HomeMy WebLinkAboutResolution - 2003-R0157 - Contract For Summer Lunch Program - Department Of Human Services - 04_24_2003Resolution No. 2003-RO157
April 24, 2003
Item No. 22
RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK
THAT the Mayor of the City of Lubbock BE and is hereby authorized and
directed to execute for and on behalf of the City of Lubbock, a contract for a summer
lunch program, by and between the City of Lubbock and the Department of Human
Services, and all related documents. Said Contract is attached hereto and incorporated
in this resolution as if fully set forth herein and shall be included in the minutes of the
City Council.
Passed by the City Council this 24th day of April , 2003.
M
ATTEST:
Rebe ca Garza, City Secretary
APPROVED AS MOONTENT:
Ran y ruesdell
Director of Parks and Recreation
APPROVED AS TO FORM:
William de Haas
Contract Manager/Attorney
WDH/erc/Summer Lunch Program.2002.res
April 10, 2003
Resolution No. 2003—RO157
April 24, 2003
Item No. 22
TEXAS
Department of
Human Services
Summer Food Service Program
Application Package
For
Current Non -School
Jim Clinton, Area Program Manager
Texas Department of Human Services
Special Nutrition Programs, MC 217-5
2109 Avenue Q
Lubbock,Tx 79405
(806)762-8664
(806)472-2388
TEXAS
Department of
Human Services
TEXAS DEPARTMENT OF HUMAN SERVICES
SPECIAL NUTRITION PROGRAMS
AGREEMENT
STATE OF TEXAS §
COUNTY OF TRAVIS §
The Texas Department of Human Services, hereinafter referred to as TDHS,
AND
City of Lubbock
hereinafter referred to as the Contractor, do hereby make and enter into this contract, as required by the National School Lunch
Act and the Child Nutrition Act, as amended, and the following program regulations: the National School Lunch Program (NSLP),
7 Code of Federal Regulations (CFR) Part 210; the Special Milk Program(SMP), 7 CFR Part 215; the School Breakfast Program
(SBP), 7 CFR Part 220; the Summer Food Service Program (SFSP), 7 CFR Part 225; and the Child and Adult Care Food Program
(CACFP) 7 CFR Part 225.
This agreement establishes or continues the rights and responsibilities of TDHS and the Contractor pursuant to the Contractor's
participation in one or more of the above named programs as stipulated herein. If this agreement continues an existing agreement,
all existing terms, conditions,. liabilities and obligations of the parties under the prior agreement remain in full force and effect,
except to the extent that those terms, conditions, liabilities and obligations conflict with this agreement, in which case this
agreement takes precedence.
By signing this agreement, both parties are bound by its terms and conditions from its beginning effective date, or the beginning
effective date of any prior agreement/s continued by this agreement, until terminated in accordance with this agreement.
I.
MUTUAL AGREEMENTS
The Parties mutually agree:
A. If the Contractor fails to provide services in accordance with the provisions of this contract, TDHS may, upon written notice
of default to the Contractor, immediately terminate the whole or any part of this contract, including refusal to pay claims for
reimbursement, and such ternnation shall not be an exclusive remedy but shad be in addition to any other rights and remedies
provided by law or under this contract.
B. If federal or state laws or other requirements are amended or judicially interpreted so that the continued fulfillment of this
contract, on the part of either party, is substantially unreasonable or impossible, or if the parties are unable to agree upon any
amendment which would therefore be needed to enable the substantial continuation of the services contemplated by this
contract then, the parties shall be discharged from any further obligations created under the terms of this contract, except for
the equitable settlement of the respective accrued interest or obligations, including audit findings, incurred up to the date of
termination.
C. This contract may be canceled by mutual consent. However, if such mutual consent cannot be attained, then and in that event,
either party to this contract may consider it to be canceled without cause by giving thirty (30) days notice in writing to the other
party and this contract shall thereupon be canceled upon the expiration of such thirty (30) day period. Nothing in this
paragraph shall be construed to prohibit immediate cancellation pursuant to above paragraphs A and/or B.
11.
CONTRACTOR PROGRAM ADMINISTRATION AND FINANCIAL MANAGEMENT
A. The Contractor will comply with the applicable regulations for its designated program, as well as 7 CFR Parts 245 and 250,
as amended, the Uniform Federal Assistance Regulation (7 CFR, Part 3015, as amended), Audits of State, Local
Governments, and Non -Profit Organizations (7 CFR 3052, as amended)and state policies and procedures as issued and
amended by TDHS. The Contractor further agrees to perform as described in its application (including its Policy statement
and supporting documents, and approved amendments to the application) for participation in the designated program.
B. The Contractor accepts final administrative and financial responsibility for food service operations in each school, summer
feeding site, and child and/or adult care facility, hereinafter referred to as a site, operated or sponsored by the Contractor. The
responsibility includes any audit exceptions or payment deficiency in the program covered by this contract, and all subcontracts
hereunder, which are found after monitoring or auditing by TDHS or USDA and will be responsible for the collections and
payback of any amount paid in excess of the proper claim amount.
C. The Contractor submits for TDHS approval only those applications for sites which have delegated the authority for the
administration of food service operations to the Contractor or which have executed subagreements with the Contractor for the
administration of food services operations.
D. Contractors participating in the NSLP agree
1. that the official signing the Claim for Reimbursement will be responsible for reviewing and analyzing meal counts
to ensure accuracy and compliance with federal regulations
2. to enter into an agreement to receive donated foods as required by federal regulations, and
3. to price lunch as a unit
E. Contractors participating in the CACFP provide or accept responsibility for the provision of organized, non-residential child
day care and will immediately report to The Texas Department of Protective and Regulatory Services (TDPRS) Licensing or
Child Protective Services staff, any suspected violations of TDPRS Licensing standards or suspected abuse of children in
sponsored centers or day homes.
RECORD KEEPING
A. The Contractor will keep financial and supporting documents, statistical records, and any other records pertinent to the services
for which a claim was submitted in the manner and detail prescribed by TDHS. The records and documents will be kept for
a minimum of 3 years and 90 days after the termination of the federal fiscal year for the relevant program. If any litigation,
claim, or audit involving these records begins before such period expires, the Contractor will keep the records and documents
for not less than 3 years and 90 days and until all litigation, claims or audit findings are resolved. The case is considered
resolved when there is a final order issued in litigation, or a written agreement is entered into between TDHS and the
Contractor. The Contractor will keep records of non -expendable property acquired under the contract for 3 years and 90 days
after final disposition of the property.
B. The Contractor and its subcontractors will allow TDHS and USDA officials and other appropriate officials determined by
TDHS to inspect facilities and records and to audit, examine, and copy records at any reasonable time. This includes access
to all records of costs paid, even in part, by TDHS.
C. The Contractor and its subcontractors will establish a method to secure the confidentiality of records and other information
relating to clients in accordance with the applicable federal law, rules, and regulations, as well as the applicable state law and
regulations. The provision shall not be construed as limiting the Department's right of access to recipient case records or other
information relating to clients served under this contract.
D The Contractor certifies that the goods and/or service(s) covered by this contract are designated to be used prior to, during,
and after calendar year 2000 AD. The goods and/or service(s) will be operated during such time periods without error relating
to date which represents different centuries or more than one century.
IV.
CIVIL RIGHTS POLICY COMPLIANCE
A. The Contractor agrees to comply with Title VI of the Civil Rights Act of 1964 (Public Law 88-352) and all requirements
imposed by the regulations of the Department of Agriculture (7 CFR Part 15), Department of Justice (28 CFR Parts 42 and
50) and FNS directives or regulations issued pursuant to that act and the regulations. Section 504 of the Rehabilitation Act
of 1973 (Public Law 93-112), the Americans with Disabilities Act of 1990 (Public Law 101-336), Title IX of the Education
Amendments of 1972 (7 CFR Part 15a), the Age Discrimination Act of 1975 (Public Law 94-135), and all amendments to
each, and all requirements imposed by the regulations issued pursuant to these acts. In addition the contractor agrees to
comply with Title 40, Chapter 73, of the Texas Administrative Code. These provide in part that no person in the United States
shall, on the ground of race, color, national origin, sex, age, disability, political beliefs, or religion be excluded from
participation in, or denied any aid, care, service or other benefits provided by federal and/or state funding, or otherwise be
subjected to discrimination. The contractor also agrees to comply with Health and Safety Code Section 85.113 (relating to
workplace and confidentiality guidelines regarding AIDS and HIV).
The contractor hereby gives assurance that it will immediately take any measures necessary to effectuate this agreement
B. This assurance is given in consideration of and for the purpose of obtaining any and all federal financial assistance, grants and
loans of federal funds, reimbursable expenditures, grant or donation of federal property and interest in property, the detail of
federal personnel, the sale and lease of, and the permission to use, federal property or interest in such property or the furnishing
of services without consideration or at a nominal consideration, or at a consideration which is reduced for the purpose of
assisting the recipient, or in recognition of the public interest to be served by such sale, lease or furnishing of services to the
recipient, or any improvements made with federal financial assistance extended to the program applicant by the TDHS. This
includes any federal agreement, arrangement, or other contract which has as one of its purposes the provision of cash
assistance for the purchase of food, and cash assistance for purchase or rental of food service equipment or any other financial
assistance extended in reliance on the representation and agreements made in this assurance.
C. The Contractor agrees to compile data, maintain records, and submit reports as required, to permit effective enforcement of
the above Acts and permit authorized TDHS, USDA and FNS personnel during normal working hours to review such records,
books, and accounts as needed to ascertain compliance with the above Acts. If there are any violations of this assurance,
TDHS, USDA and FNS have the right to seek judicial enforcement of this assurance. This assurance is binding on the
Contractor, its successors, transferees, and assignees as long as it receives assistance or retains possession of any assistance
from the department. The person whose signature appears on this contract is authorized to sign this assurance on the behalf
of the Contractor.
D. A religious or charitable organization is eligible to be a contractor on the same basis as any other private organization. The
contractor retains its independence from State and local governments, including the contractor's control over the definition,
development, practice, and expression of its charitable or religious beliefs. Except as provided by federal law, TDHS shall
not interpret this contract to require a charitable or religious organization to alter its form of internal governance or remove
religious art, icons, scripture, or other symbols. Furthermore, if a religious or charitable organization segregates the
government funds provided under the contract, then only the financial assistance provided by these funds will be subject to
audit. However, neither TDHS's selection of a charitable or faith -based contractor of services nor the expenditure of funds
under this contract is an endorsement of the contractor's charitable or religious character, practices, or expression. The
purpose of this contract is the provision of services; no State expenditures have as their objective the funding of sectarian
worship, instructions, or proselytization.
A charitable or faith -based provider of services under this contract shall reasonably apprise all assisted individuals of the
following: "Neither TDHS's selection of a charitable or faith -based provider of services nor the expenditure of funds under
this contract is an endorsement of the provider's charitable or religious character, practices, or expression. No provider of
services may discriminate against you on the basis of religion, a religious belief, or your refusal to participate in a religious
practice. If you object to a particular provider because of its religious character, you may request assignment to a different
provider. If you believe that your rights have been violated, please discuss the complaint with your provider or notify your local
TDHS Special Nutrition Programs office.
Section 104 of The Personal Responsibility and Work Opportunity Reconciliation Act of 1996. 42 U.S.C. § 604a, sets forth
certain additional rights and responsibilities for charitable and faith -based providers of services, certain additional rights of
assisted individuals, and certain additional responsibilities of TDHS to these providers and assisted individuals. This contract
is subject to those additional rights and responsibilities.
V.
TDHS CLAIMS PAYMENT
A. TDHS will, subject to the federal appropriation and availability to TDHS of sufficient funds for the applicable program,
make program payment to the Contractor in accordance with the terms of this agreement. No reimbursement shall be made
for performance under this agreement occurring prior to (a) the beginning effective date of this agreement or (b) a later
date established by TDHS based on the date of receipt of a fully executed copy of this agreement.
B. In accordance with Section 403.055(h) of the Government Code, as added by Act of May 19, 1999, 76th Leg. R.S., ch.
583, Sec. 1, 1999 Tex. Sess. Law Ser. 3125 (Vernon), any payments owing to the contractor under this contract will be
applied toward elimination of the contractor's indebtedness to the state, delinquency in payment of taxes to the state, or
delinquency in payment of taxes that the comptroller administers or collects until the indebtedness or delinquency is paid
in full. This clause does not apply if federal law requires payment to be made to the contractor for goods and services
provided in support of any of the USDA child and adult nutrition programs, and may not apply if federal law conditions
the receipt of the money for these goods or services to the state on the basis of payment being made to the contractor.
VI.
IMMIGRATION
The Contractor agrees to comply with the requirements of the Immigration Reform and Control Act of 1986 regarding
employment verification and retention of verification forms for any individuals hired after November 6, 1986, who will
perform any labor or services under this contract.
VII.
