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

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Attached to
Third Party Administrator (TPA) Conflict Claims. Amendment 1 added. update 8/27
Solicitation number
PS143950
Issued by
California

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This is a Certificate of Compliance form required by the Los Angeles County Metropolitan Transportation Authority (LACMTA) for bidders and proposers on transit-related contracts. The form establishes whether the work under the contract will require the performance of "Safety Sensitive Functions" as defined in 49 CFR Part 655, which governs the prevention of alcohol misuse and prohibited drug use in transit operations. If safety-sensitive functions are not required, bidders need only complete the signature section. If safety-sensitive functions are required, bidders must certify either that they have already established and implemented both an anti-drug use and alcohol misuse program and a drug and alcohol testing program compliant with 49 CFR Part 655, or that they will establish and implement such programs prior to contract award.

Bidders selecting the safety-sensitive functions requirement 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 form requires completion and signature by an authorized representative of the bidder/proposer, with all applicable certifications and acknowledgments initialed to confirm understanding of the submission requirements. This certificate is a mandatory compliance document for contractors performing work that may involve safety-sensitive positions within Metro's transit operations.

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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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