HomeMy WebLinkAboutSuffolk County Youth Bureau - Juvenile Delinquency Prevention Program Division/Funding Source: 001 IFMS M 21000002839
Name of Contractor: Southold Youth Bureau Department Issued Date: April 7,2021
Contract No.: VCN: VC0027287
Contract Budget/Services Revision Approval Form
Revision No. 1
Contract Period: 2021 Law No.: 2 ( -
Date
( -Date last executed/amended: Budget Period to which this revision applies:
Items that are being changed by this revision:
Budget: Adopting Revising_*
Pseudo Code: New Budget Amount: Amount of Increase/Decrease:
ARH 1 8,157.00 2,039.00
Program:
Deleted- Added:
Other Changes- (identify):
Supporting documentation attached: Resolution_*_ Budget * Program Description_ Other *_
--------------------------------------------------------------------------------------------------------------------------------------------------------
Department Approvals:
Contractor(Town of Southold): Department Head: ;
,,,,,,
By: a By:
Name: 4-Z�tSSe.\ Name:
Title: 5tkgeCj 5CV- Title:
Date: of I r 14-1 Date:
Federal Tax ID No :
County Executive Budget Office:
Co tractor Famil Service League):
B : E&�7.
Name:
Name: u! ,'
Title- �� J
Date: 'Z3 - _ZA
Date g/�3,
Federal Tax ID No.-//"/A?,/ �7
Bar Code No.-
Page 1 of 1
NEW YORK STATE
OFFICE OF CHILDREN AND FAMILY SERVICES
PROGRAM BUDGET
ARH1
AGENcY/MumciPALITY: Town of Southold FUND TYPE
PROGRAMTM: Family Service League
PERSONAL SERVICES:
POSITION TITLE RATE OF BASIS TOTAL OCFS PROGRAM AMOUNT(1) TOTAL OCFS FUNDS REQUESTED
PAY (I3 W,BW,SM) FOR THIS PROGRAM
TOTAL SALARIES AND WAGES
TOTALFRINGE BENEFITS
TOTAL PERSONAL SERVICES
CONTRACTED SERVICES AND STIPENDS
TYPE OF SERVICE OR CONSULTANTTITI. RATE OF BASIS TOTAL OCFS PROGRAM AMOUNT(1)
PAY (H,W,BWAA
Fauuly Service League $800.00 SM $8,157.00
TOTAL CONTRACTED SERVICES 1$8,157.00 Is ";t1
TOTAL MAINTENANCE&OPERATION $
FACILITY REPAIRS
PROGRAM SITE ADDRESS ?t
SMWIM r i
TOTAL FACILITY REPAIRS(4) $
TOTAL OCFS PROGRAM AMOUNT$8,157.00
TOTAL OCFS FUNDS REQUESTED '
LISP OF OTHER FUNDING SOURCES IREEvIBURSABLE TOTAL
rMUNICIPAL FUNDING
OTI�R SOURCES
@r?
a,
ay'. ,
V-",: Ke-rl2f=202U;Law No.o(I1N ms aC;NEAE 210000UMJ9
�Liit )t�Yn/Onanibus Grant YO-1 � Pseudo Code ARHI
, r
Contract
This Contract("the Contract")is between the County of Suffolk("the County"), a municipal
corporation of the State of New York, acting through its duly constituted Department of Youth Bureau) ("the
Department"),located at the H.Lee Dennison Building-3rd Floor, 100 Veterans Memorial Highway,
Hauppauge,New York(Mailing address:P.O. Box 6100,Hauppauge,New York 11788-0099); and
Town of Southold("the Contractor"),a New York Municipal Corporation,having its principle place
of business at 53095 Main Road,Southold,New York 11971 and Family Service League
Ine.(Implementing Agency),a New York Not-For Profit Corporation having its principle place of business at
790 Park Avenue,Huntington,New York 11743.
The Contractor has been designated to receive funds from the County for Juvenile Delinquency
Prevention Program("the Services")as set forth in Article I, entitled"Description of Services."
Term of the Contract: January 1,2021 through December 31,2021;with an option to extend the
Contract,to be exercised at the County's discretion,to June 30,2022 on the same terms and conditions herein.
Total Cost of the Contract: Shall not exceed$6,118.00,to be paid as set forth-in Articles V and VI as set forth
herein,unless revised by a Suffolk County Resolution and in accordance with paragraph Le. of Article V of this
Contract.
Terms and Conditions: Shall be as set forth in Articles I through VI,attached hereto and made a part hereof.
In Fitness Whereof,the parties hereto have executed the Contract as of the latest date written below.
Town of Sout of COUNT OF S
By: By:
Name:
Title: Lisa Black
Chief Deputy County Executive
Fed.Tax ID#: �1—(-600 19 2
Date: $ t t d q-k
Date: Nbd
hereby certifies
under penalties of perjury that I am an officer of Family S xc a e,Inc.
Town of Southold,that I have read and I am familiar with By'
A5-8 of Article V of the Suffolk Cour Code and Name: r s Y1, (IateL
§ t3' � Title: �[�,S(��(1� -k 8`0
that Town of Southold meets all requirements to qualify Fed.Tax IID-#: I 1- 16,.; 31 R-a-7
for exemption there der. Date:
Name �' Date S-1 LL KS CA(-P 0 apCL hd -.It V-� hereby
certifies under penalties of perjury that I am an officer
of Family Service League,Inc. ,that I have read and I
am familiar with§A5-8 of Article V of the Suffolk
County Code,and that_Fgp&Service League,
ADDITIONAL SIGNATURES ON Inc meets 411 requirements to qualify for exemption
FOLLOWING PAGE there
Nam
Date
V OC
' 1 of 26 pages
,.Key, bubl;Ah Lluuuw.Zbjv
¢Line*ItNn/Omnibus Grant YO-1 Pseudo Code ARHI
Approved;
Youth Bureau
By:
Name: Roderick A.Pearson
Title: Executive Director,
Date: 5
Approved as t orm:
Dennis M.Co en
CO
Att ey
By:
Assistant un Att me
D te:
,List of Articles
2 of 26 pages
v "
RECEIVE®
- - AUG
TOWN ATTORNEY'S OFFICE
�QguFFO ��`i��Y�®
co F AUG 1 1 2021
Southold Town Clerk
Office of the Town Attorney
Town of Southold
Town Hall Annex, 54375 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone : 631-765-1939
Facsimile: 631-765-6639
MEMORANDUM
To: Ms. Elizabeth A. Neville, Town Clerk
From: Missy Mirabelli
Secretary to the Town Attorney
Date: August 11, 2021
Subject: Agreement between Town of Southold and Suffolk County
Youth Bureau - Juvenile Delinquency Prevention Program
With respect to the above-referenced matter, I am enclosing the original
Agreement together with the Resolution.
If you have any questions regarding the enclosed, please do not hesitate to call
me. Thank you.
/mm
Enclosures
cc: Accounting