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Home My WebLink AboutGreenways Agreement WILLIAM McQUAID DUFFY SCOTT A.RUSSELL TOWN ATTORNEY O�*QF SU!/lyol Supervisor bill.duffy a town.southold.ny us DAMON A. RAGAN Town Hall Annex, 54375 Route 25 ASSISTANT TOWN ATTORNEY P.O.Box 1179 damonh@southoldtownny.gov G Southold, New York 11971-0959 IC2 a�� Telephone(631) 765-1939 CQ(f m,�`f•` Facsimile (631) 765-6639 OFFICE OF THE TOWN ATTORNEY TOWN OF SOUTHOLD RECEIVED APR 1 3 2018 April 12, 2018 Southold Town Clerk Ms. Emily R. Lauri Community Relations Director 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. Lauri: Pursuant.to your letter dated March 20, 2018 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 S)ill Secretary to the Town Attorney /ms Enclosure / cc: Ms. Elizabeth A. Neville, Town Clerk (w/encl.) d Steven Bellone M. 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 f C EMPLOYER/CORP:' • BUSINESS/COMPANY NAME: j�Jn,�j0+ ADDRESS .l 4\6 k ` CONTACT NAME: T(�urne , 'h L 1 1W1M TELEPHONE A Al AWARDING AGENCY: VENDOR,FEDERAL ID OR SOCIAL SECURITY#: CONTRACT ID: NOT-FOR-PROFIT:YES NO (Submit Proof of IRS Not-for-Profit Status) , + TERM OF CONTRACT OR EXTENSION(PROVIDE DATES): r.O u4- i—Q f yl BRIEF DESCRIPTION OF C ENSATION,PROJECT PR SERVICE: r(1 V %1L gAktrl kod/N c e_- S SUBCONTRACTOR N , A fl I-+' ADDRESS: VENDOR,FEDERAL ID OR SOCIAL SECURITY#: TELEPHONE#: CONTACT NAME: DESCRIPTION OF COMPENSATION,PROJECT OR SERVICE: EVIDENCE OF COMPLIANCE: Copies ofthe following must be maintained by covered employers or the owners thereof for each employee for thetime 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. 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 Scd+- A �,e�,Sek,being duly sworn,deposes and says: (Print Name of Deponent) _( c �Q,,,� 1. I am owner authorize presentative of Vw n 64 y ZX ' *''6( (Circ one) (Name of Corp.,Business,Company) 2. 1 certify that I have complied,in good faith,with the requirements of Title 8 of the Ugifd States Code(U.S.C.)section 1324a(Aliens and Nationality)with respect to the hiring of covered employees and with respect to the ' n and nati nality statayof the owners thereof,as set forth in Suffolk County Code Chapter 353(2006). Sworn to before me this day (Signature of Deponent) A 6 t 20 (Notary Public) LAUREN M. STANDISH DOL-LHE1/2(revised 8/17) Notary Public, State of New York No 01ST6164008 Qualified in Suffolk County Commission Expires April 9, 2019 lore 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 n v (( EMPLOYERtCORPBUSINESS/COMPANY NAME: T l� ADDRESS: b0s17 cJ QL CONTACT NAME:\�N rr�S I lC. �c1Y1 a TELEPHONE# I z�3.AWARDING AGENCY: VENDOR,FEDERAL ID OR SOCIAL SECURITY#: ^ [n� I �h CONTRACT ID: NOT-FOR-PROFIT:YES NO (Submit Proof ofIRS Not for-Profrt Stares) TERM OF CONTRACT OR EXTENSION(PROVIDE DATES): BRIEF DESCRIPTION OF COMPENSATION,PROJECT OR SERVICE: SUBCON'T'RACTOR NAME: ADDRESS: VENDOR,FEDERAL ID OR SOCIAL SECURITY#: TELEPHONE#: CONTACT NAME: . 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. AFFIDAVIT OF COMPLIANCE WITH THE REQUIREMENTS OF 8 U.S.C.SECTION 1324a WITH RESPECT TO LAWFUL HIRING OF EMPLOYEES State of New York ) C ss: County of. S-U I ) being duly sworn,deposes and says: (Print Name of Deponent) 1 I am owner/ thori presentative of UJ r1 04 (&�f (Name of Corp.,Business,Company) 2. 1 certify that I have complied,in good faith,with the requirements of Title 8 of the Ikited States Code(U.S.C.)section 1324a(Aliens and Nationality)with respect to the hiring of covered employees and with respect A ien and na' nality of the owners thereoty as set forth in Suffolk County Code Chapter 353(2006). 11 Sworn to before me this day igrrature of Deponent) of 1 20 .Lu S Notat Public) MARY L. SILLECK Notary Public, State of New York DOL-LHE1/2 (revised 8/17) No.01 S14984608 Qualified in Suffolk County�� Commission Expires July 29, 7N Steven BelloneF` 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,IChapter 353(2006) To Be Completed By Applicant/Covered Employer/Owner EMPLOYER/CORP/BUSINESS/COMPAIl NY NAME: I,DWO O ADDRESS: 10 S0,)4-t,6 li . t I I( I CONTACT NAME. & (/ C)Y^ TELEPHONE N:�G31 7(t 11B AWARDING AGENCY:.. VENDOR,FEDERAL ID OR SOCIAL SECURITY#: CONTRACT ID: NOT-FOR-PROFIT:YES NO (Submit Proof of IRS Not-for-Profit Status) TERM OF CONTRACT OR EXTENSION(PROVIDE DATES): o1W 5-I aoaS B F DESCRIPTION OF COMPENSATION,PROJECT OR SERVICE: SUBCONTRACTOR NAb'IE: .. ADDRESS: VENDOR,FEDERAL ID OR SOCIAL SECURITY#: TELEPHONE#: . CONTACT NAME: DESCRIPTION OF COMPENSATION,PROJECT OR SERVICE: EVIDENCE OF COMPLIANCE: Copies ofthe 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. 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 �y�! l� } ssi` i�USS-e—� ,being duly sworn,deposes and says: (Print Name of Deponent) T1 1 I am owner/authorized representative of y '6 (Circle one) (Name of Corp.,Business,Company) 2. 1 certify that I have complied,in good faith,with the requirements of Title 8 of the U States Code(U.S.C.)section 1324a(Aliens and Nationality)with respect to the hiring of covered employees and with respect to the " n and na•onality sta of the owners thereof,as set forth in Suffolk County C19 Qde Chapter 353(2006). Sworn to before me this fL day ature of Deponent) of '20 I b :Y&6=�&to q (Notary Public) LAUREN M. STANDISH DOL-LHE1/2 (revised 8/17) Notary Public, State of New York No. 01ST6164008 Qualified in Suffolk County Commission Expires April 9, 2019