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TABLE OF CONTENTS

SECTION 1…………………………QUALIFICATION

SECTION 2…………………………ASSESSMENT

SECTION 3…………………………APPLICATION

SECTION 4…………………………QUOTES

SECTION 5…………………………EQUIPMENT ORDER

SECTION 6…………………………INVENTORY

SECTION 7…………………………FINACIAL RECORDS

SECTION 8…………………………CORRESPONDANCE

SECTION 9…………………………PROMOTION

SECTION 10……………………….FINAL REPORT

Grant Management Seminar Attendees 2012/13

Pete Erickson

David Campbell

Carl Barr

Fred Skinner

Delone Krueger

Rotary Club of Moses Lake

Grant Management Policies and Procedures

The Rotary Club of Moses Lake officers hold the primary responsibility for Club qualification and the proper implementation of The Rotary Foundation (TRF) and Rotary District 5060 (District) grants. The President Elect of the Club is therefore appointed as an ex-officio member of the Grant Management committee.

Financial Management:1. Generally accepted accounting practices will apply to all financial records involved in the

receipt and disbursement of grant funds. This will include the practice of vouchers being approved for payment by two members of the Grant Management Committee prior to the check being written.

2. All purchases and distribution of equipment and other assets will be recorded in an inventory list and a receipt for each item shall be received upon delivery.

Bank Accounts:1. Separate bank accounts shall be maintained for each grant received. The name on the

account shall reflect the name of the grant and shall be low or non interest bearing.2. All bank statements shall be retained in the permanent file of the specific grant when the

grant project is completed.3. All accounts shall be handled by the Grant Management Committee and checks will

require any two of the following four approved signatures: Club President, Club President Elect, Grant Management Committee Chair, and Grant Management Committee Vice Chair.

4. The person who writes the check may not be a signatory on the check. 5. Custody of the accounts will be transferred by vote of approval of the Board of Directors

of the Club.6. At the completion of the project if there are any grants funds remaining, District Grant

funds shall be returned to the District, and Global Grant funds shall be returned to The Rotary Foundation within the time frame required.

Reporting:All required grant reports shall be completed by the project committee and it is the responsibility of the Grant Management committee to see that the reports are submitted according to TRF and/or District reporting requirements.

Document Retention:Documents for each grant shall be stored in hard copy in a secure location as well as in electronic format posted on the club website accessible to all members. This shall include but not be limited to the following:

Bank information and statementsClub qualification documents including a signed copy of the Memo of Understanding

(MOU)A copy of the Grant Management policies and proceduresAll Inventory documentsAll receipts and invoices

All records shall be kept for a minimum of five (5) years, or longer if required by Washington state law.

Misuse of Grant Funds:It is the responsibility of the Club President to immediately report to the District any potential and real misuse or mismanagement of grants funds.

Assessment Narrative

A club member mentioned to a Board member that the school district had only one Automated External Defibrillator in the district and it was located in the high school gymnasium area.

The club followed up by contacting the school district and learned the following:

Only one AED was in the district, located in the high school gym area The school district has 14 school buildings A total enrollment of 7,996 students grades K-12 453 faculty and 462 classified staff All buildings are available for public use through community schools Annual public use of facilities sees in excess of 250,000 people per year

Learning the information above the board saw a need and decided to write a District Grant to provide AEDs in each school building as well as provide portable units for school buses traveling out of the district. Additional AEDs were needed in certain larger square foot schools to meet guidelines of the American Heart Association.

Rotary International District 5060

Rotary Foundation District Grant Application

2013 – 2014 Program Year

1. PROJECT DESCRIPTIONExplanation: District Grants support the humanitarian, educational, and vocational service projects of Rotary clubs and the district. In this section, describe in detail the need your project will address, the intent of the project, how the project will be implemented, and how Rotarians will be directly involved in the project. Significant and active involvement by Rotarians is required of the project sponsor (and the project partner if applicable).

Please provide the name of the project, the project site, the city or village, state or province, and country. List multiple locations, if applicable.

Project Name: Automated External Defibrillators (AEDs) for the Moses Lake School District(A short name which identifies the project)

Project Site: Moses Lake, WA, USA(City, Village, State/Province, Country)

Project Description:(Describe the project and the problem or need it will address, including the intended beneficiaries and how the project will benefit the community in need. Provide the estimated length of time needed to complete the project)

The Moses Lake School District (MLSD) operates 1 high school, 1 alternative secondary school, 2 middle schools, and 10 elementary schools. The District only has 1 AED at the high school.

There are currently 7,996 students enrolled at the MLSD. There are currently 453 faculty and 462 classified staff. According to the MLSD, there were 202,920 visitors to MLSD buildings in 2008/2009 for non-MLSD events, the last year with available data. We estimate that an additional 50-60,000 people use MLSD facilities for MLSD events annually.

According to the American Heart Association, in the event of a person going into cardiac arrest, the time between “drop and shock” should not exceed three minutes. The sooner a person receives treatment, the higher the survival rate. With every minute that passes, a victim of sudden cardiac arrest loses 7% - 10% chance of survival if not defibrillated. The average response rate in the United States by Emergency Medical Services (EMS) is 6 to 12 minutes. The response rate, coupled with the large amount of persons using MLSD facilities, means that AEDs need to be placed in all MLSD facilities.

Our project will purchase 21 AEDs. We will place 3 additional units at the high school, 1 at the alternative secondary school, 2 each at the 2 middle schools, 1 each at the 10 elementary schools, 1 at the largest sports field, and provide 2 portable units that will travel on buses with athletic teams. Additional equipment needed for the AEDs, such as alarmed cabinets for fixed units, signage to identity AED locations, etc. have been allocated for in our quote so the project can be fully completed.

This project will begin in July 2013 and end in August 2013.

(Describe how the benefiting community will maintain this project after grant funding has been fully expended)

The MLSD has agreed to provide all ongoing maintenance on the AEDs. The Moses Lake Fire Department has agreed to provide all training to employees of MLSD at time of placement, as well as ongoing training in future years.

(Describe how this project will fit one of the Six Areas of Focus)

Disease Prevention & Treatment. This project will enhance the health infrastructure of our local community.

(Describe specific activities of the primary sponsor Rotary club in District 5060 (and the project partner if applicable) in implementing the project. What will the Rotarians who are members of the project sponsors do during the project? (Financial support is not considered active involvement)

Our Rotary club established a committee with representation from the MLSD, Kiwanis Club of Moses Lake, and Moses Lake Fire Department to determine the best approach on this issue. Additionally, we gathered information from the person at Providence Sacred Heart Hospital in Spokane, WA, USA that runs their AED outreach program to assure our unit placements meet suggested placement response ratios. The Rotary Club of Moses Lake will oversee the equipment purchase, inspection, and installation; as well as assure that the proper training of MLSD personnel has been accomplished.

2. PRIMARY SPONSOR ROTARY CLUB IN DISTRICT 5060Explanation: The primary sponsor is the Rotary club in District 5060 or the District itself. The primary sponsor can be either the project host or the project international partner. A committee of at least three Rotarians must be established to oversee the project. The primary contact must belong to the primary club identified below. The committee members must be committed for the duration of the grant process. Please provide the primary address for all committee members, as all Rotary information will be sent to this address. It is highly recommended that the primary contact have an e-mail address to expedite communication.

Primary Sponsor Rotary Club

Club Name: Rotary Club of Moses Lake

Club Number: 219

2013 – 2014 Club President: (Name) David Campbell

Sponsor Rotary Club Primary Contact:

Name: Jack Becker

Club: Rotary Club of Moses Lake

Rotary Position: Community Development Committee Chair

Address: 8596 Dune Lake Rd SE, Moses Lake, WA 98837

Email: [email protected] Phone: 509-760-3844

Sponsor Rotary Club Project Contact #2:

Name: Tom Thomas


Rotary Position: Community Development Committee Vice Chair

Address: 326 Clark, Moses Lake, WA 98837


Sponsor Rotary Club Project Contact #3:

Name: David Campbell


Rotary Position: 2013/2014 Club President

Address: 8852 Dune Lake Rd SE, Moses Lake, WA 98837


3. PROJECT PARTNER - Leave Blank if there is no Project Partner. Go to Section 4

Explanation: The project partner is the club, district or organization either within or outside District 5060, and either Rotary or non-Rotary. A Rotary Partner need not be in another pilot District. A committee of at least three people must be established to oversee the project. All three committee members must belong to the primary club/organization identified below for club-sponsored projects or belong to clubs in the district for district-sponsored projects. The committee members must be committed for the duration of the grant process. Please provide the primary address for all committee members, as all Rotary information will be sent to this address. It is highly recommended that the primary contact have an e-mail address to expedite communication.

Project Partner Club/District/Organization

Club/Organization Name:

Club Number (If applicable):

District Number (If applicable):

Country: USA

Project Partner Primary Contact:

Name:

Club (If Applicable):

Rotary Position (If Applicable):

Address:

Email: Phone:

Project Partner Contact #2:

Name:



Address:

Email: Phone:

Project Partner Contact #3:

Name:



Address:

Email: Phone:

4. PROJECT BUDGET Explanation: For a detailed explanation of what the District funds, refer to the Rotary International District 5060 Inc., District Grants Guidelines and/or contact the District Grants chair.

Budget Item Name of Supplier Amount $ US

AEDs, quantity of 21, including carrying cases, fast response kits, pads, 19 alarmed cabinets, wall signs, etc.

Enerspect Medical Solutions $27,734.37

Total US $ $27,734.37

5. PROJECT FINANCING Explanation: Clearly list all financing in US ($) dollars noting which funds will be contributed in club generated cash and which will be contributed from District Designated Funds (DDF). Use of DDF must be authorized by the District Rotary Foundation District Grants chair and the District Rotary Foundation Committee chair. The District matches (US) $1.00 for every (US) $1.00 of club generated funds, to a maximum grant award of (US) $15,000.

Instructions: If the project is in District 5060, the Primary Sponsor Rotary Club in District 5060 is the Host

Sponsor and completes lines 1 and 3. If the project is outside District 5060, the Primary Sponsor Rotary Club in District 5060 is the

International Sponsor and completes lines 1, 2 and 3.

Host Sponsor(Sponsor Club is in District 5060 and the project is in

District 5060)

Club GeneratedFunds 1

(US $)

District GrantFunds - DDF

(US $)

Other Funds 2

Not Matched(Including Donations in

Kind)

Total(US $)

1Club NameRotary Club of Moses Lake

$ 13,867.19 $ 13,867.18 $ -0- $ 27,734.37

International Sponsor

(Sponsor Club is in District 5060 and the project is in another

country)

Club Generated Funds 1

(US $)

District Grant Funds - DDF

(US $)

Internationally Generated Funds

2

Not Matched(US $ Equivalent)

-

2Club Name $ $ $ $

3Total Financing(Must Equal Project

Budget)$ 13,867.18 $ 13,867.18 $ -0- $ 27,734.37

1. The term “Club Generated Funds” refers to all cash raised or contributed by the Primary Sponsor Rotary club for the project including funds contributed by other Rotary clubs in District 5060. These funds are eligible for matching by the District in the ratio of (US) $1.00 to $1.00

Funds raised from sources, including Rotary clubs, outside District 5060 are not included in “Club Generated Funds”, and are not matched. These funds should be included under “Other Funds” or “Internationally Generated Funds”.

2. The terms “Other Funds” and “Internationally Generated Funds” refer to project contributions, either in cash or in kind, from sponsors other than the Primary Sponsor Rotary club in District 5060. These funds will not be matched by the District.

District Grant Funds Authorization:

1. District Grants Chair: Sharon Barnes Signature Date

2. District Rotary Foundation Committee Chair:Garry Hollingshead

Signature Date

6. PROJECT PLANNING Explanation: Before an application is submitted to the District, project partners should discuss various planning details. The questions below are a guide to aid project planning. Note that a Rotary club/district or Rotarian may not own anything purchased with grant funds.

If Applicable: Identify who will own equipment and maintain, operate, and secure items purchased with grant funds. (A Rotary club or Rotarian cannot own equipment.)

The Moses Lake School District will own, operate, and maintain the equipment. The Rotary Club of Moses Lake will secure items purchased with grant funds.

If Applicable: Will training in the use and maintenance of technical equipment be provided? If so, who will provide training?

The Moses Lake Fire Department will provide all training on this equipment at installation and going forward. A minimum of two coaches in each sport and 10% of each site staff to be trained in Year one. Training in year two will increase the number of trained staff to 25% in each site and 50% of each coaching staff. Training in subsequent years will be to refresh and maintain the percentages achieved in year two. The Moses Lake School District will maintain the equipment going forward.

If Applicable: Is software necessary to operate any items? If so, has software been provided?

If Applicable: Indicate what arrangements have been made for customs clearance if items will be purchased and shipped from outside the project country.

If Applicable: Other Relevant Planning Steps:

Required: Project must be completed within 24 months of grant award. Who will be responsible to ensure compliance with District Grants reporting requirements, namely an initial report within 12 months of the grant award, each 12 months thereafter for the life of the project, and a final report within 60 days of the project completion?(This should be the Sponsor Rotary Club Primary Contact – see page 2, section 2 – or the club president)

David Campbell, 2013/2014 Club President, Rotary Club of Moses Lake.

Required: What arrangements will be made to publicise the project?

We will work with the Publisher of the Columbia Basin Herald, the largest circulated newspaper in Grant County, to publicise the project. The Publisher is a member of the Rotary Club of Moses Lake.

7. PROJECT AUTHORIZATIONS

Explanation: Authorizations ensure that all project sponsors are aware of, and interested in, pursuing the described project. By signing below, the project committee members and current district grants subcommittee chair for district-sponsored projects agree to the criteria listed and affirm their support of the project.

All Rotary clubs, districts, and Rotarians involved in this project are responsible to The Rotary Foundation (TRF) and to District 5060 for the conduct of the project and its subsequent reporting. The signatures of all involved parties confirm that they understand and accept responsibility for the project. Parties may either sign this page or submit a separate letter of commitment.

By signing below, we agree to the following: • All information contained in this application is, to the best of our knowledge, true and accurate, and we intend to implement the project as presented in this application. • The club/district agrees to undertake this project as an activity of the club/district. • We ensure all club generated funds (as detailed in Project Financing) will be available to the project before the District Foundation Committee approves the grant application. • TRF and the District may use information contained in this application to promote the project by various means such as The Rotarian, the RI international convention, RVM: The Rotarian Video Magazine, etc. • The partners agree to share information on best practices when asked, and TRF and the District may provide partners’ contact information to other Rotarians who may wish advice on implementing similar projects. • To the best of my knowledge and belief, except as disclosed herewith, neither I nor any person with whom I have or had a personal or business relationship is engaged, or intends to engage, in benefiting from District Grant funds or has any interest that may represent a potential competing or conflicting interest. A conflict of interest is defined as a situation in which a Rotarian, in relationship to an outside organization, is in a position to influence the spending of District Grant funds, or influence decisions in ways that could lead directly or indirectly to financial gain for the Rotarian, a business colleague, or his or her family, or give improper advantage to others to the detriment of TRF or the District. (NOTE: Any and all exceptions must be explained in an attached statement.)

Required Leave Blank if no Project Partner

Primary Sponsor Rotary ClubIn District 5060

Project Partner (Local or International)(If Applicable)

Club President (If Club Sponsored)District Grants Chair (If District Sponsored)

Club President (If Club Sponsored), orDistrict Grants Chair (If District Sponsored), or

Partner Organization Chair

Name: Fred Skinner Name:

Title: 2012/2013 Club President Title:

Rotary Club: Rotary Club of Moses Lake Rotary Club: (If Applicable)

Signature: Signature:

Date: _________ Date:

Sponsor Rotary Club Primary Contact Project Partner Primary Contact(If Applicable)

Name: Jack Becker Name:


Date: Date:

Sponsor Rotary Club Project Contact # 2 Project Partner Contact # 2(If Applicable)

Name: Tom Thomas Name:


Date: Date:

Sponsor Rotary Club Project Contact # 3 Project Partner Contact # 3(If Applicable)

Name: David Campbell Name:


Date: 11/16/2012 Date:

8. COOPERATING ORGANIZATION - Leave Blank if no Cooperating Organization. Go to Section 9.

Explanation: A cooperating organization is an organization that is directly involved in the implementation of the project, offering technical expertise and project coordination. A benefiting entity is the recipient of goods or services and is not considered a cooperating organization.

If this project involves a cooperating organization (neither a Rotary club nor the beneficiary of the project), provide the following:

Name of organization:

Street address:

City, State/Province Postal code Country:

Office phone/ Fax:

E-mail/ Web address:

In addition to the above, the following must be attached:

• Letter of participation from cooperating organization that specifically states: – Its responsibilities and how it will interact with Rotarians – The organization’s agreement to cooperate in any financial review of the project • A letter of endorsement from the host partner confirming that the cooperating organization works within that country’s laws.

9. FINAL REPORT Explanation: The sponsor Rotary Club in District 5060 is responsible for completing progress and final reports. (See Page 6)

By signing below, our club/district accepts primary reporting responsibility.

Print name: David Campbell

Signature:

Rotary club: Rotary Club of Moses Lake

District Governor (District Sponsored Projects)

10. DISTRICT GRANTS CHAIR CERTIFICATIONExplanation: The District requires that the District Grants chair certifies the application as complete. If the application is not complete or eligible, it will be returned to the Rotary host partner with a brief explanation.

On behalf of the committee, I hereby certify that to the best of my knowledge and ability:1. The Primary Sponsor Rotary Club in District 5060 is qualified, and2. This grant application is complete, meets all TRF and District guidelines, and is eligible

for funding.

District Grants Chair: Print Name

Signature:

Date:

11. COMPLETION CHECKLIST Before submitting your Matching Grant application, please take a moment to review this checklist. If you have any questions or concerns, please contact the District Grants Chair.

Does the project meet all District Grants Guidelines

Does the project description clearly state how the project will assist those in need?

Are the activities of the Primary Sponsor Rotary Club in District 5060 (and Project Partner) clearly explained? Will the Rotarians be actively involved in the project?

Has the Primary Sponsor Rotary Club in District 5060 (and Project Partner) established committee(s) to oversee the project? Are these individuals correctly listed on the application with their complete contact information?

Is a detailed, itemized budget included in the application?

Are all sponsor (and Project Partner) contributions listed in the application, noting which contributions will be club generated and which will be DDF?

Has the District Grants chair and the District Foundation Committee chair provided their signatures authorizing the use of District Designated Funds?

Has the club president of the Primary Sponsor Rotary in District 5060 or the District Grants chair (District Sponsored Project) (and Project Partner) provided their authorizing signatures?

Have all three (six) committee members provided their authorizing signatures?

If a cooperating organization is involved, are the following letters included with the application:

Letter from the organization specifically stating its responsibilities, how it will interact with Rotarians, and agreeing to cooperate in any financial review of the project. Letter of endorsement from the Primary Sponsor Rotary club in District 5060 confirming that the cooperating organization is reputable and works within the laws of that country.

Has the District Grants chair certified that the application is complete and eligible?

Is there a minimum of five authorizing signatures included in the application?

Has the Primary Sponsor Rotary club in District 5060 made copies of all documents for its files prior to submitting them to the District?

Complete applications should be sent to:

Sharon Barnes

District Grants Chair

Rotary International District 5060.

5013 Treadgold Court

Kelowna, BC, Canada V1W 5B4

Email: [email protected]

Phone: Business: 250 980 3909, Home: 250 764 8248, Cell: 480 215 3951

Primary Club Project Name AmountMoses Lake Automated External Defibrillators $13,867.18

Capri Arion Farm's $15,000.00Kelowna Brain Trust $5,950.00Kelowna Needs Assessment - India $3,072.85Yakima Hearing & Speech Center $14,872.00Yakima Allied Arts Center $9,187.13

Kamloops Orphans Learn Basic Farming $5,000.00Kalamalka Community Dental Access Centre $8,500.00Peachland Volcanes School Library $3,650.00Silver Star El Tonino School Desks $1,800.00Kelowna Medical Container $8,930.87

Total $89,830.03

AED Project Committee

Pete Erickson- Chair

Delone Krueger -V Chair

Carl Barr –Treasurer

AED SUMMARYRevenue

$13,867 Rotary Foundation Grant$9,556 golf tournament.$7,450 in donations from Rotarians$5,000 Kiwanis Foundation Grant$35,873 total funds.

Placement of AEDs

Moses Lake High School 3 1 existing total 4Columbia Basin Secondary School 1Frontier Middle School 3Chief Moses Middle School 4Garden Heights Elementary 1Lakeview Elementary 1Longview Elementary 1North Elementary 1Larson Heights Elementary 1Knolls Vista Elementary 1Park Orchard Elementary 1Midway Elementary 1Peninsula Elementary 1Sage Point Elementary 1Lions Field 1Bus Garage 4 Portable unitsNew Board Room 1