HomeMy WebLinkAbout2011-356 Co Manager - TJCOG electric vehicle charging stationsContract No. TJCOG— CBS -004
CONTRACT AGREEMENT
Between the
TRIANGLE J COUNCIL OF GOVERNMENTS
and
ORANGE COUNTY
C 0,V -f j -cz c' 3�5` I
THIS AGREEMENT is made and entered into by and between the Triangle J Council of Governments
(Hereafter "TJCOG "), and Orange County ( "Contractor ").
WHEREAS, TJCOG administers the Carolina Blue Skies & Green Jobs Initiative ( "Program ") to provide
funds for eligible activities; and
WHEREAS, it is the intention of the parties to this Agreement that all activities described herein shall be for
their mutual benefit; and
WHEREAS, TJCOG has approved an award to the Contractor in the total program amount of $84,530 for
eligible activities herein described; and
WHEREAS, the terms and conditions herein shall survive the performance period and shall continue in full
force and effect until the Contractor has completed and is in compliance with all the requirements of this
Agreement; and
WHEREAS, this Agreement is mutually exclusive and is distinguished from all previous Agreements between
the Contractor and TJCOG and contains the entire understanding between the parties;
NOW, THEREFORE, in consideration of the mutual promises and dependent documents, the parties hereto
agree as follows:
The following documents are part of this contract:
1) This Contract Agreement (including all attachments and the initial work plan and budget delivered under
this contract agreement)
ORANGE COUNTY
BY:
TITLE:
TRIANGLE J COUNCIL OF
GOVERNMENTS
BY:
Kirby Bowers
TITLE: Executive Director
DATE: �- DATE:
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Contract No. TJCOG— CBS -004
GENERAL TERMS AND CONDITIONS
ARTICLE 1. APPLICABLE LAW
This Agreement shall be governed by the Laws of the State of North Carolina. Venue shall lie in Orange
County . In addition, the Contractor pledges to abide by and comply with the following requirements:
1. Contract funds shall not be used to supplant existing funding otherwise budgeted or planned for
projects outside of this program whether under local, state or federal law, without the consent of
TJCOG.
2. Matching funds shall be from non - federal funds. Contractor agrees to submit Certification of Non -
Federal Cost Share included in this contract package.
ARTICLE 2. LEGAL RELATIONS
The Contractor shall at all times comply with and observe all federal and state laws and published circulars,
local laws, ordinances, and regulations which are in effect during the period of this Agreement and which in any
manner affect the work or its conduct.
In carrying out any provisions of this Agreement or in exercising any power or authority contracted to the
Contractor thereby, there shall be no personal liability upon TJCOG.
If an audit is required by federal law and if the Contractor is also the recipient of State funds under the same or a
separate contract program, then TJCOG funded programs shall also be included in the scope of the federally
required audit.
The Contractor must submit required certifications included in this contract package, including Certification
Regarding Debarment, Certification Regarding Lobbying, annual Certification of Special Provisions of
Recovery Act, annual Certification Regarding Audit, Certification of Non - Federal Cost Share, and Property
Close -Out Certification.
ARTICLE 3. INDEMNIFICATION
Contractor shall indemnify, hold harmless and, at TJCOG's election, defend TJCOG, its directors, officers,
employees, and agents from and against all losses, costs, claims, penalties, causes of action, damages, liabilities,
fees, and expenses, including, but not limited to, reasonable attorneys' fees, all expenses of litigation and/or
settlement, and court costs, arising from or related to any act or omission of Contractor, its directors, officers,
employees, agents, suppliers, or subcontractors at any tier, in the performance of any of its obligations under this
contract. If any judgment shall be rendered against TJCOG in any such action or actions, the Contractor shall
satisfy and discharge the same without cost or expense to TJCOG. This indemnity shall not apply to claims,
actions, or suits resulting from the negligence of TJCOG or its agents.No section of this Agreement is intended
to create a waiver of the Contractor's rights or privileges as a sovereign entity.
This indemnification shall expressly extend to any losses, costs, claims, penalties, causes of action, damages,
liabilities, fees, and expenses, including, but not limited to, reasonable attorneys' fees, all expenses of litigation
and/or settlement, and court costs, arising from or related to Contractor's failure to timely submit the payroll and
other information as required bythe Davis -Bacon Act or arising from or related to any misrepresentations of the
Contractor on such submissions, on the Statement of Compliance, or on Form WH -347.
This indemnification shall also expressly extend to any losses, costs, claims, penalties, causes of action,
damages, liabilities, fees, and expenses, including, but not limited to, reasonable attorneys' fees, all expenses of
litigation and/or settlement, and court costs, arising from or related to a Special Audit conducted by the Audit
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Contract No. TJCOG— CBS -004
Division of the DOE, or related to an investigation of the Inspector General's Office, arising from the
Contractor's failure to cure its non - performance or non - compliance with the Contract terms upon notice of such
nonperformance or non - compliance.
TJCOG shall indemnify, hold harmless and, at Contractor's election, defend Contractor, its directors, officers,
employees, and agents from and against all losses, costs, claims, penalties, causes of action, damages, liabilities,
fees, and expenses, including, but not limited to, reasonable: attorneys' fees, all expenses of litigation and/or
settlement, and court costs, arising from or related to any act or omission of TJCOG, its directors, officers,
employees, agents, suppliers, or subcontractors at any tier, in the performance of any of its obligations under this
contract. If any judgment shall be rendered against Contractor in any such action or actions, then TJCOG shall
satisfy and discharge the same without cost or expense to Contractor.It is the intent of this section to require
TJCOG to indemnify the Contractor to the extent permitted under North Carolina law.
ARTICLE 4. SCOPE OF WORK
The Contractor shall supply or provide for all the necessary personnel, equipment, and materials (except as may
be otherwise provided herein) to accomplish the tasks set forth on the attached Scope of Work and Budget
(ATTACHMENTS A and B respectively), in the event of a conflict between the summary in Attachments A and
B and the application and/or other supporting documents previously submitted to TJCOG by the Contractor,
Attachments A and B shall control. Changes to the Scope of Work may be made only by written agreement of
both TJCOG and the Contractor.
ARTICLE 5. STANDARDS OF PERFORMANCE
The Contractor shall perform the project and activities as set forth in the Contract Application and described
herein in accordance with those standards established by statute, administrative rule, and any applicable
professional standards.
ARTICLE 6. PERIOD OF PERFORMANCE
The effective period of this Agreement shall be from May 1, 2010 through April 20, 2014unless otherwise
provided for by amendment to this Agreement.
ARTICLE 7. SUBLET OR ASSIGNMENT OF AGREEMENT
The Contractor, its agents, or subcontractors shall not sublet or assign all or any part of the work under this
Agreement without prior written approval of TJCOG. TJCOG reserves the right to reject any subcontractor
after notification. The Contractor must provide TJCOG with a copy of any executed subcontract or accepted
subcontractor bid for the purpose of administering this Agreement which relates to activities funded and which
exceeds the amount shown in ATTACHMENT B. The Contractor shall be responsible for all matters involving
any subcontractor engaged under this Agreement, including contract compliance, performance, and dispute
resolution between itself and a subcontractor. TJCOG bears no responsibility for subcontractor compliance,
performance, or dispute resolution hereunder.
ARTICLE 8. NONDISCRUAINATION IN EMPLOYMENT
In connection with the performance of work under this Agreement, the, Contractor agrees not to discriminate
against any employee or applicant for employment because of age, race, religion, color, handicap, sex, physical
condition, developmental disability, sexual orientation or national origin. This provision shall include, but not
be limited to, the following: employment, upgrading, demotion or transfer; recruitment or recruitment
advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training,
including apprenticeship. Except with respect to sexual orientation, the Contractor further agrees to take
affirmative action to ensure equal employment opportunities. The Contractor agrees to post in conspicuous
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Contract No. TJCOG- CBS -004
places, available for employees and applicants for employment, notices to be provided by the State setting forth
the provisions of the nondiscrimination clause.
Failure to comply with the conditions of this clause may result in the declaration of Contractor ineligibility, the
termination of this Agreement, or the withholding of funds.
ARTICLE 9. SMALL BUSINESS AND NHNORTTY -OWNED BUSINESSES
The Contractor shall make positive efforts to utilize small business and minority -owned business sources of
supplies and services. Such efforts should allow these sources the maximum feasible opportunity to compete for
contracts or subcontracts to be performed utilizing state or federal funds.
ARTICLE 10. TERMINATION AT WILL
TJCOG may terminate this Agreement at any time at its sole discretion upon thirty (30) days written notice to
the Contractor. Upon termination, TJCOG's liability shall be limited to the actual costs incurred in carrying out
the project as of the date of termination plus any termination expenses having prior written approval of TJCOG.
The Contractor may request, in writing, to terminate this Agreement. At its discretion, TJCOG may approve the
termination request. If the termination request is approved, TJCOG and the Contractor shall mutually agree
upon the termination date. Upon termination the Contractor shall refund to TJCOG any payment made by
TJCOG to the Contractor which exceeds actual costs incurred in carrying out the project as of the date of
termination.
ARTICLE 11. TERMINATION FOR NONAPPROPRIATION
The parties reserve the right to terminate this Agreement in whole or in part without penalty due to non -
appropriation of necessary funds with thirty (30) days prior written notice.
ARTICLE 12. CANCELLATION FOR CAUSE
TJCOG may cancel this Agreement if, through any cause, the Contractor fails to fulfill its obligations hereunder
in a timely and proper manner, or violates any of the provisions of this Agreement. TJCOG shall give the
Contractor 30 days written notice of its intent to cancel under this provision. TJCOG may allow the Contractor
time to cure any default or violation at its sole discretion. Upon cancellation, TJCOG's liability shall be limited
to any undisputed costs incurred in carrying out the project as of the date of cancellation. In the event this
Agreement is canceled by TJCOG, the Contractor shall refund to TJCOG any payment made by TJCOG to the
Contractor which exceeds actual costs incurred in carrying out the project as of the date of cancellation.
ARTICLE 13. FAILURE TO PERFORM
TJCOG reserves the right to suspend payment of funds if required reports are not provided to TJCOG on a
timely basis or if performance of contracted activities is not evidenced. TJCOG further reserves the right to
suspend payment of funds under this Agreement if there are deficiencies related to the required reports or if
performance of contracted activities is not evidenced on other contracts between TJCOG and the Contractor in
whole or in part.
