HomeMy WebLinkAboutUse Authorization FormFLORIDA DEPARTMENT OF EDUCATION
SCHOOL BUSINESS SERVICES
FOOD AND NUTRITION MANAGEMENT
CNP Flnridn Rianerfticer Anthnrization Fnrm
Sponsor Name
County/District
Eo -mail Address
Telephone
Number
City of Miami Parks & Rec.
Dade County
gkitchen@ci.miami.fl.us
(385) 416;1308
Food Service Management Company (FSMC):
Program Representative: -
(Please note: Food Service Management Company (FSMC) employees are not permitted access to the CNP 'Florida systeI.)
Please type or print the names and titles of employees/administrators authorized to electronically submit Applications or Monthly Claims for Reimbursement
associated Nvith participation in the federal Child Nutrition Programs. If you have a contract with a FSMC, please list above.
Please list Authorized
Name and Title of Security Action Applications i Claims
ALL
to DELETE:
Finance
Employee/Administrator Agreement Sus users from ESE003
(Please Type or Print Clearly) Add Mods Pend $FSP SF
Numbers fy the s stem NS.LP SKIP NSLP S1YIP
;Access Y SSOP SSOP - --
Name:Gwendolyn Kitchen 04-0899
Title: Assistant
i
Superintendent
E-Maili mi ami -F1 IR
Name:
Jose Matas 04-0899
Title:principal Staff Analyt
E -Mail: Imatas@ci.miami.fl.0 I
Name:
Title:
E -Mail:
I hereby authorize the above users to submit information on behalf of the sponsor noted above. Information submitted is true and correct and provided in connection with the receipt ofFeder�l funds
DELETE USER Access should be assigned very carefully. It is the responsibility of the Food Service Director or their Assigned Delegate.
Pedro G.,Hernandez
Type or int ame fofhief Administrativ Officer
�
Icity Manager
Title of Chief Administrative Officer
S�g�iatul h)&Vlninistrative Officer Date Signed
Nlail to: (850) 245-9276 or Florida Department of Education, Food and Nutrition Management, 325 W. Gaines Street, Suite 1024, Tallahassee, FL 323
Adm001 ! 112/15/08