PART III – REQUIRED PROGRAM INFORMATION

Please complete the required program information below for each school/ site applying for grant funds.

I.	School Information

1. School District:	Agreement Number:

2. School Name:	Site Number:

3. School Address:

4. Did this school receive a School Nutrition Equipment grant in FY15, FY16, FY17, FY18, FY19, FY20, FY21, FY22 (USDA)?	Yes No

II.	School Data (ESE will verify this data)

1. Total enrollment data (use October 2019 claim data)

Enrollment as of October 2019:

Number of students approved/ eligible for free meals:

Number of students approved/ eligible for reduced meals:

Percentage of free and reduced-priced eligible students as of October 2019:

2. Grade levels for the site applying:

3. Meals offered (check all that apply):
SBP NSLP Afterschool Snack CACFP At Risk Meals Summer Meals Program

4. How would you describe the school’s location? (check one): Urban Rural Suburban

5. Is this school an approved Summer Food Service Program (SFSP) feeding site? Yes No

If yes, is the site a SFSP central kitchen? Yes No

6. Does this school participate in the Community Eligibility Program (CEP)?	Yes No

7. Does this school participate in Provision 2?	Yes No
If yes, for: NSLP SBP Both NSLP and SBP

III.	Proposal	Site Name:

Describe briefly the equipment and how the school plans to address any or all of the following focus areas (if requesting the purchase of more than one piece of equipment, please attached additional proposal information as needed):

Submit the name of the piece(s) of equipment that the grant funds would purchase for the school.

Provide copies of support documentation that includes the prices for each piece of equipment as found in Chapter 30B (Uniform Procurement Act). (Please note: a piece of equipment must have an acquisition cost of greater than $1,000):

Type of equipment requested, in order of preference	Cost

Total Grant Amount Requested

Please answer the questions below to describe the school’s need for the equipment requested. Please be detailed in your responses. Each question is worth a separate number or points on the scorecard for the grant reviewers.

How will the equipment allow the SFA to support and sustain school breakfast and lunch program expansion?

b.	How will the equipment lend itself to improving the nutrition and quality of school food service meals that meet dietary guidelines (e.g., purchasing an equipment alternative to a deep fryer)? And realize meaningful impacts on the nutrition and quality of meals?

c.	Describe the age of current food service equipment or need if school is lacking the appropriate items. How will the equipment increase the efficiency of SFA procurement, food storage, and distribution/service?

How will the equipment help the school adopt strategies for adapting lunchroom changes that provide more convenience and appeal to the student?

Will the proposed equipment help support the establishment, maintenance, or expansion of the School Breakfast Program? If yes, how?

IV.	Staffing Information	Site Name:

Contact information of person responsible for overseeing the grant:

Name:
Title:
Email address:
Phone number:

V.	Signatures

We have reviewed this application and attest to the information provided. If selected, we agree to implement the program as outlined above and to implement the project in a manner consistent with the policies and the procedures established by the USDA.

We attest that the School Food Authority (SFA) is in good standing with the Child Nutrition Program reporting requirements.

We attest that the funds will be used to purchase equipment for the implementation of the School Nutrition Program in (and only in) the specific school requesting the grant.

We have provided copies of support documentation that includes the prices for each piece of equipment we are requesting as found in Chapter 30B (Uniform Procurement Act).

We agree to participate in any USDA sponsored evaluations, and to provide the information requested by the specified deadlines.

We will tag all equipment purchased with a label identifying it as being purchased with FY22 USDA School Nutrition Assistance Grant Funds.

I hereby certify that the LEA duly solicited three quotes for each piece of equipment requested and has adhered to all Federal, State, and Local procurement laws and standards, including, if applicable, as found in 7 CFR Part 210.21 and 2 CFR 200.317 through 2 CFR 200.326

Please provide the contacts shown below or equivalent positions as determined by the school.

School Nutrition Director:	Date:

Superintendent or Executive Director:	Date:

GOVERNMENT-WIDE REGULATIONS Grant recipients chosen for an award from this RFP must comply with the following regulations, principals, and assurances.
2 CFR Part 25: “Universal Identifier and System for Award Management”
2 CFR Part 170: “Reporting Sub-award and Executive Compensation Information”
2 CFR Part 175: “Award Term for Trafficking in Persons”
2 CFR Part 180: “OMB Guidelines to Agencies on Government-wide Debarment and Suspension (Non- Procurement)”
2 CFR Part 200: “Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards”
2 CFR Part 400: USDA Implementing regulations” Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards”
2 CFR Part 415: USDA “General Program Administrative Regulations”
2 CFR Part 416: USDA “General Program Administrative Regulations for Grants and Cooperative Agreements to State and Local Governments”
2 CFR Part 417: USDA “Nonprocurement Debarment and Suspension”
2 CFR Part 418 USDA “New Restrictions on Lobbying”
2 CFR Part 421: USDA “Requirements for Drug-Free Workplace (Financial Assistance)”
41 USC Section 22 “Interest of Member of Congress”
Duncan Hunter National Defense Authorization Act of Fiscal Year 2009, Public Law 110-417
Sections 738 and 739 of the Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act, 2012 (Public Law 112-55)
“The Federal Funding Accountability and Transparency Act (FFATA), dated September 26, 2006”
COST PRINCIPALS
2 CFR, Part 200: Subpart E, Cost Principles
USDA REGULATIONS
7 CFR Part 15: “Nondiscrimination”
Freedom of Information Act (FOIA). Public access to Federal Financial Assistance records shall not be limited, except when such records must be kept confidential and would have been excepted from disclosure pursuant to the “Freedom of Information” regulation (5 U.S.C. 552). ASSURANCE OF CIVIL RIGHTS COMPLIANCE
Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d-et seq.), USDA regulations at 7 CFR Part 15, Nondiscrimination, and Department of Justice regulations at 28 CFR Part 42, Nondiscrimination; Equal Employment Opportunity: Policies And Procedures
Title IX of the Education Amendments of 1972 (20 U.S.C. 1681 et seq.) and USDA regulations at 7 CFR Part 15a, Education Programs or Activities Receiving or Benefiting from Federal Financial Assistance

Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 1681 et seq.) and USDA regulations at 7 CFR Part 15a, Education Programs or Activities Receiving or Benefiting from Federal Financial Assistance, and Department of Justice regulations at 28 CFR Part 41, Implementation of Executive Order 12250, Nondiscrimination on the Basis of Handicap In Federally Assisted Programs
Age Discrimination Act of 1975 (42 U.S.C. 6101 et seq.) The Grantee assures that it will immediately take any measures necessary to effectuate the requirements in these laws, regulations, and directives. The Grantee gives this assurance inconsideration of and for the purpose of obtaining the funds provided under this agreement.
The Americans with Disabilities Act of 1990 (ADA) prohibits discrimination on the basis of disability in employment (Title I), state & local government services (Title II), places of public accommodation and commercial facilities (Title III). (42 U.S.C. 12101-12213)