HomeMy WebLinkAboutContract 60421CSC No.. 60421
WORKSITE TRAINING AGREEMENT
FOR WORKFORCE SOLUTIONS FOR TARRANT COUNTY
This WORKSITE TRAINING AGREEMENT ("Agreement') is made and entered into by and
between the CITY OF FORT WORTH ("City"), a Texas home rule municipal corporation, acting by and
through its duly authorized Assistant City Manager, and WORKFORCE SOLUTIONS FOR TARRANT
COUNTY, ("Employer"), a Non -Profit, and acting by and through its duly authorized Deputy Director,
Marc Thompson, each individually referred to as a "party" and collectively referred to as the "parties."
WHEREAS, Employer conducts the Workforce Solutions for Tarrant County Work
Experience/Subsidized Employment/Transitional Jobs program ("Program") in order to provide
opportunities to individuals with limited or no work experience ("Participants") with exposure to the world
of work by providing an opportunity to participate in paid work experience; and
WHEREAS, City believes that certain opportunities exist within the City to provide a worksite for
Participants to participate in the Program; and
WHEREAS, it is understood by both parties that Employer will be responsible for all wages to be paid to
Participants under Program and that City is not required to retain or hire Participants upon completion of
the Program; and
WHEREAS, Employer and City believe that executing this agreement will provide a meaningful
opportunity for a number of Participants while raising awareness of City functions and the programs offered
by Employer.
NOW THEREFORE, Employer and City hereby enter into the following Agreement:
AGREEMENT DOCUMENTS:
The Agreement documents include the following:
1. This Worksite Training Agreement;
2. Exhibit A — Scope of Services; and
3. Exhibit B — Participant Waiver
4. Exhibit C — Workforce Solutions for Tarrant County, Master Worksite Training Employer
Agreement
Exhibits A, B and C which are attached hereto and incorporated herein, are made a part of this Agreement
for all purposes. In the event of any conflict between the terms and conditions of Exhibits A, B and/or C
and the terms and conditions set forth in the body of this Agreement, the terms and conditions of this
Agreement will control.
1. SCOPE OF SERVICES.
City will allow up to thirty participants to engage in specific assignments under the Tarrant County
Work Experience/Subsidized Employment/Transitional Jobs program ("Program") at specified City of Fort
Worth facilities, in accordance with this Agreement. Exhibit "A," - Scope of Services more specifically
describes the services to be provided hereunder.
OFFICIAL RECORD
2. TERM. CITY SECRETARY
FT. WORTH, TX
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This Agreement will begin on October 1, 2023 ("Effective Date") and will expire on September
30, 2024 ("Expiration Date"), unless terminated earlier in accordance with this Agreement. City will have
the option, in its sole discretion, to renew this Agreement under the same terms and conditions, for up to
four (4) one-year renewal options.
3. COMPENSATION AND CONSIDERATION.
Neither Party will owe any amount of money for any reason whatsoever to the other Party for
services rendered in connection with this Agreement. City will not be liable for, nor owe, any payment, fee,
cost, penalty, or money for any other reason whatsoever to Employer or any Participant in Employer's
program who performs any services in connection with this agreement. Employer will be solely responsible
for any payment, cost, fee, or other benefit provided to the Participants in its Program and who provide
services in connection with this Agreement.
The Parties agree that there is good and valuable consideration from each party to the other and
that each Party is providing a benefit through its performance of its duties hereunder to the other. In
consideration for its performance, City recognizes that more people will become aware of City functions,
and Participants will gain work and life experience which will benefit the City overall. hi consideration for
its performance, Employer recognizes that its Participants will receive valuable work experience and
become more familiar with City programs, departments, and functions.
4. TERMINATION.
4.1. Written Notice. City or Employer may terminate this Agreement at any time and for any
reason by providing the other party with 30 days' written notice of termination without any penalty of any
kind.
4.2 Duties and Obligations of the Parties. In the event that this Agreement is terminated prior
to the Expiration Date, all services in connection with this Agreement will stop immediately.
5. DISCLOSURE OF CONFLICTS AND CONFIDENTIAL INFORMATION.
5.1 Disclosure of Conflicts. Employer hereby warrants to City that Employer has made full
disclosure in writing of any existing or potential conflicts of interest related to Employer's services under
this Agreement. In the event that any conflicts of interest arise after the Effective Date of this Agreement,
Employer hereby agrees immediately to make full disclosure to City in writing.
5.2 Confidential Information. Employer, for itself and its officers, agents and employees,
agrees that it will treat all information provided to it by City ("City Information") as confidential and will
not disclose any such information to a third parry without the prior written approval of City.
5.3 Unauthorized Access. Employer must store and maintain City Information in a secure
manner and will not allow unauthorized users to access, modify, delete or otherwise corrupt City
Information in any way. Employer must notify City immediately if the security or integrity of any City
Information has been compromised or is believed to have been compromised, in which event, Employer
will, in good faith, use all commercially reasonable efforts to cooperate with City in identifying what
information has been accessed by unauthorized means and will fully cooperate with City to protect such
City Information from further unauthorized disclosure.
6. RIGHT TO AUDIT.
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Employer agrees that City will, until the expiration of three (3) years after expiration of this
contract, or the final conclusion of any audit commenced during the said three years, have access to and the
right to examine at reasonable times any directly pertinent books, documents, papers and records, including,
but not limited to, all electronic records, of Employer involving transactions relating to this Agreement at
no additional cost to City. Employer agrees that City will have access during normal working hours to all
necessary Employer facilities and will be provided adequate and appropriate work space in order to conduct
audits in compliance with the provisions of this section. City will give Employer reasonable advance notice
of intended audits.
This provision will survive the expiration or termination of this Agreement.
7. INDEPENDENT CONTRACTOR.
It is expressly understood and agreed that Employer and all participants in Employer's Program
will operate as an independent contractors as to all rights and privileges and work performed under this
Agreement, and not as agent, representative or employee of City. Subject to and in accordance with the
conditions and provisions of this Agreement, Employer will have the exclusive right to control the details
of its operations and activities and be solely responsible for the acts and omissions of its officers, agents,
participants, servants, employees, consultants and subcontractors. Employer acknowledges that the doctrine
of respondeat superior will not apply as between City, its officers, agents, servants and employees, and
Employer, its officers, agents, participants, employees, servants, contractors and subcontractors. Employer
further agrees that nothing herein will be construed as the creation of a partnership or joint enterprise
between City and Employer. Neither Employer, nor any officers, agents, participants, servants, employees
or subcontractors of Employer will be entitled to any employment benefits from City. Employer will be
responsible and liable for any and all payment and reporting of taxes on behalf of itself, and any of its
officers, agents, participants, servants, employees or subcontractors.
8. NO JOINT EMPLOYMENT
The Participants selected by Employer will be and shall remain employees or contractors of
Employer, reporting solely to Employer, and Employer will provide for and pay the compensation and other
benefits of such personnel, including salary, health, accident and worker's compensation benefits and all
taxes and contributions that an employer is required to pay with respect to the employment of employees.
Employer's personnel performing services shall have a duty of loyalty to Employer. Employer shall
determine the terms of employment for its respective personnel in accordance with its standard practices,
including hiring and firing. All Employer's personnel assigned to perform services under this agreement
shall be required to sign an acknowledgement in form reasonably acceptable to Employer and City that
provides that although such personnel may work with employees of City, (i) they are employees of
Employer only and (ii) they are expected to follow the policies, procedures and direction of Employer.
Such direction may include that Participants are required by Employer to comply with the policies of the
City while working at City facilities; however, that direction will not change the status of such Participants,
as set out specifically in this paragraph.
9. LIABILITY AND INDEMNIFICATION.
9.1 LIABILITY - EMPLOYER WILL BE LIABLE AND RESPONSIBLE FOR ANY AND
ALL PROPERTY LOSS, PROPERTY DAMAGE AND/OR PERSONAL INJURY,
INCLUDING DEATH, TO ANY AND ALL PERSONS, OF ANY KIND OR CHARACTER,
WHETHER REAL OR ASSERTED, TO THE EXTENT CAUSED BY THE NEGLIGENT
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ACT(S) OR OMISSION(S), MALFEASANCE OR INTENTIONAL MISCONDUCT OF
EMPLOYER, ITS OFFICERS, PARTICIPANTS, AGENTS, SERVANTS OR EMPLOYEES.
9.2 GENERAL INDEMNIFICATION - EMPLOYER HEREBY COVENANTS AND
AGREES TO INDEMNIFY, HOLD HARMLESS AND DEFEND CITY, ITS OFFICERS,
AGENTS, SERVANTS AND EMPLOYEES, FROMAND AGAINST ANYAND ALL CLAIMS
OR LAWSUITS OF ANY KIND OR CHARACTER, WHETHER REAL OR ASSERTED, FOR
PROPERTY DAMAGE OR LOSS (INCLUDING ALLEGED DAMAGE OR LOSS TO
EMPLOYER'S BUSINESS AND ANY RESULTING LOST PROFITS), CONTRACTUAL
DISPUTES FROM PARTICIPANTS, AND/OR PERSONAL INJURY, INCLUDING DEATH,
TO ANY AND ALL PERSONS, ARISING OUT OF OR IN CONNECTION WITH THIS
AGREEMENT. THIS SPECIFICALL Y INCL UDES ANY LIABILITY. CLAIMS. LA WSUITS.
DAMAGES. OR OTHER COSTS OF ANY KIND OR CHARACTER THAT ARE CAUSED BY
ANY ACTION OR OMISSION BY CITY. CITY'S OFFICERS. EMPLOYEES. OR
SUBCONTRACTORS IN CONNECTION WITH THIS AGREEMENT.,
9.3 This section will survive the expiration or termination of this Agreement.
10. ASSIGNMENT AND SUBCONTRACTING.
10.1 Assiariment. Employer will not assign or subcontract any of its duties, obligations or rights
under this Agreement without the prior written consent of City. If City grants consent to an assignment, the
assignee will execute a written agreement with City and Employer under which the assignee agrees to be
bound by the duties and obligations of Employer under this Agreement. Employer and Assignee will be
jointly liable for all obligations of Employer under this Agreement prior to the effective date of the
assignment.
10.2 Subcontract. If City grants consent to a subcontract, subcontractor must execute a written
agreement with Employer referencing this Agreement under which subcontractor will agree to be bound by
the duties and obligations of Employer under this Agreement as such duties and obligations may apply.
Employer must provide City with a fully executed copy of any such subcontract.
11. INSURANCE.
Employer must provide City with certificate(s) of insurance documenting policies of the following
types and minimum coverage limits that are to be in effect prior to commencement of any work pursuant
to this Agreement:
11.1 Coverase and Limits
(a) Commercial General Liability:
$1,000,000 - Each Occurrence
$2,000,000 - Aggregate
(b) Automobile Liability:
$1,000,000 - Each occurrence on a combined single limit basis
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Coverage will be on any vehicle used by Employer, its employees, agents, or
representatives in the course of providing services under this Agreement. "Any
vehicle" will be any vehicle owned, hired and non -owned.
(c) Worker's Compensation:
Statutory limits according to the Texas Workers' Compensation Act or any other
state workers' compensation laws where the work is being performed
Employers' liability
$100,000 -
Bodily Injury by accident; each accident/occurrence
$100,000 -
Bodily Injury by disease; each employee
$500,000 -
Bodily Injury by disease; policy limit
(d) Professional Liability (Errors & Omissions):
$1,000,000 - Each Claim Limit
$1,000,000 - Aggregate Limit
Professional Liability coverage may be provided through an endorsement to the
Commercial General Liability (CGL) policy, or a separate policy specific to
Professional E&O. Either is acceptable if coverage meets all other requirements.
Coverage must be claims -made, and maintained for the duration of the contractual
agreement and for two (2) years following completion of services provided. An
annual certificate of insurance must be submitted to City to evidence coverage.
11.2 General Reauirements
(a) The commercial general liability and automobile liability policies must name City
as an additional insured thereon, as its interests may appear. The term City includes
its employees, officers, officials, agents, and volunteers in respect to the contracted
services.
(b) The workers' compensation policy must include a Waiver of Subrogation (Right
of Recovery) in favor of City.
(c) A minimum of Thirty (30) days' notice of cancellation or reduction in limits of
coverage must be provided to City. Ten (10) days' notice will be acceptable in the
event of non-payment of premium. Notice must be sent to City of Fort Worth, Attn:
Christine Hernandez, Human Resources Manager, 200 Texas Street, Fort Worth,
Texas 76102, with copies to the Fort Worth City Attorney at the same address.
(d) The insurers for all policies must be licensed and/or approved to do business in the
State of Texas. All insurers must have a minimum rating of A- VII in the current
A.M. Best Key Rating Guide, or have reasonably equivalent financial strength and
solvency to the satisfaction of Risk Management. If the rating is below that
required, written approval of Risk Management is required.
(e) Any failure on the part of City to request required insurance documentation will
not constitute a waiver of the insurance requirement.
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(f) Certificates of Insurance evidencing that Employer has obtained all required
insurance will be delivered to the City prior to Employer proceeding with any work
pursuant to this Agreement.
12. COMPLIANCE WITH LAWS. ORDINANCES. RULES AND REGULATIONS.
Employer agrees that in the performance of its obligations hereunder, it will comply with all
applicable federal, state and local laws, ordinances, rules and regulations and that any work it produces in
connection with this Agreement will also comply with all applicable federal, state and local laws,
ordinances, rules and regulations. If City notifies Employer of any violation of such laws, ordinances, rules
or regulations, Employer must immediately desist from and correct the violation.
13. NON-DISCRIMINATION COVENANT.
Employer, for itself, its personal representatives, participants, assigns, subcontractors and
successors in interest, as part of the consideration herein, agrees that in the performance of Employer's
duties and obligations hereunder, it will not discriminate in the treatment or employment of any individual
or group of individuals on any basis prohibited by law. IF ANY CLAIM ARISES FROM AN ALLEGED
VIOLATION OF THIS NON-DISCRIMINATION COVENANT BY EMPLOYER, ITS
PERSONAL REPRESENTATIVES, PARTICIPANTS, ASSIGNS, SUB EMPLOYERS OR
SUCCESSORS IN INTEREST, EMPLOYER AGREES TO ASSUME SUCH LIABILITY AND TO
INDEMNIFY AND DEFEND CITY AND HOLD CITY HARMLESS FROM SUCH CLAIM.
14. NOTICES.
Notices required pursuant to the provisions of this Agreement will be conclusively determined to
have been delivered when (1) hand -delivered to the other party, its agents, employees, servants or
representatives, (2) delivered by facsimile with electronic confirmation of the transmission, or (3) received
by the other party by United States Mail, registered, return receipt requested, addressed as follows:
City of Fort Worth
Attn: Jesica McEachern, Assistant City Manager
200 Texas Street
Fort Worth, TX 76102-6314
Facsimile: (817) 392-8654
With copy to Fort Worth City Attorney's Office at
same address
15. GOVERNMENTAL POWERS.
To EMPLOYER:
Marc Thompson
Deputy Director, Business Solutions
Workforce Solutions for Tarrant County
1320 S. University Dr., Suite 600
Fort Worth, TX 76107
Facsimile: 817-222-6318
It is understood and agreed that by execution of this Agreement, City does not waive or surrender
any of its governmental powers or immunities.
16. NO WAIVER.
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The failure of City or Employer to insist upon the performance of any term or provision of this
Agreement or to exercise any right granted herein does not constitute a waiver of City's or Employer's
respective right to insist upon appropriate performance or to assert any such right on any future occasion.
17. GOVERNING LAW / VENUE.
This Agreement will be construed in accordance with the laws of the State of Texas. If any action,
whether real or asserted, at law or in equity, is brought pursuant to this Agreement, venue for such action
will lie in state courts located in Tarrant County, Texas or the United States District Court for the Northern
District of Texas, Fort Worth Division.
18. SEVERABILITY.
If any provision of this Agreement is held to be invalid, illegal or unenforceable, the validity,
legality and enforceability of the remaining provisions will not in any way be affected or impaired.
19. FORCE MAJEURE.
City and Employer will exercise their best efforts to meet their respective duties and obligations as
set forth in this Agreement, but will not be held liable for any delay or omission in performance due to force
majeure or other causes beyond their reasonable control, including, but not limited to, compliance with any
government law, ordinance, or regulation; acts of God; acts of the public enemy; fires; strikes; lockouts;
natural disasters; wars; riots; epidemics or pandemics; government action or inaction; orders of government;
material or labor restrictions by any governmental authority; transportation problems; restraints or
prohibitions by any court, board, department, commission, or agency of the United States or of any States;
civil disturbances; other national or regional emergencies; or any other similar cause not enumerated herein
but which is beyond the reasonable control of the Party whose performance is affected (collectively, "Force
Majeure Event"). The performance of any such obligation is suspended during the period of, and only to
the extent of, such prevention or hindrance, provided the affected Party provides notice of the Force Maj eure
Event, and an explanation as to how it prevents or hinders the Party's performance, as soon as reasonably
possible after the occurrence of the Force Majeure Event, with the reasonableness of such notice to be
determined by the City in its sole discretion. The notice required by this section must be addressed and
delivered in accordance with Section 14 of this Agreement.
20. HEADINGS NOT CONTROLLING.
Headings and titles used in this Agreement are for reference purposes only, will not be deemed a
part of this Agreement, and are not intended to define or limit the scope of any provision of this Agreement.
21. REVIEW OF COUNSEL.
The parties acknowledge that each party and its counsel have reviewed and revised this Agreement
and that the normal rules of construction to the effect that any ambiguities are to be resolved against the
drafting party will not be employed in the interpretation of this Agreement or Exhibits A, B, and C.
22. AMENDMENTS/ MODIFICATIONS/ EXTENSIONS.
No amendment, modification, or extension of this Agreement will be binding upon a party hereto
unless set forth in a written instrument, which is executed by an authorized representative of each party.
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23. COUNTERPARTS.
This Agreement may be executed in one or more counterparts and each counterpart will, for all
purposes, be deemed an original, but all such counterparts will together constitute one and the same
instrument.
24. IMMIGRATION NATIONALITY ACT.
Employer must verify the identity and employment eligibility of its employees who perform work
under this Agreement, including completing the Employment Eligibility Verification Form (I-9). Upon
request by City, Employer will provide City with copies of all I-9 forms and supporting eligibility
documentation for each employee who performs work under this Agreement. Employer must adhere to all
Federal and State laws as well as establish appropriate procedures and controls so that no services will be
performed by any Employer employee who is not legally eligible to perform such services. EMPLOYER
WILL INDEMNIFY CITY AND HOLD CITY HARMLESS FROM ANY PENALTIES,
LIABILITIES, OR LOSSES DUE TO VIOLATIONS OF THIS PARAGRAPH BY EMPLOYER,
EMPLOYER'S EMPLOYEES, SUBCONTRACTORS, PARTICIPANTS, AGENTS, OR
LICENSEES. City, upon written notice to Employer, will have the right to immediately terminate this
Agreement for violations of this provision by Employer.
