HomeMy WebLinkAboutSummer Food Service ProgramFLORIDA, DEPARTMENT OF EDUCATION
FOOD AND NUTRITION MANAGEMENT
SUMMER FOOD SERVICE PROGRAM FOR CHILDREN
_SFSP TNTERNALCON
Federal and state requirements mandate that SFSP participants maintain any information pertaining to the program
for three (3) years plus the current fiscal year. Failure to retain records is a serious deficiency. Refer to SFSP
Administrative Guidance, Chapter 5 and 7 CFR 225.6 on regulations pertaining to recordkeeping regulations.
SFSP records. Also give the name and
office
or (786) 385-5295
Please list the name and address of the location where you will maintain
the phone number of the individual(s) who can access these records:
City of Miami,Parks and Recreation MRC. Building,Main
location 444 SW 2 Avenue 8 flood. .
Contact person: Gwendolyn Kitchen (305) 416-1308
i
office"):
Room Middle
Give the specific location of the files (i.e., "in the file cabinet in the director's
tl
MRC. Building, 8 Floor Recreation DepartmentFile
Row Second and Third Files Cabinets West Wall.
® Yes ❑ No
Will ALL records be maintained at the location above?
are stored:
If No, please list additional details about what years and where records
,� No
Have you previously participate in the SFSP in any states other than
Florida?
If Yes, please indicate the other state(s) you currently have programs:
Yes E No
Do you participate in any other program(s) in Florida or any otber
state(s)? (Le. NSLP, SBP, etc.)
If Yes, please indicate the other program(s) and state(s) you currently participate:
SFSP records for three years, plus
than three years.
I understand that if I no longer participate in the SFSP, I must still maintain
the current -year. -If an audit -is being -conducted, -I -will maintain-the-recordsionger
Yes
Signature of the City Manager
Authorized Person Date
1 1 Pll lYIP. n
C+P.011 171 A
,11
FLORIDA DEPARTMENT OF )EDUCATION
SCIIOOL BUSINESS SERVICES
FOOL) ANI) NUTRITiON MANAGEMENT
CNP Florida Si_ner/User Authorization Form
!6111
S onsor Name
Conn. /Dlstlict
h lnalldd►es"s !�
Tele 'Ptune lmbei
Cij1.,
of Miami Parks/Rec.
Dade County
gkitchen@ci.miami.fl.us
(305) 416-1308
'.Foo
1 ern•tce 1\iipagement Company (FSitC)
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assog,
lease note: Food Service 1vlanagement Company (FSMC) employees are not permitted access to the CNP Florida system.)
,
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• type or print the names and titles of employees/administrators authorized to electronically submit Applications or I\4onthly Claims for Reimbursement
: ted with participation in the federal Child Nutrition Programs. If you have a contract with a FSMC, please list above.
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'Gwendolyn Kitchen U4-U899
'Assistant
Superintendent
:I: •kitchen@ci.miami.f .us
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r. y authorize the above users to submit information on behalf of the sponsor noted above. Gtformation submitted is true and correct and provided in connection with the receipt of Federal fii
t ? LETE USER Access should be assigned very carefully. It is the responsibility of the Food Service Director or their Assigned Delegate
of the City Manager
I
Typ
3 r Print Name of Chief Administrative Officer Title of Chief Administrative Officer
Sig
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Ad
ure of Chief' Administrative Officer Date Signed
NI) Mail to: (850) 245-9276 or Florida Department of Education, Food and Nutrition Management, 325 W. Gaines Street, Suite 1024, Tallahassee, FL 32399-04
1 01 12/1
i
FLORIDA DEPARTMENT OF EDUCATION
FOOD AND NUTRITION MANAGEMENT
SUMMER FOOD SERVICE PROGRAM
FREE MEAL POLICY STATEMENT
rneCity of Miami Parks and Recreation Dept Agreement Number: O. -0899
assures Food and Nutrition Management Services that all children in attendance are served the
same meal(s) at no separate charge, regardless of race, color, sex, disability, age or national origin,
and there is no discrimination in the course of the food service. There will also be no overt
identification of the recipients.
Assurance is hereby given that we made available to the informational media serving the area(s)
from which our Institution draws its attendance, a public release announcing the policy as stated
above.
Assurance is also given that reimbursement will be claimed on the basis of enrolled children whose
family size and income falls within the Secretary's family and income standards for reduced price
school meals.
The program is similar to the National School Lunch Program. It provides nutritionally balanced
meals to needy children regardless of race, color, sex, disability, age, or national origin during
summer vacation when school breakfasts and lunches are not available. Children 18 years old and
younger who qualify for free or reduced price breakfasts and/or lunch during the regular school year
and children who are members of a household receiving food stamps, TANF or FDPIR benefits may
receive their meals at no charge. Each child must submit an Income Eligibility Application. The
eligibility standards used will conform to the Secretary's family size and income standards for
reduced priced meals.
Under provisions of Title 7 part 225.6 Code of Federal Regulations, you are permitted to appeal a
denial of an application for free meals. A hearing procedure has been adopted by our agency to
assist you in conducting your appeal. If you request a hearing, your child shall continue to receive
free meals until a decision in rendered.
Describe a method or methods to be used in accepting application(s) from families for program
meals. Such methods must ensure that households are permitted to apply on behalf of children who
are members of households receiving food stamp, TANF or FDPIR benefits using the categorical
eligibility procedures described in 7 CFR 225.15.
The City of Miami Department of Parks and Recreation will be using the
Income Eligibility Guideline Form for the year 2011 with family size and
yearly income similar to the Free and Reduce Price Meals Form Dade County
School issue to parents recieving Food Stamps or Tang.
Signature of the City Manager
Signature of Sponsor Representative
Signature of State Representative
C. Cr, Q )
Date
FLORIDA DEPARTMENT OF EDUCATION
FOOD AND NUTRITION MANAGEMENT
,SUMMFE E_ppn SFFRUI.GE..PROGRAM..F_OR CHILDREN
The City of Miami,Parks and Rec. Agreement Number: D4- 0R99
assures Food and Nutrition Management Services that all children in attendance are
served the same meal(s) at no charge, regardless of race, color, sex, disability, age or
national origin, and there is no discrimination in the course of the food service.
Assurance is hereby given that we made available to the informational media serving the
area(s) from which our Institution draws its attendance, a public release announcing the
policy as stated above.
Signature of the City Manager
Signature of Sponsor Representative Date
Signature of State Representative Date
Summer Food Service Program
New Site Information
IQ-
n ernaa seem,
'I -have -checked -the -following -sources- or --
the attached new site (s) Yes No N/A
Child Care Centers List _ _ CNP Report SFSRP 2032
Closed Charters School List
Site Manager — —
USDA National Disqualified List
Online Map (Le. Map Quest for site
proximity)
Internal Use Only
Date
Site Number
Agreement Number: 04- 0 8 9 9
Sponsor Name: City of Miami Department of Parks and Receration
New Site Name: T,i the Haiti Cultural Center
School Residential Camp
Check Site Type: X ( Recreation
Migrant I Church I I Homeless
Day Care — NYSP
Street Address: 260 NE 59th Street Florida
County
City: Miami
Phone: 3b5/ 964-2969
E-mail: gkittxhen @ci . mi ami . f l . us
Non -Residential Camp
CROP
Upward Bound
Zip: 33137
Today's Date: 01 / 03 / 11
Name/Title of Person Adding Site: RASHA Cameau/Fac1i vTManaQer
ct Other (specify):
How will you determine eligibility? x Survey 3
Name of qualifying school: Gertrude K. Edeman/Sabal PalmElementary School
NOTE: This form can be faxed or emailed to your Program Representative. If you choose to
submit this form to our office via e-mail, you will receive an e-mail confirmation that your form has
been received and is being processed.
REMINDER: Once your new site name has been added to the system a program representative will
email you the site number. Once verified by you, you can complete the site application process for
the new site(s). This site application should must
hautoved by te Sate e any questionstplease contact yourprior omeals
program
served and claimed at this site. If you
representative at 1/800-504-6609 or via e-mail. 245-9276 or Via e-mail:
Submit form Via fax (850)
Julie.Wilkinson@fldoe.orq Region 1
Wendy.Rude@fldoe.orq Region 2
Lisbeth.RYtiewski@fldoe.org Region 3
Lori.Ciszak@fldoe.orq Region 4
Awilda.Font@fldoe.orq Region 5
SFSP-A15
Craia,Clemmer@fldoe.orq Region 6
Brenda.Dekle@fldoe.orq Region 7
Lisamarie Church@fldoe.org Region 8
Abbey.5tewart@fIdoe.orq Region 9
Revised
nc 1,14 inns n
Has Ibis sale been under another sponsor? Yes
hstinuuui numl)er oi`children the silo could serve:
Est
matey
12cquircruenL•
--r\lic;1-h�;-rrmhlc,.,d'pi rji IcrtJtc.
bcl.innutg of ('rogranr 17pernlion
nl this site,. :1 grimy taus( lie provided
la IheStilt c,I(;enr.y.
Name ul spr)nsur r:pre:tenni
hI,OItILJA L)( 1'AI< 1 Vi • I'i I ,r ci ,, .,� ,
E000 A bl D h! LI:1'ILL1.1111\l3fv1 ENT
S 'MINA ER I:l)OC) ,5FsR VILE PR Wirt API
SPONSOR I'RC!;-OI'I?ftA'I'IONAL,Sf'1'1?,VIS('1' Site Number
Little -Haiti. Cultural Center
Sale Nona;
A�rcunlcnl ht
ether
, Gwen Kitchen
Type of Site: (Check noel
X f(ecrention Centel irk
( hIIrch
Community Center
Name ufpt:min imcrviewocRasha Cameau
!'osirinn Idle: Facility Manager
School (Public,
Sehool (Private)
I-Inusing Development
Discs the site Deceive meals or fiends from any other source (i.e., D(.)l-f) lily meals'?
or Ni X ftycs, Ilse sponsor was
lumber of personnel needed to supervise site:
Number of personnel sponsor plans in have at site:
6 lines silo have ((;heck if"ves")
X Sheller
X Refrigeration (all meals)
7.
X Refrigeration (leftovers)
70
2
2
_'Child Care ! ncilil;'
011icr (Specily)
Tutoring Center
Yes Nn X
Net to keep site records X Place to store. food boxes
Air conditioning X Garbage facilities
Telephone X Resiroam
Are (acuities adequate for an organized meal service? Yes X
No
hat is the site pion to maintain food temperature from delivery to meal service?
Refrigeration/Koolers
). ivfelhnd o!'Men) Service:
I men( Education Authority (LEA) On -site self -preparation X Food Service Management Company (lP$MC)
---Satellite self -preparation ()Hier (Explain)
Ill, is slaffavuilable;it site to receive early deliveries, if vended? Yes What Irmo? 9 : 0 0am
Is this site Within )vahting distance to another tlpprovctl S! .`iP sale**? yes i?yes, how will you ensure children do not receive meals
lore both sites, Strict enrollment for each counselors assigned to a program he o sh
will supervise. -
2. Does sponsor reviewer recommend approval ofsileI Yes X --. No Provide justification to your response below.
The Park located in a Low income area where a FREE FOOD and Nutrition program
is in need during the summer while the kids are out of school.
Signature
lonrire. 'Slums
of the City Man
.`i'gnaturc, ,Silo Supccr:vilol
Rcpreseinativc
01 —03-1 1
f)ne of Visit
Diso-iholion: I-Orir)innl/Sponsor: 2-Yellow/DOS N11 il' SIePfl .1-Pink/Site Supervisor
Julie Wilkinson@fldoe.°1- Region 1
Wendy Rude@fldoe.or_g Region 2
Lisbeth.R tlewskifldoe.ora Region 3
Lori.Ciszak@fldoe.or Region 4
_____Awilda Font@-f-idoe,or--R>;g.io.0 S
SFSP-A15
Summer Food Service Program
--�_ — New Site Information
iot1 _interinal Use Only --
InternalUseOn
I have checked the following sources for
the attached new site (s) Yes No N/A
Child Care Centers List — — CNP Report SFSRP 2032 — _ —
Closed Charters School List
Site Manager — —
USDA National Disqualified List
Online flap (i.e. Map Quest for site
proximity)
Agreement Number:
04- 0899
City Mami
Sponsor Name:
New Site Name:. Miami Learning Center
Check Site Type: X Recreation ❑ School
❑ ❑ Homeless ❑ Day Care ❑
Street Address: 278.0 SW 37't❑venue' Suite 200
❑ Migrant Church
City: Miami
Phone: /
E-mail; .k
•
chi.
T oday's Date: 01 / 03 / 11
Name/Title of Person Adding Site: Census Tract _ Other specify):
How will you determine eligibility? Survey 3 —
Nanw oT Qualifying school: Coconut Grov
This form can be faxed or emai led to your Program Representative. If you choose to
NOTE:
submit this form to our office via e-mail, you will reteive.an e-mail confirmation that your form has
been received and is being processed.
m
ve
REMINDER: Once your new site name has been added to the systethemspeograapplication protests fQ ill
email you the site number. Once verified by you, you can complete
the new site(s). This site application must be approvd by
he ate peaseencyaprio to
program
served and claimed at this site. If you should have any questions,
representative at 1/S00 Submitform Via faxia 245-92 6 or Via e-mail:
Crain Clemmer@fidoe.or Region 6
BrendaDekleC�fldoe.00r Region 7
Lisamarie.Church@fld_e.orG Region 8
Abbey Stewart@fldoe.org Region 9
--Approved-by-- ._..
Date
Site Number
Residential Camp Non -Residential Camp
NYSP CROP — O • ward Bound
v
Zip:
Revised
no?fn innnn
tequirem ent:
Must be completed prior to the
=be irtFZinR-of rogram__Operation
n e-.piney.
FLORIDA DEPARTMENT OF EDUCATION
FOOD AND NUTRITION MANAGEMENT
SUMMER FOOD SERVICE PROGRAM
-.®tee'C�'t�2[ATis1'�A7�S:TTSF Site Numbe__,
04-0899
Agreement Number
Site Name
1. Sponsor'sName::City of Miami /parks
Name of sponsor representative: Goren Kitchen
Address of sponsor food service site.... 2780 SW 37 Ave, Suit
200
Name of person ynterviewed:
Position Title: Aa w,ir ACfvi SUi
2. Type of Site: (Check one)
) Recreation Center/Park
Church
Community Center
School (Public)
School (Private)
Housing Development
3. Does the site receive meals or funds from any other source (i.e., DOH) for meals?
4. Has this site been under another sponsor? Yes
*Child Care Facility
X Other (Specify)
Tiiatoring Center
Yes
or No ?' If yes, the sponsor was
X
5. Estimated number of children the site could serve:
Estimated number of personnel needed to supervise site:
Number of personnel sponsor plans to have at site:
6. Does site have (Check if "yes")
Shelter
Rsirigeration (all meals)
X Refrigeration (leftovers)
33
2
2
Place to keep site records
X
X Telephone
Air conditioning
7. Are facilities adequate for an organized meal service? Yes ?'
No
E. What is the site plan to maintain food temperature from deliver), to meal service?
Y.P�n meple prod in 1Seo1°r or refrfoeratiOP.
9. Method of Meal Service:
Local Education Authority (LEA)
Y>
Place to store food boxes
Garbage facilities
Restroom
On -site self -preparation Food Service Management Company (FS1v1C)
Satellite self -preparation Other (Explain)
10. Is staff available at site to receive early deliveries; if vended? 1 e S
What time?
9:00am
11. is this site within walking distance to another approved SFSP site**? Yes If yes, how will you ensure children do not receive meals
one site is a close site.the site is a open site.
from both sites?
12. Does sponsor reviewer recommend approval of site? Yes X
5
No Provide justification to your response below.
ThP Situ is SPt-ttn ac a T,ttnrinn program
to go home for a nutrition mea4
gnuature of the C2ity ,Manaer
1ri13S ?ra >>nahl c• to leave the site.
Signature, Spstrts6f'Rt:preoetttative
01/03/11
SignaDate of —Visit
SFSP- F9 Distribution: 1-Original/Snonsor: 2-Yellow/DOE SFSP Staff. 3-Pink/Site Supervisor
FLORMA DEPARTMENT OF EDUCATION
41P, Gi3
SUMMER FOOD SERVICE PROGRAM FOR CHI CI) EN
Authorized Signature Form
Sponsor Name: City of Miami Department of Parks and Recreation
Agreement Number: 0 4- 0 8 9 9
Please type or print the names, titles, and signatures of persons authorized to sign the application,
agreements, documents, forms and claim for reimbursement. All authorized signers, authorized
representatives, and program contacts must be legal employees of the institution. These individuals cannot
be FSMC employees.
AUTHORIZED SIGNERS:
Ernest W. Burkeen Director
Type of Print Name
Type or Print Title t SignAture/7
i
Juan A. Paacual Deputy Director
Type of Print Name
Lina R. Blanco
Type of Print Name
Gwendolyn Kitchen
Type of Print Name
Type or Print Title / ' Stmature
per%
Administrative Assistan 111 f � 4I'fli
Type or Print Title ,Signature
Assistant Superintendent 4.4,04 1404-t47
Type or Print Title ,nature
I certify that the persons above are authorized to sign the claim for reimbursement.
AUTHORIZED REPRESENTATIVE:
Signature of the City Manager
Type or Print Name & Title of Authorized Representative Signature of Authorized Representative
Date signed
01,011 ri c
Please return completed compliance
review and supporting documents to:
Food.and Nutrition Management
Isfr{d Depat3menLflf riu tpn _
_326_Wr[Ou s t-R6tinr '9 }
Tallahassee, Florida 32399-0400
Fax: (850)245-9281,SunCam205-9281
Retain a copy for your files.
FLORIDA DEPARTMENT OF EDUCATION
FOOD AND NUTRITION MANAGEMENT
PREAWARD NONDISCRIMINATION -COMPLIANCE
REVIEW FORM
Agreement Number:
Name and 4ddr�ss
W
04-0899
Recreation
Completion of the form is required by FNS instruction 113-
8 issued by the U.S. Department of Agriculture in order to
participate in the Summer Food Service Program for
Children. Failure to complete this form will result in a denial
of the Summer Food Service Program application.
of S onso :
MAven pea8�Cs and
444y
444 SW 2 Avenue 8 Floor
Flnrirla 33130
Miami
I. Estimated Daily Meal Participation
Please Answer the Following Questions:
by Racial/Ethnic Group (Do not list percentages):
Hispanic or
Latino
Not Hispanic
or Latino
TOTAL
White
Black or
African
American
Asian
American Indian
or
Alaskan Native
Native Hawaiian
or Other Pacific
Islander
TOTAL
1,000
340
1,340
420
1,200
45
50
50
3,105
Il. Describe
Children
efforts to be used to assure that minority populations have an equal opportunity to participate:
from the ii'nner-,stclh(ooi•s Aw:11.1. litre ijilit.roduced to the summer food
Program through hand out flyer distributed to feeder school all will be
gr eusly accepted.
III. Describe efforts to be used to contact minority and grassroots organizations about the opportunity to participate:
We will advertises with the local newspaper at various Elementary school
in the inner -City.
your organization:
Federal
tV. List federal agencies other than the U.S. Department of Agriculture that provide financial support to
City of Miami recieve various levels of funding from other
Agencies such as US Hud, The Department of Justic, Department of Labor
and the children Trust.
Signature of the City Manager
Signature of Sponsor Representative
Date Signed
b ,...:.....1 n A / 11 rnn
eVeD e1
FLORIDA DEPARTMENT OF EDUCATION
FOOD AND NUTRITION MANAGEMENT
-ANLEOR.C,H1LDEiEN_
Sponsor Name City of Miami/Rec.
Address 444 S.W. 2 Avenue 8 Floor
Miami Florida
Telephone (305) 41 6-1 308
Residential Camp Yes
Dates of
Encampment
6/9/11 - 8/5/11
Agreement Number 04-0899
Zip Code 33130
Date January 24, 2011
Non-residential Camp
Total Children
Enrolled
3,105
Signature of the City Manager
Number of Children
Eligible for
Reimbursement
3, 1 05
Signature of Sponsor or Representative
SFSP-S4