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On the Job Training Agreement Checklist <br />BUSINESS NAME: Pier's Tail USA. LLC <br />YES NO <br />1. <br />Pre Award Survey <br />�� <br />❑ <br />2. <br />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 />�� <br />❑ <br />A- Training Plan. <br />3. <br />Exhibit A: Training Plan <br />io OS� �s Q� c�o� �,cGE�� <br />•� <br />❑ <br />��SVP Level is => 3+ ' -1U�.v <br />�B'�3ours of Training are reasonable <br />��Cost Computation is in accordance hourly wage 50% of wages or sliding scale <br />based on number of employees per DOL waiver. <br />E� Signed by Employer <br />4. <br />Exhibit B: Assurances <br />'B� <br />❑ <br />5. <br />Exhibit C: Insurance commercial /workers comp for 1,000,000 with Additional <br />�- <br />❑ <br />Insured Endorsement naming City of Santa Ana as Additional Insured. <br />6. <br />Exhibit D: Drug Free Workplace Form completed and signed. <br />�� <br />❑ <br />7. <br />Exhibit E: Debarment Certification signed. <br />,� <br />❑ <br />8. <br />File: <br />,�� <br />❑ <br />ADA Survey <br />EEO &� Grievance Procedures <br />9. <br />Three copies of agreement and canary routing slip attached <br />�� <br />❑ <br />Comments: <br />Program Supervisor Date <br />