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HomeMy WebLinkAboutRES 06-137 RESOLUTION NO. 06-137 WHEREAS, bids were received for a contract to furnish lunches for the Summer Food Service Program sponsored by the Recreation Division ; and, WHEREAS, Moncla's, Inc., Beaumont, Texas, submitted a bid for an estimated quantity of 27,800 lunches served in the amount of $2.59 per lunch for an estimated expenditure of$72,002; and, WHEREAS, City Council is of the opinion that the bid submitted by Moncla's, Inc., Beaumont, Texas, should be accepted; NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF BEAUMONT: THAT the bid submitted by Moncla's, Inc., Beaumont,Texas,forthe Summer Food Service Program sponsored bythe Recreation Division for an estimated quantity of 27,800 lunches served in the amount of $2.59 per lunch for an estimated expenditure of $72,002 be accepted by the City of Beaumont. PASSED BY THE CITY COUNCIL of the City of Beaumont this the 9th day of May, 2006. r 10MOM'� Mayor Guy N. Goodson - AV INTER-OFFICE MEMORANDUM City of Beaumont, Texas Recreation Division Date: June 15, 2006 To: Rose Ann Jones-City Clerk From: Fred Lemell Jr. -Recreation Center Coordinator Subject: Summer Food Service Program 2006 Application COMMENTS Please find enclosed the approved Summer Food program contract that was approved by the Texas Health and Human Services Commission. The application need to be filed with your department as part of the City of Beaumont official records for three years and 90 days from the end of the program year. The program end on August 11,2006 for this year. _ U Q FRED LEMELL JR. Recreation Center Coordinator City of Beaumont - Parks& Recreation 2930 Gulf St. (409) 838-3613 Beaumont,TX 77703 Fax (409) 838-4206 F REDLEMELL/CITYBMT@CITYB MT 1� 1 TEXAS HEALTH AND HUMAN SERVICES COMMISSION ALBERT HAWKINS EXECUTIVE COMMISSIONER May 30, 2006 TX: 123-1006 Beaumont Parks and Recreation ATTN: Fred Lemell Jr PO Box 3827 Beaumont, TX 77704 RE: Approved Summer Food Service Program Application for Program Year(PY) 2006 Application Approval Effective: June 5, 2006 - August 11, 2006 Dear Mr. Lemell Jr: Your application for the SFSP has been approved for PY 2006. A copy of your approved application is enclosed. Enclosed also are the forms listed in Attachment #1 to this letter. You need these forms for the operation of the program. You may make copies of these forms as needed or you may also print your own forms by accessing the Special Nutrition Programs (SNP) website at http://www.snptexas.org and downloading the desired forms. You must retain a copy of all forms and documents as part of your official records for at least three years and 90 days from the end of the program year or until all audit findings, claims, or litigation have been resolved whichever period is longer. Please reference the agreement for additional record retention requirements. You have the right to appeal HHSC adverse actions that affect your claims for reimbursement or participation in the program. Your request for an appeal must state the basis of the appeal of the adverse action and must include a copy of the adverse action letter. A request for an appeal must be submitted in writing and received by HHSC within 10 calendar days from the date you receive a notice of adverse action from HHSC. Requests for hearings must be mailed or faxed to: APPEALS DIVISION, MC W-613 HEALTH AND HUMAN SERVICES COMMISSION P.O. BOX 149030 AUSTIN, TEXAS 78714-9030 FAX (512) 231-5779 Special Nutrition Programs* 1210 South Chestnut*Lufkin,Texas 75901 *(936)637-7533 I Summer Food Service Program Application for Program Year (PY) 2006 May 30, 2006 Page 2 You may hand-deliver or submit your appeal request via overnight/special delivery service to the following street address: 8407 WALL STREET, SUITE 300 Austin, Texas 78754 The phone number for contacting staff at the Appeals Division is (512) 231-5729. Please note that you must comply with the Single Audit Act of 1984, as amended. Based on the information you submitted on the Form 1569, Special Nutrition Programs Single Audit Identification Data, you are subject to single audit requirements and you must submit an audit within 9 months of your organization's most recently completed fiscal year. Failure to submit an audit or comply with audit requirements can result in adverse action up to and including contract termination. You are required to submit an audit on June 30, 2007 If you have an questions, lease contact me at 936 637-7533. Y Yq , p ( ) Sincerely, f Janet Lander Area Program Manager Special Nutrition Programs Enclosures ATTACHMENT#1 MAILING ADDRESSES FOR TEXAS DEPARTMENT OF HUMAN SERVICES Mail to field office: Janet Lander Area Program Manager TEXAS HEALTH AND HUMAN SERVICES COMMISSION SPECIAL NUTRITION PROGRAMS,MAIL CODE 220-1 1210 South Chestnut Lufkin,Texas 75901 Mail Claims for Reimbursement to: TEXAS HEALTH AND HUMAN SERVICES COMMISSION ADMINISTRATIVE MANAGEMENT SERVICES SECTION SPECIAL NUTRITION PROGRAMS,Y-906 P.O.BOX 149030 AUSTIN,TEXAS 78714-9030 Mail all checks and/or cashier checks to this agency to: REBECCA COFFIELD ADMINISTRATIVE MANAGEMENT SERVICES SECTION SPECIAL NUTRITION PROGRAMS,Y-906 TEXAS HEALTH AND HUMAN SERVICES COMMISSION P.O. BOX 149030 AUSTIN,TEXAS 78714-9030 To be assured of proper credit to your contract, we request that the following information be submitted along with payment: Name of your organization Program contract number(TX) Program for which the payment is for, and Month and year of service for which payment is for, and Type of payment(i.e.,claim overpayment, advance return,etc.) ATTACHMENT #1 SUMMER FOOD SERVICE PROGRAM NON-SCHOOL SPONSORS APPROVAL PACKET PROGRAM YEAR 2006 LIST OR FORMS ENCLOSED FOR PROGRAM OPERATION FORM TITLE OF FORM NUMBER INSTRUCTIONS ENCLOSED Form H 1485 Budget Amendment 2 Complete and submit when a change in an allowable (Jan ua 2006) budgeted expense is anticipated. Form H1514 Claim for Reimbursement Worksheet 2 OPTIONAL (October 2000) Complete this worksheet daily or when needed to log the number of total meals,income,expenses,and inventory. Transfer the necessary completed columns to the Form 1532 each month.Refer-to Policv Alert SFSP 2005-1. Form H1532 Claim for Reimbursement 2 Complete and submit page I each calendar month of (August 2005) program participation. See SFSP Handbook Section 4400 for information on Filing Claims. Form H 1557 Monitor Site Review(Vended Programs) 2 Prepare when staff complete required,periodic review (January 1999) of each vended site. Maintain forms for review by HHSC and USDA. Form H1558 Monitor Site Review(On-Site 2 Prepare when staff complete required,periodic review (January 1999) Preparation) of each non-vended site. Maintain forms for review by HHSC and USDA. Form H1566 Summer Food Service Program Monitor 2 Prepare when staff complete the required site visit (.January 1999) Site Visit during the first week of program operations. Maintain forms for review by HHSC and USDA. Form H1568 Record of Recycled Food 2 This form must be completed each day recycled food is (August 1998) used in the meal services. You are not required to recycle food. You are required to avoid plate waste. Form H 1601 Beneficiary Ethnicity Data 2 Complete at least once at each site. Maintain forms for (February 1991) review by HHSC and USDA. Notification Letter of Eligibility to I copy For eligible contractors only. Acquire State Surplus Equipment and Attachment Civil Rights Poster:"And Justice for All" I per site You are required to post one poster at each site. Fair Hearing,Fraud,and Civil Rights I Retain for reference concerning appeal procedures. Handbook-Part 6100 FORMAL (Located at: APPEALS http /% ww dads.statE t.x.us handbooks (lifh 6000 6100. hun) SFSP Program Information Materials 1 Set Reference for your information and use. Internet Nutrition Assistance Payment I copy FOR NEW CONTRACTORS ONLY Process(INAPP)Guide Reference for your information and use.(Located at: p t�tx.us,'pioa�ants+snp-in Inapp.II ttl vt� thsc.s"ta tml ) Rev 3^nOf, TEXAS HEALTH AND HUMAN SERVICES COMMISSION SPECIAL NUTRITION PROGRAMS AGREEMENT STATE OF TEXAS§ COUNTY OF TRAVIS § The"texas Health and Human Services Commission,hereinafter referred to as HHSC, AND hereinafter referred to as the Contractor,do hereby make and enter into this contract,as required by the National School Lunch Act and the Child Nutrition Act, as amended, and the following program regulations: the National School Lunch Program (NSLP), 7 Code of Federal Regulations (CFR) Part 210; the Special Milk Program (SMP), 7 CFR Part 215; the School Breakfast Program (SBP),7 CFR Part 220;the Summer Food Service Program (SFSP), 7 CFR Part 225; and the Child and Adult Care Food Program (CACFP)7 CFR Part 226. This agreement establishes or continues the rights and responsibilities of HHSC and the Contractor pursuant to the Contractor's participation in one or more of the above named programs as stipulated herein. If this agreement continues as an existing agreement, all existing terms, conditions, liabilities and obligations of the parties under the prior agreement remain in full force and effect,except to the extent that those terms, conditions, liabilities and obligations conflict with this agreement, in which case this agreement takes precedence. By signing this agreement, both parties are bound by its terms and conditions from its beginning effective date, or the beginning effective date of any prior agreement/s continued by this agreement,until terminated in accordance with this agreement. I. MUTUAL AGREEMENTS The Parties mutually agree: A. If the Contractor fails to provide services in accordance with the provisions of this contract, HHSC may, upon written notice of default to the Contractor, immediately terminate the whole or any part of this contract, including refusal to pay claims for reimbursement,and such termination shall not be an exclusive remedy but shall be in addition to any other rights and remedies provided by law or under this contract. B. If federal or state laws or other requirements are amended or judicially interpreted so that the continued fulfillment of this contract, on 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 of obligations, including audit findings, incurred up to the date of termination. I I. CONTRACTOR PROGRAM ADMINISTRATION AND FINANCIAL MANAGEMENT A. The Contractor will comply with the applicable regulations for its designated program, as well as 7 CFR Parts 245 and 250, as amended, the Uniform Federal Assistance Regulation (7 CFR, Part 3015, as amended), Audits of State, Local Governments, and Non-Profit Organizations(7 CFR 3052,as amended)and state policies and procedures as issued and amended by I I HSC. Y.,.RErE71 .;L V l 1 2005 Special Nutrition Programs Lufkin, Texas 75901 n. CONTRACTOR PROGRAM ADMINISTRATION AND FINANCIAL MANAGEMENT (Continued) The Contractor further agrees to perform as described in its application(including its Policy statement and`supporting , documents,and approved amendments to the application)for participation in the designated program. B. The Contractor accepts final administrative and financial responsibility for food service operations in each school, summer feeding site, and child and/or adult care facility, hereinafter referred to as a site, operated or sponsored by the Contractor. 'The responsibility includes any audit exceptions or payment deficiency in the program covered by this contract, and all subcontracts hereunder, which are found after monitoring or auditing by HHSC or USDA and will be responsible for the collections and payback of any amount paid in excess of the proper claim amount. C. The Contractor submits for HHSC approval only those applications for sites which have delegated the authority for the administration of food service operations to the Contractor or which have executed sub agreements with the Contractor for the administration of food services operations. D. Contractors participating in the NSLP agree: 1. That the official signing the Claim for Reimbursement will be responsible for reviewing and analyzing meal counts to ensure accuracy and compliance with federal regulations 2. 'To enter into an agreement to receive donated foods as required by federal regulations 3. To price the lunch as a unit 4. To claim reimbursement at the assigned rates only for reimbursable free, reduced price and paid lunches served to eligible children in accordance with 7 CFR part 210 5. Count the number of free, reduced price and paid reimbursable meals served to eligible children at the point of service,or through another counting system if approved by HHSC 6. Limit its net cash resources to an amount that does not exceed 3 months average expenditures for its nonprofit school food service or such other amount as may be approved in accordance with 7 CFR §210.19(a); and 7. Maintain a financial management system as prescribed under 7 CFR§210.14(c) E. Contractors participating in the CACFP shall provide or accept responsibility for the provision of organized, non-residential child day care and will immediately report to the Texas Department of Family and Protective Services(DFPS) Licensing or Child Protective Services staff, any suspected violations of DFPS Licensing standards or suspected abuse of children in sponsored centers or day homes. F. CONTRACTOR understands that acceptance of funds under this Contract acts as acceptance of the authority of the State Auditor's Office ("SAO"), or any successor agency, to conduct an investigation in connection with those funds. CONTRACTOR further agrees to cooperate fully with the SAO or its successor in the conduct of the audit or investigation, including providing all records requested. CONTRACTOR will ensure that this clause concerning the authority to audit funds received indirectly by subcontractors through CONTRACTOR and the requirement to cooperate is included in any subcontract it awards. III. RECORD KEEPING A. The Contractor will keep financial and supporting documents, statistical records, and any other records pertinent to the services for which a claim was submitted in the manner and detail prescribed by HHSC. Unless otherwise provided by state or federal law,the records and documents will be kept for a minimum of 3 years and 90 days after the termination of the federal fiscal year for the relevant program. If any litigation,claim, or audit involving these records begins before such period expires. the Contractor will keep the records and documents for not less 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 a written agreement is entered into between HHSC and the Contractor. The Contractor will keep records of non-expendable property acquired under the contract for 3 years and 90 days after final disposition of the property. B. The Contractor and its subcontractors will allow HHSC and USDA officials and other appropriate officials determined by HHSC 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 HIISC. Er, 1—A iceE]" APR 11 7iJIF Special Nutrition �t oyrar„s Lufkin, Texas 7SQ02 IIL RECORD KEEPING (Continued) C. The Contractor and its subcontractors will establish a method to secure the confidentiality of records and other information relating to clients in accordance with the applicable federal law,rules, and regulations, as well as the•ap5plicable!stale law and regulations. The provision shall not be construed as limiting the Department's right of access to recipient case records or other information relating to clients served under this contract. 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 Part 15),Department of Justice(28 CFR Parts 42 and 50) and FNS directives or regulations issued pursuant to that act and 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), Title IX of the Education Amendments of 1972 (7 CFR Part 15a), the Age Discrimination Act of 1975 (Public Law 94-135), 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 person in the United States shall, on the ground 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. The contractor also agrees to comply with Health and Safety Code Section 85.113 (relating to workplace and confidentiality guidelines regarding AIDS and HIV). Additionally,Title VI of the Civil Rights Act of 1964,and its implementing regulations at 45 CFR, Part 80 or 7 CFR, Part 15, prohibit a contractor from adopting and implementing policies and procedures that exclude or have the effect of excluding or limiting the participation of clients in its programs, benefits, or activities, on the basis of national origin. Also, 40 TAC, Part 1, §73.206 requires contractors to provide alternative methods for ensuring access to services for applicants and recipients who cannot express themselves fluently in English. Accordingly,the contractor agrees to ensure that its policies do not have the effect of excluding or limiting the participation of persons in its programs and activities, on the basis of national origin. The contractor also agrees to take reasonable steps to provide services and information, both orally and in writing, in appropriate languages other than English, in order to ensure that persons with limited English proficiency are effectively informed and can effectively participate in and benefit from its programs. The Contractor accepts final administrative responsibility for ensuring that its subcontractors take reasonable steps to provide services and information,both orally and in writing, in appropriate languages other than English, in order to ensure that persons with limited English proficiency are effectively informed and can effectively participate in and benefit from that subcontractor's programs and services. The contractor hereby gives assurance that it will immediately take any measures necessary to comply with this subsection. . B. This assurance is given in consideration of and for the purpose of obtaining any and all federal financial assistance,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 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 program applicant by the HHSC. This includes any federal agreement, arrangement, or other contract that has as one of its purposes the provision of cash assistance for the purchase of food, and cash assistance for purchase or rental of food service equipment or any other financial assistance extended in reliance on the representation and agreements made in this assurance. C. The Contractor agrees to compile data, maintain records, and submit reports as required, to permit effective enforcement of the above Acts and permit authorized HHSC, USDA and FNS 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. HHSC, USDA and FNS 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 the department. The person whose signature appears on this contract is authorized to sign this assurance on the behalf of the Contractor. Special NuLritior� Prografn Lufkin, Texas 75901 IV. CIVIL RIGHTS POLICY COMPLIANCE (Continued) D. A religious or charitable organization is eligible to be a contractor on the same basis as any other private organization. The contractor retains its independence from State and local governments, including the contractor's control over the definition, development,practice, and expression of its charitable or religious beliefs. Except as provided by federal law. HHSC shall not interpret this contract to require a charitable or religious organization to alter its form of internal governance or remove religious art, icons, scripture, or other symbols. Furthermore, if a religious or charitable organization segregates the government funds provided under the contract, then only the financial assistance provided by these funds will be subject to audit. However, neither HHSC's selection of a charitable or faith-based contractor of services nor the expenditure of funds under this contract is an endorsement of the contractor's charitable or religious character,practices,or expression.The purpose of this contract is the provision of services; no State expenditures have as their objective the funding of sectarian worship, instructions,or proselytization. A charitable or faith-based provider of services under this contract shall reasonably apprise all assisted individuals of the following: "Neither HHSC' s selection of a charitable or faith-based provider of services nor the expenditure of funds under this contract is an endorsement of the provider's charitable or religious character, practices, or expression. No provider of services may discriminate against you on the basis of religion, a religious belief, or your refusal to participate in a religious practice. If you object to a particular provider because of its religious character, you may request assignment to a different provider. If you believe that your rights have been violated, please discuss the complaint with your provider or notify your local HHSC Special Nutrition Programs office. Section 104 of The Personal Responsibility and Work Opportunity Reconciliation Act of 1996. 42 U.S.C. § 604a, sets forth certain additional rights and responsibilities for charitable and faith-based providers of services, certain additional rights of assisted individuals, and certain additional responsibilities of HHSC to these providers and assisted individuals. This contract is subject to those additional rights and responsibilities. V. HHSC CLAIMS PAYMENT A. HHSC will, subject to the federal appropriation and availability to HHSC of sufficient funds for the applicable program, make program payment to the Contractor in accordance with the terms of this agreement No reimbursement shall be made for performance under this agreement occurring prior to (a) the beginning effective date of this agreement or (b) a later date established by HHSC based on the date of receipt of a fully executed copy of this agreement B. This paragraph is pursuant to §2252.903 of the Government Code. Any payments owing to the contractor under this contract will be applied toward elimination of the contractor's indebtedness to the state,delinquency in payment of taxes to the state,or delinquency in payment of taxes that the comptroller administers or collects until the indebtedness or delinquency is paid in full. V1. IMMIGRATION 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. VII. CERTIFICATION A. Regarding Debarment, Suspension, Ineligibility, or Voluntary Exclusion For Covered Contracts - The contractor certifies. bNr 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: ® r ,,r V,7 iJ 1 Special nutrition Programs Lufkin, Texas 75901 VII. CERTIFICATION (Continued) 1. The above certification is a material representation of fact upon which reliance was-based when this contract was entered into. If it is later determined that the contractor knowingly rendered an erroneous certif icatioh, 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 of agency, or the Texas Health and Human Services Commission may pursue available remedies, including suspension and/or debarment. 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. 2. 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 overage sections of federal rules implementing Executive Order 12549. Usage is defined in the attachment. 3. 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 Health and Human Services Commission,as applicable. 5. The contractor further agrees by submitting this certification that it will include NHSC Form titled "Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion for Covered Contracts" without modification,in all covered subcontracts and in all solicitation for all covered subcontracts. 6. A contractor may rely upon a certification of a subcontractor that it 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 certificates from its covered subcontractor upon each subcontractor's initiation and upon each renewal. 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. 7. 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 government, Department - of Health and Human Services, United States Department of Agriculture, or other federal department or agency, as applicable, and/or the Texas Health and Human Services Commission may pursue available remedies, including suspension and/or debarment. B. 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 510,000 and not more than 5100,000 for each such failure. The contractor certifies,to the best of his or her knowledge and belief,that: 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. 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 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 this federally funded contract, subcontract, sub grant, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying." in accordance with its instructions. r Y, : Special Nullitiofl Lufkin, Texas 75901 Vll. CERTIFICATION , (Continued) The contractor shall require that the language of this certification be included in the award documents for all covered sub awards at all tiers(including subcontracts, sub grants, and contracts under grants, loans, and cooperative agreements)and that all covered sub recipients shall certify and disclose accordingly. C. Regarding Conflicts of Interest—The contractor agrees to comply with applicable state and federal laws, rules and regulations regarding conflicts of interest in the performance of its duties under this Agreement. Contractor warrants that it has no interest and will not acquire any direct or indirect interest that would conflict in any manner or degree with its performance under this Agreement. Contractor will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest,or personal gain. Contractor will operate with complete independence and objectivity without actual, potential or apparent conflict of interest with respect to the activities conducted under this Agreement with the State of Texas. An organizational conflict of interest is a set of facts or circumstances, a relationship, or other situation under which a contractor, or a subcontractor has past, present, or currently planned personal or financial activities or interests that either directly or indirectly: 1. Impairs or diminishes the offeror's, contractor's, or subcontractor's ability to render impartial or objective assistance or advice to HHSC;or 2. Provides the contractor or subcontractor an unfair competitive advantage in future HHSC procurements. Except as otherwise disclosed and approved by HHSC prior to the Effective Date of the Agreement, Contractor warrants that, as of the Effective Date and to the best of its knowledge and belief,there are no relevant facts or circumstances that could give rise to organizational conflict of interest affecting this Agreement. Contractor affirms that it has neither given, nor intends to give,at any time hereafter, any economic opportunity, future employment,gift, loan, gratuity, special discount,trip, favor, or service to a public servant or any employee or representative of same, at any time during the procurement process or in connection with the procurement process except as allowed under relevant state and federal law. Contractor agrees that, if after the Effective Date, Contractor discovers or is made aware of an organizational conflict of interest, Contractor will immediately and fully disclose such interest in writing to the HHSC Special Nutrition Programs. In addition, Contractor must promptly disclose any relationship that might be perceived or represented as a conflict after its discovery by Contractor or by HIISC as a potential conflict. HHSC reserves the right to make a final determination regarding the existence of conflicts of interest,and Contractor agrees to abide by HHSC's decision. The disclosure will include a description of the action(s) that Contractor has taken or proposes to take to avoid or mitigate such conflicts. If HHSC determines that an organizational conflict of interest exists, HHSC may, at its discretion, terminate the contract. If HHSC determines that Contractor was aware of an organizational conflict of interest before the award of this Agreement and did not disclose the conflict to the contracting officer, such nondisclosure will be considered a material breach of the Agreement. Furthermore, such breach may be submitted to the Office of the Attorney General, Texas Ethics Commission.or appropriate State or Federal law enforcement officials for further action. Contractor must include the provisions of this Section C in all subcontracts for work to be performed similar to the service provided by Contractor and the terms "Agreement," with the terms "Contractor" and "HHSC" modified appropriately to preserve the State's rights. Contractor has not retained or promised to retain any person or company, or utilized or promised to utilize a consultant that participated in HHSC's development of specific criteria of the Agreement or who participated in the approval of the Contractor for this Agreement. Contractor will not recruit or employ any HHSC professional or technical personnel who have worked on projects relating to the subject matter of this Agreement, or who have had anv influence on decisions affecting the subject matter of this Agreement, for two(2)years following the completion of this Agreement. ` Special feu rjtj0n 'rc,cai'an5 Lufkin,Texas 75901 V 11. CERTIFICATION (Continued) Contractor certifies to its understanding and agreement regarding Conflicts of Interest. , The contractor certifies that if it is a corporation,it is either a for-profit corporation that is not delinquent in its franchise tax payments to the State of Texas, or is a non-profit corporation or is otherwise not subject to payment of franchise taxes to the State of Texas. D. 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. E. Under Section 231.006, Family Code, the vendor or applicant certifies that the individual or business entity named in this contract, bid, or application, and any individual who is a partner, shareholder, or owner with at least 25% interest in the business entity, is not ineligible to receive the specified grant, loan, or payment and acknowledges that this contract may be tenminated and payment may be withheld if this certification is inaccurate. VIII. TERM AND TERMINATION In addition to other provisions of this article allowing termination,this Agreement will terminate upon the Expiration Date unless extended in accordance with the terms of this Agreement,or terminated sooner under the terms of this Agreement. Prior to completion of the Initial Tenn and any extensions or renewal thereof, all or a part of this Agreement may be terminated for any of the following reasons: (a)Termination by mutual agreement of the Parties. This Agreement may be terminated by mutual agreement of the Parties. Such agreement must be in writing. (b)Termination in the best interest of the State. HHSC may terminate the Agreement at any time when, in its sole discretion,HHSC determines that termination is in the best interests of the State of Texas.The termination will be effective on the date specified in HHSC's notice of termination. (c)Termination for cause. HHSC reserves the right tc terminate this Agreement,in whole or in part,upon the following conditions: (1)Assignment for the benefit of creditors,appointment of receiver,or inability to pay debts. HHSC may terminate this Agreement if CONTRACTOR: (A)Makes an assignment for the benefit of its creditors; (B)Admits in writing its inability to pay its debts generally as they become due; or (C)Consents to the appointment of a receiver,trustee,or liquidator of CONTRACTOR or of all or any part of its property. (2) Failure to adhere to laws,rules,ordinances, or orders. HTISC may terminate this Agreement if a court of competent jurisdiction finds CONTRACTOR failed to adhere to any laws, ordinances, rules, regulations or orders of any public authority having jurisdiction and such violation prevents or substantially impairs performance of CONTRACTOR's duties under this Agreement. (3) Breach of confidentiality. HHSC may terminate this Agreement if CONTRACTOR breaches confidentiality laws with respect to the Services and Deliverables provided under this Agreement. (4)Failure to maintain adequate personnel or resources. HHSC may terminate this Agreement if, after providing notice and an opportunity to correct, HHSC determines that CONTRACTOR has failed to supply personnel or resources and such failure results in CONTRACTOR's inability to fulfill its duties under this Agreement. FRECET ,-Y-1. Special Nutritioll Lufkin, "texas 75901 VIII. TERM AND TERMINATION (Continued) (5)Termination for gifts and gratuities. (A) HHSC may terminate this Agreement following the determination by a competent judicial or quasi-judicial authority and CONTRACTOR's exhaustion of all legal remedies that CONTRACTOR, its employees. agents or representatives have either offered or given any thing of value an officer or employee of HHSC or the State of Texas in violation of state law. (B)CONTRACTOR must include a similar provision in each of its subcontracts and shall enforce this provision against a subcontractor who has offered or given any thing of value to any of the persons or entities described in this Section,whether or not the offer or gift was in CONTRACTOR's behalf. (C)Termination of a subcontract by CONTRACTOR pursuant to this provision will not be a cause for termination of the Agreement unless: (1)CONTRACTOR fails to replace such terminated subcontractor within a reasonable time: and (2)Such failure constitutes Cause as described in this Section. (D)For purposes of this Section,a"thing of value"means any item of tangible or intangible property that has a monetary value of more than$50.00 and includes, but is not limited to,cash,food, lodging,entertainment,and charitable contributions.The term does not include contributions to holders of public office or candidates for public office that are paid and reported in accordance with State and/or Federal law. (6)Termination for non-appropriation of funds. Notwithstanding any other provision of this Agreement, if funds for the continued fulfillment of this Agreement by HHSC are at any time not forthcoming or are insufficient,through failure of any entity to appropriate funds or otherwise, then HHSC will have the right to terminate this Agreement at no additional cost and with no penalty whatsoever by giving prior written notice documenting the lack of funding. (7)Judgment and execution.) (A)HHSC may terminate the Agreement ifjudgment for the payment of money in excess of$500,000.00 that is not covered by insurance, is rendered by any court or governmental body against CONTRACTOR,and CONTRACTOR does n ot: (I)Discharge the judgment or provide for its discharge in accordance with the terms of the judgment; (2)Procure a stay of execution of the judgment within 30 days from the date of entry thereof;or (3)Perfect an appeal of such judgment and cause the execution of such judgment to be stayed during the appeal, providing such financial reserves as may be required under generally accepted accounting principles. (B) If a writ or warrant of attachment or any similar process is issued by any court against all or any material portion of the property of CONTRACTOR,and such writ or warrant of attachment or any similar process is not released or bonded within 30 days after its entry, HHSC may terminate the Agreement in accordance with this Section. (8)Termination for insolvency. (A) HHSC may terminate the Agreement if CONTRACTOR: (1)Files for bankruptcy; (2)Becomes or is declared insolvent,or is the subject of any proceedings related to its liquidation, insolvency,or the appointment of a receiver or similar officer for it; (3)Makes an assignment for the benefit of all or substantially all of its creditors;or (4)Enters into an Agreement for the composition, extension,or readjustment of substantially all of its obligations. (B)CONTRACTOR agrees to pay for all reasonable expenses of HHSC including the cost of counsel, incident to: (I)"The enforcement of payment of all obligations of the CONTRACTOR by any action or participation in.or in connection with a case or proceeding under Chapters 7, 11, or 13 of the United States Bankruptcv Code,or am successor statute; 0 ' �.' Special Nutrition -r0CJr3litF1 Lufkin, Texas 75901 Vlll. TERM AND TERMINATION (Continued) (2)A case or proceeding involving a receiver or other similar officer duly appointed to handle the CONTRACfOR's business;or (3)A case or proceeding in a State court initiated by HHSC when previous collection attempts have been unsuccessful. (9)Termination for CONTRACTOR'S material breach of the Agreement. HHSC will have the right to terminate the Agreement in whole or in part if HHSC determines, at its sole discretion, that CONTRACTOR has materially breached the Agreement. IX. EFFECTIVE DATE AND SIGNATURES The parties hereto in their capacities stated, affix their signatures and bind themselves for the faithful performance of the terms of this contract pursuant to participation in the following program or programs: National School Lunch Program Child and Adult Care Food Program School Breakfast Program Summer Food Service Program Special Milk Program +1A (t Vf t/41 Name of C ntra ting Organization Signature of chairman of the board of directors (Please print or type) or other official who has been authorized to sign contracts on behalf of the contracting organization. Name of Official Signing Title of Official (Please print or type) (Please print or type) TEXAS HEALTH AND HUMAN SERVICES COMMISSION Effective from: `" j (% until terminated. By: !/,(}�yu /V- Date: SC Representative Approved for Form by OGC: Signature on file Revised July 200 1. RECHWE Special i'duf;iLicr rt,ams Lufkin, Texas 75901 Texas Health and Human Summer Food Service Program Form H1506 Services Commission Application for Participation January 2006 Give as much information as possible.Attach For HHSC Staff only additional sheets if needed; identify each --- - — - -- -- -- -- - attachment with the name of the contracting Contract No. TX No. organization. 1 k 1, v/ Eff.Date FY s CAL--'4.7 Approved for: ❑Breakfast ❑A.M.Su Lunch ❑P.M. Su pp. ❑Supper ❑All Section I -Sponsor Information Sponsoring Organization Name Texas ID No Telephone No. Hotline No Mailing Address(Street or P.O. Box,City,State,ZIP) Street Address(if different) E-mail Address Name of Administratol ii Title Name of SFSP tontact Person Telephone No.of Contact Person(include Area Code) w , A. Sponsor Classification (Check all that apply): ❑ National Youth Sports Program ❑ Residential/Nonresidential Summer Camp .R Unit of Government-Contractor certifies that all food service sites are operated directly by the contractor. ❑ School Food Authority ❑Continuous Calendar School Year ❑ Private Nonprofit B. Is your program a year-round program?................................................................................................................... ®Yes ❑ No C. Type of Sponsor: Public Entity Is your agency considered to be owned/operated?...................................................................................... ❑Yes X No Do you deposit your program reimbursement directly into the State Treasury? ................................❑ N/A ❑Yes X No Do you deposit your program reimbursement into a local bank?........................................................❑ N/A 9 Yes ❑ No If"Yes," is it direct deposit?........................................................................................................................ ❑Yes % No ❑ Private Nonprofit Organization-Tax-exempt status established.Attach letter of determination(IRS 501(c)(3))of tax- exempt status from IRS. Do you deposit your program reimbursement into a local bank?........................................................❑ N/A ®Yes ❑ No If"Yes,,, is it direct deposit? ........................................................................................................................ ❑Yes ® No D Does the organization provide an ongoing year-round service to the community that is to be served by the Summer Food Service Program(SFSP)?........................................................................................... ............... ®Yes ❑ No If"No,"which of the following circumstances applies? ❑ Residential Camp ❑ 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 E foes the organization expend$500,000 or more in federal funds yearly?.......................................... ....................g Yes ❑ 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. RED E � MAY I Mb APR 1 ?906 Special Nutrition Programs Special Nutrition Prog�a fis Lufkin, TexaS 75901 Lufkin, Texas 759 '.1 Form H1506 Page 2101-2006 Section II - Budget A. Estimate all SFSP costs that will be claimed for reimbursement for the program year. 1.Estimated Operational Costs Program 2.Estimated Administrative Costs Program Year Costs Year Costs Program Labor 0 VII r�3."U1 Administrative Labor m mt., monitor, clerical Fringe Benefits <-J"' Fringe Benefits 4Q Food ��i j 1 �� •;' Rental of Office Space Non-food Supplies - L' - Utilities Utilities Office Supplies — Rent Office Building Maintenance - Equipment Use Fee Equipment Use Fee Rental of Equipment - C? f1 Audit Fees Transportation-Rate pe r mile: fl`U3 vl 1� tJ�� Le al Fees Other(specify): -- L ' - Transportation-Rate per mile: Ys Other(specify): Other(specify): Other(specify): QQ <-� Other(specify): !' Total 1 Total 2 B. Indicate projected income to the food service from all sources other than SFSP reimbursement. Identify exactly the costs this income will cover. (Do not include state or federal funds.) Source of Inco e Amount Wil e used for: r1 f'' k lbt-0 ill N(1 k $ Source of Income Arppunt y�lill e used for: }11 t� 1111 I f� ►� i Section III -Management Plan A. List administrative-level personnel who will be responsible for management and monitoring of the SFSP. (Do not include site supervisors, cooks,janitors or other perso nnel involved in on-site food service.) Title of Position Number in Position Specific Food Services Program Duties iA l I MAY 1 1 2006 APR 1 1 200'; Special Nutrition Programs 2c;c,T; a T rac�i t;5 Lufkin, Texas 75901 Lufkin, Texas 75901 Form H1506 Page 3;01-2006 B Are children charged separately for meals?........... . ........... ............................. ............ ........ ........ _. ..._. .... ❑Yes g No If Yes" complete Form H1506, Attachment A(page 2)and submit with this application C Do you want to receive advance payments: for operational costs? .. ............ . ........ X1 Yes ❑ No for administrative costs?........ ..................... .......kyes ❑ No D If meal service is self-preparation, do you want to receive commodities?..................................... ... ... .. ... ..... ..... ❑Yes No If°Yes," Form H1608,Application and Agreement for Receipt of USDA-Donated Commodities, must be completed and returned with your SFSP application. Section IV— Program Operation A.1. Beginning and Ending Dates of Meal Service A.2. Number of Sites From: — ✓ To B. List dates and topics of SFSP training. Dates Topics �) (.', C Is the organization currently contracting with a year-round food service management company?........................... ❑Yes X No If"Yes,"submit a copy of your procurement procedures, bid, contract and all amendments; skip Item D. If"No,"complete Item D. D. Is the organization planning to contract with a food service management company?...............................................9 Yes ❑No If"Yes,"and the contract will exceed$10,000,attach a copy of the invitation to bid.Also provide: Date of Bid Publication Place of Publication Date of Bid Opening Time of Bid Opening C,,1 . t'� - L• c 4, tL V ,n Is bi expected to be$100,000 or more? If"Yes,"bive place of 0 opening. . Yes ❑ No '' 1, L'� Also, attach a copy of a minimum 11-day cycle menu, including all specific menus to be used. E. Attach a copy of the letter that has been (or will be)sent by the organization to the local health department notifying it of intent to operate a Food Service Program at the site(s) indicated on the attached Form H1507, Site Information. F. Are you implementing the option to allow off-site consumption of food?......................❑All Sites ❑Some Sites )C No Sites Section V—Assurances A. Free Meal Policy Statement 1 The sponsoring organization assures the Texas Health and Human Services Commission(HHSC)that all children at the sites described on the site(s)information sheets(Form H1507)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, national origin, sex, age or disability. No separate charge will be made for any meal except in accordance with Attachment A of this application. 2 The sponsoring organization assures HHSC that, if it is sponsoring camps or other enrollment programs: • the sponsoring 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, HHSC Form H4504, Income Standards for Determining Free and Reduced-Price Eligibility. 3 If the sponsoring organization is sponsoring a camp or other enrollment program that charges separately for meals, the sponsoring organization has read Attachment A to this application, "Additional Assurances for Camps and Other Enrollment Programs that Charge Separately for Meals,"and assures HHSC that all requirements have been or w RECEIVED MAY 12006 Special Nutrition Prjg annS Special Nutrition Programs Lufkin, Texas 7590 Form H1506 Page 4101-2006 B Public Release 1 The sponsoring organization will make efforts to ensure that the local news media will make a public announcement of the program and will supply them with a news release. If the sponsoring organization is sponsoring a camp or other enrollment program, this release must contain, at a minimum. a list of all approved sites, a list of the current standards for determining free and reduced-price eligibility, and the following statement: "The announces the sponsorship of the Summer Food Service Program. (name of the organization) Income eligibility will be based on family size and income using the Standards for Determining Free and Reduced- Price Eligibility, provided by the United States Department of Agriculture (USDA). Meals will be provided at the site(s) listed. In accordance with federal law and USDA policy,this institution is prohibited from discriminating on the basis of race,color, national origin,sex, age or disability. To file a complaint of discrimination,write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington,D.C. 20250-9410 or call (800) 795-3272 or(202)720-6382(TTY). USDA is an equal opportunity provider and employer." For all other groups, the announcement must contain, at a minimum,a list of all approved sites and the following statement: "The announces the sponsorship of the Summer Food Service Program. (name of the organization) Meals will be provided at the site(s)listed. In accordance with federal law and USDA policy,this institution is prohibited from discriminating on the basis of race, color, national origin,sex, age or disability. To file a complaint of discrimination,write USDA, Director, Office of Civil Rights,1400 Independence Avenue,SW, Washington,D.C.20250-9410 or call (800)795-3272 or(202)720-6382(TTY). USDA is an equal opportunity provider and employer." 2. This public release was or will be published in the following news media outlet(s): Name of Media Outlet Date of Release Name of Media Outlet Date of Release 3. Attach a copy of the sponsoring organization's public release statement as submitted to the news media and any other materials used to publicize the program's availability and nondiscrimination requirements. Section VI -Waiver Requests (Check all for which you are applying; submit appropriate waiver request form and documentation.) ❑ Waiver to operate more than 25 sites (nonprofit organizations only) ❑ Waiver of the time restrictions for meal service at migrant sites ❑ Waiver of the 15-consecutive school day requirement for year-round school program sites ❑ Waiver of the first-week site visit requirement(school food authorities only) Section VII- Certification (see Form H1506,Attachment B) I certify that the information on this application is true and correct to the best of my knowledge.I certify that reimbursement will be claimed only for approved meals served to eligible children during the hours they are in attendance at approved sites. I know that deliberate mice._ ryPTps or withholding of information may result in prosecution under applicable state and federal statutes'' = 1,.; Signature—Official of Sponsor Org ization Date/ Name(please type or print), Title } C� �J� For XHSC Use Only Approved ❑ Denied (reason): i- Signature—Official Sponsoring Organization Date A Name(p ase type 9r print) Tige tart t 'o, a�: PR I MAY 1 12006 special N"t;""l, ?rograi,15 Lufkin,Texas 75901 SCHEDULE B 2006 SFSP SANDWICH LUNCH MENU Nlenu 1 Menu 7 Ham 1 oz.-2 slices Beef Bologna 1 oz.-2 slices American Cheese 1 oz.- 1 slice American Cheese 1 oz.-1 slice White bread 2 slices White Bread 2 slices Red Apple 1 each Green Apple 1 each Pineapple Juice 4 oz.-1 each Orange Juice 4 oz.- 1 each White Milk 8 oz.- 1 each White Milk 8 oz.- 1 each Salad Dressing I each Mustard leach Utensil Kit 1 each Utensil Kit 1 each Menu 2 Menu 8 Bologna 1 oz.-2 slices Turkey loz.-1 '/slices American Cheese 1 oz.-1 slice Ham 1 oz.-2 slices White Bread 2 slices NO CHEESE Green Apple 1 each Hot Dog Bun l each Orange Juice 4 oz.- I each Raisins I oz.-1 box each White Milk 8 oz.-I each Apple Juice 4 oz. -1 each Mustard 1 each Chocolate Milk 8 oz.-1 each Utensil Kit 1 each Salad Dressing 1 each Utensil Kit 1 each Menu 3 Turkey loz.-1 'h slices Menu 9 Ham loz.-2 slices Bologna 1 oz.-2 slices NO CHEESE American Cheese 1 oz.-1 slice Hot Dog Bun 1 each White bread 2 slices Raisins l oz.- 1 box each Orange I each Apple Juice 4 oz.-1 each Pineapple Juice 4 oz.-1 each Chocolate Milk 8 oz.-1 each White Milk 8 oz.-I each Salad Dressing 1 each Mustard 1 each Utensil Kit I each Utensil Kit 1 each Menu 4 Menu 10 Bologna I oz.-2 slices I-lam t oz.-2 slices American Cheese 1 oz.-1 slice American Cheese 1 oz.-1 slice White bread 2 slices White bread 2 slices Small Banana 1 each Red Apple 1 each Pineapple Juice 4 oz.-1 each Orange Juice 4 oz.-1 each White Milk 8 oz.-1 each Chocolate Milk 8 oz.-1 each Mustard 1 each Salad Dressing 1 each Utensil Kit I each Utensil Kit 1 each Menu 5 Menu 11 Ham 1 oz.-2 slices Turkey 1 oz.-3 slices American Cheese 1 oz.-I slice NO CHEESE Hot Dog Bun I each White Bread 2 slices Red Apple 1 each Orange I each Orange Juice 4 oz.- I each Apple Juice 4 oz.-1 each Chocolate Milk 8 oz.- 1 each White Milk 8 oz.-1 each Salad Dressing 1 each Salad Dressing 1 each Utensil Kit 1 each Utensil Kit 1 each Menu 6 Ham 1 oz.-2 slices American Cheese 1 oz.- 1 slice White Bread 2 slices Orange 1 ea. Pineapple Juice 4 oz.- 1 each Chocolate Milk 8 oz.- 1 each Salad Dressing 1 each Utensil Kit 1 each 14 �[??Cldl �'{Vt71`LiGfl -`'fOa��li^,i; Lufkin, Texas 7590 INTER-OFFICE MEMORANDUM _ City of Beaumont, Texas Recreation Division Date: April 17, 2006 To: - City of Beaumont Health Director From: Fred Lemell Jr. -City of Beaumont Recreation Center Coordinator Subject: Summer Food Feeding Sites/inspections/Revised Address COMMENTS The City of Beaumont Recreation Division will be participating in the 2006 Summer Food Program Sponsored by the Texas Health and Human Services Commission. This programs provide free lunches for area children during the summer months. As in previous years we request the sites to be inspected by your department to insure all city health regulations are met. The beginning and ending dates are June 5, to August 11, 2006. The sites and feeding times are as follows: L. L. Milton YMCA 3455 Sarah a 11:15am. Sprott Park 4325 Usan @ 11:30am. Roberts Park 2755 Ave C @ 11:45am. Alice Keith Park 4050 Reed @ 12:00 noon SE TX Family Resource Center 2060 Irving @ 12:15pm. Magnolia Park 2930 Gulf @ 12:30pm. Tracewood Apt. 4925 Concord @ 12:45pm. North Ridge Apt. 4155 Madia @ 12:00 noon Concord Homes Apt. 2020 Cottonwood Magnolia Garden Apt 3720 Magnolia St. @ 12:30pm. If any additional sites are added, I will forward the information to you. Cc. Kirby Richard - Director of Parks and Recreation E(7EI MA)' ,:.pE...,a i,IAU;LrO:-r �rQ�idi15 Lufkin, -texas ;'5001 PRESS RELEASE! ! ! ! ! The City of Beaumont Recreation Division will again sponsor a summer food program for children, ages 1-18 years, Monday through Friday between June 5 and August 11, 2006, at four Beaumont parks, four Beaumont Housing Authority locations, one family resource center, and one YMCA location. All children in attendance will be offered the same meals with no discrimination against any child because of race, color, handicap, sex, age, national origin, or religious. Locations and Approximate Serving Times: L. L. Milton YMCA 3455 Sarah @ 11:15am. Sprott Park 4325 Usan @ 11:30am. Roberts Park 2755 Ave C @ 11:45am. Alice Keith Park 4050 Reed @ 12:00 noon SE TX Family Resource Center 2060 Irving @ 12:15pm. Magnolia Park 2930 Gulf @ 12:30pm. Tracewood Apt. 4925 Concord @ 12:45pm. North Ridge Apt. 4155 Maida @ 12:00 noon Concord Homes Apt. 2020 Cottonwood @ 12:15pm Magnolia Garden Apt 3720 Magnolia St. @ 12:30pm. RECEIVI APR 11 T-.!- Special Nutrition LOW,Texas __ Texas Health and Human Form H1606,Attachment B Services Commission June 2005 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$10,000 or imprisoned not more than five years. 2. Whoever being a partner,officer,director,or managing agent connected in any capacity with any partnership, association,cooperation,business,or organization,either public or private,embezzles,misapplies,steals,or obtains by fraud,false statement or forgery,any benefit provided by the program,or any money,funds,assets,or property derived from benefits provided by this program,shall be fined 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$1,000 or imprisonment for not more than one year,or both. 3. If two or more persons conspire or collude to 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 is a list of deficiencies that 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 Health and Human Services Commission. 3. Program violations at a significant proportion of the sponsor's 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 children. 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. RECEIVED APR 1 1 2006 Special Nutrition Programs Lufkin,Texas 75901 ATTACHMENT SUMMER FOOD SERVICE PROGRAM (SFSP) APPLICATION OUTREACH PLAN FOR OPEN AND RESTRICTED OPEN SITES If you operate open sites or restricted open sites, indicate your plans for conducting outreach to inform persons about the operation of the SFSP at your sites and promote participation at your sites. Check all that apply. 12/make television announcements Send letters to potential participants. Mak radio announcements. &KSistribute flyers to potential participants. �Dlay posters at locations visited by potential participants. Offe ctivities other than meals at sites. Partner with other organizations to advertise and promote the program. ❑ Other. Explain. January 2002 RECEIVED APR 112006 Special Nutrition Programs Lufkin,Texas 75901 • Texas Health and Human Special Nutrition Programs Form H1569 Services Commission Single Audit Identification Data April 2005 For Program Year ,2f`� '� (SNP Use Only) Part I �Co�tractor Name Co ct Person Afidress(Street or P.O. Box, Pity, State,ZIP Cede) Area Code and Telephone No. Texas ID No. Contract No. Contractor,Fiscal Year End (mm/dd/yyyy) Type of Contract ❑For Profit ❑ Nonprofit ❑State Agency/ Other Part II Check the appropriate box(es)to indicate the type(s) of program(s) in which you currently participate or for which you are ap lying: Commodity Assistance Programs Program Nos. Cash Reimbursement Programs Program Nos. ❑ A—National School Lunch ❑AD—Adult Day Care TX- ❑ B—Charitable Institutions ❑BL—National School Lunch/Breakfast TX- El C—Area Agency on Aging ❑CC—CACFP Center TX- ❑ G—Summer Camps ❑ DH—CACFP Day Home TX- El H—Summer Food Service SF—Summer Food TX- ❑J—Jails ❑SM—Special Milk TX- [I I—TEXCAP ❑TE—TEXCAP TX- El CS—Commodity Supplemental Food Prog. ❑CS—Commodity Supplemental Food Prog. TX- Part III A. Does your agency expend federal funds from programs other than those listed above? ❑Yes ❑ No If yes,complete Part III, B. B. Give the source and amount of any federal funds that your agency expended in your most recent completed fiscal year. Source Amount �. st it l_,C Part IV Ji Single Audit Exemption — I certify that I am not required to submit an audit under the Single Audit fJ11 ri� son. Check only one choice. I am a for-profit organization. MAY ❑ I am a military base. Special "Jutrition Pro ,, ❑ I am a nonprofit organization and expend less than $500,000 annually in total federal funding. Lufkin TeXdS 7590..1 17i ❑ I am an Indian Reservation. I understand that if I meet the requirements of the Single Audit Act, now or in the future, I must submit an audit as a condition of eligibility to participate in the Special Nutrition Programs, and that failure to do so as required could result in adverse action, including the withholding of my claim for reimbursement payments and termination of my contract. I also understand that if I am a private non- profit organization subject to the requirements of the Single Audit Act and have a financial audit performed annually, I must also obtain a single audit on an annual b �� ignature—Authorized Repre ntative M N e(please type-arprint) Titip Tel t �(16SZ 'L!iy J U.- C,n GAS 4= ( _> u t t1l'UM] j,-1 LIIJUII�,,( ST' s I 2i t.rr' F ,,i.c ---- Ii:llE1LkL.���.ULDS �l.;ai!I7'JC�I r_c• i'rrrifil� �---- - - p Block Gra:,t(CD I( _ Block G�.-t,CDBG :3 - r unit; �prm�r.t Blcc!:Grant(CDBGj 1-.2I.S Blrck G (C1)BG} rt.u:li prn,,- Block Grir:;(CDBG) L2'.S '1.-- rlt,i, :, J _.spn',ant Block Gr::r, C 1)11),G 1 >.556 r mu:',iro D c�clupn e^t Block Gn:r,t(C1)BG) 4.218 S, J3d i,,nnu:)it_ Dc, :opn Block Grant(CDDG) 1 13 :!omelcss Ass,�tance AevErnergency Shelter Grant Itcr Pkls Cjrc ltcnev:al:Ircgram 238 Shelter Plu;Care-'ienev:;a °rcgram 1 238 S.1 1C--iti-i;?C;! 10?aE 11 239 113.; 14 239 f).5, ta;I)ircct!'rograms 3,-11,"98 ul I�'�,5. Department cf}iuusing u d L'rban i 1c, 111(11U1)) 3..11 ,'95 ti ":farpn_r. of liistic� r et 1)r,:g,raris, A szt.ortciturc I OGO 37_1-_ t..rccmc!r, i,C;act 2JJ3 Loy Gn(crcement Bluck Gram _cd r:nd Sccd 2000 5 39� C' _c.', and Seed 2000 Supplemental -m'-citurc,(�0(I Sup,,.emcntai $ th i_x,as .__..n. J'J 4 i . . - I,r -,.I- i - -- - f) --- -.t T,,2 r,'It n '1P I nt'alred Di .n M1 )Dilization IIDM 163) 1 nii0 i-`rih 1 ,ISI Pa>s: Ihr-i��h !hc fex is Department of Tray;>p��rt:runn ''1.3�r� rh:m `.lass Transportation Capital and Operating s.,rnce F,)rmula Grant T t�:l Direct Procrams F N).3-6 F. talI S I)c•partmentofTr--anspertation 1'SI1281 i dcr:rl F:iicr-cncv Atanaflemcnt agency L?ir ct Prop,rams- FY i? A\ sistartce to Firefl,hters Grant Program for Fire (-)peratiuns and Firefighters Safety 83. 5-1 169 :A;sistancc to Firefighters Grant Program for Fare Oper:Itions and Firefighters Safety 83 551 ,i� �,•8 I.,tal Direct Program ii1.71_7 C,•[.rl l ,d.r,rl Flner¢cncy \Lmagement;�gency fJcalth ani-I lulrnan Seri ices hr ,i_h :he leas Departmentof(lcalth: �t-u. Ilc;i!th gran[- 1 ,dcrrl Consolidated Programs: �i)rl5 2001 .Au1_11-1st '-,H)5 ?';8 (i tiij c S:I't�.m r \,,-i 04/05;2005 14:44 512-452-2004 TACAA PAGE 01 Texas Association of Community Action Agencies) Inc. 251,21H 35 South,Suite 100 Phone: (512)462..2555 or(B00)992-9767 w •tAC a Austin,TX 78704-5751 Fax:(512)462-2004 aa.019 DATE 4!5105 Total Pages (including cover sheet) 12 TO Fred Lemell Jr. FAX# (409)838-4206 City of Beaumont FROM Anitra Hendricks FAX# (512) 462-2004 Program Assistant SUBJECT Summer Food Service Program Census Data TACAA is now using eligiblity data based on the 2000 census. To be area eligible, sites must be located in a census block group where 50% or more of children, age 18 and younger, are eligible for free and reduced priced meals. Please note that some census tract boundaries and block groups may have changed under the 2000 census. According to the 2000 census data,the following addresses are located in a block group where at least 50%or more of chlktren are eligible for free or reduced priced meals: 2930 Gulf Street is located in block group 4824 1 at 76.8%. 4050-Reed St.is located in block group 4824500261 at 57.3%x. 2755 Avenue C is located in block group 482450019 3 at 75.3%. 4325 Usan St is located in block group 482450023 4 at 77.3%. 3455 Sarah St.is located in block group 4824 0022 2 at 52.5%. 3720 Magnolia 5t.is located in block group Ag24501307 2 at 83.6%. 4925 Concord Rd,is located in block group 482460002 3 at 59%. 4155 Maida is located in block group 482450001.031 at 78.4%. According to the 2000 census date,the following addresses are not located in a block group where at least 50%or more of children are eligible for free or reduced priced meals: 5680 Concord Rd.,located in block group 482450002 2,is under 50%. Nearby eligible block groups include 482450002 3, within less than approx. Vs mile at 59%;and 462450001.031 within approx. ' mile at 78.4%. 2060 Irving,located in block group 482450017 3,is under 50%. �7 4824500174 within Nearby eligible block groups include 482450017 2,within less than approx. /mile at 52_BY, approx.%mile at 68.4%;4824500191 within approx. %mile at 61.5%;and 482450019 2 at 57.1 % within approx., mile. If you have any questions regarding this data,please contact me at(800)992-9767,ext.205. RECEIVED _ --- ---------Sincerely,— --- ----- ------------------------ ------------ ---------____ ----------- C Anitra Hendricks RECEIVED MAY 2` 0 2005 Program Assistant SPECIAL N; 17.'-,,. ITi��'`,1 Pz,0,Gr,A�lS !UFr \" l aY" APR 112006 A(, Special Nutrition Programs OArtgn". Lufkin,Texas 75901 'HNA 9 A5 H I• e4/04/2005 10:32 512�`Q-2004 TACAA FAGS 02 SUMMER FOOD SERVICE PROGRAM(SFSP) TACAA 2005 Census Data Request Form The Texas Association of Community Action Agencies (TACAA) supports the Summer Food Service Program (SFSP) by providing Census Data to organiratlons that are Interested in sponsoring SFSP sites. Note:Census Data should only be requested if your organization does not qualifyas indicated bytheschool data. Please use one form per site. Type or print clearly. ,� Our school district is NOT mandated to sponsor the Summer Food Service Program as indicated by the school data. F] Our organization does NOT qualify according to the school data available. Date of Request'. �� Person making Request: Sponsoring Organization: Cltymp: Phone: 1412 ��'p�.,�4�\ Fax:j4d . �`y'" 2 $lte Street address: _= 's _ma, �D° .w V')-T in• Z Streets bordering site: Cross streets: BlocK group#(a) (if available): T- Please use the space provided below to draw the site map, or attach a map. (Required information) tg3o N � � F � RECEIVED -r MAY 2005 z SPGCI111L NUTRMON PROGP MOS iII I TEXAS Please return this form to TACAA by fax(512) 462-2004 or by mait-tb�."``I TACAA, Inc.•2512 IM 35 South, Ste. 100 •Austin,TX 78704-5754 If you have further questions,call(512)462-2555,ext.205 RECEIVED APR 1 1 2006 Special Nutrition Programs Lufkin, Texas 75901 P-:iC14/205 10:32 512 o_20 14 7ACAA PAGE 52 SUMMER FOOD SERVICE PROGRAM(SFSP) TACAA 2005 Census Data Request Form The Texas Association of Community Action Agencies (TACAA) supports the Summer Food Service Program (SFSP) by providing Census Data to organizations that are Interested In sponsoring SFSP sites. Note:Census Data should only be requested if your organization does not qualil y as indicated by the school data. Please use one form per site, Type or print clearly. Our school district is NOT mandated to sponsor the Summer Food Service Program as indicated by the school data. Our organization does N07 qualify according to the school data Available. Date of Request:V q I. Person making Raquost: — Sponsoring Organization: ~ c 0-0 i Sla� Cltyizip: �_g,��^,.�v� r\�1 —� w r1 rlI-\ Phone: AOC11 Site Street address: 4ti �� •�n �� City � u,�n0►.1T zin ���lD Streets bordering site: 1�" �.t`a� ���e 'A� 'UNCLS � Cross streets:� ��,+ � �l�r �CA.S �.`�ti1Prc-4 S-Cv g&et Block group o(s) (if,available): Please use the space provided below to draw the site leap, or attach a map. (Required information) ' N tP N QL�ems. n1 L RECEIVED MAY 2 0 2005 Please return this form to TACAA by fax(512Y 2-jbo4-or by mail to : T- TACAA, Inc.•2512 IH 35 South, Ste.100 •Austin,TX 76704-5751 If you have further questions,call(512)462-2555,ext.205 RECEIVED APR 1 1 2006 V Special Nutrition Programs I.-flr;m TPY.'1C 7901 • 0,:i'04/2005 10:32 512(--�-20E14 TA �'� FAGE 02 SUMMER FOOD SERVICE PROGRAM(SFSP) TACAA 2005 Census Data Request Form The Texas Association of Community Action Agencies (TACAA) supports the Summer Food Service Program (SFSP) by providing Census Data to organizations that are Interested in sponsoring SFSP sites. Note:Census Data should only be requested if your organization does not qualify as indicated by the school data. Please use one form per site. Type or print clearly. Our school district is NOT mandated to sponsor the Summer Food Service Program as indicated by the school data. Out organization does NOT qualify according to the school data available. i Date of Request:, v b Parson making Request: Sponsoring Organization: `� Clty2ip: 1&A & ;Da Phone: 14TU gam - 611 Fax: ( _ Site Street address: �- p �" v , Streets bordering site: � �QA Cross streets: — Block group#(s) (if available): Please use the space provided below to draw the site reap, or attach a map. (Required information) Lo Av 7 RECc VED -------------------------MAY F.' �� 2005 SPECIAL NU7 R'I T I ON PRO RAM 1 UrKIN. TFYAS Please return this form to TACAA by fax(512)462-2004 or by mail t6: TACAA, Inc.•2512 IH 35 South, Ste,100 •Austin,TX 7B704-5751 If you have further questions,call(512)462-2555,ext.205 RECEIVED APR 1 1 2006 Special Nutrition Programs Widn, Texas 75901 04/04/2605 10:32 512i'�"T-2�J�a4 TACAA 1 FAGS fly SUMMER FOOD SERVICE PROGRAM(SFSP) TACAA 2005 Census Data Request Form The Texas Association of Community Action Agencies (TACAA) supports the Summer Food Service Program (SFSF) by providing Census Data to organizations that are Interested in sponsoring SFSP sites. Note:Census Data should only be requested if your organization does not qualify as indicated by the school data. Please use one form per site, Type or print clearly, - Our school district is NOT mandated to sponsor the Summer Food Service Program as indicated by the school data, ElOur organization does N07 qualify according to the school data available. Date of Request: (A Person making Requost:��--N 'fir 1 �1k=VYl e'yk Sponsoring Organization: CA, City/Zip: �� �mo.�-i `—� 1A� n n 0 Phone: lkjf I P)2 c'b --,'S6 1 Fax: (4 e)?Ds— 4--LO Site Street address: r..�`��— r� � �-C City 17WA sM�� zip., rArA`1 h 1 Streets bordering site: Cross streets: �� Block group#(s) (it available): Please use the space provided below to draw the site map, or attach a map. (Required information) c.� a T � C'� �,�� RECEIVE HD ---- ----- --------------------- --- -------------- -- MAY � 0 2665 SPECIAL NU 17 i;;MON P R&' !'R'VAS OF SIN, T cXAS Please return this form to TACAA by tax(512) 462-2004 or by mail to TACAA, Inc,•2512 IH 35 South, Ste, 100•Austin,TX 787045751 If you have further questions,call(512)462-2555,ext.205 RECEIVED APR 112006 Special Nutrition Programs Lufkin, Texas 75901 ' Q4i 74�2�05 10:32 512" -20��4 TACK/ ') FGE 02 SUMMER FOOD SERVICE PROGRAM(SFSP) TACAA 2005 Census Data Request Form The Texas Association of Community Action Agencies (TACAA) supports the Summer Food Service Program (SFSP) by providing Census Data to organizations that are Interested in sponsoring SFSP sites. Note:Census Data should only be requested if your organization does not qualify as indicated by the school data. Please use one form per site, Type or print clearly. Our school district is NOT mandated to sponsor the Summer Food Service Program as indicated by the school data. ElOur organization does NOT qualify according to the school data available. Date of Request: Person making Request: Sponsoring Organization: CltyiZip: wte�.y�n -� 'T-��t�� �fl!D D! -- Phone: `� ax: (At g— Site Street address S� \ Zio h Street& bordering site:,Qd"'2 &N Cross streets: y A� (ate,} 1(��C`r"L.J �• -- BIocK group#(s) (if available): Please use the space provided below to draw the site map, or attach a map. (Required information) �V1 S C Y4-X,-�Vk N 34bo T ' Q)UL L, L k,&A* d RECEIVED Y 2 0 2005 DSRAMS Please return this form to TACAA by fax(312)462-2004 or by mail to TACAA, Inc. •2512 IH 35 South, Ste. 100 •Austin,TX 78704-5751 r you have further questions,call(512)462.2555,ext.205 RECEIVED APR 112006 Special Nutrition Programs Lufkin, Texas 75901 C-:/04/2C05 10:32 512( 2-2094 TACAA � F"G E 0 SUMMER FOOD SERVICE PROGRAM(SFSP) TACAA 2005 Census Data Request Form The Texas Association of Community Action Agencies (TACAA) supports the Summer Food Service Program (SFSP) by providing Census Data to organizations that are Interested in sponsoring SFSP sites. Note:Census Data should only be requested if your organization does not qualify as indicated by the school data. Please use one form per site. Type or print clearly. Our school district is NOT mandated to sponsor the Summer Food Service Program as indicated by the school data. Our organization does NOT qualify according to the school data available. Date of Roiluest: O 5 P on making Requoat: Yn U Sponsoring Organization: Citymp: Phone:(An ax: 6 '26'tA 4 2-OL Site Street address: nj�-() MIAC-tiQOL t- 6C City MOi;\ Zip: TAn�� Street` bordering site: �?o Cross streets: �p Biook group#(a) (if available): Pleasa use the space provided below to draw the site map, or attach a map. (Required information) N o QAft t � Please return this form to TACAA by fax(512)482-2004 or by mail to : 5 S TACAA, Inc.•2512 IH 35 South, Ste. 100 •Austin,TX 7870 -5754 If you have further questions,call(512)462.2555,ext.205 APR 112006 Special Nutrition Programs ; , ct r ,,fkin.Texas 75901 -`'' �'""' '' ` P24/04/2P05 10:32 512i'"'2-2H4 TACA" "'1 F-GE 02 SUMMER FOOD SERVICE PROGRAM(SFSP) TACAA 2005 Census Data Request Form The Texas Association of Community Action Agencies (TACAA) supports the Summer Food Service Program (SFSP) by providing Census Data to organizations that are Interested In sponsoring SFSP sites. Note:Census Data should onl y be requested if your organization does not quality as indicated by the school data. Please use one form per site, 'type or print clearly, Our school district is NOT mandated to sponsor the Summer Food Service Program as indicated by the school data. Our organization does NOT qualify according to the school data available. Date of Request: Person making Request- Sponsoring Orstn Izatlo f vV� \ DCSi�� CltylZip: p Phone: AS-il P) - 1 Fax: Site Street address: ���-'� Cow n Q-rI-COX: k�NQL UWP- Vi n' Streets, bordering site: Lo i1 t' c T\ Cross streets: b�� _ Block group#(s) (if available): Please use the space provided below to draw the site map, or attach a map. .J (Required information) O .�r C N `Trwe� > �ajL�5 Please return this form to TACAA by fax(512) 462-2004 or by mail to : TACAA, Inc.•2512 IM 35 South, Ste.100•Austin,TX 78704-5751 If you have further questions,call (512)462-2555, ext.206 RECEIVED MAY 2005 APR 1 1 2006 N 7 ��.i"i 1,� j Special Nutrition Programs F,: 04/2905 10:32 51 ",2-2�J��4 TACHI l F:;GE �� SUMMER FOOD SERVICE PROGRAM(SFSP) TACAA 2005 Census Data Request Form The Texas Association of Community Action Agencies (TACAA) supports the Summer Food Service Program (SFSP) by providing Census Data to organisations that are Interested In sponsoring SFSP sites. Note:Census Data should only be requested iryour organization does not qualify as indicated by the school data. Please use one form per site. Type or print clearly, ® Our school district is NOT mandated to sponsor the Summer Food Service Program as indicated by the school data. Our organization does NOT qualify according to the school data available. Date of Request: Person making Request: Sponsoring Organlzat on: " - `OrJ \'1\Si W City/Zip: AA,,VA7),' Phone: — ax: (Q�� Site Street address: PccD \4) city aAR9W r� Zip: 11M a Streets bordering site: Cross streets: ��,� Block group#(a) (if available): Please use the space provided below to draw the site map, or attach a map. (Required information) 0 Please return this form to TACAA by fax(512) 462-2004 or by mail to TACAA, Inc.•2512 IH 35 South, Ste.100 •Austin,TX 78704-5751 If you hav�t,y}�,tp�,�tipE�all(512)462-2555, ext.205 ��((,��1120/ RE_- EIS/ED APR 1 1 2006 Special Nutrition Programs'✓ 0 200-5 Lufkin, Texas 75901 ,- 14 `2Ca--I 17: :_ =1�r , �-1Ft.4 TACAA � F E 02 SUMMER FOOD SERVICE PROGRAM(SFSP) TACAA.2005 Census Data Request Form The Texas Association of Community Action Agencies (TACAA) supports the Summer Food Service Program (SFSP) by providing Census Data to organizations that are Interested in sponsoring SFSP sites. Note:Census Data should onl y be requested if your organization does not qualify as indicated by the school data. Please use one form per site, Type or print clearly, Our school district is NOT mandated to sponsor the Summer Food Service Program as indicated by the LP school data, 7 Our organization does NOT qualify according to the school data available. Date of RequesC Person making Request: —��- Sponsoring Organlzati n: cltyrzip: ?-NQ "i i \r-n-o�r Phone:�d" Site Street address: �, Ivy�l 1�. City gbQ� Streeter bordering site: - Cross streets: �� Block group ii(s) (if available): _ Please use the space provided below to draw the site map, or attach a map. (Required information) L � 0 20105 Please return this form to TACAA by fax (512) 452-2004 or by meal fo J I ,"AS TACAA, Inc. a 2512 IH 35 South, Ste, 100 •Austin,TX 78704.5751 H you have further questions,tali (512)462-2555, ext.205 RECEIVED APR 112006 Special Nutrition Programs F4/04/2F'05 10:2 512 A1714 TACAA "'� FAGE 02 SUMMER FOOD SERVICE PROGRAM(SFSP) TACAA 2005 Census Data Request Form The Texas Association of Community Action Agencies (TACAA) supports the Summer Food Service Program (SFSP) by providing Census Data to organizations that are Interested in sponsoring SFSP sites. Note:Census Data should only be requested if your organization does not qualify as indicated by the schooi data. Please use one form per site. Type or print clearly, Our school district is NOT mandated to sponsor the Summer Food Service Program as indicated by the school data. Our organization does NOT qualify according to the school data available. Date of Request:_ h Person making Request: Sponsoring Organization: Cltyrzip: 2:4 `P'kA vv�Dtia a —���(.,►�-� ( '-1 Y1 V n l Phone:AIYkI 'e)'-4f t� Fax: (A�% �?f J� — ��•� Site Street address: Street` bordering site: Cross streeft: BlooK group#(s) (if available): Please use the space provided below to draw the site wrap, or attach a map. (Required information) �a J N � �saG� V W4� -E& �' —— ----- �SauN cre- �� !"IIAY 2 0 7005 Pie se return his f rm to TACAA by fax(512) 462-2004 or`by marl toi:� , ACAA, Inc.•25 2 IH 35 South, Ste. 100 •Austin,TX 76704-5751 -��)r, �(� ! i�zA If you h ve f her questions,call (512)462-2555, ext.205 RECEIVE-D APR 112006 Special Nutrition Programs Lufkin Tovoc -Yrnn, 05/25/2E05 16:59 512-462-2004 1AC:AA rHU� ui Texas Association of Community Action Agencies, Inc. 2512 IH 33 South,Suite 100 Phone: (512)462-2555 of (800)992-9767 'w°t w.tacaa.otg Austin,TX 78704-5751 Fax: (512)462-2004 tacaa�cacas.otg 1 DATE 5125105 Total Pages (including co ver sheet) Fred Lemell Jr. TO FAX# 1 (409) 838-4206 City of Beaumont FROM Anitra Hendricks FAX# (6 12) 462-2004 Program Assistant SUBJECT tSummer Food Service Program Census Data based on the 2000 census. To be area eligible, i eligibility data ba , TACAA is now using g y 9 sites must be located in a census block group where 50% or more of children, age 18 and younger, are eligible for free and reduced priced meals, Please note that some census tract boundaries and block groups may have changed under the 2000 census. According to the 2000 census data, the following address Is located in a block group where at least 50% or more of children are eligible for free or reduced priced meals: 2020 Cottonwood St. is located in block group 482450009 2 at 88.9%. If you have any questions regarding this data, please contact me at (800) 992-9767, ext. 205. Sincerely, Anitra Hendricks Program Assistant RECEIVED MAY 12005 :;FEC;iAL kILITRITION F'20GFtAM LUFKIN. TEXAS RECEIVE[ dd,�say APR 1 12006 6A,0-finn /A E7NE E S rl !I Special Nutrition Programs Ifto'"°'°" Lufkin, Texas 75901 r_ 1ti. �r�j5 1 12 20l'-4 TAC A SUMMER FOOD SERVICE PROGRAM(SFSP) TACAA.2005 Census Data Request Form The Texas Association of Community Action Agencies (TACAA) supports the Summer Food Service Program (SFSP) by providing Census Data to organizations that are Interested In sponsoring SFSP sites. Note:Census Data should only be requested if your organization does not qualify as indicated by the school data Please use one form per site, Type or print clearly, Our school district is NOT mandated to sponsor the Summer Food Service Program as indicated by the school data. Our organization does NOT qualify according to the school data available. Date of Request: 1 Person rMaking Request: Tz Sponsorin Organization: City0p: Phone: P - Site Street address:=; a�1 -�D"�"��C � City: P1��"^oJ� ZIP: St.reet6 bordering site: CCnr—'--r"0Q fl0 �-` ° z)IS _ Cross streets: -- Block group P(s) (if available): Please use the space provided below to draw the site map, or attach a reap, (Required information) DECEIVED N � MAY 1 1 2006 �-e-j woo S PE' i��,L P,l UT R ITION! �. A I I_UFK,IN1, TEXP,S� Co►�COV� �Ow..� Co-c o,J Wooi) r Please return this form to TA,CAA by fax (512) 462-2004 or by mail to TACAA, Inc, • 2512 IH 35 South, Ste, 100 •Austin,TX 7B704-5751 N you have furthegyt:� ;;11512 462-2555, ext.205 APR 1 12006 Special Nutrition Programs Lufkin, Texas 75901 I Texas Healm and Human Form H4508 Services Commission Special Nutrition Program July 2005 Certification of Authority This is to certify that the following person(s): Name of Authorized Representative(please type or print) Title Si nature–Authorize tative Name of Authorized Rep sentative(please typ Title - l - r Signature-Qu a es ative is(are)designated as an Authorized Representative of Name of Contracting Organization ) Address(Street, City, State, ZIP) l /; The representative(s)designated above,and myself,acknowledge that each is individually authorized on behalf of the contracting organization to make written agreements with the Texas Health and Human Services Commission(HHSC)to operate a food program,to sign documents or reports about the agreement and to present claims for reimbursement,when appropriate,to the department. By signing this document,we certify individually and collectively that to the best or our knowledge and belief,all documents submitted physically or electronically on behalf of the above named contracting organization pursuant to our participation in any and all programs administered by Special Nutrition Programs,HHSC,are/will be true and correct in all respects,that they are/will be completed according to the terms and conditions of existing agreements,including amendments,that records are/will be available to support any and all claims and that we will not submit claims(excluding amended/adjusted claims)for goods or services for which we have already received payment.We recognize that we are fully responsible for any excess amounts which may result from errors made in relation to the completion and submission of claims.We are also aware that deliberate m is representation or withholding of information may result in prosecution under applicable state and federal statutes. Name of Official.of Contracting Agency(please type orprint) Title X Signature–Official of Contracting Agency DELETED AUTHORIZED REPRESENTATIVES: A contracting organization may not have more than three(3)authorized representatives,including the official of the contracting agency.If you are deleting an authorized representative, list the name(s) of the individual(s)to be removed as authorized representative(s)below: Name of Deleted Representative Name of Deleted Representative Name of Deleted Representative For HHSC Use Only I Ir— ece' ed B Contract ' Received', /.� , Y ) � Date � t 75 — �.' 1, 1� c• •�, _—j',\' !.,\ , RECF- APR ?_006 Special Nut­: , s 1_ it,Ot, ..rograms ufldn, Tc:. I \(V V wJ Texas Health and Human Summer Food Service Program Form H1628 services commission Invitation for Bid and Contract (FNS-688) - V January 2006 Section A This document contains an invitation to food service management companies to bid for the furnishing of unitized meals to be served to children participating in the Summer Food Service Program (SFSP)authorized by Section 13 of the National School Lunch Act, and operated under Part 225 of the U.S. Department of Agriculture(USDA) regulations. This document sets forth the terms and conditions applicable to the proposed procurement. Upon acceptance it shall constitute the contract between the bidder and the Sponsor named below. Public reporting burden for this collection of information is estimated to average 39 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden,to Department of Agriculture, Clearance Officer, OIRM, Room 404-W,Washington, D.C. 20250; and to the Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, D.C.20503. Sponsor Information Name Sponsor Agreement Number Address(Street, City,IState, ZJP Code) Area Code and Telephone No. Contact Person Contract Dates Commencement Expiration Bid Bond Percentage Required(Sponsor shall insert appropriate percentage from 5% to 10%) Bid Opening Bid Issue Date Bid Number Date Time Location 1 i \i Y ' /�.'• 1 V , l Y1�'\ �il� .� 6AY1-'4 Meal Service Bids Sponsor to enter estimated number of meals. Fixed unit price bids to be inserted by the bidder. Fixed Unit Price Bid Sponsor's Estimated Totals Per Meal No.of Meals Breakfast ......................................................................... $ X $ Snack............................................................................... $ X $ Lunch/Supper................................................................... $ X $ Estimated Total $ Prompt Payment Discount(To be inserted by the bidder) % for payment within days i Performance Bond Percentage Required (State agency shall insert appropriate percentage from 10% to 25%) Bidder Information Name Area Code and Telephone No. Address(Street, City, State, ZIP Code) ( ) i rSignature(In Ink) Name(Print or Type) Title Date I Acceptance Sponsor Signature (In Ink) ,Date tract Number Oct Sponsor Name (Print or Type) Sponsor Title ;lecial Nutrition Lufkin, Texas � ; Summer Food Service Program Page 2 0 N2o06 Invitation for Bid (Continued) Certificate of Independent Price Determination Section B (A) By submission of this offer, the offeror certifies and in the case of a joint offer, each part thereto certifies as to its own organization, that in connection with this procurement: (1) The prices in this offer have been arrived at independently, without consultation, communication or agreement, for the purpose of restricting competition, as to any matter relating to such prices with any other offeror or with any competitor, (2) Unless otherwise required by law, the prices which have been quoted in this offer have not been knowingly disclosed by the offeror and will not knowingly be disclosed by the offeror prior to opening in the case of an advertised procurement,or prior to award in the case of a negotiated procurement,directly or indirectly to any other offeror or to any competitor, (3) No attempt has been made or will be made by the offeror to induce any person or firm to submit or not to submit, an offer for the purpose of restricting competition. (B) Each person signing this offer certifies that: (1) He or she is the person in the offeror's organization responsible within that organization for the decision as to the prices being offered herein and that he or she has not participated, and will not participate, in any action contrary to(A) (1)through (A)(3) above;or (2) He or she is not the person in the offeror's organization responsible within that organization for the decision as to the prices being offered herein,but that he or she has been authorized in writing to act as agent for the persons responsible for such decision in certifying that such persons have not participated and will not participate, in any action contrary to (A)(1)through(A) (3)above, and as their agent does hereby so certify, and he or she has not participated, and will not participate, in any action contrary to(A) (1)through (A) (3)above. Signature of Vendor's Authorized Representative Title Date In accepting this offer, the sponsor certifies that the sponsor's officers, employees or agents have not taken any action,which may have jeopardized the independence of the offer referred to above. Signature of Authorized Sponsor Representative Date (Accepting a bidder's offer does not constitute acceptance of the contract.) Note: Sponsor and Bidder shall execute this Certificate of Independent Price Determination. Section C 1. Definitions As used herein: (a.) Bid—the bidder's offer. (b.) Bidder—a food service management company submitting a bid in response to this invitation for bid. (c.) Contractor—a successful bidder who is awarded a contract by a Sponsor under the SFSP. (d.) Food Service Management Company—any commercial enterprise or nonprofit organization with which a sponsor may contract for preparing unitized meals, with or without milk,for use in the Program, or for managing a sponsor's food service operations in accordance with the SFSP regulations. Food service management companies may be: (a)public agencies or entities;(b) private, non- profit organizations, or(c)private,for profit companies. (e.) Invitation for Bid (IFB)—the document where the procurement is advertised. In the case of this Program, the IFB becomes the contract once both parties agree in writing to all terms and conditions of the IFB. (f.) Sponsor—the Service Institution which issues this IFB. (g.) Unitized Meal—an individual proportioned meal consisting of a combination of foods meeting the SFSP pattern requirements, delivered as a unit with or without milk or juice.The State agency may approve exceptions to the unitized meal such as separate hot and cold packs. Other terms shall have the meanings ascribed to them in the SFSP regulations(7 CFR Part 225). '). Submission of Bids (a.) Bidders are expected to examine carefully the specifications, schedules, attachments, terms and conditions of this IFB. Failure to do so will be at the bidder's risk. (b.) Bids must be executed and submitted in triplicate. If accepted, this IFB will become the contract and one copy of the contract will be forwarded to the successful bidder with the notice of award. The copy marked"original"will be governing should there be a variance between that copy of the bid and the other two copies submitted by the bidder. No changes in the specifications or general conditions are allowed. Erasures on all copies must be initialed by the bidder prior to submission. Failure to do so may result in rejection of the bid. I �. . Sped'al Nutrition Pt:- ., d_uNin,Texas 7l Summer Food Service Program Form H1628 Page 31 01-2006 Invitation for Bid (Continued) Section C (continued) (c,) Bids over$100,000 shall include a bid bond in the amount of % of bid price. (Sponsor shall insert appropriate percentage from 5% to 10%.)Sponsor should also insert the percentage on the IFB/Contract Face Sheet.Only those bonding and surety companies contained in the current Treasury Circular 570 may be used to obtain the required bonding.The Treasury Circular is published annually, for the information of Federal bond-approving officers and persons required to give bonds to the United States.All certificates of Authority expire June 30, and are renewable July 1, annually. Bid bonds will be returned (a)to unsuccessful bidders as soon as practicable after the opening of bids and (b)to the successful bidder upon execution of such further Contractual documents and bonds as may be required by the bid as accepted.The bid must be securely sealed in a suitable envelope, addressed to the office issuing the IFB and marked on the outside with the name of the bidder, bid number and date and time of opening. (d ) A copy of a current State or local health certificate for the food preparation facilities shall be submitted with the bid. Failure to comply with any of the above shall be reason for rejection of the bid. 3. Explanation to Bidders Any explanation desired by a bidder regarding the meaning or interpretation of the IFB specifications, etc.,must be requested in writing prior to bid opening and with sufficient time allowed for a reply to reach all bidders before bid opening. Oral explanations or instructions ,given before the award of the contract will not be binding.Any information given to a prospective bidder concerning an IFB will be furnished to all prospective bidders as an amendment of the IFB, if such information is necessary to bidders in submitting bids on the IFB,or if the lack of such information would be prejudicial to uniformed bidders. 4.Acknowledgement of Amendments to IFBs The sponsor must acknowledge receipt of an amendment to an IFB by a bidder by signing and returning the amendment. Such acknowledgement must be received prior to the hour and date specified for bid opening. 5. Bidders Having Interest in More Than One Bid if more than one bid is submitted by any one person, by or in the name of a clerk, partner, or other person, all such bids shall be rejected. 6. Time for Receiving Bids Sealed bids shall be deposited at the Sponsor's address no later than the exact time and date indicated on the face of this IFB. Bids received prior to the time of opening will be securely kept; unopened. 7. Errors in Bids Bidders or their authorized representatives are expected to fully inform themselves as to the conditions,requirements and specifications before submitting bids; failure to do so will be at the bidder's own risk and relief cannot be secured on the plea of error. S.Award of Contract (a.) The contract will be awarded to that responsible bidder whose bid is lowest and conforms to the specifications of the IFB. (b.) The Sponsor reserves the right to reject any or all bids and to waive informalities and minor irregularities in bids received. (c.l The Sponsor reserves the right to reject the bid of a bidder who previously failed to perform properly, or complete on time,contracts of a similar nature, or the bid of a bidder who investigation shows is not in a position to perform the contract. (d.) Sponsor reserves the right to accept any bid within 30 days from the date of bid opening. 9. Late Bids, Modification of Bids or Withdrawal of Bids (a.) Any bid received after the exact time specified for receipt of bids will not be considered unless it is received before award is made, and it was sent by registered or certified mail not later than the fifth calendar day prior to the specified date(e.g.a bid submitted in response to an IFB requiring receipt of bids by the 20th of the month must have been mailed by the 15th or earlier). (n.) Any modification or withdrawal of bid is subject to the same conditions as in (a)above,except with withdrawal of bids by telegram is authorized.A bid may also be withdrawn in person by a bidder or an authorized representative, provided identity is made known and he or she signs a receipt for the bid, but only if the withdrawal is made prior to the exact time set for receipt of bids. (c.) The only acceptable evidence to establish the date of mailing of a late bid, modifications or withdrawal sent either by registered or certified mail is the U.S. Postal Service postmark on the wrapper or on the original receipt from the U.S.Postal Service. If neither postmark shows a legible date, the bid, modification or withdrawal shall be deemed to have been mailed late. (The term"postmark" rneans a printed, stamped, or otherwise placed impression that is readily identifiable without further action as having been supplied and affixed on the date of mailing by employees of the U.S. Postal Service). (d.) Notwithstanding the above, a late modification of an otherwise successful bid which makes its terms more favorable to the Sponsor will be considered at any time it is received and may be accepted. r APR 1 1 2 vi; . :,)ecia! nutrition Pr ,,. Lufldn,Texas 75r Summer Food Service Program Form H1628 Invitation for Bid (Continued) Page 4/01-2006 Scope of Services Section D (A.) USDA regulations 7 CFR Part 225,entitled Summer Food Service Program is hereby incorporated by reference. (B) Contractor agrees to deliver unitized meals* of milk or juice to locations set out in Schedule A, attached hereto and made a part of hereof, subject to the terms and conditions of this solicitation. (C) All meals furnished must meet or exceed USDA requirements set out in Schedule C, attached hereto and made a part hereof. Food Service Management Companies may prepare unitized meals, with or without milk, for use in Summer Food Service Program. (D) Contractor shall furnish meals as ordered by Sponsor during the period of*` to" Meals are to be served `"` days a week, as specified in Schedule A. Insert"inclusive"or"exclusive"as applicable. Sponsor shall insert contract commencement date and expiration date. Sponsor shall insert appropriate number of serving days. Unit Price Schedule and Instructions Section E 1. Bidders are asked to submit prices in accordance with Schedule(s) D for meals with/without milk"meeting the contract specifications set forth in Schedule C and to be delivered to all the sites stated in Schedule A. Please note that bidders must complete a Schedule D for each meal type (breakfast, lunch, supplement,etc.)covered by the IFB. * Sponsor should indicate whether or not milk should be included in the meals/supplements. 2. Evaluation of Bids will be performed as follows: Determine the grand total bid for each bidder b totaling the bids for each meal type from Schedules D. Bidders calculations will be Y 9 YP Schedule(s) checked prior to totaling. 3. Pricing shall be on the menus described in Schedule B.All bidders must submit bids on the same menu cycle provided by the Sponsor. Deviation from the menu cycle shall be permitted only upon authorization of the Sponsor. Bid price must include the price of food components (including milk and/or juice, if part of unitized meal),packaging, transportation and all other related costs(e.g. condiments, utensils,etc.). The unit prices of each meal type which the bidder agrees to furnish must be written in ink or typed in the blank space provided and must include proper packaging as required in the specifications and delivery cost to the designated sites. Unit prices shall include taxes, but any charges or taxes which are required to be paid under future laws must be paid by the bidder at no additional charge to the Sponsor. 4. Average Daily Number of Meals are estimated:They are the best known estimates for requirements during the operating period.The Sponsor reserves the right to order more or less meals than estimated at the beginning of the operating period. Contractor will be paid at the 100% unit cost rate during the payment period specified. (The Sponsor should indicate in Section F, Item 4, "Method of Payment," whether the payment period is weekly, bi-weekly or monthly). Sponsor does not guarantee orders for quantities shown. The maximum number of meals will be determined based on the approved level of meal service designated by the administering office for each site serving meals provided by the contractor. However, if average meals delivered per day by type over the contract period fall 90%of the applicable average daily estimate, adjustments will be made to the per unit price in accordance with Schedule D. 5. Evaluation of Bidders: Each bidder will be evaluated on the following factors: a. Financial capability to perform a contract of the scope required. b. Adequacy of plant facilities for food preparation,with approved license certification that facilities meet all applicable State and local health, safety and sanitation standards. C. Previous experience of the bidder in performing services similar in nature and scope. d. Other factors such as transportation capability, sanitation and packaging. Bidders that do not satisfactorily meet the above criteria may be rejected as nonresponsive and not be considered for award. 6 Meals Orders: Sponsor will order meals on** of the week preceding the week of delivery;orders will be placed for the total number of operating days in the succeeding week, and will include breakdown totals for each site and each type of meal. The Sponsor reserves the right to increase or decrease the number of meals ordered on a"* hour notice, or less if mutually agreed upon between the parties to this contract. 7. Meals-Cycle Change Procedure: Meals will be delivered on a daily basis in accordance with menu cycle which appears in Schedule B. Menu changes may be made only when agreed upon by both parties. When an emergency situation exists which might prevent the contractor from delivering a specified meal component, the Sponsor shall be notified immediately so substitutions can be agreed upon. The Sponsor reserves the right to suggest menu changes within the vendor's suggested food cost, periodically throughout the contract period. insert mutually agreed day Sponsor shall insert appropriate number of serving days. R I I V - APR 1 12G Special Nutrition Lufkin,Texas s. Summer Food Service Program Form H1628 Invitation for Bid (Continued) Page 5/01-2006 Section E (continued) 8 Noncompliance. The Sponsor reserves the right to inspect and determine the quality of food delivered and reject any meals which do not comply with the requirements and specifications of the contract. The contractor will not be paid for unauthorized menu changes, incomplete meals,meals not delivered within the specified delivery time period, and meals rejected because they do not comply with the specifications. The Sponsor reserves the right to obtain meals from other sources, if meals are rejected due to any of the stated reasons. The contractor will be responsible for any excess cost, but will receive no adjustment in the event the meals are procured at lesser cost. The Sponsor or inspecting agency shall notify the contractor in writing as to the number of meals rejected and the reasons for rejection. The SFSP regulations provide that statistical sampling methods may be used to disallow payment for meals which are not served in compliance with Program regulations. In the event that disallowances are made on the basis of statistical sampling,the Sponsor and the contractor will be notified in writing by the administering agency as to the number of meals disallowed,the reasons for disallowance, and the methodology of the statistical sampling procedures employed. 9. Specifications (A) Packaging. 1. Hot Meal Unit–Package suitable for maintaining meals in accordance with local health standards.Container and overlay should have an air-tight closure, be of non-toxic material, and be capable of withstanding temperatures of 400 degrees(204 degrees C) or higher. 2. Cold Meals Unit(or Unnecessary to Heat)–Container and overlay to be plastic or paper and non-toxic. 3. Cartons–Each carton to be labeled. Label to include: a. Processor's name and address(plant). b. Item Identity, meal type. c. Date of production. d. Quantity of individual units per carton. 4. Meals shall be delivered with appropriate nonfood items: condiments,straws for milk, napkins, single service ware, etc. Sponsor shall insert the types of nonfood items that are necessary for the meals to be eaten: (B) Food Preparation: Meals shall be prepared in accordance with State and local health standards. (C) Food Specifications: Bids are to be submitted on the menu cycle included in Schedule B; and portions shall, as a minimum, be the quantities specified by USDA for each component of each meal, as included in Schedule C of this contract. All meals in the menu cycle must meet the food specifications and quality standards.All meat and meat products shall have been slaughtered, processed and manufactured in plants inspected under USDA approved inspection program and bear the appropriate seal.All meat and meat products must be sound, sanitary and free of objectionable odors or signs of deterioration on delivery. Milk and milk products are defined as"pasteurized fluid types of flavored or unflavored whole milk, low-fat milk,skim milk or cultured buttermilk which meet State and local standards for such milk.All milk should contain vitamins A and D at the levels specified by the Food and Drug Administration and consistent with State and local standards for such milk."Milk delivered hereunder shall conform to these specifications. General Conditions Section F 1. Delivery Requirements A. Delivery will be made by the contractor to each site in accordance with the order from the Sponsor. B. Meals are to be delivered daily,unloaded, and placed in the designated location by the contractor's personnel at each of the sites and "times listed in Schedule A. C. The contractor shall be responsible for delivery of all meals and/or dairy products at the specified time.Adequate refrigeration or heating shall be provided during delivery of all food to insure the wholesomeness of food at delivery in accordance with State or local health codes. D The Sponsor reserves the right to add or delete food service sites by amendment of the initial lists approved sites in Schedule A, and make changes in the approved level for the maximum number of meals which may be served under the Program at each site (established under Section 225.5(dX2)of the SFSP regulations).The Sponsor shall notify the contractor by providing an amendment to Schedule A, of all sites which are approved, cancelled, or terminated subsequent to acceptance of this contract, and of any changes in the approved level of meal service for a site. Such amendments shall be q�,vi hours or less. l' — �. . � rte. .. 2 Supervision and Inspection The contractor shall provide management supervision at all times and maintain constant quality control in964-tiI s Io ;heck for portion VF size,appearance and packaging, in addition to the quality of products. )Qciai Nutrition p! + , Lufkin,Texas 7 1> Summer Food Service Program Form H1628 Invitation for Bid (Continued) Page 6/01-2006 Section F (continued) 3. Pecordkeepinq A Delivery tickets must be prepared by the contractor at a minimum of three copies: one for the contractor, one for the site personnel and one for the Sponsor. Delivery tickets must be itemized to show the number of meals of each type delivered to each site. Designees of the Sponsor at each site will check adequacy of delivery and meals before signing the delivery ticket. Invoices shall be accepted by the Sponsor only if signed by Sponsor's designee at the site. B. The contractor shall maintain records supported by delivery tickets, invoices, receipts, purchase orders, production records for this contract, or other evidence for inspection and reference, to support payments and claims. C. The books and records of the contractor pertaining to this contract shall be available for a period of three years from the date of submission of the Sponsor's final claim for reimbursement,or until the final resolution of any audits,for inspection and audit by representatives of the State agency, representative of the U.S. Department of Agriculture, the Sponsor and the U.S. General Accounting Office at any reasonable time and place. 4. Method of Payment The contractor shall submit its itemized invoices to the Sponsor** in compliance with Section 225.5(hx2xiv)of the SFSP regulations. Each invoice shall give a detailed breakdown of the number of meals delivered at each site during the preceding period. The Sponsor shall calculate the average number of meals delivered each day for the applicable period. Payment will be made at the unit price shown for that range. Each payment period will be calculated and paid for independent of other periods. No payment shall be made unless the required delivery receipts have been signed by the site representative of the Sponsor. The contractor shall be paid by the Sponsor for all meals delivered in accordance with this contract and SFSP regulations. However, neither the Department nor the State agency assumes any liability for payment of differences between the number of meals delivered by the contractor and the number of meals served by the Sponsor that are eligible for reimbursement. 5. Inspection of Facility A. The Sponsor, the State agency and USDA reserve the right to inspect the contractor's facilities without notice at any time during the contract period, including the right to be present during preparation and delivery of meals. B. The contractor's facilities shall be subject to periodic inspections by State and local health departments or any other agency designated to inspect meal quality for the State. This will be accomplished in accordance with USDA regulations. C. The contractor shall provide for meals which it prepares to be periodically inspected by the local health department or an independent agency to determine bacterial levels in the meals being served.Such levels shall conform to the standards which are applied by the local health authority with respect to the level of bacteria which may be present in meals served by other establishments in the locality. 6. Performance Bond Requirement The successful bidder shall provide the Sponsor with a performance bond in the amount of*'* % of the contract price. The bond shall be executed by the contractor and a licensed surety company listed in the current Department of Treasury Circular 570 Only those bonding and surety companies contained in the current Treasury Circular 570 may be used to obtain the required bonding. The Treasury Circular is published annually, for the information of Federal bond-approving officers and persons required to give bonds to the United States.All certificates of Authority expire June 30, and are renewable July 1, annually. The Bond shall be furnished not later than ten days following award of the contract. 7. Insurance State agencies will furnish sponsors their state insurance requirements to insert herein. 8.Availability of Funds The Sponsor reserves the right to cancel this contract it the Federal funding to support the SFSP is withdrawn. It is further understood that, in the event of cancellation of the contract, the Sponsor shall be responsible for meals that have already been assembled and delivered in accordance with this contract. 9. Number of Meals and Delivery Times The contractor must provide exactly the number of meals ordered. Counts of meals will be made by the Sponsor at all sites before meals are accepted. Damaged or incomplete meals will not be included when the number of delivered meals is determined. 10. Emergencies In the event of unforeseen emergency circumstances, the contractor shall immediately notify the Sponsor by telephone or telegraph of the following: (1)the impossibility of on-time delivery, (2)the circumstance(s)precluding delivery, and (3)a statement of whether or not succeeding deliveries will be affected. No payments will be made for deliveries made later than**** hours after specified meal time. Emergency circumstances at the site precluding utilization of meals are the concern of the Sponsor. The Sponsor may cancel orders provided it gives the contractor a least***** hours notice or less if mutually agreed upon between the parties to this contract. Adjustments for emergency situations affecting the contractor's ability to deliver meals, or Sponsor's ability to utilize meals,for periods longer than 24 hours will mutually worked out between the contractor and Sponsor. ¢f ** _ Sponsor shall insert"weekly," bi-weekly"or"monthly.' � �°7 a -_� Insert percentage required by the State, but not less than 10% of the contract price and not more than 25%. # Sponsor shall set time in accordance with Stage agency instructions. APR Insert same number as in Section F-1.D. APR i Special Nul Luffldn, Summer Food Service Program Form H1628 Invitation for Bid (Continued) Page 7 101-2006 Section F (continued) 11. Termination A The Sponsor reserves the right to terminate this contract if the contractor fails to comply with any of the requirements of this contract. The Sponsor shall notify the contractor and surety company, if applicable, of specific instances of noncompliance in writing. The Sponsor shall have the right, upon such written notice, to immediately terminate the contract and the contractor or surety company, if applicable, shall be liable for any damages incurred by the Sponsor. Prior to termination,the Sponsor shall contact the State agency or regional office concerning procedures for conducting a reprocurement action. B. The Sponsor may, by written notice to the contractor,terminate the right of the contractor to proceed under this contract. If it is found by the Sponsor that gratuities in the form of entertainment, gifts or otherwise were offered or given by the contractor to an officer or employee of the Sponsor with a view toward securing a contract or securing favorable treatment with respect to the awarding or amending of the contract; provided that the existence of the facts upon which the Sponsor makes such findings shall be an issue and may be reviewed in any competent court. C In the event this contract is terminated as provided in paragraph (B)hereof, the Sponsor shall be entitled to(1)pursue the same remedies against the contractor as it could pursue in the event of the breach of the contract by the contractor,and(2)as a penalty in addition to any other damages in an amount which shall not be less than three nor more than ten times the cost incurred by the contractor in providing any such gratuities to any such officer or employee. D The right and remedies of the Sponsor provided in this clause shall not be exclusive and are in addition to any other rights and remedies provided by law or under the contract. 12. Subcontractors and Assignments The contractor shall not subcontract for the total meal, or for the assembly of the meal; and shall not assign,without the advance written consent of the Sponsor,this contract or any interest therein. In the event of any assignment, the contractor shall remain liable to the Sponsor as principal for the performance of all obligations under this contract. General Provisions Section G Equal Opportunity "The FSMC shall comply with Title VI of the Civil Rights Act of 1964, as amended, USDA regulations implementing Title IX of the Education Amendments,and Section 504 of the Rehabilitation Act of 1973,and any additions or amendments." Clean Air and Water If this contract is in excess of$100,000, the Sponsor and FSMC shall comply with all applicable standards, orders, or regulations issued pursuant to the Clean Air Act of 1970(42 USC 1857), or the Federal Water Pollution Control Act(33 USC 1319), as amended. APR 11 _r 4ecial Nutrition, Lufkin,Texas S_rn rer Food Service Program Page er oH2006 Invitation for Bid (Continued) U.S. Department of Agriculture Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion — Lower Tier Covered Transactions This certification is required by the regulations implementing Executive Order 125-19, Debarment and Suspension, 7 CFR Part 3017, Section 3017.510, Participants' responsibilities.The regulations were published as Part IV of the January 30, 1989, Federal Register (pages 4722-4733). Copies of the regulations may be obtained by contacting the Department of Agriculture agency with which this transaction originated. (Before completing certification, read instructions at the bottom of this page.) (1.) The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. (2.) Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. Organization Name PR/Award Number or Project Name Name of Authorized Representative Title of Authorized Representative Signature of Authorized Representative Date Name of Authorized Representative Title of Authorized Representative Signature of Authorized Representative Date Instructions for Certification 1. By signing and submitting this form,the prospective lower tier participant is providing the certification set out in accordance with these instructions. 2. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment. 3. The prospective lower tier participant shall provide immediate written notice to the person to which this proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 4. The terms"covered transaction," "debarred,""suspended,""ineligible,""lower tier covered transaction,""participant," "person,""primary covered transaction,""principal,""proposal'and"voluntarily excluded,"as used in this clause have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of those regulations. 5- The prospective lower tier participant agrees by submitting this form that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred,suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency with which this transaction originated. 5 The prospective lower tier participant further agrees by submitting this form that it will include this clause titled"Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion—Lower Tier Covered Transactions,"without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. 7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous.A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may. but is not required to, check the Nonprocurement List. 8. Nothing contained in 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 clause.The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings 9 Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended,debarred, ineligible, or voluntarilc Iii a "p`hHt°rcipation in this transaction, in addition to other remedies available to the Federal Government,the department or agency i ich this transaction originated may pursue available remedies, including suspension and/or debarment. APR 1 Special Nutritjc. Lufkin,Tex` Summer Food Service Program Form H1628 Invitation for Bid (Continued) Page 9 101-2006 chedule A U. S. Department of Agriculture— Food and Nutrition Service Site Information List Summer Food Service Program sponsor Nam Contact Contact Perso\\n ` T_ Area Code and Telephone No. Address(Street, City State,ZIP Code) Refrig�All Meals End Date Meal Type Total Meals Total Days Average Delivery Time for — Begin Date i op. Meals/Day Each Meal Type _ Yes No (1) — (,2) 13 (4) $ (6) 7) I Breakfast AM Supplement ❑ ❑ I Lunch I PM Supplement Supper Breakfast i AM Supplement ❑ ❑ Lunch PM Supplement Supper Breakfast AM Supplement ❑ ❑ Lunch PM Supplement i Supper Breakfast AM Supplement ❑ ❑ Lunch PM Supplement Supper rBreakfast AM Supplement ❑ ❑ Lunch PM Supplement _ ! _ Supper j Breakfast AM Supplement 1j ❑ Lunch PM Supplement I—— - --- -- --- Supper I Breakfast SAM Supplement L Lunch I t PM implement t I - — 1- --- - - — - — 1Supper -- --J APR 11 -special Nutritior-, Lufldn,Texas Surnmer Food Senjice Program Page Fo orm i OH1628 invitation for Bid (Continued) Instructions for Completion of Schedule A Site Information List Enter sponsor's name in upper left-hand corner. 2 Use correct street address for all sites listed. 3 Check 'Yes"if site has adequate refrigeration to store all meals ordered and could receive early deliveries. 4 Under columns (1)and (2), enter the beginning and ending dates for meal service at each site 5 Under column (3), enter the total number of days meals will be served at each site. 6 Enter in column (6)beside the appropriate meal type,the average number of each type of meal that is estimated to be served each clay at the site. For example, if a site plans to serve 11,000 lunches for 44 days during the summer,then the average is 250(11,000 44) Do not insert the maximum number that will be served on a particular day during the summer. 7. Enter in column (8)the result of column (3)times column (5). 8. Enter in column (7)the delivery time for each meal type. When estimating the Average Meals Served Per Day(Column (5)), use the average from the prior summer if the site was in operation at that time. Since Schedule A must be completed well in advance of the application deadline, it is recognized that changes will occur in the data by the time the program begins. However, be as accurate as possible since the data is used by the vendor to arrive at his bid prices.The vendor awarded the bid will accept changes after the bid opening. aT .ti oecial Nuty'sc . Lufdn, e�_ ry it)tcr) i n S p Dp LURUn,TPX?S Summer Food Service Program Forni H1628 Invitation for Bid (Continued) Pzg� 1.2 o;-2u06 Schedule C Summer Food Service Program USDA Required Meal Patterns The meal requirements for the Program are designed to provide nutritious and well-balanced meals to each child. Except as otherwise provided in Section 225.16(b) of the SFSP regulations, the following table presents the minimum requirements for meals served to children in the Program. Breakfast Milk . .. .... ... _.. .... .. ... ........_ ............... .... . _ .. ........ .... ._ ................... ...... ............ . 1 cup FluidMilk .... .. ....... ...... ......................... .................. ................. . .................. ................... ..............(1/2 pint) Vegetables and Fruits Vegetables and/or fruits or . . . .... ............ .. .. __. ... ... . _ . ...... ...... ..... ...... ... ... . _ ... _ ....%=cup full strength vegetable or fruit juice . .......... ....... .. .............. .... ... ... .__ .. ... ... . .. ....... . ... 1/2 cup (Or an equivalent quantity of any combination of vegetables, fruits and juices) Juices cannot be served with milk Bread and Bread Alternates Bread (Whole-grain or enriched) or . ... _.._........._.... ........................ .... ................... 1 slice ................. Bread Alternates(whole-grain or enriched) cornbread, biscuits, rolls, muffins, etc. or ._ .... . 1 serving cooked pasta or noodles products or ..................................._..............................................................1/2 cup cooked cereal grains, such as rice, corngrits, or bulgur or ._.............. ............. ............. ......................... ................ .. .................1/2 cup (whole-grain, enriched, or fortified): cooked cereal or cereal grains or....................................... ................................................. ................1/z cup cold dry cereal .................. ._...._................................. .......... .... ............._ ........ ..............................'/,cup or 1 ounce (whicheve-is less) (or an equivalent quantity of a combination of bread or bread alternates) (Optional) Serve as often as possible: Meatand Meat alternates ............ ................... .. .. .. ................... ........................................... 1 ounce (See lists Under Lunch or Supper) � ,&Ciai Ruda LUfldn.,Tex Summer Food Service Program ft•IS2 Invitation for Bid (Continued) r=3� 1 �,-z�,r;; Schedule C (continued) Snack (Supplemental Food) Choose two items from the following four components Meat and Meat Alternates Lean meat or poultry or fish or ....... ... .. ... . ... .. ... _ _ _ _ _ _ _ . _ _ I ounce(edible PoriOr, GS" _rived) Meat Alternates Cheese or .. .. ......... ... ....... .. _ _ 1 ounce Eggor . .. .. ........... .......... ....... ...... ...... ......... ........ _ _ _ 1 large Cooked dry beans or peas or.... .. ..... ......... .... ___.._. ... _ ..... .... . . ..... _ _ ._ _ '/cup Peanut butter or other nut or seed butters or.. ._..... ....... .... __ _........ _. ............. _ . .. __. .2 tablespoons nutsand/or seeds or .................._.................................................................. ........ . ..... ..... _ .. 1 ounce Yogurt(plain, sweetened, or flavored) ........... _.. .. _. ..... . ...... .......... .... ..__ ._. __ _ 4 ounces (or an equivalent quantity of any combination of meat or meat alternates) Vegetables and Fruits Vegetables and/or fruits or ................. __.................................. ........ .. .. _ ............ ... .......... .. .3/4 cup full strength vegetable or fruit juice ................................................................. ..... ........... .. . . ....... 3/4 cup (Or an equivalent quantity of any combination of vegetables, fruits and juices) Juices cannot be served with milk Bread and Bread Alternates Bread (Whole-grain or enriched) or................................................................ _.. ........ ....... ........._ . ....1 slice Bread Alternates (whole-grain or enriched) cornbread, biscuits, rolls, muffins, etc. or ......... ................................... . ........ ... .......... ... .. .... ...... ....1 serving cooked pasta or noodle products or ........ ..................................................._...... ...... ...... ....................1/2 cup cooked cereal grains, such as rice, corn grits,or bulgur or .................... ...... ..... . Yz cup (whole-grain,enriched, or fortified): cooked cereal or cereal grains or ............................_........... ........... .......................... ............ ..... ..... .%cup cold dry cereal .... .... .......................................................... .._.._.. ...... . .. . ........ .. . . .... %d cup or 1 ounce (whichever is less) (or an equivalent quantity of a combination of bread or bread alternates) Milk . ....... .......................................................... ............................ ........ .............. ..........._ _ . . . 1 cup FluidMilk ._........ .... _.................................................. ... _.........._....._...._... ._..._.. .. . . . _ .... . .......(1/2 pint) "iPR 1 � ;Dpaial Nutrit c , Summer Food Service Program Form H1628 Invitation for Bid (continued) Page 14/01-2006 Schedule C (continued) Lunch or Supper _.._ ........ ...... ..._ .... .. ........ ................... ..1 cu Milk _ .._. _......_. . .. ..... ...... . ..._ .. P Fluid Milk _ _. . _ . ..... .. .... ........ .. _ ......... . ................ . .. .............. .....................(1/2 pint) Meat and Meat Alternates Lean meat or poultry or fish or ... ............... . ......... ................ .. ... ......... . ...... .... .... .......2 ounces (edible portion as served) Meat Alternates. Cheeseor ....... ............................ ............... .........................................................................................2 ounces Eggor ................................................................................................... ..._....._...... ..................... 1 large Cooked dry beans or peas or _................. .... ... ................_. ....... . ...... ...... .... ......... ..... ....... .. .. ..'/�cup Peanut butter or other nut or seed butters or................ .. ..... . ............... ._................................... _..4 tablespoons nuts and/or seeds . ..........-......................1 ounce= 50% ............................................................................................. . (or an equivalent quantity of any combination of meat or meat alternates) Vegetables and Fruits Vegetables and/or fruits(2 or more selections for a total of 1/4 cup)or .. ...............................................3/4 cup full-strength vegetable or fruit juice ........................................................................................................3/4 cup ("or an equivalent quantity of any combination of vegetables,fruits and juice) Juice may not be counted to meet more than'/2 of this requirement. Bread and Bread Alternates Bread (Whole-grain or enriched) or.............. .................... .....................................................................1 slice Bread Alternates(whole-grain or enriched): cornbread, biscuits, rolls, muffins, etc. or ...............................................................................................1 serving cooked pasta or noodle products or .......................................................................................................'/z cup cooked cereal grains, such as rice corn grits, or buigur .........................................................................I/z cup (or an equivalent quantity of a combination of bread or bread alternates) " No more than one-half of the requirement shall be met with nuts or seeds. Nuts or seeds shall be combined with another meat/meat alternate to fulfill the requirement. Note: The serving sizes of food specified in the meal patterns are minimum amounts. If the administering agency approves the sponsor to serve smaller portion sizes to children under 6 years, the sponsor must meet the meal patterns specified in the Child Care Food Program (CCFP)regulations. You can obtain copies of these regulations from your State agency. Children over 6 years old may be served larger portions, but not less than the minimum requirements specified in the Summer Food Service Program regulations. Remember that you do not receive reimbursement for meals that do not meet the minimum program requirements. - . .SNP .�c) c;al Hut'duc r Lufkin,Text: Sumirer Food Service Program Page or oH1628 Invitation for Bid (Continued) Schedule D Sponsor ; Unit Price Schedule Instructions: Vendor.Complete Items (d) and (a)for each meal type. Sponsor: Complete Items(a)—(c)for each Meal Type. Total Meals X Cost=Total Cost. 1 2 3 (a)Meal Type (b)Average Daily (c)Total Number (d) Unit Cost (e)Total Bid i.e.,Lunch Meals Needed of Meals $ $ Adjustments If the average daily meals billed is less than the average daily meals needed (per Item (b)above), a one time adjustment to the unit price will be made as follows: Average Daily Meals Billed Multiply "Unit Cost" (d) Average Daily Meals Needed by this Amount 81 —90% 1.05 71 —80% 1.10 61 —70% 1.15 51 —60% 1.20 50% or Below 1.30 Example: If the average daily meals billed _by the"average daily meals needed"(Item(b)above)_ .82 or 82%, multiply the"unit cost" (Item (d)above)by 1.05. The contractor will invoice the sponsor at the 100% unit cost indicated above bi-weekly.To determine if an additional cost per meal is due the vendor, complete the following calculation. Divide the total number of meals billed by type(lunch, breakfast or supplement)for the total length of the program by the total number of days the program was operated.Any additional charges resulting from this higher"adjustment" will be reflected in the final statement from the vendor. Note: The unit cost per meal may not exceed the maximum operational reimbursement for each meal type as stated in Part 7 CFR 225 of the federal regulations. 1. Obtained from Columns (3)and(5), Schedule A, by dividing total meals for each specific meal type by the greatest number of days operated by a site in Column (3). 2. Obtained from Schedule A by totaling Column(5)for each specific meal type. Unit cost specified is that cost based on 100%Average Meals Needed Per Day. FTy APR riecial Nutrit: ; Lufkin,TexLv u+'r�m�rr Food Service Proararr! ;sue' invitaiuotr for Bid (Continued) - Summary Bid Sheet Meal Type -- --- --r Total Number Meals Unit Cost ai - Breakfas" 1$ - AIMI Supplement J --- - ----- ----. —.._ --- .-- I .-.- --_ - -. PM Supplement - ---- ---- -- --------Total�, �$ $ -- --- - ------ -- -- - ---- -- -- -- --- — -- - ------ - -_I _)nit c;,.-,s,must be identical to those unit costs lister: on the Unit Price .Schedule (Schedule D). pp Hutridon L j fki r,T°t. u^s BID SHEET NO. 1. PAGE I BID OPENING DATE: Thursday,April 27,2006 2:00 P.M. BEAUMONT, TEXAS CITY BID NUMBER: TF0306-32 BID SHEET FOR FURNISHING: Summer Food Program (AS PER SPECIFICATIONS) OUTLINE OF BID DATA: APPROXIMATELY I OpPlAv.T'l rz 1,310 LUNCHES PER DAY FOR 49 DAYS 6/5/06 L thru 8/11/06 -3 9,-2 ?o lo EXCLUDING 7/4/06 NOTE: DUE TO CIRCUMSTANCES BEYOND OUR CONTROL,QUANTITIES ARE ESTIMATED AND CANNOT BE GUARANTEED. RECEIVED MAY 1 12006 Special Nutrition programs Lufkin, Texas 75901 o?l � 5 C6MPANY NAME STREET ADDRESS ZIP ZSIGNATURE 6F AlbDER P.O. BOX 7770-15- (PRINT OR TYPE NAME) CITY STATE ZIP ��f�� 9 9'©- 0,5-1 q)g Lo- � TITLE TELEPHONE NUMBER FAX NUMBER "PLEASE COMPLETE BID SHEET NO. 1, PAGES 1-2** 27 '06 1 57 FR 3JPRAIHT' ; rdS�RFhJ�'E 2S1 421 79C7 TO 9--1421qE42�145 hG 1?, LUU6 y: UyHwi aa® yu. 4au r ® m e MY OF BEAUMONT WSmtANCE REQQnREl+ M AFyMAVU e�it� lite ,�,,,,,�,��^� Wll�iiRl� 8tis bid � document have been mNnwcd by=wish the below identfbed Cam. If the below identified Cauuacmr is awarded thi3 contract by the City of Beamont,I will be abk to,wit tea(10)days afbn being mtfied of soh award,f�is)z a valid ksmanae=fific4tc to the City meetitlg ell of the requ cs defmad.in tlue bid. Harold L. r�.rtlul is� J� r. _ Agent(Sim) t 9�ioo Nmme of Ageacy/$ralcer; Guaranty Insurance Services, Inc. Add=of A&cnt(Brm)sxx: P, 0. D-rawe gr 120 City/StatWziP; Raytoitim Texas 77SZJ Agent/Brakea Tdghom 4: 2 18- 1 4 21-7 6 0 5 CONTRACT'OR'S NAME: _MozicIa' (Prilm or Type) If this time rcgw-=memt is not met,the City has the right to kmd dtme the bid awaid and award the wMract to the ne4 lowest bidder t w=j;speciaoatiom Shoald au.nwarded bid be mvOdabd the Corara Wr map be liable for brcacb of=.4x ct. If you have=y q=st0m coucetmmg these lease couulct the Pure for the C Of BCUMM at= 880-3720. 24 RECEIVED MAY 1 1 ZOUb Special Nut'ltion ProgralIs Lufkin, texas 75901 CITY OF BEAUMONT INSURANCE REQUIREMENT AFFIDAVIT To be,Completed By Appropriate Insurance Agent and submitted .th bid proposal I,the undersigned Agent/Broker,certify that the insurance requirements contained in this bid document have been reviewed by me with the below identified Contractor. If the below identified Contractor is awarded this contract by the City of Beaumont,I will be able to,within ten(10)days after being notified of such award, furnish a valid insurance certificate to the City meeting all of the requirements defined in this bid. Agent(Signature) Agent(Print) Name of Agency/Broker: Address of Agent/Broker: City/State/Zip: Agent/Broker Telephone#: CONTRACTOR'S NAME: (Print or Type) NOTE TO AGENT/BROKER If this time requirement is not met, the City has the right to invalidate the bid award and award the contract to the next lowest bidder meeting specifications. Should an awarded bid be invalidated the Contractor may be liable for breach of contract. If you have any questions concerning these requirements, please contact the Purchasing Manager for the City of Beaumont at(122L880-3720 24 R r If V &- Special Nut iLIOfi i 10 ("3(115 Lufkin, -Tc;as Z590?. BID SHEET NO. 1, PAGE 2 DATE OF DELIVERY AFTER RECEIPT OF ORDER WARRANTY Receipt is hereby acknowledged of the following addenda to the Specifications: Addendum No. 1 dated Received Addendum No. 2 dated Received DOES YOUR BID MEET SPECIFICATIONS? YES V""NO IF NO IS INDICATED, ATTACH SHEET INDICATING EXCEPTIONS PLEASE CHECK THE FOLLOWING THAT WILL APPLY TO YOUR COMPANY: Ownership of firm(51%or more) ✓Non-Minority_Hispanic_Black_Other Minority (please specify) Female Owned_Handicapped owned__4�fSmall Business (less than $1,000,000 annual receipts or 100 employees) CERTIFICATE OF CORPORATE BIDDER BIDDERS I, 9,6 k VII e) ,i. f ,CERTIFY THAT I AM P e e5 The undersigned affirms that they are duly authorized to (title)OF THE CORPORATION NAMED AS execute this contract,that this company,corporation,firm, BIDDER HEREIN;THAT WHO SIGNED THIS partnership or individual has not prepared this bid in collusion with any other Bidder,and that the contents of this BID ON BEHALF OF THE BIDDER,WAS THEN P),2 L:�7 5 bid as to prices,terms or conditions of said bid have not —(title)OF SAID CORPORATION;THAT SAID BID WAS been communicated by the undersigned nor by any employee or agent to any other person engaged in this type DULY SIGNED FOR AND ON BEHALF OF SAID of business prior to the official opening of this bid. CORPORATION BY AUTHORITY OF ITS GOVERNING BODY AND IS WITHIN THE SCOPE OF ITS CORPORATE Vendor A/I 0 a c Lis t5 / w L POWERS. Address --l- ,3 a (-A/ G ,✓Y,e jO 4-t i SIGNATURE OF OFFICER �'ry (4-u A4-" L V;- Bidder TYPE OR PRINT NAME (Signature) TITLE OF OFFICER Bidder ``' ' '"4" (Print Name) Position With Compari Il ie-x-- 5 (Title) MAY i 11 1_1 :3peca Lufkin, `;,xas �'SS01 CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ For vendor or other person doing business with local governmental entity This questionnaire is being filed in accordance with chapter 176 of the Local OFFICE USE ONLY Government Code by a person doing business with the governmental entity. Date Received By law this questionnaire must be filed with the records administrator of the local government not later than the 7"' business day after the date the person becomes aware of facts that require the statement to be filed. See Section 176.006, Local Government Code. A person commits an offense if the person violates Section 176.006, Local Government Code. An offense under this section is a Class C misdemeanor. 1 Name of person doing business with local governmental entity. 2 r� Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than September 1 of the year for which an activity described in Section 176.006(a),Local Government Code,is pending and not later than the 7"'business day after the date the originally filed questionnaire becomes incomplete or inaccurate_) 3 Describe each affiliation or business relationship with an employee or contractor of the local governmental entity who makes recommendations to a local government officer of the local-governmental entity with respect to expenditure of money. 4 Describe each affiliation of business relationship with a person who is a local government officer and who appoints or employs a local government officer of the local governmental entity that is the subject of this questionnaire_ Amended 01/13,2006 A I ir'°" MAY 1 1 tun SpeCldi Nut ,-'* :uo rC: 3f ij Lul:in, Texas 75901 CONFLICT OF INTEREST QUESTIONNAIRE FORM C1Q For vendor or other person doing business with locat governmentW entity Page 2 5. Name of local government officer with whom filer has affilitation or business relationship. (Complete this section only if the answer to A, B.or C is YES.) This section,item 5 including subparts A,B,C&D,must be completed for each officer with whom the filer has affiliation or business relationship. Attach additional pages to this Form CIQ as necessary. A. is the local government officer named in this section receivingor likely to receive taxable income from the filer of the questionnaire? Yes El No B. Is the filer of the questionnaire receiving of likely to receive taxable income from or at the direction of the local government officer named in this section AND the taxable income is not from the local governmental entity? ❑Yes ❑No C. Is the filer of this questionnaire affiliated with a corporation or other business entity that the local government officer serves as an officer or director,or holds an ownership of 10 percent or move? El IYes ❑No D. Describe each affiliation or business relationship. 6. Describe any other affiliation or business relationship that might cause a conflict of interest. 7. Signature of person doing business with the governmental entity Date AmenOed 01/13/2006 C Special IN ';i..Ir r. . I Lufkin, Texas 755-1 STATEMENT OF CITY CHARTER GENERAL CONDITIONS OF BIDDING PROVISION ON CONFLICT OF INTEREST REVISED 9/23/04 The following provision was adopted in an effort to avoid potential FAILURETOCONTLY WITH THESE GENERAL CON DITIONS OF BIDDING vLkY RESULT IN THE BID BEING conflict of interest with prospective bidders and City employees or DISQUALIFIED. officers in the awarding of City contracts: L .BIDDING: L No officer,elected or appointed,or other employee of the City T shall have a financial interest,direct or indirect,or by reason of A. All bids must be on blank forms furnished by the ownership of stock or share exceeding one percent(1%)in a Purchasing Division,and must be written in ink or by business entity contracting with the City.Nor shall such officer typewriter.Pencil quotations will notbe considered.'the or employee be financially interested,directly or indirectly,in bid must be executed personally by the bidder, or, if the sale to the City of any land,materials,supplies or services executed by an agent, a power of attorney or other from such business entity,except on behalf of the City in his evidence of his authority to act on behalf of the bidder official capacity as an officer or employee. should be sent with the bid. If the bidder is a corporation, the certificate of corporate bidder must be executed under 2. Any willful violation of this provision shall constitute the corporate seal by some duly authorized officer of the malfeasance in office and any officer or employee guilty thereof corporation other than the officers signing the bid. By shall thereby forfeit their office or position. execution of the bid,the bidder accepts all general and special conditions of the contract and the specifications. 3. Any violation of this section with the knowledge expressed or implied of the person or business entity contracting with the B. TIME AND DATE:Formal bids must be in the office of City shall render the contract involved null and void. the City Clerk by 2:00 p.m.,local time,on the day bids (Beaumont City Charter,Article XVII,Section 9.) are due:unless otherwise specified,an early postmark wilt not suffice.Be sure youhave allowed ample time for / postal delivery. The City will not be responsible for the 1(name)have read and hereby delivery of your bid to the office of the City Clerk If you understand the aforementioned Beaumont City Charter provision choose to send your bid by postal delivery then it is recommended that you call the City Clerk's office to prohibiting conflict of interest between City employees or officers verify receipt of your bid prior to bid opening. A return and prospective bidders in the award of City contracts.I affi m to the envelope and/or label is furnished for your convenience. Informal bids are due at the date and time stated in the bid best of my knowledge and belief,that there is no conflict of interest document. between the herein stated person or business entity and any City Informal bids can be faxed. officer or employee if a City contract is awarded. I further state that C. WITHDRAWAL OF BID: A bidder may withdraw his Ihaveno outside intesests that conflict orsuggeata potential conflict proposal before council acceptance of his bid Without prejudice to himself,by submitting a written request for of interest with the City. I understand that knowledge,express or its withdrawal to the City Clerk. implied,or concealment of such material fact could nullify and void D. Bids should show net prices,extensions and net total. In any such City contract awarded. D. of conflict between unit price and extensions, the If I am awarded this contract,I herein agree to report promptly unit price will govern. any further situation that might involve or appear to involve me in E. No change in price will be considered after bids have any conflict of interest with the City. SIGNED this the day of been opened, r1 lO,2 I L '20 O la F. Unless ot henvisespecifred,any catalog ormanufacturees / reference or brand name used in describing an item is merely descriptive,and not restrictive,and is used onlyto N�IvIE indicate type,style or quality of material desired. If a bidder quotes on an article other than the one specified, which he considers comparable,the name and grade of TITLE said article must be specified in the bid and sufficient specifications and descriptive data must accompany same to peunit thorough evaluation In the absence,of these qualifications,he will be expected to furnish the article called for. G. If this proposal is altered, any erasure or alteration of figures on the item on which the erasurq or alteration is made must be initialed by signee of this proposal. H. Bids will not be considered in cases in which bidder quotes an item price and also an alternate price on the proposed substitute, item, except in cases in which alternate bids are called for. ?o � M `r I I 2GG0 Special NLIt !i1OIi �C Cli"-3[iij n.:... -. -7r0CII Should your bid deposit not be acceptable to the City, L All bids are to be delivered not later than the time stated your bid will be returned, in the specifications, F.O.B. Beaumont, Texas unless otherwise stated in the specifications and/or bid form. 5. DELIVERIES: J. Bidders are invited to be present at the opening of bids. A Unless otherwise stated in the bid form or specifications, After opening,bids may be inspected in tha Purchasing deliveries must consist only of new and unused Division Office. merchandise. It. If there is an honest mistake in the bid,due to clerical B. Full fare must be allowed and no charge made for errors,and the bidder calls attention thereto promptly,he packages. will not be bound by the bid. C. In the event that the deliveries of the supplies covered in L. Where the mistake was a result of bidder's negligence, the proposal are not made within the number of days and City has no knowledge of themistake when bids were specified,or in the event that the supplies delivered are opened,and contract awarded,hewill not bereleased and rejected,and are not removed and replaced within the shall be bound by the bid. number of days specified in the official nptice of rejection, the City reserves the right to purchase said M If a mistake is not discoverable and verifiable by the City, supplies in the open market Upon any such breach of bidder's incorrect interpretation of Engineering contract,the City reserves the righttoproceed against the specifications set forth in a construction contract will not successful bidder and/or the surety on his bond for any release him from his obligations once a contract has been and all damages occasioned by the breach. awarded by City Council and bidder has received notice of such award. 6. REJECTIONS: N. Sealed formal bids due in the City Clerk's office will not A Articles not in accordance with samples and specifications be accepted through facsimile equipment. must be removed by the bidder at his expense. All disputes concerning quality of supplies delivered under 1 TAXES: this proposal will be detemfined.by the City Purchasing Manager or his/her designated representative. A The City is exempt from the Federal Excise and Transportation Tax,and the Limited Sales and Use Tax. B. All articles enumerated in the proposal shall be subject to Unless the-bid form or specification specifically indicates inspection or delivery by an officer designated for the otherwise,the price bid must be net exclusive of above purpose and if found inferior to the quality called for,or mentioned taxes,and will be so construed. A vendor not equal in value to the department's samples, or desiring refunds of,or exemptions from taxes paid on deficient in weight, measurements, workmanship or merchandise accepted bythe City,must submit theproper otherwise,this fact shall be certified to the Purchasing forms. The Purchasing Manager,if satisfied as to the Manager who shall have the right to reject the tyhole or facts,will approve or issue the necessary certificates. any part of the same. 3. AWARD: 7. BILLING: A. The City reserves the right to consider and make awards A. All bills are subject to approval by the Purchasing ofbids on articles of similar nature that in all respects will Manager. serve the purpose for which the purchase is being made. The City reserves the right to be the sole judge as to g, PATENTS: whether such articles will serve the purpose. A. The contractor agrees to indemnify and save harmless the B. Unless otherwise specified,the City reserves the right to City,the Purchasing Manager,and his/he assistants from accept or reject in whole or in part any bid submitted or to all suits and actions of every nature and description waive any informalities in the best interest of the City_ brought against it or any of them,for or on account of the use of patented appliances,products or processes,and he 4. BID DEPOSIT: shall pay all royalties and charges which are legal and equitable.Evidence of such payment or satisfaction shall A. No bid deposit will be expected of bidder unless be submitted,upon request o€thePurchasing Manager,as specifications expressly provide otherwise. a necessary requirement in connection with the final estimate for payment in which such patented appliances, B. When specifications expressly call for a bid deposit,the products or processes are used. deposit may be in the form of a cashiers check,cash,a certified check made payable to the City of Beaumont or 9. CONDITIONS PART OF BID: a bond. The bond shall be executed by a surety authorized by the Texas State Insurance Commission and A The general conditions of bidding defined herein shall be must be signed by both the surety and the bidder. a part of the attached bid. C. An envelope is enclosed marked"Bid Deposit". ',Vhen specifications call for a bid deposit,it should be placed in a separate bid envelope and enclosed with your bid. EEV MAY 1 1 t Special iI:utritian ^imam Lufkin, Texas 75901. 10. CONTRACT: A. No formal contract will be executed. The following will 17. PROTEST PROCEDURES-Any actual or prospective bidder comprise the contract between the City and the successful or proposer who believes they are aggrieved in connection with bidder. or pertaining to a bid or proposal may file a protest The protest must be delivered in writing to the Purchasing Manager, in 1. Notice to bidders. person or by certified mail return receipt requested prior to 2. General specifications. award. The written protest must include: 3. General conditions to bidding. 4. The bid. 1. Name,mailing address,and business phone number 5. Resolution awarding the bid, of the protesting party; B. In case of conflict,the specifications shall be controlling. 2. Appropriate identification of the bid or proposal 11. OSHA REQUIREMENTS: being protested; 3, A precise statement of the reasons for the protest; A. The vendor or contractor hereby guarantees to tfte City of and Beaumont, Texas, that all material, supplies and equipment as listed on the proposal,contract or purchase 4. Any documentation or other evidence supporting order meets the requirements,specifications and standards the protest and any alleged claims. as provided for under the Federal Occupational Safety and Health Act of 1970,as amended and in force at the date The Purchasing Division will attempt to resolve the protest, hereof including at the Purchasing Manager's option,meeting with the protesting.party. If the protest is successfully resolved by 12. BIDS: mutual agreement,written verification of the resolution,with specifics on each point addressed in the protest, will be A- Bids must remain firm for thirty (30) days from bid forwarded to the Internal Services Director. opening date to allow for award by Council unless otherwise specified. If the Purchasing Division is not successful in resolving the protest, the protesting party may request in writing that the 13. DISCOUNTS: protest be considered by the Internal Services Director. Applicable documentation and other information A. Prompt payment discounts will be considered in making applying to the protest will be forwarded to the Internal the award provided the period of the discount offered is Services Director, who will promptly revieFy such sufficient to permit payment within such period in the documentation and information. If additional information is regular course of business(minimum 10 days). Prompt desired,theIntemal Services Director may notify the necessary payment discounts will not be considered for contract party or parties to the protest to provide such information. pgrchases. If the Internal Services Director is not successful in resolving B. In eormec6on with any discount offered, time will be the protest,.the Internal Services Director may forward to the computed from the date of receipt of supplies or services City Manager a request for review The decision of the City or from the date a correct invoice is received,whichever Manager will be final. is the later date. Payment is deemed to be made on the date of mailing of the check. 18. PUBLIC INFORMATION.ACT 14. DISCLOSURE FORMS: A. Texas Government Code,Chapter 552,gives youtheright to access government records;and an officer for public A All forms must be signed and returned with your bid information and the officer's agent may not ask why you sheet. want them. All government information is presumed to be available to the public. Certain exceptions may apply 15. EXCEPTIONS: to the disclosure oftheinformation.Governmental bodies shall promptly release requested information that is not 4 If exceptions are being taken to any part of specifications, confidential by law,either constitutional,statutory,or by have them listed separately on your letterhead and judicial decision,or information for which an exception manually sien it to disclosure has not been sought. 16. LOCAL BIDDER CONSIDERATION A. Should bids for goods and/or eor mwditiea be received from a local vendor and an out of town vendor,a sales tax impact analysis formula shall be applied to the local vendor's bid. If it is determined by this formula that the local vendor's bid generates more sales tax reveltue to the City than the difference between the two bids,award may be made to the local vendor. RX EC,EIVE MAY 1 1 200 Special ut ition f=.c+, and LUfRin! Texa> 75901 R. to raluest information From this governmental bndi_, please oontact: Rose Ann.Tones City Clerk Citv Hall Sol Nfain Street-Suite 125 P.O.Box 3827 Beaumont,TX 77704 409-880-3740(fax) 409-880-3745(phone) 19. W113SITE-Vendors are responsible for verifying addendum to specifications downloaded from website. A ^1r` AY} .`J0 ecia L��'�in, Texas 75yD1 NOTICE TO BIDDERS Sealed bids will be received by the City Clerk of the City of Beaumont, 801 Main Street, Room 125 until 2:00 p.m., local time, Thursday,April 27, 2006 and all bids will be opened and publicly read in the City Council Chambers on that date for: SUMMER FOOD PROGRAM Bidding forms, specifications and all necessary information may be obtained from the Purchasing Division, City Hall, 801 Main, Room 315, Beaumont,Texas 77701. Bids shall be returned to the City Clerk's office,801 Main,Room 125, at the above stated time. The City reserves the right to reject any or all bids, or to accept any bid or combination of bids deemed advantageous to it. Vendors requesting bid packets should call the Purchasing Division at(409) 880-3720 or you may download the specifications from our website at: www.cityofbeaumont.comlpurchasing/bidlists Please make reference to Bid Number TF0306-32 . Bid Closing Date April 27,2006. Rose Ann Jones, TRMC City Clerk First Publication: April 12, 2006 Second Publication: April 19, 2006 1 RE .. x ' MAY i 2006 Special r utrition Programs Lufkin, Texas 75901 GENERAL SPECIFICATIONS SUMMER FOOD SERVICE PROGRAM L The City of Beaumont is requesting bids for the preparation and delivery of lunch meals for the City of Beaumont's Parks and Recreation Department's Summer Food Service Program (SFSP). 2. The City's Parks and Recreation Department will be a sponsor for the Texas Department of Hunan Services (TDHS) Summer Lunch Program for area children. 3. Distribution of lunches will be the responsibility of the Parks and Recreation Department. Preparation and delivery of the lunches to ten (10) locations will be the responsibility of the successful bidder. 4. Bidders are required to comply with all regulations as stipulated in USDA FNS 7 CFR 225,16 cV governing the Summer Food Service Program for children. 5. INSURANCE REQUIREMENTS: The successful bidder shall within ten(10)days after award of Contract famish the City with proof of insurance as stated in Attachment A. 5.1 A certificate of insurance,or a copy of the insurance policies shall be furnished to the City within ten(10)days after the award of bid. 5.2 The City shall be named as additional insured on all policies.Should any insurance required by this Contract lapse,the Contractor shall immediately cease all operations as of the time and date of such lapse and shall not resume any operations until authorized in writing by the City. If the lapse period extends fifteen(15)days,the Contract shall automatically terminate and the Contractor shall be in breach of this Contract. 6. INDEMNITY: Contractor agrees to indemnify and save harmless the City of Beaumont and its officers,agents,and employees from any and all claims,causes or action,and damages of every kind, for injury to or death of any person and damages to property arising out or in connection with the work done by the Contractor under this Contract, including acts or omissions of the City of Beaumont or its officers,agents or employees in connection with said Contract. 7. If any further information is needed concerning this bid, please contact: Twila Wood,CPPB P. O. Box 3827 801 Main, Suite 315 Beaumont, Texas 77704 Phone: (409)880-3757 •(409)880-3747 fax E-mail: twood a:;ci.beaumont.tx us ECLEIV E»Dw 2 MAY i 12006 Special -Nu+b-ition P oc3 -arn;1 Lufkin, Texas 759101. SUMMER FOOD SERVICE PROGRAM TECHNICAL SPECIFICATIONS 1. The estimated number of unitized meals to be served per day is 1,310. Meals shall be prepared, packaged, and delivered in refrigerated containers or coolers. 2. Unitized meals are defined as an individual proportioned meal consisting of a combination of foods meeting the complete meal requirements, delivered and served as a unit, with milk or juice. A complete menu(Schedule B)is enclosed. 3. Meals shall be served 49 days beginning June 5, 2006 through August 11, 2006 excluding July 4, 2006. Meals will be served five(5)days per week, Monday -Friday at the times designated. The City has the right to cancel serving meals due to inclement weather. 4. The locations in Beaumont to which meals will be delivered are as follow: SITE ADDRESS L.L. Melton Y.M.C.A. 3455 Sarah Sprott Park 4325 Usan Roberts Park 2755 Avenue C Alice Keith Park 4050 Reed SE TX Family Resource Center 2060 Irving Magnolia Park 2930 Gulf Tracewood Apartments 4925 Concord North Ridge Apartments 4155 Maida Concord Homes Apartments 2020 Cottonwood Magnolia Garden Apartments 3720 Magnolia �. Designated service times at each location are enclosed in Schedule A. 6. In addition to furnishing a unitized meal,the vendor shall furnish plastic/paper eating utensils when needed for that meat. Meals shall also include condiments, straws for drinks,and napkins, etc. 7. Each meal shall be packaged suitable for a cold meal unit. Container and overlay to be plastic or paper and nontoxic. 8. Each carton shall be labeled with the following information: 8.1 Processor's name and address. E � MAY 1 1 2006 3 Specia! !N'W IUIY'.,,I i 8.2 Item identity and meal type. 8.3 Date of Production. 8.4 Quantity of individual units per carton. 9. All furnished meals must meet or exceed U.S. Department of Agriculture requirements as indicated on Schedule C. 10. The number of meals needed per day will be calculated the preceding day. The City has the right to increase or decrease the number ordered by giving the vendor twenty-four(24)hours notice. The City will notify the vendor daily of the expected number of meals needed for the following day. If the number of meals exceeds the number of children on any given day the City shall have the right to return the lunches to the Food Service Management vendor for distribution the following day. Meals shall be stored according to State and Local Health Code regulations to ensure freshness and non-contamination. 11. Bidders are expected to examine carefully the specifications, schedules, attachments, terms and conditions of this bid package. Failure to do so is at the bidder's risk. Bids must be submitted in triplicate. If accepted, this bid package becomes the contract. One (1) copy of the contract is forwarded to the successful bidder with the notice of award. The copy marked"original" will be governing if there is a difference between that copy and other copies submitted by the bidder. No change in the specifications or general conditions are allowed. The bidder must initial erasures on this bid before submission. Failure to do so may result in rejection of the bid. A copy of a current state or local health certificate for the food preparation facilities must be submitted with the bid. Failure to comply with any of the above is reason for rejection of the bid. 12. No person has the authority to verbally alter these specifications. Any changes to specifications will be made in writing and sent to each person having a bid package. 13. Award of Contract: 13.1 The contract is awarded to the responsive and responsible bidder whose bid conforms to the bid specifications and is most advantageous to the City,price and other factors considered. 13.2 The City has the right to reject any or all bids and to waive informalities and minor irregularities in bids received. 14. Pricin2 is based on the menus described in Schedule B. All bidders must submit bids on the same menu cycle provided by the City. Only the City may permit deviation from this menu cycle. Bid price must include the price of food components, milk, packaging, transportation, and all other related costs such as condiments and utensils. ErEIVED MAY 1 1 2000 4 Special Nutrition Programs Lufl-,in, Te,-as 7 5701 15. Range of servings are the best known estimates for requirements during the operating period. The Citv may order more or less meals than estimated at the beginning of the operating period. The Contractor is paid the unit price rate for the number of actual meals delivered each day. The City does not guarantee orders for the quantities shown. 16. Evaluation of Bidders. Each bidder is evaluated on the following factors. 16.1 Financial capability to perform a contract of the scope required. 16.2 Adequacy of plant facilities for food preparation,with approved certification that facilities meet all applicable state and local health, safety and sanitation standards. 16.3 Previous experience of the bidder in performing similar services. 16.4 Other factors such as transportation capability, sanitation,and packaging. ** Bidders that do not satisfactorily meet the above criteria may be rejected as non- responsible and not considered for award. 17. The unit prices of each meal type which the bidder agrees to furnish must be written in ink or typed in the blank space provided and must include proper packaging as required in the specifications and delivery cost to the designated sites. 18. Menu-Cycle Change Procedure Meals will be delivered on a daily basis according to the menu cycle in Schedule B. Menu changes may be made only when agreed upon by both parties. When an emergency exists which might prevent the Contractor from delivering a specified meal component, he should notify the City immediately so substitutions can be agreed upon. The City may suggest menu changes which are within the Contractor's suggested food cost periodically throughout the contract period. 19. Noncompliance 19.1 The City has the right to inspect and determine the quality of food delivered and to reject any meals which do not comply with the requirements and specifications of the contract. The Contractor is not paid for unauthorized menu changes, incomplete meals, meals not delivered within the specked delivery time,and meals rejected because they do not comply with the specifications. The City may obtain meals from other sources if meals are rejected due to any of the stated reasons. The Contractor is responsible for any excess cost, but receives no adjustment if meals are procured at a lesser cost. The City or inspecting agency notifies the Contractor in writing as to the number of meals rejected and the reasons for rejection. 19.2 The program regulations provide that statistical sampling methods may be used to disallow payment for meals which are not served in compliance with Summer Food Service Program Regulations. If a disallowance is made on the basis of statistical sampling,the City and the Contractor are notified in writing by the state agency about the number of meals disallowed, the reasons for the disallowance,and the methodology of the statistical sampling procedures used. j R1 Er771 v JJb LuNkin, Texas 75901. 20. Food Preparation 20.1 Meals must be prepared under properly controlled temperatures and assembled not more than twenty-four(24)hours before delivery. 20.2 Food Specifications. 20.2.1 Bids should be submitted based on the menu cycle included in Schedule B and include,as a minimum,the portions specified by the U.S.Department of Agriculture for each component of each meal in Schedule C of this contract. 20.2.2 All meals must meet the food specifications and quality standards incorporated in the menu cycle (Schedule B). 20.2.3 All meat and meat products, except sausage products, must be slaughtered, processed, and manufactured in plants inspected under a U.S. Department of Agriculture approved inspection program and bear the appropriate seal. All meat and meat products must be sound,sanitary,and free of objectionable odors or signs of deterioration on delivery. 20.2.4 Product Specifications: Milk and milk products are defined as "...fluid types of pasteurized flavored or unflavored whole milk or low-fat mill-, or skim milk or cultured buttermilk which meet State and local standards for such milk...All milk- should contain vitamins A and D at the levels specified by the Food and Drug Administration and at levels consistent with State and local standards for such milk." Milk delivered under this contract must conform to these specifications. 21. Delivery Requirements 21.1 The Contractor will make deliveries to each site according to the City's order. 21.2 Meals will be delivered daily,unloaded,and placed in the designated site by the Contractor's personnel at each of the locations and times listed in Schedule A. 21.3 The Contractor is responsible for delivery of all meals and dairy products at the specified time. Adequate refrigeration or heating will be provided during delivery of all food to ensure the wholesomeness of food at delivery according to state or local health codes. 21.4 The City may add or delete sites. This is done by amendment of the Schedule A. The sponsor will provide to the Contractor a list of the food service sites approved by the state agency, along with the approved level for the maximum number of meals to be served in each site (7 CFR 225.8(b)(6). The City will notify the Contractor of all sites which have been approved,canceled,or terminated subsequent to the submission of the initial approved site list and of any changes in the approved level of meal service for a site. This notification is provided within forty-eight(48)hours. RECET d 6 `✓ i r _0 LL+iKI r) ieXCIS 75901 22. Record keepinb 22.1 The Contractor must prepare delivery tickets in triplicate: One for the Contractor, one for the site personnel, and one for the City. Delivery tickets must be itemized to show the number of meals of each type delivered to each site. The City's designee at each site will check adequacy of delivery and meals before signing the delivery ticket. Invoices are accepted by the City only if signed by the City's designee at the site. 22.2 The Contractor must maintain records supported by delivery tickets, invoices, receipts, purchase orders, production records for this contract or other evidence for inspection and reference to support payments and claims. 22.3 The Contractor's books and records pertaining to this contract must be available for three(3) years and 90 days from the date of submission of the final claim for reimbursement,or until the final resolution of any audits,for inspection and audit by representatives of the TDHS, representatives of the U.S. Department of Agriculture, the City and the U.S. General Accounting Office at any reasonable time and place. 23. Method of Payment 23.1 The Contractor will submit itemized invoices to the City bi-weekly. Each invoice must include a detailed account of the number of meals delivered at each site during the preceding two(2)weeks. 23.2 The Contractor will be paid by the City for all meals delivered according to the contract and SFSP regulations. However, neither the U.S. Department of Agriculture nor the TDHS assumes any liability for payment of differences between the number of meals delivered by the Contractor and the number of meals served by the City that are eligible for reimbursement. 24. Inspection of Facilitv 24.1 The City,TDHS,and the U.S.Department of Agriculture(USDA)have the right to inspect the Contractor's preparation facilities before award of a contract and during the contract period without prior notice. These entities have the right to be present during preparation and delivery of meals. 24.2 The Contractor's facilities are subject to periodic inspections by the TDHS,USDA,state and local health departments,or any other agency designated to inspectmeal quality for the state. Inspections are accomplished in accordance with USDA regulations. 24.3 The Contractor must provide for periodic inspection of meals which it prepares by the local health department or an independent agency to determine bacteria levels. The bacteria levels must conform to the local health authority's bacteria level standards applied to other establishments in die City. R E C E I V 7 MAY 1 1 ?00E Special ' -7 i;' ar ras Luflkiil, Te,c�S s i 1. 25. Availability of Funds The City has the option to cancel this contract if the federal government withdraws funds for the Summer Food Service Program. It is further understood that, if the contract is canceled,the City is responsible for meals that have already been assembled and delivered according to this contract. 26. Number of Meals and Delivery Times The Contractor must provide exactly the number of meals ordered. Meals will be counted at all sites before they are accepted. Damaged or incomplete meals will not be included in determining the number of delivered meals. 27. Emer encies 27.1 In emergencies,the Contractor must immediately notify the City by telephone or telegraph of the following: (1)the impossibility of on-time delivery;(2)the circumstance precluding delivery;and(3)a statement of whether or not succeeding deliveries will be affected. The Contractor will not be paid for deliveries made later than one (1)hour after the specified delivery time stated in Schedule A. 27.2 Emergencies at the site which preclude use of meals are the City's concern. The City may cancel orders if the Contractor is given at least twenty-four (24) hours notice. This time frame may be shortened if mutually agreed upon between the parties to this contract. 28. Termination The City has the right to terminate this contract if the Contractor fails to comply with any of the contract requirements. The City must notify the Contractor of specific instances of noncompliance in writing. If the Contractor has been notified of noncompliance with the terms of the contract and has not taken immediate corrective action,the City has the right,upon written notice,to immediately terminate the contract. 29. Subcontracts and Assignments The Contractor may not subcontract for the total meal,with or without milk,or for the assembly of the meal. The Contractor may not assign his contract or any interest in this contract without the advance written consent of the City. In the event of any assignment, the Contractor remains liable to the City as principal for the performance of all the obligations under this contract. 30. Equal Opportunity 30.1 The following clause is applicable unless this contract is exempt under the rules,regulations, and relevant orders of the Secretary of Labor(41 CFR ch. 60). 30.2 During the performance of this contract, the Contractor agrees: 30.2.1 To comply with Title VI of the Civil Rights Act of 1964 (Public Law 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, EC"7_�. 1-LJ �vL.�, 1590 1. 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 ui 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. 30.2.2 To comply with Texas Revised Civil Statutes Article 4419b-4, Sections 5.03 and 5.04(relating to workplace and confidentiality guidelines regarding AIDS andI-IM. 30.2.3 To send to each labor union or representative of workers with which he has a collective bargaining agreement or other contract or understanding, a notice,to be provided by the agency Contracting Officer, advising the labor union of workers' representative of the Contractor's commitments under this Equal Opportunity clause, and to post copies of the notice in conspicuous places available to employees and applicants for employment. 30.2.4 To comply with all provisions of Executive Order No. 11246 of September 24, 1965, as amended by Executive Order 11375 of October 13, 1967, and with the rules,regulations and relevant orders of the Secretary of Labor. 30.2.5 To furnish all information and reports required by Executive Order No. 11246 of September 24, 1965, as amended by Executive Order No. 11375 of October 13, 1967, and by the rules, regulations, and orders of the Secretary of Labor. The Contractor agrees to permit access to his books, records, and accounts by the contracting agency and the Secretary of Labor for investigation purposes to ascertain compliance with the rules,regulations, and orders. 30.2.6 In the event of the Contractor's noncompliance with the Equal Opportunity clause of this contract or with any of the stated rules, regulations, or orders, this contract may be canceled,terminated,or suspended,in whole or in part, and the Contractor may be declared ineligible for further government contracts according to the procedures authorized in Executive Order No. 11246 of September 24, 1965, as amended by Executive Order 11375 of October 13, 1967. Other sanctions may be imposed and remedies invoked as provided in Executive Order No. 11246 of September 1965,as amended by Executive Order 11375 of October 13, 1967,or by rule, regulations, or order of the Secretary of Labor, or as otherwise provided by law. 30.2.7 To include the provisions of paragraph (30.2.1) through (30.2.7) in every subcontract or purchase order unless exempted by rules,regulations,or orders of the Secretary of Labor issued pursuant to section 204 of Executive Order No. 11246 of September 24, 1965, as amended by Executive Order No. 11375 of October 13, 1967, so these provisions will be binding upon each Subcontractor or vendor. The Contractor agrees to take action with respect to any subcontract or purchase order as the contracting agency may direct to enforce these provisions,including sanctions 9 MAC Special l.'otricion ',agram5 Lufkin, T eras 75901. for noncompliance. However, if the Contractor becomes involved in, or is threatened with,litigation with a Subcontractor or vendor as a result of direction by the contracting agency, the Contractor may request the United States to enter into the litigation to protect the interests of the United States. 31. Clean Air and Water Applicable only if the contract exceeds$100,000 or the Contracting Officer has determined that the orders under an indefinite quantity contract in any one (1)year will exceed$100,000, or a facility to be used has been the subject of a conviction under the Clean Air Act(41 USC 1857c-8(c)(1) or the Federal Water Pollution Control Act(33 USC 1319(c))and is listed by EPA, or the contract is not otherwise exempt. 31.1 The Contractor agrees: 31.1.1 To comply with all the requirements of section 114 of the Clean Air Act, as amended(41 USC 1857,et seq.as amended by Public Law 91-604)and section 308 of the Federal Water Pollution Control Act(33 USC 1251),et.seq.,as amended by Public Law 92-500)respectively,relating to inspection,monitoring,entry,reports and information as well as other requirements specified in section 114 and section 308 of the Air Act and the Water Act and all regulations and guidelines issued hereunder before the award of this contract. 31.1.2 That no portion of the work required by this contract will be performed in a facility listed on the Environmental Protection Agency List of Violating Facilities on the date when this contract is awarded unless and until the EPA deletes the name of the facility from the listing. 31.1.3 To use his best efforts to comply with clean air standards and clean water standards at the facilities in which the contract is being performed. 31.1.4 To insert the substance of the provisions of this clause in any nonexempt subcontract,including this paragraph(31.0)(31.0.4). 31.2 The terms used in this clause have the following meanings: 31.2.1 The term"Air Act' means the Clean Air Act,as amended(41 USC 1857) et.seq., as amended by Public Law 91-604). 31.2.2 The term"Water Act"means Federal Water Pollution Control Act,as amended(33 USC 1251 et. seq.,as amended by Public Law 92-500). 31.2.3 The term "Clean Air Standards" means any enforceable rules, regulations, guidelines, standards, limitations, orders, controls, prohibitions, or other requirements which are contained in,issued under, or otherwise adopted pursuant to the Air Act or Executive Order 11738, an applicable implementation plan as described in section 110(d)of the Clean Air Act(42 USC 1857c-5(d),an approved implementation procedure or plan under section III C or section III(d)respectively. of the Air Act(42 USC 1857c-6(c)(d)), or an approved implementation procedure 10 ECG F- av r� YrD iN1 ; i Special lNutrition =rogranis Lufkin, Texas 75901 under section 112 (d) of the Air Act(42 USC 1857c-7(d). 31.2.4 The term "Clean Water Standards" means any enforceable limitation, control, condition,prohibition,standard,or other requirement which is promulgated pursuant to the Water Act or contained in a permit issued to a discharger by the Environmental Protection Agency or by a state under an approved program, as authorized by section 402 of the Water Act(33 USC 1342)or by local govenunent to ensure compliance with pretreatment regulations as required by section 307 of the Water Act(33 USC 1317). 31.2.5 The term "compliance" means compliance with clean air or water standards. Compliance also means compliance with a schedule or plan ordered or approved by a court of competent jurisdiction, the Environmental Protection Agency,or an Air or Water Pollution Control Agency according to the requirements of the Air Act or Water Act and regulations issued pursuant thereto. 31.2.6 The term"facility"means any building,plant,installation,structure, mine,vessel, or other floating craft,location or sites of operations,owned leased or supervised by a Contractor or Subcontractor to be used in a contract or subcontract. If a location or site of operation contains or includes more than one (1) building, plant, installation,or structure,the entire location or site is considered a facility unless the Director,Office of Federal Activities,Environmental Protection Agency,determines that independent facilities are co-located in one(1) geographical area. 32. Clean Air and Water Certification Applicable if bid or offer exceeds$100,000 or the Contracting Officer has determined that orders under an indefinite quantity contract in any year will exceed $100,000 or a facility to be used has been the subject of a conviction under the Clean Air Act(42 USC 1857c-8(c)(1)or the Federal Water Pollution Control Act(33 USC 1319©and is listed by EPA, or is not otherwise exempt. 32.1 The bidder certifies that: 32.1.1 Any facility to be used in the performance of the proposed contract_has—has not been listed on the Environmental Protection Agency List of Violating Facilities. 32.1.2 He will promptly notify the Contracting Officer,before award of the contract,about any communication from the Director, Office of Federal Activities, U.S. Environmental Protection Agency, indicating that a facility which he proposes to use is under consideration to be listed on the EPA List of Violating Facilities. 32.1.3 He will include substantially this certification, including this paragraph in every nonexempt subcontract 33. Contracts Contracts shall recognize mandatory standards and policies relating to energy conservation plan issued in compliance with the Energy Policy and Conservation Act(P.L. 94-163). 11 °° I r-N EE ^w MAY 1 1 ?066 Special Nutrition Prograrts Lufkin, Texas 75902 SCHEDULE A SITES WHERE PROGRAM WILL OPERATE SITE ADDRESS MEALS PER DAY DELIVERY TIME L.L. Melton Y.M.C.A. 3455 Sarah 90 11:15 am Sprott Park 4325 Usan 130 11:30 am Roberts Park 2755 Avenue C 65 11:45 am Alice Keith Park 4050 Reed 65 12:00 noon SE TX Family Resource Center 2060 Irving 90 12:15 pm Magnolia Park 2930 Gulf 360 12:30 pm Tracewood Apartments 4925 Concord 90 12:45 pm North Ridge Apartments 4155 Maida 170 12:00 noon Concord Homes Apartments 2020 120 12:15 pm Cottonwood Magnolia Garden Apartments 3720 Ma olia 130 12:30 pm, 12 RECEIVED MAY 1 12006 Special lNutrition Programs Lufkin, Texas 7590 1. SCHEDULE B 2006 SFSP SANDWICH LUNCH MENU Vfenu 1 Menu 7 Ham I oz.-2 slices Beef Bologna 1 oz.-2 slices Ameri can Cheese 1 oz.-t slice American Cheese 1 oz.- 1 slice White bread 2 slices White Bread 2 slices Red Apple 1 each Green Apple 1 each Pineapple Juice 4 oz.-1 each Orange Juice 4 oz.-1 each White Milk 8 oz.-1 each White Milk 8 oz.- 1 each Salad Dressing 1 each Mustard leach Utensil Kit 1 each Utensil Kit 1 each Menu 2 Menu 8 Bologna I oz.-2 slices Turkey loz.-1'h slices American Cheese 1 oz.-I slice Ham loz--2 slices White Bread 2 slices NO CHEESE Green Apple 1 each Hot Dog Bun 1 each Orange Juice 4 oz.-1 each Raisirw 1 oz.-I box each White Milk 8 oz.-1 each Apple Juice 4 oz.-1 each Mustard 1 each Chocolate Milk 8 oz.-1 each Utensil Kit I each Salad Dressing 1 each Utensil Kit I each Menu 3 Turkey loz.-I'/z slices Menu 9 Ham loz-2 slices Bologna I oz,-2 slices NO CHEESE American Cheese 1 oz.-1 slice Hot Dog Bun 1 each White bread 2slices Raisins I oz.-1 box each Orange 1 each Apple Juice 4 oz.-1 each Pineapple Juice 4 oz.-I each Chocolate Milk 8 oz.-1 each White Milk 8 oz.-I each Salad Dressing I each Mustard 1 each Utensil Kit I each Utensil Kit 1 each Menu 4 Menu 10 Bologna 1 oz.-2 slices Ham 1 oz.-2 slices American Cheese I oz.-1 slice American Cheese 1 oz.-1 slice White bread 2 slices 1Vhite bread 2 slices Small Banana I each Red Apple 1 each Pineapple Juice 4 oz.-I each Orange Juice 4 oz.-1 each White Milk 8 oz.-1 each Chocolate Milk 8 oz.-1 each Mustard 1 each Salad Dressing 1 each Utensil Kit 1 each Utensil Kit 1 each Menu 5 Menu 11 Ham 1 oz.-2 slices Turkey 1 oz.-3 slices American Cheese 1 oz.-1 slice NO CHEESE Hot Dog Bun 1 each White Bread 2 slices Red Apple 1 each Orange 1 each Orange Juice 4 oz.-1 each Apple Juice 4 oz.-I each Chocolate Milk 8 oz.- 1 each White Milk 8 oz.-1 each Salad Dressing I each Salad Dressing I each Utensil Kit I each Utensil Kit 1 each Menu 6 Ham 1 m.-2 slices American Cheese 1 oz.-1 slice White Bread 2 slices Orange I ea. Pineapple Juice 4 oz.-1 each Chocolate 'filk 8 oz.-l each Salad Dressing 1 each Utensil Kit 1 each 13 .K ���,Y 12GJ6 ATTACHMENT A INSURANCE SECTION A. Prior to the approval of this contract by the City, CONTRACTOR shall furnish a completed Insurance Certificate to the Purchasing office. The certificate shall be completed by an agent authorized to bind the named underwriter(s)to the coverages, limits,and termination provisions shown thereon, and shall furnish and contain all required information referenced or indicated thereon. CITY SHALL HAVE NO DUTY TO PAY OR PERFORM UNDER THIS CONTRACT UNTIL SUCH CERTIFICATE IS RECEIVED BY THE CITY OF BEAUMONT'S PURCHASING DIVISION,and no officer or employee of the City shall have authority to waive this requirement. INSURANCE COVERAGE REQUIRED SECTION B. CITY reserves the right to review the insurance requirements of this section during the effective period of the contract and to adjust insurance coverages and their limits when deemed necessary and prudent by CITY, based upon changes in statutory law,court decisions,or the claims history of the industry as well as the CONTRACTOR. SECTION C. Subject to CONTRACTOR'S right to maintain reasonable deductibles in such amounts as are approved by CITY,CONTRACTOR shall obtain and maintain in full force and effect for the duration of this contract, and any extension hereof, at CONTRACTOR'S sole expense,insurance coverage written by companies approved by the State of Texas and acceptable to CITY,in the following type(s)and amount(s): TYPE AMOUNT 1. Workers' Compensation and Employer's Statutory Liability NOTE: For building or construction projects,the successful Contractor shall meet the minimum requirements defined in the Texas Workers' Compensation Commission Rule 28 TAC§110.110 which follows this insurance attachment. 2. Commercial General(public)Liability including coverage for the following: a. Premises operations Combined single limit for bodily injury and b. Independent contractors and property damage of$500,000 per c. Products/completed operations occurrence or its equivalent with an aggregate d. Personal injury limit of$1,000,000. e. Advertising injury f. Contractual liability g. Medical payments h. Underground hazard* i. Explosion and collapse hazard* j. Liquor liability* k. Fire legal liability* 1. City's property in Contractor's* 18 AY 1 l 2u'J6 Special i UtU i't;Cfl o!t'arms Lufikin, T exa a 7590,1 care, custody, or control m. Asbestos specific liability* n. Professional liability* * Not required for this contract 3. Comprehensive Automobile Liability Combined single limit for bodily injury and insurance,including coverage for loading property damage of$500,000 per occurrence and unloading hazards,for: or equivalent. a. Owned/leased vehicles b. Non-owned vehicles c. Hired vehicles ADDITIONAL POLICY ENDORSEMENTS CITY shall be entitled,upon request,and without expense,to receive copies of the policies and all endorsements thereto and may make any reasonable request for deletion,revision,or modification of particular policy terms,conditions,limitations, or exclusions(except where policy provisions are established by law or regulation binding upon either of the parties hereto or the underwriter of any of such policies). Upon such request by CITY,CONTRACTOR shall exercise reasonable efforts to accomplish such changes in policy coverages, and shall pay the cost thereof. REQUIRED PROVISIONS CONTRACTOR agrees with respect to the above required insurance, all insurance contracts and certificate(s) of insurance will contain and state,in writing,on the certificate or its attachment,the following required provisions. a. Name, the City of Beaumont and its officers,employees,and elected representatives as additional insured(s), (as the interest of each insured may appear)to all applicable coverage; b. Provide for 30 days notice to City for cancellation,non-renewal,or material change; c. Provide for notice to City at the address shown below by registered mail; d. CONTRACTOR agrees to waive subrogation against the City of Beaumont,its officers, employees,and elected representatives for injuries, including death,property damage,or any other loss to the extent same may be covered by the proceeds of insurance. e. Provide that all provisions of this agreement concerning liability, duty, and standard of care together shall be underwritten by contractual liability coverage sufficient to include such obligations within applicable policies. f For coverages that are only available with claims made policies, the required period of coverage will be determined by the following formula: Continuous coverage for the life of the contract,plus one year(to provide coverage for the warranty period) and an extended discovery period for a minimum of five years which shall begin at the end of the warranty period. 19 MIA, 60 Specialt1`t.Tli4^ rn' C3(11S Lufkin, NOTICES CONTRACTOR shall notify CITY in the event of any change in coverage and shall give such notices not less than 15 days prior to the change, which notice must be accompanied by a replacement CERTIFICATE OF INSURANCE. All notices shall be given to CITY at the following address: Purchasing Division City of Beaumont P.O. Box 3827 Beaumont, Texas 77704 SECTION D. Approval, disapproval, or failure to act by CITY regarding any insurance supplied by CONTRACTOR shall not relieve CONTRACTOR of full responsibility or liability for damages and accidents as set forth in the contract documents. Neither shall the bankruptcy, insolvency,or denial of liability by the insurance company exonerate CONTRACTOR from liability. 20 U `ape ;U' „ _ WORKERS COMPENSATION INSURANCE FOR BUILDING OR CONSTRUCTION PROJECTS TEXAS WORKERS' COMPENSATION COMMISSION RULE 28,§110.110 As required by the Texas Workers'Compensation Rule 28, §110.110,the Contractor shall accept the following definitions and comply with the following provisions: Workers'Compensation Insurance Coverage A. Definitions: 1. Certificate of coverage("certificate")-A copy of a certificate of insurance,a certificate of authority to self-insure issued by the commission,or a coverage agreement(TWCC-81,TWCC-82,TWCC- 83,or TWCC-84),showing statutory workers'compensation insurance coverage for the person's or entity's employees providing services on a project,for the duration of the project. 2. Duration of the project-includes the time from the beginning of the work on the project until the Contractor's/person's work on the project has been completed and accepted by the City of Beaumont. 3. Persons providing " p g services on the project( subcontractor in §406.096) includes all persons or entities performing all or part of the services the Contractor has undertaken to perform on the project,regardless of whether that person contracted directly with the Contractor and regardless of whether that person has employees. This includes,without limitation,independent Contractors, subcontractors, leasing companies,motor carriers, owner-operators,employees of any such entity, or employees of any entity which furnishes persons to provide services on the project. "Services" include,without limitation,providing,hauling,or delivering equipment or materials, or providing labor,transportation,or other service related to a project. "Services" does not include activities unrelated to the project, such as foodibeverage vendors, office supply deliveries, and delivery of portable toilets. B. The Contractor shall provide coverage, based on proper reporting of classification codes and payroll amounts and filing of any coverage agreements,which meets the statutory requirements of Texas Labor Code, Section 401.011(44)for all employees of the Contractor providing services on the project, for the duration of the project. C. The Contractor must provide a certificate of coverage to the City of Beaumont prior to being awarded the contract. D. If the coverage period shown on the Contractor's current certificate of coverage ends during the duration of the project, the Contractor must,prior to the end of the coverage period,file a new certificate of coverage with the City of Beaumont showing that coverage has been extended. 21 RECEIVED MAY 1 12006 Special Nutrition programs Lufkin, Texas 75-;01 F. The Contractor shall obtain from each person providing services on a project, and provide to the City of Beaumont: 1. A certificate of coverage,prior to that person beginning work on the project, so the City of Beaumont will have on file certificates of coverage showing coverage for all persons providing services on the project; and 2. No later than seven O days after receipt by the Contractor,a new certificate of coverage showing extension of coverage,if the coverage period shown on the current certificate of coverage ends during the duration of the project. F. The Contractor shall retain all required certificates of coverage for the duration of the project and for one(1)year thereafter. G. The Contractor shall notify the City of Beaumont in writing by certified mail or personal delivery, within ten(10) days after the Contractor knew or should have known,of any change that materially affects the provision of coverage of any person providing services on the project. H. The Contractor shall post on each project site a notice,in the text,form and manner prescribed by the Texas Workers'Compensation Commission, informing all persons providing services on the project that they are required to be covered, and stating how a person may verify coverage and report lack of coverage. L The Contractor shall contractually require each person with whom it contracts to provide services on a project, to: 1. Provide coverage,based on proper reporting of classification codes and payroll amounts and filing of any coverage agreements,which meets the statutory requirements of Texas Labor Code, Section 401.011(44)for all of its employees providing services on the project,for the duration of the project; 2. Provide to the Contractor,prior to that person beginning work on the project, a certificate of coverage showing that coverage is being provided for all employees of the person providing services on the project,for the duration of the project. 3. Provide the Contractor,prior to the end of the coverage period,a new certificate of coverage showing extension of coverage, if the coverage period shown on the current certificate of coverage ends during the duration of the project; 4. Obtain from each other person with whom it contracts, and provide to the Contractor: a. A certificate of coverage,prior to the other person beginning work on the project;and b. A new certificate of coverage showing extension of coverage, prior to the end of the coverage period, if the coverage period shown on the current certificate of coverage ends during the duration of the project; 22 r NAY 1 12006 Special Nutrition Programs Lufkin, Texas 75901 _. Retain all required certificates of coverage on file for the duration of the project and for one (1) year thereafter; 6. Notify the City-of Beaumont in writing by certified mail or personal delivery, within ten(10)days after the person knew or should have known,of any change that materially affects the provision of coverage of any person providing services on the project;and 7. Contractually require each person with whom it contracts,to perform as required by paragraphs (1) - (7),with the certificates of coverage to be provided to the person for whom they are providing services. J. By signing this contract or providing or causing to be provided a certificate of coverage,the Contractor is representing to the City of Beaumont that all employees of the Contractor who will provide services on the project will be covered by workers'compensation coverage for the duration of the project,that the coverage will be based on proper reporting of classification codes and payroll amounts,and that all coverage agreements will be filed with the appropriate insurance carrier or, in the case of a self-insured, with the commission's Division of Self-Insurance Regulation. Providing false or misleading information may subject the Contractor to administrative penalties,criminal penalties,civil penalties, or other civil actions. K. The Contractor's failure to comply with any of these provisions is a breach of contract by the Contractor which entitles the City of Beaumont to declare the contract void if the Contractor does not remedy the breach within ten(10)days after receipt of notice of breach from the City of Beaumont. As defined by the Texas Labor Code,Chapter 269, Section 406.096(e),building or construction is defined as: 1. Erecting or preparing to erect a structure, including a building,bridge,roadway,public utility facility, or related appurtenance; 2. Remodeling, extending, repairing, or demolishing a structure;or 3. Otherwise improving real property or an appurtenance to real property through similar activities. The employment of a maintenance employee who is not engaging in building or construction as the employer's primary business does not constitute engaging in building or construction. RECEIVED 23 ! 12006 �:utrition programs Lufl:iri, -texas 75901 Summer Food Service Program Form H1507 Site Information JanLja-y 2006 ( For HHSC Use Only is of Fc Seriic ,ire / }1 Telephone No. / I , I ilf �;.; � , r, , TX l�J � � ��' ❑ R ZU i l r<a of street City.Slat _zw) _ P ncd if Operation of Food Service mo./da I r mo.da /yr.) No.of Operating Days Achy. - June July Aug. Sept i ( YY Y rc rr, throe r;a= a Nap with the Site Service Area Identified ,dicate type of site ?�s =;ential Camp(serving one to three meals) ❑ Site Serving Primarily Migrant Children(serving one to three meals) iwor�residential Camp(serving one to three meals) W61ther Site(serving one or two meals) 7t ALL counties served by this site: a ;our site an open or restricted open site?.. ... ....._... ........... . . . ...0 Yes ❑ No Is your site enrolled?..._. ............. . .... . �❑Yes PIN Site Eligibility: Enter the percentage of children eligible for free and/or reduced price meals for the i l� ;rite (SFSP Handbook, Section 2000)......................................................... ........................... .. ....... ... I_i if open/restricted open sites, submit documentation supporting this percentage figure(such as census data, school data). For openirestricted open sites using school data, list the schools used to document site eligibility; attach formula used by school districi to establish percent",e of free qnd reduced-price children. E or enrolled sites, Forms H1531 will be used to document eligibility. (National Youth Sports Program—refer to SFSP ;,;r,d000k. Item 2324.) r i at is the percentage of free and reduced-price meals for the site?........................................... ...... % C,ir U­ participate in the SFSP at any time during the last five years (SFSP Handbook, Section 2000)?........ .bYes ❑ No Yes list the year(s) of participation and giNe Tbe.name of the sponsoring organization.ti Mlon.-itoring Plan (SFSP Handbook, S lion 4000 —Enter date of monitorin review to be conducted within rr ldeek of Operation B. First Four Weeks of Operation C.Additional eviews t r •` / 'a �fj /' r �7 r ' ' ! �� C_ tteai Seniice Period Information (SFSP Handbook, Section 2000) Meal Service Time No.of Eligible Children Tykes of Meats to be Served Beginning Ending � 3 r eak fa,=[ I i lei �I�:er e!it � X10 ,;p„len-1ent ;o sewed by HHSC when setting the approved meal service level (SFSP Handbook, Section 2000) ;,a", to tired children under one (1)year old?-. - _ _ __ _ -. ... . .. _ _- . _ _ - ❑Yes No ne " :; r,f F ood r >paration by Sponsoring Organization SFSP Handbook. Section 2000) - ---- Vended � �,,� t' ❑,Using School Food Authority ❑ Using Private Nonprofit Organizat � ex li a`L K i i r h en [Using Food Service Management Company(excludes all-year contracts with on-site prep) AP? 1 12005 Special Nutrition f'rugraMS Lufkin,Texas 75901 Form H1507 Page 2C1-2006 system io oe used for the serving of meals and the supervision of children during meal service period (SFSP ,�cticn 2riC0; � Cafeteria-style Meal Service ❑Children are Seated and are Given Meals XC hildren Line Up and Pick Up Meals Other. s nc �:a etena-style meal service and if sponsor is a school food authority,will the site be -;,,piernenting offer vs serve? _ _ _ _ - _ ❑ Yes ❑ No t!sr sit- nersonnel who will be involved to an extent in the meal service. SFSP Handbook, Section 2000 r_M Title of Position No.in Position Specific Food Service Program Duties IT/p y ! !nr?icat,, what provisions will be made for meal service during periods of inclement weather (SFSP Handbook. Section 2000) Jr L� }ndoor Meal Service ❑Meal Service Will Be Cancelled ❑Other: this ite implementing the option to allow off-site consumption of food?............ .................................................. ❑Yes ❑A0 `,re rneals delivered to the site?. ...... ... ............I...... ...... .. ......... ... ._.... ... .....AYes ❑ No if"Yes," complete Items 14, 15 and 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, Sections 2000 anrJ 60001 fa ' Site f-'ersonnel Will Contact Administrative Staff,Who Will Contact Vendor !1 Ate Personnel Will Communicate Directly With Vendor S 'Will delivery be within one hour of the food service period?(SFSP Handbook, Section 2000)........................ .........} Yes ❑ No if"f ia," descrihe arrangements within standards prescribed by local health authorities for delivery and holding of meals until time of er•/ica I II I a r; is an excess of meals delivered, meals will be(SFSP Handbook, Section 2000): _j Stored In Refrigerator and Served the Next Day ❑Thrown Away at the Site ❑Returned to Vendor for Disposal I Other i4 !'j •'' ,f ( f 't t (1�` ,' ') f j/ (x (. ' ( �? (��j';f/ that the information on this form is tree and correct to the best of my knowledge. I certify that this site has been isiw6 and that it has the capability and facilities for the meal service planned for the number of children anticipated. I know 1r- ?fnst deiii,erate misrepresentation or withholding of information may result in prosecution under applicable state and federal fj N?rpe of S onso n i a ffi a!cf Sponsor _Qi zation -- Date( ) - f i please Type or print] Titie i I?✓I 'approved ❑ Denied, reason: P c:•r �- Slst` I �l ` N me of Sponsoring Organization j� �- '" t jj rill' �I Sly ura- SC Representative Date Special NUtTition PrOgrams Lufkin, Texas 75901 Summer Food Service Program Form H1507 - Site Information January 2006 For HHSC Use Only e ic_Site Telephone No. t / �TX U or z (Street'City.State.ZIP) F_ -1 r Operation of Food Service(mo/day/yr.-mo.day/yr.) No.of Operating Days _May— June July Aug. Sept' through. ,i i r rtac a flap with the Site Service Area Identified In-7"-;rite 'yoe of Site: ',Residential Camp (serving one to three meals) ❑ Site Serving Primarily Migrant Children(serving one to three meals) -1 rlonresidential Camp (serving one to three r �aIs) Other Site(serving one or two meals) _r I- L counties served by this site: s Ycu,site an open or restricted open site?................................. ..... . .. ........ .. .............. . Yes E] No E i, your site enrolled?...... ............. ................ Yes b No C Site Eligibility Enter the percentage of children eligible for free and/or reduced-price meals for the - 7 - ite tSFSP Handbook, Section 2000).......................................................................... ........................ F if ooen/restricted open sites, submit documentation supporting this percentage figure(such as census data, school data). For open/restricted open sites using school data, list the schools used to document site eligibility; attach formula used by school district to establish percentage of free and reduce rice children. jl r- For enrolled sites, Forms H1531 will be used to document eligibility. (National Youth Sports Program —refer to SFSP Faodbook, Item 2324.) What is the percentage of free and reduced-price meals for the site?....................................... .......... % uid thr site participate in the SFSP at any time during the last five years (SFSP Handbook, Section 2000)?........ Yes ❑No participati�op" d give the name of the sponsoring organization. ww A ust the year(s) of l ' -- --- )� Monitoring Plan (SFSP Han book. Section 4000)—Enter date of monitoring review to be conducted within: F' week of Operation B. First Four Weeks of Operation C.Addition Reviews ( �� P,ieai Service Period Information(SFSP Handbook, Section 2000) No.of Eligible Children Meal Service Time Types of Meals to be Served Beginning Ending I�ralrast i phierneni ns tiered by HHSC when setting the approved meal service level. (SFSP Handbook. Section 2000) \ .,lad 'o teed children under one (1) year old? .. .... . _ _.. .__ __ ... .__ .. . .. .. _ .. . ... -❑Yes L71tx i oI Fond Preparation by Sponsoring Organization SFSP Handbook, Section 2000) � Vended (;r• e [:],Using School Food Authority ❑ Using Private Nonprofit Organization that is Self-Prep Kitchen � Usinq Food Service Management Company(excludes all-year contracts with ) APR 112006 Form H1507 Page 2101-2006 _ system to be used for the serving of meals and the supervision of children during meal service period (SFSP Safety a-,tyle Meal Service ❑Children are Seated and are Given Meals &//hildren Line Up and Pick Up Meals 1 r sr,g ca,e,eria-style meal service and if sponsor is a school food authority,will the site be Giernentin.� offer vs serve? .. .. .... . .. .... .... .. . _ _ . ... .. .. .. _ ._ .... ..❑Yes ❑ No personnel vho will be involved to any extent in the meal service. SFSP Handbook, Section 2000 Title of Position No.in Position Specific Food Service Program Duties .,(;1C -- - =ie v/h�at provisions will be made for meal service during periods of inclement weather. (SFSP Handbook, Section 2000) lndoor Meal Service ❑Meal Service Will Be Cancelled ether: �% s this site implementing the option to allow off-site consumption of food?.................._........................._ ........ .......❑ -Yes No •re meals delivered to the site? ................................. . Yes ❑ No If Yes," complete Items 14, 15 and 16. If"No,"form is complete except for certification at bottom. IA indicate the means of communication with the vendor which will be used to adjust meal deliveries. (SFSP Handbook, Sections 2000 nr! 6000) SSite Personnel Will Contact Administrative Staff,Who Will Contact Vendor YSite Personnel Will Communicate Directly With Vendor ,ji l delivery be within one hour of the food service period? (SFSP Handbook, Section 2000)......... .... ........ .......... Yes ❑No if"Pis;, describe arrangements within standards prescribed by local health authorities for delivery and holding of meals until time of I i i::rr; is an excess of meals delivered, meals will be(SFSP Handbook, Section 2000): ]Stored irl Refrigerator and Served the Next Day ❑Thrown Away at the Site ❑Returned to Vendor for Disposal l t I • rtaf the information t 4 � � l,�v�► W' l � � �1, � �` r�;t L�� Y. �,I L(r j (,f�{ l ��I t,f-� � 1' � eK on this form is t,ue and correct td the best of my knowledge. I certify that this site has been 3i1e!� r,.nd that it has the capability and facilities for the meal service planned for the number of children anticipated. I know ,11e ,;orate misrepresentation or withholding?of information may result in prosecution under applicable state and federal nt""'—"'- 7 f Nam _pf Sponsoring .rgan apon 1 I ------- `' 1. --.—. Ctiiria!of Sponsorin r t lion Date _ (_al_ 3se type or P. Title i 4,pproved Denied, reason: , t I_ -ppr ❑ r N e of Sponsoring Organization REC �r r \�0 :iqnjt re-.Jj1ISC Repiesentative Date APR 1 120 6 --- — S lecial Nutrition Programs Lufkin, Texas 75901 Summer Food Service Program Form H1507 Site Information January 2006 For HHSC Use Only _'I'i Site Telephone No. zu Jrr <t City.State,ZIP) F .0 p •ration of Food Seriice(moJday/yr.-mo.day/yr.) No.of Operating Days may__ June July Aug. Sept-- through •:� -t f'rlap with the Site Service Area Identified `ypc o4 site C'arnp (serving one to th r ee meals Si te Se ry i n Primarily Migrant Children servin one t o three meals) N'onrpsidential Camp (serving one to three meals) - Other Site(serving one or two meals) _ = antic served by this site w �� ) site an open or restricted open site?.............. ....... .. Yes ❑ No F, is ;;our.Ile enrolled)...... .................. .................................................-........ .....❑Yes XNo 'site Eligibility: Enter the percentage of children eligible for free and/or reduced-price meals for the e iSFSP Handbook, Section 2000) ; 3 ° If open/restricted open sites, submit documentation supporting this percentage figure(such as census data, school data) For op ar;/restricted open sites using school data, list the schools used to document site eligibility; attach formula used by school str!r i to establish p tentage of free and reduced-price children. =o:f:nrolled sites, Forms H1531 will be used to document eligibility. (National Youth Sports Program —refer to SFSP !'-',-dhook. Item 232.4.) dhat is the percentage of free and reduced-price meals for the site?................................................. % Lnci p,; sate Participate in the SFSP at any time during the last five years(SFSP Handbook, Section 2000)?.........Ayes ❑No list the year(s) of participation and ct.ye the name of the sponsoring ganrzation j y jar' -- / 1',-1 e tormq Plan (SFSP Handilybok, Section 4000)—Enter date of onitoring review to be conducted within: eel of Operation B. First Four Weeks of Operation C.Additi al Reviews I 1- uicai 'Semite Period Information(SFSP Handbook, Section 2000 ( No.of Eligible Children Meal Service Time T;rpes of Meals to be Served Beginning Ending � ul;ien e �r ons Ce red by HHSC when setting the approved meal service level (SFSP Handbook. Section 2000) teal children under one (1) year old?-_ ❑Yes KNo ro Pr,_paration by Sponsoring Organization SFSP Handbook. Section 2000) Vended -- ❑ Using School Food Authority ❑Using Private Nonprofit Organizatio ( jrE Kit hen 4,Q Usinq Food Service Management Company(excludes all-year contracts with on-site re APR 112006 Special Nutrition ProgramS I ,4Lin Towne 7r.OM Form H1507 Page 2'rl-2005 s/stem to ce used for the serving of meals and the supervision of children during meal service period (SFSP style Meal Service El Children are Seated and are Given Meals Children Line Up and Pick Up Meals �thFi a`e;erla-style meal service and if sponsor is a school food authority,will the site be e hna offer vs serves_ _ _ _ _ _ - _ _ _ _ _ .. _ ... .. . _ _ _- ❑Yes ❑ No = oerconnel r ho will be involved to any extent in the meal service (SFSP Handbook, Section 2000 Title of Position No.in Position Specific Food Service Program Duties Wt !,tfbdiz, L i i ;a? rrhat provisions will be made for meal service during periods of inclement weather. (SFSP Handbook, Section 2000) ❑indoor Meal Service, ❑Meal Service Will Be Cancelled Other: s !s site implementing the option to allow off-site consumption offood?................................................................❑Yes No meals delivered to the site?......... ..... ....... ... ....... . ...... ... ...... . ...... .. . .......... . ...... .... . .... ....... ... es ❑ No if`Yes," complete Items 14,15 and 16. If"No,"form is complete except for certification at bottom. r(lica e. the means of communication with the vendor which will be used to adjust meal deliveries. (SFSP Handbook, Sections 2000 d 6000) I iite Personnel Will Contact Administrative Staff,Who Will Contact Vendor I_ ite Personnel Will Communicate Directly With Vendor Uiili delivery be within one hour of the food service period?(SFSP Handbook, Section 2000)......... ......... ......... Yes ❑ No dascribe arrangements within standards prescribed by local health authorities for delivery and holding of meals ntil time of I ns ,: an excess of meals delivered, meals will be(SFSP Handbook, Section 2000): Stored in Refrigerator and Served the Next Day ❑ hrown Away at the Site ❑Returned to Vendor for Disposal ?ih.er �C�1`I ( ( I�1 �-' ` ,II'1' ! that the information on this form is tr and correct to the best of my knowledge. I certify that is sit has been >itee and that it has the capability and facilities for the meal service planned for the number of children anticipated. I know -tLorate misrepresentation or withholding of information may result in prosecution under applicable state and federal N p9e of Sponsorin�Organization a!ci Sponso zation Dat ' -le se type or print) Title -k-�_ j v /'approved ❑ Denied,reason: 11HS : I y - ; N�me of Sponsoring Organization CE Jas, I, _- ,,,, .o:; V' (t'>°' _ _ ( _' X,�;_�l.d.Ql4 f'r!._�fi":t�✓' iCi itijrA HHSC Rep,esentative Date R 112046 g)eciai NuLTition Programs Lufkin, Texas 75901 Summer Food Service Program rnnn*1sur �an��z000 Site Information For HHSC Use Only "'Pe Site Telephone No. TX R of Ste j.Str-eet.City.Stpte,ZIP) per,r,�' f Operation of Food Semce(mo./day/yr.-mo.day/yr.) No.of rp�ng Days May- June �uly Sept. rh u Map with the Site Service Area Identified 'Vpe of site [� noo/donua| Cmmp (xomingonemmnmmou�} [� S�e SomingPhmah� NUgmn Chi�non(uon�nOone m x ov|o) � Nonresidential Camp (serving one to threp.meals) Other She(serving two ms) z L.'_ ovooeo served uy this one� � / �F,vm,oits an open ormatrictednpenohe?-----------—---------------------- eo L� No e a vou.site onndledv— ........ ........................................... --- ......... --- . . . . ---- ....— ...-----��l Yes [(No c Site Ehgibtlity� Enter the percentage of children eligible for free and/or reduced-price meals for the � */e i SF3PHanduook, Section 2OOO)................ --------------------------- � o |fonen/roatrioteuopenabos. suUmbUocumontadonoupportingthispemenmgefigune(suchoocensuodota. ochoo|duta).Fo, open/restricted open sites using school data, list the schools used to document site eligibility; attach formula used by school dimxc/m establish percentage of free and md u nco E pn'enrolled sites, Forms H1531 will be used m document eligibility. (National Youth Sports Program—refer toSFSP esnumnok. Item 2324.) F V�xmis the percentage of free and reduced-price meals for the site?................................. ................ % � o/u rite participate in the SFSP at any time during the last five years(SFSP Handbook, Section 2000)?.......... Yes E]No ol participation and give the of the nn izab o Monitoring p| n (SFSP Han�fbook, Section 4000)—Enter date of onitoring review to be conducted within: F i rs i N I eek ol Opera I ficri B First Four Weeks of Operation C.Additional Reviews "ow Nlcal Service Period Information (SFSP Handbook, Section 2000) Meal Service Time No.of Eligible Children Types of Meals to be Served Beginning Ending ,�.ma'm, '�;:osicewo by nnscw000 setting the approved meal service level <SFapHandbook, Section znon ` »/rcm feed children under one (1) year old?---- ...... Y*« No ^ SFSp Handbook, Snctio 2000 h Vended [) �� ! �� -- ' ~ ' -- ~ . ' �� acts witftd�fte ­vFal Kitchen 'VUsing Food Service Management Company(excludes all year contr _AT 6�A 1 1YOO� �' " ' ' ���� Special Nutrition Programs I.*lr;n Tm~"" '7roml Form H1507 Page 2i;t-2006 s-ysterr io be used for the serving of meals and the supervision of children during meal service period (SFSP .a:teter!a-style Meal Service ❑Children are Seated and are Given Meals ,\Children Line Up and Pick Up Meals - r�•hE:r. cafeteria-style meal service and if sponsor is a school food authority will the site be .gent na offer vs serves _ _ .... .. _ __. ...... . .. . ❑Yes ❑ No ersonnel who will be involved to any extent in the meal service- SFSP Handbook, Section 2000 ----- Title of Position No.in Position Specific Food Service Program Duties ff c:aie vrhat provisions will be made for meal service during periods of inclement weather. (SFSP Handbook, Section 2000) k7f indoor Meal Service ❑Meal Service Will Be Cancelled Other: !s 0-!s site irnplementing the option to allow off-site consumption of food?................................................................❑Yes o ire nc-als delivered to the site?..... .. ...................... . ......._........... ......... Yes ❑ No If "Yes," complete Items 14,15 and 16. If"No,"form is complete except for certification at bottom. c{ic ±e the means of communication with the vendor which will be used to adjust meal deliveries. (SFSP Handbook, Sections 2000 and 6000) Site Personnel Will Contact Administrative Staff,Who Will Contact Vendor f 1 Site Personnel Will Communicate Directly With Vendor 'v"Jill deiivery be within one hour of the food service period? (SFSP Handbook, Section 2000).................. ......._..... Yes [] No if 't1.ir describe arrangements within standards prescribed by local health authorities for delivery and holding of me Is until time of I is an excess of meals delivered, meals will be(SFSP Handbook, Section 2000): Stored jR Refrigerator and Seryed the Next Day ❑Thrown Away at the Site El Returned to Vendor for Disposal ,1 Other: rip '� �1: 7� (l, 1�[.I { -d C `�f 1G C' l ( CYi;� tiz�t the information on this form is true and correct to the best of my knowledge. I certify that this site has been sitY:ci and that it has the capability and facilities for the meal service planned for the number of children anticipated. I know 'ri: ds::i berate misrepresentation or withholding of information may result in prosecution under applicable state and federal ---���� ---- Na r of Sponsoring Org n3�tion Jfi�ul of Spo,_ in am ation D to i�le1 � we or print) TJti° I/ ",p proved ❑ Denied, reason: - q i N me of Sponsoring Organization C nF I "i hue HHSC Re V iesentative Date r A p .44 11 ?0061 a-)ecial NutTition Programs Lufkin, Texas 75901 Summer Food Service Program Form H1507 ` Site Information Januay 2006 For HHSC Use Only thiroughi N11 apvvith the Site Service Area Identified of site *es/dentia| Camp (serving one to d`mo meals) Site Serving Primarily Mig,antChUdmn(serving nnom Ahmpmoa|o) _ `'. __—_ __., (serving_— _- to — ict served by this site ' 'sxcx,sos ao open v,restricted open site?............. ...................-- ............ ....... ........................ ..........—�£�os E] No ' ` c /n /nu.xueeomoedr..... .................. .......... .......................................................... ............................. ..............ElYes [J'�o � 3i� s|gbi|hy sn�r�epomen�goofchi��naUgi�e�r�eaong�rmduceU'phcnmeo��rmo ' ,iie I"�roP*andbook, Section 2OOO}—......................... ............ .... -------- .......... ---- % o i/oveo/ext,icted open oites, submit documentation supporting this percentage figure(such ao census data, school data), For npem/*nt^omd open sites using school data, list the schools used m document site eligibility, attach formula used byschool momr,,n establish percentage of free and reduced-price children. e poryr!oo*u sites, Forms HIo31 will be used m document eligibility. (National Youth Sports Pmgmm—refer^o3FOP /�,,cmoox� }tem23z4.) � vmaf 1,� ma percentage nf free and reduced-price meals for the site?... ........ .......... ........ .............. m � n Participate in the 8F8Pat any time during the last five years (SFSPHundbook Soobvn2OOO ?—'—'O�Yoo [lNo ist the yea.(s) ol participation and 9jv��name of ' ' /�' ^~ the sponsoring � m n p| ­i Atelek of Operation 8 First Four Weeks of Operation C.Addi I Re��,�s Section 2000 Meal Service Time No.of Eligible Children Types of Meals to be Served Beginning Ending *daieuuvHxso when setting txoavnmv um^mlu,m,m/ove/ (zpor*aocmooxsactio"zocm) cmmeovodo one (1)year old? E]Yes XN, v .,r,vvu P!rparation by Sponsoring Organization 3FSpHandbook, Section zoon �E Using School Food Authority El Using Private Nonprofit OrganizationmM1146 V E# || ^' KOt ien__- Using Food Service Management Company(excludes all-year cor-dracts with on-site prep) APR 11 Z006 Special Nutrition Programs Lufkin,Texas 75901 Form H1507 Page 2V-2005 tem io cc used for the serving of meals and the supervision of children during meal service period. (SFSP _fe?r:r!z style Meal Service ❑Children are Seated and are Given Meals �Children Line Up and Pick Up Meals n�, - - �:e,ena-style meal service and if sponsor is a school food authority will the site be ^e offer vs serve? - _ - _ _- . _ _ _. . . __ . .. ❑Yes ❑ No = ner_onrel rv'no will be involved to any extent In the meal service. SFSP Handbook, Section 2000 i ifle of Position No.in Position Specific Food Service Program Duties ' l�� � �.