Application for New Child and Adult Care Food Program (CACFP ...

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Send completed applications to one of the following: Mail to: Texas Department of Agriculture Food and Nutrition Attn: F&N Business Operations – Applications P.O. Box 12847 Austin, Texas 78711 Overnight to: Texas Department of Agriculture Food and Nutrition Attn: F&N Business Operations – Applications 1700 North Congress Ave. Austin, Texas 78701 E-mail to: BOps.Applications@TexasAgriculture.gov Fax to: 888-223-8645 Revised September 27, 2011
Texas Department of Agriculture Child and Adult Care Food Program Application Tracking – Day Care Homes August 2011 Organizations use this form to show the submittal status of each document required in the application process for day care homes. SECTION I – ORGANIZATION INFORMATION 1. Name of Organization: 2. CE ID: SECTIONS II – CONTRACTING ENTITY APPLICATION PACKET Contracting Entity Application – Day Care Homes Contracting Entity Budget Detail – Day Care Homes Budget Justification and Disclosure – Day Care Homes (upload document) Board of Directors – Day Care Homes Annual Audit Submitted in TX-UNPS Attached SECTION III – CHECKLIST ITEMS: CE APPLICATION – DAY CARE HOMES FND Permanent Agreement Permanent Agreement Contracting Entity Specific Amendment Vendor Direct Deposit/Advance Payment Notification Authorization (74-176) Application for Texas Identification Number (AP-152) Attached A. Copy of document from the IRS that establishes your EIN Contracting Entity Management Plan – Day Care Homes form, with attachments A. Monitoring Staff Information – Day Care Homes form B. Proof of IRS 501(c)(3) Tax Exemption C. Organizational Chart D. Day Care Home Appeal Procedures Performance Bond Pre-Award Civil Rights Compliance Review Subcontractor Agreements A. Invitation for Bid and Contract for Purchased Meals (IFB) B. Contract with a Public School for Meals C. Sub-contractor and/or Consultant Agreements Legal Documents A. Articles of Incorporation, Assumed Name Certificate, Certification of Formation (submit all that apply to your organization) B. Government Issued ID for each principal of the contracting entity (applies to non-governmental contracting entities only).
Page 1 and 2: Application for Child and Adult Car
Page 3 and 4: Annual Audit √ √ Those CEs that
Page 5 and 6: Legal Documents √ √ Articles or
Page 7: Permanent Agreement Between Sponsor
Page 11 and 12: INSTRUCTIONS FOR FOOD & NUTRITION C
Page 13 and 14: Texas Department of Agriculture Chi
Page 15 and 16: CACFP Contracting Entity Applicatio
Page 19 and 20: Page 3 of 4 35. Do you engage in an
Page 25 and 26: Texas Department of Child and Adult
Page 27 and 28: Budget Justification and Disclosure
Page 29 and 30: Budget Justification and Disclosure
Page 33 and 34: Page 3 of 3 SECTION IV - CERTIFICAT
Page 37 and 38: Texas Department of Agriculture Foo
Page 39 and 40: Page 2 of 2 CONTRACTING ENTITY’S
Page 41 and 42: II. PROGRAM DESIGNATION The above n
Page 43 and 44: a. If such funds, assets, or proper
Page 45 and 46: elementary schools under its jurisd
Page 47 and 48: 10. Submit claims for reimbursement
Page 49 and 50: 5. Submit Claims for Reimbursement
Page 51 and 52: 4. Termination for Change in Owners
Page 53 and 54: EXHIBIT A SCHEDULES A-K (Applicable
Page 57 and 58: Schedule C School Breakfast Pattern
Page 59 and 60:
Schedule E School Lunch Pattern for
Page 61 and 62:
Schedule H Required Minimum Calorie
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Schedule K Afterschool Care Program
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EXHIBIT C CIVIL RIGHTS POLICY COMPL
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Exhibit D (Continued) Instructions
Page 69 and 70:
Certification Regarding Lobbying EX
Page 71 and 72:
EXHIBIT F STANDARD FORM-LLL, DISCLO
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Exhibit F (cont.) . Instructions fo
Page 75 and 76:
Exhibit G Clean Air and Water (Appl
Page 77 and 78:
Exhibit H Schedule of Applicable La
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Accepted and agreed: TEXAS DEPARTME
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Form 74-176 (Back)(Rev.9-10/9) Inst
Page 83 and 84:
APPLICATION FOR TEXAS IDENTIFICATIO
Page 85 and 86:
Contracting Entity Management Plan-
Page 87 and 88:
Contracting Entity Management Plan-
Page 89 and 90:
Page 2 of 3 1. Contracting entities
Page 91 and 92:
Texas Department of Agriculture Chi
Page 93 and 94:
Page 2 of 3 PART II - MONITORING HO
Page 95 and 96:
1 STATE OF TEXAS § BOND NO._______
Page 97 and 98:
PERFORMANCE BOND Instructions PURPO
Page 99 and 100:
Line 15 - Signature — The person
Page 101 and 102:
Texas Department of Agriculture Foo
Page 103 and 104:
Pre-Award Civil Rights Compliance R
Page 105 and 106:
INSTRUCTIONS FOR FOOD & NUTRITION P
Page 107 and 108:
GOVERNING BODY MEMBER Name of Organ
Page 109 and 110:
FND-101 Certificate of Authority fo
Page 111 and 112:
Instructions for FND-101 Certificat
Page 113 and 114:
CACFP Provider Application - Day Ca
Page 115 and 116:
INSTRUCTIONS FOR FOOD & NUTRITION C
Page 117 and 118:
Page 3 of 4 26. Alternate Contact A
Page 119 and 120:
Texas Department of Agriculture Chi
Page 121 and 122:
Form H1542 Page 3/09-2007 Certifica
Page 123 and 124:
DETAILED INSTRUCTIONS Name of Spons
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