HomeMy WebLinkAboutRES 16-050RESOLUTION NO. 16-050
BE IT RESOLVED BY THE CITY COUNCIL OF THE
CITY OF BEAUMONT:
THAT the City Manager be and he is hereby authorized to execute a Permanent
Agreement between the City of Beaumont and the Texas Department of
Agriculture, Food and Nutrition Division for the City's administration and financial
management of the 2016 Summer Food Service Program. The Agreement is
substantially in the form attached hereto as Exhibit "A" and made a part hereof
for all purposes.
PASSED BY THE CITY COUNCIL of the City of Beaumont this the 15th
day of March, 2016.
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TEXAS DEPARTMENT OF AGRICULTURE
FOOD AND NUTRITION DIVISION
PERMANENT AGREEMENT
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County/District or Uniform Contract Number (UCN)
National School Lunch Program, School Breakfast Program, Summer
Food Service Program, Child and Adult Care Food Program and Special
Milk Program
The Texas Department of Agriculture, hereinafter referred to as TDA, and V-OAII M,PAFA+,
hereinafter referred to as Contractor, do hereby make and enter into this Agree ent (Agreement), as
required by the National School Lunch Act, 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 School Breakfast Program (SBP), 7 CFR 220; the Summer Food Service
Program (SFSP), 7 CFR Part 225; the Child and Adult Care Food Program (CACFP) 7 CFR Part
226 and the Special Milk Program (SMP), 7 CFR 215.
I.
DEFINITIONS
For purposes of this Agreement:
"Contractor" shall mean (1) a school food authority, which means the governing body which is
responsible for the administration of one or more schools and has the legal authority to operate the
Programs therein or be otherwise approved by the United States Department of Agriculture's
(USDA) Food and Nutrition Service (FNS); (2) an institution, which means a sponsoring
organization, child care center, at -risk after school care center, outside -school -hours care center,
emergency shelter or adult day care center which enters into an agreement with TDA to assume
final administrative and financial responsibility for CACFP operations; or (3) a sponsor of the
Summer Food Service Program, which means a public or private nonprofit school food authority, a
public or private nonprofit residential summer camp, a unit of local, municipal, county or State
government, or a private nonprofit organization which develops a special summer or other vacation
program providing food service similar to that made available to children during the school year
under the National School Lunch Program and School Breakfast Program and which is approved to
participate in the Program.
"School nutrition programs" shall mean all services provided under the authority of the National
School Lunch Program, and the School Breakfast Program.
All other terms in this Agreement have the same meaning as they are defined in the program
statutes and program regulations.
EXHIBIT "A"
II.
PROGRAM DESIGNATION
The above named Contractor applies for, and agrees to operate the Program(s) listed below, which
are indicated by an (X) in the applicable box(es). If Contractor decides to discontinue or begin
operating any of these programs after signing this Agreement, Contractor must provide TDA
advance written notice, including the proposed effective date of the change. Upon approval of the
request, TDA will, at TDA's option, enter into a new agreement with Contractor or amend this
Agreement. If TDA terminates Contractor from one or more of the programs Contractor is
operating, but allows Contractor to continue operating other programs, at TDA's option, Contractor
must enter into a new agreement with TDA to operate the remaining programs or amend this
Agreement to state which programs Contractor will continue to operate.
❑ National School Lunch Program
including:
❑ Afterschool Care Program
❑ Seamless Summer Option
❑ Fresh Fruit and Vegetable Program
❑ School Breakfast Program
JR Summer Food Service Program
❑ Child and Adult Care Food Program
❑ Adult Day Care Centers
❑ Child Care Centers
❑ Day Care Homes
❑ Special Milk Program
III.
CONTRACT PROGRAM ADMINISTRATION AND FINANCIAL MANAGEMENT
A. Contractor will comply with all laws and regulations applicable to 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), Uniform Administrative Requirements For Grants and
Cooperative Agreements To State And Local Governments (7 CFR, Part 3016, as amended), as
applicable, Uniform Administrative Requirements For Grants and Agreements With Institutions
Of Higher Education, Hospitals, and Other Non -Profit Organizations (7 CFR, Part 3019, as
amended), as applicable, Audits of State, Local Governments, and Non -Profit Organizations (7
CFR Part 3052, as amended) and FNS instructions, policy memoranda, guidance and other
written directives interpreting the statutes and regulations applicable to the programs, and state
rules, regulations, policies and procedures as issued and amended by TDA and the other laws
described in the "Schedule of Applicable Laws," which is attached to this Contract as "Exhibit
H" and fully incorporated herein by reference.
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Contractor further agrees to perform as described in application documents, policy statements
and supporting documents, and approved amendments to the application or this Agreement for
participation in designated programs.
B. Contractor accepts final administrative and financial responsibility for management of a proper,
efficient and effective food service operation in each school, summer feeding site and child
and/or adult care facility operated or sponsored by Contractor. This responsibility includes any
audit exceptions or payment deficiency in the program covered by this Agreement, and all
subcontracts hereunder, which are found after monitoring or auditing by TDA or USDA and
Contractor will be responsible for the collections and payback of any amount paid in excess of
the proper claim amount.
c. If Contractor participates in the school nutrition programs, Contractor agrees that for each
participating school under its jurisdiction, it will conduct the Programs in accordance with State
and Federal regulations, and specifically, will conform to the following requirements in the
conduct of each Program (unless the requirement is restricted to a particular program):
1. Maintain a nonprofit school food service and observe the limitations on the use of
nonprofit school food service revenues and the limitations on any competitive school food
service;
2. Use Program income only for Program purposes. Such income shall not be used to
purchase land, to acquire or construct buildings, or to make alterations of existing buildings.
Certain renovations may be allowable if prior written approval has been granted by the state
agency;
3. Maintain a financial management system as prescribed by state and federal laws and
regulations and comply with the requirements of USDA's regulations regarding financial
management;
4. Claim reimbursement at the assigned rates only for reimbursable free, reduced -price and
paid meals served to eligible children. The school food authority (superintendent or
authorized representative) signing the claim shall be responsible for reviewing and analyzing
meal counts to ensure accuracy of said claims. Failure to submit accurate claims will result
in recovery of an over claim and may result in the withholding of payments, suspension or
termination of the program. If failure to submit accurate claims reflects embezzlement,
willful misapplication of funds, theft, or fraudulent activity, the penalties specified below
shall apply:
Whoever embezzles, willfully misapplies, steals or obtains by fraud any funds,
assets or property provided under this part whether received directly or indirectly
from USDA shall:
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a. If such funds, assets, or property are of a value of $100 or more,
be fined no more than $25,000 or imprisoned not more than 5 years
or both; or,
b. If such funds, assets, or property are of a value of less than $100,
be fined not more than $1,000 or imprisoned not more than 1 year or both.
Whoever receives, conceals, or retains for personal use or gain, funds, assets, or
property provided under this part, whether received directly or indirectly from
USDA, knowing such funds, assets, or property have been embezzled, willfully
misapplied, stolen, or obtained by fraud, shall be subject to the same penalties;
5. Submit claims for reimbursement in accordance with procedures established by TDA
and program regulations. Final claims for reimbursement must be received by TDA not
later than 60 days following the last day of the month covered by the claim. Original or
revised claims not received within 60 days require special processing for reimbursement
and must comply with USDA regulationsovg erning late and/or amended claims. Original
or amended claims received late that meet USDA regulations are not guaranteed to
be reimbursed and will only be paid if funds are available:
6. Upon request, make all accounts and records pertaining to its school food service
program available to TDA and to USDA for audit or review, at a reasonable time and place.
Such records shall be retained for a period of five years (three years if operating in a private
school or residential child care institution) after the date of the final Claim for
Reimbursement for the fiscal year to which they pertain, except that if audit findings have
not been resolved, the records shall be retained beyond the five-year period (three-year
period if Contractor is a private school or residential child care institution) as long as
required for resolution of the audit findings raised by the audit;
7. Limit its net cash resources to an amount that does not exceed three months average
expenditures for its non-profit school food services or such other amount as may be
approved in accordance with TDA;
8. Serve meals that meet the minimum requirements prescribed in Schedules B, C, D, E, F,
G, H, I, J and K, as applicable, and which are attached to this Agreement as Exhibit A and
fully incorporated herein;
9. Price the meals as a unit;
10. Serve lunches/breakfasts free or at a reduced price to all children who are determined by
the school food authority to be eligible for such meals;
11. Meet the requirements specified in the school food authority's Policy Statement for Free
and Reduced -Price Meals and all attachments therein,
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12. Comply with the requirements of USDA's regulations regarding nondiscrimination and
make no discrimination against any child because of his or her eligibility for free or reduced -
price meals in accordance with said Policy Statement;
13. Maintain, in the storage, preparation and service of food, proper sanitation and health
standards in conformance with all applicable state and local laws and regulations. Maintain
necessary facilities for storing, preparing and serving food;
14. For NSLP only, enter into an agreement to receive donated foods as required by 7CFR
Part 250;
15. Accept and use, in as large quantities as may be efficiently utilized in its nonprofit
school food service, such foods as may be offered as a donation by USDA;
16. Establish procedures that are necessary to control the sale of food in competition with
the nonprofit foodservice programs in accordance with Program regulations and
instructions;
17. 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 TDA;
18. Maintain files of currently approved and denied free and reduced -price school meal
applications respectively, and the names of children approved for free meals based on
documentation for certifying that the child is included in a household approved to receive
benefits under the Supplemental Nutrition Assistance Program (SNAP) (formerly Food
Stamp Program), Food Distribution Program for Households on Indian Reservations
(FDPIR) or the Temporary Assistance to Needy Families (TANF) program. If applications
are maintained at the school food authority level, they shall be readily retrievable by school;
19. Retain the individual applications for free and reduced -price lunches/breakfasts and
meal supplements and direct certification documentation for a period of five years (three
years if Contractor is a private school or residential child care institution) after the end of the
fiscal year to which they pertain, except that if audit findings have not been resolved, the
applications shall be retained beyond the 5 -year period (three years if Contractor is a private
school or residential child care institution) as long as required for resolution of the issues
raised by the audit;
20. Agree to serve breakfast during a period designated as the breakfast period by the
school and to serve lunch during the period designated as the lunch period by the school;
21. No later than December 31 of each year, provide TDA with a the total number of
children approved for free lunches and meal supplements, the total number of children
approved for reduced price lunches and meal supplements, and the total number of children
enrolled in the school food authority as of the last day of operation in October.
Additionally, no later than December 31 of each year, provide TDA with a list of all
elementary schools under its jurisdiction of enrolled children that have been determined
eligible for free or reduced price meals as of the last operating day the preceding October;
22. When available for the schools under its jurisdiction, and upon request of a sponsoring
organization of day care homes of the Child and Adult Care Food Program, provide
information on the boundaries of the attendance areas for the elementary schools identified
as having 50 percent or more of enrolled children certified eligible for free or reduced price
meals;
23. For school food authorities serving meal supplements during afterschool care programs
shall agree to meet the following:
a. Serve meal supplements which meet the minimum requirements prescribed in
7 CFR § 210.10;
b. Price the meal supplement as a unit;
c. Serve meal supplements free or at a reduced price to all children who are
determined by the school food authority to be eligible for free or reduced
price school meals under 7 CFR part 245;
c. If charging for meals, the charge for a reduced price meal supplement shall
not exceed 15 cents;
d. Claim reimbursement at the assigned rates only for meal supplements served
in accordance with the agreement;
e. Claim reimbursement for no more than one meal
supplement per child per day;
f. Review each Afterschool Care Program two times a year, with the first
review occurring during the first four weeks that the school is in operation
each school year, except that an Afterschool Care Program operating year
round shall be reviewed during the first four weeks of its initial year of
operation, once more during its first year of operation, and twice each school
year thereafter; and
g. Comply with all requirements of this part, except that, claims for
reimbursement need not be based on "point of service" meal supplement
counts (as required by § 210.9(b)(9)).
24. Certify that each of the schools listed in Schedule A of Exhibit A, which is attached to
this Agreement and fully incorporated herein and identifies the names of all schools in the
school district conducting school nutrition programs, is nonprofit and exempt from federal
income tax under the Internal Revenue Code, as amended; and
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25. Comply with the applicable Civil Rights Policy, which is attached to this Agreement as
Exhibit B and fully incorporated herein.
D. If Contractor is a Sponsor for the Summer Food Service Program, Contractor agrees that it will
conduct the Program in accordance with State and Federal regulations, and specifically, will
conform to the following requirements:
1. Operate a nonprofit food service during the period specified, as follows:
a. From May through September for children on school vacation;
b. At any time of the year, in the case of Contractor administering the Program
under a continuous school calendar system; or
c. During the period from October through April, if Contractor serves an area
affected by an unanticipated school closure due to a natural disaster, major
building repairs, court orders relating to school safety or other issues, labor-
management disputes, or, when approved by the State agency, a similar
cause;
2. If Contractor is a school food authority, offer meals which meet the requirements and
provisions set forth in §225.16 during times designated as meal service periods by the
sponsor, and offer the same meals to all children;
3. If sponsor is not a school food authority, serve meals which meet the requirements and
provisions set forth in §225.16 during times designated as meal service periods by the
sponsor, and serve the same meals to all children;
4. Serve meals without cost to all children, except that camps may charge for meals served
to children who are not served meals under the Program;
5. Issue a free meal policy statement in accordance with §225.6(c);
6. Meet the training requirement for Contractor's administrative and site personnel, as
required under §225.15(d)(1);
7. Claim reimbursement only for the type or types of meals specified in the application and
served without charge to children at approved sites during the approved meal service period,
except that camps shall claim reimbursement only for the type or types of meals specified in
the application and served without charge to children who meet the Program's income
standards;
8. Serve a maximum number of meals under the Program, as approved by TDA, if
Contractor is serving meals prepared by a food service management company, as required
under §225.6(d)(2), and document in its files the maximum number of meals that may be
served;
9. Obtain written approval from TDA to make permanent changes in the serving time of any
meal;
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10. Submit claims for reimbursement in accordance with procedures established by the
State agency, and those stated in §225.9;
11. In the storage, preparation and service of food, maintain proper sanitation and health
standards in conformance with all applicable State and local laws and regulations;
12. Accept and use, in quantities that may be efficiently utilized in the Program, such foods
as may be offered as a donation by the USDA;
13. Have access to facilities necessary for storing, preparing, and serving food;
14. Maintain a financial management system as prescribed by the State agency;
15. Maintain on file documentation of site visits and reviews in accordance with §225.15(d)
(2) and (3);
16. Upon request, make all accounts and records pertaining to the Program available to
State, Federal, or other authorized officials for audit or administrative review, at a
reasonable time and place;
17. Retain records for a period of 3 years after the end of the fiscal year to which they
pertain, unless audit or investigative findings have not been resolved, in which case the
records shall be retained until all issues raised by the audit or investigation have been
resolved;
18. Ensure children consume meals on site unless TDA allows certain foods to be taken off
site for consumption; and
19. Retain final financial and administrative responsibility for its program.
20. Comply with the applicable Civil Rights Policy, which is attached to this Agreement as
Exhibit C and fully incorporated herein.
E. If Contractor participates in the CACFP, Contractor agrees that it will conduct the Programs in
accordance with State and Federal regulations, and, specifically, will conform to the following
requirements:
1. Provide or accept responsibility for the provision of organized, non-residential day care
and immediately report to the appropriate state agency, any suspected violations of licensing
standards or suspected abuse of children or adults in centers (sponsored or independent) or
day care homes;
2. Accept financial and administrative responsibility for management of a proper, efficient,
and effective food service, and will comply with all requirements under 7 CFR Part 226;
3. 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 TDA. Unless otherwise provided by state or federal law, the records and documents will
be kept for a minimum of 3 years after the end of the program year. If any litigation, claim,
negotiation, audit, or other action involving these records begins before such period expires,
Contractor will keep the records and documents for until all audit findings, claims or
litigation are resolved or until the end of the 3 year period, which ever is later. The case is
considered resolved when there is a final order issued in litigation, or a written agreement is
entered into between TDA and the Contractor. Contractor will keep records of non -
expendable property acquired under the contract for 3 years after final disposition of the
property;
4. Allow TDA and USDA officials and other appropriate officials determined by TDA to
inspect facilities and records and to audit, examine, and copy records at any reasonable time,
whether announced or unannounced. This includes access to all records of costs paid, even
in part, by TDA. TDA agrees that any TDA employee making such review shall show
photo identification that demonstrates that he/she is an employee of TDA;
5. 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
applicable state law and regulations. The provision shall not be construed as limiting TDA's
right of access to recipient case records or other information relating to clients served under
this contract;
6. Submit for TDA approval applications and agreements for any center/day care home for
which Contractor intends to sponsor;
7. Submit to TDA's Food and Nutrition Division an amendment to its application or
management plan, on TDA's form, when any change from information that was originally
submitted in Contractor's application occurs; and
8. Comply with the applicable Civil Rights Policy, which is attached to this Agreement as
Exhibit C and fully incorporated herein.
F. A school food authority or child care institution, as defined in 7 CFR, Part 215, participating in
the SMP agrees that it will conduct the SMP in accordance with State and Federal regulations,
and, specifically, will conform to the following requirements:
1. Operate a nonprofit milk service;
2. Serve milk free to all eligible children, at times that milk is made available to nonneedy
children under the SMP and make no discrimination against any needy child because of
inability to pay for the milk;
3. Comply with USDA's regulations respecting nondiscrimination (7 CFR, Part 15) and
with the applicable Civil Rights Policy, which is attached to this Agreement as Exhibit B
and fully incorporated herein;
4. Claim reimbursement for milk, as defined in 7 CFR, Part 215, and in accordance with the
provisions of 7 CFR §§ 215.8 and 215.10;
5. Submit Claims for Reimbursement in accordance with § 215.10 of this part and
procedures established by TDA or FSNRO where applicable;;
6. Maintain a financial management system as prescribed by TDA or FNSRO where
applicable;
7. Upon request, make all records pertaining to the SMP available to TDA, USDA or OA
for audit and administrative review, at any reasonable time and place. Such records shall be
retained for a period of three years after the end of the fiscal year to which they pertain,
except that if audit findings have not been resolved, the records shall be retained beyond the
three-year period as long as required for resolution of the issues raised by the audit;
8. Retain the individual applications for free milk submitted by families for a period of -
three years after the end of the fiscal year to which they pertain, except that if audit findings
have not been resolved, the records shall be retained beyond the -three-year period as long
as required for resolution of the issues raised by the audit; and
IV.
TDA CLAIMS PAYMENT
A. TDA will, subject to federal appropriation and availability to TDA of sufficient funds for the
applicable program, make program payment to Contractor in accordance with the terms of this
Agreement. During any fiscal year, the reimbursement paid shall be established in conformance
with applicable federal regulations. 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 TDA based on the date of receipt of a fully executed copy of this Agreement.
B. Pursuant to §2252.903 of the Texas Government Code, any payments owing to Contractor under
this Agreement will be applied toward elimination of 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.
V.
STATE AUDITOR'S OFFICE
Contractor understands that acceptance of funds under this Agreement 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.
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VI.
IMMIGRATION
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 Agreement.
VII.
CERTIFICATIONS
Contractor shall execute and comply with the following Certifications: (1) Certification Regarding
Debarment, Suspension, Ineligibility, and Voluntary Exclusion -Lower Tier Covered Transactions,
which is attached to this Agreement as Exhibit D and fully incorporated herein; (2) Certification
Regarding Lobbying, which is attached to this Agreement as Exhibit E and fully incorporated
herein; and (3) Standard Form -LLL, Disclosure Form to Report Lobbying, when applicable, which
is attached to this Agreement as Exhibit F and fully incorporated herein; (4) Clean Air and Water
Certification, which is attached to this Agreement as Exhibit G and fully incorporated herein.
VIII.
TERM AND TERMINATION
A. This Agreement shall take effect on _'20. , or upon signature by
appropriately authorized representatives of both Parties, whichever is later.
B. This Agreement may be terminated in accordance with the program laws and regulations,
including 7 CFR, Parts 3015, 3016, 3019 and 3052. In addition to termination in accordance
with the preceding, this Agreement may be terminated for any of the following reasons:
1. Termination by mutual agreement of the Parties. This Agreement may be terminated by
mutual agreement of the Parties. Such agreement must be in writing.
