HomeMy WebLinkAboutResolution - 2017-R0297 - Contract #13548 - Texas Premier Staffing Source - Temporary Employment Services - 08_24_2017Resolution No. 2017-RO297
Item No. 6.18
August 24, 2017
RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the Mayor of the City of Lubbock is hereby authorized and directed to execute for
and on behalf of the City of Lubbock, Professional Services Contract No. 13548 for Temporary
Employment Services, by and between the City of Lubbock and Texas Premier Staffing Source,
Inc., and related documents. Said Contract is attached hereto and incorporated in this resolution
as if fully set forth herein and shall be included in the minutes of the City Council.
Passed by the City Council on August 24 2017
DANIEL M. POPE, MAYOR
ATTEST:
- CD-a�.t Z--r- -
Reb cca Garza, City Secretary
6
APPROVED
Leisa Hutcheson, Director of Human Resources
APPROVED AS TO FORM:
irst Assistant City Attorney
ccdocs/RES.PSA-Texas Premier Staffing Source, Inc.
08/09/2017
Resolution No. 2017-RO297
City of Lubbock, TX
Temporary Employment Services
Service Agreement
Contract 13548
This Service Agreement (this "Agreement") is entered into as of the 24th day of August
2017("Effective Date") by and between Texas Premier Staffing Source, Inc. (the Contractor), and the
City of Lubbock (the "City").
RECITALS
WHEREAS, the City has issued a Request for Proposal 17-13294-SS Temporary Employment
Services.
WHEREAS, the proposal submitted by the Contractor has been selected as the proposal which best
meets the needs of the City for this service; and
WHEREAS, Contractor desires to perform as an independent Contractor to provide Temporary
Employment Services, upon terms and conditions maintained in this Agreement; and
NOW THEREFORE, for and in consideration of the mutual promises contained herein, the City
and Consultant agree as follows:
City and Contractor acknowledge the Agreement consists of the following exhibits which are
attached hereto and incorporated herein by reference, listed in their order of priority in the event of
inconsistent or contradictory provisions:
1. This Agreement
2. Exhibit A — Scope of Work
3. Exhibit B — Temporary Worker Qualifications
4. Exhibit C — Best and Final Offer — Rate Sheet
5. Exhibit D — Proposal
Scope of Work
Contractor shall provide the services that are specified in Exhibit A. The Contractor shall comply with all
the applicable requirements set forth in Exhibit B, C and D attached hereto.
Article 1 Services
1.1 The contract shall be for a term of one (1) year, with the option of four (4), one (1) year
extensions, said date of term beginning upon formal approval. All stated quantities are
approximations of usage during the time period to be covered by pricing established by this
bid. Actual usage may be more or less. Order quantities will be determined by actual need.
The City of Lubbock does not guarantee any specific amount of compensation, volume,
minimum, or maximum amount of services under this bid and resulting contract. The
Contractor must maintain the insurance coverage required during the term of this contract
including any extensions. It is the responsibility of the Contractor to ensure that valid
insurance is on file with the Purchasing and Contract Management Department as required
by contract or contract may be terminated for non-compliance.
1.2 This contract shall remain in effect until the first of the following occurs: (1) the expiration
date, (2) performance of services ordered, or (3) termination of by either party with a 30 day
written notice. The City of Lubbock reserves the right to award the canceled contract to the
next lowest and best bidder as it deems to be in the best interest of the city.
1.3 The Contractor shall not assign any interest in this Agreement and shall not transfer any
interest in the Agreement, whatsoever, without prior consent of the City.
1.4 All funds for payment by the City under this Agreement are subject to the availability of an
annual appropriation for this purpose by the City. In the event of non -appropriation of funds
by the City Council of the City of Lubbock for the goods or services provided under the
Agreement, the City will terminate the Agreement, without termination charge or other
liability, on the last day of the then -current fiscal year or when the appropriation made for
the then -current year for the goods or services covered by this Agreement is spent,
whichever event occurs first. If at any time funds are not appropriated for the continuance
of this Agreement, cancellation shall be accepted by the Contractor on 30 days prior written
notice, but failure to give such notice shall be of no effect and the City shall not be
obligated under this Agreement beyond the date of termination.
Article 2 Miscellaneous.
2.1 This Agreement is made in the State of Texas and shall for all purposes be construed in
accordance with the laws of said State, without reference to choice of law provisions. This
Agreement is performable in, and venue of any action related or pertaining to this
Agreement shall lie in, Lubbock, Texas.
2.2 This Agreement and its Exhibits contains the entire agreement between the City and
Contractor and supersedes any and all previous agreements, written or oral, between the
parties relating to the subject matter hereof. No amendment or modification of the terms of
this Agreement shall be binding upon the parties unless reduced to writing and signed by
both parties.
2.3 This Agreement may be executed in counterparts, each of which shall be deemed an
original.
2.4 In the event any provision of this Agreement is held illegal or invalid, the remaining
provisions of this Agreement shall not be affected thereby.
2.5 The waiver of a breach of any provision of this Agreement by any parties or the failure of
any parties otherwise to insist upon strict performance of any provision hereof shall not
constitute a waiver of any subsequent breach or of any subsequent failure to perform.
2.6 This Agreement shall be binding upon and inure to the benefit of the parties and their
respective heirs, representatives and successors and may be assigned by Contractor or the
City to any successor only on the written approval of the other party.
2.7 All claims, disputes, and other matters in question between the Parties arising out of or
relating to this Agreement or the breach thereof, shall be formally discussed and negotiated
between the Parties for resolution. In the event that the Parties are unable to resolve the
claims, disputes, or other matters in question within 30 days of written notification from the
aggrieved Party to the other Party, the aggrieved Party shall be free to pursue all remedies
available at law or in equity.
2.8 At any time during the term of the contract, or thereafter, the City, or a duly authorized
audit representative of the City or the State of Texas, at its expense and at reasonable times,
reserves the right to audit Contractor's records and books relevant to all services provided to
the City under this Contract. In the event such an audit by the City reveals any errors or
overpayments by the City, Contractor shall refund the City the full amount of such
overpayments within 30 days of such audit findings, or the City, at its option, reserves the
right to deduct such amounts owing the City from any payments due Contractor.
2.9 The City reserves the right to exercise any right or remedy to it by law, contract, equity, or
otherwise, including without limitation, the right to seek any and all forms of relief in a
court of competent jurisdiction. Further, the City shall not be subject to any arbitration
process prior to exercising its unrestricted right to seek judicial remedy. The remedies set
forth herein are cumulative and not exclusive, and may be exercised concurrently. To the
extent of any conflict between this provision and another provision in, or related to, this do.
2.10 The Contractor shall not assign or sublet the contract, or any portion of the contract, without
written consent from the Director of Purchasing and Contract Management. Should
consent be given, the Contractor shall insure the Subcontractor or shall provide proof of
insurance from the Subcontractor that complies with all contract Insurance requirements
document, this provision shall control.
IN WITNESS WHEREOF, this Agreement is executed as of the Effective Date.
CITY OF LUBBOCK, TX: CONTRACTOR: Texas Premier Staffing Source, Inc.
—L—JV /�22,
Daniel M. Pope, Mayor Contractor's Signature
ATTEST:
Reb cca Garza, City Sec—retaqJ
APPROVED AS TO CONTENT:
Leisa Hutcheson, Director of Human Resources
Mi.tcli Slitter white, tjAt Assistant City Attorney
Myrna L. Cooks
Printed Name
President/CEO
Title
Exhibit A
City of Lubbock, TX
RFP 17-13294-SS
Temporary Employment Services
IIWGIIl7 0Ke &:Llyi 1
BACKGROUND
1.1 The City of Lubbock (hereinafter called "City") is seeking proposals from temporary
employment agencies (hereinafter called "Agency") for information on the quality and cost of
temporary employment services. The City utilizes approximately 25 to 35 clerical and
professional temporary workers per year. Each clerical or professional temporary worker
requested works from a few days to several months, where the majority of requests are two to
six weeks in duration. The City also utilizes approximately 90 to 150 trade's temporary
workers per year. The majority of these workers are utilized during the summer months as
seasonal workers and work from about the middle of May through the middle of September. A
Medical category is included in the event an LVN is needed for the Health Department on a
contingency basis or as needed.
1.2 The City may select more than two temporary employment agencies, per job family category, to
service this contract and will provide personnel requests to the agencies that provide the most
prompt and quality placement by category. The City has spent an average of $1.5 million each
year over the past five years for temporary employment services. The total appropriation for
temporary employment services in FY 2016-2017 budget is $1.4 million.
1.3 The City of Lubbock will require the successful temporary employment agencies to conduct a
standard background check for all temporary employees placed with the City and provide
copies to the designated representative at the City of Lubbock.
1.3.1 Telephone reference checks to ensure education and skills are correct, as presented on
an applicant's application.
1.3.2 Conduct criminal history checks, through the Texas Department of Public Safety or
State of Current Residence, on all applicants who are being referred for City jobs.
1.3.3 Make every reasonable effort to contact past and present employers to gain information
about the work habits of the applicant(s).
1.3.4 The Lubbock Police Department will conduct a more thorough background check on
any temporary employee(s) who will be required to work in confidential police work
areas or police records.
1.4 The City of Lubbock will require the temporary employment agencies to conduct pre-
employment screening for all temporary employees placed with the City and provide
documentation that the temporary employees passed to the designated representative at the City
of Lubbock prior to placement.
1.4.1 All temporary employees must have a drug screening completed within ten (10) days
prior to placement.
1.4.2 Temporary employees in trades' positions will have a physical exam, as needed,
completed within thirty (30) days prior to placement, unless they have had one within
the last six (6) months.
1.4.3 Temporary employees who drive City vehicles must have a driver's license check
completed within one (1) year prior to placement.
1.4.4 Prior to placement at the City, Human Resources will run a check through our internal
databases and approve all temporary applicants for placement.
1.5 The City currently uses Microsoft Office Products.
GENERAL CONDITIONS
2.1 Agency will quote an hourly wage and bill rate at various levels (EXHIBIT C) for each type of
temporary worker described in the job descriptions in EXHIBIT B, as applicable. These rates
will remain effective for one year. Any increases in the second and third year of the contract
shall be in accordance with the Consumer Price Index; however, a three to five year price
guarantee will be looked on favorably. The rate should encompass any payments to the
temporary employee as well as applicable costs for conducting Driver's License Checks,
Criminal History Background Checks, Drug/Alcohol Screens, Physicals, etc. Workers
compensation coverage will be the responsibility of the agencies.
Agency must notate any difference in mark-up percentage for overtime pay. Overtime is
defined as more than 40 hours actually worked in any one week beginning on Saturday and
ending on Sunday.
City of Lubbock Retirees, returning to their same position, are an exception to the quoted rates.
They can return through a staffing agency at the same hourly rate upon retirement. The hourly
wage shall be verified with the designated representative at the City of Lubbock prior to the
temporary assignment. The bill rate for these employees shall be at the same percentage or
better as all other temporary employees.
The City reserves the right to request a temporary employee for a position that is not included
in this contract. The hourly wage shall be verified with the designated representative at the
City prior to the temporary assignment. These rates will be at 5% under the City's pay plan but
no lower than minimum wage. The bill rate for these temporary employees shall be at the same
percentage as all other temporary employees.
2.2 The selected agencies will appoint one person who is an employee of the agency who will
service this contract and who will be the liaison between the City and their agency.
2.3 The agencies will be solely responsible for ensuring the workers they provide the City meet all
legal requirements to be able to work in the United States and complete the I-9 form accurately
and in its entirety.
2.4 The agencies will be able to provide temporary workers within 8 hours of the request and if the
City is not contacted and/or provided with a temporary within that time period the City reserves
the right to contact another agency for service.
2.5 The agencies will provide workers who possess the necessary skills, knowledge, and ability to
perform the jobs into which they are to be placed, as per attached job description.
2.6 The City reserves the right to reject workers provided by the successful agencies, if they are
found to be unacceptable before or after starting on the job to which they have been assigned.
2.7 There shall be no obligation on the part of the City to hire any temporary worker it is supplied
under the terms of this RFP on a full time basis following the term of the temporary
employment.
2.8 Should the City wish to hire an individual who has been filling the temporary position, neither
the individual nor the City will be required to pay a placement fee.
2.9 The selected agencies will have and maintain a $500,000 crime bond on the employees it
provides to the City to protect the City from any loss caused by the workers it provides.
2.10 The successful agencies are to provide the City with weekly billing by department. Normal
payment terms are Net 30. The ability to accept a City purchasing card for payment is
preferred.
CONTRACT TERM/TERMINATION
3.1 The contract shall be for a term of five years, said date of term beginning upon formal approval.
This contract shall remain in effect until the expiration date, performance of services ordered,
or termination by either party with a thirty (30) date written notice. Such written notice must
state the reason for cancellation. The City of Lubbock does not guarantee any specific amount
of compensation, volume, minimum, or maximum amount of services under this proposal and
resulting contract. The Contractor must maintain the insurance coverage required during the
term of this contract including any extensions. It is the responsibility of the Contractor to
ensure that valid insurance is on file with the Purchasing and Contract Management
Department as required by contract or contract may be terminated for non-compliance.
3.2 This contract shall remain in effect until the first of the following occurs: (1) the
expiration date, (2) performance of services ordered, or (3) termination of by either party
with a 30 day written notice. Such written notice must state the reason for cancellation.
The City of Lubbock reserves the right to award the canceled contract to the next lowest
and best bidder as it deems to be in the best interest of the city.
4 INDEMNITY INSURANCE
PROOF OF COVERAGE SHALL BE FURNISHED TO THE CITY OF LUBBOCK IN THE
FORM OF A CERTIFICATE OF INSURANCE. THE INSURANCE CERTIFICATES FURNISHED
SHALL NAME THE CITY OF LUBBOCK AS A PRIMARY ADDITIONAL INSURED AND
PROVIDE A WAIVER OF SUBROGATION IN FAVOR OF THE CITY OF LUBBOCK, OR IN THE
ALTERNATIVE, SHALL BE ACCOMPANIED BY A STATEMENT FROM THE CONTRACTOR
TO THE EFFECT THAT NO WORK ON THIS PARTICULAR PROJECT SHALL BE
SUBCONTRACTED. IT SHALL BE THE CONTRACTOR'S RESPONSIBILITY TO PROVIDE TO
THE OWNER ALL PROOF OF COVERAGE INSURANCE DOCUMENTS INCLUDING
WORKERS COMPENSATION COVERAGE FOR EACH SUBCONTRACTOR.
4.1 Agency shall indemnify, hold harmless, and defend the City of Lubbock, its officers and
employees from and against any and all liability or alleged liability without fault and liability
by virtue of the obligations that the City of Lubbock assumes toward its indemnity(s) insofar as
applicable to this Contract or the work to be performed hereunder and including cost of suit,
attorneys' fees, and all other related costs and expenses of whatever kind or character arising
directly or indirectly from any cause whatsoever in connection with or incidental to this
Contract or the work to be performed hereunder, including such injury or harm as may be
caused in part by any neglect, act, or omission of the City, its officers and employees, excepting
only such injury or harm as may be caused solely by an act or omission of the City, its officers
and employees. Notwithstanding the foregoing, the Agency specifically agrees to so indemnify,
hold harmless, and defend the City from and against any and all such liability, suits, action,
legal proceedings, claims, or demands that may be made or pursued by an employee of Agency,
or of any subcontractor, or materials man, or anyone acting on behalf of contractor in
connection with or incidental to this Contract which are alleged to be attributable to any
condition of or upon the City's property facilities, materials, or equipment, including where
such condition and resulting injury or harm is caused in part by any negligent act or omission of
City, its officers and employees, but excepting only such injury or harm as may be caused
solely by an act or omission of City, its officers and employees. Agency agrees to waive any
and all claims and suits covered by this indemnity agreement and agrees that any insurance
carrier involved shall not be entitled to subrogation under any circumstance against City, its
officers and employees.
4.2 The Agency shall secure and maintain insurance for the duration of the contract. Proof of the
Agency's liability insurance shall be provided prior to receipt of a signed contract. The
following insurance is required.
4.2.1 Workers' Compensation Insurance covering all employees whether employed by the
Agency or any Subcontractor on the job including Employers Liability of at least
$1,000,000 aggregate.
Commercial General Liability Insurance at minimum combined single limits of
$1,000,000 each occurrence and in the aggregate and shall include the following:
$1,000,000 Products and completed operations
$1,000,000 Personal Injury and Advertising Injury
Crime Policy $500,000 General Aggregate
Automobile Liability - Agency's insurance shall contain a combined single limit of at
least $1,000,000 per occurrence, and include coverage for, but not limited to the
following: Any Auto
4.3 All policies or certificates shall also contain the following endorsements:
4.3.1 Name insured wording which includes the Agency, Subcontractors, and the City of
Lubbock with respect to general liability and automobile liability.
4.3.2 All liability policies shall contain cross liability and severability of interest clauses.
4.3.3 A waiver of subrogation in favor of the City of Lubbock for all types of insurance
coverages.
4.3.4 The policy shall be endorsed to require the insured to immediately notify the City of
Lubbock of any changes in the insurance coverage.
4.4 All insurance shall be purchased from an insurance company that meets the following
requirements.
4.4.1 A Best financial grading of A:VII or better
4.4.2 Licensed and admitted to do business in the State of Texas and is a subscriber to the
Texas Guaranty Fund.
4.5 All insurance must be written on forms filed with and approved by the Texas State Board of
Insurance. Certificates of insurance shall be prepared and executed by the insurance company
or its authorized agent and shall contain provisions representing and warranting the
following:
4.5.1 The company is licensed and admitted to do business in the State of Texas.
4.5.2 The company's forms have been approved by the Texas State Board of Insurance.
4.5.3 Sets forth all endorsements as required above.
4.6 The City of Lubbock shall receive at least twenty (20) calendar days' notice prior to
cancellation or termination of insurance, except in the case of non-payment.
5 PROPOSAL FORMAT
5.1 Proposals should provide a straightforward, concise description of the Agency's capabilities to
satisfy the requirements of the RFP. Emphasis should be on completeness, clarity of content,
and conveyance of the information requested by the City.
5.2 The proposal should be bound in a single volume where practical. All documentation
submitted with the proposal should be bound in that single volume. Notebooks are preferred.
5.3 If the proposal includes any comment over and above the specific information requested in the
RFP, it is to be included as a separate appendix to the proposal.
5.4 If the proposal includes any exception to the specific information requested in the RFP, it is to
be included as a separate appendix to the proposal.
5.5 Cover letter addressed to the Honorable Mayor and City Council that states the Proposer's
understanding of the services to be provided. Include any additional information believed
necessary that is not requested elsewhere in the RFP.
6 PROPOSER INFORMATION
6.1 The Agency shall submit the following information with their proposal. The proposal must be
submitted in an indexed binder with the required response item sections in the following order:
6.1.1 Describe the testing procedures used to determine skills and physical abilities of
workers.
6.1.2 Methodology used to supply qualified personnel after notification of need (criminal
history checks through the Texas Department of Public Safety, drug testing, etc.).
6.1.3 Ability to provide driver's license checks completed no longer than one year before
placement.
6.1.4 Describe procedures to replace workers that do not meet job expectations.
6.1.5 Describe normal billing procedures, include sample invoice, and state overtime rates.
Describe any special billing procedure, particularly markup on overtime rate and any
other special circumstance.
6.1.6 Describe CDL random drug testing for temporary drivers.
6.1.7 Describe bonding information (agency, capacities, etc.).
6.1.8 Describe any work restrictions (below ground, above ground, lifting of weight,
number of consecutive hours worked, driving/equipment, etc.).
6.1.9 Proposal Submittal Form Rate Sheet EXHIBIT C Part 1 and Part2.
6.1.10 Five (5) customer references, including name of customer, telephone number, and
individual to contact EXHIBIT D.
Exhibit B
City of Lubbock, TX
Temporary Employment Services
RFP 17-13294-SS
II. TEMPORARY WORKER QUALIFICATIONS
The following job descriptions are examples of the minimum experience required and fall under Level 1 of the
Proposal Submittal Form Rate Sheet in EXHIBIT C. Levels 2, 3, and 4 are used for experience in addition to
what is required in the below job descriptions. Depending on the department's needs, a request may be made
specifically for a bilingual temporary worker for any of the below positions.
Professional Positions
1.1 Summary: Performs professional level accounting duties to prepare and maintain accurate
financial records and provide financial reports to internal and external users.
Education/Experience: Any combination of education and experience equivalent to a bachelor
degree in accounting or finance with four years' experience required. May consider other
degree with 18 hours coursework in accounting. Knowledge of the principles, practices, and
standards of general and governmental accounting and financial and quantitative analysis
methods. Ability to prepare and review financial transactions; prepare accounting and financial
statements and schedules; communicate effectively orally and in writing; operate computer and
software; compile and interpret data; and analyze problems and develop effective solutions.
Licenses/Certifications: None
Work Conditions/Physical Requirements: Performs sedentary work that involves sitting most
of the time, but may involve walking or standing for brief periods of time; requires little or no
dexterity.
1.2 Worker's Compensation Classification of Operations Code: 8810
2.1 Summary: Create and draw projects using computer aided design for drafting, and assist
customers and other city employees by providing maps and other info as needed.
Education/Experience: Requires an Associate's Degree involving engineering related
coursework with one year experience in drafting, mapping, or technical drawing; or any
combination of relevant education and experience. Must have experience involving engineering
related coursework, updating information in GIS systems, provide drafting for capital projects,
maintain permanent records, transfer information from hard maps to computer -based maps and
provide various customer supports.
Licenses/Certifications: Must possess a valid Texas Driver's license.
Work Conditions/Physical Requirements: Performs light work that involves walking or
standing most of the time and involves exerting up to 20 pounds of force on a regular and
recurring basis, or skill, adeptness and speed in the use of fingers, hands or limbs on repetitive
operation of mechanical or electronic office or shop machines or tools within moderate
tolerances or limits of accuracy.
2.2 Worker's Compensation Classification of Operations Code: 8810
3 End User Suggort Tech
3.1 Summary: Provide technical support for laptops, PC's, mobile devices, printers and peripherals
to restore service and deliver solutions to meet user requirements for all employees.
Education/Experience: Requires a Bachelor's Degree in management information systems,
computer science, or a related field. Related experience may substitute for education
requirement on a year-to-year basis. No specific experience required.
Licenses/Certifications: None
Work Conditions/Physical Requirements: Performs light work that involves walking or
standing most of the time and involves exerting up to 20 pounds of force on a regular and
recurring basis, or skill, adeptness and speed in the use of fingers, hands or limbs on
repetitive operation of mechanical or electronic office or shop machines or tools within
moderate tolerances or limits of accuracy.
3.2 Worker's Compensation Classification of Operations Code: 5191
Clerical Positions
4 Account Clerk
4.1 Summary: Performs routine clerical tasks and reviews financial records.
Education/Experience: Any combination of education and experience equivalent to graduation
from high school and six months of experience in maintaining and reviewing financial and
statistical records. Knowledge of the procedures and terminology used in clerical accounting
duties; basic computer principles and procedures; and proper public contract and telephone
etiquette. Ability to compute and post arithmetical calculations, effectively operate standard
office equipment; communicate effectively with others; comprehend and follow oral and
written instructions and perform basic computer/word processing functions.
Licenses/Certifications: None
Work Conditions/Physical Requirements: Performs sedentary work that involves sitting most of
the time, but may involve walking or standing for brief periods of time; requires little or no
dexterity.
4.2 Worker's Compensation Classification of Operations Code: 8810
5 Administrative Assistant
5.1 Summary: Performs a wide variety of difficult clerical and secretarial duties.
Education/Experience: Any combination of education and experience equivalent to graduation
from high school and one year of increasingly responsible secretarial experience. Knowledge of
office practices and procedures; the organization, function, and policies of the departments;
general knowledge of municipal government organization and services; personnel and financial
recordkeeping; computer principles and procedures; and proper public contact and telephone
etiquette. Ability to spell and use correct grammar; prioritize and schedule work to meet
deadlines; transcribe material from a Dictaphone system; communicate effectively with others;
work independently in the absence of specific instructions; prepare accurate payroll and
financial records; perform computer/word processing functions.
Licenses/Certifications: None
Work Conditions/Physical Requirements: Performs sedentary work that involves walking or
standing some of the time and involves exerting up to 10 pounds of force on a regular and
recurring basis or sustained keyboard operations.
5.2 Worker's Compensation Classification of Operations Code: 8810
6.1 Summary: Performs bookkeeping tasks of average difficulty.
Education/Experience: Any combination of education and experience equivalent to the
completion of a high school diploma with one year experience in clerical work involving
financial recordkeeping or bookkeeping. Knowledge of Excel and other accounting software
applications and fundamental bookkeeping procedures. Ability to make arithmetical
calculations with speed and accuracy; communicate effectively with others; and maintain
detailed financial records accurately.
Licenses/Certifications: None
Work Conditions/Physical Requirements: Performs sedentary work that involves sitting most of
the time, but may involve walking or standing for brief periods of time; requires little or no
dexterity.
6.2 Worker's Compensation Classification of Operations Code: 8810
7.1 Summary: Provide contact service, information, and support to the public through a call center.
Education/Experience: Any combination of education and experience equivalent to the
completion of a high school diploma with one year of clerical or customer service experience.
Knowledge of customer service methods and practices; practices of a call center environment;
professional telephone etiquette; and computer software and use of business computer. Ability
to communicate verbally in a clear manner in the English language; answer calls and
communicate with others using professional telephone etiquette; assist caller in clarifying the
request or issue; apply knowledge and reasoning to determine the most suitable means for
initiating action to resolve a complaint or problem; provide accurate information to
callers;
operate computer and various office equipment; use a telephone for long periods of time;
follow verbal and written instructions; and communicate effectively in writing.
Licenses/Certifications: None
Work Conditions/Physical Requirements: Performs sedentary work that involves walking or
standing some of the time and involves exerting up to 10 pounds of force on a regular and
recurring basis or sustained keyboard operations.
7.2 Worker's Compensation Classification of Operations Code: 8810
S Cashier
8.1 Summary: Receives and accounts for money.
Education/Experience: Any combination of education and experience equivalent to graduation
from high school and three to six months of general clerical experience. Knowledge of the
methods of receiving and accounting for money and basic office procedures. Ability to make
simple arithmetical computations quickly and accurately; accurately maintain financial records
and accounts; and communicate effectively with others.
Licenses/Certifications: None
Work Conditions/Physical Requirements: Performs sedentary work that involves walking or
standing some of the time and involves exerting up to 10 pounds of force on a regular and
recurring basis or sustained keyboard operations.
8.2 Worker's Compensation Classification of Operations Code: 8810
9 Office Assistant
9.1 Summary: Performs a variety of clerical and secretarial duties.
Education/Experience: Any combination of education and experience
equivalent to graduation from high school and one to three years of secretarial
experience. Knowledge of office practices and procedures; computer principles and
procedures; and proper public contact and telephone etiquette. Ability to spell and
use correct grammar; transcribe material from a Dictaphone; communicate effectively with
others; prepare and maintain accurate records; and perform computer/word processing
functions.
Licenses/Certifications: None.
Work Conditions/Physical Requirements: Performs sedentary work that involves walking or
standing some of the time and involves exerting up to 10 pounds of force on a regular and
recurring basis or sustained keyboard operations.
9.2 Worker's Compensation Classification of Operations Code: 8810
10 Recreation Services Assistant
10.1 Summary: Plan, schedule, organize, and implement recreation programs and activities.
Education/Experience: Requires high school diploma or GED equivalent.
Licenses/Certifications: None.
Work Conditions/Physical Requirements: Performs sedentary work that involves sitting most of
the time, but may involve walking or standing for brief periods of time; requires little or no
dexterity.
10.2 Worker's Compensation Classification of Operations Code: 9102
11 Temkorary Election Worker
11.1 Summary: Assist with verifications of petitions.
Education/Experience: Must be at least 18 years of age and a registered voter of Lubbock
County. Must have experience working as an election judge or early voting clerk for Lubbock
County Elections. Knowledge of typing, computer skills, and Election laws. Ability to follow
verbal and written instructions; work independently in the absence of specific instructions;
establish and maintain effective working relationships with fellow employees and City
Secretary staff, and be detail -oriented.
Licenses/Certifications: None.
Work Conditions/Physical Requirements: Ability to continuously sit; occasionally flex upper
trunk forward at the waist and partially flex at the knees; occasionally rotate upper trunk to the
left or right while sitting or standing; and frequently place arms above, at, or below shoulder
height. Vision requirements include close vision, distance vision, peripheral vision, color
vision, and ability to adjust focus. Requires exposure to computer screens and the public; may
be required to work extended hours.
11.2 Worker's Compensation Classification of Operations Code: 8810
Trades Positions
12 Buildinty Maintenance Worker
12.1 Summary: Maintain and repair buildings; operate heating and air conditioning equipment.
Education/Experience: Any combination of education and experience equivalent to the
completion of a high school diploma and two years of responsible work experience in the repair
and maintenance of heating and air conditioning equipment. Troubleshoots minor maintenance
problems involving electrical, structural, plumbing, for equipment repairs or replacement.
Knowledge of use of basic hand tools and communicate effectively with others.
Licenses/Certifications: Must possess a valid Texas Driver's license.
Work Conditions/Physical Requirements: Performs light to medium work that involves walking
or standing virtually all of the time and also involves exerting between 20 and 50 pounds of
force on a regular and recurring basis or considerable skill, adeptness and speed in the use of the
fingers, hands or limbs in tasks involving close tolerances or limits of accuracy.
12.2 Worker's Compensation Classification of Operations Code: 9015
13 Construction and Maintenance Worker
13.1 Summary: Performs manual work in the construction and maintenance of public works
facilities.
Education/Experience: Any combination of education and experience equivalent to completion
of a high school diploma and six months of experience in performing manual labor.
Knowledge of the types and uses of common hand tools and equipment used in construction
and maintenance of public roadways. Ability to perform manual tasks requiring physical
strength and endurance; follow oral and written instructions; communicate effectively with
others; and operate heavy equipment.
Licenses/Certifications: Must possess a valid Texas Driver's License.
Work Conditions/Physical Requirements: Performs medium to heavy work that involves
walking, standing, stooping, lifting, digging, pushing, and raising objects and also involves
exerting between 20 and 50 pounds of force on a regular and recurring basis and 50 to 100
pounds of force on an occasional basis.
13.2 Worker's Compensation Classification of Operations Code: 5506
14 Custodian
14.1 Summary: Keeps an assigned building and surrounding premises clean and orderly using
janitorial equipment and supplies.
Education/Experience: Knowledge of the methods and equipment used in janitorial work.
Ability to use machines and equipment including a buffer, shampoo machine, vacuum, floor
stripper, mop, broom, and related cleaning implements; communicate effectively with others;
and follow oral and written instructions.
Licenses/Certifications: None.
Work Conditions/Physical Requirements: Performs light work that involves walking or standing
most of the time and involves exerting up to 20 pounds of force on a regular and recurring basis,
or skill, adeptness, and speed in the use of fingers, hands, or limbs on repetitive operation or
mechanical or electronic office or shop machines or tolls within moderate tolerances or limits of
accuracy
14.2 Worker's Compensation Classification of Operations Code: 9015
15 Electronics Technician
15.1 Summary: Assists in the installation and repair of radio, electronic, and related
communications equipment.
Education/Experience: Any combination of education and experience equivalent to the
completion of a high school diploma and two years of responsible work experience in the
repair and maintenance of mechanical and/or electrical equipment. Knowledge of use of basic
hand tools. Ability to learn the methods and equipment used in radio communication
installation and repair and communicate effectively with others.
Licenses/Certifications: Must possess a valid Texas Driver's License.
Work Conditions/Physical Requirements: Performs light work that involves walking or
standing most of the time and involves exerting up to 20 pounds of force on a regular and
recurring basis, or skill, adeptness, and speed in the use of fingers, hands, or limbs on repetitive
operation or mechanical or electronic office or shop machines or tolls within moderate
tolerances or limits of accuracy.
15.2 Worker's Compensation Classification of Operations Code: 5190
16 EEguinment O erator
16.1 Summary: Operates and services trucks and light motorized equipment, performs maintenance
work on equipment, and manual work in public facilities.
Education/Experience: Any combination of education and experience equivalent to completion
of tenth grade and six months experience in maintenance or construction work involving the
operation of motorized equipment. Knowledge of operation and maintenance of motorized
equipment typically used in construction or maintenance activities. Ability to follow oral and
written instructions; perform maintenance on light equipment; work cooperatively with others;
operate a spray gun and metal grinder; and communicate effectively with others.
Licenses/Certifications: Must possess a valid Texas Commercial Driver's License. Equipment
Operator at Landfill must possess a valid Texas Driver's License.
Work Conditions/Physical Requirements: Performs medium to heavy work that involves
walking, standing, stooping, lifting, digging, pushing, and raising objects and also involves
exerting between 20 and 50 pounds of force on a regular and recurring basis and 50 to 100
pounds of force on an occasional basis.
16.2 Worker's Compensation Classification of Operations Code: Solid Waste - 9403, Streets_ 9402,.
Cemetery — 9220, and Parks & Recreation - 9102
17 Grounds Maintenance Worker
17.1 Summary: Maintains landscaped areas at City of Lubbock parks and other recreational areas.
Education/Experience: Any combination of education and experience equivalent to completion of a high
school diploma and six months experience in grounds keeping, gardening, or maintenance
work. Knowledge of grounds keeping methods, tools, and supplies; and practices in planting,
cultivating, and caring for trees, shrubs, flowers, and lawns. Ability to use hand tools and
motorized equipment; perform heavy physical labor; and communicate effectively with others.
Licenses/Certifications: Must possess a valid Texas Driver's License.
Work Conditions/Physical Requirements: Performs medium work that involves walking,
standing, stooping, jumping, dancing, stretching, or lifting all of the time and also
involves exerting between 20 and 50 pounds of force on a regular and recurring basis or
exceptional skill, adeptness, and speed in the use of fingers, hands, or limbs in tasks
involving very close tolerances or limits of accuracy.
17.2 Worker's Compensation Classification of Operations Code: 9102
18.1 Summary: Operates and services the heavier types of construction equipment including but not
limited to motor graders, scrapers, asphalt paving machine and large front end loader.
Education/Experience: Any combination of education and experience equivalent to completion
of a high school diploma and three to five years' experience in the operation of motorized
construction equipment. Knowledge of operation and maintenance of heavy motorized
equipment typically used in construction or maintenance activities. Ability to operate heavy
equipment skillfully and safely; perform maintenance and service work on trucks and heavy
equipment; make field repairs; and understand and follow oral and written instructions.
Licenses/Certifications: Must possess a valid Texas Commercial Driver's License.
Work Conditions/Physical Requirements: Performs medium work that involves walking,
standing, stooping, jumping, dancing, stretching, or lifting all of the time and also involved
exerting between 20 and 50 pounds of force on a regular and recurring basis or exceptional
skill, adeptness, and speed in the use of fingers, hands, or limbs in tasks involving very close
tolerances or limits of accuracy.
18.2 Worker's Compensation Classification of Operations Code: 5506
19 Irrigation Technician
19.1 Summary: Operates, maintains, and repairs irrigation system components. Maintains
accurate irrigation records.
Education/Experience: Any combination of education and experience equivalent to completion
of a high school diploma and one year of farm labor experience including work with irrigation
systems. Knowledge of operation and maintenance of irrigation systems, pumps, pipelines,
valves, flow meters, farm machinery, and earth moving equipment; and knowledge of computer
programs and software. Ability to operate, test, and repair centerpivot irrigation system; operate
earth moving equipment; develop and interpret irrigation plans, specifications, and details;
communicate effectively with others; and operate farm equipment.
Licenses/Certifications: Must possess a valid Texas Driver's License.
Work Conditions/Physical Requirements: Performs light work that involves walking or standing
most of the time and involves exerting up to 20 pounds of force on a regular and recurring basis,
or skill, adeptness and speed in the use of fingers, hands or limbs on repetitive operation of
mechanical or electronic office or shop machines or tools within moderate tolerances or limits of
accuracy.
19.2 Worker's Compensation Classification of Operations Code: 7520
20 Labor
20.1 Summary: Cleans buildings and maintains grounds at assigned location.
Education/Experience: Any combination of education and experience equivalent to completion
of a high school diploma and six months experience in performing manual labor. Knowledge
of common hand tools and some power tools used in assembling partition system. Ability to
operate motorized equipment and use hand tools; perform heavy physical labor; follow oral and
written instructions; and communicate effectively with others.
Licenses/Certifications: Must possess a valid Texas Driver's License.
Work Conditions/Physical Requirements:
20.2 Worker's Compensation Classification of Operations Code: 9016
21 Labor (Abernathy Landfill)
21.1 Summary: Maintains grounds at assigned location.
Education/Experience: Any combination of education and experience equivalent to completion
of a high school diploma and six months experience in performing manual labor. Ability to
operate a vehicle skillfully and safely; perform heavy physical labor; follow oral and written
instructions; and communicate effectively with others.
Licenses/Certifications: Must possess a valid Texas Driver's License.
Work Conditions/Physical Requirements: Performs light to medium work that involves walking or
standing virtually all of the time and also involved exerting between 20 and 50 pounds of force on a regular
and recurring basis or considerable skill, adeptness, and speed in the use of fingers, hands, or limbs in tasks
involving close tolerances or limits of accuracy. Must have transportation to and from Landfill in
Abernathy, TX.
21.2 Worker's Compensation Classification of Operations Code: 9016
22.1 Summary: Facilitate operations at the permanent recycling drop-offs by providing good
customer service and site maintenance. Site maintenance includes proper processing of
recycling commodities by sorting and as needed, removing unacceptable items from recycling
dumpsters.
Education/Experience: Any combination of education and experience equivalent to the
completion of a high school diploma and six months experience in maintenance or construction
work. Ability to understand and follow oral and written instructions; get along well with others;
communicate effectively with others; and operate a riding lawn mower, skid loader equipment,
2-way radio, and bob cat skillfully and safely.
Licenses/Certifications: Must possess a valid Texas Driver's License.
Work Conditions/Physical Requirements: Ability to continuously lift and carry up to 25
pounds, frequently lift and carry up to 50 pounds, and occasionally lift and carry up to 75
pounds; frequently stand and walk during a shift; frequently climb ladders, stairs, and inclined
surfaces; continuously bend and kneel; push and pull objects; continuously flex upper trunk
forward at the waist and partially at the knees; frequently rotate trunk to the right or left while
sitting or standing; continuously reach above, at, or below shoulder height; and coordinate eye,
hand, and foot movement in order to operate motorized equipment. Requires working in outside
weather conditions during all seasons.
22.2 Worker's Compensation Classification of Operations Code: 7590
23 Warehouse Maintenance Worker
23.1 Summary: Performs manual work and maintains grounds at Warehouse.
Education/Experience: Any combination of education and experience equivalent to completion
of a high school diploma and six months of experience in grounds keeping or maintenance
work. Knowledge of the types and uses of common hand tools. Ability to operate motorized
equipment and use hand tools; perform physical labor; follow oral and written instructions; and
communicate effectively with others.
Licenses/Certifications: None
Work Conditions/Physical Requirements: Ability frequently lift and carry up to 75 pounds;
occasionally lift and carry up to 100 pounds; frequently walk and stand during the shift;
frequently bend and kneel during a shift; push and pull objects; continuously flex upper trunk
forward at the waist and partially at the knees; continuously rotate upper trunk to the right or
left while sitting or standing; reach above, at, or below shoulder height; and coordinate eye,
hand, and foot movement in order to operate a vehicle. Requires working outside and may
subject worker to extremes of weather conditions.
23.2 Worker's Compensation Classification of Operations Code: 8292
Medical Positions
24 Licensed Vocational Nurse
24.1 Summary: Performs technical nursing duties and assists in providing patient care at the public
health department.
Education/Experience: Any combination of education and experience equivalent to a vocational
nursing degree from an accredited program with some experience in nursing. Knowledge of the
principles and practices of vocational nursing and self -care activities that promote health and
wellness. Ability to operate basic equipment such as a thermometer, blood pressure cuff,
stethoscope, and scales; learn the operation of equipment related to the specialty area such as
Doptone and Fetascope; follow oral and written instructions; maintain accurate information;
and communicate effectively with others.
Licenses/Certifications: Must possess current CPR certification and a Licensed Vocational
Nurse certificate.
Work Conditions/Physical Requirements: This position requires work in office, clinical, and
community environments. Hazards include potential exposure to contaminated blood and
exposure to diseased patients. Ability to frequently lift up to 10 pounds, occasionally lift up to
50 pounds, and frequently carry up to 25 pounds; occasionally stand and bend during the shift;
frequently walk during the shift; push and pull objects; frequently flex upper trunk forward at
the waist and partially at the knees; frequently rotate upper trunk to the left or right while
sitting or standing; and place arms above, at, or below shoulder height.
24.2 Worker's Compensation Classification of Operations Code: 8833
25 Registered Nurse
25.1 Summary: Plan and conduct health promotion activities; provide professional nursing care,
make referrals to appropriate providers, and provide health education to public health clients.
Education/Experience: Any combination of education and experience equivalent to completion
of professional nursing degree from an accredited school of nursing and one year of public
health nursing experience. Knowledge of professional nursing principles and practices; control
and care of various communicable diseases; principles and practices use in fostering proper
community, adult, maternal, child, and dental health; practices and principles of conducting a
community assessment; and basic epidemiological principles and methods including data
collection, report writing, and interpretation. Ability to operate basic equipment necessary to
provide nursing care; communicate effective with individuals from various socioeconomic
levels, orally and in writing; maintain accurate records; write reports; establish and maintain
effective working relationships with patients, other health practitioners, and various community
agencies and organizations; develop policies and procedures based on data and assessment
outcomes; and follow written and oral instructions.
Licenses/Certifications: Must possess current CPR certification and a valid Texas Driver's
License. Must be licensed as a registered nurse in the state of Texas, or be eligible to obtain
licensure.
Work Conditions/Physical Requirements: This position requires work in office, clinical, and
community environments. Hazards include potential exposure to contaminated blood and
exposure to diseased patients. Ability to frequently lift and carry up to 10 pounds and
occasionally lift and carry up to 50 pounds; frequently stand and walk during the shift;
occasionally bend and kneel; occasionally climb stairs, ladders, and other inclined surfaces;
occasionally push and pull objects; place arms above, at, and below shoulder height; and
coordinate eye, hand, and foot movement in order to operate a vehicle.
25.2 Worker's Compensation Classification of Operations Code: 8833
Exhibit C
Best and Final Offer
City of Lubbock, TX
Temporary Employment Services
RFP 17-13294-SS
Proposal Submittal Form Rate Sheet
EXHIBIT C Part 1
The undersigned hereby offers to furnish and deliver the articles or services as specified herein and in their
proposal and proposed service agreement (attached) at the terms stated therein and in strict accordance with
the specifications, all of which are made a part of this offer. See exhibit C Part 2 for overtime rates.
Maximum number of days from signing of service agreement to inception: This proposal is valid for ninety
(90) days.
TEMPORARY AGENCY HOURLY RATE SHEET
Level l 2 3 4
Professional Positions
Hourly
Wage
Bill
Rate
Hourly
Wage
Bill
Rate
Hourly
Wage
Bill
Rate
Hourly
Wage
Bill
Rate
Accountant
19.50
25.74
21.45
28.31
23.60
31.15
25.95
34.26
GIS/CAD Technician
14.50
19.14
15.95
21.05
17.55
23.16
19.30
25.48
End User Support Tech
15.25
20.13
16.78
22.14
18.45
24.36
20.30
26.79
Clerical Positions
Hourly
Wage
Bill
Rate
Hourly
Wage
Bill
Rate
Hourly
Wage
Bill
Rate
Hourly
Wage
Bill
Rate
Account Clerk
10.15
13.40
11.17
14.74
12.28
16.21
13.51
17.83
Administrative Assistant
11.00
14.52
12.10
15.97
13.31
17.57
14.64
19.33
Bookkeeper
12.00
15.84
13.20
17.42
14.52
19.17
15.97
21.08
Call Center Representative
11.00
14-52
12.10
15.97
13.31
17.57
14.64
19-31
Cashier
9.00
11.88
9.90
13,07
10,89
14
11
15.81
Office Assistant
9.50
12.54
10.54
13.79
11.50
15.17
12.64
16.69
Recreation Service Assistant
9.50
12.54
10.54
13.79
11.50
Temporary Election Worker
9.00
11.88
9.90
13.07
10.89
14.37
11.98
15.81
Trades Positions
Hourly
Wage
Bill
Rate
Hourly
Wage
Bill
Rate
Hourly
Wage
Bill
Rate
Hourly
Wage
Bill
Rate
Building Maint. Worker
10.00
13.40
11.00
14.74
12.10
16.21
13.31
17.84
Construction & Maint. Worker
10.25
13.74
11.28
15.11
12.40
16.62
13.64
18.28
Custodian
8.50
11.39
9.35
12.53
10.29
13.78
11.31
15.16
Electronics Technician
12.25
16.42
13.48
18.06
14.82
19.86
16.30
21.85
Equipment Operator
12.00
16.08
13.20
17.69
14.52
19.46
15.97
21.40
Grounds Maintenance Worker
9.00
12.06
9.90
13.27
10.89
14.59
11.98
16.05
Heavy Equipment Operator
12.10
16.21
13.31
17.84
14.64
19.62
16.11
21.58
Irrigation Technician
11.50
15.41
12.65
16.95
13.92
18.65
15.31
20.51
Laborer
8.50
11.39
9.35
12.53
10.29
13.78
11.31
15.16
Laborer(Abernathy Landfill
9.25
12.40
10.18
13.63
11.19
15.00
12.31
16.50
Recycling Attendant
11.50
15.41
12.65
16.95
13.92
18.65
15.31
20.51
Warehouse Maintenance Worker
8,75
11.73
9.63
12.90
10.5.9
14.19
11.65
15.61
Medical Positions
Hourly
Wage
Bill Rate
Hourly
Wage
Bill Rate
Hourly
Wage
Bill Rate
Hourly
Wage
Bill Rate
Licensed Vocational Nurse
18.00
24.12
19.80
26.53
21.78
29.19
23.96
32.10
Registered Nurse
Level 1 - minimum required experience Level 3 - three to five additional years of experience
Level 2 - one to three additional years of experience Level 4 - five or more additional years of experience
Best and Final Offer
City of Lubbock, TX
Temporary Employment Services
RFP 17-13294-SS
Proposal Submittal Form Overtime Rate Sheet
EXHIBIT C Part 2
The undersigned hereby offers to furnish and deliver the articles or services as specified herein and in their
proposal and proposed service agreement (attached) at the terms stated therein and in strict accordance with
the specifications, all of which are made a part of this offer.
Maximum number of days from signing of service agreement to inception: This proposal is valid for
ninety(90) days.
TEMPORARY AGENCY HOURLY OVERTIME RATE SHEET
Level 1 2 3 4
Professional Positions
Hourly
Wage
Bill
Rate
Hourly
Wage
Bill
Rate
Hourly
Wage
Bill
Rate
Hourly
Wage
Bill
Rate
Accountant
29.35.982.1
9.5
35.
53
3
GIS/CAD Technician
21.75
26.75
23.93
29.43
26.32
32.37
28.95
35.61
End User Support Tech
22.88
28.14
25.16
30.95
27.68
34.04
30.45
37.45
Clerical Positions
Hourly
Wage
Bill
Rate
Hourly
Wage
Bill
Rate
Hourly
Wage
Bill
Rate
Hourly
Wage
Bill
Rate
Account Clerk
15.23
18.73
16.75
20.60
18.42
22.66
20.26
24.93
Administrative Assistant
16.50
20.30
18.15
22.32
19.
24.56
21.96
27.01
Bookkeeper
18.00
22.14
19.80
24.35
21.78
26.7
223.96
29.47
Call Center Representative
16.50
20.30
18.15
22.32
19.97
24.56
21.96
27.01
Cashier
13.50
16.61
14.85
18.27
16.34
20.09
17.97
22.10
Office Assistant
14.25
17.53
15.68
19.28
17.24
21.21
18.97
23.33
Recreation Service Assistant
14,25
17.53
15.68
19.28
17.24
21.21
18.97
23.33
Temporary Election Worker
13.50
16.61
14.85
18.27
16.34
20.09
17.97
22.10
Trades Positions
Hourly
Wage
Bill
Rate
Hourly
Wage
Bill
Rate
Hourly
Wage
Bill
Rate
Hourly
Wage
Bill
Rate
BuildingMaint. Worker
15.00
18.45
16.50
20.30
18.15
22.32
19.97
24.56
Construction & Maint. Worker
15.38
18.91
16.91
20.80
18.60
22.88
20.46
25.17
Custodian
Electronics Technician
30.08
Equipment Operator
Grounds Maintenance Worker
13.50
16.61
14.85
18.27
16.34
20.09
17.97
22.10
Heavy Equipment Operator
18.15
22.32
19.97
24.56
21.96
27.01
24.16
29.71
Irrigation Technician
17.25
21.22
18.98
23.34
20.87
25.67
22.96
28.24
Laborer
12.75
15.68
14.03
17.25
15.43
18.98
16.97
20.87
Laborer (Abernathy Landfill)
13.88
17.07
15.26
18.77
16.79
20.65
18.47
22.72
Recycling Attendant
17,25
21.22
18.98
23,34
20.87
2
24
Warehouse Maintenance Worker
13.13
16.14
14.44
17.76
15.88
19.53
17.47
21.49
Medical Positions
Hourly
Wage
Bill Rate
Hourly
Wage
Bill Rate
Hourly
Wage
Bill Rate
Hourly
Wage
Bill Rate
Licensed Vocational Nurse
27.00
1 33.21
29.70
36.53
1 32.67
40.18
35.94
44.20
Registered Nurse
37.50
1 46.13
41.25
50.74
1 45.38
55.81
49.91
61.39
Level 1 - minimum required experience Level 3 - three to five additional years of experience
Level 2 - one to three additional years of experience Level 4 - five or more additional years of experience
It
fl
Exhibit D
Texas Premier Staffing Source, Inc.
4640 Forbes Blvd., Suite 200A, Lanham, MD 20706
301-306-0774
Fax: 301-306-0775
Web Address: www.premierstaf tnasource.com
June 9, 2017
Honorable Mayor of the City of Lubbock and
City Council
City of Lubbock
1625 13th Street, Room 204
Lubbock,Texas 79401
Re: RFP 17-13294-SS, Temporary Employment Services
Dear Mayor and Council Members:
n Texas Premier Staffing Source, Inc. (PSS, Inc.) is pleased to offer its solution to the City of
I Lubbock's (City) need for temporary employment services under the above referenced RFP.
PSS, Inc. is a staffing firm specializing in the placement of temporary professionals to feder-
al, state, and local government as well as private companies. The company has a track
I record of over 15 years in providing similar services and is pleased to offer its solution un-
der the attached proposal. For the past three (3) years, PSS, Inc. teas delivered services to
the City under the incumbent contract. The company has the infrastructure, personnel re-
sources, experience and knowledge to successfully meet the requirements of this RFP.
PSS, Inc.'s service solution to the City's staffing needs ensures the timely placement of
qualified, pre-screened employees who meet the requirements of each task request. PSS,
Inc. assigns a dedicated customer service team (CST) to each project which is led by a sea-
soned Account Manager who is the City's liaison. PSS, Inc.'s approach includes identifying
(� a dedicated pool of PSS, Inc. Associates for the City. As a matter of practice, PSS, Inc. re-
quires eligible Associates selected for this exclusive pool to successfully satisfy all testing,
screening and background checks to qualify. This includes drug screening, telephone refer-
ence checks, and criminal history checks.
Please note this proposal is predicated upon all terms and conditions of the subject RFP 17-
13294-SS along with its Questions and Answers. PSS, Inc. agrees to the terms and condi-
tions of the RFP and will enter into a contract containing such terms and conditions if select-
ed as the consultant. Myrna Cooks is the only individual authorized to negotiate services
and costs with the City and the only individual to bind PSS, Inc. to a contract. I am located
at 4640 Forbes Boulevard, Suite 200A, Lanham, MD 20706 and may be reached at 301-
306-0774, fax number 1-866-723-1338 or email mcooks()-premierstaffingsource.com.
Sinter ly,
Myma Cooks
President/CEO
j�
11
AFN*0
d
City of Lubbock, TX
Response to RFP 17-13294-SS, Temporary Employment Services
6.1.1 Describe the testing procedures used to determine skills and physical
n abilities of workers. (CONFIDENTIAL AND PROPRIETAR1)
j As part of PSS, Inc.'s five -point recruitment, selection and placement process, PSS, Inc.
n verifies the skills and qualifications of candidates for employment in two or more ways:
I work references, skills assessment and educational verification. PSS, Inc. has part-
nered with IKM and Provelt! to provide pre -hire testing of PSS, Inc.'s candidates. Test-
ing is conducted in an on-line proctored environment to ensure the security and reliabil-
ity of each test. IKM and Provelt! assessments measure technical and non -technical
areas of knowledge, skill, aptitude and attitude. IKM and Provelt! use adaptive testing
�j to ensure each candidate is offered a test that adapts to their level of proficiency. Under
11 �� an adaptive testing model, the question and difficulty level is dynamically selected by
the tool based on the responses of the test taker. These combined nine (9) points of
difficulty inherent in each test allows the application to accurately identify the most ap-
propriate question within sub -skills of the assessment. This provides a more tailored
and thorough assessment. The sub -skills within each test are independently analyzed
�j which allows PSS, Inc.'s Recruiters to use the results to more accurately determine the
�� tt skills level of the candidate and make the best job order match using the results.
Currently, IKM offers assessments in the following areas:
Information technology Enterprise Resource Planning
Accounting MS Office
Basic Computer Skills Attitude/Aptitude
Medical and Healthcare Call Center
Administrative Staffing industry
Provelt! offers assessments in the following areas:
Accounting Health Care
Call Center Industrial
Financial Legal
MS Office Office/Professional
Where necessary, PSS, Inc. combines assessments and/or tailors them to create a cus-
tomized assessment to satisfy customer requirements. Using these assessments along
with PSS, Inc.'s reference checks, background screening and interview process, PSS,
Inc. is able to select the right candidate for each task order. PSS, Inc. makes available
n to the City the assessment results of candidates. Figure 1 is a sample candidate as-
sessment analysis PSS, Inc. can provide to the City. The analysis clearly indicates are-
as of strength and how the employee compared to others in the IKM database. This is
n an international measurement as IKM provides services nationally and abroad.
n
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9
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1
City of Lubbock, TX
Response to RFP 17-13294-SS, Temporary Employment Services
Figure 1: Sample Candidate Assessment Analysis
PROFICIENCY PROFILE Knovgvdgn
hlne Sur v,r u,,,
Aseessment Result fora Tiffanymm BiringhaID: 8163722807 Date, 10/02/2008
Subject, MICROSOFT WORD 2007 - Re—Pbe Client, IMRG Inc.
This assessment was self administered and nottake i under supervised conditions.
Score: 51 40 60
Percentile: 120io w
73
Profltlent ,SO-79 20 eo 1
:A6a0e Average
'a
SO
u 10u
51
Tiffany has achieved an overall score of 51 across all sub -skills
Tiffany has scored higher than 12% of all test
in this subjeti
takers in this subject.
Subject Analysis:
Sub -Shill. �Peollei�st
Document Customization and Change Tracking .
Ribbons and Other Applications .
Configuring MS .. erd 2007 —
Document Edit end Search
Using Tables —
Mail Merge and Specialized Documents —
Character and Paragraph Formatting
Clip Art, Word Art and Charts
Meader, Footer, Footnote, Endnote and Electrons, Signature
Document Printing and Security
Templates, Page and Section Brooks
Document Appearance and Formatting l
Lists and Graphics
Text Translation and Equation Editor
Autoformatting and Outlining, I
Macros and Table of Contents
Work Speed/Accuracy: *
Subject Coverage: 500/b
y
Average t aV. a
I Profld
Tiff any has demonstrated exceptional speed while maintaining accuracy and
should be considered for time critical projects.
Application Ability:
Mimi M;. r
. A6
Tiffany has demonstrated an average ability to apply h,s,iher knowledge to
Tiffany has dam onstrated a praf,uent a strong
practical applications.
levol of kric,=d ge Vn 509b of the subject matte..
* This test is in field testing until adequate statistics are available. During this process, the percentiles reported will reflect average percentiles
across all tests In the IKM library.
I a aaner are designed tomeasure overall proficiency ,n a subject and depth afknowledge in specific sub -topics. This score report does not
pr_, aa criterion -referenced interpretation, pass/fail score or standard of performance. Please note %hottest results, In isolation, are not pure
prodsrtnrs of success in employment or any given role. Other Indicators, such as prior aeperience, references and interviews, should be considered
prior to any employment or business decisions.
Copyright ® 1999-2008 TeckChak. Inc., All rights reserved.
PSS, Inc. has partnered with NurseCompetency to provide pre -hire testing of PSS, Inc.
candidates for nursing labor categories. NurseCompetency offers 152 current, clinically
relevant, valid, reliable clinical and nursing tests based on its six -step content validation
process.
City of Lubbock, TX
Response to RFP 17-13294-SS, Temporary Employment Services
Candidates must successfully pass the competency tests for their respective clinical ar-
ea(s). Failure to meet test requirements prevents an application from being placed.
The structure of the NurseCompetency application prevents placement as it flags can-
didates with missing information, failed test scores, etc.
Figure 2: Content Validation Process
Content Validation Process
Table 1: Clinical Competency Exams
Acute Rehabilitation Nurse Exam
Home Health Nurse Exam
Pediatric Pharmacology Exam
Cardiac Catheterization Lab
Infusion Nurses Exam
Perioperative Nurse Exam
Nursing Exam
Labor and Delivery Nurse Exam
Pharmacology Exam - Correc-
Cardiac Rhythm Identification
Long -Term Care Nurse Exam
tions RN
Competency Exam
LPN Competency Exam
Pharmacology Exam - LPN
Cardiovascular Technologist
Mammography Technologist Ex-
Pharmacology Exam - LTC LPN
Competency Exam
am
Pharmacology Exam - LTC RN
Care of Clients with Dementia -
Mechanical Ventilation - Adult
Pharmacology Test - RN
Non -Licensed Exam
Competency Exam
Pharmacy Technician - Hospital
Care of Clients with Dementia -
Mechanical Ventilation - NICU
Competency Exam
Nursing Exam
Competency Exam
Pharmacy Technician - Retail
Care of Patient with Diabetes
Mechanical Ventilation - PICU
Competency Exam
Competency Exam
Competency Exam
Phlebotomist Competency Exam
3
fl
City of Lubbock, TX
Response to RFP 17-13294-SS, Temporary Employment Services
Care of the Patient with Stroke
Medical Assistant Competency
Physical Therapist Competency
Exam
Exam
Exam
Case Manager Competency Ex-
Medical Biller - Inpatient Compe-
Physical Therapy Assistant
am
tency Exam
Competency Exam
Certified Medication Aide Com-
Medical Biller - Outpatient Com-
PICU Nurse Exam
petency Exam
petency Exam
Postpartum Competency Exam
CNA - LTC Competency Exam
Medical Coder - Inpatient Com-
Psychiatric Nurse Exam
CNA Competency Exam
petency Exam
Psychiatric Technician Compe-
Corrections Nursing Exam
Medical Coder - Outpatient
tency Exam
COTA Competency Exam
Competency Exam
Radiology Technologist Exam
Critical Care Nurses Exam
Medical Terminology for Allied
Respiratory Therapist Compe-
CT Technologist Competency
Health Exam
tency Exam
Exam
Medical Terminology for Medical
RN First Assist Competency Ex-
CVICU Nursing Exam
Coders Exam
am
Dental Assistant Competency
Medical -Surgical Nurse Exam
School Nurse Exam
Exam
Mother -Baby Competency Exam
Sonography Technologist Exam
Dialysis Nurse Exam
MRI Technologist Exam
Speech Language Pathologist
Dialysis Technician Competency
NICU Nurse Test
Competency Exam
Exam
Nuclear Medicine Technologist
Sterilization Technician Compe-
EEG Technologist Competency
Exam
tency Exam
Exam
Nursery Competency Exam
Surgical Technologist Compe-
Emergency Nursing Exam
Occupational Therapist Compe-
tency Exam
Endoscopy Nursing Test
tency Exam
Telemetry Nurse Exam
Fetal Monitoring Competency
Oncology Nursing Exam
Vascular Sonography Compe-
Exam
PACU Nurse Exam
tency Exam
Histotechnologist Competency
Palliative Care Nurses Exam
Exam
Pediatric Nursing Exam
Home Health Aide Competency
Exam
Table 2: Core Competency Exams
Advance Directives Competency
Core Competency Exam - Non-
Drug -Impaired Healthcare Work -
Exam
Licensed
ers Exam
Age -Related Competency Exam
Core Competency Exam - Nurs-
Elder Abuse Competency Exam
Blood Glucose Monitoring Com-
ing
Emergency Preparedness Com-
petency Exam
Cultural Competency Exam
petency Exam
Child Abuse and Neglect Com-
Discharge Planning Competency
End -of -Life Care Competency
petency Exam
Exam
Exam
Conscious Sedation Competen-
Documentation and Risk Man-
Facility Safety Competency Ex-
cy Exam
agement Competency Exam
am
Core Competency Exam - Allied
Malignant Hyperthermia Compe-
Fire Safety Competency Exam
HIPAA Competency Exam
tency Exam
Restraints and Seclusion Com-
Infant Abduction Competency
Medication Error Prevention
petency Exam
Exam
Competency Exam
Sexual Harassment Competen-
Intimate Partner Violence Com-
Musculoskeletal Injury Preven-
cy Exam
petency Exam
tion Exam
Tuberculosis Competency Exam
Joint Commission NPSG Com-
Organ and Tissue Donation
Universal Precautions Compe-
petency Exam
Competency Exam
tency Exam
Latex Sensitivity and Allergy
Pain Management Competency
Workplace Violence Competen-
Competency Exam
Exam
cy Exam
Patient Care Partnership Com-
petency Exam
4
d T
City of Lubbock, TX
Response to RFP 17-13294-SS, Temporary Employment Services
The NurseCompetency team is comprised of clinical educators, registered nurses, busi-
ness professionals, and Microsoft .NET/SQL developers. The company's clinical subject
matter experts (SMEs) come from a range of backgrounds, including clinicians from
some of the nation's top healthcare systems, item writers for the National Council Licen-
n sure Examination (NCLEX), nursing and allied health care professors, and authors of
(I some of the most respected clinical textbooks.
For trade positions, PSS, Inc. requires a copy of a physical examination that is complet-
ed within thirty (30) days prior to the placement date or an exam that was previously
conducted within six (6) months of the placement date.
!I
a City of Lubbock, TX
Response to RFP 17-13294-SS, Temporary Employment Services
6.1.2 Methodology used to supply qualified personnel after notification of need
(criminal history checks through the Texas Department of Public Safety, drug
testing, etc.). (CONFIDENTIAL AND PROPRIETAR)g
Once PSS, Inc. receives a request from the City's designated representative, the order
is reviewed by the assigned Account Manager. Any questions regarding the order are
addressed with the ordering individual. The assigned Recruiter searches PSS, Inc.'s
n applicant database using the skHts, experience, and other job requirements to determine
I the best Associate for the order. The Associate's qualifications and background are
presented to the City's designated representative for approval and placement. With
n highly technical or special skill task order requests, the company's goal is to submit a
1 I minimum of two Associates for consideration. PSS, Inc. ensures all task orders are
n processed within the required timeframe by the City's designated representatives.
1 PSS, Inc. employs a tailored recruiting approach to meet the recruitment requirements
of its customers. PSS, Inc.'s approach is designed to attract and retain key staff in or-
der to ensure that customers experience little disruption to their operations due to staff
turnover. Under this effort, PSS, Inc.'s approach to recruiting for candidates is com-
prised of six key elements:
• Development of a tailored staffing plan based focused on proactive recruitment
using historical data, trends, and customer input,
• Assignment of dedicated recruiters tasked to ascertain the personnel resource
+ needs of each ordering department,
A • Development of a database of personnel, with the requisite qualifications and ex-
perience to meet the needs of each ordering department,
• Utilization of incentives such as salary, bonus and fringe benefits to attract and
retain qualified personnel,
• Utilization of several recruiting sources, including referrals, media advertise-
ments, job fairs, subcontractor assistance, and trade journals to attract the per-
sonnel with the appropriate skills and experience to successfully fulfill task order
requirements, and
Training, assessment, and development programs to appropriately place the cor-
rect Associate with the correct assignment and ensure skill development.
PSS, Inc. utilizes an HRIS specific to the staffing industry which supports the company's
aggressive recruiting approach. PSS, Inc.'s recruiting approach is based on an ability to
compete for the best candidates using technology and tools attractive to candidates in
i the industry. PSS, Inc.'s HRIS application, Bullhorn, includes an applicant portal which
allows PSS, Inc.'s candidates to apply on-line and manage their application process in
an efficient and expeditious manner. Candidates are able to complete their application,
submit their resume and appropriate certifications, as well as complete the required as-
sessment testing through the portal. Once an application posts, a notification is imme-
diately sent. -��
�tuFfr�e
City of Lubbock, TX
"•.,,,,.' Response to RFP 17-13294-SS, Temporary Employment Services
PSS, Inc. has the ability and proven experience to fill requests as required under this
RFP. PSS, Inc.'s specific process for placing candidates is based on our registered
I trademarked process IQRO- This process comprises three key components:
• Identification of the critical assignment components,
• Qualification of all relevant tasks and quantifying the length of the assignment,
number of Associates required and specific technical skills necessary and
n • Resolution of the assignment through completion.
PSS, Inc. employs the following five -step matching process which is intrinsic to PSS,
Inc.'s recruiting and hiring program and ensures that gap assessments are initiated and
evaluated at each step. This ensures each candidate has been fully screened. These
steps include:
• Pre-screen - PSS, Inc.'s Recruiters begin the dialogue with a pre-screening of the
applicant over the telephone. This is an in-depth screening to solicit experience,
technical skills and work preference.
• Interview — PSS, Inc. utilizes the interview process to close the gaps and to begin
the assessment of skills, integrity, and work ethics of the candidate.
• Skills Assessment - PSS, Inc.'s skills assessments are based on the qualifications
and profession of the individuals. They include writing samples and an evaluation of
technical skills. PSS, Inc. employs computer -based testing for some skills and oth-
ers are assessed by PSS, Inc.'s technical staff. As this is a critical component to
I PSS, Inc.'s selection criteria, the bulk of a candidate's interview is spent in this area.
11
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Reference and Background Checks - All successful candidates are thoroughly
reference checked prior to joining PSS, Inc.'s firm. PSS, Inc.'s policy is to secure a
minimum of two (2) business references. The company uses National Background
Investigations, Inc. (NBI) and HireRight to conduct employment background screen-
ing which includes employment verification and criminal checks. Additional back-
ground checks such as credit, sexual offender registry and motor vehicle records
checks are performed upon request. These checks are also conducted by NBI and
HireRight on PSS, Inc.'s behalf. For this contract, PSS, Inc. will utilize HireRight. As
required by the City, PSS, Inc. incorporates a criminal history check through the
Texas Department of Public Safety. See Figure 2—NBI Applicant Release and Au-
thorization Form below as well as Attachment 1—Sample HireRight Consent Form,
and Attachment 2—PSS, Inc. Consent to Background Check Form.
7
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a City of Lubbock, TX
IN
Response to RFP 17-13294-SS, Temporary Employment Services
Figure 2—Applicant Release and Authorization Form
NATIONAL BACKGROUND INVESTIGATIONS, INC.
P.O. Box 966, Stevensville, MD 21666 PHONE:
410-604-2430, FAX: &10-604-2496
APPLICANT RELEASE AND AUTHORIZATION FORM-GW
I herby authorise (INTEGRATED MANAGEMENT RESOURCES GROUP or aultwrzed
representatives of the company beanng this release to obtain and release any nfonnatan
pertaining to my background, mducis►g any of the serv%ces noted below, for employment
purposes or volunteer stairs. I hereby fully release and discharge my prospective employer or
other source providog information from all clams and damages arising out of or relating to any
investigation of my background for said purposes PLEASE PROVIDE MINNUM 7 YEARS
RESIDENTIAL HISTORY.
Name:
(Fist, Mzdle, Last -Print Clearly) Date of B+rth: _
Driver's Lic. No.:
State Zip Code Signature:
(1) Current Addr.
County:
(2) Previous Addr.
County:
DabeslFrwn:
Da% -(from:
AliawUther.
CityiState:
To:
City/State:
To:
(3) Prerous Addr. CitylSt3te:
County: DatesTrom: To:
Wknessed by. Date- _
Social Sec. No.:
IMPORTANT: FOR CLIENT USE ONLY -Mark an "X" for any of the following:
Would you like NBI to also check ApaslOther name given?: Yes No lae
advised there Is an additional charge per alas narne)
CRIMINAL HISTORY RECORD SEARCH:
(1)ChrrentAddrea (2)Previous Addre66 O3 Previou6Address
Social Sw Number Trace Federal Criminal
VVR Drtving Record Cre(lt
Profile sexual OftBnder ReglatT List Siam:
Wayland
fStatewlde)
AID Traft Courl MD Want&Warrmts
_ MD RegdTag Matewlde
Cnrninal Search
Delaware: _ FiWda _ Georgia
Kentucky New Jersey
New Yorlk
North Carolina Pennsylvanla _ Gouth
Carmna Venncatlons ispecliy 8 W
Items) Education
Prot. License Errployrnent
Federal Ctvll CIMI judgment:
Upper Court
Lower Court Wasters Comp
Federal Tax Jen search hate
Tax Lien
Baniwupwy :,earth Other.
9
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City of Lubbock, TX
�'•.,,,,:' Response to RFP 17-13294-SS, Temporary Employment Services
• Drug Screening — Many of PSS, Inc.'s contracts require drug screening. To ensure
strict compliance, PSS, Inc. has documented procedures to ensure each employee
understands this requirement and the ramifications of failing a drug screen. PSS,
Inc. is contracted with AMC, a national drug screening service provider. AMC
standard contract requirements for PSS, Inc. include a 9-panel drug screen to iden-
tify any detection of Cocaine (COC), Amphetamine (AMP), Tetrahydrocannabinol
(THC), Methadone (MTD), Opiates (OPI), Phencyclidine (PCP), Barbiturates (BAR),
Benzodiazepines (BZD) and Propoxyphene. Employees under certain job specifica-
tions prior to placement under these contracts will have successfully completed this
screening.
Figure 3—LabCorp Collection Authorization Form
-�_�hr.•;;^t:.'ttit(nt1lirnl.;rl.:Tl"r�
Donor.- Pleaas prewar aVi audtori;adon foray m the colleeaon tiro tgpon arris-sL
IAWORP UMB COC
COLLECTION AUMOR17—knON FORM
ATTN COLLECTOR This donor is not pro -registered
Please no the information below to create a registration tag Web COC,
LabCorp Account #:253243
Premier Staffing Source, Inc.
4W Forbes Blvd. Ste 200A
Lanham. MD 20706
Test to be performed at lab: ®- 9 Panel (Profile 3)
Reuoa:
® Pre-H icl m=
D Random
❑ RaesonableCws-
I] Past-Acridew
LabCorp PSC Site Location
1'1oufs: " - 9 3u-9.3tr- :)R-G SC4ffti 9. MA-1Z 30- 2:33- 33- ---%C- 1 1143:7J-
COLLECTOR-
For Technical acsinamm please contact OT ST nhSuunort dlabc or p.c om
800-833-3994 Ext. _ 330
Ifsonhave any otherQeectiona, please contact.WC Drag Testing Customer
Service: 1-800-339-9993 k:0111-F 8:00 am-Spm CST
The above process is designed to culminate in a five -point matching plan to screen and
select the best candidate for the position. The critical components of which are experi-
ence, skills, demeanor, and professionalism. The City is assured each assigned Asso-
ciate has been through an extensive review process by PSS, Inc. This directly contrib-
utes to the high quality of PSS, Inc. contingent personnel. PSS, Inc. screening does not
stop with the hiring of an individual. Each Associate's skill sets are routinely reviewed
0
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City of Lubbock, TX
Response to RFP 17-13294-SS, Temporary Employment Services
throughout his or her tenure with PSS, Inc. to ensure skill levels remain current. PSS,
Inc. primarily employs professional individuals. Many of the skills sought require spe-
cialized testing to ensure levels of education and experience is resident with an appli-
cant. These include online and CD -based software programs that provide advanced
technical testing options.
As a best practice, PSS, Inc. maintains an ongoing recruitment program for PSS, Inc.'s
contracts. The company developed project -specific databases in PSS, Inc.'s HRIS,
Bullhorn, based on the labor category and skill requirements of a contract. This practice
has served PSS, Inc. well in dynamic, task order environments such as PSS, Inc.'s con-
tracts with University of Illinois at Chicago, Commonwealth of Virginia, City of Baltimore,
County of Baltimore, Dallas Independent School Systems, City of Detroit, City of Talla-
hassee, Metropolitan Washington Airports Authority, and state of Delaware.
PSS, Inc. maintains a database in Bullhorn of over 30,000 individuals with whom PSS,
Inc. recruiting team maintains regular contact to ensure that PSS, Inc.'s candidate
source remains current. Bullhorn allows the selection of candidates based on keyword
searches. This assists the Recruiters with identifying candidates with the exact skill
match required and reduces the turn -around time when filling supplemental positions.
PSS, Inc. has the management resources, experience and track record to effectively
partner with the City on this effort.
10
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CONSUMER DISCLOSURE AND AUTHORIZATION FORM
Disclosure Regarding Background Investigation
Premier Staffing Source Inc (the "Company") may request, for lawful employment purposes,
background information about you from a consumer repotting agency in connection with your
employment or application for employment (including independent contractor assignments, as
applicable). This background information may be obtained in the form of consumer reports and/or
investigative consumer reports (commonly known as "background reports"). These background reports
may be obtained at any time after receipt of your authorization and, if you are hired or engaged by the
Company, throughout your employment or your contract period
HireRight, Inc., or another consumer reporting agency, will prepare or assemble the background reports
for the Company. HireRight, Inc. is located and can be contacted by mail at 5151 California, Irvine, CA
92617, and HireRight can be contacted by phone at (800) 400-2761. Information about HireRighes
privacy practices is available at www.hireright.com/Privacy-Policy.aspz.
The background report may contain information concerning your character, general reputation, personal
characteristics, mode of living, and credit standing. The types of information that may be obtained
include, but are not limited to: social security number verifications; address history; credit reports and
history; criminal records and history; public court records; driving records; accident history; worker's
compensation claims; bankruptcy filings; educational history verifications (e.g., dates of attendance,
degrees obtained); employment history verifications (e.g., dates of employment, salary information,
reasons for termination, etc.); personal and professional references checks; professional licensing and
certification checks; drug/alcohol testing results, and drug/alcohol history in violation of law and/or
company policy; and other information bearing on your character, general reputation, personal
characteristics, mode of living and credit standing.
This information may be obtained from private and public record sources, including, as appropriate:
government agencies and courthouses; educational institutions; former employers; personal interviews
with sources such as neighbors, friends and associates; and other information sources. If the Company
should obtain information bearing on your credit worthiness, credit standing or credit capacity for
reasons other than as required by law, then the Company will use such credit information to evaluate
whether you would present an unacceptable risk of theft or other dishonest behavior in the job for
which you are being evaluated.
You may request more information about the nature and scope of any investigative consumer reports by
contacting the Company. A summary of your rights under the Fair Credit Reporting Act is also being
provided to you.
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Additional State Law Notices
If you are a California. Maine, Massachusetts, New York or Washington State applicant, employee or contractor,
please also note:
CALIFORNIA: Pursuant to section 1786.22 of the California Civil Code, you may view the file
maintained on you by HireRight during normal business hours. You may also obtain a copy of this
file, upon submitting proper identification and paying the costs of duplication services, by appearing
at HireRight's offices in person, during normal business hours and on reasonable notice, or by
certified mail. You may also receive a summary of the file by telephone, upon submitting proper
identification and written request HireRight has trained personnel available to explain your. file to
you, including any coded information, and will provide a written explanation of any coded
information contained in your file. If you appear in person, you may be accompanied by one other
person, provided that person furnishes proper identification. "Proper identification" includes
documents such as a valid driver's license, social security account number, military identification
card, and credit cards. If you cannot identify yourself with such information, HireRight may require
additional information concerning your employment and personal or family history to verify your
identity.
MAINE: You have the right, upon request, to be informed of whether an investigative consumer
report was requested, and if one was requested, the name and address of the consumer reporting
agency furnishing the report. You may request and receive from the Company, within five business
days of our receipt of your request, the name, address and telcphone number of the nearest unit
designated to handle inquiries for the consumer reporting agency issuing an investigative consumer
report concerning you. You also have the right, under Maine law, to request and promptly receive
from all such agencies copies of any such reports.
MASSACHUSEITS: If we request an investigative consumer report, you have the right, upon
written request, to a copy of the report -
NEW YORK: You have the right, upon written request, to be informed of whether or not an
investigative consumer report was requested. If an investigative consumer report is requested, you
will be provided with the name and address of the consumer reporting agency finishing the report_
You may inspect and receive a copy of the report by contacting that agency. Please click here for
additional information about New York law, as applicable.
WASHINGTON STATE: If the Company requests an investigative consumer report, you have the
right, upon written request made within a reasonable period of time after your receipt of this
disclosure, to receive from the Company a complete and accurate disclosure of the nature and scope
of the investigation requested by the Company. You also have the right to request from the consumer
reporting agency a written summary of your rights and remedies under the Washington Fair Credit
Reporting Act.
n
qAuthorization of Background Investigation
I bave carefully read and understand this Disclosure and Authorization form and the attached summary
of rights under the Fair Credit Reporting Act. By my signature below, I consent to preparation of
background reports by a consumer reporting agency such as HireRight, Inc., and to the release of such
background reports to the Company and its designated representatives and agents, for the purpose of
assisting the Company in making a determination as to my eligibility for employment (including
independent contractor assignments, as applicable), promotion, retention or for other lawful
(� employment purposes. I understand that if the Company hires me or contracts for my services, my
} I consent will apply, and the Company may obtain background reports, throughout my employment or
contract period.
I understand that information contained in my employment or contractor application, or otherwise
disclosed by me before or during my employment or contract assignment, if any, may be used for the
il
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purpose of obtaining and evaluating background reports on me. I also understand that nothing herein
shall be construed as an offer of employment or contract for services.
I hereby authorize law enforcement agencies, learning institutions (including public and private schools
and universities), information service bureaus, credit bureaus, record/data repositories, courts (federal,
state and local), motor vehicle records agencies, my past or present employers, the military, and other
individuals and sources to furnish any and all information on me that is requested by the consumer
reporting agency.
By my signature below, I also certify the information I provided on and in connection with this form is
true, accurate and complete. I agree that this form in original, fazed, photocopied or electronic
(including electronically signed) form, will be valid for any background reports that may be requested
by or on behalf of the Company.
Applicant Last Name "M First Middle
Applicant Signature Date 10/1012012
Electronic Signature
Email:
SSN: ANNININNOr
IP Address: �
Dated: 10 10, 2012: 12:45 Pacific Standard Time
���gtAFF/p�do
' I DISCLOSURE OF INTENTION TO REQUEST CONSUMER REPORT AND/OR
INVESTGATIVE CONSUMER REPORT
ON YOUR BACKGROUND
In considering your eligibility for employment, Premier Staffing Source intends to procure a
consumer report from a consumer reporting agency, seeking information about you that bears
i upon your credit worthiness, personal characteristics or mode of living. The consumer report
may also contain information from the Department of Motor Vehicle Records and criminal
records. Premier Staffing Source intends to use the information contained in the consumer
F report to make a decision regarding your potential or continued employment with the Company.
1� Your written authorization is required before Premier Staffing Source may obtain a consumer
I report providing information about you. Please sign and return to the Company the attached
authorization. If you wish to receive a copy of the consumer report that Premier Staffing
!� Source will purchase from the designated consumer reporting agency, please check the
I appropriate box on the authorization form. Premier Staffing Source will send you a copy of
the report at no charge to you.
If Premier Staffing Source procures or causes an investigative consumer report to be
prepared, you have the right to request in writing, within a reasonable period of time after
you receive this disclosure, a complete and accurate written disclosure of the nature and
scope of the investigation requested.
If you do not fill out and return the attached authorization form to Premier Staffing Source by
we will assume that you no longer wish to pursue or to continue your
employment with Premier Staffing Source.
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FFOP
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q
Authorization to Obtain a Consumer Report and/or Investigative Consumer Report
(Release ojlnjormation jor Employment Purposes)
I understand that in connection with my application for employment or, in connection with my
continued employment, PSSTM intends to procure one or more consumer reports and/or
investigative consumer report from a consumer reporting agency, seeking information bearing on
n my credit worthiness, personal characteristics, mode of living, Department of Motor Vehicle
Records and criminal records.
By signing below, I, , hereby voluntarily authorize
PSSTm to conduct a comprehensive review of my background through a consumer report and/or
an investigative consumer report for employment, promotion, reassignment or retention as an
�1 employee. I understand the extent of this report(s) may include but is not limited to: verification
1 of Social Security number; request of information from public and private sources which
maintain records concerning my past activities relating to my motor vehicle records, birth
records, credit history, criminal history, civil matters, employment history, including all
personnel files, specifically my last Performance Evaluation, educational background;
references and other past experiences. I acknowledge that a facsimile or photocopy of this
authorization be as valid as the original.
I hereby release PSSTm and its agents, officials, representatives or assigned agencies, both
individually and collectively, from any and all liability for damages of whatever kind, which may
at any time result to me.
I understand that, pursuant to the federal Fair Credit Reporting Act, if any adverse action is to be
taken based upon the consumer report, a copy of the report will be provided to me.
IFull Name:
Address:
Social Security No.:
Signature:
Date:
Enclosures: Summary of Rights under the Federal Fair Credit Reporting Act
❑ 1 would like to receive a copy of the consumer report at no cost to me.
49 03/06 2•
�114% %SAFf1#,.del
Q• T
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E
`11/1� 1
nA SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT
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The federal Fair Credit Reporting Act (FCRA) is designed to promote accuracy, fairness, and privacy of
information in the files of every "consumer reporting agency" (CRA). Most CRAs are credit bureaus that
gather and sell information about you — such as if you pay your bills on time or have filed bankruptcy — to
creditors, employers, landlords, and other businesses. You can find the complete text of the FCRA, 15
U.S.C. 1681-1681u, at the Federal Trade Commission's web site (http://www.ftc.gov). The FCRA gives
you specific rights, as outlined below. You may contact the Federal Trade Commission at CRC-240, 600
Pennsylvania Avenue, N.W., Washington D.C., 20580 or at (202) FTC -HELP (202-382-4357) for
additional information. You may have additional rights under state law. You may contact a state or local
consumer protection agency or a state attorney general to learn those rights.
You must be told if information in your file has been used against you. Anyone who uses information
from a CRA to take action against you — such as denying an application for credit, insurance, or
employment — must tell you, and give you the name, address, and phone number of the CRA that
provided the consumer report.
You can find out what is in your file. At your request, a CRA must provide you with the information in
your file, and a list of everyone who has requested it recently. There is no charge for the consumer report
if a person has taken action against you because of information supplied by the CRA and you request the
consumer report within sixty (60) days of receiving notice of the action. You also are entitled to one free
report every twelve months upon request if you certify that: (1) you are unemployed and plan to seek
employment within sixty (60) days; (2) you are on welfare; or (3) your report is inaccurate due to fraud.
Otherwise, a CRA may charge you up to eight dollars for a copy of the consumer report.
You can dispute inaccurate information with the CRA. If you tell a CRA that your file contains
inaccurate information, the CPA must investigate the item (usually within thirty (30) days) by presenting
to its information source all relevant evidence you submit, unless your dispute is frivolous. The source
must review your evidence and report its findings to the CRA. (The source also must advise national
CRAs — to which it has provided the data — of any error.) The CRA must give you a written report of the
investigation and a copy of your report if the investigation results in any change. If the CRA's
investigation does not resolve the dispute, you may add a brief statement to your file. The CRA must
normally include a summary of your statement in future reports. If an item is deleted or a dispute
statement is filed, you may ask that anyone who has recently received your report be notified of the
change.
Inaccurate information must be corrected or deleted. A CRA must remove or correct inaccurate or
unverified information from its files, usually within thirty (30) days after you dispute it. However, the
CRA is not required to remove accurate data from your file unless it is outdated (as described
below) or cannot be verified. If your dispute results in any change to your report, the CRA cannot
reinsert into your file a disputed item unless the information source verifies its accuracy and
completeness. In addition, the CRA must give you a written notice telling you it has reinserted the item.
The notice must include the name, address and phone number of the information source.
n
03/06 3.
F 1 You can dispute inaccurate items with the source of the information. If you tell anyone — such as a
creditor who reports to a CRA — that you dispute an item, they may not then report the information to a
CRA without including a notice of your dispute. In addition, once you have notified the source of the
error in writing, it may not continue to report the information if it is, in fact, an error.
Outdated information may not be reported. In most cases, a CRA may not report negative information
that is more than seven years old; ten years for bankruptcies.
Access to your file is limited. A CRA may provide information about you only to people with a need
recognized by the FCRA — usually to consider an application with a creditor, insurer, employer, landlord,
or other business.
Your consent is required for reports that are provided to employers, or reports that contain
medical information. A CRA may not give out information about you to your employer, or prospective
n employer, without your written consent. A CRA may not report medical information about you to
JI creditors, insurers, or employers without your permission.
You may choose to exclude your name from CRA lists for unsolicited credit and insurance offers.
Creditors and insurers may use file information as the basis for sending you unsolicited offers of credit or
insurance. Such offers must include a toll -free phone number for you to call if you want your name and
address removed from future lists. If you call, you must be kept off the lists for two years. if you request,
complete, and return the CRA form provided for this purpose, you must be taken off the lists indefinitely.
You may seek damages from violators. If a CRA, a user or (in some cases) a provider of CRA data,
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violates the FCRA, you may sue them in state or federal court.
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For further information regarding the FCRA, see the Federal Trade Commission's web site at
www.ftc.gov.
FOR QUESTIONS OR CONCERNS REGARDING:
CONTACT THE FOLLOWING
Federal Trade Commission
CRA's, creditors and others not listed:
Consumer Response Center - FCRA
Washington, DC 20580 PH: 202-326-3761
National banks, federal branches/agencies of foreign banks (word
Office of the Comptroller of the Currency
"National" or initials NA" appear in or alter bank name)
Compliance Management, Mail Stop 6-6
Washington, DC 20219 PH: 800-613-6743
Federal Reserve System member banks (except national banks, and federal
Federal Reserve Board
Division of Consumer & Community Affairs
branches/agencies of foreign banks)
Washington, DC 20551 PH: 202-452-3693
Savings associations and federally chartered savings banks (word "Federal"
Office of Thrift Supervision
or initials "F.S.B." appear in federal institution's name)
Consumer Programs
Washington, DC 20552 PH: 800-942-6929
Federal credit unions (words "Federal Credit Union" appear in institution's
National Credit Union Administration
1775 Duke Street
name)
Alexandria, VA 22134 PH: 703-518-6360
State -chartered banks that are not members of the Federal Reserve System
Federal Deposit Insurance Corporation
Division of Compliance & Consumer Affairs
Washington, DC 20429 PH: 800-934-FDIC
Air, surface, or rail common carriers regulated by former Civil Aeronautics
Department of Transportation
Office of Financial Management
Board or Interstate Commerce Commission
Washington, DC 20590 PH: 202-366-1306
Department of Agriculture
Activities subject to the Packers and Stockyards Act, 1921
Office of Dcputy Administrator - GIPSA
Washington, DC 20250 PH: 202-720-7051
n03/06 C
A( City of Lubbock, TX
Response to RFP 17-13294-SS, Temporary Employment Services
I , 6.1.3 Ability to provide driver's license checks completed no longer than one
year before placement.
PSS, Inc. conducts driver's license checks on all staff that are required to drive as a part
of their assigned duties. PSS, Inc. conducts a check with the Department of Motor Ve-
hicles prior to placement on an assignment to ensure the candidate has a valid driving
license and to ensure all information provided by the candidate matches the information
noted on the license. The driver's license record of an Associate is checked annually by
PSS, Inc. to ensure the Associate's license remains valid.
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^ City of Lubbock, TX
Response to RFP 17-13294-SS, Temporary Employment Services
6.1.4 Describe procedures to replace workers that do not meet job expectations.
(CONFIDENTIAL AND PROPRIETARY)
PSS, Inc. is committed to making certain each employee placed with the City meets the
requirements of the position and the individual represents himself/herself and the com-
pany in a professional manner. PSS, Inc. contacts the end -user within four (4) hours of
the start of each assignment. In addition, the Account Manager makes routine perfor-
mance checks with the end user to ensure performance remains high. However, if at
any time the City is dissatisfied with an employee immediate notification is requested by
PSS, Inc. With respect to timing, the company's preference is to receive feedback dur-
ing the first day of the assignment. To this end, PSS, Inc. assigned Account Manager
or other member of the Customer Service Team, contacts the end user to confirm the
assigned Associate's skills are at expected levels at the end of the first day. PSS, Inc.
encourages end users to make certain they assess assignments given to the Associate
during the first day to determine whether the Associates skills and proficiency are as re-
quested.
PSS, Inc. offers the industry standard of a four (4) guarantee on any placement. If dur-
ing the company's four hour service check during the first day of the assignment, the
City is not satisfied with the Associate, the City will not be charged. PSS, Inc. identifies
and submits a replacement Associate. PSS, Inc. service guarantee is not limited to the
first four hours. If at any time the City is not satisfied with the assigned Associate, PSS,
Inc. determines the nature of the concern and acts appropriately. For example, during
the course of an assignment concerns may arise regarding the Associate may immedi-
ately resolve with counseling from the Account Manager. If however, the concern in-
volves technical skills or work ethic issues, PSS, Inc. immediately removes the individu-
al and presents a replacement. All communication with PSS, Inc. personnel regarding
performance is done by the Account Manager or the Associates assigned Recruiting
Manager. The company takes its roles as the employer seriously and never its custom-
ers in performance matters.
PSS, Inc. Associates are recognized and rewarded for excellent performance. Through
the company's reward and recognition program, PTPTm (Performance Through Partner-
ship), Associates receive monetary and other recognition for bringing value to the client
relationship through their performance and input. Associates also receive recognition
for attendance, punctuality and the receipt of excellent customer feedback. The goal of
PTPT"" is to effectively involve its personnel in the quality of its service delivery. The
company also views the assigned Associate as a customer. As such PSS, Inc. strives
to match Associate skills, personal preferences and experience to a job order. It has
been the company's experience the better the match, the higher level of satisfaction
from both the customer and the Associate.
\�A-I%Wifj`6_1
City of Lubbock, TX
Response to RFP 17-13294-SS, Temporary Employment Services
Figure 4 outlines PSS, Inc.'s replace personnel process.-
4: rersonnel Kepiacement rrocess
Step 2: Step 3:
r r Y�S
MW
PSS, Inc. Identifies and PSS, Inc. Confinns
=f Presents Replacement Replacement
•PSS, Inc. determines the
nature of concern.
• If concern regards
technical competency,
immediate replacement.
•If concern can be
immediately rectified
with counseling, PSS, Inc.
will discuss with City.
•PSS, Inc. identifies
placement and presents
resume (if required) to
City for review.
•PSS, Inc. assigns new
Associate and ensure the
Associate is aware of
City's previous concerns
appropriate to ensuring
better placement,
13
-PSS, Inc. begins quality
review anew with current
placement:
•Check within 4 hours of
1st day and before end
of 1st day
*Bi-weekly check with City
to confirm quality of
performance
6 T
City of Lubbock, TX
Response to RFP 17-13294-SS, Temporary Employment Services
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6.1.5 Describe normal billing procedures and include a sample invoice.
PSS, Inc.'s billings and payroll processes adapt to meet the City's specification and
produce documentation of payments to support billing, tax, W-2 and deduction purpos-
es. PSS, Inc. proposes to utilize the electronic timekeeping system TimeSheets.com
�� II (see Figure 5) for staff with internet access at the job site and manual timesheets (see
Figure 6) for all other staff. Clients and PSS, Inc. can remotely monitor (via their web
I I browser) all arrivals and departures and approve time for assigned staff regardless of
' + location.
PSS, Inc.'s Senior Accountants download file interfaces; review time reports/authori-
zations and timesheets; process and distribute weekly payroll checks; and prepare
weekly or monthly billings and reports that accurately reconcile to approved timesheets.
All electronic timesheets are imported into the PSS, Inc. accounting system, Quick -
Books, and reviewed for data transfer integrity. Manual timesheets are reviewed for ac-
curacy and authenticity. Data is entered into the accounting system and the contracted
amount is billed in the agreed format. PSS, Inc. will prepare template -based manage-
ment reports or will customize to fit any of the City's additional reporting requirements.
Billings are prepared according to contract terms and quality reviewed by PSS, Inc.'s
IChief Financial Officer prior to distribution to clients. Billings are scanned and emailed
to clients as well as uploaded into PSS, Inc.'s client portal for City viewing 24R. Pay-
ment terms are typically net 30. PSS, Inc. accepts payment by check, credit card, P-
card and electronic fund transfer.
PSS, Inc. pays its employees overtime and one and a half times their regular pay rate.
The customer is billed a 28% markup on overtime. Overtime is considered hours
worked in excess of 40 hours within the work week.
Figure 5—TimeSheets
l O 30 �o ...
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14
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City of Lubbock, TX
Response to RFP 17-13294-SS, Temporary Employment Services
Figure 6—Sample PSS, Inc. Manual Timesheet
f
A w11dy-0wtlad OIb&kVwy cFMR,1w
Premier Staffing Source, Inc. WEEKLY TIMESHEET
an Cow V49K >!t M PIl11 / MLY Usm MLL/M1 Pis
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15
�tiSAfF/y`�
A
City of Lubbock, TX
Response to RFP 17-13294-SS, Temporary Employment Services
Future 7—PSS. Inc. SarnDle Invoice
\��6tl�Npp
Premier Staffing Source. Inc.
4640 Forbes Bh-d
Suite 200-A
Lanham NO ?0706
Plane 9
Fax a
977.660-4674 (Toll Free)
1-866-892-7315
I Big To I
Slaryland Dept of Hon mF & C om=mm Deg•
DHCD:DFAFtscal Plan
rm: A%is. Ann Goldman
100 C ommunny Place
Croan-ctll .MD 21032-2032
Invoice for Temp
Computer Info Staffin
Date
Invoice
"301'-011
2185
P.O. No.
SOOP-1.40-0585
Taxpayer Identification Nwnber
(FEIIvN
20-0534569
Net 30
Descnpdon
oty
Rate
Amount
, - Temporary 1T Compote Smice: Sappotr (Robert
4
20.50
$2.00
Dean. DHCD Depms Detector rr)
Work We& Ended 7-?^011
Waxk Week Faded, 7,92011
36
2050
738 00
Ro,kWeekFnded 716_01l
40
20.50
820.00
Work R e& Ended 713 2011
40
2050
82000
Work Reek Eoded: 7'30'2Ol l
40
-T
20.50
920 00
Total S3 280.00
Total Unpaid Balance s3_2Bo.00
16
THP—NK YOU FOR YOUR
BUSDIF.SS 1.
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City of Lubbock, TX
Response to RFP 17-13294-SS, Temporary Employment Services
6.1.6 Describe CDL random drug testing for temporary drivers.
Many of PSS, Inc.'s contracts require drug screening. To ensure strict compliance, PSS,
Inc. has documented procedures to ensure each employee understands this require-
ment and the ramifications of failing a drug screen. PSS, Inc. is contracted with AMC, a
national drug screening service provider. In addition to the initial drug screening, PSS,
Inc. conducts random drug test on temporary CDL drivers. Employees are not provided
prior notice and are required to submit their screen within two days of notification. Fail-
ure to comply with the company's request for the screen results in immediate removal
from an assignment. Anyone with positive results are removed immediately.
17
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s City of Lubbock, TX
Response to RFP 17-13294-SS, Temporary Employment Services
6.1.7 Describe bonding information (agency, capacities, etc.).
PSS, Inc. has crime insurance (fidelity) coverage ranging from $250,000 to $1,000,000
under existing contracts across the United States. This policy provides coverage
against employee dishonest acts such as theft of property, trade secrets, cash and oth-
er such fraud. PSS, Inc. will comply with the City's requirement to maintain a $500,000
crime bond which protects the City from loss due to PSS, Inc.'s employees placed on
assignment.
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City of Lubbock, TX
"•.,,,.. 'T Response to RFP 17-13294-SS, Temporary Employment Services
II
6.1.8 Describe any work restrictions (below ground, above ground, lifting of
weight number of consecutive hours worked, driving/equipment, etc.).
I 1 PSS, Inc. identifies applicants that meet the qualifications stipulated for each labor cat-
egory and ensures any identified restrictions are adhered to for the specific labor cate-
gory. PSS, Inc. complies with the Occupational Health and Safety Administration
(OHSA) guidelines. Safety training is provided to PSS, Inc.'s employees during the em-
ployee's new hire orientation. Employees are required to view safety training videos
I I throughout their employment to ensure compliance. The following are a few examples
of the work restrictions that PSS, Inc. comply with to ensure the safety of its employees:
I
• For driving, PSS, Inc's. employees must comply with the Hours -of -Service Regu-
lations provided by the Federal Motor Carrier Safety Regulation 49 CFR, Part
395.
• Employees are not permitted to work in an underground for a period longer than
eight (8) hours in any 24 hour period (OHS regulation, Part 22 Underground
Workings).
• Employees must use ladders, scaffolding or lift buckets to reach high places.
• Employees are limited to lifting and carrying weight that is not easily managed to
prevent back problems (National Institute for Occupational Safety and Health
guidelines concerning weight limitations).
19
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
1 of 1
Complete Nos. 1- 4 and 6 if there are interested parties.
Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties.
OFFICE USE ONLY
CERTIFICATION OF FILING
Certificate Number:
2017-221112
Date Filed:
06/08/2017
Date Acknowledged:
08/08/2017
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
Texas Premier Staffing Source, Inc.
Lanham, MD United States
2 Name of governmental entity or state agency that is a party to the contract for which the form is
being filed.
City of Lubbock
3
Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a
description of the services, goods, or other property to be provided under the contract.
RFP 17-13294-SS
Temporary Employment Services
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
I Intermediary
5
Check only if there is NO Interested Party. ❑
6
AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct.
Signature of authorized agent of contracting business entity
AFFIX NOTARY STAMP / SEAL ABOVE
Sworn to and subscribed before me, by the said this the day of
20 , to certify which, witness my hand and seal of office.
Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
Forms nrovided by Texas Ethics Commission www.ethics.state.tx.us
Version V1.0.883
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
lofl
Complete Nos. 1- 4 and 6 if there are interested parties.
OFFICE USE ONLY
Complete Nos.1, 2, 3, 5, and 6 if there are no interested parties.
CERTIFICATION OF FILING
Certificate Number:
1
Name of business entity filing form, and the city, state and country of the business entity's place
of business.
2017-221112
Texas Premier Staffing Source, Inc.
Lanham, MD United States
Date Filed:
06/08/2017
2
Name of governmental entity or state agency that is a party to the contract for which the form is
being filed.
City of Lubbock
Date Acknowledged:
3
Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a
description of the services, goods, or other property to be provided under the contract.
RFP 17-13294-SS
Temporary Employment Services
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
I Intermediary
5
Check only if there is NO Interested Party.
X
6
AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct.
Signature of authorized agent of contracting business entity
AFFIX NOTARY STAMP / SEAL ABOVE
Sworn to and subscribed before me, by the saidy-r\ ct L, Ca i7 �S this the -day of •-t T V 1n�
20_17 to certify which, witness my hand and seal of office.
MELANIE Z. BILAL-DOUGLAS
NOTARY PUBLIC
PRINCE GEORGE'S COUNTY
A- -kA-4 L4,A Yl At_.I[l r2 4" '()Q
Signature of officer ad nistering oa PrintedlbigtRndoffssioac%iptsWing oath Tide of officer administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.883