HomeMy WebLinkAboutChild Care Food Program DelegationOrganization Name: City Of Miami Day Care Programs
Authorization #: 0576
Delegaticin of Signing Authority
for the Child Care Food Program
By means of this letter, I, Daniel J. Alfonso (the Delegating Official, which
is the Board Chairman, Executive Director, President or Majority Owner), delegate the authority herein
described, to Christine T Long (my representative), on the following terms
and conditions:
1. My representative may sign, on niy behalf, any documents pertaining to the Child Care Food
Program (CCFP).
2. The designated effective time period of this delegation is as follows:
a. For a prospective contractor, this delegation will be in effect from the date that the
CCFP application checklist or contract is signed, whichever date occurs earlier,
through September 30, 2016 or until revoked in writing by the delegating official,
whichever date occurs earlier.
b. For a renewing contractor, this delegation will be in effect from the date that the CCFP
Annual Information Update and Certification or contract amendment (when applicable)
is signed, whichever date occurs earlier, through September 30, 2016 or until revoked
in writing by the delegating official, whichever date occurs earlier.
3. The authority delegated is not subject to sub -delegation without my prior and written consent.
4. I understand that this delegation does not relieve me of responsibility to manage and supervise
operation of the Child Care Food Program, that I may be liable for repayment of funds received
and that I may be subject to disqualification from future participation in the Child Care Food
Program should the terms of the contract with DOH for participation in the Child Care Food
Program not be fulfilled.
Delegating Official
Signature (Delegating Official)
Daniel J. Alfonso
Name
City Manager
Acknowledged and agreed by Representative
Signature (Representative)
Christine T Long
Name
Day Care Administrator
Title (Board Chairman, Executive Director, Title
President or Majority Owner)
Date Date
Revised 6/2015 1-132-12
Florida Department of Health: Child Care Food Program Page 1. of 2
ppllw • narinr>t 11a List File rlalm _f2evise Calm view Glalm
'ou have n t clan for
oq 's1lth cl a p(
'EoueO iu(get tor sponsor tiia ec L I
C
Application Information
S- 576 Region: S
RPS:5
Fiscal Year: 2015
Legal Name: CITY OF MIAMI DAY CARE PROGRAMS
D/B/A: CITY OF MIAMI DAY CARE
Other AN#(s):
1) Haler the estimated nonunl Voad Service- (operational) costs to he rhuj god to the Child Care Nod Program.
Food Service
(Operational)
Costs
Funding
CCFP Funds Description from
of Costs Other
Sources
Foocl Purchases $66,723
Food Service
Labor and
Benefits
Non -Contracted
Purchased
Services
Non -Food
Supplies
Food Service
Equipment
Transportation
Other (Includes
Special Cost
Items)
Total Costs
(calculated)
$66,723
re Centers Print Preview a
Name(s)
of Total
Other Funding
Funding
Source(s)
$66,'723
$0
so
$0
$0
$0
$0
$0 $66,723
2) l)ntor the ostlnuded anneal Admioistruiive Costs to tie charged to the Child Caro Pond Program,
Funding
Administrative CCFP Funds Description from
Costs of Costs Other
Sources
Administrative
Salaries and $11,738
Benefits
Non --Contracted
Purchased
Services
Training
Travel
Rent and Utilities
Office Supplies
Other (Includes
Special Cost
Items)
Total
Administrative $11,738
Costs (calculated)
Budget Grand $78,46
Total
Name(s)
of Total
Other Funding Funding
Funding
Sources)
CIILD
$39 CARE $11,777
FEES
$0
$o
so
so
$o
so
$39 $11,777
$39 $78,500
Upload Supporting Document for Applicable Budget
Costs:
Browse„,
!Unload Sunoortina Document for Aoolicahle Bucket Costs:
httnc•//ndniinncr1n111S doh.state.fl.us/CONS/S/SBudaetWorksheet.asnx 9/8/2015
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Florida Department of Health
Child Care Food Program
Pogo 1 of 3
9/14/2016
2:49PM
Child ,Care COntat Site Information
,MOMM.5.50,16.0
- „ Rgon j RPS: 6 Fisoal Year; 2010
Legal Name!
