HomeMy WebLinkAboutChild Care Food Program DelegationOrganization Name: City Of Miami Day Care Programs Authorization #: 0676
W 71�Klj lill 159 of ift
By means of this letter, 1, 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 rTiy 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. 1 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
Title (Board Cbairman, Executive Director,
President or Majority Owner)
Date
Acknowledged and agreed by Representative
Signature (Representative)
Christine T Long
Name
Day Care Administrator
Title
Date
Revised 6/2015 1.132-12
Florida llepartment of Health: Child Care Food Program
pWicaunn-- ifa l ist_.._F�le claim aAvteA r view Clal
You have n t 1b1 late 1 cla n for. ul 2,0 .0 ra i Lh cl a 1, i
+WYL10 w ge or poi son o (D� e 4 �iw�(� C` 1'C ��tlt�l"� Print Preview
!'.application Information '
S- 576 Region: S RPS. 5 Fiscal Year: 2016
Legal Name: CI'T'Y OF MIAMI DAY CARL PROGRAMS
D/B/A: CITY OF MIAMI DAY CARE
Other AN#(s):
1) Lioler the w4lllloted tionllnl rood Sol'vice (Overt(ionot) costs to 1)a ctinl't"od
to the t.11tlll care Fluod 11-ogralo.
Services
71'raining
Funding
Name(s)
$0
Food Service
(Operational)
CCFP Funds Description
from
of
Other
Total
Costs
of Costs
Other
Funding
Funding
Total
Sources
Source(s)
Costs (ealCLllated)
Food Purchases
$66,723
$78,500
Total
$66,723
Food Service
Labor and
$0
Benefits
Non-Coiltracted
Purchased
$0
Services
Non -Food
$0
Supplies
Food Service
$0
1ic(uipment
Transportation
$0
Other" (111CI1)des
Special Cost
$0
Items)
Total Costs
(C81CUlated)
$66,723
$0
$66,723
2) linter tho estinwtod unnual Admioistralive Cosis to 6e charwA to thu
Child Ciera Vood Pro>;rmu,
Funding
Name(s)
Administrative
CCFP Funds Dd'scription
from
Ok11er
Total
Costs
of Costs
Other
Other
Funding
Sources
SouI'cels)
Administrative
CIILD
Salaries and
$11,738
$39
CARE
$1.1,777
Benefits
FEES
Non --Contracted
Purchased
$0
Services
71'raining
$0
Travel
$0
Rent and Utilities
$0
Office Supplies
$0
Other (Includes '
Special Cost
$0
Items)
Total
Administrative $11,738 $39
$11,777
Costs (ealCLllated)
Budget Grand $78,461 ,$39
$78,500
Total
Upload Supporting Document for Applicable Budget Gilowso,.. i
Costs:
(J111oad SUDDortina Document for Aoi)licable Buciaet Costs:
httnc•//AdIII in,1nncrloil I5 rloh.,ol-,Ite.fl.t.ts/CCNS/S/SBi.tdael:Workshcct.asnx
Page 1. of 2
9/8/2015
I
09/12/2015 12:34 305'7593509 CTLONG
FloridaDepartment of Health
Child Care Food Program
. . .................. —_
L;§L6_ Region', G — RPS: 6 F43081 Year, 2.016
Lounl Name, gITY OF MIAMI DAY CARE PROGRAMS
DIBIA, NTY t)F MIAMI DAY (%ARF
PAGE 08/16
PaVe I of 3
11 412016
C Site information
Creqted Date- .24�/24/19913
Payment Start Date:
.10101/2014 Last Updatsd; q�2016
Sold rata:
Termination Date!
Initiotod Sy:
Site Number:
21015.3.
Center Number:
Center Namo:
MION-P-A
AR— DAY CARC-
I
Street Address*,
490 ME, 61 STREET
City: MIAMI.
stato;
Ej� Zip: 3-3.1,S7 County; PAM-
Phone.- (305)
769-aW
Ext: �
Fox:
2. COrP S11W Manager
salutation; MS. First Name; -MARY 1,_mst Name: QUARADAN
Title: MANAGER Phow J�§�- �OO Ext; Fax: La76 -
3. Type of COMOt'
For Profit Child Care Center
For Profit Outside $chool Hours Care Owter
Head Start / Early Head Start
Military
Outside School Hours Care Center (Aonryprofit)
Private Non -Profit
Public (uthertheirimilitary?
4, Type of Program; L Non -Pricing (no separate charge for meals/shook$)
— Pricing (aLhparote oharge for Mftl8/8n8oks)
S. Is oemter a church/synagagueftemplelmosque that meets the IR$ roquiremenZ to be
exempt from federal income tax under section 501(c)(3) of the Internis( Revenue Code?
$. License Information
St Lloonse
Capacity;
2nd License (if applicable)
Capacity;
— Yes X_ No
I
Exempt from State or Local Ljoensurm (rellglous.exompt) File(s) Uploaded,.
Public School Site Exempt from Child Care LlbanAure
License IC; _C11MD1641._____ Expiration ootm:al_121120 16�File Uploaded;
Licanet, 10, Expiration Data; rile Uploaded:
09/12/201 12:34 3067593509 CTL NC PAGE 09/16
Plorldo Department of Health Page 2 of 3
h ld Ogre Food Program tai 1
2:49PM
M M Y
Ahit 676 FY, 2010 DISIAt CITY OF MIAMI DAY CARE Sito NttMnberftme. X1083, EATON PARK DAY CARE
7. Cerlter OperotI01101 1nlcrmatloMi
a. Fours of Operation per uoense:
b. Grays of the week mean will be claimed;
�L M_r ALL
X Monday L Tuesday & Wednesday A_ Thursday 4 Fridey Saturday — Sunday
010ans:bi:0Q AMAM _ 01050; 46;06 PM �__,
8, Meal Servioa Informatio";
Meai Types to he Maimed: Breakfast Morning naok Launch Afternoon Snack $upper Evening $nAck
(Chock gill that apply)
bt Meals will be olairned over liconse capsolty: X No tskin to 69) w_m___ Yea, complete #8o and #lad
m Select below the meal types for which you are requesting approval to claim mr.@l oounts cvot.liw�nse raaeawity
Breakfost
Morning Snack
I,unch
Afternoon Snack Supper
I Evening neok
d, provide an explanatlQn for each r a8I type requested in Bc;
IF 4 OR MORF. METAL TYPrz$ 'U41'll ll_ 1F. CLAIMED ORIF DAILY MEAD COUNTS OIS A TYPg WILL.
XCM C LICENS1E CAPACITY, MEAD COUNTS MUST 151F KEPT R1i NAME OF CHILI] FOR MEAL TYp.
9. Meal Tirne Information., At leett 1 liour mint olepao 40. Method) Of Meal $orvilee., Cheek eadb MMhotj at €Hast service thot will tit.,
betwbbrl tiro and of ane mesl/mnttk st!rvlea and ft bopinning of used. Faht m;lcn method chookod, dirbdtly bolow if aisle all mom[ typo tnorwlll be
the next, Maximum lennth of time per is 2 Prtpired using that method, Sao moil type abbreviatlont in #g,
hours,
ar+ds0ist (BR)
Morning Snook (MS)
Lunoh (LU)
Afternoon Snuck (AS)
Supper (SU)
Evening Snack (S)
Start Finish
Center prepares motols on-site (contract not retauimd)
BR — M$ — LU AS — SU ES
Center receives meals from another center or central pfeparatlon
site owood by tate sponsor (Contract not required)
— BR — MS , LU —AS Su ES
Center/Sponsor oun'tra,cts with local public swhool system
---- BR — MS — LUI ,. AS .«., SU ,ES
Center/Sponsor contracts with another approved CCFP 6enter
with whlch It is not affiliated
r- 15R MS LU A SSU _ ES
X Center/Sponsor contracts with a 001d listed oaterer
X i3R — _.�._�. MS L _ LU X AS — SU
A-9/1 1 2/ 2015 1 12: 34 3067593509 PAGE 10/16
Florida Department of Health Page 3 of 3
0/14/201$
Child Care Food Program
gl]Llid-care Center Site hformation
AW 570 FY2016 D/181A: CITY OF MIAMI DAY CARE Site NumberiNarnw, 2100 - EATON PARK OAY OAFS'
11. N"rnhat of unrolled children by age group
0. Birth - 11 Months,. 1 - 2 Years 27 3 -15 years 6 - 12 Years
0 Disabled (Qver 12 years) Migrant (BIrth-16years) 34 — Total Enrolled
1121 Roeord the number of obnerved children In attendance by othnicity and row
(Each child must be counted as either HIspaniq or Non -Hispanic "A must be counted In at least ane race category.)
Ethniclty ToWIR. Race Tatalm, (ChildtOn can bo CoUntOd in more then one race cotego7y)
1-11;�Mnio Or
Not Hisperilo or
Black or Afflosh
Latino,
I.Rtino
Ethnicity
Alaskan Native
White
Amorlueri
8
26
34
American Indian or
Black or Afflosh
Native Hawaiian or
Alaskan Native
White
Amorlueri
Asian
othor Paciflo
Race
—
-Tofml
0
----±
13
-------- —A ...
21
Z4
12, Month(s) Wto will Vq_T operate In this fiscal year: (check all that apply)
Oct Nov Doo Jan r-mb mar
Apr May Jun Jul r Aug 80P
I certify that all Information on this Site Information rorm Is true gnd correct,
$1ginature of Authorized Representative
Printed Name
Title
Date
09/1 1 2/2015 12.34 3057593509 CTL NG PAGE 11/16
Florida Department of Health
Qhild Care Food Program
Reglw: �— RM —6 Fi-oilYear!
Legal Name! CITY OP MIAMI DAY CARE PROGRAMS
D/8/k el.IW Mr- MIAMI MAY CAPP
1. Site Information
Created Date: L4/ 4/1096 Payment Start Date: �1010112014 Ut Updated.- 9-411312.QI5
Sold Date: Termination Date: Initiated By:
. ............. . .
Site Number!_2joe�s Center Number: z
Center Name: LEMQN,QIIY DAY QAkE CENTER
Street Address: 27 N.E, 58 STREET
City; MIAMt---- state; �q Zip, 31 County: DADE�
Phone:
Ext: Fox:
2. CCFP SO Manager
Page I of 3
0114/2016
Salutatl= Ms. First Name: �MARIA Last Nome: �6V LO
DIRP-CTOR phone: 300 )-.759 � 3518 Ext: Fax:L3�769 �41
3. Type of Center-,
— For Profit Child Oarm Center Outside Scahoot Hours Care Center (nen-profit)
— For Profit Outside School Hours Care Canter Private Non -Profit
Head Start / Early Head Start X Public (other than military)
M111tory
4. Type of Program: Non -Pricing (no separate chorge friar meals/snacks)
Pricing (separate charge for rrietalsisnackt)
S. Is center a oburclilsynagogue/f4Dmplelmosque that meiM-A the IRS requirements to be Yes X No
exempt from federal income tax tinder sootion 501(c)(a) of the Internal Revenue Code?
6. License information Exempt from Mate or Local 1.1wrisurm (rellglou8-exempt) Filo(s) Uploodod:
Public $ohQQI Site Exempt from Child. Caro Licensure
lot License
Cpaolty! 63 ljcen9tflD! -C11lV1Q1_03Q
Expiration Date: 08/2812015 File Uploaded:
2nd U00rione (if applicable)
Capacity; License ID; Expiration Date-. Film upioaded!
0-9/1 /2015 12:34 3057593509 CTLONG PAGE 12/16
Florida Department of Health Pa o 2 of 3
091412016
Child Care Food Program 2AVIV
AN; sio ry. ms WOW- CITY OP MIAMI DAY CARE Oita Number/Naraa'21086 � LEMON CITY DAY CARE CENTER
7. Conter Operational Information
a, Hours of Operation per Ucense:
b, lays of the week meals will tae tlalmed'.
.2 _ M -F — ALL
Opens: qz000.2—ML—
�m Closes'.
X
Monday X Tuesday xL WOdne.SdAly X Thur8d8y Friday v Saturday Sunday
0. Moat Service Informatiow
Meal Typos to be Claimed: Breakfast Morning 8n8ok Lunch
(Check all that apply) X X
b. Meals will be olalmed over haelize Gnpaolty; No (skID to #91
Afternoon Snack Supper Evening Snook
c. Select below the meal Noes for which vou ire roauastim awovil to 61AIM meal counts over licenso oanooitvi
Breal(ftmt Morning Snook 1,unch afternoon Snack Supper Evening 8nqbk
d. Provide an explanation for each meal type requested In 8o;
15 4 OR MORE MEAL TYPES WILL BE CLAIMED OR IF DAILY MEAL COUNTS.EUR ANY MEAL 7Y WILL
EXCEED LICENSE CAPACITY, MEAL COUNTS MOST BE KEPT.8_Y..N_AF NN OP 0 0 A.—ME PS
Nq R LL AL TYP
9. MOAI TIM* InfOrfrlatiolrl' . Af. 16-s9t I hout MUM elapse 10, Method of Meal Service,, Check each method of meet service thitwIll fie
160"en the end of and M0011snilaek cervica filid the beginning of uged, Fvrouh mtthoa checked, directly Wow Ittirale all meal typom theft will be
010 next, MaxIMUM 10110th of time pOr MOVM80k cervico i1,4 2 prepared ugln� tNt molhod, See MeMl type mbbroviallom In 0.
hours, I
Start Finish
Oroakfast (51R) qqj0Q AM, S329�6N
Morning Snook (MS)
Lunch (LU) 00 P-4.
Afternoon Snack (AS) _0.2AQ PM.
Supper (81.1)
Evening Snack (5_S}
Center prepares meds on4te (oontioot not MAulred)
— BR — IVIS — LU
Center receives memb from another oenter or central prepamtIon
site owned by the sponsor (contract not required)
Center/Sponsor contracts with local publir, school Ayotom
— BR sim 4 MS — LU —AS — SU — ES
center/Sponsor contracts with another approved CCFP center
with which It is not affiliated
— BR M w. LU AS SU ES
Centor/Spomw contracts with a DOH listed cateror
-Z-- BR — MS LU L— AS — SU �S
0-9/12/2015 12:34 3057593509
CTLONG
Florida Department of Health
Child Care Food Program
PAGE 13/16
P@ge 3 of 3
9/14/2015
AN* 678 FY, 2015 Q181A,, CITY OF MIAMI DAY CARE Site Number/Not w 21086 - LEMON CITY DAY CARE CEN -1-911
11, Number of enrolled children by age 9voup
0 Birth -11 Months 7 1, 2 Years --j_2 5 Years 0 6 - 12 Yeats
Disablod (over 12 years) Migrant (1311-91 - 15 yearq) 19 Tool Enrolled
I Record the num_b2 n ty a 0
r of observed childrort In attondanci� by ath 116 , and r 0 ,
(Ear,h child must be wuntod as either Hispanic orNori-Hispanic and must be wunted In at, least one raoD category.)
EthrijulivTotals,. Race Totals; (01ildfon cin M dMntod In Moro than on6 faea eatoq6ry)
Hispania Or
" 'i� "'
Not 1-11uponle or
Latino
Lallno
Ethniolty
Arnerioun Indian at 4.31rjck or African Notive Hawaiian or
Alaskan Native White Arnericso AdAn othor Pad le Raaa
18
13, Morlth(s) Alto Will NOT operate in this flopal year. (shock all Wit apply)
oct, Nov Dec Jan Feb Mar
Apr May Jun Jul Aug Sep
I oertIfy that all InforMation on this SIt6 I nfOrtriatibn Forte is true and Qorrerft
Signature of Authoftod Representative
Printed Name
Title
Dote
09/12/2015 12, 34 3067593509 CTS. NG PAGE 14/16
Florida Department of Health
Child Cmre Food Program
azE6_ Region: $ RM 5 F 1scal Year! 2Q15
1.ogtl Name: CITY Or MIAMI DAY C RE_PROGRAMS
D/B/A: 1'*,.I*rV MW WATW NAV r.APP
1. site Information
Created Date:
Sold Date:
81to Number;
Center NLAma:
Street Address:
421222WjL Payment Start Date: Last Updated, 021061201.5
Terrnitia.tlQn Date: Initiated By.
2208$— Center Number:
.MOO E PARK DAY CARE
766 NVV 36 STREET
014; MlAMJ__ state, � Z1W L81.27 µ County'
Phone: (,,,305 ), 060 - 611_7 Ext: rax:
5. j 7k ,.-
Page I of 3
W14/2015
2. CCFP site Manager
Salutation; MR, First Name; VAL12RIE Last Narne: JACKSON
Title,, DIRECTOR Pliono: (305) 0.5177 Ext, Fax: { 305) 7§q,LL60
3, Type of Center,,,
For Profit Child Care Center Outside School Hours Gare Center (non-profit)
For Profit Outside School Hours Care enter Private NonrvProfit
Head Start / Early Head Start X Public (other than military)
Military
4, Type of Program, X- Non -Pricing (no separate charge for meals/snacks)
Pricing {separate charge for meals/snacks)
S. Is teri ter a ch urch1synagog ue /tamp tolmosque that meets the IRS raqu I roments to be Yes X No
exempt from federal Income tax under section 501(c)(3) of the Internal Revuritre Code?
6. Ucense, information Exempt from State or Local 1.1oonsure (religious -exempt) File(s) Uploaded:
Public School Site Exempt from Child Caro Licensure
tat Lica"So
Capacity: S1 License ID: _C1A L2_451 Expiration gate; 27/20/241$ Rej Uploaded:
2nd License (if applicable)
capar'Ity: License It);
Expiration Dote; - File Uoloaded:
09/12/2015 12:34 3067593509 OTLONG PAGE 15/16
Florida Department of Health Page 2 of 3
Child Care Food Program
AN: 570 FYI 2015 DID* CITY OF MIAMI DAY OARR Site Numbee/Name, 22086 - MOORC PARK DAY CARE
. ...... . ......... .
7. Center Operational Information
a. Hours of operation per License:
b, Days of the week meals will be claimed;
.�_ M -r- — AIL
OPWns 07-00 AM Closes; 06:00 PM
Monday L Tuesday A Wednesday _X Thursday _I FeldLiy _ Saturday _ Sunday
0. Meat Service Information:
Meal Types to be Clairnod: Breakfast morning Snack Lunch AfternoQn Snack Supper Evening Snack
(Check all that apply) X
. . .. . . . . .......... ........ .. ..
b. Meals will be claimed over licmns6 capacity! X No tsklb to #91 Yes, complete 98c, and #ad
r. Select below the meal types for whloh you are requesting approval to claim Meal
Breakfast Morning Snack Lunch Afternoon 8nnok Supper Evening Snack
d, Provide an explanation for each meal type requested in 8c!
IF 4 OR MORE MEAL VP E$ WILL 1314 OLAIMED OR IP DAILY MEAL COUNTS "0,A_t.4Y..MEALTYPL WILL
EXCEEDILICLNSE 6APACITY, MEAL COUNTS MUST BE KEPT BY NAME OF CHILD FOR ALL MEAL TYPE$,
9, Meal Time Information.- At 10.ftt I hour rntist olop9e 10, Meth?)d Of Meal Servicer Cheol; oath rnmhod of meal servloothint will Do
bo,"..arw the and of am moi.ilimiak cervica Od the b05InnIng of ub6d. 6or each 111ethbd chocked, tilrootly below It alrole all meal typo tnotwlli be
the next, Wiximum length of time per mikAl/I.InAl3k service ie 2 pe�,pnred uslrig that method, Sam Mesal typpabbravistlons in 0,
hoVO.
Start Finish
Breakfast (1310 SZALAU 8't j�
Morning Snack (M$)
Lunch (LU) 12:00.PM
Afternoon Snook (AS) oCwM
Supper ($U)
Evening Snack (I--$)
Center prepares meals on-site (contract not required)
— $11 — MS — LU —AS — SU — 5S
Center receives meals from another center or central prepfflnttlon
site owned by the sponsor (contract not required)
Center/Sponsor contracts with local public school system
BIR MS — LU AS — OU ES
Contedsponsor oontnarti with mother approved CCFP center
with which It is not affiliated
— 13R — M8 — LU —AS ES
X Center/Sponsor contracts with 6 DOH lioted caterer
A-9/112/ 015 12:31 3057593509 CTLONG PAG 16/13
Florida Department t f Health Page $ of 3
12016
�F4�Prtr rim
Child car! �O� d Feroy 911A�9PN
AN, S70 FY, 2015 WOW CITY or MIAMI DAY CARE Site Nttm0ohrtName: 22086 « MOORF PARK RAY a0rz
11. Number of enrolled chiideen fay age group
Q Birkh - 11 Months 1 - 2 Yv@rs _2 3 -.5 YeArs ,��,�...m_... a -12 Yogra
Disabled d (dyer ( yaars) Migrant (girth - lit years) ......_ Caths I nrotled
1Z Record the nwmber of observed children In attendance by Ohnicity and racm,
( ooh child mint be counted as either Hispanic or Nen-mii panio and must he cavmted in at least one race sategcry,)
Ethnlclty TotfflM Rcoc Total% (ohttdren can ht� 4muntod In mento than one race chtc!tory)
Hil�panla or Not Hisponlc or
Latino(.Atlnr� = Ethriio
Rang
I
a 5 a o
lty
113„ Month(s)Month(s) site will NOT alaerata in this fiscaI year: (check all that hppIy)
tact X Nov X aeq x ,lin FebMor— Afar ,..... may— JJun„,.�, Jul Aug Sep
Amoritznn Indian or
Native Howaii@n or
Amoritznn Indian or
Black or African
Native Howaii@n or
e�rtCertifythat all information an an phis $ite Information Form Is true and correct,
Sigt"tatltre 4f Aw#horfzed ReprtMsentativo Title
�
a n
Printed Nt'!r1'1e
Asko
Rza AN
�3� CT'S 0FMWdIEJAYCASE
5-576 CFTYOF
Lerm—d
SELF - S--If-Prep
CBITER- ArAfner Center Owed Sy Sperm r
CONSCH - schcvk Heard
CCFP -A40 her Geder N01 Cmmed By Sponger
CONSM - Calerm
-
fm
U3
N3
PM
w
IM
M
SIM Ei inrs FE epara&v -4
tnarx TV- Li
LTI
CD
LG
CONSER
CON-aER
-u
J>
G)
m
Florida Departmant crf Health
Child Care Food PTogram
Meal Times and PreparaC-on TypaRiapoA
AN: 575 FY- 2915
Me4huid: ALL1"- fow. 0 Area: ALL Sort Order. -SikeWdffle
Simlgumbu,
3reakfast MurgrK Lunch
Aftemcoa
IM
.a.qme
snaek
snack
2tM.-;EAT-ON RNRKDXV�CARE
W45P-M MSG m
UL --115 11.1
15 AM 12 -Oa PTA
03�wflbd
2 -USS - I ETAG-111 CUY DAY CARE UEUM
MWF AJM 1-k--30AM
UZ-45 PM
UDIBOMII I -M RAI
WAG RA
ZZOE� - MOORE PARK Dg? CARE
07-45NA ItWMA
021-15 FIM
M15 AN 1.2.00 PPA
uZA5 F?kt
fm
U3
N3
PM
w
IM
M
SIM Ei inrs FE epara&v -4
tnarx TV- Li
LTI
CD
LG
CONSER
CON-aER
-u
J>
G)
m