HomeMy WebLinkAboutPre-Award Nondiscriminaiton Compliance Review FormADAM H. PUTNAM
COMMISSIONER
Florida Department of Agriculture and Consumer Services
Division of Food, Nutrition and Wellness
SUMMER FOOD SERVICE PROGRAM FOR CHILDREN
PRE -AWARD NONDISCRIMINATION COMPLIANCE REVIEW FORM
Sections 570.98 - 570.982 F.S.
Rule 5P-1.003, F.A.C.
Agreement Number:
+d
N�a, "Ma?
C;itya of rSam?f
04-0899
Completion of the form is required by FNS Instruction 113-
8 issued by the U.S. Department of Agriculture in order to
8
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.
S�
Parks and Recreation
444 SW 2nd Avenue, 8 floor
Miami . FT. 11__M
I. Estimated Daily Meal Participation
Please Answer the Following Questions:
by Ethnic/Race Group (Do not list percentages):
Hispanic or
Latino
Not Hispanic
or Latino
ETHNIC
TOTAL
White
Black or
African
American
Asian
American Indian
or
Alaskan Native
Native
Hawaiian or
Other Pacific
Islander
RACE
TOTAL
1,100
1,835
2,935
1105
1,205
505
55
65
2,935
I1. Describe efforts to be used to assure that minority populations ha,te an equal opportunity to participate:
Children will be. introduced to the Summer Food Program thrrrnia_i (1„S handing out
of flyers to schools-.
III. Describe efforts to be used to contact minority and grassroots organizations about the opportunity to participate:
We will advertise with local newspapers....
IV. List federal agencies'other than the U.S. Department of Agriculture that provide financial support to your organization:
The City of Miami Parks and •Recrea ;on c not Nava a,,, federal Bran+-s
Signature of Sponsor Representative
CITY MANAGER
Date Signed
Please return completed compliance review and supporting documents to:
Food, Nutrition and Wellness
Florida Department of Agriculture and Consumer Services
600 S. Calhoun St., Ste. 120
Tallahassee, FL 32399
Fax: (850) 617-7402
Retain a copy for your flies.
DACS-01712 -01/12