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STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION Form 700-011-13 <br /> CERTIFICATION CONSTRUC0TION <br /> 605 <br /> COMPLIANCE WITH EQUAL EMPLOYMENT OPPORTUNITY (EEO) <br /> PROVISIONS ON FEDERAL AID CONTRACTS <br /> SAMPLE FORM FOR EEO COMPLIANCE/DATA <br /> COLLECTION <br /> NOTE: This form is suWgg to change or modification <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 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 /> of by determination of nonresponsibiity,and may subject the <br /> 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 />