Backup Documents 05/23/2017 Item #16D 8 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TOki Q 8
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNAT V
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2.
3. County Attorney Office County Attorney Office G�
z /s./ 5-V;.2Ak-\
4. BCC Office Board of County \r1��
Commissioners
5. Minutes and Records Clerk of Court's Office eTh 5123��7 3:
PRIMARY CONTACT INFORMATION t
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Matt Catoe—P&R Contact Information 239-252-4059
Contact/ Department
Agenda Date Item was 5/23/2017-Peadiliftg- ✓ Agenda Item Number 1l,<p$
Approved by the BCC yy
Type of Document Child Nutrition Programs Agreement Number of Original 2
Attached Documents Attached
PO number or account "ITV:1'563UL
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. , - (Initial) Applicable)
1. Does the document require the chairman's original signature viirt K 9 011301w R6
2. Does the document need to be sent to another agency for additional signatures? If yes,
provide the Contact Information(Name;Agency;Address; Phone)on an attached sheet. c
3. Original document has been signed/initialed for legal sufficiency. (All documents to be
signed by the Chairman,with the exception of most letters,must be reviewed and signed ,4(Ci
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's tot4 /�
Office and all other parties except the BCC Chairman and the Clerk to the Board /l•/
5. The Chairman's signature line date has been entered as the date of BCC approval of the M
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's t/
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip
should be provided to the County Attorney Office at the time the item is input into SIRE. 1 �
Some documents are time sensitive and require forwarding to Tallahassee within a certain Iy�i
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 03714121M and all changes made during
the meeting have been incorporated in the attached document. The County
Attorney's Office has reviewed the changes,if applicable. 5 9 3 A-4-
9. Initials of attorney verifying that the attached document is the version approved by the
BCC,all changes directed by the BCC have been made,and the document is ready for the ill\
Chairman's signature.
Coiii ty of Collier 1 6 DR
CLERK OF THOCIR UIT COURT
Dwight E. Brock COLLIER COUI ;'Y COO,KTHOUSE Clerk of Courts
Clerk of Courts 3315 TAMIAMI TRL E STE 1021 P.O. BOX 413044 Accountant
NAPLES, FLORIDA `'p !NAPLES,FLORIDA Auditor
34112-5324 _I- :34101-3044 Custodian of County Funds
Rachel Mohler
Florida Department of Agriculture and Consumer Services
Division of Food, Nutrition and Wellness
600 S. Calhoun Street(H2)
Tallahassee, FL 32399
Re: An Agreement between Collier County and the Florida
Department of Agriculture and Consumer Services to operate
the SFSP at designated recreation camps in Collier County
Ms. Mohler,
Attached for further processing are (2) original copies of the agreement referenced above,
approved by the Collier County Board of County Commissioners on May 23, 2017
After the agreement(s) are signed by the appropriate party, please return one of the original
agreements to the Collier County Minutes and Records Department that serves as Clerk
to the Board, thereby providing a fully executed document for the Board's Official Record.
I have included a label to facilitate mailing.
If your office requires further information, please feel free to contact me at 239-252-8406.
Thank you,
DWIGHT E. BROCK, CLERK
Ottte 2,021tia.) C-
Ann Jennejo ,
Deputy Clerk
Attachments (2)
Phone- (239) 252-2646 Fax- (239) 252-2755
Website- www.CollierClerk.com Email- CollierClerk@collierclerk.com
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Florida Department of Agriculture and Consumer Services
Division of Food, Nutrition and Wellness
CHILD NUTRITION PROGRAMS
ADAM H.PUTNAM AGREEMENT
COMMISSIONER
SPONNR NAME: SPONSOR NUMSER:
(._C) ll Cf C.47.16\/ ( 6‘15 e 1155
ADDRESS: CITY: ZIP:
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This is an agreement between the Florida Department of Agriculture and Consumer
Services (FDACS) and the sponsor identified to participate in one or more of the following
U.S. Department of Agriculture(USDA)Child Nutrition Programs administered by FDACS:
I Program Federal CFDA
Regulation
National School Lunch Program (NSLP)
Afterschool Snack Program (ASP) 7 CFR 210, 245 10.555
Seamless Summer Option (SSO)
School Breakfast Program (SBP) 7 CFR 220, 245 10.553
Special Milk Program (SMP) 7 CFR 215, 245 10.556
Summer Food Service Program (SFSP) 7 CFR 225 10.559
Food Distribution Program 7 CFR 250 _10.550
GENERAL TERMS AND CONDITIONS
1. This Agreement shall be effective from the date the Agreement and Program
Application are approved by FDACS. FDACS's performance and obligation to pay
under this Agreement are contingent upon continued availability of funds appropriated
by Congress for the Child Nutrition Programs and an annual appropriation by the
Legislature.
2. This Agreement remains in effect until terminated by either party. At least 30 days
written notice must be given to terminate this Agreement. Upon termination of this
Agreement, FDACS shall make no further disbursement of funds to the sponsor in
accordance with this Agreement, except to reimburse the sponsor in connection with
eligible meals served on or prior to the termination of this Agreement. No termination
or suspension of this Agreement shall affect the obligation of the sponsor to maintain
records and to make such records available for audit.
3. The sponsor has the right to appeal decisions made by FDACS in accordance with 7
CFR 210.18(q) and 7 CFR 225.13 that affect participation in the program(s) or Claims
for Reimbursement.
4. The sponsor and participating sites under its jurisdiction shall comply with all
provisions of 7 CFR parts 210, 215, 220, 225, 245 and 250.
FDACS-01718 Rev. 12118
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REQUIREMENTS FOR PARTICIPATION IN CHILD NUTRITION PROGRAMS
Each sponsor operating the National School Lunch Program (NSLP) or Seamless
Summer Option (SSO) shall, with respect to participating sites under its jurisdiction:
1. Maintain a nonprofit school food service and observe the requirements for and
limitations on the use of nonprofit school food service revenues set forth in 7 CFR
§210.14 and the limitations on any competitive school food service as set forth in
7 CFR §210.11;
2. Limit its net cash resources to an amount that does not exceed 3 months average
expenditures for its nonprofit school food service or such other amount as may be
approved in accordance with 7 CFR §210.19(a);
3. Maintain a financial management system as prescribed under 7 CFR §210.14(c);
4. Comply with the requirements of the USDA's regulations regarding financial
management (2 CFR 200, as applicable);
5. Serve lunches, during the lunch period, which meet the minimum requirements
prescribed in 7 CFR §210.10;
6. Price the lunch as a unit in accordance with 7 CFR §210.10(a)(2);
7. Serve lunches free or at a reduced price to all children who are determined by the
local educational agency to be eligible for such meals under 7 CFR part 245;
8. Claim reimbursement at the assigned rates only for reimbursable free, reduced
price and paid lunches served to eligible children in accordance with 7 CFR part
210. Agree that the sponsor official signing the claim shall be responsible for
reviewing and analyzing meal counts to ensure accuracy as specified in 7 CFR
§210.8 governing claims for reimbursement. Acknowledge that failure to submit
accurate claims will result in the recovery of an overclaim and may result in the
withholding of payments, suspension or termination of the program as specified in
7 CFR §210.25. Acknowledge that if failure to submit accurate claims reflects
embezzlement, willful misapplication of funds, theft, or fraudulent activity, the
penalties specified in 7 CFR §210.26 shall apply;
9. Count the number of free, reduced price and paid reimbursable meals served to
eligible children at the point of service, or through another counting system if
approved by FDACS;
10.Submit Claims for Reimbursement in accordance with 7 CFR §210.8;
11.Comply with the audit regulations stated in 2 CFR 200, Subpart F —Audit
Requirements, if during the organization's fiscal year, Federal funds received
from all programs totals $750,000 or more;
12.Comply with the requirements of the USDA's regulations regarding
nondiscrimination (7 CFR parts 15, 15a, 15b);
13.Make no discrimination against any child because of his or her eligibility for free or
reduced price meals in accordance with the approved Free and Reduced Price
Policy Statement;
14.Enter into an agreement to receive donated foods as required by 7 CFR part 250;
15.Maintain, in the storage, preparation and service of food, proper sanitation and
health standards in conformance with all applicable State and local laws and
regulations, and comply with the food safety requirements of 7 CFR §210.13;
FDACS-01716 Rev. 12/16
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16.Accept and use, in as large quantities as may be efficiently utilized in its nonprofit
school food service, such foods as may be offered as a donation by the USDA;
17.Maintain necessary facilities for storing, preparing and serving food;
18.Upon request, make all accounts and records pertaining to its school food service
available to FDACS and to the USDA, for audit or review, at a reasonable time and
place. Such records shall be retained for a period of 3 years after the date of the
final Claim for Reimbursement for the fiscal year to which they pertain, except that
if audit findings have not been resolved, the records shall be retained beyond the
3 year period as long as required for resolution of the issues raised by the audit;
a. For public school districts and charter schools, retain records for five (5)
fiscal years in accordance with General Records Schedule GS7 for Public
Schools Pre-K-12 and Adult and Career Education. This retention schedule
supersedes the requirement above;
19.Maintain files of currently approved and denied free and reduced price applications
which must be readily retrievable by school;
20.Directly certify children for free school meals using the Florida Direct Certification
System at least three times during the school year as required by FDACS. More
frequent direct certification efforts are permissible and encouraged;
21.Maintain files of the names of children currently approved for free meals through
direct certification with the supporting documentation, as specified in 7 CFR
§245.6(b)(5),which must be readily retrievable by school. Documentation for direct
certification must include information obtained directly from the appropriate State
or local agency, or other appropriate individual, as specified by the USDA, that:
a. A child in the Family, as defined in 7 CFR §245.2, is receiving benefits
from SNAP, FDPIR or TANF, as defined in 7 CFR §245.2; if one child is
receiving such benefits, all children in that family are considered to be
directly certified;
b. The child is a homeless child as defined in 7 CFR §245.2;
c. The child is a runaway child as defined in 7 CFR §245.2;
d. The child is a migrant child as defined in 7 CFR §245.2;
e. The child is a Head Start child as defined in 7 CFR §245.2; or
f. The child is a foster child as defined in 7 CFR §245.2.
22.Retain the individual applications for free and reduced price lunches and meal
supplements submitted by families for a period of 3 years after the end of the fiscal
year to which they pertain or as otherwise specified under paragraph (18) of this
section; and
23.No later than December 31 of each year, provide FDACS with a list of all sites
under its jurisdiction in which 50 percent or more of enrolled children have been
determined eligible for free or reduced price meals as of the last operating day the
preceding October. FDACS may designate a month other than October for the
collection of this information, in which case the list must be provided to FDACS
within 60 calendar days following the end of the month designated by FDACS. In
addition, each sponsor shall provide, when available for the sites under its
jurisdiction, and upon the request of a sponsoring organization of day care homes
of the Child and Adult Care Food Program, information on the boundaries of the
FDACS-01716 Rev. 12/16
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attendance areas for the sites identified as having 50 percent or more of enrolled
children certified eligible for free or reduced price meals.
