Common use of Commercial Vehicle Operators Clause in Contracts

Commercial Vehicle Operators. Employees who operate commercial vehicles for the company are subject to testing as required for general employees. Drivers are also subject to testing as required by federal and state statutes. Refusal to submit to testing in any of the above circumstances, or a positive test, is grounds for termination. An employee may become eligible for rehire upon completion of the company’s Employee Assistance Program. ATTACHMENT “B” continued PROJECT: PROJECT SUBCONTRACTOR XX/XX/XXXX ALCOHOL, DRUG, AND BACKGROUND SCREENING PROGRAM B ackground Screening Subcontractor shall ensure that background checks are conducted in compliance with all applicable federal, state, and local laws and regulations. Subcontractor shall ensure that background checks are conducted on employees covering the counties, states, and/or countries in which the person was employed or resided for the past seven (7) to ten (10) years. Subcontractor shall require the same of independent contractor(s) or additional tiered subcontractor(s). Anyone on a sex offender registry is not permitted on M. B. Xxxx job-sites. Contractor reserves the right to verify that all employees, 1099 contractors of any subcontractor, and temporary laborers have been screened. Contractor may randomly select subcontractors on a quarterly basis and require an additional affidavit of compliance with the background screening procedures. Owner/Client Requirement: Additional background screening(s) may be required of subcontractors as required by owner/client. S UBCONTRACTOR X . X. XXXX CONSTRUCTION CO., INC. Authorized Subcontractor’s Signature PROJECT MANAGER Project Manager ATTACHMENT “C” PROJECT: PROJECT SUBCONTRACTOR XX/XX/XXXX NPDES GENERAL PERMIT NPDES GENERAL PERMIT FOR STORM WATER DISCHARGES FROM CONSTRUCTION ACTIVITIES THAT ARE CLASSIFIED AS “ASSOCIATED WITH INDUSTRIAL ACTIVITY” BY EPA REGULATION (PERMIT No.(********)) CO-PERMITTEE AGREEMENT All contractors and subcontractors of the owner/operator whose activities at the construction site may impact storm water discharges or controls at the construction site along the duration of the construction project, shall sign a copy of the certification statement given below: “I certify by my signature below that I accept the terms and conditions of the Storm Water Pollution Prevention Plan (SWPPP) as required by the general National Pollutant Discharge Elimination System (NPDES Permit No. (********)) issued to the owner/operator of the construction activity for which I have been contracted to perform construction related professional services. Further, by my signature below, I understand that I am becoming a co-permittee with the owner/operator and other contractors that have been co-permittees to the general NPDES permit issued to the owner/operator of the facility for which I have been contracted to perform professional construction services. As a co-permittee, I understand that I, and my company, as the case may be, are legally accountable to the Tennessee Department of Environment and Conservation (TDEC) under the authorities of the federal Clean Water Act and the TN Water Pollution Act, to ensure compliance with the terms and conditions of the SWPPP. I also understand that TDEC enforcement actions may be taken against any specific co-permittee or combination of co-permittees if the terms and conditions of the SWPPP are not met. Therefore, having understood the above information, I am signing this certification and am receiving co-permittee status to the aforementioned general permit.” The date of the signature, the title of the person providing the signature, and the name, address, and telephone number of the contracted firm, shall also be provided. In the event the SWPPP is amended by the owner, such amendments should be incorporated to the plan and the contractors and subcontractors should acknowledge by signature. The signatory requirements of Permit No.(********) are applicable to each contracted entity that must sign the contractor’s certification statement. Upon signing the certification, the contractor is a co-permittee and becomes accountable to TDEC to ensure the terms and conditions of Permit No. (********) are implemented. All co-permittees are subject to TDEC enforcement actions if Permit No. (********) conditions are not met. Enforcement actions may be taken against any specific co-permittee or combination of co-permittees, with consideration given to the party responsible for the violation. The owner/operator submitting the NOI shall retain all contractor certifications for at least three years after a contractor has completed work at the site. Copies of all contractor certifications and a copy of Permit No. (********) shall be retained on the site of the construction activity. The owner/operator of the construction project covered by Permit No. (********) shall make all contractor certifications available upon request to TDEC. CONTRACTOR’S CERTIFICATION Certification as co-permittee with XXXXX under the Tennessee NPDES General Permit for Storm Water Discharges from Construction Activities that are classified as “Associated with Industrial Activity” by EPA Regulation (Permit No. ********). I certify under penalty of law that I understand the terms and conditions of the National Pollutant Discharge Elimination System (NPDES) permit that authorizes the storm water discharges associated with industrial activity from the construction project of the owner/operator identified as part of this certification. S UBCONTRACTOR X . X. XXXX CONSTRUCTION CO., INC. Authorized Subcontractor’s Signature PROJECT MANAGER Project Manager ATTACHMENT “D” PROJECT: PROJECT SUBCONTRACTOR XX/XX/XXXX ILLEGAL IMMIGRATION REFORM The Subcontractor will require all employees to complete an I-9 form, confirming identity and employment eligibility, within three days of hire. The Subcontractor will comply with all federal, state, and local employment verification laws. If federal funds are involved in this project, the Subcontractor will participate in E-Verify, the Internet-based system operated by the federal government that electronically verifies employment eligibility. The Subcontractor agrees to provide any documentation required to establish the applicability and compliance of these requirements to its Sub-subcontractor, and agrees to include in any contracts with its Sub-subcontractors language requiring those Sub-subcontractors to also comply with these requirements. S UBCONTRACTOR X . X. XXXX CONSTRUCTION CO., INC. Authorized Subcontractor’s Signature PROJECT MANAGER Project Manager P O BOX 1179, COLUMBIA, SC 29202 PHONE 000-000-0000 – FAX 000-000-0000 SUBCONTRACTOR APPLICATION FOR PAYMENT REMIT TO: DATE: Vendor Id MBK Job ID Vendor Name SUBCONTRACTOR Project Name PROJECT Remit Address Project Address For the Billing Period through Start Date End Date We, or I, certify that the listed work is in place and the materials stored. CODE DESCRIPTION OF WORK CONTRACT AMOUNT COMPLETED TO DATE TOTAL

Commercial Vehicle Operators. Employees who operate commercial vehicles for the company are subject to testing as required for general employees. Drivers are also subject to testing as required by federal and state statutes. Refusal to submit to testing in any of the above circumstances, or a positive test, is grounds for termination. An employee may become eligible for rehire upon completion of the company’s Employee Assistance Program. ATTACHMENT “B” continued PROJECT: PROJECT SUBCONTRACTOR XXMM/XXDD/XXXX YYYY ALCOHOL, DRUG, AND BACKGROUND SCREENING PROGRAM B ackground Background Screening Subcontractor shall ensure that background checks are conducted in compliance with all applicable federal, state, and local laws and regulations. Subcontractor shall ensure that background checks are conducted on employees covering the counties, states, and/or countries in which the person was employed or resided for the past seven (7) to ten (10) years. Subcontractor shall require the same of independent contractor(s) or additional tiered subcontractor(s). Anyone on a sex offender registry is not permitted on M. B. Xxxx job-sites. Contractor reserves the right to verify that all employees, 1099 contractors of any subcontractor, and temporary laborers have been screened. Contractor may randomly select subcontractors on a quarterly basis and require an additional affidavit of compliance with the background screening procedures. Owner/Client Requirement: Additional background screening(s) may be required of subcontractors as required by owner/client. S UBCONTRACTOR X . X. SUBCONTRACTOR M. B. XXXX CONSTRUCTION CO., INC. Authorized Subcontractor’s Signature PROJECT MANAGER Project Manager ATTACHMENT “C” PROJECT: PROJECT SUBCONTRACTOR XXMM/XXDD/XXXX YYYY NPDES GENERAL PERMIT NPDES GENERAL PERMIT FOR STORM WATER DISCHARGES FROM CONSTRUCTION ACTIVITIES THAT ARE CLASSIFIED AS “ASSOCIATED WITH INDUSTRIAL ACTIVITY” BY EPA REGULATION (PERMIT No.(********)) CO-PERMITTEE AGREEMENT All contractors and subcontractors of the owner/operator whose activities at the construction site may impact storm water discharges or controls at the construction site along the duration of the construction project, shall sign a copy of the certification statement given below: “I certify by my signature below that I accept the terms and conditions of the Storm Water Pollution Prevention Plan (SWPPP) as required by the general National Pollutant Discharge Elimination System (NPDES Permit No. .(********)) issued to the owner/operator of the construction activity for which I have been contracted to perform construction related professional services. Further, by my signature below, I understand that I am becoming a co-permittee with the owner/operator and other contractors that have been co-permittees to the general NPDES permit issued to the owner/operator of the facility for which I have been contracted to perform professional construction services. As a co-permittee, I understand that I, and my company, as the case may be, are legally accountable to the Tennessee NC Department of Environment and Conservation Natural Resources (TDEC) DENR), under the authorities of the federal Clean Water Act and the TN Water NC Sedimentation Pollution Control Act, to ensure compliance with the terms and conditions of the SWPPP. I also understand that TDEC DENR enforcement actions may be taken against any specific co-permittee or combination of co-permittees if the terms and conditions of the SWPPP are not met. Therefore, having understood the above information, I am signing this certification and am receiving co-permittee status to the aforementioned general permit.” The date of the signature, the title of the person providing the signature, and the name, address, and telephone number of the contracted firm, shall also be provided. In the event the SWPPP is amended by the owner, such amendments should be incorporated to the plan and the contractors and subcontractors should acknowledge by signature. The signatory requirements of North Carolina’s Sedimentation Pollution Control Program, as provided in Part VI.G of Permit No.(********) ), are applicable to each contracted entity that must sign the contractor’s certification statement. Upon signing the certification, the contractor is a co-permittee and becomes accountable to TDEC DENR to ensure the terms and conditions of Permit No. (********) are No.(********)are implemented. All co-co- permittees are subject to TDEC DENR enforcement actions if Permit No. (********) conditions No.(********)conditions are not met. Enforcement actions may be taken against any specific co-permittee or combination of co-permittees, with consideration given to the party responsible for the violation. The owner/operator submitting the NOI shall retain all contractor certifications for at least three years after a contractor has completed work at the site. Copies of all contractor certifications and a copy of Permit No. .(********) shall be retained on the site of the construction activity. The owner/operator of the construction project covered by Permit No. .(********) shall make all contractor certifications available upon request to TDECDENR. CONTRACTOR’S CERTIFICATION Certification as co-permittee with XXXXX XXXX under the Tennessee North Carolina NPDES General Permit for Storm Water Discharges from Construction Activities that are classified as “Associated with Industrial Activity” by EPA Regulation (Permit No. ********). I certify under penalty of law that I understand the terms and conditions of the National Pollutant Discharge Elimination System (NPDES) permit that authorizes the storm water discharges associated with industrial activity from the construction project of the owner/operator identified as part of this certification. S UBCONTRACTOR X . X. SUBCONTRACTOR M. B. XXXX CONSTRUCTION CO., INC. Authorized Subcontractor’s Signature PROJECT MANAGER Project Manager ATTACHMENT “D” PROJECT: PROJECT SUBCONTRACTOR XXMM/XXDD/XXXX YYYY ILLEGAL IMMIGRATION REFORM The Contractor is committed to the following, and the Subcontractor certifies that it will comply with the following: The Subcontractor will require all employees to complete an I-9 form, confirming identity and employment eligibility, within three days of hire. The Subcontractor will comply with all federal, state, and local employment verification laws. If federal funds are involved in this project, the Subcontractor will participate in E-Verify, the Internet-based system operated by the federal government that electronically verifies employment eligibility. The Subcontractor agrees to provide any documentation required to establish the applicability and compliance of these requirements to its Sub-subcontractor, and agrees to include in any contracts with its Sub-subcontractors language requiring those Sub-subcontractors to also comply with these requirements. S UBCONTRACTOR X . X. SUBCONTRACTOR M. B. XXXX CONSTRUCTION CO., INC. Authorized Subcontractor’s Signature PROJECT MANAGER Project Manager P O BOX 1179ATTACHMENT “E” PROJECT: MM/DD/YYYY CONTRACTOR’S PROJECT STATEMENT M. B. Xxxx Construction Co., COLUMBIAInc. (hereinafter, SC 29202 PHONE 000-000-0000 – FAX 000-000-0000 SUBCONTRACTOR APPLICATION FOR PAYMENT REMIT TO: DATE: Vendor Id MBK Job ID Vendor Name SUBCONTRACTOR “Contractor”), pursuant to G.S. 44A-27(f) hereby provides the following statement in connection with the project described below. Please forward a copy of this Contractor’s Project Name PROJECT Remit Address Project Address For the Billing Period through Start Date End Date WeStatement to all subcontractors and/or suppliers, or I, certify and remote claimants that the listed work is in place and the you contract with to provide services and/or materials stored. CODE DESCRIPTION OF WORK CONTRACT AMOUNT COMPLETED TO DATE TOTALfor this project.

Commercial Vehicle Operators. Employees who operate commercial vehicles for the company are subject to testing as required for general employees. Drivers are also subject to testing as required by federal and state statutes. Refusal to submit to testing in any of the above circumstances, or a positive test, is grounds for termination. An employee may become eligible for rehire upon completion of the company’s Employee Assistance Program. ATTACHMENT “B” continued PROJECT: PROJECT SUBCONTRACTOR XXMM/XXDD/XXXX YYYY ALCOHOL, DRUG, AND BACKGROUND SCREENING PROGRAM B ackground Background Screening Subcontractor shall ensure that background checks are conducted in compliance with all applicable federal, state, and local laws and regulations. Subcontractor shall ensure that background checks are conducted on employees covering the counties, states, and/or countries in which the person was employed or resided for the past seven (7) to ten (10) years. Subcontractor shall require the same of independent contractor(s) or additional tiered subcontractor(s). Anyone on a sex offender registry is not permitted on M. B. Xxxx job-sites. Contractor reserves the right to verify that all employees, 1099 contractors of any subcontractor, and temporary laborers have been screened. Contractor may randomly select subcontractors on a quarterly basis and require an additional affidavit of compliance with the background screening procedures. Owner/Client Requirement: Additional background screening(s) may be required of subcontractors as required by owner/client. S UBCONTRACTOR X . X. M. B. XXXX CONSTRUCTION CO., INC. Authorized Subcontractor’s Signature PROJECT MANAGER Project Manager ATTACHMENT “C” PROJECT: PROJECT SUBCONTRACTOR XXMM/XXDD/XXXX YYYY NPDES GENERAL PERMIT NPDES GENERAL PERMIT FOR STORM WATER DISCHARGES FROM CONSTRUCTION ACTIVITIES THAT ARE CLASSIFIED AS “ASSOCIATED WITH INDUSTRIAL ACTIVITY” BY EPA REGULATION (PERMIT No.. (********)) CO-PERMITTEE AGREEMENT All contractors and subcontractors of the owner/operator whose activities at the construction site may impact storm water discharges or controls at the construction site along the duration of the construction project, shall sign a copy of the certification statement given below: “I certify by my signature below that I accept the terms and conditions of the Storm Water Pollution Prevention Plan (SWPPP) as required by the general National Pollutant Discharge Elimination System (NPDES Permit No. (********)) issued to the owner/operator of the construction activity for which I have been contracted to perform construction related professional services. Further, by my signature below, I understand that I am becoming a co-permittee with the owner/operator and other contractors that have been co-permittees to the general NPDES permit issued to the owner/operator of the facility for which I have been contracted to perform professional construction services. As a co-permittee, I understand that I, and my company, as the case may be, are legally accountable to the Tennessee Virginia Department of Environment Conservation and Conservation Recreation (TDEC) DCR), under the authorities of the federal Clean Water Act and the TN Water Pollution Virginia Polluction Control Act, to ensure compliance with the terms and conditions of the SWPPP. I also understand that TDEC DCR enforcement actions may be taken against any specific co-permittee or combination of co-permittees if the terms and conditions of the SWPPP are not met. Therefore, having understood the above information, I am signing this certification and am receiving co-permittee status to the aforementioned general permit.” The date of the signature, the title of the person providing the signature, and the name, address, and telephone number of the contracted firm, shall also be provided. In the event the SWPPP is amended by the owner, such amendments should be incorporated to the plan and the contractors and subcontractors should acknowledge by signature. The signatory requirements of Georgia’s Virginia Erosion and Sediment Control Law (ESC) (VA Code 10.1-560 et. seq.) and Storm Water Management Law (SWM) (VA Code 10.1-603 et. Seq.) and the Virginia Storm Water Management Program (VSWP) permit regulations, as provided in Part VI.G of Permit No.. (********) ), are applicable to each contracted entity that must sign the contractor’s certification statement. Upon signing the certification, the contractor is a co-permittee and becomes accountable to TDEC DCR to ensure the terms and conditions of Permit No. (********) )are implemented. All co-permittees are subject to TDEC DCR enforcement actions if Permit No. (********) )conditions are not met. Enforcement actions may be taken against any specific co-permittee or combination of co-permittees, with consideration given to the party responsible for the violation. The owner/operator submitting the NOI shall retain all contractor certifications for at least three years after a contractor has completed work at the site. Copies of all contractor certifications and a copy of Permit No. (********) shall be retained on the site of the construction activity. The owner/operator of the construction project covered by Permit No. (********) shall make all contractor certifications available upon request to TDECDCR. CONTRACTOR’S CERTIFICATION Certification as co-permittee with XXXXX OWNER under the Tennessee Virginia NPDES General Permit for Storm Water Discharges from Construction Activities that are classified as “Associated with Industrial Activity” by EPA Regulation (Permit No. ********). I certify under penalty of law that I understand the terms and conditions of the National Pollutant Discharge Elimination System (NPDES) permit that authorizes the storm water discharges associated with industrial activity from the construction project of the owner/operator identified as part of this certification. S UBCONTRACTOR X . X. M. B. XXXX CONSTRUCTION CO., INC. Authorized Subcontractor’s Signature PROJECT MANAGER Project Manager ATTACHMENT “D” PROJECT: PROJECT SUBCONTRACTOR XXMM/XXDD/XXXX YYYY ILLEGAL IMMIGRATION REFORM The Contractor is committed to the following, and the Subcontractor certifies that it will comply with all applicable provisions of the South Carolina Illegal Immigration Reform Act (ACT). The Subcontractor will require all employees to complete an I-9 form, confirming identity and employment eligibility, within three days of hire. The Subcontractor will comply with all federal, state, and local employment verification laws. If federal funds are involved in this project, the Subcontractor will participate in E-Verify, the Internet-based system operated by the federal government that electronically verifies employment eligibility. The Subcontractor agrees to provide any documentation required to establish the applicability and compliance of these requirements to its Sub-subcontractor, and agrees to include in any contracts with its Sub-subcontractors language requiring those Sub-subcontractors to also comply with these requirements. S UBCONTRACTOR X . X. M. B. XXXX CONSTRUCTION CO., INC. Authorized Subcontractor’s Signature PROJECT MANAGER Project Manager P O BOX 1179, COLUMBIA, SC 29202 PHONE 000-000-0000 – FAX 000-000- 000-0000 SUBCONTRACTOR APPLICATION FOR PAYMENT REMIT TO: DATE: Vendor Id MBK Job ID Id Vendor Name SUBCONTRACTOR Project Name PROJECT Remit Address Project Address For the Billing Period through Start Date End Date We, or I, certify that the listed work is in place and the materials stored. CODE DESCRIPTION OF WORK CONTRACT AMOUNT COMPLETED TO DATE TOTAL

Commercial Vehicle Operators. Employees who operate commercial vehicles for the company are subject to testing as required for general employees. Drivers are also subject to testing as required by federal and state statutes. Refusal to submit to testing in any of the above circumstances, or a positive test, is grounds for termination. An employee may become eligible for rehire upon completion of the company’s Employee Assistance Program. ATTACHMENT “B” continued PROJECT: PROJECT SUBCONTRACTOR XX/XX/XXXX DATE ALCOHOL, DRUG, AND BACKGROUND SCREENING PROGRAM B ackground Screening Subcontractor shall ensure that background checks are conducted in compliance with all applicable federal, state, and local laws and regulations. Subcontractor shall ensure that background checks are conducted on employees covering the counties, states, and/or countries in which the person was employed or resided for the past seven (7) to ten (10) years. Subcontractor shall require the same of independent contractor(s) or additional tiered subcontractor(s). Anyone on a sex offender registry is not permitted on M. B. Xxxx job-sites. Contractor reserves the right to verify that all employees, 1099 contractors of any subcontractor, and temporary laborers have been screened. Contractor may randomly select subcontractors on a quarterly basis and require an additional affidavit of compliance with the background screening procedures. Owner/Client Requirement: Additional background screening(s) may be required of subcontractors as required by owner/client. S UBCONTRACTOR X . X. XXXX CONSTRUCTION CO., INC. Authorized Subcontractor’s Signature PROJECT MANAGER Project Manager ATTACHMENT “C” PROJECT: PROJECT SUBCONTRACTOR XX/XX/XXXX DATE NPDES GENERAL PERMIT NPDES GENERAL PERMIT FOR STORM WATER DISCHARGES FROM CONSTRUCTION ACTIVITIES THAT ARE CLASSIFIED AS “ASSOCIATED WITH INDUSTRIAL ACTIVITY” BY EPA REGULATION (PERMIT No.(********)) CO-PERMITTEE AGREEMENT All contractors and subcontractors of the owner/operator whose activities at the construction site may impact storm water discharges or controls at the construction site along the duration of the construction project, shall sign a copy of the certification statement given below: “I certify by my signature below that I accept the terms and conditions of the Storm Water Pollution Prevention Plan (SWPPP) as required by the general National Pollutant Discharge Elimination System (NPDES Permit No. .(********)) issued to the owner/operator of the construction activity for which I have been contracted to perform construction related professional services. Further, by my signature below, I understand that I am becoming a co-permittee with the owner/operator and other contractors that have been co-permittees to the general NPDES permit issued to the owner/operator of the facility for which I have been contracted to perform professional construction services. As a co-permittee, I understand that I, and my company, as the case may be, are legally accountable to the Tennessee NC Department of Environment and Conservation Natural Resources (TDEC) DENR), under the authorities of the federal Clean Water Act and the TN Water NC Sedimentation Pollution Control Act, to ensure compliance with the terms and conditions of the SWPPP. I also understand that TDEC DENR enforcement actions may be taken against any specific co-permittee or combination of co-permittees if the terms and conditions of the SWPPP are not met. Therefore, having understood the above information, I am signing this certification and am receiving co-permittee status to the aforementioned general permit.” The date of the signature, the title of the person providing the signature, and the name, address, and telephone number of the contracted firm, shall also be provided. In the event the SWPPP is amended by the owner, such amendments should be incorporated to the plan and the contractors and subcontractors should acknowledge by signature. The signatory requirements of North Carolina’s Sedimentation Pollution Control Program, as provided in Part VI.G of Permit No.(********) ), are applicable to each contracted entity that must sign the contractor’s certification statement. Upon signing the certification, the contractor is a co-permittee and becomes accountable to TDEC DENR to ensure the terms and conditions of Permit No. (********) are No.(********)are implemented. All co-co- permittees are subject to TDEC DENR enforcement actions if Permit No. (********) conditions No.(********)conditions are not met. Enforcement actions may be taken against any specific co-permittee or combination of co-permittees, with consideration given to the party responsible for the violation. The owner/operator submitting the NOI shall retain all contractor certifications for at least three years after a contractor has completed work at the site. Copies of all contractor certifications and a copy of Permit No. .(********) shall be retained on the site of the construction activity. The owner/operator of the construction project covered by Permit No. .(********) shall make all contractor certifications available upon request to TDECDENR. CONTRACTOR’S CERTIFICATION Certification as co-permittee with XXXXX CROWN HEALTH CARE LAUNDRY SRVC under the Tennessee North Carolina NPDES General Permit for Storm Water Discharges from Construction Activities that are classified as “Associated with Industrial Activity” by EPA Regulation (Permit No. ********). I certify under penalty of law that I understand the terms and conditions of the National Pollutant Discharge Elimination System (NPDES) permit that authorizes the storm water discharges associated with industrial activity from the construction project of the owner/operator identified as part of this certification. S UBCONTRACTOR X . X. XXXX CONSTRUCTION CO., INC. Authorized Subcontractor’s Signature PROJECT MANAGER Project Manager ATTACHMENT “D” PROJECT: PROJECT SUBCONTRACTOR XX/XX/XXXX DATE ILLEGAL IMMIGRATION REFORM The Contractor is committed to the following, and the Subcontractor certifies that it will comply with the following: The Subcontractor will require all employees to complete an I-9 form, confirming identity and employment eligibility, within three days of hire. The Subcontractor will comply with all federal, state, and local employment verification laws. If federal funds are involved in this project, the Subcontractor will participate in E-Verify, the Internet-based system operated by the federal government that electronically verifies employment eligibility. The Subcontractor agrees to provide any documentation required to establish the applicability and compliance of these requirements to its Sub-subcontractor, and agrees to include in any contracts with its Sub-subcontractors language requiring those Sub-subcontractors to also comply with these requirements. S UBCONTRACTOR X . X. XXXX CONSTRUCTION CO., INC. Authorized Subcontractor’s Signature PROJECT MANAGER Project Manager P O BOX 1179, COLUMBIA, SC 29202 PHONE 000-000-0000 – FAX 000-000-0000 SUBCONTRACTOR APPLICATION FOR PAYMENT REMIT TO: DATE: Vendor Id MBK Job ID Id Vendor Name SUBCONTRACTOR Project Name PROJECT Remit Address Project Address For the Billing Period through Start Date End Date We, or I, certify that the listed work is in place and the materials stored. CODE DESCRIPTION OF WORK CONTRACT AMOUNT COMPLETED TO DATE TOTAL

Commercial Vehicle Operators. Employees who operate commercial vehicles for the company are subject to testing as required for general employees. Drivers are also subject to testing as required by federal and state statutes. Refusal to submit to testing in any of the above circumstances, or a positive test, is grounds for termination. An employee may become eligible for rehire upon completion of the company’s Employee Assistance Program. ATTACHMENT “B” continued PROJECT: PROJECT SUBCONTRACTOR XX/XX/XXXX ALCOHOL, DRUG, AND BACKGROUND SCREENING PROGRAM B ackground Screening Subcontractor shall ensure that background checks are conducted in compliance with all applicable federal, state, and local laws and regulations. Subcontractor shall ensure that background checks are conducted on employees covering the counties, states, and/or countries in which the person was employed or resided for the past seven (7) to ten (10) years. Subcontractor shall require the same of independent contractor(s) or additional tiered subcontractor(s). Anyone on a sex offender registry is not permitted on M. B. Xxxx job-sites. Contractor reserves the right to verify that all employees, 1099 contractors of any subcontractor, and temporary laborers have been screened. Contractor may randomly select subcontractors on a quarterly basis and require an additional affidavit of compliance with the background screening procedures. Owner/Client Requirement: Additional background screening(s) may be required of subcontractors as required by owner/client. S UBCONTRACTOR X . X. XXXX CONSTRUCTION CO., INC. Authorized Subcontractor’s Signature PROJECT MANAGER Project Manager ATTACHMENT “C” PROJECT: PROJECT SUBCONTRACTOR XX/XX/XXXX NPDES GENERAL PERMIT NPDES GENERAL PERMIT FOR STORM WATER DISCHARGES FROM CONSTRUCTION ACTIVITIES THAT ARE CLASSIFIED AS “ASSOCIATED WITH INDUSTRIAL ACTIVITY” BY EPA REGULATION (PERMIT No.(. ********)) CO-PERMITTEE AGREEMENT All contractors and subcontractors of the owner/operator whose activities at the construction site may impact storm water discharges or controls at the construction site along the duration of the construction project, shall sign a copy of the certification statement given below: “I certify by my signature below that I accept the terms and conditions of the Storm Water Pollution Prevention Plan (SWPPP) as SWPPP)as required by the general National Pollutant Discharge Elimination System (NPDES Permit No. (********)) issued No.(********)issued to the owner/operator of the construction activity for which I have been contracted to perform construction related professional services. Further, by my signature below, I understand that I am becoming a co-permittee with the owner/operator and other contractors that have been co-permittees to the general NPDES permit issued to the owner/operator of the facility for which I have been contracted to perform professional construction services. As a co-permittee, I understand that I, and my company, as the case may be, are legally accountable to the Tennessee Georgia Department of Environment and Conservation natural Resources Environmental Protection Division (TDEC) GNREPD), under the authorities of the federal Clean Water Act and the TN Georgia Water Pollution Quality Control Act, to ensure compliance with the terms and conditions of the SWPPP. I also understand that TDEC GNREPD enforcement actions may be taken against any specific co-permittee or combination of co-permittees if the terms and conditions of the SWPPP are not met. Therefore, having understood the above information, I am signing this certification and am receiving co-permittee status to the aforementioned general permit.” The date of the signature, the title of the person providing the signature, and the name, address, and telephone number of the contracted firm, shall also be provided. In the event the SWPPP is amended by the owner, such amendments should be incorporated to the plan and the contractors and subcontractors should acknowledge by signature. The signatory requirements of Georgia’s Water Control Act and Regulations for Water Quality Control, Chapter 391-3-6, as provided in Part VI.G of Permit No.(********) ), are applicable to each contracted entity that must sign the contractor’s certification statement. Upon signing the certification, the contractor is a co-permittee and becomes accountable to TDEC GNREPD to ensure the terms and conditions of Permit No. (********) are No.(********)are implemented. All co-permittees are subject to TDEC GNREPD enforcement actions if Permit No. (********) conditions No.(********)conditions are not met. Enforcement actions may be taken against any specific co-permittee or combination of co-permittees, with consideration given to the party responsible for the violation. The owner/operator submitting the NOI shall retain all contractor certifications for at least three years after a contractor has completed work at the site. Copies of all contractor certifications and a copy of Permit No. (********) shall No.(********)shall be retained on the site of the construction activity. The owner/operator of the construction project covered by Permit No. (********) shall No.(********)shall make all contractor certifications available upon request to TDECGNREPD. CONTRACTOR’S CERTIFICATION Certification as co-permittee with XXXXX XXXXXX under the Tennessee Georgia NPDES General Permit for Storm Water Discharges from Construction Activities that are classified as “Associated with Industrial Activity” by EPA Regulation (Permit No. ********). I certify under penalty of law that I understand the terms and conditions of the National Pollutant Discharge Elimination System (NPDES) permit that authorizes the storm water discharges associated with industrial activity from the construction project of the owner/operator identified as part of this certification. S UBCONTRACTOR X . X. XXXX CONSTRUCTION CO., INC. Authorized Subcontractor’s Signature PROJECT MANAGER Project Manager ATTACHMENT “D” PROJECT: PROJECT SUBCONTRACTOR XX/XX/XXXX ILLEGAL IMMIGRATION REFORM The Contractor is committed to the following, and the Subcontractor certifies that it will comply with the following: The Subcontractor will require all employees to complete an I-9 form, confirming identity and employment eligibility, within three days of hire. The Subcontractor will comply with all federal, state, and local employment verification laws. If federal funds are involved in this project, the Subcontractor will participate in E-Verify, the Internet-based system operated by the federal government that electronically verifies employment eligibility. The Subcontractor agrees to provide any documentation required to establish the applicability and compliance of these requirements to its Sub-subcontractor, and agrees to include in any contracts with its Sub-subcontractors language requiring those Sub-subcontractors to also comply with these requirements. S UBCONTRACTOR X . X. XXXX CONSTRUCTION CO., INC. Authorized Subcontractor’s Signature PROJECT MANAGER Project Manager P O BOX 1179, COLUMBIA, SC 29202 PHONE 000-000-0000 – FAX 000-000- 000-0000 SUBCONTRACTOR APPLICATION FOR PAYMENT REMIT TO: DATE: Vendor Id MBK Job ID Id Vendor Name SUBCONTRACTOR Project Name PROJECT Remit Address Project Address For the Billing Period through Start Date End Date We, or I, certify that the listed work is in place and the materials stored. CODE DESCRIPTION OF WORK CONTRACT AMOUNT COMPLETED TO DATE TOTAL

Commercial Vehicle Operators. Employees who operate commercial vehicles for the company are subject to testing as required for general employees. Drivers are also subject to testing as required by federal and state statutes. Refusal to submit to testing in any of the above circumstances, or a positive test, is grounds for termination. An employee may become eligible for rehire upon completion of the company’s Employee Assistance Program. ATTACHMENT “B” continued PROJECT: PROJECT SUBCONTRACTOR XXxx/XXxx/XXXX xxxx ALCOHOL, DRUG, AND BACKGROUND SCREENING PROGRAM B ackground Background Screening Subcontractor shall ensure that background checks are conducted in compliance with all applicable federal, state, and local laws and regulations. Subcontractor shall ensure that background checks are conducted on employees covering the counties, states, and/or countries in which the person was employed or resided for the past seven (7) to ten (10) years. Subcontractor shall require the same of independent contractor(s) or additional tiered subcontractor(s). Anyone on a sex offender registry is not permitted on M. B. Xxxx job-sites. Contractor reserves the right to verify that all employees, 1099 contractors of any subcontractor, and temporary laborers have been screened. Contractor may randomly select subcontractors on a quarterly basis and require an additional affidavit of compliance with the background screening procedures. Owner/Client Requirement: Additional background screening(s) may be required of subcontractors as required by owner/client. S UBCONTRACTOR X . X. SUBCONTRACTOR M. B. XXXX CONSTRUCTION CO., INC. Authorized Subcontractor’s Signature PROJECT MANAGER Project Manager ATTACHMENT “C” PROJECT: PROJECT SUBCONTRACTOR XXxx/XXxx/XXXX NPDES xxxx VPDES GENERAL PERMIT NPDES GENERAL VPDES PERMIT FOR STORM WATER DISCHARGES OF STORMWATER FROM CONSTRUCTION ACTIVITIES THAT ARE CLASSIFIED AS “ASSOCIATED WITH INDUSTRIAL ACTIVITY” BY EPA REGULATION (PERMIT No.. (********)) CO-PERMITTEE AGREEMENT All contractors and subcontractors of the owner/operator operator, whose activities at the construction site may impact storm water discharges or controls at the construction site along the duration of the construction project, shall sign a copy of the certification statement given below: “I certify by my signature below that I accept the terms and conditions of the Storm Water Pollution Prevention Plan (SWPPP) as required by the general National Pollutant Xxxxxxxx Xxxxxxxxx Discharge Elimination System (NPDES VPDES Permit No. (********)) issued to the owner/operator of the construction activity for which I have been contracted to perform construction related professional services. Further, by my signature below, I understand that I am becoming a co-permittee with the owner/operator and other contractors that have been co-permittees to the general NPDES VPDES permit issued to the owner/operator of the facility for which I have been contracted to perform professional construction services. As a co-permittee, I understand that I, and my company, as the case may be, are am legally accountable to the Tennessee Virginia Department of Environment and Conservation Environmental Quality (TDEC) DEQ), under the authorities of the federal Clean Water Act and the TN Water Pollution Virginia Stormwater Management Act, to ensure compliance with the terms and conditions of the SWPPP. I also understand that TDEC DEQ enforcement actions may be taken against any specific co-permittee or combination of co-permittees if the terms and conditions of the SWPPP are not met. Therefore, having understood the above information, I am signing this certification and am receiving co-permittee status to the aforementioned general permit.” The date of the signature, the title of the person providing the signature, and the name, address, and telephone number of the contracted firm, shall also be provided. In the event the SWPPP is amended by the owner, such amendments should be incorporated to the plan and the contractors and subcontractors should acknowledge by signature. The signatory requirements of the Virginia Erosion and Sediment Control Law (ESC) (VA Code 62.1-44.15:51 et. seq.) and Storm Water Management Act (SWM) (VA Code 62.1-44.15:24) and the Virginia Storm Water Management Program (VSWP) permit regulations, as provided in Permit No.. (********) ), are applicable to each contracted entity that must sign the contractor’s certification statement. Upon signing the certification, the contractor is a co-permittee and becomes accountable to TDEC DEQ to ensure the terms and conditions of Permit No. (********) are implemented. All co-permittees are subject to TDEC DEQ enforcement actions if Permit No. (********) conditions are not met. Enforcement actions may be taken against any specific co-permittee or combination of co-permittees, with consideration given to the party responsible for the violation. The owner/operator submitting the NOI shall retain all contractor certifications for at least three years after a contractor has completed work at the site. Copies of all contractor certifications and a copy of Permit No. (********) shall be retained on the site of the construction activity. The owner/operator of the construction project covered by Permit No. (********) shall make all contractor certifications available upon request to TDECDEQ. CONTRACTOR’S CERTIFICATION Certification as co-permittee with XXXXX OWNER under the Tennessee NPDES General VPDES Permit for Storm Water Discharges of Stormwater from Construction Activities that are classified as “Associated with Industrial Activity” by EPA Regulation (Permit No. ********). I certify under penalty of law that I understand the terms and conditions of the National Virginia Pollutant Discharge Elimination System (NPDESVPDES) permit that authorizes the storm water discharges associated with industrial activity from the construction project of the owner/operator identified as part of this certification. S UBCONTRACTOR X . X. SUBCONTRACTOR M. B. XXXX CONSTRUCTION CO., INC. Authorized Subcontractor’s Signature PROJECT MANAGER Project Manager ATTACHMENT “D” PROJECT: PROJECT SUBCONTRACTOR XXxx/XXxx/XXXX xxxx ILLEGAL IMMIGRATION REFORM The Contractor is committed to the following, and the Subcontractor certifies that it will comply with all federal, state, and local employment verification laws. The Subcontractor will require all employees to complete an I-9 form, confirming identity and employment eligibility, within three days of hire. The Subcontractor will comply with all federal, state, and local employment verification laws. If federal funds are involved in this project, the Subcontractor will participate in E-Verify, the Internet-based system operated by the federal government that electronically verifies employment eligibility. The Subcontractor agrees to provide any documentation required to establish the applicability and compliance of these requirements to its Sub-subcontractor, and agrees to include in any contracts with its Sub-subcontractors language requiring those Sub-subcontractors to also comply with these requirements. S UBCONTRACTOR X . X. SUBCONTRACTOR M. B. XXXX CONSTRUCTION CO., INC. Authorized Subcontractor’s Signature PROJECT MANAGER Project Manager P O BOX 1179SUBCONTRACTOR APPLICATION FOR PAYMENT 0000 XXXXXXXXXXXXX XXXXXX, COLUMBIAXXXXXXXX XXXXX, SC 29202 XX 00000 PHONE 000-000-0000 – FAX 000-000-0000 SUBCONTRACTOR APPLICATION FOR PAYMENT REMIT TO: DATE: Vendor Id MBK Job ID Id Vendor Name SUBCONTRACTOR Project Name PROJECT Remit Address Project Address For the Billing Period through Start Date End Date We, or I, certify that the listed work is in place and the materials stored. CODE DESCRIPTION OF WORK CONTRACT AMOUNT COMPLETED TO DATE 0.00 TOTAL

Commercial Vehicle Operators. Employees who operate commercial vehicles for the company are subject to testing as required for general employees. Drivers are also subject to testing as required by federal and state statutes. Refusal to submit to testing in any of the above circumstances, or a positive test, is grounds for termination. An employee may become eligible for rehire upon completion of the company’s Employee Assistance Program. ATTACHMENT “B” continued PROJECT: PROJECT SUBCONTRACTOR XXMM/XXdd/XXXX yyyy ALCOHOL, DRUG, AND BACKGROUND SCREENING PROGRAM B ackground Screening Subcontractor shall ensure that background checks are conducted in compliance with all applicable federal, state, and local laws and regulations. Subcontractor shall ensure that background checks are conducted on employees covering the counties, states, and/or countries in which the person was employed or resided for the past seven (7) to ten (10) years. Subcontractor shall require the same of independent contractor(s) or additional tiered subcontractor(s). Anyone on a sex offender registry is not permitted on M. B. Xxxx job-sites. Contractor reserves the right to verify that all employees, 1099 contractors of any subcontractor, and temporary laborers have been screened. Contractor may randomly select subcontractors on a quarterly basis and require an additional affidavit of compliance with the background screening procedures. Owner/Client Requirement: Additional background screening(s) may be required of subcontractors as required by owner/client. S UBCONTRACTOR V ENDOR x X . X. XXXX CONSTRUCTION CO., INC. Authorized Subcontractor’s Signature PROJECT MANAGER Project Manager ATTACHMENT “C” PROJECT: PROJECT SUBCONTRACTOR XXMM/XXdd/XXXX yyyy NPDES GENERAL PERMIT NPDES GENERAL PERMIT FOR STORM WATER DISCHARGES FROM CONSTRUCTION ACTIVITIES THAT ARE CLASSIFIED AS “ASSOCIATED WITH INDUSTRIAL ACTIVITY” BY EPA REGULATION (PERMIT No.(********)) CO-PERMITTEE AGREEMENT All contractors and subcontractors of the owner/operator whose activities at the construction site may impact storm water discharges or controls at the construction site along the duration of the construction project, shall sign a copy of the certification statement given below: “I certify by my signature below that I accept the terms and conditions of the Storm Water Pollution Prevention Plan (SWPPP) as required by the general National Pollutant Discharge Elimination System (NPDES Permit No. (********)) issued to the owner/operator of the construction activity for which I have been contracted to perform construction related professional services. Further, by my signature below, I understand that I am becoming a co-permittee with the owner/operator and other contractors that have been co-permittees to the general NPDES permit issued to the owner/operator of the facility for which I have been contracted to perform professional construction services. As a co-permittee, I understand that I, and my company, as the case may be, are legally accountable to the Tennessee SC Department of Environment Health and Conservation Environmental Control (TDEC) DHEC), under the authorities of the federal Clean Water Act and the TN Water SC Pollution Control Act, to ensure compliance with the terms and conditions of the SWPPP. I also understand that TDEC DHEC enforcement actions may be taken against any specific co-permittee or combination of co-permittees if the terms and conditions of the SWPPP are not met. Therefore, having understood the above information, I am signing this certification and am receiving co-permittee status to the aforementioned general permit.” The date of the signature, the title of the person providing the signature, and the name, address, and telephone number of the contracted firm, shall also be provided. In the event the SWPPP is amended by the owner, such amendments should be incorporated to the plan and the contractors and subcontractors should acknowledge by signature. The signatory requirements of South Carolina’s Water Pollution Control Permits Regulation 61-9.122.22, as provided in Part VI.G of Permit No.(********) ), are applicable to each contracted entity that must sign the contractor’s certification statement. Upon signing the certification, the contractor is a co-permittee and becomes accountable to TDEC DHEC to ensure the terms and conditions of Permit No. (********) are implemented. All co-permittees are subject to TDEC DHEC enforcement actions if Permit No. (********) conditions are not met. Enforcement actions may be taken against any specific co-permittee or combination of co-permittees, with consideration given to the party responsible for the violation. The owner/operator submitting the NOI shall retain all contractor certifications for at least three years after a contractor has completed work at the site. Copies of all contractor certifications and a copy of Permit No. (********) shall be retained on the site of the construction activity. The owner/operator of the construction project covered by Permit No. (********) shall make all contractor certifications available upon request to TDECDHEC. CONTRACTOR’S CERTIFICATION Certification as co-permittee with XXXXX oWNER under the Tennessee South Carolina NPDES General Permit for Storm Water Discharges from Construction Activities that are classified as “Associated with Industrial Activity” by EPA Regulation (Permit No. ********). I certify under penalty of law that I understand the terms and conditions of the National Pollutant Discharge Elimination System (NPDES) permit that authorizes the storm water discharges associated with industrial activity from the construction project of the owner/operator identified as part of this certification. S UBCONTRACTOR V ENDOR x X . X. XXXX CONSTRUCTION CO., INC. Authorized Subcontractor’s Signature PROJECT MANAGER Project Manager ATTACHMENT “D” PROJECT: PROJECT SUBCONTRACTOR XXMM/XXdd/XXXX yyyy ILLEGAL IMMIGRATION REFORM The Contractor is committed to the following, and the Subcontractor certifies that it will comply with all applicable provisions of the South Carolina Illegal Immigration Reform Act (ACT). The Subcontractor will require all employees to complete an I-9 form, confirming identity and employment eligibility, within three days of hire. The Subcontractor will comply with all federal, state, and local employment verification laws. If federal funds are involved in this project, the Subcontractor will participate in E-Verify, the Internet-based system operated by the federal government that electronically verifies employment eligibility. The Subcontractor agrees to provide any documentation required to establish the applicability and compliance of these requirements to its Sub-Sub- subcontractor, and agrees to include in any contracts with its Sub-subcontractors language requiring those Sub-subcontractors to also comply with these requirements. S UBCONTRACTOR V ENDOR x X . X. XXXX CONSTRUCTION CO., INC. Authorized Subcontractor’s Signature PROJECT MANAGER Project Manager P O BOX 1179, COLUMBIA, SC 29202 PHONE 000-000-0000 – 000.000.0000 | FAX 000-000-0000 000.000.0000 SUBCONTRACTOR APPLICATION FOR PAYMENT REMIT TO: DATE: Vendor Id MBK Job ID Id Vendor Name SUBCONTRACTOR Project Name PROJECT Remit Address Project Address For the Billing Period through Start Date End Date We, or I, certify that the listed work is in place and the materials stored. CODE DESCRIPTION OF WORK CONTRACT AMOUNT COMPLETED TO DATE TOTAL

Commercial Vehicle Operators. Employees who operate commercial vehicles for the company are subject to testing as required for general employees. Drivers are also subject to testing as required by federal and state statutes. Refusal to submit to testing in any of the above circumstances, or a positive test, is grounds for termination. An employee may become eligible for rehire upon completion of the company’s Employee Assistance Program. ATTACHMENT “B” continued PROJECT: PROJECT SUBCONTRACTOR XXMM/XXDD/XXXX YYYY ALCOHOL, DRUG, AND BACKGROUND SCREENING PROGRAM B ackground Background Screening Subcontractor shall ensure that background checks are conducted in compliance with all applicable federal, state, and local laws and regulations. Subcontractor shall ensure that background checks are conducted on employees covering the counties, states, and/or countries in which the person was employed or resided for the past seven (7) to ten (10) years. Subcontractor shall require the same of independent contractor(s) or additional tiered subcontractor(s). Anyone on a sex offender registry is not permitted on M. B. Xxxx job-sites. Contractor reserves the right to verify that all employees, 1099 contractors of any subcontractor, and temporary laborers have been screened. Contractor may randomly select subcontractors on a quarterly basis and require an additional affidavit of compliance with the background screening procedures. Owner/Client Requirement: Additional background screening(s) may be required of subcontractors as required by owner/client. S UBCONTRACTOR X . X. M. B. XXXX CONSTRUCTION CO., INC. Authorized Subcontractor’s Signature PROJECT MANAGER Project Manager ATTACHMENT “C” PROJECT: PROJECT SUBCONTRACTOR XXMM/XXDD/XXXX YYYY NPDES GENERAL PERMIT NPDES GENERAL PERMIT FOR STORM WATER DISCHARGES FROM CONSTRUCTION ACTIVITIES THAT ARE CLASSIFIED AS “ASSOCIATED WITH INDUSTRIAL ACTIVITY” BY EPA REGULATION (PERMIT No.(********)) CO-PERMITTEE AGREEMENT All contractors and subcontractors of the owner/operator whose activities at the construction site may impact storm water discharges or controls at the construction site along the duration of the construction project, shall sign a copy of the certification statement given below: “I certify by my signature below that I accept the terms and conditions of the Storm Water Pollution Prevention Plan (SWPPP) as required by the general National Pollutant Discharge Elimination System (NPDES Permit No. .(********)) issued to the owner/operator of the construction activity for which I have been contracted to perform construction related professional services. Further, by my signature below, I understand that I am becoming a co-permittee with the owner/operator and other contractors that have been co-permittees to the general NPDES permit issued to the owner/operator of the facility for which I have been contracted to perform professional construction services. As a co-permittee, I understand that I, and my company, as the case may be, are legally accountable to the Tennessee NC Department of Environment and Conservation Natural Resources (TDEC) DENR), under the authorities of the federal Clean Water Act and the TN Water NC Sedimentation Pollution Control Act, to ensure compliance with the terms and conditions of the SWPPP. I also understand that TDEC DENR enforcement actions may be taken against any specific co-permittee or combination of co-permittees if the terms and conditions of the SWPPP are not met. Therefore, having understood the above information, I am signing this certification and am receiving co-permittee status to the aforementioned general permit.” The date of the signature, the title of the person providing the signature, and the name, address, and telephone number of the contracted firm, shall also be provided. In the event the SWPPP is amended by the owner, such amendments should be incorporated to the plan and the contractors and subcontractors should acknowledge by signature. The signatory requirements of North Carolina’s Sedimentation Pollution Control Program, as provided in Part VI.G of Permit No.(********) ), are applicable to each contracted entity that must sign the contractor’s certification statement. Upon signing the certification, the contractor is a co-permittee and becomes accountable to TDEC DENR to ensure the terms and conditions of Permit No. (********) are No.(********)are implemented. All co-co- permittees are subject to TDEC DENR enforcement actions if Permit No. (********) conditions No.(********)conditions are not met. Enforcement actions may be taken against any specific co-permittee or combination of co-permittees, with consideration given to the party responsible for the violation. The owner/operator submitting the NOI shall retain all contractor certifications for at least three years after a contractor has completed work at the site. Copies of all contractor certifications and a copy of Permit No. .(********) shall be retained on the site of the construction activity. The owner/operator of the construction project covered by Permit No. .(********) shall make all contractor certifications available upon request to TDECDENR. CONTRACTOR’S CERTIFICATION Certification as co-permittee with XXXXX XXXX under the Tennessee North Carolina NPDES General Permit for Storm Water Discharges from Construction Activities that are classified as “Associated with Industrial Activity” by EPA Regulation (Permit No. ********). I certify under penalty of law that I understand the terms and conditions of the National Pollutant Discharge Elimination System (NPDES) permit that authorizes the storm water discharges associated with industrial activity from the construction project of the owner/operator identified as part of this certification. S UBCONTRACTOR X . X. M. B. XXXX CONSTRUCTION CO., INC. Authorized Subcontractor’s Signature PROJECT MANAGER Project Manager ATTACHMENT “D” PROJECT: PROJECT SUBCONTRACTOR XXMM/XXDD/XXXX YYYY ILLEGAL IMMIGRATION REFORM The Contractor is committed to the following, and the Subcontractor certifies that it will comply with the following: The Subcontractor will require all employees to complete an I-9 form, confirming identity and employment eligibility, within three days of hire. The Subcontractor will comply with all federal, state, and local employment verification laws. If federal funds are involved in this project, the Subcontractor will participate in E-Verify, the Internet-based system operated by the federal government that electronically verifies employment eligibility. The Subcontractor agrees to provide any documentation required to establish the applicability and compliance of these requirements to its Sub-subcontractor, and agrees to include in any contracts with its Sub-subcontractors language requiring those Sub-subcontractors to also comply with these requirements. S UBCONTRACTOR X . X. M. B. XXXX CONSTRUCTION CO., INC. Authorized Subcontractor’s Signature PROJECT MANAGER Project Manager P O BOX 1179ATTACHMENT “E” PROJECT: MM/DD/YYYY CONTRACTOR’S PROJECT STATEMENT M. B. Xxxx Construction Co., COLUMBIAInc. (hereinafter, SC 29202 PHONE 000-000-0000 – FAX 000-000-0000 SUBCONTRACTOR APPLICATION FOR PAYMENT REMIT TO: DATE: Vendor Id MBK Job ID Vendor Name SUBCONTRACTOR “Contractor”), pursuant to G.S. 44A-27(f) hereby provides the following statement in connection with the project described below. Please forward a copy of this Contractor’s Project Name PROJECT Remit Address Project Address For the Billing Period through Start Date End Date WeStatement to all subcontractors and/or suppliers, or I, certify and remote claimants that the listed work is in place and the you contract with to provide services and/or materials stored. CODE DESCRIPTION OF WORK CONTRACT AMOUNT COMPLETED TO DATE TOTALfor this project.