HomeMy WebLinkAboutapplication for participationRebid w !o:
Florida Depwiment of edoemOse
_
Food and rbttrremr it
325 W. Gain.. au..4 Wean fps
Tiiiihaseis. r=WWOWS
sm.-eo....oa
Fiscal Year: 2004
FLORIDA DEPARTMLe1T OF EDUCATION
FOOD AND NUTRITION MANAGEMENT
SUMMER FOOD SERVICE PROGRAM FOR CHILDREN
APPLICATION FOR PARTICIPATION
Agreement Number: 0 4 - 0'8 9 9 -
TerealnMad pale:
FEID Number:
--- -- �2 Type of Sponsor � Admin. Personnel:Number-_ r--�---.-..
4. Average
Name: i ty o-f Nil ami. Dubuc School FoodA °f of Operating
Address: 4 4 4 S W 2 Avenue 0 Nonprofit Private School • a. fAdministrator a.Breakfast Ell
Drys
City: iami 33 0 t �E l "1-
�'• r __ (iGover,mt li:-c�rrada_. Santi go B.ilkrnrbarofslles
Phone: 4 X 6- 3 Ext: [) Pub Ras Title:!Director b. A1A supplementMIder>tial Camp _- - -� L2 g
Fax: (305 ) 416 �2 J �5 4 �.) Pvt Residential
�p b• Program Director.- c. Lunch- iA 5 2 5
-
StreetAddress: Summer.
_ A,4-...I SW 2 Avenue Ci No' ttPvtOM. _ - _ _
_ - !! 525 T.
County: Dade .. _ -1 SUNCOM_ _ .... _ ! (_ ) Pub NYSP wen Ki t c h e n� d. PM Supplement
Snail:_gkitchen@ci.miami_.f] r(_ From: E140
NY8P Title' -P inner e. Supper
8. Administrative Cost
a3
Mgmt. Salaries -'_ --.. -_- W. Operational Reimbursement Ma Rate) 11. Administrative Reimbursement (Max. Rate)
L , 2. 0 0-- -- li• Office Supplies [7 0 0 0 0J Total Meals Rae Total Total Meals Rate Total
b. Monitor Salaries 18., 0 Q 0 h Audit Fees $ p 0 _ 0 0 a. Brkfast x 0 _ - a. &kfast
c Clerical salmi1,1.�) I L. 1 -- o- ) C:a--- x 114 122 = 0= r
. 0 0 L Legal Fees 1 0 J b. Lunch 7..6, , 4 2 . 4 _ 5, 3� b. Lunch d. Transportation f9 J 0 7 4 �, Other — _ _ -----_ __] �17.6 L4 7 [210� 3 7 , 0 5 9� 5
e. Communication f I 0.0.0: Sphnnt - 81, .3 _. 5 6�= 101, 5 5 6 + c. Splmnt 1181,-3 PR �0 5 01=1 4 ;9_z4 , )
Il , o o. o- tSp y L - -- _._ o —] d. supper 0 x e _-0 -::: -- a.
f. Rental Off. Space 1
0 _] TOTAL 26, 5741�._ L _— �_- - �_. x ... o...�-`0 ._
--- - -� � .. -- � �-- -- �--....- -- ---- -- -�— '[oTALL 52�, --- • . 00
i'OTAL�7 , 0 3 4 ]
9.Dperall6wreojCost -.-
12. urse ant Protected 13. Describe plans to WsIL review 14. Docunren f actin taken to alive
4 7; 2 5 2 a. Administrative 7 a 3 4 monitor sites school food service for meals
��5.7,.6D0� b. Operational 26, 860 All sites will Dade Countyschool are
9 074 ] TOTAL 73 894 be visited byarea
_ interest in the food
7--'---- monitor and Supervisor service program.
= 0 _ ! 15. Sponsor Training for Personnel 16 Request for Advance Funds 17. ALL Sites are
Dates Number Attending JJ June Advance Request
0-22411 ltTi IA Jtdy Advance Request
1. Name and Nailing Address of Sponsor
a. Food
b. Labor
c. Transportation
e. Nonfood Supplies
(.Other -[.0,
(Specify)
TOTAL [511, - 2 6
18. Sponsor Handbook has been
received and read
«� Yes (*I No
SFSP-F9
19. Do you receive over 9300000 in funds from air --- 20. ponsor Signature :
federal Sources annually ?
00 Yes r7 No
DOE Page 1 of 2
a Self -Preparation kr} Yes
b• Rural C Yes
c. Self-Prep/Rural Yes
Print Date:
m:
Enoch. D.prt n.nt of Education
"Food and!Md0on Yampm.nt
ZMWelimmftwitAcomillIM
Tallahanea. Florida 3239a0400
7..,V
Fiscal Year.
P001
FLORIDA DEPARTMiiii OF EDUCATION
FOOD AND NUTRITION MANAGEMENT
SUMMER FOOD SERVICE PROGRAM FOR CHILDREN
APPLICATION FOR PARTICIPATION
2
Agreement Number: 0 4— 8 9 9
Terminated Date:
FEID Number.
Instructions: List, by position, all administrative personnel. If volunteer or paid from other sources, insert 0 in column C. Combine like positions on
one line. Positions will include site monitors, clerks, and the administrator. To calculate(f), multiply (b) * (c) * (d) * (e).
21. List By Position All Administrative Personnel
Title of
Position
(a)
Supervisor
Monitors
Clerk
instructions:
NO. in
Position
(b)
4
1
Wage i HR
Salaries and Fringe
(c)
12.00
10=00
8.00
Hours Worked
Per Day
(d)
7
5
5
Total NO.
Days Worked
(e)
40
Total Wages
Gross Wages
Salaries and Fringe
(f)
4,200.00
8_,_0Q0.--
_,800 -
_14_002-
List, by position, all operational personneilf volunteer or paid from other sources, insert 0 in column C. Combine like positions on one
line. Positions will include site supervisors, delivery men, and kitchen production workers. To calculate(f), multiply (b) * (c) * (d) * (e).
22. List By Position All Operational Personnel
Title of .NO. in
Position Position
(ate
s te_ -Moni_tot6_0
Wage i HR
Salaries and Fringe
(c)
8_0 0
Hours Worked
Per Day
(d)
3
Total NO.
Days Worked
(e)
4_0--_ __ .-
Total Wages
Gross Wages
Salaries and Fringe
(0
. __7, 6 w.(1.0-_..
57,600.00
SFSP-F1
EXP 2/28/2002
DOE Page 2 of 2
Print Date:
lib
12/28/00