Common use of CERTIFICATION STATEMENT Clause in Contracts

CERTIFICATION STATEMENT. I CERTIFY that the information on this Permanent Agreement/Policy statement and all related attachments is true and correct to the best of my knowledge and that the Institution herein named is in compliance with the audit requirements stated in 7 CFR Part 3052. The Institution named herein accepts final financial and administrative responsibility for management of an effective food service, and further agrees to comply with all requirements as specified under 7 CFR 226. An Institution/Sponsoring Organization certifies that all key staff (as defined by Wisconsin Department of Public Instruction) has attended annual program training and documentation is on file in support of this certification. The Institution certifies that neither it nor any of its principals have been declared ineligible to participate in any other publicly funded program by reason of violating that programs’ requirements. The Institution certifies that neither it or any of its principals has been convicted of any activity that occurred in the past seven years and that indicated a lack of business integrity. (A lack of business integrity includes fraud, antitrust violations, embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, receiving stolen property, making false claims obstructing justice, or any other activity indicating a lack of business integrity as defined by the state agency.) Institutions and individuals providing false certifications will be placed on the National Disqualified List and will be subject to any other applicable civil or criminal penalties. The Institution further certifies that a screening process is in place to scrutinize any criminal convictions of board members that may disqualify them from performing program administrative functions. I understand that this information is being provided in connection with receipt of federal funds and that deliberate misrepresentation may subject me to prosecution under applicable state and federal criminal statutes. By continuing to operate the CACFP after the enactment or issuance of any changed or new statutes and regulations applicable to the Program covered by this Agreement and any changed and new instructions, policy memoranda, guidance and other written directives interpreting these statutes and regulations, the sponsoring organization agrees to comply with them. If the institution does not wish to comply with any changed or new items, the institution must seek to terminate the agreement in accordance with the terms outlined in this PI-1486-AP. I further agree to abide by the terms and conditions of the Permanent CACFP Agreement/Policy Statement and the Annual CACFP Application. VI. SIGNATURE Signature of Authorized Representative  Signature 

CERTIFICATION STATEMENT. Under the provisions of the United States Department of Agriculture, Food and Nutrition Service, I CERTIFY that certify as a sponsor in the Child Nutrition Programs all information on this Permanent Agreement/Policy statement contained in the executed Contract Renewal Agreement and all related attachments accompanying contract renewal documents is true and correct to the best of my knowledge and that the Institution herein named is in compliance with the audit requirements stated in 7 CFR Part 3052. The Institution named herein accepts final financial and administrative responsibility for management of an effective food service, and further agrees to comply with all requirements as specified under 7 CFR 226. An Institution/Sponsoring Organization certifies that all key staff (as defined by Wisconsin Department of Public Instruction) has attended annual program training and documentation is on file in support of this certification. The Institution certifies that neither it nor any of its principals have been declared ineligible to participate in any other publicly funded program by reason of violating that programs’ requirements. The Institution certifies that neither it or any of its principals has been convicted of any activity that occurred in the past seven years and that indicated a lack of business integrity. (A lack of business integrity includes fraud, antitrust violations, embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, receiving stolen property, making false claims obstructing justice, or any other activity indicating a lack of business integrity as defined by the state agency.) Institutions and individuals providing false certifications will be placed on the National Disqualified List and will be subject to any other applicable civil or criminal penalties. The Institution further certifies that a screening process is in place to scrutinize any criminal convictions of board members that may disqualify them from performing program administrative functionsaccurate. I understand that this the nonprofit school food service program account cannot be used to pay for unallowable contract costs. As authorized representative for the school food authority noted above, I will ensure operation of the nonprofit school food service program, including use of nonprofit school food service program account funds, is compliant with the rules and regulations of the Illinois State Board of Education and the United States Department of Agriculture regarding Child Nutrition Programs. I understand revisions cannot be made to the executed Vended Meals Contract without first submitting proposed revisions to the Illinois State Board of Education for review and receiving written notification the proposed revisions are allowable within the regulatory guidelines. Furthermore, I understand additional documents and/or agreements, including those developed by the contractor, cannot become part of the executed contract. I understand all contract information provided to the Illinois State Board of Education is being provided given in connection with the receipt of federal funds and that deliberate misrepresentation may subject me to prosecution under applicable state and federal criminal statutes. By continuing Further, I understand such misrepresentation could result in the loss of federal and state funding received by the school food authority for School-Based Child Nutrition Programs. I certify the Contract Renewals documents submitted to operate ISBE have been reviewed by the CACFP after School Food Authority and the enactment or issuance of any changed or new statutes School Food Authority’s legal counsel, as deemed necessary, to ensure compliance with all Local, State and regulations applicable Federal regulations, statutes, and policies. I certify that no third-party entity prepared the contract renewal documents, requested amendments, and USDA foods entitlement utilization data below. I certify that all contract provisions, including those relating to USDA Foods utilization by the FSMC to the Program covered by this Agreement and any changed and new instructionsmaximum extent possible have been met: Did the Vendor manage the SFAs USDA Foods Entitlement (check one) ☐
Yes ☐
No If yes, policy memoranda, guidance and other written directives interpreting these statutes and regulations, please complete the sponsoring organization agrees following: School Year 2024-25 USDA Foods Entitlement Amount (including Bonus) (A) $_______________ School Year 2024-25 USDA Foods credits issued to comply with them. If the institution does not wish to comply with any changed or new items, the institution must seek to terminate the agreement in accordance with the terms outlined in this PI-1486-AP. I further agree to abide SFA by the terms and conditions FSMC (B) $_______________ USDA Foods Entitlement Utilization Percentage as of (insert date of certification**)
(B / A) %_____________ **Date of certification must be as of the Permanent CACFP Agreement/Policy Statement and date contract renewal is signed based on year-to-date actual credits received by the Annual CACFP Application. VI. SIGNATURE Signature of FSMC as verified by monthly invoices** _______________________________________ _________________ __________________ ________ SFA Authorized Representative  Signature Title E-mail Date

CERTIFICATION STATEMENT. Under the provisions of the United States Department of Agriculture, Food and Nutrition Service, I CERTIFY that certify as a sponsor in the Child Nutrition Programs all information on this Permanent Agreement/Policy statement contained in the executed Contract Renewal Agreement and all related attachments accompanying contract renewal documents is true and correct accurate. I understand the nonprofit school food service program account cannot be used to pay for unallowable contract costs. As authorized representative for the best school food authority noted above, I will ensure operation of my knowledge and that the Institution herein named nonprofit school food service program, including use of nonprofit school food service program account funds, is in compliance with the audit requirements stated in 7 CFR Part 3052. The Institution named herein accepts final financial rules and administrative responsibility for management regulations of an effective food service, the Illinois State Board of Education and further agrees to comply with all requirements as specified under 7 CFR 226. An Institution/Sponsoring Organization certifies that all key staff (as defined by Wisconsin the United States Department of Public Instruction) has attended annual program training and documentation is on file in support of this certification. The Institution certifies that neither it nor any of its principals have been declared ineligible to participate in any other publicly funded program by reason of violating that programs’ requirements. The Institution certifies that neither it or any of its principals has been convicted of any activity that occurred in the past seven years and that indicated a lack of business integrity. (A lack of business integrity includes fraud, antitrust violations, embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, receiving stolen property, making false claims obstructing justice, or any other activity indicating a lack of business integrity as defined by the state agency.) Institutions and individuals providing false certifications will be placed on the National Disqualified List and will be subject to any other applicable civil or criminal penalties. The Institution further certifies that a screening process is in place to scrutinize any criminal convictions of board members that may disqualify them from performing program administrative functionsAgriculture regarding Child Nutrition Programs. I understand that this revisions cannot be made to the executed Vended Meals Contract without first submitting proposed revisions to the Illinois State Board of Education for review and receiving written notification the proposed revisions are allowable within the regulatory guidelines. Furthermore, I understand additional documents and/or agreements, including those developed by the contractor, cannot become part of the executed contract. I understand all contract information provided to the Illinois State Board of Education is being provided given in connection with the receipt of federal funds and that deliberate misrepresentation may subject me to prosecution under applicable state and federal criminal statutes. By continuing Further, I understand such misrepresentation could result in the loss of federal and state funding received by the school food authority for School-Based Child Nutrition Programs. I certify the Contract Renewals documents submitted to operate ISBE have been reviewed by the CACFP after School Food Authority and the enactment or issuance of any changed or new statutes School Food Authority’s legal counsel, as deemed necessary, to ensure compliance with all Local, State and regulations applicable Federal regulations, statutes, and policies. I certify that no third-party entity prepared the contract renewal documents, requested amendments, and USDA foods entitlement utilization data below. I certify that all contract provisions, including those relating to USDA Foods utilization by the FSMC to the Program covered by this Agreement and any changed and new instructionsmaximum extent possible have been met: Did the Vendor manage the SFAs USDA Foods Entitlement (check one) ☐
Yes ☐
No If yes, policy memoranda, guidance and other written directives interpreting these statutes and regulations, please complete the sponsoring organization agrees following: School Year 2023-24 USDA Foods Entitlement Amount (including Bonus) (A) $_______________ School Year 2023-24 USDA Foods credits issued to comply with them. If the institution does not wish to comply with any changed or new items, the institution must seek to terminate the agreement in accordance with the terms outlined in this PI-1486-AP. I further agree to abide SFA by the terms and conditions FSMC (B) $_______________ USDA Foods Entitlement Utilization Percentage as of (insert date of certification**)
(B / A) %_____________ **Date of certification must be as of the Permanent CACFP Agreement/Policy Statement and date contract renewal is signed based on year-to-date actual credits received by the Annual CACFP Application. VI. SIGNATURE Signature of FSMC as verified by monthly invoices** _______________________________________ _________________ __________________ ________ SFA Authorized Representative  Signature Title E-mail Date

CERTIFICATION STATEMENT. I HEREBY CERTIFY that the information on this Permanent Agreement/Policy statement Statement and all related attachments is true and correct to the best of my knowledge and that the Institution sponsoring organization herein named is in compliance with the audit requirements stated in 7 CFR Part 3052. The Institution sponsoring organization herein named herein accepts final financial and administrative responsibility for management of an effective food service, and further agrees to comply with all requirements as specified under 7 CFR 226. An Institution/Sponsoring Organization certifies that all key staff (as defined by Wisconsin Department of Public Instruction) has attended annual program training and documentation is on file in support of this certification. The Institution sponsoring organizations certifies that neither it nor any of its principals have been declared ineligible to participate in any other publicly funded program by reason of violating that programs’ program’s requirements. The Institution sponsoring organization certifies that neither it or nor any of its principals has have been convicted of any activity that occurred in the past seven years and that indicated a lack of business integrity. (A lack of business integrity includes fraud, antitrust violations, embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, receiving stolen property, making false claims obstructing claims, obstruction of justice, or any other activity indicating a lack of business integrity as defined by the state agency.) Institutions and individuals providing false certifications will be placed on the National Disqualified List disqualified list and will be subject to any other applicable civil or criminal penalties. The Institution further sponsoring organization certifies that all day care homes under its sponsorship have adhered to the training requirements as set forth in 7 CFR 226. The sponsoring organization certifies that a screening process is in place to scrutinize any criminal convictions of board Board members that may disqualify them from performing program administrative functions. I understand that this information is being provided in connection with the receipt of federal funds and that deliberate misrepresentation may subject me to prosecution under applicable state and federal criminal statutes. By continuing to operate the CACFP after the enactment or issuance of any changed or new statutes and regulations applicable to the Program covered by this Agreement and any changed and new instructions, policy memoranda, guidance and other written directives interpreting these statutes and regulations, the sponsoring organization agrees to comply with them. If the institution sponsoring organization does not wish to comply with any changed or new items, the institution sponsoring organization must seek to terminate the agreement in accordance with to the terms outlined in this PI-1486on page five of PI-1459-AP. I further agree to abide by the terms and conditions of the Permanent CACFP Agreement/Policy Statement and the Annual CACFP Application. VI. SIGNATURE V. SIGNATURES Signature of Authorized Representative  Signature  Title of Authorized Representative Title Director, Community Nutrition Programs Date Signed Mo./Day/Yr. Date Signed Mo./Day/Yr. In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on 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. Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (▇▇▇) ▇▇▇-▇▇▇▇. Additionally, program information may be made available in languages other than English. To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: ▇▇▇▇://▇▇▇.▇▇▇▇.▇▇▇▇.▇▇▇/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (▇▇▇) ▇▇▇-▇▇▇▇. Submit your completed form or letter to USDA by:

CERTIFICATION STATEMENT. Under the provisions of the United States Department of Agriculture, Food and Nutrition Service, I CERTIFY that certify as a sponsor in the Child Nutrition Programs all information on this Permanent Agreement/Policy statement contained in the executed Contract Renewal Agreement and all related attachments accompanying contract renewal documents is true and correct accurate. I understand the nonprofit school food service program account cannot be used to pay for unallowable contract costs. As authorized representative for the best school food authority noted above, I will ensure operation of my knowledge and that the Institution herein named nonprofit school food service program, including use of nonprofit school food service program account funds, is in compliance with the audit requirements stated in 7 CFR Part 3052. The Institution named herein accepts final financial rules and administrative responsibility for management regulations of an effective food service, the Illinois State Board of Education and further agrees to comply with all requirements as specified under 7 CFR 226. An Institution/Sponsoring Organization certifies that all key staff (as defined by Wisconsin the United States Department of Public Instruction) has attended annual program training and documentation is on file in support of this certification. The Institution certifies that neither it nor any of its principals have been declared ineligible to participate in any other publicly funded program by reason of violating that programs’ requirements. The Institution certifies that neither it or any of its principals has been convicted of any activity that occurred in the past seven years and that indicated a lack of business integrity. (A lack of business integrity includes fraud, antitrust violations, embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, receiving stolen property, making false claims obstructing justice, or any other activity indicating a lack of business integrity as defined by the state agency.) Institutions and individuals providing false certifications will be placed on the National Disqualified List and will be subject to any other applicable civil or criminal penalties. The Institution further certifies that a screening process is in place to scrutinize any criminal convictions of board members that may disqualify them from performing program administrative functionsAgriculture regarding Child Nutrition Programs. I understand that this revisions cannot be made to the executed Invitation for Bid and Contract without first submitting proposed revisions to the Illinois State Board of Education for review and receiving written notification the proposed revisions are allowable within the regulatory guidelines. Furthermore, I understand additional documents and/or agreements, including those developed by the contractor, cannot become part of the executed contract. I understand all contract information provided to the Illinois State Board of Education is being provided given in connection with the receipt of federal funds and that deliberate misrepresentation may subject me to prosecution under applicable state and federal criminal statutes. By continuing Further, I understand such misrepresentation could result in the loss of federal and state funding received by the school food authority for School-Based Child Nutrition Programs. I certify the Contract Renewals documents submitted to operate ISBE have been reviewed by the CACFP after School Food Authority and the enactment or issuance of any changed or new statutes School Food Authority’s legal counsel, as deemed necessary, to ensure compliance with all Local, State and regulations applicable Federal regulations, statutes, and policies. I certify that no third-party entity prepared the contract renewal documents, requested amendments, and USDA foods entitlement utilization data below. I certify that all contract provisions, including those relating to USDA Foods utilization by the Vendor to the Program covered by this Agreement and any changed and new instructionsmaximum extent possible have been met: Did the Vendor manage the SFAs USDA Foods Entitlement (circle one) Yes No If yes, policy memoranda, guidance and other written directives interpreting these statutes and regulations, please complete the sponsoring organization agrees following: School Year 2022-23 USDA Foods Entitlement Amount (including Bonus) (A) $_____________ School Year 2022-23 USDA Foods credits issued to comply with them. If the institution does not wish to comply with any changed or new items, the institution must seek to terminate the agreement in accordance with the terms outlined in this PI-1486-AP. I further agree to abide SFA by the terms and conditions Vendor (B) $______________ USDA Foods Entitlement Utilization Percentage as of (insert date of certification**) (B / A) %___________ **Date of certification must be as of the Permanent CACFP Agreement/Policy Statement and date contract renewal is signed based on year-to-date actual credits received by the Annual CACFP Application. VI. SIGNATURE Signature of Vendor as verified by monthly invoices** _______________________________________ _________________ __________________ ________ SFA Authorized Representative  Signature Title E-mail Date

CERTIFICATION STATEMENT. Under the provisions of the United States Department of Agriculture, Food and Nutrition Service, I CERTIFY that certify as a sponsor in the Child Nutrition Programs all information on this Permanent Agreement/Policy statement contained in the executed Contract Renewal Agreement and all related attachments accompanying contract renewal documents is true and correct accurate. I understand the nonprofit school food service program account cannot be used to pay for unallowable contract costs. As authorized representative for the best school food authority noted above, I will ensure operation of my knowledge and that the Institution herein named nonprofit school food service program, including use of nonprofit school food service program account funds, is in compliance with the audit requirements stated in 7 CFR Part 3052. The Institution named herein accepts final financial rules and administrative responsibility for management regulations of an effective food service, the Illinois State Board of Education and further agrees to comply with all requirements as specified under 7 CFR 226. An Institution/Sponsoring Organization certifies that all key staff (as defined by Wisconsin the United States Department of Public Instruction) has attended annual program training and documentation is on file in support of this certification. The Institution certifies that neither it nor any of its principals have been declared ineligible to participate in any other publicly funded program by reason of violating that programs’ requirements. The Institution certifies that neither it or any of its principals has been convicted of any activity that occurred in the past seven years and that indicated a lack of business integrity. (A lack of business integrity includes fraud, antitrust violations, embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, receiving stolen property, making false claims obstructing justice, or any other activity indicating a lack of business integrity as defined by the state agency.) Institutions and individuals providing false certifications will be placed on the National Disqualified List and will be subject to any other applicable civil or criminal penalties. The Institution further certifies that a screening process is in place to scrutinize any criminal convictions of board members that may disqualify them from performing program administrative functionsAgriculture regarding Child Nutrition Programs. I understand that this revisions cannot be made to the executed FSMC Contract without first submitting proposed revisions to the Illinois State Board of Education for review and receiving written notification the proposed revisions are allowable within the regulatory guidelines. Furthermore, I understand additional documents and/or agreements, including those developed by the contractor, cannot become part of the executed contract. I understand all contract information provided to the Illinois State Board of Education is being provided given in connection with the receipt of federal funds and that deliberate misrepresentation may subject me to prosecution under applicable state and federal criminal statutes. By continuing Further, I understand such misrepresentation could result in the loss of federal and state funding received by the school food authority for School-Based Child Nutrition Programs. I certify the Contract Renewals documents submitted to operate ISBE have been reviewed by the CACFP after School Food Authority and the enactment or issuance of any changed or new statutes School Food Authority’s legal counsel, as deemed necessary, to ensure compliance with all Local, State and regulations applicable Federal regulations, statutes, and policies. I certify that no third-party entity prepared the contract renewal documents, requested amendments, and USDA foods entitlement utilization data below. I certify that all contract provisions, including those relating to USDA Foods utilization by the FSMC to the Program covered by this Agreement and any changed and new instructions, policy memoranda, guidance and other written directives interpreting these statutes and regulations, maximum extent possible have been met: School Year 2024-25 USDA Foods Entitlement Amount (including Bonus) (A) $ 242,660 School Year 2024-25 USDA Foods credits issued to the sponsoring organization agrees to comply with them. If the institution does not wish to comply with any changed or new items, the institution must seek to terminate the agreement in accordance with the terms outlined in this PI-1486-AP. I further agree to abide SFA by the terms and conditions FSMC (B) $ 168,700 USDA Foods Entitlement Utilization Percentage as of (3/20/2025) (B / A) 69.52 **Date of certification must be as of the Permanent CACFP Agreement/Policy Statement and date contract renewal is signed based on year-to-date actual credits received by the Annual CACFP Application. VI. SIGNATURE Signature of FSMC as verified by monthly invoices** SFA Authorized Representative  Signature Title E-mail Date

CERTIFICATION STATEMENT. Under the provisions of the United States Department of Agriculture, Food and Nutrition Service, I CERTIFY that certify as a sponsor in the Child Nutrition Programs all information on this Permanent Agreement/Policy statement contained in the executed Contract Renewal Agreement and all related attachments accompanying contract renewal documents is true and correct accurate. I understand the nonprofit school food service program account cannot be used to pay for unallowable contract costs. As authorized representative for the best school food authority noted above, I will ensure operation of my knowledge and that the Institution herein named nonprofit school food service program, including use of nonprofit school food service program account funds, is in compliance with the audit requirements stated in 7 CFR Part 3052. The Institution named herein accepts final financial rules and administrative responsibility for management regulations of an effective food service, the Illinois State Board of Education and further agrees to comply with all requirements as specified under 7 CFR 226. An Institution/Sponsoring Organization certifies that all key staff (as defined by Wisconsin the United States Department of Public Instruction) has attended annual program training and documentation is on file in support of this certification. The Institution certifies that neither it nor any of its principals have been declared ineligible to participate in any other publicly funded program by reason of violating that programs’ requirements. The Institution certifies that neither it or any of its principals has been convicted of any activity that occurred in the past seven years and that indicated a lack of business integrity. (A lack of business integrity includes fraud, antitrust violations, embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, receiving stolen property, making false claims obstructing justice, or any other activity indicating a lack of business integrity as defined by the state agency.) Institutions and individuals providing false certifications will be placed on the National Disqualified List and will be subject to any other applicable civil or criminal penalties. The Institution further certifies that a screening process is in place to scrutinize any criminal convictions of board members that may disqualify them from performing program administrative functionsAgriculture regarding Child Nutrition Programs. I understand that this revisions cannot be made to the executed FSMC Contract without first submitting proposed revisions to the Illinois State Board of Education for review and receiving written notification the proposed revisions are allowable within the regulatory guidelines. Furthermore, I understand additional documents and/or agreements, including those developed by the contractor, cannot become part of the executed contract. I understand all contract information provided to the Illinois State Board of Education is being provided given in connection with the receipt of federal funds and that deliberate misrepresentation may subject me to prosecution under applicable state and federal criminal statutes. By continuing Further, I understand such misrepresentation could result in the loss of federal and state funding received by the school food authority for School-Based Child Nutrition Programs. I certify the Contract Renewals documents submitted to operate ISBE have been reviewed by the CACFP after School Food Authority and the enactment or issuance of any changed or new statutes School Food Authority’s legal counsel, as deemed necessary, to ensure compliance with all Local, State and regulations applicable Federal regulations, statutes, and policies. I certify that no third-party entity prepared the contract renewal documents, requested amendments, and USDA foods entitlement utilization data below. I certify that all contract provisions, including those relating to USDA Foods utilization by the FSMC to the Program covered by this Agreement and any changed and new instructions, policy memoranda, guidance and other written directives interpreting these statutes and regulations, maximum extent possible have been met: School Year 2023-24 USDA Foods Entitlement Amount (including Bonus) (A) $_______________ School Year 2023-24 USDA Foods credits issued to the sponsoring organization agrees to comply with them. If the institution does not wish to comply with any changed or new items, the institution must seek to terminate the agreement in accordance with the terms outlined in this PI-1486-AP. I further agree to abide SFA by the terms and conditions FSMC (B) $_______________ USDA Foods Entitlement Utilization Percentage as of (insert date of certification
**) (B / A) %_____________ **Date of certification must be as of the Permanent CACFP Agreement/Policy Statement and date contract renewal is signed based on year-to-date actual credits received by the Annual CACFP Application. VI. SIGNATURE Signature of FSMC as verified by monthly invoices** _______________________________________ _________________ __________________ ________ SFA Authorized Representative  Signature Title E-mail Date