� -''�'err% �� � ✓i c= imat provisions will be made for meal service during periods of inclement weather. (SFSP Handbook, Section 2000) - j ndcor Meal Service ❑Meal Service Will Be Cancelled -'Othec n s site implementing the option to allow off-site consumption of food?.... .............................. ............................❑Yes No deliveredto the site?...... . .......... ....... ............. ...... .............................. ............. ............. .... ............... Yes ❑No Ye!," complete Items 14, 15 and 16. If"No,"form is complete except for certification at bottom. +plicate the rneans of communication with the vendor which will be used to adjust meal deliveries. (SFSP Handbook, Sections 2000 irlc ti(1�itll iie Personnel Will Contact Administrative Staff,Who Will Contact Vendor Sit;-- Personnel Will Communicate Directly With Vendor "vil4 dciiwery be within one hour of the food service period?(SFSP Handbook, Section 2000) ..........................._...,�Yes ❑No i !?u, :;t-cc,ibe arrangements within standards prescribed by local health authorities for delivery and holding of meals ntil time of °dice t ,n axcess of meals delivered, meals will be(SFSP Handbook, Section 2000). Stored in Refrigerator and Se ry 0 the Next Day ❑Thrown Away at the Site ❑Returned to Vendor for Disposal _ ��iother �1 %_ i tf,��j❑ (: ) i( �;I� IL's. ;p1 �'id'�'I� the information on this form is t1 le and correct to the best of my knowledge. I certify that this site has been e nid that it has the capability and facilities for the meal service planned for the number of children anticipated. I know "err.te misrepresentation or withholding of information may result in prosecution under applicable state and federal N m(A of Sponsoring Organization ffical of Spans p_g_ anization Dat _. typo or print) Title pproved ❑ Denied,reason: t n� . �t N me of Sponsoring Or a � �� .. P 9 9 nization `I maiur --HHSC. Representative Date APR 112006 Special Nutrition Programs 1 uflrin_TPYac 7S901 Summer Food Service Program Form H 150 7 Site Information January 2006 For HHSC Use Only Telephone No. 96 El R Fer Ciry.State ZIP) �c-_fatior of Food Service(mo.iday/yr.-mo.day/yr.) No.of Operating Days _May June July Aug. Sept— _ _ ._------�- through: V­,_ , `n the Site Service Area Identified ;n site c'en i<:I"amp (serving one to three meals) ❑ Site Serving Primarily Migrant Children(serving one to three meals) :;ideriial Camp (serving one to three meals) Other Site(serving one or two meals) niies served by this site.T } s,te an open or restricted open site?.. _......... _.... ................._....®,Yes ❑ No Y es N o = c l gibility. Enter the percentage of children eligible for free and/or reduced-price meals for the s, 1 ::r SP Handbook, Section 2000).............................................................. ... . .... . if -,oen/restricted open sites, submit documentation supporting this percentage figure(such as census data, school data). For ,;.rJrestrlcted open sites using school data, list the schools used to document site eligibility; attach formula used by school ,a o to establish percentage of free and reducAed-price children. Fn:enrolled sites, Forms H1531 will be used to document eligibility. (National Youth Sports Program —refer to SFSP item 2324.) dio-t is the percentage of free and reduced-price meals for the site?...... .... ..................._. ............... % , cipate in the SFSP at any time during the last five years(SFSP Handbook, Section 2000)? .........0 Yes ❑ No re st the year(s)of participation and give the name of the sponsoring organization. M, ,imrlir�vj F'lan (SFSP Handbook; Section 4000)—Enter date of monitoring review to be conducted within: IF k of Operation B First Four Weeks of Operation C.Additional Reviews i i=jl(- S& vice Period Information (SFSP Handbook, Section 2000) No.of Eligible Children Meal Service Time �q%(-s of Meals to be Served Beginning Ending �E 1 , I by HHSC when setting the approved meal service level (SFSP Handbook, Section 2000) teed children under one (1) year old?_ _ _ -.. _ . _ __ ... _ ❑Yes ❑ No nr; Fr=�parahnn by Sponsoring Or anization (SFSP Handbook. Section 2000) ----- !Vended ® t ❑ Using School Food Authority 0 Using Private Nonprofit OrganizaRE , f A ep® LZUsing Food Service Management Company(excludes all-year contracts with on-site prep) APR 1 1 N06 Special Nutrition Programs Lufkin-Texas 75401 Form H1507 Page 201-2006 = rr to be used for the serving of meals and the supervision of children during meal service period. `SFSP a?r,!er fyie Meal Service ❑Children are Seated and are Given Meals Children Line Up and Pick Up Meals �.a meal service and if sponsor is a school food authority,will the site be c offer vs serve _ _ _ _ _ _ _- . .. __ -❑ Yes ❑ No _srnel ,vhr ,vill be involved to an extent in the meal service. SFSP Handbook, Section 2000 Title of Fosition No.in Position Specific Food Service Program Duties I- /% �U I I rir a; pro,;;sions will be made for meal service during periods of inclement weather. (SFSP Handbook, Section 2000) {_e lndocr Meal Service ❑Meal Service Will Be Cancelled – f71fl p?r; 1 is site in plementing the option to allow off-site consumption of food?.......... ........ ......... . ❑ _... ............... Yes No s delivered to the site?.. _ .. Yes No if 'r`es,' complete Items 14,15 and 16. If"No,"form is complete except for certification at bottom. cr; the means of communication with the vendor which will be used to adjust meal deliveries. (SFSP Handbook, Sections 2000 r.;! r,r;Dn! I ;>ite Personnei Will Contact Administrative Staff,Who Will Contact Vendor L-fSitt Personnel Will Communicate Directly With Vendor nil :si'very be within one hour of the food service period?(SFSP Handbook, Section 2000).............. ............ ... ..54 Yes ❑ No t!.o dr scribe arrangements within standards prescribed by local health authorities for delivery and holding of meals until time of az;ess of meals delivered, meals will be(SFSP Handbook, Section 2000). :...,I Stored in Refrigerator and Served the Next Day ❑Thrown Away at the Site ❑Returned to Vendor for Disposal r � =- �� f `\ '�N !k-'. �`t-ti1 •.) k dv� v�'• -� ii -l.1\ -l.wµ._. (.._vT•,t�4 i the information on this form is true and correct to the best of my knowledge. I certify that this site has been �,nd that it has the capability and facilities for the meal service planned for the number of children anticipated. I know err to arisrepresentation or withholding of information may result in prosecution under applicable state and federal Nam of,Spcnsoring Organization l J {(f �. i , Spcnsor�ng O aniz ion Date or pnnU Title ---� ,p roved ❑ Denied, reason: j --- — / { of Sponsoring Organ¢atirfy ECE"I gr lure-_)HHSC Representative — Date APR 112006 Special Nutrition Programs Lufkin,Texas 75901 Summer Food Service Program Form H1507 Site Information January 2006 For HHSC Use Only Sits Telephone No. TX R .trF3t-City.State.ZI 1 r,tion of Fcod Service(moJday/yr.-mo.day/yr.) No.of Operating Days -Ah June July Aug. 11;., - through y. -'` _ ( �( " V C"� Mia P vdith the Site Service Area Identified a'' von ,:Ite Camp (serving one to three meals) ❑ Site Serving Primarily Migrant Children(serving one to three meals) +n nt e"ider,tial Camp (serving one to three meals) Other Site(serving one or two meals) �- I_ ce.inties served by this site site an open or restricted open site?.................. .....................................__...... Yes ❑No siteenrolled?-. .._._. ............................ ...................................... ...... .. ...... .................. ..................... ❑Yes No ite Eligibility Enter the percentage of children eligible for free and/or reduced-price meals for the P1-SP Handbook, Section 2000) . ......................... ... C, % <T ;z,en/!estricted open sites, submit documentation supporting this percentage figure(such as census data, school data). For c: e ,!restricted open sites using school data, list the schools used to document site eligibility; attach formula used by school to establish percentage of free and reduced price children. -c,,enrolled sites, Forms H1531 will be used to document eligibility. (National Youth Sports Program-refer to SFSP ;dhcok. Itern 2324.) Ji at is the percentage of free and reduced-price meals for the site?............... ... . . ......................... % itc participate in the SFSP at any time during the last five years (SFSP Handbook, Section 2000)? .......... Yes ❑No "'a list the yea,(s) of participation and give the name of the sponsoring organization. - � \1 ,M l; iJ 4 tL't_�L vt A^,or_„torir�Plan (SFSP Handbook. Section 4000 -Enter date of monitoring review to be conducted within: h. _l4eeF cf Operation B. First Four Weeks of Operation C.Additional Reviews nGi ;rrvice Period Information (SFSP Handbook, Section 2000) No.of Eligible Children Meal Service Time !leals to be Served Beginning Ending i - - -T --- — -- ------- ------ , ,i °;'ieo:ent i ::,os�c.•rnd by HHSC when setting the approved meal service level (SFSP Handbook. Section 2000) children under one (1)year old? - _ _ _ _- ❑Yes ^NA,No Prr�paration by Sponsoring Organization SFSP Handbook, Section 2000) _ Wended REC I E® a; ❑ Using School Food Authority ❑ Using Private Nonprofit Organization that is Self-Prep 4 k r ren Using Food Service Management Company(excludes all-year contracts with on-sit 06 Special Nutrition Programs Lufkin,Texas 75901 Form H1507 Page 2'01-2006 _. o� used for the serving of meals and the supervision of children during meal service period (SFSP a style Meal Service Children are Seated and are Given Meals ❑Children Line Up and Pick Up Meals a,e erla-style meal service and if sponsor is a school food authority,will the site be nc offer vs serve? - -.- _ - - _ - - - - - .. .-_. ❑Yes ❑ No ,vho will be involved to any extent in the meal service. SFSP Handbook, Section 2000 `'itie of Position No.in Position Specific Food Service Program Duties i rif at provisions will be made for meal service during periods of inclement weather. (SFSP Handbook, Section 2000) Indoor Meal Service ❑Meal Service Will Be Cancelled ;ire implementing the option to allow off-site consumption of food?............... ................................................❑Yes li No ".re rric' delivered tc the site?. ........... ..................................... ............................... Yes ❑ No ;f °i es," complete Items 14, 15 and 16. If"No,"form is complete except for certification at bottom. rr_li;ai. the means of communication with the vendor which will be used to adjust meal deliveries. (SFSP Handbook, Sections 2000 Sire Personnel Will Contact Administrative Staff,Who Will Contact Vendor Sit:; Personnel Will Communicate Directly With Vendor fill ;eii ery be within one hour of the food service period?(SFSP Handbook, Section 2000).................................. Yes [] No l describe arrangements within standards prescribed by local health authorities for delivery and holding of meals until time of ar, excess of 1-neals delivered, meals will be(SFSP Handbook, Section 2000): Stored in Refrigerator and Served the-Next Day ❑Thrown Away at the Site ❑Returned to Vendor for Disposal, Oth, tlfy s at the information on this form is true and correct to the best of my knowledge. I certify that this site has been wld' and that it has the capability and facilities for the meal service planned for the number of children anticipated. I know _s.;:ernte misrepresentation or withholding of information may result in prosecution under applicable state and federal Name-of Sponsoring Organ z4tion C,t Sp r,n Ling rganization f Da '/pH or print) Title ^, proved ❑ Denied,reason: r i Name of Sponsoring Organization RECEIV �SC Representative Date Special Nutrition Programs Lufkin_TPYac 7rc)n1 Summer Food Service Program Form H 1507 Site Information Januay2006 For HHSC Use Only c s SRe Telephone No. HTreet Gjty.State,ZIP) der ti:n c`Food Service(mo.lday/yr.-mo.day/yr.) No.of Op ti ays A42y June rhltY —Anger Sept through: a Vl'ip with the Site Service Area Identified too e Situ er.tiul t,arnp (serving one to three meals) ❑ Site Serving Primarily Migrant Children(serving one to three meals) _ f on-e-. der,tial Camp (serving one to three meals) �] Other Site(serving one or two meals) s '�.�i_ Ccunii85 served by this site: r si, ,: an open or restricted open site?.................................................................................. ................. Yes ❑ No !s o,u e.ite enroiled?.__......_............................................................ ...................................... ..........................❑Yes No t I gibihty. Enter the percentage of children eligible for free and/or reduced-price meals for the `'r FSP Handbook, Section 2000)__... . .............. ..................... ............................ . ............. . . v >- % If ouervr?strictecl open sites, submit documentation supporting this percentage figure(such as census data, school data).For crer/restricted open sites using school data, list the schools used to document site eligibility; attach formula used by school r'ia ict ro establish percentage of free and reduced�pfice children. enrolled sites, Forms H1531 will be used to document eligibility. (National Youth Sports Program-refer to SFSP ~;?nook. I t e im, 232.4 ) is the percentage of free and reduced-price meals for the site?.................................................. % G',_ 'rho Sit:;;articipate in the SFSP at any time during the last five years (SFSP Handbook, Section 2000)?..........❑Yes ❑ No st itie year(s) of participation andflive the name of the ponsoring�organization. J ✓; r:itor Plan (SFSP Handbook. Section 4000)-Enter date of monitorin review to be conducted within: f rdeek of Operation B First Four Weeks of Operation C.Additional Reviews r '�ennce Period Information(SFSP Handbook, Section 2000) l Meal Service Time No.of Eligible Children 1;ryes of Meals to be Served Beginning Ending en r j icy HHSC when setting the approved meal service level. (SFSP Handbook. Section 2000) :o fccd children under one (1) year old?... .... _ - ❑Yes ❑ No F ra,paration by Sponsoring Organization (SFSP Handbook. Section 2000) � Vended - — ❑ Using School Food Authority ❑ Using Private Nonprofit Organizatiort�a elf-Pre Kira t n Q Using Food Service Management Company(excludes all ear contracts i r APR 112006 Special Nutritinn Pmnrnme Form H1507 Page 2�1-2005 _ =r ;o tie used for the serving of meals and the supervision of children during meal service period (SFSP <'I6re-a-styie Meal Service ❑Children are Seated and are Given Meals 71 Children Line Up and Pick Up Meals _ ena-style meal service and if sponsor is a school food authority,will the site be offer vs serve? _ -. - . _ __ . - _ _❑Yes ❑ No rte-_, Irel r ho mil be involved to any extent In the meal service. (SFSP Handbook, Section 2000 'i`ie c,i Position No.in Position Specific Food Service Program Duties 1�` u airat G:rovisions will be made for meal service during periods of inclement weather. (SFSP Handbook, Section 2000) [ r',;uiocr Meal Service ❑Meal Service Will Be Cancelled __j!JtllPi: rite irip(ementing the option to allow off-site consumption of food?................... ............................................❑Yes No n c d�--livered to the site?.... . .... .................... . ........ Yes ❑ No -Yc` „" complete Items 14, 15 and 16. If"No,"form is complete except for certification at bottom. 4 .vicete the n;eans of communication with the vendor which will be used to adjust meal deliveries. (SFSP Handbook, Sections 2000 n-' 8')0(11 itc f ersonnel Will Contact Administrative Staff,Who Will Contact Vendor Personnel Will Communicate Directly With Vendor ci_i vary be within one hour of the food service period?(SFSP Handbook, Section 2000). ............. ......... ._..... Yes ❑No c;rscri lb,e arrangements within standards prescribed by local health authorities for delivery and holding of meals until time of I an excess of meals delivered, meals will be(SFSP Handbook, Section 2000): Sturod in Refrigerator and Served the Next Day ❑Thrown Away at the Site ❑Returned to Vendor for Disposal tl ,_at tl-e information on this form is true and correct to the best of my knowledge. I certify that this site has been that it has the capability and facilities for the meal service planned for the number of children anticipated. I know cr;te misrepresentation or withholding of information may result in prosecution under applicable state and federal Name of Sponsoring Or nization��i Spoorin rganization Dal qpr,or t"int) ITitle c 1 i A.pproved ❑ Denied, reason: rrF N me of Sponsoring Organization w. ';Y) biro-=1�HSC Representative — Date — Special Nutrition Programs Luflcin.Texas 75901 Summer Food Service Program Form HISO7 Site Information January 2006 For HHSC Use Only Site Telephone No. ❑ R of .greet.City. State.ZIP) A `l N C/ ' tion,+FaSd Service(mo'/day/yr.-mo.day/yr.) No.of Operating Days =—tVFap June July Aug. c�_p - throe h r -i f0-,F mith the Site Service Area Identified Site C;arnp (serving one to three meals) ❑ Site Serving Primarily Migrant Children(serving one to three meals) .l.iresidertial Camp (serving one to three meals) Q Other Site(serving one or two meals) )_rnties served by this site: :u, s,?c an open or restricted open site?.......... ............. .. __. ._._...... ........ .......... _....... es ❑No your site enrolled?. .- .............. ..... ................. . ..... ........................ ......................................... .............❑Yes ]No c E-I gibdity Enter the percentage of children eligible for free and/or reduced-price meals for the r L \ i, no P Handbook, Section 2000)............... ...... .......... . ..... ............... . . ................................ , i oc;enirestrictad open sites, submit documentation supporting this percentage figure(such as census data, school data). For e,.er/restncted open sites using school data, list the schools used to document site eligibility; attach formula used by school st:r;i to establish percentage of free and redu ed-price children. =crr enrolled sites, Forms H1531 will be used to document eligibility. (National Youth Sports Program —refer to SFSP � �r'book. [tern 2324 ) h:at a the percentage of free and reduced-price meals for the site?..... ._.._.................I............ % site.t;articipate in the SFSP at any time during the last five years(SFSP Handbook, Section 2000)?..........r,_71 Yes ❑No ist the year(s) of participate99n and give the rj�e of the sponsoring organizati, n. r.;', �r:itonrq Pan (SFSP Handbook. Section 4000)—Enter date of monitorin g review to be conducted within: r .I ek of Operation 8 First Four Weeks of Operation C.Additional Reviews Service Period Information (SFSP Handbook, Section 2000) - ----- ----- No.of Eligible Children Meal Service Time 1 y{yes of Meals to be Served Beginning Ending �l�ieiierit H",6n oy HHSC when setting the approved meal service level (SFSP Handbook. Section 2000) if-, +., fc;;i children under one (1)year old? _. _- -_E]Yes No ' .=rparation by Sponsoring Organization (SFSP Handbook. Section 2000) -- e-- Vended tr ❑ Using School Food Authority ❑ Using Private Nonprofit Organi t� -1 K-, hen QUsing Food Service Management Company(excludes allyear contracts wit on si a re APR 1 1 2006 Special Nutrition Programs FormH1507 Page 2",1-2006 T's ce used for the serving of meals and the supervision of children during meal service period (SFSP a-stjle Meal Service ❑Children are Seated and are Given Meals Children Line Up and Pick Up Meals nu c. `e,eria-style meal service and if sponsor is a school food authority will the site be a uffer vs serves - -._ ._ _ _ - .- - _ - ._ - .- ❑Yes ❑ No rersonnel who will be involved to any extent in the meal service SFSP Handbook, Section 2000) Ti'!e of Fosition No.in Position Specific Food Service Program Duties -r—— tic- JA 1 ,_ Ott 4 y f r�;"i❑ >)J�JUtZ) ,jhat pr;-)visions will be made for meal service during periods of inclement weather. (SFSP Handbook, Section 2000) ;ndoor Meal Service ❑Meal Service Will Be Cancelled r";tiler, 0 s site implementing the option to allow off-site consumption of food?................................................................❑Yes No F%Is delivered to the site?... ... .......... ........... ...... ... . ....... .. ......... .................. .. ...... ...... ........... es ❑No f°' ess,' complete Items 14, 15 and 16. If"No,"form is complete except for certification at bottom. uicai: the means of communication with the vendor which will be used to adjust meal deliveries. (SFSP Handbook, Sections 2000 rd 6O0M f mite Personnel Will Contact Administrative Staff,Who Will Contact Vendor Site: Personnel Will Communicate Directly With Vendor "dill,eii:ary be within one hour of the food service period?(SFSP Handbook, Section 2000)................ .....11.1.1.....XYes ❑ No J; scrli arrangements within standards prescribed by local health authorities for delivery and holding of meals until time of ax::ess of meals delivered, meals will be(SFSP Handbook, Section 2000): Stored in-Refrigerator and Served the Next Dpy ❑Thrown Away at the Site ❑Returned to Vendor for Disposal ❑othi ❑ ❑ , , fib �/ �� � ) -it�'sL1 �;; �' ����`� _ a % l � �: It ) l the information on this form is- e and correct o the best of my knowledge. I certify that EISis i e 'been r;r and that it has the capability and facilities for the meal service planned for the number of children anticipated. I know is erste misrepresentation or withholding of information may result in prosecution under applicable state and federal - Na e of Sponsoring Organizatpn of pons, g Or nization Dat �I e type or pnnn Title e C . 1VI-I..pproved ❑ Denied, reason: - - i N e of Sponsoring Organi i s A i..)am 2-HHSC.Representative Date APR 1 1 ZU06 Special Nutrition Programs Lufkin,Texas 75901 Summer Food Service Program Form H1S07 Site Information Janua'y 2006 For HHSC Use Only Telephone No. _r t pity-State.ZIP) t'rr cf Food Serrce(mo;day/yr.-mo.daylyr.) No.of Oper(tir�q Days -#ey June July Aug. -beryl. through: ti 1 l ^� raith the Site Service Area Identified i., ... i:J ;•Sit.. �arnp (serving one to three meals) ❑ Site Serving Primarily Migrant Children(serving one to hree meals) _ nres:decttial Camp (serving one to three meals) Other Site(serving one or two meals) s^-Iniies served by this site :;i!e ari open or restricted open site?..................................._...........................,............. ............_.........�Yes ❑ No :u site e-moiled? ... . .. ........... ❑Yes �,No _.. El yibility Enter the percentage of children eligible for free and/or reduced-price meals for the -.1 _ / ;P Handbook, Section 2000). ....... ....... ..... .... .. ....... ........ .... .......... ....... 4 . 1, % ooen/restricted open sites, submit documentation supporting this percentage figure(such as census data, school data). For ,°=,,'restricted open sites using school data, list the schools used to document site eligibility; attach formula used by school c;t:lrt to :establish percentage of free and reduced-price children. Li, liA sites, Forms H1531 will be used to document eligibility. (National Youth Sports Program —refer to SFSP ar„!ho,D, "ern 2324) Jr,ra is the percentage of free and reduced-price meals for the site?............. .................................... % t� �.artic pate in the SFSP at any time during the last five years (SFSP Handbook, Section 2000)0. .. ... Yes ❑ No iic.,the year(s) of participation and,gj.Xe the name of the sponsoring.-organization / \ i ` 1 t Y.f iv^r: i`, rir Plan (SFSP Handbook. Section 4000)-Enter date of monitoring review to be conducted within: /eek of Operation B. First Four Weeks of Operation C.Additional Reviews t/ l - Serice Period Information(SFSP Handbook, Section 2000) No.of Eligible Children Meal Service Time Types of Mleals to be Served Beginning Ending i I I i �J r i icy HHSC when setting the approved meal service level (SFSP Handbook. Section 2000) hiidren under one (1) year old?- - _ ._ .. . _ _ _ . - -. -__.. _- . ❑Yes LANo parahon by Sponsoring Organization SFSP Handbook. Section 2000) - ---- Vended � �` ❑ Using School food Authority ❑Using Private Nonprofit OrganiJattf l!C� e ” > k10 h nn ,Using Food Service Management Company(excludes all-year contracts with on-site prep) APH 1 12006 Special Nutrition Programs Lufkin, Texas 75901 Form H1507 Page 2101-2006 io ce used 'Or the serving of meals and the supervision of children during meal service period (SFSP fr er: -style deal Service 7 Children are Seated and are Given Meals XIC hildren Line Up and Pick Up Meals �"e;crla-style meal service and if sponsor is a school food authority.will the site be offer vs serves .❑Yes ❑ No = rersonnel l",0 ,viii be involved to any extent in the meal service. (SFSP Handbook, Section 2000) `;tie of Position No.in Position ` Specific Food Service Program Duties —_- - — —•�— ��l-�+i �' Y�_i rJ 'A. I 1 I I I )rat provisions will be made for meal service during periods of inclement weather. (SFSP Handbook, Section 2000) Indoor Meal Service ❑Meal Service Will Be Cancelled his .-ite implementing the option to allow off-site consumption of food?............................. ......................... .. .....❑Yes (A No ',r, rnsals delivered to the site?.... ................ ................................................ .... ..... .... ......................... ........ ... ... Yes ❑ No If'-Yes," complete Items 14, 15 and 16. If"No,"form is complete except for certification at bottom. �diea e the means of communication with the vendor which will be used to adjust meal deliveries. (SFSP Handbook, Sections 2000 and 6r"O"") [_!Site Personnel Will Contact Administrative Staff,Who Will Contact Vendor `_Site Personnel Will Communicate Directly With Vendor dill deiivary be within one hour of the food service period? (SFSP Handbook, Section 2000)......................... .........S�Yes ❑No -;rscribs arrangements within standards prescribed by local health authorities for delivery and holcoft FbNZ i t rr1M APR 112006 u is an excess of meals delivered, meals will be(SFSP Handbook, Section 2000): Special Nutrition Programs u n Texas 75901 Cored m Refrigerator and Served the Next,/)Day ❑Thrown Away at the Site ❑Returned to en or for Disposal - �, Z N� �� ;}e \ i,at the ii}formation on this form is true and correct to the best of my knowledge. I certify that this site has been ie and that it has the capability and facilities for the meal service planned for the number of children anticipated. I know : ssscer:-to misrepresentation or withholding of information may result in prosecution under applicable state and federal t -----> Name of,Sponsoni g O.r.E nization in Al'A of�,Orso g Organization !i_I 1gpe or print Title -S `,?.pproved ❑ Denied, reason: - i Name of Sponsoring Organization �ignh ure—HOSC Representative Date State of Texas Health & Human Services Commission Nondisclosure Statement Acknowledgment As a contractor to the Texas Health & Human Services Commission, I have been provided access to information, systems, operations,or procedures that are security sensitive or have been identified as confidential by the Health & Human Services Commission, the State of Texas, or the United States Government. As such, I acknowledge the following: • that my access to this information is provided solely in my capacity as a contractor to the Texas Health & Human Services Commission; • that access to this information is solely for the purpose of discharging my duties or the du ie of my employer under Texas Health & Human Services Commission contract number HHSC-�-�-�D;� • that premature or unauthorized disclosure of this information will irreparably harm the interests of the State of Texas and the Texas Health & Human Services Commission and may constitute a violation of Section 39.02 of the Texas Penal Code, the antitrust laws of the United States and the State of Texas, and the Texas Public Information Act[chapter 552, Texas Government Code]; • that the information may represent confidential or proprietary information, the release of which may restricted or prohibited by law. Agreement In view of the foregoing, I agree that I shall use any information that I receive in my capacity as a contractor to the Texas Health & Human Services Commission—whether written or oral, formal or informal—for the following purposes only: • to provide the services and/or deliverables required or requested under contract number HHSC 2L-� n b`_ • to provide advice, opinion or recommendation requested by the Texas Health & Human Services Commission in the course of fulfilling the duties prescribed under the contract; • to assist the Texas Health & Human Services Commission in developing any documents, reports, working papers, evaluations,schedules, or instruments necessary to fulfill the requirements of the contract. I further agree that I shall regard any such information as confidential and that I shall not disclose, reveal, communicate, impart or divulge the information or any summary or synopsis of the information in any manner or any form whatsoever, except under the following circumstances: • when authorized in writing by the Project Manager employed by the Texas Health & Human Services Commission; • when required by court order, subpoena, or ruling of the Attorney General of Texas; • when advised by legal counsel that disclosure is required by law or legal process; • when the information has previously been released to the general public by the Project Manager, the Texas Health&Human Services Commission; • when required to brief or inform a superior, provided the superior is informed of and has also executed a non-disclosure statement. In the event I receive a request for information relating to contract number HHSC-�5 D10-00 either during or after the performance of this contract, I agree to do the following: • notify the Project Manager or the Texas Health & Human Services Commission as soon as practical following receipt of the request; • seek advice from appropriate legal counsel regarding my ability to disclose the information. By signing this statement, I acknowledge that I understand and agree to adhere to the limitations on disclosure described above. u (_ aL Signature Printed Name APR 112006 Special Nutrition Pro,