HomeMy WebLinkAboutEXHIBIT 6BUREAU 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: S-576
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.
5.
2.
6.
3.
7.
4.
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 sample form is included that you may use to collect information from principals on which to base your
certification.)
Signature of Chairman of the Board, President, Owner, Date
or Delegated Authority -
Pedro G. Hernandez,, City Manager
NOTE: Any organization or individual 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.