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RESOLUTION NO. 2004-146
RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF
SAN BERNARDINO RATIFYING THE SUBMITTAL OF AN APPLICATION BY THE
DIRECTOR OF PARKS, RECREATION AND COMMUNITY SERVICES
DEPARTMENT AND AUTHORIZING THE EXECUTION OF AN AGREEMENT
WITH THE CALIFORNIA DEPARTMENT OF EDUCATION TO FURNISH FOOD
SERVICE FOR THE SUMMER FOOD SERVICE PROGRAM FOR YOUTH
THROUGH THE SAN BERNARDINO UNIFIED SCHOOL DISTRICT.
711 BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE CITY
8110F SAN BERNARDINO AS FOLLOWS:
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loll SECTION 1. The Mayor and Common Council of the City of San Bernardino hereby
111 Iratify the submittal of an application by the Director of Parks, Recreation and Community
Department and with the California Department of Education on behalf of said City,
and authorize the execution of an Agreement with the San Bernardino City Unified School
relating to the delivery of Type A lunches and snacks to lunch sites, a copy of which is
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marked Exhibit "A" and incorporated herein by reference as fully as though set forth at
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1911 SECTION 2. The authorization granted hereunder shall expire and be void and of no
20IIfurther effect if the agreement is not executed by both parties and returned to the Office of the
City Clerk within 120 days following effective date of the Resolution.
HI
HI
MA
2004-146
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RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF
BERNARDINO RATIFYING THE SUBMITTAL OF AN APPLICATION BY THE
ECTOR OF PARKS, RECREATION AND COMMUNITY SERVICES
ARTMENT AND AUTHORIZING THE EXECUTION OF AN AGREEMENT
H THE CALIFORNIA DEPARTMENT OF EDUCATION TO FURNISH FOOD
VICE FOR THE SUMMER FOOD SERVICE PROGRAM FOR YOUTH
TOUGH THE SAN BERNARDINO UNIFIED SCHOOL DISTRICT.
I HEREBY CERTIFY that the foregoing Resolution was duly adopted by the Mayor
Common Council of the City of San Bernardino at a
joint regular
Meeting,
held on the 7th day of ,rune , 2004, by the following vote to
IL MEMBERS AYES
x
x
GINNIS x
Y x
x
x
NAYS ABSTAIN ABSENT
x
qr-� /a. et -a. le
Rachel G. Clark, City Clerk
The foregoing resolution is hereby approved this "'ATrY day of .Tune 12004,
Wendy Cammack, Mayor Pro Tcm
City San Bernardino
'oved as to form
Legal content:
;s F. Penman
Attorney
3y: , a
CALIFORNIA DEPARTMENT OF EDUCATION
NUTRITION SERVICES DIVISION
2004-146
EXHIBIT "A"
SUMMER FOOD SERVICE PROGRAM
2003-04 RENEWAL APPLICATION/AGREEMENT
U.S. Department Of Agriculture - CFDA Number 10.559
NSD 8041 (REV. 02/04)
SUMMER FOOD SERVICE PROGRAM
VENDOR#: H133-02
AGREEMENT #: 36-8360-0V
Return To: Nutrition Services Division
Department of Education
1430 N Street, Suite 1500
Sacramento, Ca 95814-5901
Attention: RIM
SECTION 1-AGENCY INFORMATION (Make correctionslupdates in red ink.)
SPONSOR NAME
CONTACT PERSON
San Bernardino, City Of
Lynn Knutson
ADDRESS (INCLUDE STREET, CITY, COUNTY, AND ZIP CODE+ 4
TELEPHONE NUMBER
FAX NUMBER
647 North Sierra Way, San Bernardino, CA 92410-4816
(909)384-MX 5006
(909)384-5160
NAME OFAUTHORIZED REPRESENTATIVE
E-MAIL ADDRESS
LEMUEL P. RANDOLPH
Knut n 1 i
SECTION 11- METHOD OF MEAL SERVICE
Yes Vend ed )d)iAX9fow-n4Gw2R m
If meal service is vended, provide name and address of vendor(s) and attach a copy of the signed agreement/contract (attach a list
if necessary):
VENDOR NAME
ADDRESS
CITY
STATE, ZIP CODE +4
VENDOR NAME
ADDRESS
CITY
STATE, ZIP CODE +4
If self -preparation, provide name and address of central kitchen (attach a list if necessary):
KITCHEN
ADDRESS
CITY
STATE, ZIP CODE+4
KITCHEN
ADDRESS
CITY
STATE, ZIP CODE +4
SECTION III -SITE INFORMATION (Inclusive of all sites.)
RURAL SITES
URBAN SITES
DATES OF OPERATION
From: June 28 2004 To September 3 2004
SECTION IV - CASH ADVANCES (Indicate if an advance is requested.)
Operational Advance Yes ❑ No ® Administrative Advance Yes ❑ No
SECTION V - DISCLOSURE OF FEDERAL FINANCIAL ASSISTANCE (Private Nonprofit and Indian Tribes only.)
Does the agency receive at least $500,000 in federal funds? Yes ® No ❑ N/A ❑
If yes, indicate the agency's fiscal year: 07/2003
SECTION VI - AGREEMENT AND CERTIFICATION
The California Department of Education (CDE) and the Agency whose name and address appear above renew their Agreement to
Participate and to comply with 7 CFR Part 225. This includes all requirements developed pursuant to and imposed by those
regulations as outlined in the original Agreement between CDE and the Agency, which incorporates all amendments, Schedule A,
and the Meal Pattern (Schedule B). The Agency assures CDE it will continue to adhere to all of the requirements and
responsibilities as agreed to in the original Agreement and will follow all Nutrition Services Division policies and guidance. The
Agency will comply with Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1973, Section 504 of the
Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and USDA's regulations concerning nondiscrimination (7 CFR Parts
15a and 15b). The Agency will comply with applicable Office of Management and Budget (OMB) Circulars A21, A87, A102, A110,
A122 and A133. The Agency will comply with Uniform Federal Assistance (7 CFR Part 3016) and Debarment and Lobbying
requirements (7 CFR Parts 3017 and 3018). CDE will hold the Agency responsible for all of the requirements and responsibilities
as agreed to in the original Agreement and as outlined in 7 CFR Part 225.
1 hereby certify all information contained in this ocument is true and correct to the best of my knowledge.
SIGNATURE OF AUTH REPRE T E
TITLE
DATE(_ �I
•�-! --
Director
/ I.
CDE USE ONLY
APPROVED BY: DATE EFFECTIVE DATES COMMODITY ELIGIBLE
FROM TO 09/30/04 Yes
2004-146
CALIFORNIA DEPARTMENT OF EDUCATION SUMMER FOOD SERVICE PROGRAM
NUTRITION SERVICES DIVISION
SUMMER FOOD SERVICE PROGRAM VENDOR #' H133-02
BUDGET INFORMATION AGREEMENT #:36-8360-OV
NSD 8040C (REV. 02/041
Federal regulations require that Summer Food Service Program (SFSP) sponsors submit a budget to the California
Department of Education for review and approval. In the event that costs exceed anticipated revenue, sponsors should
have other funding sources to offset the difference. Sponsors may submit a revised budget for administrative costs as
needed.
I SECTION I - PROGRAM COSTS I
Enter the estimated costs associated with the operating and administrative expenses. Attach indirect cost
documentation for indirect costs that are associated with the operating and/or administrative budgets.
The sponsor is reimbursed the lesser of: A ctual costs or
meals times the operating rates.
GENERAL OPERATING COSTS
Food
$132,741
Food service personnel salariestbenefits
$ 6,000
Facilities/utilities
$
Food transoortation to sites
$
Nonfood suoolies
$2 , 673
Other (soecifv):
$
Indirect Cost %:
$
TOTAL
$ 141,414
SECTION tl — CONTRACTS
The sponsor is reimbursed the lesser of:A ctual costs,
meals times the administrative rates, or the sponsors
budget.
ADMINISTRATIVE COSTS
Administrative Dersonnel salades/benefits
$81000
Office suoolies
$ S R I
Facilities/utilities
$
Transoortation
$
Otherfsnecifv): Printing/Postage
S2,100
Indirect Cost %: Telephone 16.67%
s 100
TOTAL
$12 581
Is there a rental agreement, lease, or contract associated for any of the costs listed above? Yes ❑ No
If yes, attach copies.
SECTION III — INCOME
Will meals be sold to adults? Yes ❑ No Ml
If yes, list price to be charged for each meal: Breakfast Snack
Lunch Dinner
Will your SFSP receive income from other sources other than the SFSP reimbursement? Yes ❑ No
If yes, list type and amount:
Donations/Grant Unspecified Income
Administration Other
Operational
Formula for rate projections:
Co nr nDCDATUdG nAvc /nn1 Y AVPRAr]F nAll V PARTICIPATION (ADP) X MEAL (MR) / ADMINISTRATIVE (AR) RATES = TOTAL.
OPERATING RATES
ADMINISTRATIVE RATES
OD x ADP x MR
= TOTAL
OD x ADP x AR
= TOTAL
Breakfast
x x
= $
Breakfast
x x
= $
Snack
49 x 850 x .56
= $ 23,324
Snack
49 x 850 x .0550
= $ 2,290.75
Lunch
49 x 1000 x 2.41
= $ 112 090
Lunch
49 x 1000 x .2100
= $
Dinner
x x
TOTAL
= $
$141 414
Dinner
11
x x
TOTAL
= $
$12,508.7
2004-146
CALIFORNIA DEPARTMENT OF EDUCATION
NUTRITION SERVICES DIVISION
SUMMER FOOD SERVICE PROGRAM
MEDIA RELEASE
SUMMER FOOD SERVICE PROGRAM
NSD 8050C (REV. 02104)
Use the following format for your media or public release. Sponsors may clip and send a copy of this
announcement to the local media.
Check the boxes that apply and insert the name, address, and meal service times of each site in the appropriate
sections. Attach additional pages as necessary.
ENTER SITE INFORMATION BELOW OR ATTACH A LIST
❑X OPEN SITES:
City of San Bernardino Parks, "creation
Agency Name: announces the sponsorship of the Summer Food
Service Program. Free meals will be made available to all children who are 18 years of age and younger at the following sites:
DATE
DATE
see attached flier
SITE NAME
SITE NAME
ADDRESS
ADDRESS
MEAL TIME
MEAL TIME
In accordance with Federal law and United States Department of Agriculture (USDA) policy, this institution is prohibited from
discriminating on the basis of race, color, national origin, sex, age, or disability.
To file a complaint of discrimination, write United States Department of Agriculture, Director, Office of Civil Rights, Room 326-W,
Whitten Building, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410 or call (202) 720-5964 (voice and TDD).
❑ RESTRICTED -OPEN SITES:
Agency
I ==
Name: announces the sponsorship of the Summer Food
Service Program. Due to: Safety ❑ Security ❑ or Control ❑ , a limited number of meals will be made available to
attending children who are 18 years of age and younger at no cost on a first come, first serve basis.
DATE
DATE
SITE NAME
SITE NAME
ADDRESS
ADDRESS
MEAL TIME
MEAL TIME
In accordance with Federal law and United States Department of Agriculture (USDA) policy, this institution is prohibited from
discriminating on the basis of race, color, national origin, sex, age, or disability.
To file a complaint of discrimination, write United States Department of Agriculture, Director, Office of Civil Rights, Room 326-W,
Whitten Building, 1400 Independence Avenue, SW, Washington, D.C. 20250.9410 or call (202) 720-5964 (voice and TDD).
2004-146
SUMMER FOOD SERVICE PROGRAM VENDOR 0: H133-02
MANAGEMENT PLAN
AGREEMENT M: 36-8360-0V
NSD 8041 B (REV 02104)
SECTION 1 STAFFING PLAN
List all positions and training dates. For this fiscal year, list the California Department of
Education (CDE) training date that the Director attended. Refer to the USDA Administrative
Guidance handbook for staffing and responsibilities.
STAFF
TRAINING DATE
STAFF
TRAINING DATE
RW Jon Supervisor
4/22/04
Bookkeeper Lynn Knutson
4/22/04
Assistant Director
Monitor (3)
6/14 - 6/17/0
Area Supervisor
Site Supervisor
6/16 - 6/17/
Summer Lunch Clerk
Other Juanita Webster
4/22/04
6/14 - 6/17/04
Site Personnel
Other
6/16 - 6/17/0
SECTION II — SPONSOR AGREES TO THE FOLLOWING
1. Conduct a preoperational visit at each new site, and sites that had problems during the
previous year to determine the adequacy and suitability for food service. All preoperational
visits must be documented and kept on file for the CDE to review.
2. Visit all sites at least once during the first week of operation.
3. Review all sites at least once within the first four weeks of program operation. If a site
operates less than four weeks, conduct at least one review during the operational period.
4. Conduct additional monitoring visits to sites as necessary to assure compliance with program
requirements. Documentation must be kept on file for the CDE to review.
5. Accept final administrative and financial responsibilities for the operation of the Summer Food
Service Program (SFSP) at each site.
6. Retain SFSP records for three (3) years after the end of the fiscal year to which they pertain.
7. If applicable, collect and maintain the income eligibility documentation of participants for
closed -enrolled and camp sites. If you will not be using the enclosed Income Eligibility for
Camps and Enrolled Sites form, submit a copy of your proposed form for approval.
8. If applicable, camps that charge separately for meals served to non -eligible children must
have a method for collecting payment and hearing procedures in place. There will also be no
overt identification of children receiving free meals. Review the CFR 225.6 (c)(4)(iii) and 225.6
(c)(5) to ensure that the procedures include the requirements and submit a copy.
Longstanding requirement not mentioned in the applications developed before the 2004 Federal fiscal year.
2004-146
CALIFORNIA DEPARTMENT OF EDUCATION SUMMER FOOD SERVICE PROGRAM
NUTRITION SERVICES DIVISION (REV. 02104)
SCHEDULE D
SUMMER FOOD SERVICE PROGRAM
FREE MEAL POLICY STATEMENT
The authorized representative certifies that all children at the sites described on the site
information sheets will be served the same meals at no separate charge regardless of race,
color, national origin, sex, age, or disability.
City of San Bernardino Parks, Recreation and Community Services Department