NEW YORK STATE

OCCUPATIONAL SAFETY AND HEALTH

.... : HAZARD ABATEMENT BOARD

*
ROBERT F. GOLLNICK
~:; " (l ~4 STATE CAMPUS
BUILDING 12, ROOM 166
ANN MARIE TALIERCIQ
CARLJ. THURNAU
ALBANY. NEW YORK 12240 Members
ROBERT F. CARPENTER (5181457 -7629
Chairman FAX (5181465.6082

February 11. 2004

Mr. John Bulgaro

Teamsters Local 294 -
'--
890 Third sr
Albany, NY 12206

Dear Mr. Bulgaro :

Your contract number C010397 for the 2003/2004 aSH T&E grant has
been approved for modific ' . e Department of Labor.

Attach ~re six (6) copies of Appendix X 'aQd two complete modifications.
NOTE: It is now tne-Depactment of Labor's policy to send just the changed pages
to the contractor for sign ture. Please have each Appendix X, Informal
Modification Signature Sti et, signed in blue ink and notarized. Please return the
entire package at your earli st convenience ,

When the modificatio approval process has been completed, a fully

executed copy will be retur d to you for your files .

Sincerely,

oe~hai~.~
rd
'J'
Grant Manager

k A /l-l?{)
Vi(tL
Attachments 2{ /3/() 't
GOVERNMENT
EXHIBIT
GD -30
 Formal Modification
NEW YORK STATE
DEPARTMENT OF LABOR Charity Registration #
_Exempt 9 _
APPENDIX X

Agency Code 14000 Contract No. CO I 0397- - - -- - Modification No.

This is an AGREEMENT between THE STATE OF NEW YO~ acting by and through the Department
of Labor, having its principal office at State Office Building Campus, Building l2, Albany, New York (herein
referred to as the STATE,) and _Teamsters Local 294 (hereinafter referred to as the
CONTRACTOR), for modification of Contract Number _COI0397 , as set forth in attached
Appendix B (Project Budget and Program Narrative Addendum), which is hereby incorporated by reference.
This contract shall be for the period_August 1, 2003__ through_July 31, 2004 _
This contract may be extended up to four years through ----_

If Not for Profit: Contractor has ~ has not 0 timely filed with the Attorney General's Charities Bureau
all required periodic or annual written reports.

All other provisions of said AGREKMENT shall remain in full force and effect.

IN WITNESS THEREOF, the parties hereto have executed or approved this AGREEMENT as of the dates
appearing under their signatures.

STATE OF NEW YORK)

) 55.:

County of ~'i: hunteJa d), e

On the I a~ day of ~f 0n!l 0 I; ~ , 200.::L before me personally appeared

ili 10 AQ 14)
o
C"\.crBco

resides at
I

45 4lcrdl /., J'r t) , SOA

to me known, who being by me duly sworn, did depose and say that he/she

a Q 00 ~ 4)), that he/she is the G . U4)e/Dt" ofthe

I ~

S'-o QlYnl>'-Q A l> 294 the corporation described herein which executed the foregoing instrument; and that

be/she signed his/her name thereto by authority of the Board of Directors of said corporation.

(NOI'~ Qo 'CClCi' 6:'-1'!'

, ::r:::'EEN A. HARKINS R E C E rV E MPTROL~~~~ae-....,
APPROVED
I' u ~ Pl! ~ i l • State of New Yorl:
..:uoll flClC In Schenoctady Count y DEPT. OF AUDIT & CONTROL
1=\ ;: J N ,~ l1HA47B4G47 FEB 26 2003 - - ----1- - - -- --+--
C Cll1 \..~ =: t ~j I .,,;J:rns J U:y .:;1, MAR 9 2004
Date:
DEPAR"fMG r. .'; .. ~i3 0 R
FOR~~llER
GM 313.4 (06/09/03)
A COUN'I1N "'eTION
Teamsters Local294 CO 10397 Appendix B
C(frJ..;! (L «in.
NEW YORK STATE DEPARTMENT OF LABOR
SCHEDULE I
Planning Summary
Contractor: Teamsters Local294 Contract Number: C010397
Address: 890 Third Street -------
Phone: 518-489-5436
Albany, NY 12206

Liaison: John Bulgaro, President

Address: Teamsters Local 294 Phone : 518-489-5436
890 Third Street Fax: 518-453-9251
Albany, NY 12206 E-Mail : Teamsters294@aol.com

NYSDOL
Liaison: Linsay M. Baird Phone: 518-457-6670
Address: NYSDOUOSH T&E Fax: 518-485-6082
State Office Campus Bid 12 Rm 166 E-Mail: usaaab@Labor.State.NY .US
Albany, NY 12240

Submittal: FY 2003·2004
Original _
Mod # 1 X Increases Funding From : 55,800 .00 to 69,300 .00
Decreases Funding From : to
Changes End Date From :
----- to
-----
Funding Source: 8/1/03 7/31/04
Program: $69,300

OrlginaUSFY 2003-04 569 ,300 6/30/04 SFY Total: $69,300

Year Amount Lapse Date Year Amount Lapse Date

Renewal lIS FY SFY Total :

Year Amount Lapse Date Year Amount Lapse Date

Renewal II/SFY SFY Total:

Year Amount Lapse Date Year Amount Lapse Date

Renewal IIi/SFY SFY Total :

Year Amount Lapse Date Year Amount Lapse Date

Renewal IV/SFY SFY Total :

Year Amount Lapse Date Year Amount Lapse Date

Budget

1. Staff Salaries
2. Staff Frin e Benefits
3. Contracted Services
4. Other Costs
5. Total Contract Costs
6. Total Match Costs