RFP #14-01-04 Food Service - Frozen Food and Staple Groceries – Annual
NUTRITION KIT
Product Information Sheet with Nutrition Facts Label
THIS FORM MUST BE COMPLETED AND RETURNED IN THE NUTRITION KIT WITH RFP SUBMITTAL EVEN IF
THERE IS NO SAMPLE REQUIRED
Product Name: _________________________________________________
Manufacture Name: ______________________________________________
Product Code: ___________________________________________________
Product Information Sheet with Nutrition Facts Label
Nutrition Facts Label MUST Contain the Following:
Nutrition Facts
Serving Slice 1 PIECE (78g)
Servings Per Container: About 120
Amount per Serving
Calories 240 Calories form Fat 70
-----------------------------------------------
% Dailey Value*
Total Fat 7g
Saturated Fat 1g
Trans Fat 0g
Polyunsaturated Fat 4g
11%
5%
Monounsaturated Fat 1.5
----------------------------------------------------
Cholesterol 0mg 0%
----------------------------------------------------
Sodium 270mg 11%
--------------------------------------
Total Carbohydrates 37g 12%
Dietary Fiber 2g 9%
Sugars 1g
Protein 7g 14%
--------------------------------------
Vitamins A 0% * Vitamins C 0%
--
Calcium 0% Iron 4%
----------------------------------------------------
* Percent daily values are based on a
2,000 calorie diet. Your daily values may be higher or lower depending on your calories needs.

RFP #14-01-04 Food Service - Frozen Food and Staple Groceries – Annual
NUTRITION KIT
Product Information Sheet with Nutrition Facts Label
Nutrition Facts Label MUST Contain the Following:
1.
Nutrition Facts Label.
2.
Ingredient List.
3.
Trans Fatty Acid Amount that clearly designates
Product is “zero grams trans fat” as determined
By FDA standards.
4.
CN label (for meat/meat alternative and/or grain products) and/or USDA approved product analysis (attached) signed By a high ranking official.
THIS LABEL MUST BE SUBMITTED ON USB Flash Drive OR CD AS PART OF THE “NUTRITION KIT” SUBMITTED
WITH THE RFP. PLEASE SAVE EACH LINE ITEM AS A SEPARATE FILE BY PRODUCT NAME AND PRODUCT
CODE ON THE SAME USB OR CD (ONLY ONE OF THE THREE KITS NEEDS A USB OR CD). THERE NEEDS TO BE
THREE NUTRITION KITS WITH HARD COPIES IN EACH.

RFP #14-01-04 Food Service - Frozen Food and Staple Groceries – Annual
NUTRITION KIT
Nutrition Kit Envelope Label
The following is an example of information to be included on the Nutrition Kit Label:

RFP #14-01-04 Food Service - Frozen Food and Staple Groceries – Annual
NUTRITION KIT
Texas Department of Agriculture
Sample Statement| Product Analysis/Formulation | Grains
July 27, 2012
Sample Statement
Product Analysis Sheet/Product Formulation Statement to
Provide for a Grains Product
(Place on company letterhead.)
Product Name: ______________________________________ _____________________
Code No.:________________________________________________________________
Manufacturer:
_________________________________________________________________________
Case Weight and Pack/Count:
_________________________________________________________________________
Volume and weight of one serving of product:
_________________________________________________________________________
Grain ingredient(s) in product:
_________________________________________________________________________
(Note: primary grain ingredient must be enriched or whole grain flour or meal.)
Weight of grain (gram weight) in one serving of product:
_________________________________________________________________________
(Note: It takes 16.0 grams of whole grain or enriched flour or meal, bran or germ, or an equivalent amount of cereal as provided in FNS Instruction 783 ‐ 1, Rev. 2, to equal 1 serving Grain. Grains may be credited in
1/4 serving increments.)
I certify that the above information is true and correct and that one serving of the above product
(ready to eat) contains _______ serving(s) of Grains.
SIGNATURE____________________________DATE______________________________
PRINTED NAME ___________________________________________________________

RFP #14-01-04 Food Service - Frozen Food and Staple Groceries – Annual
NUTRITION KIT
Sample Product Formulation Statement (Product Analysis) for Meat/Meat Alternate
(M/MA) Products
Child Nutrition Program operators should include a copy of the label from the purchased product carton in addition to the following information on letterhead signed by an official company representative.
Product Name: Code No.:
Manufacturer: Case/Pack/Count/Portion/Size:
I.
Meat/Meat Alternate
Please fill out the chart below to determine the creditable amount of Meat/Meat Alternate
Description of Creditable
Ingredients per
Ounces per Raw Portion
of Creditable Ingredient
Multiply
Food Buying Guide (FBG)
FBG Yield/
Servings
Per Unit
Creditable
Amount *
X
X
X
A. Total Creditable M/MA Amount1
*Creditable Amount - Multiply ounces per raw portion of creditable ingredient by the FBG Yield Information.
II.
Alternate Protein Product (APP)
If the product contains APP, please fill out the chart below to determine the creditable amount of APP. If APP is used, you must provide documentation as described in Attachment A for each APP used.
Description of APP, manufacture’s name, and
code number
Ounces Dry
APP Per
Portion
Multiply
X
X
X
B. Total Creditable APP Amount1
C. TOTAL CREDITABLE AMOUNT (A + B rounded down to nearest ¼ oz)
% of
Protein
As-Is*
Divide by
18**
÷ by 18
÷ by 18
÷ by 18
Creditable
Amount
APP***
*Percent of Protein As-Is is provided on the attached APP documentation.
**18 is the percent of protein when fully hydrated.
***Creditable amount of APP equals ounces of Dry APP multiplied by the percent of protein as-is divided by 18. 1Total Creditable Amount must be rounded down to the nearest 0.25oz (1.49 would round down to 1.25 oz meat equivalent). Do not round up. If you are crediting M/MA and APP, you do not need to round down in box A (Total Creditable M/MA Amount) until after you have added the Total Creditable APP Amount from box B to box C.
Total weight (per portion) of product as purchased
Total creditable amount of product (per portion) creditable amount cannot count for more than the total weight of product.)
(Reminder: Total
I certify that the above information is true and correct and that an serving) contains ounce serving of the above product (ready for ounces of equivalent meat/meat alternate when prepared according to directions.
I further certify that any APP used in the product conforms to the Food and Nutrition Service Regulations (7 CFR Parts 210, 220, 225, 226,
Appendix A) as demonstrated by the attached supplier documentation.
Signature Title
Printed Name Date Phone Number

RFP #14-01-04 Food Service - Frozen Food and Staple Groceries – Annual
NUTRITION KIT
PRODUCT VERIFICATION FORM
Return with RFP "Nutrition Kit"
Please note; As referenced in the scope, this form needs to be returned with the RFP "Nutrition Kit" in a separate envelope marked "Nutrition Kit". There should be a total of three (3) Nutrition Kits, one of the kits must have a USB or
CD, with nutritional information listed in numerical order for all items bid submitted with the RFP. Each kit should be in a separate envelop and labeled.
Date:
Line #
Product
Name
Shelf Life (# days):
Bidder
Packer /
Brand
Manufacturer's
Name Product Code
Pack
Size
For the product listed above please fill out the following criteria placing an X in the YES or NO column and answering the questions that follow.
YES NO Allergen Information
1. Does product contain peanuts, nuts or any peanut product?
2. Does product contain any pork or pork by products?
3. Does product contain any allergen?
If yes, circle the allergens: eggs, milk, peanuts, tree nuts, fish, shellfish, soy, wheat
Contact Person: Phone #
Mailing Address: Email:
Fax:
I certify that all information provided is accurate. I understand that the product may be checked by independent laboratory for selected composition and that if the product does not comply with the bid specifications or information provided, the product may be determined to be unacceptable as a bid item
Signature Of Person Completing The Form:
Printed Name of Person Completing The Form: