HomeMy WebLinkAboutSFSP Sponsor Pre-OperationalSponsor Name:
Florida Department of Agriculture and Consumer Services
Division of Food, Nutrition and Wellness
SFSP SPONSOR PRE -OPERATIONAL SITE VISIT
City Miami
Site Narne: Coral (;ate Park
Agreement t:
04- 0899
Sponsor RepresentativeGwendolyn Kitchen .
Site Address:1 415 S. W. 3 2 Avenue 3 312 5
Site Number:
Site Contact: Maura Montiel
Position/Title: Park Manager 1
Type of Site (check one):
Recreation Center/Park School (Public) 'Child Care Facility
x
Church School (Private). Other (Specify):
Community Center Housing Deve.loprnent
Does the site receive meals or funds from any other source (i.e., 'DOH)? ❑ 1YES D NO
Has this site been under another sponsor?
❑ YES NO
if YES, who was the sponsor?
Estimated number of children the site
could serve?
(1
Number of personnel sponsor plans
to have at site?
2
Estimated number of personnel
needed to supervise site?
3
Does the site have? (check all that apply):
Shelter =X-- Place to keep site records X Place to store food boxes
Y
Refrigeration (all meals) Air Conditioning v Garbage Fadlities
Y Y
Refrigeration (leftovers) v Telephone , Re_stroom
x --ter— -^z—
Method of Meat Service:
Local Educational Authority Or -site self-p sparation Satellite self -preparation
Food Service Management Company Other -
Y
Is site staff available to receive early deliveries, if
vended? (YES ❑ NO
If YES, what time?
8 : ooam - 5 : 00pm
What is the site plan to maintain food temperature from del very to meal service?
• Kooler or Refrigeration
is this site within walking distance to another approved •
SFSP site? ■ 2YES EaNO
If YES, how will you ensure children do not receive meals
from both sites?
Are facilities adequate for an organized meal service? 2 YES v NO
Does the Sponsor Representatve recommend approval of the site? BYES ■ NO
If NO, explain:
Signature, Sponsor Representative l Signature, Site Supervisor
'i uatn of feecaive funds from Department of 'sans for children et this site.
'An approved SFSP site under your sponsorship or another sponsor.
This form MUST be cc npietsd prior to the etart of pro -gram operations. The s;.-or+sor i'/iUSST provide a copy to the s`nta
agency.
MACS-01929 09/12
J(ty) Date 3�2 -�d 13
Florida Department of Agriculture and Consumer Services
Division of Food, Nutrition and Wellness
SFSP SPONSOR PRE -OPERATIONAL SITE VISIT
ADA1vt H. PUTNAM
COMMISSIONER
Agreement #:
04-0899
Sponsor Name: City of Miami Sponsor Representative:
Site Number:
Site Address: 350 NW 13 Street Miami. FT, 33136
Position/Title:
Site Narrie: Gibson Park
Site Contact: Benj amin Hanks
Park M n03Pr
Type of Site (check one):
School (Public) 'Child Care Facility
X Recreation Center/Park:
School (Private) Other (Specify):
Church
Housing Development
Community Center
Does the site receive meals or funds from any other source (i.e., DOH)? ■ 'YES IE NO
Has this site been under another sponsor? 1
■ YES [1 NO
1f YES, wino was the sponsor?
the t o
Estimated number of children sr.. •
couldSeal r e?
60
F f sponsorplans I
Num.,-r o, personnel
to have at site?
6
Estimated number of personnel
needed to supervise site?
9
Does the site have? (check all that apply):
X Place to keep site records X Place to store food boxes
Shelter
X Air Conditioning X Garbage Facilities
_
X Refrigeration (a!! meals).
X Telephone X Restroorn
Refrigeration (leftover)
Method of Meal Service:
Local Educational Authority On -site self -preparation . Satellite self -preparation
Management Company Other:
X Food Service
Is site staff available to receive early deliveries, if
vended? ❑ YES ❑ NO
If YES, what time?
8:00 AWN
What is the site plan to maintain food temperature from delivery to meal service?
We will keep the meals in a cooler and/or refrigerated .
t
r a•''' ' •a'kin1 dlctanr-, to anntn?r �nnrrwmCi If YES, how will you ensure children do not receive meals
I� i s si,e ti,1,nm w I , g
SFSP site? •❑ `YES ❑X NO
from both sites?
Are facilities adequate for an organized meal service? MC YES ❑ NO
Does the Sponsor Representative recommend approval of the site? la YES ❑ NO
If NO, explain:
Signature, Sponsor Representative
Si„,,ature, Site Su"
'„'ust not receive funds from Department o Health ter
2An approved SFSP site under your sponsorship or another sponsor.
This form MUST be completed prior to the start of program operations. The sponsor MUST provide a copy to the state
agency.
FDACS-01929 09/12