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Home My WebLink AboutGreenways Agreement WILLIAM M.DUFFY SCOTT A.RUSSELL TOWN ATTORNEY O*QF s®Ujy� Supervisor bill.duffy@town.southold.ny.us � ® Town Hall Annex,54375 Route 25 STEPHEN F.KIELY P.O.Box 1179 ASSISTANT TOWN ATTORNEY JJF stephen.kiely@town.southold.ny.us Southold,New York 11971-0959 LORI M.HULSE `+0UTelephone(631) 765-1939 ASSISTANT TOWN ATTORNEY , Facsimile(631) 765-6639 lori.hulse@town.southold.ny.us OFFICE OF THE TOWN ATTORNEY TOWN OF SOUTHOLD RECEIVED MAR 2 4 2016 March 23, 2016 M r_Southold Town Clerk Ms. AnaMarie Cuccineillo, Contracts Examiner Suffolk County Dept. of Parks, Recreation and Conservation P.O. Box 144 West Sayville, NY 11796-0144 Re: Strawberry Fields (Greenways Agreement), Inlet Pond County Park, Laurel Lake Preserve Dear Ms. Cucciniello: Pursuant to your letter dated January 29, 2016 in connection with the referenced matter, I am enclosing a completed Lawful Hiring Forms for each License Agreement, which has been executed by Supervisor Russell before a notary public. If you require anything further in this regard, please do not hesitate to call me. Very truly yours, Mary Silleck Secretary to the Town Attorney /ms Enclosure cc: Ms. Elizabeth A. Neville, Town Clerk (w/encl.) � 4 •y3yC5C ti t Steven Bellone f��f.. �3 Frank Nardelli Suffolk County Executive 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/COMPANY NAME: ADDRESS: NOT-FOR-PROFIT: YES NO (Submit Proof of IRS Not-for-Profit Status) VENDOR# (If known): 16-,V CONTRACT ED ((If known): CONTACT: SICU e� � G—�1C1'� TELEPHONE#: 6,31 - 76) -5 I TERM OF CONTRACT OR EXTENSION(PROVIDE DATES): r BRIEF DESCRIPTION OF COMPENSATION,PROJECT OR SERVICE l lln orIyko)QlnLS 4-- 11- Gal fl e- alncC S {�c� 6.e j Ct S SUBCONTRACTOR: ADDRESS: VENDOR#: TELEPHONE#: CONTACT: 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) ,`zQ � Farr Steven Bellone Frank Nardelli Suffolk County Executive 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 ) Prss: � County of S�I�t o`IV,— ) SC,?4- - �-- LASS< �' , being duly sworn, deposed and says: (Print Name of Deponent) L , 1. I am owner/authorized representative of TOCP-' (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 the alien and nationality status of the owners thereof, as set forth in Suffolk County Code Chapter 353 (2006). (Signature of Deponent) nel Sworn to before me this 02 day of nA(k(Yh. , 20 1� (Notary Public) LAUREN M.STANDISH Notary Public,State of New York No.01 ST6164008 Qualified in Suffolk county Commission Expires April 9,2019 DOL LHE-2(revised 1/15) :to1e-t NoM Steven BelloneFrank Nardelli Suffolk County Executive 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/ (( t BUSINESS/CnOMPANYNAME: �LL�n 'Tfl�10� ADDRESS: YI � �� NOT-FOR-PROFIT: YES NO (Submit Proof of IRS Not-for-Profit Status) VENDOR# (If known): (oGO CONTRACT ID (—ktn—own): { �/l CONTACT: . cun)C- iC_S l p x-1«'1 TELEPHONE#: Com -IfJ TERM OF CONTRACT OR EXTENSION(PROVIDE DATES): BRIEF DESCRIPTION OF COMPENSATION,PROJECT OR SERVICE /j i V Q Le[,0 C,�o a t),rc4 i1 V 4- 7 7 di /S 11 C��c�r'L C e,I-ez Zni V, tram mk n JAI t� d c (A-�n SUBCONTRACTOR: ADDRESS: VENDOR#: TELEPHONE#: CONTACT: 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) (A' Steven Bellone Frank Nardelli Suffolk County Executive - 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 'SC 0 + V �' L!SsL� , being duly sworn, deposed and says: (Print Name of Deponent) 1. I am owner/authorized representative of 6i-jn o4 Sajf�6l (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 the alien and nationality status of the owners thereof, as set forth in Suffolk County Code Chapter 353 (2006). 2L ( � (Signature of Deponent) Sworn to before me this o day LAUREN M.STANDISH of ODD , 20 Notary Public,State of New York No.01ST6164008 Qualified in Suffolk County �Yl , h Commission Expires April 9,2019 t ry Public) DOL LHE-2(revised 1/15) Steven Bellone Frank Nardelli Suffolk County Executive 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/ jj '� BUSINESS/COM-PANY NAME: 7-0 t�� "� ��`tel Q ADDRESS: t' - ` ?StX I1-79 , Sou 4ko160,4- 11 -7 NOT-FOR-PROFIT: YES—�,� NO (Submit Proof of IRS Not for-Profit Status) VENDOR#(If known): ► O2, 14 -9- 1 t— G cam' 1,01 CONTRACT ID:J(Ipf known): �j CONTACT: 4nl es MC'_Hav oll TELEPHONE#: k3 j ` lks_ /,07 3 TERM OF CONTRACTOR EXTENSION(PROVIDE DATES): e�2?0 Lj_eAV-S dCo -Id(-125 BRIEF DESCRIPTION OF COMPENSATION,PROJECT OR SERVICE SUBCONTRACTOR: /V f 6 ADDRESS: VENDOR#: TELEPHONE#: CONTACT: 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) Frank Nardelli Steven Bellone Suffolk County Executive 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 ) r ss: County of SJ T L I L ) `7 C-o4 L being duly sworn, deposed and says: (Print Name of Deponent) f 1. I am owner/authorized representative of C)c J n � (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 the alien and nationality status of the owners thereof, as set forth in Suffolk County Code Chapter 353 (2006). -J&w-t&A*w (Signature of Deponent) KA Sworn to before me this o day of ftk-rV\ , 20 1� akyun "m -440dul-i (Notary Public) LAUREN M.STANDISH Notary Public,State of New York No.01ST6164008 Qualified in Suffolk County Commission Expires April 9,2019 DOL LHE-2(revised 1/15)