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Home My WebLink AboutResolution - 5189 - Summer Food Service Program Application - TDHS - 05_23_1996RESOLUTION NO.5189 May 23, 1996 Item #16 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 Summer Food Service Program Application and related documents with the Texas Department of Human Services, attached hereto, which shall be spread upon the minutes of the Council and as spread upon the minutes of this Council shall constitute and be a part of this Resolution as if fully copied herein in detail. Passed by the City Council this 23rd ATTEST -.- Betty . Johns n, City Secretary kS TO Leisure S APPROVED AS TO FORM: 99& 0 arold 4WiSrd,' Assistant City Attorney HW:js/FOODPROG.RES ccdocs/May 9, 1996 of May , 1996. VID R. 41, RESOLUTION NO. 5189 M .. )z 1 oor, SUMMER FOOD SERVICE PROGRAM AGREEMENT STATE OF TEXAS COUNTY OF TRAVIS I 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 (Section 13) and the Summer Food Service Program, hereafter referred to as the SFSP, Federal Regulations (7 Code of Federal Regulations (CFR], Part 225). I. MUTUAL AGREEMENTS The Parties mutually agree: A. If the contractor fails to provide services in accordance with the provisions of this contract, the Department may, upon written notice of default to the contractor, immediately terminate the whole or any part of this contract and refine to pay claims for reimbursement. Such termination and/or refusal to pay claims for reimbursement shall not be exclusive remedy but shall be in addition to any other rights and remedies provided by law or under this contract. B. If federal and 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 tams 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. r • II. CONTRACTOR PROGRAM ADMINISTRATION AND FINANCIAL MANAGEMENT A. The contractor will comply with the SFSP Federal Regulations (7 CFR, Part 225, as amended), Uniform Federal Assistance Regulation (1 CFR, Part 3015, 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 supporting documents and approved amendments to the application) for participation in the SFSP. B. The contractor accepts final adininistrative and financial responsibility for food service operations at each site sponsored by the contractor. 'Ibis responsibility includes the perfornnance of -the conditions, of: settlenwat.of-Any -audit.ex*Ttiont -or payment deficiency in the program and the collection and repayment of -any -amount -paid in excess of the proper claim amount which are found after monitoring or auditing by TDHS. or the United States Department of Agriculture (USDA). This responsibility applies to this contract, and all subcontracts hereunder. C. The contractor will apply to TDHS for approval of changes to its original application and for prior authorization for field trips if meals served on the field trips will be claimed for reimbursement. Requests for changes and field trip authorization must be received by TDHS at least five (5) calendar days before the requested effective date for the change or the field trip. Contractors will notify TDHS within five (S) days of the termination of an approved food service site. Ell. SFSP RECORD KEEPING A. The contractor will keep financial and supporting documents, statistical records, and any other records pertaining to the services for which a claim is submitted. The records and documents will be kept for at least three (3) years and ninety (90) days after the termination of the contrast period. If any litigation, claim, or audit involving these records begins before the stipulated time period expires, the contractor will keep the records and documents for not less than three (3) years and ninety (90) days after the termination of the contract period and until all litigation, claims or audit findings are resolved. The case is considered resolved when a final order is issued in litigation or a written agreement is signed by TDHS and the contactor. Extensions are considered as separate contract periods. B. The contractor and its subcontractors will allow TDHS and USDA officials and other appropriate officials determined by TDHS to inspect facilities and records tad to audit, examine, and copy records at any reasonable time. This includes access to all records of costs paid, even in part, by TDHS. Non School Spooson - Pale 2 • CIVIL RIGHTS POLICY COMPLIANCE A. The contractor agrees to comply with Title VI of the Civil Rights Act of 1964 (Public Law 98-352), and all requirements imposed by the regulations of the Department of Agriculture (7 CFR, Parts 15, 15a and 15b) Department of Justice (28 CFR, Parts 42 and 50) and USDA and TDHS directives or regulations issued pursuant to that Act or 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), 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 persons in the Untied States shall, on the grounds 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 under any program or activity for which the contractor receives federal financial assistance from TDHS and USDA: and hereby gives assurance that it will immediately take any measures necessary to effectuate this agreement. B. The contractor agrees to comply with Texas Revised Civil Statutes Article 4419b-4, Sections 5.03 and 5.04 (relating to workplace and confidentiality guidelines regarding AIDS and HIV). C. This assurance is given in consideration of and for the purpose of obtaining any and all federal financial assistance, grants and loans of federal fund, reimbursable expenditures, grant or donation of federal property or interest in such 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 We, lease or furnishing of services to the recipient, or any improvements made with federal financial assistance extended to the contractor by TDHS. This includes any federal agreement, arrangement, or other contract which has as one of its purposes the provision of assistance such as food, cash assistance for the purchase of food, rental of food service equipment or any other financial assistance extended in reliance on the representation and agreements made in this assurance. D. 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 TDHS or USDA. The person whose signature appears on this contract is authorized to make this assurance on behalf of the contractor. V. TDHS CLAIMS PAYMENT TDHS will, subject to the federal appropriation and availability to TDHS of sufficient funds for the SFSP, make program payments to the contractor in accordance with the terms of this contract. No reimbursement shall be made for performance under this contract occurring prior to (a) the beginning effective date of this contract or (b) a later date established by TDHS based on the date of receipt of a fully executed copy of this contract. Non School Sponsm - Page 3 VI. CERTIFICATIONS A. Immigration Reform and Control Act of 1986 - 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. B. Regarding Debarment, Suspension, Ineligibility, or Voluntarily 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 Sate 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 placed 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 States Department of Agriculture or other federal department or 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 as 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 at other federal department or agency, and/or the Texas Department of Human Services, as applicable. S. The contractor further agrees by submitting this certification that it will include TDHS Form 2046 titled 'Certification Regarding Debarment, Suspension, Ineligibility, aced Voluntary Exclusion for Covered Contracts' without modification, in all covered subcontracts and in solicitations for all covered subcontracts. 6. A contractor may rely upon a certification of a subcontractor that 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 certifications from its covered subcontractors upon each subcontract's initiation and upon each renewal. Non School Sponsors Page 4 4 V a`e CERTIFICATIONS (continued) 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. C. 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 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 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. 3. 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 I ontracts under grants, loans, and cooperative agreements) and that all covered subrecipients shall certify and disclose accordingly. 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. Non School Sponsors - Pate 5 VII. EFFECTIVE DATE AND SIGNATURES For the faithful performance of the terms of this contract, the parties hereto in their capacities stated,, affix their signatures and bind themselves. City of Lubbock 1`Iai71G VL WG WIlu- UUg.V[gdaw.A VU - (Please Print or Type) iginal signature o thorized-rip�r-,i e of the contracting organization Susan Bailey Name of the authorized representative of the contracting organization (Please Print or Type) Recreation Outreach Coordinator Title Please printor type, in the spaces provided above, the name and title of the authorized representative signing this agreement on behalf of the contracting organization. TEXAS DEPARTMENT D>' HUMA11t SERYiCEsr _ ::..;.- ..,.;: ... .. ... ,z,. .: ...._`>/.'::....a�✓w..:.:..,....a;.:ek"2c.Yy`^'c.�f:.,.M'o,.dt"q :.ir�.+,ccrc,S.c.'.'.�.vC# .. through Date: — Revised February 1994 Nan School Sponsor - Pale 6 '7a A Toga Dd w"Wg of N~ sou SUMMER POOL} t6YtCE 0966RAM APPLICATION FOR PARTICIPATION NOTE Gtve as much klforitlation as possibia. Aftch addtt oral shm to I needed; P"" Wntifl each attadhnwttt sdth dw namw of the contractinp wW&xtkxL � •ft!.� • ►.emu •- � •� FOR "STAFF OOLY oorovW For ❑ Lwkbd ❑ AJL sue. All Nam• Voo dw ID No. Fbarf� Mo CITY OF LUBBOCK 17560005906000 jT*WPh""0* (806 )767-2675 8 6 67-26 3 ira�rtp Adbyq (Ssyt or P.O. (!aL CtY. SUM. ZIP) PO BOX 2000 LUBBOCK TX 79457 916 TEXAS AVE LUBBOCK TX 79401 N•rfl• goA�tabr SUSAN BAILEY na A. Contractor Classification (Check ale that apply): Aesd"* Year NaSorrai Unit of Cow Cervie4 that al boo ❑ National Youth Sports Program ❑ Youth Sports ProVw ®:erYice sites are operated dve* by the cate-actor. ResWer&pWnsklernial C4fwoua School Calendar ❑ Pri,ra s ❑ School Food AWrorfty ❑ Summer Camp ❑School Year Nonwom E. is your program a year-round program?............................................................................ ❑Yts ® NC C. Type d Contractor: ® POW En ty (M4d^): Is your agency considered 10 be state owrndloperateO..................................................................... [Dyes ® No Do you deposit your program *ocdy into the State Treaaq?........................................ ❑ 1qA ❑ Yes ®No Do you deposit your program reirnbcrsemert ft a local bank? ............... ...................................... ❑ N/A ® Yes ❑ No A yes. is 4 dad deposit? ............................................................................................ ❑ Yea No ❑ Privab NwVeo& OryarAatbrr-Tax-exa t+pt @tabus estabWood. Aaad+ ktfar of doge minafa (IRS 501%1q of lax4mampt staves imm FS. Do You deP loff turn n0mbursement into a bad WW..................................................... DIVA ❑Yes ❑ Mo Iyes. Is 4 dired deposit? ............................................................................................ ❑Yes ❑ Nio D. Does he organizabon provide an crVoir yew-mund service to the tong wr*y ltdd is to be wmd by the Sumrrw Food Service Prograttt(SFSP)?.............................................................................. ®Yes ONO K no. mRi of the following draamshuces apples? ❑ Residentlal Camp ❑ FA n to opwaft srorrid deny pragramr to a poor arse ❑ Serves Migrant ChAdrnn ❑ Fstkn to operaI would deny a soWimt ettxriber of cllAdrsn access to prop we E.I. Does he orgarftation receive $I OD.000 or more in federal hrlds yearly? ................................................. ® Yes Elmo 2. Does the organization receive more Vw+ M,000 but less than i 100.000 in federal kods yearly'! ........................ [Dyes ® fio 3.Anach a copy of he audt eowft last years program operation or docurnenUtion hat an audit oodorming with SFSP vA be conducted, Wxkpd ft he dab k vA be owiduded. (You must submit a completed Form 1509, Speeyl NutrNon Pwgra� Slagle Arm IdanV ication Orate.) 1n 11 For„ u Pa SECTION "UOGET A. Es&mte ao SFSP costs which we De dalmed for rekr>Knoment for t tsTUAT[C OMATtOKAL C06 COSTA Pam Labor 12,440 Fdn a Benefits 179 Food 63 455 Non-food Supplies 2,432 Unties - 0- Rent -0- Eq*ff mt Use Fee -0- Rental d Equipment -0- NO orr m. Traaportation r - 0- f+peaM= cow TOTAL 1: e i 9SMAM AM MISMTM COM MOOPAM nM COS Labor mandgemem mOrvw. a ricm 4,205 Frinpe Swdfib 488 Renal d Office Space -0- L%Wdes -0- office Strppies 967 Office BL"v Mainww" -0- Use Fee -0- Audit Fees - 0- L"W Fees -0- Transportation .30 588 aK»o TOTAL 2: 6,248. B. k kaw projecaed kxome b 1he food service from all Sources Ww ftan SFSP reirbursemeM. Identify wady the costs ftis income wi cover. (Do not indude stale or federal kinds.) na is S SECTION W4AANAGEHENT PLATY A. List administrative level personnel who wit be resportside for nw negernal ar>d rrtoeiflork d Me SFSP. (Do not ktokrde sffs supervisors cooks, jenitors oncater personnel k>volved in on -silo food service.) THE of ►Osmolt uO fMttCatx Am s[s'ir= PROM" DUTIES REC. SUPERINTENDENT 1 ASSISTANT DIRECTOR OF SFSP MONITOR 1 PERSONNEL TRAINING MANAGE FOOD SERVICE, PERSONNEL RECORDS t Farts IX pow B. Are chAdren charged separately for meals? ..................................................... ...................... QYes ED ti yes, see Form 1 SM. Attachr»nt B. C. Do you want to receive advance payments?................................................................................ Dyes ®iw M yes. 1. For Operational Costs?.............................................................................. . ............ Dyes ❑ Nc 2. For Administrative Costs?......................................................................................... 0 Yes ❑ Nc 0.1 meal service is self -preparation, do your want to receive commiodities? .. R lA............................................ ❑ Yes ©Nc I yes. Form 1606. Appfkatron andAgmemere for CarnrrhocWW, must be completed. SECTION IV —PROGRAM OPERATION A. 1. Bepimirg and Ending ng Dates Meal Service: From JTNE 3, 1996 through AUGUST 9, 1996 B. 2. Number of sites:.......................................................................................................... 10 List dales and topics of 5F5P CAM TOPICS EXPLANATION OF PROGRAM, SITE MANAGE24ENT RECORD KEEPING MEAL REQUIREMENTS/IWENTORY NONDISCRIMINATION C.Is the organization planning to contract with a food service management company for the preparation of unitized meals? ................................................ ...... OYes ❑ No Ifyes, and the contract will exceed $10,000. attach a copy of the iwtation to bid. Also OM a 84 ftbikAbM of P biases+ or .w of U- I 5 i13;o� M h pro .xp.cn.a 15 to s 100.00o W mon? It "& " ow" of hro away rl Y.. 0 No Also. attach a copy of an 11-ft gfds menu kx*xling all apedre menus to be used. D.ls the organization ratting with a year-round flood service management Compeny/l..................................... [:]Yes Q No ff yes, submit a copy d your procurwriern procedures, bid. Contract. and all amwndnlents. E.Anach a copy of the loner which has been (or will be) sent by tie orgWtation to the Health Department notifying fiem d intent to operate a Food Service Program at the siWs) k4caled on the sttad»d Sire Hornalim sheet (Farm 1W). SECTION Y—ASSURANCES A. Free Meal Policy Statement j 1. The contracting organization assures the Twm Department of Hunan Services (DHS) that d d9dren at the aces described on the Siee(s) kdormw)n Sheets br the Summer Food Service Program. wit be offered tithe same awab with no physical segregation d, or ether dlsatmirha . against, any dad because of race. Color. disability. ape. sea. national origin,, reigkA or; beiefs. No separate Charge will be made for any meal except In accordance with attachment B d this application. 2. The commcting organization assures DHS that, I it Is 9 0-MAV camps or otther enrollment programs: • The contiracting organization has or will obtain family eke and irbow, a data about as dhkkw whose weals will be reported as free or reduced -price: and • The children claimed as free or reduced -price meet fthe =Wd fanny size and income atindarcls set by fha (trilled States Department of Agriculture. OHS Form 4504, Standards /ur Osoarrr kwV free and Aedroed-Price Eigilblllly. f n. : esanr+rnt `4A s IN -CM SUMMER FOOD SERVICE PROGRAM FOR CHILDREN CIVIL. RIGHTS QUESTIONNAIRE :: V(L RIGHTS ACT OF 1964 jar-" : W. ,. Estirt,ats. by rtciaVethnic group. the number of children that will participate in the program at each site. it the program can"s of several camp sessions. soecitY the praec:ed ntrnber of children by site and date of session: srrt aJNL" I AL�.SRil+ I ra I eu« I Ntsaarbc (rs�av of 614, Wh"t. um%o. eve.) 7 MAX NCTtvt 6ul.DfJl tfinCT! Clayton Cartier I 3 I 1 23 I 432 I 383 C. Rawlings Community Center 6 I I 6 35 1,605 767 Rodgers Community Center 7 ' 18 I 45 1,820 I 739 Hae Simmons Community Center 3 0 783 1 237 87 Woods Cortrmunity Center I 2 0 ` 1,746 1 tO6O 1 113 2. pes-,rbe how this prcjecion was Trade (.e.. Cased on comparative census snrciUrert in saes. ot-saevaton of swdents. student surna,r*s. _::. g pp" the organization have s,^,ecif+c nlembem.biip requirements which result in the denial of program benefits to specific grtwps?............................................................... Dyes t^ . .N: it Yes, descnbe those requireff*nts: �. 'lY`�st e!tors •rriil to ;..ace Cy :'e c ,anc:at+on to wrtar. r, u�cr+ry a:.d ;rtss :ccts crsa�za:zrs sx�z :.tee es�x+z�y ;a c.:.'tic�ate in the �-a-. publicity, p.s.a., fliers, word-of-mouth 'rat ctrer cutreach s;ccs rr.:l ba ::Rtn :y :.-* crgu:aa:ian to trs;;rt .ems; .-iYn es :n a via 'r:n wrivi it Craws rs a-endance wi, -_. art *qua► opportL;rury ;0 ;a+.c:::e :n -.e pr an? :. Has any federal agency notAec tre orwizzatien of --ton-compiiance wit.'1 04 Cvil Fights a= of IW? .............. 0Yes F *4c it Yes, give details ir-OXing crates, narres, and results: s;E}{ggIUTATION ACT OF 1973 (Sertton 504) A Oees " gntract:ng cr;ancrat+on have any xac:eS, .raciCeS. or uc`itt =W oarryers 74t !irrnL Cery. or discourago parvcoaNan +n" proSraM. e4 or erryerrr erc oy *.'+e contra=r►g canixaticn a*cse of eisaziiity? ........ 0 C. Yes _ if yes. ex;wn: 1! P sty J •a there any policies or Practices that resuft in unequal treatment in the detivery of bensfts or rr--�� f�� . nriCOS to participants. appticlnts. or ernp"es according to disabd'ay? ....... u .............. Yes air flo !es. explain: :oes the contracting organization employ /5 or nxxe pe"? ......................................... MYes ONO fes: 1. Enter the name and title of the coordinator who win work with OHS to ensure tt•at Section U)4 requirements are M*IL name Mary Andrews 2. Has the organization established grievance Procedures that incorporate appropriate due process sUuIdaros?................................................................. Eyes ❑ No " yes. do these procedures provide for the prompt and equitabte resoMion of tints that anege an action prohibited by Section 504 of the Rehabs Cation Act of 1973? ................ ® Yes ❑ No 3. Has the contracting organization informed the public of the right to file a corrptaira and Of LRe filing procedum?................................................................ � Yes ONO if yes, briefly describe how the public was intorrned: The Section 504 information is published in the Leisure Guide and in other City publications - '. -;as L`te crganizaton taken ZOOS to notify empk:ytes. ;adiciparas. and acplicants ttz; ttie orWizatiiOn nct disc im,nate on t:'.e cases of C'rsabTW. ................ ........................ ........ C Yes ENO yes, do tl"e Peotte notified irc:ude those with incased vision Or hearing and mer.+bet$ cf 6r c.-4 or ;rc,emcnat — : •;anitaticns txrcing cCttectye oar;a.nirg or ;rcfessorw arretments with the =r&a=r:j crarAubon? ........... CE Yes `c yes, briefly desc to hcw tRey are nctif-ed: Thev are notified through the Employee handbook, in all recruiting publicatians, and on the applicaticn. :. -O all organization fortrts. Publications. and recruitment materials which inkxm the outfit of xogram benefits tnd atr4"Oyment opportunities ccntain the assuraro= that the orranizabondoes nct c:=r - -ate on the Casa cfd'tsaD9'tty?......................................................._......... .............'J Yes C .%C :f no. kx5cats sxeps being taken to ConVly wiLl this mquuf:ment ZOOS the organization have a Procedure to ensure that the remedial or ctsr ec�.ive a�cn Ms been or wu7 De taken if noncompliance w4h non d'rsarnina n requirements is found by OHS. USOA. or tfte contraccing orgaj'd=ticn csett?................................................ .. . .......... �1 X7 s ' Na 'f yes. explain: All non—compliance cam2laints w1l l hp hanrflpri rhrnngb tl g Persennel r1--ttaen[ -AM s+ � SUMMER FOOD SERVICE PROGRAM FOR CHILDREN CIVIL RIGHTS QUESTIONNAIRE u :: VIL RIGHTS ACT OF 1964 2r4 ' Sa.:::4C"4'u : .arv.y, its; -. 1. Estirrate. by raeiaVethnie group, the number of children that will participate in the program at each sle. It the program consas of srreral came sessions. soecity the projected number of children by site and date of session: WE AMMCAN (narti at 81W. so-Ol. ex-0. Ole.) ! WWAX 1 NET t KAN I W-AMOUSLACKSLACK IgSP4laC :V1Qi[ Burns Park I 3 ! j 2 I 113 364 I 527 Carlisle ark, ( I--A17( 790 Chattttan Park ( 6 I ` 3 500 200 SO Hollins Park 5 I 2 137 1,176 I 726 Pioneer Park ` 1 C 43 ' 152 323 $91 Z. Oewrbe how this projection was made (i.e., based on comparative ennfirrent in sates. observation of ssuderts.s:Went surnames. a _. Census 3. Oees the organization have specific membership requirements which result in the denial of program benefits to specific groups? ... .................................................. ...... ❑ Yes va If yes. descr>te those requirements: :.'N+'sai atscrs wail �e rraYe �y .: a orsanaa•.icr► to contact .:+'+cry aid ;:zrs rats erar�za:cns axut :re ct;pcns�.y:a;.a.=c.a:e in �.e;,rc, a.-,, publicity, o.s.a., fliers, word-of-mouth �. iY!tat Ct:,er Ct.L 3aG}1 s:rCS Sri `.� :aKln cy:.' a cr;axatv,.:. tr=re .'41 -%C-::es in t:,e a-eait :awl •:S ar► a,qua► oppor;.nay :o „a: c _a:a in tra ,:rot: aan? _. "As any federal agency notified tf a oegartizaticn of with :ta C:va RiSnts ac: of !9647 ............. ❑ Yes FE� t if yes, give details inc:uding dates. names, and results: % AEMAStUTATION ACT OF 1973 (Sectors 504) A- goes ;ha contracting organamn have any policies. ,ra_.ices, or artnite: =:-as Carriers slat lintit deny. or discourage partc:oation ut the proSraM or ernpbymart oy the comraaing ce;an¢ation teca.,sa of disa:uirf? ........ ❑ Yes tt yes. exr.Wn: v t%ers any policies or pracxices that result in unequal treatment in the del"ry of benefits or ' -.ices to participants. applicants. or employees according to disability? ................................. ❑Yes No as. erpla►n: " :es the contracting organization employ tS or more people? . ...... ...... UYes ❑ No as: t Enter the narre and tit'a of the coordinator who will work with OHS to ensure that Section SOt requirements are met. Mary Andrews Director of Personnel 2. Has the grgani ation established grieyancs procedures that incorporate appropriate due Process standards? .................... ...........................................CR Yes ❑ No it yes. do these procedures provide be the prompt and equitable resolution of complaints that allege an actacn prohibited by Section 504 of the RehabMution Ali of 1973? ................. (Eyes ❑ No 3. Has the cont-'acting crsanization infCrtned the pubfc of the right to file a complaint and ofthe filing procedure? ............. ... . ...................................... [Dyes ONO if yes. briefhy descrbe how the public was inforrrred: I:he-si ;, ieu :C. iuiOt- published in the Leisure Guide and in other City publications -as :.'�e organizaton taken glee's to nctity employees; ;articipants. and a;pficants that the organization :es net discriminate on t`e tass of di abifay? .. ....... n Yes C No ' res. to G,1e zecois nctdlied i+c.'ude those with immired vision or hearing and T4mbers of ur+or's at XCfassicnal a-;zs:ors !Vicir�g c2l:ec:ve cu;aimng or professionat agseerrients with the contra=ng orgv:tza;on? ........... t� Yes L.. !�lo Thev are notified through the Employee Handbook, in all trefly descnbe low :-ey are nctified: recruiting publicaions, and on the application � o all organi=tion 5orrrs. PubfiZtions. and recruitment rnaterial.s wtkh int�orrn the public of mogram benefits and ennploysnent opportunities contain the assumce that the or,a dabor>does not disciv -ax on the basis ofdisaflifrty?.................................... ..................... .......................... E Yes C No ic. indicate steps being taken to comply with this reGUirstM= =. woes the or+ganiution have a Procedure to ensure that the remedial or aofrec:.� anion has been or wM _4 taken it non.=nvtrancs with non discrminaiton requiremerm is found by OHS. USMk or the carsuac:ing � C or,'n its anizatioelf?............................. ....... Yes ' No All non-compliance complaints will be handled through the Personnel Bppt. f yes, explain: Fom, 1 oac 3. if the contracting orpuntzstbn Fs sponsoring a amp or lower NrpimeM program that &OW separately for meats, the o rww organtration has road Attadxnant 6 to Wa app"bon `*Additional ,assurances for Camps and Older Enrolment Programs that Char Separately for Meals'. and assures DHS that all NgL*ements have been or will be rrwL B. Pu66C PAk" se 1. The contracting orgaNtatson will make eff" to ensure that the local news media wN make a public announcenwrit of the program a wa suppty them with a news release: If the contracting organmation it sponsoring a Camp or other enrolment program fts release must contain. at a minkTuxn, a Gat of approved sites, a fast of the current standards for detem**V free art receded price eligitxiity, and the following statement RIx Maw• or rti awe'adno Wywrftxwl announces the sponsorship of the Summer Food Service Progra income eliglbalty, win be based on family size and income using the Standards for Determining Free and Reduce"ri Eligibility, provided by Ow United States Department of Agriculture. Meals will be provided at the sfte(s) late& People who s eligible bo parwpats h the program must not be discriminated against because of race, color, national origin, sex, eS dhuaMy, ref kw4 or political belief. Anyone who believes that they have been discriminated against should write lemmediatt to: Director, CkA Rights Division, MC W-106, Texas Department of Human Services, P.O. Boa 149=, Austin. Texas 7tt71440 or the Secretary of Agrkutprre, Washington, D.C. 20250. NOTE: Discrimination complaints based on religion or political beet must be referred only to the Director, Civil Rights Division, Texas Department of Human Services.' For all odw programs the announcement must contain. at a minknum, a list of all approved sites and the blowing statement WThe piwft or ti cone lclky wg&*zX%w1 announces the sponsorship of the Summer Food Service Program. Mej will be provided at ftee slte(s) listed People who are eligible to paeddpate In the program awe not be dlscriminsted again because of race, color, national origin, sex, age, disability, religion, or political belief. Anyone who believes that they have bw discriminated against should write Immediately to: Director, C 4 Rights Division, MC W-106, Texas Department of Hume Services, P.O. Box 149M, Austin, Texas 75714-WW or the Secretary of Agriculture, Washington, D.C. 20M. NOT piscrimination complaints based on re%lon or poWIcal beliefs must be referred only to the DtrscUw, Cfvn Rights Division, TeL Depawrtment of Human Services.• 2. This Dubuc release was or will be published in the blowing news NAM Of YEMA OU n.Lr I DATE Of RELEASE AVALANCHE JOURNAL I 5-19-96 SOUTHWEST DIGEST B-22-96 EL EDITOR 5-23-96 I kMA OF tiMA ou nsT I DATE of RaSAV ALL RADIO 6 TV I r-99- 3. Anac h a copy of the contacting orparuation's public release XMWrOM as sutbmitled b the news media and arty COW materials used pub5dze lire program"a avalabitty and requiremecas: SECTION VI- CERTFICATION (see Foray 1506, Attachment C) I ceMy ihat the Information on fhb application is true and correct to the best of cry browfedgc l verMy that.reimbursasrrerrt wo t churned orgy for approved a+saIs Served to eligible children dewing the hot" grey are In eMmiance at approved atlas, I know th de&beratewVw a a withholding of Information may result In proeaaution under applicable state and k derW statubm 01 APPROVED ❑DENIED ff denied, reason. m. Dive date Forth 1106 sent ID FM. 1-2 Taal Depwinvt d Mvrntn SOW" t1— WN I C1av+on Tarter j -1,- y �S - - SUMMER FOOD SERVICE PROGRAM FOR CHILDREN SITE INFORMATION r'ohe and N. r_oop ?ftO, I_Uhhock, Texas 70403 RM OW Lm OILY TX 152-1004 nR park site Ul from: 6-3-96 ooa lfirougA: 8 M96 I � +Ot � 0 0 17� � 0 10�ATTACH A MAP WITH THE SITE SERVICE AREA IDENTIFIED lt"W atial Camp SM Stnr6q Prb &* L6gW4 CWrta Sd0tIW Sirs I. indicate Typed Site: ❑ A. (owing ore to tour atssls) ❑ C. oerft ww to bur mall) ® E baYkq oat b bun await) IbnmsWentlal Camp Slb StrYtcg Prima* Homeless Chften ❑ l3.(senvirgg oew b tour swab) ❑ 0.(senvYg orw b bur Halt) 2 Lkt ALL counties served by fft site: LUBBOCK 3. A. Is you site open:.....................................................................................................®Yes ❑No S. Is you site enrolled?................................................................................................. OYes ® No C. Slbe EigWity: EnW the wou age d ahldren efpble icr tree sndlor reduced price meals for the sloe WW Harbook Chapter 4... 94.65 % D. if open vies. submit doamtientation supporting this percentage figure (such as census date. school data). For open des using send data. list to sdxxgs used to docu rent site elig bW. attach Lem .Aa used by dist. is establish percentage d free S teduaed price cNdrem ARNETT ELEMENTARY E. For enrolled sites. Form 1531 will be used to document efgt ty. 6 the enrolled site used school data. list the school used In docurnent the site• F. What. Is the percentage of tree or reduoed•pnice meals for the sills? ................................................... % 4. Did the subs participate in previous years' SFSP? (SFSP Handbook. Chapter IQ.. ........................................ E3Yes [I No if Yes. "name of contracting ongartstion: CITY OF LUBBOCK 5. MoNiorinp Plan (SFSP Handbook Chapter IIQ: Enter date d monitoring review to be conducted withirx 3-96/6-7-96 1 6- 6. M"Service Period Infommtion (SFSP Handbook. Chapter 4 TTM OF NZAif • BJOMU CHUM" TO BE SMEW SAL a8!tM1C[ T SECt♦1alIG 8reaidast A.IA. supplemerd Lurch 301: 30 p.m. PAL Supplement Supper iB aonmdema by OHS Bern nano to raga m wAm nnes WmL OF&P rrnmow. 4 7. W you plan to teed ct WIW under one (1) year old?.....................................................................0V46 ti:, m 6. Method d Food Preparation by Contracting Organtntion (SFSP Handbook Chapter M IO SiOa 0 Cashel l ktm I ❑ Food Aut 0ty ® Conperh► pnduda All Yew Contrarb) ❑ Or ilwh2ke twat b fd-ft" I I i (�.. Farm Im pro h. Indictee the system to be used for the serving d meats.and to swervisim of d4dren during meat service period. (SFSP hand=k, CttapW 1) ❑" Service hrt ❑ and are Gn Idub 12 VW Pidr Up mws ❑ Ot W. 10 List sfle personnel wtlo wW t)e ttvoW to any extent in V* meat service. (51 5F' FrambooK Urapw It): TrrLE OF ►OSff)ON NO. K /OUMN SSECWC FOc0 URVICt PROGRAM 0=0 CENTER SUPERVISOR 1 HELP SUPERVISE MEAL SERVICE SL NER REC. WORKER 2 HELP SERVE MEALS J.T.P.A 2 HELP SERVE MEALS 11. kxk:de what provWom wM be made for meat service during periods of hdement weather. (SFSP H&Wbook, Chapter 1) Indoor Wkst Wks! Service ❑� ❑WW Be Cancelled ❑X ouw. FEED AT ARNETT SCHOOL 701 F. _ (liiF my, 12. 1 the sle feeds prirnarty hcmeiess children. what methods are used to ensue flat money, food stamps, or it 4&W servim am not regtirtid for meals? 13. Ara steals defrveted b the sb?........................................................................................... � Yes ❑ y F YES, COMPLETE 1 EMS 14, 1S. A I& IF NO, FORM IS COMPLETE EXCEPT FOR CER I FICATION AT BOTTOM. 14. Indicate the means d tion with the vendor which we be used to ald W meat deiverims. (SW Kw4booK Cttap.1) Sb Personnel WN Condo AdmFNst ud" Stta Puaorrral WM Comminiala INA who Wig Coebd Vendor ❑ Mreelfy Wkh Vendor 1 S. VYI 6*my be w%%h one hour of the food service period? (SFSP Handbook, Chaplet 1) ......................................ElYa Cl I II no. desa'fbe wrangemerts within standards p esarted by local health aulhotlba for deivery wd holing of meats ter time d service. I& If two is an mess of meals delMnd. n m ift wff be WW ft*o* ONPW IQ 1 CERTFY f al ft a torrrtatlon on this form is true and Correct to Me best d ON lamdedge. I M* than fhb Bile NS been vtshed and fm here et. =pabifty and bclt"for tts meal service pWvW for the rnxrlbar d dtidtat artlldptl�>fd. I know tlRat detb�Mv wntsion wfthttoidinp a rnartr result in proseadion under appticabte stale and federal eb4Ms. CITY OF LUBBOCK FSL'SAN BAILEY RECREATION OUTREACH COORDINATOR Tam OrpwVnwt d ern SOM M wma al Food S*fV . Sr. CHAT4AN PARK SUMMER FOOD SERVICrPROt3RAM FOR CHILDREN SITE INFORMATION 27th & IVORY LUB 4 FM as USE OLT TX 152-1004 ❑it r nor ov«aoon 9 Food 5«v+rn t ��''A0�'0h'�96 I �+0 � � 0 � p � 2 2 �A 7 1 � (-- ATTACH A MAP WITH THE SfTE SERVICE AREA IDENT W E0 Raideatiat Camp SAa Serwkv Pdmuly wgrwd f3hidm Dither Salt 1. kWk:i to Type d Site: ❑ A. (awAV one to bur mask) ❑ C. (a WAV one b lour mak) ® E. (wvk one to lour weak) Nw aiderdiai Camp Sh "-AV Primarily wmeka Chidrah ❑ 8. (dewing one to bur meals) ❑ D. (erring one to bur mak) 2 List ALL counties served by this sb: LUBBOCK 3. A. Is your site open: ................................................................. ® Yee ❑ Nc .................................... S. Is your site enrolled?................................................................................................. ❑Yes ®Nc C. Site EtigibW- Eraer the percerdage al ditw *tie for tree arhdlor reduced price nests for the sic pw Handbook Chaplet 4... 84_7 7 0. tl open sites, subs* doaimentdon w-worting this percentage 6M (such as census date. school dare). For open sides using school data (Est the scl`ro used to document ske etigibW, attach bmxM used by achod first to sstabbh peroentape of Iree 4 reduced price dhildren. WHEATLEY ELEMENTARY E. For enrolled sites. Form 1631 will be used to document ei& ty. If the enrolled site used school data.19 the school used lo dommwd the site• F. VVthai Is tine percentage d r>ree at reduced -price meats for (the am? ... -.............................................. __ 4. Did the Stec partidpate in previous years' SFSP? (SEEP Handbook. Chapter u).......................................... ®Ya ❑Mr S. S Yes, give name d contracting organization: Plan (SFSP Handbook. 6-3-96/6-7-96 CITY OF LUBBOCK Enter dace d rnonllo ft review to be conducted willft Mod Service Period wocrnaaon (5F5F ttanoo00K Rhapaer a): OF MEALS - NAMMTrrEs wrists pa�at�rr TO U MVIV atfxttaserrtt:aTdit "Got" DOM 8reaidsst A.M. Supplement Lunch 70 12:05 p.m. 1:15 P.M. P.M. Supplement Supper is wnoaotod b OM WW set Q to mpg a' WAN aavin •NL WV hW db=i6 Iq 7. Do you plan to feed dit a under one (1) year dd?..................................................................... QYes [ON l!. Method d Food Preparation by Contractkhg Orgsnizagon (SFSP Handbook. Chapter II) 1 ri � ❑ cw" landhen I ❑ Fuca Ant O* GCawptny kA daa AN Y� ots) 130rPrAa0oe Qhat k Sd4* ") A Fam tso?p+c 9. kx*xte to system to be urea for ttte serving a meats and ttw supenrtdon of d4dren durkV meal service period. (SFSP Handbook, Chapter If ❑ Mow �Ser ❑"am Gh" ron art � ® t e�ab ❑ Other: 10. Ust sb personnel who wm to rwotmd to any extent in Vw meal service. (5F5v nana000u. unam Tq: TTME OF POSMON No. IN FO$MDK amcm F(= "AM FROM" OIJm CENTER SUPERVISOR 1 HELP SUPERVISE MEAL SERVICE SUAMR REC. WORKER 2 HELP SERVE MEALS J.T.P.A. 2 HELP SERVE MEALS 11. tn6cate wttat provisions wM be made for meal service dump periods d kdement weatw. (SFSP Handbook. Chapter n kxfoor Mow YealSenria FEED AT ILES SCHOOL 2401 DATE AVE. Ssivics ❑Wlp Be Cancood ®Other: 12. If to sibs seeds PtT a* homeless &Adn r,. wttat methods are used b wwo that money, food stamps, or h4& d services are not neglect for meets? 13. Are meats dehwed 10 the stbe?........................................................................................... ®Yes ❑ IF YES, COMPLETE ITEMS 14 15, & 1& IF NO, FORM IS COMPLETE EXCEPT FOR CER I IFiCAT ION AT BOTTOM. 14. kWicate the means of comrmnication with the vendor wtkh va be used to adjust meat deliveries. (SFSP Ha dxwk Chap. a) Slb P'ersorxrt Wid Conrad Ad e* Sb Faw-ol WE Coen wnksb BsbA Wtw Wlp Contact Venda ❑Dhdy Wth Vendor 15. Va delivery be wttl>tt one hour d the food service peri0d4 PW 1 Wndt m p1 Chapw II) ...................................... foYb ❑ 1 no, desafe artargemerb wthin standards pnwtod by bcW heath atrfttorties for deiiiiwy and hd&V d mods ud ime d service. I& l atone h an sxoess a meat dowered. make w6be (SFSP Handbook Ch@pier 1Q Saved In Rebipe dw Thorn Away Ihiiriador ❑d b Ven&W Served the Nerd Or/ ®et Ito of ❑tor ❑OQrr: 1 CERTIFY Md the 4 torTTMft on this form Y true grid Corned Io to bo9d Cry &mw11 dpe. l G%* that Ns srie has boon visw and th has the capeb11ty and fao3*w for #w ewt servicepa for the numbs d dil6 n anlldWlsd. f Irltow that detberarei misreproser>too d may rmg in prveecs,l m under appkabie stw wd tiederai stafsrla. CITY oFjMftnry SUSAN BA 4 -,-)r Team DGPGM wrt _ F* I 1 SQT10 nzrt t -I", of M""!" SWAM . SUMMER FOOD SERVICE PROGRAM FOR CHILDREN FM am USE ONLY SITE INFORMATION TX 152-1004 R U MrM of Food SoMal SMr TwWo No. Ox- HOLLINS PARK INA PARKSITE Wie—a so (SWOK CRY. stm.M 1st 6 TEMPLE - LUBBOCK TX 79415 Ihmaber of Op. eoc Froae6-3 96 Ihrou9ti: 8 9-196 *mtbv Dam Y 0 ¢ p 42 �Aul- 7 AWITH — ATTACH A MAP TH THE SITE SERVICE AREA IDENTIFIED It"IdIc f>al Camp SibA Servtaq Pr A&* lllgrvt CAS M Ottw SIe 1. Indicate Typed Site: ❑ A. (suvbq oes b bar awed) ❑ C. (s*rAV oes b bur mal:) E. O WAV oat to bar a s&) lbrrtsidou Camp SM SWAV Primully Homeless CtftTa ❑ 6. Or Av OM IQ be bMoab) ❑ 0. *r AV ON to bar Massie) 2. List ALL cotes served by M s#e: LUBBOCK 3. A. Is your site open: ..................................................................................................... EBY*$ ❑ NC & b your site enrolled?................................................................................................. ❑Yes a Nc C. She 13g bW. EnW the peroe 00 of &Jdree Oipbie for fee an4for re&md price meals for the site (SFSP Handbook, Chapter 4... 98.2 1 D. U open sites, submit d=xmentntion wppor*V this percentage figure (such as census date, scd+ool data). For open sites u*V sdroot data Rat the schools used to doounwrd site ek bifty; attach bmvAa used by school ftL to esuNsh percentne of b" A reduced price ditwL JACKSON ELEMENTARY E. For erlrotbd sites. Form 1531 will be used to document eigtty. N the enrolbd site used school data. Lit the school used to dom meat the site• F. What b the per ge of tree or raduoed-price meals for the ells? ....................................... d. Did Ow sloe participate In prravious years' SFSM (SFSP HardOOOk, Chapter I11.......................................... InYea ❑ Mc I Yes, give name d connirac*V organization: 5. Nbrft in0 Plan (SFSP Handbook 6-3-96/6-7-96 1 6- CITY OF LUBBOCK Eimer dale d monitrxinp review to be conducted w hin: 6. wd service Period Worwatorl (SFSP Handbook. Chapter II): TY!!s OF MEALS - Mar NW OF ELa3ELt Ci—M To"fE1tYED' (MEAL W vres 111E no*@" Blom Breakfast A.W. Supplement Ltaxh -70 11:40 a.m. 12:45 p.m. P.W. Supplement Supper 6ThW- —low tw OHS M1;n Nov to wpr--� am W*lL OW NW12=K I 7. Do you plan to Ned dnifdren order one (1) Year old? ............................................................ .. Qlfes ON S. 11etiod d Food Preparatbon by Comr%*V Orparli AAw (SFSP Handbook, ChaPW m i Won us ❑ c vIrw Iadw ❑ FFwd Aat+It► (2 Ca dam= uI Y Ijdn ta��ler orttaetrre. foal b a.Il• Form I507paq D. kdlasbe the system to be wed for the serving d meals arb tl* supervision of dMm during meal service period. (SFSP Harbbook Chapter it CattttrI"tyte Children am Stated CMdrat ura Up ❑ Nest Strrbe ❑ and am Gtan Yells ® and Pick Up Muls ❑ Othsr: 10. Lust sloe personnel who wit to wwwYed to any extent in the meal aivioe. (5F5P riM000ic. Chapter tt): Tnu of ►OsrntoN tilO. IN Fo$nloN spictsc F000 st avtc>E ►RoGr" oymis CENTER SUPERVISOR 1 KELP SUPERVISE MEAL SERVICE SUMMER REC. WORKER 2 HELP SERVE MEALS J.T.P.A. 2 HELP SERVE MEALS L_ I I 11. kocate what provisions wil be made for meal service during periods of hderrtertt weather. (SFSP Handb0ok. Chapter Iq Xfoor mew BeCariceiad [a.. FEED AT JACKSON SCHOOL 201 VERNON AVE ❑ 12. 1 the sb beds prints* hor whm c A*vn. what methods are used lo ensue that money, food stamps, or iMcfnd services we not req*W for rreals7 13. Aremeds delivered ID the she7........................................................................................... =Yes F YES. COMPLETE ITEMS 14, M i 1& F NO, FORM IS COMPLETE EXCEPT FOR CEATWICATION AT BOTTOM. 14. - I>i le the means of coat< uketim wih the vendor which wilt be used to adjust meet d*veries. (SFSP Handbook ChW 1) SIY Psrsonr MI N Ca ftel Admirgstra ve Sh PKsarrttt Win Coetreunicab 133 to Who WN CoNad Vendor ❑Dk coy wuh Vtrdor 1L WE dieRmy be wihin one how d to food aerAce period? WW Hnd xmk Chapter tn...................................... Elyes Cl If no, describe wmrgemertts wbhm standards prescribed by bral health authorities br delivery wid hokkv of meals urd time d service. 16. r fts m k an 4=8n d m"ll deivered, atsals will be WV Har*ock, ChsVW Iln Q�som ® in piskowaor at ti t� Q Mmosbsl ❑OQ+r. I CEf;TfY tf & tw Y111orantf01 on SO bmn fa &m stud cornea b be bat d ay intowlsdpe. I cwft VW tNs sae has been visited and it, has to apsbilly and br tie mad serve ptartr»d for fha number d dA& m ardidpatsd. I know that deRerab mimepre:eItsfig of rss A In pr+oescr»ion under appiabie state wild federal agm yarn. wamon S _ CITY OF LUBBOCK 16 mino at oftm ;= We or vio SUSAN BAILE)i/ _ Ae I RFr'RRATTOV nTITRFArm rnnrnTVAn*nv NOR Cm uw O&Y I—) 1 Twt Os W"W t d M'ir" vh SWAM . SUMMER FOOD SERVICE'PROQRAM FOR CHILDREN SITE INFORMATION 23rd and AVE L LUBBOCK TX 79405 f Fmc: 6-3-96 "tL 9-9�-96 1 *man Dow y 0 r 20 ATTACH A MAP WITH THE SITE SERVICE AREA IDENTIFIED Rtsldtn W Camp Slit StnrbD Pfttrf Wrard Clh = 1. htdicate Type d Site: ❑ A. (waning one to four mat) ❑ C.Omkv ON to bur malt) Nonrumtntlal Camp Slb Servfnp Prim* Ilo oA= CNdm ❑ B. (W*q one to bur meals) ❑ D. ( W*-g ON fo far mab) fat"UU ora.Y TX152-1004 S wr f wa fi NA PARK SITE 22 7 0 Ottw Sib E. (sW*q on$ to lar assit) 2 tlst ALL comtks served by this site: LUBBOCK 3. A. Is you site open:..................................................................................................... ® Yes ❑ No & Is your aite enrolled?................................................................................................. ❑Yss ® No C. Sftae EBgfbflity: Enter the pen:a %Xp of thhidrea eipble for nee andAx reduced price meats br the use (S W Ha dxx)k. ChapW 4... 97.5 % D. If open sftas, sLbrra doarnentadw supporting"permntage 6G'xa (such as cen s date. school dada?. For open sites using schod data, fist the schools used 10 doa wnt sb efigibfdr. attach fonmurla used by school dal. b establish page d hee & mduoed pica chidn w, BEAN ELEMENTARY" F- For enrolled saes. Form 1631 will be used to doam*M OkUlty. S the enrolled site used school data. Lit the school used lo docxanetht the slte- F. What is the percentage of lee or reduced -price meals for the sloe? ................................................... % 4. Did the site ParticiPate In PrevlouS years' SFSP? (SFSP Handbook Chapter n......................................... ElYes []No 9Yes, gum name d contracting orp ridabon: CITY OF LUBBOCK 6. Mohilorinp Plan (SFSP Handbook Chapter Iit): Enter date of monitoing review to be conducted wk hin: -3-96/6-7-96 1 6-3-96/6-28-96 1 6-3-96/8-9-96 6. Meat Service Period k1orms6on (SFSP Handbook Chspier 4 TYMES Of MEALS • WASI 11 CR Vial" pit TO W t<ER W KWAL M rAM T= tEGeMNG a cm Ornkfast A.M. Suppienhert Lurch 75 1:40 am 1:WPM PAL SuppierneM Supper rdcrxwam Is conse5wid by Qm tr o me" ti sops Baal so WOL WSP haxtWt CWW q 7. Do you Plan 1a feed children under one (1) Year old?..................................................................... ❑Yes Oft ti Mefhod of Food Preparation by Cwftcting Orgw&rJon (SFSP Handbook, Chapter N) Ivor Iiskq Sdaot Ud q Food Swvia Hoops" Wn ► ft Ha0vot ❑ cm slr ❑ Cethfrnl MicNtn ❑ Food Wtrof Ej CauM ► (IndWas N Yw;p!*sr�s_� ❑OnUanlaNes tr1l aer — Fora+ 1 W? p, t. Irbiate the system to be used for the serving of meals and the uVervlsbn of children AedV meat service perbd. WW Handbook Chapter 1 10. ❑Caffted"" Children we Sested Children Lim Ypl Sella M ❑ and am Gn Meals ® and Pick Up W�sls ❑ Ot1rr: Ust tuts personnel who will be WOW to any extent In the meal service. (SFSP Handbook. CthaPter 11): ?T U Of POSMON MO. N PosrnoN PEOM FOOD SERVICE PrtooRm OV= CENTER SUPERVISOR 1 HELP SUPERVISE MEAL SERVICE SUMMER REC. WORKER 2 HELP TO SERVE MEALS J.T.P.A. 2 HELP TO SERVE MEALS 11. Ir>dicau what provisions will be made for meal service dmtq periods d incfarhent weather. WW Handbook. ClaPler N) 6 u" meal Strike ❑ Service 13WM Be Cancelled ® Other: FEED AT BEAN SCHOOL — 3001 AVE N. 12. 9 the site feeds prirnarly homeless ditm what methods am used to ensue that money, bod stamps, or ih4dnd service= am Rot req *W br rrleats; I& Are meats delivered to the Site?........................................................................................... ®Yes ❑ F YES, COMPLETE ITEMS 14, M & 16. IF NO, FORM IS COMPLETE EXCEPT FOR CERTiFiCIlT10N AT BOTTOIL 14. kwkde the means of oasrrrx>katiorh with the vendor which will be used b adjust meal Morles.. WW Handbook, Chap. 0) Sib Personnel WW Carted Admkdsb%Un SNe POIWn eel Will Comraunfab QSbA Who WW Contaei Vendor ❑Dkway Wtlb vendor I L Wo def.wy be within we hour of the food service period? (SFSP Handbook. Chapter 1)...................................... ®vas C ff eo. desorbe arrangements wk hkh standards Wescrbed by kcal healtth authabn br delivery shed hob*V d meals wd time of unoloe. 1d r there b an exosss of meets delivered. meals will be WW Hammock Choplar IQ ❑ andeased ®athmm eSib Away � vendor ❑08W. 1 CER WY fiat the I ft a lit on tees form b true and contest io to best of ay knoviedgL I asrly #hail Oft site has been Welled and t has the capability and tacihfes for the meal service panted for to nu moor of children wick od. I know to is It alisreprwanlaso hrtlhlJolffrhp d h�hxnhstipr►►may tis1# In prhjsecutioru healer appNeabN stall and taderal alatwas. SN lL. Ap.-I . _ .11 1=1Zwm=wGopvwWzQn Yrrra Rom i A mill wn or oft 'L I T"us D$PW% wt d 1Mm+�n SpMOM ►w�+. of had rwa CARLISLE PARK AddrNi d sft (Sv"t. CRY. 26 th & AVE W . SUMMER FOOD SERVICE PROGRAM FOR CHILDREN SITE INFORMATION LUBBOCK TX 79411 FOR 04 USE ONLY TX 15 2-1004 On X u wor,orW No. hrc NQ NA PARK SITE P riod d OPWWW Of Foos W4vm (moJael .-gwJn+M4 NuMb f 0(� may .Raw i�pC J Frow 6-3-96 fhrolrgh. 8 -9-96 �Day� 0 20 22 7 0 I ATTACH A MAP WfTH THE SITE SERVICE AREA IDENTI IED Rsidse1w Camp Slb Strvkp Prknb* Ul9rant Chum Ottr(sle 1. k4cate Type d She: ❑ A. ow q one to lour mat) ❑ C.(sKvlcp 0n4 to bar meals) ®E. Omkq one b bur afth) lbnrssWontw Coop Sb &WAV Prim ay fbmekrss ChBdrtn ❑ 8. (sW&V om b bar male) ❑ D. (strft ons b bur mat) 2. Ust ALL counties served by this ske: 3. A. Is your site apen:.....................................................................................................®Yes ❑No S. Is your site enrolled?...............................................................................................- L: Y*&- ® No i" C. She EsgfbW. Enter the pemcem> P d dAdren 869bie for free andlor m6xed price neat (or be sire (SFSP Hu dbook, OWW� ... 89.2 X D. If open sites, submit doairr►atation supporting this percentage figure (such as censw date, school data). For open sites using school d L Ist the sdxo)as used to document site *NW. attach b roA used by school &t to esu bfth percent" d free & reduced price di drm DUPREE ELEMENTARY F- For enrolled sites, Form 1531 wil be used to document dgIbIlty. If the enrolled site used school data. Est the school used to doaxnent the she. F. What Is tlhe percentage of free or reduced -price meals for the see? ................................................... % 4. Did the site partid4mm in prevbus years' SFSP? (SFSP Handbook. Chapter IQ ......................................... MYem ❑ No 9Yes. give name d contracting organization: CITY OF LUBBOCK 5. Monimeft Plan (SFSP Handbook Chapter 114: Enter date d monitoring review to be conducted wtthkr 6-3-96/6-7-96 1 6-3-96/6- & Mpl Service Period Inforrrefion (SFSP Handbook, O WPW t V CW MEALS - IWZfR OF SLf IMU CHILOM TO SE SLRYEDr' or-4L ser#= Tam DOM Sreaidssi A.hl. Strpptemerrt . Lurch 6011:30 am 12:45 pm PAL SuppieffWA Supper i mr od QY Mtin smOV I n mop r a d =W w%1M WAd- tYrwX' 1 ,ChwWLj 7. Do you plan to teed dit a under one (1) Year ad?..................................................................... QYso ONO IL Melhod of Food Preparation by Contacting Organization (SFSP Handbook. Chapter 0) 'WM v'"di° uskq sewd U q Foos 9sosat on sat. ❑ cwtral Mi„n ❑ Food Autta r ® �y I Year Cont O"Wime" ,d b 2 0—) Form 1sOTiPs4 9. Indicate the system to be used for the ser4v d meals and I* vAwAsion d chidren du Q meal sevice period. (SFSP Handbook. Ctupler rt 10. Lk* UP ❑mew Services W wenGlnn Meals ® ' Up uk ❑ ostwr: Ust sfte Personnel who w0 be Myotved to any ubeM in the meal seMcs. (SFSP Handbook Owler It): TrLa of ►osmoN No. el ►osmorr SKCM FOOD sEltV= ►ROOPAU OUTZ i CENTER SUPERVISOR 1 HELP SUPERVISE MEAL SERVICE SUMMER REC. WORKER 2 HELP TO SERVE MEALS J.T.P.A 2 HELP TO SERVE MEALS 11. irvScaI m what proviskm wia be made br meal service durkV periods d I dement weather. (SFSP Harmodr, Chapler 1) ❑kmkw mew t" Service FEED AT DUPREE ELEMENTARY — 2008 Ave T Servlcs ❑WW Be Cancslkd Mother 12 r the sibs heeds prtmtiy hbmetess ch kirem what methods are used to ensure that money, loud stamps, or ti 4*W services are not mq*vd for meals? 13. Are mesh delivered to the stbe?........................................................................................... ®Yes Cl F YES. COMPLETE BENS K 15, A I& IF N0, FORM IS COMPLETE EXCEPT FOR CERTIFICATION AT BOTTOM. M Itdioate the means d cortmuftation with the vendor which will be used to adjust meat defimdm WSP Hw4book Chap.1) SPA Persaawl Wll Contact Admit6bad" SM Personnel WE CoruMrrk* ©fltall. Who WW Caotad Vador ❑ Okscty MMh Verdor I& wa delivery be within one hour d the food service period? (SFSP Handbook, C+apw ll) ...................................... ®Yes ❑ KM describe arranpemeras wiM standards pr tcrbed by local hmllh authorl m Ior ddfimry wd h *kV d meals uryi time d:ervioe. I& gram ban excess d moos deivened. meet will be (S W Ifarboak Crpler IQ Q � � Dly o sm ThrowmAmy 1:30ow. 1 CERTIFY that the 6 ft I oft on tNs form Is true and oonact W tw bat; d ne► knm& dpe. l m* rat Oft aM Ass bees vtslled and Iw hiss t» capsbW and laces for f» meal serybe p— m— for f» number d d+idnn argidpaled. l triow rat deberatie misneprasertatioc d resat Ys poeeaafon under appicabie eta andfade- sukAes. rises CITY OF LUBBOCK d SUSAN BAILEY, I RECREATION OUTREACH COORDINATOR 155 IVA .94 WF.',A�m 9 ��WAWAW m -100D .01) i Team DepwVnert d Islnsn S�'+bM Mrns d Food SWAM Sala PIONEER PARK SUMMER FOOD SERVICE -PROGRAM FOR CHILDREN SITE INFORMATION 6th 6 Ave T - Lubbock Tx 79401 Fam 119m FM1 tAontkesLratir520❑R�mu -104 POW of apw*OM on Food ssrvlos VWWA YrhR• a kmaw Of OP. 6 'Y uY Front 6-3-96 IMapk 8-9-960 0 20 22 7 0 ATTACH A MAP WITH THE SITE SERVICE AREA IDENTIFIED Retldentw Camp SIb Smkv Pdmadt Bigrwd CAOdm Other Sae 1. k4cate Type of Me: ❑ A. (Serving ON b btr me*) ❑ C. (ur W4 ON to tour 0"IS) ® E. OM4 oft to bar Motu) Norxrmider>u Camp Stb Ser ft Prkuu* Homeless CMdran ❑ B. ( WAV one to bi mo*) ❑ D. (sVAV one to bur vmh) 2 lM ALL counties served by M tit: 3. A. Is your she open: ...................... ® Yes ❑ No S. Is your site enrolled? ................................................................................................. ❑Yes Co No C. Site Eligibility: Enter the penx %Xp d dvl&w e5gble io k" andlor mdjoed price meats io to sb (SFSP Handbook QWw 4... 93.5 x D. if open sites, svbmtt documerdabon suppo V tthb MMentage figure (such as census date, school data). For open On using schod d= ht the schools used to document site e5gUity. sitach brrruM used by school 64t. to establish pamerhtage of tree 6 reduced prise dhidren. RAMIREZ ELEMENARY F- For enrolled sites. Form 1531 will be used to document eSgEtHTity. r the erroW sfte toed school data. list the school used to document the sft- F. What is the percentage of free or reduoed-price meals Io the slte7.................................................... 'A 4. Did the she participate in previous years' SFSP? (SFSP Handbook, Chapter ll.......................................... ®Yes ❑ No itYes. pine name of contracting orpwftabon: CITY OF LUBBOCK 5. Monhorft Plan (SFSP Handbook Chapter IIQ: Enter date of monftorfng review to be =xkx td wst*L a 6-3-96/6-7-96 1 6-3-96/ mew service Perm 0htorTrham (5F by etarhatacxm unam rO: . Tni3 Of IE/LLf WAMM OF of Mfrl fTOU� SAL survcz Tm "ago" ecom Snaktsst A.M. Supplement Lyme% 1:30 pm PAL Supplement Supper — Is conadwid W OHSrrnn smv to app"W teal si brq@L JSFSP Krmook, 07epw 4 7. Do you plan to teed dhadren under ahe (1) year old?..................................................................... ❑Yes p N, e. Method of Food Preparatlon by Conb'acting Onpannt m (SFSP Handbook Clhaptr N) n oa sae ❑ ca" Kktnn ❑ Ft cod Aa 10 Cmp«m AN Tow Conbuft) ❑ OrgatmGm ad k So" -**'JA Fom,1507P* Q. alas. this system fa be used for the serving d meals and the supervisbn d d *w during meal service period. (SFSP Handbook Nagler n 10. ❑ m " ❑ Chfidren an seated CW Une Up and we Given Yeats and Fick Up M afa ❑ Other: List sloe personnel who will be trvotvtd b any extent In vie meat service. (SFSP Handbook Chapter try: TrTLE OF rOsnvw NO. N ►osnvN SPEOM FOOL MY10E PROM" OtrM CENTER SUPERVISOR 1 HELP TO SUPERVISE MEAL SERVICE SUMMER REC. WORKER 2 HELP SERVE MEALS J.T.P.A. 2 HELP TO SERVE MEALS 11. Indicsie what provisions will be made br meal service during periods d trdemeN weather. (SFSP Hmxgxx k Chapter II) ❑WINld M"kCarfcow ® im FEED AT RAMIREZ ELEMENTARY — 702 AVE T. Oservice 12 I to site feeds primarily homeless dAdreN what methods are used to ensue that money, food stamps, or ir4W services we not mgA-ed tar me&? 13. Ate moab do Bred 17 fhe she?........................................................................................... mYes ❑ F YES, COMPLETE ITEMS 14,15, & 16. F NO, FORM IS COMPLETE EXCEPT FOR CERTIFICATION AT BOTTOM. 14. ttfd , ' the means d co mxs*mlion wdh tie vendor wtkh wit be used to adjust meat deiveries. prw Ha dxwk Chap. n SPA Personnel WE Caffad Admirddrad" SfY Personnel ffltl C+ommuriclu ®Stall. WA WE Coefad VwWw ❑Oheoty VM Vendor 15. Wb deivery be wfthaf one Aour d the food service period? (SFSP Hw4book Chepler N)...................................... WYSS ❑ r m desaft arrangements Mthn standards presc tmd by Wei heMtt autafies for d*Aq and h*4 d mess ur>dl *w d service. I& • fMre b an e=u d made deiversd. maeb w0be (SFSP Handbook, Chepbr NQ �> � ®�sw Asvy ❑� bYeedor 000w. I CERTIFY flirt fife I tart.Oft on lhb ions b flue and ooereet b t» best d oW law -ledge. I om* fiat this aft has been visited and lh has M =pabRiy and b eilfes for to meat pbrmed for flfe txx.9 r d dAdren aMkipals0 1 arfow list detberate nfisreproaerftdo erltfholdng d —.& In proseoufion under appf able staved end 11- Je f l stafvles. �j— 7 L% CITY OF LUBBOCKvia ova am WE ONLY RECREATION OUTREACH COORDINATOR I ftmffiffil /D r-- . Tom oapaA' W t d Fkm.n SWAM SUMMER FOOD SERVICE PROGRAM FOR CHILDREN SITE INFORMATION RODGERS COMMUNITY CENTER 3200 AMHERST FOR Les use COLT TX152-1004 806)767-2702 Pwiad CO OPMWO Of "M Sankt FW4=rrfl -"W 4CEYNN Number of pP M.r ru+s dt.r � throups.ot I Fmw 6-3-96 h.8-9-9b " 0 20 22 7 0 ATTACH A MAP WWH THE SrrE SERVICE AREA IDENTIFIED ResldNAW Camp SM Servtnq Pftaffy Itigrmt Childrsa 0aw Sie 1. I dk2 to Type d Sao: ❑ A. (Sam" am to bar teak) ❑ C. (s C&q ON to bur mask) El E. (wrv! Ig ens w bon No* Nonrum"tw Camp Sloe UrAV Pri vly Homtkss ChIldw ❑ S. (serving am to bur mak) ❑ 0.OWAV ON to bur male) 2. List ALL counties served by this stte: LUBBOCK 3. A. is your site open: ..................... No S. Is your site enrolled?................................................................................................. ❑Y@s ® No C. SRe EBgbtTity: Eller be percerttape d o'sidnen efipble far tree ar+dlor ntdtxed price mesh for the site (SFSi' Hardtiook, Chapter n ... 8 2.7 y. D. If ure (such as census dam, school daM). For open sbn using ni-cm dW& fret open schools used tod=ffnent she . e�tsch used by school tf L to establish percentage d free i radioed prim di* n. McWHORTER ELEMENTARY (93.3) TUBBS ELEMENTARY (72.07) E. For enrolled sites. Form 1531 will be used to doaxnent eligtt ty. N the enrolled site used school data. Lit the sdW)l used to dooxneru the site- F. what Is the percentage of bee or reduced -price meals for the Nte?..... :............................................. % 4. Did the site pMicipale In previous years' SFSM (SFSP Handbook Chapter 4......................................... ®Yes ❑ No 6. e v Yes, Vm name d Contacting organaation: CITY OF LUBBOCK MonribrkV Plan (SFSP Handbook Chapter 111): Enter date d monitoring review to be conducted within: X wew etopwwron Fist Foci wwa d Op«t� Q AddNwW FMris arw 6-3-96/6-7-96 6-3-96/6-28-96 6-3-96/8-9-96 Med Service F erWa rnsorm tier (5f,'W KSW0001r. rnapter 0): TYPES OF MEALS • eaanot of CLJGAL[ CHILIM Eee Tow sonfew . IM AL =V Ct: TstE $act* 10 04xw 8reafQast A.M. SuppWmffd x Lunch (ZD 11:30 am. 1:00 Pm. PAL Suppiement Supper IBM - 'qw/ 0M wow me" M OWO n d a" aMtifOs WAL ISFSP HoUb ik Ch@PW 19 7. Do you plan tie teed chit n under am (1) year aid?.................................................................... ❑Ya Db •. Method d Food Preparation by Ca*ac tbV Orpar>Z Mm (SFSP Handbook Chapter Iq I i oe Lie ❑ Caertrai aldmcr 0 Food Ac , ��amm *Wuda AS Y ens) *a Y so Fan+ 1 W7)P* & kxkaw ate system 10 be used for the serving of rneals and the wpervWm d children 6idN meal service period. (SFSP Handbook, gaoler Il 10. ❑ Meal sorlim ❑and we 01"n eated Meals ® and Pick Up Mob ❑ OIMr: List site personnel Who wise be invWad 10 any extent In the meal service. (SFSP HWXMWK UVIP er IQ: Tr .JE of rosrnoN No. IN PoSmorr SPECM F000 SERV=11IMPAM DLfM CENTER SUPERVISOR 1 SUPERVOSE MEAL SERVICE ASST. CENTER SUPV. 2 HELP TO SERVE MEALS J.T.P.A 2 HELP TO SERVE MEALS 11. 4dcw what prwisiom wM be Rude for meal service during periods d incWement weather. (SFSP Flardbook Chaoler 1) Indoor Meal Meal Sella ® Service ❑ WW Be C4nc*4*d ❑ Ott*r. 12. If the sae feeds prirm* homeless dAdreN what methods are used to ensure that money, food stamps, or lrti•"services in not Rimed for meats? I& Arne meals delivered to the alle?........................................................................................... ©Ya ❑ F YES, COMPLETE ITEMS 14,15, IE 16. IF NO, FORM IS COMPLETE EXCEPT FOR TION AT BOTTOM. 14. Indkate the means of cmnvx>i=bm wtth the vendor which will be used to s*W meat d*mfiea. (SFSP Hardbodc gap.1) SIb Pwr wdW Will C;ontsd Adrainistrstive Stb Personnel Will Comeumicatr ®Stall. Who WW Conbd Vendor ❑Dfreotly Wth Vendor I & WE be wfthia one hour d Ill food servioe Yes deivery period? (sFSP H:ndbooic. t n......................... ❑ If no. dew lbe artargements within standards prewrited by local headh authorities for delivery and hoMV d steaks urea time d servIm I& N twn Y an a mm; of meals delivered, meals wo be (SFSP Handbook, C,hapler OQ DwServved in ��Day U so sit way Q bxmd flu v'rd°r ❑other: I CERTIFY that the Irdwndbrt an this form Is true and correct t0 tM Dent of cW kw -ledge. I arty that" ails hu boon vtslled and th toss f» capOW and facft" for ttw meal service planned for the R mtw d diten v>Wpaled. I know that ds& We ants mprssartt"a of molt in p v"c idon under applicable stall and federal sta its. _ CITY OF LUBBOCK Dui.. a�trw OrtM o► otiD SUSAN •W'doofflyAwZ20,96m; RECREATON OETREACH COORDINATOR ^a Taal Depart A rt Fom 1leT t l4t SLUMER FOOD SERVICE PROGRAM FOR CHILDREN Fm"Ust ONLY SITE INFORMATION TX15 2-1004 oft mu Namr d Food Swmf tft TOWN" Na Pr. COPPER RAWLINGS COMMUNITY CENTER (806)767-2704 40th & ave B Pei d OpaMbW d FOW s.no 0MJ=m*-14M4l=YMJ Wumpef of pp.- MW J" ++•r Frog: 6-3-96 "k: 8-9-96 Days: 0 20 22 7 0 ATTACH A MAP WITH THE SITE SERVICE AREA IDENTIFIED aaideetisl Camp SIb S*rvkg PrlsW* Llti and ClsB m Other Si 1. i'rdicab Type Of Site: ❑ A. (to d Ig ON 10 iour malt) ❑ C. (sawing one to bur Mal$) E. (sae" oft to bur usew worl"W M Camp Sate Saving Primsr� Homeless Grildrun ❑ B. (Sm*q ons Io bur m$*) ❑ D. (ter AV one to fo r Dub) 2. LW ALL counties served by tft sfe: LUBBOCK 3. A. Is your sPoe qm:...........................................:....................................... • . • ..............O Yes ❑ Na - IL Is your site enroaed?................................................................................................. ❑Yes Q No C. Site E5gtbW. Enter the percentage d chidrm eigbie br tree andfor reduced price meals for the sine (sf FLw& o* Chapter !I}.... 98.3 % 0. It open sites, submit docurnentadon supporting ft percentage Nure (such as census date, school data). For open sites using school data. list the schools used to doament sibs efglb8ity; attach tomx used by sdiool dial. to estabish percentage of tree i m*"d price dft-en. HARWELL ELEMENTARY E. For enrolled sibs. Form 1531 will be used to doonmeM okt ty. 9 the ereaged site used sdvol data, Fat to school used to doarner>t the site- F. What b the percentage of tree or reduced1wice meals for to sib?..... .............................................. % 4. Did the sib participate In previous years' SFSP? (SFSP Handbook. Chapter Ii).......................................... QYes ❑ No 5. 9 Yes. pive Heine of convacting organimation: Plan (SFSP Handbook 6-3-96/6-7-96 CITY OF LUBBOCK Enter date d 6-3-96/6- 6. Med Service Period Information (SFSP Handbook Chapier a): review to be conducted within: T V OF s1EALs MJassirit OF E11G U CMLORtt)r Tom ss7eWo WAL tiUM= Ter! SEG"" 84)m Brseldsst A.M. Supplement Lunch too 11:50 am 1:30 In PJ L. Supplement Supper is Oor www Oy DmSMfMt m*v to mpwa0 rapt 4MK WSP rianaxw. Owa, 9 + 7. Do you plan to teed cl kO n under one (1) year old7.....................................................................13 Yes p Ne a Method oti Food Preparation by Corttr• *V 0%whadon (SFSP Handbook Chapter IQ FaimR Upp-sp, S. kdcam the system fo be used for the se AV d mails and the suWvWon d didrsn durhq meal so Am period. (SFSP Handbook, Chspr Q 10. ❑clfewd"" Ch5dmn am Seated I" Lim Up Yesi Service ❑ and em Giwn Iffals ID anted Pick Up films ❑ ww: Ust site personnel WhO wig be Mvolved to any extent in the meat servioe. (SFSP Handbook. GTApter iq: TrMl OF ►OSMON NO. IN POSmOrr SPECWX FOOD UAYiCE PROMU OLMES CENTER SUPERVISOR 1 SUPERVISE MEAL SERVICE ASST. CENTER SUPV. 2 HELP TO SERVE MEAT.s J.T.P.A. 11. Wkate what prflvisforts wM be made for meal service during periods d Yxierrmnt weather. (SFSP Hardjo* Chapfsr H) ® a Be a� 12 If the site feeds p Vrxty hwoleu dvldwe what melt& are used b erarte that money, food sue. or h4dnd services are not requited kx eels? I& Are meals doWer+ed 10 the sb?.......................................................... .. BYa ❑h ............................... IF YES, COMPLETE ITEMS K1S, i 16. IF NO, FORM IS COMPLETE EXCEPT FOR CERTiFiCAT1ON AT BOTTOM. 14 ' , 5, -14 the means d cortmrnb bon with the vendor which wfl be used fo adjust meal deBYerkm (SFSP Hwdxx k Chop. 9) She PersorWM CoWAd AdtrrinhUadve She Parso" WN Communksfs ® StA Who WE CoMsd Vw4w ❑ mocity Wuh vwww 1 S. WR del t y be within one hour d the food service periods (SFSP Hww2mk. Chapter q...................................... Dyes ❑ 1 It m describe amVemert;s wOm standards prescrbed by boo health sumo tm br d*my and h0i*V d meals w d time d servbe. I& it Mrs k an excess of meals d*^wi d, meals wo be (SFSP Harxbook aww MI i CERTIFY VW fM ir>iori fioa on fhb form Is the and con b the best d"bwwbdpa.1 c3* that Ihh oft has been vislisd and M has f» mablW and ! "Of s fort* meat service phmed for the number d dAdrei arWdpafed I I�ow lftat daibsXab eriisrspnssaatad0n a result In proeewl3on under app6cabb sift and federal strum - CITY OF LUBBOCK rr.w wm or pm S RECREATION OUTREACH COORDINATOR W�tl -4�—I TO= Depa"Wt rem or HU~ SeNtas . SUMMER FOOD SERVICI: PROQRAIN FOR CHILDREN FOR 0m ust amy SITE INFORMATION TX 152-1004 R U kaiw or woe S>r Towomm No. GEORGE WOODS COMMUNITY CENTER (806)767-2698 Adonss SM (S"oK CItY. Saab. ZW) ZENITH & ERSKINE LUBBOCK TX �A'Y22 Fromm6-3-96 8--996 HatinpDeYs � 0 V�20 �A4' 1' 0 ATTACH A MAP WITH THE SfTE SERVICE AREA IDENTIFIED R"W04W Camp She Strad? Ihrllurl y mono chum Other SIY 1. k►dic;ate Type of Site: ❑ A. (servknp om to bur male) ❑ C. (smfnp one b four aaab) ® E (ea*,g one to bur as* Camp She Sen* Prfararty Ifoareless Cthlf&" ❑ IL (SWAY orr b bur meab) ❑ D. 0V*q err b bur crate) 2- list ALL co efts served by ltris site: LUBBOCK 3. A. is you site open: ..................................................................................................... 13YOS [:]No B. Is your sibs erurotfed?................................................................................................. Dyes ® No C. Site ESgtbW.. Enw the percar>tage of cfnldnnn Vgble for tree andlor mdiced pricy meals for &he tape PM Handbook. Cfhopmr 4... 96 % D. if open sides. subnft docurnentabon supporting this percentage km (such as census date, school data). For open sides using sdw.,d data, *A the sdhoofs used t0 doasnent sb orqbW. attach bmhtria used by school dst to esWbfth po:cerhtW of free d reft ed p to Widrea. HUNT ELEMENTARY (94.3) PARKWAY ELEMENTARY (97.8) F— For enrobed sites. Form 1531 will be used to document ekb&"rty. If are enrobed site used school data. fist lthe scrod used to docurrnent the site F. What Is the percentage of free or reducedVice meals for the she? ................................................... % 4. Did the sfb particiom in previous years' SFSP? (SFSP Handbook Chopw fl)..................... ...... ®Yea ❑No ................ V Yeas. give name at contramv oration: CITY OF LUBBOCK 5. a. Plan (SFSP Handbook. Chaplet 114: Enter date of 6-3-96/6-7-96 1 6-3-96/6-28-96 review lo be conducted *ftft 6-3-96/8-9-96 Mew Service Period knformaSon (SFSP Handbook Chapter II): TYPES OF IEAU - mu mER oR EUGMt.E CtLt7rtErr TO a SERVIV trEk sEatnu rarer 96400 o Dc"a Breakfast A-M. SuppWnerd Lurch (pO P.M. Suppemerd &upper tikswrron r. oonrian.a trrrr+ aar,p b apv+oaa IaM1 s.rvia bat 0) ��- 7. Do you plan 10 feed chiCtm under one (1) year old?..................................................................... QYes ® Ni a. Method of Food Prepar'adon by Oa SRe ❑ CW" fatten wtrafion (SFSP Handbook. ChapW II) Scbod U*q Food 3ervioa Moog aat kdhoft 19 Comparrrr O+dudes AN Yat Cons rn An Form tacrav S. l ndlate the systern to be used for the serving d meats and ttw tupenrfsion of &Admn during mat wAm period. WSP Harbbook, ahm;W pj Catebrta-atyN Chadnn am Seated CNidren line Up ❑ Meal Service ❑ and am Gtvr n Meats ®and Pick Up Usats ❑ mur 10. List Stbe personnel who VWS be Utv0W to any extent in the meat SWAM. (SFSP Handbook CtwW tt): TnU Cf ►OSMON No. of ►OSMON PECar1C POW SERM PROGRAM OUITIES CENTER SUPERVISOR 1 SUPERVISE MEAL SERVICE ASST. CENTER SUPV. 2 HELP TO SERVE MEALS 11. locate what provisions wAt be made for meat service during periods d Wement weather. WSP Handbook Chapbr n Wool m4w erflIx I ❑ Wm Be c4ncaw ❑ other: 12. 5 the site feeds p tnariy homeless dildrert what methods are used to onan that money. food startps, or b-W seMaes we rot rewired for meals? I& Am meats d6lvered to the atte?........................................................................................... Qya ❑ t tF YES, COMPLETE ITEMS 14.15, A 16. IF NO, FORM IS COMPLETE EXCEPT FOR CER I ICATION AT BOTTOM. 14. kx§cW the means a corrrnixiceSm with the vendor whkh wl be used fo af*m trod deAveries. (SW Hw book Chap. in saes Persomd WW Conbd Admkftty iva SIb Forsorxwt Wm Cammx icsle OWL Who WE Coebd Vendor ❑ Wme6y WVh Vendor I& WV deWory be wtthln one hour d the loud service period? (SFSP Handbook Chap w 1)...................................... lanes ❑ 1 11 no, describe arranpernaM wthm standards prescribed by loci huM authorties for ddv y and hdit d meats urd pate d serAm 1d S ttwe Is an now d meah d*mmd. a>eds wtl be (SFSP H:rdbook. Chgsbr IM SWmd In a Served go Ikia Day ©e go III& rown Any ® kned III Yerdor ❑01W.. I CERTIFY ttW to a ft-rudla on ttds form b true and Corred to the bast a ay imm IM dpa. I curdy fist this she has been vtsNsd and ft has ttw capabSty end des for tie med service panned forgo naxrA r a dA& *i irgdpsbd l brow that deft s — nda mp , mt"on wthhoidinp) d newt h prosecution under appkabis stale and ladard st dulm &-ash"11- of c MGM d �15� XTTV QF T.TTRR("W'.V err of CNr ftft a if a or or" SUSAN BAILEY RECREATION OUTREACH COORDINATOR e-') on Tans Depa "Wt rvrm i ao r m J "4 Of H~ SWAM SUMMER FOOD SERVICE-OROGRAM FOR CHILDREN ,on OHS um OKr SITE INFORMATION TX 152 R _ — DC7u MAE SIMMONS COMMUNITY CENTR 1 (866)767-2700 23rd & Oak Lubbock TX 79403 Perbd or OPW-W n or POW aanur kmkbffp( pp- +pilf ^W- �•v� I Fm=6-3-96 "h. 8-9-96 0 22 7 0 ATTACH A MAP WITH THE SITE SERVICE AREA IDENTIFIED Reslderstisl Camp Sb swoN Prfrnsrity WgrWA Chum ottw Sb 1. kbimts Type of She: ❑ A. (wAV one to bur Mob) ❑ C. (ruing one to bur mat) � E (serving one to but mews) WnsWerAW Cane Sb SarAV Pdma* Homoka ChAdrm B. (s4rvirg one to bur auasb) ❑ 0. (Ssrvinp one b bnr awls) 2. Ust ALL counties served by this sibs: 3. A. Is your site open:..................................................................................................... ®Ya ❑ No S. Is your aim enraged?................................................................................... . DY" ®No C. Sloe EBgfbAlty: Eubr to perr tsp d dMren efi$k for free w4or mkced price mews for to Site (S W Ksrmtook. Ompter F.... 97.4 % O. t1 open si'ees. submit doaewmation supporting ft pementage %ure (such as census date. school data). For open sates using sdxool data. bt r* schools used to doaument of ergbW. attach bmmula used by:zhoot dot to esmbFsh pemen:tW d tree & mduced price dAdmL POSEY ELEMENTARY E For enrolled sites. Form 1531 will be used b dommwlt efugloMV. a the enrolled site used school data.19 the school used to doannent the site, F. What Is the percentage of tree or nxkx*dVrioe rruesis for the she? ................................................... % 4. Did the site participate In previars years SFSP? (SFSP Handbook Chapter 0......................................... JDYes ❑ No S Yes. give name of contracting organization: CITY OF LUBBOCK S. Nor o&V Plan (SFSP Handbook Chapter III): Etter date of ffm t ft review to be Conducted whin: 6 eek of Gr+«ar«� eLFM weals a OpwWan Ilak�iliorFWLw-96/6-7-96 76-3 6-6-96/6-28-96 76-3-96/8-9-06 U" SwAm Period Irdm%adon (SFSP Handbook Chapter m: ?YKf OF ME= Womm OF WLKAM an"" W W tlt9 "D W84. s0NM TM ag{ *@" E 43W A.M. SuppWrW%t UXXA 0 1:30 pm PAL Supplement Supper ryuiwnron oonwk>ena dy eAnn patkp t+e epprwad wets a�rr�oe rw. Mak+moot, q 7. Do you phn to teed d Ada n under one (1) yew old?..................................................................... ❑Yes Q Nc S. W1000d d Food Preparstlor by V *WWWW (SFSP Handbook Comer N) Isal7towman I n oa Emof Se ❑ ccecral mb tm [I FI Cod Aa r 0 (lod�i" M f acb) � �� arc bay c lla* p A ., Forte 1107pa" 2. Indicm the system b be used for the sming d mew tl[d to vvervislon d d>adrsn dufinq meal service period. (SFSP ►+ar,abo k ChaplinWOWS"m une up ❑ Merl service ❑ and aChuMs Gh" m� IDn an saw � Up gs. ❑ mur: 10. list alto personnel who will be involved to any extent In V* meal aeNfce. WbF MrMOok. UWW Iq: TRtE OF ►osmok NO. K POSMON WICIFIC FOOD MY= PROM" Dun" CENTER SUPERVISOR 1 SUPERVISE MEAL SERVICE HELP TO SERVE MEALS J.T.P.A. 2 HELP TO SERVE MEALS 11. tax*mte what provisi m wQ be nude for meal service during periods d kxWnent weathm. WSP H dbooK Chapter 0) kwkw meal Mew Sertte Elservica ❑W111 Be Cancelled ❑Other: 12 K the she toads primarily homeless Wdr wr what methods we used to ensue that money, bod stamps, ar lr-" services we not rooted for meals? I& Are meats delivered to the $ile?........................................................................................... Q Yea ❑ N F YES, COMPLETE 1 EMS 14,15, & 16. IF NO, FORM IS COMPLETE EXCEPT FOR CERTW"TION AT BOTTOM. kma, ate Ind means d aomrmx* atieon with the vendor which will be used b adjust meal deliveries. JGW Handbook. Chap. 9) SIM Person" WE Contact AdmkgtMW" $tir Peraonrlet WN ComwUnicale 13 WbA Who WN Coeabd Vendor ❑ ftKoy WIlh Vendor I & Will delivery be within one hour d the good service perbd7 (SFSP Htndbook. Chaptr 1) ...................................... Yea ❑ 1 t no, describe arTangenmM wtltl standards prescribed by local health KAhar#bs for ddflvery and hd ft d meals unit lime d servicew. 1d. N thus k an oo as d mail delversd. male wtl be OW handbook Chapter W) Owd Suved In Ned Day ale 81110 I CEFTTWY that to lnformrfon on trio form ka Wm rand ooc. to tw beat d ay irwwlodge. I arty that this sit has beers visissd and tha has ft sap dMy and %e tm for to mat servla pbr nod for #0 rmtW d c ft mi► wdc00rd. I bvw the dsibor�sle rMsraprs�rsation d kft=Wlgnay rem* In msoarlion under applicable state and West stakmL c �J' — 6r ('TTY�IF�T.iTRRfX'K IF Garamov Mai end MGM mftW b" or oft i! RECREATION OUTREACH COORDINIATOR 71 l NEWS RELEASE FOR IMMEDIATE RELEASE: Contact: Susan Bailey - 767-2675 The City of Lubbock is pleased to announce the Summer Food Program for Children, sponsored by the Texas Department of Human Services and provided through the City of Lubbock. This program will provide a nourishing noon meal to youngsters age one through eighteen. Meals will be served Monday through Friday, beginning June 3 and ending August 9, at ten locations. Call 767-2675 for more information. Hollins Park - 1 st & Temple Bums Park- 23rd & Ave. L Copper Rawlings Community Center - 40th & Ave. B Pioneer Park - 6th & Ave. T Woods Community Center - Zenith & Erskine Mae Simmons Community Center - 23rd & Oak Chatman Park - 27th & Ivory Rodgers Community Center - 3200 Amherst Carlisle Park - 26th & Ave. W Clayton Carter Park - Globe & North Loop 289 Some of the City of Lubbock Programs Receive Federal Funds from the U.S. Department of the Interior. Accordingly, all its programs and activities must be operated free from discrimination, on the basis of race, color, national origin, age, religion, sex, disability, or political beliefs. Any person who believes he or she has been discriminated against, or who would like further information regarding the prohibition of discrimination should write locally to: Mary Andrews - Personnel Director, P.O. Box 2000, Lubbock, TX 79457; or to: Department of Interior Director - Office for Equal Opportunity, U.S. Department of Interior, Washington D.C. 20240. -30- IF 72 73 — W 46 ..I7 47 rio4 ■iiii�i�rrr��sr i ■ 45 ■ 105 24 5■ �� 84 71 2 106 1 r ■ " 7 _.j r e • 1 1 +_•. ■ �4 d Y . • , , . . � .... � 1♦�i. � .'11�i ��1}' ,;1� I. r� '♦ ;.. • it .�..tt IL AQI108 ' f 6 IT Y g I� .•• r• ' 1 �,c....•. mug 109 �ii ��•s�iiW i��Zl■• ti� ! � � i i..i ' 10 i+M�� ' �, •,1 '♦: i�,�,j�! 1 r��i�Y, *� �i 1� - , l s o . rrrrru��• f ` 1_r A88 ♦ Sy V • Y - `�_ ..r its' .•r• ' 819 66 i, . ♦_ . pm al, • .ram Jt. 'a' .. 90 5 t E211i a t'.' ' 1' • _ 60 t7 to ub APR-09-96 MON 02:14 PM ARAMARK_LISD 766 1222 LV"0CKQYD9P9NDeWrSCH= OMSTAICT CURTIS CULwEU , ED.D. SUP&PNTENDRiT OF $0cm Trupwom BOW6&1086 Api 9,1998 D" ice. Steam W, In rl'bvnm t0 ft Summer Lunch PeWsm the f0kmk g iltor madm is presided: School 9dw AmroAd Rm Scrod Name Etln kmtt a Redid P ur>tage Giada* 254 225 08.58% Mahon 120 121 99.0396 PMY 279 272 9 AS% Arnett 262 248 ' 84.6596 Pa&iey 230 225 97.82% Hurt 264 249 94.31% Tugs 419 3w 72.07% Ramirm 635 594 93.54% Harwell 424 417 98.34% ja*m 334 328 90.20% Been 433 422 97.4596 am 296 264 88.1896 loll aum 5a9 475 93.32% 6eert Alt' 243 127 51.21% 'Been AhernatM is a year erwW school and b managed seParet* hm Been Bemaotary Scttod. DfSTRlCT OFFICES: 1628 1tiTN 8»1lYT, l uwocK TOW 7MI-4W5 Tew+mw 8081 WA000 (FAX 808f186 M) P.01 TO= OrOntnVV J LL r� 4rf.W fem 46" JUN 1920 CERTIFICATE OF AUTHORITY This Is to c*Mty that karM Of AUMWUsd QMIMI (W&H " a pmt) Tim Todd Steelman Recreation Supervisor is designated as the authortzed representadve of The representative designated above is suthorked on behalf of the Ong orgugzttion to make wrtttsn aghe- ments wfth exM7rM"wtd, Human Services to operate a food progran, to sign documents or reports abort the agree anClaims when app"WrWft, to the department. 5/Ps �, d Orr FM DUARTMENT OF HUMM s Two Orp4nnwM e! ""WAR samew CERTIFICATE OF AUTHORITY This is to cortlfy that ko W or AcR W"d OftW lam" "S Or P-c) TW Susan Bailey Recreation Outreach Coordinator P.O. Box 2nnn I yhhq-Q4q7 Beni 4M jut IM The reprssentattw designated above is authorttsd on Whalf of the cordrwUng orgard stlon to make rrrttton agrsw- ments srtth artment of Human S*cA= to operate a food program, to sign documer+ts or reports about the ague nt, and to nt claims , when appropdtsts, to the d+partrnwd. 5 a3 �G of Agw4y Os~ am or off+ sworn " or onm T)IM David R. Langston Mayor FM DEPARTMENT OP`HUMM �� of Human Services 1-95 -SUMMER. FOOD SERVICE PROGRAM INVITATION FOR BID AND CONTRACT SECTION A This OOCVMnl COntatns an i-111lOn to. food service Public reporting burden for thin CotrtViOn Of information is management companies to bid for the furnishng Of unisbed estrrlated to average 38 hours per response. including the time moats to be served to Children participating in the Stfr'r'ner for reviewing insiruciiOnS. searching exrsirV data sources. Food Service Program (SFSP) authorized by Section 13 of the gathering and maintaining the data needed, and cernpleiing and National School Lunch Act. and operated under Part I25 of the reviewing the collection of inforM31K tL Send comments regarding U.S. Department of Agriculture USDA) regutatiOns. This this burden estrnate or any other aspect Or this collection or document sets forth, the terms and conditions applicable •10 VW informatiomL hicluding suggestions for reducing this burden. to proposed procurement. L%= acceptance it shall constitute the Deoarwwru or Agriculture. Clauarice Officer. ORM. RoCm contract between the bidder artd the Sponsor maned below. 404-W. WaShkVtort. D.C. 20250: and to the Office of atforatation and Regdatorq Affairs. Office of Management arnd Bud=. Washinotort D.C. 20503. SPONSOR BID OPENING SPONSOR AGREEMENT NLUSER BID ISSLE DATE 89) NUMBER 4/23/96 13567 NAME DATE . Vj 5 / 8,196 I ADDRESS (rtduot City. State. ZiP Code) TIME 0 4 uyck- 3:OOpm P, ( , © LOCATIDN ! L -m -ng5l City of Lubbock 1625 13th Street, Room L-04 Lubbock TX 79401 TELEPHONE NUMBER CONTACT PERSON SPONSOR TO ENTER ESTIMATED N."BER OF MEALS FIXED WIT = . PRICE BIOS TO BE tMRTED BY THE BOOER. Fitted unit sponsors price Bid Estimated TOTALS Per trteat a Of locals CONTRACT DATES COMMENCEMENT I SMA17AST S _._._M X s EXPIRAT .k I ja LU% PEA s 1.7� xW s49,980.00 BD B ERCENTAGE ktOLOWD (Sponsor shall tuert appropriate pAAarceruage tram SZ to 10%) ESTMATED TOTAL s49,980.00 �-•,p PROMPT PAYMENT DGCOUdT fro be irtsericd wi the bidder) for payment within oars PEIiFOMAANCE BOND PERCENTAGE REOUWED (State agency 00 insert awomiate percentage fron 10% to 2S%) BIDDER NAME SGNAT(><;E On Wd Holiday Inn Civic Center ti-tr r-r STREET ADDRESS (trtdude Citr State. Zip Code) NAME Print or Too) Russ Swim 801 Avenue Q WLE Lubbock TX 79401 Director of Catering TELEPHONE NUMBER DATE 1 806-763-1200 5/7/96 CONTRACT NUMBER SGNA NAME DATE FORM FM—ie• tf-941 Previous oftiyns obsolete. Pa" t } CERTIFICATE OF INDEPENDENT PRICE DETERMINATION SECTION B W By submission of this offer, the offeror eerUfles and in the case of a Joint offer, each party thereto certifies as to Its own organization, that In connection with this 'procurement (1) The prices In this offer have been arrived at independently, without consultation, communication or agreement, for the purpose of restricting competition, as to any matter relating to such prices with any other offeror or with. any competitor, (Z) Unless otherwise required by law, the prices which have been gjoted In this offer have not been knowingly disclosed by the offeror and will not knowingly be disclosed by the offeror prior to opening In the case of an advertised procurement, or prior to award In the case of a negotiated procurement, directly or Indirectly to any other offeror or to any competitor, (3) No attempt has been made or will be made by the offeror to Induce any person or firm to submit or not to submit, an offer for the purpose of restricting competition. 0 Each person slgning this offer certifies that (1) He or she is the person in the offeror's organization responsible within that organization for the decision as to the prices being offered herein and that he or she has not participated, and will not participate, In any action contrary to (A) (1) through (A) (3) above; or (Z) He or she Is not the person In the offeror's organization responsible within that organization for the decision as to the prices being offered herein, but that he or she has been authorized In writing to act as agent for the persons responsible for such decision in certifying that such persons have not participated and will not participate, In any action contrary to (A) (1) through (A) (3) above, and as their agent does hereby so certify, - and he or she has not participated, and will not participate, In any action contrary to 41 (1) through (a) (3l. above. SGNATLM Of VE S ALIT IZEO REPRESENTATIVE _ TME. � �r l/t'cj,i- a /� �4T,�/�k PATE 9/7A-Z m accepung tots OTTer, the sponsor eerunes met vie sponsors oTncers, employees or agents nave no: taken any action which may have Jeopardized the Independence of the offer referred to above. (Accepting a bidder's offer does not wi of the eantract.) NOTE Sponsor and Bidder shall execute this Certificate of Independent Price Determination. Page 2 CITY OF LUBBOCK INVITATION TO BID #13567 SUMMER LUNCH PROGRAM ITEM QTY U/M DESCRIPTION UNIT COST EXTENDED COST 1. 29,400 Each Summer Lunch Program meals served (June 3, 1996 to August 9, 1996. served at ten (10) separate Summer Lunch Program sites.) $1.70 each $49,980.00 Prices Quoted F.O.B. Lubbock The undersigned hereby offers to furnish and deliver the articles or services as specified above at the prices and terms there stated and in strict accordance with the specifications and general conditions of bidding, all of which are made a part of this offer. This offer is not subject to withdrawal. Delivery: F • 0 • B • Terms: Net %: _.L Days: 30 Name of Business (Stamp may be used): Holiday Inn Civic Center Address: 801 Avenue Q City: Lubbock State: Tx Zip 79401 DBE Firm: Oman I Black American I Native American Hispanic American Asian Pacft American Other (Specify) By Russ Swim Date 5/8/96 Authorized Representative - please print Business Telephone Number 806-763-1200 Business Fax Number 806-763-2656 All bids must be submitted on this form. 9 r U.S. DEPARTMENT OF AGW-%LTURE — Food and Nutrition Serike•v SUMMER FOOD SERVICE PROGRAM FOR CHILDREN (SFSPC) FOOD SERVICE MANAGEMENT COMPANY APPLICATION FOR REGISTRATION Public reporting burden for this collection of Information Is estimated to awrage 1 hour Par resporee, Indudinp the time for reviewing Instructions, parching existing data sources. fathering and maintaining the data needed, and completing and reviewing th4 collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information. Including suggestions for reducing this burin, to Department of Agriculture, Clearance Officer, OIRM, Room <04—W, Washington, D.C. 20260; and to the office of Information and Ragulatory Affairs, Office of Management and Budget, Washington, D.C. 20607. IIYSTRLCTI0f& Complete an original and two copes of this form (photocoms acceptaNa). The completed application must he sent to the Agency administering the Program in that State. This form is to be typed If pastbla. If henawrittem print deny. Sutxnit the criOW and one copy, retain one copy for your records. This form is to be completed by the Food Serics Management Company applying to register in the State ortwre they will perform as contracted in the Summer Food Service Program for Children CWW. A Food Service Management Company F3M0 must register each food preparation facitity (which will be used in the SFSPD with the Stale it which those meals will be served. Do not register any facilities not involved in preparing SFSPC weals in the State for which you are registering a a Food Service Management Company. In Questions 09 at for data not evailaNs due to your company s previous non -participation in the SFSPC center 'W Participating' in lieu of a Zero entry. If operations will inadude several states. an application must be completed for each State where the FSIC will operate. Approval of this application is rtstricted to the FSMCs operation of the Summer food Service Program. NOTE: The catenary is encouraged to and should mach sWitbU infpmtiation pertaining to any question if they (" the information would fw1her clarify any of their VkSwerS and aSsiST ON Administering Agency it RS atporoval decisiat. 1 - COMPANY IDENTIFICATION 1. C0MPAW LEGAL NAME AND ADDRESS (Street. f ity. State MW 2. CONTACT PERSON ZIP Code) hOLIDAY INN CIVIC CENTER RUSS SWIM — DIRECTOR OF CATERING 801 AVENUE Q DANNY WILLIAMS — GENERAL MANAGER LUBBOCK, TEXAS 79401 ARE YOU A Mttd7RITY OWNED IASMSS EIMMSE4 C3 YES Q 610 TELfPHW NO. AC 806 763-1200 Il - CORPORATE PROFILE 3. IS COMPANY 11CORPORATED? O No O YES air yes. 1;*m month. yar and sine incorporated inn 12/94 MISSOURI 4. LIST OTHER NAMES YOUR COMPANY IS PRESENTLY USNG OR HAS USED N THE PAST TWENTY-FOUR MONTH & NOT APPLICABLE 5. SPECIFY F YOM COMPANY PARTICIPATED N THE SFSPC AND STATE NUNGER OF SUMMER PROGRAM CONTRACTS YOUR COMPANY WAS AWAPZM. WMBER OF CONTRACTS TERMINATED SY SPONSORS FOR CAUSE; AND THE TYPE OF CITATION. F ANY. THE COMPANY RECEIVED FOR HEALTH. SAFETY OR SANITATION VIOLATIONS FROM THE APPROPRIATE AGENCIES N THE PAST T NTY—F MONTHS. PERIOD STATE IN WHICH NO. OF NO. OF CONTRACTS T6IMINATED BY TYPE of CITATION pdsrk 'x') PARTICIPATED CONTRACTS SPONSORISI te) AWARDED FOR CAUSE WRITTEN (a) (b) (c) REPRIMAND FIE SUSPENSION PAST 12 MONTHS PREVIOUS 12 MO NTHiS NONE NONE NONE NONE NONE NONE 6. PLEASE ATTACH A WRITTEN EXPLANATION ANO/OR COPES 7 IS THE COMPANY PROIVONG OR HAS PROVIDED MEAL�TO OF THE CITATIONS FOR EACH AREA CG€CKED A$OVE SO TFE CHID CARE FOCO PROGRAM CCFP)?Zl NO YES THAT THE SPECIFIC NATURE OF ANY NFTIACTION MAY BE Of Yes. Qi a nirne arz. address of C FP Sponsor(s). FAIRLY ASSESSED. NOT APPLICABLE FORM FNS-188 (1-80) PrOVIOUt edltlon obsolete. Paps 1 of 5 No contract may be executed by service Watution s woes the Food Service Masegwnt Company is registered In On State in which fry swats (42 USt. 1761. 111 - PERSONNEL PROFILE B. LtST NAME AND TITLE OF NDIVOLALS FROM THE CQ,.VAW ALITHORZM TO SION CONTRACTS. A. NAME TITLE Q NAME S TITLE Bob Fugazi Regional Vice President E. NAME TITLE E NANE TITLE Danny Williams General Manager = C. NAME TITLE F. NAME TITLE i 9. �� OFF EPOGOR��OSFNCCONTRACTSTTH�GERS.ADVMCTQR OF64AAN HE DLJRAATCN SPWARDEDIS YEAa .Ca ,..,..w..w 0._.., A... � —coon. NAME SOCIAL SECURITY NO. OFRM NOR. OTHER (e.g_ Any hdvidi al with ai MIS) (Position �e ce May teresi inttle a b John Q. Hammons 431-52-3951 Owner General Danny Williams Manager Scott Chapman 479-96-4776 Food 6 Beverage Director Russ Swim 456-35-9558 Director of Catering 10. LIST PERSCrnXS) (or arty reiative W blood or marriage) LGM N SUCH A FNANCAL MEREST MAY NCLUDE. BUT NOT BE SECTION Ill. ITW 9. WIiO PRESEMLY HAVE OR HAVE MD N LLpMITTED TO. STOCK OMZ:SpHtP. LOAM. PROPERTY. OR THEE PAST TWO YEARS A FROC164 FOOD NIG£tvt!?7�fT CCf+APANY OR PROGRAM IN ANY HEONSOR CJ7rviP ORACT R P SZ'ONSC Wttactl�a0dtiaGape(s)ICE M d neces=yJ NAME I MONTWYEAR I COMPANY OR SPONSOR c 11. LIST PERSONS) (or any relatives by blood or mxTtssggee) LISTED N SECTION Ill. REM 9. WHO ARE PRESENTLY SERVNG. OR N THE PAST TWO YEARS HAVE BEEN AN OFF ODVSUL- TANT. PLANT MANAGER, OR -IN A SMlV4R FI TION VYRH NATLME OF FINANCIAL INTEREST ♦tWt FOOD SERVICE MhNAGEIAM CONPANY OR w PP40G AM�{SPONSOR. Wttacn adfdttionat p�9". if nacessarVJ R IXJRAT RSV SF �CQWOUNTS OW4M5 AWAROM NAME MONTWYEAR COMPANY OR SPONSOR NATURE OF FINANCIAL INTEREST A 12. SPECIFY THE TYPE OF CONTRACTS THE COMPANY IS REGtSTERNG TO BD OK U. ftKh a copy of a Arent audited Beima Shoot Finarclat Statement of I* oplyhp Food Sena Management ComPW. Also Include. abmission of ❑ Meals coruractad to be prepared at sponsors sltefal I* arse end mailing address and any oew names finder which arch Food Settee Management Company presently or in tiw past two Hers has ® Meals coruractad to be prepared at Company: ISOM iM merwed Its earrices: as cart of w abmission an aged Schedule must be ❑ BM of the aDaw. ab"sd presatting all long term and short tam IiaDilities fa eactm congry by creditors with e» aWoorWo amount for each. ❑ Dowery of Masts Or*y MUP iluastioru 14 -16). Pope 2 of F A C L I T Y 1 F A C L T Y IV - FACILITIES (Lint the 11011owt,19 Information for each facility applied fora 14A_ FACILITY NAME AND ADDRESS (Street. OtV. C. (It AMTERED AND USEQ LAST YEAR? ❑ Slate and ZIP)-. cix vaw rare and address) YESNO Holiday Inn Civic Center Holiday Inn Civic Center, 801 Ave. Q, Lubbock 801 Avenue Q D. DO 03WANY USE THIS FACILITY FOR MEAL PREPARATIOIN ONLubbock, Texas 79401 A YEAR ROUND BASIS? ® YES ❑ NO S. NAME OF PLANT MAtNAGER(S) Danny Williams, General :Manager Scott Chapman, Food & Beverage Dir Russ Swim, Director of Catering TELEPHONE NO. AC _St - 763-1200 15A. FACILITY NAIVE AM ADDRESS (Street. City. State and ZP) B. NAME OF PLANT MANAGEF(S) 2 I TELEPHONE ,a AC - F 16A. FACILITY NAME AND ADDRESS (Street. Gty. A Sane and ZIP) C L L IS A COPY OF CLGRENT APPLCABLE HEALTH. SAFETY AND SANITATION 'CERT F CA - TON ATTACHED? (INs facility ca lflot be cortivdered for SWOVS without KINChed attached tertificauck) ® YES ❑ NO F. MAXrALr l NO. OF SFSPC MEALS WHICH CAN BE ADEQUATELY PREPARED N A 24 HOUR PERIOD. HOT 0 COLD 1500 C. WAS FACILITY REGISTERED AND USED LAST YEAR? (if m in c=party rare and address) ❑ YES ❑ NO D. DO COWANY USE THIS FACILITY FOR MEAL PREPARATION ON A YEAR ROUND BASES? ❑ YES ❑ NO E. IS A COPY OF CLIFA M F. MAX&ILI l NO. OF SFSPC APPLCABLE W-ALT1f. SAFETY MEALS WHICH CAN BE AND SAMTATIQN CERTFCA- TON ATTACHED? Qhis facility ADEQUATELY PREPARED N carrot be considered for approval without tit%Kftd A 24 HOUR PERM attached anicicatim) O YES ❑ to Hot COLD —' C. wAS FACLITY REGISTERED AND USED LAST YEAR? (If yes. 19 convarty rarne and address) ❑ YES ❑ ND D. DO CCWANY USE THIS FACILITY FOR WEAL PREPARATION ON A YEAR ROUND BASIS? ❑ YES ❑ NO ' B. NAME OF PLANT MaNAGER(S) E. IS A COPY OF CUIRlV4T F. MAXf4" NO. OF SFSPC AM APPLCABLE HEALTIL SAFETY ,qLs wHCH CAN BE Y TOQN'�TACCHED? (Ms fad ly for ADEQUATELY PREPARED N carrot be consid" apprarat without attact" A 24 HOt1R PERIOD. 3 amend certificatim) TELEPHONE Na AC ❑ YES ❑ No HOT COLD V - CERTIFICATION I have been informed that the information supplied will be used in a USDA databant and that deliberate misrepresentation may result in prosecution under applicable state and Federal Statutes. If awarded a contract. the rood service Management Company agrees to operate in accordance with current program regulations and understands that it will not be paid for meals which are delivered to nonapproved sites or for meals which are delivered to approved sites outside of the agreed -upon delivery time or do not meet the meal requirements and meal specifications and food quality standards contained in the sponsor and Food Service Management Company contract. I CERTIFY that the information supplied on tale application is true. complete and correct to the best of my tnowledge. any false statement or misrepresentation may be punishable by law (18 U.L.C. 1001). 17. NAME OF AUTHORIZED FOOD SERVCE 16. TITLE OF AUTHORIZm oFFCtAL 19. SK14ATURE OF AUTHOMNG OFFCIAL NIIWAGENIENT COMPAIW' OFFCtAL 0)nm) AND DATE Holiday Inn Civic Center- Palo 3 of 5 YI - FOR STATE ADMINVERING AGENCY USE ONLY (Do not write or type In this section.) 20A. SPECIFY THE FINAL STATUS OF THE e. APPLIc^.aNT COI+�ANY AT THE CLOSE ❑ Approved, but brminsted by Ada+INsterino Agency during operation of program. OF THE PROGRAML ; 0 Denied. but reversed In a formal hearing or court action. ❑ APPROVED ;C, F EITHER OF TK ABOVE TV40 R ROCCURRED LOCATION OF HEARING HEARING OFFICER GATE ❑ DENIED ; ' ❑ WITHDREW BEFORE AWARDED ANY PROGRAM CONTRACTS. 21. LIST THE NLlvGER OF CONTRACTS 22. LIST THE LARGEST NO OF MEALS 23. LST THE NO. OF CONTRACTS TEF#ANATEO THE C01>PAW WAS AWARDED FREPAREO PER DAY BY COMPANY FOR CAUSE BY SPONSOR N THE SFSPC. Lestrntte) FOR SFSPC N THS STATE. 24. WHAT TYPE OF CfrAT01IS. F ANY. DID THE COvIPANY RECEIVE 25. N WHICH OF THE FOLLOWING AREAS. F ANY. 00 FROv1 THE STATE OR LOCAL HEALTH DEPARTMENT FOR THE COMPANY DEMONSTRATE A PATTERN OF VIOLATIONS HEALTK SAFETY OR SANITATION VIOLATIONS SINCE MAY 1 N EXCESS OF THE ADMINISTERING A O YS LMrrS OF THIS YEAR? OF ACCEPTABLITY SNCE MAY 1 OF THIS YEAR? CITATION MARK Y; NUMBER ❑ LATE OR 1642SLI7 DELIVERIES ❑ SPOf[ED OR INCOMPLETE MEALS ❑ FAIUME TO LWTI2E MEALS ❑ FAIUME TO POST PERFORMANCE BONDS ❑ OTHER ISPed1F] EACH PREPARATION FAQlLrrY WHCH WAS APPROVED ANO ACTUALLY PRODU=CM ALS N THE PROGRAM THIS PAST AR NAME ADDRESS CITY. STATE AND 27P (A) (B) (C) C 27. AO r STERNG AGENCY OFFICIAL �MAGV'S .TELEPttCNE hLIvtBER (kArea,Gude Cone ri. ,C-11,1719/i106 Pop# 4 of 5 I bl. I mu.1 u. navel Ilme Inapec.IIffm l[i P 1 6 t tt•13 1z-18 1 5j I 5 � > 23-2L 28-26 Owner Name - �'�- "� �a'~"`� ' Estsbfthment Name: t Address: r 1 a_ Q rap PURPOSE Food Service Establishment 0 i ix ::::�2 Inspection Report�4, w-u0 2 Complaint 3 InveattgatlOn .. t e1ae0 On an dnsi, Ion tits day, the items circled below identify the tnolmWns in operations or facilities which bust be corecte�by Olhar .......... _ S the Ant rolull"a esllectson or sutyt tartar period of lime as may be soricAea in wriling by If" "Qulalory sUthortty. Failure to comply witfl any time leeris Ior corrections wledied in this notice may insult In OaSwitin of your Foac Sarvice operations. ITEM ITEM NO. WT COI. NO. Wt. COI. FOOD 01 Source: sourvi condition. no spoilage ry W-4y M 02 Original container; properly etbeled I 1 1 31 FOOD PROTECTION .W Potentially hazardous food gums temperature mgurremems p During storage, preparation.spW. service ` 32 104 Factlltles to maintain product temperadse 4 33 08 Thermometers provided andmnaptcuaa 1 34 ce Potentially hazardcus food;popedy thaald 2 3S 10T Unwrapped and potentially hKardous laad not tweetved 4 36 protection during stomps, p ispanrjorL ice, transportation �e¢�� 37 LFood! bling of food (Ice) mltdmbed 1 36 e�e food licel dispensing awsNs property stored >a PEFi OOkNEL ""I'- "'P •11 PersotltW with UIfOOwns reststcted t 40 *U Hands leamw alto clean. goof hygleNc prsuulces S t/ 13 clean clothes. hair restraints t s2 FOOC EQUIPMENT & UTENSILS 14 Food (1=1 Contact allr11801M isignsd. CMBU scud, mnti- taln•0. installed. located 1 43 AS Non-food contain surfaces: designed. Cvatlttctad. main- taln ed. Instal led. located 1 !4 It ()IanwaatUng facilities: deelpssd, constructed.nukreo. Inttattad. located, operated 1 tb tT Accurate thermormalsim, eherlaCat last kn pdyWea. pugs cock l,ti- IFS valvel t 4a ,s Pre•Ilusned, ac+aped. soaked 1 47 is wean, rinse water quail. poster temperature 1 y .20 Sanitiration ran": dean, l mpffatur4. 4onow tralion. act• polure film: equipment. ulwanitbed ls sa 4 4/ 21 wiping Goths: clean. use" okled 1 So 21 Foodtomiact surfaces of equpllNrit ant aenatis clean, free of abrasives. detergents 1 t1 231 Non-food contact Surfaces of equipmene orb utensils Chun 1 22 14 Storage, handling of Mean egsipmeniluoensda 1 53 25 Singte•serwce articles, storage. dlapanarlg 1 fit 29 No reuse tsf single service artitfes 2 SS WATER •27Water source. sate: hot a cant ewer pnrssurs FOLLOW-UP RATINGSCORE7s.77 ACTION a 74I 100 less .tepnt of y Change 78-C tid 2 items ..plaid lb- D r-e O •Crglcai gems Reaumng 1'-r'•edrate •fle•ttlpn Remarks or pack 160•11 FORM KO. C-40 18MID SEWAGE •22 Sewage trot waste water damul ! 57 PLUMBING 21 testatted. maintained , Sa -W oms-couvCtton. bath siphonage. backllow f SS TOILET & HANDWASHING FACILITIES •„ tattfnbef,= vemam. accassibb. designeo. installedM460f'� Toilet raerrs enNcited, s itciakng doom we goodV hair, crnhand dearer, serwry tovveisrO{u"Ihand drying deriCts pravidaa prtlaer visits nlceotacies GAR13AGE & REFUSE DISPOSAL Camainersor rscepraud: es. co.ssadequate number 1 92 &Amiroant ppof, IragttenM dean K Clutsiaa @Mgt area VC10SUMs PMP" constructed. 1 fie dean: paerrolled lncirwation INSECT. RODENT, ANIMAL CONTROL •1t tTe"WIceat inseetaflbd.nta —crier opantngs protected. Fl� ap t1Yds.:nt *$. ode anrnW11 Fi_AORS WALLS I CEILINGS !a oertatruCtad @afrta0. dt><+. good repair. covering,,fGr V tspatim- dustless tlnrtmTa iod4^. Sattached111IL calling, attached equipraert: COnstniCIAd. Sa .apart. surface!, austim cleaning methods LIGHTING ' 3t' tigitting Provided as Mulled. fixtures shielded I 1 67 VENTILATION >t ttboms acid equipment — vemsd as required t fie DRESSING ROOMS 40 1 Room$ C *n, IockersprolndeRfacilitiea clean. IOCateO 1 69 OTHER OPERATIONS •41 TO= hares property Stared. tabeleo. used t 7C Pormises maintained tee of litter. unnecessary articles. 42 caeaningfnalntenanceegtnttment properly stored. Author- t T1 tad personnel 43 tomptetesewratwn Iran Ihingrsleeping owners. Laundry. 72 44 Clean. soled linen property llorsd Received far tarn � V Moe Inspected by: ham - i+ra.w. +w1♦ti yy ... 17. PROOUCKA THIS CERTIFICATE is ISSUED AS ANATTER OF INFORMATION O AND CONFERS NO R101ITS UPON THECERTIFiCATE HOLDER. THIS CERTIFICATE DOES NOT AMUND. EXTEND OR ALTER TIME COVERAGEArMROED BY TI IE POLICIES BELOW. SEDGWICK JAMES OF TN, INC. - 1000 RIDGEWAY LOOP ROAD COMPANIES AFFORDING COVERAGE MEMPHIS, TN 33120 coluPA>nr " PHONE:(901j 781-1550 A AMERICAN 110TORISTS INSURANCE COMPANY INSURED COMPANY B WESTCHESTER FIRE INSURANCE COMPANY John Q. Hemmons Hotels, Inc. COMPANY 300 John Q. Hammons Parkway C Springfield, MO 65806 coMPArir"' D COMPANY INDICATED. NOTYYITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT VM RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES B£SCRIBED HEREIN IS SUWECT TO ALL THE r9RMS; EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LNXTS SHOM MAY HAVE BEER REDUCED BY PAID CLAIMS POUCYEffCG1W! PoMexPmAr TYPE OF INF{ WJW.E POLICY NUbMCR__... _ oATPIr uDOn+rl DATI MV00W1') LIMITS; GFNIMLLIMUTY QWMAGGREGATE ! 8,000,000 X COMMERCIALGENEIMUAanmr 6YM978164 lio/1195 1011/98 Cfi=T340W 0r3ACG. $ 1.000.000 1CW n MADE u OCCUA. OWNERS L CONTACTORS PRO F. X LIQUOR LIAEII m AUTOt10QI i UAiLrri » . A X ANYAum 6ZM978164 ALL OWNED 9=0 ACHEOULEOAUTOS X IaRCDAV= X NON.ovv mo AUTos QAwoe VAIIR.RY EXCLes U"UTY �WaflELLAFORM - CUA1022120 I OTI ER TI ION UMDRCU.A FO1u1 WORIKEWScOMrLNMTION GCM978154 AND PWONAL t AM.IPMRY ! EJICH OCCURRENCE ! Im LumAox- WW one WS)! MInEXPEN9 one Owson ! CoaftD tSbVOUE LUT ..___... i IMY OIAIRY $ (Pwwzm) QOKY R7mY 11 ftAoddwe P1113PERTY DAMAGE is EACH OCCURRENCE AIDWEOATE k WC STATUTORY LIMITS ELlACHACCIOENt ! 6C fF.aa!ABR aol.ecY l 1= Is SC CRFPTION OF OPEMTIOW COAnON$"MICUSIREbTA1CTI UWPCCUIL ITM RE: Holiday Inn Civic Center, 801 Annue 0, Lubbock, TX 79401 The City of Lubbock 910 Tom Avenue Lubbock, TX 79467 1,000t000 IIHOULD ANY OF Thg A110UE OESCIU13ED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYJ! WRITTEN NOTICE TO THE CER m.A iC ; iOLtXR NAM110 TO THE LEFT. BUT FA1LIAS TO MAIL VJCM NOT48 OSE NO OBLIGATIO,0811 LIABILITY OF ANY KIND {1rON TH MP IT$ Af3RN rUR AlWfESEV'TAMVES, AUTNOIlagn REPREAEMIM -JAL -o4 � r SUDG40- 5/01/96 / v 80706 LUBBOCK 293 PROFIT 8 LOSS RECAP ------------- CURRENT PERIOD ------------------------- PRIOR YEAR --- FORECAST X ACTUAL X VAR. z ACTUAL X DESCRIPTION 8,204 8,204 0 .0 8,204 ROOMS AVAILABLE 39.22 36.15 3.07- 7.8 35.76 RM. REV. PAR 5,534 5,048 486- 8.8 4,838 ROOMS OCCUPIED 58.15 5a.75 .60 1.0 60.64 AVERAGE RATE 47.5 41.5 6.0- 8.9 59.0 OCC. PERCENT 464,208 439,597 24,503- 5.3 416,200 CROSS REVENUES ROOMS DEPT 322,800 100.0 296,579 100.0 25,221- 7.8 293,376 100.6 ROOMS REV 52,200 16.2 49,526 16.7 2,674 6.1 47,442 16.2 LABOR COST 21,690 6.7 29,352 4.5 2,248 10.4 21,875 7.5 OTHER 73,800 68,87a 4,922 6.7 69,317 TOTAL EXP. 1,400 5,093 3,693 263.8 477 OTHER INCOME 249#404 77.5 232,794 78.5 16,686- 6.7 224,936 76.5. DEPT. PROF TdLE►U:O:" WT. 22,000 166.i 11,070 100.0 930- 7.8 9,892 200.0 REVENUE 6,200 51.7 4,255 38.4 1,945 31.4 6,182 62.5 COST 5,880 48.3 6,415 61.6 11015 17.5 3,710 37.5 DEPT. PROF FOOD DEPT. 97,100 100.0 97,878 100.0 778 .8 85,687 100.8 FOOD REV 30,600 31.5 31,634 32.3 1,034- 3.4 25,990 30.3 FOOD COST 28,900 29.8 26,223 28.8 677 2.3' 26,498 30.9 LABOR COST 9,800 20.2 7,217 7.4 2,683 26.4 6,169 7.2 OTHER 49,300 67,074 2,226 3.2 68,657 TOTAL EXP. 13,300 9,189 4,191- 31.5 9,094 OTHER INCOME 41,108 42.3 39013 40.8 1,107- 2.9 34,124 42.2 DEPT. PROF BAR DEPT. 18,i0f 100.0 190844 100.8 1,X68 7.4 170614 104.6 "we AAV8NU8. 4,400 23.8 4,616 23.2 216- 4.9 305" 20.3 REV. COST 2,880 16.1 2,92 10.5 708 25.3 '8,006 21.4 LABOR C0ST 30e .8 :56 2.8 456-, 436.0 930 5.3 ENTER. COST 1,480 7.6 2,049 10.3 649- 46.4 1,490 8.4 OTHER 8,700 9,313 •613- 7.0 8,014 TOTAL EXP. 9,809 MI 10,555 $3.1 756 7.7 9,660 64.7 DEPT. PROF $S,999 44.0 a8,468 48.9 438- .8 48,764 440E Fab P"WIT 3fi,10e K.0 290,077 66.0 16,023- 5.2 274#038 i5.8 GROU OP. INC. GEM. 8 UNAPPRO. 42,600 9.2 40,779 9.3 1,821 4.3 45,937 12.0 ADM. 8 Cu. 12,900 2.8 11,863 2.7 1,037 6.0 11,735 2.8 FRANCH. FEE 13,900 3.9 13,367 3.0 633 3.4 12,590 3.0 IM MCMT. 28,300 6.1 19,320 4.4 8,980 31.7 29,029 7.0 MARKETING 20,200 4.4 27,921 4.1 2,279 11.3 17,834 4.3 H - L - P 10,400 2.2 10,142 2.3 258 2.6 12,189 2.9 09" LABOR 13,180 2.8 10,732 2.4 2,368 28.1 13,942 3.3 RIM OTHER 2,500 .6 0 .0 2,500 100.0 2,221 .5 RU:N PROJECTS 143,900 31.0 124,124 28.2 19,776 13.7 146,477 35.0 TOTAL GSU 162#200 34.9 166,953 37.8 3,753 2.3 128,553 30.9 HOUSE PROFIT 940 936 36 4.4 1,32E NON -OPEN INCOME 163,100 3i.1 1K,889 38.0 3,789 2.3 229,879 31.2 GM. OPEN PROF 22,280 4.4 22,683 5.2 483- 2.2 19,762 4.7 TAX/INSUR/OTNER 140,909 38.4 144,206 32.8 3,30E 2.3 110,127 26.5 PROFIT M RID 600 .1 428 .1 28- 4.7• 693 .2 RENT 60,100 12.9 59,686 13.6 514 .9 60,077 14.4 INTEREST 37,509 8.2 43,324 9.9 50824- lb.b 42,933 10.3 DEPREC 8 AMORT. 98,200 21.2 103,b38 Z3.6 5,338- b.4 103,703 24.9 TTL. R,IiD 42,789 9.2 40'4" 9.3 2,032- 4.8 6,424 1.5 NET 84 TAXES r� FOR 4 MONTH PERIOD ENDED 4/26/96 21t55t58 5: ------------ CURRENT YEAR -TO -DATE --------------------PRIOR Y-T-D FORECAST X ACTUAL X VAR. X ACTUAL Z 34,867 340923 56 .2 34,667 $4.90 31.83 3.07- 8.8 31.76 21,114 29,526 19588- 7.5 18,932 57.44 56.93 .n- 1.2 56.49 60.6 55.9 4.7- 7.8 54.3 287530888 1,572{806 16a,994- 9.3 1,578,688 10217,000 108.0 1,111,629 100.0 105,471- 8.7 1,107,374 108.9 209,000 17.2 205,369 18.5. 30631 1.7 168,905 17.1 890500 7.4 76,020 6.4 13,472 15.1 91,662 8.3 298,590 281,397 17,103 5.7 280,567 51100 7,727 2,617 51.3 2,298 923,600 75.9 837,849 75.4 85,751- 9.3 029,10i 74.9 45,900 140.0 420029 100.0 3,871- 8.4 3919" M .$ 23,900 52.1 18,405 43.8 5,495 23.9 25,546 63.9 Z2,000 47.9 23,624 56.2 1,424 7.4 14,453 36.1 351,380 100.E 30506" 180.0 45a"S- 13.8 319,725 1ee.0 111,300 31.7 100,328 33.0 10,492 9.4 9&,529 38.8 221*200 34.5 116,265 33.0 4,935 4.1 107,838 33.7 33,600 9.6 231565 7.7 10,035 29.9 38,08E 11.9 266,100 24006" 25,452 9.6 244,45.1 47,400 38,506 8,894- 18.8 41,90` 132,640 37.7 163,513 53.9, 29,087- 22.9 117,16; 36.6 61,140 108.E 61,270 248.0 278 .4 67,3Re 1f8.e 16,000 23.8 15,660 Z3.R 940 2.1 25 0347 =8 .6 1A'AB00 17.1 9,924 24.7 1,576 13.7 9,160 23.6 440 .6 766 1.0 306- 76.5 2,443 3.6 6,500 9.7 7,155 19.6 66b- 29.1 7,Z88 10.0 34,400 33,44b 955 2.8 54,239 32,760 48.7 33,9zs 50.4 1,226 3.7 33,082 49.1 168,tee &tell 3&7,4&8 46.4 2708", 96.9 1840847 iee8 11ue8900 ".I 998,911 63.E 1u,989- 20.2 993,885 63.e 1K,388 9.6 158,164 ig.I 8,136 4.9 163,a57 11.4 48,700 2.9 44,462 2.8 4,239 8.7 44,295 2.0 $2,000 3.6 47,92b 3.0 4,075 7.8 48,860 3.8 115,300 6.7 951961 4.1 190339 16.8 118,49a 7.5 78,500 4.6 75,691 4b.6 20809 3.6 690323 4.4 44,200 2.5 41,435 2.6 2,K5 6.4 45,665 2.9 48,700 .2.8 350640 2.3 13,060 26.6 47,364 3.9 19,800 1.1 14,623 .9 b,177 26.1 80882 .6 .. $730400 $3.1 513,90e 32.7 59,510 10.4 545,839 34.6 537,580 31.6. 485*011 3f.8 62,469- 9.6 447,966 28.4 &,fife 9,484 196- 5.4 4,658 542,100 31.2 488,41E 31.1 52,685- 9.7 452,616 26.7 85,888 4.9 1110688 7.1 25,888- 38.2 113,398 7.2 455,148 26.3 $76#727 24.f 78,573- 17.3 339,22E 91.5 2,789 .2 2,706 .2 6- .2 2,964 .2 255,400 14.7 253,240 16.1 2,140 .8 255,327 16.2 149,700 8.6 1730295 11.0 23,595- 15.8 175,901 11.1 407,800 23.6 429,241 27.3 21,441- 5.3 433,292 •27.4 47,500 2.7 52,514- 3.3 100,014- 210.6 94,eK- 6.0 Ml1N►- 159-22129123- 3/01/94 706 Ll10BOPJc 293 PATE 1 P 6 L DETAIL Rfi'aiT APR 26/ IW6 LINE C U R R E N 1 P E R 1 09 ----------a YEAR- T 0 - D A T E T1 W MIODS ACCOLKF KURT KI Wk ACIUAL 1C1 O/R UARIANCE PRIOR YEAR kKQT KI Wk ACTUAL KI OM UARIAICE PRIOR YEAR ACTUAL PCT WR OHMS REV NW GOLLAR9 REV 40V DOLLARS ACTUAL MLAW REV 4w WIMS REV I= MIA M ACTUAL OOWUisC REV /M ROOItB AVAIL. 8201 am 8204 34867 34"? 34"? RWMB OCC. 5534 5040 4038 21114 19526 10932 61805 AU9. RATE 58.15 58.73 60.44 57.64 56.93 50.49 56.63 OLE, PCT. 67.5 61.3 59.0 60-6 56.0 54.3 1D. 61ESIG 503 5191 22221 21027 71315 10 RM REV 14010 GUE&L.Rm 3219M 1W.0 50.15 2Nw062 100.9 59.24 22736- 296733 121NO 100.0 57.64 1121336 1004 57.43 . 956N- III= U41467 140.6 59.02 14020 SAWEST-M N 0 0 .0 .00 630- 42- 112- 630- 64 0 .0 400 3572- .3- .18- 3572- 723- 5M1- -2- .09- 14030 96- 0 .0 .00 1853- .6- .31- . IS=- %441- a .0 .00 5123- ..i- .26- 5123- 07r.�- 15976- .4- .26- 14OW ROOK RMAAMS 0 .0 .000 0 .0 .00 0 0 0 .0 .00 1112- .1- .06- 1112- 0 1928- J- .03- 10 ROOUB SW 3218M 100.0 58.13 296379 100.0 58.75 25221- 293376 i2lMG 100.0 5144 1111=0 100.0 56.93 105471- 1107374 362M 100.0 50.63 12 LAIIM COLT 16015 FM DESK 145N 4.5 2.62 13115 4.6 2.12 M IW32 W300 4.9 2.91 56G97 5.1 2.91 2443 53035 100026 6.0 2.93 16020 MID 23M 1*2 4.21 22044 7.4 4.31 1254 19727 919N 7.3 4.35 06801 7.8 4.45 49" 82163 04461 1.6 4/44 16= MAKE 2300 .1 .42 2463 .e .49 163- 0091 "N .e� 644 loos 1f .84 680- 9413 27933 .8 .43 16M 8IL7i/UAC.A M LI 90o al 116 w. .0 .W 1434 600 33" .3 .16 47W .4 .24 1480- 4831 15516 .4 .23 "M PA"" TA198 5200 t.5 /.46 1319 2.6 1.50 621 8213 32M 2.1 1.56 317" 2.9 1-63 1134 31927 796U 2.6 1.61 16M DFUM KW1 3000 19 154 3046, 1.3 .76 a". 5 11900 1.0 .56 `/ 14645 1.3 .73 2145- SM 41021 1.1 .66 16M E1I waE MU 0 .0 .00 0 .0 .00 0 0 . 0 .0 .00 0 .0 .00 0 91 0 .0 .00 12 Lam COST 52200 16.2 9.43 47321 16.7 9.81 2613 41442 209400 11.2 9.90 2OW 18.5 l0.52 3631 ISM 439449 11.6 10.35 15 MM 161000" "0040 0 .0 .00 0 .0 .00 0 0 0 .0 .00 694 .1 .04 694- 0 6" .0 .01 16103 ROOMS "AM-OTH 15N .5 .21 IM .6 ' .37 389- 1234 6W .5 .30 1726 .7 •.40 1326- 6551 22259 .6 .36 • 16150 CONTRACT OEM 500 .2 .09 453 .2 .09 47 970 2300 .2 .11 1045 at .OS 1253 1901 4981 .1 .O8 16200 MKOW 6TEPU 600 .2 111 561 .2 .1l 39 940 2UG 12 .11 1141 41 .06 9159 2084 5w .2 .09 U= CM -Tm AGM 6900 2.1 1.25 5347 1.9 1.10 139 69A3 26M 2.2 1.23 19309 1.7 .99 6"1 23999 68988 1*9 1.12 U370 tGUIP1sF317 MOA 200 .1 .04 153 .l .03 45 144 WO .I M 8a7 of .OS 13 62S 2079 at .03 36M O=1 t1MIu 3900 1*2 .10 3755 1.3 .74 143 4062 14OW 1.2 .70 132U 1.2 .68 1567 I= 40388 1.1 .65 1"25 PAY W 60 FEE 1300 /4 .23 13111 .4 .26 10- 1304 5200 .4 .25 5212 .5 .2l 72- 5214 15704 .4 .23 16450 LADY 400 .2 oil 490 .2 .10 102 14 2300 .2 .11 1503 .l .48 79l 1523 6422 .2 #10 I" LDD - 0 .0 .00 631 .2 .13 631- am 6 4 .5 .0 7322 .7 .78 Gib- 19721 am .6 .36 WOO PRllil 6 STATION 900 .3 .16 663 .3 .17 33 600 3000 .3 #IS 3=8 .! '.13 1243 3164 10907 .3 /18 16650 RMM RMDML so 02 .09 455 .2 .09 43 $14 2140 .2 .l0 1964 .2 .10 114 574 1979 .2 .13 16700 WNWATUN IV 3000 19 454 2673 1.0 .51 121 2767 12000 1.0 .57 114112 1.0 .59 518 11032 33923 .9 .55 SAM 116aaa OUARA 104 10 .02 0 .0 $00 100 329 400 .0 .02 0 i0 .00 400 dal $49 .o 001 16800 WW O NO .2 .14 13 .0 .00 787 720 2000 .2 -09 173 .0 .01 11127 6409 199 .1 .03 I6005 4LSIC twM 100 .0 .02 44 .0 001 56 132 400 .0 .02 116 .0 .O1 224 264 440 .0 .Oi 16850 LWIPlM Fuxw 700 .2 .13 296 .1 .06 404 354 1800 .1 .09 1372 of .01 428 2110 U71 .1 .06 16M INISCMIAWM 0 .0 .00 0 .0 .00 0 0 0 .0 moo Be .0 .00 BG- 0 132 .0 .00 15 OTTER 21400 W 3.90 19333 6.5 3.83 2247 21273 89500 7.4 4.24 76021 6.8 3.69 13473 916q 250223 6.9 4.03 18 OTTER IN ME 41023 PAY T V ROD" 1700 .0 .31 4292 .0 .85 2592 917 6500 .0 .31 7939 .0 .41 1459 5141 10910 .0 .31 r 9609 soft 916111 Ma 9m 06e1 !•tt nm OL-t ►06 MITT w69 -MI t[0t' Sot 9st1 9901 t06 0006 min orm S20! ►►-9 60.9 81,e9 foot 002 6•St Iltlsl sm OM Mot t-!t OMt trot 1,111 OOu► MIT Zoof OS-t 6121 cm..1 011I 6111 W911 TWAT 111 Ot0►Z • AXOMA It [LOOT -faz; AtOf 0"1 -etBE I►t UK mlld3m 1312" ►S199 volt 1901 19Z6 toll Loot Mot M MA 13ne wo 11121 -601 Sm tics -6t u►I 101 UNIT 131209 ►►eo► O09t 5999 S901 6m ► it =I Itmn 1311M9 6LLL _Mt 910E am -M 106 SB6 19tl 00" m 0 0 1 COI 336-ODOR ►m -!E to OR -9E ►Zi m t SDI 330OQN 6-t Im -609 ►-L MI 0• mot -off coo m 00 Oft 311mm wx Md Se► I= -sec toll M 0• Wit -10I [It 1AT O0 SaZ WIN= ww IM COLT KMI Z! 4e91 Mt 00 am Zia O'LII" 0e SOL HMO 9801I m ms Cott -iti ►00I slit K1f11 0•►t Itt►c -of tott M 00 Ostt 61 COLT M6l 0• SEAT 1SMAYM M11140l'.M' w OMA 06• 00 96109 lISSC 102 t60 0- "MT till 00 00642 to" 1+6I ►B- 00 m tlot 0- am 196 tL tie o- IL" am 6St tie Do 111 • ►I• O• am a? -111 all 0- 116 tie o0 ON smi 3049M Tom 600 0- ► " tm too too 00 too 006 00 Cott "I -uT 0o0 00 m Sol 0• on 40 9 d3s 3M OM oo• 00 0 0 00► ace 00 0 no 60 Cot 0 001 0M0• 06 0 too 00 001 V3 313t-111VM OaLSt ` too 00 LSEt ut Sc too 00 at t0• 00 oft SSl S COO 00 M too 00 001 153 3101id P&MV I= t9• 00 tiff► 64LOc 9M at, a• Kett to • 00' oocsl" 9f!► Ltot SSo 00 "12 too 0e oo8t am tsTo mn CSOSt too 0' ► I'S 68 -912 to- 01 !It 100 0- act at cc • 100 00 -So too 00 OOt Blow M O►OV -10• at -tit in 0 000 00 a 400 04 a 0 a No 00 0 Co. 0• 0 sm •MJtTI or= IS03 tc Alec 00 S"SIt 666K -list SIOc o0 6Eot/ IV& 0• OM' tb86 _MA 611a 00 01011 ties 0e 00091 3 "311 it too 09 am fit -fit too 0e 6" too 00 009 u -91t to- 00 is roe 0- on 3rm3m xvi o►Ott -El- 00 -Liu • -CO►I -at -010 o0 -ZtOZ -601 0• -0061 -Tit .22 -11e 0e -M -we of -OOS 1stamal-aam am Isot 00 LM6 mit -let► 04 0- tto" st-f 00 oo►T! 10% -Rif o►•t 0e teat LSO? 0- 0010 sm 31A1td3T31 KM N• 00 am sm Ckv S►- o- am St- 00 COOL 106 616 IS- 00 61.02 He oe Mai 11M 30idm ato►t 00• 0- 0 S 0 coo 00 0 00e 00 0 0 0 000 0e 0 000 co 0 74311 93101 glow as o- um UK -Lit ace 0- I= 1t0 00 00" MY -6[l It, 00 MI it, O0 COLT 031M 3iQid3T3t al"t 3C'MM It tc• 00 V0021 "a 919E "0 00 BILL tZ• 00 oats lit UK loot o0 C609 SL• 00 00►t 34M MHID 0f -too 0- -cm -/111 _M -100 00 -MI -too 0e -00CI -lot -961 -01- 00 -96t -s0- 00 -OOT A11O M1 lu m Mac -Ito 0• -191tt -M 6Su -?To 00 -lttt -n- 00 -OOts -MI ►1B -01- 0• -9Ls -CZ' 0- -001 39aw A 1 AM sm to. 00 MI sit TLC COO Of tit 100 0o OOT oft Ott ' t0- 0' Ou too 0- cot 9 031N1WIN 0600 Ile 0e WA SIDE -MIT 600 o- out it* 00 009.,E m lot at, Qe loot 910 00 006 3MIFt M 11179M CSO►► Boo 0- GOD 6S%I S9t 010 00 9981 to• 0• OKI Tit ZOE tie ae Z09 too o• 00► WWI dw am M" A03/ • AN SWTM IMMY BbVm Aw m S!!l►TIN Awl A39 S`JVIl0i1 1VM?) MVX MY A.IN BaVM M.V AM ihNTM a/D 13d ltl ux MR WIN 33Mm am IN MN Vm 131 13311M 1MV WIN 33MIVM IM im luntiv 8/0 IN 1390119 t1f'=V Boom M1311- 9 t M O- 0 1- 11 r 9 A n 0 1 a 3 d t 11 1 s 1 11:% ------ • 3 II ---------- 1661 19c so 1Wcm MV1.3I 1 ? d t 3m t6Z R3Ceffi11 "I !A/10/S-tt161112-091 -411" OYR110- 161-22129123- 5✓01/96 706 Ltl91NOCIL 293 PAGE 3 P 6 L DETAIL REPORT AM 26 1996 LINE O U k R E N T PER I OP Y E A R- T 0- D A T E -----onatE PERIODS ACCOIN I6mT KI U/R A1:IUAL PCT 04 VARIANCE FRIOR YEAR War PCT WR ACTUAL FCT WR UARIANCE PRIOR YEAR ACTUAL. PC[ WR DOILAR9 Ts.V fCW ICLIARS REV /COV POLL" ACTUAL 0OUTARS KV /COV DOLLARS REV /COV DOLLARS ACTUAL DOLLARS REV AW 24030 DINNER 7100 76J 1.28 V443 9.6 1.87 2345 6064 3?`i40 9s3 1.54 3W1 12.3 1.92 5073 29406 109996 11.5 1s70 9.04 9.47 9.13 9.96 8.90 24045 ROM SERVICE A. 2100 2.2 @30 Jul 1.6 .31. 511- 2029 0200 2.3 s39 7991 2s6 .41 203- 7" 25571 2*7 .41 1.12 042 7.22 0.30 7.94 240" ROOT tERVICE P. S200 S.4 .94 4119 4s3 .83 1021- 400 20000 S.9 .99 20M 6s8 1.01 126 19758 647H 6.0 loco 11.30 12.90 11.21 12071 11.56 24M IMACH 3000 Sol .S4 3116 3s2 42 116 0 3000 .9 .14 3116 1.0 .14 116 0 3116 .3 .0S 12.0/y0. 13.91 12.0.�0/. 13.91 1309/�1 24"a F" DININO 0 .0 ..M 0 s0 .00 0 0 0 .0 .00 0 s0 .00 0 14 S752 .6 sof 000 too too 000 12,10 24070 IA AV tiiWA 7400 196 1651 6173 6s9 1.52 627- 5617 24M 6.9 742 14M 4*8 7.31 9569- low 3W 4s2 5@48 24411 IALM LLUM 15500 1 #9 So* 27218 21.4 6.33 11719 14702 60M 1761 9.49 60111 1909 1.01 77l 38781 lmoo 18.7 4.36 24072 LV O V DINMW 16900 19.5 12.68 15311 13.9 10@50 3323- 192T9 66200 16.0 12.46 39095 12.8 10.19 21105- 65865 150M 15.9 12,02 24013 iANGLET IOFFEE 5700 Sol 3s00 6120 64 2.04 420 501 27800 7.9 3.00 22697 7.4 2.00 5103- 2381T• 5766S 6.1 2.20 24014 IARGLET RECFPU I0800 Hot 3.51 2564 24 10664 0236- 6994 25" 7.1 3.53 8123 2.1 4.33 16872- 15139 42=1 4.4 4o23 24075 URGE FOOD No .0 1483 W do 541 am .9 6"? 8.3 3697 2124 13700 1.4 34M LTAORBiLOWWWM 0 s0 L23- .1- 123- 286- 0 .0 945- .3- 945- "4- 2834- s3- 37 fIIOD REV 97100 t00.0 .00 91079 100.0 .00 779 85681 351300 to0.0 .00 305M 100.0 .00 45646- 319715 952426 100.0 .00 TOT "a FOOD ' 7N 60.0 6.28 am 59.5 5.96 48- 32063 201300 57.9 6.36 145M 47.6 5.24 '57870- 182143 46MI 49.2 4.84 29 FOOD COST 2420 COST FLOP COLA 30M 31.5 5.5! •31M 22.3 6.21 104- 259" 1113N 31.7 5.27 100818 33.0 Sots 10401 9IS29 314260 33oO 5s08 r 29 FUM COST 30M 31.5 5.53 31634 32.3 6.27 1034- 25990 HIM 31.1 5.21 WNW 33.0 Sets 10482 98529 314260 33s0 5.00 _ 30 rLAM COST � • 26015 KITCIEN 12M 13.2 2.31 12630 12.9 2.50 170 11893 53M 15.3 2.55 50411 16.5 MY 3323 4W87 160M 16.9 2.60 24= FOOD :FWI8I0 5000 Sol .90 43M 4s4 s86 668 4881 20M S.9 .99 18422 6.0 .94 2478 W= 40598 6.4 .90 26029 6MICEB 2400 2.5 .0 23" 2s4 .49 2 2721 10200 2.9 .41 8915 2.9 .46 1223 0844 27011 2.8 944 26028 IANGIFt 12M 13.3 2.33 13267 13.6 2.63 367- 12293 4000 13,3 2.21 38211 1205 1096 OW 423W6 123454 13.0 Zoo 260V IAi M SERVICE 12200- 124- 2.20- 13639- 13.9- 2470- 1439 t1631- 43400- 12.4- 2.06- 38434- 12.6- 1.97- 4910- 43671- 105249- list- 1.70- 26030 RO1I1 SERVICE SE 1000 tsb .t$ 756 .8 .15 242 I45 4200 ls2 .20 4093 I.3 .21 l07 4040 13011 1.4 .21 26031 ROOM SERVICE 1E 1100- W- .20- 864- .9- X- 236- 1073- 4300- l.2- s20- 4121- 1.3- s21- 179- 4322- 12276- I.3- .20- 26035 TRAINING 0 .0 too 0 .0 000 0 0 0 .0 .00 0 .0 .00 0 200 0 .0 .00 26045 SUXt We 6 NO 100 .t .02 181 .2 .04 87- "1 80o .2 .04 4104 I.3 .21 mww =2 low lot .17 2AM PAYROLL TAXES 6200 6.4 1.12 SN66 Ss9 1.14 434 6142 24W 7.0 1617 22251 1.3 1.14 U47 23690 69731 7.3 1.13 26W 9 P MOM [800 l.9 .33 3361 3.5 s67 1587- 244- 1700 2.2 o36 12214 4sO .63 4514- 4451 29076 3.1 041 30 NAM C06T 28900 29.8 5.22 20222 28.8 5sS9 678 26490 U1200 34s5 5.74 116264 38.0 5.95 4936 101830 316711 31.6 solo 32 Or= 26100 $=a PAONOI-LED 1200 1.2 .22 0 .0 s00 1200 t66 2400 .7 all, 388 .1 .02 2032 K3 434 .5 .07 26105 A£ST. F&OW-ON 1000 too .t0 S46 06 Sit 434 233 280o .8 $13 2915 1.0 .15 115- 1512 9539 1.0 .15 26150 D1 SiAtitANf SUPP 1100 lot .20 970 1.0 .19 130 1269 4400 1.3 s21 3201 1.1 .11 1113 5230 11641 1,2 .19 26160 0UNkiLASS-SiL 0 .0 .00 2327 2.6 .50 2527- 1021 55W 1.6 s26 6024 2.0 .31 524- 5L57 11750 1s9 .29 2440 CLEARING SUFPLI 300 .3 $05 349 .4 .01 49- 451 1100 .3 .05 574 .2 .03 526 1051 2124 02 003 GF2110- 162-22129123- 5/01/94 706 LUBi" 293 PAGE 4 P i l DETAIL REPORT AR 26t 1996 LINE ■------------ CURREN I PERIOP YEAR - T 0 - D A T E -----------+NMQE "MIME ACCmw lU "T KT 0/A ACHiAI K? WR YARIMM PRIOR YEAR K9,GEV FCT WR ACTUAL PCT 0.2 VARIMM PRIM YEAR ACTUAL PCT " TI LARS REV /CW ULLAk8 60 /CW DOLLARS ACTUAL t41i-va REV /CW DOLLARS W AW R X ARG ACTUAL OIELARS REV 4w 26260 CONTRACT CLEAR 400 .4 401 412 .4 .06 12- W4 1700 05 ace 147A .5 .07 * 274 20ZI 4"1. 05 .00 26M EDUIPNENT RWA 200 .2 .04 158 .2 .03 42 138 6w .2 .03 332 .1 002 260 352 5172 .6 .09 26500 LIM31 2500 2.6 .45 0 .0 .00- 25N 590 4500 1.3 -21 2"1 • .7 sit 2439 6665 5745 .6 .09 26.i40 MENU i WERAM 200 .2 -04 43 -0 '01 151 256 ISO .4 .07 low .3 .05 442 1595 6500 .7 .t1 26"0 PAPER 6UPKIES 700 .7 -13 9" 1.0 .19 246- 524 2900 .B .14 26M a9 013 270 2761 12456 1.3 .20 2=0 WIFWM 300 .3 005 110 .1 .02 190 71 1900 a5 .09 99B 03 .05 902 7312 2644 .3 .04 26860 EaIU"M PURW 700 .7 013 235 .2 .05 465 Am 2700 .8 .13 902 .3 .05 1T" 2694 5824 .6 009 26870 KISCELLANMO 1200 1.2 .22 v .9 .18 260 249 1400 .5 006 9" 03 005 610 1070 16" .2 .03 33 OTHM 9000 10.1 1.77 7216 T.4 1.43 2584 4169 33600 9.6 1.59 23+65 7.7 1.21 10035 38085 91041 9.6 1041 46M KTG RN RW/WT 11600 11.9 2.10 7609 7.8 1.51 3991- 9113 40000 11.4 1.69 =I 9.9 1.0 449- 37005 63959 9.0 ISM 46085 UWARSMUCE6S- 0 .0 .00 W- .i- .12- 619- 636- 0 .0 .00 994- -3- .05- 994- 1419w- 4242- .1- .10- 46M EQUIPT I= QEV 2900 3.0 .52 3295 3.4 .63 393 2625 13600 3.8 .64 16240 5.3 .83 2748 12125 33793 3.5 055 47040 KISCELLA1ERU5 400- .4- SO?- E2B- .8- .16- 428- 161S- 23W- -I- all- 1940- .6- .10- 360 2067- 12043- 1.3- .19- 41050 EOUWT Wsf f EXP NO- .6- .14- 342- .4- .01- 452 393- 3800- let- a1B- 51W- IJ- .26- 13W 4742- 8995- .9- .15- 34 QIHM tic" 13M 13.1 2.40 9109 9.3 1.&0 4191- 9094 474W 13.5- 2.24 3=1 12.6 1.97 8693- 41902 90472 9.5 1.46 36 IEV. RE1E?iJF Y 23010 LIU=-LOAM 0 .0 000 0 .0 000 0 15233 0 .0 .00 0 .0 000. 0 50119 92211 50.2 1.49 25015 LIQL=-iEGTAURA 0 .0 000 0 .0 100 0 1670 " 0 .0 000 0 .0 000 0 7408 15439 8.4 .25 ' 25020 LI9UM-&QMJEi 0 .0 000 0 .0 .00 0 3582 0 .0 000 41- .1- .00 41- 20`.+00 2M6 14.4 .43 25040 FRMTB LIO TA 3000- 16.2- .54- 32A- 16.3- .64- 238- 2rA- 149W 16.2- 052- 10988- 16.3- oW W 10918- 29601- W l- 048- 25041, k£CTAU Wi-LI(Y! 00 4.3 a14 562 2.11 all 238- 0 3AW 5.4 o11 2120 4.2 ill 1472- 0 2W Io2 003 25M SMAULW-KER NO 4.3 •14 SPI 3.O .12 203- 0 36M 5.4 .11 30S1 4.0 •16 548- 0 3m I.7 .00 am KSIAMAK-914 NO lot 004 677 3.4 ol3 471 0 1100 106 .OS 2818 4.2 o14 1710 0 2117 too 600 2WO LOAN-LIM 6600 35.7 1.19 6624 33.3 1.31 24 0 22M 3401 IsW 21480 710P do $040 0 14441 /t►l .35 25M 1.11UEE-BEER 6600 35.7 1.19 "" 0.4 lost 1M- 0 am 44.0 fail U410 Woo 1.30 2619 0 25419 1304 $41 2114" Lallstaww 4500 1305 043 933 4.0 019 1541- 0 6100 1000 032 2510 3.7 aI3 41W 0 25t0 104 004 2W47 DANMO-UM I= 6.1 021 3049 15.3 .60 1540 0 1400 12.1 a30 10428 15*3 .57 2328 0 10429 5.1 all 25048 BA M-BEfit 000 7.6 025 3490 17.5 069 2080 0 4500 6.7 .21 7816 Il.l 040 3116 0 7876 403 013 25049 Mao-" 110o 5.9 .20 75.1 308 015 347- 0 4700 7oO .22 2115 4.1 .14 1925- 0 2778 1.5 a04 25050 LIC-00 LUC 1 0 .0 000 0 00 .00 0 129 0 .0 000 0 .0 .00 0 426 . 1121 06 602 25M i iCMEES6- 0 .0 .00 24- .1- .00 24- 82- 0 00 600 66- .l- 000 86- 155- 574- .3- .01- 36 Kv# REiE7Li< I= 100.0 3.34 1%69 100.0 3.94 1369 17674 41100 100.0 3018 67371 10000 3.45 271 i7320 183655 100.0 2.97 31 DE11. COOT 23M COS LID-WM-M 3100 16.8 .56 3702 18.6 all 602- 2453 t13W 14.8 .54 12LIS 19.0 .id 1* 11527 36M 20.1 .60 =10 COS DEER-M t 700 3.0 013 16B 3.9 015 68- 1131 2400 3.6 all 23U 3.5 .12 17 2891 6518 3.3 .11 2=15 COS KIXES tall 600 3.2 all 146 .1 003 434 4 2300 3.4 .11 443 .7 .02 IZI 929 1371 .7 002 37 T4EV. COST 4400 23.8 .80 4616 23.2 091 2166- 3580 16000 23.8 .76 1=9 23.2 .60 341 15347 . 44216 24.4 .73 IDT CATERING R 76" 13.00 1" 15.14 362- 67383 274100 12.98 213M 18.91 61041- gum 634M 10.26 Vol REST Kv R 1800 Vol 033 1B36 9.2 .36 36 1670 WW 1204 .39 799B 1109 .41 302- 7409 23436 12.9 .38 OPRito- 163-22129123- 5/01/96 1" IUBDOCX 293 PAGE 5 P i L DETAIL REPORT AFR 26, I996 LIFE ■------------- C U R R E N T P E R I O D YEAR- T 0 - D A T E AMC PERIODS ACCOli11 Bt"T PCT 0/R ACIUAI. PCT 11/R VARIANCE PRIOR YEAR kWET KT WR ACTUAL PCT WR VARIANCE PRIOR YEAR ACTUAL PCT • U/R DOLLARS REV /CUV NXLAR3 REV /COV IC LARS ACTUAL IQLARS REV /COV DOLLARS MY /COY DOLLARS ACTUAL WOL" REV /COV TOT L1NCE ICV R 12700 68.4 2.29 1075 54-2 2.13 1925- 12504 41500 . 61-11 1.97 met 57.0 1.97 • 3079- 3m? 1t3207 61.6 1.83 101 BANG KV R 4000 21.6 .72 TM l6.7 1.44 3W um 17300 25.E .62 2103E 31-2 I.O9 3738 20500 47586 23.9 .71 38 LABOR COST 30015 LING SLPER/NIXO 1700 9.2 .3L 14M 7.2 .28 266 1248 7200 10.7 .34 654E 9.7 .34 652 5893 21961 12.0 .36 30020 SERVICE 400 2.2 .01 337 1.7 .07 63 3" 1700 2.5 -09 1424 23 .O7 276 1162 4036 2.2 .01 3" BANG NixtJON am 0 .0 too 0 .0 .00 0 12 0 .0 .00 0 .0 sod 0 146 0 .0 .DO 30075 TRAY" 0 .0 .00 0 .0 .00 0 0 0 .0 too 0 .0 .00 0 24 122 at too 30M SUX# We & ND too .5 .0�2p 0 .0 .0o too 0 200 .3 .ol a.t .00 113 IN 674 .4 .0I 30065 PATROL TAWS 500 2.1 .09 411 2.1 .08 09 410 1900 2.B .09 1566 2.3 .0B 334 1B17 5129 2.6 .011 3006o sw NWITB too .5 .02 91- .5- .02- 191 30- %W .7 .02 299 .4 .02 201 77- 1944 1.1 .03 38 LABOR COST 2NN00 15.1 .51 2091 10.5 .41 709 20" II500 17.1 .54 9924 14.7 Al 1576 PILO 33WS 19.5 .SS 40 . ENTER. COST 30072 AREA ALLOC-F OO too .5 .02 0 .0 too 100 Bl 400 .6 .0.��2 0 .0 .00 400 247 0 .0 .00 30073 NEW PAW SAL. 0 .0 .00 0 .0 .00 0 111 0 .0 .00 0 .0 too 0 13Q 211 .t .00 30074 PAVROlL TALES 0 .0 .00 0 .0 .00 0 138 0 .0- .00 0 .0 .00 0 1W 42 .0 too 30075 EP KWITS 0 .0 .00 556 2-0 oil 556- 0 0 .0 .00 52 to .03 556- 0 566 .3 .Ol MIS ENTERTAIN COST 0 .0 .00 0 .0 000 0 0 300 .4 .01 Im .2 .01 i50 750 150 .t .00 30079 ADMISSIONS 0 .0 .00 0 .0 .00 0 0 30o- •04- .01=` 0 -0 .00 300- 94- 0 .0 .00 40 JENTER. COST too .5 .02 556 2.0 .Il 456- 930 400 .6 .02 706 1.0 .04 306- a" 1019 .6 .02 30100 BAR PROln-MEDIA 300 1.6 .05 0 .0 .00 300 47 1100 1.6 .05 0 ►0 .00 1100 T6l 1733 .1 003 3010� BAR PRONO.OTFER 700 3.9 .13 901 4.9 sl9 201- 140 2900 4.3 •14 4543 6-7 .23 1443- 3410 92BO 7.0 .21 30140°Iml1Plm PURCII 200 1.t .04 174 .9 • .03 16 2 400 .6 *02 iJ8 .5 .02 67 412 /10 o0 .01 30190 CH11*41LASS-SLL 0 .0 .00 0 .0 .00 0 114 700 1.0 403 Tip I.1 .04 It" MB am B.0 .a 30460 LICOW 4 KAN 0 .0 600 60 3.1 all 6oi- M so bs .0/ 601 .1 .Ol ipl l72 601 3.4 .11 i0660 ►MCA BImIu too .5 003 *M 1.4 .06 166- 104 400 .6 .02 736 lot .04 336- 639 2142 1.2 *43 4w" Wii0R110 100 A .02 0 .0 .00 :00 317 200 .3 .01 201 .3 tot t- B86 612 .3 .ot 42 GIM 1400 746 .23 2050 10.3 .41 650- 1490 6500 Vol .31 7156 10.6 .37 65b- 1288 28653 15.4 .46 60015 SALARIES4DIIIN 12200 2.6 2.20 12442 2*4 2.46 242- 11704 =00 2.9 2.4I 4=3 3.1 2.49 22" SIM 141M3 2.9 2.30 60016 SALARIES-OXMI 1300 .3 .23 1381 .3 .21 B7- 1823 5500 .3 .26 "it .4 all 61t-- 7493 22938 as .31 60019 W1 INDENT, CM 1000 .2 ..1y0. 1000 .2 .20 0 two 43W .2 .20 4300 .3 .22 0 .4WO wo- .0 .Ol- 60045 BILK VAC 4 M LI 0 .0 .ri 540 .t ./1 No- 0 600 .0 .03 2044 :1 .to 144M 94 6231 .1 .10 60065 PATROL 7AW 2100 .6 .51 221E .5 .44 58s 2635 11700 .7 .55 9047 .6 .46 262 12105 30 " .6 .50 60M DPLINE WWI 1400 .3 •2S 701 .2 .14 699 392- 5700 .3 .27 2793 • .2 .14 2911 2142 13735 .3 .25 60065 DP IDALS l WI 0 .0 .00- 0 .0 .00 0 5 0 .0 .00 0 -0 .00 0 70 0 -0 .00 60070 EP RELATIW5 1000 .2 .t0 M .2 .1B 112 Bid 5000 .3 .24 4824 .3 .25 114 4432 20115 .4 -34 60110 to& FEES 0 .0 .00 185 .0 .04 les- Ids 0 .0 too 2700 -2 .14 2700- 1031 30W .6 .49 60115 Me FEES 2700 .6 .49 2893 .7 .57 193- 2908 11400 .7 -54 1230 all .63 945- t2034 u%4 .7 .39 60133 SAW REL S=o 300 .t 005 423 .t .09 125- 215- 9400 at .07 . 1607 #1 .00 207- 454- 7156 .1 .12 ti O RIW- 164-22829823- 5/01/96 106 IULDiM3( 293 PAGE 6 P 6 I. 161A1L semi Ate 26. 1996 1.114 A6(iii17 60140 LAD LOTS 60150 CGw,QWR 6 "t 60190 CUN`CL"IT CARD 60220 CONTRIBUTIONS 60310 no 6 LiUCRIP 60320 DFLOYIENT MST 6=0 EWIP" RENTA 60" UNIMAITY Flirt 60420 FREIGHT 60470 I= 6 aNM 60520 MISCULAWDA 60630 NOVINO E3 60550 WFICE SWKIEB bm COPTSW W cWN 9 60552 FRINT i STATION 60660 EGUIPtim p6m 60M POSTAGE OfMM 60M PROTECTION on Woo Taira" cm 60110 WNi1UM 1KC 60119 T&E HOWKWA 64m TOM 6 Xas W 60721 TWW MERGE 60730 TRAINIW Ev 60000 AREA ALLOCATION 48 A�ONs 6 (FXO W FAA",, FEE 604W F&AtCHIGE FEW 50 flJ+ 0, FEE ■- -- CURREVI PERIOD ---------+ YEAR - T 0 - D A T E -------------111NMIJE FMO06 HA6£T PCI 0/9 ALWAL KI 1UR VARIANCE FRIOR YEAR Mat FCI O/R ACTUAL PCT 0/8 VARIANCE PRIOR YEAR ACTUAL 11CI Ulk W. Afd REV AXW 1431.1" KV /COY DOLLARS ACTUAL DOLLARS XV /COV DOLLARS 11V /CW DOLLARS ACTUAL DOLLARS KV A W 500 .1 .09 lot .I .06 1" 113 1700 .1 e00 w .0 .0e�4/. 980 2421 22583 .t .04 0 s0 .00 6 s0 too 6- .3461 0 .0 .00 5- .0 .00 5 3417 1239 .0 so: 7400 1.6 1.34 6836 1.6 1.35• 562 6732 2" le6 1.30 25401 1.6 1.30 20" 22922 8UP3 le7 1.34 0 .0 .00 0 .0 too 0 0 0 e0 .00 0 .0 eoo 0 0 23 .0 .00 Too .2 .13 165 .0 .04 513 675 1600 .t 40�p8 961 .1 005 633 1541 3752 of e06 400 .1 .07 303 .1 .06 95 12 1600 s1 Goo 973 .1 $05 621 G" 3625 .1 .06 400 sl .01 171 .0 .03 229 230 low .1 � .03 2113 .1 e11 1113- 1273 5473 .t .09 0 .0 e00 . 0 .0 .00 0 0 S00 .0 e02 0 .0 e00 500 0 0 .0 .00 too .0 .02 119 s0 .02 IS, 0 400 .0 .02 171 .0 .01 229 249 241 .0 .00 too .0 e02 0 .0 too too 123 200 .0 e01 169 e0 .01 3t '354 2104 .0 .03 0 .0 000 0 .0 600 0 53 0 s0 .00 6 .0 too 6- 53 151 .o too 0 00 $00 0 .0 100 0 2501 0 s0 .00 2321 .1 s12 2321- 2b01 3=3 .I .06 1200 s3 .22 1040 .2 s21 160 1240 WN .3 s24 4362 si 022 678 4"1 14M .i s23 200 00 004 3T- s0 Dot- 231 63- 1400 .1 s07 012 .1 $04 588 Go- 3049 sl .03 600 .l .11 304 .t .00 216 1411 25N •1 .12 .2331 .1 .12 143 2473 8026 s2 .13 200 00 .04 194 s0 .04 6 0 No .0 .04 590 s0 .03 202 1837 14" .0 s42 600 .1 .11 963 .2 sl7 265- 826 3000 .2 J4 2717 02 014 283 2467 1429 at •l2 404 at s0T 275 .1 s03 123 0 t9W DI, 49 964 at 045. 944 0' Z56S .1 004 0 s0 .00 0 .0 .00 0 0 0 .0 004 0 s0 i00 0 0 13 .0 .02 100 _ s0 $02 59 s0 .01 41 4 900 •1 .04 W.0 .02 543 507 1410 .0 to 0 s0 .00 0 .0 600 0 a' too .0 s00 r 6 .0 .00 140 "S 290 .0 000 9404 43 022 02 s2 .l3 528 t128 2400 s1 all 2102 at sU 298 2411 5274 •1 s09 900 •2 .16 ' 1014 .2 s2A0�. 414- "1 3;00 s2 all 3561 02 owBi- 2$9 law s2 ell 300 of,.05 49 .0 .o2 201 161 13W of sob 278 s0 .001 1022 051 2993 .1 005 4600 180 063 U14 I.3 tell ION• 4"1 12600 s1 260 IWO .9 .61 420- 13346 35M .1 .59 42600 9s2 1.70 40119 9.3 sacs 1821 45937 166300 9s6 1.08 L311164 lost 6.10 8136 l63B57 SLAM 10.3 6.35 t2900 2se 243 ltlb3 2.7 2.35 1031 11133 46NO 2.8 2.31 44W 2s9 2.21 4239 4429S 144M 2s9 2.33 12900 2.8 2.33 11863 2.7 2.33 1031 11735 49700 2.8 2e31 44461 2.8 2.20 4239 44M 144951 2.9 2.35 31 INN 1LMs . 40499 SAQ NWNAtEIEINT 11900 Sea 2.51 "1 3.0 2.63 531 12590 52M 3.0 2.46 41925 3.0 2.4S 4075 40M 15MI Sea 2.46 51 INN NEN1e 13M 3.0 2.51 13367 3.0 2.65 533 12590 52000 3s0 2.44 47925 3.0 2.43 4015 40060 1=1 L 3e0 2.4 54 1WWDG MIA SALARY-CAT(JOH 0 00 .00 26M s6 .52 2638- 4397 ) .0 .00 112U .7 te 11232- 19339 30390 .6 s49 MIT SALARIES SALES 0900 1e9 1e61 4763 1.1 .95 017 5549 319W 2.2 1.90 20w8 1.3 1e05 1730 23611 92014 I.B 1s* 6201E SALES DCW M 0 s0 .00 4016- .9- ow 4016 0 two sl .09 1"4 e1 .09 236 I569 7266 .1 .12 62045 SICIL. VAC. 6 No 0 .0 400 10 .0 too 0 103 0 .0 .00 213 e0 .01 213- 264 1662 e0 .O1 62055 PAYROLL TAXES Iwo .4 .3l 1276 .3 s25 424 23W 17o0 s4 .36 5943 .4 e30 1T37 $967 23119 .5 .39 62060 12MYEE MWI 300 4 $05 156 .2 .15 4U- 339- 1300 .1 e06 1831 e1 .0p9� 531- 59- 5823 at .09 42150 ADWERTISINA FTC 4800 1.0 .87 4N9 1.0 sBB 331 4401 18300 l.1 e67 1"73 1.1 .05 1627 16611 5"W 1.1 set 62200 HOTEL W1, AS6O 100 .0 .02 0 s0 000 100 0 600 s0 401 0 .0 .00 600 0 0 .0 .00 OPRIIO- 165-22120123- 5/01/96 706 1.118M 293 PAGE 7 P 6 L KTAM REPORT AM 24 1996 LICE CURRENT PERIOD YEAR - T 0-DATE -----4wm%c PERIM ACWitT IAA KT WR ACTUAL FEI WR WWIMM FAIOR YEAR 14MT PCt CA Acnim. m 0/R WWIANLE PRIOR YEAR ACTUAL Kt OIR t41ARS REV /COW MUM REV AMV LQLARS ACTIIAI DULAW NEW /COY OOLLARS REV /COY M.LARS ACTUAL OD CMS REV /1DW AMP MORI MAID CUR 4200 .9 .7y6. 30 7 e7 e61 1141 4392 13100 e8 P62 10395 .7 .53 - 2745 LUIS 36045 47 ON 62251 PRICRIV CLIAP CD 1200 .3 .22 652 .1 .13 548 619 4400 ei .21 4564 .3 .23 I64- 38" IVA2 $ e26 MOD MM 6 Mae 0 .0 .00 Z25 .t .04• 225- 651 2400 .1 .11 2728 e2 e14 328- 2613 SM at e09 6=1 LITERAM 500 at .09 507 .1 eta 7- 5t0 700 .0 e03 7W .o .04 w- 1798 7132 .t .12 A= DIRECT NAIL IW! 200 .0 e04 2" at .06 95- 0 24400 el .11 593 A A3 ISM 50 969 e0 .02 AM NATPL SAM 300 .1 .05 300 -1 .06 0 200 12N ./ e06 1200 .1 .o& 0 low 2201 .0 .04 62400 SIGN RFMALO 300 .1 .05 0 A too 300 300 12W at .06 624 e0 e03 S76 923 2424 .0 .04 &2401 SIGWrOTM COS 500 .t .W 6 80 too 494 0 1o00 .t e05 RI e0 e00 919 1112 SI .o too 6ZQO PROD. GUAMK 500 .t e09 231 .1 AS 269 '449 2104 .t eta 1429 .1 e07 671 2234 "to .t sit 62505 No ON I!l A ow .2 .14 596 .1 .12 204 1138 3P00 .2 .15 2013 A .10 ties SM MIA .Z .lT AUDIO RADIO AND TUM 0 .0 .00 0 80 $00 0 0 0 .0 e00 0 .0 400 0 0 400 e0 001 42650 W K W SAL OFFI 3200 .7 .56 296E .7 .59 234 2934 U200 .7 .50 tills .7 $57 1D85 11075 U240 .7 .s9 62830 TRAM We ITN 200 .0 ON 0 .0 .00 200 189 1400 .1 A7 it .0 .00 130 VIA 103 PO $44 62850 NATPL NAR INS 300 .1 .05 300 it A6 0 200 1400 P1 .07 1400 at 407 0 DOG' " 201 .0 .03 62101 R0ATI010W AD 0 .0 .00 0 .0 .00 0 230 0 .0 .00 0 e0 .00 0 2IS 119 .0 .00 6= NAM P.A. 300 P1 .05 300 .t .06 0 279 900 •1 604 "a .l AS 0 1100 2607 .1 .04 54 HAMUS 20300 6.l 5.11 19323 4.4 3.63 0977 29029 115300 6e7 5e4X 95961 6e1 4091 19339 111498 345386 6.9 3e59 57 N-L-P 64100 EIFCTRCITY 13500 2.9 2.44 IM2 2.5 2.I5 2M 12139 51400 3.0 2.44 46927 3.0 2@40 4673 44701 157411 3.l 2.33 44200 FLEL 2700 e6 A? 3229 .7 .64 529- 2304 139M e8 e66 14396 .9 e74 496- 12092 31416 e4 e51 64500 WATER 4000 e9 .12 3820 .9 .76 too Sill 13000 e7 .62 14MI .9 e74 1367- 10120 43M 89 oil 31 N - L - P 20M 4P4 3.65 17921 4.1 3.55 2279 11834 Tim 4e5 3.72 IU90 4.8 3*0 2110 69328 232912 4e7 3.77 58 AN LAM 46015 SMAWIM-4 4 of 4300 e0 .id 201 e0 ' i56 1449 4012 11000 .0 .05 12669 .0 .43 5331" 13751 3W12 .0 .61 66020 SAL. RAN UTIL. 3900 .0 .70 4963 e0 .99 I063- 5213 14900 .0 too I8424 .0 .94 1624- 21076 41214 .0 .99 66040 SIMP We 6 ID 0 .0 .00 122 .0 .02 122- 0 0 .0 .00 1311 A .01 till- 893 4619 .0 Al "am Paval. TAM 1600 e0 .29 1541 .0 e31 39 049 dw .0 .32 4393 •60 033 403 T443 act" +o 013 "GAD IV rJUST8 so e0 .11 424 .0 e12 24- 943 25W -0 412 26U .0 .13 1M- 2373 9073 .0 .15 51 RW 3AIM 10400 e0 leas 10141 .0 2.01 259 12149 44100 .0 2e09 41435 .0 2.12 266s 45566 13MI .0 2013 59 WA Ono 66075 tNIFNM 200 .0 .04 12S e0 P02 73 0 600 .0 .03 624 .o -.04 224- 331 1125 .0 .02 "l00 AUTON us 1100 e0 $30 974 .o .19 126 !07 2600 e0 e12 1545 .0 .01 IGM I138 5056 .0 .01 66110 LIFE/SAitTY 100 .o .02 195 .0 e04 95- 41 900 .0 .01 730 .0 .04 110 "1 Stu .0 .as 66120 DWIND 1100 .0 131 IIM .0 023 516 1919 AM .0 .32 4M4 -.0 .22 24U A= 17341 .0 .29 "IV ELECTRIC 8UL88 700 .0 e13 40 .0 .09 231 6" 2900 .0 414 1297 e0 .07 1603 2106 6729 .0 .11 66150 REFR MUTIOI 500 .0 .09 412 .0 e08 W 501 23W e0 all 1290 .0 .O7 tool 1759 6636 .0 ell "MG AIR CON 6 MAT 1400 .0 .25 570 .0 all 922 "1 S200 .0 .25 3949 e0 e20 1251 3910 1560E .0 .Z 66200 ELM i IE.W 600 .0 .11 64 .0 .13 46- 369 2100 .0 .10 1392 e0 e07 718 2172 5682 .0 .09 6=1Il=@-ii1;1IHW 500 .0 .09 403 .0 .00 97 639 2000 .0 .OP Ills .0 .06 117 2313 6m .0 .10 66210 OFFICE EMIPIEJI 0 .0 Soo 210 e0 .03 270- 1923 2100 .0 .10 2232 A all 132- 4.`.0< 4679 .0 .11 46250 KL40IID 1400 .0 .25 1123 e0 ' 834 323- 13" •700 .0 e32 6193 .0' .32 507 57rs 14323 e0 .24 4 OFR110- 1K-22129123- 5101/96 1" LiL9YrYJ( 293 PAGE 9 P 6 L 1ETAU- NOW AN 26. 1996 Lill t U R R E M,1 PER lop TEAR - T (I -DATE ----+riE1tE FLUOR Acmwf 1IMI Ftl Wh AOUAL F0 WR VMJAICF PRIUR TEAR Mal KT W/R ACIM Fi:( W/R WJUA WE PRIOR YEAR ACTIK PC( . O/R WLLARO 14Y /CW GUARS my /COY 1QLLAR9 ACTUAL OMLAR9 R£V /CW MAN REV /COY IMLAR9 ACTWL DOLLARS KV /CON 66255 PX%Q1TATIYE 1N 300 .0 .05 254' .0 .03 RA 720 1300 -0 406 1021 00 .OS 279 1231 2936 .0 .05 66275 LAU"T WHIRS 300 .0 .05 0 .0 too 300 442 12W .0 .06 977 .0 . .04 323 1127 2912 .0 .o$ 6d300 Dr Aum 700 00 .13 739 .0 .ls• 39- its 2WO .0 .13 29U .0 -Is 1s&- 2960 0141 .0 .14 "rA n= COLERW 200 .0 .04 14 .0 .00 186 42 000 .0 .04 lit -0 .01 611 on 959 .0 .02 A6400 Fliml6ii " too 60 e02 15 -0 $00 9s 0 500 .0 .02 US -0 ..43 Its- 4" 1109 .0 .02 66450 GR011o7B••6]=la 1900 80 .34 1450 .0 .2N9- 442 2413 2300 .0 .11 14330 .0 .0.y07 942 2W0 4617 .0 .01 A6460 GfimA r-INTLAIO too .0 .02 0 .0 .00 100 0 200 so- .01 0 00 ..0 200 0 909 .0 .Ol 66500 PAIN US i mm 200 .0 .04 52 -0 -01 149 99 7o0 .0 .03 1" .0 .ol 594 753 1122 .0 e03 66520 himVi6LK 400 .0 .01 624 e0 412 ;w ids NU 00 .Ot SAW .0 .09 120 1924 6401 00 *to U550 91" 200 .0 .04 111 -0 .42 99 92 too .0 .04 230 .0 •601 670 .rid 13U -0 -42 NA00 69112" N L 400 .0 401 293 .0 .04 to? 393 1500 00 .01 lus -0 .Od 235 1411 U42 .4 As 6KS1 WALL TOOLS too .0 .ol 191 .0 e04 9I- I" 500 .0 .02 246 .o -01 254 622 It" .0 -02 s9 mm cau 13100 .0 2.31 10734 .0 2.13 23" /3t42 49700 -0 7.31 35w .0 1.63 Lim 47354 329WO .0 i-Ot 60 RLI FFWV11 6At50 i>< OUR SLED- 0 .0 �y� 60 0 .0 /�0 .0 0 0 WOO .9 .76 0 .0 .00 SAM . 0 0 .0 40 66991 GRam i LAM 0 .0 .00 0 .0 -00 0 0 0 .0• .00 14623 .9 073 14d23- 0 2110d .4 .34 "VA 19RA lil KWI 2WO -3 -45 0 .0 .00 2500 0 2WO .1 .12 0 .0 000 2500 0 0 .0 .00 A49s4 OTIEit 0 .o -00 0 .0 .00 0 2221 1300 .I .Oi 0 .0 .00 L300 sm 245A3 .5 .40 60 R&A PRLima 2500 05 045 0 .0 -00 ' 2WO 2221 19000 Set 494 14623 .9 .73 5171 9902 45A69 .9 .74 w A2 MINE WIT 1d2200 34.9 29.31 1659W 37.4 32.61 37W 120553 53FAC 31.0 25.16 413017 30.9 24.94 52463- 4419" 1411316 2992 2344 A3t>dFim IN= 94030 RENTAL INME-A 0 .0 .00 16192 -0 3e21 tU192 14430 0 .0 .00 sWll .0 Zen SW// 54r76 HUM -0 2.42 64295 1419 ST OEM t00 .0 016 t36 .0 .19 3d told 3400 .0 -17 3395 40 .17 us- 4103 12674 .0 .21 91.503 SAL W SALU 0 .0 .00 0 .0 .00 0 260 0 .0 40 It .0 .00 19 so 110 .0 .00 "m MIT EW-W1 0 .0 .00 16192- -0 3421- 14492- 14430- 0 .0 000 DOW .0 340- 54911- IWFW 149420- .0 2di- Ool-WER lwmK t00 .0 -16 936 .0 .N id 13U 3600 .0 .17 3m .0 .17 Iw 4650 12194 .0 .21 AiiAX/I10R/OTiiA 6=0 lF1rtL FEES 0 .0 .40 0 -0 -00 0 0 0 80 .00 aw .0 .A3 1235i- 0 12(20 .o 921 95215 PiZ0113iSIOK FE 0 .0 000 0 .0 .00 0 0 0 .0 .00 Um .0 -96 16722- 0 34M -0 .56 6 960 MSC or 1131 FE 0 .0 .00 1196- .0 .24- 1196 1990- 0 .0 -00 9320- 00 '.H43- 9320 2SW7- 9989•• .0 416- B5972 LNI1151W I= 2900 .0 .52 3679 -0 .73 T19- 1132 9SW0 -0 .40 10134 .0 .52 U63M 21419 300N .0 .50 6QW PROP TX -AL PW L5400 .0 2.79 IUW .0 3.05 0 15106 61600 .0 2.T! 61600 .0 sell 0 A2900 USM .0 36" GANG IMINA S 3"0 .0 070 4600 .0 -911 "0. 4900 15700 .0 .14 It200 40 • .t9 3500- 196" 22264- .o ./3MA- "m 118INmo 6 am 0 .0 .00 0 00 $00 0 0 0 .0 .00 4 .0 .00 0 121" 0 .0 .00 66TAVIMPAIIEA 22200 .0 4-Ol 22A93 .o 4.49 413- IVM 95" .0 4.06 111699 .o 5.72 2WW- 113390 211916 .0 3.43 iIEW 96100 PWARAM EO RF do .0 .11 629 .0 .12 29- 693 2100 .0 413 2WA -0 -14 6- 2964 9251 .0 413 71RElii 400 .o .11 429 -0 .12 29- A93 2700 .0 613 210A .0 814 4- 2m 9251 .4 .13 s lll1 - 167-22129123- 3/01/96 T04 L1!➢M 293 PAGE 9 P 4 L KTAU. REPORt AK 2A. Mal LINE CURIENI PER too TEAR - T 0.-D A T EKRING ACWM VAGET FCI Wk W.IUAL Ft) 0/0 YARIAWS PRIOR YEAR Mal FCI 0/k ACTUAI. ITT MR W AIAU PRIOR TEAR ACTUAL PCT 0/R MARS REV iCUV W.LARS RLV 4 W 00 LARS AMAK BOILAiCS REY /MV I)MLARB REV /COV 01ARS ACTUAL OOILAR9 REV AW 721Ualm 84700 INT-" TEST 60100 .0 10.06 5VU6 .0 II.60 • 514 60011 255W .0 12.10 ZOO .0 12.97 2140 w' .. . ?MI3 .0 L2.40 72U9lRW 60100 .0 10694 595" .0 11.90 514 "al? t:.a4o0 .0 12.10 25940 .0 12.91 2140 25SW 7MI3 .0 12.60 J'. DU%C 6 AMT. so" A"I PIMA Cat 40O .o .01 U4 .0 .OT 36 iN 1A00 .o .0i 1435 .o .07. 143 14" 43N .0 .07 Won A1a7-LM CM1 BB00 .0 flit 8121 .0 954 13 2121 10900 .o 033 .10908 to .56 0- ,low 32124 .0 AS "No o17REC1ATtom 34700 .0 6620 40M .0 7.91 5933- 39W 13t200 .0 6.50 U0932 t0 &M 23T32- 1N393 41=4 .0 7.82 "Bat cwm OEFRVAA a .o .00 0 .0 .00 0 0 0 .0 so a .0 .00 0 3244 0 .0 .00 MEW 6 Not. 3M .0 6.74 43324 .0 a.SB 5824- 42933 149700 .0 1.W IT= .o am 235055- 17=1 52" .0 6042 LET IN= 42100 9.2 40665 9.3 2035- 604 4T500 1.1 5230P- 3.3 100009- '94066- 45708- .9 v QFIUIO- Mg-22IM23- S/ol/% PAGE to _. aFR zd, tevd - Ll1E �------ CUkRfm.1 PERIOD TEAR•t 0-GATE'--•TiEIIEPERM AMIN EJDMI KI 1Wk ACIUAL KI 0/2 WIMM FR1UR TM 0=1 FCI U/R ACi11Al. FCT 04 MUM MU YEAR ACTIYY. KI DA MARS KV /CW W #m REY ICOY DOLLARS ACAWL OMLARS SO ICOY DOLLARS REV /CDII DOLLARS ACIM DOLLARS REY ICON • Teas Oeprtn**V 1996 CPNTRACT YEAR «H+1e/'so-ms SPECIAL NUTRITION PROGRAMS SINGLE AUDIT IDENTIFICATION DATA Fenn 1; conwom Name Qity of Lubbock Canna Pelson Susan Baffle Address V4W* t a P.O. dose GAY. Stale, LP) P.O. Box 2000• Lubbock Texas 79457 Teleprlaq Na. Payee 10 "a. Conww tro. 806 ) 767-2675 1-75-6000590-6000 tax-exempt anew Year End VnaVO W Typo al / 9 5 ❑ For ProM []No~ ® Govemmental Check the appropriate box(es) to Indicate the type(s) of program(s) In which COMMOOnY ASSISTANCE PROGRAMS A - National School lunch B - Charitable Institutions C - Area Agency on Aging G - Stemmer Camps ® H - Summer Food Service J - Jails K - Soup Kitchen 1 - TEFAP Commodities Give the source and amount of See Attached Listi federal financial assistance that SOURCE entty participate or for which you are CASH RE1MailRSEMENT PROGRAMS AD - Adult Day Caro BL- National School LuncWBM3k&s1 CC - CACFP Center OH - CACFP Day Home SF- Summer Food SM - Special M& TE - TEFAP hcv receives other than from those pin am listed above: AMOUNT ❑ SMILE AUDrr EXEMMON-I certify Ihat I am not required Io submit an audit under the Sinpb Audit Act for the blowing reason(s): — ❑ 1 am a for -profit orgaMution. ❑ 1 rscehre tees than U5,000 annuaiiy in total federal fundins. IDS1NC1%LE AUDIT ASSURANCE-1 understand that if I meet the requirements of the SkVW Ault Act.I will agree to submit: Jl An Annual [:]A Biennial audit as a condition of eligibrity to partidpate in the Special Nutrition Programs, and tuu failure to do so as required could msuti in adverse actio% inducing the withholding of my claim for reimbursement payments and lerm&u ion of my contract. I also understand that I I am a private non-prord organization subject to the nnui arrrents of tee Single Audi Act and have a rnalhrzat audit peAomxd ar qsaly. I anal also obtain a single au& on an annual basis. -k 6, Azl� �;;�z 4, � �4 �- �i�e Zl-?6 or M s Federal Grantor/ Program Pass -Through Grantorf or Award Program Title Amount FEDERAL FINANCWL AS315TANCE - ORANTS �- U.S. Department of Agriculture Passed through Texas Department of Human Services Summer Food Services Program for Children 94.95 i 95,274 Passed through South Plains Association of Governments: Nutrition Program for the Elderly 94-95 127,636 Total Department of Agriculture U.S. Department of Education Direct Programs: Library Literacy 94-95 33,399 Library Literacy 93-94 33,515 Passed through Texas State Library and Archives Commission: Library System Services 95-96 141,458 Library System Services 94-95 120,601 Library System Services 93-94 115,466 Library System Services 92-93 140.984 Urban Library Aid Contract 94-95 17,196 Urban Library Aid Contract 93-94 17,196 Interlibrary Loan Service 95-96 55,103 Interlibrary Loan Service 94-95 60,374 interlibrary Loan Service 93-94 72,444 Interlibrary Loan Service 91-92 80,689 Total Department of Education U.S. Emergency Management Agency Passed through Texas Department of Public Safety: Emergency Management Assistance Program 44.003 Total Emergency Management Agency U.S.Department of Energy Passed through Texas Department of Housing 6 Comm. Affairs: DOE/Oil Overcharge Weatherization Asst. Prog. 95-96 34,342 DOE/Oil Overcharge Weatherization Asst. Prog, 94-95 68,017 Oil Overcharge Weathertzation A.W. Plus Prog. 94-95 80,135 Passed through Texas Department of Human Services: LIHEAP Enhanced Weatherization Asst, Prog. 95-96 40,899 LIHEAP Enhanced Weatherization Asst. Prog. 94-95 49,659 Total Department of Energy U.S. Department of Health 3 Human Services Passed through State Department Housing 1t: Comm. Affairs: Community Services Block Grant 94-95 233,469 Community Services Block Grant 9344 226,065 Comprehensive Energy Assistance Program 94-95 357,401 Comprehensive Energy Assistance Program 93-94 596,161 Emergency Community Services Homeless Grant 95-96 13,495 Emergency Community Services Homeless Grant 94-95 $ 13.550 A Federal Grantorl Pass -Through Grantor/ Program Title Passedthr 0ii State Department of Heattti State Legalization Impact Assist, Grant 92.93 State Legalization Impact Assist. Grant 91.92 Total Department of Health 6 Human Services U.S. Department of Housing 3 Urban Development Direct Programs: Community Development Block Grant 95-96 " Community Development Block Grant 94-95 " Community Development Block Grant 93-94 -' Community Development Block Grant 92.93 Emergency Shelter Grants Program 95-96 Emergency Shelter Grants Program 94-95 Emergency Shelter Grants Program 93-94 HOME Investment in Affordable Housing 95-96 •• HOME Investment in Affordable Housing 94-95 " HOME Investment in Affordable Housing 93-94 " HOME Investment in Affordable Housing 92-93 " HOPE for Homeownership of Single Family Homes 95-96 " HOPE for Homeownership of Single Family Homes 93-94 " HOPE for Homeawnership of Single Family Homes 92-93 " Total Department of Housing b Urban Development U.S. Department of the Interior Passed through State Historical Commission: Certified Local Govemmerd Program 94-95 Total Department of the Interior U.S. Department of Justice Passed through State Criminal Justice Division: South Plains Regional Narcotics Task Force Grant 95-96 South Plains Reg -venal Narcotics Task Force Grant 94-95 Total Department of Justice U.S. Department of Transportation Federal Aviation Administration: Airport Improvement Program " Airport Improvement Program — Airport Improvement Program " Airport Improvement Program '• Airport Improvement Program " Federal Transit Administration: Capital. Operating and Planning 94-95 •• Capital. Operating and Planning 93-94 " Capital, Operating and Planning 92-93 '• Capital, Operating and Planning 91.92 " Under the Unified Work Program: Management Systems Administration/Management Data Development & Maintenance Start Range Planning Program or Award Amount 10.539 9.209 3 421,000 3.553,000 3,265.000 2.555.000 128,00E 95,00E 38,00E 1.012,000 938.000 701.000 1,066.000 8W.000 1.710.000 1,000,000 4,920 340,510 320,952 1,440,532 1,685,668 1,917,000 1,744.803 1.731,992 9,426,165 1.614.920 1,790,500 3, 759,880 44,200 50,800 70.000 93.900 i Federal Grantor/ Program Pass -Through Grantor/ or Award Program Title_ _ _ Under the Unified Work Program (continued) _A_mou_nt_ Metropolitan Transportation Plan 11 21.100 Comprehensive Bicycle Study 65.000 Program Development, Management, d Coordination 50.000 Travel Authorized by MPO 4.000 Long-range Transportation Plan Update' 76.500 Land Use Program Update 67.700 Management Systems' 13.000 Passed through State Department of Transportation: Driwng While Intoxicated -STEP 94-95 8.000 I Occupant Protection -STEP 94-95 11.999 Total Department of Transportation U.S. Small Business Administration Passed through Texas Forest Service: National Tree Planting Program 92-93 8.100 Total U.S. Small Bus. Adm. and USDA Forest Svice TOTAL GRANT FEDERAL FINANCIAL ASSISTANCE OTHER FEDERAL FINANCIAL ASSISTANCE U.S. Environmental Protection Agency Passed through Texas Water Development Board: State Revolving Fund Project B " 34,520.000 State Revolving Fund Project C " 14,425.000 Total Environmental Protection Agency U.S. General Services Administration Passed through General Services Commission Federal Surplus Property — 130,2M Total U.S.'General Services Administration