ADD DOCUMENT

TO BID

SPECIFICATIONS

Project Name:

Project Number:

Agency:

Project Manager:

Project Location:

Allegheny County Economic Development Federally-Funded Projects

Procurement Compliance Package Checklist

PROCUREMENT DOCUMENTS TO BE SUBMITTED BY THE PRIME CONTRACTOR/SUBCONTRACTOR/SUPPLIER

The documents listed on this checklist must be included in your bid submission, unless otherwise noted below. These documents are to be submitted to the Agency by all contractors and forwarded to the ACED Project Manager for final approval. The documents pertaining to Subcontractors must be provided within 10 days of the project award letter, if not included with the Prime Contractor’s original bid proposal.

INITIAL TO INDICATE THE DOCUMENTS HAVE BEEN PROVIDED

Agency / Project Manager

Revised October 2025

Notice to Prime Contractors/Subcontractors This document must be included in the bid package and completed by the Prime Contractor/Subcontractor as part of the original bid proposal.

Award Verification for Prime/ Subcontractors (Form-PL3/PL4) This document must be included in the bid package and completed by the Agency/Prime Contractor/Subcontractor as part of the original bid proposal.

Schedule of Subcontractors This document must be included in the bid package and submitted no more than 10 days after contract is awarded.

Agency Prime Contractor/Subcontractor Verification This document must be included in the bid package and submitted no more than 10 days after contract is awarded.

Fringe Benefit Letter This document must be included in the bid package and completed by the Prime Contractor/Subcontractor as part of the original bid proposal.

U.S. Department of Labor Certified Payrolls/ Apprentice Registrations Upon being awarded the contract, all contractors must submit a weekly certified payroll sheet to the Project Manager. This document is two (2) pages. Provide valid apprenticeship program documents for all apprentices.

Construction Stoppage Statement This document is provided to the Project Manager if the project requires a delay of work for six weeks or more.

Section 3 - Contractor’s Compliance Certification (see separate Section 3 Packet) For housing construction, rehabilitation, or other public construction: Agencies that receive assistance that exceeds $200,000, contractors/ subcontractors are required to comply with Section 3 requirements.

Section 3 Monthly Employment and Business Utilization Reports (Due Monthly)

Final Schedule of Subcontractors This document ensures that all subcontractors who worked on the project are recorded

Award Verification for Suppliers / Professional Services -PL5 This document is to be submitted for all suppliers or professional services receiving $1,000 or more.

Agency/Prime Contractor/SubcontractorSupplier / Professional Services Verification This document must be included in the bid package and submitted no more than 10 days after contract is awarded.

Allegheny County Economic Development Federally-Funded Projects

Procurement Compliance / Bid Package Documents

NOTICE TO PRIME CONTRACTORS/SUBCONTRACTORS

PROJECT NAME__________________________________________ Project #_______________________

PROJECT LOCATION_____________________________________________________________________

Agency_______________________________________________________________________________

All contractors for the above-named project understand that any payment requests for the project will not be processed by Allegheny County Economic Development until all requirements are met. It is the responsibility of the Agency to make sure that all the paperwork is submitted by everyone on the project before request for payments are submitted.

It is further understood that the Prime Contractor is responsible for collecting all paperwork for each Subcontractor hired and must submit it to the Agency, along with a signed agreement between the Prime and Subcontractor(s. Both Prime and Subcontractors are required to retain copies of all paperwork for this Federally-funded project for a period of three (3) years after completion of the project.

By signing this form, you have acknowledged that you did receive a copy of the U.S. Department of Housing and Urban Development’s Federal Labor Standards Provision and that you understand all the requirements.

The Prime Contractor was given: U.S. Department of Labor publication WH 1321, “Notice to All Employees”; U.S.

Occupational Safety and Health Administration publication 3165, “Job Safety & Health Protection Poster”; and U.S.

Department of Housing and Urban Development publication 901, “Equal Employment Opportunity.” These posters, along with a copy of the issued U.S. Department of Labor Wage Decision, are to be displayed in a prominent place at the work site.

The contractor understands that no basic wage can be lower than the wage issued: if fringe benefits are not paid into a special fund, the fringe benefits listed for any particular trade in the wage decision is added to, and becomes part of, the basic hourly wage for the employee performing the work.

All payrolls must be forwarded within seven days after the pay period. Payrolls must be certified on the reverse side and Legally valid electronic signatures are acceptable. A legally valid electronic signature includes any electronic process that indicates acceptance of the certified payroll record, and includes an electronic method of verifying the signer’s identity. The electronic signature must show a dated time stamp. It should include the physical date, time and persons name. Note: Photocopies, stamps, or non-dated timestamps of signatures do not satisfy this requirement.

Acknowledgment by Prime Contractor____ Subcontractor____

Company Name_________________________________________________________________________

Authorized Official:______________________________________________________________________

Signature:__________________________________________________________Date:______________

This form must be signed by the Prime Contractor or Subcontractor

Revised October 2025

ADD DOCUMENT

SPECIFICATIONS

Project #

Project Name:

Date Contract Awarded to Contractor Above:

Agency Signature

Print Name

Date:Company Signature:

Title:

THIS PORTION IS TO BE COMPLETED BY OPERATING AGENCY ONLY:

Total Project Contract Award Amount $

Project Location:

Date

Title

Revised October 2025

State:

Email Address:

IRS ID Number:

Zip Code:

CAGE Number: CAGE Expiration Date:

Print Name:

Allegheny County Economic Development Federally-Funded Projects Procurement Compliance / Bid Package Documents

Above Contractor Contract Amount: $

Above Contractor CDBG Contract Amount $___________________

Above Contractor HOME Contract Amount $___________________

Above Contractor HARP Contract Amount $_________________

AWARD VERIFICATION FOR PRIME/ SUBCONTRACTORS- PL3/PL4

THIS FORM MUST BE COMPLETED, SIGNED, AND SUBMITTED FOR ALL CONTRACTORS USED ON THE JOB.

ALL INFORMATION MUST BE FILLED IN COMPLETELY OR FORM MUST BE RESUBMITTED.

(Check One)

PL3- Award Notice for Prime Contractor PL4- Award Notice for Subcontractor

To be filled out by Prime/ Subcontractor:

ADD DOCUMENT

TO BID

SPECIFICATIONS

DUNS Number:

Company Name:

Address:

City:

Telephone Number:

SCHEDULE OF SUBCONTRACTORS

PRIME CONTRACTORS: This form must be submitted to the Agency no more than ten days after you have received a bid award letter notifying you that you have been awarded the contract. Failure to submit this form could disqualify your bid.

SUB CONTRACTORS: This form must be completed and submitted to the prime contractor

PROJECT NAME

PROJECT LOCATION PROJECT #

CONTRACTOR’S NAME

IRS ID#_ DATE

STATE:

IRS ID#:

Revised October 2025

ZIP:

Check here if no sub contractors will be utilized by the above contractor

ADD DOCUMENT

TO BID

SPECIFICATIONS

COMPANY NAME:

ADDRESS:

CITY:

TELEPHONE #:

Type of Work:

ZIP:

COMPANY NAME:

ADDRESS:

CITY:

STATE:

TELEPHONE #:

IRS ID#:

Type of Work:

ZIP:

COMPANY NAME:

ADDRESS:

CITY:

STATE:

TELEPHONE #:

IRS ID#:

Type of Work:

ZIP:

COMPANY NAME:

ADDRESS:

CITY:

STATE:

TELEPHONE #:

IRS ID#:

Type of Work:

AGENCY > PRIME CONTRACTOR / SUBCONTRACTOR VERIFICATION

(Agency/Prime/Subcontractor Legal Name) has an agreement with

(Prime/Subcontractor Legal Name) to work on the

(Project Name)_ located in the area of , PA.

If awarded the contract, the above Agency/Prime Contractor/Subcontractor intends to have a written, binding contract with the above Prime Contractor or Subcontractor to perform the following work:

(Provide Brief Description of the Type of Work Agreed Upon)

Agency’s Authorized Signature:_____________________________________________ Date:

Agency’s Printed Name:___________________________________________________ Title:

Prime Contractor’s Authorized Signature:_____________________________________ Date:

Prime Contractor’s Printed Name: __________________________________________ Title:

Subcontractor’s Authorized Signature:_______________________________________ Date:

Subcontractor’s Printed Name: _____________________________________________ Title

Revised October 2025

The contract dollar amount as specified in the written agreement is $

The portion of the above to be reimbursed/paid with Federal funds is $

THIS FORM MUST BE SUBMITTED FOR EVERY PRIME / SUBCONTRACTOR HIRED FOR THIS FEDERALLY-FUNDED PROJECT AND SUBMITTED TO THE AGENCY. THIS FORM IS TO BE SUBMITTED 10 DAYS AFTER CONTRACT IS AWARDED.

Project #:

ADD DOCUMENT

FRINGE BENEFIT LETTER

Wage Decision Serial #

IRS ID#

City State

Project Name_

Project #

Contract Amount $

Prime/Subcontractor Company Name (Circle One)_

Address:

FRINGE BENEFITS:

All Fringe Benefits will be paid as follows:

_Fringes will be included in the basic hourly wage rates.

_Fringes will be paid into the following Benefit Plans: (List Hourly Fringe Benefit Rate)

Name of Plan:

Address:

City:

Classification: Hourly Fringe Benefit Rate

Name of Plan:

Address:

City:

Classification: Hourly Fringe Benefit Rate

Name of Plan:

Address:

City:

Classification: Hourly Fringe Benefit Rate

Prime/ Subcontractor’s Signature

Printed Name: Date:

Revised October 2025

Zip Code

State: Zip Code:

State: Zip Code:

State: Zip Code:

ADD DOCUMENT

Rev. January 2025 OMB No.: 1235-0008 Expires: 01/31/2028

U.S. Department of Labor Wage and Hour Division

Davis-Bacon and Related Acts Weekly Cer� fied Payroll Form (For Contractor’s Op� onal Use; See Instruc� ons at www.dol.gov/whd/forms/wh347instr.htm)

Unless otherwise noted, the informa� on requested is specific to the named project below.

Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number.

SUBMISSION OF FINAL DBRA CERTIFIED PAYROLL FORM PRIME CONTRACTOR SUBCONTRACTOR

PROJECT NAME PROJECT NO. or CONTRACT NO. CERTIFIED PAYROLL NO. PRIME CONTRACTOR’S/SUBCONTRACTOR’S BUSINESS NAME

PROJECT LOCATION WAGE DETERMINATION NO. WEEK ENDING DATE PRIME CONTRACTOR’S/SUBCONTRACTOR’S BUSINESS ADDRESS

(1A) (1B) (1C) (1D) (1E) (2) (3) (4) (5) (6A) (6B) (6C) (7A) (7B) (8) (9)

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While use of Form WH-347 itself is op. onal, covered contractors and subcontractors performing work on Federal or federally assisted construc � on contracts are required by the DBRA regula � ons and the contract clauses to submit payroll informa� on on a weekly basis. The Copeland Act (40 U.S.C. § 3145) requires contractors and subcontractors performing work on Federal or federally financed construc � on contracts to, on a weekly basis, “furnish a statement on the wages paid each employee during the prior week.” U.S. Department of Labor (DOL) Regula � ons at 29 C.F.R. § 5.5(a)(3)(ii) require contractors and subcontractors to submit weekly cer� fied payrolls to the appropriate Federal agency if the agency is a party to the contract (or, if the agency is not such a party, to the applicant, sponsor, owner, or other en� ty, as the case may be, that maintains such records, for transmission to the Federal agency). Each cer� fied payroll must be accompanied by a signed “Statement of Compliance” (e.g., page 2 of the WH-347 or another document with iden � cal wording) indica � ng that the cer � fied payrolls are accurate and complete, and that each laborer or mechanic has been paid not less than the required Davis-Bacon prevailing wage rate(s) (including any fringe benefits) for the work performed. DOL and contrac � ng agencies receiving this informa � on review the informa � on to determine whether workers have received legally required wages and fringe benefits.

Public Burden Statement We esti ate that it will take an average of 55 minutes to complete this collecti n, including � me for reviewing instructi ns, searching exis � ng data sources, gathering and maintaining the data needed, and comple � ng and reviewing the collec � on of informa � on. If you have any comments regarding these es � mates or any other aspect of this collec � on, including sugges � ons for reducing this burden, send them to the Administrator, Wage and Hour Division, U.S. Department of Labor, Room S3502, 200 Cons� tu � on Avenue, N.W. Washington, D.C. 20210 (over)

PROJECT NAME PROJECT NO. or CONTRACT NO. PAYROLL NO. PRIME CONTRACTOR’S/SUBCONTRACTOR’S BUSINESS NAME

PROJECT LOCATION WEEK ENDING DATE CERTIFYING OFFICIAL’s NAME AND TITLE

I paid or supervised the payment of the laborers or mechanics working on the above project during the stated � me period. I cer� fy the following:

The payroll informa� on submi� ed with this statement is correct and complete for the above project during the above period, and the wage and fringe benefit rates paid to the workers, including credit taken for the reasonably an� cipated costs of a bona fide fringe benefit plan, fund or program, are not less than the applicable wage and fringe benefits rates for the classifica� on(s) of work actually performed, as specified in the wage determina� on(s) incorporated into the contract.

All regular payrolls and all other basic records that the contractor is required to maintain for this payroll period are complete and accurate and will be made available upon request from the agency or the Department of Labor.

The classifica� ons reported for each laborer or mechanic are the classifica� on(s) of work that each worker actually performed.

Any workers paid as appren� ces during the above period are duly registered in a bona fide appren� ceship program registered with the Office of Appren� ceship, Employment and Training Administra� on, United States Department of Labor (“OA”), or a State Appren� ceship Agency (“SAA”) recognized by Department of Labor. I have verified the registered appren� ceship program informa� on provided below as accurate and applicable to any appren� ces iden� fied on page 1 of this form.

APPRENTICESHIP PROGRAM NAME REGISTERED NAME OF LABOR CLASSIFICATION

OA SAA

OA SAA

OA SAA

Fringe benefits have been paid in cash and/or to bona fide fringe benefit plans, funds, or programs. Where the contractor is claiming an hourly credit for their contribu � ons to or reasonably an� cipated costs of a bona fide fringe benefit plan, fund, or program, provide plan informa� on and the hourly credit claimed for each worker listed on the previous page of this form.

HOURLY CREDIT FOR FRINGE BENEFITS

If an amount is listed in (6B) on the first page of this certified payroll form, enter the hourly credit claimed under each plan name, type and number for each worker and check whether the plan is funded or unfunded.

NAME OF WORKER

FB NAME FB NAME FB NAME FB NAME FB NAME FB NAME

TOTAL

HOURLY

CREDIT

FB TYPE FB TYPE FB TYPE FB TYPE FB TYPE FB TYPE

PLAN NO. PLAN NO. PLAN NO. PLAN NO. PLAN NO. PLAN NO.

Funded Unfunded Funded Unfunded Funded Unfunded Funded Unfunded Funded Unfunded Funded Unfunded Hourly Credit $ Hourly Credit $ Hourly Credit $ Hourly Credit $ Hourly Credit $ Hourly Credit $ $ Hourly Credit $ Hourly Credit $ Hourly Credit $ Hourly Credit $ Hourly Credit $ Hourly Credit $ $ Hourly Credit $ Hourly Credit $ Hourly Credit $ Hourly Credit $ Hourly Credit $ Hourly Credit $ $ Hourly Credit $ Hourly Credit $ Hourly Credit $ Hourly Credit $ Hourly Credit $ Hourly Credit $ $ Hourly Credit $ Hourly Credit $ Hourly Credit $ Hourly Credit $ Hourly Credit $ Hourly Credit $ $ Hourly Credit $ Hourly Credit $ Hourly Credit $ Hourly Credit $ Hourly Credit $ Hourly Credit $ $ Hourly Credit $ Hourly Credit $ Hourly Credit $ Hourly Credit $ Hourly Credit $ Hourly Credit $ $ Hourly Credit $ Hourly Credit $ Hourly Credit $ Hourly Credit $ Hourly Credit $ Hrly Credit $ $

All workers on the project have been paid the full weekly wages earned, and no rebates or deduc � ons have been or will be made either directly or indirectly, other than permissible deduc � ons as defined in 29 CFR part 3.

ADDITIONAL REMARKS

SIGNATURE OF CERTIFYING OFFICIAL DATE TELEPHONE NUMBER EMAIL ADDRESS

THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION (SEE SECTION 1001 OF TITLE 18 AND SECTION 3729 OF TITLE 31 OF THE UNITED STATES CODE), AS WELL AS DEBARMENT FROM FUTURE FEDERAL AND FEDERALLY-ASSISTED CONTRACTS. INFORMATION REPORTED IN CERTIFIED PAYROLLS MAY BE SUBJECT TO DISCLOSURE IN RESPONSE TO A FREEDOM OF INFORMATION ACT REQUEST.

How to Correctly Fill Out the New WH-347 Form (2025)

Completing the WH-347 Payroll Form is optional; contractors may utilize their own payroll system as long as it conforms to the WH-347 Payroll Form and contains all the necessary information. If you utilize the WH-347

Payroll Form as a pdf, saving it electronically aids in making any needed corrections.

Payrolls must be numbered sequentially. The last payroll should be marked “Final.”

Check one of the boxes and list the name of the Prime/Subcontractor.

Complete address of the Prime/Subcontractor should be listed

The days and dates indicate the weekly pay period. (Date should match with week ending directly above)

The wage determination number is found on the Wage Decision Letter.

List the name of the project, its location, and the project number.

21.

October 2025

Employee Information Section

Line Items:

1A) The sequential number of the employees listed.

1B) Workers' Last Name

1C) Workers’ First Name

1D) Workers' Middle Initial

1E) Works unique identifiers, such as employee number or Social Security Number.

2) Write J if the employee is a journey worker.

Write RA if the employee is a registered Apprentice

3) Classification or trade title that correlates with one of the listed in the wage determina�on. Examples: Carpenter, Electrician, Laborer Class II, Power Equipment Operator Class III, etc

Work Week Hours

Days of the Work Week (4)

• Top: Days of the Work Week o EXAMPLE: M, Tu, W, Th, F, Sat, Sun

• Bottom: Numerical Day of the Week o EXAMPLE: 4/22, 4/23, 4/24, 4/25, 4/26, 4/27, 4/28

Work weeks aren’t required to occur on a Monday-Sunday structure and would follow the date range of your pay period

Hours Worked Each Day

• ST (Straight Time) – Number of hours worked at a regular, non-overtime rate for each day

• OT (Over�me Time) – Number of hours worked past the straight time rate for each date. Overtime only accumulates over 40 Straight hours and must be paid at time and a half.

Total Hours Worked for the Week (5)

• ST (Straight Time) – Calculate the total hours worked at a regular (non-overtime rate for each day)

• OT (Over�me Time) – Calculate the hours worked past the straight time rate for each date

Payment Section

Hourly Wage and Fringe Benefit Details (6A – 6C)

• Hourly Rate Paid for ST & OT (6A): Enter the actual hourly rate paid for straight time and overtime. The wage rate can be found in the Wage Determination.

• Total Fringe Benefit Credit (6B): Document the total gross fringe benefit credit amount. This should reflect the total dollar value of fringe benefits provided based on the hours worked [Example: If the hourly fringe is $15 and the employee worked a total of 8 hours, the total credit would be $120]

• Payment in Lieu of Fringe Benefits (6C): Record the total cash amount paid directly to the worker. This is in place of an actual fringe benefit plan.

Gross and Net Pay & Deduc�ons Details (7A – 9)

• Gross Amount Earned (7A): Calculate the total earnings for hours worked on a federal project. (ONE Given project)

• Gross Amount Earned for ALL WORK (7B): Include earnings from the project worked on that week

• Deduc�ons for ALL WORK (8): Provide a breakdown of all deductions, including federal and state taxes, FICA contributions, and all other deductions.

• Net Pay to Worker for ALL WORK (9): Enter the final take-home pay after all deductions.

Certification Section

Authorized Certifier Information. This individual should verify that they were given authorization by a party to certify all information included on the payroll report.

Their name and title/position should be written in.

Certification of Fringe Benefits Section

Cer�fica�on of Fringe Benefits If you’re claiming an hourly credit for contributions to benefit plans, funds or programs, this box should be checked with the following information completed:

o Name of Worker o FB Name: Fringe Benefit Name (Ex. Anthem) o FB Type: Fringe Benefit Type (Ex. Health Insurance) o Plan No.

o Funded or Unfunded o Hourly Credit o Total Hourly Credit o Per the DOL, if more than six bona fide fringe benefits are provided to the workers for which the contractor is claiming a credit, submit an addendum for each providing the information requested in this section.

Cer�fica�on of Deduc�ons Certifies that all workers on the project have been paid the full weekly wages earned. No deductions other than what is permissible.

Statement of Compliance

Addi�onal Remarks: Optional space for additional information on deductions, hourly cost of fringe benefits, or explanations.

Signature of Cer�fying Official, Date, Telephone Number, and Email Address

• The Statement of Compliance must be signed by the contractor or subcontractor, or their agent, who paid or supervised the payment of the workers under the contract during the weekly time period covered by the form.

• Enter the phone number and email address of the individual who is signing the statement and the date signed.

• Legally valid electronic signatures are acceptable. A legally valid electronic signature includes any electronic process that indicates acceptance of the certified payroll record, and includes an electronic method of verifying the signer’s identity. The electronic signature must show a dated time stamp. It should include the physical date, time and persons name. Note: Photocopies, stamps, or non-dated timestamps of signatures do not satisfy this requirement.

CONSTRUCTION STOPPAGE STATEMENT

State Zip Code

If there is no work performed on the project for SIX WEEKS or MORE, this form must be completed and submitted to the Agency by the Contractor.

Company Name

Company Address

City

Telephone Number

Project #

Project Name

Project Address City Zip Code

I certify that work on this project will be delayed for a period of six (6) weeks or more effective as of . this date _. The work on this project will resume on (date)_

The payroll number which was last submitted to the AGENCY was payroll number .

Therefore when the work resumes, the payrolls will be numbered starting with the next sequential number from the last payroll submitted.

Authorized Signature: Prime Contractor_ Date Print Name Prime Contractor

Authorized Signature: Subcontractor_ Date Print Name Subcontractor

This form must be submitted to the AGENCY to be forwarded to the Project Manager at Allegheny County Economic Development.

Date

Received by (Agenc Name)

Authorized Signature

Received by ACED Project Manager_

Signature Date

Revised October 2025

State

ADD DOCUMENT

Revised October 2025

Allegheny County Economic Development Federally-Funded Projects Procurement Compliance / Bid Package Documents

FINAL SCHEDULE OF SUBCONTRACTORS

PRIME CONTRACTORS: This form must be submitted to the Agency after you have completed all the work on the project. Failure to submit this form could delay final grant disbursement.

SUBCONTRACTORS: This form must be completed and submitted to the prime contractor

PROJECT NAME

PROJECT LOCATION PROJECT #

CONTRACTOR’S NAME

IRS ID#_ DATE

Check here if no sub-contractors were utilized by the above contractor

COMPANY NAME

ADDRESS_______________________________________________CITY_____________________________

STATE ____ ZIP________

TELEPHONE: ___________________ IRS ID: _____________

Type of Work: __________________________________________

First Day on Jobsite: _____________________

Final Day on Jobsite: ____________________

Amount reimbursed with grant funds: $__________________

COMPANY NAME

ADDRESS_______________________________________________CITY_____________________________

STATE ____ ZIP________

TELEPHONE: ___________________ IRS ID: _____________

Type of Work: __________________________________________

First Day on Jobsite: _____________________

Final Day on Jobsite: ____________________

Amount reimbursed with grant funds: $__________________

COMPANY NAME

ADDRESS_______________________________________________CITY_____________________________

STATE ____ ZIP________

TELEPHONE: ___________________ IRS ID: _____________

Type of Work: __________________________________________

First Day on Jobsite: _____________________

Final Day on Jobsite: ____________________

Amount reimbursed with grant funds: $__________________

ADD DOCUMENT

Project #

Project Name:

Date Contract Awarded to Contractor Above:

Agency Signature

Print Name

Date:Company Signature:

Title:

THIS PORTION IS TO BE COMPLETED BY OPERATING AGENCY ONLY:

Total Project Contract Award Amount $

Project Location:

Date

Title

Revised October 2025

State:

Email Address:

IRS ID Number:

Zip Code:

CAGE Number: CAGE Expiration Date:

Print Name:

Allegheny County Economic Development Federally-Funded Projects Procurement Compliance / Bid Package Documents

Above Contractor Contract Amount: $

Above Contractor CDBG Contract Amount $___________________

Above Contractor HOME Contract Amount $___________________

Above Contractor HARP Contract Amount $_________________

ADD DOCUMENT

TO BID

SPECIFICATIONS

DUNS Number:

Company Name:

Address:

City:

Telephone Number:

AWARD VERIFICATION FOR SUPPLIERS AND PROFESSIONAL SERVICES–PL5

THIS FORM MUST BE COMPLETED, SIGNED, AND SUBMITTED FOR SUPPLIERS ($1,000 or more) AND ALL PROFESSIONAL SERVICES USED ON THE JOB. ALL INFORMATION MUST BE FILLED IN COMPLETELY OR FORM MUST BE RESUBMITTED.

PL5—Award Notice for Suppliers and Professional Services

This portion to be completed by Supplier / Professional Service Provider:

Allegheny County Economic Development Federally-Funded Projects Procurement Compliance / Bid Package Documents

AGENCY / PRIME CONTRACTOR / SUBCONTRACTOR > SUPPLIER/

PROFESSIONAL SERVICES VERIFICATION FORM

(Agency/Prime/Subcontractor Legal Name) has an agreement with

(Supplier/ Professional Service Legal Name/ Address) to work on the

(Project Name) _ located in the area of _, PA.

If awarded the contract, the above Agency/Prime Contractor/Subcontractor intends to have a binding contract with the above supplier or professional service to provide the following materials or services:

(Provide a Brief Description of the Supplies or Professional Services Agreed Upon)

Agency Authorized Signature: ______________________________________________Date: ______________________

Agency’s Printed Name: _____________________________________________Title: _____________________________

Prime Contractor’s Authorized Signature: ______________________________________Date: ______________________

Prime Contractor’s Printed Name: ______________________________________ Title: ____________________________

Subcontractor’s Authorized Signature: ________________________________________ Date: ______________________

Subcontractor’s Printed Name: _________________________________________ Title: ____________________________

Supplier / Service Authorized Signature: _______________________________________Date: ______________________

Supplier / Service Printed Name: ________________________________________Title: ____________________________

THIS FORM MUST BE SUBMITTED FOR EVERY SUPPLIER ($1,000 or more) and ALL PROFESSIONAL

SERVICES HIRED FOR THIS FEDERALLY-FUNDED PROJECT AND SUBMITTED TO THE AGENCY.

Project #:

. . The contract dollar amount as specified in the written agreement is $

The portion of the above to be reimbursed/paid with Federal funds is $ . .

Revised October 2025

ADD DOCUMENT

866-487-9243 dol.gov/agencies/whd

PREVAILING

WAGES

You must be paid not less than the wage rate listed in the Davis-Bacon Wage Decision posted with this notice for the work you perform.

OVERTIME You must be paid not less than one and one-half times your basic rate of pay for all hours worked over 40 in a work week. There are few exceptions.

ENFORCEMENT Contract payments can be withheld to ensure workers receive wages and overtime pay due, and liquidated damages may apply if overtime pay requirements are not met. Davis-Bacon contract clauses allow contract termination and debarment of contractors from future federal contracts for three years. A contractor who falsifies certified payroll records or induces wage kickbacks may be subject to civil or criminal prosecution, fines and/or imprisonment.

APPRENTICES Apprentice rates apply only to apprentices properly registered under approved federal or state apprenticeship programs.

RETALIATION The law prohibits discharging or otherwise retaliating against workers for filing a complaint, cooperating in an investigation, or testifying in a proceeding under the Davis-Bacon and Related Acts.

PROPER PAY If you do not receive proper pay, or require further information on the applicable wages, contact the Contracting Officer listed below:

or contact the U.S. Department of Labor’s Wage and Hour Division.

WORKER RIGHTS

UNDER THE DAVIS-BACON ACT

FOR LABORERS AND MECHANICS

WORKING ON FEDERAL OR

FEDERALLY ASSISTED

CONSTRUCTION PROJECTS

WH1321 REV 07/24

WAGE AND HOUR DIVISION

UNITED STATES DEPARTMENT OF LABOR

The law requires employers to display this poster where workers can readily see it.

Allegheny County Economic Development 436 Seventh Avenue, Suite 500

Pittsburgh, PA 15219 412-350-100

Equal Employment Opportunity is

THE LAW

Private Employers, State and Local Governments, Educational Institutions, Employment Agencies and Labor Organizations

Applicants to and employees of most private employers, state and local governments, educational institutions, employment agencies and labor organizations are protected under Federal law from discrimination on the following bases:

RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN

Title VII of the Civil Rights Act of 1964, as amended, protects applicants and employees from discrimination in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment, on the basis of race, color, religion, sex (including pregnancy), or national origin. Religious discrimination includes failing to reasonably accommodate an employee’s religious practices where the accommodation does not impose undue hardship.

DISABILITY

Title I and Title V of the Americans with Disabilities Act of 1990, as amended, protect qualified individuals from discrimination on the basis of disability in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment. Disability discrimination includes not making reasonable accommodation to the known physical or mental limitations of an otherwise qualified individual with a disability who is an applicant or employee, barring undue hardship.

AGE

The Age Discrimination in Employment Act of 1967, as amended, protects applicants and employees 40 years of age or older from discrimination based on age in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment.

SEX (WAGES)

In addition to sex discrimination prohibited by Title VII of the Civil Rights Act, as amended, the Equal Pay Act of 1963, as amended, prohibits sex discrimination in the payment of wages to women and men performing substantially equal work, in jobs that require equal skill, effort, and responsibility, under similar working conditions, in the same establishment.

GENETICS

Title II of the Genetic Information Nondiscrimination Act of 2008 protects applicants and employees from discrimination based on genetic information in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment. GINA also restricts employers’ acquisition of genetic information and strictly limits disclosure of genetic information. Genetic information includes information about genetic tests of applicants, employees, or their family members; the manifestation of diseases or disorders in family members (family medical history); and requests for or receipt of genetic services by applicants, employees, or their family members.

RETALIATION

All of these Federal laws prohibit covered entities from retaliating against a person who files a charge of discrimination, participates in a discrimination proceeding, or otherwise opposes an unlawful employment practice.

WHAT TO DO IF YOU BELIEVE DISCRIMINATION HAS OCCURRED

There are strict time limits for filing charges of employment discrimination. To preserve the ability of EEOC to act on your behalf and to protect your right to file a private lawsuit, should you ultimately need to, you should contact EEOC promptly when discrimination is suspected:

The U.S. Equal Employment Opportunity Commission (EEOC), 1-800-669-4000 (toll-free) or 1-800-669-6820 (toll-free TTY number for individuals with hearing impairments). EEOC field office information is available at www.eeoc.gov or in most telephone directories in the U.S. Government or Federal Government section. Additional information about EEOC, including information about charge filing, is available at www.eeoc.gov.

Employers Holding Federal Contracts or Subcontracts

Applicants to and employees of companies with a Federal government contract or subcontract are protected under Federal law from discrimination on the following bases:

RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN

Executive Order 11246, as amended, prohibits job discrimination on the basis of race, color, religion, sex or national origin, and requires affirmative action to ensure equality of opportunity in all aspects of employment.

INDIVIDUALS WITH DISABILITIES

Section 503 of the Rehabilitation Act of 1973, as amended, protects qualified individuals from discrimination on the basis of disability in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment. Disability discrimination includes not making reasonable accommodation to the known physical or mental limitations of an otherwise qualified individual with a disability who is an applicant or employee, barring undue hardship. Section 503 also requires that Federal contractors take affirmative action to employ and advance in employment qualified individuals with disabilities at all levels of employment, including the executive level.

DISABLED, RECENTLY SEPARATED, OTHER PROTECTED,

AND ARMED FORCES SERVICE MEDAL VETERANS

The Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended, 38 U.S.C. 4212, prohibits job discrimination and requires affirmative action to employ and advance in employment disabled veterans, recently separated veterans (within three years of discharge or release from active duty), other protected veterans (veterans who served during a war or in a campaign or expedition for which a campaign badge has been authorized), and Armed Forces service medal veterans (veterans who, while on active duty, participated in a U.S. military operation for which an Armed Forces service medal was awarded).

RETALIATION

Retaliation is prohibited against a person who files a complaint of discrimination, participates in an OFCCP proceeding, or otherwise opposes discrimination under these Federal laws.

Any person who believes a contractor has violated its nondiscrimination or affirmative action obligations under the authorities above should contact immediately:

The Office of Federal Contract Compliance Programs (OFCCP), U.S.

Department of Labor, 200 Constitution Avenue, N.W., Washington, D.C.

20210, 1-800-397-6251 (toll-free) or (202) 693-1337 (TTY). OFCCP may also be contacted by e-mail at OFCCP-Public@dol.gov, or by calling an OFCCP regional or district office, listed in most telephone directories under U.S. Government, Department of Labor.

Programs or Activities Receiving Federal Financial Assistance

RACE, COLOR, NATIONAL ORIGIN, SEX INDIVIDUALS WITH DISABILITIES

In addition to the protections of Title VII of the Civil Rights Act of 1964, as Section 504 of the Rehabilitation Act of 1973, as amended, prohibits employment amended, Title VI of the Civil Rights Act of 1964, as amended, prohibits discrimination on the basis of disability in any program or activity which receives discrimination on the basis of race, color or national origin in programs or Federal financial assistance. Discrimination is prohibited in all aspects of activities receiving Federal financial assistance. Employment discrimination employment against persons with disabilities who, with or without reasonable is covered by Title VI if the primary objective of the financial assistance is accommodation, can perform the essential functions of the job.

provision of employment, or where employment discrimination causes or may

If you believe you have been discriminated against in a program of any cause discrimination in providing services under such programs. Title IX of the institution which receives Federal financial assistance, you should immediately Education Amendments of 1972 prohibits employment discrimination on the contact the Federal agency providing such assistance. basis of sex in educational programs or activities which receive Federal financial assistance.

EEOC 9/02 and OFCCP 8/08 Versions Useable With 11/09 Supplement EEOC-P/E-1 (Revised 11/09)

Job Safety and Health

IT’S THE LAW!

All workers have the right to:

�� A safe workplace.

�� Raise a safety or health concern with your employer or OSHA, or report a work-related injury or illness, without being retaliated against.

�� Receive information and training on job hazards, including all hazardous substances in your workplace.

�� Request a confidential OSHA inspection of your workplace if you believe there are unsafe or unhealthy conditions. You have the right to have a representative contact OSHA on your behalf.

�� Participate (or have your representative participate) in an OSHA inspection and speak in private to the inspector.

�� File a complaint with OSHA within 30 days (by phone, online or by mail) if you have been retaliated against for using your rights.

�� See any OSHA citations issued to your employer.

�� Request copies of your medical records, tests that measure hazards in the workplace, and the workplace injury and illness log.

Employers must:

�� Provide employees a workplace free from recognized hazards. It is illegal to retaliate against an employee for using any of their rights under the law, including raising a health and safety concern with you or with OSHA, or reporting a work-related injury or illness.

�� Comply with all applicable OSHA standards.

�� Notify OSHA within 8 hours of a workplace fatality or within 24 hours of any work-related inpatient hospitalization, amputation, or loss of an eye.

�� Provide required training to all workers in a language and vocabulary they can understand.

�� Prominently display this poster in the workplace.

�� Post OSHA citations at or near the place of the alleged violations.

On-Site Consultation services are available to small and medium-sized employers, without citation or penalty, through OSHA-supported consultation programs in every state.

U.S. Department of Labor

Contact OSHA. We can help.

1-800-321-OSHA (6742) • TTY 1-877-889-5627 • www.osha.gov

This poster is available free from OSHA.

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