HomeMy WebLinkAboutCOM 0140.056 2002-2004 JNYY os ~7w
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Patricia G. Engelhard
Harry Kim Director
Mayor o:'w:.~
} jj Pamela N. Mizuno
~CLQU~tp Ql ~~b~dl~l Deputy Director
DEPARTMENT OF PARKS AND RECREATION
25 Aupuni Street, Room 210 • Hilo, Hawaii 96730-4252
(808) 961-831 I • Fax (808) 961-8411 rv
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DATE: July 1, 2003 Z r-.
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TO: James Y. Arakaki Council Chair and -
Council Members ~
VIA: Deanna Sako, Controller ~r" ~ - s
J~~ ~
FROM: Patricia Engelhard, Director~GiOQ,G~
RE: NOTIFICATION OF GRANT AWARD
Compliance with Ordinance No. 03-91, Section 7(1)
Name of Grant Program: Summer Food Service Program
Grantor: US Department of Agriculture, Food and Nutrition Service
County Grantee Department or Agency: Parks and Recreation -Recreation Division
Grant No. (IF KNOWN): 1707-8
Amount of Grant: 82,940.00
Amount of County Match: 38,479.21
County Revenue & Expenditure Account Numbers: 3302.76 (Revenue)
010-500-5509.30-341 (Expenditure)
Grant Period (Commencement & Completion): .Tune 16, 2003 -July 25, 2003
Purpose of Grant: Summer Fun Meal Program
The grant application is based upon all desired Summer Fun sites at maximum attendance. Phis figure is
usually much higher than the actual grant received as (1) there are usually sites where meals cannot be
provided due to various reasons and (2) daily attendance fluctuates.
Is final report required by grantor? ? Yes ~ No
Notification attached: ®Yes ? No, because
Comm. No. /yo•5~.,_
Ref. To: _
Ref. Date
Form
SFSP-25, 3/87, RS 57-1421
~.~;w STATE OF HAWAII NOTIFICATION OF AGREEMENT APPROVAL
. ',~y,.,p.° ,DEPARTMENT OF EDUCATION
j OFFICE of RuslNESS sERVlces RENEWAL OR CHANGE
l School Food Services Branch
//7 1106 Koko Head Avenue (Summer Food Service Program for Children)
o Honolulu, Hawaii 96816-3797
i. Agreement Number 2. Action Code 3. Fiscal Year 4. Type of Sponsor 5. Type of Program
E=ESTABLISH A. School 1. Sell-prep
ok (New to master Ille) B. GOV Z. Vended
digit C=CHANGE TO MASTER FILE C. Rea. Camp 3. Combination
D. Others Sell-prep 8 Vended
D=DELETE FROM MASTER FILE i't J,
L i.
a a
6. Name and Address of Service Institution (DO not exceed maximum line length)
n -
7. Telephone Number 8. Contact Person
9. Meals Authorized (Enter 0, 1, or 2 indicating number of 10. Average Daily Number of 11. Days of Operation
meal(s) per child to be served each day.) Children Served (estimate) (actual)
Breakfast Lunch Supper Supplement June July August
12. Months Approved for Operation 13. Number of 14. Administrative 15. Request for Advance Payment
o=NO r-res Self-Prep Sites Cost Limitations o=NO r--res
June July August Dollars Atlmin Oper
0 0 ~ ~ r;.-~7! ~ n
16. Advance Authorization for Administrative Cost 17. Advance Authorization for Operating Cost
(Whole Dollars Only) (Whole Dollars Only)
First Atlvance Secontl Advance First Advance Secontl Advance Thirtl Advance
18. Number of Sites by Type
A. Schools B. Government C. Resitlential Camps D. Otner
19. Comments
=~wrT
20. Date of Preparation Signature Title
Month Day Yeer
m ~ ~ ~ ~ ,
DISTRIBUTION: ORIGINAL -DOE (White), Copy 1 -School Food Authority (Yellow), Copy 2 -Commodity Distribution Assistant (Pink)
SFSP-3 1/02
STATE OF HAWAII I. AGREEMENT NUMBER _
DEPARTMENT OF EDUCATION I ~ D ~ -~j
OFFICE OF HAWAII CHILD NUTRITION PROGRAMS 2. NAME & MAILING ADDRESS OF APPLICANT/SPONSOR
SPONSOR APPLICATION FOR PARTICIPATION CollntV of, Hawaii-Depdrtm~pt,of Parks &
SUMMER FOOD SERVICE PROGRAM ec eatl0n- ecrea 10n 1v1S10n
799 Piilani Street, Hilo, HI 96720
INSTRUCTIONS: Complete two copies oC[his application. Submit applicafions
with an original form SFSP-4 (Site Information Sheet) for each site and for each TELEPHONE NUMBER ( )(808) 961-8740 eXt 23
session (if more than one is offered) where [he program will be administered by the ~ ,t,~~ QF` _ " , ~
applicant If more space is needed, continue on a plain sheet of paper numbering ) r k
each item. Type or print clearly all infornaNon. _
NOTE FOR SPONSORS WHO OPERATED THE SFSP LAST YEAR' The State r 2 rf '""S't?s "7tr ~ t~ l~s _ ~ =
r~~t i
agency may designate sponsors which have operated some or all of the same sites in 4 ~ bi s : ~ DMIviER~
[he SFSP in [he prior year with no significant deficiencies or operafional problems as ` ' C. u ' 'r t x -
"Experienced;' and allow these sponsors to omit certain information from Sponsor t` + kk 1 § ~ t t t t ar-.:' k -
and Site application fortis if the information has no[ changed from the previous I k~3~ ~~21+~~ #IN' `
yeas If [he State agency has designated you as an "Experienced" sponsor, you may ' rA ~ ~ '
omit the questions in the shaded blocks on the Sponsor Application and on Site r i ` a > ~yh4ft'~ ~ x ~a s~"' -r`"nu"s;:~"r~' ~ n `
Infoma[ion Sheets for sites which you operated last year if the answers [o these ~4}~~. 'L_
.+ai ~ tzs y a I 6 xu .o. ,
questions have no[ changed since last year. You must file a complete Site y, ~ I ~ i y~ 'rJrs~I ~y;, s~y`_ t" a,~~~~tg,
Information Sheet for any new site which you will operate [his year. I v x r s ~ s ~ z , -
r:~x , r,~.
Tz'e~~4~t - ~~~.at
~ ~
3. INTENDED DATES OF FOOD SERVICE PROGRAM ~ ~ `
oPERArtoN Ik~~RT>FtGATtf~7~~;~;TAp~I&D. t;
BE June 16 2003 END Jul 25 2003 ' -
TOTAL NUMBER OF DAYS OF OPERATION .;i; .
29
4. NAME & TITLE OF AUTHORIZED SPONSOR REPRESENTATIVE WHO ~ ~ ~ - '
WILL SIGN THE AGREEMENT, FORM SFSP-3 - -
Patricia Engelhard, Director
Department of Parks & Recreation -
6. INDICATE OTHER PROGRAMS IN WHICH THE APPLICANT PARTICIPATES
~ *NONE ~ ~ CHILD & ADULT CARE FOOD PROGRAM ~ ~ NATIONAL SCHOOL LUNCH PROGRAM
~ I SCHOOL BREAKFAST PROGRAM ~ ~ FOOD DISTRIBUTION PROGRAM ~ ~ SPECIAL MILK PROGRAM
NOTE: Sites may not participate in [he SFSP and SMP simultaneously
7. HAS THE APPLICANT PARTICIPATED IN THE SUMMER FOOD SERVICE PROGRAM IN PRIOR YEARS? $$YES~ ~ NO
IC7yes", has the Stale agency designated you as an "Experienced" sponsor? (If you are unsure, please contact your State agency.)
YES ~ ~ NO
If'yes'", you may ortut shaded questions on Sponsor Application and on [he Si[e InCornanon Sheets for sites which you operated last year if the responses to the
questions have not changed since last year.
If "no', state the agreement number, year, and State in which the applicant participated for the most recent period of participafion and complete all sections of the
Sponsor Application for Participation and the Site Information Sheet(s) for each site you plan to operate.
8A. DOES THE APPLICANT PROVIDE AN ONGOING, YEAR-ROUND SERVICE TO THE COMMUMTY THAT WOUL,D:~E 9E~tVPD BXTHE SUMMER
FOOD SERVICE PROGRAM7'I) YES ~ NO ~ -
If `yes", describe the nature df the service; the date it was instituted, and the avetage:number of paid and Yohmtoci^ workers during the shtttioutbs precedmg this
application -
86. WAS THE APPLICANT EVER TERMINATED OR DETERMINEDTQ,HAVEBEFN SERIOUSLY DEFfC1ENT'IN,ITS
QPERe~TIOpI.OF THE SUMMER
FOOD SERVICE PROGRAM OR ANY CHII.D NUTRITION PROGRAM?; ' - - - ' '
I YES- ~I NO Tf `yes"-Please explain below. . ~ . _ _ - -
PAGEI OFS
SFSP-3 1/02)
t . ~ z e * ~ a ~ x s ?sttl is si
~ iw' v RURAL NON-RURAL
a 1 t°
~t 2
9_HOW WILL MEALS B,$PROVIpED Td, SITES`
~~.'~~,'„k~k,E. t.,,r c ,.',rt~ s+l,
_~S~t
a.!~ ~ , 71`~u`~ *rh?~~~'}5 I L NO. OF SITES SERVED
~ ~ A. SELF 2REPARgTIO~I ON sSTF.~~a`s'jfi r'~ r''PKFt+yt , tt
..'§st , q':1,lx~~
~ ~B SPONSOR PREpARi1TIQ~S AT C>v~`I'j:1~` }v"ux$~'s{*' NO. OF SITES SERVED
KITCHEN FACI~ ;PN;, ~Y~~
R
s ~ r ADp1R,~ES ~"y,'~ + sty "
i t c!k M ~~a 4 6 a +l. F "u
pp_~ ~ ~
r s vX~* ry -0~SMi t,~a~~~a o+>Fr ~~f~ h~rt~'"S+~x, ~ Fr
Yom' u 3{~~ ~a.+ ~E ~ Y~,
~a'.a vr~ MI ~ tV 4<5.~~~a *X r ~ ~s~t` }Y
4
~ ~C. SPONSOR PREPARATION AT A„~ ~jNU,~54 }o i No. OF SITES SERVED
SCHOOL FOOD SIyRVICEFA.CIL,)TY ~ Es N? 'r.~
f tzk Y Lfto~i.}l(kd~~..vs+et`,.9::
NAME(S) A2vD ADj)RE S(~ is _
> ~ t
~ t q. n; 'P ~N • y ~ ~Y
A i / X 4'
I ~ ~u
'i ~ r': t` 't~i4t t P `^`'ZEa~ : 4 ~ M
x x v _,4 t x ~ r,
t F fi:+t ii
~jLD AGREEMENT WITH SCHOOL FOO~AU~'Q.RI~ry`, NO. OF SIT S SERV~.D
(~i
SCHOOL NAMEjS~ AND ADDRF,SS~ES) { t ` COMP Y NAME S AND ADDRESS ES
T~aiekea'.~titer a.3.6 ~a ~,nf^aegwa ( )
rvte,F,. yy ,s, rI~ ~~M~ HCEOC-Hawaii my Economic Opportunity Council
Ltatu EI2`~1TI 'C~l$.~ i{dn tYh Pj:n'n~~`[ *i ;
Honok~~t ~ ~ kYti nit 47 Rainb rive SChO7~/
~ ~ ~ ~t~ti ~I $r; S~~r~V'/~~
~@1$Ll ELE(Na !x s~ Pn fi't` 4 zt~i tk'!~ Hll , I 96720 7 / ~~J ~ ~~Ts ~C~(~~
$ghafa~a~u~h: ~ ' ~ Gal/~~ f-~.1 l'G
`6A E. CONTRACT ITH FOOD SE VICE MGMT NO. OF SITES SERVED RUIjAL NON-RURAL
COMPANY /K./_
IF YOIJ ARE A IF YOU HAVE BEEN
NEW SPONSOR DESIGNATED AS AN
OK HAVE NOT EXPERIENCED
BEEN SPONSOR: Ifa contract C-'l.I
DESIGNATED AS will exceed $10,000, f
~W EXPE}21ENCED abachabid schedule. r%(I~~
SPONSOR: Ifa Sponsors must also JI
Contract will excecd submit a summary _
S 10,000, attach a of meal service and copy
s'chcdule of bid dates of IFB if changing
and a copy of IFB method of procuring
meals.
COMPANY NAME(S) AND ADDRESS(ES)
C F-fQ ~t~'GIr~! 1 CUtar~ f
~Z 1 V~(~~70 ?V" J/Yl V/z'i7 l /Gtr~yrrry %i
~F. OTHER P li ~(.TI l ~~~~'ti~bC~~ ~tCI /Zl.~
I0. FOR TkIE GEOGRAPHIC AREA SERVED BY YOUR SPONSOR PROVIDE AN ESTIMATE OF THE RACIALETHNIC MAKEUP OF THE
POPULATION TO BE SERVED, AND DESCRIBE EFFORTS TO (I) ASSURE THAT MINORITY POPULATIONS HAVE EQUAL OPPORTUNITY TO
PARTICIPATE AND (2) CONTACT MEJORITY AND GRASSROOTS ORGANIZATIONS ABOUT THE OPPORTUNITY TO PARTICIPATE M THE
PROGRAM.
1 I . INDICATE TO]'AL AVERAGE DAILY PARTICIPATION OF ELIGIBLE CHILDREN TO BE SERVED BY MEAL TYPE AT ALL SITES LISTED ON
FORM(S) SFSP-Q SITE INFORMATION SHEET(S). (FOR CAMPS, LIST ONLY THE ESTIMATED TOTAL AVERAGE DAILY PARTICIPATION OF
ELIGIBLE CHILDREN FOR EACH SESSION IN WHICH REIMBURSEMENT FOR MEALS WILL BE CLAIMED UNDER SFSP.
k3RfiARFAST AM SUPPLEMENT LUNCH PM SUPPLEMENT SUPPER
(A) (C) (D) (E)
1,040
PACE 2 OF 5
srsp-3 (I
I2. START lIP AND ADVANCE PAYMENTS None
A. DOES THE APPLICANT REQUEST B. DOES THE APPLICANT REQUEST C. DOES THE APPLICANT REQUEST ADVANCE PAYMEN
START-UP PAYMENTS ADVANCE PAYMENTS FOR FOR ADMINISTRATIVE COSTS?
OPERATIOddN'AL COSTS?
YES TU NO I I YES ~M NO I YES ~ NO
] 3. LIST T}1E SPONSOR-LEVEL PERSONNEL WHO WILL BE RESPONSIBLE FOA ADMINISTERRJG THE SUMMER FOOD SERVICE PROGRAM
'CITLE OF POSITCON NO. HOURS SALARY PER NO. TOTAL SOURCE OF NAME OF SA
PER HOUR OF SALARY FUNDS ADMN[STRATNE APPROVE
DAY (VOLUNTEER- DAYS FOR PERSONNEL AMOUNT
ON USE"V") PROGRAM
SFSP
ADMINISTRATOR
1 1.5 33.50 29 1 457.25 USDA lene Mi ake
spsP-DIRECTOR OR 5 1.5 23.26 29 5 059.05 " See attached
COORDINATOR r
COORDINATORT D1R.f 14 1.5 17.90 29 0,901.10 " See attached
ACCOUNTANT 1 1.5 15.00 29 652.50 " Donette Iyo
cLER1CAL STAFF 1 1.5 10.24 29 441.09 " Shari IVakamur
Secreta
MONITORS (not less „ ACt1Vlt 4' deS 1 th
than one er zo sites 47 1.5 8.93 29 8 257.39 rocess ~f` bei Mired
OTHERS 3 1.5 13.11 29 1,710.86 " Alana Hindle, na
TOTAL rana a, ns
ADMw1sTRATIVE 72 38,479.2
SALARIES
14. U[D ANY OF THE PERSONNEL NAMED IN ITEM 13 WORK FOR ANOTHER SUMMER FOOD SERVICE PROGRAM SPONSOR OR A FOOD SERVICE
MANAGEMENT COMPANY? AYES IINO
(If yes, give name of person, name and address of sponsor or food service management company and dates of employment [here)
I5. OPERA"fIONAL AND ADMNISTRATIVF, BUDGET
A- ES'f1MATED OPERATIONAL C05T (FOOD SERVICE) B. ESTIMATED ADMINISTRATIVE COSTS
SPONSOR SA APPROVED SPONSOR SA APPROVED
~t~~ ~-y AMOUNT AMOUNT AMOUNT AMOUNT
l TOTAL ADMINIS"CRATIVE
FooD $ ~~(~tf-~ SALARIES (see 13 abn~e) 8 479.21 ~ ~r
(c-7 I
Si' RENT OF OFFICE SPACE
(Attach contract)
UTILITIES
KITCHEN
OFFICE SUPPLIES
LABOR
AUDIT FEES Attach letter
7RANSPORTATION RENTAL
(ADMINISTRATIVE
NON-FOOD SUPPLIES I ~J~j AND MONITORS) MILEAGE
v TELEPHONE
UTILITIPS POSTAGE
KITCHF,N OR TRUCK RENTAL LEGAL PEES REIMBURSEMENT ILL NOT EXC ED ELIGIBLE
(Atach contract) USE ALLOWANCE ° ac
EQUIPMENT REN"CAL OFFICE BLDG. MA '
1Attach contract (Not included in Rental A Bement
OTHER S eeif 1 OTHER S ecif~
/j ` INDIRECT COST (Rate) (Attach copy of
SUB-TOTAL "b ~ ~ / co rizan[ a ~encv's a royal
_ suBTOTAL 8,479.21 A ~~7~
PAGE30F5
SFSP-I ATTACHMENT A
SE, O-~F9
y~~'; ~s.>~^ STATE OF HAWAII
e - DEPARTMENT of EDUCAT[ON SUMMER FOOD SERVICE PROGRAM
{ j OtTice oI Hawau Child Nutritiao Prog~ams
~ - 1106 Koko Head Aveuue
qa~•_ ~ Honolulu, HI 96816.3797 SITE INFORMATION SHEET
'i
M:P,tRJ:\
County of Hawaii-Dept. of Parks &
SPONSOR NAME: Recreation, Recreation Division AGREEMENT NUMBER: ~ 70 7
INSTRUCTIONS: COMPLETE EVERYTHING IN BLACK INK. LIST SITES CONSECUTIVELY. IF MORE SPACES FOR SITES ARE NEEDED,
PLEASE DUPLICATE THIS PAGE. SHOW ONLY THE TOTAL NUMBER OF DAYS FOOD WII,L BE SERVED. DO NOT INCLUDE HOLIDAYS
(IULY 4) OR WEEKENDS, UNLESS FOOD IS ACTUALLY SERVED. CAP'S WII,L BE COMPLETED BY THE DEPARTMENT OF EDUCATION.
*CAMPS MUST LIST EACH SESSION SEPARATELY.
*ALL NEW SITES MUST ALSO COMPLETE A SITE INFORMATION FORM (SFSP~4).
*ACCORDING TO REGULATIONS, SPONSOR MUST VISIT ALL NEW SITES BEFORE THE SITES ARE L[STED BELOW.
*ADP =AVERAGE DAII,Y PARTICIPATION AT THE MEAL SERVICE. IF THE SITE PARTICIPATED LAST YEAR, USE THE ACTUAL ADP FROM
LAST YEAR'S DAII,Y SITE RECORDS (NOT WHAT WAS ON LAST YEAR'S APPLICATION) OR CURRENT ENROLLMENT. CAMPS SHOULD REPORT
HERE THE NUMBER OF ELIGIBLE CHII,DREN ONLY.
*IF ANY OF THE FOLLOWING SITES HAS DISABLED ADULTS YOU MUST CONTACT THE DEPARTMENT OF EDUCATION IMMEDIATELY.
