COUNTY OF ATLANTIC
DIVISION OF INTERGENERATIONAL SERVICES
AREA AGENCY ON AGING
REQUEST FOR A COMPETITIVE CONTRACT PROPOSAL FOR
HOME DELIVERED MEAL PROGRAM
FOR ATLANTIC COUNTY
Contact Person:
Palma Conover, Director
Office of Budget and Purchasing
(609) 343-2316
Mailing Address:
Atlantic County Government
Office of Budget and Purchasing
6th Floor
1333 Atlantic Avenue
Atlantic City, NJ 08401
DUE Date:
No later than 11:00 AM
September 24, 2015
NOTICE TO PROPOSERS
Public Notice is hereby given that SEALED PROPOSALS will be received by the
Purchasing Agent of the County of Atlantic, New Jersey at 11:00am prevailing time on
September 24, 2015 in the Conference Room; 3rd Floor; 1333 Atlantic Avenue;
Atlantic City, New Jersey for:
CC 201509.2
REQUEST FOR A COMPETITIVE CONTRACT PROPOSAL FOR
HOME DELIVERED MEAL PROGRAM FOR ATLANTIC COUNTY
Area Plan 2016 – 2018 Area Plan Contract Services
Atlantic County Area Agency on Aging
Within the Division of Intergenerational Services
Contract Period: January 1, 2016 to December 31, 2016
(With up to two (2) one-year renewable options at the discretion of the county,
subject to the availability of funds and to the continuing satisfactory performance
by the provider)
The Atlantic County Division of Intergenerational Services, Area Agency on Aging,
announces the development of the Area Plan Contract for 2016 – 2018 and is accepting
proposals for Nutritional Support Services, as outlined, for County residents aged 60+
and for caregivers that may be under sixty years of age, for the 2016 – 2018 calendar
years. Services will be funded from and in accordance with rules and regulations
implementing Title III C2of the Older Americans Act of 1965 as amended.
Proposals are being sought for services related to the above services to senior
residents in Atlantic County, NJ. Funding sources for these services include Older
Americans Act (Title III), funds.
Specifications and blank Bid Forms may be obtained online at the following web
address http://bids.aclink.org
Any questions concerning this specification must be directed to the Office of Budget &
Purchasing, in writing to purchasing@aclink.org or fax (609) 343-2193
If awarded a contract, your company/firm will be required to comply with requirements of
NJSA 10:5-31 et seq. and N.J.A.C. 17:27,
Every bidder must abide by the New Jersey Prevailing Wage Act, P.L. 1963, Chapter
150.
The County of Atlantic reserves the right to reject any or all bids
By order of the County Executive of the County of Atlantic
Palma Conover; Director,
Budget & Purchasing
County of Atlantic, New Jersey
COMPETITIVE CONTRACT TABLE OF CONTENTS
PAGE LETTER
Instruction to Proposers
I
TECHNICAL SPECIFICATIONS
Purpose & Intent
PROPOSAL FORM
Rating Tool
CONTRACT FORMS
Insurance
INS
Sample Contract
CT
Affirmative Action
A.A.
FORMS
Check List
THESE FORMS MUST BE COMPLETED AND SIGNED OR PROOSAL WILL BE REJECTED.
Disclosure Statement
D.S.
THE FOLLOWING ITEMS SHOULD ALSO BE SUBMITTED WITH PROPOSAL
Non-Collusion
N.C.
Affirmative Action Information
AAI
Recycling Affidavit
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COUNTY OF ATLANTIC, NEW JERSEY
RECEIPT OF PROPOSALS, INSTRUCTIONS TO PROPOSERS,
SPECIFICATIONS AND PROPOSAL FORMS
RECEIPT OF PROPOSALS
Sealed Proposals will be received by the Purchasing Agent of the County of Atlantic, New Jersey, in
the,34th floor Conference Room, 1333 Atlantic Avenue, Atlantic City, NJ 08401, at the time and date
as specified in the "Notice to Proposers" at which time and place the proposals shall be publicly
opened and read aloud
REQUEST FOR A COMPETITIVE CONTRACT PROPOSAL FOR
HOME DELIVERED MEAL PROGRAM FOR ATLANTIC COUNTY
INSTRUCTIONS TO PROPOSERS
1. A complete original proposal and FIVE (5) copies shall be submitted in a clearly marked
sealed envelope plainly marked on the outside as follows: Name and Address of the proposer
and the name of the subject of proposal.
Atlantic County will not be held responsible for any erroneous pages or pages missing
from this bid document if it is obtained form a source other than the Division of Budget
and Purchasing or the Atlantic County Bid Portal. Atlantic County will not be held
responsible if bidders (vendors) fail to receive any updates or addenda to the specification, if
they haven’t contacted the Purchasing office.
2. The Disclosure Statement (Public Law 1977, Chapter 33) attached to the specifications must be
filled in completely and sworn to before a Notary Public. Failure to do so shall result in
automatic rejection of proposals.
3. The Non-Collusion Affidavit attached to the specifications must be filled in completely and
sworn to before a Notary Public.
4. The Affidavit of Compliance on Contractor's Recycling Program attached to the
specifications must be filled in completely and sworn to before a Notary Public.
5.
Affirmative Action
The Contractor shall be required to comply with the requirements of N.J.S.A. 10:5-31at seq.
and N.J.A.C. 17:27.
Each successful contractor is required to submit one of the following documents PRIOR TO
EXECUTION OF A CONTRACT:
1.A copy of the contractor’s Letter of Federal Approval indicating the contractor has an
existing Federally approved affirmative action program , or
2. A copy of the contractor’s Certificate of Employee Information Report , or
3. Contractor’s initial Affirmative Action Employee Information Report (Form AA 302)
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6.
This Competitive Contract requires certain documents be provided to the County as required by
law. Some of the documents shall REQUIRE original signatures at the time of the Vendor’s
submission of its proposal to the County, while other documents shall not. Below is a list of these
documents:
A. ORIGINAL SIGNATURES REQUIRED AT THE TIME OF SUBMISSION OF THE VENDOR’S
PROPOSAL. These documents shall REQUIRE ORIGINAL SIGNATURES AT THE TIME OF
SUBMISSION BY THE VENDOR TO THE COUNTY. FACSIMILE, COPY OR RUBBER
STAMP SIGNATURES WILL NOT BE ACCEPTED AND SHALL BE CAUSE FOR AN
AUTOMATIC REJECTION OF THE PROPOSAL. Any bid price showing any erasure or
alteration must be initialed by the bidder in INK.
1. Proposal Page.
B. ORIGINAL SIGNATURES NOT REQUIRED AT THE TIME OF SUBMISSION OF THE
VENDOR’S PROPOSAL. These documents shall NOT require original signatures at the time
of submission by the Vendor. However, THESE ORIGINAL DOCUMENTS WITH THE
ORIGINAL SIGNATURES shall be required by the County. This requirement is explained more
fully in Section C, below.
1.
2.
3.
4.
5.
6.
7.
8.
Disclosure Statement;
Non-Collusion Affidavit;
Recycling Affidavit;
Plumbing Affidavit;
Subcontractor’s Affidavit;
Bid bond;
Consent of Surety;
Employee Benefits Affidavit.
C. ORIGINAL SIGNATURES REQUIREMENTS CLARIFICATION. In order for the County to
prepare and sign a contract with the Vendor who is being recommended for the award of the
contract, the County must have the original signatures on ALL of the documents listed in
Sections A and B above, but at various times. The Proposal Page listed in Section A must
have the original signature at the time that the Vendor submits his proposal to the County.
At the time of the submission of the proposal to the County, the items listed in Section B may
be copies and do not need to have the original signatures. However, the Vendor must submit
the originals of all the items in Section B WITHIN FIVE (5) BUSINESS DAYS after the date of
the written Notice of the Recommendation of the award by the County to the Vendor. THERE
ARE NO EXCEPTIONS TO THESE RULES; FAILURE TO COMPLY WITH THESE
REQUIREMENTS SHALL RESULT IN AN AUTOMATIC DISQUALIFICATION OF THE
VENDOR, and the County shall have the right to award the contract to the next lowest
responsible vendor. There will be no negotiation of this requirement.
7. The County is exempt from all taxes including Federal Excise Tax, Transportation Taxes, State
Excise and Sales Tax, and local taxes.
8. Proposal prices are to remain firm for a period of not less than sixty (60) days to allow the County
to determine the lowest that shall most economically serve the intentions of this proposal.
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9. No Proposer shall be allowed to offer more than one price on each item even though he/she may
feel that he/she has two or more type or styles that will meet specifications. Bidders must
determine for themselves which to offer. If said bidder should submit more than one price on
any item, all prices for the item shall be rejected.
10. It is understood and agreed that all prices quoted are firm and not subject to any increase during
the life of the contract. Should there be any reduction in successful bidder(s) prices as
submitted, vendor agrees that all deliveries made on and after such date of price reduction will
be invoiced on the basis of reduced prices.
11. The County reserves the right to reject any or all proposals covered in the RFP request, or any
portion(s) thereof, waive informalities, re-advertise and/or take such other actions decreed
necessary and in the best interest of the County of Atlantic.
12. All proposals corrections or erasures shall be initialed by the person signing the bid or an
authorized representative.
13. All proposals shall be typewritten or printed in ink on the form(s) prepared by the County. All
proposals must be signed by officials of the Corporation or Company duly authorized to sign
bid proposals.
14. Proposals may be submitted prior to bid date to the Division of Purchasing, 6th floor, 1333
Atlantic Avenue, Atlantic City, NJ 08401.
Proposals delivered the day of the CC opening shall be delivered to the Division of Purchasing,
6th floor, if delivered before 10:30 A.M. If Proposals are delivered after 10:30 A.M., the
proposer shall deliver the Proposal to the 4th floor Training Room and wait until the time of the
CC opening. PROPOSERS ARE NOTIFIED THAT NO PROPOSAL WILL BE OPENED IF
RECEIVED AFTER THE SPECIFIED HOUR.
The County shall not be responsible for late postal or overnight delivery, nor shall
postmark dates or overnight dates be considered in honoring of bids. The County shall
not be responsible for bidders hand delivering bids who arrive late or to the wrong
location
15. The County of Atlantic shall award all contracts to the most advantageous proposal, price and
other factors considered, in accordance with the evaluation methodology established in this
proposal (see page “RATING SHEET” ). Failure or inability to meet any of the requirements set
forth in this proposal will be sufficient reason to disqualify proposer as non responsive.
16. The award of the contract or the rejection of the proposals shall be made within one hundred
twenty (120) days of the date of receiving proposals; unless written extensions are requested
by the Purchasing Agent and accepted by the proposer(s). The successful proposer(s) to
whom the award is to be made shall be notified by receipt of the contract or a written "Notice to
Proceed" from the County department for whom the work is being provided.
17. When award of contract is made in one fiscal year with an effective date in the next fiscal year,
award shall be contingent upon the availability of appropriation of sufficient funds for that
purpose for the year in which said contract takes effect. When a contract shall be awarded for
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a period in excess of one year, said contract shall be contingent upon the annual availability
and appropriation of sufficient funds for that purpose for each year of the contract.
18. Successful bidder(s) specifically and explicitly agrees to indemnify and save and keep harmless
and defend the County of Atlantic against any and all losses, cost damage, claim expense or
liability whatsoever, because of accident or injury to person or property of others occurring in
connection with the operations under the contract including but not limited to employees,
agents, servants, contractors and subcontractors of the successful bidder, even if the losses,
cost damage, claim expense, or liability stem from negligence of the County of Atlantic.
19. The proposals is irrevocable by the subscriber, or his, their or its personal or legal
representatives. Said proposer and award thereunder is made to the subscriber by the County
of Atlantic and shall bind the subscriber, his, their or its heirs, executors, administrators,
successors or assigns.
20. Assignment to any third party of any Moines due or to grow due the contract on any contract
based on this proposal is prohibited and will not be recognized by the County.
21. The contractor shall not transfer or sublet any portion of the work covered by these specifications
without written consent of the County of Atlantic.
22. The parties to any County contract resulting from this proposal do hereby agree that the
provisions of N.J.S.A. 10:2-1 through 10:2-4, dealing with discrimination in employment on
public contracts, and the Rules and Regulations promulgated pursuant thereunto, are hereby
made a part of such contract and are binding upon them.
23. A written request for the withdrawal of the proposal, or any party thereof, will be granted if the
request is received by the County Purchasing Agent prior to the specified time of the proposal
opening.
24. Every successful contractor shall be required to sign the standard County form contract, a copy
of which attached to this proposal specification under APPENDIX . If proposer desires to
make any modifications to the contract language, or if bidder has another contract form that
he/she desires to sign in lieu of or in addition to the County contract form, a sample copy of
the proposer's proposed contract language or form must be submitted with the
proposal as a separate attachment. If no attachment is given it will be presumed that the
contract documents will consist exclusively of the County's form contract. Any proposed
language or form changes which in any way modifies the contractor's responsibilities as set
forth in the RFP specifications will not be acceptable and will be deemed to constitute a RFP
exception.
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25. Safety: The Contractor hereby covenants and agrees to take, use provide and make all proper,
necessary and sufficient precautions, safeguards and protections against the occurrence of
happenings, accidents, injuries, damages or hurt to any person or property during the progress
of the work herein covered, and be responsible for any indemnity and save harmless the
County of Atlantic, its officers, agent, servants and employees from payment of all sums of
money by reason of all or any such happenings, accidents, injuries, damages, hurt to person
or property that may happen or occur upon or about such work, and all fines, penalties and
loss incurred for or by reason of violations or any Federal, State, City or Borough ordinance or
regulations while said work is in progress.
26. The successful proposer will be required to comply with all applicable provisions of the N.J.
Public Employees Occupational Safety and Health Act, (N.J.A.C. 34:6A-25), when providing
any materials, supplies or services as part of this contract.
27. Oral Instructions Neither the County of Atlantic or their authorized representatives will be
responsible in any way for oral answers unconfirmed in writing to any inquires regarding the
intent or meaning of these specifications
28. To Request a reasonable accommodation of a disability, contact the ADA coordinator at: 3432389 (phone); 348-5551 (TTD); 345-4295 (FAX) at least five (5) business days prior to the
event.
29. MULTIPLE PROPOSALS NOT ALLOWED: No proposer shall be allowed to submit more than
one proposal from an individual, firm, partnership, corporation or association under the same
or different name, this will be cause for automatic rejection of your proposal.
30. QUESTIONS: Questions must be directed in writing to Kathy Arrington, Director of Budget &
Purchasing by fax at (609) 343-2193 . No firm intending to submit a proposal or any employee
of any firm intending to submit a proposal shall contact any County employee for any reason
either directly or indirectly related to this Request for Proposal for Competitive Contract. Any
firm found violating this policy may be cause for disqualified from submitting a proposal.
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31.
NEW JERSEY BUSINESS REGISTRATION CERTIFICATE
Section 1 of P.L. 2001,c.134 is amended to read as follows:
An act concerning business registration for providers of goods and services to the State, State
colleges and universities , county colleges, local contracting units, boards of educations, water
and wastewater contractors and casinos, supplementing Title 54 of the revised Statues and
amending P.L.1977,c.110.
No contract shall be entered into by any contracting agency unless the contractor
provides a copy of its business registration
All non governmental entities SHOULD submit a copy of their Business Registration
Certificate or a copy of their 501(c) designation with their proposal. Proposer must
submit a copy of their NJ Business Registration or 501( c ) designation prior to award of
the contract.
All proposals must comply with the provisions mandated by applicable Federal Law and New
Jersey Statutes.
Any provision in the RFP which may be in conflict with any New Jersey statute are amended to
conform to the minimum requirement of such statute.
CONTRACTORS / VENDORS
The successful bidder must maintain and submit to Atlantic County a list of subcontractors and
their addresses that may be updated from time to time during the course of contract
performance. A complete and accurate list shall be submitted before final payment is made for
goods provided or services rendered or for construction of a construction project under this
contract
A subcontractor shall provide a copy of its business registration to any contractor who shall
forward it to the County. No contract with a subcontractor shall be entered into by any
contractor under any contract with Atlantic County unless the subcontractor first provides proof
of valid business registration.
The successful bidder as well as their subcontractors and each of their affiliates shall collect
and remit to the Director of the Division of Taxation in the Department of the Treasury the use
tax due Pursuant to the “Sales and Use Tax Act” P.L.1966,c.30(C.54:32B-1et seq.) On all their
sales of tangible personal property delivered into the state of New Jersey.
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TECHNICAL
SPECIFICATION
7
Public Notice
County of Atlantic
Request for Proposals
Home Delivered Meal (HDM)
Notice is hereby given that sealed proposals will be received by the County of Atlantic, State of
New Jersey, at the (Atlantic County Office building September 24, 2015, 11:00 AM p.m.
prevailing time, and at that time and place, the following will be publicly opened and read:
Area Plan 2016 – 2018 Area Plan Contract Services
Atlantic County Area Agency on Aging
Within the Division of Intergenerational Services
Contract Period: January 1, 2016 to December 31, 2016
(With up to two (2) one-year renewable options at the discretion of the county, subject to
the availability of funds and to the continuing satisfactory performance by the provider)
The Atlantic County Division of Intergenerational Services, Area Agency on Aging, announces the
development of the Area Plan Contract for 2016 – 2018 and is accepting proposals for Nutritional
Support Services, as outlined, for County residents aged 60+ and for caregivers that may be under
sixty years of age, for the 2016 – 2018 calendar years. Services will be funded from and in
accordance with rules and regulations implementing Title III C2of the Older Americans Act of 1965
as amended.
Home Delivered Meal Program
------------------Proposals are being sought for services related to the above services to senior residents in Atlantic
County, NJ. Funding sources for these services include Older Americans Act (Title III), funds.
1
APPLICATION AND REVIEW PROCESS
Proposal packets for the funding period commencing January 1, 2016, will be available on Atlantic
County bid Portal http://bids.aclink.org
The resulting contracts for Older Americans Act (Title III), C2 Nutritional Home Delivered Meal
Support Program funding will be for a one-year period commencing January 1, 2016,with two (2)
one-year renewable options at the discretion of the County, subject to the availability of funds and
to the continuing satisfactory performance by the provider of service.
Sealed proposals must be received by September 24, 2015 at which time the proposals will be
opened and contents publicly announced.
A proposal review panel will be chosen. The role of the proposal review panel is to provide
recommendations for funding to the Atlantic County Division of Intergenerational Services
Executive Director.
The review panel will evaluate proposals based on the Evaluation form at the back of this R.F.P.
packet.
The review panel will then provide its recommendations to the Atlantic County Division of
Intergenerational Services Executive Director.
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PROJECT OVERVIEW
The Older Americans Act was originally signed into law by President Lyndon B. Johnson on July
14, 1965. Later amendments to the Act added grants to Area Agencies on Aging for local needs
identification, planning, and funding of services, including but not limited to nutrition programs in
the community as well as for those who are homebound; services targeted at low-income minority
elders; health promotion and disease prevention activities; in-home services for frail elders and
those services which protect the rights of older persons.
The Atlantic County Division of Intergenerational Services was designated by the State as the Area
Agency on Aging for Atlantic County. The Office serves the growing population of adults age 60
and over and their caregivers. It develops programs and partnerships to deliver essential services
to senior citizens of Atlantic County.
The Older Americans Act intends that the area agency on aging shall be the leader relative to all
aging issues on behalf of all older persons in the planning and service area. As mandated under
the Older Americans Act, the Atlantic County Division of Intergenerational Services must prepare,
develop and carry out an Area Plan Contract which is submitted to and approved by the State
Division of Aging and Community Services. The plan is to develop a comprehensive and
coordinated system for supportive services, nutrition services and caregiver services. This plan is
designed to lead to the development or enhancement of comprehensive and coordinated
community based systems in, or serving, each community in the planning and service area. These
systems shall be designed to assist older persons in leading independent, meaningful and dignified
lives in their own homes and communities as long as possible.
In order to fulfill its requirements under the Older Americans Act, the Atlantic County Division of
Intergenerational Services must grant out federal and state funding to a large number of agencies
to ensure a wide range of services are available for county seniors. Specific areas to be contracted
for are:
Home Delivered Meal Program
3
Table of Contents
Home Delivered Meal Program
Specifications
Meal Route Example
Delivery
Meal Prep
Sub-Contracting
 Letter of Intent to Apply & Notice of Subcontractor Needs
Mandatory Provisions
 Agency Monitoring
 Reporting Requirement
 Outcome Measures
 Title III Grievance Procedures for Clients
 Client Contribution
 Target Populations
Proposal Form
Proposal Questions 1 - 19
Budget
 Budget Request Form Instructions
o Home Delivered Meal Budget Request Form Monday – Friday
o Justification
o Weekend Home Delivered Meal Request Form Saturday – Sunday
o Justification
Evaluation Criteria – Proposal Check List
Proposal Evaluation Form
Official Nutrition Standards – Appendix I
Example Grant/Contract Agreement - Appendix II
4
Service List and Definitions
Home Delivered Meal Nutritional Services
The Atlantic County Area Agency on Aging has received funding under the Older Americans Act,
Title III-C2 and Week End, for the provision of Home Delivered Meals to elderly residents, 60 and
older, along with other eligible individuals as outlined:
The AAA is soliciting proposals from agencies which can provide the service outlined in the scope
of Services and specifications.
Older American Act Funding is not expected to support entire program. Please include
where other funding will come from in support of your Bid.
SPECIFICATION FOR THE FURNISHING AND DELIVERING OF
FRESH NOT FROZEN HOME DELIVERED MEALS.
FOR
THE ATLANTIC COUNTY AREA AGENCY ON AGING
FUNDING AVAILABILITY:
Title III C-2 – Home Delivered Meals. It is anticipated that approximately $197,000.00
Weekend Home Delivered Meals. It is anticipated that approximately $35,145.00
SCOPE:
The intent of these specifications is to outline the requirements of providing nutritionally adequate
meals which assure, at a minimum, one-third of the Dietary Recommended Intakes (DRI) to older
persons in their places of residence in various Atlantic County locations for the County of Atlantic.
TERM OF CONTRACT:
This contract is a Twelve Month Period (January 1, 2016 – December 31, 2016) with an
option by the County to renew for (2) additional one-year periods.
SUMMARY:
This bid requests the submission of a flat per meal rate which includes preparing, packaging,
transporting and delivery of EACH MEAL with MILK.




The successful bidder shall prepare meals for delivery to Home Delivered Meal clients
home.
The successful bidder shall be responsible for delivery of Home Delivered Meals.
The bidder is to base their bid on delivery to all Atlantic County Municipalities with
the exception of Atlantic City. The Atlantic County Area Agency on Aging will provide the
successful bidder with Home Delivered Meal client list, including all necessary
demographics.
SUBCONTRACT ALLOWED FOR: Caterer for meal preparation/packaging and/or
transport delivery portion of the bid
5
Average numbers of meals served and routes are best estimates, AS LISTED IN NEXT
SECTION. The food service provider shall be reasonably flexible regarding the number of
meals for each day. Accepted price quotations will apply to all meals served at any volume on
any given day.
Present Home Delivered Meals are approximately
360-380 meals per day ( Monday – Friday)
25 meals per day ( Saturday and Sunday)
MEAL ROUTES
LISTED MEAL ROUTES ARE FOR EXAMPLE PURPOSES ONLY AND ARE TO ASSIST YOU
IN ROUTE PLANNING. SOME MUNICIPALITIES ARE LISTED IN MORE THAN ONE ROUTE.
Route
1
2
HDM Served
80
75
3
75
4
80
5
6
85
25
Municpalities within each Route
Linwood, Somers Point, Margate, Longport Ventnor
Mayslanding, Egg Harbor City, Sweetwater, Mullica
Woods, Hammonton, Collings Lake
Egg Harbor Twp, Mayslanding, Mizpah, Weymouth, Corbin
City, Dorothy, Milmay, Buena, Minotola, Landisville,
Newtonville, Buena Vista
Pleasantville, Absecon, Galloway, Egg Harbor City, Port
Republic
Northfield, Pleasantville, Egg Harbor Township, Linwood
Brigantine
Atlantic County Division of Aging will provide selected candidate with all demographic information
pertaining to qualified approved Home Delivered Meal recipients.
PAYMENT:
The Company shall mail the meal invoices and a completed County Standard Invoice to the
Atlantic County Area Agency on Aging on a monthly basis. These invoices should be in the
Atlantic County Area Agency on Aging's Main Office no later than 5 days after the end of the month
in which the meals were served. The Company should be paid by the end of the following month
after services were rendered.
ADDITIONAL INFORMATION
In the event that the Company fails to provide meal or meals or other food to the Atlantic County
Area Agency on Aging, as agreed upon, the Atlantic County Area Agency on Aging may procure a
meal or other food elsewhere, and charge to the Company twice the cost of such replacement
meal or meals or other food, plus any expenses incurred by the Atlantic County Area Agency on
Aging in procuring such replacement meal or meals or other food provided. Meals not delivered
or delivered late shall be deducted from the billing at twice the contract rate.
6
Atlantic County reserves the right to have access to the Company purchase records bearing upon
the food purchased for the Atlantic County Area Agency on Aging, for review and audit, as
necessary.
Atlantic County reserves the right to approve the menus and recipes for meals and other food to be
delivered so as to insure compliance with the Department of Health, Education and Welfare meal
type requirements, and to withhold payments for meals not meeting the prescribed requirements.
Atlantic County reserves the right to inspect at any time the Company's food preparation,
packaging, and storage areas and the food containers which house prepared meals and other food
to determine the adequacy of the Company's cleaning, sanitation and maintenance practices.
Atlantic County reserves the right to determine the adequacy of the Company's storage and record
keeping practices so as to insure the safekeeping of all food and in connection therewith to have
ready access to the related food inventory control record of the Company.
The Company shall comply with all Federal, State, and Local laws and regulations governing the
preparing and handling of food, shall procure and keep in effect all necessary licenses, permits
and food handler's cards as are required by law and shall post such licenses, permits and cards in
a prominent place within the meal preparation areas, as required by law. The Company shall
comply with all applicable Federal, State and Local laws and regulations pertaining to wage and
hours of employment.
Bidder is required to provide proof of current sanitary inspection to be submitted with their bid. If
there is any change in inspection report status (ie – if they receive unsatisfactory inspection) that
they must contact the County immediately.
The Company shall indemnify the Atlantic County Area Agency on Aging against any loss or
damage (including attorney fees and other cost of litigation) caused by the Company's negligent
act or omission, theft by the Company's agents or employees. The Company shall defend any suit
against the Atlantic County Area Agency on Aging alleging personal injury, sickness or disease
arising out of the consumption of the meals or other foods delivered to the Atlantic County Area
Agency on Aging. The Atlantic County Area Agency on Aging shall promptly notify the Company in
writing of any claims against the Company or the Atlantic County Area Agency on Aging and in the
event of a suit being filed, shall promptly forward to the company all papers in connection herewith .
All records of the company bearing upon food purchase, storage, food preparation and
transportation directly related to the meals and other food delivered under this agreement,
including the records on receipt, storage and use of Government donated commodities, shall be
made available to the Atlantic County Area Agency on Aging upon request. The Atlantic County
Area Agency on Aging Director or Nutritionist, State Agency and the State Distributing Agency
representatives and the auditors of the Department of Health, Education and Welfare and the US
General Accounting Office, upon request, shall have access to all such records for audit or review
at a reasonable time and place.
Termination
7
a. The Atlantic County Area Agency on Aging or the Company may at any time during the
life of this agreement or any extension thereof terminate the agreement with respect to
the serving of meals, by giving sixty (60) days notice in writing to the other party of its
intention to do so.
b. The Atlantic County Area Agency on Aging may terminate this agreement, with respect
to the serving of meals and conditions herein stated if the terms and conditions thereof
are not fully complied with by the Company, by giving ten (10) days notice in writing of its
intention to do so.
Conditions, herein referred to, which may result in the termination of the contract, are as
follows:
1. Improper preparation of food
2. Poor appearance, texture, or taste of food.
3. Improper temperature of food.
c. This contract is contingent upon Federal funding. Should this funding cease or should
the County decide not to sponsor such a project, the Atlantic County Area Agency on
Aging will give five (5) days notice in writing or termination of said contract.
DELIVERY

Delivery of the meals shall be on a daily basis, Monday through Friday. Delivery of Saturday
and Sunday Weekend Meals can be delivered on Thursday or Friday. ONLY the Weekend
Meals CAN BE FRESH OR FROZEN. MONDAY – FRIDAY MEALS MUST BE FRESH.

Delivery MUST be between 10 am and 2 pm.

Each delivered FRESH meal must have a USDA nutritional label, a use by date, and simple
instructions.

All meals are to be delivered in portioned compartment sealed containers/trays.
o Each package must have identifying information such as content, reconstitution
directions, expiration date, etc
The bidders are to identify on the proposal page what mode of transportation they will use
for delivery.
o Bidder must show that adequate sanitary practices must be maintained while food is
in transit.
Vendors are to give a price which includes all costs, including insurance, associated with
transporting the meals to the clients’ home
o If the vendor desires to subcontract the transport delivery portion of the bid
specifications they must name the subcontractor in their bid proposal. The
subcontractor must provide the required insurance.


8
STANDARDS:
(See Official Nutrition Standards – Appendix I)
Home Delivered Nutrition services must meet or exceed the following standards:
1. Each meal must contain at least one-third of the current Dietary Recommended Intakes
(DRI),
2. Menu Preparation and Menu Components

Menus for Home Delivered Nutrition programs must be certified and
documented as meeting DRI standards by a qualified nutritionist.
 The Company shall provide meals, for approximately 380 people, which conform to
1/3 DRI and/or the Nutrient Standard Method: An Entree, fruits, vegetables, dessert,
unsweetened juices and/or soup. Where applicable, little or no salt shall be used in
the preparation or cooking process.
 The Company shall provide ½ pint container of fresh refrigerated 1% milk with each
meal.
3.
The Company shall supply a Nutritionist or Home Economist or Dietitian or anyone who
contains a B.A. Degree in an ADA accepted food related curriculum. This person must be a
paid staff member of the Company. The bidder must submit the name and resume of this
individual with their bid.
A sample monthly menu must be submitted with the bid. The Company shall be flexible
in their management of the menu schedule. Additions, deletions, and substitutions may be
periodically requested by the Atlantic County Area Agency on Aging. All changes shall
conform to the existing bid structure.
The menus will be a combined effort of the Atlantic County Area Agency on Aging Director,
the Atlantic County Area Agency on Aging's Nutritionist, the State Nutritionist, the
Company's Food Service Person and the Atlantic County Area Agency on Aging's Advisory
Board. The menus shall conform to the existing bid structure. The Company shall supply
the name, phone number and fax number of the dietician or nutritionist who prepares the
menus.
Poor appearance, texture or taste of food due to improper cooking procedure, or poor
quality of food is grounds for terminating said contract.
All foods used must be
1. from approved sources;
2. in compliance with applicable state and local laws, ordinances and regulations;
3. clean, wholesome, free from spoilage, free from adulteration and mislabeling, and
safe for human consumption.
9
This will be in judgment of the Atlantic County Area Agency on Aging Director and the
Atlantic County Area Agency on Aging's food service person. To insure compliance, meat
and vegetable components will be prepared on their respective day of delivery. All other
meal components must be prepared and properly stored no earlier than one day preceding
their respective delivery.
Meal Preparation Staff Standards
1. Staff supervising on-site meal preparation must have at least one year of experience in food
management.
2. Head cook (s) must have at least one year of paid employment as a cook.
3. Each home delivered meal packaging/delivery center has designated staff present during all
hours of program operation and there is a trained backup person on duty when the center
staff is absent.
If the vendor desires to subcontract with a Caterer for the Meal Preparation portion of the
bid specifications they must name the subcontractor in their bid proposal. The subcontractor
must provide the required insurance.
1.
a. Meal Production Kitchen: Meals must be prepared from kitchens that maintain valid
health certification. An agreement with the meal production kitchen must be developed if the
selected Applicant(s) does not operate a kitchen and will subcontract with caterer.
b. The Food Contractor shall prepare food for bulk shipments at required temperatures so
that the food will arrive at each Home Delivered Meal recipients home and be consumed
at the proper Chapter 24 (N.J.A.C. 8:24) New Jersey Department of Health and Senior
Services, effective January 2, 2007 mandated temperatures, at least 135 degrees for hot
foods or above and 41 degrees or lower for cold food. Temperatures must be taken
before food leaves the kitchen.
Food Contractor is responsible for all equipment necessary in keeping the hot and
cold foods at the required temperatures while in transit on the trucks from the
central kitchen/caterer.
c. It is mutually agreed by the Food Contractor and the County that neither party shall be
held responsible to the other for any meal losses resulting from its delay or failure to
perform to the extent that the said party is delayed or prevented by Federal, State,
County or Municipal action, war, revolution, riot, fire, flood, Act of God, or by any cause
not within the control of the party whose performance is interfered with and which by the
exercise of reasonable diligence, the party is unable to prevent.
3.
Accountability - The County shall be represented in its overall food service operations by the
Project’s employees, including: the County Project Director and Nutritionist who shall have
the right and authority as follows:
a. To develop and supply the Food Contractor, prior to the beginning of operations under
this agreement, specification for food which the Food Contractor is to use in the meals
and other food prepared for the County.
10
b. To inspect such food to determine compliance with the specifications and to reject food
not meeting such specifications.
c. To have access to the Food Contractor’s purchase records bearing upon the food
purchased for the County, for review and audit, as necessary.
d. To supply and approve the menus for meals and other foods to be delivered so as to
insure compliance with the Department of Health and to insure that the DRI standards
are met. Failure to do so will result in payments withheld for meals not meeting the
prescribed requirements.
e. To inspect at any time the Food Contractor's food preparation, packaging, and storage
areas and the food containers which house prepared meals and other food to determine
the adequacy of the Food Contractor's cleaning, sanitation and maintenance practices.
f. To determine the adequacy of the Food Contractor's storage and record keeping
practices so as to insure the safekeeping of all food including the food donated for the
use of the County by the U.S. Department of Agriculture, and in connection therewith to
have ready access to the related food inventory control record of the Food Contractor.
g. The Food Contractor shall comply with all Federal, State, and Local laws and regulations
governing the preparing and handling of food, shall procure and keep in effect all
necessary licenses, permits and food handler's cards as are required by law and shall
post such licenses, permits and cards in a prominent place within the meal preparation
areas, as required by law. The Food Contractor shall comply with all applicable Federal,
State and Local laws and regulations pertaining to wage and hours of employment.
h. The Food Contractor shall purchase all food for the County at the lowest prices possible
consistent with maintaining the quality standards prescribed by the County in
accordance with Federal Guidelines.
EXHIBIT B
i.
To the maximum extent possible, the Food Contractor shall use, in the meals and other
food delivered to the County, food donated for the use of this County by the U.S.
Department of Agriculture. The Food Contractor shall maintain adequate storage
practices, inventory and control of such food to insure that their use is in conformance
with the Project's agreement with the State Distributing Agency. The Food Contractor
agrees to give the County Project Director and Nutritionist ready access to the food
storage area and to the inventory control records on the purchased food and the
government donated food for such inspection as the Director and Nutritionist determine
is necessary.
j.
Since this is a fixed price contract, the Atlantic County AAA and the Food
Contractor agree that an amendment to this contract adjusting the fixed price
downward can be executed if the NSIP (formerly USDA) food commodities become
available and are utilized by the Food Contractor on behalf of the County.
Transportation for the NSIP foods will be worked out mutually by the County and
11
the Food Contractor. The AAA will inform all selected Food Contractors through a
Memorandum of Agreement attached to their formal contract with Atlantic County
Division of Intergenerational Services, Area Agency on Aging.
The Food Contractor and the County will mutually concur on the inventory status
of the NSIP commodities if they are utilized.
When this contract is terminated, the County will be given either the donated
foods or the dollar value on the ending inventory, if the NSIP commodities are
used.
k. The Food Contractor shall indemnify the County against any loss or damage (including
attorney fees and other cost of litigation) caused by the Food Contractor's negligent act
or omission, theft by the Food Contractor's agents or employees. The Food Contractor
shall defend any suit against the County alleging personal injury, sickness or disease
arising out of the consumption of the meals or other foods delivered to the County. The
County shall promptly notify the Food Contractor in writing of any claims against the
Food Contractor or the County and in the event of a suit being filed, shall promptly
forward to the contractor all papers in connection herewith.
The County shall not incur any expense or make any settlement without the Food
Contractor's consent. However, if the Food Contractor refuses or neglects to defend any
such suit, the County may defend, adjust or settle and such claim and the cost of any
such defense, adjustment or settlement, including reasonable attorney's fees, shall be
charged to the Food Contractor.
l.
All records of the Food Contractor bearing upon food purchase, storage, food
preparation and transportation directly related to the meals and other food delivered
under this agreement, including the records on receipt, storage and use of Government
donated commodities, shall be made available to the County upon request. The County
Project Director or Nutritionist, State Agency and the State Distributing Agency
representatives and the auditors of the Department of Health, Education and Welfare
and the US General Accounting Office, upon request, shall have access to all such
records for audit or review at a reasonable time and place.
m. The Food Contractor shall meet with the County Project Director and site managers for
review and evaluation of services, the County reserves the right to require the
attendance of the Food Contractor representatives at any meeting which the County
calls to resolves emergencies associated with the Food Contractor's services to the
County.
4
Emergency and Special Circumstances
a. The County reserves the right to cancel orders, without penalty, up to 6:00 am on the
day of the scheduled delivery. Deliveries will be received and payment made for same,
in situations wherein notification to vendor was not made in time to hold or recall
deliveries.
12
b. If the Food Contractor is unable to provide meals for any reasons, including holiday
closures, it is the company’s responsibility to ensure an alternative arrangement is made.
This alternative must meet the required nutritional and menu specifications at outlined in
the Menu Preparation and Menu Components section.
c. In the event that the Food Contractor fails to provide meal or meals or other food to the
county, as agreed upon, the county may procure a meal or other food elsewhere, and
charge to the Food Contractor the cost of such replacement meal or meals or other food,
plus any expenses incurred by the projects in procuring such replacement meal or meals
or other food provided.
d. The Food Contractor shall provide supplies for one day's meals to be stored at their
location to be used in case of an emergency.
5.
Menu Preparation and Menu Components
a.
The Food Contractor shall provide Home Delivered Meals that comply with the current
Dietary Guidelines for Americans published by the Secretary of Health and Human
Services and the Secretary of Agriculture which provide to each participating older
individual, a minimum of 1/3 the Dietary Reference Intake DRI as established by the
Food and Nutrition Board of the National Research Council of the National Academy of
Sciences. (Table 1- Appendix I)
Food handling must comply with NJAC 8:24-1, “Chapter 24 Sanitation in Retail Food
Establishments and Food and Beverage Vending Machines”. An entree, vegetables,
fruit, dessert, soups and/or unsweetened juices. Little or no salt shall be used in the
cooking process. Menus, certified to meet 1/3 DRI must be submitted to the Atlantic
County AAA 2 weeks prior to the execution of the contract.
b. The Food Contractor shall supply a Nutritionist or Home Economist or Dietitian or
anyone else who maintains a B.A. Degree in an ADA accepted food related curriculum.
This person must be a paid staff member of the Company. The bidder must submit
the name and resume of this individual with their bid.
c. A sample monthly menu must be submitted with the bid. (Menu included for
example purposes).The menu must be analyzed using a State Unit on Aging - approved
computerized nutrition analysis program. All menus must be reviewed, approved and
certified by a qualified nutritionist employed by the Area Agency on Aging and/or
Nutrition Service Provider. The Food Contractor shall be flexible in their management of
the menu schedule. Additions, deletions, and substitutions may be periodically
requested by the Atlantic County Area Agency on Aging. All changes shall conform to
the existing bid structure.
d. Menu revisions will be adopted every 4 months. The menus will be a combined effort of
the Atlantic County Area Agency on Aging County Director, the Atlantic County Area
Agency on Aging’s Nutritionist, the State Nutritionist, the Food Contractor’s Food Service
Person and the Atlantic County Area on Aging’s Advisory Board. The menus shall
conform to the existing bid structure. The Food Contractor shall supply the name,
13
phone number and fax number of the dietitian or nutritionist who prepares the
menus.
e. If the Food Contractor cannot provide any item on the menu for particular day, the Food
Contractor shall contact the County in advance so that the participants can be notified.
Any food items purchased by the County, when mutually agreed upon, may be credited
upon proper documentation.
f. Poor appearance, texture or taste of food due to improper cooking procedure, or poor
quality of food is grounds for terminating said contract.
All foods used must be
4. from approved sources;
5. in compliance with applicable state and local laws, ordinances and regulations;
6. clean, wholesome, free from spoilage, free from adulteration and mislabeling, and
safe for human consumption.
This will be in judgment of the Atlantic County Area Agency on Aging Director and the
Atlantic County Area Agency on Aging's food service person. To insure compliance, meat
and vegetable components will be prepared on their respective day of delivery. All other
meal components must be prepared and properly stored no earlier than one day preceding
their respective delivery.
Food Standards (See Appendix I for additional Standards)
Food Purchased for this contract must meet the following minimum requirements
Meat (dry heat cooking) - USDA Choice cut to I.M.P. specifications.
Meat (moist heat cooking) - USDA Choice cut to I.M.P. specifications.
Frankfurters/Knockwurst - all beef.
Poultry - U.S. Grade A. No chicken or turkey roll may be used. When chicken parts are
served, all meals shall contain like parts, i.e. all legs or all breasts.
Eggs – Fresh pasteurized whole eggs with shells intact and no cracks or pasteurized fluid
egg products only.
Ground beef - USDA Standard or better, not to exceed 10% fat
Fresh Fruits and Vegetables - USDA No. 1.
Canned Fruits, Vegetables and Juices - USDA Grade A. Canned fruits shall be packed
without added sugar. All fruit juices must be 100% pure fruit juice with the exception
of vitamin-C enriched cranberry juice.
Frozen Fruits, Vegetables and Juices - USDA Grade A.
Dairy Products:
One percent milk fortified with 400 I.U. vitamin D per quart and equivalent of 500 I.U.
14
vitamin A. Milk should be Pasteurized Grade A Quality Standard.
Cheese – USDA Grade A. No cheese substitute or imitation cheese permitted with the
exception of sauces.
15
Meal Delivery Staff Standards
1.
2.
The contractor assures that all personnel providing HDM services shall receive initial and
ongoing training.

Meal Delivery Staff shall receive training to recognize major physical and emotional
needs of the service recipients, including observation and recognition of signs of
trouble or emergency.

Staff shall have criminal background checks. All staff with convictions shall be
submitted to and must be approved by the County. Any decision rejecting staff shall
be at the sole discretion of the County and not subject to appeal.
Delivery driver arrives at door and knocks and announces his /her name prior to entering
home. If no answer, the driver contacts Intergenerational Services project office for
instructions. Meals are not to be left if no answer. If the client is in bed or bathroom, meal
can be left in the residence.

If a critical emergency situation arises while making deliveries, HDM drivers are to
call emergency 911 and Intergenerational Services project office.
3
Agencies staff in contracting with and expending Older Americans Act funds shall
neither solicit nor accept gratuities, favors or anything of monetary value from HDM
recipients.
4
All staff shall be neat in appearance and wear uniforms identifying them as part of the HDM
program.
16
Menu Example--See attached New Jersey Standards for New Jersey Guide for Meal Planning
Baked Fish in Creole Sauce
Parslied Potatoes, Green Peas
Rye Bread, Margarine
Apple Juice, Purple Plums
Milk
Tossed green salad
Tomato rice soup
Meatballs (4oz), spaghetti
Broccoli, honey cake
Milk
Baked flounder, tartar sauce
Whole kernel corn
Rye bread, margarine
Tomato juice, applesauce, cookie
Milk
Cole Slaw, Vegetable Soup
Meat Loaf (4oz)
Mashed Potato, Diced Carrots
Bread & Butter
Fresh Fruit salad or melon
Milk
Veal patty on bun
Baked potato, margarine
Lettuce, tomato slices
Grapefruit juice, fresh fruit
Milk
Oven fried chicken
Potato salad, tomato wedges
Rye bread, margarine
Pineapple juice, fresh fruit
Milk
Tuna Rice patty, mushroom sauce
Green Beans, Carrot raisin salad
Rye Bread, margarine
Tomato juice, peach slices, cookie
Milk
Baked chicken, cranberry sauce
Rice pilaf, peas and carrots
Rye bread, margarine
Tomato juice, pear halves
Milk
Meatballs & spaghetti, tomato sauce
Tossed salad, French dressing
Rye bread, margarine
Grapefruit juice, applesauce
Milk
Pot Roast, gravy
Oven browned potatoes, carrots
Challah, margarine
Pineapple juice, fruit cocktail
Milk
Meat loaf, catsup
Cauliflower, carrot raisin salad
Rye bread, margarine
Orange juice, fruit cocktail
Milk
Batter dipped fish, tartar sauce
Green lima beans, coleslaw
Rye bread, margarine
Pineapple juice, apricot halves
Milk
Baked flounder, tartar sauce
Succotash, spinach
Rye bread, margarine
Tomato juice, apricot halves
Milk
Tuna salad
3-bean salad, lettuce 1000 island
dressing
Rye bread, margarine
Tomato juice, pineapple tidbits, cookie
Milk
Liver Creole
Rice pilaf, green peas
Challah, margarine
Grapefruit juice, parfait
Milk
Tossed green salad, chicken noodle soup
Roast Chicken
Green squash, noodle pudding
Bread & butter, pie
Milk
Unstuffed cabbage
Green beans
Rye bread, margarine
Tomato juice, apricot halves
Milk
Beet salad, mushroom soup
Pepper steak, fluffy rice
Cauliflower, bread & butter
Cake of the day
Milk
Turkey Chow Mein, Chinese noodles
St. rice, green peas
Rye Bread, margarine
Grapefruit juice, fresh fruit
Milk
Turkey a-la king
Noodles, broccoli spears
Challah, margarine
Apple juice, pear slices
Milk
17
FRIDAY ENTRÉE SHALL BE BAKED
CHICKEN
The following items are not to be used in place of fruit or vegetable requirements in any meal pattern. They may be use as an
addition to a meal and use in conjunction with the US Department of Agriculture required portions.
Pasta or Macaroni Products
Fruit Drinks or beverages
Potato Chips or Sticks
Pickles, Relish or ketchup
Plain gelatin
MEAT & MEAT PRODUCTS
All meat and meat products including meats in the manufacture of provision and sausage products, shall have been
slaughtered and manufactured in plants operated under USDA inspection program and bear the appropriate seal. All meat
and meat products must be sound and sanitary upon delivery. They must be free of objectionable odors or signs of
deterioration. NO Preservatives, tenderizers or coloring agents may be added to any fresh meat or fresh meat product.
Imported fresh or frozen meat products are prohibited for any purposes.
DAIRY PRODUCTS
Butter – USDA fancy grade A 92 score
Milk Products – USDA Grade A
Eggs Fresh – USDA grade A
Cheese- USDA grade A process type
CANNED VEGETABLES
Shall be USDA fancy grade
FRESH FRUITS AND VEGETABLES
Shall be USDA Fancy or No 1 for all graded fresh fruits or fresh vegetables
MARGARINE
Margarine shall be made from cottonseed oil or corn oil and shall be manufactured from whole or skim milk and shall
contain no artificial flavoring. Oil shall be properly refined and deodorized and shall contain a minimum of 15,000 units
of Vitamin A per pound as prescribed by the USDA
BREAD AND ROLLS
Shall be made from enriched ingredients fortified with Thiamine (vitamin B1), Riboflavin (Vitamin B) a, niacin and iron
as prescribed by the USDA
SALADS
Shall be made of fresh vegetables or ingredients and shall be prepared daily with wholesome, high quality items
processed, handled and properly stored under refrigeration (below 45 deg F)
DESSERTS
Shall be products that are acceptable to the elderly, palatable, attractive in appearance and nutritious
CANNED FRUITS AND JUICES
Canned fruits shall be USDA Grade A or better
Canned juices shall be USDA fancy Grad A
18
19
SPECIFICATIONS FOR
Meal preparation, packaging and delivery to include developing of menu
In consideration of the mutual promises and covenants contained herein, the Food Contractor and
the County agree as follows:
SUBCONTRACTING OF SERVICES IS ALLOWED for:
CATERER and/or TRANSPORTATION ONLY
Any subcontracted agreement involving the provision of the meal service and the use of awarded
dollars must meet the approval of the Atlantic County AAA. Any proposed subcontractor
agreements must be included in the proposal. All proposed nutrition agreements under a
subcontract agreement are subject to the same requirement as the proposer, specific to said RFP
and attached New Jersey Standards for the Nutrition Program for Older Americans.
The chosen candidate (s) must maintain and submit to Atlantic County a list of subcontractors and
their addresses that may be updated from time to time during the course of contract performance.
A complete and accurate list shall be submitted before final payment is made for goods provided or
services rendered or for construction of a construction project under this contract.
A subcontractor shall provide a copy of its business registration to any contractor who shall forward
it to the County. No contract with a subcontractor shall be entered into by any contractor under any
contract with Atlantic County unless the subcontractor first provides proof of valid business
registration.
The successful applicant (s) as well as their subcontractors and each of their affiliates shall collect
and remit to the Director of the Division of Taxation in the Department of the Treasury the use tax
due Pursuant to the “Sales and Use Tax Act” P.L.1966,c.30(C.54:32B-1et seq.) On all their sales
of tangible personal property delivered into the state of New Jersey.
PLEASE FILL OUT FORM ON NEXT PAGE
The space for your response will expand to the length of your response. Please click on
and type in check box and underlined areas.
20
LETTER OF INTENT TO APPLY
&
NOTICE OF SUBCONTRACTOR NEEDS
The following agency declares its intention to apply as a Home Delivered Meal
Provider under Title IIIC of the Older Americans Act.
1. Food Applicant:
Name:
2. Subcontractor Needs – check one:
This agency will submit an application without
subcontractors
This agency will subcontract services – See
details below
Caterer
Transportation Vehicles
Name of Subcontractor:
Address:
21
MANDATORY PROVISIONS
AGENCY MONITORING
As outlined within the MANDATORY PROVISIONS FOR NUTRITION SERVICE PROVIDERS, it is
the responsibility of the Atlantic County Area Agency on Aging to monitor Nutrition Service
Providers. This includes but not limited to random monitoring of food at delivery of home, kitchen
staff and food preparation.






REPORTING REQUIREMENTS
The successful Proposer must submit monthly invoices to the County reflecting the delivery
of and count of meals.
The successful Proposer for the Home Delivered Meal program must submit client rosters
and/or data files that indicate the number of meals served to each registered client at an
interval set by the County.
The successful Proposer for the Home Delivered Meal program must work in conjunction
with the County to track referrals, service openings and closings, short-term stops in
service, and other information deemed necessary and appropriate by the County.
Grantees must prepare an annual “Grant Closeout”, to be submitted to the Office on Aging
by January 15th for the previous fiscal year. (Area Plan Accountant will provide assistance
with this area)
The Division of Intergenerational Services shall carry out the monitoring and evaluation
activities required by the State Division. These include annually one programmatic and one
fiscal monitoring visit.
The Director of the project, or a designated representative, must attend the quarterly
Coordinating meetings on the dates established by the Office on Aging. Attendance is
mandatory; all absences must be excused by the Division of Intergenerational Services.
Should circumstances arise that have a significant impact upon the program, the Agency is
required to notify the Division of Intergenerational Services. The following types of conditions must
be reported as soon as they become known:

A change in key staff.

Problems, delays or adverse conditions which will materially affect the ability of the Agency
to attain program objectives, prevent meeting of time schedules or goals, or preclude the
attainment of project work units by established time periods. This disclosure shall be
accompanied by a statement of the action to be taken or contemplated, and any assistance
needed to resolve the situation.
22
Outcome Measures
The Atlantic County Division of Aging Nutrition Program is committed to ensuring a high level of
participant satisfaction with the quality and variety of the food that is served, and with other aspects
of service that is provided. Participants are surveyed on a regular basis to assess satisfaction with
the program. Successful proposers will partner with the County on these efforts by:



Assisting in the distribution and collection of paper surveys.
Partnering with the County to review and address issues related to participant satisfaction.
Partnering with the County on quality improvement efforts to identify steps that can be
implemented to address dissatisfaction and overall program performance.
Successful proposer should expect site visits by the Atlantic County Division of Aging to review
such efforts.
Proposals should include a description of any quality improvement processes that the Proposer
currently has in place for existing programs, including how client feedback is incorporated into
quality improvement efforts.

The Division of Intergenerational Services should be notified of reasons for slippage in
cases where established goals were not met.
Title III Grievance Procedures for Clients
As per Older American Act guidelines, PM96-11, III-9, vendor MUST inform clients that if
they are dissatisfied with the food delivery or improperly denied service that they be provided an
opportunity to submit a written complaint at the service provider level, of which will be
acknowledged within (3) business days of receipt, investigated and then notified of findings.
Agency must also inform Intergenerational Services immediately upon receipt of complaint.
CLIENT CONTRIBUTIONS
Title III Contract Requirements
Each Agency must:
• Provide each older person with a free and voluntary opportunity to contribute to the cost of the
services.
• Protect the privacy of each older person with respect to his or her contribution.
• Establish appropriate procedures to safeguard and account for all contributions.
• Where services are provided at a specific site, or where services are provided in large groups,
unencoded envelopes shall be given to all recipients.
Drivers must be ready to accept donations from clients on a daily basis. The project
office will supply the envelopes. All donations are to be deposited into an account
designated by the County the following business day.
Agencies staff in contracting with and expending Older Americans Act funds, shall neither
solicit nor accept gratuities, favors or anything of monetary value from HDM recipients.
23
TARGET POPULATIONS
In order to assure preference to individuals with the greatest social and economic needs, the State
Division has identified four general target population groups based on target populations outlined in the
Older Americans Act.
Below is a list of these four groups followed by a brief definition for each. Please note that these groups are
not listed in priority order.
Minority
Persons aged 60+ of African American, Hispanic, Asian/Pacific Islander, American Indian or
Alaskan Native, or two or more races
Impoverished Persons aged 60+ with incomes at or below 100 percent of the poverty level as defined in
the Federal Register by the Secretary of the Department of Health and Human Services
(attached)
Frail
Persons aged 60+ having a physical or mental disability, including Alzheimer’s disease or a
neurological or organic brain disorder of the Alzheimer’s type, that restricts the ability of an
individual to perform normal daily tasks or which threatens the capacity of an individual to live
independently
Vulnerable
Persons aged 60+ exposed to unfavorable environmental conditions, as well as persons
aged 60+ with a lack of social resources which may include the following:
Income levels between 100-200 percent of the poverty level
Language Barriers
Isolation
No informal support system
Not within service system
2014 Poverty Guidelines for the
48 Contiguous States and the District of Columbia
Persons in
family/household
Poverty guideline
1
$11,670
2
15,730
3
19,790
4
23,850
5
27,910
6
31,970
7
36,030
8
40,090
For families/households with more than 8 persons,
add $4,060 for each additional person.
24
PROPOSAL FORM
DATE:
NAME AND ADDRESS OF SUBMITTING AGENCY
Name:
Address:
Telephone #:
E-mail:
Type of Organization:
Public Agency
Private Non-Profit
For Profit
PROJECT DIRECTOR
B
A
HOME DELIVERED MEAL
WEEKEND HOME DELIVERED
COST PER HOME DELIVERED MEAL UNIT
COST PER WEEKEND HOME DELIVERED MEAL UNIT
REQUESTED REIMBURSEMENT RATE FROM
ATLANTIC COUNTY
REQUESTED REIMBURSEMENT RATE FROM ATLANTIC
COUNTY
(TOTAL MUST BE THE SAME AS ON THE BUDGET
PAGE)
(TOTAL MUST BE THE SAME AS ON THE BUDGET PAGE)
Signature
SUBMITTING AGENCY PERSONNEL:
Printed Name
Agency Director
Project Director
Fiscal Contact
Contact Person
25
E-Mail
PROPOSAL INSTRUCTIONS
QUESTIONS
(Questions 1 – 19)
In the space provided below please answer the listed questions. The space for your response will
expand to the length of your response. Please click on and type in underlined areas.
Please do not attach brochures, newspaper clippings or other materials. Points will be deducted
for unanswered questions and indirect answers.
Agency Description – and Experience
Proposals must include a description of the applicant organization as follows:
1. Include mission of your organization.
2. Include geographic areas your organization currently serves.
3. Include a description of your organization’s experience providing a home delivered meal
program.
4. Include credentials and professional experience of key personnel. Please attach job
descriptions and resumes.
5. Describe anticipated outcomes/objectives/goals of Home Delivered Meal program.
Meal & Service Standards
6. Please detail your experience in food service.
7. Are you – food Provider or subcontracted Caterer presently operating any volume food
operations? If YES, what is the volume of meals that you SERVE?
8. Indicate all experience food provider or subcontracted caterer has had in preparing meals
that meet OAA requirements.
9. How do you propose to deliver Home Delivered MEALs? What transportation arrangements
do you envision providing? Please include if this piece will be subcontracted. Please include
the type, number, model, year and condition of the vehicles to be used in the nutrition
program.
10. Please include the equipment you will use in keeping the food hot and cold, at the required
temperatures, while in transit in the trucks to the recipients homes.
11. Describe your organization’s plan for meal production (agency’s self-operating kitchen or
caterer) that meet the Title III C requirements? Please include location and brief description
of facility and outline kitchen capacity, equipment available; age of equipment; plans for
replacement.
12. A staff Nutritionist or Home Economist or Dietitian or anyone who contains a B.A. Degree in
an ADA accepted food related curriculum is required. Include role in standardizing recipes,
menu development and certification, in-service staff food safety and sanitation trainings,
quarterly monitoring of kitchen.
26
13. How will you insure that each meal provided meets the recommended 1/3 DRI . Please
include a sample menu.
14. Food Purchasing System: Describe your food purchasing system, indicating procurement
process used and include present food suppliers.
15. Food Preparation: Briefly describe the proposed food preparation system (Hot Meals
prepared daily vs Meals prepared a day ahead and chilled/frozen).
16. Food Packaging System: Briefly describe the proposed food packaging system; specify
brand names and materials/products used.
17. Food Safety: Briefly describe the food handling system in place for procurement, food
storage, food preparation and food delivery and how you plan to handle emergencies.
Emergency Standards
18. Detail what contingency plans your agency has in the event of a significant employee
absenteeism.
19. Briefly describe your contingency plans to provide meals in case of the following:
a. Power Outage
b. Vehicle Breakdown
c. Weather Emergencies
d. Other as listed within the Nutrition Standard Under Emergencies (Appendix I)
27
BUDGET
You MUST complete a BUDGET page as outlined below.
Because your program CANNOT be fully funded through the Older Americans Act, as outlined,
please indicate other funding sources.
Failure to answer will jeopardize your bid

UNIT COST IS PER MEAL.
Determining Unit Cost Per Meal -- The following factors must be taken into account in determining
the Unit Cost Per Meal. These factors MUST be outlined within your BUDGET, whether utilizing
OAA funds or other sources.
1. Raw Food Cost – Including all menu items: entrée, vegetables, fruit, dessert, bread and
alternate, fortified spread, milk, including condiments.
2. Packaging Cost: Disposables, miscellaneous (pre-packaged knife/fork/spoon set, napkins, 5
compartment Styrofoam tray, coffee cup, bowl as menu would dictate.
3. Labor Cost - Production, Preparation, Service, Packaging, Food Service Management,
Transportation Labor (drivers).
4. Transportation - Gas, Oil, Van Maintenance, Depreciation, Insurance (van).
5. Administration - Administrative Salaries, Travel, Fees, Insurance, Office Supplies, Postage,
Printing, Misc., Rent, Utilities, Telephone, Maintenance, Equipment Repairs, Small Equipment,
28
Budget Request Form Instructions: The space for your response will expand to the length of
your response. Please click on and type in underlined areas.
Expenditure Items
Column A – Requested OAA C2 broken out per section
(MAXIMUM OAA C2 FUNDS – HOME DELIVERED MEALS – $197,000.00)
(MAXIMUM OAA WEEKEND HDM FUNDS - $35,145.00)
Column B – Other funds to support program, broken out per section.
Other Funds Example: United Way funds, Applicant Agency fund, such as other funds agency
chooses to use to support program outside of OAA federal/state funds.

Weekend Home Delivered Meals requires 25% match, which must be included in Column
B – other funds to support program.
Column C – Total Budgeted Program broken out per section.
Personnel – Include expenses for salaries, wages, fringe and related employee benefits provided
for persons contributing to the program for administrative, management and program operation
purposes and are employed by your agency.
Contractual – Include services performed for the agency by another entity under a subcontract for:
Food Caterer/Vendor – if food is prepared by a subcontractor
Transportation – if food is being transported to site by a subcontractor
Operating –
Food Costs: Include expenses for raw food, and related costs such as equipment, utility,
labor, packaging etc. that are essential for food preparation and are not listed in other
categories.
Transportation: Include expenses for delivery of food to sites, include gas, oil, insurance,
maintenance of vehicles and are not listed in other categories.
Other: Include expenses for telephone, postage, supplies, printing, etc. that are not included
in other categories.
C2 Net Costs: Total sections 1,2,3 and this is the amount you are requesting from Atlantic County.
Number of Meal Units: Total meals your will be preparing/packaging/transporting to Home
Delivered Meal Recipients per year.
Cost per Meal Unit: (This will be the reimbursement rate from the AAA)
C2 Net Costs ÷ Meal Units = Cost per Meal Unit
29
NAME OF APPLICANT:
(Page 1)
HOME DELIVERED MEAL BUDGET REQUEST FORM – MONDAY THROUGH FRIDAY
Complete the Budget Request Form. Identify all costs that will be implementing the program and attaining the performance objective.
A
B
C
Expenditure Item
Title C2 OAA Budgeted
Other Non-OAA
TOTAL BUDGET
Funds Requested From
Funding Sources
A+B
Atlantic County.
(Maximum that can be
requested: $197,000.00)
Section 1 Personnel (complete personnel details)
Section 2
Contractual (specify items and list below)
Food Caterer/Vendor SubContract
Transportation SubContract
Section 3
Operating
Food
Transportation
Other
Add
Sections
1,2,3
Title C2 Net Costs Paid from OAA Funds
Requested
Total of Sections 1,2,3 
Please Add this
Column C for
aTtotal Budget
Number of
HOME DELIVERED Meal To Be Provided
90,000
Cost per Home Delivered Meal
(This will be the reimbursement rate from the AAA)
C2 Net Costs ÷ Meal =
Cost per Meal 
Cost Per Meal Unit to be included on the PROPOSAL PAGE.
30
NAME OF APPLICANT:
HOME DELIVERED MEAL BUDGET (Page 2)
Please Justify each Position Title as outlined above. List all project staff.
Identify the number of full-time equivalent (FTE) staff to be employed in each
position. Also indicate which staff will be funded in whole or in part with the C2
OAA requested funds. Include the amount requested If already hired, list by
name all key staff who will be essential to the program’s success.
Position
Title
Education & Experience
Name if Available
Total Amount requested
through OAA funds/as
outlined in your budget. If
any
1.
2
3.
4.
5.
(MUST total PERSONEL
COSTS as on your BUDGET
REQUEST FORM)
Total

OTHER COST CATEGORIES
(Specify) –
Justify Each Cost Item
Supplies, Travel,
Equipment, Admin
and Other Direct
Expenses.
Raw Food Costs
Packaging Cost:
Labor Cost:
Transportation Cost:
Admin
Other
(MUST total OPERATING COSTS as on your
BUDGET REQUEST FORM)
Total Amount
requested through
OAA funds/as outlined
in your budget.

Total 
If Applicable: Name and Address of SUBCONTRACTOR for CATERER and/or
TRANSPORTATION
NAME:
ADDRESS:
31
NAME OF APPLICANT:
(Page 1)
WEEKEND HOME DELIVERED MEAL BUDGET REQUEST FORM – SATURDAY AND SUNDAY (REQUIRES 25% MATCH)
Complete the Budget Request Form. Identify all costs that will be for implementing the program and attaining the performance objective.
B
A
C
MUST INCLUDE 25% MATCH
Title C2 OAA Budgeted Funds
Requested From Atlantic Co.
Maximum that can be
Requested: $35,145.00
Expenditure Item
Section 1
Personnel (complete personnel details)
Section 2
Contractual (specify items and list below)
Food Caterer/Vendor SubContract
Other Non-OAA Funding
Sources
TOTAL BUDGET
A+B
Transportation SubContract
Section 3
Operating
Food
Transportation
Other
Add
Sections
1,2,3
Title C2 Net Costs Paid from OAA Funds
Requested
Total of Sections 1,2,3 
Please Add this
Column C for a
Total Budget
Number of WEEK END HOME DELIVERED Meal Units 2,600
To Be Provided 
Cost per Weekend Home Delivered Meal
(This will be the reimbursement rate from the AAA)
C2 Net Costs ÷ Meal Units = Cost per Weekend Meal 
Cost Per meal Unit to be included on the PROPOSAL PAGE
32
NAME OF APPLICANT:
WEEKEND HOME DELIVERED MEAL BUDGET (Page 2)
Please Justify each Position Title as outlined above. List all project staff. Identify the number
of full-time equivalent (FTE) staff to be employed in each position. Also indicate which
staff will be funded in whole or in part with the C2 OAA requested funds. Include the
amount requested If already hired, list by name all key staff who will be essential to the
program’s success.
Position
Title
Education & Experience
Name if Available
Total Amount requested
through OAA
funds/as outlined in
your budget. If any
1.
2
3.
4.
5.
(MUST total PERSONEL
COSTS as on your
BUDGET REQUEST
FORM)
Total

OTHER COST CATEGORIES
(Specify) –
Justify Each Cost Item
Supplies,
Travel,
Equipment,
Admin and
Other Direct
Expenses.
Raw Food Costs
Packaging Cost:
Labor Cost:
Transportation Cost:
Admin
Other
(MUST total OPERATING COSTS as on your
BUDGET REQUEST FORM)
Total Amount
requested
through OAA
funds/as
outlined in your
budget.

Total 
If Applicable: Name and Address of SUBCONTRACTOR for CATERER and/or
TRANSPORTATION
NAME:
ADDRESS:
33
EVALUATION CRITERIA - PROPOSAL CHECK LIST:
Selection of chosen Congregate Food Service Provider (FSP) is competitive. As such, all
proposals received shall be subject to an evaluation by an Evaluation Committee consisting of
Atlantic County Staff and others, as deemed appropriate for the purpose of selecting the
service provider with whom a contract will be executed. The following factors, as listed below,
will be considered in making the selection.
Evaluation of documentation furnished by Food Service Provider (FSP) in response to bid specifications,
____Description of food preparation site indicates adequacy to comply with Area Agency requirements.
____FSP employs staff with experience, credentials and training to successfully produce and package
home delivered meals for the Area Agency
____FSP employs a staff Nutritionist or Home Economist or Dietitian or anyone who contains a B.A.
Degree in an ADA accepted food related curriculum who is responsible for menu development and
nutritional requirements compliance.
____Sample menu submitted by FSP meets nutritional analyses which meets or exceeds requirements as
listed in Appendix I.
____Copy of current operating permit from health department is provided, along with any other local
and state regulations consistent with food preparation.
____Food transport equipment meets Area Agency requirements for holding food at safe temperatures
____Schedule for maintenance and cleaning for delivery vehicles is acceptable and reflects FSP’s
understanding of the importance of clean and safe vehicles.
____Budget attached reflects financial stability and viability of FSP.
____Past experience and expertise in the operation of commercial/institutional food service demonstrates
ability to implement and sustain services required by Area Agency.
34
Atlantic County
Area Plan Contract Proposal Evaluation Form
Home Delivered and Weekend HDM Meals – Food Service Provider
Agency: _____________________________
Total Points ____________
Program: _______________________________________________________________
Reviewer: _________________________________
Date: __________________
Proposal package is well organized and
complete
Sample menus meet nutritional requirements
Goals/ objectives/ outcomes of program
outlined
Experience and expertise in institutional food
service demonstrates ability to implement
and sustain required services.
Food Preparation Site, equipment, storage
are adequate to meet program requirements
Food transport equipment meets
requirements for holding food at safe
temperatures
Job Descriptions: qualifications and
experience of budgeted personnel for project
are appropriate
Reasonableness of budget
 Backup for unit cost
 Cost within budgetary guidelines
Total
35
Appendix I
New Jersey Standards
for the Nutrition Program for Older Americans
Effective: January 3, 2012
New Jersey Department of Health & Senior Services
NJ Division of Aging and Community Services
36
TABLE OF CONTENTS
Page
Mission and Purpose …………………………………………………………. 3
Nutrition Program Staffing ……………………………………………..……4-7
Social Assistance Management System (SAMS) ……………………………. 8
Record Keeping…………………………………………………………………9-11
Food Service ,Congregate and Home Delivered, Standards ……….. …….. 12-14
Emergencies ……………………………………………………………………. 14-15
Insurance ……………………………………………………………………….. 15
Inspections and Technical Assistance of Consumer and Environmental
Health Services (CEHS)……………………….……………………………….. 15-17
Monitoring ………………………………………………………………………. 17
Target Groups …………………………………………………………………… 18
Coordinated Programs and Activities ……………………………………….…. 19
Appendices
Dietary Reference Intakes for Older Americans………………….. 21-22
New Jersey’s Guide for Meal Planning…………………………….. 23-24
Nutritionist Certification Report …………………………………… 25-28
Facility Use Agreements ……………………………………………... 29-30
Sample Policy on Handling Special Circumstances …………………31
Nutrition Program: Notification of Facility Change………………. . 32-33
New Jersey Standards
For the Nutrition Program for the Older Americans
Mission Statement
To provide nutritious meals and services, which are designed to promote independence, dignity, socialization, health and well being
of the participants.
Definition of Nutrition Program for the Elderly
A program to distribute awarded federal grant funds to establish a network of community-based providers and sites to provide
congregate and home delivered meals for persons 60 years of age or older, nutrition education, counseling, socialization
opportunities and outreach services.
37
Purpose of Document
The New Jersey Department of Health and Senior Services, Division of Aging and Community Services Standards for the Nutrition
Program for Older Americans are established to define statewide standards of administration, responsibility and practice in programs
funded under the Older Americans Act of 1965 as amended (OAA) and under Area Plan Contract (APC) grants to the Area
Agencies on Aging (AAAs) and community service providers.
Policies/Procedures
Written procedures are necessary for efficient program operation, maintaining continuity and avoiding misinterpretations. At a
minimum, procedures covering the following topics must be developed and reviewed annually by the Nutrition Program in
cooperation with the Area Agency on Aging.









Personnel Policies including job descriptions (for staff and/or volunteers)
Program Policy and Procedure Manuals
Home Delivered Meal Program Standards
Congregate Meal Program Standards
Nutrition Education Standards
Nutrition Counseling Procedures
Food Service Standards
Data Collection Standards including National Aging Program Information System (NAPIS) data and the use of the state
designated electronic database Social Assistance Management System (SAMS).
Interagency coordination
38
Nutrition Program Staffing
An adequate number of staff must be employed to provide administration and implementation of the program as required under the
current amended Older Americans Act. An organizational chart showing paid and volunteer positions must be developed and/or
included in grant agreements. A job description outlining responsibilities, minimum educational and experience requirements must
be on file for each position. Staff development and training records must be maintained. Nutrition programs are equal opportunity
providers and employers.
Required Positions
Project Director - Congregate/Home Delivered Nutrition Services
The project director should be a full-time employee who must be empowered with the necessary authority to conduct day-to-day
management and administrative functions of the program. The director must uphold quality food service standards including
adherence to Title III of OAA and NJAC 8:24-1, “Chapter 24 Sanitation in Retail Food Establishments and Food and Beverage
Vending Machines” requirements. This includes supervision of all staff and volunteers within the project.
The project director's qualifications should include:

Graduation from a four-year course at an accredited College or University.

Three years of responsible professional experience in either a paid or volunteer capacity in social work, working with the
elderly, public health, gerontology, psychology, community organization work, nursing home administration, nutrition, dietetics
or food service management.
Note: Possession of a master's degree in any of the above fields may be substituted for one year of work experience.

Broad knowledge of issues pertaining to older people, of community and State agencies and resources available to older
people and of the methods of utilizing community resources for older people; current principles and techniques of program
planning, budgetary control and personnel management.
Required Activities
 Administration, supervision, plan, conduct and evaluate staff/volunteer orientation and in-service training
 Maintaining statistical information, submitting required reports, preparing and monitoring Title III contracts
 Assures National Aging Program Information System (NAPIS) data is input into the state designated electronic database
Social Assistance Management System (SAMS).
 Implementing, maintaining and monitoring of all purchased services and space; this may include negotiations with
caterer/vendors and physical plant owners
 Fiscal management/fundraising and accountability
 Needs assessment/program development
 Public relations/marketing/outreach
 Participation in professional, interagency activities and associations on the community, county and state levels
 Assures Title III nutritional requirements are met and that nutrition education and counseling is done
Nutrition Program Staffing (continued)
Nutritionist
Each Area Agency/Nutrition Provider must employ or retain the services of a qualified nutritionist for congregate and home
delivered meal programs, whose academic preparation and experience will provide the expertise necessary to address the required
activities listed below.
The nutritionist qualifications should include:

Three years of recent, relevant experience working with the elderly in a food and nutrition related capacity.
Note: Possession of a master's degree in foods, nutrition or institutional management may be substituted for one year of work
experience
39
The nutritionist should also possess one of the following professional credentials:



Registered Dietitian and a current member of the Academy of Nutrition and Dietetics (formally the American Dietetic
Association)
Graduate of an accredited college with a bachelor’s degree in food and nutrition.
Person who has successfully completed a NJ civil service exam for the job title of Project Nutritionist, Health; Nutrition
Consultant I or II (Public Health Nutritionist I or II).
Required Activities
 Monitor the food preparation facility and the food service operation at the nutrition sites on a regular basis.
 Evaluation and monitoring of food safety in preparation, packaging, and delivery of congregate and home delivered meals.
This shall include compliance with local, state and federal regulations, food safety, and evaluation of the nutritional
adequacy of the meal served.
 Periodic home delivered route monitoring for acceptability of temperature, quality and food safety of home delivered meals
as received in the participant’s home.
 Make recommendations in the development of budget proposals as appropriate.
 Plan/review and certify culturally diverse menus (using computerized nutrient analysis) to insure that each menu meets the
minimum nutritional standards, i.e. 1/3 Dietary Reference Intake (DRI) using males 51-71+ as reference and the current US
Dietary Guidelines. Refer to table 1
 Develop/identify nutrition education materials and presentations relative to the needs of the elderly (homebound and
congregate).
 Conduct, and/or coordinate nutrition education programs for participants at each site and distribute literature to homebound,
at least quarterly.
 Plan, conduct/coordinate and evaluate in-service training for nutrition staff and volunteers at least annually.
 Assist in reviewing new facilities or planning the renovations of current facilities used for meal service or meal preparation
to determine impact on food service.
 Provide individualized Medical Nutrition Therapy (homebound and congregate) a doctor's prescription is required.
(Registered Dietitian only).
 Provide Nutritional Counseling (Individualized advice to those who require guidance regarding their diet).
Required Activities (continued)

Provide in-home nutritional counseling for frail elderly requiring counseling services on a priority basis to enhance
nutritional well being. Evaluation and nutrition counseling by a registered dietitian will enable the participant or caregiver
to plan for other meals not provided by the program. For example, nutrition counseling is frequently necessary for
recipients who present health problems such as hypertension, osteoporosis, diabetes, congestive heart failure, dental
problems, or have inadequate cooking facilities and special diets. The assessment process should help identify the frail
elderly participant requiring this level of nutrition counseling.

Coordinate annual Nutrition Screening survey of clients.

Follow the data collection requirements of the federal and state governments related to participants (NAPIS and USDA).

Provide technical assistance to Area Agencies on Aging and nutrition service providers on food service practices,
equipment facilities, programming, training and policy/procedures for food service.
Time Required
The director of the employing agency will determine how best to utilize the time and expertise of the nutritionist. Each nutritionist
employed as a part-time consultant must sign a written agreement, which clearly specifies the number of hours to be worked and
defines his/her specific responsibilities. The contracted time must be adequate to allow for the completion of the required activities.
This information should be specified in the contract between the Area Agency on Aging and nutrition service providers.
Congregate Programs
The time required for a nutritionist will depend on the number of sites, number of congregate and home delivered meals served in
the program, type of meal service, number of participants, logistics of the project, and the nutrition services to be provided.
Home Delivered Programs
40
It is the responsibility of the Area Agency on Aging to ensure that home delivered nutrition programs have regular consultation by a
qualified nutritionist to ensure standards are met. The nutritionist may be an employee of the Area Agency on Aging or the nutrition
service provider. Programs serving only meals to the homebound must have available regular consultation by a qualified
nutritionist. As with the congregate program, the time required for the nutritionist will be dependent upon a number of factors
including: the number of home delivered meals served, the type of meal preparation, the number of routes, and the number of frail
elderly requiring nutrition counseling.
Site Manager – Congregate Programs
Each site should have a paid, responsible manager to assure program stability. Good management is necessary for a smooth running
site that meets the needs of the participants. The site manager's job duties, areas of responsibility, line of authority and
communication must be clearly defined in a job description.
The site manager must be provided/be made aware of the job description and specific knowledge and abilities required to perform
essential functions. Volunteers may be assigned duties to assist the site manager in accomplishing the required duties.
Nutrition Program Staffing (continued)
Meal Production Staff
If the nutrition service provider has a central or on-site kitchen, a lead staff person must be designated. The additional number of
kitchen employees needed will be determined by the number of meals, type of menu, available equipment, etc.
Staff Development & Training
All staff, paid and volunteer, must receive orientation prior to beginning work for the program. In addition, training to enhance job
performance must be provided on a regular basis.
Required Staff Training Documentation
 The date and outline of the actual training
 The person conducting the training
 Summary attendance records for each employee.
Social Assistance Management System (SAMS)
AAAs are required to use SAMS for the following:

For all Area Plan Contract (APC) data reporting, client tracking and all care management funded by and through
Division of Aging and Community Services (DACS).

For intake, screening individuals for community services, recording service delivery, client characteristics and
managing the activities of the Aging and Disability Resource Connection (ADRC) business process.

The system will be the single data system by which all AAAs report National Aging Program Information System
(NAPIS) and ADRC data going forward.

It is the responsibility of the Area Agency on Aging (AAA) to ensure their providers are using SAMS and entering
data thoroughly and correctly. The AAA subcontract language may also contain this language as a requirement
for receiving funding. Should the AAA choose not to require grantees to input their data directly into SAMS, it
will be the responsibility of the AAA to enter the data.
41
Record Keeping
To establish and maintain a system for the collection of data that will accurately reflect the performance of the program and be used
for administrative control. This data must be available for Area Agency and State review.
The following records must be initiated and maintained for a period of three (3) years from the date of expiration of the grant year or
contract, unless indicated otherwise.
A.
Congregate Nutrition Programs
1. Intake
By the end of the third visit, basic information for each participant should be obtained. (It must be obtained by the end of the fifth
visit.) This includes name, address, phone numbers, contact person, emergency instructions, services needed, proof of age, i.e. date
of birth, demographics and income data etc. This information is confidential and access will be limited to those approved by the
project director. The use of, a State Unit on Aging, approved common assessment tool is required.
2. Attendance or Daily Sign-In Sheets
Any form that will document the number of meals served to: participants, including staff over 60; guests, including staff under 60;
volunteers; the homebound and handicapped if appropriate (See PM 83-7 III-6). Participants must sign a daily attendance sheet to
verify registration. This information must be accurate and maintained at the project office. A reservation system is recommended.
3. Daily Food and Supply Records
Detailed records must be maintained for each day of operation showing:
 Quantities – ordered, shipped, received, prepared, served or delivered on site
 Temperatures – shipped, received and served
 Quality of products, comment section
 Supplies – ordered, shipped and received
 Time – shipped, arrived, serviced
 Menus – served (Any deviation from approved menu must be recorded and reported to the project office)
 Signature (or initial) of receiving person
 Location – site identification
 Date
42
Records (continued)
4. Equipment Temperature Logs (i.e.)
 Refrigerator, freezer and chill table logs
 Thermometer calibration accuracy logs
 Rethermalization oven reheat temperature log
5. Fire drill records
6. Personnel records shall be maintained for a minimum of three years. This includes time sheets, attendance records, training
documentation, performance evaluations etc. for paid and volunteer staff.
7. Related Health Department inspection reports and placards (see section on Health Inspections and Technical Assistance of
CEHS).
8. State Unit on Aging and Agency Program and Fiscal Reports
9. Contribution Records (as per PM 84 - 4, III-2)
10. Nutrition screening, education and counseling records shall be maintained for a minimum
of three years.
9. Menus with corresponding nutritional analysis
B.
Home Delivered Nutrition Services -Records
1. Needs Assessments
 Client intake shall be completed by designated staff to determine participant eligibility and service needs prior to or within
10 days of initiating the service. Use of the common assessment tool adopted by the State Unit on Aging is
recommended.
 Reassessments must be completed within six-month intervals.
2. Nutrition screening, education and counseling records
3. Contributions Records (PM 84-4, III- 2)
4. Related Health Department inspection reports and placards
5. List of personnel including volunteers
6.
Menus with corresponding nutrition analyses
7.
Waiting lists shall be maintained to assist in determining the extent of program need in the service area and to
identify service gaps.
8.
Waiting list procedures shall be clear and include specific guidelines for prioritizing clients who are most in
need. These procedures should be periodically reviewed by the nutrition service provider and the Area
Agency on Aging.
9.




Temperature Logs
Delivery Truck Hot/ Cold vehicle temperature logs
Last house delivery temperature logs
Thermometer calibration accuracy logs
Rethermalization oven reheat temperature logs
43
Food Service – Congregate and Home Delivered Standards
Goal
To provide meals that comply with the current Dietary Guidelines for Americans published by the Secretary of Health and Human
Services and the Secretary of Agriculture which provide to each participating older individual, a minimum of 1/3 the DRI as
established by the Food and Nutrition Board of the National Research Council of the National Academy of Sciences. Two meals
served to the same individual must equal 2/3's the DRI; three meals must equal 100% of the DRI. (Table 1- Appendix)
Food handling must comply with NJAC 8:24-1, “Chapter 24 Sanitation in Retail Food Establishments and Food and Beverage
Vending Machines”
Meal and Service Standards
A. Meal Planning
1.
The menu must be analyzed using a State Unit on Aging - approved computerized nutrition analysis program. All
menus must be reviewed, approved and certified by a qualified nutritionist employed by the Area Agency on
Aging or Nutrition Service Provider. The Nutritionist's Quarterly Activities and Menu Certification Report must
be prepared by the nutritionist and supplied to the Area Agency on Aging. The Area Agency on Aging must
forward this report to the State Unit on Aging within ten (10) working days following the end of each quarter.
2.
Cyclical menu planning is recommended. Menus with documentation as to nutrient content, based on the
required use of standardized recipes, must be kept on file by the service provider for a minimum of three years.
B. The Food Service System: Congregate and Home Delivered Nutrition Services
The food service system can be one, or a combination of, contract vendor, central kitchen, or on-site kitchen.
1.General Requirements
a. Food procurement from approved sources.
 Foods must be purchased from licensed vendors
 Donated food supplies must meet all applicable regulations as stated in NJAC 8:24-1, “Chapter 24 Sanitation in Retail Food
Establishments and Food and Beverage Vending Machines” and where appropriate, the "Food Bank Good Samaritan Act."
NJ S. A. 24:4A-1-4A-5 (L. 1982 c. 178).
b. The amount of time between food preparation and serving must meet the guidelines established in
JAC 8:24-1, “Chapter 24 Sanitation in Retail Food Establishments and Food and Beverage Vending
Machines”
c. Adequate dry, frozen, refrigerated storage areas.
d. Approved washing/sanitizing practices in accordance with NJAC 8:24-1, “Chapter 24 Sanitation
in Retail Food Establishments and Food and Beverage Vending Machines”
e. Foods maintained at safe temperatures during preparation, holding and distribution:
 Meal delivery routes should be planned and reviewed regularly with the delivery personnel to assure the expeditious use of
manpower, vehicles and time. No delivery run should exceed two hours. The use of special heated/refrigerated vehicles and
equipment may extend the delivery time as long as food quality and temperatures are maintained.
Food Service-Congregate and Home Delivered Standards (continued)
2. Contract Vendor (Catered)
There must be a written contract between the service provider/project and vendor, which establishes conditions, methods,
responsibilities and food standards for the term of the agreement. This contract should include but not be limited to:
 Bidding procedures (if applicable)
 Penalties for inadequate service
 Records/facilities inspection rights
 Specifications for food, meal types ( puree, kosher, vegetarian, shelf stable and special events) and disposable items
 General provisions for meal preparation and distribution
 Adequate preparation and transport equipment
 Staff background (of staff who will be assigned to the County’s Nutrition Program for the Elderly
 Facility description
44









Equipment list to be used in the contract
References
Quality assurance mechanisms
Claims against contractor
Maintenance
Extermination
Licensing
Safe and sanitary handling of food in compliance with NJAC 8:24-1, “Chapter 24 Sanitation in Retail Food Establishments
and Food and Beverage Vending Machines”
Handling of emergencies (i.e. power failures, caterer equipment breakdown, etc.)
3. Central Kitchen and/or On Site Preparation
a. Written Procedures - To assure adequate staffing, purchasing, meal preparation and distribution, the
following should be included but not limited to:
 Staffing
 Purchasing
 Receiving
 Storage/Inventory
 Food Preparation
 Distribution, Packaging, Transporting and Delivery
 Maintenance
 Cost Control
 Safe and sanitary handling of food in compliance with NJAC 8:24-1, “Chapter 24 Sanitation in Retail Food Establishments
and Food and Beverage Vending Machines”
 Quality assurance mechanisms
b. Equipment – The type and scope of the meal program will dictate the appropriate equipment for the
operation. Many resources are available on interrelating kinds and sizes of equipment.
4. Home Delivered Meals
Home Delivered Meals routes must be monitored at least semi–annually for the palatability and temperature of the foods on arrival
at the participant’s destination. Documentation must be kept on file for three years. (See record retention.)
Written procedures for all aspects of the home delivered program must be developed and available for State review. These
procedures will document resource acquisition and use as well as establishing how tasks are to be completed.
Emergencies
In order to protect the health and well being of participants, volunteers, and staff, the establishment of emergency preparedness and
training for emergency situations is essential. Staff and volunteers must be trained in emergency procedures. Review and update
emergency procedures with staff and/or volunteers at least annually and maintain appropriate documentation.
Congregate Program Implementation
The nutrition service provider is responsible for developing written procedures and designating a specific individual for initiating
and implementing procedures for the following situations:
 Fire at site
 Medical emergency
 Emergency meal provisions for disaster or system failure. (Contact Emergency Management to coordinate planning).
 Weather related situations
 Transportation breakdown
 Food service emergencies (i.e. late food deliveries, inadequate quantities, food arriving out of temperature, poor food
quality, personnel shortage)
 Food borne illness
All site managers or designated individuals must be trained to follow established emergency procedures.
45



Training should include staff, volunteers and participants as appropriate.
Prominently post emergency procedures and phone numbers at site.
Review and update emergency procedures with staff, volunteers and participants at least annually and maintain appropriate
documentation.
Training in CPR, first aid, the Heimlich Maneuver or other medical emergency techniques is recommended for staff and/or
volunteers

Home Delivered Program Implementation
1. The home delivered nutrition service provider is responsible for developing written procedures and designating a specific
individual for initiating and implementing procedures for the following situations:



Fire at meal distribution site
Medical emergency
Emergency meal provisions for disaster (Contact Emergency Management to coordinate planning)
 Weather related situations
Meal delivery vehicle breakdown
Food service emergencies (i.e., late food deliveries, inadequate quantities, food arriving out of temperature, poor food
quality, personnel shortage)
Food borne illness
Driver/volunteer in-home emergency




Insurance
All Area Agencies should assure that the congregate and home delivered nutrition service providers have liability, comprehensive,
product and accident insurance coverage.
Area Agencies should annually review the following insurance checklist with nutrition service providers:






Product liability
General liability
Fidelity bonding
Performance bonding
Accidental auto insurance for project owned vehicles
Fire, theft, comprehensive – buildings and project/county owned vehicles
Inspections and Technical Assistance of
Consumer and Environmental Health Services (CEHS)
All food service establishments must comply with all applicable licensing laws and ordinances relating to food service operations.
(NJAC 8:24-1, “Chapter 24 Sanitation in Retail Food Establishments and Food and Beverage Vending Machines”) Area Agencies
on Aging receive additional inspection services for congregate and home delivered nutrition services through an intra-agency
agreement between the NJ Division of Aging & Community Services and the Division of Epidemiology, Environmental and
Occupational Health.
A.
Evaluation/Inspections
State (CEHS) and/or local health department personnel will conduct routine unannounced operational inspections as often as deemed
necessary and conduct follow-up inspections and/or initiate legal action when conditions warrant.
a. An evaluation of the overall operation will be issued at the conclusion of the inspection.
A copy of the inspection report must be signed by a project representative and left by the
health department representative. A certificate will be signed and left with the operator.
b.
This certificate must be posted in a conspicuous place near the public entrance.
c. The original inspection report must be kept on file at the facility for a minimum of two
years. A copy of the inspection report may be made and kept on file at the Area Agency
if desired.
46
Inspections and Technical Assistance of CEHS (continued)
B. New or Renovated Facilities Inspection
1. Plan Review and Approval
NJAC 8:24-1, “Chapter 24 Sanitation in Retail Food Establishments and Food and Beverage Vending Machines” requires all retail
food establishments or facilities which are to be extensively renovated to submit plans and specifications for the design, layout and
equipping of the food service to the local health department as well as obtain all necessary permits from the appropriate construction
officials.
2. Pre-Operation Inspections for New/ Closed and/or Relocated Facilities
a. Pre-operational inspections should be requested of state health officials when a project plans to move into an existing food
establishment without making renovations. The State Nutrition Consultant, Division of Aging & Community Services is the contact
person for requesting state inspections. CEHS will be notified to conduct the inspections.
b. Evaluation of the facility will focus on availability of equipment, equipment for washing and sanitizing, equipment to maintain
food temperatures, hand washing facilities, and other sanitation controls. (form in appendix)
C.
Training and Technical Assistance
Sanitation Training
a. Food handler’s training for staff is required every two years. The Nutrition Program
Director should determine which staff should participate in the training. (Contact local
health departments for availability of training programs). This is recommended for all
Risk Type 2 Food Establishments
b. It is recommended that volunteer staff be knowledgeable in food safety policies and
procedures.
c. The State requires that at least one person in charge of a Risk Type 3 Food Establishment
be a certified food protection manager who has shown proficiency of required information
through obtaining a food safety certificate and passing a food safety certification
examination administered by an accredited certifying program recognized by the
Conference for Food Protection( ServSafe).
D.
Contract Vendor Inspection
1. All contract vendors (i.e. wholesale caterers, commissaries, restaurants and other food production facilities)
providing meals to nutrition programs must possess a food/cosmetic (FC license) issued by the DHSS. Meals
provided by licensed health care facilities such as hospitals or long-term care facilities are not under the FC
licensure.
2. These food production facilities will be inspected prior to awarding contracts upon written request from the
nutrition service provider to the State Unit on Aging..
3. Any request for vendor’s history should be requested from the New Jersey Division of Aging and Community
Services.
4. Complaints regarding sanitary conditions or transportation methods including improper/inadequate food
temperatures should be reported to the NJ Division of Aging and Community Services and will be investigated by
the CEHS.
Inspections and Technical Assistance of CEHS (continued)
E.
Food Borne Illness ( reported incident involving two or more people who experience the same
illness after eating the same food on the same day.)
1. Reporting
Nutrition projects, which suspect that a food borne illness may have resulted from food served at the facility or to home delivered
meal clients, must report the incident to State and local Health Departments as well as the State Unit on Aging. See NJAC 8:24-1,
“Chapter 24 Sanitation in Retail Food Establishments and Food and Beverage Vending Machines”
47
2. Necessary information to be reported:
 Menu served
 Suspected food
 Number of people involved
 Names and addresses of people
 Symptoms
 Time and meal service
 Medical treatment
 Other pertinent information (i.e. temperature records from the caterer and in-house temperature records)
3. Investigation
a. The State and local Health Departments will coordinate the investigation and report their findings to the Division of Aging and
Community Services, Area Agency on Aging, the service provider and the vendor (if appropriate).
Monitoring
It will be the responsibility of the Area Agency on Aging to monitor nutrition providers and nutrition programs that are directly
provided. The purpose of the monitoring is to ensure compliance with the Nutrition Standards, evaluate provision of service, and
arrange for/ provide technical assistance as needed. A copy of the monitoring report shall be furnished to the Nutrition Program.
Records of monitoring visits conducted by the Area Agency on Aging will be made available to the State Division of Aging and
Community Services representatives reviewing and monitoring nutrition services.
Nutrition providers funded under the Area plan Contract are required to be monitored a minimum of twice per contract year-one visit
to specifically address the Congregate Nutrition Program and the other to focus on the performance of the Home Delivered Nutrition
Program.
The State Division of Aging and Community Services will be responsible for monitoring nutrition services of all 21 Area Agencies
on Aging focusing on the overall performance of the Nutrition Program . A report summarizing findings will be furnished to the
Area Agency on Aging.
Target Groups
Every effort should be made to increase the participation of low income, isolated, frail and minority elders in congregate and home
delivered nutrition programs. Limited resources necessitate giving primary consideration to those non-institutionalized individuals
with the greatest need.
Implementation

The nutrition provider, in cooperation with the Area Agency on Aging, should analyze service utilization data to
determine current participation of target groups.

Nutrition providers should identify target groups and address the needs of the most vulnerable and frail elderly
participants in the service area.

Nutrition providers with the Area Agency on Aging will identify agencies to work with to help locate frail and underserved elderly.

Nutrition providers should partner with agencies to serve the most vulnerable, frail participants and target groups.

Nutrition providers shall define and develop appropriate programs tailored to the needs of target groups and vulnerable,
frail participants. Efforts should include:
48
1.
Placing more services in neighborhoods with high concentrations of low income and/or minority older
persons or persons in greater social or economic need.
2.
Programs shall be culturally relevant, provided in the language spoken by the majority of clients attending
the program.
3.
When possible, ethnic menus should be designed to meet the needs of the various cultures of the program
participants.
4.
Develop creative outreach activities to locate target population.
APPENDIX
49
Table1. Dietary Reference Intakes for Older Americans
Nutrients1
Macronutrients
Calories2
Carbohydrates3
50% of Kcals
Protein
20% of Kcals
Fat
30% of Kcals
Fiber
Minerals And Vitamins
Calcium*
Magnesium
Potassium*
Sodium*
Zinc
Vitamin A
Vitamin C
Vitamin D*4
B6
Folate
B12
Male 51-70+
(females)
1/3 DRI-males
(females)
Compliance Range
( weekly averages )
2100/day
(1900/day)
263g/day
(238g/day)
105g/day
(95g/day)
70g/day
(64g/day)
25g/day
(20g/day)
700
(634)
88gl
(80g)
35g
(32g)
24g
(22g)
8g
(7g)
650- 950
1200mg/day
400 mg
420 mg/day
(320mg/day)
4.7g/day
1.3g/day
1.2g/day
140 mg
(107 mg)
1.6g/day
434 mg
400 mg
400 mg or higher
may require personal supplementationplease consult your health practitioner
110mg or higher
11mg/day
(7mg/day)
900 ug/day
(700ug/day)
90mg/day
(75mg/day)
10 ug/day
15 ug/day
3.7 mg/meal
(2.4 mg)
300 ug
(233 ug)
30 mg
(25 mg)
3.33 ug
5 ug
1.7 mg
(1.5mg/day)
400 ug/day
2.4 ug/day
0.57 mg
(0.5 mg)
134 ug
0.8ug
50% of Calories
20% of Calories
30% or less of Calories
7g or higher
1200 mg or higher
1200mg or less (most days of the week)
1500 mg accepted occasionally
(Limit processed smoked or cured meats to
no more than once per week (smoked ham,
sausage, cold cuts, hot dogs, etc.)
2.4-3.7 mg
250 ug or higher
25mg or higher
3.33ug-5ug/meal
may require personal supplementationplease consult your health practitioner
0.5 mg- 0.57 mg/ meal
may require personal supplementationplease consult your health practitioner
1
Recommended Dietary Allowances(RDAs) are in bold type and Adequate Intakes (AIs) are in ordinary type followed by an (*)
Values for estimated energy requirement (EER) used 75 years, height of 5’7’’, “low activity” physical activity level and calculated
the median BMI, subtracted 10kcal/day (men) and 7kcal/day (female) for each year over 30.
3
Acceptable Macronutrient Distribution Ranges (AMDRs) for intakes of carbohydrates, proteins and fats expressed as % of total
calories.
The values for this table were excerpted from the Institute of Medicine, Dietary Reference Intakes: Applications in Dietary
Assessment, 2000 and Dietary Reference Intakes for Energy, Carbohydrates, Fiber, Fat, Protein and Amino Acids (Macronutrients)
2002.
4
Recent findings indicate People age 71 and older may require as much as 800 IUs(20ug) per day because of potential changes in
people’s bodies as they age.( Institute of Medicine 11/30/10)
2
The 2010 Dietary Guidelines recommend shifts in food consumption patterns, encouraging people to eat more of some foods and
nutrients and less of others. The Dietary Guidelines encourage Americans to eat more: whole grains, vegetables, fruits, low-fat or
fat-free milk, yogurt and cheese or fortified soy beverages, vegetable oils such as canola, corn, olive, peanut and soybean, seafood.
And the 2010 Dietary Guidelines recommend eating less: added sugars, solid fats, including trans fats, refined grains, and sodium.
(ADA press release January 31, 2011)
50
This Page is Intentionally Blank
51
New Jersey Guide for Meal Planning
(Minimum requirement Version) Model to meet 1/3 of the RDI and US Dietary Guidelines for Americans
Based on a combination of the USDA Food Guide and DASH Eating Plan
Calorie range: 650-950 per meal
Food Group
Minimum Number of Servings
Serving Information
1 meal
2 meals
3 meals
Vegetables and Fruits
2-3serv.
4-6 serv.
6-9 serving Serving Sizes
 1 cup raw leafy vegetables
 ½ cup cooked vegetables
 6 oz vegetable juice
 1 medium fruit
 ¼ cup dried fruit
 ½ cup fresh, frozen, or canned fruit
 6 oz fruit juice
 1/8 melon
Starchy Vegetables
 1 small potato, or ½ large potato or ½ cup
mashed potatoes
 ½ cup sweet potato or yams
 ½ cup corn, winter squash, sweets peas or
lima beans
Special Instructions:
1. Provide high Vitamin A vegetable (darkgreen, red and orange) at least three (3)
times per week.
2. Provide a Vitamin C source daily
3. Limit starchy vegetables to one serving per
meal
4. Limit the use of canned vegetables
containing salt/sodium.
Lean Protein Sources
3 oz or
4 -6 oz or
6 -8 oz or
Serving Sizes
equivalents equivalents equivalents
 1oz cooked lean meat, poultry, or fish
 1/3 cup or 1 ½ ounces nuts
 2 Tbsp or ½ ounce seeds
 ½ cup cooked dry beans or peas
 1 egg
 1 oz low- fat cheese

½ cup low-fat cottage cheese
 ¼ cup tofu ( bean curd)
Special Instructions
1. Limit processed, smoked or cured meats to
no more than once per week (smoked ham,
sausage, cold cuts etc.)
2. Meats should be baked, broiled , grilled or
roasted
3. Fish ( a good source of omega-3 fatty acids )
should be included regularly as feasible
4. Use reduced sodium cheese as is feasible
Skim or Low-Fat Milk and
1 serv.
2 serv.
3 serv.
Serving Sizes
Dairy
 8 oz milk (fortified with Vit. D) or 8oz soy
milk (fortified with Calcium and Vit. D)
 1 cup yogurt
 1 ½ ounces cheese
Special Instructions
1. Use fat free (skim) or low-fat milk (1%) and
reduced fat cheeses
2. Products fortified with Vitamin D
3. Cheese (low fat / reduced sodium) can not
52
be used as both a protein source and milk
alternative at the same meal
Grains
2 serv.
4 serv.
6 serv.
Serving Sizes
 1 slice bread (1oz)
 ½ English muffin, bun, small bagel, or pita
 1-6 inch tortilla
 4-6 crackers
 ¾ cup dry or ready to eat cereal
 ½ cup cooked pasta, rice, noodles , bulgur,
barley or cereal
 1 ¼’’ square of cornbread
 1-2’’ diameter biscuit or muffin
Special Instructions
1. Whole grain products are encouraged.
Brown rice may be used as an inexpensive
whole grain product
2. Limit use of high fat and sodium containing
quick breads
Oils and Fats
1 serv.
2 serv.
3 serv.
Serving Sizes
 1 tsp soft margarine
 1 Tbsp low fat mayonnaise
 2 Tbsp light salad dressing
 1 tsp vegetable oil
Special Instructions
Use a variety of liquid oils including olive, corn,
sunflower, canola, peanut safflower, and soybean
Desserts
optional
optional
optional
Special Instructions
1. Nutrient rich desserts containing fruit,
whole grains, low-fat milk product( apple
crisp with oatmeal topping, low fat
pudding, gelatin with fruit, low-fat ice
cream or frozen yogurt should be used
most frequently.
2. Cakes, pies and cookies (high in fat and
sugar) should be used less frequently.
Beverages
optional
optional
optional
Special Instructions
Water and unsweetened beverages should be
provided with meals to promote hydration and aid
with digestion
Reference: U. S. Department of Health and Human Services. Facts about the DASH Eating Pattern.
53
Facility Use Agreements
The Area Agency on Aging must assure that all nutrition sites, meal preparation facilities, and dining areas have current
written agreements with the organization providing facilities to establish: 1) maintenance responsibilities; 2) budgeting
requirements; 3) scheduling priorities; 4) equipment, furnishings and areas available for program use. Current written
agreements should include:
A.
Requirements and Responsibilities
1. Length and terms of the contract
a. Rental fees should be negotiated where appropriate.
b. Days of operation, operating hours, and advanced notification required by each party for exceptions to normal days of
operation.
c. Minimum space required (For dining allow approximately
15 – 20 sq. ft. per participant.)
d. Average number of meals to be served daily.
2. Actual facilities to be used
Specific rooms should be listed; (i.e. hall, restrooms, kitchen (with hot and cold running water, use of stove, and/or other
cooking equipment, steam table, refrigerator/freezer and adequate counter or table space), cloakroom or hanging space for
wraps, parking use, office space where applicable, additional room for meetings, secured storage space for foods, separate
storage for cleaning supplies, minimum (68) and maximum (78) temperatures and where applicable, the use of air
conditioning or other ventilating equipment. Space and equipment to maintain files and records.
3. Responsibility for recurring expenses including:
Utilities, phone, snow removal, garbage removal, pest control, equipment repair etc
4. Care and maintenance of the physical facility
Include sanitation of restrooms and common areas, cleaning range hoods, fans, furnace vents, daily light maintenance,
expected heavy maintenance, i.e. window and wall washing, grease trap cleaning, painting, floor scrubbing, waxing and
other cleaning.
5. Responsibility for installation and ownership of special equipment
Include items such as phone, food warming/steam table, refrigerator, freezer, range, three compartment sink, signs or
bulletin boards.
6. Insurance coverage for items owned by the project and personal liability insurance.
7. Specific job descriptions for facility staff not directly employed by the nutrition program.
54
Facility Use Agreements (cont.)
8. Conditions of termination of the agreement.
9. Responsibilities for compliance with all Federal, State and local laws and codes, including NJAC 8:24-1, “Chapter 24
Sanitation in Retail Food Establishments and Food and Beverage Vending Machines” fire code, and building code
(Certificate of Occupancy where appropriate).
B.
Furnishings and Food Service Equipment
1. All furnishing, including tables and chairs, must be sturdy and appropriate for older persons. (Comfortable lounge
chairs, television sets, game tables, etc. may be included.) Specify ownership, exclusive use of, maintenance and cleaning
responsibilities of all furnishings and equipment.
2. Outline responsibility for minimum compliance, (i.e. installation of a three compartment sink, range, exhaust systems,
refrigerator, freezer, plumbing and other maintenance items) with State Health Department requirements.
3. Insure accessibility to dry storage for disposable paper products, utensils, pots and pans, coffee urns, etc. supplied by the
program.
4. Additional equipment may be needed depending on the type and extent of the menu being provided, i.e. special diets,
kosher service and home delivered meals, or on-site meal preparation. All such equipment and facilities must be in
compliance with NJAC 8:24-1, “Chapter 24 Sanitation in Retail Food Establishments and Food and Beverage Vending
Machines”
55
Sample Policy
Guidelines for Dealing with Special Circumstances
In order for Nutrition Program participants to fully benefit from the available social and nutritional opportunities, it is
essential to recognize behaviors that can be problematic and/or unsafe and to formalize appropriate and consistent guidelines
through the use of written protocols. To assure orderly operations and provide the best possible nutrition site environment,
the program expects participants to follow rules of conduct that will protect the interests and safety of all and the public.
Disruptive behavior is defined as that activity which impinges on the rights, privacy or physical and/or emotional well being of
others. The following will serve as some examples of unacceptable or disruptive behaviors:






Harassment, discrimination of any nature, or disrespect
Substance abuse
Use of profanity, verbal, emotional or physical abuse or threats
Inappropriate sexual behavior
Unsafe behaviors (i.e. endangering personal safety or safety of others)
Personal hygiene issues
Each incident of disruption should be examined for appropriate action to be taken by program staff. Consideration needs to
be taken of the severity of the disruption when determining the restrictions or corrective measures to be imposed. Individual
programs should also have written grievance procedures and an appeal process which clients or their caregiver may use
following the imposed action of the Nutrition Program.
56
Coordinated Program and Activities
Because of its importance in maintaining or improving the health status of the elderly, nutrition screening and education are
priorities.(See required activities of the nutritionist) Other activities that stimulate the mind, body and spirit to help contribute to
overall wellness are encouraged.
Services include:

Nutrition providers, in cooperation with Area Agencies on Aging, will participate in partnerships both public and private to
enhance coordination of services for older adults and cover any costs

The nutrition provider, in cooperation with the Area Agency on Aging and other entities, will develop and provide a variety
of recreational, informational and/or health related programs and activities. A monthly calendar outlining the activities
scheduled at each location shall be made available.

Annual participant satisfaction surveys are recommended.

Information and Assistance and Outreach are essential services that should be made available through nutrition programs in
conjunction with the Area Agency on Aging.
Nutrition Education
1. Programs for Congregate Nutrition Education
a. An educational program shall be provided quarterly by a nutritionist. (can be an outside nutritionist) Written information should be
provided with nutrition education programs. The nutritionist should be available to answer questions.
b. Documentation of nutrition education by topic, dates, and attendance must be maintained. (See records.)
c. Individual nutrition counseling should be available and is the responsibility of the nutritionist.
2. Programs for Home Delivered Nutrition Education
a. Nutrition and consumer education materials should be sent out quarterly to all participants.
b. The nutritionist must approve all materials provided.
Transportation Services/Access
The Area Agency on Aging should develop written agreements to provide transportation for the elderly participating in nutrition
programs. Because nutrition is a life sustaining service, priority should be given to provide access to nutrition services with emphasis
given to low income and minority elders.
57
Atlantic County
Area Plan Contract Proposal Evaluation Form
Agency+_______ ____________
Total Points ____________
Program: _______________________________________________________________
Reviewer: _________________________________
Date: __________________
Clear statement of goals, objectives,
outcomes and evaluation methods
Level of service(s) offered
Area(s) to be served
Methods to evaluate quality and
effectiveness of the service(s), including
Client satisfaction
Experience of Agency in providing the
proposed services
Job Descriptions: qualifications and
experience of budgeted personnel
Reasonableness of budget
 Backup for unit cost
 Cost within budgetary guidelines
Total
58
GRANT AGREEMENT
GRANT AGREEMENT NUMBER ____________________________________________DATE__________
APPROPRIATION CODE_____________________________________________________ _____________
PROJECT____________________________________________________________________________________
PROJECT CODE________________________________________________________________
SUB-GRANTEE_________________________________________________________________
______________________________________________________________________________
TERM OF GRANT__________________________________TO____________________________________
Grant Agreement Pages 1 through________________
COUNTY OF ATLANTIC
DIVISION OF INTERGENERATIONAL SERVICES
INDEX TO PROVISION OF GRANT AGREEMENT
General Provisions
1. Term of Agreement
2. Governing Statutory and Regulatory Provisions
3. Changes in Agreement
4. Termination of Agreement
5. Stipulations
6. Scope of Services
7. Compensation
8. Method of Payment
9. Travel Expenses
10. Personal Property
11. Unexpended Fund Balances
12. Assignability
13. Insurance
14. Publications and Reports
15. Compliance
16. Liability Statement
17. Monitoring, Auditing and Evaluation
18. Reporting Requirements
19. Other Funds
20. Availability of Funds
21. Bidding
22. Liquidation
23. Non-Discrimination
24. Project Income
25. Sale of Property
26. Certified Audits
27. Rules and Regulations
28. Carryover Funds
29. Barrier-Free Environment
30. Client Views
31. Licensure
32. Low-Income Minority Clients
33. Client Donations
ATTACHMENTS
“A” - Scope of Services
“B” - Approved Budget
“C” - Method of Payment and Reporting Requirements
COUNTY OF ATLANTIC
DIVISION OF INTERGENERATIONAL SERVICES
Attachment to Grant Agreement _____________________
Dated_____________________
The following provisions shall be added to the captioned grant agreement:
LIQUIDATION OF EQUIPMENT. Grantee agrees that in the event of termination of the grant agreement and
non-renewal of the grant agreement, all equipment having a value of $300 or more, purchased in whole or
part with Title III funds will revert to the County of Atlantic.
NON-DISCRIMINATION. Grantee agrees that he will not discriminate in employment practices, in the
provision of services, or in any other way, because of sex, race, creed, national origin, physical handicap, or for
any other reason.
County of Atlantic
BY: ______________________________________
NAME: Dennis Levinson
TITLE: County Executive
DATE:____________________________________
Sub-Grantee
BY:_______________________________________
NAME:
TITLE:
DATE:____________________________________
LETTER OF AGREEMENT
Between the Governing body of Atlantic County and New Jersey Division of Senior Affairs
Re:
As the County Executive of the County of Atlantic, I do hereby agree to carry out the program as detailed in
the accompanying scope of services and budget for the
By:________________________________________________
Name: Dennis Levinson
Title: County Executive
Date:______________________________________________
Attest:
By:_____________________________________________
Title: Clerk of the Board of Chosen Freeholders
Date:____________________________________________
COUNTY OF ATLANTIC
DIVISION OF INTERGENERATIONAL SERVICES
GRANT AGREEMENTS
DEFINITIONS
Project:_____________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Act:________________________________________________________________________________________
Authorized Appropriation:
Account Title_______________________________________________________________________________
Account Code_______________________________________________________________________________
Contract Period: Contract period shall mean the Term of Agreement as specified in paragraph No. 1
This AGREEMENT, entered into this __________________day of ______________________, _______,
by and between the Atlantic County Division of Intergenerational Services, referred to as the “County” and
Name:______________________________________________________________________________________
Address:____________________________________________________________________________________
hereinafter referred to as the “Sub-Grantee”.
Witnesseth That:
1. Term of Agreement. This agreement shall be effective as of the ____________________________
day of __________________, ______and shall terminate no later than the day of __________________,
_______. ** With the County obligating the right to reserve the option to renew said services for an additional
year.
2. Governing Statutory and Regulatory Provisions. This Agreement and all sub-contracts, renewals,
modifications are subject to the provisions of Public Law cited as the “Older Americans Comprehensive
Services amendments of 1978 and the applicable Atlantic County Area Plan adopted pursuant to said statutes
and regulations wherein the Atlantic County Division of Intergenerational Services is designated as the sole
Agency to administer Title III of the Older Americans Act as amended by the aforementioned Public Law.
3. Changes in Agreement. Any parties hereto may, from time to time, request changes in the scope of services
to be performed hereunder. Such changes, including any increase or decrease in the amount of
reimbursement to the Sub-Grantee, which are mutually agreed upon by the parties to this Agreement, must
be incorporated in written amendments to this Agreement and signed by the parties.
The Sub-Grantee shall review actual and projected expenditures pursuant to this Agreement on a quarterly
basis and shall advise the County of any projected variation in expenditures from the maximum expenditure
allowance.
4. Termination of Agreement. Termination of this Agreement may occur prior to the date agreed upon by the
parties herein only upon the grounds and in the following manner:
A. In the event the funds required by the parties from local, state and federal sources are not obtained
and continued at an aggregate level sufficient to allow for the provision of the indicated quantity of services,
the obligations of each party hereunder shall thereupon be reduced, or in the case of a complete failure of
funds, terminated, provided that any termination of this Agreement shall be without prejudice to any
obligations or liabilities of any party already accrued prior to such termination;
B. Should the Sub-Grantee fail to perform or provide services, or otherwise fail to abide by the provision
of this Agreement, thereby jeopardizing the continued receipt of Federal funds to this State, the County may
terminate the whole or any part of this Agreement as long as it notifies the Sub-Grantee in writing within 15
working days of notice that Federal funding is jeopardized. Said written notice shall advise the Sub-Grantee
that non-compliance may be corrected within a time period designated by the County and failure to correct
non-compliance shall mean federal funds shall no longer be made available pursuant to this AGREEMENT;
C. Utilization of any portion of the appropriation hereunder to employ or otherwise compensate any
person employed by the County, who has directly participated in the negotiation or approval of this
Agreement;
D. Discovery of any pecuniary or personal interest by the Sub-Grantee, its employees, its officers, its
Trustees or its Directors in the project, or in any contract emanating from the operation of this project;
E.
Failure, for any reason, of the Sub-Grantee to satisfy its obligations under this Agreement:
F. Submission by the Sub-Grantee to the County of reports that are incorrect or incomplete in any
material respect;
G. Any improper or inefficient use of funds, provided under this Agreement;
H. Failure of the Sub-Grantee and/or its staff which are detrimental to the objectives of this project;
I.
Any violation of the New Jersey Conflicts of Interest Law, N.J.S.A. 52:I3D-I2 et. seq.
J. Failure of the Sub-Grantee to permit the County to make an inspection of the administrative or
operational facilities of the project;
K. By mutual agreement.
Upon termination of this Agreement, the Sub-Grantee shall forthwith return all proceeds of the grant to the
County.
5. Stipulations.
A. Retention of Records. The Sub-Grantee agrees to retain all books, records and other documents
relevant to this Agreement for three years after final payment unless an audit is in progress or exceptions
have not been resolved and Federal auditors and any persons duly authorized by the County shall have full
access to and the right to examine any of the said documents during the three year period. Any claimed
waiver of these rights or privileges must be documented in writing.
B. Safeguarding of Information. The Sub-Grantee agrees to safeguard information and records pertaining
to clients served under this Agreement in accordance with the relevant standards on the use and disclosure of
such information as defined in Federal Regulations governing same under Title III of the Older Americans Act
as amended.
C. Covenant of Non-Discrimination. During the performance of this Agreement, the Sub-Grantee shall
comply with all the requirements of Title IV of the Civil Rights Act of 1964 and other applicable federal and
state laws and regulations pertaining to the civil rights of individuals.
1. Title VI of the Civil Rights act of 1964 (42 U.S.C.A. S2000d et. seq.) and the regulations promulgated to
implement this Act (45 C.F.R. Part 80), which require that no person shall on the ground of race, color, or
national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to
discrimination under any program or activity receiving Federal financial assistance.
2. Title VII of the Civil Rights Act of 1964 (42 U.S.C.A. S2000e et seq.), as amended and Presidential
Executive Order No. 11246, and any subsequent orders, which establish affirmative action employment
standards and practices applicable to the Contractor.
3. New Jersey Law Against Discrimination (N.J.S.A. 10:5-1 et seq., P.L. 1975, c. 127), as amended, which
requires that the Contractor recruit and hire employees and thereafter treat them equally with respect to
compensation and all other terms, conditions and privileges of employment, without regard to any
employee’s race, religion, color, sex, age, national origin, ancestry or marital status.
4. N.J.A.C. 17:27-1.1 et seq. which establishes affirmative action employment standards and practices
applicable to public agencies and their contractors and subcontractors and which are intended to ensure
compliance with the affirmative action requirements established under N.J.S.A. 10:5-36 et seq. C.1979, c.266.
5. The Americans with Disabilities Act of 1990, Pub.L. 101-336, 104 Stat. 327, 42 U.S.C. 12101-12213 and
47 U.S.C. 225 and 611, and the regulations promulgated pursuant thereto.
6. Any other applicable federal and state laws and regulations pertaining to the civil rights of individuals.
7. The Sub-Grantee will not, on the grounds of race, age, color, sex or national origin:
a. deny an individual any services or other benefits provided under this program;
b. provide any services or other benefits to an individual which are different, or are provided in a
different manner, from these provided to others, under the program;
c. subject any individual to segregation or separate treatment in any manner related to that person’s
receipt of any services or other benefits provided under that program;
d. restrict an individual in any way in the enjoyment of any advantage or privilege enjoyed by others
receiving any services or other benefits provided under this program;
e. treat an individual differently from others in determining whether that person satisfies any eligibility
or other requirements or condition which individuals must meet in order to receive any aid, care, services, or
other benefits provided under the program;
f. deny an individual an opportunity to participate in the program through the provision of services or
otherwise or afford that person an opportunity to do so which is different from that afforded others under the
program;
g. in no event shall any individual who is provided with services funded under this agreement be asked
or encouraged in any manner whatsoever to participate in any religious program, services or activity;
h. any services to be provided under this agreement shall be exclusively secular and non-religious in
nature and scope and in no event shall there be any religious services, counseling, proselytizing, instruction,
or other religious influence undertaken in connection with the provision of such services.
D. That the grant and services it proposes to fund in are not now being funded by other Older Americans Act
funds, and that the proposed funds will not replace the non-federal resources of programs and services now
in place; and
E. That this program comply with the accessibility requirements and the employment requirements of
Section 504, of the Rehabilitation Act of 1973 (CFR Title 45, Part 84) and that funds will not be awarded to
any agency in non-compliance; and
F. That a Affirmative Action Plan, meeting all federal requirements, is available for review; and
G. That, subject to merit system requirements, preference will be given to persons 60 or older or Older
Americans Act Title V Community Service Employment Program Enrollees in permanent positions (Section
1321.69 as revised by N.J. DOA); and
H. That the Sub-Grantee utilizes such methods of administration as are necessary for the proper and
efficient administration of this grant; and
I. That all policies and procedures promulgated by the Atlantic County Division of Intergenerational
Services will be adhered to; and
J. That the Sub-Grantee will make every effort to: Participate in conferences on minority issues; use or
develop materials specifically designed for minority elderly; be involved in training programs on minority
issues; make hearings accessible to minority elderly by locating in minority neighborhoods or communities;
assure adequate minority representation in community needs assessment; and
K. That minority elderly are represented in proportion to their presence in the general population of the
zone on the grantees Advisory Council; and
L. That the Advisory Council has been established in accordance with policies set forth by the Atlantic
County Division of Intergenerational Services; and
M. That in those planning and service areas in which a substantial number of older persons have limited
English-speaking ability, the Area Agency shall insure that persons fluent in the other predominate
language(s) and knowledgeable about programs and services available to older persons in that service area
are available to provide counseling to the limited English-speaking, to assist them in participating in
programs and receiving assistance and to sensitize staff to cultural and linguistic differences; and
N. Staff funded by this grant will attend job related training; and
O. That this Sub-Grantee will follow priorities established by the Area Agency for servicing older persons
with greatest economic or social need; and
P. That all services provided under this grant will meet any existing State and Local licensure for health and
safety requirements for provision of services; and
Q. That this Sub-Grantee will: Provide each older person with a free and voluntary opportunity to
contribute to the cost of the program, protect the privacy of each older person with respect to the
contribution, establish procedures to safeguard and account for all contributions, and use all contributions for
expansion of services (Proposed Regulations section 1321.39); and
R. That all new programs and services will to the great extent feasible, be located within walking distance of
those eligible participants; and
S. That the Older Americans Act funds applied for have been pooled with other community resources to the
greatest extent.
6. Scope of Services. In consideration of the grant provided by this Agreement, the Sub-Grantee shall, in a
satisfactory and proper manner as determined by the County perform all services specified in Attachment
“A”.
7. Compensation. The County shall grant to the Sub-Grantee a sum not to exceed $_________________. The SubGrantee shall expend project funds in accordance with the Approved Budget as set forth on Attachment “B”.
Except as shall be more specifically limited on Attachment “B”, the amounts expended for each of the program
activity listed on Attachment “B” may not exceed the approved amount by more than 10% or $500.00,
whichever is greater, provided however, that the total Approved Budget is not exceeded. The express prior
written approval of the County is necessary to exceed these limitations.
8. Method of Payment. The County shall make payments under this Agreement upon the submission of a
properly executed County invoice form, together with such documentation as may be required. The manner
and form of such submissions shall be in accordance with the procedures described on Attachment “C”.
9. Travel Expenses. The Sub-Grantee, if a public agency, shall charge expenses for travel in accordance with
the customary practice in the government of which the agency is a part. If the Sub-Grantee is a private
agency, expenses charged for travel shall not exceed those allowable under the State of New Jersey Travel
Regulations. In any event, travel expenses shall not be charged in access of the allowable budget amount.
10. Personal Property. If personality, including equipment, costing less than one hundred ($100.00) dollars
per item is acquired and used for three (3) years from the date of acquisition for approved contract purposes,
title to such property shall vest in the Sub-Grantee, Personality, including equipment, costing more than one
hundred ($100.00) dollars or used for less than three (3) years shall be owned by the County. The County, at
its option, may, however, permit the Sub-Grantee to retain such property subject to reimbursement to the
County of its cost minus a fair rental value for the period of actual use.
*All other allowable expenses are subject to those definitions set forth in “Guidelines for
Implementation Title III”, issued by the Division of Senior Affairs.
11. Unexpected Fund Balances. The Sub-Grantee may incur costs only during the period set forth in
paragraph No. 1 of this Agreement. Expenditures made before or after these dates shall be disallowed. Funds
obligated, but not disbursed at the end of the contract period, shall be liquidated within 30 days after the
close of the contract period and any unexpected fund balance remaining shall be returned to the County with
the submission of the final report. The County,
at its discretion, may authorize the Sub-Grantee to use the unexpended grant funds:
(a) for approved grant purposes after the end of the contract period if the project is a continuing
activity and the County intends to enter into another agreement for a period of time immediately
following the contract period. Under such circumstances, the amount of the subsequent grant shall
be reduced by the amount of the unexpended funds remaining at the end of the previous contract
period.
(b) for approved grant purposes if the County authorizes an extension of the contract period.
In no event shall the Sub-Grantee use expended grant funds after the contract period without the
express written approval of the County.
12. Assignability. The Sub-Grantee shall not subcontract any of the work or services covered by this
Agreement, nor shall any interest in the Agreement be assigned or transferred, except as may be provided
within the terms of this Agreement or with the express written approval of the County. Except that the SubGrantee may apportion not more than 2.0% of the Compensation detailed in Paragraph 7 for legal and
auditing fees in the execution process.
13. Insurance. The Sub-Grantee shall submit evidence of insurance coverage in amounts specified by and in
companies satisfactory to the County.
14. Publications and Reports. The following regulations concerning publications shall be adhered to by the
Sub-Grantee:
A. Any books, reports, pamphlets, papers or articles based on activities receiving
Title III must contain an acknowledgment of that support.
support under
B. The Department of Health, Education and Welfare, Office on Human Development, Administration
on Aging, (hereinafter called AoA) reserves the option to receive free of charge up to 12 copies of any
publications published as a part of a Title III project, and two copies of any publication based on project
activities.
C. Where a project results in a book or other copyrightable material, the author is free to obtain a
copyright, but AoA reserves a royalty free, non exclusive and irrevocable license to reproduce, publish, or
otherwise use, or authorize others to use, all such material. All project material produced by project staff
shall bear proper agency acknowledgment when reproduced.
15. Compliance. To be adhered to by the County and Sub-Grantee.
A. The Sub-Grantee, in order to induce the County to make the within grant for the project, agrees
that is shall comply with all provisions of the authorizing appropriation, the Act, and any regulations,
requirements or guidelines which the Department may issue, whether explicitly referred to herein or not. It
is further agreed that the Sub-Grantee shall seek and develop its own source of funding in anticipation of the
expiration of this Grant. In no event shall this Grant be construed as a commitment by the County to expand
beyond the termination date set forth in paragraph 1.
B. The appointment of the Project Director shall be subject to the advice and consent of the Division
of Intergenerational Services.
C. There shall be no requirements to be met by the elderly client and/or participant a prerequisite to
receiving the services of the project other than that they have reached their sixteenth year.
D. All vehicles operated by the project shall be in accordance with New Jersey Motor Vehicle Laws
and operated by persons who:
a. possess a valid New Jersey Driver’s License;
b. are free from any impairing illness or disability.
E. Where applicable a sign shall be prominently displayed on all vehicles and in all facilities operated
by or in conjunction with the project stating that the project is funded under Title III of the Older Americans
Act of 1965, as amended, through a grant by the Division of Intergenerational Services, Atlantic County, New
Jersey.
F. In like manner, a notation of the above shall appear on all stationary, publications and public
information relating to the project and its scope of services.
G. Quarterly narrative and statistical reports shall be due on or before the fifth of January, April, July
and October, covering the prior three-month period. A copy shall be forwarded to the Division of
Intergenerational Services.
H. All sub-grants shall be made in accordance with the provisions of this agreement and abide by the
Guidelines of Title III issued by the Division of Intergenerational Services.
I. All sub-grants shall not extend beyond the termination date of this agreement set forth in
Paragraph No. 1.
16. Liability Statement. The Sub-Grantee agrees to save, defend and hold the County harmless from and
against any claim, suit or liability to any third parties resulting from the Sub-Grantee’s performance under
this Agreement.
17. Monitoring, Auditing and Evaluation.
A. The County shall provide to the Sub-Grantee, consultation and technical assistance for the duration of
the contract.
B. The County shall perform fiscal management activities to oversee the management of funds provided to
the Sub-Grantee through this Agreement, the County shall monitor all reports of such fiscal management
activities on a monthly basis and conduct a semi-annual program evaluation of the operations performed by
the Sub-Grantee for the purpose of obtaining information necessary to assure the continued receipt of federal
funds, to justify the past expenditure of funds, or to form the basis for a future claim for federal funds.
C. The Sub-Grantee shall receive, retain and make available to the County, within 60 days of the
termination of this Agreement, an external fiscal audit report of the Sub-Grantee. The cost for these external
audits shall be paid from the funds provided the Sub-Grantee under this Agreement.
D. The County, and the Sub-Grantee agree that the right is reserved for the County to make on-site visits to
the premises where social services are being provided pursuant to this Agreement at time which are mutually
agreeable to the County and the Sub-Grantee, in order to assure that the agreeable to the County and the SubGrantee, in order to assure that the purpose of this Agreement are being furthered and fulfilled. Any claimed
waiver of these rights or privileges must be known and in writing.
E. In fulfilling the above (17B) of this Agreement, the County will provide at least one in-depth evaluation
of the Sub-Grantee during the term of this Agreement.
F. Evaluations will be conducted by persons designated by the County, in conformance with regulations
governing Title III of the Older Americans Act as amended.
G. The Sub-Grantee will be given a minimum of ten working days notice of the dates of an evaluation, and
each evaluation will not exceed three (3) days in duration, except in exceptional circumstances.
H. Evaluations shall be conducted in the following manner and steps:
1. County selects the Sub-Grantee to be evaluated, notifies the Sub-Grantee, designates the members of the
team and arranges the dates, which as far as possible should be mutually convenient to County and SubGrantee.
2. County coordinates the evaluation.
3. Evaluators meet and prepare informal recommendations, which are first transmitted to executive
director of the Sub-Grantee only. If affirmative actions are recommended, an informal meeting between the
evaluators and the executive director is held, to establish areas of agreement and disagreement, and to give
the Sub-Grantee an opportunity to present its position.
4. If recommended actions are agreed to by the Sub-Grantee, the evaluator shall conduct a follow-up in
whatever form is appropriate within 60 days of agreement. If agreed changes have been made, a favorable
written report concluding the evaluation shall be prepared by the evaluators and submitted to the County and
the Sub-Grantee.
5. If there is no agreement, or agreed actions are not carried out, the evaluators shall prepare a complete
written report, which shall be forwarded to the County and the Sub-Grantee.
6. Only properly recommended affirmative action involving fundamental deficiencies, substantially
jeopardizing the ability of the program to provide social services in compliance with this Agreement may be
considered at the time of refunding. Any properly recommended affirmative action may be considered in
determining allocation of new federal or state funds.
I. Evaluation to be conducted by the Sub-Grantee:
1. All projects funded from the funds described herein (Title III) shall be formally monitored twice
annually and evaluated annually in accordance to the established procedures of the State Division on Aging.
18. Reporting Requirements The following reports will be required:
A. Financial: The Sub-Grantee shall submit financial reports as required by the Atlantic County Division of
Intergenerational Services on a monthly basis, by the 5th calendar day of the following month.
B. Programmatic: The Sub-Grantee shall submit monthly statistics (QPRS reports) by the 5th calendar day
of the following month. Quarterly reports with emphasis on progress of new programs, justifications of
increased or decreased services and a description of the problems (long and short term), shall be submitted.
19. Other Funds. The Sub-Grantee shall not use funds provided under this Agreement to replace existing or
committed financial support for the same project, except as may be provided by this Agreement or with the
express written approval of the County.
20. Availability of Funds. The parties hereto recognized that this Grant Agreement, made on behalf of the
County, is dependent upon such funding appropriations as may be made by the State of New Jersey, the
Federal Government or other funding sources; the County shall not be held liable for any breach of this
Agreement because of the absence of available funding appropriations.
21. Bidding. This contract is subject to the New Jersey Public Bidding Laws and all of the laws of the State of
New Jersey and ordinances and resolutions of the County of Atlantic.
22. Liquidation of Equipment. The Sub-Grantee agrees that in the event of termination of the grant
agreement and non-renewal of the grant agreement, all equipment having a value of $100.00 or more,
purchased in whole or part with Title III funds will revert to the County of Atlantic.
23. Non-Discrimination. The Sub-Grantee agrees that he will not discriminate in employment practices, in
the provision of services, or in any other way, because of sex, race, creed, national origin, physical
handicapped, or for any other reason.
24. Project Income. All funds, accrued interest derived there from, generated by Sub-Grantees shall be
implemented to replace amount of federal funds as designated by contractual agreement.
25. Sale of Property. Property, including equipment, purchased with Federal funds costing in excess of
$100.00 may not be sold without authorization of the Division of Intergenerational Services. Monies
generated by sale of said property or equipment will be termed as project income. Contractual Agreement
will be amended to reflect sale amount as part of the revenue resource.
26. Certified Audits. The Division of Intergenerational Services will initiate procedures to have the Project
audited. Certified audit reports will be required for all projects funded under the Area Plan with Title III
funds. Up to three percent of the total amount of current Title III funds allocated to the County will be used
for said audits. The County agrees to inform the Sub-Grantee of the date and location of the closing audit
conference and to have a representative of the Sub-Grantee at the closing audit conference, if requested. The
audits will be performed by a Registered Municipal Accountant (RMA) or a Certified Public Accountant (CPA)
whose firm also has RMA’s on staff.
27. Rules and Regulations. The Sub-Grantee must abide by Administration of Grants, Federal Regulations
Title 45-Part 74 and Federal Register Volume 45-No. 63, Department of Health, Education and Welfare Grants
for the State and Community Programs on Aging, dated Monday, March 31, 1980, and all other related state
and federal laws, and state, federal and county rules, regulations and formal administrative requirements as
well as subsequent federal guidelines affecting Title III grants
28. Carryover Funds. Carryover funds, if any, will be used before further Title III funds are made available.
Carryover Title III funds will be expended as a part of the total commitment of Title III funds as specified
elsewhere in this Grant Agreement..
29. Barrier-Free Environment. The Sub-Grantee, in accepting this Grant, agrees to comply with the specific
provisions implementing Section 504 of the Rehabilitation Act of 1973 (Public Law Regulations, Title 45-Part
84), and were issued in the Federal Register, Volume 42-No. 86, May 4, 1977. Section 504 stipulates that no
otherwise qualified handicapped individual shall, solely by reason of his handicap, be excluded from
participation in, be denied the benefits of, or be subjected to discrimination, under any program or activity
receiving Federal Financial Assistance.
30. Client Views. Procedures for obtaining the views of participants about the services they received under
this grant will be developed and implemented by the Sub-Grantee.
31. Licensure. Where applicable the Sub-Grantee will obtain appropriate licenses and meet all safety
requirements.
32. Low Income Minority Clients. Low-income minority individuals will be sought out by the Sub-Grantee to
provide services to them.
33. Client Donations. Donations made by, for, or on behalf of any client to the Sub-Grantee for services
provided through this project will be used exclusively for this project.
ATTACHMENT A TO GRANT AGREEMENT NUMBER___________________________
SCOPE OF SERVICES
ATTACHMENT B TO GRANT AGREEMENT NUMBER _________
DOA 3-2
State of New Jersey
Department of Community Affairs
Division of Senior Affairs
P.O. 2768
Trenton, New Jersey 08625
(FOR STATE AGENCY USE)
1. TITLE OF PROJECT:
2. TYPE OF APPLICATION:
____NEW
____CONTINUATION
3. PROJECT DIRECTOR (NAME, TITLE,
DEPARTMENT, AND ADDRESS-STREET,
CITY, STATE, ZIP CODE)
____REVISION
____SUPPLEMENT
6. DATES OF
FROM
THROUGH
AMOUNT
A. PROJECT
PERIOD
$
B. BUDGET
YEAR
$
7. TYPE OF ORGANIZATION:
__PUBLIC AGENCY
__PRIVATE NON-PROFIT AGENCY
4. APPLICANT AGENCY(NAME AND
ADDRESS-STREET, CITY, STATE, ZIP CODE):
8. PAYEE(SPECIFY TO WHOM CHECKS
SHOULD BE SENT-NAME, TITLE, ADDRESS):
5. NAME, TITLE, ADDRESS OF OFFICIAL
AUTHORIZED TO SIGN FOR APPLICANT
AGENCY:
9. (FOR STATE AGENCY USE)
A. Total Project Cost:
$
B. Project Income:
$
C. Project Net Costs (Line A less Line B)
$
D. Local Non-Federal Participation:
%
$
E. Funds Requested (Line C less Line D)
%
$
ESTIMATED COST for PROPOSED PROJECT
Categories
1. Personnel ( Title,
number and percent of
time employed)
Total Personnel Costs
2. Consultants and
Contracts Services
Total Consultants and
Contract Services
3. Travel
Total Travel
Cash
In-Kind
Total
ESTIMATED COST for PROPOSED PROJECT
Categories
4. Building Space
Total Building Space
5. Printing and Office
Supplies
Total Printing and Office
Supplies
6. Equipment
Total Equipment
Cash
In-Kind
Total
ESTIMATED COST for PROPOSED PROJECT
Categories
7. Other Costs
Total Other Costs
Total Direct Costs
Categories 1-7
Indirect Costs
Rate____% Base____%
Total Costs
Cash
In-Kind
Total
LOCAL NON-FEDERAL PARTICIPATION
SOURCE
AMOUNT
A. Cash Resources
SUB-
$
SUB-
$
$
TOTAL
B. In-Kind Resources
TOTAL
TOTAL
C. Estimated Income (Include Services)
TOTAL
$
COUNTY OF ATLANTIC
DIVISION OF INTERGENERATIONAL SERVICES
ATTACHMENT ‘C’ TO GRANT AGREEMENT NUMBER________________
METHOD OF PAYMENT AND REPORTING REQUIREMENTS
The Sub-Grantee shall be paid, upon execution of this Agreement and submission of properly executed
standard invoice forms detailing to monthly or quarterly sums not to exceed a total award of
$______________________________________.
The following reports will be required:
The NJ Department of Health and Senior Services Title III Reporting System:
Quarterly Project Report Expenses (QPRE-1)
Monthly/Quarterly Project Report Services (QPRS-1)
Monthly Statistical Reports shall be due on or before the fifth calendar day of the
following
month.
Quarterly Narrative and Statistical Reports shall be due on or before the fifth of
April, July and October, covering the prior three month period.
January,
ATTACHMENT D
In executing this contract and accepting funds under this contract, the Contractor agrees in the performance
of this contract to comply with all federal, state and municipal laws, rules and regulations generally applicable
to the activities by whomsoever performed in which Contractor is engaged in the performance of this
contract. In addition, the Contractor agrees in the performance of this contract to comply with all policies and
procedures promulgated by the New Jersey State Division on Aging and Atlantic County Area Agency on
Aging.
Specifically, the Contractor assures compliance with the following:
A. Federal Laws, Rules and Regulations: The Contractor, in accepting this contract, agrees to comply with:
1. The conditions set forth below which are intended to assure that funds provided under this contract shall
not be utilized in a manner which would contravene the Establishment Clause of the First Amendment of the
United States Constitution. Specifically, these conditions are as follows:
a. Any services to be funded under this agreement shall be provided regardless of religious affiliation or
beliefs;
b. In no event shall the provision of the services to be funded under this agreement be conditioned upon
attendance at or participation in religious programs, services, or activities.
c. Any services to be provided under this agreement shall be essentially secular in nature and scope and in
no event shall there be any religious services, counseling, proselytizing, instruction or other religious
influence undertaken in connection with the provision of such services.
d. Funds provided under this contract shall not be used for the construction, rehabilitation, or restoration
of any facility owned by a religious organization and used, now or in the future, for any religious activity or
purpose.
The parties hereto acknowledge that this Grant Agreement numbered_________________________
consists of ____________________pages numbered 1 through ____________consecutively.
IN WITNESS WHEREOF, the County and the Sub-Grantee have executed this Agreement as of the date first
written above.
COUNTY OF ATLANTIC
GOVERNING BODY
BY:______________________________________________
Name
Title
Date:_________________________________________
ATTEST:
Sub-Grantee: (Fill in exact name as on page 1)
By:_______________________________________ By_______________________________________________
Secretary or Governmental Clerk
Name
Title
Date___________________________________
Date:___________________________________________
The aforementioned Agreement has been reviewed and approved as to form.
By:______________________________________________
Date:____________________________________________
CONTRACT
FORMS
CONTRACTORS INSURANCE REQUIREMENTS
A/. GENERAL REQUIREMENTS
1/ The Contractor(s) shall provide and pay for insurance coverage of such type and in such amounts
as will completely protect the Contractor and the County, its elected officials, officers, agents, servants
employees and assigns against any and all risks of loss (including costs of defense) or liability arising
out of this contract.
2/ The insurance should be furnished by insurance companies with and "A- (Excellent) VII" or
better or better rating as published in the most recent editions of Best Insurance Key Rating and shall be
authorized to conduct business in the State of New Jersey.
3/ It is recognized that in some instances that insurance may be acceptable which is underwritten by
an insurance company that is not reported in the BEST GUIDE , or the coverage is extended under a
self insured program. This insurance, or self insurance, must be in conformity with the rules and
regulations of the Commissioner of Insurance of the State of New Jersey. Any insurance or self
insurance of this type is subject to the review and acceptance by the County Risk Manager or the County
Counsel. Furthermore written proof of acceptability by the Office of the Commissioner of Insurance
may be necessary.
4/ The Contractor(s) shall furnish the County with Certificates of Insurance, as shown under “B”
Specific Coverage Requirements, policies for General Liability must be endorsed to include the County
of Atlantic as an Additional Insured, a copy of ISO Endorsements CG 20 10 is required along
with the certificate. The Certificates of Insurance shall set out the types of coverage, the limits of
liability, describe the operation by reference to this contract and provide for (30 days) written notice to
the County of cancellation and/or non-renewal. All of the Contractors. Deductibles or Retention's
shall be the sole responsibility of the contractor, those in excess of $10,000 are to be disclosed and are
subject to approval by the County. If requested actual policy copies or incurred loss information may be
required.
5/ The policies and specified limits of coverage must be effective prior to the commencement of
work and must remain in force until final acceptance of the work under the contract. Contracts that
involve construction, installation, or maintenance repair must maintain completed operations
insurance, endorsing the County as an additional insured for a term of two (2) years beginning on
the date of the final acceptance. They also must include a copy of I.S O. Endorsement CG 2011
CG 2037 , or their equivalent.
6/ The Contractor(s) shall obtain, and furnish the County, certificates of insurance from their
subcontractor(s) or sub sub contractor(s) showing polices in force with coverage and limits as described
under these insurance requirements.
7/ The Certificate of Insurance with a A COPY OF THE ADDITIONAL INSURED
ENDORSEMENTS , are to be signed by a person authorized by the insuring company(s) to bind
coverage on it's behalf. Neither approval by the County nor failure to disapprove Certificates of
Insurance/ furnished by the Contractor shall release the Contractor from full responsibility for all
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liability including costs of defense. Insurance is required as a measure of protection and the Contractor's
liability is not limited thereby.
8/ The Certificates of Insurance, must be submitted to the County and shall be subject to the
review and approval of the County Counsel or Risk Manager.
9/ If at any time during the term of this contract or any extension thereof, if any of the required
policies of insurance should expire, change or be canceled, it will be the responsibility of the
Contractor, prior to the expiration, change or cancellation, to furnish to the County a Certificate of
Insurance indicating renewal or an acceptable replacement of the policy so that there will be no lapse
in any coverage. In the event of interruption of any coverage for any reason, all payments and work
under the contract shall cease and not be resumed until coverage has been restored and a current
Certificate of Insurance received and approved.
10/ Any policy of insurance that is written on a claims made basis shall, under the terms of this
contract, be renewed or the coverage extended for a period of not less than three years and shall provide
coverage for the period operations were performed by the contractor. Proof of such extension shall
annually be presented to the Risk Manager for the County of Atlantic and indicate the retroactive date of
coverage or indicate that all prior acts coverage is provided.
11/ Insurance or Risk Funding maintained by the County shall be considered as Excess over
Contractors Insurance. Insurance or Risk Funding Maintained by the County of Atlantic does not
provide protection for Contractors liability.
12/ Certificates of Insurance and Evidence of Property Forms shall show the Certificate Holder
as follows:
COUNTY OF ATLANTIC
COUNTY OFFICE BUILDING
1333 ATLANTIC AVENUE
ATLANTIC CITY, NEW JERSEY 08401
ATTN.: RISK MANAGER
Certificates of Insurance not reading as above will not be acceptable and will
delay contract signature and/or payment.
13/ Questions regarding these insurance requirements may be directed to (609)-345-6700 Ext.
2495. Certificates for approval may be preliminarily submitted via fax to (609)-343-2164, or to (609)343-2373.
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B./ SPECIFIC COVERAGE REQUIREMENTS
1/ The following checked items are the minimum mandatory types of insurance coverage to be
carried under the preceding requirements:
a) Workers Compensation-Statutory Limits , Employers Liability - with minimum limits of $1,000,000,/1,000,000,/1,000,000.
b) General Liability in a comprehensive form, with minimum limits as follows:
1/ Each Occurrence
$1,000,000
2/ Damage to Rented or Leased Properties
$ 100,000
3/ Medical Expense
$
5,000
4/ Personal & Adv. Injury
$1,000,000
5/ General Aggregate
$2,000,000
6/ Products-Completed Operations Aggregate $2,000,000
c) Motor Vehicle Liability Insurance in a comprehensive form, endorsed to include pollution coverage,
with minimum limits of $1,000,0000 CSL
1/ Owned Vehicles
2/ Hired/Leased Vehicles
3/ Non-Owned Vehicles
d) Umbrella /Excess Liability over General / Automobile liability , with minimum limits of $1,000,000
e)
Professional Liability Insurance, including errors and omissions coverage with minimum limits of
$ 1,000,000/ $2,000,000
January , 2011
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(REVISED 4/10)
EXHIBIT A
MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE
N.J.S.A. 10:5-31 et seq. (P.L. 1975, C. 127)
N.J.A.C. 17:27
GOODS, PROFESSIONAL SERVICE AND GENERAL SERVICE CONTRACTS
During the performance of this contract, the contractor agrees as follows:
The contractor or subcontractor, where applicable, will not discriminate against any employee or
applicant for employment because of age, race, creed, color, national origin, ancestry, marital status,
affectional or sexual orientation, gender identity or expression, disability, nationality or sex. Except with
respect to affectional or sexual orientation and gender identity or expression, the contractor will ensure
that equal employment opportunity is afforded to such applicants in recruitment and employment, and
that employees are treated during employment, without regard to their age, race, creed, color, national
origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability,
nationality or sex. Such equal employment opportunity shall include, but not be limited to the
following: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff
or termination; rates of pay or other forms of compensation; and selection for training, including
apprenticeship. The contractor agrees to post in conspicuous places, available to employees and
applicants for employment, notices to be provided by the Public Agency Compliance Officer setting
forth provisions of this nondiscrimination clause.
The contractor or subcontractor, where applicable will, in all solicitations or advertisements for
employees placed by or on behalf of the contractor, state that all qualified applicants will receive
consideration for employment without regard to age, race, creed, color, national origin, ancestry, marital
status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex.
The contractor or subcontractor will send to each labor union, with which it has a collective
bargaining agreement, a notice, to be provided by the agency contracting officer, advising the labor
union of the contractor's commitments under this chapter and shall post copies of the notice in
conspicuous places available to employees and applicants for employment.
The contractor or subcontractor, where applicable, agrees to comply with any regulations promulgated
by the Treasurer pursuant to N.J.S.A. 10:5-31 et seq., as amended and supplemented from time to time
and the Americans with Disabilities Act.
The contractor or subcontractor agrees to make good faith efforts to meet targeted county
employment goals established in accordance with N.J.A.C. l7:27-5.2.
The contractor or subcontractor agrees to inform in writing its appropriate recruitment agencies
including, but not limited to, employment agencies, placement bureaus, colleges, universities, and labor
AA
unions, that it does not discriminate on the basis of age, race, creed, color, national origin, ancestry,
marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or
sex, and that it will discontinue the use of any recruitment agency which engages in direct or indirect
discriminatory practices.
The contractor or subcontractor agrees to revise any of its testing procedures, if necessary, to
assure that all personnel testing conforms with the principles of job-related testing, as established by the
statutes and court decisions of the State of New Jersey and as established by applicable Federal law and
applicable Federal court decisions.
In conforming with the targeted employment goals, the contractor or subcontractor agrees to
review all procedures relating to transfer, upgrading, downgrading and layoff to ensure that all such
actions are taken without regard to age, race, creed, color, national origin, ancestry, marital status,
affectional or sexual orientation, gender identity or expression, disability, nationality or sex, consistent
with the statutes and court decisions of the State of New Jersey, and applicable Federal law and
applicable Federal court decisions.
The contractor shall submit to the public agency, after notification of award but prior to execution
of a goods and services contract, one of the following three documents:
Letter of Federal Affirmative Action Plan Approval
Certificate of Employee Information Report
Employee Information Report Form AA302 (electronically provided by the Division and
distributed to the public agency through the Division’s website at
www.state.nj.us/treasury/contract_compliance)
The contractor and its subcontractors shall furnish such reports or other documents to the Division
of Public Contracts Equal Employment Opportunity Compliance as may be requested by the office from
time to time in order to carry out the purposes of these regulations, and public agencies shall furnish
such information as may be requested by the Division of Public Contracts Equal Employment
Opportunity Compliance for conducting a compliance investigation pursuant to Subchapter 10 of the
Administrative Code at N.J.A.C. 17:27.
AA
FORMS
BID CHECK LIST
Checked
Items required with bid
Items submitted with bid
(Bidder’s INITIALS )
A
FAILURE TO SUBMIT ANY OF THESE ITEMS IS
MANDATORY CAUSE FOR REJECTION OF BID
X
X
Complete and sign Proposal page(s) ORIGINAL SIGNATURES
Corporate Disclosure Statement, Pursuant to N.J.S.A.40A:11-16
Bid guarantee (bid bond or certified /cashier‘s check)
Certificate from a Surety Company (Consent of Surety)
Acknowledgment of receipt of addenda or revisions (if any)
Employee Benefit Affidavit (Executive order # 2000-4)
Copy of Certificate for Public Works Contractor Registration
Subcontractors Affidavit (N.J.S.A. 40A:11-16),
includes Plumbing, HVAC, Electrical and Structural Steel
Plumbers Affidavit
x
B
MANDATORY ITEM(S) REQUIRED PRIOR TO AWARD OF
CONTRACT
X
Copy of New Jersey Business Registration Certificate for bidder
and designated subcontractors
C
FAILURE TO SUBMIT ANY OF THESE ITEMS AT TIME OF BID
MAY BE CAUSE FOR REJECTION
X
X
X
X
X
X
Non–Collusion Affidavit
Affirmative Action Page (AA 201 Completed & Submitted)
Affidavit of Compliance on Contractor’s Recycling
References (if required)
Deviations from Specifications, if applicable, attached in letter form
Other : Grant Documents per specifications
Print Name of Bidder :____________________________________________ Date:___________
Signed By: _____________________________________________________________________
Print Name & Title: ______________________________________________________________
THIS CHECKLIST SHOULD BE INITIALED AND SIGNED
WHERE INDICATED AND RETURNED WITH ALL ITEMS
DISCLOSURE STATEMENT
Name of Business:
________________________________________________________________
Principal place of Business: ___________________________________________________________
____ PARTNERSHIP
____CORPORATION
____ SOLE PROPRIETORSHIP
I certify that the list below contains the names and home addresses of all stock holders
holding 10% or more or the issued and outstanding stock of the undersigned. If one or
more of the below is itself a corporation or partnership, I have annexed the names and
addresses of anyone owning a 10% or greater interest therein.
I certify that no one stockholder owns 10% or more of the issued and outstanding stock of
the undersigned
PLEASE CHECK APPROPRIATE BOXES ABOVE AND SIGN BELOW
STOCKHOLDERS:
NAME
STREET ADDRESS
CITY AND STATE
____________________
__________________________
____________________
____________________
__________________________
____________________
____________________
__________________________
____________________
____________________
__________________________
____________________
I further certify that no officer or employee of the _______________________ has any interest, direct or
indirect in this corporation or partnership or in this contract.
I certify that the foregoing statements made by me are true. I am aware that if any of the foregoing
statements made by me are willfully false, I am subject to punishment.
SWORN AND SUBSCRIBED TO
BEFORE ME THE ________ DAY
OF _____________ 20____
____________________________
Signature of Notary Public
_____________________________
SIGNATURE
Notary Public of __________________
_____________________________
PRINT OR TYPE NAME
My Commission Expires _____________
_____________________________
TITLE OF PERSON SIGNING
DS
NON-COLLUSION AFFIDAVIT
State of New Jersey )
) ss
County of __________________
I, _______________________ of __________________________ in the County of
_________________ and the State of ____________________________, of full age, being duly sworn
according to law on my oath, depose and say, that :
I am ___________________________ of the Firm of _____________________,
the bidder making the Proposal for the herein project, and that I executed the said Proposal with full
authority to do so, that said bidder has not directly or indirectly entered into any agreement, participated
in any collusion, or otherwise taken any action in restraint of free, competitive bidding in connection
with the above named project, and that all statements contained in said Proposal and in this affidavit are
true and correct, and made with full knowledge that the _________________________ relies upon the
truth of the statements contained in said Proposal and in the statements contained in this affidavit in
awarding the contract for the said project.
I warrant that no requirement or commitment was made in reference to any political contribution to any
party, person, or elected official and that no undisclosed benefits of any kind were promised to any one
connected with County government or any political party in reference hereto.
I further warrant that no person or selling agency has been employed or retained to solicit or secure such
contract upon agreement or understanding for a commission, percentage, brokerage or contingent fee,
except bona fide employees or bona fide established commercial or selling agencies maintained by
_______________________________________
NAME OF CONTRACTOR
I further warrant and represent that I have never been convicted of or acknowledge nor admitted to any
payment of kickbacks or unlawful gifts to any government official or employee for which conduct the
County of Atlantic deems me disqualified from doing business with County of Atlantic under such
circumstances.
I also understand that the above disqualification does not apply to any vendor who cooperates with the
prosecution and gives supporting testimony on behalf of the prosecution in the course of a judicial
inquiry.
SWORN AND SUBSCRIBED TO
BEFORE ME THE ________ DAY
OF _____________ 20____
____________________________
Signature of Notary Public
_______________________________
SIGNATURE OF AFFIANT
Notary Public of __________________
_______________________________
PRINT OR TYPE NAME OF AFFIANT
My Commission Expires _____________
NC
AFFIRMATIVE ACTION INFORMATION
Please complete the following:
Company Name __________________________________________________
1.
Our Company has a Federal Affirmative Action Plan Approval:
YES ______
NO _______
a. If yes, submit a photographic copy of the Approval
2.
Our Company has a New Jersey Certificate of Employee Information Report:
YES ______
NO _______
a. If yes, submit a Photographic copy of the Certificate
3.
Our Company has neither of the above, therefore send us Form AA-302 (Affirmative Action
Employee Information Report)
SEND AA-302 __________
(check if applicable)
I certify that the above information is correct to the best of my knowledge.
NAME: _________________________________________
SIGNATURE: ___________________________________
TITLE: _________________________________________
DATE: _________________________________________
AAI
AFFIDAVIT OF COMPLIANCE ON CONTRACTOR'S RECYCLING PROGRAM
(CONTRACTOR MUST COMPLETE, SIGN AND NOTARIZE THIS FORM AND SUBMIT
WITH BID PACKAGE)
The County of Atlantic has pursuant to P.L. 1987, Chapter 102, adopted the Atlantic County
Recycling Plan and Ordinance #7 of 1988, which designates the following commercial and
institutions materials as recyclable and mandates the recycling thereof;
Glass, food and beverage containers: clear, amber, green
Newspapers
Aluminum beverage cans
corrugated cardboard
White office paper
Computer Paper
I. a. I hereby acknowledge that compliance with all applicable recycling laws is a material
term and condition of my contract with the County of Atlantic.
b. I hereby certify that _______________________________
Name of Company
(check as many as apply)
__________ currently is recycling.
__________ agrees to commence or continue recycling during the term of this contract
with the County.
II. The following recyclable waste generated during the performance of this contract, in
accordance with the requirements of the applicable N.J. Municipal Recycling Plan, or other
applicable State or local recycling law, shall be recycled:
_____ Aluminum Cans
_____ Glass
_____ Plastic
_____ Newspaper
_____ Office Paper
_____ Computer Paper
_____ Asphalt
_____ Concrete
_____ Other Please Specify ______________________________
Signed and sealed
before me on
_______________, 20____
_____________________
NAME
_____________________
TITLE
_____________________
DATE
______________________
NOTARY
R