Common use of Check Here Clause in Contracts

Check Here. If you have not opened your business and leave the table blank. Name Title Hours per Week Xxxx Xxx Owner 40 VACANT Server 26 1 6 7 9 10 Are you planning on hiring additional employees? Yes No If Yes, How many? I certify that all my answers above are true and correct to the best of my knowledge. I also agree that by accepting to receive assistance from the Service Provider, I will cooperate and provide staff with all requested information and documents to verify the outcomes including but not limited to job forms signed by my new and/or retained employees and payroll documents. I will cooperate and provide the Service Provider staff with all requested information and documents to verify the outcomes reported. Signature of Business Owner Date Signature of Service Provider Staff Date SERVICE PROVIDER STAFF SECTION 2 Digit NAICS Code 6 Digit NAICS Code xxxxx://xxx.xxxxxx.xxx/naics/ Council District Registered in RAMP? xxxxx://xxx.xxxxxx.xxx/s/ Needs Assessment Complete? Photo ID? Proof of Residency/Business in City? Yes No City Certifications (Check on RAMP) Local Business Enterprise (LBE) Minority Business Enterprise (MBE) Women Business Enterprise (WBE) Small Business Enterprise (SBE) Emerging Business Enterprise (EBE) County and State Certifications Small Business (SB) (State) Small Local Business (SLB) (County) Small Business Enterprise – Proprietary (SBE) LGBT Business Enterprise Disabled Veteran Business Enterprise (DVBE) Disabled Vets Business Enterprise- LAWA (DVBE) Very Small Business Enterprise- Harbor (VSBE) Disadvantaged Business Enterprise (DBE) (State)

Check Here. If you have not opened your business and leave the table blank. Name Title Hours per Week Xxxx Xxx Owner 40 VACANT Server 26 1 6 7 9 10 Are you planning on hiring additional employees? Yes No If Yes, How many? I certify that all my answers above are true and correct to the best of my knowledge. I also agree that by accepting to receive assistance from the Service Provider, I will cooperate and provide staff with all requested information and documents to verify the outcomes including but not limited to job forms signed by my new and/or retained employees and payroll documents. I will cooperate and provide the Service Provider staff with all requested information and documents to verify the outcomes reportedreported in compliance with CFR 570.506(b)(5) and (6) listed above. Signature of Business Owner Date Signature of Service Provider Staff Date SERVICE PROVIDER STAFF SECTION 2 Digit NAICS Code 6 Digit NAICS Code xxxxx://xxx.xxxxxx.xxx/naics/ Council District Registered in RAMP? xxxxx://xxx.xxxxxx.xxx/s/ Needs Assessment Complete? Photo ID? Proof of Residency/Business in City? Yes No City Certifications (Check on RAMP) Local Business Enterprise (LBE) Minority Business Enterprise (MBE) Women Business Enterprise (WBE) Small Business Enterprise (SBE) Emerging Business Enterprise (EBE) County and State Certifications Small Business (SB) (State) Small Local Business (SLB) (County) Small Business Enterprise – Proprietary (SBE) LGBT Business Enterprise Disabled Veteran Business Enterprise (DVBE) Disabled Vets Business Enterprise- LAWA (DVBE) Very Small Business Enterprise- Harbor (VSBE) Disadvantaged Business Enterprise (DBE) (State)

Check Here. ☐ If you have not opened your business and leave the table blank. Name Title Hours per Week NAME TITLE HOURS PER WEEK Xxxx Xxx Owner 40 VACANT Server 26 1 4 5 6 7 8 9 10 11 12 13 14 15 16 18 Are you planning on hiring seeking to hire additional employees? Yes No If Yes, How many? I certify that all my answers above are true and correct to the best of my knowledge. I also agree that by accepting to receive assistance from the Service Provider, Provider I will cooperate and provide staff with all requested information and documents to verify the outcomes including but not limited to job forms signed by my new and/or retained employees and payroll documentsoutcomes. I will cooperate and provide the Service Provider staff with all requested information and documents to verify the outcomes reportedcompliance. Signature of Business Owner Date Signature of Coach Date Service Provider Staff Date SERVICE PROVIDER STAFF SECTION Section 2 Digit NAICS Code Code: _ 6 Digit NAICS Code xxxxx://xxx.xxxxxx.xxx/naics/ Code: _ _ xxxxx://xxx.xxxxx.xxx/search/ Council District Registered in RAMP? xxxxx://xxx.xxxxxx.xxx/s/ District: _ _ xxxxx://xxxxxxxxxxxxxxxx.xxxxxx.xxx/ Needs Assessment Complete? ☐ Yes ☐ No Photo ID? ☐ Yes ☐ No Proof of Residency/Business in City? ☐ Yes ☐ No City Registered in LA BAVN? ☐ Yes ☐ No ☐ Not Interested Certifications (Check on RAMP) ☐ Local Business Enterprise (LBE) ☐ Minority Business Enterprise (MBE) ☐ Women Business Enterprise (WBE) ☐ Small Business Enterprise (SBE) ☐ Small Business Enterprise – Proprietary (SBE) ☐ Emerging Business Enterprise (EBE) ☐ LGBT Business Enterprise ☐ Disabled Veteran Business Enterprise (DVBE) ☐ Disabled Vets Business Enterprise- LAWA (DVBE) ☐ Very Small Business Enterprise- Harbor (VSBE) ☐ Other Business Enterprise (OBE) County and State Certifications ☐ Small Business (SB) (State) ☐ Small Local Business (SLB) (County) Small Business Enterprise – Proprietary (SBE) LGBT Business Enterprise Disabled Veteran Business Enterprise (DVBE) Disabled Vets Business Enterprise- LAWA (DVBE) Very Small Business Enterprise- Harbor (VSBE) ☐ Disadvantaged Business Enterprise (DBE) (State) ☐ Airport Concession Disadvantaged Business Enterprise (ACDBE) (State)