6-Appendix C Acknowledgement of Personnel Relationships-LPT-7NJV654 (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

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This is an Appendix C Acknowledgement of Personnel Relationships form for a Food Service Management Contract (FSMC) with Advantage Arts Academy, a School Food Authority (SFA) located in Herriman, Utah. The form addresses potential conflicts of interest when the SFA and FSMC employ the same person or persons. The RFP for this food service management solicitation has a questions cutoff date of June 5, 2026, at 5:00 PM MDT, with proposals due to Kelly Simonsen at 6171 W 11800 S, Herriman, UT 84096 no later than June 29, 2026, at 3:00 PM MDT. Questions regarding the solicitation should be submitted via email to ksimonsen@advantagearts.org, with answers posted on the Utah Public Procurement Place (U3P) portal.

The acknowledgement form requires certification that any employees shared between the SFA and FSMC do not have real or apparent conflicts of interest and will not participate in contract selection, award, or administration; access or control food service financial accounts; establish selling prices for meals and related items; access student or foodservice software systems; or participate in free and reduced-price meal application processes or eligibility determinations. The form provides space for documenting up to ten shared employees, their positions, and job duties at both entities, with signature lines for authorized representatives from both the SFA and FSMC. Kelly Simonsen is identified as the Director serving as the FSMC Authorized Representative for Advantage Arts Academy.

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Appendix C Acknowledgement of Personnel Relationships

Yes No (choose one), the SFA employs the same person/people that is/are employee(s) of the FSMC.

If Yes, we the undersigned certify that the employee(s):

• Does not have a real or apparent conflict of interest.

• Will not participate in the selection, award, or administration of the contract.

• Will not have access to or control of the food service financial account.

• Will not be involved in the establishment of the selling prices for all reimbursable and non-reimbursable meals, a la carte items, adult meals, catering, or vending items.

• Will not have access to SFA’s Student information software system or foodservice software system

• Will not be involved in the completion, distribution or collection of the parent letters and household applications for free and reduced-price meals.

• Will not be involved in the determination or verification of eligibility for free and reduced-price meals.

Employee Name SFA Position Title and Job Duties FSMC Position Title and Job Duties

SFA FSMC

SFA Authorized Representative Signature FSMC Authorized Representative Signature

Printed Name of SFA Authorized Representative Printed Name of FSMC Authorized Representative

SFA Authorized Representative Title FSMC Authorized Representative Title

Yes: Off
No choose one the SFA employs the same personpeople that isare employees of the FSMC: On
Employee NameRow1:
SFA Position Title and Job DutiesRow1:
FSMC Position Title and Job DutiesRow1:
Employee NameRow2:
SFA Position Title and Job DutiesRow2:
FSMC Position Title and Job DutiesRow2:
Employee NameRow3:
SFA Position Title and Job DutiesRow3:
FSMC Position Title and Job DutiesRow3:
Employee NameRow4:
SFA Position Title and Job DutiesRow4:
FSMC Position Title and Job DutiesRow4:
Employee NameRow5:
SFA Position Title and Job DutiesRow5:
FSMC Position Title and Job DutiesRow5:
Employee NameRow6:
SFA Position Title and Job DutiesRow6:
FSMC Position Title and Job DutiesRow6:
Employee NameRow7:
SFA Position Title and Job DutiesRow7:
FSMC Position Title and Job DutiesRow7:
Employee NameRow8:
SFA Position Title and Job DutiesRow8:
FSMC Position Title and Job DutiesRow8:
Employee NameRow9:
SFA Position Title and Job DutiesRow9:
FSMC Position Title and Job DutiesRow9:
Employee NameRow10:
SFA Position Title and Job DutiesRow10:
SFA:
Printed Name of SFA Authorized Representative:
SFA Authorized Representative Title:
FSMC Position Title and Job DutiesRow10:
FSMC: Advantage Arts Academy
Printed Name of FSMC Authorized Representative: Kelly Simonsen
FSMC Authorized Representative Title: Director

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