22 CAR pt. 5, Appendix A
22 CAR pt. 5, Appendix A. Vendor Operating Procedures Forms
Length: 13,446 wordsOfficial source
A-0
Appendix
Procedures.
VFP Purchasing/Invoice Processing/Payments 3/5/18
PROCEDURES:
A.
All original invoices are to be forwarded to the following address unless
instructed otherwise:
Vending Facility Program
P.O. Box 3237, Little Rock, Arkansas 72203
Prepayment for Goods and Services is not allowed. Credit card payments for
orders/products over the phone or by mail/internet will not be paid until
services/goods are received and processed by VFP staff on VFP 23 CC form.
B.
Invoicing Requirements:
1.
An original invoice. Only “official” invoices prepared by the vendor will be
accepted.
2.
Products of facsimile (FAX) transmission, copier, or “cut and paste”
invoices, and signed facsimiles or copies of invoices are NOT considered
valid original invoices.
3.
A document submitted as an invoice must meet the following
requirements:
a.
The business name and address is required on original invoices.
b.
If the name and address of the business firm is not printed on the
invoice, but has been placed on it by rubber stamp, typewriter,
computer, or in ink, the original and all copies of the invoice must be
signed manually by an authorized agent of the business firm and must
include the agent’s official title with the vendor.
c.
All handwritten invoices including invoices with letterhead which are
handwritten must be signed manually by an authorized agent of the
business firm and must include the agent’s official title with the
vendor.
d.
All invoices submitted to VFP Account Payables must include a VFP
Purchase Verification/Purchase Order (form VFP 23, VFP# and/or PO #
can serve as the same) with signatures from the VFP Specialist and
Administrator, approving payments of invoices must have the word
“APPROVAL or Approved to Pay”, a legible signature and complete full
name of the person approving the invoices for payment. Only the VFP
Administrator and VFP Specialist can approve payment. The VFP
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Accountant is not allowed to approve payments. Only the VFP
Accountant
or
designated
back
up
of
DSB
Administrative
Specialist/Assistant can draft and process checks for payment. The
VFP Administrator and VFP Specialist cannot draft or process checks.
e.
All invoices must be billed to the VFP.
f.
The invoice must have a complete description of the goods or services
being billed. Do not use abbreviations (such as “P/R” or “cont.”).
These are not standardized and may cause delays in the payment
process due to invoices being returned for clarification purposes.
g.
Invoices for services must have the date(s) of service.
h.
All invoices are required to have an invoice date.
i.
The invoice must have the unit price and number of units billed or the
lump sum price being billed. The invoice must also include the total
amount billed. The information on the invoice must agree with the
terms of the applicable bid/contract or purchase order.
4.
If two or more names, corporate entities and/or addresses are printed on
the invoice, the letterhead used for invoices must be that specifically of the
payee, matching the applicable W-9 and vendor file.
5.
For invoices with multiple pages, each page must adhere to the
requirements listed above. The pages must be numbered in successive
order.
VFP Invoice processing checklist, as of 3/5/18.
Invoice Requirements for processing and payment:
• Invoice number
• Date
• Providers Information/address
• Must be billed to VFP
• Description of goods/services
• Dates of services
• Units/items and cost
• Total cost billed
• If multiple pages, pages are to be numbered and reference original invoice number
• Signed by authorized provider and title
C.
Receipting and approving requirements are as follows:
1.
All invoices submitted for goods or services authorized by VFP Bid or VFP
Purchase Verification/Order must be received and approved by the
appropriate staff of the VFP on the VFP Purchase Verification/Purchase
Order (form VFP 23, VFP# and/or PO # can serve as the same) before
payment can be made. The receiving of proof on form VFP 23 must be
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completed as proof of receipt of goods purchased and services rendered.
2.
All invoices not associated with a VFP Purchase Verification/Purchase Order
(form VFP 23, VFP# and/or PO # can serve as the same), excluding
commissions/payroll, must be received and approved by the VFP staff or
designee. The words, “Approved for Payment or Approved to Pay”, a full
and legible signature (initials are not acceptable), and the date of approval
should be written on the invoice/document submitted for payment.
Procedures for Authority to Use VFP Credit Card – Form VFP 23-CC
1.
Approval for use of all credit cards rests with the VFP Administrator. The
cards will be kept by the VFP Accountant in a secure place, accessible to
accountant only. VFP Staff must request approval in writing to the VFP
Administrator for use of a card. VFP Specialist must write a request with
details of the purchase on form VFP 23CC. Requests shall state:
a.
Purpose, intended use of card
b.
Number and type of cards
c.
Details- Date of request, Provider, Goods to purchase, and Price.
d.
Justification
2.
The VFP Accountant will sign out and issue credit cards to staff; and will be
on a trip-by-trip basis unless the employee is required to travel on a weekly
basis. All credit card issues will be signed for by the traveling employee
and a permanent record maintained for all credit card issues. VFP
Accountant will maintain record and cards. VFP Administrator will approve
use of card and then forward approved request to the VFP Accountant to
obtain card to be used for purchase by staff.
3.
A credit card receipt signed by the employee concerned must support all
charges. When a billing is received, the charges will be reviewed and
validated against signed credit card receipts, by the VFP Accountant. A
copy of all credit card receipts will be attached to a copy of the billing and
permanently filed in the office for audit purposes. All of the supporting
documentation (e.g., receipts and purchase approvals) must be returned to
the VFP Accountant, by user. VFP Accountant will sign in the returned
credit card.
The payment process begins when VFP Accountant receives the invoice and
all necessary supporting documentation on form VFP 23CC.
4.
All of the supporting documentation (e.g., receipts and purchase
approvals) must be returned to the VFP Accountant.
5.
The cardholder statement(s) for the billing period.
6.
VFP Accountant processes payment.
See attached documents:
A-3
VFP 23
VFP 23-CC
DHS Division of Services for the Blind VFP 23
Vending Facility Program
VFP Purchase Verification/Purchase Order
The following goods or services have been provided and payment is approved for:
VFP # ________, PO #_____________ Credit Card Purchase Yes No
Description: ________________________________________________________
This work falls in the following category of:
Repairs/maintenance of equipment ________________________________
New equipment #'s ________________________________________________
VFP Account #_________ Invoice/acct. #_____________
VFP Account #_________ Invoice/acct. #_____________
Pay to: ______________________________ Cost: $________________________
APPROVED FOR PAYMENT AND GOODS/SERVICES RECEIVED
Date _________ Signed _________________________ VFP Specialist
Date _________ Signed __________________________VFP Administrator
Paid by check No. _____________ Date: _________________________
DHS Division of Services for the Blind VFP 23CC
Vending Facility Program
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VFP Credit Card Purchase Verification/Purchase Order
I, ________________________, requests use of the VFP credit card to purchase/order the
following goods/items:
Purpose/Description: ________________________________________________________
Card #______________________ (last 4) TYPE: VISA Home Depot
Details:
Date: ________________________
Provider: _______________________
Goods/Items: _______________________________________________________________
Price: __________________________________________
Justification: ________________________________________________________________
On-line purchase
Special order
VFP # ________
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxx
APPROVED FOR PAYMENT AND GOODS/SERVICES RECEIVED
Date _________ Signed _________________________ VFP Specialist
Date _________ Signed __________________________VFP Administrator
VFP ASSET POLICY
7/20/18
I.
Purpose
This policy establishes a uniform Capital Asset System for VFP.
II.
Responsibility
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VFP accounting shall keep and maintain a record of all property belonging to the VFP.
VFP will maintain a perpetual inventory of assets on the computers assigned to VFP.
III.
Policy
(a)
A “capital asset” is defined as real, personal or intangible property that has a value equal to
or greater than the capitalization threshold (detailed below) and has an estimated life of
greater than one year. Assets include any item purchase with VFP funds from SA, SP, or
SP302 accounting codes.
(
1
)
A
s
s
e
t
s
t
h
a
t
a
r
e
easily susceptible to pilferage shall also be included in either Low Value Equipment
or Low Value High Risk Equipment depending on value.
(2)
“Equipment – Low Value Collective” consists of groupings of smaller like items that
would not individually meet the equipment threshold of $2,500.00 per item required for
the Equipment – Low Value class.
(3) All items of a purchase price over $500.00, as listed above, must be tagged by VFP staff
and assigned an inventory number specific to VFP- see “blue tags” for assignment.
Once tagged, items must be listed on assigned VFP location and inventoried annually by
managers and/or staff.
Equipment
(c)
Equipment is defined as fixed or movable tangible assets to be used for operations with an
acquisition cost or fair market value at time of acquisition of $500 or greater with an expected
useful life of greater than one year. Acquisition costs consist of cost of the item, sales tax,
freight or shipping cost, and installation for the item.
Asset Class
Threshold
Land
Capitalize All
Land Improvements
$5,000
Easements
Capitalize All
Buildings/Building Improvements
$100,000
Leasehold Improvements
$5,000
Equipment
$5,000
Equipment – Low Value
$ 2,500 - $ 4,999.99
Equipment – Low Value High Risk
$500 - $2,499.99
Equipment – Low Value Collective
(See note below)
Works of Art/Historical Treasures
$5,000
Works of Art/Historical Treasures – Low Value
$0 - $4,999.99
Library Holdings
Capitalize All
Other Tangible/Intangible Assets
$5,000
Other Tangible/Intangible Assets – Low Value
$2,500 - $4,999.99
Internally Generated Software
$1,000,000
Infrastructure
$5,000
Capital Leases
$5,000
Asset under Construction
Not Applicable
A-6
(1)
Costs of extended warranties and/or maintenance agreements which can be separately
identified from the cost of the equipment should not be capitalized.
Equipment – Low Value and Low Value High Risk
(d)
Equipment – low value asset class will be utilized for tracking equipment with a useful life
of one year or more and an initial value of at least $500 but not more than $4,999.99.
Assets under $2,500.00 may be expensed unless the asset is easily susceptible to pilferage
and those items must be recorded in the Equipment –Low Value High Risk category: $500
- $2,499.99. This asset class is only used for tracking purposes and not for the
capitalization of equipment.
6.
Depreciation
7.
8.
(a)
Generally Accepted Accounting Principles require capital assets to be reported
and depreciated over their estimated useful life in the government-wide financial
statements. Capital assets that are inexhaustible are not depreciated.
9.
(b)
The purpose of depreciation is to spread the cost of the asset over the asset’s economic
life. The straight-line depreciation method will be used to calculate depreciation.
Asset Retirement/Deactivation
(a)
The VFP accountant will retire/deactivate assets (capital & low-value) when provided
documentation by staff in form of email listing the asset number, location, and reason for
removal form the inventory listing. The documentation must be retained for audit
purposes.
(b)
Documentation required for retirement/deactivation:
(1)
Assets that have been lost, stolen or destroyed require:
(2)
DHS Form 1036, Missing Asset Investigation Report, to include police report for
stolen items, if applicable and timely. Assets that have been traded-in for another
asset require an email of explanation attached to retirement documents of the
asset.
VENDING FACILITY PROGRAM OPERATING PROCEDURES
OFFICE MANUAL
APPENDIX A
Page
A-7
●
Set-Aside Schedule
A- 1
●
VFP-1
Employee Time Sheet (Extra Help Payroll)
A- 2
●
VFP-1a
Receipt of Checks for (date)
A- 5
VFP-2
Cash Report
A- 6
●
VFP-3
Leave Form
A- 7
VFP-4
Narrative
A- 9
●
VFP-5
Inventory Form
A-10
●
VFP-6
Weekly Sales Report
A-13
VFP-7
Equipment Transfer and Inventory Control
A-15
VFP-8
Temporary Extra Help Agreement
A-16
VFP-9
Draw Payroll Worksheet
A-18
●
VFP-10
Four Week Report
A-21
●
VFP-11
Employment Application, Vending Facility Program
A-22
VFP-12
Vendor Payroll Control Sheet
A-25
VFP-13
Late Reports for Vending Facility Program Stands
A-26
VFP-14
Contract for new/remodel location
A-27
VFP-14a
Contract for moving a location
A-30
VFP-15
Vending Machine Contract
A-33
VFP-16
VFP Evaluation/Training Policy Form
A-35
●
VFP-17
Vendor Evaluation (DSB-8002)
A-39
VFP-18
Site Survey Form
A-45
VFP-19
Statement of Liability
A-47
VFP-20
Closed Location Memo
A-48
VFP-22
Training Statement of Account
A-50
VFP-23
Purchase Verification
A-51
VFP-24
Training Progress Report
A-52
●
VFP-25
Vendor Operating Agreement
A-54
VFP-26
Vending Stand Trainee - Progress Report
A-58
VFP-27
VFP Application for Evaluation and Training
A-60
●
VFP-28
Receipt for Petty Cash Funds
A-63
●
VFP-29
Trainer Agreement
A-64
●
VFP-30
Management Service Contract
A-65
●
Retirement Contribution List
A-66
VFP-31
Certification for Vending Facility Program
Management Training
A-67
VFP-32
VOP Manual Receipt
A-68
VFP-33
Check Pickup Authorization
A-69
VFP-34
Stand Losses From Burglary/Theft
A-71
VFP-35
VF Key Checkout Form
A-72
VFP-36
Remodeling/Construction Inspection Report
A-73
VFP-37
Miscellaneous Cash Receipts
A-74
VFP-38
Data Entry Form
A-75
Agreement for State Property
A-76
● - These forms are in the Vendor Operating Procedures Manual.
A-8
Set-Aside Schedule
1. A uniform set-aside charge of 11% will be levied against the net
proceeds of each licensed vendor. This charge will be made against
the net proceeds for each four-week period. However, if a vendor's net
profit is less than $470.00 in a four week period, no set-aside charge
will be levied for that period. Effective January 4, 2002, the set-aside
charge will change to 11%.
2. The fair minimum guarantee to all operators is $400.00 per four-week
period.
3. If the set-aside schedule produces more revenue than is required to
meet expenditures from set-aside funds during the next year, there will
be a pro rata distribution of excess funds or a reduction in the set-aside
charge for the ensuing year, at the election of the Committee of
Licensed Blind Vendors.
A-9
Employee Time Sheet
VFP-1
The extra-help payroll is calculated by the Accounting Department and
produced each two weeks. The extra-help payroll schedule dates are
covered on the payroll schedule you receive yearly. It is necessary that all
information on extra-help employees be received by the Accounting
Department no later than the Monday of the week following the close of
the two week period. The VFP-1 form must be completed for each extra-
help employee for each two week period or any portion thereof that is
worked. The VFP-1 form will be completed by the Vending Facility
Program Specialist from information supplied by the vendor. Instructions
for completing the VFP-1 are as follows:
FRONT SIDE
Name of Employee - Extra-help employee's name - must be completed.
VFP#, VFP Manager's Name - Number of the location where employee
was employed. If employee worked in more than one location during the
two weeks, a form must be completed for each location with applicable
time shown for each location.
SA, SP, SP-302 - Check which payroll the extra help is to be paid from -
must be completed.
Vacation, Sick, Admin. - Check where appropriate for the type of leave.
Rate of Pay - Enter agreed upon rate of pay. Must be completed.
Payroll Dates - Enter payroll dates, beginning and ending.
Day Worked Section - Enter regular and overtime hours worked for each
day of the pay period.
Total Hours - Total number of hours for regular and overtime.
Comments - When leave is checked, include explanation here. Also, any
instructions or comments affecting the payroll including pay rate changes.
VFP Specialist - Signature of Vending Facility Program Specialist.
Date - Date form is completed.
A-10
VFP-1
VENDING FACILITY PROGRAM
EMPLOYEE TIME SHEET
Name of Employee _______________________________________________________
VFP Manager's Name _____________________________________________________
Location Number __________
PAYROLL DATES: From _____________________ Through _____________________
RATE OF PAY __________ Rate changed, check here _______
SA _____
SP - 302 Sick _____ Vacation _____ Agency Business ____
SP _____
DAY WORKED
REG. HRS.
O.T. HRS.
FRI
SAT
MON
TUE
WED
THU
FRI
SAT
MON
TUE
WED
THU
TOTAL REGULAR HOURS ______________ TOTAL OVER TIME HOURS___________
COMMENTS: ____________________________________________________________
__________________________________________________________________________________
__________________________________________________________
__________________________ VFP SPECIALIST
A-11
__________________________ DATE
VFP-1a
Vending Facility Program
Receipt of Checks for _________________________
Name
Amount
Name
Amount
A-12
VFP-2
VENDING FACILITY PROGRAM
CASH REPORT
DEPOSIT # ___________ PERIOD #_____ DATE __________________
ACCOUNTS RECEIVABLE
MERCHANDISE
STAND
#
DEPOSIT
ACCOUNTS RECEIVABLE
MERCHANDISE
STAND #
DEPOSIT
1
2
54
55
3
4
56
57
5
6
58
59
7
8
60
61
9
10
62
63
11
12
64
65
13
14
66
67
15
16
70
69
17
18
70
71
19
20
72
73
21
22
74
75
23
24
76
77
25
26
78
79
27
28
80
81
29
30
82
83
31
32
84
85
33
34
86
87
35
36
88
89
37
38
90
91
39
40
92
93
41
42
94
95
43
44
96
97
45
46
98
99
47
48
100
101
49
50
102
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51
52
53
TOTAL
Leave Form
Refer to Leave Policies in Section 6.
This form will be completed by the Vending Facility Program Specialist
when the vendor reports payroll and non-essential leave. The specialist
will turn the form in to bookkeeping with the payroll form. The leave will
then be entered on the vendor's leave record and a copy mailed to the
vendor. A leave printout will be mailed to the vendor quarterly, unless
the vendor requests a printout sooner.
* VFP Staff.
This form is to be used for full days or half days only. Do not put hours
in the space for leave days. On the line for month, day, year; the space
for hour does not need to be completed unless the leave is for part of a
day. If the specialist wants to use the same form for two or more days
that has days in between that are not leave days, the comment section
of the form should be used to list the days that are leave days. If more
than one type of leave is used on the form, then the days for each type
of leave must be written and the type of leave that applies to them.
A-14
VFP-3
12/93
VENDING FACILITY PROGRAM
700 Main St., P.O. Box 3237
Little Rock, AR 72203
LEAVE FORM
____________________________________________, took _____ leave days from
(Vendor's Name)
_______ _______ ________ to _______ _______ ________ for
Month DAY YEAR Month DAY YEAR
_______________________________ ______
Vending Facility Location Number
This leave is to be charged to:
Annual (vacation) Leave .................... ___
Sick Leave .......................................... ___
Extended Sick Leave .......................... ___
Funeral (sick) Leave ............................ ___
Immediate Family Illness (sick leave) ___
Maternity (sick leave) ......................... ___
Agency Business Leave ..................... ___
Non-essential Leave ........................... ___
Date _____________ ___________________________________
Specialist's Signature
Comments: ______________________________________________________________
________________________________________________________________________
________________________________________________________________________
A-15
________________________________________________________________________
________________________________________________________________________
A-16
VFP-4
6/1/84
Narratives
Vending Facility Program
VFP # ____________ Location ________________________________________
________________________________________
Vending Facility Manager: ______________________________________________
Vending Facility Specialist: _____________________________________________
Date _____________
_____________
A-17
Inventory - VFP-5
This form is completed by the Vending Facility Specialist when a vendor is
assigned or leaves a facility or may be done at the discretion of the
Vending Facility Program. Copies of each original inventory sheet should
be made and distributed as follows:
1 copy to Bookkeeping Section
1 copy for Office file
1 copy to be returned to the vendor
The original copy of the inventory sheet will be signed by the vendor.
All items of merchandise must be inventoried to determine the amount on
hand. The description should include the item's name, size (if applicable)
and count (per normal purchase unit or actual count). The Unit Wholesale
Price should be the amount that the vendor paid per normal purchase
unit. The Total Value should be the number of items or purchase units
times the value per item or purchase unit. The information provided on
this form determines the vendor's inventory gain or loss (if any) while
operating the enterprise.
If a facility is closed after an inventory is taken, the remaining inventory
may be disbursed as follows:
1. Returned to supplier for check or money order.
2. Sold to other facilities that can either have the merchandise added
to their initial inventory or pay for it.
3. Sold to customers.
A-18
All funds and inventory adjustments are to be forwarded to bookkeeping.
All outdated and spoiled merchandise will be disposed of and an accurate
count of disposed merchandise given to bookkeeping. All merchandise of
a closed location must be depleted and accounted for.
Merchandise which is out of date, spoiled, or which cannot be sold
according to public health regulations will not be counted on the
inventory of the outgoing or incoming vendor.
Inventories should be recorded so that the amount listed in the "Units on
Hand" column multiplied by the "Unit Wholesale Price" column equals the
"Total Value".
When the "Units on Hand" do not equal an exact "Unit Wholesale Price",
the "Units on Hand" should be listed as a fraction. See example below:
Units on Hand Description
Unit Wholesale Price Total Value
5/20
Wrigley Gum
$1.90
.48
The preceding is the proper way to list an item that comes in a box of 20
at a price of $1.90 per box when there are only 5 of 20 items on hand.
If there were 30 items when a box of 20 had a price of $1.90 per box, the
"Units on Hand" column should be shown as follows:
Units on Hand Description
Unit Wholesale Price Total Value
30/20
Wrigley Gum
$1.90
$2.85
or could be shown:
Units on Hand Description
Unit Wholesale Price Total Value
1 10/20
Wrigley Gum
$1.90
$2.85
A-19
Routing of Forms:
Bookkeeping
Vendor
Specialist
VFP-5
6/1/84
ARKANSAS VENDING FACILITY PROGRAM
700 Main St., P.O. Box 3237
Little Rock, AR 72203
Inventory Stand No. __________________
For Period Ending ____________________
Units
On Hand
Description of Merchandise
Unit
Selling
Price
Total
Value
$ ¢
A-20
Vendor’s Signature _______________________________________ Total _____________
Date: _________________
A-21
Weekly Sales Report
Complete the dates, beginning and ending, for which the report is
submitted.
Name - Name of the Vendor who is submitting the report and the Number
of the location.
1. Cash Beginning of Day - Record the amount of cash at the beginning of
each day. On Friday, the amount recorded should be the amount of
petty cash. The amount recorded Monday through Thursday should
be equal to item 5. (cash at end of day) for the previous day.
2. Supplies/Operating Expense - Record the amount spent for
supplies/operating expense during the day. This amount should agree
with the total cash paid-out receipts for supplies/operating expense for
the day. Supplies/operating expenses are those items such as cups,
lids, bowls, straws, napkins, stir sticks, cleaning supplies, postage,
janitorial services, telephone calls, etc., which are not directly sold to
customers.
3. Total Purchase of Stock - Record the total amount spent for stock for
resale. This amount should agree with cash paid-out receipts for stock
for the day.
4. Total Cash Paid Out - Add items 2, and 3.
5. Cash At End Of Day - Count the cash at the end of the day and record
this amount in item 5.
6. Sales - Add items 4 and 5 and subtract item 1. This is the amount of
sales for the day.
Total for the Week
1. Do not total item 1.
2. Add item 2 across and record the total under Total for the Week.
3. Add item 3 across and record the total under Total for the Week.
4. Add item 4 across and record the total under Total for the Week.
5. Deposit - The amount recorded for deposit should be equal to the
amount of cash at the end of the day on Thursday less the amount of
petty cash (the amount recorded in item 1 for the previous Friday).
A-22
6. Add item 6 across and record the total under Total for the Week. This
amount should be equal to the sum of items 4 and 5. Credit card funds
must be included from the card company statements and supporting
documents.
A-23
VFP-6
8/18
DIVISION OF SERVICES FOR THE BLIND
VENDING FACILITY PROGRAM
Weekly Sales Report of Manager
FROM ___________________________ TO ____________________________________
VENDOR ______________________________________________ STAND NO. ________
FRI.
MON.
TUES.
WED.
THURS.
TOTAL
FOR
WEEK
1. Cash
Beginning
Of Day
2. Supplies/
Operating
Expense
3. Total
Purchase
Of Stock
4. Total Cash
Paid Out
2 + 3
5. Cash At
End Of
Day
Credit Card
Funds
Total Deposit
Deposit
6. Sales
4 + 5 - 1
DSB-8000 (10/87)
A-24
VFP-7
10/85
Revised
DIVISION OF SERVICES FOR THE BLIND
Vending Facility Program
EQUIPMENT TRANSFER AND INVENTORY CONTROL FORM
Inventory Number: ______________________________________________________
Description: __________________________________________________________
__________________________________________________________
__________________________________________________________
□ Delete item from inventory.
□ Transfer item as shown.
□ Add item to inventory - new.
Date of Acquisition ____________________________________________________
Cost of Acquisition ____________________________________________________
Fund Code _________________________ 1 Set Aside
_________________________ 2 State-Federal
_________________________ 3 Special Programs
Transferred From: ____ _________________________________________
VFP# Location
Transferred To: ____ _________________________________________
VFP# Location
COMMENTS: _____________________________________________________________
________________________________________________________________________
________________________________________________________________________
A-25
Date: _____________________________ __________________________________
Specialist
A-26
VFP-8
TEMPORARY EXTRA HELP EMPLOYMENT AGREEMENT
I, ___________________________________, understand that I am a
(type or print)
temporary employee for the Vending Facility Program and do not have the same
rights and remedies as a person who has been granted a license to operate a vending
facility within the Vending Facility Program. I further understand that a person who
has been licensed to operate a vending facility has first priority to this location and I
further understand that I may be relieved from duties at any time. I additionally agree
to abide by and comply with the following policies and understand that failure to
comply with one or more of these policies will result in my termination as an
employee.
1. The vending facility shall be opened and closed and operated within the
prescribed hours as presented by the blind vendor or Vending Facility Program
Specialist. Any deviation from these assigned hours will require permission from
the Vending Facility Program office.
2. Under no circumstances will cash be removed from the vending facility for
personal use and then returned at a later date. Only stock, merchandise, or other
materials as approved by the Vending Facility Program Specialist may be
purchased and a cash receipt for the purchase of such items shall be placed in the
facility cash drawer.
3. If a weekly sales report is submitted to the Vending Facility Program office, no
cash shall be sent through the mail or brought to the Vending Facility Program
office. Only a check or money order will be accepted. Money order fees may be
included as a part of the operating expense of the location and shall be included
as part of the weekly sales tickets and listed as a miscellaneous operating expense
on the weekly sales report.
4. Unless otherwise stipulated by the Vending Facility Program Specialist or licensed
blind vendor assigned to the location, temporary extra help will file weekly sales
reports in accordance with Vending Facility Program policies and procedures.
5. Vending Facility Program policies and procedures will be followed in the operation
of the location. Any questions or doubts should be directed to the Vending Facility
Program Specialist as soon as possible regarding policy questions.
6. No family members or other persons shall be allowed access to the vending
facility's cash receipts or to any other secured area of the vending facility.
Additionally, family members are not allowed to loiter or remain at the location.
7. Under no circumstances shall another person be contacted to operate the location
in the absence of the temporary extra help person. In the event of illness or
emergency requiring the necessity to leave the location, the Vending Facility
Program office shall be contacted immediately and it shall be the responsibility of
the Vending Facility Program office to obtain another person to work the facility.
Under no circumstances shall an extra help person employ another person in their
place and pay for such employment out of their own pocket.
A-27
8. Only authorized Vending Facility Program personnel or the licensed blind vendor
of the facility shall be given keys to the facility.
9. Under no circumstances should the internal financial operation of the facility be
discussed with customers nor should the operation, pricing, or any other business
operation or performance of a vending facility manager be discussed with
customers at any location. If an extra help person notes problems or difficulties
within the facility, the extra help person should notify the Vending Facility
Program Specialist responsible for the location. Extra help persons shall not
discuss price differentials between various locations with customers nor any other
business of the assigned licensed blind vendor with the customers or other
individuals.
10. Breakdowns and failure of equipment should be reported to the Vending Facility
Program office immediately so that appropriate repair work may be initiated.
11. Rudeness, failure to serve, or general disregard for customers will not be
tolerated.
12. Temporary extra help persons will be expected to conform to state health codes
and food sanitation procedures.
13. Extra help persons shall not provide to other licensed blind vendors other than the
licensed blind vendor assigned to the location, if any, operating information,
income figures, or any other information regarding the location. If individuals call
regarding the operation of the location, they should be directed to the Vending
Facility Program office and the Vending Facility Program Specialist assigned to the
location in question.
I have agreed to and understand the policies regarding my employment as a
temporary extra help person for the Vending Facility Program. I understand that
failure to comply with these policies will result in my termination.
I am presently employed at VFP #______.
__________________________________
Signature of Employee
__________________________________
Date
A-28
VFP-9
VENDING FACILITY PROGRAM DRAW PAYROLL WORKSHEET
Reporting Period: _________________
VFP #
Manager
Draw
Vacation
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
TOTALS
COMMENTS: ________________________________________________________
________________________________________________________
SPECIALIST: ___________________________
A-29
DATE: ___________________________
A-30
Four Week Report
Purpose of Form
The Four Week Report is calculated from the 4 Weekly Sales Reports
which are completed by the vendor. The accuracy of the Four Week
Report depends on the accuracy of the Weekly Sales Reports and the
accuracy with which extra-help is reported.
Completion of Form
1. Vendor - Enter name of vendor.
2. VFP# - Enter number assigned to stand location.
3. Place - Enter name of facility.
4. Period - Enter the number of the period for which the report is being
made.
5. From - Thru - Enter the dates of the time covered by the report.
6. Specialist - Enter name of specialist.
7. Total Sales - The totals of item 6 on the Weekly Sales Report for the
period (4 weeks) plus any other income other than sales that accrues
to the location through the program - e.g., income from vending
machines, etc.
8. Total Stock Purchases - The total of item 3 on the four Weekly Sales
Reports. All receipts for purchases of stock during the four week
period are shown here.
9. Gross Profit - Total Sales minus Total Purchases of Stock.
10. Percentage Gross Profit of Sales - Gross Profit divided by Total Sales.
A-31
11. Operating Expense/and/or Supplies - The total of item 2 on the
Weekly Sales Report.
12. Vendor's Deposit - The amount remaining after the costs for Supplies
and Operating Expenses are deducted from Gross Profit.
13. Extra Help - Total amount charged to compensate essential extra-help
that has been employed during the period. The gross amount shown
on the books as charged to a particular vendor or location and is
based on documentation of essential extra-help submitted by the
Vending Facility Program Specialist.
14. FICA Matching - The employer's (vendor's) matching contribution for
Social Security on an extra-help employee's wages.
15. Rent - The amount agreed to that is paid to the lessor of a location.
The rent is paid by the VFP office and charged back to the appropriate
location.
16. Liability Insurance/Worker's Comp. - Liability insurance and/or
Worker's Compensation Insurance amounts paid by the VFP office
and charged back to the location.
17. State Unemployment Insurance - The amount of the premium(s) that
is paid for a particular location. This amount is paid by the VFP office
and charged back to the location.
18. Other - Costs that may be charged as operating expenses not
otherwise covered on the form.
Total Operating Expense - The sum of (11) Operating Expenses and/or
Supplies, (13) Extra Help, (14) FICA Matching, (15) Rent, (16) Liability
A-32
Insurance/Worker's Comp., (17) State Unemployment Insurance and
(18) Other Expenses.
19. Total - The sum of lines 13 through 18.
20. Income Before Set-Aside Contribution - The amount remaining after
deducting all operating expenses from gross profits.
21. Set-Aside Contribution - The amount derived when applying the set-
aside formula to the income before the set-aside contribution.
22. Net Profit - The percentage of sales and dollar amount after set-aside
contribution has been deducted.
23. Profit or (Loss) Brought Forward - This figure is the net profits and
losses from previous periods for the location (losses are indicated by
amounts in parentheses).
24. Total Profit or (Loss) for Periods - The sum of Profit or (Loss) this
Period and Profit for (Loss) Brought Forward.
VENDOR INCOME INFORMATION
25. Commission/(Loss) Brought Forward - The net difference between
commissions earned by the vendor but not paid during the fiscal year
and any losses incurred by the vendor.
26. Net Profit This Period - The dollar amount computed for Net Profit
above.
27. Draw Paid - The amount guaranteed under the fair minimum return
provision for the number of days worked during the period.
28. Commission/(Loss) This Period - The net profits minus the drawing
account.
A-33
29. Commission Paid This Period - That portion of commissions accrued
during the current and previous periods that will be paid to the
vendor for the period covered by this report.
30. Total Commissions or (Loss) Carried Forward - The accumulative
Commissions or loss for the year.
Routing of Form: Original - Bookkeeping
Copy - Vendor
Copy - Specialist
VFP-10
VENDING FACILITY PROGRAM - FOUR WEEK REPORT
1. Vendor __________________________________ 2. VFP# _______ 3. Place ____________________________
4. Period _______ 5. __________________ Thru ________________ 6. Specialist __________________________
7. Total Sales. ..............................................................................................$_____________________________________
8. Total Stock Purchases..............................................................................$_____________________________________
9. Gross Profits.............................................................................................$_____________________________________
10. Percentage Gross Profit of Sales............................................_________%
11. Operating Expenses and/or Supplies.......................................................$_____________________________________
12. Vendor's Deposit................................................................................. ....$_____________________________________
13. Extra Help............................................ .$_________________________________
14. FICA (Matching)....................................$_________________________________
15. Rent.......................................................$_________________________________
16. Liability Insurance/Worker's Comp.........$_________________________________
17. State Unemployment Insurance.............$_________________________________
18. Other............................................... .....$_________________________________
19. Total........................................................................................................$_____________________________________
20. Income before Set-Aside Contribution....................................................$_____________________________________
21. Set-Aside Contribution............................................................................$_____________________________________
22. Net Profit......(Percentage New Profit of Sales __________%)...............$_____________________________________
A-34
23. Profit (Loss) Brought Forward.................................................................$_____________________________________
24. Total Profit (Loss) for Periods.................................................................$_____________________________________
Vendor Income Information
25. Commission/(Loss) brought forward........................................................$_____________________________________
26. Net Profit this Period.................................$_______________________________
27. Draw Paid................................................$________________________________
28. Commission/(Loss) this Period..............................................................$______________________________________
29. Commission paid this Period.................................................................$______________________________________
30. Total Commissions or (Loss) Carried Forward......................................$______________________________________
A-35
VFP-11
EMPLOYMENT APPLICATION
VENDING FACILITY PROGRAM
Applications for employment with the Vending Facility Program are
accepted without regard to sex, race, or color, national origin,
physical/mental handicap, age, religion, or political affiliation. Conviction
of a crime does not automatically bar any applicant from employment or
other opportunities with the Vending Facility Program.
Applications, once filed, may be subject to disclosure as a public record
under the Arkansas Freedom of Information Act.
Applications filed do not create a contract of employment with the
Vending Facility Program. If any individual is hired, employment is for no
definite period of time. Individuals hired will also be required to provide
proof of eligibility to work in the United States pursuant to the
Immigration Reform and Control Act of 1986.
Please answer all questions which apply to you. Please print, type, or
write legibly.
LAST NAME FIRST NAME MIDDLE INITIAL
COMPLETE MAILING ADDRESS
CITY STATE ZIP CODE
HOME PHONE NUMBER WORK PHONE NUMBER
MESSAGE OR OTHER PHONE NUMBER
SOCIAL SECURITY NUMBER
EDUCATIONAL HISTORY
Did you graduate from high school? ____ Yes ____ No
If not, do you have a G.E.D.? ____ Yes ____ No
List below schools, colleges, universities, vocational, or others attended:
Name and Location From To Date Graduated
A-36
REFERENCES
Please list three (3) references who are not related to you.
Name Address Telephone
1. ____________________________________________________________
2. ____________________________________________________________
3. ____________________________________________________________
WORK HISTORY List all prior work experience. Beginning with your most recent
employment. If you do not have enough space to list all your work experience use a
separate sheet for continuation. If you include a resume instead of completing the
work history section, make sure all the requested information is included.
1. Current or most recent employer ____________________________________
Complete mailing address ____________________________________________
Business
City _____________ State ____ Zip Code ______ Phone #__________________
Type of Business ___________________________________________________
Your job title _______________________________________________________
Your job duties (be specific) ___________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Reason for leaving ___________________________________________________
Employed from __________________________ To ______________________
2. Employer _________________________________________________________
Complete mailing address ____________________________________________
Business
City _____________ State ____ Zip Code ______ Phone #__________________
Type of Business ___________________________________________________
Your job title _______________________________________________________
Your job duties (be specific) ___________________________________________
____________________________________________________________________
A-37
____________________________________________________________________
____________________________________________________________________
Reason for leaving ____________________________________________________
Employed from __________________________ To ______________________
3. Employer _________________________________________________________
Complete mailing address ____________________________________________
Business
City _____________ State ____ Zip Code ______ Phone #_____________________
Type of Business ______________________________________________________
Your job title __________________________________________________________
Your job duties (be specific) ______________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Reason for leaving _____________________________________________________
Employed from __________________________ To ______________________
Before you sign this application, check your answers to make sure that all
questions have been completed properly.
I, the below signed individual, hereby declare that, to the best of my
knowledge and my ability, the information on this application is true and
factual.
I understand that my employment is for no definite period of time, and I
may be terminated at any time.
I understand that I will be required to provide proof of eligibility to work in
the United States pursuant to the Immigration Reform and Control Act of
1986 as a condition to any employment.
A-38
I understand that false, misleading, or incomplete statements could lead
to my dismissal as an employee.
Signature of applicant ___________________________ Date ___________
A-39
Vendor Payroll Control Sheet VFP-12
Check Date: _____________
Period Ending: ________________
VFP Manager Payroll: Draw Commission
1. _______________
$_____________
Records Selected: ___________
2. _______________
$_____________
Total: $____________________
3. _______________
$_____________
Starting Check #: ___________
4. _______________
$_____________
5. _______________
$_____________
6. _______________
$_____________
7. _______________
$_____________
8. _______________
$_____________
9. _______________
$_____________
10. ______________
$_____________
11. ______________
$_____________
12. ______________
$_____________
13. ______________
$_____________
14. ______________
$_____________
15. ______________
$_____________
16. ______________
$_____________
17. ______________
$_____________
18. ______________
$_____________
19. ______________
$_____________
20. ______________
$_____________
21. ______________
$_____________
22. ______________
$_____________
A-7
23. ______________
$_____________
VFP-13
LATE REPORTS FOR VENDING FACILITY PROGRAM STANDS
VFP
VFP
#001 __________
#031 __________
#002 __________
#032 __________
#003 __________
#035 __________
#004 __________
#036 __________
#006 __________
#037 __________
#007 __________
#038 __________
THESE REPORTS HAVE NOT
#008 __________
#040 __________
BEEN RECEIVED AS OF
#009 __________
#051 __________
_____________________________
#010 __________
#055 __________
#011 __________
#057 __________
#012 __________
#058 __________
#013 __________
#061 __________
#014 __________
#064 __________
PERIOD #______________
#015 __________
#068 __________
WEEK # ______________
#016 __________
#070 __________
ENDING #______________
#017 __________
#071 __________
#018 __________
#073 __________
#019 __________
#074 __________
#020 __________
#078 __________
#022 __________
#081 __________
#024 __________
#082 __________
#025 __________
#083 __________
#026 __________
#085 __________
#027 __________
#089 __________
#028 __________
#094 __________
A-26
#029 __________
#097 __________
#030 __________
#102 __________
A-26
VFP-15
DIVISION OF SERVICES FOR THE BLIND
Vending Facility Program
Vending Machine Contract
This right of contract is granted to the Division of Services for the Blind
Vending Facility Program under Federal Randolph-Sheppard Act P.L. 74-
732 as amended by P.L. 83-565 and Title II of P.L. 93-516 and Arkansas Act
201 of the 1969 General Assembly which allows for the receipt of
proceeds to the Vending Facility Program from the sale of vended items
on any property owned, rented, leased or otherwise acquired by the
Federal Government or the State of Arkansas.
The Division of Services for the Blind Vending Facility Program,
henceforth referred to as Agency, and the ______________________________
henceforth referred to as Vendor, jointly enter into and agree to the
following terms and conditions.
I. The Vendor and Vendor's subcontractor agree to comply with Title VI
of the Civil Rights Act of 1964 and Title VII of the Civil Rights Act of
1964 as an equal opportunity employer.
II. The Vendor agrees to initiate operation of specified vending machines
on ___________ _____, ______, at the location(s) specified
(month) (day) (year)
in Exhibit A for sale at the specified locations(s) under the following
terms and conditions.
1. The Vendor agrees to pay to the Vending Facility Program ______%
of gross sales on a monthly basis. Checks or money orders will be
made payable to:
Vending Facility Program, VFP #
P.O. Box 3237
Little Rock, AR 72203
Payments shall be submitted within 15 calendar days following the
close of the previous calendar month or
A-27
2. The Vendor shall furnish to the Vending Facility Program with the
commission payment a record of gross sales. The VFP # shall be a
required part of this report.
3. Vendor is responsible for maintenance and repair of all machine(s)
as listed in Exhibit A.
4. Equipment will be kept in good repair and sanitary condition by
Vendor.
5. Vendor is responsible for all applicable federal, state or local
permits, licenses, and taxes.
6. Vendor is responsible for all applicable federal, state or local laws
or ordinances regarding the operation of such vending machine(s).
7. Vendor shall maintain a sufficient quality of product and shall
insure overall freshness and sanitation of all food products served.
8. Agency may inspect facility at any time and will do so on a
minimum of a quarterly basis to ensure customer satisfaction and
general state of repair and condition of equipment.
9. Vendor will provide customer and product liability insurance
sufficient to meet and protect Agency against losses or claims
made by customers due to Vendor's alleged or proven negligence.
Vendor shall provide to Agency copies of customer and product
liability insurance prior to initiation of this contractual document.
10. Contract may be terminated for the following reasons:
A. Failure to comply with agreed upon terms or conditions.
B. Documented evidence by Vendor that machine(s) are not
operating at profitable level.
C. Removal of federal or state agency or office as tenants in
location.
D. Increase in business such that a vendor could be installed in
lieu of vending machines.
11. With exception to item 9, contract will run for a period of _____
months beginning on ________________________.
12. This contract may be amended at any time by a written agreement
signed by both parties and attached to original contractual
document.
A-28
13. Agency will provide to Vendor 30 days written notice of contract
termination based upon contracted arrangements and agreements.
14. This contract may be renegotiated at the conclusion of the _____
month contract term providing that all other terms and conditions
of the contract have been met.
15. Additional vending machines and products may be added upon
amendment to this contract according to item 12 in addition to
those machines or products listed in Exhibit A.
16. Exhibit A and attached amendments as defined under item 12 will
become an integral part of this contractual document.
17. Vendor shall display sign at each vending location that will be
supplied by the Agency. Additionally, the Agency will place a sign
at each vending location with Agency's name and logo.
Entered into this ____ day of _______________, 19_____.
_________________________________________________
Division of Services for the Blind Representative
_________________________________________________
Vending Machine Company's Representative
A-29
VFP-16
Vending Facility Program
Evaluation/Training Policy Form
1.5. Application, Evaluation and Training Process
1.5.1. Applicant. An individual who has been referred in writing with
accompanying documentation to the Vending Facility Program
Training Specialist via a Division of Services for the Blind
Vocational Rehabilitation Counselor. An applicant must meet
the criteria outlined in Section 1.4. of the Vendor Operating
Procedures Manual in order to be eligible for entry into
evaluation.
1.5.2. Evaluee. A person accepted by the Vending Facility Program
to have met the initial application requirements and who is
participating in a formalized four week period of evaluation.
Subsequent to entry into the training phase of the Vending
Facility Evaluation and Training Program, an evaluee is subject
to both the passage of the formal written examination and/or
in-location evaluations.
1.5.3. Trainee. Any individual who has been deemed to have
successfully completed the four week evaluation phase and is
in a custom designed training program to become a licensed
blind vendor.
1.5.4. Certified Licensee. Those individuals who have successfully
completed the designated, customized Vending Facility
Training Program and have been certified by the Vending
Facility Program Training Specialist to be eligible for licensing
as a licensed blind vendor. Certified licensees do not hold a
license until after their probation at the initial assignment to a
vending facility as established by transfer and/or promotion
policies.
1.6. Evaluation and Training Rights and Responsibilities
A-30
1.6.1. Purpose. The purpose of evaluation and training is to directly
ascertain the potential to manage a vending facility and
provide in a customized fashion vocational training needs for
eligible persons to become licensed blind vendors. The
training is not designed to provide remedial or personal
adjustment training for prospective licensees. Alternative
skills for dealing with blindness should have been
accomplished prior to the individual's referral to the Vending
Facility Program for vocational training. Should it be
determined that additional alternative skills to deal with
blindness are insufficient to meet the vocational training
needs, the perspective trainee will be referred to the
sponsoring vocational rehabilitation counselor for additional
training prior to the continuation or conclusion of the Vending
Facility Program evaluation.
1.6.2. Program Rights and Responsibilities. The Vending Facility
Program has the sole right to assign prospective trainees or
evaluees to specific vending facilities for evaluation or
training purposes. Every effort will be made to accommodate
the evaluee's or trainee's particular needs or personal
situations but the final placement in a location is the sole
right of the Vending Facility Program.
1.6.3. Training Manager's Rights and Responsibilities. A licensed
vending facility manager providing training services may,
with or without cause or reason, have an evaluee or trainee
removed from a location by making a request to the Vending
Facility Program Training Specialist. Evaluees or trainees
have no right of assignment to any specific vending facility
for evaluation or training.
1.6.4. Payment. Under no circumstances will an evaluee or trainee
be paid for any work performed during the assignment to a
vending facility as an evaluee or trainee. Additionally, no
evaluee/trainee will be used as paid relief help or in
substitution or in lieu of paid relief help with the exception of
a solo experience as part of the final segment of the Vending
Facility program training curriculum. Licensed blind vendors
who are serving as training managers will take sick, non-
A-31
essential or vacation leave in accordance with agency policies
and not utilize evaluees or trainees to serve as unpaid relief
help. Certified licensees will be eligible to work as temporary
relief help between the time of license certification and initial
assignment.
1.6.5. Training Money. Requests for additional transportation,
maintenance, or other types of training money will be made
by the evaluee/trainee to the sponsoring vocational
rehabilitation counselor. The Vending Facility Program
serves only as a mechanism in order to assure more
expedient payment of funds when appropriate vocational
rehabilitation authorizations for services have been submitted
by the sponsoring vocational rehabilitation counselor.
1.6.6. Complaints and Grievances. Applicants, evaluees, trainees
and persons certified for licensing have no rights under the
Federal Randolph-Sheppard Act, Division of Services for the
Blind Vending Facility Program grievance procedures (Section
XI), or access to the State Committee of Blind Vendors for
redress of grievances or complaints. Applications, evaluees,
trainees and persons certified for licensing are considered
vocational rehabilitation clients and have rights under the
Federal Vocational Rehabilitation Act and Division of Services
for the Blind client grievance procedures. Applicants,
evaluees, trainees and persons certified for licensing but not
yet assigned to a location will be referred to the sponsoring
vocational rehabilitation counselor regarding formal
complaints or grievances concerning the Vending Facility
Program.
1.6.7. Completion of Evaluation. After the conclusion of a
successful evaluation period, the Vending Facility Program
Training Specialist will determine, in consultation with the
trainee and, if necessary, the Vending Facility Program
Administrator, the type and approximate duration of training
based upon information obtained from the initial four week
evaluation. Persons beginning training simultaneously may
or may not complete training at the same time.
Determination for certification will be made by the Vending
A-32
Facility Program Training Specialist and final decisions of
licensing are the responsibility of the Vending Facility
Program Administrator.
1.6.8. Assignments. Specific vending facility assignments are the
sole responsibility of the Vending Facility Program Training
Specialist. Efforts will be made to provide a variety of
training experiences dependent upon the evaluation results of
the individual involved.
1.6.9. Absenteeism. All persons in evaluation or training are
expected to be at their assigned location, either classroom or
vending facility, on time and on each day of scheduled
evaluation or training. Each person will complete a minimum
of 20 days of evaluation, with the exception of unexcused
absences. Those persons committing three or more
unexcused absences during evaluation or training will be
automatically dropped. Excused absences will be made up
during the evaluation to maintain the 20 day evaluation rule.
Excused absences are absences for reason of legitimate
illness or other medical reasons or other circumstances as
approved by the Vending Facility Program Training Specialist.
The Vending Facility Program reserves the right to obtain a
doctor's statement for absences due to medical reasons. If a
trainee or evaluee is absent, the VFP Training Specialist
should be notified by the evaluee or trainee on the same date
of the absence or the absence will be counted as an
unexcused absence.
1.6.10. Conduct. All evaluees and trainees will be expected to
perform in a businesslike manner when in vending facilities
or at the Vending Facility Program office or other vending
facility evaluation or training locations. Any unbusinesslike
conduct will be grounds for expulsion from the training
program. The use of alcoholic beverages or other chemical
substances not specifically prescribed by a medical doctor
while in evaluation or in a training setting or coming onto an
evaluation or training setting under the influence of such
substances is grounds for expulsion from the training
program and will not be tolerated. Abusive language,
A-33
cursing, racial or sexual slurs, or failure to respond to a
reasonable request made by the training specialist or training
vendor shall be grounds for expulsion from the evaluation or
training program. Theft of property or funds from the
Vending Facility Program or a Vending Facility Program
vendor shall be grounds for automatic expulsion from
evaluation or training.
1.6.11. Upon certification, the certified licensee will remain certified
for licensing for a period of two years. Should the licensee
not be assigned a location at the end of the two years, the
Vending Facility Program Training Specialist will determine,
through testing, what the licensee will need to obtain for an
extension to the certification. This could consist of on-the-job
training, additional classroom instruction and/or
examinations. Upon successful completion, the licensee will
receive an extension of certification for an additional two
years or until the licensee has refused the third location offer.
Licensee can refuse only two location offers without losing
certification no matter how many certification extensions
licensee might obtain. Should licensee refuse or not
successfully complete the above requirements, the individual
would have the certification terminated and would have to
apply for Vending Facility Program training as a new trainee
to enter the Program.
I have read or have had read to me the rules and policies concerning my
participation in the Division of Services for the Blind Vending Facility
Program evaluation and training and understand the rules and
consequences for failing to follow them as well as my rights and
responsibilities.
________________________________
Client's Signature
________________________________
Date
A-34
________________________________
VFP Representative
________________________________
Date
A-35
VFP-17
Vendor Evaluation
Purpose of Form
This form is to be completed on an annual basis by the Vending Facility
Specialist to make determination, in an objective manner, of the vendor's performance
as an operator of a food service facility as well as the vendor's adherence to VFP
policies and procedures. The form will also be used as a means to provide
qualification information should the vendor request a transfer or promotion to another
vending facility. The form will be completed in the presence of the vendor and fully
reviewed with the vendor. The vendor will sign the form to indicate that he/she is
aware of the contents. Any changes in or amendments to the evaluation must also be
done in the presence of the vendor.
This form is also used to determine training needs as expressed by the vendor.
Completion of Form
The form will be completed in duplicate.
1. Location - Enter vending facility location number and name of facility.
2. Vendor - Enter full name of the vendor.
3. Date - Enter the date the evaluation is done.
4. Type of Facility - Check appropriate box.
5. Number of –
Potential Customers - Enter the number of employees or students in the
building, factory, or school.
Tables - Enter number of tables available for customers.
Seating Capacity - Enter number which can be seated.
Section A - Fiscal Information
This information will be completed by the VFP prior to evaluation.
Section B through G -
All items in these sections will be rated according to the scale on
the form.
Section H and I - Training Needs
Enter any comments regarding training needs. If "none", enter none.
Section J - Overall Evaluation Rating
This rating should take into account all other ratings of the various
subsections of the form. Enter any comments made by the vendor as well
as observations made by the specialist. The manager and the specialist will
sign the form.
Routing of Form - Original to vendor with copy to be placed in the vendor's personnel
file.
A-36
VFP-17
DIVISION OF SERVICES FOR THE BLIND
Vending Facility Program
Vendor Evaluation
1. Location: __________________________________________________________
2. Vendor: _____________________________________ 3. Date: _______________
4. Type of Facility: (Check one)
Private □
Factory □
Federal □
Vo-tech/school □
County □
State □
5. Number of: Potential Customers _______ Tables ____ Seating Capacity ______
Satisfactory
Unsatisfactory
A. Fiscal Information
1. Promptness of Reporting
2. Accuracy of Sales Reports
3. Profit Percentages:
a. Average % since last evaluation:
Gross _________%
Net _________%
b. Average % current fiscal year:
Gross _________%
Net _________%
Describe items that are unsatisfactory _______________________________________
_________________________________________________________________________
_________________________________________________________________________
RATING: 1 - Unacceptable, 2 - Needs improvement, 3 - Satisfactory, 4 - Above
average,
5 - Excellent
B. Cleanliness:
1
2
3
4
5
1. Counter tops
2. Under counters and counter tracks and sinks
3. Fountain heads and ice makers
4. Food preparation, (if applicable); Utensils, coffee
pots,
etc.
5. Pest control
A-37
6. Equipment/Furnishings: tables, chairs, bar towels,
etc.
7. Walls, floors and ceilings (if not manager's
responsibility,
note here.)
8. Refrigerators and freezers
Comments: _____________________________________________________
_______________________________________________________________
_______________________________________________________________
C. Equipment: For Office Use Only. Not to be included as part of manager's
rating. Check each item which is in need of repair or maintenance.
1
2
3
4
5
1. Cabinets
2. Tables and/or chairs
3. Refrigerators or freezers
4. Coffee makers
5. Drink machines
6. Microwaves
7. Other, specify ________________________________________________
Comments: _____________________________________________________
_______________________________________________________________
_______________________________________________________________
D. Food Preparation
1
2
3
4
5
1. Utensils
2. Food preparation methods
3. Prepared food storage: Cold
Hot
Comments: ____________________________________________________
_______________________________________________________________
_______________________________________________________________
1
2
3
4
5
E. Personal Hygiene:
Comments: ________________________________________________________
A-38
___________________________________________________________________
___________________________________________________________________
1
2
3
4
5
F. Customer Relations:
1. Courtesy
2. Individual sales
3. Speed of service
Comments: _________________________________________________________
___________________________________________________________________
___________________________________________________________________
G. Marketing and Merchandising:
1
2
3
4
5
1. Adequate inventory
2. Stock rotation
3. Display of merchandise
4. Pricing of merchandise
Comments: ________________________________________________________
___________________________________________________________________
___________________________________________________________________
H. Training Needs:
Specialist's comments: ________________________________________________
___________________________________________________________________
Vendor's comments: __________________________________________________
___________________________________________________________________
I. Upward Mobility Training Comments or Needs:
Specialist's comments: ___________________________________________
___________________________________________________________________
Vendor's comments: _______________________________________________
A-39
___________________________________________________________________
Comments of Grantor or Designee: _________________________________
___________________________________________________________________
Date: ____________ Grantor's or Designee's Signature: _____________________
1
2
3
4
5
J. Overall Evaluation Rating:
Specialist's comments: ________________________________________________
___________________________________________________________________
Vendor's comments: __________________________________________________
___________________________________________________________________
Recommendations for possible promotion or reassignment: ___________________
___________________________________________________________________
___________________________________________________________________
Comments: _________________________________________________________
___________________________________________________________________
I have been read and understand all sections of this evaluation. I understand that my
signature does not signify agreement with the evaluation but the fact that the entire
evaluation has been presented to me. I further understand that any changes or
amendments to this evaluation will not be made unless I have had an opportunity to
review any changes and that no changes will be made without my knowledge of the
specific changes.
Date: __________________ Vendor's Signature: ________________________________
Date: __________________ Specialist's Signature: ______________________________
A-40
DSB-8002 (R. 4/91)
A-41
VFP-18
Vending Facility Program Site Survey Form
1. Name of Company or Building ______________________________________________
Federal □ State □ Private □
2. Location __________________________________________________________
Street City Zip
3. Name and title of person responsible for approval of Vending Facility Program
installation _____________________________________________________ Telephone #
_______________________________
E-mail ____________________________________
4. Area market/trends: _____________________________________________________
5. Estimated number of employees or occupants x
$1.50__________________
6. Number of work shifts or hours of operation ___________________________________
7. Estimated distance from competition. ________________________________________
8. Length of lunch break ____________________________________________________
9. Would lunch area meet minimum Randolph-Sheppard standards? Yes ____ No
_____
10. Is present level of work force reasonably stable or does employee level fluctuate?
___________________________________________________________________
11. Are there prolonged periods of employee layoff or shut down; i.e., plant closing
for periods longer than one week? ____________________________________________
12. Is transportation available to site? __________________________________________
13. Will grantor provide plumbing and electric hookup. Yes ____ No ____
Comments/needs:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
A-42
_________________________________________________________________________
Surveyor Name: ____________________________________ Date: __________________
A-43
VFP-20
2/92
DIVISION OF SERVICES FOR THE BLIND
Vending Facility Program
700 Main, P.O. Box 3237
Little Rock, AR 72203
TO: ____________________________
FROM: ____________________________
Vending Facility Program
DATE: ____________________________
SUBJECT: Closing of Location, VFP #_________
VFP #_____, _________________________________________ was closed on
___________________. The location was closed because:
□ location was deficit.
□ location was deficit and converted to vending machine, VFP #____.
□ vending machine location was converted to manned location, VFP #____.
□ grantor was dissatisfied with services offered.
□ grantor was dissatisfied with vendor.
□ grantor wanted services that program cannot offer or _________________________
____________________________________________________________________
____________________________________________________________________
□Other, specify. ________________________________________________________
___________________________________________________________
A-44
___________________________________________________________
___________________________________________________________
/ps
cc: files
A-45
VFP-22
DIVISION OF SERVICES FOR THE BLIND
Vending Facility Program
700 Main, P.O. Box 3237
Little Rock, AR 72203
Statement of Account
_________________________________
Name of Trainee
The above trainee was provided with on-the-job training, on dates checked below,
during the month of ______________________.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
______ TOTAL DAYS __________________________
Vendor
Training fee payable ____ days @ $5.00 per day $____________
_________________________________
Approved by Training Specialist
VFP-22
DIVISION OF SERVICES FOR THE BLIND
Vending Facility Program
700 Main, P.O. Box 3237
Little Rock, AR 72203
Statement of Account
_________________________________
Name of Trainee
The above trainee was provided with on-the-job training, on dates checked below,
during the month of ______________________.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
______ TOTAL DAYS __________________________
Vendor
Training fee payable ____ days @ $5.00 per day $____________
_________________________________
Approved by Training Specialist
A-46
VFP-23
State of Arkansas
Department of Human Services
Division of Services for the Blind
Vending Facility Program
Purchase Verification
The following services have been provided and payment is approved for:
VFP # __________________________________________________________________
Location at ______________________________________________________________
This work falls in the following category:
Repairs and maintenance of equipment ________________________________
New equipment #'s ________________________________________________
VFP Account #_________ Invoice/acct. #_____________
VFP Account #_________ Invoice/acct. #_____________
VFP Account #_________ Invoice/acct. #_____________
VFP Account #_________ Invoice/acct. #_____________
Description of improvement or work done: ______________________________
__________________________________________________________________________________
__________________________________________________________________________________
_______________________________________________________
Mail check to: ________________________________________________________
________________________________________________________
________________________________________________________
Cost: $ _____________________________
Date ______________________ Signed ___________________________________
VF Specialist
Date ______________________ Signed ___________________________________
Administrator, Vending Facility Program
Paid by check No. _____________ Date: _________________________
Accounting - White, Stand File - Pink, Inventory Control - Yellow
A-47
VFP-24
VENDING FACILITY PROGRAM
Trainee Progress Report
Name of Trainee ___________________________ Date ______________________
VFP Vendor Training From ________________ To ________________
1. Attendance: Days scheduled _____ Days absent _____ Days tardy ____
Reason for absence or tardiness: ________________________________________
___________________________________________________________________
___________________________________________________________________
2. Trainee's progress for this report _________________________________________
___________________________________________________________________
3. Does trainee's appearance or mannerisms need improvement?
Yes ____ No ____ If yes, in what area ___________________________________
___________________________________________________________________
4. Is trainee a clean person? Yes ____ No ____
If no, what needs improvement __________________________________________
___________________________________________________________________
5. Abilities and attitudes of trainee:
A. Cooperativeness
D. Ability to learn
□ Gets along well with others
□ Learns very rapidly
□ Falls in line
□ Learns reasonably well
Needs repeated
□ Sometimes argues
□ instructions
□ Disagreeable
□ Very slow to learn
B. Production
E. Work Quality
□ ÀÙ Works hard and steadily
□ ÀÙ Accurate and neat
□ Does only work required
□ Generally acceptable
□ Slow
□ Inferior
□ Avoids the job
□ Usually not acceptable
C. Work Attitude
F. Dependability
□ Enthusiastic about work
□ Very Dependable
□ Shows some/much interest
□ Usually dependable
Requires close
□ Usually appears indifferent
□ supervision
A-48
□ Shows very little interest
□ Cannot be relied upon
6. Is trainee's work habits and attitudes suitable for public employment? Yes ____
No ____ If no, why _________________________
___________________________________________________________________
7. Does trainee have adequate physical ability to perform the duties of a vendor?
Yes ____ No ____ If no, in what area is the trainee limited.
__________________________________________________________
Can trainee work a full day. _____________________________________
8. Does trainee need special accommodations (e.g., hearing aid, calculator,
magnifier). __________________________________________
___________________________________________________________________
9. Does trainee have the skills necessary for communication and record keeping?
Yes ____ No ____ Comments: ____________________________
___________________________________________________________________
10. Are trainee's mobility skills adequate? Yes ____ No ____
Does trainee need additional instruction? ________________________
___________________________________________________________________
11. Can trainee discriminate various denominations of coins/bills?
___________________________________________________________________
12. Any problems encountered with trainee during this report period?
___________________________________________________________________
___________________________________________________________________
13. Summary (narrative) of training for this report.
Trainer: ________________________________
Signature
A-49
VFP-25
AGREEMENT FOR OPERATION
OF A VENDING FACILITY
UNDER RANDOLPH-SHEPPARD ACT
BETWEEN
THE DIVISION OF SERVICES FOR THE BLIND
(The Designated State Licensing Agency) AND
__________________________________________
(A Licensed Blind Vendor)
THIS AGREEMENT entered into this ____ day of ____________ 19___, by and between
the Division of Services for the Blind (hereinafter, DSB), and ______________________
__________________________, licensed as a blind vendor under the Randolph-Sheppard
program (hereinafter, vendor) by the DSB, WITNESSETH:
WHEREAS, the DSB has been granted a permit by _______________________________
______________ for the operation of a vending facility by a licensed blind vendor under
the Randolph-Sheppard program (hereinafter, permit) on the property located at
____________ _______________________________, a copy of which permit is attached
hereto and made a part hereof; and,
WHEREAS, the DSB has offered the vendor the opportunity to operate the vending
facility under the terms and conditions hereinafter set forth; and,
WHEREAS, the vendor has agreed to undertake the operation of the vending facility
under the terms and conditions hereinafter set forth; and,
WHEREAS, the parties do not intend to derogate in any way from responsibilities and
rights imposed and granted by applicable Federal, State or local laws or regulations
by this agreement;
NOW, THEREFORE, in consideration of the premises, it is mutually agreed as follows:
A. THE DSB WILL:
1. Equip the vending facility for carrying out the business authorized by the
permit.
2. Furnish initial stocks of merchandise and petty cash sufficient to enable the
vendor to commence operating the business authorized by the permit.
3. Furnish the vendor with a complete inventory of all equipment, initial stocks,
and petty cash provided.
4. Maintain the equipment at the vending facility in good repair, and replace
obsolete and worn-out equipment as necessary.
A-50
-2-
5. Provide for substitute operation of the vending facility as may be necessitated
by the vendor's absence because of illness, vacation, or otherwise. The salary
of the person who substitutes for the vendor or that of other emergency help,
shall be charged to the vending facility where the service is performed, except
to the extent that is otherwise covered by the vacation and sick leave plan
provided by the DSB.
6. Provide supervisory and management services necessary for the efficient
operation of the vending facility.
B. THE VENDOR WILL:
1. Be responsible for having the vending facility open for business on the days
and during the hours specified in the permit.
2. Operate the vending facility business on a cash basis except for such credit
accounts as may be established or authorized in writing by the DSB.
3. Be accountable to the DSB for the proceeds of the business of the vending
facility, and handle the proceeds, including payments to suppliers and deposits
of funds, in accordance with instructions from the DSB.
4. Carry on the business of the vending facility in accordance with: (a) the
Randolph-Sheppard Act and the regulations issued pursuant thereto; (b) the
rules and regulations of DSB and the written standards and policies issued
thereunder after consultation with the State Committee of Blind Vendors; (c)
applicable Federal, State, and local laws, ordinances or regulations; (d) terms
and conditions of the permit.
5. Maintain a neat business-like appearance while working at the vending facility,
and conduct the facility in an orderly, business-like manner.
6. Take proper care of the equipment of the vending facility, and make alterations
or changes therein only with the written approval of the DSB.
7. Notify the DSB a reasonable time in advance of taking of any voluntary leave
from the vending facility, and as soon as possible with respect to any
involuntary leave.
A-51
8. Keep such records and make such reports as the DSB shall require and furnish
information and comply with such conditions as may be necessary to assure
the correctness and verification of such records and reports, including
participation in management audits of the facility's operation.
-3-
9. If the value of the inventory and cash-on-hand is less than the value of the
inventory when the vendor was assigned to the facility, the amount of the
deficit is due and payable by the vendor to the Special Programs Fund. Any
loss of commission(s), payroll, or other financial obligations related to the
Vending Facility Program (VFP) manager and his stand operations will be due
and payable to the Program by the VFP manager upon revocation of vendor's
license or vendor's resignation. Notification of this amount will be given to the
vendor in writing by the VFP. Any financial loss not paid to the VFP will be
processed through the established legal system for recovery.
10. Cooperate with the officials of the DSB and provide them access to the vending
facility and to such pertinent information as they may require in discharging
the responsibilities of the DSB as the State Licensing Agency.
C. GENERAL:
1. The business to be carried on at the vending facility will be limited to that
specified and authorized in the permit.
2. The right, title, and interest in and to the equipment of the vending facility, the
stock in trade, and funds on hand are vested in the DSB, and will be left at the
vending facility or turned over to the DSB upon the termination of this
agreement for any reason by either of the parties. In such event, the fair
market value of the vendor's interest will be determined by the DSB and paid
to the vendor or to the vendor's heirs or assignees.
3. Rebates, commissions, or bonuses received by the vendor from suppliers are,
and must be accounted for, as income of the vending facility. Under no
circumstances are such funds to be treated as the separate, personal funds of
the vendor.
4. Merchandise taken from the stock in trade of the vending facility by the
vendor for the vendor's own use shall be accounted for by the vendor and
paid for at cost prices.
5. The business premises of the vending facility shall be covered by public
liability insurance, and any such other insurance as will protect the vendor,
A-52
any one employed by the vendor, and the DSB against losses and claims
arising out of the conduct of the business of the vending facility. The cost of
such insurance shall be a cost of operating the business of the vending facility
and taken into account as such in determining the net proceeds of the
business.
6. The income of the vendor shall be 100% of the net profits of the facility less
funds to be set aside in accordance with the schedule prescribed by DSB after
consultation with the State Committee of Blind Vendors. Payments and
adjustments will be made periodically as determined by DSB after
consultation with the State Committee of Blind Vendors. The vendor will be
guaranteed a fair minimum return uniformly applicable to all locations, as
determined by DSB after consultation with the State Committee of Blind
Vendors.
-4-
7. If the Vendor is dissatisfied with an action by the DSB arising from the
operation or administration of the Vending Facility Program, the vendor may
request an administrative review and, if necessary, a full evidentiary hearing.
If the vendor is dissatisfied with the decisions of the Review and Hearing, the
vendor may request that an arbitration panel be convened by filing a
complaint with the Secretary of the Department of Education.
8. This agreement may be terminated at any time by the vendor. It shall be
terminated upon revocation or termination of the permit or contract. In
addition, it may be terminated by the DSB if the business of the vending
facility is not conducted in accordance with this agreement, or with applicable
Federal, State, or local laws and regulations.
__________________________________
Division of Services for the Blind
Date: _________________ by _________________________________________________
Title
Date: _________________ by _________________________________________________
Vendor
Date: _________________ by _________________________________________________
Witness
A-53
VFP-26
Vending Stand Trainee - Progress Report
Name of Trainee: _______________________________________________________
Location of Training Stand: ________________________________________________
Training Period From: _______________________ To: ________________________
Attendance Record: Days Absent ____ Reasons: _____________________________
Days Tardy ____ _____________________________
A. Attitude and Personal Characteristics
Good Fair Poor Improving
1. Alert and attentive to customers
2. Friendly and courteous
3. Dresses and grooms self appropriately
4. Cares for personal hygiene
5. Willingness to work
6. Eagerness to learn
7. Sincerity of purpose
8. Acceptance of supervision and instruction
9. Memory and ability to learn
10. Common sense and good
11. Poise and confidence
B. Orientation to Stand
Good Fair Poor Improving
1. Moves about stand area easily
2. Locates and handles merchandise properly
C. Change Making
Good Fair Poor Improving
1. Accurate
2. Fast
3. Sense of touch
4. Ability to count and roll money
A-54
5. Hand and finger dexterity
6. Adds amounts without difficulty
7. Ability to handle fast lines
D. Handling Daily Stand Routine
Good Fair Poor Improving
1. Cleaning table area
2. Cleaning counters and equipment
3. Cleaning of sink
4. Arrange and display stock (including coffee
making and stocking drink box)
5. Knows selling prices
6. Knows cost prices
7. Knows how to order merchandise
8. Understands making reports
9. Ability to open and close stand
10. Familiarity with inventory management
Vendor's Comments: (Progress since last report and other)
Signed: ______________________________________
Vendor
Training Supervisor's Comments:
Signed: ______________________________________
Training Specialist
A-55
VFP-27
DIVISION OF SERVICES FOR THE BLIND
Vending Facility Program
700 Main, P. O. Box 3237
Little Rock, AR 72203
Application for Evaluation and Training
I. Client's Name ___________________________________ Telephone # ____________
Address _______________________________________________________________
Date of Birth ___________ Social Security # ______________________ Sex ______
Race _________ Marital Status ____________ High School Diploma Yes __ No __
Highest Grade Completed 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
GED ____ College Degree ____________ Emergency ______________________
______________________________________________________________________
II. Legally blind Yes ___ No ___ Other disabilities _____________________________
______________________________________________________________________
Current Medication ______________________________________________________
Last job ___________________________________ From _________ To __________
Has client had mobility training? ____ DSB ___ LWS ___ Other _________________
Basic mathematical skills: Good ___ Average ___ Poor ___
Communication skills: Reads print ___ Reads braille ___ Neither ___
Uses low vision aids: Yes ___ No ___ Type _________________________________
Is client willing to accept assignment anywhere in the state. Yes ___ No ___
Counselor's assessment of client's personal adjustment. ________________________
______________________________________________________________________
Grooming and hygiene ___________________________________________________
Date client is available for training _______________ Client's statement of why he
selected vending facility management as a vocational objective:
___________________
______________________________________________________________________
______________________________________________________________________
Client's signature _______________________________________________
A-56
Counselor's signature: ___________________________________________
Date: ______________________
A-57
Vending Facility Training Program Checklist
Criteria
1. Legally blind
2. Citizen of U.S.A.
3. High school diploma, GED or equivalent
4. Client can travel independently
5. Client's hygiene and grooming is acceptable
6. Ability to:
A. Read and write braille or
B. Read and write print or
C. Use recorded and taped materials
Documentation
1. VFP Application for Evaluation and Training
2. Orientation and mobility report
3. Ophthalmological report
4. General medical report (current)
5. Client Referral and Survey Information, DSB-8006
6. Client's profile or interest inventory
7. Client's work history
8. Client's statement for entry
9. Other pertinent information
10. Audiological examination report, if needed
11. Any other special medical or visual reports, if needed
12. Any psychological and/or vocational test results, if needed
13. Final summary report from a training facility, if needed
14. Mobility assessment and/or IL assessment if available
A-58
VFP-28
Vending Facility Program
Receipt for Petty Cash Funds
VFP #_____
Petty Cash Amount _____________________________________
Date ______________________________________
Received by: ______________________________________________
VFP Vendor
______________________________________________
Date
______________________________________________
VFP Specialist
______________________________________________
Date
Distribution: 1 copy to bookkeeping/accounting
1 copy to vendor with stock and merchandise inventory
1 copy to files
A-59
VFP-29
DSB VENDING FACILITY PROGRAM
Trainer Agreement
Between
Division of Services for the Blind
and
Vending Facility Manager
Statement of Agreement
I, _______________________ assigned as manager of Vending Facility #____
Name of Vendor
located at ____________________________________________ agree to provide
Location
on-the-job vending facility training for _______________________________
Name of Trainee
for ______________ for the period beginning ________________________ and
Number of Days Date
ending _______________________ at the rate of $_______ per day. Payment
will be computed only for actual days trainee is on-the-job.
It is understood that the trainee assigned will be under my supervision while on-the-
job and that the training provided will be under the direction and authority of the
DSB/VFP Training Specialist. Training Progress Reports will be furnished as
requested.
Signed: ___________________________ Date: _________________
Vendor
A-60
Signed: ___________________________ Date: _________________
Training Specialist
A-61
VFP-30
Management Service Contract
I, _________________________________, Social Security #________________,
Address ______________________________________, City __________________,
contract with ________________________________, assigned licensed blind
vendor to VFP #_____, agree to provide management services in the
absence of the licensed blind vendor on the following date(s)
________________ and the following hours from ________ to ________ for
the following amount _______. I further certify to the licensed blind vendor that I am
not liable for backup withholding to the Federal Internal Revenue Service as a private
self-employed contractor. I further understand and agree that I will comply with the
written policies of the Vending Facility Program as they apply to a licensed blind
vendor as well as any additional written requirements attached to this contract. I
further understand that I am not an employee of the Vending Facility Program and in
no way hold the Vending Facility Program liable for payments due through this
contractual agreement.
Notations of any additional instructions or agreements attached to this document:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_____________________________________
Private Management Contractor
_____________________________________
Date
_____________________________________
Licensed Blind Vendor
A-62
_____________________________________
Date
A-63
Retirement Contributions Schedule
Years of Service
Amount of Contribution
5
$ 200.00
6
$ 225.00
7
$ 250.00
8
$ 275.00
9
$ 300.00
10
$ 325.00
11
$ 350.00
12
$ 375.00
13
$ 400.00
14
$ 425.00
15
$ 450.00
16
$ 475.00
17
$ 500.00
18
$ 525.00
19
$ 550.00
20
$ 575.00
21
$ 600.00
22
$ 625.00
23
$ 650.00
24
$ 675.00
25
$ 700.00
26
$ 725.00
27
$ 750.00
28
$ 775.00
29
$ 800.00
30
$ 825.00
31
$ 850.00
32
$ 875.00
33
$ 900.00
34
$ 925.00
35
$ 950.00
36
$ 975.00
37
$1,000.00
38
$1,025.00
39
$1,050.00
40
$1,075.00
41
$1,100.00
42
$1,125.00
43
$1,150.00
44
$1,175.00
45
$1,200.00
46
$1,225.00
A-64
47
$1,250.00
48
$1,275.00
A-65
VFP-31
Certification for Vending Facility Program Management Licensing
This is to certify that Mr./Ms. ________________________________________ has/has not
successfully completed all of the requirements for licensing as a Vending Facility
Vendor. I am, therefore, recommending/not recommending that
_________________________________________ be certified for licensing.
_____________________________________
Training Specialist
A-66
VFP-32
VFP Manual Receipt
I, ________________________________ received a copy of the Vendor Operating
Procedures Manual on ____________________.
_________________________________
Signature
A-67
VFP-33
Check Pickup Authorization
_____________________________
_____________________________
_____________________________
has permission to pick up the paycheck of ______________________________ from the
Vending Facility Program Accounting Department until further notice. No one else will
be allowed to pick up a check.
_____________________________
Signature
_____________________________
Date
A-68
A-62
VFP-34
Stand Loses From Burglary/Theft
Date of
Incident
VFP #
Location
Assigned Manager & Status
Monetary
Losses
Stock
Losses
Equipment
Losses
Police
Report
Y/N
Person
Notified
Date
and
Time
Notified
A-63
2-0
VFPOP Office Manual Original Date 10/5/10 Updated
11/8/17
VFP-35
VENDING FACILITY KEY CHECKOUT FORM
Name
# of
Sets
VFP #
Date
Checked
Out
Date
Checked
In
2-1
VFPOP Office Manual Original Date 10/5/10 Updated
11/8/17
2-2
VFPOP Office Manual Original Date 10/5/10 Updated
11/8/17
VFP-36
Arkansas Division of Services for the Blind
Vending Facility Program
_______________Stage ____________Semi-Final
____________Final
REMODELING/CONSTRUCTION INSPECTION REPORT
VFP #____
Location __________________________________________
Date of Inspection _________
Contractor: ______________________________
Inspector: _______________________________
Date Work Began _______________
Date to be Completed
____________
% Drawn on Job ________
Unpaid Balance ______________________
Date Job Substantially Complete __________________________
Inspection Party: ________________________________________________
________________________________________________
________________________________________________
________________________________________________
REMARKS:
2-3
VFPOP Office Manual Original Date 10/5/10 Updated
11/8/17
Submitted by _______________________
Date _______________________
2-4
VFPOP Office Manual Original Date 10/5/10 Updated
11/8/17
VFP-37
VENDING FACILITY PROGRAM
MISCELLANEOUS CASH RECEIPTS
DATE: ____________________
Program
SA/SP/HWY
A/R
#
Description
Deposit
2-5
VFPOP Office Manual Original Date 10/5/10 Updated
11/8/17
TOTAL
2-6
VFPOP Office Manual Original Date 10/5/10 Updated
11/8/17
VFP-38
Data Entry Form
Check Date: ____________
Payroll: SA SP SP-302
Period Ending:
__________
`Records Selected:
Regular Hours:
Overtime Hours:
Regular Earnings:
Overtime Earnings:
TOTAL EARNINGS:
Starting Check #:
2-7
VFPOP Office Manual Original Date 10/5/10 Updated
11/8/17
DIVISION OF SERVICES FOR THE BLIND
VENDING FACILITY PROGRAM
The Division of Services for the Blind of the State of Arkansas requests approval of
to place a vending facility on the property located
.
SATISFACTORY SITE: It has been determined that this location meets the criteria of
a satisfactory site. Any exceptions are documented in Exhibit A.
TYPE, LOCATION AND SIZE OF FACILITY: Type of facility
; facility location ;
Facility size sq. ft. (floor plan, Exhibit B). The types of articles to be sold and
services to be offered are enumerated in Exhibit C. The fixtures and equipment for
this facility, including the responsibility for the provision thereof, are set forth in
Exhibit D. The location, type and number of vending machines which constitute all
or part of this facility are noted in Exhibit E. The facility will operate days of the
week from A.M. to
P.M. commencing on
.
OTHER TERMS AND CONDITIONS: Any additional terms and conditions applicable
to this location are included in Exhibit F. This permit shall be issued for an indefinite
period of time subject to suspension or termination on the basis of non compliance
by either party with any of the agreed upon terms and conditions of the permit. By
mutual agreement the State Licensing Agency and the property agency/owner may
terminate the permit after providing 30 days notice of the intended terminations,
including the reason therefore and supporting documentation to the other party.
Both parties shall comply with all regulations issued in Title VI of the Civil Rights Act
of 1964.
__________________________________ __________________________________
Approving Property Official Approving Division Official
_________________________________
__________________________________
Title Date
Title Date