Agenda 03/26/2019 Item #16D 416.D.4
03/26/2019
EXECUTIVE SUMMARY
Recommendation to approve an Agreement to Purchase Vended Meals from Another Approved
School Food Service Facility with the District School Board of Collier County (School Board) to
sponsor and operate the 2019 Summer Food Service Program (SFSP) at designated recreation
camps with unitized meals provided by the School Board and authorize all necessary Budget
Amendments. (Total anticipated Fiscal impact $170,064.60 with a Federal Share of $138,114.60
and a local contribution of $31,950).
OBJECTIVE: To provide nutritional breakfasts and lunches during the summer for children that are not
able to go to the sites offered by the School Board.
CONSIDERATIONS: The SFSP is grant funded by the United States Department of Agriculture Food
and Nutrition Service and administered by the Florida Department of Agriculture. The grant reimburses
agencies that serve free meals to children 18 years and under in neighborhoods that qualify.
Neighborhood eligibility is determined by census income data or by the percentage of children who
receive free and reduced meal service during the school year. The County's Parks and Recreation
Division has historically provided summer food service to recreation camps throughout Collier County
for the last 37 years.
The School Board Nutrition Services Department is uniquely qualified to provide this level of support for
the SFSP. The program guidelines closely resemble those associated with the free and reduced lunch
program the school district provides throughout the school year. The school food service staff is already
under the management of the Nutrition Services Department, and better accountability can be maintained
by having the School Board supervise/provide these resources during the summer months.
Under this arrangement, the County's Parks and Recreation Division would:
1. Continue to be a Sponsor for select County site recreation camps not served by the Collier County
School Board.
2. Provide for the transportation of unitized meals vended by the School District to select County
sites.
3. Purchase unitized meals associated with the program from the School District.
4. Monitor County sites recreation food service according to the Department of Agriculture
guidelines.
An Agreement to Purchase Vended Meals between the School Board and the Board of County
Commissioners (Board) is required to implement this plan.
The SFSP Grant Agreement between the Board and the Department of Agriculture for the Collier County
Parks and Recreation Division (previously approved by the Board in 2017) is a rotating Agreement that
remains active until one of the parties decides to withdraw from the program. A copy of that Agreement
is attached to this Agenda Item.
FISCAL IMPACT: It is anticipated that the program will cost $170,064.60 with a reimbursement from
the Florida Department of Agriculture in the amount of $138,114.60 to cover the cost of the vended meals
associated with the program. Budget Amendments are required in the amounts of $138,114.60 within
Public Services Grant Fund (709), Project 33612 and $31,950 within Public Services Grant Match Fund
(710) Project 33612. Local funding needs will be absorbed within MSTU General Fund (111) operating
expenses associated with summer recreation camps for $31,950.
Packet Pg. 983
03/26/2019
GROWTH MANAGEMENT IMPACT: There is no Growth Management impact.
LEGAL CONSIDERATIONS: This item is approved as to form and legality and requires a majority
vote for approval. -CMG
RECOMMENDATION: To approve and authorize the Chair to sign the Agreement to Purchase Vended
Meals from Another Approved School Food Service Facility with the District School Board of Collier
County so that the Parks and Recreation Division can participate in the 2019 Summer Food Service
Program and approve the associated Budget Amendments.
Prepared By: Matthew Catoe, Operations Analyst, Parks and Recreation Division
ATTACHMENT(S)
1.2019 SFSP Reimbursement Rates Notice (PDF)
2. (linked) 1155 CNP Agreement (PDF)
3. Sponsor to Sponsor Agreement - Parks and Rec 2019 (PDF)
16.D.4
Packet Pg. 984
16.13.4
03/26/2019
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.13.4
Doe ID: 8223
Item Summary: Recommendation to approve an Agreement to Purchase Vended Meals from
Another Approved School Food Service Facility with the District School Board of Collier County
(School Board) to sponsor and operate the 2019 Summer Food Service Program (SFSP) at designated
recreation camps with unitized meals provided by the School Board and authorize all necessary Budget
Amendments. (Total anticipated Fiscal impact $170,064.60 with a Federal Share of $138,114.60 and a
local contribution of $31,950).
Meeting Date: 03/26/2019
Prepared by:
Title: Operations Analyst — Parks & Recreation
Name: Matthew Catoe
03/01/2019 8:41 AM
Submitted by:
Title: Division Director - Parks & Recreation — Parks & Recreation
Name: Barry Williams
03/01/2019 8:41 AM
Approved By:
Review:
Parks & Recreation
Ilonka Washburn
Additional Reviewer
Parks & Recreation
Barry Williams
Additional Reviewer
Public Services Department
Kimberley Grant
Level 1 Reviewer
Public Services Department
Todd Henry
Level 1 Division Reviewer
Public Services Department
Steve Carnell
Level 2 Division Administrator Review
County Attorney's Office
Colleen Greene
Level 2 Attorney Review
Grants
Erica Robinson
Level 2 Grants Review
Office of Management and Budget
Valerie Fleming
Level 3 OMB Gatekeeper Review
County Attorney's Office
Jeffrey A. Klatzkow Level 3 County Attorney's Office Review
Budget and Management Office
Ed Finn
Additional Reviewer
Grants
Therese Stanley
Additional Reviewer
County Manager's Office
Heather Yilmaz
Level 4 County Manager Review
Board of County Commissioners
MaryJo Brock
Meeting Pending
Completed
03/04/2019 8:14 AM
Completed
03/08/2019 2:07 PM
Completed
03/11/2019 12:07 PM
Completed
03/11/20194:02 PM
Completed
03/12/2019 11:22 AM
Completed
03/12/2019 12:30 PM
Completed
03/12/2019 12:33 PM
Completed
03/13/2019 11:15 AM
Completed
03/13/2019 4:19 PM
Completed
03/18/2019 5:06 PM
Completed
03/19/2019 10:27 AM
Completed
03/19/2019 1:08 PM
03/26/2019 9:00 AM
Packet Pg. 985
Billing Code: 3410-30-P
DEPARTMENT OF AGRICULTURE
Food and Nutrition Service
Summer Food Service Program
2019 Reimbursement Rates
AGENCY: Food and Nutrition Service, USDA.
ACTION: Notice.
SUMMARY: This notice informs the public of the annual adjustments to the
reimbursement rates for meals served in the Summer Food Service Program for Children.
These adjustments address changes in the Consumer Price Index, as required under the
Richard B. Russell National School Lunch Act. The 2019 reimbursement rates are
presented as a combined set of rates to highlight simplified cost accounting procedures.
The 2019 rates are also presented individually, as separate operating and administrative
rates of reimbursement, to show the effect of the Consumer Price Index adjustment on
each rate.
EFFECTIVE DATE: January 1, 2019.
FOR FURTHER INFORMATION CONTACT: Jessica Saracino, Program
Monitoring and Operational Support Division, Child Nutrition Programs, Food and
Nutrition Service, United States Department of Agriculture, 3101 Park Center Drive,
Suite 628, Alexandria, Virginia 22302.
16.D.4.c
Packet Pg. 986
SUPPLEMENTARY INFORMATION:
The Summer Food Service Program (SFSP) is listed in the Catalog of Federal Domestic
Assistance under No. 10.559 and is subject to the provisions of Executive Order 12372,
which requires intergovernmental consultation with State and local officials. (See 2 CFR,
415 and final rule -related notice published at 48 FR 29114, June 24, 1983.)
In accordance with the Paperwork Reduction Act of 1995, 44 U.S.C. 3501-3520, no new
recordkeeping or reporting requirements have been included that are subject to approval
from the Office of Management and Budget.
This notice is not a rule as defined by the Regulatory Flexibility Act, 5 U.S.C. 601-612,
and thus is exempt from the provisions of that Act. Additionally, this notice has been
determined to be exempt from formal review by the Office of Management and Budget
under Executive Order 12866.
Definitions
The terms used in this notice have the meaning ascribed to them under 7 CFR Part 225 of
the SFSP regulations.
Background
This notice informs the public of the annual adjustments to the reimbursement rates for
meals served in SFSP. In accordance with sections 12(f) and 13, 42 U.S.C. 1760(f) and
1761, of the Richard B. Russell National School Lunch Act (NSLA) and SFSP
16.D.4.c
Packet Pg. 987
regulations under 7 CFR Part 225, the United States Department of Agriculture
announces the adjustments in SFSP payments for meals served to participating children
during calendar year 2019.
The 2019 reimbursement rates are presented as a combined set of rates to highlight
simplified cost accounting procedures. Reimbursement is based solely on a "meals times
rate" calculation, without comparison to actual or budgeted costs.
Sponsors receive reimbursement that is determined by the number of reimbursable meals
served, multiplied by the combined rates for food service operations and administration.
However, the combined rate is based on separate operating and administrative rates of
reimbursement, each of which is adjusted differently for inflation.
Calculation of Rates
The combined rates are constructed from individually authorized operating and
administrative reimbursements. Simplified procedures provide flexibility, enabling
sponsors to manage their reimbursements to pay for any allowable cost, regardless of the
cost category. Sponsors remain responsible, however, for ensuring proper administration
of the Program, while providing the best possible nutrition benefit to children.
The operating and administrative rates are calculated separately. However, the
calculations of adjustments for both cost categories are based on the same set of changes
in the Food Away From Home series of the Consumer Price Index for All Urban
16.D.4.c
Packet Pg. 988
Consumers, published by the Bureau of Labor Statistics of the United States Department
of Labor. They represent a 2.6 percent increase in this series for the 12 -month period,
from November 2017 through November 2018 (from 271.152 in November 2017 to
278.306 in November 2018).
Table of 2019 Reimbursement Rates
Presentation of the 2019 maximum per meal rates for meals served to children in SFSP
combines the results from the calculations of operational and administrative payments,
which are further explained in this notice. The total amount of payments to State
agencies for disbursement to SFSP sponsors will be based upon these adjusted combined
rates and the number of meals of each type served. These adjusted rates will be in effect
from January 1, 2019 through December 31, 2019.
These changes are reflected below.
All States except Alaska and Hawaii — Rural or Self -prep Sites — Breakfast — 2 dollars
and 29.75 cents (6.5 cent increase from the 2018 reimbursement rate), Lunch or Supper —
4 dollars and 3.25 cents (11 cent increase), Snack — 95.25 cents (2.25 cent increase); All
Other Types of Sites — Breakfast — 2 dollars and 25.5 cents (6.5 cent increase), Lunch or
Supper — 3 dollars and 96.75 cents (11 cent increase),
Snack — 93.25 cents (2.25 cent increase).
Alaska — Rural or Self -prep Sites — Breakfast — 3 dollars and 72.5 cents (9.75 cent
increase), Lunch or Supper — 6 dollars and 52.75 cents (16.5 cent increase), Snack — 1
dollar and 54.75 cents (4.5 cent increase); All Other Types of Sites — Breakfast — 3
16.D.4.c
Packet Pg. 989
dollars and 65.5 cents (9.5 cent increase), Lunch or Supper — 6 dollars and 42.25 cents
(16.25 cent increase), Snack — 1 dollar and 51.25 cents (4.25 cent increase).
Hawaii — Rural or Self -prep Sites — Breakfast — 2 dollars and 68.25 cents (6.5 cent
increase), Lunch or Supper — 4 dollars and 71.5 cents (12 cent increase), Snack — 1 dollar
and 11.25 cents (2.5 cent increase); All Other Types of Sites — Breakfast — 2 dollars and
63.25 cents (6.5 cent increase), Lunch or Supper — 4 dollars and 64 cents (12 cent
increase), Snack — 1 dollar and 8.5 cents (2.25 cent increase).
2019 Reimbursement Rates (Combined)
Operating Rates
The portion of the SFSP rates for operating costs is based on payment amounts set in
section 13(b)(1) of the NSLA, 42 U.S.C. 1761(b)(1). They are rounded down to the
nearest whole cent, as required by section 11(a)(3)(B)(iii) of the NSLA, 42 U.S.C.
1759a(a)(3)(B)(iii).
These changes are reflected below.
16.D.4.c
Packet Pg. 990
All
All
Per Meal Rates
States
States
in whole or
except
except
Alaska
Alaska
Hawaii
Hawaii
fractions of U.S.
Alaska
Alaska
dollars
and
and
Hawaii
Hawaii
Rural
All
Rural
All
Rural
All
or Self-
Other
or Self-
Other
or Self-
Other
Site Types
prep
Types
prep
Types
prep
Types
Sites
of Sites
Sites
of Sites
Sites
of Sites
Breakfast
2.2975
2.255
3.725
3.655
2.6825
2.6325
Lunch or
4.0325
3.9675
6.5275
6.4225
4.715
4.64
Supper
Snack
0.9525
0.9325
1.5475
1.5125
1.1125
1.085
Operating Rates
The portion of the SFSP rates for operating costs is based on payment amounts set in
section 13(b)(1) of the NSLA, 42 U.S.C. 1761(b)(1). They are rounded down to the
nearest whole cent, as required by section 11(a)(3)(B)(iii) of the NSLA, 42 U.S.C.
1759a(a)(3)(B)(iii).
These changes are reflected below.
16.D.4.c
Packet Pg. 990
All States except Alaska and Hawaii — Breakfast — 2 dollars and 9 cents (6 cents increase
from the 2018 reimbursement rate), Lunch or Supper — 3 dollars and 65 cents (10 cents
increase), Snack — 85 cents (2 cents increase).
Alaska — Breakfast — 3 dollars and 39 cents (9 cents increase), Lunch or Supper — 5
dollars and 91 cents (15 cents increase), Snack — 1 dollar and 38 cents (4 cents increase).
Hawaii — Breakfast — 2 dollars and 44 cents (6 cents increase), Lunch or Supper — 4
dollars and 27 cents (11 cents increase), Snack — 99 cents (2 cents increase).
Operating Component of 2019 Reimbursement Rates
Operating Rates in U.S.
All States except Alaska
dollars, rounded down to the
Alaska
Hawaii
and Hawaii
nearest whole cent
Breakfast
2.09
3.39
2.44
Lunch or Supper
3.65
5.91
4.27
Snack
0.85
1.38
0.99
Administrative Rates
The administrative cost component of the reimbursement is authorized under section
13(b)(3) of the NSLA, 42 U.S.C. 1761(b)(3). Rates are higher for sponsors of sites
located in rural areas and for "self -prep" sponsors that prepare their own meals at the
SFSP site or at a central facility instead of purchasing them from vendors. The
administrative portion of SFSP rates are adjusted, either up or down, to the nearest
quarter -cent.
These changes are reflected below.
All States except Alaska and Hawaii — Rural or Self -prep Sites — Breakfast — 20.75 cents
(0.5 cent increase from the 2018 reimbursement rate), Lunch or Supper — 38.25 cents (1
16.D.4.c
Packet Pg. 991
cent increase), Snack — 10.25 cents (0.25 cent increase); All Other Types of Sites —
Breakfast — 16.50 cents (0.5 cent increase), Lunch or Supper — 31.75 cents (1 cent
increase), Snack 8.25 cents (0.25 cent increase).
Alaska — Rural or Self -prep Sites — Breakfast — 33.50 cents (0.75 cent increase), Lunch or
Supper — 61.75 cents (1.5 cent increase), Snack — 16.75 cents (0.5 cent increase); All
Other Types of Sites — Breakfast — 26.50 cents (0.5 cent increase), Lunch or Supper —
51.25 cents (1.25 cent increase), Snack — 13.25 cents (0.25 cent increase).
Hawaii — Rural or Self -prep Sites — Breakfast — 24.25 cents (0.5 cent increase), Lunch or
Supper — 44.50 cents (1 cent increase), Snack — 12.25 cents (0.5 cent increase); All Other
Types of Sites — Breakfast — 19.25 cents (0.5 cent increase), Lunch or Supper — 37 cents
(1 cent increase), Snack — 9.5 cents (0.25 cent increase).
16.D.4.c
Packet Pg. 992
Administrative Component of 2019 Reimbursement Rates
Authority: Sections 9, 13, and 14, Richard B. Russell National School Lunch Act, 42
U.S.C. 1758, 1761, and 1762a, respectively.
Brandon Lipps
Administrator,
Food and Nutrition Service
Date
16.D.4.c
Packet Pg. 993
All
All
States
States
Administrative Rates in U.S.
dollars, adjusted, up or down, to
except
except
Alaska
Alaska
Hawaii
Hawaii
Alaska
Alaska
the nearest quarter -cent
and
and
Hawaii
Hawaii
All
Rural
All
Rural
All
Rural
Other
or Self-
Other
or Self-
Other
or Self-
Site Types
yp
Types
prep
Types
prep
Types
prep
o
Sites
of Sites
Sites
of Sites
Sites
Sites
Breakfast
0.2075
0.165
0.335
0.265
0.2425
0.1925
Lunch or Supper
0.3825
0.3175
0.6175
0.5125
0.445
0.37
Snack
0.1025
0.0825
0.1675
0.1325
0.1225
0.095
Authority: Sections 9, 13, and 14, Richard B. Russell National School Lunch Act, 42
U.S.C. 1758, 1761, and 1762a, respectively.
Brandon Lipps
Administrator,
Food and Nutrition Service
Date
16.D.4.c
Packet Pg. 993
AGREEMENT TO PURCHASE VENDED MEALS FROM
ANOTHER APPROVED SCHOOL FOOD SERVICE FACILITY
This agreement is made and entered into by and between Collier County Public Schools (herein referred to as the "VENDOR")
and Collier County Parks and Recreation (herein referred to as the "SPONSOR");
WHEREAS the VENDOR agrees to supply unitized meals inclusive / esive of milk to SPONSOR with and for the rates herein listed
MEAL TYPE
EST. # SERVINGS EST. # SERVING DAYS
(DAILY) (PROGRAM TOTAL)
UNIT PRICE CONTRACTTOTAL
(FIXED) (ESTIMATE)
BREAKFAST
550 f 39
$2.01 $43,114.50
LUNCH
580 39
$3.53 $79,848.60
SNACK
$
SUPPER
I
I $ (+)
(Meals per day) x (Program days) x (Meal price) $122,963,10
It is further agreed that VENDOR will provide meals that meet or exceed the minimum meal pattern requirements as to nutritive
value and content, maintain full and accurate records to the extent needed by SPONSOR to meet Program requirements, and
otherwise perform in accordance with the following provisions:
1. VENDOR shall comply with all applicable rules and regulations of the Florida Department of Agriculture and Consumer
Services (FDACS) and the United States Department of Agriculture (USDA), including Title 7 CFR Parts 210, 215, 220, 225,
345, 250, 3016, 3019 and FDACS Division of Food, Nutrition, and Wellness policies.
> —2. moth Parties will retain meal records, delivery tickets, purchase orders, production records, or any other records that are
:material to the accounting and verification of payments and claims under this Agreement.
E �WENDOR must submit to the SPONSOR all costs incurred pertaining to the SPONSOR's food service operation within 30 days
n ^of the last day of each month or the final day of the program.
4. o oth Parties agree to retain all records required under the preceding paragraph for a period of three years after the end of
< the fiscal year to which they pertain; and upon request, to make all accounts and records pertaining to the program
a available to representatives of the U.S. Department of Agriculture, Florida Department of Agriculture and Consumer
C -Services, and the and the General Accounting Office for audit or administrative review at a reasonable time and place.
3 5.2 Service shall be discontinued immediately if an invoice has not been paid by the SPONSOR organization within forty-five
calendar days of the invoice.
6.`< Service shall be discontime?d im diately if the VENDOR delivers meals unfit for human consumption.
7. PARTIES SHALL ACT IN COMPLIANCE WITH SECTION 768.28, FLA. STAT.
The effective dates for this Agreement are ^June 3,2019 through _July 26,2019 . Either Party may terminate this
Agreement by giving the other Party notice in writing not less than 60 days prior to the date designated in the notice for termination
of the Agreement.
IN WITNESS WHEREOF, The Vendor and the Library have caused this Agreement to be executed this day of
in the year
SPONSOR
William L. McDaniel Jr
(NAME) PLEASE PRINT
Chairperson
TITLE
ATTEST
SIGNATURE � ' �VFEt,
W
VENDOR
(NAME) PLEASE PRINT
TITLE
SIGNATURE DATE
Packet Pg. 994
16. D.4.e
SCHEDULE A
SITE INFORMATION LIST
SPONSOR NAME Collier County Parks &
I
Recreation De artment
ADDRESS: 15000 LivingSton Rd, Naples FL, 34109
K le Bre enter 239-252-7377
SITE NAME
BEGIN DATE
END DATE
TOTAL
MEAL TYPE
AVERAGE
TOTAL
DELIVERY TIME
ADDRESS
DAYS
MEALS/DAY
MEALS
FOR EACH MEAL
PHONE
(1)
(2)
OP.
TYPE
(3)
(4)
(5)
(6)
7
Eagles Lakes
6/3/2019
7/26/2019
39
BREAKFAST
45
1,755
8:00am
11565 E.
AM SUPPLEMENT
Tamiami
Trail Naples
FL
239-252-
3527
REFRIG ALL
LUNCH
40
1,560
11:00am
MEALS
YES
NO
PM SUPPLEMENT
❑
x
SUPPER
East Naples
6/3/2019
7/26/2019
39
BREAKFAST
40
1,560
8:00am
3500
AM SUPPLEMENT
Thomasson
Naples FL
239-793-
4414
REFRIG
LUNCH
60
2,340
11:00am
MEALSLL
YES
NO
PM SUPPLEMENT
❑
X
SUPPER
East Naples
6/3/2019
6/28/2019
20
BREAKFAST
55
1,100
8:00am
Baptist
AM SUPPLEMENT
Church
1967
Shadowlawn
Naples F1
239-287-
8524
REFRIG ALL
LUNCH
55
1,100
11:00am
MEALS
YES
NO
PM SUPPLEMENT
❑
x
SUPPER
Golden Gate
6/3/2019
7/26/2019
39
BREAKFAST
120
4,680
8:00am
Comm.
AM SUPPLEMENT
Center 4701
Golden Gate
Naples FL
239-252-
d
Cn
U-
N
E
L
a�
O
d
CD
m
Cn
O
O
U-
a�
E
E
W
0
N
a
Packet Pg. 995
16.D.4.e
418039
REFRIG39 ALL
LUNCH
120
4,680
11:00am
MEAL39S
YES
NO
PM SUPPLEMENT
❑
X
SUPPER
Immokalee
6/3/2019
7/26/2019
39
BREAKFAST
120
4,680
8:00am
Comm. Park
AM SUPPLEMENT
321 N. 1St St
Immokalee
FL 239-657-
4449
REFRIG ALL
LUNCH
120
4,680
11:00am
MEALS
YES
NO
PM SUPPLEMENT
❑
X
SUPPER
Immokalee
6/3/2019
7/26/2019
39
BREAKFAST
70
2,730
8:00am
South Park
AM SUPPLEMENT
418 School
Dr.
Immokalee
FL
239-252-
4977
REFRIG ALL
LUNCH
70
2,730
11:00am
MEALS
YES
NO
PM SUPPLEMENT
❑
X
SUPPER
River Park
6/3/2019
7/26/2019
39
BREAKFAST
45
1,755
8:00am
Rec.
AM SUPPLEMENT
301 11th St.
N. Naples
FL 239-213-
3037
REFRIG ALL
LUNCH
60
2,340
11:00am
MEALS
YES
NO
PM SUPPLEMENT
❑
X
SUPPER
Avalon
6/3/2019
7/26/2019
39
BREAKFAST
55
2,145
8:00am
Elementary
AM SUPPLEMENT
3300
Thomasson
Dr. Naples
FL 34112
239-377-
6200
REFRIG ALL
LUNCH
55
2,145
11:00am
MEALS
YES
NO
PM SUPPLEMENT
❑
X
SUPPER
a
a_
U)
E
�a
L
O
L
a
m
N
N
O
O
U-
E
E
3
U)
rn
0
N
M
N
N
a�
0
N
V
a�
c
ca
a
a
Packet Pg. 996
Amended and Restated Agreement
Florida Department of Agriculture and Consumer Services
Division of Food, Nutrition and Wellness
CHILD NUTRITION PROGRAMS
ADAM N. PUTNAM AGREEMENT
COMMISSIONER
DA-CS-CO-NTRACN
.O18Fa68
— &'
�` r j� SPONSOR NUMBER:
i� )A� ai�*
ADDRESS: T l CITY. ZIP.
15 a �IJngl�on KJ ik). k&lk Twirl:
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) 1 7 CFR 210, 245 10.555
- ---
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-01716R".12J16 JUNi 4 2017
Peg& 1 of 13
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 GFR §210.8;
1 i.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. 12116
Page 2 of 13
9
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, FOP1R 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 fora 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. 1216
Page 3 or 13
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 GFR 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;
FDACS-01716 Rev. 12116
Page 4 of 13
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 §245.6(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
Page 5 of 13
c to
directly from the appropriate State or local agency, or other appropriate
individual, as specified by the USDA, that:
L A child in the Family, as defined in 7 CFR §245.2, is receiving
benefits from SNAP, FDPlR 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 chili 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 at 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
FDACS-01716 Rev. 12116
Page 6 of 13
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 specked 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 specked 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;
FDACS-01716 Rev. 12/16
Page 7 of 13
9
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 theirfault
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 80.3 and 42; and the Food
and Nutrition Service (FNS) 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
POACS-01716 Ret. 12116
Page 8 of 13
CAO
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.
FDACS-01718 Rev. 17116
Page 0 of 13
9
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 D; 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 orviolation 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).
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. 12116
Page 10 of 13
CAO
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 (I).
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):
'SI
PF i�TtfVJ , " Sets 1 I+1 FtflMa ;011.
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.
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, orvoluntadly 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 govemmental 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.
FOACS-01716 Rev. 12/76
Page 11 of 13
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-01716 Rev. 12/16
Page 12 of 13 CEtO
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,
underst nds it, and agrees to be bound by its terms and conditions.
ATTESr
Signature of Autb6rized Pftial DWIGHT F-8Rru--L- rk
�r--
Printed Name o Autho ized Official
Title:
Date
Sign and return two (2) original copies of this Agreement to:
4
By: o L
Attest as' , hai n's
signature only:,,
r
Florida Department of Agriculture and Consumer Services
Division of Food, Nutrition and Wellness
600 S. Calhoun Street (1-12)
Tallahassee, Florida 32399
OFFICIAL USE ONLY
Florida Department of Agriculture and Consumer Services
APPROVED BY:
e
Directorthin istration
1-7
Date
FDAC"1716 Rev. 1?fl6
Page 13 of 13
C9O