2. Termination in the best interest of the State. TDA may terminate this Agreement at any
time when, in its sole discretion, TDA determines that termination is in the best interest of
the State of Texas. The termination will be effective on the date specified in a notice of
termination from TDA.
3. Termination for non -appropriation of funds. Notwithstanding any other provision of
this Agreement, if funds for the continued fulfillment of this Agreement by TDA are at any
time not forthcoming or are insufficient, through failure of any entity to appropriate funds or
otherwise, then TDA 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.
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4. Termination for Change in Ownership or Legal Identity of Institution. Contractor
understands and agrees that this contract is not transferable and that in the event of change in
legal identity or ownership of Institution, this Contract will terminate.
5. Termination for impossibility or unreasonability. If federal or state laws or other
requirements are amended or judicially interpreted so that the continued fulfillment of this
Agreement, 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 Agreement then, the parties
shall be discharged from any further obligations created under the terms of this Agreement,
except for the equitable settlement of the respective accrued interest of obligations,
including audit findings, incurred up to the date of termination.
IX.
AMENDED OR NEW STATUTES, REGULATIONS, INSTRUCTIONS, POLICY
MEMORANDA, AND GUIDANCE
By continuing to operate covered programs after the enactment or issuance of any changed or new
statutes or regulations applicable to the programs covered by this Agreement, and any changed or
new instructions, policy memoranda, guidance, and other written directives interpreting these
statutes or regulations, Contractor agrees to comply with them.
If Contractor does not wish to comply with any changes or new items, Contractor must seek to
terminate this Agreement in accordance with section VIII of this Agreement.
X.
SEVERABILITY
If one or more provisions of this Agreement, or the application of any provision to either party or
circumstance is held invalid, unenforceable or illegal in any respect, the remainder of this
Agreement and the application of the provision to other parties or circumstances shall remain valid
and in full force and effect.
XI.
SIGNATURES
This Agreement establishes or continues the rights and responsibilities of TDA and Contractor
pursuant to Contractor's participation in one or more of the above named programs as stipulated
herein. By signing this Agreement, both parties are bound by its terms and conditions from its
beginning effective date until terminated in accordance with this Agreement.
Contractor certifies that all information submitted pursuant to this agreement is true and correct.
Contractor understands that the deliberate misrepresentation or withholding of information is a
violation of this Agreement and may result in prosecution under applicable state and federal
statutes.
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The Parties hereto in their capacities stated, agree to all statements and conditions contained herein
and are authorized to sign this Agreement on behalf of the entity stated herein below. The Parties
affix their signatures and bind themselves for the faithful performance of the terms of this
Agreement.
CONTRACTOR
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PZ-afme-& Con mg Organization
(Please print or type)
By:
Signature of the
official who has been authorized to sign
contracts on behalf of the contracting organization.
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Na of Official Sighing Title of Officim.,
(Please print or type) (Please print or type)
Date:
TEXAS DEPARTMENT OF AGRICULTURE
Un
TDA Representative
Date:
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Revised January 2009
EXHIBIT A .
SCHEDULES A -K
(Applicable to NSLP/SBP/SMP only)
Schedule A: Names of all schools/sites in the school food authority that participate in the
NSLP/SBP/SMP
Schedule B: School Breakfast Pattern for Traditional Food Based Menu Planning
Schedule C: School Breakfast Pattern for Enhanced Food Based Menu Planning
Schedule D: School Lunch Pattern for Enhanced Food Based Menu Planning
Schedule E: School Lunch Pattern for Traditional Food Based Menu Planning
Schedule F: Required Minimum Calorie and Nutrient Levels for Enhanced Food Based, Traditional
Food Based and Nutrient Standard Menu Planning Systems for School Breakfasts by Grade Levels
Schedule G: Required Minimum Calorie and Nutrient Levels for Enhanced Food Based and
Nutrient Standard Menu Planning Systems for School Lunches by Grade Levels
Schedule H: Required Minimum Calorie and Nutrient Levels for Traditional Food Based Menu
Planning System for School Lunches by Grade Levels
Schedule I: Optional Minimum Nutrient and Calorie Levels for School Lunches Nutrient Standard
Menu Planning Approaches (by Age Groups)
Schedule J: Optional Minimum Nutrient and Calorie Levels for School Breakfasts Nutrient
Standard Menu Planning Approaches (by Age Groups)
Schedule K: Afterschool Care Program Meal Pattern
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G-Ui6obFood Authority (SFA) Name
RETURN TO STATE OFFICE
Schedule A
eLl�t r.,z; p n
ounty/District# or Program#
- List all requested information for all schools/sites within the SFA in Section I.
- Be sure to use enrollment and total eligible data from the previous October 31. If additional space is necessary, please
make a photocopy of this blank form.
- A copy of the completed Schedule A form will be returned to the SFA with the approved application/agreement so that it
may be filed as a permanent record.
- Please see "Instructions for Completing the Schedule A Form".
- For public and charter schools, the Schedule A will need to be renewed every year online via the Child Nutrition
Programs Information Management System (CNPIMS) internet application by an authorized representative.
Column 1
Column 2
Column 3 Column 4
Column 5
Schools/SitesCampus Names of
Number
Program
TotalEligibleI
Free + Reduced
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Texas Department of Agriculture
Child Nutrition Programs
Instructions for Completing the Schedule A Form
Please enter the school food authority (SFA) name and county/district number or program number in the spaces provided at the top of
the form. Use data from last October 31 for total enrollment and total eligible. If no data is available from October 31, then use the
most current figures available. All public and charter schools affiliated with the Texas Education Agency have been assigned
county/district numbers. All private schools and residential child care institutions (RCCIs) have been assigned a program number by
Texas Department of Agriculture. If you are unsure of this number, please contact the Food and Nutrition Division at (877) 839-6325.
Section I:
Column 1— Campus Number: For public and charter schools, please list the 3 -digit campus number as assigned by the Texas
Education Agency for each school. If you are unsure of the campus number, please contact the Food and Nutrition Division at (877)
839-6325. Private schools and RCCIs will leave this column blank.
Column 2— Names of Schools/Sites: Please list the name of each school/site located in your SFA.
Column 3 — Enrollment: Please provide the total current enrollment (membership, population) for each school/site listed under
Column 1. You may estimate enrolhnent for a school/site beginning operation during the upcoming year. (Public and charter schools
may update enrollment online through the Child Nutrition Programs Information Management System (CNPIMS) at any time.) For
assistance, please contact the Food and Nutrition Division at (877) 839-6325.
Column 4 — Total Eligible: For each school/site listed, please enter the total # of students approved to receive free and reduced -price
meals. If a new school/site is listed, and eligible figures are not available, please provide your best estimate. (Public and charter
schools may update eligible counts at any time online through the CNPIMS.) For assistance, please contact the Food and Nutrition
Division at (877) 839-6325.
Column 5— Program Participation: For each school/site listed, please indicate with an 'W' which programs will be provided:
National School Lunch Program (NSLP), School Breakfast Program (SBP), After School Snack Program (Snack) or Special Milk
Program (SMP). Note: If a school/site is participating in NSLP, they are not eligible to participate in SMP.
Grand Totals — (Last Row): Please enter the sum total of each column in Section I (total # of schools/sites, total enrollment, total #
of students eligible for free and reduced -price meals, and total participation by program).
Schedule B
chool Breakfast Pattern for Traditional Food Based Menu Planning
Meal Components
Minimum Quantities
USDA
Ages 1-2 Ages 3,4,5 Grades K-12
Recommendation
Milk (Fluid): As a beverage,
1/2 cup
3/4 cup
1 cup
Whole milk for children
on cereal or both.
(4 fl oz)
(6 fl oz)
(8 fl oz)
1-2 years of age Lowfat,
skim, or buttermilk for
1/2 ounce
'/Z ounce
1 ounce
No more than 1 ounce
children over the age of
of nuts or seeds may be
2
Juice/Fruit/Vegetable: Fruit and/or
1/4 cup
'/Z cup
1/2 cup
A juice or fruit or
vegetable; or full-strength fruit
'/Z ounce
1 ounce
vegetable that is a good
juice or vegetable juice.
`/Z egg
1/2 egg
source of Vitamin C
Select one serving from each of the following components or two servings front one component:
Grains/Breads:
2 Tbsp.
Caution: Children
nut or seed butters
One of the following or
under 5 are at a higher
•Cooked dry beans/peas
2 Tbsp.
an equivalent combination:
4 Tbsp.
risk of choking than
*Nuts and/or seeds
V, ounce
•Whole -grain or
/Z slice
V. slice
1 slice
See Food Buying Guide
enriched bread
4 ounces
recommended that
unsweetened or sweetened
for Child Nutrition
• Whole -grain or
' / serving
1/2 serving
1 serving
Programs for
enriched biscuit,
served ground or
serving sizes.
roll, muffin, etc.
finely chopped in a
•Whole -grain, enriched
1/4 cup or
1/3 cup or
3/4 cup or
(whichever is less)
or fortified cereal.
1/3 ounce
1/z ounce
1 ounce
Meat/Meat Alternates:
One of the following
or an equivalent
combination:
•Lean meat, poultry
1/2 ounce
'/Z ounce
1 ounce
No more than 1 ounce
or fish
of nuts or seeds may be
'!Alternate protein products (APP)
1/2 ounce
1/2 ounce
1 ounce
served in any one meal.
•Cheese
1/2 ounce
'/Z ounce
1 ounce
-Large egg
� /Z egg
`/Z egg
1/2 egg
• Peanut butter or other
1 Tbsp.
1 Tbsp.
2 Tbsp.
Caution: Children
nut or seed butters
under 5 are at a higher
•Cooked dry beans/peas
2 Tbsp.
2 Tbsp.
4 Tbsp.
risk of choking than
*Nuts and/or seeds
V, ounce
/2 ounce
1 ounce
older children. It is
•Yogurt, plain or flavored,
2 ounces
2 ounces
4 ounces
recommended that
unsweetened or sweetened
or 1/4 cup
or 1/4 cup
or 1/Z cup
nuts and/or seeds be
(frozen yogurt not allowed)
served ground or
finely chopped in a
prepared food.
"*Alternate Protein Products (APP) are also known as Vegetable Protein Products (VPP).
Schedule C
School Breakfast Pattern for
Enhanced Food Based Menu Planning
V
Minimum Quantities Required For
Meal Component
--
----- ----
Ages 1-2
Preschool
Grades K-12*
3/ scup
Milk (Fluid): As a beverage, on cereal
'/ 2cup
1 cup
or both. USDA recommends whole
(4 fl oz)
(6 fl oz)
(8 fl oz)
milk for children 1-2 years of age.
Juice/Fruit/Vegetable:
'/
'/
Fruit and/or vegetable; or full-strength
4cup
2cup
^cup
fruit juice or vegetable juice.
Select one serving from each of the following components or two from one component:
Grains/Breads*:
1
One of the following or an equivalent
combination:
Whole -grain or enriched bread
'/ tslice'/
plice
1 slice
Whole -grain or enriched biscuit,
'/ perving
'/ perving
1 serving
roll, muffin, etc.
Whole -grain, enriched or fortified cereal.
'/.,cup or
'/ 3cup or
3/ scup or 1 ounce
3ounce
'/ ounce
(whichever is less)
Meat/Meat Alternates:
Meat/poultry or fish
'/ Zounce
'/ dunce
1 ounce
*Alternate Protein Products (APP)
'/ Zounce
'/ bounce
1 ounce
Cheese
'/ 2ounce
'/ punce
1 ounce
Egg (large)
'/.egg
'/ ?gg
'/ pgg
Peanut butter or other nut or seed
1 Tbsp.
1 Tbsp.
2 Tbsp.
butters
I
Cooked dry beans and peas
2 Tbsp.
2' Tbsp.
4 Tbsp.
Nuts and/or seeds (as listed in
'/ iounce
'/ dunce
1 ounce
program guidance).'
Yogurt, plain or flavored, unsweetened
2 ounces or
2 ounces or
4 ounces or'/, cup
or sweetened (frozen yogurt not al-
'/ "cup
'/,cup
lowed.
Caution: Children under 5 are at a higher
risk of choking than older children. It is rec-
ommended that nuts andlor seeds be served
ground or finely chopped in a prepared food.
'No more than 1 ounce of nuts and/or seeds may be offered in any one meal.
*Option for Grades 7-12; one additional serving of Grains/Breads should be served daily in addition to the
components listed above.
**Alternate Protein Products (APP) also known as Vegetable Protein Products (VPP).
Schedule D
School Lunch Pattern for Enhanced Food Based Menu Planning
Schools may use the minimum nutrient and quantity requirements applicable to the majority of children as long as only
one ante or tirade is outside the levels for the maioritu ofchildren.
Meal Component
Meat or Meat Alternate (quantity of the
edible portion as served):
Lean meat, poultry or fish
*Alternative Protein Products (APP)
Cheese
Large egg
Cooked dry beans or peas
Peanut butter or other nut or seed
butters
Yogurt, plain or flavored,
unsweetened or sweetened (frozen
yogurt not allowed)
The following may be used to meet no
more than 50% of the requirement and
must be used in combination with any o
the above:
Peanuts, soynuts, tree nuts or seeds, as
listed in program guidance, or an
equivalent quantity of any combina-
tion of the above meat/meat alternate
(1 oz. of nuts/seeds = 1 oz. of cooked
lean meat, poultry or fish).
Minimum Quantities Required For
Ages 1-2 Preschool Grades K-6 Grades 7-12 Option For
Grades K-3
1 oz.
1 '/_ oz.
2 oz.
2 oz.
1 '/z oz.
1 oz.
1 V, oz.
2 oz.
2 oz.
1 V, oz.
1 oz.
1 V, oz.
2 oz.
2 oz.
1 '/Z oz.
minimum of
3/4
1
1
3/4
cup
2 Tbsps.
3/y cup
3 Tbsp.
1
/2 Cup
4 Tbsp.
1/3 cup
4 Tbsp.
3/8 cup
3 Tbsp.
day'
day'
4 oz. or
6 oz. or
8 oz. or
8 oz. or
6 oz. or
'/2 cup
'/, cup
1 cup
1 cup
V, cup
'/Z oz.= 50% 1 3/, oz= 50%11 oz.= 50% 11 oz.= 50% 1 3/, oz.= 50%
Vegetables/Fruits (2 or more servings '/2 cup /, cup 3/, cup plus 1 cup 3/, cup
from different sources of vegetables or additional
fruits or both). '/2 cup over
a week'
Grains/Breads. Must be enriched or
5 servings
8 servings
12 serving
15 servings
10 servings
whole grain.
per week—
per week—
per week
per week—
per week—
A serving is a slice of bread or an
minimum
minimum
minimum of
minimum
minimum of
equivalent serving of biscuits, rolls,
of V, per
of 1 per
1 per day' 2
of 1 per day
1 per day' 2
etc., or'/, cup of cooked rice, macaroni,
day'
day'
noodles, other pasta products or cereal
grains.
Milk (As a beverage). 1 6 fl, oz. 1 6 fl. oz. 1 8 fl. oz. 18 fl. oz. 1 8 fl. oz.
'For the purposes of this chart, a week equals five days.
'- Up to one grains/breads serving per day may be a dessert.
'USDA recommends whole milk for children 1-2 years of age.
*Alternate Protein Product (APP) also known as Vegetable Protein Product (VPP).
Schedule E
School Lunch Pattern for Traditional Food Based Menu Planning Schools may use the minimum nutrient and quantity requirements applicable to the majority of
children as long as only one age or grade is outside the levels for the majority of children.
USDA recommends, but does not require, that portions be adjusted by
age/grade group to better meet the food and nutritional needs of children
Minimum Quantities
Recommended
according to their ages. If portions are adjusted, Groups I-IV are mini-
Quantities
Preschool Grades
Grades
Grades
mum requirements for the age/grade groups specified. if portions are not
adjusted, the Group IV portions are the portions to serve all children.
K-3
4-12
7-12
ages 1-2 ages 3-4 ages 5-8
ages 9 & over
ages 12 & over
Food Components Food Items
(Group I) (Group II) (Group III)
(Group IV)
(Group V)
Meat or A serving of one of the following or a combina-
Meat tion to give an equivalent quantity:
Alternate Protein Products
Alternate
l oz. 1 t/ 2oz. 1 /,oz.
2 oz.
3 oz.
• Must be served in the main dish or
Lean meat, poultry or fish
t oz. 1 '/ Zoz. 1 /,oz.
2 oz.
3 oz.
the main dish and only one other
(quantity of the Cheese
1 oz.1 '/ oz. 1 '/-Oz.
1
2 oz.
3 oz.
menu item.
edible portion Large eggs)
�/ '/ '/ -
1
1 /
as served): Cooked dry beans or peas
'/+cup '/s cu
'/8 cup
`p , cup
'/+ cup
• Alternate protein products [(APP)
Peanut butter or other nut or seed butters.
2 Tbsp. 3 Tbsp. 3 Tbsp.
4 Tbsp.
6 Tbsp.
sometimes referred to as vegetable
Yogurt, plain or flavored, unsweetened or sweet-
4 oz. or'/ zcup 6 oz. or cup 6 oz. or cup
8 oz, or 1 cup
12 oz. or
protein products (VPP)J and
ened (frozen yogurt not allowed)
A 4
I 1/
enriched macaroni with fortified
,cup
a
protein may be used to meet part
Peanuts, soynuts, tree nuts or seeds, as listed in
'/ oz.= 50% '/ + oz.= 50% '/ oz: 50%
I oz: 50%
1 '/2 oz.= 50%
of the meat or meat alternate
program guidance, meet no [Wore than 50% of
a
requirement. Food and Nutrition
the requirement and must be corn-bined in the
Service fact sheets on each of
meal with at least 50% of other meat or [neat
these alternate foods give detailed
alternates (1 oz. of nuts/seeds=
instructions for use.
I oz. of cooked lean meat, poultry or fish).
Vegetables 2 or more servings from different sources of
• No more than one-half of the total
vegetables or fruits or both to total:
i i
/,cup /Z cup /,cup
s+
/ cup
/ cup p
requirement may be met with full -
or
strength fruit or vegetable juice.
Fruits
• Cooked dry beans or peas may be
used as a meat alternate or as a veg -
etable, but not as both in the same meal.
Grains/ Servings of grains/breads:
5 per week 8 per week 8 per week
8 per week
10 per week
• Enriched macaroni with fortified
protein may be used as a meat
Must be enriched or whole grain.
Breads
alternate or as a bread altemate
but not as both in the same meal.
A serving is a slice of bread or an equivalent
minimum of minimum of 1 minimum of 1
minimum of
minimum of 1
serving of biscuits, rolls, etc., or '/ zcup of
1/Z serving per serving per day serving per day
1 serving per
serving per day
NOTE: Food Buying Guide for Child
cooked rice, macaroni, noodles, other pasta
day
day
Nutrition Programs provides the
products or cereal grains or a combination of
information for the minimum weight
any of the above.
of a serving.
Milk
'/,cup '/ cup '/ pint
'/Z pint
'/j pint
Serve a variety of milk.
(As a beverage)
(6 fl, oz.)' (6 fl. oz.) (8 fl. oz.)
(8 fl, oz.)
(8 fl. oz.)
USDA recommends whole milk for
children 1-2 years of age.
Schedule F
Required Minimum Calorie and Nutrient Levels for Enhanced Food Based, Traditional Food Based and
Nutrient Standard Menu Planning Systems for School Breakfasts by Grade Levels
(School Week Averages: Minimum of three consecutive days and a maximum of seven consecutive days)
Nutrients and energy allowances
Preschool
Grades K-12
Option for Grades 7-12
Energy Allowances/Calories
388
554
618
Fat (as a percentage of actual
total food energy)
(1)
(1,2)
(2)
Total Saturated Fat (as a percent-
age of actual total food energy)
RDA for Protein (g)
(1)
5
(1,3)
10
(3)
12
RDA for Calcium (mg)
200
257
300
RDA for Iron (mg)
2.5
3.0
3.4
RDA for Vitamin A (RE)
113
197
225
RDA for Vitamin C (mg)
11
13
14
77re Dietary Guidelines recommend that after 2 years of age "...children should gradually adopt a diet that, by about 5 years of
age, contains no more than 30 percent of calories from fat."
2Not to exceed 30 percent over a school week.
3Less than 10 percent over a school week.
Schedule G
Required Minimum Calorie and Nutrient Levels for Enhanced Food Based and Nutrient Standard Menu
Planning Systems for School Lunches by Grade Levels
(School Week Averages: Minimum of three consecutive days and a maximum of seven consecutive days)
Nutrients and energy allowances
Minimum Requirements
Optional
Preschool
Grades K-6
Grades 7-12
Grades K-3
Energy Allowances/Calories
517
664
825
633
Total Fat (as a percent of actual total
food energy)
(1)
(1,2)
(2)
(1,2)
Saturated Fat (as a percent of actual
total food energy)
(1)
(1,3)
(1,3)
RDA for Protein (g)
7
10
16
9
RDA for Calcium (mg)
267
286
400
267
RDA for Iron (mg)
3.3
3.5
4.5
3.3
RDA for Vitamin A (RE)
150
224
300
200
RDA for Vitamin C (mg)
14
15
18
15
1The Dietary Guidelines recommend that after 2 years of age "...children should gradually adopt a diet that, by about 5 years of
age, contains no more than 30 percent of calories from fat."
2Not to exceed 30 percent over a school week.
3Less than 10 percent over a school week.
Schedule H
Required Minimum Calorie and Nutrient Levels for Traditional Food Based Menu Planning
System for School Lunches by Grade Levels (School Week Averages)
Minimum Requirements
Nutrients and Energy Allowances Preschool Grades K-3 Grades 4-12
Energy Allowances/Calories 517 633 785
Optional
rades 7-12
825
Total Fat (as a percentage of actual
total food energy)
(1)
(1,2)
(2)
(2)
Total Saturated Fat (as a percentage
of actual total food energy)
(1)
(1,3)
(3)
(3)
RDA for Protein (g)
7
9
15
16
RDA for Calcium (mg)
267
267
370
400
RDA for Iron (mg)
3.3
3.3
4.2
4.5
RDA for Vitamin A (RE)
150
200
285
300
RDA for Vitamin C (mg)
14
15
17
18
'The Dietary Guidelines recomtttend that after 2 years of age "...children should gradually adopt a diet that by about 5 years of age,
contains no more than 30 percent of calories from fat."
2Not to exceed 30 percent over a school week.
3Less than 10 percent over a school week.
Schedule I
Optional Minimum Nutrient and Calorie Levels for School Lunches
Nutrient Standard Menu Planning Approaches (School Week Averages)
Nutrients and Energy Allowances
Ages 3-6
Ages 7-10
Ages 11-13
ges 14 and Abov
Energy Allowances/Calories
558
667
783
846
Total Fat (as a percentage of actual
total food energy)
(1,2)
(2)
(2)
(2)
Total Saturated Fat (as a percentage
of actual total food energy)
(1,3)
(3)
(3)
(3)
Protein (g)
7.3
9.3
15.0
16.7
Calcium (mg)
267
267
400
400
Iron (mg)
3.3
3.3
4.5
4.5
Vitamin A (RE)
158
233
300
300
Vitamin C (mg)
14.6
15
16.7
19.2
177te Dietary Guidelines recommend that after 2 years of age "...children should gradually .adopt a diet that, by about 5 years of
age, contains no more than 30 percent of calories from fat."
2Not to exceed 30 percent over a school week.
3Less than 10 percent over a school week.
Schedule J
Optional Minimum Nutrient and Calorie Levels for School Breakfasts
Nutrient Standard Menu Planning Approaches (School Week Averages)
Nutrients and energy
allowances
Ages 3-6
Ages 7-10
Ages 11-13
Ages 14 and above
Energy Allowances/Calories
419
500
588
625
Total Fat (as a percent of
actual total food energy)
(1,2)
(2)
(2)
(2)
Saturated Fat (as a percent
of actual total food energy)
(1,3)
(3)
(3)
(3)
RDA for Protein (g)
5.50
7.00
11.25
12.50
RDA for Calcium (mg)
200
200
300
300
RDA for Iron (mg)
2.5
2.5
3.4
3.4
RDA for Vitamin A (RE)
119
175
225
225
RDA for Vitamin C (mg)
11.00
11.25
12.50
14.40
'The Dietary Guidelines recommend that after 2 years of age "...children should gradually adopt a diet that, by about 5 years
of age, contains no more than 30 percent of calories from fat."
-Not to exceed 30 percent over a school week.
3Less than 10 percent over a school week.
Schedule K
Afterschool Care Program Meal Pattern
Select two different components front the four listed.
Snack Ages 1-2 Ages 3-5 Ages 6-12 Ages 13-18 Recommended
Portions fir children ages 13
through 18 shall be no less titan
the portions stipulated for children
ages 6 through 12. We recommend
Milk, fluid
'/ 2cup
'/2 Cup
1 cup
that schools offer larger portions for
older children (ages 13-18) based on
their greater food energy require-
nients.
Meat or meat alternate
,oz.
'/20z.
1 oz.
Yogurt
2 oz./'/4 cup
2 oz./'/, cup
2 oz./'/4 cup
4 oz./'/, cup
Egg
1/2
1/2
1/2
1/2
juice or fruit or vegetable
'/Z cup
'/, cup
3/,,cup
Bread and/or cereal: Enriched
'/2slice
'/2slice
1 slice
or
whole grain bread or
/3cup/ '/2
Cereal: Cold dry or
'/4cup/'/3oz:
oz.
3/4 cup/1 oz.
cooked cereal grains
`/,cup
'/4cup
'/,cup
Juice may not be served when milk
is served as the
only other component.
Caution: Children under five years of
age are at the highest
risk of choking.
USDA recommends
that nuts and/or seeds be
served to them ground or finely chopped
in a prepared food.
EXHIBIT B
CIVIL RIGHTS POLICY COMPLIANCE FOR
SCHOOL NUTRITION PROGRAMS (NSLP,
SBP and SMP)
Contractor agrees to comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. §
2000d et seq.), Title IX of the Education Amendments of 1972 (Title 20 U.S.C. § 1681 et seq.),
Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. § 794), the Age Discrimination Act of
1975 (42 U.S.C. § 6101 et seq.); all provisions required by the implementing regulations of the
Department of Agriculture; Department of Justice Enforcement Guidelines, , 28 C.F.R. Parts 50.3
and 42; and FNS directives and guidelines, to the effect that, no person shall, on the grounds of
race, color, national origin, sex, age, or disability, be excluded from participation in, be denied
benefits of, or otherwise be subject to discrimination under any program or activity for which the
program applicant receives Federal financial assistance from FNS; and hereby gives assurance that
it will immediately take measures necessary to effectuate this agreement.
Contractor agrees to compile data, maintain records, and submit reports as required, to
permit effective enforcement of the above Acts and permit authorized TDA and USDA personnel
during normal working hours to review such records, books, and accounts as needed to ascertain
compliance with the above Acts. If there are any violations of this assurance, TDA and the
Department of Agriculture 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 USDA. The person or persons
whose signatures appear on this Agreement are authorized to sign this assurance on the behalf of the
Contractor.
15
EXHIBIT C
CIVIL RIGHTS POLICY COMPLIANCE FOR
CACFP AND SFSP
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, to the effect that, no person in the United States shall, on
the ground of race, color, national origin, age, sex, or disability be excluded from participation in,
be denied the benefits of, or be otherwise subject to discrimination under any program or activity
for which the Program applicant received Federal financial assistance from USDA; and hereby
gives assurance that it will immediately take any measures necessary to fulfill this agreement.
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 that 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 service to the recipient, or any improvements made with Federal
financial assistance extended to the Program applicant by USDA. 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 representations and
agreements made in this assurance.
By accepting this assurance, Contractor agrees to compile data, maintain records, and submit
reports as required, to permit effective enforcement of nondiscrimination laws and permit
authorized TDA and USDA personnel during hours of program operation to review such records,
books, and accounts as needed to ascertain compliance with the nondiscrimination laws. If there are
any violations of this assurance, TDA and the Department of Agriculture, FNS, shall 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 USDA. The person or persons whose signatures appear below are authorized to sign
this assurance on the behalf of the Contractor.
16
EXHIBIT D
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 12549, 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 ON NEXT 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
/?Ijo" <31,4
N of Authorized Representative
Signature
17
PR/Award Number or Project Name
I0-,t�ztv4lorz
Title
Date
Exhibit D (Continued)
Instructions for Certification
1. By signing and submitting this form, the prospective lower tier participant is providing
the certification set out on the form in accordance with these instructions.
2. The certification in this clause is a material representation of fact upon which reliance was
placed when the 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 tiered
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
tiered 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.
6. 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 is not debarred, suspended, ineligible
or voluntarily excluded from that 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 Excluded Parties Lists System (EPLS).
18
Exhibit D (Continued)
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 voluntarily excluded from participation
in this transaction, 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.
19
EXHIBIT E CERTIFICATION REGARDING
LOBBYING
PROCUREMENT
Applicable to Grants, Sub -grants, Cooperative Agreements, and Contracts Exceeding $100,000
in Federal funds.
Submission of this certification is a prerequisite for making or entering into this transaction and
is imposed by section 1352, Title 31, U.S. Code. This certification is a material representation of
fact upon which reliance was placed when this transaction was made or entered into. Any person
who fails to file the required certification shall be subject to a civil penalty of not less than
$10,000 and not more than $100,000 for each such failure.
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal 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, an employee of a
Member of Congress, or any Board Member, officer, or employee of [School] Independent
School District in connection with the awarding of a Federal contract, the making of a Federal
grant, the making of a Federal loan, the entering into a cooperative agreement, and the extension,
continuation, renewal, amendment, or modification of a Federal contract, grant, loan, or
cooperative agreement.
(2) If any funds other than Federal 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, an employee of a Member of
Congress, or any Board Member, officer, or employee of [School] Independent School District in
connection with this Federal grant or cooperative agreement, the undersigned shall complete and
submit Standard Form -LLL, "Disclosure Form to Report Lobbying", in accordance with its
instructions.
(3) The undersigned shall require that the language of this certification be included in the
award documents for all covered sub -awards exceeding $100,000 in Federal funds at all
appropriate tiers and that all sub -recipients shall certify and disclose accordingly.
20
Exhibit E (cont.)
Name/Address of Organization
1-0i �cj W Cc C SCJ
N e/Title of ubmitting Off
Signature Date
r Q
C�vtd 4ct,off,
21
EXHIBIT F
STANDARD FORM -LLL, DISCLOSURE FORM TO REPORT LOBBYING
PROCUREMENT
Disclosure of Lobbying Activities
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
(See next page for public burden disclosure)
Approved byOMB
0348-0046
1. Type of Federal Action:
2. Status of Federal Action:
3. Report Type:
contract
a. bid/offer/application
initial offering
_a.
— b. grant
_b. initial award
_a.
_b. material change
_c. cooperative
_c. post -award
agreement
For Material Change Only:
d. loan
Year Quarter
e. loan guarantee
Date of last report
f. loan insurance
4. Name and Address of Reporting Entity:
5. If Reporting Entity in No. 4 is Sub-awardee, Enter Name &
Address Of Prime:
_Prime
Sub-awardee
_
Tier , if known:
Congressional District, if known:
Congressional District, i known:
6. Federal Department/Agency:
7. Federal Program Name/Description:
CFDA Number, if applicable:
8. Federal Action Number, if known:
9. Award Amount, if known:
10. a. Name and Address of Lobbying
b. Individuals Performing Services
Entity
(Incl. Address if dierent from No. I0a) (last name, first name,
(If individual, last name, first name, MI):
MI):
(Attach continuation sheet(s) if necessary)
22
Exhibit F (Cont.)
11. Amount of Payment (check all that
13. Type of Payment (check all that apply).
apply):
a. retainer
b. one-time fee
$
c. commission
Actual Planned
d. contingent fee
12. Form of Payment (check all that apply):
e. deferred
a. cash
ff, other; specify:
b. in-kind; specify: nature
value
14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including officer(s),
employee(s), or member(s) contacted for Payment Indicated in Item 11:
Attach continuation sheets if necessary)
15. Continuation Sheets attached: Yes
No
16. Information requested through this form is
Signature:
authorized by article 31 U.S.C. section 1352.
Print Name:
This disclosure of lobbying activities is a material
Title:
representation of fact upon which reliance was
Telephone No: Date:
placed by the tier above when this transaction was
made or entered into. This disclosure is required
pursuant to 31 U.S.C. 1352. This information will
be reported to the Congress semi-annually and will
be available for public inspection. Any person
who fails to file the required disclosure shall be
subject to civil penalty of not less than $10,000
and not more than $100,000 for each such failure.
Federal Use Only:
Authorized for Local
Reproduction of
Standard Form — LLL
23
Exhibit F (cont.)
Instructions for Completion of SF -LLL, Disclosure of Lobbying Activities
This disclosure form shall be completed by the reporting entity, whether sub-awardee or prime
Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a
previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each
payment or agreement to make payment to any lobbying entity 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 a covered Federal
action. Use the SF -LLL -A Continuation Sheet for additional information if the space on the
form is inadequate. Complete all items that apply for both the initial filing and material change
report. Refer to the implementing guidance published by the Office of Management and Budget
for additional information.
1. Identify the type of covered Federal Action for which lobbying activity is and/or has been
secured to influence the outcome of a covered Federal Action.
2. Identify the status of the covered Federal Action.
3. Identify the appropriate classification of this report. If this is a follow-up report caused
by a material change to the information previously reported, enter the year and quarter in
which the change occurred. Enter the date of the last previously submitted report by this
reporting entity for this covered Federal Action.
4. Enter the full name, address, city, state and zip code of the reporting entity. Include
Congressional District, if known. Check the appropriate classification of the reporting
entity that designates if it is, or expects to be, a prime or sub -award recipient. Identify the
tier of the sub-awardee, e.g., the first sub-awardee of the prime is the I" tier. Sub -awards
include but are not limited to subcontracts, subgrants, and contract awards under grants.
5. If the organization filing the report in item 4 checks "sub-awardee", then enter the full
name, address, city, state and zip code of the prime Federal recipient. Include
Congressional District, if known.
6. Enter the name of the Federal Agency making the award or loan commitment. Include at
least one organizational level below agency name, if known. For example, Department
of Transportation, United States Coast Guard.
7. Enter the Federal program name or description for the covered Federal Action (item 1).
If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for
grants, cooperative agreements, loans, and loan commitments.
8. Enter the most appropriate Federal identifying number available for the Federal Action
identified in item 1 (e.g., Request for Proposal (RFP) number; Invitation For Bid (IFB)
number; grant announcement number; the contract, grant, or loan award number; the
application proposal control number assigned by the Federal agency). Include prefixes,
e.g., "RFP -DE -90-001."
9. For a covered Federal Action where there has been an award or loan commitment by the
Federal agency, enter the Federal amount of the award/loan commitment for the prime
entity identified in item 4 or 5.
10. (a.) Enter the full name, address, city, state and zip code of the lobbying entity engaged
by the reporting entity identified in item 4 to influence the covered Federal Action.
(b.) Enter the full names of the individual(s) performing services, and include full address
if different from 10 (a). Enter last name, first name, and middle initial (MI).
24
Exhibit F (coot.)
11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting
entity (item 4) to the lobbying entity (item 10). Indicate whether the payment has been
made (actual) or will be made (planned). Check all boxes that apply. If this is a material
change report, enter the cumulative amount of payment made or planned to be made.
12. Check the appropriate box(es). Check all boxes that apply. If payment is made through
an in-kind contribution, specify the nature and value of the in-kind payment.
13. Check the appropriate box(es). Check all boxes that apply. If other, specify nature.
14. Provide a specific and detailed description of the services that the lobbyist has performed,
or will be expected to perform, and the date(s) of any services rendered. Include all
preparatory and related activity, not just time spent in actual contact with Federal
officials. Identify the Federal official(s) or employee(s) contacted or the officer(s),
employee(s), or Member(s) of Congress that were contacted.
15. Check whether or not a SF -LLL -A continuation sheet(s) is attached.
16. The certifying official shall sign and date the form, print his/her name, title, and
telephone number.
Public reporting burden for this collection of information is estimated to average 30 minutes
per response, including 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 the burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden, to the Office of
Management and Budget, Paperwork Reduction Project (0348-0046), Washington, D.C.,
20503.
25
Exhibit G
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 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.)
a) The contractor agrees as follows:
i) 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, respectively, and all regulations and guidelines issued hereunder before the award of
this contract.
ii) 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 was awarded unless and until the EPA eliminates the name of such facility or
facilities from such listing.
iii) 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.
iv) To insert the substance of the provisions of this clause in any nonexempt subcontract,
including this paragraph (a)(4).
b) The terms used in this clause have the following meanings:
i) The term "Air Act" means the Clean Air Act, as amended [41 USC 1857 et seq., as
amended by Public Law 91-604].
ii) The term "Water Act" means Federal Water Pollution Control Act, as amended [33 USC
1251 et seq., as amended by Public Law 92-500].
iii) 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 111(c) or Section 111(d), respectively, of the Air Act [42 USC 1857c-
6(c)(c)] or Section 111(d), respectively, of the Air Act [42 USC 1857c-6(c)(d)], or an
approved implementation procedure under Section 112(d) of the Air Act [42 USC 1857c -
1(d)].
M
Exhibit G (cont.)
iv) 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 government to ensure compliance with
pretreatment regulations, as required by Section 307 of the Water Act [33 USC 1317].
v) The term "compliance" means compliance with clean air or water standards. Compliance
shall also mean 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 in accordance with the requirements of the Air Act or Water
Act and regulations issued pursuant thereto.
vi) 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 utilized in the performance of a contract or subcontracts.
Where a location or site of operations contains or includes more than one building, plant,
installation, or structure, the entire location or site shall be deemed to be a facility except
where the Director, Office of Federal Activities, Environmental Protection Agency,
determines that independent facilities are co -located in one geographical area.
Clean Air and Water Certification
The bidder certifies as follows:
a) Any facility to be utilized in the performance of this proposed contract has ❑, has not ❑
been listed on the Environmental Protection Agency List of Violating Facilities.
b) He will promptly notify the Contracting Officer, prior to award, of the receipt of any
communication from the Director, Office of Federal Activities, U. S. Environmental
Protection Agency, indicating that any facility which he proposes to use for the performance
of the contract is under consideration to be listed on the EPA List of Violating Facilities.
c) He will include substantially this certification, including this paragraph c) in every
nonexempt subcontract.
(Date) Signature of Authorized Representative, Bidder
27
Exhibit H
Schedule of Applicable Laws
I . Contractor shall comply with the mandatory standards and policies relating to
energy efficiency that are contained in the state energy conservation plan issued in compliance
with the Energy Policy and Conservation Act (P.L. 94-163, 89 Stat. 871).
2. Contractor shall comply with Sections 103 and 107 of the Contract Work Hours
and Safety Standards Act (the "Act'), 40 U.S.C. § 327-330, as supplemented by Department of
Labor regulations, 29 CFR Part 5. Under Section 103 of the Act, FSMC shall be required to
compute the wages of every laborer on the basis of a standard workweek of 40 hours. Work in
excess of the standard workweek is permissible provided that the worker is compensated at a rate
of not less than 1 % times the basic rate of pay for all hours worked in excess of 40 hours in any
workweek. Section 107 of the Act provides that no laborer or mechanic shall be required to
work in surroundings or under working conditions, which are unsanitary, hazardous or dangerous
to his health and safety as determined under construction, safety and health standards
promulgated by the Secretary of Labor.
3. Contractor shall comply with Executive Order 11246, entitled Equal Employment
Opportunity, as amended by Executive Order 11375 of October 13, 1967, and as supplemented
in Department of Labor regulations, 41 CFR Part 60.
4. Contractor has signed the Certification Regarding Debarment, Suspension,
Ineligibility, and Voluntary Exclusion, Exhibit D, which is attached herein and is incorporated by
reference and made a part of this Contract. (Reference 7 CFR § 3017.)
5. Contractor has signed the Lobbying Certification, Exhibit E, which is attached
herein and is incorporated and made a part of this Contract. If applicable, FSMC has also
completed and submitted Standard Form -LLL, Disclosure Form to Report Lobbying, Exhibit F
herein, or will complete and submit as required in accordance with its instructions included in
Exhibit F.
6. Contractor shall comply with all applicable standards, orders, or requirements
issued under Section 306 of the Clean Air Act (42 U.S.C. 1857[h]), Section 508 of the Clean
Water Act (33 U.S.C. 1368), Executive Order 11738, and Environmental Protection Agency
(EPA) regulations (40 CFR Part 15), Exhibit G, which is attached herein and is incorporated by
reference and made a part of this Contract.
28
Texas Department of Agriculture January 2016
Page 1 of 10
Summer Food Service Program
Viability, Capability and Accountability (VCA) Checklist
The Texas Department of Agriculture (TDA) requires all private nonprofit organizations applying to
be sponsors in the Summer Food Service Program (SFSP) with TDA to complete the SFSP Viability,
Capability and Accountability (VCA) Checklist.
VCA is a requirement per the SFSP regulations found in 7 Code of Federal Regulations (CFR) Part 225. The
term "contracting entity" or "CE" as used in this document refers to a sponsor of the SFSP. The term
"Program" as used in this document refers to the SFSP.
Private nonprofit organizations applying to be SFSP sponsors must submit all supporting documents
required within this checklist. TDA will review the information submitted in this checklist and all supporting
documentation to assess whether an organization's financial and administrative viability, capability, and
accountability are sufficient to participate in the SFSP as a sponsor.
Instructions:
Read the following document carefully. Answer all questions completely. Add additional pages, as needed.
Submit all supporting documentation that is specified in this document. Submit legible copies of supporting
documentation, not originals. If you already have a CE ID number from TDA, please put that number on
every page of supporting documentation you submit.
It may be helpful to reference the USDA Administrative Guidance for Sponsors and FNS Instruction 796-4,
Rev. 4, Financial Management - Summer Food Service Program for Children.
This checklist is a component of the SFSP application. Submission of this checklist and the required
supporting documentation does not guarantee approval.
Section I — Contractina Entity Information
Contracting Entity's Name (Legal name of organization)
City of Beaumont
CE ID (if known)
01500
Texas Department of Agriculture January 2016
Page 2 of 10
Section II — Organization Background and Eligibility
7 CFR § 225.2 defines a sponsor as "a public or private nonprofit school food authority, a public or private
nonprofit residential summer camp, a unit of local, municipal, county or State government, a public or private
nonprofit college or university currently participating in the National Youth Sports Program (NYSP), or a
private nonprofit organization which develops a special summer or other school vacation program providing
food service similar to that made available to children during the school year under the National School
Lunch and School Breakfast Programs and which is approved to participate in the Program."
I. Check the box which describes the organization and attach the required documentation
as stated below:
❑ A private nonprofit college/university currently participating in the National Youth Sports
Program (NYSP)
❑ A private nonprofit residential summer camp
® Any other type of private nonprofit organization Qh4/C4t�
❑ A church (as stated in IRS Publication 557, Tax -Exempt Status for Your Organization)
Organizations must attach copies of the following documentation:
A. An exemption determination letter from the U.S. Internal Revenue Service, indicating that
the organization is exempt pursuant to § 501(c)(3) of the United States Tax Code.
(Churches do not need to submit this letter.)
Note: There is no Federal requirement that a church provide documentation of its tax-
exempt status. However, TDA may request documentation to verify the tax-exempt status.
B. All that apply:
1. Articles of Incorporation
2. Certificate of Formation
3. Assumed Name Certificate
Texas Department of Agriculture January 2016
Page 3 of 10
Section III – Financial Viability & Financial Management
7 CFR § 225.14(d)(6)(iii) requires "if the sponsor is a private nonprofit organization, it must certify that it
demonstrates that the organization has adequate management and the fiscal capacity to operate the
Program."
USDA FNS Instruction 796-4, Rev. 4, Financial Management - Summer Food Service Program for Children
states: "Financial management includes such activities as budgeting, accounting, costing standards,
management of revenues, management of property, procurement standards, and fiscal audits. Records of
these activities must be supported by source documents to accurately and completely disclose the sources
and applications of funds."
I. A private nonprofit organization must have adequate financial resources to operate the
SFSP on a daily basis, have adequate sources of funds to withstand temporary
interruptions in Program payments and/or fiscal claims against the organization, and
must be able to document its financial viability.
Submit one of the following:
Note: TDA may request additional documentation as needed to determine financial viability.
A. Audited financial statements performed by a Certified Public Accountant (CPA) in an
independent audit conducted within the last two fiscal years; or
B. Twelve months of comprehensive financial statements, to include the following:
• Statement of financial position or statement of net assets — This shows the
assets, liabilities, and net assets of private nonprofit organizations. This report is
commonly known as the balance sheet in the for-profit world.
• Statement of activities or statement of changes in net assets — This reports
the revenue, expenses, gains and losses for a private nonprofit. This report is
commonly known as the income statement in the for-profit world.
• Statement of cash flows — This report has three sections – operating activities,
investing activities, and financing activities.
• Twelve months of all bank statements for all account(s) in the name of the
organization
C. For organizations less than 12 months old — Provide the following financial documentation:
• Statement of financial position or statement of net assets — This shows the
assets, liabilities, and net assets of private nonprofit organizations. This report is
commonly known as the balance sheet in the for-profit world.
• Statement of activities or statement of changes in net assets — This reports
the revenue, expenses, gains and losses for a private non-profit. This report is also
known as the income statement in the for-profit world.
• Comprehensive financial statements and documentation (i.e., cash flow
statements, tax returns) for the amount of time for which the organization has a
financial history.
• Bank statements for all account(s) in the name of the organization for the amount
of time for which the organization has a financial history.
Texas Department of Agriculture
January 2016
Page 4 of 10
Refer to the Summer Feeding Policy & Handbooks page on www.summerfood.org for USDA FNS Instruction
796-4, Rev. 4, Financial Management - Summer Food Service Program for Children and for the current
USDA Administrative Guidance for Sponsors, which include definitions and explanations of allowable
operating costs, allowable administrative costs, and unallowable costs.
II. A private nonprofit organization must have procedures that demonstrate adequate
management of financial operations to ensure fiscal integrity and accountability for all
program funds.
Attach the organization's written procedures for all items A to B:
Procedures must contain, at minimum, the following information:
1. Step by step instructions for each procedure
2. When the procedure is carried out (e.g., the date, or frequency such as daily, weekly, monthly)
3. Pcsition(s) responsible for performing tasks in the procedure
4. How staff will be trained on the procedure(s)
5. When staff will be trained on the procedure(s)
6. Position(s) responsible for ensuring compliance of the procedure
7. When monitoring/review of the procedure takes place (e.g., daily, weekly, biweekly, monthly)
A. Procedure that ensures the integrity and accountability of all Program expenses, by
ensuring Program funds are used for allowable costs and that expenses are
supported by source documents (e.g., receipts, invoices).
B. Procedure that ensures all funds or donations received to operate the SFSP are
documented and credited to the nonurofit food service account.
Ill. Describe below the ornanization's financial management system. Provide a written
explanation that contains, at minimum, the following information:
Note: SFSP sponsors using cash as a method of payment will be required to retain thorough
and detailed records to support all Program transactions. Failure to retain the documents
required by TDA to fully support cash withdrawal transactions may result in adverse actions
including meal disallowances and/or declaration of serious deficiency.
A. The current accounting method (e.g., accrual, cash basis, modified) used to track and
manage financial information
B. How the accounting method will clearly present information on:
1. When a Program cost was incurred (i.e., the date)
2. Where a Program cost was incurred (i.e., the name of business where purchase was
made)
3. What the Program cost was for and in what amount
C. Accounting software used, if applicable
D. Position(s) responsible for developing the budget
E. Position(s) responsible for reviewing and comparing actual expenses against budgeted
amount
F. When reviews of actual expenses against budgeted amounts take place (e.g., daily,
weekly, biweekly, monthly)
G. Position(s) responsible for amending the budget, as needed
Texas Department of Agriculture
Section IV — Administrative Capability
January 2016
Page 5 of 10
7 CFR § 225.14(d)(6)(iii) requires that "if the sponsor is a private nonprofit organization, it must certify that it
demonstrates that the organization has adequate management and the fiscal capacity to operate the
Program."
7 CFR § 225.14(c)(1) states "no applicant sponsor shall be eligible to participate in the Program unless it
demonstrates financial and administrative capability for Program operations and accepts final financial and
administrative responsibility for total Program operations at all sites at which it proposes to conduct a food
service."
7 CFR § 225.14(d)(3) requires that "sponsors which are private nonprofit organizations will only be approved
to administer the Program at sites where they have direct operational control. Operational control means that
the sponsor shall be responsible for: managing site staff, including the hiring, terminating and determining
conditions of employment for site staff; and exercising management control over Program operations at sites
throughout the period of Program participation by performing the functions specified in § 225.15."
Refer to the USDA Administrative Guidance for Sponsors on information regarding personnel duties and
descriptions of responsibilities.
Attach the following documents for all items A to C:
A. Organizational Chart which includes:
1. All positions/titles/board members/officers associated with the Program, including:
a. All management personnel
b. All site personnel and the sites they are designated for
c. All full legal names associated with the positions/titles
d. If applicable: List "Vacant" if personnel not hired yet. See "Hiring Plan" below.
Note: If the same personnel are designated for multiple sites, you must ensure they can
perform their duties at their designated sites during the designated time frame(s).
Note: Your organizational chart must include an adequate number of site personnel to conduct
proposed operations at each site.
B. Hiring Plan (Required only for organizations that do not have all personnel hired yet)
1. Plan for hiring all personnel prior to the first day of service (for all positions listed as
"Vacant" in the organizational chart)
2. Position(s) responsible for hiring personnel
3. When new personnel will receive training
4. Position(s) responsible for training new personnel
C. Organization's Compensation Policy for Program Personnel
1. Rate of pay for each position in the organizational chart
2. Hours of work, including breaks and meal periods
Texas Department of Agriculture
January 2016
Page 6 of 10
II. List all board members and officers and their titles below. Provide each member's full
legal name, a description of their Program duties, and disclose any relationship to other
board members or staff of the organization.
Board
Member/Officer
Title
SFSP Duties
Relationship to other
members or staff of
Name
the organization
Kyle Hays
City Manager
Enter Contact/Policy
Chief Executive Officer
Director of
Parks and
Manage/Supervise Parks and
Ryan Slott
Recreation
recreation Budget
Director
Senior Services
Lynn Huckaby
Coordinator
Supervise Program
Coordinator
Outreach
Administer program, Hire
Deborah Queen, PhD
Coordinator
personnel
Administrator
Recreation
Program
Assistant to Administrator,
Antonia Leger
Assistant
Monitor sites, Enter Data
Assistant
III. Describe how the aovernina board and/or organization's officers will have adequate
oversight of the Program.
Note: The by-laws, or a similar document, must grant program oversight responsibility to the
governing board/officers.
Attachment VCA Viability Capability Accountability
Section IV Administrative
A. Organizational Chart
Director Parks and Recreation: Ryan Slott
Senior Services Coordinator: Lynn Huckaby
Outreach Coordinator/ Administrator: Deborah Queen, PhD
Recreation Program Assistant: Antonia Leger
Summer Food Site Supervisors: 19 hires
1. Cathedral of Faith — Vacant 2 hires pending
2. Perlstein Park - Vacant 2 hires pending
3. Northridge - Vacant 2 hires pending
4. Point North - Vacant 2 hires pending
5. Magnolia - Vacant 2 hires pending
6. Alice Keith Park - Vacant 2 hires pending
7. Sprott Park - Vacant 2 hires pending
8. Robert Park - Vacant 2 hires pending
9. Central Park - Vacant 2 hires pending
B. Hiring Pian
1. The City of Beaumont uses a modern electronic hiring system called NeoGov. All 19
positions will be posted for hiring in March/April. Dr. Queen will review applicants,
submit names to the Human Resources Department for scheduling interviews,
interview, select 19 Summer Food Site Supervisors, submit them to drug and
background testing, begin city and summer food orientation June 9, complete Texas
Department of Agriculture Civil Rights training on June 9, and to have two
employees serving vended meals on June 13 at each site.
C. Organization's Compensation Policy for Program Personnel
1. Rate of Pay
Full time Personnel
Ryan Slott—Director, Salaried
Lynn Hucka by- Senior Services, Salaried
Deborah Queen- Outreach Coordinator, Salaried
Part time Personnel
Antonia Leger- Program Assistant, 12.00 hr.
Summer Food Site Supervisors -Temporary 8.00 hr. for each worker
2. Hours of work: Full time Personnel 40 hr a week
Hours of Work: Program Assistant work 29 hrs. per week and the Summer Food
Site Supervisors @ work 20 hrs. a week.
II. and III. See attached document page 6.
Section V Program Accountability
City of Beaumont Procedures for items A—E
Part 1 Creation of Records/ Documentation
• A. Number of Meals Ordered daily
The beginning number ordered is set by last year's records. Site supervisors turn in daily
records and lunches are adjusted daily with the vender. Day Cares and other group
leaders of children are encouraged to call 1 week prior to their adding a large number to
one of the park counts.
• B. Records
Use standard forms provided in TDA materials and training. Staff development on filling
forms out occurs during initial training and is critiqued and coached for accuracy at
weekly y staff meetings. Site Supervisors are asked to redo and sign new forms if
incorrectly done.
• C. Time Reports / Operating Personnel
Timesheets provided from the website are used, filed, shared with the financial
department for payment and filed.
• D. Time Reports/ Administrative Personnel
Timesheets provided from the website are used, filed, shared with the financial
department for payment and filed.
• E. Camp/ Closed Enrolled
All sites Open Sites
Part II Storage and Record Retention
• A. Retention — 3 years
• B. Organization — We create a binder with key papers. We use a labeled storage box with all the
file folders which are used in the office all summer. The binger is often requested by the grants
department when they perform their audit or have reason to review the program.
• C. Storage Location -Best Years Senior Center 780 South 4`h Street, Beaumont, Tx 77701
• D. How - In the Summer they are housed in the Summer Food Office. At the close of the
program the large storage container is moved to a locked storage area in the building. The
binder is kept in the Outreach Coordinator's office for easy access and referral.
• E. Authorized Access- Senior Services Coordinator, Outreach Coordinator, Program Assistant,
Finance Grants Officer, Purchasing Officer.
Texas Department of Agriculture January 2016
Page 7 of 10
Part III Debt
• The City of Beaumont does not participate in the advanced payments program.
Section III -Financial Viability & Financial Management
(A) An audit for the fiscal year 2015 will be submitted as it become available.
II. (A) The City of Beaumont's Grants division has a clerk assigned to handle the Summer Food
Program. The clerk is assigned with monitoring expenses and revenues received. The expenses are
analyzed on a monthly basis to ensure that only allowable costs are applied towards grant. If an
unallowable cost(s) is/are found then those costs are removed from the Summer Food Program and
charged to the appropriate general fund account. Program staff is notified of the issue and made aware
of the unallowable cost(s). More information see Financial Policies and Grant Procedures.
(B) The City of Beaumont has a specific revenue account set up specifically forthe Summer
Food Program. All reimbursements are deposited to the account specified for the Summer Food
Program. A copy of the actual check and receipt are sent to the Grants division for their files. More
information see Financial Policies and Grant Procedures.
III. (A) -(G) The City of Beaumont has a separate set of account numbers set up specifically for the
Summer Food Program. These account numbers have been set up to track all expenses and revenues
received for the Summer Food Program. Account activity listings are ran and analyzed monthly to
ensure that program funds have been expended and to provide up to date dollar amounts to the
Program Coordinator if needed. The Grants division tracks the expenses on a monthly basis as well as
the revenues. If expenses exceed revenues received/reimbursed the excess expenses are then moved
to the City of Beaumont's general fund to cover the remaining costs of the Summer Food Program.
(B) -(G) The current accounting method, the system used to track/manage financial -related
information, the position responsible for developing and executing the organization's operating budget
and the position responsible for developing and executing the organization's administrative budget
would require additional information which can be found under Financial Policies on the city's website
at http://beaumonttexas.gov/departments/finance/ and click on comprehensive annual financial report.
Texas Department of Agriculture
Section V — Program Accountability
January 2016
Page 8 of 10
7 CFR § 225.15(b)(3) states that "sponsors shall plan for and prepare or order meals on the basis of
participation trends with the objective of providing only one meal per child at each meal service. The sponsor
shall make the adiustments necessary to achieve this objective using the results from its monitoring of sites."
7 CFR § 225.15(c) states that "sponsors shall maintain accurate records which justify all costs and meals
claimed. Failure to maintain such records may be grounds for denial of reimbursement for meals served
and/or administrative costs claimed during the period covered by the records in question. The sponsor's
records shall be available at all times for inspection and audit ... for a period of three years following the date
of submission of the final claim for reimbursement for the fiscal year."
7 CFR § 225.6(e)(14) states that 'records shall be retained for a period of 3 years after the end of the fiscal
year to which they pertain, unless audit or investigative findings have not been resolved, in which case the
records shall be retained until all issues raised by the audit or investigation have been resolved."
7 CFR § 225.12(a) states that "the State agency shall disallow any portion of a claim for reimbursement and
recover any payment to a sponsor not properly payable under this part, except as provided for in §225.10(c).
State agencies may consider claims for reimbursement not properly payable if a sponsor's records do not
justify all costs and meals claimed. However, the State agency shall notify the sponsor of the reasons for any
disallowance or demand for repayment."
7 CFR § 225.9(c)(7) states that "upon demand of the State agency, sponsors shall repay any advance
Program payments in excess of the amount cited on a valid claim for reimbursement."
Attach the organization's procedures for all items A to E.
Procedures must contain, at minimum, the following information:
1. Step by step instructions for each procedure
2. When the procedure is carried out (e.g., the date, or frequency such as daily , weekly,
monthly)
3. Position(s) responsible for performing tasks in the procedure
4. How staff will be trained on the procedure(s)
5. When staff will be trained on the procedure(s)
6. Position(s) responsible for ensuring compliance of the procedure
7. When monitoring/review of the procedure takes place (e.g., daily, weekly, biweekly, monthly)
A. Procedure that ensures the number of meals prepared or ordered during the
Program will be adiusted as needed to provide only one meal per child at each meal
service.
B. Procedure that ensures complete and accurate records of original daily site meal
counts are kept in an organized manner.
C. Procedure that ensures complete and accurate records of operating personnel time
distribution reports are kept in an organized manner.
D. Procedure that ensures complete and accurate records of administrative personnel
time distribution reports are kept in an organized manner.
E. If organization has camp and/or closed -enrolled sites: Procedure that ensures
complete and accurate records of eligibility forms are kept in an organized manner.
Texas Department of Agriculture
January 2016
Page 9 of 10
II. Describe the record retention plan which details how Program records are secured and
stored to be available for review when needed. Provide a written explanation that
contains, at minimum, the following information:
A. Method to ensure original records are kept for three years after Program year end, or
longer, if required
B. Method to ensure original records are organized and available on-site for review when
needed
C. Where original records will be stored
D. How original records will be secured
E. Position(s) which have authorized access to original records
III. Describe in detail the organization's plan to repay any debt owed to TDA. Provide a
written plan that contains, at minimum, the following information:
Note: Debt owed to TDA can occur due to organizations receiving advance payments greater
than their reimbursement claims and/or TDA's recoupment of funds.
Note: Unpaid debts are turned over to the Texas Attorney General's office for collection.
A. Step by step plan for repaying debt owed to TDA
B. Position(s) responsible for repaying debt owed to TDA
C. Funds to be used to in order to repay debt owed to TDA. Note: Funds from other USDA
Child Nutrition Programs cannot be used for repayment of debt or unallowable costs.
Texas Department of Agriculture
Section VI — Certification
January 2016
Page 10 of 10
I certify under penalty of perjury that the information submitted on this form and all information
submitted on supporting documentation is true and correct. I further attest that I will promptly
report to the Texas Department of Agriculture any substantive changes that occur to the
information submitted. I understand that this information is being given in connection with receipt
of federal funds. I understand that the Texas Department of Agriculture may verify information
submitted here and may ask for additional information. t understand that the deliberate
misrepresentation of information will subject me to prosecution under applicable federal
and state criminal statutes.
1
Signature of Autho - epresentative
Ryan Slott
Date
Printed Name of Authorized Representative Title
Director of Parks & Rec.