WORKER PROTECTION AND INVESTMENT CERTIFICATION FORM

A. Pursuant to Executive Order 2021-06, Worker Protection and Investment (October 21, 2021), the Commonwealth is responsible for ensuring that every worker in Pennsylvania has a safe and healthy work environment and the protections afforded them through labor laws. To that end, contractors and grantees of the Commonwealth must certify that they are in compliance with Pennsylvania’s Unemployment Compensation Law, Workers’ Compensation Law, and all applicable

Pennsylvania state labor and workforce safety laws including, but not limited to:

1. Construction Workplace Misclassification Act

2. Employment of Minors Child Labor Act

3. Minimum Wage Act

4. Prevailing Wage Act

5. Equal Pay Law

6. Employer to Pay Employment Medical Examination Fee Act

7. Seasonal Farm Labor Act

8. Wage Payment and Collection Law

9. Industrial Homework Law

10. Construction Industry Employee Verification Act

11. Act 102: Prohibition on Excessive Overtime in Healthcare

12. Apprenticeship and Training Act

13. Inspection of Employment Records Law

B. Pennsylvania law establishes penalties for providing false certifications, including contract termination; and three-year ineligibility to bid on contracts under 62 Pa. C.S. § 531 (Debarment or suspension).

CERTIFICATION

I, the official named below, certify I am duly authorized to execute this certification on behalf of the contractor/grantee identified below, and certify that the contractor/grantee identified below is compliant with applicable Pennsylvania state labor and workplace safety laws, including, but not limited to, those listed in Paragraph A, above. I understand that I must report any change in the contractor/grantee’s compliance status to the Purchasing Agency immediately. I further confirm and understand that this Certification is subject to the provisions and penalties of 18 Pa. C.S. § 4904 (Unsworn falsification to authorities).

Signature Date

Name (Printed)

Title of Certifying Official (Printed)

Contractor/Grantee Name (Printed)

BOP-2201

Published: 02/07/2022

NONDISCRIMINATION/SEXUAL HARASSMENT

a. Representations. The Grantee represents that it is presently in compliance with and will remain in compliance with all applicable federal, state, and local laws, regulations, and policies relating to nondiscrimination and sexual harassment for the term of the agreement. The Grantee shall, upon request and within the time periods requested by the Commonwealth, furnish all necessary employment documents and records, including EEO-1 reports, and permit access to its books, records, and accounts by the Commonwealth for the purpose of ascertaining compliance with provisions of this

Nondiscrimination/Sexual Harassment Clause.

b. Nondiscrimination/Sexual Harassment Obligations. The Grantee shall not:

i. in any manner discriminate in the hiring of any employee(s) for the performance of the activities required under this agreement or any subgrant agreement, contract, or subcontract, by reason of race, gender, creed, color, sexual orientation, gender identity or expression, or in violation of the

Pennsylvania Human Relations Act (“PHRA”) and applicable federal laws, against any citizen of this Commonwealth who is qualified and available to perform the work to which the employment relates.

ii. in any manner discriminate by reason of race, gender, creed, color, sexual orientation, gender identity or expression, or in violation of the PHRA and applicable federal laws, against or intimidate any of its employees.

iii. in any manner discriminate by reason of race, gender, creed, color, sexual orientation, gender identity or expression, or in violation of the PHRA and applicable federal laws, in the provision of services under this agreement or any subgrant agreement, contract, or subcontract.

iv. in any manner discriminate by reason of race, gender, creed, color, sexual orientation, gender identity or expression, or in violation of PHRA and applicable federal laws, against any subgrantee, contractor, subcontractor, or supplier who is qualified to perform the work to which this agreement relates.

v. in any manner discriminate against employees by reason of participation in or decision to refrain from participating in labor activities protected under the Public Employee Relations Act, Pennsylvania Labor Relations Act, or National Labor Relations Act, as applicable, and to the extent determined by entities charged with the Acts’ enforcement and shall comply with any provision of law establishing organizations as employees’ exclusive representatives.

c. Establishment of Grantee Policy. The Grantee shall establish and maintain a written nondiscrimination and sexual harassment policy that complies with the applicable law and these Nondiscrimination/Sexual

Harassment provisions and shall inform its employees in writing of the policy. The policy must contain a provision that states that sexual harassment will not be tolerated and employees who practice it will be disciplined. For the entire period of this agreement, the Grantee shall: (1) post its written nondiscrimination and sexual harassment policy or these Nondiscrimination/Sexual Harassment provisions conspicuously in easily accessible and well-lighted places customarily frequented by employees at or near where the grant activities are performed; or (2) provide electronic notice of the policy or this clause to its employees not less than annually.

d. Notification of Violations. The Grantee’s obligations pursuant to these provisions are ongoing from the effective date and through the termination date of the agreement. Accordingly, the Grantee shall notify the Commonwealth if, at any time during the term of this agreement, it becomes aware of any actions or occurrences that would result in violation of these provisions.

e. Cancellation or Termination of Agreement. The Commonwealth may cancel or terminate this agreement and all money due or to become due under this agreement may be forfeited for a violation of the terms and conditions of these Nondiscrimination/Sexual Harassment provisions. In addition, the granting agency may proceed with debarment or suspension and may place the Grantee in the

Contractor Responsibility File.

f. Subgrant Agreements, Contracts, and Subcontracts. The Grantee shall include these

Nondiscrimination/Sexual Harassment provisions in its subgrant agreements, contracts, and subcontracts with all subgrantees, contractors, and subcontractors providing goods or services under this agreement. The incorporation of these provisions in the Grantor’s subgrants, contracts, or subcontracts does not create privity of contract between the Commonwealth and any subgrantee, contractor, or subcontractor, and no third-party beneficiaries are created by those provisions. If the Grantee becomes aware of a subgrantee’s, contractor’s, or subcontractor’s violation of these provisions, the Grantee shall use its best efforts to ensure the subgrantee’s, contractor’s, or subcontractor’s compliance with these provisions.

Company DCED Contract #

Print

Davis-Bacon and Related Acts (DBRA) Policies Acknowledgement Form

This Acknowledgement form describes policies that must be followed when undertaking construction projects funded with Community Development Block Grant (CDBG) and/or HOME

Investment Partnerships (HOME) Program funds to ensure compliance with the labor laws and requirements. Under the DOL regulations, the prime or general contractor and the Sub-recipient are responsible for full compliance with applicable requirements, including all subcontractors on the project. The Bucks County Department of Housing and Community Development (HCD), as the CDBG or HOME grantee, is responsible for the administration and enforcement of the requirements to ensure compliance.

Please review, initial and sign the following policies in acknowledgment:

I acknowledge that I am required to maintain documentation that demonstrates compliance with Davis-Bacon prevailing wage requirements during the course of the project work and for a period of five years thereafter. I affirm that I shall make the records available to the County for review upon request. Such documentation includes completed weekly payroll reports for all contractor employees working on the covered job, this includes prime/general contractor for its employees and those of the subcontractor(s) if applicable.

I understand that the payrolls should be reviewed by the prime/general contractor to ensure that there are no discrepancies or underpayments as per the applicable wage determination. I recognize that the HUD payroll form (WH-347) or alternative payroll documentation that includes the same elements to determine compliance with applicable regulations is required to be submitted. I further acknowledge that physical and original signed certified payrolls must be mailed to HCD in a timely manner.

I acknowledge that all submitted certified payrolls must include proper designation of trade and classification in accordance with the wage decision applicable to the project for each worker based on the actual type of work he/she performed on the project.

I recognize that if the wage determination applicable to the project is missing a wage rate needed for a specific job classification, HCD must be notified in writing with an attached job description. HCD will submit a conformance request for the proposed additional classification and wage rate by the Department of Labor (DOL).

I also understand that if apprentices or trainees are employed, the prime/general contractor must provide HCD with a copy of the employee(s) registration in an approved program demonstrating ratio and wage schedule with the first payroll on which an apprentice or trainee appears. I further acknowledge that if any apprentice or trainee that is not registered in an approved program must receive the journeyman's wage rate for the classification of work they performed.

I also acknowledge that a Statement of Compliance must be completed and signed by an authorized representative of the company with all submitted payroll forms. This statement shall be executed by the Owner, Principal, or President of the Firm/Company. The

Statement of Compliance may only be signed by an authorized employee if the

“Certificate from Contractor Appointing Officer or Employee to Supervise Payment of

Employees” form or a letter authorizing such a delegation is submitted to HCD.

I understand that if a portion of prevailing wages is in the form of employer contributions to a benefits plan, verification of such contributions may be requested via an account statement from the benefits plan(s) administrator. I recognize that acceptable types of fringe benefits plans include: health insurance, life insurance, disability insurance, dental insurance, tuition assistance, retirement plans, apprenticeship costs, sick leave, and paid vacation days. Employee contributions to benefits plan should not be included in the fringe benefit calculation. If contributions are completed through a union, such rates must be evidenced by the prospective union collective bargaining agreement.

I further recognize that deductions required by law such as FICA, worker’s compensation, and unemployment benefits do not qualify as fringe benefits.

I understand that payroll deductions which do not require approval, are permitted by DOL

Regulations 29 CFR Part 3 and include employee obligations for income taxes, Social

Security payments, insurance premiums, retirement, savings accounts, payments on judgments and other financial obligations legally imposed against the employee, and any other legally-permissible deduction authorized by the employee. “Other/miscellaneous” deductions should be identified. Any voluntary deduction (that is, not required by law or by an order of a proper authority) must be authorized in writing by the employee or provided for in a collective bargaining (union) agreement. The employee authorization form should accompany the first payroll on which the other deduction appears.

Contractor acknowledges that project costs are subject to the allowability and cost principles of 2 CFR 200 Subpart E, as applicable, and that records are subject to audit under 2 CFR 200 Subpart F.

Name Printed, Title Company

Certificate from Contractor Appointing Officer or Employee to Supervise Payment of

Employees

Project Name: Date:

Location: Project No.:

In accordance with 29 CFR 3.3(b), each contractor and subcontractor shall furnish a weekly statement with respect to the wages paid to each of its employees engaged on work covered by the above mentioned project. This statement shall be executed by the Owner, Principal, or

President of the Firm/Company or by an authorized officer or employee of the contractor or subcontractor who supervises the payment of wages, and shall certify, and sign the back of Form

WH 347 or on any form with identical wording; as set forth below.

I/We (Name of Firm/ Corporation) hereby certify that I am/we are the prime contractor/subcontractor for:

(Project Name/Location) in, and that I/We have appointed:

(Authorized Officer/Employee Name), (Authorized Officer/Employee Title) whose signature appears below, to supervise the payment of my/our employees beginning , 20 , that he/she is in a position to have full knowledge of the facts set forth in the payroll documents and in the settlement of compliance required by the so-called Kick-Back Statute which he/she is to execute with my/our full authority and approval until such time as I/We submit to the Bucks County Department of

Housing & Community Development a new certificate appointing some other person for the purposes hereinabove stated.

Identifying Signature of Appointee

Printed Name of Appointee

Witness:

Owner/President/Principal -Signature Signature

Title Title

Note: This certificate must be executed by an authorized officer of a corporation or by a member of a partnership, and shall be executed prior to and be submitted with the first payroll. Should the appointee be changed, a new certificate must accompany the first payroll for which the new appointee executes a statement of compliance required by the Kick-Back Statute.

U.S. Department of Housing and Urban Development

(To Be Executed by Bidder and Submitted with Bid)

False Claims Statement: U.S. Code, Title 31, Section 3729, False Claims, provides a civil penalty of not less than $5,000 and not more than $10,000, plus 3 times the amount of damages for any person who knowingly presents, or causes to be presented, a false or fraudulent claim; or who knowingly makes, or caused to be used, a false record or statement; or conspires to defraud the Government by getting a false or fraudulent claim allowed or paid.

HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)

User Acknowledgement and Certification:

I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate.

Authorized Applicant Name

(Print Full Name)

Authorized Applicant Signature Date

False Claims Act, 31 U.S.C. §§ 3729-3733

Contractor’s Certification on Federal Contract Requirements

(To Be Executed by Bidder and Submitted with Bid)

I hereby certify that I have reviewed the federal construction contract-related requirements imposed on the Contractor(s) of CDBG Grant Program-funded construction projects and fully understand all my obligations if the project is awarded to me.

Project Name:

Location:

Amount of Bid: $

Name of Bidder:

Authorized Applicant Name

(Print Full Name)

Street Address

City, State Zip Code

Authorized Applicant Signature

CONTRACTOR'S and SUBCONTRACTOR’S QUESTIONNAIRE

All Contractors and Subcontractor’s must complete and return this form to:

BUCKS COUNTY

DEPARTMENT OF HOUSING & COMMUNITY DEVELOPMENT

NESHAMINY MANOR CENTER

1260 ALMSHOUSE ROAD

DOYLESTOWN, PA 18901

Attach a separate copy of this questionnaire for each subcontractor.

1. Name, Address, Telephone, e-mail address, and Employer Identification

Number:

(Sole proprietors who do not have an EIN number, please provide Social-

Security number)

2. Project Name, Location and Contract Number:

3. Type of Work to be Undertaken:

4. Amount of Contract: $

5. Date of Award of Contract:

6. How Many Subcontractors will be Employed on this project:

7. Estimate Completion Date:

Contractor & Subcontractor Questionnaire 1

8. The below information is used by HUD to monitor and evaluate awarded contracts against the total program activity and the designated as mandated by the Small

Business Act (SBA). The Department requires the information to provide guidance and oversight of programs for the development of small business, minority firms, businesses owned by disadvantaged persons, and women-owned firms.

Are any of the Principal Owners of the Contracting Firm:

a) A Resident of Bucks County:

b) Female:

c) Section 3:

d) A Member of a Minority Group:

If yes, please select the appropriate code below:

Below are the Racial/Ethnic codes that are offered on HUD’s report.

1 = White Americans

2 = Black Americans

3 = Native Americans

4 = Hispanic Americans

5 = Asian/Pacific Americans

6 = Hasidic Jews

All Contractors and subcontractors undertaking projects funded through the Community

Development program will indicate the number of their employees, by race and sex, on this form. Include all employees of the firm, not just those working on the Community

Development project.

RACIAL

GROUP

# OF MALE

EMPLOYEES

# OF

HISPANIC

MALE

EMPLOYEES

# OF

FEMALE

EMPLOYEES

# OF

HISPANIC

FEMALE

EMPLOYEES

White

Black/African

American

Asian

Some Other

Race

More than

One Race

Contractor & Subcontractor Questionnaire 2

SECTION 3 DEFINITIONS

A Section 3 person is one that earns less than 80% of the region's median income. A

Section 3 business is 51 percent or more owned by low-income residents or is a business who employs Section 3 residents for at least 30 percent of its full-time, permanent staff;

or provides evidence of a commitment to subcontract to Section 3 business concerns, 25 percent or more of the dollar amount of the awarded contract. For purposes of the

CDBG program, household income is calculated to include income earned by each member of the household.

QUALIFYING AS A SECTION 3 BUSINESS

1. Is your business owned (51 % or more) by individuals whose household incomes are LESS THAN 80% of the Bucks County Median Income?

Yes: Complete Chart A Information for all owners of the business.

No

Owner’s Name Home Address Household Size Household Income Percent Ownership

2. Do 30% (or more) of your full-time, permanent employees have household incomes that are LESS THAN 80% of the Bucks County Median Income?

Yes: Complete Chart B information on employees qualifying as Section 3.

No

Employee Name Home Address Household Size Household Income Date of Hire

3. Will your business sub-contract more than 25% of this contract with any business that has any of the characteristics noted in Questions 1 or 2?

Yes: Complete Chart C contracts with Section 3 qualifying businesses.

No

Section 3

SubContractor

Sub-Contractor

Business Address

Contact Person Percent of Contract awarded to Sub-Contractor

By signing below, I certify all information in this form is true and correct to the best of my knowledge.

Authorized Representative Signature and Title

Contractor & Subcontractor Questionnaire 3

AFFIRMATIVE ACTION PLAN

TO INSURE EQUAL OPPORTUNITY IN HIRING AND EMPLOYMENT FOR ALL

WORK FUNDED THROUGH THE BUCKS COUNTY COMMUNITY

DEVELOPMENT PROGRAM.

All contractors and sub-contractors agree to take the following actions:

1. Endorse the following statement: The undersigned contractor has agreed that it will not discriminate against any employee or applicant for employment because of race, color, religion, sex or national origin and will take affirmative action to insure that applicants are employed and that employees are treated during employment without regard to their race, color, religion, sex or national origin.

2. When hiring any subcontractors, to provide an opportunity for any minority owned firms located within Bucks County to bid for the job.

3. Report to the Department of Housing & Community Development on the firm’s total employees, by race and sex.

4. Send a copy of this Affirmative Action Plan to any collective bargaining organization with which the contractor has an agreement.

5. Post the Equal Opportunity Poster and this Affirmative Action Plan in conspicuous location available to employees.

(Name of Firm) hereby agrees to abide by the provisions of this Affirmative Action Plan.

Authorized Representative Signature and Title

Contractor's Acknowledgment of Receipt of HUD 4010

(https://www.hud.gov/sites/documents/4010.PDF)

The Contractor certifies receipt of HUD 4010: “Federal Labor Standards Provisions”.

The Contractor agrees to abide by the requirements set forth therein in connection with any funds that may be made by the Government pursuant to the Contractor for Construction.

Title and Company

PENALTY FOR FALSE OR FRAUDULENT STATEMENT. U.S.C. TITLE 18, SEC. 1001, provides:

“whoever, in any matter within jurisdiction of any department or agency of the United State knowingly and willfully falsifies . . . or makes any false, fictitious, or fraudulent statements or representations, or makes or uses any false writing or document knowing the same to contain any false, fictitious, or fraudulent statement or entry, shall be fined not more than $10,000, not imprisoned not more than five years or both.”

Name of Contractor Signature of Authorized Representative

Address Date

City/State/Zip

Telephone Number License Number http://www.hud.gov/sites/documents/4010.PDF)

TITLE 49, CODE OF FEDERAL REGULATION, PART 29

DEBARMENT AND SUSPENSION CERTIFICATION

(see: http://www.sam.gov/portal/SAM/#1)

The bidder, under penalty of perjury, certifies that, except as noted below, he/she or any person associated therewith in the capacity of owner, partner, director, officer, manager:

o is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by any federal agency;

o has not been suspended, debarred, voluntarily excluded or determined ineligible by any federal agency within the past three years;

o does not have a proposed debarment pending; and o has not been indicted, convicted, or had a civil judgment rendered against it by a court of competent jurisdiction in any matter involving fraud or official misconduct within the past three years;

If there are any exceptions to this certification, insert the exceptions in the following space:

Exceptions will not necessarily result in denial of award, but will be considered in determining bidder’s responsibility. For any exception noted above, indicate below to whom it applies, initialing agency, and dates of action.

No part of this contract shall be subcontracted to any person of firm ineligible to be awarded of a

Government contract by virtue of Section 3(a) of the Davis-Bacon Act, 29 CFR 5.12(a)(1) or 49

CFR 29.

The penalty for making false statements is prescribed in the U.S. Criminal Code, 18 U.S.C. 1001.

Type or Print Name and Title of Signer

NOTE: Each member of a Joint Venture must submit this form. Additionally, previous certifications under the present Joint Venture shall be submitted upon request.

http://www.sam.gov/portal/SAM/#1)

NON COLLUSION AFFIDAVIT

, being first duly sworn, deposes and says that he or she is (Sole owner, a partner, president, etc.) of . The party making the foregoing bid that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid or that anyone shall refrain from bidding;

that the bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other bidder, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and further, that the bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid.

Name of Authorized Official

Signature of Authorized Official

Company Name

Anti-Lobbying Amendment Certification

For all orders above the limit prescribed in 2 CFR 200 – Appendix II

(currently $100,000), the Offeror must complete and sign the following:

The following certification and disclosure regarding payments to influence certain federal transactions are made per the provisions contained in 2 CFR

200 – Appendix II and 31 U.S.C. 1352, the “Byrd Anti‐Lobbying

Amendment.”

(a) 2 CFR 200 – Appendix II, “Contract Provisions for Non-Federal Entity Contracts

Under

Federal Awards” is hereby incorporated by reference into this certification

(b) The offeror, by signing its offer, hereby certifies to the best of his or her knowledge and belief that:

(1) No Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress on his or her behalf in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment or modification of any Federal contract, grant, loan, or cooperative agreement;

(2) If any funds other than Federal appropriated funds (including profit or fee received under a covered Federal transaction) have been paid, or will be paid, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress on his or her behalf in connection with this solicitation, the offeror shall complete and submit, with its offer, OMB standard form LLL, Disclosure of

Lobbying Activities, to the Contracting Officer; and

(3) He or she will include the language of this certification in all subcontract awards at any tier and require that all recipients of subcontract awards in excess of $150,000 shall certify and disclose accordingly.

(c) This certification is a material representation of fact upon which reliance is placed when this transaction was made or entered into. Submission of this certification and disclosure is a prerequisite for making or entering into this contract imposed by section 1352, title 31, United States Code. Any person making an expenditure prohibited under this provision or who fails to file or amend the disclosure form to be filed or amended by this provision, shall be subject to a civil penalty of not less than $10,000, and not more than $100,000, for each such failure.

Authorized Applicant Name (Print Full Name)

Authorized Applicant Signature Date

Benchmark 1: Twenty-five (25%) percent or more of the total number of labor hours worked by all workers on a Section 3 project must be done by Section 3 workers; and

Section 3 Labor Hours/Total Labor Hours = 25%

Benchmark 2: Five (5%) percent or more of the total number of labor hours worked by all workers on a Section 3 project must be done by Targeted Section 3 workers.

Targeted Section 3 Labor Hours/Total Labor Hours = 5%

Section 3 Acknowledgement Form

Circle one:

Subrecipient OR Contractor Organizational Name:

Business Address

Phone Number & E-mail Address

Primary Contact Name, Title

Project Name and Contract No.

Section 3 of the Housing and Urban Development Act of 1968 requires that, to the greatest extent feasible, economic opportunity generated by CDBG, HOME, ESG funds and other HUD assistance, most importantly employment, is directed to low- and very low-income persons, particularly those who are recipients of government assistance for housing, as well as residents of the community in which the federal funds are spent. HUD’s regulations for implementing Section 3 can be found at 24 CFR Part 75. The current Safe Harbor benchmarks codified at 24 CFR 75.23 that apply to all Section 3 projects include the following:

Please review, and sign the following in acknowledgment:

(hereinafter the subrecipient/contractor) hereby CERTIFIES that upon being awarded a contract to participate in the following HUD-funded project: (the project name) located in (city/town/township) in Bucks County, PA that the subrecipient/ contractor:

1. is under no contractual or other impediment that would prevent it from complying with requirements of Section 3 as set forth in 24 CFR part 75; and

2. will take all affirmative actions to comply with HUD’s regulations in 24 CFR Part 75 including but not limited to contracting and reporting obligations; and

3. will submit to HCD appropriate Section 3 documentation of total labor hours performed per contractor/subcontractor, certifications of all workers, Section 3 workers, and Targeted Section 3 workers. If the Section 3 safe harbor benchmarks are not met agency will also submit qualitative reporting to demonstrate compliance; and

4. will maintain documentation and applicable certifications to ensure that workers meet the definition of a Section 3 worker or Targeted Section 3 worker, or are verified to be employed by a Section 3 business concern at the time of hire or the first reporting period; and

5. will include the Section Clause and HCD Section 3 Requirements language into all HUD Section 3 covered bid documents, contracts, and subcontracts and further agree to take the appropriate action pursuant to those regulation contained therein in the event the contractor/ subcontract is found to be in violation of 24 CFR Part 75; and

6. will not contract/subcontract with any contractor(s)/ subcontractor(s) where the subrecipient/contractor has notice or knowledge that the contractor/ subcontractor has been found in violation of any provision of 24 CFR Part 75; and

7. certifies that any vacant employment positions, including training positions, that are filled (a) after the contractor is selected will prioritize targeted Section 3 workers; and

8. further certifies persons hired other than those to whom the regulations of 24 CFR part 75 require employment opportunities to be directed, were not filled to circumvent the contractor's obligations under 24 CFR Part 75.

9. Acknowledges that HUD may adjust funding thresholds or establish new benchmarks periodically as new information becomes available.

10. Further acknowledges to contact HCD for technical assistance as needed for Section 3 implementation and reporting requirements.

Authorized Representative Name:

Signature:

Title: Date: