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

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Attached to
As-Needed Battery Supply and Install
Solicitation number
PS139177
Issued by
California

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This is an Exhibit 10 Certificate of Compliance form required by the Los Angeles County Metropolitan Transportation Authority (LACMTA) for bidders and proposers on the As-Needed Battery Supply and Install contract. The document establishes compliance requirements under 49 CFR Part 655 regarding the prevention of alcohol misuse and prohibited drug use in transit operations. Bidders must first determine whether the work requires the performance of "Safety Sensitive Functions" as defined in the regulation. If safety-sensitive functions are not required, bidders may proceed directly to the signature section. If safety-sensitive functions are required, bidders must complete additional sections addressing anti-drug use and alcohol misuse programs and drug and alcohol testing programs, selecting either that such programs have already been established and implemented or that they will be established and implemented prior to contract award.

Bidders selecting the option that safety-sensitive functions are required must submit their Anti-drug Use and Alcohol Misuse Program and Drug and Alcohol Testing Program to LACMTA for review and approval prior to contract award. The certificate requires an authorized representative's signature, title, and date. All applicable checkboxes and signature fields must be completed and submitted as part of the bidding package for this transit-related contract opportunity in California.

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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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