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STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 275M-13 <br /> CERTIFICATION OF NON SEGREGATION & EQUAL OPPORTUNITY OFFICE <br /> 07105 <br /> NON DISCRIMINATION <br /> SECTION 1: PROJECT IDENTIFICATION <br /> 1.Financial Project No. 2.F.A.P.No. 3.FDOT LAP Contract No. 4.county 5.District or Name of Local A enc <br /> 6.Prime Contractor's Name <br /> l <br /> 7.Com an Na of Contractor,,,Supplier,Rental Com or A enc Rfihmifflnq this certification 8.FEID No of Co.in Box 7 <br /> SECTIO 2: CERTIFICATION STATEMENTS <br /> i <br /> CERTIFICATION OF CERTIFICATION OF <br /> NONSEGREGATED FACILITIES NON DISCRIMINATION <br /> As a federally assisted construction contractor, I As a contractor, sub recipient or subcontractor on a <br /> hereby certify:the following for t his company: Federally funded Contract, this company certifies that it <br /> A. This company does not maintain or provide shall not discriminate on the basis of race, color, national . <br /> any segregated facilities for employees at <br /> origin,or sex in the performance of such contracts. <br /> any of our establishments and we do not The contractor shall carry out applicable requirements of <br /> permit our employees to perform their 49 CFR Part 26 in the award and administration of DOT <br /> services at any location, under our control, assisted contracts. The company agrees that a failure to <br /> where segregated facilities are maintained. carry out these requirements is a material breach of <br /> B. Agreement that a breach of this certification contract,which may result in the contract's termination or <br /> is a violation of the equal opportunity clause such other remedy as the recipient deems appropriate. <br /> In this contract Each subcontract, rental agreement and or material <br /> supplier agreement this company subsequently enters <br /> C. We will obtain and retain identical into for this contact will require this same Certification. <br /> certifications from proposed subcontractors <br /> prior to the award of subcontracts exceeding It is the policy of this company to assure that applicants <br /> $10,000 which are not exempt from the are employed, and that employees are treated during <br /> provisions of the equal opportunity clause. employment, without regard to their race, religion, sex, <br /> As used in this certification,the terms "segregated color, national origin, age or disability. Actions include: <br /> facilities" means any waiting rooms, work areas, employment, upgrading, demotion, or transfer; <br /> restrooms and washrooms, restaurants and recruitment or recruitment advertising; layoff or <br /> termination; rates of pay and other .forms of <br /> fountains, recreation or entertainment area, compensation; and selection for training, including <br /> transportation, and housing facilities provided for <br /> employees which are segregated by explicit apprenticeship, pre apprenticeship, and/or on-the-job <br /> directives or are in fact segregated on the basis of training. <br /> race, color, religion or national origin because of This certification extends to the project identified above <br /> habit,local custom,or any other reason. and affirms our commitment to insure nondiscrimination <br /> and to take affirmative action to assure equal <br /> opportunity as set forth under laws, executive orders, <br /> rules, regulations (28 CFR 35, 29 CFR 1630 and 41 CFR <br /> 60) and orders of the Secretary of Labor as modified by <br /> the provisions of FHWA-1273. <br /> Compliance with Title VI of the Civil Rights Act and the <br /> provisions of the American Disabilities Act of 1990 are <br /> inco orated in this certification. <br /> 9.Name first/last of corporate Official signing Certification 10.Job Title of person named in Box 9 <br /> 11.Signature of Cetg&q <br /> Officlal 12.Date of Si <br /> gnature <br /> -� Lam` �-�-•-----..-__ Y G b� Cr �� <br /> i <br /> j <br /> I <br /> 00490-1 <br /> I <br />