EXHIBIT 10 - CERTIFICATE OF COMPLIANCE WITH 49 CFR PART 655.pdf
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- Solicitation number
- OP143876
- Issued by
- California
About this file
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. The form requires bidders to certify compliance with federal regulations governing the prevention of alcohol misuse and prohibited drug use in transit operations. Bidders must first determine whether the work under the contract will require the performance of "Safety Sensitive Functions" as defined in 49 CFR Part 655. 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 confirming they have established or will establish both an anti-drug use and alcohol misuse program and a drug and alcohol testing program, each meeting the specific requirements outlined in 49 CFR Part 655.
For contracts requiring safety-sensitive functions, bidders 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. Bidders are required to select whether these programs are already established and implemented or will be established and implemented prior to contract award. An authorized representative of the bidder/proposer must sign the certificate, providing their title and date of signature. This exhibit represents a mandatory compliance requirement and does not address pricing, set-asides, or other commercial terms.
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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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