HomeMy WebLinkAbout992366.tiff RESOLUTION
RE: APPROVE FAMILY EDUCATIONAL NETWORK OF WELD COUNTY CONTRACT
RENEWAL LETTER#1 AND AUTHORIZE CHAIR TO SIGN - COLORADO
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
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 Contract Renewal Letter#1 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 Human Services, Family Educational Network of
Weld County, and the Colorado Department of Public Health and Environment, commencing
October 1, 1999, and ending September 30, 2000, with further terms and conditions being as
stated in said letter, and
WHEREAS, after review, the Board deems it advisable to approve said letter, 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, that the Contract Renewal Letter#1 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 Human Services, Family Educational Network of Weld County, and
the Colorado Department of Public Health and Environment be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said letter.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 27th day of September, A.D., 1999.
BOARD OF COUNTY COMMISSIONERS
01„orw D COUNTY, C LORADO
ATTEST: �►/fr1 t. ,t/J S
av �� Dal- K. Hall, Chair
Weld County Clerk to t C : .�`:'%�
L
• y
`, ri . A`i Barbar J. Kirkmeyer, ro-Tem
Deputy Clerk to the Bo- I t �I /Z
Georg E. ter
APPROV,t`D AS TO FORM: ileLc;
. eile
%' ` / z
Coyrmty Attorne EXCUSED DATE OF SIGNING (AYE)
Glenn Vaad
ft ', 41(4.
i f w 992366
I HR0070
STATE OF COLORADO
Bill Owens,Governor p co
Jane E.Norton,Executive Director Rc pt: 4;4
Dedicated to protecting and improving the health and environment of the people of Colorado )16
4300 Cherry Creek Dr.S. Laboratory and Radiation Services Division ,�,'. #,ri
Denver,Colorado 80246-1530 8100 Lowry Blvd. *ta76'r
Phone(303)692-2000 Denver CO 80220-6928
Located in Glendale,Colorado (303)692-3090 Colorado Department
http://www.cdphe.state.co.us of Public Health
and Environment
August 16, 1999 Contract Renewal Letter
(Amendment to the Agreement)
State Fiscal Year 1999-2000, Contract Renewal Letter Number 1, Contract Routing Number 00-00451
Pursuant to paragraph A of the contract with contract routing number 99-01295,hereinafter referred to as the"Original
Contract" between the
State of Colorado,Department of Public Health and Environment and WELD COUNTY,FAMILY EDUC NETWORK
OF WELD CO.PO BOX 1805.GREELEY.CO. 80632-1805,for the renewal term from October 1, 1999,through
September 30.2000. A revised listing of all centers or sites participating in the CACFP is attached hereto as"Attachment B",
incorporated herein by this reference,and made a part hereof The first sentence in paragraph C.4.of the Original Contract is
hereby modified accordingly. All other terms and conditions of the Original Contract are hereby reaffirmed. This amendment
to the Original Contract is intended to be effective as of October 1.1999.However,in no event shall this amendment be
deemed valid until it shall have been approved by the State Controller or such assistant as he may designate.
Please sign, date,and return all 3 originals of this Contract Renewal Letter by September 17, 1999,to the attention of: Wes
Hamlyn,Colorado Department of Public Health and Environment,4300 Cherry Creek Drive South,Denver,Colorado
80246.Mail Code: FCHSD-CAC-A4. One fully executed original of this Contract Renewal Letter will be returned to you
when fully approved.