The Contractor's management and financial capability including, but not limited to, audit results and
performance may be taken into consideration in any or all future determinations by TJCOG and may be a factor
in a decision to withhold payment and may be cause for termination of this Agreement.
ARTICLE 14. PUBLICATIONS
The Contractor may publish materials produced under this Agreement subject to the following conditions:
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Contract No. TJCOG —CBS -004
a) All materials produced under this Agreement shall become the property of the Contractor and may be
copyrighted in its name. Triangle J Council of Governments reserves a royalty -free, nonexclusive and
irrevocable license to reproduce, publish, otherwise use, and to authorize others to use such materials for
government purposes.
ARTICLE 15. ENTIRE AGREEMENT AND AMENDMENT
This Agreement and all Attachments comprise the entire Agreement of both parties. This Agreement may be
amendedby mutual written consent of the parties.
ARTICLE 16. SEVERABILITY
If any provision of this Agreement shall be adjudged to be unlawful or contrary to public policy, then that
provision shall be deemed null and void and severable from the remaining provisions, and shall in no way affect
the validity of this Agreement.
ARTICLE 17. SURVIVAL OF REQUIREMENTS
Unless otherwise authorized in writing by TJCOG, the terms and conditions of this Agreement shall survive the
performance period and shall continue in full force and effect until the Contractor has completed, and is in
compliance with, all of its requirements.
ARTICLE 18. WAIVER
Failure or delay on the part of either party to exercise any right, power, privilege or remedy hereunder shall not
constitute a waiver thereof. A waiver of any default shall not operate as a waiver of any other default or of the
same type of default on a future occasion.
ARTICLE 19. FORCE MAJEURE
Either party's performance of any part of this Agreement shall be excused to the extent that it is hindered,
delayed or otherwise made impractical by reason of flood, riot, fire, explosion, war, acts or omissions of the
other party or any other cause, whether similar or dissimilar to those listed, beyond the reasonable control of that
party. If any such event occurs, the non - performing party shall make reasonable efforts to notify the other party
of the nature of such condition and the extent of the delay and shall make reasonable, good faith efforts to
resume performance as soon as possible.
ARTICLE 20. ASSIGNMENT
This Agreement and the obligations, duties and undertakings of the Contractor described herein may not be
assigned or delegated by the Contractor without the express written consent of TJCOG, and any attempted
assignment or delegation without such consent shall be void.
ARTICLE 21. EXTRA WORK
If TJCOG desires to have the Contractor perform work or render services other than provided for by the
expressed intent of this Agreement, this shall be considered as Extra Work, subject to written amendment to this
Agreement setting forth the nature and scope thereof and the compensation therefore as determined by mutual
agreement between TJCOG and the Contractor. Work under such amendment shall not proceed unless and until
so authorized by TJCOG. Any such continuance of service which would cause compensation to exceed the total
amount of this Agreement shall be contingent upon the above provision and the appropriation of necessary
funds.
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Contract No. TJCOG— CBS -004
FISCAL TERMS AND CONDITIONS
ARTICLE 22. VARIANCES
Variances may be permissible as outlined in ATTACHMENT A. A variance shall not be used to authorize a
revision of the amount awarded or a change in the performance period. Such changes must be made by
amendment to the Agreement.
ARTICLE 23. LIMITATION ON COSTS
TJCOG's contribution to the total cost, both direct and indirect, of performing the tasks under this Agreement
shall not exceed $84,530 for Eligible Costs (see Budget attached as ATTACHMENT B). Changes to this
Agreement, which do not affect the Budget total, may be made by written agreement of both TJCOG and the
Contractor.
ARTICLE 24. ELIGIBLE COSTS
Eligible Costs are those costs which can be audited and which are directly attributable to contracted activities
and identified and approved in the Contract Application.
1. No Eligible Costs subject to reimbursement by this Agreement may be incurred prior to the start
date of this Agreement.
2. Costs only as identified in the Budget and described in the Scope of Work are allowed.
3. All methods of charging expenses against this Agreement must be submitted for review and
approval by TJCOG.
ARTICLE 25. REIMBURSEMENT OF FUNDS
The Contractor shall return to TJCOG or other appropriate governmental agency or entity any funds paid to the
Contractor in excess of the allowable costs under this Agreement. If the Contractor fails to return excess funds,
TJCOG may deduct the appropriate amount from subsequent payments due to the Contractor from TJCOG.
TJCOG also reserves the right to recover such funds by any other legal means including litigation if necessary.
The Contractor shall be responsible for reimbursement to TJCOG for any disbursed funds, which are determined
by TJCOG to have been misused or misappropriated. TJCOG may also require reimbursement of funds if
TJCOG determines that any provision of this Agreement has been violated. Any reimbursement of funds which
is required by TJCOG, with or without termination, shall be due within forty-five (45) days after giving written
notice to the Contractor.
ARTICLE 26. LIMITED USE OF PROGRAM FUNDS
This Agreement is a mutually exclusive Agreement. The Contractor shall not apply funds authorized pursuant
to other Program Agreements toward the activities for which funding is authorized by this Agreement nor shall
funding authorized by this Agreement be used toward the activities authorized pursuant to other Program
Agreements. The word "funds" as used in this Article does not include Program income.
ARTICLE 27. FINANCIAL MANAGEMENT
The Contractor agrees to maintain a financial management system which complies with the rules and regulations
required by the Program funding source described in ATTACHMENT A and with standards established by
TJCOG to assure funds are spent in accordance with law and to assure that accounting records for funds
received under this Agreement are sufficiently segregated from other Agreements, programs, and/or projects.
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Contract No. TJCOG— CBS -004
ARTICLE 28. METHOD OF PAYMENT
Payments are to be used exclusively for costs incurred during the Performance Period. TJCOG shall make
payment to the Contractor upon receipt of invoices submitted either 1) to the following mailing address:
Triangle J Council of Governments
Attn: Kathy Boyer
Post Office Box 12276
Research Triangle Park, NC 27709
or 2) electronically to the Contractor's online project portal.
a) Invoices shall reflect costs incurred by approved Budget line item. Invoices should be accompanied by
written documentation of costs.
b) The final invoice should be submitted to TJCOG no later than sixty (60) days following termination of
this Agreement.
ADMINISTRATIVE TERMS AND CONDITIONS
ARTICLE 29. SINGLE AUDIT REOUIREMENT
The Contractor shall have a certified annual audit performed utilizing Generally Accepted Accounting
Principles and Generally Accepted Auditing Standards.
Federal Funded Awards:
Governmental Contractors, or their assignees, that expend $300,000 or more in a single year from awards
which funding originated from Federal Government sources shall comply with the Single Audit Act of 1996,
OMB Circular A -133, and TJCOG Single Audit Guidelines. Audit reports are due to TJCOG within thirty (30)
days from issuance of the report, but no later than nine (9) months after the end of the audit period.
Non - profit Contractors, or their assignees, that expend $300,000 or more in a single year from awards which
funding originated from Federal Government sources shall comply with the Single Audit Act of 1996, OMB
Circular A -133 and TJCOG Single Audit Guidelines. In addition, a separate footnote or schedule shall be
included listing all awards which funding originated from State Government sources and the total cash expended
under each of those awards for the year under audit. Audit reports are due to TJCOG within thirty (30) days
from issuance of the report, but no later than nine (9) months after the end of the audit period.
For - profit Contractors, or their assignees, that expend $300,000 or more in a single year from awards which
funding originated from Federal Government sources shall have a certified annual audit performed utilizing
Generally Accepted Accounting Principles, Generally Accepted Auditing Standards and Government Auditing
Standards. In addition, a separate footnote or schedule shall be included listing all awards which funding
originated from Federal Government sources and the total cash expended under each of those awards for the
year under audit. Audit reports are due to TJCOG within thirty (30) days from issuance of the report, but no
later than nine (9) months after the end of the audit period.
One (1) copy of the Audit along with the Management Letter shall be submitted to the address listed below.
Responses and corrective action to be taken by management must be included for any findings or comments
issued by the auditor.
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Contract No. TJCOG— CBS -004
If the combined total expended from all funding originating from Federal Government sources is less than
$300,000 in a single year, the Contractor, or its assignee, shall confirm annually in writing that the above audit
requirements are not applicable. This confirmation shall be submitted to the address listed below.
Submit To:
Send one copy of the Audit and Management Letter or the letter confirming that the audit requirements are not
applicable to:
Kathy Boyer
Triangle J Council of Governments
PO Box 12276
RTP, NC 27709
ARTICLE 30. EXANIINATION OF RECORDS
The Contractor agrees that TJCOG shall have access at any time and the right to examine, audit, excerpt,
transcribe and copy on the Contractor's premises any directly pertinent records and computer files of the
Contractor involving transactions relating to this Agreement. Similarly, TJCOG shall have access at any time to
examine, audit, test and analyze any and all physical projects subject to this Agreement. If the material is held
in an automated format, the Contractor shall provide copies of these materials in the automated format or such
computer file as may be requested by TJCOG. Such material shall be retained for three years by the Contractor
following final payment on the Agreement.
This provision shall also apply in the event of cancellation or termination of this Agreement. The Contractor
shall notify TJCOG in writing of any planned conversion or destruction of these materials at least 90 days prior
to such action. Any charges for copies provided by the Contractor of books, documents, papers, records,
computer files or computer printouts shall not exceed the actual cost thereof to the Contractor and shall be
reimbursed by TJCOG.
The minimum acceptable financial records for the project consist of: 1) Documentation of employee time;
2) Documentation of all equipment, materials, supplies and travel expenses; 3) Inventory records and supporting
documentation for allowable equipment purchased to carry out the project scope; 4) Documentation and
justification of methodology used in any in -kind contributions; 5) Rationale supporting allocation of space
charges; 6) Rationale and documentation of any indirect costs (submitted with initial invoice); 7) Documentation
of Agreement Services and Materials; and 8) Any other records which support charges to project funds. The
Contractor must maintain sufficient segregation of project accounting records from other projects or programs.
ARTICLE 31. PERFORMANCE REPORTS AND INVOICES
The Contractor shall submit Invoices accompanied by Performance Reports to TJCOG according to the
guidelines in ATTACEIMENT A as long as this Agreement is in effect. These Invoices and Performance
Reports shall detail the uses of the funds received under this Agreement, how funds have been expended and the
amounts expended during the immediately preceding fiscal period, until all funds have been expended.
