Bid Packet for Construction Contracts Sample Forms

FY2011 CDBG Administrative Manual
Contract Management
VIII-24
CERTIFICATION BY PROPOSED SUBCONTRACTOR REGARDING
EQUAL EMPLOYMENT OPPORTUNITY
NAME OF PRIME CONTRACTOR
PROJECT NUMBER
INSTRUCTIONS:
The certification is required pursuant to Executive Order 11246 (30 F.R. 12319-25). The implementing
rules and regulations provide that any bidder or prospective contractor, or any of their proposed
subcontractors, shall state as an initial part of the bid or negotiations of the contract whether it has
participated in any previous contract or subcontract subject to the equal opportunity clause; and, if so,
whether it has filed all compliance reports due under applicable instructions.
Where the certification indicates that the subcontractor has not filed a compliance report due under
applicable instructions, such subcontractor shall be required to submit a compliance report before the
owner approves the subcontract or permits work to begin under the subcontract.
SUBCONTRACTOR'S CERTIFICATION
NAME AND ADDRESS OF SUBCONTRACTOR (Include ZIP Code):
1. Bidder has participated in a previous contract or subcontract subject to the Equal Opportunity
Clause.
YES NO
2. Compliance reports were required to be filed in connection with such contract or subcontract.
YES NO
3. Bidder has filed all compliance reports due under applicable instructions.
YES NO
4. Have you ever been or are you being considered for sanction due to violation of Executive Order
11246, as amended?
YES NO
NAME AND TITLE OF SIGNER (Please type):
SIGNATURE:
DATE:
Page 24/82
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