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Partner Organization Application Form

Thank you for your interest in becoming a partner with the Redwood Empire Food Bank. Please fill out the application form below. If you have any questions in the meantime, please don’t hesitate to reach out to Kim Caffrey at kcaffrey@refb.org. We look forward to hearing from you!

Application Document Checklist

❏    Copy of your organization’s IRS 501(c)(3) supporting documents

❏    Copy of linkage documents if your organization’s address is not the actual distribution address

❏    Copy of your current Board of Directors

❏    Partner Organization Application and Agreement, Program Application (via electronic form below, or if you prefer, you may download a PDF form here)

❏    Copy of Food Handler Certificate/Card for onsite Food Program Lead

❏    You may ​scan/email​ documents to kcaffrey@refb.org, ​fax​ to (707) 523-7901, or ​mail​ to 3990 Brickway Blvd., Santa Rosa, CA 95403, Attn: Kim Caffrey

 

Primary Information
Country
Address Line 1
City
State
Postal Code
Staff and/or Volunteer Information
First Name
Last Name
First Name
Last Name
Country
Address Line 1
City
State
Postal Code
Partner Organization Agreement
  • View Agreement

    By applying to utilize the services of the Redwood Empire Food Bank, the Partner Organization agrees to abide by the following Redwood Empire Food Bank policies:

    1. The Partner Organization agrees that it meets the IRS eligibility requirements for receipt, transfer and use of donated food under section 170(c)(3). The Partner Organization certifies that it is an established, federally tax exempt 501(c)(3) organization, or wholly-owned by a 501(c)(3) organization or an established church; and it must be incorporated for the purpose of serving the ill, needy or infants (minor children).
    2. The Partner Organization may not be a private foundation, even if it has a 501(c)(3) exemption.
    3. The Partner Organization agrees that if its 501(c)(3) status is revoked or expires, the Partner Organization will stop distributing Redwood Empire Food Bank products and will notify the Redwood Empire Food Bank immediately.
    4. The Partner Organization is required to inform the Redwood Empire Food Bank, without being requested, of all changes to its programs, on either Agency letterhead or via company branded email from the Program’s Main Contact, regarding ALL of the following:
      • Changes in Agency shopper(s), Main Contact for program, On-sight Program Lead, Executive Director/Chief Executive Officer, Recall contacts, or billing contact.
      • Change in location, days, or hours of site distributions, telephone numbers or emails, mailing address, and/or billing address.
      • New food programs the Partner Organization wishes to implement and food programs the Partner Organization plans to discontinue. Failure to provide changes may result in suspension of privileges.
    5. The Partner Organization certifies 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.
    6. The Partner Organization certifies that it will not collect or exchange fees, donations or services of any kind for products received from the Redwood Empire Food Bank.
    7. The Partner Organization certifies that it agrees to distribute Redwood Empire Food Bank food prior to scheduled activities, and will not require client participation, including religious services, in order to receive food.
    8. The Partner Organization certifies that it will not use Redwood Empire Food Bank products for fundraising of any kind. Donation cans are not permitted within the area of food distributions, whether the food is from the Redwood Empire Food Bank or not.
    9. Partner Organizations may not share, trade, barter, or redistribute Redwood Empire Food Bank products with other Partner Organizations.
    10. The Partner Organization agrees to pay charges based on standard Net 30 days terms. Failure to do so may result in suspension of ordering ability or termination of membership. No personal checks.
    11. The Partner Organization agrees to regular inspections, both scheduled and unscheduled, as well as monitoring every two years by the Redwood Empire Food Bank as required by our affiliation with Feeding America.
    12. The Partner Organization agrees that a key food program staff member will maintain a current CA Food Handler Card or certificate, a copy of which must be provided for Redwood Empire Food Bank files.
    13. The Partner Organization agrees that it will only distribute Redwood Empire Food Bank products to programs or individuals residing in their own county of Sonoma, Lake, Mendocino, Humboldt, or Del Norte Counties, unless otherwise stipulated and approved.
    14. All items shall be accepted in “as is” condition.
    15. The Partner Organization must properly store, refrigerate and handle (in accordance with appropriate Federal, State and local health regulations) Redwood Empire Food Bank products to ensure that these products remain in good condition from the point they are accepted from the Redwood Empire Food Bank until distributed by the Organization, including required temperature controlled transport.
    16. The Partner Organization agrees to complete and return Redwood Empire Food Bank surveys and other requested information in the allotted time.
    17. The Partner Organization agrees to use Redwood Empire Food Bank products only in a manner relating to the expressed mission and tax-exempt status of the Organization’s food program. No personal shopping is permitted.
    18. The Partner Organization certifies that it will abide by federal, state and local law, including all applicable statutes and regulations; and will adhere to additional donor stipulations.
    19. Partner Organization must maintain a file of all food bank receipts for 1 year, either digitally or by hard copies.
    20. Partner Organizations may not collect Social Security numbers, copy IDs or gather any other sensitive information.

    The Partner Organization recognizes that all Redwood Empire Food Bank donations are accepted under the legislative guidelines as outlined in the Bill Emerson Good Samaritan Food Donation Act of 1996 which states that: “A non-profit organization shall not be subject to civil or criminal liability arising from the nature, age, packaging, or condition of apparently wholesome food or an apparently fit grocery product that the non-profit organization received as a donation in good faith from a person or gleaner for ultimate distribution to needy individuals.”

    By signing this agreement, the Partner Organization agrees to waive any and all rights it may have in relationship to liability on the part of the Redwood Empire Food Bank, Feeding America and the original donor, for the quality and edible nature of the food it has received from the Redwood Empire Food Bank. Also, the Redwood Empire Food Bank, Feeding America and the original donor will be held harmless from any claims or obligations in regard to the Partner Organization or the donated goods; and the aforementioned will offer no express warranties in relation to the gift of goods.

    I, the undersigned, have read, reviewed, understand and agree to the Redwood Empire Food Bank policies as described above. I understand a violation or a loss of confidence on the part of the Redwood Empire Food Bank that the policies or conditions of this agreement are being adhered to may result in the loss of Redwood Empire Food Bank privileges. I understand that this agreement is voluntary and either party may terminate the agreement by notifying the other party.

I have read and agree to abide by the policies of this agreement.
Program Application
Country
Address Line 1
City
State
Postal Code
What is the main focus of this program?
If more than 1, please enter priority below
Check all applicable sub focuses of this program
If other, please describe below
First Name
Last Name
First Name
Last Name
First Name
Last Name

Service Information 

Distribution Programs

Do you deliver food?

Kitchen/Meal Programs (Meals prepared/cooked, distinguished from snacks) 

Which meals do you serve?

Referral Information – Pantries and Meal Programs only
Is this site open to anyone?
May the Redwood Empire Food Bank refer people to your program?
Do you require people to call ahead of time?
Do you require any documentation to receive food?
If yes, check documents you require
(describe)

Health Certificate/License for Kitchens, Meal Programs, Centers, etc.
Are you required to have a Health Certificate or License?

Statistics – ​per Month 
What percent of people served fall into the following categories?

(Each section should equal 100%. A guestimation is accepted.) 

Ages
Ages 0–5
Ages 6–18
Ages 19–59
Ages 60+
Gender
Male
Female
They
Disabilities
Physical
Psychiatric
Developmental

Client Qualification

What client qualifications are required to participate?

Income Based
Age
Disability
Other
None

List all Authorized Shoppers – Maximum of 8 per program 

It is ​very​ important that you keep Shoppers current as your Organization is  responsible for invoices shopped by people currently authorized to do so.

First Name
Last Name
First Name
Last Name
First Name
Last Name
First Name
Last Name
First Name
Last Name
First Name
Last Name
First Name
Last Name
First Name
Last Name

Sources of Food by % 

Please guesstimate percentages you obtain from each resource listed below. If Costco, Raley’s, Save Mart, Smart & Final, Sprouts, Target, or Walmart—please state which exact location for each store, ie: 10% Target/Coddingtown. Please aim for a 100% total. 


I confirm that all information listed above is true to the best of my knowledge.
First Name
Last Name
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