/A $7,500 $ 330,094 $7,800 Reserve contingency fund $0 $0 $0 $0 All other sources (please specify: Grants + Foundations) $N/A $5,500 $72,450 $5,500 Total $ N/A $34,000 $ 634,289 $29,800 9 Expense Category FY 2018/19 Organizational Budget FY 2018/19 Program Budget FY 2017/18 Organizational Budget FY 2017/18 Program Budget Personnel $N/A $15,680 $448,431 $15,680 Facility $N/A $3,800 $56,654.00 $0 Overhead $N/A $3,042.00 $25,321..00 $3,042.00 Materials/Supplies $N/A $600.00 $72,093.00 $800.00 Professional Services $N/A $11,000 $82,120 $9,000 Fundraising $N/A $0 $8,729 $0 Capital Projects $N/A $0 0 $0 Other (please specify: Bus Stipends) SN/A $2,000 $2,000 $2,000 Total $N/A $34,122.00 $695,349,00 $30,522.00 B. Organization Contracts --Has your organization ever had funds withdrawn or a contract terminated for cause, unsatisfactory performance, or questionable costs on any financial statements or audit? if so, please describe. No C. Organization Investigations --Is your organization currently on probation or under investigation by any agency which is or was a funding source within the past two years? If so, please describe. No D. Budget Alternatives --What alternatives will your organization consider if the requested Community Grant funding is not provided, or provided at a reduced level? Describe how a reduction will affect the achievement of stated goals. There will be no impact on the achievement of the basic two weeks of the Explorer program. However, the Museum will continue to seek private and foundation funding to increase the offered dates and to offer scholarships to Title l Schools in Los Gatos. E. Funding Sources --Describe your organization's efforts in pursuing other funding sources. The Museum continues to seek private donations, restricted gifts, and foundation and corporate funding for its programs. The Executive Director and Development Team are in close communication with potential donors through personal meetings, cultivation events and general Museum activities. Development consultant expertise is sought from time to time. Granting 10 opportunities are actively researched and applications are continually submitted. F. Supplies Disclosure --If any non -expendable supplies with a unit cost of $ l00 or more are to be purchased with Community Grant funds, please describe. No G. Travel Expense Disclosure --If Community Grant funds are to be used for staff travel expenses, please describe. No CERTIFICATION The applicant hereby proposes to provide the services as listed in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state, and local regulations, including non- discrimination laws and other assurances as required by the Town of Los Gatos, will be adhered to. Furthermore, as the duly authorized representative of the applicant organization, I certify that the applicant is fully capable of fulfilling its obligation under this proposal as stated herein. This application and the information contained herein are true and correct and complete, to the best of my knowledge. Date: 15 (v 1 , 2017 Los Gatos Museum Association Organization Name Executive hector or hD (Print Name) 11 ATTACHMENT 1 SAMPLE PARTICIPATION AGREEMENT Over the course of the contract period, a grantee may be required submit Participation Agreements similar to this sample. Do not submit this Sample Participation Agreement with your completed application. , a nonprofit corporation, provides certain services to individuals and families in Santa Clara County. Partial funding (subsidy) for these services is provided under contract by the Town of Los Gatos to this Agency. This information is reviewed for quality control and/or auditing purposes only. Therefore it is held in confidence by the Agency, the Town, and the Federal representatives and not considered "Public Information." The purpose of this Participation Agreement is as follows: I . To have the client acknowledge the request and receipt of needed services and provide the client with an opportunity to evaluate such services. 2. To have the client authorize the release of demographic information to the Agency/the Town. 3. To assure the client that information about them is held in confidence and not considered public information and that only statistical information about all clients served is reported. 4. To have the client hold harmless and release from liability the Agency, the Town, and their respective employees, officers, and agents in the event of any suit, claim, loss, damage, or obligation arising out of/or attributed to any of the Agency's programs. Please complete the following: Name: Age: Address: Phone: Sex (check one): ❑ Male ❑ Female Disability Status (check one): o Disabled Female Head of Household (check one): Income Level (check one): o 30% of median and below o 31% - 50% of median o 51 % - 80% of median ❑ 81% - 100% of median ❑ Above 100% of median o Not Disabled ❑ Yes ❑ No 1 understand that this agreement is an affidavit and certify that the information provided above is true and complete. Signature Date 12 NUMU (Video History) Town of Los Gatos FY 2018/19 Community Grant Program Application Summary TOWN OF LOS CLERK DEPARTMENT RECEIVED 1d8MAR —5 AU:31 Project: Project/Program: Video Histories of LGHS Alumni with KCAT Program Manager: Lisa Coscino Agency: Name of Agency: Los Gatos Museum Association/New Museum Los Gatos Site Address: 106 E. Main Street Name of Executive Director: Lisa Coscino Project Description: Provide brief description of agency, agency goals, and agency services. Describe your program briefly, including who benefits from your program. The Mission of New Museum Los Gatos (NUMU): Engaging community at the intersection of art, history and education through innovative, locally connected and globally relevant exhibits, programs and experiences. Program description: New Museum Los Gatos (Los Gatos Museum Association) is seeking funding for a collaborative partnership with KCAT, our community public TV station. For 36 years KCAT has been the non-profit station and digital media center serving Los Gatos and Monte Serena. KCAT encourages the entire community to tell their story through the power of TV and social media platforms. Continuing this legacy and in support of our upcoming exhibition Sis Boom Bah! The Life and Times of Los Gatos High School. NUMU will record the video histories of LGHS alumni for use in our exhibition, to create community based programing, to broadcast to their 20,000 Comcast subscribers and to archive these valuable histories of the residents of Los Gatos Program Funding: Provide prior year fiscal year actual budget amounts and proposed amounts for new fiscal year. Program Funding: FY 2017/18 (adopted) FY 2018/19 (requested) Clients: FY 2017/18 (actual) FY 2018/19 (proposed) Town annual funding amount N/A $6.000 Unduplicated annual Los Gatos clients N/A 40,000 Total annual program budget N/A $24,000 Total unduplicated annual clients N/A 50,000 Town $ as % of annual total N/A 25% Los Gatos clients as % of annual total N/A 90% 1 TOWN OF LOS GATOS 0. FY 201$/19 APPLICATION FOR COMMUNITY GRANT FUNDING GRANT APPLICATION I. PROGRAM/PROJECT INFORMATION A. Contact Information Legal name of organization Los Gatos Museum Association Address of organization 106 E. Main Street Los Gatos, CA 95030 Organization contact (Name, title, telephone number, email address) Lisa Coscino Executive Director 408.354.2646 ED@numulosgatos.org Program name Visual Histories of LGHS Site address of program 106 E. Main Street Los Gatos Program manager (Name, title, telephone number, email address) Lisa Coscino Executive Director 408.354.2646 ED@numuiosgatos.org Annual grant amount requested FY 2018/19 $6,000 B. Community Need Statement Describe briefly the demonstrated need in the Los Gatos community for the program. Cite data sources as appropriate. Since opening its doors at the current location in 1908, Los Gatos High School has remained one of the town's most iconic institutions. The historic trajectory of LGHS has run parallel to some of the most significant social and cultural events in this, and the last two, centuries. We want to record and share the personal stories of triumph and tragedy of alumni and current students. From its small town roots and the settling of the American West in 1887 and into the new millennium, multiple generations of Los Gatos teenagers left indelible footprints up and down the hallways of Los Gatos High School and the town itself. We want the community to know who they were. Recording video histories will archive what it's meant to be a Wildcat over the course of 100 + years. We will relive highlights of Wildcat dominance in sports, the arts, student activities, and the social events that created lasting friendships and a distinct campus community. And we will learn the evolution of high school events and traditions over the last century, check in on notable alumni who left their mark locally and on the world stage and save these stories for future generations. 3 c. Direct Services For Human Services and Arts, Culture and Education grant requests, list, describe, and quantify each direct service to be provided annually from July 1, 2018 through June 30, 2019. A Direct Service is a service for which there is an identifiable client. A Participation Agreement (Attachment 2) must be completed by each client receiving the direct services described below. Description of Service FY 2018/19 Number of Services Provided Annually FY 2018/19 Number of Unduplicated Los Gatos Residents served Annually 1.Outreach for stories 6 community meetings 300 2.Video interview filming 2 -3 hour sessions 40 3. Video panel live filming 6 600 4. Video histories in exhibit 6 monitors with rotating content 20,000 annual visitors 5. Average number of direct services received by each unduplicated client: Average number of direct services received by each unduplicated Los Gatos client: D. Indirect Services List, describe, and quantify each indirect service to be provided annually from July 1, 2018, through June 30, 2019. An Indirect Service is a service for which there is no identifiable client; for example, information and referral that is given over the phone. Description of Service FY 2018/19 Number of Services Provided Annually 1. KCAT broadcasting of panels 20,000+ 2. Website announcements 100% clients available to 3. Marketing outreach to community groups 10,000 4. 4 F. Demographic Information Provide demographic breakdown of unduplicated Los Gatos residents expected to receive direct services. Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2018/19 Age Under 18 years old N/A 19 — 50 years old N/A 51 years old and over N/A We expect 20,000+ visitors to NUMU. We do not maintain demographic details related to age. 20,000+ Disability Status Disabled N/A Not Disabled N/A. Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2018/19 Income 50% of median and below N/A 51% - 100% of median N/A Above 100% of Median N/A Sex aminmfaxa S Female N/A Male N/A Total Total Los Gatos clients 40,000+ G. Client Participation Requirements Attach appropriate fee schedules, membership requirements, or other fee listings. II. AGENCY INFORMATION A. General Information Legal Name of Organization Los Gatos Museum Association Address of Organization 106 E. Main Street Name of Executive Director Lisa Coscino Date of Incorporation 1965 Insurance/'Tax Information Federal Employer Tax Number 94-1619601 State Employer Tax Number 3649433-4 Worker's Compensation Carrier/ Policy Number AP Intego/ Employers Policy #EIG207701401 5 Liability Insurance Carrier Hartford Amount of Liability Coverage 1 million per occurrence Property Damage (combined with liability) 2 Million aggregate of annual claims Combined Single Limit I Million Policy Period January 12, 2018 — January I2, 2019 B. Staffing Profile Please complete the chart below for your organization as it will be staffed during FY 2018/19. Identify the hours to be devoted to the program for which you are requesting funding, for both employees and volunteers, Position. Title Number in Classification Approximate Hourly Rate Hours Worked per Week Percent of Time to Program Employees Executive Director 1 salary 40 5% Education Coordinator 1 hourly 25 10% Volunteers C. Agency Experience --Describe the experience of your Agency in providing program services. The Los Gatos Museum Association has delivered cultural and historical educational programs as part of its core mission since its' founding in 1965. These programs have focused on providing children and adults with outstanding learning experiences. All NUMU education programs use a combination of trained staff, experienced volunteers, and professional consultants to deliver exceptional learning experiences for participants. It is a measure of the excellence of these programs that the NZJIVIU has been successful in obtaining the needed financial support for all our programming YOY. Credentialed consultants are interviewed and carefully selected to ensure excellent delivery, creative and imaginative curriculum planning. Video Histories of LGHS Alumni with KCAT will follow the same high quality measures that have created success for us in the past. Partnering with KCAT will allow us to produce quality video that can be edited for many purposes and uses. KCAT's broadcasting reach will extend NUMU's reach far beyond the walls of the museum and will last far longer than the exhibition. As the culture and history steward for Los Gatos, NUMU will keep the video archived for the future residents, LGHS alums and armchair historians to view, learn from and share. D. Staff Experience --Describe the experience of key staff assigned to the program. Lisa Coscino is the NUMU Executive Director. She received her AB (Bachelors with comprehensive exam) from Occidental College in Psychology with a double minor in Art History and Religious Studies. Lisa owned and operated an eponymous gallery in Pacific Grove for 10 years before shifting her focus to the on -profit world. She was Executive Director of Marine Mammal Conservation Through the Arts and The Museum of Monterey before leading the relocation and re -branding of New Museum of Los Gatos in 2014. Maritza Lara-Martinez is the NUMU Education & Programs Coordinator. She received her Bachelor's in Human Communications from California State University, Monterey Bay, with a minor in Human Development. She has four years of experience working with students inside the classroom, grades K-10. Ms. Lara currently designs, coordinated, schedules the Explorer program and other educational programming and is part of the Explorer teaching team. She has been working with the Museum since August, 2017. Melissa Toren is the Executive Director of KCAT TV 16, a local television and digital media center serving Los Gatos, Monte Sereno and neighboring South Bay Area California communities. As Executive Director, Melissa manages the broadcast of public, educational and government programming. As Executive Producer, she creates innovative, compelling, informative and entertaining original content that enables the community to amplify their messages, tell their stories and express their views through various multimedia platforms. Laura Clark Murray, Marketing & Production Laura brings to KCAT years of experience as an Executive Producer, Product Manager, Marketing Director and Software Engineer in the high-tech world with companies including Apple Computer and Electronic Arts. Passionate about history, heritage and small vibrant American towns, KCAT allows Laura to combine her professional expertise with her love for Los Gatos. Laura, her husband and three children have lived in Los Gatos for almost a decade. Roger Apolinar, Cinematographer Roger is an video producer with extensive experience in digital cinema, photography, producing, lighting, visual effects, motion graphics, and non -linear editing. In addition to KCAT, his clients include the Golden State Warriors and San Francisco Giants organizations. Roger's position as the Dynamic Aerial Imagery professor at the Academy of Art University in San Francisco and as the instructor of KCAT's aerial cinematography classes and camps, enables him to combine his passions for cinematography, drones, and teaching. Dave Kustin, Editor Dave launched his second career in vidcography in 2006, after more than two decades working as a software engineer. He began contracting on KCAT projects in 2015 bringing deep experience in public access television from his pervious work with a TV station in Massachusetts. Dave earned an Architectural Engineering degree from Penn State. E. Staffing Plan --Describe any anticipated staffing changes to occur during FY 2018/19. No staffing changes are planned 7 III. FISCAL INFORMATION A. Program Budget Please complete the following summary tables to reflect the budget for your organization and program. All amounts should be rounded to the nearest dollar. Alternatively, please attach single page revenue/expense summary sheets for the program for which funds are requested and a separate summary for the organization. Budget Summa Budget Data FY 2018/19 FY 2017/18 Los Gatos grant funding Requested: $6,000 Received: 0 Total Program budget $24,000 $0 Los Gatos grant as percentage of total Program budget 25% N/A Total Organization budget FY18/19 budget approved in June 2018 $695,349 Cost per year per unduplicated Los Gatos client $1.20 N/A Revenue Summar Revenue Source FY 2018/19 Organizational Budget FY 2018/19 Program Budget FY 2017/18 Organizational Budget FY 2017/18 Program Budget Los Gatos grant (2 grants) $13,000 $6,000 $9,300 SN/A 1 Other municipal funding (please specify: ) $N/A $N/A $N/A $ N/A County funding (please specify:) $N/A $N/A $N/A $ N/A State funding (please specify:) $N/A $NIA $N/A $ N/A Federal funding (please specify:) SN/A $N/A SN/A $ N/A Other jurisdiction funding (please specify:) $N/A $N/A $N/A $ N/A Fees for services $N/A $8,000 $214,445 $ N/A Donations $N/A $10,000 $330,094 $ N/A Reserve contingency fund $0 $0 $0 $ N/A All other sources (please specify:)grants and foundations $N/A $0 $80,450 $ N/A Total N/A $24,000 $695,349 $ N/A 8 Expenditure Summer Expense Category FY 2018/19 Organizational Budget FY 2018/19 Program Budget FY 2017/18 Organizational Budget FY 2017/18 Program Budget Personnel $ N/A $4,000 $448,431 $ N/A Facility $ N/A $ $56,654 $ N/A Overhead $ N/A $1,500 $25,321 $ N/A Materials/Supplies $ N/A $2,000 $72,093 $ N/A Professional Services $ N/A $16,000 $84,120 $ N/A Fundraising $ N/A $500 $8,729 $ N/A Capital Projects $ N/A $ $0 $ N/A Other - (please specify:) $ N/A $ $0 $ N/A Total $ N/A $24,000 $695,349 $ N/A B. Organization Contracts --Has your organization ever had funds withdrawn or a contract terminated for cause, unsatisfactory performance, or questionable costs on any financial statements or audit? If so, please describe. NO C. Organization Investigations --Is your organization currently on probation or under investigation by any agency which is or was a funding source within the past two years? If so, please describe. NO D. Budget Alternatives --What alternatives will your organization consider if the requested Community Grant funding is not provided, or provided at a reduced level? Describe how a reduction will affect the achievement of stated goals. We will continue to seek funding for this project through private donations. If we cannot secure the appropriate funding we will reduce programing frequency, density of content. E. Funding Sources --Describe your organization's efforts in pursuing other funding sources. The Museum continues to seek private donations, restricted gifts, and foundation and corporate funding for its programs. The Executive Director and Development Team are in close communication with potential donors through personal meetings, cultivation events and general Museum activities. Development consultant expertise is sought from time to time. Granting opportunities are actively researched and applications are continually submitted. 9 F. Supplies Disclosure --If any non -expendable supplies with a unit cost of $100 or more are to be purchased with Community Grant funds, please describe. NO G. Travel Expense Disclosure --If Community Grant funds are to be used for staff travel expenses, please describe. NO CERTIFICATION The applicant hereby proposes to provide the services as listed in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state, and local regulations, including non- discrimination laws and other assurances as required by the Town of Los Gatos, will be adhered to. Furthermore, as the duly authorized representative of the applicant organization, I certify that the applicant is fully capable of fulfilling its obligation under this proposal as stated herein. This application and the information contained herein are true and correct and complete, to the best of my knowledge. N _ Date: '5 (VI - v`' 1 , 2018 Lcs C-cifcs Husevrn MS0b, Organization Name Executive 1 irector (Print Name) c»(Y'o I0 TOWN OF LOS GATOS ❖ FY 2018/19 APPLICATION FOR COMMUNITY GRANT FUNDING APPLICANT AGENCY/PROGRAM DOCUMENTS CHECKLIST Please submit one copy of each of the documents listed below with your completed application. This page should serve as the cover sheet for that section of your submittal. I. PROGRAM/PROJECT INFORMATION ❑ Fee Schedule, Membership, or other fees II. AGENCY INFORMATION ❑ Current Board of Directors • Articles of Incorporation ❑ Bylaws ❑ Organizational Chart ❑ Brochures, Flyers, Promotional Materials III. FISCAL INFORMATION ❑ Audit or Financial Statement plus Letter ofAuditability ❑ Organizational Budget CJ Internal Revenue Service Ruling Letter (Section 501 c.3) ❑ California Revenue Code (Section 23701 d) 2 Veterans Memorial Foundation VETERANS * * MEMORIAL 6. SUPPOR.T * FOUNDATION ** OF Los carol February 22.2018 Community Grant Committee Town of Los Gatos TOWN OF LOS GAT0S CLERKS DEPARTMENT R Z018 MAR -5 P 2: 35 Subject: Community Grant Application for the Veterans Memorial & Support Foundation Dear Community Grant Committee Associates: It gives us great pleasure to submit our grant application for $8,000 for an educational program within the "Arts and Education" category. This funding will contribute to a very exciting endeavor for the Town of Los Gatos in support of an inaugural Veterans Foundation and Support Foundation community Veterans Day celebration. This inaugural event coincides with a special date in America's history, the 100th anniversary celebration of the event that served as the roots to what later became known as Veterans Day in the U.S. November 11, 2018 is the 100th anniversary of the armistice that was signed between the Allies of World War I and Germany, which took place at the 11 th hour on the 11 th day of the l l th month of 1918. The United States previously observed Armistice Day in recognition of this historical date in history. The U.S. holiday was later renamed "Veterans Day" in 1954. What better date to launch a Town tradition in recognition of America's Veterans than on the 100`h anniversary of Veterans Day itself! This commemoration serves to educate the community and to support our efforts to build a permanent veterans memorial in Los Gatos through our Veterans Foundation Liberty Capital Campaign. Your approval for funds will be put to excellent use immediately towards delivering honor, respect and gratitude to America's service members, veterans, their families, Emergency Services personnel who support our homeland security and the Los Gatos heroes of 9/11's United flight 93. Please feel free to contact the named parties cited herein for more information. We would be grateful for the opportunity to tell you about this program. Let us stand united as one; united in gratitude; united in Los Gatos. Sincerely, The Veterans Memorial & Support Foundation Board Honoring Our Veterans VETERANS MEMORIAL & SUPPORT FOUNDATION OF LOS GATOS P.O. BOX 1696, LOS GATOS, CA 95031 • www.HonorAVet.or2 • 408-221-1512 2 Town of Los Gatos FY 2018/19 Community Grant Program Application Summary Project: Project/Program: Celebrating Liberty and the 1 00t Anniversary of Armistice Day, the End of World War 1 Program Manager: Major General Kent Hillhouse U,S, Army (Ret.) Name of Agency: VETERANS MEMORIAL & SUPPORT FOUNDATION OF LOS GATOS Site Address: 110 East Main Street, Los Gatos CA 95030 Mailing Address: P.O. Box 1696, Los Gatos CA 95031 Name of Executive Director: Major General Kent Hillhouse U_S_ Army (Ret.) Project Description: Provide brief description of agency, agency goals, and agency services. Describe your program briefly, including who benefits from your program. The Veterans Memorial & Support Foundation of Los Gatos exists to honor and support U.S. military service members, veterans and their families. The Veterans Memorial & Support Foundation of Los Gatos is a non-profit staffed by volunteers who are passionate about delivering compassion to those who have been so courageous in support of America's freedom. Our network of generous donors and volunteers share a mission to: a) Establish and support the on -going maintenance of a veterans' memorial in Silicon Valley that delivers honor, respect and gratitude to active U.S. military service members and veterans and to their contributions and sacrifices in support of America's freedom. b) Educate the community on the sacrifices borne by those who have defended America's freedom. c) Support yellow ribbon programs in perpetuity that deliver humanitarian support to service members, veterans and their families and in particular, provide support to heroes returning from deployment in adjusting to civilian life. 3 The main focus of the Foundation in this proposal "Celebrating Liberty, Celebrating Veterans —the End of World War I" is to deliver on the second tenet of its mission — to "educate the community on the sacrifices borne by those who have defended America's freedom" in tribute to the men and women who have honorably served America in the United States Army, Navy, Marines, Air Force, Coast Guard, Merchant Marines, and their contributions in support of natural disaster recovery, humanitarian aid, and in defense of America's freedom. The Veterans Foundation also intends to recognize through the construction of The Flame of Liberty, a memorial in the Town of Los Gatos, Emergency Services First Responders who combine forces with the United States military in playing a pivotal role in homeland security and finally, local Los Gatos 9/11 heroes aboard United Flight 93 who attempted to retake cockpit control away from hijackers. See details that follow regarding the memorial. Foundation Board members and advisors include notables Major General Kent Hillhouse, US Army (Ret.), Francis J. Harvey, 19th Secretary of the U.S. Army, Gil Decker, former Assistant Secretary of the U.S. Army, John Lochner, veteran and two-time mayor of Los Gatos, James Free, veteran and former Chairman Emeritus of the Campbell Veterans Memorial, LT COL Thomas Griffin U.S. Army (Ret.) and Founder, Veterans Transition Center and multiple veterans from all branches and patriotic grateful citizens. About The Flame of Liberty Memorial In 2017, the Los Gatos Town Council approved a donation of land use for placement of the memorial at the Civic Center in downtown Los Gatos. The right to build a memorial in such a prominent place in the center of Town is both a profound privilege and responsibility. Until this memorial is fiinally constructed we will schedule events at other venues in the Los Gatos community. In short, our organization conducts celebrations in connection with national holidays that serve to educate the community on the spirit of those who have put so much on the line to rise to the limitless horizons of freedom. The Foundation board conducted two national artists challenges to secure renderings for a memorial design and recommended its final choice following public and stakeholder 4 reviews of the top two designs to the Los Gatos Town Council. This has been a vigorous five and a half years endeavor engaging the support of eleven consultants in the process. The Town Council approved the town recommended real estate, recommended conceptual design, and architectural plans for The Flame of Liberty Memorial by internationally acclaimed artist Frank Kocian Morris. The Flame of Liberty by Artist Frank Kocian Morris: https://vimeo.com/171576336 The Flame of Liberty - Artist's Inspiration: https://youtu.be/wALP63Mg8ms Mr. Morris is an award -winning designer, illustrator, portrait artist and Master Designer for the U.S. Mint. His design clients include Bantam Books, Dell Books, Simon & Schuster, New American Library, Warner Brothers, Random House, Vintage Books, major television networks and advertising agencies. His paintings are in private collections, appear in magazines such as Newsweek and New York Magazine and include luminaries - Presidents Ronald Reagan and Jimmy Carter, First Ladies Nancy Reagan and Rosalynn Carter, Hamilton Jordan, the Shah of Iran and government dignitaries. The U.S. Department of the Treasury chose Mr. Morris for the artist -elite position of Master Designer for the U.S. Mint for whom he has designed multiple coins and medals, most notably the Congressional Gold Medals that honor the WWII Native American Code -Talkers_ Finally, what better person to create a design for veterans than that of a veteran himself - Mr. Morris served in the U.S. Air Force. Finally and of great significance, the Foundation supports in perpetuity, the critical needs of service members, veterans and their families through Yellow Ribbon programs, the nature of which vary depending upon the greatest needs supportable within the resources of the Foundation over the course of time. Brief Program Summary This funding will contribute to a very exciting endeavor for the Town of Los Gatos in support of an inaugural Veterans Foundation and Support Foundation community Veterans Day celebration, This inaugural event coincides with a special date in America's history, the 100th anniversary celebration of the event that served as the roots to what later became 5 known as Veterans Day in the U.S. November 11, 2018 is the 100th anniversary of the armistice that was signed between the Allies of World War I and Germany, which took place at the 11 th hour on the 11 th day of the 11 `h month of 1918. The United States previously observed Armistice Day in recognition of this historical date in history. The U.S. holiday was later renamed "Veterans Day" in 1954. What better date to launch a Town tradition in recognition of America's Veterans than on the 100th anniversary of Veterans Day itself. The day's event will include invited participants: military notables, historians, Town of Los Gatos Mayor and Town Council members, to participate in the program. The Foundation intends to incorporate support from First Responders — Town of Los Gatos Police and Fire, a military color guard, National and California State Guard personnel in conducting ceremony elements plus a chorus (military or local educational group) to incorporate music into the program. Reception will follow. Living Town veterans from WWII and the Korean War will be provided premier seats followed by Vietnam veterans and veterans of later service years. • Community need for the program: Celebrating Liberty, Celebrating Veterans - the End of World War I as with many of our events and in keeping with our overall mission we provide a time and place for healing through commemoration activities • Uniqueness of program, lack of duplications in service: There is no other program suggesting a celebration program of this type in the Town of Los Gatos. • Qualifications and experience of the agency and its staff: The all -volunteer board has worked to produce similar events annually each Veterans Day at schools like Fisher Middle School. The board members are successful in civilian life in business, politics and community service. See the attached Board Member List • Past performance in providing established services and meeting Town requirements. The Foundation has been active in community engagement through programs with members of all ages in our Town since 2012 as well as veterans groups in the Bay Area. • Effectiveness in serving an identified audience: We serve the community through our outreach programs to local schools, community groups and veterans programs. • Community involvement in program, including volunteers: We have an all -volunteer board and fundraising committee (39 people in all) and an email list of interested parties in the community of 665 names, mostly from Los Gatos.- • Number of Los Gatos clients served vs. total clients served (unduplicated clients) through all our programs: We estimate that we will serve 2,250 Los Gatos residents and 1,750 non -Los 6 Gatos residents for a total of 4,000 • Cost per Los Gatos resident vs. cost per non -Los Gatos resident: All our services are free. Allocating the $8,000 cost of the project is $8,000/4.000 = $2 per resident of Los Gatos and $2 per non -Los Gatos resident. • Target audience for program (e.g., youth, seniors, and students): We target all ages youth in school, their parents, veterans (many of whom are also seniors). • Percent of total program budget requested from Town Approximately: $8,000/$16,000 = 50% • Reasonable cost: We are working to secure reduced costs from those who will provide their services as either in -kind or at a reduced rate for labor/materials. Program Funding: Provide prior year fiscal year actual budget amounts and proposed amounts for new fiscal year. Program Funding: FY 2017/18 (adopted) FY 2018/19 (requested) Clients: FY 2017/18 (actual) FY 2018/19 (proposed) Town annual funding amount N/A $8,000 Unduplicated annual Los Gatos clients N/A 2,-250 Total annual program budget N/A $16,000 Total unduplicated annual clients N/A 4,,000 Town $ as % of annual total N/A 50% Los Gatos clients as % of annual total N/A 56% TOWN OF LOS GATOS 4• FY 2018/19 APPLICATION FOR COMMUNITY GRANT FUNDING APPLICANT AGENCY/PROGRAIVI DOCUMENTS CHECKLIST Please submit one copy of each of the documents listed below with your completed application. This page should serve as the cover sheet for that section of your submittal. I. PROGRAM/PROJECT INFORMATION f Fee Schedule, Membership, or other fees None We Charge no Fees 7 AGENCY INFORMATION ✓ Current Board of Directors —Attached ✓ Articles of Incorporation —Attached 1 Bylaws —Attached ✓ Organizational Chart —Attached ✓ Brochures, Flyers, Promotional Materials —Attached M. FISCAL INFORMATION ✓ Audit or Financial Statement plus Letter of Auditability Attached ✓ Organizational Budget —Attached ✓ Internal Revenue Service Ruling Letter (Section 501 c.3) —Attached ✓ California Revenue Code (Section 23701 d) —Attached TOWN OF LOS GATOS + FY 2018/19 APPLICATION FOR COMMUNITY GRANT FUNDING GRANT APPLICATION I. PROGRAMIPRO.IECT INFORMATION A. Contact Information Legal name of organization Veterans Memorial & Support Foundation of Los Gatos Address of organization P.O. Box 1696, Los Gatos, CA 95031 Organization contact Major General Kent Hillhouse U_S_ - Army (Ret.) 8 (Name, title, telephone number, email address) Foundation. President 408-221-1512 —Cell 408-615-3413 — Work kent.hillhouse@cushwake.com Program name Celebrating Liberty the End of World War I Site address of program 110 East Main Street, Los Gatos, CA 95030 Program manager (Name, title, telephone number, email address) Major General Kent Hillhouse U.S. - Army (Ret.) Foundation President 408-221-1512 — Cell 408-615-3413 — Work kent.hillhouse@cushwake.com Annual grant amount requested FY 2018/19 $8,000 B. Community Need Statement Describe briefly the demonstrated need in the Los Gatos community for the program. Cite data sources as appropriate. A time and a place —to remember and to heal Celebrating Liberty, Celebrating Veterans - the End of World War 1 can serve this purpose. A place to heal, a place to bind up emotional wounds, a place to remember those who gave their last full measure to protect our freedoms and those of others around the world -- these can be the roles of a commemorative event. This year we will meet in a temporary location —in the future at a more permanent location. America's service members, veterans and families are responsible for defending the freedom all members of Los Gatos and surrounding communities enjoy. Throughout the proud history of Los Gatos, residents and community members have participated in the ongoing struggle to defend and maintain our freedom — many giving their own lives. Currently, there are over 80 members of our own Los Gatos community serving on active duty. Yet today, there is no place to memorialize, heal and celebrate the sacrifice of the men and women who have answered the call. In 2012, the Veterans Memorial & Support Foundation was created to set this change in motion, The commemoration will celebrate not just the past but also active service members and veterans 9 of the U.S. Army, Navy, Marines, Coast Guard, Air Force, Merchant Marines, and their families. It will also recognize local Emergency Service personnel and the Los Gatos heroes who bravely attempted to regain cockpit control during the September 11, 2001 hijacking of United Flight 93. The memorial will serve to commemorate the liberty made possible by all U.S. veterans with the support of Emergency Services who today play a great role in homeland security and local heroic citizens, showing that Los Gatos cares. c. Direct Services For Human Services and Arts, Culture and Education grant requests, list, describe, and quantify each direct service to be provided annually from July 1, 2018 through June 30, 2019. A Direct Service is a service for which there is an identifiable client. A Participation Agreement (Attachment 2) must be completed by each client receiving the direct services described below. Description of Service FY 2018/19 Number of Services Provided Annually FY 2018/19 Number of Unduplicated Los Gatos Residents served Annually 1. Town of Los Gatos July 4 Celebration • Support of town weekend block party event • Color guard support & booth at Town July 4 celebration at Oak Meadow Park • Serves to educate the community on the values of freedom and contributions of our community 2 days of events over the coming year. Significant number of Los Gatos residents participate in this community event 2. Fisher Middle School Veterans Day event • Veterans interviews • Presentation to Students, Faculty, Veterans & Parents • Serves to educate Middle School students on the contributions of veterans to America One time event that begins in the fall with multiple veteran interviews plus celebration day event at Fisher Middle School. Entire Fisher Middle School Community of 350 middle school students, and another 350 faculty members, parents, invited guests. Very significant because this is the 100th Anniversary of the end of World War I. (11/11/1918) 3. Fiesta de Artes Booth in Childrens' Quarters Educates children attending the Fiesta de Artes on fag etiquette, patriotic holidays and other American values surrounding freedom. One time event Over 20,000 attendees from all over the San Francisco Bay area. 4. Palo Alto VA Christmas Program/Fisher House Polytrauma Christmas Celebration • Holiday giveaways to service members currently in rehab/healing at the Palo Alto VA in the Poly Trauma Center & Spinal Cord Injury Center. (See 2016 reference cited on p. 15, of the Los One time event. All service members, veterans currently in rehabilitation or healing at the Palo Alto VA. Numbers vary depending upon the number of patients in treatment. The team also delivers dinners 10 Gatos Living Magazine, February 2017 Issue section provided in the Documents section of this application.) 5. Hosting a booth at Jazz on the PIav7 • Support of a booth (pending availability over the course of the ten week concert series.) Exposure and Fund Raising to family members and patients usually once over the course of the year.. (2016 event supported $4500 of holiday presents to 44 patients and their families at the VA Hospital in Palo Alto.) All concert attendees 6. Presentations planned to community organizations: • LG Rotary Morning • LG Rotary Afternoon • LG Kiwanis • LG Lions • Vietnam Veterans of America • Daughters of the American Revolution • Senior residents at LG Assisted Living Communities in our town • Town Council • Los Gatos Recreation Senior Community Center • Los Gatos Korean War Veterans see photo shoot • Chamber of Commerce Averaging 20 events per year • 1,670 estimated are in attendance across these events • 379 veterans owned firms 7. Stand Down Weekend for Homeless Veterans at Veterans Transition Center in Monterey CA • Set up tents for average homeless vets for a weekend stay during which time they will receive transportation to the site, meals, medical and dental check-ups, vet services for their pets, resource counseling on VA benefits, job searches and educational opportunities, clergy support and psychological support provided through professional therapists. One-time event, lasting 5 days • 2014, and 2016 Stand Down programs supported 360 and 405 homeless vets respectively and an estimated 450-500 homeless vets are anticipated at the 2018 Stand Down 8. Police Officer's Ball - Los Gatos Monte Sereno Police Foundation annual fund raising event. Annual Event — exposure • 500 people are present 9. Los Gatos Spring Wine Walk 2018: Downtown Los Gatos (not yet announced --likely April 21, 2018) Exposure and Fund Raising • Several hundred people present Average number of direct services received by each unduplicated client: 1 Average number of direct services received by each unduplicated Los Gatos client: 1 We also have a 665 person email contact list and over 300 followers on our Facebook page which represents a fraction of the people with whom we engage on a regular basis. 11 D. Indirect Services List, describe, and quantify each indirect service to be provided annually from July 1, 2018, through June 30, 2019. An Indirect Service is a service for which there is no identifiable client; for example, information and referral that is given over the phone. Description of Service FY 2018/19 Number of Services Provided Annually 1. 2. 3. 4. F. Demographic Information Provide demographic breakdown of unduplicated Los Gatos residents expected to receive direct services. Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2018/19 Age Under 18 years old 490 19 — 50 years old 885 51 years old and over 875 Disability Status Disabled 565 Not Disabled 1,685 Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2018/19 Income 50% of median and below 70 51 % - 100% of median 67 Above 100% of Median 2,113 Sex Female 1,178 Male 1,072 Total Total Los Gatos clients 2,250 Sources http://www.city-data.comipoverty/poverty-Los-Gatos-California.html#ixzz58AQMfBt0 https://en.wikipedia.org/wikifLos_Gatos,Salifomia#Demogmphics The demographic mix for the World War 1 Commemoration may vary from our year-round pattern depending on the location of the event, (School vs a seniors facility,) 12 G. Client Participation Requirements Attach appropriate fee schedules, membership requirements, or other fee listings. There is no fee to receive our services. Board members are solicited for donations in a Leadership campaign effort. Board members are highly encouraged to donate in kind services or financially. Proposed Advisory Board suggested level of cash or in -kind donation Platinum Level: Equal to and over $10,000 Gold Level: Equal to or over $5000 and less than $10,000 Silver Level: Equal to or over $2500 and less than $5000 Bronze Level: Equal to or over $1000 and less than $2500 II. AGENCY INFORMATION A. General Information Legal Name of Organization Veterans Memorial & Support Foundation of Los Gatos Address of Organization Site Address: 110 East Main Street, Los Gatos, CA 95030 Mailing Address: P.O. Box 1696, Los Gatos, CA 95031 Name of Executive Director Major General Kent Hillhouse US - Army (Ret.) Foundation President Date of Incorporation October 04, 2012 Insurance/Tax Information Federal Employer Tax Number 46-1338469 State Employer Tax Number 3511875 Worker's Compensation Carrier/ Policy Number N/A Until we get closer to hiring a part-time executive assistant Liability Insurance Carrier Alliance Members Services/Nonprofits Insurance Alliance of California Amount of Liability Coverage General Liability $2M aggregate, $0 deductible Property Damage (combined with liability) N/A at present. Will be applicable in future. Combined Single Limit $1M per occurrence Policy Period 02/04/2018 — 02/04/2019 13 B. Staffing Profile Please complete the chart below for your organization as it will be staffed during FY 2018/19. Identify the hours to be devoted to the program for which you are requesting funding, for both employees and volunteers. Position Title Number in Classification Approximate Hourly Rate Hours Worked per Week Percent of Time to Program Employees Professional Fundraisers 2 $99,000 for the 12 month period. 4 avg. days per month for 12 Mos. $750/month in average expenses. 0% Part Time Executive Assistant 1 $30/hour includes benefits 30 hours for 12 months 5% Volunteers 90% of all board and committee members (The balance of board/committee members will be focused on the building effort.) 12 Board members; Average 10 committee members pre recruitment effort for campaign personnel Free 6 hours per week 100% C. Agency Experience —Describe the experience of your Agency in providing program services. The majority of board members comprising the Veterans Memorial & Support Foundation are career veterans accustomed to providing service to their country. Veterans, as a whole, provide support to communities more than most other demographical sectors for the reason that they were accustomed to providing service to others in their careers. As active service personnel, they provided humanitarian support and defense of our nation. They are involved in handling tropical storm recovery, earthquake recovery, medical crisis related concerns (e.g. the Ebola crisis), volcanic eruption recovery, hurricane recovery (e.g. Hurricanes Katrina, Sandy, Harvey, Maria, Irma, the Napa and SoCal fires), and more, in addition to providing defense for our nation. Providing program services is a natural for them. 14 The balance of board members comprising the Foundation are individuals accustomed to providing service to their community through various community programs for decades. D. Staff Experience —Describe the experience of key staff assigned to the program. See the commentary regarding the board's skills in the prior sections E. Staffing Flan --Describe any anticipated staffing changes to occur during FY 2018/19. We will be hiring a part-time executive assistant to help conduct the event management on this project. 15 F. DI. FISCAL INFORMATION A. Program Budget Please complete the following summary tables to reflect the budget for your organization and program. All amounts should be rounded to the nearest dollar. Alternatively, please attach single page revenue/expense summary sheets for the program for which funds are requested and a separate summary for the organization. Budget Summa Budget Data FY 2018/19 FY 2017/18 Los Gatos grant funding Requested: $8,000 Received: N/A Total Program budget $16,000 $0 Los Gatos grant as percentage of total Program budget 50% 0.0% Total Organization budget $600,000 $440,000 Cost per year per unduplicated Los Gatos client $2 $N/A Revenue Summa Revenue Source FY 2018/19 Organizational Budget FY 2018/19 Program Budget FY 2017/18 Organizational Budget FY 2017/18 Program Budget Los Gatos grant $8,000 $-8,000 $ $ Other municipal funding (please specify: ) $ 0 $ 0 $ $ County funding (Please specify :) $ 0 $ 0 $ $ State funding (Please specify :) $ 0 $ 0 $ $ Federal funding (Please specify :) $ 0 $ 0 $ $ Other jurisdiction funding (Please specify :) $ 0 $ 0 $ $ Fees for services $ 0 $ 0 $ $ Donations $ 8,000 $ 8,000 $ $ Reserve contingency fund $ 0 $ 0 $ $ All other sources (Please specify) $ 0 $ 0 $ $ Total $16,000 $16,000 $ $ Expenditure Summary 16 Expense Category FY 2018/19 Organizational Budget FY 2018/19 Program Budget FY 2017/18 Organizational Budget FY 2017/18 Program Budget Personnel $1,250 $1,250 $ $ Facility $ $ $ $ Overhead $ $ $ $ Materials/Supplies $ $ $ $ Professional Services $ $ $ $ Fundraising using Professional Services $ $ $ $ Capital Projects $ $ $ $ Other (Please specify) Essay Prizes and after event snacks See Details below $6,750.00 $6,750.00 $ $ Total $8,000 $8,000 $ $ Lin=ne Item Los Gatos Grant Other Funds Total Paid Assistant 100 hr. @$25/hour 1,250 1,250 2,500 Room rental 300 300 600 Seating rental set up and tear down 600 chairs 440 360 800 Security--LG PD? 550 450 1,000 Airfare -two speakers, air fare from/to Washington DC, @ $400 per speaker 440 360 800 Lodging @ 2 nights for each speaker at @$218 per night (Federal Rate for 2018) 480 392 872 Travel Expenses @ 64 per diem (Federal Rate for 2018) 140 116 256 Marketing collateral to advertise the affair. 400 272 672 Music (Quartet) 200 200 400 Essay Prizes 0 500 500 Military Honor Guard with Bugler 550 450 1,000 Musical/choral group 825 675 1,500 Electronic Recording/Streaming 275 225 500 Equipment rentals for sound system. 550 450 1,000 Reception to follow for the veterans and the community @ $6 X 600 people 1,600 2,000 3,600 Total $8,000 $ 8,000 $16,000 B. Organization Contracts --Has your organization ever had funds withdrawn or a contract terminated for cause, unsatisfactory performance, or questionable costs on any financial statements or audit? If so, please describe. No. 17 C. Organization Investigations--ls your organization currently on probation or under investigation by any agency which is or was a funding source within the past two years? If so, please describe. No D. Budget Alternatives --What alternatives will your organization consider if the requested Community Grant funding is not provided, or provided at a reduced level? Describe how a reduction will affect the achievement of stated goals. The estimated cost for the commemoration is $16,000, if not fully funded we will go to community members and ask for donations E. Funding Sources --Describe your organization's efforts in pursuing other funding sources. We have funds set aside to cover our share of the project F. Supplies Disclosure --If any non -expendable supplies with a unit cost of $100 or more are to be purchased with Community Grant funds, please describe. None G. Travel Expense Disclosure --If Community Grant funds are to be used for staff travel expenses, please describe. None, just for guest speakers with costs set at 2018 Federal Rates as shown in the budget 18 CERTIFICATION The applicant hereby proposes to provide the services as listed in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state, and local regulations, including non- discrimination laws and other assurances as required by the Town of Los Gatos, will be adhered to. Furthermore, as the duly authorized representative of the applicant organization, I certify that the applicant is fully capable of fulfilling its obligation under this proposal as stated herein. This application and the information contained herein are true and correct and complete, to the best of my knowledge. Date: March 5, 2018 Organization Name: Veterans Memorial & Support Foundation of Los Gatos Foundation President MG Kent Hillhouse US -Army (Ref.), Foundation President l FY 2018/19 Grant Application Summaries Human Services ATTACHMENT 1 CASSY TOWN OF L0S GATOS !LERI( DEPARTMENT Town of Los Gatos RECEIVED FY 2018/19 Community Grant Program/018 FEBA ID 05 Application Summary Project: Project/Program: School Based Mental Health Services at Los Gatos High School Program Manager: Kelly Sumner Agency: Name of Agency: Counseling and Support Services for Youth (CASSY Site Address: LGHS 20 High School Court Los Gatos. CA 95030 Name of Executive Director: Christy Hayes Project Description: Provide brief description of agency, agency goals, and agency services. Describe your program briefly, including who benefits from your program. Now entering our eighth year in partnership with Los Gatos High School, CASSY is well positioned to deepen the impact of our programs on student's social/emotional health, which has far reaching implications for students' academic success. We have developed a strong partnership with the district, with the school, and with the community at large. As a result, we are the sole provider of school -based mental health services at LGHS and are now an established presence in our schools, which has led to an increase in self selection among students for services. CASSY will address the gap in youth mental health services in Los Gatos by partnering with Los Gatos High School to provide competent, accessible therapists on the school campus at no cost to students and families. Program Funding: Provide prior year fiscal year actual budget amounts and proposed amounts for new fiscal year. Program Funding: FY 2017/18 (adopted) FY 2018/19 (requested) Clients: FY 2017/18 (actual) FY 2018/I9 (proposed) Town annual funding amount S 10,000 $15,000 Unduplicated annual Los Gatos clients 350 500 Total annual program budget $384,485 $395,991 Total unduplicated annual clients 350 500 Town $ as % of annual total 2.6% 3.7% Los Gatos clients as % of annual total 100°,0 100% TOWN OF LOS GATOS *:• FY 2018/19 APPLICATION FOR COMMUNITY GRANT FUNDING APPLICANT AGENCY/PROGRAM DOCUMENTS CHECKLIST Please submit one copy of each of the documents listed below with your completed application. This page should serve as the cover sheet for that section of your submittal. I. PROGRAM/PROJECT INFORMATION 0 Fee Schedule, Membership, or other fees II. AGENCY INFORMATION Current Board of Directors 0 Articles of Incorporation Bylaws 0 Organizational Chart 0 Brochures, Flyers, Promotional Materials III. FISCAL INFORMATION 0 Audit or Financial Statement plus Letter of Auditability 0 Organizational Budget 0 Internal Revenue Service Ruling Letter (Section 501 c.3) 0 California Revenue Code (Section 23701 d) 2 TOWN OF LOS GATOS d• FY 2018/19 APPLICATION FOR COMMUNITY GRANT FUNDING GRANT APPLICATION I. PROGRAM/PROJECT INFORMATION A. Contact Information Legal name of organization Counseling and Support Services for Youth (CASSY) Address of organization 544 Valley Way Milpitas, CA 95035 Organization contact (Name, title, telephone number. email address) Christy Hayes — Executive Director 408-493-5289, Christy@cassybayarea.org Program name School Based Mental Health Services at Los Gatos School Site address of program LGHS 20 High School Court Los Gatos, CA 95030 Program manager (Name, title, telephone number, email address) Kelly Sumner — Program Manager 408-493-5289, Kelly@cassybayarea.org Annual grant amount requested FY 2018/19 $10,000 B. Community Need Statement Describe briefly the demonstrated need in the Los Gatos community for the program. Cite data sources as appropriate. According to the California Healthy Kids Survey, nearly 1 in 5 high school students in Santa Clara County has seriously considered suicide in the last year. A recent CDC report also found that 20% of young people —nearly 60,000 students in Santa Clara county alone —experience other mental health issues, such as depression, anxiety, eating disorders, academic stress, post -traumatic stress due to trauma or violence, and low self-esteem. Sadly, only one-third of children who are actually diagnosed with a mental health issue will even receive treatment. For adolescents living in poverty, the statistics are much worse: 90 percent diagnosed with a mental health issue report not receiving counseling or other services. Regardless of socioeconomic class, the cost of private care, complicated insurance battles, transportation issues, and stigma often act as 3 barriers to a child receiving proper care. Lett untreated, mental health issues have a profound impact on a student's academic achievement and career readiness. Research clearly shows that students with unmet mental health needs are more likely to have lower grades and test scores while also experiencing higher rates of suspension, expulsion, and truancy; not surprisingly, they are also more likely to dropout of school altogether. Simply put, when a child is depressed or processing trauma, they have a difficult time focusing on school. Meanwhile, teachers and parents are often at a loss as to how to get a child back on track, or how to handle the classroom disruption or noncompliance that can accompany mental health issues. Too often, the result is a child who become increasingly isolated, who abuses substances, or, in the most tragic cases, commits suicide the second leading cause of death for youth in Santa Clara County. However, there is hope. Studies also show that students are far more likely to seek counseling when it is at their school, especially if it is free. Research also shows that when struggling youth do receive proper support, academic success is likely to follow. They build important emotional regulation and coping strategies that help them stay focused in class and help them develop positive peer, teacher and familial relationships, among other benefits. Providing high -quality school -based mental health support benefits the entire school, resulting in increased attendance and a more positive school climate —one in which students feel safe and supported. Clearly, if we are to ensure that all students thrive academically, we must ensure they have high -quality social -emotional support on school campuses. c. Direct Services For Human Services and Arts, Culture and Education grant requests, list, describe, and quantify each direct service to be provided annually from July 1, 2018 through June 30, 2019. A Direct Service is a service for which there is an identifiable client. A Participation Agreement (Attachment 2) must be completed by each client receiving the direct services described below. Description of Service FY 2018/19 Number of Services Provided Annually FY 2018/19 Number of Unduplicated Los Gatos Residents served Annually 1. Psychotherapy sessions (individual, family, group and crisis) 2500 250 2. Classroom presentations 18 500 3. Peer Mediation Training 30 15 4. Staff trainings and consultations 300 65 5. Community Education Presentations l 0 150 Average number of direct services received by each unduplicated client: 12 Average number of direct services received by each unduplicated Los Gatos client: 12 D. Indirect Services List, describe, and quantify each indirect service to be provided annually from July 1, 2018, through June 30, 2019. An Indirect Service is a service for which there is no identifiable client; for example, information and referral that is given over the phone. 4 Description of Service FY 2018/19 Number of Services Provided Annually 1. N/A 2. 4. F. Demographic Information Provide demographic breakdown of unduplicated Los. Gatos residents expected to receive direct services. Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2018/19 Age Under 18 years old 350 19 — 50 years old 150 51 years old and over Disability Status Disabled r Not Disabled Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2018/19 Income 50% of median and below 51% - 100% of median Above 100% of Median Sex Female 210 Male 140 Total Total Los Gatos clients 500 G. Client Participation Requirements Attach appropriate fee schedules, membership requirements, or other fee listings. CASSY services are provided free to all participants, 5 II. AGENCY INFORMATION A. General Information Legal Name of Organization Counseling and Support Services for Youth Address of Organization 544 Valley Way Milpitas, CA 95035 Name of Executive Director Christy Hayes Date of Incorporation 5/8/2009 Insurance/Tax Information Federal Employer Tax Number 26-4655116 State Employer Tax Number 298-2814-2 Worker's Compensation Carrier/ Policy Number Hartford Insurance Company/policy # 76 WEG LN1696 Liability Insurance Carrier CPH & Associates Amount of Liability Coverage $1 million each occurrence/$5 million aggregate Property Damage (combined with liability) $1.5,000 Combined Single Limit $1 million Policy Period Annual renewal each September B. Staffing Profile Please complete the chart below for your organization as it will be staffed during FY 2018/19. Identify the hours to be devoted to the program for which you are requesting funding, for both employees and volunteers. Position Title Number in Classification Approximate Hourly Rate Hours Worked per Week Percent of Time to Program Employees Executive Director 1 $62 40 5% Program Manager 1 $45 40 15% Site Coordinator 1 $32 40 100% Therapists 2 $28 40 100% Volunteers 6 C. Agency Experience --Describe the experience of your Agency in providing program services. Seven years ago, CASSY was founded by two experienced school therapists to meet the glaring need for high -quality mental health support in Silicon Valley schools. From a single Ravenswood City School District summer school program in 2009, CASSY has grown into a non-profit organization that partners with 43 Santa Clara and San Mateo county public schools to provide comprehensive mental health services to all enrolled students at no charge. Our mission is to de -stigmatize mental health services and make supporting students' social and emotional well-being the norm in our schools. CASSY places competent, compassionate therapists directly on school campuses, eliminating the transportation, financial, and insurance barriers that so often prevent young people from getting the help they need. We support students through individual, group, and family counseling, while also offering crisis support and intervention, staff and parent consultations, and classroom lessons on bully prevention, depression, and suicide awareness. Annually, we provide direct services to over 5,000 students. Indirectly, 33,000 students benefit from their peers, teachers, and parents developing tools to foster positive relationships, responsible decision -making, and social skills. D. Staff Experience --Describe the experience of key staff assigned to the program. Executive Director, Christy Hayes, is a credentialed early childhood teacher and brings to CASSY more than a decade in diverse nonprofit management and leadership roles in addition to deep experience with and understanding of every level of child development and student support. Program Director, Kelly Sumner, is an established clinician with over 15 years of experience, including the past six years as a clinical supervisor. Before joining CASSY, Kelly was the clinical supervisor for Adolescent Counseling Services in Palo Alto and supervised a team of MFT Trainees and Interns at Palo Alto High School. She was a clinical supervisor at Family and Children Services of Silicon Valley for the Independent Living Program Wellness Services, which served transition -aged foster youth. Site Coordinator, Shahbie Afshar, is an Associate Marriage and Family Therapist. Shabbie joined CASSY after completing her traineeship at Jordan Middle School and Gunn High School in Palo Alto and has been part of the CASSY team at LGHS since 2015. Therapists employed by CASSY hold a graduate degree in a mental health related field and have a minimum of two years working with school based services for youth. All CASSY therapeutic staff are registered with the Board of Behavior Sciences, which includes a LiveScan background check. E. Staffing Plan --Describe any anticipated staffing changes to occur during FY 2018/19. We do not anticipate any changes to our current staffing structure at this time. 7 III. FISCAL INFORMATION A. Program Budget Please complete the following summary tables to reflect the budget for your organization and program. All amounts should be rounded to the nearest dollar. Alternatively, please attach single page revenue/expense summary sheets for the program for which funds are requested and a separate summary for the organization. Budget Summar Budget Data FY 2018/19 FY 2017/18 Los Gatos grant funding Requested: $15,000 Received: $10,000 Total Program budget $395,991 $384,485 Los Gatos grant as percentage of total Program budget 3.7% 2.6% Total Organization budget $3,737,736 $3,628,870 Cost per year per unduplicated Los Gatos client $1,000 $1,000 Revenue Summar Revenue Source FY 2018/19 Organizational Budget FY 2018/19 Program Budget FY 2017/18 Organizational Budget FY 2017/18 Program Budget Los Gatos grant $15,000 $15,000 $10,000 , $10,000 Other municipal funding (please specify: ) $ $ $ $ County funding (please specify:) $ $ $ $ State funding (please specify:) $ $ $ $ Federal funding (please specify:) $ $ $ $ Other jurisdiction funding (please specify:) $ $ $ $ Fees for services $3,045,969 $277,482 $2,957,250 $269,400 Donations $676,767 $103,509 $661,620 $105,085 Reserve contingency fund $ $ $ $ All other sources (please specify:) in -kind, etc $46,556 $ $45,200 $ Total $3,737,736 $395,991 $3,628,870 $384,485 xpenditure Summar Expense Category FY 2018/19 Organizational Budget FY 2018/19 Program Budget FY 2017/18 Organizational Budget FY 2017/18 Program Budget Personnel $3,385,753 $348,123 $3,385,753 $337,994 Facility $ $ $ $ Overhead $289,441 $45,293 $227,338 $43,991 Materials/Supplies $15,779 $2,575 $15,779 $2,500 Professional Services $ $ $ $ Fundraising $ $ $ $ Capital Projects $ $ $ $ Other (please specify:) PD, Ins, etc $ $ $ $ Total $3,737,736 $395,991 $3,628,870 $384,485 B. Organization Contracts --Has your organization ever had funds withdrawn or a contract terminated for cause, unsatisfactory performance, or questionable costs on any financial statements or audit? If so, please describe. No C. Organization Investigations --Is your organization currently on probation or under investigation by any agency which is or was a funding source within the past two years? If so, please describe. No D. Budget Alternatives --What alternatives will your organization consider if the requested Community Grant funding is not provided, or provided at a reduced level? Describe how a reduction will affect the achievement of stated goals. CASSY is committed to providing comprehensive mental health services at or above current levels in Los Gatos and will seek additional funds through other grants or individual donors as necessary to sustain the program. E. Funding Sources --Describe your organization's efforts in pursuing other funding sources. CASSY works in collaboration with several local organizations in Los Gatos to ensure community awareness and expand our financial support. We attend meetings with: CASA, Los Gatos Lions Club, Los Gatos Rotary, Los Gatos History Club, LGHS Home and School Club, The New Millennium Foundation, The Parenting Continuum, and Drug Free Community Committee Meeting. We solicit individual donor support through the Los Gatos Wildcat Days each fall as students return to school. 9 F. Supplies Disclosure --If any non -expendable supplies with a unit cost of $I00 or more are to be purchased with Community Grant funds, please describe. We do not plan to use the grant funds to purchase supplies. G. Travel Expense Disclosure --If Community Grant funds are to be used for staff travel expenses, please describe. We do not plan to use the grant funds for travel expenses. CERTIFICATION The applicant hereby proposes to provide the services as listed in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state, and local regulations, including non- discrimination laws and other assurances as required by the Town of Los Gatos, will be adhered to. Furthermore, as the duly authorized representative of the applicant organization, I certify that the applicant is fully capable of fulfilling its obligation under this proposal as stated herein. This application and the information contained herein are true and correct and complete, to the best of my knowledge. qL Date: ,2018 Counseling and Support Services for Youth (CASSY) Organization Name ve Director Christy Hayes (Print Name) 10 LGS (55+) Town of Los Gatos FY 2018/19 Community Grant Program Application Summary Project: Project/Program: LOS Recreation's 55 Plus Program Program Manager: Ms. Janet Sumpter TOWN CF LOS GATOS l ERM DEPARTMENT RECEIVED Z 8 MAR —5 P 3: 06 Agency: Name of Agency: Los Gatos -Saratoga Community Education and Recreation (LGS Recreation) Site Address: 208 E. Main St., Los Gatos, CA 95030 Name of Executive Director: Ms. Nancy Rollett Project Description: Provide brief description of agency, agency goals, and agency services. Describe your program briefly, including who benefits from your program. LGS Recreation serves over 60,000 residents in Los Gatos, Saratoga, Monte Sereno and Mountain Communities. We are located in Los Gatos and housed in two buildings owned by the Town, one building is dedicated to Youth & Adult programing and the other dedicated to our Adult & Senior Community. We serve our 30,000 Los Gatos residents by offering enrichment programs, recreational activities, and community events fostering personal growth for participants and their families. LGS Recreation operates under the Education Code and is in a joint powers agreement with the three public school districts in Los Gatos and Saratoga. The LGS Recreation's 55 Plus Program is responsible for managing Senior Services and Recreational/EnrichmentiSocial Programs for Seniors living in the Town of Los Gatos. Older adults thrive and flourish when there is social contact and opportunities for personal growth and socialization. The programs that we have developed under the auspices of the 55 Plus program are geared to enrich the day to day lives of Los Gatos Seniors. Program Funding: Provide prior year fiscal year actual budget amounts and proposed amounts for new fiscal year. Program Funding: FY 2017/18 (adopted) FY 2018/19 (requested) Clients: FY 2017/18 (actual) FY 2018/19 (proposed) Town annual funding amount $10,000 $26,103 Unduplicated annual Los Gatos clients 60 240 Total annual program budget 212,925 214.193 Total unduplicated annual clients 75 300 Town $ as % of annual total 4.6% 12.1 %4 Los Gatos clients as % of annual total 80% ' 80% TOWN OF LOS GATOS + FY 2018/19 APPLICATION FOR COMMUNITY GRANT FUNDING APPLICANT AGENCY/PROGRAM DOCUMENTS CHECKLIST Please submit one copy of each of the documents listed below with your completed application_ This page should serve as the cover sheet for that section of your submittal. I. PROGRAM/PROJECT INFORMATION ❑ Fee Schedule, Membership, or other fees ]Llf. AGENCY INFORMATION ❑ Current Board of Directors ❑ Articles of Incorporation ❑ Bylaws • Organizational Chart ❑ Brochures, Flyers, Promotional Materials III. FISCAL INFORMATION ❑ Audit or Financial Statement plus Letter of Auditability ❑ Organizational Budget ❑ Internal Revenue Service Ruling Letter (Section 501 c.3) ❑ California Revenue Code (Section 23701 d) TOWN OF LOS GATOS + FY 2018/19 2 APPLICATION FOR COMMUNITY GRANT FUNDING GRANT APPLICATION I. PROGRAM/PROJECT INFORMATION A. Contact Information Legal name of organization Los Gatos -Saratoga Community Education and Recreation (LGS Recreation) Address of organization 208 East Main Street Los Gatos, CA 95030 Organization contact (Name, title, telephone number, email address) Nancy Rollett Executive Director 408-207-4900 nrollett@lgsrecreation.org Program name LGS Recreation's 55 PIus Program Site address of program LG Adult Recreation Center 208 E. Main St. Los Gatos, CA 95030 Program manager (Name, title, tele phone number, email address) Janet Sumpter, LGS Recreation Supervisor 408-335-9982 janet@lsrecreation.org Annual grant amount requested FY 2018/19 TOTAL: $26,103 We have included DIRECT costs only in the Grant application for 2018/19. i. Lynnette: Wednesday 49 days x $417 includes supplies) per day per contract = $20,433 2. Lynnette: Single Again/Loss: $67.50 hr. x 2 hrs. = $135 x 24 mtgs. a year = $3,240.00 3. Janeen-Transitions: $67.50 hr. x 1.5 hrs. _ $101.25 x 24 mtgs, a year = $2,430.00 B. Community Need Statement Describe briefly the demonstrated need in the Los Gatos community for the program. Cite data sources as appropriate. The LGS Recreation's 55 Plus Program is responsible for managing Senior Services and Recreational/Enrichment/Social Programs for Seniors living in the Town of Los Gatos. We provide on -going social and educational opportunities to over 6,000 seniors aged 55 years and older and have 450 program memberships. In addition, we offer informational presentations, outreach and referral services to over 1,000 seniors in the community each year. Older adults thrive and flourish when there is social contact and opportunities for personal growth. The programs that we have developed under the auspices of the 55 Plus program are geared to enrich the day to day lives of Los Gatos Seniors. In offering a myriad of well organized, robust, small social group experiences facilitated by senior specialists, 3 we endeavor to help people maintain a rich and healthy lifestyle. Comments from one of our participants speaks to the value and influence our program has on the lives of LG Seniors. Statement from a 55+ Member: "Yes, this is a crazy world, nothing like when 1 grew up in the 30's, 40's, 50's and that is why our group is so important to us all. We kind of look out for each other. The Senior Center is my lifeline, it keeps me going and if I can't go for some reason or other, I feel down. There are several others that tell me that and one of the fellows last year had to have surgery and couldn't come for a long time. His wife told me that he really, really, really misses the group, because to him it's like family. Me and others say that this is really their family, because most of our parents are gone, our children and grandchildren live all over the map and aren't around as much anymore. I think that the Los Gatos Senior Center is most unique that way. I don't know why Los Gatos is so different and great compared to other centers, but I guess it's all of us, the people, and we're so caring and helpful to each other. I am so grateful to this Senior Center and especially to all the employees there who are so helpful and fun. " c. Direct Services For Human Services and Arts, Culture and Education grant requests, list, describe, and quantify each direct service to be provided annually from July 1, 2018 through June 30, 2019. A Direct Service is a service for which there is an identifiable client. A Participation Agreement (Attachment 2) must be completed by each client receiving the direct services described below, Description of Service FY 2018/19 Number of Services Provided Annually FY 2018/19 Number of Unduplicated Los Gatos Residents served Annually 1.Grief Support- `Single Again for Widows' This group teaches coping skills while traveling this new road with friends and a professional facilitator. 12 meetings 20 participants 2.GriefSupport Group- `Living With Loss' — Coed — Loss can touch us in many ways, Le.. loss of a spouse, job, lifestyle, friend, memory, physical function, child. This group teaches coping skills while traveling this new road with friends and a professional facilitator. 12 meetings 30 participants 3.'Transitions' Support Group — Navigating life's changes can be isolating and frightening. This group offers Seniors a professional facilitator and a supportive group of new friends. 24 meetings 40 participants 4.Wednesday - Senior Social Engagement Day Every Wednesday morning participants gather to play games — Bridge, Chess, Scrabble and more. The Senior Specialist coordinates the tables based on preferences and abilities. In addition to the games, we honor seniors with awards, prizes, raffles, flowers on birthdays, celebrations/gifts on special days, call missing seniors, send cards, organize music, bring in special speakers and entertainment and more. 49 meetings 150+ participants Average number of direct services received by each unduplicated client: _4 Average number of direct services received by each unduplicated Los Gatos client: 4 4 D. Indirect Services List, describe, and quantify each indirect service to be provided annually from July 1, 2018, through June 30, 2019. An Indirect Service is a service for which there is no identifiable client; for example, information and referral that is given over the phone. Description of Service LGSR Note: Below are Indirect costs not calculated in the grant request. Service to all Senior programming. FY 2018l19 Number of Services Provided Annually 1. Flyers for each program. 80 flyers annually 2. Newsletter — monthly newsletter includes information on each program. Edit/copy/distribute. 12 newsletters annually 3. Phone calls and outreach to existing members. Recruit/invite new members. 4,800 seniors annually 4. Office/volunteer support to seniors who drop in to talk about programs and sign up. 600 drop -ins annually 5. Supervisor — oversee, supervise and coordinate programs Attend all meetings 6. Marketing — agency activity guide, agency website, Agency Facebook, press releases, Nextdoor, Town of Los Gatos website etc. 200+ annually F. Demographic Information Provide demographic breakdown of unduplicated Los Gatos residents expected to receive direct services. Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2018/19 Age Under 18 years old 0 19 — 50 years old 0 51 years old and over 240 (seniors grant request) in Disability Status Disabled 100 Not Disabled 140 Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2018/19 Income 50% of median and below 80 51% - 100% of median 140 Above 100% of Median 20 Sex Female 150 Male 90 Total Total Los Gatos clients 240 (seniors grant request) in 5 G. Client Participation Requirements Attach appropriate fee schedules, membership requirements, or other fee listings. The items below have been attached to this grant: • 55 Plus Membership attached • Twitter/Newsletter • Insurance Documents II. AGENCY INFORMATION A. General Information Legal Name of Organization Los Gatos -Saratoga Community Education and Recreation (LGS Recreation) Address of Organization 208 East Main Street Los Gatos, CA 95030 Name of Executive Director Nancy Rollett Date of Incorporation 1956 Insurance/Tax Information Federal Employer Tax Number 77-0415139 State Employer Tax Number 698-1541 3 Worker's Compensation Carrier/ Policy Number Protection Insurance Program for Schools / PIPS0012114 Liability Insurance Carrier Alliance of Schools for Cooperative Insurance Programs / 155-2017 Amount of Liability Coverage $5,000,000 per occurrence Property Damage (combined with liability) $100,000,000 Combined Single Limit $5,000,000 per occurrence Policy Period July 1, 2017-July 1, 2018* *Existing COI and Endorsements Documents for Grants are still valid. The 2018 / 2019 documents wi11 not be available until end of May 2018. 6 B. Staffing Profile Please complete the chart below for your organization as it will be staffed during FY 2018/19, Identify the hours to be devoted to the program for which you are requesting funding, for both employees and volunteers. Position Title Number in Classificati on Approximat e Hourly Rate Hours Worked per Week Percent of Time to Program Employees Janet Sumpter: Recreation Supervisor (Indirect costs -not included in grant) 1 $60.06 40 hours per week 75% Lori Krueger: Senior Office Clerk (Indirect costs -not included in grant) 1 $41.85 40 hours per week 40% Lynnette Vega: Independent Contractor (Direct costs included in grant) 1 $67.50 7 hours per week 100% Janeen Pratt: Independent Contractor (Direct costs included in grant) 1 $67.50 3 hours per mo. 100% Volunteers Numerous Volunteers Assist on our programs 3 0 1 10 hours weekly C. Agency Experience --Describe the experience of your Agency in providing program services. LGS Recreation has been providing Senior Programs to the Los Gatos community for over 40 years. The past eight years LGS Recreation staff has successfully provided Information and Referral services along with enrichment and social programs in the form of small, intimate groups to large gatherings. Over 1,000 seniors participate in one or more programs every month. D. Staff Experience --Describe the experience of key staff assigned to the program. Lynnette Vega: Masters Art Therapy, Notre Dame De'Namur University. Group facilitator, Senior Resource Specialist, Counselor, Senior Exercise, Community Based class facilitator for Foothill College. Adult Education Credential. Janeen Pratt: MA- GCM. Care Manager and coach. The Masters health/gerontology involves study in the process of human aging with relevant information related to the physical, mental and psychosocial aspects of the aging of adults as well as human services, economic and legal factors that influence elders. Janeen has been employed in the valley for over 30 years providing case management and support services for agencies including Pathways Home Health Hospice and Private Duty, Interim, Council on Aging and was a Senior Housing Administrator. Janet Sumpter: LGS Recreation Adult Program Supervisor and LGSUHSD Adult Education Supervisor, 1984-2008. During that time, Janet managed Senior Enrichment programs for LGS Recreation and Adult Education. She currently oversees all the Senior/55+ Plus programming for LGS Recreation. (Janet's salary is an indirect cost not calculated in this year's grant rest). Lori Krueger: Senior Recreation Clerk involved in supporting the Senior office and programs. (Lori's salary is an indirect cost not calculated in this year's grant rest). 7 E. Staffing Plan --Describe any anticipated staffing changes to occur during FY 2018/19. No expected change [II. FISCAL INFORMATION A. Program Budget Please complete the following summary tables to reflect the budget for your organization and program. All amounts should be rounded to the nearest dollar. Alternatively, please attach single page revenue/expense summary sheets for the program for which funds are requested and a separate summary for the organization. Budget Swnma Budget Data FY 2018/19 FY 2017/18 Los Gatos grant funding Requested: $26,103 (240 people) Received: $10,000 (60 people) Total Program budget $212,925 $213,583 Los Gatos grant as percentage of total Program budget 12.3% 4.7% Total Organization budget $9,028,896 $8,962,842 Cost per year per unduplicated Los Gatos client $108.76 $166.66 Revenue Summa Revenue Source FY 2018/19 Organizational Budget FY 2018/19 Program Budget FY 2017/18 Organizational Budget FY 2017/18 Program Budget Los Gatos grant $0 $26,103 SO $10,000 Other municipal funding (please specify: ) $0 $0 $0 $0 County funding (please specify:) $0 $0 $0 $0 State funding (please specify:) $0 $0 $0 $0 Federal funding (please specify:) $0 $0 SO $0 Other jurisdiction funding (please specify:) $0 $0 $0 $0 Fees for services $9,028,221 $55,140 $8,820,827 $68,400 Donations $0 $ $ $ Reserve contingency fund $0 $ $ $ All other sources (please specify:) $0 $ $ $ Total $9,028,221 $81,243 $8,820,827 $78,400 8 Expenditure Summa Expense Category FY 2018/19 Organizational Budget FY 2018/19 Program Budget FY 2017/18 Organizational Budget FY 2017/18 Program Budget Personnel $5,067,315 $136,718 $5,251,415 $136,876 Facility $796,122 $2,600 $795,601 $2,201 Overhead $0 $0 $0 $0 Materials/Supplies $467,117 $34,820 $475,714 $39,400 Professional Services $1,867,998 $36,436 $1,922,850 $34,000 Fundraising $0 $0 $ $0 Capita] Projects SO $0 $ S0 Other (please specify:) $835,344 $2,351 $848,561 $1.106 Total 59,033,896 $212,925 $9,294,141 S213,583 B. Organization Contracts --Has your organization ever had funds withdrawn or a contract terminated for cause, unsatisfactory performance, or questionable costs on any financial statements or audit? if so, please describe. N/A C. Organization lnvestigations--Is your organization currently on probation or under investigation by any agency which is or was a funding source within the past two years? If so, please describe. N/A D. Budget Alternatives --What alternatives will your organization consider if the requested Community Grant funding is not provided, or provided at a reduced level? Describe how a reduction will affect the achievement of stated goals. • Program fees will need to be required for continued participation or to continue the program. E. Funding Sources --Describe your organization's efforts in pursuing other funding sources. • Silcon Valley Community Foundation -serves the Adult Community in Los Gatos F. Supplies Disclosure --If any non -expendable supplies with a unit cost of $100 or more are to be purchased with Community Grant funds, please describe. N/A G. Travel Expense Disclosure --If Community Grant funds are to be used for staff travel expenses, please describe. N/A 9 CERTIFICATION The applicant hereby proposes to provide the services as listed in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state, and local regulations, including non-discrimination laws and other assurances as required by the Town of Los Gatos, will be adhered to. Furthermore, as the duly authorized representative of the applicant organization, I certify that the applicant is fully capable of fulfilling its obligation under this proposal as stated herein. This application and the information contained herein are true and correct and complete, to the best of my knowledge. Date: 4hvG4 � , 2018 Organization ame (tA&A," c4eadh Executive Director Nancy Rollett (Print Name) 10 ATTACHMENT 1 SAMPLE PARTICIPATION AGREEMENT Over the course of the contract period, a grantee may be required submit Participation Agreements similar to this sample. Do not submit this Sample Participation Agreement with your completed application. . a nonprofit corporation, provides certain services to individuals and families in Santa Clara County. Partial funding (subsidy) for these services is provided under contract by the Town of Los Gatos to this Agency. This information is reviewed for quality control and/or auditing purposes only. Therefore, it is held in confidence by the Agency, the Town, and the Federal representatives and not considered "Public Information." The purpose of this Participation Agreement is as follows: 1. To have the client acknowledge the request and receipt of needed services and provide the client with an opportunity to evaluate such services. 2. To have the client authorize the release of demographic information to the Agency/the Town. 3. To assure the client that information about them is held in confidence and not considered public information and that only statistical information about all clients served is reported. 4. To have the client hold harmless and release from liability the Agency, the Town, and their respective employees, officers, and agents in the event of any suit, claim, loss, damage, or obligation arising out of/or attributed to any of the Agency's programs. Please complete the following: Name: Age: Address: Phone: Sex (check one): 0 Male 0 Female Disability Status (check one): 0 Disabled Female Head of Household (check one): Income Level (check one): O 30% of median and below © 31 % - 50% of median ❑ 51 % - 80% of median ❑ 81 % - 100% of median ❑ Above 100% of median ❑ Not Disabled ❑ Yes ❑ No I understand that this agreement is an affidavit and certify that the information provided above is true and complete. Signature Date 11 Town of Los Gatos FY 2018/19 Community Grant Program Application Summary LGS (Clubhouse) TOWN OF LOS GATOS CLERK DEPARTMENT RECEIVED 1818 MAR - 5 P 3: 01 Project: Project/Program: LGS Recreation Clubhouse Scholarship Fund Program Manager: Manuel Enriquez, Jr. Agency: Name of Agency: Los Gatos -Saratoga Community Education and Recreation (LGS Recreation) Site Address: 208 E. Main Street, Los Gatos, CA 95030 Name of Executive Director: Nancy Rollett Project Description: Provide brief description of agency, agency goals, and agency services. Describe your program briefly, including who benefits from your program. Since 1956, Los Gatos -Saratoga Community Education and Recreation (LGS Recreation) has been dedicated to providing high -quality community education and recreational services to the residents of Los Gatos, Saratoga, Monte Sereno and Mountain communities. A joint powers agency under the authority of three local school districts, Los Gatos Union School District, Saratoga Union. School District and Los Gatos -Saratoga Union High School District, LGS Recreation builds a healthy community through administering hundred of fee -based programs that are enriching, innovative and fun for all. The agency's popular out of school time program, Clubhouse, is currently offered at nine elementary schools (four within Los Gatos) and serves more than 1,500 students daily. Thanks to Clubhouse, our young people have a safe, healthy and nurturing place before and after school to explore their unique talents and interest and discover their full potential. The program is an expansion of the traditional school day offering a range of engaging activities that incorporate academics, youth development and recreation. Program Funding: Provide prior year fiscal year actual budget amounts and proposed amounts for new fiscal year, Program Funding: FY 2017/18 (adopted) FY 2018/19 (requested) Clients: FY 2017/18 (actual) FY 2018/19 (proposed) Town annual funding amount $11.000 $15,000 Unduplicated annual Los Gatos clients 661 673 Total annual program budget $792,621 $817,174 Total unduplicated annual clients 1541 1572 Town $ as % of annual total 1.39% 1.83% Los Gatos clients as % 43% 43% 1 of annual total TOWN OF LOS GATOS + FY 2018/19 APPLICATION FOR COMMUNITY GRANT FUNDING APPLICANT AGENCY/PROGRAM DOCUMENTS CHECKLIST Please submit one copy of each of the documents listed below with your completed application. This page should serve as the cover sheet for that section of your submittal. I. PROGRAM/PROJECT INFORMATION ✓ Fee Schedule, Membership, or other fees Note: 2017-18 pricing sheet included as pricing for the 2018-19 school year has not been finalized. IL AGENCY INFORMATION ✓ Current Board of Directors ✓ Articles of Incorporation ✓ Bylaws ✓ Organizational Chart ✓ Brochures, Flyers, Promotional Materials III. FISCAL INFORMATION ✓ Audit or Financial Statement plus Letter of Auditability ✓ Organizational Budget N/A Internal Revenue Service Ruling Letter (Section 501 c.3) N/A California Revenue Code (Section 23701 d) 2 TOWN OF LOS GATOS +i FY 2018/19 APPLICATION FOR COMMUNITY GRANT FUNDING GRANT APPLICATION I. PROGRAM/PROJECT INFORMATION A. Contact Information Legal name of organization Los Gatos -Saratoga Community Education and Recreation (LGS Recreation) Address of organization 208 East Main Street Los Gatos, CA 95030 Organization contact (Name, title, telephone number, email address) Nancy Rollett Executive Director 408-207-4900 nrollett@lgsrecreation.org Program name LGS Recreation Clubhouse Scholarship Fund Site address of program Blossom Hill Clubhouse 16400 Blossom Hill Rd, Los Gatos, CA 95032 Daves Ave Clubhouse 17770 Daves Ave, Los Gatos, CA 95030 Lexington Clubhouse 19700 Old Santa Cruz Highway, Los Gatos, CA 95033 1 Van Meter Clubhouse 16445 Los Gatos Blvd., Los Gatos, CA 95032 Program manager (Name, title, telephone number, email address) i Manuel Enriquez School Services Director (408) 354-8700 menriquez@lgsrecreation.org Annual grant amount requested FY 2018/19 $l 5,000 B. Community Need Statement Describe briefly the demonstrated need in the Los Gatos community for the program. Cite data sources as appropriate. As the cost of living in the Bay Area increases year after year and dual income households become more of a necessity, it's more important than ever to make quality before and after school child care accessible to parents/guardians in the workforce. According to a 2017 report published by the U.S Department of Housing and Urban Development, a family income of $84,750 in Santa Clara County is on the low- income threshold. For the 2017-18 school year, LGS Recreation awarded 21 qualifying families, who could not afford the service otherwise, a Clubhouse Scholarship as we know out of school time programs increase students' academic performance, reduce risky behaviors, promote physical health and provide a safe, structured environment for the children of working parents. 3 c. Direct Services For Human Services and Arts, Culture and Education grant requests, list, describe, and quantify each direct service to be provided annually from July 1, 2018 through June 30, 2019. A Direct Service is a service for which there is an identifiable client, A Participation Agreement (Attachment 2) must be completed by each client receiving the direct services described below. Description of Service FY 2018/19 Number of Services Provided Annually FY 2018/19 Number of Unduplicated Los Gatos Residents served Annually 1. Child care at Blossom Hill Clubhouse 1 2 2. Child care at Daves Ave Clubhouse 1 2 3. Child care at Lexington Clubhouse 1 2 4. Child care at Van Meter Clubhouse l 2 5 Average number of direct services received by each unduplicated client: _1_ Average number of direct services received by each unduplicated Los Gatos client: 1 D. Indirect Services List, describe, and quantify each indirect service to be provided annually from July 1, 2018, through June 30, 2019. An Indirect Service is a service for which there is no identifiable client; for example, information and referral that is given over the phone. Description of Service FY 2018/19 Number of Services Provided Annually 1. Front office representatives (fielding scholarship inquiries) On -going 2. School Services Director publicizing application and disseminating amongst families. Reviewing submitted applications, notifying families of decision and entering awards into software system. On -going 3. 4. 4 F. Demographic Information Provide demographic breakdown of unduplicated Los Gatos residents expected to receive direct services. Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2018/19 Age Under 18 years old 661 19 — 50 years old 0 51 years old and over 0 Disability Status Disabled 0 Not Disabled 661 Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2018/19 Income 50% of median and below At this time we do not survey our participants for this information. 51% - 100% of median Above 100% of Median Sex Female 284 Male 377 Total Total Los Gatos clients 661 G. Client Participation Requirements Attach appropriate fee schedules, membership requirements, or other fee listings. II. AGENCY INFORMATION A. General Information Legal Name of Organization Los Gatos -Saratoga Community Education and Recreation (LGS Recreation) Address of Organization 208 East Main Street Los Gatos, CA 95030 Name of Executive Director Nancy Rollett Date of Incorporation 1956 Insurance/Tax Information Federal Employer Tax Number 77-0415139 State Employer Tax Number 698-1541 3 Worker's Compensation Carrier/ Policy Number Protection Insurance Program for Schools / PIPS0012114 Liability Insurance Carrier Alliance of Schools for Cooperative Insurance Programs / 155-2017 5 * Amount of Liability Coverage $5,000,000 per occurrence Property Damage (combined with liability) $100,000,000 Combined Single Limit $5,000,000 per occurrence Policy Period July 1, 2017 —July I, 2018* not be available until end of May 2018. B. Staffing Profile Please complete the chart below for your organization as it will be staffed during FY 2018/19. Identify the hours to be devoted to the program for which you are requesting funding, for both employees and volunteers. Position Title Number in Classification Approximate Hourly Rate Hours Worked per Week Percent of Time to Program Employees Supervisor -Clubhouses 1 $39.71 40+ 80% Clubhouse Director 4 $24.97 40+ 80% Senior & Recreation Leaders 19 $14.05 25-30 100% Volunteers C. Agency Experience --Describe the experience of your Agency in providing program services. LGS Recreation has a great responsibility to the residents it serves in Los Gatos and participants in the surrounding area. For 60 plus years the agency has continuously fulfilled its vision of building a healthy community through enrichment, innovation and fun by offering various education and recreational programs that meet the needs of youth, adults and seniors in the community. And for over half of the agency's existence, the Clubhouse program has continually been a reliable, affordable and convenient out of school time program for parents/guardians. Through continued program monitoring and stakeholder input, the program has developed a reputation for being a place young people want to be before and after the school bell rings. D. Staff Experience --Describe the experience of key staff assigned to the program. The agency recognizes the type of adults needed to work with our young people. Our staff are supportive adults committed to making participants feel connected, confident and empowered. All staff members are given the necessary tools and resources to ensure Clubhouse is a safe and healthy environment for everyone. They complete mandatory new hire training and participate in on -going monthly training covering topics like; active supervision, child abuse and neglect, mandated reporting, emergency preparedness, CPR & first aid, bullying prevention, creating an inclusive program, 40 Developmental Assets and more. 6 E. Staffing Plan --Describe any anticipated staffing changes to occur during FY 2018/19. At this time, we don't anticipate any staffing changes to our Clubhouse program. Although, if a member of our current team does decide to move on in their professional career, we have a Human Resources department that is robust in recruitment and will react thoughtfully and timely to fill any staffing shortages. III. FISCAL INFORMATION A. Program Budget Please complete the following summary tables to reflect the budget for your organization and program. Ali amounts should be rounded to the nearest dollar. Alternatively, please attach single page revenue/expense summary sheets for the program for which funds are requested and a separate summary for the organization. Budget Summar Budget Data FY 2018/19 FY 2017/18 Los Gatos grant funding Requested: $15,000 Received: 11,000 Total Program budget $817,174 $792,621 Los Gatos grant as percentage of total Program budget 1.83% 1.38% Total Organization budget $9,028,221 $8,962,842 Cost per year per unduplicated Los Gatos client $5,370 $5,260 Revenue Summar Revenue Source FY 2018/19 Organizational Budget FY 2018/19 Program Budget FY 2017/18 Organizational Budget FY 2017/18 Program Budget Los Gatos grant $0 $15,000 $0 11,000 Other municipal funding (please specify:) $0 $0 $0 $0 County funding (please specify:) $0 $0 $0 $0 State funding (please specify:) $0 $0 $0 $0 Federal funding (please specify:) $0 $0 $0 $0 Other jurisdiction funding (please specify:) $0 $0 $0 $0 Fees for services $9,028,221 $3,889,500 $8,820,827 $3,440,900 Donations $0 $0 $0 $0 Reserve contingency fund $0 $0 $0 $0 7 Revenue Source FY 2018/19 Organizational Budget FY 2018/19 Program Budget FY 2017/18 Organizational Budget FY 2017/18 Program Budget Ali other sources (please specify:) $0 $0 $0 $0 Total $9,028,221 $3,904,500 $8,820,827 $3,451,900 Expenditure Summa Expense Category FY 2018/19 Organizational Budget FY 2018/19 Program Budget FY 2017/18 Organizational Budget FY 2017/18 Program Budget Personnel $5,067,315 $610,386 $5,251,415 $595,809 Facility $796,122 $67,042 $795,601 $57,001 Overhead $0 SO $0 $0 Materials/Supplies $467,117 $51,995 $475,714 $54,210 Professional Services $1,867,998 $8,522 $1,922,850 $6,700 Fundraising $0 $0 $0 $0 Capital Projects $0 $0 $0 $0 Other (please specify:) Subscription & Fees, Employee Development, Depreciation $835,344 $37,506 $848,561 $78,901 Total $9,033,896 $817,174 $9,294,141 $792,621 B. Organization Contracts --Has your organization ever had funds withdrawn or a contract terminated for cause, unsatisfactory performance, or questionable costs on any financial statements or audit? If so, please describe. No. C. Organization Investigations --Is your organization currently on probation or under investigation by any agency which is or was a funding source within the past two years? If so, please describe. No. D. Budget Alternatives --What alternatives will your organization consider if the requested Community Grant funding is not provided, or provided at a reduced level? Describe how a reduction will affect the achievement of stated goals. If this request is not funded or if funding is provided at a reduced rate, LGS Recreation will continue to offer Clubhouse Scholarships but a reduced funded amount. 8 E. Funding Sources —Describe your organization's efforts in pursuing other funding sources. The agency's long-term goal is to attract donors to fund our scholarship opportunities in 2019-20. F. Supplies Disclosure --If any non -expendable supplies with a unit cost of $100 or more are to be purchased with Community Grant funds, please describe. N/A G. Travel Expense Disclosure--lf Community Grant funds are to be used for staff travel expenses, please describe. N/A CERTIFICATION The applicant hereby proposes to provide the services as listed in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state, and local regulations, including non- discrimination laws and other assurances as required by the Town of Los Gatos, will be adhered to. Furthermore, as the duly authorized representative of the applicant organization, 1 certify that the applicant is fully capable of fulfilling its obligation under this proposal as stated herein. This application and the information contained herein are true and correct and complete, to the best of my knowledge. Date: March 2 LGS Recreation Organization Name Ex.cutive Di Mot - , 2018 Nancy Rollett (Print Name) 9 LGS (Summer Enrichment) TOWN OF LOS GATOS Town of Los Gatos CLERK DEPARTMENT FY 2018/19 Community Grant Program RECEIVED Application Summary 2818 MAR : oi Project: Project/Program: LGS Recreation Summer Enrichment School Scholarship Fund Program Manager: Manuel Enriquez, Jr. Agency: Name of Agency: Los Gatos -Saratoga Community Education and Recreation (LGS Recreation) Site Address: 208 E. Main Street, Los Gatos, CA 95030 Name of Executive Director: Nancy Rollett Project Description: Provide brief description of agency, agency goals, and agency services. Describe your program briefly, including who benefits from your program. Since 1956, Los Gatos -Saratoga Community Education and Recreation (LGS Recreation) has been dedicated to providing high -quality community education and recreational services to the residents of Los Gatos, Saratoga, Monte Sereno and Mountain communities. A joint powers agency under the authority of three local school districts, Los Gatos Union School District, Saratoga Union School District and Los Gatos -Saratoga Union High School District, LGS Recreation builds a healthy community through administering hundreds of fee -based programs that are enriching, innovative and fun for all. During the summer months, the agency offers Summer Enrichment School for students entering grades Kindergarten — 8th that reside in the Town of Los Gatos and surrounding area. The program is different from the traditional summer school in that it is open to all students, not just those needing remedial instruction. The program is designed and facilitated by credentialed teachers from various local school districts. It provides students the opportunity to keep learning and strengthen their academics while school is out. Heavily project -based, participating students are engaged through a wide range of challenging, unique and fun classes that are non -graded. Program Funding: Provide prior year fiscal year actual budget amounts and proposed amounts for new fiscal year. Program Funding: FY 2017/18 (adopted) FY 2018/19 (requested) Clients: FY 2017/18 (actual) FY 2018/19 (proposed) Town annual funding amount $0 $7,500 Unduplicated annual Los Gatos clients 358 365 Total annual program budget $397,114 $387,033 Total unduplicated annual clients 914 932 1 Town $ as % of annual total 0% 1.94% Los Gatos clients as % of annual total 39% 39% TOWN OF LOS GATOS • FY 2018/19 APPLICATION FOR COMMUNITY GRANT FUNDING APPLICANT AGENCY/PROGRAM DOCUMENTS CHECKLIST Please submit one copy of each of the documents listed below with your completed application. This page should serve as the cover sheet for that section of your submittal. I. PROGRAM/PROJECT INFORMATION ✓ Fee Schedule, Membership, or other fees II. AGENCY INFORMATION ✓ Current Board of Directors ✓ Articles of Incorporation ✓ Bylaws 1 Organizational Chart V. Brochures, Flyers, Promotional Materials M. FISCAL INFORMATION ✓ Audit or Financial Statement plus Letter ofAuditability ✓ Organizational Budget N/A Internal Revenue Service Ruling Letter (Section 501 c.3) N/A California Revenue Code (Section 23701 d) 2 TOWN OF LOS GATOS + FY 2018/19 APPLICATION FOR COMMUNITY GRANT FUNDING GRANT APPLICATION 1. PROGRAM/PROJECT INFORMATION A. Contact Information Legal name of organization Los Gatos -Saratoga Community Education and Recreation (LGS Recreation) Address of organization 208 East Main Street Los Gatos, CA 95030 Organization contact (Name, title, telephone number, email address) Nancy Rollett Executive Director 408-207-4900 nrollett@lgsrecreation. org Program name LGS Recreation Summer Enrichment School Scholarship Fund Site address of program Van Meter Elementary School 16445 Los Gatos Blvd., Los Gatos, CA 95032 Raymond J. Fisher Middle School 19195 Fisher Ave, Los Gatos, CA 95032 Program manager (Name, title, telephone number, email address) Manuel Enriquez School Services Director (408) 354-8700 menriquez@lgsrecreation.org Annual grant amount requested FY 2018/19 $7,500 B. Community Need Statement Describe briefly the demonstrated need in the Los Gatos community for the program. Cite data sources as appropriate. In California, not all School Districts are mandated to provide summer school instruction to their student population. However, in most cases if summer school classes are being held by a district, they are only offered to certain students -those underperforming or for credit recovery purpose. Studies show detrimental effects of summer learning loss, including one to three months of reading Toss (Summer Matters, 2017). LGS Recreation recognizes that summer provides a valuable time for the agency to help our students continue to build upon their academic progress gained during the regular school year. The agency's four -week program has helped many youth avoid losing academic ground during the summer months and is requesting grant funds so those families demonstrating financial hardship can afford this opportunity for their child. 3 c. Direct Services For Human Services and Arts, Culture and Education grant requests, list, describe, and quantify each direct service to be provided annually from July 1, 2018 through June 30, 2019. A Direct Service is a service for which there is an identifiable client. A Participation Agreement (Attachment 2) must be completed by each client receiving the direct services described below. Description of Service FY 2018/19 Number of Services Provided Annually FY 2018/19 Number of Unduplicated Los Gatos Residents served Annually 1. Summer Enrichment School at Van Meter Elementary (K -3') 1 5 2. Summer Enrichment School at Fisher Middle (4th — 8th) 1 5 3. 4. Average number of direct services received by each unduplicated client: _1 Average number of direct services received by each unduplicated Los Gatos client: 1 D. Indirect Services List, describe, and quantify each indirect service to be provided annually from July 1, 2018, through June 30, 2019. An Indirect Service is a service for which there is no identifiable client; for example, information and referral that is given over the phone. Description of Service FY 2018/19 Number of Services Provided Annually 1. Front office representatives (fielding program questions and scholarship inquiries) On -going 2. School Services Director publicizing application and disseminating amongst families. Reviewing submitted application, notifying families of decision and entering award amounts into software system. On -going 3. 4. 4 F. Demographic Information Provide demographic breakdown of unduplicated Los Gatos residents expected to receive direct services. Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2018/19 Age Under 18 years old 914 19 — 50 years old 0 51 years old and over 0 Disability Status Disabled 0 Not Disabled 914 Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2018/19 Income 50% of median and below At this time we do not survey Our participants for this information. 51 % - 100% of median Above 100% of Median Sex Female 170 Male 188 Total Total Los Gatos clients 358 G. Client Participation Requirements Attach appropriate fee schedules, membership requirements, or other fee listings. II. AGENCY INFORMATION A. General Information Legal Name of Organization Los Gatos -Saratoga Community Education and Recreation (LGS Recreation) Address of Organization 208 East Main Street Los Gatos, CA 95030 Name of Executive Director Nancy Rollett Date of Incorporation 1956 Insurance/Tax Information Federal Employer Tax Number 77-0415139 State Employer Tax Number 698-1541 3 Worker's Compensation Carrier/ Policy Number Protection Insurance Program for Schools / PIPS0012114 5 *E Liability Insurance Can-ier Alliance of Schools for Cooperative Insurance Programs / 155-2017 Amount of Liability Coverage $5,000,000 per occurrence Property Damage (combined with liability) $100,000,000 Combined Single Limit $5,000,000 per occurrence Policy Period July 1, 2017 —July 1, 2018* not be available until end of May 2018. B. Staffing Profile Please complete the chart below for your organization as it will be staffed during FY 2018/19. Identify the hours to be devoted to the program for which you are requesting funding, for both employees and volunteers. Position Title Number in Classification Approximate Hourly Rate Hours Worked per Week Percent of Time to Program Employees School Services Director 1 $58.68 40+ 25% Principal 2 $7,875- Stipend 30 100% Teacher 21 $4,000- Stipend 25 100% Volunteers C. Agency Experience --Describe the experience of your Agency in providing program services. LGS Recreation has a great responsibility to the residents it serves in Los Gatos and participants in the surrounding area. For 60 plus years the agency has continuously fulfilled its vision of building a healthy community through enrichment, innovation and fun by offering various education and recreational programs that meet the needs of youth, adults and seniors in the community. For close to a decade, the agency's Summer Enrichment School program has met this community's need for quality summer instruction that is aligned to California State Content Standards for students in grades Kindergarten — 8t". Today, the program remains highly attended and regarded due to the thoughtful construction of unique course offerings and the quality of teachers/instructors recruited and delivering this summer learning program. I.J. Staff Experience --Describe the experience of key staff assigned to the program. The agency recognizes the type of adults needed to work with our young people. Our staff are supportive adults committed to making participants feel connected, confident and empowered. All Summer 6 Enrichment School staff are given the necessary tools and resources to ensure the program is a safe and healthy environment for everyone. They complete mandatory new hire training and participate in a teacher orientation covering topics like; child abuse and neglect, mandated reporting, emergency preparedness, bullying prevention, creating an inclusive program, 40 Developmental Assets and curriculum development planning sessions. E. Staffing Plan --Describe any anticipated staffing changes to occur during FY 2018/19. At this time we don't anticipate any staffing shortages for our Summer Enrichment School program. Although, if a member of our current team is unable to fulfill their summer contracted agreement, we have a Human Resources department that is robust in recruitment and will react thoughtfully and timely to fill any staffing shortages. III. FISCAL INFORMATION A. Program Budget Please complete the following summary tables to reflect the budget for your organization and program. All amounts should be rounded to the nearest dollar. Alternatively, please attach single page revenue/expense summary sheets for the program for which funds are requested and a separate summary for the organization. Budget Surma Budget Data FY 2018/19 FY 2017/18 Los Gatos grant funding Requested: $7,500 Received: 0 Total Program budget $387,033 $397,114 Los Gatos grant as percentage of total Program budget 1.93% 0% Total Organization budget $9,028,221 $8,962,842 Cost per year per unduplicated Los Gatos client $757 $659 Revenue Surma Revenue Source FY 2018/19 Organizational Budget FY 2018/19 Program Budget FY 2017/18 Organizational Budget FY 2017/18 Program Budget Los Gatos grant $0 $7,500 $0 $0 Other municipal funding (please specify:) $0 $0 $0 $0 County funding (please specify:) SO $0 $0 $0 State funding (please specify:) $0 $0 $0 $0 Federal funding (please specify:) $0 $0 $0 $0 Revenue Source FY 2018/19 Organizational Budget FY 2018/19 Program Budget FY 2017/18 Organizational Budget FY 2017/18 Program Budget Other jurisdiction funding (please specify:) $0 $0 $0 $0 Fees for services $9,028,221 $603,000 $8,820,827 $595,000 Donations $0 $ $ $0 Reserve contingency fund $0 $0 $0 $0 All other sources (please specify:) $0 $0 $0 $0 Total $9,028,221 $610,500 $8,820,827 $595,000 Exvenditure Summa Expense Category FY 2018/19 Organizational Budget FY 2018/19 Program Budget FY 2017/18 Organizational Budget FY 2017/18 Program Budget Personnel $5,067,315 $281,410 $5,251,415 $304,264 Facility $796,122 $40,373 $795,601 $31,000 Overhead $ $ $ $ Materials/Supplies $467,117 $46,500 $475,714 $51,350 Professional Services $1,867,998 $18,750 $1,922,850 $10,500 Fundraising $ $ $ $ Capital Projects $ $ $ $ Other (please specify:) Subscription & Fees, Employee Development, Depreciation $835,344 $0 $848,561 $0 Total $9,033,896 $387,033 $9,294,141 $397,114 B. Organization Contracts --Has your organization ever had funds withdrawn or a contract terminated for cause, unsatisfactory performance, or questionable costs on any financial statements or audit? If so, please describe. No. C. Organization Investigations --Is your organization currently on probation or under investigation by any agency which is or was a funding source within the past two years? If so, please describe. No. 8 D. Budget Alternatives --What alternatives will your organization consider if the requested Community Grant funding is not provided, or provided at a reduced level? Describe how a reduction will affect the achievement of stated goals. If this request is not funded, LGS Recreation will not be able to offer scholarships for this specific agency program. If funding is provided at a reduced level, less than ten students will receive a scholarship for the program. E. Funding Sources --Describe your organization's efforts in pursuing other funding sources. The agency's Iong-term goal is to attract donors to fund our scholarship opportunities in 2019-20. F. Supplies Disclosure --If any non -expendable supplies with a unit cost of $100 or more are to be purchased with Community Grant funds, please describe. N/A G. Travel Expense Disclosure --If Community Grant funds are to be used for staff travel expenses, please describe. N/A CERTIFICATION The applicant hereby proposes to provide the services as listed in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state, and local regulations, including non- discrimination laws and other assurances as required by the Town of Los Gatos, will be adhered to. Furthermore, as the duly authorized representative of the applicant organization, I certify that the applicant is fully capable of fulfilling its obligation under this proposal as stated herein. This application and the information contained herein are true and correct and complete, to the best of my knowledge. Date: March 2 _LGS Recreation Organization Name Exec utive Di -ctor Nancy Rollett (Print Name) . 2018 9 Live Oak Adult Day Services Town of Los Gatos FY 2018/19 Community Grant Program Application Summary Project: Project/Program: Adult Day Care — Los Gatos Program Manager: Colleen Hudgen, Executive Director TOWN OF LOS GATOS CLERK DEPARTMENT RECEIVED 2O8 FEB 22 A cl: 50 Agency: Name of Agency: LIVE OAK ADULT DAY SERVICES Site Address: 111 Church Street, Los Gatos, CA 95030 Name of Executive Director: Colleen Hudgen Project Description: Provide brief description of agency, agency goals, and agency services. Describe your program briefly, including who benefits from your program. Service FY 2018/2019 (proposed) FY 2016/17 (actual) Days of adult day care (recreation and social activities) provided to Los Gatos frail seniors. 1000 FY 2016/17 — 900 FY 2017/18 (as of 12/31/2017) 347 Days of respite provided to Los Gatos caregivers corresponding to program days. 1000 FY 2016/17— 900 FY 2017/18 (as of 12/31/2017) 347 Noon meals provided to Los Gatos frail seniors. 1000 FY 2016/17 — 900 FY 2017/18 (as of 12/31/2017) 347 Breakfasts provided to Los Gatos frail seniors. 1000 FY 2016/17 — 900 FY 2017/18 (as of 12/31/2017) 347 Program Funding: Provide prior year fiscal year actual budget amounts and proposed amounts for new fiscal year. Program Funding: FY 2017/18 (adopted) FY 2018/19 (requested) Clients: FY 2017/18 (actual) FY 2018/19 (proposed) Town annual funding amount 13,000 13,000 Unduplicated annual Los Gatos clients 20 20 Total annual program budget 117,007 117,007 Total unduplicated annual clients 64 64 Town $ as % of annual total 12% 12% Los Gatos clients as % 31% 31% of annual total TOWN OF LOS GATOS + FY 2018/19 APPLICATION FOR COMMUNITY GRANT FUNDING APPLICANT AGENCY/PROGRAM DOCUMENTS CHECKLIST Please submit one copy of each of the documents listed below with your completed application. This page should serve as the cover sheet for that section of your submittal. . PROGRAM/PROJECT INFORMATION ✓ Fee Schedule, Membership, or other fees II. AGENCY INFORMATION ✓ Current Board of Directors ✓ Articles of Incorporation ✓ Bylaws ✓ Organizational Chart ✓ Brochures, Flyers, Promotional Materials III. FISCAL INFORMATION ✓ Audit or Financial Statement plus Letter of Auditability ✓ Organizational Budget ✓ Internal Revenue Service Ruling Letter (Section 501 c.3 ) ✓ California Revenue Code (Section 23701 d) 2 TOWN OF LOS GATOS + FY 2018/19 APPLICATION FOR COMMUNITY GRANT FUNDING GRANT APPLICATION I. PROGRAM/PROJECT INFORMATION A. Contact Information Legal name of organization LIVE OAK ADULT DAY SERVICES Address of organization 1147 Minnesota Avenue San Jose, CA 95125 Organization contact (Name, title, telephone number, email address) Colleen Hudgen, Executive Director 408-971-9363 liveoalcdayeare@att.net Program name Adult Day Care — Los Gatos Site address of program 1 I 1 Church Street Los Gatos, CA 95030 Program manager (Name, title, telephone number, email address) Colleen Hudgen, Executive Director 408-971-9363 liveoakdaycare@att.net Kim Hughes, Assistant Program Director -Los Gatos 408-354-4782 lgliveoak@hotmail.com Annual grant amount requested FY 2018/19 $13,000 B. Community Need Statement Describe briefly the demonstrated need in the Los Gatos community for the program. Cite data sources as appropriate. Santa Clara County is home to over 200,000 seniors aged 60 and over, about 16% of the total county population, expected to double in the next 10 years (2010 U.S. Census). The county's senior population has grown faster in the last 20 years than state and national rates. (COASV, Exec. Summary, June 2012 and SCC, Seniors' Agenda: Phase II, Oct.2012). As the population ages over time the increase in the need for care and services is a priority issue for our community. One out of eight people in this country is 65 and older. 3 By 2030, 20% of the population will be senior citizens. Disabled seniors with chronic mobility and self - care limitations, living on low -fixed incomes, are at the highest risk of social isolation, depression, neglect, abuse, and premature / long-term institutionalization. Also "at -risk" are family members who provide over 70% of care for their elderly loved ones. County needs assessments on health and quality of life consistently report inadequate services for the elderly, as well as the strain on family members caring for an older dependent relative. A recent study found family caregivers are more likely to experience negative health effects like anxiety, depression and chronic disease. Even worse, those who experienced mental or emotional stress while caring for a disabled spouse were 63% more likely to die within four years than non -caregivers who were also tracked. ("Who Will Care for the Caregivers?", New York Times, January 19, 2017). Persons most likely to need support and long-term services, i.e., those aged 85 and over, will increase at a dramatic rate. By 2030, more than one in four (25%) of county residents will be a senior (COASV and SCC CAP). Day care for frail seniors and respite for their caregivers have been designated by all the aforementioned community health studies as priority needs. With the steady and ongoing increase in the aging population, and the frequency of older adults subject to disorders impeding self-sufficiency and quality of life, the needs of seniors will continue to demand greater attention, while respite care for informal caregivers will be an accompanying key senior issue. LIVE OAK's senior clients are frail, at -risk, dependent and disabled by age -related disorders which deny them the ability for self -care, mobility, and healthy functioning. The dearth of appropriate and affordable services, isolation, loneliness and depression, malnutrition and neglect or abuse challenge their health, dignity, comfort and overall quality of life. Day care for frail seniors and respite for their caregivers have been designated by all of the aforementioned community health studies as priority needs. Through advocacy on behalf of seniors and promotion of adult day care as a positive and economical mode of care for the frail elderly population, LIVE OAK provides a viable and consistent contribution to meeting the critical need for senior -related services in Santa Clara County. With the steady and ongoing increase in the aging population, and the frequency of older adults subject to disorders impeding self-sufficiency and quality of life, the needs of seniors will continue to demand greater attention, while respite care for informal caregivers will be an accompanying key senior issue. By promoting adult day care as a positive and economical mode of care for the frail elderly population, LIVE OAK provides a viable and consistent contribution to meeting the critical need for senior -related services in Santa Clara County. Our request for funds is geared to providing essential human services for special needs, very low and low income populations and households (disabled and dependent seniors). The frail, at -risk seniors who will attend LIVE OAK are not able to attend mainstream senior center programs. They need a safe and supportive environment offering hands-on assistance with activities of daily living including eating, ambulating, toileting, etc. They are also at great risk of isolation, falls, over/under medicating and/or premature hospitalization/institutionalization. 4 c. Direct Services For Human Services and Arts, Culture and Education grant requests, list, describe, and quantify each direct service to be provided annually from July 1, 2018 through June 30, 2019. A Direct Service is a service for which there is an identifiable client. A Participation Agreement (Attachment 2) must be completed by each client receiving the direct services described below. Description of Service FY 2018/19 Number of Services Provided Annually FY 2018/19 Number of Unduplicated Los Gatos Residents served Annually 1. Days of adult day care (recreation and social activities) provided to Los Gatos frail seniors. 1000 20 2. Days of respite provided to Los Gatos caregivers corresponding to program days. 1000 20 3. Noon meals provided to Los Gatos frail seniors. 1000 20 4. Breakfasts provided to Los Gatos frail seniors. 1000 20 Average number of direct services received by each unduplicated client: _238_ Average number of direct services received by each unduplicated Los Gatos client: _200 D. Indirect Services List, describe, and quantify each indirect service to be provided annually from July 1, 2018, through June 30, 2019. An Indirect Service is a service for which there is no identifiable client; for example, information and referral that is given over the phone. Description of Service FY 2018/19 Number of Services Provided Annually 1. Referrals/Outreach. 120 2. Staff consultations, counseling, assessments, Caregiver Support Workshops. 