LS-2_Contractors_Certification.docx

FORM LS-2

Contractors certification concerning labor standards and prevailing wages

Recipient:

Contract No:

Activity Name:

1. I, the undersigned, am submitting a bid to (name of recipient):

for the construction of the (name of project): and hereby acknowledge that the following items are included in the bid and will be incorporated by reference into the contract, should I be selected as the contractor for the project.

a. Labor Standards Provisions (HUD 4010);

b. Wage Decision # Modification # Bid Open Date: ; and that

c. The correction of any infractions of the aforesaid conditions, including infractions by any of my sub-contractors and lower tier sub-contractors, is my responsibility.

2. I hereby certify that:

a. To the best of my knowledge, neither I nor any firm, partnership or association in which I have a substantial interest, is designated as an ineligible contractor by the Comptroller General of the United States pursuant to Section 5.6(b) of the Regulations of the Secretary of Labor, Part 5 (29 CFR Part 5) or pursuant to Section 3(a) of the Davis-Bacon Act, as amended [40 U.S.C. 276a-2(a)].

b. No part of the aforementioned contract is or will be sub-contracted to any sub-contractor, if such sub-contractor or firm, corporation, partnership or association in which such sub-contractor has a substantial interest is, to the best of my knowledge, designated as an ineligible contractor pursuant to any of the aforementioned regulatory or statutory provisions.

3. I agree to obtain and forward to the aforementioned grantee a Sub-contractor's Certification Concerning Labor Standards and Prevailing Wage Requirements executed by each and every sub-contractor, preferably prior to or where circumstances do not allow within ten (10) days after the execution of any sub-contract, including those executed by his/her sub-contractors and any lower tier sub-contractors.

(Y/N)

(Y/N) Construction Firm Legal Name Address, City, State, Zip AZ License #

* See Demographic and Trade Code table below for information

Demographic and Trade Codes

14 American Indian or Alaskan Native

15 Native Hawaiian or other Pacific Islander

16 American Indian or Alaskan Native and White

17 Asian and White

18 African American and White

19 American Indian or Alaskan Native and White

20 Other Multi-racial

b. The undersigned is:

|_| a sole proprietorship;

|_| a partnership;

|_| a corporation organized in the State of ; or |_| another organization (describe)

WARNING: U.S. Criminal Code, Section 1010, Title 18, U.S.C. provides in part: “Whoever...makes, passes, utters or publishes any statement, knowing the same to be false...shall be fined under this title or imprisoned not more than two (2) years, or both.”

LS-2 (REV. 11/2019)

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