EXHIBIT 15 - CERTIFICATE OF COMPLIANCE WITH 49 CFR PART 655, PREVENTION OF ALCOHOL MISUSE A.pdf
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- Solicitation number
- DR145771
- Issued by
- California
About this file
This is a Certificate of Compliance with 49 CFR Part 655 document for a state and local transit contract opportunity, likely under the jurisdiction of the Los Angeles County Metropolitan Transportation Authority (LACMTA). The document serves as a compliance certification form that bidders and proposers must complete to demonstrate adherence to federal regulations regarding the prevention of alcohol misuse and prohibited drug use in transit operations. Bidders are required to certify whether the work under the contract will or will not involve the performance of "Safety Sensitive Functions" as defined in 49 CFR Part 655. If safety-sensitive functions are involved, bidders must further certify their establishment and implementation of both an anti-drug use and alcohol misuse program and a drug and alcohol testing program that meet federal requirements, or commit to establishing and implementing such programs prior to contract award.
If safety-sensitive functions are identified as part of the contract work, bidders 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 certificate requires authorization by an authorized representative of the bidder/proposer, who must sign and date the document. The form provides structured checkboxes for bidders to indicate their compliance status and program readiness, ensuring that all transit-related personnel performing safety-sensitive duties are subject to appropriate drug and alcohol testing protocols in accordance with federal transportation regulations.
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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: |
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