D/B/A:
CITY OF MIAMI DAY CARE PROGRAMS
pity_QUIVI DAY CARE
. t
1 Site Information
Created Data: p4/24/190,5
Sold Date:
Site Numher:
Center Name:
Street Addre$$:
City: I
Phone: ,( 506 ) 769 - 3601
Payment Start Date: 10/01/2014
Termination Date:
21083 Center Nornber:
„EATON 163.1__< D.i,kY CARE.
400 N,E, CI S1RET
2. CCPP Site manager
Salutation: MS, First Name; MARY
Last Updated; 04/.1=016
Initiated 18y:
Last Name: CHARADAN
Title; MANAGER
U.11.1.111.1416.11. Phoro; 5 1 - 0 Ext: Fax: LSO5 ,769 - 3509
3. Type of Center:
For Profit Child Cara Center
For Profit Outside School Hours Cara Center
Head Start / Early Head Start
Military
4. Type of Program;
Outside School Hours Care Center (non-profit)
Private NonProfit
X_ Public (other than military)
Non -Pricing (no separate charge for meals/snaoks)
Pricing (separate charge thr meals/snacks)
5. le canter a church/synagogueitempleimosque that meets the 113$ requirernents to be
exempt from federal income tax under section $01(c)(3) of the Interne( Revenue Code?
Yes X No
C. License Information
lst License
Capacity;
,F.xempt from State or Local Licensure (rellg lous-exempt) File(s) Uploaded°
Poblio School Site Exempt from Child Caro Lloonsure
License ID: tiMD1641 Expiration noto: ,91/21/2010..... File Uploaded; ,
g
am*
2nd License (if applicable)
Capsoity: LIcart6ID
Expiration Date Pile Uploaded: —
12/ 2015 12 : 34 '3057593509
CTLCNC
PACE 016
Honda Department of Health
Child Care Food Program
Page 2 of 3
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2:49PM
AN 576 FY; 2015 D/E /At CITY OF MIAMI DAY CARD $i,ta Number/Name. t
EATON PARK DAY CARE
7, Center Operational inf'ormatk f
. Hours of Operation per License: 7pnns: 07:00 AM AM Chases: 06:O0 PM
b. Bays of the week meals will be claimed:
M-F ALL
X Monday X Tuesday X 1Alednesday X Thursday X Friday Saturday , „ Sunday
Meal Service Information;
Meal Types to be Claimed:
(Check all that apply)
b. Meals will be claimed over license capacity:
c. Select below the meal types for which you are requ
No (skip to 69)
Afternoon Snack
Yes, complete #ac and #8d
ting approval to claim meal counts ovrst• ii;canse pahacity:
Breakfast
Mornin Snack
Lunch
Afternoon Snack
Supper
Evening $neck
d, Provide an explanation for each (meal type requested in 8c:
IF 4 OR MORE MEAL TYPES Wi1,L L3H C ,AiM J OR iF DAILY MEAL COUNTS POR ANY MEAL TYPE, WILL
exomeo LICENSE CAPACITY, MEAL COUNTS MUST 9E KEPT pY NAME OF CHILD FOR ,ALL, MEAL TYPES.
S. Meal Time Information: At Nest 1 hour must alapea
betwbbrl thtr and of one masllsnti t Service and the beginning of
the next, Maximum length of time per moolf r)wok servIco is 2
hours,
Breakfast (ER)
Morning Snack (MS)
Lunch (LU)
Afternoon Snack (AS)
Supper (SU)
Evening Snack (ES)
Start Finish
fai 05:08 AM ,
11'30 AM
12:00 PM
m.
