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

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Attached to
Self-Performing Construction Work Feasibility Study
Solicitation number
PS136577(3)
Issued by
California

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This is a Certificate of Compliance form with the Los Angeles County Metropolitan Transportation Authority (LACMTA) regarding compliance with 49 CFR Part 655, which governs the prevention of alcohol misuse and prohibited drug use in transit operations. The form requires bidders and proposers to certify whether the work under the contract will involve the performance of "Safety Sensitive Functions" as defined in federal regulations. If safety-sensitive functions are not required, bidders may proceed directly to signature sections. If safety-sensitive functions are required, bidders must demonstrate establishment of both an anti-drug use and alcohol misuse program and a drug and alcohol testing program that comply with 49 CFR Part 655 standards, either currently implemented or to be implemented prior to contract award.

Bidders selecting the safety-sensitive functions option must submit their anti-drug use and alcohol misuse program and drug and alcohol testing program to LACMTA for review and approval before contract award. The form includes checkboxes for bidders to indicate whether they have already established required programs or will establish them prior to award, and requires initials acknowledging understanding of submission requirements. All submissions must be signed by an authorized representative with title and date documentation to be considered complete.

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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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