quotations for small purchases (qsp) conditions to quote – …€¦ · 13-10-2016 · conditions...

Quotations for Small Purchases (QSP)

CONDITIONS TO QUOTE – CONSTRUCTION

Solicitation No. QSP 19: Fencing Services

Ocala Housing Authority

PROCEDURE: Quoters must submit proposed pricing where provided on the last page of this form only! The HA will accept the proposed pricing in person, by fax, email or by mail delivery only! The HA will NOT accept proposed pricing verbally or by telephone! Bids are due by Friday March 3, 2017 @ 3:00pm. 1.0 OHA CONTACT: All questions pertaining this QSP shall be addressed to James Haynes

(hereinafter, the Contracting Officer or CO), Telephone: 352-620-3411; e-mail: [email protected]. All Quotes are to be returned to Bennie Munnerlyn, Telephone: 352-620-3675, email: [email protected].

2.0 APPLICABILITY: By submitting a quote to the OHA, the firm or individual doing so

(hereinafter, "the quoter") is automatically agreeing to abide by all terms and conditions listed herein, including those terms and conditions within the HUD document, form HUD-5370-EZ (10/2006), General Contract Conditions for Small Construction/Development Contracts, which is attached hereto.

3.0 OHA RESERVATION OF RIGHTS: The OHA reserves the right to:

3.1 Reject any or all quotes, to waive any informalities in the QSP process, or to terminate the QSP process at any time, if deemed by the OHA to be in the best interest of the OHA;

3.2 Terminate a contract awarded pursuant to this QSP at any time for its

convenience upon delivery of a 10-day written notice to the apparent or successful quoter;

3.3 Determine the days, hours and locations that the successful quoter shall

provide the items or services called for in this QSP;

3.4 Reject and not consider any quote that does not, in the opinion of the CO, meet the requirements of this QSP, including but not necessarily limited to incomplete quotes offering alternate (not including “or equal” items) or non-requested items or services;

4.0 QUOTER’S RESPONSIBILITY: Each quoter must carefully review and comply with all

instructions provided herein, provided within any named attachments and those provided within the noted Internet system.

5.0 DEADLINE: Each quoter shall submit his/her proposed costs, prior to the posted

mailto:[email protected]






deadline, as provided for herein. Whereas this is an informal solicitation process, the OHA reserves the right to extend the posted deadline at any time prior to the deadline, if, in the opinion of the CO, it is in the best interests of the OHA to do so.

6.0 HOLD PRICES/NON-ESCALATION: By submitting a quote, and whereas the quote sum

submitted is a firm-fixed quote, each quoter thereby agrees to "hold" or not increase the proposed quote prices during the term of the work.

7.0 CONTRACT: The OHA will procure the applicable goods or services by issuance of a

contract. By submitting a quote, the successful quoter thereby agrees to confirm receipt of the CONTRACT in the manner directed by the OHA.

7.1 AWARD CRITERIA: If an award is completed pursuant to this QSP, and unless

otherwise instructed in writing by the CO, award shall be made to the responsive and responsible quoter that submits the lowest cost.

8.0 INVALID OR ALTERNATE QUOTES: Failure to complete and submit all required

information, or to add any additional requirements not acceptable to the OHA, may invalidate the quote submitted. Furthermore, the OHA shall reserve the right to reject, without consideration, alternate quotes, meaning those that do not meet the requirements of this QSP.

9.0 QUOTE COSTS: There shall be no obligation for the OHA to compensate any quoter

or prospective quoter for any costs that he/she may incur in responding to this QSP. 10.0 SHIPPING COSTS: Each quoted sum submitted shall include completion of the

specified services at the OHA site or location, as specified within this QSP or on the PO issued.

11.0 ASSIGNMENT OF PERSONNEL: The OHA shall retain the right to demand and receive a

change in personnel assigned by the successful quoter to provide services to the OHA if the OHA believes that such change is in the best interest of the OHA and the completion of the work or provision of the items.

12.0 UNAUTHORIZED SUB-CONTRACTING PROHIBITED: The successful quoter shall not

assign any right, nor delegate any duty for the work proposed pursuant to this QSP (including, but not limited to, selling or transferring the ensuing PO or contract) without the prior written consent of the CO. Any purported assignment of interest





or delegation of duty, without the prior written consent of the CO shall be void and may result in the cancellation of the PO or the contract with the HA.

13.0 LICENSING AND INSURANCE REQUIREMENTS: The successful quoter will be required to provide:

13.1 An original certificate evidencing General Liability coverage, naming the OHA

as an additional insured, together with the appropriate endorsement to said policy reflecting the addition of the HA as an additional insured under said policy (minimum of $1,000,000 each occurrence, general aggregate minimum limit of $1,000,000, together with damage to premises and fire damage of $50,000 and medical expenses any one person of $5,000), with a deductible of not greater than $1,000;

13.2 An original certificate evidencing the quoter’s current industrial (worker’s compensation) insurance carrier and coverage amount;

13.3 An original certificate showing the quoter's automobile insurance coverage in

a combined single limit of $500,000. For every vehicle utilized during the term of this program, when not owned by the entity, each vehicle must have evidence of automobile insurance coverage with limits of no less than $50,000/$100,000 and medical pay of $5,000.

13.4 A copy of the quoter’s business license allowing that entity to provide such

services within the jurisdiction; (if applicable)

13.5 A copy of the quoter's license issued by the State of Florida licensing authority allowing the quoter to provide the services detailed herein.

14.0 Documents that apply to this QSP:

14.1 This Conditions To Quote form; 14.2 form HUD 5370-EZ (10/2006), General Contract Conditions for Small

Construction/Development Contracts (attached); 14.3 Applicable HUD Wage Rate Decision (attached). 14.4 A copy of 24 CFR 135, commonly known as Section 3 (included by reference--

a copy will be delivered by the HA to any firm upon submission to the CO of a written request for such). The successful quoter hereby agrees to comply with all requirements of the HUD Section 3 Program as detailed therein. If a





bidder chooses to certify as a Section 3 quoter, he/she shall receive the preference noted therein. In any case, the successful quoter shall be required to, as detailed therein, "to the greatest extent feasible . . . provide economic opportunities to low- and very-low income persons," meaning, if the successful quoter must hire anyone to help with the work, he/she must submit a work plan showing how he/she will give first preference to such jobs to Section 3 persons.

14.5 The OHA reserves the right to require the successful quoter/contractor to utilize any form required by HUD to complete the required work and by submitting his/her quote each contractor agrees to do so at no additional charge.

15.0 Technical Specifications or Statement of Work (SOW) that apply to this QSP:

Contractor shall/is:

• Responsible for all field measurements/counts • Repair any damage to surrounding area and grounds to pre-existing

conditions or better • Responsible for providing their own utility source, toilet facility and

dumpster • Keep work area clean, organized and free of hazards at all times • Guarantee all equipment, material and workmanship to be free of defects

for a period of 1 year from date of final acceptance by OHA and repair any such defect at no cost to the OHA

• Be prepared to provide OHA with permits, product approvals, signed and sealed engineering recommendations, color and/or texture choices, manufactures and contractor warranties and as-built drawings when necessary or when project requires





FORM OF QUOTE

Each quoter shall submit his/her quote on this form only, which shall be completed and returned to the HA as detailed herein.

Item No.

Description

Cost to Install

1 Terminal Post Caps $ $ 2 Rail End $ $ 3 Rail End Band $ $ 4 Tension Band $ $ 5 Line Post Tap $ $ 6 Gate Frame Hinge $ $ 7 Gate Post Hinge $ $ 8 Gate Fork Latch $ $ 9 Terminal Post $ 5’ $6’ $8’ 10 Tension Bar $ $ 11 Line Post $5’ $6’ $8’ 12 Top Rail $ $ 13 Bottom Tension Wire $ $ 14 Tension Wire Cap $ $

15 Chain Link Mesh per/ sq ft.

$5’ $6’

$8’

Total Amount Quoted**: $ *First, place within the above an amount for each noted unit to complete the required work. Second, add the unit costs to arrive at a Total Amount Quoted. **In the case of any discrepancy between the "Total Amount Quoted" and the recalculated sum of adding each of the individual quote amounts entered (e.g. the quoter makes a mistake in adding the amount to arrive at a Total Amount Quoted), the OHA reserves the right to choose either the new calculated sum or the original Total Amount Quoted submitted, either as may be in the favor of the OHA.





The undersigned quoter hereby quotes the above amounts to complete the required work (print clearly and legibly!). Further, by submitting this quote, the undersigned quoter agrees to abide by all terms and conditions listed within any document issued by the HA pertaining to this issue. COMPLETED BY: ____________________________ __________ ____________________________ Signature Date Printed Name ____________________________ ________________________________________ Company Name Address (Street; City; State; Zip)

Non-Construction Contract Documentation Required

HUD Forms (Forms Included – Please sign and return): • HUD 5369-A• HUD 5369-B• HUD 5369-C• HUD 5370-C (Section 1 and 2)• HUD 50070 – Certificate of Drug Free Workplace

OHA Forms (Forms Included – Please sign and return): • Conflict of Interest Statement• Section 3 Procurement Notice• Section 3 Outline• Certificate of Corporate Principal• Contractor’s Certification of Authorization

Other Required Documents to be Submitted: • Business License• Certificate of Insurance (General, Liability, Auto, Worker’s

Compensation) naming Ocala Housing Authority as CertificateHolder

• Worker’s Compensation Exemption Certificate• W-9• Driver’s License• References (3 minimal)• Non-Collusive Affidavit• Statement of Bidders Qualifications

Please sign below and return this sheet to acknowledge receipt of the above referenced HUD documents and OHA forms. Please make a copy for your records.

________________________________ ___________________ Signature Date

________________________________ Printed Name

________________________________ Company Name

CHIEF EXECUTIVE OFFICER Gwendolyn B. Dawson, MBA FL Licensed Real Estate &

Mortgage Broker NMLS #383663

BOARD OF COMMISSIONERS

Howard L. Gunn, Jr. Chairman

Tanya M. Hanks Vice Chairwoman

Dr. Marcia Roberson-Fields Treasurer

Alfreda Richardson Resident-Commissioner

Reginald E. Landers, Jr. Commissioner

PHYSICAL ADDRESS 1629 NW 4th Street

Ocala, FL 34475-6051

MAILING ADDRESS P.O. Box 2468

Ocala, FL 34478-2468

TELEPHONE (352) 369-2636

TDD +1 (800) 545-1833; ext. 507

FAX (352) 369-2642

EMAIL [email protected]

WEBSITE www.ocalahousing.org

HUD Certified Housing Counseling Agency

Equal Opportunity Employer


http://www.ocalahousing.org/

Previous edition is obsolete form HUD-5369 (10/2002)

Instructions to Bidders for ContractsPublic and Indian Housing Programs

U.S. Department of Housing andUrban DevelopmentOffice of Public and Indian Housing


Instructions to Bidders for ContractsPublic and Indian Housing Programs

Table of ContentsClause Page

1. Bid Preparation and Submission 1

2. Explanations and Interpretations to Prospective Bidders 1

3. Amendments to Invitations for Bids 1

4. Responsibility of Prospective Contractor 1

5. Late Submissions, Modifications, and Withdrawal of Bids 1

6. Bid Opening 2

7. Service of Protest 2

8. Contract Award 2

9. Bid Guarantee 3

10. Assurance of Completion 3

11. Preconstruction Conference 3

12. Indian Preference Requirements 3

1. Bid Preparation and Submission(a) Bidders are expected to examine the specifications, drawings,all instructions, and, if applicable, the construction site (see also thecontract clause entitled Site Investigation and Conditions Affect-ing the Work of the General Conditions of the Contract for Construc-tion). Failure to do so will be at the bidders’ risk.

(b) All bids must be submitted on the forms provided by the PublicHousing Agency/Indian Housing Authority (PHA/IHA). Bidders shallfurnish all the information required by the solicitation. Bids must besigned and the bidder’s name typed or printed on the bid sheet andeach continuation sheet which requires the entry of information bythe bidder. Erasures or other changes must be initialed by the personsigning the bid. Bids signed by an agent shall be accompanied byevidence of that agent’s authority. (Bidders should retain a copy oftheir bid for their records.)

(c) Bidders must submit as part of their bid a completed form HUD-5369-A, “Representations, Certifications, and Other Statements ofBidders.”

(d) All bid documents shall be sealed in an envelope which shall beclearly marked with the words “Bid Documents,” the Invitation forBids (IFB) number, any project or other identifying number, thebidder’s name, and the date and time for receipt of bids.

(e) If this solicitation requires bidding on all items, failure to do so willdisqualify the bid. If bidding on all items is not required, biddersshould insert the words “No Bid” in the space provided for any itemon which no price is submitted.

(f) Unless expressly authorized elsewhere in this solicitation, alter-nate bids will not be considered.

(g) Unless expressly authorized elsewhere in this solicitation, bidssubmitted by telegraph or facsimile (fax) machines will not beconsidered.

(h) If the proposed contract is for a Mutual Help project (as de-scribed in 24 CFR Part 905, Subpart E) that involves Mutual Helpcontributions of work, material, or equipment, supplemental informa-tion regarding the bid advertisement is provided as an attachment tothis solicitation.

2. Explanations and Interpretations to ProspectiveBidders

(a) Any prospective bidder desiring an explanation or interpretationof the solicitation, specifications, drawings, etc., must request it atleast 7 days before the scheduled time for bid opening. Requestsmay be oral or written. Oral requests must be confirmed in writing.The only oral clarifications that will be provided will be those clearlyrelated to solicitation procedures, i.e., not substantive technicalinformation. No other oral explanation or interpretation will beprovided. Any information given a prospective bidder concerningthis solicitation will be furnished promptly to all other prospectivebidders as a written amendment to the solicitation, if that informationis necessary in submitting bids, or if the lack of it would be prejudicialto other prospective bidders.

(b) Any information obtained by, or provided to, a bidder other thanby formal amendment to the solicitation shall not constitute a changeto the solicitation.

3. Amendments to Invitations for Bids(a) If this solicitation is amended, then all terms and conditionswhich are not modified remain unchanged.

(b) Bidders shall acknowledge receipt of any amendment to thissolicitation (1) by signing and returning the amendment, (2) byidentifying the amendment number and date on the bid form, or (3)by letter, telegram, or facsimile, if those methods are authorized inthe solicitation. The PHA/IHA must receive acknowledgement by thetime and at the place specified for receipt of bids. Bids which fail toacknowledge the bidder’s receipt of any amendment will result in therejection of the bid if the amendment(s) contained information whichsubstantively changed the PHA’s/IHA’s requirements.

(c) Amendments will be on file in the offices of the PHA/IHA and theArchitect at least 7 days before bid opening.

4. Responsibility of Prospective Contractor(a) The PHA/IHA will award contracts only to responsible prospec-tive contractors who have the ability to perform successfully underthe terms and conditions of the proposed contract. In determiningthe responsibility of a bidder, the PHA/IHA will consider such mattersas the bidder’s:

(1) Integrity;

(2) Compliance with public policy;

(3) Record of past performance; and

(4) Financial and technical resources (including constructionand technical equipment).

(b) Before a bid is considered for award, the bidder may be re-quested by the PHA/IHA to submit a statement or other documenta-tion regarding any of the items in paragraph (a) above. Failure by thebidder to provide such additional information shall render the biddernonresponsible and ineligible for award.

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5. Late Submissions, Modifications, and Withdrawal of Bids(a) Any bid received at the place designated in the solicitation afterthe exact time specified for receipt will not be considered unless it isreceived before award is made and it:

(1) Was sent by registered or certified mail not later than thefifth calendar day before the date specified for receipt of offers (e.g.,an offer submitted in response to a solicitation requiring receipt ofoffers by the 20th of the month must have been mailed by the 15th);

(2) Was sent by mail, or if authorized by the solicitation, wassent by telegram or via facsimile, and it is determined by the PHA/IHAthat the late receipt was due solely to mishandling by the PHA/IHAafter receipt at the PHA/IHA; or

(3) Was sent by U.S. Postal Service Express Mail Next DayService - Post Office to Addressee, not later than 5:00 p.m. at theplace of mailing two working days prior to the date specified forreceipt of proposals. The term “working days” excludes weekendsand observed holidays.

(b) Any modification or withdrawal of a bid is subject to the sameconditions as in paragraph (a) of this provision.

(c) The only acceptable evidence to establish the date of mailing ofa late bid, modification, or withdrawal sent either by registered orcertified mail is the U.S. or Canadian Postal Service postmark bothon the envelope or wrapper and on the original receipt from the U.S.or Canadian Postal Service. Both postmarks must show a legibledate or the bid, modification, or withdrawal shall be processed as ifmailed late. “Postmark” means a printed, stamped, or otherwiseplaced impression (exclusive of a postage meter machine impres-sion) that is readily identifiable without further action as having beensupplied and affixed by employees of the U.S. or Canadian PostalService on the date of mailing. Therefore, bidders should request thepostal clerk to place a hand cancellation bull’s-eye postmark on boththe receipt and the envelope or wrapper.

(d) The only acceptable evidence to establish the time of receipt at thePHA/IHA is the time/date stamp of PHA/IHA on the proposal wrapper orother documentary evidence of receipt maintained by the PHA/IHA.

(e) The only acceptable evidence to establish the date of mailing ofa late bid, modification, or withdrawal sent by Express Mail Next DayService-Post Office to Addressee is the date entered by the postoffice receiving clerk on the “Express Mail Next Day Service-PostOffice to Addressee” label and the postmark on both the envelope orwrapper and on the original receipt from the U.S. Postal Service.“Postmark” has the same meaning as defined in paragraph (c) of thisprovision, excluding postmarks of the Canadian Postal Service.Therefore, bidders should request the postal clerk to place a legiblehand cancellation bull’s eye postmark on both the receipt and Failureby a bidder to acknowledge receipt of the envelope or wrapper.

(f) Notwithstanding paragraph (a) of this provision, a late modifica-tion of an otherwise successful bid that makes its terms morefavorable to the PHA/IHA will be considered at any time it is receivedand may be accepted.

(g) Bids may be withdrawn by written notice, or if authorized by thissolicitation, by telegram (including mailgram) or facsimile machinetransmission received at any time before the exact time set foropening of bids; provided that written confirmation of telegraphic orfacsimile withdrawals over the signature of the bidder is mailed andpostmarked prior to the specified bid opening time. A bid may bewithdrawn in person by a bidder or its authorized representative if,before the exact time set for opening of bids, the identity of the personrequesting withdrawal is established and the person signs a receiptfor the bid.

6. Bid OpeningAll bids received by the date and time of receipt specified in thesolicitation will be publicly opened and read. The time and place ofopening will be as specified in the solicitation. Bidders and otherinterested persons may be present.

7. Service of Protest(a) Definitions. As used in this provision:

“Interested party” means an actual or prospective bidder whosedirect economic interest would be affected by the award of thecontract.

“Protest” means a written objection by an interested party to thissolicitation or to a proposed or actual award of a contract pursuantto this solicitation.

(b) Protests shall be served on the Contracting Officer by obtainingwritten and dated acknowledgement from —

[Contracting Officer designate the official or location where a protestmay be served on the Contracting Officer]

(c) All protests shall be resolved in accordance with the PHA’s/IHA’s protest policy and procedures, copies of which are maintainedat the PHA/IHA.

8. Contract Award(a) The PHA/IHA will evaluate bids in response to this solicitationwithout discussions and will award a contract to the responsiblebidder whose bid, conforming to the solicitation, will be most advan-tageous to the PHA/IHA considering only price and any price-relatedfactors specified in the solicitation.

(b) If the apparent low bid received in response to this solicitationexceeds the PHA’s/IHA’s available funding for the proposed contractwork, the PHA/IHA may either accept separately priced items (see8(e) below) or use the following procedure to determine contractaward. The PHA/IHA shall apply in turn to each bid (proceeding inorder from the apparent low bid to the high bid) each of the separatelypriced bid deductible items, if any, in their priority order set forth inthis solicitation. If upon the application of the first deductible item toall initial bids, a new low bid is within the PHA’s/IHA’s availablefunding, then award shall be made to that bidder. If no bid is withinthe available funding amount, then the PHA/IHA shall apply thesecond deductible item. The PHA/IHA shall continue this processuntil an evaluated low bid, if any, is within the PHA’s/IHA’s availablefunding. If upon the application of all deductibles, no bid is within thePHA’s/IHA’s available funding, or if the solicitation does not requestseparately priced deductibles, the PHA/IHA shall follow its writtenpolicy and procedures in making any award under this solicitation.

(c) In the case of tie low bids, award shall be made in accordancewith the PHA’s/IHA’s written policy and procedures.

(d) The PHA/IHA may reject any and all bids, accept other than thelowest bid (e.g., the apparent low bid is unreasonably low), and waiveinformalities or minor irregularities in bids received, in accordancewith the PHA’s/IHA’s written policy and procedures.

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(e) Unless precluded elsewhere in the solicitation, the PHA/IHAmay accept any item or combination of items bid.

(f) The PHA/IHA may reject any bid as nonresponsive if it ismaterially unbalanced as to the prices for the various items of workto be performed. A bid is materially unbalanced when it is based onprices significantly less than cost for some work and prices which aresignificantly overstated for other work.

(g) A written award shall be furnished to the successful bidder withinthe period for acceptance specified in the bid and shall result in abinding contract without further action by either party.

9. Bid Guarantee (applicable to construction and equip-ment contracts exceeding $25,000)

All bids must be accompanied by a negotiable bid guarantee whichshall not be less than five percent (5%) of the amount of the bid. Thebid guarantee may be a certified check, bank draft, U.S. GovernmentBonds at par value, or a bid bond secured by a surety companyacceptable to the U.S. Government and authorized to do business inthe state where the work is to be performed. In the case where thework under the contract will be performed on an Indian reservationarea, the bid guarantee may also be an irrevocable Letter of Credit(see provision 10, Assurance of Completion, below). Certifiedchecks and bank drafts must be made payable to the order of thePHA/IHA. The bid guarantee shall insure the execution of thecontract and the furnishing of a method of assurance of completionby the successful bidder as required by the solicitation. Failure tosubmit a bid guarantee with the bid shall result in the rejection of thebid. Bid guarantees submitted by unsuccessful bidders will bereturned as soon as practicable after bid opening.

10. Assurance of Completion(a) Unless otherwise provided in State law, the successful biddershall furnish an assurance of completion prior to the execution of anycontract under this solicitation. This assurance may be [ContractingOfficer check applicable items] —

[ ] (1) a performance and payment bond in a penal sum of 100percent of the contract price; or, as may be required or permitted byState law;

[ ] (2) separate performance and payment bonds, each for 50percent or more of the contract price;

[ ] (3) a 20 percent cash escrow;

[ ] (4) a 25 percent irrevocable letter of credit; or,

[ ] (5) an irrevocable letter of credit for 10 percent of the totalcontract price with a monitoring and disbursements agreement withthe IHA (applicable only to contracts awarded by an IHA under theIndian Housing Program).

(b) Bonds must be obtained from guarantee or surety companiesacceptable to the U.S. Government and authorized to do business inthe state where the work is to be performed. Individual sureties willnot be considered. U.S. Treasury Circular Number 570, publishedannually in the Federal Register, lists companies approved to act assureties on bonds securing Government contracts, the maximumunderwriting limits on each contract bonded, and the States in whichthe company is licensed to do business. Use of companies listed inthis circular is mandatory. Copies of the circular may be downloadedon the U.S. Department of Treasury website http://www.fms.treas.gov/c570/index.html, or ordered for a minimum feeby contacting the Government Printing Office at (202) 512-2168.

(c) Each bond shall clearly state the rate of premium and the totalamount of premium charged. The current power of attorney for theperson who signs for the surety company must be attached to thebond. The effective date of the power of attorney shall not precedethe date of the bond. The effective date of the bond shall be on or afterthe execution date of the contract.

(d) Failure by the successful bidder to obtain the required assur-ance of completion within the time specified, or within such extendedperiod as the PHA/IHA may grant based upon reasons determinedadequate by the PHA/IHA, shall render the bidder ineligible foraward. The PHA/IHA may then either award the contract to the nextlowest responsible bidder or solicit new bids. The PHA/IHA mayretain the ineligible bidder’s bid guarantee.

11. Preconstruction Conference (applicable to constructioncontracts)

After award of a contract under this solicitation and prior to the startof work, the successful bidder will be required to attend apreconstruction conference with representatives of the PHA/IHA andits architect/engineer, and other interested parties convened by thePHA/IHA. The conference will serve to acquaint the participants withthe general plan of the construction operation and all other require-ments of the contract (e.g., Equal Employment Opportunity, LaborStandards). The PHA/IHA will provide the successful bidder with thedate, time, and place of the conference.

12. Indian Preference Requirements (applicable only ifthis solicitation is for a contract to be performed on aproject for an Indian Housing Authority)

(a) HUD has determined that the contract awarded under thissolicitation is subject to the requirements of section 7(b) of the IndianSelf-Determination and Education Assistance Act (25 U.S.C. 450e(b)).Section 7(b) requires that any contract or subcontract entered into forthe benefit of Indians shall require that, to the greatest extent feasible

(1) Preferences and opportunities for training and employment(other than core crew positions; see paragraph (h) below) in connec-tion with the administration of such contracts or subcontracts begiven to qualified “Indians.” The Act defines “Indians” to meanpersons who are members of an Indian tribe and defines “Indiantribe” to mean any Indian tribe, band, nation, or other organizedgroup or community, including any Alaska Native village or regionalor village corporation as defined in or established pursuant to theAlaska Native Claims Settlement Act, which is recognized as eligiblefor the special programs and services provided by the United Statesto Indians because of their status as Indians; and,

(2) Preference in the award of contracts or subcontracts inconnection with the administration of contracts be given to Indianorganizations and to Indian-owned economic enterprises, as de-fined in section 3 of the Indian Financing Act of 1974 (25 U.S.C.1452). That Act defines “economic enterprise” to mean any Indian-owned commercial, industrial, or business activity established ororganized for the purpose of profit, except that the Indian ownershipmust constitute not less than 51 percent of the enterprise; “Indianorganization” to mean the governing body of any Indian tribe or entityestablished or recognized by such governing body; “Indian” to meanany person who is a member of any tribe, band, group, pueblo, orcommunity which is recognized by the Federal Government aseligible for services from the Bureau of Indian Affairs and any“Native” as defined in the Alaska Native Claims Settlement Act; andIndian “tribe” to mean any Indian tribe, band, group, pueblo, orcommunity including Native villages and Native groups (including

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corporations organized by Kenai, Juneau, Sitka, and Kodiak) asdefined in the Alaska Native Claims Settlement Act, which is recog-nized by the Federal Government as eligible for services from theBureau of Indian Affairs.

(b) (1) The successful Contractor under this solicitation shall com-ply with the requirements of this provision in awarding all subcon-tracts under the contract and in providing training and employmentopportunities.

(2) A finding by the IHA that the contractor, either (i) awardeda subcontract without using the procedure required by the IHA, (ii)falsely represented that subcontracts would be awarded to Indianenterprises or organizations; or, (iii) failed to comply with thecontractor’s employment and training preference bid statement shallbe grounds for termination of the contract or for the assessment ofpenalties or other remedies.

(c) If specified elsewhere in this solicitation, the IHA may restrict thesolicitation to qualified Indian-owned enterprises and Indian organi-zations. If two or more (or a greater number as specified elsewherein the solicitation) qualified Indian-owned enterprises or organiza-tions submit responsive bids, award shall be made to the qualifiedenterprise or organization with the lowest responsive bid. If fewerthan the minimum required number of qualified Indian-owned enter-prises or organizations submit responsive bids, the IHA shall rejectall bids and readvertise the solicitation in accordance with paragraph(d) below.

(d) If the IHA prefers not to restrict the solicitation as described inparagraph (c) above, or if after having restricted a solicitation aninsufficient number of qualified Indian enterprises or organizationssubmit bids, the IHA may advertise for bids from non-Indian as wellas Indian-owned enterprises and Indian organizations. Award shallbe made to the qualified Indian enterprise or organization with thelowest responsive bid if that bid is -

(1) Within the maximum HUD-approved budget amount estab-lished for the specific project or activity for which bids are beingsolicited; and

(2) No more than the percentage specified in 24 CFR 905.175(c)higher than the total bid price of the lowest responsive bid from anyqualified bidder. If no responsive bid by a qualified Indian-ownedeconomic enterprise or organization is within the stated range of thetotal bid price of the lowest responsive bid from any qualifiedenterprise, award shall be made to the bidder with the lowest bid.

(e) Bidders seeking to qualify for preference in contracting orsubcontracting shall submit proof of Indian ownership with their bids.Proof of Indian ownership shall include but not be limited to:

(1) Certification by a tribe or other evidence that the bidder isan Indian. The IHA shall accept the certification of a tribe that anindividual is a member.

(2) Evidence such as stock ownership, structure, manage-ment, control, financing and salary or profit sharing arrangements ofthe enterprise.

(f) (1) All bidders must submit with their bids a statement describ-ing how they will provide Indian preference in the award of subcon-tracts. The specific requirements of that statement and the factorsto used by the IHA in determining the statement’s adequacy areincluded as an attachment to this solicitation. Any bid that fails toinclude the required statement shall be rejected as nonresponsive.The IHA may require that comparable statements be provided bysubcontractors to the successful Contractor, and may require theContractor to reject any bid or proposal by a subcontractor that failsto include the statement.

(2) Bidders and prospective subcontractors shall submit acertification (supported by credible evidence) to the IHA in anyinstance where the bidder or subcontractor believes it is infeasible toprovide Indian preference in subcontracting. The acceptance orrejection by the IHA of the certification shall be final. Rejection shalldisqualify the bid from further consideration.

(g) All bidders must submit with their bids a statement detailing theiremployment and training opportunities and their plans to providepreference to Indians in implementing the contract; and the numberor percentage of Indians anticipated to be employed and trained.Comparable statements from all proposed subcontractors must besubmitted. The criteria to be used by the IHA in determining thestatement(s)’s adequacy are included as an attachment to thissolicitation. Any bid that fails to include the required statement(s), orthat includes a statement that does not meet minimum standardsrequired by the IHA shall be rejected as nonresponsive.

(h) Core crew employees. A core crew employee is an individualwho is a bona fide employee of the contractor at the time the bid issubmitted; or an individual who was not employed by the bidder at thetime the bid was submitted, but who is regularly employed by thebidder in a supervisory or other key skilled position when work isavailable. Bidders shall submit with their bids a list of all core crewemployees.

(i) Preference in contracting, subcontracting, employment, andtraining shall apply not only on-site, on the reservation, or within theIHA’s jurisdiction, but also to contracts with firms that operate outsidethese areas (e.g., employment in modular or manufactured housingconstruction facilities).

(j) Bidders should contact the IHA to determine if any additionallocal preference requirements are applicable to this solicitation.

(k) The IHA [ ] does [ ] does not [Contracting Officer checkapplicable box] maintain lists of Indian-owned economic enterprisesand Indian organizations by specialty (e.g., plumbing, electrical,foundations), which are available to bidders to assist them in meetingtheir responsibility to provide preference in connection with theadministration of contracts and subcontracts.

Page 4 of 4

form HUD-5369-A (11/92)Previous edition is obsolete

Representations, Certifications,and Other Statements of Bidders

Public and Indian Housing Programs

U.S. Department of Housingand Urban DevelopmentOffice of Public and Indian Housing


Representations, Certifications,and Other Statements of BiddersPublic and Indian Housing Programs

Table of Contents

Clause Page

1. Certificate of Independent Price Determination 1

2. Contingent Fee Representation and Agreement 1

3. Certification and Disclosure Regarding Paymentsto Influence Certain Federal Transactions 1

4. Organizational Conflicts of Interest Certification 2

5. Bidder's Certification of Eligibility 2

6. Minimum Bid Acceptance Period 2

7. Small, Minority, Women-Owned Business Concern Representation 2

8. Indian-Owned Economic Enterprise and IndianOrganization Representation 2

9. Certification of Eligibility Under the Davis-Bacon Act 3

10. Certification of Nonsegregated Facilities 3

11. Clean Air and Water Certification 3

12. Previous Participation Certificate 3

13. Bidder's Signature 3

1. Certificate of Independent Price Determination(a) The bidder certifies that--

(1) The prices in this bid have been arrived at independently,without, for the purpose of restricting competition, any consultation,communication, or agreement with any other bidder or competitorrelating to (i) those prices, (ii) the intention to submit a bid, or (iii) themethods or factors used to calculate the prices offered;

(2) The prices in this bid have not been and will not beknowingly disclosed by the bidder, directly or indirectly, to any otherbidder or competitor before bid opening (in the case of a sealed bidsolicitation) or contract award (in the case of a competitive proposalsolicitation) unless otherwise required by law; and

(3) No attempt has been made or will be made by the bidder toinduce any other concern to submit or not to submit a bid for thepurpose of restricting competition.

(b) Each signature on the bid is considered to be a certification bythe signatory that the signatory--

(1) Is the person in the bidder's organization responsible fordetermining the prices being offered in this bid or proposal, and thatthe signatory has not participated and will not participate in anyaction contrary to subparagraphs (a)(l) through (a)(3) above; or

(2) (i) Has been authorized, in writing, to act as agent for thefollowing principals in certifying that those principals have notparticipated, and will not participate in any action contrary tosubparagraphs (a)(l) through (a)(3) above.

_______________________________________________ [insertfull name of person(s) in the bidder's organization responsible fordetermining the prices offered in this bid or proposal, and the title ofhis or her position in the bidder's organization];

(ii) As an authorized agent, does certify that the principalsnamed in subdivision (b)(2)(i) above have not participated, and willnot participate, in any action contrary to subparagraphs (a)(1)through (a)(3) above; and

(iii) As an agent, has not personally participated, and willnot participate in any action contrary to subparagraphs (a)(1)through (a)(3) above.

(c) If the bidder deletes or modifies subparagraph (a)2 above, thebidder must furnish with its bid a signed statement setting forth indetail the circumstances of the disclosure.

[ ] [Contracting Officer check if following paragraph is applicable]

(d) Non-collusive affidavit. (applicable to contracts for constructionand equipment exceeding $50,000)

(1) Each bidder shall execute, in the form provided by the PHA/IHA, an affidavit to the effect that he/she has not colluded with anyother person, firm or corporation in regard to any bid submitted inresponse to this solicitation. If the successful bidder did not submitthe affidavit with his/her bid, he/she must submit it within three (3)working days of bid opening. Failure to submit the affidavit by thatdate may render the bid nonresponsive. No contract award will bemade without a properly executed affidavit.

(2) A fully executed "Non-collusive Affidavit" [ ] is, [ ] is notincluded with the bid.

2. Contingent Fee Representation and Agreement(a) Definitions. As used in this provision:

"Bona fide employee" means a person, employed by a bidderand subject to the bidder's supervision and control as to time, place,and manner of performance, who neither exerts, nor proposes toexert improper influence to solicit or obtain contracts nor holds outas being able to obtain any contract(s) through improper influence.

"Improper influence" means any influence that induces or tendsto induce a PHA/IHA employee or officer to give consideration or toact regarding a PHA/IHA contract on any basis other than the meritsof the matter.

(b) The bidder represents and certifies as part of its bid that, exceptfor full-time bona fide employees working solely for the bidder, thebidder:

(1) [ ] has, [ ] has not employed or retained any person orcompany to solicit or obtain this contract; and

(2) [ ] has, [ ] has not paid or agreed to pay to any person orcompany employed or retained to solicit or obtain this contract anycommission, percentage, brokerage, or other fee contingent upon orresulting from the award of this contract.

(c) If the answer to either (a)(1) or (a)(2) above is affirmative, thebidder shall make an immediate and full written disclosure to thePHA/IHA Contracting Officer.

(d) Any misrepresentation by the bidder shall give the PHA/IHA theright to (1) terminate the contract; (2) at its discretion, deduct fromcontract payments the amount of any commission, percentage,brokerage, or other contingent fee; or (3) take other remedypursuant to the contract.

3. Certification and Disclosure Regarding Payments toInfluence Certain Federal Transactions (applicable tocontracts exceeding $100,000)

(a) The definitions and prohibitions contained in Section 1352 oftitle 31, United States Code, are hereby incorporated by referencein paragraph (b) of this certification.

Page1 of 3


6. Minimum Bid Acceptance Period(a) "Acceptance period," as used in this provision, means thenumber of calendar days available to the PHA/IHA for awarding acontract from the date specified in this solicitation for receipt of bids.

(b) This provision supersedes any language pertaining to theacceptance period that may appear elsewhere in this solicitation.

(c) The PHA/IHA requires a minimum acceptance period of[Contracting Officer insert time period] calendar days.

(d) In the space provided immediately below, bidders may specifya longer acceptance period than the PHA's/IHA's minimum require-ment. The bidder allows the following acceptance period:calendar days.

(e) A bid allowing less than the PHA's/IHA's minimum acceptanceperiod will be rejected.

(f) The bidder agrees to execute all that it has undertaken to do, incompliance with its bid, if that bid is accepted in writing within (1) theacceptance period stated in paragraph (c) above or (2) any longeracceptance period stated in paragraph (d) above.

7. Small, Minority, Women-Owned Business ConcernRepresentation

The bidder represents and certifies as part of its bid/ offer that it --

(a) [ ] is, [ ] is not a small business concern. "Small businessconcern," as used in this provision, means a concern, including itsaffiliates, that is independently owned and operated, not dominantin the field of operation in which it is bidding, and qualified as a smallbusiness under the criteria and size standards in 13 CFR 121.

(b) [ ] is, [ ] is not a women-owned business enterprise. "Women-owned business enterprise," as used in this provision, means abusiness that is at least 51 percent owned by a woman or womenwho are U.S. citizens and who also control and operate the business.

(c) [ ] is, [ ] is not a minority business enterprise. "Minoritybusiness enterprise," as used in this provision, means a businesswhich is at least 51 percent owned or controlled by one or moreminority group members or, in the case of a publicly owned business,at least 51 percent of its voting stock is owned by one or moreminority group members, and whose management and daily opera-tions are controlled by one or more such individuals. For the purposeof this definition, minority group members are:

(Check the block applicable to you)

[ ] Black Americans [ ] Asian Pacific Americans

[ ] Hispanic Americans [ ] Asian Indian Americans

[ ] Native Americans [ ] Hasidic Jewish Americans

8. Indian-Owned Economic Enterprise and IndianOrganization Representation (applicable only if thissolicitation is for a contract to be performed on a project for anIndian Housing Authority)

The bidder represents and certifies that it:

(a) [ ] is, [ ] is not an Indian-owned economic enterprise."Economic enterprise," as used in this provision, means any com-mercial, industrial, or business activity established or organized forthe purpose of profit, which is at least 51 percent Indian owned."Indian," as used in this provision, means any person who is amember of any tribe, band, group, pueblo, or community which isrecognized by the Federal Government as eligible for services fromthe Bureau of Indian Affairs and any "Native" as defined in the AlaskaNative Claims Settlement Act.

(b) [ ] is, [ ] is not an Indian organization. "Indian organization,"as used in this provision, means the governing body of any Indiantribe or entity established or recognized by such governing body.Indian "tribe" means any Indian tribe, band, group, pueblo, or

(b) The bidder, by signing its bid, hereby certifies to the best of hisor her knowledge and belief as of December 23, 1989 that:

(1) No Federal appropriated funds have been paid or will bepaid to any person for influencing or attempting to influence anofficer or employee of any agency, a Member of Congress, an officeror employee of Congress, or an employee of a Member of Congresson his or her behalf in connection with the awarding of a contractresulting from this solicitation;

(2) If any funds other than Federal appropriated funds (includ-ing profit or fee received under a covered Federal transaction) havebeen paid, or will be paid, to any person for influencing or attemptingto influence an officer or employee of any agency, a Member ofCongress, an officer or employee of Congress, or an employee of aMember of Congress on his or her behalf in connection with thissolicitation, the bidder shall complete and submit, with its bid, OMBstandard form LLL, "Disclosure of Lobbying Activities;" and

(3) He or she will include the language of this certification in allsubcontracts at any tier and require that all recipients of subcontractawards in excess of $100,000 shall certify and disclose accordingly.

(c) Submission of this certification and disclosure is a prerequisitefor making or entering into this contract imposed by section 1352,title 31, United States Code. Any person who makes an expenditureprohibited under this provision or who fails to file or amend thedisclosure form to be filed or amended by this provision, shall besubject to a civil penalty of not less than $10,000, and not more than$100,000, for each such failure.

(d) Indian tribes (except those chartered by States) and Indianorganizations as defined in section 4 of the Indian Self-Determina-tion and Education Assistance Act (25 U.S.C. 450B) are exemptfrom the requirements of this provision.

4. Organizational Conflicts of Interest CertificationThe bidder certifies that to the best of its knowledge and belief andexcept as otherwise disclosed, he or she does not have anyorganizational conflict of interest which is defined as a situation inwhich the nature of work to be performed under this proposedcontract and the bidder's organizational, financial, contractual, orother interests may, without some restriction on future activities:

(a) Result in an unfair competitive advantage to the bidder; or,

(b) Impair the bidder's objectivity in performing the contract work.

[ ] In the absence of any actual or apparent conflict, I hereby certifythat to the best of my knowledge and belief, no actual or apparentconflict of interest exists with regard to my possible performance ofthis procurement.

5. Bidder's Certification of Eligibility(a) By the submission of this bid, the bidder certifies that to the bestof its knowledge and belief, neither it, nor any person or firm whichhas an interest in the bidder's firm, nor any of the bidder's subcon-tractors, is ineligible to:

(1) Be awarded contracts by any agency of the United StatesGovernment, HUD, or the State in which this contract is to beperformed; or,

(2) Participate in HUD programs pursuant to 24 CFR Part 24.

(b) The certification in paragraph (a) above is a material represen-tation of fact upon which reliance was placed when making award.If it is later determined that the bidder knowingly rendered anerroneous certification, the contract may be terminated for default,and the bidder may be debarred or suspended from participation inHUD programs and other Federal contract programs.

Page 2 of 3


community including Native villages and Native groups (includingcorporations organized by Kenai, Juneau, Sitka, and Kodiak) asdefined in the Alaska Native Claims Settlement Act, which isrecognized by the Federal Government as eligible for services fromthe Bureau of Indian Affairs.

9. Certification of Eligibility Under the Davis-BaconAct (applicable to construction contracts exceeding $2,000)

(a) By the submission of this bid, the bidder certifies that neither itnor any person or firm who has an interest in the bidder's firm is aperson or firm ineligible to be awarded contracts by the United StatesGovernment by virtue of section 3(a) of the Davis-Bacon Act or 29CFR 5.12(a)(1).

(b) No part of the contract resulting from this solicitation shall besubcontracted to any person or firm ineligible to be awardedcontracts by the United States Government by virtue of section 3(a)of the Davis-Bacon Act or 29 CFR 5.12(a)(1).

(c) The penalty for making false statements is prescribed in the U.S. Criminal Code, 18 U.S.C. 1001.

10. Certification of Nonsegregated Facilities (applicableto contracts exceeding $10,000)

(a) The bidder's attention is called to the clause entitled EqualEmployment Opportunity of the General Conditions of the Con-tract for Construction.

(b) "Segregated facilities," as used in this provision, means anywaiting rooms, work areas, rest rooms and wash rooms, restaurantsand other eating areas, time clocks, locker rooms and other storageor dressing areas, parking lots, drinking fountains, recreation orentertainment areas, transportation, and housing facilities providedfor employees, that are segregated by explicit directive or are in factsegregated on the basis of race, color, religion, or national originbecause of habit, local custom, or otherwise.

(c) By the submission of this bid, the bidder certifies that it does notand will not maintain or provide for its employees any segregatedfacilities at any of its establishments, and that it does not and will notpermit its employees to perform their services at any location underits control where segregated facilities are maintained. The bidderagrees that a breach of this certification is a violation of the EqualEmployment Opportunity clause in the contract.

(d) The bidder further agrees that (except where it has obtainedidentical certifications from proposed subcontractors for specifictime periods) prior to entering into subcontracts which exceed$10,000 and are not exempt from the requirements of the EqualEmployment Opportunity clause, it will:

(1) Obtain identical certifications from the proposed subcon-tractors;

(2) Retain the certifications in its files; and

(3) Forward the following notice to the proposed subcontrac-tors (except if the proposed subcontractors have submitted identicalcertifications for specific time periods):

Notice to Prospective Subcontractors of Requirement forCertifications of Nonsegregated FacilitiesA Certification of Nonsegregated Facilities must be submitted beforethe award of a subcontract exceeding $10,000 which is not exemptfrom the provisions of the Equal Employment Opportunity clause ofthe prime contract. The certification may be submitted either foreach subcontract or for all subcontracts during a period (i.e.,quarterly, semiannually, or annually).

Note: The penalty for making false statements in bids is prescribedin 18 U.S.C. 1001.

11. Clean Air and Water Certification (applicable to con-tracts exceeding $100,000)

The bidder certifies that:

(a) Any facility to be used in the performance of this contract [ ]is, [ ] is not listed on the Environmental Protection Agency List ofViolating Facilities:

(b) The bidder will immediately notify the PHA/IHA ContractingOfficer, before award, of the receipt of any communication from theAdministrator, or a designee, of the Environmental ProtectionAgency, indicating that any facility that the bidder proposes to usefor the performance of the contract is under consideration to belisted on the EPA List of Violating Facilities; and,

(c) The bidder will include a certification substantially the same asthis certification, including this paragraph (c), in every nonexemptsubcontract.

12. Previous Participation Certificate (applicable toconstruction and equipment contracts exceeding $50,000)

(a) The bidder shall complete and submit with his/her bid the FormHUD-2530, "Previous Participation Certificate." If the successfulbidder does not submit the certificate with his/her bid, he/she mustsubmit it within three (3) working days of bid opening. Failure tosubmit the certificate by that date may render the bid nonresponsive.No contract award will be made without a properly executed certifi-cate.

(b) A fully executed "Previous Participation Certificate"

[ ] is, [ ] is not included with the bid.

13. Bidder's SignatureThe bidder hereby certifies that the information contained in thesecertifications and representations is accurate, complete, andcurrent.

__________________________________________________________________(Signature and Date)

__________________________________________________________________(Typed or Printed Name)

__________________________________________________________________(Title)

__________________________________________________________________(Company Name)

(Company Address)

Page 3 of 3

General Conditions for Non-Construction Contracts Section I – (With or without Maintenance Work)

U.S. Department of Housing and Urban Development Office of Public and Indian Housing Office of Labor Relations OMB Approval No. 2577-0157 (exp. 1/01/2014)

Public Reporting Burden for this collection of information is estimated to average 0.08 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Reports Management Officer, Office of Information Policies and Systems, U.S. Department of Housing and Urban Development, Washington, D.C. 20410-3600; and to the Office of Management and Budget, Paperwork Reduction Project (2577-0157), Washington, D.C. 20503. Do not send this completed form to either of these addressees.

Applicability. This form HUD-5370-C has 2 Sections. These Sections must be inserted into non-construction contracts as described below:

1) Non-construction contracts (without maintenance) greater than $100,000 - use Section I;

2) Maintenance contracts (including nonroutine maintenance as defined at 24 CFR 968.105) greater than $2,000 but not more than $100,000 - use Section II; and

3) Maintenance contracts (including nonroutine maintenance), greater than $100,000 – use Sections I and II.

==================================================== Section I - Clauses for All Non-Construction Contracts greater than $100,000 ==================================================== 1. Definitions The following definitions are applicable to this contract:

(a) "Authority or Housing Authority (HA)" means the Housing Authority.

(b) "Contract" means the contract entered into between the Authority and the Contractor. It includes the contract form, the Certifications and Representations, these contract clauses, and the scope of work. It includes all formal changes to any of those documents by addendum, Change Order, or other modification.

(c) "Contractor" means the person or other entity entering into the contract with the Authority to perform all of the work required under the contract.

(d) "Day" means calendar days, unless otherwise stated. (e) "HUD" means the Secretary of Housing and Urban

development, his delegates, successors, and assigns, and the officers and employees of the United States Department of Housing and Urban Development acting for and on behalf of the Secretary.

2. Changes

(a) The HA may at any time, by written order, and without notice to the sureties, if any, make changes within the general scope of this contract in the services to be performed or supplies to be delivered.

(b) If any such change causes an increase or decrease in the hourly rate, the not-to-exceed amount of the contract, or the time required for performance of any part of the work under this contract, whether or not changed by the order, or otherwise affects the conditions of this contract, the HA shall make an equitable adjustment in the not-to-exceed amount, the hourly rate, the delivery schedule, or other affected terms, and shall modify the contract accordingly.

(c) The Contractor must assert its right to an equitable adjustment under this clause within 30 days from the date of receipt of the written order. However, if the HA decides that the facts justify it, the HA may receive and act upon a

proposal submitted before final payment of the contract. (d) Failure to agree to any adjustment shall be a dispute under

clause Disputes, herein. However, nothing in this clause shall excuse the Contractor from proceeding with the contract as changed.

(e) No services for which an additional cost or fee will be charged by the Contractor shall be furnished without the prior written consent of the HA.

3. Termination for Convenience and Default

(a) The HA may terminate this contract in whole, or from time to time in part, for the HA's convenience or the failure of the Contractor to fulfill the contract obligations (default). The HA shall terminate by delivering to the Contractor a written Notice of Termination specifying the nature, extent, and effective date of the termination. Upon receipt of the notice, the Contractor shall: (i) immediately discontinue all services affected (unless the notice directs otherwise); and (ii) deliver to the HA all information, reports, papers, and other materials accumulated or generated in performing this contract, whether completed or in process.

(b) If the termination is for the convenience of the HA, the HA shall be liable only for payment for services rendered before the effective date of the termination.

(c) If the termination is due to the failure of the Contractor to fulfill its obligations under the contract (default), the HA may (i) require the Contractor to deliver to it, in the manner and to the extent directed by the HA, any work as described in subparagraph (a)(ii) above, and compensation be determined in accordance with the Changes clause, paragraph 2, above; (ii) take over the work and prosecute the same to completion by contract or otherwise, and the Contractor shall be liable for any additional cost incurred by the HA; (iii) withhold any payments to the Contractor, for the purpose of off-set or partial payment, as the case may be, of amounts owed to the HA by the Contractor.

(d) If, after termination for failure to fulfill contract obligations (default), it is determined that the Contractor had not failed, the termination shall be deemed to have been effected for the convenience of the HA, and the Contractor shall been titled to payment as described in paragraph (b) above.

(e) Any disputes with regard to this clause are expressly made subject to the terms of clause titled Disputes herein.

4. Examination and Retention of Contractor's Records

(a) The HA, HUD, or Comptroller General of the United States, or any of their duly authorized representatives shall, until 3 years after final payment under this contract, have access to and the right to examine any of the Contractor's directly pertinent books, documents, papers, or other records involving transactions related to this contract for the purpose of making audit, examination, excerpts, and transcriptions.

Section I - Page 1 of 6

form HUD-5370-C (10/2006)

(b) The Contractor agrees to include in first-tier subcontracts under this contract a clause substantially the same as paragraph (a) above. "Subcontract," as used in this clause, excludes purchase orders not exceeding $10,000.

(c) The periods of access and examination in paragraphs (a) and (b) above for records relating to: (i) appeals under the clause titled Disputes; (ii) litigation or settlement of claims arising from the performance of this contract; or, (iii) costs and expenses of this contract to which the HA, HUD, or Comptroller General or any of their duly authorized representatives has taken exception shall continue until disposition of such appeals, litigation, claims, or exceptions.

5. Rights in Data (Ownership and Proprietary Interest)

The HA shall have exclusive ownership of, all proprietary interest in, and the right to full and exclusive possession of all information, materials and documents discovered or produced by Contractor pursuant to the terms of this Contract, including but not limited to reports, memoranda or letters concerning the research and reporting tasks of this Contract.

6. Energy Efficiency

The contractor shall comply with all mandatory standards and policies relating to energy efficiency which are contained in the energy conservation plan issued in compliance with the Energy Policy and Conservation Act (Pub.L. 94-163) for the State in which the work under this contract is performed.

7. Disputes

(a) All disputes arising under or relating to this contract, except for disputes arising under clauses contained in Section III, Labor Standards Provisions, including any claims for damages for the alleged breach there of which are not disposed of by agreement, shall be resolved under this clause.

(b) All claims by the Contractor shall be made in writing and submitted to the HA. A claim by the HA against the Contractor shall be subject to a written decision by the HA.

(c) The HA shall, with reasonable promptness, but in no event in no more than 60 days, render a decision concerning any claim hereunder. Unless the Contractor, within 30 days after receipt of the HA's decision, shall notify the HA in writing that it takes exception to such decision, the decision shall be final and conclusive.

(d) Provided the Contractor has (i) given the notice within the time stated in paragraph (c) above, and (ii) excepted its claim relating to such decision from the final release, and (iii) brought suit against the HA not later than one year after receipt of final payment, or if final payment has not been made, not later than one year after the Contractor has had a reasonable time to respond to a written request by the HA that it submit a final voucher and release, whichever is earlier, then the HA's decision shall not be final or conclusive, but the dispute shall be determined on the merits by a court of competent jurisdiction.

(e) The Contractor shall proceed diligently with performance of this contract, pending final resolution of any request for relief, claim, appeal, or action arising under the contract, and comply with any decision of the HA.

8. Contract Termination; Debarment

A breach of these Contract clauses may be grounds for termination of the Contract and for debarment or denial of participation in HUD programs as a Contractor and a subcontractor as provided in 24 CFR Part 24.

9. Assignment of Contract

The Contractor shall not assign or transfer any interest in this contract; except that claims for monies due or to become due from the HA under the contract may be assigned to a bank, trust company, or other financial institution. If the Contractor is a partnership, this contract shall inure to the benefit of the surviving or remaining member(s) of such partnership approved by the HA.

10. Certificate and Release

Prior to final payment under this contract, or prior to settlement upon termination of this contract, and as a condition precedent thereto, the Contractor shall execute and deliver to the HA a certificate and release, in a form acceptable to the HA, of all claims against the HA by the Contractor under and by virtue of this contract, other than such claims, if any, as may be specifically excepted by the Contractor in stated amounts set forth therein.

11. Organizational Conflicts of Interest

(a) The Contractor warrants that to the best of its knowledge and belief and except as otherwise disclosed, it does not have any organizational conflict of interest which is defined as a situation in which the nature of work under this contract and a contractor's organizational, financial, contractual or other interests are such that: (i) Award of the contract may result in an unfair

competitive advantage; or (ii) The Contractor's objectivity in performing the contract

work may be impaired. (b) The Contractor agrees that if after award it discovers an

organizational conflict of interest with respect to this contract or any task/delivery order under the contract, he or she shall make an immediate and full disclosure in writing to the Contracting Officer which shall include a description of the action which the Contractor has taken or intends to take to eliminate or neutralize the conflict. The HA may, however, terminate the contract or task/delivery order for the convenience of the HA if it would be in the best interest of the HA.

(c) In the event the Contractor was aware of an organizational conflict of interest before the award of this contract and intentionally did not disclose the conflict to the Contracting Officer, the HA may terminate the contract for default.

(d) The terms of this clause shall be included in all subcontracts and consulting agreements wherein the work to be performed is similar to the service provided by the prime Contractor. The Contractor shall include in such subcontracts and consulting agreements any necessary provisions to eliminate or neutralize conflicts of interest.

12. Inspection and Acceptance

(a) The HA has the right to review, require correction, if necessary, and accept the work products produced by the Contractor. Such review(s) shall be carried out within 30 days so as to not impede the work of the Contractor. Any


Form HUD-5370-C (10/2006)

product of work shall be deemed accepted as submitted if the HA does not issue written comments and/or required corrections within 30 days from the date of receipt of such product from the Contractor.

(b) The Contractor shall make any required corrections promptly at no additional charge and return a revised copy of the product to the HA within 7 days of notification or a later date if extended by the HA.

(c) Failure by the Contractor to proceed with reasonable promptness to make necessary corrections shall be a default. If the Contractor's submission of corrected work remains unacceptable, the HA may terminate this contract (or the task order involved) or reduce the contract price or cost to reflect the reduced value of services received.

13. Interest of Members of Congress

No member of or delegate to the Congress of the United States of America or Resident Commissioner shall be admitted to any share or part of this contract or to any benefit to arise there from, but this provision shall not be construed to extend to this contract if made with a corporation for its general benefit.

14. Interest of Members, Officers, or Employees and Former Members, Officers, or Employees

No member, officer, or employee of the HA, no member of the governing body of the locality in which the project is situated, no member of the governing body in which the HA was activated, and no other pubic official of such locality or localities who exercises any functions or responsibilities with respect to the project, shall, during his or her tenure, or for one year thereafter, have any interest, direct or indirect, in this contract or the proceeds thereof.

15. Limitation on Payments to Influence Certain Federal Transactions

(a) Definitions. As used in this clause:

"Agency", as defined in 5 U.S.C. 552(f), includes Federal executive departments and agencies as well as independent regulatory commissions and Government corporations, as defined in 31 U.S.C. 9101(1).

"Covered Federal Action" means any of the following Federal actions:

(i) The awarding of any Federal contract; (ii) The making of any Federal grant; (iii) The making of any Federal loan; (iv) The entering into of any cooperative agreement; and, (v) The extension, continuation, renewal, amendment, or

modification of any Federal contract, grant, loan, or cooperative agreement.

Covered Federal action does not include receiving from an agency a commitment providing for the United States to insure or guarantee a loan.

"Indian tribe" and "tribal organization" have the meaning provided in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450B). Alaskan Natives are included under the definitions of Indian tribes in that Act.

"Influencing or attempting to influence" means making, with the intent to influence, any communication to or appearance before 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 any covered Federal action.

"Local government" means a unit of government in a State and, if chartered, established, or otherwise recognized by a State for the performance of a governmental duty, including a local public authority, a special district, an intrastate district, a council of governments, a sponsor group representative organization, and any other instrumentality of a local government.

"Officer or employee of an agency" includes the following individuals who are employed by an agency:

(i) An individual who is appointed to a position in the Government under title 5, U.S.C., including a position under a temporary appointment;

(ii) A member of the uniformed services as defined in section 202, title 18, U.S.C.;

(iii) A special Government employee as defined in section 202, title 18, U.S.C.; and,

(iv) An individual who is a member of a Federal advisory committee, as defined by the Federal Advisory Committee Act, title 5, appendix 2.

“Person" means an individual, corporation, company, association, authority, firm, partnership, society, State, and local government, regardless of whether such entity is operated for profit or not for profit. This term excludes an Indian tribe, tribal organization, or other Indian organization with respect to expenditures specifically permitted by other Federal law.

"Recipient" includes all contractors, subcontractors at any tier, and subgrantees at any tier of the recipient of funds received in connection with a Federal contract, grant, loan, or cooperative agreement. The term excludes an Indian tribe, tribal organization, or any other Indian organization with respect to expenditures specifically permitted by other Federal law.

"Regularly employed means, with respect to an officer or employee of a person requesting or receiving a Federal contract, grant, loan, or cooperative agreement, an officer or employee who is employed by such person for at least 130 working days within one year immediately preceding the date of the submission that initiates agency consideration of such person for receipt of such contract, grant, loan, or cooperative agreement. An officer or employee who is employed by such person for less than 130 working days within one year immediately preceding the date of submission that initiates agency consideration of such person shall be considered to be regularly employed as soon as he or she is employed by such person for 130 working days.

"State" means a State of the United States, the District of Columbia, the Commonwealth of Puerto Rico, a territory or possession of the United States, an agency or instrumentality of a State, and a multi-State, regional, or interstate entity having governmental duties and powers. (b) Prohibitio n.

(i) Section 1352 of title 31, U.S.C. provides in part that no appropriated funds may be expended by the recipient of a Federal contract, grant, loan, or cooperative agreement to pay any person 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 any of the following covered Federal actions: the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.

(ii) The prohibition does not apply as follows:


Form HUD-5370-C (10/2006)

(1) Agency and legislative liaison by Own Employees. (a) The prohibition on the use of appropriated funds, in paragraph (i) of this section, does not apply in the case of a payment of reasonable compensation made to an officer or employee of a person requesting or receiving a Federal contract, grant, loan, or cooperative agreement, if the payment is for agency and legislative activities not directly related to a covered Federal action. (b) For purposes of paragraph (b)(i)(1)(a) of this clause, providing any information specifically requested by an agency or Congress is permitted at any time. (c) The following agency and legislative liaison activities are permitted at any time only where they are not related to a specific solicitation for any covered Federal action: (1) Discussing with an agency (including individual demonstrations) the qualities and characteristics of the person's products or services, conditions or terms of sale, and service capabilities; and,

(2) Technical discussions and other activities regarding the application or adaptation of the person's products or services for an agency's use.

(d) The following agency and legislative liaison activities are permitted where they are prior to formal solicitation of any covered Federal action:

(1) Providing any information not specifically requested but necessary for an agency to make an informed decision about initiation of a covered Federal action;

(2) Technical discussions regarding the preparation of an unsolicited proposal prior to its official submission; and

(3) Capability presentations by persons seeking awards from an agency pursuant to the provisions of the Small Business Act, as amended by Public Law 95-507 and other subsequent amendments.

(e) Only those activities expressly authorized by subdivision (b)(ii)(1)(a) of this clause are permitted under this clause.

(2) Professional and technical services. (a) The prohibition on the use of appropriated

funds, in subparagraph (b)(i) of this clause, does not apply in the case of- (i) A payment of reasonable compensation

made to an officer or employee of a person requesting or receiving a covered Federal action or an extension, continuation, renewal, amendment, or modification of a covered Federal action, if payment is for professional or technical services rendered directly in the preparation, submission, or negotiation of any bid, proposal, or application for that Federal action or for meeting requirements imposed by or pursuant to law as a condition for receiving that Federal action.

(ii) Any reasonable payment to a person, other than an officer or employee of a

person requesting or receiving a covered Federal action or an extension, continuation, renewal, amendment, or modification of a covered Federal action if the payment is for professional or technical services rendered directly in the preparation, submission, or negotiation of any bid, proposal, or application for that Federal action or for meeting requirements imposed by or pursuant to law as a condition for receiving that Federal action. Persons other than officers or employees of a person requesting or receiving a covered Federal action include consultants and trade associations.

(b) For purposes of subdivision (b)(ii)(2)(a) of clause, "professional and technical services" shall be limited to advice and analysis directly applying any professional or technical discipline.

(c) Requirements imposed by or pursuant to law as a condition for receiving a covered Federal award include those required by law or regulation, or reasonably expected to be required by law or regulation, and any other requirements in the actual award documents.

(d) Only those services expressly authorized by subdivisions (b)(ii)(2)(a)(i) and (ii) of this section are permitted under this clause.

(iii) Selling activities by independent sales representatives.

(c) The prohibition on the use of appropriated funds, in subparagraph (b)(i) of this clause, does not apply to the following selling activities before an agency by independent sales representatives, provided such activities are prior to formal solicitation by an agency and are specifically limited to the merits of the matter: (i) Discussing with an agency (including individual

demonstration) the qualities and characteristics of the person's products or services, conditions or terms of sale, and service capabilities; and

(ii) Technical discussions and other activities regarding the application or adaptation of the person's products or services for an agency's use.

(d) Agreement. In accepting any contract, grant, cooperative agreement, or loan resulting from this solicitation, the person submitting the offer agrees not to make any payment prohibited by this clause.

(e) Penalties. Any person who makes an expenditure prohibited under paragraph (b) of this clause shall be subject to civil penalties as provided for by 31 U.S.C. 1352. An imposition of a civil penalty does not prevent the Government from seeking any other remedy that may be applicable.

(f) Cost Allowability. Nothing in this clause is to be interpreted to make allowable or reasonable any costs which would be unallowable or unreasonable in accordance with Part 31 of the Federal Acquisition Regulation (FAR), or OMB Circulars dealing with cost allowability for recipients of assistance agreements. Conversely, costs made specifically unallowable by the requirements in this clause will not be made allowable under any of the provisions of FAR Part 31 or the relevant OMB Circulars.


Form HUD-5370-C (10/2006)

16. Equal Employment Opportunity

During the performance of this contract, the Contractor agrees as follows: (a) The Contractor shall not discriminate against any employee

or applicant for employment because of race, color, religion, sex, or national origin.

(b) The Contractor shall take affirmative action to ensure that applicants are employed, and that employees are treated during employment without regard to their race, color, religion, sex, or national origin. Such action shall include, but not be limited to (1) employment; (2) upgrading; (3) demotion; (4) transfer; (5) recruitment or recruitment advertising; (6) layoff or termination; (7) rates of pay or other forms of compensation; and (8) selection for training, including apprenticeship.

(c) The Contractor shall post in conspicuous places available to employees and applicants for employment the notices to be provided by the Contracting Officer that explain this clause.

(d) The Contractor shall, in all solicitations or advertisements for employees placed by or on behalf of the Contractor, state that all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, or national origin.

(e) The Contractor shall send, to each labor union or representative of workers with which it has a collective bargaining agreement or other contract or understanding, the notice to be provided by the Contracting Officer advising the labor union or workers' representative of the Contractor's commitments under this clause, and post copies of the notice in conspicuous places available to employees and applicants for employment.

(f) The Contractor shall comply with Executive Order 11246, as amended, and the rules, regulations, and orders of the Secretary of Labor.

(g) The Contractor shall furnish all information and reports required by Executive Order 11246, as amended and by rules, regulations, and orders of the Secretary of Labor, or pursuant thereto. The Contractor shall permit access to its books, records, and accounts by the Secretary of Labor for purposes of investigation to ascertain compliance with such rules, regulations, and orders.

(h) In the event of a determination that the Contractor is not in compliance with this clause or any rule, regulation, or order of the Secretary of Labor, this contract may be canceled, terminated, or suspended in whole or in part, and the Contractor may be declared ineligible for further Government contracts, or federally assisted construction contracts under the procedures authorized in Executive Order 11246, as amended. In addition, sanctions may be imposed and remedies invoked against the Contractor as provided in Executive Order 11246, as amended, the rules, regulations, and orders of the Secretary of Labor, or as otherwise provided by law.

(i) The Contractor shall include the terms and conditions of this clause in every subcontract or purchase order unless exempted by the rules, regulations, or orders of the Secretary of Labor issued under Executive Order 11246, as amended, so that these terms and conditions will be binding upon each subcontractor or vendor. The Contractor shall take such action with respect to any subcontractor or purchase order as the Secretary of Housing and Urban Development or the Secretary of Labor may direct as a means of enforcing such provisions, including sanctions for noncompliance; provided that if the

Contractor becomes involved in, or is threatened with, litigation with a subcontractor or vendor as a result of such direction, the Contractor may request the United States to enter into the litigation to protect the interests of the United States.

17. Dissemination or Disclosure of Information

No information or material shall be disseminated or disclosed to the general public, the news media, or any person or organization without prior express written approval by the HA.

18. Contractor's Status

It is understood that the Contractor is an independent contractor and is not to be considered an employee of the HA, or assume any right, privilege or duties of an employee, and shall save harmless the HA and its employees from claims suits, actions and costs of every description resulting from the Contractor's activities on behalf of the HA in connection with this Agreement.

19. Other Contractors

HA may undertake or award other contracts for additional work at or near the site(s) of the work under this contract. The contractor shall fully cooperate with the other contractors and with HA and HUD employees and shall carefully adapt scheduling and performing the work under this contract to accommodate the additional work, heeding any direction that may be provided by the Contracting Officer. The contractor shall not commit or permit any act that will interfere with the performance of work by any other contractor or HA employee.

20. Liens

The Contractor is prohibited from placing a lien on HA's property. This prohibition shall apply to all subcontractors.

21. Training and Employment Opportunities for Residents in

the Project Area (Section 3, HUD Act of 1968; 24 CFR 135) (a) The work to be performed under this contract is subject to the

requirements of section 3 of the Housing and Urban Development Act of 1968, as amended, 12 U.S.C. 1701u (section 3). The purpose of section 3 is to ensure that employment and other economic opportunities generated by HUD assistance or HUD-assisted projects covered by section 3, shall, to the greatest extent feasible, be directed to low- and very low-income persons, particularly persons who are recipients of HUD assistance for housing.

(b) The parties to this contract agree to comply with HUD's regulations in 24 CFR Part 135, which implement section 3. As evidenced by their execution of this contract, the parties to this contract certify that they are under no contractual or other impediment that would prevent them from complying with the Part 135 regulations.

(c) The contractor agrees to send to each labor organization or representative of workers with which the contractor has a collective bargaining agreement or other understanding, if any, a notice advising the labor organization or workers' representative of the contractor's commitments under this section 3 clause, and will post copies of the notice in conspicuous places at the work site where both employees and applicants for training and employment positions can see the notice. The notice shall describe the section 3 preference, shall set forth minimum number and job titles subject to hire, availability of


Form HUD-5370-C (10/2006)

apprenticeship and training positions, the qualifications for each; and the name and location of the person(s) taking applications for each of the positions; and the anticipated date the work shall begin.

(d) The contractor agrees to include this section 3 clause in every subcontract subject to compliance with regulations in 24 CFR Part 135, and agrees to take appropriate action, as provided in an applicable provision of the subcontract or in this section 3 clause, upon a finding that the subcontractor is in violation of the regulations in 24 CFR Part 135. The contractor will not subcontract with any subcontractor where the contractor has notice or knowledge that the subcontractor has been found in violation of the regulations in 24 CFR Part 135.

(e) The contractor will certify that any vacant employment positions, including training positions, that are filled (1) after the contractor is selected but before the contract is executed, and (2) with persons other than those to whom the regulations of 24 CFR Part 135 require employment opportunities to be directed, were not filled to circumvent the contractor's obligations under 24 CFR Part 135.

(f) Noncompliance with HUD's regulations in 24 CFR Part 135 may result in sanctions, termination of this contract for default, and debarment or suspension from future HUD assisted contracts.

22. Procurement of Recovered Materials (a) In accordance with Section 6002 of the Solid Waste Disposal Act,

as amended by the Resource Conservation and Recovery Act, the Contractor shall procure items designated in guidelines of the Environmental Protection Agency (EPA) at 40 CFR Part 247 that contain the highest percentage of recovered materials practicable, consistent with maintaining a satisfactory level of competition. The Contractor shall procure items designated in the EPA guidelines that contain the highest percentage of recovered materials practicable unless the Contractor determines that such items: (1) are not reasonably available in a reasonable period of time; (2) fail to meet reasonable performance standards, which shall be determined on the basis of the guidelines of the National Institute of Standards and Technology, if applicable to the item; or (3) are only available at an unreasonable price.

(b) Paragraph (a) of this clause shall apply to items purchased under this contract where: (1) the Contractor purchases in excess of $10,000 of the item under this contract; or (2) during the preceding Federal fiscal year, the Contractor: (i) purchased any amount of the items for use under a contract that was funded with Federal appropriations and was with a Federal agency or a State agency or agency of a political subdivision of a State; and (ii) purchased a total of in excess of $10,000 of the item both under and outside that contract.


Form HUD-5370-C (10/2006)

General Conditions for Non-Construction Contracts

U.S. Department of Housing and Urban Development Office of Public and Indian Housing

Section II – (With Maintenance Work) Office of Labor Relations OMB Approval No. 2577-0157 (exp. 1/01/2014)

Public Reporting Burden for this collection of information is estimated to average 0.08 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Reports Management Officer, Office of Information Policies and Systems, U.S. Department of Housing and Urban Development, Washington, D.C. 20410-3600; and to the Office of Management and Budget, Paperwork Reduction Project (2577-0157), Washington, D.C. 20503. Do not send this completed form to either of these addressees. Applicability. This form HUD-5370C has 2 Sections. These Sections must be inserted into non-construction contracts as described below:

1) Non-construction contracts (without maintenance) greater than $100,000 - use Section I;

2) Maintenance contracts (including nonroutine maintenance as defined at 24 CFR 968.105) greater than $2,000 but not more than $100,000 - use Section II; and

3) Maintenance contracts (including nonroutine maintenance), greater than $100,000 – use Sections I and II.

==================================================== Section II – Labor Standard Provisions for all Maintenance Contracts greater than $2,000 ==================================================== 1. Minimum Wages

(a) All maintenance laborers and mechanics employed under this Contract in the operation of the project(s) shall be paid unconditionally and not less often than semi-monthly, and without subsequent deduction (except as otherwise provided by law or regulations), the full amount of wages due at time of payment computed at rates not less than those contained in the wage determination of the Secretary of Housing and Urban Development which is attached hereto and made a part hereof. Such laborers and mechanics shall be paid the appropriate wage rate on the wage determination for the classification of work actually performed, without regard to skill. Laborers or mechanics performing work in more than one classification may be compensated at the rate specified for each classification for the time actually worked therein; provided, that the employer’s payroll records accurately set forth the time spent in each classification in which work is performed. The wage determination, including any additional classifications and wage rates approved by HUD under subparagraph 1(b), shall be posted at all times by the Contractor and its subcontractors at the site of the work in a prominent and accessible place where it can be easily seen by the workers.

(b) (i) Any class of laborers or mechanics which is not listed in the wage determination and which is to be employed under the Contract shall be classified in conformance with the wage determination. HUD shall approve an additional classification and wage rate only when the following criteria have been met:

(1) The work to be performed by the classification required is not performed by a classification in the wage determination;

(2) The classification is utilized in the area by the industry; and

(3) The proposed wage rate bears a reasonable relationship to the wage rates contained in the wage determination.

(ii) The wage rate determined pursuant to this paragraph shall be paid to all workers performing work

in the classification under this Contract from the first day on which work is performed in the classification.

2. Withholding of funds

The Contracting Officer, upon his/her own action or upon request of HUD, shall withhold or cause to be withheld from the Contractor under this Contract or any other contract subject to HUD-determined wage rates, with the same prime Contractor, so much of the accrued payments or advances as may be considered necessary to pay laborers and mechanics employed by the Contractor or any subcontractor the full amount of wages required by this clause. In the event of failure to pay any laborer or mechanic employed under this Contract all or part of the wages required under this Contract, the Contracting Officer or HUD may, after written notice to the Contractor, take such action as may be necessary to cause the suspension of any further payment or advance until such violations have ceased. The Public Housing Agency or HUD may, after written notice to the Contractor, disburse such amounts withheld for and on account of the Contractor or subcontractor to the respective employees to whom they are due.

3. Records

(a) The Contractor and each subcontractor shall make and maintain for three (3) years from the completion of the work records containing the following for each laborer and mechanic: (i) Name, address and Social Security Number; (ii) Correct work classification or classifications; (iii) Hourly rate or rates of monetary wages paid; (iv) Rate or rates of any fringe benefits provided; (v) Number of daily and weekly hours worked; (vi) Gross wages earned; (vii) Any deductions made; and (viii) Actual wages paid.

(b) The Contractor and each subcontractor shall make the records required under paragraph 3(a) available for inspection, copying, or transcription by authorized representatives of HUD or the HA and shall permit such representatives to interview employees during working hours on the job. If the Contractor or any subcontractor fails to make the required records available, HUD or its designee may, after written notice to the Contractor, take such action as may be necessary to cause the suspension of any further payment, advance or guarantee of funds.

4. Apprentices and Trainees

(a) Apprentices and trainees will be permitted to work at less than the predetermined rate for the work they perform when they are employed pursuant to and individually registered in: (i) A bona fide apprenticeship program registered

with the U.S. Department of Labor, Employment and Training Administration (ETA), Office of

Section II - Page 1 of 3

form HUD-5370-C (10/2006)

Apprenticeship Training, Employer and Labor Services (OATELS), or with a state apprenticeship agency recognized by OATELS, or if a person is employed in his/her first 90 days of probationary employment as an apprentice in such an apprenticeship program, who is not individually registered in the program, but who has been certified by OATELS or a state apprenticeship agency (where appropriate) to be eligible for probationary employment as an apprentice;

(ii) A trainee program which has received prior approval, evidenced by formal certification by the U.S. Department of Labor, ETA; or

(iii) A training/trainee program that has received prior approval by HUD.

(b) Each apprentice or trainee must be paid at not less than the rate specified in the registered or approved program for the apprentice’s/trainee’s level of progress, expressed as a percentage of the journeyman hourly rate specified in the applicable wage determination. Apprentices and trainees shall be paid fringe benefits in accordance with the provisions of the registered or approved program. If the program does not specify fringe benefits, apprentices/trainees must be paid the full amount of fringe benefits listed on the wage determination for the applicable classification.

(c) The allowable ratio of apprentices or trainees to journeyman on the job site in any craft classification shall not be greater than the ratio permitted to the employer as to the entire work force under the approved program.

(d) Any worker employed at an apprentice or trainee wage rate who is not registered in an approved program, and any apprentice or trainee performing work on the job site in excess of the ratio permitted under the approved program, shall be paid not less than the applicable wage rate on the wage determination for the classification of work actually performed.

(e) In the event OATELS, a state apprenticeship agency recognized by OATELS or ETA, or HUD, withdraws approval of an apprenticeship or trainee program, the employer will no longer be permitted to utilize apprentices/trainees at less than the applicable predetermined rate for the work performed until an acceptable program is approved.

5. Disputes concerning labor standards

(a) Disputes arising out of the labor standards provisions contained in Section II of this form HUD-5370-C, other than those in Paragraph 6, shall be subject to the following procedures. Disputes within the meaning of this paragraph include disputes between the Contractor (or any of its subcontractors) and the HA, or HUD, or the employees or their representatives, concerning payment of prevailing wage rates or proper classification. The procedures in this section may be initiated upon HUD’s own motion, upon referral of the HA, or upon request of the Contractor or subcontractor(s). (i) A Contractor and/or subcontractor or other

interested party desiring reconsideration of findings of violation by the HA or HUD relating to the payment of straight-time prevailing wages or classification of work shall request such reconsideration by letter postmarked within 30 calendar days of the date of notice of findings issued by the HA or HUD. The request shall set

forth those findings that are in dispute and the reasons, including any affirmative defenses, with respect to the violations. The request shall be directed to the appropriate HA or HUD official in accordance with instructions contained in the notice of findings or, if the notice does not specify to whom a request should be made, to the Regional Labor Relations Officer (HUD).

(ii) The HA or HUD official shall, within 60 days (unless otherwise indicated in the notice of findings) after receipt of a timely request for reconsideration, issue a written decision on the findings of violation. The written decision on reconsideration shall contain instructions that any appeal of the decision shall be addressed to the Regional Labor Relations Officer by letter postmarked within 30 calendar days after the date of the decision. In the event that the Regional Labor Relations Officer was the deciding official on reconsideration, the appeal shall be directed to the Director, Office of Labor Relations (HUD). Any appeal must set forth the aspects of the decision that are in dispute and the reasons, including any affirmative defenses, with respect to the violations.

(iii) The Regional Labor Relations Officer shall, within 60 days (unless otherwise indicated in the decision on reconsideration) after receipt of a timely appeal, issue a written decision on the findings. A decision of the Regional Labor Relations Officer may be appealed to the Director, Office of Labor Relations, by letter postmarked within 30 days of the Regional Labor Relations Officer’s decision. Any appeal to the Director must set forth the aspects of the prior decision(s) that are in dispute and the reasons. The decision of the Director, Office of Labor Relations, shall be final.

(b) Disputes arising out of the labor standards provisions of paragraph 6 shall not be subject to paragraph 5(a) of this form HUD-5370C. Such disputes shall be resolved in accordance with the procedures of the U.S. Department of Labor set forth in 29 CFR Parts 5, 6 and 7. Disputes within the meaning of this paragraph 5(b) include disputes between the Contractor (or any of its subcontractors) and the HA, HUD, the U.S. Department of Labor, or the employees or their representatives.

6. Contract Work Hours and Safety Standards Act

The provisions of this paragraph 6 are applicable only where the amount of the prime contract exceeds $100,000. As used in this paragraph, the terms “laborers” and “mechanics” includes watchmen and guards. (a) Overtime requirements. No Contractor or subcontractor

contracting for any part of the Contract work which may require or involve the employment of laborers or mechanics shall require or permit any such laborer or mechanic in any workweek in which he or she is employed on such work to work in excess of 40 hours in such workweek unless such laborer or mechanic receives compensation at a rate not less than one and one-half times the basic rate of pay for all hours worked in excess of 40 hours in such workweek.

(b) Violation; liability for unpaid wages; liquidated damages. In the event of any violation of the provisions set forth in paragraph 6(a), the Contractor and any


form HUD-5370-C (10/2006)

subcontractor responsible therefor shall be liable for the unpaid wages. In addition, such Contractor and subcontractor shall be liable to the United States (in the case of work done under contract for the District of Columbia or a territory, to the District or to such territory), for liquidated damages. Such liquidated damages shall be computed with respect to each individual laborer or mechanic, including watchmen and guards, employed in violation of the provisions set forth in paragraph (a) of this clause, in the sum of $10 for each calendar day on which such individual was required or permitted to work in excess of the standard workweek of 40 hours without payment of the overtime wages required by provisions set forth in paragraph (a) of this clause.

(c) Withholding for unpaid wages and liquidated damages. HUD or its designee shall upon its own action or upon written request of an authorized representative of the U.S. Department of Labor withhold or cause to be withheld, from any moneys payable on account of work performed by the Contractor or subcontractor under any such Contract or any federal contract with the same prime Contractor, or any other federally-assisted contract subject to the Contract Work Hours and Safety Standards Act, which is held by the same prime Contractor such sums as may be determined to be necessary to satisfy any liabilities of such Contractor or subcontractor for unpaid wages and liquidated damages as provided in the provisions set forth in paragraph (b) of this clause.

7. Subcontracts

The Contractor or subcontractor shall insert in any subcontracts all the provisions contained in this Section II and also a clause requiring the subcontractors to include these provisions in any lower tier subcontracts. The prime Contractor shall be responsible for the compliance by any subcontractor or lower tier subcontractor with all the provisions contained in these clauses.

8. Non-Federal Prevailing Wage Rates

Any prevailing wage rate (including basic hourly rate and any fringe benefits), determined under state law to be prevailing, with respect to any employee in any trade or position employed under the Contract, is inapplicable to the contract and shall not be enforced against the Contractor or any subcontractor, with respect to employees engaged under the contract whenever such non-Federal prevailing wage rate, exclusive of any fringe benefits, exceeds the applicable wage rate determined by the Secretary of HUD to be prevailing in the locality with respect to such trade or position.


form HUD-5370-C (10/2006)

form HUD-50070 (3/98)ref. Handbooks 7417.1, 7475.13, 7485.1 & .3

U.S. Department of Housingand Urban Development

Certification fora Drug-Free Workplace

Applicant Name

Program/Activity Receiving Federal Grant Funding

I certify that the above named Applicant will or will continueto provide a drug-free workplace by:

a. Publishing a statement notifying employees that the un-lawful manufacture, distribution, dispensing, possession, or useof a controlled substance is prohibited in the Applicant's work-place and specifying the actions that will be taken againstemployees for violation of such prohibition.

b. Establishing an on-going drug-free awareness program toinform employees ---

(1) The dangers of drug abuse in the workplace;

(2) The Applicant's policy of maintaining a drug-freeworkplace;

(3) Any available drug counseling, rehabilitation, andemployee assistance programs; and

(4) The penalties that may be imposed upon employeesfor drug abuse violations occurring in the workplace.

c. Making it a requirement that each employee to be engagedin the performance of the grant be given a copy of the statementrequired by paragraph a.;

d. Notifying the employee in the statement required by para-graph a. that, as a condition of employment under the grant, theemployee will ---

Acting on behalf of the above named Applicant as its Authorized Official, I make the following certifications and agreements tothe Department of Housing and Urban Development (HUD) regarding the sites listed below:

(1) Abide by the terms of the statement; and

(2) Notify the employer in writing of his or her convic-tion for a violation of a criminal drug statute occurring in theworkplace no later than five calendar days after such conviction;

e. Notifying the agency in writing, within ten calendar daysafter receiving notice under subparagraph d.(2) from an em-ployee or otherwise receiving actual notice of such conviction.Employers of convicted employees must provide notice, includ-ing position title, to every grant officer or other designee onwhose grant activity the convicted employee was working,unless the Federalagency has designated a central point for thereceipt of such notices. Notice shall include the identificationnumber(s) of each affected grant;

f. Taking one of the following actions, within 30 calendardays of receiving notice under subparagraph d.(2), with respectto any employee who is so convicted ---

(1) Taking appropriate personnel action against such anemployee, up to and including termination, consistent with therequirements of the Rehabilitation Act of 1973, as amended; or

(2) Requiring such employee to participate satisfacto-rily in a drug abuse assistance or rehabilitation program ap-proved for such purposes by a Federal, State, or local health, lawenforcement, or other appropriate agency;

g. Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs a. thru f.

2. Sites for Work Performance. The Applicant shall list (on separate pages) the site(s) for the performance of work done in connection with theHUD funding of the program/activity shown above: Place of Performance shall include the street address, city, county, State, and zip code.Identify each sheet with the Applicant name and address and the program/activity receiving grant funding.)

Check here if there are workplaces on file that are not identified on the attached sheets.

I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate.Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties.

(18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)

Name of Authorized Official Title

Signature Date

X

OCALA HOUSING AUTHORITY APPLICANT CONFLICT OF INTEREST DISCLOSURE FORM

To ensure that the Ocala Housing Authority maintains the continued confidence of the people of Marion County and its partners in carrying out its mission of providing affordable housing, Ocala Housing Authority employees and commissioners must avoid situations in which their obligations or commitments to other organizations or individuals or their personal or financial relationships or interests are or appear to be at odds with their responsibilities to the Ocala Housing Authority. When federal funding is involved, federal regulations govern conflicts of interest. In general, these laws prohibit Ocala Housing Authority employees and commissioners from working on transactions with applicants with whom they have financial, business, professional or personal relationships or other ties. In addition, these laws prohibit former Ocala Housing Authority employees and commissioners from working on certain transactions for up to two years after leaving Ocala Housing Authority. To help ensure the continuing integrity of Ocala Housing Authority’s business and compliance with these laws, applicants for loans or certain other assistance under Ocala Housing Authority’s programs must disclose any financial, business, professional, civic, charitable, family (or other personal) relationships, associations or connections that the applicant, its affiliates, employees of applicant who may work on the Ocala Housing Authority’s project, or any parties the applicant intends to hire to work on the Ocala Housing Authority’s project (whether employees, contractors or consultants) may currently have with Ocala Housing Authority or any Ocala Housing Authority employee or commissioner or may have had within the past two years. An applicant and its affiliates include:

• if the applicant is one or more individuals, all individuals; • if the applicant is a business or nonprofit entity, that entity; • the officers and board members of the applicant; • employees of the applicant with decision-making authority, including an executive director,

manager or someone in a similar position; • if the applicant is a business corporation, any shareholder with a controlling interest; • if the applicant is a partnership, the applicant’s partners; • any other business partner or associate of the applicant involved in this Ocala Housing

Authority project; • if the applicant is a limited liability company, the members and managers; • a family member (including husband, wife, child, brother, sister) or other person in a personal

relationship;

If you are unsure whether a relationship, association, or connection you have may constitute a conflict of interest, please consult with Ocala Housing Authority’s Chief Counsel.

OCALA HOUSING AUTHORITY

APPLICANT CONFLICT OF INTEREST DISCLOSURE FORM

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OCALA HOUSING AUTHORITY APPLICANT CONFLICT OF INTEREST DISCLOSURE FORM

To the best of your knowledge: 1. Are you, any of your affiliates, or any party you intend to hire to work on the project a party to (or financially interested in) any business owned or operated by an Ocala Housing Authority commissioner or employee either as an individual or through an interest in a corporation, partnership, limited liability company, or other entity? (please circle) YES NO 2. Do you, any of your affiliates, or any party you intend to hire to work on the project have family relations or other personal associations with any Ocala Housing Authority employee or Ocala Housing Authority commissioner? (please circle) YES NO 3. Do you or any party you intend to hire to work on the project have any employee who was once an employee or commissioner of Ocala Housing Authority? (please circle) YES NO 4. Do you, any of your affiliates, or any party you intend to hire to work on the project have any other type of relationship either with an Ocala Housing Authority employee or Ocala Housing Authority commissioner that may be construed to be a conflict of interest? (please circle) YES NO PLEASE NOTE: If you answered yes to any of the above questions, please describe below (or on back).

Name of Applicant

Signed

Date

Printed Name

Title

OCALA HOUSING AUTHORITY

APPLICANT CONFLICT OF INTEREST DISCLOSURE FORM

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SECTION 3 PROCUREMENT NOTICE

The purpose of Section 3 of the Housing and Urban Development Act of 1968 is to ensure that employment and other economic opportunities generated by certain HUD financial assistance shall, to the greatest extent feasible, and consistent with existing Federal, State and local laws and regulations, be directed to low- and very low-income persons, particularly those who are recipients of government assistance for housing, and to business concerns which provide economic opportunities to low- and very low-income persons. The Contractor will be required to hire Section 3 employees as 30% of all new hires. A new hire is defined as any persons hired after the signing of the contract. At the time of contract negotiation specific new hires will be determined based on the contractor’s plan/schedule for completing the job. Positions for new hires shall not be filled immediately prior to undertaking work in order to circumvent regulations set forth in 24 C.F.R. Part 135. Procurement Documents Each bidder/proposer must include a Section 3 Opportunities Plan and Schedule A, which indicates its commitment to meet the PHA’s resident hiring requirement. If a bidder/proposer fails to submit a Section 3 Opportunities Plan and Schedule A and the related data along with the bid/proposal, such bid/proposal will be declared as non-responsive. Section 3 Plan The proposal submitted by the interested bidder shall include a Section 3 Plan outlining the plan of the company for incorporating Section 3 as part of the contract. Prior to the award of any contract, the contractor shall negotiate with the OHA the number of OHA residents or other Section 3 residents to be trained or employed through the contract. This number shall be subject to OHA’s approval and shall be a minimum of 30% of new hires. The resulting provision will be incorporated into the contract and shall obligate the contractor to achieve the stated goal. The OHA reserves the right to review the plan and request additional information and/or changes to the plan. This plan shall include the following: 1. A narrative of the steps that will be taken to aggressively pursue and comply with Section 3. 2. Job categories of construction trade, administrative or other jobs that will be necessary on this project

(Column 1 on the attached spreadsheet). 3. Total number of expected hours to be spent on the job in each of the above employee/trade categories

provided throughout the life of the contract. These numbers should reflect both existing and new employee time (Column 2 & 3 on the attached spreadsheet).

4. Total number of expected new hires in each category. These numbers should reflect the total number

of expected employees in each category, minus the number of existing employees in each category (Column 7 on the attached spreadsheet).

5. Total number of expected Section 3 new hires in each category. This number should reflect all the low-

and very low-income individuals the contractor intends to hire in order to comply with the numerical goals of Section 3 which is 30% of all new hires (Column 8 & 9 on the attached spreadsheet).

6. Expected hire date(s) of new hires by category. This should reflect the progression of work on the

project, i.e., when the workers will be needed on the project for concrete work, framing, plumbing, finish work, etc.

7. Total number of expected Section 3 new hires that the contractor will aggressively pursue. In order to maximize contractor efforts to recruit and hire Qualified Section 3 residents (see definition), the following order of priority will apply:

PHA public housing residents referred through training/social service programs Youthbuild participants referred through training/social service programs OHA Section 8 residents referred through training/social service programs Any low- or very low-income candidates referred through training/social service programs Any low- or very low-income candidates from any source Any candidate through training/social service programs Any candidate from any source

8. List of any anticipated needed training relating to this project. This training does not have to be

exclusive to construction. 9. Type of training available and the number of expected training hours available by the contractor per

the training category. 10. Narrative plan for the outreach, implementation, monitoring and enforcement of the Section 3

program. 11. A list of core employees with the bid package. This list is to include the names and dates of hire of all

employees, including clerical, supervisory, warehouse and other staff for the General Contractor and all Sub-contractors.

Compliance The PHA will monitor contractor compliance over the life of the contract as follows:

1. Review compliance monthly and cumulatively. 2. Monitor contractor response to deficiencies in compliance. 3. Assessment of liquidated damages where appropriate for non-compliance.

The contractor shall provide a status report identifying its progress in meeting the Section 3 goals established in this Schedule A on a monthly basis throughout the contract period. The monthly status report shall be submitted no later than 15 days after the end of each calendar month of the contract (e.g. April 15 for March). The status report shall provide at least the same detail, as the approved Schedule A. For any goal not met, the report shall identify any other economic opportunities, which the contractor has provided or intends to provide to OHA residents. This report will provide the OHA with all information required to monitor compliance with its Section 3 plan including, but not limited to, new hires, core employees, certified payroll, workforce utilization and other relevant data to be specified. The contractor will be required to appoint a Section 3 Coordinator. Contractor compliance and liquidated damages will be assessed by subtracting the number of Section 3 hires for the month from the goal number of Section 3 hires. If the goal is not met, liquidated damages of $1,500 (fifteen hundred dollars) per Section 3 designated position not filled by a Section 3 Qualified resident will be assessed against the contractor. The contractor may appeal the assessment for Section 3 liquidated damages by delivering a written appeal to the contracting officer within three (3) business days of receipt of the deficiency notice. The Contractor and sub-contractors will be required to be in compliance with the Owner’s Section 3 Plan throughout the duration of the contract.

Alternative Compliance Contractors may demonstrate compliance with Section 3 by committing to employ Section 3 residents as 30% of the aggregate number of new hires for the duration of the contract. Definitions Core Employee - The core crew employee is an individual who is a certified employee of the contractor at the time the contract is awarded, and was employed by the contractor not less than 120 days prior to the contract award or worked not less than 350 hours during the 120 days preceding the contract award. The contractor is responsible for verifying that core employees are defined by and meet the criteria of the Housing Authority. New Hires - Any person hired after the signing of the contract or who is not a core employee. Low Income Persons - Families (including single persons) whose incomes do not exceed 80 percent of the median income for the area, as determined by the Secretary, with adjustments for smaller and larger families, except that the Secretary may establish income ceilings higher or lower than 80 percent of the median for the area on the basis of the Secretary’s finding that such variations are necessary because of prevailing levels of construction costs or unusually high or low-income families. Very Low Income Persons - Families (including single persons) whose incomes do not exceed 50 percent of the median family income for the area, as determined by the Secretary with adjustment for smaller and larger families, except that the Secretary may establish income ceilings higher or lower than 50 percent of the median for the area on the basis of the Secretary’s findings that such variations are necessary because of unusually high or low family incomes. Qualified Section 3 Resident - Any individual who meets the low-income or very low-income criteria, who is 18 years of age or older, who is a resident in good standing of public housing, whose name appears on the lease, or who is a resident of the surrounding community. Qualified Section 3 Residents will receive recruiting and hiring priority in the following order:

OHA residents Youthbuild participants OHA Section 8 residents Other low- or very low-income residents

HUD Youthbuild - HUD Youthbuild programs are programs that receive assistance under subtitle D of Title IV of the National Affordable Housing Act, as amended, and provide disadvantaged youth with opportunities for employment, education, leadership development, and training in the construction or rehabilitation of housing for homeless individuals and members of low- and very low-income families. 30% of New Hires/Employees - 30% of new hires/employees is calculated by dividing the total hours worked by all new hires into the total hours worked by Section 3 new hires. The result must be greater than or equal to 30% for compliance. Name______________________________________________________________ Signature___________________________________________________________ Title_____________________________________________________ Date_____________________________________________________

_____________________________________________________________________ Company Name or Individual Name

_____________________________________________________________________ Address City State Zip

_____________________________________________________________________ Telephone Number

The Ocala Housing Authority: This letter is to advise you that I received and am aware of the Ocala Housing Authority’s Section 3 Procurement Notice. I am aware if a hiring opportunity arises, I will contact Ocala Housing Authority regarding employment opportunities for its residents or other qualified persons that may meet the requirements needed to fill the position. Sincerely, _____________________________________________________________________ Signature _____________________________________________________________________ Printed Name _____________________________________________________________________ Title

CERTIFICATE OF CORPORATE PRINCIPAL

I, ___________________________________ herby certify that I am a/the Corporate Principal

for __________________________________________________, a Florida Corporation.

Sign: ____________________________________________________________________________

Print: ____________________________________________________________________________

Date: ____________________________________________________________________________

State of Florida

County of Marion

The forgoing instrument was acknowledged before me this ______day of _____20____,

by (owner) __________________________________and______________________________ . Such person(s) are _____personally known or Produced (ID) ___________________________

(Notary Seal)

Sign__________________________________ Notary Public, State of Florida

Print Name: _____________________________ Commission No.:_________________________ My commission expires _________, _______

CERTIFICATE OF CORPORATE PRINCIPAL

Contractor’s Certification Of Authorization to Execute Bid/Contract on Behalf of Company

I, ___________________________________ certify that I am the ________________________ of

the corporation named as Contractor herein; that ___________________________________,

who signed this Contract of behalf of the Contractor, was then

___________________________________ of said corporation; that said Contract was duly

signed for and in behalf of said corporation by authority of its governing body, and is

within the scope of its corporate powers.

Affix Corporate Seal

By: ____________________________________________________________________________

Title: ____________________________________________________________________________

Date: ____________________________________________________________________________

Form W-9(Rev. December 2014)Department of the Treasury Internal Revenue Service

Request for Taxpayer Identification Number and Certification

Give Form to the

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1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.

2 Business name/disregarded entity name, if different from above

3 Check appropriate box for federal tax classification; check only one of the following seven boxes:

Individual/sole proprietor or single-member LLC

C Corporation S Corporation Partnership Trust/estate

Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership)

Note. For a single-member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for the tax classification of the single-member owner.

Other (see instructions)

4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3):Exempt payee code (if any)

Exemption from FATCA reporting

code (if any)(Applies to accounts maintained outside the U.S.)

5 Address (number, street, and apt. or suite no.)

6 City, state, and ZIP code

Requester’s name and address (optional)

7 List account number(s) here (optional)

Part I Taxpayer Identification Number (TIN)

Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3.

Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for guidelines on whose number to enter.

Social security number

– –

orEmployer identification number

–

Part II Certification

Under penalties of perjury, I certify that:

1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and

2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and

3. I am a U.S. citizen or other U.S. person (defined below); and

4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 3.

Sign Here

Signature of

U.S. person Date

General InstructionsSection references are to the Internal Revenue Code unless otherwise noted.

Future developments. Information about developments affecting Form W-9 (such as legislation enacted after we release it) is at www.irs.gov/fw9.

Purpose of Form

An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following:

• Form 1099-INT (interest earned or paid)

• Form 1099-DIV (dividends, including those from stocks or mutual funds)

• Form 1099-MISC (various types of income, prizes, awards, or gross proceeds)

• Form 1099-B (stock or mutual fund sales and certain other transactions by brokers)

• Form 1099-S (proceeds from real estate transactions)

• Form 1099-K (merchant card and third party network transactions)

• Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition)

• Form 1099-C (canceled debt)

• Form 1099-A (acquisition or abandonment of secured property)

Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN.

If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding? on page 2.

By signing the filled-out form, you:

1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued),

2. Certify that you are not subject to backup withholding, or

3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income, and

4. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting, is correct. See What is FATCA reporting? on page 2 for further information.

Cat. No. 10231X Form W-9 (Rev. 12-2014)

Form W-9 (Rev. 12-2014) Page 2

Note. If you are a U.S. person and a requester gives you a form other than Form W-9 to request your TIN, you must use the requester’s form if it is substantially similar to this Form W-9.

Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are:

• An individual who is a U.S. citizen or U.S. resident alien;

• A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States;

• An estate (other than a foreign estate); or

• A domestic trust (as defined in Regulations section 301.7701-7).

Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax under section 1446 on any foreign partners’ share of effectively connected taxable income from such business. Further, in certain cases where a Form W-9 has not been received, the rules under section 1446 require a partnership to presume that a partner is a foreign person, and pay the section 1446 withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid section 1446 withholding on your share of partnership income.

In the cases below, the following person must give Form W-9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business in the United States:

• In the case of a disregarded entity with a U.S. owner, the U.S. owner of the disregarded entity and not the entity;

• In the case of a grantor trust with a U.S. grantor or other U.S. owner, generally, the U.S. grantor or other U.S. owner of the grantor trust and not the trust; and

• In the case of a U.S. trust (other than a grantor trust), the U.S. trust (other than a grantor trust) and not the beneficiaries of the trust.

Foreign person. If you are a foreign person or the U.S. branch of a foreign bank that has elected to be treated as a U.S. person, do not use Form W-9. Instead, use the appropriate Form W-8 or Form 8233 (see Publication 515, Withholding of Tax on Nonresident Aliens and Foreign Entities).

Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a “saving clause.” Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise become a U.S. resident alien for tax purposes.

If you are a U.S. resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement to Form W-9 that specifies the following five items:

1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien.

2. The treaty article addressing the income.

3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions.

4. The type and amount of income that qualifies for the exemption from tax.

5. Sufficient facts to justify the exemption from tax under the terms of the treaty article.

Example. Article 20 of the U.S.-China income tax treaty allows an exemption from tax for scholarship income received by a Chinese student temporarily present in the United States. Under U.S. law, this student will become a resident alien for tax purposes if his or her stay in the United States exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the first protocol) and is relying on this exception to claim an exemption from tax on his or her scholarship or fellowship income would attach to Form W-9 a statement that includes the information described above to support that exemption.

If you are a nonresident alien or a foreign entity, give the requester the appropriate completed Form W-8 or Form 8233.

Backup Withholding

What is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS 28% of such payments. This is called “backup withholding.” Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, payments made in settlement of payment card and third party network transactions, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding.

You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return.

Payments you receive will be subject to backup withholding if:

1. You do not furnish your TIN to the requester,

2. You do not certify your TIN when required (see the Part II instructions on page 3 for details),

3. The IRS tells the requester that you furnished an incorrect TIN,

4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or

5. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only).

Certain payees and payments are exempt from backup withholding. See Exempt payee code on page 3 and the separate Instructions for the Requester of Form W-9 for more information.

Also see Special rules for partnerships above.

What is FATCA reporting?

The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign financial institution to report all United States account holders that are specified United States persons. Certain payees are exempt from FATCA reporting. See Exemption from FATCA reporting code on page 3 and the Instructions for the Requester of Form W-9 for more information.

Updating Your Information

You must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this person. For example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you no longer are tax exempt. In addition, you must furnish a new Form W-9 if the name or TIN changes for the account; for example, if the grantor of a grantor trust dies.

Penalties

Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect.

Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty.

Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment.

Misuse of TINs. If the requester discloses or uses TINs in violation of federal law, the requester may be subject to civil and criminal penalties.

Specific Instructions

Line 1

You must enter one of the following on this line; do not leave this line blank. The name should match the name on your tax return.

If this Form W-9 is for a joint account, list first, and then circle, the name of the person or entity whose number you entered in Part I of Form W-9.

a. Individual. Generally, enter the name shown on your tax return. If you have changed your last name without informing the Social Security Administration (SSA) of the name change, enter your first name, the last name as shown on your social security card, and your new last name.

Note. ITIN applicant: Enter your individual name as it was entered on your Form W-7 application, line 1a. This should also be the same as the name you entered on the Form 1040/1040A/1040EZ you filed with your application.

b. Sole proprietor or single-member LLC. Enter your individual name as shown on your 1040/1040A/1040EZ on line 1. You may enter your business, trade, or “doing business as” (DBA) name on line 2.

c. Partnership, LLC that is not a single-member LLC, C Corporation, or S Corporation. Enter the entity's name as shown on the entity's tax return on line 1 and any business, trade, or DBA name on line 2.

d. Other entities. Enter your name as shown on required U.S. federal tax documents on line 1. This name should match the name shown on the charter or other legal document creating the entity. You may enter any business, trade, or DBA name on line 2.

e. Disregarded entity. For U.S. federal tax purposes, an entity that is disregarded as an entity separate from its owner is treated as a “disregarded entity.” See Regulations section 301.7701-2(c)(2)(iii). Enter the owner's name on line 1. The name of the entity entered on line 1 should never be a disregarded entity. The name on line 1 should be the name shown on the income tax return on which the income should be reported. For example, if a foreign LLC that is treated as a disregarded entity for U.S. federal tax purposes has a single owner that is a U.S. person, the U.S. owner's name is required to be provided on line 1. If the direct owner of the entity is also a disregarded entity, enter the first owner that is not disregarded for federal tax purposes. Enter the disregarded entity's name on line 2, “Business name/disregarded entity name.” If the owner of the disregarded entity is a foreign person, the owner must complete an appropriate Form W-8 instead of a Form W-9. This is the case even if the foreign person has a U.S. TIN.


Line 2

If you have a business name, trade name, DBA name, or disregarded entity name, you may enter it on line 2.

Line 3

Check the appropriate box in line 3 for the U.S. federal tax classification of the person whose name is entered on line 1. Check only one box in line 3.

Limited Liability Company (LLC). If the name on line 1 is an LLC treated as a partnership for U.S. federal tax purposes, check the “Limited Liability Company” box and enter “P” in the space provided. If the LLC has filed Form 8832 or 2553 to be taxed as a corporation, check the “Limited Liability Company” box and in the space provided enter “C” for C corporation or “S” for S corporation. If it is a single-member LLC that is a disregarded entity, do not check the “Limited Liability Company” box; instead check the first box in line 3 “Individual/sole proprietor or single-member LLC.”

Line 4, Exemptions

If you are exempt from backup withholding and/or FATCA reporting, enter in the appropriate space in line 4 any code(s) that may apply to you.

Exempt payee code.

• Generally, individuals (including sole proprietors) are not exempt from backup withholding.

• Except as provided below, corporations are exempt from backup withholding for certain payments, including interest and dividends.

• Corporations are not exempt from backup withholding for payments made in settlement of payment card or third party network transactions.

• Corporations are not exempt from backup withholding with respect to attorneys' fees or gross proceeds paid to attorneys, and corporations that provide medical or health care services are not exempt with respect to payments reportable on Form 1099-MISC.

The following codes identify payees that are exempt from backup withholding. Enter the appropriate code in the space in line 4.

1—An organization exempt from tax under section 501(a), any IRA, or a custodial account under section 403(b)(7) if the account satisfies the requirements of section 401(f)(2)

2—The United States or any of its agencies or instrumentalities

3—A state, the District of Columbia, a U.S. commonwealth or possession, or any of their political subdivisions or instrumentalities

4—A foreign government or any of its political subdivisions, agencies, or instrumentalities

5—A corporation

6—A dealer in securities or commodities required to register in the United States, the District of Columbia, or a U.S. commonwealth or possession

7—A futures commission merchant registered with the Commodity Futures Trading Commission

8—A real estate investment trust

9—An entity registered at all times during the tax year under the Investment Company Act of 1940

10—A common trust fund operated by a bank under section 584(a)

11—A financial institution

12—A middleman known in the investment community as a nominee or custodian

13—A trust exempt from tax under section 664 or described in section 4947

The following chart shows types of payments that may be exempt from backup withholding. The chart applies to the exempt payees listed above, 1 through 13.

IF the payment is for . . . THEN the payment is exempt for . . .

Interest and dividend payments All exempt payees except for 7

Broker transactions Exempt payees 1 through 4 and 6 through 11 and all C corporations. S corporations must not enter an exempt payee code because they are exempt only for sales of noncovered securities acquired prior to 2012.

Barter exchange transactions and patronage dividends

Exempt payees 1 through 4

Payments over $600 required to be reported and direct sales over $5,0001

Generally, exempt payees 1 through 52

Payments made in settlement of payment card or third party network transactions

Exempt payees 1 through 4

1 See Form 1099-MISC, Miscellaneous Income, and its instructions.

2 However, the following payments made to a corporation and reportable on Form 1099-MISC are not exempt from backup withholding: medical and health care payments, attorneys' fees, gross proceeds paid to an attorney reportable under section 6045(f), and payments for services paid by a federal executive agency.

Exemption from FATCA reporting code. The following codes identify payees that are exempt from reporting under FATCA. These codes apply to persons submitting this form for accounts maintained outside of the United States by certain foreign financial institutions. Therefore, if you are only submitting this form for an account you hold in the United States, you may leave this field blank. Consult with the person requesting this form if you are uncertain if the financial institution is subject to these requirements. A requester may indicate that a code is not required by providing you with a Form W-9 with “Not Applicable” (or any similar indication) written or printed on the line for a FATCA exemption code.

A—An organization exempt from tax under section 501(a) or any individual retirement plan as defined in section 7701(a)(37)

B—The United States or any of its agencies or instrumentalities

C—A state, the District of Columbia, a U.S. commonwealth or possession, or any of their political subdivisions or instrumentalities

D—A corporation the stock of which is regularly traded on one or more established securities markets, as described in Regulations section 1.1472-1(c)(1)(i)

E—A corporation that is a member of the same expanded affiliated group as a corporation described in Regulations section 1.1472-1(c)(1)(i)

F—A dealer in securities, commodities, or derivative financial instruments (including notional principal contracts, futures, forwards, and options) that is registered as such under the laws of the United States or any state

G—A real estate investment trust

H—A regulated investment company as defined in section 851 or an entity registered at all times during the tax year under the Investment Company Act of 1940

I—A common trust fund as defined in section 584(a)

J—A bank as defined in section 581

K—A broker

L—A trust exempt from tax under section 664 or described in section 4947(a)(1)

M—A tax exempt trust under a section 403(b) plan or section 457(g) plan

Note. You may wish to consult with the financial institution requesting this form to determine whether the FATCA code and/or exempt payee code should be completed.

Line 5

Enter your address (number, street, and apartment or suite number). This is where the requester of this Form W-9 will mail your information returns.

Line 6

Enter your city, state, and ZIP code.

Part I. Taxpayer Identification Number (TIN)

Enter your TIN in the appropriate box. If you are a resident alien and you do not have and are not eligible to get an SSN, your TIN is your IRS individual taxpayer identification number (ITIN). Enter it in the social security number box. If you do not have an ITIN, see How to get a TIN below.

If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN. However, the IRS prefers that you use your SSN.

If you are a single-member LLC that is disregarded as an entity separate from its owner (see Limited Liability Company (LLC) on this page), enter the owner’s SSN (or EIN, if the owner has one). Do not enter the disregarded entity’s EIN. If the LLC is classified as a corporation or partnership, enter the entity’s EIN.

Note. See the chart on page 4 for further clarification of name and TIN combinations.

How to get a TIN. If you do not have a TIN, apply for one immediately. To apply for an SSN, get Form SS-5, Application for a Social Security Card, from your local SSA office or get this form online at www.ssa.gov. You may also get this form by calling 1-800-772-1213. Use Form W-7, Application for IRS Individual Taxpayer Identification Number, to apply for an ITIN, or Form SS-4, Application for Employer Identification Number, to apply for an EIN. You can apply for an EIN online by accessing the IRS website at www.irs.gov/businesses and clicking on Employer Identification Number (EIN) under Starting a Business. You can get Forms W-7 and SS-4 from the IRS by visiting IRS.gov or by calling 1-800-TAX-FORM (1-800-829-3676).

If you are asked to complete Form W-9 but do not have a TIN, apply for a TIN and write “Applied For” in the space for the TIN, sign and date the form, and give it to the requester. For interest and dividend payments, and certain payments made with respect to readily tradable instruments, generally you will have 60 days to get a TIN and give it to the requester before you are subject to backup withholding on payments. The 60-day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester.

Note. Entering “Applied For” means that you have already applied for a TIN or that you intend to apply for one soon.

Caution: A disregarded U.S. entity that has a foreign owner must use the appropriate Form W-8.


Part II. Certification

To establish to the withholding agent that you are a U.S. person, or resident alien, sign Form W-9. You may be requested to sign by the withholding agent even if items 1, 4, or 5 below indicate otherwise.

For a joint account, only the person whose TIN is shown in Part I should sign (when required). In the case of a disregarded entity, the person identified on line 1 must sign. Exempt payees, see Exempt payee code earlier.

Signature requirements. Complete the certification as indicated in items 1 through 5 below.

1. Interest, dividend, and barter exchange accounts opened before 1984 and broker accounts considered active during 1983. You must give your correct TIN, but you do not have to sign the certification.

2. Interest, dividend, broker, and barter exchange accounts opened after 1983 and broker accounts considered inactive during 1983. You must sign the certification or backup withholding will apply. If you are subject to backup withholding and you are merely providing your correct TIN to the requester, you must cross out item 2 in the certification before signing the form.

3. Real estate transactions. You must sign the certification. You may cross out item 2 of the certification.

4. Other payments. You must give your correct TIN, but you do not have to sign the certification unless you have been notified that you have previously given an incorrect TIN. “Other payments” include payments made in the course of the requester’s trade or business for rents, royalties, goods (other than bills for merchandise), medical and health care services (including payments to corporations), payments to a nonemployee for services, payments made in settlement of payment card and third party network transactions, payments to certain fishing boat crew members and fishermen, and gross proceeds paid to attorneys (including payments to corporations).

5. Mortgage interest paid by you, acquisition or abandonment of secured property, cancellation of debt, qualified tuition program payments (under section 529), IRA, Coverdell ESA, Archer MSA or HSA contributions or distributions, and pension distributions. You must give your correct TIN, but you do not have to sign the certification.

What Name and Number To Give the Requester

For this type of account: Give name and SSN of:

1. Individual The individual2. Two or more individuals (joint

account)The actual owner of the account or, if combined funds, the first individual on the account1

3. Custodian account of a minor (Uniform Gift to Minors Act)

The minor2

4. a. The usual revocable savings trust (grantor is also trustee) b. So-called trust account that is not a legal or valid trust under state law

The grantor-trustee1

The actual owner1

5. Sole proprietorship or disregarded entity owned by an individual

The owner3

6. Grantor trust filing under Optional Form 1099 Filing Method 1 (see Regulations section 1.671-4(b)(2)(i)(A))

The grantor*

For this type of account: Give name and EIN of:

7. Disregarded entity not owned by an individual

The owner

8. A valid trust, estate, or pension trust Legal entity4

9. Corporation or LLC electing corporate status on Form 8832 or Form 2553

The corporation

10. Association, club, religious, charitable, educational, or other tax-exempt organization

The organization

11. Partnership or multi-member LLC The partnership12. A broker or registered nominee The broker or nominee

13. Account with the Department of Agriculture in the name of a public entity (such as a state or local government, school district, or prison) that receives agricultural program payments

The public entity

14. Grantor trust filing under the Form 1041 Filing Method or the Optional Form 1099 Filing Method 2 (see Regulations section 1.671-4(b)(2)(i)(B))

The trust

1 List first and circle the name of the person whose number you furnish. If only one person on a joint account has an SSN, that person’s number must be furnished.

2 Circle the minor’s name and furnish the minor’s SSN.

3 You must show your individual name and you may also enter your business or DBA name on the “Business name/disregarded entity” name line. You may use either your SSN or EIN (if you have one), but the IRS encourages you to use your SSN.

4 List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN of the personal representative or trustee unless the legal entity itself is not designated in the account title.) Also see Special rules for partnerships on page 2.

*Note. Grantor also must provide a Form W-9 to trustee of trust.

Note. If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed.

Secure Your Tax Records from Identity Theft

Identity theft occurs when someone uses your personal information such as your name, SSN, or other identifying information, without your permission, to commit fraud or other crimes. An identity thief may use your SSN to get a job or may file a tax return using your SSN to receive a refund.

To reduce your risk:

• Protect your SSN,

• Ensure your employer is protecting your SSN, and

• Be careful when choosing a tax preparer.

If your tax records are affected by identity theft and you receive a notice from the IRS, respond right away to the name and phone number printed on the IRS notice or letter.

If your tax records are not currently affected by identity theft but you think you are at risk due to a lost or stolen purse or wallet, questionable credit card activity or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit Form 14039.

For more information, see Publication 4535, Identity Theft Prevention and Victim Assistance.

Victims of identity theft who are experiencing economic harm or a system problem, or are seeking help in resolving tax problems that have not been resolved through normal channels, may be eligible for Taxpayer Advocate Service (TAS) assistance. You can reach TAS by calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD 1-800-829-4059.

Protect yourself from suspicious emails or phishing schemes. Phishing is the creation and use of email and websites designed to mimic legitimate business emails and websites. The most common act is sending an email to a user falsely claiming to be an established legitimate enterprise in an attempt to scam the user into surrendering private information that will be used for identity theft.

The IRS does not initiate contacts with taxpayers via emails. Also, the IRS does not request personal detailed information through email or ask taxpayers for the PIN numbers, passwords, or similar secret access information for their credit card, bank, or other financial accounts.

If you receive an unsolicited email claiming to be from the IRS, forward this message to [email protected]. You may also report misuse of the IRS name, logo, or other IRS property to the Treasury Inspector General for Tax Administration (TIGTA) at 1-800-366-4484. You can forward suspicious emails to the Federal Trade Commission at: [email protected] or contact them at www.ftc.gov/idtheft or 1-877-IDTHEFT (1-877-438-4338).

Visit IRS.gov to learn more about identity theft and how to reduce your risk.

Privacy Act Notice

Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons (including federal agencies) who are required to file information returns with the IRS to report interest, dividends, or certain other income paid to you; mortgage interest you paid; the acquisition or abandonment of secured property; the cancellation of debt; or contributions you made to an IRA, Archer MSA, or HSA. The person collecting this form uses the information on the form to file information returns with the IRS, reporting the above information. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation and to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their laws. The information also may be disclosed to other countries under a treaty, to federal and state agencies to enforce civil and criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You must provide your TIN whether or not you are required to file a tax return. Under section 3406, payers must generally withhold a percentage of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to the payer. Certain penalties may also apply for providing false or fraudulent information.

REFERENCES FOR

Company Name

Reference 1

• Company Name • Contact Person • Address to Contact

• Telephone Number to Contact

Reference 2



Reference 3



Reference 4



Reference 5



NON-COLLUSIVE AFFIDAVIT State of Florida County of Marion City of Ocala ,being first duly sworn, deposes and says: That he/she is the party making that foregoing proposal or bid, that such proposal or bid is genuine and not collusive or, that said bidder has not colluded, conspired, connived or agreed, directly or indirectly, with any bidder or person, to put in a sham bid or to reframe from bidding, and has not in any manner, directly or indirectly sought by agreement or collusion, or communication or conference, with any person, to fix the bid price of affiant or of any other bidder, to fix overhead ,profit or cost element of said bid price, or that of any other or to secure any advantage against the Housing Authority or any person interested in the proposed contract; and that all statements in said proposal or bid are true. Signature of:

(Bidder, if the bidder is an individual)

(Partner, if the bidder is a Partnership)

(Officer, if the bidder is a Corporation)

Subscribed and sworn to before me this _______ day of __________ 20___. My Commission Expires: Notary: (Seal)

STATEMENT OF BIDDER’S QUALIFICATIONS (Prime Contractor)

All questions must be answered and the data given must be clear and comprehensive. This statement must be notarized. If necessary add separate sheets for items requiring additional explanation. This information may be submitted in a separate sealed envelope marked “Bidder’s Qualifications” and inserted inside the sealed Bid Envelope. In the event your bid is not selected for award, this envelope will be returned to the Contractor unopened. 1. Name of Bidder. 2. Permanent main office address. 3. Date organized. 4. State incorporated. 5. How many years have you been engaged in contracting business under your

present firm name. 6. Listing of current contracts: (Schedule these showing nature of the work, gross

amount of each contract, anticipated dates for completion, name and telephone number of owner’s representative.)

7. General character of work usually performed by your company. 8. Have you ever failed to complete any work awarded to you? If so, where and

why? 9. Have you ever defaulted on a contract? If so, where and why? 10. List the three (3) most important projects recently completed by your company,

stating approximate cost of each, month and year completed, name and telephone number of owner’s representative.

11. List your major equipment available for use on this contract. 12. Experience in construction work similar in importance to this project. 13. Background and experience of the principal members of your firm, including the

officers and proposed construction superintendent. 14. The undersigned hereby authorizes and requests any person, firm or

corporation to furnish any information requested by the Ocala Housing Authority in verification of the recitals compromising the Statement of Bidder’s Qualifications.

1

Dated at ____________ this __________day of _____________________2003. _________________________________ (Name of Bidder) By _________________________________ Title _________________________________ State of ______________________________________)ss. County of ____________________________________) _____________________________________________being duly sworn deposes and says that he is __________________________________of _______________________ _____________________________ and that he answers to the foregoing questions and all statements therein contained are true and correct. Sworn to before me this ____________day of ____________________2003 __________________________________ (Notary Public) My Commission Expires_______________

2

Property Listing and Addresses

Kings Landing Community - NW 21st Avenue, Ocala, Florida 34475 (Units 1602 thru 1718)

Deer Run Community – NE 4th Court, Ocala, Florida 34479 (Units 2804 thru 3148)

Pavilion Oaks Community – NW 1st Avenue, Ocala, Florida 34475 (Units 2193 thru 2231)

Pine Gardens Community – 515 SW 2nd Street, Ocala, Florida 34471 (Units 2 thru 21)

Shady Hollow – SW 19th Avenue Road, Ocala, Florida 34471 (Units 802 thru 961)

Duplex – NW 19th Avenue, Ocala, Florida 34475 (Unit 215 and 217)

City NSP Homes

1515 SW 23rd Avenue, Ocala, Florida 34471

1636 NW 4th Street, Ocala, Florida 34475

1530 NW 17th Avenue, Ocala, Florida 34475





1316 NE 16th Street, Ocala, Florida 34470

2420 NE 2nd Avenue, Ocala, Florida 34470

1886 NE 29th Street, Ocala, Florida 34479

1828 NE 12th Avenue, Ocala, Florida 34470

County NSP Homes (Marion Oaks)

2848 SW 145th Place Road, Ocala, Florida 34473

4073 SW 159th Lane, Ocala, Florida 34473

2580 SW 153rd Lane, Ocala, Florida 34473

Ocala Housing Authority’s Administrative Office/Warehouse


10/13/2016 www.wdol.gov/wdol/scafiles/std/052113.txt?v=18

http://www.wdol.gov/wdol/scafiles/std/052113.txt?v=18 1/9

WD 05‐2113 (Rev.‐18) was first posted on www.wdol.gov on 01/05/2016************************************************************************************REGISTER OF WAGE DETERMINATIONS UNDER | U.S. DEPARTMENT OF LABOR THE SERVICE CONTRACT ACT | EMPLOYMENT STANDARDS ADMINISTRATIONBy direction of the Secretary of Labor | WAGE AND HOUR DIVISION | WASHINGTON D.C. 20210 | | | | Wage Determination No.: 2005‐2113Daniel W. Simms Division of | Revision No.: 18Director Wage Determinations| Date Of Revision: 12/29/2015_______________________________________|____________________________________________Note: Under Executive Order (EO) 13658, an hourly minimum wage of $10.15 forcalendar year 2016 applies to all contracts subject to the Service ContractAct for which the solicitation was issued on or after January 1, 2015. If thiscontract is covered by the EO, the contractor must pay all workers in anyclassification listed on this wage determination at least $10.15 per hour (orthe applicable wage rate listed on this wage determination, if it is higher)for all hours spent performing on the contract in calendar year 2016. The EOminimum wage rate will be adjusted annually. Additional information oncontractor requirements and worker protections under the EO is available atwww.dol.gov/whd/govcontracts.____________________________________________________________________________________State: Florida

Area: Florida Counties of Alachua, Bradford, Citrus, Dixie, Gilchrist, Lake,Levy, Marion, Sumter, Union____________________________________________________________________________________ **Fringe Benefits Required Follow the Occupational Listing**OCCUPATION CODE ‐ TITLE FOOTNOTE RATE01000 ‐ Administrative Support And Clerical Occupations 01011 ‐ Accounting Clerk I 13.42 01012 ‐ Accounting Clerk II 16.40 01013 ‐ Accounting Clerk III 17.80 01020 ‐ Administrative Assistant 18.03 01040 ‐ Court Reporter 14.78 01051 ‐ Data Entry Operator I 11.46 01052 ‐ Data Entry Operator II 12.51 01060 ‐ Dispatcher, Motor Vehicle 14.48 01070 ‐ Document Preparation Clerk 13.15 01090 ‐ Duplicating Machine Operator 13.15 01111 ‐ General Clerk I 11.33 01112 ‐ General Clerk II 12.36 01113 ‐ General Clerk III 13.88 01120 ‐ Housing Referral Assistant 16.29 01141 ‐ Messenger Courier 11.03 01191 ‐ Order Clerk I 12.04 01192 ‐ Order Clerk II 13.14 01261 ‐ Personnel Assistant (Employment) I 13.67 01262 ‐ Personnel Assistant (Employment) II 15.29 01263 ‐ Personnel Assistant (Employment) III 17.05 01270 ‐ Production Control Clerk 17.01 01280 ‐ Receptionist 11.59 01290 ‐ Rental Clerk 10.86 01300 ‐ Scheduler, Maintenance 12.97 01311 ‐ Secretary I 12.97 01312 ‐ Secretary II 14.78 01313 ‐ Secretary III 16.29 01320 ‐ Service Order Dispatcher 13.44 01410 ‐ Supply Technician 18.03 01420 ‐ Survey Worker 14.78 01531 ‐ Travel Clerk I 12.32 01532 ‐ Travel Clerk II 13.45



01533 ‐ Travel Clerk III 14.49 01611 ‐ Word Processor I 12.19 01612 ‐ Word Processor II 13.68 01613 ‐ Word Processor III 15.3005000 ‐ Automotive Service Occupations 05005 ‐ Automobile Body Repairer, Fiberglass 18.13 05010 ‐ Automotive Electrician 16.92 05040 ‐ Automotive Glass Installer 14.59 05070 ‐ Automotive Worker 14.98 05110 ‐ Mobile Equipment Servicer 12.16 05130 ‐ Motor Equipment Metal Mechanic 16.92 05160 ‐ Motor Equipment Metal Worker 14.98 05190 ‐ Motor Vehicle Mechanic 16.92 05220 ‐ Motor Vehicle Mechanic Helper 12.02 05250 ‐ Motor Vehicle Upholstery Worker 14.98 05280 ‐ Motor Vehicle Wrecker 14.98 05310 ‐ Painter, Automotive 15.96 05340 ‐ Radiator Repair Specialist 14.98 05370 ‐ Tire Repairer 9.52 05400 ‐ Transmission Repair Specialist 16.9207000 ‐ Food Preparation And Service Occupations 07010 ‐ Baker 11.46 07041 ‐ Cook I 10.48 07042 ‐ Cook II 12.16 07070 ‐ Dishwasher 7.98 07130 ‐ Food Service Worker 8.82 07210 ‐ Meat Cutter 12.98 07260 ‐ Waiter/Waitress 9.4209000 ‐ Furniture Maintenance And Repair Occupations 09010 ‐ Electrostatic Spray Painter 13.97 09040 ‐ Furniture Handler 9.38 09080 ‐ Furniture Refinisher 13.97 09090 ‐ Furniture Refinisher Helper 9.38 09110 ‐ Furniture Repairer, Minor 12.06 09130 ‐ Upholsterer 13.7911000 ‐ General Services And Support Occupations 11030 ‐ Cleaner, Vehicles 9.88 11060 ‐ Elevator Operator 9.88 11090 ‐ Gardener 14.48 11122 ‐ Housekeeping Aide 10.02 11150 ‐ Janitor 10.02 11210 ‐ Laborer, Grounds Maintenance 11.12 11240 ‐ Maid or Houseman 9.36 11260 ‐ Pruner 9.87 11270 ‐ Tractor Operator 13.33 11330 ‐ Trail Maintenance Worker 11.12 11360 ‐ Window Cleaner 11.2912000 ‐ Health Occupations 12010 ‐ Ambulance Driver 14.26 12011 ‐ Breath Alcohol Technician 15.04 12012 ‐ Certified Occupational Therapist Assistant 22.51 12015 ‐ Certified Physical Therapist Assistant 20.96 12020 ‐ Dental Assistant 17.01 12025 ‐ Dental Hygienist 20.52 12030 ‐ EKG Technician 20.75 12035 ‐ Electroneurodiagnostic Technologist 20.75 12040 ‐ Emergency Medical Technician 14.26 12071 ‐ Licensed Practical Nurse I 15.53 12072 ‐ Licensed Practical Nurse II 17.38 12073 ‐ Licensed Practical Nurse III 19.38 12100 ‐ Medical Assistant 12.90 12130 ‐ Medical Laboratory Technician 18.02 12160 ‐ Medical Record Clerk 14.30 12190 ‐ Medical Record Technician 17.01 12195 ‐ Medical Transcriptionist 12.93



12210 ‐ Nuclear Medicine Technologist 33.17 12221 ‐ Nursing Assistant I 9.83 12222 ‐ Nursing Assistant II 11.06 12223 ‐ Nursing Assistant III 12.07 12224 ‐ Nursing Assistant IV 13.54 12235 ‐ Optical Dispenser 17.38 12236 ‐ Optical Technician 15.53 12250 ‐ Pharmacy Technician 13.41 12280 ‐ Phlebotomist 13.54 12305 ‐ Radiologic Technologist 23.63 12311 ‐ Registered Nurse I 19.98 12312 ‐ Registered Nurse II 24.44 12313 ‐ Registered Nurse II, Specialist 24.44 12314 ‐ Registered Nurse III 29.57 12315 ‐ Registered Nurse III, Anesthetist 29.57 12316 ‐ Registered Nurse IV 35.43 12317 ‐ Scheduler (Drug and Alcohol Testing) 20.3613000 ‐ Information And Arts Occupations 13011 ‐ Exhibits Specialist I 19.34 13012 ‐ Exhibits Specialist II 23.96 13013 ‐ Exhibits Specialist III 29.31 13041 ‐ Illustrator I 17.56 13042 ‐ Illustrator II 21.97 13043 ‐ Illustrator III 27.74 13047 ‐ Librarian 26.53 13050 ‐ Library Aide/Clerk 13.46 13054 ‐ Library Information Technology Systems 22.14 Administrator 13058 ‐ Library Technician 14.87 13061 ‐ Media Specialist I 13.10 13062 ‐ Media Specialist II 14.87 13063 ‐ Media Specialist III 16.58 13071 ‐ Photographer I 12.81 13072 ‐ Photographer II 15.03 13073 ‐ Photographer III 18.61 13074 ‐ Photographer IV 22.76 13075 ‐ Photographer V 27.54 13110 ‐ Video Teleconference Technician 15.0114000 ‐ Information Technology Occupations 14041 ‐ Computer Operator I 14.52 14042 ‐ Computer Operator II 16.48 14043 ‐ Computer Operator III 18.70 14044 ‐ Computer Operator IV 20.77 14045 ‐ Computer Operator V 23.01 14071 ‐ Computer Programmer I (see 1) 17.10 14072 ‐ Computer Programmer II (see 1) 21.19 14073 ‐ Computer Programmer III (see 1) 25.92 14074 ‐ Computer Programmer IV (see 1) 14101 ‐ Computer Systems Analyst I (see 1) 24.10 14102 ‐ Computer Systems Analyst II (see 1) 14103 ‐ Computer Systems Analyst III (see 1) 14150 ‐ Peripheral Equipment Operator 14.52 14160 ‐ Personal Computer Support Technician 20.7715000 ‐ Instructional Occupations 15010 ‐ Aircrew Training Devices Instructor (Non‐Rated) 21.76 15020 ‐ Aircrew Training Devices Instructor (Rated) 26.33 15030 ‐ Air Crew Training Devices Instructor (Pilot) 30.98 15050 ‐ Computer Based Training Specialist / Instructor 21.76 15060 ‐ Educational Technologist 23.72 15070 ‐ Flight Instructor (Pilot) 30.98 15080 ‐ Graphic Artist 17.91 15090 ‐ Technical Instructor 17.86 15095 ‐ Technical Instructor/Course Developer 21.85 15110 ‐ Test Proctor 14.41 15120 ‐ Tutor 14.41



16000 ‐ Laundry, Dry‐Cleaning, Pressing And Related Occupations 16010 ‐ Assembler 8.67 16030 ‐ Counter Attendant 8.67 16040 ‐ Dry Cleaner 11.05 16070 ‐ Finisher, Flatwork, Machine 8.67 16090 ‐ Presser, Hand 8.67 16110 ‐ Presser, Machine, Drycleaning 8.67 16130 ‐ Presser, Machine, Shirts 8.67 16160 ‐ Presser, Machine, Wearing Apparel, Laundry 8.67 16190 ‐ Sewing Machine Operator 11.79 16220 ‐ Tailor 12.51 16250 ‐ Washer, Machine 9.4419000 ‐ Machine Tool Operation And Repair Occupations 19010 ‐ Machine‐Tool Operator (Tool Room) 15.89 19040 ‐ Tool And Die Maker 20.0421000 ‐ Materials Handling And Packing Occupations 21020 ‐ Forklift Operator 13.22 21030 ‐ Material Coordinator 17.01 21040 ‐ Material Expediter 17.01 21050 ‐ Material Handling Laborer 11.64 21071 ‐ Order Filler 10.60 21080 ‐ Production Line Worker (Food Processing) 13.22 21110 ‐ Shipping Packer 10.99 21130 ‐ Shipping/Receiving Clerk 10.99 21140 ‐ Store Worker I 9.85 21150 ‐ Stock Clerk 14.02 21210 ‐ Tools And Parts Attendant 13.22 21410 ‐ Warehouse Specialist 13.2223000 ‐ Mechanics And Maintenance And Repair Occupations 23010 ‐ Aerospace Structural Welder 17.40 23021 ‐ Aircraft Mechanic I 16.93 23022 ‐ Aircraft Mechanic II 17.95 23023 ‐ Aircraft Mechanic III 19.00 23040 ‐ Aircraft Mechanic Helper 11.76 23050 ‐ Aircraft, Painter 16.69 23060 ‐ Aircraft Servicer 13.83 23080 ‐ Aircraft Worker 14.86 23110 ‐ Appliance Mechanic 18.63 23120 ‐ Bicycle Repairer 8.90 23125 ‐ Cable Splicer 18.51 23130 ‐ Carpenter, Maintenance 15.93 23140 ‐ Carpet Layer 14.84 23160 ‐ Electrician, Maintenance 16.93 23181 ‐ Electronics Technician Maintenance I 17.37 23182 ‐ Electronics Technician Maintenance II 21.14 23183 ‐ Electronics Technician Maintenance III 22.67 23260 ‐ Fabric Worker 13.83 23290 ‐ Fire Alarm System Mechanic 15.19 23310 ‐ Fire Extinguisher Repairer 12.79 23311 ‐ Fuel Distribution System Mechanic 16.41 23312 ‐ Fuel Distribution System Operator 12.52 23370 ‐ General Maintenance Worker 14.32 23380 ‐ Ground Support Equipment Mechanic 16.93 23381 ‐ Ground Support Equipment Servicer 13.83 23382 ‐ Ground Support Equipment Worker 14.86 23391 ‐ Gunsmith I 12.79 23392 ‐ Gunsmith II 14.84 23393 ‐ Gunsmith III 16.54 23410 ‐ Heating, Ventilation And Air‐Conditioning 16.43 Mechanic 23411 ‐ Heating, Ventilation And Air Contditioning 17.42 Mechanic (Research Facility) 23430 ‐ Heavy Equipment Mechanic 16.87 23440 ‐ Heavy Equipment Operator 14.44 23460 ‐ Instrument Mechanic 16.93



23465 ‐ Laboratory/Shelter Mechanic 15.89 23470 ‐ Laborer 11.64 23510 ‐ Locksmith 15.84 23530 ‐ Machinery Maintenance Mechanic 18.65 23550 ‐ Machinist, Maintenance 17.13 23580 ‐ Maintenance Trades Helper 10.35 23591 ‐ Metrology Technician I 16.93 23592 ‐ Metrology Technician II 17.95 23593 ‐ Metrology Technician III 19.00 23640 ‐ Millwright 16.93 23710 ‐ Office Appliance Repairer 16.45 23760 ‐ Painter, Maintenance 14.45 23790 ‐ Pipefitter, Maintenance 16.12 23810 ‐ Plumber, Maintenance 15.21 23820 ‐ Pneudraulic Systems Mechanic 16.93 23850 ‐ Rigger 16.93 23870 ‐ Scale Mechanic 14.84 23890 ‐ Sheet‐Metal Worker, Maintenance 15.76 23910 ‐ Small Engine Mechanic 14.58 23931 ‐ Telecommunications Mechanic I 18.70 23932 ‐ Telecommunications Mechanic II 19.84 23950 ‐ Telephone Lineman 19.10 23960 ‐ Welder, Combination, Maintenance 14.83 23965 ‐ Well Driller 16.93 23970 ‐ Woodcraft Worker 16.93 23980 ‐ Woodworker 12.3924000 ‐ Personal Needs Occupations 24570 ‐ Child Care Attendant 8.55 24580 ‐ Child Care Center Clerk 13.13 24610 ‐ Chore Aide 10.40 24620 ‐ Family Readiness And Support Services 13.27 Coordinator 24630 ‐ Homemaker 14.2625000 ‐ Plant And System Operations Occupations 25010 ‐ Boiler Tender 19.89 25040 ‐ Sewage Plant Operator 19.12 25070 ‐ Stationary Engineer 19.89 25190 ‐ Ventilation Equipment Tender 13.82 25210 ‐ Water Treatment Plant Operator 19.1227000 ‐ Protective Service Occupations 27004 ‐ Alarm Monitor 13.87 27007 ‐ Baggage Inspector 11.99 27008 ‐ Corrections Officer 17.13 27010 ‐ Court Security Officer 17.13 27030 ‐ Detection Dog Handler 13.87 27040 ‐ Detention Officer 17.13 27070 ‐ Firefighter 17.20 27101 ‐ Guard I 11.99 27102 ‐ Guard II 13.87 27131 ‐ Police Officer I 18.01 27132 ‐ Police Officer II 19.7828000 ‐ Recreation Occupations 28041 ‐ Carnival Equipment Operator 12.49 28042 ‐ Carnival Equipment Repairer 13.55 28043 ‐ Carnival Equpment Worker 9.25 28210 ‐ Gate Attendant/Gate Tender 13.25 28310 ‐ Lifeguard 10.82 28350 ‐ Park Attendant (Aide) 14.82 28510 ‐ Recreation Aide/Health Facility Attendant 10.82 28515 ‐ Recreation Specialist 14.17 28630 ‐ Sports Official 11.81 28690 ‐ Swimming Pool Operator 15.9829000 ‐ Stevedoring/Longshoremen Occupational Services 29010 ‐ Blocker And Bracer 14.86 29020 ‐ Hatch Tender 14.84



29030 ‐ Line Handler 14.84 29041 ‐ Stevedore I 13.83 29042 ‐ Stevedore II 16.1530000 ‐ Technical Occupations 30010 ‐ Air Traffic Control Specialist, Center (HFO) (see 2) 35.77 30011 ‐ Air Traffic Control Specialist, Station (HFO) (see 2) 24.66 30012 ‐ Air Traffic Control Specialist, Terminal (HFO) (see 2) 27.16 30021 ‐ Archeological Technician I 16.94 30022 ‐ Archeological Technician II 18.54 30023 ‐ Archeological Technician III 23.67 30030 ‐ Cartographic Technician 23.67 30040 ‐ Civil Engineering Technician 20.97 30061 ‐ Drafter/CAD Operator I 16.94 30062 ‐ Drafter/CAD Operator II 19.10 30063 ‐ Drafter/CAD Operator III 21.30 30064 ‐ Drafter/CAD Operator IV 26.18 30081 ‐ Engineering Technician I 14.12 30082 ‐ Engineering Technician II 15.85 30083 ‐ Engineering Technician III 18.18 30084 ‐ Engineering Technician IV 22.52 30085 ‐ Engineering Technician V 27.55 30086 ‐ Engineering Technician VI 33.33 30090 ‐ Environmental Technician 19.24 30210 ‐ Laboratory Technician 17.67 30240 ‐ Mathematical Technician 23.18 30361 ‐ Paralegal/Legal Assistant I 15.94 30362 ‐ Paralegal/Legal Assistant II 18.83 30363 ‐ Paralegal/Legal Assistant III 23.03 30364 ‐ Paralegal/Legal Assistant IV 27.87 30390 ‐ Photo‐Optics Technician 23.67 30461 ‐ Technical Writer I 16.84 30462 ‐ Technical Writer II 20.60 30463 ‐ Technical Writer III 24.92 30491 ‐ Unexploded Ordnance (UXO) Technician I 22.74 30492 ‐ Unexploded Ordnance (UXO) Technician II 27.51 30493 ‐ Unexploded Ordnance (UXO) Technician III 32.97 30494 ‐ Unexploded (UXO) Safety Escort 22.74 30495 ‐ Unexploded (UXO) Sweep Personnel 22.74 30620 ‐ Weather Observer, Combined Upper Air Or (see 2) 21.30 Surface Programs 30621 ‐ Weather Observer, Senior (see 2) 23.6731000 ‐ Transportation/Mobile Equipment Operation Occupations 31020 ‐ Bus Aide 10.69 31030 ‐ Bus Driver 14.09 31043 ‐ Driver Courier 12.25 31260 ‐ Parking and Lot Attendant 9.48 31290 ‐ Shuttle Bus Driver 13.03 31310 ‐ Taxi Driver 10.91 31361 ‐ Truckdriver, Light 13.03 31362 ‐ Truckdriver, Medium 14.09 31363 ‐ Truckdriver, Heavy 15.69 31364 ‐ Truckdriver, Tractor‐Trailer 15.6999000 ‐ Miscellaneous Occupations 99030 ‐ Cashier 8.53 99050 ‐ Desk Clerk 9.20 99095 ‐ Embalmer 22.74 99251 ‐ Laboratory Animal Caretaker I 9.27 99252 ‐ Laboratory Animal Caretaker II 9.73 99310 ‐ Mortician 22.74 99410 ‐ Pest Controller 12.99 99510 ‐ Photofinishing Worker 11.95 99710 ‐ Recycling Laborer 11.18 99711 ‐ Recycling Specialist 15.41 99730 ‐ Refuse Collector 10.65 99810 ‐ Sales Clerk 12.28



99820 ‐ School Crossing Guard 10.51 99830 ‐ Survey Party Chief 18.83 99831 ‐ Surveying Aide 11.70 99832 ‐ Surveying Technician 16.03 99840 ‐ Vending Machine Attendant 13.62 99841 ‐ Vending Machine Repairer 18.85 99842 ‐ Vending Machine Repairer Helper 13.62

____________________________________________________________________________________

ALL OCCUPATIONS LISTED ABOVE RECEIVE THE FOLLOWING BENEFITS:

HEALTH & WELFARE: $4.27 per hour or $170.80 per week or $740.13 per month

VACATION: 2 weeks paid vacation after 1 year of service with a contractor orsuccessor; 3 weeks after 8 years, and 4 weeks after 15 years. Length of serviceincludes the whole span of continuous service with the present contractor orsuccessor, wherever employed, and with the predecessor contractors in theperformance of similar work at the same Federal facility. (Reg. 29 CFR 4.173)

HOLIDAYS: A minimum of ten paid holidays per year, New Year's Day, Martin LutherKing Jr's Birthday, Washington's Birthday, Memorial Day, Independence Day, LaborDay, Columbus Day, Veterans' Day, Thanksgiving Day, and Christmas Day. (Acontractor may substitute for any of the named holidays another day off with pay inaccordance with a plan communicated to the employees involved.) (See 29 CFR 4174)

THE OCCUPATIONS WHICH HAVE NUMBERED FOOTNOTES IN PARENTHESES RECEIVE THE FOLLOWING:

1) Does not apply to employees employed in a bona fide executive, administrative,or professional capacity as defined and delineated in 29 CFR 541. (See CFR 4.156)

2) AIR TRAFFIC CONTROLLERS AND WEATHER OBSERVERS ‐ NIGHT PAY & SUNDAY PAY: If youwork at night as part of a regular tour of duty, you will earn a night differentialand receive an additional 10% of basic pay for any hours worked between 6pm and 6am. If you are a full‐time employed (40 hours a week) and Sunday is part of yourregularly scheduled workweek, you are paid at your rate of basic pay plus a Sundaypremium of 25% of your basic rate for each hour of Sunday work which is not overtime(i.e. occasional work on Sunday outside the normal tour of duty is consideredovertime work).

HAZARDOUS PAY DIFFERENTIAL: An 8 percent differential is applicable to employeesemployed in a position that represents a high degree of hazard when working with orin close proximity to ordinance, explosives, and incendiary materials. Thisincludes work such as screening, blending, dying, mixing, and pressing of sensitiveordance, explosives, and pyrotechnic compositions such as lead azide, black powderand photoflash powder. All dry‐house activities involving propellants or explosives. Demilitarization, modification, renovation, demolition, and maintenance operationson sensitive ordnance, explosives and incendiary materials. All operationsinvolving regrading and cleaning of artillery ranges.

A 4 percent differential is applicable to employees employed in a position thatrepresents a low degree of hazard when working with, or in close proximity toordance, (or employees possibly adjacent to) explosives and incendiary materialswhich involves potential injury such as laceration of hands, face, or arms of theemployee engaged in the operation, irritation of the skin, minor burns and thelike; minimal damage to immediate or adjacent work area or equipment being used.All operations involving, unloading, storage, and hauling of ordance, explosive, andincendiary ordnance material other than small arms ammunition. These differentialsare only applicable to work that has been specifically designated by the agency for



ordance, explosives, and incendiary material differential pay.

** UNIFORM ALLOWANCE **

If employees are required to wear uniforms in the performance of this contract(either by the terms of the Government contract, by the employer, by the state orlocal law, etc.), the cost of furnishing such uniforms and maintaining (bylaundering or dry cleaning) such uniforms is an expense that may not be borne by anemployee where such cost reduces the hourly rate below that required by the wagedetermination. The Department of Labor will accept payment in accordance with thefollowing standards as compliance:

The contractor or subcontractor is required to furnish all employees with anadequate number of uniforms without cost or to reimburse employees for the actualcost of the uniforms. In addition, where uniform cleaning and maintenance is madethe responsibility of the employee, all contractors and subcontractors subject tothis wage determination shall (in the absence of a bona fide collective bargainingagreement providing for a different amount, or the furnishing of contraryaffirmative proof as to the actual cost), reimburse all employees for such cleaningand maintenance at a rate of $3.35 per week (or $.67 cents per day). However, inthose instances where the uniforms furnished are made of "wash and wear"materials, may be routinely washed and dried with other personal garments, and donot require any special treatment such as dry cleaning, daily washing, or commerciallaundering in order to meet the cleanliness or appearance standards set by the termsof the Government contract, by the contractor, by law, or by the nature of the work,there is no requirement that employees be reimbursed for uniform maintenance costs.

The duties of employees under job titles listed are those described in the"Service Contract Act Directory of Occupations", Fifth Edition, April 2006,unless otherwise indicated. Copies of the Directory are available on the Internet. Alinks to the Directory may be found on the WHD home page at http://www.dol.gov/esa/whd/ or through the Wage Determinations On‐Line (WDOL) Web site athttp://wdol.gov/.

REQUEST FOR AUTHORIZATION OF ADDITIONAL CLASSIFICATION AND WAGE RATE {Standard Form1444 (SF 1444)}

Conformance Process:

The contracting officer shall require that any class of service employee which isnot listed herein and which is to be employed under the contract (i.e., the work tobe performed is not performed by any classification listed in the wagedetermination), be classified by the contractor so as to provide a reasonablerelationship (i.e., appropriate level of skill comparison) between such unlistedclassifications and the classifications listed in the wage determination. Suchconformed classes of employees shall be paid the monetary wages and furnished thefringe benefits as are determined. Such conforming process shall be initiated bythe contractor prior to the performance of contract work by such unlisted class(es)of employees. The conformed classification, wage rate, and/or fringe benefits shallbe retroactive to the commencement date of the contract. {See Section 4.6 (C)(vi)}When multiple wage determinations are included in a contract, a separate SF 1444should be prepared for each wage determination to which a class(es) is to beconformed.

The process for preparing a conformance request is as follows:

1) When preparing the bid, the contractor identifies the need for a conformedoccupation(s) and computes a proposed rate(s).

2) After contract award, the contractor prepares a written report listing in orderproposed classification title(s), a Federal grade equivalency (FGE) for eachproposed classification(s), job description(s), and rationale for proposed wagerate(s), including information regarding the agreement or disagreement of theauthorized representative of the employees involved, or where there is no authorizedrepresentative, the employees themselves. This report should be submitted to the



contracting officer no later than 30 days after such unlisted class(es) of employeesperforms any contract work.

3) The contracting officer reviews the proposed action and promptly submits a reportof the action, together with the agency's recommendations and pertinentinformation including the position of the contractor and the employees, to the Wageand Hour Division, Employment Standards Administration, U.S. Department of Labor,for review. (See section 4.6(b)(2) of Regulations 29 CFR Part 4).

4) Within 30 days of receipt, the Wage and Hour Division approves, modifies, ordisapproves the action via transmittal to the agency contracting officer, ornotifies the contracting officer that additional time will be required to processthe request.

5) The contracting officer transmits the Wage and Hour decision to the contractor.

6) The contractor informs the affected employees.

Information required by the Regulations must be submitted on SF 1444 or bond paper.

When preparing a conformance request, the "Service Contract Act Directory ofOccupations" (the Directory) should be used to compare job definitions to insurethat duties requested are not performed by a classification already listed in thewage determination. Remember, it is not the job title, but the required tasks thatdetermine whether a class is included in an established wage determination.Conformances may not be used to artificially split, combine, or subdivideclassifications listed in the wage determination.