WESTCHESTER/PUTNAM LOCAL WORKFORCE INVESTMENT AREA
REQUEST FOR QUOTES
FOR
ADULT AND DISLOCATED WORKER TRAINING
WORKFORCE INVESTMENT ACT of 1998 (WIA)
PROGRAM YEAR 2005
ISSUE DATE: April 15, 2005
DUE DATE: May 9, 2005
ISSUED BY
The Westchester County and The Putnam County
Department Of Social Services Department of Social Services
Office Of Workforce Investment Putnam Workforce Partnership
143 Grand Street 110 Old Rt. 6. Building #3
White Plains, New York 10601 Carmel, New York 10510
ON BEHALF OF:
ANDREW J. SPANO
WESTCHESTER COUNTY EXECUTIVE
ROBERT J. BONDI
PUTNAM COUNTY EXECUTIVE
The Westchester/Putnam Local Workforce Investment Board
143 Grand Street
White Plains, New York 10601
Kevin P. Mahon, Commissioner, County Department of Social Services
Michael J Piazza Jr., Commissioner, Putnam County Department of Social Services
Jewru Bandeh, Deputy Commissioner, Department of Social Services
Diane Atkins, Director, Westchester/Putnam Workforce Investment Board
Donnovan Beckford, Director, Westchester County DSS/Office of Workforce Investment
TABLE OF CONTENTS
I. ANNOUNCEMENT
Notice of solicitation page 4
Timetable page 4
II. INTRODUCTION/BACKGROUND
Workforce Investment Act requirements page 5
One Stop System page 5
Performance Standards page 5
Demand Occupation List page 6
Affirmative Action/EEO page 7
III. APPLICATION PROCESS
NYSDOL web-based application process page 7
List of required forms and components of LWIB application page 8
GENERAL PROVISIONS
Confidentiality page 9
Availability of funds page 9
Agreement requirement page 9
Statement of Rights page 9
Required signatures page 9
TABLE OF CONTENTS Continued
REQUIRED FORMS
Applicant Certification page 11
Provider/Offering Application Authorized Signature Form (STATE)
Authorized Signature Form page 12
Certification of Drug Free Workplace page 13
Certification of Lobbying page 14
Certification Regarding Debarment and Suspension, page 15
Certification of Compliance with Specifications page 16
Certification of Assurance of Qualifications of Staff page 17
Minority Business Questionnaire page 19
Required Disclosure of Relationships to County page 21
Training Provider Performance Chart page 22
STATE WEB-BASED APPLICATION MATERIAL
Instructions for completing eligibility applications page 24
Provider Eligibility Application (hard copy) page 25
Offering/Program Eligibility Application (hard copy) page 26
I. ANNOUNCEMENT
The Westchester County Department of Social Services Office of Workforce Investment, the Putnam County Department of Social Services and the Putnam Workforce Partnership, on behalf of The Westchester/Putnam Local Workforce Investment Board, and in accordance with the Workforce Investment Act (WIA) of 1998, is soliciting applications from organizations that desire to apply for initial or subsequent eligibility to provide training services for eligible WIA customers to the Local Workforce Investment Board (WIA Sec. 122). Organizations approved as Training Providers will appear on a list of approved Training Providers that will be used to provide training services to adults and dislocated workers under the provisions of the WIA (WIA Sec.122 and Sec.134 (d) (4) (c). Preference will be given to the Balance of Westchester and Putnam Workforce area residents. The approved training provider may also be used to provide training for customers eligible under Welfare to Work funding.
Interested parties may pick up copies of this Request for Quotes at the Westchester County DSS/Office of Workforce Investment, 143 Grand St. White Plains, New York 10601, or at the Putnam County DSS and Workforce Partnership Office located at 110 Old Rt. 6, Building #3 Carmel, New York 10510.
This RFQ may also be downloaded from the Westchester County Web Site,
www.westchestergov.com/wplwis, the Putnam County Web Site www.putnamcountyny.com/pwp, or request a copy by mail by calling (914) 995-3708 (Westchester County) or (845) 225-7043 Ext.1600 (Putnam County).
TIMETABLE
Date of Issuance: April 15, 2005
Briefing Meeting: April 22, 2005, 10:00 a.m. to 12:00 noon
DSS Office of Workforce Investment
143 Grand St, 2nd Floor
White Plains, New York
Application Due: May 9, 2005 by 12:00 Noon
Questions and inquiries may be directed in writing to:
Diane Atkins, Director
Workforce Investment Board
DSS Office of Workforce Investment
143 Grand St., 2nd Floor
White Plains, New York 10601
(914) 995-3708 FAX (914) 995-7406
II. BACKGROUND
On August 7, 1998, President Clinton signed into law the Workforce Investment Act ("WIA"). This Act replaces the Job Training Partnership Act as of July 1, 2000. The goal of WIA is "to consolidate, coordinate and improve employment training, literacy and vocational rehabilitation programs in the United States."
A most important aspect of WIA is its emphasis on customer choice and customer service. The Act requires that services to customers (both individuals and business) be provided through a "One-Stop Service Delivery System" in which multiple agencies providing employment services come together to serve the customer. The one-stop system is the basic delivery system for services to adult and dislocated workers under WIA and through this system, adults and dislocated workers can access a continuum of services designed to identify and overcome barriers to employment. Services under the WIA are organized into three (3) levels, which are, Core Services, Intensive Services and Training Services.
Customers using the One Stop System may move through the three levels of service as required to meet their employment goals. Customers will first have access to Core Services including, job search resources, job market information, job listings, schools/training provider information and if needed an initial need assessment. Many customers will need to go no further through the system having met their needs and employment goals solely through access to and the use of Core Services.
Intensive Services under WIA consist of the more one-on-one, in depth, services needed by those who cannot reach their employment goal through Core Services. Services such as comprehensive assessment, diagnostic testing (basic skills and vocational), interviewing and the evaluation of service needs, will be provided as will short term Pre-vocational instruction and counseling. Employment Plan development with a customer, during Intensive Services, may indicate the need for training. Individual Training Accounts ("ITAs") will be opened for these customers and may be drawn upon to pay tuition or other training costs for the customer. As a part of Intensive Services, the case manager will assist the customer in determining the appropriate program course/s that will help to achieve their individual employment plan. Training should be limited to short term not to exceed 12 months. However, there might be exceptions to this with regard to certain career ladder programs. All training must be pre-approved by appropriate staff and authorized by the Director. No funding will be given to anyone who has started training prior to receiving written approval from authorized WIA staff.
Under WIA, each Local Workforce Investment Area ("LWIA") must meet negotiated performance standards (see WIA Performance Standards below). In addition, all training related courses must be directly linked to the demand occupation list (see Demand Occupation List below) as identified by the Westchester/Putnam Workforce Investment Board and the customer’s Individual Employment Plan established by the case manager and customer.
WIA PERFORMANCE STANDARDS
Performance Standards
All participants receiving services through the One-Stop System are tracked to determine LWIA compliance with performance standards. The following are the proposed performance measures for Adults and Dislocated Workers for the Westchester/Putnam Local Workforce Investment Area for PY-2004.
ADULTS DISLOCATED WORKERS
Entered Employment 71% Entered Employment 80%
Employment Retention 85% Employment Retention 88%
Earnings Gain $3,000 Earnings Replacement 92%
Employment & Credential 61% Employment & Credential 60%
CUSTOMER SATISFACTION
Participants 70%
Employers 70%
DEMAND OCCUPATION LIST
Systems Analysts
Computer Programmers
Accountants and Auditors
Human Services Workers
Registered Nurses
Emergency Medical Technicians
Dental Hygienists
Sales Agent
Customer Services Representative Waiter & Waitresses
Food Preparation Workers
Database Administrators
Computer Programming Aides
Social Workers Teachers and Instructors
Licensed Practical Nurses
Medical Laboratory Technicians
Retail Sales Medical Secretary
Guards
The above list is subject to revision, as new data becomes available on the demand occupations in the area.
This Request for Quotes is being used to solicit applications from interested, qualified training providers, who wish to be determined either initially eligible or subsequently by the Local Workforce Investment Board and by the New York State Department of Labor to provide training services and be reimbursed for such services through the Individual Training Accounts (ITAs). Each training provider must submit an application for each training course that it plans to offer. Approval of the programs will result in the provider being placed on a State list of approved vendors and training programs that will be used on an as needed basis to meet the training needs of One Stop System Customers.
Initial eligibility will be good for one year. Training providers must submit subsequent eligibility application annually after the end of the 12-month period.
Westchester County, Putnam County, The Department of Social Services Office of Workforce Investment, the Putnam County Department of Social Services, and The Westchester/Putnam Local Workforce Investment Board ("LWIB") are committed to a policy, which extends services to all individuals without discrimination on the basis of race, color, creed, handicap, national origin, sex, age, religion, political affiliation or belief, or citizenship. Westchester County, Putnam County, the DSS/OWI and the LWIB takes Affirmative Action to ensure that service is extended equitably and adheres to all applicable Equal Employment Opportunity (EEO) Federal legislation.
Please note that training programs and worksites must be accessible to the disabled in accordance with the Americans with Disabilities Act.
III. APPLICATION PROCESS
TRAINING PROVIDER PERFORMANCE*
(For New Applicants Only)*
A. Performance Standards
In an effort to assess training provider’s program performance, we are asking new applicants to submit data on the program(s) and/or course(s) it wishes to offer WIA participants. This information will be used as a qualifier to the WIA Performance Measures. Please provide program/course name and:
The total number of students enrolled during 2004
The number of students completing program/course
The number of students in the program/course who obtained training related unsubsidized employment
The number of youth who received a license, certification or awarding of degree or other skill attainment measures that are recognized by the industry.
B. If the LWIB determines that the provider meets the initial eligibility requirement, the provider and program name will be added to the local list of eligible training providers, which will then be submitted to The New York State Department of Labor ("NYSDOL"). The State will review and verify the information and, if acceptable, will add the provider name and program to the State list of approved training providers. The training provider will be required to submit annual program performance data, which will be reviewed by the LWIB and NYSDOL. Those that meet expected performance levels will be retained on the LWIA's and on the State list of approved vendors
C. NYSDOL has established a web-based application process that consists of a Provider Initial and Subsequent Eligibility Application Form and an Offering/Program Initial Eligibility Application Form. These application forms will be available on the Internet along with an Authorized Signature Form and instructions. Organizations applying for approval as training providers will be able to submit applications directly to the NYSDOL by completing both the Provider Subsequent Eligibility form and the Offerings/Program Initial Eligibility Application Form electronically.
D.
Hard copies of the forms requiring signature are included with this RFQ. You must provide us with hard copy of all forms. Please submit three hard copies of the applications along with three copies (original and two copies) of the signature forms listed below, to the Office of Workforce Investment.E. When submitting your application the following material and forms that are included in the RFQ must also be returned. Training providers must submit three (3) hard copies of these forms (one original and two copies), for the LWIB to review. Please submit three (3) packets (one original and two copies), of the forms and material listed bellow.
Applicant Certification
A copy of the authorized signature form
Certification Regarding Debarment, Lobbying, Suspension, and Drug -Free Workplace
Certification of Compliance with Specifications
Certification of Assurance of Qualifications of Staff
Minority Business Questionnaire
Three (3) Current Catalogs depicting, course titles, descriptions, schedules, application requirements, tuition rates and refund and cancellation policy.
Each program wishing to be determined subsequently eligible, must provide supporting documentation for performance measures provided on the NYSDOL Offering /Program Subsequent Eligibility Form.
Required Disclosure of Relationships to County
Training Provider Performance Chart
Each packet submitted (Original and two copies) must have an original with original signature. The diskette or hard copy of the NYSDOL application forms, signature forms, catalogues and supporting material should be submitted to Diane Atkins at the Westchester County DSS/Office of Workforce Investment at 143 Grand St., White Plains, New York 10601.
*For approved vendors:
Will be asked to provide $1,000,000 combined single limit General Liability insurance. Certificate naming "the County of Westchester, its officers, employees, and agents as additional insured" must be provided for each training site.
Must provide Workers’ Compensation insurance coverage for all employees engaged in work as employees as defined by New York State law. In the event that coverage is not provided under the New York State worker’s compensation laws, the Contractor must provide adequate on-site medical and accident insurance for work-related activities (e.g. work experience, internship), if any, and for classroom training and other follow-up program training activities. I
IV. GENERAL PROVISIONS
1. Each contracting agency must agree that all information shall be protected from unauthorized disclosures. In addition, the agency must agree to guard the confidentiality of recipient information. Access to recipient identifying information shall be limited by the agency to persons or agencies which require the information in order to perform their duties in accordance with any agreements, including New York State, Westchester County, Putnam County or the United States government.
The referral of customers to organizations approved eligible, as training providers as a result of a response to this RFQ will be contingent on the availability of WIA funds.
This RFQ is for Initial Eligibility or Subsequent Eligibility as an approved training provider in program year 2005. Organizations approved by the LWIB and NYSDOL as training providers will be required to enter into an agreement of Terms and Conditions with Westchester County. . Training providers servicing customers in Putnam County may be required to enter into an agreement of Terms and Conditions with Putnam County. Organizations determined initially eligible as training providers will be required to submit yearly subsequent eligibility application after the 12 month initial eligibility period ends, and to provide program performance statistics as required by the LWIB and NYSDOL (WIA Sec.122. (c))
LEGAL UNDERSTANDINGS
Please take notice, by submission of an application to this RFQ, the applicant agrees to and understands:
Submission of an application, attachments, and additional information shall not entitle the applicant to enter into a service agreement with either the County of Westchester or the County of Putnam for the required services;
By submitting an application, the applicant agrees and understands that neither the County of Westchester nor the County of Putnam are obligated to respond to the application, nor are they legally bound in any manner whatsoever by submission of same;
That any and all counter proposals, negotiations or any communications received by an applicant, its officers, employees or agents, from the County of Westchester and/or the County of Putnam, their elected officials, officers, employees or agents, shall not be binding against the County of Westchester or the County of Putnam, their elected officials, officers, employees or agents, unless and until a formal written agreement for the services sought by this RFQ is duly executed by both parties and approved by the LWIB, the NYSDOL, the Westchester County Board of Acquisition & Contract and the Office of he Westchester County Attorney.
This RFQ does not commit Westchester County, Putnam County, the DSS Office of Workforce Investment, The Putnam County Department of Social Services or the Local Workforce Investment Board to award any contract, to pay any costs incurred in the presentation of a response to this request, or to procure any contract for training and/or services. The LWIB, the County of Westchester and Putnam County have the right to accept, reject or modify any or all responses received as a result of this request.
Any responses not containing all required forms, with correct signatures, may not be considered for approval.
The County assumes no responsibility or liability for costs incurred in the preparation or submission of any proposal. The County is not responsible for any internal or external delivery delays, which may cause any applications to arrive beyond the stated deadline. To be considered, applications must arrive at the place specified herein and be time stamped prior to the deadline. Requests for clarification of the RFQ must be directed to Diane Atkins. Applications must include all of the forms contained in this RFQ. All forms must have original signatures. Unsigned applications will be rejected. Applicants may be required to give an oral presentation to the Office of Workforce Investment and/or the Local Workforce Investment Board to clarify or elaborate on the written application.
Requests for clarification of this RFQ must be in writing and submitted to Diane Atkins at the address set forth on page "4" of this RFQ no later than 12 pm on Wednesday, April 20, 2005. Formal written responses will be distributed by the County on or before Friday, April 22, 2005. NO COMMUNICATION OF ANY KIND WILL BE BINDING AGAINST THE COUNTY, EXCEPT FOR THE FORMAL WRITTEN RESPONSES TO ANY REQUEST FOR CLARIFICATION.
Applications must include all of the forms contained in this RFQ. All forms must have original signatures. Unsigned applications will be rejected. Applicants may be required to give an oral presentation to the Office of Workforce Investment and/or the Local Workforce Investment Board to clarify or elaborate on the written application.
The County of Westchester, The DSS Office of Workforce Investment and The Westchester/Putnam Local Workforce Investment Board reserves the right to weigh its evaluation criteria for applications in any manner it deems appropriate. The County reserves the right to reject any or all of the applications submitted.
No application will be accepted from, nor any agreement awarded to, any applicant that is in arrears upon any dept or in default of any obligation owed to the County. Additionally, no agreement will be awarded to any applicant that has failed to satisfactorily perform pursuant to any prior agreement with the County. All applications (materials) submitted in response to this RFQ shall remain the property of Westchester County.
The County of Westchester reserves, and may in its sole discretion exercise, the following rights and options with respect to this Request for Quotes (RFQ):
a. to reject any or all applications;
b. to issue additional solicitations for applications and/or addenda to this RFQ;
c. to waive any irregularities in applications received after notification to applicants
affected
d . to select any application as the basis for negotiations of a contract, and to negotiate
with applicants for amendments or other modifications to their applications;
e. to conduct desk, on-site, file reviews with respect to the qualifications of each WIA
applicant;
to exercise its discretion and apply its judgment with respect to any aspect of this RFQ, the evaluation of applications, and the negotiation and award of any contract;
g . to enter into an agreement for only portions (or not to enter into an agreement for any)
of the services contemplated by the applications;
h . to select the applications that best satisfies the interests of Westchester County, the
DSS Office of Workforce Investment and the Westchester/Putnam Local Workforce
Investment Board and not necessarily on the basis of price or any other single factor.
i. Program costs and content as they are published and offered to the general public will
apply to WIA customers. Program costs and content changes will be made public and
apply to non-WIA and WIA customers. Westchester/Putnam Local Workforce
Investment Board must be notified immediately of changes in program costs and
content.
j. to terminate relationship due to non-performance.
CONTRACT
After selection of the successful applicants, a formal written contract will be prepared by the County of Westchester and will not be binding until signed by both parties and approved by the LWIB, the NYSDOL, the Westchester County Board of Acquisition & Contract and the Office of the County Attorney. NO RIGHTS SHALL ACCRUE TO ANY APPLICANT BY THE FACT THAT AN APPLICATION HAS BEEN SELECTED BY THE COUNTY FOR SUBMISSION TO THE LWIB OR THE BOARD OF ACQUISITION & CONTRACT FOR CONTRACT APPROVAL. SAID BOARDS HAVE THE RIGHT TO REJECT ANY RECOMMENDATION AND THE APPROVAL OF SAID BOARDS IS NCESSARY BEFORE A VALID AND BIDING CONTRACT MAY BE EXECUTED BY THE COUNTY.
APPLICANT CERTIFICATION
The undersigned agrees and understands that this application and all attachments, additional information, etc. submitted herewith constitute merely an offer to have the Westchester County Department of Social Services Office of Workforce Investment, the Putnam County Department of Social Services and the Putnam Workforce Partnership, on behalf of the Westchester/Putnam Local Workforce Investment Board (the "County") review the application, and is NOT A BID. Submission of this application, attachments, and additional information shall not obligate or entitle the applicant to enter into a contract for training services with the County. The undersigned agrees and understands that the County is not obligated to respond to this application nor is it legally bound in any manner whatsoever by the submission of same. Further, the undersigned agrees and understands that this application shall not be binding or valid against the County, its directors, officers, employees or agents unless an agreement is signed by a duly authorized officer of the County and approved by the LWIB, the NYSDOL, the Westchester County Board of A&C, and the Office of the County Attorney.
It is understood and agreed that the County reserves the right to reject consideration of any and all applications including, but not limited to, applications which are conditional or incomplete. It is further understood and agreed that the County reserves all rights specified in the RFQ.
It is represented and warranted by those submitting this application that except as disclosed in the application, no officer or employee of the County is directly or indirectly a party to or in any other manner interested in this application or any subsequent service agreement that may be entered into.
__________________________________________________________
Applicant’s Name (Print)
By: __________________________________________________________
Name and Title
Date: ____________________
AUTHORIZED SIGNATURE SHEET
The applicant hereby certifies that the information in the application is correct to the best of her/his knowledge and belief, and that projected costs are reasonable and necessary for the operation of the proposed program. The applicant further certifies that projected costs are not a duplication of funds already available or which will be available from other sources.
Legal Name of Organization______________________________________________________________________
_________________________________________________________________________________
Telephone Number__________________________
Address__________________________________________________________________________
________________________________________________________________________________
The following individual(s) has/have the authority to negotiate and contractually bind the applicant, and may be contacted during the period of proposal evaluation.
Name_______________________________Title_________________________________________
Adress___________________________________________________________________________
Telephone Number_______________________
Name________________________________Title________________________________________
Address__________________________________________________________________________
Telephone Number_______________________
_________________________________________Date________________________________________
Signature of Authorized Representative
_________________________________________
Typed Name & Title of Authorized Representative
CERTIFICATION REGARDING
DRUG-FREE WORKPLACE REQUIREMENTS
GRANTEES OTHER THAN INDIVIDUALS
This certification is required by regulations implementing Section 5151-5160 of the Drug-Free Workplace Act of 1988 (Pub. L. 100-690, Title V, Subtitle D; 41U.S.C. 701 et seq.). 7 CFR Part 3017, Subpart F, Section 3017.600 and 45 CFR Part 76, Subpart F. The January 31, 1989 regulations were amended and published as Part II of the May 25, 1990 Federal Register (Page 21681-21691).
The grantee certifies that it will provide a drug-free workplace by:
(a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the grantee’s workplace and specifying the actions that will be taken against employees for violation of such prohibition;
(b) Establishing a drug-free awareness program to inform employees about:
(1) The dangers of drug abuse in the workplace;
(2) The grantee’s policy of maintaining a drug-free workplace;
(3) Any available drug counseling, rehabilitation, and employee assistance programs; and,
(4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace;
(c) Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement required by paragraph (a);
(d) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the grant, the employee will:
(1) Abide by the terms of the statement; and,
(2) Notify the employer of any criminal drug statute conviction for a violation occurring in the workplace no later than five days after such conviction;
(e) Notifying the agency within ten days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction;
(f) Taking one of the following actions, within 30 days of receiving notice under subparagraph (d)(2), with respect to any employee who is so convicted:
(1) Taking appropriate personnel action against such an employee, up to and including termination; or
(2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State or local health, law enforcement, or other appropriate agency;
(g) Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraph (a), (b), (c), (d), (e) and (f).
Certification Regarding Lobbying
Certification for Contracts, Grants, Loans,
and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member or Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
Organization
Authorized Signature Title Date
NOTE: If Disclosure Forms are required, please contact: Mr. Will Sexton, Deputy Director, Grants and Contracts Management Division, Room 341F, HHH Building, 200 Independence Avenue, SW, Washington, D.C. 20201-0001
APPENDIX III (C) (iii)
Certification Regarding Debarment and Suspension
1) As required by Federal Executive Order 12549, and prescribed by federal regulations, including 40 CRF Part 32, the contractor certifies that it, and its principals:
(a) Are not presently disbarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded by any Federal department or agency;
(b) Have not within a 3-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction, including any violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;
Are not presently indicted for or otherwise criminally or civilly charged by a Government entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph (b) above; and
(d) Have not within a 3-year period preceding this application/proposal had one or more public transactions (Federal, State or local) terminated for cause or default.
2) Where the Contractor is unable to certify to any of the statements in this paragraph, the Contractor shall attach an explanation to this certification.
Date:
Signature
Title
Organization
CERTIFICATION OF COMPLIANCE WITH SPECIFICATIONS
This is to certify that, to the best of the undersigned's knowledge and belief, the data in this application is responsive to the specifications and is true and correct. The undersigned understands that non-responsive applications, as determined by the Westchester/Putnam Local Workforce Investment Board, Westchester County DSS/Office of Workforce Investment or The Putnam County Department of Social Services, may not be reviewed for consideration. Further, the submission of this application shall comply with the requirement of NYSDOL web-based application and the requirements for initial application as set forth in the Workforce Investment Act of 1998 (WIA Sec. 122 (c)).
_______________________________
Name and Title
_______________________________
Signature
_______________________________
Date
CERTIFICATION OF ASSURANCE OF QUALIFICATIONS OF STAFF
This is to certify that, to the best of the undersigned's knowledge and belief, all staff hired, meet the minimum requirements for their respective positions, and conform to the requirements as set forth by the State Education Department or similar regulatory agency (e.g. DMV regarding truck driver/commercial driver training, etc.,) having oversight of training agencies.
__________________________________
Name/Title
___________________________________
Signature
___________________________________
Date
For Informational Purposes Only
QUESTIONNAIRE REGARDING BUSINESS ENTERPRISES
OWNED AND CONTROLLED BY PERSONS OF COLOR OR WOMEN
As part of the County’s program to encourage the meaningful and significant participation of business enterprises owned and controlled by persons of color or women in County contracts, and in furtherance of Local Law No. 27-1997 we request that you answer the questions listed below.
The term persons of color means a United States citizen or permanent resident alien who is and can demonstrate membership of one of the following groups: (a) Black persons having origins in any of the Black African racial groups; (b) Hispanic persons of Mexican, Puerto Rican, Dominican, Cuban, Central or South American descent of either Indian or Hispanic origin regardless of race; (c) Native American or Alaskan native persons having origins in any of the original peoples of North American; or (d) Asian or Pacific Islander persons having origins in any of the Far East countries, South East Asia, the Indian sub-continent or the Pacific Islands.
An enterprise owned and controlled by persons of color or women means a business enterprise including a sole proprietorship, limited liability partnership, partnership, limited liability corporation or corporation that is (a.) at least 51% owned by one or more persons of color or women; (b.) an enterprise in which such ownership by persons of color or women is real, substantial and continuing; (c.) an enterprise in which such ownership interest by persons of color or women has and exercises the authority to control and operate, independently, the day-to-day business decisions of the enterprise; and (d.) an enterprise authorized to do business in this state which is independently owned and operated.
In addition, a business enterprise owned and controlled by persons of color or women shall be deemed to include any business enterprise certified as an MBE or WBE pursuant to Article 15-a of the New York State Executive Law and implementing regulations, 9 NYCRR subtitle N Part 540 et seq. , or as a small disadvantaged business concern pursuant to the Small Business Act, 15 U.S.C. 631 et seq., and the relevant provisions of the Code of Federal Regulations as amended.
1. Are you a business enterprise which is owned and controlled by persons of color or women in accordance with the standards listed above?
___________ No
___________ Yes (as a business owned and controlled by persons of color)
___________ Yes (as a business owned and controlled by women)
2. If you are a business owned and controlled by persons of color, please specify, the minority classifications which apply: _________________________________________
3. Are you certified with the State of New York as a minority business enterprise ("MBE") or a women business enterprise ("WBE")?
___________ No
___________ Yes (as a MBE)
___________ Yes (as a WBE)
4. If you are certified with the State of New York as an MBE, please specify the minority classifications which apply: _________________________________________________
5. Are you certified with the Federal Government as a small disadvantaged business concern?
___________ No
___________ Yes
Name of Firm/Business Enterprise:______________________________________________________
Address:___________________________________________________________________________
Name/Title of Person completing MBE/WBE Questionnaire:_________________________________
__________________________________________________________________________________
Signature: _________________________________________________________________________________
REQUIRED DISCLOSURE OF RELATIONSHIPS TO COUNTY
(Prior to execution of a contract by the County, a potential County contractor must complete, sign and return this form to the County)
Contract Name and/or ID No.:
(To be filled in by County)
Name of Contractor:
(To be filled in by Contractor)
A.) Related Employees:
Are any of the employees that you will use to carry out this contract with Westchester County also an officer or employee of the County, or the spouse, or the child or dependent of such County officer or employee?
Yes ______ No ______
If yes, please provide details:________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________
B.) Related Owners:
If you are the owner of the Contractor, are you or your spouse, an officer or employee of the County?
Yes ______ No ______
If yes, please provide details:________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________
To answer the following question, the following definition of the word "interest" shall be used:
Interest means a direct or indirect pecuniary or material benefit accruing to a county officer or employee, his or her spouse, child or dependent, whether as the result of a contract with the county or otherwise. For the purpose of this chapter, a county officer or employee shall be deemed to have an "interest" in the contract of:
His/her spouse, children and dependents, except a contract of employment with the county;
A firm, partnership or association of which such officer or employee is a member or employee;
A corporation of which such officer or employee is an officer, director or employee; and
A corporation of which more than five (5) percent of the outstanding capital stock is owned by any of the aforesaid parties.
2. Do any officers or employees of the County have an interest in the Contractor or in any subcontractor that will be used for this contract?
Yes ______ No ______
If yes, please provide details:________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________
Authorized Company Official shall sign below and type or print information below the signature line:
Name:
Title:
Date:
TRAINING PROVIDER PERFORMANCE CHART
(Performance Information Must Reflect Activity During the Last 12 Months)
For each proposed training course, identify the name of course, the total number of students who started the classes; the number who completed training; the total number received a certificate, and the total number who were placed in training-
Related jobs during the last twelve (12) months.
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Training Program/Course |
# Enrolled |
# Graduated |
# Received Credential |
# Placed in Training Related Employment |
WPLWIB use only |
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________________________________________________________________ ____________________
Signature and Title of Authorized School Representative Date
Shown below is the home page for the newly designed eligible training provider website:
workforcenewyork.org/etp
After selecting "PROVIDERS ENTER HERE" in the upper right corner, the provider login page will appear. Training providers that have submitted an offering via the old website (www.wdsny.org/provider) and have not yet visited the new site should select "Activate Existing Provider Records."
Enter your federal employer identification number (FEIN) to obtain a list of your training locations for activation.
Click on "Activate and Manage This Location" to begin the activation process.
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THIS IS PART 1 OF A MULTI-PART PROCESS |
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1 |
» Location Information |
2 |
Contact Information |
3 |
Login Information |
4 |
Login To Site |
Top of Form
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PROVIDER IDENTIFICATION - Choose Only One » Provider ID » Provider ID Type Federal ID (FEIN) Or Social Security #
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PROVIDER NAME » Provider Name
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LOCATION ADDRESS » Street Address 1
Street Address 2
» City
» County
» State
» Zip
» Phone ( ) - Ext: Fax ( ) -
» This Address Is Headquarters Location Yes No
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TYPE OF ORGANIZATION » Organization Type (Select One) Private For Profit Not For Profit » Ownership (Select One) Corporation Partnership Sole Proprietorship Other » Provider Type (Select One) Vocational, Technical, Business School
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DISABILITY ADAPTATIONS » Choose All That Apply None
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ADDITIONAL SERVICES » Choose All That Apply Child day care
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COMPANY INFORMATION Company Profile
Year Business Established (YYYY) Current Enrollment (Numeric value) Accrediting Entities
Licensing Entities
Approval Entities
Oversight Entity
Certification Entity
Professional Associations
Placement Services
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FINANCIAL AID Available Financial Assistance
PELL Eligible? Yes No TAP Eligible? Yes No
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INTERNET INFORMATION Web Site
Online Catalog? Yes No Online Registration? Yes No
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REQUIREMENTS DETAILS » Have copies of your tax return, signature form and refund policy been forwarded to the Local Workforforce Investment Boards where you plan to offer courses? Yes No » Does your organization comply with the Assurance of Non-discrimination and Equal Employment Opportunity? Yes No
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PROVIDER AGREEMENT » WIA initial eligibility requires providers to report performance information on their offerings on an annual basis for purposes of determining subsequent eligibility. By selecting "yes" below, the provider agrees to report required performance information for subsequent eligibility. Click here for a printable version of the signature form. I Agree: Yes No
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At the provider main management screen, you will be prompted to activate your training offerings.
Listed below are the questions which are included on the offerings application. Providers should verify that the information is correct and that all required fields include an entry.
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OFFERING DETAILS
» Offering Title
Offering Description
Offering Keywords
Offering Prerequisites
Skill Level Select One
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OFFERING COSTS
» Offering Cost
NOTE: Only numbers (0-9), a dollar sign, a comma, and a period are allowed in the above field. » Cost Comments
Cost Includes
Cost Does Not Include
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TYPE OF OFFERING
» Offering Credit Type (Select One) Credit Bearing Non-Credit Bearing » Offering Program Type (Select One) Post-secondary degree program » Credential Granted (Select One) Workforce Credential
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CLASS DETAILS
» Method Of Delivery Select One NOTE: The same programs offered by different Methods Of Delivery must have individual Offering records. Class Size
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OCCUPATIONAL TRACK
Related Occupations
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OFFERING SCHEDULE
Course Schedule
Course Length
Offering Dates
Daytime Classes Yes No Evening Classes Yes No Class is Ongoing Yes No Catalog Code
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OFFERING CREDENTIALS
Credit Hours Conferred
Accrediting Entities
Number of CEUs
Entity(s) Granting CEUs
Instructor Credentials
Years Experience Offering Course
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OFFERING LANGUAGES
Languages Available
Korean
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OFFERING MISCELLANEOUS
HEGIS Code
Target Audience
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OFFERING CONTACT
» Select Contact test, test - Primary Location Contact
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Following is a sample of the form for providers to use to submit performance information for offerings which are due for subsequent eligibility review:
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ADD OFFERING PERFORMANCE DATA |
» Required Field
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Select Offering
» Offering Title
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SECTION 1 - Specify the Beginning and Ending Date of the Offering
» Begin Date / / (MM/DD/YYYY) » End Date / / (MM/DD/YYYY)
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SECTION 2 - WIA Participants
» Did you have a WIA funded student enrolled in the offering? Yes No » IMPORTANT NOTE: For "Yes" responses complete Section 3 AND 4.
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SECTION 3 - WIA Funded Students Performance Information
1. Number of WIA funded students enrolled in offering
2. Number of WIA funded students that completed the offering
3. Number of WIA funded students that did not complete the offering
a. Number of WIA funded students in question 3 that withdrew failing
b. Number of WIA funded students in question 3 that withdrew passing
c. Number of WIA funded students in question 3 that received an incomplete
4. Number of WIA funded students that obtained a credential, licensure, certification or other measures of skill attainment after completing this course.
5. Number of WIA funded students placed in unsubsidized employment
a. Average monthly wages at placement of the WIA funded students in question 5 .
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Section 4 - All Students Performance Information
I. Number of students enrolled in offering
II. Number of students that completed the offering
III. Number of students that did not complete the offering
a. Number of students in question III that withdrew failing
b. Number of students in question III that withdrew passing
c. Number of students in question III that received an incomplete
IV. Number of students that obtained a credential, licensure, certification or other measures of skill attainment after completing this course.
V. Number of students placed in unsubsidized employment
a. Average monthly wages at placement of the students in question V.
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