JFES CONTRACT Connecticut Department of Labor
Part I – FACE SHEET Rev. 5/14/14
(1) __X__Original Contract ____Amendment # ____ / (2) CT DOL Contract #:Contractor / (3) Contractor Name and Address / (4) Contractor FEIN / SSN
(5) Contractor Representative / (6) Contractor DUNS #
(7) Telephone Number / (8) Contractor IRS ID #
(9) Type of ownership:
Corporation incorporated under the laws of the State of Connecticut / Limited Liability Company
Sole Proprietorship / Partnership
Trusteeship / Governmental Entity
(10) Check each item (Yes or No):
Minority Business: / Yes / No
Women Business: / Yes / No
Non-Profit: / Yes / No
State Agency / (11) Agency Name and Address
State of Connecticut, Department of Labor (DOL)
200 Folly Brook Boulevard
Wethersfield, CT 06109 / (12) Agency No.
DOL-40000
(13) State IRS ID #
06-600798
Contract Period / (14) START DATE
July 1, 2015 / (15) END DATE
June 30, 2016
Amount / (16) The maximum allowable amount paid or reimbursed under this contract shall not exceed: / $
Purpose / (17) Purpose of Contract:
To implement the goals and purposes of Connecticut General Statutes (CGA) Sec. 17b-688i
Terms and Conditions
of Contract / (18) The parties to this contract mutually agree that the contractor shall provide services in accordance with the services described and deliverables required under this contract. Upon the DOL’s timely receipt and approval of acceptable services, deliverables and reports, payment shall be processed by the DOL in accordance with the provisions of this contract. This contract consists of the following Parts:
Part I / DOL Contract Face Sheet
Part II / JFES Program-Specific & Terms and Conditions
Part III / State of Connecticut General Terms and Conditions
Part IV / Budget, Cumulative Month Status Funds Report, Year End Projected Funds Report
Part V / Appendices 1-2
This is a performance-based contract and payment/reimbursement are based on successful performance, acceptable deliverables and actual costs incurred. The State of Connecticut assumes no liability for payment under the provisions of this contract, until the Contractor is notified by the DOL that said contract has received final approval. This contract is the entire agreement between the parties and may be amended, modified or revised only in writing by the DOL.
Statutory Authority / (19) For the CT DOL, Section 403(a) (42 U.S.C. 603(a)) and the Connecticut General Statutes (C.G.S.) §§ 4-8, 31-3b, 17b-688h
Acceptances / In witness hereof, the parties have affixed their authorized signatures on the day, month and year written below.
(20) Collective Bargaining Concurrence: / Not Applicable / Yes (if Yes, see attachment)
(21) Contractor Approval:
______
Signature of Contractor’s Authorized Officer Date
______
Printed or Typed Name and Title
(22) DOL Approval
______
Sharon M. Palmer, Commissioner, Connecticut Department of Labor Date
(23) Approved as to form (if applicable) by the Office of Attorney General:
______
AAG Date / (24) DOL Business Management (for fund availability)
______
DOL Business Mgmt Date