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Home My WebLink About2016-187 I RESOLUTION NO. 2016-187 2 RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN BERNARDINO RATIFYING THE SUBMISSION OF AN APPLICATION FOR 3 AND ACCEPTING A CONTRIBUTION SPONSORSHIP FROM KAISER 4 PERMANENTE OPERATION SPLASH FONTANA COMMUNITY BENEFIT GRANT PROGRAM, AND APPROPRIATING ADDITIONAL GENERAL FUND 5 EXPENDITURES IN THE AMOUNT OF $15,000 FOR THE 2016-17 SUMMER AQUATICS PROGRAMS. 6 7 BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN BERNARDINO AS FOLLOWS: 8 SECTION 1. That the Mayor and Common Council hereby ratify the submission of 9 10 the grant application to the Kaiser Permanente Fontana/Ontario Medical Centers Operation 11 Splash Community Benefit Grants Program ("Kaiser Grants Program"), marked Exhibit "A" 12 and incorporated herein by reference as fully as though set forth at length; and 13 SECTION 2. That the Mayor and Common Council hereby accept the Kaiser Grants 14 Program award of $15,000 and authorize the City Manager , or his designee, to execute the 15 16 Letter of Agreement from the California Community Foundation, marked as Exhibit "B" and 17 incorporated herein by reference as fully as though set forth at length; and 18 SECTION 3. That the Director of Finance, or his designee, is authorized to allocate 19 the $15,000 in accepted grant funds to the FY 2016-2017 Object Codes in the amounts shown 20 on the attachment marked as Exhibit "C" and incorporated herein by reference as fully as 21 though set forth at length. 22 23 24 25 26 27 28 1 1 RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF 2 SAN BERNARDINO RATIFYING THE SUBMISSION OF AN APPLICATION FOR AND ACCEPTING A CONTRIBUTION SPONSORSHIP FROM KAISER 3 PERMANENTE OPERATION SPLASH FONTANA COMMUNITY BENEFIT 4 GRANT PROGRAM, AND APPROPRIATING ADDITIONAL GENERAL FUND EXPENDITURES IN THE AMOUNT OF $15,000 FOR THE 2016-17 SUMMER 5 AQUATICS PROGRAMS. 6 I HEREBY CERTIFY that the foregoing Resolution was duly adopted by the Mayor 7 and Common Council of the City of San Bernardino at a joint regular meeting thereof, held on 8 the 61h day of September, 2016, by the following vote, to wit: 9 10 Council Members: AYES NAYS ABSTAIN ABSENT 11 MARQUEZ X 12 BARRIOS X 13 VALDIVIA X 14 SHORETT X 15 NICKEL X 16 17 RICHARD X 18 MULVIHILL X 19 20 Georg l nn Hanna, MC, City Clerk 21 /'J 22 The foregoing resolution is hereby approved this � day of September, 2016. 23 )k111' c� 24 R. Carey Dav s, Mayor City of San ernardino 25 26 Approved as to Form: GARY D. SAENZ, City Attorney 27 28 By: - 2 EXHIBIT "A" Mitch Assumma From: Kaiser Permanente Online Application <mail @grantapplication.com> Sent: Friday, March 25,2016 3:33 PM To: Mitch Assumma Subject: Your Fontana &Ontario Medical Centers'Second Stage Grant Application Submission Thank you for your submission. Your Fontana& Ontario Medical Centers' Second Stage Grant application has been submitted successfully,and the tracking number is 143004. If you have questions about your application, please use the contact information designated in your application form. At Kaiser Permanente,we are always looking for ways to improve our grant submission process. Your input can help us in that effort. We estimate it will take 15-20 minutes for you to complete. Please click on the link to the survey: https://www.surveymonkey.com/r/KPGrantmaking For your records,here is a copy of the contents of your application. Introduction Congratulations! You:have heeri'iurted to,submifi an amine applictlon to Kaiser PermanenteFon'tana and Omar"io Medical Centers' Community Benefit Gharitat We Coritr�but(ans Pr graim Online Submission Process . ' SAVE THIS itl �ti htt sflwwwGrantReguest.corn/S!D6?SA AM U§61 his b Irnk tb acos ariy Kiser Fermanenfe Gorrtmunity Benefit a`pplications?you may have t' 'd ah,d/4r submi:tted through our online prbeess. '4 } en returnl<in� fa :complete:Ihe forn, �rlease use the personal !og-in lick yota receted pia errr;at! Vuher�th,s ancourt arras established, which tws the sairnlq'li>I�ik' lisfedrtw the` llet ak�oye. • ' `All app`lioations mustbesubmitte'd th,r`ough°this online form When wor kM ,on the online applrcatbn form, you have the aptio;n to save your: work and`ret"'P to tf a app'llcation at a later.time:through the "account you created YQU:rnusf complete items.with e red a�ster�sk a: 4rne o Ahi ipforrx�atron you previously coCnpleted �n ,yqur grant inquiry will. be repeated here ag;�in with ypur original respot'ise to prov[de you with an . opportunity to update tho information Q : Rlease review all infQrmation carefully to ensure it is complete and aooura#e,;and That you have included all th.e necessary attachmen#s a Prir#er�fiendlyrversions of the applrcatior ;can be fiou"rid at-the top of this •, You;will ;receive a subrrtissjon a;aknowledgement. Please note The time stamp on your application submission will be Eastern t •" On:ce a grant applica#loci has been submitted, it caTnnot be..edited or.resubmitted. , c Filing Deadline The deadline fpr submittrr�g'yQ�r cQ p�ete graft a pl�catton is ll�l 'd i L', arc 20, 2016 OO p° Facif�¢fi�me�,( 'T�`;' v�ry requtrd �ornent rnt b sukmitted e` by this dt and #irevWt'recomrrien� you plan acGOr'd'Knly fcir"uplbading�all documents and attachments' {nc�'rnplete applteettons'wil{ 'i'tct �e corlidered 'All submit#ed grant i roposaals°arid supplemental documents become the'pt`aperty of Kaiser Pet -man ihte ! Contact Us Rlease dlr ct any cont' it Jelate`d quesp ns to Martha Varencta C;arnmt . Benefit Health Mna�et' You mayssend bier an emai{ byre{egfing fh o,ntact Us" link at the tc�p of tFiis pace t E` v t S ft c Please direct any #echntca(;gUeStns regarding the applic l n ptsgoess: io to I� thertne Murphy, $r Data/Database Analysfi, t f�P Commun�ty�a kpt'e ar:{66) 4Q5sg9.9:;1n your:message, Tease enter "IQnitne R'ppllcatton Question for Fanfana & Ontario Medical G1�t'rs " to thelsub�ectYltne In ue the bod�r Qf the era�lr state your stlans.or a q detailed desctipttrt Qf � o-t'3th`rtia°ld�flcuity Be &fit"e'to,tl4pf�ade aphQrfie numbt t.! h3 , aet IF 3 ! 9 whrpu'aan be reaphed ,We rutll!resppllds soon ,a '°ossibl Organization Information Sorne of the to ormiation yqy prevaou$ly bompl�ted Qn ypur grarwt t�gutrry utii11 be reputed here to prQviide your,Kith'„an apport, ty't upc a e the information. Tax Status Information Applicant Oxgnizat�on's ;eg�l.Nme This is the name that appears on your IRS determination letter, other legal documentation, or Form 990. City of San Bernardino - Parks, Recreation and Community Services Department Orgaiahpn's TaxD#( N or TIN) Please enter your organization's Tax ID number as 12-3456789. If you do not have a Tax ID number and are working with a fiscal agent, enter 'x' and complete the fiscal agent information below. 95-6000772 Tax Status Select your organization's tax status from the list below. If you use a fiscal agent, select "Other”and complete information requested later in this application. Government or Public Agency 2 Organization Documentation List of Qtcers and DirectorS Please upload a current list of your board of directors, including those who hold officer positions and their affiliations. Your application will be considered incomplete without the affiliations. City of San Bernardino Board of Directors.pdf W9 Required for organizations not previously funded by Kaiser Permanente Please upload a signed copy of your (or that of your fiscal agent organization's) W9. A blank form can be found here. City of San Bernardino W-9.pdf IRS F R-Alt Required for requests $25,000 and over Please attach a copy of your organization's most recent IRS Form 990. (Not required of government entities.) CityofSanBernardino IRS Tax Exempt Status VER 1.PDF Applicant Organization Information bxgatm.ion Name Please use the name as it appears on your letterhead. City of San Bernardino - Parks, Recreation and Community Services Department Street Addxess Please enter a street address. Do not use a post office box. 201 North E Street, Suite 301 San Bernardino State::. -... ... . ... ... .... .... : . . :: . ... -... : CA ZIP "]CLode 92401 Organizat"IUM General Fh n nb r Please enter the phone number as shown; do not use punctuation: 1234567890 (909) 384-5233 Orgntation's Generl `a Number Please enter the fax number as shown; do not use punctuation: 1234567890 (909) 384-5160 3 , r OrgapszatiQrr's.l�airBr}�ai),Address ; . ; .,. .. " ., . assumma—mi@sbcity.org brgari�atiori`.s Well A.ddrpss,(i,TRL� ` Please use the following format: www.kaiserpermanente.org http://www.sbcity.org Organization Budget Information Tofa1 AtinualOrganzafiYon'Bu�gx 204164694 OrgaxtYZ�tlOn$udget i , ' Required for requests $25,000 and over Please attach a copy of your organization's current itemized operating budget. City of San Bernardino - 2016 Budget & Narrative Rev 3-24-16.pddf Adzted 13uanetal,statement . ............. Required for requests $25,000 and over Please attach a copy of your organization's (or the fiscal agent organization's) most recent independent audited financial statement. (Not required of government entities.) City of San Bernardino Single Audit Fiscal Year 2013-14.pdf Organizational Capacity Date the Or g an�2aton was Bstal?;lshed If you do not know the exact date, please use January 1 of the year the organization was established. 01/01/1854 Mssoz�.St�terrteaat Limit statement to 50 words. Creating Community through People, Parks, and Programs: The Department of Parks, Recreation and Community Services is committed to providing quality services, programs, and activities for all residents of the City of San Bernardino youth, adult, senior, and challenged populations. Organrzatip 's Brief summary of your organization's history (Limit your answer to 950 words.) The City of San Bernardino ("City") is one of Southern California's most historic communities. Incorporated in 1854, it is a city of 210,000 residents in 59.3 square miles at 1,049 feet above sea level. As the county seat of San Bernardino County, it lies in the midst of the booming Inland Empire region. The City was founded early in California's history, and it had recently celebrated its Bicentennial in 2010. Influences of Native Americans, Mexican settlers, Spanish missionaries, Mormon emigrants, and Railroads can still be seen throughout the City today. From 1910 when Franciscan missionary Father Dumetz named the area San Bernardino to the present, San 4 Bernardino has been recognized for its scenic beauty and strategic location, once a resort stop for movie stars and famous entertainers traveling from L.A. to Palm Springs. The City operates under a hybrid Mayor-Council-City Manager form of government. Background Inform�tt6,n Describe your organization's goal(s), communities/cities, and general target population served. NOTE: Do not repeat content from "Organization's History"or "Current Services and Programs" sections. (Limit your answer to 950 words.) Creating Community through People, Parks, and Programs: The Department of Parks, Recreation and Community Services is committed to providing quality services, programs, and activities for all residents of the City of San Bernardino youth, adult, senior, and challenged populations. Programs include sports and fitness, after-school activities, recreational classes, open gym, nutrition programs, special events, aquatics, trips/tours, volunteer management and outdoor play. Current Services and Pro rare . Describe the organization's current services, programs, recent accomplishments and/or recognition received. (Limit your answer to 400 words,) The Parks, Recreation and Community Services Department's mission is to provide excellent parks, recreation and cultural opportunities which enhance the quality of life within the San Bernardino community. We create community through people, parks and programs and espouse the public leisure industry's mantra that"Parks Make Life Better". In the Aquatics division alone for the 2015 Season, we have successfully provided open swim to more than 26,793 visitors, taught 361 youth in swim lessons and the Junior Lifeguard Program students at 18 workshops/class sessions, assisted 492 low-income family members through 87 family swim passes gain access to pools, and offered 10 water safety and lifeguard certification classes. Through the partnership with Operation Splash Kaiser Regional Grants that funded summer aquatics programming (Jr. Lifeguard, Learn-to-Swim and free swim passes) our city pools improved physical fitness activity for low-income members and provided safe and affordable relief to the summer heat for San Bernardino residents. The City remains a Playful City, USA, despite a flat FY2014-2015 Budget. The Department also conducted a highly successful 2015 Operation SPLASH Opening/SwimFest with over 1,200 in attendance.In addition to pools and community centers, the department continues to offer after-school programs, senior services, and therapeutic recreation to regional visitors. 5 Current Grays v�itla K��sr'Pertnrieptearxtana or Qntarip 1Vedi1 Ceti If your organization has a current grant with either the Kaiser Permanente Fontana or Ontario Medical Centers provide a brief statement on your year-to-date progress, including quantitative measurements directly related to the grant objectives and outcomes. (Limit your answer to 250 words.) None. if your organ"zatiQt�:provid�s direct bediea� s r�nces, please suppF�►the following. n b ifil�ti'an Direct Medical Service Organizations Select the organization type that best describes your organization. The primary type should be selected first. If applicable, you may select more than one type, up to three types maximum. Orgarizatic�n';Desrgraiao'n4 � : s - : ... , Please select any designation your organization has received. If applicable, you may select more than one designation, up to three designations maximum. T6416. thataiser Permanente completesits due d[Iigence, eatih organization requestm s Cohtrilbotior must ansyrer tihe fo,llduvirg questions Organization Attestation S C on�i.�ct o In e e t Kaiser Permanente asks each organization requesting a contribution to disclose any relationships with Kaiser Permanente that may be, or appear to be, a conflict of interest. Such relationships may not create actual conflicts of interest and do not necessarily prohibit your organization from receiving a contribution. However, they must be disclosed in order for Kaiser Permanente to complete its due diligence. Do any Kaiser Permanente executives, managers, directors, physicians, or other employees or their family members: 6 3 • Serve as a board member, director, officer, manager, employee or fiduciary agent of your organization? • Have a compensation arrangement or financial interest with your organization? • Hold any position of substantial influence with respect to your organization? No con of. interest Details: • If you answered Yes above, in the text box below enter the name of the Kaiser Permanente employee or their family member and describe the nature of the relationship with your organization. • If you answered No above, enter"N/A" in the text box below. NA if yoc 'ara unaware ofrzy r�;la#ronhrp at#hrs trrrre but becarrte aware of arse during the applleation P0001 or gtant ;erlod, vtfe ask that ybu ctrl!rfrc(aSe° �red tronsl 1p ,6ygntactrng Krat' Permane te. Font h arra Madreal O n#ars ommunity gnefrt Grants Prr7gr rn at; martha r valencra:0h Qra w/ti the sub�o t lr>fe grant Quesfron G(71 -�— Does a Member of Congress, Executive Branch Official, State Official, or their staff: • Serve as a board member, director, officer, manager, employee or fiduciary agent of your organization? • Have a compensation arrangement or financial interest with your organization? • Hold any position of substantial influence with respect to your organization? No i'artici patxorr;aJetails If you answered Yes above, in the text box below enter the name of the Member of Congress, Executive Branch Official, State Official, or their staff and describe the nature of the relationship with your organization. • If you answered No above, enter"N/A" in the text box below. NA Recog�zto 4 Govennmertf � ... Will any portion of this contribution request be used to honor or recognize the achievements of a Member of Congress, Executive Branch Official, State Official, or their staff? No • If you answered Yes above, in the text box below enter the name, title, and affiliation of the official and provide a brief description of the honor. • If you answered No above, enter"NIA" in the text box below. NA PAC &CODE Does your organization have a political action committee (PAC) or committee on political education (COPE)? No PAC&CO Details • If you answered Yes above, in the text box below enter whether or not any portion of this contribution request will be used to support the PAC or COPE or any program that will support or oppose candidates for public office or political party. • If you answered No above, enter"NIA" in the text box below. NA Nondiscriminatxonol� y Does your organization have a policy or statement that prohibits discrimination on the basis of sex, age, economic status, educational background, race, color, ancestry, national origin, sexual orientation, gender expression, gender identity, or marital status in your programs, services, policies and administration? Yes Non Frt�selytiz�ng. For a religious or faith-based organization, will the proceeds be used to support general operations, services and programs of the congregation/membership/students, or to advance religious doctrine or philosophy? N/A Fiscal Agent Information If your organization:w g a:fiscal agsrafi, please compaefie the following information on behalf of tha fiscel agent: If nit, please select 'Next' (afi the torn of th`e tae) 3 Fiscal Agent Memorandum of Understanding fzsdal Agenti''MOU Required if using a fiscal agent A memorandum of understanding/agreement between the fiscal agent and the requesting organization. IMPORTANT: All documents must be submitted in PDF format. 8 Organization Information Fiscal Agents g,. As it appears on the IRS determination letter or Form 990 FiscalAgent's Tax ID# (EIN or TIN) Please enter your organization's Tax ID number as 12-3456789. Street Address, City, State, and ZIP Code Ftsoa]=A genti Cpritt Natfle Prefix, first and last name of the chief executive of the fiscal agent. Fiscal:A gent`Contae. I� l Riscs Agent contact Email Address Fiscal'Aenfi'Cantaet Phane Number Please use the following format: (123) 456-7890 TO ensure that Kaiser Pelrrriailhente completes its due,di igence, each organization reU. enti contribution mint �invWer the told owing U:estions aaout the fiscal q n a g agt Fiscal Agent Organization Attestation Co nfl. ict o�:Inxeresx Kaiser Permanente asks each fiscal agent organization requesting a contribution to disclose any relationships with Kaiser Permanente that may be, or appear to be, a conflict of interest. Such relationships may not create actual conflicts of interest and do not necessarily prohibit the requesting organization from receiving a contribution. However, they must be disclosed in order for Kaiser Permanente to complete its due diligence. Answer the following question as it pertains to the Fiscal Agent Organization: Do any Kaiser Permanente executives, managers, directors, physicians, or other employees or their family members: 9 • Serve as aboard member, director, officer, manager, employee or fiduciary agent? Have a compensation arrangement or financial interest? • Hold any position of substantial influence? • If Yes, in the text box below enter the name of the Kaiser Permanente employee or their family member and describe the nature of the relationship with the fiscal agent organization. • If No, enter"No" in the text box below. !f ou are unaware of an re/atronshr at thrs trme brut became aware of one tlunng .: ap p: pplrcatrorn p oCess or.grant perrod'we a�k;t��tfrypu�t111�Ci��lpse the r�l�trnn�h�p b,�eont�cfing Kamer Perrt��rtenfe'Fonfana/Or7t�n,a�1(!lediGal Centers CpmmUtlrfy Benefit:Gfants Pro�rarn at ' rnarfl7a r rratencia�kp arq with the sub1egf lrne- Gr�r1t C,�ues�ia(� CO! „ participafion by Government Ociai(Fiscal Agent) Does a Member of Congress, Executive Branch Official, State Official, or their staff: • Serve as a board member, director, officer, manager, employee or fiduciary agent of the fiscal agent organization? • Have a compensation arrangement or financial interest with the fiscal agent organization? • Hold any position of substantial influence with respect to the fiscal agent organization? • If Yes, in the text box below, enter the name of the Member of Congress, Executive Branch Official, State Official, or their staff and describe the nature of the relationship with the fiscal agent organization. • If No, enter"No" in the text box below. t' C CODE(F 9`A"',"eft) ;. .,. Does the fiscal agent organization have a political action committee (PAC) or committee on political education (COPE)? • If Yes, in the text box below, enter whether or not any portion of this contribution request will be used to support the PAC or COPE or any program that will support or oppose candidates for public office or political party. • If No, enter"No" in the text box below. Nandzscrimmation'Pol�cy;.(Fi�ca1�1 ant g. ) . Does the fiscal agent organization have a policy or statement that prohibits discrimination on the basis of sex, age, economic status, educational background, race, color, ancestry, national origin, sexual orientation, gender expression, gender identity, or marital status in your programs, services, policies and administration? Please enter Yes or No in the text box below. 10 By answering "Yes," you affirm that your organization does have a nondiscrimination policy/statement and it does not discriminate. yes Non Proselytizing("T,scal Agent) l If the fiscal agent is a religious or faith-based organization, will the proceeds be used to support general operations, services and programs of the congregation/membership/students, or to advance religious doctrine or philosophy? Please enter Yes, No, or Not Applicable in the text box below. NA Key Contact Information The �n#airrn #iQ> �ou,'pr+��rously com�letee Qn Maur grant i�qu�ry uv�ll be'-repeated here:tct prou�tle you:with an oportluni 'vii;-, o update the infprsion; Phase rew 11;1.01_following iinfQrmation,for,your agency`s �xpcut�ve director., CE4 or president.and coma ; neces$ ry. Chief Executive Information Pre#ix!. jl Mr. First Name Mickey Lit Name" f� Valdivia Suffix <None> Title Director of Parks, Recreation and Community Services Phone: Please enter the phone number as shown; do not use punctuation: 1234567890 (909) 384-5030 Fens�on If applicable. Fax 11 Please enter the fax number as shown; do not use punctuation: 1234567890 (909) 384-5160 Etna.�l valdivia_mi @sbcity.org The Project Gontact,is the indlldual responslble for a4rr� leting th1s;grant propQSal and should serve as the primarY Cpritct far a}�y�ddlt loan l,rnoratton requested Nits 1'leasecheek.thls box 1�f the pro�edt confiact for th1�proposal 1S the same as the chief executive(above;}; No Ifi the;pirQ�ect co�fiac# is r�o RIO, as liCSVe, ple a t' V19N the following SA youg!iinfarmaiop #®r tihe,.p�r�a��Gtsonact,of the pr,`dpG'sal and colwr t if n:eessry Project Contact Information Prefix Mr. P1rst Naxx1� .! . ......... .... Mitch Assumma Sixffixi �7��Whha Was,AMOCO <None> Tale. #. . Community Recreation Manager Phone MY AWAY K Please enter the phone number as shown; do not use punctuation. 1234567890 (909) 384-5132 ExtenslQli - If applicable. Fax . .... . ...... , _ . .... .. . ..... _ , Please enter the fax number as shown; do not use punctuation. 1234567890 (909) 384-5160 Ema1l; has BOA Novi 1 Nil 12 assumma_mi @sbcity.org Grant Request GOV I�ette r Please attach a letter on the organization's letterhead that must include: • The legal name of the organization. • The organization's street address as listed earlier in the application. Do not use a post office box. • Signature and date signed by the chief executive of the organization. • Ensure that the letterhead includes updated address and telephone number as indicated on page 2 of this application. City of San Bernardino Cover Ltr 2016-2017 Operation SPLASH, 3-25-16.pdf Some df the hfartnation yob previously complefied on ydur grant inquiry will be repete� here to provide yQU wrth �npportunity_ a update the mformatlnn Project Information Gxaptycle: tart bate „ 07/01/2016 Gran. Cycle:J6,` Date . 06/30/2017 Project Title ', Please provide a descriptive title of the project you are proposing. (Limit your answer to 20 words.) 2016 Open Swim & Learn-To-Swim in Hernandez & Mill Neighborhoods SA M.Dro1ect00M. On,i ,U k? Continuing What type Qf:funding are,your reque tmg? General Operating Support TYpe; f Finding If you selected "Other" please describe. AmJ. of fu 4",c�ing:3'ou q t-.:xeque�tlrlg Below is the amount you applied for on your grant inquiry. If you were invited to apply for a different amount, please enter the new amount now. 15000 13 J T6W,,Project Budget Please enter the total cost of the project you are proposing. Project should not solely rely on this funding request. 64000 In fihe sections below;` please de��Xbe tie need or problem your protect or ro ram ses, what ca aCit our or anization has to ac#dress phis need, P 9. P Y Y g yourpropased project pr prpgram,.and chaling�s and/or bairrierstMat may" d:66 the work you a,reproposing ..... Proposal Narrative Funding Priority Visit our website at http://community kp org/be-informed/service-area/fontana#grantmaking- section for further details on the scope, descriptions, and priorities of Kaiser Permanente Fontana and Ontario Medical Centers' grants. 2. Chronic Conditions (Southern California-Fontana) Population aIiarnasj ion Describe the geographic area(s) and population(s) to be served. Specify the geographic areas (e.g., specific cities or ZIP codes) where the project services/activities will be delivered. Proposed services must be delivered within the Kaiser Permanente Fontana or Ontario Medical Centers service area. (Limit your answer to 250 words.) The population served include low to moderate income residents of the City of San Bernardino living or frequenting the neighborhoods of the Hernandez and Mill Pools in the 1st Ward (mid- Central area of the City) and 3rd Ward (South). This population includes the broad community with a diverse ethnic minority, especially a high concentration of Latinos and Blacks, of all ages, primarily between the ages of 10-15 years, male and female. Sixty scholarship-qualifying families will be issued pool passes, learn-to-swim to accommodate 120 beginners ages 6-17 years, 5,000 open swim visitations, and distribution of thousands of copies of promotional materials. Need Staternnt Describe the needs, problems and/or issues to be addressed by this project. Include data used to highlight and/or justify the need for this request and cite the references used. (Limit your answer to 250 words.) City of San Bernardino FY2015-2016 Aquatics Budget remains under-funded. The City's bankruptcy Plan of Adjustment calls for continued belt tightening. The aquatics facilities are in threat of under-utilization. Regional Kaiser contributed $27,000 to the 2015 Season to supplement an aquatics program operational deficiency, which is half of prior years support. This allowed low- 14 income residents access to local pools during the summer to promote physical activity in reducing chronic diseases and obesity and advance swim skills in preventing drowning and improving family unity.The City recruits, hires, trains, and retains each year approximately 50 certified aquatics personnel toward life-saving service directly at four pools, and it partners with the Boys & Girls Club to service an additional public pool. A large number of the City's at-risk youth and low- income housing are adjacent to these pools; access to pools within a walking distance is parameter to healthy living. The economy stills lags behind the Nation, and the recent Terrorist Mass Shooting has created a community seeking comfort through unity and a sense of identity. Without supplemental funding, low income residents have few options to stay fit, seek relief from summer heat, learn swim skills to prevent drowning, and gain insight to the benefits of a healthy diet. The City has a large investment in pools that need to remian as beacons to support active living. Combined with hot summer months and a lack of in-home pools, our community lacks safe water play opportunities and places in whcih to learn swim skills. proposedequet Below is the proposed request as entered on the grant inquiry. You now have the opportunity to update and expand your answer. Describe the proposed request and how it directly supports the selected Kaiser Permanente Fontana or Ontario Medical Centers Priority Need this proposal is intended to meet. (Limit your answer to 400 words.) Provide a second safe swim session at the Hernandez and Mill Pools and allow a longer day's access, which will increase the opportunity for longer physical activity through water play. Offer no-cost swim lessons to beginner students ages 6-17 years of age at at the Hernandez and Mill Pools as a means to lower mortality in youth due to drowning and open opportunities to junior lifeguard training and future employment. Promote the ReThink Your Drink branded message to low-income patrons in the Hernandez and Mill neighborhoods to encourage healthy and active lifestyles. Funding Partaers List other funders supporting this project. Please describe type of monetary support provided (i.e., grants or sponsorships), number of years funding the project and when the funding term ends. 15 Please list and describe briefly. Kaiser Permanente Regional Office annual application/award since 2009 Cotlalioratly Partners List key collaborative partners and clearly describe their role in the coordination, collaboration, and/or implementation of this project. Please list and describe briefly. Boys & Girls Club of San Bernardino programs the City's pool at that same location. Briefly list the goal(s) of the proposal. Goals are broad, brief statements of about the long-term intent or desired outcome of the program or project. Example: To reduce obesity in adolescents in the San Gabriel School District. (Limit your answer to 35 words.) PRCSD's primary mission through the aquatics activities and facilities is to promote healthier lifestyles, water safety awareness, and a higher quality of life among community residents as one means to reduce childhood obesity. ok b ctives , Briefly list three or fewer primary objectives for the proposed request. Objectives: • Are key strategies that the project will undertake and intends to accomplish; • Are steps contributing to the goal; • Must be tangible, specific, measureable, and achievable in a specified time period; and • Must be achievable within the requested budget. Example: By May 31 (time), a minimum of 100 adults (target population, reach) will be recruited and trained on chronic self-management(activity/process) (Limit your answer to 35 words per objective.) Objective #1: By August 15, 2016, serve 3,400 visitors in open swim at the Hernandez and Mill Pools. Objective#2: By August 15, 2016, save lives through the provision of safe learn-to-swim activities to 60 students that prevents drownings, especially among youth. Objective#3: By August 15, 2016, offer swim play opportunities to 65 (260 family members) under-privileged families that promotes safe and healthy physical activity. Objective #4: Throughout the 2016 Summer Aquatics Season, engage the low-income pool- attending community at two under-served pool locations and through other community partners in a ReThink Your Drink campaign. Project Activities 16 Describe the activities, tasks, and/or methods to undertake to successfully accomplish the objectives listed above. Examples: • Gather baseline data on diabetic population and average HbA1 c. • Partner with local organizations to recruit high-risk community members that could benefit from the program. • Train the trainer on the chronic-care management (Limit your answer to 200 words.) This project proposes to meet the Need II of the KP Fontana Medical Center Needs Assessment to reduce obesity rates through physical activity. Open Swim and Learn-To-Swim programs are a part of the Parks, Recreation and Community Services Department mission in the municipal recreation and leisure service delivery system. The community's access to these facilities promotes healthy physical fitness, which in return helps reduce obesity. Open swim is drop-in water play, six days a week (M-Sat), from 1:OOp.m.-3:OOp.m. and 3:30p.m.-5:30p.m. where the community can come and swim for their health, socialize with friends, and/or cool down from the hot summer weather. In the Learn-To-Swim program, low-income youth ages 6-16 years are taught basic swim skills and water safety awareness in a two-week session, 45-minute daily lesson in a small group setting. Hernandez Pool will be used to serve both the Mill and Hernandez neighborhoods for free swim instruction for low-income recipients. A iarge portion of the City's at- risk youth and low-income housing is situated in the Hernandez and Mill Pools service area. Operating these two pools will promote a more fit community and build water skills in children, opportunities not available without this funding. �xpectec Outcomes: . . Identify the expected outcomes to be achieved by successfully accomplishing your objectives. Outcomes: • Describe a benefit or transformation that will result from your work, i.e., what will change in the lives of individuals, families, organizations, or the community as a result of the program. • Are short and medium term results of the project or program; what you hope will be the results of your activities. • Are realistic, and tangible. • Should include time frame, target population, and reach. Example: By the end of the project(timeldate), at least 80% of program participants (population, reach) will control blood sugar levels (HbA1c control (Limit your answer to 35 words per outcome.) By August 15, 2016: Serve 3,400 visitors in Open Swim at Hernandez and Mill Pools. Teach 60 youth in learn-to-swim classes at Hernandez and Mill Pools. Disperse 65 Family Pool Passes to the Hernandez and Mill Pool neighborhoods. Conduct a minimum of 10 RYD workshops at the Hernandez and Mill Pools, disperse 3,000 17 copies of healthy living promotional materials, post RYD banners at pool facilities. Long'Berm Strategies Describe long-term strategies for funding and sustaining this work. (Limit your answer to 100 words.) The Department will continue to lobby the City Council for full funding through the General Fund at Budget Development time each year of the fiscal year cycle. The City expects to complete the Plan of Adjustment activities by the close of the 2016 chronological year and would expect to see more of the discretionary use of revenues expand to other non-public safety services in fiscal year 2017-2018. However, partnerships/collaborations will continue to be used to supplement much of the mission of parks and recreation service delivery. Project lvliat1Qn Describe how you will evaluate the success of the program. Describe how you will demonstrate that you successfully achieved the objectives and outcomes. Example: Participants will monitor and report HbA 1 c levels which will be compared to baseline data. All changes will be documented by program staff. (Limit your answer to 200 words.) Open Swim:Attendance will be tracked daily, and safe, sanitary conditions will be provided by staff on site. Swim pass issuance and attendance will be noted separately. Monthly Status Reports are a routine City policy and procedure. End of season totals can be provided upon request. Health and fitness improvement will be surveyed by personal opinion. Learn-To-Swim Classes: Instructors will track attendance and assess the skills development of each student and recommend/encourage the appropriate advancement plan to the parents of each participant. By creating new habits and teaching purposeful swim lessons, participants will leave with positive lifesaving skills and attributes to prepare them for other safe water play activities. Students will also be prepared to enter the City's Junior Lifeguard program through successful completion of a prerequisite swim test. Rethink Your Drink: Banners will be posted pre-season. All printed Rethink Your Drink literature will get into the hands of swim patrons repeatedly over the hot summer months. A short questionnaire will help us qualify the message effectiveness. Pledge Cards will track participation, including the Summer Reading Program participants and other youth-serving partners. A successful swim program with large attendance will maximize the audience to whom the campaign is primarily intended. 18 Ivey Staff'and I�esponslbilties List key project staff and volunteers on the y p j project and describe their responsibilities. (Limit your answer to 100 words.) The Staff at the Hernandez and Mill Pools(1 Pool Manager,1 Senior Lifeguard,1 Lifeguard,1 Cashier) are budgeted to serve as the lifesaving services for the open swim program and as swim instructors. Pool staff is hired from a "pool` of qualified employees with varying work experience history. The Aquatics Recreation Supervisor has been employed in like capacity for over 27 years. Challen pr�z ttzties Provide relevant information on challenges, both internal and external, confronting the proposed project. Describe how you will mitigate those risks. The greatest challenge in the Aquatics Program is identifying and hiring enough qualified staff in lifeguard service. The City intends to offer certification classes in Lifeguarding and Water Safety Instruction in the Spring months in order to build a pool of respective candidates. A recent MOU with the San Bernardino City Unified School District has not only netted us the opportunity to conduct certification classes in a heated pool but also to improve our recruitment efforts at the high school level. A second challenge is maintaining equipment in operational order by coordinating a comprehensive preventative maintenance plan and a capital replacement program; legislative changes and State-mandated health and safety codes must be adhered to on a daily/hourly basis. Staff training and supervision is key to this objective. The primary challenge in programming is to identify the needy patrons and motivate them to register into the activities. Providing promotion materials in Spanish and aggressively marketing the target group through existing programs especially will provide larger results in this effort. However, weather patterns can greatly influence this interest and are not controllable. The scheduling of activities is already based upon maximizing attendance during times of greatness availability and need (such as when we offered swim classes at the 6p.m, hour instead of morning or noon times). As a reminder, the City is still immersed in a Recovery Plan as a condition of bankruptcy since 2012 with the FY2016- 2017 revenues expected to remain "flat". Involvement Kaiser PerinanenteInvolwment List Kaiser Permanente physicians and/or employees affiliated with your organization and/or project. None Pendiirxg Requests to Kaiser Permanente` List other pending proposals submitted to Kaiser Permanente. (indicate Kaiser Permanente Medical Center location, amount, and proposed project.) None pending. 19 Visibility Briefly describe any plans to communicate your progress and results to an external audience (e.g., newsletters, press releases, presentations) The City of San Bernardino will introduce and launch the Operation Splash Program on June 3, 2016 with the Operation Splash Kickoff& SwimFest event. We will partner with the County's First 5 Program in promoting water safety on this day. Open Swim and Learn-To-Swim classes will start the following Monday and continue throughout the summer months. Promotion of these activities will take place no later than eight weeks prior and be on-going, allowing for sufficient time for service recipients to pre-register. Registration will be on-going. Marketing to the target group will be accomplished by production and distribution of fliers in both English and Spanish to students of the San Bernardino City Unified School District (grades 5th-8th), local churches, Boy and Girl Scout Troops, Boys & Girls Club of San Bernardino, the Public Safety Academy, Norton Space and Aeronautic Academy and other charter schools, Inland Empire American Red Cross, local EDD Office (SBETA), local doctor/dentistry offices, resident youth sports groups organizations, neighborhood associations, and all community centers and libraries. Periodic press releases will be dispersed to a local and regional media list, on the City of San Bernardino Website, Public Cable Access Channel 3 (IEMG), and posted banners at public facilities. Announcements and recognition will be provided at several televised City Council Meetings and at other City Commissions meetings. Please providethe following irtfo�m'atwn about the: groups(s� targefed by your proposal Population Demographics Number of --4ivzduals to b.e T ireet)y P.p reed 3,720 „ Population Srved Please select the top three populations served. Broader Community Ethnic Minority Low-Moderate Income Age Crrqup a the Pdpulat�gx served our project If y will serve all ages listed, please select"All." Otherwise, please select up to three. (0-12) Children (13-17) Teens All Ages Gender of the Populat-on Served. If your project will serve all genders listed, please select "All." Otherwise, please select all that apply. All Ethnicity of the Population':;Served 20 Please select all that apply. Please select "Other"if your project serves an ethnicity not listed. American Indian or Alaska Native Asian South Asian (Incl Indian, Pakistani, Afghani) Black -African-American Black- Other Black Latino/Hispanic Middle Eastern Native Hawaiian Pacific Islander White Ethnicity"" " of h TT I 'P Av�r. O , x ......-,U If you selected "Other" because your project serves an ethnicity not listed, please enter the ethnicity here: 21 c � Mickey Valdivia Director of Parks,Recreation&Community Services 201 North"E"Street,Suite 301 ( i San Bernardino,CA 92401 (909)384-5233 San Berl N gte March 25,2016 Community Benefit Grants Program Kaiser Permanente Public Affairs Office Attn: Roberta Tinajero-Frankel 393 E.Walnut Street,2"d Floor Pasadena,CA 91188 Dear Ms.Tinajero-Frankel: The City of San Bernardino is pleased to be invited for stage two of the application for the Kaiser Permanente Fontana& Ontario Medical Centers funding for our 2016 Operation Splash program. The Department of Parks, Recreation and Community Services continues to emphasize its commitment to the reduction of the chronic diseases leading to an epidemic of childhood obesity in our city.Our summer water play programming is a critical piece of the our overall community health plan since this audience is so well connected to us in the summer months,starting with greater accessibility to our pools and swim play apparatus. Furthermore, we are very pleased with our progress in the branding of the Rethink Your Drink campaign and look forward to even greater things working alongside Kaiser Permanente for this Summer 2016, The City of San Bernardino struggles with high poverty rate, low median family income levels, and a growth in the Hispanic/Latino and African American populations, who are disproportionately affected by overweight and obesity. The recent mass shooting tragedy in San Bernardino will not delay our efforts to keep"SB STRONG". We will continue to be ever hardworking with such limited resources in a community we are proud to call"home"and hope that you will continue to share in that sentiment.As mentioned time and again,our summer aquatics programs are a focal point for healthy eating and active living. The 2015 Operation Splash program's successes are well documented in the on-line application as we continue to apply diminishing grant contributions into real-world successes, such as providing pools for 87 low-income families with 492 members the ONLY opportunity for water play and teaching 361 youth how to swim and stay alive while having fun in a water environment.Furthermore,the Rethink Your Drink promotion has really livened up many of the community members in making healthier food and beverage choices. Our greatest challenge this year will be to secure enough qualified part-time life-saving work force to do the things we do best, which is to Create Community through Parks, People and Programs, which is why the Junior Lifeguard Program is so important to us as well(Regional Kaiser funded program). Thank you for your past support.I look forward to our future successes in such a challenging community as San Bernardino. Sincerely, Mitch Assumma on behalf of Mickey Valdivia Director Of Parks,Recreation and Community Services "Parks Make Life Better" cc: Mark Scott,City Manager Enclosures 004 iW5ER MMANEl t. r t t r °s .E t •t, Organization Name: C€ty of San Bernardino PRCSp Project Title:'nandez&Mill Pools Open Swim&Learn-To-Si Date: 24-Mar-16 Request from In-Kind Other TOTAL Kaiser Foundation Contribution Sources BUDGET Hospitals of Income PERSONNEL/STAFFING EXPENSES List title and%on project) 1 10%-Aquatics Recreation Supervisor $ - $ 12,336.00 $ 000-00 $ 17 336.00 2 50%-Pool Manager $ 5,318.00 $ 5,318.00 $ 10,636.00 3 50%-Senior Lifeguard $ 4,792.00 $ 4,792.00. $ 9,584.00 4 40%-Lifeguard $ 4,965.00 $ 6,193.00 $ 11,158.00 6 50%-Recreation Leader Cashier $ $ 6,600.00 $ 6,600.00 Subtotal Personnel/Staffing Expenses $ 15,075.00 $ 35,239.00 $ 5,000.00 $ 55,314.00 Benefits( 7,5 %of Personnel) $ - $ 3,773.56 $ 3,773.56 TOTAL,PERSONNEL $ 15,075.00 $ 39,012.56 $ 5,000.00 $ 59,087.56 PROGRAMIOPERATING EXPENSES Office Supplies $ 100.00 $ 100.00 Communications e. printing,co in -RYD $ 770.00 $ 770.00 First Aid Supplies $ 200.00 $ 200.00 Custodial Supplies $ 400.00 $ 400.00 Swim Class Supplies $ 200.00 $ 200.00 Other: $ TOTAL,PROGRAM EXPENSES $ - $ 4,846.00 $ - $ 4,846.00 INDIRECTIOVERHEAD EXPENSE* (_j 0 %of Expenses) $ $ - TOTAL X EN Personnel+Program+Indirect $ 15,075.00 $ 43 858.56 $ 5,000.00 $ 63 933.56 NARRATIVE:City pays all utilities cost(water,electric,gas),all pool chemical costs,licenses and fees for commercial pool operation, and equipment maintenance and replacement(circulation system,chemical feed system,filtration,deck&grounds),NOT shown as In-Kind. PERSONNEL:The Staff at the Hernandez and Mill Pools(1 Pool Manager,l Senior Lifeguard,l Lifeguard,l Cashier)are budgeted to serve as the lifesaving services for the open swim program and as swim Instructors.Pool staff is hired from a"pool"of qualified employees with varying work experience history.The Aquatics Recreation Supervisor has been employed in like capacity for over 27 years.Two swim sessions are offered Monday through Saturday from 1:00pm-3:00pm&3:30pm-5:30pm for a 10-week summer season only.Learn-to-swtm classes are taught 6:00pm-6:45pm on M-Th Just after open swim.Five 2-week swim sessions are taught to oneltwo classes of 8-10 students each session.IN-KIND: Operating supplies include toiletries and sanitation supplies(staff also serve as custodians during daily use),routine first aid supplies needs,minor repair items(chemical tubing replacement or hardware for signs,etc.),and kickboards as teaching aids-10wks. SUSTAINABILITY:General Fund(small%user fee cost recovery)and partnering to share costs and gain discountsirebates,etc. 4. O O VOl O O O vj O O N — Q O O 110 O 'n O N %O M r- O O Vl Vt O O N m O "O O(2�N N 6 O d Q Q Q OV �o .-" N Vl = O O O N M rte-.+ �. .Z Zi Vl 69 U p O O N S iO 00 O p p O Q o O q .-. O - M p OOO��, In M 00 00 O M vW_ �Qi yQ �Qi M U O 00 M N r+ O t7' r., t`, N O O O Q N ° g °oc�ioS, 00aO• ° otn o 3 1 N � 'D N .-i N .� M .--i "o N�--� VO• O r7i �. �. Z 69 O h q d N O C O O O O O N O O Q V) o O O C t-- M N 'n O O O 0� (V 00 'b .. v, d M W, cl %% t� Vl iD m cf t� d d r A O O V� o0 0o n cv It d o O o v 0; O 10 m v y3 �, N � r-im M O Z Z o c0 _� N o 0 O ° ¢ >, °Q. z oQ 0 o �nv� oo 0O 0 'n — M N 0 0 0 0 0 " o 00 1... Vl M Vn V1 -4 " Vl Vl O� V"; O lc Q/ o o 00°�°�� °�t�Ma `r r- in c`�n^�M Q Q Q Q ¢ � u) N •--� M .-. .. N O� ...� m rr N m O� O z z z z 7-+ 09 O t }0}. OU Cl L6 0 V) b N O Ell Vl cc O O S Q V l Q O O U a OI, � 0 Q V) kn 00 t` in W O O O V v T v C W .. 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[- 3 A R U U N y o r; C-i ri 4 vi T"" q on o Gq ,s � wV' a° vin I Mitch Assumma From: kp-community @kp.org Sent: Monday, March 14, 2016 4;28 PM To: SCAL.MC.Grants @nsrntp.kp.org Cc: Martha.R.Valencia @ kp.org Subject: Kaiser Permanente Budget& Narrative Hello, You are receiving this email because you have hegun a stage two application for the Kaiser Permanente Fontana& Ontario Medical Centers. We realized that the budget template and narrative were not included in the application. • Attach a completed budget, based the budget template that you can download here: http:/Icommunity.kp.org/downloads/sC<i lBudaetTem plate.xls • If you prefer, you may upload an ul)dated version of the budget you submitted during the first stage. • Items listed in the "in-Kind Coidliholions"column of the budget template should list only non-cash support for your project. For example, this is where you would list the value of donated office space, health education materials, or office equij.);nent. • Attach a Word or PDF document descrihing how the requested funds will be used. • Briefly describe the categories of I, idin:j you are requesting (e.g., personnel, program and/or operating expenses). • Send the documents to scal.mc.grantstii?t�q� by March 31, 2016 at 2:00 p.m. Please note: You have 3 additional days beyand ;! original due date.Your new due date is March 31,2016 at 2:00 p.m. Please let me know if you need anything else, Katherine Murphy Technical Assistance KP-Community NOTICE TO RECIPIENT: If you are not the Intended recipierl ol u e-mail,you arc prohibited from sharing,copying,or otherwise using or disclosing its contents. If you have received this e-mail in error,please nolif;Me ruder immcdiateiy by mply e-mail and permanently delete this e-mail and any attachments without reading,forwarding or saving them. Thank you. I 2016 GENERAL FUNDED PROGRAM PERSONNEL BUDGET DRAFT WIREVENUE RECREATION SWIM: DAYS DAYS COST COST REVENUE POOL SITE POS.TITLE #OF EMPL. WAGE HRIDAY $-SUN HRIDAY MON-FRI S-SUN MON-FRI TOT.COST PROJECTED JERRY LEWIS PL MNGR.II 1 $15.90 6.3 28 8.3 66 $2 805 $5,610 $8,414 PL MNGR.1 1 $14.85 6.3 28 8.3 56 $2,684 $5,169 $7,763 SR.UG 2 $13.20 6.3 28 6.3 58 4 857 $9,314 $13,971 UG 4 $11.55 6.3 28 6.31 58 $8150 $16.299 $24.449. CASHIER 4 $10.00 6 28 6 56 $6720 $13,440 $20160 REC LDR 2 $10.50 51 28 2 56 $2,940 $2,352 $5.2921 TOTAL $80 039 $41,250 ffm POOL SITE POS.TITLE #OF EMPL. WAGE HRIDAY DAYS I COST REV.PROJ. Start May 30-August 6,2016&Wknds Thru August NUNEZ PL MNGR.1 1 $14.65 5.5 76 $6 124 (Thru Aug 12th&Wknds Q J.Lewis) SR.UG 2 13.20 5.5 78 11 035 Note:Revenue projections are based on the prior yews actuals, UG 2 $11.55 5.5 76 9 656 CASHIER 1 $10.00 5 76 3 800 TOTAL 3D 615 $4.76 0 •IL•f POOL SITE POS.TITLE #OF EMPL. WAGE HRIDAY DAYS COST REV.PROJ. HERNANDEZ PL MNGR.1 1 $14.65 5,5 66 $5 318 SR.UG 1 $13.20 5.5 68 $4 792 UG 1 $11.55 5.5 66 $4193 CASHIER 1 $10.00 5 66 $3300 TOTAL $1702 2. 0 POOL SITE POS.TITLE #OF EMPL. WAGE HRIDAY DAYS COST REV,PROJ. DELMANN HTS PL MNGR.11 1 $14.66 5.5 66 $5,318 SR.LIG. 1 $13.20 5,5 66 $4,792 UG 1 $11551 5,5 66 4.193 CASHIER 1 $10.00 6 66 $3.300 TOTAL $1.200 SWIM CLASSES: POS.TITLE #OF EMPL. WAGE HRIDAY DAYS M-TH #SESSIONS COST REV.PROJ HERNANDEZ UG 3 $11.55 11 5 $1386 $0.00 NUNEZ UG 4 $11.55 11 5 $1848 $0.00 JERRY LEWIS UG 7 $11.55 1 8 5 $3,234 $5000 TOTAL c $.6468 $5,000 SWIM RENTALS: POS.TITLE J#OF EMPL. WAGE HR/DAY J# RENTALS COST REV�PROJ JERRYLEWIS UG 6 11.55 2 20 2 772 64 JUNIOR LIFEGUARD PROGRAM: POS.TITLE #OF EMPL. WAGE HRIWK I#WEEKS- COST REV.PROD JERRY LEWIS Coord./Instr,Train 1 17.53 41- 10 701 $300 Coord./Instr.Trein 1 $17.63 2 10 351 TOTAL 1 Dfi2 300 RETHINK YOUR DRINK: P03.TITLE #OF EMPL. WAGE HR/WK #WEEKS COST REV.PROJ CITY-WIDE Su v. 1 29.37 2 10 $587 0 POOL M,R 1 3 115-901 1.5 5 358 TOTAL ��itt $945 $300 :III oil 1111111 llll�49JEW y � IBS Department of the Treasury Interual Revenue Service P.O. Box 2508 In reply refer to : 0248221235 Cincinnati OH 45201 Oct . 30 , 2009 LTR 4076C EO 95-6000772 000000 00 00014241 BODC: TE CITY OF SAN BERNARDINO CITY HALL Yo MICHAEL GOMEZ 300 N D ST SN BERNRDNO CA 92418-0001 )03426 Federal Identification Number: 95-6000772 Person to Contact : April Howard Toll Free Telephone Number: 1-877-829-5500 Dear Taxpayer: This responds to your request for information about your federal tax status. Our records do not specify your federal tax status. However , the following general information about the tax treatment of state and local governments and affiliated organizations may be of interest to you . GOVERNMENTAL. UNITS Governmental units , such as States and their political subdivisions, are not generally subject to federal income tax. Political subdivisions of a State are entities with one or more of the sovereign powers of the State Such as the power to tax. Typically they include counties or municipalities and their agencies or departments . Charitable contributions to governmental units are tax-deductible under section 170 (c) ( 1) of the Internal Revenue Code if made for a public purpose . ENTITIES MEETING THE REQUIREMENTS OF SECTION 115( 1) An entity that is not a governmental unit but that performs an essential government function may not be subject to federal income tax, pursuant to Code section 115(1) . The income of such entities is excluded from the definition of gross income as long as the income (1) is derived from a public utility or the exercise of an essential government function, and (2) accrues to a State , a political subdivision of a State , or the District of Columbia . Contributions made to entities whose income is excluded income under section 115 may not be tax deductible to contributors. TAX-EXEMPT CHARITABLE ORGANIZATIONS An organization affiliated with a State, county, or municipal government may qualify for exemption from federal income tax under section 501 (c) (3) of the Code, if ( 1) it is not an integral part of the government , and (2) it does not have governmental powers inconsistent with exemption (such as the power to tax or to exercise enforcement or regulatory powers) . Note that entities may meet the requirements of both sections 501 (c) (3) and 115 under certain circumstances. See Revenue Procedure 2003--12, 2003-1 C. B . 316 . 0248221235 Oct . 30 , 2009 LTR 4076C EO 95-6000772 000000 00 00014242 CITY OF SAN BERNARDINO CITY HALL MICHAEL GOMEZ 300 N D ST SN BERNRDNO CA 92418-0001 Most entities must file a Form 1023, Application for Recognition of Exemption Under Section 5O1(c) ) (3) of the Internal Revenue Code, to request a determination that the organization is exempt from federal income tax under 501(c) (3) of the Code and that charitable contributions are tax deductible to contributors under section 170(c) (2) . In addition , private foundations and other persons sometimes want assurance that their grants or contributions are made to a governmental unit or a public charity. Generally, grantors and contributors may rely an the status of governmental units based on State or local law. Form 1023 and Publication 4220 , Applying for 501(c) (3) Tax-Exempt Status, are available online at www.irs.gov/eo. We hope this general information will be of assistance to you. This letter , however , does not determine that you have any particular tax status. If you are unsure of your status as a governmental unit or state institution whose income is excluded under section 115(1) you may seek a private letter ruling by following the procedures specified in Revenue Procedure 200.7-1, 2007-1 I .R.B. 1 (updated annually) . If you have any questions, please call us at the telephone number shown in the heading of this letter.. Sincerely yours , Michele M. Sullivan , Oper. Mgr. Accounts Management Operations I Form ■■-9 Request for Taxpayer Give Form to the (Rev.August 2013) requester.Do not CepertmentoftheTreasury identification Number and Certification send to the IRS. Internal Revenue Service Name(as shown on your income tax return) City of San Bernardino City Hall N Business name/disregarded entity name,if different from above � . Check appropriate box for federal tax classification: Exemptions(see instructions). ❑Individual/sole proprietor C Corporation w p pri ❑ p ❑S Corporation ❑ Partnership ❑Trust/estate to p Exempt payee code(if any) 3 u ❑ Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=partnership)► Exemption from FATCA reporting ccode(if any) C p�,5 ❑ Other(see instructions)► u Address(number,street,and apt.or suite no.) Requester's name and address(optional) 300 N."b"Street City,state,and ZIP code tin San Bernardino CA,92418 List account number(s)here(optional) EU7 Mil Taxpayer Identification Number IN Enter your TIN In the appropriate box.The TIN provided must match the name given on the"Name"line I Social security number to avoid backup withholding.For Individuals,this is your social security number However,fora _m _ resident alien,sole proprietor,or disregarded entity,see the Part E instructions on n page 3.For other entities,it Is your employer identification number(EIN).If you do not have a number,sea Now to get a TiN on page 3. Note,If the account is in more than one name,see the chart on page 4 for guidelines on whose I Employer Identification number number to enter. 9 5 _ 6 1 4 0 0 7 7 2 FM MIL Certification Under penalties of perjury,I certify that: 1. The number shown on this form Is my correct taxpayer identification number(or I am waiting for a number to be issued to me),and 2. 1 am not subject to backup withholding because:(a)1 am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all Interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding,and 3. 1 am a U.S.citizen or other U.S.person(defined below),and 4.The FATCA codes)entered on this form(If any)Indicating that I am exempt from FATCA reporting is correct. Certification Instructions.You must cross out Item 2 above.if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report an Interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments other than interest and dividends,you are not required to sign the certification,but you must provide your correct TIN.See the Instructions on page 3. sign signature of ^tip Community Recreation agar Here: U.S.person 0- � J� Date 0-- General,Instructions withholding tax on foreign partners'share of effectively connected Income,and 4.Certify that FATCA code(s)entered on this form(if any)indicating that you are Section references are to the Internal Revenue Code unless otherwise noted. exempt from the FATCA reporting,Is correct. Future developments.The IRS has created a page on IFIS.gov for Information Note.if you are a U.S.person and a requester gives you a form other than Form about Form W-9,at www.1rs.gov 1w9,Information about any future developments W-9 to request your TIN,you must use the requester's form If it is substantially affecting Form W-9(such as legislation enacted after we release it)will be posted similar to this Form W9. on that page. Definition of a U.S.person.For federal tax purposes,you are considered a U.S. Purpose of Form person if you are: A person who is required to file an Information return with the iRS must obtain your, •An Individual who Is a U.S.citizen or U.S.resident alien, correct taxpayer Identification number(TIN)to report,for example,•income paid to •A partnershlp,corporation,company,or association created or organized In the you,payments made to you in settlement of payment card and third party network United States or under the laws of the United States, transactions,real estate transactions,mortgage interest you paid,acquisition or •An estate(other than a foreign estate),or abandonment of secured property,cancellation of debt,or contributions you made .A domestic trust(as defined In Regulations section 301.7701-7). to an IRA. Use Form W-9 only if you are a U.S.person(including a resident alien),to Special rules for partnerships.Partnerships that conduct a trade or business In provide your correct TIN to the person requesting it(the requester)and,when the United States are generally required to pay a withholding tax under section applicable,to: 1446 on any foreign partners'share of effectively connected taxable Income from such business,Further,in certain cases where a Form W-9 has not been received, 1,Certify that the TIN you are giving is correct(or you are walting for a number the rules under section 1446 require a partnership to presume that a partner is a to be issued), foreign person,and pay the section 1446 withholding lax.Therefore,if you are a 2.Certify that you are not subject to backup wtthholding,or U.S.person that is a partner in a partnership conducting a trade or business in the 3.Claim exemption from backup withholding(Cyou are a U.S.exempt payee.# United States,proves Form W-9 to the partnership to establish your U.S,status applicable,you are also certifying that as a U.S.person,your allocable share of and avoid section 1446 with holding on your share of partnership Income. any partnership income from a U.S.trade or business is not subject to the Cat.No.10231X Form W-9(Rev.9-2013) EXHIBIT "B" L LITER 0FAGREEMMNT KAISER FOUNDATION HOSPITALS,FONTANA COMMUNITY BENEFIT CHARITABLE CONTRIBUTIONS PROGRAM This Letter of Agreement(hereinafter"Agreement")is entered into by and between Kaiser Foundation Hospitals,a California nonprofit,public benefit corporation (hereinafter"KFH")and City of San Bernardino,a charter city organized in the State of California and not subject to federal or state income tax. This Agreement sets forth the understanding of the parties hereto as to the terms and conditions under which KFH shall donate funds in the amount of$15,000.00 for a one year funding period beginning July 1,2016 through July 1,2017 for 2016 Open Swim& Learn-To-Swim in Hernandez& Delmann Heights Pools. Such terms and conditions are as follows: I. Tax Exemption Status: Grantee represents that at all times relevant herein,it is a charter city organized in the State of California and not subject to federal or state income tax. 2. Purpose of Grant. Grantee shall use entire Grant to support the specific goals, objectives,activities, and outcomes as stated in the Grant Summary. 3. Expenditure of Funds. This Grant(together with any income earned upon investment of grant funds) is made for the purpose outlined in the Grantee's Work Plan and may not be expended for any other purpose without KFH's prior written approval. 4. Prohibited Uses. In no event shall Grantee use any of the funds from this Grant to (a) support a political campaign,(b)support or attempt to influence any government legislation, except making available the results of non-partisan analysis, study or research,or(c) grant an award to another party or for any purpose other than one specified in Section 170(c)(2)(b)of the Internal Revenue Code of 1986 as amended. 5. Return of Funds. KFH reserves the right to discontinue,modify or withhold payments to be made under this Agreement or to require a total or partial return of any funds, including any unexpended funds under the following conditions: (a) If KFH, in its sole discretion,determines that the Grantee has not performed in accordance with this Agreement or has failed to comply with any term or condition of this Agreement. (b) If Grantee loses its status as an eligible Grantee under Paragraph 1 above. (c) Any portion of the funds is not used for the approved purpose (d) Such action is necessary to comply with the requirements of any law or regulation applicable to Grantee or to KFH or to this Grant. 6. Records,Audits and Site Visits. KFH is authorized to conduct audits,including on-site audits,at any time during the term of this Grant and within four years after completion of the Grant. Grantee shall allow KFH and its representatives,at its request, to have reasonable access during regular business hours to Grantee's files,records, accounts;personnel and client or other beneficiaries for the purpose of making such audits,verifications or program evaluations as KFH deems necessary or appropriate Community Benefit-Letter ofAgreement Kaiser Tracking number for this grant/donation is 20649586 1 of 4 . concerning this Grant. Grantee shall maintain accounting records sufficient to identify the Grant and to whom and for what purpose such funds are expended for at least four(4) years after the Grant has been expended. 7. No Assignment or.Delegation. Grantee may not assign, or otherwise transfer, any rights or delegates any of Grantee's obligations under this Agreement without prior written approval from KFH. 8. Records and Reports. Grantee shall submit written progress report(s)to KFH in accordance with the due dates stated on the Grant Summary(Attachment). Grantee shall be primarily responsible for the content of the evaluation report. If KFH determines IRB approval is necessary, as part of the evaluation process,Grantee shall follow KFH IRB approval processes and procedures. 9. Required Notification. Grantee is required to provide KFH with immediate written notification of any change in Grantee's tax exempt status or when Grantee is unable to expend the grant funds for the approved purposes described in the Work Plan. 10. Identification of KFH. Grantee shall identify KFH as a supporting organization in all published material relating to the subject matter of this Grant. Whenever possible and appropriate, Grantee shall publicly acknowledge KFH for this Grant. 11. Equal Employment Opportunity:Grantee agrees to comply with and be bound by the nondiscrimination and affirmative action clauses contained in: Executive Order 11246,"as amended,relative to equal opportunity for all persons without regard to race, color,religion, sex or national origin; the Vocational Rehabilitation Act of 1973, as amended,relative to the employment of qualified handicapped individuals without discrimination based upon their physical or mental handicaps;the Vietnam Era Veterans Readjustment Assistance Act of 1974,as amended,relative to the employment of disabled veterans and veterans of the Vietnam Era,and the implementing rules and regulations prescribed by the Secretary of Labor in Title 41,Part 60 of the Code of Federal Regulations(CFR). 12. Immigration Act Requirements. Grantee shall comply during the term of this Agreement with the provisions of the Immigration Reform and Control Act of 1986 and any regulations promulgated thereunder. Grantee hereby certifies that it has obtained a properly completed Employment Eligibility Certificate(INS Form 1-9)for each worker performing services related to the program described in the Work Plan. 13. Licensing and Credentials. Grantee agrees to maintain, in full force and effect,all required governmental or professional licenses and credentials for itself, its facilities and for its employees and all other persons engaged in work in conjunction with this Grant. 14. Payment of Grant. First payment by KFH will be contingent upon a signed Agreement between KFH and Grantee. Subsequent payments(if any)are contingent upon compliance with this Agreement,including timely receipt of reports as outlined in Paragraph 8 above. Community Benefit-Letter of Agreement Kaiser Tracking number for this grant/donation is 20649586 2o 4 s IN WITNESS WHEREOF,the parties hereto have executed this Agreement as of the date first above written. Kaiser Found4tion Hospitals Trish Lopez ( ? Date Area Chief Financial OfNi 'er--, Grantee By: Micictyaldivia Date Director of Parks,Recreation and Community Services City of San Bernardino Community Benefit-Letter of Agreement Kaiser Tracking number for this grant/donation is 20649586 3 of 4 LETTER OF AGREEMENT Attachment GRANT SUMMARY GRANT NUMBER: 20649586 DATE AUTHORIZED: June 15,2016 GRANTEE NAME: City of San Bernardino- Parks,Recreation and Community Services AMOUNT: $15,000.00 over 12 months Department CONTACT,TITLE: Mr. Mitch Assumma, Interim Recreation Division Manager TELEPHONE: (909)384-5132 FAX: (909)384-5160 CB PROJECT MANAGER: Martha Valencia,Community Benefit Health Manager Phone: 909 427-5269 Email: martha.r.valencia k .or GRANT PURPOSE: 2016 Open Swim&Learn-To-Swim in Hernandez&Delmann Heights Neighborhood Pools GRANT OBJECTIVES: • To provide open swim to 3,400 visitors; swimming passes to 60 households(240 total individuals); swimming lessons to 120 beginners ages 6-17 years; 5,000 open swim visitations,a Hernandez and Delmann Heights Pool to 3,400. GRANT PERIOD: Start date: 7/1/2016 End Date: 7/1/2017 NARRATIVE AND FINANCIAL REPORTS DUE: Requirement Due Date Final Report August 1,2017 City of San Bernardino-Parks,Recreation and Community Services Department CB Grant Summary Grant#20649586 4of4 Kaiser Foundation Hospitals July 14,2016 Mitch Assumma Interim Recreation Division Manager City of San Bernardino-Parks,Recreation and Community Services Department 201 North E Street, Suite 301 - San Bernardino,CA 92401 Dear Mr. Assumma, It is with great pleasure that we at Kaiser Foundation Hospitals enclose a check to your organization in the amount of$15,000.00.These fung�s;�are for the support of your project,2016 Open Swim&Learn- To-Swim in Hernandez&�`'l�eig�hborhoods. By endorsing, depositing,or cashing this check,you certify that: • There has been no change in your I.R.S. tax classification as an organization described in Internal Revenue Service Code sections 501(c)(3), 501(c)(8),501(c)(10),or 501(c)(19); or the grantee is a local, state,and federal government agency. • The funds will be used as outlined in your grant proposal. • The organization will submit an Acknowledgment of Cash Contribution(see attachment)within five 5)business days of receipt of the check. • The organization will complete an online final grant report. A link will be sent to you at the end of the grant period. For your reference,your tracking number is 20649586. (Please use this number in all correspondence.) Sincerely, Martha Valencia Community Benefit Health Manager Fontana,Kaiser Foundation Hospitals Enclosures: Check 4 9943400 Acknowledgment of Cash Contribution Instructions Acknowledgment of Cash Contribution cc: 9961 Sierra Avenue Fontana, CA 92335 Instructions for Recipient Organizations to Complete 2416 Acknowledgement of Cash Contribution(s) from Kaiser Foundation Hospitals Your organization provides valuable services to the community and we are pleased to support your work. In order for us to comply with the United States Department of the Treasury, Internal Revenue Service's rules regarding contribution documentation,we are requesting a Donation Receipt(enclosed) from your organization for the 2016 cash contribution(s)you received from Kaiser Foundation Hospitals, ("KFH"), listed in the attached document. We have enclosed the Acknowledgement of Cash Contribution. Please follow the instructions below to finalize the process: 1. Review the pre-populated data(items 1-8) in column.2 for accuracy; 2. If you have any changes to column 2,please make the updatcs\corrections in column 3; 3. Complete item 9; ■ If no Goods or Services(tangible benefit) were received by Kaiser Foundation Hospitals for the contribution listed, select `None' in 9a and continue to the signature section. ■ If Goods and Services (tangible benefit)were received by Kaiser Foundation Hospitals for the contribution listed,complete 9a, 9b, and 9c before continuing to the signature section. 4. Sign,date and print or type the name and title of the Chief Executive or Officer from your organization; 5. Scan and email the signed Acknowledgement of Cash Contribution to Kaiser Foundation Hospitals.within S e dy from receipt of the contribution to scal.mc.grants @kp.org. Please�"scal.mc,grants@kp.org if you have questions, or if you would like an electronic version of the receipt. __J Kaiser Foundation Hospitals 2016 Acknowledgement of Cash Contribution from Kaiser Foundation Hospitals Information Requested Records Show Corrections 1)Organ ization's Legal Name: City of San Bernardino 2)Organization's Tax ID: 95-6000772 3)Organization's Tax Exempt Government or Public Agency Status: 4)Fiscal Agents only:The name of the benefiting or " -,H CONL—M, At c N AT 5)Brief description of project: 2016 Open Swim&Learn-To-Swim in 2016 Upen SWIIM&L earn-lo- Swim in Hernandez&Mill Neighborhoods Hernandez & Delmann lei hts Neighbrhds. 6)Check amount: $15,000.00 7)Check number: 9943400 8)Check date: 7/6/2016 GOOUS ANA SER1ii+ E$ 9)Goods or services provided to Kaiser Foundation Hospitals and/or its representatives for the contribution listed above, a)Type(s)of goods or services provided: ❑ Meal ❑Advertisement ❑Event Ticket ❑ Booth ❑Other: b)Quantity of goods or services provided: (for example, 10 dinner seats) c)Fair market value of goods or services provided:(for example, $50 perseat,totaling$500) 10)Signature(Item 9 above must be completed before signing Interim Jim TickerRyer - Director of Parks, Recreation and Community Services Dept Name&Title(type or print) Signature Date INTERNAL USE ONLY -11)Tracking Number 20649686 12)Payment Number: 90077 -13)Medical Center Service area; Fontana Document Rev: 12/1/2014 Instructions: Please return the signed document within five (5) days of check receipt to cad r4 \\cnndeebap003\Giftsdata\Template\09112345L.doe « Check Date:Jul/06/2016 Vendor Number:100011527 0009943400 Invoice Number Invoice Date Voucher ID Gross Amount Discount Taken Paid Amount 90077 Jua/30/2016 33277254 15,000.00 0.00 15,000.00 2016 OPEN SWIM LEARN-TO-SWIM IN HERNANDEZ M11L NEIGHBORHOODS Total Total Total Check Number Date Gross Amount Discounts Paid Amount 0009943400 Jul/0612016 $15,000.00 $0.00 $15,000.00 ..... ;IKP:FJNIAL S?I!c�uOPS ;0 �;�43 a A :.• 75 N Fattf)Aks Avenlii4th FI q tDoe Peztii:'sWay Pasadena 'New C466'DE 19720 Date 2016 07.:06 �iZS�/3f1` t::• - •, . .. Pa y Am ount *k*15,000.00 # ** Pay F.WTEE UMO?(SAND AND X /.100 DOLLAR tit To The CITY OF SAN BERNARDIN.O orderQe 201 NO i7H . ..E .STE SQi ♦ .•��L SANi'J3.eRNAR:C$1N0 :' .A92404i t Authorized Sipat ure Authoriy'ed,StBnature Ivp :. t V0009943400u' 403 L 100 2091: 3878 10.0911' Schedule CITY OF SAN BERNARDINO, CALIFORNIA EXHIBIT rrC'r "H" DEPARTMENT: Parks & Recreation PROSECT#: Fontana Kaiser Permanente Contribution - 2016-17 FY2015-16 BUDGET Account Number Description ESTIMATES MATCH* TOTAL Grant Name: *NO MATCH REQUIRED-GRANTOR REQUESTED Salaries TOTAL COSTS 5011 Salaries perm/fulitime 5013 Automobile allowance 5014 Salaries temp/parttime 15,000 40,239 55,239 5015 Overtime Total:Salaries 15,000 40,239 55,239 Benefits 5026 PERS retirement 3,774 3,774 5027 Health and life Insurance - 5028 Unemployment insurance 5029 Medicare - Total:Benefits 3,774 3,774 Total:Salaries&benefits 15,000 44,013 59,013 Maintenance and Operations 5111 Materlal and supplies - 900 900 5112 Small tools&equip(consumables) - 5114 Raw foods 5122 Dues and subscriptions 5131 Mileage 5132 Meetings and conferences 5133 Education and training 5150 Utilities 5172 Equipment maintenance - 5174 Printing charges 770 770 5175 Postage 5176 Copy machine charges 5181 Other operating expense 5186 Civic and promotional 5193 Grant match - Total:Maintenance and Operations 1,670 1,670 Contract Services 5502 Professional/contractual services - 5505 Other professional services Total:Contractual Services - - - Internal Service Charges 5601 Garage charges 5602 Workers compensation 5603 Liability 5604 IT charges in-house 5605 Telephone support 5606 Electric 5612 Fleet charges-fuel Total:Internal Service Charges - - Capital Outlay 5703 Communications equipment - Total:Capital Outlay - - - Credit/billables 5910 Credit-federal and state program funding - Total:Credit/billables - - - Total:Non-Personnel Expenses - 1,670 1,670 Grant Total 15,000 45,683 60,683 8/4/2016 tP4 IG115ER pfRMANe.NTF, off 1 {k n t („ e::�} al't::inu,!�`�i�3Tk'r`Yef:)f''�iit�rnlr�i�b��°4�t��ci�tj�$'..ps•��H��yGi,�tiv'�o�i' i'��i!}`��. �3�rSga r,tr if f_s(1ar�.'h.�t�{{tt4t i k i•,J, '�)kl;,}t iiA 1Si_t i f 13111-,!kt +t Mn Sa1rP) tit''1 f f i;Y..1 L{ }1t^£)r'✓:Iii 4i'StFr{1R.jT.it i)!t.'+.�it`f }_' :y�h1S-n$::qtr ( �'�:fl ;t r in :' I lYixi t T# ''''♦♦{ S .:I I -u- r. hpt mr{r.Y.s..,,irl�t. tnt t-4?3;4 fir. iak n.. ... rlr•c,`7i"m.. 'itt.t l fiZhr'f`1 r 0..Y.r i. i.f1"n i.niiJiti>i u if i a H r i 4 9;i$S�1�t i:%s.t! t��riifcf),.ti7t)p Fk}1.�2�1 t?i riS:.1c�i i�l.i.i i f i�;'.ii i t)i.)s%t•i f s.it-:x{i..f ii:�r tv Y i l.�,x1i�l�dJ::�f1 t'+1 i�i'j i r.,,f',t rS.i t'u l.i t.LL k i t:t r}I f si.<ri)t 5 i xr'.!.;r.'�hLar� 1 i l t 1{r C,cy+a+�l i�tt'i#'r.(Ix n a=� ir. if,�f: HIM. _. I PER Y?l i f t t n t)�,. I�K1;WG«�t J?. .i •N Organization Name: City of San Bernardino-PRCSD Project Title:&Delmann hts or Mill Pools Open Swim&Lea Date: 2-Aug-16 Request from In-Kind Other TOTAL Kaiser Foundation Contribution Sources BUDGET Hospitals of Income PERSONNELISTAFFING EXPENSES List title and%on project) 1 10%'-Aquatics Recreation Supervisor $ - $ 12,336.00 $ 5,000.00 $ 17,336.00 2 50%-Pool Manager $ 5,318.00 $ 5,318.00 $ 10,636.00 3 50%-Senior Lifeguard $ 4,717.00 $ 4,792,00 $ 9,509.00 4 40%-Lifeguard $ 4,965.00 $ 6,193.00 $ 11,158.00 6 50%-Recreation Leader Cashier $ - $ 6,600.00 $ 6,600.00 $ Subtotal Personnel/Staffing Expenses $ 15 000.00 $ 35,239.00 $ 5,000,00 $ 55,239.00 Benefits( 7:5 %of Personnel) $ - $ 3,773.56 $ 3,773.56 TOTAL,PERSONNEL $ 15,000.00 $ 39,012.58 $ 5,000.00 $ 59,012.55 PROGRAM/OPERATING EXPENSES Office Supplies $ 100.00 $ 100.00 Communications(e.g.,printing,co in -RYD $ 770.00 $ 770.00 First Aid Supplies $ 200.00 $ 200.00 Custodial Supplies $ 400.00 $ 400.00 Swim Class Supplies $ 200.00 $ 200.00 Other: $ - TOTAL,PROGRAM EXPENSES $ $ 1,670.00 $ - $ 1,670.00 INDIRECTIOVERHEAD EXPENSE' ( 10 °/a of Expenses) $ $ - TOTAL EXPENSES Personnel+Program+Indirect $ 15,000.00 $ 40,682.56 $ 5,000.00 $ 60,682.56 NARRATIVE:City pays all utilities cost(water,electric,gas),all pool chemical costs,licenses and fees for commercial pool operation, and equipment maintenance and replacement(circulation system,chemical feed system,filtration,deck&grounds),NOT shown as In-Kind. PERSONNEL:The Staff at the Hernandez and D.H.or MITI Pools(1 Pool Manager,l Senior Lifeguard,l Lifeguard,l Cashier)are budgeted to serve as the lifesaving services for the open swim program and as swim Instructors.Pool staff is hired from a"poor'of qualified employees with varying work experience history.The Aquatics Recreation Supervisor has been employed In like capacity for over 27 years.Two swim sessions are offered Monday.through Saturday from 1:00pm-3:00pm&3:30pm-5:30pm for a 10-week summer season only.Learn-to-swim classes are taught 6:00pm-6:450m on M-Th just after open swim.Five 2-week swim sessions are taught to one/lwo classes of 8-10 students each session.IN-KIND: Operating supplies include toiletries and sanitation supplies(staff also serve as custodians during daily use),routine first aid supplies needs,minor repair items.(chemicat tubing replacement or hardware for signs,etc.),and klckboards as teaching aids-lowl s. SUSTAINABILITY:General Fund(small%user fee cost recovery)and partnering to share costs and gain discounts/rebates,etc.