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Local Assistance Procedures Manual EXHBIT 10-Q Disclosure of Lobbying Activities

EXHIBIT 10-Q DISCLOSURE OF LOBBYING ACTIVITIES

COMPLETE THIS FORM TO DISCLOSE LOBBYING ACTIVITIES PURSUANT TO 31 U.S.C. 1352

1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:

a. contract a. bid/offer/application a. initial

b. grant b. initial award b. material change

c. cooperative agreement c. post-award

d. loan For Material Change Only:

e. loan guarantee year ____ quarter _________

f. loan insurance date of last report __________

4. Name and Address of Reporting Entity 5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime:

Prime Subawardee

Tier _______ , if known

Congressional District, if known Congressional District, if known

6. Federal Department/Agency: 7. Federal Program Name/Description:

CFDA Number, if applicable ____________________

8. Federal Action Number, if known: 9. Award Amount, if known:

10. Name and Address of Lobby Entity 11. Individuals Performing Services

(If individual, last name, first name, MI) (including address if different from No. 10)

(last name, first name, MI)

(attach Continuation Sheet(s) if necessary)

12. Amount of Payment (check all that apply) 14. Type of Payment (check all that apply)

$ _____________ actual planned a. retainer

b. one-time fee

13. Form of Payment (check all that apply): c. commission

a. cash d. contingent fee

b. in-kind; specify: nature _______________ e deferred

Value _____________ f. other, specify _________________________

15. Brief Description of Services Performed or to be performed and Date(s) of Service, including officer(s), employee(s), or member(s) contacted, for Payment Indicated in Item 12:

(attach Continuation Sheet(s) if necessary)

16. Continuation Sheet(s) attached: Yes No

17. Information requested through this form is authorized by Title

31 U.S.C. Section 1352. This disclosure of lobbying reliance was placed by the tier above when his transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C.

1352. This information will be reported to Congress semiannually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

Signature: ________________________________________

Print Name: _______________________________________

Title: ____________________________________________

Telephone No.: ____________________ Date:___________

Authorized for Local Reproduction

Federal Use Only: Standard Form - LLL

Standard Form LLL Rev. 04-28-06

Distribution: Orig- Local Agency Project Files

LPP 13-01 May 8, 2013

Local Assistance Procedures Manual EXHBIT 10-Q Disclosure of Lobbying Activities

INSTRUCTIONS FOR COMPLETING EXHIBIT 10-Q DISCLOSURE OF LOBBYING ACTIVITIES

This disclosure form shall be completed by the reporting entity, whether subawardee or prime federal recipient at the initiation or receipt of covered federal action or a material change to previous filing pursuant to title 31 U.S.C. Section 1352.

The filing of a form is required for such payment or agreement to make payment to lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress an officer or employee of Congress or an employee of a Member of Congress in connection with a covered federal action. Attach a continuation sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.

1. Identify the type of covered federal action for which lobbying activity is or has been secured to influence, the outcome of a covered federal action.

2. Identify the status of the covered federal action.

3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last, previously submitted report by this reporting entity for this covered federal action.

4. Enter the full name, address, city, state, and zip code of the reporting entity. Include Congressional District if known. Check the appropriate classification of the reporting entity that designates if it is or expects to be a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the first tier. Subawards include but are not limited to:

subcontracts, subgrants, and contract awards under grants.

5. If the organization filing the report in Item 4 checks "Subawardee" then enter the full name, address, city, state, and zip code of the prime federal recipient. Include Congressional District, if known.

6. Enter the name of the federal agency making the award or loan commitment. Include at least one organization level below agency name, if known. For example, Department of Transportation, United States Coast Guard.

7. Enter the federal program name or description for the covered federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loan commitments.

8. Enter the most appropriate federal identifying number available for the federal action identification in item 1 (e.g., Request for Proposal (RFP) number, Invitation for Bid (IFB) number, grant announcement number, the contract grant. or loan award number, the application/proposal control number assigned by the federal agency). Include prefixes, e.g., "RFP-DE-90-001."

9. For a covered federal action where there has been an award or loan commitment by the Federal agency, enter the federal amount of the award/loan commitments for the prime entity identified in item 4 or 5.

10. Enter the full name, address, city, state, and zip code of the lobbying entity engaged by the reporting entity identified in Item 4 to influence the covered federal action.

11. Enter the full names of the individual(s) performing services and include full address if different from 10 (a). Enter Last Name, First Name and Middle Initial (Ml).

12. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (Item 4) to the lobbying entity (Item 10). Indicate whether the payment has been made (actual) or will be made (planned). Check all boxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be made.

13. Check all boxes that apply. If payment is made through an in-kind contribution, specify the nature and value of the in-kind payment.

14. Check all boxes that apply. If other, specify nature.

15. Provide a specific and detailed description of the services that the lobbyist has performed or will be expected to perform and the date(s) of any services rendered. Include all preparatory and related activity not just time spent in actual contact with federal officials. Identify the federal officer(s) or employee(s) contacted or the officer(s) employee(s) or Member(s) of Congress that were contacted.

16. Check whether or not a continuation sheet(s) is attached.

17. The certifying official shall sign and date the form, and print his/her name title and telephone number.

Public reporting burden for this collection of information is estimated to average 30-minutes per response, including time for reviewing instruction, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, D.C. 20503. SF-

LLL-Instructions Rev. 06-04

LPP 13-01 May 8, 2013

Certification of Indirect Costs and Financial Management System - Independent Office of Audits and Investigations - Revised 9/2022

Inspector General California Department of Transportation

Certification of Indirect Costs and Financial Management System (Note: If a Safe Harbor Indirect Cost Rate is approved, this form is not required)

Consultant’s Full Legal Name:

Important: Consultant means the individual or consultant providing engineering and design related services as a party of a contract with a recipient or sub-recipient of Federal assistance. Therefore, the Indirect Cost Rate(s) shall not be combined with its parent company or subsidiaries.

Indirect Cost Rate (ICR):

Combined Rate: Or

Home Office Rate: and Field Office Rate (if applicable):

Facilities Capital Cost of Money (if applicable):

Fiscal Period:*

* Fiscal period is annual one year applicable accounting period that the ICR was developed (not the contract period). The ICR is based on the consultant’s one-year applicable accounting period for which financial statements are regularly prepared by the consultant.

I have reviewed the proposal to establish an ICR(s) for the fiscal period as specified above and have determined to the best of my knowledge and belief that:

• All costs included in the cost proposal to establish the ICR(s) are allowable in accordance with the cost principles of the Federal Acquisition Regulation (FAR) 48, Code of Federal Regulations (CFR), Chapter 1, Part 31 (48 CFR Part 31).

• The cost proposal does not include any costs which are expressly unallowable under the cost principles of 48 CFR Part 31.

• The accounting treatment and billing of prevailing wage delta costs are consistent with our prevailing wage policy as either direct labor, indirect costs, or other direct costs on all federally-funded A&E Consultant Contracts.

• All known material transactions or events that have occurred subsequent to year-end affecting the consultant’s ownership, organization, and indirect cost rates have been disclosed as of the date of this certification.

I am providing the required and applicable documents as instructed on the Financial Document Review Request form.

Financial Management System:

Our labor charging, job costing, and accounting systems meet the standards for financial reporting, accounting records, and internal control adequate to demonstrate that costs claimed have been incurred, appropriately accounted for, are allocable to the contract, and comply with the federal requirements as set forth in Title 23 United States Code (U.S.C.) Section 112(b)(2); 48 CFR Part 31.201-2(d); 23 CFR, Chapter 1, Part 172.11(a)(2);

and all applicable state and federal rules and regulations.

Our financial management system has the following attributes:

• Account numbers identifying allowable direct, indirect, and unallowable cost accounts;

• Ability to accumulate and segregate allowable direct, indirect, and unallowable costs into separate cost accounts;

https://www.govinfo.gov/content/pkg/USCODE-2011-title23/pdf/USCODE-2011-title23-chap1-sec112.pdf https://www.govinfo.gov/content/pkg/USCODE-2011-title23/pdf/USCODE-2011-title23-chap1-sec112.pdf https://www.ecfr.gov/

Certification of Indirect Costs and Financial Management System - Independent Office of Audits and Investigations - Revised 9/2022

• Ability to accumulate and segregate allowable direct costs by project, contract and type of cost;

• Internal controls to maintain integrity of financial management system;

• Ability to account and record costs consistently and to ensure costs billed are in compliance with FAR;

• Ability to ensure and demonstrate costs billed reconcile to general ledgers and job costing system; and

• Ability to ensure costs are in compliance with contract terms and federal and state requirements.

Cost Reimbursements on Contracts:

I also understand that failure to comply with 48 CFR Part 16.301-3 or knowingly charge unallowable costs to Federal-Aid Highway Program (FAHP) contracts may result in possible penalties and sanctions as provided by the following:

• Sanctions and Penalties - 23 CFR Part 172.11(c)(4)

• False Claims Act - Title 31 U.S.C. Sections 3729-3733

• Statements or entries generally - Title 18 U.S.C. Section 1001

• Major Fraud Act - Title 18 U.S.C. Section 1031

All A&E Contract Information:

• Total participation amount ___________________ on all State and FAHP contracts for Architectural &

Engineering services that the consultant received in the last three fiscal periods.

• The number of states in which the consultant does business is

• Years of consultant’s experience with 48 CFR Part 31 is

• Identify the type of audits listed below that the consultant has had performed (if applicable):

Cognizant ICR Audit Local Govt ICR Audit Caltrans ICR Audit

CPA ICR Audit Federal Govt ICR Audit

I, the undersigned, certify all of the above to the best of my knowledge and belief and that I have reviewed the ICR Schedule to determine that any costs which are expressly unallowable under the Federal cost principles have been removed and comply with Title 23 U.S.C. Section 112(b)(2), 48 CFR Part 31, 23 CFR Part 172, and all applicable state and federal rules and regulations. I also certify that I understand that all documentation of compliance must be retained by the consultant. I hereby acknowledge that costs that are noncompliant with the federal and state requirements are not eligible for reimbursement and must be returned to Caltrans.

Name:** Title**:

Signature: Date:

Phone**: Email**:

**An individual executive or financial officer of the consultant’s or subconsultant’s organization at a level no lower than a Vice President, a Chief Financial Officer, or equivalent, who has authority to represent the financial information used to establish the indirect cost rate.

Note: Both prime and subconsultants as parties of a contract must complete their own forms. Caltrans will not process local agency’s invoices until a complete form is accepted and approved by the Independent Office of Audits and Investigations.

https://www.ecfr.gov/ https://www.justice.gov/sites/default/files/civil/legacy/2011/04/22/C-FRAUDS_FCA_Primer.pdf https://www.govinfo.gov/content/pkg/USCODE-2011-title18/pdf/USCODE-2011-title18-partI-chap47-sec1001.pdf https://www.govinfo.gov/content/pkg/USCODE-2010-title18/pdf/USCODE-2010-title18-partI-chap47-sec1031.pdf https://www.govinfo.gov/content/pkg/USCODE-2011-title23/pdf/USCODE-2011-title23-chap1-sec112.pdf https://www.ecfr.gov/ https://www.gpo.gov/fdsys/pkg/USCODE-2011-title23/pdf/USCODE-2011-title23-chap1-sec112.pdf http://www.ecfr.gov/cgi-bin/text-idx?SID=7d7984e723af183358e1cb797a78877f&amp%3Bmc=true&amp%3Bnode=sp48.1.31.31_12&amp%3Brgn=div6 http://www.ecfr.gov/cgi-bin/text-idx?rgn=div5&amp%3Bnode=23%3A1.0.1.2.3

California Safe Harbor Indirect Cost Rate Program

SHR Form Revised 9/25/2020 1

Consultant Firm Certification of Eligibility and Certification of Financial Management System

Consultant Firm Name _____________________________________________________________

Local Agency (if applicable) _______________________________________________________

Contract Number / Federal Project Number ________________________________________

Contract Total $ ___________________________________________________________________

For Subconsultant Firms – estimated % of work to be performed ____________________ %

Safe Harbor Indirect Cost Rate (SHR): Home: 120% and/or Field: 90% Field SHR will be utilized for contracts where the work deliverables are not completed from the consultant offices (i.e. Construction Inspection, Material Testing, Sources Inspection, others).

Consultant Firm Certification of Eligibility

I, the undersigned, certify that I am eligible to use the Safe Harbor indirect cost rate as I:

1. Am not a Prime Consultant Firm on a Caltrans contract > $3.5M, or Local Government contract > $1M, regardless of the participation amount.

2. Have not used SHR for more than three (3) years since entering the program on a state or federally funded contract.

AND

1. Do not have relevant contract cost history to use as a base for developing a Federal Acquisition Regulations (FAR) of Title 48, Code of Federal Regulations (CFR), Part 31 compliant ICR.

2. Do not have a previously accepted ICR by a cognizant agency, or with an audited/accepted actual ICR, and do not have an existing contract with a provisional rate.

Certification of Financial Management System

I, the undersigned, certify that our financial management system in place for this contract and moving forward meets the standards for the Safe Harbor indirect cost rate requirements and financial reporting, accounting records, internal and budget control as set forth in 2 CFR 200, Subpart D. These standards require consulting firms have an accounting system

SHR Form Revised 9/25/2020 2 adequate to accumulate, and track allowable, allocable, and reasonable direct labor and other direct costs by contract; segregate indirect costs and remove unallowable costs.

Print Name ________________________________________________

Signature ________________________________________________ (Electronic Signature Allowed)

Title ________________________________________________

Date Completed _______________________

Note: The certification of this Safe Harbor Rate was made by, and are the responsibility of, the Company’s management.

Definition of Terms

Direct Cost is any cost that is identified specifically with a particular cost objective. Direct costs are not limited to items that are incorporated in the end products as material or labor.

Costs identified specifically with a contract are direct costs of that contract. All costs identified with other final cost objectives of the contractor are direct costs of those objectives, 48 CFR 31.202.

Indirect or overhead cost is any cost that is not directly identified with a single final cost objective but is identified with two or more final cost objectives or with at least one intermediate cost objective, 48 CFR 31. 203.

References

Title 48 Code of Federal Regulations (CFR) Part 31 -Federal cost principles.

Title 48 CFR Chapter 99, Subchapter B - Procurement Practices and Cost Accounting Standards.

Title is 2 CFR 200 Subpart D, Standards for Financial and Program Management.

Title 23 United States Code (U.S.C.), Chapter 1, Section 112 - Letting of Contracts.

Title 23 CFR, Chapter 1, Part 172 - Procurement, Management, and Administration of Engineering and Design Related Services.

American Association of State Highway and Transportation Officials (AASHTO) Uniform Audit & Accounting Guide (2016 Edition).

SHR Form Revised 9/25/2020 3

Caltrans Contract

If participating on a Caltrans Contract, also attach a completed copy of the following Safe Harbor Indirect Cost Rate Questionnaire for Evaluating Consultant Firm’s Financial Management System.

SHR Form Revised 9/25/2020 4

Questionnaire for Evaluating Consultant Firm’s Financial Management System Consultant Firm Name _____________________________________________________________

Firm Headquarters Address _________________________________________________________

Accounting Records

• Location where Accounting records are held ________________________

• Name and Title _____________________________________________________

• Email and Phone ____________________________________________________

• Mailing Address _____________________________________________________

To be eligible for Safe Harbor indirect cost rate (SHR), the Consultant Firm’s financial management system must be adequate to accumulate and track direct labor and other direct costs by contract, segregate indirect costs, and remove unallowable costs in accordance with 48 CFR 31 for the different business segments.

Instructions

1. Answer all questions and provide an explanation and additional supporting documentation where requested.

2. If additional space is required, please attach a separate sheet and refer to items being answered by number.

Has the Firm developed an indirect cost rate in the past? Yes ____ No ___ If “Yes”, you are NOT ELIGIBLE to use the SHR.

DO NOT CONTINUE with this Questionnaire and please complete the AASHTO Appendix B ICQ and provide an ICR Schedule.

Is the Firm a Prime Consultant Firm on a Caltrans contract > $3.5M Yes ____ No ___ Or Local Government contract > $1M, regardless of the participation Amount?

If “Yes”, you are NOT ELIGIBLE to use the SHR.

DO NOT CONTINUE with this Questionnaire and please complete the AASHTO Appendix B ICQ and provide an AUDITED ICR Report.

SHR Form Revised 9/25/2020 5

1. What form of business entity is the Firm?

Sole Proprietorship ___ Partnership ____ C Corporation __ S Corporation __

Other __________________________________________________

2. What types of services will the Firm provide for this contract? (Select all that apply.)

Architectural and Engineering Services ____ Program Management ____

Preliminary Engineering ____ Design Engineering ____

Surveying ____ Feasibility Studies ____

Mapping or Architectural Related Services ____ Other _____________________

3. Does the Firm have prior government contracting experience? Yes ____ No ____

4. Does the general ledger contain separate direct and indirect accounts for the following?

Labor Yes ___ No _____ Non-Labor Yes ____ No ____

5. Does the company have a system in place to identify and remove form the indirect cost pools all unallowable cost? Yes_____ No ____

6. Does the firm assign a unique identification/project number in your accounting system for each contract/project?

Yes _____ No _____

7. Is indirect and direct labor separated by contract/project/cost objectives on employee timesheets with unique reporting codes?

Yes _____ No _____

SHR Form Revised 9/25/2020 6

8. Do you have written policies on the following cost categories?

Accounting Yes ___ No ____ Overtime Yes _____ No ____

Billing Yes ___ No ____ Direct/Indirect Expenses Yes _____ No ____

Timesheet Preparation Yes ___ No ____ Prevailing Wage Yes _____ No ____

Bonus Yes ___ No ____

9. What types of employee status will the Firm provide for this contract?

Non-exempt ____ Exempt-salaried ___ Exempt-hourly ___ Contract Employee ___

Other __________________________________________________

10. Does the Firm pay overtime for exempt employees?

Yes _____ No ___

11. Besides labor, does the Firm normally bill/invoice the following as direct contract/project costs? (Select all that apply)

Vehicle _____ Shipping ______

Computer/CADD _____ Lab ______

Printing _____ Travel ______

Specialty Equipment ____ (List below)

Other (List below) ______

12. Are mileage logs maintained for all vehicles? If no, please explain below.

Explanation _____________________________________________________________________

Where is the vehicle stored after work? ___________________________________________

Does employee use vehicle for personal use? Yes ______________________ No_______

What is the recovery/billing rate used for Firm or personal vehicle mileage reimbursement?

$ ________ per mile

SHR Form Revised 9/25/2020 7

I certify that to the best of my knowledge and belief the responses to this questionnaire are accurate.

Print Name ________________________________________________

Signature ________________________________________________ (Electronic Signature Allowed)

Title ________________________________________________

Date Completed _______________________

Note: The certification of this Safe Harbor Rate was made by, and are the responsibility of, the Company’s management.

I

SAMPLE COST PROPOSAL

Sample Only - Required Cost Proposal Template To Be Determined By Agency

SAMPLE COST PROPOSAL 1

COST-PLUS-FIXED FEE OR LUMP SUM OR FIRM FIXED PRICE CONTRACTS

(DESIGN, ENGINEERING AND ENVIRONMENTAL STUDIES)

Note: Mark-ups are Not Allowed ☐ Prime Consultant ☐ Subconsultant ☐ 2nd Tier Subconsultant

Consultant __________________________________________________________

Project No. _______________________ Contract No. ____________________ Date ____________________

DIRECT LABOR

Classification/Title Name Hours Actual Hourly Rate Total

LABOR COSTS

a) Subtotal Direct Labor Costs _______________

b) Anticipated Salary Increases (see page 2 for calculation) _______________

c) TOTAL DIRECT LABOR COSTS [(a) + (b)] _______________

INDIRECT COSTS

d) Fringe Benefits (Rate: _____ ) e) Total Fringe Benefits [(c) x (d)] _______________

f) Overhead (Rate: _____ ) g) Overhead [(c) x (f)] _______________

h) General and Administrative (Rate: ___ __ ) i) Gen & Admin [(c) x (h)] _______________

j) TOTAL INDIRECT COSTS [(e) + (g) + (i)] _______________

FIXED FEE k) TOTAL FIXED FEE [(c) + (j)] x fixed fee ______ ] ______________

Description of Item Quantity Unit Unit Cost Total

l) TOTAL OTHER DIRECT COSTS

m) SUBCONSULTANTS’ COSTS (Add additi

l) CONSULTANT’S OTHER DIRECT COSTS (ODC) – ITEMIZE (Add additional pages if necessary) onal pages if necessary) Subconsultant 1:

Subconsultant 2:

Subconsultant 3:

Subconsultant 4:

m) TOTAL SUBCONSULTANTS’ COSTS

n) TOTAL OTHER DIRECT COSTS INCLUDING SUBCONSULTANTS [(l)+(m)] ___________________

TOTAL COST [(c) + (j) + (k) + (n)] _____________________

NOTES:

1. Key personnel must be marked with an asterisk (*) and employees that are subject to prevailing wage requirements must be marked with two asterisks (**). All costs must comply with the Federal cost principles. Subconsultants will provide their own cost proposals.

2. The cost proposal format shall not be amended. Indirect cost rates shall be updated on an annual basis in accordance with the consultant’s annual accounting period and established by a cognizant agency or accepted by Caltrans.

3. Anticipated salary increases calculation (page 2) must accompany.

Sample Only - Required Cost Proposal Template To Be Determined By Agency

SAMPLE COST PROPOSAL 1

COST-PLUS-FIXED FEE OR LUMP SUM OR FIRM FIXED PRICE CONTRACTS

(CALCULATIONS FOR ANTICIPATED SALARY INCREASES)

1. Calculate Average Hourly Rate for 1st year of the contract (Direct Labor Subtotal divided by total hours)

Direct Labor Total Hours per Avg 5Year Subtotal per Cost Cost Proposal Hourly Contract

Proposal Rate Duration

=$250,000.00 500 $50.00 Year 1 Avg Hourly Rate

2. Calculate hourly rate for all years (Increase the Average Hourly Rate for a year by proposed escalation%)

Avg Hourly Rate Proposed Escalation

Year 1 $50.00 + 2% = $51.00 Year 2 Avg Hourly Rate Year 2 $51.00 + 2% = $52.02 Year 3 Avg Hourly Rate Year 3 $52.02 + 2% = $53.06 Year 4 Avg Hourly Rate Year 4 $53.06 + 2% = $54.12 Year 5 Avg Hourly Rate

3. Calculate estimated hours per year (Multiply estimate% each year by total hours)

Estimated % Completed Total Hours per Cost Total Hours per Each Year Proposal Year

Year 1 20.0% 5000 = 1000 Estimated Hours Year 1 Year 2 400% 5000 = 2000 Estimated Hours Year 2 Year 3 15.0% 5000 = 750 Estimated Hours Year 3 Year 4 15.0% 5000 = 750 Estimated Hours Year 4 Years 100% 5000 = 500 Estimated Hours Year 5

Total 100% Total = 5000

4. Calculate Total Costs including Escalation (Multiply Average Hourly Rate by the number of hours)

Avg Hourly Rate Estimated hours Cost per (calculated above) (calculated above) Year

Year 1 $50.00 1000 $50,000.00 Estimated Hours Year 1 = Year 2 $51.00 2000 $102,000.00 Estimated Hours Year 2 = Year 3 $52.02 750 $39,015.00 Estimated Hours Year 3 = Year 4 $53.06 750 $39,795.30 Estimated Hours Year 4 = Years $54.12 500 = $27,060.80 Estimated Hours Year 5

Total Direct Labor Cost with Escalation $257,871.10= Direct Labor Subtotal before Escalation = $250,000.00

Estimated total of Direct Labor Salary Transfer to Page 1 = Increase $7,871.10

NOTES:

1. This is not the only way to estimate salary increases. Other methods will be accepted if they clearly indicate the % increase, the# of years of the contract, and a breakdown of the labor to be performed each year.

2. An estimation that is based on direct labor multiplied by salary increase % multiplied by the# of years is not acceptable.

(i e. $250,000 x 2% x 5 yrs= $25,000 is not an acceptable methodology)

3. This assumes that one year will be worked at the rate on the cost proposal before salary increases are granted.

4. Calculations for anticipated salary escalation must be provided.

Sample Only - Required Cost Proposal Template To Be Determined By Agency

SAMPLE COST PROPOSAL 1

Certification of Direct Costs:

I, the undersigned, certify to the best of my knowledge and belief that all direct costs identified on the cost proposal{s) in this contract are actual, reasonable, allowable, and allocable to the contract in accordance with the contract terms and the following requirements:

1. Generally Accepted Accounting Principles {GAAP)

2. Terms and conditions of the contract

3. Title 23 United States Code Section 112 - Letting of Contracts

4. 48 Code of Federal Regulations Part 31 - Contract Cost Principles and Procedures

5. 23 Code of Federal Regulations Part 172 - Procurement, Management, and

Administration of Engineering and Design Related Service

6. 48 Code of Federal Regulations Part 9904 - Cost Accounting Standards Board {when applicable)

All costs must be applied consistently and fairly to all contracts. All documentation of compliance must be retained in the project files and be in compliance with applicable federal and state requirements.

Costs that are noncompliant with the federal and state requirements are not eligible for reimbursement.

Local governments are responsible for applying only cognizant agency approved or Caltrans accepted Indirect Cost Rate{s).

Prime Consultant or Subconsultant Certifying:

Name:_______________ Title*:

Signature:_ _ _ _ __ _ __ __ Date of Certification {mm/dd/yyyy): _____

_______ Phone Number:Email: ______ _ _

Address:_________________________________

*An individual executive or financial officer of the consultant's or subconsultant's organization at a level no lower than a Vice President or a Chief Financial Officer, or equivalent, who has authority to represent the financial information utilized to establish the cost proposal for the contract.

List services the consultant is providinq under the proposed contract: