HomeMy WebLinkAbout28703CONTRACT INFORMATION SHEET
DATE: 10/28/16
Contract No.: P-16-601-P Vendor Number:
Contract Title: Work Experience & Name/Address:
Supervised Training
Contract Period: 10/01/16 -09/30/17 Representative:
Using Agencies: 5610 Phone No.:
Email:
Terms: N45 ---------------------
Total Contract Amt.: $0.00
~-------------------
Buyer Name: Debbie Scharnick
Requisition No: _5_61_1_7_00_3_3_3 ______ _ Org: 56107001
Supersedes:
'----'' RENEWAL .__ _ _,I ADJUSTMENT [!]NEW
D TICKDATE .__ _ _,I REFERENCE (RFQ# I RFP#)
DESCRIPTION: Work Experience Activities & Supervised Work Training
Vendor: Neighborhood Industries
0000258832
Purchasing Master
Agreement
RFSQ 17-023
SPECIAL INSTRUCTIONS: One year contract-May be extended for two additional one year periods by mutual consent.
DISTRIBUTION:
DEPARTMENT: _D_ss ______ _
REQUISITIONER: Jessica Rangel
Dean Brawley
Rev 112/15
Completed By: Date: Completed By: Date
PROCUREMENT AGREEMENT NUMBER: P-16-601-P
Error! Reference source not found.
October 3, 2016
CONTRACTOR TO COMPLETE:
Company:
Type of Entity:
0. Individual
0 Sole Proprietorship
)2r Corporation
\
Print Name and~~ I {L
/, i{L . 'JA./~
Signature (In ~JUe Ink):
Print Name and Title
Signature (In Blue Ink):
.•
Address
Ollct
0 Limited Liability Company
0 Limited Liability Partnership
0 General Partnership
• Date
Date
City State Zip
Page 5
TELEPHONE NUMBER
( ) n f tA o t.k<~ 0i\Q)ZH"\ v.:rJ..-\'l:.'iDr:J~~r f { dV14
-=F AX---cN-:-U-M-BE-R-4--'--'-"'--'-----E-MAIL ADDRESS
ACCOUNTING USE ONLY
ORG No.: 5610/7001
Account No.: 7870
Requisition No.: 5611700333
(09/2015)
G:\PUBLIC\CCNTRACTS & EXTRACTS\P\P-16-601-P M<\STER AGREEMENLIXlCX
I
Work Experience/Communty Service Qualification Survey
17-023
Attachment A
...
Employer Name: Neighborhood lndustires Employer Category:
----
Address: ~Private Non-profit*
353 E. Olive .I Zip Code93728
--D Public Non-profit* City:
Fresno [] Private Business -----
Contact Person: *Must provide SOl( c) (3) Addie Carr
I Extens1on:
---·------Phone Number:
559.498.0708 1--------Fax Number:
n/a
"" ~~T-::bi~-/~qi\.·&';-i~~--~0\~o..f!. <£;.U_?ii.1t:r;;;:~i''D:W~~.;.~?t~-::-.
Type of Service to be Provided: Work Experience D Comrnun'1ty Service
·"·o;-·iii'. • ·< •• 'j';''.'~·
Worksite Location c------·---,--;-:-------·---------··--· ------------------------------------
Address: 1 Worksite SupervisorAddie Carr/Stephen Love
240 N Thorne
City: Fresno =l Pho~eNumber 559.498.0708/0704
-
Zip Code: 93706 Extension:
'"·. ~ ,1:;"~~~:;~~"7.FJ:£l!~<;~~g;r~,~jf>'•;(!;~~;'l':,l>i:?'F.J'ic:1:r•.,.. "
Job Title: Warehouse Team Member I Duties to be Performed:
I
---------------------···----j Number of Positions Available:
15 Sorting product
!--I Testing Electronics
Minimum Requirements for the Position: Light Janitorial
Ability to stand, sit, and walk I
Preparing E-waste I
'
Ability to lift 25 lbs i Assisting driver with pick-ups
I Organizing
I Utilizing a pallet jack
--.. I Moving product for recycling Length of Project: 6-12 months 1 Forklift operation (once certified)
I
I
I
: ---"'--1--------------------------------------·-~-----~--··-"'·~--·-~------·-
Weekly Hours Available (Maximum 40 hours/week): I Special Clothing I Equipment Hequirements:
35 hours a week max 1 Close toed shoes
M-F 8-4:30 (open) !
! Modest Attire
I
I
i
.. ·• .·.-"":""~~~~D-n.<:':J~ " • ~5 ;. --.;:-"'' •r.f ~
Worksite Supez;t;; Signat11(c Date:
I /'; Zv(;e_ c~ ··--·--··-·--------------------------C( 00·/(~J _j
I
Work Experience/Communty Service Qualification Survey
17-023
Attachment A
Employer Name: Neighborhood lndustires Employer Category:
Address: !if Private Non-profit*
353 E. Olive
City: I Zip Cod~93728 D Public Non-profit*
Fresno D Private Business
Contact Person: *Must provide 501(c) (3) Addie Carr
--
Phone Number: I Extension:
559.498.0708
Fax Number:
n/a
Type of Service to be Provided: Work Experience D Community Service
Worksite Location
Address: Worksite Supervisor: Addie Carr/Anthony Armour
353 E Olive
City: Fresno Phone Number: 559.498.0708
Zip Code: 93728 Extension:
Job Title: Team Member Retail Duties to be Performed:
Number of Positions Available:
15 Customer Service
Sorting product
Minimum Requirements for the Position: I, Answering phones/messages
Ability to stand, sit, and walk Light Janitorial
Merchandising
:! Assisting driver with pick-ups and deliveries
Organizing
Length of Project: 6-12 months
Utilizing a pallet jack
Cashiering (at end of placement)
Forklift operation (not required)
(once certified)
'
'
Weekly Hours Available (Maximum 40 hours/week;): Special Clothing I Equipment Requirements:
'
35 hours a week max Close toed shoes
Open M-Sat 9:00-7:00pm Modest Attire
Worksite Sup7rvisor Sig,n.ature: Date: ; d',~z 4':30/G /~fL/ z M.,c_} -·------