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HomeMy WebLinkAboutGreenways AgreementMARTIN D. FINNEGAN TOWN ATTORNEY martin.finnegan@town.southold.ny.us STEPHEN F. KIELY ASSISTANT TOWN ATTORNEY stephen.kiely@town.southold.ny.us LORI M. HULSE ASSISTANT TOWN ATTORNEY lori.hulse@town.southold.ny.us of So�ryo� h O ` ,COUNTi SCOTT A. RUSSELL Supervisor Town Hall Annex, 54375 Route 25 P.O. Box 1179 Southold, New York 11971-0959 OFFICE OF THE TOWN ATTORNEY TOWN OF SOUTHOLD February 12, 2015 Suffolk County Department of Parks, Recreation & Conservation P.O. Box 144 West Sayville, NY 11796-0144 Attention: Ms. Tracy Seeba, Contracts Unit Telephone (631) 765-1939 Facsimile (631) 765-6639 RECEIVED F E'-' i Southold Town Clerk Re: Strawberry Fields (Greenways Agreement), Inlet Pond County Park, Laurel Lake Preserve Dear Ms. Seeba: Pursuant to your letter dated January 22, 2015, 1 am enclosing the completed and executed Lawful Hiring Forms in connection with the referenced matter. We will retain copies in our file. If you have any questions regarding the enclosed, please do not hesitate to call me. Thank you for your attention. Very truly yours, fnnfKrauza Secretary to the Town Attorney /lk Enclosures cc: Elizabeth A. Neville, Town Clerk Steven Bellone' Suffolk County Executive J'[ ( QIiCJdJ li• •/ 1 L �✓�LU� Frank Nardelli Acting Commissioner SUFFOLK COUNTY DEPARTMENT OF LABOR, LICENSING, & CONSUMER AFFAIRS NOTICE OF APPLICATION TO CERTIFY COMPLIANCE WITH FEDERAL LAW (8 U.S.C. SECTION 1324A) WITH RESPECT TO LAWFUL HIRING OF EMPLOYEES Suffolk County Code, Chapter 353 (2006) To Be Completed By Applicant/covered Employer/Owner BUSINESS COMPANY NAME: / pCAJ ✓l O �` �,� Get 0 CC ADDRESS: e, 0, dox ((/? 2, !�a(,f-4,o k, viii( x[7171' 0� S% NOT-FOR-PROFIT: YES NO (Submit Proof of IRS Not -for -Profit Status) VENDOR # (If known): CONTRACT ID (If known): CONTACT: �GL�CGI`S� TELEPH NE #: /It02 T3 TERM OF CONTRACT OR EXTENSION (PROVIDE DATES): ® -2Z v �rS BRIEF DESCRIPTION OF r VENDOR#: CONTACT: TELEPHONE #: 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, Section 353-14 (A): 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 -1B 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. DOL: LHE-1 (revised 1/15) Steven Bellone ' Frank Nardelli Suffolk County Executive Acting Commissioner SUFFOLK COUNTY DEPARTMENT OF LABOR, LICENSING & CONSUMER AFFAIRS AFFIDAVIT OF COMPLIANCE WITH THE REQUIREMENTS OF 8 U.S.C. SECTION 1324a WITH RESPECT TO LAWFUL HIRING OF EMPLOYEES State of New York ss: County of 54&]F:E(� l k ) 4� c l SSC - (Z , being duly sworn, deposed and says: (Print Name of Deponent) 1. I am owner authorized representative f �/ c�� �'� �� "-�10 /0/ (Circ a one) (Name of Corp., Business, Company) 2. I certify that I have complied, in good faith, with the requirements of Title 8 of the United States Code (U.S.C.) section 1324a (Aliens and Nationality) with respect to the hiring of covered employees and with L ebp';Ct to the alien mid nationality status of the ownei s thereof, as set forth in Suffbik eounty eode Chapter 353 (2006). (Signature of Deponent) Sworn to before me this /Q� day of — 20j-,5-- /) h (Notary Public) LAUREN M. STANDISH Notary Public, State of New Yak No. 01ST6164008 Qualified in Suffolk Courft Commission Expires April 9, 2015 DOL: LHE-2 (revised 1/15) Steven Bellone y Frank Nardeili Suffolk County Executive Acting Commissioner SUFFOLK COUNTY DEPARTMENT OF LABOR, LICENSING, & CONSUMER AFFAIRS NOTICE OF APPLICATION TO CERTIFY COMPLIANCE WITH FEDERAL LAW (8 U.S.C. SECTION 1324A) WITH RESPECT TO LAWFUL HIRING OF EMPLOYEES Suffolk County Code, Chapter 353 (2006) To Be Completed By Applicant/Covered Employer/Owner EMPLOYER/CORP/ BUSINESS/COM�ME PANY NA: Uj /1 OP �Sn i c O�Cl� ADDRESS: r/ 0- '9px (�I `74 -50C�y 0 1a/_f�� NOT-FOR-PROFIT: YES NO (Submit Proof of IRS Not -for -Profit Status) VENDOR # (If known): CONTRACT ID (If knon(wn)): CONTACT: TELEPHO #: TERM OF CONTRACT OR EXTENSION (PROVIDE DATES): BRIEF DESCRIPTION OF COMPENSATION, PROJECT OR SERVICE / u f P l r" h C G' t SUBCONTRACTOR: /V VENDOR#: CONTACT: TELEPHONE #: 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, Section 353-14 (A): 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 -IB 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. DOL: LHE-1 (revised 1/15) Steven Bellone Frank Nardelli Suffolk County Executive Acting Commissioner SUFFOLK COUNTY DEPARTMENT OF LABOR, LICENSING & CONSUMER AFFAIRS AFFIDAVIT OF COMPLIANCE WITH THE REQUIREMENTS OF 8 U.S.C. SECTION 1324a WITH RESPECT TO LAWFUL IMUNG OF EMPLOYEES State of New York nn County of _� C.."_ -Apo (/ ) ss: ,Zq_ A L -S E /being duly sworn, deposed and says: (Print Name of Deponent) I am owneauthorized representative of c,Jyi o 5.0c,C'`t�0AW (Circle one (Name of Corp., Business, Company) 2. I certify that I have complied, in good faith, with the requirements of Title 8 of the United States Code (U.S.C.) section 1324a (Aliens and Nationality) with respect to the hiring of covered employees and with respect to die afien mid nationality status of die owners thereof, as set fbrth in suffolkeotmty rGode Chapter 353 (2006). (Signature of Deponent) Sworn to before me this a day of r- blra 20_1,:�' ►i4 h Votary Public) t.AUREN M. STANDtSH Notary Nob101YolkST6 8 008 oualified in Suffolk Ap�*015 commission Expires DOL: LH&2 (revised 1/15) Steven Bellone Frank Nardelli Suffolk County Executive Acting Commissioner SUFFOLK COUNTY DEPARTMENT OF LABOR, LICENSING, & CONSUMER AFFAIRS NOTICE OF APPLICATION TO CERTIFY COMPLIANCE WITH FEDERAL LAW (8 U.S.C. SECTION 1324A) WITH RESPECT TO LAWFUL HIRING OF EMPLOYEES Suffolk County Code, Chapter 353 (2006) To Be Completed By Applicaut/Covered Employer/Owner EMPLOYER/CORP/ 11 BUSINESS/COMPANY NAME: (Ij n � So cxc z—n D kp( ADDRESS:...P D_ i3 ox ((I 1�, o tgt, ,L� NOT-FOR-PROFIT: YES NO (Submit Proof of IRS Not for -Profit Status) VENDOR # (If known): CONTRACT ID (If known): ` CONTACT: TELEPHONE #: 6"5-- l a f3 TERM OF CONTRACT OR EXTENSION (PROVIDE DATES): BRIEF DESCR3PTION OF COMPENSATION, PROJECT OR SERVICE SUBCOkTRACTOR: -Al / ,e ADDRFCfi• VENDOR#: CONTACT: TELEPHONE #: 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, Section 353-14 (A): 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 -IB 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. DOL: LHE-1 (revised 1/15) Steven Bellone Frank Nardelli Suffolk County Executive Acting Commissioner SUFFOLK COUNTY DEPARTMENT OF LABOR, LICENSING & CONSUMER AFFAIRS___ AFFIDAVIT OF COMPLIANCE WITH THE REQUIREMENTS OF 8 U.S.C. SECTION 1324a WITH RESPECT TO LAWFUL HIRING OF EMPLOYEES State of New York ) ss: County of —:5- ( k ) 5O-e7f4 A /Z.c sC C'. (, being duly sworn, deposed and says: (Print Name of Deponent) 1. I am owner uthorized representative of Dt')pq C>ip S©u (Circle one (Name of Corp., Business, Company) 2. I certify that I have complied, in good faith, with the requirements of Title 8 of the United States Code (U.S.C.) section 1324a (Aliens and Nationality) with respect to the hiring of covered employees and with respect to die afien mid nationafity status of die owners thereof, as set fbrth in Suffolk Go—�&&jy- IV-dwe Chapter 353 (2006). (Signature of Deponent) Sworn to .before me this /0 day of r—Cir,-c T, 20� 6 'Kdtary Public) LAUREN M. STANDISH Notary Public, State of New York No. 01ST6164008 Qualified in Suffolk County Commission Expires April 9, 2015 DOL: LHE•2 (revised 1/15)