6-CCS - Schedule H1-C.pdf

Schedule H1-C

Alternative Placement Request

Student Employment

Please submit the following form identifying your election for Alternative Placement. The Office of Contract Compliance Services is the sole approver for alternative placement and will assist with referrals of available sites.

Alternative Placement is available to MPS Contractors/Vendors with justified limitations which prevent actual student employment participation within their place of employment. Additionally, a company representative will be required to perform 2 alternative placement site visits for the duration of the project or per 12 month contract period (where applicable). “Alternative Placement” is defined as a work site other than that of the

MPS Contractor/Vendor’s worksite, identified as appropriate for work experience with MPS students in order to meet MPS Contractor/Vendor’s

Student Employment obligations under the DFMS Participation Plan for Contractors or MPS Professional Services Contract. Justifications for

Alternative Placement include the following: company age restrictions, work-site capacity limitations and location limitations.

In limited circumstances, when the Contractor’s place of employment is beyond the transportation resources available to students or when certain project circumstances exist that prevent student employment at the job site, the Contractor may subcontract with a third party who is currently providing services that were originally agreed upon between MPS and the Contractor for an “alternative placement” of students.

In such cases, the contractor maintains responsibility for the student’s work site and wages as well as ensuring a reasonably safe and meaningful work experience. Under this arrangement the contractor will be the “statutory employer” for all insurance purposes, including, but not limited to worker’s compensation purposes, and is hereinafter referred to as “Contractor/Statutory Employer.” The placement is hereinafter referred to as “Alternative Placement” or “Alternative Placement Site.” The Contractor/Statutory Employer understands and agrees that financial responsibility for claims or damages to students/employees, shall rest with Contractor/ Statutory Employer. Contractor/ Statutory Employer shall effect and maintain any insurance coverage, including but not limited to, Workers’ Compensation, Employers’ Liability and Commercial General Liability.

A company representative will be required to perform 2 alternative placement site visits for the duration of the project or per 12 month contract period (w here applicable). Each company must provide MPS with documentation of the alternative placement site visit and verification of site safety.

Project/Contractor Information

CONTRACTOR COMPANY NAME MPS PROJECT NAME BID/RFP NUMBER

CONTACT PERSON PRIMARY PHONE E-MAIL

Number of required project hours:

ALTERNATIVE PLACEMENT SITE ELECTION

Place an “X” below to indicate if you plan to fulfill your student employment requirement through an alternative placement site.

Yes, I am requesting alternative placement.

No, I plan to employ the student employee within my organization.

Please list below justification for student employment request.

TO BE COMPLETED BY CONTRACTOR/VENDOR:

I hereby declare and affirm that [ ] is in agreement with the conditions for utilizing an

INSERT COMPANY NAME

Alternative Placement Site and that our company meets the standards for which an accommodation is granted. I also understand that it will be the responsibility of our company representative to complete the required site visits and report to

MPS CCS a student status report which will contain signatures from the identified MPS alternative placement site liaison. I also agree to pay the student worker, at minimum, the City of Milwaukee’s Living Wage Rate.

SIGNATURE OF AUTHOR IZED COMPANY OFFICER TITLE DATE

SIGNATURE OF CCS REPRESENTATIVE TITLE DATE

09-2014