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On the Job Training Agreement Checklist <br />BUSINESS NAME: ?'j()?'???a•S LCIi,l) <br /> YES NO <br />1. Pre Award Survey ? <br />2. OJT Agreement Template: Training dates (pg 1), reimbursement rate (pg 1), and ? <br /> maximum reimbursement amount (pg 4), and Employer Info (pg 5) match Exhibit <br /> A-Training Plan. <br />3. Exhibit A: Training Plan <br /> XOJT's to employees do not exceed 1-5 ratio ?,hs cJ ° 1 ? <br /> `RSVP Level is => 3+ <br /> Hours of Training are reasonable <br /> Cost Computation is in accordance hourly wage 5001. of wages or sliding scale <br /> based on number of employees per DOL waiver. <br /> ,Signed by Employer <br />4. Exhibit B: Assurances <br /> 12f ? <br />5. Exhibit C: Insurance commercial/workers comp for 1,000,000 with Additional ? <br /> Insured Endorsement naming City of Santa Ana as Additional Insured. <br />6. Exhibit D: Drug Free Workplace Form completed and signed. ? <br />7. Exhibit E: Debarment Certification signed. / ? <br />8. File: ? <br /> ADA Survey <br /> EEO & Grievance Procedures <br />9. Three copies of agreement and canary routing slip attached ? <br />Comments: <br /> <br /> <br />(2 ?? _3/ 14 1 -,;I-o vz- <br />Program Supervisor Date