2023-04 CDBG-CHIP Procurement

CITY OF PERRY, GEORGIA

REQUEST FOR QUALIFICATIONS AND PROPOSALS

FOR PLANNING, ADMINISTRATION AND RELATED SERVICES

The City of Perry is requesting statements of qualifications and proposals from consultants with a strong record in successfully assisting local governments with the implementation of Federally Assisted Projects. Responding firms should be qualified to provide grant writing, grant administration, and related services for projects utilizing federal funds. The City plans to contract with a consulting firm for grant writing and administration services for a 2023

Community Development Block Grant (CDBG) and a 2023 Community Home Improvement Program (CHIP).

Responding firms should be qualified to provide the above stated services for a period of 2 to 3 years.

This 2023 procurement action may also lead to additional contracts and/or contract addendums for planning, design, administrative and other related services. All contracts are subject to Federal and State contract provisions prescribed by the Georgia Department of Community Affairs.

INTERESTED QUALIFIED FIRMS MAY SUBMIT QUALIFICATION STATEMENTS TO PROVIDE

THESE SERVICES.

Criteria for evaluation includes:

1) History of firm and resources

2) Federal Funds Grant Writing & Administration Experience, including CDBG Housing and Public Facilities project experience and CHIP experience along with references for current and completed projects.

3) Key personnel/qualifications

4) Current workload

5) Scope and level of service proposed

6) Experience with similar projects and list of references

7) Fees associated with Grant Writing and Administration – percentage for administration is acceptable.

8) Statement of Qualifications Form

9) Section 3 Certification Form for HUD assisted projects, if claiming Section 3 Status

The City of Perry reserves the right to accept or reject any and all proposals and to waive informalities in the proposal process. The City of Perry is an equal opportunity employer. Further in accordance with section 504 of the

Rehabilitation Act of 1973, as amended. The City of Perry does not discriminate on the basis of handicapped status in the administration or operation of its programs. This project is covered under the requirements of Section 3 of the

HUD Act of 1968.

The City also abides by the following laws as they pertain to HUD Assisted Projects: Title VI of the Civil Rights Act of

1964; Section 109 of the HCD Act of 1974, Title 1; Title VII of the Civil Rights Act of 1968 (Fair Housing Act);

Section 104(b)(2) of the Housing and Community Development Act of 1974; Section 504 of the Rehabilitation Act of

1973 as amended; Title II of the Americans with Disabilities Act of 1990 (ADA); and the Architectural Barriers Act of 1968.

For consideration, interested parties should request copies of the Statement of Qualifications Form and Section 3

Certification Form prior to preparing and submitting their proposal. Proposals should be received no later than 4:00 PM on December 5, 2022. Proposals received after the above date and time may not be considered. We reserve the right to accept or reject any and all proposals and to waive informalities in the proposal process. Questions and proposal packages should be submitted to the name and address listed below:

Holly Wharton, Community Planner

City of Perry

P.O. Box 2030

Perry, GA 31069

Office 478.988.2702 holly.wharton@perry-ga.gov

IF SUBMITTING PROPOSALS FOR BOTH CDBG AND CHIP, PLEASE INCLUDE 2 SETS OF PROPOSALS.

ONE FOR EACH PROGRAM. PLEASE WRITE CDBG AND/OR CHIP PROPOSAL STATEMENT ON THE

EXTERIOR OF THE ENVELOPE.

CITY OF PERRY

GRANT WRITING/ADMINISTRATION

STATEMENT OF QUALIFICATIONS (CDBG)

Grant Administration Statement of Qualifications Page | 1

NAME OF FIRM:

ADDRESS:

1. Years in Business in Present Form:

2. Firms History and Resource Capability to Perform Required Services:

3. Titles, names, and addresses of all officers.

4. List up to five (5) projects which demonstrate skills to be used on CDBG projects.

1.

2.

3.

4.

5.

5. Feeto write the Application:___________________________________________

Grant Writing/Administration Statement of Qualifications Page | 2

6. If you were awarded the administration on these type of projects, what would your fee for grant administration services be (fees can be expressed in percentages, but all agreements will be lump sum amounts)?

7. List key personnel (with qualifications) likely to be involved on these projects and explain their specific role in CDBG work.

8. List three references with contact information.

2.

3.

9. Are you a Section 3 Business Concern? Yes ______ No _______

The Attached Section 3 Business Concern Certification, Previous Certification and Action Plan must be filled out, signed, notarized, and submitted with your proposal if claiming Section 3 preference. If not, you do not have to submit with your proposal.

10. Certifying that:

Mr./Mrs./Ms. being duly sworn deposes and states that he/she is the (title) of (name of firm) and that answers to the foregoing questions and all statements herein contained are true and correct.

CITY OF PERRY

GRANT WRITING/ADMINISTRATION

STATEMENT OF QUALIFICATIONS (CHIP)

Grant Administration Statement of Qualifications Page | 1

NAME OF FIRM:

ADDRESS:

1. Years in Business in Present Form:

2. Firms History and Resource Capability to Perform Required Services:

3. Titles, names, and addresses of all officers.

4. List up to five (5) projects which demonstrate skills to be used on CDBG projects.

2.

3.

4.

5.

5. Feeto write the Application:___________________________________________

Grant Writing/Administration Statement of Qualifications Page | 2

6. If you were awarded the administration on these type of projects, what would your fee for grant administration services be (fees can be expressed in percentages, but all agreements will be lump sum amounts)?

7. List key personnel (with qualifications) likely to be involved on these projects and explain their specific role in CDBG work.

8. List three references with contact information.

2.

3.

9. Are you a Section 3 Business Concern? Yes ______ No _______

The Attached Section 3 Business Concern Certification, Previous Certification and Action Plan must be filled out, signed, notarized, and submitted with your proposal if claiming Section 3 preference. If not, you do not have to submit with your proposal.

10. Certifying that:

Mr./Mrs./Ms. being duly sworn deposes and states that he/she is the (title) of (name of firm) and that answers to the foregoing questions and all statements herein contained are true and correct.

DO YOU USE THIS PACKAGE?

(ANSWER ALL 3 QUESTIONS)

YES NO

1. Did you contract for $200,000 or more directly from DCA? If so, you are a Sub-recipient and this package is applicable to you.

2. Did you contract for $100,000 or more directly from the Sub-recipient (see above)? If so, you are a Contractor and this package is applicable to you.

3. Did you contract for $100,000 or more directly from the

Contractor (see above)? If so, you are a Sub-Contractor and this package is applicable to you.

If you answered “YES” to any question, this package IS applicable to you

IMPORTANT NOTE!!!

Even if you answered “NO” to ALL questions, this package BECOMES APPLICABLE to you when, during the life of your contract, you trigger “YES” to any of the above questions.

This form must be returned to the soliciting entity with your bid package. Failure to return this documentation will render your bid package as non-responsive.

Signature Print Name Position Title

Entity Name Date

Georgia Department of Community Affairs 60 Executive Park South, NE, Atlanta, GA 30329

Mandatory Section 3 Solicitation Package

This mandatory solicitation package has been developed in accordance with DCA’s Section 3 Policy for Covered HUD Funded Activities. DCA encourages all sub-recipients, contractors, and sub-contractors to review this policy prior to completion of the solicitation package. For those solicitations that meet the applicable Section 3 thresholds, this package must be returned in accordance with the applicable instructions to the contracting entity prior to award or at the time of submission of a bid/proposal in order to claim a Section 3 preference. The Section 3 Clause, required forms, and instructions are included in this package.

To be considered for a contract award exceeding $100,000, the entire solicitation package must be satisfactorily completed and submitted prior to award. In order to claim a preference for a contract award exceeding $100,000, the Section 3 Self-Certification and Action Plan and the Section 3 Business Concern Self Certification portions of the solicitation package must be satisfactorily completed and submitted at the time of submission of a bid/proposal.

For Section 3 Covered Assistance of $100,000 or less, the solicitation package must be made available to bidders/offerors in accordance with DCA’s Section 3 Policy; however, bidders/offerors are not required to submit the solicitation package unless a preference is being claimed. In this case, only the Section 3 Self-Certification and Action Plan and the Section 3 Business Concern Self Certification must be completed at the time of submission of a bid/proposal

Any bid/proposal claiming a preference must include the completed and signed Section 3 Self- Certification and Action Plan and the Section 3 Business Concern Self Certification, and be submitted by the bid/proposal deadline.

The following Section 3 forms must be completed and returned as instructed:

Section 3 Self Certification and Action Plan

Previous Section 3 Compliance Certification

Assurance of Compliance Certification

Additionally, if the contractor is claiming certification as a 51% Resident Owned Business (ROB) or is certifying as a 30% employer, the Resident Self-Certification and Skills Data Form must be returned for all employees who meet the low- or very low-income requirement as well as the appropriate Section 3 Business Certification.

DCA Mandatory Section 3 Solicitation Package Page 2

Section 3 Solicitation Overview and Instructions for Contractors

The DCA Section 3 Policy requires that, when the Section 3 regulation is triggered, every effort within the contractor’s disposal must be made, to the greatest extent feasible, to offer all available employment and contracting opportunities to Section 3 residents and Section 3 businesses based on the compliance methods below.

All Contracts and All Contractors must meet Section 3 compliance by:

A. Giving notice of any and all opportunities for employment and contracting to residents of the local Public Housing Authority (PHA), and other low and very low income area residents and businesses, by posting the opportunity in community sources generally available to low income residents and the general public. Exercising a minimum of three (3) of the following listed sources must be completed prior to offering employment to anyone not covered by Section 3 requirements:

1. The local community newspaper

2. The most widely distributed newspaper

3. Company or agency website

4. The management office of the local housing authority/homeless service agency/local low income housing community

5. Local Workforce Board (i.e. Department of Labor)

6. Local office of the Georgia Division of Family and Children Services

7. Dodge Room http://www.construction.com/dodge/dodge.asp

8. Other locations as approved by DCA

B. The sub-recipient or contractor must check the HUD Section 3 Business Registry to determine if there are any Section 3 businesses in the County where the work will be performed. If there are Section 3 businesses in the County that may be able to perform the work, the sub-recipient or contractor must provide a copy of the contracting opportunity(ies) (e.g., bid notices) to the Section 3 businesses. See the HUD Section 3 Business Registry at:

https://portalapps.hud.gov/Sec3BusReg/BRegistry/What.

C. Clearly stating in notices that the position is a “Section 3 covered position under the HUD Act of 1968 and that Section 3 Residents and Business Concerns are encouraged to apply.”

D. Placing the Section 3 Clause provided in Appendix A in ALL solicitations.

E. When possible, other activities may be done to demonstrate effort to comply with the Safe Harbor Limits. These other efforts are listed in the appendix to part 135 of the Code of Federal Regulations—24 CFR Part 135 and include:

1. Distributing or posting flyers advertising positions to be filled;

https://portalapps.hud.gov/Sec3BusReg/BRegistry/What

DCA Mandatory Section 3 Solicitation Package Page 3

2. Contacting the local government or housing authority for a list of residents who have expressed interest in Section 3 employment;

3. Holding job informational meetings for residents, contractors, etc…;

4. Contacting agencies administering HUD YouthBuild programs and requesting their assistance in recruiting HUD YouthBuild program participants for training and employment positions.

F. Linking residents or businesses to local resources that may be available to help prepare them for applying for and achieving the opportunity.

G. Working with DCA, the subrecipient or contractor as applicable in developing a communication and follow up process to track and report all Section 3 applications and hiring activities to ensure the reporting of compliance efforts, and that contracting and sub-contracting are accurate. Provide preference in hiring and contracting to Section 3 applicants and contractors when employment or contracting opportunities are offered and all requirements are met and remain equal. Contractors must:

1. Provide this package to all sub-contractors when soliciting bids for all contracts or sub-contracts;

2. Meet all the same processes in A-E; and

3. Provide Preference to all sub-contractors meeting the definitions as stated in Section VI of DCA’s Section 3 Policy for Covered HUD Funded Activities.

H. In order for Preference as a Section 3 Contractor to be factored into the award decision, all elements of the solicitation criteria must be equal between contracts. This means price and all other factors must be equal. Then the contractors that elect Preference on the Certification and Action Plan form that meet that Preference criterion will be provided Preference in the award of the contract as provided in Part VI., Preferences and Eligibility of DCA’s Section 3 Policy for Covered HUD Funded Activities.

Example:

Bill’s electrical and Sue’s Electrical bid a job where the housing authority has a budget of $500,000. Bill bids $480,000 and elects a Preference as a Section 3 business concern because he qualifies as a 51% Resident Owned Business. Sue bids $450,000 but does not elect any Preference. Both companies met all the other requirements. Sue will be awarded the contract because Bill’s bid was higher.

Important items to remember about receiving Preferences in contract award:

All contractors and/or subcontractors that elect a Preference and are awarded a contract must be in compliance prior to the issuance of a Notice to Proceed by DCA, the subrecipient, or the contractor based on the policies established for the applicable DCA funding program.

The contractor and/or subcontractor must maintain the elected Preference standard during the entire contract or risk having the contract terminated for failure to comply. See Appendix B for further details.

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When a contractor and/or subcontractor that elected a Preference is unable to identify a Section 3 resident or a Section 3 business for employment or contracting opportunities, the contractor then must offer employment related training to the Section 3 residents in the county. The training must be provided according to Part VII – Other Economic Opportunities in DCA’s Section 3 Policy.

Appendix A Section 3 Clause

Training and Employment Opportunities for Residents in the Project Area (Section 3, HUD Act of 1968;

24 CFR 135)

(a) The work to be performed under this contract is subject to the requirements of section 3 of the Housing and Urban Development Act of 1968, as amended, 12 U.S.C. 1701u (section 3). The purpose of section 3 is to ensure that employment and other economic opportunities generated by HUD assistance or HUD-assisted projects covered by section 3, shall, to the greatest extent feasible, be directed to low- and very low-income persons, particularly persons who are recipients of HUD assistance for housing.

(b) The parties to this contract agree to comply with HUD's regulations in 24 CFR Part 135, which implement section 3. As evidenced by their execution of this contract, the parties to this contract certify that they are under no contractual or other impediment that would prevent them from complying with the Part 135 regulations.

(c) The contractor agrees to send to each labor organization or representative of workers with which the contractor has a collective bargaining agreement or other understanding, if any, a notice advising the labor organization or workers' representative of the contractor's commitments under this section 3 clause, and will post copies of the notice in conspicuous places at the work site where both employees and applicants for training and employment positions can see the notice. The notice shall describe the section 3 preference, shall set forth minimum number and job titles subject to hire, availability of Section 3 apprenticeship and training positions, the qualifications for each; and the name and location of the person(s) taking applications for each of the positions; and the anticipated date the work shall begin.

(d) The contractor agrees to include this section 3 clause in every subcontract subject to compliance with regulations in 24 CFR Part 135, and agrees to take appropriate action, as provided in an applicable provision of the subcontract or in this section 3 clause, upon a finding that the subcontractor is in violation of the regulations in 24 CFR Part 135. The contractor will not subcontract with any subcontractor where the contractor has notice or knowledge that the subcontractor has been found in violation of the regulations in 24 CFR Part 135.

(e) The contractor will certify that any vacant employment positions, including training positions, that are filled (1) after the contractor is selected but before the contract is executed, and (2) with persons other than those to whom the regulations of 24 CFR Part 135 require employment opportunities to be directed, were not filled to circumvent the contractor's obligations under 24 CFR Part 135.

(f) Noncompliance with HUD's regulations in 24 CFR Part 135 may result in sanctions, termination of this contract for default, and debarment or suspension from future HUD assisted contracts.

DCA Mandatory Section 3 Solicitation Package Page 6

Appendix B Section 3 Contract Non-Compliance Cure /Termination Processes

This language is a component of contract compliance with the work to which you are responding in this solicitation. The full requirements are provided in the Section 3 Clause found elsewhere in this package and in DCA’s Section 3 Policy for Covered HUD Funded Activities.

Any subrecipient or contractor claiming Preference must be in compliance prior to issuance of a notice to proceed by DCA, subrecipient, or contractor based on the policies established for the applicable DCA funding program. This preference can be met by any of the three qualifications:

1. Resident Owned Businesses (ROBs) owned and operated at 51% by Section 3 Residents.

2. Businesses that employ Section 3 residents at no less than 30% of the contractors aggregate full time staff.

3. Contractors that at the time of bid show evidence (meaning the specific name and preference met) of their intent to award no less than 25% of their total award to Section 3 business concerns.

The subrecipient or contractor must maintain compliance throughout the life of the contract. The contractor understands and agrees that a compliance management firm may be used to conduct routine and certified payroll reviews to ensure compliance. The Contractor agrees to provide the payroll data in an Excel or Word format each time the payroll is processed throughout the contract.

Failure to meet the Section 3 requirements will result in penalties up to and including contract termination. Any contractor triggering the regulation by doing any hiring or contracting once they are awarded the contract through execution must comply with the Section 3 requirements by executing the efforts on their Certification and Action Plan in accordance with DCA’s Section 3 Policy.

DCA, the subrecipient or contractor shall execute these remedies to achieve compliance in this order:

NON-COMPLIANCE CURE PROCESS

A. Based on the first observation or report of non-compliance with Section 3, the subrecipient or contractor will be sent an e-mail by the compliance manager notifying them of their non-compliance issue. The subrecipient or contractor will have until the next payroll or 10 business days, whichever is less, to bring the contract into compliance and/or justify in writing why they cannot meet compliance requirements.

B. DCA, the subrecipient or contractor must render a response to the violating party within 10 business days of receipt of the violating party’s letter of reason for non-compliance. If DCA, the subrecipient, or the contractor deems the reason to be unacceptable, at its option, DCA, the subrecipient, or the contractor can extend the response period one time

DCA Mandatory Section 3 Solicitation Package Page 7 for up to 5 business days to allow the violating party to identify and secure other compliance options.

NON-COMPLIANCE TERMINATION PROCESS

If the violating party fails to take any corrective action to bring the contract into compliance within the allotted time, or DCA, the subrecipient, or the contractor rejects any of the corrective plans and justifications for non-compliance, DCA, the subrecipient, or the contractor will either terminate the contract immediately or impose liquidated damages equal to the number of days out of compliance divided by the total contract period multiplied by the contract amount. For example, if a violating party is out of compliance for 30 days of a total contract period of 120 days and as part of total contract of $600,000, then the liquidated damages will equal 25% (30/120) of the total contract amount ($600,000), or $150,000. At DCA’s determination, any liquidated damages received must be paid to the subrecipient or DCA, at DCA’s determination, and be used to promote economic opportunities for Section 3 Residents and Business Concerns.

DCA, the sub-recipient, or the contractor will hold all funds due to the violating party until such time that a financial workout is completed.

Additionally the violating party may be banned by DCA, the sub-recipient, and the contractor on future HUD funded projects.

DCA Mandatory Section 3 Solicitation Package Page 8

Appendix C Section 3 Forms

DCA Mandatory Section 3 Solicitation Package Page 9

Required Submittal - Section 3 Self-Certification and Action Plan All firms and individuals intending to do business with DCA, its subrecipients and contractors MUST complete and submit this Action Plan and submit it with the bid, offer, or proposal in order to claim a preference on any contract or prior to award of a contract exceeding $100,000 if no preference is claimed. For contracts exceeding $100,000, this document (signed, and notarized) must be satisfactorily completed to be eligible for award.

Business Name:

D.B.A. (if different from above):

Address: City:

State/Zip:

Business Phone:

Fax:

E-Mail:

Business Website:

Federal Employer Identification Number:

Owner Social Security Number (if no EIN):

Contact Person & Title:

Contact Phone:

Trade Description:

Carpentry Heating (HVAC) Electrical Painting

Masonry Restoration Asbestos Plumbing Roofing

Lead (Abatement) General Contractor Concrete Ironwork

Carpet/Flooring Rubbish Removal/Hauling Appraisal Services Landscaping

Demolition Other:

Date Business was established (MM/DD/YYYY): ________________________________

Type of Business (Check One): Corporation Partnership Sole Proprietorship

Limited Liability Corporation (LLC) Limited Liability Partnership (LLP) Joint Venture

Other (Describe):

Number of employees: Full-time: _______ Part-time: _______ Contract: _______ Total: _______

Section 3 employees: Full-time: _______ Part-time: _______ Contract: _______ Total: _______

DCA Mandatory Section 3 Solicitation Package Page 10

I am Certifying as a Section 3 Business Concern and requesting Preference accordingly (Select only One Option):

Option 1

A business claiming status as a Section 3 Resident-Owned Business Concern (ROB) entity:

_____Initial here to confirm selection of this option

Option 2

A business claiming Section 3 status, because at least 30% of the existing or newly hired workforce for this specific contract will be Section 3 residents throughout the entire contract period. If a Prime or

General Contractor is electing this option, the 30% employment requirement will be for the entire project including all the sub-contractors’ employees:

Check all methods you will employ to secure Section 3 Residents/Persons

Posting the position in community sources that are generally available to low income residents and the general public is a standard requirement. Check at least three (3) methods you will employ:

The local community newspaper The most widely distributed newspaper Company or agency website The management office of the local housing authority, or homeless service agency, or local low income housing community Local Workforce Board (i.e., Department of Labor) Local office of the Georgia Division of Family and Children Services Local office of the Georgia Department of Public Health Dodge Room http://www.construction.com/dodge/dodge.asp Other locations identified below and subject to DCA approval:

I anticipate my total number of employees for this contract to be ____ and _____ will be qualified Section 3 Residents/persons.

Option 3

A business claiming Section 3 status by subcontracting 25% of the dollar award to qualified Section 3

Business:

Attach a list of intended subcontract Section 3 business(es) with subcontract amount.

Attach certification & all supporting documentation for each planned subcontract Section 3 Business.

http://www.construction.com/dodge/dodge.asp

DCA Mandatory Section 3 Solicitation Package Page 11

I am NOT Requesting Preference under Section 3:

I am NOT certifying as a qualified Section 3 Business Concern and I am not requesting a preference.

However if I do trigger the regulation by doing any sub-contracting or hiring, I will comply by meeting all requirements of DCA’s Section 3 policy and am committing to do the outreach as specified below.

Check all methods you will employ to secure Section 3 Residents/Businesses

Posting the position/contract opportunity in community sources that are generally available to low income residents and Section 3 Businesses and the general public is a standard requirement. Check at least three

(3) methods you will employ:

The local community newspaper The most widely distributed newspaper Company or agency website The management office of the local housing authority, or homeless service agency, or local low income housing community Local Workforce Board (i.e., Department of Labor) Local office of the Georgia Division of Family and Children Services Local office of the Georgia Department of Public Health Dodge Room http://www.construction.com/dodge/dodge.asp Other locations identified below and subject to DCA approval:

Signature:

Printed/Typed Name:

Title:

Date:

Notarial Affidavit

Sworn to and subscribed before me this ___________ day of ____________________, 20_____.

Signature of Notary Public

Printed Name of Notary Public

Commission Expiration Date: ___________________________

(Notarial Seal) http://www.construction.com/dodge/dodge.asp

DCA Mandatory Section 3 Solicitation Package Page 12

Required Submittal - Previous Section 3 Compliance Certification

Name of Business:

Address of Business:

Type of Business (Check One): Corporation Partnership

Sole Proprietorship Other

Business Activity:

All firms and individuals intending to do business with DCA, its subrecipients, or contractors MUST complete and submit this certification of prior compliance prior to award of any contract exceeding

$100,000. Please check the appropriate line box below and sign and date the form.

1. I am certifying that I have complied with the HUD Section 3 Regulations, when triggered by new hiring or contracting opportunities, in my past contracts when required by the recipient, subrecipient or contractor by either:

i. Certifying as Resident Owned Business (ROB); or,

ii. Employing Section 3 residents for at least 30% of the newly hired workforce; or,

iii. Subcontracting 25% of the total dollar award to a qualified Section 3 Business; or,

iv. Hiring or contracting to the “greatest extent feasible” with Section 3 Residents or Section

3 Businesses.

Check this box

2. I have never done any HUD funded contracting.

3. I completed HUD Section 3 covered contracts in the past three years but the regulation was not triggered because either there were no new hires on the contract(s) and/or I did not do any new contracting or subcontracting.

Signature:

Print Name:

Title:

Required Submittal - Assurance of Compliance Certification Section 3 Action Plan

DCA Mandatory Section 3 Solicitation Package Page 13

Housing and Urban Development Act of 1968 (12 U.S.C. 1701 U)

Contract/Solicitation Name or Number:

DCA Funding

Program:_______________________________________________________________

Entity Receiving DCA Funding Award:____________________________________

Purpose: To ensure that regulations promulgated under 24 CFR Part 135 Employment Opportunities for Businesses and Lower Income Persons in Connection with Assisted Projects and the Section 3 Policy of DCA, its subrecipients and contractors to the greatest extent feasible is adhered to, and to serve as the “assurance of compliance” certification and action plan as required in the bid documents, supplemental general conditions, and required forms for the contract for any HUD work funded by DCA.

Description of the project’s work detail: The project work will be as listed in the final scope of work in the contract with DCA, its subrecipients and contractors including any change orders. List all known subcontractors below:

Subcontractor(s):

Use an additional sheet if required.

Note: If subcontractors are unknown at this time, print UNKNOWN on the line above. Also, the contractor must notify DCA or subrecipient if subcontractors are added or changed during the contract.

Any changes to this certification requires a resubmission of this form to DCA or subrecipient.

Preliminary Statement for Work Force Needs:

DCA Mandatory Section 3 Solicitation Package Page 14

DCA intends to meet Section 3 compliance at the highest level and it is our intent to identify any short-term and long-term employment or contracting opportunities for qualified Section 3 persons and Business Concerns during the course of the contract funded by DCA via its subrecipients and contractors. Please list the status of all planned employment positions and opportunities for this contract. Preference for all opportunities must be given to low and very low-income residents if they qualify. If awarded a contract, regardless of whether your firm has elected a preference, you are required to provide a list of your aggregate workforce on this project. Any changes to that workforce during the project will constitute NEW hires. You must notify DCA, its subrecipient or contractor (respectively) overseeing your contract of any new hire opportunities that arise during the life of your contract. The anticipated workforce list may be provided on a separate sheet or in a different format.

List All Employees Date Hired

Section 3 Resident (Yes/No) Job Title/Trade

Salary Range

Name:

Address:

City, ZIP:

Name:

City, Zip Code:

Use additional pages as needed.

“To the Greatest Extent Feasible”: