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HomeMy WebLinkAbout05.R- Parks Recreation & Community Services RESOLUTION(ID# 1627) DOC ID: 1627 CITY OF SAN BERNARDINO—REQUEST FOR COUNCIL ACTION O Agreement/Coutract Amendment From: Kevin L. Hawkins M/CC Meeting Date: 03/19/2012 Prepared by: Aaliyah Harkley, (909) 384- 5233 Dept: Parks,Recreation&Community Ward(s): All Services Subject: Resolution of the Mayor and Common Council of the City of San Bernardino Authorizing the City Manager to Execute Amendment No. 3 to Contract 10-318 with the County of San Bernardino Department of Aging and Adult Services (DAAS) with an Additional $33,770 to be Added to the Current Senior Nutrition Program Contract and to Authorize the Issuance and Increase of Annual Purchase Orders in an Amount Not to Exceed $141,623 in the Aggregate to Sysco Foods,Merit Day, Ross Swiss, and US Foods for FY 2011-12. Financial Impact: Account Budgeted Amount: $233,483 Account No. 123-513-0000-0000-0075 j C Account Description: Senior Nutrition Program �✓ Balance as of: 07/01/2011 Balance after approval of this item: $267,253 Please note this balance does not indicate available funding. It does not include non-encumbered reoccurring expenses or expenses incurred,but not yet processed. Motion: Adopt Resolution. Synopsis of Previous Council Action: 05/16/2011 - Resolution No. 2011-105, Amendment No. 2, to execute Contract 10-318 A-2 for FY2011-12 Senior Nutrition Program. 04/04/2011 - Resolution No. 2011-81, Amendment No. 1, to increase Contract 10-318 A-1 to $259,462 (increase of$82,502)and increase annual food vendor purchase orders. 05/17/2010 - Resolution No. 2010-109 to execute Contract 10-318 for FY2010-11 Senior Nutrition Program. Backl4round: I Packet Pg.273 i Undated-3/15/2012 by Linda Sutherland Page I 1627 The Financial Accounting System (FAS) Standard Contract for Senior Nutrition Services is an agreement between the City and the County of San Bernardino Department of Aging and Adult Services (DAAS) to provide senior nutrition services for the County of San Bernardino for the period of July 1, 2011,through June 30, 2012. During FY 2010-11, the Senior Nutrition Program served 47,642 meals within 253 days, a daily average of 188, at six nutrition sites: 5th Street Senior Center, Perris Hill Senior Center, Highland Senior Center,New Hope Family Life Center, Hernandez Community Center, and Lytle Creek Community Center. Furthermore, the City currently contracts with Sysco Foods, Merit Day, Ross Swiss and US Food's to provide these meals. Food Vendor P.O. Summary: Vendor Requested Prior Revised Name Action Encumbrance Encumbrance Variance Sysco Foods Increase $44,483 $51,983 $7,500 Merit Day Increase $27,000 $28,000 $1,000 Ross Swiss Increase $18,500 $22,500 $4,000 US Foods Increase $35.640 $39,140 $3,500 Total $125,623 $141,623 $16,000 Amended Contract Budget: Staff Training $ 1,000 Equipment $12,032 Food/Consumables $16,000 Repairs $ 1,238 Vehicle Operations $ 2,000 Misc./Other $ 1,000 Nutrition Education $ 500 I Jndated-1115/2012 by Linda Sutherland Page 2 1627 rr Total $33,770 v The current grant began in FY2010-11 and will cover three years of contract services;the current agreement year plus two single year renewal options. The amount awarded for subsequent years will depend upon the demand for meal service as identified in reports from the previous funding cycle. This contract Amendment No. 3 for Senior Nutrition Services covers the Second year of service for FY 2011-12. Attached is the FAS Standard Contract, with contract number to be assigned by the County once executed by the City. The FY 2011-12 County contract amount is $233,483 with the program expected to service 42,000 congregate meals at all six sites. However the contract Amendment No. 3 for FY 2011-12 from DAAS reflects an increase to $267,253 with the program expected to service 48,000 congregate meals. An additional $33,770 was allocated to the budget for food purchases, consumables, equipment, and other budget line items. The number of meals served the last three years has exceeded the budget contract expectations. In compliance with the provisions of the grant, the proposed action is to execute the Amendment increase and to increase the annual purchase orders to Sysco Foods, Merit Day, Ross Swiss and �•/ US Foods in an aggregate amount of$141,623 for the term of one year, beginning July 1, 2011. As the budgeted costs for these food items are likely to fluctuate during the next fiscal year, the one year purchase order with the option of one more single year extension, to be exercised at the discretion of the City and subject to the funding budgeted in this fiscal year, is the most appropriate approach. The approval of the recommended action will allow the Senior Nutrition Program to continue the delivery of nutrition services to the City's senior population. A The Amended amount of grant funding available for FY 2011-12 is $267,253. There is no General Fund cash match required; the City's in-kind contribution is budgeted at $68,229 for FY { 2011-12, as an 11.11% minimum in-kind matching contribution requirement for FY 2011-12. The program's goals include collecting$40,000 in Program Income through meal donations. The s new adjusted contracted number of meals served is 48,000. City Attorney Review: i Supporting Documents: ! CON-DAAS-032712 San Bernardino Amd 3(PDF) 3 j O RESOLUTION TEMPLATE 1 (DOC) i Updated:3/15/2012 by Linda Sutherland Page 3 1627 2012 Senior Nutrition Reso (PDF) O i i I { i I l i i i Updated: 3/15/2012 by Linda Sutherland Page 4 i I I RESOLUTION NO. 2 ® RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN 3 BERNARDINO AUTHORIZING THE CITY MANAGER TO EXECUTE AMENDMENT NO. 4 3 TO CONTRACT 10-318 WITH THE COUNTY OF SAN BERNARDINO DEPARTMENT OF AGING AND ADULT SERVICES (DAAS), AND TO INCREASE THE ANNUAL 5 PURCHASE ORDERS TO SYSCO FOODS, MERIT DAY, ROSS SWISS AND US FOODS TO AN AGGREGATE AMOUNT NOT TO EXCEED $141,623 FOR FY 2011-12. 6 BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE CITY OF 7 SAN BERNARDINO AS FOLLOWS: 8 SECTION 1. The City Manager is hereby authorized and directed to execute Amendment No. 9 3 to Contract No. 10-318 with the County of San Bernardino Department of Aging and Adult 10 Services (DAAS) to increase the grant funding for the Senior Nutrition Program (the "Amendment"), 11 A copy of the Amendment is attached hereto and incorporated herein, marked Exhibit"A". 12 SECTION 2. The Director of Finance is hereby authorized and directed to increase the annual 13 purchase orders to Sysco Foods by $7,500 to $51,983; to Merit Day by $1,000 to $28,000, to Ross 14 Swiss by $4,000 to $22,500, and to US Foods by $3,500 to $39,140, to a total aggregate amount not C15 to exceed$141,623. 16 SECTION 3. The authorizations granted herein are rescinded if the Amendment is not 17 fully executed/issued within sixty(60)days of the passage of this Resolution. 18 19 20 21 22 23 24 25 26 07 28 1 4�I aJ 1, I RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN BERNARDINO AUTHORIZING THE CITY MANAGER TO EXECUTE AMENDMENT NO. 2 3 TO CONTRACT 10-318 WITH THE COUNTY OF SAN BERNARDINO DEPARTMENT OF AGING AND ADULT SERVICES (DAAS), AND TO INCREASE THE ANNUAL 3 PURCHASE ORDERS TO SYSCO FOODS, MERIT DAY, ROSS SWISS AND US FOODS 4 TO AN AGGREGATE AMOUNT NOT TO EXCEED $141,623 FOR FY 2011-12. 5 I HEREBY CERTIFY that the foregoing Resolution was duly adopted by the Mayor and 6 Common Council of the City of San Bernardino at a meeting thereof,held on the 7 day of 2012,by the following vote,to wit: 8 9 COUNCIL MEMBERS: AYES NAYS ABSTAIN ABSENT 10 MARQUEZ 11 JENKINS 12 VALDIVIA 13 SHORETT 14 IS KELLEY 16 JOHNSON 17 MCCAMMACK 18 Georgeann Hanne, City Clerk 19 City of San Bernardino 20 21 The foregoing Resolution is hereby approved this day of 2012. 22 23 Patrick J. Morris,Mayor City of San Bernardino 24 Approved as to form: 25 JAMES F. PENMAN, City Attorney 26 27 By: 28 2 FOR COUNTY USE ONLY ❑ New Vendor Code Dept. Contract Number ® Change ❑ Cancel CITYOFS772 `SC OOA A 10-318 A-3 County Depanment Dept Orlin. Contractor's License No. A ing and Adult Services County Department Contract Representative Telephone Total Contract Amount County of San Bemardino Wendy Everett (909) 387-2917 $526,715 F A S Contract Type ❑ Revenue ® Encumbered ❑ Unencumbered ❑ Other: STANDARD CONTRACT If not encumbered of revenue contract type,provide reason: Commodity Code Contract Stan Date Contract End Date Original Amount Amendment Amount 95200 July 1,2010 June 30,2012 $176,960 $33,770 Fund De t. 0 anization c O /Rev Source GRC/PROJ/JOBNo. Amount AAF OOA 210 300 3357 $33,770 Project Name Estimated Payment Total by Fiscal Year Elderly Nutrition Services FY Amount 110 FY Amount I/D Program 11/12 $33,770 1 THIS CONTRACT is entered into in the State of California by and between the County of San Bernardino, hereinafter called the County, and Name City of San Bernardino hereinafter called Contractor Address 300 North D Street San Bernardino, CA 92418 Telephone Federal ID No or Social Security No. (909) 384-5231 95-6000772 IT IS HEREBY AGREED AS FOLLOWS: AMENDMENT NO. 3 It is hereby agreed to amend Contract No. 10-318 as follows: III. CONTRACTOR GENERAL RESPONSIBILITIES Paragraph DD is deleted in its entirety. V. FISCAL PROVISIONS Paragraph A is amended to read as follows: A. The maximum amount of funds available for payment under this Contract shall not exceed $526,715 of which $433,055 may be federally funded, and shall be subject to availability of funds to the County. The consideration to be paid to Contractor shall be in full payment for all Contractor's services and expenses incurred in the performance hereof, including travel and per diem. Auditor/Controller-Recorder Use only ❑Contract Database 13 FAS Input Data I Keyed By Page 1 of 4 P Paragraph B is amended to read as follows: B. Contractor shall be compensated on a fee-for-service basis based on the following rate, as specified in Scope of Work(Attachment A): Congregate Site: $5.53 per meal, up to 46,152 meals Paragraph M is amended to read as follows: M. Matching contributions 1. The Contractor shall provide in-kind matching contributions of a minimum of$29,692, which is the Title I I I portion of the Contract multiplied by 11.11%. 2. Allowable match shall be in compliance with the following requirements: 3. Matching in-kind contributions must be for allowable costs as determined by CDA PM. Allowable costs include but are not limited to rent, utilities, supplies, and volunteers. 4. To qualify as a matching in-kind contribution, indirect or Contractor allocated overhead expenses must be supported by a documented cost allocation plan. 5. Costs incurred by the Contractor or subcontractor must be verifiable from the records of the Contractor or subcontractor. 6. Non-Matching contributions are local funding that does not qualify as matching contributions and/or is not being budgeted as matching contributions (e.g., Title V, overmatch, etc.). X. GENERAL PROVISIONS Paragraph D, item 6 is amended to read as follows: 6. The Contractor shall record the following information when property is acquired: a. Date acquired; b. Property description (include model number); C. Property identification number(serial number); d. Location of property; e. Cost or other basis of valuation; f. Fund source; and g. Rate of depreciation (or depreciation schedule), if applicable. The Contractor shall keep track of property purchased with Contract funds, whether capitalized or not. The Contractor shall notify DAAS, in writing, within 30 days of purchase of any capitalized asset. The notification should, at a minimum address all of the criteria in Section X, Paragraph D, Item 6 above. Written notification should be sent to: DAAS Program Analyst 686 E. Mill Street Second floor San Bernardino, CA 92415-0640 The Contractor shall not use DAAS funded properties as collateral to obtain loans, etc. Any liens placed against properties purchased with the funds available through this contract should be reported to DAAS within five (5) days. The Contractor shall maintain and submit to DAAS annually with the closeout, a current inventory of property furnished or purchased by either the Contractor or the subcontractor with funds awarded under the terms of this ® Contract or any predecessor contracts for the same purpose. The Contractor shall use the Report of Project Property Furnished/Purchased with Agreement Funds (CDA 32), unless otherwise directed by DAAS. Page 2 of 4 f Paragraph D, item 16 is deleted. Paragraph D, item 17 is amended to read as follows: 17. All property purchases require the following: a. If purchase of equipment is to be reimbursed by DAAS, the equipment to be purchased must be specified in the budget previously submitted and approved by DAAS, or be specified in a revised budget that Contractor submits to DAAS for DAAS approval. b. Contractor must seek bids from "multiple firms" in selecting a supplier of goods. "Multiple firms" means a minimum of three (3) separate and distinct business entities in competition to supply the same or similar good. When selecting a bid, Contractor must consider such factors as type of goods/supplies needed, cost, schedule, and availability. C. "Request To Purchase Property/Equipment Form"(Attachment N) and "Property/Equipment Bid Form" (Attachment O) must be submitted by Contractor and be approved by DAAS prior to any equipment purchases of$5000.00 by Contractor. ATTACHMENT A— SCOPE OF WORK: Fiscal Year 2011-12, dated March 27, 2012, is added to this Contract. ATTACHMENT B — BUDGET— Fiscal Year 2011-12, dated March 27, 2012, is added to this Contract. ATTACHMENT N — REQUEST TO PURCHASE PROPERTY/EQUIPMENT FORM is added to this Contract. ATTACHMENT O — PROPERTY/EQUIPMENT BID FORM is added to this Contract. Auditor/Controller-Recorder Use only 17 Contract Database 13 FAS Input We Keyetl By Page 3 of 4 All other terms and conditions remain in full force and effect. COUNTY OF SAN BERNARDINO City of San Bernardino (Print ortype name of corporation,company,connector,etc.) ► By ► Josie Gonzales, Chair, Board of Supervisors (AufMnzed signature-sgninblueink) Dated Name SIGNED AND CERTIFIED THAT A COPY OF THIS (Print or type nemeofpenson signing contract) DOCUMENT HAS BEEN DELIVERED TO THE Title CHAIRMAN OF THE BOARD (Print or Type) Laura H.Welch Clerk of the Board of Supervisors Dated of the County of San Bernardino. By Address 300 North D Street Deputy San Bernardino, CA 92418 Approved as to Form: Jam s F. Penman, City Attorney ILL Approved as to Legal Form Revien ed by Contract Cepollance Presented to BOS for signature ► ► ► Jacqueline Carey-Wilson,County Counsel Lory Klopfer,Contracts Manager Colleen Krygier,Director Date Date Date AuditorlController•Recorder Use Only ❑Contract Database ❑FAS Input Date Keyed By Page 4 of 4 San Bernardino County ATTACHMENT A Elderly Nutrition Program