HomeMy WebLinkAboutExhibit 4FLORIDA DSPARTMDU OF
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FY 2009-2010 CUP Renewal
Checklist of Materials Required
SPONSOR OF AFFILIATED CHILD CARE CENTERS
Name of Contractor: City of Miami Day Care Program Authorization Number: S — 576
A. Please answer the following questions:
1. Is your organization a non-profit entity or a non-federal governmental entity that expended
$500,000 or more in federal funds during its most recent fiscal year? Yes No
2. If yes, what is your organization's Fiscal Year end date? Month/ Day: /
B. Send the following materials and this checklist to your Program Specialist for approval.
Please check the items that you have enclosed.
Check (V)
if Enclosed
1. Budget (with red -line changes)
2. Supplemental Budget for Special Cost Items (applicable only if charging/expensing
a special cost item to the CCFP)
3. Management Plan
4. Contract with D.O.H. — submit both copies with original signatures
5. Delegation of Signing Authority (if applicable)
6. Board of Directors Certification — Private, not-for-profit organizations only
I certify that all the enclosed information is true and correct.
Signature of Board Chairman, President, Owner
or Delegated Authority
Date
Pedro G. Hernandez, City.,Manager City Manager
Printed Name Title