Form FDACS-01804 "Direct Certification Report Sponsor Agreement" - Florida

What Is Form FDACS-01804?

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 December 1, 2019;
  • 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 fillable version of Form FDACS-01804 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-01804 "Direct Certification Report Sponsor Agreement" - Florida

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Florida Department of Agriculture and Consumer Services
Division of Food, Nutrition and Wellness
DIRECT CERTIFICATION REPORT
SPONSOR AGREEMENT
NICOLE “NIKKI” FRIED
7 CFR 245
COMMISSIONER
FDACS Contract Number
Sponsor Agreement Number
Sponsor Name
Food Service Director or Designee
Name of Individual to Access Report(s) (User)
User’s Telephone Number
Alternate Number
User’s Email Address
STATEMENT OF POLICY
It is a policy of the Department of Agriculture and Consumer Services (“Department”) to
exercise due diligence to protect confidential and exempt information by using appropriate
administrative, technical, and physical controls.
Department information or any other State information which by law is confidential must be
protected from unauthorized access, destruction, disclosure, modification, replication, or use.
Confidential information is defined as information which is confidential by law and information
which requires protection from unauthorized access by virtue of its legal exemption from the
Florida Public Records Act.
By signing this agreement, the sponsor’s agent understands the direct certification report(s)
contain confidential information per Chapter 119, Florida Statutes (Public Records Act). The
sponsor’s agent and worker certifies they have read and agree to the following in reference to
the security of the contents of the report(s) as required by Chapter 71A-1, Florida Administrative
Code (F.A.C.), Florida Information Technology Resource Security Policies and Standards. The
details can be accessed via the following link:
https://www.flrules.org/gateway/ruleNo.asp?id=71A-1.
Signature of Food Service Director or Designee
Date
FDACS-01804 Rev. 12/19
Florida Department of Agriculture and Consumer Services
Division of Food, Nutrition and Wellness
DIRECT CERTIFICATION REPORT
SPONSOR AGREEMENT
NICOLE “NIKKI” FRIED
7 CFR 245
COMMISSIONER
FDACS Contract Number
Sponsor Agreement Number
Sponsor Name
Food Service Director or Designee
Name of Individual to Access Report(s) (User)
User’s Telephone Number
Alternate Number
User’s Email Address
STATEMENT OF POLICY
It is a policy of the Department of Agriculture and Consumer Services (“Department”) to
exercise due diligence to protect confidential and exempt information by using appropriate
administrative, technical, and physical controls.
Department information or any other State information which by law is confidential must be
protected from unauthorized access, destruction, disclosure, modification, replication, or use.
Confidential information is defined as information which is confidential by law and information
which requires protection from unauthorized access by virtue of its legal exemption from the
Florida Public Records Act.
By signing this agreement, the sponsor’s agent understands the direct certification report(s)
contain confidential information per Chapter 119, Florida Statutes (Public Records Act). The
sponsor’s agent and worker certifies they have read and agree to the following in reference to
the security of the contents of the report(s) as required by Chapter 71A-1, Florida Administrative
Code (F.A.C.), Florida Information Technology Resource Security Policies and Standards. The
details can be accessed via the following link:
https://www.flrules.org/gateway/ruleNo.asp?id=71A-1.
Signature of Food Service Director or Designee
Date
FDACS-01804 Rev. 12/19