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On the Job Training Pre Award Survey <br />BUSINESS NAME: Pacific Cleaning Services STATE TAX I.D. # 347-3575-3 <br />ADDRESS: 1220 Village Way, #A <br />Santa Ana. CA 92701 FEDERAL TAX I.D. # 330-834-870 <br />YES NO <br />1. The business does provide worker's compensation coverage. X ? <br /> Policy Number: CPCA 1 1414 <br />2. The business does provide General Liability Insurance in the amount of X ? <br /> One Million Dollars ($1,000,000). Policy must identify the City of Santa Ana as <br /> the certificate holder. <br />3. The system used for business accounting does document cash received, state and <br /> federal tax withholdings, FICA deductions. X ? <br />4. The business has not been cited for any health, safety, wage and hour, or child <br /> labor violations during the past 12 months. X ? <br />5. The business maintains a grievance and/or complaint handling procedures for X ? <br /> employees. <br />6. The prospective OJT client is not a former employee of the business. X ? <br />7. Wages for the planned OJT position are wages comparable to similar positions. X ? <br />8. A written job description for this position is on file. X ? <br />9. Union concurrence has been obtained. X ? <br />1 O. Business license is current. X ? <br />1 1. The business has not had any employees laid off in the past 6 months. X ? <br />12. The business is financially stable and has the means to train and pay for the <br /> prospective OJT em to ee <br />P Y X ? <br />The employer stipulates and agrees by signing below that the establishment in which on-the job <br />training will be given: <br />(1) Has not been moved from any previous location less than 120 days prior to the effective date of the <br />OJT contract. <br />(2) Is not a branch, affiliate or subsidiary of a business entity in another location which has, at any time <br />subsequent to the date of the OJT contract, relocated or expanded so as to cause an increase in <br />unemployment or the closing down of operations in which the entity conducts business operations. <br />TOTAL WORKFORCE # <br />CONTRACT RECOMMENDED YES X NO ? <br />?-??jj?0?rk ??G??/?--- 3/15/11 <br />Employer Title Date <br />G? ?1.lGL'L ?l/ <br />3/15/11 <br />/ a Date <br />Program Supervisor/Director Date