HomeMy WebLinkAbout20142637.tiff RESOLUTION
RE: APPROVE GRANTEE AGENCY PERIODIC CONTRACT AND AUTHORIZE CHAIR TO
SIGN - UNITED WAY OF WELD COUNTY, INC.
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Grantee Agency Periodic Contract
between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Department of Public Health and Environment,
and United Way of Weld County, Inc., commencing July 1, 2014, and ending June 30, 2015, with
further terms and conditions being as stated in said contract, and
WHEREAS, after review, the Board deems it advisable to approve said contract, a copy of
which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Grantee Agency Periodic Contract between the County of Weld, State
of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the
Department of Public Health and Environment, and United Way of Weld County, Inc., be, and
hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said contract.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 25th day of August, A.D., 2014, nunc pro tunc July 1, 2014.
BOARD OF COUNTY COMMISSIONERS
WELD COUNLORADO
ATTEST: C� Si .,../ ; /. 4art
anoWeld County Clerk to the Board 1 S
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William . Garcia
Date of signature: 9'9'1 (/
'( t. S7) 9 Jio 2014-2637
HL0044
1861 Memorandum
TO: Douglas Rademacher, Chair
G O U N?? Board of County Commissioners
FROM: Mark E. Wallace, MD, MPH,
Executive Director
Department of Public Health & Environment
DATE: August 21, 2014
SUBJECT: United Way of Weld County Community
Impact Fund Contract—Prenatal Community
Outreach Program
Enclosed for the Board's review and approval is the FY2014-15 United Way of Weld County
Community Impact Fund continuation contract for our Prenatal Community Outreach Program.
This contract will provide funding for the continuance of a Prenatal Outreach Coordinator to
facilitate community resource referrals and educational opportunities, such as nutrition and
childcare classes, for pregnant Weld County residents. The Coordinator also helps Weld County
prenatal clients apply for Medicaid, if eligible, and assists with prenatal healthcare
appointments and follow-up. Program evaluation includes interviews after each delivery to
assess birth outcomes, contributions of early prenatal healthcare and positive behavior changes
during pregnancy. The Prenatal Outreach Coordinator will be housed at the Weld County
Department of Public Health and Environment, but will also serve areas of southern Weld
County.
The term of this contract is from July 1, 2014, to June 30, 2015. The County will receive $64,910
for this one year funding cycle. This contract is funded by United Way of Weld County through
its Community Impact Fund.
Assistant County Attorney, Brad Yatabe, has reviewed this contract and has determined that
the terms of this contract with United Way are acceptable
This contract was approved for placement on the agenda by the Board via pass-around dated
August 19, 2014.
I recommend approval of this contract with United Way of Weld County.
2014-2637
United g Way J
UNITED WAY OF WELD COUNTY
UNITED WAY OF WELD COUNTY, INC.
GRANTEE AGENCY PERIODIC CONTRACT
A contract between UNITED WAY OF WELD COUNTY, P.O. Box 1944, Greeley,
Colorado 80632, and, Weld County Department of Public Health & Environment 1555 N.
17th Avenue, Greeley, CO, 80631, from July 1, 2014 to June 30, 2015.
WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT AGREES
TO:
1. Be responsible and accountable for the "Grantee Agency Agreement".
2. Familiarize and abide by all policies pertinent to the Agency/United Way of Weld
County relationship, specifically the Grantee Agency Fund-Raising Policy
(Attachment C).
3. Provide support to United Way of Weld County, its philosophy, mission and goals,
and specifically support the campaign, fund distribution process and community
problem solving efforts and process.
4. Work with United Way and other community agencies in meeting human care needs,
preventing duplication of services, and promoting high standards of performance.
5. Respond to all requests for information, reporting forms, applications for federated
campaigns, and budget packets in a timely manner and take responsibility for
meeting all deadlines regarding the same (Attachments B & D).
6. Be accountable for submitting semi-annual reports, outcome table results and client
numbers as approved by United Way of Weld County (Attachment D)
UNITED WAY OF WELD COUNTY AGREES TO:
1. Be subject to the "Grantee Agency Agreement".
2. Recognize the autonomy of the agency and its position in determining the nature and
scope of its programs and services.
3. Support and promote grantee agencies in year round publicity and activities.
4. Support the agency's philosophy, mission and goals.
5. Work with the agency in partnership to advance the United Way of Weld County
priority areas relating to Children, Youth and Families.
6. Provide access for the agency to participate in federated campaigns. Facilitate and
manage the applications to the federated campaigns.
7. Reimburse Weld County Department of Public Health & Environment for the
Prenatal Outreach program $64,910 for the 2014-15 funding cycle. Payment will be
on a cost reimbursement basis for the attached agreed upon client numbers and
outcomes on Attachment A.
8. Reimbursement for services shall be made quarterly. No payments from a funding
cycle will be made on bills submitted after one month following the close of the fiscal
year.
These funds are a function of the collection of the United Way campaign pledges and
accounts receivable, as well as other factors. Therefore, the agency agrees to abide by
the discretionary distribution of United Way funds and acknowledges that if United Way
funds are not available because of reduced receipts, that the agency's allocation may be
adjusted or reduced.
This contract shall be in effect from July 1, 2014 to June 30, 2015.
This is to certify that this contract was considered and reviewed and its execution
authorized by proper action by the agency's board of directors at a meeting held May 8,
2014, to be effective upon approval of the United Way of Weld County.
rr 411
Dated this O66 day of , 2014
Grantee leny Bo rd hairC /CVO/or Authorized Agent AUG 2 5 2014
Executive Director/President/CEO
Approved this 8th of May, 2014
THE UNITED WAY LD COUNTY, INC.
United ay of Weld County Executive Director
Jeannine Truswell
coo.
Unitedtay of We County Board Chairman
Jay Hinrichs
United
Way J
UNITED WAY OF WELDCOUNTY
UNITED WAY OF WELD COUNTY, INC.
GRANTEE AGENCY AGREEMENT
An agreement between the United Way of Weld County hereinafter referred to as UNITED
WAY, and WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT,
hereinafter referred to as the AGENCY.
IT IS MUTUALLY AGREED THAT:
AGENCY elects and agrees to enter into a partnership with UNITED WAY as a Funded
Partner Agency thereof, and to participate and support the United Way annual mission,
goals, values and strategies for the support of community needs with the understanding
that:
1. AGENCY is, and during the term of this Agreement shall be and remain, a charitable
501(c)3 non-profit organization or have other non-profit status such as governmental
entity, faith based organization or educational institution, engaged in charitable
services with contributions thereto deductible for the purposes of Federal and State
Income Taxes. This non-profit status shall be verified in a manner acceptable to
UNITED WAY at the execution of this Agreement, as well as, upon request of
UNITED WAY during the term of this Agreement. Should the AGENCY have a
change in its charitable purpose or no longer have a charitable purpose, AGENCY
shall immediately notify UNITED WAY. Any change in AGENCY'S exempt status
shall be reported immediately to UNITED WAY.
2. AGENCY agrees to operate under all state and federal regulations, as appropriate,
including: registered with the Colorado Secretary State as an AGENCY in good
standing, registered under the Colorado Charitable Solicitation Act, meeting
Sarbanes Oxley requirements, and Patriot Act requirements.
3. AGENCY during the terms of this Agreement shall be and will remain, under the
governance and direction of a soundly constituted volunteer Board of Directors or
Trustees of reasonable size that meets at least four (4) times annually. Attendance
of members shall be sufficiently regular to indicate genuine interest and participation.
The Board shall ensure that established financial and administrative policies and
procedures are adequate to assure efficient and economical operation consistent
with the mission and purpose AGENCY. (It is recommended based on sound
nonprofit governance practices that by-laws require board member term limits and
require rotation off the board for a period of time before re-nomination for a board
position.)
4. AGENCY agrees to operate with a current and sound statement of personnel
practices approved by its governing body. Policies shall be in place regarding
sexual harassment and non-discrimination with regard to race, color, sex, religion.
national origin, age or physical handicap. Policies shall apply to the persons served
by AGENCY, staff members hired, and to volunteer membership and the governing
board.
5. AGENCY shall render a quality health and human service and in such quantity that a
genuine community need is met.
6. AGENCY shall provide services at such times and at such locations as to be
available and accessible to clients. Facilities must be adequately accessible to
clients.
7. AGENCY agrees to maximize the use of volunteers consistent with effective and
efficient management and appropriate for program delivery or be able to explain why
a waiver is necessary.
8. AGENCY shall use generally accepted accounting principles for nonprofit
organizations to ensure strong fiscal management and maintain regular records of
accounts, open to inspection by representatives of UNITED WAY. From time to time,
AGENCY agrees to provide financial information and program reports. If the total
operating budget exceeds $100,000, AGENCY agrees to complete an annual,
independent audit according to generally accepted auditing standards. If AGENCY
falls below the limits for an independent audit, AGENCY will complete an annual
independent Internal Review.
9. If AGENCY operates under religious or political auspices, AGENCY shall clearly
distinguish both in its budget and program services a distinction between its religious
services and those of a charitable, character-building, or recreational nature.
10. AGENCY shall carry all appropriate insurance including liability insurance and fidelity
bond coverage.
11. If AGENCY is accredited by a state or federal licensing review or an accreditation
system, AGENCY agrees to provide proof of current accreditation or licensing upon
request by UNITED WAY. If AGENCY operates under national, state or local
charter, AGENCY agrees to provide services consistent with that charter. If
AGENCY is evaluated by a private accreditation body and/or a national membership
organization, AGENCY agrees to share its evaluation upon request by UNITED
WAY.
12. AGENCY agrees to work with other agencies, groups and organizations, private or
public, to improve the lives of people and to participate in coordination, collaboration,
and communication to avoid duplication and enhance delivery of services.
13. AGENCY shall comply with nonprofit rules and regulations required by the IRS and
the State of Colorado, i.e., operating within the limits of legal documents (Articles of
Incorporation, By-laws; Form 1023, etc.); disclosure requirements; lobbying
restrictions; substantiation of charitable contributions; employment laws and
employment reporting; annual financial reporting requirements; operation of bingo
and raffles; and other requirements. If the AGENCY operates as a 501 (c) (3) an
annual form 990 must be completed.
14. UNITED WAY annually shall conduct a fundraising Campaign for the support of
health and human service programs and for its own support in Weld County,
Colorado. AGENCY agrees to support United Way's annual campaign.
15. Insofar as is practical, UNITED WAY, in its Campaign and other endeavors, shall
promote the identity and accomplishments of AGENCY programs. For such purpose
the AGENCY grants to UNITED WAY the right to use, exhibit, and publicize the
name, logo, and accomplishments of the programs provided by AGENCY.
16. In each funding year, as determined by UNITED WAY, UNITED WAY shall distribute
at its discretion, the proceeds of its annual community fund raising Campaign for
such year. Pledges made to any UNITED WAY, but specifically designated to
AGENCY shall be paid directly to AGENCY according to United Way of Weld County
Designation Policies and Procedures.
17. AGENCY acknowledges that any funding received through UNITED WAY is a
function of the collection of the UNITED WAY annual Campaign pledges and
accounts receivable. Therefore, AGENCY agrees to abide by the discretionary
distribution of UNITED WAY funds and acknowledges that if UNITED WAY funds are
not available because of reduced receipts, that AGENCIES allocation may be
adjusted or reduced.
18. AGENCY and any of its funded programs and activities insofar as is reasonable,
shall give due recognition to UNITED WAY for its financial support and assistance.
The UNITED WAY logo shall appear on publications, and other appropriate
materials. In addition, AGENCY shall give support to each UNITED WAY joint
Campaign, which includes but is not limited to the Colorado Combined Campaign
and Combined Federal Campaign, and for such purpose shall make available to the
Campaign its volunteer and professional leadership. AGENCY agrees to provide all
necessary documentation for the Colorado Combined Campaign and Combined
Federal Campaign as well as provide all annual documentation and reports
requested by UNITED WAY (see Attachments B & D). AGENCY will render such
other assistance as will promote the success of the Campaign.
19. AGENCY agrees to accept any apportionment of funds made to it by UNITED WAY,
upon terms and conditions established by UNITED WAY, for the determined funding
period.
20. AGENCY agrees to abide by any fund-raising policies and guidelines established by
UNITED WAY.
21. AGENCY may terminate this agreement prior to the end of the contract period by
filing with the Executive Director of UNITED WAY written notice of termination not
less than 45 days prior to the end of the contract period as stated in the UNITED
WAY Periodic Contract. Termination of AGENCY shall be subject to an accounting
by AGENCY to UNITED WAY and UNITED WAY'S approval of such accounting.
AGENCY hereby agrees to make available to UNITED WAY whatsoever books,
accounts, and records of any description which UNITED WAY wishes to review.
UNITED WAY funding that had not been expended will be returned to UNITED
WAY.
22. UNITED WAY may terminate this Agreement with AGENCY for any reason including
a breach of this Agreement by giving AGENCY a 45 day written notice of such
proposed termination at the address of AGENCY listed herein.
23. Additional procedures regarding termination may be defined by UNITED WAY from
time to time, and such procedures are herein incorporated by reference into this
Agreement. In the event AGENCY breaches this Agreement, then UNITED WAY
may, without notice at its discretion, cease the allocation of funds to AGENCY until
such time as a hearing may be held to determine whether termination is an
appropriate remedy. Such hearing shall be scheduled by giving AGENCY a 20 day
written notice of the hearing on termination at the address of AGENCY listed herein,
and providing for a hearing before the UNITED WAY Executive Committee, at which
time said AGENCY may be present and/or represented.
24. In the event this Agreement for any reason is canceled by AGENCY, AGENCY, if it
substantially continues its functions for which its current funding award from UNITED
WAY was made, may, at UNITED WAY'S discretion, continue to receive payments
from its allocated balance for the remainder of the funding period. AGENCY may not
announce. publicize, conduct, or participate in any other financial appeal or
Campaign in the area served by UNITED WAY in the contract year in which they
agree to receive funds raised by UNITED WAY.
25. In the event this Agreement is canceled by UNITED WAY, after notice and hearing
as provided by this Agreement, then all payments to AGENCY shall cease, unless
the Executive Committee of UNITED WAY, at the time of cancellation shall order
otherwise. In no event shall payment be made to AGENCY beyond the end of the
current contract period or that time period designated by the Board of Directors of
UNITED WAY.
26. This Agreement shall continue for the term of the contract.
27. AGENCY agrees to execute such documents as UNITED WAY may request to carry
out the intent of this Agreement.
28. The parties agree that all remedies against each other are herein defined, and no
remedies against each other exist beyond those set forth in this Agreement.
29. The parties acknowledge that this Agreement may be supplemented on a periodic
basis by an Agency Periodic Contract which terms are incorporated herein as if set
forth verbatim. The parties further acknowledge that UNITED WAY may from time to
time, at their discretion, submit to AGENCY for execution a revision of this
Partnering Agency Agreement.
30. The AGENCY warrants that it possesses the legal authority to enter into this
Agreement and it has taken all actions required by its procedures, bylaws, and/or
applicable laws to exercise that authority and to lawfully authorize its undersigned
signatory to execute this Agreement and to bind the AGENCY to its terms. The
person executing this Agreement on behalf of the AGENCY warrants that such
persons have sole authorization to execute this Agreement.
Weld County Department of Public Health & Environment
DATED this h day of June , 2012
Grantee Agency Board Chair/CVO/ or Authorized Agent JUN 2 5 2012
William F. Garcia, Chair Pro-Tem, Board of Weld County Commissioners
)cINCNA, k_ Crt0CrCCG,r
Executive Director/President/CE6
UNITED WAY OF WELD COUNTY, INC.
APPRQV,jED this I day of V urrz_. , 2012
I .
United ay of We County
Board C air, Rick enkins
United ay of Weld County
Exec ve Director, Jeannine Truswell
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Attachment B: Sample of Required f
United :,
Annual Documentation due in L!�'
January of 2013 & 2014 y
UNITED WAY OF WELD COUNTY
AFR%
UNITED WAY OF WELD COUNTY
REQUIRED ANNUAL DOCUMENTATION FOR PARTNERING AGENCIES
Name of Agency
These documents are required to be on file at United Way for the Combined Federal Campaign:
Demonstration of Substantial Local Presence(Attachment A): a description of the programs, services,
benefits, etc. provided by the organization in calendar year 2012 and how those programs, services,
etc. affect human health and welfare of target population. Also must include address, phone number
and hours of operation
Copy of the Most Recent IRS Determination Letter(Attachment B):501 (c) 3 - IRS determination letter
and legal name change documentation if applicable. This only needs to be supplied if there was a
change in 2011 or most recent letter is 5 years old or older. Please check here if there have been
no changes and doesn't need to be supplied this year.
Annual Audit OR Internal Control Review (Attachment C):Agencies with a total budget exceeding
$100,000.00 must submit an audit from within the last 18 months (i.e. no earlier than June 30, 2011).
For those with an annual budget less than $100,000.00, an Internal Control Review needs to be
submitted. This form can be requested from the United Way of Weld County.
Copy of Completed, Signed IRS 990 Long Form (Attachment D):covering same fiscal period as the
submitted audit. Forms must be signed by the Executive Director and utilize Generally Accepted
Accounting Principles.
Percentage of Administrative/Fundraising expenses (AFR): Compute percentage to a tenth of a
percentage (i.e. 15.7%) using Form 990. Add the amount in Part IX (Statement of Functional Expenses),
Line 25, Column C (Management and General Expenses) to the amount in Line 25, Column D
(Fundraising Expenses), and divide the sum by Part VIII (Statement of Revenue), Line 12, Column A
(Total Revenue).
25 Word Statement Agency Description (Attachment E): Describe organization's program activities
without using the agency name more than once. Must also provide legal name as registered with the
IRS, include EIN regardless of whether or not they are operating under a "doing business as." Include
website, address, telephone number, legal name, EIN, fundraising/administrative rate, and the
Taxonomy Code. These items will NOT count towards the 25 words.
Y:AResource Invesunent\Agencies\Grantee Agencies\Grantee Agency Files_?0I?-2014\Awards\Attachment
B_2_1)12_CFC-CCC.docx
Example: 0000 Name of Organization (legal name of organization, if applicable) (202) 555-1234
www.opm.gov/cfc EINkt 123456789 The description will contain no more than 25 words. It
should be worded so the donor understands the program services provided. 4.2% B,V,O
These documents are required to be on file at United Way for Colorado Combined Campaign:
***NOTE: If a document is required for both CFC and CCC or United Way, only one copy of the document is
required to be submitted to United Way of Weld County***
Copy of the Most Recent IRS Determination Letter 501 (c) 3 - IRS determination letter and legal name
change documentation if applicable. This only needs to be supplied if there was a change in 2011 or
most recent letter is 5 years old or older. Please check here if there have been no changes and
doesn't need to be supplied this year.
Copy of Completed, Signed IRS 990 Long Form: Should cover same fiscal period as the submitted
audit. Forms must be signed by the Executive Director and utilize Generally Accepted Accounting
Principles.
Current Colorado Secretary of State Certificate of Good Standing: May be obtained at
www.sos.state.co.us
Proof of Registration with the Colorado Secretary of State in accordance with the Solicitation of
Charitable Contributions Act. This needs to be completed annually to receive Renewal ID Number,
which can be obtained at www.sos.state.co.us
2011 Year-End Financials: Including Balance Sheet (Statement of Financial Position), Income and
Expense Statement, and Annual Budget
25 Word Statement Agency Description Description(Attachment E): Describe organization's program
activities without using the agency name more than once. Must also provide legal name as registered
with the IRS, include EIN regardless of whether or not they are operating under a "doing business as."
Include website, address, telephone number, legal name, EIN, fundraising/administrative rate, and the
Taxonomy Code. These items will NOT count towards the 25 words.
Example: 0000 Name of Organization (legal name of organization, if applicable) (202) 555-1234
www.opm.gov/cfc EINtt 123456789 The description will contain no more than 25 words. It
should be worded so the donor understands the program services provided. 4.2% B,V,O
Annual Report on 2012 Activities.
If the following items are not included in the published Annual Report, they require supplemental
attachments specific to the required information:
Overall Goals and Objectives of Agency and Organization's Activities
Names, Address, and Title of Chief Administrative Personnel
Contribution Disclosure: Listing of all sources, types/methods of solicitations and use of
contribution dollars (list of grants, corporations and individuals and what programs money was
used on)
Y:AResource Invc,tmentAAgenciesAGrantee AgenciesAGrantee Agency Files_2012-2014\AwardsAAttachment
B_2012_CFC-CCC.doc.x
Board of Directors Roster: Include names, addresses,title, length of term (include beginning&
ending dates) and committee assignments
Board Meetings- must include; attendance, location,date, and time of EACH meeting held in
2012.
Percentage of Administrative/Fundraising expenses (AFR): Compute percentage to a tenth of
a percentage (i.e. 15.7%) using Form 990. Add the amount in Part IX (Statement of Functional
Expenses), Line 25, Column C (Management and General Expenses) to the amount in Line 25,
Column D (Fundraising Expenses), and divide the sum by Part VIII (Statement of Revenue), Line
12, Column A(Total Revenue).
Non-Discrimination Policy: Must be applicable to: persons served, staff, Board of Directors and any
volunteers in regard to race, color, religion, national origin, sexual orientation, handicap, age, and
gender. This only needs to be supplied if there was a change in 2012. Please check here if this
does not need to be supplied this year.
These documents are required to be on file for Grantee Agencies of United Way of Weld County:
***NOTE:If a document is required for both CFC and CCC or United Way, only one cony of the document is
required to be submitted to United Way of Weld County***
Proof of Current Fidelity Bond
liability Insurance
Current Agency Brochure
Fact Sheet: Include mission, purpose of agency and detailed description of programs receiving United
Way of Weld County funding. How agency programs and services affect the health and welfare of the
target group. If updated since previous year, please provide new one. Please check here if this
does not need to be supplied this year.
Articles of Incorporation or Bylaw Changes:To include any changes made to previously submitted
Articles of Incorporation or bylaws, such as policies regarding rotation or term limits for Board
members. This only needs to be supplied if there were changes made in 2012. Please check here
if this does not need to be supplied this year.
2012 Beneficiary Report: Detailed breakdown of numbers of clients served by region within Weld
County, age, gender, and ethnic origin (Form available from United Way of Weld County)
2012 Anti-Terrorism Compliance Measures: (Form available from United Way of Weld County)
Projected Changes for 2013: (Form available from United Way of Weld County)
Y:\Resource Investment\Agencies\Grantee Agencies\Grantee Agency Files_2012-2014\Awards\Attachment
B__20 l2_CFC-CCC.docx
rst
Outside Events Policy: Current board policy regarding events conducted by any outside group, which
benefits the agency. This only needs to be supplied if there were changes made in 2012. Please check
here if this does not need to be supplied this year.
50-100 Word Description of Programs Funded by United Way for Internal Campaign Website
FOR AGENCIES APPLYING FOR CCC/CFC THROUGH ANOTHER UMBRELLA AGENCY:
These documents will still need to be submitted to United Way of Weld County as well:
Copy of the Most Recent IRS Determination Letter(Attachment B): 501 (c) 3 - IRS determination letter
and legal name change documentation if applicable. This only needs to be supplied if there was a
change in 2012 or most recent letter is 5 years old or older. Please check here if there have been
no changes and doesn't need to be supplied this year.
Copy of Completed, Signed IRS 990 Long Form (Attachment D): covering same fiscal period as the
submitted audit. Forms must be signed by the Executive Director and utilize Generally Accepted
Accounting Principles.
Percentage of Administrative/Fundraising expenses (AFR): Compute percentage to a tenth of a
percentage (i.e. 15.7%) using Form 990. Add the amount in Part IX (Statement of Functional Expenses),
Line 25, Column C (Management and General Expenses) to the amount in Line 25, Column D
(Fundraising Expenses), and divide the sum by Part VIII (Statement of Revenue), Line 12, Column A
(Total Revenue).
Annual Audit OR Internal Control Review:Agencies with a total budget exceeding$100,000.00 must
submit an audit from within the last 18 months (i.e. no earlier than June 30, 2011). For those with an
annual budget less than $100,000.00, an Internal Control Review needs to be submitted. This form can
be requested from the United Way of Weld County.
2012 Year-End Financials: Including Statement of Financial Position (balance sheet), Income and
Expense Statement, and Annual Budget
Current Colorado Secretary of State Certificate of Good Standing: May be obtained at
www.sos.state.co.us
Proof of Registration with the Colorado Secretary of State in accordance with the Solicitation of
Charitable Contributions Act. This needs to be completed annually to receive Renewal ID Number,
which can be obtained at www.sos.state.co.us
Annual Report on 2012 Activities.
If the following items are not included in the published Annual Report, they require supplemental
attachments specific to the required information:
Overall Goals and Objectives of Agency and Organization's Activities
Names, Address, and Title of Chief Administrative Personnel
Y:AResource Investment\Agencies\Grantee Agencies\Grantee Agency Files_2012-2014Wwards\Attachment
B_?012_CFC-CCC.doex
Contribution Disclosure: Listing of all sources, types/methods of solicitations and use of
contribution dollars (list of grants, corporations and individuals and what programs money was
used on)
Board of Directors Roster: Include names, addresses, title, length of term (include beginning&
ending dates) and committee assignments
Board Meetings- must include; attendance, location, date, and time of EACH meeting held in
2012.
Percentage of Administrative/Fundraising expenses (AFR): Compute percentage to a tenth of
a percentage (i.e. 15.7%) using Form 990. Add the amount in Part IX (Statement of Functional
Expenses), Line 25, Column C (Management and General Expenses) to the amount in Line 25,
Column D (Fundraising Expenses), and divide the sum by Part VIII (Statement of Revenue), Line
12, Column A (Total Revenue).
Non-Discrimination Policy: Must be applicable to: persons served, staff, Board of Directors and any
volunteers in regard to race, color, religion, national origin, sexual orientation, handicap, age, and
gender. This only needs to be supplied if there were changes made in 2012. Please check here if
this does not need to be supplied this year.
Any questions regarding CFC, CCC,or UWWC Required Documents can be directed through the Resource
Investment Department at United Way of Weld County by calling either
Dawn Pace at 304-6163 or Susan Van Deren 304-6183
or emailing dawnPunitedway-weld.org or susanv@unitedwav-weld.org
Y:\Resource Investment\Agencies\Grantee Agencies\Grantee Agency Files_2012-20141Awards\Attachment
B_20I 2_CFC-CCC.docx
ATTACHMENT C
United
Way
UNITED WAY OF WELD COUNTY
GRANTEE AGENCY UNITED WAY OF WELD COUNTY
FUNDRAISING POLICY
Introduction
The intent of the fundraising policy is to maximize resources raised in the annual United
Way of Weld County community-wide Campaign and to support agencies and programs
in their ability to generate funds beyond those provided by United Way of Weld County.
Agencies and programs who receive grant funding awards from United Way of Weld
County agree to the following requirements and guidelines.
General Requirements
1. All fundraising activities and events conducted shall be in harmony with the
principles of the agency and United Way of Weld County. Activities and events shall
reflect positively on both entities.
2. A listing of all annual fundraising activities shall be submitted as part of the annual
documentation process. Activity updates shall be submitted throughout the year for
communication purposes. This enables United Way of Weld County to put together
a calendar for agencies and answer questions from the community regarding
fundraising activities.
3. Agencies and programs will abide by all legal requirements for their fundraising
event activities including state raffle requirements, proper insurance coverage, and
verification of tax deductible amounts for donors or materials.
4. The agency Board of Directors shall adopt a policy and develop procedures
regarding events conducted by other groups for their agency. If an agency engages
in or contracts for fundraising services, the agency should be the primary financial
benefactor. A current copy of this policy shall be kept on file at United Way. Policy
changes or updates are part of the annual documentation process.
5. United Way of Weld County should be recognized alongside other funders on
materials such as an annual report. The United Way of Weld County logo will be
provided for use in such materials.
6. If clarification is needed regarding appropriate fundraising activities, the United Way
of Weld County Executive Director and Executive Committee are available for
assistance and review.
iJ 'n
7. Solicitation of donor designations by a partnering agency staff, volunteers,
constituents or the community-at-large is not allowed at any time. Designations
regarded by the United Way Board of Directors as a result of such solicitations will
not be accepted.
8. Establishing or participating in employee workplace campaigns, including payroll
deductions, through any entity other than United Way organizations is not
permitted.
9. Membership solicitation from employee groups is not permitted. An agency shall not
build membership and direct mail solicitation contribution lists from individuals
designating the agency through the United Way of Weld County, state (CCC) and
federal (CFC) campaigns. Agencies in the CCC and CFC campaigns sign contracts
in this regard.
Capital Fund Drives
United Way of Weld County provides operating funds needed to support partnering
agencies and does not typically provide capital funds. United Way of Weld County asks
to be informed, in writing, regarding all partnering agency capital campaigns prior to
initiation of such campaigns. This enables United Way to answer questions from the
public and advocate for the grantee agency or program.
Sanctions
Violation of the written waiver policy shall result in the agency being subject to
appropriate action up to and including disaffiliation with United Way of Weld County.
Our organization has read and understands the above supplemental fundraising policy.
Weld County, Colorado
Agency Name
,w l
Executive Director/President/CEO Grantee Agency Board Chair/CVO/or
Authorized Agent
William F. Garcia, Chair Pro-Tem
Board of Weld County Commissioners
G ) ' .5 / k JUN 252012
Date Date
ATTACHMENT D
GRANTEE AGENCY DEADLINES
United Way of Weld County's role in community accountability,resource development,
fund distribution, community problem solving and advocacy for health and human
services requires that we gather information and data from grantee agencies and affiliated
agencies. In many cases United Way is qualifying agencies to be listed in company and
organization materials that provide opportunities for resource development.
As United Way of Weld County works for a high level of effectiveness and efficiency in
financial and program management, the following policies regarding deadlines help
assure smooth operation and access to resources.
Submission of Requests for Funding from Grantee Agencies
Grantee agencies responding to United Way of Weld County request for funding must be
received on the set date and time as noted on the"Request for Funding" announcement.
Late submissions will not be accepted.
Submission of Reports from Grantee Agencies
Grantee agencies who do not turn in complete semi-annual reports, annual
documentation, semi-annual or any other requested reporting documents by established
deadlines will have their grantee check(s)withheld until the report(s) are received. A
reduction of grantee award of$100.00 a day will be assessed on grantee agencies for late
submission of reports. In the event of extenuating circumstances causing the grantee
agency to miss a set deadline,an extension and waiver may be granted. Communication
must be made to the United Way Resource Investment Director requesting the extension
and approval requested by the United Way Executive Director for an alternative deadline
and waiver of late costs. If reports are habitually late or late beyond 30 days,grant award
payments may be permanently withheld.
Application for Combined Federal Campaigns (CFC),the Colorado Combined
Campaign(CCC) and National Company Campaigns
United Way of Weld County receives a significant amount of funding from the
CCC/CFC campaigns and nationally based companies. These campaigns benefit most
grantee agencies with designated funds and all with undesignated funds. A set number of
agencies are required to participate in CFC/CCC and some company campaigns. It is
important that grantee agencies complete and submit the applications and requests for
supporting materials to United Way of Weld County by the set deadline dates.
Grantee agencies who do not return the applications jeopardize the entire United Way
campaign; therefore,penalties may include a reduced grant award equal to the lost
amount or no award payments from United Way of Weld County.
Adopted: July 18, 1996
Y^,Resource Investment\Agencies\Grantee Agencies\Grantee Agency Files_2012-2014\Awards'Grantee
Agency Reporting Requirements_Attachment D.doc
UNITED WAY OF WELD COUNTY
2012-2014 FUNDING CYCLE
EXPECTATIONS FOR PROJECTS RECEIVING FUNDING
United Way of Weld County agrees to:
• Provide funding for projects selected through the RFP during the 2012-2014 funding years,
contingent on available funds through the United Way of Weld County Community Wide Fund.
• Communicate and collaborate with funded projects on such topics as other community
resources, opportunities for collaboration, technical assistance and training opportunities, etc.
as deemed appropriate.
• Communicate relationship between funded agencies and United Way of Weld County and the
endorsement of the organization and program(s).
Funded Organization agrees to:
• Provide services as outlined in its application for funding, including activities, outcomes and
budget, unless otherwise agreed upon.
• Meet all deadlines and adhere to all policies as specified in the Contract.
61_ Recognize United Way of Weld County support at annual and/or public events. Recognition
also includes displaying the United Way of Weld County logo in published materials such as
letterheads, annual reports, brochures, web sites, etc.
• Conduct a United Way of Weld County campaign within the funded programs workplace.
• Cooperate with United Way of Weld County in requests for site visits, campaign speakers,
fiscal and service information related to the use of funds allocated to organization by United
Way of Weld County, and to the maintenance of the organization's not-for-profit, tax-exempt
status.
• Provide financial service information as prescribed by United Way of Weld County including,
but not limited to, the follow requirements:
1) Signed Contract Due June 4, 2012
2) Change in Executive Director or Project Notification in writing within 15 days of
Director hire or taking office
3) Changes to project design, target Written approval from the Resource
population, collaboration partners or Investment Department
project budget/re-allocations of project
funds
4) Mergers/Consolidations/Bylaw changes Information given in writing 30 days before
document is finalized
5) Board of Directors List and Meeting Notification in writing of Board Chair
Schedule changes within 30 days
6) Progress and Evaluation Reports Due Quarterly
United Way of Weld County - 18 - 10/03/11
Request for Proposal
2012-2014 Funding Cycle
,.,Measurement Plan Requirement: If you are awarded funding, you will be required to work
rith United Way of Weld County's Resource Investment team to develop a complete Measurement
-Plan to monitor and evaluate program outcomes.
Progress Report and Evaluation Requirement: You will be required to collect data and report
quarterly on the actual performance of your project as outlined in your Measurement Plan.
Fundraising Policy: The organization will be required to review and adhere to the United Way of
Weld County Fundraising Policy.
Annual Documentation: Organizations who receive funding will be required to submit the
attachments listed on the Required Attachments section of this proposal (pages 21-23) on an
annual basis in order to qualify for the Colorado Combined Campaign and the Colorado Federal
Campaign guidelines.
United Way of Weld County - 19 - 10/03/11
Request for Proposal
2012-2014 Funding Cycle
EXPECTATIONS
OTE: This is NOT the Funding Agreement. Signing this document page acknowledges that
you have carefully reviewed the Expectations for Projects Receiving Funding (pages 24-25 of this
document);
I, the undersigned, certify that I have reviewed the Requirements of the Funding
Agreement; the entire RFP and the forms and reference documents outlined in the
RFP; and that the information provided to United Way of Weld County in this
application for funding is true and accurate to the best of my knowledge, and is
submitted in good faith.
Weld County Department of Public Health and Environment
Organization Name
1 ' On, 'Z V G-C- i t l l 5 III
Executive Director Signature Date
[<1 k? IC- • U. Iq LA—k C xt e• D i` .
r^'.`Trinted/Typed Name Title
To be obtained after grant awarded
Board Chair Signature Date
Printed/Typed Name Title
United Way of Weld County - 20 - 10/03/11
Request for Proposal
2012-2014 Funding Cycle
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