4-4 Appendix B FSMC Certification of Acknowledgement Bridge Elementary.docx
DOCX document 13 KB Posted
- Attached to
- Bridge Elementary- Food Service Management
- Solicitation number
- RA26-156
- Issued by
- Weber County, Utah
About this file
This is a Food Service Management Contract Certification of Acknowledgement form for Bridge Elementary in Utah, requiring the Food Service Management Company (FSMC) authorized representative to certify understanding and compliance with specific contractual and operational requirements. The contract involves food service operations for the school's Child Nutrition (CN) programs, with proposals due to Janey Stoddard at 4824 Midland Drive, Roy, UT 84067 no later than July 22, 2026 at 5:00 PM. Questions regarding the solicitation must be submitted in writing to janey@bridgecharter.org no later than June 29, 2026 at 5:00 PM. The FSMC is required to commit to following a 21-day menu for the initial service period without modification and ensuring all food complies with current meal standards and the school's Local Wellness Policy.
The certification form establishes critical governance and compliance parameters, including requirements that the School Food Authority (SFA) retain legal responsibility for the CN programs' nonprofit food service account, signature authority, and overall financial responsibility, while the FSMC shall have no control over these functions or access to student information systems. The FSMC must certify that employees meet minimum Professional Standards requirements, are trained in the SFA's Code of Conduct, and that neither the FSMC nor its principals are debarred, suspended, or have criminal backgrounds affecting CN program involvement. The FSMC must further certify it is not a paid consultant or contractor with the SFA in any other capacity and that neither it nor its employees have received solicitations, gifts, donations, or items of monetary value from SFA personnel. Additional certifications address compliance with environmental regulations, USDA nondiscrimination policies, and accuracy of monthly reimbursement claims with supporting documentation.
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Text version
Appendix B
FSMC Certification of Acknowledgement
Revised: 04/24/2026
Initial below next to each statement certifying that you have read and fully understand the contents of this contract.
A. I certify that I, , the FSMC Authorized Representative, on behalf of the FSMC, have read and fully understand the contents of this contract.
Initial Here:
B. I certify that I, , nor any of the employees of the FSMC, have not received any solicitations from any SFA employee. In addition, I certify that no gifts, donations, or anything of monetary value (i.e., golf outings, meals, etc.) have been provided.
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C. I certify that employees of the FSMC will be trained to understand and comply with all necessary trainings including the current written Code of Conduct authored by the SFA.
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D. I certify that all the FSMC food service employees meet the minimum Professional Standards requirements.
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E. I certify that the SFA will be legally responsible for the conduct of the non-profit school food service program, and shall have access to all necessary documents, which will be maintained onsite, including but not limited to all contracts with vendors so that they may supervise the food service operations in such manner as will ensure compliance with the rules and regulations of PDE and the USDA regarding each of the CN programs covered by this contract.
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F. I certify that the FSMC will not have control of the CN programs’ non-profit school food service account, signature authority, and overall financial responsibility for the CN programs. This includes access to the student information system and/or food service system.
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G. I certify that the SFA will be responsible for determining student eligibility for all applicable programs and that the FSMC will have no involvement in the process.
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H. I certify that the FSMC will follow the 21-day menu for the first 21-days of service, without change.
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I. I certify that all food will be in compliance with the current meal standards and Local Wellness Policy.
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J. I certify that the FSMC will comply with all applicable standards, orders, or requirements issued under the Clean Air Act and the Federal Water Pollution Control Act and will report violations to the Federal awarding agency and the Regional Office of the Environmental Protection Agency.
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K. I hereby certify that neither the FSMC 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.
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L. I further certify that neither the FSMC nor any of its principals/authorized representatives has a reported criminal background that would affect the involvement in CN programs.
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M. I certify that the FSMC is not a paid consultant or contractor with the SFA in any other capacity than for this contract.
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I certify under penalty of perjury that the information on these forms is true and correct, and that I will immediately report to the state agency any changes that occur to the information submitted. I understand that this information is being given in connection with receipt of federal funds. The state agency 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 SFA I hereby agree to comply with all state and federal laws and regulations governing the CN programs administered by the state agency. In accordance with Federal law and USDA policy, the SFA does not discriminate on the bases of race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by the USDA. I will ensure that all monthly claims for reimbursement are true and correct and that records are available to support these claims.
Printed Name of FSMC Authorized Representative
FSMC Authorized Representative Title
FSMC Authorized Representative Signature
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