Teamster Grant Modification 0204 (gd-30)

NEW YORK STATE

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OCCUPATIONAL SAFETY AND HEALTH HAZARD ABATEMENT BOARD

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ROBERT F. GOLLNICK ANN MARIE TALIERCIQ CARLJ. THURNAU

STATE CAMPUS BUILDING 12, ROOM 166 ALBANY. NEW YORK 12240 (5181457 -7629 FAX (5181465.6082

ROBERT F. CARPENTER Chairman

Members

February 11. 2004

Mr. John Bulgaro Teamsters Local 294 890 Third sr Albany, NY 12206

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'--

Dear Mr. Bulgaro : Your contract number C010397 for the 2003/2004 aSH T&E grant has been approved for modific ' . e Department of Labor. Attach ~re six (6) copies of Appendix X 'aQd two complete modifications. NOTE: It is now tne-Depactment of Labor's policy to send just the changed pages to the contractor for sign ture. Please have each Appendix X, Informal Modification Signature Sti et, signed in blue ink and notarized. Please return the entire package at your earli st convenience , When the modificatio approval process has been completed, a fully executed copy will be retur d to you for your files . Sincerely,

oe~hai~.~ rd Grant Manager

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Vi(tL Attachments 2{ /3/()

't GOVERNMENT EXHIBIT GD -30

Formal Modification

NEW YORK STATE DEPARTMENT OF LABOR

Charity Registration #

_Exempt 9

_

APPENDIX X Contract No. CO I 0397- - - -- -

Agency Code 14000

This is an AGREEMENT between THE STATE OF NEW

YO~

Modification No. acting by and through the Department

of Labor, having its principal office at State Office Building Campus, Building l2, Albany, New York (herein referred to as the STATE,) and _Teamsters Local 294

(hereinafter referred to as the

CONTRACTOR), for modification of Contract Number _COI0397

, as set forth in attached

Appendix B (Project Budget and Program Narrative Addendum), which is hereby incorporated by reference.

This contract shall be for the period_August 1, 2003__ through_July 31, 2004 This contract may be extended up to four years through

_ ----_

If Not for Profit: Contractor has ~ has not 0 timely filed with the Attorney General's Charities Bureau all required periodic or annual written reports. All other provisions of said AGREKMENT shall remain in full force and effect. IN WITNESS THEREOF, the parties hereto have executed or approved this AGREEMENT as of the dates appearing under their signatures.

STATE OF NEW YORK)

) County of ~'i: hunteJa d), I a~

On the

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C"\.crBco

55.:

e

day of ~f 0n!l 0

ili 10 AQ 14)

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,

200.::L before me personally appeared

to me known, who being by me duly sworn, did depose and say that he/she

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45 4lcrdl /., J'r t) , SOA

resides at

a

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~ 4)), that he/she is the I

S'-o QlYnl>'-Q A l>

294

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G . U4)e/Dt"

ofthe

the corporation described herein which executed the foregoing instrument; and that

be/she signed his/her name thereto by authority of the Board of Directors of said corporation.

(NOI'~ Qo 'CClCi' 6:'-1'!' , ::r:::'EEN A. HARKINS ' u ~ Pl! ~ i l • State of New Yorl: ..:uoll flClC In Schenoctady Count y 1=\ ;: J N ,~ l1HA47B4G47 C Cll1 \..~ =: t ~j I .,,;J:rns J U:y .:;1,

R E C E rV E

MPTROL~~~~ae-...., APPROVED DEPT. OF AUDIT & CONTROL

I

GM 313.4 (06/09/03)

FEB 26 2003 - - ----1- - - -- --+-MAR

9 2004

Date:

DEPAR"fMG r. .'; .. ~i3 0 R A COUN'I1N "'eTION

FOR~~llER

Teamsters Local294

CO 10397

Appendix B

C(frJ..;!

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NEW YORK STATE DEPARTMENT OF LABOR SCHEDULE I

Planning Summary Contractor: Teamsters Local294 Address: 890 Third Street Albany, NY 12206 Liaison: Address:

Contract Number: C010397 Phone: 518-489-5436

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John Bulgaro, President Teamsters Local 294 890 Third Street Albany, NY 12206

NYSDOL Liaison: Address:

Phone : 518-489-5436 Fax: 518-453-9251 E-Mail : [email protected]

Linsay M. Baird NYSDOUOSH T&E State Office Campus Bid 12 Rm 166 Albany, NY 12240

Submittal:

FY Original Mod #

2003·2004 _ 1

Phone: 518-457-6670 Fax: 518-485-6082 E-Mail: [email protected] .US

X

Increases Funding Decreases Funding Changes End Date

2003-04 Year

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569 ,300 Amount

6/30/04 Lapse Date

Amount

Lapse Date

Year

Amount

Lapse Date

Total:

SFY

Year

Amount

Lapse Date Total :

Year

Amount

Lapse Date

Year

Amount

Lapse Date

Year

Amount

Lapse Date Total:

SFY

Renewal II/SFY

Year

Amount

Lapse Date

Year

Amount

Lapse Date

Year

Amount

Lapse Date

Total :

SFY

Renewal IIi/SFY

Total :

SFY

Renewal IV/SFY

69,300 .00

7/31/04

SFY

Renewal lIS FY

Year

to to to

8/1/03 $69,300

Funding Source: Program: OrlginaUSFY

From : 55,800 .00 From : ----From :

Budget

1. Staff Salaries 2. Staff Frin e Benefits 3. Contracted Services 4. Other Costs 5. Total Contract Costs 6. Total Match Costs

$69,300

«in.