NEW YORK STATE

OCCUPATIONAL SAFETY AND HEALTH

HAZARD ABATEMENT BOARD
STATE CAMPUS
ROBERT F. GOLLNICK
BUILDING 12, ROOM 166 ANN MARIE TAliERCIO
ALBANY, NEW YORK 12240 CARL J. THURNAU
(518) 457-7629 Members
ROBER T F. CARPENTER FAX (518) 485·6082
Chairman

o·

Co
October 4, 2002

John Bulgaro
President
Teamsters Local 294
890 Third Street
Albany, New York 12206

Dear Mr. Bulgar o:

I am pleased to inform you that you." contract #C009564, Teamsters Local

294 for 9/1/02/-7/31/03, Occupational Safety and Health training & Education Grant
Program has been fully executed. Enclosed is a copy of the contract for your files.

Congratulations on receiving this grant. I look forward to working with you

on your Training and Education Grant Program this year.

Sincerely,

Albert A. Blackman
Grant Manager

Enclosure

A t! r (contract)

GOVERNMENT
EXHIBIT

GD -24
 C009564 Informal Modification

NEW YORK STATE

Charity Registration #
DEPARTMENT OF LABOR

APPENDIX X EXEMPT-9

Agency Code: 14000 Contract Number: C009564 Modification No. Mod-O-A

This is an AGREEMENT between the STATE OF NEW YORK, acting by and through the
Department of Labor, having its principal office at State Office Building Campus, Bldg, 12,
Albany, New York (herein referred to as the STATE), and
Teamsters Local 294
(herein referred to as the CONTRACTOR), for modification of Con tract Number C009564
as set forth in attached Appendix 8 (Project Budget and Program Narrative/Addendum), which
is hereby incorporated by reference.
All other provisions of said AGREEMENT shall remain in full force and effect.

This contract shall be for the period 9/1/02 through 7/31/03

IN WITNESS THEREOF, lhe parties hereto have executed or approved this

AGREEMENT as of the dates appearing under their signatures.

CONTRACTOR SIGNATURE STATE AGENCY SIGNATURE

?b';<~~, _ J
'i- Au.~ / Jk
; I //

Date:
U 0 \ \7 \0 3

STATE OF NEW YORK )

) 88.:
County of 6.c.hvo..t.ctncl~ )

On the \ 7:\€ day of _~===

' = 20_0_"3__, before me
:z::;..;:.... ,

personally appeared ~ aHll;)~ to me known, who

being sworn did depose ~nd say that he/she resides at
4B "A\arxO.bl.roQ ~. 0 () a~ ~ ~ 12208' , that he/she is the
aQh."c()br1Jt /~ oftt-te ,).J~A O<~ 294 ,
the corporation described herein which executed the foregoing instrument; and that
he/she signed his/her name thereto by order of the Board of Directors of said
Corporation. I<ATH · EN H AAKI~ ~
)~.~~ PI.! I:::, st ate 0 .- ' "
:.J311","C I. -~" nElc t~ ~ y ,Jr" .
r N , '-' .'; 7 B"~
(Notar)(~JPQcoQ,~"",,-
: .:...L- _ _ .. • _ . ~ J:... _'. 2005

ConiractMaster11 TeamstersLocal 294 2002-03 Mod ificalion as sent to Finance Appendix X 10/6/03 3:46 PM
 I i
Teamsters Local 294 C009564 Appe ndix B

NEW YORK STATE DEPARTMENT OF LABOR

SCHEDULE I
Planning Summary
Contractor: Teamsters Local 294 Contract Number, C009564
Address: 890 Third Street Phone: -=5~1-:-8-48~::-9-~5-:-43-=-6-=----
Albany NY 12206

Liaison: Mr. John Bulqaro, President & PEO

Addr ess: Teamsters Local 294 Phone : 518-489-5436
890 Third Street Fax : 518-453-9251
Albany NY 12206 E-Mail : Teamsters@MSN.COM

NYSDOL
Liaison: Albert A. Blackman Phone : 518-457-6670
Address: NYSDOllOSH T&E Fax : 518-485-6082
State Office Cam pus Bid 12 Rm 166 E-Mail·usaaab@Labor.S1ate.NY .US
Albany. NY 12240

SubmiHal : FY 2002-2003
Original _
Mod # a-A Increases Funding From :
----- to
Decreases Funding From : to
-----
Changes End Dale From : to

Funding Source: OSH T&E 305 Fund 9/1/02 7/31/03

Program: 2002 - 2003 aSH T&E $80,000

OriginatiSFY 2002-03 $80.000 6/30/03 SFY Total : $80,000

Year Amount Lapse Date Year Amount Lapse Date

Renewal I/SFY SFY Total :

Year Amount Lapse Date Year Amount Lapse Dale

Renewal li/SFY SFY Total:

Year Amount Lapse Date Year Amount Lapse Date

Renewal IIJ/SFY SFY Total:

Year Amount Lapse Date Year Amount Lapse Date

Renewal iVISFY SFY Total:

Year Amounl Lapse Date Year Amount Lapse Date

Budget

Expense Categories Total

1. Staff Salaries $0
2 . Siaff Fringe Benefits $0
3. Contracted Services $52,100
4. Other Costs $27,900
5, Total Contract Costs $80,000
6 , Total Match Costs $0
#REFl

ConiractMaster11 TeamstersLocal 294 2002-03 Mod ification as sent 10 Finance Planning Su~8)3 3:46 PM
 I. ' If U "" II r j}
r~ , •
FACE PAGE I ,J-.I

New or tate Con tract Number. C009564

Department of Labor
Governor W. Averell Harriman Amount of Agre ement: S80,OOO
State Office Building Campus, Building 12
Albany, NY 12240 Contract Period: 9/1/02 to 7/31/03
Agency Code 14000 Multi-Year Term (if app licable)
From: n/a 10 n/a
Contractor Name/Project Sponsor:
Teamsters Local 294 Federal T:llf Identification Number: 'V()11 / 9.Y~
890 Third Street
A lbany NY 12206 Contractor is 0 is not 0 a Sect arian Entity

Billing Address (if different from above) Contractor is 0 is not 0 a Not-Far-Profit Org anization
Stre et City.
State: Zip: Charities Registration Number: Exempt-9
Title/Description of Proiect: aSH T&E
THIS AGREEMENT INCLUDES THE FOLLOWING:
o This Face Page and Slandard Agreement
[8] Appendix A -Standard Clauses for all New York State Contracts
[8] A ppendix B - Project Budget, and Addendum to Proposal, if
Applicable
[8] Appendix C . The Department's General Conditions
[8] Appendix 0 - RFP and Certifications (as applicable)
[8] Appendix E • Other Conditions, If applicable
D Appendi x F - Proposal
D Appendix X - Modification Agreemenl Form (10 accompany modified
appendicies for changes In terms or consicerauon on an
existing period or for renewal pencds)
The Contractor and the Department agree to be bound by the
terms and conditions contained in this Agreement
CONTRACTOR NYS DEPARTMENT OF LABOR
;--- - - - - - - - - - - - - - - - - - - - - - - - --+- - - - - - - - - - - - - - -- - _ .....- ---
Signature of Contractor's Authorized R Signature of Authorized Official:

Date: 8 \2Co \ 02
IZv
Date:
.:«.».
$ J V \.../
Type or Printed Name of ave Representative: Type or Printed Name of Above Official:
qchn '2>u\ 9 a.("0 ~Octer B a~ie
T itle of Auth orized Rep resentative: Title of Authorized R'epre sentali ve:
DrI5 ide n -t-/ PE.O
Notary Public Ch'Ief.of ~abor Budgeting and
State of New York ) C'
IF') n r.lql I > A" "' ", _ ", ~
) State Agency el1lficafion:' ln a dlfion'ltoihe-'.-:;
County of 6c.¥u.r<i .) Acceptance of this con tract, I also cert ify that original
Copies of this sign u~r;g all
.....QJ.t1er exact cop ie of . 11 a . 8
.2:~.!::::!:!:!~~~#~~, • Lj 1] . A U & CONTROL

~~~'--;---1 SEP 30 2002

O/~~
FORTHE aATEGOMPTROll ER
ffice of the State Comptro ller: