HomeMy WebLinkAboutExhibit 7k
BUREAU OF CHILD NUTRITION PROGRAMS
CHILD CARE FOOD PROGRAM
CERTIFICATION STATEMENT
REGARDING BUSINESS INTEGRITY AND
PUBLICLY FUNDED PROGRAM COMPLIANCE
(Form #1)
Name of Organization: City of Miami
Authorization Number: A-2364
All Child Care Food Program (CCFP) contractors must provide a declaration of eligibility to participate in the
CCFP based on the criteria that the contractor has not been disqualified nor have any of the principals of the
contractor or sponsored affiliated centers been disqualified from any publicly funded program because of a
violation of that program's requirements.."Publicly funded program" means any program or grant funded by
the Federal, State, or local government.
The CCFP contractor is required to report the name of all publicly funded program(s) it has participated' in
within the past seven years and the principals of the CCFP contractor and each sponsored affiliated center.
"Principal" means any individual who holds a management position within, or is an officer of a CCFP contractor
or sponsored affiliated center. Principal includes all members of the CCFP contractor's board of directors or
the sponsored affiliated center's board of directors.
List publicly funded programs (e.g., Child Care Food Program, Social Services Block Grant, Child Care
Development Block Grant) participated in within the past 7 years by: 1) the CCFP contractor; and 2) the
principals of the CCFP contractor and sponsored affiliated centers:
1. Child Care Food Program
5.
2. Summer Food Service Program
3 Child Day Care Food Program -Year -.
round: breakfast, lunch and dinner
4.
6.
7.
8.
To add more publicly funded programs, list on separate page(s).
I certify that the CCFP contractor and principals of the CCFP contractor and sponsored affiliated centers have
not been disqualified from any publicly funded program because of a violation of that program's requirements
within the past seven years. In addition, I certify that neither the CCFP contractor nor any of its principals nor
the principals of its sponsored affiliated centers has been convicted within the past seven years of any activity
that indicated a lack of business integrity, A business -related offense includes fraud, antitrust violations,
embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, receiving
stolen property, making false claims, obstruction of justice, or any other activity indicating a lack of business
integrity.
(A sa 1 e form is included that you may use to collect information from principals on which to base your
certifition.)
Eye /66
S) nature of Chairman o the Board, Pre ' ent, Owner, Date
r Delegated Authority v
See additional CitySignature Attached
NOTE: Any organization or indvidual that provides false information on this form will be subject to applicable
civil or criminal penalties and will be placed on the National Disqualified List.
I-031-03
Authorized pursuant to City of Miami City Commission Resolution
No. adopted , 2006.
City of Miami, A Florida
Attest• municipal corporation
Priscilla A. Thompson Pedro G. Hernandez
City Clerk City Manager
Approved as to Insurance Approved as to Form
Requirements and Correctness
LeeAnn Brehm Jorge L. Fernandez
Risk Management Director City Attorney