17-z16 - COM MPL Socially Responsible Contractors Form.pdf

MILWAUKEE PUBLIC LIBRARY

SOCIALLY-RESPONSIBLE CONTRACTORS (SRC)

AFFIDAVIT OF COMPLIANCE

NOTE: This affidavit must be completed in its entirety and submitted with your bid or proposal to be considered for SRC bid incentive.

Bid or RFP #:

Company Name:

Address, City, State, Zip:

A “Socially-Responsible Contractor” or “SRC” is an entity submitting a bid as part of the City’s formal competitive bidding or Request for Proposal (RFP) process that has acted or implemented a program to eliminate, or significantly reduce, barriers to employment for current and prospective employees of the contractor. Actions or implemented programs shall include at least three (3) of the programs listed in Section I below. To indicate which programs you have acted or implemented, place a checkmark in the box next to each item pertaining to the business entity as a bidder or proposer for the City of Milwaukee.

I. SRC CRITERIA

☐ A. Hire persons with felony convictions;

☐ B. Assist current or prospective employees with earning their high school diploma;

☐ C. Underwrite or facilitate industry-linked career-assessed pre-employment services and subsidized work experience including: internships, job shadowing, on-the-job training, and summer employment;

☐ D. Partner with an employment service agency to monitor and track individualized employment plans;

☐ E. Provide, underwrite, or facilitate industry-linked career-based instruction to current or prospective employees in areas such as the following: blueprint reading, basic math and measurement, technical math, labor history, construction culture and essential skills, health and safety awareness, manufacturing processes and production, maintenance, and budgeting and financial literacy;

☐ F. Provide or facilitate occupational skills training and related adult mentoring and networking;

☐ G. Underwrite or facilitate subsidized or unsubsidized programs which provide supportive services for current or prospective employees to obtain or fund the following:

- A valid driver’s license

- Transportation vouchers to work and home

- Appropriate work attire, work safety gear, and other needed equipment

- Testing and certification fees

- Legal aid services

- Child care and family-related dependent care

- Emergency housing, health care, and short-term emergency assistance

- Career and training services

- School supplies, books, and fees

- Referrals for medical services and exams

- Reasonable accommodations for persons with disabilities

☐ H. Partner with employment agencies to supplement subsidized wages to ensure employees receive a living wage;

☐ I. Provide breast feeding facilities for employees who are nursing children;

☐ J. Provide a minimum of 120 hours of paid sick leave;

☐ K. Provide a minimum of five (5) paid sick days;

☐ L. Provide an employer-assisted housing program providing homebuyer assistance in the form of mortgages, down payment assistance, or homebuyer education for residences within walking distance of their employer;

☐ M. Provide assistance to reduce fees and penalties on tardy child support payments, manage payment of child support arrears, and become current on child support obligations.

Continue to the next page to complete Sections II & III Page 1 of 2

II. DISCLOSURE

The purpose of the Socially-Responsible Contractor Program (SRC) is to ensure contributions toward community betterment made by socially-responsible contractors are recognized and rewarded. Each bidder or proposer seeking to qualify for the SRC bid incentive shall submit, as part of its bid or proposal, this sworn affidavit describing actions taken and programs implemented to eliminate, or significantly reduce, the barriers to employment for current and prospective employees of the contractor. The outcomes of these actions and programs shall be described in verifiable detail in the section below. (Please include an attachment if additional line space is required).

This signed and notarized affidavit of compliance will be the contractor’s sworn statement that the business satisfies the criteria for Socially-Responsible Contractors pursuant to Chapter 310-10 of the City of Milwaukee Code of Ordinances.

I hereby declare compliance with Chapter 310-10 of the City of Milwaukee Code of Ordinances.

Authorized Signature: _______________________________________________________________________________

Printed Name: _______________________________________________________________________________

Date: _______________________________________________________________________________

III. NOTARIZATION

Subscribed to before me on this ________ day of ____________________________ in the year ____________, at

__________________________________ County, ________________________________ State.

NOTARY PUBLIC SIGNATURE: _____________________________________________

(SEAL)

PRINT NAME: _____________________________________ My commission expires:___________________________

PLEASE SUBMIT THIS FORM WITH YOUR BID OR PROPOSAL THROUGH BONFIRE AS

INSTRUCTED IN THE SOLICITATION.