CACFP Agreement#: 65103-05
WELD COUNTY STATE OF COLORADO
A Public Entity Bill Owens,Governor
By: Y_ 9 Jt' By:
//t 7 For the Executive Di for
Print Name: Dale K. Hall DEPARTMENT OF LIC HEALTH
AND ENVIRONME
Title: Chairperson, Weld County Board
Commissioners
FEIN: 84-6000813 L
APPROVALS:
CONTROLLER: PROGRAM:
By: By: �l+t f d
Arthur L. .x amhart
1:\CONTRACT\CONRENEW.MRG fin\
n(9 1
Renewal Form
CDPHE-CACFP
October 1, 1999-September 30, 2000
Dear Center CACFP Representative:
This form reflects the most current information the Colorado Department of Public Health and Environment, Child and Adult
Care Food Program (CDPHE-CACFP) has on file concerning your center and its participation in the CACFP. Please review
the form and verify the accuracy of the information. Make the necessary corrections (in red ink)to those items that are not
correct and/or no longer applicable. Sign and return the form to the CDPHE-CACFP by September 17, 1999. If you have
any questions, please contact Tracy Lewis at 303-692-2346.
1.CENTER/SPONSOR INFORMATION Name and Address: FAMILY EDUCATION NETWORK
Agreement Number:65103-05 OF WELD COUNTY
PO BOX 1805
Federal Tax ID Number: 84-6000813 L GREELEY,CO 80632-1805
2 I have reviewed this form and certify that the information it contains is correct. //
Print Name: Tere Kel 1 Pr-Amdya Signature: /.-t-t.i f( -r
3. MAILING ADDRESS __ III
If you would like your reimbursement check mailed to an address different from the above, your W-9 form must reflect the correct address. Call
the CACFP if you have any questions.
4. Number of Centers: 15 County: Weld
Authorized Representative: 1. TERE KELLER-AMAYA ��,,yy 2. BEVERLY SANCHEZ
Center Telephone: (970)353-3800 Alternate Telephone: (6'iv)."1 Fax (970)356-3975
5. Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep
Months Approved for CACFP Participation:
6. Commodities: Cash-In-Lieu of Commodities:IN
7. Number of Shifts:2 8. License Capacity: 605 9. Does center care for infants?
License Number: N/A Yes No
Bkfst AM Sn Lun PM Sn Sup Late S Meals Approved: License Expiration Date: 9/30/1999
lay/
T.f`1; Timely Renewal:. N Does Center claim infants on the CACFP?
Hours: 6:30A-6:9
10. Is this a pricing program? Yes No ;, 0P (up to first birthday)
Days Open::MON-SAT Yes No
11.Center contracts meal service? Yes No 12.Contractor's Name: 5 SCHOOL DISTRICTS 13. Food Service Contract Expiration
(please list additional contractors on the back) (please list additional dates on the back)
Date: 6/30/1997
14. Meals are:Prepared at the center Prepared off-site 15. Age Range of Participants: 0 to 5
16. FOR PROFIT CENTERS 17. Request information on advance payments.
ONLY
According to our records,your center has Step 1 -.Tracy/Debbie Step 2-Specialist Follow-up Information
Title XIX or XX contracts with these counties. Packet. Packet Incomplete
Please update as necessary. Received: follow-up
nftTuate
County Expiration Date Initial Date
All Forms Received:_.
Forms.Missing: .Person Contacted:
Card Sent: or
Date
Form Ltr.Sent
a—
Renewal'complete: Date: Initial
Card Sent(?).(see step 1): already sent _send
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Renewal/New Center
Chifd& Adult Care Food Program
SPONSOR OF CENTERS APPLICATION
1. List the number of CACFP participating centers in each category under your administration:
Nonprofit Child Care Centers Early Head Start Centers
Outside-school-hours Centers 10 Migrant Head Start Centers
For Profit Title XX Centers Nonprofit Adult Day Care Centers
12 Head Start Centers For Profit Title XIX Adult Day Care Centers
2. List the total number of participants enrolled at CACFP participating centers under your administration:
Nonprofit Child Care Centers Early Head Start Centers
Outside-school-hours Centers '1 RR Migrant Head Start Centers
For Profit Title XX Centers Nonprofit Adult Day Care Centers
b 56 Head Start Centers For Profit Title XIX Adult Day Care Centers
3. All centers must be visited at least three times a year with no visit being more than six months apart. A person from the
sponsoring organization who is a recognized authority and has food program responsibility and knowledge on the CACFP
should be assigned to do all site visits. The first site visit must occur during the first six weeks of operation. All non-
school sponsored,outside-school-hours centers must be monitored at least six times a year. If they are in session only nine
months,they must be visited four times. Please describe how you will meet this requirement, including who will be
responsible for the visits and an approximate schedule of when the visits will be made. If available,attach a copy of your
evaluation form and your schedule for visiting centers.
4. Please describe your procedure for following up on problems discovered during monitoring visits.
5. Sponsors are responsible for collecting,maintaining,and reviewing the following records for each center. Please describe
the system you use for:
A. Income Eligibility Forms(IEFs): Income Eligibility Forms are completed at the
beginning of the school year.
m B. Record of MealsServed(ROMS): Teachers complete Record of Meals Service and turn
into Family Services and the information is compiled for the Meal Caaim Forms.
C. Menus: At the beginning of the school year menus are formulated with the
appropriate school districts and approved by Parent Policy Council .
D. Production Records: Production Records are done by the school district cooks and
reviewed by the Director.
E. Food Receipts and Invoices: Invoices are approved by the Director and sent to the Fiscal
Officer for payment and recording pu?j uses .
6. Sponsors must distribute CACFP reimbursements to centers within 5 days of receipt from CDPHE-CACFP. Please
describe how you do this:
Reimbursements are made directly to Weld County - Individual centers do not
receive direct reimbursement.
7. All center staff who work with CACFP must receive initial training as well as annual training regarding the food program
and nutrition. Please describe how you will be training staff regarding food program recordkeeping requirements,
administrative and food service. Please include dates and topics to be covered.
Center staff will receive training in November and cover the aforementioned
topics.
8. Before you bring on a new center,you will be required to conduct a preapproval visit. Please describe how you will do
this. If available,attach a copy of your preapproval evaluation form.
We will not be mpemlawg opening or operating new centers.
9. Will any of the centers contract with a food service management company or caterer for meals? Yes No x
If yes,please list,for each center,the contractor and the type of delivery procedure that will be used to supply meals for the
center(attach separate sheet if needed).
Food Service Management Company Food Service Management Company
Address Address
Contact Contact
I certify that the infomlatian on this application andatly otherapplcation materials is truth)the best ofmy lmowledgq that I will accept final
administrative and fnancial'responsibiiity for total Child and Adult Care Food Program operations at all centers under myaponsorslup:and that
reimbursement will be claimed only for meals served to enrolled participants;that the CACFP will be available to aft ellaible participants without
regardtoace,cow,natimialarigin,ges ter,religion,age,disability,orpoluiml bellS attire approved food service thlides and thatthese facilities
have the capability forte meal service planned for the number otpartithpanls anticipatedtobesavedormealsamprovidedbyafoodservice
inanageniatt company bi compliance with CACEP regulations understand thaithis infeinna6M is being given in connection with the receipt of
Federal funds and That deilbemate misrepresentation may subject me toprosecutiom tinder applicable State and Federal criminal statutes.
Signature of A istrator or Authorize epresentative Date
(CDPHE.CACFP 1:WEWRA.FAMWPPLSPDN.CTR DM 6/99) (2)
Child&Adult Care'Food Program
Certificate and Statement of Authority
This organization is a:
For Profit Corporation❑ Non Profit Corporation❑ Limited Liability Corporation U
Sole Proprietorship ❑ Public Entity ❑ Partnership ❑ Church 0
I, (We),the undersigned,state that the child care center(s) listed on Schedule A of the
Agreement (CACFP 300) or the Multiple-Site Summary Sheet is an integral part of, and
therefore under the direct control of,the governing body of the
Weld County Division of Human SPrvire.s Family Educational Network of Weld County
(Name of the Organization,Business or Church)
whose address is 1551 North 17th Avenue, P.O. Box 1305 Greeley 20632
(Street or Route) (City) (Zip Code)
(970 ) 353-3o00
(Telephone Number)
and that all funds relating to the Child and Adult Care Food Program (CACFP) will be subject to the control
of the duly constituted governing body of the above-named organization, business, or church and that all
funds received for the operation of the CACFP will be used exclusively for the purpose for which they were
received. The individual(s) whose name and signature(s) appears below is authorized to sign the Claim for
Reimbursement and is fully-empowered to enter into any agreement with the Colorado Department of Public Health&
Environment CACFP and may act for the above-mentioned center or sponsor in preparing and signing documents and
reports pertaining to the management of the CACFP.
When there is a change of Authorized Representative,it shall be the responsibility of the center or sponsor to
request from this office,Colorado Department of Public Health&Environment CACFP,forms to register the
change. The signature of the Authorized Representative on the Claim for Reimbursement must match the signature on
this form or the Claim cannot be processed and your reimbursement will be delayed.
AUTHORIZED REPRESENTATIVE(S) /
• 1. - 1. , L% ?tt e 2. ��lzk /� mitt
Signature ,/ SSignature /
Tere Keller-Amaya 1. Beverly SanrhP7
Print Name Print Name
Director Director of Operations
Title Title
is the duly designated Authorized Representative(s) for the Center/Sponsor listed above.
Note: It is to your benefit to have two people designated as Authorized Representatives.
THIS BOX MUST BE'SIGNED
I(we)understand that the information on this form is being given in connection with the receipt of
deral funds and that all of the provisions of the Agreement (CACFP 300)4apply.
Weld County Board of Commis.
Dale K Hail Chairperson
Signature of Chair ofthe Board of Directors, Print Name Official Tide
or Pastor,or Executive Director,or Owner 09/2 7/9 9
Date
(CDPHE-CACFP 306 6/99-c:\forms\cert-soa.PM5)
Renewal
Child&Adult Care Food Program
CIVIL RIGHTS COMPLIANCE REVIEW
65103-05 05 1 _WELD COUNTY
FAMILY EDUC NETWORK OF WELD CO
PO BOX 1805
GREELEY,CO 80632-1805
The Colorado Department of Public Health and Environment, Child and Adult Care rood Program is required to conduct a preaward civil rights
compliance review of centers or sponsors of centers applying for CACFP participation. Please complete the following information below.
1. List the _s•_ ury. for each racial/ethnic group in the community served by our cater. Usually this information can be obtained from the jI
school •rsntct. . ber of Commerce Census Bureau.or Public Library If you have more than one center,combine this information for all centers.
% American Indian or Alaskan Native 0,7 % Hispanic(a person of Mexican, Puerto Rican, Cuban, Central or
South American, or other Spanish culture or origin, regardless of
% Asian or Pacific Islander race)
% Black(not of Hispanic origin) 1; % White(not of Hispanic origin)
2. *Count the pctyal number of children enrolled in your center for each group listed below. Write the number in the space provided. If
you have more than one center,combine this information for all centers.
5 r
American Indian or Alaskan Native Gnu 1 Hispaniceia (a personof Mexican,PuertortrRican, g Centralof or South
American,or other Spanish culture or origin, regardless of race)
Asian or Pacific Islander
__ White(not of Hispanic origin)
Black(not of Hispanic origin)
*Visual identification may be used by centers or sponsors to determine the child's racial/ethnic category. A child may be included in the group to
which he or she appears to belong, identifies with,or is regarded in the community as belonging. Parents/Guardians may be asked to identify the
racial/ethnic group of their own child only after it has been explained,and they as well as we understand that the collection of this information is
strictly for statistical reporting requirements and has no effect on the determination of their eligibility to receive benefits under the Program. As
new children are enrolled,you will need to determine their racial/ethnic background and keep this information in a confidential place.
3. Do you do any activities to assure that minority populations and grassroots organizations have an equal opportunity to participate or are:
informed about changes in the Program? Yet _No If yes,please check all that apply:
Distribution of brochures of Program information at public locations
Public service announcements in local newspaper, on radio,or on television(circle media type used)
Paid advertisements in local newspapers
Other. Please explain:
The CACFP requires all advertising about the food program to contain a nondiscrimination statement. DO or will the items you checked
above include the following nondiscrimination statement?Yes Y No
The U.S.Department of Agriculture(USDA)prohibits discrimination in its programs and activities on the basis of race,color,national
origin,gender,religion,age,disability,or political beliefs. (Not all prohibited bases apply to all programs.) Persons with disabilities who
require alternative means for communication of program information(Braille,large print,audiotape,etc.)should contact the USDA's
TARGET Center at(202)720-2600(voice and TDD).
To file a complaint of discrimination,write USDA,Director,Office of Civil Rights,Room 326-W,Whitten Building, 14th and
Independence Avenue,SW,Washington,D.C.20250-9410 or call(202)720-5964(voice and TDD). USDA is an equal opportunity
provider and employer.
4. Is membership in a specific organization required before children can be enrolled? Yes No ]l
If yes, please explain _
5. Have you ever been found to be in noncompliance of the Civil Rights laws by any federal agency? Yes No y
If yes, please explain _
We assure the Colorado Department of Public Health and Environment,Child and Adult Care Food Program that all enrolled participants in
the Child and Adult Care Food Program at the center(s)described on the application forms gre served the same meals at no s-palate charee
regardless of race,color, national origin,gender, religion,age,disability,or political beliefs, and there is no discrimination m the course of
the meal service.
♦:g t- •1lY 9-a3 'h
Si mire o Administrator or Au Tit bate
yM'y/r/ . Administrator e/ /y5
Signa, etotyLDPHE CACFP Title Date
irnpucr Arrp ,-ippupwer ckrrvn err RFT/MA Rropl
Child&Adult Care Food Program;
AUDIT QUESTIONNAIRE
Organizations receiving federal funds are required to be audited. The information requested on this form will help us
satisfy those requirements. It may be helpful to have someone in your accounting or business office,or someone on your
board who is familiar with auditing procedures,prepare this questionnaire. Please return this form even if you do not
receive federal funds.
Center/Sponsoring b5103 05
Organization: Weld County Division of Human Service�greemeniNumber.
Family Educational Network of Weld County
Address: 1551 N. 17th Avenue. P 0 Rom 1305
Greeley. Colorado R0632
1. Do you contract* with an accounting fora to conduct an audit of
your center/sponsoring organization? Yes X No
2. If your center/sponsor is part of another organization, does the
organization have an organization-wide audit? Yes X No
((The term"organization-wide audit"means an audit of all funds received by an
organization,including federal,state,local,and private funds. The audit must include
a random sampling of all federal funds received by the organization,and it must be
conducted by an independent auditor. J
3. Is a review of the CACFP included in that organization-wide audit? Yes_ No
4. What is the legal name of the organization being audited?
Weld County Division of Hnmaq , Services
5. What federal funds does your organization receive other than CACFP?
(Examples:National School Lunch Program,Title XX) Dollar amount
List: received per year:
Region VIII Head Start $ / &n, O?O
Region XII Migrant Head Start $ ijg4/533
$
$
6. What is the total annual budget for the organization identified in Question #4?
(include all federal, state, and"other" funds) $ 56 4,64 4 t)i
7. When does your organ zations's fiscal year begin and end?
l J I through o a J /
8. Does your organization have fiscal year end schedules(fmancial statements)? Yes X No
9. Does you organization have computerized records? Yes )( No
* ALL audit contracts must include the paragraph on the reverse side of this form.
• Questionnaire prepared by:191 n,II e r��-1 L Date:
-/ ' `-3 -5500
Tide: 135 t L 7(P K Phone Number: (7�G ) .
(CDPHE-CACFP 6/99 c:\Fomis\AuditQue.PM5) OVER
Certification Regarding_Debarment. etc.:
This Certification is given by the Contractor in compliance with regulations implementing Executive
Order 12549, Debarment and Suspension, 7CFR Part 3017, Section 3017.510. The Contractor hereby
certifies,by execution of the contract,that neither it nor its principals is presently debarred, suspended,
proposed for debarment,declared ineligible or voluntarily excluded from participation by any federal
department or agency.
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