HomeMy WebLinkAbout941018.tiff RESOLUTION
RE: APPROVE FOOD DISTRIBUTION AGREEMENT FOR EMERGENCY FOOD ASSISTANCE PROGRAM
WITH COLORADO DEPARTMENT OF HUMAN SERVICES AND AUTHORIZE CHAIRMAN TO SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado,
pursuant to Colorado statute and the Weld County Home Rule Charter, is vested
with the authority of administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Food Distribution Agreement
for the Emergency Food Assistance Program between the County of Weld, State of
Colorado, by and through the Board of County Commissioners of Weld County, on
behalf of the Department of Social Services, and the Colorado Department of Human
Services, commencing October 1, 1994, and ending September 30, 1995, with further
terms and conditions being as stated in said agreement, and
WHEREAS, after review, the Board deems it advisable to approve said
agreement, a copy of which is attached hereto and incorporated herein by
reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, ex-officio Board of Social Services, that the Food Distribution
Agreement for the Emergency Food Assistance Program between the County of Weld,
State of Colorado, by and through the Board of County Commissioners of Weld
County, on behalf of the Department of Social Services, and the Colorado
Department of Human Services be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chairman be, and hereby is,
authorized to sign said agreement.
The above and foregoing Resolution was, on motion duly made and seconded,
adopted by the following vote on the 17th day of October, A.D. , 1994, nunc pro
tunc October 1, 1994.
Attekia/4912
BOARD OF COUNTY COMMISSIONERS
ATTEST: WELD COUNTY, COLORADO
/> 7 A' 0
Weld County Clerk to the Board %/ // < 7-" Pc 2/
W. H. Webster, airman
BY: nn./ Pik
Deputy Cork to the Board Dale . Hall, ro- em
APPROVED AS TO FORM: /�/_-- C
/Geo`rse/E. Baxter 6j
ts .
Constance L. Harbert
EXCUSED DATE OF SIGNING (AYE)
Barbara J. Kirkmeyer
941018
ascol€3
922221 ; LEONA . ARTENS
WELD FOOD BANK
104 11TH AVE.
GREELEY, CO 80631
DF-2B(Rev.9/94)
COLORADO DEPARTMENT OF HUMAN SERVICES
1575 Sherman Street, 3rd Floor
Denver, CO 80203-1714
Food Distribution Agreement
The Emergency Food Assistance Program
This agreement is made this (Enter today's date)17th day ofo,.r 1994 by and between the
Colorado Department of Human Services, 1575 Sherman Street, 3rd Floor, Denver, CO 80203-1714
(hereinafter referred to as the "Department"), and the (Enter your agency's name)
Weld Co. Dept. of Social Services (hereinafter referred to as the "Recipient Agency").
Whereas, the Department is a distributing agency under a contract with the U.S. Department of
Agriculture (hereinafter referred to as "USDA"). The contract with USDA is subject to all federal laws
and regulations. USDA controls the amount and types of commodities available to the Department.
Whereas, the Department has the responsibility for administering the Food Distribution Program in
accordance with the terms of the Agreement; and
Whereas, as of the date of execution of the Agreement, Recipient Agency meets all requirements
for participation in this program.
NOW, THEREFORE, it is hereby agreed:
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1. The Recipient Agency is operating The Emergency Food Assistance Program which provides
emergency foods for distribution to authorized low income households; and
Complete the following questions:
The Recipient Agency has the following types of storage facilities available:
Dry YesjLNo_
Cooler Yes x No_
Frozen Yes x No_
2. Recipient Agency shall participate in the Food Distribution Program in accordance with the
terms of the Agreement and applicable legal requirements described below.
3. The term "legal requirements" as it is used throughout this Agreement includes federal and
state statutes, federal and state regulations, program requirements as identified in the Food
Distribution Unit Recipient Agency User's Handbook, Colorado TEFAP Plan attached hereto and
incorporated herein as Exhibit A and any amendments thereto, which are applicable to the Food
Distribution Program, which are in effect when this Agreement is executed. The Recipient
Agency agrees to fully comply with all legal requirements defined above, and to submit any
reports requested by the Department or USDA in a prompt and complete manner, and to
enforce such legal requirements against any sub-distributing agencies which are under contract
with Recipient Agency.
4. Recipient Agency shall receive, store and distribute donated foods. In addition, the Recipient
Agency agrees to comply with following terms and conditions:
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941018
A. Use of Donated Foods
Donated foods will be used only in connection with Recipient Agency's established
feeding operation for the sole benefit of persons served by the Recipient Agency and
will not be sold, exchanged, or otherwise disposed of by the Recipient Agency without
express written approval being obtained by the Recipient Agency from the Department.
B. Storage Facilities
The Recipient Agency and any sub-distributing agencies under contract with the
Recipient Agency shall provide adequate facilities for the handling, storage and
distribution of donated foods. These facilities shall be such as to properly safeguard
against damage, theft, spoilage, or other loss as recommended in the "Food Storage
Guide for Schools and Institutions" in the Food Distribution Unit User's Handbook. The
Recipient Agency shall provide facilities and services that:
1. Are sanitary and free from rodent, bird, insect and other animal infestation;
2. Safeguard against theft, spoilage and other loss;
3. Maintain foods at proper storage temperatures;
4. Stock and space foods in a manner so the USDA donated foods are readily
identified;
5. Rotate stock utilizing "First-In/First-Out" inventory practices;
6. Store donated food off the floor and away from walls in a manner to allow for
adequate ventilation;
7. Maintain accurate inventory records of product issuance; and
8. Take other protective measures as may be necessary.
The Department reserves the right to inspect the facilities, without the benefit of prior
notification, to ensure these standards are met.
C. Responsibility for Damage. Spoilage. Theft or Other Loss
Once the donated foods have been delivered to the Recipient Agency or its carrier
agency, the Recipient Agency is responsible to the Department for said food. In the
event of damage, spoilage, theft or other loss, the Recipient Agency will promptly
notify the Department. In case of spoilage, the Recipient Agency shall furnish a
certificate from the County or the State Health Department representative confirming
such spoilage.
The Recipient Agency assumes full responsibility for reimbursing the Department for
the USDA dollar value of any donated foods improperly used or disposed of or any loss
or damage to donated foods due to the failure of the Recipient Agency or its agents
to provide proper storage, care or handling. The Recipient Agency may be required by
the Department to submit documentation regarding the loss.
D. Physical Inventory
Recipient Agencies shall take a monthly physical inventory of USDA commodities the
last working day of each month and submit the inventory to the Department, not later
than the 10th of each month, in a format prescribed by the Department. Such
inventory shall be reconciled with the Recipient Agency's book inventory records and
maintained on file by the Recipient Agency.
In no event, may the inventory level of each donated food in storage exceed a six
month supply unless sufficient justification for additional inventory has been submitted
and approved by the Department.
2 9A10tS
E. Complaints
The Recipient Agency shall immediately advise the Department in writing of any
complaints regarding the donated foods. The Recipient Agency shall provide
appropriate information regarding the product and nature of the complaint so that an
investigation can be pursued by the Department or USDA. In addition, any complaints
regarding the commercial distribution system shall be provided to the Department in
writing for appropriate action.
F. Bur American
When purchasing food products with federal funds, Recipient Agencies shall, whenever
possible, purchase only food products that are produced in the United States.
The purchase requirement does not apply in instances when the Recipient Agency
determines: (1) Recipients have unusual or ethnic food preferences which can only be
met through purchases of products not produced in the U.S.; (2) the product is not •
produced in the U.S. in sufficient and reasonably available in quantities of a
satisfactory quality; or (3) the cost of the U.S. product is significantly higher than
foreign products.
G. Utilization and Redistribution
Available donated foods will be requested only in such quantities as will be fully utilized
and will be receipted for by the authorized representative of the Recipient Agency. The
Department reserves the right to redistribute any USDA donated foods in possession
of the Recipient Agency.
H. Records
The Recipient Agency will accurately maintain records of donated foods received and
such accountability records as may be prescribed by the Department. Such records
shall include, but not be limited to, accurate and complete records with respect to the
receipt, disposal, and inventory of donated foods and with respect to any funds which
arise from the operation of the program. The Recipient Agency shall also keep
accurate and complete records showing the certification and eligibility determination
of those making application for program participation. All records must be retained for
a period of three years from the close of the federal fiscal year to which they pertain.
Audits and Inspection
The Recipient Agency shall allow representatives of the Department and/or USDA to
inspect and inventory donated foods in storage, the facilities used in handling or
storage of such donated foods, inspect and audit all records, including financial records
and reports pertaining to the distribution of donated foods, and to review or audit the
procedures and methods used in carrying out the audit requirements at any reasonable
time with or without the benefit of prior notification.
All Recipient Agencies receiving more than $25,000 in federal financial assistance per
fiscal year shall have an audit made by an independent auditor, that complies with the
audit requirements established by the Office of Management and Budget Circular
Number A-128 or A-133. The audit standards to be followed can be found in the
Standards for Audit of Governmental Organizations. Proarams.Activities and Functions
(1988 revision) issued by the U.S. General Accounting Office, and the Guidelines for
Audits of Federal Awards to Nonprofit Organizations (April 1989) published by the
3 91:1018
•
Department of Health and Human Services. For this purpose, the term independent
auditor means a state or local government auditor who meets the independence
standards specified in generally accepted government auditing standards; or, certified
public accountant who meets such standards.
J. Donations of Food
Food donations from other sources will not be reduced because of the receipt of
Section 110 commodities donated to the Recipient Agency for distribution to eligible
food bank and soup kitchen agencies as defined in Exhibit A.
K. Financial
1. Administrative Funds
The Recipient Agency shall claim reimbursement for administrative
expenditures for costs incurred for storage, transportation and distribution of
donated foods. Claims shall be submitted in a format prescribed by the
Department, by providing proof of prepaid expenditures. Administrative funds
shall be allocated to the Recipient Agency by the Department as indicated in
the Colorado TEFAP Plan.
2. Distributor Charges
The Recipient Agency shall pay the quoted price per case directly to the
contracted regional distributor as billed for the number of cases received on
each shipment. The Recipient Agency shall comply with the distributor's credit
policy and payment terms. In the event a Recipient Agency falls more than 60
days in arrears in payments to the distributor, the Department and the
distributor may jointly agree to suspend issues of donated foods and the
distributor may take necessary action to pursue collection of the account. The
Recipient Agency shall request reimbursement for payments made to the
distributor on a form prescribed by the Department.
L. Civil Rights and Nondiscrimination
The Recipient Agency at all times during the execution of this agreement shall strictly
adhere to all applicable federal and state laws and implementing regulations as they
currently exist and may hereafter by amended. This includes protection of the
confidentiality of all applicant/recipient records, papers, documents, tapes and any
other materials that have been or may hereafter by established which relate to this
agreement. The Recipient Agency acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. sea.
and its implementing regulation, 45 C.F.R. Part 80 et. sea.; and
Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. section 794, and its
implementing regulation, 45 C.F.R. Part 84; and
the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. sea. and its
implementing regulation, 45 C.F.R. Part 91;
and
Title VII of the Civil Rights Act of 1964; and
the Age Discrimination in Employment Act of 1967; and
the Equal Pay Act of 1963; and
the Education Amendments of 1972.
Immigration Reform and Control Act of 1986, P.L. 99-603
4 941018
The Recipient Agency shall comply with all regulations applicable to these laws
prohibiting discrimination because of race, color, national origin, age, sex, religion and
handicap, including Acquired Immune Deficiency Syndrome (AIDS) or AIDS related
conditions, covered in Section 504 of the Rehabilitation Act of 1973, as amended,
cited above. This assurance is given in consideration of and for the purpose of
obtaining any and all federal and/or state financial assistance. Any person who feels
that s/he has been discriminated against has the right to file a complaint either with the
Colorado Department of Human Services or with the U.S. Department of Agriculture,
Office for Civil Rights.
The Recipient Agency is responsible for any additional Civil Rights reporting
requirements as set forth in the Colorado TEFAP Plan.
M. Indemnification
To the extent authorized by law, the Recipient Agency shall indemnify, save and hold
harmless the State, its employees and agency, against any and all claims, damages,
liability and court awards including costs, expenses, and attorney fees incurred as a
result of any act or omission by the Recipient Agency, or its employees, agents,
subcontractors, or assignees pursuant to the terms of this Agreement.
N. gnforcement
If the Recipient Agency fails to comply with the provisions of this Agreement, it may,
at the discretion of the Department, be disqualified from further participation in the
Program. The Recipient Agency or the Department may seek judicial relief for any
provision of this Agreement.
O. Effective Date
This Agreement will become effective on the date of approval by the Executive Director
of the Department or authorized designee, and shall remain in effect until September
30, 1995. The Recipient Agency or the Department may terminate this Agreement at
any time by giving thirty days notice in writing. Upon such termination by either the
Recipient Agency or the Department, the Recipient Agency shall, at its expense, return
all unused donated foods in its possession to such place within the State of Colorado
as may be designated by the Department.
P. Assignment
The Recipient Agency agrees not to assign its rights or to delegate its obligations under
this Agreement without prior approval in writing from the Department.
Q. Future Effect
This Agreement is binding upon the present and future elected or employed officials
of the Recipient Agency and the State of Colorado.
R. Authorized Representative
It shall be the duty of the Recipient Agency to promptly notify, in writing, the
Department of any change in its Agency Head or authorized representative or change
in legal address.
5 9410: 8
S. Signatures
The individual signing this Agreement as the "Agency Head" or "Authorized
Representative" (as attested if a corporation) certifies that his/her signature leaally
binds the Recipient Agency to the terms of this Agreement.
TYPE OR PRINT ALL INFORMATION BELOW:
DATE: October 17. 1994
NAME OF RECIPIENT AGENCY:
Weld County Department of Snrial Services
ADDRESS: STATE OF COLORADO
P.O. Box A - 315 N. 11th Ave. DEPARTMENT OF HUMAN SERVICES
Greeley, CO 80632 DATE APPROVED
PHONE #:(303) 352-1551
SIGNATURE AND TITLE OF AGENCY HEAD
OR AUTHORIZED REPRESENTATIVE: FOR: BARBARA McDONNELL
EXECUTIVE DIRECTOR -
m%/eiv
W. H. Webster, Chairman, Board of Weld County Commissioners
TYP OR PRINT NAME AND TITLE OF
A OR r NTA IVE:
A'DfE IF CORPORATION:I �A
6 941019
Revised 09/94 COLORADO TEFAP PLAN
October 1, 1994
1. ELIGIBILITY CRITERIA
Each household must meet one of the following household income
eligibility criteria to be potentially eligible to receive an
allocation of commodity foods at any scheduled distribution. Actual
receipt of commodity foods shall depend on the availability of
sufficient quantities of USDA commodities.
A. Participation in federal or state programs which have an
established income eligibility criteria as follows:
1. Aid to Families with Dependent Children (AFDC) .
2. Low-Income Energy Assistance Program (LEAP) .
3. Old Age Pension (OAP) , Aid to the Needy Disabled (AND) , and
Aid to the Blind (AB) .
4. Supplemental Security Income (SSI) .
5. Medicaid Eligible Foster Children.
6. Food Stamp Program
B. Households containing foster children as defined in Staff
Manual, Volume VII (7,708.1) , shall have their household
size based only on the number of Medicaid eligible foster
children in the household. For example, a household
containing three Medicaid eligible foster children will be
classified as a household of three persons.
C. Household gross monthly income declared by the household at
or prior to the scheduled distribution which shall not exceed the
following:
HOUSEHOLD SIZE GROSS MONTHLY INCOME
1 $1,135
2 1,517
3 1,900
4 2,282
5 2,664
6 3,047
7 3,429
For each additional household member add $383.00.
If the distribution worker believes there is reason to question
the self declaration of the household's participation in one of
the programs set forth in paragraph "A" or income guidelines set
forth in paragraph "C" above, the worker may require the
household to provide proof of program participation or monthly
income through pay stubs or written information from a
knowledgeable, collateral contact. Gross monthly income is to be
used for the particular month of distribution only.
1
2. DETERMINATION OF ELIGIBILITY PROCEDURE
The county agency shall establish procedures to assure that each
household desiring to participate in The Emergency Food Assistance
Program (TEFAP) meets the eligibility criteria and that this
determination is recorded in a manner which will allow the accumulation
of eligibility and issuance statistics. (DF-SDP-2, attached)
Any county may submit a plan for accomplishing the determination of
eligibility for their county. This plan shall, at a minimum, contain
provisions for determining categorical eligibility and income
eligibility and a procedure for recording this determination in a
manner which will allow accumulation of data for completion of
necessary participating reports prescribed by the state (DF-SDP-3,
attached) .
3. VERIFICATION OF IDENTITY OF HOUSEHOLD AND COMPLETION OF ISSUANCE
RECORD
Prior to the completion of the eligibility determination, the county
agency shall verify the identity of the household member by viewing a
driver's license or other documentation which the agency representative
determines acceptable. The agency representative shall then complete
a form approved by the state agency, which shall include the name of
the household, number of persons in the household, the date of
issuance, the number of packages of each commodity and have the
household representative sign the certification and receipt. (DF-SDP-1,
attached)
4. DISTRIBUTION RATE GUIDE
Each county shall establish distribution rates for their county prior
to any distribution. . The guide rates will be posted in a conspicuous
place before the distribution begins and must be followed for the
entire distribution. (Rates cannot be changed during a distribution for
any reason) .
Guide rates should be established using the amount of product on hand
divided by the number of participating households. Households of five
or more should be counted as two households for the purposes of
determining guide rates and should be issued twice the amount of
product as smaller households.
The following are recommended guide rates and can be changed prior to
a distribution if a shortage or surplus of any product is anticipated.
2 94101.3
*Item & Unit size 1-4 Members 5 or More Members
Butter 1# print 1 per member 1 per member
Cornmeal 5# bag 1 2
Egg Mix 6 oz. package 1 2
Juice 46 oz can 1 2
Fruit #303 can 2 4
Peanut Butter 2# can 1 2
Meat or Fish can 1 2
Raisins 1# box 1 2
Vegetables #303 can 2 4
Other, unless specified 1 2
5. REPORTING REQUIREMENTS
County agencies shall report to the state agency monthly, listing the
number of households and individuals participating and an itemized
accountability inventory record indicating the quantities of foods at
the beginning of the month, balance on hand at the end of the month,
quantities received and distributed during the month and any overages
or shortages. (DF-SDP-3, attached)
Failure of county agencies to provide monthly reports to the state
agency in a timely manner, may result in suspension of program
participation until required reports are received. Monthly reports
should be submitted to the state agency by the tenth of each month.
Monthly reports are required, even if the county only distributes
quarterly.
6. RIGHT TO APPEAL
The requirement for safeguarding confidential information and for
providing adequate notice and opportunity for hearings and appeals
shall be the same as for the Food Stamp Program.
7. CIVIL RIGHTS
Participation in The Emergency Food Assistance Program (TEFAP) is
available to all eligible persons regardless of race, color, national
origin, sex, age, or handicap. This statement shall be printed on all
public information regarding TEFAP.
3
941018
8. RECORD RETENTION
County agencies shall maintain records to document the receipt,
disposal and inventory of USDA commodities for a period of three years
after the close of the federal fiscal year to which they pertain.
County agencies shall also maintain records for the amount of
administrative funds received and expended and the actual costs
incurred for the storage, transportation, and distribution of USDA
commodities. These records shall also be maintained for a period of
three years after the close of the federal fiscal year.
9. ALLOCATION OF ADMINISTRATIVE FUNDS TO COUNTIES
The state agency will make funds available to the counties
administering TEFAP and soup kitchen agencies serving homeless persons
as follows:
1. At least forty percent of the administrative funds allocated by
the federal government for this program will be passed through to
county agencies and soup kitchens for administrative costs
directly related to the storage, transportation and distribution
of TEFAP and soup kitchen commodities. Agencies may also submit
requests for direct expenditures incurred for storing and
distributing non-commodity foods along with TEFAP commodities.
