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Home My WebLink About840920.tiff FORM APPROVED OMB NO.0584-0055 U.S.DEPARTMENT OF AGRICULTURE FOR FNS USE ONLY FOOD AND NUTRITION SERVICE AGREEMENT NUMBER AGREEMENT • (CHILD CARE FOOD PROGRAM) i•![ r T ` - - laF ;1^ 41 - s; 1—r-r: 1 . . . INSTRUCTIONS. The Institution should complete Sections A and Bin dupli- cate, sign both copies and return to ENS Regional Office.The Regional Office (�D C.C I F-y ( A - �, c • will complete Sections C and D, sign both copies and return one copy to the Institution. The Institution MUST RECEIVE A COPY OF THE CHILD CARL FOOD PROGRAM REGULATIONS. SECTION A CHILD CARE FOOD PROGRAM is approved to operate In order to carry out the purpose of Section 17 of the National from 10/01/84 to 09/30/85 _ School Lunch Act, as amended, and the Regulations governing the Child Care Food Program issued thereunder (7 CFR Part 226) the United States Department of Agriculture (hereinafter referred to as the "Department") and the Institution, whose name and THE DEPARTMENT AND THE INSTITUTION MUTUALLY address appear above,agree as follows: AGREE: THE INSTITUTION: To comply with and meet all responsibilities and requirements set forth in 7 CFR Part 226, Child Care Food Program Regulations. Represents and warrants that it will accept final administrative (Copy(ies)attached) and financial responsibility for total Child Care Food Program operations at all homes, centers, or proprietary Title XX centers That the Institution will be reimbursed under the following listed in Section C. methods: Understands and agrees that any publications by the Institution — For child care centers or outside-school-hours care centers, may be freely copied by the Department or by other Institutions according to the Institution's under the Child Care Food Program. El Claiming Percentages,or Certifies as to the number of private for-profit child care centers under its auspices that received amounts granted to the State under Actual count of meals served by eligibility category. Title XX of the Social Security Act for at least 25 percent of each center's enrolled children during the month preceding application — For sponsoring organizations of day care homes, according to to the Program; and shall continue to certify and provide such the payment rates for administrative costs. information in each succeeding month. The Institution shall not claim reimbursement for meals served in any for-profit center for — For day care homes, according to the full food service payment any month during which the center receives such compensation for rates. However, sponsoring organizations electing to receive less than 25 percent of its enrolled children. If the Institution is a commodities for family day care homes will be reimbursed al. for-profit sponsoring organization, the Institution also certifies that the lower rates for lunches and suppers rather than at the full all centers under this Agreement have the same legal identity as the rates that include the value of commodities. Institution. RECEI VEC) SEP 21 lc FNS a USDA No monies or other benefits may be paid out under this Program unless this Agreement is completed 840.420 and filed as required by existing Regulations(7 CFR Part 226) /i t/%tI Cno1M ERIC ,AA rl On n • - -,_•..•. _ . . . SECTION B Fill in the name and address of Centers and Homes for the Child Care Food Program. (Attach additional sheets if necessary.) TYPE OF CENTER OR HOME HOURS AND TYPE OF MEALS SERVED (Indicate "C"if Child Note. No more than 3 meals per day Care Center, "0"if per child shall be claimed. CHILD CARE FOOD PROGRAM Outside-School-Hours (Name and address of center or home) Care Center, "P"if Proprietary Title XX BREAK- AM PM Center, or "H"if FAST SNACK LUNCH SNACK SUPPER Day Care Home (a) (b) Icl (d) lel UI Igl 1. Greeley Head Start Center C 9:30 11:30 2:00 P.O. Box 1805 520 13th Avenue Greeley, CO 80632 Phone: '(303). 