Produce Distribution Application and Agreement 1Application2Requirements Agreement Section I: General InformationWhich Produce Distribution Program is your organization applying for?* Mobile Pantry Senior Market Food as Medicine School Market Organization Name* Is your organization an affiliate of another organization?* Yes No If yes, name of umbrella / parent organization*(Parent organization is programmatically, legally and fiscally responsible for the operation and liabilities of your program) Site Address* Street Address Address Line 2 City ZIP Code County* Ashland Ashtabula Cuyahoga Geauga Lake Richland Is the billing address the same?* Yes No Billing Address* Street Address Address Line 2 City ZIP Code Main contact phone number:* Phone number for the organization:* Phone number listed for the public:* Does your organization have a 501c3 status (Non-profit)?* Yes No Is your program at / in a school?* Yes No If yes, please provide the name of the school:* Type of school:*Example: Elementary, Middle School, High School, Early Learning, etc. If no, please list the closest elementary, middle and high school buildings:* If no, is your organization a Property Management Company or Senior High Rise?* Will your organization utilize staff or volunteers for the Senior Market?* Staff Volunteers Both Number of volunteers involved in program(s)* Number of staff involved in program(s)* Number of volunteers able to lift 40 pounds* Number of staff able to lift 40 pounds* Geographic service boundaries (if any) Client restrictions (if any) What specific population will you program serve?*For example: seniors, children, patients, etc. Please briefly describe your program and client base.*Does your organization have consistent, reliable access to the internet and a device in which to access it?* Yes, we have internet and a device No, we have a device but no internet access No, we have internet access but no device No, we do not have internet access or a device If no, is there a plan in place to acquire access to both the internet and a device?* Section II: SchedulingAnticipated/Requested Months of Programming (check all that apply)* January February March April May June July August September October November December Anticipated frequency of programming* Weekly Twice per month Monthly Available days / times for delivery drop-off (Morning is 8-9:00am, Afternoon is 2-3:00pm)MONDAY Morning Afternoon TUESDAY Morning Afternoon WEDNESDAY Morning Afternoon THURSDAY Morning Afternoon FRIDAY Morning Afternoon SATURDAY Morning Section III: Contact InformationMain Program Contact Name* Phone (Home)* Phone (Work) Email Address* Alternate Program Contact Name* Phone (Home)* Phone (Work) Email Address* Director/Administrator/Pastor Name (if different than above) Phone (Director/Pastor/Etc) Authorized people to sign the invoice upon delivery:*NamePhone (Click the "+" to the right of the field to add more than one name)Section IV: Community ConnectionsWhy are you interested in becoming a produce partner?*Are you currently connected with any community resources or wraparound services?* Yes No If yes, please list below.* What type of programming/resources would your community benefit from?* To the best of my knowledge the above information is correct.* Yes Name of person filling out this form:* Section IV: Food as MedicineWhat type of Food as Medicine Program are you interested in?Check all that apply. Produce Prescription Produce Distribution/Mobile Pantry Healthy Shelf & On-Site Pantry Nutrition Education Other If other, please list.* Other than food, what type of services do you plan to provide?*Check all that apply. Health Screenings Health & Nutrition Information (may include information about the clinic, recipes, handouts, etc.) Assistance with Health Insurance Cooking Demonstrations Other If other, please describe.* To the best of my knowledge the above information is correct.* Yes Name of person filling out this form:* General Requirements for Produce Distribution Programs FY2023 Please read the following requirements and agree to the terms at the bottom of this page. The Greater Cleveland Food Bank works with over 200 Produce Distribution partners. Each partner is different in size and function, but they are all held to a set of requirements and responsibilities. Physical Requirements · Paved parking lot or indoor space for distribution · Space for up to a 32 foot box-truck to maneuver · Flat space for 4 to 12 pallets · Clear path to pallet area: no steps, curbs, steep inclines, grass, gravel, snow, ice or soft surfaces · Space to discard recyclables, trash, and unusable produce · Space to store empty pallets until next distribution or a plan to discard pallets · The organization must pass a site evaluation prior to programming and be subject to annual site visits during distributions · Access to internet (wifi), laptops, tablets, or smart phones · Tables for distribution and bags to pack produce · Storage area for required paperwork (invoices, training documents, stats receipts, and TEFAP forms) for five years Organizational Requirements The organization must : · The organization must submit the appropriate distribution online application: https://portal.clevelandfoodbank.org/programs/mobilepantry/produce-distribution-app/ · The organization must complete an online Food Safety Training Course · The organization cannot require, accept fees, or solicit donations for produce. All produce must be distributed at no charge · The organization cannot require or imply participation or attendance in religious service, ministry, or political event in order to receive produce · The organization must commit to at least six (6) months of monthly distributions scheduled and agreed upon by the Food Bank · Food Bank product must only be distributed/used for the approved program’s clients. It must not be distributed to another agency, group, or organization, or used for any other purpose (ex: fundraisers, block parties, funeral meals) · The organization must publish, promote, and adhere to regular hours and dates of distributions to the public · The organization must recruit volunteers for the distribution (10-20 is recommended for most distributions) Distribution Requirements The organization must : · The organization must attend an annual USDA/Civil Rights training with at least one (1) representative · The organization must administer USDA Civil Rights Training to all volunteers and volunteers must sign the training sheet on an annual basis · “And Justice For All”, “Apply for SNAP”, “Household Eligibility Guideline” and “Written Notice of Beneficiary Rights” posters must all be displayed during all distributions · The organization must comply with the client intake process of utilizing PantryTrak for intake and reporting purposes · In the event paper forms are used, the current TEFAP / ODJFS form must be used and kept on file for five (5) years · In case of cancellation, the organization must provide a 48 hour notice by phone or e-mail prior to scheduled distribution. If this notice is not given, the organization will incur a $75 fee · In the case that the organization rejects any product which is deemed servable by the Food Bank, the organization will be charged a $25 restocking fee per item · The organization is responsible for any excess product at the end of the distribution and required to follow the redistribution process · The organization must report statistics from each month on The Portal within 48 hours of the distribution · The Greater Cleveland Food Bank has the right to discontinue this program at its discretion due to funding, delinquent statistics, excessive account balances, or improper treatment of clients or product · Food Discrimination guidelines must be adhered to at all times General Requirements for Produce Distribution Programs FY2023 Please read the following requirements and agree to the terms at the bottom of this page. The Greater Cleveland Food Bank works with over 200 Produce Distribution partners. Each partner is different in size and function, but they are all held to a set of requirements and responsibilities. Physical Requirements · Paved parking lot or indoor space for distribution · Space for up to a 32 foot box-truck to maneuver · Flat space for 4 to 12 pallets · Clear path to pallet area: no steps, curbs, steep inclines, grass, gravel, snow, ice or soft surfaces · Space to discard recyclables, trash, and unusable produce · Space to store empty pallets until next distribution or a plan to discard pallets · The organization must pass a site evaluation prior to programming and be subject to annual site visits during distributions · Tables for distribution and bags to pack produce · Storage area for required paperwork (invoices, training documents, and stats receipts) for five years Organizational Requirements The organization must : · The organization must submit the appropriate distribution online application: https://portal.clevelandfoodbank.org/programs/mobilepantry/produce-distribution-app/ · The organization must complete an online Food Safety Training Course · The organization cannot require, accept fees, or solicit donations for produce. All produce must be distributed at no charge · The organization cannot require or imply participation or attendance in religious service, ministry, or political event in order to receive produce · The organization must commit to at least three (3) months of monthly distributions scheduled and agreed upon by the Food Bank · Food Bank product must only be distributed/used for the approved program’s clients. It must not be distributed to another agency, group, or organization, or used for any other purpose (ex: fundraisers, block parties, funeral meals) · The organization must publish, promote, and adhere to regular hours and dates of distributions to the public · The organization must recruit volunteers for the distribution (10-20 is recommended for most distributions) Distribution Requirements The organization must : · The organization must attend an annual School Market training with at least one (1) representative · The organization must administer USDA Civil Rights Training to all volunteers and volunteers must sign the training sheet on an annual basis · “And Justice For All” and “Apply for SNAP” posters must all be displayed during all distributions · The organization must comply with the client intake process of utilizing sign in sheets for intake and reporting purposes · In case of cancellation, the organization must provide a 48 hour notice by phone or e-mail prior to scheduled distribution. If this notice is not given, the organization will incur a $75 fee. Cancellations due to weather are not included in this rule. · In the case that the organization rejects any product which is deemed servable by the Food Bank, the organization will be charged a $25 restocking fee per item · The organization is responsible for any excess product at the end of the distribution and required to follow the redistribution process · The organization must report statistics from each month on The Portal within 48 hours of the distribution · The Greater Cleveland Food Bank has the right to discontinue this program at its discretion due to funding, delinquent statistics, excessive account balances, or improper treatment of clients or product · Food Discrimination guidelines must be adhered to at all times HiddenMobile Pantry, Senior Market, or Food as MedicineHiddenSchool MarketSignI have read and agree to the above requirements.* Yes Director/Administrator/Pastor Initials* CommentsThis field is for validation purposes and should be left unchanged.