The state agency shall determine a per case allocation of
administrative funds by dividing the federal funds available for
this purpose by a projection of the number of cases of food
estimated to be available for the federal fiscal year. These
funds may be claimed on a monthly or quarterly basis using the
Statement of Expenditure form (attached) . All agencies must
certify that reported expenditures are for direct costs incurred
for the storage, transportation, and distribution of TEFAP and
soup kitchen commodities. All documentation pertaining to the
Statements of Expenditures which are submitted should be
available during any federal, state or independent financial
audit.
2. Funds will be retained at the state level to reimburse counties
and soup kitchens 100% for payments made to the, commercial
distributors who warehouse and deliver commodities to county and
soup kitchen agencies. These funds should be claimed on a
Distributor Reimbursement Claim Form as soon as the commodities
are received by the agency and the distributor has been paid by
the county or soup kitchen agency. Failure to pay the
distributor on a timely basis will result in suspension of
further commodity orders or will result in a delivery or pick up
on a cash only basis. Any funds which are retained and are not
claimed as payments to distributors by the end of the federal
fiscal year, will be reallocated to county and soup kitchen
agencies for administrative costs which were not reimbursed
during the year.
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941013
10. STATE MATCHING REQUIREMENT
The estimated amount of federal funds to be retained at the state level
for FY95 are computed as follows:
Anticipated Grant: $448,760
(Based on FY94 Grant)
*40% Local Agency
Pass Thru-Adm. $214,069
Est. Distributor
Payments: $206,000
State Agency Retention $ 28,691
*This analysis reflects a higher than a 40% pass thru of administrative
funds based on preliminary estimates of distributor payments and state
agency retention.
The anticipated amount of federal funds to be retained at the state
level is $28,691 and will be matched as follows:
Personal Services and Operating for FY94 $478,185
(Average percent of expenditures to the
total operation for FY94) x12%
$ 57,382
Remaining funds to be matched with state
general fund dollars. $ 28,691
11. ALLOCATION OF COMMODITIES TO COUNTIES
Allocation of available commodities shall be based upon the data from
the latest month's available Food Stamp Participation Report which is
used as an indicator of needy people. The state agency shall determine
each county's participation in the Food Stamp Program as a percentage
of all counties participating in The Emergency Food Assistance Program
(TEFAP) . This percentage shall then be applied against the total
available quantity of each type of commodity food available to provide
the participating counties with their fair share.
Information shall be submitted to the county agencies indicating the
number of cases of each food item allocated and months(s) in which the
commodity foods are expected to be available.
Any county agency not having an approved agreement with the state
agency may not receive food until after the beginning of the quarter
following the quarter in which an agreement is approved.
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941018
12. MONITORING PLAN
Colorado currently has agreements with sixty-one out of sixty-three
counties in the state to participate in the program. Each county
agency will be reviewed by the state agency periodically. Findings and
recommendations will be provided to each agency. Agencies will be
required to respond within thirty days describing the corrective
actions they have taken. Follow up reviews will be made if necessary.
Each county agency will be provided a copy of this plan along with the
form for site monitoring (attached) . Every county agency will review
it's distribution sites once each year. This review will take place
when distribution or eligibility determination activities are
occurring. Results of these reviews along with a description of any
corrective actions taken, must be sent to the state agency within
thirty days. On site reviews must insure compliance with all TEFAP
regulations as stated above in addition to the following storage
procedures.
Storage procedures shall be as described in the Food Storage Guide in
your Recipient Agency User's Handbook. These procedures must be
followed to insure protection of commodities at all times by all
distribution sites.
County agencies are responsible for the USDA value of commodities
received. If a loss of product should occur county agencies are to
follow the attached, "Actions to be Taken" , .procedures. A claim
determination will be made by the state agency as to fault or neglect
on the part of the county agency. Based on this determination,
collection of the claim for the value of the loss may be pursued from
the county or soup kitchen agency by the state agency for submission to
the USDA.
13. SOUP KITCHENS
Soup Kitchens will be made eligible as Charitable Institutions serving
the homeless as defined in the Hunger Prevention Act of 1988.
Commodity foods purchased for Soup Kitchens will be allocated to
eligible agencies based upon the average daily participation of
homeless persons served. Soup Kitchens must comply with all federal
and state regulations as a Charitable Institution and will be subject
to agency review as required.
6
941019
INSTRUCTIONS FOR COMPLETING STATEMENT OF ACTUAL EXPENDITURES
1. Check the line after quarter indicated for which you axe maiming reimbursement.
2. Indicate in the appropriate block die amount of actual expenditures for which you are ruining
reimbazsemea . Note: County Departments of Social Services am reminded that they are not to
claim TEFAP expenditures which are being reimbursed through the 80/20 deparaneatal
administration funds received from the State Depamnent of Social Services.
3. Total the amount requested and place it in the bottom total line of the actual expenditure table.
Please do not request over 1/4 of your administrative allocation at a time on each quarterly report.
Keep tract of those expenses which are not reimbursed during the year. If finds should amain
at the close of the fiscal year.we will give each agency adequate notice to apply for these finds.
4. FlU out all requested brfromerlon on the bottom of the form including signature authorization and
date. Note: Signal=indicates certification that the expenditures reposed are accurate and that
documentation of those expendiuues will be available for audit and kept on file for a period of
three years after the federal fiscal year to which they pertain.
5. . Submit the form to the address on the top of the form.attaxon: Beat Pens or Rita Klee.
INSTRUCTIONS FOR COMPLETING REIMBURSEMENT CLAIM FOR DISTRIBUTOR PAYMENTS
1. List the invoice/s for which you are claiming reimbursement, the amount: invoice number and
name of distributor.
2 Complete the requested information on the bottom of the form air-wing signature authorization
and date. Note: Signature certifies that all invoices are correct as to actual amounts of products
received and that those invoices will be kept on file for a period of three years after the federal
fiscal year to which they pertain. •
3. Attach copies of all original distributor invoices for which you are maiming reimbursement
4. Requests can be made for invoices dated October 1 - September 30 for the current federal fiscal
year.
5. Submit the form to the address on the top of the form. natation: Bert Peas or Risa Klee
Requests for actual expenditure a reimbursement and distributor payment reimbursement can be made on
the same form at the same time or separate forms can be submitted for reimbursement on an as needed
basis for distributor payments. Actual expenditure requests should be requested on a quarterly basis.
Questions about this form can be directed to Berk Pens (866-5101) or Risa Klee (866-5100).
.9411.9
COLORADO DEPARTMENT OF SOCIAL SERVICES-FOOD ASSISTANCE PROGRAMS-DONATED FOODS UNIT
1575 SHERMAN STREET, 3RD FLOOR. DENVER. CO 80203-1714
STATEMENT OF ACTUAL EXPENDITURES FOR TEFAP AND SOUP KITCHEN AGENCIES
REIMBURSEMENT FOR THE QUARTER(CHECK ONE): OCTOBER-DECF.MBER_JANUARY-MARCH_
APRIL -JUNE JULY - SEP'T'EMBER_
ACIUAL EXPENDMIRES AMOUNT CY.AIME D
CAPITAL OUILAY"
MILEAGE
NUTRITION EDUCATION •
OUTREACH
•
PERSONAL SERVICES
RENT. UIIIIIIES- OFFICES
RENT. UTILITIES - WAREHOUSE
OTHER •
TOTAL
•
't-Vital outlay must have prior approval tram the Donated-Foods-Unit
`�a'}s �itltiFII1�G3 VD£,iFaq�₹t d'f5Y #�`F3'Q� d .7 •£ '@$;£)�,b'�'s t'�3�L�t#
INVOICE DATE AMOUNT OF INVOICE INVOICE NUMBER NAME OF DISTRIBUTOR
'Copies of original mvoices tram your dzsu bu wr must be attached and should reelect aauai amounts of products received
at time of delivery.
I certify that the expenditures repotted have been made and that payrolls,invoices and other documentation are available
for audit at
Name of Agency
Mailing Address City ZIP
Phone Number
Signature of Authorization Date .1 - �'�
INSTRUCTIONS ON BACK OF FORM
l)F-SDP-3 (REV. 7/92)
THE EMERGENCY FOOD ASSISTANCE PROGRAM (TEFAP)
RECEIPT AND DISTRIBUTION OF COMMODITIES
COUNTY: TOTAL # OF INDIVIDUALS
REPORT FOR MONTH OF: TOTAL # OF HOUSEHOLDS
INVENTORY ACCOUNTABILITY
ITEM/CASE PACK BALANCE QUANTITY QUANTITY PHYSICAL OVER/
SI7F AT START RECEIVED DISTRIBUTED INVENTORY SHORT
OF DURING DURING END OF
MONTH MONTH - MONTH MONTH
Beans, Dry 12/2#
Butter 36/1#
Cornmeal 10/5#
Egg Mix 48/6 oz.
Flour 10/5#
Fruit 24/#303
Honey 24/24 oz.
Juice 12/46 oz.
Meat 24/29 oz.
Peanut Butter 24/2#
Raisins 48/1#
Vegetables 24/#303
Explanation of Over/Short:
TEFAP is available to all those eligible regardless of race, color, national origin, age, sex or handicap.
Signature of Authorized Representative Date
• 341018
ISSUANCE RECORD
AMT AMT AMT AMT AMT AMT 1 .
COMMODITY REC'D REC'D RECD REC'D RECD REC'' •
BEANS DRY
BUTTER
CORNMEAL
FLOUR
FRUIT
HONEY
JUICE I
MEAT
PEANUT BUTTER
RAISINS
RICE
VEGETABLES
I CERTIFY THAT 1 AM IN NEED OF FOOD ASSISTANCE.THE FOOD I RECEIVE IS FOR MY HOUSEHOLD AND WILL NOT BE
SOLD OR EXCHANGED.
SIGNATURE DATE SIGNATURE DATE
SIGNATURE DATE SIGNATURE DATE
SIGNATURE DATE SIGNATURE DATE
DF-SDP-1 THE EMERGENCY FOOD ASSISTANCE PROGRAM(TEFAP)
County ELIGIBILITY, ISSUANCE RECORD
Name/Head of household - Social Security *
Address Spouse Social Security *
City,State, Zip Code
Phone
Authorized Representative
Names Of Household Members INCOME
Currently Participating in:
Food
LEAP AFDC OAP AND AB SSI Stamps
If 'Other,' State source / Gross Monthly Income:
Signature of Applicant
Date
TEFAP is available to all eligible people regardless of race,color,national origin,sex,age or handicap,within quantities of USDA com-
modities available for distribution.
Verfication:
Identification: Eligibility: Approved:
Income: Denied Reason:
Signature/Certification Worker Date
9141014
r nc DEPARTMENT OF SOCIAL SERVICES
P.O. 80 2
I '+?:47; n^ i 7 pe( I�; 25 A
GREELEY,COLORADO 80632
wimple
Administration and Public Assistance(303)352-1551
` ``Q A N D U M Child Support(303)352-6933
TO i IL Protective and Youth Services(303)352-1923
Food Stamps(303)356-3850
FAX(303)353-5215
COLORADO
TO: W. H. Webster, Chairman, Board of County Co ission rs
FROM: Judy A. Griego, Director, Social Services
SUBJECT: The Emergency Food Assistance Program (TEF ) gr ent/ etw
the Colorado Department of Social Service nd b Well Co ty
Department of Social Services
DATE: October 12, 1994
Enclosed for Board approval is a TEFAP Agreement between the Colorado
Department of Human Services and the Weld County Department of Social
Services. We were in receipt of this TEFAP Agreement on October 5, 1994,
with a due date from the State on October 31, 1994.
The Agreement continues our participation in the Donated Food Program
according to the terms of the Agreement. The term of the Agreement is
October 1, 1994 through September 30, 1995.
The Weld County Department of Social Services will coordinate services with
the Weld Food Bank.
If you have any questions, please telephone me at extension 6200.
JAG:jac
Enclosure
941018
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