efghijkjlmnoopjqfrohstguofjtfvjwoxyhjzt[yp1232.nysed.gov/psc/csdirectory/rooseveltchildrens...inspection...
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Inspection and Testing Certificate
Presented To
Roosevelt Childrens Academy 105 Pleasant Avenue Roosevelt NY 11550
USA
This site has been inspected and tested in compliance with applicable standards.
CompletedGThursday, December 28, 2017G
Test Session: 12/28/17
ACCEPTED BY TESTED BY Abdull Setta Keith Christ Roosevelt Childrens Academy Garland Fire Systems, Inc. 105 Pleasant Avenue Roosevelt NY 11575 USA
Garland Fire Systems, Inc.
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Roosevelt Childrens Academy Garland Fire Systems, Inc.
Inspection SummaryJBuilding Information PROPERTY Roosevelt Childrens Academy CONTACT ADDRESS 105 Pleasant Avenue PHONE CITY/STATE/ZIP Roosevelt, NY 11550 MOBILE COUNTRY USA EMAIL
Inspector Information COMPANY ADDRESS CITY/STATE/ZIP COUNTRY
Garland Fire Systems, Inc. CONTACT PHONE MOBILE EMAIL
John Garland
NAME John Garland JG
INITIALS QUALIFICATION AND PROFICIENCIES
Testing Summary EQUIPMENT TYPE TOTAL TESTED PASSED FAILED
Fire Control Panel 2 2(100 %) 2(100 %) 0(0 %) Initiating Device 126 122(97 %) 122(97 %) 0(0 %) Alarm Notification Appliance 2 2(100 %) 2(100 %) 0(0 %) Emergency Control Equipment 6 6(100 %) 6(100 %) 0(0 %) [Other] 6 6(100 %) 6(100 %) 0(0 %)
General Information
Test Session Comment:
Cleaned and tested all accessible initiating devices.G
Tested indicating circuitry for audio visual integrity.GHowever on the 3rd floor outside of the elevator the horn portion is not working, also on the 1st floorGin classroom 101 the strobe does not work. Both needs to be replaced.G
System found to be in complete working condition.G
Panel returned to normal operating condition upon completion.G
Certification The equipment specified herein was inspected and tested according to the NFPA 72 standard for fire alarm and signaling systems, with the inspection completed on Thursday, December 28, 2017
ACCEPTED BY TESTED BY 12/28/2017 12/28/2017 Abdull Setta Keith Christ Building Representative Technician
Garland Fire Systems, Inc.
Page 2 of 16
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System DetailsJControl Units
MANUFACTURER MIRTONE DESCRIPTION FIRE ALARM CONTROL PANEL MODEL QS1 S/W VERSION SERIAL NUMBER LAST UPDATE INSTALL DATE 8/16/2016 S/W LOCATION
Monitoring Information
Garland Fire Systems, Inc.
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Open Corrective Action & Solution Summary The following 1 corrective action(s) remain open following the system inspection, testing or maintenance activities
EQUIPMENT TYPE ADDRESS DESCRIPTION
N/A General N/A Created By: John Garland Creation Date: 8/16/2016 Corrective Action: Found a non working strobe in classroom 101. Proposed Solution: Must replace it
Garland Fire Systems, Inc.
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Testing DetailsJFire Control Panel
Passed EQUIPMENT TYPE ADDRESS DESCRIPTION METHOD DATE/TIME
Remote Annunciator 20437 FIRE ALARM REMOTE ANNUNCIATOR Scan 12/28/2017 10:17 AMGFire Alarm Panel 20454 FIRE ALARM CONTROL PANEL Manual 12/28/2017 1:35 PMG
Initiating Device
Passed EQUIPMENT TYPE ADDRESS DESCRIPTION METHOD DATE/TIME
Smoke Detector - General 70 00131513 1ST FL STAIR #1 SMOKE DET Scan 12/28/2017 10:09 AM
Smoke Detector - General 115 00131515 1ST FLOOR S CORRIDOR SMOKE DET Scan 12/28/2017 10:09 AM
Smoke Detector - General 67 00131494 1ST FL CORRIDOR W AHC SMOKE DET Scan 12/28/2017 10:10 AM
Smoke Detector - General 68 00131493 1ST FL CORRIDOR W SMOKE DET Scan 12/28/2017 10:10 AM
Smoke Detector - General 65 00131490 1ST FL CLASSROOM 107 SMOKE DET Scan 12/28/2017 10:11 AM
Smoke Detector - General 64 00131491 1ST FL CLASSROOM 107 AHC SMOKE DET Scan 12/28/2017 10:11 AM
Smoke Detector - General 57 00131501 1ST FL CORRIDOR E SMOKE DET Scan 12/28/2017 10:16 AM
Smoke Detector - General 55 00131503 1ST FL ELEVATOR LOBBY SMOKE DET Scan 12/28/2017 10:16 AM
Smoke Detector - General 56 00131502 1ST FL CORRIDOR E AHC SMOKE DET Scan 12/28/2017 10:16 AM
Manual Fire Box 137 00131504 1ST FL EAST EXIT PULL STA Scan 12/28/2017 10:17 AM
Smoke Detector - General 6 20442 3RD FL E OFFICE AHC SMOKE DET Scan 12/28/2017 10:24 AM
Smoke Detector - General 7 20443 3RD FL E OFFICE SMOKE DET Scan 12/28/2017 10:24 AM
Smoke Detector - General 5 00131599 3RD FL STAIR #2 SMOKE DET Scan 12/28/2017 10:24 AM
Manual Fire Box 126 00131598 3RD FL STAIR #2 PULL STA Scan 12/28/2017 10:24 AM
Smoke Detector - General 27 20453 3RD FL WOMEN'S RM SMOKE DET Scan 12/28/2017 10:25 AM
Smoke Detector - General 26 20452 3RD FL WOMEN'S RM AHC SMOKE DET Scan 12/28/2017 10:25 AM
Smoke Detector - General 24 20450 3RD FL MEN'S RM AHC SMOKE DET Scan 12/28/2017 10:25 AM
Smoke Detector - General 25 20451 3RD FL MEN'S RM SMOKE DET Scan 12/28/2017 10:25 AM
Smoke Detector - General 4 00131588 3RD FL ELEVATOR LOBBY SMOKE DET Scan 12/28/2017 10:26 AM
Smoke Detector - General 3 00131587 3RD FL CORRIDOR EAST AHC SMOKE Scan 12/28/2017 10:26 AM
Smoke Detector - Duct 10 00131581 3RD FL RTU-4 SUPPLY DUCT DET Scan 12/28/2017 10:28 AM
Smoke Detector - General 11 00131578 3RD FL COMPUTER LAB AHC SMOKE DET Scan 12/28/2017 10:29 AM
Garland Fire Systems, Inc.
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EQUIPMENT TYPE ADDRESS DESCRIPTION METHOD DATE/TIME
Smoke Detector - General 12 00131577 3RD FL COMPUTER LAB SMOKE DET Scan 12/28/2017 10:29 AM
Smoke Detector - General 9 00131579 3RD FL COMPUTER LAB SMOKE DET Scan 12/28/2017 10:30 AM
Smoke Detector - General 8 00131580 3RD FL COMPUTER LAB ACH SMOKE DET Scan 12/28/2017 10:30 AM
Smoke Detector - Duct 19 00131584 3RD FL RTU-1 SUPPLY DUCT DET Scan 12/28/2017 10:31 AM
Smoke Detector - General 18 00131591 3RD FL LIBRARY ENTRY SMOKE DET Scan 12/28/2017 10:31 AM
Smoke Detector - Duct 20 00131596 3RD FL RTU-3 SUPPLY DUCT DET Scan 12/28/2017 10:32 AM
Smoke Detector - General 23 00131594 3RD FL LIBRARY SMOKE DET Scan 12/28/2017 10:32 AM
Smoke Detector - General 22 00131595 3RD FL LIBRARY AHC SMOKE DET Scan 12/28/2017 10:32 AM
Smoke Detector - General 21 00131593 3RD FL LIBRARY AHC SMOKE DET Scan 12/28/2017 10:33 AM
Smoke Detector - General 108 00131592 3RD FL LIBRARY SMOKE DET Scan 12/28/2017 10:33 AM
Manual Fire Box 129 00131571 3RD FLRSTAIR #1 PULL STATION Scan 12/28/2017 10:35 AM
Smoke Detector - General 16 00131572 3RD FL CORRIDOR W SMOKE DET Scan 12/28/2017 10:35 AM
Smoke Detector - General 15 00131573 3RD FL CORRIDOR W AHC SMOKE DET Scan 12/28/2017 10:35 AM
Smoke Detector - General 14 00131574 3RD FL STORAGE RM SMOKE DET Scan 12/28/2017 10:35 AM
Smoke Detector - General 13 00131575 3RD FL STORAGE RM AHC SMOKE DET Scan 12/28/2017 10:35 AM
Manual Fire Box 136 00131565 2ND FL STAIR #1 PULL STA Scan 12/28/2017 10:36 AM
Smoke Detector - General 38 00131567 2ND FL CLASSROOM 201 AHC SMOKE DET Scan 12/28/2017 10:38 AM
Smoke Detector - General 39 00131566 2ND FL CLASSROOM 201 SMOKE DET Scan 12/28/2017 10:38 AM
Smoke Detector - General 42 00131563 2ND FL CORRIDOR W SMOKE DET Scan 12/28/2017 10:38 AM
Smoke Detector - General 41 00131564 2ND FL CORRIDOR W AHC SMOKE DET Scan 12/28/2017 10:38 AM
Smoke Detector - General 44 00131561 2ND FL CLASSROOM 202 SMOKE DET Scan 12/28/2017 10:39 AM
Smoke Detector - General 43 00131562 2ND FL CLASSROOM 202 AHC SMOKE DET Scan 12/28/2017 10:39 AM
Smoke Detector - General 29 00131549 2ND FL CORRIDOR E SMOKE DET Scan 12/28/2017 10:40 AM
Smoke Detector - General 28 00131556 2ND FL CLASSROOM 203 ENTRY SMOKE DET Scan 12/28/2017 10:40 AM
Smoke Detector - General 34 00131560 2ND FL CLASSROOM 203 AHC SMOKE DET Scan 12/28/2017 10:40 AM
Smoke Detector - General 35 00131559 2ND FL CLASSROOM 203 SMOKE DET Scan 12/28/2017 10:40 AM
Smoke Detector - General 37 00131557 2ND FL CLASSROOM 203 SMOKE DET Scan 12/28/2017 10:41 AM
Smoke Detector - General 36 00131558 2ND FL CLASSROOM 203 AHC SMOKE DET Scan 12/28/2017 10:41 AM
Smoke Detector - General 45 00131551 2ND FL CLASSROOM 204 ENTRY SMOKE DET Scan 12/28/2017 10:41 AM
Smoke Detector - General 46 00131553 2ND FL CLASSROOM 204 AHC SMOKE DET Scan 12/28/2017 10:42 AM
Smoke Detector - General 48 00131555 2ND FL CLASSROOM 204 AHC SMOKE DET Scan 12/28/2017 10:42 AM
Garland Fire Systems, Inc.
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EQUIPMENT TYPE ADDRESS DESCRIPTION METHOD DATE/TIME
Smoke Detector - General 49 00131554 2ND FL CLASSROOM 204 SMOKE DET Scan 12/28/2017 10:42 AM
Smoke Detector - General 30 00131550 2ND FL CORRIDOR E AHC SMOKE DET Scan 12/28/2017 10:43 AM
Smoke Detector - General 31 00131548 2ND FL ELEVATOR LOBBY SMOKE DET Scan 12/28/2017 10:43 AM
Smoke Detector - General 51 00131545 2ND FL MEN'S RM SMOKE DET Scan 12/28/2017 10:43 AM
Smoke Detector - General 109 00131546 2ND FLR MEN'S RM AHC SMOKE DET Scan 12/28/2017 10:43 AM
Manual Fire Box 134 00131547 2ND FL STAIR #2 PULL STATION Scan 12/28/2017 10:44 AM
Smoke Detector - General 110 20446 2ND FLR WOMEN'S RM ACH SMOKE DET Scan 12/28/2017 10:44 AM
Smoke Detector - General 50 20445 2ND FL WOMEN'S RM SMOKE DET Scan 12/28/2017 10:44 AM
Smoke Detector - General 17 00131570 3RD FL STAIR #1 SMOKE DET Manual 12/28/2017 10:47 AM
Smoke Detector - General 2 00131586 3RD FL CORRIDOR EAST SMOKE DET Manual 12/28/2017 10:47 AM
Smoke Detector - General 32 20448 2ND FL E OFFICE AHC SMOKE DET Manual 12/28/2017 10:47 AM
Smoke Detector - General 33 20447 2ND FL E OFFICE SMOKE DET Manual 12/28/2017 10:47 AM
Smoke Detector - Duct 40 00131568 2ND FL RTU-2 SUPPLY DUCT DET Manual 12/28/2017 10:47 AM
Smoke Detector - General 87 00131531 BSMT CORRIDOR E AHC SMOKE DET Scan 12/28/2017 10:49 AM
Manual Fire Box 140 00131519 BSMT STAIR #1 PULL STA Scan 12/28/2017 10:51 AM
Manual Fire Box 138 00131541 BSMT STAIR #2 PULL STA Scan 12/28/2017 10:51 AM
Heat Detector - Restorable Spot 83 00131536 BSMT UTILITY RM HEAT DET Scan 12/28/2017 10:53 AM
Smoke Detector - General 84 00131535 BSMT UTILITY RM SMOKE DET Scan 12/28/2017 10:53 AM
Smoke Detector - General 89 00131530 BSMT CORRIDOR E SMOKE DET Scan 12/28/2017 10:55 AM
Smoke Detector - General 90 00131544 BSMT CLASSROOM B11 AHC SMOKE DET Scan 12/28/2017 10:56 AM
Smoke Detector - General 91 00131543 BSMT CLASSROOM B11 SMOKE DET Scan 12/28/2017 10:56 AM
Smoke Detector - General 105 20438 BSMT CLASSROOM B94 SMOKE DET Scan 12/28/2017 10:58 AM
Smoke Detector - General 104 20439 BSMT CLASSROOM B94 AHC SMOKE DET Scan 12/28/2017 10:58 AM
Smoke Detector - General 101 00131528 BSMT CLASSROOM B05 AHC SMOKE DET Scan 12/28/2017 10:59 AM
Manual Fire Box 139 00131529 BSMT B05 CLASSRM EXIT PULL STA Scan 12/28/2017 11:00 AM
Smoke Detector - General 98 00131524 BSMT MEN'S ROOM SMOKE DET Scan 12/28/2017 11:01 AM
Smoke Detector - General 97 00131525 BSMT MEN'S ROOM AHC SMOKE DET Scan 12/28/2017 11:01 AM
Smoke Detector - General 95 00131523 BSMT WOMEN'S RM AHC SMOKE DET Scan 12/28/2017 11:01 AM
Smoke Detector - General 96 00131522 BSMT WOMEN'S RM SMOKE DET Scan 12/28/2017 11:01 AM
Smoke Detector - General 94 00131516 BSMT CLASSROOM B10 ENTRY SMOKE DET Scan 12/28/2017 11:02 AM
Smoke Detector - General 92 00131518 BSMT CLASSROOM B10 AHC SMOKE DET Scan 12/28/2017 11:02 AM
Garland Fire Systems, Inc.
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EQUIPMENT TYPE ADDRESS DESCRIPTION METHOD DATE/TIME
Smoke Detector - General 93 00131517 BSMT CLASSROOM B10 SMOKE DET Scan 12/28/2017 11:02 AM
Manual Fire Box 141 00131526 BSMT B10 CLASSRM EXIT PULL STA Scan 12/28/2017 11:03 AM
Smoke Detector - General 58 00131496 1ST FL CLASSROOM 109 ENTRY AHC SMOKE DET Scan 12/28/2017 11:06 AM
Smoke Detector - General 59 00131495 1ST FL CLASSROOM ENTRY SMOKE DET Scan 12/28/2017 11:06 AM
Smoke Detector - General 61 00131497 1ST FL CLASSROOM 109 SMOKE DET Scan 12/28/2017 11:06 AM
Smoke Detector - General 60 00131498 1ST FL CLASSROOM 109 AHC SMOKE DET Scan 12/28/2017 11:06 AM
Smoke Detector - General 62 00131500 1ST FL CLASSROOM 109 AHC SMOKE DET Scan 12/28/2017 11:06 AM
Smoke Detector - General 63 00131499 1ST FL CLASSROOM 109 SMOKE DET Scan 12/28/2017 11:06 AM
Smoke Detector - General 74 00131487 1ST FL CLASSROOM 108 SMOKE DET Scan 12/28/2017 11:07 AM
Smoke Detector - General 73 00131486 1ST FL CLASSROOM 108 SMOKE DET Scan 12/28/2017 11:07 AM
Smoke Detector - General 80 00131507 1ST FL CLASSROOM 110 ENTRY SMOKE DET Manual 12/28/2017 11:08 AM
Smoke Detector - General 81 00131506 1ST FL E OFFICE AHC SMOKE DET Manual 12/28/2017 11:08 AM
Smoke Detector - General 75 00131510 1ST FL CLASSROOM 110 AHC SMOKE DET Scan 12/28/2017 11:10 AM
Smoke Detector - General 76 00131509 1ST FL CLASSROOM 110 SMOKE DET Scan 12/28/2017 11:10 AM
Smoke Detector - General 85 00131539 BSMT E STORAGE RM SMOKE DET Manual 12/28/2017 11:11 AM
Heat Detector - Restorable Spot 86 00131540 BSMT E STORAGE RM HEAT DET Manual 12/28/2017 11:11 AM
Smoke Detector - General 88 00131532 BSMT ELEVATOR LOBBY SMOKE DET Manual 12/28/2017 11:11 AM
Smoke Detector - General 99 00131521 BSMT CORRIDOR W AHC SMOKE DET Manual 12/28/2017 11:11 AM
Smoke Detector - General 1 00131576 3RD FL COMPUTER LAB SMOKE DET Manual 12/28/2017 11:22 AM
Smoke Detector - General 113 00131583 3RD FLOOR JANITORS CLST SMOKE DET Manual 12/28/2017 11:22 AM
Smoke Detector - General 114 20444 2ND FLOOR E JANITORS CLST SMOKE DET Manual 12/28/2017 11:23 AM
Smoke Detector - General 47 00131552 2ND FL CLASSROOM 204 SMOKE DET Manual 12/28/2017 11:23 AM
Smoke Detector - General 54 00131542 1ST FL STAIR #2 SMOKE DET Manual 12/28/2017 1:32 PM
Smoke Detector - General 116 116 1ST FLOOR E STAIRWAY SMOKE DET Manual 12/28/2017 1:33 PM
Smoke Detector - General 66 00131492 1ST FL CLASSROOM 107 CLST SMOKE DET Manual 12/28/2017 1:33 PM
Smoke Detector - General 69 00131489 1ST FL STORAGE RM SMOKE DET Manual 12/28/2017 1:33 PM
Smoke Detector - General 71 00131514 1ST FL STAIR #1 SMOKE DET Manual 12/28/2017 1:33 PM
Smoke Detector - General 72 00131488 1ST FL CLASSROOM 108 CLST SMOKE DET Manual 12/28/2017 1:33 PM
Smoke Detector - General 77 00131512 1ST FL CLASSROOM 110 AHC SMOKE DET Manual 12/28/2017 1:33 PM
Smoke Detector - General 78 00131511 1ST FL CLASSROOM 110 SMOKE DET Manual 12/28/2017 1:33 PM
Smoke Detector - General 79 00131508 1ST FL CLASSROOM 110 ENTRY AHC SMOKE DET Manual 12/28/2017 1:33 PM
Garland Fire Systems, Inc.
Page 8 of 16
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EQUIPMENT TYPE ADDRESS DESCRIPTION METHOD DATE/TIME
Smoke Detector - General 82 00131505 1ST FL E OFFICE SMOKE DET Manual 12/28/2017 1:33 PM
Manual Fire Box 1ST FL WEST SIDE EXIT PULL STA Manual 12/28/2017 1:33 PM
Smoke Detector - General 100 00131520 BSMT CORRIDOR W SMOKE DET Manual 12/28/2017 1:34 PM
Smoke Detector - General 102 00131527 BSMT CLASSROOM B05 SMOKE DET Manual 12/28/2017 1:34 PM
Smoke Detector - General 106 00131537 BSMT MACHINE RM SMOKE DET Manual 12/28/2017 1:34 PM
Heat Detector - Restorable Spot 107 00131538 BSMT MACHINE RM HEAT DET Manual 12/28/2017 1:34 PM
Smoke Detector - General 103 20440 BSMT CLOSET B96 SMOKE DET Manual 12/28/2017 1:34 PM
Skipped EQUIPMENT TYPE ADDRESS DESCRIPTION METHOD DATE/TIME
Smoke Detector - General 111 00131534 ELEVATOR PIT HEAT DET Manual 7/18/2014 2:39 PM
Smoke Detector - General 53 00131589 TOP OF ELEVATOR SHAFT SMOKE DET Manual 7/18/2014 3:44 PM
Heat Detector - Restorable Spot 112 00131590 TOP OF ELEVATOR SHAFT HEAT DET Manual 7/18/2014 3:45 PM
Smoke Detector - General 52 00131533 ELEVATOR PIT SMOKE DET Scan 12/28/2017 10:49 AM
Alarm Notification Appliance
Passed EQUIPMENT TYPE ADDRESS DESCRIPTION METHOD DATE/TIME
Audible And Visible 20449 FIRE ALARM BOOSTER PANEL Scan 12/28/2017 10:52 AMGAudible And Visible 20441 FIRE ALARM BOOSTER PANEL Scan 12/28/2017 10:52 AMG
Emergency Control Equipment
Passed EQUIPMENT TYPE ADDRESS DESCRIPTION METHOD DATE/TIME
Fan Control 128 00131582 3RD FL RTU-4 FAN SHUTDOWN Scan 12/28/2017 10:28 AM
Fan Control 130 00131585 3RD FL RTU-1 FAN SHUTDOWN Scan 12/28/2017 10:31 AM
Fan Control 131 00131597 3RD FL RTU-3 FAN SHUTDOWN Scan 12/28/2017 10:32 AM
Fan Control 135 00131569 2ND FL RTU-2 FAN SHUTDOWN Manual 12/28/2017 10:47 AM
Fan Control 127 127 3RD FL RTU-6 FAN SHUTDOWN Manual 12/28/2017 11:22 AM
Fan Control 132 132 3RD FL RTU-5 FAN SHUTDOWN Manual 12/28/2017 11:22 AM
[Other]
Passed EQUIPMENT TYPE ADDRESS DESCRIPTION METHOD DATE/TIME
Other 145 5280054828 GENERAL ALARM RELAY FACP Manual 12/28/2017 1:33 PM
Garland Fire Systems, Inc.
Page 9 of 16
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EQUIPMENT TYPE ADDRESS DESCRIPTION METHOD DATE/TIME
Other 142 142 BSMT MACHINE RM ALT FL RECALL Manual 12/28/2017 1:33 PM
Door Holder 133 133 BSMT UTILITY RM DOOR HOLDERS Manual 12/28/2017 1:34 PM
Other 143 143 BSMT MACHINE RM ELEV RECALL Manual 12/28/2017 1:35 PM
Other 144 144 BSMT UTILITY RM ELEV SOLENOID Manual 12/28/2017 1:35 PM
Other 146 4835476276 HVAC SHUTDOWN MONITOR IN FACP Manual 12/28/2017 1:35 PM
Garland Fire Systems, Inc.
Page 10 of 16
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-
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Device/Equipment DetailsJFire Control Panel ADDRESS DESCRIPTION Manufacturer Model SERIAL INSTALL DATE
Fire Alarm Panel 20454 FIRE ALARM CONTROL PANEL MIRTONE QS1 8/16/2016
Remote Annunciator 20437 FIRE ALARM REMOTE ANNUNCIATOR MIRTONE RLCD-C 8/16/2016
Initiating Device ADDRESS DESCRIPTION Manufacturer Model SERIAL INSTALL DATE
Heat Detector Restorable Spot 107 00131538 BSMT MACHINE RM HEAT DET EDWARDS GSA HRS 3691014387 1/1/2012
112 00131590 TOP OF ELEVATOR SHAFT HEAT DET EDWARDS GSA HRS 3691014486 1/1/2012
83 00131536 BSMT UTILITY RM HEAT DET EDWARDS GSA HRS 3691014851 1/1/2012
86 00131540 BSMT E STORAGE RM HEAT DET EDWARDS GSA HRS 3691013984 1/1/2012
Manual Fire Box 126 3RD FL STAIR #2 PULL STA EDWARDS GSA H270 4882826192 1/1/201200131598 129 3RD FLRSTAIR #1 PULL STATION EDWARDS GSA H270 4882829155 1/1/201200131571 134 2ND FL STAIR #2 PULL STATION EDWARDS GSA H270 4882829186 1/1/201200131547 136 2ND FL STAIR #1 PULL STA EDWARDS GSA H270 4882826529 1/1/201200131565 137 1ST FL EAST EXIT PULL STA EDWARDS GSA H270 4882831011 1/1/201200131504 138 BSMT STAIR #2 PULL STA EDWARDS GSA H270 4882806934 1/1/201200131541 139 BSMT B05 CLASSRM EXIT PULL STA EDWARDS GSA H270 4882807412 1/1/201200131529 140 BSMT STAIR #1 PULL STA EDWARDS GSA H270 4882830649 1/1/201200131519 141 BSMT B10 CLASSRM EXIT PULL STA EDWARDS GSA H270 4882807474 1/1/201200131526
1ST FL WEST SIDE EXIT PULL STA EDWARDS GSA H270 4882831011 12/28/2017
10 00131581 3RD FL RTU-4 SUPPLY DUCT DET EDWARDS GSA PS 3984554439 1/1/2012
19 00131584 3RD FL RTU-1 SUPPLY DUCT DET EDWARDS GSA PS 3984606169 1/1/2012
20 00131596 3RD FL RTU-3 SUPPLY DUCT DET EDWARDS GSA PS 3984587321 1/1/2012
40 00131568 2ND FL RTU-2 SUPPLY DUCT DET EDWARDS GSA SD 3984554408 1/1/2012
Smoke Detector Duct
Smoke Detector General 1 00131576 100 00131520 101 00131528
3RD FL COMPUTER LAB SMOKE DET
BSMT CORRIDOR W SMOKE DET
BSMT CLASSROOM B05 AHC SMOKE DET
EDWARDS
EDWARDS
EDWARDS
GSA PS
GSA PS
GSA PS
3990245888
3990244331
3990244492
1/1/2012
1/1/2012
1/1/2012
Garland Fire Systems, Inc.
Page 11 of 16
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ADDRESS DESCRIPTION Manufacturer Model SERIAL INSTALL DATE
102 00131527 BSMT CLASSROOM B05 SMOKE DET EDWARDS GSA PS 3990244461 1/1/2012
103 20440 BSMT CLOSET B96 SMOKE DET EDWARDS GSA PS 3990244041 1/1/2012
104 20439
BSMT CLASSROOM B94 AHC SMOKE DET EDWARDS GSA PS 3990244904 1/1/2012
105 20438 BSMT CLASSROOM B94 SMOKE DET EDWARDS GSA PS 3990244348 1/1/2012
106 00131537 BSMT MACHINE RM SMOKE DET EDWARDS GSA PS 3990244911 1/1/2012
108 00131592 3RD FL LIBRARY SMOKE DET EDWARDS GSA PS 3990246106 1/1/2012
109 00131546 2ND FLR MEN'S RM AHC SMOKE DET EDWARDS GSA PS 3990244096 1/1/2012
11 00131578
3RD FL COMPUTER LAB AHC SMOKE DET EDWARDS GSA PS 3990243907 1/1/2012
110 20446
2ND FLR WOMEN'S RM ACH SMOKE DET EDWARDS GSA PS 3990239535 1/1/2012
111 00131534 ELEVATOR PIT HEAT DET EDWARDS GSA PS 3691013731 1/1/2012
113 00131583
3RD FLOOR JANITORS CLST SMOKE DET EDWARDS GSA PS 3691019283 1/1/2012
114 20444
2ND FLOOR E JANITORS CLST SMOKE DET EDWARDS GSA PS 3691019528 1/1/2012
115 00131515 1ST FLOOR S CORRIDOR SMOKE DET EDWARDS GSA PS 3990426164 1/1/2012
116 116 1ST FLOOR E STAIRWAY SMOKE DET EDWARDS GSA PS 3990425358 1/1/2012
12 00131577 3RD FL COMPUTER LAB SMOKE DET EDWARDS GSA PS 3990245574 1/1/2012
13 00131575
3RD FL STORAGE RM AHC SMOKE DET EDWARDS GSA PS 3990246120 1/1/2012
14 00131574 3RD FL STORAGE RM SMOKE DET EDWARDS GSA PS 3990245994 1/1/2012
15 00131573
3RD FL CORRIDOR W AHC SMOKE DET EDWARDS GSA PS 3990245567 1/1/2012
16 00131572 3RD FL CORRIDOR W SMOKE DET EDWARDS GSA PS 3990245963 1/1/2012
17 00131570 3RD FL STAIR #1 SMOKE DET EDWARDS GSA PS 3990243501 1/1/2012
18 00131591 3RD FL LIBRARY ENTRY SMOKE DET EDWARDS GSA PS 3990821358 1/1/2012
2 00131586 3RD FL CORRIDOR EAST SMOKE DET EDWARDS GSA PS 3990243617 1/1/2012
21 00131593 3RD FL LIBRARY AHC SMOKE DET EDWARDS GSA PS 3990246328 1/1/2012
22 00131595 3RD FL LIBRARY AHC SMOKE DET EDWARDS GSA PS 3990246182 1/1/2012
23 00131594 3RD FL LIBRARY SMOKE DET EDWARDS GSA PS 3990246113 1/1/2012
24 20450 3RD FL MEN'S RM AHC SMOKE DET EDWARDS GSA PS 3990246076 1/1/2012
25 20451 3RD FL MEN'S RM SMOKE DET EDWARDS GSA PS 3990246151 1/1/2012
26 20452
3RD FL WOMEN'S RM AHC SMOKE DET EDWARDS GSA PS 3990246083 1/1/2012
27 20453 3RD FL WOMEN'S RM SMOKE DET EDWARDS GSA PS 3990243884 1/1/2012
28 00131556
2ND FL CLASSROOM 203 ENTRY SMOKE DET EDWARDS GSA PS 3990245710 1/1/2012
29 00131549 2ND FL CORRIDOR E SMOKE DET EDWARDS GSA PS 3990243723 1/1/2012
Garland Fire Systems, Inc.
Page 12 of 16
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ADDRESS DESCRIPTION Manufacturer Model SERIAL INSTALL DATE
3 00131587 3RD FL CORRIDOR EAST AHC SMOKE EDWARDS GSA PS 3990246403 1/1/2012
30 00131550
2ND FL CORRIDOR E AHC SMOKE DET EDWARDS GSA PS 3990246175 1/1/2012
31 00131548
2ND FL ELEVATOR LOBBY SMOKE DET EDWARDS GSA PS 3990243815 1/1/2012
32 20448 2ND FL E OFFICE AHC SMOKE DET EDWARDS GSA PS 3990243471 1/1/2012
33 20447 2ND FL E OFFICE SMOKE DET EDWARDS GSA PS 3990243648 1/1/2012
34 00131560
2ND FL CLASSROOM 203 AHC SMOKE DET EDWARDS GSA PS 3990243877 1/1/2012
35 00131559 2ND FL CLASSROOM 203 SMOKE DET EDWARDS GSA PS 3990243457 1/1/2012
36 00131558
2ND FL CLASSROOM 203 AHC SMOKE DET EDWARDS GSA PS 3990243839 1/1/2012
37 00131557 2ND FL CLASSROOM 203 SMOKE DET EDWARDS GSA PS 3990243563 1/1/2012
38 00131567
2ND FL CLASSROOM 201 AHC SMOKE DET EDWARDS GSA PS 3990243655 1/1/2012
39 00131566 2ND FL CLASSROOM 201 SMOKE DET EDWARDS GSA PS 3990243594 1/1/2012
4 00131588
3RD FL ELEVATOR LOBBY SMOKE DET EDWARDS GSA PS 3990245956 1/1/2012
41 00131564
2ND FL CORRIDOR W AHC SMOKE DET EDWARDS GSA PS 3990246038 1/1/2012
42 00131563 2ND FL CORRIDOR W SMOKE DET EDWARDS GSA PS 3990246137 1/1/2012
43 00131562
2ND FL CLASSROOM 202 AHC SMOKE DET EDWARDS GSA PS 3990243624 1/1/2012
44 00131561 2ND FL CLASSROOM 202 SMOKE DET EDWARDS GSA PS 3990246144 1/1/2012
45 00131551
2ND FL CLASSROOM 204 ENTRY SMOKE DET EDWARDS GSA PS 3990243419 1/1/2012
46 00131553
2ND FL CLASSROOM 204 AHC SMOKE DET EDWARDS GSA PS 3990243426 1/1/2012
47 00131552 2ND FL CLASSROOM 204 SMOKE DET EDWARDS GSA PS 3990243822 1/1/2012
48 00131555
2ND FL CLASSROOM 204 AHC SMOKE DET EDWARDS GSA PS 3990243747 1/1/2012
49 00131554 2ND FL CLASSROOM 204 SMOKE DET EDWARDS GSA PS 3990243525 1/1/2012
5 00131599 3RD FL STAIR #2 SMOKE DET EDWARDS GSA PS 3990245970 1/1/2012
50 20445 2ND FL WOMEN'S RM SMOKE DET EDWARDS GSA PS 3990197774 1/1/2012
51 00131545 2ND FL MEN'S RM SMOKE DET EDWARDS GSA PS 3990243891 1/1/2012
52 00131533 ELEVATOR PIT SMOKE DET EDWARDS GSA PS 3990244294 1/1/2012
53 00131589
TOP OF ELEVATOR SHAFT SMOKE DET EDWARDS GSA PS 3990243792 1/1/2012
54 00131542 1ST FL STAIR #2 SMOKE DET EDWARDS GSA PS 3990244300 1/1/2012
55 00131503
1ST FL ELEVATOR LOBBY SMOKE DET EDWARDS GSA PS 3990243853 1/1/2012
56 00131502 1ST FL CORRIDOR E AHC SMOKE DET EDWARDS GSA PS 3990243808 1/1/2012
57 00131501 1ST FL CORRIDOR E SMOKE DET EDWARDS GSA PS 3990246168 1/1/2012
58 00131496
1ST FL CLASSROOM 109 ENTRY AHC SMOKE DET EDWARDS GSA PS 3990244102 1/1/2012
Garland Fire Systems, Inc.
Page 13 of 16
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ADDRESS DESCRIPTION Manufacturer Model SERIAL INSTALL DATE
59 00131495
1ST FL CLASSROOM ENTRY SMOKE DET EDWARDS GSA PS 3990239382 1/1/2012
6 20442 3RD FL E OFFICE AHC SMOKE DET EDWARDS GSA PS 3990245581 1/1/2012
60 00131498
1ST FL CLASSROOM 109 AHC SMOKE DET EDWARDS GSA PS 3990243532 1/1/2012
61 00131497 1ST FL CLASSROOM 109 SMOKE DET EDWARDS GSA PS 3990243488 1/1/2012
62 00131500
1ST FL CLASSROOM 109 AHC SMOKE DET EDWARDS GSA PS 3990243914 1/1/2012
63 00131499 1ST FL CLASSROOM 109 SMOKE DET EDWARDS GSA PS 3990243587 1/1/2012
64 00131491
1ST FL CLASSROOM 107 AHC SMOKE DET EDWARDS GSA PS 3990244232 1/1/2012
65 00131490 1ST FL CLASSROOM 107 SMOKE DET EDWARDS GSA PS 3990244355 1/1/2012
66 00131492
1ST FL CLASSROOM 107 CLST SMOKE DET EDWARDS GSA PS 3990243600 1/1/2012
67 00131494
1ST FL CORRIDOR W AHC SMOKE DET EDWARDS GSA PS 3990243495 1/1/2012
68 00131493 1ST FL CORRIDOR W SMOKE DET EDWARDS GSA PS 3990243433 1/1/2012
69 00131489 1ST FL STORAGE RM SMOKE DET EDWARDS GSA PS 3990244805 1/1/2012
7 20443 3RD FL E OFFICE SMOKE DET EDWARDS GSA PS 3990246014 1/1/2012
70 00131513 1ST FL STAIR #1 SMOKE DET EDWARDS GSA PS 3990244454 1/1/2012
71 00131514 1ST FL STAIR #1 SMOKE DET EDWARDS GSA PS 3990244553 1/1/2012
72 00131488
1ST FL CLASSROOM 108 CLST SMOKE DET EDWARDS GSA PS 3990243860 1/1/2012
73 00131486 1ST FL CLASSROOM 108 SMOKE DET EDWARDS GSA PS 3990244690 1/1/2012
74 00131487 1ST FL CLASSROOM 108 SMOKE DET EDWARDS GSA PS 3990243549 1/1/2012
75 00131510
1ST FL CLASSROOM 110 AHC SMOKE DET EDWARDS GSA PS 3990244799 1/1/2012
76 00131509 1ST FL CLASSROOM 110 SMOKE DET EDWARDS GSA PS 3990244638 1/1/2012
77 00131512
1ST FL CLASSROOM 110 AHC SMOKE DET EDWARDS GSA PS 3990244485 1/1/2012
78 00131511 1ST FL CLASSROOM 110 SMOKE DET EDWARDS GSA PS 3990243716 1/1/2012
79 00131508
1ST FL CLASSROOM 110 ENTRY AHC SMOKE DET EDWARDS GSA PS 3990243464 1/1/2012
8 00131580
3RD FL COMPUTER LAB ACH SMOKE DET EDWARDS GSA PS 3990245550 1/1/2012
80 00131507
1ST FL CLASSROOM 110 ENTRY SMOKE DET EDWARDS GSA PS 3990243846 1/1/2012
81 00131506 1ST FL E OFFICE AHC SMOKE DET EDWARDS GSA PS 3990243679 1/1/2012
82 00131505 1ST FL E OFFICE SMOKE DET EDWARDS GSA PS 3990243402 1/1/2012
84 00131535 BSMT UTILITY RM SMOKE DET EDWARDS GSA PS 3990234646 1/1/2012
85 00131539 BSMT E STORAGE RM SMOKE DET EDWARDS GSA PS 3990239290 1/1/2012
87 00131531 BSMT CORRIDOR E AHC SMOKE DET EDWARDS GSA PS 3990244881 1/1/2012
88 00131532 BSMT ELEVATOR LOBBY SMOKE DET EDWARDS GSA PS 3990244867 1/1/2012
Garland Fire Systems, Inc.
Page 14 of 16
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ADDRESS DESCRIPTION Manufacturer Model SERIAL INSTALL DATE
89 00131530 BSMT CORRIDOR E SMOKE DET EDWARDS GSA PS 3990244256 1/1/2012
9 00131579 3RD FL COMPUTER LAB SMOKE DET EDWARDS GSA PS 3990246205 1/1/2012
90 00131544
BSMT CLASSROOM B11 AHC SMOKE DET EDWARDS GSA PS 3990244508 1/1/2012
91 00131543 BSMT CLASSROOM B11 SMOKE DET EDWARDS GSA PS 3990244287 1/1/2012
92 00131518
BSMT CLASSROOM B10 AHC SMOKE DET EDWARDS GSA PS 3990243761 1/1/2012
93 00131517 BSMT CLASSROOM B10 SMOKE DET EDWARDS GSA PS 3990243709 1/1/2012
94 00131516
BSMT CLASSROOM B10 ENTRY SMOKE DET EDWARDS GSA PS 3990244812 1/1/2012
95 00131523 BSMT WOMEN'S RM AHC SMOKE DET EDWARDS GSA PS 3990244768 1/1/2012
96 00131522 BSMT WOMEN'S RM SMOKE DET EDWARDS GSA PS 3990244065 1/1/2012
97 00131525 BSMT MEN'S ROOM AHC SMOKE DET EDWARDS GSA PS 3990244379 1/1/2012
98 00131524 BSMT MEN'S ROOM SMOKE DET EDWARDS GSA PS 3990244515 1/1/2012
99 00131521 BSMT CORRIDOR W AHC SMOKE DET EDWARDS GSA PS 3990244478 1/1/2012
Alarm Notification Appliance ADDRESS DESCRIPTION Manufacturer Model SERIAL INSTALL DATE
Audible And Visible 20449 FIRE ALARM BOOSTER PANEL MIRTONE BPS10A 8/16/2016 20441 FIRE ALARM BOOSTER PANEL MIRTONE BPS10A 8/16/2016
Emergency Control Equipment ADDRESS DESCRIPTION Manufacturer Model SERIAL INSTALL DATE
Fan Control 127 127 3RD FL RTU-6 FAN SHUTDOWN EDWARDS GSA CR 5280891676 1/1/2012
128 00131582 3RD FL RTU-4 FAN SHUTDOWN EDWARDS GSA CR 5280441406 1/1/2012
130 00131585 3RD FL RTU-1 FAN SHUTDOWN EDWARDS GSA CR 5280437973 1/1/2012
131 00131597 3RD FL RTU-3 FAN SHUTDOWN EDWARDS GSA CR 5280760552 1/1/2012
132 132 3RD FL RTU-5 FAN SHUTDOWN EDWARDS GSA CR 5280760897 1/1/2012
135 00131569 2ND FL RTU-2 FAN SHUTDOWN EDWARDS GSA CR 5280437843 1/1/2012
[Other] ADDRESS DESCRIPTION Manufacturer Model SERIAL INSTALL DATE
Door Holder 133 BSMT UTILITY RM DOOR HOLDERS EDWARDS GSA CR 5089083975 1/1/2012133
Other 142 BSMT MACHINE RM ALT FL RECALL EDWARDS EDWARDS 5280437942 1/1/2012142 143 BSMT MACHINE RM ELEV RECALL EDWARDS EDWARDS 5280437157 1/1/2012143
Garland Fire Systems, Inc.G
Page 15 of 16
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ADDRESS DESCRIPTION Manufacturer Model SERIAL INSTALL DATE
144 BSMT UTILITY RM ELEV SOLENOID EDWARDS EDWARDS 5280054187 1/1/2012144 145G GENERAL ALARM RELAY FACP EDWARDS EDWARDS 5280054828 1/1/20125280054828G146 HVAC SHUTDOWN MONITOR IN FACP EDWARDS EDWARDS 4835476276 1/1/20124835476276
Garland Fire Systems, Inc.
Page 16 of 16
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Fire Alarm and Life Safety System
Inspection Certificate
For
Roosevelt Children's Academy
201 Debevoise Avenue
Roosevelt, NY 11575
Tested to NFPA 72 Standards
This Inspection was performed in accordance with applicable NFPA Standards. The subsequent pages
of this report provide performance measurements, listed ranges of acceptable results, and complete
documentation of the inspection. Whenever discrepancies exist between acceptable performance
standards and actual test results, notes and/or recommended solutions have been proposed or provided
for immediate review and approval.
Inspection Date
Jun 20, 2018
Building: Roosevelt Children's Academy Company: DGA Security Systems, Inc
Contact: Reggie Brinson Contact: Miguel Lalman
Title: Manager Title: Inspector
-
Executive Summary Generated by: BuildingReports.com
Building Information
Building: Roosevelt Children's Academy
Address: 201 Debevoise Avenue
Address:
City/State/Zip: Roosevelt, NY 11575
Country: United States of America
Contact: Reggie Brinson
Phone:
Fax:
Mobile:
Email:
Inspection Performed By
Company: DGA Security Systems, Inc
Address:
Address:
City/State/Zip:
Country: United States of America
Inspector: Miguel Lalman
Phone:
Fax:
Mobile:
Email:
System Control Unit
Manufacturer: Edwards
Model Number: IO500
Software Version:
Location: 1st Corridor by rear exit
Inspection Date: 06/20/2018 IDC Style:
Install Date: 08/14/2017 SLC Style:
Version Date: 08/14/2017 NAC Style:
Current Protection:
Monitoring
Company: Phone: Account #:
Central Station Signal Verification
Type:
Test Time/Date:
Mfg: Model #:
Restore Time
DGA Security Systems, Inc 1 06/22/2018
http:BuildingReports.com
-
Inspection Summary
Category Total Items Serviced Passed Failed/Other
Qty % Qty % Qty % Qty %
Initiating
Control
84
2
97.67%
2.33%
84
2
100.00%
100.00%
84
2
100.00%
100.00%
0
0
0%
0%
Totals 86 100% 86 100.00% 86 100.00% 0 0%
Certification
Company: DGA Security Systems, Inc
Inspector: Miguel Lalman
Signed:
Building: Roosevelt Children's Academy
Contact: Reggie Brinson
Signed:
DGA Security Systems, Inc 2 06/22/2018
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Inspection & Testing Generated by: BuildingReports.com
Building: Roosevelt Children's Academy Control Panel: 1 - Edwards IO500
The Inspection & Testing section lists all of the items inspected in your building. Items are grouped by Passed or
Failed/Other. Items are listed by Category. Each item includes the services performed, and the time & date at which
testing occurred.
Device Type Location Service Time Date
Passed
Control
Control Panel 1st Corridor by rear exit Tested 11:18:48 AM 06/20/2018
Initiating
CO Detector Basement boiler room Tested 10:50:11 AM 06/20/2018
Heat Detector Basement boiler room Tested 10:52:12 AM 06/20/2018
Heat Detector 1st janitor closet Tested 12:29:06 PM 06/20/2018
Heat Detector 2nd bathroom 205 Tested 11:54:38 AM 06/20/2018
Heat Detector 2nd bathroom 205 back Tested 11:54:10 AM 06/20/2018
Heat Detector 2nd bathroom 205 front Tested 11:53:15 AM 06/20/2018
Heat Detector 2nd bathroom 216 back Tested 11:50:28 AM 06/20/2018
Heat Detector 2nd bathroom 216 front Tested 11:51:30 AM 06/20/2018
Heat Detector 2nd room 206 bathroom Tested 12:06:05 PM 06/20/2018
Pull Station Basement exit Tested 10:53:45 AM 06/20/2018
Pull Station 1st back exit Tested 12:33:31 PM 06/20/2018
Pull Station 1st devevoise ave exit Tested 12:36:17 PM 06/20/2018
Pull Station 1st exit by facp Tested 11:26:37 AM 06/20/2018
Pull Station 1st reception area Tested 12:50:02 PM 06/20/2018
Pull Station 1st teachers lounge exit Tested 11:34:37 AM 06/20/2018
Pull Station 2nd south stair Tested 11:35:50 AM 06/20/2018
Pull Station 2nd stair north Tested 12:09:24 PM 06/20/2018
Smoke Detector Basement storage room Tested/Cleaned 10:55:39 AM 06/20/2018
Smoke Detector Basement storage room 2 Tested/Cleaned 10:59:08 AM 06/20/2018
Smoke Detector Basement storage room 3 Tested/Cleaned 10:57:47 AM 06/20/2018
Smoke Detector 1st above remote enunciator Tested/Cleaned 12:36:05 PM 06/20/2018
Smoke Detector 1st bathroom by room 111 Tested/Cleaned 12:39:09 PM 06/20/2018
Smoke Detector 1st class 2 back Tested/Cleaned 12:31:00 PM 06/20/2018
Smoke Detector 1st class 2 front Tested/Cleaned 12:30:02 PM 06/20/2018
Smoke Detector 1st classroom 1 left Tested/Cleaned 12:25:43 PM 06/20/2018
Smoke Detector 1st classroom 1 right Tested/Cleaned 12:26:38 PM 06/20/2018
Smoke Detector 1st closet left by facp Tested/Cleaned 12:57:24 PM 06/20/2018
Smoke Detector 1st closet right by facp Tested/Cleaned 11:27:36 AM 06/20/2018
Smoke Detector 1st conference room Tested/Cleaned 12:59:58 PM 06/20/2018
Smoke Detector 1st conference room back Tested/Cleaned 12:58:26 PM 06/20/2018
Smoke Detector 1st corridor Tested/Cleaned 12:31:47 PM 06/20/2018
Smoke Detector 1st corridor by class 2 Tested/Cleaned 12:28:46 PM 06/20/2018
Smoke Detector 1st corridor by facp Tested/Cleaned 12:27:32 PM 06/20/2018
Smoke Detector 1st corridor by front office Tested/Cleaned 12:38:15 PM 06/20/2018
Smoke Detector 1st corridor by reception Tested/Cleaned 10:44:43 AM 06/20/2018
Smoke Detector 1st corridor by room 112 Tested/Cleaned 12:38:51 PM 06/20/2018
DGA Security Systems, Inc 3 06/22/2018
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Device Type Location Service Time Date
Passed Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
Smoke Detector
1st corridor by stairs
1st corridor center
1st corridor front office hallway
1st front office
1st mens bathroom
1st office 1
1st office 105
1st office 2
1st office 3
1st office by class 3
1st office hallway
1st reception
1st staff bathroom
1st staff kitchen
1st staff lounge
1st women bathroom
2nd closet 214
2nd corridor by 203
2nd corridor by 209
2nd corridor by rm 208
2nd corridor by room 209
2nd corridor middle
2nd hallway by 207
2nd ladder to roof closet
2nd office 202
2nd office 203
2nd office 203
2nd office 203 right
2nd office 204 left
2nd office 204 right
2nd office 206
2nd office 206 closet
2nd office 207
2nd office 207 closet
2nd office 208 left
2nd office 208 right
2nd office 209 left
2nd office 209 right
2nd office 211
2nd office 218
2nd office 219
2nd room 210
2nd storage 213
2nd top of stair 1
2nd top of stairs
2nd above by 207
2nd above corridor by 208
2nd above corridor middle
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
Tested/Cleaned
12:34:34 PM
12:37:56 PM
12:38:06 PM
12:40:20 PM
12:28:32 PM
12:55:54 PM
11:28:45 AM
12:54:47 PM
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12:39:38 PM
12:51:23 PM
12:45:26 PM
12:48:22 PM
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12:28:15 PM
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11:37:13 AM
12:09:43 PM
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11:46:25 AM
12:05:06 PM
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11:36:21 AM
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11:44:52 AM
11:45:09 AM
12:05:46 PM
1:04:40 PM
12:05:31 PM
1:04:52 PM
12:04:07 PM
12:04:32 PM
12:12:12 PM
12:11:22 PM
12:14:43 PM
11:45:45 AM
11:44:00 AM
1:06:23 PM
12:13:51 PM
12:16:08 PM
1:10:35 PM
12:04:48 PM
12:07:12 PM
11:46:55 AM
06/20/2018
06/20/2018
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DGA Security Systems, Inc 4 06/22/2018
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Building: Roosevelt Children's Academy Control Panel: 2
The Inspection & Testing section lists all of the items inspected in your building. Items are grouped by Passed or
Failed/Other. Items are listed by Category. Each item includes the services performed, and the time & date at which
testing occurred.
Device Type Location Service Time Date
Passed
Control
Power Supply 1st Corridor by rear exit Tested 12:40:48 PM 06/20/2018
DGA Security Systems, Inc 5 06/22/2018
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Service Summary Generated by: BuildingReports.com
Building: Roosevelt Children's Academy
The Service Summary section provides an overview of the services performed in this report.
Device Type Service Quantity
Passed CO Detector Tested
Control Panel Tested
Heat Detector Tested
Power Supply Tested
Pull Station Tested
Smoke Detector Tested/Cleaned
Total
1
1
8
1
8
67
86
DGA Security Systems, Inc 6 06/22/2018
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Inventory & Warranty Report Generated by: BuildingReports.com
Building: Roosevelt Children's Academy Control Panel: 1 - Edwards IO500
The Inventory & Warranty Report lists each of the devices and items that are included in your Inspection Report. A
complete inventory count by device type and category is provided. Items installed within the last 90 days, within the last
year, and devices installed for two years or more are grouped together for easy reference.
Device or Item Category % of Inventory Quantity
Smoke Detector Initiating 77.91% 67
CO Detector Initiating 1.16% 1
Heat Detector Initiating 9.30% 8
Pull Station Initiating 9.30% 8
Control Panel Control 1.16% 1
Power Supply Control 1.16% 1
Type Qty Model # Description Install Date
In Service - 90 Days - 1 Year
edwards
CO Detector 1 siga cod 08/14/2017
Edwards
Control Panel 1 IO500 08/14/2017
edwards
Heat Detector 1 siga hfs 08/14/2017
Heat Detector 7 siga-hfs Fixed Temperature 08/14/2017
Edwards
Pull Station 1 IO500 08/14/2017
edwards
Pull Station 2 rgs inc 08/14/2017
Edwards
Pull Station 1 rsg inc 08/14/2017
edwards
Pull Station 1 rsg inc Dual Action 08/14/2017
Smoke Detector 1 11207412 Photoelectric 08/14/2017
Smoke Detector 1 siga 2phcos Photoelectric 08/14/2017
Smoke Detector 1 siga 2ps 08/14/2017
Smoke Detector 43 siga 2ps Photoelectric 08/14/2017
Smoke Detector 1 siga a2 phcos Fixed Temperature 08/14/2017
Smoke Detector 2 siga-hfs Fixed Temperature 08/14/2017
Smoke Detector 3 siga2 ps 08/14/2017
Smoke Detector 1 siga2-pcos Combination smoke/CO 08/14/2017
Smoke Detector 12 siga2-phcos Combination smk, heat, CO 08/14/2017
Smoke Detector 2 siga2-ps Photoelectric 08/14/2017
rsg inc.
Pull Station 3 rms-1p-lp Dual Action 08/14/2017
DGA Security Systems, Inc 7 06/22/2018
http:BuildingReports.com
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Building: Roosevelt Children's Academy Control Panel: 2
The Inventory & Warranty Report lists each of the devices and items that are included in your Inspection Report. A
complete inventory count by device type and category is provided. Items installed within the last 90 days, within the last
year, and devices installed for two years or more are grouped together for easy reference.
Type Qty Model # Description Install Date
In Service - 90 Days - 1 Year
Edwards
Power Supply 1 BPS10A 08/14/2017
DGA Security Systems, Inc 8 06/22/2018
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Zone Address Report Generated by: BuildingReports.com
Building: Roosevelt Children's Academy Control Panel: 1 - Edwards IO500
The Zone Address Report lists all of the devices and items that have an individual address, or are grouped together under
a common zone. The device type, location, and description are included for your reference.
Address Device Type Location Type ScanID 126 Pull Station 1st teachers lounge exit 11207412
132 Pull Station 2nd south stair 11207399
Zone/Circuit: 1
Heat Detector Basement boiler room 11207524
002 Smoke Detector 1st corridor by front office Combination smk,
heat, CO
11204326
003 Smoke Detector 1st corridor by reception Combination smk,
heat, CO
11204344
004 Smoke Detector 1st conference room back Photoelectric 11204330
008 Smoke Detector 1st office 1 Photoelectric 11204325
009 Smoke Detector 1st corridor by facp Photoelectric 11204347
010 Smoke Detector 1st reception Photoelectric 11204333
012 Smoke Detector 1st office by class 3 Photoelectric 11204332
013 Smoke Detector 1st corridor by stairs Photoelectric 11204336
014 Smoke Detector 1st office 3 Photoelectric 11204320
017 Smoke Detector 1st corridor front office hallway Photoelectric 11204335
018 Smoke Detector 1st office 2 Photoelectric 11204324
019 Smoke Detector 1st above remote enunciator Photoelectric 11204328
020 Smoke Detector 1st bathroom by room 111 Photoelectric 11204321
021 Smoke Detector 1st staff bathroom Photoelectric 11204343
022 Smoke Detector 1st corridor by class 2 Combination smk,
heat, CO
11204339
023 Smoke Detector 1st front office Photoelectric 11204329
024 Smoke Detector 1st conference room Photoelectric 11204331
028 Smoke Detector 1st office hallway Combination smk,
heat, CO
11204322
030 Smoke Detector 1st corridor center Combination
smoke/CO
11204338
031 Smoke Detector 1st women bathroom Photoelectric 11204342
032 Smoke Detector 1st closet left by facp Photoelectric 11204346
033 Smoke Detector 1st classroom 1 left Photoelectric 11207410
036 Smoke Detector 1st classroom 1 right Photoelectric 11207411
038 Smoke Detector 1st office 105 Photoelectric 11204341
040 Smoke Detector 1st closet right by facp Photoelectric 11204345
041 Smoke Detector 1st mens bathroom Photoelectric 11204340
042 Smoke Detector 1st corridor by room 112 Photoelectric 11204323
044 Smoke Detector 2nd office 219 Photoelectric 11204289
045 Smoke Detector 2nd office 207 closet Photoelectric 11204308
046 Smoke Detector 2nd above corridor middle Combination smk,
heat, CO
11204295
047 Smoke Detector 2nd top of stair 1 Photoelectric 11204319
DGA Security Systems, Inc 9 06/22/2018
http:BuildingReports.com
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048 Smoke Detector 2nd hallway by 207 Photoelectric 11204307
050 Smoke Detector 2nd office 218 Photoelectric 11204290
051 Smoke Detector 2nd corridor middle Photoelectric 11204296
052 Smoke Detector 2nd storage 213 Photoelectric 11207401
055 Smoke Detector 2nd corridor by rm 208 Photoelectric 11204315
056 Smoke Detector 2nd above corridor by 208 Combination smk, 11204314
heat, CO
057 Smoke Detector 2nd office 203 Combination smk, 11207402
heat, CO
058 Smoke Detector 2nd corridor by room 209 Photoelectric 11204317
059 Smoke Detector 2nd office 202 Combination smk, 11207398
heat, CO
060 Smoke Detector 2nd office 203 right Combination smk, 11207403
heat, CO
061 Smoke Detector 2nd office 203 Photoelectric 11204294
062 Smoke Detector 2nd office 204 left Photoelectric 11204292
063 Smoke Detector 2nd office 208 left Photoelectric 11204311
064 Smoke Detector 2nd office 206 closet Photoelectric 11204306
065 Smoke Detector 2nd office 208 right Photoelectric 11204310
066 Smoke Detector 2nd office 209 left Photoelectric 11204313
067 Smoke Detector 2nd office 204 right Photoelectric 11204291
068 Smoke Detector 2nd office 209 right Photoelectric 11204312
07 Smoke Detector 1st staff lounge Photoelectric 11207413
073 Smoke Detector 2nd room 210 Photoelectric 11207405
074 Smoke Detector 2nd corridor by 209 Combination smk, 11204316
heat, CO
078 Smoke Detector 2nd corridor by 203 Combination smk, 11204293
heat, CO
079 Smoke Detector 2nd office 211 Photoelectric 11207404
081 Smoke Detector 2nd office 206 Photoelectric 11204305
082 Smoke Detector 2nd office 207 Photoelectric 11204309
1 Smoke Detector Basement storage room 11207392
128 Pull Station 1st exit by facp Dual Action 11204348
129 Pull Station Basement exit Dual Action 11207396
130 Pull Station 1st reception area Dual Action 11204334
131 Pull Station 1st back exit 11207408
134 Pull Station 2nd stair north Dual Action 11204318
16 Smoke Detector 1st staff kitchen 11207520
19 Pull Station 1st devevoise ave exit 11204327
25 Smoke Detector Basement storage room 3 11207394
26 Smoke Detector 1st class 2 front Fixed Temperature 11207406
26 Heat Detector 1st janitor closet Fixed Temperature 11204337
27 CO Detector Basement boiler room 11207395
35 Smoke Detector 1st class 2 back Fixed Temperature 11207407
39 Smoke Detector 1st corridor Fixed Temperature 11207409
49 Smoke Detector 2nd top of stairs Combination smk, 11207397
heat, CO
5 Smoke Detector Basement storage room 2 11207393
53 Smoke Detector 2nd ladder to roof closet Photoelectric 11204302
54 Smoke Detector 2nd closet 214 Photoelectric 11204303
69 Heat Detector 2nd room 206 bathroom Fixed Temperature 11204304
70 Heat Detector 2nd bathroom 216 front Fixed Temperature 11204297
71 Heat Detector 2nd bathroom 216 back Fixed Temperature 11204298
DGA Security Systems, Inc 10 06/22/2018
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72 Heat Detector 2nd bathroom 205 front Fixed Temperature 11204301
75 Heat Detector 2nd bathroom 205 back Fixed Temperature 11204300
76 Heat Detector 2nd bathroom 205 Fixed Temperature 11204299
77 Smoke Detector 2nd above by 207 Photoelectric 11207522
DGA Security Systems, Inc 11 06/22/2018
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-
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-
GENERAL INSTRUCTIONS FOR ANNUAL BUDGET/QUARTERLY REPORT�
TEMPLATE TABS
1- GRAY tab contains the Instructions Instructions Provides description of tabs and input requirements. Funding by District Charter School Tuition Rates
2- BLUE tabs require input of information 1.) Name of School >Select school name from list.
>Enter contact information. 2.) Enrollment Enter enrollment information for Annual Budget (& Revisions) and
Quarterly Actuals. Includes: >Enrollment by Grade >Enrollment by District
3.) Staffing Plan Enter staffing plan information for Annual Budget (& Revisions) and Quarterly Actuals. Includes: >Full Time Equivalent (FTE), by Position Category, By Quarter
4.) Yearly Budget Enter Yearly Budget information. Includes: >"Pior Year" column may be completed based upon preliminary data, and adjusted with Annual Audited data when the Quarter 2 Actuals are being submitted. (Note: Quarterly Revenue allocation may be set) >Budgeted Enrollment data and Per Pupil Revenue for the current year are populated based upon input on tab "2.) Enrollment." >Budgeted FTE for current year is populated based upon input on tab "3.) Staffing Plan." >All other sources of revenue >All expenses >Budget Revisions, as necessary and approved by the school's Board of Directors, should be submitted when submitting Quarterly Actuals.
5.) Balance Sheet Enter Balance Sheet information for EdCorps. Separate schools merged into a primary EdCorp should NOT use this tab. >"Pior Year" column may be completed based upon preliminary data, and adjusted with Annual Audited data when the Quarter 2 Actuals are being submitted.
-
6.) Quarterly Report Enter Actual Quarterly Report information . Includes: >Actual Enrollment data and Per Pupil Revenue for the current year are populated based upon input on tab "2.) Enrollment." >Actual FTE for current year is populated based upon input on tab "3.) Staffing Plan." >All other sources of revenue >All expenses
7.) Annual Report Requirement Complete when submitting Actual Quarter 4.
CELL COLORS & GUIDANCE COMMENTS
= Enter information into the light BLUE shaded cells. = Cells labeled in ORANGE containe guidance regarding the input of information.
= Cells containing RED triangles in the upper right corner contain "guidance comments" on that particular line item. Please "mouse-over" the triangle to reveal each comment.
Ver. 20180531
-
Charter Funding Alphabetical By NYS School District * (Sum of Charter School Basic Tuition and Supplemental Basic Tuition)
Page 3 of 64�
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ANNUAL BUDGET & QUARTERLY REPORT TEMPLATE�
Roosevelt Children's Academy Charter School�
SCHOOL Name: Roosevelt Children's Academy Charter School
CONTACT INFORMATION Contact Name: PHILIP LECONTE Contact Title: CHIEF FINANCIAL OFFICER Contact Email: Contact Phone:
REPORT PERIOD Current Academic Year: 2018-19 Prior Academic Year: 2017-18
Page 4 of 64
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4
Column(s)for the
4
5 of 64
Other District 20 (Select from drop-down list) →Other District 21 (Select from drop-down list) →Other District 22 (Select from drop-down list) →Other District 23 (Select from drop-down list) →Other District 24 (Select from drop-down list) →Other District 25 (Select from drop-down list) →Other District 26 (Select from drop-down list) →
ROOSEVELT CHILDREN'S ACADEMY CHARTER SCHOOL�2018-19�
ENROLLMENT BY GRADES
GRADES K 1 2 3 4 5 6 7 INITIAL BUDGETED ENROLLMENT 73 78 80 81 85 62 65 57 TOTAL ENROLLMENT = 630
ENROLLMENT BY DISTRICT
PRIOR YEAR
Funding by DistrictANNUAL BUDGET TOTAL DISTRICTS/ENROLLMENT BY QUARTER
ACTUAL QUARTER 1 QUARTER 2 QUARTER 3 QUARTER Original Revised Original Revised Original Revised Original
NUMBER OF SCHOOL DISTRICTS ENROLLED: 0 18 0 18 0 18 0 18 NUMBER OF STUDENTS ENROLLED: 0 630 0 630 0 630 0 630
*NOTE: If there are NO budget revisions at the time of quarterly submittal leave the 'REVISED' COMPLETELY BLANK. If budget revisions ARE made, the entire "REVISED" budget columns affected quarter(s) must be completed on tabs 2, 3 and 4.
PRIOR YEAR ANNUAL BUDGET 2017-18 QUARTER 1 ENROLLMENTQUARTER 2 BY QUARTERQUARTER 3 QUARTER
PRIMARY/OTHER DISTRICT NAME(S) Actual
Enrollment
Original Budgeted Enrollment
Revised Budgeted Enrollment
Original Budgeted Enrollment
Revised Budgeted Enrollment
Original Budgeted Enrollment
Revised Budgeted Enrollment
Original Budgeted Enrollment
PRIMARY District ROOSEVELT UFSD 231 231 231 231 SECONDARY District UNIONDALE UFSD 54 54 54 54 Other District 3 HEMPSTEAD UFSD 234 234 234 234 Other District 4 FREEPORT UFSD 15 15 15 15 Other District 5 NYC CHANCELLOR'S OFFICE 41 41 41 41 Other District 6 AMITYVILLE UFSD 9 9 9 9 Other District 7 BALDWIN UFSD 8 8 8 8 Other District 8 ROCKVILLE CENTRE UFSD 2 2 2 2 Other District 9 WYANDANCH UFSD ` 1 1 1 1 Other District 10 VALLEY STREAM 13 UFSD 2 2 2 2 Other District 11 WESTBURY UFSD 4 4 4 4 Other District 12 BRENTWOOD UFSD 21 21 21 21 Other District 13 EAST MEADOW UFSD 2 2 2 2 Other District 14 LONG BEACH CITY SD 2 2 2 2 Other District 15 MERRICK UFSD 1 1 1 1 Other District 16 MALVERNE UFSD 1 1 1 1 Other District 17 WEST HEMPSTEAD UFSD 1 1 1 1 Other District 18 HERRICKS UFSD 1 1 1 1 Other District 19 (Select from drop-down list) →
Page
-
4
Other District 27 (Select from drop-down list) →Other District 28 (Select from drop-down list) →Other District 29 (Select from drop-down list) →Other District 30 (Select from drop-down list) →Other District 31 (Select from drop-down list) →Other District 32 (Select from drop-down list) →Other District 33 (Select from drop-down list) →Other District 34 (Select from drop-down list) →Other District 35 (Select from drop-down list) →Other District 36 (Select from drop-down list) →Other District 37 (Select from drop-down list) →Other District 38 (Select from drop-down list) →Other District 39 (Select from drop-down list) →Other District 40 (Select from drop-down list) →Other District 41 (Select from drop-down list) →Other District 42 (Select from drop-down list) →Other District 43 (Select from drop-down list) →Other District 44 (Select from drop-down list) →Other District 45 (Select from drop-down list) →Other District 46 (Select from drop-down list) →Other District 47 (Select from drop-down list) →Other District 48 (Select from drop-down list) →Other District 49 (Select from drop-down list) →Other District 50 (Select from drop-down list) →
PRIOR YEAR ANNUAL BUDGET 2017-18 QUARTER 1 ENROLLMENTQUARTER 2 BY QUARTERQUARTER 3 QUARTER
PRIMARY/OTHER DISTRICT NAME(S) Actual
Enrollment
Original Budgeted Enrollment
Revised Budgeted Enrollment
Original Budgeted Enrollment
Revised Budgeted Enrollment
Original Budgeted Enrollment
Revised Budgeted Enrollment
Original Budgeted Enrollment
Page 6 of 64
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ROOSEVELT CHILDREN'S ACADEMY CHARTER SCHOOL2018-19
ENROLLMENT BY GRADES
ENROLLMENT BY DISTRICTFunding by DistrictANNUAL BUDGET
TOTAL DISTRICTS/ENROLLMENT BY QUARTER
*NOTE: If there are NO budget revisions at the time of quarterly submittal leave theCOMPLETELY BLANK. If budget revisions ARE made, the entire "REVISED" budgetaffected quarter(s) must be completed on tabs 2, 3 and 4.
ANNUAL BUDGETENROLLMENT BY QUARTER
7 of 64
8 9 10 11 12 49
ACTUAL QUARTERLY TOTAL DISTRICTS/ENROLLMENT
QUARTER 1 QUARTER 2 QUARTER 3 QUARTER 4 Revised Actual Actual Actual Actual
0 0 0 0 0 0 0 0 0 0
ACTUAL ENROLLMENT BY QUARTER QUARTER 1 QUARTER 2 QUARTER 3 QUARTER 4
Revised Budgeted Enrollment
Actual Enrollment
Actual Enrollment
Actual Enrollment
Actual Enrollment
QUARTER 4
'REVISED' Column(s) columns for the
QUARTER 4
Page
-
ANNUAL BUDGETENROLLMENT BY QUARTER
QUARTER 4
Revised Budgeted�Enrollment�
ACTUAL ENROLLMENT BY QUARTER QUARTER 1 QUARTER 2 QUARTER 3 QUARTER 4
Actual Enrollment
Actual Enrollment
Actual Enrollment
Actual Enrollment
Page 8 of 64
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Each quarter, the actual FTE should be input.
ACTUAL QUARTERLY FTEQ1 Q2 Q3
Actual Actual
0.0 0.0 0.0
ACTUAL QUARTERLY FTEQ1 Q2 Q3
Actual Actual
0.0 0.0 0.0
ACTUAL QUARTERLY FTEQ1 Q2 Q3
Actual Actual
0.0 0.0 0.0
0.0 0.0 0.0
SCHOOL
("FTE")
ROOSEVELT CHILDREN'S ACADEMY CHARTER ROOSEVELT CHILDREN'S ACADEMY CHARTER SCHOOL 2018-19 2018-19
STAFFING PLAN - FULL TIME EQUIVALENT STAFFING PLAN - FULL TIME EQUIVALENT ("FTE")
*NOTE: Enter the number of FTE *NOTE: Enter the number of FTE *NOTE: If there are NO budget revisions at the time of quarterly submittal leave the 'REVISED' Column(s) COMPLETELY *NOTE: positions in the "blue" cells. positions in the "blue" cells. BLANK.
If budget revisions ARE made, the entire "REVISED" budget columns for the affected quarter(s) must be completed on tabs 2, 3 and 4. ADMINISTRATIVE PERSONNEL FTE ADMINISTRATIVE PERSONNEL FTE PRIOR YEAR ANNUAL BUDGETED FTE
2017-18 Q1 Q2 Q3 Q4 ACTUAL Original Revised Original Revised Original Revised Original Revised Actual
Executive Management Executive Management 1.0 1.0 1.0 1.0 1.0 Instructional Management Instructional Management 3.0 3.0 3.0 3.0 3.0 Deans, Directors & Coordinators Deans, Directors & Coordinators 1.0 2.0 2.0 2.0 2.0 CFO / Director of Finance CFO / Director of Finance 1.0 1.0 1.0 1.0 1.0 Operation / Business Manager Operation / Business Manager 1.0 1.0 1.0 1.0 Administrative Staff Administrative Staff 11.0 11.0 11.0 11.0 11.0 TOTAL ADMINISTRATIVE STAFF TOTAL ADMINISTRATIVE STAFF 17.0 19.0 0.0 19.0 0.0 19.0 0.0 19.0 0.0
INSTRUCTIONAL PERSONNEL FTE INSTRUCTIONAL PERSONNEL FTE PRIOR YEAR ANNUAL BUDGETED FTE 2017-18 Q1 Q2 Q3 Q4 ACTUAL Original Revised Original Revised Original Revised Original Revised Actual
Teachers - Regular Teachers - Regular 31.0 31.0 31.0 31.0 31.0 Teachers - SPED Teachers - SPED 1.0 1.0 1.0 1.0 1.0 Substitute Teachers Substitute Teachers 2.0 2.0 2.0 2.0 2.0 Teaching Assistants Teaching Assistants 30.0 30.0 30.0 30.0 30.0 Specialty Teachers Specialty Teachers 23.0 23.0 23.0 23.0 23.0 Aides Aides Therapists & Counselors Therapists & Counselors 2.0 2.0 2.0 2.0 2.0 Other Other 9.0 9.0 9.0 9.0 9.0 TOTAL INSTRUCTIONAL TOTAL INSTRUCTIONAL 98.0 98.0 0.0 98.0 0.0 98.0 0.0 98.0 0.0
NON-INSTRUCTIONAL PERSONNEL FTE NON-INSTRUCTIONAL PERSONNEL FTE PRIOR YEAR ANNUAL BUDGETED FTE 2017-18 Q1 Q2 Q3 Q4 ACTUAL Original Revised Original Revised Original Revised Original Revised Actual
Nurse Nurse 2.0 2.0 2.0 2.0 2.0 Librarian Librarian 1.0 1.0 1.0 1.0 1.0 Custodian Custodian 11.0 11.0 11.0 11.0 11.0 Security Security 2.0 2.0 2.0 2.0 2.0 Other Other TOTAL NON-INSTRUCTIONAL TOTAL NON-INSTRUCTIONAL 16.0 16.0 0.0 16.0 0.0 16.0 0.0 16.0 0.0
131.0 133.0 0.0 133.0 0.0 133.0 0.0 133.0 0.0TOTAL PERSONNEL SERVICE FTE TOTAL PERSONNEL SERVICE FTE
Page 9 of 64
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ROOSEVELT CHILDREN'S ACADEMY CHARTER SCHOOL2018-19
STAFFING PLAN - FULL TIME EQUIVALENT ("FTE")
*NOTE: Each quarter, the actual FTE
ACTUAL QUARTERLY FTE
ACTUAL QUARTERLY FTE
ACTUAL QUARTERLY FTE
SCHOOL
("FTE")
ROOSEVELT CHILDREN'S ACADEMY CHARTER�2018-19�
*NOTE: State the assumptions that are being made for personnel FTE levels.
Description of Assumptions Q4
Actual
0.0
Description of Assumptions Q4
Actual
0.0
Description of Assumptions Q4
Actual
0.0
0.0
should be input.
STAFFING PLAN - FULL TIME EQUIVALENT
*NOTE: Enter the number of FTE positions in the "blue" cells.
ADMINISTRATIVE PERSONNEL FTE
Executive Management Instructional Management Deans, Directors & Coordinators CFO / Director of Finance Operation / Business Manager Administrative Staff TOTAL ADMINISTRATIVE STAFF
INSTRUCTIONAL PERSONNEL FTE
Teachers - Regular Teachers - SPED Substitute Teachers Teaching Assistants Specialty Teachers Aides Therapists & Counselors Other TOTAL INSTRUCTIONAL
NON-INSTRUCTIONAL PERSONNEL FTE
Nurse Librarian Custodian Security Other TOTAL NON-INSTRUCTIONAL
TOTAL PERSONNEL SERVICE FTE
Page 10 of 64�
-
- 1/1 - 3/31
the 'REVISED' Column(s) COMPLETELY BLANK.quarter(s) must be completed on tabs 2, 3 and 4.
Page 11 of 64
ROOSEVELT CHILDREN'S ACADEMY CHARTER SCHOOL Budget / Operating Plan
2018-19
Total Revenue - 3,100,656 - - 3,100,656 - - 3,100,656 Total Expenses - 3,344,653 - - 3,344,653 - - 3,344,653 Net Income - (243,997) - - (243,997) - - (243,997) Actual Student Enrollment - 630 - - 630 - - 630
Prior Year Actual 1st Quarter - 7/1 - 9/30 2nd Quarter - 10/1 - 12/31 3rd Quarter 2017-18
Revenue Per Pupil
Original Budget
Revised Budget Variance
Original Budget
Revised Budget Variance
Original Budget
Allocate Per Pupil Revenue
by Quarter *NOTE: If there are NO budget revisions at the time of quarterly submittal leave
If budget revisions ARE made, the entire "REVISED" budget columns for the affected REVENUE
REVENUES FROM STATE SOURCES 2018-19 Per Pupil Revenue Per Pupil Rate PPR %/Qtr-> 25.0% 25.0% 25.0% 25.0% 25.0%
ROOSEVELT UFSD 1,032,743 - - 1,032,743 - - 1,032,743 UNIONDALE UFSD 289,724 - - 289,724 - - 289,724 HEMPSTEAD UFSD 1,137,942 - - 1,137,942 - - 1,137,942 FREEPORT UFSD 64,316 - - 64,316 - - 64,316 NYC CHANCELLOR'S OFFICE 156,897 - - 156,897 - - 156,897 AMITYVILLE UFSD 42,984 - - 42,984 - - 42,984 BALDWIN UFSD 33,472 - - 33,472 - - 33,472 ROCKVILLE CENTRE UFSD 10,130 - - 10,130 - - 10,130 WYANDANCH UFSD 4,510 - - 4,510 - - 4,510 VALLEY STREAM 13 UFSD 8,386 - - 8,386 - - 8,386 WESTBURY UFSD 20,226 - - 20,226 - - 20,226 BRENTWOOD UFSD 78,787 - - 78,787 - - 78,787 EAST MEADOW UFSD 8,487 - - 8,487 - - 8,487 LONG BEACH CITY SD 11,827 - - 11,827 - - 11,827 MERRICK UFSD 4,822 - - 4,822 - - 4,822 ALL OTHER School Districts: ( Weighted Avg ) 14,503 - - 14,503 - - 14,503
TOTAL Per Pupil Revenue (Weighted Average Per Pupil Funding) - 2,919,753 - - 2,919,753 - - 2,919,753
Special Education Revenue - -Grants
Stimulus - -DYCD (Department of Youth and Community Development) - -Other - -
NYC DoE Rental Assistance Other - -
TOTAL REVENUE FROM STATE SOURCES - 2,919,753 - - 2,919,753 - - 2,919,753
REVENUE FROM FEDERAL FUNDING IDEA Special Needs - -Title I 41,044 - 41,044 - 41,044 Title Funding - Other 2,359 - 2,359 - 2,359 School Food Service (Free Lunch) 106,250 - 106,250 - 106,250 Grants
17,883 21,461 19,452 17,151 15,307 19,104 16,736 20,259 18,039 16,771 20,226 15,007 16,973 23,654 19,286 19,337
18,538
-
- 1/1 - 3/31
ROOSEVELT CHILDREN'S ACADEMY CHARTER SCHOOL Budget / Operating Plan
2018-19
Total Revenue Total Expenses Net Income Actual Student Enrollment
- 3,100,656 - - 3,100,656 - - 3,100,656 - 3,344,653 - - 3,344,653 - - 3,344,653 - (243,997) - - (243,997) - - (243,997) - 630 - - 630 - - 630
Prior Year Actual 2017-18
Revenue Per Pupil
1st Quarter - 7/1 - 9/30
Original Budget
Revised Budget Variance
2nd Quarter - 10/1 - 12/31
Original Budget
Revised Budget Variance
3rd Quarter
Original Budget
Charter School Program (CSP) Planning & Implementation Other
Other TOTAL REVENUE FROM FEDERAL SOURCES
LOCAL and OTHER REVENUE Contributions and Donations Fundraising Erate Reimbursement Earnings on Investments Interest Income Food Service (Income from meals) Text Book OTHER
TOTAL REVENUE FROM LOCAL and OTHER SOURCES
TOTAL REVENUE
- -- -- -
- 149,653 - - 149,653 - - 149,653
- -- -
12,500 - 12,500 - 12,500 - -
13,750 - 13,750 - 13,750 5,000 - 5,000 - 5,000
- -- -
- 31,250 - - 31,250 - - 31,250
- 3,100,656 - - 3,100,656 - - 3,100,656
Page 12 of 64
-
- 1/1 - 3/31
Page 13 of 64
EXPENSES
ADMINISTRATIVE STAFF PERSONNEL COSTS Avg. No. of Positions Executive Management 1.00 61,689 - 61,689 - 61,689 Instructional Management 3.00 67,694 - 67,694 - 67,694 Deans, Directors & Coordinators 2.00 53,190 - 53,190 - 53,190 CFO / Director of Finance 1.00 36,367 - 36,367 - 36,367 Operation / Business Manager 1.00 - -Administrative Staff 11.00 274,810 - 274,810 - 274,810
TOTAL ADMINISTRATIVE STAFF 19.00 - 493,750 - - 493,750 - - 493,750
INSTRUCTIONAL PERSONNEL COSTS Teachers - Regular 31.00 615,212 - 615,212 - 615,212 Teachers - SPED 1.00 20,000 - 20,000 - 20,000 Substitute Teachers 2.00 17,500 - 17,500 - 17,500 Teaching Assistants 30.00 223,750 - 223,750 - 223,750 Specialty Teachers 23.00 168,750 - 168,750 - 168,750 Aides - - -Therapists & Counselors 2.00 30,114 - 30,114 - 30,114 Other 9.00 144,602 - 144,602 - 144,602
TOTAL INSTRUCTIONAL 98.00 - 1,219,928 - - 1,219,928 - - 1,219,928
NON-INSTRUCTIONAL PERSONNEL COSTS Nurse 2.00 17,095 - 17,095 - 17,095 Librarian 1.00 7,342 - 7,342 - 7,342 Custodian 11.00 140,451 - 140,451 - 140,451 Security 2.00 30,184 - 30,184 - 30,184 Other - - -
TOTAL NON-INSTRUCTIONAL 16.00 - 195,072 - - 195,072 - - 195,072
SUBTOTAL PERSONNEL SERVICE COSTS 133.00 - 1,908,750 - - 1,908,750 - - 1,908,750
PAYROLL TAXES AND BENEFITS Payroll Taxes 136,250 - 136,250 - 136,250 Fringe / Employee Benefits 328,750 - 328,750 - 328,750
ROOSEVELT CHILDREN'S ACADEMY CHARTER SCHOOL Budget / Operating Plan
2018-19
Total Revenue - 3,100,656 - - 3,100,656 - - 3,100,656 Total Expenses - 3,344,653 - - 3,344,653 - - 3,344,653 Net Income - (243,997) - - (243,997) - - (243,997) Actual Student Enrollment - 630 - - 630 - - 630
Prior Year Actual 1st Quarter - 7/1 - 9/30 2nd Quarter - 10/1 - 12/31 3rd Quarter 2017-18
Revenue Per Pupil
Original Budget
Revised Budget Variance
Original Budget
Revised Budget Variance
Original Budget
-
- 1/1 - 3/31
ROOSEVELT CHILDREN'S ACADEMY CHARTER SCHOOL Budget / Operating Plan
2018-19
Total Revenue Total Expenses Net Income Actual Student Enrollment
- 3,100,656 - - 3,100,656 - - 3,100,656 - 3,344,653 - - 3,344,653 - - 3,344,653 - (243,997) - - (243,997) - - (243,997) - 630 - - 630 - - 630
Prior Year Actual 2017-18
Revenue Per Pupil
1st Quarter - 7/1 - 9/30
Original Budget
Revised Budget Variance
2nd Quarter - 10/1 - 12/31
Original Budget
Revised Budget Variance
3rd Quarter
Original Budget
Retirement / Pension TOTAL PAYROLL TAXES AND BENEFITS
TOTAL PERSONNEL SERVICE COSTS
CONTRACTED SERVICES Accounting / Audit Legal Management Company Fee Nurse Services Food Service / School Lunch Payroll Services Special Ed Services Titlement Services (i.e. Title I) Other Purchased / Professional / Consulting
TOTAL CONTRACTED SERVICES
133.00
120,000 - 120,000 - 120,000 - 585,000 - - 585,000 - - 585,000
- 2,493,750 - - 2,493,750 - - 2,493,750
11,250 - 11,250 - 11,250 17,500 - 17,500 - 17,500
- -- -
115,000 - 115,000 - 115,000 - -- -- -
230,544 - 230,544 - 230,544 - 374,294 - - 374,294 - - 374,294
Page 14 of 64
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- 1/1 - 3/31
Page 15 of 64
ROOSEVELT CHILDREN'S ACADEMY CHARTER SCHOOL Budget / Operating Plan
2018-19
Total Revenue Total Expenses Net Income Actual Student Enrollment
- 3,100,656 - - 3,100,656 - - 3,100,656 - 3,344,653 - - 3,344,653 - - 3,344,653 - (243,997) - - (243,997) - - (243,997) - 630 - - 630 - - 630
Prior Year Actual 2017-18
Revenue Per Pupil
1st Quarter - 7/1 - 9/30
Original Budget
Revised Budget Variance
2nd Quarter - 10/1 - 12/31
Original Budget
Revised Budget Variance
3rd Quarter
Original Budget
SCHOOL OPERATIONS Board Expenses Classroom / Teaching Supplies & Materials Special Ed Supplies & Materials Textbooks / Workbooks Supplies & Materials other Equipment / Furniture Telephone Technology Student Testing & Assessment Field Trips Transportation (student) Student Services - other Office Expense Staff Development Staff Recruitment Student Recruitment / Marketing School Meals / Lunch Travel (Staff) Fundraising Other
TOTAL SCHOOL OPERATIONS
FACILITY OPERATION & MAINTENANCE Insurance Janitorial Building and Land Rent / Lease / Facility Finance Interest Repairs & Maintenance Equipment / Furniture Security Utilities
TOTAL FACILITY OPERATION & MAINTENANCE
DEPRECIATION & AMORTIZATION RESERVES / CONTINGENCY DEFERRED RENT
2,500 - 2,500 - 2,500 17,500 - 17,500 - 17,500
- -21,250 - 21,250 - 21,250
- -1,250 - 1,250 - 1,250
- 16,250 - 16,250 - 16,250 37,500 - 37,500 - 37,500
- 21,250 - 21,250 - 21,250 - 16,250 - 16,250 - 16,250 - - -
2,500 - 2,500 - 2,500 - 27,500 - 27,500 - 27,500 - 32,359 - 32,359 - 32,359 - 3,750 - 3,750 - 3,750
- -- -
1,750 - 1,750 - 1,750 - -
23,750 - 23,750 - 23,750 - 225,359 - - 225,359 - - 225,359
28,750 - 28,750 - 28,750 - -
120,000.00 - 120,000.00 - 120,000.00 31,250 - 31,250 - 31,250 12,500 - 12,500 - 12,500
- -58,750 - 58,750 - 58,750
- 251,250 - - 251,250 - - 251,250
- -- -
-
- 1/1 - 3/31
TOTAL EXPENSES - 3,344,653 - - 3,344,653 - - 3,344,653
NET INCOME - (243,997) - - (243,997) - - (243,997)
ROOSEVELT CHILDREN'S ACADEMY CHARTER SCHOOL Budget / Operating Plan
2018-19
Total Revenue - 3,100,656 - - 3,100,656 - - 3,100,656 Total Expenses - 3,344,653 - - 3,344,653 - - 3,344,653 Net Income - (243,997) - - (243,997) - - (243,997) Actual Student Enrollment - 630 - - 630 - - 630
Prior Year Actual 1st Quarter - 7/1 - 9/30 2nd Quarter - 10/1 - 12/31 3rd Quarter 2017-18
Revenue Per Pupil
Original Budget
Revised Budget Variance
Original Budget
Revised Budget Variance
Original Budget
Page 16 of 64�
-
- 1/1 - 3/31
- 1/1 - 3/31
231.0 54.0 234.0
15.0 41.0
9.0 8.0
2.0 1.0
2.0 4.0
21.0 2.0 2.0
1.0 3.0
ROOSEVELT CHILDREN'S ACADEMY CHARTER SCHOOL Budget / Operating Plan
2018-19
Total Revenue Total Expenses Net Income Actual Student Enrollment
- 3,100,656 - - 3,100,656 - - 3,100,656 - 3,344,653 - - 3,344,653 - - 3,344,653 - (243,997) - - (243,997) - - (243,997) - 630 - - 630 - - 630
3rd Quarter
Prior Year Actual 2017-18
Revenue Per Pupil
1st Quarter - 7/1 - 9/30
Original Budget
Revised Budget Variance
2nd Quarter - 10/1 - 12/31
Original Budget
Revised Budget Variance
3rd Quarter
Original Budget
ENROLLMENT - *School Districts Are Linked To Above Entries* Number of Districts:
ROOSEVELT UFSD UNIONDALE UFSD HEMPSTEAD UFSD FREEPORT UFSD NYC CHANCELLOR'S OFFICE AMITYVILLE UFSD BALDWIN UFSD ROCKVILLE CENTRE UFSD WYANDANCH UFSD VALLEY STREAM 13 UFSD WESTBURY UFSD BRENTWOOD UFSD EAST MEADOW UFSD LONG BEACH CITY SD MERRICK UFSD ALL OTHER School Districts: ( Weighted Avg )
TOTAL ENROLLMENT
REVENUE PER PUPIL
EXPENSES PER PUPIL
- 18 - - 18 - - 18 - 231 - - 231 - - 231 - 54 - - 54 - - 54 - 234 - - 234 - - 234 - 15 - - 15 - - 15 - 41 - - 41 - - 41 - 9 - - 9 - - 9 - 8 - - 8 - - 8 - 2 - - 2 - - 2
` 1 - - 1 - - 1 - 2 - - 2 - - 2 - 4 - - 4 - - 4 - 21 - - 21 - - 21 - 2 - - 2 - - 2 - 2 - - 2 - - 2 - 1 - - 1 - - 1 - 3 - - 3 - - 3 - 630 - - 630 - - 630
- 4,922 - - 4,922 - - 4,922
- 5,309 - - 5,309 - - 5,309
Page 17 of 64
-
ROOSEVELT CHILDREN'S ACADEMY CHARTER SCHOOLBudget / Operating Plan
2018-19
3rd
*NOTE: If there are NO budget revisions at the time of quarterly submittalIf budget revisions ARE made, the entire "REVISED" budget columns for the
Total Revenue Total Expenses Net Income Actual Student Enrollment
- - 3,100,656 -- - 3,344,653 -- - (243,997) -- - 630 -
----
Revised Budget Variance
Quarter - 1/1 - 3/31 4th Quarter - 4/1 - 6/30
Original Budget
Revised Budget Variance
Page 18
REVENUE REVENUES FROM STATE SOURCES 2018-19
Per Pupil Revenue Per Pupil Rate ROOSEVELT UFSD 17,883 UNIONDALE UFSD 21,461 HEMPSTEAD UFSD 19,452 FREEPORT UFSD 17,151 NYC CHANCELLOR'S OFFICE 15,307 AMITYVILLE UFSD 19,104 BALDWIN UFSD 16,736 ROCKVILLE CENTRE UFSD 20,259 WYANDANCH UFSD 18,039 VALLEY STREAM 13 UFSD 16,771 WESTBURY UFSD 20,226 BRENTWOOD UFSD 15,007 EAST MEADOW UFSD 16,973 LONG BEACH CITY SD 23,654 MERRICK UFSD 19,286 ALL OTHER School Districts: ( Weighted Avg ) 19,337
TOTAL Per Pupil Revenue (Weighted Average Per Pupil Funding) 18,538
Special Education Revenue Grants
Stimulus DYCD (Department of Youth and Community Development) Other
NYC DoE Rental Assistance Other
TOTAL REVENUE FROM STATE SOURCES
REVENUE FROM FEDERAL FUNDING IDEA Special Needs Title I Title Funding - Other School Food Service (Free Lunch) Grants
leave the 'REVISED' Column(s) COMPLETELY BLANK. affected quarter(s) must be completed on tabs 2, 3 and 4.
25.0% 25.0% 25.0% - - 1,032,743 - -- - 289,724 - -- - 1,137,942 - -- - 64,316 - -- - 156,897 - -- - 42,984 - -- - 33,472 - -- - 10,130 - -- - 4,510 - -- - 8,386 - -- - 20,226 - -- - 78,787 - -- - 8,487 - -- - 11,827 - -- - 4,822 - -- - 14,503 - -
- - 2,919,753 - -
- -
- -- -- -
- -- - 2,919,753 - -
- -- 41,044 -- 2,359 -- 106,250 -
of 64
-
ROOSEVELT CHILDREN'S ACADEMY CHARTER SCHOOLBudget / Operating Plan
2018-19
3rd
Total Revenue Total Expenses Net Income Actual Student Enrollment
- -- -- -- -
3,100,656 - -3,344,653 - -(243,997) - -
630 - -
Revised Budget Variance
Quarter - 1/1 - 3/31 4th Quarter - 4/1 - 6/30
Original Budget
Revised Budget Variance
Charter School Program (CSP) Planning & Implementation Other
Other TOTAL REVENUE FROM FEDERAL SOURCES
LOCAL and OTHER REVENUE Contributions and Donations Fundraising Erate Reimbursement Earnings on Investments Interest Income Food Service (Income from meals) Text Book OTHER
TOTAL REVENUE FROM LOCAL and OTHER SOURCES
TOTAL REVENUE
- -- -- -
- - 149,653 - -
- -- -- 12,500 -- -- 13,750 -- 5,000 -- -- -
- - 31,250 - -
- - 3,100,656 - -
Page 19 of 64
-
ROOSEVELT CHILDREN'S ACADEMY CHARTER SCHOOLBudget / Operating Plan
2018-19
3rd
Page 20 of 64
- 61,689 -- 67,694 -- 53,190 -- 36,367 -- -- 274,810 -
- - 493,750 - -
- 615,212 -- 20,000 -- 17,500 -- 223,750 -- 168,750 -- -- 30,114 -- 144,602 -
- - 1,219,928 - -
- 17,095 -- 7,342 -- 140,451 -- 30,184 -- -
- - 195,072 - -
- - 1,908,750 - -
- 136,250 -- 328,750 -
Total Revenue Total Expenses Net Income Actual Student Enrollment
EXPENSES
ADMINISTRATIVE STAFF PERSONNEL COSTS Avg. No. of Positions Executive Management 1.00 Instructional Management 3.00 Deans, Directors & Coordinators 2.00 CFO / Director of Finance 1.00 Operation / Business Manager 1.00 Administrative Staff 11.00
TOTAL ADMINISTRATIVE STAFF 19.00
INSTRUCTIONAL PERSONNEL COSTS Teachers - Regular 31.00 Teachers - SPED 1.00 Substitute Teachers 2.00 Teaching Assistants 30.00 Specialty Teachers 23.00 Aides -Therapists & Counselors 2.00 Other 9.00
TOTAL INSTRUCTIONAL 98.00
NON-INSTRUCTIONAL PERSONNEL COSTS Nurse 2.00 Librarian 1.00 Custodian 11.00 Security 2.00 Other -
TOTAL NON-INSTRUCTIONAL 16.00
SUBTOTAL PERSONNEL SERVICE COSTS 133.00
PAYROLL TAXES AND BENEFITS Payroll Taxes Fringe / Employee Benefits
- - 3,100,656 - -- - 3,344,653 - -- - (243,997) - -- - 630 - -
4th Quarter - 4/1 - 6/30
Revised Budget Variance
Original Budget
Revised Budget Variance
Quarter - 1/1 - 3/31
-
ROOSEVELT CHILDREN'S ACADEMY CHARTER SCHOOLBudget / Operating Plan
2018-19
3rd
Total Revenue Total Expenses Net Income Actual Student Enrollment
- -- -- -- -
3,100,656 - -3,344,653 - -(243,997) - -
630 - -
Revised Budget Variance
Quarter - 1/1 - 3/31 4th Quarter - 4/1 - 6/30
Original Budget
Revised Budget Variance
Retirement / Pension TOTAL PAYROLL TAXES AND BENEFITS
TOTAL PERSONNEL SERVIC