FSMC/Vendor Contract Submissions – Cover Sheet

Food Service Management Company/Vendor Invitation for Bid and Contract Submission Form

Prior to beginning the bid solicitation process, submit this completed form along with all Invitation for Bid and Contract documents to the Tennessee School Nutrition Program (TSNP) per instructions. When the documents submitted are deemed in compliance with federal and state regulations and statutes, TSNP will provide written notification to the school food authority authorizing the school food authority to begin the bid solicitation process. Allow a reasonable number of days for TSNP to complete the initial review of the documents.

A. School Food Authority (SFA) Information

Agreement Number ______School Food Authority ______Address, City, Zip Code ______

Authorized Representative (as listed on TMAC application) ______Phone Number ______Ext. ______Email ______

Contract Contact Person (for purposes of this proposed contract) ______Phone Number ______Ext. ______Email ______

B. Current Contract(s) –

Food Service Management Company (FSMC)/Vendor Name ______

Contract Type (circle one) FSMC Vendor None

Expiration Date (including renewal options) ______

If the SFA has more than one contractor, please use additional paper.

C. General Information

School food service personnel are employed by (circle one): SFA Contractor Both

Does the SFA offer summer school? Yes ______No ______

School-Based Child Nutrition Programs currently offered by the SFA include (Check all that apply):

 National School Lunch Program  School Breakfast Program  Seamless Summer Option  After-School Care Program

Updated 01/15 pm ph D. Other Agreements List all other district(s)/school(s) for which you provide meals. Use additional paper if necessary. ______

E. Projected Dates Allow a recommended minimum of 28 days between the newspaper advertisement and the public bid opening.

1) Newspaper Advertisement ______Date 2) Pre-Bid Conference (if applicable) ______Date Location 3) Public Bid Opening ______Date Location 4) Contract Award ______Date

F. Certification Statement

I hereby confirm the Invitation for Bid and Contract documents submitted to the Tennessee School Nutrition Program have been reviewed by the school food authority’s legal counsel as necessary to ensure compliance with all local regulations, statutes, and policies.

______Authorized Representative Signature Title Date

Mail or fax to: Tennessee School Nutrition Program 1240 Foster Avenue Nashville, TN 37243 Fax: 615-532-4748 Email: [email protected]

Updated 1/26/15 ph pm Invitation for Bid and Contract Document Checklist (For School Food Authority Use Only—Do Not Submit With Bid Documents)

______Invitation for Bid and Contract Submission Form

______Invitation for Bid and Contract Main Document

______Insurance Requirements

______Bidder Responsibility and Bid Responsiveness Criteria

______Bid Summary with annual projected units completed

______Certification Forms ______Bid-Rigging Certification ______Certificate of Independent Bid Determination ______Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion —Lower Tier Covered Transactions ______Certificate Regarding Lobbying ______Disclosure of Lobbying Activities ______Other Certifications as Required by the SFA

______Exhibit A: School Data (FSMC)/Site Data (Vendor) ______Exhibit A-1: School/Site Data Form ______Exhibit A-2: Eligibility Data and Projected Enrollments ______Exhibit A-3: Meal Service Information and Delivery Schedule

______Exhibit B: Menu Requirements ______Exhibit B-1: 21-Day Cycle Menu(s) ______Exhibit B-2: Meal Choices and Additional Daily Offerings ______Exhibit B-3: A la Carte Price List

______Exhibit C: Meal Pattern Nutrition Standards and Implementation Timeframe

______Exhibit D: School Year (SY) 2015–2016 Commodities ______Annual Commodity Order for SY 2015–2016 ______Diversion to Processor form for SY 2015–2016

______Exhibit E: School Year 2013–2014 SFA/LEA Claims for Reimbursement

______Exhibit F: School Year 2014–2015 Sponsor/Site Claims for Reimbursement ______SFA Claims for Reimbursement for all months to date for SY 2014–2015 ______Site Claims for Reimbursement for October 2014 and March 2015

Food Service Management Company Contracts Only

______Exhibit G: Staffing Patterns

______Exhibit H: Local Wellness Policy

______Exhibit I: Contractor-Owned Equipment

______Exhibit J: Collective Bargaining Agreement, if applicable

Updated 1/26/15 ph pm