HomeMy WebLinkAbout28704CONTRACT INFORMATION··SHEET
DATE: 10/28/16
Contract No.: P-16-601-P Vendor Number: 0000258832
Contract Title: Work Experience & Name/Address: Purchasing Master
Supervised Training Agreement
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_6_11_7_0_03_3_3 _______ _ Org: 56107001
Supersedes:
[!]NEW .___ _ _,, RENEWAL ..___ _ __,, ADJUSTMENT
D TICKDATE I REFERENCE (RFQ# I RFP#) '-----' RFSQ 17-023
DESCRIPTION: Work Experience Activities & Supervised Work Training
Vendor: Spirit of Woman of California Inc.
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:
Page 5
Company: ~ ~ -~
Type of Entity~-=-\~~~1'.1'< ·<~~ 0~~~:. ~ ... ~ ~V>'V\ ... ~~
0; Individual
0 Sole Proprietorship
0 Corporation
Print Nal¥ie and Title \
Q~A~Qii.
Signature(ln Blue Ink):\
Print Name and Title
Signature (In Blue Ink):
~))....-=:\_
Address
ACCOUNTING USE ONLY
ORG No.: 5610/7001
Account No.: 7870
Requisition No.: 5611700333
(09/2015)
G:\PUBLIC\CONIRACTS & EXfRACTS\P\P-16-601-P Ml\STER AGREEMENT.COO<
0 Limited Liability Company
0 Limited Liability Partnership
0 General Partnership
Date
Issuance Date:
Closing Date:
Submittals:
Addressed To:
Mailing Address:
Mark Envelope:
Cost Limit for
Agreement(s):
REQUEST FOR STATEMENT OF QUALIFICATIONS
NO. 17-023
COUNTY OF FRESNO
Work Experience Activities and
Supervised Work Training
September 29, 2016
Wednesday, October 12, 2016 2:00P.M.
Two (2) paper copies of the Statement of Qualifications
Debbie Scharnick, Purchasing Technician I
County of Fresno, Purchasin~
4525 E. Hamilton Avenue, 2" Floor
Fresno, CA 93702
"RFSQ -Work Experience Activities and Supervised Work Training"
No Cost to Vendors
STATEMENT OF QUALIFICATIONS (SOQ) PACKAGES RECEIVED AFTER THE TIME AND DATE
STATED ABOVE WILL BE RETURNED UNOPENED TO THE VENDOR.
Inquiries and Updates: Requests for clarification regarding this Request for Statement of Qualifications
(RFSQ) must be submitted in writing via email to Debbie Scharnick, Purchasing Technician I, at
dscharnick@co.fresno.ca.us, and received by the County no later than 10:00 A.M., Tuesday, October
4, 2016. Such information as is reasonably available and will facilitate preparation of responses hereto,
requests for clarification and associated responses, and any addenda to this RFSQ will be posted at:
•
0
•• ·~ .•• and will not otherwise be distributed.
~~ Address/P.O. Bo:
""'-.. Q a n"'-0
City
$:"<;; '\-~-1..)'-?,S (~ ~ S s-q fL?:/s --'1$ I Do
Telephone Fax Number
State Zip Code . ' ,_,
Lo c e.,,,,p CV ~f\ritc&-klX)roet o\'®1 a. c rG\
E-Mail Address \..)
17-023
Work Experience/Communty Service Qualification Survey Attachment A
Employer Category:
~~~~~~~~~~~~~4t'
0 ~ate Non-profit*
~-=--~_.:._::-~~'"'---L----"--'~-r-'---"-_..c_-"---"~-------~ ~Public Non-profit*
4--_p::,.~~~:....t------L------'c.__....!.-.::::._:____--l 0 Private Business
*Must provide 501(c} (3)
Extension:
Ito
Type of Service to be Provided: ~ork Experience 0 Community Service
Worksite Location
Extension:
Duties to be Performed:
~~~~~~~~~~ANS~~ P#oNLS
1-------------ll/S G PA:-X
f)~i~f:e:Sr~fh~ZeJ)/pLo~i-+ MA-KE Co PI £5>
if_ E9U!VAL£f\IT ;-eEE-r ·VtsiTD!2.S ,
!Zf2EJV·-1 // L SStsT STAfF wjfRDJGCJ
1------------~A-SS!S T /!A-t2_/f{!__/ PAIVTS length of Project:
wjmA-tE u_p C-L4sSES
Weekly Hours Available (Maximum 40 hours/week): Special Clothing I Equipment Requirements:
ff2oFt=SS 1 DN4l_
Date:
/t? . .f. I [p
Work Experience/Communty Service Qualification Survey
Employer Category:
0 Private Non-profit*
f-"'-"'=cJ--'-----"-':o___~:_;;_-=-=-__._,~.,....__~.__:::_-=---------l rsf Public Non-profit*
~~~~~~--------~~~~---~ 0 Private Business
*Must provide SOl(c) (3)
Extension:
II o
Type of Service to be Provided: 62( Work Experience 0 Community Service
Worksite Location
17-023
Attachment A
Phone Number:{_ s-s: I ~ 33 -43·5' 3
Extension: j 0 9
Duties to be Performed:
!3 A3 f(!_ ki1D ~u lfc)·t c o -P . Number of Positions Available: '/T-L
1---------------""'d-:_ _____ ---j t) L L LJh b iJ?q c+ c e c f/ZtC ff-L
Minimum Requirements for the Position: '!J J
f/IGH ~L /)LploiVlit r?ftti!TJNG
CJR EQU.t t/A Lf;VT. /!_£(Jfttf2_ tJ~ ~tltNOtnAJ~
~u f(_ e.HJr JJ . L P.Ltt cJ--1 w DR-k
f--Le-ngt-h-of-Pro-je-ct:----~---IKnut{) /ec/(]-6 o-P Pow~(!._ I aLs
A lA) Ill c:l/4--t(_ ~
SiLilY +o L;/Jr ,;J,5 !h
Weekly Hours Available (Maximum 40 hours/week): Special Clothing I Equipment Requirements:
' H& vy /AJ()/L/Z JeatlS ~r__s
Heavy dw__ly wo,zt_ b
Work Experience/Communty Service Qualification Survey
17-023
Attachment A
Employer Name: Employer Category:
5cr r·,+ o+-'v..h-"rv~ ,.,r ft:>~\i~('A\0,. ']:::,...
Address: 0 Private Non-profit*
7,;:2::}. w, \'.., ... \ ~ 0.'"'\ ~ Ave. 'gJ Public Non-profit* City: Zip Code:
i=rC"')f"\.t? rA q<;~.}r; 0 Private Business
Contact Person: *Must provide SOl( c) (3}
Lore..""~ ?erf''7 ( \)·, r-<. C -'<:-or")
Phone Number: Extension:
('5-')4"> ,d-.,~; -L-j ~ ') 3 l \ b
Fax Number:
Type of Service to be Provided: ~ Work Experience 0 Community Service
Worksite location
Address: Worksite Supervisor:
~;). q_ \N \>,..,-\ '""" n"'-\.. Ave. L () (" <. V\t/\ \Jer-e., ( 'D' r-t".C"\nr)
City: . Err_,_"'-··· (A Phone Number: ( 4)-y-4 _~ :;2:)-; _ L.(-;3·)~
Zip Code: q ; ·-::;. ;) 'X' Extension: \ l 0
Job Title:~ C:: . . Duties to be Performed: . ·l~ p 1'1::> vt c.\; ,.,.,} h'j:J'-"./'Ii <. -er"\ v i YDV'\ -~ <"'_......._ t-.
Number of Positions Available: -c ""~:) <':. ~,A_,c_\'er5 VI/\<~ C<J-:..i S'+ (...v; .t--h 3 1.:-J.q ~'--' 1! ov-~ +i~e.
Minimum Requirements for the Position:
A)')i':)-1-)<."" o ... >J\ e.d J e of C'-"; \Jr~ i v-O'V""< ,'., f'"""' ~J -1?..,.;::..;-e'\-T-') (......-i~h ~"'il'-~"'ti'J 'Slc;jl),
to :rchoc\ C<·y~ (o·-IOJ I) 13-e. '-"'.:: v ; ors ~c -f\5Sl s-i-.__,~~...-. c.; pp v--oer; "'"+e. d i c. pI;'"' cc
)/\~•v<-V'\·HO\ . .;')Ac\<t> C'!PftA::>fr-lc.-\-e... 0--"1 <J ~)-~ r-"pprop,~,.,.. ... k heh<'-"\. vi'O'/:J.
. ' ! ' ) ._) d d< s-c.: f •"e. s ~cicL-e)s;""''J () ;c,('t''"'e. ""-' · -Kec~j ,..,.;-z:..e. yo::>S~bl e. <::. 'v-,'1 1 .:..\ hoo J h.'j'•:J-'Yl e · .:-{) l<-f"l o, .. ,A e.cJ'y~ of c:h. I.Jt..-.e>ocJ
\ J. 'So>""'~ e., . ut rse~:>es.
Length of Project: ~e<t> h::>rc«:. -.C...ff?"""(O{"i?-1 k fH""'j +i~e.
-A-:.-::d Sk ~\..rh ho........,~•--';:;.rl< ,:?o-~cl
d je0 rs dc:::.,..CA:J+rc..~ .r-1-..-cY"'j \'(\+e. ~c.-+;-v-,
Sl<-i l \'s .
Weekly Hours Available (Maximum 40 hours/week): Special Clothing I Equipment Requirements:
··-~ -------. ~ ·c·---o_· ---·--. ,-.--o:_-• .,,. '·
Ca.5vC\ / / ch.IJ yn~ot~ Ot-\-+lre_
,;;o hovvS
Worksite S~ Signature: -....... ,........---....
Date:c{
1 '4Uv
(~/ r ---I
Work Experience/Communty Service Qualification Survey
Employer Name: ~· Employer Category: ~ ("""', ,, .... ·~_,-,~\ \ ~ l ~"'-.J~i::, -;-..("-. C~ r_ ~ J I
*Must provide SOl( c) (3)
Add~ss: _ '" ~, ~ 'l\ ~ \ 0 Private Non-profit*
21 ~\ b.J '\ t~ ,..Sl. f'.N'\ t~' n '"~ .
City: Zip Code: ~ Public Non-profit*
~~k._"" _\::'\ ~~'t\ (-{ f\ C\_ ~~ ~-~ 0 Private Business ~~~~~~~~~~-----L~~~~~~--~
Contact Person:o'
i\,~-.... .. ~~ -~ '"' o ~ -"" (_ D u,: -.-~ ~ )
Phone Number: ) Extension:
b:SC\-~ -'~'1, ~ ""~ ~ <1).. \ \b
Fax Number:
Type of Service to be Provided: 0 Work Experience 0 Community Service
Worksite location
Address: ~'J:..\ w ·~''"\?\~ c~"~· Worksite Supe'('~or:
1\--. ~~~' o, "<-~~"' ......
Zip Code: Extension: \\, 0
Job Title:
length of Project:
Weekly Hours Available (Maximum 40 hours/week): Special Clothing I Equipment Requirements:
17-023
Attachment A
~0 ~~~;~ ~~")
\"-~ ~ ~ Q~'{'o.-\-~ -
Worksite Sup,erv~ignature:
y_ __ / /