Commercial Refrigerator/Industrial Platform Scales Grant Application – Fall 2014
Second Harvest Food Bank of NW NC
Commercial Refrigerator/Industrial Platform Scales Grant Application
3655 Reed St. • Winston Salem • NC • 27107
Second Harvest Food Bank of Northwest NC is excited to extend a Request for Application to our partner
agencies to apply for one or more of the following: (1) commercial refrigerator unit or (1) ULINE
industrial platform scale. Each program may apply for one or both of the above via the same application
form. However, no program will be awarded more than one item/grant for the Fall 2014 grant cycle.
Therefore, should your program choose to apply for a commercial refrigerator, a platform scale and a
Food Acquisition Matching Grant (see separate application), please understand that your program will
only be eligible to receive ONE of these items/grants during this grant cycle. We encourage every
program in need of greater capacity for refrigerated storage and/or platform scales to apply, as
recipients will be chosen from across our service area and from all types and sizes of programs.
Applications must be submitted by close of business Friday, October 31st, 2014.
Late applications will not be accepted. No exceptions.
The equipment available through this application process is described below.
REFRIGERATOR – Arctic Air Commercial Model No. AR23 –
Reach-In Refrigerator, one-section, 23 ft. capacity, 26.75”W x 32.75”D x 82.75”H (height includes 6”
for casters), EnergyStar compliant, electronic thermostat with external digital LED display,
115v/60/1, 6 amps, three adjustable, heavy-duty epoxy coated wire shelves, self-closing door that will
remain open at 90 degrees, lockable, field reversible door, tested to NSF Standard 7 requirements for
open food storage, stainless steel exterior construction, 1-year parts and labor warranty and a 5-year
compressor warranty.
PLATFORM SCALES – ULINE Deluxe Model No. H-747 –
Platform size 18 x 23”; capacity is 660 lbs., accuracy within 0.1 lb.; unit weighs approximately 52 lbs.;
operates on rechargeable batteries or AC adapter (included); auto zero tracking; stainless steel
platform; recalls last weight; removable 26” tower included; calculates sample weight; counts up to
999,999 pieces.
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Commercial Refrigerator/Industrial Platform Scales Grant Application – Fall 2014
**Before submitting the application, please ensure that the program is in compliance with Monthly
Service and TEFAP reporting and that the account balance is current.
PLEASE NOTE:
Applications received after 5:00 p.m. on Friday, October 31st will not be considered, so please submit
applications as soon as possible to avoid any last minute complications. Grant recipients will be
announced via email on Friday, November 21st. Recipients will be responsible for coordinating
refrigerator pick up directly from TriMark Foodcraft, 2601 Hope Church Road, Winston-Salem NC
27103. Platform scales will be available for pick-up at Second Harvest Food Bank. Deadlines and
detailed pickup instructions will be provided to grant recipients on Friday, November 21st. Should the
program close or stop providing services to the community for any reason, the recipient program shall
return the commercial refrigerator or platform scale to Second Harvest Food Bank to be re-granted to
an active food distribution site. If you are not able to fulfill any of these grant requirements, please do
not apply.
Program Information
Agency/Program Name: ________________________________________________________________
Program Number: ________________________________________________________________
County: ______________________________________________________________________________
Phone Number: _______________________________________________________________________
Email Address: ________________________________________________________________________
Contact Person: _______________________________________________________________________
Program Type (Please Circle Only One):
Food Pantry
Soup Kitchen
Shelter
Please place a check mark beside the unit(s) for which you are applying:
( ) REFRIGERATOR – Arctic Air Commercial Model No. AR23
( ) PLATFORM SCALES – ULINE Deluxe Model No. H-747
1. What is the program’s current refrigerated capacity and/or platform scale capacity (i.e. none,
two upright refrigerators, one platform scale, two table scales etc.)?
______________________________________________________________________________
______________________________________________________________________________
________________________________________________________________________
2. If awarded, will this equipment replace existing equipment?
Yes
No
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Commercial Refrigerator/Industrial Platform Scales Grant Application – Fall 2014
3. Circle the products your program regularly accesses from Second Harvest Food Bank:
SNAP
PRODUCE
TEFAP
EGGS
FOOD PURCHASE
FOOD DRIVE/SALVAGE
MEATS
TRIAD COMMUNITY KITCHEN
4. Did the program submit all monthly reports by the deadline during January 2014 - September
2014? (Answering no to this question does not automatically make a program ineligible to apply.)
Yes
5.
No
If no, what are the plans to ensure that the program remains in compliance with MSTR policies?
______________________________________________________________________________
______________________________________________________________________________
6. Did the program experience a suspension of shopping privileges for any reason during January
2014 – September 2014? (Answering yes to this question does not automatically make a program
ineligible to apply.)
Yes
No
7.
If yes, why were shopping privileges for the program suspended? What are the plans to ensure
that the program remains in compliance?
______________________________________________________________________________
______________________________________________________________________________
8. If your program is a food pantry, what is the average number of individuals served by the
program each month?
Total (Duplicated) Individuals_____________ Unduplicated Individuals ____________
9. If your program is an onsite feeding program, what is the average number of meals served by
the program each month?
Total Meals ___________________________
10. How frequently is the program open (i.e. Monday-Friday 8:00 am – 5:00 pm, the 3rd Saturday of
each month 12:00 pm – 3:00 pm etc.)?
______________________________________________________________________________
11. How frequently can the same individual and/or household be served by the program (i.e. once
every 30 days, as needed, once each quarter etc.)?
_____________________________________________________________________________
12. Is the program open to the general public?
Yes
No
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Commercial Refrigerator/Industrial Platform Scales Grant Application – Fall 2014
Program Description
Please answer each question below. Answers should be as thorough as possible. If additional space is
needed, please attach a separate sheet(s) to the application and make sure to identify the questions to
which additional information is being provided.
13. What are the current needs for refrigerated/platform scale capacity at the program site?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
14. Please describe how the item(s) for which your program is applying will increase your capacity
to serve the community. What will this additional refrigerated storage/platform scale capacity
allow the program to do? In other words, what impact will the item(s) have on the program
and how will that impact be measured? (Please provide specific goals (i.e. will allow the
program to access and provide fresh produce and other fresh products for distribution to clients;
will enable program to open one extra day each week/month; will allow accurate tracking of
fresh produce and other donations etc.)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
5. Does your program provide Food and Nutrition Services (formerly known as the Food Stamp
program) outreach? If so, please describe. Do you provide tracking information to Second
Harvest Food Bank each month? If you do not provide tracking information to the Food Bank,
please help us understand why.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
15. Does your program provide Nutrition Education outreach and services? If so, please describe.
______________________________________________________________________________
______________________________________________________________________________
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Commercial Refrigerator/Industrial Platform Scales Grant Application – Fall 2014
______________________________________________________________________________
______________________________________________________________________________
16. What do you see as the most valuable aspects of your partnership with Second Harvest Food
Bank?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
17. Are there other areas for consideration you would like to bring to the attention of the Second
Harvest Food Bank selection committee that may help clarify the need for additional
refrigerated storage/platform scales at your program location and the anticipated impact on
your program if chosen to receive this grant?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Questions?
Please contact our Agency Relations department (336-784-5770) and ask to speak with the
Agency Outreach Coordinator for your county.
Peggy Robinson
Alamance
Caswell
Guilford
Randolph
Jan Jones
Alexander
Alleghany
Ashe
Caldwell
Davidson
Iredell
Surry
Watauga
Wilkes
Tracy Doss
Davie
Forsyth
Rockingham
Stokes
Yadkin
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