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HomeMy WebLinkAboutResidential Repair - Office for the Aging .. ~?~ ..~, """" RESOLUTION 2007-590 ADOPTED DOC ID: 3017 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2007-590 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON JULY 3, 2007: RESOLVED that the Town Board of the Town of Southold hereby authorizes and directs Supervisor Scott A. Russell to execute an Al!reement with the Suffolk Countv Office of the Al!inl! for communitv services for the Elderlv Residential Repair Prol!ram, IFMS No. SCS EXE 0000000 No. 001-6777-4980-95285 from April I, 2006 through March 31, 2008, subject to the approval of the Town Attorney. f'~.( ~Cl.r{erxll"" Elizabeth A. Neville South old Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Thomas H. Wickham, Councilman SECONDER: Louisa P. Evans, Justice AYES: Krupski Jr., Edwards, Ross, Wickham, Evans, Russell County of Suffolk i5), ~ (i; ~ ~ \19 ~ ~ lnl AUG 2 1 2007 19J Steve Levy Suffolk County Executive SUPERVISOR'S OFFICE TOWN OF SOUTHOlO Office for the Aging Holly S. Rhodes-Teague Director August 16, 2007 The Honorable Scott A. Russell Supervisor Town of Southold 53095 Main Street, PO Box 1179 Southold, New York 11971 RE: Community Services for the Elderly - Residential Repair IFMS No. SCS EXE 07000000605 Dear Supervisor Russell: The fully executed Agreement referenced above is enclosed for your files. Attached is a copy of All Department Heads Memorandum 30-97 explaining budget modification requirements. Any budget modification not meeting these requirements may be delayed or rejected by the Budget Office. Also enclosed find the Notification of Rights, which must be posted as part of your compliance with Local Law No. 12-2001, the Living Wage Law. If you require any further information, please contact Mary-Valerie Kempinski at 853-8209. Sinc~rely, ~ ~-------- U ;t,(j~ -Y--<4.--J Leonor Hunter Fiscal Administrator LH:MVK:sl Ene. cc: Karen McLaughlin G:ISLEVlMVKformletterslLtr4Bfullyexec.ADH.NOR. TownCC.doc (631) 853-8200 H. Lee Dennison Building. 100 Veterans Memorial Highway. P.O. Box 6100 . Hauppauge, New York 11788-0099 . FAX 853-8225 Over 30 years as the designated Area Agency on Aging Providing Services for Older Citizens I 30-97 OFFICE OF THE COUNTY EXECUTIVE All-DEPARTMENT-HEADS MEMORANDUM DATE: June 10, 1997 CONTRACf AGENCY BUDGET MODIFICATIONS .TIlls memorandum applies to those departments who pay contract agencies from the Operating Budget 4770 or 4980 objects. 0) On August 29.1995, ADH 47-95 was issued to resolve problems whicli had developed regarding the procedures and reqUirements for modifying confract agency budgets. In early 1997, there were again problems with timeliness and the reasons for modifications for certain dep~ents involving 1996 contracts. Departments who .deal with contract agencies have a major responsibility ~ the processing of contract budget modifications. Therefore, the attached procedures, which take effect with all 1997 contracts should be closely followed. Please. distribute these procedures to all of your contract agencies. If there are any questions regarding this ADH, please contact your departmenfs Budget Examiner. -~~ ERIC A. KOP . Chief Deputy County Executive Distribution Department Heads Attachment t\t~~~~ , < -. . .._01.--....,-..-- .. BUDGET MODIFICATIONS REOUIREMENTS: I. Non-equipment requests for contract budget modifications must be received at the County Executive's Budget Office no later than 45 calendar days prior to the end of the contract fiscal year. Equipment modifications must be received 90 calendar days prior to the end of the contract fiscal year. . 2. Under no circumstances can expenditures for which a budget modification is being requested be made prior to the approval of the modification by the Budget Office. 3. An agency will be restricted to three approved modifications per year. 4. Each line item requested to be modified must befuUy justified and must be directly related to the intent of the program. - ) 5. Any transfers to increase saI81j' rates of contract employees, create new positions, or change the title of a position, must be submitted prior to the rate increase being given or the position being filled. The Budget Office will not approve retroactive salary increases~ The only exception applies to a retroactive labor agreement between an agencY and their . . union bargaining unit(s). 6. Budget modifications cannot increase the dollar amount of the contract. PROCEDURE: I. !?our copies of the proposed budget modification and one copy of the justification, including a letter from the agency requesting the change, should be forwarded to the Budget office with the depar1ment's recommendation within fifteen (IS) calendar days of receipt of the request by the department. 0- - 2. Thejustification must include the effect of the modification on the program;changes in the available reimbursement to the County, ifany, the additional dollar amount which will be paid to the agency, and the dollar amount of reimbursement to the County, ir"the modification is approved. ./ 3. If the contract is funded under a Federal or State grant. or State reimburse1f1ent, the Department Head must advise in the transmittal memo whether State or Federal approval for the modification is required and whether the attached documentation showing the change has been approved by the funding agency. 4. The budget modification fonnat must indicate the line item, the current budget amount. the amount spent year to date, the new amount of the line item and the dollar amount of the change. NOTIFICATION OF RIGHTS UNDER THE LIVING WAGE LAW According to the provisions of Local Law #12-2001 (the Living Wage law) enacted by Suffolk County in July of2001, a living wage rate was established. The Living Wage shall be adjusted each year in proportion to the increase of the area Consumer Price Index. The increase in the area Consumer Price Index for 2006 is 3.8%. Effective July I, 2007, the Living Wage will increase to $10.40 per hour with health benefits and $11.84 per hour without health benefits for covered employees of an agency receiving financial compensation through the County. The law also mandates that full time workers receive at least 12 compensated days off per year through any combination of sick, vacation or personal leave and includes paid holidays provided by the employer. The Suffolk County Department of Labor has been designated as the agency to administer this law and to this end has established a Living Wage Unit. Further information concerning the parameters of the Living Wage law may be obtained by contacting this Unit (631 853-3808) or accessing the Suffolk County web page at www.co.suffolk.nv.us/labor and following the link to the Living Wage section. All inquiries will remain confidential. Law No. AG006M/0029-11 RA Rev. 6/25/07 Community Services for the Elderly - Residential Repair IFMS No. SC EXE 07000000605 No. 001-6777-4980-95285-0605 First Amendment Amendment of Agreement This is a First Amendment of an Agreement, (Agreement), last dated June 30, 2006, between the County of Suffolk (County), a municipal corporation of the State of New York, having its principal office at the County Center, Riverhead, New York 11901, acting through its duly constituted Office for the Aging (Aging), having its principal office at the H. Lee Dennison Building - 3rd Floor, 100 Veterans Memorial Highway, Hauppauge, New York (Mailing address: P.O. Box 6100, Hauppauge, New York 11788-0099), and the Town of Southold (Contractor), a New York municipal corporation, having its principal place of business at 53095 Main Road, P.O. Box 1179, Southold, New York 11971. The parties hereto desire to make modify the Agreement to extend the term of the CSE Residential Repair Program from March 31, 2007 through March 31, 2008 (the period April 1 , 2007 through March 31, 2008 being hereinafter called the "2007 Budget Period") and to amend other contract provisions to comply with current County Standards, as set forth herein. Sufficient funding exists in the 2007 Suffolk County Operating Budget. Term of Agreement: Shall be April 1, 2006 through March 31, 2008, with three one-year extensions at the County's option. 1,200 Units of Residential Repair Service Total Cost of Agreement: Shall not exceed $ 40,800 (of which $20,400 is for the 2007 Budget Period). Shall be as set forth in Exhibit A-2007, C-2007 and the Exhibit entitled "Suffolk County Legislative Requirements Exhibit for Contracts" revised 1/04/07, attached. In Witness Whereof, the parties hereto have executed this First Amendment of Agreement as of the latest date written below. T~"'fSo~:~ By: ~""fL.b/ Scott A. Russell Supervisor Units of Service: Terms and Conditions: County of Suffolk By: --' Date: f 10- S~ u y couZ Exec,ve B 1M Fed. TaXpayer~:~6001939 Date: 'J I.J 47 , , Approved as to Form, Legality: Samantha N. cEachin Assistant County Attorney Approved: By: ~.,-q~~.71~/()? Holly ho es-Teague Date Director, Office for the Aging . Recomme~d: Date67 By: . ~;A P-- l~ Jl PI () Regina eTuro Administrator I '7(;M~6 ? ate AG6 CSE Res Rpr Sohld exl 07 Law No. AG006M10029-11 RA Rev. 6/25/07 Community Services for the Elderly - Residential Repair IFMS No. SC EXE 07000000605 No. 001-6777-4980-95285-0605 First Amendment Exhibit A-2007 Whereas, the County and Contractor have entered into an Agreement (Law No. AG006M/0029- 11 R), last dated June 30, 2006, for a term from April 1 , 2006 through March 31, 2007 for a CSE Residential Repair Program for the elderly at a Total Cost of $20,400; and Whereas, the parties hereto desire to modify the Agreement to extend the term from March 31,2007 through March 31,2008 (at an additional cost of $20,400) and to increase the Total Cost of the Agreement to $40,800, as set forth below; Now, Therefore, in consideration of the covenants, promises and consent herein contained, the parties hereto agree as follows: 1. Term of Aoreement: The Term of Agreement paragraph on page 1 of the Agreement is amended to read April 1 ,2006 through March 31, 2008 as set forth on the page 1 of this First Amendment of Agreement. 2. Pavment of Services: The Total Cost of Agreement $40,800 is comprised as follows: (a) $20,400 for program year 2006/2007; (b) $20,400 for program year 2007/2008; 3. Poverty Threshold: For the 2007 Budget Period, the Poverty Threshold in Exhibit B to the Agreement, the paragraph entitled "Reporting Requirements, Low Income" is hereby amended to read as follows: Size of Familv Unit 1 2 150% of Poverty Threshold $15,315 $20,535 4. Budoet: The Budget annexed hereto as Exhibit C - 2007, including advance payment schedule, if any, is made part of the Agreement. 5. Paragraph 17 to the Agreement, "Suffolk County Living Wage Law" is amended in its entirety to read as follows: Suffolk County Living Wage Law This Agreement is subject to the Living Wage Law of the County of Suffolk. The law requires that, unless specific exemptions apply all employers (as defined) under service contracts and recipients of County financial assistance, (as defined) shall provide payment of a minimum wage to employees as set forth in the Living Wage Law. Such rate shall be adjusted annually pursuant to the terms of the Suffolk County Living Wage Law of the County of Suffolk. Under the provisions of the Living Wage Law, the County shall have the authority, under appropriate circumstances, to terminate this Agreement and to seek other remedies as set forth therein, for violations of this Law. AG 6 (3/02) Page 2 AG6 CSE Res Rpr Sohld exl 07 Law No. AG006M/0029-11 RA Rev. 6/25/07 Community Services for the Elderly - Residential Repair IFMS No. SC EXE 07000000605 No. 001-6777-4980-95285-0605 First Amendment The Contractor represents and warrants that it has read and shall comply with the requirements of Suffolk County Code Chapter 347, Suffolk County Local Law No. 12- 2001, the Living Wage Law. Required Forms: Suffolk County Living Wage Form LW-1; entitled "Suffolk County Department of Labor - Living Wage Unit Notice of Application for County Compensation (Contract)" Suffolk County Living Wage Form LW-38; entitled "Suffolk County Department of Labor - Living Wage Unit Living Wage CertificationlDeclaration - Subject To Audit" 6. Lawful Hiring of Employees Law This Agreement is subject to the Lawful Hiring of Employees Law of the County of Suffolk (Local Law 52-2006). It provides that all covered employers, (as defined), and the owners thereof, as the case may be, that are recipients of compensation from the County through any grant, loan, subsidy, funding, appropriation, payment, tax incentive, contract, subcontract, license agreement, lease or other financial compensation agreement issued by the County or an awarding agency, where such compensation is one hundred percent (100%) funded by the County, shall submit a completed sworn affidavit (under penalty of perjury), the form of which is attached, certifying that they have complied, in good faith, with the requirements of Title 8 of the United States Code Section 1324a with respect to the hiring of covered employees (as defined) and with respect to the alien and nationality status of the owners thereof. The affidavit shall be executed by an authorized representative of the covered employer or owner, as the case may be; shall be part of any executed contract, subcontract, license agreement, lease or other financial compensation agreement with the County; and shall be made available to the public upon request. All contractors and subcontractors (as defined) of covered employers, and the owners thereof, as the case may be, that are assigned to perform work in connection with a County contract, subcontract, license agreement, lease or other financial compensation agreement issued by the County or awarding agency, where such compensation is one hundred percent (100%) funded by the County, shall submit to the covered employer a completed sworn affidavit (under penalty of perjury), the form of which is attached, certifying that they have complied, in good faith, with the requirements of Title 8 of the United States Code Section 1324a with respect to the hiring of covered employees and with respect to the alien and nationality status of the owners thereof, as the case may be. The affidavit shall be executed by an authorized representative of the contractor, subcontractor, or owner, as the case may be; shall be part of any executed contract, subcontract, license agreement, lease or other financial compensation agreement between the covered employer and the County; and shall be made available to the public upon request. An updated affidavit shall be submitted by each such employer, owner, contractor and subcontractor no later than January 1 of each year for the duration of any contract and upon the renewal or amendment of the contract, and whenever a new contractor or subcontractor is hired under the terms of the contract. AG 6 (3/02) Page 3 AG6 CSE Res Rpr Sohld exl 07 Law No. AG006M/0029-11 RA Rev. 6/25/07 Community Services for the Elderly - Residential Repair IFMS No. SC EXE 07000000605 No. 001-6777-4980-95285-0605 First Amendment The Contractor acknowledges that such filings are a material, contractual and statutory duty and that the failure to file any such statement shall constitute a material breach of this agreement. Under the provisions of the Lawful Hiring of Employees Law, the County shall have the authority to terminate this Agreement for violations of this Law and to seek other remedies available under the law. The Contractor represents and warrants that it has read, is in compliance with, and shall comply with the requirements of Suffolk County Code Chapter 234, Suffolk County Local Law No. 52-2006, the Lawful Hiring of Employees Law. Required Forms: Suffolk County Lawful Hiring of Employees Law Form LHE-1; entitled "Suffolk County Department of Labor -"Notice Of Application To Certify Compliance With Federal Law (8 U.S.C. SECTION 1324a) With Respect To Lawful Hiring of Employees" "Affidavit Of Compliance With The Requirements Of 8 U.S.C. Section 1324a With Respect To Lawful Hiring Of Employees" Form LHE-2. 7. Non Responsible Bidder The Contractor represents and warrants that it has read and is familiar with the provisions of Suffolk County Code Chapter 143, Article II, 99143-5 through 143-9. Upon signing this Agreement the Contractor certifies that he, she, it, or they have not been convicted of a criminal offense within the last ten (10) years. The term "conviction" shall mean a finding of guilty after a trial or a plea of guilty to an offense covered under the provision of Section 143-5 of the Suffolk County Code under "Nonresponsible Bidder." 8. Gratuities: The Contractor represents and warrants that it has not offered or given any gratuity to any official, employee or agent of Suffolk County or New York State or of any political party, with the purpose or intent of securing an agreement or securing favorable treatment with respect to the awarding or amending of an agreement or the making of any determinations with respect to the performance of an agreement, and that he has read and is familiar with the provisions of Local Law No. 32-1980 of Suffolk County (Chapter 386 of the Suffolk County Code). 