HomeMy WebLinkAboutInlet Pond Park Compliance DEPARTMENT OF
PARKS, RECREATION AND CONSERVATION
COUNTY OF SUFFOLK
STEVE LEVY
SUFFOLK COUNTY EXECUTIVE
JOHN W. PAVACIC
COMMISSIONER
TRACEY BELLONE
DEPUTY COMMISSIONER
January 11,2010
Honorable Scott A. Russell
Town of Southold
PO Box 1179
53095 Main Road
Southold, NY 11971
RE: INLET POND COUNTY PARK
Dear Supervisor Russell:
Pursuant to your License Agreement with Suffolk County, all Licensees are contractually required
to comply with the laws and Charters of Suffolk County.
The Lawful Hiring Law requires Licensees to submit Lawful Hiring Forms each and every year of
their License Agreement. Failure to file any such statement shall constitute a material breach of
the agreement. Under the provisions of the Lawful Hiring of Employees Law, the County shall
have the authority to terminate an Agreement for violations of the Law and to seek other
remedies available under the law.
To satisfy this License requirement, please complete the enclosed forms. Attention is called
specifically to having page LHE-2 notarized and LHE-1 filled out in its entirety.
Please forward the completed paperwork to the Contracts Unit to the attention of JoAnn
Williams, Administrative Aide. If you have any questions, feel free to call Mrs. Williams at 854-
4983.
Sinc~e~ly,
Colleen Logan Hofmeister
Contracts Manager
cc: Scott Stocker, Auditor
MONTAUK HIGHWAY- P.O. BOX 144
WEST SAYVILLE, NEW YORK 117964)144
(631)854~.949 FAX: (631)854-4977 ....... '""'
]PARKS
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
Suffolk Count~' Code, Chapter 234 (2006/
To Be Completed By Applicant/Covered Employer//Owner
EMPLOYER/CORP./BUSINESS/COMPANY NAME:
1) ADDRESS:
2) NOT-FOR-PROFIT: YES__ NO__ (SUBMIT PROOF OF IRS NOT-FOR-PROFIT STATUS)
3) VENDOR#:
' (If known)
: 5) CONTACT:
4) **CONTRACT ID:
6) TELEPHONE #:
(If known)
7) TERM OF CONTRACT OR EXTENSION (PROVIDE DATES):.
8) AMOUNT OF CONTRACT OR EXTENSION:
9) BRIEF DESCRIPTION OF PROJECT OR SERVICE
SUBCONTRACTOR:
1) ADDRESS:
2) VENDOR#: 3) TELEPHONE #:
4) CONTACT:
5) DESCRIPTION OF COMPENSATION, PROJECT OR SERVICE:
EVIDENCE OF COMPLIANCE:
COPIES OF THE FOLLOWING MUST BE MAINTAINED BY COVERED EMPLOYERS OR THE
OWNERS THEREOF FOR EACH EMPLOYEE FOR THE TIME PERIODS SET FORTH IN SUFFOLK
COUNTY CODE, CHAPTER 234, SECTION 5 (C):
A. United States passport; or
B. resident alien card or alien registration card; or
C. birth certificate indicating that person was born in the United States; or
D. (1) a driver's license, if it contains a photograph of the individual; and
(2)a social security account number card (other than such a card which
specifies on its face that the issuance of the card does not authorize
employment in the United States); or
E. employment authorization documents such as an H-lB visa, H-2B visa,
and L-1 visa, or other work visa as may be authorized by the United
States Government at the time the County contract is awarded for all
covered employees. LHE-1 (03/07)
AFFIDAVIT OF COMPLIANCE
WITH THE REQUIREMENTS OF
8 U.S.C. SECTION 1324a
WITH RESPECT TO LAWFUL HIRING OF EMPLOYEES
State of New York
County of
., being duly sworn, deposed and says:
(Print Name of Deponent)
1. I am owner/authorized representative of
(Circle one)
(Name of Corp., Business, Company)
I certify that I have complied, in good faith, with the requirements of Title 8 of thc United
States Code (U.S.C.) section 1324a (Aliens and Nationality) with respect to the hiring of
covered employees and with respect to the alien and nationality status of the owners
thereof, as set forth in Suffolk County Code Chapter 234 (2006).
(Signature of Deponent)
Sworn to before me this
of ,20
__ day
(Notary Public)
LHE-2
(01/07)
SUFFOLK COUNTY DEPARTMENT OF LABOR
NOTICE OF NON-APPLICABILITY FOR COMPLIANCE WITH FEDERAL LAW
(8 U.S.C. SECTION 1324A)
WITH RESPECT TO LAWFUL HIRING OF EMPLOYEES
Suffolk County Code, Chapter 234 /2006)
To Be Completed By Awarding Agency
The Lawful Hiring of Employees Law does not apply to the covered employer, contractor or sub-
contractor, listed below. Please check the appropriate box to indicate the basis for non-applicability.
Contractor Name:
Contractor Address:
Federal Employer ID#
Contractor Phone #:
Description of project or service:
1)
[~ Recipients of compensation from the County, through any grant, loan,
subsidy, agreement, lease or other financial compensation agreement issued by
the County or awarding agency, where such compensation is NOT one hundred
percent (100%) funded by the County.
2) I___l This law shall not apply to the subcontractors of not-for-profit
corporations.
Authorized County Signature
Date
Print Name and Title of Authorized County Representative
LHE-6
(0 /07)