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Home My WebLink AboutContract 51822 SER SCSEP `�cGO (This is a Training Program for SCSEP ParticipantFYSECRETARY �, 61 - HOST AGENCY AGREEMENT CONTRACT Na" fJ 12 o2a r ��.t1oQy See Sections 11, 13, &27 of the SOP Agency/ G�!on:gb of Fort Worth DEIN: 75-6000528 The Senior Community Service Employment Program (SCSEP) aids unemployed low income individuals, 55 years and older, In re-entering the workforce by providing subsidized community service training assignments with non-profit and government agencies to gain experience. Thank You for partnering with SER SCSEP to enhance employment opportunities for the participants that will be assigned with your agency/organization. Your agency will assist participants with meaningful training opportunities to update andlor develop job skills needed to obtain unsubsidized employment. SER SCSEP responsibilities: Agency/Organization responsibilities: Ot Assessment of the participant's skills; oR Provide supervision,orientation,training,safe training site and oR Development of a customize employment plan; adhere to all applicable state laws regarding meal/rest breaks; oR Assignment to a suitable training site; %P Abide by agreed-upon training schedule (not to exceed io hours Der we and submit properly prepared and signed oR Create a list of training activities and appropriate timesheets. schedule for each participant not exceeding iq Ot Adhere to the policies/procedures outlined in the SER SCSEP hours per week, Handbook; Ot Provide compensation (at the federal/state Ot Consider hiring the participant if appropriate openings occur minimum wage)to participants for training; [no special consideration is implied]; Ot Provide job search guidance through aP Cover the cost for background checks,health screenings or drug employment referrals and job readiness testing required by the agency; workshops; oR Maintain open communication with the SCSEP staff regarding it Communicate to host agencies any changes in the participant's training and any issues/situations; regards to training and/or SCSEP policies and oe Inform SCSEP staff when the participant gets a job. procedures; Ot Agree not to use participants as substitutes for permanent it Make available opportunities for participants to employees; to displace currently employed or laid off employee rotate to other host sites for additional training [wig 2 years];or to reduce regular hours,wages or benefits. experience; oR Agree not to compensate the participant in any form or manner; oR Conduct annual/bi-annual informational Host oR Attend SER SCSEP host agency meetings;and Agency meetings;and aP Provide a copy of the following upon request: General Liability Ot Cover all SER participants under a worker's Insurance, IRS 5oi(c)(3) letter [non-profits], an annual HA compensation insurance policy during training Assessment of SCSEP,and supervisor hours for In-kind services hours. provided[if applicable]. This agreement will be in effect from January 1. 2019 until June 30 of 2022 [42 months]; a rehewai of this partnership must be signed to continue partnership past this date. Type of Agency/Organization: Participant Supervisor is Paid From: Additional Sites: ❑Non-Profit Organization—IRS code ®Federal funds ❑ No 501(c)(3)-documentation attached ® Public Organization-Government agency ®Non-federal funds ® Yes--fill out Form#62(HAA-Additional Including federal,state,county,or city Supervisor Hourly Pay Rate:$25.13- Sites) $32.82 The subsequent representative's signature on this agreement acknowledges that each supervisor will read and adhere to the above requirements. It further signifies your agency accepts and agrees to cooperate with SER SCSEP. Please check each appropriate box: City of Fort Worth SER National Texas--Fort Worth Agency/Organization—Main Office Location SER SCSEP Site 200 Texas Street Fort Worth,TX 76102 2300 Circle Drive,#2309, Fort Worth,TX 76119 Address City,State,ZIP Address City,Stat 817-392-5774 (817)360-8905 817-536-3600 Fax 817-536-3601 Telephone&Fax Telephone&Fax COR® respinoza@ser-national.org CITY SECRETARY Email Email City of Fort Worth Fernando Costa Ruth Espinoza FT. WORTH,TX Agency/Organization Representative Name(Print) yI� EEStaff Name(Print) Ruth M.Espinoza(Fe 9,2019) Feb 5,2019 Agency/Organtzation Representative Signature Date Signed SER SCSEP Staff Signature Date Signed Original: Host Agency File Copy: Host Agency,SER National-In-Kind Effective 07/01/2017 SER SCSEP (This is a Training Program for SCSEP Participants) 62 - HOST AGENCY AGREEMENT-ADDITIONAL SITES Please attach to the Host Agency Agreement See Sections 11, 13, &27 of the SOP Host Agency Name: CITY OF FORT WORTH Neighborhood Services Department Fort Worth TX 76102 Mailing Address City State ZIP 200 Texas Street Fort Worth TX 76102 Physical Address CRY State ZIP Telephone& Fax (817) 392-5774 (81 360_8905 Email sonia.singletonO—fortworthtexas.gov SONIA M. SINGLETON, MBA Assit. Dir. / Neighborhood Serv. Dept. Contact Person Name(Print) Title Other Host Agency Authorized Sites [each site listed below must have a separate Host Agency File] Name: Andrew "Doc" Session Community Ctr Phone No. 8( 17)392-6585 201 S. Sylvania St Fort Worth TX 76111 Address City State ZIP Telephone& Fax (817)392-6580 Email linda.beitram@fortworthtexas.gov Linda Beltram Community Center Coordinator Contact Person Name(Print) Title ****************************************************** Name: Chisholm Trail Community Center Phone No. 8( 17 )392-8070 4936 McPherson Blvd Fort Worth TX 76123 Address City State ZIP Telephone& Fax (817) 392-8070 Email sharetta.goodwinCWfortworthtxas.gov Sharetta Goodwin Community Center Supervisor Contact Person Name(Print) Title Name: COMO Community Center Phone No. 8( 17 )871-5300 4900 Home Street Fort Worth TX 76107 Address City State ZIP Telephone&Fax (817) 392-5300 Email clara.kirbvC)-fortworthtexas.gov Clara Kirby Community Center Coordinator Contact Person Name(Print) Title Name: Martin Luther King_Community Center Phone No. (81Z )871-5966 5565 Truman Drive Fort Worth TX 76112 Address City State ZIP Telephone& Fax (817) 392-5966 Email Paula.iackson2t@-fortworthtexas.gov Paula Jackson Community Center Coordinator Contact Person Name(Print) TRIe Original:Host Agency File of Main Site Copy:Host Agency File[for each site listed] Effective 07/01/2017 SER SCSEP (This is a Training Program for SCSEP Participants) fit - HOST AGENCY AGREEMENT-ADDITIONAL SITES Please attach to the Host Agency Agreement See Sections 11, 13 &27 of the SOP Host Agency Name: City of Fort Worth Neighborhood Services Department Fort Worth TX 76102 Mailing Address City State .ZIP 200 Iffl 9S Street Fort Worth TX 76102 Physical Address City state ZIP Telephone& Fax 817) 392-5774 (817) 360-8905 Email sonia.singletonOfortworthtexas.gov SONIA M. SINGLETON MBA Assit. Dir./ Neighborhood Serv. Dept Contact Person Name(Print) Title Other Host Agency Authorized Sites [each site listed below must have a separate Host Agency File] Name: North Tri-Ethnic Community Center Phone No. ( 17 )392-5200 2950 Roosevelt Avenue Fort Worth TX 76106 Address City State ZIP Telephone&Fax (817)392-5200 Emailarturo.mercadoCa).fortworthtexas.gov Arturo Mercado Community Center Coordinator Contact Person Name(Print) Title Name: Northside Community Center Phone No. 8( 17 )392-5992 1100 N.W. 18th Street Fort Worth TX 76106 Address City State ,ZIP Telephone&Fax 817)392-5992 Email eric.lopezmartinezCa?fortworth.gov Eric Lopez Community Center Coordinator Contact Person Name(Print) Title Name: Southside Community Center Phone No. 8( 17 )392-6605 959 E. Rosedale Street Fort Worth TX 76104 Address City State ZIP Telephone&Fax (817)871-6600 Emailfelicia.iohnson(o)-fortworthtexas.gov Felicia Johnson Community Center Coordinator Contact Person Name(Print) Title Name: Worth Heights Community Center Phone No. (817 )392-8722 5§§lNew York Avenue Fort Worth TX 76104 Address State ZIP Telephone&Fax (817)392-8722 Email deierdre.iimerson@fortworthtexas.gov Deierdre Jimerson Community Center Coordinator Contact Person Name(Print) Title Original:Host Agency File of Main Site Copy:Host Agency File[for.each site listed] Effective 07/01/2017 SER SCSEP (This is a Training Program for SCSEP Participants) 62 - HOST AGENCY AGREEMENT-ADDITIONAL SITES Please attach to the Host Agency Agreement See Sections 11, 13, &27 of the SOP Host Agency Name:.of Fort Worth Neighborhood Services Department Fort Worth TX 76102 Mailing Address City State ZIP 200 Texas Street Fort Worth TX 76102 Physical Address City State ZIP Telephone&Fax (8 17) 392-5774 (81 i) 360-8905 Email sonia.singieton(afortworthtexas.gov SONIA M. SINGLETON, MBA Assit. Dir./ Neighborhood Serv. Dept Contact Person Name(Print) Title Other Host Agency Authorized Sites (each site listed below must have a separate Host Agency Flle] Name: Diamond Hill Community Center Phone No. ( 17 )392-5485 1701 N. E. 36th Street Fort Worth TX 76104 Address City State ZIP Telephone&Fax (817)392-5485 Email raul.mezaOfortworthtexas.gov Raul Meza Community Center Supervisor 'Contact Penson Name(Print) Title Name: Euqene McCrae Community Center Phone No. 8( 17 )392-7146 4932 Wll§grger Street Fort Worth TX 76119 Address City State ZIP Telephone&Fax (817) 392-7146 Emailledn.smithO-fortworthtexas.gov Jerin Smith Community Center Supervisor Contact Person Name(Print) Title ••**,►•••ier�*•*•i�**•�,►r►*•i*♦*�t►irii+e•,ee**yes*ti*■:*,t Name: Handley Meadowbrook Community Center Phone No. 8( 17 )392-2830 6201 Beaty Street Fort Worth TX 76112 Address City State ZIP Telephone&Fax (817) 392-2830 Email Jerry.wallace@fortworthtexas.gov Jerry Wallace Community Center Supervisor Contact Person Name(Print) Title Name: Hillside Community Center Phone No. (.817 )392-7660 I,201 ,E,,MgddgX Fort Worth TX 76104 Address State ZIP Telephone&Fax (817) 392-7660 Email delana.ionesafortworthtexas.gov Delana Jones Community Center Supervisor Contact Person Name(Print) Titin Original:Host Agency File of Main Site Copy:Host Agency File[for each site listed] Effective 07/01/2017 SER SCSEP (This is a Training Program for SCSEP Participants) 62 - HOST AGENCY AGREEMENT-ADDITIONAL SITES Please attach to the Host Agency Agreement See Sections 11, 13, &27 of the SOP Host Agency Name: GIjy of Fort Worth Neighborhood Services Department Fort Worth TX 76102 Mailing Address City State ZIP 200 Texas Street Fort Worth TX 76102 Physical Address City State ZIP Telephone&Fax (817) 392-5774 (817)360-8905 Email sonia.singleton(afortworthtexas.gov SONIA M. SINGLETON MBA Assit. Dir. /Neighborhood Serv. Dept. Contact Person Name(Print) Title Other Host Agency Authorized Sites [each site listed below must have a separate Host Agency File] Name: Riverside Community Center Phone No. ( 17 )392.7640 3700 E. Belknap Street Fort Worth TX 76111 Address City State ZIP Telephone&Fax (817)392-7670 Emaildavid.keithC�fortworthtexas.gov David Keith Community Center Supervisor Contact Person Name(Print) Title Name: Sycamore Community Center Phone No. 8( 17 )392-7650 2525 E. Rosedale Street Fort Worth TX 76105 Address City State ZIP Telephone&Fax (817) 392-7650 Email aaron.muhammad@fortworthtexas.gov Aaron Muhammad Community Center Supervisor Contact Person Name(Print) Title Name: Fire Station Community Center Phone No. 8t 17,392-2240 1601 Lipscomb Street Fort Worth I 76104 Address City State ZIP Telephone&Fax(817) 392-2240 Email daniel.leach(&.fortworthtexas.gov Daniel Leach Community Center Supervisor Contact Person Name(Print) Title Name: Greenbriar Commurib Center Phone No. (817 )_392-6270 5200 Hemphill uc&W Fort worth TX 76115 Address State ZIP Telephone&Fax (817)392-6270 Email iames.turner0fortworthtexas.aov James Turner Community Center Supervisor Contact Person Name(Print) Title Original:Host Agency File of Main Site Copy:Host Agency File[for each site listed] Effective 07/01/2017 SER SCSEP (This is a Training Program for SCSEP Participants) 62 - HOST AGENCY AGREEMENT-ADDITIONAL SITES Please attach to the Host Agency Agreement See Sections 11, 13, &27 of the SOP Host Agency Name: Cily Qf Fort Worth Neighborhood Services Department Fort Worth TX 76102 Mailing Address City State ZIP 200 Texas Street Fort Worth TX 76102 Physical Address City State ZIP Telephone&Fax (81 7) 392-5774 (817) 360-8905 Email. sonia.singleton@fortworthtexas.gov SONIA M. SINGLETON, MBA Assit. Dir. /Neighborhood Sery. Dept. Contact Person Name(Print) Title Other Host Agency Authorized Sites [each site listed below must have a separate Host agency Flle] Name: Highland Hills Community Center Phone No. 8( 17 )392-2580 1600 Glasgow Road Fort Worth TX 76134 Address city State ZIP Telephone&Fax (817)392-2580 Emailterrance.iones(cb-fortworthtexas.gov Terrance Jones Community Center Supervisor Conted Person Name(Print) Title Name: R.D. Evans Community Center Phone No. 8( 17 )392-7400 3242 Lackland Road Fort Worth TX 76116 Address City State ZIP Telephone&Fax (817) 392-7400, Email amber.brvantO-foltworthtexas.gov Amber Bryant Recreation Programmer Contact Person Name(Print) Title Name: Southwest Community Center Phone No. 8( 17 )392-7613 6300 Welch Avenue Fort Worth TX 76133 Address City State ZIP Telephone&Fax (817) 392-7613 Email nicholle.wilsonOfortworthtexas.gov Nichofle Wilson Community Center Supervisor Contact Person Name(Print) Title tew�� t� ►�*+r��,e�,e�,t��rr,r*,ease*,ew,e��,e,e��,e• Name: Thomas Place Community Center Phone No. (817 )_392-7427 4237 Lafayette Avenue Fort worth TX 76107 Address State ZIP Telephone&Fax (817) 392-7427 Email karen.stuhmer(afortworthtexas.gov Karen Stuhmer Community Center Supervisor Contact Person Name(Print) Title Original:Host Agency Fite of Main Site Copy:Host Agbncy File[for each site listed] Effective 07/01/2017 SER SCSEP (This is a Training Program for SCSEP Participants) 62 - HOST AGENCY AGREEMENT-ADDITIONAL SITES Please attach to the Host Agency Agreement See Sections 11, 13, &27 of the SOP Host Agency Name: Cily of Fort Worth Nei hborhood Services Department Fort Worth TX 76102 Mailing Address City State , ZIP 7011 TexaS„Street Fort Worth TX 76102 Physical Address Clty State ZIP Telephone&Fax X8171392-5774 (817) 360-8905 Email sonia.singleton(c_fortworthtexas.gov SONIA M -SINGLETON MBA Assit. Dir./Neighborhood Serv. Dept. Contact Person Name(Print) Title Other Host Agency Authorized Sites [each site llsted below must have a separate Host Agency F)le] Name: Victory Forest Community Center Phone No.( 17,392-8200 3427 Hemphill Street Fort Worth TX 76110 Address City State ZIP Telephone&Fax-(817)392-8200 Email peggy.mccoy@fortworthtexas.gov Peggy McCoy Community Center Supervisor Contact Penson Name(Print) Tide Name: Forest Park Pool Phone No. 8( 17 )392-7691 2850 Park Place Fort Worth TX 76116 Address City State ZIP Telephone&Fax (817)392-7691 Email kelli.pickard(D-fortworthtexas.gov Actinq Assistant Director Contact Person Name(Print) Title Name: Marine Park Pool Phone No. 8l 17 )392-7650 303 N.W. 20th Street Fort Worth TX 76106 Address city state ZIP Telephone&Fax (817)392-7650 Email core.stuhme[@fortworthtexas.gov Cory Stuhmer Athletic Coordinator Contact Person Name(Print) Tito •,rww+r***, �w*w*:ww****r*,►+►r*tr*«*w,ew:.�.*,►a*rrr,rk,►,►w*r*• Name: Log Cabin ViliBg„e Phone No. (817 )x,92-5881 2100 Lw Cabin Villaae Lane Fort worth TX • 76109 Address State ZIP Telephone &Fax (817) 392-5881 Email rene.lawrence(&fortworthtexas.gov Rene Lawrence Acting Assistant Director Contact Person Name(Prat) Tine Original:Host Agency File of Main Site Copy:Host Agency File[for each site listed) Effective 07/01/2017 SER SCSEP 2019-2022 61-HOST AGENCY AGREEMENT APPROVED AS TO FORM AND LEGALITY: Matt Murray Assistant City Attorney ATTEST: f�ORr J.K ity Secre #' ! M&C Not Required Dated:N/A By signing below, I acknowledge that I am the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. 4vro L-19� onia Singleton,A si ant Director Neighborhood Se i s OFFICIAL RECORD CITY SECRETARY FT. WORTH,TX