Florida Department of Agriculture and Consumer Services
Division of Food, Nutrition and Wellness
ADAM H. PUTNAM
COMMISSIONER
SUMMER FOOD SERVICE PROGRAM SPONSOR MANAGEMENT PLAN
(1) Organization Name and Address
(2) Federal Employer ID Number
(3) Date
Name must match name and address on supporting
documentation. All information is verified upon receipt.
(2a) SAM/DUNS Registration Number
(3a) Revision Number
(2b) Cage Code Expiration Date
(2c) Online W-9 attached?
(2d) Has My Florida Marketplace
Registration Completed?
(4) Primary Administrative Contact Name & Title
(5) Primary Contact Phone Number
(6) Primary Contact Email Address
(7) Alternate Administrative Contact Name & Title
(8) Alternate Contact Phone Number
(9) Alternate Contact Email Address
(10) Alternate Administrative contact Name & Title
(11) Alternate Contact Phone Number
(12) Alternate Contact Email Address
(13) Board Member List: All sponsor organization leadership will be checked against the USDA’s National Disqualified List of Institutions. Identify board members that
are related, please specify relationship (i.e. parent, sibling, in-law, etc.).
Full Legal Name
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Permanent Mailing Address
Date of Birth
(14) Have any of the prospective SFSP employees or board members ever been associated with any organization terminated for failure to
correct serious deficiencies, that received notices of serious deficiencies, that received notices of serious deficiency as prepared by a state
agency, and/or are included on the USDA’s National Disqualified List of Institutions?  Yes
 No
If yes, attach a statement of explanation.
MANAGEMENT PLAN (7CFR225.6(c)(2))
GENERAL OPERATIONS (7CFR 225.14)
(15) List the county or counties in which your organization plans to operate:
(16) Describe the mission of your non-profit organization and the year-round services that you provide to the communities that you currently
serve.
(17) Provide details on all current programs offered by your non-profit organization.
Program/Activity
Dates of Operation
Annual Program Annual Program
(to/from)
Income
Expenses
Funding Sources
(18) Child Nutrition Program Experience:
Does the organization currently or has it previously participated in the Child and Adult Care Food Program (CACFP)?
 No  Yes
If yes, please provide the dates of participation: __________________________
Our organization was/is a _____Sponsor _____ Site
Does the organization currently or has it previously participated in the National School Lunch Program (NSLP)?
 No  Yes
If yes, please provide the dates of participation: __________________________
Our organization was/is a _____Sponsor _____ Site
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Organization Name:_________________________________________________
Does the organization currently or has it previously participated in the Summer Food Service Program (SFSP)?
 No  Yes
If yes, please provide the dates of participation: __________________________
Our organization was/is a _____Sponsor _____ Site
ORGANIZATION FINANCIAL VIABILITY, CAPACITY AND ACCOUNTABILITY
(7CFR 225.1), (7CFR 225.6(e)(1), (7CFR225.14), 7 CFR 225.15(a)(3)
(19) Each sponsor must demonstrate that it has adequate financial viability, capacity and accountability to successfully operate the SFSP.
Viability includes financial and human resources to operate the SFSP on a daily basis, sources of funds to continue to pay employees and
suppliers during periods of temporary interruptions in Program payments and/or ability to pay debts when fiscal claims have been assessed
against the institution. Each management plan must include a projected program budget for SFSP operations as well as supporting financial
documentation (see questions numbered 20 through 21i below).
Use the space below to explain how your organization maintains organizational capacity and accountability, and attach documentation to
support your explanation. Examples of documentation should include (but not limited to) organizational by-laws, organizational chart, board
minutes concerning program monitoring and compliance, employee resumes demonstrating non-profit food service experience, written
policies and procedures, or other documentation useful in determining your organizational capacity and accountability to operate the SFSP.
Continue on separate sheets as necessary.
