May 2010 Nutrition Reporting
COUNTY OF SAN DIEGO - AGING & INDEPENDENCE SERVICES
P.O. BOX 23217, SAN DIEGO, CA, 92193-3217
NUTRITION PROGRAM
AMERICANREINVESTMENTANDREDISTRIBUTIONCLAIMFORM
Invoice
#
1035
-ARRA
Contractor:Contract #:
Encinitas Senior Nutrition513851
Address: Month/Year:
1140 Oakcrest Park Dr.May-10
Encinitas, CA 92024
Telephone: Prepared by:
760-943-2251Christie Goodsell
Fixed
Funding# of MEALS
Service
Monthly TotalYearly Total
Supplemental
Sourceprovided
Rate $
Recovery Act
Congregate Meals
715
$0.70$500.50 $4,159.71
2009 - C1
Recovery Act
Home-Delivered Meals
$0.50$0.00
2009 - C2
$500.50 $4,159.71
TOTAL
CERTIFICATION STATEMENT ~ :
Please sign and date below
I certify that the above deliverables and/or services were delivered and/or performed specifically for this contract in accordance
with the terms and conditions set forth herein.
Title
Authorized Signature
Date
AIS FY 09/10Page 2