Ade Form 718 - Permanent Agreement Page 22
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23ARIZONA DEPARTMENT OF EDUCATION
Child Nutrition Programs
1535 West Jefferson Street
Phoenix, Arizona 85007
CHILD AND ADULT CARE FOOD PROGRAM
PERMANENT AGREEMENT
Revised May 2011
CFDA# 10.558
A.G. Contract No. KR02-1170-ALS
CERTIFICATION PAGE
(Applicable to SPONSORS with governing boards only;
must be completed and signed before signature page.)
DIRECTIONS:
(1) County in which the governing board is located.
(2) Name of governing board member authorized to sign this certification page.
(3) City in which governing board meeting regarding the Permanent Agreement was held.
(4) Date of governing board meeting.
(5) Legal title of the SPONSOR’S governing board; current year.
(6) Name of designated official who will be signing the Permanent Agreement (same designated official
as on line 1, page 20, of the Food Service Agreement).
(7) Signature of governing board member (same name as on line (2) of this certification page).
Please note that a governing board member cannot designate himself or herself as the Designated
Official.
CERTIFICATION
State of Arizona
)
County of (1) ___________________ )
I, (2) ________________________________________, the duly appointed or elected and qualified
Name of Governing Board Member
member of, and acting on behalf of the governing board, so hereby certify that during a regular meeting
held in (3) _______________________ Arizona, on (4) _________________________, this governing
board, by motion made, seconded and carried, approved and authorized execution of an agreement
between the (5) ___________________________________________________ and the Arizona
Department of Education, a State Agency, for the purpose of participating in Child Nutrition and/or Food
Distribution Programs.
(6)___________________________________ has been designated by the governing board to sign this
Name of Designated Official
Agreement.
I further certify that this meeting was duly noticed, called and convened and was attended by a majority
of the members of the governing board and that approval has not since been altered or rescinded.
(7) ______________________________________
Signature of Governing Board Member
(Same as (2) above)
ADE FORM 718 (799)
22
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