HomeMy WebLinkAbout28706CONTRACT 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: 5611700333 -----------------------Org: 56107001
Supersedes:
0NEW I RENEWAL '-----' .____ _ _,! ADJUSTMENT
D TICKDATE .____ _ __.! REFERENCE (RFQ# I RFP#) RFSQ 17-023
DESCRIPTION: Work Experience Activities & Supervised Work Training
Vendor: Delta Care 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:
Company:
Type of Entity:
0 Individual
0 Sole Proprietorship
<E:f Corporation
SgnatUre{ifl Blue Ink):
Print Name and Title
Signature (In Blue Ink):
Address
0 Limited Liability Company
0 Limited Liability Partnership
0 General Partnership
Date
Date
City State Zip
PageS
rs:")l' r 1eo -(5. tt5 8
TELEPHONE NUMBER FAX NUMBER
~C~ln'-0.~'\i.l~"
E-MAIL ADDRESS
ACCOUNTING USE ONLY
ORG No.: 5610/7001
Account No.: 7870
Requisition No.: 5611700333
(09/2015)
G:\PUBLIC\CONTRACfS & EXTRACfS\P\P-16-601-P MASTER AGREEMENT.OOCX
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, 2n 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:
httos://www2.co.fresno.ca.us/0440/Bids/BidsHome.aspx and will not otherwise be distributed.
Organization
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Individual/Contact Person Title
Street Address/P.O. Box
-Dr J2.__ ~ \f'Oa
City State Zip Code
G::_5. '5~\_) ~ l b =!55 ~ (__~3.~ ~~ b ·-0'5 ~ '< d.sJ~ V::v~ \ '-"<-ct#'\J ~v~~
Telephone Fax Number E-Mail Address
<;..,
Work Experience/Communty Service Qualification Survey
17-023
Attachment A
Employer Name: Employer Category:
Address: 0 Private Non-profit* ~\~ ~~-~~l'\crot ~~\\·~ [A Public Non-profit* City: Zip Code:
\='(" ....s.L b.Y\C ~ ' ~oq-o-'-0 Private Business
Contact Person: *Must provide SOl( c) (3) ~v. F="~ \ \cf...... t\f\ U V\ \.J~ G\
Phone Number: Exten:tn:
~':zjc~ o\ \.6 ----t:s ~ ~ ,NA
~(a~~~ "")_""" \a -.::c c:) ~ )(
Type of Service to be Provided: M' Work Experience 0 Community Service
Worksite location
Address: Worksite Supervisor:
4-\~S t~-~So v,{J (c, ~{~ <\~ \\ ~ ~...r-~.JL \L.( t=:·· ~ \111\\ .. )'-l"tt
City: \=v -e.. <r::. '(\ c:J (_~ Phone Number~~-~"<-\) ~'lb _ (SI::) 8;'
Zip Code: "\1:>·--:r-~"l.--Extension:
Job Title: Duties to be Performed:
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Number of Positions Available: ,.A;;, .
~ \Y~~k~V'--
Minimum Requirements for the Position: ~\l\ V\1 ,. ~ ~l, $-_Q;\N~~ k f ~~ ~ ' fst" "b \Ji c ( \ "\:J ~\,v~~
·t:J~~-<=t-·V'\~
~~c_:_"\ ~*;s·
~~~-~~~~ _ _)'
Length of Project:
~~~~L \l---~~s. ~~ ~m-~(_;) .. '-~~ '
Weekly Hours Available (Maximum 40 hours/week): Special Clothing I Equipment Requirements:
'-\.a \'\.~~-.._,.J~ f.s.\ ~~ '
N'u~-
Worksite Supervisor Signature: Date: