Exibit_B_Federal_Compiance_Certifications.pdf

Exhibit B

Federal Compliance Certifications

Consultant Certification

FEDERAL COMPLIANCE CERTIFICATION

The undersigned certifies that the Proposer has reviewed this Federal Compliance Exhibit B Section 1 thru 20 and agrees to comply with all applicable federal statutes, regulations, executive orders, grant conditions, and funding requirements that may apply to this Project.

The Proposer further acknowledges that additional federal requirements may be imposed through future funding agreements and agrees to comply with such requirements as a condition of continued performance.

Firm Name: _______________________________

Authorized Representative: _______________________________

Title: _______________________________

Signature: _______________________________

Date: _______________________________

Attachment B Forms

Consultant and subconsultant if applicable shall review and each sign and submit as part of Statement of Qualifications as an appendix, all Exhibit C Forms. Exhibit C Forms does not count toward maximum RFQ page limits.

Certification Submitted Debarment Certification ☐ Lobbying Certification ☐ Conflict of Interest ☐ Organizational Conflict of Interest ☐ Non-Collusion Affidavit ☐ Equal Employment Opportunity ☐ Title VI Assurance ☐ ADA Certification ☐ Key Personnel Availability ☐ Iran Contracting Act ☐ Addendum Acknowledgement ☐ Insurance Certificate ☐

Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion

Federal Funding Requirement (2 CFR Part 180; 2 CFR §200.214)

The Consultant certifies that neither the Consultant, its principals, nor any proposed subcontractor:

1. Is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in any federally funded contract or transaction.

2. Has within the preceding three (3) years been convicted of or had a civil judgment rendered against it for:

a. Fraud;

b. Criminal offense related to obtaining, attempting to obtain, or performing a public transaction;

c. Violation of federal or state antitrust statutes;

d. Embezzlement;

e. Theft;

f. Forgery;

g. Bribery;

h. Falsification or destruction of records;

i. Making false statements.

3. Has any pending criminal prosecution or administrative action related to the above.

The Consultant agrees to immediately notify the City if circumstances change during contract performance.

Consultant/Firm:

Authorized Representative:

Title:

Signature:

Date:

Certification Regarding Lobbying Activities

Federal Funding Requirement

(31 U.S.C. §1352; 2 CFR Part 200 Appendix II)

The undersigned certifies, to the best of their knowledge and belief, that:

1. No Federal appropriated funds have been paid or will be paid by or on behalf of the Consultant to any person for influencing or attempting to influence:

• An officer or employee of any Federal agency;

• A Member of Congress;

• An employee of Congress;

• An officer or employee of Congress.

2. If any non-Federal funds have been paid or will be paid for lobbying activities related to this Project, the Consultant shall complete and submit Standard Form LLL.

3. The Consultant agrees this certification shall be included in all subcontract agreements exceeding $100,000.

Consultant/Firm:

Authorized Representative:

Title:

Consultant Conflict of Interest Certification

The Consultant certifies that:

1. No employee, officer, partner, or agent of the Consultant has any financial interest, personal interest, or other relationship that would create an actual, potential, or perceived conflict of interest with the City of Napa.

2. The Consultant has disclosed all relationships involving:

• City employees;

• City elected officials;

• Regulatory agencies;

• Adjacent property owners;

• Other consultants involved with Conn Dam.

3. The Consultant agrees to immediately disclose any conflict arising during performance.

Known Conflicts:

☐ None

☐ Attached Disclosure

Consultant/Firm:

Authorized Representative:

Title:

Signature:

Organizational Conflict of Interest Disclosure

The Consultant shall disclose any existing or prior work that may create an organizational conflict.

The Consultant shall identify work involving:

Organization Project Relationship

USACE

DSOD

City of Napa

Napa County

Regulatory Agencies

Adjacent Property Owners Others

The Consultant certifies that no organizational conflict exists that would:

• Impair objectivity;

• Provide an unfair competitive advantage;

• Limit independent engineering judgment.

☐ No Organizational Conflict Identified

☐ Organizational Conflict Disclosure Attached

Consultant/Firm:

Authorized Representative:

Title:

Non-Collusion Affidavit

The Consultant certifies that:

1. The proposal has been prepared independently without consultation, communication, agreement, or arrangement with any competing proposer.

2. The proposed fees, staffing, and approach have not been disclosed to any competing proposer.

3. No attempt has been made to induce another proposer to submit or not submit a proposal.

4. The Consultant has not paid or offered anything of value to influence the procurement process.

Consultant/Firm:

Authorized Representative:

Title:

Equal Employment Opportunity

Executive Order 11246

The Consultant certifies compliance with applicable Equal Employment Opportunity requirements.

The Consultant agrees not to discriminate based upon:

• Race;

• Color;

• Religion;

• Sex;

• Sexual orientation;

• Gender identity;

• National origin;

• Age;

• Disability;

• Veteran status.

The Consultant maintains policies consistent with:

• Title VII;

• Executive Order 11246;

• Rehabilitation Act;

• Americans with Disabilities Act.

Title:

Title VI Civil Rights Assurance

Civil Rights Act of 1964

The Consultant assures that no person shall be excluded from participation in, denied benefits of, or subjected to discrimination under this Agreement based on:

• Race;

• Color;

• National origin.

The Consultant agrees to comply with:

• Title VI of the Civil Rights Act;

• Related federal civil rights regulations;

• Applicable State civil rights requirements.

Consultant/Firm:

Authorized Representative:

Title:

Americans with Disabilities Act (ADA)

The Consultant certifies compliance with:

• Americans with Disabilities Act of 1990;

• Section 504 Rehabilitation Act;

• Applicable accessibility requirements.

Consultant shall ensure project deliverables are accessible, including:

• Reports;

• Public presentations;

• Digital documents;

• Web content.

Title:

Key Personnel Availability Certification

The Consultant certifies that the following personnel proposed in the SOQ will remain assigned to the project unless approved by the City.

Position Name

Project Manager

Dam Safety Lead

Geotechnical Engineer

Engineering Geologist

Hydraulic Engineer

Structural Engineer

Environmental Lead

Cost Estimator

Replacement personnel shall possess equal or greater qualifications.

Title:

Iran Contracting Act Certification

California Public Contract Code Sections 2200-2208

The Consultant certifies that:

☐ The Consultant is not identified on the California Department of General Services Iran Contracting Act list.

☐ The Consultant has received an exemption.

☐ The Consultant is subject to applicable restrictions and has provided required documentation.

Consultant/Firm:

Authorized Representative:

Title:

Federal Compliance Certification

The Consultant acknowledges that this Project may receive federal funding and agrees to comply with all applicable federal requirements including:

☐ 2 CFR Part 200 Uniform Guidance

☐ Appendix II to 2 CFR Part 200

☐ Federal procurement requirements

☐ Debarment and Suspension

☐ Lobbying restrictions

☐ Civil rights requirements

☐ Environmental requirements

☐ Audit requirements

☐ Records retention requirements

☐ Federal reporting requirements

☐ Subconsultant flow-down requirements

☐ Applicable USACE requirements

☐ Applicable CWIFP requirements

☐ Applicable DSOD requirements

The Consultant acknowledges that additional requirements may be imposed by future funding agreements.

Consultant/Firm:

Authorized Representative:

Title: