Okaloosa County BOCC — May 4, 2013 — FDACS AGREEMENT RENEWAL 2013 2014 005 — reading text

THE Mayo BUILDING 407 SoutH CALHOUN STREET TALLAHASSEE, FLORIDA 32399-0800 Drvision oF Foon, Nutrition AND WELLNESS BUREAU OF Foop DISTRIBUTION (850) 617-7170 FLORIDA DEPARTMENT OF AGRICULTURE AND CONSUMER SERVICES COMMISSIONER ApaM H. Putnam MEMORANDUM TO: National School Lunch Program (NSLP) Participants FROM: Andy Windsor, Supervisor, Program Oversight Section HA) DATE: March 4, 2013 RE: Agreement Renewal/Update for NSLP SY2013/14 Enclosed please find the documents required for updating your Agency’s information on file with the Bureau of Food Distribution. Please update, in full, the enclosed Agreement Update form, Emergency/Disaster Contact Information form and Delegation of Authority form. Please attach a copy of any requested Contracts, if applicable. Also, enclosed for your convenience please see the “Who to Call List” for office information. If your Agency has a new admmnistrator/director who will be signing documents related to the Food Distribution program, a new Delegation of Authority must be signed by that Agency Head and submitted with the returned Update Package. If there is no change to the Delegation of Authority from the previous year, please write “No Change” on the form. Please remember to put your Agency name and RA# on all of the documents returned to this office. Inasmuch as original signatures are required, we will be unable to accept any faxed/scanned. forms. Please return all of the required documents no later than COB April 30, 2013 to: Florida Department of Agriculture Program Oversight Section, BFD 407 South Calhoun Street, M-39 Tallahassee, FL 32399-0800 Attention: Gail Kapitulnik Thank you for your cooperation, and if you have any questions or need assistance, please do not hesitate to contact Gail Kapitulnik at (850) 617-7160. Enclosures t 2 1-800-HELPFLA Flirida. www.FreshFromFlorida.com EMERGENCY / DISASTER CONTACT LIST 2013 (Please print or type all information) Date: APYil 2, Agency Name: Okaloosa County Board of County Commissioners Program Number:_82002 Address: ©/0 Contracts & Grants 1804 Lewis Tumer Bivd., Suite 206 Fort Walton Beach, Florida 32547 RECIPIENT AGENCY INFORMATION Contact Person: Brenda L. Bailey Title. Contracts & Grants Mgr. Phone Numbers: Work: (850) 651-7200 ext 4381 Fax: (850) 609-5029 Home: Cell: Emergency: Email: bbailey @clerkofcourts.cc Alternate Contact: Marcella B. Eubanks Alternate Phone: (850) 651-7200 ext. 4383 Email: Meubanks @clerkofcourts.cc Agency Head:__ Don R. Amunds, Chairman DISASTER INFORMATION Contact Person: April McQueen Title. Lieutenant Phone Numbers: Work: (850) 689-5645 Fax: (850) 689-5643 Home: Cell: (850) 758-6202 Emergency: Email: amcqueen @co.okaloosa.fl.us Alternate Contact:Dennis Knighten Alternate Phone: (850) 689-5690 ext 1315 Email: dknighten @co.okaloosa.fl.us WAREHOUSE INFO TION ency Warehouse Warehouse Name: Contact Person: Address: City: State: Zip: Phone Numbers: Work: Fax: Home: Cell: Emergency: Email: Altemate Contact: Alternate Phone: Email: FOOD SAFETY INFORMATION Contact Person: April McQueen Title: Lieutenant Phone Numbers: Work: (850) 689-5645 Fax. (850) 689-5643 Home: Cell: Emergency: Email: amcqueen @ co.okaloosa.fl.us Alternate Contact: Dennis Knighten Alternate Phone: (850 689-5690 ext 1315 Email: dknighten@co.okaloosa-fl.us Florida Department of Agriculture and Consumer Services Division of Food, Nutrition and Wellness ——— saves 7 eos : SCHOOL LUNCH PROGRAM . n a07 8 Caboun St ( , Florida 99-0800 ADAM H. PUTNAM USDA FOODS PROGRAM ae Phone. (850) 617.7170 7 CFR 250 Fax: (850) 617-7171 SCHOOL AGREEMENT UPDATE FOR SY- _ 2013-14 FEID# 59-6000765 RA Name: Okaloosa County Department of Corrections _ RA #82002 Address: c/o Contracts & Grants, 1804 Lewis Tumer Blvd. Suite 206, Fort Walton Beach, Florida, 32547 l affirm that this organization wishes to continue as an agency receiving U.S.D.A. commodities from the Florida Department of Agriculture and Consumer Services (FDACS), Bureau of Food Distribution. I understand that the terms and conditions in our agreement(s) remain the same unless notified in writing by the Bureau of Food Distribution. Please update the following information and return to the Bureau at the address above: Are you currently approved by FDACS for participation in the National School Lunch Program (NSLP)? (_] No If no, please proceed to section B. below [x] Yes (Program # 91-0303/82002 A. All Agencies: Is organization (check one): — ["_] Non-profit/Faith-based...[_] Non-profit/Secular...[_] Educational institution [2] Government agency...[7] Other 1. Do you currently contract for services with a Food Management Company? [_] No (dd Yes Ifypes, please submit a copy of that contract. 2. Do you have your own warehouse? No L] Yes Jfyes, please provide address. 3. Do you currently contract for services with a Food Storage Warehouse, other than one which maintains a contract with the Bureau of Food Distribution? No LJ Yes Ifves, please submit a copy of that contract 4, Do you currently participate in processing? K]No [[] Yes 5. Total number of lunches served in the immediately preceding school year (do not include staff): 4756 Total number of days that lunches are served each year: 365 B. Contact Person: Brenda L. Bailey Title: Contracts & Grants Manager (Contact person must be a school district/school employee. May not be a contractor, FSMC employee, etc.) Signature - Agency official with binding signature authority (must be a school district/school employee): Signature Title: Chairman The Catalog of Federal Domestic Assistance (CFDA) reference for this program is NSLP, Number 10.555. 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. (Please review the information regarding your agency and make any corrections, as needed.) FDACS-06419 Rev. 02/13 Division of Food, Nutrition and Weliness DELEGATION OF AUTHORITY 7 CFR 250 & 251 ADAM H. PUTNAM COMMISSIONER Florida Department of Agriculture and Consumer Services Bureau of Food Distribution Mayo Bidg., 2” Floor (M39) 407 S. Calhoun St. Tallahassee, Florida 32399-0800 Phone: (850) 617-7170 Fax: (850) 617-7171 Print Name Print Title do hereby authorize Print Name Print Title to execute the Application/Agreement package for distribution and use of USDA foods on behalf of Okaloosa Board of County Commissioners Agency Name Signature Date FDACS Recipient Agency #:__ 82002 NO CHANGE FROM 2012 FDACS-06404 Rev. 08/12