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HomeMy WebLinkAbout065570 - General - Contract - Advance Child Care - ARTS, Inc.Texas Department of Agriculture May 2025 Page 1 Child and Adult Care Food Program Permanent Agreement Between Sponsoring Organization and Child Care Site Name of Sponsoring Organization Advance Child Care -ARTS. Inc. Address of Sponsoring Organization (Street, City, State, ZIP) 4220 W. Oak St., Palestine, TX 75801 Name of Child Care Site City of Fort Worth Physical Address of Child Care Site (Street, City, State, ZIP) CSC No. 65570 CIE ID 06112 OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX County Name 100 Fort Worth Trail, Fort Worth Texas 76102 1 U.S. Mailing Address of Child Care Site, if different from physical address (Street, P.O. Box, City, State, ZIP) Agreement This permanent agreement specifies the rights and responsibilities of the above named Sponsoring Organization (Sponsor) and the Child Care Site (Site) as participants in the Child and Adult Care Food Program (CACFP). By signing this permanent agreement, both parties are bound by its terms and conditions from its beginning effective date until terminated. Rights and Responsibilities of the Sponsor The Sponsor agrees to accept final financial and administrative management of a proper, efficient, and effective food service, and comply with all CACFP requirements, including the following: 1. Train child care Site staff according to CACFP requirements. 2. Provide technical assistance when problems are cited during monitoring visits, upon request from the Site, and as needed, and scheduled at a time and place convenient to the Site staff. 3. Provide CACFP record -keeping forms to the Site at no charge, and ensure the Site maintains records on -site according to CACFP record -keeping requirements. 4. Timely disburse any reimbursement payments, including advance payments, for meals to the Site within five working days of receipt of payment from Texas Department of Agriculture (TDA) for the corresponding claim period. 5. Make no charge whatsoever to the Site for CACFP services. 6. Retain no more than 15% of the CACFP reimbursement (excluding cash -in -lieu) for allowable, actual administrative costs. 7. Ensure that all meals are served to enrolled/participating children without regard to race, color, national origin, sex, age or disability in accordance with Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and USDA's regulations concerning nondiscrimination. 8. Ensure that the Site complies with requirements for racial and ethnic participation data collection and public notification of the nondiscrimination policy. 9. Ensure that all meals claimed for reimbursement are those served to children who are properly enrolled, if applicable and in attendance at the meal service. 10. Ensure that all meals claimed meet CACFP requirements. 11. Claim reimbursement for no more than two meals and one snack, or one meal and two snacks, per child per day. If at -risk, claim no more than one meal and one snack per child per day. Exception: Emergency shelters may claim reimbursement for three meals or two meals and one snack per child per day. 12. Ensure Sponsor staff that conduct announced or unannounced monitoring reviews show photo identification to demonstrate they are employees of the Sponsor. 13. Conduct announced and unannounced monitoring reviews of the Site's food program operation according to CACFP requirements during the Site's normal hours of operation, including weekends, if applicable. 14. Submit the Site Application and any amendments on behalf of the Site to TDA in a timely manner. 15. Ensure the child care Site maintains a current license, if applicable. 16. Ensure an At -Risk Afterschool Care Center or Emergency Shelter maintains a current license or written verification of exemption from the Texas Health and Human Services (HHSC), if applicable. If not subject to licensing, ensure completion of required local health/sanitation and safety inspections. 17. Ensure that no person acting in any capacity on behalf of the Sponsor will enter any child care Site when participants are present, if the person has been convicted of a felony or misdemeanor classified as an offense against the person or the family, or public indecency, or a felony violation of any statute intended to control the possession or distribution of a substance included in the Texas Controlled Substance Act (Chapter 481 of the Texas Health and Safety Code). 18. Immediately inform the health or licensing authority of any situation existing in child care sites that would threaten the health or Texas Department of Agriculture May 2025 Page 2 safety of participants in attendance. 19. Ensure policies and procedures do not exclude or limit participation, benefits or activities of a Site on the basis of race, color, national origin, sex, age or disability. 20. Take reasonable steps to provide and ensure services and information, both orally and in writing, are available to the Site in appropriate languages other than English. 21. Accept final administrative responsibility for ensuring the Site takes reasonable steps to provide services and information, both orally and in writing, in appropriate languages other than English. 22. Review the purchased meal vendor according to CACFP requirements, if the Site contracts for meals. Rights and Responsibilities of the Child Care Site The Site agrees to: 1. Record daily the: a. menus, food items and quantity used to serve children; b. meal type and meal count (taken at the point of service) served to each child; and C. number of enrolled/participating children in attendance. 2. Claim only meals actually served during approved meal service times to children who are enrolled (or participate in an At -Risk Afterschool Care Center, Outside -School -Hours Child Care (OSHCC) programs or reside in an Emergency Shelter) in child care, in attendance and participating in the meal service. 3. Serve meals that meet the current CACFP meal pattern requirements for the ages of the children served. 4. Ensure that food is prepared and served in amounts sufficient for each enrolled child to have one reimbursable meal/snack at each meal service. 5. Notify the Sponsor immediately if there is any change in the meal service, including days, times, and/or types of meals served. 6. Notify the Sponsor immediately of the names of children added or withdrawn from the child care enrollment. (Not applicable to At -Risk Afterschool Care Centers, Emergency Shelters and OSHCC.) 7. Receive mandatory CACFP training prior to program participation and annually thereafter as required by TDA and the Sponsor. 8. Allow representative of the Sponsor, TDA, USDA and other state and federal officials to enter the Site, announced or unannounced, to review CACFP operations and records during normal hours of child care operation. Individuals making such reviews must show photo identification of their employment with one of these entities. 9. As required by the Sponsor, periodically submit meal records for Sponsor review. 10. Notify the Sponsor immediately if there is any change in the Site's licensing/approval status, update license as required by the Texas Health and Human Services or other authority (if military or tribal), or if not subject to licensing, ensure completion of required local health/sanitation and fire safety inspections, including correction of any violations cited. 11. Serve meals to all children without regard to race, color, national origin, sex, age or disability in accordance with Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and USDA's regulations concerning nondiscrimination.. 12. Serve snacks free of charge to all children participating in an At -Risk Afterschool Care Center. 13. Serve snacks free of charge to all eligible children residing in an Emergency Shelter. 14. Meet all local health and sanitary code requirements applicable to food service. 15. Participate with one Sponsor at a time. 16. Authorize the Sponsor to apply for participation in the CACFP on behalf of the child care Site. 17. Distribute a copy of the Sponsor's notice to parents if instructed by the Sponsor. 18. Provide education or enrichment activities for children participating in an At -Risk Afterschool Care Center. 19. Maintain records on -site relating to the Program according to CACFP record -keeping requirements; failure to do so is grounds for denial of reimbursement. 20. If the site is a child care center, or emergency shelter, or OSHCC: Obtain prior written approval from TDA before transferring to another Sponsor within the program year. Termination of this permanent agreement during the program year does not constitute approval to transfer to another Sponsor. If the Site terminates this permanent agreement and wants to participate in the CACFP again during the same program year, the Site may only participate with its current Sponsor unless the transfer is approved by TDA. Exceptions: Each year a Site may transfer to a different Sponsor without TDA approval, if otherwise eligible to participate in the CACFP, by signing a permanent agreement with a new Sponsor between June 1 and September 30 to become effective on the following October 1. Additionally, a Site may terminate this permanent agreement with its current Sponsor, with proper notice as outlined in Term and Termination below, and apply to participate with TDA at any time during the year. Texas Department of Agriculture May 2025 Page 3 21. If the site is an at -risk afterschool care center ONLY: Obtain prior written approval from TDA before transferring to another Sponsor within the program year. Termination of this permanent agreement during the program year does not constitute approval to transfer to another Sponsor. If the Site terminates this permanent agreement and wants to participate in the CACFP again during the same program year, the Site may only participate with its current Sponsor unless the transfer is approved by TDA. Exceptions: Each year a Site may transfer to a different Sponsor without TDA approval, if otherwise eligible to participate in the CACFP, by signing a permanent agreement with a new Sponsor between June 1 and July 31 to become effective on no earlier than August 1 of the same year. Additionally, a Site may terminate this permanent agreement with its current Sponsor, with proper notice as outlined in Term and Termination below, and apply to participate with TDA at any time during the year. Term and Termination This agreement is effective from: date signed by City of Fort Worth Assistant City Manager until terminated. The Site will provide 30 days written notice if terminating this permanent agreement without the mutual consent of the Sponsor. If terminating this permanent agreement due to transfer to another Sponsor during the applicable exception provided in #20 or #21 above, the Site will provide written notification as soon as possible. The Sponsor will provide the Site 30 day's written notice if terminating this permanent agreement for mutual consent or for reasons other than the Site's failure to meet the terms of this permanent agreement. Certification We, the undersigned, do hereby make and enter into this contract. By so doing, we do certify that the information contained in this document to be true and correct to the best of our knowledge and is provided for the purpose of obtaining Federal financial assistance. We do mutually agree to comply with the CACFP federal regulations (7 CFR Part 226, as amended), Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (2 CFR Part 200, as amended), and state policies and procedures as issued and amended by TDA. The Site does further agree to perform as described in its application for participation in the CACFP (including approved amendments to the application). The Site certifies it is not currently participating under any other sponsoring organization, has not been disqualified from participation in the CACFP in Texas or any other state, and is not currently debarred or otherwise excluded from entering into agreements for Federal funds. We understand that the deliberate misrepresentation or withholding of information may result in prosecution under applicable State and Federal laws. s'Gte�i � ��"�rdsleY Sheri Endslev Signature — Child Care Site Representative District Superintendent, City of Fort Worth Title — Child Care Site Representative Dana Buwhdoff Dana Bur hdoff Dana Burghdoff (Jul 24, 2026 14:59:37 CDT) Signature — Sponsoring Organization Authorized Representative Assistant City Manager, City of Fort Worth Title — Sponsoring Organization Authorized Representative 07/20/2026 Date :�1NMAKIW19 Date FOR CITY OF FORT WORTH INTERNAL PROC SSES: Approval Recommended: By: Aw f0-1 Name: Dave Lewis Title: Director Park & Recreation Department By. Name: Monique Hill Title: Assistant Director, Recreation Park & Recreation Department Approved as to Form and Legality: By. Im Name: Hye Won Kim Title: Assistant City Attorney Contract Authorization: M&C: N/A Form 1295: N/A Contract Compliance Manager: By signing I acknowledge that I am the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. By: Name: Sheri Endsley Title: District Superintendent Park & Recreation Department City Secretary: By: Name: Title: �Aa.w A ..$ate Jannette S. Goodall City Secretary 4,DpU60gn p4F Fon> °�a v � 0 00 0, o�oAdd Ovo o d Qaa�n��so4,n OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX INSTRUCTIONS FOR CACFP — AT -RISK AFTERSCHOOL CARE CENTER PRE -APPROVAL VISIT A sponsoring organization must conduct a pre -approval visit of each site it intends to sponsor in the Child and Adult Care Food Program (CACFP) prior to submitting the site to TDA for Program participation. The purpose of the pre -approval visit is to discuss Program benefits and requirements, provide technical assistance, and determine a site's ability to operate the Program in accordance with the CACFP regulations. The following areas are reviewed and documented: • Meal Counts and Attendance • For -profit Center Eligibility (if applicable) • Menus and Meal Production Records • Monitoring Requirements • Claims • Training Requirements • Financial Management, including o Non-profit food service o Procurement • Record Retention Requirements • Civil Rights Requirements • Serious Deficiency • Health and sanitation • Other Additionally, the sponsoring organization must ensure each site is familiar with the Program Handbook, regulations, and policies related to the Program. GENERAL INFORMATION Name of Sponsoring Organization — Enter the name of the sponsoring organization. CE ID — Enter the five -digit CE ID that has been assigned to you by the Texas Unified Nutrition Programs System (TX-UNPS). Date of Pre -Approval Visit — Enter the date of the pre -approval visit. Time of Arrival — Enter the time of arrival. Be sure to identify a.m. or p.m. Time of Departure — Enter the time of departure. Be sure to identify a.m. or p.m. Site Type — Check the appropriate box. CACFP Status — Indicate if the site is currently participating in the CACFP, previously participated in the CACFP, or never participated in the CACFP. If the site currently or previously participated with a sponsoring organization indicate the name of the sponsoring organization in the space provided. Note: If the site is currently active with a sponsoring organization and the pre -approval visit is not being conducted during the open enrollment period of June 1 through July 31, you may not continue to enroll the site and the site will not be eligible to participate under your sponsorship. Refer to Section 4000, Managing the Program of the CACFP Handbook for guidance related to open enrollment, transfers and good cause. Site Name — Enter the name of the site. Affiliation — Check the appropriate box. Refer to Section 9000, Terms, Definitions, and Acronyms of the CACFP Handbook for definitions of affiliated and unaffiliated. Site Address — Enter the complete address of the site, including State and zip code. Person Interviewed at Site — Enter the name of the person interviewed during the visit. Title of Person Interviewed — Enter the title of the person interviewed during the visit. PROGRAM REQUIREMENTS Discuss the Program requirements with the site representative. Space is provided to document observations, comments, and discussion. Indicate N/A in areas that are not applicable to the site. ELIGIBILTY TO PARTICIPATE Indicate the site's eligibility to participate in the Program. If no, document the reason(s) in the space provided. Attach additional pages as needed. CERTIFICATION The sponsoring organization representative and the site representative must sign and date the certification. A copy of the pre -approval visit must be left with the site. Texas Department of Agriculture CACFP — At -risk Afterschool Care Center Form H1606-AT-P Pre -Approval Visit October 2017 Name of Sponsoring Organization CE ID Advance Child Care -ARTS, Inc. 06112 Date of Pre -Approval Visit Time of Arrival Time of Departure TBD ❑ AM ❑ PM ❑ AM ❑ PM Site Type ® Public or Private Non -Profit ❑ For -Profit CACFP Program Status ❑ Currently Active: Sponsor ❑ Previous Participation: Sponsor ❑ Never Participated Site Name Affiliation City of Fort Worth Community Centers ❑ Affiliated ® Unaffiliated Site Address various Person Interviewed at Site Title of Person Interviewed at Site TBD TBD Program Requirements Observations, Comments, Discussion Meal Counts and Attendance Explain Daily Meal count and Attendance Records (H15351HI535-AT) or alternate to ensure the site understands how to complete the form and when the form must be completed. Explain 'point of service" meal counts. Ensure the site understands that these forms are used to complete their monthly claim. If possible, conduct the pre -approval visit during meal service to observe the point of service meal count. For -Profit Center Eligibility Ensure that the facility understands how to calculate the 25% Title XX or Free and Reduced - price to determine the eligibility of for profit centers. Explain how this affects the site's claim. Form H1606-AT-P Page 2/10- 2017 Program Requirements Observations, Comments, Discussion Menus and Meal Production Records Review the menus that have been developed or completed to date. Ensure that all components for the meal types being claimed are included. Review meal production records, if any have been completed. Ensure that these forms are completed on a daily basis. Ensure that the site understands the documentation requirements for special diets, disabilities, processed foods, etc. Review the use of the Food Buying Guide for Child Nutrition Programs (FBG) with the site. If contracting with a vendor, ensure that vendor has had appropriate trainingfrom the site and is completing meal production records as indicated in the contract. Monitoring Requirements Discuss monitoring requirements. Explain announced and unannounced reviews. Discuss the review form and its elements and explain corrective action requirements and disallowances. Claims Review the procedures for filing claims. Explain which documentation must be submitted so that a claim can be submitted. Emphasize the due date requirements for submittal of claim documentation. Explain late claims and disallowances. Training Requirements Discuss the mandatory training requirements and the consequences for failure to attend. Form H1606-AT-P Page 3/10- 2017 Program Requirements Observations, Comments, Discussion Financial Management Ensure the site understands that it must maintain a non profit food service which means that all Program funds must be used to provide Program meals in compliance with Program requirements. Ensure the site understands that the Program funds must be kept in a separate account or accounted for as a separate ledger item in their accounting system. CACFP funds help defray the cost of the food program and are not intended to pay for all of the food program operations. Ensure the site understands the documentation requirements related to financial management. Ensure that time distribution records are maintained, if required. Discuss the procurement requirements and explain the documentation that must be maintained to demonstrate compliance with procurement requirements. Review Section 7000, Financial Management of the CACFP Handbook. Record Retention Requirements Explain that Program records must be maintained for 3 years, or until audit findings, claims, or litigation have been resolved. Ensure the site understands what records would be considered Program records. Civil Rights Requirements Discuss civil rights requirements with the site including training requirements and the required poster that must be displayed. Ensure the site has the poster. Ensure the site has a process for handling complaints and can explain the complaint procedure. Form H1606-AT-P Page 4/10- 2017 Program Requirements Observations, Comments, Discussion Serious Deficiency Explain the serious deficiency process as well as what actions and non -compliances might result in a determination of serious deficiency. Health and Sanitation Look for any obvious health, sanitation, or safety concerns. Review the most recent inspection report. Discuss any areas of concern. Other Discuss any other issues or concerns not discussed above and document here. Is this site eligible to participate in the CACFP? ❑ Yes ❑ No If no, explain: Certification and Signature The site representative acknowledges that the sponsoring organization representative has fully explained, discussed and provided technical assistance for all Program requirements listed above. Dana BowMoff Dana Burghdoff (Jul 24, 26W26 14:59:37 CDT) Signature Sponsoring Organization Representative S'ffort Y ZffdkltY Signature — Site Representative 07/24/2026 Date 07/20/2026 Date Texas Department of Child and Adult Care Food Program Agriculture August 2011 Site Application - Centers See the Site Application - Centers Instructions for information on the completion, submittal and maintenance of this form. CONTRACTING ENTITY (CE) AND SITE INFORMATION 1. Name of Contracting Entity 2. CE ID 3. Version Advance Child Care -ARTS, Inc. 06112 Original 4. Site Name 5. Site ID 6. County City of Fort Worth - various Community Centers LICENSE/REGISTRATION INFORMATION Al. Site Type: (check all that apply) ❑ Adult Care Center ® Child Care Center — Regular Child Care ❑ Child Care Center — Head Start ❑ Child Care Center — Outside School Hours ❑ At Risk Afterschool Care Center ❑ Emergency Shelter 2. Tax Status: (check only one box) ❑ For Profit ❑ Non Profit ❑x Public ❑ Other, please explain: If For Profit, select all that apply (eligibility status): ❑ Title XIX/XX (Adult Care Center) ❑ Title XX (Child Care Center) ❑ Free and Reduced Price A3. Licensed by: (check only one box) ® DFPS (Child Care Center) ❑ DADS (Adult Care Center) ❑ Exempt ❑ Not required (operate less than 2 hours per day) ❑ Other, please explain: A4. License Number: N/A A5. License Effective Date: A6. License Expiration Date: A7. License Capacity: A8 Age Range of Participants: From: 5 Yrs Mos To: 18 Yrs Mos A9. Do you provide child care for infants under 12 months old? ❑ Yes ® No A10. Enter the elementary, middle or high school a child would attend if he/she lived next door to this center: Name: Address: STREET ADDRESS Al 1. Street Address — Address Line 1: Address Line 2: Al2. City: A13. State: Zip+4: 100 Fort Worth Trail Fort Worth TX 76102 + CACFP Site Application — Centers Page 2/08-2011 MAILING ADDRESS Mailing Address - Same as Street Address? ❑x Yes ❑ No (If no, enter mailing address) A14. Mailing Address (Street or P.O. Box) — Address Line 1: Address Line 2: A15. City: A16. State: ;Zip+4: CENTER INFORMATION A17. Affiliation: (check only one box) ❑ Affiliated ® Unaffiliated Affiliated means the sites are part of the Contracting Entity organization. Unaffiliated means the sites are not part of the Contracting Entity organization. A18. Has this site previously participated in the CACFP under a sponsoring organization? ❑ Yes x❑ No If yes, provide previous Sponsor(s) name: Dates of participation with previous Sponsor(s): A19. Date of Pre -Approval visit: 20. Unaffiliated site will make meal counts and menu records available to the Contracting Entity by the following date of each month: 1 st CENTER CONTACT — PERSON IN CHARGE OF THIS CENTER ON A DAILY BASIS B1. Salutation First Name Last Name I B2. Email Address B3. Facility Phone (include area code) Extension Fax (include area code) B4. Cell/Alt Phone (include area code) B5. Title ADDITIONAL CENTER CONTACT — ALTERNATE PERSON IN CHARGE OF THIS CENTER ON A DAILY BASIS B6. Salutation First Name Last Name B7. Email Address B8. Facility Phone (include area code) Extension Fax (include area code) B9. Cell/Alt Phone (include area code) 1310. Title SCHEDULE C1. A. Months of Operation (Check all that apply) All: ® Jan: ❑ Feb: ❑ Mar: ❑ Apr: ❑ May: ❑ Jun: ❑ Jul: ❑ Aug: ❑ Sep: ❑ Oct: ❑ Nov: ❑ Dec: ❑ B. Days of Operation (Check all that apply) Mon -Fri: ® Mon: ❑ Tue: ❑ Wed: ❑ Thu: ❑ Fri: ❑ Sat: ❑ Sun: ❑ CACFP Site Application — Centers Page 3/08-2011 Regular Schedule C2. Normal Hours of Operations: Time Open: Time Close: C3. Regular Meals Meal Types First Shift Second Shift ❑ Breakfast Start Time: End Time: Start Time: End Time: ❑ AM Snack Start Time: End Time: Start Time: End Time: ❑ Lunch Start Time: End Time: Start Time: End Time: ❑ PM Snack Start Time: End Time: Start Time: End Time: ❑ Supper Start Time: End Time: Start Time: End Time: ❑ Evening Snack Start Time: End Time: Start Time: End Time: C4. At Risk Meals Meal Types First Shift Second Shift ❑ Breakfast Start Time: End Time: Start Time: End Time: ❑ Snack Start Time: End Time: Start Time: End Time: ❑ Lunch Start Time: End Time: Start Time: End Time: ❑ Supper Start Time: End Time: Start Time: End Time: Weekend Schedule C5. Weekend Hours of Operations: Time Open: Time Close: C6. Regular Meals Meal Types First Shift Second Shift ❑ Breakfast Start Time: End Time: Start Time: End Time: ❑ AM Snack Start Time: End Time: Start Time: End Time: ❑ Lunch Start Time: End Time: Start Time: End Time: ❑ PM Snack Start Time: End Time: Start Time: End Time: ❑ Supper Start Time: End Time: Start Time: End Time: ❑ Evening Snack Start Time: End Time: Start Time: End Time: C7. At Risk Meals Meal Types First Shift Second Shift ❑ Breakfast Start Time: End Time: Start Time: End Time: ❑ Snack Start Time: End Time: Start Time: End Time: ❑ Lunch Start Time: End Time: Start Time: End Time: ❑ Supper Start Time: End Time: Start Time: End Time: C8. Anticipated Closures: CACFP Site Application — Centers Page 4/08-2011 Food Service C9. How are meals prepared? (Check all that apply) ® Prepared on site ❑ Prepared at Central Facility and Delivered ❑ Contracted with a Public School ❑ Purchased from a food service vendor ❑ Other, please explain: C10. How are meal served? (Check all that apply) ® Unit (Cafeteria) ❑ Family C11. Check all meals that are purchased through a food service vendor: (Check all that apply) ❑ Breakfast ❑ Lunch ❑ Supper ❑ Snacks C12. Do you have a food service contract? ❑ Yes ® No C13. Name of Food Service Vendor: C14. Contract Period: From: To: Adult Care Centers Only (questions C15 and C16) C15. Does the site receive Title III-C funds or Title III-C commodities for meals served at the site? ❑ Yes ❑ No C16. Which meal types does offer vs. serve apply? (Check all that apply) ❑ Breakfast ❑ Lunch ❑ Supper ❑ None PARTICIPANTS D1. Number of enrolled participants in each income eligibility category: A. Free Category: B. Reduced -Price Category: C. Paid Category: D. Total Enrolled: D2. Number of enrolled children receiving Title XX: D3. Number of enrolled participants (Adult Care Center) receiving Title XIX/XX: SIGNATURE DATE ON AGREEMENT If Site is Unaffiliated, enter Signature Date of Site Representative from Permanent Agreement with Sponsoring Organization: If Site is Unaffiliated, enter Signature Date of Contracting Entity Representative from Permanent Agreement with Sponsoring Organization: CACFP Site Application — Centers Page 5/08-2011 CERTIFICATION I hereby certify that neither the Contracting Entity nor its principals/authorized representatives is presently debarred, suspended, proposed for debarment, declared ineligible, disqualified, or voluntarily excluded from participation in this transaction by any Federal/State department or agency. I certify under penalty of perjury that the information on these application forms is true and correct, and that I will immediately report to the Texas Department of Agriculture any changes that occur to the information submitted. I understand that this information is being given in connection with receipt of federal funds. The Texas Department of Agriculture may verify information; and the deliberate misrepresentation of information will subject me to prosecution under applicable federal and state criminal statutes. On behalf of the Contracting Entity, I hereby agree to comply with all state and federal laws and regulations governing the Child Nutrition Programs administered by the Texas Department of Agriculture. In accordance with Federal law and U.S. Department of Agriculture policy, this Contracting Entity does not discriminate on the basis of race, color, national origin, sex, age or disability. I will ensure that all monthly claims for reimbursement are true and correct and that records are available to support these claims. S'lten "/1' Z'tdsley Signature — Site Representative, Sheri Endsley, District Superintendent Cit of Fort Worth Cana st)W doff Dana Buiuhdoff (Jul 37 CDT Signature — Authorized Representative of Contracting Entity 07/20/2026 Date 07/24/2026 Name (please type or print) Title Dana Burghdoff Assistant City Manager Date At -Risk After -School Meals Component of the CACFP Child care centers may be able to designate their After -School Program for children, ages 5-18, as an At -Risk program if they meet certain criteria. The advantages of participating in the At -Risk program are: ❑ All school age children are reimbursed at the higher CACFP rate (free level); ❑ An At -Risk program may elect to serve a supper as soon as the traditional school day is over; ❑ You can claim both a supper and pm or evening snack per child per day. The At -Risk program operates only during the traditional school year, including school holidays, in-service days and bad weather days . At -Risk meals and snacks are served to school age children AFTER the school day ends or *at designated meal services during holidays, in-service and bad weather days throughout the school year. *Any child participating in the At Risk program can only be reimbursed for up to 1 At Risk meal and 1 At Risk snack per day. If a child participates in both the CACFP and At Risk Programs they may not exceed the maximum reimbursement of 2 snacks and 1 meal or 2 meals and 1 snack per day. There are specific requirements to operating the At -Risk After -School Program, which include maintaining a clear separation of programs (CACFP and AT RISK) and providing organized, regularly scheduled educational or enrichment activities. Listed below is a checklist to help you determine if your after -school program is a candidate for the At -Risk Program: Eligibility: ❑ The child care center (where the At -Risk program will be held) must be located in a public school attendance zone that qualifies for At -Risk Services. ❑ The child care center can be either Non -Profit for For -Profit. If For -Profit, you must qualify under the 25% Low Income Rule as a Child Care Center before you can earn an At -Risk reimbursement. Separation of Programs: ❑ There must be a clear separation of the After -School At -Risk Program and the regular CACFP Program during the designated "At -Risk Program" operating times. This includes separation of participants, use of indoor/outdoor areas , activities, and meal services. ❑ Areas (i.e. bathrooms) within the child care center should be separate for At -Risk children, however, there are allowable exceptions. ❑ At -Risk meal service must be separate from the regular CACFP meal service. ❑ At Risk documentation must be recorded and maintained separately from the regular CACFP documentation. This includes pre -planned totals, meal components quantities, menu guides, attendance, meal counts, etc. Educational or Enrichment Program ❑ There must bean educational or enrichment component that is conducted during the designated At -Risk Program times. ❑ Teachers must be actively engaged in the educational or enrichment activity. (i.e. "Homework time" is not an approved At -Risk educational activity, but tutorials with teachers actively engaged in assisting students would be a valid educational activity.) At -Risk After -School Program Agreement In order for your site to participate in the At -Risk Afterschool Meals component of CACFP, you must sign below, acknowledging your agreeance to comply with At -Risk Program requirements. Child Care Center _City of Fort Worth Address 100 Fort Worth Trail City Fort Worth Phone _817-392-5726 School District Center License Number N/A Initial next to each statement below indicating that you understand and agree to the following At Risk Program requirements. DB Dg I agree not to mix or combine At Risk participants and regular CACFP participants during the designated At Risk Program operating times. DO Dg I agree to designate At Risk classrooms and keep areas occupied by At Risk Program participants and regular CACFP Program participants separate during At Risk Program operating times. ❑ YES❑ No Are there any areas (Le bathrooms) within the child care center that are shared by both the At Risk child and CACFP child simultaneously? ❑ YES❑ No Is there a clearly separate and regularly designated outside play area for the At Risk program? D13 D13 I agree to maintain At -Risk Preplanned Totals and Meal Component Quantities separate from regular CACFP Program Preplanned Totals and Meal Component Quantities. DB Ds I agree to prepare, serve, and record At -Risk meals/snacks separately from regular CACFP Program meals/snacks. DB 06 I agree to provide an educational or enrichment component during the designated At -Risk program operating times. DO DB I agree that designated At -Risk staff will actively engage in the educational or enrichment activities. Certification Statement I certify that the child care center named above operates a School Age After -School program and will comply with At -Risk After -School Program requirements, including eligibility, separation of programs and an educational/enrichment component with teacher interaction. Dana BuWMoff 07/24/2026 Dana Burghdoff (Jul 24. 66 14:51 Dana Burghdoff, Assistant City Manager — City of Fort Worth Date Signature of Authorized Representative Child Care Center: Various Designated After -School At -Risk Program Operating Times: Start Time: pm End Time: pm Days: M T W TH F At -Risk Meals/Snacks: () PM Snack: Start Time: pm End Time: pm Days: M T W TH F Menus: ( ) Use same menus as child care program ( ) Use different menus for At -Risk program (submit to Bilynda Lange) () Supper: Start Time: pm End Time: pm Days: M T W TH F Menus: ( ) Use same menus as child care program ( ) Use different menus for At -Risk program (submit to Bilynda Lange) () Evening Snack: Start Time: _ pm End Time: pm Days: M T W TH F Menus: ( ) Use same menus as child care program ( ) Use different menus for At -Risk program (submit to Bilynda Lange) On school holidays/inservice days, the school -age children will be served the following meals/snacks: = Breakfast = AMS —_ Lunch z: PMS = Supper :: Evening Snack On school holidays/inservice days, will the school -age children be mixed or grouped with regular CACFP children? ❑ YES = NO Name the designated At -Risk classroom(s) used for At -Risk Program participants (i.e. Afterschoolers, Class 4, Eagles, etc.) Qualifying School: ATTENDANCE VERIFICATION: Address: O Grades: EDP: O Qualifying School: Address: Grades: EDP: Child Care Center Address City Center License Number School District After School Educational / Enrichment Activities: Circle and/or describe the activities you will provide to all school age children participating in the After -School At -Risk program. (Be prepared to submit curriculum schedules, calendars, and/or other materials to validate this educational/enrichment requirement throughout the school year. * Board Games Holidays & Seasons E Reading ❑ Character Building Cooking = Homework Help = Science ❑ Crafts c Learning Centers = Service ❑ Dance c Math z Social Skills E: Drawing = Multiculturalism = Spirituality ❑ ESL c Music = Study Skills ❑ Exercise ❑ Nutrition = Team Building ❑ Experiments and Exploration Games ❑ Gardening ❑ Health ❑ Online Learning ❑ Problem Solving a Projects ❑ Puzzles :: Technology z Theater/ Drama/ Speech z Tutoring z: Writing ❑ OTHER How will program staff be engaged in the above activities? ADVANCE CHILD CARE — ARTS, INC. (CE# 06112) SPONSORED SITE AGREEMENT FOR CACFP FOOD SERVICE AFTER SCHOOL PROGRAM Name of Site: City of Fort Worth - various Community Centers Address of Site: 100 Fort Worth Trail, Fort Worth, TX 76102 Site Supervisor/Manager: Sheri Endsley, District Superintendent Telephone (site): 817-392-5726 Telephone (cell): The Sponsored Agency agrees to: 1. Serve meals to all enrolled children 18 years of age and under, who are also enrolled in public/private school. 2. Serve meals that meet the minimum meal patter requirements. 3. Provide adequate supervision during the meal service. 4. Provide after School Enrichment Activities on days of service. 5. Maintain and submit promptly such reports and records that the program requires. 6. Report to the supervisor any changes in the number of meals required as attendance fluctuates. 7. Report any other problems regarding the meal services and curriculum. 8. Comply with civil rights laws and regulations. 9. Attend mandatory training sessions. i, representing the interest of the said site, do agree to the terms stated above and do permit this site to be allowed to participate under the CACFP Food Program for all participants enrolled. I further agree to allow Sponsored Agency to use the assigned facilities for said purposes. S'/terl --� zffAsley 07/20/2026 Site Supervisor/Manager- Sheri Endsley, District Superintendent Date Dana Sur hK doff 07/24/2026 Dana Burghdoff (Jul 24, 6 14:59:37 CDT) Sponsored Site Representative- Dana Burghdoff, Assistant City Manager Date CSC No. 65570 FORT WORTH. City Secretary's Office Contract Routing & Transmittal Slip Contractor's Name: Advance Child Care - ARTS, Inc. Subject of the Agreement: Food Service Agreement with Advance Child Care - ARTS, Inc. for after school programming for various Fort Worth Community Centers M&C Approved by the Council? * Yes ❑ No M If so, the M&C must be attached to the contract. Is this an Amendment to an Existing contract? Yes ❑ No 0 If so, provide the original contract number and the amendment number. Is the Contract "Permanent"? *Yes ❑ No 0 If unsure, see backpage for permanent contract listing. Is this entire contract Confidential? *Yes ❑ No 0 If only specific information is Confidential, please list what information is Confidential and the page it is located. Effective Date: If different from the approval date. Expiration Date: If applicable. Is a 1295 Form required? * Yes ❑ No 21 *If so, please ensure it is attached to the approving M&C or attached to the contract. Project Number: If applicable. *Did you include a Text field on the contract to add the City Secretary Contract (CSC) number? Yes 0 No ❑ Contracts need to be routed for CSO processing in the followingorder: rder: 1. Katherine Cenicola (Approver) 2. Jannette S. Goodall (Signer) 3. Allison Tidwell (Form Filler) *Indicates the information is required and if the information is not provided, the contract will be returned to the department.