EXHIBIT 11 - CERTIFICATE OF COMPLIANCE WITH 49 CFR PART 655.pdf
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- Attached to
- Employee Assistance Program
- Solicitation number
- PS141248
- Issued by
- California
About this file
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 document establishes compliance requirements under 49 CFR Part 655, which governs the prevention of alcohol misuse and prohibited drug use in transit operations. Bidders must determine whether the contract work will require the performance of "Safety Sensitive Functions" as defined in the federal regulation. 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 addressing their drug and alcohol programs and testing procedures.
For contracts involving safety-sensitive functions, bidders must certify that they either have established or will establish anti-drug use and alcohol misuse programs compliant with 49 CFR 655 prior to contract award. Similarly, bidders must demonstrate that they have implemented or will implement drug and alcohol testing programs meeting federal compliance standards. Bidders selecting options indicating future program implementation must submit both their Anti-drug Use and Alcohol Misuse Program and their Drug and Alcohol Testing Program to LACMTA for review and approval before the contract award date. An authorized representative must sign the certificate and provide their title and date of execution.
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Text version
BIDDER/PROPOSER: ______________________
EXHIBIT 11 - 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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