356-0600 2: *Frederick Head Start Center C 8:30 11:30 2:00 St. Teresa' s Church Frederick, CO 80530 Phone: (303) 833-9997 3. *Johnstown Head Start Center C 8:30 11:30 2:00 Letford Elementary School West Charlotte Street, Circl Drive Johnstown, CO 80534 Phone: (303) 587-2888 4. Pierce Head Start Center C 9:00 11:45 2:00 United Methodist Church 429 3rd Street Pierce, CO 80650 Phone: (303) 834-1264 *Vended Food FORM FNS-344 (7-83) Previous editions obsolete. Page 2 SECTION C(For FNS Regional Office Use) THE INSTITUTION AND THE DEPARTMENT MUTUALLY AGREE THAT THE INSTITUTION WILL RECEIVE FOR ITS CHILD CARE CENTERS AND OUTSIDE-SCHOOL•HOURS CARE CENTERS AND PROPRIETARY TITLE XX CENTERS. OX DONATED COMMODITIES, OR ❑ CASH-IN-LIEU-OF-COMMODITIES SECTION D - ANNUAL ADMINISTRATIVE BUDGET* *THIS SECTION IS REQUIRED FOR ORGANIZATIONS WHICH SPONSOR DAY CARE HOMES. IT IS OPTIONAL FOR SPONSOR- ING ORGANIZATIONS OF CENTERS. ITEM APPROVED AMOUNT A. ADMINISTRATIVE LABOR $ B. OFFICE SUPPLIES -0- C. POSTAGE -0- D. TRANSPORTATION FOR FACILITY MONITORING -0- E. MILEAGE ALLOWANCE FOR FACILITY MONITORING -0- CCFP's SHARE OF: F. TELEPHONE -0- G. OFFICE RENTAL AND MAINTENANCE -0- H. UTILITIES FOR OFFICE AREA -0- I. OTHER (Specify) -0- J. TOTAL APPROVED ADMINISTRATIVE BUDGET $ -0- FORM FNS-344 (7-83) Previous editions obsolete. Page 3 NONDISCRIMINATION CLAUSE THE INSTITUTION: HEREBY AGREES THAT it will comply with Title VI of the Civil lease, or furnishing of services to the recipient,or any improvements Rights Act of 1964 (P.L. 88-352) and all requirements imposed by made with Federal financial assistance extended to the applicant by the Regulations of the Department of Agriculture (7 CFR Part 15), the Department. This includes any Federal agreement.arrangement. Department of Justice (28 CFR Pails 42 & 50), and FNS directives or other contract which has as one of its purposes the provision cf or regulations issued pursuant to that Act and the Regulations, to assistance such as food, food stamps,cash assistance for the purchase the effect that, no person in the United States shall,on the grounds of food, and any other financial assistance extended in reliance on o f age,sex,handicap,color,race,or national origin, be excluded from the representations and agreements made in this assurance. participation in,or be denied the benefits of,or be otherwise subject to discrimination under any program or activity for which the BY ACCEPTING THIS ASSURANCE, the applicant agrees tc •.:an- applicant received Federal financial assistance from the Department; pile data, maintain records and submit reports as required, to per nit and HEREBY GIVES ASSURANCE THAT it will immediately take effective enforcement of Title VI and permit authorized Ui aA any measures necessary to effectuate this agreement. personnel during normal working hours to review such Ieo: ds. books and accounts as needed to ascertain compliance with 1 illy \,I THIS ASSURANCE IS given in consideration of and for the purpose If there are any violations of this assurance, the Departmen' of of obtaining any &pd all Federal financial assistance,grants and loans Agriculture, Food and Nutrition Service, shall have the right to :•aeh of Federal funds, reimbursable expenditures, grant or donation of judicial enforcement of this assurance. Federal property and interest in property, the detail of Federal personnel, the sale and lease of, and the permission to use, Federal This assurance is binding on the applicant,its successors, transit.'t eS. property or interest in such property or the furnishing of services and assignees as long as it receives assistance or retains possession el without consideration or at a nom:.nal consideration, or at a con- any assistance from the Department. The person of persons wrose sideration which is reduced for the purpose of assisting the recipient, signatures appear below are authorized to sign this assurance on the or in recoimition of the public interest to he served by such sale, behalf of the applicant. CERTIFICATION STATEMENT I HEREBY CERTIFY that all of the above information is true and correct. I understand that this information is being given in connection .vith the receipt of Federal funds; that Department Officials may, for cause, verify information; and that deliberate misrepresentation will subject me to prosecution under applicable State and Federal criminal statutes. SIGNATURE ON BEHALF OF INSTITUTION BY UNITED STATES DEPARTME OF AGRICULTURE AUTHORIZED REP SENT py FOOD ID NUTR IONS CE REGIONAL OFFICE --- BY. �l//hn—{ _.4i..._SIGNATURE U/ IGNATURF�_/ • NAME• Norman Carlson, Chairman NAME:JOSE R. GARC7A ---- (Print or Type) (Print or Type) Chief, Program Operations Section, TITLE: Board of Cou CommissionersDATE:---9/12/84Ttrr_: _____ -„ -i -nt.y ReeJ'iOn VIII costs, endC 1A.1 I7.R71 0.0.,;,.,,,adianns obsolete. Pc4N,4 A, ament Number 08-65103-00-0 INFORMATION UPDATE - Fiscal Year (FY) 1985 The Institution certifies that it is currently operating the Child Care Food Program (CCFP) and will continue to operate it during FY 1985 (October 1, 1984 , through September 30, 1985) in accordance with the CCFP Regulations, Part 226 , dated August 20 , 1982. The Institution further certifies that: 1. All centers are currently licensed or approved in accordance with the provisions of Sections 226.15(b)(4) or 226.16(b) (3) of the Regulations; 2. For any new center for which the Institution will be applying for participation, it will submit a completed Form FNS-341, Application for Participation for Child Care Center, prior to operation, as required by Section 226.16(b) of the Regulations; 3. It will advise the MPRO of any information changes affecting currently operating centers; e.g. , changes of address, of meal types, of meal service times, etc. 4. Form FNS-342 , Application for Participation & Management Plan for Sponsoring Organizations, as submitted for FY 1984, is accurate, is being adhered to, and will be followed during FY 1985. The Institution also certifies that if there should be any change in this application data or management plan, a new Form FNS-342 will be completed and submitted; 5. Preapproval visits and staff training will be scheduled and provided in accordance with Section 226.16(d) of the Regulations and documentation of these activities will be maintained on file; 0 6. If meals are supplied by a vendor, a copy of the contract will be submitted with this Information Update and the FNS-344, Agreement. 7. It elects the following with respect to advance payments for FY 1985: a. ( X) No advance payments b. ( ) Partial advance payments c. ( ) Full advance payments 8. The USDA Family Size and Income Guidelines effective July 1, 1984, will be utilized in classifying children into ineligible , free and reduced-price categories. The current enrollment figures are: 0 ineligible , 2B0 free, and q reduced price . The Department's Agreement to reimburse the Institution is contingent upon the continued availability of funds appropriated for CCFP purposes in a sufficient amount, and no legal liability on the part of the Government for the payment of any money shall arise unless and until such appropriations shall have been provided. Signature on Behalf of CCFP Institution U. S. Department of Agriculture Byp-,a,_,.n-4-._ .e r ,� �. By <� Norman Carlson, Chairman L Title Board cf County Commissioners Title oilz- Date 09/12/84 Date i%/ CO/NE Agreement No. 08-65103-00-0 NONDISCRIMINATION POLICY STATEMENT FOR THE CHILD CARE FOOD PROGRAM 1. Weld County Division of Human Resources assures the Food and Nutrition (Name of Sponsor) Service Regional Office that all children at the facilities described on the application forms are served the same meals at no separate charge regardless of race, color, national origin, age, sex, or handicap, and and there is no discrimination in the course of the meal service. 2. We will annually submit a public release to the news media serving the area(s) from which our institution draws attendance announcing the availability of meals at no separate charge to enrolled children. (A sample public release is shown on the reverse side of this form.) 3. We understand that we are not required by the Food and Nutrition Service to pay for publication of our release. 4. We will retain a copy of the public release sent to the media in our permanent files. 5. At least one of the following boxes must be checked. a. Q We have attached a copy of the public release and have indicated to whom and when it was sent. b. A copy of the news release that was published is attached. (Please send the full newspaper page on which the release was printed.) c. 0 We will issue a news release on the week of September 24, 1984 (date) A copy of our release and the published release, if any, will be sent to your office within 1 month of this date. /� Norman Carlson, Chairman a — � ^— Board of County Commissioners 9/12/84 For Sponsor (Signature) (Title) (Date) FOR USDA ONLY r , ce--c— Li . _,,,, Approved y ( ame) (Title) at (This form is not to be used by FDCH sponsors.) Hello