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STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION Form 700-011 -13 <br /> CERTIFICATION CONSTRUCTION <br /> 06 05 <br /> COMPLIANCE WITH EQUAL EMPLOYMENT OPPORTUNITY ( EEO ) <br /> PROVISIONS ON FEDERAL AID CONTRACTS <br /> DATE <br /> FIN PROJECT I . D . CONTRACT NO . <br /> prime contractor <br /> for the above referenced contract , hereby certifies that this company and all of it' s subcontractors have made every Good Faith Effort <br /> to <br /> comply with the EEO provisions of FHWA Form- 1273 (Section II . Nondiscrimination and Section III . Nonsegregated facilities) on this <br /> contract. <br /> Exception : <br /> The following subcontractor(s) have been found to be in noncompliance with the provisions stated above . Attached is notification sent <br /> to the respective subcontractor(s) explaining their noncompliance with these provisions . <br /> Subcontractor Name Subcontractor Name <br /> Street Address Street Address <br /> City/State/Zip City/State/Zip <br /> State of Florida A false statement or omission made in connection with <br /> County of this certification is sufficient cause for suspension , <br /> Sworn to and subscribed before me this day revocation , or denial of qualification to bid , and a <br /> determination of nonresponsibiity, and may subject the <br /> of by person and/or entity making the false statement to any <br /> (Print name of person signing Certication) and all civil and criminal penalties available pursuant to <br /> applicable Federal and State law. <br /> Notary Public Contractor <br /> Commission Expires By <br /> Personally Known ❑ OR Produced Identification ❑ <br /> Title <br /> Type of Identification Produced <br /> Instructions : <br /> 1 . Attach copy of any notifications of noncompliance sent to each applicable subcontractor. <br /> 2 . List the subcontractors found not in compliance at the time of this certification . <br /> 3 . A separate certification is required for each contract. <br /> 4 . To be signed by an officer or director of the Contractor with the authority to bind the Contractor and notarized . <br /> 5 . To avoid delay in payment, certification must be submitted to the Project Engineer no later than the Friday before the monthly <br /> estimate cutoff date (generally the 3rd Sunday of the month) . <br />