Tero Compliance Plan and Agreement

TERO Compliance Plan and Agreement

Lummi Nation’s Tribal Employment Rights Office

PROJECT INFORMATION

Project Name:     Project No.:

Location:

Project Owner:

Project Architect:     Phone:

Project Funding Agency:

Funding Agency Contact:     Phone:

CONTRACTOR INFORMATION

Check all that apply: Prime Contractor Subcontractor Union Non-Union

Company:

Address:

Contact Person:     Title:

Phone:     Fax:     Cell:

Insurance Company:     Policy #:

Scope of Work to be performed:

PERIOD OF PERFORMANCE

Approximate Start Date:     Ending:

TERO FEE

Contracts/Subcontract in the sum of $10,000.00 or more are subject to a fee of 2% of the total amount.

Requests for TERO fee payment schedule must be approved prior to the commencement of work activity on the project.

IDENTIFICATION OF CORE CREW

Core crew employees are defined as one who is an owner of the company, or in a top supervisory or lead position and has been on the employer contractor’s annual payroll for a minimum period of one year continuously.

Name / Position / Classification / Licensed Yes-No / Hrly Rate / Length w/ Company

Employee 1:

Employee 2:

Employee 3:

Employee 4:

IDENTIFICATION OF KEY PERSONNEL

A Key Employee is defined as one who the employer has invested time and costs to train for a critical function.

Employee 1:

Employee 2:

Employee 3:

Employee 4:

Employers who wish to utilize workers that do not meet these definitions must obtain approval through a written request for a TERO Waiver.

All supervisory employees listed will be required to attend the TERO Preconstruction Meeting.

IDENTIFICATION OF SUBCONTRACTORS

Subcontractor 1 - Company Name: Phone:

Scope of Work: Estimated Start Date:

Subcontractor 2 - Company Name: Phone:

Scope of Work: Estimated Start Date:

MANPOWER REQUESTS

Provide a preliminary estimate of workers needed for this project.

Manpower Request 1: Skill/Qualification Start Date No. Pay Rate Special Instruction

Manpower Request 2: Skill/Qualification Start Date No. Pay Rate Special Instruction

Manpower Request 3: Skill/Qualification Start Date No. Pay Rate Special Instruction

TERO PRE-CONSTRUCTION MEETING

Meeting Date: Location: Time:

UNDERSTANDING & ACCEPTANCE

On behalf of I hereby certify that I have received and understand the TERO requirements.

Dated this day of , 20.

Project: Project No.:

Contractor: Sub-Contractor:

Address:

Phone: Fax:

Printed Name: Title:

TERO DISPATCH FORM

Project:

Location:

Company Name:

Address:

Phone: Fax: Cell/Shed:

Classification/Title:

Hourly Pay Rate: Fringe Benefit Rate:

Start Date: Time: AM PM Job Length:

Whom to Report to: Title:

Brief Job Summary:

Tools/Equipment required:

Employer will provide the following:

TERO REQUEST / REFERRAL

Name:

Employer: Contact Person:

Phone: Mobile Phone:

Address:

Job Location:

Job Title:

Rate of Pay: Per: Hour Day Week Other

No. of Positions: Date Needed:

Job is: Full Time Part Time Permanent Temporary Overtime

Job will last: 1-5 Days 1-2 weeks over 150 Days

Hours: M-F Weekends Shift

Driver’s License Required: Yes CDL: A B C D

Working Conditions / Physical Demands:

Skills / Training:

Report Date: Time: AM PM

Special Instructions:

Alcohol/Drug Test Required: Yes No Physical Required: Yes No

Testing Center/Lab:

TERO EMPLOYEE DISPOSITION FORM

Project:

Employer Name: Job Title/Class:

Employee Name:

Today’s Date: Job Start Date:

Interview: Hired: Not Hired: Job Completed: Terminated:

Reason for termination: Safety Violation Work Ethics No Call/No Show Other

Briefly Explain:

Would you rehire this employee? Yes No Not Sure

Ratings / Notes:

Employer Representative: Date:

Date Received by TERO Representative:

TERO Official:

TERO WAIVER REQUEST FORM

Date Received: By:

Project:

Employer:

Name & Title of Person Making Request:

Address:

Phone: Fax: Cell/Shed:

Information of Waived Employee - Name: Social Security #:

Address:

Phone: Fax: Cell/Shed:

This waiver request is being submitted because:

Specialized skill requiring licensing/certification

TERO did not have a referral meeting qualifications

Other:

Authorized Employer: Date:

Approval Status: Approved Disapproved

Effective Date: To

Authorized TERO Official: Date:

NOTICE OF SUBCONTRACTING OPPORTUNITY FORM

Date:

Project Name: Project No.:

Location:

Project Owner:

Project Architect:

Project Funding Agency:

Funding Agency Contact:

CONTRACTOR INFORMATION

Name: Contract #:

Address:

Phone: Fax: Email:

Bid opening Date: Time: AM PM

Interested division:

Authorized Signature of Prime Contractor:

Response from TERO Certified Indian Businesses:

Reviewed opportunity: Yes No If yes, date received:

Declined opportunity:

Bid and negotiated:

Comments:

TERO CERTIFIED INDIAN BUSINESS INFORMATION

Company Name: CIB #:

Owner Name/Contract: Title:

Address:

Insurance/Bonding Company:

Phone: Fax: Cell/Email:

Date:

CC: Lummi TERO U.S. Postal Fax Hand Delivered Other