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Home My WebLink About065185 - General - Contract - SER National_ OFFICIAL RECORD SER SCSEP CSC No. 65185 CITY SECRETARY (This is a Training Program for SCSEP Participants) FT. WORTH, TX 61 - HOST AGENCY AGREEMENT See Sections 10, 11, & 25 of the SOP Agency/Organization: City of Fort Worth FEIN: 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 and/or develop job skills needed to obtain unsubsidized employment. SER SCSEP responsibilities: AgrencylOrganization responsibilities: oR Assessment of the participant's skills; iR Provide supervision, orientation, training, safe training site and Development of a customize employment plan; I adhere l applicable state laws regarding meal/rest breaks; oR Abideby to agreed -upon training schedule and submit prperly Ot Assignment to a suitable training site; P0. prepared and signed timesheets. oft Create a list of training activities and appropriate ; oP Adhere to the policies/procedures outlined in the SER SCSEP 00 schedule for each participant; Handbook; 0 Provide compensation (at the federal/state 0 Consider hiring the participant if appropriate openings occur minimum wage) to participants for training; [no special consideration is implied]; 0 Provide job search guidance through 0 Cover the cost for background checks, health screenings or drug employment referrals and job readiness a testing required by the agency; workshops; Ot Maintain open communication with the SCSEP staff regarding 0 Communicate to host agencies any changes in the participant's training and any issues/situations; regards to training and/or SCSEP policies and 0 Inform SCSEP staff when the participant gets a job. procedures; 0 Agree not to use participants as substitutes for permanent oP Make available opportunities for participants to employees; to displace currently employed or laid off employee rotate to other host sites for additional training (within ] 0 Agreen t to compensate the parti; or to reduce c p nt in nyf form or m nar hours, wages or ner; experience; y 0 A Attend SER SCSEP host agency meetings; and 011 Conduct annual/bi-annual informational Host Agency meetings; and provide a copy of the following upon request: General Liability Insurance, IRS 501(c)(3) letter [non -profits], an annual HA 01 Cover all SER participants under a worker's Assessment of SCSEP, and supervisor hours for In -kind services compensation insurance policy during training provided [if applicable]. hours. This agreement will be in effect from the date signed until June 30 of following year [one program year], a renewal of this partnership must be signed each program year [July — June]. 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: Type of Agencv/Organization: Participant Supervisor is Paid From: Additional Sites: ❑ No ❑ Non -Profit Organization -- IRS code ❑x Federal funds 501(c)(3)-- documentation attached ❑x Public Organization - Government agency ❑Non-federal funds ®Yes —ell out Form# 62 (HAA- Additional Including federal, state, county, or city Supervisor Hourly Pay Rate: Sites) City of Fort Worth Agency/Organization — Main Office Location 100 Fort Worth Trail Fort Worth, Texas 76102 Address City, State, ZIP ,(817) 392-5774 (817) 360-8905 Telephone & Fax delana.jones@fortworthtexas.gov Email Delana Jones Agency/ ganization Representative NTA(M/2026 Agency/Organization Representative Signature Date Signed SER National TX - Tarrant SER SCSEP Site 4200 South Freeway, Suite 550 Fort Worth, TX 76115 Address City, State, ZIP (817) 536-3600 Telephone & Fax krucobo(a-)ser-national.org Email Karla Rucobo-ETS S SCSEP StaiF Name (Print) 05/01 /202_ 6 K&IJ L. Rucobo (May 1. 2026 13:10:11 CDT) SER SCSEP Staff Signature Date Signed Copy: Host Agency File, Host Agency, SER National -In -Kind Effective 12/01/2021 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 10, 11, & 25 of the SOP Host Agency Name: City of Fort Worth 100 Fort Worth Trail Mailing Address 100 Fort Worth Trail Physical Address Telephone & Fax _L17) 392-6585 Delana Jones Contact Person Name (Print) Forth Worth, Texas 76102 City State ZIP Forth Worth, Texas 76102 City State ZIP EmaiLdelana.lonesga fortworthtexas.gov District Superintendent Title Other Host Agency Authorized Sites [each site listed below must have a separate Host Agency File] FORT WORTH COXIMUNTTY CE'4TER CENTER ADDRESS Chisholm Trail (CT) 4936 NkPherson Blvd. (76123) NickDeitering (DS) 817-392-5716 Diamond Hill (DH) 1701 NE 37th St. (76106) Eric Lopez (DS) 817-392-5447 Eugene-NIcCray (Elf) 4932 Wilbarger St- (76119) Delana (Dee) Jones (DS) 817-392-5461 Fire Station (FS) 601 Lipscomb St. (76104) Sheri Endslev (DS) 817-392-5726 FWAS, labile Rec 100 Fort Worth Trail_ (76102) Sheri Endslev (DS) 817-392-5726 Greenbriar (GB) 5200 Hemphill St (76115) Sheri Endsley (DS) 817-392-5726 Handlev Meadotiybrook(HNIB) 6201 Beaty St (76112) Delana (Dee) Jones S) 517-392-5461 Highland Hills (FHi) 1600 Glasgow Rd. (76134) Sheri Endsley (DS) 817-392-5426 Atatiana Carr -Jefferson Community Center at Hillside (ACJCC. HS) 1201 E. Maddox Ave. (76104) Delana (Dee) Jones (DS) 817-392-5461 Be�ty Price (RPCC) 8375 glue Mound Rd 76131 Eric Lopez (DS) 817-392-5447 R. D. Evans (RDE) 3242 Lackland Rd. (76116) NickDeitering (DS) 317-392-5716 Riverside (RS) 3 '00 E. Rellonap St. (76111) Eric Lopez (DS) 817-392-54-17 Southwest (SQL') 6300 Welch Av. e_ (76133) Nick Deiterina (DS) 517-392-5 i 16 Sycamore (SY) 2525 E. Rosedale St. (76105) Sharetta Goodwin (DS) 817-3392-7692 Thomas Place (TPi 4237 Lafayette Ave. (76107) Nick Deiterina {DS) 817-392-5716 Victory Forest ('YF) 3427 Hemphill St (76118) Sheri Endsle.:- (DS) 817-392-5 ; 26 Copy: Host Agency File of Main Site, Host Agency File [for each site listed] Effective 12/01/2021 Andrew `Doc' Session(ADS) 201 S. Sylvania Ave.(76111) Eric Lo+rz (DS) 817-392-5147 Como(CCC) 4900 Home St. (76107) 'Nick Deitering (DS) 817-392-5716 Martin Luther King(>t•ILK) 5565 Truman Dr. (76112) Delana (Dee) !ones (DS) 517-392-5461 'North Tri-Ethnic (17) 2950 Roosevelt Ave- (76106) Eric Lo�z!DSl 317-392-5447 'Northside (\S) 1100 NA' 19*1 St (76164) Eric Lopez (DS_ 817-392-5447 Southside (SS) 959 E. Rosedale St(76104-) Delana (Dee) !ones (DS) 317-392-5461 Worth Heights (WH) 3551 New York- kve.(76110) Sheri Endslev (DS) 317-392-5726 Copy., Most Agency File of Main Site, Host Agency FlIa (tor eat► site listed] Effective 12)OV2021 IN WITNESS WHEREOF, the parties hereto have executed this Agreement in multiples. City: Dam &kyhk�f By: Dana Burghdoff (Ma 12, 202 2:44:54 CDT) Name: Dana Burghdoff Title: Assistant City Manager Date: 05/12/2026 Vendor: By: Kgrld L. kumbo (May 1, 2026 13:10:11 CDT) Name: Karla Rucobo Title: ETS Email: krucoboAa ser-national.org Telephone: 817.536.3600 FOR CITY OF FORT WORTH INTERNAL PROCESSES: Approval Recommended: By: Name: Title: By: Name: Title: M-- Contract Compliance Manager: By signing I acknowledge that I am the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. Dave Lewis Director Park & Recreation Department By: Name: Delana Jones l Title: District Superintendent Park & Recreation Department Monique Hill Assistant Director Park & Recreation Department Approved as to Form and Legality: By: Name: Title: Hye Won Kim Assistant City Attorney Contract Authorization: M&C: N/A Form 1295: N/A City Secretary: By. Name: Title: dogFonT° & C �� adartgnEXaSoa Jannette S. Goodall City Secretary OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX FORT WORTH. City Secretary's Office Contract Routing & Transmittal Slip Contractor's Name: SER Host Agency Agreement Subject of the Agreement: Please review and complete the attached SER Host Agency Agreement For 2026-2027. SER aids unemployed and low income individuals 55 years and older in re-entering the workforce by providing subsidized community service training with non-profit and government agencies to gain experience. M&C Approved by the Council? * Yes ❑ No 8 If so, the M&C must be attached to the contract. Is this an Amendment to an Existing contract? Yes ❑ No 8 If so, provide the original contract number and the amendment number. Is the Contract "Permanent"? *Yes ❑ No 8 If unsure, see back page for permanent contract listing. Is this entire contract Confidential? *Yes ❑ No 8 If only specific information is Confidential, please list what information is Confidential and the page it is located. Effective Date: ACM signature If different from the approval date. Expiration Date: 06/30/2027 If applicable. Is a 1295 Form required? * Yes ❑ No 8 *If so, please ensure it is attached to the approving M&C or attached to the contract. Project Number: If applicable. N/A *Did you include a Text field on the contract to add the City Secretary Contract (CSC) number? Yes 8 No ❑ Contracts need to be routed for CSO processing in the following order: 1. Katherine Cenicola (Approver) 2. Jannette S. Goodall (Signer) 3. Allison Tidwell (Form Filler) *Indicates the information is required and if the information is not provided, the contract will be returned to the department.