FOR DOE
USE ONLY
DATES OF
EXACT NAME, ADDRESS & OPERATION TOTAL MEAL TB11ES
SITE PHONE NUMBER OF SITES, BEGIN END NO OF CAP CAP
NO. NAME OF S1TE SUPERVISOR MO/DAY MO/DAY DAYS MEAL ADP FROM TO 1 2
Yano Memorial Hall
1 82-6156 Mamalahoa Hwy 6/16/03 7/25/03 29 ttBUN~cli` 80 10:30 11:30
Capt. Cook, HI 96704 sxgcx am am
PxoNE: (gpg) 323-3060/) hn Littl DEVNER ~IU
Hale Halawai BR~_
75-5760 Alii Dr. <LuNCII-~ 40 "
2 Kailua-Kona, HI 96740 sxgcx
PHONE: SO8 7- DINNER ~S
Kekuaokalani Gym/Park
75-5500 Kuakini Hwy " L"BU~NCI[ 150 "
3 Kailua-Kona, HI 96745 sNncK
PHONE: (g08) 327-3553/V ctor McD niel DINNER
Hisao aGyym-Kam Park
54-3853 Akoni-Pule Hwy CB~xcI~• 60 "
4 Kohala, HI 96715 sNACx
PHONE: (808) 889-6506/ ris Cac ley DINNER
Waimea Comm Ctr
65-1260 Kawaihae Road H ~ 80 "
5 Kamuela, HI 96743 sNncx ~3g
PHONE: (808) 887-3014/ can Goya DINNER 7~
Papaikou Gym aRK_
27-228 Maluna Place "
6 Papaikou, HI 96781 ~-.L[JNCH- • 75 11:00 12:00
PHONE: SNACK
(808) 964-3304/J e Bautis a DINNER am
35-1994 Government Roa e>tx
7 Papaaloa, HI 96780 sNA H 11:30
PHONE: g08 962-2103/J hn Kushi DINNER am am
SFSP-1 ATTACFIl~7EN1' A (continued)
FOR DOE
USE ONLY
DATES OF
EXACT' NAME, ADDRESS & OPERATION TOTAL MEAL TIMES
SITE PHONE NUMBER OF SITES, BEGIN END NO OF CAP CAP
NO. NAME OF SITE SUPERVISOR MO/DAY MONDAY DAYS MEAL ADP FROM TO 1 2
O
g 43-9 ym 0 7 25/0 29 -B~ 40 10:30 11:30
Paauilo, HI 96776 L?m1--~' ~ ~
PHONE: (8O8) 776-7601/ SOn SDUZ DINNER
Honokaa Gym
45-541 Akia Street " eRx 60 "
g Honokaa, HI 96727 LUNCH
PxoNE: (808) 775-7505/ ohn Will ams sNACI~~ .7 ~
DINNER
aia ea a
1200 Ainaola Drive BRK
10 Hilo, HI 96720 'r SNACK 90 " "
PxoNE: (808) 959-9474/ arrell Y amoto DAR ~ G'~l
Andrews Gym Waiakeawa na Sc oo Bwc
33 W. Kawailani Street
11 Hilo, HI 96720 " ~s
Acx 120 "
PxoNE: (808) 959-9047/ oyden Ch w DINNER x-35
Hilo Armory
12 28 Shipman Street BRx
~UNCH _
Hilo, HI 96720 " sNACK 45 " "
PxoNE: (808) 961-8734/ ail Rose ill D[rsIER LJ'~
a a a mm tr
13 96-1149 Kamani Street /BaK
„ „ „ \LUNCH
Pahala, HI 96777 sNACx 40 " "
rHONE: (808) 928-3102/6 inona Ma uakane DINNER
Mt. View Gym
18-1345 A Volcano Road BRx_."'
14 Mt. View HI 96771 srincx ` 60 " 7~
PHONE: 1808) 968-2000/ erle Gor ick DIMMER
ipman ym
15 Bale---~
Keaau, HI 96749 " 'LUNCH-'' rr
SNACK 6O
PxoNE: (g08) 966-5803/G enn Koku un DINNER 0
Pahoa Comm Ctr BRtL,~„
16 15-2910 Puna Road I,ur?cI-i~
PPHONE~ HI 96778 " " " SNACK 80 " rr
_ DINNER
LUNCIt
PHONE: SNACK
DINNER
RK-
LUNCH'
SNACK
PHONE: DINNER
BRK
LUNCH
SNACK
PHONE: DINNER
BRK
LUNCH
SNACK
PHONE: DWNER