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Home My WebLink About2000-072 t 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 RESOLUTION NO. 2000-72 RESOLUTION OF THE CITY OF SAN BERNARDINO AUTHORIZING THE MAYOR OF THE CITY OF SAN BERNARDINO OR HER DESIGNEE TO APPLY FOR AND ADMINISTER A GRANT IN THE AMOUNT OF $230,000 FROM USDA FOR THE ADMINISTRATION OF THE SUMMER FOOD SERVICE PROGRAM FOR YOUTH. BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN BERNARDINO AS FOLLOWS: SECTION 1. The Mayor of the City of San Bernardino or her designee is hereby authorized to apply for and administer a grant in the amount of $230,000 from USDA for the administration of the Summer Food Service Program for youth. III III III /II III III III III III /II III III III III III III III III III III III III 2000-72 RESOLUTION OF THE CITY OF SAN BERNARDINO AUTHORIZING THE MAYOR OF THE CITY OF SAN BERNARDINO OR HER DESIGNEE TO APPLY FOR AND ADMINISTER A GRANT IN THE AMOUNT OF $230,000 FROM USDA FOR THE ADMINISTRATION OF THE SUMMER FOOD SERVICE PROGRAM FOR YOUTH. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 By: I HEREBY CERTIFY that the foregoing Resolution was duly adopted by the Mayor and Common Council of the City of San Bernardino at a ;:~~~~T meeting thereof, held on the 3rd day of April , 2000, by the following vote, to wit: Council Members: AYES NAYS ABSTAIN ABSENT ESTRADA x LIEN x McGINNIS x SCHNETZ x SUAREZ x ANDERSON x McCAMMACK x 'x/f1A/IrlJJ D /}yy(iJ~ lw.flJ Jt, City Clerk ~ The foregoing resolution is hereby approved this 5:J day of April ,2000. Approved as to Form and legal content: /{~ L./"t- ...- dit Valles, Mayor City f San Bernardino 27 28 TELEPHONE (916) 327-6465 MESSAGE U -------...--.....- Agreement Number . RETURN TO: Califomia Department of Education Nutrition Services Division 560 J Street, Su~e 270 Sacramento, CA 95814-2342 . Attention: Summer Food Service Program Unit NAME OF CONTACT PERSON: FOUR): TELEPHONE NUMBER: ( ) FAX NUMBER: ( ) 5. Dates of operation: From: To: 6. Would you like to receive an: Operational costs advance? DYes o No Administrative costs advance? DYes o No 7. Does the agency receive at least $300,000 in federal funds? If yes, indicate your agency's fiscal year. (Private nonprofit and Indian Tribes only) DYes 0 No 0 N/A Fiscal Year - I - 8. Do you wish to receive commodity foods? 0 Yes 0 No name and address appear above renew thei, Agreement to Participele eve/oped pursuant to and imposed by those regulations as outlined in fates all amendments, Schedule A, and the Meal Pattem (Schedule B). rements and responsibilities as agreed to in the original Agreement and Iy with TdJe VI of the Civil Rights Act of 1964, TtIJe IX of the Education the Age Discrimination Act of 1975, and USDA's regulations conceming Ie Office of Management and Budget Circulars A21, A87, A 102, A 110, 3015) and Debarment and Lobbying requirements (7 CFR Perts 3017 responsibilities as agreed to in the original Agreement and as outlined correct to the best of my knowledge. TITLE: I DATE: T OF EDUCATION USE ONLY COMMODITY EUGIBLE Oves ONo TION SERVICES DIVISION ice Hunt, Manager Service Program Unit on Services Division DATE NE (800) 333-5675 FAX (800) 333-5775 CALIFORNIA DEPARTMENT OF EOUCA TlON NUTRITION se,RVlCES DIVISION 2000-72 SUMMER FOOD SERVICE PROGRAM 2000 RENEWAL APPLICATION/AGREEMENT NSD 8041 (2100) PLEASE PRINT OR lYPE ALL INFORMA nON 1. NAME OF SPONSOR: ADDRESS OF SPONSOR (INCLUDE STREET. CITY, COUNTY, AND ZIP PLUS NAME OF AUTHORIZED REPRESENTATIVE: 2. Method of meal service (check one or more): o Sel1-preparation o Vended 3. If vended, provide name(s) of vendor and attach a copy of the Food Service Agreement or Invitation for Bid Packet. If sel1.preparation, provide name(s) and address of central kitchen (attach list if necessary): 4. Number and type of ~es: Rural # Urban # The Califomia Department of Education (CDE) and the Agency whose and to comply with 7 CFR Part 225. This includes all requirements d the Original Agreement between COE and the Agency, which incorpo The Agency assures CDE it will continue to adhere to all of the requi will follow all Nutrition Services Division policies and guidance. Comp Amendments of 1973, Section 504 of the Rehabilitation Act of 1973, nondiscrimination (7 CRF Parts 158 and 15b). Comply with app/icab A 122 and A 133. Comply with Uniform Federal Assistance (7 CFR Part and 3(18). COE will continue to adhere to all of the requirements and in 7 CFR Part 225. I hereby certify all information contained in this document is true and SIGNATURE OF AUTHORIZED REPRESENTATIVE: CALIFORNIA DEPARTMEN APPROVAL BY NUTRI Jan Summer Food Nulriti APPROveO CALIFORNIA DEPARTMENT OF EOUCA TrON NUTRITION SERVICES DIVISION RENEWAl. ~SO 8040-8 2000-72 SUMMER FOOO SERVICE PROGRAM UNIT . . AGENCY NAME MANAGEMENT PLAN 1. Staffing Pattern: List below all administrative staff who will be involved with management. food services, training, and monitoring of the SFSP. . PRINT EMPLOYEE NAME AND POSITION SPECIFIC DUTIES SFSP TRAINING DATES By signing this Renewal Application/Agreement you are agreeing to do the following: 2. 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 California Department of Education (CDE) to review. 3. Visit all sites at least once during the first week of operation. 4. Review all sites at least once during the first 4 weeks of program operation. If a site operates less than 4 weeks, conduct at least one review. 5. You will conduct additional monitoring visits to sites as necessary to assure compliance with program requirements. Documentation must be kept on file for CDE to review. 6 You agree to accept final administrative and financial responsibilities for operations of the SFSP at each site. 7. You agree to retain SFSP records for three (3) years after the end of the fiscal year to which they pertain. 8. If you operate an enrolled site, day camp or residential camp, you agree to collect and maintain the income eligibility documentation of participants. If you will not be using the forms provided by the SFSP (Attachment B-1). please submit a copy of your proposed form for approval. /"\~ I:> CALIFORNIA DEPARTMENT OF EDUCATION NUTRITiON SERVrCES DIVISION SUMMER FOOD SERVICE PROGRAM UNIT RENEWAL NSO 8041-C (2100) 2000-72 Agency Name: Agreement Number: SUMMER FOOD SERVICE PROGRAM 2000 BUDGET INFORMATION Federal regulations require sponsors to submit a budget for State agency review and approval. In the event that costs exceed anticipated revenue. sponsors should have other funding sources to pay the difference. Sponsors may subm~ a revised budget for administrative costs as needed. PROGRAM COSTS The sponsor is reimbursed for actual cost or meals times the applicable operating rates, whichever is lesser of the two. GENERAL OPERATING COSTS Food $ Food labor $ Facilities/utilities $ Food transportation to sites $ Nonfood supplies $ Other (specify) $ TOTAL $ The sponsor is reimbursed for actual cost, meals times the applicable administrative rate or the approved budget, whichever is the lesser of the three. ADMINISTRATIVE COSTS Salarieslwages $ Office supplies $ Facilities/utilities $ Transportation $ "Indirect costs rate: $ Other (specify) $ TOTAL $ "Attach indirect cost documentation for costs that are associated with the above administrative budget. CONTRACTS Is there a rental agreement. lease, or contract for any of the costs listed above? DYes D No If yes, list and attach a copy: INCOME Will meals be sold to adults who are not SFSP staff? If yes, list price to be charged for each meal: Breakfast Snack List any anticipated income to the program, by type: Donations/Grant Income: Operational Administration DYes D No Lunch Dinner Unspecified RATES Formula for meal rate projections: y participation (ADP) X meal rate (MR) = total Number of operating days (Om x averaae dail OPERATING RATES 00 X ADP X MR = TOTAL Breakfast X X = $ Snack X X = $ Lunch X X = $ Dinner X X = $ TOTAL $ ADMINISTRATIVE RATES 00 X ADP X MR = TOTAL Breakfast X X = $ Snack X X = $ lunch X X = $ Dinner X X = $ TOTAL $ 2000-72 cid.IFO~NIA OEP-A.RTMENT OF EOUCA nON NUTRITION SERVICES OtvlS10N SUMMER FOOO SERVICE PROGRAM UNIT (NSO 805O-c) (2100) MEDIA RELEASE CERTIFICATION Use the following format for your media/public reJease or send this form to announce your site location( s): Check the box(es) that apply and insert the name, address and meal service time(s) of each of your site(s) in the appropriate section. Attach an additional sheet of paper if necessary. OPEN SITES: o Agency name: announces the sponsorship of the SFSP. Free meals will be made available to all attending children under 19 years of age. The United States Department of Agriculture (USDA) and the California Department of Education's Nutrition Services Division (NSD) prohibit discrimination in all their programs and activities on the basis of race, color, national origin, gender, religion, age, or disability. To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326- W, Whitten Building, 14th and Independence Avenue, SW, Washington, DC 20250-9410 or call (202) 720-5964 (voice and TOO). The USDA and the NSD are equal opportunity providers and employers. Enter site name, address, meal service times and dates below, or attach a list. OPEN ENROLLED SITES: (security. s;tfety. capacity or control) be made available to attending children under 19 years of age at no cost on a first come, first serve basis. The United States Department of Agriculture (USDA) and the California Department of Education's Nutrition Services Division (NSD) prohibit discrimination in all their programs and activities on the basis of race, color, national origin, gender, religion, age, or disability. announces the sponsorship , a limited number of meals will o Agency name: of the SFSP. Due to To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326- W, Whitten Building, 14th and Independence Avenue, SW, Washington, DC 20250-9410 or call (202) 720-5964 (voice and TOO). The USDA and the NSD are equal opportunity providers and employers. Enter site name, address, meal service times and dates below, or attach a list. CAliFORNIA DEP,\RTt.tENT OF EDuCATION NUTRlTlON SERVlCES OtVlSION 2000-72 SUMMER FOOO SERVICE PROGRAM UNIT (2100) ENROLLED SITES, CAMPS AND AGENCIES WITH SITES OTHER THAN OPEN SITES: o Agency name: announces the sponsorship of the SFSP. Free meals will be made available to all eligible enrolled children. The United States Department of Agriculture (USDA) and the California Department of Education's Nutrition Services Division (NSD) prohibit discrimination in all their programs and activities on the basis of race, color, national origin, gender, religion, age, or disability. To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326- W, Whitten Building, 14111 and Independence Avenue, SW, Washington, DC 20250-9410 or call (202) 720-5964 (voice and TDD). The USDA and the NSD are equal opportunity providers and employers. Children who are members of households receiving food stamps or benefits from a food distribution program on an Indian reservation, or are recipients of California Work Opportunity and Responsibility to Kids Act (CaIWORKs) are automatically eligible to receive free meal benefits. Children from households with incomes at or below the income eligibility guidelines attached are also eligible for free meal benefits. Enter enrolled site name, address, meal service times and dates below, or attach a list. Income Eligibility Guidelines Effective Summer 2000 FAMILY SIZE YEAR MONTH WEEK 1 $15,244 $1,271 $294 2 20,461 1,706 394 3 25,678 2,140 494 4 30,895 2,575 595 5 36,112 3,010 695 6 41,329 3,445 795 7 46,546 3,879 896 8 51,763 4,314 996 For each + 5,217 +435 + 101 additional family member add: 70 2000-72 CALIFORNlll" DEPARTMENT OF EDUCATION NUTRITION SERVICES DIVISION SUMMER FOOD SERVICE PROGRAM UNIT SCHEDULE 0 (NSD 8050-D) (2100) 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, gender, religion, age, or disability. The free meal policy statement must be signed by all new sponsors and by any returning sponsors who have substantive changes in their original site document(s) (e.g. from open to enrolled). SIGNATURE OF AUTHORIZED REPRESENTATIVE: AGENCY NAME: DATE: