CHILD AND ADULT CARE FOOD PROGRAM ANNUAL
INFORMATION CERTIFICATION

NORTH DAKOTA DEPARTMENT OF PUBLIC INSTRUCTION

CHILD NUTRITION AND FOOD DISTRIBUTION PROGRAMS

SFN 59989 (7/2011)

Sponsor of Center

If there have been changes to any of the items below, please contact our office.

This is to certify that the Sponsor of Center(s) named above meets all of the requirements for renewing institutions contained in 7 CFR 226.6(b)(2). This entity certifies that:

·  The management plan on file with the State Agency is complete and up to date;

·  No sponsored facility or principal of a sponsored facility is currently on the CACFP National Disqualified list;

·  The outside employment policy most recently submitted to the State Agency remains current and in effect;

·  The names, mailing addresses, and dates of birth of all current Sponsor of Center’s principals have been submitted to the State Agency;

·  The Sponsor of Centers itself, and the sponsor’s principals, are not currently on the CACFP National Disqualified list;

·  The list of any publicly funded programs that Sponsor of Centers and principals have participated in the past seven year is current;

·  The Sponsor of Centers itself, and the Sponsor of Center’s principals have not been determined ineligible for any other publicly funded programs due to violation of that program’s requirements in the past seven years;

·  No principals of the Sponsor of Center have been convicted of any activity that occurred during the past seven years and that indicated a lack of business integrity; and

·  The Sponsor of Centers is currently compliant with the required performance standards of financial viability and management, administrative capability, and program accountability as described in
7 CFR 226.6(b)(2)(vii):

Compliance with Performance Standards: Each renewing institution must submit information sufficient to document that is financially viable, is administratively capable of operating the program in accordance with this part, and has internal controls in effect to ensure accountability. To document this, any renewing institution must demonstrate in its application that it is capable of operating in conformance with the following performance standards. The State Agency must only approve the applications of those renewing institutions that meet these performance standards, and must deny the applications of those that do not meet the standards.

Signature / Title / Date