HomeMy WebLinkAboutCOM 0082.071 2004-2006 J•T~'.U~'
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Patricia G. Engelhard
Director
Harry Kim :.•J ~ Y , • .
Mayor 'h'o~'w~"
Pamela N. Mizuno
~uuntp of Ramat ` i Deputy Director
DEPARTMENT OF PARKS AND RECREATION
25 Aupuni Street, Room 210 • Hilo, Hawaii 96720-4252
(808) 961-8311 • Fax (808) 961-8411
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DATE: July 12, 2006 ~
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TO: Stacy Higa Council Chair and rv
Council Members -C
VIA: Deanna Sako, Controller ~
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FROM: el Mizuno, Deputy Director - ra
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RE: NOTIFICATION OF GRANT AWARD
Compliance with Ordinance No. 06-79, 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: $84,250
Amount of County Match: $37,754
County Revenue & Expenditure Account Numbers: 3302.76 (Revenue)
010-500-5509.30-341 (Expenditure)
Grant Period (Commencement & Completion): June 16, 2006 -July 21, 2006
Purpose of Grant: Summer Fun Meal Program
The grant application is based upon all desired Summer Fun sites at maximum attendance. This figure is
usually much higher than the actual grant received as (1) there are usually sites where meals cannot be
provided due to various reasons and (2) daily attendance fluctuates.
Is final report required by grantor? ? Yes ~ No Q
Notification attached: ~ Yes ? No, because Comm. No. v Z'~
Ref. To: - -
ftef. Uate OCT 3 0 2006
Form NGA 6/01
1. AGREEMENT NUMBER ~ ~o ~ .g
STATE OF HAWAII
DEPARTMENT OF EDUCATION 2. NAME 8 MAILING ADDRESS OF APPLICANTISPONSOR
OFFICE OF HAWAII CHILD NUTRITION PROGRAMS County of Hawaii
SPONSOR APPLICATION FOR PARTICIPATION Department of Parks &Recreation-Recreation Division
SUMMER FOOD SERVICE PROGRAM 799 Piilani Street
Hilo, HI 96720
INSTRUCTIONS' Complete two copies of this application. Suhmit applications with TELEPHONE NUMBER: (608) 961-8740
an original Site Information Sheet for each site and for each session (if more than 5 TYPE OF APPLICANT . ` ~ .
one is offeretl) where the program will be atlministered by the applicant. If mare ~ ' ~ " '
space is neetleQ continue on a plain sheet of paper numbering each item. Type o ? (1} PUBLIC OR PRIVATENONPROFI,j (SGHO¢L fOQP AUTHQRITY
print clearly all information.
NOTE FOR SPONSORS WHO OPERATED THE SFSP LAST YEAR' The State , ~ (2) PUBLIC ¢R NPNRROFIT PRIVATE RESIDE{dT(faL SUMMER' CAMP
agency may designate sponsors which have operated some or all of the same sites P 6 -
in the SFSP in the prior year with no significant defciencies or operational problems ~ ~ ~ ~ i
fl'' (3) .COLLAGES AND UNIICER$ITdES PAF,TIGfi'/4T;ING IN NATI¢tJAL
as "Experienced," and allow These sponsors to omit certain information from _ ~ ~ y r,~ +
Sponsor and Site application forms if the information has not changed from the YtfUTH SPQRTS PRQ~aRAM
previous year. If the State agency has designated you as an "Experiencetl" sponsor 'I v s ~
you may omit the questions in the shaded blocks on the Sponsor Application and on +r"'i .SdA 'STATE LO~AI. N1Ut~IC1pAL tlft.CQIJNTY.~,dY~RNM~NT'~hlTl~f?f
Site Information Sheets for sites which you operated last year if the answers to these LLJJ 1 A + ~ i I ~ t a
questions have not changed since last year. You must fle a complete Site r ~ ~ -
Information Sheet for any new site which you will operate this year. ~ ~ ? {5~ OTHEE'~ PI2lVATE NONt~ROFFT ORGANIZN,Td¢FIS ~
3. INTENDED DATES OF FOOD SERVICE PROGRAM OPERATION " + t x ~ s t f Er r
BEGIN END ",)'tmEd (GQV~RNtd¢(J'~-EN~'fT1, L~@TYPE ~4 (CfTF~IER Pfj1VATEiNONPI~pfIP+
QRGANI~h'iDN),SP4NS,9~ Mt7ERTIFI';~1i,7;fHEY'N114L HAVE'DIR~CY
6/16/2006 7/21/2006 r gP$RATIONAI, CCNTf~Q43~V~(i~ PROGR~,(yl,:~$ taEfINEOuW(v 7 Cf:R.
TOTAL NUMBER OF DAYS IN OPERATION : 32519tdH4) E - a r #
4. NAME 8 TITLE OF AUTHORIZED SPONSOR REPRESENTATIVE ~ ~ + 1 "L~a-r r (r '
WHO WILL SIGN THE AGREEMENT. CEY~TIFI.CATION~,'!~'ACMEp
i,n k ~ NSE t ~ ~ "4
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NAME: Patricia G. Engelhard ~ t 4 r ~ ~ '
y t {
TITLE: Director, Department of Parks & Recreation ~ t.... " `''r ` + ~ ` '
6. INDICATE OTHER PROGRAMS IN WHICH THE APPLICANT PARTICIPATES
NONE ? CHILD & ADULT CARE FOOD PROGRAM ? NATIONAL SCHOOL LUNCH PROGRAM
J SCHOOL BREAKFAST PROGRAM ? FOOD DISTRIBUTION PROGRAM ? SPECIAL MILK PROGRAM
NOTE: Sites may not participate in the SFSP and SMP simultaneously.
7. HAS THE APPLICANT PARTICIPATED IN THE SUMMER FOOD SERVICE PROGRAM IN PRIOR YEARS? ~ YES NO
If "YES", has the State agency designated you as an "Experienced" sponsor? (If you are unsure, please contact your State agency.)
D YES ? NO
If "YES", you may omit shaded questions on Sponsor Application and on the Site Information 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 Slate in which the applicant participated for the most recent period of participation and complete
all sections of the Sponsor Application for Participation and the Site Information Sheet(s) for each site you plan to operate.
Agreement Number Year State
bA.° ¢QES TH6 RPpL(GANT#'RbVIPEYtN ONGQING YEARrROUND 5~,~GE'( THEy~QMA~tJNiT'~'FHf~T Wi~ULD B~ STEP ~~HE'uUMM~12 ~ s r
4 b i d I ` t l ~?"av ""d t i i' `QE 4 "It
F¢¢P SERV~G~~,.E29C+R?n4? a a~' ~ ~ ~ ~ ~ .~<T t .d T,~' : r ~ t ~ w r~ 'fi..v. :,s
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7r t ~ .t1LE~ k~riJ. 'yy NC3 I a a ~ r ~ If~F.4.~f~ " ~ ? ,ad x.~~ .pia 1 ~s, ~ ~~r' s: t,r
it'I`YES" "ileac i e #~ie nalu[e~f 1111' ~~rv, the det2 tf was 3nsiltthed fiche a ~'~,'~~r~~f ~~d and YOIc~~~er vtQiKeFdsm~kiTthe ~ ~
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+ ' ».m'I•'Se r. _ ,,..ra +i:~.t ~ , k 'a,:-e: i t.+ _ ,..,i ...~1,._...:., _ , a,
sg manih5 ~Qding ihls app6ddifb I 1 I
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t + , t c r '",F~ , nn~1 ~ ~ i s a r, s , ~s, `"+ns' r
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-SB'~WASTNEAPPLIG'~`1,T,~'TEf3MINATF,P4i2~RT~Rfv~INERTd~FJ~V~~~~ O $LYb~FI~I~NT~f~B'~3fr'EE~A'~iON~7F"F1'H~SUMI~Ef~'S x
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PAGE 1 OF 6
" 9;;HOW WILLi1v1EALS:BE PROVIDED TO$ITES? RURAL NON-RURAL
" ~ NO. OF SITES SERVED
? A. SELF RREPARATiON ON$tTE
B. SRON50R?REPARATION AT C':=NTi2AL KITCHEN NO. OF SITES SERVED
FAC)L.ITY "
-AD?RESS.{ES)
G~'SP9NSQR PRERARATION AT CENTRAL KITCHEN NO. OF SITES SERVED
.FACILITY _
=..NAMEj§}ANOAOC}RESS(ES}.':' '
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A~ _
3 t P.
Z
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a ' ' - NO. OF SITES SERVED X
? D At3RREMENTINIIN RC#~00(fFS30DAllTH4RITY , . s
'l~ " COMPANY NAME(S) AND ADDRESS(ES)
scH.4p~NaM~i)A~(o;ADpE?ESS(I^s} '
. ~ E r ;.~~e ~ , _ - Department of Education
t. r ~ i a : , g' . ~;i School Food Services Branch
4 .
- ~ r: t r ~ ~ ~ ~ b, j ~ - 1106 Koko Head Avenue
ass s*.,i t .a" Honolulu, HI 96816
is
E~ CONTRACT WITH FOOD SERVICE MANAGEMENT"~ N0. OF SITES SERVED RURAL NON-RURAL
COMPANY
YOU ARE A NEW IF YOU HAVE BEEN DESIGNATED AS 8 x
~ONSOR OR HAVE NOT AN EXPERIENCED SPONSOR: If a
BEEN DESIGNATED AS AN contract will exceed $100,000, attach a
EXPERIENCED SPONSOR: bid schedule. Sponsors must also submit
If a Contract will exceed a summary of meal service and copy of
$100,000, attach a schedule IFB changing method of procuring meals.
of bid dales and a copy of a
IFB.
COMPANY NAME(S) AND ADDRESS(ES)
HCEOC
47 Rainbow Drive
Hilo, HI 96720
F. OTHER
10. FOR THE GEOGRAPHIC AREA SERVED BY YOUR SPONSOR PROVIDE AN ESTIMATE OF THE RACIAVETHNIC MAKEUP OF THE
POPULATION TO BE SERVED, AND DESCRIBE EFFORTS TO (1) ASSURE THAT MINORITY POPULATIONS HAVE EQUAL
OPPORTUNITY TO PARTICIPATE AND (2) CONTACT MINORITY AND GRASSROOTS ORGANIZATIONS ABOUT THE OPPORTUNITY
TO PARTICIPATE IN THE PROGRAM.
11. INDICATE TOTAL AVERAGE DAILY PARTICIPATION OF ELIGIBLE CHILDREN TO BE SERVED BY MEAL TYPE AT ALL SITES LISTED
ON FORM(S) SFSP-4, 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)
BREAKFAST AM SUPPLEMENT LUNCH PM SUPPLEMENT SUPPER
(A) (B) (C) (D) (E)
1040
PAGE 2 OF s
Revisetl 11!02
12. STARTUP AND ADVANCE PAYMENTS
A. DOES THE APPLICANT B. DOES THE APPLICANT REQUEST ADVANCE C. DOES THE APPLICANT REQUEST ADVANCE
REQUEST START-UP PAYMENTS PAYMENTS FOR OPERATIONAL COSTS? PAYMENTS FOR ADMINISTRATIVE COSTS?
? YES Q NO ? YES NO ? YES D NO
LIST THE SPONSOR-LEVEL PERSONNEL WHO WILL BE RESPONSIBLE FOR ADMINISTERING THE SUMMER FOOD SERVICE PROGRAM.
SALARY PER TOTAL
HOUR NO. OF SALARY NAME OF
HOURS PER (VOLUNTEER- DAYS FOR SOURCE OF ADMINISTRATIVE SA APPROVED
TITLE OF POSITION NO. DAY ON SFSP USE "V") PROGRAM FUNDS PERSONNEL AMOUNT
ADMINISTRATOR 1 1.5 $35.18 25 $1,319.25 USDA Arlene Miyake
SFSP-DIRECTOR OR
COORDINATOR 5 1.5 $25.84 25 $4,845.00 See attached
SFSP-ASSISTANT DIR./
COORDINATOR 19 1.5 $19.37 25 $13,801.13 See attached
BOOKKEEPER/
ACCOUNTANT 1 1.5 $16.95 25 $635.63 Danette lyo
CLERICAL STAFF
(Secretary) 1 1.5 $11.92 25 $447.00 Shari Nakamura
MONITORS (not less than
one per 20 sites) 42 + 6 1.5 $9.20/$9.85 25 $14,490.00 $2,216.25 See attached
OTHERS 1 1.5 V 25 n/a n/a Evelyn logashi
TOTAL ADMINISTRATIVE
SALARIES 76 1.5 $37,754.36
14. DID ANV OF THE PERSONNEL NAMED IN ITEM 13 WORK FOR ANOTHER SUMMER FOOD SERVICE PROGRAM SPONSOR OR A FOOD
SERVICE MANAGEMENT COMPANY?
? YES NO
(If "YES", give name of person, name and address of sponsor or food service management company and dates of employment there)
NAME OF PERSON
NAME:
ADDRESS:
Y/STATE/ZIP CODE:
.iPLOYMENT DATES:
15. OPERATIONAL AND ADMINISTRATIVE BUDGET
A. ESTIMATED OPERATIONAL COST (FOOD SERVICE) B. ESTIMATED ADMINISTRATIVE COSTS
SA APPROVED SA APPROVED
SPONSOR AMOUNT AMOUNT SPONSOR AMOUNT AMOUNT
FOOD $84,250.00 TOTAL ADMINISTRATIVE SALARIES $37,754.36
SITE (See #13 above)
LABOR
KITCHEN RENT OF OFFICE SPACE
NON-FOOD SUPPLIES (Attach Contract)
UTILITIES UTILITIES
KITCHEN OR TRUCK OFFICE SUPPLIES
RENTAL (Attach Contract) AUDIT FEES (Attach Letter)
EQUIPMENT RENTAL TRANSPORTATION RENTAL
(Attach Contract) (ADMINISTRATIVE &
MONITORS) MILEAGE
OTHER (Specify) TELEPHONE
SUB-TOTAL POSTAGE
LEGAL FEES
USE ALLOWANCE
OFFICE BUILDING MAINTENANCE
(Not included in Rental Agreement)
OTHER (Specify)
INDIRECT COST (Rate) (Attach copy
of cognizant agency's approval)
SUB-TOTAL $37,754.36
PAGE 3 OF 6
18. ? A. THE SCHEDULE FOR MAKING PRE-OPERATIONAL VISITS TO SITES (INCLUDE THE NUMBER OF SPONSOR PERSONNEL
AND NUMBER OF SITES THAT WILL BE VISITED PER WEEK.
DATE(S) # SPONSOR PERSONNEL SITES VISITS PER WEE
? B. THE SCHEDULE FOR VISITING ALL SITES LISTED ON THE SITE INFORMATION SHEETS (FORM SFSP-4) DURING THE
FIRST WEEK OF OPERATION AND FOR REVIEWING ALL SITES DURING THE FIRST FOUR WEEKS OF OPERATION
(INCLUDE THE NUMBER OF SPONSOR PERSONNEL AND NUMBER OF SITES THAT WILL BE VISITED AND REVIEWED.)
DATE(S) SITE(S) # SPONSOR PERSONNEL # SITE VISITS PER WEEK
6/16/2006 Waiakea Uka; Waiakea Rec, Panaewa, Armory 5;6;1;2 teach
6/19/2006 Yano; Hisaoka, Waimea 2;3;4 1 each
6/20/2006 Mt. View; Naalehu, Pahala, Honokaa 2;7;1;2 i each
6/21/2006 Carvalho, Kawananakoa; Pahoa 5;5;4 i each
6/22/2006 Papaikou, Papaaloa; Shipman 2;1;2 1 each
6/29/2006 Yano Hall 2 i each
7/6/2006 Waiakea Uka; Waiakea Rec, Panaewa, Armory 5;6;1;2 i each
7/7/2006 Hisaoka, Waimea 3;4 7 each
7/10/2006 Pahoa 4 teach
7/11/2006 Carvalho, Kawananakoa 5;5 1 each
7/12/2006 Papaikou, Papaaloa 2;1 1 each
7/13/2006 Shipman, Panaewa, Armory 2;1;2 1 each
7/14/2006 Waiakea Uka; Waiakea Rec 5;6 1 each
7/17/2006 Mt. View; Naalehu, Pahala, Honokaa 2;1;1;2 1 each
7/18/2006 Carvalho; Kawananakoa; Pahoa 5;5;4 7 each
7/19/2006 Papaikou; Papaaloa 2;1 teach
7/20/2006 Yano; Waimea 2;4 1 each
C. A COPY OF THE FREE MEAL POLICY STATEMENT
D. A COPY OF THE PUBLIC ANNOUNCEMENT AND NON-DISCRIMINATION WITH A DESCRIPTION OF WHEN, HOW, AND
TO WHOM THE ANNOUNCEMENT WILL BE ISSUED.
E. DESCRIPTION OF PROCEDURES FOR COLLECTING INFORMATION ON THE DAILY NUMBER OF MEALS SERVED TO
CHILDREN, THE DAILY NUMBER OF HOURS WORKED BY SITE PERSONNEL (IF LABOR COSTS WILL BE CLAIMED.)
PERSONNEL (IF LABOR COST WILL BE CLAIMED), INCLUDING BOTH THE FREQUENCY OF INFORMATION
COLLECTION, THE METHOD USED TO COLLECT INFORMATION FROM SITES. IF FORM FOR MEAL COUNTS IS
AVAILABLE, ATTACH COPY.
Explain the procedure for collection information on the daily number of meals served to children.
See attached.
Explain the procedure for collecting the daily number of hours worked by site personnel (if labor costs will be claimed.)
n/a
PAGE 4 OF 6
18. ? E. Explain the procedure for personnel (if labor costs will be claimed), including both the frequency
of information collection, the method used to collect information from sites.
n/a
18. 0 F. A DESCRIPTION OF THE METHOD USED TO SECURE CORRECTIVE ACTION IF PROBLEMS ARE OBSERVED AT A SITE,
INCLUDING PLANS FOR FOLLOW-UP AND EXPLANATION OF WHEN A SITE WOULD BE CLOSED.
See attached.
18. ~ G. A COPY OF THE PROPOSED LETTER TO LOCAL HEALTH DEPARTMENT PROVIDING NOTIFICATION OF INTENTION
TO OPERATE A SUMMER FOOD SERVICE SITE LISTED ON THE ATTACHED SITE SHEETS. (Give specific dates and
times of operation for each site.)
19. MANAGEMENT PLAN : IDENTIFY BY NAME AND TITLE, THE PERSON(S):
A. AUTHORIZED TO APPROVE PURCHASES OR RENTALS (Specify dollar limitation, as applicable)
Arlene Miyake Recreation Administrator
NAME TITLE AMOUNT
B. AUTHORIZED TO APPROVE THE NUMBER OF HOURS OF REGULAR AND OVERTIME PAY FOR EMPLOYEES
Arlene Miyake Recreation Administrator
NAME TITLE
C. RESPONSIBLE FOR RECEIVING PARTICIPATION AND COST DATA, AND FOR PREPARING CLAIMS FOR REIMBURSEMENT
Donette L. lyo Account Clerk
NAME TITLE
D. RESPONSIBLE FOR SCHEDULING AND SUPERVISING MONITORS, REVIEWING SITE REPORTS OF DEFICIENCIES, RESTRICTING
OR TERMINATING FOOD SERVICE IF NECESSARY, AND EFFECTING CORRECTIVE ACTION
Arlene Miyake Recreation Administrator
NAME TITLE
E. RESPONSIBLE FOR COORDINATING WITH OFFICIALS TO WHOM SITE SUPERVISORS REPORT, IF APPLICABLE
Arlene Miyake Recreation Administrator
NAME TITLE
PAGE 5 OF 6
WARNING STATEMENT OF CRIMINAL PROVISIONS AND PENALTIES
A. ESTABLISHED IN Section 13 (o) of the National School Lunch Act (42 U.S.C. 1761 (o)).
~ver, in connection with any application, procurement, recordkeeping entry, claim for reimbursement, or other document or statement made in connection
2 Program, knowingly and willfully falsifes, conceals, or covers up by any trick, scheme, or device a material fact or makes any false, fctitious or fraudulent
s«.~ments or representations or makes or uses any false writing or document knowing the same to contain any false, fictitious, or fraudulent statement or entry,
or whoever, in connection with the Program, knowingly makes an opportunity for any person to defraud the United States, or does or omits to do any act with
intent to enable any person to defraud the United States, shall be fined not snore than $25,000 or imprisoned not more than five years, or both.
(B) Whoever being a partner, officer, director, or managing agency connected in any capacity with any partnership, association, corporation, business, or
organization, either public or private, that receives benefits under the Program, knowingly or willfully embezzles, misapplies, steals, or obtains by fraud, false
statement, or forgery any benefits provided by this Program, or any money, funds, assets, or property derived from benefits provided by this Program, shall be
fined not more than $25,000 or imprisoned for not more than five years, or both (but, if the benefits, money, funds, assets, or property involved is not over $200,
then the penalty shall be a fine of not more than $1,000 or imprisonment for not more than one year, or both.)
(C) If two or more persons conspire or collude to accomplish any act described in paragraphs (a)(5)(I)(A) and (B) of Section 225.6 and one or more of such
persons do an act to effect the object of the conspiracy or collusion, each shall be fined not more than $25,000 or imprisoned for not more than five years, or
both.
TERMINATION PROCEDURES
As established by Section 225.11 (c) of the SFSP regulations.
1 ~ The State agency shall terminate the Program agreement with any sponsor which it determines to be seriously deficient. However, the
Stale agency shall afford a sponsor a reasonable opportunity to correct problems before terminating the sponsor for being seriously
deficient.
2. The State agency may approve the application of a sponsor which has been disapproved or terminated in prior years in accordance with
this paragraph if the sponsor demonstrates to the satisfaction of the State agency that the sponsor has taken appropriate corrective
actions to prevent recurrence of the deficiencies. Serious deficiencies which are grounds for disapproval of applications and for
terminations include, but are not limited lo, any of the following:
a) Noncompliance with the applicable bid procedures and contract requirements of Federal Child Nutdtion Program regulations
b) The submission of false information to the Slate agency
c) Failure to return to the State agency any start-up or advance reimbursement payments
d) Noncompliance with civil rights laws and regulations
e) Program violations al a significant proportion of the sponsor's sites. Such violations include, but are not limited to the following:
1) Noncompliance with the meal service time restrictions set forth in Section 225.15 (c)
2) Failure to maintain adequate records
3) Failure to adjust meal orders to conform to variations in the number of participating children
4) The simultaneous service of more than one meal to any child
5) The claiming of Program payments for meals not served to participating children
6) Service of significant number of meals which did not include required quantities of all meal components
7) Excessive instances of off-site meal consumption
8) Continued use of food service management companies that are in violation of health codes
f) Failure to take corrective action on Program violations cited in an audit or review or after being determined seriously deficient; and
g) Any imminent threat to the health and safety of participating children
NOTE: Sponsors or sites which have been terminated in accordance with the provisions above shall be allowed to appeal in accordance with
Section 225.13.
I certify that the information on this application and the attached forms SFSP-4, Site Information Sheet, is true to be best of my knowledge, that reimbursements
will be claimed only for meals served to eligible children at the approved food service sites, and that these sites have been visited and have the capability and
facilities for the meal service planned for the number of children anticipated to be served. I understand that this information is being given in connection with the
receipt of Federal funds, and that deliberate misrepresentation may subject me to prosecution under applicable State and Federal criminal statutes. The
program must be made available to all eligible children regardless of age, gender, disability, race, color, or national origin. If government sponsor, I certify that
the program is directly operated at all sites.
DATE NAME & TITLE OF AUTHORIZED SPONSOR SIGNATURE OF AUTHORIZED SPONSOR REPRESENTATIVE
f REPRESENTATIVE (Print or type)
! NAME: ~-PATRICIA G. ENGELHARD _ _ _
' nrLe Director, Department of Parks & Recreation ~ min
PAGEfi OF6