Exhibit E - AF-79 Headcount Record.pdf
PDF 60 KB Posted
- Attached to
- ACRTC Food Services RFP 230000000003
- Solicitation number
- RFP - 511 - 230000000003
- Issued by
- Ingham County, Lansing City, Michigan
About this file
This document is an Headcount Record form used to account for meals sold in a dining facility, flight kitchen, or field feeding operation. The form contains columns to record the number of Subsistence-in-Kind (SIK) meals, sales amounts, and operating charges for each meal period. It also includes sections for refund data, cash overages/shortages, and signatures of the facility supervisor and collection personnel. The Privacy Act Statement outlines the authority, purpose, and routine uses of the information collected on this form.
The related state and local contract opportunity is the ACRTC Food Services RFP 230000000003 issued by the state of Michigan. This RFP covers food services for the Ingham County and the City of Lansing jurisdictions. The RFP includes a Questions and Answers document and a Labor Cost Estimator attachment. Details on the specific products, services, quantities, response requirements, and contract term are not provided in the given information.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Exhibit A Government Furnished Facilties.pdf | ||
| 230000000003 ACRTC Food Services Schedule A v2 Final.docx | DOCX document | |
| standard_contract_terms v2 Final.docx | DOCX document | |
| Labor Cost Estimator.pdf | ||
| 230000000003 Proposal-instructions-confidential-treatment-vendor-questions-worksheet v2 Final.docx | DOCX document | |
| 230000000003 ACRTC Food Services Schedule B Pricing v2 Final.docx | DOCX document | |
| Exhibit D AFI48-116.pdf | ||
| Exhibit G 14 Day Menu.xlsx | XLSX spreadsheet | |
| Exhibit F AFMAN 34-240.pdf | ||
| Federal Holidays attachment.docx | DOCX document | |
| Exhibit B Hours of Operations.pdf | ||
| Exhibit C Workload Estimates - Units.pdf | ||
| RFP 230000000003 Question and Answer sheet.docx | DOCX document |
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Text version
HEADCOUNT RECORD Accounts for meals sold in a dining facility, flight kitchen or field feeding
Serial No.
ORGANIZATION OR DINING FACILITY:
DATE:
Meal/Flight Meal Rate For Meal Periods Shown
B/L/D/M Operating Charge for Meals Shown
COLUMN A COLUMN B
NAME Grade Meal Period
Social Security Number
Sales Amount
Op Chg
NAME Grade Meal Period
Social Security Number
Sales Amount
Op Chg
1.
26.
2.
27.
3.
28.
29.
5.
30.
6.
31.
7.
32.
8.
33.
9.
34.
10.
35.
11.
36.
12.
37.
13.
38.
14.
39.
15.
40.
16.
41.
17.
42.
18.
43.
19.
44.
20.
45.
21.
46.
22.
47.
23.
48.
24.
49.
25.
50.
# of SIK Meals from Column
B
Sales Amount from Column
B
$ Operating Charge from
Column B
# of SIK Meals from
Column A
Sales Amount from
Column A
$ Operating Charge from
Column A
$ # of SIK Meals from Column
A & B
Sales Amount from Column
A & B
$ Operating Charge from
Column A & B
PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C., Chapter 40; 37 U.S.C., Chapter 9; EO 9397, November 1943 PRINCIPAL PURPOSES: Used to authorize and verify the Subsistence-in-Kind entitlement; record the numbers of people subsisting; and account for cash collected.
ROUTINE USES: Information may be disclosed to the Department of Justice, and to federal, state, local or foreign law enforcement authorities for investigating or prosecuting a violation or potential violation of law.
DISCLOSURE: Disclosure of SSN is voluntary. However, members otherwise entitled to Subsistence-in-Kind will not be provided a meal at no cost without the SSN, since the SSN is used to verify the entitlement.
AF Form 79, Headcount Record (supersedes previous editions of AF form 79, 1339,463, and 2039)
COLUMN C COLUMN D
from
Column A & B
Sales Amount from Column A & B
$ Operating Charge from
Column A & B
$ # of SIK Meals From Column
A, B, & C
Sales Amount From Column
A, B, & C
Operating Charge From Col A, B, & C
NAME Grade Meal Period
Social Security Number
Sales Amount
Op Chg
NAME Grade Meal Period
Social Security Number
Sales Amount
Op Chg
51.
72.
52.
73.
53.
74.
54.
75.
55.
76.
56.
77.
57.
78.
58.
79.
59.
80.
60.
81.
61.
82.
62.
83.
63.
84.
64.
85.
65.
86.
66.
87.
67.
88.
68.
89.
69.
90.
70.
91.
71.
92.
from Column
C
Sales Amount from Column
C
$ Operating Charge from Column
C
$ # of SIK Meals from Column
D
Sales Amount from Column
D
$ Operating Charge from
Column D
Refund Data Total All Cash Collected $
NAME Grade Meal Period
Meal Type*
Amount Refunded
Less Refunds $ a.
$ Cash Overages/Shortages $ b.
$ Net Cash for Turn-In $ c.
$ Total All
SIK
Meals
Total # of Cash Meals
Total Discount
Rate Collected
Total Operating
Charge
Explanation for Refunds:
Explanation of overages/shortages
Signature and Grade of Facility Supervisor
Signature and Grade of Person Making Collection
PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C., Chapter 40; 37 U.S.C., Chapter 9; EO 9397, November 1943 PRINCIPAL PURPOSES: Used to authorize and verify the Subsistence-in-Kind entitlement; record the numbers of people subsisting; and account for cash collected.
ROUTINE USES: Information may be disclosed to the Department of Justice, and to federal, state, local, or foreign law enforcement authorities for investigating or persecuting a violation on potential violation of law.
DISCLOSURE: Disclosure of SSN is voluntary. However, members otherwise entitled to Subsistence-in-Kind will not be provided a meal at no cost without the SSN, since the SSN is used to verify the entitlement.
| Number |
| Number |
| B |
| B |
| A & B |
| Sales |
| From Column |
| Grade |
| Security Number |
| D |
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