Each sponsor with eligible sites, as defined in 7 CFR 210.10(n)(1), that elects to serve
meal supplements during afterschool care programs, shall:
1. Serve meal supplements which meet the minimum requirements prescribed in 7
CFR §210.10;
2. Price the meal supplement as a unit in accordance with 7 CFR §210.10(a)(2);
3. Serve meal supplements free or at a reduced price to all children who are
determined by the sponsor to be eligible for free or reduced price school meals
under 7 CFR part 245;
4. If charging for meals, the charge for a reduced price meal supplement shall not
exceed 15 cents;
5. Claim reimbursement at the assigned rates only for meal supplements served in
accordance with the agreement;
6. Claim reimbursement for no more than one meal supplement per child per day;
7. Comply with the audit regulations stated in 2 CFR 200, Subpart F—Audit
Requirements, if during the organization's fiscal year, Federal funds received
from all programs totals $750,000 or more;
8. Review each afterschool care program two times a year; the first review shall be
made during the first four weeks that the site is in operation each school year,
except that an afterschool care program operating year round shall be reviewed
during the first four weeks of its initial year of operation, once more during its first
year of operation, and twice each school year thereafter; and
9. Comply with all requirements of 7 CFR §210.9, except that, claims for
reimbursement need not be based on "point of service" meal supplement counts
(as required by 7 CFR 210.9(b)(9)).
Each sponsor operating the School Breakfast Program (SBP) shall, with respect to
participating sites under its jurisdiction:
1. Maintain a nonprofit school food service;
2. In accordance with the financial management system established under 7 CFR
§220.13(i), use all revenues received by such food service only for the operation
or improvement of that food service except that facilities, equipment, and
personnel support with funds provided to a sponsor under this part may be used
to support a nonprofit nutrition program for the elderly, including a program funded
under the Older Americans Act of 1965 (42 U.S.C. 3001 et seq.);
3. Revenues received by the nonprofit school food service shall not be used to
purchase land or buildings or to construct buildings;
4. Limit its net cash resources to an amount that does not exceed three months
average expenditure for its nonprofit school food service or such other amount as
may be approved by FDACS; and
5. Observe the limitations on any competitive food service as set forth in 7 CFR
§210.10 and 7 CFR §220.12;
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6. Serve breakfasts which meet the minimum requirements prescribed in 7 CFR
§220.8, during a period designated as the breakfast period by the site;
7. Price the breakfast as a unit in accordance with 7 CFR §220.8(a)(2);
8. Supply breakfast without cost or at reduced price to all children who are
determined by the sponsor to be unable to pay the full price thereof in accordance
with the free and reduced price policy statements approved under 7 CFR part 245;
9. Make no discrimination against any child because of his inability to pay the full
price of the breakfasts;
10.Claim reimbursement at the assigned rates only for breakfasts served in
accordance with the agreement;
11.Submit Claims for Reimbursement in accordance with 7 CFR §220.11 and
procedures established by FDACS, or the USDA where applicable;
12.Comply with the audit regulations stated in 2 CFR 200, Subpart F —Audit
Requirements, if during the organization's fiscal year, Federal funds received
from all programs totals $750,000 or more;
13.Maintain, in the storage, preparation and service of food, proper sanitation and
health standards in conformance with all applicable State and local laws and
regulations, and comply with the food safety requirements in paragraph (a)(2) and
paragraph (a)(3) of 7 CFR §220.7;
14,Purchase, in as large quantities as may be efficiently utilized in its nonprofit school
food service, foods designated as plentiful by FDACS;
15.Accept and use, in as large quantities as may be efficiently utilized in its nonprofit
school food service, such foods as may be offered as a donation by the USDA;
16.Maintain necessary facilities for storing, preparing, and serving food;
17.Maintain a financial management system as prescribed by FDACS, or the USDA
where applicable;
18.Upon request, make all accounts and records pertaining to its nonprofit school food
service available to FDACS, to the USDA and to the USDA's Office of Audit for
audit or review at a reasonable time and place. Such records shall be retained for
a period of three years after the end of the fiscal year to which they pertain, except
that if audit findings have not been resolved, the records shall be retained beyond
the three-year period as long as required for the resolution of the issues raised by
the audit.
a. For public school districts and charter schools, retain records for five (5)
fiscal years in accordance with General Records Schedule GS7 for Public
Schools Pre-K-12 and Adult and Career Education. This retention
schedule supersedes the requirement above.
19.Retain documentation of free or reduced price eligibility as follows:
a. Maintain files of currently approved and denied free and reduced price
applications which must be readily retrievable by school for a period of three
years after the end of the fiscal year to which they pertain; or
b. Maintain files with the names of children currently approved for free meals
through direct certification with the supporting documentation, as specified
in §245,8(b)(4) of this chapter, which must be readily retrievable by school.
Documentation for direct certification must include information obtained
FDACS-01716 Rev. 12/16
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directly from the appropriate State or local agency, or other appropriate
individual, as specified by the USDA, that:
i. A child in the Family, as defined in 7 CFR §245.2, is receiving
benefits from SNAP, FDPIR or TANF, as defined in §245.2; if one
child is receiving such benefits, all children in that family are
considered to be directly certified;
ii. The child is a homeless child as defined in 7 CFR §245.2;
iii. The child is a runaway child as defined in 7 CFR §245.2;
iv. The child is a migrant child as defined in 7 CFR §245.2;
v. The child is a Head Start child, as defined in 7 CFR §245.2; or
vi. The child is a foster child as defined in 7 CFR §245.2.
20.Directly certify children for free school meals using the Florida Direct Certification
System at least three times during the school year as required by FDACS. More
frequent direct certification efforts are permissible and encouraged; and
21.Comply with the requirements of the USDA's regulations respecting
nondiscrimination (7 CFR part 15).
Each sponsor approved to participate in the Special Milk Program (SMP) shall, with
respect to sites under its jurisdiction:
1. Operate a nonprofit milk service. However, sponsors may use facilities,equipment,
and personnel supported with funds provided to a sponsor to support a nonprofit
nutrition program for the elderly, including a program funded under the Older
Americans Act of 1965 (42 U.S.C. 3001 et seq.).
2. If electing to provide free milk (i) serve milk free to all eligible children, at times that
milk is made available to nonneedy children under the program; and (ii) make no
discrimination against any needy child because of his inability to pay for the milk.
3. Comply with the requirements of the USDA's regulations respecting
nondiscrimination (7 CFR part 15);
4. Claim reimbursement only for milk as defined in this part and in accordance with
the provisions of 7 CFR §215.8 and 7 CFR §215.10;
5. Submit Claims for Reimbursement in accordance with 7 CFR §215.10 of this part
and procedures established by FDACS or the USDA where applicable;
6. Comply with the audit regulations stated in 2 CFR 200, Subpart F—Audit
Requirements, if during the organization's fiscal year, Federal funds received
from all programs totals $750,000 or more;
7. Maintain a financial management system as prescribed by FDACS, or the USDA
where applicable;
8. Upon request, make all records pertaining to its milk program available to FDACS
and to the USDA for audit and administrative review, at any reasonable time and
place. Such records shall be retained for a period of three years after the end of
the fiscal year to which they pertain, except that, if audit findings have not been
resolved, the records shall be retained beyond the three-year period as long as
required for the resolution of the issues raised by the audit; and
9. Retain the individual applications for free milk submitted by families for a period of
three years after the end of the fiscal year to which they pertain, except that, if
DACS•01716 Rev. 12)16
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audit findings have not been resolved, the records shall be retained beyond the
three-year period as long as required for the resolution of the issues raised by the
audit.
a. For public school districts and charter schools, retain records for five (5)
fiscal years in accordance with General Records Schedule GS7 for Public
Schools Pre-K-12 and Adult and Career Education. This retention
schedule supersedes the requirement above.
Each sponsor approved for participation in the Summer Food Service Program (SFSP)
shall:
1. Operate a nonprofit food service during the period specified, as follows:
a. From May through September for children on school vacation;
b. At any time of the year, in the case of sponsors administering the Program
under a continuous school calendar system; or
c. During the period from October through April, if it serves an area affected
by an unanticipated school closure due to a natural disaster, major building
repairs, court orders relating to school safety or other issues, labor-
management disputes, or, when approved by FDACS, a similar cause.
2. For sponsors, offer meals which meet the requirements and provisions set forth in
7 CFR §225.16 during times designated as meal service periods by the sponsor,
and offer the same meals to all children;
3. For all other sponsors, serve meals which meet the requirements and provisions
set forth in 7 CFR §225.16 during times designated as meal service periods by the
sponsor, and serve the same meals to all children;
4. Serve meals without cost to all children, except that camps may charge for meals
served to children who are not served meals under the program;
5. Issue a free meal policy statement in accordance with 7 CFR §225.6(c);
6. Meet the training requirement for its administrative and site personnel, as required
under 7 CFR §225.15(d)(1);
7. Claim reimbursement only for the type or types of meals specified in the agreement
and served without charge to children at approved sites during the approved meal
service period, except that camps shall claim reimbursement only for the type or
types of meals specified in the agreement and served without charge to children
who meet the program's income standards. The agreement shall specify the
approved levels of meal service for the sponsor's sites if such levels are required
under 7 CFR §225,6(d)(2). No permanent changes may be made in the serving
time of any meal unless the changes are approved by FDACS;
8. Submit claims for reimbursement in accordance with procedures established by
FDACS, and those stated in 7 CFR §225.9;
9. Comply with the audit regulations stated in 2 CFR 200, Subpart F — Audit
Requirements, if during the organization's fiscal year, Federal funds received from
all programs totals $750,000 or more;
10.In the storage, preparation and service of food, maintain proper sanitation and
health standards in conformance with all applicable State and local laws and
regulations;
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11.Accept and use, in quantities that may be efficiently utilized in the program, such
foods as may be offered as a donation by the USDA;
12.Have access to facilities necessary for storing, preparing, and serving food;
13.Maintain a financial management system as prescribed by FDACS;
14.Maintain on file documentation of site visits and reviews in accordance with 7 CFR
§225.15(d) (2) and (3);
15.Upon request, make all accounts and records pertaining to the program available
to State, Federal, or other authorized officials for audit or administrative review, at
a reasonable time and place. The records shall be retained for a period of 3 years
after the end of the fiscal year to which they pertain, unless audit or investigative
findings have not been resolved, in which case the records shall be retained until
all issues raised by the audit or investigation have been resolved
a. For public school districts and charter schools, retain records for five (5)
fiscal years in accordance with General Records Schedule GS7 for Public
Schools Pre-K-12 and Adult and Career Education. This retention schedule
supersedes the requirement above.
16.Submit information as required in this Program agreement that is true and correct,
acknowledging that deliberate misrepresentation or withholding of information may
result in prosecution under the applicable State and Federal statutes;
17.Maintain children on site while meals are consumed; and
18.Retain final financial and administrative responsibility for its program.
Each sponsor receiving donated foods under FDACS' Food Distribution Program shall:
1. Distribute and use of donated foods is in accordance with 7 CFR part 250;
2. Be responsible for reporting to FDACS for any improper distribution or use of
donated foods or for any loss of,or damage to,donated foods caused by their fault
or negligence;
3. Have and preserve a right to assert claims against other persons to whom donated
foods are delivered for care, handling or distribution; and
4. Take action to obtain restitution in connection with claims for improper distribution,
use or loss of, or damage to, donated foods.
ASSURANCE OF CIVIL RIGHTS COMPLIANCE
The sponsor hereby agrees that it will comply with Title VI of the Civil Rights Act of 1964
(42 U.S.C. 2000d et seq.),Title IX of the Education Amendments of 1972(20 U.S.C. 1681
et seq.), Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), the Age
Discrimination Act of 1975 (42 U.S.C. 6101 et seq.); all provisions required by the
implementing regulations of the United States Department of Agriculture (USDA);
Department of Justice Enforcement Guidelines, 28 CFR Part 50.3 and 42; and the Food
and Nutrition Service (ENS) directives and guidelines, to the effect that, no person shall,
on the grounds of race, color, national origin, age, sex, or disability, be excluded from
participation in, be denied the benefits of, or otherwise be subjected to discrimination
under any program or activity for which the SPONSOR receives federal financial
FDACS-01716 Rev. 12/18
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assistance from the USDA; and gives assurance that it will immediately take measures
necessary to effectuate this Agreement.
By accepting this assurance, the sponsor agrees to compile data, maintain records, and
submit reports as required to permit effective enforcement of the nondiscrimination laws
and permit authorized FDACS and USDA personnel, during hours of program operation,
to review such records, books, and accounts as needed to ascertain compliance with the
nondiscrimination laws. If there are any violations of this assurance, the USDA, shall
have the right to seek judicial enforcement of this assurance.
This assurance is binding on the sponsor, its successors, transferees, and assignees as
long as it receives assistance or retains possession of any assistance from USDA. The
person (or persons) whose signature(s) appear(s) below is/are authorized to sign this
assurance on behalf of the sponsor.
CERTIFICATION REGARDING LOBBYING
This certification is a material representation of fact upon which reliance was placed when
this transaction was made or entered into. Submission of this certification is a prerequisite
for making or entering into this transaction imposed by section 1352, title 31, U.S. Code.
Any person who fails to file the required certification shall be subject to a civil penalty of
not less than $10,000 and not more than $100,000 for each such failure.
The undersigned sponsor certifies, to the best of his or her knowledge and belief, that:
1. No Federal appropriated-funds have been paid or will be paid, by or on behalf of
the undersigned, to any person for influencing or attempting to influence an officer
or employee of congress, or an employee of a member of congress in connection
with the awarding of any Federal contract, the making of any Federal grant, the
making of any Federal loan, the entering into of any cooperative agreement, and
the extension, continuation, renewal, amendment, or modification of any Federal
contract, grant, loan, or cooperative agreement.
2. If any funds other than Federal-appropriated funds have been paid or will be paid
to any person for influencing or attempting to influence an officer or employee of
any agency, a member of congress, an officer or employee of congress, or an
employee of a member of congress in connection with this Federal contract, grant,
loan, or cooperative agreement, the undersigned shall complete and submit
Standard Form-LLL, Disclosure Form to Report Lobbying, in accordance with its
instructions.
3. The language of this certification shall be included in the award documents for all
sub-awards at all tiers (including sub-contracts, subgrants, and contracts under
grants, loans and cooperative agreements) and that all sub-recipients shall certify
and disclose accordingly.
FOACS-01716 Rev. 12/16
Page 9 of 13
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16fl8
CERTIFICATION REGARDING DRUG-FREE WORKPLACE
This certification is required by the regulations implementing Sections 5151-5160 of the
Drug Free Workplace Act of 1988 (Pub. L. 100-690, Title V, Subtitle 0; 41 U.S.C. 701 et
seq.), 2 CFR Part 182. The regulations, published as Part II of the May 25, 1990 Federal
Register(pages 21681-21691), require certification by grantees, prior to award, that they
will maintain a drug-free workplace.
This certification is a material representation of fact upon which reliance was placed when
this transaction was made or entered into. False certification or violation of the certification
shall be grounds for suspension of payments, suspension or termination of grants, or
suspension or debarment (see 7 CFR Part 3017, Sections 3017.615 and 3017.620).
1. The applicant certifies that it will provide a drug-free workplace by:
a. Publishing a statement notifying employees that the unlawful manufacture,
distribution, dispensing, possession, or use of a controlled substance is
prohibited in the grantee's workplace and specifying the actions that will be
taken against employees for violation of such prohibition.
b. Establishing an on-going, drug-free awareness program to inform
employees about:
i. The dangers of drug abuse in the workplace
ii. The grantee's policy of maintaining a drug-free workplace
iii. Any available drug counseling, rehabilitation, and employee
assistance programs, and
iv. The penalties that may be imposed upon employees for drug abuse
violations occurring in the workplace.
c. Requiring that each employee engaged in the performance of the grant
be given a copy of the statement required by paragraph (a).
d. Notifying the employee in the statement required by paragraph (a) that, as
a condition of employment under the grant, the employee will:
i. Abide by the terms of the statement.
ii. Notify the employer in writing of his or her conviction for a violation
of a criminal drug statute occurring in the workplace no later than five
calendar days after such conviction.
e. Notifying the agency in writing, within 10 calendar days after receiving
notice under subparagraph (d)(2) from an employee or otherwise receiving
actual notice of such conviction. Employers of convicted employees must
provide notice, including position title, to every grant officer or other
designee. Notice shall include the identification number(s) of each affected
grant.
f. Taking one of the following actions, within 30 calendar days of receiving
notice under subparagraph (d)(2), with respect to any employee who is so
convicted:
i. Taking appropriate personnel action against such an employee, up
to and including termination, consistent with the requirements of the
Rehabilitation Act of 1973, as amended; or
FDACS•01716 Rev. 11/18
Page 10 of 13
CSC
1608
ii. Requiring such employee to participate satisfactorily in a drug abuse
assistance or rehabilitation program approved for such purposes by
a federal, state, or local health,law enforcement,or other appropriate
agency.
g. Making a good faith effort to continue to maintain a drug-free workplace
through implementation of paragraphs (a), (b), (c), (d), (e), and (f).
2. The grantee may insert in the space provided below the site(s) for the
performance of work done in connection with the specific grant:
Place of Performance (street address, city, county, state, zip code):
{?PerA 05 f G�, 5� }cs irl tMa�'�•oI •
Check 0 if there are workplaces on file that are not identified here.
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
MATTERS— PRIMARY COVERED TRANSACTIONS
This certification is required by the regulations implementing Executive Order 12549,
Debarment and Suspension, 2 CFR Part 180, Subpart C, Responsibilities of Participants
Regarding Transactions Doing Business with Other Persons. Copies of the regulations
may be obtained by contacting the Department of Agriculture agency offering the
proposed covered transaction.
1. The prospective primary participant [Sponsor] certifies to the best of its
knowledge and belief, that it and its principals:
a. are not presently debarred, suspended, proposed for debarment,
declared ineligible, or voluntarily excluded from covered transactions by
any Federal department or agency;
b. have not within a three-year period preceding this proposal been
convicted of or had a civil judgment rendered against them for
commission of fraud or a criminal offense in connection with obtaining,
attempting to obtain, or performing a public (Federal, State or local)
transaction or contract under a public transaction; violation of Federal or
State antitrust statutes or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, making false statements,
or receiving stolen property;
c. are not presently indicted for or otherwise criminally or civilly charged by
a governmental entity (Federal, State or local) with commission of any
of the offenses enumerated in paragraph (1)(b) of this certification: and
d. have not within a three-year period preceding this application/proposal
had one or more public transactions (Federal, State or local)terminated
for cause or default.
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1613E
2. Where the prospective primary participant [Sponsor] is unable to certify to any
of the statements in this certification, such prospective participant shall attach
an explanation to this agreement.
FDACS-01718 Rev 12/16
Page 12 of 13
1 6 0 8 -.
This Agreement constitutes the entire Agreement between the parties. No waiver,
consent, modification, or change of terms of this Agreement shall bind either party
unless in writing and signed by both parties. The Sponsor, by the signature of its
authorized representative, hereby acknowledges that he/she has read this Agreement,
understands it, and agrees to be bound by its terms and conditions.
ATTEST: -1
Signature of Autfiarizeb ial DWIGHT E.BR
dl' !C, Cisrtc'
6y: � < rc - 6 -
� � �Q om r �+
Printed Name of Aut orized Official AtteS a tr7 `ajr[pan' j
signature only.
•
Approved as to form and legality
Title cO I, it p
5/23/J6/7
/3/J6/7 Assistant County Attorney
Date
Sign and return two (2) original copies of this Agreement to:
Florida Department of Agriculture and Consumer Services
Division of Food, Nutrition and Wellness
600 S. Calhoun Street(H2)
Tallahassee, Florida 32399
OFFICIAL USE ONLY
Florida Department of Agriculture and Consumer Services
APPROVED BY:
Director of Administration
[ Date
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