HomeMy WebLinkAboutResolution - 158 - Grant Application - TDHR - Summer Food Service Program For Children - 05_10_1979LGB:hw RESO #158 5/10/79
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�•`� RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the Mayor of the City of Lubbock BE and is hereby authorized and
directed to execute for and on behalf of the City of Lubbock an Application
for participation in the Summer Food Service Program for Children and docu-
ments related to said grant application to the Texas Department of Human
Resources, attached herewith 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 10th day of May ,1979.
- DIRK WEST, MAYOR
-ATTEST:
or Evelyn fga, City retary-Tr sur
APPROVED AS TO CONTENT:
LawrLInce Banks, Community Facilities
APPROVED AS TO FORM:
Leon G. Bean, Asst. City Attorney
TIED TO RESO #158 - 5/10/79
luxnf I)efwrtnnvrl
ot"'lunwn Re.,uut I es
�3aJ APPLICATION FOR PARTICIPATION
s//, (Summer Food Service Program for Children)
INSTRUCTIONS: complcte in duplicate Submit (original with an original
horn 1507, Sit,- Information Sheet, for each feeding site and for each
%ession (if more than one is offered) which will be administered by the
Applicant. If more space is needed, continue on a plain sheet of paper,
numbering each item" Type or print clearly all information.
a
FOR TDHR Agreement Number
USE ONLY TX 152-103
Vender ID # 1-756-005906-008
Name Ot Applicant Phone No. Onclsrde area code)
City of Lubbock Parks and Recreation Department 1 (806) 762-6411 Ext. 2661
Mailing Address
P.O.- -Box 2000 Lubbock, TX 79457
Name of Adrninrstrator (Autbarized Sponsor representative who will sign the Agreement, Form 1 S08)
John A. Alford
Title of Administrator
1. Is applicant a public entity?
Ld Yes • 0 No
If NO, attach a copy of the letter from IRS documenting tax exempt status.
2. Does applicant participate in any other programs
funded by tho Food and Nutrition Service?
EX Yes El No
If YES, specify.
Title V I I Nutrition Program
3 Does applicant participate in any otho► programs
DqYes [:.]No
If YES, specify. Title III and V I I ; Revenue Sharingg
funtled by thu Federal government ?
Community Development; Summer Youth Recreatic
4. Are you planning to utilize school food service
Ex Yes 0No
If NO, describe your efforts to utilize such facilities.
facilities for the preparation of rtrealO
5. Is the fond t j be prepared at a location other than
If YES, list location of food preparation site(t).
the food vuvice sites?
Yes [_J No
Estacado High School
1504 E. Itasca
6. Are you planning to contract with a food service
If YES, and the contract will exceed $10,000. attach a copy of the wording
manayevicnt company for the preparation of
to be used in the synopsis of your invitation to bid, the planned date and
unitized meals?
L Yes kANo
place of publication, and the planned date and place of opening of the bids
7. If progtam payments under your agreement will
exceed $50 000, attach a copy of;
A. Letter of Engagement from a certified public accountant.
B. Service Institution
organization chart including officers and directors with names. (identity the
administrator named above.)
8. Did the applicant participate in any prior. year's
UYes ONo
If YES, give agreement number from prior year.
summer food service program?
TX 152-103
9. Did any of the applicant's personnel or officers
G�Vies No
It YES, give name and addres$ of sponsor or vendor.
named m Itern 12 (next page) work for a summer
City of Lubbock Parks and Recreation
food service program sponsor or vendor in any
P.O. Box 2000, Lubbock, TX 79451
prior y""`�
Lubbock Independent School District
10. Does the applicant provide, an ongoing year-round
_
ICilyes No
H YES —
service to th-• community that would be served by
Describe the nature of the service:
the surnmcer food service program?
The Parks and Recreation Department conducts
a variety of year-round recreation programs
that will be enhanced by the Summer Food
•
Service Program
Date Service Instituted:
Average number of paid and volunteer
workers during the six months preceding 40
this application ........................................ __.
It List sponsor level personnel who will be involved in administering the summer food program.
(Site nemonnel should be listed on Form 1 5n7 Site Infnrmatinn Sheet 1
Fgrrn 150E
Page
i
Number of ,Numberot Hrs.
Title of Posit+on Personnel I per Day Spent
in that on Food
Position Service
Wages per Hr.
(indicate
Volunteers
with V)
Total Wages
for
Program
Source of Funds
(Reimbursement, CETA- etc.)
i Specific Food Service Duties
Ddte of
Emnlovment
in tnis Program
Rec. Specialist 1 I 8
Ass't Rec. Su v. 1 j 4
12.55
$5.24
I1 305.60
1,446.24
Reimbursement
Reimbursement
Supervision of food site monitors 5-28-79
Bookkeeping, scheduling, supervis'on
-
-8,24-7�
_ '�_31-79
Rec. Supervisor 1 2
1$7.13
i 983.94
Reimbursement
Administration of Program 5_28_79
—
- 8-31-79
j
12. Training Sessions
Name of Person Responsible for Conducting Training Sessions Number of Sponsor Person- Number of Site Personnel Dates of Training Sessions
nel to Receive Training to Receive Training
Kav Stiner 2 18 5-31-79
Outline of Topics to Be Covered
1. Read and discuss all information in the Site Supervisor's Guide
2. Explain the proper procedure to make meal adjustments
3. Describe persons to contact and the line of communication.
13.Outline your schedule for visiting all sites listed on Form 1507, Site Information Sheet, during the first week of operation, and for reviewing all sites during the first four weeks of operation.
if more space is needed, attach additional sheet.
All sites will be visited daily. Prompt action will be taken to correct any deficiencies found.
The food service operation will be observed at least once during the duration of the program.
L -
14. Dates of Operrtion 15. No, of Days of 16. Number of Sites 17. Average Daily Participation
June 4 to August 17, 1979 operation
54 16 825
` r ' Form 9
Pr
+ 14L Proposed Summer Feeding Administrative Budget: Estimate all costs for which you plan to claim reimbursement by TDHR. All such costs must ba elocunv
A. Estimated Operational B. Estimated Administrative s
Costs: _ Montldy Cost Total Cost Costs: Monthly Cost Total Cost
Food
s101,150
2,000
40
s 30,450
5,872
120
Labor
Non-food Supplies
Utili�;e.
Rent
New d of Equipment
Equwlo%n: Use Fee
Other (specify)
TOTAL (A)
s 36.442
Management Salaries
s 810
s 24X
Monitoring Salaries
435
1306
Clerical Salaries
Rental of Office Space
Utilities
Office Supplies
84
250
Office Building Maintenance
Use Allowance of Furniture
and Fixtures
----__.-- ----
M!
15 at
—
---__^..
Audit Fees
Legal Fees
— -- —
Other Ispecify)
—for 711QTT
.150,ger mil e
TOTAL IB)
4031
C. Estimated Grand Total (Total Program Cost = Sum of Total A + Total 8) .......................... S 40,473
jj ��
Q. L— ; The applicant requests advance payments for El Net Program Operational Cost U Administrative Cost
L� The, applicant does not request advance payments for Net Program Operational Cost or Administrative Cost.
19.Show projected income'for all sources other then TDHR. Identify exactly what costs this income will be used for.
(Attach additional sheets it necessary)
Income Source
Income Amount Describe the Costs for Which This Income Will Be Used
` !6 FQfI•.�
,. !�
O. Define your procedure for collect'
3 yo W u+g information on the daily number of meals sorted to the children, the daily number of meab satised lo'tadull alto �(jR
nel, and the number of hours worked by site personnel (if labor costs will be claimed) from each site. Include (AI the frequaricy pf informatlbq'aIW faq'I
(13) the method used to collect information from the sites
The program monitor will visit each site to collect all i nformai ton 'during daily vi sits
the sites.
21: Specify your lime limits for correcting problems after which food service to a site or to the program would be terminated and method of fatlowillg iut�46.9
sure problems have been corrected: s z,
Problems wi11 be corrected immediately. The 'program administrator and program monitor':wJ.1.-1'
ensure correction of all problems.10.
22. Attach copy of your letter to the local Health Department notifying them of your intention to operate a food service at lime sites fisted on 110 attached,
Site Information Sheets
23. When apd how will public statement on nondiscrimination be Issued? (Attach copy of 4tatement.)
The statement Will be included on the News,.Release on May 289 1979
t:
24
• mane ement.f lan: Identify by Name and Title the
ierson(s): '
Name
Title .
A. Authorized to approve purchases or rentals.
'(Specify dollar limitations. a$ applicable.)
Kay.
Stiner
Recreation
Super.O.sor
Name
Title
Vti Authorized to approve the number of hours
Of regular and overtime pay.
Kay
Stiner
Recreation
Supervisor,
¢: Responsible for receiving participation, cost
apd, fq*nue data, +nd for prepering glaimt
Nettle'
�a� .
"
Sit ;; .
j-(let
Title
Recreai:iQn
,�
- l�perv� b�^ +
for rairrtbunement.
i
Jd�h
Al ford `
Park and Recreatlort R..,i reotl
'Jl
Q Reipgnsible..for scheduling and: supervising
Name
'
Title
mon)tors, reviewin4site reports of defician
Kay
Stiner.
Recreation
Supervipor
pes;,restricting or terminating food service
' it.'necesaary and affecting corrective action
ri vl1e Fox
Recreoi,6n
r
Speri al:'f sti ;..
NBrtte
Title
.E, Responsible for coordirwting with officials
• t4 wlsom ute•supervisors report, II applicable,
Ka
Stiner
Recreation
-
.Supervi�or'.
1 certify that the,information, on this application and in the attached Site ,
Information Sheets (Form 15071 is true to the best of my knowledge; that ,
reimbursement will be claimed only for meals served to eligible children at
approved food service sites, and that these sites have been visited and hero
the ceppbility and facilities for the meal service planned for the numt Signature —Authorized Repro;entat
children anticipated to be served. 1 understand that this information is being M von of the C i t Of Lubbock'
given in, connection with the receipt of Federal funds, and that deliberate #4 --t —
misrepresentation may subject me to prosecution under applicable state and Title
Federal criminal statutes. The program must be made available to all eligible April 30, 1979
t ,. _ �...
children regardless of taco, color, or national origin. Approved as to lon: n•' i . Va a- ,,.
Aisistwg City AttemYf
•
Tezd! Jeltjrtrt'ie Nt
af-Nuriten R.rcr.•u r Aa
TIED TO RESO #158 — 5/10/79 Furrnl e
April 197E
9lLplr4.,e No. —'--1
806/762-6411 ext.266
his Is to certify that
TEXASDEPARTMENT
OF HUMAN RESOURCES
COMMODITIES DIVISION
CERTIFICATE OF AUTHORITY
FOR SUMMER FOOD SERVICE PROGRAM
Agreement No.
_ Parks and Recreation Director
Srgranue-Pe sun Authorized f — fitl<
i� designareci .:i the authorir.cd reptcsentarive t,i the
City of Lubbock Parks and Recreation P.O. Box 2000, Lubbock, Texas, 79457
- -' S1;.;; , mtsg Agency —� --_- -� - - Address (Street, City, State, ZIP Code)
.vhich is the governing body of the
Summer Food Program
Natrje of Summer Food Service Program -
,•catvdat Amherst and Guava, 23rd and Ave. L, 27th and Ivory, 323 Ave. F.,
6th and Ave.T., loth and Guava, 35th and Ave. L, 22nd and 5. Ave. C „ Vth a d
?81s�L ber Dr_-.- � 4, ih-and-Ave B 'and
O an Oak, Lubbock,t and s.
is an ni verse ty, t Address (&aet, City, State, "LIP Code) and Oxford -bboTexas
Authority is hereby given the above designated representative to enter into written agree-
ments on behalf of the Sponsoring Agency kith Texas Department of Human Resources,
C-;,;mrnaditi�� Division, for the operation of a Summer Food Service Program, and to present
Lla tas for reirnbursemertts and sign fur the -)ponsorink Agency any other documents or
reports rclaring thereto. -
A;Prn,ed as to torrn:
Citv of Lubbock
Name of Sponsoring Agency
i3 y;
Signature --Official of Sponsoring Agency
Mayor
"Title of Official
( Assistant City Alwr-y
;Apojvd as co tent:
i
i
. of Community Facilities
ij
5/10/79
Date
i)
I
gve..W;
Ers ki n ,
79457
.i
Pyas Department
c f N&-.Lan rw tu•r.es
TIED TO RESO # 158 - 5/ 10/79 Form 1
April 1976
eiepnr rx No.
806/762-6411 ext.267
-,'-his is to certify that
TEXAS DEPARTMENT
OF HUMAN RESOURCES
COMMODITIES DIVISION
CERTIFICATE OF AUTHORITY
FOR SUMMER FOOD SERVICE PROGRAM
Recreation Supervisor
Signature -Person Authorized Title
is designated zs the authorized representative of the
Agreement No.
City of Lubbock Parks adn'Recreation, P.O. Box 2000, Lubbock, Texas 79457
Sponsoring Agency Address (Street, City, State, ZIP Code)
hich is the governing body of the
Summer Food Program I'
Name of Summer Food Service Program
'catedat Amherst and Guava, 23rd and Ave. L, 27th and Ivory, 323 Ave. F., 6th and
Ave. T., 10th and Guava, 35th and Ave. L 22nd and E. Ave. C., 24th and Ave. W, 28th
-and Weber Drive, 3200 Amherst. 40th and AvP. R, 23rd and flak, 7tnith and N. Erskine,
41st and University, 30thAddress (stre.E, City, state, ZIP Co e) and Oxford - Lubbock, Texas 79457 -.
Authority is hereby given the above designated representative to enter into written agree-
ments on behalf of the Sponsoring Agency with Texas Department of Human Resources,
Commodities Division, for the operation of a Summer Food Service Program, and to present
claims for reimbursements and sign for the Sponsoring Agency any other documents or
reports relating thereto.
Apprcved as to form:
Assistant City AtlarW
City of Lubbock
Name of Sponsoring Agency
By:
ature-Official of Sponsoring Agency
Mayor
Title of Official
A pro ed as t cont nt:
CPWr_ of Community Facilities
5/10/79
Date