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CALIFORNIA DEPARTMENT OF EDUCATION <br />NUTRITION SERVICES DIVISION <br />SUMMER FOOD SERVICE PROGRAM <br />OFFICIAL AGENCY CERTIFICATION <br />SUMMER FOOD SERVICE PROGRAM <br />NSD 1/10 <br />By signing the certification below, the agency's executive director, or equivalent official, is <br />formally designating an Authorized Representative for the Summer Food Service Program. <br />The Authorized Representative is the person with the authority to enter into a legal agreement <br />or contract on behalf of your agency. <br />Provide the following information to identify your agency's Authorized Representative. <br />AGENCY NAME <br />CITY OF COLTON <br />AUTHORIZED REPRESENTATIVE NAME <br />AUTHORIZED REPRESENTATIVE TITLE/POSITION <br />WILLIAM SMITH <br />COMMUNITY SERVICES DIRECTOR <br />MAILING ADDRESS <br />CITY <br />ZIP CODE <br />670 COLTON AVENUE <br />COLTON <br />1 92324 <br />TELEPHONE NUMBER <br />FAX NUMBER <br />E-MAIL ADDRESS <br />909 370 6152 <br />909 777 3351 <br />BSMITH@CI.COLTON.CA.US <br />I certify that the above agency has the authority to implement the Summer Food Service <br />Program (SFSP). I authorize the above named individual as the Authorized <br />Representative to have full oversight of the SFSP. This person will assign the <br />administrative staff necessary to implement and operate the SFSP according to the <br />Program's requirements and ensure that training for Program's operation are <br />conducted annually and as needed. <br />PRINTED NAME OF HIGHEST AGENCY OFFICIAL <br />SIGNATURE OF HIGHEST AGENCY OFFICIAL DATE <br />