1-Administrative Requirements Packet.pdf

A dm in is tr at iv e

Re qu ire m en ts

Administrative Requirements

Forms and explanatory documents for each of the following administrative requirements are identif ied below and are included in the respective sections of this package. Also included, as the final section, is a checklist to assist with your proper completion of the required forms prior to bid/proposal submittal. Please note that all documents must be signed by the duly authorized representative of the entity or sole proprietor. In the event of a Joint Venture (JV), officers authorized by each entity must sign and submit a separate set of the following documents:

• Vendor ID Form

• Af f idavit of Non-Collusion

• Bidder Contributions CEC Form 55

• Contractor Responsibility Questionnaire and Pledge of Compliance

• Equal Benef its Ordinance Compliance Af f idavit

• Municipal Lobbying Ordinance Bidder Certif ication CEC Form 50

The following administrative requirements may refer to the Los Angeles City Charter (LACC), Los Angeles Municipal Code (LAMC), or Los Angeles Administrative Code (LAAC).

For further information or assistance regarding all administrative requirements, contact:

Los Angeles World Airports Procurement Services Division P O Box 92216 Los Angeles, CA 90009-2216 Phone: (424) 646-5380 Fax: (424) 646-9262 E-mail: ProcurementRequirements@lawa.org Internet: https://www.lawa.org/en/lawa-businesses/lawa-administrative-requirements

1. VENDOR ID FORM

The Vendor ID form requires general information about a bidder/proposer’s business as well as the Seller’s Permit and the Business Tax Registration Certif icate (BTRC) numbers, Payment Terms, Equal Employment Opportunity Officer contact information, and data on the firm’s City of Los Angeles contracts (if applicable).

• Seller’s Permit Number

The Seller’s Permit Number is required if the vendor is engaged in business in California;

intends to sell or lease tangible personal property that would ordinarily be subject to sales tax if sold at retail; will make sales for a temporary period, normally lasting no longer than 30 days at one or more locations. The enforcing agency for this requirement is the Board of Equalization, the Sales and Use Tax Department. Additional information regarding this requirement can be found at http://www.cdtfa.ca.gov/services/permits-licenses.htm.

mailto:ProcurementRequirements@lawa.org https://www.lawa.org/en/lawa-businesses/lawa-administrative-requirements https://www.lawa.org/en/lawa-businesses/lawa-administrative-requirements http://www.boe.ca.gov/sutax/sutprograms.htm http://www.boe.ca.gov/sutax/sutprograms.htm http://www.cdtfa.ca.gov/services/permits-licenses.htm

• Business Tax Registration Certificate

Pursuant to the LAMC, Chapter 2, Article 1, Section 21.03, persons engaged in any business or occupation within the City of Los Angeles are required to register and pay the required tax.

Businesses, including vendors, subject to this tax are issued a Business Tax Registration Certif icate (BTRC) or a Vendor Registration Number (VRN).

Information regarding this requirement may be obtained at Office of Finance, Tax & Permit Division, 200 N. Spring St., Room 101, Los Angeles, CA 90012, Phone: (844) 663-4411, Web:

http://f inance.lacity.org.

• Out-of-state Vendors The State of California requires the City of Los Angeles (City) to withhold income taxes from payments to out-of-state vendors for services performed within California unless the vendor submits one of the required forms. The tax withholding rate is seven percent (7%) of payments subject to withholding.

If you are out-of-state vendor, please return one of the following forms to help the City clarify your non-resident tax withholding status:

• Form 590, Withholding Exemption Certif icate, certifying exemption from the withholding requirement.

• Form 587, Nonresident Income Allocation Worksheet, which allocates the expected income under the City contract for work completed within and outside of California

• Notice from the CA Franchise Tax Board (CAFTB) that a withholding waiver was authorized (you must first f ile CA Form 588, Nonresident Withholding Waiver Request to the CAFTB)

• Notice from CAFTB that a reduced withholding request was authorized (you must first f ile CA Form 589 Nonresident Reduced Withholding Request to CAFTB)

2. AFFIDAVIT OF NON-COLLUSION

Pursuant to the LAAC, Division 10, Chapter 1, Article 2, Section 10.15, each bid/proposal must include the attached affidavit of the Bidder/Proposer that the bid/proposal is genuine, and not a sham or collusive, or made in the interest or on behalf of any person, and that the Bidder/Proposer has not directly or indirectly induced or solicited any other Bidder/Proposer to submit a sham bid, or any other person, firms, or corporation to refrain from bidding, and that the Bidder/Proposer has not sought by collusion to secure for himself/herself an advantage over any other Bidder/Proposer.

Bidders/Proposers must complete, notarize, and submit the attached “Affidavit to Accompany Proposals or Bids” with the bid/proposal.

Failure to include an Affidavit with the bid/proposal will render the bid/proposal non-responsive and will result in its rejection.

Attachment:

• Affidavit of Non-Collusion http://finance.lacity.org/

3. BIDDER CONTRIBUTIONS CEC FORM 55 (CONTRACT BIDDER CAMPAIGN

CONTRIBUTION AND FUNDRAISING RESTRICTIONS)

Persons who submit a response to this Request for Bid/Proposal/Qualif ications are subject to Charter section 470(c)(12) and related ordinances. As a result, bidders/proposers/respondents may not make campaign contributions to and or engage in fundraising for certain elected City officials or candidates for elected City office from the time they submit the response until either the contract is approved or, for successful bidders/proposers/respondents, 12 months after the contract is signed. The bidder's/proposer’s/respondents’ principals and subcontractors performing $100,000 or more in work on the contract, as well as the principals of those subcontractors, are also subject to the same limitations on campaign contributions and fundraising.

Bidders/Proposers/Respondents must submit CEC Form 55 (attached) to LAWA with their bid/proposal/Statement of Qualif ications. The form requires bidders to identify their principals, their subcontractors performing $100,000 or more in work on the contract, and the principals of those subcontractors. Bidders/Proposers/Respondents must also notify their principals and subcontractors in writing of the restrictions and include the notice in contracts with subcontractors. Responses submitted without a complete CEC Form 55 shall be deemed non-responsive. Bidders/Proposers/Respondents who fail to comply with City law may be subject to penalties, termination of contract, and debarment.

Additional information regarding this requirement may be obtained at:

200 N. Spring Street City Hall, 24th Floor Los Angeles, California 90012

(213) 978-1960

(213) 978-1988 [Fax] ethics.commission@lacity.org Web: http://ethics.lacity.org

Attachments:

• Bidder Contributions CEC Form 55

• Los Angeles City Ethics Commission Special Bulletin, available at http://ethics.lacity.org/pdf/pressrelease/press_042511_New_Charter_Amend_Limits_Bidder_Bulletin.pdf

4. CONTRACTOR RESPONSIBILITY PROGRAM

Pursuant to Resolution No. 21601 adopted by the Board of Airport Commissioners, effective May 20, 2002, the Contractor Responsibility Program (CRP) is the policy of Los Angeles World Airports (LAWA) to ensure that all LAWA contractors have the necessary quality, f itness and capacity to perform the work set forth in the contract. LAWA shall award contracts only to entities and individuals it has determined to be Responsible Contractors. The provisions of this Program apply to leases and contracts for construction, for services, and for purchases of goods and products that require Board approval.

Bidders/Proposers are required to complete and submit with the bid/proposal the attached “Contractor Responsibility Program Questionnaire” that provides information LAWA needs to http://ethics.lacity.org/ http://ethics.lacity.org/pdf/pressrelease/press_042511_New_Charter_Amend_Limits_Bidder_Bulletin.pdf determine if the Bidder/Proposer is responsible and has the capability to perform the contract.

The information contained in the CRP Questionnaire is subject to public review for a period of not less than 14 days. Bidders/Proposers are also required to complete, sign and submit with the bid/proposal the attached “Contractor Responsibility Program Pledge of Compliance.”

Bidders/Proposers are also required to respond within the specified time to LAWA’s request for information and documentation needed to support a Contractor Responsibility determination.

Subcontractors will be required to submit the Pledge to the prime contractor prior to commencing work.

For the list of Contractor Responsibility Program respondents, please visit our website www.lawa.org -> Contractor Responsibility Program -> Contractor Responsibility Program Questionnaire Respondents.

Attachments:

• Contractor Responsibility Program Questionnaire

• Contractor Responsibility Program Pledge of Compliance

5. EQUAL BENEFITS ORDINANCE

Any contract awarded pursuant to this procurement process shall be subject to the applicable provisions of the Los Angeles Administrative Code Section 10.8.2.1, Equal Benefits Ordinance (EBO). The EBO requires City contractors who provide benefits to employees with spouses provide the same benefits to employees with domestic partners. Domestic partners are defined as two adults living together, jointly responsible for living expenses, committed to an intimate and caring relationship and registered as domestic partners with a governmental entity.

Bidder/Proposer/Lessees must submit the Equal Benefits Ordinance Compliance Affidavit (2 pages) with Bid/Proposal/Lease.

The Equal Benefits Ordinance Compliance Affidavit shall be valid for a period of twelve months.

Bidders/Proposers/Lessees do not need to submit supporting documentation with their bids or proposals or leases. However, the City may request supporting documentation to verify that the benefits are provided equally as specified on the Equal Benefits Ordinance Compliance Affidavit.

Bidders/Proposers/Lessees seeking additional information regarding the requirements of the Equal Benefits Ordinance may visit the Bureau of Contract Administration’s web site at http://bca.lacity.org or call Procurement Services at (424) 646-5380.

Attachment:

• EBO Compliance Affidavit

6. INSURANCE

Pursuant to LAAC, Division 11, Chapter 2, Article 2, Section 11.47 and the Risk Management Policy (Council File #79-3194-S1) adopted by Los Angeles City Council on March 1, 1991, the City of Los Angeles is to be protected to the maximum extent feasible, against loss or losses http://www.lawa.org/ http://bca.lacity.org/ which would significantly affect personnel, property, f inances, or the ability of the City to continue to fulf ill its responsibilities to taxpayers and the public. Consequently, prior to the commencement of this contract, the selected Bidder/Proposer must provide evidence of insurance that conforms to the insurance requirements of the bid/proposal. Insurance requirements which specifically outline the types and amount of coverage required for this project are explained in detail in the attached language and “Insurance Requirement Sheet”.

Successful Bidder/Proposer must provide acceptable evidence of insurance as explained in the attachments prior to the commencement of the contract. Said acceptable evidence of insurance must remain current throughout the term of the contract and be on file with the Insurance Compliance Unit in order to receive payment under any contract with the City of Los Angeles.

Attachments:

• Insurance Requirement Sheet

• General Insurance Provisions

Additional information is available at www.lawa.org -> Administrative Requirements -> Insurance.

7. MUNICIPAL LOBBYING ORDINANCE

The City's Municipal Lobbying Ordinance, Los Angeles Municipal Code, Section 48.09 requires certain individuals and entities to register with the City Ethics Commission and requires public disclosure of certain lobbying activities, including money received and spent. Additionally, for all construction contracts, public leases, or licenses of any value and duration; goods or service contracts with a value greater than $25,000 and a term of at least three months, each bidder/proposer must submit with its bid a certif ication, on a form (CEC Form 50) proscribed by the City Ethics Commission, that the bidder acknowledges and agrees to comply with the disclosure requirements and prohibitions established in the Los Angeles Municipal Lobbying Ordinance, if the bidder qualif ies as a lobbying entity.

Failure to submit the Bidder Certification CEC Form 50 with the bid/proposal will render the bid/proposal non-responsive.

Additional information regarding this requirement may be obtained at:

200 N. Spring Street City Hall, 24th Floor Los Angeles, California 90012

(213) 978-1960

(213) 978-1988 [Fax] ethics.commission@lacity.org Web: http://ethics.lacity.org

Attachments:

• Municipal Lobbying Ordinance, available at http://www.lawa.org/welcome_LAWA.aspx?id=586

• Bidder Certif ication CEC Form 50, available at http://www.lawa.org/welcome_LAWA.aspx?id=586 http://www.lawa.org/ http://ethics.lacity.org/

ADMINISTRATIVE REQUIREMENTS THAT DO NOT REQUIRE FORMS

The following administrative requirements are language only. Submit any questions you may have regarding these ordinances to the LAWA Procurement Services Division at ProcurementRequirements@lawa.org or at (424) 646-5380.

• Affirmative Action

• Alternative Fuel Vehicle Requirement Program

• Assignment of Anti-Trust Claims

• Child Support Obligations

• Federal Requirements – Title VI

• Living Wage Ordinance mailto:ProcurementRequirements@lawa.org

C he ck lis t

Administrative Requirements Checklist

BIDDERS/PROPOSERS (PRIME CONTRACTORS) MUST SUBMIT THE FOLLOWING SIGNED

DOCUMENTS, WITH THEIR PROPOSAL, AS INDICATED

1. VENDOR ID FORM

Is the required Vendor ID Form completed?

Is the BTRC/VRN number provided?

Is the Form enclosed in the Packet?

2. AFFIDAVIT OF NON-COLLUSION

Is the “Affidavit to Accompany Proposals or Bids” completed and signed?

Is the Affidavit notarized?

Is the Affidavit enclosed in the Packet?

Failure to include an Affidavit with the bid/proposal will render the bid/proposal non-responsive and will result in its rejection.

3. LOCAL BUSINESS PREFERENCE PROGRAM (LBPP)

Local Business Certif ication – Please refer to the attached RAMP instructions for more information.

4. SUBCONTRACTOR PARTICIPATION PLAN

Are you using any subcontractors for this project?

Yes No

If Yes, Is the Subcontractor Participation Plan completed and enclosed in the Packet?

5. BIDDER CONTRIBUTIONS

Is the required Bidder Contribution CEC Form 55 completed and signed?

Schedule A - Please list all principals on Schedule A.

Schedule B - Please list all subcontractors and their principals on Schedule B (If you check “Yes”)

Failure to include the Bidder Contribution CEC Form 55 with the bid/proposal will render the bid/proposal non-responsive and will result in its rejection.

6. CONTRACTOR RESPONSIBILITY PROGRAM

Is the required "Contractor Responsibility Program Questionnaire" completed and signed?

Is the Questionnaire enclosed in the Packet?

Is the required "Contractor Responsibility Program Pledge of Compliance" completed and signed?

Is the Pledge of Compliance enclosed in the Packet?

7. EQUAL BENEFITS ORDINANCE

Is the EBO Compliance Affidavit Form completed and signed?

8. MUNICIPAL LOBBYING ORDINANCE

Is the required Bidder Certif ication CEC Form 50 completed and signed?

Failure to include the Bidder Certification CEC Form 50 with the bid/proposal will render the bid/proposal non-responsive and will result in its rejection.

THE FOLLOWING REQUIREMENTS DO NOT REQUIRE THE COMPLETION OF FORMS

BUT MAY BE INCORPORATED AS PROVISIONS OF THE CONTRACT:

9. AFFIRMATIVE ACTION

Have you read and agreed with the City of Los Angeles’ Non-discrimination, Equal Employment and Affirmative Action provisions?

10. ASSIGNMENT OF ANTI-TRUST CLAIMS

Have you read and agreed with California Government Code Sections 4550 – 4554?

11. CHILD SUPPORT OBLIGATIONS

Have you read and agreed with Child Support Obligations provisions?

12. LIVING WAGE ORDINANCE

If you are claiming exemption from said Ordinances:

Is the appropriate Exemption form completed and signed?

Is the Exemption form enclosed in the Packet?

IF YOU ARE AWARDED THE CONTRACT AND PRIOR TO EXECUTION OF THE

CONTRACT:

Prime contractors are required to submit to LAWA forms pertaining to the following requirements:

• Business Tax Registration Certif icate

• Insurance

V en do r I de nt ifi ca tio n

Fo rm

VENDOR IDENTIFICATION FORM

ALL FIELDS MUST BE COMPLETED. INCOMPLETE FORMS MAY BE REJECTED AND RESUBMITTED.

GENERAL INFORMATION

Entity type (code)

Individual/Proprietor (I)

Corporation (C or S)

Partnership (P)

BUSINESS ADDRESS

Fax

Airport Concessions Disadvantaged Business Enterprise (ACDBE)

Disadvantaged Business Enterprise (DBE)

Disabled Veteran Business Enterprise (DVBE) (LAWA)

Local Business Enterprise (LBE)

Minority Business Enterprise (MBE)

Minority Women Business Enterprise (M/WBE)

Small Business Enterprise* (Proprietary)

Local Small Business (LSB) (formerly SLB)

Women Business Enterprise (WBE) *Per SBA or DGS criteria verification

CERTIFICATION

The undersigned declares and certifies that all statements on this form are true and correct. I agree to notify Strategic Sourcing Division immediately of any changes to the information contained herein. I have read and agreed with the administrative requirements set for this project and have been provided as a checklist in the bid/proposal package. If selected, I/We will comply with these requirements for the duration of the contract.

DateAuthorized Signature

Title

For instructions and additional information, please click LAWA, call 424-646-5380, or email Los Angeles World Airports Procurement Services Division at procurementrequirements@lawa.org

Form VIF 04082025 LM

For LAWA use only:

Contact Person:

F-590 F-589F-588

BUSINESS CERTIFICATION

(Check all that apply - If required, attach copies of all applicable certifications)

F-587

Phone No:

CALIFORNIA FRANCHISE TAX BOARD (FTB)

Click FTB Publication 1017 for further information

City of Los Angeles Office of Finance (OOF) BTRC/VRN No.

Government

LLC (enter entity code below) BTRC/VRN application pending (attach proof of submission)

An FTB form is required from all vendors with a payment address outside of California. Submit form 587 or 590 or proof of submission of form 588 or 589:

For foreign vendors, click Foreign Entity for related instructions

Legal Name

IRS Taxpayer ID No.

(EIN or SSN)

Doing Business As (DBA)

If applicable:

CA SOS Entity/Registration No.

For further information click Office of Finance

Contact Street

Phone

Email

EIN - Employer Identification number SSN - Social Security Number

Print Name

Submit IRS W9 form (required)

SOS - California Secretary of State VRN - Vendor Registration Number

Zip Code

City

State/ Region

Remittance address:Country

Legend:

BTRC - Business Tax Registration Certificate DTFA - California Department of Tax & Fee Administration

CA DTFA Seller Permit No.

(If different from above)

Is the vendor providing healthcare/medical or legal services?

Requesting Division:

https://www.lawa.org/en/lawa-businesses/lawa-administrative-requirements https://www.ftb.ca.gov/forms/misc/1017.html?_sm_au_=isV6qr3j1DZSWN7sFVjLLLQ6vMVN1 https://finance.lacity.org https://www.irs.gov/forms-pubs/about-form-w-9 https://www.irs.gov/forms-pubs/about-form-w-8 https://www.irs.gov/forms-pubs/about-form-w-9 https://www.sos.ca.gov/business-programs/business-entities?adlt=strict https://www.cdtfa.ca.gov/taxes-and-fees/faqseller.htm www.lawa.org/en/lawa-businesses/lawa-administrative-requirements or further information

Vendor ID Form - Attach Back-Up Documents Instructions

If applicable, Attach Forms in Bonfire

IRS W9 Form (Required) California Franchise Tax Board (FTB) Form is required from all vendors with a payment address outside of California.

Copy of Business Tax Registration Certificate or copy of application submitted to the Office of Finance

A ffi da vi t o f N on -C ol lu si on

ENG. 3--1M--4-59---(R)

AFFIDAVIT TO ACCOMPANY PROPOSALS OR BIDS

STATE OF CALIFORNIA )

) ss.:

COUNTY OF )

being first duly sworn, deposes and says:

(Type or print name) that he or she is the of (Type or print title)

, who submits herewith ( Type or print name of company/firm) to the Board of Airport Commissioners the attached bid/proposal; that he or she is the person whose name is signed to the attached bid/proposal; that said bid/proposal is genuine; that the same is not sham or collusive; that all statements of fact therein are true; and that such bid/proposal was not made in the interest or behalf of any person, partnership, company, association, organization, or corporation not herein named or disclosed.

Affiant further deposes and says: that the bidder/proposer has not directly or indirectly by agreement, communication or conference with anyone, attempted to induce action prejudicial to the interests of the public body which is to award the contract, or of any other bidder/proposer, or anyone else interested in the proposed contract; and that the bidder/proposer has not in any manner sought by collusion to secure for himself/herself/itself/themselves, an advantage over any other bidder/proposer.

Affiant further deposes and says that prior to the public opening and reading of bids/proposals, said bidder/proposer:

(a) did not, directly or indirectly, induce or solicit anyone else to submit a false or sham bid/proposal;

(b) did not, directly or indirectly, collude, conspire, connive or agree with any one else that said bidder/proposer or anyone else would submit a false or sham bid, or that anyone should refrain from bidding or withdraw their bid/proposal;

(c) did not, in any manner, directly or indirectly, seek by agreement, communication or conference with anyone to raise or fix the bid price of said bidder/proposer or of anyone else, or to raise or fix any overhead, profit or cost element of their price or of that of anyone else;

(d) did not, directly or indirectly, submit their bid/proposal price or any breakdown thereof, or the contents thereof, or divulge information or data relative thereto, to any corporation, partnership, company, association organization, bid depository, or to any member or agent, thereof, or to any individual or group of individuals, except to the awarding authority or to any person or person who have a partnership or other financial interest with said bidder/proposer in their business.

Signed:

Name:

Title:

Subscribed and sworn to (or affirmed) before me on this day of , 20 , by

, proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me.

Notary Public Signature (Notarial Seal)

B id de r C on tri bu tio n C

EC

F or m

ATTENTION:

The following CEC Form 55 must be signed on page 1 and you are required to list all principals on Schedule A. Please refer to the attached instructions.

If you fail to sign the form or if you submit an incomplete CEC Form 55, your proposal/bid may be deemed non-responsive.

FORM Prohibited Contributors

(Bidders)

Revised Los Angeles City Charter § 470(c)(12), Los Angeles Municipal Code §§ 49.7.35(B)(3), (4) Page 1 of 3 ethics.lacity.org

This form must be completed in its entirety and submitted with your bid or proposal to the City department that is awarding the contract. Failure to submit a completed form may affect your bid or proposal. If you have questions about this form, please contact the Ethics Commission at (213) 978-1960.

Original Filing Amendment: Date of Signed Original ________________. Date of Last Amendment _________________.

Schedule Summary

Please complete all three of the following:

1. SCHEDULE A — Bidder’s Principals (check one) The bidder has one or more PRINCIPALS, as defined in LAMC § 49.7.35(A)(6).

At least one principal is required for entities. (If you check “Yes”, Schedule A is required.)

2. SCHEDULE B — Subcontractors and Their Principals (check one) The bidder has one or more SUBCONTRACTORS on this bid or proposal with subcontracts worth $100,000 or more. (If you check “Yes”, Schedule B is required.)

3. TOTAL NUMBER OF PAGES SUBMITTED (including this cover page): _______

Yes No

Yes No

Certification

Name Signature

Title Date

I certify the following under penalty of perjury under the laws of the City of Los Angeles and the state of California:

A) I understand, will comply with, and have notified my principals and subcontractors of the requirements and restrictions in Los Angeles City Charter § 470(c)(12) and any related ordinances; B) I understand that I must amend this form within ten business days if any information changes; C) I am the bidder named above or I am authorized to represent the bidder named above, and my name appears below; and D) The information provided in this form is true and complete to the best of my knowledge and belief.

Reference Number (Bid, Contract, or A ): ___ ______________________ Date Bid Submitted: ________________ __

Contract Description (Title of the RFP or City contract solicitation and description of the services to be provided):

Awarding Authority (Department awarding the contract): ________________________________________________________

Bidder Name: ____________________________________________________________________________________________________

Bidder Address: _________________________________________________________________________________________________

Bidder Email Address: __________________________________________ Bidder Phone Number: ________________________

(Bidders)

Revised Los Angeles City Charter § 470(c)(12), Los Angeles Municipal Code §§ 49.7.35(B)(3), (4) Page 2 of 3 ethics.lacity.org

Please identify the names and titles of all the bidder’s principals (attach additional sheets if necessary). Principals include a bidder’s board chair, president, chief executive officer, chief operating officer, and individuals who serve in the functional equivalent of one or more of those positions. Principals also include individuals who hold an ownership interest in the bidder of at least 20 percent and employees of the bidder who are authorized by the bid or proposal to represent the bidder before the City.

Name: _______________________________________________________________ Title: _____________________________________________________

Address: _______________________________________________________________________________________________________________________

Name: _______________________________________________________________ Title: _____________________________________________________

Address: _______________________________________________________________________________________________________________________

Name: _______________________________________________________________ Title: _____________________________________________________

Address: _______________________________________________________________________________________________________________________

Name: _______________________________________________________________ Title: _____________________________________________________

Address: _______________________________________________________________________________________________________________________

Name: _______________________________________________________________ Title: _____________________________________________________

Address: _______________________________________________________________________________________________________________________

Name: _______________________________________________________________ Title: _____________________________________________________

Address: _______________________________________________________________________________________________________________________

Name: _______________________________________________________________ Title: _____________________________________________________

Address: _______________________________________________________________________________________________________________________

Name: _______________________________________________________________ Title: _____________________________________________________

Address: _______________________________________________________________________________________________________________________

Name: _______________________________________________________________ Title: _____________________________________________________

Address: _______________________________________________________________________________________________________________________

Schedule A - Bidder’s Principals

Check this box if additional Schedule A pages are attached.

(Bidders)

Revised Los Angeles City Charter § 470(c)(12), Los Angeles Municipal Code §§ 49.7.35(B)(3), (4) Page 3 of 3 ethics.lacity.org

Please identify all subcontractors whose subcontracts are worth $100,000 or more. Separate Schedule B pages are required for each subcontractor who meets the threshold.

Schedule B - Subcontractors and Their Principals

Subcontractor’s Name

Subcontractor’s Address

Name: _______________________________________________________________ Title: _____________________________________________________

Address: _______________________________________________________________________________________________________________________

Name: _______________________________________________________________ Title: _____________________________________________________

Address: _______________________________________________________________________________________________________________________

Name: _______________________________________________________________ Title: _____________________________________________________

Address: _______________________________________________________________________________________________________________________

Name: _______________________________________________________________ Title: _____________________________________________________

Address: _______________________________________________________________________________________________________________________

Name: _______________________________________________________________ Title: _____________________________________________________

Address: _______________________________________________________________________________________________________________________

Name: _______________________________________________________________ Title: _____________________________________________________

Address: _______________________________________________________________________________________________________________________

Please check one of the following options:

This subcontractor has one or more principals. Yes* No

Each principal’s name and title must be identified below. Attach additional sheets if necessary. Principals include a subcontractor’s board chair, president, chief executive officer, chief operating officer, and individuals who serve in the functional equivalent of one or more of those positions. Principals also include individuals who hold an ownership interest in the subcontractor of at least 20 percent and employees of the subcontractor who are authorized by the bid or proposal to represent the subcontractor before the City.

Check this box if additional Schedule B pages are attached.

Form 55 Instructions | Revised February 2022

Form 55 Instructions

TABLE OF CONTENTS

INTRODUCTION

CONTACT INFORMATION

BIDDER RESPONSIBILITIES

PAGE 1: COVER PAGE AND BIDDER INFORMATION

Original or Amended Filing

Reference Number

Date Bid Submitted

Contract Description

Awarding Authority

Bidder Information

Schedule Summary

Certification

PAGE 2: SCHEDULE A – BIDDER’S PRINCIPALS

PAGE 3: SCHEDULE B – SUBCONTRACTORS AND THEIR PRINCIPALS

Form 55 Instructions | Revised February 2022 Page | 1

INTRODUCTION

Bidders who respond to certain City contract solicitations are limited by City law in their ability to spend money in connection with City elections. They are prohibited from making campaign contributions to and engaging in prohibited fundraising activity for City candidates and officeholders. They are also required to disclose their identities and the identities of their subcontractors and principals. Form 55 must be used for that purpose, and these instructions provide information about how to complete the form.

CONTACT INFORMATION

All questions about Form 55 and the laws regarding bidders and contractors should be directed to the Los Angeles City Ethics Commission:

ethics.commission@lacity.org

(213) 978-1960 phone

(213) 978-1988 fax

Whistleblower Hotline: (800) 824-4825

200 North Spring Street City Hall 24th Floor, Suite 2410

Los Angeles CA 90012 ethics.lacity.org https://ethics.lacity.org/

Form 55 Instructions | Revised February 2022 Page | 2

BIDDER RESPONSIBILITIES

A bidder is any person who bids on or submits a proposal or other response to a City contract solicitation, whether it involves a competitive or a non-competitive selection process.

You are a bidder required to complete Form 55 when all of the following apply:

• You submit a response or proposal for an RFP (request for proposals), RFQ (request for qualifications), RFB (request for bids), or any other written or verbal request to enter into a competitive or non-competitive City contract; and

• The contract is expected to be valued at $100,000 or more; and

• The contract must be approved by an elected office (City Council, Mayor, City Controller, or City

Attorney).

For purposes of Form 55, a contract is any agreement, franchise, lease, non-regulatory permit, land use license or easement, or concession with the City that meets the qualifications listed above. This includes an agreement for the performance of any work, service, or construction; the provision of any materials, goods, or equipment; the sale or purchase of property; and the making of grants. This also includes the selection of a pre-qualified list of persons to contract with the City if the RFQ’s not-to-exceed amount is at least $100,000 and the list selection requires approval by an elected City office. The definition does not include a contract with another government agency or a contract between a City proprietary department and an underwriting firm for a noncompetitive sale of revenue bonds.

Form 55 is used to disclose information about the following individuals and entities:

• You (the bidder);

• Your principals;

• Your subcontractors with subcontracts valued at $100,000 or more; and

• The principals of those subcontractors.

The campaign finance restrictions and requirements in Los Angeles City Charter § 470(c)(12) and Los Angeles Municipal Code § 49.7.35 apply to all of those individuals and entities. They are subject to the laws because of the positions they hold in relation to a City bid, not because they are disclosed on your Form 55. See section G for more information.

You are required to do all of the following:

1. Submit a completed Form 55 with your bid or proposal documents to the City department awarding the contract.

2. Amend your Form 55 within 10 business days if the information in the form changes after you submit it with your bid or proposal.

3. Notify your principals and subcontractors of the campaign finance restrictions and requirements that apply to them.

https://codelibrary.amlegal.com/codes/los_angeles/latest/laac/0-0-0-1874 https://codelibrary.amlegal.com/codes/los_angeles/latest/lamc/0-0-0-224321

Form 55 Instructions | Revised February 2022 Page | 3

PAGE 1: COVER PAGE AND BIDDER INFORMATION

You must complete all sections on the cover page.

ORIGINAL OR AMENDED FILING

ORIGINAL FILING

Check this box if this is the first time you are submitting a Form 55 in connection with the City contract that you are currently seeking or have been awarded.

AMENDMENT

Check this box if you are making changes to a Form 55 that you previously submitted in connection with the same City contract that you are seeking or have been awarded. For an amended filing, you must provide the later of:

• The date that your original Form 55 submission was signed; or

• The date that your most recent amendment was signed.

Example 1: Your law firm submitted a Form 55 last month when responding to an RFP from the City Attorney’s Office for legal services. Your law firm is now responding to an RFP with the Port of Los Angeles for a different contract to provide legal services. Check the “Original Filing” box on the Form 55 submitted to the Port, because this is the first time your firm is submitting Form 55 in connection with the contract with the Port.

Example 2: Your company submitted a Form 55 last week when responding to an RFP from the Department of Water and Power (DWP) for construction services. This week, your company moved its offices to a new location. Your company is required to update its contact information on the Form 55 submitted with its proposal. On a new Form 55, check the “Amendment” box, because your company is submitting an updated version of the Form 55 that was already submitted in connection with the construction services contract.

REFERENCE NUMBER

If applicable, provide the bid number, contract number, RAMP ID, or other identifying number or code assigned to the bid or contract that you seek. You can usually find this number on the City solicitation package (e.g., the RFP documents). However, not all solicitations have a reference number.

If there is no reference number for the bid or contract, enter “N/A” in this box.

DATE BID SUBMITTED

Enter the date that you submit your bid or response documents to the City department that will be awarding the contract.

Form 55 Instructions | Revised February 2022 Page | 4

CONTRACT DESCRIPTION

Provide the following information in this section:

• Title of the RFP, RFQ, or RFB, as listed on the City solicitation documents; and

• Description of the services to be provided under the contract.

A brief description of the contract is usually given in the RFP, RFQ, RFB, or solicitation documents. If you cannot find one, describe what will be performed under the contract.

AWARDING AUTHORITY

Provide the name of the City department that will be awarding the contract you seek.

BIDDER INFORMATION

Provide all of the following information:

• Bidder’s full legal name;

• Bidder’s business address;

• Bidder’s phone number; and

• Bidder’s email address.

The email address and telephone number provided in this section will be used to contact you if there are questions about the information provided in your Form 55.

Remember to amend your Form 55 to keep this information current.

SCHEDULE SUMMARY

ITEM 1: BIDDER’S PRINCIPALS

Indicate whether you have one or more principals. Check only one box (“Yes” or “No”).

A principal is any of the following:

• Board chair;

• President;

• Chief executive officer;

• Chief operating officer;

• An individual who serves in the functional equivalent of any of the above positions;

• An individual who holds an ownership interest of 20% or more; or

• An employee authorized to represent you before the City regarding this contract.

Form 55 Instructions | Revised February 2022 Page | 5

Example 1: You are putting together a proposal for a City contract on behalf of your employer, ABC, Inc. The proposal must include a Form 55. Because ABC, Inc. is an entity, you must check the “Yes” box and disclose ABC, Inc.’s principals on attached Schedule A pages.

Example 2: You are an individual submitting a proposal for a City contract and must complete a Form 55. You have two employees who are authorized to represent you before the City on this proposal. You must check the “Yes” box and disclose yourself and those employees as your principals on attached Schedule A pages.

All bidders who are entities are required to complete Schedule A. Most bidders are entities, so most bidders must check the “Yes” box and attach Schedule A pages to the cover page.

Attach to the cover page as many Schedule A pages as necessary to identify all of your principals.

ITEM 2: SUBCONTRACTORS AND THEIR PRINCIPALS

Indicate whether you have one or more subcontractors with subcontracts valued at $100,000 or more on the City contract you seek. Check only one box (“Yes” or “No”).

Example 1: Your construction company is submitting a response to a City RFP to provide construction services on a development project and must submit a Form 55. For the proposed project, you expect to hire ABC Company as a subcontractor that will perform $50,000 worth of work and XYZ Corporation as another subcontractor that will perform $200,000 worth of work.

Check the “Yes” box and attach Schedule B pages to disclose XYZ Corporation and its principals.

Example 2: Your architecture firm is submitting a response to a City RFP to provide landscape design services at a new park, and a Form 55 is required. For the proposed project, you expect to hire two subcontractors: More Sunshine, Inc., which will provide consulting services worth $30,000;

and Beautiful Parks Company, which will perform $85,000 worth of the work. Check the “No” box, indicating that you do not have any subcontractors with subcontracts valued at $100,000 or more.

Attach to the cover page as many Schedule B pages as necessary to identify all of your subcontractors and their principals.

ITEM 3: TOTAL NUMBER OF PAGES SUBMITTED

Enter the total number of Form 55 pages that you are submitting, including the cover page and all attached Schedule A and B pages.

CERTIFICATION

Form 55 must be signed by an authorized representative of the bidder. By signing this section, you are certifying under penalty of perjury all of the following:

• You understand and will comply with the requirements and restrictions in Los Angeles City Charter § 470(c)(12) and Los Angeles Municipal Code § 49.7.35;

• You have notified your principals and subcontractors of the requirements and restrictions; and

• The information you provided in the Form 55 and all attached pages is true and complete to the best of your knowledge and belief.

https://codelibrary.amlegal.com/codes/los_angeles/latest/laac/0-0-0-1874 https://codelibrary.amlegal.com/codes/los_angeles/latest/laac/0-0-0-1874

Form 55 Instructions | Revised February 2022 Page | 6

PAGE 2: SCHEDULE A – BIDDER’S PRINCIPALS

You must complete this section if you have principals. If you are an entity, this section is required. You must disclose the name, title, and business address for each of your principals. For a definition of “principal”, see the instructions for Page 1, Section G.

If you need more space, mark the box indicating that you are attaching additional Schedule A pages. You may attach as many additional Schedule A pages as necessary to disclose all of your principals.

Remember to include all Schedule A pages in the total page count on your cover page and attach them to the cover page.

PAGE 3: SCHEDULE B – SUBCONTRACTORS AND THEIR PRINCIPALS

You must complete this section if you will have subcontractors with subcontracts worth $100,000 or more.

You must disclose the names and business addresses of those subcontractors and the names, titles, and business addresses of their principals. For a definition of “principal”, see the instructions for Page 1, Section G.

You must submit at least one Schedule B page for each subcontractor. Provide the name and business address of the subcontractor, and then mark the appropriate box to indicate whether the subcontractor has principals.

If a subcontractor has more principals than will fit on one page—or if you have multiple subcontractors to disclose—mark the box indicating that you are attaching additional Schedule B pages. You may attach as many additional Schedule B pages as necessary to disclose all of your subcontractors with subcontracts worth $100,000 or more and all of their principals.

Remember to include all Schedule B pages in the total page count on your cover page and attach them to the cover page.

on tra ct or

R es po ns ib ilit y Q ue st io nn ai re a nd

P le dg e of om pl ia nc

LOS ANGELES WORLD AIRPORTS

CONTRACTOR RESPONSIBILITY PROGRAM

QUESTIONNAIRE

On December 4, 2001, the Board of Airport Commissioners adopted Resolution No. 21601, establishing LAWA’s Contractor Responsibility Program (CRP). The intent of the program is to ensure that all LAWA contractors have the necessary quality, fitness and capacity to perform the work set forth in the contract. To assist LAWA in making this determination, each bidder/proposer is required to complete and submit with the bid/proposal the attached CRP Questionnaire. If a non-competitive process is used to procure the contract, the proposed contractor is required to complete and submit the CRP Questionnaire to LAWA prior to execution of the contract. Submitted CRP questionnaires will become public records and information contained therein will be available for public review for at least fourteen (14) calendar days, except to the extent that such information is exempt from disclosure pursuant to applicable law.

The signatory of this questionnaire guarantees the truth and accuracy of all statements and answers to the questions herein. Failure to complete and submit this questionnaire may make the bid/proposal non-responsive and result in non-award of the proposed contract. During the review period if the bidder/proposer or contractor (collectively referred to hereafter as “bidder/proposer”) is found non-responsible, he/she is entitled to an Administrative Hearing if a written request is submitted to LAWA within ten (10) working days from the date LAWA issued the non-responsibility notice. Final determination of non-responsibility will result in disqualification of the bid/proposal or forfeiture of the proposed contract.

All Questionnaire responses must be typewritten or printed in ink. Where an explanation is required or where additional space is needed to explain an answer, use the CRP Questionnaire Attachment A. Submit the completed and signed Questionnaire and all attachments to LAWA. Retain a copy of this completed questionnaire for future reference. Contractors shall submit updated information to LAWA within thirty (30) days if changes have occurred that would make any of the responses inaccurate in any way.

A. PROJECT TITLE: _______________________________________________________________________

B. BIDDER/CONTRACTOR INFORMATION:

Legal Name DBA

Street Address City State Zip

Contact Person, Title Phone Fax

C. TYPE OF SUBMISSION: The CRP Questionnaire being submitted is:

An initial submission of a CRP Questionnaire. Please complete all questions and sign Attachment A.

An update of a prior CRP Questionnaire dated _____/_____/_____. Please complete all questions and sign Attachment A.

A copy of the initial CRP Questionnaire dated _____/_____/_____/. Please sign below and return this page.

I certify under penalty of perjury under the laws of the State of California that there has been no change to any of the responses since the firm submitted the last CRP Questionnaire.

Print Name, Title Signature Date

CRP Questionnaire Revised 3/2019.doc

Contractor Responsibility Program Questionnaire

A. OWNERSHIP AND NAME CHANGES

1a. In the past five (5) years, has the name of the bidder/proposer (also referred to herein as “your firm”) changed?

If Yes, list on Attachment A all prior legal and D.B.A. names used by the bidder/proposer, the addresses of each of the identified entities, and the dates when each identified entity used those names. Additionally, please explain in detail the specific reason(s) for each name change.

1b. In the past five (5) years, has the owner of your firm (if your firm is a sole proprietorship) or any partner of your firm (if your firm is a partnership), or any officer of your firm (if your firm is a corporation) engaged in the same or similar type of business as the current firm?

If Yes, list on Attachment A the names of those firms.

B. FINANCIAL RESOURCES AND RESPONSIBILITY

2. In the past five (5) years, has your firm ever been the debtor in a bankruptcy proceeding?

If Yes, explain on Attachment A the specific circumstances and dates surrounding each instance.

3. Is your company now in the process of, or in negotiations toward, or in preparations for being sold?

If Yes, explain on Attachment A the specific circumstances, including to whom being sold and principal contact information.

4. In the past five (5) years, has your firm's financial position significantly changed?

If Yes, explain the specific circumstances on Attachment A.

5. In the past five (5) years, has your firm ever been denied bonding?

If Yes, explain on Attachment A the specific circumstances surrounding each instance and include the name of the bonding company.

6. In the past five (5) years, has any bonding company made any payments to satisfy any claims made against a bond issued on your firm's behalf or a firm where you were the principal?

If Yes, explain on Attachment A the specific circumstances surrounding each instance.

PERFORMANCE HISTORY

7. In the past five (5) years, has your firm or the owner of your firm (if your firm is a sole proprietorship) or any partner of your firm (if your firm is a partnership), or any officer of your firm (if your firm is a corporation) defaulted under a contract with a governmental entity or with a private individual or entity?

If Yes, explain on Attachment A the specific circumstances surrounding each instance.

8. In the past five (5) years, has a governmental or private entity or individual terminated your firm's contract prior to completion of the contract?

If Yes, explain on Attachment A the specific circumstances surrounding each instance, and principal contact information.

9. In the past five (5) years, has your firm ever failed to meet any scheduled deliverables or milestones?

If Yes, explain on Attachment A the circumstances surrounding each instance, and principal contact information.

10. In the past ten (10) years, has the bidder/proposer had any contracts with any private or governmental entity to perform work which is similar, in any way, to the work to be performed on the contract for which you are bidding or proposing?

If Yes, list on a separate…