Attachment_H_-_Equal_Employment_Opportunity_Statement.pdf

CONTRACTOR’S LETTERHEAD

EQUAL EMPLOYMENT OPPORTUNITY (EEO) POLICY STATEMENT

______________________SHALL NOT DISCRIMINATE AGAINST ANY EMPLOYEE OR

APPLICANT FOR EMPLOYMENT BECAUSE OF ACTUAL OR PERCEIVED: RACE, COLOR,

RELIGION, NATIONAL ORIGIN, SEX, AGE, MARITAL STATUS, PERSONAL APPEARANCE,

SEXUAL ORIENTATION, GENDER IDENTITY OR EXPRESSION, FAMILIA L STATUS, FAMILY

RESPONSIBILITIES, MATRICULATION, POLITICAL AFFILIATION, GENETIC INFORMATION,

DISABILITY, SOURCE OF INCOME, OR PLACE OF RESIDENCE OR BUSINESS.

______________________AGREES TO AFFIRMATIVE ACT ION TO ENSURE THAT APPLICANTS

ARE EMPLOYED, AND THAT EMPLOYEES ARE TREATED DURING EMPLOYMENT WITHOUT

REGARD TO THEIR ACTUAL OR PERCEIVED: RACE, COLOR, RELIGION, NATIONAL ORIGIN,

SEX, AGE, MARITAL STATUS, PERSONAL APPEARANCE, SEXUAL ORIENTATION, GENDER

IDENTITY OR EXPRESSION, FAMILIAL STATUS, FAMILY RESPONSIBILITIES,

MATRICULATION, POLITICAL AFFILIATION, GENETIC INFORMATION, DISABILITY, SOURCE

OF INCOME, OR PLACE OF RESIDENCE OR BUSINESS. THE AFFIRMATIVE ACTION SHALL

INCLUDE, BUT NOT BE LIMITED TO THE FOLLOWING: (A) EMPLOYMENT, UPGRADING, OR

TRANSFER; (B) RECRUITMENT OR RECRUITMENT ADVERTISING; (C) DEMOTION, LAYOFF,

OR TERMINATION; (D) RATES OF PAY, OR OTHER FORMS OR COMPENSATION; AND (E)

SELECTION FOR TRAINING AND APPRENTICESHIP.

______________________AGREES TO POST IN CONSPICUOUS PLACES THE PROVISIONS

CONCERNING NON-DISCRIMINATION AND AFFIRMATIVE ACTION.

______________________SHALL STATE THAT ALL QUALIFIED APPLICANTS WILL RECEIVE

CONSIDERATION FOR EMPLOYMENT PURSUANT TO SUBSECTION 1103.2 THROUGH 1103.10

OF MAYOR’S ORDER 85-85; “EQUAL EMPLOYMENT OPPORTUNITY REQUIREMENTS IN

CONTRACTS.”

______________________AGREES TO PERMIT ACCESS TO ALL BOOKS PERTAINING TO ITS

EMPLOYMENT PRACTICES , AND TO REQUIRE EACH SUBCONTRACTOR TO PERMIT ACCESS

TO BOOKS AND RECORDS.

______________________AGREES TO COMPLY WITH ALL GUIDELINES FOR EQUAL

EMPLOYMENT OPPORTUNITY APPLICABLE IN THE DISTRICT OF COLUMBIA.

______________________SHALL INCLUDE IN EVERY SUBCONTRACT THE EQUAL

OPPORTUNITY CLAUSES, SUBSECTION 1103.2 THROUGH 1103.10 SO THAT SUCH

PROVISIONS SHALL BE BINDING UPON EACH SUBCONTRACTOR OR VENDOR.

AUTHORIZED OFFICIAL AND TITLE DATE

AUTHORIZED SIGNATURE NAME FIRM/ORGANIZATION

CONTRACTOR’S LETTERHEAD

ASSURANCE OF COMPLIANCE WITH EQUAL EMPLOYMENT OPPORTUNITY REQUIREMENTS

MAYOR’S ORDER 85-85, EFFECTIVE JUNE 10, 1985, AND THE RULES IMPLEMENTING MAYORS

ORDER 85-85, 33 DCR 4952, (PUBLISHED AUGUST 15, 1986), “ON COMPLIANCE WITH EQUAL

OPPORTUNITY REQUIREMENTS IN DISTRICT GOVERNMENT CONTRACTS,” ARE HEREBY INCLUDED AS PART OF THIS BID/PROPOSAL. THEREFORE, EACH BIDDER/OFFEROR SHALL INDICATE BELOW THEIR

WRITTEN COMMITMENT TO ASSURE COMPLIANCE WITH MAYOR’S ORDER 85-85 AND THE

IMPLEMENTING RULES. FAILURE TO COMPLY WITH THE SUBJECT MAYOR’S ORDER AND THE

IMPLEMENTING RULES SHALL RESULT IN REJECTION OF THE RESPECTIVE BID/PROPOSAL.

I, ______________________________________________, THE AUTHORIZED REPRESENTATIVE OF

___________________________________________, HEREINAFTER REFERRED TO AS “THE

CONTRACTOR,” CERTIFY THT THE CONTRATOR IS FULLY AWARE OF ALL OF THE PROVISIONS OF MAYOR’S ORDER 85-85, EFFECTIVE JUNE 10, 1985, AND OF THE RULES IMPLEMENTING MAYOR’S ORDER 85-85, 33 DCR 4952. I FURTHER CERTIFY AND ASSURE THAT THE CONTRACTOR WILL FULLY COMPLY WITH ALL APPLICABLE PROVISIONS OF THE MAYOR’S ORDER AND IMPLEMENTING RULES IF

AWARDED THE D.C. GOVERNMENT REFERENCED BY THE CONTRACT NUMBER ENTERED BELOW.

FURTHER, THE CONTRACTOR ACKNOWLEDGES AND UNDERSTANDS THAT THE AWARD OF SAID

CONTRACT AND ITS CONTINUATION ARE SPECIFICALLY CONDITIONED UPON THE CONTRACTOR’S

COMPLIANCE WITH THE ABOVE-CITED ORDER AND RULES.

CONTRACTOR

NAME

SIGNATURE

TITLE

CONTRACT NUMBER

DATE

EQUAL EMPLOYMENT OPPORTUNITY

EMPLOYER INFORMATION REPORT

GOVERNMENT OF THE DISTRICT OF COLUMBIA

DC Office of Contracting and Procurement Employer Information Report (EEO)

Reply to:

Office of Contracting and Procurement 441 4th Street, NW, Suite 700 South Washington, DC 20001 Washington, DC 20001

Instructions:

Two (2) copies of DAS 84-404 or Federal Form EEO-1 shall be submitted to the Office of Contracting and Procurement.

One copy shall be retained by the Contractor.

Section A – TYPE OF REPORT

1. Indicate by marking in the appropriate box the type of reporting unit for which this copy of the form is submitted (MARK ONLY ONE BOX) Single Establishment Employer Multi-establishment Employer:

(1) . Single-establishment Employer Report (2) � Consolidated Report

(3) � Headquarters Report

(4) � Individual Establishment Report (submit one for each establishment with 25 or more employees)

(5) � Special Report

1. Total number of reports being filed by this Company. _______________________

Section B – COMPANY IDENTIFICATION (To be answered by all employers) OFFICIAL OFFICIAL

USE

ONLY

1. Name of Company which owns or controls the establishment for which this report is filed a.

Address (Number and street) City or Town Country

State Zip Code b.

b. Employer Identification No.

2. Establishment for which this report is filed. OFFICIAL

USE

ONLY

a. Name of establishment c.

State Zip Code d.

b. Employer Identification No.

3. Parent of affiliated Company

a. Name of parent or affiliated Company

b. Employer Identification No.

State Zip Code

Section C - ESTABLISHMENT INFORMATION

1. Is the location of the establishment the same as that reported last year? 2. Is the major business activity at this establishment the same Yes No Did not report Report on combined as that reported last year? Yes No last year basis No report last year Reported on combined basis

OFFICIAL

USE

ONLY

2. What is the major activity of this establishment? (Be specific, i.e., manufacturing steel castings, retail grocer, wholesale plumbing supplies, title insurance, etc. Include the specific type of product or service provided, as well as the principal business or industrial activity.

e.

3. MINORITY GROUP MEMBERS: Indicate if you are a minority business enterprise (50% owned or 51% controlled by minority members).

Yes No DAS 84-404 (Replaces D.C. Form 2640.9 Sept. 74 which is Obsolete) 84-2P891

INFORMATION CITED HEREIN SHALL BE HELD IN CONFIDENCE.

SECTION D – EMPLOYMENT DATA

Employment at this establishment – Report all permanent, temporary, or part-time employees including apprentices and on-the-job trainees unless specifically excluded as set forth in the instructions. Enter the appropriate figures on all lines and in all columns. Blank spaces will be considered as zero. In columns 1, 2, and 3, include ALL employees in the establishment Including those in minority groups

JOB

CATEGORIES

TOTAL EMPLOYEES IN

ESTABLISHMENT

MINORITY GROUP EMPLOYEES

MALE FEMALE

Total Employees Including Minorities

(1)

Total Male

Including Minorities

(2)

Total Female

Including Minorities

(3)

Black

(4)

Asian

(5)

American Indian

(6)

Hispanic

(7)

Black

(8)

Asian

(9)

American Indian

(10)

Hispanic

(11) Officials and Managers

Professionals

Technicians

Sales Workers

Office and Clerical

Craftsman (Skilled)

Operative (Semi- Skilled)

Laborers (Unskilled)

Service Workers

TOTAL

Total employ reported in previous report

(The trainee below should also be included in the figures for the appropriate occupation categories above) Formal On- The-Job Trainee

White collar

(1) (2) (3) (4)) (5) (6) (7) (8) (9) (10) (11

Production

1. How was information as to race or ethnic group in Section D obtained? 2. Dates of payroll period used

a. Visual Survey c. Other Specify ________________ 3. Pay period of last report submitted for this

b. Employment Record ______________________________ establishment.____________________________ Section E – REMARKS Use this Item to give any identification data appearing on last report which differs from that given above, explain major changes in composition or reporting units, and other pertinent information.

Section F - CERTIFICATION Check 1. › All reports are accurate and were prepared in accordance with the instructions (check on consolidated only) One 2. › This report is accurate and was prepared in accordance with the instructions.

Name of Authorized Official Title Signature Date Name of person contact regarding Address This report (Type of print) (Number and street)

Title City and State Zip Code Telephone Number Extension

DEPARTMENT OF SMALL AND LOCAL BUSINESS DEVELOPMENT

CONTRACT COMPLIANCE DIVISION

SUBCONTRACT SUMMARY FORM

This SUMMARY form is to be completed by the PRIME contractor.

BID NO. CCB NUMBER: _________of _________ pages NOTE: the standard for minority subcontracting is 25% or the TOTAL contract dollar amount to be subcontracted.

AMOUNT OF PRIME CONTRACT $______________________

AMOUNT OF ALL SUBCONTRACTS: $______________ equals

__________ % OF THE PRIME CONTRACT.

NAME OF PRIME CONTRACTOR:

TELEPHONE NO.

ADDRESS:

PROJECT NAME:

ADDRESS:

________ WARD NO:______

PROJECT DESCRIPTIONS:

SECTION II LIST ALL SUBCONTRACTORS THAT WILL BE UTILIZED OH THE ABOVE PROJECT

1. NAME OF SUBCONTRACTOR

2. ADDRESS

3. CONTACT PERSON

4. MBOC CERT. NO. 5. PHONE NO.

1. IS THIS A MINORITY SUB?

_______YES _______NO

2. TRADE OR BUSINESS PRODUCT

THAT SUB WILL PROVIDE.

1. $ AMOUNT OF-SUBCONTRACT

equals (=)

2. ________ % (percent) OF TOTAL

PRIME CONTRACT.

1.

2.

3.

4. 5.

1. MINORITY SUBCONTRACTOR

_______YES _______NO

2.

1. _________________________ equals (=)

2. _________________%

1.

2.

3.

4. 5.

1. MINORITY SUBCONTRACTOR

_______YES _______NO

2.

1. _________________________ equals (=)

2. _________________%

1.

2.

3.

4. 5.

1. MINORITY SUBCONTRACTOR

_______YES _______NO

2.

1. _________________________ equals (=)

2. _________________%

1.

2.

3.

4. 5.

1. MINORITY SUBCONTRACTOR

_______YES _______NO

2.

1. _________________________ equals (=)

2. _________________%

1.

2.

3.

4. 5.

1. MINORITY SUBCONTRACTOR

_______YES _______NO

2.

1. _________________________ equals (=)

2. _________________%

1.

2.

3.

4. 5.

1. MINORITY SUBCONTRACTOR

_______YES _______NO

2.

1. _________________________ equals (=)

2. _________________%

1.

2.

3.

4. 5.

1. MINORITY SUBCONTRACTOR

_______YES _______NO

2.

1. _________________________ equals (=)

2. _________________%

1.

2.

3.

4. 5.

1. MINORITY SUBCONTRACTOR

_______YES _______NO

2.

1. _________________________ equals (=)

2. _________________%

1.

2.

3.

4. 5.

1. MINORITY SUBCONTRACTOR

_______YES _______NO

2.

1. _________________________ equals (=)

2. _________________%

1.

2.

3.

4. 5.

1. MINORITY SUBCONTRACTOR

_______YES _______NO

2.

1. _________________________ equals (=)

2. _________________%

1.

2.

3.

4. 5.

1. MINORITY SUBCONTRACTOR

_______YES _______NO

2.

1. _________________________ equals (=)

2. _________________%

TOTAL DOLLAR AMOUNT SUBCONTRACTED TO 'MINORITY BUSINESS ENTERPRISES $______________________________

PERCENT OF PRIME CONTRACT. _________________%

SOLICITATION NO:___________________________

PROJECTED GOALS AND TIMETABLES FOR FUTURE HIRING

MINORITY GROUP EMLOYES GOALS TIMETABLES

JOB

CATEGORIES

MALE FEMALE

Black Asian American

Indian Hispanic Black Asian American

Indian Hispanic Officials and Managers

Professionals

Technicians

Sales Workers

Office and Clerical

Craftsman (Skilled)

Operative (Semi- Skilled)

Laborers (Unskilled)

Service Workers

TOTAL

NAME OF AUTHORIZED OFFICIAL: TITLE: SIGNATURE:

FIRM NAME: TELEHONE NO: DATE:

INDICATE IF THE PRIME UTILIZES A “MINORITY FINANCIAL ISTITUTION”

_____ Yes _____ No

NAME:

ADDRESS:

TYPE OF ACCOUNT/S: