HomeMy WebLinkAboutEXHIBIT 4Name of Contractor: ,-C\•
`\r" � Authorization Number: S — J-
FY 2008-2009 (Renewal)
Checklist of Materials Required
for Participation in the Child Care Food Program
Sponsoring Organizations of Centers
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. Application (with red -line changes)
2. Budget (with red -line changes)
J 3. Supplemental Budget for Special Cost Items (applicable only if charging/expensing
a special cost item to the CCFP)
4. Management Plan
5. Site Information Forms (with red -line changes)
6. Copies of current child care center licenses - attach to Site Forms
7. Contract with D.O.H. - submit both copies w/original signatures
8. Delegation of Signing Authority (if applicable)
9. Conflict of Interest & Ethics Statement
10. Certification Statement Regarding Business Integrity and Publicly -Funded
Program Compliance
11. Board of Directors Certification Not -for -profit organizations
12. Building for the Future Parent Letter (submit only if not using sample provided)
*Remember a copy must be provided to each parent or posted in each center
I certify that all the enclosed information is true and correct.
Signature of Board Chairman, President, Owner
or Delegated Authority
Pedro G. Hernandez, City Manager
Date
De.,innii C/AA
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