9. Except as herein amended, all other representations, terms and conditions of said Agreement, including any and all amendments or budget modifications executed prior to the date hereof, are hereby ratified and confirmed to be in full force and effect. -End of Text- AG 6 (3/02) Page 4 AG6 CSE Res Rpr Sohld exl 07 Law No. AG006M/0029-11 RA Rev. 6/25/07 Community Services for the Elderly - Residential Repair IFMS No. SC EXE 07000000605 No. 001-6777-4980-95285-0605 First Amendment Exhibit C-2007 Budget Town of Southold CSE Residential Repair Program April 1 , 2007 - March 31, 2008 PERSONNEL ~20,700 Mechanic I 13,500 Mechanic I 7,200 FRINGE 1.500 TRAVEL 2.200 TOTAL ~24,400 Less Anticipated Income (4,000) NET REIMBURSEMENT S2Q.40Q Suffolk County Legislative Requirements Exhibit for Contracts; last rev. 1/04/07 Suffolk County Legislative Requirements Exhibit for Contracts This exhibit is attached to and is made part of the contract executed with the County. Suffolk County Living Wage Requirements Suffolk County Department of Labor - Living Wage Unit Notice of Application for County Compensation Form LW-1 (consists of 1 page) Suffolk County Department of Labor - Living Wage Unit Certification/Declaration - Subject to Audit Form LW-38 (consists of 1 page) II Contractor'sNendor's Public Disclosure Statement Form SCEX 22; rev. 3/30/04 (form consists of three pages; requires signature & notarization) Note: The Contractor'sNendor's Public Disclosure Statement Form SCEX 22; rev. 3/30/04, III Union Organizing Certification/Declaration - Subject to Audit; rev. 6/05 Form L01 (consists of 2 pages) IV Lawful Hiring Compliance Requirements Notice of Application to Certify Compliance with Federal Law (8 U.S.C. Section 1324A) with Respect to Lawful Hiring of Employees (consists of 1 page) Affidavit of Compliance with the Requirements of (8 U.S.C. Section 1324A) with Respect to Lawful Hiring of Employees (consists of 1 page) I Suffolk County Living Wage Documents Suffolk County Living Wage Requirements Exhibit As Last Revised by the Suffolk County Department of Labor on 5/12/04 Suffolk County Living Wage Requirements Exhibit As Last Revised by the Suffolk County Department of Labor on 5/12/04 Pursuant to Section 6 of Chapter 347 of the Suffolk County Local Law No. 12-2001, "A Local Law to Implement Living Wage Policy for the County of Suffolk" (the "Living Wage Law"), all RFPs, County contracts and financial assistance agreements subject to the law shall contain the following two paragraphs or substantially equivalent language: This Agreement is subject to the Living Wage Law of the County of Suffolk. The law requires that, unless specific exemptions apply all employers (as defined) under service contracts and recipients of County financial assistance, (as defined) shall provide payment of a minimum wage to employees as set forth in the Living Wage Law. Such rate shall be adjusted annually pursuant to the terms of the Suffolk County Living Wage Law of the County of Suffolk. Under the provisions of the Living Wage Law, the County shall have the authority, under appropriate circumstances, to terminate this Agreement and to seek other remedies as set forth therein, for violations of this Law. Suffolk County Local Law No. 18-2002, "A Local Law to Implement Living Wage Policy for the County of Suffolk" provided for certain amendments to the Living Wage Law. ~---------------------------------------------~--------------------------------------------------------------------------- Forms for Completion and/or Signature (as applicable) · Suffolk County Department of Labor - Living Wage Unit Notice of Application for County Assistance (Contract) Form LW-1 (consists of 1 page) · Suffolk County Department of Labor - Living Wage Unit Certification/Declaration - Subject to Audit Form LW-38 (consists of 1 page) (Replaces LW2, LW3 and LW33) · Suffolk County Department of Labor - Living Wage Unit Request for General Living Wage Exemption Form LW-4 (consists of 1 page) · Suffolk County Department of Labor - Living Wage Unit Request for Specific Living Wage Exemption Form LW-5 (consists of 2 pages) 1 of 2 pages Suffolk County Living Wage Requirements Exhibit As last Revised by the Suffolk County Department of labor on 5/12/04 Note: Pursuant to Section 7 of local law NO.18- 2002, "A Local Law to Implement Living Wage Policy for County of Suffolk", all covered employers subject to the provisions of the Living Wage Law shall submit a completed and sworn (under penalty of perjury) Certification/Declaration - Subject to Audit Form LW-38, signed by an authorized representative, as part of an executed contract with the County of Suffolk. The complete CertificationlDeclaration - Subject to Audit Form LW-38 shall be made a part of any executed contract or project agreement and made available to the public upon request. ~~--------------------------------------~----------------------------------------------------------------------- . To certify Living Wage compliance: Return Forms LW-1 and LW-38. or . To certify non-applicability of Living Wage law: Return Form LW-38. or . To request and document a general living wage exemption: Return Forms LW-1, LW-38 and LW-4. or . To request and document a specific living wage exemption: Return Forms LW-1, LW-38 and LW-5. ------------------------------------------------------------------------------------------------------------------------- . In the event that there is a change in circumstances, it is the Contractor's responsibility to submit to the County additional Living Wage forms which either replace or supplement prior submissions of Living Wage forms. . Living Wage Law Information Fact Sheet, text of the Local Law, Frequently Asked Questions, Forms, and Rules and Regulations can be found on the Suffolk County web site at www.co.suffolk.nv.us Click: Department Directory Labor Living Wage Law Info . Suffolk County Department of Labor Living Wage Unit Tel. (631) 853-3808 End of Text for Suffolk County Living Wage Requirements Exhibit As last Revised by the Suffolk County Department of labor on 5/12/04 2 of 2 pages II Contractor'sNendor's Public Disclosure Statement 6. 7. 8. 9. 10. Suffolk County Form 22 Contractor'sNendor's Public Disclosure Statement Pursuant to Section A5-7 of the Suffolk County Administrative Code, this Public Disclosure Statement must be completed by all contractors/vendors that have a contract with Suffolk County. In the event contractor/vendor is exempt from completing paragraphs numbered I through I I below, so indicate at paragraph number 12 below setting forth the reason for such exemption. Notwithstanding such exempt status, you must execute this form below before a notary public. 1. 2. ~ Contractor'sNendor's Name Address ( . City and State Zip Code {( 9: '1 ( - 0 (57 Contracting Department's Name ~~~ )I?~) r'7l;...r Address 1"')0 ~ c:.i-f'.,'c S+: rK . ~+'''f,''fu(L. AlYa(0o?, Payee Identification or Social Security No. r Type of Business_Corporation _Partnership_Sole Proprietorship_Other Is contractor/vendor entering into or has contractor/vendor entered into a contract with Suffolk County in excess of $1 ,OOO? _Yes_No. Has contractor/vendor entered into three or more contracts, including the one for which you are now completing this form, with Suffolk County, any three of which, when combined, exceed $I,OOO? _Yes_No. Table of Organization. List names and addresses of all principals; that is, all individuals serving on the Board of Directors or comparable body, names and addresses of all partners, and names and addresses of all corporate officers. Conspicuously identify any person in this table of organization who is also an officer or an employee of Suffolk County. (Attach additional sheet if necessary. ) 51 3. 4. 5.3 5.b List all names and addresses of those individual shareholders holding more than five percent (5%) interest in the contractor/vendor. Conspicuously identify any shareholder who is also an officer or an employee of Suffolk County. (Attach additional sheet if necessary). Does contractor/vendor derive 50% or more of its total revenues from its contractual or vendor relationship with Suffolk County? _Yes_No. If you answered yes to 8 above, you must submit with this disclosure statement, a complete financial statement listing all assets and liabilities as well as a profit and loss statement. These statements must be certified by a Certified Public Accountant. (Strike this out if not applicable.) The undersigned shall include this Contractor'sNendor's Public Disclosure Statement with the contract. (Describe general nature of the contract.) Page I 00 Public Disclosure Form 11. Remedies. The failure to file a verified public disclosure statement as required under local law shall constitute a material breach of contract. Suffolk County may resort, use or employ any remedies contained in Article II of the Uniform Commercial Code of the State of New York. In addition to all legal remedies, Suffolk County shall be entitled, upon a determination that a breach has occurred, to damages equal to fifteen percent (15%) of the amount of the contract. 12. If you are one of the entities listed below at a) through c) or you qualify under d) below, you are exempt from completing paragraphs numbered I through I I herein: _ a) Hospital =:2b) Educational or governmental entities _ c) Not-for-profit corporations _ d) Contracts providing for foster care, family day-care providers or child protective services Please check to the left side of the appropriate exemption. 13. Verification. This section must be signed by an officer or principal of the contractor/vendor authorized to sign for the company for the purpose of executing contracts. The undersigned being sworn, affirms under the penalties of perjury, that he/she has read and understood the foregoing statements and that they are, to hislher own kn edge, true. Dated: ~li"G7 Printed Nam of 8'lgner: Title of Signer: Name of Contractor /Vendor: - ~~A:::L'r~ _ T 1 ;{2.-- r) cA. H n IC/ Signed: UNIFORM CERTIFICATE OF ACKNOWLEDGMENT (Within New York State) STATE OF NEW YORK) COUNTY OF5u.ffbLt.:-) ss.: On the / Z ~ of ---I...J (..( ~,r in the year 2007 before me, the undersigned, personally appeared \;-.::otf.4. <..(m/( per onally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged 10 me that he/she/they executed the same in his/her/their capacity(ies) and that by hislher/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument. ~'L..-() ~ (signature and offictlof individual taking acknowledgement) NOT LINDA J COOPER ARY PUBLIC S ~O. 01C04822563,t;l~f?;'~~W York erm EXPires December 31, 2~~ Page 2 of 3 Public Disclosure Form UNIFORM CERTIFICATE OF ACKNOWLEDGEMENT (Without New York State) STATE OF ) )ss.: ) COUNTY OF On the day of in the year 2007 before me, the undersigned, personally appeared personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in hislher/their capacity(ies) and that by hislherltheir signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument, and that such individual(s) made such appearance before the undersigned in (Insert the city or other political subdivision and the state or country or other place the acknowledgement was taken) (signature and office of individual taking acknowledgement) Contractor'slVendor's Public Disclosure Statement Form (Rev. 3/04) Page 3 of 3 Public Disclosure Form H:\TBlumenauer\masler forms,labels\pub disc form22.doc III Union Organizing CertificationlDeclaration-Subject to Audit Suffolk County, New York Department of Labor SUFFOLK COUNTY DEPARTMENT OF LABOR- LABOR MEDIATION UNIT UNION ORGANIZING CERTlFICA TIONIDECLARA TlON - SUBJECT TO AUDIT If the following definition of "County Contractor" (Union Organizing Law Chapter 466-2) applies to the contractor's/beneficiary's business or transaction with Suffolk County, the contractor/beneficiary must complete Sections I, '", and IV below, If the following definitions do not apply, the contractorlbeneficiary must complete Sections II, III and IV below, Completed forms must be submitted to the awarding agency, County Contractor: "Any employer that receives more than $50,000 in County funds for supplying goods or services pursuant to a written contract with the County of Suffolk or any of its agencies; pursuant to a Suffolk County grant; pursuant to a Suffolk County program; pursuant to a Suffolk County reimbursement for services provided in any calendar year; or pursuant to a subcontract with any of the above," Section I The Union Organizing Law applies to this contract Ilwe hereby agree to comply with all the provisions of Suffolk County Local Law No, 26-2003, the Suffolk County Union Organizing Law (the law) and, as such shall not use County funds to assist, promote, or deter union organizing (Chapter 466-3 A), nor seek reimbursement from the County for costs incurred to assist, promote, or deter union organizing. (Chapter 466-3 B) Check if IIwe further agree to take all action necessary to ensure that County funds are not used to assist, promote, or deter Applicable union organizing. (Chapter 466-3 H) ~ I/we further agree that if any expenditures or costs incurred to assist, promote, or deter union organizing are made, IIwe shall maintain records sufficient to show that no County funds were used for those expenditures and, as applicable, that no reimbursement from County funds has been sought for such costs. Ilwe agree that such records shall be made available to the pertinent County agency or authority, the County Comptroller, or the County Department of Law upon request (Chapter 466-3 I) Ilwe further affirm to the following: . IIwe will not express to employees any false or misleading information that is intended to influence the determination of employee preferences regarding union representation; . Ilwe will not coerce or intimidate employees, explicitly or implicitly, in selecting or not selecting a bargaining representative; . Ilwe will not require an employee, individually or in a group, to attend a meeting or an event that is intended to influence his or her decision in selecting or not selecting a bargaining representative; . IIwe understand mylour obligation to limit disruptions caused by prerecognition labor disputes through the adoption of none on fro ntationa I procedures for the resolution of pre recognition labor disputes with employees engaged in the production of goods or the rendering of services for the County; and . IIwe have or will adopt any or all of the above-referenced procedures, or their functional equivalent, to ensure the efficient, timely, and quality provision of goods and services to the County. IIwe shall include a list of said procedures in such certification. IIwe further agree that every County contract for the provision of services, when such services will be performed on County property, shall include a requirement that IIwe adopt a reasonable access agreement, a neutrality agreement, fair communication agreement, no intimidation agreement, and a majority authorization card agreement. Ilwe further agree that every County contract for the provision of human services, when such services are not to be performed on County property, shall include a requirement that Ilwe adopt, at the least, a neutrality agreement. I1we understand that the efficient, timely, and nondisruptive provision of goods and services is a paramount financial interest of the County of Suffolk and as such, the County expects the potential County contractor to protect the County's financial interest by adopting nonconfrontational procedures for the orderly resolution of labor disputes, including, but not limited to, neutrality agreements, majority authorization card agreements, binding arbitration agreements, fair communication agreements, non intimidation agreements, and reasonable access agreements. DOL-LOI (6/05) Suffolk County. New York Department of Labor Section II The Union Organizing Law does not apply to this contract for the following reason(s): D Check if Applicable See lion III Jl _ c' /1 / I Contractor Name: '-;,')11 nT ') ~ u-fil0 ((j Federal Employer ID#: Contractor Address: c:; '3 () (j)./ oJ. f/ ,(./.; to 15 (( '7 '1 Amount of Assistance: ~ u+h~/rI" /.Jy u?1(- 0'1.)1 Vendor#: ContractorPhone#: 0-7/ 1t>.F r'bt? IY1 tj,)/-,)('{r- fcf60 Description of project or service: C);f: Kf?,;jen{;ct ( /&'fAA ~Jro,ri.-1.-hn {(-(POOl r.J'( J'fO K'CO. Do , )(.41(0'---5 Section IV I declare under penalty of perjury under the Laws of the State of New York that the undersigned is authorized to provide this cenification, and that the above is tr::zect. 4:7 '4 ~A.UA/-t/ Date ~~/? Authorized Signature 0( DOL-WI (6/05) IV Lawful Hiring Compliance Requirements . . IV Suffolk County's Lawful Hiring of Employee's Law Compliance Requirements The following forms may be necessary for certify compliance to with Federal Law (8 U.S.C. Section 1324A) with Respect to Lawful Hiring of Employees Suffolk County's Lawful Hiring of Employees Law. Forms: . LHE-1-Lawful Hiring of Employees . LHE-2-Affidavit of Compliance . LHE-3-Submission . LHE-4-Complaint . LHE-5-Appeal . LHE-6-Non-Applicability . LHE-7-Sign-in Sheet