State Funded Youth Employment Program Connecticut Department of Labor
Part I – FACE SHEET Rev. 6/14/11
(1) ____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 (CTDOL)
200 Folly Brook Boulevard
Wethersfield, CT 06109 / (12) Agency No.
DOL40000
(13) State IRS ID #
06 - 6000798
Contract Period / (14) START DATE
7/1/2011 / (15) END DATE
6/30/2012
Amount / (16)The maximum allowable amount paid or reimbursed under this contract shall not exceed: / $
Purpose / (17) Purpose of Contract:
To provide State General Fund dollars in support of Connecticut Youth Employment Program
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 CTDOL’s timely receipt and approval of acceptable services, deliverables and reports, payment shall be processed by the CTDOL in accordance with the provisions of this contract. This contract consists of the following Parts:
Part I / CT DOL Contract Face Sheet
Part II / CT Youth Employment Program Narrative
Part III / CT Youth Employment Program Budget
Part IV / State of Connecticut General Terms and Conditions
Part V / CT Youth Employment Program Deliverables
Part VI / CT Youth Employment Program Service Providers
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 CTDOL 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 CTDOL.
Statutory Authority / (19) For the CT DOL, Connecticut General Statutes (C.G.S.) §§ 4-8, 31-3d
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) CTDOL Approval
______
Glenn Marshall, Commissioner, Connecticut Department of Labor Date
(23) Approved as to form (if applicable) by the Office of Attorney General:
______
AAG Date / (24) CTDOL Business Management (for fund availability)
______
CTDOL Business Mgmt Date
State Funded Youth Employment Program CONTRACT
TABLE OF CONTENTS
Part I / CTDOL Contract Face Sheet
Part II / Connecticut Youth Employment Program Narrative
Part III / Connecticut Youth Employment Program Budget
Part IV / State of Connecticut General Terms and Conditions
Part V / Connecticut Youth Employment Program Deliverables
Part VI / Connecticut Youth Employment Program Service Providers