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Organization Name:_________________________________________________
FINANCIAL VIABILITY DOCUMENTATION
All financial information submitted must be signed and attested as complete and accurate by the officer or director of your organization signing
this Management Plan. Providing fraudulent or misleading information and/or documentation will result in automatic denial for participation in
all FDACS nutrition programs.
(20) Did you or will you receive any state and/or federal funding in 2014?  Yes  No
(20a) If yes, please provide the documentation disclosing the amount received.
(20b) Please list your Fiscal Year Month/Date to Month/Date:
Please note that if your organization has a fiscal year other than the calendar year, you may submit your financial information formatted for the
most recent two fiscal year-ends.
(21) SPONSOR FINANCIAL STATEMENTS AND DOCUMENTATION
Please note that all financial information must be prepared using generally accepted accounting principles (GAAP). Financial statements
prepared by a third party must be signed and certified by both the preparer and the organization’s representative signing this Management Plan. If
you have any questions, please contact your program specialist.
PLEASE ATTACH A COPY OF THE FOLLOWING DOCUMENTS:
 (21a) Organization Balance Sheets for the 2 previous fiscal years
 (21b) Organization Statement of Income and Expenses the 2 previous fiscal years
 (21c) Organization signed/filed Federal Income Tax Returns (IRS Form 990) for 2 previous fiscal years
 (21d) Organization’s previous 12 monthly bank statements for all cash accounts on the Balance Sheet
 (21e) Organization’s letter from Internal Revenue Service granting 501(c) status, if applicable. If your organization does not
hold a 501(c)3 designation but operates under a parent organization that does (such as a religious denomination), please provide a
copy of their IRS tax determination letter.
 (21f) Current statements of all loans, lines of credit, revolving credit card accounts or other financing arrangements
 (21g) All CPA-prepared compiled, reviewed or audited financial statements, both interim and year-end, for 2 previous fiscal years
 (21h) If required pursuant F.S. 496, your organization solicits charitable donations from the general public in the State of Florida, please
provide a copy of the signed, letter of compliance issued by the Florida Department of Agriculture and Consumer Services.
 (21i) Current signed and filed State of Florida Annual Report for Non-Profit Organization
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Organization Name:_________________________________________________
SITE APPROVAL PLAN
(7 CFR 225.6), (7 CFR225.11(c)), (7 CFR 225.14)
(22) Please list all sites you have identified for participation in the SFSP.
Prequalified sites must serve an area in which poor economic conditions exist, as defined in 225.2. Sites must be area eligible, meaning sites
are located in geographical areas where 50 percent or more of the children residing in the school attendance area are eligible for free or
reduced-price school meals. This percentage may be documented by data provided by public or non-profit private school officials, census
data, welfare or education agencies, zoning commissions, or other appropriate sources. There are many resources available to assist you in
identifying eligible sites. For example, the Capacity Builder Map (http://www.fns.usda.gov/capacitybuilder) created by the USDA allows you
to lay over various layers of data such as area eligibility. Contact your Program Representative for further assistance in identifying eligible
sites. Please use a separate line for each meal service and additional paper as needed.
Site Name and
Address
Veteran’s Park
101 Main St
Sunny Town, FL
XXXXX
Veterans Park
101 Main St
Sunny Town, FL
XXXXX
#Projected meals Service
per day
100
Lunch
100
PM Snack
Inclement Weather
Enrichment Program Description
Prequalified Using
Meals served inside
on rainy days
Swimming Lessons
Sunny Town Elementary
80% free/reduced lunch
Meals served inside
on rainy days
Reading tutor
Sunny Town Elementary
80% free/reduced lunch
(23) Describe your plan for determining that each potential site is a safe environment to serve meals to children. Attach any policies and
procedures describing site selection, employee/volunteer background screening and emergency preparedness procedures.
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Organization Name:_________________________________________________
(24) Provide your organization’s plan for outreach to new sites in your area. Describe the community analysis you have conducted to support
the need for a SFSP in the communities you plan to serve, and attach supporting documentation as necessary.
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Organization Name:_________________________________________________
SPONSOR STAFFING PLAN
Management responsibilities cannot be delegated below the sponsor administrative level or to any Food Service Management Company (FSMC)
employees or outside consultants. The positions described here must be consistent with the information presented in the anticipated program
operations budget, as well as any additional supporting information provided in this management plan.
(25a) OPERATIONAL STAFF
(25b) ADMINISTRATIVE STAFF
Number of SFSP Kitchen Personnel:
Number of Admin. Personnel:
Number of SFSP Drivers:
Name of SFSP Administrator:
Number of Meal Service Personnel:
Name of SFSP Director:
Number of Site Supervisors:
Name of Sponsor Financial Officer/Director:
Number of Other Operations Personnel:
Name(s) of SFSP Monitoring Staff:
Number/Types of Volunteers (if applicable):
Number of SFSP Clerical Staff:
Number of Other Administrative Personnel:
TRAINING PLAN
(7 CFR 225.15(d))
(26) Please attach a copy of your training plan for SFSP personnel. Use the space below to provide any additional information.
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Organization Name:_________________________________________________
MONITORING PLAN
(7 CFR 225.15(d))
(27) Please attach a copy of your site and operations monitoring plan for SFSP. Use the space below to provide additional information.
MEAL SERVICE AND DELIVERY PLAN
(7CFR225.2), (7CFR 225.6), (7CFR225.15(b)), (7CFR225.15(m)), (7 CFR 225.16)
(28) Sponsors who procure their SFSP meals through an approved vendor must demonstrate that all meals meet the meal pattern guidelines
for the SFSP. All sponsors are encouraged to submit their menus for approval by FDACS. Describe in detail how your organization plans to
serve meals to children that meet all federal USDA meal pattern requirements as addressed in 7 CFR 225.16(d). Attach supporting
documentation as necessary.
(29) Please attach a copy of your current SFSP meal service and delivery plan. Your plan must include procedures to demonstrate that:
meals are consumed on site, each child receives one meal prior to any child receiving a second meal, meals are served at the point of service
and that all SFSP meals are delivered to sites consistent with standards prescribed by state and local health departments. Please use the space
below to provide any additional information about your meal service and delivery plans.
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Organization Name:_________________________________________________
(30) Please attach a copy of your current procedures that describe in detail how only creditable meals and documented allowable costs will be
claimed. Please use the space below to provide any additional information about how your organization plans to monitor meal claiming and
cost accounting processes for SFSP.
(31) Please attach a copy of your current procedures and arrangements for storing and refrigerating any leftover food.
CERTIFICATION STATEMENT (7CFR225.6)
I certify that the organization is in compliance with all applicable laws governing its board of directors and registration of its non-profit corporation. I
certify that the organization has never been a principal in an organization participating in a publicly funded program that has been ruled ineligible as a
result of violating that program’s requirements. I certify that the organization and its officers and directors have never been convicted of a businessrelated offense. I certify that no organization’s SFSP employees have been convicted of a criminal offense.
I understand that the submission of false information to the state agency is grounds for termination or denial from the SFSP as described in 7 CFR 225.
I understand that any deliberate omissions, falsifications, misstatements, misrepresentation of SFSP records will subject this organization to
prosecution under applicable State and Federal Criminal statutes. I understand that any information I give may be investigated as allowed by law.
This consent shall continue to be effective during my sponsorship if approved. I understand that supporting documents submitted for approval to
participate on this program are public records.
I certify all of the information provided is true and correct. I am aware that deliberate misrepresentation or withholding of information may result in
prosecution under applicable State and Federal statutes.
Print Name:
Title:
Date:
Authorized Signature:
Date Received:
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Received By:
FOR FDACS USE:
Verified As Complete:
Review Completed Date:
Organization Name:_________________________________________________