Mdc Internal Use

MDC INTERNAL USE

BUYER:______

SUPPLIER:______

ANNUAL REPRESENTATION AND CERTIFICATION MD-7260 (31 Jan 2001) Revised

______This is an annual representation and certification valid for 12 months from the date of execution.__ The BIDDER represents that: (1) It has developed and has on file, Note: All sections must be checked. has not developed and does not have on file, at each establishment, affirmative action programs 1. EQUAL OPPORTUNITY required by the rules and regulations of the Not Applicable - Foreign Supplier Secretary of Labor (41 CFR 60-1 and 60-2), OR A. PREVIOUS CONTRACTS AND COMPLIANCE REPORTS (2) It has not previously had contracts subject to written affirmative action programs The BIDDER represents that: requirement of the rules and regulations of the Secretary of Labor. (1) It has has not participated in a previous contract or subcontract subject either to C. CERTIFICATION OF the Equal Opportunity clause of a solicitation, the NONSEGREGATED FACILITIES clause originally contained in Section 301 of (1) "Segregated facilities" as used in this Executive Order No. 10925, or the clause provision, means any waiting rooms, work areas, contained in Section 201 of Executive Order No. restrooms, and washrooms, restaurants and other 11114; eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking (2) It has has not filed all required fountains, recreation or entertainment areas, compliance reports; and transportation and housing facilities provided for employees, that are segregated by explicit (3) Representations indicating submission of directive or are in fact segregated on the basis of required compliance reports, signed by proposed race, color, religion, or national origin because of subcontractors, will be obtained before subcontract habit, local custom or otherwise. awards. (2) By the submission of this document the B. AFFIRMATIVE ACTION BIDDER certifies that it does not and will not maintain or provide for its employees any (The following representations shall be completed segregated facilities at any of its establishments, if the BIDDER employs 50 or more employees). and that it does not and will not permit its employees to perform their services at any location Not Applicable - Less than 50 Employees under its control where segregated facilities are maintained. The BIDDER agrees that a breach of (Continue, if applicable) this certification is a violation of the Equal Opportunity clause in the contract.

of 2 (3) The BIDDER further agrees that (except 3. CLEAN AIR AND WATER where it has obtained identical certifications from Not Applicable - Foreign Supplier proposed subcontract or for specific time periods) it will: The BIDDER certifies that: (a) Obtain identical certifications from proposed subcontractors before the award of (a) Any facility to be used in the subcontracts under which the subcontractor will be performance of this proposed contract is , subject to Equal Opportunity clause; is not , listed on the Environmental Protection Agency ("EPA") List of Violating Facilities. (b) Retain the certifications in the files; and (b) BIDDER will immediately notify the (c) Forward the following notice to the cognizant MDC Purchasing Representative, before proposed subcontractors (except if the proposed award, of the receipt of any communication from subcontractors have submitted identical the Administrator, or a designee, of the EPA, certifications for specific time periods) indicating that any facility that BIDDER proposes to use for the performance of the contract is under NOTICE TO PROSPECTIVE consideration to be listed on the EPA List of SUBCONTRACTS OF REQUIREMENT Violating Facilities; and FOR CERTIFICATIONS OF NON- SEGREGATED FACILITIES (c) If the BIDDER's facility should become listed or considered for listing on the EPA List of A Certification of Nonsegregated Facilities must be Violating Facilities, at anytime during the 12 submitted before the award of a subcontract under months this certification is in effect, BIDDER will which the subcontractor will be subject to the notify MDC in writing. Equal Opportunity clause. The certification may be submitted either for each subcontract or for all (d) BIDDER will include a certification subcontracts during a period (i.e., quarterly, substantially the same as this certification, semiannually, or annually). including this paragraph (d), in every nonexempt subcontract. 2. REPRESENTATION CONCERNING DEBARMENT, SUSPENSION OR NOTE: The penalty for making false statements in PROPOSED DEBARMENT bids is prescribed in 18 U.S.C. 1001.

The BIDDER represents that: Signature ______BIDDER and its principals are not debarred, suspended or proposed for debarment by the Name ______Federal Government. If BIDDER should become Please Print debarred, suspended or proposed for debarment, at anytime during the 12 months this certification is Title ______in effect, BIDDER will notify MDC in writing. Company ______

Address ______

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______Date of Execution