Scope of Work March 27, 2012 This Scope of Work contains the measurable objectives mandated by the Department of Aging and Adult Services (DAAS) and the California Department of Aging (CDA) required of the Elderly Nutrition Program (ENP) Provider. The Scope of Work specifies and establishes monthly, quarterly, and annual time frames and constitutes the primary document for on-going monitoring and annual Program and Fiscal monitoring. It will be used to measure the Provider's efforts towards providing quality nutrition services. Contractor: City of San Bernardino Service Area: San Bernardino and Surrounding Areas I. Program Description: A. Purpose — The purpose of the ENP is to provide nutrition services as described in the Older Americans Act (OAA) of 1965, as amended, and to assist older individuals in California to live independently, by promoting better health through improved nutrition, and reduced isolation through programs coordinated with nutrition-related supportive services. B. Definition — Nutrition Services means the procurement, preparation, transport, and service of meals, nutrition education, nutrition screening, and nutrition counseling, to eligible individuals at congregate sites or in their homes. C. Goals — to maintain or improve the physical, psychological, and social well being of older individuals, by providing or securing appropriate nutrition services. D. Objectives: 1. Give preference to older individuals in greatest economic or social need with particular attention to low-income minority individuals. 2. Serve meals that provide one-third (1/3) of the Recommended Dietary Allowances (RDA's) and are safe and of good quality. 3. Promote and maintain high food safety and sanitation standards. 4. Promote good health behaviors through nutrition education and nutrition screening of participants. 5. Promote or maintain coordination with other nutrition-related supportive services for older individuals. E. Target Population — The ENP Provider shall target individuals who are sixty (60) years of age or older, minorities, low income and living in rural areas of the County of San Bernardino. II. Eligibility for Nutrition Services: A. Congregate Meals—Individuals eligible to receive a meal at a congregate nutrition site are: 1. Any older individual 60 or older. 2. The spouse of any older individual 60 or older. 3. A person with a disability, under age sixty (60) who resides in housing facilities occupied primarily by older individuals (60 or older) at which congregate nutrition services are provided. 4. A disabled individual who resides at home with and accompanies an older individual who participates in the program. B. Volunteer Meals: 1. A volunteer under age sixty (60) may be offered a meal if doing so will not deprive an older individual who is 60 or older of a meal. C. Home-Delivered Meals—Individuals eligible to receive a home-delivered meal are: 1. Any older individual who is frail, as defined below, and homebound by reason of illness, © disability, or isolation: Page 1 of 14 ATTACHMENT a. "Frail" means that an older individual is determined to be functionally impaired because the individual ether: 1) Is unable to perform at least two (2) activities of daily living, including bathing, toileting, dressing, feeding, breathing, transferring and mobility and associated tasks, without substantial human assistance, including verbal reminding, physical cueing or supervision. 2) Due to a cognitive or other mental impairment, requires substantial supervision because the older individual behaves in a manner that 2. A spouse of a person sin a serious sub-section l(C)(1)safety bove, regardless individual age or condition, an assessment concludes that it is in the best interest of the homebound older individual. 3. An individual with a disability who resides at home with older individuals if an assessment concludes that it is in the best interest of the homebound older individual who participates in the program. 4. Priority shall be given to older individuals in sub-section (C)(1) above. III. Requirements for Nutrition Services: A. Congregate Meals: 1. Each Congregate Meal Provider shall: a. Include procedures for obtain the views of participants about the services received. b. Not preclude the service of a meal to a participant who has failed to make a reservation when food is available. 1) Ensure each Congregate Meal participant completes sections I and IV of the Client Intake Sheet (provided by DAAS) on the first day of service and annually thereafter. 2) Maintain appropriate documentation on each client. Documentation shall be kept on file to be monitored by DAAS. 2. Each Congregate Meal site shall meet all of the following: a. Have a paid staff or volunteer designated to be responsible for the day-to-day activities at each site, and physically be on-site during the time that ENP activities are taking place. b. Have restrooms, lighting, and ventilation, which meet the requirements of the California Retail Food Code(CRFC). C. Have equipment, including tables and chairs that are sturdy and appropriate for older individuals. Tables shall be arranged to assure ease of access and encourage socialization. B. Home-Delivered Meals: 1. Develop and implement criteria to assess the level of need for home-delivered nutrition services of each eligible participant. a. An initial determination of eligibility may be accomplished by telephone. This initial contact with the participant shall include completion of sections I, II, III, and IV of the Client Intake Sheet(provided by DAAS). b. A written assessment shall be done in the home within two (2) weeks of beginning meal service, and shall include an assessment of the type of meal appropriate for the participant in their living environment. C. An older individual eligible for receiving home-delivered meals shall be assessed for need of nutrition-related supportive services, and referred as necessary. d. Re-assessment of need shall be determined quarterly. Such re-assessment shall be done in the home of the participant at least every other quarter. Each quarter's re-assessment shall include completion of sections I, ll, III, and IV of the Client Intake Sheet(provided by DAAS). 2. Provide written instructions, in the language of the majority of the participants, for handling and re-heating of the meals. Page 2 of 14 ATTACHMENT A 3. Establish a waiting list for home-delivered meals whenever the home-delivered meal providers are unable to provide meals to all eligible individuals. The decision to place eligible recipients of a home-delivered meal on a waiting list, and their position on such a list, shall be based on greatest need and-or in accordance with policy established by the home-delivered meal provider, in consultation with DAAS. 4. Provide home-delivered meals in pre-packaged divided trays (hot or frozen meals). 5. Maintain appropriate documentation on each client. Documentation shall be kept on file to be monitored by DAAS. IV. Program Outcomes: A. Total Number of Meals to be Served: 46,152" 1. A minimum of 95% of the total number of meals is to be provided. The Director of DAAS must approve requests to serve less than 95% of the total number of meals to be provided. All such requests must be in writing. Program: C-1 Con re ate Meals Pro ram C-2 Home-Delivered Meals #of Days of Sery ice: 255 #of Dams of Service: Number of Meals: 46,152 Number of Meals Sites to be Served: Areas to be Served: 5° Street Senior Center Perris Hill Senior Center Hernandez Community Center Lytle Creek Community Center New Hope Family Life Center Highland Senior Center V. Staffing: (� A. Manager or Director: `�•r 1. The ENP provider shall have a manager on staff who shall conduct the day-to-day management and administrative functions of the ENP, and either have(1), (2), or(3): a. Possess an associate degree in institutional food service management, or a closely related field, such as, but not limited to, restaurant management, plus two (2) years experience as a food service supervisor, or, b. Demonstrate experience in food service, such as, but not limited to, cooking at a restaurant, and within twelve (12) months of hire successfully complete a minimum of twenty (20) hours specifically related to food service management, business administration, or personnel management at a college level. Prior to completion of meeting the hours, this individual's performance shall be evaluated through quarterly monitoring by a registered dietitian, or, C. Two years experience managing food services. Such experience shall be verified and approved by a registered dietitian prior to hire. 2. The ENP Provider shall maintain documentation on file of the qualifications of the Program Manager or staff. 3. If the Provider has more than one site, the Manager/Director shall monitor the sites on a bi- monthly basis. The bi-monthly visit shall be for the purpose of monitoring the food service practices of the employees and the implementation of the program requirements at the site level. Documentation of each visit shall be maintained on file for DAAS review. B. Personnel—Paid Staff/Volunteers: 1. There shall be sufficient qualified paid staff or volunteer staff with the appropriate education and experience to carry out the requirements of the ENP. The total number of staff should be based on the method and level of services provided and size of the service area. 2. Contractor is encouraged to hire multi-lingual/multi-cultural staff to increase low-income and O ethnic minority program participation in accordance with federal mandates. i Page 4 of 14 3. Contractor shall recruit for vacant positions in an open and competitive application p oce s free of discriminatory questions. Written job descriptions for all paid and volunteer staff shall be maintained. 4. Contractor shall complete a written work performance evaluation on all paid and volunteer staff at least annually. 5. All staff, paid and volunteer, that will be handling food must be in possession of a current Food Handlers Card. 6. Volunteers shall be recruited and used in any phase of the program operation where qualified. 7. Volunteers shall be screened and selected through a formal process that assesses their capabilities. 8. Volunteers shall receive the same training as paid staff. 9. Volunteers that are paid through other job training programs are not considered volunteers and must be paid the agreed upon rate charged for regular paid staff. 10. The ENP Provider shall maintain a written Volunteer Policy that describes how volunteers are recruited, screened, what topics they are taught at orientation, and how often their performance is evaluated. C. Registered Dietitian: 1. Each ENP Provider shall establish and administer nutrition services with the advice of a Registered Dietitian in accordance with Section 339 of the OAA, and follow the general requirements in Title 22, Division 1.8, Section 7500. 2. The Registered Dietitian will provide the following activities to meet the mandated requirements: a. At a minimum, quarterly monitor for safe food handling and sanitation practices of food facilities. b. Review and approve the content of staff training prior to presentation. C. Develop, or review and approve the cycle menus. d. Provide input, review, and approve the Nutrition Education Plan prior to presentation. e. Provide technical support and assistance as needed. VI. Staff Training Activities: A. A yearly written Staff Training Plan shall be developed, implemented, and maintained on file by the ENP Provider, as required in Title 22, Division 1.8, Section 7636.7(c). B. The Provider's Registered Dietitian shall review and approve the content of the Plan prior to presentation. C. The Staff Training Plan must identify who is to be trained, who will conduct the training, content of the training, and when it is scheduled. D. A copy of the Staff Training Plan that has been approved by the Provider's Registered Dietitian must be submitted to DAAS by September 1s' of the FY it is being provided in. The DAAS Registered Dietitian will review and approve the Staff Training Plan and return it to the Provider. The DAAS approved Staff Training Plan must be kept on file. E. A minimum of four (4) hours of staff training shall be provided annually for paid and volunteer food service staff, including congregate and home-delivered meal staff. F. Training sessions shall be evaluated by those receiving the training. G. The ENP Provider shall maintain documentation of each training session on file. Documentation includes, but is not limited to, sign-in sheets, agendas, handouts, and completed evaluations. H. All staff, paid and volunteer, shall be oriented and trained to perform their assigned responsibilities and tasks. Training, at a minimum, shall include: 1. Food safety, prevention of food borne illness, and Hazard Analysis Critical Control Points (HACCP) principles. 2. Accident prevention, instruction on fire safety, first aid, choking, earthquake preparedness, and other emergency procedures. 3. Elder Abuse Law and reporting procedures. Page 4 of 14 VII. Senior Participants: ATTACHMENT A A. Satisfaction Survey: 1. The ENP Provider shall conduct a Client Satisfaction Survey at least annually. The Survey instrument must be approved by DAAS prior to its use, and all findings from the Survey must be used to improve services. The Provider must keep the completed Surveys and the tabulated results on file. A copy of the tabulated results must be submitted to DAAS by March 3"of the FY it is being conducted for. B. Complaint Procedures: 1. Each Provider shall have a written Complaint Procedure. 2. The Complaint Procedure will be available for the participants and will provide them the opportunity to provide positive as well as negative feedback to the Program Manager. 3. The Provider shall have an assessment tool readily accessible for the seniors attending the congregate site or receiving a home-delivered meal. C. Nutrition Education Services for Participants: 1. Nutrition Education shall be provided a minimum of four(4)times per year to participants in congregate and home-delivered meal programs. a. Nutrition Education for congregate sites is defined as demonstrations, presentation, lectures or small group discussions, all of which may be augmented with printed materials. b. Nutrition Education for home-delivered meal participants may consist solely of printed material that is in conjunction with a congregate meal Nutrition Education presentation. 2. Nutrition Education shall be based on the particular need of congregate and home- delivered meal participants. An annual Needs Assessment shall be performed by the ENP Provider to make this determination. 3. The Nutrition Education Plan and annual Needs Assessment must be submitted to DAAS by September 1"of the FY it is being provided in. 4. Nutrition Education sessions must be reported monthly to DAAS using the Nutrition Education Monthly Service Unit Report. Nutrition Education Units of Service: Pro ram: C-1 Con r ate Meals Pro ram: C-2 Home-Delivered Meals #of units to be Provided: 723 #of Units to be Provided: #of Sites to be Presented at 5 #of Participants to be Presented to: VIII. Menu Planning Guidelines/Menu Requirements: A. A minimum of a 3-month cycle shall be planned and submitted to DAAS. B. Menu cycles shall include the availability of seasonal foods. C. Health, cultural, ethnic and regional dietary practices shall be considered in menu planning, food selection, and meal preparation. D. The menu cycle shall be approved by the Provider's Registered Dietitian and upon approval forwarded to the DAAS Registered Dietitian for certification. Menus shall be submitted to the DAAS Registered Dietitian forty-five (45) days prior to the menu start date. Allow thirty (30) days for the menu certification process. Menus will be returned to the Provider at least fifteen (15) days prior to the menu start date. ENP Providers are required to have menus certified prior to the menu start date. All signatures on the menu shall be original signatures. E. A copy of the certified menu must be posted in a spot conspicuous to clients at each congregate site. F. Copies of the menus shall be made available to the participants upon request. G. When planning the menus, the California Daily Food Guide and the Dietary Guidelines for Americans (DGA) are to be considered. Menus shall conform to the following criteria © referenced in the sources: 1. Provide an average of 550-750 calories per meal. Page 5 of 14 ATTACHMENT A 2. Limit total fat to no more than 25-30% of the calories averaged for the week. 3. Choose and prepare foods with low amounts of salt, soy sauce and other high sodium items. 4. Include good sources of dietary fiber such as whole grains and cooked dry beans at least four times a week. 5. Include a variety of foods and preparation methods with consideration to color, combinations, texture, size, shape, taste, and preference of the participants served. 6. Dietary Reference Intake Values: a. Table one (1) represents the most current Dietary Reference Intakes (DRI) values and daily compliance range for target nutrients. The values provided are based on the U.S. Department of Agriculture (USDA) Food Guide calculated for one (1) meal for a woman over seventy (70) years of age whose activity level is sedentary. This example represents a majority of the older adult population served by the ENP statewide. 1) The nutrients selected for this Table are based on the target nutrients to: i. Promote health and prevent disease ii. Prevent deficiencies iii. Indicate diet quality iv. Manage disease Table 1 Target Nutrients Nutrient Target Value Daily Compliance Range r meal Calories(Kcal) >550 Kcal >550—700 Kcal Protein 14 gm 14 gm(in the entrde) Fat(%of total calories) 30°/u 7350%weekly average Vitamin A(ug) 250 ug > 250 ug 3 out of 5 days /wk or 4 out of 7 daystwk Vitamin C(mg) 25 mg Vitamin B6(mg) 0.5 mg Vitamin B12(ug)"' 0.8 ug Calcium(mg) 400 mg Magnesium(mg) 140 mg Zinc(mg)" 2.6 mg >2.6 mg"* Sodium(mg) <800 mg <1,200 mg (over 1,000 mg place an icon on the menu) Fiber(gm) >7 gm >7 gm Potassium(gm) " 1565 mg 1565 mg- Vitamin D 200 IU 200 IU Vitamin E** 5 IU Provide education— 'Target Value: This value represents one-third of the DRI for a 1600 calorie range. The 1600 calorie range was chosen based on the requirements for a 70-year-old sedentary female. If a majority of the senior population served by the AAA ENP Program differs from the above example, use your ENP predominate demographic characteristics to calculate target nutrient values. Page 8 of 14 ATTACHMENT A If these elements are not provided to the level noted as a weekly average, the Program must educate the participants on how to obtain these elements. NOTE: Fortified foods should be used to meet vitamin B12 needs. Recommended sodium content was liberalized based on the information from the Mathematical study data which indicated that,for many participants, the ENP meal provides 40-50 percent of the participants'daily intake. 7. Component Meal Pattern Requirements: a. The California 1600-calorie component meal pattern has been developed to reflect the new DGA requirements for those programs that are not using computerized nutrient analysis. 1) The ENP Provider has the discretion to allow occasional flexibility in planning meals that may not meet the meal pattern, but does meet the nutrient value requirements. Fortified food products and combination dishes used in a menu may not match the meal pattern, but may provide for the required nutrient values. For example, a fortified snack bar as a dessert could be used to boost the nutrient value of a boxed lunch or special occasion meal. 2) Items that provide the following target nutrients should be identified on the menu when using a component meal pattern template: a) Vitamin C — Provide one-third (1/3) of the DRI for vitamin C each meal—25 mg (for a 1600-calorie menu). b) Vitamin A — Provide one-third (1/3) of the DRI for vitamin A at least three(3)times per week, 250 µg (for a 1600-calorie menu). C) Sodium — meals that contain over 1,000 mg of sodium must be noted on the menu as a high sodium meal. b. Table two (2) descries the elements in the California 1600-calorie meal pattern. Serving sizes are based on the USDA Food Guide Pyramid. This sample component meal pattern does not assure that meals meet one-third (1/3) of the DRI's and the DGA. Meals will require specific types of fruits and vegetables, whole grains, and high fiber foods in order to assure the target nutrients are provided. The component meal pattern may be deficient in vitamins E, B12, and Zinc, requiring additional nutrition education for participants on the selection of foods that are good sources of these nutrients. C. The meal pattern in Table two (2) below is based on the minimum requirements for a sedentary female 70 years of age. If the majority of the population served by a provider falls within another requirement range (i.e. active 60 year old men), the serving sizes and minimum number of servings required can be adjusted to meet the service population. ENP Providers should verify the population served Table 2 and develop menu criteria accordingly. California 1600 Calorie per Day Component Meal Pattern Minimum Recommended Elements Food Group Required servings for Serving sizes for 1600 550 calories per meal calorie level Lean meat or beans 1 serving 2 ounces= 1 serving 2 ounces per meal Vegetable 1 —2 servings '/ cup= 1 serving Fruit 1 serving '%cup= 1 serving Bread or Grain 1 —2 servings 1 slice Bread= 1 serving At least'/2 whole rain % cu of rice or asta = 1 servin Low-fat milk or milk alternate 1 serving 1 cup ore uivalent measure Page 8 of 14 A Fat Optional ATTACHMENT A Dessert Optional - limit sweets use Select foods high in fiber and low in fruit fat and sugar (1) The number of servings per meal estimates provision of one-third of the DRIB. (2) Caloric value (1,600 Kcal/day) based on a 70-year-old female, "sedentary" physical activity level using Table 3- Estimated Caloric Requirements in Each Gender and Age Group at Three Levels of Physical Activity, from the DGA 2005. H. Meal Components—required for both computerized and component menus: 1. Protein—meat, fish, poultry, legumes, eggs, and cheese: a. A minimum of 2.0 ounces of cooked, edible portions of meat, fish, poultry, legumes, eggs, cheese, (or a combination thereof) providing at least 14 grams of protein. Programs should consider the preferences of the participants they serve. b. Legumes should not be counted as both vegetable and protein. ENP Providers may use other protein sources to provide the occasional vegetarian meal. 2. Vegetables (1-2 % cup servings): a. Vegetables as a primary ingredient in soups, stews, casseroles, or other combination dishes should total ''/: cup per serving. b. Raw leafy vegetables (salads) should equal 1-cup if they are to be considered a serving. 3. Fruit (1 serving): a. A serving of fruit equals: 1) 1 medium sized whole fruit 2) /2 cup fresh, chopped, cooked, frozen, or canned drained fruit 3) % cup 100%fruit juice b. Fresh, frozen, or canned fruit should be packed in juice, light syrup, or without sugar. Fruit packed in high sugar content syrup may be rinsed before using. 4. Breads/Grains (1 ounce equivalent serving): a. One-half of the daily intake of grains should be from whole grains. Grains that are processed (not whole) must be fortified. 5. Milk (8 fl. oz.): a. Each meal shall contain eight (8) fluid ounces of fortified skim, low fat, or buttermilk. If religious preference precludes the acceptance of milk with the meal, it may be omitted from the menu (however, an equivalent substitute must be used). 6. Fat (Optional): a. Each meal may contain fat components to increase the palatability and acceptability of the meal. b. When selecting and preparing meat, poultry, dry beans, and milk or milk products, make choices that are lean, low fat, or fat free. C. Consume less than 10% of calories from saturated fatty acids and less than 300 mg/day of cholesterol, and keep trans fatty acid consumption as low as possible. d. Keep total fat intake between 20 to 35 percent of calories, with most fats coming from sources of polyunsaturated and monounsaturated fatty acids such as fish, nuts, and vegetable oils. 7. Dessert(Optional): a. Dessert may be provided as an option to satisfy the caloric requirements or for additional nutrients. Use fruit as a dessert as often as possible and limit sweets. The fruit, grains, and dairy products served as dessert can count towards the fruit, grain, or dairy requirements. Desserts that are low in fat and/or low in sugar are encouraged. Page 8 of 14 ATTACHMENT A b. When a dessert contains 1/2 cup of fruit per serving, it may be counted as a serving of fruit. c. When a dessert contains the equivalent of 1 serving (1 ounce) starches/grains per serving, it may be counted as a serving of starches/grains (example: rice pudding or oatmeal cookie). d. When a dessert contains the equivalent of Y cup of milk per serving, it may be counted as % serving of milk. 8. Condiments and Product Substitutes: a. Sugar substitutes, pepper, herbal seasonings, lemon, vinegar, non-dairy coffee creamer, salt, and sugar may be provided, but should not be counted as fulfilling any part of the nutritive requirements. b. Condiments such as salad dressings, ketchup, soy sauce, mustard, and mayonnaise do not need to be counted in a menu analysis if they are served "on the side" and are not combined with the food. 9. Sodium: a. The commitment to reduce sodium in the meals stems from the fact that nutrition- related chronic diseases remain the primary cause of death among people aged 65 and older. California has a diverse population, and the ENPs in the State provide culturally appropriate meals for many ethnicities. Asian meals traditionally have higher sodium levels. Programs that choose to provide culturally appropriate meals, but are concerned with the sodium content of the meals, may consider: 1) Using low sodium soy sauce or diluting soy sauce with water to produce low sodium soy sauce; 2) Offering soy sauce as a condiment to be added by the senior; 3) Providing Nutrition Education on sodium; 4) Continuing to work with the sodium levels of meals, making small steps to reduce the risk of developing kidney stones, and possibly decrease bone loss with age; 5) Not providing potassium chloride salt substitutes; 6) Noting meals that have more than 1000 mg of sodium on the menu as such: "This meal contains more than 1000 mg of sodium," or using an icon denoting a high sodium meal; and 7) Using low sodium versions of high sodium foods when available and feasible with budget allowances. I. Meal Component/Nutrient Analysis: 1. A meal component/nutrient analysis of the entire menu cycle conducted and/or approved by a Registered Dietitian shall be done to ensure compliance with Title 22, Division 1.8, Section 7638.5. a. Computerized Nutrient Analysis Requirements 1) Although not required, use of computerized nutrient analysis is strongly recommended and will help ensure and verify the nutritional adequacy of meals. The goal of assessing nutrient intakes of groups is to determine the prevalence of inadequate or excessive nutrient intakes within a particular group of individuals. While meal patterns serve as a basic framework for menu planning, providers are encouraged to use computerized nutrient analysis because it provides specific information on nutrients the menu may not be providing. The information that a menu is not supplying all of the desired nutrients will guide the development of future menus. As required menu elements are expanded, it is more difficult to meet all of the requirements on a daily basis. ENP Providers should focus on: i. Vitamin A ii. Vitamin C Page 9 of 14 ATTACHMENT A iii. Protein iv. Fat V. Sodium 2) FiberNot all nutrient guidelines will be met with each meal. However, areas that do not meet the requirements should be the focus of future menu revisions and nutrition education. 3) The following nutrients should be included in the analysis when the computerized nutrient analysis method is used: calories; protein; carbohydrates; total fat; saturated fat; total fiber; vitamins A, C, D, E, K, thiamin, riboflavin, niacin, B6, folate, B12, calcium, chromium, copper, iron, magnesium, sodium, and zinc. In addition to meeting one-third of the DRIs, the menus should also follow the DGA. IX. Food Procurement: A. Food procurement procedures shall comply with Title 22, CRFC standards, and HACCP best practices guidelines. B. All food shall be of good quality and shall be obtained from sources that conform to Federal, State, and local regulatory standards fro quality, sanitation, and safety. C. To the extent possible, providers are encouraged to participate in group food purchasing. D. A comparative cost analysis shall be performed either by the ENP Provider or its group purchasing organization on an on-going basis to obtain the highest quality food for the lowest price available. X. Food Storage: A. Food storage procedures shall comply with Title 22, CRFC standards, and HACCP best practices guidelines. B. Adequate and suitable space free from vermin, dirt, and contamination or adulteration shall be provided for the storage of food and beverages, and cooking, serving, and eating supplies. XI. Food Production: A. Food production procedures shall comply with Title 22, CRFC standards, and HACCP best practices guidelines. B. Food production and meal service shall be under the supervision of a trained staff in food service management to ensure food service sanitation and the practice of hygienic food handling techniques are followed. This person shall function with the advice of the Provider's Registered Dietitian. C. Meals shall be served as indicated on the certified menus. In the event that a menu substitution must occur, the following procedure must be followed: 1. The Provider's Registered Dietitian must approve all menu substitutions. 2. A Menu Substitution Form must be completed and signed by the Provider's Registered Dietitian. 3. The completed Menu Substitution form shall be kept on file for DAAS review. D. Production Control: 1. Production schedules or worksheets must be available in the food preparation area. 2. Food shall be prepared in sufficient quantities to serve all participants. Careful planning shall minimize the leftover food and prevent waste. 3. Standardized recipes shall be used to ensure consistency of quality and quantity and adherence to menu guidelines. 4. Appropriate utensils for correct and consistent portion control shall be available and used at each site. E. Meal Service/Temperature Monitoring: 1. All food for congregate sites shall be packaged and transported in a manner in which it is protected from potential contamination and maintains appropriate hot and cold food temperatures. Page 10 of 14 ATTACHMENT A 2. Meals shall be served to seniors "offer versus serve" — meaning participants are to be given an opportunity to decline a menu item. Food trays shall not be served ahead of time.Temperature Checks: a. All hot, cold, and frozen potentially hazardous meal components, including milk, shall be checked daily immediately prior to dispatch from the central kitchen. b. All hot, cold, and frozen potentially hazardous meal components, including milk, shall be checked at satellite congregate sites upon delivery and at all congregate sites immediately before meal service. C. The ENP Provider must have written procedures for monitoring food temperature. d. The ENP Provider must use a form to document food temperatures daily (i.e. Food Temperature Log). e. The ENP Provider shall have a staff member review the completed Food Temperature Logs at random a minimum of every other month. If problems are discovered, an action plan must be developed to resolve the issue. f. All completed Food Temperature Logs must be maintained on file for DAAS review. 1 To maintain quality in prepared foods, holding times shall be kept to a minimum. Long periods of holding hot foods at required temperatures diminishes the nutrient content and palatability of foods. 4. Holding time shall not exceed 2 hours between the end of production and the beginning of food service at the congregate site. 5. Milk and milk products shall be provided in individual, commercially filled containers, or shall be poured by a staff member directly from commercially filled bulk containers into the glass or cup from which it is consumed. 6. Single service utensils and tableware shall be used one time only and then discarded. 7. Safety of the food after it has been served at the congregate site and then removed by the participant from the congregate site is the sole responsibility of the participant and may be consumed by the participant as he/she deems it appropriate. 6. The Provider shall have a sign posted in the congregate site stating, "Food removed from the congregate site is at your own risk." XII. Food Service Requirements: A. The ENP Provider shall ensure that the following forms are available, completed daily, and maintained at each nutrition site for a minimum of 12 months: 1. Food Temperature Log — one should be available for congregate meals and one for home delivered meals if hot foods are delivered to the client. 2. Cleaning Schedule 3. Equipment Temperature Log—for all dish machines, refrigerators, and freezers. 4. Production Schedule—applicable only if food is cooked at the site. 5. The current Environmental Health inspection shall be available at the site for review. 6. Staff and volunteers who are handling food shall possess a current food handlers' card that shall be available for review. XIII. Program Requirements: A. Client Intake Sheets: 1. The ENP Provider will ensure that each participant completes the Client Intake Sheet form (provided by DAAS) to determine his or her level of nutritional risk. Forms shall be completed for: a. Congregate Meal Participants — at the beginning of service and then annually thereafter for clients who remain on the program. 1) Sections I and IV are required for congregate meals. b. Home-Delivered Participants — at the beginning of service and then quarterly thereafter for clients who remain on the program. Page 11 of 14 ATTACHMENT A 1) Sections I, II, III, and IV are required for home-delivered meals. 2. ENP Providers who are required to complete their own data entry into the SAMS System must enter the annual and quarterly Client Intake Sheets into the database in a timely manner. 3. ENP Providers who are not required to complete their own data entry must send the Client Intake Sheets to DAAS for data entry into the SAMS System. B. Outreach/Marketing Activities: 1. ENP Providers are required to provide outreach in the community through community organizations and other groups. All outreach and marketing activities shall be documented and kept on file for the annual monitoring visit conducted by DAAS. 2. ENP Providers shall develop and have handouts, brochures, and/or signs available in languages other than English and posted in locations such as churches, community service locations, and small stores serving the minority communities. C. Emergency Procedures: 1. ENP Providers shall have a written Emergency/Disaster Plan. 2. Each nutrition site shall have an evacuation plan posted identifying the emergency exits and assembly areas. 3. Staff must be knowledgeable of emergency procedures. 4. Where feasible and appropriate, ENP Providers shall make arrangements for the availability of meals to participants during a major disaster, as defined in 42 U.S.C., Chapter 68, Section 5122 (2). Such arrangements shall be included in the Emergency/Disaster Plan. D. Donations and Confidentiality: 1. An Eligible individual who receives a meal shall be given the opportunity to contribute to the cost of the meal 2. The ENP Provider shall develop a suggested contribution/donation amount. When developing this contribution/donation amount, the income ranges of the older individuals in the community and the Provider's other sources of income shall be considered. 3. A sign indicating the suggested contribution for eligible individuals and the fee for guests shall be posted near the contribution container at each congregate meal site. A guest fee shall cover all meal costs. 4. No eligible individual shall be denied participation because of failure or inability to contribute. 5. The Provider shall ensure that the amount of the eligible participant's contribution is kept confidential. 6. The ENP Provider shall establish written procedures to protect contributions and fees from loss, mishandling, and theft (i.e. Contribution/Donation Procedures). Such Procedures shall be kept on file for DAAS review. 7. All contributions and fees shall be identified as program income and used to increase the number of meals served, to facilitate access to such meals, and to provide nutrition- related supportive services. E. "No Soliciting" Sign: 1. The ENP Provider shall ensure that a "No Soliciting" sign is posted on the door leading to the congregate nutrition site. No soliciting of any kind is permitted on the premises during the lunch hours for services or goods promoted by businesses. F. Coordination: 1. If applicable, develop a fair and equitable policy and procedure for referring participants to the appropriate transportation provider for securing public transportation to and from nutrition sites and have the policy available for review by DAAS. 2. Include the following statement on all advertising, brochures, poster, etc., "Funding for this service has been provided by the San Bernardino County Department of Aging and Adult Services through a grant award from the California Department of Aging." Page 12 of 14 ATTACHMENT A 3. Coordinate service with other County departments and local agencies by providing time for presentations or special activities that promote a community based system of care for the participants attending nutrition sites. G. Reporting: 1. All fiscal and program data must be reported monthly (i.e. Request for Reimbursement, Rosters, Monthly Service Unit Report, etc.). All reports are due to DAAS by the 5'" business day of the month following the month of service. DAAS will provide training as needed. 2. The Provider shall maintain support files including, but not limited to, invoices, payroll, Client Intake Sheets, and any other supporting documents to substantiate monthly reports. 3. ENP Providers are required to report all known or suspected cases of elder abuse to DAAS Adult Protective Service or law enforcement immediately by telephone. A written report must be sent within two (2) working days. Abuse of an elder or dependent adult means physical abuse, neglect, intimidation, cruel punishment, fiduciary abuse, abandonment, isolation, or other treatment resulting in physical harm or pain or mental suffering or the deprivation by a care custodian of goods or services which are necessary to avoid physical harm or mental suffering. 4. Maintain records, by month, that support claimed in-kind expenditures. 5. Report expenditures funded with Deferred Income by September 30' of the FY in which it is being claimed. 6. Develop and have on hand for review by DAAS, a cost allocation plan which explains the methods used to allocate costs between congregate and home-delivered meals or any other program funded by DAAS. 7. In the event additional funds become available, the Provider will use the funds to increase the number of meals being provided to participants by either increasing the number of individuals attending its present sites, or by opening new sites in communities not already served by the Provider. Exceptions to this requirement must be fully documented in writing and submitted to the Director of DAAS for prior approval. 8. Other Reporting Requirements: a. SAMS (Social Assistance Management System): 1) The following reports are to be completed and submitted to DAAS by the 5 business day of the month following the month of service if the Provider is serving less than 500 clients per month: i. Client Intake Sheets for any new clients or any annual or quarterly assessments completed in the month. ii. Meal Rosters 2) Providers that are serving more than 500 clients shall secure the appropriate licensing, have a dedicated staff responsible for maintaining the client tracking software, obtain and maintain an Internet Service Provider and the appropriate hardware that can support the program. These Providers shall be responsible for entering the following data into SAMS by the 5' business day of the month following the month of service: i. Client Intake Sheets for any new clients or any annual or quarterly assessments completed in the month. ii. Rosters iii. Routes (if applicable) 9. Nutrition Education Monthly Service Unit Report a. The Nutrition Education Monthly Service Unit Report is a tool that is used to report the number of Nutrition Education service units that have been provided to participants. This report is to be completed and submitted to DAAS by the 5`" business day of the month following the month of service. Copies of any Page 13 of 14 ATTACHMENT A handouts presented to the participants as a component of the Nutrition Education shall be attached to the Nutrition Education Monthly Service Unit Report. H. Disposal of Equipment: 1. If the Provider wishes to dispose of equipment purchased with Nutrition grant funding, they must submit a request, in writing, to DAAS. The request shall state the equipment description, the location of the equipment, and the reason for disposal. 2. Provider shall submit a list of equipment purchased with grant funding by location. I. Quarterly Meetings 1. Provider is required to attend all Quarterly Nutrition Provider meetings hosted by DAAS. J. OTO Purchases Food Meal no-Time-Only Purchases: Steamer Trays Freezer Purchase of non-Equipment(under$5000 per unit) $4,804 $3,300 $3,928 Page 14 of 14 ATTACHMENT B COUNTY OF SAN BERNARDINO NUTRITION SERVICES PROGRAM BUDGET-March 27,2012 Provider:City of San Bernardino Fiscal Year: 2011/2012A1 CONGREGATE SITES C-1 ® HOME DELIVERED MEALS C-2 Section I: Prepare this section based on annual estimated costto serve the meals. A I b C=a+b Cost to Provider for the year Expenditure Category: Cash In-Kind Annual Expense 1 Personnel 132,207 36,300 168,507 2 Staff Travel&Training 1,000 1,000 3 Equipment 12,032 12,032 4 Consultants 15,500 15,500 5 Catered Food 6 Raw Food 125,343 10,000 135,343 7 Other Expenses: a. Consumable Supplies 16,280 1 16,280 b. Insurance c. Repair&Maintenance 5,738 5,738 d. Rent/Building Space e. Utilities 21,929 21,929 I. Vehicle Operations 5,000 5,DD0 g. Miscellaneous 3,088 3,088 8. Indirect Cost O 9. Nutrition Education 1,065 1,065 Total Expenditures(add lines 1-9) 317,253 68,229 385,482 Revenue Sources: Federal/State/County funds 267,253 267,253 Program Income 40,000 40,000 Deferred Income Matching Cash Matching In-Kind 68,229 68,229 Non-Match Cash _ 10,000 10,000 Non-Match In-Kind Total Revenue 385,482 385,482 Section II: Prepare this section based on estimated number of meals that will be served multiplied by meal cost per unit. D E f=d-e Estimated annual number of Proposed meal cost per unit Annual Budget meals 46,152 $5.53 $255,221 Submitted by: DAAS Apprmal: Name Date Signature Date Page 1 of 1 ATTACHMENT SAN BERNARDINO COUNTY DEPARTMENT OF AGING AND ADULT SERVICES REQUEST TO PURCHASE PROPERTY/EQUIPMENT This form is to be completed whenever a contractor is requesting to purchase property or equipment under a California Department of Aging(CDA)grant. Contractor must obtain a minimum of three(3)bids and attach an Equipment Bid Form for each item requested. Date: FY: Contractor Name: Address: Contact: Phone No: Item(s)Requested (attach additional sheet if required: QTY DESCRIPTION AMOUNT FUNDING SOURCE I Explain how requested item(s)will be used to carry out the objectives related to the funding to be received (attach additional sheet if required): Administrative Use Only: Approved❑ Denied ❑ Value over$5000/unit: Yes❑ No❑ Inventory: Yes❑ No ❑ Program Review by: Name Title Date Director Approval : Date Page 1 of 1 ATTACHMENT O SAN BERNARDINO COUNTY DEPARTMENT OF AGING AND ADULT SERVICES PROPERTY/EQUIPMENT BID FORM Fund Source: Contractor Name: Contact: Address: Phone: Item Description: Date of Bid: Date of Bid: Date of Bid: Vendor: Vendor: Vendor: Contact: Contact: Contact: Phone: Phone: Phone: Cost per unit: Cost per unit: Cost per unit: Number of units: Number of units: Number of units: Total Cost: Total Cost: Total Cost: Comments: Comments: Comments: Page 1 of 1