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Ncy Name 1. Agency No. Food Service Policy 1.1 Determination of eligibility for meals and explanation of benefit(s) provided to employer, if applicable: 1.2 Calculation of agency charges for meals: 110% (direct raw food cost + direct labor cost) Number of meals served cost per meal OR 1.10 ( + ( ) ) Charge adopted by agency (Charge adopted by agency must be rounded to the nearest 5 cents of computed cost.) 2. 1.3 Method of collection of meal charges: 1.4 Desc.

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