Partner Agency Application. (ex. login i.d. #) Name of Agency: Cell: Cell: Hours of Operation:

Transcription

1 Check # Page 1 of 7 Partner Agency Application Date / / Agency No. (ex. login i.d. #) Name of Agency: Agency Phone: (Clients should be able to call this #) County: Pastor or Executive Director Program Director Name: Name: Phone: Phone: Cell: Cell: Site Address Mailing Address Hours of Operation: (Please specify if you only distribute one particular day of the month i.e., 1 st Saturday, 2 nd Wednesday etc.) Example Sunday Monday Tuesday Wednesday Thursday Friday Saturday 1 st & 3 rd 9am-noon Food Pantry On-Site Agency Marketplace Authorized Shoppers: (Please list the first/last names of the authorized shoppers for your agency. Only 3 shoppers permitted per agency)

2 Page 2 of 7 Golden Harvest Food Bank Partner Agency Agreement The purpose of the Agreement is to establish the Agency s continued partnership with Golden Harvest Food Bank, provide definition and guidance for the partnership, set compliance standards, and to improve the efficiency of the network of charitable delivery programs and the delivery of service to those in need. This Agreement covers fiscal year 2019, (beginning October 1, 2018 ending September 30, 2019), between Golden Harvest Food Bank (GHFB), a 501c3 and (Partner Agency), The above Partner Agency agrees that it will abide by the following terms and conditions, along with additional terms and conditions specific to program types that are outlined in the GHFB Partner Agency Manual. If any of these terms or conditions are violated, GHFB reserves the right to stop distributing product to the Partner Agency. Requirements: The Partner Agency agrees to abide by the policies, procedures, and record keeping requirements of GHFB. IRS Eligibility Requirements: The Partner Agency agrees that it meets the IRS eligibility requirements for the receipt, transfer, and use of donated products (food and non-food) under section 170(e) (3) of the IRS code, as stated below: 501c3 or Church /Religious Organization: The Partner Agency agrees that it is incorporated as a 501c3 Non-profit corporation or is considered a church as defined by the IRS and meets all of the criteria below for each type of eligible organization. Check the type of organization that the agency will qualify as: 501c3 Non-Profit Corporation- If this box is selected, the Partner Agency is required to submit, prior to approval: A current 501c3 determination letter from the IRS verifying its non-profit corporate status and verifying that it is not a private foundation. The Corporation name must match the name that the Partner Agency is known by the community. If the Partner Agency name does not match the corporation name listed on the 501c3 determination letter, the Partner Agency is required to submit current official and verifiable documentation regarding the Partner Agency s ability to use the 501c3 verification letter proving their non-profit status. Church (as defined by the IRS)/Religious Organization If this box is selected, the Agency is required to complete the applicable documents.

3 Page 3 of 7 Purpose of Incorporation and Service: The Partner Agency agrees that it is incorporated to serve the ill, needy and/or infants (minor children 0-18 years old). The Partner Agency also agrees that it is not incorporated for a purpose unrelated to serving the ill, needy and/or infants (minor children). Distribution without charge: The Partner Agency agrees that it will distribute the donated products (food and non-food items) obtained from GHFB free of charge (monetary, volunteer hours, services or otherwise). Client Eligibility: Partner Agency agrees that it will provide food assistance to all clients on the client s first visit to the agency. Partner Agency will not require additional information outside of photo ID and the self-declared applications provided by Golden Harvest Food Bank (or the compliance guidelines in TEFAP or GNAP programs) without written approval from Golden Harvest Food Bank s Outreach Department. Any agency seeking to request additional information from the client must submit a letter to the Outreach Department that includes the items that will be requested from clients. Recipients of Distributed products: The Partner Agency agrees that it will only distribute donated products to recipients who qualify as ill, needy and/or infants (minor children 0-18 years old) as defined in IRS code section 170(e)3. The Partner Agency also agrees that it will not distribute donated products to people who do not qualify to receive the products as defined in IRS Code section 170(e)3. Religious Proselytizing: Partner Agency agrees that it will not require clients to participate in or attend a religious service, pray, or to receive religious messages as a condition of receiving food. Religious information or counseling may be provided only at the clients request, after receiving food. Use of GHFB Products: The Partner Agency agrees that it will not sell, barter or use products in exchange for money, other property or services, including using products for the purpose of fundraising programs and events. The Partner Agency also agrees that it will comply with the restrictions related to the use and transfer of donated property, as described in IRS Tax Code Section 170(e)3 and any amendments to the code.

4 Page 4 of 7 Area of Distribution: The Partner Agency also agrees that it will not distribute any products outside of the United States and Puerto Rico. Record Keeping: The Partner Agency agrees that it will maintain adequate records and accurately reflect the total amount of product received and distributed (or used), a description of the products and the date of its receipt. Reporting: The Partner Agency agrees to submit monthly service reports via online reporting system by the 5 th of each month. If applicable, Retail Donation Program reports are due by the 28 th. Reports that are habitually late will result in your agency being placed on probation for a period of 30 days. Availability of Records: The Partner Agency agrees to provide its records, including but not limited to those which track the receipt and distribution of products obtained from GHFB, with or without notice. Local, State and Federal Regulations: The Partner Agency agrees that it will affirm the safe and proper handling of the donated goods, which conforms to all State and Federal regulations. Storage and Handling of Products: The Partner Agency agrees that it will store, handle and distribute products consistent with the safe food handling guideline outlined in the GHFB Partner Agency Manual. The Partner Agency also agrees that it will have adequate refrigeration and/or storage space to ensure the integrity of the product. All food will be stored 6 inches off the floor, proper temperatures maintained, and FEFO (First Expired, First Out) method of inventory control will be used. Food Safety: The Partner Agency agrees that at least one staff person be trained in food safety from a food safety training course approved by GHFB. Approved trainings are GHFB online Food Safety Training and or ServSafe Certification. The Partner Agency also agrees that if it utilizes food provided by GHFB to make meals, their key food service program staff are required to meet local commercial food safety standards and have one person with the authority to direct and control food preparation obtain the ServSafe Food Protection Manager certification or equivalent and be on site during meal preparation.

5 Page 5 of 7 Transporting Product: The Partner Agency agrees to load and transport product from GHFB in a manner that ensures safe handling, and that safe temperatures for transporting foods are maintained. The Partner Agency must have adequate help to pick up product at GHFB, or to unload a delivery made at their agency. Partner Agency will use chest coolers, freezer blankets, or a refrigerated truck for transport of frozen or perishable foods. Donor Stipulations: The Partner Agency agrees that it will adhere to any donor stipulations placed on donated products. As Is Condition: The Partner Agency agrees that it will accept all products received from GHFB in as is condition. Shared Maintenance and Transportation: The Partner Agency agrees to pay any applicable Shared Maintenance and/or handling fees (Delivery Charges) for the products received from GHFB. Discrimination: Partner Agency agrees that it will not engage in discrimination in the provision of service against any person because of race, color, citizenship, religion, gender, national origin, ancestry, age, marital status, disability, sexual orientation including gender identity or expression, unfavorable discharge from the military or status as a protected veteran, reprisal or retaliation for prior civil rights activity, and where applicable, political beliefs, or if all or part of an individual s income is derived from any public assistance program, or protected genetic information in employment or in any program or activity. Partner Agency also agrees to abide by Golden Harvest Food Banks definition of a household which is persons related or not residing at the same address. Agency Visits: The Partner Agency agrees to allow representatives of GHFB and government agencies to inspect and audit all facilities where products received from GHFB are received, stored and distributed, with or without notice. Program Expansion: The Partner Agency agrees to request approval from GHFB before changing or adding programs that involve the distribution of products received from GHFB.

6 Page 6 of 7 Access to One Feeding America Member Food Bank: The Partner Agency agrees that it will only receive food from GHFB and no other Feeding America Member Food Bank. Agency Activity Status: The Partner Agency agrees that it will obtain products from GHFB at least every 90 days to be deemed an Active Agency. If the Partner Agency becomes inactive, the Agency will not be allowed to obtain products from GHFB. This includes participating in the Retail Donation Program. The Partner Agency agrees that it will complete the agency application process again, prior to being considered for reinstatement as an Active Agency and allowed to obtain products from GHFB. Multiple Locations and Sub-distribution: The Partner Agency agrees that it will only receive and store product from GHFB at multiple locations if: 1. all locations individually meet the requirements of this agreement, 2. have been inspected and, 3. are approved by GHFB prior to receiving and distributing food. The agency is not allowed to sub-distribute product to any organization, agency, partner, or entity other than a qualifying client. Sharing of any product received via GHFB is prohibited without prior written approval from GHFB, this includes any product obtained via the Retail Donation Program. GHFB Partner Agency Manual: The Partner Agency agrees that it will abide by the rules, regulations and guidelines at all times set forth by GHFB Partner Agency Manual. Termination of Agency Agreement: GHFB may terminate this agreement, and may confiscate any/all product received if Partner Agency is found in violation of the agreement, agency manual and or policy with or without notice. Every attempt will be made to resolve non-compliant areas. Partner Agency understands that refunds will not be issued upon termination. The Partner Agency s authorized representative s signature below confirms that the Partner Agency is accepting and agrees to abide by all terms of this agreement. Partner Agency s Signature Date Print Name of Representative Who Signed This Agreement Golden Harvest Representative Signature Date

7 Page 7 of 7 Partner Agency Statement of Release Agency Name (Please Print) County Physical Address Mailing Address Whereas, Golden Harvest Food Bank has agreed to make available certain grocery products, and related items, as available to (name of your organization), a charitable, non-profit corporation or church, herein after referred to as Partner Agency. Whereas, Partner Agency has warranted to Golden Harvest Food Bank that all items will be duly inspected by a qualified member of their staff and found fit for human consumption or they will not be accepted. Therefore, Partner Agency hereby warrants, represents, and guarantees as follows: 1. That Golden Harvest Food Bank, the primary donor, and Feeding America have specifically disclaimed any warranties or representations, expressed or implied, as to the purity or fitness for consumption of any or all such donated items. 2. That all items are received and accepted in an as is condition. 3. That Partner Agency hereby accepts full responsibility for the purity and fitness for human consumption of any and all items accepted from Golden Harvest Food Bank and/or Retail Donor Partners. 4. That Partner Agency hereby warrants and guarantees to the Golden Harvest Food Bank, to the primary donor, and to Feeding America that it will hold them harmless from any and all liabilities, claims, losses, causes of action, suits of law or inequity, or any obligation whatsoever arising out of or attributed to any action by Partner Agency in connection with its storage and/or use of items supplied to it by the Golden Harvest Food Bank. 5. The undersigned hereby warrants that he/she is legally warranted and authorized agent of Partner Agency, whose name appears below, and by his/her signature does hereby bind it to the terms, conditions, and limitations of this document of release. Dated: This day of, This agreement is valid for the current fiscal year and it may be terminated by either party at any time upon written notification. I have read the above requirements and agree to abide by them, and I am authorized to enter into this agreement on behalf of the Partner Agency. I understand failure to maintain terms of this agreement may result in partnership status being suspended or terminated. Partner Agency Director / or Pastor Golden Harvest Food Bank Representative