25. OWNERSHIP OF WORK PRODUCT.
City will be the sole and exclusive owner of all reports, work papers, procedures, guides, and
documentation, created, published, displayed, and/or produced in conjunction with the services provided
under this Agreement (collectively, "Work Product"). Further, City will be the sole and exclusive owner
of all copyright, patents, trademark, trade secret and other proprietary rights in and to the Work Product.
Ownership of the Work Product will inure to the benefit of City from the date of conception, creation or
fixation of the Work Product in a tangible medium of expression (whichever occurs first). Each
copyrightable aspect of the Work Product will be considered a "work -made -for -hire" within the meaning
of the Copyright Act of 1976, as amended. If and to the extent such Work Product, or any part thereof, is
not considered a "work -made -for -hire" within the meaning of the Copyright Act of 1976, as amended,
Employer hereby expressly assigns to City all exclusive right, title and interest in and to the Work Product,
and all copies thereof, and in and to the copyright, patent, trademark, trade secret, and all other proprietary
rights therein, that City may have or obtain, without further consideration, free from any claim, lien for
balance due, or rights of retention thereto on the part of City.
26. SIGNATURE AUTHORITY.
The person signing this Agreement hereby warrants that he/she has the legal authority to execute
this Agreement on behalf of the respective party, and that such binding authority has been granted by proper
order, resolution, ordinance or other authorization of the entity. This Agreement and any amendment hereto,
may be executed by any authorized representative of Employer whose name, title, and signature is affixed
on the Signature Page of this Agreement. Each party is fully entitled to rely on these warranties and
representations in entering into this Agreement or any amendment hereto. Any signature delivered by a
party by facsimile or other electronic transmission (including email transmission of a portable file (pdf) or
similar image) shall be deemed to be an original signature hereto.
27. CHANGE IN COMPANY NAME OR OWNERSHIP
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Employer must notify City's Purchasing Manager, in writing, of a company name, ownership, or
address change for the purpose of maintaining updated City records. The president of Employer or
authorized official must sign the letter. A letter indicating changes in a company name or ownership must
be accompanied with supporting legal documentation such as an updated W-9, documents filed with the
state indicating such change, copy of the board of director's resolution approving the action, or an executed
merger or acquisition agreement. Failure to provide the specified documentation so may adversely impact
future invoice payments.
28. PROHIBITION ON CONTRACTING WITH COMPANIES THAT BOYCOTT ISRAEL
If Employer has fewer than 10 employees or this Agreement is for less than $100,000, this
section does not apply. Employer acknowledges that in accordance with Chapter 2271 of the Texas
Government Code, the City is prohibited from entering into a contract with a company for goods or services
unless the contract contains a written verification from the company that it: (1) does not boycott Israel; and
(2) will not boycott Israel during the term of the contract. The terms "boycott Israel" and "company" has
the meanings ascribed to those terms in Section 2271 of the Texas Government Code. By signing this
Agreement, Employer certifies that Employer's signature provides written verification to the City
that Employer: (1) does not boycott Israel; and (2) will not boycott Israel during the term of the
Agreement.
29. PROHIBITION ON BOYCOTTING ENERGY COMPANIES.
Employer acknowledges that, in accordance with Chapter 2274 of the Texas Government Code, as
added by Acts 2021, 87th Leg., R.S., S.B. 13, § 2, the City is prohibited from entering into a contract for
goods or services that has a value of $100,000 or more that is to be paid wholly or partly from public funds
of the City with a company with 10 or more full-time employees unless the contract contains a written
verification from the company that it: (1) does not boycott energy companies; and (2) will not boycott
energy companies during the term of the contract. The terms "boycott energy company" and "company"
have the meaning ascribed to those terms by Chapter 2274 of the Texas Government Code, as added by
Acts 2021, 87th Leg., R.S., S.B. 13, § 2. To the extent that Chapter 2274 of the Government Code is
applicable to this Agreement, by signing this Agreement, Employer certifies that Employer's signature
provides written verification to the City that Employer: (1) does not boycott energy companies; and (2) will
not boycott energy companies during the term of this Agreement.
30. PROHIBITION ON DISCRIMINATION AGAINST FIREARM AND AMMUNITION
INDUSTRIES.
Employer acknowledges that except as otherwise provided by Chapter 2274 of the Texas
Government Code, as added by Acts 2021, 87th Leg., R.S., S.B. 19, § 1, the City is prohibited from entering
into a contract for goods or services that has a value of $100,000 or more that is to be paid wholly or partly
from public funds of the City with a company with 10 or more full-time employees unless the contract
contains a written verification from the company that it: (1) does not have a practice, policy, guidance, or
directive that discriminates against a firearm entity or firearm trade association; and (2) will not discriminate
during the term of the contract against a firearm entity or firearm trade association. The terms
"discriminate," "firearm entity" and "firearm trade association" have the meaning ascribed to those terms
by Chapter 2274 of the Texas Government Code, as added by Acts 2021, 87th Leg., R.S., S.B. 19, § 1. To
the extent that Chapter 2274 of the Government Code is applicable to this Agreement, by signing this
Agreement, Employer certifies that Employer's signature provides written verification to the City that
Employer: (1) does not have a practice, policy, guidance, or directive that discriminates against a firearm
entity or firearm trade association; and (2) will not discriminate against a firearm entity or firearm trade
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association during the term of this Agreement.
31. ELECTRONIC SIGNATURES.
This Agreement may be executed by electronic signature, which will be considered as an original
signature for all purposes and have the same force and effect as an original signature. For these purposes,
"electronic signature" means electronically scanned and transmitted versions (e.g. via pdf file or facsimile
transmission) of an original signature, or signatures electronically inserted via software such as Adobe Sign.
32. ENTIRETY OF AGREEMENT.
This Agreement, including Exhibits A, B and C, contains the entire understanding and agreement
between City and Employer, their assigns and successors in interest, as to the matters contained herein. Any
prior or contemporaneous oral or written agreement is hereby declared null and void to the extent in conflict
with any provision of this Agreement. Nothing herein is intended and should not be construed to create any
third -party beneficiaries to this Agreement.
(signature page follows)
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ACCEPTED AND AGREED:
CITY OF FORT WO TH:
CONTRACT CO LIANCE MANAGER:
By signing I acknowledge that I am the person
responsible for the monitoring and administration of
this contract, including ensuring all performance and
By. Name: Jesica McEachern reporting requirements.
Title: Assistant City Manager
Date: Nov 6, 2023
By: Vanessa Hottman (Oct 17, 202316:36 CDT)
Name: Vanessa Hottman
APPROVAL RECO NDED: Title: Interim Human Resources Manager
'Diaiyia M. Giodallo
By: Dianna M. Giordano (Oct 25,202316:19 CDT)
Name: Dianna Giordano
Title: Director, Human Resources
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By: l//1
Name: Jannette Goodall
Title: City Secretary
EMPLOYER:
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By: Marc Thompson (Oct 11, 2b2314:36 CDT)
Name: Marc Thompson
Title: Deputy Director, Business Solutions
Date: Oct 11, 2023
APPROVED AS TO FORM AND LEGALITY:
By:
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Name: Jessika Williams
Title: Assistant City Attorney
CONTRACT AUTHORIZATION:
M&C: N/A
1295: N/A
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
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EXHIBIT A
SCOPE OF SERVICES
A. Worksite availability:
1. Participant placement will be based upon identified needs.
2. All work will take place at City of Fort Worth Facilities or properties.
3. Only Participants ages 17 and over are eligible for placement at City worksites.
4. Participants will not work more than forty (40) hours per week.
B. City requirements prior to participant's arrival:
1. Unless Participant has completed all CJIS requirements, the Participant must be
escorted by a City employee at all times when in any CJIS secured area —regardless of
whether a computer terminal is present.
2. Participant must provide a signed and notarized waiver included as Exhibit B.
3. In the event that a background check or drug screening is required of Participant,
Employer will be responsible for providing these services and will solely be responsible
for any related fees and will be responsible for providing to a Participant any notices or
copies of documents required by law.
C. City's Requirements:
1. City's supervisor(s)/mentor(s) must go through a supervisor's/mentor's orientation
prior to any placement.
2. Provide supervision (and if required), safety training, supplies and equipment to
perform the work.
3. Record and report work hours using the Youth Work Experience Payroll Timesheet.
Submit timesheet to Employer for processing.
4. Evaluate each participant's performance on a weekly basis. City will also provide a
performance analysis of each participant at the end of the program.
5. "Contact Employer's contact person when problems occur related to any Participant or
training."
6. Notify Employer if or when change in supervision occurs.
7. May not assign a participant to perform work that: a.) engages in political patronage,
lobbying or other political activities; b.) is of a religious or anti -religious organization;
or c.) involves any task not allowed under applicable Child Labor Laws.
8. Will not use a participant to fill a job opening (1) when another individual is on layoff
from the same or substantially equivalent job, or (2) when the City has terminated the
employment of any regular employee or otherwise reduced its workforce with the
intention of filling the vacancy so created by utilizing a participant.
9. May not create jobs for participants in a promotional line that will infringe in any way
upon the promotional opportunities of currently employed individuals.
10. Will comply with the Americans with Disabilities Act (ADA), and the Drug Free Work
Place Act, to the extent such laws are applicable.
11. A participant will not participate in activities that occur in a casino or other gambling
establishments, aquarium, zoo, golf course, or swimming pool.
D. Employer's Requirements:
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1. Provide group or individual orientation to the City's Direct Supervisor/Mentor and the
Alternate Supervisor/Mentor, prior to the assignment of a participant to a work site.
Such orientation will include the objectives of the program, supervisory responsibilities,
training responsibilities, record keeping and DOL regulations.
2. Use the Trainee's component enrollment and objective assessment results to assist with
the Participant's assignment to a work site training slot.
3. Assign a single point of contact that will assist the City with the identification and
resolution of training issues and any questions/concerns.
4. Monitor work sites for compliance with all objectives of the program, supervisor
responsibilities, training responsibilities, record keeping, and DOL regulations
including Child Labor Laws when applicable.
5. Pay all participant wages, taxes, and all benefits of any kind, if applicable, for the
scheduled work hours as stated on the Placement Authorization Form (provided by the
participant) and in accordance with current Federal Minimum Wage Regulations. All
participants must be paid in accordance with applicable laws and regulations.
6. Maintain a current Worker's Compensation Policy and other required insurance and
coverage for all participants (copy of report provided in Supervisor Handbook)
7. Prior to placement, Employer will require each participant who will be placed with the
City to execute a Waiver, as attached as Exhibit C, and will provide the original copy
to the City. For participants younger than 18, their parent and/or legal guardian
will be required to sign the Waiver on their behalf.
E. Termination of Participant from Worksite:
Participants may be terminated from the worksite by the Employer at any time and for any reason
whatsoever without any penalty to the City. City will notify Employer of any participant whose
participation under this agreement the City wants Employer to end, as soon as practicable once that decision
has been made by the City. Employer may remove any participant from the worksite at any time for any
reason whatsoever without any penalty to Employer. The decision to terminate the employment of a
Participant is solely the decision of Employer. Employer will notify City of removal or termination of
employment as soon as practicable once the decision has been made by Employer.
Worksite Training Agreement Page 13 of 18
EXHIBIT B
PARTICIPANT WAIVER
Each Participant who is an adult and legally able will sign the waiver below and return a
signed, notarized original to the City prior to beginning any work at the City.
CITY OF FORT W TH
WAIVER, RELEASE, AND INDEMNITY AGREEMENT
I, . am at least 18 years of age and, for myself, my heirs
and assigns, hereby affirm that I am aware that my participation in the Workforce Solutions for Tarrant
County Work Experience/Subsidized Employment/Transitional Jobs program ("Program") solely managed
by Workforce Solutions of Tarrant County, but partly taking place at a worksite location owned by the City
of Fort Worth ("City") primarily at <INSERT PRIMARY LOCATION> ("Facility")
in Fort Worth, Texas and other City -owned locations, has inherent risks which may result in serious injury
or death. As a condition precedent to participating in the Program and entering onto the City's property, I
confirm that I understand and accept all risks, dangers and hazards presented by my participation in the
Program, and I am participating in these activities freely and voluntarily. In consideration of being
permitted to participate in the Program specifically at a City Facility, I hereby assume all risk of harm and
injury to myself and others, as well as to the property of others, which may result from my participation in
the Program, regardless of the cause or blame. I agree to act in a reasonable and cautious manner in all
aspects of my participation in the Program.
Further, I, for myself, my heirs and assigns, in consideration of being able to utilize the Facility and
participate in the Program, do hereby FOREVER RELEASE AND WAIVE all claims against the City of
Fort Worth, its officers, agents and employees, for injuries, death or property damage which may arise from
my use or presence at the Facility. This waiver and release is intended to release and forever discharge
the Citv of Fort Worth, its officers, servants, agents and emnlovees from anv and all claims, actions,
causes of action, damages, losses or expenses, including attornev's fees whether real or asserted, of
every kind or character, arising out of my use of the Facilitv, including going to and from such
Facilitv. I, for myself, my heirs and assigns, hereby assume the risk of all conditions of the Facility,
dangerous or otherwise, all occurrences that may be encountered while using or going to or from such
Facility and waive any and all specific notice of the existence of such conditions or occurrences. This
waiver is intended to release the Citv of Fort Worth, its officers, servants, agents and emnlovees even
if said iniuries, death or other damages are caused in whole or in Dart by the alleged acts of
commission, omission, negligence or fault of the Citv of Fort Worth, its officers, servants, agents or
emulovees. I, for myself, and my heirs and assigns hereby assume all responsibility and liability for such
injuries or damages, including death, and hereby covenant not to sue the entities and parties named above
for such injuries or damages.
I FURTHER AGREE TO INDEMNIFY AND DEFEND THE CITY AND HOLD THE CITY
HARMLESS FROM ALL CLAIMS, TOGETHER WITH ALL COSTS, EXPENSES, AND LEGAL
FEES IN DEFENDING ALL CLAIMS DIRECTLY OR INDIRECTLY ATTRIBUTABLE TO MY
USE OF THE FACILITY. THIS INDEMNITY PROVISION (INCLUDING, W THOUT
LIMITATION, INDEMNITY FOR COSTS, EXPENSES AND LEGAL FEES) IS SPECIFICALLY
INTENDED TO OPERATE AND BE APPLICABLE EVEN IF IT IS ALLEGED OR PROVED THAT
ALL OR SOME OF THE DAMAGES BEING SOUGHT WERE CAUSED AS A W E OR IN
PART BY ANY ACT, OMISSION, NEGLIGENCE, GROSS NEGLIGENCE, BREACH OF
CONTRACT, INTENTIONAL CONDUCT, VIOLATION OF STATUTE OR COMMON LAW,
BREACH OF WARRANTY, PRODUCT DEFECT, STRICT PRODUCT LIABILITY, OR ANY
Worksite Training Agreement Page 14 of 18
OTHER CONDUCT WHATSOEVER OF THE CITY. I REALIZE THAT BY SIGNING THIS
AGREEMENT, I AM GIVING UP MY RIGHT TO SUE THE CITY FOR INJURY, DEATH OR
DAMAGE I MAY SUFFER AT THE EVENT. IF ANY COURT FINDS A PORTION OF THIS
AGREEMENT TO BE INVALID, THE REMAINDER OF THE AGREEMENT WILL NOT BE
AFFECTED.
I have read this Waiver, Release, and Indemnity Agreement and fully understand its terms,
provisions and conditions. I have not been influenced to any extent whatsoever by any representations,
agreements, promises, or statements not contained within this agreement.
Dated this day of , 20
Participant's Signature
Address
City, State and Zip Code
Telephone
State of Texas
County of Tarrant
This document was acknowledged before me on by
Notary Public
Date
[REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK]
Worksite Training Agreement Page 15 of 18
Each Participant who is either not an adult or otherwise legally unable to complete a waiver
individually, will have a legal parent or guardian complete a copy of the waiver below and return a
signed, notarized original copy to the City prior to beginning any work at the City.
CITY OF FORT WORTH
WAIVER, RELEASE, AND INDEMNITY AGREEMENT
I, , on behalf of , for whom I am a the legal guardian,
for myself, , my heirs and assigns, hereby affirm that I am aware that is
participation in the Workforce Solutions for Tarrant County Work Experience/Subsidized
Employment/Transitional Jobs program ("Program") solely managed by Workforce Solutions of Tarrant
County, but partly taking place at a worksite location owned by the City of Fort Worth ("City") primarily
at ("Facility") in Fort Worth, Texas and other City -owned locations, has inherent
risks which may result in serious injury or death. As a condition precedent to participating in the Program
and entering onto the City's property, I confirm that I understand and accept all risks, dangers and hazards
presented by is participation in the Program, and I am allowing to
participate in these activities freely and voluntarily. In consideration of being permitted to participate in
the Program specifically at a City Facility, I hereby assume all risk of harm and injury to ,
myself and others, as well as to the property of others, which may result from 's
participation in the Program, regardless of the cause or blame. I agree to require that
act in a reasonable and cautious manner in all aspects of is participation in the
Event.
Further, I, for , myself, my heirs and assigns, in consideration of
being able to utilize the Facility and participate in the Program, do hereby
FOREVER RELEASE AND WAIVE all claims against the City of Fort Worth, its officers, agents and
employees, for injuries, death or property damage which may arise from is use or
presence at the Facility. This waiver and release is intended to release and forever discharge the Citv
of Fort Worth, its officers, servants, agents and emplovees from anv and all claims, actions, causes of
action, damages. losses or expenses. including attornev's fees whether real or asserted, of every kind
or character, arising out of 'sl use of the Facilitv. including going to and from such
Facilitv. I, for myself, , my heirs and assigns, hereby assume the risk of all
conditions of the Facility, dangerous or otherwise, all occurrences that may be encountered while using or
going to or from such Facility and waive any and all specific notice of the existence of such conditions or
occurrences. This waiver is intended to release the Citv of Fort Worth, its officers, servants, agents
and em0ovees even if said iniuries, death or other damages are caused in whole or in part by the
alleued acts of commission, omission, negligence or fault of the Citv of Fort Worth, its officers,
servants. agents or emplovees. I, for myself, , and my heirs and assigns hereby
assume all responsibility and liability for such injuries or damages, including death, and hereby covenant
not to sue the entities and parties named above for such injuries or damages.
I FURTHER AGREE TO INDEMNIFY AND DEFEND THE CITY AND HOLD THE CITY
HARMLESS FROM ALL CLAIMS, TOGETHER WITH ALL COSTS, EXPENSES, AND LEGAL
FEES IN DEFENDING ALL CLAIMS DIRECTLY OR INDIRECTLY ATTRIBUTABLE TO
's USE OF THE FACILITY. THIS INDEMNITY PROVISION (INCLUDING,
WITHOUT LIMITATION, INDEMNITY FOR COSTS, EXPENSES AND LEGAL FEES) IS
SPECIFICALLY INTENDED TO OPERATE AND BE APPLICABLE EVEN IF IT IS ALLEGED OR
PROVED THAT ALL OR SOME OF THE DAMAGES BEING SOUGHT WERE CAUSED AS A
WHOLE OR IN PART BY ANY ACT, OMISSION, NEGLIGENCE, GROSS NEGLIGENCE,
BREACH OF CONTRACT, INTENTIONAL CONDUCT, VIOLATION OF STATUTE OR
Worksite Training Agreement Page 16 of 18
COMMON LAW, BREACH OF WARRANTY, PRODUCT DEFECT, STRICT PRODUCT
LIABILITY, OR ANY OTHER CONDUCT WH TSOEVER OF THE CITY. I REALIZE THAT BY
SIGNING THIS AGREEMENT, I AM GIVING UP MY RIGH TO SUE THE CITY FOR INJURY,
DEATH OR DAMAGE I MAY SUFFER AT THE EVENT. IF ANY COURT FINDS A PORTION
OF THIS AGREEMENT TO BE INVALID, THE REMAINDER OF THE AGREEMENT WILL
NOT BE AFFECTED.
I have read this Waiver, Release, and Indemnity Agreement and fully understand its terms,
provisions and conditions. I have not been influenced to any extent whatsoever by any representations or
statements not contained within this agreement.
Dated this day of 920
Legal Guardian's Signature
Address
City, State and Zip Code
Telephone
State of Texas
County of Tarrant
This document was acknowledged before me on by
Notary Public
Date
[REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK]
Worksite Training Agreement Page 17 of 18
EXHIBIT C
WORKFORCE SOLUTIONS FOR TARRANT COUNTY,
MASTER WORKSITE TRAINING EMPLOYER AGREEMENT
(ATTACHED)
Worksite Training Agreement Page 18 of 18
WORKFORCE SOLUTIONS
`Po" rvxeatrr Coutar
A proud partner of the Amerf anJobCenter'network
MASTER WORKSITE TRAINING EMPLOYER AGREEMENT
This agreement is entered into and between Workforce Solutions for Tarrant County (Agent) and the undersigned Work
Site Training Employer. The purpose of this agreement is to provide a statement of responsibilities for each of the parties
to this agreement:
Work Site Issuing Office:
Name of Employer
Street Address City State Zip Code
Actual Worksite Address City State Zip Code
Employer Representative Name Title Date
Effective date of Contract:
Assigned Work Experience Site Supervisor's Name:
Assigned Work Experience Site Contact Number:
This agreement is made between Workforce Solutions for Tarrant County authorized agent, and
; hereafter, referred to as "work experience site", for Work Experience/Subsidized
Employment/Transitional Jobs participation under the Workforce Investment & Opportunity Act & Personal
Responsibility Act and/or the TANF Emergency Contingency Fund.
An equal opportunity employer/program. Auxiliary aids and services are available, upon request, to individuals with disabilities. (TDD/TTY) 1-800-RELAYTX
Purpose of the Program
The purpose of the Workforce Solutions for Tarrant County Work Experience/Subsidized Employment/Transitional
Jobs activity is to provide opportunities to customers with limited or no work experience and effective
comprehensive services that improve leadership abilities and provide customers with exposure to the world of work,
these services will improve employability of customers to ensure self-sufficiency is achieved.
This program serves Youth (ages 16 to 24) and Adults (ages 18 and older). Wages are paid by Workforce Solutions
for Tarrant County. The work experience site is not required to retain the customer upon completion of the program,
but employment opportunities are encouraged.
Work Experience Site Conditions and Requirements
The following responsibilities are made a part of this agreement.
1. Work Experience Site's assigned supervisor(s)/mentor (s) must go through a supervisor's/mentor's orientation
prior to any placement.
2. Submit a written job description/expected performance (will become part of agreement) prior to any placement.
3. Provide supervision (and if required), safety training, supplies and equipment to perform the work.
4. Accurately report work hours using the Youth/Adult Work Experience Payroll Timesheet.
5. Evaluate each customer's performance.
6. Contact Workforce Solutions for Tarrant County's contact person when customer or training related problems
occur.
7. Notify Workforce Solutions for Tarrant County if or when a change in supervision occurs.
A Work Experience Site:
• May not displace a current employee to replace with a Work Experience/Subsidized
Employment/Transitional Jobs customer (including partial displacement such as reduction in the hours or
overtime work, wages, or employment benefits).
• May not assign customers to perform work that: a.) engages in political patronage, lobbying or other political
activities; b.) are of a religious or anti -religious organization; or c.) partake in any tasks not allowed under
Child Labor Laws.
• Must comply with the Non -Traditional Employment Act of 1991.
• May not compromise existing contracts for services or collective bargaining agreement, and the Work
Experience/Subsidized Employment/Transitional Jobs customer may not be inconsistent with the terms of
any collective bargaining agreement without the written concurrence of the labor organization.
• Shall not use a customer to fill a job opening (1) when another individual is on layoff from the same or
substantially equivalent job, or (2) when the work experience site has terminated the employment of any
regular employee or otherwise reduced its workforce with the intention of filling the vacancy so created by
utilizing Work Experience/Subsidized Employment/Transitional Jobs whose wages are subsidized at current
minimum wage level
• No work experience site officer or employee will allow the placement of a member of his/her immediate
family under his/her supervision. Immediate family includes: wife, husband, mother, father, brother, sister,
son, daughter, brother-in-law, sister-in-law, aunt, uncle, cousin, nephew, niece, step-parent or step -child.
• May not create jobs for customer in a promotional line that will infringe in any way upon the promotional
opportunities of currently employed individuals.
• A Work Experience/Subsidized Employment/Transitional Jobs customer will not be denied training or other
job opportunities and benefits because of race, color, sex, national origin, disability, political affiliation or
beliefs, or age.
• Shall comply with the Americans with Disabilities Act (ADA), and the Drug Free Work Place Act.
• A Work Experience/Subsidized Employment/Transitional Jobs customer shall not participate in activities
that occur in a casino or other gambling establishments, aquarium, zoo, golf course, or swimming pool.
An equal opportunity employer/program. Auxiliary aids and services are available, upon request, to individuals with disabilities. (TDD/TTY) 1-800-RELAYTX
Workforce Solutions for Tarrant County's Responsibilities
Workforce Solutions for Tarrant County will:
1 Agent will provide group or individual orientation to the Employer's Direct Supervisor/Mentor and the Alternate
Supervisor/Mentor, prior to the assignment of a Trainee to a work site. Such orientation will include the
objectives of the program, supervisory responsibilities, training responsibilities, record keeping and DOL
regulations.
2. Agent will use the Trainee's component enrollment and objective assessment results to assist with the Trainee's
assignment to a work site training slot.
3. Agent will assign a single point of contact that will assist the Employer with the identification and resolution of
training issues and any questions/concerns.
4. Agent will monitor work sites for compliance with all objectives of the program, supervisor responsibilities,
training responsibilities, record keeping, and DOL regulations including Child Labor Laws when applicable.
5. Agent will pay all Subsidized Trainee wages for the scheduled work hours as stated on the Placement
Authorization Form (provided by the participant) and in accordance with current Federal Minimum Wage
Regulations. Please note any hours and/or days above what is indicated will be the sole responsibility of the
employer.
6. Agent will maintain a current Worker's Compensation Policy for all Trainees (copy of report provided in
Supervisor Handbook).
7. Agent may provide, at no cost to the Employer, all safety equipment required for the Training contingent upon
funding.
Termination of Customer
Customer(s) must adhere to Work Experience Site's personnel policies. A work experience site can request that a
customer be terminated, for just cause, at any time. Workforce Solutions for Tarrant County is available at all times
should problems arise and will attempt to resolve the problem to the worksite's satisfaction.
Accidents (Liability Insurance)
Workforce Solutions for Tarrant County covers the customer's worker's liability insurance in the event an accident
occurs on the work experience site. In case of an accident, the worksite must ensure medical services are rendered
immediately and notify emergency contact persons. Worksite must also notify Workforce Solutions for Tarrant
County and Unique HR Risk Management Department (800) 824-8367 within 24 hrs of any accident. After hours or
on weekends, call (361) 877-3357.
Customer Evaluations
Workforce Solutions for Tarrant County and work experience site supervisor/mentor will conduct a joint evaluation
of customer's performance every ninety days while enrolled in the program.
PROCEDURES FOR EVALUATION:
1. The same supervisor/mentor must evaluate the customer throughout the work experience period, unless a change
in supervisor/mentor occurs and is documented.
2. Customer must remain performing the same work throughout the evaluation period.
3. A final evaluation must be completed for each participant at the conclusion of their employment experience.
An equal opportunity employer/program. Auxiliary aids and services are available, upon request, to individuals with disabilities. (TDD/TTY) 1-800-RELAYTX
Monitoring Activities
Workforce Solutions for Tarrant County will monitor worksite for:
1. Procedures and/or controls to record and maintain accurate time and attendance records.
2. Completed evaluations.
3. General work conditions (safety, sanitary, etc.).
4. Supervisor/mentor to customer ratio (if applicable) and presence of supervision.
5. Status of worksite as an equal employment opportunity employer, and compliance with ADA.
Customer Compensation
1. Workforce Solutions for Tarrant County does not pay overtime nor holiday hours for customers.
2. Customers will be compensated in accordance with the Fair Labor Standards Act.
Other
1. All forms incorporated herein by reference shall be construed as part of this agreement.
2. Workforce Solutions for Tarrant County reserves the right to remove customers from the worksite(s) if any EEOC
violations occur.
Any hours and/or days above what is indicated in the Placement Authorization Form, will be the sole
responsibility of the employer.
(Initials)
Termination of Agreement
This agreement is in effect, when the signatures of duly authorized representatives of the Work Experience Site
Provider and Workforce Solutions for Tarrant County are affixed, and shall be in force until terminated in writing by
either party.
Work Experience Site Authorized Signature
Title
Workforce Solutions for Tarrant County Authorized
Signature
Title
Deputy Director of Business Solutions
Signature
Work Experience Site Authorized Representative
(Print Name)
Date
Date
Authorized Representative
(Print Name/)
Authorized Representative
(Print Name)
Title Date
An equal opportunity employer/program. Auxiliary aids and services are available, upon request, to individuals with disabilities. (TDD/TTY) 1-800-RELAYTX
WORKFORCE SOLUTIONS
t ffitk. r nwt+T''
A prood partner of the Ameni n1o6Center'network
Work Experience/Subsidized Employment/Transitional Jobs Training Supervisor/Mentor Handbook Orientation
Work Experience is a training and work experience opportunity involving placement of a Workforce Center program
participant in a subsidized or unsubsidized position with designated hours, tasks, and staff supervision. The purpose of
Work Experience training is to improve the employability of a participant who has been unable to secure employment due
to their limited work history, skills, or education. Work Experience training provides an actual "hands on" training and
employment experience relevant to the trainee's employment goal. In addition to learning about specific job skills,
trainees also gain experience as an "employee" and learn about workplace expectations and behaviors. The goal of the
Work Experience is to provide the trainee an opportunity to acquire marketable work skills and training which he or she
can utilize to secure unsubsidized employment.
As a supervisor/mentor, your objective is to provide meaningful training and work experience that will increase skills,
instill work ethics, encourage responsibility, and expand the knowledge of the world of work for the trainee.
As a supervisor/mentor, you will be expected to be a positive mentor and role model who encourages the trainee to
succeed in this training opportunity. The partnership of the supervising team will determine the degree of success for this
program, its trainees, the community, and our future workforce.
The information listed below has been included in the supervision orientation:
1. The review and understanding of Work Experience Training Agreement and all required forms for placement.
2. To review and comply with Work Experience Placement Authorization, such as, start and end date of agreement, total
allocated training hours, hours per week, and work week schedule. Any hours and/or days above what is indicated will be the
sole responsibility of the Employer.
3. Supervisor responsibilities and understanding of EEO laws, grievance procedures and injury reporting procedures.
4. Time sheet verification. If any variation to work week schedule occurs, list explanation under comments section of
timesheet.
5. Telephone number of designated specialized programs staff and emergency number for reporting an accident.
I have attended the supervisor/mentor orientation for the Work Experience Training Program and received Work
Experience Supervisor/Mentor Handbook. I accept the responsibilities and objectives of the program. I further
understand that a placement of a person for subsidized work experience cannot occur until a Placement Authorization
Form has been signed and delivered with other required documentation as noted in the Work Experience agreement.
Training Worksite Supervisor's Signature Date
Alternate Supervisor's Signature Date
Business Solutions Representative Signature Date
Original: MD Copy: Training worksite, Centerfile
An equal opportunity employer/program. Auxiliary aids and services are available, upon request, to individuals with disabilities. (TDD/TTY) 1-800-RELAYTX