Teamster Training Grant 1002 (gd-24)

NEW YORK STATE

OCCUPATIONAL SAFETY AND HEALTH HAZARD ABATEMENT BOARD

ROBER T F. CARPENTER Chairman

STATE CAMPUS BUILDING 12, ROOM 166 ALBANY, NEW YORK 12240 (518) 457-7629 FAX (518) 485·6082

ROBERT F. GOLLNICK ANN MARIE TAliERCIO CARL J. THURNAU Members

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October 4, 2002

John Bulgaro President Teamsters Local 294 890 Third Street Albany, New York 12206 Dear Mr. Bulgar o: I am pleased to inform you that you." contract #C009564, Teamsters Local 294 for 9/1/02/-7/31/03, Occupational Safety and Health training & Education Grant Program has been fully executed. Enclosed is a copy of the contract for your files. Congratulations on receiving this grant. I look forward to working with you on your Training and Education Grant Program this year. Sincerely,

Albert A. Blackman Grant Manager

Enclosure A t!

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GOVERNMENT EXHIBIT GD -24

C009564

Informal Modification

NEW YORK STATE DEPARTMENT OF LABOR

Charity Registration #

APPENDIX X Agency Code:

14000

Contract Number:

EXEMPT-9

C009564

Modification No.

Mod-O-A

This is an AGREEMENT between the STATE OF NEW YORK, acting by and through the Department of Labor, having its principal office at State Office Building Campus, Bldg, 12, Albany, New York (herein referred to as the STATE), and

Teamsters Local 294 (herein referred to as the CONTRACTOR), for modification of Con tract Number C009564 as set forth in attached Appendix 8 (Project Budget and Program Narrative/Addendum), which is hereby incorporated by reference. All other provisions of said AGREEMENT shall remain in full force and effect. This contract shall be for the period

9/1/02

through

7/31/03

IN WITNESS THEREOF, lhe parties hereto have executed or approved this AGREEMENT as of the dates appearing under their signatures. CONTRACTOR SIGNATURE

STATE AGENCY SIGNATURE

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Date:

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STATE OF NEW YORK County of 6.c.hvo..t.ctncl~

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On the \ 7:\€ day of _~=== ' 20_0_"3__, before me to me known, who personally appeared ~ aHll;)~ being sworn did depose ~nd say that he/she resides at 4B "A\arxO.bl.roQ ~. 0 () a~ ~ ~ 12208' , that he/she is the aQh."c()br1Jt /~ oftt-te ,).J~A O<~ 294 , the corporation described herein which executed the foregoing instrument; and that he/she signed his/her name thereto by order of the Board of Directors of said Corporation. I
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ConiractMaster11 TeamstersLocal 294 2002-03 Mod ificalion as sent to Finance Appendix X 10/6/03 3:46 PM

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Teamsters Local 294

C009564

i

Appe ndix B

NEW YORK STATE DEPARTMENT OF LABOR SCHEDULE I

Planning Summary Contractor: Teamsters Local 294 Address: 890 Third Street Albany NY 12206 Liaison: Addr ess:

NYSDOL Liaison: Address:

Contract Number, C009564 Phone: -=5~1-:-8-48~::-9-~5-:-43-=-6-=----

Mr. John Bulqaro, President & PEO Teamsters Local 294 890 Third Street Albany NY 12206

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

Albert A. Blackman NYSDOllOSH T&E State Office Cam pus Bid 12 Rm 166 Albany. NY 12240

SubmiHal :

FY Original Mod #

Funding Source: Program: OriginatiSFY

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

2002-2003 _

a-A

Increases Funding Decreases Funding Changes End Dale

OSH T&E 305 Fund 2002 - 2003 aSH T&E

2002-03 Year

$80.000 Amount

Lapse Date

Year

Amount

Lapse Date

Year

Amount

Lapse Date

Year

Amount

Lapse Date

Year

Amounl

Lapse Date

6/30/03

Renewal I/SFY

From : ----From : ----From :

9/1/02 $80,000

7/31/03

Total :

SFY

Year

Amount

Lapse Date

Year

Amount

Lapse Dale

Year

Amount

Lapse Date

Year

Amount

Lapse Date

Year

Amount

Lapse Date

Total:

SFY

Renewal IIJ/SFY

Total:

SFY

Total:

SFY

Renewal iVISFY

$80,000

Total :

SFY

Renewal li/SFY

to to to

Budget Expense Categories 1. Staff Salaries 2 . Siaff Fringe Benefits 3. Contracted Services 4. Other Costs 5, Total Contract Costs 6 , Total Match Costs #REFl

Total

$0 $0

$52,100 $27,900 $80,000 $0

ConiractMaster11 TeamstersLocal 294 2002-03 Mod ification as sent 10 Finance Planning

Su~8)3

3:46 PM

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New or tate Department of Labor Governor W. Averell Harriman State Office Building Campus, Building 12 Albany, NY 12240 Agency Code 14000 Contractor Name/Project Sponsor: Teamsters Local 294 890 Third Street A lbany NY 12206

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I

Con tract Number.

C009564

Amount of Agre ement: Contract Period:

S80,OOO to

9/1/02

Multi-Year Term (if app licable) From: n/a 10

7/31/03

n/a

'V()11 / 9.Y~

Federal T:llf Identification Number:

Billing Address (if different from above) Stre et City. Zip: State:

, •

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FACE PAGE

Contractor is

0

is not

0

a Sect arian Entity

Contractor is

0

is not

0

a Not-Far-Profit Org anization

Charities Registration Number:

Exempt-9

aSH T&E Title/Description of Proiect: THIS AGREEMENT INCLUDES THE FOLLOWING:

o

[8] [8] [8] [8] [8]

D D

This Face Page and Slandard Agreement Appendix A -Standard Clauses for all New York State Contracts A ppendix B - Project Budget, and Addendum to Proposal, if Applicable Appendix C . The Department's General Conditions Appendix 0 - RFP and Certifications (as applicable) Appendix E • Other Conditions, If applicable Appendi x F - Proposal Appendix X - Modification Agreemenl Form (10 accompany modified appendicies for changes In terms or consicerauon on an existing period or for renewal pencds)

The Contractor and the Department agree to be bound by the terms and conditions contained in this Agreement CONTRACTOR NYS DEPARTMENT OF LABOR

;--- - - - - - - - - - - - - - - - - - - - - - - - --+- - - - - - - - - - - - - - -- - _ .....- --Signature of Contractor's Authorized R

Date:

Signature of Authorized Official:

8 \2Co \ 02

Type or Printed Name of

Date: ave Representative:

DrI5 ide n -t-/

V \.../

Type or Printed Name of Above Official:

~Octer B a~ie

Title of Authorized R'epre sentali ve:

T itle of Auth orized Rep resentative:

PE.O

Notary Public

Ch'Ief.of ~abor Budgeting and

C'

)

IF')

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County of

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State of New York

.:«.». $

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State Agency el1lficafion:' ln a dlfion'ltoihe-'.-:; Acceptance of this con tract, I also cert ify that original

6c.¥u.r
Copies of this sign u~r;g .....QJ.t1er exact cop ie of . 11 a . .2:~.!::::!:!:!~~~#~~, • Lj 1] . A U & CONTROL

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SEP 30 2002 O/~~

FORTHE aATEGOMPTROll ER ffice of the State Comptro ller:

all