SENIOR CITIZENS' SERVICES FUND BOARD
SENIOR SERVICES PROPOSAL
FOR SENIOR CENTERS
This document constitutes a proposal by the Provider, indicated below, to furnish services to persons, sixty years of age or older, who reside in Camden County, Missouri.
IMPORTANT
This proposal must be received NO LATER THAN:
TIME: 4:00 p.m.
DATE: Second Friday in November
Late proposals are subject to rejection or penalty.
Original Proposal and seven (7) copies must be securely sealed, clearly marked SENIOR SERVICES PROPOSAL, and mailed or hand-carried to:
Senior Services Fund Board
PO BOX 44
Sunrise Beach, MO 65079
TO BE COMPLETED BY PROVIDER
Date of Proposal: Corporate Office Location:
Organization Name: Telephone:
Mailing Address
Email Address:
Organizational Status: Check whether your organization is for profit or is non-profit:   Profit   Non-Profit
The Provider hereby agrees to provide the following services for those persons, sixty years of age or older, who reside in Camden County, Missouri:
Specify the dollar amount requested: $ Indicate the Contract period:
Person to contact: Sign, then print name, and title:
EXHIBIT A
Projected Revenue for Proposed Service(s)

In addition to the dollar amount being requested with this proposal, indicate all other sources of funds and their amounts, currently projected, that are also applicable to the services described with this proposal.

Source of Funds$ Amount
Camden Co. Sr. Funds Requested
Central MO Area Agency on Aging
Donations
Fundraisers
Bank Interest
TOTAL PROJECTED:
Remaining funds from previous year's grant as of Dec. 31st:
EXHIBIT B: Personnel
Personnel

List the titles only, of those personnel involved in the provision or the administration of the proposed service(s).

Position Title# Employees
EXHIBIT C
Detailed Budget for Proposed Service

Indicate dollar amount of the proposed service as they will be paid by outside sources and by the Camden County Funds specified in this Senior Services Proposal. Use Expense Item titles that fit your service provided.

Expense ItemOutside Funds$ Camden
Total Outside:
Total Camden:
Grand Total:
SUMMARY - PROVIDER'S SERVICES TO SENIORS

Each requester must briefly describe/summarize services provided to Seniors of Camden County. Indicate the annual estimated total number of Camden County Seniors affected by each service provided.

SUMMARY OF SERVICES PROVIDED # CAMDEN CO. CITIZENS SERVED
Total unduplicated number of Camden County Seniors served:
SENIOR CITIZENS' SERVICES FUND BOARD
COMMENTS - SUGGESTIONS and/or
SUMMARIZE SERVICES PROVIDED
(Continued from page 4)
EXHIBIT D
End-Year Performance to Budget Report
Organization Name:
Actual Meals & Individuals Served
Category Total # Meals Served Total # Individuals Served % Camden Co Residents
Congregate Meals 0 0 0
Home Bound Meals 0 0 0
Total unduplicated number of Camden County Seniors served during the contract year: 0
Camden Co. FUNDS received Jan. 1 – Dec. 31: $ 0.00
Expense Item $ Camden Co. FUNDS Expended
Personnel Salaries 0.00
Travel (Staff & Volunteers) 0.00
Raw Food 0.00
HB Frozen Meals 0.00
Kitchen & Dining Supplies 0.00
Bldg. Utilities 0.00
Office Expenses 0.00
Equipment 0.00
Construction 0.00
Maintenance 0.00
Insurance 0.00
Advertising 0.00
Total EXPENDED Funds 0.00
Camden Co. FUNDS as of Dec. 31 0.00
SENIOR CITIZENS' SERVICES FUND BOARD
End-Year Performance to Budget Report
Organization Name:
SENIOR CITIZENS' SERVICES FUND BOARD
SENIOR SERVICES PROPOSAL
CONTRACT (Senior Centers)

This agreement made and entered into the day of , , by and between the Camden County Senior Citizens' Services Fund Board, and hereafter referred to as the Grantee.

WITNESSED:

Whereas, the Board desires to provide significant services to assist the Senior Citizens of Camden County, Missouri by and through the use of tax levy funds held by it and collected under 67.990 - 67.995

Revised Statutes of Missouri: and

Whereas, the Board, a unit of county government, is engaging in providing services for senior citizens of Camden County agreed as follows:

  1. The Board shall recommend that the Board Treasurer pay to the Grantee the sum of $ .
  2. The Grantee shall;
    • a. Apply said funds to provide services for the senior citizens.
    • b. Provide the Board with reports regarding the use of said funds and financial information.
  3. Reports regarding the use of said funds,
  4. Financial information relating to the services listed in the RFP,
  5. Permit on the premises inspection of the facilities operated by the Grantee.
  6. Provide the Board with a copy of its actual operating budget for the full year at the completion of the calendar year.
  7. The End of the year report shall be due on or before Jan. 15 of the following year emailed to the board secretary as an attachment.
  8. Senior Nutrition Centers shall utilize the report provided with the RFP.

In witness whereof, the parties hereto set their signatures by their authorized representative on two original copies the day and year first above written.

______________________________
Chairman, Applicant Agency
______________________________
Chairman, Camden County Senior Citizens Services Fund Board

A new Contract will be completed with each funds distribution amount in Feb and July. The total sum of the distribution is the portion received not what was Granted for overall award.