EXHIBIT 10 - CERTIFICATE OF COMPLIANCE WITH 49 CFR PART 655.pdf
PDF 62 KB Posted
- Attached to
- Metro C/K Line Mainline Fastener Replacement
- Solicitation number
- OP138405
- Issued by
- California
About this file
This is a Certificate of Compliance with 49 CFR Part 655 form related to prevention of alcohol misuse and prohibited drug use in transit operations, issued by LACMTA (Los Angeles County Metropolitan Transportation Authority). The certificate requires bidders and proposers to certify their compliance status regarding safety-sensitive functions as defined in federal transit regulations. Bidders must indicate whether the work required under the contract will or will not involve performance of safety-sensitive functions. 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 documenting their drug and alcohol programs.
For contracts involving safety-sensitive functions, bidders must certify either that they have already established and implemented an anti-drug use and alcohol misuse program meeting 49 CFR 655 requirements, or that they will establish and implement such a program prior to contract award. Similarly, bidders must certify compliance status regarding drug and alcohol testing programs. Bidders selecting the latter option for either program must acknowledge their obligation to submit both their anti-drug use and alcohol misuse program and their drug and alcohol testing program to LACMTA for review and approval before contract award. The form requires signatures from an authorized representative of the bidder/proposer and includes designated spaces for initials confirming understanding of submission requirements.
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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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