Membership Application

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1 1501 John Tipton Blvd Pennsauken, NJ Phone (856) Fax: (856) Membership Application The Food Bank of South Jersey exists to provide an immediate solution to the urgent problem of hunger by providing food to needy people, teaching them to eat nutritiously, and helping them find sustainable ways to improve their lives. Food Bank of South Jersey 1501 John Tipton Blvd. Pennsauken NJ Marie Robles, Senior Manager of Customer Relations Ph: ext. 115 C: Fax : mrobles@foodbanksj.org

2 Table of Contents Who is the Food Bank of South Jersey Page 3 Core Values Page 4 Food Programs Page 5 Criteria for Membership Page 6 New Customer Check List Page 7 General Application Page 8-12 Policy & Procedures Page Monitoring Site Page Agreement Contract & Release Waiver Page

3 Who is the Food Bank of South Jersey The Food Bank of South Jersey (FBSJ) is a nonprofit, 501(c)(3) organization dedicated to salvaging potentially wasted food and redirecting that same food into channels to feed the hungry. We serve more than 200 member feeding organizations throughout Burlington, Camden, Gloucester and Salem counties. The FBSJ was founded in 1985 by a group of 25 nonprofit feeding organizations and the FEED Consortium, established by the Community Policy & Advocacy Council (CPAC). The founding group saw the need for a central clearinghouse for food donations and distributions. Providing emergency food on the scale that was needed and required a fully operational warehouse with dry, cool and frozen storage so that surplus and donated food could be efficiently and economically collected and stored. The FBSJ s centralized solicitation, storage, and distribution of food allows recipient customers to focus their efforts and resources on direct service to the community while providing them with increased access to a variety of nutritious food products. Solicitation, collection, and distribution of food throughout the year is done through a powerful network of united forces including members, individuals, corporations, and an affiliation with Feeding America the Nation s Food Bank Network. 3

4 Core Values Respect - We respect the inherent worth and dignity of every person and treat all with justice, equity and compassion. We honor the lives, concerns and stories of people in need and expect our partners to do the same. We accept one another and encourage diversity of thoughts and ideas. Stewardship and Accountability -We keep faith with the public trust through the efficient and compassionate use of resources entrusted to us and are mindful that our mission is accomplished through the generosity of others. We maintain and communicate accurate and timely information on hunger research, education, advocacy and service. We evaluate and account regularly for how resources are used to implement and achieve our mission. Collaboration - We believe in the power of the community. We collaborate and build strong relationships, based on trust with and among those who share our vision of creating a hunger-free South Jersey. Urgency - We operate with an acute sense of urgency that reflects the immediate needs of hungry people. We challenge our employees, volunteers and partners to embrace the same urgency to accomplish our shared vision. Service - We believe service is fundamental to creating a hunger-free South Jersey. We serve with excellence, compassion and responsiveness to meet the needs of those with whom we work, internally and externally. The better we serve the more people we bring together in commitment to our vision Integrity - We act with honesty, trust and openness and deliver on commitments. We act within the spirit of agreements, contracts and the law. Our intentions and actions will be transparent and above reproach. Diversity - We believe that the ethnic, cultural and social diversity of our nation should be reflected in our staff, Board and in all our external relationships, to better understand and resonate with our community. 4

5 Food Programs Donated Food Program Consist of food that is donated by the industry such as growers, retailers, manufacturers, processors, wholesaler, the general public and most of all Feeding America. This program can only be used to provide for emergency food assistance to infant, ill and needy. Purchase Food Program (COOP) Supplements the donated food program and enables us to fill in the gap with products that are not normally donated. We purchase the product from wholesalers. This program can be used for any of events, parties, social media etc. TEFAP The Emergency Food Assistance Program (USDA Commodities) consists of federal surplus commodities allocated to food banks for distribution to all the emergency feeding programs. Food products include meat, vegetables, fruit, grain and dairy. This program can only be provided to those that qualify. State Food Purchase Program Is a state level grant used to purchase nutrient rich foods. This program is set up for those that do not qualify for TEFAP (The Emergency Food Assistance Program). The only requirement is that you live in the state of New Jersey. 5

6 Criteria for Membership Please complete ALL appropriate sections of this application. Incomplete applications will not be accepted. 1. The Director of the food program must sign the enclosed Agreement Contract & release Waiver along with a copy of your IRS/US DEPT. OF TREASURY LETTER OF DETERMINATION, which states your 501(c) b tax-exempt status. 2. ***INDEPENDENT (non-denominational) CHURCHES WITHOUT A 501(c) 3 LETTER ARE NOT ELIGIBLE. 3. Fill out the enclosed survey in order to classify the type of program you are currently in and where we can provide technical assistance. 4. Please return the APPLICATION and ATTACHMENTS to the Food Bank of South Jersey, 1501 John Tipton Blvd., Pennsauken, NJ or to mrobles@foodbanksj.org. Please submit your application to Marie Robles, Senior Manager of Customer Relations. 5. Your organization must be within the four counties we serve, Burlington, Camden, Gloucester and Salem Counties. 6. We will arrange a site visit with your program. No membership can be finalized until a site visit is completed. 7. Must attend an orientation session at the Food Bank of South Jersey. This session is REQUIRED before an agency may begin receiving food from us. 8. Please note: Completion of this application does NOT guarantee membership. 9. We reserve the right to refuse membership to programs not meeting our criteria. 10. Applications may be put on a waiting list if there are no membership openings available at the moment. 11. Application fee is $25.00 (non-refundable even if your organization does not become a member of the FBSJ). 6

7 New Customer Application - Check List Customer Name Please returns with completed forms along with required documents. If documents requested are not attached to application, it will delay process. Steps in Application Process Complete Application Department of the Revenue (IRS) Prove of nonprofit status (501c3) 170 b. Agency Contract & Release Waiver List of Board Member or governing body that has direct oversight of your food program Brochure describing your program (if available) List of Authorized Shoppers $25.00 dollar application fee. (This will not be reimbursed if application is denied) We serve the right to refuse membership to organizations not meeting our criteria. Or if an organization is located in an area that is already being served. Once your application is completed and all supporting steps are taken, then your organization will officially become a member of the FBSJ: Application: 1. Senior Manager verifies completeness 2. Organization is approved, denied and/or put on a waiting list Site Inspection: 1. Reviewer will visit site to see if it meets standards for food storage 2. Site is approved, denied or advised on how to improve of storage area 3. Orientation - Once site is approved program staff & volunteers must attend a mandatory orientation 7

8 General Information 1. Name of Organization/Food Program Site Address City Zip Code Site Phone Site Fax Mailing Address Website Alternative Number Food Director or Primary Contact Person Contact person Number Contact person cell phone number Address Chief Executive Name (e.g. Executive Directory, Board President, Pastor, Imam, Rabbi, etc. Name Phone 2. Billing/Mailing Address (If different from above) Address City Zip Code 8

9 Phone Alt. Phone Number Fax Billing/Contact Person 3. Additional Sites and Address (If any) Address City Zip Code 4. Please describe your charity program mission and purpose? 5. How did you hear about the Food bank of South Jersey? 6. Please list any services your program provides in addition to food 7. Please check the description that best describes your program (more than one may apply): Emergency Food Distribution Program - (distribution of bagged or boxed groceries) One-Site Program (Preparation of Hot Meals) Emergency and On-Site Distribution Program (both) Shelter Substance Abuse Services Soup Kitchen Group Home Youth Program Senior Citizens Serv. Child Day Care Adult Day Care Other 8. Please indicate any dietary requirements that your recipients may have: 9

10 9. Has your organization ever been a participating program with the Food Bank of South Jersey? Yes No If yes, when?. Why did your participation with the Food Bank of SJ end? 10. Hours of Operation: What hours will you be open to distribute food? We require that you are open at least 4 hours a month. From To (Specify if this is every week, once a month. Example 1 st & 3 rd Saturday, etc.) _ 11. Will your organization be available for emergency referrals in addition to your regular distribution hours? organization be available for emergency food assistance? _ 12. Will your organization be available for deliveries to homebound clients? If yes, please provide days & hours of service. _ 13. Please define the geographic area or zip code (s) your program plans to serve. Please keep in mind that there is a possibility that there are other programs in the area providing food assistance. _ 14. Approximately what percentage of food served or distributed by your program will come from the Food Bank of South Jersey? % 15. List two or more organization (s) that are also providing a food program in your service area: Name 10

11 Name Name 16. What kind of referral system will you have (or develop) for people who will need additional help from your program? 17. Does your program have a record-keeping system in place for the food distribution program? Yes No If yes, please describe how your charity will maintain record keeping. 18. What other services will your program provide to people? 19. How many staff members will be involved in your food distribution program? Paid Volunteers 20. Food Storage Area (s) a. Total number of freezer (s) b. Total number of refrigerator (s) c. Dry storage: (describe) 21. How will the community be aware of the existence of your program? 22. Are their written guidelines for providing service to potential recipients? Yes No If yes, please submit a copy. 23. Name of organization s bank Only Organization Check Will Be Accepted Branch address 11

12 (Street) (City) (State) (Zip Code) Authorized check signers: Fees/Subsidies Information a. How is your food program funded? (Please be specific) b. What percentage of your food will come from the Food Bank of South Jersey? % Direct purchases? % Donations? % Other sources? % Please list other sources 12

13 Policy & Procedures Legal Responsibilities Recipient Customer has received IRS approval of its status as a not-for-profit, taxexempt organization under IRS code 501(c)(3) or is under a church or umbrella of a national church entity. Recipient Customer will use the donated items only to feed the needy, ill, or infants within the five boroughs of the Food Bank of South Jersey. Recipients Customer will not discriminate in the provision of services on basis of race, creed, religion, color, gender, sexual orientation, disability, marital status, veteran status, national origin, age, pregnancy, political beliefs, or any other characteristic protected by law. Safe Food Handling Recipient Customer will comply with all laws and ordinances concerning the storage, preparation and distribution of food and other products. Additionally, all food/products must be stored on site of the customer s legal address, not a personal residence. Recipient Customer accepts all donated items from the Food Bank of South Jersey in an as is condition, and accepts sole responsibility for the safety and fitness for human consumption of all items accepted from the FBSJ. Recipient Customer, utilizing training personnel as specified above, will inspect all donated items and accept only such items that its employees or volunteers determine to be safe for human consumption. Recipient Customer will distribute or serve food as described in its original application and will notify FBSJ of any significant changes. Recipients Customer will distribute or serve food products to eligible clients as soon as possible, to ensure maximum palatability and freshness. 13

14 Administrative Recipient Customer must keep all FBSJ donation receipts (invoices, statements etc. on file for one year. Recipient Customer must agree to be monitored every two years by the FBSJ staff and to periodic unannounced visits as deemed necessary during the agency stated hours of operation. Recipient Customer must attend two mandatory meetings a year. Indemnification Recipient Customer understands that neither the FBSJ nor the primary donor make any warranties or representations as to the purity, quality, or fitness for consumption of any and all items accepted by the Recipient Customer. Recipient Customer hereby warrants that it will hold FBSJ, its employees, Board of Directors and primary donors, harmless for any all claims, lawsuits and damages involving liability arising out of or in connection with, the acceptance and/or distribution of items. Recipient Customer will notify FBSJ whenever it receives notice of any claim of liability with respect to the food/product. Recipient Customer will not offer any of the items it receives from the Food Bank of South Jersey for sale or barter in exchange for money, services or property. This will call for immediate removal of membership with the FBSJ. I certify that the above application is complete and the information is true and correct to the best of my knowledge. I agree to abide by these requirements. I understand that false information on this application may be grounds for non-approval of charity application or termination of charity s participation with the Food Bank of South Jersey. 14

15 Monitoring of Site This phase of the application process gives the Food Bank staff a firsthand look at the charity s program(s) and mode of operation. Site visits are a necessary process because they give the Food Bank an opportunity to meet charity representatives who will be responsible for the day to day operation of your feeding program. Site visits also provide an opportunity to provide technical assistance in the completion of reports required by the Food Bank. Staff has found that although technical assistance was given to the charity and food directors, the people actually involved with the reporting process were unaware of proper procedures and documentation (e.g. UDSA commodities). This process also allows the Food Bank to network with your charity. Staff members have the knowledge of matching like charities together, so that they may network with each other. What does a monitor looks for? 1. The existence of all site(s) or program(s) listed on the application 2. Adequate and appropriate storage for food products received from the Food Bank of South Jersey (dry storage space, refrigerators and freezers) 3. The general cleanliness of the food preparation and storage areas. 4. Existing record keeping procedures and/or systems. 5. Evidence of pest control. Violations Exchanging donated food or other products for money, property, or services. Removal of donated food or other products from the site for private use. Using donated food or other products in a manner that is not related to the exempt purpose of the Food Bank. Delinquent reimbursement of shared maintenance contributions. 15

16 Donated food or other products are improperly stored, refrigerated, or transported. Donated food or other product is improperly stockpiled. Member customer is in violation of any state or local statute, ordinance code, or regulations. Member customer otherwise violates the Basic Agreement between itself and the Food Bank. Procedure A member may be placed on probation for a period not to exceed six months if found to be in violation. Notification must be in writing. The Customer Relations Manager has the authority to place member customers on probation. In any event, the Customer Relations Manager, the Executive Director, and the Board of Directors shall be informed when a member customer is placed on probation. The member customer may appeal its probationary status to the Board of Directors by delivering such appeal, in writing to the Customer Relations Manager. During the probationary period, the member customer is not permitted to utilize the food bank services until such violation is rectified by the end of the probationary period. The Customer Relations Manager shall have the authority to extend the probationary period or to recommend suspension of the member customer. The Member Customer may appeal this decision as previously outlined. 16

17 1501 John Tipton Blvd Pennsauken, NJ Phone (856) Fax: (856) Food Bank of South Jersey, Inc. Agency Agreement Contract & Release Waiver The return of this signed document certifies that the below listed agency has read the Membership manual and agrees to the terms, rules and regulations. I,, from This document is an agreement made between located at and the Food Bank of South Jersey, Inc. located at 1501 John Tipton Blvd., Pennsauken, NJ The Agency agrees to all of the following terms and conditions of this agreement: 1. Requirements: The Customer agrees to abide by the policies, procedures and record keeping requirements of the Food Bank of South Jersey, Inc. 2. IRS Eligibility Requirements: The Customer agrees that it meets the IRS eligibility requirements for receipt, transfer and use of donated products (food and non-food) under section 170(e)(3) (c )(3) or Church /Religious Organization: The Customer agrees that it is incorporated as a 501(c)(3) Non-Profit corporation or a Church as defined by the IRS and meets all of the criteria below for each type of eligible organization. Please check the type of organization that your organization currently falls: 501(c)(3) Non-Profit Corporation Church 3A. The customer agrees that it is incorporated to serve the ill, needy and/or infants. 17

18 3B. The customer agrees that it will distribute product obtained from the Food Bank of South Jersey, Inc. free of charge (monetary, volunteer hours, services or otherwise). 3C. The customer agrees that it will only distribute donated products to recipients who qualify as ill, needy and/or infant as defined in the IRS code section 170(e)3. The customer also agrees that it will not distribute donated products to people who do not qualify to receive the products as defined in the IRS code. 3D. The customer agrees that it will not sell or use products received from the Food Bank of South Jersey, Inc. in exchange for money, other property or services, including using donated products for the purpose of fundraising programs and events. The customer also agrees that it will comply with the restrictions on the use and transfer of donated property, as described in IRS Tax code section 170(e)3 and any amendments to the code. Must NOT sell food, exchange food for service, use food for the purpose of a raffle, or ask for a donation of any kind. (Failure to ignore this will result in three month suspension for the first offence. Second offence your organization will be permanently closed.) 3E. Must notify the Food Bank in writing when program changes locations, director, type or size of food program. 3E. The customer agrees that it will not barter, sell or use for fundraising purposes any donated products obtained from the Food Bank of South Jersey, Inc. 4. Record Keeping: The customer agrees that it will maintain adequate records for 3 years (reports) and accurately reflect the total amount of product received and distributed. The customer also agrees to outline its procedure for determining that the final recipient of the product is ill, needy or infant. 5. Availability of Records: The customer agrees to make its record used to track the receipt and distribution of products obtained from the Food Bank of South Jersey, Inc. with or without notice. 6. Storage and Handling of Product: The customer agrees that it will store, handle, and distribute products consistent with the Federal Food, Drug and Cosmetic Act and any other regulations that follow. 18

19 7. Food Safety: The customer agrees that at least one staff person is or shortly will be trained in food safety from a food safety training course approved by the Food Bank of South Jersey, Inc. The customer also agrees that if it utilizes food from the Food Bank of South Jersey, Inc. to prepare meals that their key food service program provider and facility meet local commercial food safety requirements. 8. Donor Stipulations: The Customer agrees to adhere to additional donor stipulations. 9. As Is Condition: The Customer agrees that it will accept all products received from the Food Bank of South Jersey, Inc. in as is condition. 10. Shared Maintenance: Transportation and Value Added Processing Fees: The Customer agrees to pay any applicable shared maintenance and/or handling fees (value added processing, delivery charges, transportation fees) for the products received from the Food Bank of South Jersey, Inc. 11. Purchased Product: The customer agrees that if it chooses to purchase nondonated product from the Food Bank of South Jersey, Inc. then it may pay extra charges and costs associated with that product. 12. Discrimination: The Customer agrees that it will not engage in discrimination, in the provision of service against a person because of race, color, citizenship, religion, sex, national origin, ancestry, age, and marital status, and disability, sexual orientation including gender identity, unfavorable discharge from the military or status as a protected veteran. Agency may not use food in a manner that would promote a particular creed, faith, or political organizations, or solicit members for such an organization. The feeding program does not have as its primary purpose the advancement of a particular religion. 13. On-Site Inspections: The customer agrees to allow representatives of the Food Bank of South Jersey, Inc. donors and governments agencies to inspect and audit all facilities and vehicles used to receive, store and distribute product received with or without notice. 14. Authorized Agent: The customer agrees to assign authorized customer representatives (shoppers) to order, pick up and/or sign for product from the 19

20 Food Bank of South Jersey, Inc. and notify the Food bank in writing when changes to the listing of authorized representative s changes. 15. Liability Release: The located at hereby affirm that the original donor, the Food Bank of South Jersey, Inc., and Feeding America: Initial each box. Are released by the customer from any liabilities resulting from the donated goods. Are held harmless from any claims or obligations in regard to the customer or the donated goods. Offer no express warranties in relation to the gift of goods. 16. Active/Inactive Customer Designation: The customer agrees that it will obtain products from the Food Bank of South Jersey, Inc. at least every three months (90 days) and be open for a minimum of 4 hours every month (30 days) to be deemed and active agency. If the agency becomes inactive, then the agency will not be allowed to obtain products from the Food Bank of South Jersey, Inc. until the customer has completed the application process again and reinstated as an active agency. 17. Termination of Customer Agreement: The Customer or the Food Bank of South Jersey, Inc. can terminate this agreement, with or without cause, at anytime in writing. 18. Multiple Location: The customer agrees that it will only receive and store product from the Food Bank of South Jersey, Inc at multiple locations if: All locations individually meet the requirements of this agreement All location have been inspected and approved by the Food Bank of South Jersey, Inc. prior to receiving food. Must be sure all products received from the Food Bank of South Jersey are stored at the location noted on the application. Food Can Not Be Stored In a Private Home. If food is stored in a private home we will cancel your membership with the FBSJ. Must NOT share with other programs without written permission from the Food Bank of South Jersey. 20

21 19. Food Bank of South Jersey Handbook: The customer agrees that it has received and will abide by the rules, regulations and guidelines at all times set forth by the Food Bank of South Jersey, Inc. 20. The below signed customer recognized that membership is a privilege, that membership can and will be revoked should any information contained within this application be found untrue, that membership can and will be revoked should any terms of this or any other agreement be violated. In accordance with Federal law and U.S. Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, or disability. (Not all prohibited bases apply to all programs.)to file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 1400 Independence Avenue, SW, Washington, DC or call (202) (voice and TDD). USDA is an equal opportunity provider and employer. The Customer s authorized representative s signature below confirms that the Customer is accepting and agrees to abide by all terms of this agreement. Customer Signature: (Must be signed by the highest authority in the organization) Date: (Print name of representative who signed this agreement) Customer Coordinator Signature: (Must be signed by the person responsible for the implementation of the program) Date: Print name of representative Food Bank of South Jersey Representative: Date 21

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