EXHIBIT 10 - CERTIFICATE OF COMPLIANCE WITH 49 CFR PART 655.pdf
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- Attached to
- Hi-Rail Stake Bed Truck
- Solicitation number
- DR143889
- Issued by
- California
About this file
This is a Certificate of Compliance with 49 CFR Part 655 issued by LACMTA (Los Angeles County Metropolitan Transportation Authority) regarding prevention of alcohol misuse and prohibited drug use in transit operations. The document serves as a compliance certification form that bidders and proposers must complete as part of the contracting process. The certificate requires bidders to determine whether the work under the contract will involve "Safety Sensitive Functions" as defined in 49 CFR Part 655. If safety-sensitive functions are not required, bidders proceed directly to signature sections. If safety-sensitive functions are required, bidders must demonstrate compliance with anti-drug use and alcohol misuse program requirements and establish drug and alcohol testing programs that meet 49 CFR Part 655 standards prior to contract award.
Bidders selecting the safety-sensitive functions alternative must choose whether they have already established the required anti-drug and alcohol misuse programs or will establish them prior to contract award, and similarly must confirm the existence or planned implementation of a compliant drug and alcohol testing program. Bidders selecting the safety-sensitive functions pathway must submit both their Anti-drug Use and Alcohol Misuse Program and Drug and Alcohol Testing Program to LACMTA for review and approval before contract award. The certificate requires signature by an authorized representative of the bidder or proposer, with space provided for the representative's title and date of execution.
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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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