Form FDACS-16079 "Application and Agreement for Donated Usda Foods Csfp Participant" - Florida

What Is Form FDACS-16079?

This is a legal form that was released by the Florida Department of Agriculture and Consumer Services - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2014;
  • The latest edition provided by the Florida Department of Agriculture and Consumer Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form FDACS-16079 by clicking the link below or browse more documents and templates provided by the Florida Department of Agriculture and Consumer Services.

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Download Form FDACS-16079 "Application and Agreement for Donated Usda Foods Csfp Participant" - Florida

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Florida Department of Agriculture and Consumer Services
Division of Food, Nutrition and Wellness
APPLICATION AND AGREEMENT
Bureau of Food Distribution
FOR DONATED USDA FOODS
Holland Building
600 S. Calhoun St.
CSFP PARTICIPANT
NICOLE "NIKKI" FRIED
Tallahassee, Florida 32399-0800
COMMISSIONER
Phone: (850) 617-7170
7 CFR 247
Fax: (850) 617-7171
Part I. Application for Participation
1.
Agency Name:
FEID #
Is organization (check one):
Food Bank
Other non-profit organization _____________________
2.
Mailing Address:
City:
County:
Zip Code:
3.
Physical Address:
City:
County:
Zip Code:
4.
Telephone Number(s): (
)
-
(
)
-
Fax: (
)
-
E-Mail:
5.
CSFP Contact Person:
Title:
6.
This organization’s fiscal year ends on:
(month and day) each year.
7.
Do you participant in any other federal feeding programs in Florida? (Check all that apply)
National School Lunch Program
Summer Food Service Program
Child and Adult Care Food Program
The Emergency Food Assistance Program
Other _________________________________
8.
How many preparation and storage sites do you operate that will be utilizing USDA Foods for CSFP?
(Please attach a list if there is more than one.)
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
For Office Use Only:
Date Application Received:
Date Application Reviewed:
[ ] Approved or [ ] Rejected
Date:
By:
FDACS 16079 08/14
Page 1 of 4
Florida Department of Agriculture and Consumer Services
Division of Food, Nutrition and Wellness
APPLICATION AND AGREEMENT
Bureau of Food Distribution
FOR DONATED USDA FOODS
Holland Building
600 S. Calhoun St.
CSFP PARTICIPANT
NICOLE "NIKKI" FRIED
Tallahassee, Florida 32399-0800
COMMISSIONER
Phone: (850) 617-7170
7 CFR 247
Fax: (850) 617-7171
Part I. Application for Participation
1.
Agency Name:
FEID #
Is organization (check one):
Food Bank
Other non-profit organization _____________________
2.
Mailing Address:
City:
County:
Zip Code:
3.
Physical Address:
City:
County:
Zip Code:
4.
Telephone Number(s): (
)
-
(
)
-
Fax: (
)
-
E-Mail:
5.
CSFP Contact Person:
Title:
6.
This organization’s fiscal year ends on:
(month and day) each year.
7.
Do you participant in any other federal feeding programs in Florida? (Check all that apply)
National School Lunch Program
Summer Food Service Program
Child and Adult Care Food Program
The Emergency Food Assistance Program
Other _________________________________
8.
How many preparation and storage sites do you operate that will be utilizing USDA Foods for CSFP?
(Please attach a list if there is more than one.)
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
For Office Use Only:
Date Application Received:
Date Application Reviewed:
[ ] Approved or [ ] Rejected
Date:
By:
FDACS 16079 08/14
Page 1 of 4
PART II: Agreement with CSFP Program Participants
In order to carry out the program of the United States Department of Agriculture (USDA)
for the donation of USDA Foods, the Florida Department of Agriculture and Consumer
Services, Bureau of Food Distribution and the applicant Recipient Agency (RA) do
covenant and agree as follows:
A. Florida Department of Agriculture and Consumer Services agrees to:
1. Order the USDA Foods used in the Program.
2. Provide guidance on the approved food package content.
3. Provide the caseload numbers to the RA on a monthly basis for packaging purposes.
4. Provide the RA regulatory guidance and oversight in administering the Commodity
Supplemental Food Program.
5. Allocate administrative funds to RA for services rendered as they are available from the
USDA.
6. Monitor the RA for compliance to rules and regulations of the program.
B. The RA agrees to:
1. Receive the commodities used in the Florida CSFP.
2. Break down the commodities into the Food Packages in accordance with the approved
food package guide rate.
3. Store the food until delivered.
4. Deliver the packages to sub-distributing agencies on a monthly basis.
5. Receive the product into the inventory system and track until a written receipt is obtained
upon delivery to sub-distributing agencies.
6. Be responsible to the State CSFP Agency for any loss resulting from improper storage
care or handling of commodities entrusted to the RA for oversight.
7. Maintain accurate and complete records with respect to activities under the program and
retain such records for a period of five (5) years from the close of the fiscal year to which
they pertain, or longer if the records are related to unresolved claims actions, audits or
investigations.
C. Other Conditions:
1.
It is understood and agreed upon that the federal regulations for the United States
Department of Agriculture, relating to the Food and Nutrition Services, 7 CFR Part 250
and 247, are made a part of this Agreement and that the Bureau of Food Distribution and
the RA are to abide by all of the conditions and terms set forth in the Regulations.
2.
This agreement is permanent pursuant to 7 CFR 247; however, it may be amended as
necessary by the Department or at the request of the United States Department of
Agriculture.
FDACS 16079 08/14
Page 2 of 4
3.
Agreement may be terminated for cause by either party giving 30 days written notice to
the other. Upon any termination, the RA agrees to comply with Bureau of Food
Distribution instructions in regard to the disposition of any donated USDA Foods
remaining in their possession or control.
4.
The RA must update all pertinent information annually. Any changes during the year
should be reported to the Bureau as soon as possible to ensure the accuracy of the
records.
5.
The Undersigned Entity (Sub-recipient) receiving federal financial assistance under this
agreement hereby acknowledges and agrees that it will comply with the applicable
provisions of the latest version of Office of Management and Budget Circular A-133
(Audits of States, Local Governments, and Non-Profit Organizations). Copies of the
latest version of the above which would relate to the undersigned Entity (Sub-recipient)
are available for review at the following address:
Department of Agriculture and Consumer Services
Division of Administration, Contract Administrator
Room 509, Mayo Building
Tallahassee, Florida 32399-0800
If the undersigned Entity (Sub-recipient) expends $500,000 or more in federal financial
assistance in a fiscal year, either directly from federal agencies or indirectly through other
units of state or local governments, or a combination thereof, the Entity (Sub-recipient)
shall have an audit made in accordance with the applicable Office of Management and
Budget Circular A-133 (Audit of States, Local Governments, and Non-Profit
Organizations). The $500,000 threshold specified above shall be from all federal
sources, not just the amount provided by this agreement. A copy of this audit shall be
submitted to the Department of Agriculture and Consumer Services, Bureau of Food
Distribution, within nine (9) months after the end of the agency’s fiscal year to which it
pertains. The undersigned Entity (Sub-recipient) receiving funds under this agreement
hereby agrees that it will allow the Department of Agriculture and Consumer Services and
any federal agency to audit the Entity’s (Sub-recipient’s) books for compliance with the
above circular.
If applicable, based on your reported fiscal year end date of
(Month, day),
your audit is due at the Department no later than
, (Month, day) each year.
6.
Certification Regarding Lobbying Language. If this agreement contains federal funding in
excess of $100,000, the Entity (Sub-recipient) must, prior to agreement execution,
complete the Certification Regarding Lobbying form. If a Disclosure of Lobbying Activities
form, Standard Form LLL, is required, it may be obtained from the Agreement Manager.
All disclosure forms as required by the Certification Regarding Lobbying form must be
completed and returned to the Food Distribution Office Agreement Manager.
7.
The recipient agency (RA) is informed that the Department shall consider the
employment by any RA of unauthorized aliens, a violation of Section 274A(e) of the
Immigration and Nationality Act. Such violation shall be cause for unilateral cancellation
of this agreement.
FDACS 16079 08/14
Page 3 of 4
8.
The recipient agency is informed that a person or affiliate who has been placed on the
convicted vendor list following a conviction of a public entity crime may not submit a
contract to provide any goods or services to a public entity, may not submit a bid on a
contract with a public entity for the construction or repair of a public building or public
work, may not submit bids on leases of real property to a public entity, may not be
awarded or perform work as a contractor, supplier, subcontractor, or consultant under a
contract with any public entity, and may not transact business with any public entity in
excess of the threshold amount provided in Section 287.01, Florida Statutes, for
CATEGORY TWO for a period of 36 months from the date of being placed on the
convicted vendor list.
9.
In accordance with Federal Law and U.S. Department of Agriculture policy, this institution
is prohibited from discriminating on the basis of race, color, national origin, sex, age, or
disability. To file a complaint of discrimination, write USDA, Director, Office of
Adjudication, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410 or call toll
free (866) 632-9992 (Voice). Individuals who are hearing impaired or have speech
disabilities may contact USDA through the Federal Relay Service at (800) 877-8339; or
(800) 845-6136 (Spanish). USDA is an equal opportunity provider and employer.
D. The Catalog of Federal Domestic Assistance (CFDA) reference for the Commodity
Supplemental Food Program is Number 10.565.
Signature of RA Authorized Representative
Date
Print Name and Title
Division of Food, Nutrition and Wellness
Date
Print Name and Title
FDACS 16079 08/14
Page 4 of 4