Form FDACS-02025 "Child Nutrition Programs Food Service Vendor Information Sheet" - Florida

What Is Form FDACS-02025?

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 January 1, 2018;
  • 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-02025 by clicking the link below or browse more documents and templates provided by the Florida Department of Agriculture and Consumer Services.

ADVERTISEMENT
ADVERTISEMENT

Download Form FDACS-02025 "Child Nutrition Programs Food Service Vendor Information Sheet" - Florida

Download PDF

Fill PDF online

Rate (4.8 / 5) 16 votes
Florida Department of Agriculture and Consumer Services
Division of Food, Nutrition and Wellness
CHILD NUTRITION PROGRAMS
NICOLE "NIKKI" FRIED
FOOD SERVICE VENDOR INFORMATION SHEET
COMMISSIONER
7 CFR 210.19(a)(5), 7 CFR 225.6(h)
Please select one:
NEW Food Service Vendor, or
Food Service Vendor Renewal VIN #:_______________
VENDOR INFORMATION
Company Name:
Doing Business As, if applicable:
Mailing Address Line 1:
Mailing Address Line 2:
City, State, Zip Code:
County:
Regional Address Line 1:
Regional Address Line 2:
City, State, Zip:
County:
Website:
List all names/aliases you have
used in the past 24 months, if
applicable:
FDACS-02025 Rev. 01/18
Page 1 of 4
Florida Department of Agriculture and Consumer Services
Division of Food, Nutrition and Wellness
CHILD NUTRITION PROGRAMS
NICOLE "NIKKI" FRIED
FOOD SERVICE VENDOR INFORMATION SHEET
COMMISSIONER
7 CFR 210.19(a)(5), 7 CFR 225.6(h)
Please select one:
NEW Food Service Vendor, or
Food Service Vendor Renewal VIN #:_______________
VENDOR INFORMATION
Company Name:
Doing Business As, if applicable:
Mailing Address Line 1:
Mailing Address Line 2:
City, State, Zip Code:
County:
Regional Address Line 1:
Regional Address Line 2:
City, State, Zip:
County:
Website:
List all names/aliases you have
used in the past 24 months, if
applicable:
FDACS-02025 Rev. 01/18
Page 1 of 4
CONTACT(S) FOR PROCUREMENT NOTICES
This information will be listed publicly on the FDACS Food Service Vendor List.
Please provide the information below of a representative to receive procurement
notices, solicitations from sponsors, emails from FDACS and annual vendor training
opportunities.
Representative
Contact Name:
Title:
Telephone Number:
Fax Number:
Email Address:
AUTHORIZED SIGNATORIES
Please provide a list of individuals that are authorized to enter into contractual
agreements.
Name (Last, First)
Title
CORPORATE PROFILE
Primary Business Function
Please mark the one box that best describes your company.
Caterer
Food Service Management Company
Restaurant
Other: _______________________________
FDACS-02025 Rev. 01/18
Page 2 of 4
Primary Program(s)
Mark the USDA program that your company has an interest in participating.
National School Lunch Program (NSLP)
Summer Food Service Program (SFSP)
School Breakfast Program (SBP)
Fresh Fruit and Vegetable Program (FFVP)
Special Milk Program (SMP)
Afterschool Snack Program (ASSP)
NUTRITION INFORMATION
Specialty Menu
Mark the box next to each specialty or diet menu that your company can provide.
Please mark all that apply.
V
Vegetarian
H
Halal
VG
Vegan
L
Latin
F
Gluten-Free
N
All Natural
DF
Dairy-Free
R
Renal
PF
Peanut-Free
K
Kosher
PKF
Pork-Free
P
Puree
CF
Casein-Free
ORG
Organic
SF
Salt-Free
SS
Shelf-Stable
ALG
Special Allergy
DIAB Diabetic
LS
Low-Sodium
Other ___________
FDACS-02025 Rev. 01/18
Page 3 of 4
SERVICE AREA(S)
Mark the box next to each Florida county or counties that your company is able and
willing to contract for food services.
Alachua
Franklin
Lee
Pinellas
Baker
Gadsden
Leon
Polk
Bay
Gilchrist
Levy
Putnam
Bradford
Glades
Liberty
Santa Rosa
Brevard
Gulf
Madison
Sarasota
Broward
Hamilton
Manatee
Seminole
Calhoun
Hardee
Marion
St. Johns
Charlotte
Hendry
Martin
St. Lucie
Citrus
Hernando
Miami-Dade
Sumter
Clay
Highlands
Monroe
Suwannee
Collier
Hillsborough
Nassau
Taylor
Columbia
Holmes
Okaloosa
Union
DeSoto
Indian River
Okeechobee
Volusia
Dixie
Jackson
Orange
Wakulla
Duval
Jefferson
Osceola
Walton
Escambia
Lafayette
Palm Beach
Washington
Flagler
Lake
Pasco
All Counties
______________________________________________
__________________
SIGNATURE OF AUTHORIZED OFFICIAL
Date
______________________________________________
__________________
PRINT NAME
Date
FDACS-02025 Rev. 01/18
Page 4 of 4
Page of 4