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On the J,LobT,?X CL XXing Agreement Checklist <br />BUSINESS NAME: n? <br />571 w 1 ? LYQ? <br />YES NO <br />1. Pre Award Survey `?( ? <br />2. OJT Agreement Template: Training dates (pg 1), reimbursement rate (pg 1), and I? <br />' <br />? ? <br /> maximum reimbursement amount (pg 4), and Employer Info (pg 5) match Exhibit 7 <br /> A-Training Plan. <br />3. Exhibit A: Training Plan <br /> 'Y.OJT's to employees do not exceed 1-5 ratio ? <br /> SVP Level is =- 3+ <br /> Hours 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 DOE waiver. <br /> ly Signed by Employer <br />4. Exhibit B: Assurances <br /> y? <br />5. Exhibit C: Insurance commercial/workers comp for 1,000,000 with Additional ?r ? <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: Imo ? <br /> ADA Survey T <br /> EEO & Grievance Procedures <br />9. Three copies of agreement and canary routing slip attached ? <br />Comments: <br /> <br /> <br /> <br />Program Supervisor Date