Laserfiche WebLink
SFSP-3 1/02) <br /> t . ~ z e * ~ a ~ x s ?sttl is si <br /> ~ iw' v RURAL NON-RURAL <br /> a 1 t° <br /> ~t 2 <br /> 9_HOW WILL MEALS B,$PROVIpED Td, SITES` <br /> ~~.'~~,'„k~k,E. t.,,r c ,.',rt~ s+l, <br /> _~S~t <br /> a.!~ ~ , 71`~u`~ *rh?~~~'}5 I L NO. OF SITES SERVED <br /> ~ ~ A. SELF 2REPARgTIO~I ON sSTF.~~a`s'jfi r'~ r''PKFt+yt , tt <br /> ..'§st , q':1,lx~~ <br /> ~ ~B SPONSOR PREpARi1TIQ~S AT C>v~`I'j:1~` }v"ux$~'s{*' NO. OF SITES SERVED <br /> KITCHEN FACI~ ;PN;, ~Y~~ <br /> R <br /> s ~ r ADp1R,~ES ~"y,'~ + sty " <br /> i t c!k M ~~a 4 6 a +l. F "u <br /> pp_~ ~ ~ <br /> r s vX~* ry -0~SMi t,~a~~~a o+>Fr ~~f~ h~rt~'"S+~x, ~ Fr <br /> Yom' u 3{~~ ~a.+ ~E ~ Y~, <br /> ~a'.a vr~ MI ~ tV 4<5.~~~a *X r ~ ~s~t` }Y <br /> 4 <br /> ~ ~C. SPONSOR PREPARATION AT A„~ ~jNU,~54 }o i No. OF SITES SERVED <br /> SCHOOL FOOD SIyRVICEFA.CIL,)TY ~ Es N? 'r.~ <br /> f tzk Y Lfto~i.}l(kd~~..vs+et`,.9:: <br /> NAME(S) A2vD ADj)RE S(~ is _ <br /> > ~ t <br /> ~ t q. n; 'P ~N • y ~ ~Y <br /> A i / X 4' <br /> I ~ ~u <br /> 'i ~ r': t` 't~i4t t P `^`'ZEa~ : 4 ~ M <br /> x x v _,4 t x ~ r, <br /> t F fi:+t ii <br /> ~jLD AGREEMENT WITH SCHOOL FOO~AU~'Q.RI~ry`, NO. OF SIT S SERV~.D <br /> (~i <br /> SCHOOL NAMEjS~ AND ADDRF,SS~ES) { t ` COMP Y NAME S AND ADDRESS ES <br /> T~aiekea'.~titer a.3.6 ~a ~,nf^aegwa ( ) <br /> rvte,F,. yy ,s, rI~ ~~M~ HCEOC-Hawaii my Economic Opportunity Council <br /> Ltatu EI2`~1TI 'C~l$.~ i{dn tYh Pj:n'n~~`[ *i ; <br /> Honok~~t ~ ~ kYti nit 47 Rainb rive SChO7~/ <br /> ~ ~ ~ ~t~ti ~I $r; S~~r~V'/~~ <br /> ~@1$Ll ELE(Na !x s~ Pn fi't` 4 zt~i tk'!~ Hll , I 96720 7 / ~~J ~ ~~Ts ~C~(~~ <br /> $ghafa~a~u~h: ~ ' ~ Gal/~~ f-~.1 l'G <br /> `6A E. CONTRACT ITH FOOD SE VICE MGMT NO. OF SITES SERVED RUIjAL NON-RURAL <br /> COMPANY /K./_ <br /> IF YOIJ ARE A IF YOU HAVE BEEN <br /> NEW SPONSOR DESIGNATED AS AN <br /> OK HAVE NOT EXPERIENCED <br /> BEEN SPONSOR: Ifa contract C-'l.I <br /> DESIGNATED AS will exceed $10,000, f <br /> ~W EXPE}21ENCED abachabid schedule. r%(I~~ <br /> SPONSOR: Ifa Sponsors must also JI <br /> Contract will excecd submit a summary _ <br /> S 10,000, attach a of meal service and copy <br /> s'chcdule of bid dates of IFB if changing <br /> and a copy of IFB method of procuring <br /> meals. <br /> COMPANY NAME(S) AND ADDRESS(ES) <br /> C F-fQ ~t~'GIr~! 1 CUtar~ f <br /> ~Z 1 V~(~~70 ?V" J/Yl V/z'i7 l /Gtr~yrrry %i <br /> ~F. OTHER P li ~(.TI l ~~~~'ti~bC~~ ~tCI /Zl.~ <br /> I0. FOR TkIE GEOGRAPHIC AREA SERVED BY YOUR SPONSOR PROVIDE AN ESTIMATE OF THE RACIALETHNIC MAKEUP OF THE <br /> POPULATION TO BE SERVED, AND DESCRIBE EFFORTS TO (I) ASSURE THAT MINORITY POPULATIONS HAVE EQUAL OPPORTUNITY TO <br /> PARTICIPATE AND (2) CONTACT MEJORITY AND GRASSROOTS ORGANIZATIONS ABOUT THE OPPORTUNITY TO PARTICIPATE M THE <br /> PROGRAM. <br /> <br /> 1 I . INDICATE TO]'AL AVERAGE DAILY PARTICIPATION OF ELIGIBLE CHILDREN TO BE SERVED BY MEAL TYPE AT ALL SITES LISTED ON <br /> FORM(S) SFSP-Q SITE INFORMATION SHEET(S). (FOR CAMPS, LIST ONLY THE ESTIMATED TOTAL AVERAGE DAILY PARTICIPATION OF <br /> ELIGIBLE CHILDREN FOR EACH SESSION IN WHICH REIMBURSEMENT FOR MEALS WILL BE CLAIMED UNDER SFSP. <br /> k3RfiARFAST AM SUPPLEMENT LUNCH PM SUPPLEMENT SUPPER <br /> (A) (C) (D) (E) <br /> 1,040 <br /> PACE 2 OF 5 <br /> <br />