Okaloosa County BOCC — March 15, 2016 — LETF Request — reading text

donation in one of the following categories®: Platinum $2,500.00 Gold $1,500.00 Silver $1,000.00 Bronze $500.00 *All contributions at gold level or higher receive free advertising in the Youth Services Directory. Please contact Willie Farrow at 850-865-6029 (or email to: success2@cox.net) by COB March 18, 2016 to confirm your level of support. If you prefer, you can forward your contribution by mail to the following address: Kappa Alpha Psi Fraternity Fort Walton Beach Alumni P.O. Box 4913 Ft Walton Beach, FL 32549-4913 Please make checks payable to: Kappa Alpha Psi-FWB Alumni Thank you in advance for your consideration and financial support of this event. Together, we can make a difference in the lives of our youth. Sincerely, DeAllen Hobbs Willie Farrow Polemarch YSD 2016 Chairman Post Office Box 4931 Fort Walton Beach Florida 32548 OKALOOSA COUNTY LAW ENFORCEMENT TRUST FUND (“LETF”) APPLICATION FROM A NON-COUNTY AGENCY/ORGANIZATION APPLICANT INFORMATION Name of Agency: Emerald Coast Crime Stoppers Name of Program to be funded by LETF: Emerald Coast Crime Stoppers Name/ Title of Contact: | Nicole Wagner Address: PO Box 2335 Phone: 850-259-0035 City * Zip Code: FWB, Florida 32549 Fax: 850-609-3048 Total Program Budget: | $131,944.13 E-mail: uwsgnengisheritt: okaloosa.org Program is: New [ ] Renewal EJ gmount . $1,000.00 equested: : If renewal, circle number of years this program has been funded thru LETF? 13 4 or more LETF CATEGORY (Place an “X” to the left of one program area for which you intend to apply): L0 ] 1. Crime Prevention 2. Drug Abuse Prevention/Education 3. Safe Neighborhood 4. School Resource Officer 5. Other Law Enforcement Purpose (specify below): Tool for all law enforcement agencies in which citizens can report criminal activity anonymously to help solve and prevent crimes PROPOSED PROGRAM INFORMATION 1. Program Summary and Purpose: Provide an overview of program services, including target population and how many will be served while completing the following statement. Emerald Coast Crime Stoppers, Inc. is a non-profit organization that removes criminals from the street and solves crimes in Okaloosa County by engaging the community, uniting media, law enforcement and citizens. Anonymous cash rewards are provided to tipsters who provide valuable information to law enforcement. 2. Proposed use of LETF proceeds: Please identify the proposed use(s) of LETF proceeds and specify how it fulfills the statutorily authorized uses set forth in Section 932.7055, Florida Statutes. All supporting documentation necessary to establish such shall be attached to this Application. Proposed funds will aid in the expenditures for a crawfish boil fund raiser to be held April 23, 2016 in Okaloosa County. 3. Has your agency received funding from LETF within the last three (3) years? (If yes, state when such funding was received and the dollar amount). Yes, student crime stoppers drawstring backpacks were purchased to be distributed in middle and high schools in an effort to create awareness of the program to help keep Okaloosa County schools safe. 4. Have you applied for funding for this program from any other entity or agency? (If yes, identify the source from which the funding was sought, the dollar amount requested from the source and provide the outcome of that application). 5. Will the LETF proceeds be utilized year round or for a one-time expenditure? (If year-round, state the anticipated last date of expenditure). One-Time Expense per year. Upon completing this application in its entirety, please read the following statement and affix your signature accordingly. I have read, fully understand and agree to be bound by Okaloosa County’s Operating Procedures for Law Enforcement Trust Fund (“LETF Policy”) and applicable state statutes. I have completed this application fully and accurately and have not misrepresented any information contained herein. I certify that the requested funds will be used for the purposes set forth in this application and in conformity with Florida law. I acknowledge that our agency/organization may be subject to an audit by the County for a period of three (3) years after receipt of the LETF funds. I agree to submit proper supporting documentation, which establishes that LETF proceeds were expended for the purposes they were approved and in conformity with Florida law. I further agree that should I fail to provide such documentation, I will be responsible for reimbursing Okaloosa County for the amounts received. 2 Norlo %/////r-——~ 3/7/201¢ Signature of Applicant / Date of Application P Nicole Ma&fl//‘ Print Name of Applicant OFFICIAL USE ONLY I, Larry R. Ashley, do hereby certify that the aforementioned request for LETF proceeds is in compliance with Section 932.7055, Florida Statutes. — % Sheriff Larey'R. Ashley fl Board of County Commissioners: Approved/Disapproved Date: ég 7/ #Me Amount approved: $ flOO AFFIDAVIT OF [insert name and title] STATE OF FLORIDA COUNTY OF OKALOOSA BEFORE ME, the undersigned authority, personally appeared Paula Nicole Wagner who being first duly sworn, deposes and says: 1. My name is Paula Nicole Wagner. I currently serve as the Coordinator for Emerald Coast Crime Stoppers. I have personal knowledge of the matters contained within this affidavit. 2. On , the Okaloosa County Board of County Commissioners (the “Board”) approved our entity or organization’s Law Enforcement Trust Fund (“LETF”) Application, which is attached hereto as Exhibit “A.” 3. Emerald Coast Crime Stoppers agrees to utilize the LETF funds in accordance with Okaloosa County’s Operating Procedures for Law Enforcement Trust Fund and applicable state statutes. Specifically, the LETF funds will be expended for the following purposes: a. b. FURTHER AFFIANT SAYETH NOT. A [insert name of affiant] Sworn to and subscribed before me this 7 day of I Chl ,201L. Printed Name: 100\)e( _N\\\_‘\;fl'ju{) Notary Public, State of Florida My Commission Expires: Commission No: L Affiant personally known or produced Identification Type of identification Produced: i, AMBER MILONAS = Commission # FF 925851 & Expires October 8, 2019 Bonded Thru Tray Fain Insurance 800-385-7019