The following statement must filled out and be certified by checking the certification statement and signed by the authorized representative of the Local Education Agency (LEA) operating the National School Lunch (including SSO) and/or School Breakfast Programs.

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* 1. Local Education Agency (LEA) Name

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* 2. LEA Agreement Number

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* 3. LEA Authorized Representative Contact Name

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* 4. LEA Authorized Representative Contact Phone Number

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* 5. LEA Authorized Representative Contact E-Mail Address

As the Authorized Representative of the LEA listed above, I do hereby attest that the aforementioned LEA and all school buildings under its jurisdiction operate the National School Lunch Program authorized under the Richard B. Russell National School Lunch Act (42 U.S.C. 1751 et seq), and/or the School Breakfast Program, will utilize the Supply Chain Assistance (SCA). Funding is to be used exclusively as described below:
  • Are experiencing supply chain disruptions and related financial difficulties/need;
  • Will only use funds to purchase domestic unprocessed or minimally processed foods;
  • Will not use funds for any labor, indirect, or other administrative expenses;
  • Will comply with all recordkeeping and review requirements per 7 CFR 210.9(b)(17) and 7 CFR 210.18, which would include maintaining documentation demonstrating appropriate use of SCA funds; and
  • Will comply with all applicable Federal procurement and financial management requirements per 2 CFR 200.

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* 6. I certify that this attestation is true and correct and agree to the terms and conditions above.

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* 7. The LEA will maintain documentation, including purchases made and other records such as invoices and receipts to document SCA funds were used for allowable purchases and I understand during Administrative Reviews (ARs) the LEA will need to provide documentation of SCA funds usage.

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* 8. Did the LEA attest to the first round of SCA funds?

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* 9. Does your LEA contract with a Food Service Management Company to provide meals for the National School Lunch Program?

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* 10. By typing my name below, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature.

The Department of Elementary and Secondary Education does not discriminate on the basis of race, color, religion, gender, sexual orientation, national origin, age, veteran status, mental or physical disability, or any other basis prohibited by statute in its programs and activities. Inquiries related to department programs and to the location of services, activities, and facilities that are accessible by persons with disabilities may be directed to the Jefferson State Office Building, Director of Civil Rights Compliance and MOA Coordinator (Title VI/Title IX/504/ADA/ADAAA/Age Act/GINA/USDA Title VI), 5th Floor, 205 Jefferson Street, P.O. Box 480, Jefferson City, MO 65102-0480; telephone number 573-526-4757 or TTY 800-735-2966; email civilrights@dese.mo.gov.

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