Attachments for 06-07 RFCR for WorkSource contractors - Download Now DOC

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Attachments for 06-07 RFCR for WorkSource contractors - Download Now DOC Powered By Docstoc
					                                                                              RFCR—Form 1
                                                                              PY 2012-2013
    FamilySource, Specially Targeted, Day Laborer, and BusinessSource Systems
                     Request for Contract Renewal Checklist
Contractor:

                                    Completion Status                     Guidelines

Form 1                                                     Please include completed checklist with
RFCR Document Checklist            Completed:              RFCR submission


                                                           Please include the completed Contractor
Form 2
                                                           General Information Form with RFCR
Contractor General Information     Completed:              submission.
                                   No Change:

                                   Revised and attached:
                                      Agency Legal Name    If there have been any changes to your
                                      Corporate Status     Agency’s Legal Name, Corporate Status,
                                                           City Business License Number, IRS
                                      City Business
Corporate Documents                                        Taxpayer Identification Number, Articles
                                   License Number          of Incorporation, or Corporate Bylaws, or
                                      IRS Taxpayer         DUNS number, submit the revised
                                   Identification Number   documents with this RFCR or select No
                                      Articles of          Change.
                                   Incorporation
                                      Corporate Bylaws
                                      DUNS#

Form 3                                                     Please include original Certification of
Certification of Authorities       Attached:               Authorities with wet signatures


Form 4
                                   Attached:               Please include Board Resolution and
Board Resolution and
                                   N/A:                    Certification
Certification (sample)

Form 5                             Updated list            Please include updated list of
Resolution Identifying Members     Attached:               Board Members along with Certification
of Board of Directors (sample)     Resolution Attached:    of Board Resolution.
                                                           Please include original Certification
Form 6                                                     Compliance Form with wet signatures
                                   Form 50 Attached:
Bidder Certification Certificate
of Compliance Form 50                                      CEC Form 50 can be downloaded at
                                                           http://ethics.lacity.org/PDF/form_cec50.p
                                                           df

Form 7                                                     Please include original Certification
                                                           Compliance Form with wet signatures
                                   Form 55 Attached:
Bidder Contributions
                                                           CEC Form 55 can be found on the Ethics
CEC Form 55                                                Commission's website, on the Forms



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                                                                  RFCR—Form 1
                                                                  PY 2012-2013
    FamilySource, Specially Targeted, Day Laborer, and BusinessSource Systems
                     Request for Contract Renewal Checklist
                                                page, or by clicking this link:
                                                http://ethics.lacity.org/pdf/forms/CEC_For
                                                m_55_June2011.pdf


Form 8                          Attached:       Please attach completed Inventory Form
Equipment Inventory Form        N/A:            if applicable.

                                                Please attach a completed CRO
                                                questionnaire
Form 9
Contractor Responsibility                       The CRO Service Questionnaire can be
Ordinance (CRO) Service         Attached:       downloaded at
Questionnaire                                   http://bca.lacity.org/site/pdf/cro/CROQ%2
                                                0Service%20Questionnaire%20Rev%20
                                                1-20-12.pdf

                                                Please attach a completed signed
Form 10
CRO Pledge of Compliance        Attached:       The CRO Pledge can be downloaded at
                                                http://bca.lacity.org/site/pdf/cro/CRO%20
                                                Pledge%20of%20Compliance.PDF
                                                Please attach the completed signed
                                                FSHO forms.

                                FSHO-1          FSHO-1 can be downloaded at
                                Attached:       http://bca.lacity.org/site/pdf/fsho/FSHO-
Forms 11-12
                                                1.pdf
First Source Hiring Ordinance
(FSHO) forms
                                FSHO-2
                                Attached:
                                                FSHO-2 can be downloaded at
                                                http://bca.lacity.org/site/pdf/fsho/FSHO-
                                                2.pdf

                                                Please refer to the attached instructions
                                                to register on BAVN. Upload the
                                                applicable ordinance forms: EEP, AA,
                                                EBO, and SDO (Guidelines 2a—2d).

                                                IMPORTANT: If you have uploaded and
Guideline 1
                                                received approvals on the above
Los Angeles Business
                                                referenced ordinance forms within the
Assistance Virtual Network      Registered:
                                                last 12 months, no action is necessary.
(BAVN) “Download Templates”
                                                Instead, please select the “Uploaded”
Instructions                                    boxes on Guidelines 1a-1d, wherever
                                                applicable. Approved BAVN ordinance
                                                forms remain in effect for 12 months for
                                                any number of contracts.

                                                For more details please go to



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                                                                 RFCR—Form 1
                                                                 PY 2012-2013
    FamilySource, Specially Targeted, Day Laborer, and BusinessSource Systems
                     Request for Contract Renewal Checklist
                                                http://bca.lacity.org/index.cfm?nxt=cfm&n
                                                xt_body=top_ordina2nces.cfm.


Guideline 1a
Equal Employment Practices     Uploaded:        Please upload the completed EEP form
(EEP) Affidavit                                 at www.labavn.org.


Guideline 1b
                                                Please upload the completed AA form at
Affirmative Action Plan (AA)   Uploaded:
                                                www.labavn.org.
Affidavit

Guideline 1c
                                                Please upload the completed EBO form
Equal Benefits Ordinance       Uploaded:
                                                at www.labavn.org.
(EBO) Affidavit

Guideline 1d
                                                Please upload the completed SDO form
Slavery Disclosure Ordinance   Uploaded:        at www.labavn.org.
(SDO) Affidavit
                                                Please refer to the attached LWO
                                                Submission Guidlelines, complete and
Guideline 2
                                                attach the appropriate LWO forms.
Living Wage Ordinance (LWO)    Attached:
                                                LWO forms can be downloaded at
Submission Guidelines                           http://bca.lacity.org/index.cfm?nxt=ee&nx
                                                t_body=div_occ_lwo_forms.cfm




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                                                                              RFCR—Form 2
                                                                              PY 2012-2013
CONTRACTOR GENERAL INFORMATION

Contractor Legal Name:



Agency’s days of operation:



Agency’s hours of operation:




To update our records, please identify your contact people for the following areas:

Coordination of:                 Contact Name         Phone               E-mail address
Administrative
Issues
Programmatic
Issues
Fiscal Issues
Administrative
Liaison for City
Program


                                                     is interested in a contract with the City for
PY 2012-2013.
(Insert Contractor name above)




(Original) Signature of Individual Authorized to Sign Contracts


Typed name of above individual                              Title


Date




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