EXHIBIT 15 - CERTIFICATE OF COMPLIANCE WITH 49 CFR PART 655, PREVENTION OF ALCOHOL MISUSE A.pdf
PDF 126 KB Posted
- Solicitation number
- MA130013
- Issued by
- California
About this file
This is an Exhibit 15 Certificate of Compliance form required by the Los Angeles County Metropolitan Transportation Authority (LACMTA) for bidders and proposers on transit-related contracts. The certificate addresses compliance with 49 CFR Part 655 regarding the prevention of alcohol misuse and prohibited drug use in transit operations. Bidders must first determine whether the work under the contract requires the performance of "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 required, bidders must demonstrate compliance with anti-drug use and alcohol misuse program requirements and drug and alcohol testing program requirements, either by certifying that such programs are already established and implemented or by committing to establish and implement compliant programs prior to contract award.
Bidders selecting the alternative that their work will require safety-sensitive functions must submit both their Anti-drug Use and Alcohol Misuse Program and their 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 or proposer, including title and date. No pricing, set-asides, funding information, or contract term details are addressed in this compliance certificate.
View the file
Other files
Show all 47
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
BIDDER/PROPOSER: ______________________
EXHIBIT 15 - 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: |
File details come from the government source that posted it. Updated .