HomeMy WebLinkAboutItem 8.1 Budget Study Attach 7 f
Pacific Chamber Symphony Funding Request Review Checklist
PAR'I:,~III~PLlCA TION SUB:IIII"lIllilllll'l.
A. Application
1. Date application received*... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .
(Completed applications are due by 5:00 p.m. on February 5, 2007)
2. Two copies of the completed application form are submitted.......
B. Organization Information
1. Name of the organization...... ... ... ...... ...... ... ... ................ ....... I
2. Is the applicant a nonprofit organization?...................................... I
3. Does the organization has a 501 (c)3 State of California ID#?....... I
4. Does the organization have a current City Business License?...... I
C. Funding Request
1. Funding amount requested... ...... ......... ... ....... ...... ......... ... .....
2. Funding Source (i.e. General Fund, CDBG Fund)... ...... ............
D. Project Information
1. Proposed project name.... .. .. .. .. . . . . . .. ... . .. .. . .. . .. .. . .. .. ... ... .. . ... ...
2. Project start date... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
3. Project complete date... ... ............... ...... ...... ............... .........
4. Total # of organization clients...... .. . . .. .. . . .. .. . .. . .. . .. . ... .. . ... ... .. . ..
5. # of Dublin businesses / residents will serve... ... ... ...... ...... .......
E. Attachments
1. Name and home address of governing board of the organization..
2. List of current board officers of the organization... .. .. . ... .. .. .. .. . .. ..
3. Current total organization operating budget, including revenue....
4. Most recent audit or tax return is submitted...... ... ...... ...............
5. Document providing evidence of board/organization approval of
application and date of approval...........................................
6. Organization's certificate of insurance showing coverage of
liability and worker's compensation.... ... .......... ... ........... .... ....
7. Signed affidavit form from each collaborating agency identified
for the proposed project (if applicable).............................. .....
8. Application verification declaration signature page............... .....
1/25/2007
Yes
Pacific Chamber Symphony
Yes
94-3105631
10045
$7,000
General Fund
"Music Is Fun" Assembly Program For Dublin
Elementary Schools
1/1/2008
5/30/2008
2,100
2,100
Yes
Yes
Yes
Yes
Yes, 01/22/07
Yes
N/A
POST
Yes
1. Is the application complete?* (Y/N).................................................
If no, which sections are incomplete?.............................................
2. Did the applicant organization complete a mandatory
presentation at City Council Public Hearing?* (Y /N)..................
3. Date notification letter of Council Approval of funding &
mandatory financial reporting packet sent...............................
4. Date summary report is submitted to City*..................... ...... ....
(Report must submit to City by the end of August 2008. Failure to submit a report will result ineligibility for future funding)
~:Faill1re to subl]1it a complete~p of the
requirements.~i"t~move atl~p
Yes
X
No
II
II
Attachment
f
H:\Budget\COMMGRPS\Pacific Chamber Symphony Funding Request Checklist.:flslte Printed: 2/23/2007 2:05 PM
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CITY OF DUBLIN
Fiscal Year 2007-2008
erry iVi.l~i~Al1t;I'i Q U'''rIGE
COMMUNITY GROUP/ORGANIZATION
ApPLICATION FOR FUNDS
COVER PAGE
AGENCY NAME: PACIFIC CHAMBER SYMPHONY
PROPOSED PROJECT/PROGRAM NAME:
"MUSIC IS FUN" ASSEMBLY PROGRAM FOR DUBLIN
ELEMENTARY SCHOOLS
FUNDING AMOUNT REQUESTED: $7,000
SECTION 2
Page 2 of20
CITY OF DUBLIN
Fiscal Year 2007-2008
ApPLICATION FOR FUNDS
1. Please select one expense category: 0 Capital X Operating
2. Applicant Information:
Organization/Agency Name Pacific Chamber Symphony
Mailing Address
Street Address 1155 East 14th Street, Suite 215
City San Leandro
State CA
Zip 94577
925-484-9873 Lawrence@PacificChamberSvmphony.org
Work Phone Email
...s 10 Z 7 .9 8~~Y Ne'"Z.S<J ,0 ft( O~fft.;..-1l...~/!..t::! .0/1-'-' N...~r
Work Phone Email
Please list the Primary Project Contact Person who would be able to answer questions about this application and
project/program during the funding period.
Lawrence Kohl Music Director/CEO
Contact Person for ProjectJProgram Job Title
925-484-9873 Lawrence@PacificChamberSvmphony.org 510-352-3947
Work Phone Email Fax
Nonprofit Identification No. (required) 94-3105631
City of Dublin Business License No. (required)
l't:~~~.t
SECTION 2
Page 3 of 20
City of Dublin
Fiscal Year 2007-2008
Application for Funds
3. Proposed Project/Program Information (Do not describe Organization.)
Amount of Funds Requested $ 7,000
(Maximum $25,000 per project.)
Proposed ProjectlProgram Name "MUSIC IS FUN" ASSEMBLY PROGRAM FOR DUBLIN
Proposed ProjectlProgram Date(s): Start 1 /1 /08 and End 5/30/08
mo. day yr.
mo. day yr.
a.
How would the requested funds be used?
· Describe, in detail, the PROPOSED PROJECTIPROGRAM (not the Agency).
· Bulleted text is acceptable.
· Identify if the proposed project/program is a new service, or extension of an
existing one.
An additional page may be added, if needed.
.
Pacific Chamber Symphony
Overview of Educational Program for Elementary Grades
Music in school: facilitating a child's capacity for discovery and
mental growth.
~ Quintet performance and teacher packet: basic musica~ concepts
and how each instrument makes it's unique sounds
This program goes beyond a simple exploration of what different
instruments look like and the instrumental families they belong
to, to an in-depth presentation through accessible classical
music, demonstration on how each instrument really achieves it's
unique acoustical profile and the exploration of a basic musical
concept. Thus over a period of several years the student will
lean about what musically makes rhythm, melody, harmony, scales,
character of music, texture, etc. This ensemble consists of the
five orchestral and band instruments children are most likely to
choose: violin, cello, trumpet, clarinet and flute. In various
combinations they produce a compelling blend of the individual
voices. The members of the ensemble have literally done thousands
of concerts for kids and have led assembly organizers in our
feedback reviews to give rave accolades. This assembly is
SECTION 2
Page 4 of 20
supported by a comprehensive educational package that covers
music teaching theory, developmental milestones in children's
relationship to music, class projects and activities. It also
contains the opportunity for each student to create artwork or
write a letter describing the concert. This is a proven method
reinforcing the meaning and joy of the musical experience.
SECTION 2
Page 5 of 20
City of Dublin
Fiscal Year 2007-2008
Application for Funds
b. How would the PROPOSED PROJECTIPROGRAM address an unmet community
need and improve the quality of life for Dublin residents. Why is this project/program
needed? (Additional page may be added, if needed):
Music in school: facilitating a child's capacity for discovery and
men tal growth.
1. Music helps the child:
. It engages the whole child and stimulates integration of left and
right brain; process and goal driven learning.
. It facilitates sensory learning and offers opportunities to link
learning styles.
· It honors individuality and expression.
. It establishes a space for reflection in life, in school and in
the community.
2. Our program helps the music programs:
Best practices:
Most theorists agree that music is best learned through recurring
sensory experiences that provide both variety and repetition. Next,
concepts that categorize elements in music and help students develop
awareness ("Ear Training") are introduced. This teaches students to
identify musical concepts as they listen. Also, students should be
encouraged to develop individual musical opinions and preferences, as a
first step to establishing a relationship to music.
3. Curriculum:
The following package is designed with respect to the teleological
considerations outlined above. Each year the curriculum takes on a
specific musical concept with a corresponding musical ensemble. As
children learn about the basic concepts of music (rhythm, melody,
acoustics and timbre, harmony, form, style, etc.) throughout the
elementary grades awareness, understanding and discerning appreciation are
developed.
SECTION 2
Page 6 of 20
c. What documentation/data/records support the need for this PROPOSED
PROJECTIPROGRAM? Please identify your data sources. (Additional page may be
added, if needed.)
Our program has been endorsed by the School Board and by the Dublin Partners in Education. Our
feedback forms as well as informal comments demonstrate that the program is needed and enjoyed by the
students. It has been pointed out that our program gives teachers a common language to talk about music
and to do follow-up activities with their students. Enrollment in music programs has increased in the school
districts where our ensemble has performed.
SECTION 2
Page 7 of 20
City of Dublin
Fiscal Year 2007-2008
Application for Funds
d. Specify the PROPOSED PROJECTIPROGRAM population to be served.
Dublin Elementary School Children k-5
e. Projects/programs must be evaluated to determine if they are being carried out efficiently
and if project/program goals are being met. Please describe how you plan to monitor
your project/program's success and impact.
· An additional page may be added, if needed.
Pacific Chamber Symphony evaluates the success of our in-school performances
from the compiled results of feedback forms to participating teachers and the
drawings and letters of the students who are remarkably articulate about
their experience. PCS in discussion with the elementary schools seeks to
gain a greater understanding of specific needs and preferences. The feedback
is then processed by the PCS music director and the professional mUSlClans
who make up the ensemble and influences the shaping of future programs.
f. Specify numbers of clients served by agency, then by PROPOSED
PROJECTIPROGRAM:
SECTION 2
Page 8 of 20
Total Proposed Participants Served by this ProjectlPro ram 2,100
Total Number of Dublin Residents Served by this Pro'ed 2,100
SECTION 2
Page 9 of 20
,~I~AIYl bE.ie.. 6LfolfjhonLI
nr-,r','~.,''''~'' ~rD
n.C:'v;::'i V t:::
CiTY OF DUBUN
City of Dublin
Fiscal Year 2007-2008
'11\'\' ..~~) ..)j'f""
cny MANAGEff ti OffiCE
Application for Funds
5. Financial Information - Operating Budget
a. Expense Budget
son
Program Services
Supporting Services
Other (please specify)
Other (please specify)
TOTAL
$252,520
$10,000
$7,000
Further Comments/Explahat~q,l1S (if necessary):
SECTION 2
Amended -Page 7 of 16
.'J'
fu~',\ (-\C./ D'(J-'i ~\bL,\~ SL\('I \\\\,oY\.L..i "',\"-7",
\ tn.:.!....,..' I eLl
CITY OCI. ;JBUN
City of Dublin
Fiscal Year 2007-2008
I ,"_:i' .:) ~i~
CHY IvU\NAUthS Oft-lel:
Application for Funds
b. Revenue Budget
FY 2007-2008
REVENUE BUDGET ORGANIZATION PROJECTIPROGRAM
CommittedlRestricted Funds
(specify source)
Non-CommittedlRestricted Funds
(specify source)
Contributions $145,000 (DPIE) $500
Contributions Hacienda Child
Development Fund $1,000
Contributions (to be taken from general
operating) $1,500
Contracts and tuition $10,000
Government $46,190 (City of Dublin) $7,000
Ticket sales $52,000
TOTAL $253,190 $10,000
Further Comments/Explanations (if necessary):
SECTION 2
Amended -Page 8 of 16
City of Dublin
Fiscal Year 2007-2008
Application for Funds
6. General Agency Information
a. List all years that Organization has previously received City of Dublin funding (not
Community Development Block Grant - CDBG).
2002 $10,000
2003 $10,000
2004 $10,000
2005 $10,000
2006 $ 7,000
b. Describe the population(s) served by the Organization.
Dublin public school elementary school children - all children at four elementary schools
c. Describe all the services the Organization currently provides to Dublin residents.
· An additional page may be added, if needed.
Currently our program in Dublin is the "Music is Fun! Assembly program.
SECTION 2
Page 12 of20
d. Has your agency ever previously received funds from the City of Dublin? If yes,
please specify in what Fiscal Years and the amount received each year.
2002 $10,000
2003 $10,000
2004 $10,000
2005 $10,000
2006 $ 7,000
SECTION 2
Page 13 of20
City of Dublin
Fiscal Year 2007-2008
Application for Funds
7. Required Attachments:
o Onlv one (1) copy per Ae:encv of each ofthe following is required, even with multiple
projects/programs submitted.
o Applications without the following documents will not be reviewed for funding.
o Please label attachments: A. B. C. etc.
~. Names of Governing Board; identify current Board officers.
.( B. Current total Organization operating budget, including revenue.
· Clearly label/identify the program that includes the PROPOSED
PROJECT/PROGRAM.
/
'I;t C. Most recent audit report or tax return (if applicable).
VD.
Resolution, letter or other document providing evidence of
Board/Organization approval of application, and date approval was granted.
· Board/Organization approval may be pending.
Organization's certificate of insurance showing coverage for liability and
workers' compensation.
tiE.
li'F.
Application Verification Declaration Signature Page.
D G. Signed affidavit form from each collaborating agency named in proposed
project/program plan (if applicable).
SECTION 2
Page 14 of20
Pacific Chamber Symphony, Board ofTmstees 06-07
Board members
Nelson Mosher, Esq. Chairman
Ruth Forbes, Secretary
Sheldon Cement, Treasurer
Lawrence Kohl, Music Director/ CEO
Larry Goldfarb
Joel Wienstein
Richard Wine field
Brian Fowler
Pat Kernan
Larrry Thorpe
Gil Roeder
Council members
Bill Criss
Sharon Collins
Sherri Ferris
A
-
."
PACIFIC CHAMBER SYMPHONY
PROJECTED STATEMENT OF ACTIVITIES
Pro;ected Year Ended June 30. 2007
Total
Project
Public support and revenues:
Contributions
$ 160,000
46,190
15, 110
42,500
$3,000
7,000
Government grants
Contracts and tuition
Ticket sales
Total public support and revenues
$10.000
263,800
Expenses:
Program services:
Community performances
Education and outreach
165,362
41,397 $9.100
207,096 $9.100
26,732 $450
18,692 $450
45,424 $900
252,520 $10,000
1l,280
(16,167)
$ (4,887 )
Total program services
Supporting services:
Management and general
Fundraising
Total supporting service
Total expenses
CHANGE IN NET ASSETS
NET ASSETS, BEGINNING OF YEAR
NET ASSETS, END OF YEAR
D
~
Q(
I
,
Contract labor - musicians $
Contract labor - other
Salaries - Music Director
Concert production costs
Rent
Printing and publications
Postage
Payroll taxes
Supplies
Insurance
Other expenses
Health insurance
Telephone
Advertising
Special events
Professional fees
Bank charges
Interest expense
Total expenses
before depreciation
Depreciation
TOTAL EXPENSES
Percent of total expenses
"
PACIFIC CHAMBER SYMPHONY
PROJECTED STATEMENT OF FUNCTIONAL EXPENSES
Community
Performances
165,362
165 362
65.5%
Projected Year End June 30. 2007
PROGRAM SERVICES
Education
and Outreach
41,734
Total
207,096
41 397 $ 207,096
16.5% 82.0%
SUPPORTING SERVICES
Management
and General Fundraising
26,243
18,692
489
$ 26,732
Total
44,935
489
18 692 $ 45,424
10.6%
7.4% 18.0%
Total
Expenses
$ 90,000
20,200
40,000
41,000
12,688
10,593
4,382
8,500
1,890
3,359
500
4,374
3,600
4,500
6,189
256
252,031
489
252 520
100.0%
~...
.'
'- c
PACIFIC CHAJ\IBER SYl\IPIIOX\'
ACCOU~TANTS' REVIE\V REPORT
and
FINANCIAL STATEl\lEl\;TS
June 30, 2005
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P ACI FIQ..JdibMBER SYMPHONY
STATEMENT OF FINANCIAL POSTTION
June 30. 2005
!~See
countants' Revlew Reoort
ASSET.S.
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The accornpan.y"ing notes are an integral oa:::t e,f these fin.ancia,l statements.
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SUPPORTING SERVICES
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PACIFIC c.Hju.f.J2.:!j)JLi2.xPIPHO~
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C
Chamber 8yrnplwny
D
Council Members
City of Dublin
January 22, 2007
Dear City Council
The Board of Trustees of the Pacific Chamber Symphony hereby approves the
submission of this grant proposal for a $7,000 one year grant in support of the Pacific
Chamber Symphony's "Music is Fun!" assembly program for the Dublin schools.
Thank you for your consideration and your support.
Cordially,
u? /;fuz,-.:z
/ Nelson Mosher,
Chair of the Board of rustees
Pacific Chamber Symphony
1155 East 14th Street Suite 215
San Leandro, CA 94577
p 510.352.3945 F 510.352.3947
114 San some Street Suite 825
San Francisco, CA 94108
p 415.989.6872 F 415.989.6873
6834 Garland Court
Pleasanton, CA 94588
p 925.484.9783
P acifi cCha mberSym phony. org
LAWRENCE KOHL Music Director & Conductor
~
OP ID DAlE(MMIDDIYYYY)
PACI-I0 01 22 07
THIS CER11f1CATE IS ISSUED AS A MAneR OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON 1HE CERnACA TE
HOLDER. THIS CERllFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLlQES BELOW.
ACORD..
CERTIFICATE OF LIABILITY INSURANCE
THE pOLICIES OF INSURANCE lISTED BELOW HAIlE BEEN ISSUED TO THE INSURED N.OMED N3(NE FOR THE POLICY PERIOD INDICATED. NOTVIlTHSTANDING
AN( REQUIREMENT. TERM OR CONDITION OF AN( CONTRACT OR OTHER DOCUMENT WTH RESPeCT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN. THE INSURANCE JlfFORDED 8f THE POLICIES oeSCRIBED HEREN IS SUBJECT TO ALL THE TERM$, EXCLUSONS AND CONQTIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHCl'NN MAY HAVE BEEN REDUCED Sf PAlO CLAIMS.
LTR NSRt TYPE OF INSURANCE POLICY NUMBER "D~~~ DAll! ~ UMlTS
~NERAL UABlUlT EACHOCCAJRRENCE , 1000000
A ~ COMMERCIAL GENERAl. LIABILITY 200600695NPO 11/17/06 11/17/07 PREMiSes lEa 0Cl1lIlIIlC61 S 100000
:=J ClAIMS MACe [K] OCCUR MED EXP (AnY one penon) s 10000
-
PERSONAL & KN INJURY S 1000000
X Liquor Liability GENERAl.I'GGREGATE $ 2000000
GEN'L AGGREGATE LlMlT APPLIES PER: PROOUCTS. COMP!OP AGO S 2000000
I POLICY n ~& n Loo
~TOM08ILE UA81UTY COMBINED SiNGlE LIMIT $ 1000000
A Atf'f AVTO 200600695NPO 11/17/06 11/17/07 lEa aoadellt)
-
ALL OWNED AUTOS BODILY INJURY
- S
SCHEDUlED MOS (Per penon)
-
~ HIRED AUTOS BODILY INJURY $
~ NON-O'MIIED AUTOS (Per aoaderrtl
- PROPERTY DAMAGE ,
(Per accideoIl
GARAGE UABlUlY AUTO ONLY. EA ACCIDENT S
=1,ANY AUTO OTHER THAN EA ACe $
AUTO ONLY: AGO $
EXCES!lUMBREUA UABlUTY EACH ooOJRRENCE S
:J OCCUR 0 ClAIMS MADE AGGREGA.TE $
S
==J oeOUClIBtE $
RETENTION $ ,
WORKERS C(MPENSA11ON AND hORY LlMlTS I IQ~
B EMPLOYERS' UABlUTY 1600067-05 07/22/06 07/22/07 E.L. EACHACCIOENT $1,000,000
AN( PROPRIETQRA>ARTNERlEXECUllVE
OFflCERlMEMBER EXCLLOEO? E.L. DISEASE. EA EMPLOYEE $1,000,000
~~~~~~ below E. L. DISEASE - POLICY LIMIT $1,000,000
OTHER
OESCRlPllDN OF OPERATIONS I LOCA11ONS I VEIICl..ES I EXCLUSIONS ADDED BY ENXlRSEMENT I SPECIAL PRO\Il$lONS
Proof of Insurance only.
PRODUCER
McDermott-Costa Co., Inc.
Lic * 0167057
276 Dolores Ave
San Leandro CA 94577
Phone:510-351-7460 Fax: 510-357-3230
INSURED
Pag~fic Chamber SymphoOY
1155 East 14th Stre.t 1215
San Leandro CA 94577
COVERAGES
CERTIFICATE HOLDER
City of Dublin
ACORD 25 (2001108)
INSURERS AFFORDING COVERAGE
NAIC .
INSURER A:
INSURER B:
INSURER C:
INSURER 0:
INSURER E:
MonP.-ofi.t.~ Ins- Allianoe o~ CA
Stele. C~.*.ion .I1M'. SUn,cl
CANCELLAnON
SHOULD ANY OF ntI! AJIOVE DESCRIBED POLICIES BE C~I!LLED 8EI'QRIlHE elIP1tA'IlON
DAlE THEREOF. THE ISSUING INSURER.....LL ENDEAVOR TO MAll ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE. H ED TO THE LEFT. BUT FAILURE TO DO so SHALL
IMPOS lION OR I) UPON THe INSURER, 1111 AGEHlS OR
REP NTATlVE
AU
@ ACORD CORPORATION 1988
f
-
City of Dublin
Fiscal Year 2007-2008
Application for Funds
ApPLICATION VERIFICATION
I attest that the information contained in this FY 2007-2008 grant application is accurate and that
the funds requested will not supplant any other monies secured by the organization.
Attached is a resolution, letter, or other document providing evidence that the Board of Directors
approved the application as submitted. Successful applicants are required to submit a summary
report as soon as possible after submitting the reimbursement request, but not later than August
30, 2008. Failure to submit a report will result in ineligibility for future funding.
SignaPMe"d~ 1M!
Executive Director
IJ23l07
ate
. . . ~,~ ~L
Board President/Chairpersori
1~~Q7
I / Date
SECTION 2
Page 15 of20