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CONTRACT 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:
OONEW ..__ _ _,! RENEWAL '-----'' ADJUSTMENT
D TICKDATE '----'' REFERENCE (RFQ# I RFP#) RFSQ 17-023
DESCRIPTION: Work Experience Activities & Supervised Work Training
Vendor: Boys 2 Men Girls 2 Women Foundation 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: 15a~ j "Z ~f\ Ct~r/ Ez 2W0fnM~~~~KL"'~~··
Type of Entity:
0 Individual
gr Sole Proprietorship
E!l Corporation
Print Name and Title
Signature (In Blue Ink):
Address
0 Limited Liability Company
0 Limited Liability Partnership
0 General Partnership
Date
City State Zip
Page 5
TELEPHONE NUMBER FAX NUMBER
~bir~QbD-~As :z.Vf\~e;~ \"~ z~QADro
E-MAIL ADDRESS 0
ACCOUNTING USE ONLY
ORG No.: 5610/7001
Account No.: 7870
Requisition No.: 5611700333
(09/2015)
G:\PUBLIC\CONTRACTS & EXTRACTS\P\P-16-601-P MOSTER AGREEMENLOOCX
REQUEST FOR STATEMENT OF QUAUFICAnoNS
NO~ 17-023
COUNTY OF FRESNO
Work Experience Activities and
Supervised Work Training
Issuance Date: Seplember 29, 2016
Closing Date: Wednesday. October 12. 201& 2:00 P.M.
Submiltals: Two .(2} paper copies of tbe Statement of Qualifications
Addressed To: DebbieSc:hamick, Pw'chasingTedmidan I
Mailing Address: County of Fresno, Purchasif!g
4525 E. Hamilton Avenue, zm Floor
Fresno, CA 93702
llaJk Envelope: "RFSQ-Work Experience Activifies and Supenrised Work Tltlining"'
Cost Umitfor No Cost to Vendors
AgJeement{s):
STA.TEIIENT OF QUAUFJCATIONS (SOQ) PACKAGES RECEIVED AFTER THE 11IIE AND DATE
STATED ABOVE WILL BE RE11JRNED UNOPENED TO THE VENDOR.
Inquiries and Updales:: Requests for darification regarding fhis Request for Statement of Quaflfica.OOns
{RFSQ) must be submitted in writing via email to Debbie Scharnick,. Purchasing Tedmician I, at
dsdJamicl@co.fnsaoza.us, and received byibe County no later than 1D:DO ~ Tuesday3 October
4. 201&. Such inbmation as is reasonably availalie and-vii fa iM* Jifepaafit:ll'rn of resp:mses trerem.
requests for clarification and associated and any addenda m this RFSQ will be posted at:
!~,.ii!~~L:::J:'U:~::0~·-g~~,~~~!.:~:c:~L'"""""~'~oi'~"'-"-'"'~..c:c~:!L and will not ol:helwise be Orsfributed.
Tllfe
state
Work Experience/Communty Service Qualification Survey
~J11ployer Name:
i
ll Em~ Category:
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Address: [2( Private Non-profit*
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City: --~ Zip, Code:
0 Public Non-profit*
0 Private Business ,_
Contact Person: *Must provide SOl( c) (3)
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Phone Number: ~ Ext~n~io~: I ![ --' "~ ---,,
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Fax Number:
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Type of Service to be Provided: t:=( Work Experience D Community Service
Worksite Location
Address: \1\(orksite Supervisor:/-
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City: Phone Number:
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Zip Code: Extension:
Job Title: "--,• Duties to be Performed:
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Number of Positions Available: ! '.-'
Minimum Requirements for the Position: i
II
--·\ ! 11
17-023
Attachment A
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[Length of Project: i
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Weekly Hours Available (Maximum 40 hours/week): Special Clothing I Equipment Requirements:
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Worksite Supervisor Signatlire: Date:
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