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CI.TY OF SAN BERNODINO - REQUEST F(')I COUNCIL ACTION
From: ANNIE F. RAMOS, DIRECTOR
Dept: PARKS, RECREATION & COMMUNITY SERVICES
Date: MAY 19, 1994
Subject: AUTHORIZATION FOR THE DIRECTOR OF PARKS,
RECREATION AND COMMUNITY SERVICES
DEPARTMENT TO APPLY FOR AND ACCEPT
COMMODITIES FROM THE CALIFORNIA DEPARTMENT
OF EDUCATION TO BE UTILIZED IN THE 1994
SUMMER FOOD SERVICE PROGRAM FOR CHILDREN
Synopsis of Previous Council action:
IMiN. OFf~~~Council approved the Director to apply for and accept California Department of
Education Commodities in 1993.
I.:AY 94 ~}:>
Recommended motion:
That the Parks, Recreation and Community Services Department's Director be
authorized to apply for and accept commodities from the California Department
of Education for use in the 1994 Summer Food Service Program for Children.
~7'~
Signature
Contact person:
.JOHN A KRAMFR
Phone:
5031
CITY-WIDE
Supporting data attached: STAFF REPORT AND APPLICATION
Ward:
FUNDING REQUIREMENTS:
Amount:
Source: (Acct, No,)
(Acct, Descriotion)
Finance:
Council Notes:
75-0262
Agenda Item No g
CI.TY OF SAN BERNetDINO - REQUEST F01 COUNCIL ACTION
STAFF REPORT
AUTHORIZATION FOR THE DIRECTOR
OF PARKS, RECREATION AND
COMMUNITY SERVICES DEPARTMENT
TO APPLY FOR AND ACCEPI' COMMODITIES
FROM THE CALIFORNIA DEPARTMENT
OF EDUCATION TO BE UTJI.T7.RD IN THE
1994 SUMMER FOOD SERVICE PROGRAM
FOR CHILDREN.
The Parks, Recreation and Community Services Department has contracted in the past with the
City Unified School District to prepare meals for its Summer Lunch Program for Children. The
City Department, as sponsor, is eligible to receive donated U.S.D.A. Commodities, from the
California Department of Education, for use in meal preparation. By obtaining and directing
these commodities to the School District, program costs are lessened,
amt 5/19/94
summer food staff report
75-0264
CAlIFORNIA DEPARTMENT OF EDucATION
CHilD NUTRITION - FOOD DISTRIBUTION DfVlSION
o
AGREEMENT FOR DISTRIBUTION OF
,DONATED FOOD INSTITUTION
FDS -1038 (10190)
Return 10: CALI^,A DEPARTMENT OF EOUCATlON
FOod' ~bu1ion Section
P.O. Box 944272
SacramenlO, CA 94244-2720
The applicant agency identifl8d below, herBinaftereall<<lthe reclp.nl /lgeney. hereby makes application forcommodities tfon/ll/ld
by Ihe Agriculture Marl<eting Service, U,S, Depat/ment of Agriculture, to the California Dllpartment of Educallon, hereinaflercaHetf
the /llIIle /lJ1/Incy. for use and disposition in accordance with the/erms and conditions appetuing on Ihe reverse side he_I. which
by reference arB incorporated herBin,
1. R8c:ipienlall8ncy is:
~ A lax-supported agency
o A priV8lll, nonptOfilllgOncy operating. nonptOfit _ng program
2. Type of institution operating the nonprofil feeding program: (ctwQ ~ _prior. "_.1
(~J
ryp.
Typ.
. Cily/=unlyjail
NJ Typ. (~J T",.
(e, Home lor 1he needy llgld (h) Su","* _lor dlldr.n
(~ Nu~ition progtam lor Ill. (ij S_food....co
oIdetIy Ihol is nor lundId by X progtam lor dlildlln
1he Oidet Am..-. Act. (j) Hom.Ior1he _opmonlall,
TItIoIII-C diSlbIod
(g) Mi..ion 0I1U1dlIn lor (k) 0Ihet (Specify,)
feeding -,--
(oj Hospital
ld) Adult rohlbilitation
(b) Adu~ drug ondJOIllcahol
,.habilitation cente,
. Stare COrrectional iNti-
Mion
3... Indicate number 01 eligible
persons served meals daBy.
. Prerelease cemerll
halfway house
Lund!
1700
3.b. Incicala number 01 days per
week meals served,
5
4. Length of time I8eding
program has been in
continuous operation.
5. Is any USDA food given 10
private homes or individuals?
14 Years
[!) Ve. 0 No
Program Rules Allow
6. WiD your agency be senctng any USDA food 10 .
commerclal proce.sor lor the lIIp8Ckaging or
mlllulaclUre 01 preperlld food item.?
o VtI IXI No
7. Ale the I8fVices 01 . public or private 0llI1II~
zaIion used 10 prepare any pan 0/ th.II1NI.?
"'*: 011)' .",.W1II,......... """''''''10,..,.. UIIAI,... on,."." III
......,. A....,."",...,. r f I JJJ ...,...,."..... ,..,....
o VtI III No
8. Have lilY Ioase. or 'poilage 0/ USDA food
OOCU"""?
o VtI ~ No
,,... .cq,yIll..Ioot1/NfPM111On..,..., nut ~,.. ---"PftC/IIf.,,,,.,
.._.FOB_.....-...."'MyUSl)l_...___
.,.,----...-
RECIPIENT AGENCY AGREEMENT CERTIFICATION
I, /h. ~""t euthorized by /he I/O-rig boarrI of Ihe recipient 8(18n<:y (or by Ihe chief
admini.tra~WI ofli_ of /I recipient agency wftich has no goveminfJ boIIrrI) ID l1li1., into /his
II(1fHmIIIIt cartiIy /hat /he information pre.enlfld is accullll8 _ agree. III /he lerrn. _
"""<Irion. of /hi. /lglllement as /hey /lrB presenlfld on /he Ill...... side of /hi. farm.
PR",TED DR TYPED NAME OF AUTHORIZED REClPENT AGENCV REPRESENTATIVE
ANNIE F. RAMOS. DIRECTOR
TIlI.E TELEPHONE NO,
PARKS. RECREATION & COMMUNITY SERVICES ( 909) 384-5233
STATE AGENCY APPROVAL
'TIIi. application wften approved by Ihe .ra", a(18ncy
,ha. con'~1lIffI an a~ wItidI ,hall ramain in
""!oraI IIIId aff8ct unlil wrillen noraID /he contraty
II (1iWln as provided in paragraph 8 of /he ,."", and
conr:Ilions on Ihe llI""r.. .ide of thi.Iorm,
FOR OFFICE USE ONLY
SHOW
NAUEOR
OODRESS
::HAHClE
-<ERE
APPROVED - The I8Cip1ent ~ency i. approved 10
order commodities lor the loIlowing number of meaIa
per week:
IENDDR
<UMBER
H13J-02 36 63127 1
CITY OF SAN BERNARDINO
SUMMER FOOD SERVICE PROGRAM
547 NORTH SIERRA WAY
SAN BERNARDINO ,CA 92401
S_TURE OF AUTHDRlZEDSTATEAOENCY REPRESENTATM;
OOENCY
~
S_TURE OF AUlHORIZED RECIPIENT AGENCY REPRESENTATIVE
~
DATE
DATE
STATE AGENCY
o
o
California Department of Education
Child Nutrition and Food Distribution Division
Pomona Distribution Center
2550 Fulton Road
Pomona, CA 91767-2176
CERTIFICATION OF NONPARTICIPATION
IN THE SUMMER CAMP PROGRAM
THIS CERTIFICATION FORM MUST BE COMPLETED AND
RETURNED WITH YOUR SUMMER FOOD SERVICE PROGRAM
FOR CHILDREN OFFERING. ORDERS WILL NOT BE FILLED
WITHOUT THIS CERTIFICATION.
CERTIFICATION OF COMPLIANCE
I am aware that my organization is prohibited from participating in BOTH the Summer
Food Service Program for Children (SFSPC) and the Summer Camp Program at the
same time.
City of San Bernardino Parks.
This is to certify that Recreation & C~nity Services Dept_will not participate as a
(Rocipiorc AgoiIcy)
sponsor in the 1994 Summer Camp Program.
_oI_~(PrinI..Typo) TOle DIRECTOR OF PARKS.
ANNIE F. RAMOS RECREATION & COMMUNIT
SERVICES DEPARTMENT
SIgn8Iure . v..-_
NIA
Dolo ToIophono
(909) 384-5233
OFD/C-F-014
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