EXHIBIT 10 - CERTIFICATE OF COMPLIANCE WITH 49 CFR PART 655.pdf
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- Attached to
- PURCHASE OF THREE (3) NEW SEATED FORKLIFTS
- Solicitation number
- OP143265
- Issued by
- California
About this file
This is a Certificate of Compliance with 49 CFR Part 655 for the Los Angeles County Metropolitan Transportation Authority (LACMTA), addressing prevention of alcohol misuse and prohibited drug use in transit operations. The certificate requires bidders and proposers to certify their compliance status regarding safety-sensitive functions as defined in federal regulations. Bidders must select whether the contracted work will or will not require the performance of safety-sensitive functions. If safety-sensitive functions are required, bidders must indicate whether they have already established anti-drug use and alcohol misuse programs meeting 49 CFR 655 requirements, or whether they will establish such programs prior to contract award. Similarly, bidders must certify their status regarding drug and alcohol testing programs that comply with 49 CFR Part 655, selecting between existing compliance or establishment of compliant programs before award.
Bidders selecting that safety-sensitive functions are required 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 certificate requires signature from an authorized representative of the bidder or proposer, including the representative's title and date of execution. The document serves as a mandatory compliance certification for transit-related contracts subject to federal drug and alcohol testing regulations.
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Text version
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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