CERTIFICATION
A. Regarding Debarment, Suspension, Ineligibility, or Voluntary Exclusion For Covered Contracts - The contractor certifies,
by execution of this agreement, that neither it nor its principals is presently debarred, suspended, proposed for debarment,
declared ineligible, or voluntarily excluded from participating in this contract by any federal department or agency or by
the State of Texas. By making this certification the contractor agrees to the following terms:
1. The above certification is a material representation of fact upon which reliance was based when this contract was
entered into. If it is later determined that the contractor knowingly rendered an erroneous certification, in addition to
other remedies available to the federal government, the Department of Health and Human Services, United State
Department of Agriculture or other federal department of agency, or the Texas Department of Human Services may
pursue available remedies, including suspension and/or debarment.
2. The contractor shall provide immediate written notice to the person to which this certification is submitted if at any
time the contractor learns that the certification was erroneous when submitted or has become erroneous by reason of
changed circumstances.
3. The words "covered contract," "debarred," suspended," "ineligible," "participant," "person," "principal," "proposal,"
and voluntarily excluded," as used in this certification have meanings based upon materials in the Definitions and
Coverage sections of federal rules implementing Executive Order 12549. Usage is defined in the attachment.
4. -The contractor agrees by submitting this certification that, should the proposed covered contract be entered into, it
shall not knowingly enter into any subcontract with a person who is debarred, suspended, declared ineligible, or
voluntarily excluded from participation in this covered transaction, unless authorized by the Department of Health and
Human Services, United States Department of Agriculture or other federal department or agency, and/or the Texas
Department of Human Services, as applicable.
VII.
CERTIFICATION
(Continued)
5. The contractor further agrees by submitting this certification that it will include TDHS Form 2046 titled
"Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion for Covered Contracts"
without modification, in all covered subcontracts and in all solicitation for all covered subcontracts.
6. A contractor may rely upon a certification of a subcontractor that it is not debarred, suspended, ineligible, or
voluntarily excluded from the covered contract, unless it knows that the certification is erroneous. A contractor must,
at a minimum, obtain certificates from its covered subcontractor upon each subcontractor's initiation and upon each
renewal.
7. Nothing contained in all the foregoing shall be construed to require establishment of a system of records in order to
render in good faith the certification required by this certification document. The knowledge and information of a
contractor is not required to exceed that which is normally possessed by a prudent person in the ordinary course of
business dealings.
8. Except for contracts authorized under paragraph 4 of these terms, if a contractor in a covered contract knowingly
enters into a covered subcontract with a person who is suspended, debarred, ineligible, or voluntarily excluded from
participation in this transaction, in addition to other remedies available to the federal government, Department of
Health and Human Services, United States Department of Agriculture, or other federal department or agency, as
applicable, and/or the Texas Department of Human Services may pursue available remedies, including suspension
and/or debarment.
B. Regarding Federal Lobbying - This certification applies only to this contract and is a material representation of fact upon
which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite
for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the
required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such
failure.
The contractor certifies, to the best of his or her knowledge and beliet that:
No federally appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for
influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or
employee of Congress, or an employee of a member of Congress in connection with the awarding of any federal contract,
the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, or the
extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative
agreement.
If any funds other than federally appropriated funds have been paid or will be paid to any person for influencing or
attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress,
or an employee of a member of Congress in connection with this federally funded contract, subcontract, subgrant, or
cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report
Lobbying," in accordance with its instructions.
The contractor shall require that the language of this certification be included in the award documents for all covered
subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and -cooperative agreements)
and that all covered subrecipients shall certify and disclose accordingly.
C. The contractor certifies that if it is a corporation, it is either a for -profit corporation that is not delinquent in its franchise
tax payments to the State of Texas, or is a non-profit corporation or is otherwise not subject to payment of franchise taxes
to the State of Texas.
D. The contractor certifies that all information submitted pursuant to this agreement is true and correct. The contractor
understands that the deliberate misrepresentation or withholding of information is a violation of this contract and may
result in prosecution under applicable state and federal statutes.
E. Under Section 231.006, Family Code, the vendor or applicant certifies that the individual or business entity named in this
contract, bid, or application is not ineligible to receive the specified grant, loan, or payment and acknowledges that this
contract may be terminated and payment may be withheld if this certification is inaccurate.
Vill. ,
EFFECTIVE DATE AND SIGNATURES
The parties hereto in their capacities stated, affix their signatures and bind themselves for the faithful performance of the
terms of this contract pursuant to participation in the following program or programs:
National School Lunch Program
School Breakfast Program
Special Milk Program
. City of LUbbock
Name of Contracting Organization
(Please print or type)
Attest To: _
Name of Official Signing
(Please print or type)
Child and Adult Care Food Program
Summer Food Service Program
Siignatur f ch of the board of directors
or other offici o been authorized to sign
contracts on b half of the contracting organization.
Mayor j
Title of Official
(Please print or type)
" TEXAS DEPARTMENT OF HUMAN SERVICES
r
affective o - until terminated.
By:' � �` Date: � '
S Rearese tative
Approved for Form by OGC: Signature on file
Revised May 2001
Approved as Form:
�1/�`-�--- G .
lam a aas
Competition and Contracts Manager
Approved as to Content
.. .: ,. -♦ .:..t7-y:;'wti<+'w-=L .'1 :- 'Si t,Qyy }..i. { :x�� KY:r. +'e 4ci' T _,i.�••-L a.:r 1xl PF `A 1:, F+• w Tj^5
P'.anav Truesdell Parks Recreation Manager MY' 24 200?
Resolution No. 2003—RO157
TEXAS DEPARTMENT OF HUMAN SERVICES
AMENDMENT (A) '
TO THE SPECIAL NUTRITION PROGRAMS AGREEMENT
The Texas Department of Human Services, hereinafter designated the Department, and
_City Of Lubbock
(Name of Contracting Organization)
Hereinafter designated the Contractor, entered into a Special Nutrition Programs agreement, which is effective until terminated. The
Contractor and the Department hereby agree to the following amendment to such agreement.
A limited English proficiency clause is added following the closing paragraph under the title: " IV. CIVIL RIGHTS POLICY
COMPLIANCE" in the agreement. The clause states:
"Additionally, Title VI of the Civil Rights Act of 1964, and its implementing regulations at 45 CFR, Part 80 or 7 CM
Part 15, prohibit a contractor from adopting and implementing policies and procedures that exclude or have the effect
of excluding or limiting the participation of clients in its programs, benefits, or activities, on the basis of national origin.
Also, 40 TAC, Part 1, §73.206 requires contractors to provide alternative methods for ensuring access to services for
applicants and recipients who cannot express themselves fluently in English. Accordingly, the contractor agrees to
ensure that its policies do not have the effect of excluding or limiting the participation of persons in its programs and
activities, on the basis of national origin. The contractor also agrees to take reasonable steps to provide services and
information, both orally and in writing, in appropriate languages other than English, in order to ensure that persons
with limited English proficiency are effectively informed and can effectively participate in and benefit from its
programs. The Contractor accepts final administrative responsibility for ensuring that its subcontractors take
reasonable steps to provide services and information, both orally and in writing, in appropriate languages other than
English, in order to ensure that persons with limited English proficiency are effectively informed and can effectively
participate in and benefit from that subcontractor's programs and services."
A clause that allows the comptroller to apply contract payments to cover delinquent taxes and debts replaces clause B cited under the
title: "V. TDHS CLAIMS PAYMENT' in the agreement. The clause states:
"This paragraph is pursuant to §2252.903 of the Government Code. Any payments owing to the contractor under this
contract will be applied toward elimination of the contractor's indebtedness to the state, delinquency in payment of
taxes to the state, or delinquency in payment of taxes that the comptroller administers or collects until the indebtedness
or delinquency is paid in full."
This Amen t s ' 1 be in effec for the duration of
i ature of chairman of t e board of directors or h,
been authorized to sign contracts on behalf of the fonj
Victor Hernandez
Name of Official (Please print or type)
Mayor Pro Tem
Title of Official
41:24%3
Date
FOR DHS USE ONLY
unless revoked, suspended, or amended.
official who has
cting organization.
ATTEST TO:
Rebecca Garza, City Sec tart'
ature -DHS Repres tative ate Title of the DHS Representative
IAY � 6 2pD�
Texas Department Form 1506/March 2001
of Human Services SUMMER FOOD SERVICE PROGRAM FOR DHS STAFF ONLY
APPLICATION FOR PARTICIPATION Contract No. TX No.
Give as much information as possible. Attach Eff. Date FY
additional sheets if needed; identify each
attachment with the name of the contracting Approved For
organization. Breakfast A.M. Su pp. ❑ Lunch ❑ P.M. Supp. El Supper ❑All
SECTION I — SPONSOR INFORMATION
Contracting Organization Name
Texas ID No.
Telephone No.
Hotline No.
City Of Lubbock Parks and Recreation
11756000590-6
1(806) 775-2678
(806) 775-2673
Mailing Address (Street or P.O. Box, City, State, ZIP)
P. O. Box 2000 Lubbock, TX 79457
Street Address (if different)
E-mail Address
1010 9th St. Lubbock, TX
ljmcfellan@maii.ci.lubbock.tx.us
Name of Administrator
Title
Johnny McLellan
Indoor Recreation Supervisor
Name of SFSP Contact Person
Telephone of Contact Person (include Area Code)
Johnny McLellan
(806) 775-2678
A. Contractor Classification (Check all that apply):
❑ National Youth Sports Program
❑ School Food Authority
❑Residential/Nonresidential
Summer Camp
❑Continuous Calendar
School Year
®Unit of Government -Contractor certifies that all food
service sites are operated directly by the contractor.
❑ Private Nonprofit
B. Is your program a year-round program?........................................................................................................................... ❑ Yes ® No
C. Type of Contractor:
® Public Entity
Is your agency considered to be state owned/operated?............................................................................................. ❑ Yes ® No
Do you deposit your program reimbursement directly into the State Treasury? ........................................ ❑ N/A ❑ Yes ® No
Do you deposit your program reimbursement into a local bank?............................................................... ❑ N/A ® Yes ❑ No
If yes, is it direct deposit?........................................................................................................ ❑ Yes ® No
..............................
❑ Private Nonprofit Organization -Tax-exempt status established. Attach letter of determination (IRS 501-30) of tax-exempt status from IRS.
Do you deposit your program reimbursement into a local bank?............................................................... ❑ N/A ❑ Yes ❑ No
Ifyes, is it direct deposit?...................................................................................................................................... ❑ Yes ❑ No
D. Does the organization provide an ongoing year-round service to the community that is to be served by ®Yes ❑ No
the Summer Food Service Program(SFSP)?...................................................................................................................
If no, which of the following circumstances applies?
❑ Residential Camp ❑ Failure to operate would deny program to a poor area
❑ Serves Migrant Children ❑ Failure to operate would deny a significant number of children access to program
E. Does the organization expend $300,000 or more in federal funds yearly?....................................................................... ® Yes ❑ No
Attach a copy of the audit covering last year's program operation or documentation that an audit conforming with SFSP policy will
be conducted, including the date it will be conducted.
Form 1506
Page 2
SECTION If — BUDGET
A. Estimate all SFSP costs which will be claimed for reimbursement for the program year:
1.
ESTIMATED OPERATIONAL COSTS
PROGRAM YEAR
COSTS
Program Labor
Fringe Benefits
Food
$43,120.35
Non-food Supplies
Utilities
Rent
Equipment Use Fee
Rental of Equipment
Rate per mile
Transportation
Other (specify);
Coolers
$500.00
Other (specify);
Other (specify);
TOTAL 1:
$43,620.35
2.
PROGRAM YEAR
ESTIMATED ADMINISTRATIVE COSTS
COSTS
Administrative Labor
$5,733.54
(Management, Monitor, Clerical)
Fringe Benefits
$828.22
Rental of Office Space
Utilities
Office Supplies
$200.00
Office Building Maintenance
Equipment Use Fee
Audit Fees
Legal Fees
Rate per mile
$1,440.00
Transportation .36" 4,000
Other (specify);
Adverstising
$600.00
Other (specify);
TOTAL 2:
$8,801.76
B. Indicate projected income to the food service from all sources other than SFSP reimbursement. Identify exactly the costs this income
will cover. (Do not include state or federal funds.)
Source of Income
Amount
Will be used for:
N/A
$
Source of Income
Amount
Will be used for:
N/A
$
SECTION III — MANAGEMENT PLAN
A. List administrative level personnel who will be responsible for management and monitoring of the SFSP. (Do not include site supervisors,
cooks, janitors or other personnel involved in on -site food service.)
TITLE OF POSITION
NUMBER IN
POSITION
SPECIFIC FOOD SERVICE PROGRAM DUTIES
Indoor Supervisor
1
Director of SFSP
Program Manager
1
Assist Program Director & Monitor
Administrative Assistant
1
Manage Records
Monitor
1
Manage Records & Personnel
Form 1506
Page 3
B. Are children charged separately for meals?..................................................................................................................... ❑ Yes ® No
If yes, complete Form 1506, Attachment A (page 2), and submit with this application.
C. Do you want to receive advance payments?
For Operational Costs? ❑ Yes ® No For Administrative Costs? ❑ Yes ® No
D. If meal service is self -preparation, do you want to receive commodities?........................................................................ ❑ Yes ® No
If yes, Form 1608, Application and Agreement for Commodities, must be completed and returned with your SFSP application.
SECTION IV — PROGRAM OPERATION
A.1. Beginning and Ending Dates of Meal Service A.2. Number of Sites
FROM: May 27, 2003 TO: August 8,2003 I 7
B. List dates and topics of SFSP training:
DATES TOPICS
May 23, 2003 Summer Satellite Staff Training
May 30, 2003 SFSP Training LISD Monitors
C. Is the organization currently contracting with a year-round food service management company? ................................... ❑ Yes ® No
If yes, submit a copy of your procurement procedures, bid, contract, and all amendments; skip Item D. If no, complete Item D.
D. Is the organization planning to contract with a food service management company?...................................................... ® Yes ❑ No
If yes, and the contract will exceed $10,000, attach a copy of the invitation to bid. Also give:
Date of Bid Publication Place of Publication Date of Bid Opening Time of Bid Opening
April 6, 2003 Lubbock Avalanche Journal April 22, 2003 10:00 AM
Is bid expected to be $100,000 or more? If yes, give place of bid opening:
❑ Yes ® No
Also, attach a copy of a minimum 11-day-cycle menu including all specific menus to be used.
E. Attach a copy of the letter which has been (or will be) sent by the organization to the Health Department notifying them of intent to
operate a Food Service Program at the site(s) indicated on the attached Site Information sheet (Form 1507).
F. Are you implementing the option to allow off -site consumption of food? ................... ❑ All Sites ❑ Some Sites ® No Sites
SECTION V — ASSURANCES
A. Free Meal Policy Statement
1. The contracting organization assures the Texas Department of Human Services (DHS) that all children at the sites described on the
Site(s) Information Sheets for the Summer Food Service Program will be offered the same meals with no physical segregation of, or
other discrimination against, any child because of race, color, disability, age, sex, national origin, religion, or political beliefs. No
separate charge will be made for any meal except in accordance with attachment A of this application.
2. The contracting organization assures DHS that, if it is sponsoring camps or other enrollment programs:
• The contracting organization has or will obtain family size and income data about all children whose meals will be reported as free
or reduced -price; and
• The children claimed as free or reduced -price meet the current family size and income standards set by the United States
Department of Agriculture, DHS Form 4504, Standards for Determining Free and Reduced -Price Eligibility.
3. If the contracting organization is sponsoring a camp or other enrollment program that charges separately for meals, the contracting
organization has read Attachment A to this application, "Additional Assurances for Camps and Other Enrollment Programs that
Charge Separately for Meals," and assures DHS that all requirements have been or will be met.
Form 1506
Page 4
B. Public Release
1. The contracting organization will make efforts to ensure that the local news media will make a public announcement of the program
and will supply them with a news release.
If the contracting organization is sponsoring a camp or other enrollment program, this release must contain, at a minimum, a list of all
approved sites, a list of the current standards for determining free and reduced price eligibility, and the following statement:
"The (Name of the organization) announces the sponsorship of the Summer Food Service Program. Income
eligibility will be based on family size and income using the Standards for Determining Free and Reduced -Price Eligibility,
provided by the United States Department of Agriculture. Meals will be provided at the site(s) listed. People who are eligible
to participate in the program must not be discriminated against because of race, color, national origin, sex, age, disability,
religion, or political belief. Anyone who believes that they have been discriminated against should write immediately to:
Director, Civil Rights Division, MC W-206, Texas Department of Human Services, P.O. Box 149030, Austin, Texas 78714-9030
or the Secretary of Agriculture, Washington, D.C. 20250. NOTE: Discrimination complaints based on religion or political
beliefs must be referred only to the Director, Civil Rights Division, Texas Department of Human Services."
For all other programs, the announcement must contain, at a minimum, a list of all approved sites and the following statement:
"The (Name of the organization) announces the sponsorship of the Summer Food Service Program. Meals
will be provided at the site(s) listed. People who are eligible to participate in the program must not be discriminated against
because of race, color, national origin, sex, age, disability, religion, or political belief. Anyone who believes that they have
been discriminated against should write immediately to: Director, Civil Rights Division, MC W-206, Texas Department of
Human Services, P.O. Box 149030, Austin, Texas 78714-9030 or the Secretary of Agriculture, Washington, D.C. 20250. NOTE:
Discrimination complaints based on religion or political beliefs must be referred only to the Director, Civil Rights Division,
Texas Department of Human Services."
2. This public release was or will be published in the following news media outlet(s):
NAME OF MEDIA OUTLET DATE OF RELEASE NAME OF MEDIA OUTLET DATE OF RELEASE
Lubbock AJ Activity Guide April 20, 2003
Lubbock AJ May 25, 2003
3. Attach a copy of the contracting organization's public release statement as submitted to the news media and any other materials used
to publicize the program's availability and nondiscrimination requirements.
SECTION VI — WAIVER REQUESTS (Check all for which you are applying, submit appropriate waiver request form and documentation.)
❑ Waiver to operate more than 25 sites (Nonprofit organizations only.)
❑ Waiver of the time restrictions for meal service at migrant sites.
❑ Waiver of the 15 consecutive school day requirement for year-round school program sites.
❑ Waiver of the first -week site visit requirement (School Food Authorities only).
SECTION VI — CERTIFICATION (see Form 1506, Attachment B)
I certify that the information on this application is true and correct to the best of my knowledge. I certify that reimbursement will be
claimed only for approved meals served to eligible children during the hours they are in attendance at approved sites. I know that
deliberate misrepresentation or withholding of information may result in prosecution under applicable state and federal statutes.
-Wnbture-OffieWil of Contracting Organization Date
Name (please type or print) Title
Johnny McLellan Indoor Recreation Supervisor
FOR DHS USE ONLY
❑ APPROVED ❑ DENIED (reason):
Title
Signature -Official of Contracting Organization Date
Texas Department
of Human Services
SUMMER FOOD SERVICE PROGRAM FOR CHILDREN
CRIMINAL PROVISIONS AND PENALTIES
Form 1506, Attachment B
January 1999
1. Whoever, in connection with any application, procurement, record keeping entry, claim for reimbursement, or
other document or statement made in connection with the program, knowingly and willfully falsifies, conceals or
covers up by any trick, scheme, or device a material fact, or makes any false, fictitious or fraudulent statements 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 more than $10,000 or imprisoned not more than five years.
2. Whoever being a partner, officer, director, or managing agent connected in any capacity with any partnership,
association, cooperation, business, or organization, either public or private, embezzles, misapplies, steals, or
obtains by fraud, false statement or forgery, any benefit provided by the program, or any money, funds, assets, or
property derived from benefits provided by this program, shall be fined not more than $10,000 or imprisoned for
not more than five years or both. 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.
3. If two or more persons conspire or collude to accomplish any act made unlawful under this subsection, and one
or more such person commit any act to effect the object of conspiracy or collusion, each shall be fined not more
than $10,000 or imprisoned for not more than five years, or both.
TERMINATION PROCEDURES
The following is a list of deficiencies that are grounds for termination. Grounds for termination, however, are not
limited to this list.
1. Non-compliance with applicable bid procedures and contract requirements of Federal Child Nutrition regulations.
2. The submission of false information to the Texas Department of Human Services.
3. Program violations at a significant proportion of the sponsor's sites. Such violations include, but are not limited
to the following:
A. Non-compliance with the meal service time restrictions.
B. Failure to maintain accurate records.
C. Failures to adjust meal orders to conform to the variations in the number of participating children.
D. The simultaneous service of more than one meal to any child.
E. Service of a significant number of meals which do not include required quantities of all meal components.
F. The claiming of program payments for meals not served to participating children.
G. Excessive instances of off -site meal consumption.
H. Continued use of food service management companies that are in violation of health codes.
Resolution No. 2003—RO157
ATTACHMENT
SUMMER FOOD SERVICE PROGRAM (SFSP) APPLICATION
OUTREACH PLAN FOR OPEN AND RESTRICTED OPEN SITES
If you operate open sites or restricted open sites, indicate your plans for conducting outreach to
inform persons about the operation of the SFSP at your sites and promote participation at your
sites. Check all that apply.
❑ Make television announcements.
❑ Send letters to potential participants.
❑ Make radio announcements.
❑ Distribute flyers to potential participants.
® Display posters at locations visited by potential participants.
® Offer activities other than meals at sites.
❑ Partner with other organizations to advertise and promote the program.
® Other. Explain.
Send out Press Releases to the local newspapers. Information in the Summer Activities Guide
distributed through Lubbock Avalanche Journal.
January
Texas Department Form 1507/ March 2001
of Human Services SUMMER FOOD SERVICE PROGRAM FOR DHS USE ONLY
SITE INFORMATION TX JEI R ❑ U
Name of Food Service Site Telephone No. (Inc. A/C)
Maggie Trejo (806) 767-2703
Address of Site (Street, City, State, ZIP)
3200 Amherst Lubbock, TX 79415
Period of Operation of Food Service (mo./day/yr.-mo./day/yr.) i Number of Op- I May I June July I Aug. I Sept.
From: May 27,2003 through: August 8,2003 erating Days: 4 21 22 6
ATTACH A MAP WITH THE SITE SERVICE AREA IDENTIFIED
1. Indicate Type of Site: ❑ Residential Camp ❑ Site Serving Primarily Migrant Children
(serving one to three meals) (serving one to three meals)
❑Nonresidential Camp ® Other Site
(serving one to three meals) (serving one or two meals)
2. List ALL counties served by this site: Lubbock
3. A. Is your site an open or restricted open site?.................................................................................................................. ® Yes ❑ No
B. Is your site enrolled?..................................................................................................................................................... ❑ Yes ® No
C. Site Eligibility: Enter the percentage of children eligible for free and/or 93 %
reduced -price meals for the site (SFSP Handbook, Section 2).....................................................................................
D. If open/restricted open sites, submit documentation supporting this percentage figure (such as census data, school data). For
open/restricted open sites using school data, list the schools used to document site eligibility; attach formula used by school dist. to
establish percentage of free & reduced -price children.
McWhorter
E. For enrolled sites, Forms 1531 will be used to document eligibility. (National Youth Sports Program — refer to SFSP Handbook, Section 2.)
F- What is the percentage of free and reduced -price meals for the site?........................................................................
°lo
4. Did the site participate in the previous years' SFSP? (SFSP Handbook, Section 2).......................................................... ® Yes ❑ No
5.
If yes, give name of contracting organization: City Of Lubbock
1Aonitoring Plan (SFSP Handbook, Section 4) — Enter date of monitoring review to be conducted within:
A. First Week of Operation B. First Four Weeks of Operation C. Additional Reviews
May 27-30, 2003 May 27-June 20, 2003 May 27-August 8, 2003
6. Meal Service Period Information (SFSP Handbook, Section 2):
TYPES OF MEALS
NUMBER OF
ELIGIBLE CHILDREN
TO BE SERVED
MEAL SERVICE TIME
BEGINNING
ENDING
Breakfast
A. M. Supplement
Lunch
125
12:30
1:30
P.M. Supplement
Supper
'This information is considered by DHS when setting the approved meal service level. (SFSP Handbook, Section 2)
7. Do you plan to feed children under one (1) year old?......................................................................................................... ❑ Yes ® No
0
Method of Food Preparation by Contracting Organization (SFSP Handbook, Section 2):
Self -Preparation Vended Using School Using Food Service Management Company Using Private Nonprofit
❑ On -Site 0 Central Kitchen 11:1 Food Authority 0 (excludes all -year contracts with on -site prep) ❑ Organization that is Self -Prep
Form 1507
Page 2
9. A. Indicate the system to be used for the serving of meals and the supervision of children during meal service period. (SFSP Handbook,
Section 2)
Cafeteria -style Children are Seated Children Line Up
❑ Meal Service ❑ and are Given Meals ® and Pick Up Meals ❑ Other:
B. If using cafeteria -style meal service and if sponsor is a school food authority, will the site be implementing offer vs. ❑ Yes ❑ No
serve?............................................................................................................................................................................
10. List site personnel who will be involved to any extent in the meal service. (SFSP Handbook, Section 2):
TITLE OF POSITION
NO. IN POSITION
SPECIFIC FOOD SERVICE PROGRAM DUTIES
Center Supervisor
1
Monitor Daily Operations, Site Supervisor
Center Assistants
5
Meal Service
11. Indicate what provisions will be made for meal service during periods of inclement weather. (SFSP Handbook, Section 2):
Indoor Meal Meal Service
® Service ❑ Will Be Cancelled ❑ Other:
12. Is this site implementing the option to allow off -site consumption of food?......................................................................... ❑ Yes ® No
13. Are meals delivered to the site?.......................................................................................................................................... ® Yes ❑ No
IF YES, COMPLETE ITEMS 14, 15, & 16. IF NO, FORM IS COMPLETE EXCEPT FOR CERTIFICATION AT BOTTOM.
14. Indicate the means of communication with the vendor which will be used to adjust meal deliveries. (SFSP Handbook, Sections 2 and 6)
Site Personnel Will Contact Administrative Site Personnel Will Communicate
® Staff, Who Will Contact Vendor ❑ Directly With Vendor
15. Will delivery be within one hour of the food service period? (SFSP Handbook, Section 2)............................................... ® Yes ❑ No
If no, describe arrangements within standards prescribed by local health authorities for delivery and holding of meals until time of service.
16. If there is an excess of meals delivered, meals will be (SFSP Handbook, Section 2)
Stored in Refrigerator Thrown Away Returned to Vendor
❑ and Served the Next Day ® at the Site ❑ for Disposal ❑ Other:
I CERTIFY that the information on this form is true and correct to the best of my knowledge. I certify that this site has been visited
and that it has the capability and facilities for the meal service planned for the number of children anticipated. I know that deliberate
misrepresentation or withholding of information may result in prosecution under applicable state and federal statutes.
� Name of Contracting Organization
r �— O,3 City Of Lubbock
S&6ture — O cial of Contracting Organization Date
Name of Official (please type or print) Title
Johnny McLellan Indoor Recreation Supervisor
FOR ❑ Approved ❑ Denied, reason:
DHS
USE
ONLY
— DHS
Date
Title
Texas Department Form 1507/ March 2001
of Human Services SUMMER FOOD SERVICE PROGRAM FOR DHS USE ONLY
SITE INFORMATION TX TOR ❑ U
Name of Food Service Site Telephone No. (inc. A/C)
Mae Simmons Community Center (806) 767-2700
Address of Site (Street, City, State, ZIP)
2004 Oak Ave. Lubbock, TX 79404
Period of Operation of Food Service (mo./day/yr.-mo./day/yr.) Number of Op- I May I June I July Aug. I Sept.
From: May 27, 2003 through: Aug. 8, 2003 1 erating Days: 4 21 22 6
ATTACH A MAP WITH THE SITE SERVICE AREA IDENTIFIED
1. Indicate Type of Site: ❑
Residential Camp
(serving one to three meals)
❑
Site Serving Primarily Migrant Children
(serving one to three meals)
❑
Nonresidential Camp
(serving one to three meals)
®
Other Site
(serving one or two meals)
2. List ALL counties served by this site: Lubbock
3. A. Is your site an open or restricted open site?.................................................................................................................. ® Yes ❑ No
B. Is your site enrolled?..................................................................................................................................................... ❑ Yes ® No
C. Site Eligibility: Enter the percentage of children eligible for free and/or 89 %
reduced -price meals for the site (SFSP Handbook, Section 2).....................................................................................
D. If open/restricted open sites, submit documentation supporting this percentage figure (such as census data, school data). For
open/restricted open sites using school data, list the schools used to document site eligibility; attach formula used by school dist. to
establish percentage of free & reduced -price children.
Iles
E. For enrolled sites, Forms 1531 will be used to document eligibility. (National Youth Sports Program — refer to SFSP Handbook, Section 2.)
F. What is the percentage of free and reduced -price meals for the site? .....
.............................................................. %
4. Did the site participate in the previous years' SFSP? (SFSP Handbook, Section 2).......................................................... ® Yes ❑ No
AN
If yes, give name of contracting organization: City Of Lubbock
Monitoring Plan (SFSP Handbook, Section 4) — Enter date of monitoring review to be conducted within:
A. First Week of Operation B. First Four Weeks of Operation C. Additional Reviews
May 27-30, 2003 1 May 27-June 20, 2003 May 27-August 8, 2003
6. Meal Service Period Information (SFSP Handbook, Section 2):
TYPES OF MEALS
NUMBER OF
ELIGIBLE CHILDREN
TO BE SERVED
MEAL SERVICE TIME
BEGINNING
ENDING
Breakfast
A. M. Supplement
Lunch
125
11:50
12:50
P.M. Supplement
Supper
'This information is considered by DHS when setting the approved meal service level. (SFSP Handbook, Section 2)
7. Do you plan to feed children under one (1) year old? ....................................................... ............ ❑ Yes ® No
......................................
8.
vlethod of Food Preparation by Contracting Organization (SFSP Handbook, Section 2):
Self -Preparation vended Using School Using Food Service Management Company Using Private Nonprofit
❑ On -Site ❑ Central Kitchen ❑ Food Authority ® (excludes all -year contracts with on -site prep) ❑ Organization that is Self -Prep
Form 1507
Page 2
9. A. Indicate the system to be used for the serving of meals and the supervision of children during meal service period. (SFSP Handbook,
Section 2)
Cafeteria -style Children are Seated Children Line Up
❑ Meal Service ❑ and are Given Meals ® and Pick Up Meals ❑ Other:
B. If using cafeteria -style meal service and if sponsor is a school food authority, will the site be implementing offer vs. ❑ Yes ❑ No
serve?............................................................................................................................................................................
10. List site personnel who will be involved to any extent in the meal service. (SFSP Handbook, Section 2):
TITLE OF POSITION
NO. IN POSITION
SPECIFIC FOOD SERVICE PROGRAM DUTIES
Center Supervisor
1
Monitor, Site Supervision
Camp Monitor
1
Monitor & Daily Operations
Center Assistant
5
Daily Meal Service
11. Indicate what provisions will be made for meal service during periods of inclement weather. (SFSP Handbook, Section 2):
Indoor Meal Meal Service
® Service ❑ WIII Be Cancelled ❑ Other:
12. Is this site implementing the option to allow off -site consumption of food?......................................................................... ❑ Yes ® No
13. Are meals delivered to the site?.......................................................................................................................................... ® Yes ❑ No
IF YES, COMPLETE ITEMS 14, 15, & 16. IF NO, FORM IS COMPLETE EXCEPT FOR CERTIFICATION AT BOTTOM.
14. Indicate the means of communication with the vendor which will be used to adjust meal deliveries. (SFSP Handbook, Sections 2 and 6)
Site Personnel Will Contact Administrative Site Personnel Will Communicate
® Staff, Who Will Contact Vendor ❑ Directly With Vendor
15. Will delivery be within one hour of the food service period? (SFSP Handbook, Section 2)............................................... ® Yes ❑ No
If no, describe arrangements within standards prescribed by local health authorities for delivery and holding of meals until time of service.
16. If there is an excess of meals delivered, meals will be (SFSP Handbook, Section 2)
Stored in Refrigerator Thrown Away Returned to Vendor
❑ and Served the Next Day ® at the Site ❑ for Disposal ❑ Other:
I CERTIFY that the information on this form is true and correct to the best of my knowledge. I certify that this site has been visited
and that it has the capability and facilities for the meal service planned for the number of children anticipated. I know that deliberate
misrepresentation or withholding of information may result in prosecution under applicable state and federal statutes.
`f -
Nme aof Contracting Organization 9a ���� City Of Lubbock
Sig ure — OffKal of Contracting Organization Date
Name of Official (please type or print) Title
Johnny McLellan Indoor Recreation Supervisor
FOR 1 ❑ Approved ❑ Denied, reason:
DHS
USE
ONLY
Signature - DHS Representative Date
Title
Texas Department Form 1507/ March 2001
of Human Services SUMMER FOOD SERVICE PROGRAM FOR DHS USE ONLY
SITE INFORMATION TX FEI R ❑ U
Name of Food Service Site Telephone No. (inc. A/C)
Rawlings/Harwell Gym (806) 767-2704
Address of Site (Street, City, State, ZIP)
213 40th St. Lubbock, TX 79404
Period of Operation of Food Service (mo./day/yr.-mo./day/yr.) Number of Op- I May I June I July I Aug. Sept.
From: May 27, 2003 through: Aug. 8, 2003 1 erating Days: 4 21 22 6
ATTACH A MAP WITH THE SITE SERVICE AREA IDENTIFIED
1. Indicate Type of Site: ❑
Residential Camp
(serving one to three meals)
❑
Site Serving Primarily Migrant Children
(serving one to three meals)
❑Nonresidential
Camp
(serving one to three meals)
®
Other Site
(serving one or two meals)
2. List ALL counties served by this site: Lubbock
3. A. Is your site an open or restricted open site?.................................................................................................................. ® Yes ❑ No
B. Is your site enrolled?..................................................................................................................................................... ❑ Yes ® No
C. Site Eligibility: Enter the percentage of children eligible for free and/or 96 %
reduced -price meals for the site (SFSP Handbook, Section 2).....................................................................................
D. If open/restricted open sites, submit documentation supporting this percentage figure (such as census data, school data). For
open/restricted open sites using school data, list the schools used to document site eligibility; attach formula used by school dist. to
establish percentage of free & reduced -price children.
Harwell
E. For enrolled sites, Forms 1531 will be used to document eligibility. (National Youth Sports Program — refer to SFSP Handbook, Section 2.)
F. What is the percentage of free and reduced -price meals for the site?..........................................................................
4. Did the site participate in the previous years' SFSP? (SFSP Handbook, Section 2)
5.
If yes, give name of contracting organization: City Of Lubbock
... ......... .... ......................... I......... ® Yes ❑ No
Monitoring Plan (SFSP Handbook, Section 4) — Enter date of monitoring review to be conducted within:
A. First Week of Operation B. First Four Weeks of Operation C. Additional Reviews
May 27-30, 2003 1 May 27-June 20, 2003 May 27- August 8, 2003
6. Meal Service Period Information (SFSP Handbook, Section 2):
TYPES OF MEALS
NUMBER OF
ELIGIBLE CHILDREN
TO BE SERVED
MEAL SERVICE TIME
BEGINNING
ENDING
Breakfast
A. M. Supplement
Lunch
135
11:30
12:30
P.M. Supplement
Supper
'This information is considered by OHS when setting the approved meal service level, (SFSP Handbook, Section 2)
7. Do you plan to feed children under one (1) year old?......................................................................................................... ❑ Yes ® No
8.
Method of Food Preparation by Contracting Organization (SFSP Handbook, Section 2):
Self -Preparation Vended Using School Using Food Service Management Company Using Private Nonprofit
❑ On -Site ❑ Central Kitchen I ❑ Food Authority 0 (excludes all -year contracts with on -site prep) ❑ Organization that is Self -Prep
Form 1507
Page 2
9. A. Indicate the system to be used for the serving of meals and the supervision of children during meal service period. (SFSP Handbook,
Section 2)
Cafeteria -style Children are Seated Children Line Up
❑ Meal Service ❑ and are Given Meals ® and Pick Up Meals ❑ Other:
B. If using cafeteria -style meal service and if sponsor is a school food authority, will the site be implementing offer vs. ❑ Yes ❑ No
serve?............................................................................................................................................................................
10. List site personnel who will be involved to any extent in the meal service. (SFSP Handbook, Section 2):
TITLE OF POSITION
NO. IN POSITION
SPECIFIC FOOD SERVICE PROGRAM DUTIES
Center Supervisor
1
Monitor Daily Operations
Center Assistant
5
Daily Meal Service
11. Indicate what provisions will be made for meal service during periods of inclement weather. (SFSP Handbook, Section 2):
Indoor Meal Meal Service
® Service ❑ Will Be Cancelled ❑ Other:
12. Is this site implementing the option to allow off -site consumption of food?......................................................................... ❑ Yes ® No
13. Are meals delivered to the site?.......................................................................................................................................... ® Yes ❑ No
IF YES, COMPLETE ITEMS 14, 15, & 16. IF NO, FORM IS COMPLETE EXCEPT FOR CERTIFICATION AT BOTTOM.
14. Indicate the means of communication with the vendor which will be used to adjust meal deliveries. (SFSP Handbook, Sections 2 and 6)
Site Personnel Will Contact Administrative Site Personnel Will Communicate
® Staff, Who Will Contact Vendor ❑ Directly With Vendor
15. Will delivery be within one hour of the food service period? (SFSP Handbook, Section 2)............................................... ® Yes ❑ No
If no, describe arrangements within standards prescribed by local health authorities for delivery and holding of meals until time of service.
16. If there is an excess of meals delivered, meals will be (SFSP Handbook, Section 2)
Stored in Refrigerator Thrown Away Returned to Vendor
❑ and Served the Next Day ® at the Site ❑ for Disposal ❑ Other:
I CERTIFY that the information on this form is true and correct to the best of my knowledge. I certify that this site has been visited
and that it has the capability and facilities for the meal service planned for the number of children anticipated. 1 know that deliberate
misrepresentation or withholding of information may result in prosecution under applicable state and federal statutes.
Name of Contracting Organization
City Of Lubbock
— Offici of ontracting Organization Date
(please type or print) ITitle
McLellan I Indoor Recreation Supervisor
FOR ❑ Approved ❑ Denied, reason:
DHS
USE
ONLY
— DHS
Date
Title
Texas Department Form 1507/ March 2001
of Human Services SUMMER FOOD SERVICE PROGRAM FOR DHS USE ONLY
SITE INFORMATION TX ❑ R ❑ U
Name of Food Service Site Telephone No. (inc. A/C)
Parkway Center (806) 763-3969
Address of Site (Street, City, State, ZIP)
405 N.MLK Lubbock, TX 79407
Period of Operation of Food Service (modday/yr.-modday/yr.) Number of Op- ( May I June I July I Aug. I Sept.
From: June 9, 2003 through: July 25, 2003 erating Days: 6 18
ATTACH A MAP WITH THE SITE SERVICE AREA IDENTIFIED
1. Indicate Type of Site: ❑ Residential Camp ❑ Site Serving Primarily Migrant Children
(serving one to three meals) (serving one to three meals)
❑ Nonresidential Camp ® Other Site
(serving one to three meals) (serving one or two meals)
2. List ALL counties served by this site: Lubbock
3. A. Is your site an open or restricted open site?.................................................................................................................. ® Yes ❑ No
B. Is your site enrolled?..................................................................................................................................................... ❑ Yes ® No
C. Site Eligibility: Enter the percentage of children eligible for free and/or 96
reduced -price meals for the site (SFSP Handbook, Section 2).....................................................................................
D. If open/restricted open sites, submit documentation supporting this percentage figure (such as census data, school data). For
open/restricted open sites using school data, list the schools used to document site eligibility; attach formula used by school dist. to
establish percentage of free & reduced -price children.
Alderson
E. For enrolled sites, Forms 1531 will be used to document eligibility. (National Youth Sports Program — refer to SFSP Handbook, Section 2.)
F. What is the percentage of free and reduced -price meals for the site?.......................................................................... %
4. Did the site participate in the previous years' SFSP? (SFSP Handbook, Section 2).......................................................... ® Yes ❑ No
5.
If yes, give name of contracting organization: City Of Lubbock
Monitoring Plan (SFSP Handbook, Section 4) — Enter date of monitoring review to be conducted within:
A. First Week of Operation B. First Four Weeks of Operation C. Additional Reviews
June 9-13, 2003 June 9-July 3, 2003 June 9-July 25, 2003
6. Meal Service Period Information (SFSP Handbook, Section 2):
TYPES OF MEALS
NUMBER OF
ELIGIBLE CHILDREN
TO BE SERVED
MEAL SERVICE TIME
BEGINNING
ENDING
Breakfast
A. M. Supplement
Lunch
100
12:10
1:10
P.M. Supplement
Supper
'This information is considered by DHS when setting the approved meal service level. (SFSP Handbook, Section 2)
7. Do you plan to feed children under one (1) year old?......................................................................................................... ❑ Yes ® No
Method of Food Preparation by Contracting Organization (SFSP Handbook, Section 2):
Self -Preparation Vended Using School Using Food Service Management Company Using Private Nonprofit
❑ On -Site ❑ Central Kitchen 11:1 Food Authority 0 (excludes all -year contracts with on -site prep) ❑ Organization that is Self -Prep
Form 1507
Page 2
9. A. Indicate the system to be used for the serving of meals and the supervision of children during meal service period. (SFSP Handbook,
Section 2)
Cafeteria -style Children are Seated Children Line Up
❑ Meal Service ❑ and are Given Meals ® and Pick Up Meals ❑ Other:
B. If using cafeteria -style meal service and if sponsor is a school food authority, will the site be implementing offer vs. ❑ Yes ❑ No
serve?............................................................................................................................................................................
10. List site personnel who will be involved to any extent in the meal service. (SFSP Handbook, Section 2):
TITLE OF POSITION
NO. IN POSITION
SPECIFIC FOOD SERVICE PROGRAM DUTIES
Center Supervisor
1
Monitor Daily Operations & Site Supervision
Center Assistant
2
Daily Meal Service
11. Indicate what provisions will be made for meal service during periods of inclement weather. (SFSP Handbook, Section 2):
Indoor Meal Meal Service
® Service ❑ Will Be Cancelled ❑ Other:
12. Is this site implementing the option to allow off -site consumption of food?......................................................................... ❑ Yes ® No
13. Are meals delivered to the site?.......................................................................................................................................... ® Yes ❑ No
IF YES, COMPLETE ITEMS 14, 15, & 16. IF NO, FORM IS COMPLETE EXCEPT FOR CERTIFICATION AT BOTTOM.
14. Indicate the means of communication with the vendor which will be used to adjust meal deliveries. (SFSP Handbook, Sections 2 and 6)
Site Personnel Will Contact Administrative Site Personnel Will Communicate
® Staff, Who Will Contact Vendor ❑ Directly With Vendor
15. Will delivery be within one hour of the food service period? (SFSP Handbook, Section 2)............................................... ® Yes ❑ No
If no, describe arrangements within standards prescribed by local health authorities for delivery and holding of meals until time of service.
16. If there is an excess of meals delivered, meals will be (SFSP Handbook, Section 2)
Stored in Refrigerator Thrown Away Returned to Vendor
❑ and Served the Next Day ® at the Site ❑ for Disposal ❑ Other:
I CERTIFY that the information on this form is true and correct to the best of my knowledge. I certify that this site has been visited
and that it has the capability and facilities for the meal service planned for the number of children anticipated. I know that deliberate
misrepresentation or withholding of information may result in prosecution under applicable state and federal statutes.
Name of Contracting Organization
City Of Lubbock
S' ture — cial of Contracting Organization Date
Name of Official (please type or print) Title
Johnny McLellan Indoor Recreation Supervisor
FOR ❑ Approved ❑ Denied, reason:
DHS
USE
ONLY
— DHS
Date
Title
Texas Department Form 1507/ March 2001
of Human Services SUMMER FOOD SERVICE PROGRAM FOR DHS USE ONLY
SITE INFORMATION TX JEI R ❑ U
Name of Food Service Site Telephone No. (Inc. A/C)
McWhorter Elementary (806) 766-1799
Address of Site (Street, City, State, ZIP)
2711 1" Street Lubbock, TX 79415
Period of Operation of Food Service (mo./day/yr.-mo./day/yr.) Number of Op- I May I June I July I Aug. Sept.
From: June 2, 2003 through: June 27, 200: 1 erating Days: 20
ATTACH A MAP WITH THE SITE SERVICE AREA IDENTIFIED
1. Indicate Type of Site: ❑ Residential Camp ❑ Site Serving Primarily Migrant Children
(serving one to three meals) (serving one to three meals)
❑Nonresidential Camp Other Site
(serving one to three meals) ® (serving one or two meals)
2. List ALL counties served by this site: Lubbock
3. A. Is your site an open or restricted open site?.................................................................................................................. ® Yes ❑ No
B. Is your site enrolled?..................................................................................................................................................... ❑ Yes ® No
C. Site Eligibility: Enter the percentage of children eligible for free and/or 93 %
reduced -price meals for the site (SFSP Handbook, Section 2).....................................................................................
D. If open/restricted open sites, submit documentation supporting this percentage figure (such as census data, school data). For
open/restricted open sites using school data, list the schools used to document site eligibility; attach formula used by school dist. to
establish percentage of free & reduced -price children.
McWhorter
E. For enrolled sites, Forms 1531 will be used to document eligibility. (National Youth Sports Program — refer to SFSP Handbook, Section 2.)
F. What is the percentage of free and reduced -price meals for the site? ..............................
...............................
4. Did the site participate in the previous years' SFSP? (SFSP Handbook, Section 2).......................................................... ® Yes ❑ No
5.
If yes, give name of contracting organization: City Of Lubbock
Aonitoring Plan (SFSP Handbook, Section 4) — Enter date of monitoring review to be conducted within:
A. First Week of Operation B. First Four Weeks of Operation C. Additional Reviews
June 2-6, 2003 June 2-27, 2003 June 2-27, 2003
6. Meal Service Period Information (SFSP Handbook, Section 2):
TYPES OF MEALS
NUMBER OF
ELIGIBLE CHILDREN
TO BE SERVED
MEAL SERVICE TIME
BEGINNING
ENDING
Breakfast
A. M. Supplement
Lunch
100
11:30
12:30
P.M. Supplement
Supper
'This information is considered by DHS when setting the approved meal service level. (SFSP Handbook, Section 2)
7. Do you plan to feed children under one (1) year old?......................................................................................................... ❑ Yes ® No
f-A
Method of Food Preparation by Contracting Organization (SFSP Handbook, Section 2):
Self -Preparation vended Using School Using Food Service Management Company Using Private Nonprofit
❑ On -Site ❑ Central Kitchen 11:1 Food Authority ® (excludes all -year contracts with on -site prep) ❑ Organization that is Self -Prep
Form 150T
Page 2
9. A. Indicate the system to be used for the serving of meals and the supervision of children during meal service period. (SFSP Handbook,
Section 2)
Cafeteria -style Children are Seated Children Line Up
❑ Meal Service ® and are Given Meals ❑ and Pick Up Meals ❑ Other:
B. If using cafeteria -style meal service and if sponsor is a school food authority, will the site be implementing offer vs. ❑ Yes ❑ No
serve?.............................................................................................................................................. ..............................
10. List site personnel who will be involved to any extent in the meal service. (SFSP Handbook, Section 2):
TITLE OF POSITION
NO. IN POSITION
SPECIFIC FOOD SERVICE PROGRAM DUTIES
Site Supervisor
1
Monitor Daily Operations & Meal Service
11. Indicate what provisions will be made for meal service during periods of inclement weather. (SFSP Handbook, Section 2):
Indoor Meal Meal Service
® Service ❑ Will Be Cancelled ❑Other:
12. Is this site implementing the option to allow off -site consumption of food?......................................................................... ❑ Yes ® No
13. Are meals delivered to the site?.......................................................................................................................................... ® Yes ❑ No
IF YES, COMPLETE ITEMS 14, 15, & 16. IF NO, FORM IS COMPLETE EXCEPT FOR CERTIFICATION AT BOTTOM.
14. Indicate the means of communication with the vendor which will be used to adjust meal deliveries. (SFSP Handbook, Sections 2 and 6)
Site Personnel Will Contact Administrative Site Personnel Will Communicate
® Staff, Who Will Contact Vendor ❑ Directly With Vendor
15. Will delivery be within one hour of the food service period? (SFSP Handbook, Section 2)............................................... ❑ Yes ® No
If no, describe arrangements within standards prescribed by local health authorities for delivery and holding of meals until time of service.
Refrigerated
16. If there is an excess of meals delivered, meals will be (SFSP Handbook, Section 2)
Stored in Refrigerator Thrown Away Returned to Vendor
® and Served the Next Day ❑ at the Site ❑ for Disposal ❑ Other:
I CERTIFY that the information on this form is true and correct to the best of my knowledge. I certify that this site has been visited
and that it has the capability and facilities for the meal service planned for the number of children anticipated. I know that deliberate
misrepresentation or withholding of information may result in prosecution under applicable state and federal statutes.
Name of Contracting Organization
z%- f `e3 City Of Lubbock
Si re — Offi I of Con racting Organization Date
Name of Official (please type or print) Title
Johnny McLellan Indoor Recreation Supervisor
FOR ❑ Approved ❑ Denied, reason:
DHS
USE
ONLY
— DHS Representative Date
Title
Texas Department Form 15071 March 2001
of Human Services SUMMER FOOD SERVICE PROGRAM FOR DHS USE ONLY
SITE INFORMATION TX ❑ R ❑ U
Name of Food Service Site Telephone No. (inc. A/C)
Bean Elementary (806) 766-1666
Address of Site (Street, City, State, ZIP)
3001 Ave. N Lubbock, TX 79405
Period of Operation of Food Service (mo./day/yr: mo./day/yr.) Number of Op- I May I June I July I Aug. I Sept.
From: June 2, 2003 through: June 27, 2003 erating Days: 20
ATTACH A MAP WITH THE SITE SERVICE AREA IDENTIFIED
1. Indicate Type of Site: ❑ Residential Camp ❑Site Serving Primarily Migrant Children
(serving one to three meals) (serving one to three meals)
❑Nonresidential Camp ® Other Site
(serving one to three meals) (serving one or two meals)
2. List ALL counties served by this site: Lubbock
3. A. Is your site an open or restricted open site?.............................................................................. ® Yes ❑ No
....................................
B. Is your site enrolled?..................................................................................................................................................... ❑ Yes ® No
C. Site Eligibility: Enter the percentage of children eligible for free and/or 96 %
reduced -price meals for the site (SFSP Handbook, Section 2).....................................................................................
D. If open/restricted open sites, submit documentation supporting this percentage figure (such as census data, school data). For
open/restricted open sites using school data, list the schools used to document site eligibility; attach formula used by school dist. to
establish percentage of free & reduced -price children.
Bean
E. For enrolled sites, Forms 1531 will be used to document eligibility. (National Youth Sports Program — refer to SFSP Handbook, Section 2.)
F. What is the percentage of free and reduced -price meals for the site?.......................................................................... %
4. Did the site participate in the previous years' SFSP? (SFSP Handbook, Section 2).......................................................... ® Yes ❑ No
5.
If yes, give name of contracting organization: City Of Lubbock
Monitoring Plan (SFSP Handbook, Section 4) — Enter date of monitoring review to be conducted within:
A. First Week of Operation B. First Four Weeks of Operation C. Additional Reviews
June 2-6, 2003 June 2-27, 2003 June 2-27, 2003
6. Meal Service Period Information (SFSP Handbook, Section 2):
TYPES OF MEALS
NUMBER OF
ELIGIBLE CHILDREN
TO BE SERVED
MEAL SERVICE TIME
BEGINNING
ENDING
Breakfast
A. M. Supplement
Lunch
75
11:30
12:30
P.M. Supplement
Supper
'This information is considered by DHS when setting the approved meal service level. (SFSP Handbook, Section 2)
7. Do you plan to feed children under one (1) year old?......................................................................................................... ❑ Yes ® No
8. Method of Food Preparation by Contracting Organization (SFSP Handbook, Section 2):
Self -Preparation Vended Using School Using Food Service Management Company Using Private Nonprofit
❑ On -Site ❑ Central Kitchen ❑ Food Authority ® (excludes all -year contracts with on -site prep) ❑ Organization that is Self -Prep
Form 1507
Page 2
9. A. Indicate the system to be used for the serving of meals and the supervision of children during meal service period. (SFSP Handbook,
Section 2)
Cafeteria -style Children are Seated Children Line Up
❑ Meal Service ❑ and are Given Meals ® and Pick Up Meals ❑ Other:
B. If using cafeteria -style meal service and if sponsor is a school food authority, will the site be implementing offer vs. ❑ Yes ❑ No
serve?............................................................................................................................................................................
10. List site personnel who will be involved to any extent in the meal service. (SFSP Handbook, Section 2):
TITLE OF POSITION
NO. IN POSITION
SPECIFIC FOOD SERVICE PROGRAM DUTIES
Site Supervisor
1
Monitor Daily Operations & Meal Services
11. Indicate what provisions will be made for meal service during periods of inclement weather. (SFSP Handbook, Section 2):
Indoor Meal Meal Service
® Service ❑ WIII Be Cancelled ❑Other:
12. Is this site implementing the option to allow off -site consumption of food?......................................................................... ❑ Yes ® No
13. Are meals delivered to the site?.......................................................................................................................................... ® Yes ❑ No
IF YES, COMPLETE ITEMS 14, 15, & 16. IF NO, FORM IS COMPLETE EXCEPT FOR CERTIFICATION AT BOTTOM.
14. Indicate the means of communication with the vendor which will be used to adjust meal deliveries. (SFSP Handbook, Sections 2 and 6)
Site Personnel Will Contact Administrative Site Personnel Will Communicate
® Staff, Who Will Contact Vendor ❑ Directly With Vendor
15. Will delivery be within one hour of the food service period? (SFSP Handbook, Section 2)............................................... ❑ Yes ® No
If no, describe arrangements within standards prescribed by local health authorities for delivery and holding of meals until time of service.
Refrigerated
16. If there is an excess of meals delivered, meals will be (SFSP Handbook, Section 2)
Stored in Refrigerator Thrown Away Returned to Vendor
® and Served the Next Day ❑ at the Site ❑ for Disposal ❑ Other:
I CERTIFY that the information on this form is true and correct to the best of my knowledge. I certify that this site has been visited
and that it has the capability and facilities for the meal service planned for the number of children anticipated. I know that deliberate
misrepresentation or withholding of information may result in prosecution under applicable state and federal statutes.
Name of Contracting Organization
City Of Lubbock
SigWrii'—_OffiOfil of Contracting Organization Date
Name of Official (please type or print) Title
Johnny McLellan Indoor Recreation Supervisor
FOR ❑ Approved ❑ Denied, reason:
DHS
USE
ONLY
Signature — DHS Representative
Title
Texas Department Form 1507/ March 2001
of Human Services SUMMER FOOD SERVICE PROGRAM FOR DHS USE ONLY
SITE INFORMATION TX tEIR ❑ U
Name of Food Service Site Telephone No. (inc. A/C)
Big Brothers/Big Sisters (806) 763-6131
Address of Site (Street, City, State, ZIP)
4500 Avenue U Lubbock, TX 79412
Period of Operation of Food Service (mo./day/yr.-mo./day/yr.) Number of Op- I May I June July I Aug. I Sept.
From: July 14, 2003 through: July 18, 2003 erating Days: 5
ATTACH A MAP WITH THE SITE SERVICE AREA IDENTIFIED
1. Indicate Type of Site: ❑
Residential Camp
(serving one to three meals)
❑
Site Serving Primarily Migrant Children
(serving one to three meals)
❑
Nonresidential Camp
(serving one to three meals)
®
Other Site
(serving one or two meals)
2. List ALL counties served by this site: Lubbock
3. A. Is your site an open or restricted open site?.................................................................................................................. ® Yes ❑ No
B. Is your site enrolled?..................................................................................................................................................... ❑ Yes ® No
C. Site Eligibility: Enter the percentage of children eligible for free and/or 90 %
reduced -price meals for the site (SFSP Handbook, Section 2).....................................................................................
D. If open/restricted open sites, submit documentation supporting this percentage figure (such as census data, school data). For
open/restricted open sites using school data, list the schools used to document site eligibility; attach formula used by school dist. to
establish percentage of free & reduced -price children.
Dupre
E. For enrolled sites, Forms 1531 will be used to document eligibility. (National Youth Sports Program — refer to SFSP Handbook, Section 2.)
F. What is the percentage of free and reduced -price meals for the site?.......................................................................... %
4. Did the site participate in the previous years' SFSP? (SFSP Handbook, Section 2).......................................................... ®Yes ❑ No
M
If yes, give name of contracting organization: City Of Lubbock
vlonitoring Plan (SFSP Handbook, Section 4) — Enter date of monitoring review to be conducted within:
A. First Week of Operation B. First Four Weeks of Operation C. Additional Reviews
July 14-18, 2003 jJuly 14-18, 2003 IJuly 14-18, 2003
6. Meal Service Period Information (SFSP Handbook, Section 2):
TYPES OF MEALS
NUMBER OF
ELIGIBLE CHILDREN
TO BE SERVED
MEAL SERVICE TIME
BEGINNING
ENDING
Breakfast
A. M. Supplement
Lunch
50
11:45
12:45
P.M. Supplement
Supper
*This information is considered by DHS when setting the approved meal service level. (SFSP Handbook, Section 2)
7. Do you plan to feed children under one (1) year old?......................................................................................................... ❑ Yes ® No
M.
Method of Food Preparation by Contracting Organization (SFSP Handbook, Section 2):
Self -Preparation Vended Using School Using Food Service Management Company Using Private Nonprofit
❑ On -Site ❑ Central Kitchen ❑ Food Authority ® (excludes all -year contracts with on -site prep) ❑ Organization that is Self -Prep
Form 150T
Page 2
9. A.
Indicate the system to be used for the serving of meals and the supervision of children during meal service period. (SFSP Handbook,
Section 2)
Cafeteria -style Children are Seated Children Line Up
❑ Meal Service ❑ and are Given Meals ® and Pick Up Meals ❑ Other:
B. If using cafeteria -style meal service and if sponsor is a school food authority, will the site be implementing offer vs. ❑ Yes ❑ No
serve?............................................................................................................................................................................
10. List site personnel who will be involved to any extent in the meal service. (SFSP Handbook, Section 2):
TITLE OF POSITION
NO. IN POSITION
SPECIFIC FOOD SERVICE PROGRAM DUTIES
Site Supervisor
1
Monitor Daily Operations & Meal Service
11. Indicate what provisions will be made for meal service during periods of inclement weather. (SFSP Handbook, Section 2):
Indoor Meal Meal Service
® Service ❑ Will Be Cancelled ❑ Other:
12. Is this site implementing the option to allow off -site consumption of food?......................................................................... ❑ Yes ® No
13. Are meals delivered to the site?.......................................................................................................................................... ® Yes ❑ No
IF YES, COMPLETE ITEMS 14, 15, & 16. IF NO, FORM IS COMPLETE EXCEPT FOR CERTIFICATION AT BOTTOM.
14. Indicate the means of communication with the vendor which will be used to adjust meal deliveries. (SFSP Handbook, Sections 2 and 6)
Site Personnel Will Contact Administrative Site Personnel Will Communicate
® Staff, Who Will Contact Vendor ❑ Directly With Vendor
15. Will delivery be within one hour of the food service period? (SFSP Handbook, Section 2)............................................... ® Yes ❑ No
If no, describe arrangements within standards prescribed by local health authorities for delivery and holding of meals until time of service.
16. If there is an excess of meals delivered, meals will be (SFSP Handbook, Section 2)
Stored in Refrigerator Thrown Away Returned to Vendor
❑ and Served the Next Day ® at the Site ❑ for Disposal ❑ Other:
I CERTIFY that the information on this form is true and correct to the best of my knowledge. I certify that this site has been visited
and that it has the capability and facilities for the meal service planned for the number of children anticipated. I know that deliberate
misrepresentation or withholding of information may result in prosecution under applicable state and federal statutes.
of Contracting Organization
type or print)
Johnny McLellan
FOR ❑ Approved ❑ Denied, reason:
DHS
USE
ONLY
OEM
q-d�
Date
Date
Name of Contracting Organization
City Of Lubbock
Indoor Recreation Supervisor
Title
Texas Department SPECIAL NUTRITION PROGRAMS Form 1569
of Human Services SINGLE AUDIT IDENTIFICATION DATA March 2001
For Program Year
(SNP Use Only)
Contractor Name
Contact Person
City Of Lubbock
Johnny McLellan
Address (Street or P.O. Box, City, State, ZIP)
P.O. Box 2000 Lubbock, TX 79457
Telephone No.
Texas ID No. (Payee ID No.)
Contract No.
(806) 775-2678
1-75-60006590-6
�75- J5001
Contractor Fiscal Year End (mmlddlyyyy)
Type of Contract
9/31/2003
❑ For Profit ❑ Non -Profit
® Governmental
Check the appropriate box(es) to indicate the type(s) of program(s) in which you currently participate or for which you are applying:
COMMODITY ASSISTANCE PROGRAMS
PROGRAM NOS.
CASH REIMBURSEMENT PROGRAMS
PROGRAM NOS.
❑ A - National School Lunch
❑ AD - Adult Day Care
TX -
❑ B - Charitable Institutions
❑ BL- National School Lunch/Breakfast
TX -
❑ C - Area Agency on Aging
❑ CC - CACFP Center
TX -
❑ G -Summer Camps
❑ DH - CACFP Day Home
TX -
❑ H - Summer Food Service
® SF -Summer Food
TX - 152-1004
❑ J -Jails
❑ SM - Special Milk
TX -
❑ I - TEXCAP
❑ TE - TEXCAP
TX -
❑ CS - Commodity Supplemental Food Prog.
❑ CS - Commodity Supplemental Food Prog.
TX -
Give the source and amount of any federal funds that your agency expends other than from those programs listed above:
SOURCE
AMOUNT
Community Development Block Grants
$3,211,000.00
South Plains Association of Governments
$111,000.00
SINGLE AUDIT EXEMPTION - I certify that I am not required to submit an audit under the Single Audit Act for the following reason(s):
❑ I am a for -profit organization. ❑ 1 expend less than $300,000 annually in total federal funding.
® SINGLE AUDIT ASSURANCE - I understand that if I meet the requirements of the Single Audit Act, I will agree to submit an audit as
a condition of eligibility to participate in the Special Nutrition Programs, and that failure to do so as required could result in adverse
action, including the withholding of my claim for reimbursement payments and termination of my contract. I also understand that if I am
a private non-profit organization subject to the requirements of the Single Audit Act and have a financial audit performed annually, I
must also obtain a single audit on an annual basis.
Si ature-Authorized Representative Date
Name (please type or print) Title
Johnny McLellan Indoor Recreation Supervisor
Resolution No. 2003—RO157
Office of Accounting
P.O. Box 2000 • 1625 13th Street
Lubbock, Texas 79457
(806) 775-2156 • Fax (806) 775-3273
March 24, 2003
Texas Department of Human Services
Special Nutrition Programs, Operation Division
2109 Avenue Q
Lubbock, TX 79405
To whom it may concern,
We are in the process of compiling information for the single audit report, which is performed in
accordance with the Single Audit Act of 1984 and OMB Circular A-133. We anticipate that this will be
completed and published by June 30, 2003.
If you have any questions, please feel free to contact me at (806) 775-2148.
Sincerely,
,
Dena Morris
Grant Accountant
Texas Department Form 4508
of Human Services May 2000
SPECIAL NUTRITION PROGRAM
CERTIFICATION OF AUTHORITY
This is to certify that the following erson s :
Name of Authorized Representative (please type or print) Title
Johnny McLellan Indoor Recreation Supervisor
X
gnature — Authorized Representative
Name of Authorized Representative (please type or print) I f Title
Randy Truesdell I I Parks & Recreation Director
is (are) designated as an Authorized Representative of
Name of Contracting Organization
City Of Lubbock
Address (Street, City, State, ZIP)
P.O. Box 2000 Lubbock, TX 79457
The representative(s) designated above, and myself, acknowledge that each is individually authorized on behalf of the
contracting organization to make written agreements with the Texas Department of Human Services to operate a food
program, to sign documents or reports about the agreement, and to present claims for reimbursement, when appropriate, to
the department.
By signing this document, we certify individually and collectively that to the best or our knowledge and belief, all documents
submitted physically or electronically on behalf of the above named Contracting Organization pursuant to our participation
in any and all programs administered by Special Nutrition Programs, TDHS, are/will be true and correct in all respects, that
they are/will be completed according to the terms and conditions of existing agreements including amendments, that
records are/will be available to support any and all claims, and that we will not submit claims (excluding amended/adjusted
claims) for goods or services for which we have already received payment. We recognize that we are fully responsible for
any excess amounts which may result from errors made in relation to the completion and submission of claims. We are also
aware that deliberate misrepresentation or withholding of information may result in prosecution under applicable state and
federal statutes.
Name of Official of Contracting Agency (please ty or print) Title
Victor Hernandez �_ ' Mayor Pro Tem ATTEST TO:
r
— Official of
DELETED AUTHORIZED REPRESENTATIVES: A contracting orga*ation may not have more than three (3) Authorized
Representatives, including the Official of the Contracting Agency. If you are replacing or deleting an Authorized
Representative, list the names of the individuals to be removed as Authorized Representative(s) below:
Name of Deleted Representative Name of Deleted Representative Name of Deleted Representative
FOR DHS USE ONLY
Contract No.
75 - Zf 6'00
Date Rqceive9I
SAY .i 6 200
TEXAS DEPARTMENT OF HUMAN SERVICES
HUB Best Practices Clause
For Client Service Vendor Contracts
A contractor/provider is encouraged to make a good faith effort to consider HUBs when subcontracting. Some
methods for locating HUBs include:
X utilizing the State of Texas General Services Commission's website http://www.gsc.state.tx.us/cmbl;
X utilizing Web sites or other minority/women directory listings maintained by local Chambers of
Commerce;
X advertising subcontract work in local minority publications; and/or
X contacting the contracting state agency for assistance in locating available HUBs.
Definitions
Subcontract means a contract entered between a prime contractor and a third party. The subcontract
expressly provides all or a portion of the work specified in the prime contract. A prime contractor's purchase of
ancillary goods and services that support the direct provision of the contract are excluded. Each HHS agency,
at its option, specifies in the contract what is and is not ancillary.
A Historically Underutilized Business (HUB) is defined as a business that is formed for the purpose of making a
profit and is otherwise a legally recognized business organization under the laws of the State of Texas. At least
51% of the assets and interest and/or classes of stock and equitable securities must be owned by one or more
persons who are United States citizens born or naturalized. The following are recognized by the State of Texas
as having been economically disadvantaged because of their identification as members of the qualifying
groups - Asian Pacific Americans (AS), Black Americans (BL), Hispanic Americans (HI), Native Americans
(NA), and American Women (WO). These individuals must demonstrate active participation in the control,
operation and management of the daily business affairs of the company that is proportionate to their ownership
interest. HUB businesses must have a permanent business office located in Texas where the majority HUB
owner(s) makes the decisions, controls the daily operations of the organization, and participates in the
business. Owners must be residents of the State of Texas and meet all other certification and compliance
requirements. Out-of-state businesses are ineligible for state certification.
(C-ASD)
TEXAS DEPARTMENT OF HUMAN SERVICES (DHS)
CLIENT SERVICES HUB SUBCONTRACTING PLAN
APPLICANT STATUS DETERMINATION
DHS Contract Number:
Description Goods/Services Purchased: Summer Food Service Program
PREAMBLE: The Texas Department of Human Services and other Health and Human Services agencies are committed
to promoting full and equal business opportunities for ail businesses in state contracting. To better promote these
opportunities, it is imperative that we collect information on prime contractors and their subcontractors to determine if an
entity meets the General Services Commission (GSC) Historically Underutilized Business (HUB) certification criteria.
PURPOSE: The purpose of the Applicant Status Determination form (C-ASD) and the Subcontractor Status
Determination form (C-SSD) is to collect HUB -related information about a prime contractor and its subcontractors.
PROCEDURE: Please complete this form with information about the prime contractor. Complete Form C-SSD
(additional copies may be attached if necessary) with information about subcontractors. Return the signed and completed
forms to DHS along with the other forms in your SFSP Contract Application Package. After DHS reviews the information,
a representative may contact you to share additional information about HUB certification and reporting. Information on the
State of Texas HUB program can be found on the GSC website at http://www.gsc.state.tx.us or by contacting Hope
Degollado, DHS HUB Coordinator, at (512) 438-5429 or by email at hope.degolladoCa7.dhs.state.tx.us.
1. Print Legal Name of Prime Contractor: City Of Lubbock
2. Print the 14-digit Vendor Identification Number assigned by the State of Texas Comptroller (or enter the
Federal Tax ID # (9-digits): 756000590
3. Is the owner or company a for -profit entity? If no, skip to number 9.
Yes ❑
No X
4. Is Prime Contractor a GSC certified HUB? (see HUB definition on form C-SSD). Yes 0 No
If yes, please provide your GSC Certification No. and continue with number 9.
5. Is the Prime Contractor certified as a minority/women-owned business from an I Yes M I No El
agency other than the GSC?
If yes, please provide the name of the certifying agency.
6. Please indicate which group best describes the individuals who own at least 51% of the assets and interest
and/or classes of stock and equitable securities. These individuals must demonstrate an active
participation in the control, o eration and management of firm's daily business affairs.
. ;{, s� s:
.. 'i x
Asian Pacific Americans (AS)
Black Americans (BL)
Hispanic Americans (HI)
Native Americans (NA)
American Women (WO)
None of the above
7. Is your primary place of business in Texas?
Yes El
No
8. Has the Prime Contractor maintained or exceeded gross receipts or total Yes ❑ No ❑
employment levels four consecutive years in any of the following categories of
the U.S. Small Business Administration's size standards?
• Financial and Accounting - $17,000,000 • Wholesale Commodities -100 Full Time Employees
• Medical and Other Services - $5,000,000 • Manufactured Commodities - 500 Full Time Employees
9. If Prime Contractor will NOT subcontract any portion of the contract/agreement, please check this box. ❑
Complete Form C-SSD if any contract/agreement activities will be subcontracted. NIA
To the best of my knowledge, I certify the above information to be true and complete.
SignatuWof Coritractor's Authorized Representative
Date
(C-SSD)
TEXAS DEPARTMENT OF HUMAN SERVICES (DHS)
HUB SUBCONTRACTING PLAN
SUBCONTRACTOR STATUS DETERMINATION FOR VENDOR AND GRANT CONTRACTS
Applicant/Prime Contractor's Name: N/A
DHS Vendor/Grant Contract Identifier (To be entered by state agency prior to distribution.)
Prime contractor should contact Subcontractor to obtain information as required to complete this form. Include each proposed
Subcontractor.
Subcontractor Name
Address
Estimated
Dollar Value of
Subcontract
Description of Subcontracted
Goods and/or Services
If certified as a
Minority/Women-
Owned Business,
enter certification
number and
certifying entity
If HUB" Qualified,
but not Certified
enter Qualifying
Ethnicity/Gender
*A Historically Underutilized Business (HUB) is defined as a business that is formed for the purpose of making a profit and is otherwise a legally recognized
business organization under the laws of the State of Texas. At least 51 % of the assets and interest and/or classes of stock and equitable securities must be owned
by one or more persons who are United States citizens born or naturalized. The following are recognized by the State of Texas as having been economically
disadvantaged because of their identification as members of the qualifying groups - Asian Pacific Americans (AS), Black Americans (BL), Hispanic
Americans (HI), Native Americans (NA), and American Women (WO). These individuals must demonstrate active participation in the control, operation and
management of the daily business affairs of the company that is proportionate to their ownership interest. HUB businesses must have a permanent business office
located in Texas where the majority HUB owner(s) makes the decisions, controls the daily operations of the organization, and participates in the business. Owners
must be residents of the State of Texas and meet all other certification and compliance requirements. Out-of-state businesses are ineligible for state certification.
- NUNUUVt:KNMENTAL CUN I KA(:TOR CERTIFIGA IIUN rurrn qr3
of Human Services September 199
The Texas Department of Human Services (DHS) has adopted rules pertaining to contracting with organizations in which a former
board member or employee (whose last day of duty was within the past two years) has any ownership or control, or who is an
employee or consultant of such organization. Also, Human Resources Code §22.0033 prohibits for one year after employment
former OHS employees in pay grades equivalent to or above pay grade 17, Step 1, from helping (for pay) another entity obtain a
contract with DHS in an area for which the former employee was directly concerned or had administrative responsibility.
Additionally, DHS has adopted standards for contracting with contractors associated with current or former employees and board
members, and their relatives. This form is necessary to help the Departmentdetermine compliance with those rules.
All potential non -governmental contractors for any type of contract must complete this certification. The contract, if awarded, may
be terminated for cause if
(1) the contractor knowingly provides incorrect information in its certification; or
(2) the contractor uses a subterfuge, such as a subcontract arrangement, to avoid the application of state laws or DHS rules.
Does the potential contractor have an officer, director, employee, consultant, or owner (in whole or in part):
1. A person who is currently a DHS employee or DHS board member? .............. Yes No
2. A person who was a former DHS employee or board member whose last day of duty with DHS was
withinthe past two years?................................................................................................................................................. Yes No
3. A person who is related (see Relationship key below) to a current DHS employee or DHS board member? .................. Yes No
4. A person who is related (see Relationship key below) to a former DHS employee or DHS board member
whose last day of service to DHS was within the past two years?................................................................................... Yes No
Wife Brother Stepdaughter Spouse's Sister
RELATIONSHIP Husband Sister Stepson Spouse's Brother
KEY Father Son Mother-in-law
Mother Daughter Father-in-law
IF YOU ANSWERED "YES" TO ANY OF THE ABOVE QUESTIONS, YOU MUST COMPLETE AND ATTACH FORM 4732-A.
CERTIFICATION
I certify that the information above is complete, true and correct to the best of my knowledge. I understand that
lack of full, true and complete disclosure may be grounds for withholding payment for delivered services and
may cause contract termination.
Name of Potential Nongovernmental Contractor Contract No. Social Security No. or VIN
,�/.�
Signature - Authorized Representative
Date
Print or Type Name
rage t of Z
FORM 2047
Instructions
CERTIFICATION REGARDING FEDERAL LOBBYING
(Certification for Contracts, Grants, Loans, and Cooperative Agreements)
Form/instructions in:
CACFP-ADC, CACFP-CCC, CACFP-DCH, CAH, FDP, FVP/SCPM, FVSNPPM, MPM/LTCF, NSLP/SBP, SFSP, TEXCAP
08-1992
PURPOSE
Federal legislation, Section 319 of Public Law 101- 121, generally prohibits entities from using federally appropriated
funds to lobby the executive or legislative branches of the federal government. A federal government- wide rule,
"New Restrictions on Lobbying," published in the Federal Register. February 26, 1990. requires a debarment
certification for contracts, subgrants, and subcontracts over $100.000 which contain federal funds and are initiated
on or after December 23, 1989.
Certification is conducted to assure that
— a contractor understands prohibitions against lobbying the federal government using federally appropriated
funds, and
— DHS does not knowingly enter into transactions in which entities have lobbied the federal government using
federally appropriated funds.
If federal funds are used to lobby the federal government in order to obtain the award, the award cannot legally be
granted.
PROCEDURE
When to Prepare
DHS is required to obtain a lobbying certification as part of the screening process for contracts, subgrants, and
subcontracts that are over $100,000 and that contain federal funds. Such contracts, subgrants, and subcontracts are
defined as covered. The prospective contractor, subgrantee, or subcontractor must be notified in the procurement or
subgrant package that the certification will be used to help screen his offer. Using the certification, screening is done i�—
the contract was originally initiated on or after December 23. 1989.
Note: The following is an example of one situation involving a new contract and requiring a lobbying certification form:
A family care contract has just been awarded. The competitive procurement process results in the same provider as the
one previously holding the contract in the procurement's geographic area. Even though the contract is with the same
provider, it is a new contract: it is not a renewed contract.
Renewals are also screened using the form, if either of the following conditions exist:
• A contract initiated prior to December 23, 1989. is renewed, and its scope is changed.
• A contract initiated on or after December 23, 1989. is subsequently renewed.
The same conditions apply to contractors and subgrantees when they purchase subcontracts in excess of $100,000 and
use federal funds to meet their obligations to DHS. By signing the certification, a contractor or subgrantee has an
obligation to screen his covered potential subcontractors before he can enter into a covered subcontract.
Number of Copies
One form for each application, procurement, or renewal package is submitted to the department. Each form must bear
an original signature -
Transmittal
The certification is returned to DHS as part of the completed application. procurement, or renewal package. The
Page 2 of 2
instructions in the package specify to whom the material, including the certification, is returned.
Form Retention
Form 2047 for the successful offeror must be kept for three years and 90 days after the contract period ends, or until all
litigation, claims, or audit findings are resolved, whichever is longer. Form 2047 for unsuccessful offerors must be kept a
minimum of six months after the effective date of the contract or until the resolution of any appeal or litigation resulting
from the procurement, whichever is longer.
DETAILED INSTRUCTIONS
3. Subawards... — If the contractor or subgrantee subcontracts for any type of goods or services (client services. audit
office space, computer hardware, or software, etc.), the answer must be "yes."
Name of Contractor or Potential Contractor — Enter the contractor's, subgrantee's, or subcontractor's official name
If the entity is registered with the Texas Secretary of State, type or legibly print the name as registered with the
Secretary of State.
Vendor ID No. or Social Security No. — If the entity has a vendor identification number (VIN) from the State
Comptroller's Office, enter that number; otherwise, the person authorized to sign the certification is to enter his Social
Security number (SSN).
DHS Contract No. — If the certification is prepared as part of an application or procurement package, leave this space
blank. If the certification is prepared during the renewal of a contract. enter the contract number. Use the OHS uniform
contract number, if available.
Name of Authorized Representative and Title — Self-explanatory.
Signature — Authorized Representative and Date — Self-explanatory.
2047
of Htxmnn Services CERTIFICATION REGARDING FEDERAL LOBBYING pgobe 19M
(Certification for Contracts, Grants, Loans, and Cooperative Agreements)
1
PREAMBLE
F-,feral legislation, Section 319 of Public Law 101-121 generally prohibits entities from using federally appropriated funds to lobby the executive or
legislative branches of the federal government. Section 319 specifically requires disclosure of certain lobbying activities. A federal government -wide
rule, "New Restrictions on Lobbying: published in the Federal Register, February 26,1990. requires certification and disclosure in specific instances
and defines terms:
Covered Awards and Subawards-Contracts, grants, and cooperative agreements over the $100.000 threshold need (1) certifications, and (2)
disclosures, if required. (See certification term number 2 concerning disclosure.)
Lobbying -To lobby means "to influence or attempt to influence an officer or employee of any agency (federal), a member of Congress, an officer or
employee of Congress, or an employee of a member of Congress in connection with any of the following covered federal actions:
• the awarding of any federal contract,
• the making of any federal grant,
• the making of any federal loan,
• the entering into of any cooperative agreement, and
• the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan or cooperative agreement."
Limited Use of Appropriated Funds Not Prohibited -The prohibition on using appropriated funds does not apply to activities by one's own
employees with respect to:
• liaison activities with federal agencies and Congress not directly related to a covered federal action;
• providing any information specifically requested by a federal agency or Congress;
• discussion and/or demonstration of products or services if not related to a specific solicitation for a covered action: or
• professional and technical services in preparing, submitting or negotiating any bid, proposal or application for a federal contract, grant loan or
cooperative agreement or for meeting legal requirements conditional to receipt of any federal contract, grant, loan or cooperative agreement.
(The prohibition also does not apply to such services provided by nonemployees for the same purposes.)
Professional and Technical Services -Professional and technical services shall be advice and analysis directly applying any professional or
technical expertise. Note that the professional and technical services exemption is specifically limited to the merits of the matter.
Other Allowable Activities -The prohibition on use of federally appropriated funds does not apply to influencing activities not in connection with a
specific covered federal action. These activities include those related to legislation and regulations for a program versus a specific covered federal
action.
Funds Other Than Federal Appropriations -There is no federal restriction on the use of nonfederal funds to lobby the federal government for
contracts, grants, and cooperative agreements.
Applicability of Other State and Federal Requirements -Neither the government -wide rule nor the law affect either (1) the applicability of cost
principles in OMB circulars A-87 and A-122. or (2) riders to the Texas State Appropriations Acts which disallow use of state funds for lobbying.
TERMS OF CERTIFICATION
This certification applies onl to the instant federal action for which the certification is being obtained and is a material representation of fact upon
which reliance was placed en tnis transaction was made or entered into. ZSubmission of this certification is a prerequisite tor making ore eeng
into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil
penalty of not less than $10,000 and not more than $100,000 for each such failure.
The undersigned certifies, to the best of his or her knowledge and belief, that:
1. No federally appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to
influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a member of
Congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering
into of any cooperative agreement, or the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or
cooperative agreement.
2. If any funds other than federally appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an
officer or employee of any agency, a member of Congress, an officer or employee of Congress. or an employee of a member of Congress in
connection with this federally funded contract, subcontract, subgrant, or cooperative agreement, the undersigned shall complete and submit
Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (If needed, contact your Texas Department of
Human Services procurement officer or contract manager to obtain a copy of Standard Form-LLL.)
3. The undersigned shall require that the language of this certification be included in the award documents for all covered subawards at all tiers
(including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all covered subrecipients shall
certify and disclose accordingly.
Do you have or do you anticipate having covered subawards under this transaction? ....................................... ❑ Yes ❑ No
arm of Contractor/Potential Contractor endor ID No. or Social Security No. OHS Contract No.
rme of Authorized Representative Title
Signature -Authorized Representative
Date
With a few exceptions. you have the right to request and be informed about the information that the Department of Human Services (DHS) obtains about
you. You are entitled to receive and review the information upon request. You also have the right to ask DHS to correct information that is determined to be
incorrect. (Government Code. Sections 552.021. 552.023. 559.004). To find out about your information and your right to request correction. please refer to
the contact information in your application. procurement. or renewal packet.
F;•'
„���,a-'�-,
nnn. to Vuwwnp IU•r.r ulou - JUC1. VCV. 1LLr.000 !00 141V r.UUL
' LUBBOCK INDEPENDENT SCHOOL DISTRICT
ELEMENTARY SCHOOLS PERCENTAGE OF FREE OR REDUCE"RICE LUNCHES
2002-2003 SCHOOL YEAR (USING FALL PEIMS SNAPSHOT DATA)
CAMPUS
I ENR
# FIR
%FIR
Alderson
512
493
08.68%
Amett
245
229
93.47%
Sall r
315
315
100.W%
sayiess
735
569
78.05%
Bean
400
474
96.73%
Bowie
313
122
38.9i%
Bozeman
171
1 3
95.49%
Brown
464
401
86.42%
Duge
301
271
90.03%
Guadakip
232
206
88.79%
Hardwick
591
228
38.58%
HarweN
410
395
96.34%
Haynes
353
71
20.11%
847
532
89.95%
Honey
476
48
10.11%
Iles
325
292
89.06%
Jackson
291
260
94.22%
Maedgen
393
235
59.80%
Mahon
250
255
98.46%
Martin
322
306
95.03%
McWhortel
458
426
93.01 %
MurNe
1 372
31
8.33%
Overton
1 327
241
73.70%
Pa
1"
192
96.48%
Parsons
552
265
48.01%
R. Wilson
4B2
153
31.74%
Ramirez
428
391
91.38%
Rush f
587
286
45.32%
Smith
749
75
10.01 %
Stewart
428
290
67.76%
Tubbs
320
268
78.42%
Waters
645
204
31.63%
Wester
414
274
08.18%
Wheatley
238
221
93.64%
VvT&eIo(*
398
285
71.61%
Whiteside
716
65
9.08%
--
Williams
453
168
37.09%
Wowarth
479
"3F
92.48%
Wright
156
1221
77.22%
News Release
FOR IMMEDIATE RELEASE:
Contact: Johnny McLellan, 775-2678
The City Of Lubbock is pleased to announce the Summer Food Program for Children,
sponsored by the Texas Department of Human Services. This program is provided
through the City Of Lubbock Parks and Recreation Department, under direction of Civic
Services. The Program will provide a nourishing noon meal to youngsters age one
through eighteen. Meals will be served Monday through Friday, beginning May 27th and
ending August 8, 2003 in the following locations:
Maggie Trejo Supercenter — 3200 Amherst at 12:30
Mae Simmons Community Center — 23rd & Oak at 11:50
Parkway Center — 405 N. MLK at 12:10
Rawlings Community Center/Harwell Gym — 4101 Ave D at 11:30
Beginning June 2nd and ending June 27th, meals will be served Monday through Friday, at
11:30am at the following locations:
Bean Elementary — 3001 Ave N
McWhorter Elementary — 3202 Erskine
Rawlings Community Center/Harwell Gym - 4101 Ave D
Also participating in the program is Big Brothers Big Sisters of Lubbock, located at 1706
23rd. The program will run from July 14 — July 18, 2003. Service time for this site will
begin at 11:45.
Children who are eligible to participate in this program must not be discriminated against
on the basis of race, color, national origin, age, religion, sex, disability, or political
beliefs. Anyone who believes he or she has been discriminated against, should write to:
Director, Civil Rights Division, MC W-206, Texas Department of Human Services, P.O.
Box 149030, Austin, Texas 78714-9030 or Secretary of Agriculture, Washington D.C.
20250. NOTE: Discrimination complaints based on religious or political beliefs must be
referred only to the Director, Civil Rights Division, Texas Department of Human
Services.
CITY OF LUBBOCK
MEMO
TO: Peter Kern, Environmental Inspection
FROM: Johnny McLellan, Indoor Recreation Supervisor
DATE: 3/24/03
RE: Summer Lunch Program
The City Of Lubbock will once again be participating in the Summer Lunch Program for
children. = This program will begin on Tuesday, May 27 and will end on Friday, August 8,
2003. Meals will be served in the following locations:
Trejo Supercenter — 3200 Amherst 12:30 —1:30
Simmons Community Center — 23rd & Oak 11:50 —1:50
Parkway Center — 405 N. MLK 12:10 —1:10
In addition to these sites, LISD will be participating in the program from June 2nd through
June 27th. Meals will be served at 11:30am and last till 12:30pm in the following
locations:
Bean Elementary — 3001 Ave. N
McWhorter — 2711 1st
Rawlings Community Center/Harwell Gym — 40th & Ave. B
Also participating in the program this year is Big Brothers Big Sisters of Lubbock,
located at 1706 23rd. The program will run from July 14 — July 18, 2003. Service time for
this site will begin at 11:45.
Summer Lunch Menu
City of Lubbock
Day 1 Poor Boy
loz — bologna
1 oz — cheese
%2oz — Salami
'/4 cup — Lettuce/tomato
1 whole apple
1 cookie
1 cup — Chocolate Milk
Day 2 Peanut Butter/Jelly Sandwich
1 oz — Peanut Butter/Jelly
2 Slices — Bread
loz — American cheese
'/4 cup — Celery stick
1 whole apple
1 cup — Chocolate Milk
Day 3 Turkey Ham & Cheese Sandwich
1 oz — Turkey Ham
1 oz — American cheese
2 Slices — Bread
4oz — Orange Juice — 100%
3/8 cup — mixed fruit
2 — cookies
1 cup — Chocolate Milk
Day 4 Pastrami & Swiss Sandwich
1 oz — Turkey Pastrami
loz — Swiss cheese
2 Slices — Bread
'/4 cup — Potato Salad
1 whole orange
1 cookie
1 cup — Chocolate Milk
Day 5 Ham & Cheese Sandwich
loz - Ham
1 oz — American cheese
2 Slices — Bread
'/ cup — lettuce, tomato, pickle chips
'/2 cup — peaches
2 cookies
1 cup — Chocolate Milk
Day 6 Bologna & Cheese Sandwich
1 oz — Bologna
1 oz — Cheese
2 Slices — Bread
4oz Apple juice —100%
3/8 cup — Pineapple Chunks
1 brownie
1 cup — Chocolate Milk
Day 7 Turkey & Swiss Sandwich
1 oz —Turkey
loz — Swiss cheese
2 Slices — Bread
'/4 cup — Lettuce/Tomato
1 whole orange
1 cookie
1 cup — Chocolate Milk
Day 8 Poor Boy
1 oz — bologna
1 oz — cheese
%zoz — Salami
1/4 cup — Lettuce/tomato
1 whole apple
1 cookie
1 cup — Chocolate Milk
Day 9 Peanut Butter/Jelly Sandwich
1 oz — Peanut Butter/Jelly
2 Slices — Bread
1 oz - American cheese
1/4 cup — Celery stick
1 whole apple
1 cup — Chocolate Milk
Day 10 Turkey Ham & Cheese Sandwich
1 oz — Turkey Ham
1 oz — American cheese
2 Slices — Bread
4oz — Orange Juice — 100%
3/8 cup — mixed fruit
2 — cookies
1 cup — Chocolate Milk
Day 11 Pastrami & Swiss Sandwich
1 oz — Turkey Pastrami
1 oz — Swiss cheese
2 Slices — Bread
1/a cup — Potato Salad
1 whole orange
1 cookie
1 cup — Chocolate Milk