HomeMy WebLinkAboutExhibit 3EXHIBIT B — WORK PROGRAM ELDERLY MEALS
1'. SUBRECIPIENT understands that the National Objective is Limited Clientele.
2. SUBRECIPIENT will recruit program participants that meet the following
criteria:
a) Must be a resident of the City of Miami District that funded the program
b) Must be a member of a low -to moderate income household
c) Must be at least 62 years of age
3. SUBRECIPIENT will submit the following information to the City of Miami
Department of Community Development to obtain certification that proposed
participant is eligible to receive program benefits and for SUBRECIPIENT to
invoice the City of Miami for services provided.
a) Program Application, in a form provided by the City of Miami
Department of Community Development, signed by prospective
participant or by legal guardian if prospective participant is incapable of
doing so
b) Proof of residency
c) Proof of income
d) Proof of age
4. SUBRECIPIENT may replace participants who stop receiving program benefits
by providing the information required in 2 above. SUBRECIPIENT will not
invoice the City of Miami until the proposed participant is certified as eligible by
the City of Miami.
5. SUBRECIPIENT will provide:
a) Congregate Meals to participants times per day on the
following days: Monday, _ Tuesday, Wednesday, ^ Thursday,
Friday, _ Saturday, _ Sunday, at the following addresses:
Address:
Meals will be provided for up to a total of program days.
SUBRECIPIENT will provide proof of having provided the congregate
meals to the elderly via the Monthly Report of Clients Served form and
charged to the City of Miami Program.
b) Homebound Meals to participants times per day on the
following days: — Monday, _ Tuesday, Wednesday, _ Thursday,
Friday, _ Saturday, _ Sunday.
Meals will be provided for up to a total of program days.
SUBRECIPIENT will provide proof of having provided the congregate
meals to the elderly via the Monthly Report of Clients Served form and
charged to the City of Miami Program.
6. Program will commence on October 1, 2007 and will end on September 30, 2008.
SIGNED:
Name: Date
Executive Director
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before me this
by ' , Executive Director of [Name of Agency], a
Florida not -for -profit corporation, on behalf of the corporation. He/she is personally
known to me or has produced as identification.
Print Notary Public's Name Signature
(SEAL)