10, Method of Meal Service; Check eebh tether) of meal service Viet willbc
used. FG+ Nien method checked, dir3Ctiy bolow II circle all meal t'E}en Mot will be
brObererd using that method. S80 meal type abbreviatIont in #9,
Center prepares mesis on -site (contract not rhtluired)
. BR ,MS —_ LU . AS SU — ES
Venter receives meals from another center or central preparation
site owned by the sponsor (contract not required)
BR — MS LU ---- AS SU — ES
Center/Sponsor contracts with local pubiic school system
— BR , MS .....,.. LU AS , SU
Center/Sponsor contracts with another approved CCFP center
with which It is not affiliated
IR MS I,U AS SU CS
x Center/Sponsor contracts with e DOH listed caterer
BR
MS X- - LU ,S AS — SU
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PAGE
Florida Department of Health
Child Care Food Program
page 3 of 3
8114/2015
2:49PM
ChiIdCre Center Site information
AN; SIG ry: 2016 OSA: CM OF MIAMI DAY CARE Site Number]Name; 21053 EATON PARK DAY CARE
11. Niurnher of enrolled Children by age group
0 Birth -11 Months
7 1 - 2 Years 27 3 - 5 Years 0 6 - 12 Years
Disabled (over 12 years) 0 Migrant (Birth - 16 years)
34 Total Enrolled
2, Record the member of observed children in attendance by ethnicity and raw
(EAU') child must be counted as either Hispanic or Non -Hispanic and must be counted in at least one race category.)
tnnicIty Totala:
Hispania or
Latino
.1,
Not Hispanic or
Latino
4.
.- Ethnicity
8
26
,
34
Race 'retain: (children can be counted in more than One race eategotY)
American Indian or
Alaskan Native
VVhite
6Ick or Afrioen
American
An
Native Hawaiian or
mho(' Pacific
m Race
. + ,
,
--1.---....
,
— .t.,
0
13
21
0
0
34
3, Month() site MOM", operate in this fincal year: (check all that apply)
Oot _ Nov Deo Jan Feb Mar
Apr May Jun Jul Aug Sep
I certify that all Information on this Site information Form is true and correct,
Signature of Authorized Representative
Printed Name
Title
Date
12015 12' 34
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Florida Department of He h
child Care Food Program
Page 1 of 3
9/14/20 1 d
2:49PM
Childre emit
lnforl
tiCirt.
R
Legal Neale:
D/SIA:
givn: .. fi PE:
CITY OP MIAMI DAY CARE PRO(.RAIVI
IAMB DAY CARE
1. Site Information
Craated Date;
Sold Date;
Site Number:
Center Name:
Street Address:
City; MIAMI
Flscai Year: 201E
Q4124/1 g95 , Payment Start Data:
Termination Date:
Center Number:
2100
LE w CiTYDAY GARS CENTER
27 N.E, 55 STREET
1Q/Q11
b1 4-
Last Updated)
Initiated Icy:
04/13/2Q15
Phone: ,( 7,05,} ,759-3517
Ext;
2. CCFP Site Manager
Salutation; MS.
'Title: DIRECTOR
First Name:
State;
MAR ;IA
rax:
Zip: !3187
County:
Last Name: ARVELo
Phone: 30S)759 3518 Ext: Fax; (30 ) 76
3. type of Center,
For Profit Child Cara Center
For Profit outside School Hours Care Cen
.__ Head Mart / Early Head Start
I1 mt ry
4. Type of Program:
r
Outside Sohoot Hours Care Center (non-profit)
Private Non -Profit
X Pubilo (other than military)
Y Non -Pricing (no separate charge for mealalana
Priding (separate charge for meaislsnacks)
5. Is center ehurcl►)synagogue/ternpleltmosgtie that meets the IRS rectuiremetYte to be
exempt from federal income tax tinder emotion 501(c)(3) of the internal Revenue Cade
Yes
Na
6, License Ir1f'omatron
let License
Capacity: , 63,
Exempt from State yr Looal LIsensure (religious -exempt)
Public School Site Exempt from Child Care Lioensure
License ID: a11MD1,03G
2ncl License (If applicable)
Capeo ty; Limn
ID;
Expiration Oat
Expiration Date:
File(s) Upload
08/28/2015 File Uploaded:
File Uploaded'
09/12/215 12: 34
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Florida Department of Health
Child Care Food Prorai
Chgare Center Site Information
Page 2 of 3
9/14/2015
AN: 670 PY: 2015 OA: oar( oF MIAMI DAY CARE Site Number/Namet 21006 LEMON CITY DAY CARE CENTER
7,, Center Operational information
a. Hours of Operation per License: Opens:
b, Days of the week meals will be claimed:
M-F ALL
2S„, Monday & Tuesday
MilS toe Informatioit
Meal Types to be Claimed:
peck all that apply)
b. Meals will be olalmed over license GoPeoHlYi
Closes: 9,012,9
mecaxammom,
Wednesday X Thursday X Friday Saturday Sunday
Lunch
A ernoon Snack
Evening Snack
—4_, No (skip to #9) Yea, complete #8o and #8d
Seleot below the meal types for which you are requesting approval to laim meaLcounts over license ovacitv;
Breakfast
Morning Snack
Lunch
d. Provide an explanation for oath meal type requested in 6 ;
Afternoon Snack
Supper
Evening Snack
lit 4 OR MORE MEAL TYPES WILL BE CLAIMED OR IF DAILY MEAL. COUNTS FOR ANY NIEAL TYeE WILL
EXCEED LICENSE CAPACITY, MEAL COUNTS MUST BE KEPT EY NAME, or omi,h. FOR ALL MEAL TYPES.
9. Mon! Tirao Information: At least 1 hour MOM elapse
botwOen the end of one h10611/Srleok service end the beginliirlp of
the next, Maximum ioncith f km per hioalion8ok servIee is 2
hours,
Breakfast 03R)
Morning Snack (MS)
Lunch (LU)
Afternoon Snack (AS)
Scippei. (SU)
Evening Snack (ES)
Start Finish
0$:00 AM
11:30 AlVl
02:4$ PM
.0:29AM
10. Method of Meal Service: Check each methOd Of mem! service thet will be
used, For etch rrlOthOd checked, directly bOlOvv It Circle all meal typos that will be
prepared uir llt melhod, $ee mail type ebbrovletIons In ill.
Center prepares meals on-slte (oOntrack not required)
BR MS LU m.AS SU
Center receives meals from another center or central preparatIOn
site owned by the sponsor (contract not required)
12:00 PM BR MS LU AS SU - ES
Center/Sponsor contracts with local publio school system
--MS LU ®. AS $U ES
Center/Sponsor contracts with another approved CCFP center
with which it is not affiliated
BR MS LU AS SU ES
Center/Sponsor oontracts with a DOH listed caterer
..)C 8R MS I,U AS SU as
09/12/2015 12:34 3057.5
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PAGE 13
Florida Department of Health
Child Care Food Program
Page 3 ef
9/14/2015
2:49PM
Child Cere Center Site itiforrnation
AN: 878 FY: 2015 ID/BIA: CITY OP NIIA I DAY CARE Site Numbor/Name: 21085 - LEMON CITY t)AY CARE CENTER
11, Number of enrolled children by age grain
0 Birth - 11 Months
7
2 Years
12
Oisabled (over 12 years) 0 Migrant (Birth - 15 years)
5 Years 0 6 12 Years
12, Record the number of observed children in attendance by ethnicity and race:
(Each child must be oountgd as either Hispanic or Non.Hisponic and must be counted In at least one race category.)
Ethnicity Totals:
Hispanic or
Latino
Not Hispanic or
Latino
...i.
g Ethnioity
Total
1
18
19
REM Totals; (childran c n ba counted In rrie5113 than on6, ran catenary)
American Indian or
Alaskan Native Mite
0
1
I Enrolled
5Iack or African
American
18
Native Hawaiian or
?Wan other Pao&
4,4teinagui--
0
0
13, Month(s) site wlfl NOT operateki this fiscal year; (check all that apply)
Oct
Nov
Os°
Apr May Jun
JII
Jan
Feb
Aug
I certify that All Informt1n on thl Sit Information Form is true and correct.
Signature of Authori Representative
printed Name
Mar
$ep
Title
Dote
09/12/2 12:34
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PAGE 14/16
Florida Department of He I h
Child Care Food Program
Page 1 of 3
9/14/2015
2:49PM
Child Care,Qenter ,Sit0,Inforr11011,011
171,_„„, Region: RPS; Fiscal Year: 2015
Legal Name: CITY C')F' MIMI! DAYpAr-Is PROGRAMS
D/B/A: CITY OF MIA AY CAF
. Site Information
Created Date: fl2/06/2q15 ,
Sold Date:
Site Number; 22()8$
Center Name: MOORE PARK DAY CAR
Street Address: '785 NW 36 STREET
Last Updated: OZ/063/2015
Initiated By:
City, MLMJ State: EL Zip: 38127
Pima: - 6117 Ext Fax: Lgo,112,5.9,. 3500
2. CCFP Site Manager
Salutation; MR,
Title; DIRECTOR
First Nerne; VALERIE
3. Type of Center:
For Profit Child Care Center
Phone; ) 5177
For Profit Outside School Hours Care Center
Head Start / early Head Start
Military
4. Type of Program:
Payment Start Date:
Termination Date:
02/pl/2015,
Center Number: 22086
County: la&DE
Last Name: JACKSON
Ext:
Fax: ( 305 ) 75 moo
Outside School Hours Gars Center (non,crofit)
Private Non -Profit
X Public (other than military)
Non.,Pricing (no separate charge for meals/snacks)
Pricing (separate charge for meals/snacks)
6. Is center a ehurchtsynagogueltemple/mosque that meets the IRS requirements to be
exempt from federal income tax under section 501(e)(3) of the Internal Revenue Code?
6. License Information
1st LicenSe
Capacity:
.M......•••••••1•••••••11.1•Wel
Yes 2L NQ
Exempt from State or Local 1.,Iconsure.(religious.exempt)
Public School Site Exempt from Child Care Licensure
License ID: C11N102451
2nd License (If applicable)
Capacity. License ID;
File(s) Uploaded;
Expiration Date: 07/201201$ File Uploaded:
Expiration Data;
File Uploaded; —
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Florida Department of Health
Child Caro Food Program
Page 2 of 3
9/14/2015
2:49PM
, ,Oare, Center Site, Information „
AN: 679 FYi 2015 0/131A; CITY OF MIAMI DAY CARE Site NumberIName: 22086 - MOORE PARK DAY CARE
7. Cnter Operational Information
a. Hours of Operation per License: Opens: 07:09Aivi olom)0; mop pm
b, Days of the week meals will be Qlaimeci:
X IVIondaY
— ALL
X Tuesday X Wednesday x Thursday fIdy
1•10raffl Saturday Sunday
, Meal Service Inform atIon:
Meal Types to be Claimed:
(Check all that apply)
Breakfast
X
b. Meals wins oIimed over In paoRy
morning Snack
Lunch
No tskib to #91
Afternoon Snack
Supper
ening Snack
Yes, complete #00 and • 8d
c. Select below the meal types for which you are requesting approval to claim meal counts oKerlcznSe conacity:
Breakfast
Morning Snack
Lunch
Afternoon Snack
Supper
Evening Snook
d, Provid ii explanation for each meal type requested in Sc:
IF 4 OR MORE MEAL TYPES WILL SE CLAIMED OR IF OAILY MEAL COUNTS rRk,l1‘1 L YPL WILL
EXCEED,LICENSE CAPACITY, MEAL COUNTS MUST BE KEPT DY NAME OF CHILD FOR ALL MEAL TYPES.
9. Meal Time Information: At lOont 1 hour mi.* elope
brAween the end of one mud/sack service er4 the mooning of
the next, Maximum length of time per me411/erisok service is 2
hours.
Breakfast (BR)
Morning Snack (MS)
Lunch (LU)
Afternoon Snack (AB)
Supper (SU)
Evening Snack(k,7S)
Start Finish
,,C12,14211.1
1200.PM
444,52111...„
10, Method of Meal Service: Check each Method ot meal servIma IPA tle
Libbti. For each method oheokod, drolly below It circle ell meal type101. will be
peeparad using that method, $00 MOW type abbreviations in O.
r prepares moats on.site (contract not require0
,— AS _SU ES
Center receives meals from another center or central preparation
site owned by the sponsor (contract not required)
BR — MS — LU — AS — SU — ES
Center/Sponsor contracts with local public school system
BR MS LU AS SU 8
Conte:e/Sponsor contracts with another approved C FP center
with which It Is not affiliated
BF m8 LU AS SU ES
Center/Sponsor contracts with 6 DOH listed caterer
X BR MB X LU A8 SU
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Florida Department of Health
child Care Food Program
Page 3 of 3
9/14/2015
2:49PM
hild,Care Ceriter Site information
AN: 570 FY: 2016 0/13/A: CITY O �AMI DAY CAR Site NumberIName:220fl6• 1‘40OR PARK DAY CARE
. Number of unrolled children by age group
Birth - 11 Months
1.2 Years 2 3 - 5 YArt 0 e - 12 roars
Disabled (over 12 years) 0 migrant (5111h -15 yeara) Total Enrolled
42„ Record the number of ',haunted children In attendance by ethnicity and race:
(Each child must be counted es either Hispanic or Non-i-lispanio and must be counted in t least one race oategory,)
Ethnicity Trat$11A:
Hispanic: or
Not Hispanic or
Latino
Latino
=1Ethniolly
Isti-
0
5
Race Totals; (children can b dOurttod in more than ono mot: category)
American Indian or
Allan Native
White
+
T50< or African
ArneOcan
,
Asian
-I- .
Native Hawaiian or
dther Pacitio
• ipitugaci- -
---,I-4
i
0
0
5
0
0
43. Month(s) site will NOT operate In this fiscal year; (cheek all that aPPIY)
X Oot X Nov X Deo X Jan
Apr May Jun Jul
Feb
Aug
Mer
Sep
See
I certify t1iet II information on this Bite Information Form is true and correct,
SignatureSignure orAuthtIzed Repre
Printed Marne
Pate
RPS .31,14
Florida Depai inent of Health
Child Cara Food Program
Meal Times and Prerra ratkm Typa REARcat
AN: 575 FY: 21)15 Method:. ALL Region: Q Area: ALL Sort Ordar. Site Name
Site nratfor Breakfast Wm Lunch Ahersroue
.S._e N an e Snack Smack
Si-5 - OF MIAMI DAY CARE 2t0K-- EATON PARK DAYCARE D7:45AM MSG PIA ITL-45 Pid
D3:15 AM L2UPM 3OiM
ST5 S-576 CITY OF MIAMI DAYCARE 21465 - LEPLIN CITY DAY CARE D-L-NTF_ M.-173f .41.1 11:30 Arsi t.12:45 P7,4
OB10.41,1 12-As Phi 532:10 Ptd1
S.175 s-Tes CITY MIANI DAY CAF—oz 22055-- MOORE PARK DAY CARE 1130 AM OZ:15
51.3,1 12:00 PM 02:45-
.thpror-
3D
u)
C23
fLTI
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093-1412015
2:41 PM
CC
01
Evestiroa Prep
Biack -Noe crt
CO4SER 01
10
CONSER
CONSER
Lecand
SELF - Self -Prep
CENTER- Another Canter Owned By Spoialr
CONSCH - Schnef Beard
-I.1•CFP -Aroolha CerAer Not Cobzed By Spoastr
COrnaal - Caterer
--t