253814 ORI6IFIAL TO CITY CL6RK ����/1�/"�
CITY OF ST. PAUL couNCa `� �Z
" OFFICE OF THE CITY CLERK �+�E NO.
COUNCIL RESOLUTION—GENERAL FORM
PRESENTED BY
COMMISSIONE A�
RESOLVED� that the Council of the City of Saint Paul does
hereby approve an application for a Special Food Service Program
for Children and does hereby authorize execution of the said
application on beha.lf of the City of Saint Paul by the Ma.yor'
City Clerk� and Comptroller� that a copy of said application
is attached hereto and incorporated herein by reference; and
be it
FURTHER RESOLVED� that in addition to the foregoing? the
Mayor of the City of Saint Paul is hereby authorized to execute
all additional supporting documents and agreements pertaining
to the City's application for Special Food Service Program for
Children.
,FORM A R4V�
►pss or � C uns
APR 2 61i�1
COUNCILMEN Adopted by the Council 19_
Yeaa Naya
Butler APR 2 S 197'1
�,,._ Ap oved 19—
Levine �
__In Favor
Meredith
Sprafka d Mayor
A gainst
Tedesco .
Mr. President, McCarty
µAy 1 1971
PUSLISHED — �
�'iA I h U1' \1�N!��' 1(l�l�,� ^ F2:-?"
� ���1'(`:i[tnlCP.t OI f'.;�UC:7tlOp ��
,�,i Sct�oal Lunch �cction APPI.ICATIQN c�,
� � �P�CIAI. FOOQ S�RVIC� PRQGRAM FOR CMII.DR�N ��
� ���
1, tiAA!F: ANI �1�?f�R1:SS OF fPC1NSCiR (Stroet R���I Nn.� RFn Nn„ CilYr 2, NA+�1F: �PII) �I�I�RES9 OF Rf�:kVICF: IN8'CI"Cl�"1'1nN (`+trrnl :���,:tir.. k::)
S�:�le an�l Z1�' Code) Mn�� CitS'� Sl��la And 7{{� Cocit)
City of Saint �'aul Service ictati.tut�oqa inc�ud� a number nf cent� �
�h u the Ma r Co nc �. on You portun xy
1� C it y Ha�� �5 t, �au�, M in�. � �. � _ �_____'_._—___._ -------
3. '�yF�}. nF tNSTtTU- 4. �r.i: GROUH ATTENp- e. TVITT�?N C11/1R4� %� ATl'�NPANCR P.�TA (}i�tirnHtn jt n�re,�ury)
TIOn (Chock� IN4 (1( �nY)
1).1Y-CARF. C�:hTFR � t� �� . . . . . . . . . . . . . . __.�
�^�,_.,� a. Avernge dtiilv ettendaqce .
�'RI.T'C:.F:�!FNT HO['SF -^�-�-^-^�
f ..,,,.-�..,,,.,pe�
�hh;CRl?ATIUN C�;K"Ck:R 5. y101'Id8 OF QPF RATIn h. (ac� of chilAren aith wotkinE���anthors . . . . . . .�--
��,�orf�E:�la ro 7 � ,,, �ree . . . --
(Specify .L..xi.L.tti�to�.t. c, Prl of children from inv. in._ome fam�l�eF . `�
wor�C s�. -
e. pP�RATING P�1'A .. SFRVIC� [N�TITUTION�B CUkRRNT 6'�nl� SF.I:��tcE? f�ROC�;t�St � ,_T'_`—�-
(a) P�dF-'VA]1-1NG PRICG h) AV6:RACF D.�ILti' NU�It3FR OF 11IrAI.� ic) f�{NAN�'1�1. C�1C�11'i��V Oi'
Oi� A1EA1.6 ET�kVFip �'i�' 'T . ' SEh�'(C 'C1 CIII_) ' .N f�oq eert'iCe pro
TYPE Jf mEUI� pric��d Ecr,�ratelv FK�� Uk T—
ch•ck qiT.�' wF.k:K Y FUt-1• PRice RFnt�FP FRICF:
I;rcakfasc
Fund� naw on harici . . . . . , S None
ii
lfidn�orn i:�r; supplcmrnt Valua nf tanc� on h�nd ---�-------
�.unc`i (&�tinwte) , . . . . . . , . . , __._-----•-r
A�:dafternnon su ple�nen[ "'"NQ��� blonthlY cast of operatirn� i�
��FF�� b�cluding lahor(Fe�ircwat�) . __.__
I�1iI�_ c�nit. Arnrn��t o(�rn�;ram ii
--- dcficit (If ans'1 , _— '_-'._"�'-�
9. I�F:SCRIT3F. c[Nt:RAi. ECCINOMIC AR�A FR���+1 WF1lC1i IN8T1'CUT10N pRAN'S ATTTNPANCF (.''+ee 1(1R�fqC�1�T15. A«A�'�� s�o:i:�l etatrm��:�: �
nec�•csery)
Saint Paul Tar.�aet Areas
^` .,. LA;:::,;:G L',L:.', -• StEAi.:: Fat•: �etiIC�( �_sisTAKC!: 1S h;:Fni:P _ 11. YFOFSAt,t.t: PFO:�i:-'`,1 I': ;:1:;1:
' T- 11) E6TI1fATEP CHAh<iF. (h) FST'ISI.'\�I'EI) NU!,iflFk C1F A1FAl.S .�.�/,w
TO C3i,I.IaR�N Tn I3E SF.R�'Ep DAll.i' Tn Ct11L.I�REW •• T���° �P �'�P'" . . , , . . "f
PAYTNG FUt_{. YRTCF TOTAl. Sept o �
TYP� FRE� OR (Paid. froe or b. Pate to cloao . , . . . . ..,...r -.----
Checkl . C e uce ric _�
tirc.t�:f:1Gt l:. ��TI�111I�FD Nl;R1A�R vF D:\`.'S
�1i,{mcrnink �uTplemcnc ARC1GFAt�i NRLI, orl,K:�TE
1.unch s, Pst week . , . , . . 5 D:.��
\1id;t'tcrnonn s u lemen d, Th't� liscal vear . . .
__�D.,•:�
���„���—_ 250 5 _-- _ —
. . a ��� 'l_ .:
l3. Is srr��icr intititutian �srmpt (Mm Fede�ql income tqx un4er�he Intamnl Re��rnuc Code? . . . . . . . . . . • • • • � • � • • • • �
� , .�.ri .�qm� . �P�X.�.�.�4k��Jn�. '. 9.�'ti . . . . , i-�. i._ x,
14. Is srr��i�r insti�utl�i� nnw p:�rtici{��ting in th�� SpcCiil h1i�k 1'r!��.{�rnm . . �
Yrs ��,' Sc'
15. Poee, a pri�•a�e fooA srrvire mana�ement �nmppny oparatn N (��,d servjce ptngtam in �he seryice inatituti��n? . . . . . � � . . . . , i
I( "yrs" descrit�e or atinch ropy o( ccmtttict with (and mnnafrment cotR�any. S�mE ,_.,
IG, R'i!1 a I� carte food xervice ot ennck hA_r_j�cilities he nvdiit�hlC.�^ chlld�en during thn l�ours_in uUendanca nt the `netitution? 1'ec I_ `�.:
L C1N PRG51ISF.S L 'IN C�NTRA1. KII'CI{TN �f Cp\tF3�NATlO.y PR Fhll`H:� ��I� Ch:i:I RAL 1:1�i tIF:>:
J7, U'here �ill f�nd be preparrd' (Check) �,QTtiF.R (Specify) In ceterin ki.tchen COl1tTaCtBCi W�.tf1•
13, Rriefly dexcribr 6(1HCP arY1 facilitios qti'nilable for preparing qM �erving�(Op•d11���� R�^Q°�^px',°epaxedRP�-1y CAtE.'��rr R9uservede �}�t
kinA and nrncunt o( tquipment. Attdch dddition:�1 Rtatem��t if Reeded.) ��u,(
CERTIFICATION: 1 CERTIrY TtiAT the :�bove infnm�ption !s tru�end corr�et to the b��t of mY kiiowled�;�, pnd �hat t0imh;irsrment w:;: be clriced
only for the h�pes of ineRl� speci(ied in itcm 10 above eerved to chlld�tn durinQ the hours th�y 11re io attendanc� at tf�e service inrtitution.
Charle� Po McCar�y
U)ATE:I (TTC1-E) (SIGNATUR� OF' AU'I'HUR1ZkA FTPRh_sr:N'CACR'F: �'�R SPt_':'` �—
� V�'h�n sponsor �s a nnnprofit aP,erCY (civl� ET�up, church or�*nqiaation, tte.) the (oltou�nR.PeNorntion of 11UiL`ority m4st hF ��+�,�i��ltted.
The np,nsor shou�� ohove Is h�rtby duthn�lisd to a�ntrol nnA opr�nte lhe(ood a�rvice prn�ram fnr r.riiliren in the service inr.ti��rtinn n.im�rf a�����,� .,-�• �
to erter into nn .��rrrment uith th� U. S. GeS���+rtmrnl�f Ag�iculture in col�tTCtton v:ilhlhe nF�e�A���n n(the progrq(i� UI1�I►f lh� Speeiel F������-1 tirr�:::r
Yn,�,ram for Chil�lren.
C it Go i x' e
gn ure
C i.t v C 1 er k - -------
(��A�.F.� (T��.�) (51GNATURF� OF ShNVIC� INgTI"�'VPIO� N__._Ol�f'ICIAI,i
t
,,►
• .
INSTRUCT{ONS FOR FII,IN� APPI.ICATION
I. General lnstruction�.
1, (,efiibly complete an originzl and onc capy of this (orm fQt eaCll se�VICA iltstitutiorl
applying for Participation.
2. Fnr«�ard the oti�inal �+nd copy o! thifi form �nd HktGichmeq�F (if an}') tn thB S(ate
[�epa�tment of �ducation, School I.unch SQCtion•
3, Si^n hnth conica t��h�rc indicntcd.
a. If not �nau�h space is pcovided fot any itnm, ufie a plain �hAet Qf papac, number e�ch
item, And attach to application•
II• Specific Instructions, (AU items are self-axplanato�y excspt as noted.)
1. If Sponsor is a pcivate n�npcofit agency (civic, churctl or�;�nization, or service group,
etc,) other th�n the service institution, insert the exaet nama and ad�iress of the �+,ency.
This is particularly important because ceimbucs�ment checks will k�c� mailed to the
Spo�so�.
3. Check appropriatQ block. If "Othet." ���ai��r� kina at type pr�gr+m; i.c:., specinl
summer program, yeart�und pr��gran� f�t 1�andicapNed childran; etc.
�. Cc�my;eie ��nly i( sKt�'iee ?�:�'tiiutiuil s� ���r.santly u�n:t�i�it�s :� ioud nurvi[�e f��u���ani.
9. Include when posaiblQ, information nn the per capita incama ot the county in which
the ser��ice institution is located; the petcentage of f�+mil�es in aceas from which
service institution draws attend�+nce with annual incame qf less than �3,OQQ; estimated
numbor of childrQn from such families, and kh� �stimated �umk�e� of childreq from
families with working mothers. Soures of such data �nd pecipd coverad should also
be included. Such informatiQq can aften be pcQVided h5� the Gounty welfare d�partment.
1�• Include pcice ta be charged paying children fot each typa of faQd sen�ice to ba
pro��ided (breakfast, lunch, supper, midmotning and midafternoon supploments).
Also include the e�tim�ted numbe� of maals, 4y type, ta bo served t� childcen
d�ily if this institution is appro�•ed f�r packicipaKi��n.
l6, �`A la carte" means an c�rran�;ement ���hereby ench compone�t ot thc mrnl is
selectod and priced separately�
ti
.! . - � • . ,
�4.. •
♦ 1
, ` City of Saint Pattl thx'u the �
The Ma or 's counc on o t hareby assuxe� the Stat� of
' ponsor ng gency
Mi.nnesota I�par�nt o£ �ducation, SchQO�. I.unch S�ctian, that the S�rvic�
Institution nam�d a.n Item 3 wi�.l observs the �'al�,awin� p��.�.cy wzth r��pect
to detex�nina.ng the eli.gibil,ity �£ ch�.ldren �or �xee nr r�adu��� p��a-ce meals
and �upplemental food s�xv�d batw��n m�al.s undar t.h� Sp�cial FaAd S�xv�ce
Prca�ram for Childrsn.
The execuxive directar o�
1. �� '�'��'has been designatea ta detenni»e �allicli
e o, f: �ica.a .
individua� children are eligible far free ox reduced prics
msa�s and supplemental food, under the fol��cnvi.ng pozicy.
z. In making collections from children who pay far tli�ir meals,
and in accowitin� far ths nwnb�r of fxa� or reduced pra.c�
moals sBxved� th� �allaw�.ng procedux� will 68 ohs�rv�d in
ordex that no oxher ch�ld in the Ssrv�.ca Instituxion will bP
mad� aware, by such pxacedure, o� the �,de�tity of the �]�ildren
recei.ving �rea or reduc�d pric� mQa�� ox supplcmentai �ooa.
r� � vc
3. The policy set forth hsrein for detez�nzning the eli�ibzlit>'
o� children �or free or reducsd price m�als and S�rpp�emental
food, and the procedure ta be foJ.lowed by patrAn� w�.shing to
apply £or such determination, will be mad� known to a�.l patrons
of t e �
ame o ervzce nst�tutzon
� • ' ' .
� _ Z - �
„
a. The na�nes of children detarminad to be eligibla £ox �ree or
reduced price moals and supp],emental food wi].1 nox be pub-
lished, posted, or announced �.n any ma.nner.
5. Childrsn receiving £xee or reduced pxics meals or supp�ementa�.
food wi.11 not be required, as a condition of xscei.ving such
^ �
msal� to; ,
a. Use a sepai axe l�u'►c]iroom or�sBCta.on o£ the lunchroom.
b. Go thxough a separata 1ine.
c, Enter the lunchroart through a different entxance tha�� is
ua�d by childxen who are paying the ful�. price for m�als
or supplemenxal f,cod.
d. Bat at a differant �ima from paying children.
a. Woxk �or their meal or Supplemantal food,
f. USe a di.ff�rent medium o� sxchange in the lunchroom tll�ri
is used by pay�ng children.
g, Eat different food than iS eatan by paying children.
6. Children from £amila.eS whose income level has a�.roady aual�-
fied them for public assistance such as Aid to I�ependent.
Children, General Assistance, etc. , or fran familias partici-
pating in the Food Stamp or Cormnodit� Di.stribut�c�n Pxogra�ns,
will be considered ��.�gibl� for �re@ or reduced price meals
or supplemental £ood.
7, The Service Institut�on will use tho attached �.ncomQ scale as
an aid in determining the eligibility of children far free oz
reduced prics moa�.s or sup�lemental faod, when such children
!.
� . .
A � � � 3w .
� '
' are £rom families who are not rsce�.v�.n� any �arm Q� puU�.iG
a�sis�anc�a Qr ara not part�.cipants i.ra tlta Food Starr� or Com-
madi�y Ui��ribution Progrr�ns.
8. The Service Inst�.tutian wa.��. make tha palicy autli�ied in tha.s
assurance effective on the data of execution of this dacunx�nt.
Ci.ty o� SainC Paul thru khe
Ma or�s Cou il an Youth„ 0� orCutti.ty
ame o • por�sor�ng ancy'� ame o 5erv�.ce �nst�tutinn
St Paul. ner-Qit
8ettlement HQUaea Recr�eation
Sexvi.ce Ceritera Parks and
Pla rout�da.
''^�'�']'.t��na�ur � i Oi iicial j T�'
Ch�rl"�s Y� �Ic�arty
Ma ar
ate '�" t �
APPROV�A BY STAT� Dk�'ART?�fE,ti'T QF �:DUGATION
scHOCa�, �uNC�� s�cr�o�v
� ��natura
Schoal Lw1cJi Ai.r�ct4r
it �
ate
�
DUr�1�ATS TO�RIN7�I! 25��
CITY OF ST. PAUL w�u�� N� [�
t OFFICE OF THE CITY CLERK
COUNCIL RESOLUTION—GENERAL FORM
n�e�e�r�.r
COMMISSIONER oA*z
�t'�.�, that t�a C�fi a� l.�e Cit' o� �aint i�a�l daa�
l�r�t�y an arp�pl�.�at�► fat a Spacial l�bod S��v#re�r Pro�r
f�r Chi]��r�a�d �r �b� �r�orisa ac�utiopa a►� tl�s �ai.d
Cp!plie��ti� pa b�balf ot� tha Citp of Saixet Pa� b�r t�a i�,
itjr Cl�c a�d Ca�ptroil�r, �r€ a a�p�r �f �sld appliea�tioa
� �tt� hs�tt.o ivad laa�rporat�l b�#n by zt���; and
Et�RT'�lt aR8�0�.V'E�, t�►t l.�a addl.t�oa� to t� loregof�, t�ra
all ardod,ftt ���� of �t Paul is �b,�► �nt�►�fs�d ta
�
t+e► �e City r app cati�at for 8�paa:tal S���vl.�.� foar
t�ildra�n.
� as �9�r
covxcn.�x Aa�r,�a by the co�M� i9—
Y� Na� � a 8 �st�
Butler
�� ApproveA �19—
�°� T*+ Favor
Meredith
Sprafka � ��r
Tedeaco A8'ainet
Mr. President, McCarty
���