HomeMy WebLinkAboutExhibit 5Ott
HEALT
Bureau of Child Nutrition Programs
Child Care Food Program
BOARD OF DIRECTORS CERTIFICATION
(Not -For -Profit Independent Child Care Centers, Affiliated Sponsoring Organizations of Child Care Centers,
Affiliated Afterschool Snack Programs, and Homeless Child Nutrition Program Contractors Only)
Authorization Number: A2384
I certify that the following are the board members for the City of Mimi
Name of Organization
If attaching a list of board members, it must include addresses and phone numbers and you must still complete the last two columns below and sign the back of this form.
Mr. Angel Gonzalez commissioner
. in a `as ins commission
Mr. Joe M. Sanchez commissioner
305.250.5430
305.250.5390
Mr. Tomas P. Regalado
commissioner
305.25U.5410
N/A
N/A
Ms. Michelle Spence -
Jones
commissioner
305.250.5390
N/A
N/A
Mr. Ernest Burkeen
Director
305.416.1320-
N/A
N/A
Revised 6/06
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1-029-03
BOARD OF DIRECTORS CERTIFICATION
1. I certify that, if an incorporated institution, this board is in compliance with all applicable state statutes and rules regarding governing boards
of corporations.
2. 1 certify that, as an institution holding federal tax-exempt, not -for -profit status, the board is in compliance the following:
• A majority of the board resides in the geographical area in which the institution is located, as defined below:
a. The urban area adjacent to or surrounding the CCFP institution; or
b. The county/counties in which the CCFP institution is located and the bordering counties.
■ The board has described, in writing, the purpose(s) for which the institution is organized, and provisions for managing the business and
regulating the affairs of the institution.
• Less than 50% of the board has a direct and/or indirect financial interest in the activities of the institution.
• Less than 50% of the board is related by blood or marriage to the institution's personnel or to each other.
■ No board member has been convicted of or found guilty of, or entered a plea of nolo contendere to a felony in any jurisdiction, regardless
of adjudication.
• Board members do not vote on decisions regarding their own compensation.
• Minutes of board meetings are recorded and are available for review.
3. I understand that the submission of false information to the Department of Health is grounds for termination from, or denial of participation in,
the Child Care Food Program as described in 7 CFR Part 226.6(c)2.
City of Miami, A FLorida municipal corporate.
the City of Miami By:
Institution Name Pedro G. Hernandez, City Manager
// Date:
f1i}-4--
signature of Chairman of the Bd, President,
"or Delegated Authority
Mr. Ernest Burkeen, Jr.
Printed Name of Chairman of the Board, President,
or Delegated Authority
August 8, 2006
Date
Attest:
Priscilla A. Thompson, City Clerk
Date:
Approved as to Form and Correctness:
Jorge L. Fernandez, City Attorney
Date:
Approved as to Insurance Requirements:
LeeAnn Brehm, Risk Management Director
2 Date: