4-Appendix B FSMC Certification of Acknowledgement (3) (5).pdf
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- Attached to
- Advantage Arts Academy- Food Service Management
- Solicitation number
- RA26-144
- Issued by
- Salt Lake County, Hildale City, Utah
About this file
This is a Food Service Management Contract Certification of Acknowledgement form for Advantage Arts Academy, a Utah-based school food service authority (SFA). The document serves as a binding certification that the Food Service Management Company (FSMC) authorized representative has read, understood, and agrees to comply with all contract requirements and federal regulations governing Child Nutrition (CN) programs. The FSMC must acknowledge its understanding of operational requirements including adherence to a 21-day initial menu without modification, compliance with current meal standards and Local Wellness Policies, and submission of proposals to Kelly Simonsen at Advantage Arts Academy no later than June 29, 2026, at 3:00 PM Mountain Daylight Time.
The certification requires the FSMC to confirm critical compliance matters including that no solicitations or gifts have been received from SFA employees, that all food service employees meet minimum Professional Standards, and that the FSMC will not retain control of the CN programs' financial accounts, signature authority, or student eligibility determinations—responsibilities that remain with the SFA. The FSMC must further certify that neither it nor its principals are debarred or suspended from federal participation, possess disqualifying criminal backgrounds, or serve as paid consultants to the SFA in other capacities. The document includes a non-discrimination clause compliant with USDA policy and requires the FSMC authorized representative to sign under penalty of perjury, with immediate reporting obligations for any material changes to submitted information. Questions regarding the solicitation must be submitted in writing to ksimonsen@advantagearts.org by June 5, 2026, at 5:00 PM MDT, with answers posted on the Utah Public Procurement Place portal.
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Appendix B FSMC Certification of Acknowledgement
Initial below next to each statement certifying that you have read and fully understand the contents of this contract.
A. I certify that I, Enter Name of 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 the 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 of 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 SFA’s student information system and/or State Agency food service system(s).
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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 SFA 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 FSMC, 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 FSMC 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 USDA.
Printed Name of FSMC Authorized Representative
FSMC Authorized Representative Title
FSMC Authorized Representative Signature
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