75 3. In-service programs. 4 5 F. Demographic Information Provide demographic breakdown of unduplicated Los Gatos residents expected to receive direct services. Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2018/19 Age Under 18 years old 19 — 50 years old 1 51 years old and over 19 Disability Status Disabled 20 Not Disabled Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2018/19 Income 50% of median and below 20 51 % - 100% of median Above 100% of Median Sex Female 12 Male 8 Total Total Los Gatos clients 20 G. Client Participation Requirements Attach appropriate fee schedules, membership requirements, or other fee listings. H. AGENCY INFORMATION A. General Information Legal Name of Organization LIVE OAK ADULT DAY SERVICES Address of Organization 1147 Minnesota Avenue San Jose, CA 95125 Name of Executive Director Colleen Hudgen Date of Incorporation April 26, 1985 Insurance/Tax Information Federal Employer Tax Number 77-0069106 State Employer Tax Number 324-0529 2 Worker's Compensation Carrier/ Policy Number Arthur J. Gallagher & Co. Ins, Brokers of CA, Inc. / 9061931-17, Policy Period 7/1/17-7/1/18 Liability Insurance Carrier San Jose Insurance Agency, Inc. 201701332NPO 6 Amount of Liability Coverage $2,000,000 Property Damage (combined with Liability) Included Combined Single Limit $1,000,000 Policy Period ~9/10/2017-9/10/2018 B. Staffing Profile Please complete the chart below for your organization as it will be staffed during FY 2018/19. Identify the hours to be devoted to the program for which you are requesting funding, for both employees and volunteers. Position Title Number in Classification Approximate Hourly Rate Hours Worked per Week Percent of Time to Program Employees Executive Director 1 51.84 40 25 Chief Operations Officer 1 38.07 40 25 Development Associate 1 30.00 20 25 Program Dir., Willow Glen 1 23.81 35 0 Program Dir., Gilroy 1 31.82 32 0 Assist. Program Dir., Los Gatos 1 21.88 35 100 Program Dir., Cupertino 1 28.13 35 0 Program Specialists (4 sites) 1 10.80-14.50 32 2@100 Volunteers Program Volunteers* 155 N/A Variable 25 Board of Directors 6 N/A Variable 100 Advisory Council 12 N/A Variable 25 *Over 300 volunteer hours are donated to the agency every month. C. Agency Experience —Describe the experience of your Agency in providing program services. LIVE OAK has been the primary adult day care provider for the general disabled senior population in Santa Clara County for 33 years. Since its inception in 1983 as a small part-time program in Los Gatos, services have been expanded to four full-time adult day care centers serving hundreds of frail seniors and their families with life -sustaining adult day care and caregiver respite services. D. Staff Experience —Describe the experience of key staff assigned to the program. Executive Director: 37 years nonprofit experience in development, administration of health, human services and senior programs, including 14 years managing the Senior Outreach Case Management program at OUTREACH and six in Florida as Executive Director of a 24-hour facility for mentally/physically/developmentally challenged adults. Chief Operations Officer: almost 30 years in nonprofit industry. BS. Sociology and Certificate in Gerontology. Program Directors: PhD, M.A. in gerontology or related fields. Asst. Program Directors: degreed/trained in gerontology. Program Specialists are trained and experienced in elder care. E. Staffing Plan --Describe any anticipated staffmg changes to occur during FY 2018/19. Each of the four LIVE OAK adult day care centers is staffed with a Program Director, Assistant Program Director and 2 — 4 Program Specialist who provide direct client care in serving frail senior participants. Currently the Program Director position for the Los Gatos center is vacant, and the organization is conducting a search for the right individual to fill this position. Other than that hiring, no other staff' changes are anticipated during FY 2018-19. a F. M. FISCAL INFORMATION A. Program Budget Please complete the following summary tables to reflect the budget for your organization and program. All amounts should be rounded to the nearest dollar. Alternatively, please attach single page revenue/expense summary sheets for the program for which funds are requested and a separate summary for the organization. Budget Summa Budget Data FY 2018/19 FY 2017/18 Los Gatos grant funding Requested: $13,000 Received: $13,000 Total Program budget $117,007 $117,007 Los Gatos grant as percentage of total Program budget 12% 12% Total Organization budget $1,271,572 $1,271,572 Cost per year per unduplicated Los Gatos client $650.00 (13,000 / 20) $650.00 (13,000 / 20) Revenue Summary Revenue Source FY 2018/19 Organizational Budget FY 2018/19 Program Budget FY 2017/18 Organizational Budget FY 2017/18 Program Budget Los Gatos grant $13,000 $13,000 $13,000 $13,000 Other municipal funding (please specify: ) $ $ $ $ City of Campbell $7,500 $7,500 City of Gilroy $10,000 $10,000 City of Santa Clara $10,000 $7,245 City of Cupertino $15,892 $15,098 City of Sunnyvale $10,000 $10,000 County funding (please specify:) $ $ $ $ SSA - General Funds Day Care $67,002 $16,750 $67,002 $16,752 SSA - General Funds Safety Net $37,694 $9,423 $37,694 $9,423 SCC CDBG $20,300 $10,000 $20,300 $I0,000 State funding (please specify:) Meals reimb. $38,000 $6,500 $38,000 $6,500 Federal funding (please specify:) SourceWise $111,371 $ $111,371 $ Other jurisdiction funding (please specify.) $ $ $ $ 9 Revenue Source FY 2018/19 Organizational Budget FY 2018/19 Program Budget FY 2017/18 Organizational Budget FY 2017/18 Program Budget Fees for services $659,085 $84,259 $659,085 $84,259 Donations $103,166 $1,072 $103,166 $1,072 Reserve contingency fund $ $ $ $ All other sources (please specify:) Government $316,157 $23,314 $316,157 $23,314 Foundations & Corporation $105,860 $8,361 $105,860 $8,361 Interest income $227 $227 Net investment Income $9,410 $9,410 Special Events $30,488 $30,488 Total 81„224,393 $117,006 $1,224,393 $117,006 Expenditure Summa Expense Category FY 2018/19 Organizational Budget FY 2018/19 Program Budget FY 2017/18 Organizational Budget FY 2017/18 Program Budget Personnel $882,156 $130,806 $882,156 $130,806 Facility $64,415 $14,098 $64,415 $14,098 Overhead $0 $0 $0 $0 Materials/Supplies $115,616 $4,878 $115,616 $4,878 Professional Services $34,655 $9,766 $34,655 $9,766 Fundraising $0 $0 $0 $0 Capital Projects $0 $0 $0 $0 Other (please specify:) Misc, Taxes, Equip., Training, Insurance $59,712 $3,354 $59,712 $3,354 Accounting/Audit S38,237 $ $38237 $ Building Repairs $I5,071 $529 $15,071 $529 Depreciation $22,254 $236 $22,254 $236 Purchased Services $39,456 $8,472 $39,456 $8,472 Total $1,271,572 $172,139 $1,271,572 $172,139 10 B. Organization Contracts —Has your organization ever had funds withdrawn or a contract terminated for cause, unsatisfactory performance, or questionable costs on any financial statements or audit? If so, please describe. N/A C. Organization Investigations --Is your organization currently on probation or under investigation by any agency which is or was a funding source within the past two years? If so, please describe. N/A D. Budget Alternatives --What alternatives will your organization consider if the requested Community Grant funding is not provided, or provided at a reduced level? Describe how a reduction will affect the achievement of stated goals. LIVE OAK maintains a diverse funding base including government agencies, private foundations, businesses and clubs, individual donors, Board pledges, client fees and special fundraising events. In the event of reduced, or loss of, funding, our efforts would include seeking increased gifts from existing funders, researching new donors, encouraging increased support from our client families, etc. CDBG funding from Los Gatos and other communities is integral to our ability to provide day care for the growing numbers of frail seniors. We maintain a 5:1 client — staff ratio to ensure safety and quality care for our frail clients. Any reduction in funds would directly impact the number of clients we are able to serve. E. Funding Sources --Describe your organization's efforts in pursuing other funding sources. Maintaining a diversified, stable funding base is an ongoing agency priority to ensure financial stability and uninterrupted operation in case of a loss or reduction in funding from a particular source. Fundraising efforts are ongoing and include renewing proposals with known donors, researching new sources, keeping abreast of developments in the nonprofit arena, participating in speaking presentations and community and business fundraising events. The agency's Board includes a Fund Development Chairperson. Board recruitment requires willingness to make personal gifts to the agency and participate in fundraising efforts. F. Supplies Disclosure --If any non -expendable supplies with a unit cost of $100 or more are to be purchased with Community Grant funds, please describe. N/A G. Travel Expense Disclosure --If Community Grant funds are to be used for staff travel expenses, please describe. N/A. CDBG funds are used only to cover salaries of program personnel. 11 CERTIFICATION The applicant hereby proposes to provide the services as listed in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state, and local regulations, including non- discrimination laws and other assurances as required by the Town of Los Gatos, will be adhered to. Furthermore, as the duly authorized representative of the applicant organization, I certify that the applicant is fully capable of fulfilling its obligation under this proposal as stated herein. This application and the information contained herein are true and correct and complete, to the best of my knowledge. Date: ,2018 Organization Name Executive Director J e.-ri (Print Name) 12 ATTACHMENT 1 SAMPLE PARTICIPATION AGREEMENT Over the course of the contract period, a grantee may be required submit Participation Agreements similar to this sample. Do not submit this Sample Participation Agreement with your completed application. a nonprofit corporation, provides certain services to individuals and families in Santa Clara County. Partial funding (subsidy) for these services is provided under contract by the Town of Los Gatos to this Agency. This information is reviewed for quality control and/or auditing purposes only. Therefore it is held in confidence by the Agency, the Town, and the Federal representatives and not considered "Public Information." The purpose of this Participation Agreement is as follows: 1. To have the client acknowledge the request and receipt of needed services and provide the client with an opportunity to evaluate such services. 2. To have the client authorize the release of demographic information to the Agency/the Town. 3. To assure the client that information about them is held in confidence and not considered public information and that only statistical information about all clients served is reported. 4. To have the client hold harmless and release from Iiability the Agency, the Town, and their respective employees, officers, and agents in the event of any suit, claim, loss, damage, or obligation arising out of/or attributed to any of the Agency's programs. Please complete the following: Name: Age: Address: Phone: Sex (check one): 0 Male 0 Female Disability Status (check one): 0 Disabled 0 Not Disabled Female Head of Household (check one): 0 Yes 0 No Income Level (check one): ❑ 30% of median and below ❑ 31%-50%of median ❑ 51% - 80% of median ❑ 81% - 100% of median ❑ Above 100% of median I understand that this agreement is an affidavit and certify that the information provided above is true and compl= e Signature Date 2-6 fr 13 Live Oak Senior Nutrition TOWN OF LOS GATOS Town of Los Gatos CLERK DEPARTMENT FY 2018/19 Community Grant Program RECEIVED Application Summary IO I8 MAR -5 P I: 50 Project: Project/Program: Live Oak Senior Nutrition and Service Center Program Manager: Mary Alden Goulart Agency: Name of Agency: Live Oak Senior Nutrition and Service Center Site Address: 111 Church St., Los Gatos, CA 95030 Name of Executive Director: Mary Alden Goulart Project Description: Provide brief description of agency, agency goals, and agency services. Describe your program briefly, including who benefits from your program. Live Oak Senior Nutrition and Service Center (LOSNSC) has been a County based Senior Nutrition Program (SNP) since 1974. It is the only weekday hot lunch senior program in the Los Gatos/Monte Sereno/Saratoga area. LOSNSC's founders were members of the Los Gatos United Methodist Church (LGUMC) and through their partnership efforts with the Santa Clara County (SCC), they established one of the first Santa Clara County Senior Nutrition Programs (SCCSNP). The original Board Members were all LGUMC members but today, the Board is made up of both community members and church members alike. Our primary site, including our large dining hall and office, remains at LGUMC. In addition, we also serve meals at two other Los Gatos sites, Villa Vasona Apartments and the Los Gatos Adult Rec Center. LOSNSC's mission statement is "We are driven by a passion to improve the quality of life for seniors in our community through high quality, cost efficient, nutritious meals in a social setting". Our emphasis remains seated in enhancing the quality of life for our seniors and maintaining their independence for as long as possible. By providing a supportive, social and stimulating atmosphere that promotes friendships and good nutrition, 95% of our SNP clients surveyed state that attending our program has enhanced the overall quality of their lives. LOSNSC also offers live musical luncheon entertainment, weekly fitness classes twice a week, free blood pressure screenings, health presentations, information and referral services and festive special events throughout the year. Program Funding: Provide prior year fiscal year actual budget amounts and proposed amounts for new fiscal year. Program Funding: FY 2017/18 (adopted) FY 2018/19 (requested) Clients: FY 2017/18 (actual) FY 2018/19 (proposed) Town annual funding amount $28,500 $30,000 Unduplicated annual Los Gatos clients 142 150 Total annual program budget $166,746 175,339 Total unduplicated annual clients 283 300 Town $ as % of annual total 17% 17% Los Gatos clients as % of annual total 50% 50% Note 2. Actual number of clients is based on the last completed Fiscal Year 16/17. See notes under the Section F Demographic Information table. We have projected a slight increase in population for FYI 8/19. 2 TOWN OF LOS GATOS FY 2018/19 APPLICATION FOR COMMUNITY GRANT FUNDING APPLICANT AGENCY/PROGRAM DOCUMENTS CHECKLIST Please submit one copy of each of the documents listed below with your completed application. This page should serve as the cover sheet for that section of your submittal. I, PROGRAM/PROJECT INFORMATION L Fee Schedule, Membership, or other fees II. AGENCY INFORMATION ❑ Current Board of Directors • Articles of Incorporation ❑ Bylaws ❑ Organizational Chart ❑ Brochures, Flyers, Promotional Materials III, FISCAL INFORMATION ❑ Audit or Financial Statement plus Letter of Auditability ❑ Organizational Budget ❑ Internal Revenue Service Ruling Letter (Section 501 c.3) Q California Revenue Code (Section 23701 d) 3 TOWN OF LOS GATOS • FY 2018/19 APPLICATION FOR COMMUNITY GRANT FUNDING GRANT APPLICATION I. PROGRAM/PROJECT INFORMATION A. Contact Information Legal name of organization Live Oak Senior Nutrition and Service Center Address of organization 111 Church St. Los Gatos, CA 95030 Organization contact (Name, title, telephone number, email address) Mary Alden Goulart Executive Director (408)3 54-0707 Mary.goulart@lgumc.org Program name Same as above Site address of program Same as above Program manager (Name, title, telephone number, email address) Same as above Annual grant amount requested FY 2018/19 $30,000.00 B. Community Need Statement Describe briefly the demonstrated need in the Los Gatos community for the program. Cite data sources as appropriate. LOSNSC caters mostly to the needs of an under -represented target population, primarily seniors over the age of 75 (60%), seniors living alone (40%) and low income seniors (43%). In addition, LOSNSC serves a growing number of older adults (60%) who claim to experience moderate to high levels of social isolation. Although serious malnutrition does not appear to be a huge problem in our area, Social Malnutrition definitely is. Extensive research has been done by the World Health Organization (WHO) that advocates for more Age -Friendly communities. Social isolation amongst older adults, especially those in our "target population", is listed as one of the most serious challenges impacting the health and wellbeing of our aging population. The WHO research also shows the impact of social isolation and report that older adults who live alone or are otherwise isolated from regular social engagement, have a much greater risk of depression, early onset dementia and other neurological challenges. The SCCSNP gathers data each year through their Nutrition Risk Survey. The FY 16/17 survey indicates that 85% of Los Gatos clients who attend LOSNSC state that our social luncheons helps them stay healthy. 75% of those surveyed claim that the program helps them maintain their independence. Socialization is a key element to making SNPs popular and 100% of clients surveyed say the socialization they enjoy during their luncheons is what helps them maintain their physical health and good spirit. LOSNSC enjoyed an upswing in positive feedback in FY 16/17 and 100% of our clients say the service at this site improved in the last year. 58% of our clients eat 3 or more 4 meals a week at our site, the majority of them attend because of friends, followed closely by the food they enjoy during their luncheons. Overall wellbeing, including many physical health issues, have also been linked to loneliness. US News reports support these facts and add "mental abilities can suffer as a person's world shrinks and cognitive decline and dementia are more likely with isolation". An increase in older adult suicides and elder abuse have also been associated with social isolation in seniors. Although Social Malnutrition is more of a problem in and around Los Gatos and Monte Sereno,AARP stated in 2014, more than 10 million adults aged 60 and older in the US were at risk of hunger, lacking access to enough nutritious food to lead to a healthy, active lifestyle, resulting in a higher prevalence of chronic conditions, medication non- adherence and hospital readmissions. AARP also reports that Second Harvest Heartland has seen a 1000% increase in referrals for "food insecure older adults". Santa Clara County Second Harvest Food Bank estimates that 47% of seniors in Santa Clara County do not receive adequate nutrition. Nationally, the issues of hunger and social isolation are both on the rise, making physical and social malnutrition two of the leading causes of health decline in American older adults today. c. Direct Services For Human Services and Arts, Culture and Education grant requests, list, describe, and quantify each direct service to be provided annually from July 1, 2018 through June 30, 2019. A Direct Service is a service for which there is an identifiable client. A Participation Agreement (Attachment 2) must be completed by each client receiving the direct services described below. Description of Service FY 2018/19 Number of Services Provided Annually FY 2018/19 Number of Unduplicated Los Gatos Residents served Annually 1. Meals Served 12,455 142 2. Transportation (Paratransit included) 2,690 46 3. Socialization (hours per week) 4,400 142 4. Phone Assistance 700 100 5. Homebound Assistance 190 85 6. Physical Fitness 900 100 7. Weekly Blood Pressure Checks (Tntergenerational education opportunity with San Jose State nursing students) 450 110 Average number of direct services received by each unduplicated client: _283 Average number of direct services received by each unduplicated Los Gatos client: _142_ *Although 50% of clients are from Los Gatos, 63% of meals and service are used by Los Gatos residents D. Indirect Services List, describe, and quantify each indirect service to be provided annually from July 1, 2018, through June 30, 2019. An Indirect Service is a service for which there is no identifiable client; for example, information and referral that is given over the phone. Description of Service FY 2018/19 Number of Services Provided Annually i. Information and Referrals 580 2. Health & Safety Info, Transportation/bus route info 210 F. Demographic Information Provide demographic breakdown of unduplicated Los Gatos residents expected to receive direct services. Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2018/19 Age Under 18 years old 0 19--50years old 0 51 years old and over 142 60-65 15 66-75 50 76-85 46 86 and older 31 Disability Status Disabled Not avail Not Disabled Not avail Demographic Notes: Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2018/19 Income 50% of median and below No data — number below is those below 100% of median 51 % - 100% of median 46 Above 100% of Median 73 Sex Female 84 Male 50 Total Total Los Gatos clients 142 a. The grant application asks the applicant to project the demographics of the future FY18/19 clientele. We have provided detailed information from a complete FY16/17 data set just received from Santa Clara County based on participant registration information and daily client sign -in scans. We do not expect that the projected FY18/19 demographics will be materially different than the FY16/17 actuals. 6 b. Data based on spreadsheet provided on March 1, 2018 by SCCSNP staff containing details of each unique participant for FY16-17 containing age, zip/city, gender, poverty status (above/below 100% Federal Poverty Level), Living status (alone/not alone), ethnicity, race, number of times in year each participant signed in for a meal. Per instructions, we have extracted stats from the whole data set for only Los Gatos Town residents to populate the table above. Note that disability status is not gathered in the county's registration process. We have added rows to break out the ages of our participants. With 54% of the Los Gatos unique participants being 76 or older, this is considered a fragile, but not necessarily disabled population. This listed 283 overall participants, with 142 or 50°/a being Los Gatos Town residents. FYI, here is the location information of the participants in the data set. Town of Los Gatos residents are the overwhelmingly most numerous participants. Campbell 11 4% Gilroy 4 1% Hollister 1 0% Los Gatos 142 50% Monte Sereno 8 3% Mountain View 3 1% Palo Alto 1 0% San Jose 58 20% Santa Clara 7 2% Saratoga 47 17% Sunnyvale 1 0% Grand Total 283 100 % G. Client Participation Requirements Attach appropriate fee schedules, membership requirements, or other fee listings. A $3.00 voluntary contribution is requested for lunches but no one is turned away if unable to pay some or all of this requested amount. All contribution are remitted directly and entirely to the County of Santa Clara and LOSNSC retains none of the money from contributions. Fees are charged for fitness classes or other programs offered by LOSNSC. Clients must be 60 years of age or older. 7 II. AGENCY INFORMATION A. General Information Legal Name of Organization Live Oak Senior Nutrition and Service Center Address of Organization 111 Church St., Los Gatos, CA 95030 Name of Executive Director Mary Alden Goulart Date of Incorporation May 1974 Insurance/Tax Information Federal Employer Tax Number 94-1399283 State Employer Tax Number 347-821-3 Worker's Compensation Carrier/ Policy Number State Compensation Fund Policy # 9075149-14 Liability Insurance Carrier Great American Insurance Group — MAC 0594766 Amount of Liability Coverage 2,000,000.00 (aggregate) Property Damage (combined with liability) 1,000,000.00 Combined Single Limit 1,000,000.00 Policy Period 10/08/18 to 10/08/19 B. Staffing Profile Please complete the chart below for your organization as it will be staffed during FY 2018/19. Identify the hours to be devoted to the program for which you are requesting funding, for both employees and volunteers. Position Title Number in Classification Approximate Hourly Rate Hours Worked per Week Percent of Time to Program Employees Executive Director n/a $26.52 30 100 Office Assistant n/a $17.23 9 100 Office Bookkeeper n/a $21.29 3 100 Kitchen Manager n/a $12.92 25 100 Volunteers Board of Directors 8 0 n/a 100 Community Volunteers 30 0 n/a 100 8 C. Agency Experience —Describe the experience of your Agency in providing program services. Since May 1974, Live Oak Senior Nutrition and Service Center (LOSNSC) has been dedicated to providing hot and nutritious lunches to older adults (sixty and over) in the Los Gatos Community. For almost 44 years, LOSNSC has been the ONLY ongoing week -day hot lunch program in town. LOSNSC provides live luncheon music almost daily, offers local seniors a welcoming and comfortable place to gather, make friends, socialize, get health, transportation and emergency preparedness information and information regarding other programs and services available to them Locally and beyond. Staff also provide a safe place for nutrition clients to share their hardships, life concerns and life stories that shape the individuals they have become. With funding from SCCSNP and the town of Los Gatos, augmented by in -kind support from Los Gatos United Methodist Church, grants, community support, and a cadre of dedicated volunteers, LOSNSC has been able to fill many of the needs of our seniors to continue to live a healthy and independent life for over 4 decades. LOSNSC has maintained a consistently high rating in the County Department of Social Services' annual assessment. The Board of Directors has successfully guided the agency through economic downturns and changing times, keeping the operating costs to a minimum while seeking adequate sources of income on an ongoing basis. D. Staff Experience --Describe the experience of key staff assigned to the program. Mary Alden Goulart - Ex. Director: 22+ yrs. experience in the Senior Care industry, management of retirement communities, assisted living, nursing home care, adult day care, senior center and some Hospice work. She has 11 yrs. experience in an acute care pediatric hospital with emphasis on improving patient and family centered care, working alongside top hospital management. She is a Life coach and transition consultant, specializing in aging, elder care, End -of -life and Grief coaching. Goulart is a certificated Food Safety Manager through the National Registry of Food Safety Professionals and is certified through Santa Clara County as a Community Emergency Rescue Team (CERT) member. E. Staffing Plan --Describe any anticipated staffing changes to occur during FY 2018/19. Continuing our long practice in recruiting and retaining excellent management, we will be recruiting a new Executive Director to come on board early in FY18/19. Our existing Executive Director will remain onboard until her replacement is fully trained and oriented to all responsibilities and practices. No other staffing changes are anticipated at this time so the program will benefit from the ongoing stability of the Kitchen Manager and Office Manager. 111. FISCAL INFORMATION A. Program Budget Please complete the following summary tables to reflect the budget for your organization and program. All amounts should be rounded to the nearest dollar. Alternatively, please attach single page revenue/expense summary sheets for the program for which funds are requested and a separate summary for the organization. 9 et Sumrna Budget Data FY 2018/19 FY 2017/18 Los Gatos grant funding Requested: $30,000 Received: $28,00 Total Program budget $175,339 $166,746 Los Gatos grant as percentage of total Program budget 17% % Total Organization budget $175,339 $ Cost per year per unduplicated Los Gatos client $620 $589 NOTE: FY2018/19 budget based on full proposed county budget. See explanation below the revenue summary. Revenue Sumrraa r Revenue Source FY 2018/19 Organizational Budget FY 2018/19 Program Budget FY 2017/18 Organizational Budget FY 2017/18 Program Budget Los Gatos grant $30,000 $30,000 $28,500 $28,500 Other municipal funding (please specify: ) $0 $0 $0 $0 County funding (please specify:) $0 $0 $0 $0 State funding (please specify:) $0 $0 $0 $0 Federal funding (please specify:) $0 $0 $0 $0 Other jurisdiction funding (please specify:) $0 $0 $0 $0 Fees for services $0 $0 $0 $0 Donations: Board members, mail campaign, individuals, churches $11,500 $11,500 $11,500 $11,500 Reserve contingency fund $1,083 $1,083 $6,130 $6,I30 All other sources (please specify:) Schwab Interest/Dividends, fund raisers, project grants, Live Oak Adult Day Services reimbursement $13,500 $13,500 $13,500 $13,500 Total $175,339 $175,339 $166,746 $166,746 a. FY17-18 based on executed contract amendment Number 7 to Santa Clara County contract of $133,519.83 adjusted to reflect expected County payments against contract. The contract value is the maximum available, provided LOSNSC serves the number of contracted meals. The county payment through the fiscal year is based on the number of meals served, despite fixed line -item costs enumerated in the contract. FY17/18 original program budget was $186,449, but due to anticipated I0 shortfall in Santa Clara County Senior Nutrition Program funding, our board adopted a lower working budget of $166,746. Our estimate total program budget for FY18/19 does not include a reduction of Santa Clara County funding, but reflects the maximum available county funds. FY18/19 county funding is based on our proposal to Santa Clara County for FY18/19 and subsequent yearly extensions submitted on Jan 29, 2018. The county's proposal evaluation schedule key future dates are: Contract Negotiations March 12-22, 2018, Notices of Intent to Award March 27, 2018, anticipated start date 01 July 2018. b. Re: fees for service. Noted as net zero. We collect on behalf of Santa Clara County a voluntary contribution from the participants for meal costs; all such contributions are remitted each month directly and completely to the county — our program retains none of the contributions for its local budgetary purposes. This revenue is an important part of the funding for the Santa Clara County Senior Nutrition Program overall. Expenditure Summa Expense Category FY 2018/19 Organizational Budget FY 2018/19 Program Budget FY 2017/18 Organizational Budget FY 2017/18 Program Budget Personnel $82,877 $82,877 $79,069 $79,069 Facility $6,000 $6,000 $6,000 $6,000 Overhead $16,465 $16,465 $16,565 $16,565 Materials/Supplies $0 $0 $0 $0 Professional Services $0 $0 $0 $0 Fundraising $375 $375 $375 $375 Capital Projects $0 $0 $0 $0 Other (please specify) Catered food; non food [napkins, cups, paper supplies, etc.], program costs [senior celebrations, entertainment, etc.]) $69,662 $69,662 $64,737 $64,737 Total $175,339 $175,339 $166,746 $166,746 Note Overhead: Includes general ledger items Program Overhead, Insurance/Workers Comp Fiscal/Audit fees B. Organization Contracts —Has your organization ever had funds withdrawn or a contract terminated for cause, unsatisfactory performance, or questionable costs on any financial statements or audit? If so, please describe. No li C. Organization Investigations --Is your organization currently on probation or under investigation by any agency which is or was a funding source within the past two years? If so, please describe. No D. Budget Alternatives —What alternatives will your organization consider if the requested Community Grant funding is not provided, or provided at a reduced level? Describe how a reduction will affect the achievement of stated goals. Absent the Town of Los Gatos grant, LOSNSC would have to curtail supplements (information and referral, exercise, entertainment, participant celebration etc.) and reduce staff and staff hours that make these programs possible. E. Funding Sources --Describe your organization's efforts in pursuing other funding sources. Approximately 17% of our Board of Director's fundraising efforts come from our annual fund raising letter, fundraising through the LGUMC, Los Gatos Community and Service Clubs, and Corporate and individual donors. We will pursue within the next year include the Beulah Grant from the United Methodist Women organization. In addition, the Board and staff will investigate other possible grants that are available to our organization. F. Supplies Disclosure --If any non -expendable supplies with a unit cost of $100 or more are to be purchased with Community Grant funds, please describe. None G. Travel Expense Disclosure --If Community Grant funds are to be used for staff travel expenses, please describe. None 12 CERTIFICATION The applicant hereby proposes to provide the services as listed in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state, and local regulations, including non- discrimination laws and other assurances as required by the Town of Los Gatos, will be adhered to. Furthermore, as the duly authorized representative of the applicant organization, I certify that the applicant is fully capable of fulfilling its obligation under this proposal as stated herein. This application and the information contained herein are true and correct and complete, to the best of my knowledge. Date: l A- -C :4 7-11 , 2018 L, fve- Aic 5eooe_ Nv; iar' v 9L 5EiZV/Cc V71 Organization Name Execu we e Director IA At Pi A L4oEikr ‘ov4,AIL — (Print Name) 13 Next Door Solutions Town of Los Gatos TOWN Of LOS GATOS FY 2018/19 Community Grant Program CLERKDEPARTMENT Application Summary RECEIVED 10I8 MAR -5 A II, 01 Project: Project/Program: Crisis & Support Services for Survivors of Domestic Violence Program Manager: Colsaria Henderson, Director of Programs Agency: Name of Agency: Next Door Solutions to Domestic Violence Site Address: 234 E. Gish Road, Suite 200; San Jose, CA 95112 Name of Executive Director: Esther Peralez-Dieckmann Project Description: Provide brief description of agency, agency goals, and agency services. Describe your program briefly, including who benefits from your program. Next Door Solutions to Domestic Violence (NDS) is an autonomous 501 c3 based in San Jose, CA — whose mission is to end domestic violence in the tnonnent and for all time — creating paths for survivors from crisis to safety, stability, and greater self-reliance. In 1971 a woman victimized by domestic violence (DV) had little in the way of legal support. community advocacy, or a safe place to go. Fortunately, a small group offemale activists concerned by the lack of services took action, establishing a hotline and shelter in a garage. Three years later a new location for the Shelter was established, becoming the second DV shelter in California, and the first in the nation to offer bilingual services. In 1974 they incorporated as Woman's Alliance and in 1989 changed the name to Next Door Solutions to Domestic Violence. Today, the Hotline is the same phone number and the Shelter, which moved to a larger home in 1994, provides 19 beds to women and their children fleeing abuse. NDS is governed by a 12 member volunteer Board of Directors comprised of members of the community. Agency management is made up of the executive director, and the directors of programs, of finance and operations, and of development. Agency Goals: The agency's new Theory of Change sets a long-range goal, divided into 5-year increments, of decreasing the number of women and girls in Santa Clara County (SCC) who will experience abusive relationships in their lifetime (current baseline is 1 in 3). To work towards this goal, NDS uses strategies of intervention and advocacy programs focusing on increasing self-determination and safety for DV victims, and prevention programming focused on mobilization at the individual and community level to shift social norms that make violence against women unacceptable, and to increase advocacy for policy change. Building upon its foundation of 47 years of creating and implementing innovative programs and services to address the needs of survivors, and coupled with supportive community partnerships. NDS will work to further expand strategies of: • Survivor -Defined intervention and advocacy programs focusing on increasing safety, knowledge, and options, and • Targeted policy and advocacy that support adequate life domains • Prevention programming focused on strengthening individual knowledge and skills, community education, and fostering coalitions and networks, and social mobilization at the individual and community level, and policy making, and • Targeted policy and advocacy that supports safe relationships As more women, and men, come to NDS, the agency continues to develop and implement new and expanded services that address survivors' unmet and unique needs. NDS four core programs are: 1. Shelter and Housing Services: Shelter, Hotline, and Housing First 2. Community & Systems Advocacy: Walk-in Crisis Counseling, legal advocacy and court accompaniment, and other supportive services 3. Support Services: Support Groups (17); and Kids Club — positive play for youth; Self- Sufficiency program; HomeSafe collaborative 4. Community Partnerships: Domestic Violence and Health Care initiative; CalWORKs; and support services for survivors living with HIV/AIDS in partnership with The Health Trust For this proposal, client sessions, which include multiple services per session, will be from the first three programs. • Shelter Next Door - provides a safe, home -like environment for victims and their children who are escaping or have been displaced by abuse. Open 24 hours a day every day of the year, the Shelter Next Door is staffed by bilingual English -Spanish Advocates who also have access to a third party service for providing other language assistance. Holistic, comprehensive services help reduce the client's, and their children's, feelings of isolation and anxiety: • Safe respite (shelter, temporary housing) from potentially life -threatening abuse (physical and psychological) in a home -like environment • Food, personal hygiene products, and same -day assistance in obtaining necessary medications Shelter Advocates provides: • Culturally and linguistically specific Risk Assessment • Holistic case management and advocacy focused on Safety Planning and immediate and short-term goals • Assistance with housing searches and identifying resources to assist in obtaining housing • Financial literacy screening, and links to emergency cash aid, food stamps, and rental subsidies for eligible clients • Links to NDS legal advocacy (including restraining orders), Support Groups, Self - Sufficiency workshops and case management, children's services, and referrals to outside resources The (Shelter) Children's Advocate provides: • Transition Planning — to assist the mother and any children in making as smooth as possible transition from their home into the shelter, and the transition from the shelter to other housing; and referrals to other child -centered services • Assistance enrolling children in school or maintaining current enrollment, including free transportation when necessary • Kids Club - Child -centered, age and development appropriate recreational activities (group/individual) while mothers are in other on -site sessions/services • Educational/homework assistance • Parent/Child bonding activities • Parenting information and assistance to caregivers The Shelter provides 19 beds and is similar to a multi -family style home, with two family rooms, a ground -floor bedroom and bathroom for physically -challenged clients, a dorm room with bunk beds, three full bathrooms, and a large common kitchen where clients can prepare and share meals (if desired). The Shelter location is confidential, maintains a safety gate and several active security cameras, and has a lift for those who cannot navigate stairs. Victims receive support in a supportive, nurturing environment and receive information, resources and referrals that help the client establish immediate goals. Shelter Advocates assist the client in navigating the legal system and in obtaining the resources and support needed to maintain safety and security. For the women and children that are not able to stay at NDS' Shelter due to full occupancy, NDS works with them to find alternative safe housing, such as with a trusted friend or family member, or by providing "hoteling" for a few nights. NDS places clients in hotel rooms that have a basic kitchen setup (small frig/microwave/toaster) so that the individual/family can prepare simple meals. The clients are also provided with gift cards for nearby grocers so the individual/family can purchase food. Throughout, the clients are supported by a NDS Advocate and have access to NDS services. • Community & Systems Advocacy: Survivors receive Walk -In Crisis Counseling (drop -in), Risk Assessment, Safety Planning, Legal Advocacy, completing and filing Emergency Orders of Protections and Restraining Orders, case management, referrals to pro bono attorney services, and access to a Virtual Legal Clinic; advocacy and support; and Peaceful Contact assistance and workshops. Advocates coordinate emergency services and refer clients to NDS and other community services to address identified needs. Coordinated services address risk, safety, hunger, homelessness, and health. Advocates are sensitive to client cultural and linguistic needs and, when necessary, make referrals to community agencies that help specific ethnic groups. and make referrals to medical service providers and counselors who understand their language and culture. Services are offered on a walk-in basis or by appointment and clients receive a one-to- one session (encounter). Advocates provide additional sessions in order to continue to work with the client as long as needed. Survivors develop their self -efficacy to address immediate and short-term challenges to safety and stability. Legal advocacy provides survivors with assistance with restraining orders, referrals to attorneys and follow-up services, and Peaceful Contact (Peaceful Contact is a type of restraining order issued in domestic violence cases to a person by the. court allowing the restrained person to contact the protected person as long as all contact is peaceful). Advocates provide clients with information on how to navigate the legal system according to the provisions of the Violence Against Women Act (VAWA). NDS also works in partnership with Pro Bono Project (PBP) which provides no fee Iegal counsel for people of limited means. PBP has also established a confidential, Virtual Legal Clinic at NDS' Community Office where NDS clients can schedule an appointment to speak, online, with a PBP attorney on any legal matter via 3 WebEx. For ending abuse, many survivors rate filing a RO to increase safety as one of the most effective tools, second only to leaving the abuser. • Support Groups: 17 throughout SCC; includes five groups in Spanish; one group is conducted at St. Mary's Church on Bean Street in Los Gatos. Los Gatos residents may attend any group at any location. Led by highly trained NDS Advocates and group facilitators, Support Groups are important in our work with victims of domestic violence (DV) as they provide a larger circle of support and sharing of experiences and information with others facing similar problems and experiences. Examples of weekly discussion topics include: What is DV; DV's Effect on Children; Characteristics of a Batterer; Boundaries; Stress Management; Self -Esteem; and Feelings. Facilitators also introduce other topics for discussion, such as reproductive coercion, or on topics that participants suggest. Facilitators incorporate the use of the Equality Wheel tool, developed by the Domestic Abuse Intervention Project. The participants help one another in coping with feelings of anxiety, stress, and isolation; isolation is a prevalent control tactic used by an abuser. Participants in group sessions find discussing their problems with those who can offer genuine empathy gives them a sense of belonging and encouragement. Group members provide support and direction for others struggling with the same issues they have faced in the past, connecting and creating a healing environment for each other. Support Groups help clients develop the tools: • To make healthy choices about their lives and relationships; • To enhance self-esteem and emotional resiliency; • To improve coping and communication skills, self-sufficiency, and parenting and life skills; and • To use critical thinking skills to understand abuse and rebuild their lives toward a safe, thriving future. Overall during the Support Group process, victims become survivors as they reduce the impact of violence on their lives by talking with their peers about the abuse — and to understand the abuse is not their fault. Two Self -Sufficiency Support Groups, one in Spanish, provide additional focus on employment and personal development and wellness, and Employrnent Law and the rights of employees as it relates to DV/IPV, i.e. being allowed time off to attend court related to the employee's DV matter. All Programs: NDS' service model is based on the Survivor -Defined Advocacy model (best practice) that builds a partnership between the Advocate and client, who ultimately defines the advocacy and help she needs. All NDS program staff are trained and certified Domestic Violence Peer Counselors (State of California Evidence Code: Section 1037-1037.8) which establishes confidentiality status in working with DV victims/clients. And program staff receive additional trainings in Survivor -Defined Advocacy, Trauma Informed Care, Client -Centered Intensive Case Management, Motivational Interviewing (all best practices), restraining orders/filing, court systems; and skills in advocacy, resource identification, and referrals. The majority of program 4 staff are bilingual -bicultural English/Spanish and additional language assistance is through a third -party language line/contractor for interpretation services. All NDS clients receive a Risk Assessment and Safety Plan (initial and updated): Culturally and linguistically specific lethality Risk Assessment help clients understand life -generated risks and batterer-generated risks - the level of risk of abuse and a victim's risk of further assault. Using conversational interviewing and questions, the Advocate looks to determine the client's particular needs, to help the client decide on the most beneficial services, and assist them in accessing those services. The information is used to develop a realistic Safety Plan - for home, familial residences, places of employment, with any children, and for court - and contain simple but critical steps the survivor can take to increase their, and any children's, safety while they deal with the violence they face in their personal life. Risk Assessments and Safety Plans are updated and changed accordingly as the client's situation evolves. Program Funding: Provide prior year fiscal year actual budget amounts and proposed amounts for new fiscal year. Program Funding: FY 2017/18 (adopted) FY 2018/I9 (requested) Clients: FY 2017/18 (actual) FY 2018/19 (proposed) Town annual funding amount $6,000 $6,000 Unduplicated annual Los Gatos clients 20 20 Total annual program budget 1,342,322 1,328,827 Total unduplicated annual clients 2,305 2,326 Town $ as % of annual total .447% .452% Los Gatos clients as of annual total .87% .86% APPLICATION FOR COMMUNITY GRANT FUNDING GRANT APPLICATION I. PROGRAM/PROJECT INFORMATION A. Contact Information Legal name of organization Next Door Solutions to Domestic Violence Address of organization 234 E. Gish Road, Suite 200 San Jose, CA 95112 Organization contact (Name, title, telephone number, email address) Susan McInnis, Director of Finance & Operations 408.501.7564; smcinnis@nextdoor.org Program name Crisis & Support Services for Survivors of Domestic Violence Site address of program Primary locations; Los Gatos residents may also access Support Groups at offOsite locations in Mountain View, Sunnyvale, Milpitas, and E. San Jose • Shelter— undisclosed location in Santa Clara County (confidentiality and safety) • NDS' Community Office (above address) • St. Mary's Church; 219 Bean Ave.; Los Gatos 95030 Program manager (Name, title, telephone number, email address) Colsaria Henderson, Director of Programs 408.501.7557; chenderson@nextdoor.org Annual grant amount requested FY 2018/19 $6,000 B. Community Need Statement Describe briefly the demonstrated need in the Los Gatos community for the program. Cite data sources as appropriate. Domestic violence, also known as intimate partner violence (DV/IPV), is prevalent in every community and affects all people regardless of age, socioeconomic status, sexual orientation, gender, race, culture, religion, or nationality. Victims of DV/IPV comprise an isolated and extremely underserved - almost invisible — population in need of a distinctive approach to providing safe housing and other crisis services, peer counseling and support groups, and self- sufficiency services. Those whose lives are characterized by DV/IPV face very unique and difficult obstacles to achieving safety, stability, and greater self-reliance. 7 Per the Centers for Disease Control and Prevention (CDC), "intimate partner violence is a preventable health epidemic": 1 in 3 women, and 1 in 4 men have been physically abused by an intimate partner; 1 in 4 women and 1 in 7 men have been severely physically abused by an intimate partner in their lifetime. The effects of partner violence within ethnic minority and gay/lesbian populations is compounded by the fact that these populations often experience a greater need to keep their victimization silent. Physical violence is often accompanied by emotionally abusive and controlling behavior as part of a much larger, systematic pattern of dominance and control. DV/IPV can result in physical injury, psychological trauma, and even death. The devastating consequences of DV can cross generations and last a lifetime. Per the Santa Clara county Public Health — City and Small Area/Neighborhood Profiles, 9% of Los Gatos adults reported being hit, slapped, pushed, kicked, or hurt in any way by an intimate partner. During the 10 year period of 2007 — 2016, an annual average of 67 calls for domestic violence assistance were placed (more than one each week) to the Los Gatos Monte Sereno Police Department (Los Gatos only). Of those, nearly 10% involved a weapon. DV/IVP is a leading cause in women's homelessness. And generally, if there are children in the household, then they, also, are at greater risk of homelessness. Without supports to find viable housing options, many battered women, particularly those already living in poverty, or those without control of their financial assets, are forced to remain in abusive relationships, to accept inadequate or unsafe housing conditions, or become homeless and perhaps increase their risk of further violence. Housing instability is associated with poorer outcomes above and beyond a survivor's level of danger. Increased housing stability is a significant predictor of improvements in many areas of life: • Increased safety; decreased vulnerability to abuse • Lower levels of PTSD and depression • Higher quality of life • Increased ability to sustain employment • Improvements in children's outcomes Economic abuse is a form of DV and includes a range of tactics used by an abuser to undermine the economic independence of a current or former intimate partner. In economic abuse the abuser separates the victim from their own resources, rights and choices, isolating the victim financially and creating a forced dependency for the victim and other family members. Victims fleeing DV often have problems finding safe, stable, and permanent housing due to their unique and often urgent circumstances, poor credit history — which may also be tied to their abuser's (poor) credit history, rental and employment histories, lack of income, limited income due to inability to collect and enforce child support and alimony payments, and lack of other resources, i.e. work or personal credentials, immigration status; and overall stigma/stereotyping of survivors. As batterers isolate their partners, victims become increasingly vulnerable to social and economic isolation. In addition to addressing issues of income, employment, and education, survivors are also addressing serious safety issues for themselves and their children as well as dealing with DV related health issues, i.e., anxiety, stress, trauma. 8 For this proposal, NDS will provide support and services that address the unique needs of those impacted by DV/IPV through the three core programs previously described. c. Direct Services For Human Services and Arts, Culture and Education grant requests, list, describe, and quantify each direct service to be provided annually from July 1, 2018 through June 30, 2019. A Direct Service is a service for which there is an identifiable client. A Participation Agreement (Attachment 2) must be completed by each client receiving the direct services described below. Description of Service FY 2018/19 Number of Services Provided Annually FY 2018/19 Number of Unduplicated Los Gatos Residents served Annually 1. Support Group Sessions 85 10 2. Community & Systems Advocacy Sessions 18 9 3. Shelter — Case Management Sessions 5 1 4. 5. Average number of direct services received by each unduplicated client: 7 Average number of direct services received by each unduplicated Los Gatos client: 5 D. Indirect Services List, describe, and quantify each indirect service to be provided annually from July 1, 20] 8, through June 30, 2019. An Indirect Service is a service for which there is no identifiable client; for example, information and referral that is given over the phone. Description of Service FY 2018/19 Number of Services Provided Annually 1. Crisis Counseling via 24/7 hotline 30 2. Brochure Disbursement 100 3. Community Outreach 10 9 F. Demographic Information Provide demographic breakdown of unduplicated Los Gatos residents expected to receive direct services. Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2018/19 Age Under 18 years old 0 19 — 50 years old 12 51 years old and over 8 Disability Status Disabled 0 Not Disabled 20 Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2018/19 Income 50% of median and below 16 51 % - 100% of median 3 Above 100% of Median 1 Sex Female 20 Male 0 Total Total Los Gatos clients 20 G. Client Participation Requirements Attach appropriate fee schedules, membership requirements, or other fee listings. NDS does not charge a fee for service and has no membership requirements. 11. AGENCY INFORMATION A. General Information Legal Name of Organization Next Door Solutions to Domestic Violence Address of Organization 234 E. Gish Road, Suite 200 San Jose, CA 95112 Name of Executive Director Esther Peralez-Dieckmann Date of Incorporation 1974 Insurance/Tax Information Federal Employer Tax Number 942420708 State Employer Tax Number 0728377 Worker's Compensation Carrier/ Policy Number GuideOne / 001438255 Liability Insurance Carrier Nonprofit Insurance Alliance of California Amount of Liability Coverage $2,000,000 10 Property Damage (combined with liability) $2,000,000 Combined Single Limit $1,000,000 Policy Period 07/01/2017-07/01/2018 B. Staffing Profile Please complete the chart below for your organization as it will be staffed during FY 2018/19. Identify the hours to be devoted to the program for which you are requesting funding, for both employees and volunteers. Position Title Number in Classification Approximate Hourly Rate Hours Worked per Week Percent of Time to Program Employees Management 8.0 $25 - $70 40 0% - 100% Emergency Shelter 7.23 $18 - $23 Varies 100% Community & Systems Advocacy 5.0 $19 - $24 40 100% Self Sufficiency 8.85 $17 - $25 Varies 100% Support Group 2.95 $17 - $25 Varies 100% Administration & Fundraising 4.4 $20 - $36 Varies 0 - 25% Volunteers Volunteers / Interns 32 X Varies Unknown C. Agency Experience --Describe the experience of your Agency in providing program services. Next Door Solutions is the only stand-alone domestic violence agency and is the oldest and largest provider of domestic violence services in Santa Clara County (47 years). Last year, Next Door Solutions alone answered 14,597 crisis hotline calls and served 2,779 unduplicated clients. As a domestic violence agency, NDS provides the 14 mandated core services defined in California Statute that can ensure confidentiality (an essential component of maintaining safety), as well as having the specific expertise about the complex needs of survivors of domestic violence and the complex systems they must navigate. As described on page 4, NDS' service model is based on the Survivor -Defined Advocacy model, and all NDS program staff are trained and certified Domestic Violence Peer Counselors (State of California Evidence Code: Section 1037-1037.8) as well as other training, and have a BA, BSW, or AA with three years DV service provision experience. The majority of program staff are bilingual -bicultural English/Spanish (most requested second language) and additional language assistance is through a third -party language line/contractor for interpretation services. NDS staff are also Domestic Violence Peer Counselor trainers. NDS is a member of the Santa Clara County Domestic Violence Advocacy Consortium whose 11 members represent the five agencies that provide DV services; the Consortium provides advice, information, and education to community leaders — in all sectors. NDS staff sit on community committees, including the Bail/Bond Review Committee of SCC, Police -Victim Advocacy Committee (PVAC), Family Court Committee, and the SCC Judge's Committee. They also serve as advisors/commissioners to the County's Domestic Violence Council, the Human Trafficking Commission, and the Intimate Partner Violence Blue Ribbon Task Force. NDS is one of the county's Emergency Service Network providers, and a participating member in the 1,000 Out of Poverty committee (Step Up Silicon Valley: goal to cut poverty in SCC). D. Staff Experience --Describe the experience of key staff assigned to the program. • Esther Peralez-Dieckmann, Executive Director: Masters in Public Administration; joined NOS in April 2017; 12 years as director of the Office of Women's Policy — County of Santa Clara; extensive experience in women's issues, raising the visibility of the issue of domestic violence, and in leading cross -sector collaborations; skills in project management and evaluation: grants and contracts administration and competitive bidding; workforce, criminal justice, and human service programming, systems and policy; media coordination and messaging for a wide variety of platforms and audiences. Other experience includes seven years of project coordination related to STD, HIV and dating violence; workforce development, community revitalization, and welfare reform; and public health/policy of underage drinking. Recipient of numerous awards; co-authored articles appearing in publications on women's issues and on health/wellness. As executive director: provides overall leadership and management of the organization; responsible for its operational, financial, and strategic direction; implementation of NDS' strategic plan; overall revenue generation; and community relations and advocacy for victims of domestic violence at the individual, community, and public/policy level; supervises the director of finance and operations, or programs, and of development. Reports to the board. • Colsaria Henderson, Director of Programs: Masters of Social Work, emphasis Administration and Planning, joined NDS in 2014; six years directorial level experience in managing DV programs and 11 years of experience providing case management, treatment plan development, and counseling. Reports to Executive Director; responsible for planning, directing, evaluating, providing leadership to all program areas; advocates on behalf of victims of DV in relevant community -wide policy discussions; supervises 3 FTE program managers and 1 program coordinator (.5FTE), and the Intern Manager (contractor). Reports to the executive director. • Patricia Nanez, Manager of Crisis Services, joined NDS in 2002 as the Shelter Case Manager and has continued to grow with the organization becoming the Shelter Coordinator in 2006 and then Manager of Shelter and Housing Services in 2007. Additional experience includes four years in office management and services, and college course work in health care administration, management and supervision, business communications and skills, and computer Information Technology. Responsible for oversight of day-to-day program operations; develops, maintains, and monitors trauma informed program services, activities, events, and development; oversees shelter, hotline, and housing program services; supervises eight FTE advocates. Reports to the director of programs. • Rachel Arias-Busta, Manager of Community and Systems Advocacy: BA Psychology, 12 joined NDS in 2014. Experience: six years DV advocacy providing legal advocacy, crisis intervention, support group curriculum development and facilitation, client intake and direct services, and volunteer management. Oversees NDS crisis counseling, risk assessment, safety planning, legal advocacy and immigration services, staff program training, and supervision of five FTE advocates. Reports to the director of programs. • Aparna Dhoraje, Support Group Coordinator, MA Counseling Psychology; joined NDS in 2000 as the Shelter Coordinator, leaving in 2002. She rejoined the agency in 2008 as the Support Group Coordinator. Additional experience includes four additional years working with and providing services to domestic violence populatons, and two years providing counseling services to youth. Aparna is fluent in South Asian languages. Supervises the equivalent of 2.675 FTE group facilitators, including an interpreter, advocate. Reports to the director of programs. E. Staffing Plan --Describe any anticipated staffing changes to occur during FY 2018/19. Next Door Solutions does not anticipate any staffing changes in those listed above to occur during FY 2018/19. 13 F. III. FISCAL INFORMATION A. Program Budget Please complete the following summary tables to reflect the budget for your organization and program. All amounts should be rounded to the nearest dollar. Alternatively, please attach single page revenue/expense summary sheets for the program for which funds are requested and a separate summary for the organization. Budget Summa Budget Data FY 2018/19 FY 2017/18 Los Gatos grant funding Requested: $6,000 Received: $6,000 Total Program budget $ 1,328,827 $ 1,342,322 Los Gatos grant as percentage of total Program budget .452% _447% Total Organization budget $ 3,088,463 $ 3,215,355 Cost per year per unduplicated Los Gatos client $301.50 per support services/client; $109.60 per shelter bednight $306.08 per support services/client; $98.12 per shelter bednight Revenue Surma, Revenue Source FY 2018/19 Organizational Budget FY 2018/19 Program Budget FY 2017/18 Organizational Budget FY 2017/18 Program Budget Los Gatos grant $ 6,000 $ 6,000 $ 6,000 $ 6,000 Other municipal funding (City of San Jose, City of Milpitas, City of Santa Clara) $ 206,842 $ 54,112 $ 160,763 $ 22,309 County funding (SCC Social Services Administration, Adult Protection Services, Urban CDBG) $ 594,714 $ 359,714 $ 661,369 $ 404,631 State funding (CA Office of Emergency Services) $ 878,287 $ 344,273 $ 965,970 $ 368,128 Federal funding (FEMA, HUD) $ 25,000 $ 25,000 $ 34,198 $ 25,000 Other jurisdiction funding (Marriage & Probation Fees) $89,652 $ 80,791 $ 103,500 $ 103,500 Fees for services $ $ $ $ 0 Donations $ 1,175,163 $ 433,937 $1,170,843 $ 387,754 Reserve contingency fund $ $ $ $ All other sources (Interest, lnkind and Other income) $ 112,805 $ 25,000 $ 112,856 $ 25,000 Total $ 3,088,463 $ 1,328,827 $3,215,499 $ 1,342,322 14 Expenditure Summat Expense Category FY 2018/19 Organizational Budget FY 2018/19 Program Budget FY 2017/18 Organizational Budget FY 2017/18 Program Budget Personnel $ 2,230,559 $ 996,558 $ 2,250,373 $ 948,225 Facility $ 237,485 $ 148,128 $ 235,952 $ 149,695 Overhead $ 89,923 $ 48,014 $ 90,818 $ 49,740 Materials/Supplies (includes housing first client assistance) $ 264,921 $ 53,558 $ 385,714 $ 109,187 Professional Services $ 75,473 $ 38,323 $ 78,236 $ 41,367 Fundraising $ 17,550 $ 0 $ 11,150 $ 0 Capital Projects $ 0 $ 0 $ 0 $ 0 Other: Travel $ 24,481 $ 1,460 $ 15,041 $ 1,320 Inkind $ 109,522 $ 25,000 $ 109,522 $ 25,000 Depreciation $ 22,148 $ 16,979 $ 22,148 $ 16,979 Misc. $ 16,401 $ 807 $ 16,401 $ 807 Total $ 3,088,463 $ 1,328,827 $ 3,215,355 $ 1,342,322 B. Organization Contracts -Has your organization ever had funds withdrawn or a contract terminated for cause, unsatisfactory performance, or questionable costs on any financial statements or audit? If so, please describe. NDS has never had funds withdrawn or a contract terminated. C. Organization Investigations --Is your organization currently on probation or under investigation by any agency which is or was a funding source within the past two years? If so, please describe. NDS is not currently on probation or under investigation by any agency. D. Budget Alternatives --'What alternatives will your organization consider if the requested Community Grant funding is not provided, or provided at a reduced level? Describe how a reduction will affect the achievement of stated goals. Funding from the Town of Los Gatos Community Grant is essential to providing the level of service which will generate the greatest outcomes for its residents receiving services. Primarily, with any shortfall from the Town of Los Gatos, NDS would have to use available unrestricted funds used to cover necessary operational and administrative expenses to keep program services up to an acceptable level. Barring that, our recourse would be to reduce the number of program staff or not fill open positions and to reduce services, i.e., limit the number of crisis counseling sessions per clients. E. Funding Sources --Describe your organization's efforts in pursuing other funding sources. NDS has a resource development team composed of a full-time Director of Development, a Grants Manager, a Development and Communications Officer, and a part-time Development Database Specialist that is responsible for the creation and execution of an annual resource development plan. 15 Acknowledging the importance of community support to offset economic challenges, NDS continues to put a priority on building relationships with private and corporate foundations and individual donors and raising awareness of the widespread impact that domestic violence (DV) has on the community. As DV is a primary cause of women's homelessness, increasing awareness and investments is on -going. And as DV does not recognize economic status, level of education, place of residence, or race/ethnicities, we reach out to other municipalities to contribute to the support of their constituents impacted by DV, as well as state and federal funding. Other sources of revenue that are projected to fund services for Los Gatos residents include the County's Social Services Administration, Adult Protection Services, Urban CDBG; California Office of Emergency Services (CaIOES); FEMA, Office on Violence Against Women (Department of Justice), HUD; grants from other municipalities; California Marriage License & Probation Fees; Foundations, Individual Donors; and Interest, In -kind and Other Income. F. Supplies Disclosure --If any non -expendable supplies with a unit cost of $100 or more are to be purchased with Community Grant funds, please describe. NDS will not be purchasing any non -expendable supplies with a unit cost of $100 or more. G. Travel Expense Disclosure--lf Community Grant funds are to be used for staff travel expenses, please describe. All travel expense in (full) budget is for local travel relating to program services; mileage is reimbursed at current Federal Reimbursement Rate and parking reimbursed at cost. Staff turn in mileage reimbursement forms monthly or when they have accumulated $10 in costs. 16 CERTIFICATION The applicant hereby proposes to provide the services as listed in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state, and local regulations, including non- discrimination laws and other assurances as required by the Town of Los Gatos, will be adhered to. Furthermore, as the duly authorized representative of the applicant organization, I certify that the applicant is fully capable of fulfilling its obligation under this proposal as stated herein. This application and the information contained herein are true and correct and complete, to the best of my knowledge. Date: , - a`a ,2018 Next Door Solutions to Domestic Violence Organization Name Executive Dire Esther Peralez-Dieckmann (Print Name) 17 TOWN OF LOS GATOS ❖ FY 2018/19 APPLICATION FOR COMMUNITY GRANT FUNDING APPLICANT AGENCY/PROGRAM DOCUMENTS CHECKLIST Please submit one copy of each of the documents listed below with your completed application. This page should serve as the cover sheet for that section of your submittal. I, PROGRAM/PROJECT INFORMATION Fee Schedule, Membership, or other fees 11. AGENCY INFORMATION ✓ Current Board of Directors 1 Articles of Incorporation ✓ Bylaws ✓ Organizational Chart ✓ Brochures, Flyers, Promotional. Materials III. FISCAL INFORMATION ✓ Audit or Financial Statement plus Letter of Auditability ✓ Organizational Budget Internal Revenue Service Ruling Letter (Section 501 c.3) ✓ California Revenue Code (Section 23701 d) TOWN OF LOS GATOS ❖ FY 2018/19 NEXT DOOR sOLurIONs Tc7 DOMESTIC VIOLENCE NO FEE FOR SERVICES No individual, family, or household will be charged a fee for service for assistance received. All services are at -will. Esther Peralez-Dieckmann Executive Director February 27, 2018 Ending domestic violence in the moment and for all time 234 E. GISH ROAD SUITE 200 • SAN JOSE, CA 95112 OFFICE (408) 501-7550 • HOTLINE (408) 279-2962 • FAX (408) 441-7562 www.nextdoor.org Veterans Memorial Foundation TOWN OF LOS GATOS rLERK DEPARTMENT RECEIVED 20l8MAR -5 P 2: 35 VETERANS ***MEMORIAL a. SUrr0RT ** FOUNDATION OF 1°5 GAT05 February 22.2018 Community Grant Committee Town of Los Gatos Subject: Community Grant Application for the Veterans Memorial & Support Foundation Dear Community Grant Committee Associates: It gives us great pleasure to submit our grant application for $34,000 for a one-time Project: Funding within the "Human Service program" category. This funding will contribute towards a very exciting endeavor for the Town of Los Gatos in support of our Veterans Foundation Liberty Capital Campaign. Your approval for funds will be put to excellent use inunediately towards delivering honor, respect and gratitude to America's service members, veterans, their families, Emergency Services personnel who support our homeland security and the Los Gatos heroes of 9/11's United flight 93. This requested grant amount of $34,000 represents 2.27% of the total cost of building the Memorial. Please feel free to contact the named parties cited herein for more information. We would be grateful for the opportunity to tell you about this program. Let us stand united as one; united in gratitude; united in Los Gatos. Sincerely, The Veterans Memorial & Support Foundation Board Honoring Our Veterans VETERANS MEMORIAL & SUPPORT FOUNDATION OF LOS GATOS P.O. BOX 1696, LOS GATOS, CA 95031 • www.HonorAVet.or2 • 408-221-1512 Town of Los Gatos FY 2018/19 Community Grant Program Application Summary Project: Project/Program: VETERANS MEMORIAL CAPITAL CAMPAIGN Program Manager: Major General Kent Hillhouse U.S. Army (Ret.) Name of Agency: VETERANS MEMORIAL & SUPPORT FOUNDATION OF LOS GATOS Site Address: 110 East Main Street, Los Gatos CA 95030 Mailing Address: P.Q. Box 1696, Los Gatos CA 95031 Name of Executive Director: Major General Kent Hillhouse U.S. Army (Ret.) Project Description: Provide brief description of agency, agency goals, and agency services. Describe your program briefly, including who benefits from your program. The Veterans Memorial & Support Foundation of Los Gatos exists to honor and support U.S. military service members, veterans and their families. The Veterans Memorial & Support Foundation of Los Gatos is a non-profit staffed entirely by volunteers who are passionate about delivering compassion to those who have been so courageous in support of America's freedom. Our network of generous donors and volunteers share a mission to: a) Establish and support the on -going maintenance of a veterans' memorial in Silicon Valley that delivers honor, respect and gratitude to active U.S. military service members and veterans and to their contributions and sacrifices in support of America's freedom. b) Educate the community on the sacrifices borne by those who have defended America's freedom. c) Support yellow ribbon programs in perpetuity that deliver humanitarian support to service members, veterans and their families and in particular, provide support to heroes returning from deployment in adjusting to civilian life. 2 The main focus of the Foundation at present is to deliver on the first tenet of its mission — to erect a veterans memorial in Silicon Valley. The veterans memorial is a tribute to the men and women who have honorably served America in the United States Army, Navy, Marines, Air Force, Coast Guard, Merchant Marines, and their contributions in support of natural disaster recovery, humanitarian aid, and in defense of America's freedom. The Memorial also recognizes Emergency Services First Responders who combine forces with the United States military in playing a pivotal role in homeland security and finally, local Los Gatos 9/11 heroes aboard United Flight 93 who attempted to retake cockpit control away from hijackers. In 2017, the Los Gatos Town Council approved a donation of land use for placement of the memorial at the Civic Center in downtown Los Gatos. The right to build a memorial in such a prominent place in the center of Town is both a profound privilege and responsibility. The Foundation board conducted two national artists challenges to secure renderings for a memorial design and recommended its final choice following public and stakeholder reviews of the top two designs to the Los Gatos Town Council. This has been a vigorous five and a half years endeavor engaging the support of eleven consultants in the process. The Town Council approved the town recommended real estate, recommended conceptual design, and architectural plans for The Flame of Liberty Memorial by internationally acclaimed artist Frank Kocian Morris. The Flame of Liberty by Artist Frank Kocian Morris: https://vimeo.com/171576336 The Flame of Liberty - Artist's Inspiration: https://youtu.be/wALP63Mq8ms Mr. Morris is an award -winning designer, illustrator, portrait artist and Master Designer for the U.S. Mint. His design clients include Bantam Books, Dell Books, Simon & Schuster, New American Library, Warner Brothers, Random House, Vintage Books, major television networks and advertising agencies. His paintings are in private collections, appear in magazines such as Newsweek and New York Magazine and include luminaries - Presidents 3 Ronald Reagan and Jimmy Carter, First Ladies Nancy Reagan and Rosalynn Carter, Hamilton Jordan, the Shah of Iran and government dignitaries. The U.S. Department of the Treasury chose Mr. Morris for the artist -elite position of Master Designer for the U.S. Mint for whom he has designed multiple coins and medals, most notably the Congressional Gold Medals that honor the WWII Native American Code -Talkers. Finally, what better person to create a design for veterans than that of a veteran himself - Mr. Morris served in the U.S. Air Force. Our organization conducts celebrations in connection with national holidays that serve to educate the community on the spirit of those who have put so much on the line to rise to the limitless horizons of freedom. Finally and of great significance, the Foundation supports in perpetuity, the critical needs of service members, veterans and their families through Yellow Ribbon programs, the nature of which vary depending upon the greatest needs supportable within the resources of the Foundation over the course of time. Foundation Board members and advisors include notables Major General Kent Hillhouse, U.S_ Army (Ret.), Francis J. Harvey, 19th Secretary of the U.S. Army, Gil Decker, former Assistant Secretary of the U.S. Army, John Lochner, veteran and two-time mayor of Los Gatos, James Free, veteran and Chairman Emeritus of the Campbell Veterans Memorial, LT COL Thomas Griffin U.S. Army (Ret.) and Founder, Veterans Transition Center for the Veterans Foundation of CA, multiple veterans from all branches and patriotic grateful citizens. Brief Program Summary • Community need for the program: Liberty A place for Healing -- Veterans Memorial Capital Campaign. • Uniqueness of program, lack of duplications in service: There is no other program suggesting a memorial of this type in the Town of Los Gatos. • Qualifications and experience of the agency and its staff: The all -volunteer board and 4 fundraising committee. See the attached Board Member Bios. • Past performance in providing established services and meeting Town requirements. We have been active in the engaging with members of our community in our Town since 2012 as well as veterans groups in the Bay Area. • Effectiveness in serving an identified audience: We serve the community through our outreach programs to local schools, community groups and veterans programs. • Community involvement in program, including volunteers: We have an all -volunteer board and fundraising committee (39 people in all) and an email list of interested parties in the community of 665 names. • Number of Los Gatos clients served vs. total clients served (unduplicated clients): We estimate that we will serve 2,250 Los Gatos residents and 1,750 non -Los Gatos residents for a total of 4,000 • Cost per Los Gatos resident vs. cost per non -Los Gatos resident: All our services are free. Allocating the $34,000 cost of the project is $34,000/4,000 = $8.50 per resident of Los Gatos and $8.50 per non -Los Gatos resident. • Number of low and very low income clients served. We estimate this number at 450 - 500 homeless veterans served during the biannual Stand Down event. Percent of total program budget requested from Town Approximately: $34,000/$1,500,000 = 2.27% Reasonable cost: Chairman of Devcon and Los Gatos resident Gary Filizetti has agreed to serve as the General Contractor of the project. We are working to secure subcontractors and other individuals who will provide their services as either in -kind or at a reduced rate for labor and materials. Program Funding: Provide prior year fiscal year actual budget amounts and proposed amounts for new fiscal year. Program Funding: FY 2017/18 (adopted) FY 2018/19 (requested) Clients: FY 2017/18 (actual) FY 2018/19 (proposed) Town annual funding amount N/A $34,000 Unduplicated annual Los Gatos clients N/A 2,250 Total annual program budget $444,000 $634,000 Total unduplicated N/A 4,000 5 annual clients Town $ as % of annual total N/A 5.36% Los Gatos clients as % of annual total N/A 56% TOWN OF LOS GATOS r+ FY 2018/19 APPLICATION FOR COMMUNITY GRANT FUNDING APPLICANT AGENCY/PROGRAM DOCUMENTS CHECKLIST Please submit one copy of each of the documents listed below with your completed application. This page should serve as the cover sheet for that section of your submittal. I. PROGRAM/PROJECT INFORMATION ✓ Fee Schedule, Membership, or other fees None We Charge no Fees II. AGENCY INFORMATION ✓ Current Board of Directors —Attached ✓ Articles of Incorporation ---Attached if Bylaws —Attached ✓ Organizational Chart —Attached ✓ Brochures, Flyers, Promotional Materials —Attached III. FISCAL INFORMATION ✓ Audit or Financial Statement plus Letter of Auditability—Attached ✓ Organizational Budget —Attached ✓ Internal Revenue Service Ruling Letter (Section 501 c.3) —Attached ✓ California Revenue Code (Section 23701 d) —Attached 6 TOWN OF LOS GATOS $• FY 2018/19 APPLICATION FOR COMMUNITY GRANT FUNDING GRANT APPLICATION I. PROGRAM/PROJECT INFORMATION A. Contact Information Legal name of organization Veterans Memorial & Support Foundation of Los Gatos Address of organization P.O. Box 1696, Los Gatos, CA 95031 Organization contact (Name, title, telephone number, email address) Major General Kent Hillhouse U.S. - Army (Ret.) Foundation President 408-22I-1512 —Cell 408-615-3413 — Work kent.hillhouse@cushwake.com Program name Veterans Memorial Capital Campaign Site address of program 110 East Main Street, Los Gatos, CA 95030 Program manager (Name, title, telephone number, email address) Major General Kent Hillhouse U.S. - Army (Ret.) Foundation President 408-221-1512 —Cell 408-615-3413 — Work kent.hillhouse@cushwake.com Annual grant amount requested FY 2018/19 $34,000 B. Community Need Statement Describe briefly the demonstrated need in the Los Gatos community for the program. Cite data sources as appropriate. A place to heal, a place to bind up emotional wounds, a place to remember those who gave their last full measure to protect our freedoms and those of others around the world -- these can be the roles of a memorial. The Argentinian -American architect Julian Bonder writes in Places Journal As events and circumstances unveil in the present, a memorial's destiny is to recall the past and provide conditions for new responses in the future. As our psycho- political and ethical companions, memorials should help us consider trauma and rethink and reactualize the past. They should encourage critical consciousness, committed memory -work, and the possibility of engaging with the world through transformative practices." 1 America's service members, veterans and families are responsible for defending the freedom all members of Los Gatos and surrounding communities enjoy. And yet, Los Gatos is void of recognition for the contributions these individuals provide to America. The Veterans Memorial & Support Foundation intends to change that paradigm by erecting a memorial in town that delivers honor, respect and gratitude to our service members, veterans and families. Throughout the proud history of Los Gatos, residents and community members have participated in the ongoing struggle to defend and maintain our freedom — many giving their own lives. Currently, there are over 80 members of our own Los Gatos community serving on active duty. Yet today, there is no place to memorialize, heal and celebrate the sacrifice of the men and women who have answered the call. In 2012, the Veterans Memorial & Support Foundation was created to set this change in motion. The memorial will celebrate active service members and veterans of the U.S. Army, Navy, Marines, Coast Guard, Air Force, Merchant Marines, and their families. It will also recognize local Emergency Service personnel and the Los Gatos heroes who bravely attempted to regain cockpit control during the September 11, 2001 hijacking of United Flight 93. The memorial will serve to commemorate the liberty made possible by all U.S. veterans with the support of Emergency Services who today play a great role in homeland security and local heroic citizens, showing that Los Gatos cares. The Foundation Board is approaching Los Gatos Community Grants to support the Liberty Capital Campaign effort. The benefits of veterans memorials are cited in the "Honor Flight Commemorates America's WWII Veterans" article in the February, 2017 issue of Los Gatos Living Magazine, the excerpt of which is included in the Documents section of this grant application.) 1 Source: On Memory, Trauma, Public Space, Monuments, and Memorials Journal Issue: Places, 21(1) Author: Bonder, Julian Publication Date: 2009 Publication Info: Places Permalink: http://escholarship.orglue/iteml4g88l2kv Acknowledgements: This article was originally produced in Places Journal. c. Direct Services For Human Services and Arts, Culture and Education grant requests, list, describe, and quantify each direct service to be provided annually from July 1, 2018 through June 30, 2019. A Direct Service is a service for which there is an identifiable client. A Participation Agreement (Attachment 2) must be completed by each client receiving the direct services described below. Description of Service FY 2018/19 Number of Services Provided Annually FY 2018/19 Number of Unduplicated Los Gatos Residents served Annually I . Town of Los Gatos July 4 Celebration • Support of town weekend block party event • Color guard support & booth at Town July 4 celebration at Oak Meadow Park • Serves to educate the community on the values of freedom and contributions of our community 2 days of events over the coming year. Significant number of Los Gatos residents participate in this community event 2. Fisher Middle School Veterans Day event • Veterans Interviews • Presentation to Students, Faculty, Veterans & Parents • Serves to educate Middle School students on the contributions of veterans to America One time event that begins in the fall with multiple veteran interviews plus celebration day event at Fisher Middle School. Entire Fisher Middle School Community of 350 middle school students, and another 350 faculty members, parents, invited guests. Very significant because this is the 100th Anniversary of the end of World War i. (11/11/2018) 3. Fiesta de Artes Booth in Childrens' Quarters Educates children attending the Fiesta de Artes on flag etiquette, patriotic holidays and other American values surrounding freedom. One time event Over 20,000 attendees from all over the San Francisco Bay area. 4. Palo Alto VA Christmas Program/Fisher House Polytrauma Christmas Celebration • Holiday giveaways to service members currently in rehab/healing at the Palo Alto VA in the Poly Trauma Center & Spinal Cord Injury Center. (See 2016 reference cited on p. 15, of the Las Gatos Living Magazine, February 2017 Issue section provided in the Documents section of this One time event. . All service members, veterans currently in rehabilitation or healing at the Palo Alto VA. Numbers vary depending upon the number of patients in treatment. The team also delivers dinners to family members and patients usually once over 9 application.) the course of the year. (2016 event supported $4500 of holiday presents to 44 patients and their families at the VA Hospital in Palo Alto.) 5. Hosting a booth at Jazz on the Plazz • Support of a booth (pending availability over the course of the ten week concert series.) Exposure and Fund Raising All concert attendees 6. Presentations planned to community organizations: • LG Rotary Morning • LG Rotary Afternoon • LG Kiwanis • LG Lions • Vietnam Veterans of America • Daughters of the American Revolution • Senior residents at LG Assisted Living Communities in our town • Town Council • Los Gatos Recreation Senior Community Center • Los Gatos Korean War Veterans see photo shoot • Chamber of Commerce Averaging 20 events per year • 1,670 estimated are in attendance across these events • 379 veterans owned firms 7. Stand Down Weekend for Homeless Veterans at Veterans Transition Center in Monterey CA • Set up tents for average homeless vets for a weekend stay during which time they will receive transportation to the site, meals, medical and dental check-ups, vet services for their pets, resource counseling on VA benefits, job searches and educational opportunities, clergy support and psychological support provided through professional therapists. One-time event, lasting 5 days • 2014, and 2016 Stand Down programs supported 360 and 405 homeless vets respectively and an estimated 450-500 homeless vets are anticipated at the 2018 Stand Down 8. Police Officer's Ball - Los Gatos Monte Serena Police Foundation annual fund raising event. Annual Event— exposure • 500 people are present 9. Los Gatos Spring Wine Walk 2018: Downtown Los Gatos (not yet announced --likely April 21, 2018) Exposure and Fund Raising • Several hundred people present Average number of direct services received by each unduplicated client: 1 Average number of direct services received by each unduplicated Los Gatos client: 1 We also have a 665 person email contact list and over 300 followers on our Facebook page which represents a fraction of the people with whom we engage on a regular basis. 10 D. Indirect Services List, describe, and quantify each indirect service to be provided annually from July 1, 2018, through June 30, 2019. An Indirect Service is a service for which there is no identifiable client; for example, information and referral that is given over the phone. Description of Service FY 2018/19 Number of Services Provided Annually 1. 2. 3. 4. F. Demographic Information Provide demographic breakdown of unduplicated Los Gatos residents expected to receive direct services. Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2018/19 Age Under I8 years old 490 19 — 50 years old 885 51 years old and over 875 Disability Status Disabled 565 Not Disabled 1,685 Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2018/19 Income 50% of median and below 70 51% - 100% of median 67 Above 100% of Median 2,113 Sex Female 1,178 Male 1,072 Total Total Los Gatos clients 2,250 Sources http://www.city-data.com/poverty/poverty-Los-Gatos-California.html#ixzz58AQMfBtO https://en.wikipedia.org/wiki/Los Gatos,California#Demographics G. Client Participation Requirements Attach appropriate fee schedules, membership requirements, or other fee listings. There is no fee to receive our services. 11 Board members are solicited for donations in a Leadership campaign effort. Board members are highly encouraged to donate in kind services or financially. Proposed Advisory Board suggested level of cash or in -kind donation Platinum Level: Equal to and over $10,000 Gold Level: Equal to or over $5000 and less than $10,000 Silver Level: Equal to or over $2500 and less than $5000 Bronze Level: Equal to or over $1000 and less than $2500 H. AGENCY INFORMATION A. General Information Legal Name of Organization Veterans Memorial & Support Foundation of Los Gatos Address of Organization Site Address: 110 East Main Street, Los Gatos, CA 95030 Mailing Address: P.O. Box 1696, Los Gatos, CA 95031 Name of Executive Director Major General Kent Hillhouse US - Army (Ret.) Foundation President Date of Incorporation October 04, 2012 Insurance/Tax Information Federal Employer Tax Number 46-1338469 State Employer Tax Number 3511875 Worker's Compensation Carrier/ Policy Number N/A Until we get closer to hiring a part-time executive assistant Liability Insurance Carrier Alliance Members Services/Nonprofits Insurance Alliance of California Amount of Liability Coverage General Liability $2M aggregate, $0 deductible Property Damage (combined with liability) N/A at present. Will be applicable in future. Combined Single Limit $1 M per occurrence Policy Period 02/04/2018 — 02/04/2019 12 B. Staffing Profile Please complete the chart below for your organization as it will be staffed during FY 2018/19. Identify the hours to be devoted to the program for which you are requesting funding, for both employees and volunteers. Position Title Number in Classification Approximate Hourly Rate Hours Worked per Week Percent of Time to Program Employees Professional Fundraisers 2 $99,000 for the 12 month period. 4 days avg/ month plus $750 /month in expenses 100% Part Time Executive Assistant 1 $30/hour includes benefits 30 hours for 8 months 90% Volunteers 90% of all board and committee members (The balance of board/committee members will be focused on the building effort.) 12 Board members; Average 10 committee members pre recruitment effort for campaign personnel Free 6 hours per week 100% C. Agency Experience —Describe the experience of your Agency in providing program services. The majority of board members comprising the Veterans Memorial & Support Foundation are career veterans accustomed to providing service to their country. Veterans, as a whole, provide support to communities more than most other demographical sectors for the reason that they were accustomed to providing service to others in their careers. As active service personnel, they provided humanitarian support and defense of our nation. They are involved in handling tropical storm recovery, earthquake recovery, medical crisis related concerns (e.g. the Ebola crisis), volcanic eruption recovery, hurricane recovery (e.g. Hurricanes Katrina, Sandy, Harvey, Maria, Irma, the Napa and SoCaI fires), and more, in addition to providing defense for our nation. Providing program services is a natural for them. The balance of board members comprising the Foundation are patriotic citizens accustomed to providing 13 service to their community through various community programs for decades. D, Staff Experience —Describe the experience of key staff assigned to the program. Please see the Board Member and Advisory Board Member profiles that are included with this application. E. Staffing Plan --Describe any anticipated staffing changes to occur during FY 2018/19. The Foundation will roll out the Liberty Capital Campaign over the 2018/19 fiscal year. Work towards this endeavor began extensively in fall, 2016. During that time, we hired Netzel Grigsby consultants, a professional fundraising concern, to conduct a feasibility study in which they interviewed 25 members within our community and concluded from their study that all systems were "go" for a successful 18 month capital campaign. The Liberty Capital Campaign will require consultant and hired resources to secure success. The proposal from professional fundraisers includes a $99,000 cost to the Foundation to include professional fees and expenses over a 12-month time period of the 18-month campaign effort. In addition, it is anticipated that the Foundation will require a part time Executive Assistant capable of working on the payroll an average 30 hours per week. 14 F. M. FISCAL INFORMATION A. Program Budget Please complete the following summary tables to reflect the budget for your organization and program. All amounts should be rounded to the nearest dollar. Alternatively, please attach single page revenue/expense summary sheets for the program for which funds are requested and a separate summary for the organization. Bud. et Summa Budget Data FY 2018/19 FY 2017/18 Los Gatos grant funding Requested: $34,000 Received: N/A Total Program budget $634,000 $444,000 Los Gatos grant as percentage of total Program budget 5.36% 0.0% Total Organization budget $634,000 $444,000 Cost per year per unduplicated Los Gatos client =$634,000/4;000 = $158.50 $N/A Revenue Summa Revenue Source FY 2018/19 Organizational Budget FY 2018/19 Program Budget FY 2017/18 Organizational Budget FY 2017/18 Program Budget Los Gatos grant $ 35,000 $-34,000 $ $ Other municipal funding (please specify: ) $ 0 $ 0 $ $ County funding (Please specify :) $ 0 $ 0 $ $ State funding (Please specify :) $ 0 $ 0 $ $ Federal funding (Please specify :) $ 0 $ 0 $ $ Other jurisdiction funding (Please specify :) $ 0 $ 0 $ $ Fees for services $ 0 $ 0 $ $ Donations $ 600,000 $ 600,000 $423,000 $423,000 Reserve contingency fund $ 0 $ 0 $ $ All other sources (Please specify) Paver sales. Other Income $ 0 $ 0 $21,000 $21,000 Total $634,000 $634,000 $440,000 $440,000 Note: Total Donations from 2012-2016 = $54.416 Outstanding Pledges as of 2/18 = $200,032 15 Expenditure Summa Expense Category FY 2018/19 Organizational Budget FY 2018/19 Program Budget FY 2017/18 Organizational Budget FY 2017/18 Program Budget Personnel $30,000 $30,000 $ $ Facility $ $ $ $ Overhead $ $ $ $ Materials/Supplies $ $ $ $ Professional Services $ $ $ $ Fundraising using Professional Services $54,000 $50.000 $34.000 $34,000 Capital Projects $554.000 $554,000 $ 406,000 $406,000 Other (PIease specify) $ $ $ $ Total $634,000 $634,000 $ 440,000 $440,000 B. Organization Contracts —Has your organization ever had funds withdrawn or a contract terminated for cause, unsatisfactory performance, or questionable costs on any financial statements or audit? If so, please describe. No. C. Organization Investigations --Is your organization currently on probation or under investigation by any agency which is or was a funding source within the past two years? if so, please describe. No D. Budget Alternatives --What alternatives will your organization consider if the requested Community Grant funding is not provided, or provided at a reduced level? Describe how a reduction will affect the achievement of stated goals. The estimated cost for the Memorial; is $1,500,000 which includes a maintenance fund of $200,000, fundraising costs of $120,000; giving a build amount of $1,180,000 We have already incurred expenses of $71,000 design fees, some of the town permit fees, etc. and $67,000 in fundraising costs for the feasibility study and the initial "quiet" campaign. The Foundation will endeavor to increase individual and corporate monetary and in kind donations to make up the difference E. Funding Sources —Describe your organization's efforts in pursuing other funding sources. The Foundation just completed our fundraising feasibility study which confirmed the presence of positive support amongst the 25 interviewees of influence and / or affluence resulting in a recommendation to launch the campaign. The Foundation has received $359,511 in pledges since inception of which $I 66,123 is in the bank and has been utilized for expenses to date and $193,388 remains to be secured. It 16 conducted its Leadership Campaign and attained 103% of its targeted goal soliciting $258,641 of the $359,511 in pledges from Board Members and Advisors. The Foundation recently launched its Capital Campaign and in doing so, recruited members for a Steering Committee and Major Gifts Committee. Solicitation is underway for major gifts (valued at $25K and greater). The Foundation is now in the process of recruiting a Special Gifts Committee (valued at $5K - $24,999.) F. Supplies Disclosure —If any non -expendable supplies with a unit cost of $100 or more are to be purchased with Community Grant funds, please describe. None G. Travel Expense Disclosure--lf Community Grant funds are to be used for staff travel expenses, please describe. None 17 CERTIFICATION The applicant hereby proposes to provide the services as listed in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state, and local regulations, including non- discrimination laws and other assurances as required by the Town of Los Gatos, will be adhered to. Furthermore, as the duly authorized representative of the applicant organization, I certify that the applicant is fully capable of fulfilling its obligation under this proposal as stated herein. This application and the information contained herein are true and correct and complete, to the best of my knowledge. Date: March 5, 2018 Organization Name: Veterans Memorial & Support Foundation of Los Gatos Foundation President Mr Kent Htllh 1 TC-Army (RPt ), Fni ndatinn President West Valley Community Services Town of Los Gatos FY 2018/19 Community Grant Program Application Summary Project: Project/Program: Community Access to Resource and Education Program Manager: Sujatha Venkatraman, Associate Executive Director Agency: Name of Agency: West Valley Community Services Site Address: 10104 Vista Drive Name of Executive Director Josh Selo, Executive Director Project Description: Provide brief description of agency, agency goals, and agency services. Describe your program briefly, including who benefits from your program. Community Access to Resources and Education (CARE) provides support to Iow income seniors, high -risk families with children, at -risk youth and the disabled in Los Gatos through case management and supportive services. The main objectives of CARE are to encourage more stable and sustainable solutions to help clients facing hunger and homelessness, and make critical human services easily available and accessible to clients through a one -stop full service concept. CARE incorporates both case management and wrap around services to help low income, at -risk and vulnerable households manage a food or housing crisis. CARE will provide stabilization to help Los Gatos residents maintain housing stability, prevent eviction, and rapidly re -house homeless households. Program Funding: Provide prior year fiscal year actual budget amounts and proposed amounts for new fiscal year. Program Funding: FY 2017/18 (adopted) FY 2018/19 requested Clients: FY 2017/18 (actual) FY 2018/19 (proposed Town annual funding amount 20,000 20,000 Undup annual LG clients 20 Household 20 Household Total annual program budget 150,000 200,000 Total undup annual clients 500 Household 500 Household Town $ as % of annual total 13% 15% LG clients as % of annual total 6% 10% TOWN OF LOS GATOS ❖ FY 2018/19 TOWN OF LOS GATOS CLERK DEPARTMENT RECEIVED APPLICATION FOR COMMUNITY GRANT FUNDINGZ018 RAR -5 P 2 54 APPLICANT AGENCY/PROGRAM DOCUMENTS CHECKLIST Please submit one copy of each of the documents listed below with your completed application. This page should serve as the cover sheet for that section of your submittal. I. PROGRAM/PROJECT INFORMATION C Fee Schedule, Membership, or other fees II. AGENCY INFORMATION 7 Current Board of Directors IArticles of Incorporation Bylaws 9- Organizational Chart Brochures, Flyers, Promotional Materials III. FISCAL INFORMATION Audit or Financial Statement plus Letter of Auditability Organizational Budget Internal Revenue Service Ruling Letter (Section 501 c.3) California Revenue Code (Section 23701 d) 2 TOWN OF LOS GATOS ❖ FY 2018/19 APPLICATION FOR COMMUNITY GRANT FUNDING GRANT APPLICATION I. PROGRAM/PROJECT INFORMATION A. Contact Information Legal name of organization West Valley Community Services Address of organization 10104 Vista Drive Cupertino CA 95014 Organization contact (Name, title, telephone number, email address) Josh Selo Executive Director 408-956-6113 joshs@wvcommunityservices.org Program name Community Access to Resources and Education Site address of program 10104 Vista Drive Cupertino CA 95014 Program manager (Name, title, telephone number, ernaiI address) Sujatha Venkatraman Associate Director Stability Support Services sujathav@wvcommunityservices.org Annual grant amount requested FY 2018/19 $20,000 B. Community Need Statement Describe briefly the demonstrated need in the Los Gatos community for the program. Cite data sources as appropriate. According to the last U.S. Census Bureau report, more than 330,000 Californians fall below the federal poverty line. In Santa Clara County, 10.9% of its population lives below the poverty line, including 12.6% of children who live in poverty and 8% of seniors that are barely able to afford the high cost of living in the county. (https://www.census.gov/library/publications/2016/demo/p60-256.html) In the West Valley, 22,000 men, women, and children are living in poverty. Town of Los Gatos data indicates 5.2% of its population is living in poverty and 17% of its residents are above the age of 65. 3 Some of the challenges these low income households are facing in west valley region are: • Lack of affordable housing for low-income families • Income insecurity due to high debt ratios and low savings • Underpaid workforce with lack of benefits including paid sick leave, vacation and retirement benefits • Increase in commute time and transportation costs Due to these challenges, low-income individuals and families are facing enormous threats to their safety, health, and successful life. In fact last year West Valley Community Services experienced an increase in demand year over year of 35% since 2017. We were able to scale our operation and assist everyone who came to our doors for help. West Valley Community Services assisted 1,590 new individuals facing a hunger or housing crisis in our community. 3,893 men, women, and children received help from West Valley Community Services. We provided groceries, household items, adult diapers and personal care items to 1,586 individuals, and distributed more than 516 pounds of food per client in the last year (824,644 pounds of food through our pantry overall). In addition, we helped clients avoid homelessness by providing $166,544 in emergency financial assistance for rent, utilities, and apartment deposits. Here is a breakdown of the services provided specifically to Los Gatos residents last fiscal year: 16% of new clients were Los Gatos residents. 24 Los Gatos residents participated in special programs 24 Los Gatos residents received emergency financial assistance 14% of food pantry users lived in Los Gatos Los Gatos client household demographics: 54% single adult 33% households with children 13% adult couple, no children Community Access to Resources and Education (CARE) builds healthy communities by providing easy access to services such as food, public benefits, and medical insurance enrollment for low income and high -risk households in our communities; educating the clients about new policies such as housing laws, rent control, payday lending, immigration laws policy changes that have major impacts on the local level; connecting the clients to resources by hosting health fairs and resource fairs which benefits everyone in the community; and educating the community at large about the changing demographics, changing needs CARE services include: ➢ Benefits Assistance: Case managers work with clients so that they understand the application process, processing time and their legal rights, as well as overall education on how these programs help clients transition to self-sufficiency. In addition to the on -site services described above, case managers also provide assistance with applications to other benefits including Covered California, CalWorks, CalFresh, Medi-Cal, Free/Reduced lunch, and Healthy Kids. Emergency Financial Assistance: WVCS provides one-time emergency financial assistance for homeless prevention to help families avoid eviction and maintain housing 4 and/or rapid re -housing to help re -house families that have been displaced. ➢ Food Pantry: All qualified clients have access to the food pantry in Cupertino or the mobile food pantry in order to supplement their needs and reduce grocery expenses. Currently the mobile food pantry locations in Los Gatos are United Methodist Church and Mountain Bible Church. Every visit to the food pantry includes fresh fruit and vegetables, fresh bread, eggs, a source of protein, and milk, sourced from Second Harvest Food Bank and generous donations from local grocery stores such as Safeway and Whole Foods. ➢ Educational Workshops: Workshops offered by CARE supplement client goals with a focus on various topics relating to overall client health. For example, classes on diabetes management, healthy eating, and fall prevention presentations for seniors. ➢ Employment Services: For clients who are unemployed or underemployed, assistance and resources are provided that help them achieve and maintain long-term, stable employment. Through the assistance of volunteer career counselors, program participants receive assistance with resumes and cover letters, career assessment, job searches, and interview training. ➢ Financial Coaching: This program works on breaking the cycle of a financial crisis by increasing income, decreasing debt, and establishing or improving credit. Clients learn how to stretch income to cover all expenses, understanding their credit score and repairing credit, creating a savings plan, or learning more about how to better manage money. In Los Gatos, the CARE program will serve the most vulnerable population with a main focus on senior citizens and the chronically homeless. Under the senior services component of CARE, case managers will provide intensive case management to seniors including bi-weekly check -ins, and coordination of services through our partners, including Live Oak Adult Day Services' Senior Nutrition program, Sourcewise, the Health Trust and other local senior programs to ensure that seniors are connected to available resources in their community. West Valley Community Services is proposing to co -locate at the Live Oak site so that the case manager will be connected to the high risk and low income seniors. West Valley Community Services will develop a partnership with Villa Vasona and other senior housing programs. The CARE program will continue to provide outreach at the Los Gatos Adult Recreation Services and the Caring about Resident Elders program in Los Gatos, who will be providing direct referrals to CARE. CARE will also be available to Los Gatos residents from our Mobile Food Pantry unit, located weekly in Los Gatos. This population is at risk because they are unable to afford or have access to basic needs such as food, healthcare, and housing. While the west valley region of Santa Clara County is often perceived as affluent, almost 22,000 individuals (11.17%) are living in poverty. The median rental rates have increased in Silicon Valley by 33% since 2011 and wages have stayed flat. This is straining household budgets and pushing families closer and closer to a financial or housing crisis. At West Valley Community Services, requests for basic human needs such as food, emergency financial assistance, and housing assistance have increased year over year. In looking closely at client data, we learned that 80% of clients who seek our services are in some form of financial crisis due to personal loans, high -interest payday loans, credit card debt, past due medical bills, or car repair bills. The high cost of living in Santa Clara County, combined with 5 the challenges created by personal debt and poor financial literacy, is creating enormous challenges in our community and undermining the ability for our clients to meet their basic needs and realize household stability. According to WVCS case management reports about 90% of our clients have to choose between paying utilities, rent or a mortgage and food. For most client's, 80% of their income is going towards rent which leaves them will little money for food, other basic needs, or to save money in the event of a financial emergency. c. Direct Services For Human Services and Arts, Culture and Education grant requests, list, describe, and quantify each direct service to be provided annually from July 1, 2018 through June 30, 2019. A Direct Service is a service for which there is an identifiable client. A Participation Agreement (Attachment 2) must be completed by each client receiving the direct services described below. Description of Service FY 2018/19 Number of Services Provided Annually FY 2018/19 Number of Unduplicated Los Gatos Residents served Annually 1. Case management 100 20 Average number of direct services received by each unduplicated client: _3 Average number of direct services received by each unduplicated Los Gatos client: 3 D. Indirect Services List, describe, and quantify each indirect service to be provided annually from July 1, 2018, through June 30, 2019. An Indirect Service is a service for which there is no identifiable client; for example, information and referral that is given over the phone. Description of Service FY 2018/19 Number of Services Provided Annually 1. Supportive Services such as employment classes, financial coaching, and nutritional classes 10 2. Special program such as back to school, food baskets, holiday gift program thanksgiving 20 3. Food Pantry 100 6 F. Demographic Information Provide demographic breakdown of unduplicated Los Gatos residents expected to receive direct services. Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2018/19 Age Under 18 years old 0 19 — 50 years old 10 51 years old and over 10 Disability Status Disabled 10 Not Disabled 10 Demographic Data Annual Number of Unduplicated Los Gatos residents FY 2018/19 Income 50% of median and below 10 51% a 100% of median 10 Above 1 00% of Median 0 Sex Female 10 Male 10 Total Total Los Gatos clients 20 G. Client Participation Requirements Attach appropriate fee schedules, membership requirements, or other fee listings. West Valley Community Services provides programs and services free of charge. Households applying for services will be asked to provide the following documents: • Proof of Los Gatos residency by PG&E bill or other utility bill. • Proof of income (entire household) to determine HUD income guidelines. • ID for all adults in household and birth certificates for all children. • Proof of emergency for any financial assistance. Also, individuals must provide proof that with the requested assistance, they are able to pay the following month's expenses. • Proof of rental agreement. 7 II. AGENCY INFORMATION A. General lnformation Legal Name of Organization West Valley Community Services of Santa Clara County, Inc. (West Valley Community Services) Address of Organization 10104 Vista Drive Cupertino, CA 95014 Name of Executive Director Josh Selo Date of Incorporation July 1976 Insurance/Tax Information Federal Employer Tax Number 94-2211685 State Employer Tax Number C0773975 Worker's Compensation Carrier/ Policy Number ProSight Specialty Insurance WV20170007927 Liability Insurance Carrier 2,000,000 Amount of Liability Coverage Commercial General Liability General annual aggregate: $2,000,000 Property Damage (combined with liability) $3,000,000 Combined Single Limit $1,000,000 Policy Period 7/1/2017-6/30/2018 Worker's Compensation Policy Period 12/31/2017-12/31/2018 B. Staffing Profile Please complete the chart below for your organization as it will be staffed during FY 2018/19. Identify the hours to be devoted to the program for which you are requesting funding, for both employees and volunteers. Position Title Number in Classification Approximate Hourly Rate Hours Worked per Week Percent of Time to Program Employees Case Manager 1 $22 14 36% Volunteers N/A 8 C. Agency Experience --Describe the experience of your Agency in providing program services, West Valley Community Services is the only agency in the west valley region that provides intensive case management and supportive services to at -risk seniors, the disabled, and/or dependent adults. The goal of intensive case management is to help clients achieve self- sufficiency by incorporating the different service components set forth in the client's individual case plan using the Self -Sufficiency Matrix. Most case management services that exist in the west valley region are associated with a membership to a senior center or a meals program. Many of the clients who are receiving services from West Valley Community Services cannot afford a senior center membership or are not in need of a meal program. When they come to use for assistance, clients indicate that they have to make tough tradeoffs such as which utility to pay or whether to have medical insurance. For seniors in the west valley that are fortunate enough to own their own homes, they are in a position of being "asset rich, but cash poor", and are unable to provide for their daily needs. West Valley Community Services has become the first responder for many of these clients. West Valley Community Services' case management is intended to help low-income seniors and disabled adults become independent by improving accessibility to services, helping low-income individuals meet their basic needs, and promoting a connection to the community. The long- term outcome of this program is to help low-income household's safety, health, and independence so that they can remain living in the community and maintain a good quality of life. We can achieve this outcome through an array of programs and services we provide our clients: • By providing emergency rental and utility assistance, West Valley Community Services is preventing clients from evictions and homeless. With this help clients are prevented from entering the downward spiral that can make returning to stability difficult or impossible. • By providing supplemental food, West Valley Community Services is preventing hunger, improving health and nutrition, and enabling clients to spend more of their financial resources on housing, transportation, medical costs, and other life essentials. • By providing case management, information, and referrals, West Valley Community Services is helping clients find the resources they need to acquire suitable housing, learn about public benefits, eat more healthfully, cover healthcare expenses, and much more. • By providing access to a mobile food pantry, West Valley Community Services is making food pantry service accessible to all close to where they live. The mobile food pantry has several locations in West San Jose, Saratoga and Los Gatos. • By providing curb to curb transportation, West Valley Community Services is providing scheduled rides for social inclusion, events, errands, and medical appointments (as well as some on -demand non -medical, non -emergency appointments) transportation to ambulatory seniors and dependent adults over the age of 55 who reside in the West Valley communities of Saratoga, Cupertino, Campbell, Monte Serena, and Los Gatos. West Valley Community Services programs and services encourage more stable and sustainable solutions, thus promoting self-sufficiency instead of dependability. Our programs are intended to create economic security using the case management model which connects clients to various supportive services. The array of supportive services focuses on helping clients maintain income or increase income so that they can resolve their current crisis and move to long-term stability for their families and the community overall. In 2016-2017, West Valley Community Services experience an increase in demand year over year of 35%. Despite this challenge, we were able to scale our operation and assist everyone who came to our doors for help. West Valley Community Services assisted 1586 new individuals facing a hunger or housing crisis in our community and 26% of new clients were seniors. We provided groceries, household items, adult diapers and personal care items to individuals, and distributed more than 516 pounds of food per client in the last year (82.4,644 pounds of food through our pantry overall). In addition, we helped clients avoid homelessness by providing $166,544 in emergency financial assistance for rent, utilities, and apartment deposits. Currently, 242 at -risk seniors' households are accessing our services. D. Staff Experience --Describe the experience of key staff assigned to the program. West Valley Community Services' employees have significant educational and professional expertise in working with low-income families and the homeless community. Program management and clinical supervision will be provided by Grace Davis who holds a BSW and is currently in the process of obtaining her MSW. Strategic program direction will be led by Sujatha Venkatraman, Associate Executive Director, who holds an MSW and has over 20 years' experience in community development. Josh Selo, the Executive Director, has an MBA in Finance and more than 17 years of nonprofit management experience. He works closely with West Valley Community Services employees to ensure appropriate financial and programmatic transparency to support the organization's core mission. The management of CARE is integrated and each staff member is cross -trained to ensure consistent and quality services. Employees and volunteers represent the clientele served and speak many of the client languages. WVCS staff and volunteers are bi-linguaI and bi-cultural. Currently, WVCS has the capacity to provide services in Cantonese, Vietnamese, Hindi, and. Spanish. WVCS volunteers increase our linguistic capability, expanding our services to Russian, Vietnamese, Korean, and Farsi-speaking clients. The WVCS intake form is available in English, Chinese, and Spanish, Vietnamese, and Russian. E. Staffing Plan --Describe any anticipated staffing changes to occur during FY 2018/19. N/A 10 III.FISCAL INFORMATION A. Program Budget Please complete the following summary tables to reflect the budget for your organization and program. All amounts should be rounded to the nearest dollar. Alternatively, please attach single page revenue/expense summary sheets for the program for which funds are requested and a separate summary for the organization. Budget Summary Budget Data FY 2018/19 FY 2017/18 Los Gatos grant funding Requested: 20,000 Requested: $20,000 Total Program budget $225,000 $200,000 Los Gatos grant as percentage of total Program budget 9% 10% Total Organization budget $3,166,183 $2,750,770 Cost per year per unduplicated Los Gatos client $ 333 (20 household X3 unique services) $333( 20 household X3 unique services) Revenue Summar Revenue Source FY 2018/19 Organization al Budget $45,000 FY 2018/19 Program Budget $20,000 FY 2017/18 Organizationa 1 r Budget $30,000 FY 2017/18 Program Budget $ 20,000 Los Gatos grant Other municipal funding (please specify: ) $500,090 $ $347,490 0 County funding (please specify:) $637,730 $ $531,187 $ State funding (please specify:) $0 $ $0 $ Federal funding (please specify:) $729,759 $ $604,902 $ Other jurisdiction funding (please specify:) $0 $ $0 $ Fees for services $351,212 $ $381,491 $ Donations $420,000 $ $361,700 $ Reserve contingency fund $0 $ $0 $ All other sources (please specify:)Foundations $482.392 $205,000 $507,502 $180,000 Total $3,166,183 $225,000 $2,764,272 $ 200,000 Expenditure Summary Expense Category FY 2018/19 Organizationa 1 Budget FY 2018/19 Program Budget FY 2017/18 Organizationa 1 Budjet FY 2017/18 Program Budget Personnel $1,366,397 $175,000 _ $1,200,666 $150,00 Facility $443,716 $ $396,079 $ Overhead $142„800 ' $ $ 57,821 $ Materials/Supplies $ 84,000 $ $ 64,000 $ Professional Services $100,925 $ $ 87,825 $ Fundraising $258,548 $ $241,134 $ Capital Projects $ $ $ Other Direct Client Assistance (please specify:) $769,797 $50,000 $703,245 $50,000 Total $3,166,183 $225,000 $ 2,750,770 $ 200,000 B. Organization Contracts --Has your organization ever had funds withdrawn or a contract terminated for cause, unsatisfactory performance, or questionable costs on any financial statements or audit? If so, please describe. N/A C. Organization investigations --Is your organization currently on probation or under investigation by any agency which is or was a funding source within the past two years? If so, please describe. N/A D. Budget Alternatives --What alternatives will your organization consider if the requested Community Grant funding is not provided, or provided at a reduced level? Describe how a reduction will affect the achievement of stated goals. West Valley Community Services is the agency assigned to provide basic need services to Los Gatos residents as part of the county -wide Emergency Assistance Network. If not funded at the requested level, West Valley Community Services will be required to deny services to qualified individuals residing in the Town of Los Gatos. This would be a first in West Valley Community Services' history of services to the west valley region of the county. E. Funding Sources --Describe your organization's efforts in pursuing other funding sources. 12 West Valley Community Services is committed to its mission to providing services to all qualified residents of our county's west valley communities. To ensure this, West Valley Community Services employs a multilayered approach to fundraising, including events. major gift solicitations, planned giving, grant writing, corporate gifts, and direct mail appeals. F. Supplies Disclosure --If any non -expendable supplies with a unit cost of $100 or more are to be purchased with Community Grant funds, please describe. NIA G. Travel Expense Disclosure --If Community Grant funds are to be used for staff travel expenses, please describe. Community Grant funds will not be used for staff travel expense. 13 CERTIFICATION The applicant hereby proposes to provide the services as listed in this proposal, If this proposal is approved and funded, it is agreed that relevant federal, state, and local regulations, including non-discrimination laws and other assurances as required by the Town of Los Gatos, will be adhered to. Furthermore, as the duly authorized representative of the applicant organization, l certify that the applicant is fully capable of fulfilling its obligation under this proposal as stated herein. This application and the information contained herein are true and correct and complete, to the best of my knowledge. Date: , � c , 2018 5 ' 1 \ Organization Name YY . vr, vl I Executive Director (Print Name) ,Le 14