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HomeMy WebLinkAbout1995-101A:\SUMMER.SER ORDINANCE NO q�l AN ORDINANCE OF THE CITY OF DENTON, TEXAS, AUTHORIZING THE CITY MANAGER TO EXECUTE ALL DOCUMENTS AND AGREEMENTS, AS REQUIRED, TO OBTAIN FUNDING FOR THE 1995 SUMMER FOOD SERVICE PROGRAM; AUTHORIZING THE EXPENDITURE OF FUNDS TO ADMINISTER THE PROGRAM; AND PROVIDING AN EFFECTIVE DATE. WHEREAS, the City of Denton, Texas will submit an application for funding under the National School Lunch Act, to the Texas De- partment of Human Services for the purpose of making meals avail- able to eligible children at the City's Summer Action Site pro- grams; and WHEREAS, pursuant to the grant, if received, the City will con- tract with the Denton Independent School District to provide the meals at the various sites; NOW, THEREFORE, THE COUNCIL OF THE CITY OF DENTON HEREBY RESOLVES: SECTION I. That the City Manager is hereby authorized to execute, on behalf of the City, an application for funding under the National School Lunch Act, and if funded, the Summer Food Ser- vice Program Agreement with the Texas Department of Human Services, a copy of which is attached hereto and incorporated by reference herein. SECTION II. That the City Manager is hereby authorized to execute a contract with the Denton Independent School District to provide meals for eligible individuals at the various sites, and such certifications as are necessary to carry out the 1995 Food Service Program, and to handle all fiscal and administrative matters relating to the application and the program. SECTION III. That the expenditure of funds necessary to administer the 1995 Summer Food Service Program is hereby authorized. SECTION IV. That this ordinance shall become effective immed- iately upon its passage and approval. // PASSED AND APPROVED this the !014 day of 1995. AGREEMENT TO FURNISH FOOD SERVICE CITY OF DENTON and DENTON INDEPENDENT SCHOOL DISTRICT FOOD SERVICES THIS AGREEMENT is made and entered into by and between the Denton Inds ndent School and the City of Denton. Denton Indeoendent School District agrees to supply unitized meals inclusive of milk and juice to the City of Denton Parks and Recreation Department at the MLK Recreation Center, Phoenix Park, Denia Park, Civic Center Park, Owsley Neighborhood, TWU Playhouse Program, Village East Apartments, Rivera Elementary Summer School, and Wilson Elementary Summer School, with and for the rates herein listed: Breakfasts ...... $ 0.00 each Lunches ........ $ 1.50 each Snacks ........ ..$ 0.00 each Supper ......... $ 0.00 each It is further agreed that the Denton Independent School District, pursuant to the provisions of the Summer Food Service Program Regulations, a copy of which is attached as Exhibit "A" and is part of this agreement, will assure that said meals meet the minimum requirements as to nutritive value and content as outlined in the U. S.D. A.'s Sponsor Meal Preparation Handbook, and will maintain full and accurate recordings of such, including the following: 1. Menu Records, including amount of food prepared. 2. Meals, including daily number of meals delivered by type. These records must be reported to the institution promptly at the end of each month. Denton Independent School District agrees also to retain records required under the preceding clause for a period of three years and 90 days after the end of the fiscal year to which they pertain (or longer, if an audit or litigation is in progress); and upon request, to make all accounts and records pertaining to the program available to representatives of the U.S. Department of Agriculture and the General Accounting Office for audit or administrative review at a reasonable time and place. The Denton Ind --dent School District agrees to comply with the requirements of the Immigration Reform Control Act of 1986 regarding employment verification and retention of verification forms for any individuals hired after November 6, 1986 who will perform labor or services under this contract. The agreement shall be effective as of May30, 1995. It may be terminated by notice in writing given by any party hereto to the other parties at least 30 days prior to the date of termination. IN WITNESS WHEREOF, the parties hereto have executed this agreement as of the dates indicated below: Agre( Spon Title Agreed to this date 4- 2 5- 9 5 �} Da J s64 School Sponsor J� Title DISD School Board President . Duparin en1 an Samos$ SUMMER FOOD SERVICE PROGRAM APPLICATION FOR PARTICIPATION NOTE: Give as much information as possible. Attach additional sheets If needed; please Identify each attachment with the name of the contracting organization. cenuCAO 1A,Cr%0UATInM Form 15061, 95 FOR DNS STAFF ONLY Tx No. EN. ate Fv Approved For ❑ Breakfast ❑ A.M.Supp. ❑ Lunch P.M. Supp. ❑ Supper ❑ All traUkq Orpanlzation Name Vendor 10 No. Telephone NO. Honino No. Cit of Denton 17560005146015 (817 ) 566-8125 (817) 566-8125 ng Address (Street or P.O. Box, Ciry, State, ZIP) 321 E. McKinney Denton, Texas 76201 .at Address IN dWennl) no of Adminlslrator rnl. Children's Programs Supervisor Brenda Burton ontractor Classification (Check all that apply): Academic Year National Unit of Government -Contractor certifies that all food National Youth Sports Program ❑ Youth Sports Program ® service sites are operated directly by the contractor. Residential/Nonresidential Continuous Calendar School Food Authority ❑ Summer Camp ❑ School Year ❑ Private Non-profit s your program a year-round program? ......................................... © Yes ❑ No .......................................... Type of Contractor: Public Entity (explain): City Agency Is your agency considered to be state ownedloperated?.................................................................... [:]Yes Q No Do you deposit your program reimbursement directly into the State Treasury? ........................................ 0 N/A ❑ Yes ❑ lto Do you deposit your program reimbursement into a local bank? ... _ .... ... ........... . 0 N/A ❑ Yes ❑ No It yes, is it direct deposit? ............... . . .... .. .... ....... ....... ❑ Yes ❑ No Private Nonprofit Organization -Tax-exempt status established. Attach letter of determination (IRS 501-30) of tax-exempt status from IRS. Do you deposit your program reimbursement into a local bank? ................. I .. ............ .... - -. .......... Q N/A [:]Yes ❑ No If yes, Is it direct deposit? ....... ........ ............... .......................................................... ❑ Yes ❑ No oes the organization provide an ongoing year-round service to the community that is to be served by - e Summer Food Service Program (SFSP)?. ....- .............................................. .. .......... ...... ®Yes ❑ No no. which of the following circumstances applies? ❑ Residential Camp E. Failure to operate would deny program to a poor area ❑ Serves Migrant Children ❑ Failure to operate would deny a significant number of children access to program Does the organization receive $100,000 or more in federal funds yearly? ................... ..............I............... ®Yes ❑ No Does the organization receive more than $25.000 but less than $100,000 in federal funds yearly? .... ................... ❑Yes EI No Attach a copy of the audit covering last year's program operation or documentation that an audit conforming with SFSP policy will be conducted, including the date it will be conducted. saTlnp gqiM zoqaazta SITSST T 104PUTp1000 saDTAzas poo; sa;eutpz000 Islzod-az aledajd salts m ruoTssas BuTwtvaq sgonpuo0 zojOaITC S3LLna WVtlDOtld 301MRS 000� 01d103dS i.__.. 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For Operational Costs?.......................................................................................... ❑Yes 7 No 2. For Administrative Costs?......................................................................................... ❑ Yes ❑ No meal service Is self -preparation, do you want to receive commodities?................................................... x Yes ❑ No yes, Form 1608, Application and Agreement for Commodities, must be completed. :TION IV —PROGRAM OPERATION Beginning and Ending Dates of Meal Service: From May 30, 1995 through August 11, 1995 Numberof sites: ........................................... .......................................... ................... 9 st dates and topics of SFSP training: DATES TOPICS 5 25 95 Site su ervisor and monitor training on S.F.S.P, guidelines the organization planning to contract with a food service management company r the preparation of unitized meals? ...................... ............ ❑Yes No yes, and the contract will exceed $10,000, attach a copy of the invitation to bid. Also give: ate of Bid Publication Place of Publication Date of Bid Opening Tuna of Brd Opening bid expected to be $100.000 or more? It yes, give place of bid opening: n Yes ❑ No o, attach a copy of an 11-day-cycle menu including all specific menus to be used. the organization contracting with a year-round food service management company? ..................................... ❑Yes Q No yes, submit a copy of your procurement procedures, bid, contract, and all amendments. ach a copy of the letter which has been (or will be) sent by the organization to the Health Department notifying them of intent to operate a -od Service Program at the site(s) indicated on the attached Site Information sheet (Form 1507). ,TION V—ASSURANCES ,ee Meal Policy Statement The contracting organization assures the Texas Department of Human Services (DHS) that all children at the sites described on the Site(s) Information Sheets for the Summer Food Service Program, will be offered the same meals with no physical segregation of, or other discrimination against, any child because of race, color, disability, age, sex, national origin, religion, or political beliefs. No separate charge will be made for any meal except in accordance with attachment B of this application. The contracting organization assures DHS that, If it is sponsoring camps or other enrollment programs: • The contracting organization has or will obtain family size and Income data about all children whose meals will be reported as free or reduced -price; and • The children claimed as free or reduced -price meet the current family size and Income standards set by the United States Department of Agriculture, DHS Form 4504, Standards for Determining Free and Reduced -Price Eligibility. 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I. MUTUAL AGREEMENTS The Parties mutually agree: A. If the contractor fails to provide services in accordance with the provisions of this contract, the Department may, upon written notice of default to the contractor, immediately terminate the whole or any part of this contract and refuse to pay claims for reimbursement. Such termination and/or refusal to pay claims for reimbursement shall not be exclusive remedy but shall be in addition to any other rights and remedies provided by law or under this contract. B. If federal and state laws or other requirements are amended or judicially interpreted so that the continued fulfillment of - this-- contract; otr the part of either party, is substantially unreasonable or impossible, or if the parties are unable to agree upon any amendment which would therefore be needed to enable the substantial continuation of the services contemplated by this contract, then the parties shall be discharged from any further obligations created under the terms of this contract, except for the equitable settlement of the respective accrued interest or obligations, including audit findings, incurred up to the date of termination. C. This contract may be canceled by mutual consent. However, if such mutual consent cannot be attained, then and in that event, either party to this contract may consider it to be canceled without cause by giving thirty (30) days notice in writing to the other party and this contract shall thereupon be canceled upon the expiration of such thirty (30) day period. Nothing in this paragraph shall be construed to prohibit immediate cancellation pursuant to above paragraphs A and/or B. II. CONTRACTOR PROGRAM ADMINISTRATION AND FINANCIAL MANAGEMENT A. The contractor will comply with the SFSP Federal Regulations (7 CFR, Part 225, as amended), Uniform Federal Assistance Regulation (7 CFR, Part 3015, as amended), and state policies and procedures as issued and amended by TDHS. The contractor further agrees to perform as described in its application (including supporting documents and approved amendments to the application) for participation in the SFSP. B. The contractor accepts final administrative and financial responsibility for food service operations at each site sponsored by the contractor. This responsibility includes the performance oUthe cond+tions. of eetdetnent.of.aay audit.exceptions or payment deficiency in the program and the collection and repayment of -any -amount -paid in excess of the proper claim amount which are found after monitoring or auditing by TDHS or the United States Department of Agriculture (USDA). This responsibility applies to this contract, and all subcontracts hereunder. C. The contractor will apply to TDHS for approval of changes to its original application and for prior authorization for field trips if meals served on the field trips will be claimed for reimbursement. Requests for changes and field trip authorization must be received by TDHS at least five (5) calendar days before the requested effective date for the change or the field trip. Contractors will notify TDHS within five (5) days of the termination of an approved food service site. SFSP RECORD KEEPING A. The contractor will keep financial and supporting documents, statistical records, and any other records pertaining to the services for which a claim is submitted. The records and documents will be kept for at least three (3) years and ninety (90) days after the termination of the contract period. If any litigation, claim, or audit involving these records begins before the stipulated time period expires, the contractor will keep the records and documents for not less than three (3) years and ninety (90) days after the termination of the contract period and until all litigation, claims or audit findings are resolved. The case is considered resolved when a final order is issued in litigation or a written agreement is signed by TDHS and the contractor. Extensions are considered as separate contract periods. B. The contractor and its subcontractors will allow TDHS and USDA officials and other appropriate officials determined by TDHS to inspect facilities and records and to audit, examine, and copy records at any reasonable time. This includes access to all records of costs paid, even in part, by TDHS. Non School Sponsors - Page 2 IV. CIVIL RIGHTS POLICY COMPLIANCE A. The contractor agrees to comply with Title VI of the Civil Rights Act of 1964 (Public Law 88-352), and all requirements imposed by the regulations of the Department of Agriculture (7 CFR, Parts 15, 15a and 15b) Department of Justice (28 CFR, Parts 42 and 50) and USDA and TDHS directives or regulations issued pursuant to that Act or the regulations, Section 504 of the Rehabilitation Act of 1973 (Public Law 93-112), The Americans with Disabilities Act of 1990 (Public Law 101-336), and all amendments to each, and all requirements imposed by the regulations issued pursuant to these acts. In addition, the contractor agrees to comply with Title 40, Chapter 73, of the Texas Administrative. Code. These provide in part that no persons in the Untied States shall, on the grounds of race, color, national origin, sex, age, disability, political beliefs or religion be excluded from participation in, or denied, any aid, care; service or other benefits provided by federal and/or state funding, or otherwise be subjected to discrimination under any program or activity for which the contractor receives federal financial assistance from TDHS and USDA: and hereby gives assurance that it will immediately take any measures necessary to effectuate this agreement. B. The contractor agrees to comply with Texas Revised Civil Statutes Article 4419b4, Sections 5.03 and 5.04 (relating to workplace and confidentiality guidelines regarding AIDS and HIV). C. This assurance is given in consideration of and for the purpose of obtaining any and all federal financial assistance, grants and loans of federal fund, reimbursable expenditures, grant or donation of federal property or interest in such property, the detail of federal personnel, the sale and lease of, and the permission to use, federal property or interest in such property or the furnishing of services without consideration or at a nominal consideration, or at a consideration which is reduced for the purpose of assisting the recipient, or in recognition of the public interest to be served by such sale, lease or furnishing of services to the recipient, or any improvements made with federal financial assistance extended to the contractor by TDHS. This includes any federal agreement, arrangement, or other contract which has as one of its purposes the provision of assistance such as food, cash assistance for the purchase of food, rental of food service equipment or any other financial assistance extended in reliance on the representation and agreements made in this assurance. D. This assurance is binding on the contractor, its successors, transferees, and assignees as long as it receives assistance or retains possession of any assistance from TDHS or USDA. The person whose signature appears an this contract is authorizedto make this assurance on behalf of the contractor. ►A TDHS CLAIMS PAYMENT TDHS will, subject to the federal appropriation and availability to TDHS of sufficient funds for the SFSP, make program payments to the contractor in accordance with the terms of this contract. No reimbursement shall be made for performance under this contract occurring prior to (a) the beginning effective date of this contract or (b) a later date established by TDHS based on the date of receipt of a fully executed copy of this contract. Non School Sponsors - Page 3 VI. CERTIFICATIONS A. Immigration Reform and Control Act of 1986 - The contractor agrees to comply with the requirements of the Immigration Reform and Control Act of 1986 regarding employment verification and retention of verification forms for any individuals hired after November 6, 1986, who will perform any labor or services under this contract. B. Regarding Debarment, Suspension, Ineligibility, or Voluntarily Exclusion For Covered Contracts - The contractor certifies, by execution of this agreement, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participating in this contract by any federal department or agency or by the State of Texas. By making -this certification -the contractor agrees to the following terms: 1. The above certification is a material representation of fact upon which reliance was placed when this contract was entered into. If it is later determined that the contractor knowingly rendered an erroneous certification, in addition to other remedies available to the federal government, the Department of Health and Human Services, United States Department of Agriculture or other federal department or agency, or the Texas Department of Human Services may pursue available remedies, including suspension and/or debarment. 2. The contractor shall provide immediate written notice to the person to which this certification is submitted if at any time the contractor learns that the certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 3. The words "covered contract," "debarred," "suspended," 'ineligible," "participant," "person," "principal," "proposal," and "voluntarily excluded," as used in this certification have meanings based upon materials in the Definitions and Coverage sections of federal rules implementing Executive Order 12549. Usage is as defined in the attachment. 4. The contractor agrees by submitting this certification that, should the proposed covered contract be entered into, it shall not knowingly enter into any subcontract with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the Department of Health and Human Services, United States Department of Agriculture or other federal department or agency, and/or the Texas Department of Human Services, as applicable. 5. The contractor further agrees by submitting this certification that it will include TDHS Form 2046 titled "Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion for Covered Contracts" without modification, in all covered subcontracts and in solicitations for all covered subcontracts. 6. A contractor may rely upon a certification of a subcontractor that is not debarred, suspended, ineligible, or voluntarily excluded from the covered contract, unless it knows that the certification is erroneous. A contractor must, at a minimum, obtain certifications from its covered subcontractors upon each subcontract's initiation and upon each renewal. UV Im EFFECTIVE DATE AND SIGNATURES For the faithful performance of the terms of this contract, the parties hereto in their capacities stated, affix their signatures and bind themselves. City of Denton Name of the Contracting Organization (Please Print or Type) Original signature of the autho of the contracting organization Lloyd Harrell Name of the authorized representative of the contracting organization (Please Print or Type) City Manager Title Please print or type, in the spaces provided above, the name and title of the authorized representative signing this agreement on behalf of the contracting organization. Effective Dates: QI TEXAS DEPARTMENT OF HUMAN SERVICES through Date: Revised February 1994 c - - "` c_.._, n F uP CERTIFICATIONS (continued) 7. Nothing contained in all the foregoing shall be construed 'to require establishment of a system of records in order to render in good faith the certification required by this certification document. The knowledge and information of a contractor is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. 8. Except for contracts authorized under paragraph 4 of these terms, if a contractor in a covered contract knowingly enters into a covered subcontract with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to:the federal ,goverment, Department of Health and Human Services, United States Department of Agriculture, or, other federal department or agency, as applicable, and/or the Texas Department of Human Services may pursue available remedies, including suspension and/or debarment. C. Regarding Federal Lobbying - This certification applies only to this contract and is a material representation of fact upon which reliance was- placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The contractor certifies, to the best of his or her knowledge and belief, that: 1. No federally appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, or the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement. 2. If any funds other than federally appropriated funds have been paid or will be paid to any person for influencing or attempting to _ influence. an officer employee of any agency, a member of congress, an officer or employee of Congress, or an employee of a member of Congress in connection with this federally funded contract, subcontract, subgrant, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. 3. The contractor shall require that the language of this certification be included in the award documents for all covered subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all covered subrecipients shall certify and disclose accordingly. The contractor certifies that all information submitted pursuant to this agreement Is true and correct. The contractor understands that the deliberate misrepresentation or withholding of information is a violation of this contract and may result in prosecution under applicable state and federal statutes. Voc S.� x�! Sonrsors - PnCt 5 Form 1s,.&Atucnment A SUMMER FOOD SERVICE PROGRAM FOR CHILDREN January 990 -,mat, swra. CIVIL RIGHTS QUESTIONNAIRE. CIV:'. RIGHTS ACT OF 1964 A. 1. Estimate, by raciallethnic group, the number of children that will participate in the program at each site. If the program consists __•___ ---- a...t _ nnrnhnr of rh;Ljmn by Stra and date of session: of several camp sesstvns. sw"„r M. r,,.,o,..,. w......-- - - - - -• - - SftE AMERICAN ALASKAN P� MACK HISPANIC WHITE f "'I nehool, ""' Nc.) INOIAN NATIVE 6LANOER 10 5 5 Elementary School School Fisiey 100 100 20 Elementary TO 35 e g or o0 IO U Clubhouse Program 10 IO en aPark10 Phoenix Park 50 30 to — Civic c Center Park MLK Recreation Center 20 10 20 Village East Apartments 2. Descn'be how this projection was made (.e.. based on comparative enrollment in sites, observation of students, student surnames, etc. Observation of neighborhoods B. Does the organization have specific membership requirements which result in the denial of [IYes 0 No program benefits to specific groups?............................................................... It yes, describe those requirements: C. what efforts will be made by the organization to contact minority and grass roots organizations about the opportunity to participate in the program? Posters displayed in neighborhoods, attend community meetings and public service announcements D. What other outreach stops will be taken by the organization to ensure that minorities in the area from which it draws its attendance will have an equal opportunity to participate in the program? S.F.S.P. information will be printed in spanish E. Has any federal agency notified the organization of non-compliance with the Civil Rights act of 1964? .............. ❑ Yes J No If yes, give details including dates, names, and results: ;!. REHABIUTATION ACT OF 1973 (Section 504) A. Does the contracting orcanization have any policies, practices, or architectural barriers that limit, deny, or ' Yes KJ No discourage participation in the program or employment by the contracting organization because of disability. If yes, explain: Fenn ISO$ / 4tlach, ni a . PAP t 3. Are there any policies or practices that result in unequal treatment in the delivery of benefits or services to participants, applicants, or employees according to disability? ................................. QYes tf��11 'U No If Yes, explain: Does the contracting organization employ 15 or more people? ......................................... � Yes EI.No N yes: 1. Enter the name and title of the coordinator who will work with DHS to ensure that Section 504 requirements are met. Name rise Brenda Burton Children's Programs Supervisor 2. Has the organization established grievance procedures that incorporate appropriate due process standards?..................................................................... ® Yes ❑ No If yes, do these procedures provide for the prompt and equitable resolution of complaints that allege an action prohibited by Section 504 of the Rehabilitation Act of 1973? ................. ® Yes ❑ No 3. Has the contracting organization informed the public of the right to file a complaint and ofthe filing procedure?.................................................................. ® Yes ❑ No If yes, briefly describe how the public was informed: There are nrigrerg and ft Py ra p ncrori throughout the City of Denton which acknowledges the City's compliance with the guidelines set by the EEOC, ADA, and the Civil Rights Act. These posters give instructions for filing a complaint. D. Has the organizaton taken steps to notify employees, participants, and applicants that the organization does not discriminate on the basis of disability?..................................................... ® Yes ❑ No If yes, do the people notified include those with impaired vision or hearing and members of unions or professional organizations holding collective bargaining or professional agreements with the contracting organization? ........... ® Yes ❑ No If yes, briefly describe how they are notified: The visually or hearing impared are notified through radio and television advertisgment. Also flyers, announcements, etc. are mailed _. Do all organization forms, publications, and recruitment materials which inform the public of program benefits and employment opportunities contain the assurance that the organ izationdoes not discriminate on the basis of disability? ...................................................................................7 Yes ❑ No If no, indicate steps being taken to comply with this requirement: Does the organization have a procedure to ensure that the remedial or corrective action has been or will be taken if non-compliance with non discrimination requirements is found by OHS, USDA, or the contracting © ❑ organization itself?............................................................................. Yes No If yes, explain: If not handled within the department in question, the City generally channels all complaints through the Legal Department. Form 1506/Artachment 8 SUMMER FOOD SERVICE PROGRAM FOR CHILDREN Page 2 COLLECTION OF PAYMENT OPTIONS FOR PROGRAMS THAT CHARGE :'PARATELY FOR MEALS (Camps and Other Enrollment Programs Only) COLLECTION PROCEDURE 1) Each day, children can buy tickets in the food service manager's office, but they do not receive the tickets. The food ser- vice manager sends the purchased tickets and tickets for free meal recipients to the site each day. The site supervisor distributes the tickets just before meal time. The tickets are coded for accounting purposes. COLLECTION PROCEDURE 2 Each day, children pay for their meals in an office. A list with the names of all children who paid or are eligible for free meals is prepared and sent to the meal service area. A staff member who knows the children checks the names as children pats though the receive their r e list oses. This method works mail site her eservice Of the meal, s where staff member knows all the'returned to the office for children accounting pu rp COLLECTION PROCEDURE 3 The site supervisor gives each child an envelope foirdaily, weekly, session or monthly Payments. Children return the envel- op" with the payments enclosed, or empty if eligible for free meals. The envelopes are collected in the office and coded tickets are issued to each child. COLLECTION PROCEDURE 4 Parents pay in advance by the month or session. Each site supervisor receives a list of those children who have paid. The site supervisor marks the list as paid for children who receive free meals. Only the bookkeeper knows which children receive a free most. The site supervisor keeps daily records of each child served and sends the records to the office for ac- counting purposes. COLLECTION PROCEDURE 5 Meal payments are collected in the office. Payments can be made by children or parents on a daily, weekly, session or monthly basis. The secretary records payments and knows which children qualify for free meals. At the sites, the secretary distributes identical tickets labeled only with the children's names. Since the parents may make payments, even children who receive free meals may not know whether their meals are free or paid. COLLECTION PROCEDURE 6 Parents are billed monthly or by session for paid meals their children are served. Parents mail in all payments. All participa- ting children receive a coded ticket each month, which is punched at each meal service. At the end of the month, the tic- kats are collected and a clerk calculates the amount to be billed. COLLECTION PROCEDURE 7 Other- Explain in detail (attach a sheet if more space is required). The contractor must ensure that this method prevents the overt identification of children receiving free meals. Form 15061Anacnment B SUMMER FOOD SERVICE PROGRAM FOR CHILDREN :anuary i9go ADDITIONAL ASSURANCES FOR CAMPS AND OTHER ENROLLMENT PROGRAMS THAT CHARGE SEPARATELY FOR MEALS As required in Section V of this application, the contracting organization assures the Texas Department of Human Services that: 1. The method of collecting meal payments will protect the anonymity of children who receive free meals. 2. The organization has or will establish a hearing procedure for families wishing to appeal a denial of an application for free meals, which provides the following: A. That a simple, publicly announced method will be used for a family to make an oral or written request for a hearing; B. That the family will have the opportunity to be assisted or represented by an attorney or other person; C. That the family will have an opportunity to examine the documents and records supporting the decision being appealed both before and during the hearing; 0. That the hearing will be reasonably prompt and convenient for the family; E. That adequate notice will be given to the family of the time and place of the hearing; F. That the family will have an opportunity to present oral or documentary evidence and arguments supporting its position. G. That the family will have an opportunity to question or refute any testimony or other evidence and to confront rid cross- examine any adverse witnesses; H. That the hearing will be conducted and the decision made by a hearing official who did not participate in the action being appealed; I. That the decision will be based on the documentary evidence presented at the hearing and made part of the record; J. That the family and any designated representative will be notified in writing of the decision: k. That a written record will be prepared for each hearing, which includes the action being appealed, any documentary evidence and a summary of oral testimony presented at the hearing, the decision and the reasons for the decision, and a copy of the notice sent to the family; and L That the written record will be maintained for a period of three years and 90 days following the conclusion of the hear- ing, during which it will be available for examination by the family or its representatives, and officials of the Texas De- partment of Human Services (TDHS), the United States Department of Agriculture and other relevant officials as deter- mined by TDHS at any reasonable time and piece. 3. If a family requests a hearing, the chiid(ren) will continue to receive free meals until a decision is rendered. Summer Food Service Program Sack Lunches Menus Eleven Day Cycle Tuesday - May 30 Peanut Butter/Jelly Sandwich Carrot Sticks Banana Lowfat Milk Wednesday - May 31 Bologna/Cheese Sandwich Carrot Coins Mixed Fruit Potato Chips Lowfat Milk Thursday - June 1 Tuna Salad Sandwich Pickle Spears Orange Juice Lowfat Milk 2 oz Peanut Butter, 1 T. Jelly, 2 slices Bread 1/4 cup 1/2 cup 1/2 pint 1 1/2 oz Bologna, 1/2 oz Cheese 2 slices Bread 1/4 cup 1/2 cup 1/2 pint 2 oz Tuna 2 slices Bread 1/4 cup 6 oz 1/2 pint Friday - June 2 Ham/Cheese Sandwich Whole Pickle Fruit Cup Cookie Lowfat Milk Monday - June 5 Deli Sandwich Pickle/Carrot Apple Lowfat Milk Tuesda - June 6 Peanut Butter/Jelly Sandwich Carrot Sticks Banana Lowfat Milk Wednesday - June 7 Deli Sandwich Pickle/Carrot Apple Lowfat Milk 1 1/2 oz Ham, 1/2 oz Cheese 2 slices Bread 1/4 cup 1/2 cup 1/2 pint 2 oz Meat 2 slices Bread 1/4 cup 1/2 cup 1/2 pint 2 oz Peanut Butter, 1 T. Jelly 2 slices Bread 1/4 cup 1/2 cup 1/2 pint 2 oz Meat 2 slices Bread 1/4 cup 1/2 cup 1/2 pint Thursday - June 8 Tuna Salad Sandwich 2 oz Tuna 2 slices Bread Pickle Spears 1/4 cup Orange Juice 6 oz Lowfat Milk 1/2 pint Friday -June 9 Ham/Cheese Sandwich 1 1/2 oz Ham, 2 slices Bread Whole Pickle 1/4 cup Fruit Cup 1/2 cup Cookie Lowfat Milk 1/2 pint Monday - June 12 Bologna/Cheese Sandwich Carrot Coins Mixed Fruit Potato Chips Lowfat Milk Tuesday - June 13 Deli Sandwich Pickle/Carrot Apple Lowfat Milk 1/2 oz cheese 1 1/2 oz Bologna, 1/2 oz Cheese 2 slices Bread 1/4 cup 1/2 cup 1/2 pint 2 oz Meat 2 slices Bread 1/4 cup 1/2 cup 1/2 pint CITY of DENTON, TEXAS May 1, 1995 MUNICIPAL BUILDING / 215 E. McKINNEY / DENTON, TEXAS 76201 Ms. Laurie Callahan, Registered Sanitarian Environmental Health Department 300 Woodrow Denton, Texas 76205 Dear Ms. Callahan, The Denton Parks and Recreation Department is applying to the Texas Department of Human Services for a grant to provide the Summer Food Service Program to the children of Denton. This program will provide lunch for children ages 1 - 18 years of age. The food preparation will be contracted with the Denton Independent School District. We will be serving sack lunches from igloos at the sites listed below. This is a request that your department inspect the locations of food service. Time of Site/Address Dates Lunch Service Civic Center Park 5/30/95 - 8/11/95 12:00pm-1:00pm 321 E. McKinney Phoenix Park 5/30/95 - 8/11/95 12:00pm-1:00pm Wood Street Owsley Neighborhood 5/30/95 - 8/11/95 12:00pm-1:00pm Stella Street Denia Park 5/30/95 - 8/11/95 12:00pm-1:00pm 1001 Parvin TWU Clubhouse 5/30/95 - 8/11/95 Mary Hufford Court Village East Apts. 5/30/95 - 8/11/95 1700 Village East Rivera Elem School 5/31/95 - 6/27/95 701 Newton Wilson Elem School 5/31/95 - 6/27/95 1501 Emerson MLK Recreation Center 6/28/95 - 8/11/95 1300 Wilson If you have any questions I may be reached at 566-8125. Brenda Burton Children's Programs Supervisor 12:00pm-1:00pm 12:00pm-1:00pm 11:45am-12:45pm 11:45am-12:45pm 12:00pm-1:00pm puBLIC SERVICE ANNOUNCEMENT FOR NON -ENROLLED SITES The Denton Parks and Recreation Department announces the sponsorship of the Summer Food Service Program. Meals will be provided at the sites listed. People who are eligible to participate in the program must not be discriminated against because of race, color, national origin, sex, age, disability, religion, or political belief. Anyone who believes that they have been discriminated against should write immediately to: Director, Civil Rights Division, MC-106, Texas Department of Human Services, P.O. Box 149030, Austin, Texas 78714-9030 or the Secretary of Agriculture, Washington, D.C. 20250. Note: Discrimination complaints based on religion or political beliefs must be referred only to the Director, Civil Rights Division, Texas Department of Human Services. Dates Si e May 30-Aug 11 Civic Center Park May 30-Aug 11 Denia Park June 28-Aug 11 MLK Rec Center May 30-Aug 11 Owsley Neighborhood May 30-Aug 11 Phoenix Park May 30-Aug 11 Rivera Elementary May 30-Aug 11 TWU Playhouse Prog Address 321 E. McKinney 1001 Parvin 1300 Wilson Stella St. 308 S. Ruddell 701 Newton Mary Hufford Court Time 12pm-lpm 12pm-lpm 12pm-lpm 12pm-lpm 12pm-lpm 11:45am-12:45pm 12pm-lpm Certification That All Required Pre -operational Site Visits Have Been Conducted At All Proposed Sites Name Of Person Name Of Site Visited Date Of Visit Wh—oVisited Site Civic Center Park April 140 1995 Brenda Burton Phoenix Park April 14, 1995 Brenda Burton Owsley Neighborhood April 14, 1995 Brenda Burton Denia Park April 14, 1995 Brenda Burton MLK Recreation Center April 14, 1995 Brenda Burton TWU Clubhouse April 14, 1995 Brenda Burton Village East Apts April 14, 1995 Brenda Burton Rivera Elementary April 14, 1995 Brenda Burton School Wilson Elementary April 14, 1995 Brenda Burton School Signature of Authorized Representative Date PUBLIC SERVICE ANNOUNCEMENT FOR ENROLLED SITES The Denton Parks and Recreation Department announces the sponsorship of the Summer Food Service program. Income Eligibility will be based on family size and income using the Standards for Determinig Free and Reduced -Price Eligibility, provided by the United States Department of Agriculture. Meals will be provided at the sites listed. People who are eligible to participate in the program must not be discriminated against because of race, color, national origin, sex, age, disability, religion, or political belief. Anyone who believes that they have been discriminated against should write immediately to: Director, Civil Rights Division, MC-106, Texas Department of Human Services, P.O. Box 149030, Austin, Texas 78714-9030 or the Secretary of Agriculture, Washington, D.C. 20250. Note: Discrimination complaints based on religion or political beliefs must be referred only to the Director, Civil Rights Division, Texas Department of Human Services. May 30-August 11 May 31-June 27 0 Village East Apts Wilson Elementary Address 1700 Village East 1501 Emerson Time 12pm-lpm 11:45am-12:45pm ***NOTICE*** The Summer Food Service Program is sponsored by the City of Denton, Parks and Recreation Department, and is offered through a federal grant which requires that sponsors apply each year to retain eligibility to offer the program. It is therefore, our declaration that the SFSP will be offered this summer, from May 30th through August 11 st, strictly as a PILOT PROGRAM, and that the City of Denton.. PARD, is in no way directly liable or responsible for the continuance of the program in the future. Texas DepaMunt Farm 15641 of Hunan SerAoss SPECIAL NUTRITION PROGRAMS Mal 191141 SINGLE AUDIT IDENTIFICATION DATA Contractor Name Contact Person City of Denton Brenda Burton Address (Street or P.O. Box. City. State. ZIP) 321 E. McKinney Denton, Texas 76201 Telephone No. vendor 10 No. Contract No. ( 817 ) 566-8125 17560005146015 Contractor Fiscal year End ("ddlyy) Type of Contrad For Profit Non -Profit ElGovernmental Check the aoorooriate box(es) to Indicate the tvoe(s1 of orooram(sl in which you currently narticinate or for whteh vnu ere annlvinn- COMMOOr Y ASSISTANCE PROGRAMS CASH REIMBURSEMENT PROGRAMS' A - National School Lunch AD - Adult Day Care B - Charitable Institutions BL- National School Lunch/Breakfast C - Area Agency on Aging ❑ CC - CACFP Center G - Summer Camps DH - CACFP Day Home ® H - Summer Food Service ❑ SF- Summer Food ❑ J - Jails ❑ SM - Special Milk K - Soup Kitchen TE - TEFAP I - TEFAP Commodities Give the source and amount of any federal financial assistance that see attached 'Jame (please ype or SOURCE receives other than from those programs listed above: Lloyd Darrell I City Manager AMOUNT ESTIMATED AMOUNTS TO BE RECEIVED FY95 FVQ S _ems Department Form 1506, Attachment C of Human servtc" February 1991 SUMMER FOOD SERVICE PROGRAM FOR CHILDREN CRIMINAL PROVISIONS AND PENALTIES 1. Whoever, in connection with any application, procurement, record keeping entry, claim for reimbursement, or other document or statement made in connection with the program, knowingly and willfully falsifies, conceals or covers up by any trick, scheme, or device a material fact, or makes any false, fictitious or fraudulent statements or whoever in connection with the program knowingly makes an opportunity for any person to defraud the United States or does or omits to do any act with intent to enable any person to defraud the United States, shall be fined not more than S10,000 or imprisoned not more than five years. 2. Whoever being a partner, officer, director, or managing agent connected in any capacity with any partner- ship, association, cooperation, business, or organization, either public or private, embezzles, misapplies, steals, or obtains by fraud, false statement or forgery, any benefits provided by the program, or any money, funds, assets, or property derived from benefits provided by this program, shall be fines not more than $10,000 or imprisoned for not more than five years or both. If the benefits, money, funds, assets, or property involved is not over $200, then the penalty shall be a fine of not more than S1,000 or imprisonment for not more than one year, or both. 3. If two or more persons conspire or colludeto accomplish any act made unlawful under this subsection, and one or more such person commit any act to effect the object of conspiracy or collusion, each shall 'be fined not more than $10,000 or imprisoned for not more than five years, or both. TERMINATION PROCEDURES The following list of deficiencies are grounds for termination. Grounds for termination, however, are not limited to this list: 1. Non-compliance with applicable bid procedures and contract requirements of Federal Child Nutrition regulations. 2. The submission of false information to the Texas Department of Human Services (OHS). 3. Program violations at a significant proportion of the sponsors' sites. Such violations include but are not limited to the following: A. Non-compliance with the meal service time restrictions. B. Failure to maintain accurate records. C. Failures to adjust meal orders to conform to the variations in the number of participating childrem. D. The simultaneous service of more than one meal to any child. E. Service of a significant number of meals which do not include required quantities of all meal components. F. The claiming of program payments for meals not served to participating children. G. Excessive instances of off -site meal consumption. H. Continued use of food service management companies that are in violation of health codes. ex" leperen0m Poem si0ti wue July 1tIa0 t Human Ser CERTIFICATE OF AUTHORITY This Is to certify that Name of Authorized Official (please type or print) Title Lloyd Harrell City Manager Signature —Authorized Is designated as the authorized representative of Name of Contracting Organization City of Denton Adoress (Street. city. State. ZIP) 321 E. McKinney Denton, Texas 76201 The representative designated above is authorized on behalf of the contracting organization to make written agree- ments with the Texas Department of HumAn Services to operate a food program, to sign documents or reports about the agreement, and to present claimreimbursement, when appropr06, to the department. of Contracting Agency DaW Name of Otftaal (please type or print) le T Lloyd Harrell City Manager OR DEPARTMENT OF HUMAN SERVICES USE ONLY: -;reement No Received By Date TX- 'e.as Department Form esos 11 Human Sen oft Juty tow CERTIFICATE OF AUTHORITY This is to certify that Name of Authorized Official (please type or print) Tnle Mark Shipman SFSP C3ordinator Signature —Authorized Official Is designated as the authorized representative of Name of Contracting Organization City of Denton Address (Street, City. State, 21P) 321 E. McKinney Denton, Texas 76201 I The representative designated above is authorized on behalf of the contracting organization to make written agree- ments with the Texas Department of Human Services to operate a food program, to sign documents or reports about the agreement, and to present claim or reimbursement, when appropriate to the department. Contracting Agency/ Date Name of Official (please type or print) Ti e Lloyd Harrell City Manager R DEPARTMENT OF HUMAN SERVICES USE ONLY: -eement No Received By TX - Date ex" Deparyryrm Form e69e Hulett Serrioea July 1990 CERTIFICATE OF AUTHORITY This is to certify that Name of Authorized Official (please type or print) Tate Brenda Burton Children`s Programs Supervisor &01� &::�� Signature—Authorzed Official Is designated as the authorized representative of Name of Contracting Organaatwn City of Denton Address (Street. City. State. LP) 321 E. McKinney Denton, Texas 76201 The representative designated above is authorized on behalf of the contracting organization to make written agree- ments with the Texas Department of Auman Services to operate a food pr gram, to sign documents or reports about the agreement, and to present cWFO for reimbursement, when appiate, to the department. 01 0 Name of Official (please y it or print) Title City Lloyd Harrell Y Manager OR DEPARTMENT OF HUMAN SERVICES USE ONLY: y,eement No. Received By I Date TX- rae Depr"anit Form INT mew Ind It's 341441o" SUMMER FOOD SERVICE PROGRAM FOR CHILDREN I = 01e UN ONLY SITE INFORMATION TXoil OU nr on FeW Somm See ehepnrr No. thne Village East Apartments (817) 566-8125 onss of (SaM1. Coy. State. ZIP) 1700 Village East Denton, Texas 76201 rod of Opwabon or Food SorAw (moJdayM _mjdayNr.) Number of 0 Mat' f�A" •►W AW. r": 5/30/95 through: 8/11/95 orating Days: 2 y 22 �21 4 9 4 TACH A MAP WITH THE SITE SERVICE AREA IDENTIFIED Residential Camp Site Serving Primarily Migrant Children DOW Site Indicate Type of Site: ❑ A. (serving one to four meals) ❑ C. (serving one to four meals) R❑ E. (serving one to lour meats) Nonresldantlal Camp Sb Servhg Pri nary Homeless Chgdnn ❑ B. (serving one to four meals) ❑ D. (serving one to four moms) List ALL counties served by this site: Denton A. Is your she open: ..................................................................................................... ❑Yes ®No B. Is your she enrolled?................................................................................................. ®Yes ❑ No C. Site Eligibility, Enter the percentage of children eligible for free andlor reduced price meals for the site (SFSP Handbook, Chapter II).... 100 % 0. If open sites, submit documentation supporting this percentage figure (such as census date, school data). For open sites using school data, list the schools used to document site eligibility; attach formula used by school dist to establish percentage of free 3 reduced price children. For enrolled sites, Form 1531 will be used to document eligibility. If the enrolled site used school data, list the school used to document the site: What is the percentage of free or reduced -price meals for the site? .................................................. 100 % Did the site participate in previous years' SFSP? (SFSP Handbook, Chapter 11).......................................... ©Yes ❑ No If Yes, give name of contracting organization: City of Denton monitonng Plan (SFSP Handbook, Chapter III): Enter date of monitoring review to be conducted within: A F,rS' wee. of Operation j 8. First Four weeks of Operation C. Addb" Reviews June 2 June 22 July 20 August 10 Neal Service Period Information (SFSP Handbook. Chaoter II): NUMBER OF TYPES OF MEALS ELIGIBLE CMLDREN TO BE SERVED' MEAL SERVICE TIME SEGINNMG ENDING Breakfast A.M. Supplement t Lunch 50 12:00 p.m. 1:00 P.M. P.M. Supplement Supper rg ..v..n.w„ .� wv.,..,.., .,� .....a .., v.. ,..,,.y ,.•..yy.v.w ,.c., A...P ..... �.a..a. ,wv,,,.,w,, v..ey.....� Do you plan to feed children under one (1) year old? ................................................ ............. ....... ❑Yes ©No . Method of Food Preparation by Contracting Organization (SFSP Handbook, Chapter 11) 'eii-pr"Wsi on I VeAOed Using School Using Food Service Management It on S`te 71 Centre! K11c11e- r4i�l Food Aatscrl�v r' r..r...a�v !ln,'.:• 0, a'l v.a• rr,1,3.4, Using Private Non -Profit ram 1Serp"62 Indicate the system to be used for the serving of meals and the supervision of children durkq meal service period. (SFSP Handbook. Chapter m Cafetods•style Children we Seated Children Line Up ❑ Meal Service ❑ and are Given Meals © and Pick Up Meals ❑ Other: List site personnel who will be involved to any extent in the meal service. (SFSP Handbook, Chapter In: TITLE OF POSRION NO. at POSMON SPECIFIC FOOD SERVICE PROGRAM OUT1ES Site Supervisor 1 Su ervis ten era Site Helper/Server 1 Assist site supervisor Indicate what provisions will be made for meal service during periods of inclement weather. (SFSP Handbook, Chapter II) ® Meal Meal Service ❑ Will Be Cancelled ❑ Other: If the site feeds primarily homeless children, what methods are used to ensure that money, food stamps, or in -kind services are not required for meats? N/A 3. Are meals delivered to the site?........................................................................................... Q Yes ❑ No IF YES, COMPLETE ITEMS 14,15, 3 16. IF NO, FORM IS COMPLETE EXCEPT FOR CERTIFICATION AT BOTTOM. Indicate the means of communication with the vendor which Mnll be used to adjust meal deliveries. (SFSP Handbook, Chap. II) Site Personnel Will Contact Administrative Site Personnel Will Communicate ® Staff, Who Will Contact Vendor ❑ Directly With Vendor Will delivery be within one hour of the food service period? (SFSP Handbook, Chapter 11)...................................... ©Yes ❑ No If no, describe arrangements within standards prescribed by local health authorities for delivery and holding of meals until time of service. If there is an excess of meals delivered, meals will be (SFSP Handbook, Chapter 111) Stored in Refrigerator Thrown Away Returned to Vendor © and Served the Next Day ❑ at the Site for Disposal ❑Other. ERTIFY he information on this form is true rrect to the best of my knowledge. I certify that this site has been visited and that s the abili and facilities for a meal sere ned for the number of children anticipated. I know that deliberate misrepresentation o- ^nhold' ,g o formation may/re iyr�roseyu der applicable stWI#Qd federal statutes. v am 01 on" (plea" type a ity of Denton Lloyd Hatrell I City Manaaer FOR I ❑Approved ❑Dented, reason: OHS USE Tpe ONLY Sgnatse-OHS Reprcsental" Date uus DeoerVnent Hyena services SUMMER FOOD SERVICE PROGRAM FOR CHILDREN SITE INFORMATION Phoenix Park W4 2 limot► Wood Street Denton, Texas 76201 wed CO OPembon at Food SONIC. (moldayly.-MJayM.) ►ran � JuN AWSept. 5/30/95 8/11/95 Number of Op 422 21 9 �rom: through: araUng Days: ITACH A MAP WITH THE SITE SERVICE AREA IDENTIFIED Residential Camp Site Serving Primarily Migrant ChUdren Other site Indicate Type of Site: ❑ A. (serving one to four meals) ❑ C. (serMrg one to tour mash) Q E. (serving one to but meals) Nonresidendal Camp site Serving Primarily ftnekms CNdnm ❑ B. (serving one to but meal:) ❑ D. (serving one to bur mesh) 1. List ALL counties served by this site: Denton A. Is your site open: .................................................................................................... © Yes ❑ No B. Is your site enrolled?................................................................................................. ❑ Yes Q No C. Site Eligibility: Enter the percentage of children eligible for free w4or reduced price meals for the site (SFSP Handbook Chapter II).... 31 % D. If open sites, submit documentation supporting this percentage figure (such as census date, school data). For open sites using school data, list the schools used to document site eligibility: attach formula used by school dist. to establish percentage of free & reduced price children. N/A E. For enrolled sites, Form 1531 will be used to document eligibility. If the enrolled site used school data, list the school used to document the site: F. What is the percentage of free or reduced price meals for the site? ............................. .................... 100 % Did the site participate in previous years' SFSP? (SFSP Handbook, Chapter II) .......................................... ®Yes ❑No !f Yes. give name of contracting organization: Monitonng Plan (SFSP Handbook, A Firs' Week of gyeratmon I t JuneL I Citv of Denton Enter date of monitoring review to be conducted within: Meal Service Period Information (SFSP Handbook. Chapter 11): I NUMBER OF TYPES OF MEALS ELIGIBLE CHILDREN TO BE SERVED* MEAL SERVICE TIME BEGINNING ENDING Breakfast A.M. Supplement I Lunch 90 12:00 P.M. 1:00 P.M. P.M. Supplement Supper TMs Norn%abon a oonsdered by OHS when sorting the approved anal service level. (SFSP Handbook. Chaplet Ip Do you plan to feed Children under one (1) year old?..................................................................... ❑Yes C] No Method of Food Preparation by Contracting Organization (SFSP Handbook, Chapter 11) see•PreparNcn Vended Using School Using Food Service Management Using Private Non -Profs r: L. Ciy r l`=.. r.31 j(1..6�n �' :nn� � i.�_.: �, � n_..,-,.� ^...i .,/�e E" Vie. r__,_., r-•� n._.. .., __ ,�., ., c.. �,�_ Fore IWO'Spe t 9. indicate the system to be used for the serving of meals and the supervision of Children during meal service period. (SFSP Handbook, Chapter m Caleteda-style Children are Seated Children Line Up ❑ Meal Service ❑ and are Gwen Meals ©and Pick Up Meals ❑ OUIer: 0. List site personnel who will be Involved to any extent in the meal service. (SFSP Handbook, Chapter 10: TITLE OF POSrrION NO. IN POSmoN SPECIFIC FOOD SERVICE PROGRAM OUMS Site Supervisor 1 Supervise and maintain mpal temperature. Site Helper/Server 1 Assist site supervisor Indicate what provisions will be made for meal service during periods of inclement weather. (SFSP Handbook, Chapter II) Indoor Meal Meal Service ®Service ❑ Will BeCancelled ❑Other: If the site feeds primarily homeless children, what methods are used to ensure that money, food stamps, or in -kind services are not required for meals? N/A 3. Are meals delivered to the site?........................................................................................... [D Yes ❑ No IF YES, COMPLETE ITEMS 14,15, & 16. IF NO, FORM IS COMPLETE EXCEPT FOR CERTIFICATION AT BOTTOM. 4. Indicate the means of communication with the vendor which will be used to adjust meal deliveries. (SFSP Handbook, Chap. II) Site Personnel Will Contact Administrative Site Personnel Will Communicate ®Staff, Who Will Contact Vendor ❑Directly With Vendor Will delivery be within one hour of the food service period? (SFSP Handbook, Chapter II) ...................................... ©Yes ❑ No If no. describe arrangements within standards prescribed by local health authorities for delivery and holding of meats unfit time of service. If there is an excess of meals delivered, meals will be (SFSP Handbook, Chapter III) Stored in Refrigerator Thrown Away Returned to Vendor ©and Served the Next Day ❑at the Site zfor Disposal ❑Other. ERTIFY the information o this form is correct to the best of my knowledge. I Certify that this site has been visited and tha:.- �s the b' fly and facili 'es I r the meal se anned for the number of children anticipated. I know that deliberate misrepresentation c- �nhoidi information ay in p os ti un er applicable state and federal statutes. 1 Named trecfxV Orgarazabon to qs- City of Denton Spnatvrart,am of Contraawv Orpanra game of U n w (press type or poor) Harrell FOR CApproved ❑Denied, reason: OHS USE ONLY Spnaaxe-DMS Representawe Date City Manager . I w OaFerMert Ferro 1adT am0a teW aa"a" airiOO" SUMMER FOOD SERVICE PROGRAM FOR CHILDREN Ftm DW Usl (fty SITE INFORMATION TX R OU vne or Foo SAe TOWPI ar No. lrrc MLK Recreation Center (817) 566-81 5 area of t. Cay. Sue.ZIP) 1300 Wilson Denton, Texas 76205 nod of Operation or Food savior (roomy yr.-MidayM.) Number of Op- May 2 kq9 ept. • 6/28/95 through: 8/11/95 eIn9 y rat Da s: 1 .3MIN: 4 — - TACH A MAP WITH THE SITE SERVICE AREA IDENTIFIED Residential Camp Site Serving Primarily Migrant Children Other She Indicate Type of Site: ❑ A (servkg one to tour meals) ❑ C. (sm* one to tour meals) 0 E. (serving one to bur meats) Nonresidential Camp Site Serving PrI early Homeless Children ❑ B. (serving one to bur meats) ❑ D. (serving one to tour meals) . Ust ALL counties served by this site: Denton A. Is your site open: .................................................................................................... ®Yes ❑No B. Is your site enrolled?................................................................................................. ❑Yes ®No C. Site Eligibility: Enter the percentage of children eligible for free andifor reduced price meals for the site (SFSP Handbook Chapter II).... 31 % 0. If open sites, submit documentation supporting this percentage figure (such as census date, school data). For open sites using school data, list the schools used to document site eligibility; attach formula used by school dist. to establish percentage of free 3 reduced price children. E. For enrolled sites, Form 1531 will be used to document eligibility. If the enrolled site used school data, fist the school used to document fine F. What is the percentage of free or reduced -price meals for the site? ............................... .................. 100 % Did the site participate in previous years' SFSP? (SFSP Handbook, Chapter II) .......................................... ®Yes []No If Yes, give name of contracting organization: City of Denton Plan (SFSP Handbook, Chapter 111): Enter date of monitoring review to be conducted within: June 2 1 V- -.Tune 2 J y-20 August 10 Waal Service Period Information (SFSP Handbook. Chapter II): i NUMBER OF TYPES OF MEALS EUGIBLE CHILDREN TO BE SERVED* MEAL SERVICE TIME BEGINNING ENDING Breakfast A.M. Supplement Lunch 90 12:00 p.m. 1:00 P.M. P.M. Supplement Supper ' Tnra nreflne" rf 00AS411 a Dy IJnA when "FUV v •PP W meal aer �Wl. iQ101 nr Do you plan to feed children under one (1) year old?..................................................................... ❑Yes E]No Method of Food Preparation b e._. 1___..r 7 On Site r, Cents' KRche^ Organization (SFSP Handbook, Chapter 'a Using School Using Food Service Management Using Private Non -Profit , ' hr r' ro,A JOBi r.. _,,,�. n,.,.�:.a.. All V•,• n nr..e.t.,': ....Fel 1. Ca" D... Fw m Isosi►aee t 9. Indicate the system to be used for the serving of meals and the supervision of dd&oi durft meal service period. (SFSP Handbook. Chapter 11) ❑caltyle Children we StaW Children Lim Itleal�Serrvice ❑ and are Given Meals Eland Pick Up ❑ Other: 0. List site personnel who will be Involved to any extent in the meal service. (SFSP Handbook. Chapter 10: TITLE OF PosrnoN No. Of PosmoN SPECIFIC FOOD SZRVICE PROGRAM DUTIES Site Supervisor 1 Supervise and maintain mpall tea era Site Helper/Server 1 Assist site supervisor Indicate what provisions will be made for meal service during periods of inclement weather. (SFSP Handbook, Chapter II) ce ®11111411001 mew Meal Seri ❑WWIIIBeCancelled ❑Other If the site feeds primarily homeless children, what methods are used to ensure that money, food stamps, or in -kind services are not required for meals? N/A Are meals delivered to the site? .................................................................................. .. run Yes ❑ No IF YES, COMPLETE ITEMS 14,1S, & 16. IF NO, FORM IS COMPLETE EXCEPT FOR CERTIFICATION AT BOTTOM. Indicate the means of communication with the vendor which will be used to adjust meal deliveries. (SFSP Handbook, Chap, II) Site Personnel Will Contact Administrative Site Personnel Wtll Communicate ® Staff, Who Will Contact Vendor ❑ Directly With Vendor Will delivery be within one hour of the food service period? (SFSP Handbook, Chapter 11)...................................... ©Yes ❑ No If no, describe arrangements within standards prescribed by local health authorities for delivery and holding of meals until time of service. If there is an excess of meals delivered, meals will be (SFSP Handbook, Chapter 111) Stored In Refrigerator and Served the Next Day CERTIFY th�t-fhe information as the ca d"9v and facilities "of Thrown Away Returned to Vendor ❑at the She ❑for Disposal ❑Other this form is d oorract to the best of my knowledge. I certify that this site has been visited and tha: the meat planned for the number of children anticipated. 1 know that deliberate misrepresentation c- Ot ;n7ion upoer applicable state and federal statutes. Name or Stang arprizatim 6 City of Denton OrQ tqnI Crete; rell FOR ❑Approved []Denied, reason: DNS USE ONLY S"t oe-DHS Reproxntatme Date m Dever"Wo Fone ttlsr 1*4 ~" MOet SUMMER FOOD SERVICE PROGRAM FOR CHILDREN FOR on USE ONLY SITE INFORMATION TX R U ff* a SOA No. V TWU Clubhouse Program (817) 566-8 5 Mary Hufford Court Denton, Texas 76201 100 of WManon a rood b*FA= (MJaayM.-+r+olayM.) May .Iu�e ,nay Aup. Sept 5/30/95 8/11/95 Number 2 22 21 9 rom: Through: crating Days: TACH A MAP WITH THE SITE SERVICE AREA IDENTIFIED Residential Camp Site Serving Primarily Migrant Childnn Other She Indicate Type of Site: ❑ A. (serving one to four meals) ❑ C. (swvhg one to four mesls) Xj E. (serving one to four meals) Nonmidentlal Camp Site Serving PrMnarly Homeless Chlldnn ❑ B. (seMrg one to four meals) ❑ D. (arvlrg one b bur malt) List ALL counties served by this site: Denton A. Is your site open: ............. % Yts ❑ No S. Is your site enrolled?................................................................................................. ❑Yes ®No C. Site Eligibility: Etter the percentage of children eligible for free and/or reduced price meals for the site (SFSP Handbook, Chapter 11).... 19 % 0. If open sites, submit documentation supporting this percentage figure (such as census date, school data). For open sites using school data, list the schools used to document site eligibility: attach formula used by school disc to establish percentage of free 3 reduced price children. E. For enrolled sites, Form 1531 will be used to document eligibility. If the enrolled site used school data, list the school used to document the site: F. What is the percentage of free or reduced -price meals for the site? .................................................. 100 % Did the site participate in previous years' SFSP? (SFSP Handbook, Chapter II) .......................................... [3Yes []No if Yes, give name of contracting organization: City of Denton Monitoring Plan (SFSP Handbook, Chapter 111): Enter date of monitoring review to be conducted within: c.... w�Y ..� n.,...,..,. � a c..r, c.Y Y wr... ..� n,.�.,,..,.. I r• •wwn....., a.,....... June 2 Meal Service Period Information (SFSP Handbook. Chanter II): August 10 i NUMBER OF TYPES OF MEALS ELIGIBLE CWL.DREN TO BE SERVED* MEAL SERVICE TIME BEGINNING ENDING Breakfast A.M. Supplement Luny j 55 12:00 p.m. 1:00 P.M. P.M. Supplement Supper I! .i W .Y Vi V. w,T. , Y7 � V ... N. A... J. J, ,Y. LWVw, V� ., Do you plan to teed children under one (1) year old? ........... ❑ Yes ® No ............................... Method of Food Preparation by Contracting Organization (SFSP Handbook, Chapter II) see•Prowel on 11eI Using School Using Food Service Management Using Private Non -Profit 7 On Site r" Central Kitchen Food Autherlty h Ccmn3mv (inc!udes All Year Contracts' n Oroanizaflon that Is S0.15 er Fen%IMYPa et Indicate the system to be used for the serving of meals and the supervision d children durklg meal service period. (SFSP Handbook, Chapter 0) Cameris•s" Chimm are Seated Children Line Up ❑Meal Service ❑ and am own Meals Eland Pick Up Meals ❑ other List site oersonnei who will be Involved to any extent in the meal service. (SFSP Handbook, Chapter 10: TWA OF ►OSMON NO. IN PDSRIDN SPECIFIC FOOD SERVICE PROORAM DUMS Site Supervisor 1 Supervise and maintain mpAl temperature. indicate what provisions will be made for meal service during periods of inclement weather. (SFSP Handbook, Chapter 11) a don MOW Meal Service ®savics ❑ WitII Be Cancelled ❑ Other: B the site feeds primarily homeless children, what methods are used to ensure that money, food stamps, or in -kind services are not required for meals? N/A Are meals delivered to the site?........................................................................................... Q Yes ❑ No IF YES, COMPLETE ITEMS 14, 15, & 16. IF NO, FORM IS COMPLETE EXCEPT FOR CERTIFICATION AT BOTTOM. Indicate the means of communication with the vendor which will be used to adjust meal deliveries. (SFSP Handbook, Map. II) Site Personnel Will Contact Administrative Site Personnel Will Communicate In Staff, Who Will Contact Vendor ❑ Directly With Vendor Will delivery be within one hour of the food service period? (SFSP Handbook, Chapter II) ...................................... ®Yes ❑ No If no, describe arrangements within standards prescribed by local health authorities for delivery and holding of meals unfit time of service. If there is an excess of meals delivered, meals will be (SFSP Handbook, Chapter 111) Stored In Refrigerator Thrown Away Returned to Vendor and Served the Next Day ,Thrown the site El for Disposal ❑Other. ERTIFY that intomlation on Is town is true correct to the best of my knowledge. I certify that this site has been visited and ma: is the capab and facilities, for jie meal sere anned for the number of children anticipated. I know that deliberate misrepresentabon c- :ot p�ding ormatiog re 1JrI pros unger applicable state and federal statutes. Name of Cantracap Omeruawn G s' City of Denton iLial of Connsctmp Organza to arre of official (DNne type or VOO TAM Harrell FOR FJ Approved ❑ Denied, reason: DHS USE JNLY City Manager TAM I Spnst se-DHS Representatme Date Deperrrrnr N'r"r" s"40a` SUMMER FOOD SERVICE PROGRAM FOR CHILDREN FOR 011t USE OIILY SITE INFORMATION TX OR Ou aof ooa Sae e( 817e No. umOwsley Neighborhood 817) 566-8125 R A Stella St. Denton, Texas 76201 viod of OW~ of Food SerAw (f+wlayM.-r++oASYM I Number of Otr (1 (� it l ^�- ft cL From: 5 / 30 / 95 thr h: 8 / 11 / 95 arating Days: y/ y y y Y rTACH A MAP WITH THE SITE SERVICE AREA IDENTIFIED Residential Camp Sit* Servirq Primarily Migrant Children Other Site . Indicate Type of Site: ❑ A. (unving one to lour meals) ❑ C. (servinp ON Oo lour orals) Q E. (serving one to lout meals) Nonresldendal Camp Site SeMng Prknarly Homeless CNMM ❑ B. (scoring one to four meals) ❑ D. (serving oa to four most$) List ALL counties served by this site: Denton ). A. is your site open: ....................................... ............................................................. 9 Yes ❑ No B. Is your site enrolled?................................................................................................. ❑Yes Q No C. Site Eligibility: Enter the percentage of children eligible for free and/or reduced price meals for the site (SFSP Handbook Chapter 11).... 19 D. If open sites, submit documentation supporting this percentage figure (such as census date, school data). For open sites using school data, list the schools used to document site eligibility-, attach formula used by school dist. to establish percentage of free 3 reduced price children. N/A E. For enrolled sites, Form 1531 will be used to document eligibility. If the enrolled site used school data, list the school used to document the site: F. What is the percentage of free or reduced -price meals for the site? .................................................. 100 % Did the site participate in previous years' SFSP? (SFSP Handbook, Chapter ID .......................................... ®Yes ❑ No If Yes, give name of contracting organization: City of Denton Monitoring Plan (SFSP Handbook. Chapter III): Enter date of monitoring review to be conducted within: k Firs: wee• of OW&WM I B. FirstT W e2ae2s of Operation C. Add "Revitws August 10 June 2 LUU .i e.. ,n. vnnnrt Inrnrmatinn (SFSP Handbook. Chapter II): NUMBER Of TYPES OF MEALS EUGISLE CMLOREN TO BE SERVED' MEAL SERVICE TIME BEGINNING ENDING Breakfast A.M. Supplement Lung j 40 12:00 p.m. 1:00 p.m. P.M. Supplement Supper 'TM eVormabon is aorurdered CY OMS when "MV " approves meal servo love'. (SFSP r WOboti , ur Do you plan to feed children under one (1) year old? ........................... .......................................... []Yes ®No Method of Food Preparation Contracting Organization (SFSP Handbook, Chapter 11) seM•Pmamton 1 v'n0sd Using School Using Food Service Management Using Private Non Profit On Site ❑ Central Kitchen Food Authority 7 Company (includes All Year Contracts) ❑ Organization that is Self -Prep Form 1Se71Paea 2 Indicate the system to be used for the serving of meats and the supervision of children during meal servioe period. (SFSP Handbook Chapter m en Line Up ❑ Meal service ❑ and are Given Meals El anChIldr" we Sealedted Pick Meals ❑ 00*r: , :-..n_ _ _t ...k., r.tm w inunF,oA to env avtwnt in the meal sarvim. (SFSP Handbook. Cheater In: TITLE of yosrnON NO. N POSITION SPECIFIC FOOD SERVICE PROGRAM DUTIES Site Supervisor 1 Supervise and maintain mpal tem er Site Helper/Server 1 Assist site supervisor Indicate what provisions win be made for meal service during periods of inclement weather. (SFSP Handbook, Chapter 11) YWoor Meal Meal Servke ® service ❑ Will Be Cancelled ❑ Otter: 2. 0 the site feeds primarily homeless children, what methods are used to ensure that money, food stamps, or in -kind services are not required for meals? N/A Are meals delivered to the site?........................................................................................... El Yes ❑ No IF YES, COMPLETE ITEMS 14, 15, & 16. IF NO, FORM IS COMPLETE EXCEPT FOR CERTIFICATION AT BOTTOM. Indicate the means of communication with the vendor which will be used to adjust meat deliveries. (SFSP Handbook. Chap.11) Site Personnel Will Contact Administrative Site Personnel Will Communicate ® Staff, Who Will Contact Vendor ❑ Directly With Vendor Will delivery be within one hour of the food service period? (SFSP Handbook, Chapter II) ...................................... ©Yes []No If no, describe arrangements within standards prescribed by local health authorities for delivery and !aiding of meals until time of service. If there is an excess of meals delivered, meals will be (SFSP Handbook, Chapter 111) Stored In Refrigerator Thrown Away Returned to Vendor and Served the Next Day ❑at the Site ❑for Disposal ❑Other. ERTIFY that the information on this form is true an erect to the best of my knowiedge. 1 certify that this site has been visited and tha: ;: -as Ownuaton the Capabili nd facilities r meal serv' dnLCed for the number of children anticipated. I know that deliberate misrepresentation c• .nholding ormation may a It in pros n' applicable state and federalfC4statutes. I<��FtYFrI � Nam. a aaw+o City of Denton err! 9;;;j d F' tramro o,a �G J tiarly of ONKW (pease type Or Harrell FOR []Approved ❑Denied, reason: DHS USE ONLY City Manager Spnanne-DHS Aewesentatrve Date W Depatt visto "unl'n Ser"ims SUMMER FOOD SERVICE PROGF' 1M FOR CHILDREN FOR DNS USE ONLY SITE INFORMATION TX R U tvne of Food Swv�ce Soe olaphale No. line. ) Denia Park (817) 566-8125 Wass of Sao (Sueel. Gty. State. ZIP) 1001 Parvin Denton, Texas 76201 ,nod Lion of Food (rtaldaylyr.-m idayMJ Number of Op- n May Juno Jug nAug.Sept., From: 5 / 30 / 95 through: 8 / 11 / 95 crating Days: 4 2 22 21 y 9 rTACH A MAP WITH THE SITE SERVICE AREA IDENTIFIED Residential Camp Site Serving Primarily Migrant Children Other Site Indicate Type of Site: ❑ A. (serving one to four meals) ❑ C. (serving one to four meals) Q E. (serving one to four meals) Nonresidential Camp Site Serving primarily Homeless Children ❑ B. (serving one to four meals) ❑ D. (serving one to four meals) t. List ALL counties served by this site: Denton I. A. Is.yoursite open: .....................................................................................................❑Yes ❑No B. Is your site enrolled?................................................................................................. ❑Yes ®No C. Site Eligibility: Enter the percentage of children eligible for free andior reduced price meals for the site (SFSP Handbook, Chapter II).... 64 % D. If open sites, submit documentation supporting this percentage figure (such as census date, school data). For open sites using school data, list the schools used to document site eligibility: attach formula used by school diet. to establish percentage of free A reduced price children. N/A E. For enrolled sites, Form 1531 will be used to document eligibility. If the enrolled site used school data, list the school used to document the site: F. What iS the percentage of free or reduced -price meals for the site? ................................................... 100% % Did the site participate in previous years' SFSP? (SFSP Handbook, Chapter Iq.......................................... ®Yes ONO If Yes, give name of contracting organization: City of Denton Monitoring Plan (SFSP Handbook, Chapter Ill): Enter date of monftonng review io oe cwnouutud wunn\. t First week of Opwanon B. First Four Weeks of Operation C. Additio" Reviews June 2 June 22 July 20 August 10 TYPES OF MEALS NUMBER OF ELIGIBLE CHILDREN TO BE SERVED' MEAL SERVICE TIME BEGINNING ENDING Breakfast A.M. Supplement Lunch 3Q 12:00 p.m. 1:00 P.M. P.M. Supplement Supper l laa avomuam\ u � v, Do you plan to feed children under one (1) year old?..................................................................... El Yes ® No 6. Method of Food Preparation by Contracting Organization (SFSP Handbook, Chapter II) S.a wev�bn Using School Using Food Service Management Using Private Non Profit n On Site ❑ Central Kitchen] Food Authority ❑ Company (Includes All Year Contracts) ❑ Organization that Is Self -Prep Form tseTfPaae a indicate the system to be used for the serving of meals and the supervision of children during meal service period. (SFSP Handbook, Chapter Iq Cafeterla-style Children are Sealed Children Line Up ❑ Meal Service ❑ and are Given Meals © and Pick Up Meals ❑ ftw. i :.s nit...e. ...i ...hat at ha inunlvnA in env avtant in that moral sPnrica_ (SFSP Handbook. Chanter III: TITLE OF POSITION No. vi Pou oN SPECIFIC FOOD SERVICE PROGRAM DUTIES Site Supervisor 1 Supervise te>n era indicate what provisions will be made for meal service during periods of inclement weather. (SFSP Handbook, Chapter II) Indoor Mat Meal Service ®Service ❑Will Be Cancelled ❑Other: it the site feeds primarily homeless children, what methods are used to ensure that money, food stamps, or in -kind services are not required for meals? N/A Are meals delivered to the site?............................................................................................ ] Yes []No IF YES, COMPLETE ITEMS 14,15, & 16. IF NO, FORM IS COMPLETE EXCEPT FOR CERTIFICATION AT BOTTOM. Indicate the means of communication with the vendor which will be used to adjust meal deliveries. (SFSP Handbook. Chap. II) Site Personnel Will Contact Administrative Site Personnel Will Communicate ® Staff, Who Will Contact Vendor ❑ Directly With Vendor Will delivery be within one hour of the food service period? (SFSP Handbook, Chapter II) ............. . ........................ ®Yes (]No If no, describe arrangements within standards prescribed by local health authorities for delivery and holding of meals until time of service. ' S. If there is an excess of meals delivered, meals will be (SFSP Handbook, Chapter III) Stored In Refrigerator Thrown Away Returned to Vendor and Served the Next Day Cl at the Site El for Disposal ❑Other. CERTIFY th a information on this form is and correct to the best of my knowledge. I certify that this site has been visited and that it -as the cap it' and facilities f the meal planned for the number of Children anticipated. 1 know that deliberate misrepresentation or oath i informati ay es in on under applicable state and federal statutes. SN/ Nam Of traCf . �(p �' City of Denton of cw*sdinp Or lion Nttme or Off" 0111ase caw or vMUIT** d Harrell FOR I `.E]Approved El Denied. reason: DNS USE ONLY Two City Manager Spnaane-DNS Representat" Date uoa D@Wb'MM I,ian.n s«ad.s SUMMER FOOD SERVICE PROGRAM FOR CHILDREN SITE INFORMATION am of Food Sarvloa 44m Rivera Elementary School 701 Newton Denton, Texas 76201 FOR DNS USE ONLY TX R atapwrw No. (inc. ) (817) 566-8125 anod of OpwaWn of Fodd Service (w4jdny/yr.-m jdayM.) Number of Op- " Ir From 5/31/95 through:-6/27/95 crating Days 1 19 TTACH A MAP WITH THE SITE SERVICE AREA IDENTIFIED Residential Camp Site Serving Primarily Migrant Children Other Site 1. Indicate Type of Site: ❑ A. (serving one to lour meals) ❑ C. (serving one to tau meals) � E. (serving one to four meals) Nonresidential Camp Site Serving Primarily ltolnekss Children ❑ B. (servhtg one to four meek) ❑ D. (serving one to four meals) List ALL counties served by this site: Denton 3. A. Is, your site open:................................................. ........ ............................................ QYes ❑No B. Is your site enrolled?................................................................................................. [:]Yes' ®No C. Site Eligibility: Enter the percentage of children eligible for free and/or reduced price meals for the site (SFSP Handbook, Chapter If)... . 22 '/o D. If open sites, submit documentation supporting this percentage figure (such as census date, school data). For open sites using school data, list the schools used to document site eligibility: attach formula used by school disc to establish percentage of free 3 reduced price children. E. For enrolled sites. Form 1531 will be used to document eligibility. If the enrolled site used school data, list the school used to document the site: F. What is the percentage of free or reduced -price meals for the site? ................................................... 100 % 4. Did the site participate in previous years' SFSP? (SFSP Handbook, Chapter In .......................................... [Dyes ®No if Yes, give name of contracting organization: Monitoring Plan (SFSP Handbook, Chapter III): Enter date of monitoring review to De conoucteo wain: A Fini Welk of Operation B. First Four Weeks d Operation C. Addit" ROVIS" June 1 I June 21 Meal Service renou iniunnauun k- TYPES OF MEALS -- , .o.... .. ......_...I. NUMBER OF ELIGIBLE CHILDREN TO BE SERVED' MEAL SERVICE TIME BEGINNING ING ENDING Breakfast A.M. Supplement Lunch 220 11:45 a.m.- 12:45 p.m. P.M. Supplement Supper 7. Do you plan to feed children under one (1) year old?.............................................................. , _ .... , Dyes QNo 8. Method of Food Preparation by Contracting Organization (SFSP Handbook, Chapter 11) SNI•Prowation IYinOsd Using School Using food Service Management Using Private Noe-Prord n On Site ❑ Central Kitchen I © Foci! Authority 13 Company (includes All Year Contracts) ❑ Organization that is Self• Form 130711180a Y 9. Indicate the system to be used for the serving of meals and the supervision of children during meal service period. (SFSP Handbook, Chapter IQ Cafeteria -style Children are Seated Children Line Up ❑Meal Service Cl and are Given Meals ❑ and Pick Up Meals ❑ Other. 10. List site personnel who will be involved to any extent in the meal service. (SFSP Handbook. Chapter 11): TITLE OF POSITION NO. IN POSITION SPECIFIC FOOD SERVICE PROGRAM DUTIES Site Supervisor ] Supervise and assist distribution of meals, monitor and maintain meal temperature, site clean—up, and other duties as assigned Site Helper/Server 2 Assist site supervisor 11. W61!e what provisions will be made for meal service during periods of inclement weather. (SFSP Handbook, Chapter 11) ®lindoormeal Meal Service Service ❑WII Be Cancelled ❑Other: 12 If the site feeds primarily homeless children, what methods are used to ensure that money, food stamps, or in -kind services are not required for meals? N/A 13. Are meals delivered to the site?........................................................................................... © Yes ❑ No IF YES, COMPLETE ITEMS 14, 15, & 16. IF NO, FORM IS COMPLETE EXCEPT FOR CERTIFICATION AT BOTTOM. 14. Indicate the means of communication with the vendor which will be used to adjust meal deliveries. (SFSP Handbook, Chap. II) Site Personnel Will Contact Administrative Site Personnel Win Communicate ®Staff, Who Will Contact Vendor ❑Directly With Vendor 15. Will delivery be within one hour of the food service period? (SFSP Handbook, Chapter 11)...................................... L.❑ No If no, describe arrangements within standards prescribed by local health authorities for delivery and holding of meals until time of service. 16. If there is an excess of meals delivered, meals will be (SFSP Handbook, Chapter 111) aStomd In Refrigerator Thrown nd Served the Next Day Flat the site ❑ or D sposalturned to Vendor ❑Oftr CERTIFY tha a information this form is and correct to the best of my knowledge. I certify that this site has been visited and that it ^as the cap try and facllitie or the meat planned for the number of children anticipated. 1 know that deliberate misrepresentation or with information re to pr on nder applicable state and federal statutes. Name of Contracbre omwambon %Q City of Denton e-0riidat a convaaina a tion Harrell FOR --❑Approved ❑Denled,mason: OHS USE ONLY ride Ci Spn3hoe-OHS Representative Date ms oaON & — r+un—nserwim Is SUMMER FOOD SERVICE PROGRAM FOR CHILDREN POR o11e USE SITE INFORM.` TION Vne at Few swvmsM TX Wilson Elementary SchoolTe'wRimam 817) 56-81 6125 tares of L City. Stare. ziv/ 1501 Emerson Denton, Texas 76201 -.�,.,...._..,,.• Number of Op. May Jt.hxr rom: 5 / 31 / 95 through: 6 / 2 7 / 9 5 waling Days 1 19 TACH A MAP WITH THE SITE SERVICE AREA IDENTIFIED I r Residential Camp Site Servlrq Prlmsrgy Migrant Children Indicate Type of Site: ❑ A (serVIng one to four meals) ❑ C. (servklg one to bur weak) X Other SMe Norimsidentlal Camp Sit* Se P E' (aervNg one to tour Moak) ❑B. ( one to four meak Homeless; ess Chgdnn u^� ) ❑ D. (Bening orw b bur meek) u List ALL counties served by this site: Denton A. Is your Bite open: ............................................ B. Is your site enrolled?................................................................ ........................... ..... X Yes C No C. Site Eligibility: Enter the percentage of children eligible for free ar4or reduced price meals for the site (SFSP Handbook, Chapter 11)... • 22 y4 D. If open sites. submit documentation supporting this percentage figure (such as census date, school data). For open sites using school data, list fhe schools used to document site eligibility, attach formula used by school diet to establish percentage of free & reduced price children. For enrolled sites, Form 1531 will be used to document eligbility. It the enrolled site used school data, list the school used to document the site: What is the percentage of free or reduced -price meals for the site? ........................... )id the site participate in previous years' SFSP? (SFSP Handbook, Chapter In ... . . . . . . . ... . ❑Yes �No Yes, give name of contracting organization: ^onitonng Plan (SFSP Handbook, Chapter III): Enter date of monitoring review to be conducted within: :.r3' wook of Obwahnn i u e..-. ems.-."--`- - June 1 1 June 21 'eal Service Period Information (SFSP Handbook, Chapter 11): TYPES OF MEALS Breakfast A M. Supplement Lunch P.M. Supplement Supper � NontiUon rs mnsrd NUMBEROF ELIGIBLE CHILDREN TIME MEAL SERVICE TO BE SERVEO• BEGINNING IENDM 20 I 11:45 a.m. 12.45 p.m. > you plan to feed children under one (1) year old? ... , .. , , , .. . ........................................ ................. Yes ®No �thod of Food Preparation by Contracting P*sovwon i On Site Central Kitchen Using School Food Authorll (SFSP Handbook, Chapter II) using Food Service Management U" Private Non-Prord Company (Includes All Year Contracts) ❑ Organization that Is Sell. Fong lappaa 2 Indicate the system to be used for the serving of meats and the supervision of ehildree during meal service period. (SFSP Handbook, CWW 111) Cateteds-s le ❑ Meal Service Eland we Given Meals ® and we Seated Pick Up Men Una als ❑ 0ther. List site personnel who will be Involved to anv extent in the meal service. (SFSP Handihnnlr rhaelw in. T11E OF POSrrION NO. N ►O$mON 11"CIFIC FOOD SERVICE PROGRAM 01,17111113 Site Supervisor 1 Supervise and maintain mpal ten er Indicate what provisions will be made for meal service during periods of inclement weather. (SFSP Handbook, Chapter IQ a wooll MOW meal Service ® Service ❑ Wil Be Cancelled ❑Other. If the site feeds primarily homeless children, what methods are used to ensure that money, food stamps, or h4dnd services are not required for meals? N/A Are meals delivered to the site?........................................................................................... QYes ❑ No IF YES, COMPLETE ITEMS 14, 15, & 16. IF NO, FORM IS COMPLETE EXCEPT FOR CERTIFICATION AT BOTTOM. Indicate the means of communication with the vendor which will be used to adjust meat deliveries. (SFSP Handbook. Chap.11) ®Site Personnel Will Contact Administrative Site Personnel Will Communicate Staff, Who Will Contact Vendor ❑Directly With Vendor Will delivery be within one hour of the food service period? (SFSP Handbook, Chapter II) ...................................... ®Yes ❑ No If no, describe arrangements within standards prescribed by local health authorities for delivery and holding of meals until time of service. If there is an excess of meals delivered, meals will be (SFSP Handbook. Chapter 111) Stored in Refrigerator Thrown Away Returned to Vendor and Served the Next Day Cl at the Site ❑ for Disposal ❑Other: =RTIFY that the information on 's form is tru d correct to the best of my knowledge. I certify that this site has been visited and tha; :sycalprab*and facilities for a meal se planned for the number of children anticipated. I know that deliberate misrepresentation c- rmati ma re It in pr n under applicable state and federal statutes. Name a aehq . 6J j /g� City of Denton gnanse-o foal of Contracvv Orgy son Da erne a - waase type or p m Taw oyd Harrell City Manager i `OR -OApproved ❑ Denied. reason: )HS :SE 1NiV TiW Spnature-DHS Repesentatwe Date Iexas Deparvywlt 4 Human SeCOM SUMMER FOOD SERVICE PROGRAM FOR CHILDREN SITE INFORMATION Civic Center Park 321 E. McKinney Denton, Texas 76201 5.roe lion of Food Service (MJday1Yr.-=4deyAYra Number of Op- (j y (�� "q From: 5 / 30 / 95 through: 8 / 11 / 95 ersting Days: y 2 y 22 r 1TTACH A MAP WITH THE SITE SERVICE AREA IDENTIFIED Residential Camp Site Serving Primarily Migrant Chi iren 1. Indicate Type of Site: [:]A. (serving one to four meals) ❑ C. (serving one to four meals) Nonresidential Camp Site Serving Primarily Homeless Children ❑ B. (serving one to four meals) ❑ D. (serving one to four meals) FOR OHS USE ONLY TX R Ou Nepnale No. tine. AIQ (817) 566-8125 b Auo. Sept. 21 4 9 Other Site 0 E. (serving one to four meals) 2. List ALL counties served by this site: Denton 3. A. Is,your site open: ..................................................................................................... ®yes ❑ No B. Is your site enrolled?................................................................................................. ❑Yes ®No C. Site Eligibility: Enter the percentage of children eligible for free and/or reduced price meals for the site (SFSP Handbook, Chapter II).... 22 D. If open sites, submit documentation supporting this percentage figure (such as census date, school data). For open sites using school data, list the schools used to document site eligibility; attach formula used by school dist. to establish percentage of free A reduced price children. E. For enrolled sites. Form 1531 will be used to document eligibility. If the enrolled site used school data, list the school used to document the site: F. What is the percentage of free or reduced -price meals for the site? .................................... 100 % 4. Did the site participate in previous years' SFSP? (SFSP Handbook, Chapter 11).......................................... [Eyes ❑No If Yes, give name of contracting organization: Citv of Denton Monitoring Plan (SFSP Handbook, Chapter III): Enter date of monitoring review to be conducted within: A. First Week of Operation B. First Four Weeks of operation C. Additional Reviews 5/31/95 1 6/23/95 7/19/95 8/8/95 I'CCD Ulo A . tr Chan/or ul- .goo.,,�....,...,....._...._.._--- .- TYPES OF MEALS — - NUMBER OF ELIGIBLE CHILDREN TO BE SERVED' MEAL SERVICE 71ME BEGINNING ENDING Breakfast A.M. Supplement Lunch 40 12:00 p.m. 1:00 P.M. P.M. Supplement Supper I Ella fllprmyllRlaw•sws.wr,.....,...._.. �.-..�_._-rr__.__-.-____...__ _ , 7. Do you plan to feed children under one (1) year old......................................................................QYes QNo 8. Method of Food Preparation by Contracting Organization (SFSP Handbook, unapter it) sea -Preparation V*nd d Using School Using Food Service Management Using Private Non-Prord On Site []Central Kitchen 1 ® Food Authority ❑ Company (Includes All Year Contracts) ❑ Organization that Is Self -Prep Form 16070 spe 2 9. Indicate the system to be used for the serving of meals and the supervision of children during meal service. period. (SFSP Handbook, Chapter IQ ❑MealtSenkce e Children are ❑ and are Given Seated ® and Pick Up MeChildren Una als ❑ Ather: 10. List site personnel who will be involved to any extent in the meal service. (SFSP Handbook. Chapter 11): TITLE OF POSMON NO. IN POSITION SPECIFIC FOOD SERVICE PROGRAM DUTIES Site Supervisor 1 Supervise and assist distribution and maintain meal temperature, site clean—up and other duties as assigned Indicate what provisions will be made for meal service during periods of inclement weather. (SFSP Handbook, Chapter 11) rvice ®Irldoor rvteeMeai ❑WII BMealeeCancelled ❑Other. 12. If the site feeds primarily homeless children, what methods are used to ensure that money, food stamps, or h4drid services are not required for meals? N/A 13. Are meals delivered to the site?........................................................................................... ® Yes []No IF YES, COMPLETE ITEMS 14,15, & 16. IF NO, FORM IS COMPLETE EXCEPT FOR CERTIFICATION AT BOTTOM. 14. Indicate the means of communication with the vendor which will be used to adjust meal deliveries. (SFSP Handbook, Chap. II) Site Personnel Will Contact Administrative Site Personnel Will Communicate ® Staff, Who Will Contact Vendor ❑ Directly With Vendor 15. Will delivery be within one hour of the food service period? (SFSP Handbook, Chapter 11)...................................... ®Yes ❑ No If no, describe arrangements within standards prescribed by local health authorities for delivery and holding of meats until time of service. 16. If there is an excess of meals delivered, meals will be (SFSP Handbook, Chapter Ill) Stored In Refrigerator Thrown Away Returned to Vendor Qand Served the Next Day ❑at the site ❑for Disposal []Other CERTIFY that the information o this form is tru d correct to the best of my knowledge. 1 certify that this site has been visited and that ".as the a ity and faciliti f the meal planned for the number of children anticipated. I know that deliberate misrepresentation c, ti,thhcUn nforrnati y siiftln onpnder applicable state and federal statutes. l woe of Cantraciery I City of Denton ors-Onfaat of Conaartinp Or uon FOR OHS USE ONLY wPny Z Lloyd Harrell ❑ Approved ❑ Denied, reason: IT," SV*tws-DMS Representative Date City Manager Name of Agency: Address: Contact: TEXAS DEPARTMENT OF HUMAN SERVICES Special Nutrition Programs Assessment Fee for USDA Commodities Summer Food Service Program May 1, 1995 to September 1, 1995 City of Denton Phone Number: To determine the assessment fee, complete the following: divided by - Total number of Total days of operation ADP participating children x .08 = ADP Assessment Fee Send a copy of this page with your payment, made payable to the Texas Department of Human Services, and submit by June 15, 1995, to: Texas Department of Human Services Financial Management Services (Y-906) P. O. Box 149030 Austin, Texas 78714-9030 Note: Also submit a copy of this page with your Form 1608. 'ens Department of HUttan $micas SUMMER FOOD SERVICE PROGRAM APPLICATION AND AGREEMENT FOR RECEIPT OF USDA COMMODITIES Fan lips Jarmn 1992 NMI* City of Denton Adam (street Gty. sate. county MaJng Add(*" (if different) - I i contact Person (for cmirrtodity nfomtatan) TeNpnore No. I Period of Operaton Of Food Ssr#cs (=JdaYhr.—=JdaYtYrJ I From through APPOINTMENT OF THE AUTHORIZED REPRESENTATIVE —The official who signs this form must appoint an authorized representa- tive. The official may name himself as the authorized representative, If he chooses to serve In that capacity. The authorized represen- tative Is given full responsibility for all matters pertinent to the receipt, handling, storage, protection, accountability, and use of __x....Amea am tha maintenance of all reaulred records and reports pertaining to the commodities. Name a AtAtOttaaO ReprpaMawe Job Tilde TMeplwna W. Mailing Ad**" (N different from agency adbeae) I certify that I have read the agreement on the back of this form and that my signature below acknowledges this agency's responsibil- ity to comply with all of the terms and conditions of that agreement. This agreement shall be In effect for no longer than one year. It may be extended at both parties' option for two additional one-year periods. If extended, the applicant must update all pertinent Information and must demonstrate that all donated food received during the prior contract period has been accounted for. The agreement may be terminated for cause by either party upon 30 days written notice. The official who signs this Application and Agreement assumes full responsibility for compliance with the terms and conditions list- ed in the agreement. Sgrntutr—Agettcy O ftlel Dam 116W. Title TV 6f3 GUMt+Lt i CN 17 r una JUNE JULY AUGUST . Days oats I erval Average Dail An•nd.ne• Total Mille To Be Served This Month No. Days Meals �(rved Avers g• Daily Attendance Total UNIs To Be Served This Month No. Days Meals Will Be Served Avera I Total Meals 9• Dail To Be Served Y Attendance I This Month =INFORMATION Breakfast AM Supplement I Lunch PM Supplen*nl Supper Agroonitnt No. Amt. Official Effecvve Dates of Agreerrwa From: To: Date cn.cxw BY For is" Pot AGIREEMENT tr , THE APPLICANT FOR USDA -DONATED COMMOQITIES AGREES: 1. To abide by the instructions and regulations sued by DIMS and USDA for storing, handling, and using commodities. 2. To use commodities only to benefit poWhiser4d in theippljoant's established food services operation. 3. To request and accept commodities only in amounts that will be properly stored and fully utilized. 4. To not sell, trade, or dispose of commodities, including commercial processing of commodities into different end products, without OHS' approval. 5. To provide adequate facilities and personnel to handle, store, protect, and use commodities. 6. To allow DHS and USDA to inspect, at any reasonable turtle, the commodities in storage and the facilities used for han- dling and storing corrrttodities. 7. To pay the assessments laud by DHS to now the administrative expenses of the program as provided by state law. S. To accurately maintain au necessary records, including the application and agreement kir., ; recslpts and freight bills; notices of availability, arrival and issuance of donated foods: Forms 506, inventory control sheets: finaneJal and support- irg documents: statistical records; and any other retards pertinent to the services for which a claim was submitted, for 3 years and 90 days after the contract period ended, or for 3 years after the end of the federal fiscal year In which services were provided it this contract has no specific termination date. If any litigation. claim or audit involving these records be- gins before the 3 year period expires, the contractor must keep the records for not Ices than 3 years and 90 days and until all litigation, claims or audit findings are resolved. The case is considered resolved when there is a final order issued in litigation, or when DHS and the contractor enter into a written agreement. The contractor will keep records of non - expandable property acquired under the contract for 3 years after the final disposition of the property. Contract period means the beginning date through the ending date specified in the original agreement/contract; extensions are consi- dered to be separate contract periods. 9. To comply with the requirements of the Immigration Reform and Control Act of 1986 regarding employment verification and retention of verification forms for any individuals hired atter November 6.1986, who will perform any labor or services under this contract. 10. To comply with the instructions and regulations issued by DHS for conducting financial and compliance audits. 11. To reimburse DHS, according to DHS' procedures, for any improper distribution or use of donated food, or for any loss of, or damage to, donated foods caused by the applicant's fault or negligence. 12. That any misuse of donated foods may cause them to be disqualified from program participation, and that reinstatement is at DHS' option. 13. That any embezzlement, misuse, theft, or obtainment by fraud of donated foods or donated food -related funds, assets, or property, shall cause the applicant to be subject to Federal criminal prosecution. 14. Civil Rights (a) To comply with Title VI of the Civil Rights Act of 1964 (Public taw 88.352). Section 504 of the Rehabilitation Act of 1973 (Public Law 93.112). The Americans with Disabilities Act of 1990 (Public Law 101.336). and all amendments to each, and all requirements imposed by the regulations issued pursuant to these acts. In addition, the contractor agrees to comply with Title 40, Chapter 73, of the Texas Administrative Code. These provide in part that no persons in the United States shall, on the grounds of race, color, national origin, sex, age, disability, political beliefs or religion be excluded from participation in, or denied, any aid, care, service or other benefits provided by federal and/or state funding, or otherwise be subjected to discrimination. (b) To comply with Texas Revised Civil Statutes Article 4419b-4, Sections 5.03 and 5.04 (relating to workplace and con- fidentiality guidelines regarding AIDS and HIV). (c) To compile date, maintain records, and submit reports as required, to permit effective enforcement of the above Acts and permit authorized DHS and USDA personnel during normal working hours to review such records, books and accounts as needed to ascertain compliance with the above Acts. If there are any violations of this assurance, DHS and USDA have the right to seek judicial enforcement of this assurance. This assurance is binding on the Contractor, its successors, transferees, and assignees as long as it receives assistance, or retains possession of any assistance from DHS. The person whose signature appears on this contract is authorized to sign this assurance on the behalf of the Contractor. The above assurances are given in consideration of and for the purpose of obtaining any and all federal financial as- sistance, grants and loans of federal funds, reimbursable expenditures, grant or donation of federal property, and interest in property, the detail of federal personnel, the sale and lease of, and the permission to use, federal property or interest in such property or the furnishing of services without consideration or at a nominal consideration, or at a consideration which is reduced for the purposes of assisting the recipient, or in recognition of the public interest to be served by such sale, lease, or furnishing of services to the recipient, or any improvements made with federal financial assistance extend- ed to the program applicant by DHS. This includes any federal agreement, arrangement, or other contract which has as one of its purposes the provision of cash assistance extended in reliance of the representation and agreements made in this assurance. Fwm 20" MM MayIwt+n��a APPLICATION FOR NON-PROFIT HUB STATUS' (Non -Profit Organizations) DR $TAT[ AGENCY Upr ONLY �W � A9�Y " AWAY Repe�DMa aMD�M No. RETVr1N COMPUTE APPLICATION TO THIS ADDRESS :omplete this form and return it to the address shown at the right. K your Yorgo ration qualitles as a Historically Underutilized Business (HUB) you ill be ,laced on a HUB vendor listing which is accessed by Texas state agencies for ,rocurement of goods and services. D No. (do riot chow tWPhws or d.slls as a^ YDa a Wnber Prodded SS No. Fed Emiloyer Texas Payee ID No. already ❑ Tex. Taxpayer No. (l l digits) ❑ (9 dl its [:IIDNo.ffdlg D assigned 14 digits) Teleoxm No.R W1109 AQ /bye bid reotrnb or PA. a" Cay SD1M DP Cauttly Members of the Board: Identify the individuals on your governing board. CHECK ALL THAT APPLY Aanerkan Person srl NAME TtrLE I alwk I Nktpank I Paelae I k+diarl I Wonsan IDlaablalMs 2. Give a brief de CLASS of the areas in which you wish to receive bid invitations. include Class and Item No., if known. Continue on back N ITEM NO. DESCRIPTION 3. Indicate what geographic area(s) you are able to serve. (See map showing geographic areas.) �nscc g hi gin sM woes. d DKXwV oray n certain areas, lore* appro"o mxrber(s). 0 ALL 1 2 3 4 5 6 7 6 9 10 11 12 13 14 15 16 17 16 19 20 21 23 24 25 I certify, under penalty of law, that the above and foregoing information is a full, true, and correct statement of the facts. Title Signeaxe—Autplomed RepesentaMe Date 7 Please send me information on how to get on the General Services Commission bidders mailing list. (An annual fee is required.) Comments: Instructions for Form 2066 APPUCATION FOR" N®N-P(ROFIT NUB STATUS For assistance in completing this application, you may call (512) 450- -.882. Afrumative Action Initiatives/Civil Rights Depanm*nt. Beginning with 'ID No.' composts all items. If your information has already been entered, please correct any errors. Your Identification number will be onepf tho jollowing: - • your Texas T umber assigned by the Texas State Comptrollers office, • your Social Socuirily, umber issued by the Social Security Administration, • your Federal Env" NumW issued by the Internal Revenue Service, or • your Texas Payeethlukiber a6gnedlby the Texas State Comptrollers office. item 1: Enter the name and title of *Etch member of yoAur governing board, along with appropriate information for each. B you need additional space. provide names and information on an attached sheet. Itern 2: Enter the dam -item nurnbei, and description of the the service or goods for which you wish to receive bid kivita win AN items pipchased by the state of Texas are described by a commodity code. The first three numbers represent fhe class and the next two, the ilea► number. item 3: Circle this numbers of the areas of Texas. as shown on the map below, to which you can provide services or goods. ti you, serve the *mire state, check •ALL' Map used to determine area in Item 3: (Note — Area 22 has been deleted.) 0M=== =CP O= Mc Man o a= The authorized representative of your organization must sign and date the form. Include the representative's tide. If you are interested in receiving information about being on the General Services Commission bidders mailing list, check the box indicated. The General Services Commission has the statutory responsibility for purchasing supplies, materials, services and equipment for the state, including all state agencies. The commission mails bid invitations to interested vendors. An annual fee is required for being on the mailing list.