Attachment A - Blanket Agreement Application DETA-19515-P.docx

ILA0030A Attachment A YA Consortium Bridging Outcomes Blanket Agreement Application (including Debarment & Suspension Certification) Wisconsin SAE 2020 Grant – YA Consortia Outcomes Funding for Bridging YA Completers to RA Contracts US Dept of Labor Grant: AP-35130-20-60-A-55 Effective Date: August 26, 2022

Program Information This Wisconsin Youth Apprenticeship (YA) Consortium funding opportunity is open only to Wisconsin YA consortia that are registered with the State of Wisconsin, Department of Workforce Development - Division of Employment and Training - Bureau of Apprenticeship Standards - Youth Apprenticeship Section (collectively "DWD"). Payments shall be made to the Consortium based on having provided direct services to its YA completers who bridged into Registered Apprentice contracts in accordance with the Wisconsin Youth Apprenticeship Local Grant Application and executed Education / Training Agreement (ETA).

DWD has $200,000 in Federal grant funding available for this Initiative. Funding is available on a first-come, first-served basis. DWD will accept applications and requests for payment until funds are exhausted or no longer available (grant expires 6/30/23), or the application deadline has passed.

With an approved Application, a Consortium may submit a Request for Payment (Attachment B), which can include up to five apprentices. Each Request for Payment must be accompanied by an Attestation form (Attachment C). DWD will review each request, and, if approved, make payment to the Consortium of up to $1,000.00 for each qualifying apprentice.

Terms and Conditions If countersigned by DWD, this application becomes a Blanket Agreement under which the Consortium may request payments in accordance with RFA ILA0030A. The Blanket Agreement is effective as of the date of DWD's signature through June 15, 2023, or until funds are no longer available, whichever occurs sooner.

By signing this Blanket Agreement, the Consortium agrees to comply with the terms and conditions included in the Request for Applications. DWD reserves the right to cancel this Blanket Agreement in whole or in part without penalty due to non-appropriation of funds or for failure of the Consortium to comply with terms, conditions, and specifications of RFA ILA0030A.

Payment is not guaranteed under this Blanket Agreement. The Consortium will only receive payment if DWD approves a Request for Payment (with accompanying Attestation form) and funds are still available. This Blanket Agreement shall be governed under the laws of the State of Wisconsin.

Youth Apprenticeship Consortium Information Consortium/Fiscal Agent Name:

Consortium/Fiscal Agent Address:

Street Address

Certification Regarding Debarment & Suspension

As the duly authorized representative of the applicant, I certify, to the best of my knowledge and belief, that neither the applicant nor its principals:

· Is presently excluded or disqualified;

· Has been convicted within the preceding three years of any of the offenses listed in 2 CFR § 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period;

· Is presently indicted for, or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with, commission or any of the offenses listed in 2 CFR § 180.800(a); or

· Has had one or more public transactions (federal, state, or local) terminated within the preceding three years for cause or default.

Signatures I certify that the information provided above is true and complete to the best of my knowledge.

Consortium Fiscal Agent/ Authorized Rep Signature Date

Printed/typed name

By countersigning, the Department of Workforce Development approves for the Consortium to submit requests for payments in accordance with RFA ILA0030A.

WI DWD Signature:

Date:

DETA-19515-P (N. 08/2022)For DWD use only: ILA0030A Ref #

This project is funded in whole by the Department of Labor, SAE 2020 Grant, AP-35130-20-60-A-55 (ILA0030A), receiving Federal funding at $9 million which reflects 100% of the project’s total budget.

This work is licensed under a Creative Commons Attribution 4.0 International License.

DETA-19515-P (N. 08/2022)For DWD use only: ILA0030A Ref # image1.png