"Food Service Management Contract" - Florida

Food Service Management Contract is a legal document that was released by the Florida Department of Elder Affairs - a government authority operating within Florida.

Form Details:

  • Released on July 1, 2018;
  • The latest edition currently provided by the Florida Department of Elder Affairs;
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Food Service Management Contract
Contracts may be renewed for two consecutive years after the initial contract year.
Step 1: Complete Vendor Contract with the vendor.
Step 2: Complete Memorandum of Agreement.
Step 3: Obtain the required documents from the vendor.
A. Debarment & Suspension Certification, recently completed and signed by Vendor
B. Cop y of Vendor’s current food-service Inspection Report from licensing agenc y,
with any needed explanations for deficiencies
C. Vendor’s current license to operate a food-service facility
D. Current 28-day c ycle menus for each type of meal service vended (breakfast, snacks,
lunch, dinner)
Step 4: Submit a copy of the Vendor Contract, Memorandum of Agreement, and other
required documents to State Agenc y.
Rev.7/18
Food Service Management Contract
Contracts may be renewed for two consecutive years after the initial contract year.
Step 1: Complete Vendor Contract with the vendor.
Step 2: Complete Memorandum of Agreement.
Step 3: Obtain the required documents from the vendor.
A. Debarment & Suspension Certification, recently completed and signed by Vendor
B. Cop y of Vendor’s current food-service Inspection Report from licensing agenc y,
with any needed explanations for deficiencies
C. Vendor’s current license to operate a food-service facility
D. Current 28-day c ycle menus for each type of meal service vended (breakfast, snacks,
lunch, dinner)
Step 4: Submit a copy of the Vendor Contract, Memorandum of Agreement, and other
required documents to State Agenc y.
Rev.7/18
VENDOR CONTRACT
ADULT CARE FOOD PROGRAM
Purpose – This is a contract to furnish meals (unitized, if applicable) to be served to adults participating in the Adult Care Food Program (ACFP), a component of the Child and
Adult Care Food Program established by the United States Department of Agriculture (7 CFR, Part 226), administered by the Florida Department of Elder Affairs. It sets forth
the terms and conditions applicable to the proposed procurement. Upon acceptance, this document and its required attachments shall constitute the contract between the
vendor and the institution named herein. The Caterer may not subcontract for the total meal or the assembly of the meal. Subcontracting includes producing food from
any kitchen other than from the location stated in Section 3 of this contract. The institution is entitled to change the number of meals ordered with 24-hour advance
notice. Increases and decreases in the number of meal orders may be made by the institution, as needed, within a prior notice period mutually agreed upon in the contract.
Please Type or Print Clearly (in Ink)
ACFP Provider: Complete Parts 1, 2, 3 and 7. Vendor: Complete Parts 4, 5 and 6. DOEA/ACFP Representative: Complete Part 8.
1.
Contract Issued by:
Name of Institution/ACFP Provider
Telephone:
(
)
-
Address:
Fax:
(
)
-
City/State:
Zip_
Email address
OTHER CONTRACT O PT IO NS
2.
Initial Vendor Contract
st
year Contract Renewal Option exercised
1
nd
______ 2
year Contract Renewal Option exercised
The following attachments are required:
A. Debarment & Suspension Certification recently completed and signed b y Vendor.
B. Copy of Vendor’s current food-service Inspection Report from licensing agenc y, with an y needed explanations.
C. Vendor’s current license to operate a food-service facilit y.
D. Current 28-day cycle of menus for each type of meal service vended.
VENDOR IN FOR MAT ION
3. The accumulation of 10 high priority violations in 12 calendar
months, beginning July 1 through June 30, an Administrative
Complaint, and/or closure (temporary or permanent) issued by DBPR
4. Price per Meal (Including Tax)
will result in immediate termination of this contract & subsequent
removal from the ACFP catering list.
Name of Approved Food Service Company:
_
Breakfast: $
Kitchen Address: _____________________________________
Supplement (Snack) AM: $
PM: $
Lunch: $
City/State: _____________________________ Zip: _________
5. Contract Commence Date:
/_
/_
Sup per: $
6.
Contract Expiration Date:
/_
/_
Signature:
Caterer Ow ner or Authorized Designee
_
#
ACCEPTANCE BY INSTITUTION/ACFP PROVIDER
7. Signature:
Witness:
Board President or Authorized Designee
Printed Name:
Title:
(Typed or Printed Clearly)
Date:
/_
/
FLORIDA DEPARTMENT OF ELDER AFFAIRS/ACFP APPROVAL
8. Period of Provider Contract: 10/1/
- 9/30/_
Approved Date:
/
/
Denied Date:
/_
/
Signature of DOEA/ACFP Representative:
Rev. 7/18
Certification regarding Debarment, Suspension, Ineligibility and Voluntary
Exclusion Contracts/Subcontracts
This certification is required by the regulation implementing Executive Order 12549, Debarment and Suspension,
signed Februar y 18, 1986. The guidelines were published in the May 29, 1987, Federal Register (52 Fed. Reg.,
pages 20360-20369).
(1)
The prospective vendor certifies, by signing this certification, that neither he nor his principals are
presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
participation in contracting with the Department of Elder Affairs b y an y federal department or agency.
(2)
Where the prospective vendor is unable to certify to an y of the statements in this certification, such
prospective vendor shall attach an explanation to this certification.
Vendor Signature
Date
/_
/_
Printed Name and Title of Authorized Individual
Name of Organization
Page 1 of 2
Rev. 7/18
M:\acfp - current\Application\Application Forms\Food Service Mgmt Annual Contract
Vender Contract
Adult Care Food Program
Certification regarding Debarment, Suspension, Ineligibility and Voluntary
Exclusion Contracts/Subcontracts
1.
Each provider whose contract equals or exceeds $100,000 in federal monies must sign
this debarment certification prior to contract execution. Independent auditors who audit
federal programs regardless of the dollar amount are required to sign a debarment
certification form. Neither the Department of Elder Affairs nor its contract providers
can contract with providers if the y are debarred or suspended by the federal
government.
2.
This certification is a material representation of fact upon which reliance is placed when
this contract is entered. If it is later determined that the signed knowingly rendered an
erroneous certification, the Federal Government may pursue available remedies,
including suspension and/or debarment.
3.
The provider shall provide immediate written notice to the contract manager at an y
time the provider learns that its certification was erroneous when submitted or has
become erroneous due to changed circumstances.
4.
The terms "debarred," "suspended," "ineligible," "person," "principal," and "voluntarily
excluded," as used in this certification, have the meanings set out in the Definitions and
Coverage sections of rules implementing Executive Order 12549 and 45 CFR (Code of
Federal Regulations), Part 76. You ma y contact the contract manager for assistance in
obtaining a cop y of these regulations.
5.
The provider further agrees by submitting this certification that, it shall not knowingl y
enter an y subcontract with a person who is debarred, suspended, declared ineligible, or
voluntarily excluded from participation in this contract unless authorized by the Federal
Government.
6.
The provider further agrees by submitting this certification that it will require each
subcontractor of this contract whose payment will equal or exceed $100,000 in federal
monies, to submit a signed copy of this certification with each contract.
7.
The Department of Elder Affairs and its contract providers may rel y upon a certification
of a provider that is not debarred, suspended, ineligible, or voluntaril y excluded from
contracting/subcontracting unless it knows that the certification is erroneous.
Page 2 of 2
Florida Department of Elder Affairs / Adult Care Food Program
Memorandum of Agreement to Furnish Food Service
This Agreement is made and entered into by and between______________________________________________
Name of Institution
whose address is
and the
Institution’s Address
_______________________________ whose address is _________________________________________________________.
Name of Food Service Vendor
Food Service Vendor’s Address
The Food Service Vendor agrees to furnish meals from the above location daily, except for attached list of holidays or other days of in-
operation.
Menus will meet or exceed the Adult Care Food Program pattern, as outlined in the ACFP Policy Manual, ACFP Food Crediting Guide and
USDA Buying Guide. Menus will be created by:
Adult Care Center or
Food Service Vendor.
28 day menu cycle(s) for:
breakfast
a.m. snack
lunch
p.m. snack
supper is/are attached.
Attached menu cycle is the proposed menu cycle. Menu cycle must be approved by ACFP Contract Manager prior to use. Adult Care Center
or Corporation/Institution must approve menu cycle substitutions prior to meal service. Adult Care Center or Corporation/Institution will not
pay for unapproved, inappropriate menu substitutions.
Food Service Vendor will provide meals in
bulk or
individual containers. Each container must be labeled with meal type, food item, date
of production, and serving size. If meals are provided in bulk, appropriate measured serving utensils will be provided by:
Adult Care Center
or
Food Service Vendor.
Meals will be:
picked up by Adult Care Center or
delivered by Food Service Vendor.
Meals will be:
available for pick up at ________ (+/- 10 minutes) or
delivered by Food Service Vendor at ________
(+/- 10 minutes). Adult Care Center or Corporation/Institution may not pay for meals provided outside approved time frame.
Food safe, transportation containers capable of maintaining potentially hazardous hot food at 140 degrees F or above, and potentially
hazardous cold foods at 41degrees F or below, will be provided in an adequate quantity by:
Adult Care Center or
Food Service Vendor.
Adult Care Center will ensure potentially hazardous foods are received at appropriate temperatures and will ensure appropriate temperatures
are maintained prior to serving. Adult Care Center will not accept nor pay for potentially hazardous foods delivered or picked up at the
incorrect temperature.
Daily or Weekly delivery slips, in accordance with ACFP policy 5.14 or 6.15 will be created by:
Adult Care Center or
Food Service Vendor, and will be used. Adult Care Center will ensure delivery slips are in accordance with ACFP policy.
Food Service Vendor will submit billing invoice for payment within 30 days. Invoice will be mailed to:
Adult Care Center address or
Day Care Corporation/Institution address or
other: _________________________________________.
Food Service Vendor agrees to furnish meals, complete with required
paper products,
condiments and
milk pursuant to the following:
Name of Institution and Address of the facility
Projected # of Daily
Unit Price
Delivery or Pick up Time
Meals
Site# 1
Breakfast:
______
Breakfast:
______
Breakfast:
______
AM Snack: ______
AM Snack: ______
AM Snack: ______
Lunch:
______
Lunch:
______
Lunch:
______
PM Snack: ______
PM Snack: ______
PM Snack: ______
Site# 2
Supper:
______
Supper:
______
Supper:
______
Food Service Vendor will maintain receipts, cost determination records and production records for a period of three (6) years after the end of
the agreement period to which they pertain. These records will be made available to Adult Care Center, Day Care Corporation/Institution,
State Agency, USDA and / or the Comptroller’s Office for audit purposes.
This Agreement covers the period of _________, 20___ through _________, 20___. Period will not exceed 365 days.
If, for any reason, this agreement is no longer desired, either party may terminate these services by giving two weeks written notice.
If the Food Service Vendor has an accumulation of 10 high priority violations (July 1-June 30), an Administrative Complaint, and/or closure
issued by DBPR, this agreement will be terminated immediately and automatically without further action from the Department.
WITNESS WHEREOF: The parties hereto have caused this agreement to be executed by their duly authorized officers:
_______ By: _________________________________________ Witness: __________________________________________
Date
Day Care Corporation / Institution
Witness to Day Care Corporation / Institution
Authorized Representative’s signature
_______ By: _________________________________________ Witness: __________________________________________
Date
Food Service Vendor
Witness to Food Service Vendor Authorized
Representative’s signature
Attached:
-Excluded holidays or inoperative days
-Current Food Service Inspection Report
Rev. 7/2018
-28 day menu cycle