CHILD AND ADULT CARE FOOD PROGRAM ANNUAL
INFORMATION CERTIFICATION - INDEPENDENT CENTERS

NORTH DAKOTA DEPARTMENT OF PUBLIC INSTRUCTION

CHILD NUTRITION AND FOOD DISTRIBUTION PROGRAMS

SFN 59995 (7/2011)

Center Name

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

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

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

·  The Center itself, and the Center’s principals, are not currently on the CACFP National Disqualified list;

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

·  The Center itself, and the 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 Center have been convicted of any activity that occurred during the past seven years and that indicated a lack of business integrity; and

·  The Center 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