EXHIBIT 10 - CERTIFICATE OF COMPLIANCE WITH 49 CFR PART 655.pdf

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Attached to
Grease Interceptor Services
Solicitation number
OP137196(3)
Issued by
California

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This is a Certificate of Compliance with 49 CFR Part 655 form required by the Los Angeles County Metropolitan Transportation Authority (LACMTA) for bidders and proposers on transit-related contracts involving the prevention of alcohol misuse and prohibited drug use in transit operations. The form requires bidders to certify whether the work performed under the contract will involve "Safety Sensitive Functions" as defined in 49 CFR Part 655. If safety-sensitive functions are not required, the bidder may proceed directly to the signature section. If safety-sensitive functions are required, the bidder must complete additional sections certifying compliance with federal drug and alcohol testing requirements.

Bidders selecting safety-sensitive functions must confirm they have either established and implemented anti-drug use and alcohol misuse programs meeting 49 CFR 655 requirements or will do so prior to contract award. Similarly, bidders must certify they have or will establish drug and alcohol testing programs compliant with 49 CFR Part 655 before award. Bidders acknowledging safety-sensitive functions must submit both their Anti-drug Use and Alcohol Misuse Program and their Drug and Alcohol Testing Program to LACMTA for review and approval prior to contract award. The form requires signature and authorization from a bidder representative with designated title and date of execution.

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Other files

File Type Posted
ATTACHMENT D.pdf PDF
EXHIBIT E-1 - PAYMENT CERTIFICATION (CONTINUOUS).pdf PDF
ATTACHMENT A.pdf PDF
ATTACHMENT E.xlsx XLSX spreadsheet
EXHIBIT 4 - LIST OF CERTIFIED FIRMS (RESERVED).pdf PDF
EXHIBIT 5 - BID LETTER.pdf PDF
EXHIBIT 7 - LIST OF COMPLETED CONTRACTS - LAST FIVE (5) YEARS.pdf PDF
ATTACHMENT B.pdf PDF
ATTACHMENT C.pdf PDF
FORM 5 - BIDDERS LIST FORM.pdf PDF
EXHIBIT 6 - LIST OF CURRENT CONTRACTS - BACKLOG.pdf PDF
EXHIBIT E-2 - PAYMENT CERTIFICATION (FINAL).pdf PDF
IFB No. OP137196(3).pdf PDF
FORM 3 - BUSINESS DATA SHEET.pdf PDF
EXHIBIT 11 - NONCOLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER.pdf PDF
EXHIBIT B - PRICING AGREEMENT.pdf PDF
Exhibit A Pre-Assessment Form.pdf PDF
EXHIBIT F - RELEASE OF CLAIMS.pdf PDF
FORM 1 - SBE-DVBE SUBS & SUPPLIERS.pdf PDF
EXHIBIT 9 - GENERAL CERTIFICATIONS.pdf PDF
EXHIBIT C - WORK-COMPLETION_DELIVERABLE SCHEDULE (RESERVED).pdf PDF
EXHIBIT 2 - SCHEDULE OF QUANTITIES AND PRICES.pdf PDF
Exhibit B Post-Assessment Form.pdf PDF
EXHIBIT 3 - MINIMUM QUALIFICATIONS.pdf PDF
FORM 6 - SBE-DVBE DEALER-DISTR AFFIRMATION.pdf PDF
EXHIBIT D - DEOD CONTRACT COMPLIANCE MANUAL(Non-Fed).pdf PDF
FORM 2 - AFFIDAVIT.pdf PDF
EXHIBIT 8 - ETHICS DECLARATION.pdf PDF
FORM 4 - SBE-DVBE AFFIRMATION.pdf PDF
EXHIBIT A.pdf PDF
EXHIBIT G - APPROVED SUBCONTRACTORS AND SUPPLIERS.pdf PDF
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BIDDER/PROPOSER: ______________________

EXHIBIT 10 - CERTIFICATE OF COMPLIANCE WITH 49 CFR PART 655,

PREVENTION OF ALCOHOL MISUSE AND PROHIBITED DRUG USE IN

TRANSIT OPERATIONS

Bidder/Proposer hereby certifies that:

A. Safety Sensitive Functions Requirement

(Choose one of the following alternatives by checking the appropriate box)

1.

To the best of my knowledge and belief the Work required under the Contract WILL NOT require the performance of “Safety Sensitive Functions” as defined in 49 CFR Part 655.

OR

2.

To the best of my knowledge and belief the Work required under the Contract WILL require the performance of “Safety Sensitive Functions” as defined in 49 CFR Part 655.

If alternative A.1 was chosen, Bidder/Proposer shall proceed directly to Section D.

If alternative A.2 was chosen, Bidder/Proposer must complete Section B, parts 1 and 2, and Section C, prior to proceeding to Section D.

B. Required Drug and Alcohol Programs

1. Anti-drug Use and Alcohol Misuse Program

(Choose one of the following alternatives by checking the appropriate box)

a. Bidder/Proposer has established and implemented an anti-drug use and alcohol misuse program meeting the requirements on 49 CFR 655.

OR

b.

Bidder/Proposer will establish and implement an anti-drug use and alcohol misuse program meeting the requirements on 49 CFR 655 prior to contract award.

2. Drug and Alcohol Testing Program

(Choose one of the following alternatives by checking the appropriate box)

a. Bidder/Proposer has established and implemented a drug and alcohol testing program that complies with 49 CFR Part 655.

OR

b. Bidder/Proposer will establish and implement a drug and alcohol testing program that will comply with 49 CFR Part 655 prior to contract award.

BIDDER/PROPOSER: ______________________

C. Submittals

If Bidder/Proposer marked Section A.2 above, Bidder/Proposer understands and acknowledges that it must submit (1) its Anti-drug Use and Alcohol Misuse Program and

(2) its Drug and Alcohol Testing Program to LACMTA for review and approval prior to contract award.

Bidder/Proposer Initials ___________

D. Signatures

Bidder/Proposer:

Authorized Representative:

Signature of Authorized Representative:

Title:

Date:

EXHIBIT - CERTIFICATE OF COMPLIANCE WITH 49 CFR PART 655, PREVENTION OF ALCOHOL MISUSE AND PROHIBITED DRUG USE IN TRANSIT OPERATIONS

Authorized Representative:
Title:
Date:
A:
1: Off
2: Off
B:
1:
a: Off
b: Off
2:
a: Off
b: Off
Bidder/Proposer2:
BIDDER/PROPOSER:

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