Appendix B Compliance Exhibit (REV) (1).pdf

Fillmore Piru Veterans Memorial District

Compliance Exhibit

Compliance Exhibit- Table of Contents- See PDF Bookmarks

1. Initial/One Time Forms

a. DAS 140

b. DAS 142

c. Fringe Benefit Statement

d. LCP Tracker Information Sheet

e. Letter of Payroll Authorization

f. Subcontractor List

g. Contractors Certification on Federal Contract Requirements

h. Certification Regarding Debarment and Suspension

i. False Claims Act, 31 USC 3729-3733

j. Certification of Bidder Regarding Non-Segregated Facilities

k. Byrd Anti-Lobbying Amendment Certification

l. Disclosure of Lobbying Activities

m. Section 3 Economic Opportunity Plan

n. Section 3 Contract Clause

o. Notice of Project Service Area

p. Section 3 Compliance Bidder’s Certification

q. (Optional) Section 3 Business Concern Certification

2. Weekly Submittals Summary

a. LCP Tracker- dual entry Certified Payrolls and Davis Bacon

b. Other Deductions

c. Sign In Sheets

3. Prevailing Wage Overview (“higher of the two”) including:

a. California Commercial State Rates 2026-2 (Interim and may be subject to change prior to work on site)

b. Federal Davis Bacon Rate CA20260015 Modification 5 dated 09/03/2026 (Interim and may be subject to change prior to work on site)

4. VENTURA COUNTY SECTION 3 PLAN

5. PLACING VETS FIRST/DVBE GOALS

6. APPRENTICESHIP LABOR CODE SECTION 1777.5

7. HUD 4010 FEDERAL LABOR STANDARDS PROVISIONS (A-1)

8. CONTRACT WORK HOURS AND SAFETY STANDARDS ACT, AS AMENDED

9. COPELAND ANTI KICKBACK ACT TITLE 18, USC

10. HOUSING AND COMMUNITY DEVELOPMENT ACT OF 1974 STATUTORY PROVISIONS

SECTION 110

11. CODE OF FEDERAL REGULATIONS TITLE 24 HOUSING AND URBAN DEVELOPMENT

12. REQUIREMENT FOR AFFIRMATIVE ACTION TO ENSURE EQUAL OPPORTUNITY

EMPLOYMENT OPPORTUNITY (EXECUTIVE ORDER 11246)

13. CIVIL RIGHTS, EMPLOYMENT AND CONTRACTING OPPORTUNITIES, AND OTHER FEDERAL

REQUIREMENTS

14. THE DAVIS BACON ACT, AS AMENDED

15. DAVIS BACON REQUIREMENT. POSTINGS/NOTICES

16. BUILD AMERICA, BUY AMERICA (BABA) SUMMARY

17. COUNTY OF VENTURA FEDERAL LABOR STANDARDS POLICY AND PROCEDURES

Compliance How To and Requirements Checklist

Preliminary Items

Task Resource Complete

1. Business Certificate. All subcontractors must have a current Fillmore Business Tax Certificate.

https://www.fillmoreca.gov/19 6/Business-License

2. DIR Public Works Contractor Registration. All subcontractors must be a registered and current DIR Public Works Contractor.

https://www.dir.ca.gov/public-works/contractor-registration.html

1st Round: Compliance documents must be submitted with proposal. Once compliance documents are filled out, send in for review and approval prior to signature. Digital signatures are acceptable.

Please keep originals on file for your records.

Task Resource Complete

Fringe Benefit Statement Section 1 One Time Forms

Letter of Payroll Authorization for Public Works. Section 1 One Time Forms

Subcontractor Listing Form Section 1 One Time Forms

CSLB Pocket License. Provide CSLB Pocket license.

DAS 140. Required for all apprenticeable trades per Section 1777.5.

Please review this link to find apprentice programs available based on your trade:

https://www.dir.ca.gov/databases/das/pwaddrstart.asp Need proof of transmission via fax or email return receipt.

Section 1 One Time Forms

Contractors Certification on Federal Contract Requirements Section 1 One Time Forms

Certification Regarding Debarment and Suspension Section 1 One Time Forms

False Claims Act, 31 USC 3729-3733 Section 1 One Time Forms

Certification of Bidder Regarding Non-Segregated Facilities Section 1 One Time Forms

Byrd Anti-Lobbying Amendment Certification Section 1 One Time Forms

Disclosure of Lobbying Activities Section 1 One Time Forms

Section 3 Economic Opportunity Plan Section 1 One Time Forms

Section 3 Contract Clause Section 1 One Time Forms

Notice of Project Service Area Section 1 One Time Forms

Section 3 Compliance Bidder’s Certification Section 1 One Time Forms https://www.fillmoreca.gov/196/Business-License https://www.fillmoreca.gov/196/Business-License https://www.dir.ca.gov/public-works/contractor-registration.html https://www.dir.ca.gov/public-works/contractor-registration.html https://www.dir.ca.gov/public-works/contractor-registration.html https://www.dir.ca.gov/databases/das/pwaddrstart.asp

(Optional) Section 3 Business Concern Certification

Section 1 One Time Forms

2nd Round: Prior to Work Start

Task Resource Complete

DAS 142. Required for all apprentice able trades per Section 1777.5.

Send to all applicable joint apprenticeship training committees. List of applicable apprenticeship training committees can be found here: https://www.dir.ca.gov/databases/das/aigstart.asp Need proof of transmission via fax or email return receipt.

Item 2 DAS 140 and 142

3rd Round: During Construction – In addition to Certified Payroll Entry as detailed in Prevailing Wage

Task Resource Complete

Provide Authorization to Deduct Payroll (i.e. Child Support Garnishments) with form signed by employee.

Section 3. Other Deductions

Sign in Sheets. To be completed daily and submitted to Contractor onsite. Subcontractor’s foreman to keep copy for Subcontractor’s record (by photo to file or hard copy).

Section 3. Sign in Sheets.

Training Fund Contributions/Proof of Fringe Benefits being paid Item 4 Training Funds https://www.dir.ca.gov/databases/das/aigstart.asp

1. Initial One Time Forms

1.

2.

Enter name of the Committee

3.

Date

Apprenticeship Committee. We will employ and train under their Standards. Enter name of the Committee

We will employ and train apprentices in accordance with the California Apprenticeship Council regulations, including § 230.1 (c) which requires that apprentices employed on public projects can only be assigned to perform work of the craft or trade to which the apprentice is registered and that the apprentices must at all times work with or under the direct supervision of journeyman/men.

We will comply with the standards of

Apprenticeship Committee for the duration of this job only.

We are already approved to train apprentices by the

THIS FORM IS BEING SENT TO: (NAME & ADDRESS OF APPRENTICESHIP PROGRAM(S))

Check One Of The Boxes Below

PUBLIC WORKS CONTRACT AWARD INFORMATION

NAME & ADDRESS OF PUBLIC AGENCY AWARDING CONTRACT

Contract award information must be sent to your Apprenticeship Committee if you are approved to train. If you are not approved to train, you must send the information (which may be this form) to ALL applicable Apprenticeship Committees in your craft or trade in the area of the site of the public work. Go to: http://www.dir.ca.gov/das/PublicWorksForms.htm for information about programs in your area and trade. You may also consult your local Division of Apprenticeship Standards (DAS) office whose telephone number may be found in your local directory under California, State of, Industrial Relations, Division of Apprenticeship Standards.

Do not send this form to the Division of Apprenticeship Standards.

NAME OF YOUR COMPANY

MAILING ADDRESS- NUMBER & STREET, CITY, ZIP CODE

CONTRACTOR'S STATE LICENSE NO

APPROXIMATE DATES TO BE EMPLOYED

ESTIMATED NUMBER OF APPRENTICE HOURS

AREA CODE & TELEPHONE NO.

DATE OF EXPECTED OR ACTUAL START OF PROJECT

ESTIMATED NUMBER OF JOURNEYMEN HOURS

This is not a request for dispatch of apprentices.

Contractors must make a separate request for actual dispatch, in accordance with Section 230.1(a) California Code of Regulations

DATE YOUR CONTRACT EXECUTED

OCCUPATION OF APPRENTICE

NAME & ADDRESS OF PUBLIC WORKS PROJECT

DAS 140 (REV. 1/04)

State of California - Department of Industrial Relations DIVISION

OF APPRENTICESHIP STANDARDS

Signature

Typed Name

Title

REQUEST FOR DISPATCH OF AN APPRENTICE – DAS 142 FORM

DO NOT SEND THIS FORM TO DAS

You may use this form to request dispatch of an apprentice from the Apprenticeship Committee in the craft or trade in the area of the public work. Go to: ƘǘǘLJΥκκǿǿǿΦŘƛNJΦŎŀΦƎƻǾκŘŀǘŀōŀǎŜǎκŘŀǎκLJǿŀŘŘNJǎǘŀNJǘΦŀǎLJ for ƛƴŦƻNJƳŀǘƛƻƴ about programs in your area and trade. You may also consult your local Division Apprenticeship {ǘŀƴŘŀNJŘǎ (DAS) office whose telephone number may be found in your local directory under California, State of, LƴŘdzǎǘNJƛŀƭ Relations, Division of Apprenticeship Standards. Except for projects with less than 40 hours of

ƧƻdzNJƴŜȅƳŀƴ work, you must request and employ apprentices in no less than 8 hour increments.

Date: Contractor Requesting Dispatch:

To Applicable Apprenticeship Committee:

Name:____________________________________________

Address:__________________________________________

Tel. No. _______________ Fax No. ___________________

Name: ______________________________________

Address: ____________________________________

License No. __________________________________

Tel. No. _______________ Fax No. _______________

Project Information:

Contract No.

Project:____________________________________________________________________________________

Address:_____________________________________________

Dispatch Request Information:

Number of Apprentice(s) Needed: _________________ Craft or Trade: ___________________________________

Date Apprentice(s) to Report: _______________ (72 hrs. notice required) Time to Report: _________________

Name of Person to Report to: ______________________________________

Address to Report to: _____________________________________________

You may use this form to make your written request for the dispatch of an apprentice. Requests for dispatch must be in writing and submitted at least 72 hours in advance (excluding weekends and holidays) via first class mail, fax or email. Proof of submission may be required. Please take note of California Code of Regulations, Title 8, § 230.1 (a) for all applicable requirements regarding apprenticeship requests and/or visit http://www.dir.ca.gov/DAS/DASApprenticesOnPublicWorksSummaryOfRequirements.htm

DAS 142 (Revised 04/14) http://www.dir.ca.gov/databases/das/pwaddrstart.asp http://www.dir.ca.gov/DAS/DASApprenticesOnPublicWorksSummaryOfRequirements.htm

LETTER OF PAYROLL AUTHORIZATION FOR PUBLIC WORKS

Project Name:

Contract Number

The following person is designated as the payroll officer for the undersigned and is authorized to certify all weekly payroll records for this project.

Payroll Officer (Name)

By:

Payroll Officer (Signature)

(Company Name)

(Principal Name)

By:

(Principal’s Signature)

(Title)

(Contractor License Number)

(Date)

PUBLIC W ORKS FRINGE BENEFIT STATEMENT

Date: In reply, Refer to Case No.:

Prime: Sub-Contractor:

PROJECT NAME:

PROJECT CONTRACT No.: County/Location

Health and W elfare

NAME OF PLAN____________________________ Address, City, and Zip____________________________________

ADMINISTRATOR__________________________ Address, City, and Zip____________________________________

CLASSIFICATION(S) USED CONTRIBUTION PER CLASSIFICATION PER HOUR

CONTRIBUTIONS: W EEKLY _________ Monthly ________ Quarterly ________ Annually _____

PENSION

NAME OF PLAN____________________________ Address, City, and Zip____________________________________

ADMINISTRATOR__________________________ Address, City, and Zip____________________________________

CLASSIFICATION(S) USED CONTRIBUTION PER CLASSIFICATION PER HOUR

CONTRIBUTIONS: W EEKLY _________ Monthly ________ Quarterly ________ Annually _____

VACATION/HOLIDAY

NAME OF PLAN____________________________ Address, City, and Zip____________________________________

ADMINISTRATOR__________________________ Address, City, and Zip____________________________________

CLASSIFICATION(S) USED CONTRIBUTION PER CLASSIFICATION PER HOUR

CONTRIBUTIONS: W EEKLY _________ Monthly ________ Quarterly ________ Annually _____

TRAINING

NAME OF PLAN____________________________ Address, City, and Zip____________________________________

ADMINISTRATOR__________________________ Address, City, and Zip____________________________________

CLASSIFICATION(S) USED CONTRIBUTION PER CLASSIFICATION PER HOUR

CONTRIBUTIONS: W EEKLY _________ Monthly ________ Quarterly ________ Annually _____

IF YOU USE OTHER PLANS NOT LISTED ABOVE, YOU MAY USE THE BACK OF THIS FORM TO

PROVIDE THIS ADDITIONAL INFORMATION

Fillmore Piru Veterans Memorial District Ventura

SUBCONTRACTOR LISTING

PROJECT NAME PRIME CONTRACTOR Contract No:

COMPANY NAME C/V WORK ASSIGNED AMOUNT CONTACT PERSON PHONE E-MAIL

Form AA004 (9/2006) C = CONTRACTOR, V = VENDOR

Company Name (Contractor) *

Federal Tax ID Number * D-U-N-S Number

Contractor License No. or 10-digit Phone Number * Contractor License Expiring Date

Contractor License (To Display on Certified Payroll)

Insurance Certificate Number Specialty License Number Local Business (City) License

Motor Carrier Permit Number Worker's Compensation Policy Number

Union Status *

Ethnicity *

Section 3 Business Non-Construction Contractor

Principal Name* Principal Title*

Contact Name *

Phone Number * Contact Fax

Address 1 * Address 2

City * State/Province * ZIP Code *

Standard Hours Per Day * Standard Work Week Hours *

Pay date is calendar days after week end date.*

Contractor Status Owner Operator

Contact E-Mail * (Login information will be sent to this email address)

PWCR Number*

Name of Project:

Subcontractor to:

Estimated Start Date:

Estimated End Date:

Contract Amount:

LCP Tracker Information Sheet

Contractor’s Certification On Federal Contract Requirements

NOTE TO BIDDER: Failure to complete all items on this page may cause rejection of your bid.

CONTRACTOR’S CERTIFICATION ON

FEDERAL CONTRACT REQUIREMENTS

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: Fillmore Piru Veterans Memorial District

Location:

Amount of Bid: $

Name of Bidder

Print Name and Title

Street Address

City, State Zip Code

Signature

Page 1 of 2 form HUD-2992(3/98)

Certification Regarding Debarment and Suspension

U.S. Department of Housing and Urban Development

Certification A: Certification Regarding Debarment, Suspension and Other Responsibility Matters – Primary Covered Transactions

1. The prospective primary participant certifies to the best of its knowledge and belief that its principals:

a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal debarment or agency;

b. Have not within a three-year period preceding this proposal, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification, or destruction of records, making false statement, or receiving stolen property;

c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this certification; and

d. Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State or local) terminated for cause or default.

2. Where the prospective primary participant is unable to certify to any of the statement in this certification, such prospective participant shall attach an explanation to this proposal.

Instructions for Certification (A)

1. By signing and submitting this proposal, the prospective primary participant is providing the certification set out below.

2. The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction.

The prospective participant shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the department or agency’s determination whether to enter into this transaction. However, failure of the prospective primary participant to furnish a certification of the prospective primary participant to furnish a certification or an explanation shall disqualify such person from participation in this transaction.

3. The certification in this clause is a material representation of fact upon which reliance was in place when the department or agency determined to enter into this transaction. If it is later determined that the prospective primary participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause or default.

4. The prospective primary participant shall provide immediate written notice to the department or agency to whom this proposal is submitted if at any time the prospective primary participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.

5. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. You may contact the department or agency to which this proposal is being submitted for assistance in obtaining a copy of these regulations.

6. The prospective primary participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency entering into this transaction.

7. The prospective primary participant further agrees by submitting this proposal that it will include the clause titled “Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion – Lower Tier Covered Transaction,” provided by the department or agency entering into this covered transaction, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.

8. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded form the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines this eligibility of its principals. Each participant may, but is not required to, check the Non-procurement list.

9. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.

10. Except for transactions authorized under paragraph (6) of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause of default.

Page 2 of 2 form HUD-2992(3/98)

Certification B: Certification Regarding Debarment, Suspension, Ineligible and Voluntary Exclusion – Lower Tier Covered Transactions

1. The prospective lower tier participant certifies, by submission of this proposal, that neither it not its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency.

2. Where the prospective lower tier participant is unable to testify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal.

Instructions for Certification (B)

1. By signing and submitting this proposal, the prospective lower tier participant is providing the certification set out below.

2. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment.

3. The prospective lower tier participant shall provide immediate written notice to the person to which this proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous when submitted or has become by reason of changed circumstances.

4. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of these regulations.

5. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into an lower tier transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency with which this transaction originated.

6. The prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled “Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion – Lower Tier Covered Transaction,” without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.

7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the Non-procurement list.

8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.

9. Except for transactions authorized under paragraph (5) of these instructions, if a participant in a lower covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies including suspension and/or debarment.

Applicant Date

Signature of Authorized Certifying Official Title

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

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

CERTIFICATION OF BIDDER REGARDING NON-SEGREGATED FACILITIES

(To Be Executed by Bidder and Submitted with Bid)

This certification is required pursuant to Executive Order 11246 (30 F.R. 12319-25). The bidder's attention is called to the clause entitled Equal Employment Opportunity of the General Conditions of the Contract for Construction.

"Segregated facilities," as used in this provision, means any waiting rooms, work areas, rest rooms and wash rooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees, that are segregated by explicit directive or are in fact segregated on the basis of race, color, religion, or national origin because of habit, local custom, or otherwise.

By the submission of this bid, the bidder certifies that it does not and will not maintain or provide for its employees any segregated facilities at any of its establishments, and that it does not and will not permit its employees to perform their services at any location under its control where segregated facilities are maintained. The bidder agrees that a breach of this certification is a violation of the Equal Employment Opportunity clause in the contract.

The bidder further agrees that (except where it has obtained identical certifications from proposed subcontractors for specific time periods) prior to entering into subcontracts which exceed $10,000 and are not exempt from the requirements of the Equal Employment Opportunity clause, it will obtain identical certifications from the proposed subcontractors; retain the certifications in its files; and forward the following notice to the proposed subcontractors (except if the proposed subcontractors have submitted identical certifications for specific time periods):

Notice to Prospective Subcontractors of Requirement for Certifications of Non-segregated Facilities

A Certification of Non-segregated Facilities must be submitted before the award of a subcontract exceeding $10,000 which is not exempt from the provisions of the Equal Employment Opportunity clause of the prime contract. The certification may be submitted either for each subcontract or for all subcontracts during a period (i.e., quarterly, semiannually, or annually).

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

BYRD 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.

SIGNATURE: ______________________________________________________________________

COMPANY NAME: _________________________________________________________________

DATE: _____________________

DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB

Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 0348-0046

(See reverse for public burden disclosure.)

1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:

a. contract a. bid/offer/application a. initial filing

b. grant b. initial award b. material change

c. cooperative agreement c. post-award For Material Change Only:

d. loan year _________ quarter _________

e. loan guarantee date of last report ______________

f. loan insurance

4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is a Subawardee, Enter Name and Address of Prime:

Tier ______, if known :

Congressional District, if known : Congressional District, if known :

6. Federal Department/Agency: 7. Federal Program Name/Description:

CFDA Number, if applicable: _____________

8. Federal Action Number, if known : 9. Award Amount, if known :

10. a. Name and Address of Lobbying Registrant b. Individuals Performing Services (including address if ( if individual, last name, first name, MI): different from No. 10a )

(last name, first name, MI ):

11. Signature:

Print Name:

Title:

Telephone No.: _______________________

Authorized for Local Reproduction

Standard Form LLL (Rev. 7-97)

Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be available for public inspection.

required disclosure shall be subject to a not more than $100,000 for each such failure.

Prime Subawardee

Federal Use Only:

Date:

who fails to file the Any person $10,000 and than civil penalty of not less

INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES

This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employeeof any agency, a Member of Congress, an officer or employeeof Congress, or an employeeof a Member of Congress in connectionwith a coveredFederalaction. Completeall items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.

1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action.

2. Identify the status of the covered Federal action.

3. Identify the appropriateclassification of this report. If this is a followup report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal action.

4. Enter the full name, address, city, State and zip code of the reporting entity. Include CongressionalDistrict, if known. Check the appropriateclassification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee,e.g., the first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.

5. If the organization filing the report in item 4 checks "Subawardee," then enter the full name, address, city, State and zip code of the prime Federal recipient. Include Congressional District, if known.

6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizationallevel below agency name, if known. For example, Department of Transportation, United States Coast Guard.

7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance

(CFDA) number for grants, cooperative agreements, loans, and loan commitments.

8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number;

Invitation for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001."

9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5.

10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting entity identified in item 4 to influence the covered Federal action.

(b) Enter the full names of the individual(s) performing services, and include full address if different from 10 (a). Enter Last Name, First Name, and Middle Initial (MI).

11. The certifying official shall sign and date the form, print his/her name, title, and telephone number.

According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB Control Number. The valid OMB control number for this information collection is OMB No. 0348-0046. Public reporting burden for this collection of information is estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, DC 20503.

Attachment A - Section 3 Economic Opportunity Plan

(SUBMIT WITH BID)

Project Name: Date:

Project Address:

Project City/County:

Name of Bidder/Organization:

Contact Person and Title:

Telephone Number: email:

Address of Bidder:

Description of Service Area or Neighborhood of the Section 3 Project, bordering streets, etc. (or attach map)

Census Tract(s) and Block Group(s):

A. Economic Opportunities for Section 3 Business Concerns

1. List of all subcontractors and construction related vendors you plan to use regardless of contract amount. You may use additional sheets to complete this section if necessary.

Name:

Address:

Amount:

Contact:

Phone Number:

License Number:

Section 3 Business Concern: Yes or No

Name:

Address:

Amount:

Contact:

Phone Number:

License Number:

Section 3 Business Concern: Yes or No

Name:

Address:

Amount:

Contact:

Phone Number:

License Number:

Section 3 Business Concern: Yes or No

Attachment A

(page 2)

Name:

Address:

Amount:

Contact:

Phone Number:

License Number:

Section 3 Business Concern: Yes or No

Name:

Address:

Amount:

Contact:

Phone Number:

License Number:

Section 3 Business Concern: Yes or No

Name:

Address:

Amount:

Contact:

Phone Number:

License Number:

Section 3 Business Concern: Yes or No

Name:

Address:

Amount:

Contact:

Phone Number:

License Number:

Section 3 Business Concern: Yes or No

Name:

Address:

Amount:

Contact:

Phone Number:

License Number:

Section 3 Business Concern: Yes or No

Name:

Address:

Amount:

Contact:

Phone Number:

License Number:

Section 3 Business Concern: Yes or No

Name:

Address:

Amount:

Contact:

Phone Number:

License Number:

Section 3 Business Concern: Yes or No

Name:

Address:

Amount:

Contact:

Phone Number:

License Number:

Section 3 Business Concern: Yes or No

(page 3)

3. Detailed description of: 1) all efforts planned to outreach to, identify and secure bids from Section 3 Business Concerns; 2) all Technical Assistance planned to help Section 3 Business Concerns understand and bid on the Section 3 Project; and 3) any assistance made available to Section 3 Business Concerns in bonding, guaranties, or other efforts to support viable bids.

4. List of sources and methods of identifying and soliciting Section 3 Business Concerns for this project.

(page 4)

B. Economic Opportunities for Section 3 Workers

1. List of Sources and Methods of Recruitment of Section 3 Workers.

2. List State approved apprenticeship programs to be utilized, if any.

3. List any Job Training Partnership Act (JTPA) programs to be utilized, if any.

4. Detailed description of: 1) all efforts planned to outreach to and generate job applicants who qualify as Section 3 Workers; and 2) all planned Technical Assistance to help Section 3 Workers apply for jobs.

5. List other methods utilized to provide economic opportunities and comply with Section 3 requirements (use additional sheets if necessary).

(page 5)

C. Preliminary Statement of Workforce Needs

1. Complete the following table for the project. Depending upon the magnitude of the project, you may wish to prepare a table for you and each subcontractor.

Occupations

Total Labor Hours Estimated to be Worked by all

Workers

Total Labor

Hours Estimated to be Worked by Section 3

Workers

Total Labor Hours Estimated to be

Worked by Targeted Section 3 Workers

Vacancies to Fill

Skilled Trades

Semi-skilled

Unskilled Labor

Trainees/ Apprentices

Professional Services (architectural, engineering, etc.)

Other:

Totals

Total Goal for Section 3 Workers (Total Labor Hours Estimated to be Worked by Section 3 Workers Divided by Total Labor Hours Estimated to be Worked by al Workers)

Total Goal for Targeted Section 3 Workers (Total Labor Hours Estimated to be Worked by Targeted Section 3 Workers Divided by Total Labor Hours Estimated to be Worked by al Workers)

Section 3 Benchmarks require that Subrecipients, Contractors and Subcontractors make every effort to meet the following benchmarks:

• Section 3 Workers will make up 25% of the total number of labor hours worked by all workers, exclusive of the labor hours worked by Targeted Section 3 Workers; and

• Targeted Section 3 Workers will make up 5% of the total number of labor hours worked by all workers.

SUBMIT WITH BID

AND PRIOR TO ANY SUBCONTRACTS WITH SECTION 3 BUSINESS CONCERNS

Attachment B - Section 3 Clause

24 CFR 75

(to be inserted into every contract/subcontract for work)

A. The work to be performed under this contract is on a project assisted under a program providing direct federal financial assistance from the Department of Housing and Urban Development and is subject to the requirements of Section 3 of the Housing and Urban Development Act of 1968, as amended, 12 U.S.C. 1701u, as amended in the Section 3 Final Rule on September 29, 2020 (the Final Rule). Section 3 requires that to the greatest extent feasible, opportunities for training and employment be given to lower income residents of the project area and contracts for work in connection with the project be awarded to business concerns which are located in, or owned in substantial part by persons residing in the area of the project.

B. The parties to this contract will comply with the provisions of said Section 3 and the regulations issued pursuant thereto by the Secretary of Housing and Urban Development set forth in 24 CFR 75 and all applicable rules and orders of the Department issued thereunder prior to the execution of this contract. The parties to this contract certify and agree that they are under no contractual or other disability which would prevent them from complying with these requirements.

C. The contractor will send to each labor organization or representative of workers with which he has a collective bargaining agreement or other contract or understanding, if any, a notice advising the said labor organization or worker's representative of his commitments under this Section 3 clause and shall post copies of the notice in conspicuous places available to employees and applicants for employment or training.

D. The contractor will include this Section 3 clause in every subcontract for work in connection with the project and will, at the direction of the applicant for or recipient of Federal financial assistance, take appropriate action pursuant to the subcontract upon a finding that the subcontractor is in violation of regulations issued by the Secretary of Housing and Urban Development, 24 CFR 75. The contractor will not subcontract with any subcontractor where it has notice or knowledge that the latter has been found in violation of regulations under 24 CFR 75 and will not let any subcontract unless the subcontractor has first provided it with a preliminary statement of ability to comply with the requirements of these regulations.

E. Compliance with the provisions of Section 3, the regulations set forth in 24 CFR 75, and all applicable rules and orders of the Department issued thereunder prior to the execution of the contract, shall be a condition of the federal financial assistance provided to the project, binding upon the applicant or recipient for such assistance, its successors, and assigns.

Failure to fulfill these requirements shall subject the applicant or recipient, its contractors and subcontractors, its successors, and assigns to those sanctions specified by the grant or loan agreement or contract through which federal assistance is provided, and to such sanctions as are specified by 24 CFR 75.

Attachment C - Sample Notice of Project Service Area or Neighborhood of Project Employment Commitments

INSTRUCTIONS

The County of Ventura’s Section 3 Plan requires that a notice similar to this sample be sent by all firms awarded or contracting for work on a Section 3 Project funded by the County with federal funds to any labor organizations with which the firm has a collective bargaining agreement or other agreement or understanding. If awarded a contract, you will be required to submit a notice of this type and to post it in a prominent place available to your employees. This notice should be provided on your company's letterhead.

S A M P L E

TO WHOM IT MAY CONCERN:

The (Insert Name of Company) has entered into an agreement with the County of Ventura for work to be performed at (Insert Project Name and Location). This project is funded in part by the U.S. Department of Housing and Urban Development (HUD) and as such is subject to the terms of Section 3 of the Housing and Urban Development Act of 1968, 12 USC 1701 u, as amended in the Section 3 Final Rule on September 29, 2020 (the Final Rule). As a contractor or subcontractor on this project, and pursuant to the provisions of Section 3, the (Insert Name of Company) is committed to utilizing Section 3 Workers/Targeted Section 3 Workers residing within the Service Area or Neighborhood of the Project as employees and trainees to the greatest extent feasible. In addition, the (Insert Name of Company) will utilize to the greatest extent feasible, Section 3 Business Concerns located in or owned in substantial part by residents of the Section 3 Service Area or Neighborhood of the Project.

The Service Area or Neighborhood of the Project is defined as follows:

(insert description)

It is the intention of the (Insert Name of Company) to fulfill its obligations under Section 3.

[Signature of Authorized Company Representative]

Provided in Word to complete specifics https://lahousingcompliance.sharepoint.com/:w:/s/LAHCxP2WTeam/EcTIbJxw21RCuu_6fTDYlPwBvUjg4uP-2CjtkPCxt--nfg?e=c0ve4m

Attachment D - Section 3 Compliance Bidder's Certification

Name of Company:

Address:

Project Title & Address:

The undersigned does hereby certify that he/she has read and understood the County of Ventura’s Section 3 Plan and requirements that apply to the above cited project, said requirements being known as the Section 3 Clause found in 24 CFR 75, as amended in the Section 3 Final Rule on September 29, 2020 (the Final Rule) and that neither the project nor the company are under any contractual restrictions or other disabilities which would prevent the company from complying with said requirements.

Signature of Company Officer:

Title of Officer: Date:

Attachment E - Certification for Business Concerns Seeking Section 3 Preference in Contracting and Demonstration of Capability

Business Name: Contractor’s Lic. #

Address:

Type of Business: □ Corporation □ Partnership

□ Sole Proprietorship □ Joint Venture

The above-referenced business is requesting preference in selection for a Section 3 Project based upon its status as a Section 3 Business Concern.

The above-referenced business is claiming status as a Section 3 Business Concern as follows:

□ Within the last six months, the business was more than 51% owned and controlled by low-income persons (≤ 80 % AMI). The following documentation is attached.

□ Copy of Section 3 Business Registry

□ List of all owners of the business and signed self-certifications for each certifying the total household income, demonstrating that at least 51% of the owners are within the 80% AMI limit.

□ Other evidence (please specify): ______________________________________________________

□ Within the last six months, more than 75% of the labor hours performed for the business over the prior three-month period were performed by Section 3 Workers. The following documentation is attached.

□ List of all current employees, with documentation of the number of hours worked and identifying Section 3 Workers.

□ Other evidence (please specify): ______________________________________________________

□ Within the last six months, the business was more than 51% owned and controlled by current public housing residents or residents who currently live in Section 8-assisted housing. The following documentation is attached for at least 51% of the owners.

□ Confirmation of residency in public housing from the local housing authority.

□ Evidence of Section 8 assistance.

□ Signed self-certifications declaring that the owner is currently living in public housing or Section 8-assisted housing.

For the business entity, the following documentation is attached, as applicable:

□ Copy of Articles of Incorporation □ Organization chart with names and titles

□ Assumed Business Name Certificate □ Additional documentation

Evidence of ability to perform successfully under the terms and conditions of the proposed contract (all required):

□ Current Financial Statement □ Statement of ability to comply with

Signature: Date:

Print Name: Title:

Telephone:

2. Weekly Submittals Summary

Every week, Subcontractor must submit the following items:

A. Certified Payroll Reports in LCP Tracker. Fines and Penalties apply if payments are not submitted timely. Please review attached Department of Labor standards as it relates to apprenticeship ratios which are required to be met daily. In the event Subcontractor has a different ratio agreed to in their collective bargaining agreement(s), Subcontractor shall provide a Standards of Apprenticeship approved by Federal Department of Labor

DOL expressly approving such apprenticeship ratio exemption. If Subcontractor does not have the required ratio of apprentices: journeyman, Subcontractor must pay the apprentices journeyman wages for those hours and reflect those hours on a separate line on payroll.

B. Authorization to Deduct Payroll. Subcontractor must upload an Other Deduction

Authorization for all Other Deductions. Amounts must match Other deduction amount on payroll. Other Deduction Authorization Form attached. Other deduction required by court order or other type of garnishment will require proof of court order or other documentation expressing requirement.

C. Sign In Sheets On File. Regarding sign in sheets, please keep a copy of the daily sign in sheet for Subcontractor’s own records. Subcontractor can have their foremen send a screenshot to Subcontractor’s office for file, or maintain a separate log. Please ensure

Subcontractor has sign in sheets on file for every day of work.

Revised 09/15/2020

Contractor

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CONTRACTOR QUICK START GUIDE

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