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HomeMy WebLinkAboutEXHIBIT 5�HEALT Bureau of Child Nutrition Programs Child Care Food Program BOARD OF DIRECTORS CERTIFICATION (Private, 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: S-576 I certify that the following are the board members for City of Miami Name of Private, Not -for -Profit Organization f 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. Please see back of form for board criteria. ..wi... . i. ..l .G. N.},: .: '.....,.. 1 `:..a. ,1 1:,> ,., f,.,_• � ..,.,.. i.•i. .. .rX tk•r .l.n...}.t-. .. ., '�.:'4 . . 1.. 4. ,,.. 1... _ s n a:. .. .. ... ..:. , ....... _ ,>!. r'f¢..,. . .. ,'S:. 9. N a: ... kName ofU,ggard Me best ?� u, :nS t i �t.. .1?,. 5 ....r .,. r.,., : %;`.1✓r.. @S5.,S _.L.r1 ., ... �. } ,: t.. .,..E ../4.. 1Y :.,. ,: l e•.. ... '. .,, n b {,t ., , . 4{r .^v •fit '-ii!'J J r . ,, . 4l M ., f .Y .. ,... .<,. . .., . .. ., ;....,. r.t ..::'., .. 5 3 K� 1 >z, Y.. ..:.-, ..i: -. .. ...::....... ..i ...:..Gi. r. tSSJ .. .t ( }3.ti.., 1/ . .,4..• • .... - :r. n. . .. ,. .:: .�. :,,. ,r. a �L}.. � tle..o <, , .. L ,. � .. , 15.. .-. t.. 4, .w ,� i. _� . .. Y. s.,'S?., � , .,•q(�� . :_. Position ; T At c�.: /.::;. P3. a1 ,t '�. ry _eld one ,:.::., ,. v,^ ,.. i _ �� , , �a: ;�Lh. w re'-i4 � 1:.., . .t, -:.t 1 B F x,::.. .,. � � T f �i.rF h. C: ..3: C - .u:.1Y �:�: 'sF i' �'.. ,., n ti• : r. 1.....' tlL,.. , . r- . ,: -� . ; s q f 4...i 7 i .t .•,ir zl r .._r. r. ? ,..' w 1.1, -.A. t .. .. .. . �+, tr 'f-'f } t, n.„�, 11.y..t✓.t -i.*a i• ` i .: t •rP>. _ r..J _ .�. �.. ,• _>_ _ nr.r ..:._.1._ -� ...t�. , t..... ... _..,.... ... ._ ,.. ,, . ,.. .. .. .4 T�j rg}rY' u :. ,v 1y+ 3., :. x •. -.x? - s...}: yp -i �.. .h. ,4 �. . A. �`ar.. a . ! 1 f.. .. ...vjj 7 1 : .s... r, :t•. ,& . >. ... �?...r 4 � -�>. f7. Ta '�... .:Y. ri'. ,i d} .. Y'�,. .. i , .... .t. -hc ,7 4... , t. ''3:. . a:. ..i.. i:. a. , ,. -, ... f .,, .. .. <?.' t re. F.: ., ..._ :. .,.. a ( + t P ..tf . T ,5.�Y.0 .v .•. F>.t ., �. ,. - # . �... `,. ,._,r r ..., s in. :,TbPC..k xf !•�-cb.i ,. . .:,. .. ,. f;:1' '.;. ..., �x i+.: ... >.e i}... 1 a .. .. t1°: # r :.t$'.} ,.rJ;sfw.-.. ,t:�.... _-fx ;,,.,a_,•, .t /l {. , ; .y,C .,� 3 2a:..., .:. ..y �.. a.. ,Resid; Yr #� , once Address andtCo' ntV ,isr '.P "� 1 :..,-. .YI ::� ! a .. .. :!;•,._ t o ,,�.,� �,, ,,, r 4 3.- ..w .. kr`o, w... ... ._ p.tr .:- .. ,tc. :.. «u,. .., f.,� } ... i, .&: . 1.. ,a.. :..rt.} .rf ., r.•,. o.. :rtr ii .,ia.,- h - :1.... ,14' . .. r_. 1r.i ( - ,..uA - .. <�,.1 r ,. �x.- ,,� �.: • � �� , , s ,.5":, .+. !.. :.�_� �_. iY . ni„1�.r i 6,-..�; 1. ..,, _.. y;,.. " .. .5, Ls .. ..r. r.... {£.�.7 t1 +�. { �c S � tY" tr, 11SC 1 t Y -�'i d!Y '}.. .. {-� A... ...., ri ..... .L,t... .ri ,v ). 3 :. 7 rr _a a. S s: ,, : , ... ,,. ,, ✓•r .. ! +m.. r.X. ... } r...::fx ,n 1. M ,., 't M Lh . r^ Nk�e .,e �p -ii. F .. .. .1'..}., i li M .,.-.i.. } v.': }:.. f'r , ,.. - .. �..,.? ., :-Y )- .r, ... sk T•I v,F ,r,:. ..4. •,,:✓. r.1-.:..,.Y .' a '!. I .:'. ,. Y '.:1r1 n� 11 .. S�,••.; !1'i 1 � rl. +l. 9 ..: �'. �`f}'r y��-Y} .S pii f ks t ...i ....:..:. ?•4 e' Jh.r «-, r. v. f �:,':. ,.•{: J. 'j4.r7i1=� H t • y } „l'1 -:t: iF >}... �., t n� .:.., ...:.. •.:t 1..( r. .. 4 t f ,yt FS " '•.y.) f 1 .._ 3 s ,.}. k 'L v ( sx:F( ' ! 1W f . .,{ .r S, is f 1 .. s. ..al:. <„ GD. ... ,i, .r .. 5. Yf4 t ltll! .l- ( , . , t�� ,. , ..,.. . r.'`i..,r I -.1 3) , "f- :.,, C n. 4 } S I ,, r: " .:!. ; _. „ S, . 4d....= ;. .:r r Phone Numbe yy ,:... t..... jr e . 1 :T.-,P .� ... � . .. , a r ,.,l. ll 2kx .1't. .3 1. f -..1 t [ ,..3. .. 1 [ ..: ..:, : !.•,:. A jJF. , a < i3'.. '. .Yr F:.'V.: 1 ' rtl xA�7,4�. xi,'L -.`24 i- ,c" n Fn,. '.1 4-1. iln � F ancial r , .:� rp is - «,.lute e , r st In l,;r .�xy ,i•i,r - i Or - •':: ,r g /Ct > a •'o Vim/. ep�'of or t�� >: Y 9 ,.. �. . 4'H{ .. C ' enter ,etC �. I '..i:. 3 Yes! J Famil r; -Relation hi , to Institution s . or> Other Board '. ,, n,nn embers FY • • • • Revised 5/08 1 of 2 ' 1-029-05