2-Documents Required with Bid.pdf

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BID BOND

KNOW ALL MEN BY THESE PRESENTS that we, (hereinafter called the “Principal”) as Principal, and a corporation authorized to transact business in Pennsylvania, and having its principal office at

(hereinafter called the “Surety”) as surety, are held and firmly bound unto

(hereinafter called the “Obligee”) as Obligee, in the sum of

DOLLARS ($ ),

lawful money of the United States of America; for the payment of which we bind ourselves, and each of our respective heirs, legal representatives, successors, and assigns, jointly and severally, by these presents, on this day of , 20 .

WITNESSETH THAT:

WHEREAS, said principal is herewith submitting to the Obligee a proposal to perform the contract work for the Obligee’s, proposed pursuant to plans, specifications and other Contract Documents incorporated into said proposal by reference; and it is a condition of the Obligee’s receipt and consideration of said proposal that the proposal be accompanied by bid security to be held by the Obligee on terms embodied herein.

THEREFORE, the condition of this obligation is that if said principal shall furnish a performance bond, payment bond, and insurance certificates to the Obligee upon the Obligee’s delivery to the principal of fifteen days notice of intention to accept his proposal and to make a formal award of contract to him, and shall enter into such contract in all respects as required by said Contract Documents, then this obligation shall be void; but otherwise it shall remain in full force, and the principal and surety will pay to the Obligee the difference between the amount of the Principal’s accepted bid(s) and any higher amount for which the

Obligee may contract for the required work, plus any advertising, architect’s, legal and other expenses

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incurred by the Obligee by reason of the default; provided, however, that the obligations of the Surety hereunder shall not exceed the amount of this bond together with the interest.

IN WITNESS WHEREOF, the Principal and Surety, intending to be legally bound, have executed this bond the day and year aforementioned.

(Individual Principal)

(SEAL)

Witness: (Signature of Individual)

Trading and doing business as

(Partnership Principal)

(SEAL)

(Name of Partnership)

Witness:

By:

(SEAL) (Partner)

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(Corporation Principal)

(Name of Corporation)

ATTEST:

Title or (if appropriate)

*By:

(Authorized Representative)

Witness or Attest:

*Attach appropriate proof, dated as of the same date as the Bond, evidencing authority to execute in behalf of the Corporation.

(Corporation Surety)

Witness or Attest:

**By:

Title

(CORPORATE SEAL)

**Attach an appropriate power of attorney, dated as of the same date as the Bond, evidencing the authority of the Attorney-In-Fact to act in behalf of the Corporation.

N:\Admins\2-Project Execution\Specifications\Bid Bond (complete).docx

NON-COLLUSION AFFIDAVIT

OF PRIME BIDDER

State of:

SS:

County of:

Before me personally appeared the undersigned , who, on oath says that he/she has submitted to the a bid and offer to do the following work under contract as set-up in the plans and specifications attached hereto.

a. By submission of this bid, each bidder and each person signing on behalf of any bidder, certifies, and in the ease of a joint bid, each party thereto certifies as to its own organization under penalty of perjury, that, to the best of his knowledge and belief;

1. The prices in this bid have been arrived at independently, without collusion, consultation, communication, or agreement, for the purpose of restricting competition, as to any matter relating to such prices with any other bidder or with any competition;

2. Unless otherwise required by law, the prices which have been quoted in this bid have not been knowingly disclosed by the bidder, and will not be knowingly disclosed by the bidder prior to the opening, directly or indirectly, to any other bidder or to any competitor; and

3. No attempt has been made or will be made by the bidder to induce any other person, partnership or corporation, to submit or not to submit a bid for the purposes of restricting competition.

Signed:

Title:

Sworn to and subscribed before me the undersigned notary public this day of , _______.

(Seal)

Notary Public

My Commission Expires:

N:\Admins\2-Project Execution\Specifications\Non-Collusion Affidavit of Prime Bidder.docx

REQUIREMENTS OF BIDDERS

THE BIDDERS ATTENTION IS DIRECTED TO THE FOLLOWING REQUIREMENTS THAT MUST ACCOMPANY THEIR BID

PROPOSAL.

Please note: To all contractors: you are responsible for obtaining information for the Section 3 Compliance from all subcontractors. The completed Labor Hours report must be submitted once project is completed.

Forms to complete with Bids for all contractors:

A) SECTION 3 CLAUSE: Please ANSWER THE QUESTIONS AND read carefully. These are the requirements and must be included in every CDBG, HOME, ESG funded construction Section 3 projects

B) MINORITY & FEMALE OWNED BUSINESS AND SECTION 3 BUSINESS CONCERN CERTIFICATION

(form2) The completion of this forms are to certify that you have read the Section 3 Clause, and your status of eligibility for preference as a Section 3 Business. OTHER NOT necessary to submit at bidding time only if you are the selected bidder and futhther instruction will be provided.

SECTION 3 WORKER AND TARGETED SECTION 3 WORKER SELF-CERTIFICATION (form 2)–The form can help you verify if any of your employees meet the Section 3 criteria, that is detailed on the MINORITY AND FEMALE OWNED BUSINESS LISTING AND SECTION 3 BUSINESS CONCERN LISTING form. This form is not to be submitted to YCPC, unless requested for HUD monitoring purposes. It must be kept on each employee file for at least 5 years after completion of project. It is a tool to be used as verification for any business in order to verify their status as a Section 3 business.

DEFINITIONS

The terms HUD, Public housing, and Public Housing Agency (PHA) are defined in 24 CFR part 5. The following definitions also apply to 24 CFR Part 75 HUD’s Economic Opportunities for Low-and Very Low-Income Persons:

1937 Act means the United States Housing Act of 1937, 42 U.S.C. 1437 et seq. activities related to Public Housing Contractor means any entity entering into a contract with:

(1) A recipient to perform work in connection with the expenditure of public housing financial assistance or for work in connection with a Section 3 project; or

(2) A subrecipient for work in connection with a Section 3 project.

Labor hours means the number of paid hours worked by persons on a Section 3 project or by persons employed with funds that include public housing financial assistance.

Low-income person means a person as defined in Section 3(b)(2) of the 1937 Act, at or below 80% AMI. Note that Section 3 worker eligibility uses individual income rather than family/household income.

Material supply contracts means contracts for the purchase of products and materials, including, but not limited to, lumber, drywall, wiring, concrete, pipes, toilets, sinks, carpets, and office supplies.

Professional services means non-construction services that require an advanced degree or professional licensing, including, but not limited to, contracts for legal services, financial consulting, accounting services, environmental assessment, architectural services, and civil engineering services.

Public housing financial assistance means assistance as defined in 24 CFR Part 75.3(a)(1).

Public housing project is defined in 24 CFR 905.108.

Recipient means any entity that receives directly from HUD public housing financial assistance or housing and community development assistance that funds Section 3 projects, including, but not limited to, any State, local government, instrumentality, PHA, or other public agency, public or private nonprofit organization.

Section 3 means Section 3 of the Housing and Urban Development Act of 1968, as amended (12 U.S.C. 1701u).

Section 3 business concern means:

(1) A business concern meeting at least one of the following criteria, documented within the last six-month period:

(i) It is at least 51 percent owned and controlled by low- or very low-income persons;

(ii) Over 75 percent of the labor hours performed for the business over the prior three-month period are performed by Section 3 workers; or

(iii) It is a business at least 51 percent owned and controlled by current public housing residents or residents who currently live in Section 8-assisted housing.

(2) The status of a Section 3 business concern shall not be negatively affected by a prior arrest or conviction of its owner(s) or employees.

(3) Nothing in this part shall be construed to require the contracting or subcontracting of a Section 3 business concern.

Section 3 business concerns are not exempt from meeting the specifications of the contract.

Section 3 Coordinator is person tasked with overseeing all Section 3 responsibilities for the PHA/CD office.

Section 3 project means a project defined in 24 CFR Part 75.3(a)(2).

Section 3 worker means:

(1) Any worker who currently fits or when hired within the past five years fit at least one of the following categories, as documented:

(i) The worker's income for the previous or annualized calendar year is below the income limit established by

HUD.

(ii) The worker is employed by a Section 3 business concern.

(iii) The worker is a YouthBuild participant.

(2) The status of a Section 3 worker shall not be negatively affected by a prior arrest or conviction.

(3) Nothing in this part shall be construed to require the employment of someone who meets this definition of a Section 3 worker. Section 3 workers are not exempt from meeting the qualifications of the position to be filled.

Section 8-assisted housing refers to housing receiving project-based rental assistance or tenant-based assistance under Section 8 of the 1937 Act.

Service area or the neighborhood of the project means an area within one mile of the Section 3 project or, if fewer than 5,000 people live within one mile of a Section 3 project, within a circle centered on the Section 3 project that is sufficient to encompass a population of 5,000 people according to the most recent U.S. Census.

Small PHA means a public housing authority that manages or operates fewer than 250 public housing units.

Subcontractor means any entity that has a contract with a contractor to undertake a portion of the contractor's obligation to perform work in connection with the expenditure of public housing financial assistance or for a Section 3 project.Subrecipient has the meaning provided in the applicable program regulations or in 2 CFR 200.93.

Targeted Section 3 worker has the meanings provided in 24 CFR Part 75.11, 75.21, or 75.29, and does not exclude an individual that has a prior arrest or conviction.

Very low-income person means the definition for this term set forth in section 3(b)(2) of the 1937 Act (at or below 50% AMI). YouthBuild programs refers to YouthBuild programs receiving assistance under the Workforce Innovation and Opportunity Act (29 U.S.C. 3226).

Build America, Buy America Act All federal projects that is subject to the Build America, Buy America Act (BABAA) requirements under Title IX of the Infrastructure Investment and Jobs Act (“IIJA”), Pub. L. 177-58. Absent an approved waiver, all iron, steel, manufactured products, and construction materials used in this project must be produced in the United States, as further outlined by the Office of Management and Budget’s Memorandum M-22-11.

Provider shall obtain all necessary compliance certificates for work that is within provider’s scope of work.

Failure to do so shall be a default under this bid. Guidance on complying with BABAA is outlined by the Office of Management and Budget’s Memorandum M-22-11, Initial Implementation Guidance on Application of Buy America Preference in Federal Financial Assistance Programs for Infrastructure, April 18,2022

See attachment in your bidder pack titled: What Is Build America, Buy America?

For details and links to resources on what to do. For BABBA HUD waivers please see link:

https://www.hudexchange.info/programs/baba/waivers/

UNIQUE ENTITY IDENTIFIER (UEI) NUMBER

Funds or partial funds for this project are Federal funds therefore a Unique Entity Identifier (UEI) number will be required. Read this notice carefully as part of the requirements necessary for bidding on this project.

For our CDBG and HOME projects, the York County Planning Commission on behalf of York County must follow the 2 CFR

200.214 Suspension and debarment requirements. What this means to you is that all Non-Federal entities are subject to the non-procurement debarment and suspension regulations implementing Executive Orders 12549 and 12689, 2 CFR part 180. The regulations in 2 CFR part 180 restrict awards, subawards, and contracts with certain parties that are debarred, suspended, or otherwise excluded from or ineligible for participation in Federal assistance programs or activities.

In order to meet the debarment and suspension exclusion requirement, all participants will need a Unique Entity Identifier (UEI) as the primary means of entity identification for Federal awards government-wide. UEIs are required in accordance with 2 CFR Part 25. This change streamlines the entity identification and validation process, making it easier and less burdensome for entities to do business with the Federal Government.

https://www.ecfr.gov/current/title-2/part-180 https://www.ecfr.gov/current/title-2/part-180

To obtain, and maintain a Unique Entity Identifier (UEI) number at www.SAM.gov. and the registration must result in a status of “Active Registration.” To maintain an “Active Registration” in the SAM.gov database after the initial registration, the applicant is required to review and update its information in the SAM.gov database every 365 days to ensure it is current, accurate and complete.

Please acknowledge by signature form(attach) “Notification to bidders” with the bid package proposal.

http://www.sam.gov/

Notification to bidders ALL BIDDERS MUST READ AND SIGN ACKNOWLEDGING THEY HAVE READ (Effective 7/1/2024)

Funds or partial funds for this project are Federal funds therefore a Unique Entity Identifier (UEI) number will be required. Read this notice carefully as part of the requirements necessary for bidding on this project.

For our CDBG and HOME projects, the York County Planning Commission on behalf of York County must follow the

200.214 Suspension and debarment requirements. What this means to you is that all Non-Federal entities are subject to the non-procurement debarment and suspension regulations implementing Executive Orders 12549 and 12689, 2 CFR part

180. The regulations in 2 CFR part 180 restrict awards, subawards, and contracts with certain parties that are debarred, suspended, or otherwise excluded from or ineligible for participation in Federal assistance programs or activities.

In order to meet the debarment and suspension exclusion requirement, all participants will need a Unique Entity Identifier (UEI) as the primary means of entity identification for Federal awards government-wide. UEIs are required in accordance with 2 CFR Part 25. This change streamlines the entity identification and validation process, making it easier and less burdensome for entities to do business with the Federal Government. To obtain, and maintain a Unique Entity Identifier (UEI) number at www.SAM.gov and the registration must result in a status of “Active Registration.” To maintain an “Active Registration” in the SAM.gov database after the initial registration, the applicant is required to review and update its information in the SAM.gov database every 365 days to ensure it is current, accurate and complete.

If you do not have a UEI number and intend to bid on this project, please begin the process immediately. It takes some time to complete and obtain the number.

I ______________________________ acknowledge that I have read and understand the requirements and will obtain a UEI number to comply with federal funding regulations, if awarded the project.

Company Name _______________

Official Signature Title Date https://www.ecfr.gov/current/title-2/part-180 https://www.ecfr.gov/current/title-2/part-180 https://www.ecfr.gov/current/title-2/part-180

MINORITY & FEMALE OWNED BUSINESS AND SECTION 3 BUSINESS CONCERN CERTIFICATION

INSTRUCTIONS: ENTER THE FOLLOWING INFORMATION AND SELECT THE CRITERIA THAT APPLIES TO CERTIFY YOUR BUSINESS’ SECTION 3 BUSINESS CONCERN AND MBE/WBE STATUS Certification expires within six months of the date of signature Information regarding Section 3 Business Concerns can be found at 24 CFR 75.5

Name of Business: _____________________________________________________________ Address: _____________________________________________________________________ Phone: _________________ Fax:________________ UEI:-__________________________ Contact Person: _______________ E-mail:- ____________________ EIN#_________________________ Please check one: Currently active business. No longer in business.

Type of Business (select from the following options): ☐Corporation ☐Partnership ☐Sole Proprietorship ☐Joint Venture

Description of Work or service: _____________________________________________________

MBE/WBE BUSINESS LISTING: Please check those that apply:

1a. This business: IS IS NOT a Minority Owned Business 2a. This business: IS IS NOT a Female Owned Business

SECTION 3 Listing: Does the business meet one of the following preferences? ______Yes ____NO A Section 3 Business means a business that meets one or more of the following criteria: To become CERTIFIED as a Section 3 Business please check all boxes that apply and RETAIN written evidence of the same:

1) ___ At least 51 percent of the business is owned and controlled by low- or very low-income persons;

2) ___ At least 51 percent of the business is owned and controlled by current public housing residents or residents who currently live in Section 8-assisted housing; or

3) ___ Over 75 percent of the labor hours performed for the business over the prior three-month period are performed by Section 3 workers.

Section 3 worker means:

(1) Any worker who currently fits or when hired within the past five years fit at least one of the following categories, as documented:

(i) The worker's income for the previous or annualized calendar year is below the income limit established by

HUD.

(ii) The worker is employed by a Section 3 business concern.

(iii) The worker is a YouthBuild participant.

Business Concern Affirmation I affirm that the above statements are true, complete, and correct to the best of my knowledge and belief. I understand that businesses who misrepresent themselves as Section 3 business concerns and report false information to YCPC may have their contracts terminated as default and be barred from ongoing and future considerations for contracting opportunities. I hereby certify, under penalty of law, that the following information is correct to the best of my knowledge.

Signature Name of Authorized Official of Business Date

Print Name: ________________________________

FOR ADMINISTRATIVE USE ONLY

Is the business a Section 3 business concern based upon their certification? □YES □NO EMPLOYERS MUST RETAIN THIS FORM IN THEIR SECTION 3 COMPLIANCE FILE FOR FIVE YEARS https://www.ecfr.gov/cgi-bin/text-idx?SID=569b66a547528bf6c5c47f75b825cb94&mc=true&node=pt24.1.75&rgn=div5#se24.1.75_15

Minority and Women-Owned Business Listing 2026 Revised: May 2026

*Woman-owned business

General Construction/Rehabilitation Grow Healthy Corp* Ashley Hospelhorn 116 W 3rd St Waynesboro PA 17268 Phone (717) 762-9679 Fax (717) 762-8633 Email: growhealthycorp@gmail.com (Construction company focusing on new residential construction)

R&R Handyworks Angel Rodrigues 3765 E Market St Suite 4 York PA 17402-2766 Phone (717)893-3695 Email: rrhandyworkspa@gmail.com (Moving services, landscaping, construction, clean outs & organization)

Engineers, Architects – Consultants, Planners

First Capital Engineering, Inc* Ann K Luciani 48 S Richland Ave York PA 17404 Phone: (717) 845-3227 Email: annl@fcap.com (Civil & Municipal Engineering, Landscape Architecture & Land Surveying) https://fcap.com/

Luzerne Consulting LLC* Tara Labosky PO Box 187 New Freedom PA 17349 Phone: (443) 415-7901 Email: tara@luzerneconsulting.com (Project Management, Construction Management, Owner’s Representative, Program Management) https://luzerneconsulting.com/

Hive Consulting, LLC* Angie Garrison 40 3rd Street York Haven PA 17370 Phone: (717) 880-3372 Email: angie@hiveconsultants.com (Grant writing & compliance, owners rep, marketing, RFP management) https://hiveconsults.com/

NTM Engineering, INC* Donna Newell 130 W Church St Suite 200 Dillsburg PA 17011 Phone (717)432-4425 Fax (717) 432-4426 Email: dnewell@ntmeng.com (Civil Engineering & Environmental Services Firm) https://www.ntmeng.com/

In order to comply with the requirements of Section 3 of the HUD Act of 1968, we ask that all contractors attempt to use MBE/WBE's for sub-contracting labor and supplies - confirm MBE/WBE status prior to sub-contract (see last page for Sec # explanation) mailto:growhealthycorp@gmail.com mailto:rrhandyworkspa@gmail.com mailto:annl@fcap.com https://fcap.com/ mailto:tara@luzerneconsulting.com mailto:angie@hiveconsultants.com https://hiveconsults.com/ mailto:dnewell@ntmeng.com https://www.ntmeng.com/

Plumbing/HVAC Flooring Henicle’s Plumbing* Ashley Hospelhorn 116 W 3rd St Waynesboro PA 17268 Phone (717) 762-4348 Fax (717) 762-8633 Email: ashley@henicles.plumbing

(Plumbing company focusing on new construction)

Carpet for Pennies LLC Takisha Booker

2930 Washington Boulevard

Baltimore MD 21230

Phone (410) 977-8568

Email: shikabooker@gmail.com & cfpgroup1@gmail.com

(Ceramic Flooring Contractor) https://cfpgroup.co/about-us/

Trucking & Excavation Perry Co Excavating & Paving, LLC*

Tara-Dawn Hazen

3297 Cold Storage Rd

New Bloomfield PA 17068

Phone (717) 645-7608

Email: pcep@pa.net

(Trucking & Excavation) www.perrycoexcavating.com

Miscellaneous

Your Kingdom Workforce Services* Tannisha Fuentes 301 W Market St York PA 17401 Mailing PO Box 535 York PA 17405 Phone: (717) 683-6275 Email: tfuentes@yourkingdomworkforce.com

(Staffing services providing temporary, contract, direct-hire employees and labor for commercial and project base work.)

https://youremploy.com

TalentDecode LLC* Tannisha Fuentes 301 W Market St

York PA 17401

Mailing PO Box 535 York PA 17405 Phone: (717) 683-6275 tfuentes@talentdecode.ai

(AI workforce analytics and hiring technology for skills-based talent matching and workforce insights) https://talentdecode.ai mailto:ashley@henicles.plumbing mailto:shikabooker@gmail.com mailto:cfpgroup1@gmail.com https://cfpgroup.co/about-us/ mailto:pcep@pa.net mailto:tfuentes@yourkingdomworkforce.com https://youremploy.com/ mailto:tfuentes@talentdecode.ai https://talentdecode.ai/

SECTION 3 BUSINESS CONCERNS

Carpet for Pennies LLC

Takisha Booker

2930 Washington Boulevard

Baltimore MD 21230

Phone (410) 977-8568

Email: shikabooker@gmail.com & cfpgroup1@gmail.com

(Ceramic Flooring Contractor) https://cfpgroup.co/about-us/

AllSafe Construction, INC (ACI) Larry V. Mitchell 2225 Sycamore St Harrisburg PA 17111 Phone (717) 608-1739 Email: lmitchell.aci@gmail.com (Selective Interior Demolition, Asbestos Abatement, we also Provide Construction Labor) https://aciasbestosremoval.com/

Your Kingdom Workforce Services* Tannisha Fuentes 301 W Market St York PA 17401 Mailing PO Box 535 York PA 17405 Phone: (717) 683-6275 Email: tfuentes@yourkingdomworkforce.com

(Staffing services providing temporary, contract, direct-hire employees and labor for commercial and project base work.)

https://youremploy.com

TalentDecode LLC*

Tannisha Fuentes 301 W Market St

York PA 17401

Phone: (717) 683-6275 tfuentes@talentdecode.ai

(AI workforce analytics and hiring technology for skills-based talent matching and workforce insights) talentdecode.ai

Perry Co Excavating & Paving, LLC*

Tara-Dawn Hazen

3297 Cold Storage Rd

New Bloomfield PA 17068

Phone (717) 645-7608

Email: pcep@pa.net

(Trucking & Excavation) www.perrycoexcavating.com

Please note: Section 3 Compliance was amended November 30, 2020 per 24 CFR 75. It replaced the interim Section 3 rule that had been in place since 1994.

The purpose of Section 3 of is to ensure that when HUD funds are used to assist housing and community development projects “to the greatest extent feasible,” preference for some of the jobs and other economic opportunities created go to low-income people, “particularly those who are recipients of government assistance for

In order to comply with the requirements of Section 3 of the HUD Act of 1968, we ask that all contractors attempt to use MBE/WBE's for sub-contracting labor and supplies -confirm MBE/WBE status prior to sub-contract (see last page for Sec # explanation) mailto:shikabooker@gmail.com mailto:cfpgroup1@gmail.com https://cfpgroup.co/about-us/ mailto:lmitchell.aci@gmail.com https://aciasbestosremoval.com/ mailto:tfuentes@yourkingdomworkforce.com https://youremploy.com/ mailto:tfuentes@talentdecode.ai https://talentdecode.ai/ mailto:pcep@pa.net

*Woman-owned business housing.” Another Section 3 obligation is to support businesses owned or controlled by low-income people or businesses that hire them. Public housing agencies (PHAs) and jurisdictions using Community Development Block Grant (CDBG), HOME Investment Partnerships program, and other HUD funds must comply with Section 3 and ensure that contractors and subcontractors comply.

Businesses may seek Section 3 Business Concern preference by demonstrating that it meets one or more of the following criteria:

1) At least 51 percent of the business is owned and controlled by low- or very low-income persons; or

2) At least 51 percent of the business is owned and controlled by current public housing residents or residents who currently live in Section 8-assisted housing; or

3) Over 75 percent of the labor hours performed for the business over the prior three-month period are performed by Section 3 workers.

SECTION 3 WORKER AND TARGETED SECTION 3 WORKER SELF-CERTIFICATION

The purpose of HUD’s Section 3 program is to provide employment, training and contracting opportunities to low-income individuals, particularly those who are recipients of government assistance for housing or other public assistance programs. Your response is voluntary, confidential, and has no effect on your employment.

Project Name_________________________ Project Address:________________________ Applicant Name:________________________ Applicant address: ______________________ Phone # _______________ Email: ______________________ Are you a Public Housing Resident? or YES NO Participant in YouthBuild Program YES __NO Holder of a Section 8 voucher? ___ YES ___ NO Participant reside within 1 mile of the project YES NO (If you checked “YES” just complete “Employee Information”, and sign & date at the bottom of the form – if you checked “No,” and are a resident of the COUNTY OF YORK, complete the remainder of the form.)

EMPLOYER INFORMATION:

COMPANY NAME STREET ADDRESS CITY

STATE ZIPCODE

PHONE # FAX #

EMPLOYEE INFORMATION:

NAME ADDRESS CITY _________ ZIP CODE

COUNTY STATE_____HOME PHONE # ______ CELL PHONE # ___ HIRE DATE (mm/dd/yyyy) ________ RACE/ETHNICITY: __ White (Non-Hispanic) _ American Indian/Alaskan Native __Asian/Pacific Islanders Black (Non-Hispanic) Hispanic (All Races) Hasidic Jews Select the amount of individual income you believe you earn on an annual basis from below

☐ Less than $10,000 ☐ $30,001 - $40,000 ☐ More than $60,000 ☐ $10,001 - $20,000 ☐ $40,001 - $50,000 ☐ $20,001 - $30,000 ☐ $50,001 - $60,000

HUD Income limits can be found at: https://www.huduser.gov/portal/datasets/il.html I qualify as a:

☐ Section 3 Worker Definition-A low or very low-income resident (the worker’s income for the previous or annualized calendar year is below the income limit established by HUD); or Employed by a Section 3 business concern; or A YouthBuild participant ☐ Targeted Section 3 Worker Definition - Employed by a Section 3 business concern or currently meets or when hired met at least one of the following categories as documented within the past five years: Living within the service area or the neighborhood of the project, as defined in 24 CFR 75.5. A YouthBuild participant.

Employee Affirmation

I affirm that the above statements are true, complete, and correct to the best of my knowledge and belief. I hereby certify, under penalty of law, that the following information is correct to the best of my knowledge.

Signature: Date: _________ Employee Address:

Print Name:

FOR ADMINISTRATIVE USE ONLY

The worker’s income must be at or below the amount provided below for an individual (household of 1) regardless of actual household size.

Is the employee a Section 3 worker based upon their self-certification? □YES □NO Is the employee a Targeted Section 3 worker based upon their self-certification? □YES □NO Was this an applicant who was hired as a result of the Section 3 project? □YES □NO If Yes, what is the name of the company? _______________________ What was the date of hire? _________________ EMPLOYERS MUST RETAIN THIS FORM IN THEIR SECTION 3 COMPLIANCE FILE FOR FIVE YEARS.

https://www.huduser.gov/portal/datasets/il.html

OVERVIEW FOR LABOR HOURS The regulation introduces several new concepts and definitions to align the regulations more closely with the statutory priorities for hiring and contracting and with grantee current practices. The most significant change is the switch from tracking and reporting new hires and contracts to tracking and reporting labor hours.

“Labor hours” means the number of paid hours worked by persons on a Section 3 project or by persons employed with funds that include public housing financial assistance (24 CFR 75.5). The Final Rule’s focus on labor hours seeks to measure total actual employment and the proportion of the total employment performed by low- and very low-income workers. In addition, the change to tracking labor hours captures continued and long-term employment.

The focus on labor hours creates an incentive for employers to invest in and retain their newly hired workers.

The report of total labor hours will include three categories of workers on the project:

1) all workers,

2) Section 3 workers, and

3) Targeted Section 3 workers.

The definitions in 24 CFR 75.5 for a “Section 3 worker,” and “Targeted Section 3 worker,” simplify grantee reporting and better align with statutory priorities.

Definitions A Section 3 Worker is, or when hired in the past five years was:

• A low- or very low-income individual; or

• A YouthBuild participant; or

• Someone employed by a Section 3 Business Concern Targeted Section 3 Workers.

A Targeted Section 3 Worker is a Section 3 Worker who is:

• Employed by a Section 3 Business Concern; or

• Who currently fits or when hired fit one of the following definitions, as documented in the previous five years:

●Living within the service area of the neighborhood of the project (i.e.

within one mile of the project); or ●A YouthBuild participant; or o Resident of public housing or Section 8 assisted housing; or o Resident of another project managed by the PHA

SECTION 3 LABOR HOURS SUMMARY REPORT INSTRUCTIONS

The form bellow is an example for labor hours reporting, YCPC has an excel spreadsheet that I can provided by request or any contractor can developed their own if preferred.

All contractors and subcontractors involved with federally assisted project will need to complete the report separately even if they are working in the same project. Table instructions:

1) Top Lines- 1. thru 6. -Please complete basic project and business information

2) Top Line - 7. Reporting period – should start the day construction begins until the end of construction. If construction is to be more than 90 days; then report end period should be at the end of 90 days and quarterly reports on 90 days periods generated until the completion of the project.

3) Top Line 8.- Date report Submitted – the date you are submitting to YCPC –

4) Column 9. - Project dates- project starting and ending dates

5) Awarded amount- contractor or subcontract amount

6) Top Line11. - Funding program name –the federal funding source

7) Column A “Worker name and position” – add all employee working on this project and their position

8) Column B “All worker labor hours” –add total labor hours for each employee for the reporting period

9) Column C “Section 3 Worker” –this column will show all employee that meet this criteria the definition of a section 3 worker is above on this instruction for your convenience. Form RESIDENT EMPLOYMENT OPPORTUNITY ELIGIBILITY CERTIFICATION FY 2022 can be used as a tool to certify and verify this requirement.

10) Column D % of Section 3 worker - this column will generated your “%” of section 3 worker for this project

11) Column E “Section 3 Targeted Worker” –this column will show all employee that meet this criteria; the definition of a section 3 targeted worker is above on this instruction for your convenience. Form RESIDENT EMPLOYMENT OPPORTUNITY ELIGIBILITY CERTIFICATION FY 2022 can be used as a tool to certify and verify this requirement.

12) Column E “% of Section 3 targeted worker” - this column will generated your “%” of section 3 targeted worker for this project.

13) Column F trainees – will be indicated any new hires for the project

Blank Labor Hour Table

Street Address 2

City State Zip Code

Doing Business As:

(if different from Legal Name)

Commonwealth of Pennsylvania Public Works Employment Verification Form

Complete and return the form to the contracting Public Body prior to the award of the contract.

Company Legal Name: ___________________________________________________________

Mailing Address: ______________________________________________________

Check one: Contractor Subcontractor

Contracting Public Body: _________________________________________________________

Contract/Project Number: ________________________________________________________

Project Description: _____________________________________________________________

Project Location: _______________________________________________________________

Date Enrolled in E-Verify (MM/DD/YYYY): ___________________________________________ As a contractor/subcontractor for the above referenced public works contract, I hereby affirm that as of today’s date, __________________________, our company is in compliance with the Public Works Employment Verification Act (‘the Act’) through utilization of the federal E-Verify Program (EVP) operated by the United States Department of Homeland Security. To the best of my/our knowledge, all employees hired are authorized to work in the United States.

It is also agreed to that all public works contractors/subcontractors will utilize the federal EVP to verify the employment eligibility of each new hire within five (5) business days of the employee start date throughout the duration of the public works contract. Documentation confirming the use of the federal EVP upon each new hire shall be maintained in the event of an investigation or audit.

I,____________________________________________, authorized representative of the company above, attest that the information contained in this verification form is true and correct and understand that the submission of false or misleading information in connection with the above verification shall be subject to sanctions provided by law.

Authorized Representative Signature Date of Signature

Printed Name: _________________________________________________________________

Phone Number: ______________________ Email: ____________________________________

Street Address 1