Common use of CERTIFICATION OF NONSEGREGATED FACILITIES Clause in Contracts

CERTIFICATION OF NONSEGREGATED FACILITIES. a. The DWR and the City hereby certify that they do not maintain or provide for their employees any segregated facilities at any of its establishments and that they do not permit their employees to perform their services at any location under their control where segregated facilities are maintained. They certify further that they will not maintain or provide for their employees any segregated facilities at any of their establishments and that they will not permit their employees to perform their services at any location under their control where segregated facilities are maintained. The DWR and the City agree that a breach of this certification is a violation of the Equal Employment Opportunity clause in this MOA. As used in this certification, the term “segregated facilities” means any waiting rooms, work areas, rest rooms and wash rooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, creed, color, or national origin, because of habit, local custom, disability, or otherwise. The DWR and the City further agree that (except where they have obtained identical certifications from proposed subcontractors for specific time periods) they will obtain identical certifications from proposed subcontractors prior to the award of subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Employment Opportunity clause; that they will retain such certifications in their files; and that they will forward the following notice to such proposed subcontractors (except where the proposed subcontractors have submitted identical certifications for specific time periods): NOTICE TO PROSPECTIVE SUBCONTRACTORS OF REQUIREMENT FOR CERTIFICATIONS OF NONSEGREGATED FACILITIES A Certification of Nonsegregated Facilities must be submitted prior to the award of a subcontract exceeding $10,000 which is not exempt from the provisions of the Equal Employment Opportunity clause. The certification may be submitted either for each subcontract or for all subcontracts during a period (i.e., quarterly, semiannually, or annually). Note: The penalty for making false statements in offers is prescribed in 18 U.S.C. § 1001.

CERTIFICATION OF NONSEGREGATED FACILITIES. a. The DWR and the City hereby certify Bidder certifies that they do he does not maintain or provide for their his employees any segregated facilities at any of its establishments his establishments, and that they do he does not permit their his employees to perform their services at any location location, under their control his control, where segregated facilities are maintained. They certify The Bidder certifies further that they he will not maintain or provide for their his employees any segregated facilities at any of their establishments and that they will not permit their employees to perform their services at any location under their his control where segregated facilities are maintained. The DWR and the City agree Bidder agrees that a breach of this certification is will be a violation of the Equal Employment Opportunity clause in any contract resulting from acceptance of this MOABid. As used in this certification, the term “"segregated facilities” " means any waiting rooms, work areas, rest rooms restrooms and wash roomswashrooms, restaurants and other eating areas, time clocks, locker rooms and other storage or and dressing areas, parking lots, drinking fountains, recreation or entertainment areasarea, transportation, transportation and housing facilities provided for employees which are segregated by explicit directive directive, or are in fact segregated on the basis of race, creed, color, religious disability or national origin, because of habit, local custom, disability, or otherwise. The DWR and the City further agree Bidder agrees that (except where they have he has obtained identical certifications from proposed subcontractors for specific time periods) they he will obtain identical certifications from proposed subcontractors prior to the award of subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Employment Opportunity clause; , and that they he will retain such certifications in their his files; and that they will forward the following notice to such proposed subcontractors (except where the proposed subcontractors have submitted identical certifications for specific time periods): NOTICE TO PROSPECTIVE SUBCONTRACTORS OF REQUIREMENT FOR CERTIFICATIONS OF NONSEGREGATED FACILITIES A Certification of Nonsegregated Facilities must be submitted prior to the award of a subcontract exceeding $10,000 which is not exempt from the provisions of the Equal Employment Opportunity clause. The certification may be submitted either for each subcontract or nondiscriminatory guidelines as promulgated in Section 202, Executive Order 11246, and as amended by Executive Order 11375 and as amended, relative to Equal Opportunity for all subcontracts during a period (i.e., quarterly, semiannually, or annually)persons and implementations of rules and regulations prescribed by the United States Secretary of Labor are incorporated herein. NoteNOTE: The penalty for making false statements in offers is prescribed in 18 U.S.C. § 1001.. Date: By: Print Name: Official Address: Title: (Include Zip Code) ATTACH AND INCLUDE THIS PAGE AS PART OF BID FORM; FAILURE TO DO MAY BE CAUSE FOR DISQUALIFICATION OF YOUR BID. CERTIFICATION OF NONSEGREGATED FACILITIES 00300-1 09/07 AMERICANS WITH DISABILITIES ACT AFFIDAVIT The undersigned CONTRACTOR swears that the information herein contained is true and correct and that none of the information supplied was for the purpose of defrauding COUNTY. The CONTRACTOR will not discriminate against any employee or applicant for employment because of physical or mental handicap in regard to any position for which the employee or applicant for employment is qualified. The CONTRACTOR agrees to comply with the rules, regulations and relevant orders issued pursuant to the Americans with Disabilities Act (ADA), 42 USC s. 12101 et seq. It is understood that in no event shall the COUNTY be held liable for the actions or omissions of the CONTRACTOR or any other party or parties to the Agreement for failure to comply with the ADA. The CONTRACTOR agrees to hold harmless and indemnify the COUNTY, its agents, officers or employees from any and all claims, demands, debts, liabilities or causes of action of every kind or character, whether in law or equity, resulting from the CONTRACTOR's acts or omissions in connection with the ADA. CONTRACTOR: Signature: Printed Name: Title: Date: Affix Corporate Seal STATE OF ) ) ss COUNTY OF ) The foregoing instrument was acknowledged before me this of , 20 , by day of firm), on behalf of the firm. He/She is personally known to me or has produced identification. Print Name Notary Public in and for the County and State Aforementioned My commission expires: AMERICANS WITH DISABILITIES ACT AFFIDAVIT 00310-1 9/2007 PUBLIC ENTITY CRIMES FORM 00330-1 CC-1391-17/RTB – MSA for Public Works Construction Projects Under $500,000.00 Page 35 of 227 CC-1391-17/RTB – MSA for Public Works Construction Projects Under $500,000.00 Rev. 3/22/12 WORKERS' COMPENSATION COMPLIANCE CERTIFICATION Purchasing & Contracts Division‌ Contracts Section Section 00400 General Conditions (Construction Forms) Date (Contractor) Subject: Notice of Award – Number and Name On , 20 , the Seminole County Board of County Commissioners selected your firm for award of an Agreement for the above referenced project. Accompanying this letter is one copy of the Agreement Documents for execution by the authorized parties within your firm. Please return a Certificate of Insurance listing Seminole County, Board of County Commissioners, as additional insured. This certificate must reference project number CC- , in compliance with section 00700 of the bid documents. Your firm is required to submit both the signed documents and insurance certificate within fifteen days of receipt of said contract. The Agreement documents are not to be dated, and Seminole County will date them upon execution. Upon submission and acceptance of all required documentation, which may include but not be limited to bonds, a fully executed Agreement will be furnished to your firm. Please be advised that no work shall commence on the site until a Notice to Proceed (NTP) has been issued by the County. We look forward to having you as part of the Seminole County team! Sincerely, Procurement Analyst Enclosure CIP# cc: User Department Finance/File (Date) (Contractor) Subject: (Project Number and Name) NOTICE TO PROCEED (NTP) The services provided by your firm for the above subject project shall commence on , 20 . In accordance with the content of the executed Agreement for the above-referenced project, the term for Substantial Completion shall be calendar days or until , 20 . The term for Final Completion shall be calendar days or until , 20 . The timely and accurate performance of the work set forth in the Agreement documents is important to the County. It is also a primary consideration for Contractor selection for future projects. We are glad to have you on as part of the County’s project team and we look forward to a successful project! Sincerely, Procurement Analyst

CERTIFICATION OF NONSEGREGATED FACILITIES. a. The DWR By entering into this lease, the lessee certifies that he does not and the City hereby certify that they do will not maintain or provide for their his employees any segregated facilities at any of its establishments his establishments, and that they do he does not and will not permit their his employees to perform their services at any location under their control where segregated facilities are maintained. They certify further that they will not maintain or provide for their employees any segregated facilities at any of their establishments and that they will not permit their employees to perform their services at any location under their his control where segregated facilities are maintained. The DWR and the City agree lessee agrees that a breach of this certification is a violation of the Equal Employment Opportunity clause in of this MOAlease. As used in this certification, the term “"segregated facilities” means " means, but is not limited to, any waiting rooms, work areas, rest rooms and wash rooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, creedcolor, colorreligion, or national origin, because of habit, local custom, disability, or otherwise. The DWR and the City Lessee further agree agrees that (except where they have xxxxxx has obtained identical certifications from proposed contractors and subcontractors for specific time periods) they lessee will obtain identical certifications from proposed contractors and subcontractors prior to the award of contracts or subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Employment Opportunity clause; that they lessee will retain such certifications certification in their lessee's files; and that they lessee will forward the following notice to such proposed contractors and subcontractors (except where the proposed subcontractors have contractor or subcontractor has submitted identical certifications for at specific time periods): NOTICE TO PROSPECTIVE SUBCONTRACTORS OF REQUIREMENT FOR CERTIFICATIONS OF NONSEGREGATED FACILITIES ). Notice to prospective contractors and subcontractors of requirement for certification of nonsegregated facilities. A Certification of Nonsegregated Facilities Facilities, as required by the May 9, 1967, order (32 F.R. 7439, May 19, 1967) on Elimination of Segregated Facilities, by the Secretary of Labor, must be submitted prior to the award of a subcontract contract exceeding $10,000 which is not exempt from the provisions of the Equal Employment Opportunity clause. The certification Certification may be submitted either for each contract and subcontract or for all contracts and subcontracts during a period (i.e., quarterly, quarterly semiannually, or annually). Note: The penalty for making false statements in offers is prescribed in 18 U.S.C. § 1001.

CERTIFICATION OF NONSEGREGATED FACILITIES. a. The DWR Unisys agrees as follows: Unisys certifies that it does not and the City hereby certify that they do will not maintain or provide for their its employees any segregated facilities at any of its establishments establishments, and that they do it does not and will not permit their its employees to perform their services at any location under their its control where segregated facilities are maintained. They certify further that they will not maintain or provide for their employees any segregated facilities at any of their establishments and that they will not permit their employees to perform their services at any location under their control where segregated facilities are maintained. The DWR and the City agree Unisys agrees that a breach of this certification is a violation of the Equal Employment Opportunity clause in this MOArequired by Executive Order 11246 of September 24, 1965. As used in this certification, the term “segregated facilities” means any waiting rooms, work areas, rest rooms and wash rooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, creedcolor, colorreligion, or national origin, origin because of habit, local custom, disability, or otherwise. The DWR and the City Unisys further agree agrees that (except where they have it has obtained identical certifications from proposed subcontractors for specific time periods) they it will obtain identical certifications from proposed subcontractors prior to the award of subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Employment Opportunity clauseClause; that they will retain such certifications in their files; and that they it will forward the following notice to such proposed subcontractors (except where the proposed subcontractors have submitted identical certifications for specific time periods): NOTICE TO PROSPECTIVE SUBCONTRACTORS OF REQUIREMENT FOR CERTIFICATIONS OF NONSEGREGATED FACILITIES Notice to Prospective Subcontractors of Requirement For Certifications of Nonsegregated Facilities A Certification of Nonsegregated Facilities Facilities, as required by the May 21, 1968, order on Elimination of Segregated Facilities, by the Secretary of Labor (33 Fed. Reg. 7804, May 28, 1968), must be submitted prior to the award of a subcontract exceeding $10,000 which is not exempt from the provisions of the Equal Employment Opportunity clauseClause. The certification may be submitted either for each subcontract or for all subcontracts during a period (i.e., quarterly, semiannuallysemi-annually, or annually). NoteNOTE: The penalty for making false statements in offers is prescribed in 18 U.S.C. § Section 1001.

CERTIFICATION OF NONSEGREGATED FACILITIES. a. The DWR and the City Contractor hereby certify certifies that they do it does not maintain or provide for their its employees any segregated facilities at any of its establishments and that they do it does not permit their its employees to perform their services at any location under their its control where segregated facilities are maintained. They certify It certifies further that they it will not maintain or provide for their its employees any segregated facilities at any of their its establishments and that they it will not permit their its employees to perform their services at any location under their its control where segregated facilities are maintained. The DWR and the City agree Contractor agrees that a breach of this certification is a violation of the Equal Employment Opportunity clause in this MOAContract. As used in this certification, the term “"segregated facilities” " means any waiting rooms, work areas, rest rooms and wash rooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, creed, color, or national origin, because of habit, local custom, disability, or otherwise. The DWR and the City Contractor further agree agrees that (except where they have it has obtained identical certifications from proposed subcontractors for specific time periods) they it will obtain identical certifications from proposed subcontractors prior to the award of subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Employment Opportunity clause; that they it will retain such certifications in their its files; and that they it will forward the following notice to such proposed subcontractors (except where the proposed subcontractors have submitted identical certifications for specific time periods): periods):‌ NOTICE TO PROSPECTIVE SUBCONTRACTORS OF REQUIREMENT FOR CERTIFICATIONS OF NONSEGREGATED FACILITIES A Certification of Nonsegregated Facilities must be submitted prior to the award of a subcontract exceeding $10,000 which is not exempt from the provisions of the Equal Employment Opportunity clause. The certification may be submitted either for each subcontract or for all subcontracts during a period (i.e., quarterly, semiannually, or annually). Note: The penalty for making false statements in offers is prescribed in 18 U.S.C. § 1001.

CERTIFICATION OF NONSEGREGATED FACILITIES. a. The DWR By entering into this lease, the lessee certifies that he does not and the City hereby certify that they do will not maintain or provide for their his employees any segregated facilities at any of its establishments his establishments, and that they do he does not and will not permit their his employees to perform their services at any location under their control where segregated facilities are maintained. They certify further that they will not maintain or provide for their employees any segregated facilities at any of their establishments and that they will not permit their employees to perform their services at any location under their his control where segregated facilities are maintained. The DWR and the City agree lessee agrees that a breach of this certification is a violation of the Equal Employment Opportunity clause in of this MOAlease. As used in this certification, the term “"segregated facilities” means " means, but is not limited to, any waiting rooms, work areas, rest rooms and wash rooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, creedcolor, colorreligion, or national origin, because of habit, local custom, disability, or otherwise. The DWR and the City Leasee further agree agrees that (except where they have xxxxxx has obtained identical certifications from proposed contractors and subcontractors for specific time periods) they lessee will obtain identical certifications from proposed contractors and subcontractors prior to the award of contracts or subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Employment Opportunity clause; that they lessee will retain such certifications in their leasee's files; and that they lessee will forward the following notice to such proposed contractors and subcontractors (except where the proposed subcontractors have contractor or subcontractor has submitted identical certifications for specific time periods): NOTICE TO PROSPECTIVE SUBCONTRACTORS OF REQUIREMENT FOR CERTIFICATIONS OF NONSEGREGATED FACILITIES ). Notice to prospective contractors and subcontractors of requirement for certification of non-segregated facilities A Certification of Nonsegregated Facilities Facilities, as required by the May 9, 1967, order (32 F.R. 7439, May 19, 1967) on Elimination of Segregated Facilities, by the Secretary of Labor, must be submitted prior to the award of a subcontract contract exceeding $10,000 which is not exempt from the provisions of the Equal Employment Opportunity clause. The certification Certification may be submitted either for each contract and subcontract or for all contracts and subcontracts during a period (i.e., quarterly, semiannually, or annually). Note: The penalty for making false statements in offers is prescribed in 18 U.S.C. § 1001.

CERTIFICATION OF NONSEGREGATED FACILITIES. a. The DWR By entering into this lease, the lessee certifies that he does not and the City hereby certify that they do will not maintain or provide for their his employees any segregated facilities at any of its establishments his establishments, and that they do he does not and will not permit their his employees to perform their services at any location under their control where segregated facilities are maintained. They certify further that they will not maintain or provide for their employees any segregated facilities at any of their establishments and that they will not permit their employees to perform their services at any location under their his control where segregated facilities are maintained. The DWR and the City agree lessee agrees that a breach of this certification is a violation of the Equal Employment Opportunity clause in of this MOAlease. As used in this certification, the term “"segregated facilities” means " means, but is not limited to, any waiting rooms, work areas, rest rooms and wash rooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, creedcolor, colorreligion, or national origin, because of habit, local custom, disability, or otherwise. The DWR and the City Lessee further agree agrees that (except where they have lessee has obtained identical certifications from proposed contractors and subcontractors for specific time periods) they lessee will obtain identical certifications from proposed contractors and subcontractors prior to the award of contracts or subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Employment Opportunity clause; that they lessee will retain such certifications in their lessee's files; and that they lessee will forward the following notice to such proposed contractors and subcontractors (except where the proposed subcontractors have contractor or subcontractor has submitted identical certifications for specific time periods): NOTICE TO PROSPECTIVE SUBCONTRACTORS OF REQUIREMENT FOR CERTIFICATIONS OF NONSEGREGATED FACILITIES ). Notice to Prospective Contractors and Subcontractors of Requirement for Certification of Nonsegregated Facilities. A Certification of Nonsegregated Facilities Facilities, as required by the May 9, 1967, order (32 F.R. 7439, May 19, 1967) on Elimination of Segregated Facilities, by the Secretary of Labor, must be submitted prior to the award of a subcontract contract exceeding $10,000 which is not exempt from the provisions of the Equal Employment Opportunity clause. The certification Certification may be submitted either for each contract and subcontract or for all contracts and subcontracts during a period (i.e., quarterly, semiannually, or annually). Note: The penalty for making false statements in offers is prescribed in 18 U.S.C. § 1001.

CERTIFICATION OF NONSEGREGATED FACILITIES. a. The DWR and the City hereby certify federally-assisted construction contractor certifies that they do she or he does not maintain or provide provide, for their employees his employees, any segregated facilities at any of its his establishments and that they do she or he does not permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. The federally-assisted construction contractor certifies that she or he will not maintain or provide, for his employees, segregated facilities at any of his establishments and that she or he will not permit his employees to perform their services at any location under their control where segregated facilities are maintained. They certify further that they will not maintain or provide for their employees any segregated facilities at any of their establishments and that they will not permit their employees to perform their services at any location under their his control where segregated facilities are maintained. The DWR and the City agree federally-assisted construction contractor agrees that a breach of this certification is a violation of the Equal Employment Opportunity clause Clause in this MOAcontract. As used in this certification, the term “"segregated facilities” " means any waiting rooms, work areas, rest rooms restrooms, and wash roomswashrooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive directives or are are, in fact fact, segregated on the basis of race, creedcolor, colorreligion, or national origin, origin because of habit, local custom, disability, or otherwiseany other reason. The DWR and the City further agree federally-assisted construction contractor agrees that (except where they have she or he has obtained identical certifications from proposed subcontractors for specific time periods) they she or he will obtain identical certifications from proposed subcontractors prior to the award of subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Employment Opportunity clause; Clause and that they she or he will retain such certifications in their his files; . OCCUPATIONAL SAFETY AND HEALTH ACT OF 1970 (Reference 20 CFR part 1910) APPLICABILITY. The United States Department of Labor Occupational Safety & Health Administration (OSHA) oversees the workplace health and that they will forward the following notice to such proposed subcontractors (except where the proposed subcontractors have submitted identical certifications for specific time periods): NOTICE TO PROSPECTIVE SUBCONTRACTORS OF REQUIREMENT FOR CERTIFICATIONS OF NONSEGREGATED FACILITIES A Certification of Nonsegregated Facilities must be submitted prior to the award of a subcontract exceeding $10,000 which is not exempt safety standards wage provisions from the provisions Occupational Safety and Health Act of 1970. All contracts and subcontracts must meet comply with the Equal Employment Opportunity clause. The certification may be submitted either for each subcontract or for all subcontracts during a period (i.e., quarterly, semiannually, or annually). Note: The penalty for making false statements in offers is prescribed in 18 U.S.C. § 1001Occupational Safety and Health Act of 1970.

CERTIFICATION OF NONSEGREGATED FACILITIES. a. The DWR and the City hereby certify federally-assisted construction contractor certifies that they do she or he does not maintain or provide provide, for their employees his employees, any segregated facilities at any of its his establishments and that they do she or he does not permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. The federally-assisted construction contractor certifies that she or he will not maintain or provide, for his employees, segregated facilities at any of his establishments and that she or he will not permit his employees to perform their services at any location under their control where segregated facilities are maintained. They certify further that they will not maintain or provide for their employees any segregated facilities at any of their establishments and that they will not permit their employees to perform their services at any location under their his control where segregated facilities are maintained. The DWR and the City agree federally-assisted construction contractor agrees that a breach of this certification is a violation of the Equal Employment Opportunity clause Clause in this MOAcontract. As used in this certification, the term “"segregated facilities” " means any waiting rooms, work areas, rest rooms restrooms, and wash roomswashrooms, restaurants and other eating areas, time clockstimeclocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive directives or are are, in fact fact, segregated on the basis of race, creedcolor, colorreligion, or national origin, origin because of habit, local custom, disability, or otherwiseany other reason. The DWR and the City further agree federally-assisted construction contractor agrees that (except where they have she or he has obtained identical certifications from proposed subcontractors Sub-contractors for specific time periods) they she or he will obtain identical certifications from proposed subcontractors Sub-contractors prior to the award of subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Employment Opportunity clause; Clause and that they she or he will retain such certifications in their his files; . Application Incorporate in all construction contracts and subcontracts that they will forward the following notice to such proposed subcontractors (except where the proposed subcontractors have submitted identical certifications for specific time periods): NOTICE TO PROSPECTIVE SUBCONTRACTORS OF REQUIREMENT FOR CERTIFICATIONS OF NONSEGREGATED FACILITIES A Certification of Nonsegregated Facilities must be submitted prior to the award of a subcontract exceeding exceed $10,000 which is not exempt from the provisions of the Equal Employment Opportunity clause10,000. The notices should be placed within the solicitation for proposals. The actual certification may should be submitted either for each subcontract or for all subcontracts during a period (i.e.incorporated in the contract agreement. Reference Executive Order 11246 41 CFR Part 60 -1.8 AC 150/5100-15, quarterly, semiannually, or annually)Para. Note: The penalty for making false statements in offers is prescribed in 18 U.S.C. § 100122.b.

CERTIFICATION OF NONSEGREGATED FACILITIES. a. The DWR Supplier/Contractor certifies that it does not and the City hereby certify that they do will not maintain or provide for their its employees any segregated facilities at any of its establishments establishments, and that they do it does not and will not permit their its employees to perform their services at any location under their control where segregated facilities are maintained. They certify further that they will not maintain or provide for their employees any segregated facilities at any of their establishments and that they will not permit their employees to perform their services at any location under their control its control, where segregated facilities are maintained. The DWR and the City agree bidder, offeror, applicant, or subcontractor agrees that a breach of this certification is a violation of the Equal Employment Opportunity clause Clause in this MOAcontract. As used in this certification, the term “"segregated facilities” means " means, but is not limited to, any waiting rooms, work areas, rest rooms rooms, and wash rooms, restaurants and other eating areas, time clocks, locker rooms rooms, and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, transportation and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, creed, colorcolor or national origin by explicit direction, or national origin, are in fact segregated because of habit, local custom, disability, or otherwise. The DWR and the City It further agree certifies that (except where they have it has obtained identical certifications from proposed subcontractors for specific time periods) they it will obtain identical certifications from proposed subcontractors prior to the award of subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Employment Opportunity clauseClause; that they it will retain such certifications certification in their its files; and that they it will forward the following notice to such proposed subcontractors (except where the proposed subcontractors have submitted identical certifications for specific time periods): ). “NOTICE TO PROSPECTIVE SUBCONTRACTORS OF REQUIREMENT FOR CERTIFICATIONS OF NONSEGREGATED FACILITIES FACILITIES” A Certification certification of Nonsegregated Facilities must be submitted prior to before the award of a subcontract exceeding $10,000 under which is not exempt from the provisions of subcontractor will be subject to the Equal Employment Opportunity clauseClause. The certification may be submitted either for each subcontract or for all subcontracts during a period (i.e., quarterly, semiannually, semi-annually or annually). Note: The penalty for making false statements in offers is prescribed in 18 U.S.C. § 1001X.X.X 0000.

CERTIFICATION OF NONSEGREGATED FACILITIES. a. The DWR and the City Contractor hereby certify certifies that they do it does not maintain or provide for their its employees any segregated facilities at any of its establishments and that they do it does not permit their its employees to perform their services at any location under their its control where segregated facilities are maintained. They certify It certifies further that they it will not maintain or provide for their its employees any segregated facilities at any of their its establishments and that they it will not permit their its employees to perform their services at any location under their its control where segregated facilities are maintained. The DWR and the City agree Contractor agrees that a breach of this certification is a violation of the Equal Employment Opportunity clause in this MOAcontract. As used in this certification, the term “"segregated facilities” " means any waiting rooms, work areas, rest rooms and wash rooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, creed, color, or national origin, because of habit, local custom, disability, or otherwise. The DWR and the City Contractor further agree agrees that (except where they have it has obtained identical certifications from proposed subcontractors for specific time periods) they it will obtain identical certifications from proposed subcontractors prior to the award of subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Employment Opportunity clause; that they it will retain such certifications in their its files; and that they it will forward the following notice to such proposed subcontractors (except where the proposed subcontractors have submitted identical certifications for specific time periods): NOTICE TO PROSPECTIVE SUBCONTRACTORS OF REQUIREMENT FOR CERTIFICATIONS OF NONSEGREGATED FACILITIES A Certification of Nonsegregated Facilities must be submitted prior to the award of a subcontract exceeding $10,000 which is not exempt from the provisions of the Equal Employment Opportunity clause. The certification may be submitted either for each subcontract or for all subcontracts during a period (i.e., quarterly, semiannually, or annually). Note: The penalty for making false statements in offers is prescribed in 18 U.S.C. § 1001.

CERTIFICATION OF NONSEGREGATED FACILITIES. a. The DWR and the City hereby certify Seller certifies that they do it does not maintain or provide for their its employees any segregated facilities at any of its establishments establishments, and that they do it does not permit their its employees to perform their services at any location locations, under their control its control, where segregated facilities are maintained. They certify It certifies further that they it will not maintain or provide for their its employees any segregated facilities at any of their establishments its establishments, and that they it will not permit their its employees to perform their services at any location location, under their control its control, where segregated facilities are maintained. The DWR and the City agree bidder, offeror, applicant, or subcontractor agrees that a breach of this certification is a violation of the Equal Employment Opportunity clause Clause in this MOAcontract. As used in this certification, the term “"segregated facilities” " means any waiting rooms, work areas, rest rooms rooms, and wash rooms, restaurants restaurant and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, creedcolor, colorreligion, or national origin, because of habit, local custom, disability, or otherwise. The DWR and the City It further agree agrees that (except where they have it has obtained identical certifications certification from proposed subcontractors for a specific time periodsperiod) they it will obtain identical certifications from proposed subcontractors prior to the award of subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Employment Opportunity clause; Clause that they it will retain such certifications in their its files; and that they hat it will forward the following notice to such proposed subcontractors (except where the proposed subcontractors have submitted identical certifications for specific time periods): : NOTICE TO PROSPECTIVE SUBCONTRACTORS OF REQUIREMENT OR REQUIREMENTS FOR CERTIFICATIONS CERTIFICATION OF NONSEGREGATED FACILITIES A Certification certification of Nonsegregated Facilities nonsegregated facilities must be submitted prior to the award of a subcontract exceeding $10,000 which is not exempt from the provisions of the Equal Employment Opportunity clauseClause. The certification may be submitted either for each subcontract or for all subcontracts during a period (i.e., quarterly, semiannuallysemi-annually, or annually). NoteNOTE: The the penalty for making false statements in offers is prescribed in 18 U.S.C. § 1001.

CERTIFICATION OF NONSEGREGATED FACILITIES. a. The DWR and the City Contractor hereby certify certifies that they do it does not maintain or provide for their its employees any segregated facilities at any of its establishments and that they do it does not permit their its employees to perform their services at any location under their its control where segregated facilities are maintained. They certify It certifies further that they it will not maintain or provide for their its employees any segregated facilities at any of their its establishments and that they it will not permit their its employees to perform their services at any location under their its control where segregated facilities are maintained. The DWR and the City agree Contractor agrees that a breach of this certification is a violation of the Equal Employment Opportunity clause in this MOAContract. As used in this certification, the term “segregated facilities” means any waiting rooms, work areas, rest rooms and wash rooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, creed, color, or national origin, because of habit, local custom, disability, or otherwise. The DWR and the City Contractor further agree agrees that (except where they have it has obtained identical certifications from proposed subcontractors for specific time periods) they it will obtain identical certifications from proposed subcontractors prior to the award of subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Employment Opportunity clause; that they it will retain such certifications in their its files; and that they it will forward the following notice to such proposed subcontractors (except where the proposed subcontractors have submitted identical certifications for specific time periods): NOTICE TO PROSPECTIVE SUBCONTRACTORS OF REQUIREMENT FOR CERTIFICATIONS OF NONSEGREGATED FACILITIES A Certification of Nonsegregated Facilities must be submitted prior to the award of a subcontract exceeding $10,000 which is not exempt from the provisions of the Equal Employment Opportunity clause. The certification may be submitted either for each subcontract or for all subcontracts during a period (i.e., quarterly, semiannually, or annually). Note: The penalty for making false statements in offers is prescribed in 18 U.S.C. § 1001.

CERTIFICATION OF NONSEGREGATED FACILITIES. a. The DWR and As a condition for performance under this agreement, the City hereby certify Cooperator certifies that they do he or she does not maintain or provide for their his or her employees any segregated facilities at any of its establishments his or her establishments, and that they do he or she does not permit their let his or her employees to perform their services work at any location under their his or her control where segregated facilities are maintained. They certify He or she certifies further that they he or she will not maintain or provide for their his or her employees any segregated facilities at any of their establishments his establishments, and that they he or she will not permit their let his or her employees to perform their services work at any location under their his or her control where segregated facilities are maintained. The DWR and the City agree Cooperator agrees that a breach of this certification is a violation of violates the Equal Employment Opportunity equal opportunity clause in this MOAagreement. As used in this certification, the term “segregated facilities” means any waiting rooms, work areas, rest rooms restrooms and wash rooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, creedcolor, colorreligion, or national origin, because of habit, local custom, disability, or otherwise. The DWR and the City Cooperator further agree agrees that (except where they have obtained identical certifications from proposed subcontractors for specific time periods) they he or she will obtain identical certifications from proposed subcontractors prior to the award of subcontractors, if any, before awarding subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Employment Opportunity equal opportunity clause; , and that they he or she will retain such certifications certification in their his or her files; and that they will forward the following notice to such proposed subcontractors (except where the proposed subcontractors have submitted identical certifications for specific time periods): NOTICE TO PROSPECTIVE SUBCONTRACTORS OF REQUIREMENT FOR CERTIFICATIONS OF NONSEGREGATED FACILITIES A Certification of Nonsegregated Facilities must be submitted prior to the award of a subcontract exceeding $10,000 which is not exempt from the provisions of the Equal Employment Opportunity clause. The certification may be submitted either for each subcontract or for all subcontracts during a period (i.e., quarterly, semiannually, or annually). Note: The penalty for making false statements in offers is prescribed in 18 U.S.C. § 1001. __________________________________________________ ________________ Cooperator/Corporate Officer’s Signature Date __________________________________________________ Please Print Name and Title Notification to MRPBS/FMD/FOB/FOST to Close Cooperator’s Account for Quarantine Facilities for Commercial Birds, Poultry, and Avian Eggs for Hatching This affirms that the accounting records contained in the current APHIS system for accounting and cost management reflect all charges for the account noted below have cleared, activities have concluded, and the cooperator agrees with this request for closure. Please process a final billing or provide a refund as applicable. Cooperator/Corporate Officer’s Name: ____________________________________________ FMMI WBS Element: ___________________________ Quarantine Period (inclusive dates): _____________________________________ Current Account Balance: _________________________________ If the cooperator has a positive balance, please select from the following options: ___ Refund blance to cooperator ___ Transfer balance to another of the Cooperator’s open TF accounts, as referenced below: FMMI WBS Element: _________________________ Cooperator/Corporate Officer’s Billing Address: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ Requestor’s Name: ___________________________________________ Requestor’s Signature: _________________________________________ Date Signed: ____________________ Send scanned form to: XXXX.XX.XXXX@XXXXX.XXXX.XXX Memorandum for Incoming Funds FISCAL YEAR ______ PENDING AWARDS Agreement No.: _______________ Quarantine Period Start Date:_______________ Cooperator Name:______________________________ Funding Deposit: $_____.___

CERTIFICATION OF NONSEGREGATED FACILITIES. a. The DWR By entering into this lease, the lessee certifies that he does not and the City hereby certify that they do will not maintain or provide for their his employees any segregated facilities at any of its establishments his establishments, and that they do he does not and will not permit their his employees to perform their services at any location under their control where segregated facilities are maintained. They certify further that they will not maintain or provide for their employees any segregated facilities at any of their establishments and that they will not permit their employees to perform their services at any location under their his control where segregated facilities are maintained. The DWR and the City agree lessee agrees that a breach of this certification is a violation of the Equal Employment Opportunity clause in of this MOAlease. As used in this certification, the term “"segregated facilities” means " means, but is not limited to, any waiting rooms, work areas, rest rooms and wash rooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, creedcolor, colorreligion, or national origin, because of habit, local custom, disability, or otherwise. The DWR and the City Leasee further agree agrees that (except where they have xxxxxx has obtained identical certifications from proposed contractors and subcontractors for specific time periods) they lessee will obtain identical certifications from proposed contractors and subcontractors prior to the award of contracts or subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Employment Opportunity clause; that they lessee will retain such certifications certification in their leasee's files; and that they lessee will forward the following notice to such proposed contractors and subcontractors (except where the proposed subcontractors have contractor or subcontractor has submitted identical certifications certificates for specific time periods): NOTICE TO PROSPECTIVE SUBCONTRACTORS OF REQUIREMENT FOR CERTIFICATIONS OF NONSEGREGATED FACILITIES ). Notice to prospective contractors and subcontractors of requirement for certification of nonsegregated facilities. A Certification of Nonsegregated Facilities Facilities, as required by the May 9, 1967, order (32 F.R. 7439, May 19, 1967) on Elimination of Segregated Facilities, by the Secretary of Labor, must be submitted prior to the award of a subcontract exceeding contract excluding $10,000 which is not exempt from the provisions of the Equal Employment Opportunity clause. The certification Certification may be submitted either for each contract and subcontract or for all contracts and subcontracts during a period (i.e., quarterly, quarterly semiannually, or annually). Note: The penalty for making false statements in offers is prescribed in 18 U.S.C. § 1001.

CERTIFICATION OF NONSEGREGATED FACILITIES. a. 296 21. The DWR and the City Contractors hereby certify certifies that they do it does not maintain or provide for their its 297 employees any segregated facilities at any of its establishments and that they do it does not permit their its 298 employees to perform their services at any location under their its control where segregated facilities 299 are maintained. They certify It certifies further that they it will not maintain or provide for their its employees any 300 segregated facilities at any of their its establishments and that they it will not permit their its employees to 301 perform their services at any location under their its control where segregated facilities are 302 maintained. The DWR and the City Contractors agree that a breach of this certification is a violation of the Equal 303 Employment Opportunity clause in this MOAcontract. As used in this certification, the term “304 "segregated facilities” " means any waiting rooms, work areas, rest rooms and wash rooms, 305 restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, 306 parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing 307 facilities provided for employees which are segregated by explicit directive or are in fact 308 segregated on the basis of race, creed, color, or national origin, because of habit, local custom, 309 disability, or otherwise. The DWR and the City Contractor further agree agrees that (except where they have it has obtained 310 identical certifications from proposed subcontractors for specific time periods) they it will obtain 311 identical certifications from proposed subcontractors prior to the award of subcontracts 312 exceeding $10,000 which are not exempt from the provisions of the Equal Employment 313 Opportunity clause; that they it will retain such certifications in their its files; and that they it will forward the 314 following notice to such proposed subcontractors (except where the proposed subcontractors 315 have submitted identical certifications for specific time periods): 316 NOTICE TO PROSPECTIVE SUBCONTRACTORS OF 317 REQUIREMENT FOR CERTIFICATIONS OF NONSEGREGATED 318 FACILITIES 319 A Certification of Nonsegregated Facilities must be submitted prior to the 320 award of a subcontract exceeding $10,000 which is not exempt from the 321 provisions of the Equal Employment Opportunity clause. The certification may 322 be submitted either for each subcontract or for all subcontracts during a period 323 (i.e., quarterly, semiannually, or annually). Note: The penalty for making false 324 statements in offers is prescribed in 18 U.S.C. § 1001.. 325 MEDIUM FOR TRANSMITTING PAYMENTS