SMALL MANUFACTURING GRANT AGREEMENT
Version 2-10-15
WIB Agreement No. / WPM-001 / EWIB / NC WIB / NW WIB / SC WIB / SW WIB
Parties To Agreement / WIB Name:
Address:
Street / City / State / Zip
WIB’s STEP UP Rep:
Name / Phone Number
Email:
Employer’s Legal Name: / NAICS
DBA (if applicable):
Employer’s STEP UP Rep:
Name / Phone Number
Email:
Terms and Conditions Of Agreement / Agreement Start Date: / Agreement End Date:
The total dollar amount of this agreement is not to exceed: / $
These funds shall be used to subsidize the wages of:
The parties hereto agree that the Employer shall employ and provide all training services for the named employee. In consideration for such services, the Employer shall receive an amount not to exceed the total amount shown above. This amount shall be paid pursuant to the terms and conditions of this Agreement. Employer’s training plan and certification of eligibility of both employer and employee for these Step-Up program funds are required.
STEP UP EMPLOYER INFORMATION
Employer’s IRS ID No. or FEIN: / Employer’s State Unemployment Tax No.:
Employer Address:
Street / City / State / Zip
Remittance address if different:
Street / City / State / Zip
Would you (Employer) have hired this EMPLOYEE without STEP UP incentives? / Yes / No
EMPLOYER CERTIFICATION
Employer named in this Agreement certifies that it:
  • is a manufacturer with not more than 100 full-time workers at time of application;
/ Yes / No
  • is a manufacturer with operations in Connecticut;
/ Yes / No
  • has been registered to conduct business for not less than twelve months;
/ Yes / No
  • is in good standing with the payment of all state and local taxes; and
/ Yes / No
  • will provide training to the STEP UP employee at the business site.
/ Yes / No
EMPLOYER CONDITIONS and ESTIMATION OF INCENTIVES:
  • Training grants may be used to subsidize wages up to but not exceeding the employee’s salary. Grant reimbursement shall be capped at $12,500 per STEP UP employee.
  • STEP UP employees are only eligible for wage reimbursement from the funding for the STEP UP program for up to 40 hours per week in accordance with the terms of the program. Any hours worked over 40 hours per week shall be at the Employer’s expense according to wage and hour regulations. After successful completion of the six-month training period, the Employer shall make all good faith efforts to retain the named employee as a full-time employee.
  • The employer’s STEP UP Representative agrees to provide wage and hour, and worker status information for the STEP UP employee on a monthly basis to the WIB’s STEP UP Representative for the purposes of wage reimbursement and program evaluation.
  • The STEP UP employer cited in this Agreement is required as a condition of this Agreement to contact or be contacted by the WIB Regional Coordinator at the expiration of the term of this Agreement and provide information as to the status of the hire made under this contract: (1) whether the hire is still employed or is no longer employed and (2) whether or not any such hire was promoted and given a raise in hourly wage after this Agreement ended.

Employer’s Legal Name: / WIB Agreement Number:
EMPLOYER CONDITIONS and ESTIMATION OF INCENTIVES, continued:
  • STEP UP incentives under this Agreement shall be in accordance with the following estimation:
Month 1 at $ / Month 2 at $ / Month 3 at $
Month 4 at $ / Month 5 at $ / Month 6 at $
STEP UP EMPLOYEE INFORMATION:
Employee Name:
Address:
Street / City / State / Zip
Telephone Number: / Email:
This employee shall be hired and trained as a(n):
This employee’s start date shall be:
The number of hours per week that the employee shall work is:
The starting hourly wage is: / $
Employment and training shall be provided at:
SIGNATURES AND APPROVALS:
The parties to this Agreement hereby certify by their signatures that the respective information each has provided is true to the best of their knowledge and belief and that they agree to the terms and conditions stated herein and will comply with their respective duties and responsibilities under this Agreement.
STEP UP Employer:
Signature of Employer’s Authorized Officer / Title / Date
I certify that the above-named authorized officer held said title at the time he/she signed this Agreement on behalf of the Employer and I also certify as keeper of the records of this Employer that this Agreement was duly signed on behalf of said Employer by authority of its governing body and within the scope of the Employer’s organizational powers.
Signature of Employer’s Certifying Officer / Title / Date
Approval by WIB:
Signature / Title / Date
Approval by The Workplace, Inc:
Signature / Title / Date

S:\DOL-Docshare-CO-3rdFloor\WIA Contracts, Monitoring, Reports\1. Contracts\STEP UP II 2014+\1. Contracts and Modifications\3. Contract Mod #2 (#1 for NW and SC)\Exhibit 2 -- Small Manufacturer Agreement. 2015 02 10.doc