EXHIBIT 10 - CERTIFICATE OF COMPLIANCE WITH 49 CFR PART 655.pdf
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- Attached to
- Federal Advocacy Services
- Solicitation number
- PS145628
- Issued by
- California
About this file
This is a Certificate of Compliance with 49 CFR Part 655 exhibit required for state and local transit contract opportunities, specifically addressing prevention of alcohol misuse and prohibited drug use in transit operations. The document serves as a compliance certification that bidders and proposers must complete and submit as part of their bid or proposal package. The certificate requires bidders to first 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 may proceed directly to the signature section. If safety-sensitive functions are involved, bidders must complete additional sections certifying their anti-drug use and alcohol misuse programs, as well as their drug and alcohol testing programs, all meeting the requirements of 49 CFR Part 655.
For contracts involving safety-sensitive functions, bidders must certify whether they have already established and implemented compliant anti-drug and alcohol misuse programs or will establish such programs prior to contract award. Similarly, bidders must confirm either existing or planned drug and alcohol testing programs that comply with 49 CFR Part 655 standards. If safety-sensitive functions are designated, bidders acknowledge they must submit both their anti-drug use and alcohol misuse program documentation and their drug and alcohol testing program documentation to the Los Angeles County Metropolitan Transportation Authority (LACMTA) for review and approval before contract award. The authorized representative of the bidder or proposer must sign and date the certificate, with all applicable sections completed based on the nature of the proposed work.
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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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