BOARD REPORT
August 20, 2018
Educating people to be life-long learners and respectful, responsible citizens Independence Community School District 1207 First Street West (319) 334-7400 Phone Independence, Iowa 50644 (319) 334-7 404 Fax
Superintendent Russell Reiter
Director of Finance/ Board Secretary Laura J. Morine
August 16, 2018
To: All School Board Members Gina Trimble- At Large '21 Brian C. Eddy - DD #1 '19 From: Russell Reiter, Superintendent Kim Hansen - DD #3 '19 Eric B. Smith - DD #2 '19 Jennifer Somson - DD #3 '21
Re: Working agenda for the regular meeting on Monday, August 20, 2018 beginning at 6:00p.m. at the School Administration Office, 1207 1st Street West, Independence, IA
1. PLEDGE OF ALLEGIANCE A. Call to Order
2. FRIENDS OF EDUCATION A. Student Support We would like to thank Kevin McRae and Shyla Bagge from Central Rivers ABA, Father David Beckman from St John's Catholic Church, Pastor John Slteda from Living Water Church, Pastor Bob Solon from Hope Wesleyan Church, Angie Trenary and Kristy Martensen from Foundation 2, Julie Davison from Community Services, and Nancy Muir from the Abbe Center for their guidance, professionalism, and support
3. CONSIDERATION OF ACTION ON CONSENT ITEMS A. Approval of the minutes of the regular meeting on July 16, 2018, the special Motion 3.A. meeting on July 23 , 2018, and the work session on August 13, 2018. I am seeking approval ofthe minutes.
B. Approval of Agenda Motion I am seeking approval of the agenda.
"1:aucating yeoy(e to 6e (ije-(ong (ean'Lers anaresyectfu{, resyonsi6(e citizens" C. Approval ofBoard Policies (*changes noted) Motion 3.C. First Readings: POLICY# POLICY NAME 1. 606.8 School Assembly 2. 606.9 Insufficient Classroom Space 3. 606.10* Early Release for Seniors 4. 607.1 * Student Guidance and CounselingProgram 5. 607.2 and 607 .2R 1 Student Health Services and Student Health Services Administrative Regulations 6. 607.3 Musical Instrument Display Night 7. 607.4 Class Ring Display 8. 606.5* Animals in the Classroom 9. 710.1 * School Nutrition Program I am seeking approval of the above policies' first readings.
D. Resignations Motion NAME ASSIGNMENT DATE Susan Case West Elem 5.75 hr SpEd Para and East Elem .5 hr Bus Duty 08/02/2018 Travis Walker Head Boys Baseball Coach 08/07/2018 I am seeking approval ofthe above resignation(s).
E. Transfers/Reassignments Motion I NAME I PREVIOUS ASSIGNMENT NEW ASSIGNMENT I SALARY I DATE !Mary Kohlhaas !Bus Garage 3.5 hr Para ECC 7.0 hr SpEd Para I$9.95 /hr I08 /23/2018 I am seeking approval ofthe above transfer(s)lreassignment(s).
F. New Hires (pending acceptable background checks) Motion NAME ASSIGNMENT SALARY DATE Shawn Conaway Head Girls Soccer Coach $3,175 03111/2019 Brandon Drew JH Volleyball Coach $2,223 08/23/2018 DawnMonis JSH 6.5 hr Cook/FSW $9.50/hr 08/22/2018 Megan Rawlins JH Volleyball Coach $2,286 08/23/2018 I am seeking approval ofthe above new hire(s).
G. Approval of Financial Reports Motion 3.0. 1. Approval of Bills - Director Trimble will have reviewed the bills 2. Vendor Report 3. Board Report 4. Budget Report
4. ANNOUNCEMENTS, COMMUNICATIONS and PRESENTATIONS A. Comments from the Public. Residents of the District, students attending the District, parents/guardians of students attending the District, and District staff members may address the Board about any topic relevant to the District whether on the current agenda or not. Those who wish to speak must sign up at the beginning of the meeting. Speaker's participation is limited to three minutes once per board meeting. The Board President may need to reduce the three-minute time limit to accommodate more speakers in the 20 minutes allotted for the public forum. The Board must approve an extension of the 20-minute time allocation to allow all speakers up to three-minutes. The views and opinions of citizens addressing the Board do not necessarily reflect those ofthe Board, District administration, or staff. We ask speakers to remember that Iowa law prohibits the Board from discussing specific employees or students or their performance. Student speakers will state their name and school. Others will state their name and address.
B. Comments from the Board/Superintendent
C. Presentations 1. 2016 Senior Follow Up Survey - John Howard 2. 2018 Senior Exit Survey - John Howard
5. REPORTS A. Building Administrator Reports 1. Junior-Senior High School Principal 2. Junior-Senior High School Assistant Principal 3. West Elementary Principal 4. East Elementary/Early Childhood Center Principal
B. District Director Reports 1. Activities Director Report 2. Director of School Improvement Report 3. Director of Technology Report 4. Director of Food Service Report 5. Director of Buildings & Grounds Report 6. Director of Transportation Report
6. NEW BUSINESS A. Relay for Life - Don Mumm
B. Travel Request Form - September, 2018 Agticultural Trip to Kosovo Motion 6.B.
C. Tri-County Contracted Services Renewal Agreement for 2018-2019 Motion 6.C.
D. Buchanan County Health Center Agreement for Sports Injury Coverage through Motion 6.D. July 31 , 2019
E. Level I, Level II Investigator and Alternate for 2018-2019 Motion 6.E.
F. Catastrophic Accident Insurance for Student Athletes Motion 6.F.
7. ADJOURNMENT Motion
UPCOMING MEETINGS - Monday, September 17th Regular Meeting 6:00 p.m. - Central Office Board Room, Independence 3J\. Independence Community School Board Meeting Regular Meeting July 16, 2018
A regular meeting of the Independence Community School Board was called to order at 6:00p.m. by Chairman Eric Smith at the Administration Building, Independence, Iowa on July 16,2018.
Members Present: Chainnan Eric Smith, Brian C. Eddy, Kim Hansen, Jennifer Somson and Gina Trimble. Superintendent Present: Russell Reiter Board Secretary: Laura Morine
The Board recited the Pledge of Allegiance.
FRIENDS OF EDUCATION A. Robert Hearn, Scott Kleve and Cole Trimble - Robert Hearn and Scott Kleve for designing and building bat racks and bag/helmet holders for the softball dugouts and Cole Trimble for helping to install them.
CONSIDERATION OF ACTION ON CONSENT ITEMS Motion by Eddy, second by Hansen to approve consent items 3A-D. Motion carried 5-0.
A. Approval of the minutes of the regular meeting on June 18, 2018.
B. Approval of Agenda
C. Resignations NAME ASSIGNMENT DATE Jacob Harberts JH Football Coach 07/06/2018 Kelly Post JH Volleyball Coach 06/26/2018 Brad Schultz Assistant Girls Basketball Coach 06/25/2018
D. New Hires (pending acceptable background checks) NAME ASSIGNMENT SALARY DATE Melissa Hauschild East Elem Special Ed Teacher $43 ,226 08/17/2018 Deana Miller West Elem Special Ed Summer School Para $12.00/hr 06/26/2018 Bryce Pierce .5 FTE Strength and Conditioning Coach $1,746 08/01/2018 Donalyn Pogue East Elem Kindergarten Curriculum Leader $5,000 08117/2018 Erin Rosburg JSH Mentor Teacher $2,000 08117/2018 Please notice-Donalyn Pogue is listed above for the East Elem Kdg position because Bonnie 0 'Brien was incorrectly listed last 11Wnth for that position.
E. Approval of Financial Reports- Motion by Trimble, second by Somson to approve financial reports. Smith, Trimble, Somson and Hansen voted "aye", Eddy abstained. Motion carried 4-0.
1. Approval of Bills - Director Trimble reviewed the bills 2. Vendor Report 3. Board Report 4. Budget Report ANNOUNCEMENTS, COMMUNICATIONS and PRESENTATIONS A. Public Comments-none
B. Comments from the Board/Superintendent - Trimble congratulated the girls' softball team for qualifying for the State Tournament. Also wanted to thank Amy Gustafson for organizing the gth grade trip to Washington D.C. Hansen also congratulated the softball team and wanted to recognize Coach Heather Hupke as being named the W AMAC West Coach of the Year. Update on the Mustang Way Park, both gardens are planted and a big thank you to Chad O'Brien, Tom Zimmerly, Kris Martin and her students, Shelly Shaffer, Brian Eddy and Troy Butters for their help in getting the beds planted and the rock put back in. Camp Creamery will be back this Friday for another workshop. Eddy wanted to thank Kim Hansen for coordinating the flower gardens at Mustang Way Park. Smith reported that he had taken Supt. Reiter to the Brandon and Rowley Council meeting and the will be going to an Independence Council meeting, Rotary meeting and a Lions Club meeting for introductions. Supt Reiter said he will also be getting out into the community to introduce himself. He also wanted to thank the Board and central office staff for helping him get off to a good start in the district.
OLD BUSINESS A. IASB Legislative Priorities - Trimble moved to approve the following legislative priorities for the next year. Hansen second, motion carried 5-0. 1. Mental Health Funding (#7) 2. SAVE-Secure an Advanced Vision for Education: supports repealing the December 31 , 2029 sunset on statewide pem1y sales tax for school infrastructure. (#27) 3. Supplemental State Aid - setting supplemental state aid by set dates. (#20) 4. Preschool Funding (#3)
NEW BUSINESS A. Hard Rock Cafe Indianapolis Group Menu Agreement. Eddy moved to approve the Hard Rock Cafe Group Menu Agreement. Somson second. Motion failed 0-5 as the Board needed more information on the administration and gratuity fees.
B. Board Self-Assessment - Discussion of the Board Self-Assessment - those areas where the scores didn't align were due to the interpretation of the questions. After discussion the Board was in agreement of the assessments and they felt they worked well together and show a united front. The Board will work on scheduling some work sessions to establish goals and expectations for Supt. Reiter as well as some sessions to look at the board goal of achieving academic excellence. Supt. Reiter was glad to see the Board do the self assessment and it is evident that the Board keeps the students first.
ADJOURNMENT - Eddy moved, Somson second to adjoum at 7:54pm. Motion can-ied 5-0.
Eric Smith, Board President Laura Morine, Board Secretary Independence Community School Board Special Board Meeting July 23, 2018
A special meeting of the Independence Community School Board was called to order at 12:05 p.m. by Chaim1an Eric Smith at the Administration Building, Independence, Iowa on July 23,2018.
Members Present: Jennifer Samson Members Present Telephonically: Chairman Eric Smith and Kim Hansen Members Absent: Gina Trimble and Brian Eddy Board Secretary: Laura Morine
CONSIDERATION OF ACTION ON CONSENT ITEMS Motion by Samson, second by Hansen to approve the agenda. Motion carried 3-0.
OLD BUSINESS A. Hard Rock Cafe Indianapolis Group Menu Agreement - Motion by Samson, second by Hansen to approve the Hard Rock Cafe Indianapolis Group Menu Agreement with a 15% gratuity. Motion carried 3-0.
ADJOURNMENT - Hansen moved, Samson second to adjourn the meeting at 12:08 pm. Motion carried 3-0.
Eric Smith, Board President Laura Morine, Board Secretary Independence Community School Board Work Session August 13, 2018
A work session of the Independence Community School Board was called to order at 6:15p.m. by Chainnan Eric Smith at the Central Rivers AEA Building, Cedar Falls, Iowa on August 13, 2018.
Members Present: Eric Smith, Gina Trimble, Brian Eddy, Jennifer Somson and Kim Hansen Superintendent Present: Russell Reiter Board Secretary: Laura Morine
SUPERINTENDENT GOALS - Supt. Reiter reviewed the six Iowa Standards for School Leaders and discussed his personal goals and board goal for each of the standards for the upcoming year. These goals will be reviewed again in January or February.
ADJOURNMENT - Eddy moved, Hansen second to adjoum the meeting at 8:52pm. Motion carried 5-0.
Eric Smith, Board President Laura Morine, Board Secretary 3.C,.
Code No. 606.8
SCHOOL ASSEMBLY
The building principal may authorize programs or activities in the form of a school assembly when such events contribute to the achievement of education goals of the school district. School assemblies shall comply with the school calendar.
In authorizing a school assembly, the building principal shall consider the financial condition of the school district, the educational benefit of the activity, the inherent risks or dangers of the activity, and other factors the building principal or superintendent consider relevant.
Legal Reference: Iowa Code§§ 279.8; 280.3, .14 (2003).
Cross Reference: 504 Student Activities
Approved 111112004 Reviewed 05/27/2008 Revised ____ 03/18/2013
INDEPENDENCE COMMUNITY SCHOOL DISTRICT POLICY MANUAL Code No. 606.9
INSUFFICIENT CLASSROOM SPACE
Insufficient classroom space shall be determined on a case-by-case basis. In making its determination whether insufficient classroom space exists, the board may consider several factors, including but not limited to, the nature of the education program, the grade level, the available licensed employees, the instructional method, the physical space, student-teacher ratios, equipment and materials, facilities either being planned or under construction, facilities planned to be closed, financial condition of the school district and projected to be available, a sharing agreement in force or planned, a bargaining agreement in force, laws or rules governing special education class size, board-adopted school district goals and objectives, and other factors considered relevant by the board.
This policy shall be reviewed by the board annually. It shall be the responsibility of the superintendent to bring this policy to the attention of the board each year.
Legal Reference: Iowa Code § 282.18(13) (2003). 281 I.A.C. 17.6(3).
Cross Reference: 105 Long-Range Needs Assessment 501.15 Open Enrollment Transfers - Procedures as a Receiving District 606.2 Class Size - Class Grouping
Approved 1111/2004 Reviewed 05/27/2008 Revised ____ 03/18/2013
INDEPENDENCE COMMUNITY SCHOOL DISTRICT POLICY MANUAL Code No. 606.10
EARLY RELEASE FOR SENIORS
The school academic year for students shall be for a minimum of one hundred and eighty days 1,080 hours of instruction in the school calendar. Seniors may be excused up to five days 30 hours of instruction after they have met the district's requirements for graduation. The board may also excuse graduating seniors from making up days due to inclement weather if the student has met the school district's graduation requirements.
The superintendent has the authority to deny early release, or reduce the number of days for which graduating seniors may be excused, if a senior has failed to meet the requirements for graduation, as a form of discipline for an individual or for the class as a whole, or if the academic year has been disrupted by school closings for severe weather or other emergencies.
Legal Reference: Iowa Code§§ 20.9; 279.10 (2003). 281 LA.C. 12.2(1).
Cross Reference: 501 Student Attendance 601.1 School Calendar
Approved 11/1/2004 Reviewed 05/27/2008 Revised ---- 03/18/2013
INDEPENDENCE COMMUNITY SCHOOL DISTRICT POLICY MANUAL Code No. 607.1
STUDENT GUIDANCE AND COUNSELING PROGRAM
The board will provide a student guidance and counseling program. The guidance counselor will be certified with the Iowa Department of Education and hold the qualifications required by the board. The guidance and counseling program will serve grades pre-kindergarten through twelve. The program will assist students with their personal, educational, and career development. The program is coordinated with the education program and involves licensed employees.
Legal Reference: Iowa Code§ 280.14; 622.10 (2003). 281 I.A.C. 12.3(1 1).
Cross Reference: 506 Student Records 603 Instructional Curriculum 604.5 Program for At-Risk Students
Approved 11/ 1/2004 Reviewed 05/27/2008 Revised ___ _ 03/18/2013
INDEPENDENCE COMMUNITY SCHOOL DISTRICT POLICY MANUAL Code No. 607.2
STUDENT HEALTH SERVICES
Health services are an integral part of comprehensive school improvement assisting all students to increase learning, achievement, and performance. Health services coordinate and support existing programs to assist each student in achievement of an optimal state of physical, mental, and social well being. Student health services ensure continuity and create linkages between school, home, and community service providers. The school district's comprehensive school improvement plan, needs, and resources determine the linkages.
The superintendent, in conjunction with the school nurse, will develop administrative regulations implementing this policy.
Legal Reference: No Child Left Behind, Title II, Sec. 1061, P.L. 107-110 (2002). 42 U.S.C. §§ 12101 et seq. (1997). 20 U.S.C. 1232g § 1400 6301 et seq. (1997). 29 U.S.C. § 794(a)(1988) 28 C.P.R. 35 34 C.P.R. pt. 99, 104, 200, 300 et seq. (2002) Iowa Code§§ 22.7, 139A3 ..8, .21; 143.1 , 152, 256.7(24), .11, 280.23 (2003). 281 LAC. 12.3(4), (7), (11); 12.4(1 2); 12.8; 41.12(11), .96. 282 LAC. 15.3(14); 22. 641 I.AC. 7. 655 I.AC. 6, 6.3(1), 6.3(6), 6.6(1), 7.
Cross Reference: 501.4 Entrance - Admissions 507 Student Health and Well-Being
Approved 1111/2004 Reviewed 03/18/2013 Revised 05/27/2008
INDEPENDENCE COMMUNITY SCHOOL DISTRICT POLICY MANUAL Code No. 607.2Rl Page 1 of2
STUDENT HEALTH SERVICES ADMINISTRATIVE REGULATIONS
I. Student Health Services - Each school building may develop a customized student health services program within comprehensive school improvement based on its unique needs and resources. Scientific advances, laws, and school improvement necessitate supports to students with health needs to receive their education program.
A. Supports to improve student achievement include: 1. Qualified health personnel 2. School superintendent, school nurse, and school health team working collaboratively 3. Family and community involvement 4. Optimal student health services program with commitment to its continuing improvement
B. Components provided within a coordinated school health program include: 1. Health Services 2. Nutrition 3. Healthy, safe environment 4. Staff wellness 5. Health Education 6. Physical education and activity 7. Counseling, psychological, and social services 8. Family and community involvement
Student health services are provided to identify health needs; facilitate access to health care; provide for health needs related to educational achievement; promote health, well-being, and safety; and plan and develop the health services program.
II. Student Health Services Essential Functions
A. Identify student health needs: 1. Provide individual initial and annual health assessments 2. Provide needed health screenings 3. Maintain and update confidential health records 4. Communicate (written, oral, electronic) health needs as consistent with confidentiality laws
B. Facilitate student access to physical and mental health services: 1. Link students to community resources and monitor follow through 2. Promote increased access and referral to primary health care financial resources such as Medicaid, HAWK-I, social security, and community health clinics 3. Encourage appropriate use of health care
C. Provide for student health needs related to educational achievement: 1. Manage chronic and acute illnesses 2. Provide special health procedures and medication including delegation, training, and supervision of qualified designated school personnel
INDEPENDENCE COMMUNITY SCHOOL DISTRICT POLICY MANUAL Code No. 607.2R1 Page 2 of2
STUDENT HEALTH SERVICES ADMINISTRATIVE REGULATIONS
3. Develop, implement, evaluate, and revise individual health plans (IHPs) for all students with special health needs according to mandates in the Individuals with Disabilities Education Act (IDEA), Rehabilitation Act (Section 504), and Americans with Disabilities Act (ADA) 4. Provide urgent and emergency care for individual and group illness and injury 5. Prevent and control communicable disease and monitor immunizations 6. Promote optimal mental health 7. Promote a safe school facility and a safe school environment 8. Participate in and attend team meetings as a team member and health consultant
D. Promote student health, well-being, and safety to foster healthy living: 1. Provide developmentally appropriate health education and health counseling for individuals and groups 2. Encourage injury and disease prevention practices 3. Promote personal and public health practices 4. Provide health promotion and injury and disease prevention education
E. Plan and develop the student health services program collaboratively with the superintendent, school nurse, and school health team: 1. Gather and interpret data to evaluate needs and performance 2. Establish health advisory council and school health team 3. Develop health procedures and guidelines 4. Collaborate with staff, families, and community 5. Maintain and update confidential student school health records 6. Coordinate program with all school health components 7. Coordinate with school improvement 8. Evaluate and revise the health service program to meet changing needs 9. Organize scheduling and direct health services staff 10. Develop student health services annual status report 11. Coordinate information and program delivery within the school and between school and major constituents 12. Provide health services by qualified health professionals to effectively deliver services, including multiple levels of school health expertise such as registered nurses, physicians, and advanced registered nurse practitioners 13. Provide for professional development for school health services staff
III. Expanded Health Services - These additional health services address leaming barriers and the lack of access to health care. Examples include school-based services in the school, school-linked services connected to the school, primary care, mental health, substance abuse, and dental health.
INDEPENDENCE COMMUNITY SCHOOL DISTRICT POLICY MANUAL Code No. 607.3
MUSICAL INSTRUMENT DISPLAY NIGHT
Annually, as a service to students and their parents, the board may hold a musical instrument display night. The event is designed to provide an opportunity for students and their parents to view, purchase, or rent musical instruments and accessories if they desire.
This policy does not require students and parents to purchase musical instruments from the vendor displaying at this event. This policy shall not limit a student's participation in the band or require a student to participate in band or other activities involving musical instruments.
It shall be the responsibility of the superintendent to develop guidelines regarding the qualifications a vendor must meet to display at this event. Vendors, invited by the teacher, must meet those qualifications.
Legal Reference: Iowa Code § 280.14 (2003). 1980 Op. Att'y Gen. 580.
Cross Reference: 504 Student Activities 906 Use of School District Facilities & Equipment
Approved 11/1 /2004 Reviewed 05/27/2008 Revised ---- 03/18/2013
INDEPENDENCE COMMUNITY SCHOOL DISTRICT POLICY MANUAL Code No. 607.4
CLASS RING DISPLAY
Annually, as a service to students and their parents, the board may provide a class ring display for students in grades nine through twelve. The service is designed to provide an opportunity for students and their parents to view class rings and accessories.
This policy does not require students or parents to purchase class rings from the vendor displaying at the school.
It shall be the responsibility of the superintendent to develop guidelines regarding the qualifications a vendor must meet to display at this event. Vendors are chosen by the principal and must meet the qualifications established by the superintendent.
Legal Reference: Iowa Code § 280.14 (2003). 1980 Op. Att'y Gen. 580.
Cross Reference: 504 Student Activities 906 Use of School District Facilities & Equipment
Approved 11/1/2004 Reviewed 05/27/2008 Revised ____ 0311 8/2013
INDEPENDENCE COMMUNITY SCHOOL DISTRICT POLICY MANUAL Code No. 606.5
ANIMALS IN THE CLASSROOM
Live animals will not be allowed in school district facilities except under special circumstances and only for an educational purpose. Permission from the principal will be required of anyone wishing to bring an animal into school district facilities. Appropriate supervision of animals is required when animals are brought into the school district facilities.
The person bringing the animal must furnish transportation for the animal brought to school. Animals will not be allowed to travel to and from the student's attendance center on the school bus without prior approval from the principal.
It shall be the responsibility of the principal to determine appropriate supervision of animals in the classroom. This policy is not intended to address the use ofservice animals, assistive animals, therapy animals or emotional support animals on district property.
Legal Reference: Iowa Code§ 279.8 (2003).
Cross Reference: 507 Student Health and Well-Being
Approved 11 /1/2004 Reviewed 05/27/2008 Revised ____ 02115/2013 05/21/2018
INDEPENDENCE COMMUNITY SCHOOL DISTRICT POLICY MANUAL Code No. 710.1
SCHOOL NUTRITION PROGRAM
The school district will operate a school nutrition program in each attendance center. The school nutrition program will include meals through participation in the National School Lunch Program. Students may bring their own food from home and purchase milk and other incidental items.
School nutlition program facilities are provided to serve students and employees when school is in session and during school-related activities duling the school day. They may also be used under the supervision of the Director of Food Service for food service to employee groups, parent-teacher meetings, civic organizations meeting for the purpose of better understanding the schools, and senior citizens in accordance with law and board policy.
The school nutlition program is operated on a nonprofit basis. The revenues of the school nutrition program will be used only for the operation or improvement of such programs. Supplies of the school nutrition program shall only be used for the school nutlition program.
The board will set, and annually review, the prices for school nutlition programs. It is the responsibility of the superintendent to make a recommendation regarding the prices of school nutlition programs, in accordance with federal and state law.
It is the responsibility of Director of Food Service to administer the program and to cooperate with the superintendent and appropriate personnel for the proper functioning of the school nutrition program.
The district shall comply with all federal and state laws and regulations required for procurement, including the selection and evaluation of contractors. The superintendent or designee is responsible for developing an administrative process to implement this policy, including, but not limited to, procedures related to suspension and debarment for transactions subject to those requirements.
Legal Reference: 42 U.S.C. §§ 1751 et seq.. 7 C.F .R. Pt. 210 et seq.. Iowa Code ch. 283A. 281 I.A.C. 58.
Cross Reference: 710 School Food Services 710.2 Free or Reduced Cost Meals Eligibility 710.3 Vending Machines 710.4 Meal Charge Policy 906 Use of School District Facilities and Equipment
Approved 1111 /2004 Reviewed 01 / 19/2015 Revised 12/21 /2009 06/19/2017
INDEPENDENCE COMMUNITY SCHOOL DISTRICT POLICY MANUAL 3.G,.
Independence Community School District Vendor Totals Report by Fund Page: 1 08/15/2018 3:20 PM 07/01 /2018 - 07/31 /2018 User ID: ARL
Fund: 10 OPERATING FUND
V~ngor Name Description Total ACCENT LASER SERVICES SUP/EQUIP 684.60 AHLERS AND COONEY, PC. SERVICES 364.00 AMAZON CAPITAL SERVICES SUPPLIES 537.66 AMES CSD TUIT 2,358.55 ASCD SUP/SRV 89.00 BRYAN HEAVY EQUIPMENT EQUIP 46.23 BUCHANAN COUNTY AUDITOR SERVICE 917.16 CEDAR FALLS COMM. SCHOOLS OE TUITION 92,118.00 CEDAR RAPIDS CSD REIM/TUIT/FEES 4,716.81 CENTER POINT-URBANA CSD INSTRUCTION 23,719.92 CENTRAL RIVERS AEA SUP/SRV 605.00 CITY LAUNDERING CO SRV/SUP 568.24 CONSOLIDATED ENERGY COMPANY DIESEL/GASOLINE 3,492.60 CULLIGAN TOTAL WATER MONTICELLO lA SUPPLIES 221.42 CY & CHARLEY'S INC REPAIRS/MAl NT/SUP 40.00 DHS CASHIER 1ST FLOOR MEDICAID 4,413.09 DISCOUNT SCHOOL SUPPLY SUPPLIES 184.99 DUBUQUE COMMUNITY SCHOOLS TUITION 28,713.60 EAST BUCHANAN CSD REIMB/FEESITUIT 33,299.62 ELECTRICAL ENGINEERING & EQUIP SUPIIMPROV 799.79 ESCHEN TARPY NAPA SUP/EQUIP 1,072.14 FBO-ADMIN REGISTRATION-ANDREA LYNN CHANGE 400.00 FUSION FORWARD SERVICES 3,960.00 HAUSERS WATER SYSTEM SUPPLIES 16.50 HAWKEYE FIRE & SAFETY SUP/SRV 132.00 HEARTLAND PAPER COMPANY SUP/EQUIPMENT 34.93 HERFF JONES SUPPLI ES 42.50 HOUCHEN BINDERY INC BOOK BINDING 1,469.75 I.C.S. ACTIVITY FUND REIMBURSEMENT 9,998.96 IASB DUES/FEES 5,114.00 INDEPENDENCE CHAMBER AMBASSADORS DUES/FEES 49.50 INDEPENDENCE CHIROPRACTIC CENTER SRV 190.00 INDEPENDENCE LIGHT & POWER UTILITIES 39,681 .64 INFRASTRUCTURE TECH SOLUTIONS SRV/EQUIP 500.00 IOWA CITY CSD TUITION 477.00 ISFIS INC SERVICES 110.00 JENKINS, MINDY REIMBURSEMENT 45.42 JESUP CSD TUIT/FEES/REIMB 8,290.23 JOBLINSKE, TORI REIMBURSEMENT 35.80 JOHN DEERE FINANCIAL SUP/SRV/EQUIP 24060 LYNN, ANDREA REIMBURSEMENT 50.69 MARCO INC SUP/LEASE 3,731 .33 MARION JANITORIAL SUPPLIES 197.45 MAXIMOVICH, VALERIE REIMBURSEMENT 61.23 MIDAMERICAN ENERGY CO. NATURAL GAS 72.41 MILLER QUARRY IMPROVEMENT 708.22 O'REILLY AUTOMOTIVE, INC. SUPPLIES 69.17 OELWEIN PUBLISHING COMPANY ADS/LEGALS 1,183.29 Independence Community School District Vendor Totals Report by Fund Page: 2 08/15/2018 3:20 PM 07/01/2018 - 07/31/2018 User ID: ARL
Fund: 10 OPERATING FUND
Vendor Name Description Total PERMA BOUND SUPPLIES 238.34 PINEAPPLE APPEAL, INC. SUPPLIES 94.84 PRINT EXPRESS-MILLER PRINTERIE SRV/SUP 41.00 PROJECT LEAD THE WAY SUPPLIES 3,000.00 READING READING BOOKS LLC SUPPLIES 493.24 REITER, RUSSELL REIMBURSEMENT 5,000.00 SAFARI MONTAGE SOFTWARE 15,243.80 SAWSTOP, LLC SUPPLIES 291 .00 SCHOOL ADMINISTRATORS OF IOWA SERVICES 3,858.00 SCHOOL BUS SALES VEHICLE/SUPPLIES 836.24 SHERWIN WILLIAMS SUPPLIES 10.39 SIGNS AND MORE SUP/IMPROV 463.36 SPAHN & ROSE LUMBER CO INC SUP/IMPROV/EQUIP 733.93 STATE CHEMICAL SOLUTIONS SUPPLIES 216.72 SUPERIOR CLEANING SERVICES LTO SERVICE 10,091 .22 SUPERIOR WELDING INC SUPPLIES 40.00 THOMAS BUS SALES, INC. SUPPLIES 25.49 THOMPSON TRUCK AND TRAILER EQUIPMENT 532.49 TIMBERLINE BILLING SERVICES LLC SERVICES 373.00 U.S. CELLULAR TELEPHONE 563.36 UNION CSD TUIT/FEES/REIMB 202.32 UNITED STATE TREASURY SRV 397.76 VERN'S TRUE VALUE SUPPLIES 697.37 VINTON-SHELLSBURG CSD TUIT/FEES/REIMB 15,755.26 VISA CARD SERVICES SUPPLIES 3,31 1.11 WALMART COMMUNITY SUPPLIES 169.73 WASTE MANAGEMENT OF WI-MN SERVICE 3,767.96 WATERLOO CSD OE TUITION 37.02 WAVERLY-SHELL ROCK SCHOOL REG/FEESITUIT 30,703.86 Vendors Listed: 77 Total: 373,013.85 Independence Community School District Vendor Totals Report by Fund Page:3 08/1 5/2018 3:20 PM 07/01/2018 - 07/31/2018 User ID: ARL
Fund: 21 STUDENT ACTIVITY FUND
Vendor Name Description Total A & P FOOD EQUIPMENT SUPPLIES 62.56 A TEAM APPAREL SUPPLIES 80.00 BERGMAN, ROBERT OFFICIAL 29.43 BONWELL, MIKE OFFICAL 110.00 BRODBECK, DENNE OFFICIAL 11 0.00 BSN SPORTS SUP/EQUIPMENT 2,262.38 DANIELS, DENNIS OFFICIAL 85.00 DEKE, SONNY OFFICIAL 85.00 FBO SOFTBALL - ANDREA LYNN MEALS 375.00 FEDERER, MIKE OFFICIAL 110.00 FROST, JOE OFFICIAL 85.00 GROEN, GENE OFFICIAL 305.00 HADEN, MICHAEL REIMBURSEMENT 177.00 HERMSEN, ALLAN OFFICIAL 100.00 HUDL SRV/SUP 2,599.00 HUDSON HIGH SCHOOL DUES AND FEES 80.00 I. C.S. GENERAL FUND REIMBURSEMENT 2,158.38 IOWA GIRLS' HS ATHLETIC UNION SUP/REG FEES 5,064.00 JOHNSON, MICHAEL OFFICAL 110.00 KLEIN, DAN OFFICIAL 110.00 LINK, RANDY OFFICIAL 100.00 MADISON, CLARK OFFICIAL 255.00 MATTHIAS, MAX OFFICIAL 110.00 MAXIMOVICH, VALERIE REIMBURSEMENT 9.59 MAY E, BRENDAN OFFICIAL 170.00 MURPHY, BOB OFFICIAL 85.00 NASSP SERVICE 95.00 NIEHAUS, JEFF OFF I CAL 320.00 OLSON, ERIC OFFICIAL 110.00 PATRICK, TROY OFFICIAL 790.00 PAYNE, DAYN OFFICIAL 353.94 PHILLIPS, MARK OFFICIAL 110.00 REED, CHERIL YN REIMBURSEMENT 71.00 RESILITE SPORTS PRODUCTS EQUIP 13,114.00 SIGNS A ND MORE SUP/IMPROV 292.50 SNYDER, GLEN OFFICIAL 11 0.00 SOUTH TAMA COUNTY MIDDLE SCHOOL ENTRY FEE 120.00 STANEK, RANDY OFFICIAL 110.00 STEFFEN, PHILIP OFFICIAL 255.00 TEE, JARED OFFICIA L 220.00 TURNER, CHRIS OFFICIAL 110.00 VISA CARD SERVICES SUPPLIES 12.80 WALMART COMMUNITY SUPPLIES 31 .59 WATKINS, MIKE OFFICIAL 110.00 WAVERLY-SHELL ROCK H.S. SUPPLIES 110.00 WRIGHT, KYLE OFFICIAL 170.00 Vendors Listed : 46 Total: 31,443.1 7 Independence Community School District Vendor Totals Report by Fund Page: 4 08/15/2018 3:20 PM 07/01 /2018 - 07/31 /2018 User ID: ARL
Fund: 22 MANAGEMENT FUND
Vendor Name Description Total AUL Health Benefits Trust EMPLOYEE INVESTMENTS 33,804.69 AUL Special Pay Trust EMPLOYEE INVESTMENTS 25,629.75 IOWA WORKFORCE DEVELOPMENT SERVICES 42.26 SMITH - D & L INSURANCE SERVICES 234,673.50 WAVERLY-SHELL ROCK SCHOOL REG/FEES/TUIT 460.82 Vendors Listed : 5 Total: 294,611 .02 Independence Community School District Vendor Totals Report by Fund Page: 5 08/15/2018 3:20 PM 07/01/2018 - 07/31 /2018 User ID: ARL
Fund: 33 LOCAL OPTION SALES AND SERVICES TAX
Vendor Name Description Total CEDAR FALLS COMM. SCHOOLS OE TUITION 8,408.76 FRONTLINE TECHNOLOGIES GROUP LLC SOFTWARE 5,380.00 SPAHN & ROSE LUMBER CO INC SUP/IMPROV/EQUIP 72.00 WAVERLY-SHELL ROCK SCHOOL REG/FEES/TUIT 7,463.84 Vendors Listed: 4 Total: 21,324.60 Independence Community School District Vendor Totals Report by Fund Page: 6 08/15/2018 3:20 PM 07/01/2018 - 07/31 /2018 User ID: ARL
Fund: 36 PHYSICAL PLANT & EQUIPMENT Vendor Name Description Total COMPANION CORPORATION SUPPLIES 3,385.00 FILEMAKER, INC. SUPPLIES 3,711.00 HELPER HELPER SOFTWARE 1,083.00 INFRASTRUCTURE TECH SOLUTIONS SRV/EQUIP 5,248.00 ISFIS INC SERVICES 2,106.42 KAMI SOFTWARE 5,500.00 MARCO INC SUP/SRV/EQUIP 2,147.49 MOOSE MECHANICAL SRV 6,080.11 MOSYLE CORP SOFTWARE 4,400.00 PSNI SFTWARE/SUP 840.00 R & E REAL ESTATE LLC LEASE 1,200.00 SPAHN & ROSE LUMBER CO INC SUP/IMPROV/EQUIP 2,371 .69 VISA CARD SERVICES SUPPLIES 480.18 Vendors Listed: 13 Total: 38,552.89 Independence Community School District Vendor Totals Report by Fund Page: 7 08/1 5/2018 3:20PM 07/01/2018 - 07/31/2018 User ID: ARL
Fund: 61 SCHOOL NUTRITION FUND Vendor Name Description Total ACCOUNT LIQUIDATION SERVICES SRV 26.00 BIMBO BAKERIES USA BREAD 1,184.09 HEARTLAND PAYMENT SYSTEMS INC SFTWARE/EQUIP 425.00 MARTIN BROS DIST CO SUPPLIES 19,875.01 VISA CARD SERVICES SUPPLIES 178.08 Vendors Listed: 5 Total: 21 ,688. 18 Independence Community School District Board Report For Packet Page: I 0811 5/20 18 3: 19PM AUGUST 2018 BOARD BILLS UseriD: ARL Vendor Name Vendor Description Checking 1 Checking 1 Fund: 10 OPERATING FUND AABLE PEST CONTROL SRV Vendor Total: 110.00 ACCENT LASER SERVICES SUP/EQUIP Vendor Total : 1,889.00 ADVANCE AUTO PARTS SUPPLI ES Vendor Total: 59.23 AHAZON CAPI TAL SERVICES SUPPLIES Vendor Total: 5,147.40 ANDERSON , ALLISON REINBURSEMENT Vendor Total : 68.92 BLICK ART MATERIALS SUPPLIES
Vendor Total: 200.52 BMI EDUCATIONAL SERVICES INC BOOKS Vendor Total : 203.64 BOUBIN TIRE CO INC SUPPLIES
Vendor Total: 341.66 BSN SPORTS SUP/EQUIPNENT
Vendor Total: 87.28 BUCHANAN COUNTY ISU EXTENSION & SRV OUTREACH Vendor Total: 4 , 668.25 CENTRAL RIVERS AEA SUP/SRV Vendor Total: 1,366.00 CITY LAUNDERING CO SRV/SUP Vendor Total: 688 . 16 CONSOLIDATED ENERGY COMPANY DIESEL/GASOLINE Vendor Total : 3 , 816 . 86 CULLIGAN TOTAL WATER !·lONTICELLO IA SUPPLIES
Vendor Tota l: 950 . 75 CY & CHARLEY'S INC REPAIRS/MAINT/SUP
Vendor Total : 1 7 6.00 D;:..HL , DAN REIHBURSEMENT
Vendor Total: 226.60 DENCO INC SUP/EQUIP
Vendor Total: 254.03 DES MOI NES AIRPORT HOL I DAY INN TRAVEL
Vendor Total : 2 03.84 ELECTRICAL ENGINEERING & EQUI P SUP/IMPROV
Vendor Total : 513 . 49 ESCHEN TARPY NAPA SOP/EQUIP vendor Tota l: 85. 91 FASTENAL COHPANY SUPPLIES Vendor Total: 1 23.44 FBO WEST LIBRARY PETTY CASH - CHANGE VIRGINIA LAKE Vendor Tot a l : 5 0 .00 GOPHER SPORT SUPPLIES Vendo r Total : 2, 5 93 . 19 HARDWARE HANK SUPPLIES Ve ndor To t a l : 9.98 HAUSERS WATER SYSTEH SUPPLIES Independence Community School District Board Report For Packet Page: 2 08/ 15/2018 3:19 PM AUGUST 2018 BOARD BILLS User ID: ARL Ve ndor Name Vendor Desc ription
Vendor Total: 16.50 HAWKEYE ALAR!'! SIGNAL COMPANY SERVICES Vendor Total: 250.00 HEARTLAND PAPER COMPANY SUP/EQUIPMENT Vendor Total: 5,472 . 91 I ASB DU ES / FEES Vendor Total: 140.00 INDEPEN DENCE BULLETIN JOURNAL SUPPLIES Vendor Total: 142 . 00 INDEPENDENCE CHIROPRACTIC CENTER SRV Vendor Total: 190 . 00 INDEPENDENCE LIGHT & POWER UTILITIES Vendor Total: 34,001.23 INFRASTRUCTURE TECH SOLUTIONS SRV/EQUIP Vendor Total: 1,430 . 00 I OWA FUTURE PROBLEN SOLVING REG FEES Vendor Total: 225.00 I OWA WORKFORCE DEVELOPME NT SERVICES Vendor Total: 165 .00 JOHN DEERE FINANCIAL SUP/SRV/EQUIP Vendor Total: 25.86 KNACKK, TIM AND JESSICA REIMBURSEMENT Vendor Total: 1,257.02
LAKE, VI RGINIA RE IMBURSE~1ENT Vendor Total: 340.19 LOUGHREN , BRIAN REIMB URSEMENT Vendor Total : 25.00 MARCO I NC SUP/SRV/EQUIP Vendor Total: 247.50 MARCO INC SUP/LEASE Vendor Total: 642.41 MARION JANITORIAL SUPPLIES Vendor Total: 363 . 60 HCGRAW HILL CONPANIES SUPPLIES Vendor Total: 9,497 . 93 l'lCG RAW' S CARPETS I MPROVE!1ENT Vendor Total : 72.00 MIDANERICAN ENERGY CO. NAT URAL GAS Vendor Total : 86.60 HOOS E MECHANICAL SRV Vendor Total : 1,960.00 WT!4D DRI VING SCHOOL LLC SRV Vendor Total : 4,304 .00 NASCO SUPPLIES Vendor Total: 21.00 NORTHWEST EVAL UATION ASSOCIATION TESTI!IG SERVICES Vendor Total: 13,875.00 OELWEIN PUBLISHING C0!1PANY ADS/LEGALS Vendor Total : 1,622.21 OFFICE DEPOT, INC SUP/EQU IP Vendor Total: 4 ,307 . 91 Independence Community School District Board Report For Packet Page: 3 0811512018 3:19PM AUGUST 2018 BOARD BILLS User!D: ARL vendor Name Vendor Descri ption PEARSON EDUCAT I ON INC SUPPLIES Vendor Total : 76.98 PIONEER VALLEY BOOKS SUPPLIES Vendor Total: 99.83 POSITIVE ACTI ON INC SUPPLIES Vendor Total: 7 , 050.00 PRINT EXPRESS-MILLER PRI NTERIE SRV/ SUP Vendor Total : 103.00 REALLY GOOD STUFF SU PPLIES Vendor Total: 526.74 RENAISSANCE LEARNING , INC . SU P/EQUI P Vendor Total: 4,215.50 RICOH USA INC SUP/LEASE Vendor Total : 4,453 . 02 RITE PRICE OFFICE SUPPLY INC S UP PLIES Vendor Total : 644.67 SCHOLASTIC INC SUPPLIES Vendor Total : 192.28 SCHOLASTIC INC SUPPLIES Vendor Total: 274.61 SCHOOL BUS SALES VEHICLE / SUPPLIES Vendor Total: 105.00 SCHOOL OUTFI TTERS SUP/EQUIP Vendor Total : 296.18 SCHOOL SPECI ALTY/CLASSROOM DIRECT SUP/EQUI P Vendor Total: 2,291.86 SIGNS AND MO RE SUP/IMPROV Vendor Total: 2,656.82 SPAHN & ROSE LUMBER CO INC SUP/IMPROV/EQUIP Vendor Total: 324.31 STEINBROH, KRISTAN REIMBURSEMENT Vendor Total : 454.01 SUPERIOR CLEANING SERVICES LTD SERVICE Vendor Total: 22 , 950.52 TEACHER DIRECT SUPPLIES Vendor Total: 338.80 TEACHER'S DISCOVERY SUPPLIES Vendor Total: 50.95 THOME , SARA REIHBURSEMENT Vendor Total : 50 . 00 U.S . CELLULAR TELEPHONE Vendor Total : 139.55 VERN 'S TRUE VALUE SUPPLIES Vendor Total : 1 , 009.32 VI SA CARD SERVICES SUPPLIES Vendor Total: 5, 624.02 WALKER, TPJWIS REIMBURSEI>!ENT Vendor Total: 50.33
WASTE t~ANAGEMENT OF WI- !~N SERVICE Vendor Total : 2,673 . 53 WELLS FARGO VEHDOR SUP/LEASE Independence Community School District Board Report For Packet Page: 4 081l5/2018 3:19PM AUGUST 2018 BOARD BiLLS UserlD: ARL Vendor Name Vendor Description Vendor Total: 2,727.54 Fund Total: 163,894.39 Checking 1 Fund: 22 MANAGEMENT FUND AUL Health Benefits Trust EMPLOYEE INVESTMENTS Vendor Total: 2,160.94 Fund Total: 2,160.94 Checking 1 Fund: 71 PARTIAL SELF-FUNDING PLAN FUND WELLHARK BLUE CROSS BLUE SHIELD OF SERVICE IA Vendor Total: 1,730. 00 Fund Total: 1,730.00 Checking Account Total: 167,785.33 Checking 2 Checking 2 Fund: 61 SCHOOL NUTRITION FUND ACE REFRIGERATION INC SRV Vendor Total: 2,294 . 47 EMS DETERGENT SERVICES SUPPLIES Vendor Total: 1,010.55 HARBAUGH, ANNETTE REIMBURSEMENT Vendor Total: 210 . 00 OFFICE TOWNE , INC. SUP/EQUIP Vendor Total: 293.68 RAPIDS WHOLESALE EQUIPMENT CO. EQUIP/SUP Vendor Total: 2,822 . 35 Fund Total : 6, 631.05 Checking Account Total: 6,631.05 Checking 3 Checking 3 Fund: 21 STUDENT ACTIVITY FUND AJ.!hZON ChPITAL SERVICES SUPPLIES Vendor Total: 117.26 BLAND'S FLOWER SHOP I NC FLOWERS Vendor Total: 57.00 BRITThiN, CHhRLES OFFICIAL Vendor Total: 375.00 BSN SPORTS SUP/EQU IPMENT Vendor Total: 1,100.00 GREENLEY LU MBER INC SUPPLIES Vendor Total : 374.15 HADEN, NICHAEL REH1BURSEHENT Vendor Total: 353.62 IOWA SPORTS SUPPLY INC SUPPLIES Vendor Total: 536.25 J I LL MARIE PHOTOGRAPHY SRV Vendor Total: 796.00 PORTA PHONE CO SUPPLIES Vendor Total: 669.50
RJS MOTORSPORTS & WEL DING Il~PROV E t·! EN T Vendor Total: 300.00 SCHENCK , DhVE OFFICIAL Vendor Total: 110 . 00 STOUT SEED IHPROVEMENT Vendor Total : 79.20 Independence Community School District Board Report For Packet Page: 5 08/15/2018 3:19 PM AUGUST 2018 BOARD BILLS User !D: ARL Vendor Name Ve ndor Description STUTZMAN ' S BUGGY SHOP SUPPLIES
Vendor Total: 934 . 31 VI SA CARD SERVICES SUPPLIES .
Vendor Total: 1,818.35 Fund Total: 7,620.64 Checking Account Total: 7 , 620 . 64 Che cking 4 Checking 4 Fund: 33 LOCAL OPTION SALES AND SERVICES TAX BLUE SKY SOLAR It1PROV EMEN T
Vendor Total : 3,575.00 CANVAS BY I NSTRUCTURE SFTWARE Vendor Total: 10,945 . 00 CUSTO!'l CONCRETE LLC IMPROVEr-lENT
Vendor Total: 34,497.00 MIDWEST COMPUTER PRODUCTS,INC SUP/EQUI P Vendor Total: 23 , 728.64 HILLER QUARRY H1PROVEMENT
Vendor Total: 2,241.79 TANGIBLE PLAY INC SUPPLIES
Vendor Total: 990 . 00 VARSITY GROUP EQUIPMENT
Vendor Total: l3,750.00 Fund Total : 89,727 . 43
Checking 4 Fun d: 36 PHYSICAL PLANT & EQUIPMENT AMAZON CAPITAL SERVICES SUPPLIES
Vendor Total: 2,996 . 00 APPLE INC EQUIP/SUP/SRV
Vendor Total: 82,535 . 00 CDI'I GOVERN NENT LLC SUP / EQUIP
Vendor Total: 4 , 873.70 ELECTRICAL ENGINEERING & EQUIP SUP/IMPROV
Vendor Total: 5 , 970 . 38 GRINNELL COMHUN I TY SCHOOLS EQUIP Vendor Total: 500.00 INFRASTRUCTURE TECH SOLUTIONS SRV/EQUIP
Vendo:r: Total: 68 , 172 . 00 HOOSE MECHANICAL SRV Vendo:r: Total: 6 , 087.50 R & E REAL ESTATE LLC LEASE
Vendo:r: Tot al : 1,200.00 SCHOOL BUS SALES VEHICLE/SUPPLIES
Vendor Total : 112 , 049.00 SPAHN & ROSE LU!•IB ER CO INC SUP/UIPROV/EQUIP
Vendo:r: Total: 607.03 WELTER STORAGE EQUIP CO SU PPLIES
Vendo:r: Total: 1,074.00 WEST INTERACTIVE SERVI CES CORP SRV
Vendor Total: 6,361.80 Fund Total: 292,426 . 41 Checking Account Total: 382 , 153 . 84 Account Number Ending In: XXXX XXXX XXXX 2575 BANKIOWA PO BOX 419734 KANSAS CITY MO 64141-6734 VISA
Please Detach And Enclose Top Portion With Payment New Balance Payment Due Date Past Due Amount Minfllum Payment Amount Enclosed 7,442.37 a8128t18 o.oo 7.442.37 l...._s ______,
Make Check Payable To: 0 Please check box ff making address change as Card Services indicated on the back
CO NTROL A CCOUN T Ca r d Servi c es INDEPENDEN CE CO HH SC P O Bo x 875 6 52 1207 1ST ST W Kan sas City MO 64187 - 5852 I NDEP ENDENCE I A 506 44 -2375 ltl' olol th'llfl'l'tl"f"llllful•ln•lwt1"'1i'·""'lll'lu' tlf lololofftl flo lot•Hfllltflflf•f•lltl•f•loffloflflf•lftfft lfo lt
Ac count Number Ending In· XXXX XXXX XXXX 2575 Summary of Account Activity Payment lriformatlon
Previous Balance $ 7,531.07 Statement Closing Date 08103/18 · Payments 7,531.07 Other Credits 2,605.39 New Balance 7,442.37 Purchases/DebHs + 10,047.76 Minimum Payment Due 7.442.37 Cash Advances + 0.00 Payment Due Date 08128/18 Finance Charges + 0.00 Past Due Amount 0.00 New Balance 7.442.37
Credit Limit 50,000.00 Available Credit 42,046.00
An amount foHowed by a minus{-) is a credit or a credit balance, unless otherwise Indicated.
PAYMENT ADDRESS ACCOUNT INQUIRIES A ND SANK IOWA CARD SERV ICES LOST STOLEN CARDS PO BOX 419734 PO BOX 875852 800·821-5184 KANSAS CITY MO 64141 -6734 KANSAS CITY, MO 64187-5852 816·843-2000 IN KANSAS CITY Telephoning a bout billing errors wiH not preservo your rights under federal law. See the Billing Rights Summary on the reverse side.
Your rewards balance is: 384.455 Points
The above rewards balance may not reflect aU
transaction activity included on this statement.
Vtsit www.rev.ards.umb.com to get your current
rewards balance and redeem )'OlK rewards.
You ITIBY also call855-861-2162.
I Transaction Information I
Transaction Post1ng Reference Purchases , Cash Advances. Payments, Credrts Amount Date Dale Numbe.r and Adjustments smce last statement TOTAL )()()()( )()()()( )()()()( 2575 $7,531.07- 07118 07118 7471562JREHM92FLT CK PAYMENT THANK YOU KANSAS CITY MO 7,531.07- WEST ELEMENTARY TOTAL )()()()( XXXX XXXX 3481 $80.23 07/12 07/12 2405523JH2DYKKK1W WAL MART.COM 8009666546 800-966-6546 AR 55.25 MCC: 5310 MERCHANT ZIP: 72716 07115 07116 2405523JL20YKKK23 WALMART.COM 8009666546 800-966-6546 AR 7.98 MCC: 5310 MERCHANT ZI P: 72716 07/26 07/27 2449215JZLS206DTM TEACHERSPAYTEACHERS.COM 646-588-0910 NY 17.00 MCC: 8299 MERCHANT ZIP: 100 03 EAST ELEMENTARY TOTAL )()()()( )()()()( )()()()( 3499 $725.16 07104 07105 2405523J92DL8Q7NT WALMART.COM 8009666546 800-966-6546 AR 76.99 MCC: 5310 MERCHANT ZIP: 72716 07104 07105 2469216J92XMVQ4TG WALMART.COM 800-~546AR 334.45 MCC: 5310 MERCHANT ZIP: 72712 07130 07/31 2449215K3LRDAS2TN OFFICESUPPLY.COM 866-302-5397 WI 313.72 MCC: 5111 MERCHANT ZIP: 53925 LAURAJ MORINE TOTAL )()()()( )()()()( )()()()( 3705 $662.37 07/13 07115 2469216JJ2XM1DVAK REI'GREENWOODHEINEMANN 800-225·5800 NH 622.38 MCC: 5942 MERCHANT ZIP: 03801 07/28 07/ 30 2441289K20FY6Y7FS ITECH 319-268-8324 TX 39.99 MCC: 5045 MERCHANT ZIP: 50613 INDEPENDENCE JSH TOTAL )()()()( )()()()( )()()()( 9556 $5,974.61 07/02 07/04 2490641J71M6TOKMH NASSP Product & Service 703-8600200 VA 385.00 MCC: 8699 MERCHANT ZIP: 20191 07/06 07/06 2469216JB2XFLHSOZ AUTOMOTIVE EQUIPMENT S 81 8-268-9963 CA 3,680.00 MCC: 5533 MERCHANT ZIP: 91504 07/06 07/06 2469216JB2XK6SK2A BARNES&NOBLE.COM-BN 800-84 3-2665 NY 97 .65 MCC: 5192 MERCHANT ZIP: 11590 07/09 07/10 2449215JEJHMOEASW DRAKE WBB CAMPS 5155989540 lA 525.00 MCC: 7032 MERCHANT ZIP: 50010 Continued on nexl page Account Number Ending In: XXXX XXXX XXXX 2575
I Transaction Information Continued I
Transaction Post1ng Reference Purchases, Cash Advances, Payments, Cr€-dJts Amount Dale Date Num ber and Adjustments smce last statement 07/09 07/10 7469216JE2XABOF4Q BARNES&NOBLE.COM-BN 800-843- CREDIT 6.39- MCC: 5192 MERCHANT ZIP: 11590 07/16 07/17 2449215JMJHWP2PSV HUDL HTTPSWWW.HUDL NE 2.599.00 MCC: 5734 MERCHANT ZIP: 68508 07116 07/17 2469216JM2X93AV4M OMNI CHEER 800-299·7822 CA 78.00 MCC: 5655 MERCHANT ZIP: 92128 07117 07/19 2427074JPS66JRXWR SPORTS PAGE FT DODGE FORT DODGE lA 359.83 MCC: 5814 MERCHANT ZIP: 07/23 07/24 7449215JXJH86SPJ1 HUDL 40281700 CREDIT 2,599.00- MCC: 5734 MERCHANT ZIP: 68508 07125 07/26 2469216JY2X55Z5HH IN •cHEER BUTTONS & BOWS 262-3088403 WI 564.32 MCC: 5999 MERCHANT ZIP· 53128 07/29 07131 2469216K42XTF1 DEW AMERICINN JOHNSTON JOHNSTON lA 72.80 MCC: 3614 MERCHANT ZIP: 50131 LODGING CHECK-IN DATE: 07/28/18 07129 07/31 2469216K42XTF10GD AMERICINN JOHNSTON JOHNSTON lA 72.80 MCC: 3614 MERCHANT ZIP: 50131 LODGING CHECK-IN DATE: 07/28/18 07/29 07/31 2469216K42XTF10GM AMERICINN JOHNSTON JOHNSTON lA 72.80 MCC: 3614 MERCHANT ZIP: 50131 LODGING CHECK-IN DATE: 07/28/18 07/29 07/31 2469216K42XTF10K1 AMERICINN JOHNSTON JOHNSTON lA 72.80 MCC: 3614 MERCHANT ZIP: 50131 LODGING CHECK-IN DATE: 07/28/18 -., In terest Ch arge Calculati on . ~~ ;5'_ Your Annual Percentage Rate (APR) is the annual interest rate on your account
Annual Current Billing Period Percentage Balance Subject to Interest T:iQ~ Qf B~li!DQ~ Rate IAPRl Interest Rate ~ Purchases 13.25(v) 0.00 0,00 Cash Advances 17.25(v) 0.00 0.00
Annual Previous Billing Period Percentage Balance Subject to Interest I~~~ Qf El~li!m;~ ~ lnt~r~st Bat~ ~ Purchases 13.25{v) 0.00 0.00 {v) = Variable Rate
Periodic rates and APRs may vary. See your Cardmember Agreement for an explanation. There is a 25-day grace period for Purchases but not for Cash Advances. You can avoid additional finance charges on Purchases if you pay the New Balance within 25 days of the Statement Closing Date {which may not be the same as the Payment Due Date). See reverse side for important information and disclosures and, if an Annual Fee was posted above, regarding renewals.
INDEPENDENCE CSD MONTHLY EXPENDITURE REPORT BY FUNCTION July 2018 INDEPENDENCE CSD MONTHLY EXPENDITURE REPORT BY FUNCTION July 2018 8/14/2018 FUNCTION Jul-18 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 TOTAL 1000-lnstr 42,436 90,562 867,00? 841,1·"2 8110,239 8?7 .U2 1,084,119 992,910 907,936 871,048 1,103,014 2,656,693 11,184,213 2100-Student Supp 7,608 10.14, 48,880 ..so , 7:!_7 52,133 (;1,2';2 48,2f:7 ·f/584 50,211 48,647 ::,o, %.' 129,324 607,392 2200-lnst Supp 10,631 10,171 63,707 67,396 66,206 65,387 54,032 70,988 64,137 64,659 64,206 171,185 782,705
7 2300-Gen Admn 34,962 :l"J.S5f _7 J3d 2!.1.89A 2~. "'l 32 !....;7 26-94 '889.9 ~8.850 24,fi62 .;?.6'>9 1~.rr 369,168 2400-Bidg Admn 52,746 63,4115 71,511 70,129 59,6511 7:5h4 66,418 68,1~1 77,872 66,595 70,228 98,853 843,676 2500-Cent Admn 39,407 ;·~:186 .J ~:.C8~... t::JJ'~75 4~,~5'"; !/1 428 568-iJ .~.;_7fi8 52,090 6.~.938 5:!,.143 {.2~49E.< 615,169 2600-0p & Main 34,786 97,590 106,902 107,16] 100.900 88,083 83,872 97,105 107,504 93,043 109,0..:9 180,102 1,206,099 2700-Transp 13,949 -'~'.i:i, FUNCTION Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 TOTAL 1000-lnstr 82,068 90,562 867,002 841,142 840,239 897,112 1,084,119 982,910 907,936 871,048 1,103,014 2,656,693 11,223,845 2100-Student Supp 7,029 10,147 48,880 50,727 52,183 63,252 48,267 47,584 50,211 48,647 50,562 129,324 606,813 2200-lnst Supp 17,051 10,171 63,707 67,396 66,206 65,387 64,032 70,988 64,137 64,659 64,206 171,185 789,125 2300-Gen Admn 36,011 30,556 37,834 26,894 24,611 32,767 26,194 28,899 38,850 24,662 27,659 35,280 370,217 2400-Bidg Admn 52,583 63,445 71,511 70,129 69,464 73,264 66,418 68,151 72,872 66,595 70,228 98,853 843,513 2500-Cent Admn 39,954 45,086 48,085 49,076 49,459 41,428 56,891 54,768 52,090 63,938 52,443 62,498 615,716 2600-0p & Main 44,088 97,590 106,902 107,163 100,900 88,083 83,872 97,105 107,504 93,043 109,049 180,102 1,215,401 2700-Transp 13,700 33,701 40,943 66,048 75,154 64,409 56,916 79,374 59,205 51,015 73,331 10 3,039 716,835 3200-Enterprise . 548 - - - 548 6000-AEA - - - - 656,428 - 656,428 292,484 381,806 1,284,864 1,278,575 1,934,644 1,325,702 1,486,709 1,429,779 1,352,805 1,283,607 1,550,492 3,436,974 17,038,441 Difference TOTAL 1000-lnstr {39,632) {39,632) 2100-Student Supp 579 579 2200-lnst Supp {6,420) (6,420) 2300-Gen Admn (1,049) (1,049) 2400-Bidg Admn 163 163 2500-Cent Admn (547) (547) 2600-0p & Main {9,303) - (9,303) 2700-Transp 249 - 249 3200-Enterprise 6000-AEA Total Difference (55,959) (55,960) INDEPENDENCE CSD MONTHLY EXPENDITURE REPORT BY OBJECT- July 2018 8/14/18 Object Jul-18 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 TOTAL 100-Salaries 154,973.09 197,768.''0 S18,3J7.00 84C.,207.18 S35, -61 .00 8.JS,320.90 [,35,585.00 546,837.00 1;23,256.51 /1}8,743.73 356,~75.46 2,158 462. '0 10,046,127 200-Benes 37,429 90 ,15 J i /f)(' /F1 9·,,1 t~r. ; -.· ·: .;.~!{. l' .:··:1,9..:.6.J;J :78, J..t::. ~:. .'75 Object Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 TOTAL 100-Salaries 151,011.70 197,768.00 818,337.00 845,207.18 835,461.00 845,320.90 835,585.00 846,837.00 823,256.51 828,743.73 856,175.46 2,158,462.20 10042166 200-Benes 35,240.72 45,117.00 281,964.00 274,468 49 271,956.00 278,448.55 275,608.00 276,662.82 273,311.74 274,243.68 250,786 17 751,625.29 3289432 300-Purch Svcs 53,668.32 18,911.00 37,968.00 56,866.02 52,198.00 118,871.85 54,709.00 51,589.72 126,867.51 60,824.80 46,005.83 183,216.96 861697 400-Prop Svcs 96000 11,009 00 12,888.00 13,44125 13,338.00 17,327 77 8,769 00 13,510.10 12,843.36 11,208.21 11,445 21 28,069.43 154809 500-0th Svcs 1,744.00 4,435.00 6,403.00 6,001.05 19,205.00 9,497.48 259,810.00 160,459.66 41,140.17 63,246.33 292,927 96 141,114.93 1005985 GOO-Supplies 37,58100 103,159.00 115,675.00 82,453.61 80,786.00 54,37172 49,796.00 78,916.77 73,295.00 44,131.18 91,88179 160,266.63 972314 700-Property 1,065.91 207.00 6,465.00 (445.02) 965.00 714.00 550.00 209.83 410.45 4.40 384.32 14,028.64 24560 800-Debt 11,211.95 1,200.00 5,164.00 582 76 4,307.00 1,149 95 1,882.00 1,592.54 1,679.95 1,204.95 885.53 189.95 31051 900-AEA 656,428.00 656428 292,484.00 381,806.00 1,284,864.00 1,278,575.34 1,934,644.00 1,325,702.22 1,486,709.00 1 , 429 , 778.~- 1,352,804.69 1, 283, 60_2~,550,492 . 27 3,436,974.03 17038441 Difference TOTAL 100-Salaries 3,961 0 0 0 0 0 0 0 0 0 0 0 3,961 200-Benes 2,189 0 0 0 0 0 0 0 0 0 0 0 2,189 300-Purch Svcs (37,091) 0 0 0 0 0 0 0 0 0 0 0 (37,091) 400-Prop Svcs (252) 0 0 0 0 0 0 0 0 0 0 0 (252) 500-0th Svcs (1,181) 0 0 0 0 0 0 0 0 0 0 0 (1,181) 600-Supplles (20,103) 0 0 0 0 0 0 0 0 0 0 0 (20, 103) 700-Property (1,066) 0 0 0 0 0 0 0 0 0 0 0 (1,066) 800-Debt (2,417) 0 0 0 0 0 0 0 0 0 0 0 (2,417) 900-AEA 0 0 0 0 0 0 0 0 0 0 0 0 0 Total Difference (55,959) 0 0 0 0 0 0 0 0 0 0 0 (55,959) S.t\. Report to the Board of Education Jr /Sr High School August 2018 John Howard, 7-12 Principal Jr /Sr High School Vision Be the BEST Educational Environment in the state of Iowa. Jr /Sr High School Mission The mission of Independence Jr /Sr High School is to provide a safe environment where students are provided the skills and opportunities to be productive and responsible citizens. Jr /Sr High School Motto Think. Believe. Do. Jr /Sr High School Goals • 80% of all students, in all grade levels, will demonstrate proficiency on the Iowa Assessments in reading, math and science. • Improve our MTSS at all grade levels. • Increase the positive interactions and displayed respect shown by both students and staff in all settings.-- Baseline- Respect and Protect Survey (2018) • Utilize more technology in the classroom to improve student achievement. Actions to Meet Goals o 7th Grade and New Student "Refresher Night" is tonight. o Special education teachers came in last week to prepare for the school year. More specifically, they worked on IEPs, schedules and contacting parents. o I attended Grant Wood Power Teacher Pro training with Mr. Hupke and some of our curriculum leaders and teachers. Staff had an opportunity to work individually or in a small group to become more familiar with this feature of Power School. o I have updated my Canvas page (JSH 18-19) with beginning of the school information, evaluation procedures, term start and end dates, our academic and bullying and harassment goals, and many other items to help communication. o I sent five "Summer Update" e-mails to staff in an effort to promote more/better communication. o Summer school went well. Thanks to the staff who helped our students be successful. o I am very excited about our new staff. They are positive, professional, and eager to start the year. o We have 7 foreign exchange students this year. Thanks to all the families who agreed to host these students. o Student schedules were sent to students/parents/guardians. The only addition to student schedules will be Mustang Time. That will be added in the next couple of days and communicated out to students. Other Information • Congratulations to our all-district/all-state recipients in baseball and softball. • Good Luck to our fall activity teams/groups. • We are anticipating a great year. Go Mustangs! Report to the Board of Education Junior/Senior High School August 2018 Dewey Hopke, Assistant Principal School Administrators of Iowa: I recently attended the annual SAl Conference with the administrative team. I attended some very good sessions. John Coyle, an Olympic silver medalist in speed skating, facilitated a session focusing on 'knowers and learners'. John spoke a great deal about focusing on your strengths and shared his personal experience of when he was forced to focus on his weaknesses. Another break out session I had the opportunity to listen to was led by Joe Sanfelippo. Joe's message was very upbeat and focused on 'promoting the great things your school does everyday.' The message was powerful and he received a standing ovation when he was finished. Cookout: Mr. Howard and I invited our staffto the Hupke house for a night of grilling and social fun on August 13, 2018. It is our goal to increase the interactions of our staff outside of the school day. Last year, we had this social gathering and it was a great way to kick off the school year. We are hopeful it will again be a positive experience for all who attend. Welcoming new students/staff: This year, we are welcoming two new staff members, both of whom are new to the teaching profession. Brea Griffith and Bryce Pierce will be great additions to our building. Brea is from Vinton and will be teaching junior high special education. Bryce is from Decorah. He will be teaching physical education classes. In the hiring process, both came with high recommendations and praise. Video for staff: Here is a video we will be including in a "Welcome Back" Power Point presentation to our teachers. I thought you might like to watch it too. https://youtu.be/1UtCgZZeUel Thank you for all that you do to make the Independence School District a great place to work and learn! Respectfully, Dewey Hupke Report to the Board of Education West Elementary August2018 Cherilyn Reed, Principal Developing our Literacy Framework Through Workshop I Balanced Literacy is ... • • . I The CCSS dictates a comprehensive literacy program with its standards I for reading, writing, listening, speaking, and foundational skills. If we •I use the standards as our guide we will, in fact, have a comprehensive •• I system in place. Finally, we strike a balance between skill instruction • and instruction based on language and literacy learning. "Effective I •• I instruction is entirely based dependent on the artful orchestration skills • I I of the teacher. We are asking teachers to do a thorough job of teaching •. I I literacy - one that nurtures and grows a rich set of literacy skills and • strategies across a wide variety of texts, used for a variety of purposes • .I•I I that map to real-world challenges." • I Gambrell and Morrow - Best Practices in Literacy Instruction •••• It is with incredible gratitude and admiration that I commend our West Elementary staff as life-long learners always eager to strengthen their craft with outside learning opportunities and supports. We see this innovation as we continue with our literacy work from the 2017-2018 school year. For 2018-2019 West Elementary has a second cohort of teachers attending Literacy Instruction through a Workshop Setting at Central Rivers AEA. Under the guidance of our Director of School Improvement, Erin Burmeister, for the 2018-2019 school year, along with our Instructional Coach, Kay Reidy, Lyndzi Roth (3rd Grade), Heather Nefzger (4th Grade), Ricky Nolan (Sth Grade), and Jillian Schares (6th Grade) will be attending the Year One learning for which our Curriculum Leaders completed last year. We also have our Curriculum Leaders: Katie Kleitsch (3rd Grade), Bridget Brown (4th Grade), Diane Kinseth (5th Grade), and Sara Thome (6th Grade) and our Instructional Coach, Kay Reidy advancing their learning by attending the Year Two Next Steps in Literacy Workshop for Model Classroom Teachers. I have had the privilege to attend last years' and this years' learning, and it is truly incredible at the AEA's responsiveness and adaptability to its learners. It is evident that the feedback provided from last year's cohort was absolutely considered, analyzed, and implanted. One of the most beneficial distinctions made to our team this year is the difference between a goal, a skill, and a strategy. When teaching literacy, it becomes so very important to make this distinction as clear and measurable as possible because our learners come from such diverse literacy backgrounds, experiences, and expectations. By being as intentional as possible with our instruction, we can better ensure a comprehensible curriculum for ALL students. ' Planning a teaching point ... o What- Explicit description of what you're s kil ls ,, . teaching o How- Strategies and/or steps to accomplish it '> .r ... ! ·r- o Why- Rationale for doing it •-•--•• •• ••• •••• What are you Today I will teach you that readers ••••••••• SkiJ1 teaching? •••••••••• How might you do it. 1. First, ••••••••• ***Might consist of 2. Next, ••••• Strategy more or fewer steps 3. Finally, • •• •• • •• • Why should you do Readers do this because • •••• ••• Goal it? •••••• • •• •••••• •••• •••••• Again, a huge thank you to our West Elementary learning leaders and the Central Rivers AEA staff. Together, we will continue to see our students grow in reading, writing, listening, and speaking. Suicide Prevention, ACEs Identification, and Toxic Stress Response Mitigation Training- SF 2113 (cont.) • Requires all schQol_personnel_ ~hq_ hold a license, certificate, authorlzation...... Q.U>_@tement o.Lr.!?cognijjon issued by the BOEE to ANNUALLY b ~Y.J!~ a s t _o_n e hour .Qf suicide P.rc_vention anq postvontion tralnill.g. • By J uly 1, 2019, school boards must require annual training for school personnel on the identification of A CEs and strategies to mitigate toxic s tress response. • The Department will collaborate with AEAs and other partners to support schools as they implement t11ese requirements. 30 A beneficial practice for both adults and students: Self Control. West Elementary began our learning and teaching around self-control last year (2017 -2018). We will continue our learning and practice of the skill this year. When attending our School Administrator's of Iowa Learning, Matt Carver, J.D., shared the legal updates in regards to Suicide Prevention, ACEs Identification, and Toxic Stress Response Mitigation. The Independence Community School District and West Elementary has been working very intentionally to be proactive in supporting our students in building resiliency through Positive Action Strategies. As one strategy of our Positive Action Curriculum and Living the Mustang Way, West Elementary has been working on teaching the philosophy and method for the practice and application of self-control for our students and staff. Mindfulness/Self-Control in the classroom is a research-based strategy to support the social and emotional well being of our students as well as a way to enhance a student's ability to be present and ready to learn in our classrooms. To move our work forward, West Elementary teachers are learning from books written by Dr. Robert Marzano, Carla Tantillo Philibert, and Dr. Ross Greene. Report to the Board of Education Early Child Center, East Elementary August 2018 Danielle Donnelly, Principal Summer Literacy Program I Student arrival/Read to Student arrival/Read to Student arrival/Read to I 18:15-8:30 self/talk with students self/talk with students self/talk with students I Whole group Reading Mini Whole group Reading Mini Whole group Reading Mini 18:30-8:50 Lesson Lesson Lesson l I Rotation 1: small grp guided Rotation 1: small grp guided I I rdg, Read to self, Listen to rdg, Read to self, Listen to I 18:50-9:10 Rdg, Wd Wk, Read to adult Rdg, Wd Wk, Read to adult Rotation 1: library or lab ! I Rotation 2: small grp guided Rotation 2: small grp guided I I rdg, Read to self, Listen to rdg, Read to self, Listen to I 19:10-9:30 Rdg, Wd Wk, Read to adult Rdg, Wd Wk, Read to adult Rotation 2: library or lab I Recess/drinks All Associates Recess/drinks All Recess/drinks All I I go out; plan time for Associates go out; plan time Associates go out; plan t ime 19:30-9:45 teachers for teachers for teachers l Snack/Read Aloud/Apply Snack/Read Aloud/Apply Snack/Read Aloud/Apply I mini lesson Associates get mini lesson Associates get mini lesson Associates get I I snacks ready for first 10; last snacks ready for first 10; snacks ready for first 10; I I 19:50-10:10 10 break if needed last 10 break if needed last 10 break if needed I Rotation 3: small grp guided Rot ation 3: small grp guided rdg, Read to self, Listen to rdg, Read to se l f~ Listen to i 10:10-10:30 Rdg, Wd Wk, Read to adult Rotation 3: library or lab Rdg, Wd Wk, Read to adult Rotation 4: small grp guided Rotation 4: small grp guided rdg, Read to self, Listen to rdg, Read to self, Listen t o 10:30-10:50 Rdg, Wd Wk, Read to adult Rotation 4: library or lab Rdg, Wd Wk, Read to adult Rotation 3: small grp guided Rotation 3: small grp guided rdg, Read to self, Listen to rdg, Read to self, Listen to 10:50-11:10 Rotation 5: library or lab Rdg, Wd Wk, Read to adult Rdg, Wd Wk, Read to adult Rotation 4: small grp guided Rotation 4: small grp guided rdg, Read to self, Listen to rdg, Read to self, Listen to 11:10-11:30 Rotation 6: library or lab Rdg, Wd Wk, Read to adult Rdg, Wd Wk, Read to adult ! Start Dismissal (To Start Dismissal (To Start Dismissal (To i 0.47916667 buses/front doors) buses/front doors) buses/front doors) This is the summer school schedule we used for 2018. As you can see students are taken through six rotations all with an emphasis on literacy. One of our goals is to get books in the hands of our struggling readers. At the end of summer school, we take a trip to the library and help students get an account. Sue Knott (retired 1st grade teacher) is instrumental in the planning of this trip. Teachers recommended 78 students for our summer literacy program. Of those children, we had 51 routinely attend our program. It runs T,W,Th June 26- July 26 and transportation and snacks are provided. We grouped our students based on their literacy needs rather than grade level. This ensures that all students are getting their instructional needs met. As you can see, 100% of our focus is on literacy. I will be comparing their end of the year assessment data with their fall assessment data. Our hope is that this program will lesson the summer "dip" in scores. Last year the data told us that the program was successful. Curriculum Leadership Team (CL T)- My CL T consists of Angie Bonefas and Lori Kurt (Instructional Coaches), a grade level teacher from K (Donalyn Pogue), 1st (Brandi Davis), and z nct (Robin Van Raden). As a reminder, these are the positions created by the Teacher Leadership Compensation aka TLC. This team is vital to the implementation of our literacy framework and workshop model. Below is an agenda for an upcoming meeting. I am so thankful to have this team, as their work is so important for our students. PLC's (Professional Learning Committees) • Times, locations, agenda for PLC's. How will they look different and focus more on instruction? • Title and special education team members • Essential Learning • Create map for essential learning at each grade level incorporating Units of Study for Reading and Writing Testing • Kinder C to D instructional by the spring • No MAP in winter, unless it will change instruction o If teacher wants it they do it during their time • Data sheets and reporting to parents Lucy Calkins expectations • October 1 small groups • First 20 days September 24th Mustang Time (Tier 2 intervention) • 10-20 minutes? 3xs a week? • Kindergarten expectations • Staffing ELP K-2 (Extended Learning Program) **I have invited Mr. Reed • Is this appropriate in K? (push in) • What does it look like in 1-2? • Criteria set by Mr. Reed. S".B. Report to the Board of Education Activities August 2018 Justin Putz, Activities Director August is the official start of the fall activities. Students are wrapping up camps, offseason work, and we are getting ready for upcoming competitions. It is an exciting time and we have high expectations for our fall activities. Volleyball- Volleyball officially started practices on Monday, August 6th. Coach Schmitz said he expects over SO girls out for volleyball this year. Those are outstanding numbers for our program. Coach Schmitz will have a freshman, sophomore, junior varsity, and varsity team. The team returns much of their state qualifying team and I expect them to be in the hunt for a Wamac title and a potential state birth. I would also expect them to be in the rankings when they come out. Football- Football has had a fast summer. The football team expects to have just under 60 athletes out for football. The football team has been busy doing 7 on 7 scrimmages, attending team camps at Central College, hosting youth camp, and lifting weights to get ready for the season. By the time of the board meeting, the team will have scrimmaged North Tama at home in our annual Buck Bowl. Cross Country- Both cross country teams plan to started in early August as well. Coach Osvald and Coach Miller, our new boys coach, have hosted summer running opportunities to prepare for the season. They plan to run a combined program again this year. Marching Band- The marching band has been very busy preparing for the upcoming season. Mr. Lang held a jazz band camp, marching band camp, practices, and an overnight drum line camp. The students have been working extremely hard and the numbers are good. Mr. Lang reports they are working on a more difficult show this year and he is excited with the progress. In addition, they have done an excellent job of representing us in parades this summer. The reason for their success is obvious. The dedication that the staff and students have is outstanding. Strength and Conditioning- We ran summer strength and conditioning again this summer for students coming into 7-12th grades. Our students have done a nice job showing up, working hard, and improving over the course ofthe summer. We broke the session up into two sessions. The first session is grades 10-12 and the second session is more developmental and for students coming into grades 7-9. Summer Sports Wrap-Up: Baseball- The baseball team finished the season at 11-29 against a very difficult schedule. We underperformed at times but do have some talented kids returning. Softball- The softball team finished 35-7 and made a trip to the state tournament. The team went 1-1 in Fort Dodge to finish an excellent season. The team was Wamac West Champions. In addition to that, Mackenzie Hupke was named 1st team All-State and Lydia Butters was named 2nd team All-State. I saw tremendous improvement this year and we will return a lot of talent. All-District Assembly Plan for this year: Proposed Dates (Unless it does not work for a majority of the Board) First Semester-1/16 or 1/17 (make-up)- 9:00AM Goal of35 Minutes Rationale: The first semester ends on 1/12. This leaves a little wiggle room in case the semester is extended and so we do not have the assembly on the last day of 1st semester classes. This also allows us to have the assembly within one week of the end of the first semester. Second Semester- 5/8 or 5/9 (second choice)- 9:00AM Goal of35 Minutes Rationale: This allows us to have the assembly when seniors are present but not on their last day. However, we will not have spring sport state qualifiers or all-state performers. This is ok as the second semester one is usually longer due to speech and jazz band. What we recognize: Activities: Accomplishments at the State and All-State Level that would have earned a "Spotlight in Education" Certificate in the past. Note: it must be a state event in which one had to qualify for. I would prefer it be a school-sponsored activity. Academics: Up to the building principals to decide what their building wants to recognize. Report to the Board of Education School Improvement August 20, 2018 Erin Burmeister, Director of School Improvement Over the summer I have had some time to reflect on our school improvement efforts. I truly believe we have come along way, but I also believe t hat there is still work to do. In the words of Brian Tracy, "Practice the philosophy of continuous improvement. Get a little bit better every single day". This summer I was able to practice this philosophy and help others to engage at a district level. Continuous School Improvement I certainly didn't want to leave you hanging with our school improvement graphic so here it is to look at the final piece, infrastructure. Although we tend to think of infrastru cture as the space students learn in, it actually includes much more than just the physical things. It also includes structures that are in place for professional learning and support for staff as well as effective evaluation of implementation of practices and impact on achievement, just to name a few. We continue to work hard to make sure our infrastructure is conducive to continuous improvement. Some of the things we have been working on include, scheduling, so that we can better meet student needs. By offering more classes as "skinnies" we can help students get the continued practice they need in the core subjects and avoid the possibility of students going a year without a core subject. In addition, sched ules at the elementary level have been designed to allow for common planning and PLC time for teachers. Addit ionally, we have changed the structure of professional learning and have been able to offer more opportunities for staff with an Ed camp structure. Also, we have utilized Central Rivers AEA more for professional learning opportunities. These are just a few of the things we are doing to make sure we have the infrastructure needed to support continuous school improvement. District Goals for 2018-2019 All of our continuous school improvement efforts support our district goa ls. Just as it has been, we will continue to focus our efforts on improving student achievement in the areas of reading, math, and science. In addition, we will work to strengthen climate and culture and integrate technology into instruction and continue to get a little bit better every single day. For the 2018-2019 school year we are sending a second team of Kindergarten-6th grade teachers to Central Rivers AEA to learn more about literacy instruction in a workshop setting. The team we sent last year will also continue their learning and will work closely with instructional coaches, principals, and myself to lead professional learning at a building level. Additionally, we were able to purchase Lucy Ca lkins Units of Study as a resource to help support our improvement efforts in the area of literacy. All teachers at East will be using these resources for both reading and writing and two teachers from each grade level at West will be piloting the reading and writing units. This will rea lly help support teachers and ultimately student learning. We know the importance of a strong literacy program and we are determined to provide the best for our students. In the areas of math and science, we will continue to learn about the Iowa Core Standards and best practices for instruction and assessment. At the elementary level, teachers will be using Mystery Science, an online resource, to support the new Iowa Science Standards. This resource promotes inquiry-based learning and is very hands on for students. I was able to pilot one of the units with Ms. Nefzger's class last spring. We had so much fun and learned a lot about energy and motion. This summer we worked to purchase the supplies teachers will need in order to build "kits" for each unit. At the secondary level, science teachers created units that align with the Core and are investigating some new resources. Some teachers will be piloting a few of these resources to determine what will best meet our students' needs. Additionally, we will continue our work with PLC's and this will help us to strengthen climate and culture. Authentic Intellectual Work (AIW) will also be rolled out to all staff at the JSH beginning next week. I have no doubt that this framework will really help strengthen instruction and ultimately student learning in all content areas. Teacher Leadership and Compensation (TLC) Another area that we continue to improve is ourTLC. I met with the TLC committee in June and we reflected on the year and the direction the committee would like to see TLC go in Independence. The committee would like to look at the possibility of adding some coaching positions; this is something we will investigate. Additionally, it was decided to have the instructional coach at East, Angie, will serve teachers at ECC, East and 3'd grade at West. We will then be able to have the instructional coach at West, Kay, work with the 7 th and 8th grade ELA teachers at the Junior High in order to set up workshop model for literacy instruction. We were able to block the reading and language arts courses to have a literacy block instead of the two stand-alone classes for 2018-2019. Kay will be able to support them with instruction and integrate workshop model. I am very excited about this change and the opportunities this creates for both staff and students. Report to the Board of Education Technology August 2018 Stephen Noyes, Director of Technology August 20, 2018 It is exciting time of year, full hope and anticipation. Staff are smiling and students are ready to come back to school. The buildings look great. Over the summer, we purchased replacement iPads for 1st and 2nd grade and moved iPads around to better serve students in the fall. East is also piloting iPad control of their presentation computer with West soon to follow. The process works well in testing. It will be interesting to see how it works for the teachers in actual classrooms with real students. Speaking of presentation computers, we changed all older iMacs at East and West for laptops. The screens are smaller, but they are better computers compared to the older iMacs. We also have SSL properly running at East. It has been a battle, but we are ready for West and JSH to use the more secure Internet protocol. Once we make the transition, staff and students will not notice any speed or access problems related to the new secure certificates. At West, we cleaned up several of the network closets. We moved the wires and equipment to a network closet. Chad and Tom worked hard to install the equipment and troubleshoot the wiring. The Snack Shop at West is a vast improvement compared to last year. At JSH, we move many of the network switches around for better cable management. We have one closet left at JSH to clean up. I needed to order a special cabinet because of the moisture in the area. Registration is going well and we should have nearly all students registered by the time school starts. Each building will become more aggressive to get the remaining students registered before school starts. We should start school is good shape and look forward to a great year. Sincerely, Stephen B. Noyes Report to the Board of Education Food Service August 2018 Annette Harbaugh, Director of Food Service Let the 2018- 2019 school year begin. The Free and Reduced Lunch program is up and running. Steve helped get the website set up to be able to download the application. Most of the families go on line to apply at www.myschoolapps.com . We also sent out emails and phone messages to all the families to remind them to reapply for the program. The food service department hired two new ladies for this school year. Nikki Rippel will be at East Elementary as the 2 hour dishwasher and Dawn Morris will be at the JSHS as the 6.5 hour cook/food service worker. The ladies are excited to get started and they both are good additions to the team. The Lunch Policy was sent out to all the families and can also be found on the website. We ended the school year with zero negative balances. I am hoping the school year will start smoothly with parents putting money into the accounts. I will continue to call parents and email them when their accounts are negative. It worked well last year so I will continue it this year. We have never taken a tray away from a child and we never will. Feed the Mustangs has been very helpful with donating money to help the kids in need. Thank you Laura, Steve, Ryan, and the people at Heartland Schools Solutions for all the help and support with the computer lunch programs. There are a lot of changes and I couldn't have gotten it all done without your help. Respectfully, Annette Harbaugh, Director of Food Service Report to the Board Report of Education Buildings and Grounds August 2018 Chad O'Brien, Director of Buildings and Grounds The night locks are on all classroom doors at the Jr/Sr High School. The air conditioning at East Elementary is finished in the lunchroom and kitchen. The East Elementary gym lights have been switched to LED. We added some storage in the old wrestling room by adding walls. We have been replacing concrete around the district. The solar panel at the greenhouse is wired up. The milling machine in the machine shop is wired up. We moved some dust collecting pipes around in the wood shop. We hooked up a parts washer in the automotive shop. We replaced two exterior doors at the multi-purpose room. We changed all the server racks at West Elementary. We added internet runs and electrical outlets around the district. We fixed some stools around the district. We have painted in all buildings. The hallways are all finished around the district. We installed Fob keys at East, West and the Admin Office. The Jr/Sr High School and West Elementary gym floors have been refinished. The carpet has all been shampooed around the district. We are still mowing and keeping up with weed eating around the district. We will be cleaning up the football field getting ready for the first game. All parking lots will be repainted by the time school starts. We cleaned up around the baseball/softball field. We moved the picnic tables and bleachers back to the football field. We had the city come in and grade the gravel road and level it out. We pulled weeds around the football field and parking lots. We fixed lights around the district. We will be putting the lights up in the parking lot for the football games. We hung some speakers and new lights in the auditorium. Report to the Board of Education Transportation August 2018 Kim Chesmore, Director of Transportation The summer activities have come to a close and we working on getting all the buses ready for the start of school. The new bus shou ld be arriving before the start of school. I have been in contact with conso lidated energy and they are coming to set up the LP station for the new bus. I have been working on the bus routes for the new school year. Independence Schools will be sending a bus to River Hills every day, along with a student from Oelwein and East Buchanan. The East Buchanan child meets the bus at the St. John's Church parking lot. Independence Schools has made an agreement with Oelwein Schools that we would continue to haul a wheel chair child on our River Hill's bus that moved out of our district. The child now lives in Hazelton, not too far from our most northern stop. Oelwein Schools will be paying us for hauling him. Independence Schools will still be transporting a student to the Lied Center in Waverly this year. I have received their school calendar for the year. The two buses that we received the grant for have been retro-fitted for the clean diesel act. I have had one driver come and get their license to drive this year and I am working on getting them ready for the driving test. I will be starting the school year with one route driver off for two weeks due to surgery and one route driver position not filled as of yet. I will be having a sub driver for the route driver that will be off, and Brandon or I will drive the other bus until will get the new driver authorized. Vehicle ~ Mml!h Mileage &..Mil Act. Mi. ElL..Mi.,. .!2r....ElL. SJ!...E.!! w..tt Q1!w: fuL.A.!!m Total Miles E:!W. ~ ~ Bil!w ~ Bearbower Bus 1-2010 B July 103556 795 36 831 63 13.19 65 Activity Bus 2-2012 B July 47269 240 240 28.6 8.39 65 Activity Bus 3-2014 B July 42809 466 466 50.7 9.19 65 Sped bus Bus 38-2014 B-lift bus July 93362 2746 2746 226.1 12.15 II Randall Bus 4-2007 B J uly 79766 42 42 0 #DIV/0! 65 Activity Bus 5-2015 B July 39746 305 305 24.6 12.40 65 Mason Bus 6-2017 B July 24078 0 0 #DIV/0! 84 Kiler Bus 7-2011 B July 76258 1422 1422 83.1 17.11 65 GOOD Bus 8-2007 B July 133400 0 0 #DIV/0! 65 Lift Bus Bus 9-2008 B-lift bus July in shop #DIV/0! 44 Krempges Bus 10-2007 B July 91218 0 0 #DIV/0! 65 Activity Bus I 1-2011 B July 58974 73 73 0 #DIV/0! 65 Activity Bus 12-2008 B July 67563 14 14 0 #DIV/0! 65 Stolfus Bus 15-2001 B July 169900 65 65 0 #DIV/0! 65 Activity Bus 16-2016 B July 10987 542 542 60.9 8.90 Activity/shuttle Bus 17-2015 B July 19790 276 276 31 .2 8.85 84 EXTRA Bus 18-1999 B July to junk #DIV/0! 65 VAn Ianingham Bus20-2005 B July 86966 22 22 0 #DIV/0! 65 Butler Bus 21-2005 B July 69259 0 0 #DIV/0! 65 Extra van 4 Ford ec-2003 Van July 15011 2 2 #DIV/0! 8 Extra car #5 Equinox-2015 Car July 45134 354 354 13 27.23 5 Hammers-van 6 Ford ec-2007 Van July 146693 450 14 464 42.7 10.87 8 Extra-van 7 Ford ec-2008 Van July 118531 286 16 302 23.2 13.02 8 Extra-van 8 Ford ec2009 Van July 104536 71 451 608 39 15.59 8 Extra car-#9 Equinox-2011 Car July 141062 255 255 0 #DIV/0! 5 Extra- van 10 Ford Ec-2013 Van July 58794 242 305 547 44 12.43 8 Extra van-11 Ford ec-2013 Van July 57034 183 183 11 16.64 8 Extravan-12 Gmc 2017 Van July 11 134 2941 2941 149.59 19.66 Extra Van -14 Chrysler-2017 Van July 8963 438 353 791 28 28.25 Totals___ _ 1237 4962 - 0 0 2746 87 64 1 0 9759 741.1 #DIV/0! $0.00 0 1191 Independence Community School District TRAVEL REQUEST FORM Any staff member requesting permission to attend meetings, conventions, or field trips shall file this form with their building supervisor at least 10 working days prior to the meeting or trip. If you are requesting overnight travel, the Superintendent must also' approve your request. If your travel request is outside a 200 mile radius and outside the state of Iowa you also need the approval of the Board of Education. I If you are appwved this form will be returned to you with the appropriate signatures. At this time, you can make your requests for any registration fees, hotel/motel accommodations and request a vehicle if it is needed. DO NOT submit those requests until you are approved. Please submit requests timely. /_! Requested By: 1-\ a-.&...e V'- Date 7/2... ~ I I LL 8 Departure Date : ------O.f--=::._:_-f'---+-'-~--- Date Returning: ---~1-=---=-/--'~!:!....______Sponsoring Organization ------l---'-':....__.:....___,r....:>--==--~C=-.L"~C=_.,:....______ Will this workshop allow you to apply for and receive graduate credit? )( Yes ___No Wyes,p~aseex~a~---~~\~~~r~~'---~~~~~~~~~~-~>~1~~~~------ Are you being reimbursed by any other group or organization for any expenses or receiving a stipend for attending this meeting? ____ Yes K No If yes, please explain------ Rational for Attendance b e..v?Af7 S(> ;, ~\e (' Y\0-.....=\-\·u .f'~ \_ ~ ~t+V~-'f s \,<1 ~ vJ ~ ~ ~ kos oJ C hjt'l c v._\h, ~\ . s:\ v'"&~\ s: _ Others in the District who you know are going to this meeting or convention? f± \I~'( Si HC {..V\ (.t. t-0 Ct. J ~ 0 ~ ~ {"_SMe Ylt) Who are you coordinating your travel expenses/plans with? _ ____:.tH__.l,..Jo-c..::\..J-.I=::,:....}.L~~..:.=;~-e..,~~-C=-:._=-C=:.;:':..._------ Is this meeting/in-service applicable to any of our special school projects (i.e. Eisenhower, School-to-Work, Title I, etc. or are you requesting Hto be paid bytheGene~IFund? __~~~------___ Activity Fund ___ General Fund Code(s) :. ______ Estimated Cost: Transportation- (See Administration Office for current cost per mile.) $. _____-t Check One: _ _ School Vehicle _ _ Public Transportation __Own Vehicle Meals $ <; LJ-"o- f> "--1 ,c • ~ uc._a.._ Lodging $ Superintendent of Schools (Overnight or out of state trips ONLY) Registration Fee $ ~ i A1(\1\ q co.-""' Cost of Sub $ ~v-.re..o....V'.. Approved by Board of Education Date Fce. .r <"'- (Outside 200 mile radius & outside Iowa ONLY) Other $ f JC._~U ~\ ,·«\.. TOTAL $ Date Returned to Employee by Central Office • Tt._Courtty Child & Family 0.-1 Council In< . J~~ ...... /'>1' - AI I'...... ,.,Nt} .. ~W. ·-' TRI-COUNTY CHILD AND FAMILY DEVELOPMENT COUNCIL, INC. 2018-2019 CONTRACTED SERVICES AGREEMENT DECLARATION SHEET Agency Contact Information: Provider Contact Information: Tri-County Child and Family Independence Community School Development Council, Inc. District Attn: John M. Berry PhD Attn: Danielle Donnelly 205 Adams Street Suite 2 1207 1st Street West PO Box 1050 Waterloo, lA 50704 Independence, lA 50644 Telephone: 319-235-0383 Telephone: 319-334-7 400 Email: [email protected] [email protected] Head Start Grant No: 07CH7073-5 Start Date: August 23, 2018 Maximum/Minimum # Children: 10 Hours Per Day: 3.5 Days Per Week: 4 Minimum Hours per Contract: 448 Payment: $2,072.52 per child per semester Maximum Payment: $41,450.40 Bills to be submitted: Each semester with the first semester bill to be submitted by December 1, 2018 and the second semester bill to be submitted by March 1, 2019. Fiscal Reporting: All fiscal reporting supported with invoices must be submitted by May 31, 2019. This cover sheet is provided for your convenience only. The Contracted Services Agreement and incorporated documents const it ute the binding term s of the agreement between the parties. PURCHASE OF SERVICES AGREEMENT The undersigned hereby enter into an agreement under which Tri-County Child & Family Development Council, Inc. (Tri-County), an Iowa not for profit corporation, shall purchase certain specified goods and services from the Independence School District (Provider) for duration of Provider's 2018-2019 District Calendar school year, that currently anticipated to be from August 23,2018 to May 31,2019 on the following terms and conditions: PART I. PARTIES 1. Purchaser of Services: Tri-County Child & Family Development Council Inc., an Iowa not for profit corporation, is the purchaser of services. For the purposes of all notices under this Agreement the following addresses and telephone numbers shall be used until such time as written notice is provided to use different addresses or telephone numbers: Tri-County Child and Family Development Council, Inc. Attn: John M. Berry PhD 205 Adams Street Suite 2 PO Box 1050 Waterloo, IA 50704 Telephone: 319-235-0383 Email: [email protected] 2. Provider of Services: Independence Community School District (Provider) shall be the provider of services. For the purposes of all notices under this Agreement the following addresses and telephone numbers shall be used until such time as written notice is provided to use different addresses or telephone numbers: Independence Community School District Attn: Danielle Donnelly 1207 1st Street West Independence, IA 50644 Telephone: 319-334-7400 [email protected] 12.ia. us PART II SUMMARY OF GOODS & SERVICES 3. Location for Provision of Services. The physical facilities where the services shall be provided under this Agreement shall be provided at the sole cost of the Provider at 1207 1st Street West, Independence, IA 50644 4. Services to be Provided. During the term of this agreement, Provider shall provide the 1 following services: a. Educational Services: educational services in a manner which conforms to the standards and requirements for Center-Based Head Start Programming, including Special Education Services as recommended by the IEP for specific students with diagnosed educational and physical disabilities as more specifically detailed in the Services Checklist attached to, and made a part of, this Agreement by reference; b. Transitional Planning Services: transitional planning and implementation for children and families into their community K-12 School District system; c. Family Access: access for Head Start Families to participate fully in classroom and appropriate building activities without their payment any school fee, including, but not limited to fees for registration, field trips, special projects, and similar activities; d. Nutrition Services: food services for all enrolled children as more specifically detailed in the Services Checklist attached to, and made a part of, this Agreement by reference; e. Health Services: Provider shall maintain basic healthcare services on site for children served and Tri-County shall provide nursing staff to oversee and update student files and perform the Vision, Hearing Screens and Fluoride Varnish required by the Services Checklist attached to, and made a part of, this Agreement by reference; f. Changes in Services: Tri-County may request changes in the scope of the services to be performed under this Agreement. Mutually agreed upon changes, including any increase or decrease in the amount ofthe Provider's compensation must be reduced to written form before they shall be enforceable by either party. 5. Services to Be Provided in a Manner Which is in Compliance With Tri-County's Approved Program. Provider acknowledges Tri-County is a Head Start Program agency and as such is required to comply with: its approved grant application used for funding its programs, federal, state, and local laws, including, but not limited to, all policies, standards, regulations, and guidelines ofthe HHS/ACF, the Equal Employment Opportunity Act [41 CFR Part 60 and implementing regulations at 41 CDR Part 60], Clean Air Act [42 U.S.C. 1251-1387], Federal Water Pollution Control Act as amended [33 U.S.C. 1251-1387], Byrd Anti-Lobbying Amendment [31 U.S.C.1352], and mandatory standards and policies relating to energy efficiency which are contained in the State of Iowa energy conservation plan issued in compliance with the Energy and Policy Conservation Act [42 U.S.C. 6201] Davis Bacon Act as applicable [40 U.S.C. 276a to 276a-7] and that to be in compliance with that grant, all purchased services and goods must also comply with those restrictions and standards. Provider further acknowledges it is Tri-County's obligation to assure Provider's standard of performance of services under this Agreement is in compliance with those requirement and agrees to provide all goods and services called for under this agreement in a manner that is consistent with the standards and restrictions of those documents, policies, standards, regulations and guidelines and to cooperate fully in Tri-County's monitoring of its compliance. 6. Duration of Educational Services. Educational services shall be provided during the 2 period of this Agreement for no less than 3.5 hours per day, 4 days per week, for 128 days during the contract period, but in no event less than 448 hours of direct student instruction. 7. Frequency of Nutritional Services. Nutritional services as detailed in the Services Checklist shall be provided during the period of this Agreement for all days when Educational services are provided. 8. Service Group Eligibility and Monitoring of Attendance. The persons for whom services will be provided shall be 100% Head Start income eligible. Tri-County retains sole responsibility for determining service eligibility and for monitoring attendance. The Provider shall be responsible for conducting enrollment and initial screening for Head Start Eligible children in Provider's school district. If not collected directly by Tri-County prior to enrollment, Provider shall provide Tri-County with eligibility documentation prior to acceptance for enrollment and shall not enroll children for services under this Agreement without prior Tri-County approval. Children shall also reside in the Provider school district unless Tri-County and Provider both waive that requirement in writing prior to placement after receipt of written request for residency waiver. Provider shall provide attendance records for service group children to Tri-County on a monthly basis. Tri-County shall have the sole authority to determine whether a child shall be removed from the Service Group receiving services from the Provider under this agreement based on the child's, which Provider acknowledges is 85% attendance, and which may be lower than 85% attendance upon demonstration of approved special circumstances. 9. Removal from Service Group. Tri-County shall have the sole authority to determine an enrolled child will be ·removed from the Service Group receiving services from Provider under this Agreement. Tri-County agrees to work cooperatively with Provider to make arrangements to transfer an enrolled child to another program site operated by Tri-County in the event of circum~tances where the enrolled child would be ineligible to continue to receive educational services from Provider due to behavior or similar (non-attendance based) concerns but would remain eligible to receive services under Tri-County's guidelines. 10. Discrimination Prohibited. The Provider shall not discriminate against child or family in the Service Group in the performance of this contract, or against any applicant for membership in the Service Group, because of race, sex, age, creed, religion, color, national origin, sexual orientation, political affiliation, veteran's status, disability or handicapping condition. 11. Discrimination Policies and Procedures. The Provider shall maintain a policy and procedure for reporting and remediating any allegations of such discriminate. 12. Maximum Size of Service Group. Provider shall provide all listed services for all Tri County enrolled and designated children, and their families as applicable, up to a maximum of 10 children, and their families as applicable, which Service Group shall have a target of being composed of 10% children who have been diagnosed as disabilities eligible for Special Services. 13. Class Size. Members of the Service Group shall not be placed in a class where the class size exceeds 20 children in a classroom classified as a four year old classroom, or where the class size exceeds 16 in a classroom classified as a three year old classroom or mixed 3 aged classroom. In addition, all class sizes shall comply with all laws, rules, and regulations concerning class size including class size limitations imposed by regulations governing provision of services to children with disabilities. 14. Books, Supplies, Consumables and Fees. Unless otherwise specifically provided in this Agreement, Provider shall pay for all books, supplies, and consumable required for provision of services under this Agreement and costs and fees associated with programs and activity for the Service Group. Provider acknowledges all applicable parent/guardian tees and costs are included in the scheduled payments under this agreement. No Head Start enrolled family will be expected to pay any school fee, including, but not limited to fees for field trips, special projects, and similar activities and Provider specifically agrees to waive such fees 15. Reporting Forms. All informational reporting required under this Agreement shall be provided in a timely manner in the form and format as may be designated from time to time by Tri-County. If forms are provided by Tri-County for informational reporting, the reporting shall be provided on those forms, but Tri-County is not obligated by this Agreement to provide forms for reporting. 16. Facilities. Provider shall provide physical facilities which comply with all applicable federal, state, and local laws, rules, and regulations for the purposes for which they are being used at Provider's sole cost and for which Provider assumes all premises liability and shall hold Tri-County harmless for any such premises liability. 17. Staffing. Provider agrees that all services performed under this Agreement shall be provided by qualified staff who meet the health, educational, training, screening, and document provision requirements set out in this Agreement, including the Personnel Requirements and Document Checklists which are incorporated into this Agreement by reference. They further agree staff will be provided in sufficient number to accomplish the services required by this Agreement and to maintain required adult to child ratio at all times. 18. Tri-County Staff Performing Services at Provider's Sites: The parties agree that certain employees ofTri-County shall be engaged in providing direct services to the children and families of the Service Group served by this Agreement at the sites and in the placements and configurations as mutually agreed by the parties. Provider agrees to respect the right of Tri-County employees under their existing contract of employment. All Provider concerns about performance and conduct ofTri-County employees performing services at Provider sites be referred to Tri-County's Human Resources Director in a prompt manner. In the event of performance, disciplinary, or other concerns related to Provider and Tri-County employees working together in the same classroom, the parties agree the Human Resources manager or director of each party to this agreement shall work in concert with each other to resolve this issues. The Tri-County staff that will be providing services on site to the Service Group being served by this Agreement shall be: one family worker as needed to assist in fulfilling family needs. 19. Training At its sole cost for trainers and materials, Tri-County shall provide all Head Start Program-specific training, including pre-service and in-service training, and such other training and career opportunities as Tri-County determines to be necessary and appropriate, for all staff performing services for the Service Group under this 4 Agreement, whether employed by Provider or employed by Tri-County. Provider shall cooperate with making staff and facilities available for training. 20. Provider Submission of Reports, Records and Evaluations and Monitoring. a. Provider further agrees to submit to Tri-County such reports as may be required by evaluations required by the Services Checklist which is incorporated into this Agreement by reference , HHS/ACF directives or separately required by Tri County, including (but not exclusive of) computer and Quarterly reports, monthly attendance reports, monthly enrollment reports, Program Information Reports, Self Assessment Instruments, improvement plans and semester fmancial reports. Tri-County's representative shall have the right to inspect all such records and reports whether related to Provider's performance of services under this Agreement or any other activity conducted by Provider as Tri-County reasonably determines. Reports may be provided in an electronic format mutually agreed to by the parties and delivered with a level security appropriate to the information contained in those reports. b. Provider agrees to prepare, retain and permit Tri-County to inspect, as Tri-County · considers necessary, all records required in the provision of these services by HHS and Tri-County regulations. Provider further agrees Tri-County may carry out monitoring and evaluation activities to include, as minimum, periodic observations of the daily program, conferring with staff and parents, validation of the Provider self-assessment procedures and on- site visits to conduct specific activities. Provider shall insure the cooperation of Provider's employees, contractors, policy groups and board members in those efforts. c. Monitoring. At its sole cost, Tri-County shall monitor the performance of Provider on an on-going basis, which monitoring shall include, but not be limited to, review of documents, records, reports and evaluations required by the Services Checklist which is incorporated into this Agreement by reference and by on-site monitoring on the schedule established by Tri-County, but no less frequently than once per month. Provider shall insure the cooperation of Provider's employees, contractors, policy groups and board members in those efforts. d. Consulting. At its sole cost, Tri-County agrees to provide consulting services to Provider as requested and as needed to support compliance with this agreement and provision of high-quality services. 21. Compliance. The Provider agrees to perform all services provided under this agreement in a manner which conforms to the specific requirements of this Agreement in accordance with Tri-County's approved work program, approved program funding requirements, and grant conditions inclusive of Head Start Performance Standards, Program Instructions, CFR 45 (Administration of Grants), Audit Guide, Head Start guidelines and all other HHS/ACF directives. Provider acknowledges failure to do so would jeopardize Tri-County's primary source of funds for purchasing the services under this Agreement and would impact the availability of Tri-County to secure funds to perform Tri-County's obligations under this Agreement. Tri-County agrees to provide information and consultation to Provider concerning applicable rules and regulations to support compliance efforts. 5 22. Remediation. IfTri-County determines Provider is not performing services in a manner which is in compliance with the terms of this Agreement, including failure to be in compliance with application laws, rules, regulations, it will notify Provider of the manner in which it is out of compliance with this Agreement, what actions are required to remediate the non-compliance, and the date by which the non- compliance shall be remediated. Tri-County agrees to assist Provider in developing an improvement plan if Tri-County determines such a plan is necessary and appropriate. 23. Consequences of Continued Failure of Compliance. Non-compliance may result in financial reimbursement being withheld, probationary status being imposed immediately upon determination of non-compliance, and such other penalties as Tri-County deems appropriate under the circumstances. Continuation of non-compliance past the deadline by which the non-compliance is to be remediated shall result in this Agreement for . Services being terminated immediately and Tri-County may at its sole option terminate this contract without further notice or liability under this Agreement. Any financial reimbursements which have been withheld may be forfeited at Tri-County's sole option PART III DATA MANAGEMENT 24. Program Data Management. All data acquired or maintained in connection with the performance of services under this Agreement shall be acquired, maintained, and transmitted in a manner that effectively supports the availability, usability, integrity, and security of that data and shall further protect the privacy of child records in accordance with 45 CFR 1303 subpart C and applicable federal, state, local and tribal laws and Tri County Management of Program Data policies. 25. Access to Child Records. Provider policies for access to child records shall strictly comply with 45 CFR 1303 subpart C and applicable federal, state, local and tribal laws. 26. Written Policies and Procedures. Provider shall have written policies and procedures concerning data management, including access to child records, and shall provide a copy of those policies to Tri-County. Where the Provider policies, in full compliance with all federal, state, local, and tribal laws, vary from Tri-County Management of Program Data standard policies Provider shall, in coordination with Tri-County's similar disclosures, provide parents (as defined by 45 CFR1305.2) with their rights in writing, including the kinds of personal information that may be disclosed, to whom the personal information may be disclosed, and what may constitute a necessary reason for the disclosure without parental consent under 45 CFR 1303.22(c) and other applicable laws, rules, and regulations. 27. Violation of Data Management. In the event of a finding of violation of Data Management policies, laws, rules, or regulations, Provider shall be given ten working days to self-correct. Provider shall hold Tri-County harmless for any such violation. Failure to self-correct shall result in Provider being prohibited from access to records for a set period oftime as determined by the Tri-County Child and Family Development Council, Inc. Board of Directors and Policy Council. 6 PART IV COMPENSATION 28. Payment. Subject to Tri-County's receipt of funds from HHS/ACF through its underlying operating grant no. 07CH7073-5 Provider shall be paid $2,072.52 per child served per semester with a total maximum payment of $41,450.40 for Educational Services. Enrollment for the semester shall be based on the number of children enrolled on the first day of class on the first day of instruction of the semester. No more than fifteen percents of the funds received shall be used for administrative costs. Payments shall be made for each semester within 30 days of presentation of billing invoices, which billing invoices shall be submitted no later than December 1st for the first semester and March 1st for the second semester. Provider shall retain all CACFP reimbursements as its sole compensation for Nutritional Services. 29. Maximum Funding. Tri-County shall provide no more than the specified maximum payment level in federal funds .. It is expressly understood and agreed that in no event will the total amount paid under this Agreement exceed the Maximum Funding level for full and complete performance unless additional funding is specifically authorized in writing by Tri-County. Payment includes all operational costs associated with the provision of services, including certified Teacher salary, and fringe benefits. 30. Budget. Use of funding shall be governed by the Project Budget which is attached to and incorporated into this Agreement. Requests for amendments to the Project Budget must be made in writing in advance of expenditures and must be approved in writing by Tri-County. 31. Fiscal Reporting and Invoicing. Fiscal reports outlining expenditures and supported by invoices shall be provided no less than each semester with the final fiscal report with invoices to be received by May 31 , 2018. PARTV FISCAL MANAGEMENT 32. Evaluation of Program Costs and Fiscal Reports. At its sole cost, Tri-County shall conduct on-going review and evaluation of fiscal reports and program costs related to the performance of this Agreement. 33. Maintenance of Books and Records. Provider shall maintain such records and accounts, including property, personnel, and financial, as are deemed necessary by Tri County or the Department of Health and Human Service/ Administration for Child and Families (HHS/ACF) to assure proper accounting for all federal funds used by Tri County in making payments under this Agreement. These records, and such personnel as are necessary and appropriate to discuss those records, will be made available for audit purposes to Tri-County, HHS/ACF, and the Comptroller General ofthe United States or any authorized representative of them and will be retained for four (4) years after the expiration date of this contract and any renewals of it, unless permission to destroy them is granted by both Tri-County and HHS/ACF. Tri-County reserves the right to request 7 an extension of the retention period, in which case records will be retained until Provider is authorized to destroy the records. Access shall continue as long as the records are retained and shall not be limited to the mandatory retention period. 34. Reports and Fiscal Management Guidelines. Provider shall specifically provide the following specified reports and conform to the following fiscal management guidelines: a. Semester financial reports on the program shall be submitted to Tri-County within fifteen (15) calendar days following the close of each semester but with the final report to be submitted by May 31, 2019. b. Copies of all external and internal audits shall be provided within 30 days of audit completion. c. No contract funds shall be used for: 1. Expenditures other than those necessary to meet the performance requirements of this agreement as determined by Tri-County as set out in the Project Budget; 11. The purchase of real property or construction of real property; 111. Research or development of copyrightable materials; or 1v. Expenditures resulting from failure of the Provider obtaining and documenting "other related assistance" funds (such as CCFP, AEA, Title XIX, and the like.) 35. Reimbursement of Authorized Expenditures. Tri-County agrees to reimburse Provider for authorized expenditures on a not less than a semester basis. In no event shall the Provider receive reimbursement for costs exceeding the Maximum Funding for Services under this Agreement, or four times the total non-Federal share contributions provided by Provider, whichever is less. 36. Disallowed Expenditures. Disallowed expenditures shall be the sole responsibility of the Provider. Any funds received by the Provider from Tri-County which have been used for disallowed expenses shall be reimbursed to Tri-County within thirty days of notice of disallowance. Tri-County may, at its option, withhold from any payments due from Tri County to Provider under the this or any other current or subsequent contracts between the parties an amount necessary to reimburse Tri-County for the disallowed expense or expenses. In the event the disallowed expenses are not reimbursed within thirty days, the Provider shall be liable for attorney's fees, court costs, and all other reasonable fees and expenses incurred by Tri-County in collecting the amount due for the disallowed expenses. 37. Mandatory Use of Alternate Funding. If alternate funding sources are available for nutrition and educational services, Head Start dollars shall be the last dollars spent. It is specifically required that benefits from the United States Department of Agriculture (USDA) (CACFP or School Lunch program or the like) will be.utilized fully before Head Start Funds are used to support food costs. Provider shall maintain documentation of its receipt and application of alternative food and educational funding sources. 38. Insurance Coverage and Fidelity Bonding. Provider agrees to secure and keep in force for the duration of this Agreement adequate insurance coverage to protect against losses. Coverage must include student accident, general liability, and fidelity bonding. Insurance against Head Start property damage/loss/theft is required. Copies of the cover sheet of the 8 policies, or a summary of the applicable insurance coverage, shall be submitted by Provider as evidence of current coverage. Tri-County must also be included as an additional named insured on all applicable policies. Should transportation become part of required or provided services, vehicle coverage (collision and liability) for any vehicle used for Head Start program purposes must be provided in the same manner. Required insurance shall be at least in the amount set out in the Insurance Requirements, which are part of this Agreement. 39. Protection of Property. Provider agrees to protect all Head Start purchased equipment/property in its care, custody, and control and to reimburse Tri-County for all loss and/or damage to that property of whatever kind, excluding only normal depreciation and wear and tear. 40. Format for Fiscal Information. All information shall be provided in the format specified by Tri-County, and shall be on the forms specified by Tri-County, if such forms are provided. PART VI PROVIDER PERSONNEL MANAGEMENT 41. Personnel Management System. Provider shall assure there shall be a personnel management system covering Provider's staff which is consistent with the Regulations set forth in Head Start Performance Standards and Head Start regulatory standards CPR 45 1300 series. Provider shall provide a copy of its personnel policies and procedures to Tri-County. This shall include, but shall not be limited to, a current organizational chart for Provider's organization and those sections of Provider's policies, which cover performance appraisals. 42. Compliance With Staff Requirements. Provider shall assure compliance with HHS and Tri-County's requirements regarding staff certification, training, and technical assistance which shall include maintenance of personnel records of each of Provider's employees providing services under this Agreement. These personnel records shall include the documents specified on Personnel Requirements for Head Start Pre-K Partner Employees, attached to and incorporated into this Agreement by reference, which shall include verification of: a. Current teaching license for Teachers b. Evidence of CDA or other specified credential for associates c. Proof of criminal records check prior to employment for all staff d. Current health assessment for Tuberculosis or TB test e. Current individual professional development plan f. Current Mandatory Child Abuse Reporter training 43. Report of New Hires to Tri-County. New hires who will be providing services under this Agreement shall be reported to Tri-County within five working days of hire along with verification of verification of compliance with the Personnel Requirements for Head Start Pre-K Partner Employees. 44. Employee Notice. Provider shall comply with 29 CPR part 471 , appendix A to subpart A. including all requirements of posting notices. 9 45. Compliance by Sub-Contractors. All subcontracts with third party businesses or individuals to conduct any activity under this Agreement and to be paid with funds acquired under this Agreement must meet Head Start Standards, the standards set out in this Agreement, and shall be properly documented, including specific data describing work to be performed and expected outcomes, and time sheets maintained to support the contractual agreement. Tri-County shall be notified prior to Provider entering into any sub-contract, the sub-contractor must agree in writing to be bound by all terms and conditions of this Agreement, and Tri-County shall be provided with a copy of the sub contract agreement. 46. Discrimination In Employment Prohibited. The Provider shall not discriminate against any person employed in the performance of this contract, or against any applicant for employment because of race, sex, age, creed, religion, color, national origin, sexual orientation, political affiliation, veteran's status, disability or handicapping condition. This requirement shall apply to, but not be limited to the following: employment, upgrading, demotion or transfer, selection for training, recruitment or recruitment advertising, layoff or termination, rates of pay or other forms of compensation and all other privileges, terms and conditions of employment. 47. Discrimination Policies and Procedures. The Provider shall maintain a policy and procedure for reporting and remediating any allegations of such discriminate. 48. Certification Regarding Wages and Salaries. Provider certifies that all of Provider's employees who are involved in providing services under this agreement have, or will have by the effective date of this Agreement, received at least a 2.6% increase in their compensation since the commencement of the most recent Purchase of Services agreement for provision of Educational or Nutrition Services between the parties. PART VII TERMINATION OF AGREEMENT 49. Notice ofTri-County Intent to Terminate. Except in the case ofTri-County's loss of funding from HHS, or as provided above, financial assistance under this contract shall not be terminated or reduced, or an application for refunding denied or financial assistance suspended for longer than 30 days unless the Provider has been afforded reasonable notice. Tri-County may terminate this agreement without cause at any time on thirty (30) days prior written notice to the Provider. 50. Termination on Loss of Funding. In the event ofTri-County's loss of funding from HHS, at Tri-County's sole option, Tri-County may terminate this agreement without any minimum notice period. 51. Dissolution Clause. Upon termination or expiration of this Agreement: a. Tri-County shall notify Provider in writing, no later than 120 days after termination of its intention to transfer equipment purchased with federal funds and having an initial unit purchase price of $500.00 or more and unused supplies, which exceed $500.00 in total aggregate fair market value. b. Provider shall be entitled to be paid any reasonable resulting shipping cost incurred for the transfer of equipment, supplies, and records. 10 c. Alternatively, within thirty (30) days following termination, Provider shall have the option to purchase any equipment and supplies at a price mutually agreeable to Tri-County and Provider. d. Provider shall arrange for immediate transfer of record and reports generated during the performance of this Agreement as required by HHS regulation and/or Tri-County. PART VIII GENERAL PROVISIONS 52. Political Activity Prohibited. None ofthe funds, materials, property, services contributed by Tri-County or the Provider under this contract shall be used for any partisan political activity, (1) to further the election or defeat of any candidate for public office, or to pay directly or indirectly, the salary or expenses of either party to this contract or their agent, to engage in any activity designed to influence legislation or appropriations pending before Congress, (2) to provide voters or prospective voters with transportation to the polls or similar assistance in connection with any such election (3) to assist any voter registration activity, (4) to pay any person or organization for influencing or attempting to influence an officer or employee of any agency, a member of Congress, officer or employee of Congress, or an employee of a member of Congress in connection with obtaining any Federal contract, grant or award covered by 31 U.S.C.l352 .. Nothing in the above statement is intended in any way to inhibit or discourage any party from exercising its lawful rights to attempt to influence legislation pending before Congress as long as the costs are not charged to this Head Start Program. Any required certifications shall be filed upon request. 53. Drug Free Environment. Provider shall not permit use of drugs, alcohol, or tobacco by its employees or contractors at any Location used for Primary or Secondary Services, in any motor vehicles owned or provided by Tri-County or otherwise used in conjunction with providing Primary or Secondary Services, or in any manner in the presence or in the view of the children and families being served under this agreement. Provider shall further fully comply with the provisions of the Iowa Smokefree Air Act set out in Iowa Code Chapter 142D. 54. Covenant Against Contingent Fees. Provider warrants no person, selling agency or other organization has been employed or retained to solicit or secure this contract upon an agreement or understanding for a commission, percentage, brokerage or contingent fee. For breach or violation ofthis warrant, the Tri-County shall have the right to annul this contract or otherwise recover the full amount of any such commission, percentage, brokerage or contingent fee, or to seek such other legal remedies as may be available. 55. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion. a. The Provider certifies that neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. 11 b. If the Provider is unable now, or at any time during the term of this agreement to certify to any of the statements in this certification, Provider shall immediately provide an explanation to Tri-County and this contract shall be subject to immediate termination by Tri-County in the event Provider's participation is disallowed because of that debarment or suspension 56. Discrimination Policies and Procedures. The Provider shall maintain a policy and procedure for reporting and remediating any allegations of such discriminate. 57. Construction of Agreement. This Agreement shall be construed under the laws of the State of Iowa. 58. Headings and Declaration Sheet Not Part of Agreement. Paragraph headings, division captions, and Declaration Sheet shall not be construed as part of the substantive agreement between the parties. In the event of a conflict between the Declaration Sheet and the Purchase of Services Agreement language, the language of the Purchase of Services Agreement shall control. The parties further agree the following documents are incorporated into this Agreement by reference: A. Project Budget B. Insurance Requirements (attached) C. Services Checklist (attached) D. Personnel Requirements for Head Start Pre-K Partner Employees (attached) E. Tri-County Personnel Document Checklist (attached) F. Head Start Performance Standards (available at https://eclkc.ohs.acf.hhs.gov/policy/45- cfr-chap-xiii) G. Head Start Act (available at https://eclkc.ohs.acf.hhs.gov/policy/head-start-act) H. Head Start Policy Clarifications (to be provided and updated as received) I. ACF/HHS Communications (to be provided and updated as received) Dated: Dated: ------Provider: Tri-County: Independence Community School Tri-County Child & Family Development District Council, Inc. By: ______By: ______Harrison Cass PhD Vice Chair Board of Directors 12 INSURANCE REQUIREMENTS Liability: $1,000,000.00 each occurrence $2,000,000.00 aggregate Umbrella $1,000,000.00 excess liability Sexual Abuse Coverage $ 1,000,000.00 each person $ 2,000,000.00 maximum Bond: All persons who control money need to be bonded in an amount sufficient to assure no loss of contract funds in the context of all funds handled, including those from other sources. Tri-County must be listed as an additional insured on all policies; if self-insured, fiscal responsibility at the above level must be demonstrated and approved in writing by Tri County and Tri-County must be held harmless for liability. 13 Head Start Compliance Checklist 2018-2019 NUTRITION Service Requirement Source Frequency Details How will this be monitored? Nutritional HSPS 1302.46 (b)(2) 2x during school Survey is completed by This compliance item is monitored through the Assessment year family with the Family monthly report in the data base PROM IS Worker during the 2nd scheduled home visit and submitted to the Tri-County Dietitian for review. The surveys are returned to the family worker. The follow up survey is due to be completed in February and submitted to the Tri-County Dietitian for review and returned to the family worker. Menu HSPS: 1302.44 Monthly To be provided to the Tri- This compliance item is monitored through the (a)(1)(2 iii) County Dietitian in writing. reciept of the monthly menu and by the Dietician Any variation from the menu is to be recorded on the food production reports at mealtime for each partnering location. Menus need to follow all the requirements of the CACFP and National School Lunch programs, including providing special menus for children with specialized dietary needs. Nutrition Activity HSPS 1302.31 (e) (2) Monthly Activities need to be This item is monitored monthly through a review documented on lesson plans of lesson plans, interview with children and and on monthly reports given observation, and on monthly reports. to family workers. Nutrition Education Activities provided by contracted Dietician Page 1 of 8 Head Start Compliance Checklist 2018-2019 Service Requirement Source Frequency Deta ils How will this be monitored? Birthday treats HSPS 1302.44 (a) Yearly Children are allowed to bring This item is not monitored but is best practice {1)2)(iii) treats once a year. Food cannot be homemade; it needs to be in its original store packaging. Holidays HSPS 1302.40 (a) Treats are discouraged for This item is not monitored but is best practice 1302.44 (a)(1) holidays. The celebration of holidays is discouraged due to a range of cultural considerations. Head Start services should acknowledge and respect all individual culture. Due to food allergies it is strongly recommended all treats are nut free and of fruit or vegetable in nature other hea I thy options are encouraged. EDUCATION All Teachers will HSPS 1302.91 (e) Update annually The building Principal or This item is monitored annually by the Executive have a SA degree {2)(ii) on the first day of designee will provide staff Director and Human Resource Director. in Early H.S. ACT pg. 99 648 the contract and credentials to Tri-County. In a Childhood A. (a)(2)(A)(i)(ii) within five review year, credentials must working days of be made available to new hire/staff reviewers upon request. change All Assistant Head Start Act pg. Update annually The building Principal or This item is monitored annua lly by the Deputy teachers will 100 Section 648 A on the first day of designee will provide staff Director and Human Resource Director have at Minimum (a){2), (B)(ii) the contract and credentials to Tri-County. In a a CDA or be within five triennial review year, enrolled in a working days of credentials must be made program leading new hire/staff available to reviewers upon to an AAS or SA change request. degree or enrolled in a CDA program to be completed within 2 years. Cla ssroom HSPS 1302.31(a-c) As needed but a The classroom shall be open The results of observations are shared with t he Observations 1302.102 {b)(1) minimum of 2x for informal and formal Teacher, District Coordinator, and building (anecdotal notes, (2)(C)(1) 1304.16 per year. observations by Tri-County Principal for continuous improvement. HSPS, Self- staff. Assessment, Health & Safety Checklists, C. L.A.S. S or similar tools) Page 2 of 8 Head Start Compliance Checklist 2018-2019 Service Requirement Source Frequency Details How will this be monitored? Brigance Ill HSPS: 1302.33(a)(1) Within 45 days of The classroom Teacher shall This requirement is monitored on the PROM IS Screen student's administer the screen. The data base and copies of the report will be made enrollment. date of the screen and the available to the Early Childhood Coordinator or score is put on the Child Data District designee Check list and sent to the Program Manager. If needed, 30 day rescreens will be completed and the date and score is put on the Child Data Check list and sent to the Program Manager. The screen is placed in the child's file. Computer tracking reports are generated and reviewed by Tri-County Program Manager and shared with the Teacher for follow-up. Speech Screen HSPS 1302.33(a)(1) Within 45 days of The classroom Teacher shall This requirement is monitored on the PROMIS Communication student's administer the data base and copies of the report will be made Skills Checklist enrollment Communication Skills available to the Early Childhood Coordinator or Checklist Screen within 45 District designee days of enrollment using the form from their manual. The . date of the screen and a concern, if any, is put on the Child Data Check List and sent to the Program Manager or EMA for data entry. Original form is placed in the child's file. Teachers will follow thei r School District procedure for and speech concerns. Any new children enrolled must have all screenings within 45 days of enrollment. Kindergarten HSPS 1X per year Classroom Teacher Observations will be made by the Program Transition 1302.71(a)(b)(c) completes a transition form. Manager and records will be reviewed every This form and the Progress Spring reports are provided to Tri- County and to parents of student 7 days prior to student's Kindergarten Roundup. Page 3 of 8 Head Start Compliance Checklist 2018-2019 Service Requirement Source Frequency Details How will this be monitored? Lesson Plans HSPS 1302.30, Weekly Classrooms must have a Observations will be made by the Program 1302.31(a)(b)(c) written curriculum and Manager and records will be reviewed quarterly. written program of activities. Schedules/plans must be posted and based on Developmentally Appropriate Practices. Lesson plans are placed in a file or binder for review. Home Visits & HSPS 1302.34 (a)(b At least 2 Home Home visits and conferences Visit s are documented on a home visit form and Conferences 1-7) Visits and 2 are scheduled at the family's dates are submitted to the Program Manager on a Conferences per convenience. These visits monthly basis on the Child Data Checklist. Home year conducted by may be done jointly with the visits should be conducted in the home of the the Teacher Family Worker; however that family whenever possible. A parent signature is is not a requirement. GOLD required on the Home Visit or Conference form. assessment also provides a This information will be presented to the Early family conference form that Childhood Coordinator or designee on quarterly may be used to meet this basis. requirement at the conclusion of each checkpoint. ASQ-SE HSPS 1302.45(b, 1- Within 45 days of This tool is intended to be PROM IS data reports with this information will be (Ages and Stages 6), 1302.46 student done with parent input. shared monthly with Early Childhood Coordinator Questionnaire enrollment Teachers report scores on or designee. -Social Child Data Checklist, sent to Emotional) the program manager and place the ASQ/SE in the child's file. If concerns are noted, family is consulted and referral to Mental Health Specialist is made per parent request. Any new children enrolled mid-year must have all screenings within 45 days of enrollment. Parent/child HSPS 1302.34(a)(b,1 Monthly Meetings are planned with Quarterly reports will be made available to Early events 7) 1302.50 (a)(b,1-6), the Family Worker & the Childhood Coordinator or designee. classroom staff, and held at a time convenient to families. The Teacher and the Family Worker hold joint meetings, covering education, nutrition, health and mental health and other topics that may be identified by the parent survey or input. The Assistant Teachers are available to assist with these activities. Page 4 of8 Head Start Compliance Checklist 2018-2019 . Service Requirement Source Frequency Details How will this be monitored? Individualizing HSPS 1302.33(b,1-3) Ongoing The Teacher must use the Observations will be made by the Program the program information from screenings, Manager and records will be reviewed quarterly including health screenings, observations, and evaluations for individualizing for each child. This would include tailoring activities, adapting the environment, and being responsive to the different learning styles. The individualization must be documented either in some format on lesson plans via a code for confidentiality purposes or in anecdotal records. Participate in HSPS 1302.102(b)(2) At least once a Assist in program self- Annually t his summation of issues, concerns and program self- year assessment by providing the celebrations is completed. Results will be shared assessment items/documentation with all contractors. In many cases action plans required to conduct the self- for improvement will need to be implemented. assessment of the program. Page 5 of 8 Head Start Compliance Checklist 2018-2019 Service Requirement Source Frequency Details How will this be monitored? Child HSPS At least 3 times The Teachers use the child's On-line GOLD is the current assessment used that assessments that 1302.33 per program year ongoing documentation to meets this requirement. Use of any other meet the Head complete the assessment. assessment tool requires prior approval of this Start mandated The results are used in agency. domains. classroom planning and individualizing. Creative 1302/33(b) At least 3 times This information is shared This assessment is accessible via the on-line Curriculum Gold per program year with parents and must system and available for viewing at the discretion Assessment as designated by indicate parent goals are of the District or Provider. the State incorporated into the deadlines for process. Parents will receive check points a written copy of the parent summary form. DISABILITIES How will this be monitored? Addressing needs HSPS Ongoing The teacher will employ All legal procedures regarding the establishment of children with 1302.33(a )(3,i}.(4). multiple intervention of an IEP will be followed. suspected 1302.60, 1302.61, strategies to address disabilities 1302.62, 1302.63 individual needs of each child, including use of Tri- County Mental Health Referra Is, Positive Behavior Instructional Supports (PBIS) and use of Behavior Incident Reports (BIR's). Data will be collected & documented to support the degree of success. Collaboration with parents will occur and be on- going. Tri-County must be consulted regarding any child potentially removed from the classroom/school on a temporary basis for any behavioral issue. Page 6 of 8 Head Start Compliance Checklist 2018-2019 Service Requirement Source Frequency Details How will this be monitored? Establishment of HSPS 1302.63 As needed Copies of the signed parent permission for Individual evaluation & services page, the IEP goals page s Education Plans and the IEP services pages will be included in the (IEP's) child's file. Services w ill be provided as specified in the child's IEP. Communication and collaboration with classroom teaching staff will occur regarding identified IEP goals for the child. Basic Care Service Requirement Source Frequency Details How will this be monitored? Orientation HSPS 1302.34 (b)(7) 1 X per child On or before the first day of Quarterly reports will be made available to Early attenda nee the student and Childhood Coordinator or designee. the family of the student shall be provided with orientation concerning the programs and site. The orientation process must be planned with the Family Worker from Tri-County. This applies to Head Start funded children. Vision, Hearing HSPS 1302.42(a), 1 X per year The students will be screened Monthly reports will be made available to Early Screens (b,2),(d) within first 45 by Head Start contracted Childhood Coordinator or designee. days of Nurses or School Nurses and ' enrollment results will be given to Tri- County. Individual child PROM IS reports will be provided to PM for Child's classroom file. Fluoride Varnish 1302.43(c)(3) 3 x per year Nurses, with parental Quarterly reports will be made available to Early consent apply fluoride Childhood Coordinator or designee. varnish three times per year. In-Kind Activities HSPS 1303.4 Weekly Each classroom will plan Quarterly reports will be made available to Early activities that will engage Childhood Coordinator or designee. parents with their child and accrue in-kind contributions. In-Kind Head Start Act Weekly Documentation of in-kind Quarterly reports will be made available to Early Documentation 640(b) contributions shall be in Childhood Coordinator or designee. writing on forms provided by Tri-County and submitted via the Tri-County cou'rier. Permanent 1302.17(a(b) As applicable No Head Start child shall be Tri-County must be consulted and involved in any Removal of Child permanently removed from removal discussion prior to the removal. the school without coordination with Head Start. Page 7 of 8 Head Start Compliance Checklist 2018-2019 Service Requirement Source Frequency Details How will this be monitored? Health and Safety 1302.47 {b)1-7 At least annually Procedures for Health and Annnual Health and Safety screens will be Emergencies updated as Safety emergencies must be completed on every classroom and turned into needed posted in the cla ssroom. This Program Manager by Sept. 15 every program year. would include natural disasters, fire, and injured child. First Aid; CPR and 1302.47 (b)(4)(i- Annually or as Teachers or Assistant This is monitored in the Human Resources Mandatory k),{5) needed by teachers will maintain Employee checklist. Reporting for standard current certification in first Child Abuse aid, CPR and Mandatory Reporting regarding Child Abuse and Neglect. The documentation for certification will be made available to Tri-County. Incident/Accident 1302.47(5) As needed The Teacher or Assistant This tracking information will be shared with the Reports 1302.50(b)(6) Teacher will provide building administrator, Early Childhood documentation for the Coordinator or designee and the teaching staff on parent of any child who was a quarterly basis. involved in an incident resulting in injury or exposure. Tri-County will also receive notification of incidents or accidents for tracking and documentation purposes. Annual Physical H5PS 1302.42(a) w ithin 30 days of Documentation will be This will be monitored by monthly PROM IS reports Exams and up to 1302.15(c)(e) enrollment provided to Tri-County Child and made available to Early Childhood date and Family within 30 days of Coordinator or des1gnee immunizations enrollment. Must be current in Annual update for Teachers assist Family This will be monitored by monthly PROM IS reports past 12 immediate children that Workers in working with the and made available to Early Childhood months within 30 continue in the family to keep the physical Coordinator or designee days of enrollment. program more examinations up to date. than one year Annual Dental HSPS 1302.42(c)(l- Annual Dental Documentation will be This will be monitored by monthly PROM IS reports Examinations 3), 1302.43 examinations provided to Tri-County Child and made available to Early Childhood and Family. Teachers will Coordinator or designee Partners will 45 CFR Part 75.403, At least every Provider will submit financial This will be monitored by the Financial offices at need to provide 404 Contract funds semester, report of use of contract Tri-County and with the Financial office of the documentation must be allowable monthly preferred funds showing Provider. of expenditures and reasonable reasonableness and lallowabilitv. Page 8 of 8 (g. D. AGREEMENT FOR SPORTS INJURY COVERAGE THIS AGREEMENT entered into this 19th day of July 2018, by and between Independence Community High School hereinafter referred to as "FACILITY", and Buchanan County Health Center hereinafter referred to as "BCHC"; WHEREAS, FACILITY, from time to time, is in need of spOits injury services which BCHC is capable of providing and the parties have agreed to the provision of such services as hereinafter provided. NOW THEREFORE, the parties agree to the terms and conditions as hereinafter set forth, to-with: SECTION I. FACILITY agrees: I. To compensate BCHC a total cost of $12,007.74 for the provision of sports inj ury services. 2. To allocate no more than $500. annually, for tape and pre-wrap. This wi ll be billed seasonally on a needed basis. 3. To make payments following every athletic season to BCHC upon receipt of invoice. 4. To comply, at all times. with all applicable federal, Iowa and local laws, ordinances, rules. regulations and standards in the performance of its obligations under this Agreement. SECTION ll. BCHC agrees: I. To provided athletic training coverage for the foll owing events: - Football- a Varsity = 5 home games and 4 away games o JV = 4 home games o Freshmen = 5 home games - Cross Country- I home meet - Volleyball- 3 home games, I tournament - Wrestling- a Varsity = 1 two-day tournament with coverage of two ATs, I meet -Boys Basketball- I 0 home games - Girls Basketball- I 0 home games - Boys Soccer- a Varsity = 6 home games o JV = 6 home games - Girls Soccer- a Varsity = 7 home games o JV = 7 home games - Girls Track- I home meet - Softball- 4 home doubleheaders - Baseball- 6 home doubleheaders and I home game -Baseball & Softball shared- 2 home doubleheaders The athletic trainer will arrive I hour prior to the start of each event. One practice visit a week will be provided at 1.5 hours from the start of the football season Agreement for sports injury coverage and completing at the end of the spring regular season. School visits after this date will be billed separately on a needed basis, following the completion of the competition season. Additional events, scheduled after 7/18/18, will be billed individually to Independence Community School District. This may include games that have not yet been scheduled, playoff events, and hosted events. These events will be billed at $30/hour, in addition to drive time and mileage for away events. The athletic trainer will arrive 1 hour prior to the event start. *Coverage of these events cannot be guaranteed.* Routine training supplies will be provided. 2. To submit an invoice quarterly to FACILITY. 3. To comply, at all times, with all applicable federal. Iowa, and local laws, ordinances, rules, regulations and standards in the perfonnance of its obligations under this Agreement. 4. BCHC shall indemnify and hold harmless FACILITY against all actions, claims, demands and liabilities, and against all loss, damage, costs and expenses including reasonable attorneys fees, arising directly or indirectly, out of any violation of the above li sted Section of this agreement by BCHC, or due to the exclusion of BCHC from a federally funded health care program, including Medicare and Medicaid. SECTION Ill. Both parties mutually agree: 1. The duration of this contract is for the period beginning August 1, 2018 and ending July 31 , 2019. 2. This contract may be cancelled in advance of its tennination date by either party, by the canceling party providing written notice to the other party at least 60 days in advance of the effective date of cancellation. In the event of cancellation, all amounts due BCHC shall be paid by FACILITY. Notice Whenever under the terms of this Agreement written notice is required or permitted to be given by any party to any other party. such notice shall be in writing and shall be deemed to have been sufficiently given if personally delivered, delivered by a national overnight courier service (such as Federal Express), transmitted by electronic facsimile or deposited in the Un ited States Mail, in a properly stamped envelope, certified or registered mail, return receipt requested, addressed to the party to whom it is to be given, at the address hereinafter set forth. Any party hereto may change its address by written notice in accordance with this Section: Notice to BCHC: Notice to Sponsoring Institution: Agreement for sp01ts injury coverage Buchanan County Health Center Independence Community High School 1600 First Street East 1207 First St. West Independence, IA 50644 Independence, lA 50644 Attention: Steve Slessor, CEO Attention: Athletic Director 3. BCHC shall indemnify and hold harmless FACILITY for actual or alleged injury to any person or property, including the FACILITY premises and its property. as the result of the negligent or intentional act or omission of BCHC or of any of BCHC's employees, subcontractors or agents providing services pursuant to this Agreement, except to the extent that any such loss, damage, cost or expenses were caused by the negligent or intentional act or omission of FACILITY, it's officers, employees or agents. 4. FACILITY shall indemnify and hold harmless BCHC for actual or alleged injury to any person or property, as the result of the negligent or intentional act or omission ofFACILJTY or of any ofFACILITY's employees, subcontractors or agents providing services pursuantto this Agreement, except to the extent that any such loss, damage, cost or expenses were caused by the negligent or intentional act or omission ofBCHC, it's officers, employees or agents. 5. The parties hereto agree that the services to be provided hereunder shall comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Insofar as FACILITY or BCHC has access to or has been provided with protected personal health information ("PHI" as defined in HIPAA) of patients or employees, each party agrees that it shall only use or disclose PHI as permitted (i) under this Agreement or (ii) under the HIPAA rules. FACILITY and BCHC each agree to: (a) Use appropriate safeguards to prevent misuse of PHI. (b) Make PHI available to individuals as set forth under the HIPAA rules. (e) Report any improper disclosure of PHI immediately to other party hereto. 6. This Agreement constitutes the whole agreement between the prnties and it is mutually understood and agreed that no amendment to this Agreement shall be valid unless the same is made in writing and signed by both parties. Agreement for sports injury coverage IN WITNESS WHEREOF, the pmiies hereto have affixed their signatures the date first above written. Athletic Director Date Independence Community High School Board President Date Independence Community High School Buchanan County Health Center Date ABUSE OF STUDENTS BY SCHOOL DISTRICT EMPLOYEES Physical or sexual abuse of students, including inappropriate and intentional sexual behavior, by employees will not be tolerated. The definition of employees for the purpose of this policy includes not only those who work for pay but also those who are volunteers of the school district under the direction and control of the school district. Employees found in violation of this policy will be subject to disciplinary action up to and including discharge. The school district has appointed a Level I investigator and alternate Level I investigator. The school district has also arranged for a trained, experienced professional to serve as the Level II investigator. Level I Investigator: Erin Burmeister Alternative Investigator: Dewey Hupke Level II Investigator: Independence Police Department {Q.F. IOWA HIGH SCHOOl ATHLETIC ASSOCIATION P.O. BOX 10 • BOONE, lA 50036-0010 • (515) 432-2011 • FAX (515) 432-2961 • wvvvv.iahsaa.org AlAN BESTE, Executive Director • BRETI NANNINGA, Associate Director TODD THARP, Assistant Diredor • CHAD ElSBERRY, Assistant Dlredor • JARED CHIZEK, Assistant Director May 30,2018 TO: SCHOOL ADMINISTRATORS (Superintendent, Principal, Athletic Director) RE: NOTICE OF TERMINATION OF CATASTROPHIC ACCIDENT SECONDARY MEDICAL INSURANCE POLICY Dear School Administrators, For many years the IHSAA, through the sponsorship of the Iowa Farm Bureau, has provided a catastrophic accident secondary medical insurance policy issued by Mutual of Omaha Insurance Company to our member schools for participants (grades 9-12) in IHSAA sponsored athletic programs. The policy provides coverage for eligible student athletes, student managers, student trainers and student cheerleaders enrolled in grades 9-12, as well as those who have graduated the eighth grade and play baseball before beginning their ninth-grade year, who suffered catastrophic injury while participating in interscholastic competition governed by the regulations of the IHSAA. The policy also covered injuries suffered by eligible students while participating in certain related school supervised practices, tryouts, and contest related activities. Unfortunately, as of August 1, 2018, the IHSAA will no longer be providing this insurance benefit. This letter is notice to our member schools that the last day of coverage under the existing policy is July 31,2018. Written notice of a claim must be received by Mutual of Omaha Insurance Company within 60 days after a loss occurs or begins, or as soon as reasonably possible. Any claim is subject to the terms and restrictions of the policy. We would ask that you notify any eligible students and their parents of this deadline. Any claim or questions regarding this policy should be immediately directed to: Mutual of Omaha Insurance Company Special Risk Services P.O. Box 31156 Omaha, Nebraska 68131 Mutual of Omaha Claim Inquiries 1-800-524-2324 In addition, inquiries may be directed to Dissinger Reed, the insurance agency through whom the original policy was purchased, at 1-800-386-9183 or http://www.dissingerreed.com/contact-us/. SAr-,iDRA AI\'DERSON, Diredor of Finance • LEWIE CURTIS, Director of Officials • BUD LEGG. Information Director • CHRIS CUELLAR. Communications Director It is anticipated that the IHSAA will continue to provide a post-season catastrophic accident secondary medical insurance policy to cover eligible students who participate in its post-season tournaments. If your school district would like to purchase additional catastrophic accident secondary medical insurance, you may contact Dissinger Reed or your current liability insurance agent for options. If you have additional questions or concerns, please do not hesitate to contact me. Sincerely, Alan Beste Executive Director _1_ STUDENT ASSURANCE SERVICES I NCORPORATED August 15, 2018 Dear School Administrator: You should have received information from the State High School Activities Association explaining that they are no longer providing catastrophic coverage for your athletes. Attached you will find the catastrophic plan that we can provide to your school. We are currently providing coverage to many school districts in Iowa and surrounding states. Class 1 provides coverage for all interscholastic sports, grade 7-12. Class 2 can provide coverage for all school sponsored and supervised activities other than interscholastic sports. Class 2 would provide coverage for an active shooter situation. If you have any question, please call me at 800-328-2739. Sincerely, David Desch, Sales Director Student Assurance Services, Inc. David Desch, Sales Director 333 North Main Street • P.O. Box 196 • Stilh.vater, MN 55082-0196 (651) 439-7098 · Toll Free (800) 328-2739 · Fax (65 1) 439-0200 • Email: [email protected] ~ GREA:!4M£RICAN. CATASTROPHIC ACCIDENT INSURANCE INSURANCE GROUP 2018-2019 School Year BENEFIT SUMMARY Provides Accident Medical Expense Benefits with a maximum benefit of $5,000,000 per Insured per Covered Accident. Accident Expense Benefits are payable. (a) after $25,000 of covered expenses have been incurred within two years after the date of the Covered Accident; and (b) after benefits have been paid under other Health Care Plans; and (c) for Covered Expenses incurred within 10 years from the date of the Covered Accident. Provides an Accidental Death benefit of $10,000, and a Dismemberment benefit of up to $20,000. CLASS DESCRIPTION & COVERAGE CLASS 1: All student athletes, student managers, student trainers, student coaches, cheerleaders and band members who participate in school sponsored and supervised interscholastic athletic activities. CLASS 2: All students, from pre-kindergarten through the twelfth grade, while they are attending regularly scheduled classes and taking part in all school-sponsored and supervised activities including off-season athletic training and conditioning, except interscholastic athletics. (Includes Class 3 students, if Class 2 students are covered under the Policy) CLASS 3: All students who participate in all school-sponsored and supervised extracurricular non-athletic activities and clubs. PREMIUM CLASS 1: Rate is based on the total enrollment of each High School & Junior High, not just athletes. If you need Class I Sports Coverage for Junior High & 9111 Grade, but the 91h Grade is in a different building, add the total number of 91h Grade students to the enrollment of the Jun1or High and use the corresponding Junior High rate. RATE PER BUILDING Number of Students in each High School Number of Students in each Junior High 0-200 $ 250 0-100 $ 150 201-400 $ 350 101-250 $ 200 401-1 ,000 $ 600 251 -500 $ 400 1,001-1,400 $ 1,250 501-750 $ 650 1,401 & up $ 1,650 751 & up $ 1,000 CLASS 2: $1.20 per student CLASS 3: $0.40 per student 100% participation is required- Minimum Policy Premium - $500.00 HOW TO ENROLL Please complete the attached APPLICATION Include your check with the APPLICATION made payable to Student Assurance Services, Inc. Please send the APPLICATION and check to: STUDENT ASSURANCE SERVICES, INC. P.O. BOX 196 STILLWATER, MN 55082-0196 This brochure provides a summary of the coverage to be provided and is not intended to substitute for or duplicate policy provisions. It is subject to the provisions of the policy of insurance to be issued by Great American Insurance Company. You will need to contact us for exact policy language, as well as for any limitations and restrictions that may be applicable. The policy is the only contract between the Policyholder and us. It contains the actual terms, conditions and limits of the coverage to be provided. If there is any conflict between this quote and the policy, the policy will govern in all cases. Acceptance of th1s quote is contingent upon and subject to the actual terms and conditions of the policy as issued. CONTACT INFORMATION Marketed by: Student Assurance Services, Inc. 333 North Main Street P.O. Box 196 Stillwater, MN 55082-0196 Phone (651) 439-7098- Toll Free 1-800-328-2739 Underwritten by: Great American Insurance Group Cincinnati, Ohio 45202 Description of Coverage This plan provides benefits for Covered Expenses incurred for treatment of injuries resulting directly, and independently of all other causes, from a Covered Accident. The Covered Accident must occur while the student is taking part in the activity described in the Covered Activity(ies), or while traveling, via transportation provided by the school, directly to or from an activity as a member of a group supervised by the school. General limitations Benefits are payable only for Covered Losses incurred as a result of participation in Covered Activities. LIMITATION ON MU LTIPLE COVERED ACTIVITIES: If an Insured suffers a Covered Loss while participating in more than one Covered Activity, We will pay only one benefit, the largest benefit unless there is a specific written exception in this Policy. LIM ITATION ON MULTIPLE BENEFITS: If an Insured can recover benefits under more than one of the Benefits stated in the Schedule, as a result of the same Accident, We will pay only one benefit, the largest benefit. CAT1-(GREAT AMER)16 Accident Medical Expense Benefits If, as a result of a covered Injury. the Insured, requires care and treatment rendered by a doctor, the Company will pay the Usual and customary charges which are deemed medically necessary provided the first expense is incurred no later than 180 days after the date of the Covered Accident. This Benefit is payable subject to the Benefit Maximum per Covered Accident, the Deductible, and the Maximum Benefit Period shown in the Application. The benefit amount for this benefit is payable in excess of any In Force Policy and its applicable deductible. In the event and only in the event of the reduction or exhaustion of the limit of insurance of the In Force Policy solely as the result of actual payment of benefits covered thereunder, this Policy shall pay excess of the reduced limit of insurance of the In Force Policy and its applicable deductible. This Policy shall only pay pursuant to the terms and conditions of this Policy and no other policy We will pay the Usual and Customary amount, reduced by the payment by any other insurance plan. This Policy will recognize payment by any other insurance plan as reducing or satisfying the deductible amount of this Policy. Accidental Death and Dismemberment Benefit If an Insured suffers a loss of life as a result of a Covered Injury, We will pay the applicable amount shown in the Schedule. The death must occur within 365 days of the Covered Injury. Accidental Dismemberment Benefit If a Covered Injury to an Insured results in any of the following Covered Losses. We will pay the percentage shown below. The Covered Loss must occur within 365 days of the Covered Accident The benefit amount is based on the maximum amount shown in the Schedule for the person suffering the Covered Loss. Covered Loss Percentage of Max1mum Amount Covered Loss Percentage of Maximum Amount Both Hands or Both Feet 100% Sight of Both Eyes 100% One Hand or One Foot plus the loss of Sight of One Eye 100% Speech and Hearing 100% One Hand ; One Foot; or Sight of One Eye SO% Hearing in One Ear 25% Thumb and Index Finger of the same Hand 25% For purposes of this Benefit, DEFINITIONS is amended to include the following: Covered Loss means: 1. For a foot or hand, actual severance through or above the ankle or wrist joint; 3. Total and permanent loss of sight; 2. For thumb and index finger, complete severance through or above the 4. Total and permanent loss of speech; or metacarpophalangeal joint of Both digits; 5. Total and permanent loss of hearing. General Exclusions -A loss will not be a Covered Loss if it is caused by, contributed to, or results from: 1. Sickness, disease, mental infirmity, emotional or psychological trauma, or 9. A covered accident that occurs while on active duty service in the military, naval bacterial or viral infection, or medical or surgical treatment thereof, except for or air force of any country or international organization. Upon our receipt of proof any bacterial infection resulting from an accidental external cut or wound or of service, we will refund any premium paid for this time. Reserve or National accidental ingestion of contaminated food; Guard active duty training is not excluded, unless it extends beyond 31 days: 2. Suicide, self-destruction, attempted suicide or self-destruction, or mtentional 10. Travel in any aircraft owned , leased, or controlled by the Policyholder, or any self-inflicted injury, while sane or insane; of its subsidiaries or affiliates. An aircraft will be deemed to be ·controlled" by 3. War or any act of war, whether declared or not; the Policyholder if the aircraft may be used as the Policyholder wishes for more 4. Commission of, or attempt to commit, a felony, an assault, or other illegal activity: than 10 straight days, or more than 15 days in any year; 5. The covered person being legally intoxicated as determined according to the 11 . Practice or play in any sports activity, including travel to and from the activity laws of the jurisdiction in which the injury occurred and practice, except as specifically provided in the policy: 6. The covered person being mtoxicated or under the influence of any drugs or 12. Aggravation, during a covered activity, of an injury the covered person suffered narcotics unless administered by or upon the advice of a physician. before participating in that covered activity, unless we receive a written medical 7 . Any loss arising out of terrorism or terrorist acts. release from the covered person's physician; 8. Injury covered by workers' compensation, employer's liability laws, or similar 13. Participation in covered activities not sponsored by or under the supervision occupational benefits, or while engaging in activity for monetary gain from of the Policyholder. sources other than the Policyholder; 14. The covered person rid ing or driving in any kind of race. Accident Medical Exclusions: In addition to the General Exclusions stated in the Policy, We will not cover expenses under this additional benefit for: 1. Pre-existing conditions occurring withm the first 12 months of coverage (except 12. Replacement of artificial limbs, eyes, or other prosthetic appliances; as specifically provided by the policy): 13. Routine physicals, check-ups, routine ob-gyn visits, pap smears, or well ness visits: 2. Treatment 'by persons employed or retained by a Policyholder, or by any 14. Overuse symptoms including, but not limited to, bursitis, tendonitis, shin splints, immediate family member or member of the covered person's household; stress fracture s, heat exhaustion, heat stroke, heat prostration, malfunctions of the 3. Pregnancy, childbirth, or miscarriage: heart, embolism, reinjure s or the aggravation thereof, sprains, hernia, strains, muscle 4. Elective abortion, an abortion for any reason other than to preserve the life of tears, or repetitive motion injury, except as specifically provided in the policy; the female upon whom the abortion is performed; 15. Expenses due to an aggravation or re-mjury of a pre-existing condition (except 5. Mental and nervous d1sorders (except as specifically provided in the policy): as specifically provided in the policy): 6. Damage to or loss of dentures or bridges, or damage to existing orthodontic 16. Repair or replacement of existing dentures, partial dentures, braces, fixed or equipment (except as specifically covered by the policy); removable bridges, or other artificial dental restoration (except as specifically 7. Elective or cosmetic surgery, except for reconstructive surgery needed as the provided in the policy): result of an injury: 17. Repair, replacement, examinations for prescriptions, or the fitting of eyeglasses 8. Eyeglasses, contact lenses, hearing aids. wheelchairs, braces, appliances, or contact lenses; examinations or prescriptions for them, or repair or replacement of artificial limbs, 18. Medical expenses and disability for which the covered person is entitled to orthopedic braces, or orthotic devices (except as specifically provided 1n the policy; benefits under any Worker's Compensation Act: 9. Expenses for which the covered person would not be responsible for in the 19. Expenses incurred that are in excess of reasonable charges, or expenses that absence of this policy: are not medically necessary; or 10. Treatment of injuries that result over a period oftime (such as blisters, tennis elbow, 20. Dental treatment necessitated by sickness, deterioration or disease, for etc.), and that are a normal, foreseeable result of participation in the covered activity: cosmetic, preventive, diagnostic or orthodontic purposes, or by any reason 11 . Treatment or service provided by a private duty nurse (except as specifically other than an injury. provided in the policy): Defin itions Accident means a sudden, abrupt, and unexpected event. Covered Accident means an accident that occurs directly and independently of all other causes while coverage is in effect for a covered person resulting in a covered loss or injury under the policy for which benefits are payable. Contributory means the Insured is required to pay all or a portion of the premium. Whether the benefits are Contributory o r Non-Contributory is stated in the Schedule. Covered Activity means those activities set out in the Covered Activities section of the schedule of benefits, with respect to which covered persons are provided accident insurance under the policy. Covered Loss or Covered Losses means an accidental death, dismemberment or other injury covered under the policy. Covered Person means an eligible person, who enrolls for coverage, if required, and for whom the required premium is paid. Eligible Person means a person in a Class of Eligible Persons, as shown in the schedule of benefits. Injury means bodily injury sustained by a covered person caused by a covered accident that: 1. Occurs while thiS policy is in effect as to the person whose injury is the basis of claim; 2. Occurs while the covered person is participating in a covered activity; and 3. Results directly and independently of all other causes in a covered loss. Physician means a provider or practitioner who: 1. Is properly licensed or certified to provide care or treatment under the laws of the state where he or she practices; 2. Provides services that are within the scope of his or her license or certificate; and 3. Is neither the covered person nor a member of the covered person's household or an immediate family member. Schedule of Benefits means the benefits, benefit amounts, terms, limitations and provisions of coverage selected by the Policyholder which is attached to and made a part of this policy. Spouse means an adult person with whom the covered person enters into a marriage, civil union, or comparable relationship in a state or nation in which the marriage, civil union or comparable relationship is sanctioned by law and legally valid at the time it is entered into by the parties. Policy means the contract issued by us to the Policyholder for the benefit of a covered person. CAT1-(GREAT AMER)18 ~======PA=R=T=I=C=IP=A=T=IN=G=O==R=G=A=N=IZ=A=T=IO=N=A=P=P=L=IC=A=T=I=O=N======:dl ~ Application is hereby made for a Catastrophic Student Accident Insurance Plan based on the following statements and representations. GREAJ:A.MEruCAN. INSURAIICE GROUP Applicant (Name of School/District): ------ StreetAddress: ------ City, State, Zip: ------ Taxpayer ID# (if applicable): ------ If the Applicant is a School District, please attach the list of schools to be insured. (ON BACK SIDE IF ADDT'L SPACE IS NEEDED) It is agreed the insurance applied for will not become effective unless: a) this Application is received and approved by the Insurance Company based on current rules and requirements; b) the Policy is accepted by the Applicant; and c) the required premium is paid when due. Policy Term: August 1 2018 to August 1 2019 Requested Policy Term, if other than August 1, 2018 to August 1, 2019: ------ Class lesl of Eligible Persons The Applicant named above elects to provide coverage to the Class(es) of Eligible Persons checked below. Do not elect Class 3, if Class 2 is elected. CHECK ALL THAT APPLY D CLASS 1: All student athletes, student managers, student trainers, student coaches, cheerleaders and band members who participate in school sponsored and supervised interscholastic athletic activities. CLASS 2: All students, from pre-kindergarten through the twelfth grade, while they are attending regularly scheduled classes and taking part in all school D sponsored and supervised activities Including off-season athletic training and conditioning, except interscholastic athletics. (Includes Class 3 students, if Class 2 students are covered under the Policy) D CLASS 3: All students who participate in all school-sponsored and supervised extracurricular non-athletic activities and clubs. CLASS 1: Rate is based on the total enrollment of each High School & Junior High, not just athletes. If you need Class I Sports Coverage for Junior High & 91h Grade, but the 9th Grade is in a different building, add the total number of 9'" Grade students to the enrollment of the Junior High and use the corresponding Junior High rate. • Please list all grades to be covered (Attach list if you need more space) RATE PER BUILDING Number of Students in each High School Number of Students in each Junior High 0-200 $ 250 0-100 $ 150 201-400 $ 350 101 -250 $ 200 401-1 ,000 $ 600 251-500 $ 400 1,001 -1,400 $ 1,250 501-750 $ 650 1,401 & up $ 1,650 751 & up $ 1,000 Class 1: High School Junior High (1)$______(1) _____ (2)$______(2) _____ Premium Totals:Total$ ------Total$ ______= $ ------Number of Insureds X =Premium Class 2: ...... _____ X $1.20 per student =$.__ _ _ Class 3:...... _ ____ X $0.40 per student =$.__ _ _ Please list Class 3 activities and clubs to be covered, ______(ADDT'L SPACE OTHER SIDE) TOTALPREMIUM $ ______(Subject to minimum premium of $500! Please include premium check with this Application, mail and make payable to: STUDENT ASSURANCE SERVICES, INC. FRAUD STATEMENT Any person who knowingly and with intent to defraud any insurance company or other person, files an application for insurance or a statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation. Title: ______Signature of Authorized Person: ------ email: ______Please Print Name:------Telephone: ______ Signed at:-----~~------~~------' Y a e Date: ------ Signed by Licensed Resident Agent ------ (Where Required by Law) SEE REVERSE SIDE FOR IMPORTANT INFORMATION CAT-APP1(GREAT AMER)18 The signed application declares that: All information provided in this application and any attachments hereto is true and correct. The undersigned understands that all information provided in this application and any attachments hereto is material to Great American Insurance Company's decision to provide this insurance, and that insurance will be provided, at Great American Insurance Company's sole discretion. in reliance upon the truth of such information. It is hereby understood and agreed that: 1. this insurance is provided by Great American Insurance Company in consideration of payment of the required premium; 2. the insurance under the policy begins on the Policy Effective Date 8/1/18-8/1/19, except as noted on front of this form; and 3. the acceptance of the policy terminates any prior policy of the same policy number, effective with the inception of the policy. Please list Class 3 activities and clubs to be covered (ADDT'L) ------ Description of Coverage Accidental Death & Dismemberment Benefits Covered Loss Benefit Amount Covered Loss Benefit Amount Death $10,000 One Hand; One Foot; or Sight of One Eye $10,000 Both Hands or Both Feet $20,000 Speech and Hearing $20,000 One Hand or One Foot plus Speech or Hearing $10,000 the loss of Sight of One Eye $20,000 Thumb and Index Finger of the same Hand $ 5,000 Sight of Both Eyes $20,000 Hearing in One Ear $ 5,000 Accident Medical Expense Benefits Scope of Coverage: ...... Full Excess Benefit Maximum: ...... $5.000 .000 Deductible: ...... $25.000 Deductible lncurral Period: ...... 2 years from date of the Covered Accident Maximum Benefit Period: ...... 520 weeks after the date of the Covered Accident ADDT'L INFORMATION SPACE- Coverage is summarized. Coverage features and product availability may vary by state. Please contact us for additional information, and refer to the actual policy for a full description of applicable terms, conditions, limits and exclusions. Policies are underwritten by Great American Insurance Company. The Great American Insurance Group eagle logo and the word marks Great American ®are registered service marks of Great American Insurance Company.© 2016 Great American Insurance Company. Great American Insurance Group, 301 E. Fourth St., Cincinnati, OH 45202. All rights reserved. Please send all correspondence and payments to: Student Assurance Services, Inc. P.O. Box 196 Stillwater, MN 55082 CAT-APP1(GREAT AMER)1 8