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ST {"/ftGE ` °Y' f..T EEMENT
HOST AGENCY: CITY OF YAKIMA HARMAN CENTER
PY: 17
As part of the Senior Community Service Employment Program (SCSEP), operated under Title V of the
Older Americans Act, this Agreement is voluntarily entered into by City of Yakima Harman Center a
governmental agency or a non-profit agency designated under Section 501(c)(3) of the Internal
Revenue Code, (hereinafter referred to as the Host Agency), and Goodwill Industries [Goodwill of the
Olympics and Rainier Region (hereinafter referred to as Goodwill). The intent of this agreement is to
provide useful community service assignments for low-income mature workers, in order to increase
their skills and assist transition to permanent employment.
THE HOST AGENCY AGREES:
• To provide a safe and healthy training site, adequate orientation and training, additional training as
needed, and to treat each participant as a valued partner in the host agency.
• To assist Goodwill in transitioning fully trained participants off the program; and to consider
participants for regular employment on its staff when vacancies occur or when new positions are
created.
• To abide by mutually agreed to training schedules, documented through properly prepared time
sheets, activity reports and periodic performance evaluations: Volunteer or overtime hours are not
permitted. Participants are required to attend periodic meetings during regular working hours, and
the host agency recognizes that participants will be unavailable for training during these times.
• To report any in-kind contributions accurately, documenting supervisors' rates of pay, time spent
training and providing oversight of the participant, and any other and all other records and
assistance necessary to prove Goodwill's compliance with SCSEP regulations. (See Host Agency
In-kind Supervision Report and Host Agency Handbook)
• Sporisorship of a participant will not result in the partial or total displacement of currently employed
workers; will not reduce regular hours worked, wages, or benefits; will not be used as a
replacement for a position from which a person has been laid off; will not impair existing contracts
or result in the substitution of Federal funds for other funds in connection with work that would
otherwise be done. See Host Agency Handbook for more information on Maintenance of Effort
violations.
• To assure that participants are not discriminated against based on age, race, color, religion, sex,
national origin, disability, veteran status, political affiliation, or any other basis prohibited by law.
• To send a representative to a group meeting of host agency supervisors. Group meetings of host
agency supervisors or designated representatives will be held annually to acquaint all concerned
with the SCSEP goals and objectives.
• To not serve as a host agency for any other SCSEP project sponsor site while this agreement is in
effect unless approved by Goodwill SCSEP Project Director.
• To inform Goodwill immediately if its Section 501(c) (3) certification changes.
• To furnish any tools, equipment, supplies and safety training, equipment or preparation required to
perform the participant's training assignment.
• To comply with applicable provisions of the Americans with Disabilities Act.
• To maintain adequate insurance covering participants while acting under the host agency's
supervision. This obligation includes the maintenance of comprehensive general liability insurance.
Additionally, if participants have been authorized to drive as part of their assignments, the agency
will insure that all documentation required is completed before participant is assigned to drive. This
includes an agreement of continuous liability coverage ($100,000/$300,000), agency insurance
1 HOST AGENCY AGREEMENT
REVISED MAY 2016
• To not hold Goodwill liable for any damages incurred in the case of a driving accident involving an
assigned participant.
• Assure that participants are not assigned to positions that involve political activities on behalf of
either partisan or non-partisan groups.
• To adhere to policies and responsibilities as detailed in the Goodwill SCSEP Host Agency
Handbook.
GOODWILL AGREES:
• To recruit, enroll, and assign a participant to the host agency for the purpose of engaging in
productive community service training with duties and tasks as specified in a written description of a
community service training assignment.
• To be responsible for all administrative and fiscal controls of the SCSEP and for paying wages and
providing applicable fringe benefits, including worker's compensation, to each participant as defined
in the Goodwill SCSEP Participant Handbook.
Goodwill reserves the right to reassign any participant whenever reassignment will increase
opportunities for training or unsubsidized employment, will serve the best interests of the participant, or
will better support the goals and objectives of the program. Host agency understands that they have no
inherent right to a participant and that assignment of participants to that host agency depends upon the
training needs and job goals of that participant. The host agency may terminate its participation as a
host agency at any time for any reason upon notification to Goodwill. This agreement may be amended
by written mutual agreement. This Host Agency Agreement is in effect from 7/1/2016 to 6/30/2017
**PLEASE NOTE MAINTENANCE OF EFFORT VIOLATIONS:
Sponsorship of a participant will not result in the partial or total displacement of currently employed
workers; will not reduce regular hours worked, wages, or benefits; will not be used as a replacement for a
position from which a person has been laid off; will not impair existing contracts or result in the
substitution of Federal funds for other funds in connection with work that would otherwise be done. See
Host Agency Handbook for more information on Maintenance of Effort violations. This organization
agrees not to willingly violate any maintenance of effort.
Host Agency:Ct ry 01= yitel m 4 - -(�i M�'U •
Address: 01 M. 65-F-(1 ,QVC y4tom- Wi:
County: 464-r(MA--
FEIN:
t — 600 lag 3
Signature: C
Name: Ct (ff Oor&
Title: (✓iak`. er
Date: a / a0, ( 17
CITY CONTRACT NO 20/ 7- Day
RESOLUTION NO' n/lA
2 HOST AGENCY AGREEMENT
REVISED MAY 2016
Goodwill: Yakima Work Opportunity
Center /
Signature: i< /,uL
Name: CA,/ 600de-
Title: 4---ay/oy,1414,41 5tr_e-
Date: - /--
Host Agency Status:
❑ This host agency is a government agency.
❑ This host agency is a non-profit agency under
Section 501(c) (3) of the U.S. Internal Revenue Code
❑ 501(c) (3) documentation attached.
❑ 501(c) (3) documentation at Goodwill.
9and will
Goodwill Industries
Senior Community Service Employment Program
Host Agency Supervisor's Responsibilities
cCry or- Y41" 4
Host Agency /*2Mil-N CeA/T f2
reas that require the constant attention of the training supervisors.
Absence
If a participant is absent due to illness for 3 days (i.e. hospital stay), please notify Yakima
Work Opportunity Center @ 509-452-6061
Accident
If a participant is hurt on the job, please notify Yakima Work Opportunity Center @ 509-452-
6061 immediately. Please follow the instructions in the Workers' Compensation Instructions.
Evaluations
Periodically the host agency Supervisor will be required to evaluate the performance of the
participant(s) assigned to his/her site. These should be completed in a timely fashion and
returned to Yakima Work Opportunity Center, 10 N 10th Avenue, Yakima WA 98902. At the
end of each participant's Community Service Assignment, an exit evaluation will be required
and promptly returned to Yakima Work Opportunity Center..
Employment
One of the main goals of the SCSEP program is to aid the participant(s) in finding unsubsidized
employment. This may require that interviews be scheduled during hours that the participant is
scheduled to work at your site. The participant must be excused from the work site and shall be
paid for this time.
Interviews
Assignment
The participant should be assigned only those duties that are part of the Community Service
Assignment, which the host agency representative completed for the position. If new training or
new duties are added, a new Community Service Assignment must be completed, and approved
by Goodwill, prior to the change of assignment.
Description
Maintenance of
A participant will neither displace nor replace any paid employee. Goodwill must be
notified if your site is in the process of laying off any employees. At that time an evaluation will
determine if the participant may continue to train at your site.
Effort
Mandatory
Quarterly meetings are scheduled for all participants. It is mandatory for all participants attend
these meetings. Supervisors will support the participant's attendance at these meetings by
releasing them from their training assignments for the designated hours. A participant's failure
to attend may result in loss of wages and/or termination from the program.
Quarterly
Meetings
Time Sheets
It is the responsibility of the host agency supervisor to verify that Time Sheets are filled out
correctly and that the hours trained reflects the actual time that the participant was on the
assignment. Time Sheets may only be signed by supervisors who have signed the Host Agency
Authorized Signature Form. Timesheets must be delivered to Yakima Work Opportunity Center
by the participant or faxed to 509-452-0352. All originals must be turned to the office as well.
Volunteer
Participants may not volunteer at the host agency where the participant is assigned. Permitting
participants to volunteer may jeopardize host agency status.
I certify that a SCSEP staff member reviewed this information with me, answered my questions, and provided
me wit a copy of this document.
ature of host agency supervisor
Signature of SCSEP staff member
Date
Ej
9aadwill
Goodwill Industries
Senior Community Service Employment Program
Host Azencv Authorized Signature Form
Host Agency
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It is a requirement of the Department of Labor that Goodwill has an authorized signature of all the host agency
supervisors and alternates. Only supervisors whose signatures are on this form will be allowed to sign
Participant Time Sheets. Use additional forms if necessary.
Note: A new Authorized Signature Form must be submitted along with a new Host Agency In -Kind Supervision
Report, immediately if supervisor changes occur. Participant Time Sheets without authorized signatures will not
be processed.
Program Year: July 01, 2016
Supervisor's Signature:
(year)
TO June 30, 2017
(year)
Supervisor's Typed or Printed Name & Title:
Supervisor's Signature:
Supervisor's Typed or Printed Name & Title:
Supervisor's Signature:
Supervisor's Typed or Printed Name & Title:
The following people are only authorized to sign Participant Time Sheets when the direct supervisor(s)
listed above is not available:
Alternate Supervisor's Signature:
Alternate's Typed or Printed Name 4 Title:
iy)\NJhe.1Lynn
a
Alternate Supervisor's Signature:
Oo(\ SZ41kor C nkrx-\
Alternate's Typed or Printed Na ' &Title:4 V14716.(fisdN kers 5- -ArLicodki
1 of 1
PY 16
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goodwill
Senior Community Employment
Service Program (SCSEP)
I, C1nt jYX\e. `CJam <1 have received a
copy of the most recent Host Agency Handbook, Grievance
Procedure, Political Activities Notice.
ost Agency Signature
SCSEP Staff
Date