Performance Reports must identify the status of progress of tasks as provided in the Scope of Work. The Final
PerformanceReport shall be submitted no later than 60 days following termination of this Agreement. It shall
include a summary of the work performed, a data report in a form that is consistent with reporting standards
described in ATTACHIVIENT A, a final financial report and a short narrative of problems and achievements, all
of which shall be consistent with any format instructions provided by TJCOG.
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Contract No. TJCOG- CBS -004
ARTICLE 32. CHANGES
TJCOG may at any time, by written notice, and without notice to sureties or assignees, make changes within the
general scope of this Contract as necessary due to modifications required by the USDOE, adjustments required
by Change Orders accepted by TJCOG from the Contractor or other team members. However, nothing
contained in this paragraph shall excuse Contractor from proceeding without delay in the performance of this
Contract as changed.
Only the Finance Director or Executive Director of TJCOG has authority to make changes in, to amend, or to
modify this Contract. Such changes, amendments or modifications must be in writing.
TJCOG personnel and other Primary Investigators in the Carolina Blue Skies Initiative may render assistance,
give technical advice, discuss, or exchange information with Contractor's personnel concerning the Project
hereunder.
Contractor shall, at the request of TJCOG, accept amendments to this Contract to incorporate additional
provisions herein ,or to change provisions hereof, as TJCOG may reasonably deem necessary in order to comply
with the provisions of the applicable Prime Contract, or with the provisions of amendments to such Prime
Contract.
SPECIAL TERMS AND CONDITIONS
ARTICLE 33. COMPETITIVE PROCUREMENT PRACTICES
Contractor agrees to utilize Contractor's competitive procurement practices for products and services purchased
as a result of this award.
ARTICLE 34. REASONABLE COSTS
Contractor further agrees to attempt to control unit costs for products and services procured as a result of this
Agreement, to the state average experience.
FA al I Istponlw rj &W
Contractor agrees to perform an "Agreed upon Procedures Audit" on request. This audit shall consist of
procedures and questions agreed upon by TJCOG and the Auditor and shall expand beyond the scope of that
provided for under the North Carolina State Single Audit Guideline requirements and applicable audit standards
for Federal Awards.
ARTICLE 36. EOUIPMENT ACCOUNTABILITY
Title to equipment purchased with funds provided under this Agreement shall vest in the contractor's name.
Disposition of any equipment shall be in accordance with applicable property disposal procedures. Real
property and equipment acquired by the Contractor shall be subject to the rules set forth in 10 CFR 600.130 -137,
10 CFR 600.320 -324, or 10 CFR 600.231 -233 as applicable.
ARTICLE 37. PATENT INFRINGEMENT
The Contractor selling the articles described herein guarantees the articles were manufactured or produced in
accordance with applicable federal labor laws. Further that the sale or use of the articles described herein shall
not infringe any United States' patent. The Contractor covenants that it shall, at its own expense, defend every
suit which shall be brought against TJCOG (provided that such Contractor is promptly notified of such suit, and
all papers therein are delivered to it) for any alleged infringement of any patent by reason of the sale or use of
such articles and agrees that it shall pay all costs, damages, and profits recoverable in any such suit.
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Contract No. TJCOG— CBS -004
ARTICLE 38. PROGRAM INCOME
Program income means gross income received by the Contractor which is directly generated from the use of the
Agreement award, including but not limited to repayments of funds that had been previously provided to eligible
beneficiaries; interest earned on any or all Agreement funds obtained; proceeds derived after the Agreement
close out from the disposition of real property acquired with any or all funds provided under this Agreement or
interest earned on Program income pending its disposition.
The Contractor agrees that all Program income shall be recorded and used in accordance with the rules and
regulations of the Program funding source described herein. If at any time changes in the use of Program
income is considered, the Contractor must submit a plan detailing the proposed uses of Program income to
TJCOG for approval. Should the Contractor decide following Agreement close out to discontinue using
Program income for such purposes, the Contractor further agrees to return the Program income balance and any
additional Program income accrued to TJCOG by January 31 of the following year.
ARTICLE 39. SPECIAL PROVISIONS REGARDING THE AMERICAN RECOVERY AND
REINVESTMENT ACT (ARRA) OF 2009
The Contractor agrees to adhere to all Special Provisions included in ATTACHMENT A -1 of this contract. In
addition, the following applies:
1. The Act:
a. Requires the Prime Contractor, the 1 st Tier Sub - Recipient, and the Contractor to comply with
all terms and conditions in the Recovery Act relating generally to governance, accountability,
transparency, data collection and resources as specified in the Act itself and as discussed below;
b. Is not fully developed and its implementing instructions, particularly those concerning specific
procedural requirements for the new reporting requirements, may be adjusted. Details regarding
these adjustments will be provided as they become available. The Contractor shall comply with
all requirements of the Act. If the Contractor believes there is any inconsistency between ARRA
requirements and any current award terms and conditions or Special Conditions, the issues will
be referred to TJCOG for reconciliation by the DOE Contracting Officer;
c. Requires subcontracts, to the maximum extent possible, be awarded as fixed price and through
the use of competitive procedures.
2. Flow -Down Requirements
a. The Contractor is subject to all requirements of these Special Provisions. In addition, the
Contractor shall flow these Special Provisions to any and all of its lower -tier subcontractors,
particularly as they relate to the following paragraphs for Wage Rates; Publication;
Registration; Utilization of Small Business; Segregation and Payment of Costs; and the
Certification made part of these Special Provisions.
3. Wage Rates
a. All laborers and mechanics employed by contractors and subcontractors on projects funded
directly by or assisted in whole or in part by and through the Federal Government pursuant to
the American Recovery and Reinvestment Act of 2009, Pub. L. 111 -5, shall be paid wages at
rates not less than those prevailing on projects of a character similar in the locality as
determined by the Secretary of Labor in accordance with subchapter IV of chapter 31 of title 40,
United States Code (commonly referred to as the `Davis -Bacon Act'). With respect to the labor
standards specified in this section, the Secretary of Labor shall have the authority and functions
set forth in Reorganization Plan numbered 14 of 1950 (64 Stat. 1267, 5 U.S.C. App.) and
section 3145 of title 40 United States Code. See
hitp://www.dol.gov/esa/whd/contracts/dbra.htm.
4. Publication
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Contract No. TJCOG— CBS —004
a. Information about this work will be published on the Internet and linked to the website
www.recovery.gov, maintained by the Accountability and Transparency Board. The Board may
exclude posting contractual or other information on the website on a case -by -case basis when
necessary to protect national security or to protect information that is not subject to disclosure
under sections 552 and 552a of title 5, United States Code.
5. Registration Requirements
a. Contractor and subcontractors shall: i) provide a valid DUNS number (including information
update as may be necessary) and ii) be registered with the Central Contractor Registration
(CCR) no later than the date the first report is due under Section 9. American Recovery and
Reinvestment Act — Reporting Requirements.
6. Utilization of Small Business
a: Contractor shall to the maximum extent practicable give a preference to small business in the
award of subcontracts for projects funded by Recovery Act dollars.
7. Segregation and Payment of Costs
a. Contractor must segregate the obligations and expenditures related to funding under the
Recovery Act. Financial and accounting systems should be revised as necessary to segregate,
track and maintain these funds apart and separate from other revenue streams. No part of the
funds from the Recovery Act shall be commingled with any other funds or used for a purpose
other than that of making payments for costs allowable for Recovery Act projects. Recovery
Act funds can be used in conjunction with other funding as necessary to complete projects, but
tracking and reporting must be separate to meet the reporting requirements of the Recovery Act
and OMB Guidance. Invoices must clearly indicate the portion of the requested payment that is
for work funded by the Recovery Act.
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ATTACHMENT A
SCOPE OF WORK
Orange County
Contract No. TJCOG— CBS —004
In the event of conflict between the provisions of the Terms and Conditions and the Scope of Work and Budget,
the provisions in the Scope of Work and Budget shall take precedent.
Summary:
In cooperation with TJCOG, Orange Countywill participate in the Carolina Blue Skies and Green Jobs Initiative.
The goal of this program is to achieve significant reductions in fuel and emissions by supporting: (1) The
increased use of alternative -fuel vehicles (AFVs) and advanced technology vehicles; and (2) installation of
infrastructure necessary to directly support AFVs or advanced - technology vehicles. The program also aims to
maximize the preservation and creation of jobs by investing in the technology and training necessary to continue
to develop a strong alternative fuels industry. Limited funding will also support the operation and maintenance
of vehicles, infrastructure and other associated equipment acquired through the program.
Site Specific Deliverables and Milestones:
Fulfill National Environmental Protection Act Requirements
The Department of Energy (DOE) National Environmental Policy Act (NEPA) Implementing
Procedures (10 CFR 1021) require careful consideration of the potential environmental
consequences of all proposed actions during the early planning stages of a project or activity. DOE
policy directs at the earliest possible stage in a project whether such actions will require preparation
of an Environmental Assessment, an Environmental Impact Statement, or a Categorical Exclusion.
To comply with these requirements, an Environmental Questionnaire (NETL Form F 451.1 -1/3)
must be completed for each proposed action to provide DOE with the information necessary to
determine the appropriate level of NEPA review and documentation. If the proposed project
qualifies for Categorical Exclusion designation, a Categorical Exclusion Designation Form (NETL
Form F451.1 -1 /1) will also be completed in addition to the Environmental Questionnaire.
If DOE determines that an Environmental Assessment is required, Contractor agrees to comply with
all necessary Environmental Assessment requirements, including but not limited to accommodating
DOE personnel and/or DOE designated contractors to perform the Environmental Assessment.
Advanced Technology Vehicle Purchase
2. Purchase and Take Delivery of Vehicles —
a. Complete actions necessary to enable vehicle purchase. This could include, but is not limited to
drafting specifications, issuing Requests for Quotes (RFQs), Evaluating Quotes, Selecting
Vehicle Vendor, Negotiating Agreements with Vendor, etc.
b. Minimum vehicle purchase requirements:
i. The vehicles must be commercially available original equipment or conversions for
alternative fuel or advanced technology vehicles (i.e. pre - commercial demonstration or
research & development vehicle projects are not eligible). Commercially available
vehicles are those that are available for purchase and unrestricted operation by the
general public and are fully compliant with all applicable emissions and safety
regulations on May 29, 2009.
ii. Dual -fuel vehicles must use the alternative fuel a majority of the time and
documentation must be provided to affirm alternative fuel use.
iii. The vehicles must be light, medium, or heavy duty vehicles, which shall not include 2
or 3 wheel vehicles.
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Contract No. TJCOG— CBS -004
iv. Provide documentation to TJCOG of vehicle technology certification, purchase orders,
certification of vehicle receipt, photographs of all 4 sides of vehicle plus photos of VIN
plate.
V. Certification that Neighborhood Electric Vehicle (NEV) purchases are replacing
traditional petroleum vehicles, including photos of VIN plate and description of
traditional vehicle disposal.
vi. Vehicles must be procured by April 30, 2012.
Apply Si Wage: Apply appropriate signage to vehicles stating that they are part of a U.S.
Department of Energy (U.S. DOE) Clean Cities Award and are powered by an alternative fuel
and/or advanced technology.
4. Post Deployment of Vehicles: Provide TJCOG performance data (see reporting below) on vehicles
until 4 /30/2014.
Infrastructure Equipment Purchases
Purchase and Take Delivery of Equipment
c. Obtain necessary state and local permits.
d. Complete actions necessary to begin construction and/or retrofit. This could include, but is not
limited to drafting specifications, issuing Requests for Quotes (RFQs), Evaluating Quotes,
Selecting Infrastructure/Fuel Hardware Vendor, Negotiating Agreements with Vendor, etc.
e. Certify that where appropriate, American Iron & Steel provisions have been followed, using the
form supplied in this contract package.
6. Installation: Install equipment of Fueling Infrastructure. This includes complying with all Davis
Bacon requirements (guidance provided below).
7. Apply ig_nage: Apply appropriate signage to fueling infrastructure including all required federal,
state and local fuel dispensing information including, but not limited to fuel contents, safety
precautions, etc. In addition, apply appropriate signage to fueling infrastructure stating that it is part
of a U.S. DOE Clean Cities Award.
Infrastructure Operational: All equipment must be operational by April 30, 2012.
9. Post Operation of Infrastructure: Provide TJCOG performance data (see reporting below) on fuel
usage until 4 /30/2014.
Additional Deliverables
10. Training: Identify and report to TJCOG specific training needs of vehicle operators, vehicle
technicians, vehicle staff, refueling site supervisors, refueling site staff. Participate in scheduled
training events, as needed.
11. Submit complete documentation/invoices related to work performed for reimbursement.
12. Comply with and submit timely reports related to the American Recovery and Reinvestment Act.
13. Comply with the Special Terms and Conditions provided by the U.S. DOE (see Attachment A -1)
14. Obtain any required permits and comply with applicable federal, state, and municipal laws, codes,
and regulations for work performed under this award.
Funding:
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Contract No. TJCOG— CBS -004
Funding in the amount of $84,530 is provided by the U.S. DOE American Recovery and Reinvestment Act
monies to cover the incremental cost of purchasing the vehicle and/or purchasing equipment for alternative fuels
infrastructure. Incremental cost shall be calculated on the difference between the cost of the AFV /Advanced
Technology Vehicle and the cost of a comparable conventional model verified by manufacturer estimate, after
all other applicable manufacturer and local/state rebates, tax credits, and cash equivalent incentives are applied.
Funding shall be applied to the following activities:
Purchase and install electric vehicle charging infrastructure.
Required match will be a minimum of $0.00.
Invoicing:
Submit all the required documentation (i.e. copy of title, photographic documentation, equipment cost details,
comparable non -AFV vehicle price info, technology certification, invoice for reimbursement, and other
documentation as described above) to TJCOG. After review and approval, funds will be distributed for
reimbursement.
Site Visits:
U.S. DOE and its authorized representatives have the right to make site visits at reasonable times to review
project accomplishments and management control systems and to provide technical assistance, if required.
Orange County must provide reasonable access to facilities, office space, resources, and assistance for the safety
and convenience of the government representatives in the performance of their duties. All site visits and
evaluations must be performed in a manner that does not unduly interfere with or delay the work.
Period of Performance:
This contract becomes effective on May 1, 2010 and terminates on April 30, 2014
Publications:
An acknowledgment of Federal support and a disclaimer must appear in the publication of any material, whether
copyrighted or not, based on or developed under this project, as follows:
Acknowledgment: "This material is based upon work supported by the Department of Energy under Award
Number DE- EE0002491."
Disclaimer: "This report was prepared as an account of work sponsored by an agency of the United States
Government. Neither the United States Government nor any agency thereof, nor any of their employees, makes
any warranty, express or implied, or assumes any legal liability or responsibility for the accuracy, completeness,
or usefulness of any information, apparatus, product, or process disclosed, or represents that its use would not
infringe privately owned rights. Reference herein to any specific commercial product, process, or service by
trade name, trademark, manufacturer, or otherwise does not necessarily constitute or imply its endorsement,
recommendation, or favoring by the United States Government or any agency thereof. The views and opinions
of authors expressed herein do not necessarily state or reflect those of the United States Government or any
agency thereof."
Reporting Requirements:
The American Recovery and Reinvestment Act require that the public be informed of how money is used for
economic recovery. The law ensures accountability and transparency through a number of reporting
requirements. Under the guidelines in the law, Orange County will be required to:
• Report on the use of recovery funds for this program;
• Ensure the funds are used appropriately as defined by the law;
• Provide the number of jobs that were created or saved by the funds.
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Contract No. TJCOG— CBS —004
Reporting requirements detailed below are subject to changes by U.S. DOE throughout the period of
performance. Compliance with any changes to reporting is required.
Special Terms & Conditions Certification — compliance with Recovery Act Reporting
Contractor agrees to submit annually the Certification of Special Provisions American Recovery and
Reinvestment Act of 2009 (Form UCN- 22179) included in ATTACHMENT C.
Monthly manhour reportine— compliance with Recovery Act Reporting
1. Monthly reporting of hours expended to perform subcontracted work during each reporting month is
required by the Contractor. The hours reported are to be inclusive of all full -time, part-time, temporary,
and permanent positions supported by ARRA funding. The manhour reporting Excel sheet included in
this contract package is the tool to capture your monthly hours expended. In addition, the below text
provides general guidance on how to report the various types of hours that may be involved.
a) Agreements for which Direct Productive Labor Hours are invoiced (i.e. Staff Augmentation), the
Subcontractor shall report those hours expended in the performance of the work.
b) Agreements that are fixed price (such as paving, deliverable reports, construction, etc.) the
subcontractor shall report those hours expended in the performance of the work. This category is
also inclusive of Agreements containing milestone or progress payments.
c) For Agreements that are fixed price and the subcontractor is delivering purchased products (i.e.,
equipment/ materials /AVID supplies), report only those hours associated with filling and delivery
the purchase order. If the purchased product is fabricated, report those hours expended in the
performance of the fabrication during the reporting month. This report is due electronically to the
subcontract administrator on or before the third calendar day of the month following the reporting
period. If that third calendar day is a weekend day or Company holiday, the first Company business
day thereafter becomes the required due date.
2. Subcontractor Reporting: Jobs Created, Jobs Retained
a) The Contractor shall report on a quarterly basis the number of jobs either created and /or retained
and any jobs created or retained through its sub - subcontracting utilizing ARRA funding. The report
shall keep data pertaining to jobs created and jobs retained separate by First -Tier level and each
lower tier subcontractor. A job shall not be reported as both created and retained, nor can the
Contractor count the jobs created and/or retained by any of its subcontractors. The report shall be
provided electronically to TJCOG by the third calendar day following the end of the reporting
quarter. If that third calendar day is a weekend day or Contractor holiday, the first Contractor
business day thereafter becomes the required due date. Each report shall identify the cumulative of
all previous reporting periods, net changes (plus or minus) that occurred for the reporting quarter,
and the grand total (previous reporting periods plus current reporting period) for both job categories.
b) Jobs created and jobs retained are defined as follows:
i. Jobs created – those new positions created and filled, or previously unfilled positions that
are filled as a result of ARRA funding. This shall be inclusive of full time and part time
employees. The number shall be expressed as "full time equivalents" (FTE) as determined
by the cumulative of all hours worked divided by the total number of hours in a full time
schedule as defined by the subcontractor.
ii. Jobs retained – those previously filled existing positions that are retained as a result of
ARRA funding. This shall be inclusive of full time and part-time employees. The number
shall be expressed as "full time equivalents" (FTE) as determined by the cumulative of all
hours worked divided by the total number of hours in a full time schedule as defined by the
subcontractor.
Ouarterly Reporting and Data Collection
Under the provisions of the ARRA, the Government requires the collection of certain data during the course of
the Contract. The Contractor shall provide the required data or provide support for the collection of the data,
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Contract No. TJCOG— CBS —004
depending on the Work performed by the Contractor, in accordance with the specifications set forth in the
attachments described below. Report templates will be available on your internet portal.
1. Quarterly Progress. This report will document a comparison of actual accomplishments, the cost status,
schedule status, any changes in approach that have been approved by TJCOG, actual or anticipated
problems or delays and actions taken, any changes or absence of key personnel, and a description of
outreach/marketing activities.
2. Data Collection Site Requirements for Fuel Dispensing contains the instructions and specifications
applicable to support the installation and operation of data collection devices at fuel dispensing sites. To
the extent that the Contractor either operates a fuel dispensing site or provides infrastructure for a fuel
dispensing site, the Contractor shall comply with these specifications, which may be modified from time
to time as necessary to collect the required data.
3. Data Collection Site Requirements for Vehicle Fleets contains the instructions for the collection of
weekly operational data from the use of fleet vehicles. If the Contractor is a fleet operator under the
Contract, the Contractor shall provide the required data in the form and manner set forth in this
attachment.
Buy American Provisions
If applicable, the Contractor is required to provide a listing of the manufacturers of the equipment purchased to
perform activities funded by the Carolina Blue Skies & Green Jobs Initiative, in compliance with the Buy
American (see Attachment A -2) requirements.
Davis Bacon Provisions
All construction projects are required to comply with requirements in the Davis -Bacon Act. The provisions
referenced in Attachment A -3 relating to wage rates or the Davis -Bacon Act refer to local standards as
determined by the Secretary of Labor as they apply to this Contract. The Secretary of Labor has made the
determinations by county that apply to this contract. These determinations are incorporated by reference and
included herein as Attachment A -4. The Contractor shall apply the wage rates that apply to this Contract.
In order to comply with these provisions, all construction projects are required to submit Form WH347, Weekly
Wage reports. The Form shall be uploaded to your project's internet portal. Hard copies will not be accepted.
_Special Status Reports
A report is required (via email), as soon as possible, after any of the following events occur:
1. Developments that have a significant favorable impact on the project.
2. Problems, delays, or adverse conditions which materially impair the ability to meet the objectives of
the award or which may require the OEI or the U.S. DOE to respond to questions relating to such
events from the public. Report on any of the following incidents and include the anticipated impact
and remedial action to be taken to correct or resolve the problem /condition:
a. Any single fatality or injuries requiring hospitalization of five or more individuals.
b. Any significant environmental permit violation.
c. Any verbal or written Notice of Violation of any Environmental, Safety, and Health
statutes.
d. Any incident which causes a significant process or hazard control system_ failure.
e. Any event which is anticipated to cause a significant schedule slippage or cost increase.
£ Any damage to Government -owned equipment in excess of $50,000.
g. Any other incident that has the potential for high visibility in the media.
Final Report
Provide information for a final report due 60 days after the contract terminates on April 30, 2014. This
includes providing the Property Certification, including the required inventories of non - exempt property. The
certification is located on your internet portal, and at
hqp: / /www management energ .gov /documents /Pro e�rtyCertFINAL doe
Page 16 of 34
Special Instructions & Provisions:
None
Contract No. TJCOG— CBS —004
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Contract No. TJCOG— CBS -004
ATTACHMENT A -1
SPECIAL PROVISIONS RELATING TO WORK FUNDED UNDER AMERICAN RECOVERY AND
REINVESTMENT ACT OF 2009
Preamble
The American Recovery and Reinvestment Act of 2009, Pub. L. 111 -5, (Recovery Act) was enacted to preserve
and create jobs and promote economic recovery, assist those most impacted by the recession, provide
investments needed to increase economic efficiency by spurring technological advances in science and health,
invest in transportation, environmental protection, and other infrastructure that will provide long -term economic
benefits, stabilize State and local government budgets, in order to minimize and avoid reductions in essential
services and counterproductive State and local tax increases. Recipients shall use grant funds in a manner that
maximizes job creation and economic benefit.
The Recipient shall comply with all terms and conditions in the Recovery Act relating generally to governance,
accountability, transparency, data collection and resources as specified in Act itself and as discussed below.
Recipients should begin planning activities for obtaining a DUNS number (or updating the existing DUNS
record), and registering with the Central Contractor Registration (CCR).
Be advised that Recovery Act funds can be used in conjunction with other funding as necessary to complete
projects, but tracking and reporting must be separate to meet the reporting requirements of the Recovery Act and
related guidance. For projects funded by sources other than the Recovery Act, Contractors must keep separate
records for Recovery Act funds and to ensure those records comply with the requirements of the Act.
The Government has not fully developed the implementing instructions of the Recovery Act, particularly
concerning specific procedural requirements for the new reporting requirements. The Recipient will be
provided these details as they become available. The Recipient must comply with all requirements of the Act.
If the recipient believes there is any inconsistency between ARRA requirements and current award terms and
conditions, the issues will be referred to the Contracting Officer for reconciliation.
Definitions
For purposes of this clause, Covered Funds means funds expended or obligated from appropriations under the
American Recovery and Reinvestment Act of 2009, Pub. L. 111 -5. Covered Funds will have special accounting
codes and will be identified as Recovery Act funds in the grant, cooperative agreement or TIA and/or
modification using Recovery Act funds. Covered Funds must be reimbursed by September 30, 2015.
Non - Federal employer means any employer with respect to covered funds — the contractor, subcontractor,
grantee, or recipient, as the case may be, if the contractor, subcontractor, grantee, or recipient is an employer;
and any professional membership organization, certification of other professional body, any agent or licensee of
the Federal government, or any person acting directly or indirectly in the interest of an employer receiving
covered funds; or with respect to covered funds received by a State or local government, the State or local
government receiving the funds and any contractor or subcontractor receiving the funds and any contractor or
subcontractor of the State or local government; and does not mean any department, agency, or other entity of the
federal government.
Recipient means any entity that receives Recovery Act funds directly from the Federal government (including
Recovery Act funds received through grant, loan, or contract) other than an individual and includes a State that
receives Recovery Act Funds.
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Contract No. TJCOG- CBS —004
A. Flow Down Reauirement
As required by the US Department of Energy, the contract between TJCOG and its Contractors must include
these special terms and conditions in any sub - recipient. All sub - recipients are held to the following special
provisions and requirements as the main recipient.
B. Segregation of Costs
Recipients must segregate the obligations and expenditures related to funding under the Recovery Act.
Financial and accounting systems should be revised as necessary to segregate, track and maintain these funds
apart and separate from other revenue streams. No part of the funds from the Recovery Act shall be
commingled with any other funds or used for a purpose other than that of making payments for costs allowable
for Recovery Act projects.
C. Prohibition on Use of Funds
None of the funds provided under this agreement derived from the American Recovery and Reinvestment Act of
2009, Pub. L. 111 -5, may be used by any State or local government, or any private entity, for any casino or other
gambling establishment, aquarium, zoo, golf course, or swimming pool.
D. Access to Records
With respect to each financial assistance agreement awarded utilizing at least some of the funds appropriated or
otherwise made available by the American Recovery and Reinvestment Act of 2009, Pub. L. 111 -5, any
representative of an appropriate inspector general appointed under section 3 or 8G of the Inspector General Act
of 1988 (5 U.S.C. App.) or of the Comptroller General is authorized —
(1) to examine any records of the contractor or grantee, any of its subcontractors or subgrantees, or any State
or local agency administering such contract that pertain to, and involve transactions relation to, the
subcontract, subcontract, grant, or subgrant; and
(2) to interview any officer or employee of the contractor, grantee, subgrantee, or agency regarding such
transactions.
E. Publication
An application may contain technical data and other data, including trade secrets and/or privileged or
confidential information, which the applicant does not want disclosed to the public or used by the Government
for any purpose other than the application. To protect such data, the applicant should specifically identify each
page including each line or paragraph thereof containing the data to be protected and mark the cover sheet of the
application with the following Notice as well as referring to the Notice on each page to which the Notice
applies:
Notice of Restriction on Disclosure and Use of Data
The data contained in pages - - -- of this application have been submitted in confidence and contain trade secrets
or proprietary information, and such data shall be used or disclosed only for evaluation purposes, provided that
if this applicant receives an award as a result of or in connection with the submission of this application, DOE
shall have the right to use or disclose the data here to the extent provided in the award. This restriction does not
limit the Government's right to use or disclose data obtained without restriction from any source, including the
applicant.
Information about this agreement will be published on the Internet and linked to the website www.recovery.gov,
maintained by the Accountability and Transparency Board. The Board may exclude posting contractual or other
information on the website on a case -by -case basis when necessary to protect national security or to protect
information that is not subject to disclosure under sections 552 and 552a of title 5, United States Code.
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Contract No. TJCOG— CBS -004
F. Protecting State and Local Government and Contractor Whistleblowers.
The requirements of Section 1553 of the Act are summarized below. They include, but are not limited to:
Prohibition on Reprisals: An employee of any non - Federal employer receiving covered funds under the
American Recovery and Reinvestment Act of 2009, Pub. L. 111 -5, may not be discharged, demoted, or
otherwise discriminated against as a reprisal for disclosing, including a disclosure made in the ordinary course
of an employee's duties, to the Accountability and Transparency Board, an inspector general, the Comptroller
General, a member of Congress, a State or Federal regulatory or law enforcement agency, a person with
supervisory authority over the employee (or other person working for the employer who has the authority to
investigate, discover or terminate misconduct, a court or grant jury, the head of a Federal agency, or their
representatives information that the employee believes is evidence o£
• gross management of an agency contract or grant relating to covered funds;
• a gross waste of covered funds
• a substantial and specific danger to public health or safety related to the implementation or use of
covered funds;
• an abuse of authority related to the implementation or use of covered funds; or
• as violation of law, rule, or regulation related to an agency contract (including the competition for or
negotiation of a contract) or grant, awarded or issued relating to covered funds.
Agency Action: Not later than 30 days after receiving an inspector general report of an alleged reprisal, the
head of the agency shall determine whether there is sufficient basis to conclude that the non - Federal employer
has subjected the employee to a prohibited reprisal. The agency shall either issue an order denying relief in
whole or in part or shall take one or more of the following actions:
• Order the employer to take affirmative action to abate the reprisal.
• Order the employer to reinstate the person to the position that the person held before the reprisal,
together with compensation including back pay, compensatory damages, employment benefits, and
other terms and conditions of employment that would apply to the person in that position if the reprisal
had not been taken.
• Order the employer to pay the employee an amount equal to the aggregate amount of all costs and
expenses (including attorneys' fees and expert witnesses' fees) that were reasonably incurred by the
employee for or in connection with, bringing the complaint regarding the reprisal, as determined by the
head of a court of competent jurisdiction.
Nonenforceablity of Certain Provisions Waiving Rights and remedies or Requiring Arbitration: Except as
provided in a collective bargaining agreement, the rights and remedies provided to aggrieved employees by this
section may not be waived by any agreement, policy, form, or condition of employment, including any
predispute arbitration agreement. No predispute arbitration agreement shall be valid or enforceable if it requires
arbitration of a dispute arising out of this section.
Requirement to Post Notice of Rights and Remedies: Any employer receiving covered funds under the
American Recovery and Reinvestment Act of 2009, Pub. L. 111 -5, shall post notice of the rights and remedies
as required therein. (Refer to section 1553 of the American Recovery and Reinvestment Act of 2009, Pub. L.
111 -5, www.Recovery.gov, for specific requirements of this section and prescribed language for the notices.).
G. RESERVED.
H. False Claims Act
Recipient and sub - recipients shall promptly refer to the DOE or other appropriate Inspector General any credible
evidence that a principal, employee, agent, contractor, sub - grantee, subcontractor or other person has submitted
a false claim under the False Claims Act or has committed a criminal or civil violation of laws pertaining to
fraud, conflict or interest, bribery, gratuity or similar misconduct involving those funds.
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Contract No. TJCOG— CBS —004
I. Information in supporting of Recovery Act Renortin
Recipient may be required to submit backup documentation for expenditures of funds under the Recovery Act
including such items as timecards and invoices. Recipient shall provide copies of backup documentation at the
request of the Contracting Officer or designee.
J. Availability of Funds
Funds appropriated under the Recovery Act and obligated to this award are available for reimbursement of costs
until April 30, 2014.
L. Certifications
With respect to funds made available to State or local governments for infrastructure investments under the
American Recovery and Reinvestment Act of 2009, Pub. L. 111 -5, the Governor, mayor, or other chief
executive, as appropriate, certifies by acceptance of this award that the infrastructure investment has received
the full review and vetting required by law and that the chief executive accepts responsibility that the
infrastructure investment is an appropriate use of taxpayer dollars. Recipient shall provide an additional
certification that includes a description of the investment, the estimated total cost, and the amount of covered
funds to be used for posting on the Internet. A State or local agency may not receive infrastructure investment
funding from funds made available by the Act unless this certification is made and posted.
ATTACHM ENT A -2
REQUIRED USE OF AMERICAN IRON STEEL AND MANUFACTURED GOODS -- SECTION 1605 OF
THE AMERICAN RECOVERY AND REINVESTMENT ACT OF 2009
(a) Definitions. As used in this award term and condition—
(1) Manufactured good means a good brought to the construction site for incorporation into the building or
work that has been --
(i) Processed into a specific form and shape; or
(ii) Combined with other raw material to create a material that has different properties than the
properties of the individual raw materials.
(2) Public building and public work means a public building of, and a public work of, a governmental entity
(the United States; the District of Columbia; commonwealths, territories, and minor outlying islands of the
United States; State and local governments; and multi- State, regional, or interstate entities which have
governmental functions). These buildings and works may include, without limitation, bridges, dams, plants,
highways, parkways, streets, subways, tunnels, sewers, mains, power lines, pumping stations, heavy
generators, railways, airports, terminals, docks, piers, wharves, ways, lighthouses, buoys, jetties,
breakwaters, levees, and canals, and the construction, alteration, maintenance, or repair of such buildings
and works.
(3) Steel means an alloy that includes at least 50 percent iron, between .02 and 2 percent carbon, and may
include other elements.
(b) Domestic preference.
(1) This award term and condition implements Section 1605 of the American Recovery and Reinvestment
Act of 2009 (Recovery Act) (Pub. L. 111 - -5), by requiring that all iron, steel, and manufactured goods used
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Contract No. TJCOG— CBS -004
in the project are produced in the United States except as provided in paragraph (b)(3) and (b)(4) of this
section and condition.
(2) This requirement does not apply to the material listed by the Federal Government as follows: none
(3) The award official may add other iron, steel, and/or manufactured goods to the list in paragraph (b)(2) of
this section and condition if the Federal Government determines that --
(i) The cost of the domestic iron, steel, and/or manufactured goods would be unreasonable. The cost of
domestic iron, steel, or manufactured goods used in the project is unreasonable when the cumulative
cost of such material will increase the cost of the overall project by more than 25 percent;
(ii) The iron, steel, and/or manufactured good is not produced, or manufactured in the United States in
sufficient and reasonably available quantities and of a satisfactory quality; or
(iii) The application of the restriction of section 1605 of the Recovery Act would be inconsistent with
the public interest.
(c) Request for determination of inapplicability of Section 1605 of the Recovery Act.
(1)(i) Any recipient request to use foreign iron, steel, and/or manufactured goods in accordance with
paragraph (b)(3) of this section shall include adequate information for Federal Government evaluation of the
request, including—
(A) A description of the foreign and domestic iron, steel, and/or manufactured goods;
(B) Unit of measure;
(C) Quantity;
(D) Cost;
(E) Time of delivery or availability;
(F) Location of the project;
(G) Name and address of the proposed supplier; and
(H) A detailed justification of the reason for use of foreign iron, steel, and/or manufactured goods cited in
accordance with paragraph (b)(3) of this section.
(ii) A request based on unreasonable cost shall include a reasonable survey of the market and a
completed cost comparison table in the format in paragraph (d) of this section.
(iii) The cost of iron, steel, and/or manufactured goods material shall include all delivery costs to the
construction site and any applicable duty.
(iv) Any recipient request for a determination submitted after Recovery Act funds have been obligated
for a project for construction, alteration, maintenance, or repair shall explain why the recipient could not
reasonably foresee the need for such determination and could not have requested the determination
before the funds were obligated. If the recipient does not submit a satisfactory explanation, the award
official need not make a determination.
(2) If the Federal Government determines after funds have been obligated for a project for construction,
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Contract No. TJCOG— CBS -004
alteration, maintenance, or repair that an exception to section 1605 of the Recovery Act applies, the award
official will amend the award to allow use of the foreign iron, steel, and/or relevant manufactured goods.
When the basis for the exception is nonavailability or public interest, the amended award shall reflect
adjustment of the award amount, redistribution of budgeted funds, and/or other actions taken to cover costs
associated with acquiring or using the foreign iron, steel, and/or relevant manufactured goods. When the
basis for the exception is the unreasonable cost of the domestic iron, steel, or manufactured goods, the
award official shall adjust the award amount or redistribute budgeted funds by at least the differential
established in 2 CFR 176.110(a).
(3) Unless the Federal Government determines that an exception to section 1605 of the Recovery Act
applies, use of foreign iron, steel, and/or manufactured goods is noncompliant with section 1605 of the
American Recovery and Reinvestment Act.
(d) Data. To permit evaluation of requests under paragraph (b) of this section based on unreasonable cost, the
Recipient shall include the following information and any applicable supporting data based on the survey of
suppliers:
Foreign and Domestic Items Cost Comparison
Description Unit of measure Quantity Cost(dollars)*
Item 1:
Foreign steel, iron, or manufactured good
Domestic steel, iron, or manufactured good
Item 2:
Foreign steel, iron, or manufactured good
Domestic steel, iron, or manufactured good
[List name, address, telephone number, email address, and contact for suppliers surveyed. Attach copy of
response; if oral, attach summary.] [Include other applicable supporting information.] [ *Include all delivery
costs to the construction site.]
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Contract No. TJCOG— CBS —004
ATTACHMENT A -3
DAVIS BACON ACT AND CONTRACT WORK HOURS AND SAFETY STANDARDS ACT
WAGE RATE REQUIREMENTS UNDER SECTION 1606 OF THE RECOVERY ACT
(a) Section 1606 of the Recovery Act requires that all laborers and mechanics employed by contractors and
subcontractors on projects funded directly by or assisted in whole or in part by and through the Federal
Government pursuant to the Recovery Act shall be paid wages at rates not less than those prevailing on projects
of a character similar in the locality as determined by the Secretary of Labor in accordance with subchapter IV
of chapter 31 of title 40, United States Code.
Pursuant to Reorganization Plan No. 14 and the Copeland Act, 40 U.S.C. 3145, the Department of Labor has
issued regulations at 29 CFR parts 1, 3, and 5 to implement the Davis -Bacon and related Acts. Regulations in 29
CFR 5.5 instruct agencies concerning application of the standard Davis -Bacon contract clauses set forth in that
section. Federal agencies providing grants, cooperative agreements, and loans under the Recovery Act shall
ensure that the standard Davis -Bacon contract clauses found in 29 CFR 5.5(a) are incorporated in any resultant
covered contracts that are in excess of $2,000 for construction, alteration or repair (including painting and
decorating).
(b) For additional guidance on the wage rate requirements of section 1606, contact your awarding agency.
Recipients of grants, cooperative agreements and loans should direct their initial inquiries concerning the
application of Davis -Bacon requirements to a particular federally assisted project to the Federal agency funding
the project. The Secretary of Labor retains final coverage authority under Reorganization Plan Number 14.
Definitions: For purposes of this article, Davis Bacon Act and Contract Work Hours and Safety Standards Act,
the following definitions are applicable:
(1) "Award" means any grant, cooperative agreement or technology investment agreement made with
Recovery Act funds by the Department of Energy (DOE) to a Recipient. Such Award must require
compliance with the labor standards clauses and wage rate requirements of the Davis -Bacon Act (DBA) for
work performed by all laborers and mechanics employed by Recipients (other than a unit of State or local
government whose own employees perform the construction) Subrecipients, Contractors and subcontractors.
(2) "Contractor" means an entity that enters into a Contract. For purposes of these clauses, Contractor shall
include (as applicable) prime contractors, Recipients, Subrecipients, and Recipients' or Subrecipients'
contractors, subcontractors, and lower -tier subcontractors. "Contractor" does not mean a unit of State or
local government where construction is performed by its own employees."
(3) "Contract" means a contract executed by a Recipient, Subrecipient, prime contractor or any tier
subcontractor for construction, alteration, or repair. It may also mean (as applicable) (i) financial assistance
instruments such as grants, cooperative agreements, technology investment agreements, and loans; and, (ii)
Sub awards, contracts and subcontracts issued under financial assistance agreements. "Contract" does not
mean a financial assistance instrument with a unit of State or local government where construction is
performed by its own employees.
(4) "Contracting Officer" means the DOE official authorized to execute an Award on behalf of DOE and
who is responsible for the business management and non - program aspects of the financial assistance
process.
(5) "Recipient" means any entity other than an individual that receives an Award of Federal funds in the
form of a grant, cooperative agreement or technology investment agreement directly from the Federal
Page 24 of 34
Contract No. TJCOG— CBS —004
Government and is financially accountable for the use of any DOE funds or property, and is legally
responsible for carrying out the terms and conditions of the program and Award.
(6) "Subaward" means an award of financial assistance in the form of money, or property in lieu of money,
made under an award by a Recipient to an eligible Subrecipient or by a Subrecipient to a lower- tier
subrecipient. The term includes financial assistance when provided by any legal agreement, even if the
agreement is called a contract, but does not include the Recipient's procurement of goods and services to
carry out the program nor does it include any form of assistance which is excluded from the definition of
"Award" above.
(7) " Subrecipient" means a non - Federal entity that expends Federal funds received from a Recipient to carry
out a Federal program, but does not include an individual that is a beneficiary of such a program.
(a) Davis Bacon Act
(1) Minimum wages.
(i) All laborers and mechanics employed or working upon the site of the work (or under the United
States Housing Act of 1937 or under the Housing Act of 1949 in the construction or development of the
project), will be paid unconditionally and not less often than once a week, and without subsequent
deduction or rebate on any account (except such payroll deductions as are permitted by regulations
issued by the Secretary of Labor under the Copeland Act (29 CFR part 3) ), the full amount of wages
and bona fide fringe benefits (or cash equivalents thereof) due at time of payment computed at rates not
less than those contained in the wage determination of the Secretary of Labor which is attached hereto
and made a part hereof, regardless of any contractual relationship which may be alleged to exist
between the Contractor and such laborers and mechanics.
Contributions made or costs reasonably anticipated for bona fide fringe benefits under section 1(b)(2) of
the Davis -Bacon Act on behalf of laborers or mechanics are considered wages paid to such laborers or
mechanics, subject to the provisions of paragraph (a)(1)(iv) of this section; also, regular contributions
made or costs incurred for more than a weekly period (but not less often than quarterly) under plans,
funds, or programs which cover the particular weekly period, are deemed to be constructively made or
incurred during such weekly period. Such laborers and mechanics shall be paid the appropriate wage
rate and fringe benefits on the wage determination for the classification of work actually performed,
without regard to skill, except as provided in § 5.5(a)(4). Laborers or mechanics performing work in
more than one classification may be compensated at the rate specified for each classification for the time
actually worked therein: Provided, That the employer's payroll records accurately set forth the time
spent in each classification in which work is performed. The wage determination (including any
additional classification and wage rates conformed under paragraph (a)(1)(ii) of this section) and the
Davis -Bacon poster (WH -1321) shall be posted at all times by the Contractor and its subcontractors at
the site of the work in a prominent and accessible place where it can be easily seen by the workers.
(ii)(A) The Contracting Officer shall require that any class of laborers or mechanics, including helpers,
which is not listed in the wage determination and which is to be employed under the Contract shall be
classified in conformance with the wage determination. The Contracting Officer shall approve an
additional classification and wage rate and fringe benefits therefore only when the following criteria
have been met:
(1) The work to be performed by the classification requested is not performed by a classification
in the wage determination; and
(2) The classification is utilized in the area by the construction industry; and
Page 25 of 34
Contract No. TJCOG— CBS -004
(3) The proposed wage rate, including any bona fide fringe benefits, bears a reasonable
relationship to the wage rates contained in the wage determination.
(B) If the Contractor and the laborers and mechanics to be employed in the classification (if known),
or their representatives, and the Contracting Officer agree on the classification and wage rate
(including the amount designated for fringe benefits where appropriate), a report of the action taken
shall be sent by the Contracting Officer to the Administrator of the Wage and Hour Division, U.S.
Department of Labor, Washington, DC 20210. The Administrator, or an authorized representative,
will approve, modify, or disapprove every additional classification action within 30 days of receipt
and so advise the Contracting Officer or will notify the Contracting Officer within the 30 -day period
that additional time is necessary.
(C) In the event the Contractor, the laborers or mechanics to be employed in the classification or
their representatives, and the Contracting Officer do not agree on the proposed classification and
wage rate (including the amount designated for fringe benefits, where appropriate), the Contracting
Officer shall refer the questions, including the views of all interested parties and the
recommendation of the Contracting Officer, to the Administrator for determination. The
Administrator, or an authorized representative, will issue a determination within 30 days of receipt
and so advise the Contracting Officer or will notify the Contracting Officer within the 30 -day period
that additional time is necessary.
(D) The wage rate (including fringe benefits where appropriate) determined pursuant to paragraphs
(a)(1)(ii)(B) or (C) of this section, shall be paid to all workers performing work in the classification
under this Contract from the first day on which work is performed in the classification.
(iii) Whenever the minimum wage rate prescribed in the Contract for a class of laborers or mechanics
includes a fringe benefit which is not expressed as an hourly rate, the Contractor shall either pay the
benefit as stated in the wage determination or shall pay another bona fide fringe benefit or an hourly
cash equivalent thereof.
(iv) If the Contractor does not make payments to a trustee or other third person, the Contractor may
consider as part of the wages of any laborer or mechanic the amount of any costs reasonably anticipated
in providing bona fide fringe benefits under a plan or program, Provided, That the Secretary of Labor
has found, upon the written request of the Contractor, that the applicable standards of the Davis -Bacon
Act have been met. The Secretary of Labor may require the Contractor to set aside in a separate account
assets for the meeting of obligations under the plan or program.
(2) Withholding. The Department of Energy or the Recipient or Subrecipient shall upon its own action or
upon written request of an authorized representative of the Department of Labor withhold or cause to be
withheld from the Contractor under this Contract or any other Federal contract with the same prime
contractor, or any other federally- assisted contract subject to Davis -Bacon prevailing wage requirements,
which is held by the same prime contractor, so much of the accrued payments or advances as may be
considered necessary to pay laborers and mechanics, including apprentices, trainees, and helpers, employed
by the Contractor or any subcontractor the full amount of wages required by the Contract. In the event of
failure to pay any laborer or mechanic, including any apprentice, trainee, or helper, employed or working on
the site of the work (or under the United States Housing Act of 1937 or under the Housing Act of 1949 in
the construction or development of the project), all or part of the wages required by the Contract, the
Department of Energy, Recipient, or Subrecipient, may, after written notice to the Contractor, sponsor,
applicant, or owner, take such action as may be necessary to cause the suspension of any further payment,
advance, or guarantee of funds until such violations have ceased.
(3) Payrolls and basic records.
Page 26 of 34
Contract No. TJCOG— CBS -004
(i) Payrolls and basic records relating thereto shall be maintained by the Contractor during the course of
the work and preserved for a period of three years thereafter for all laborers and mechanics working at
the site of the work (or under the United States Housing Act of 1937, or under the Housing Act of 1949,
in the construction or development of the project). Such records shall contain the name, address, and
social security number of each such worker, his or her correct classification, hourly rates of wages paid
(including rates of contributions or costs anticipated for bona fide fringe benefits or cash equivalents
thereof of the types described in section 1(b)(2)(B) of the Davis -Bacon Act), daily and weekly number
of hours worked, deductions made and actual wages paid. Whenever the Secretary of Labor has found
under 29 CFR 5.5(a)(1)(iv) that the wages of any laborer or mechanic include the amount of any costs
reasonably anticipated in providing benefits under a plan or program described in section 1(b)(2)(B) of
the Davis -Bacon Act, the Contractor shall maintain records which show that the commitment to provide
such benefits is enforceable, that the plan or program is financially responsible, and that the plan or
program has been communicated in writing to the laborers or mechanics affected, and records which
show the costs anticipated or the actual cost incurred in providing such benefits. Contractors employing
apprentices or trainees under approved programs shall maintain written evidence of the registration of
apprenticeship programs and certification of trainee programs, the registration of the apprentices and
trainees, and the ratios and wage rates prescribed in the applicable programs.
(ii) (A) The Contractor shall submit weekly for each week in which any Contract work is performed a
copy of all payrolls to the Department of Energy if the agency is a party to the Contract, but if the
agency is not such a party, the Contractor will submit the payrolls to the Recipient or Subrecipient (as
applicable), applicant, sponsor, or owner, as the case may be, for transmission to the Department of
Energy. The payrolls submitted shall set out accurately and completely all of the information required to
be maintained under 29 CFR 5.5(a)(3)(i), except that full social security numbers and home addresses
shall not be included on weekly transmittals. Instead the payrolls shall only need to include an
individually identifying number for each employee (e.g., the last four digits of the employee's social
security number). The required weekly payroll information may be submitted in any form desired.
Optional Form WH -347 is available for this purpose from the Wage and Hour Division Web site at
http:// www. dol. gov /esa/whd/forms /wh347instr.htm or its successor site. The prime Contractor is
responsible for the submission of copies of payrolls by all subcontractors. Contractors and
subcontractors shall maintain the full social security number and current address of each covered
worker, and shall provide them upon request to the Department of Energy if the agency is a party to the
Contract, but if the agency is not such a party, the Contractor will submit them to the Recipient or
Subrecipient (as applicable), applicant, sponsor, or owner, as the case may be, for transmission to the
Department of Energy, the Contractor, or the Wage and Hour Division of the Department of Labor for
purposes of an investigation or audit of compliance with prevailing wage requirements. It is not a
violation of this section for a prime contractor to require a subcontractor to provide addresses and social
security numbers to the prime contractor for its own records, without weekly submission to the
sponsoring government agency (or the Recipient or Subrecipient (as applicable), applicant, sponsor, or
owner).
(B) Each payroll submitted shall be accompanied by a "Statement of Compliance," signed by the
Contractor or subcontractor or his or her agent who pays or supervises the payment of the persons
employed under the Contract and shall certify the following:
(1) That the payroll for the payroll period contains the information required to be provided
under § 5.5 (a)(3)(ii) of Regulations, 29 CFR part 5, the appropriate information is being
maintained under § 5.5 (a)(3)(i) of Regulations, 29 CFR part 5, and that such information is
correct and complete;
(2) That each laborer or mechanic (including each helper, apprentice, and trainee) employed on
the Contract during the payroll period has been paid the full weekly wages earned, without
rebate, either directly or indirectly, and that no deductions have been made either directly or
Page 27 of 34
Contract No. TJCOG— CBS -004
indirectly from the full wages earned, other than permissible deductions as set forth in
Regulations, 29 CFR part 3;
(3) That each laborer or mechanic has been paid not less than the applicable wage rates and
fringe benefits or cash equivalents for the classification of work performed, as specified in the
applicable wage determination incorporated into the Contract.
(C) The weekly submission of a properly executed certification set forth on the reverse side of
Optional Form WH -347 shall satisfy the requirement for submission of the "Statement of
Compliance" required by paragraph (a)(3)(ii)(B) of this section.
(D) The falsification of any of the above certifications may subject the Contractor or subcontractor
to civil or criminal prosecution under section 1001 of title 18 and section 3729 of title 31 of the
United States Code.
(iii) The Contractor or subcontractor shall make the records required under paragraph (a)(3)(i) of this
section available for inspection, copying, or transcription by authorized representatives of the
Department of Energy or the Department of Labor, and shall permit such representatives to interview
employees during working hours on the job. If the Contractor or subcontractor fails to submit the
required records or to make them available, the Federal agency may, after written notice to the
Contractor, sponsor, applicant, or owner, take such action as may be necessary to cause the suspension
of any further payment, advance, or guarantee of funds. Furthermore, failure to submit the required
records upon request or to make such records available may be grounds for debarment action pursuant
to 29 CFR 5.12.
(4) Apprentices and trainees-
(i) Apprentices. Apprentices will be permitted to work at less than the predetermined rate for the work
they performed when they are employed pursuant to and individually registered in a bona fide
apprenticeship program registered with the U.S. Department of Labor, Employment and Training
Administration, Office of Apprenticeship Training, Employer and Labor Services, or with a State
Apprenticeship Agency recognized by the Office, or if a person is employed in his or her first 90 days of
probationary employment as an apprentice in such an apprenticeship program, who is not individually
registered in the program, but who has been certified by the Office of Apprenticeship Training,
Employer and Labor Services or a State Apprenticeship Agency (where appropriate) to be eligible for
probationary employment as an apprentice. The allowable ratio of apprentices to journeymen on the job
site in any craft classification shall not be greater than the ratio permitted to the Contractor as to the
entire work force under the registered program. Any worker listed on a payroll at an apprentice wage
rate, who is not registered or otherwise employed as stated above, shall be paid not less than the
applicable wage rate on the wage determination for the classification of work actually performed. In
addition, any apprentice performing work on the job site in excess of the ratio permitted under the
registered program shall be paid not less than the applicable wage rate on the wage determination for the
work actually performed. Where a Contractor is performing construction on a project in a locality other
than that in which its program is registered, the ratios and wage rates (expressed in percentages of the
journeyman's hourly rate) specified in the Contractor's or subcontractor's registered program shall be
observed. Every apprentice must be paid at not less than the rate specified in the registered program for
the apprentice's level of progress, expressed as a percentage of the journeymen hourly rate specified in
the applicable wage determination. Apprentices shall be paid fringe benefits in accordance with the
I of the apprenticeship program. If the apprenticeship program does not specify fringe benefits,
apprentices must be paid the full amount of fringe benefits listed on the wage determination for the
applicable classification. If the Administrator determines that a different practice prevails for the
applicable apprentice classification, fringes shall be paid in accordance with that determination. In the
event the Office of Apprenticeship Training, Employer and Labor Services, or a State Apprenticeship
Agency recognized by the Office, withdraws approval of an apprenticeship program, the Contractor will
Page 28 of 34
Contract No. TJCOG — CBS —004
no longer be permitted to utilize apprentices at less than the applicable predetermined rate for the work
performed until an acceptable program is approved.
(ii) Trainees. Except as provided in 29 CFR 5.16, trainees will not be permitted to work at less than the
predetermined rate for the work performed unless they are employed pursuant to and individually
registered in a program which has received prior approval, evidenced by formal certification by the U.S.
Department of Labor, Employment and Training Administration. The ratio of trainees to joumeymen on
the job site shall not be greater than permitted under the plan approved by the Employment and Training
Administration. Every trainee must be paid at not less than the rate specified in the approved program
for the trainee's level of progress, expressed as a percentage of the journeyman hourly rate specified in
the applicable wage determination. Trainees shall be paid fringe benefits in accordance with the
provisions of the trainee program. If the trainee program does not mention fringe benefits, trainees shall
be paid the full amount of fringe benefits listed on the wage determination unless the Administrator of
the Wage and Hour Division determines that there is an apprenticeship program associated with the
corresponding journeyman wage rate on the wage determination which provides for less than full fringe
benefits for apprentices. Any employee listed on the payroll at a trainee rate who is not registered and
participating in a training plan approved by the Employment and Training Administration shall be paid
not less than the applicable wage rate on the wage determination for the classification of work actually
performed. In addition, any trainee performing work on the'job site in excess of the ratio permitted
under the registered program shall be paid not less than the applicable wage rate on the wage
determination for the work actually performed. In the event the Employment and Training
Administration withdraws approval of a training program, the Contractor will no longer be permitted to
utilize trainees at less than the applicable predetermined rate for the work performed until an acceptable
program is approved.
(iii) Equal employment opportunity. The utilization of apprentices, trainees and journeymen under this
part shall be in conformity with the equal employment opportunity requirements of Executive Order
11246, as amended and 29 CFR part 30.
(5) Compliance with Copeland Act requirements. The Contractor shall comply with the requirements of 29
CFR part 3, which are incorporated by reference in this Contract.
(6) Contracts and Subcontracts. The Recipient, Subrecipient, the Recipient's and Subrecipient's contractors
and subcontractor shall insert in any Contracts the clauses contained herein in(a)(1) through (10) and such
other clauses as the Department of Energy may by appropriate instructions require, and also a clause
requiring the subcontractors to include these clauses in any lower tier subcontracts. The Recipient shall be
responsible for the compliance by any subcontractor or lower tier subcontractor with all of the paragraphs in
this clause.
(7) Contract termination: debarment. A breach of the Contract clauses in 29 CFR 5.5 may be grounds for
termination of the Contract, and for debarment as a contractor and a subcontractor as provided in 29 CFR
5.12.
(8) Compliance with Davis -Bacon and Related Act requirements. All rulings and interpretations of the
Davis -Bacon and Related Acts contained in 29 CFR parts 1, 3, and 5 are herein incorporated by reference in
this Contract.
(9) Disputes concerning labor standards. Disputes arising out of the labor standards provisions of this
Contract shall not be subject to the general disputes clause of this Contract. Such disputes shall be resolved
in accordance with the procedures of the Department of Labor set forth in 29 CFR parts 5, 6, and 7. Disputes
within the meaning of this clause include disputes between the Recipient, Subrecipient, the Contractor (or
any of its subcontractors) and the contracting agency, the U.S. Department of Labor, or the employees or
their representatives.
Page 29 of 34
Contract No. TJCOG— CBS -004
(10) Certification of eligibility.
(i) By entering into this Contract, the Contractor certifies that neither it (nor he or she) nor any person or
firm who has an interest in the Contractor's firm is a person or firm ineligible to be awarded
Government contracts by virtue of section 3(a) of the Davis -Bacon Act or 29 CFR 5.12(a)(1).
(ii) No part of this Contract shall be subcontracted to any person or firm ineligible for award of a
Government contract by virtue of section 3(a) of the Davis -Bacon Act or 29 CFR 5.12(a)(1).
(iii) The penalty for making false statements is prescribed in the U.S. Criminal Code, 18 U.S.C. 1001.
(b) Contract Work Hours and Safety Standards Act. As used in this paragraph, the terms laborers and
mechanics include watchmen and guards.
(1) Overtime requirements. No Contractor or subcontractor contracting for any part of the Contract work
which may require or involve the employment of laborers or mechanics shall require or permit any such
laborer or mechanic in any workweek in which he or she is employed on such work to work in excess of
forty hours in such workweek unless such laborer or mechanic receives compensation at a rate not less than
one and one -half times the basic rate of pay for all hours worked in excess of forty hours in such
workweek.
(2) Violation; liability for unpaid wages; liquidated damages. In the event of any violation of the clause set
forth in paragraph (b)(1) of this section the Contractor and any subcontractor responsible therefore shall be
liable for the unpaid wages. In addition, such Contractor and subcontractor shall be liable to the United
States (in the case of work done under contract for the District of Columbia or a territory, to such District
or to such territory), for liquidated damages. Such liquidated damages shall be computed with respect to
each individual laborer or mechanic, including watchmen and guards, employed in violation of the clause
set forth in paragraph (b)(1) of this section, in the sum of $10 for each calendar day on which such
individual was required or permitted to work in excess of the standard workweek of forty hours without
payment of the overtime wages required by the clause set forth in paragraph (b)(1) of this section.
(3) Withholding for unpaid wages and liquidated damages. The Department of Energy or the Recipient or
Subrecipient shall upon its own action or upon written request of an authorized representative of the
Department of Labor withhold or cause to be withheld, from any moneys payable on account of work
performed by the Contractor or subcontractor under any such contract or any other Federal contract with
the same prime Contractor, or any other federally- assisted contract subject to the Contract Work Hours and
Safety Standards Act, which is held by the same prime contractor, such sums as may be determined to be
necessary to satisfy any liabilities of such Contractor or subcontractor for unpaid wages and liquidated
damages as provided in the clause set forth in paragraph (b)(2) of this section.
(4) Contracts and Subcontracts. The Recipient, Subrecipient, and Recipient's and Subrecipient's contractor
or subcontractor shall insert in any Contracts, the clauses set forth in paragraph (b)(1) through (4) of this
section and also a clause requiring the subcontractors to include these clauses in any lower tier
subcontracts. The Recipient shall be responsible for compliance by any subcontractor or lower tier
subcontractor with the clauses set forth in paragraphs (b)(1) through (4) of this section.
(5) The Contractor or subcontractor shall maintain payrolls and basic payroll records during the course of
the work and shall preserve them for a period of three years from the completion of the Contract for all
laborers and mechanics, including guards and watchmen, working on the Contract. Such records shall
contain the name and address of each such employee, social security number, correct classifications, hourly
rates of wages paid, daily and weekly number of hours worked, deductions made, and actual wages paid.
The records to be maintained under this paragraph shall be made available by the Contractor or
subcontractor for inspection, copying, or transcription by authorized representatives of the Department of
Page 30 of 34
Contract No. TJCOG— CBS —004
Energy and the Department of Labor, and the Contractor or subcontractor will permit such representatives
to interview employees during working hours on the job.
Page 31 of 34
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Contract No. TJCOG- CBS -004
ATTACHMENT C: Certification of Special Provisions American Recovery and Reinvestment Act of 2009
(Form UCN- 22179)
ATTACHMENT D: Davis Bacon Form WH147 and Instructions
ATTACHMENT E: Certification Regarding Lobbying
ATTACHMENT F: Certification Regarding Debarment
ATTACHMENT G: Certification of Non - Federal Cost Share
ATTACHMENT H: Environmental Questionnaire NETL Form 451.1 -1/3
ATTACHMENT I: Financial Assistance Property Close -Out Certification
ATTACHMENT J: Wage Rates
ATTACHMENT K: Manhour Report Template
ATTACHMENT L: Data Collection Report Template
Page 34 of 34
CERTIFICATION
SPECIAL PROVISIONS
AMERICAN RECOVERY AND REINVESTMENT ACT OF 2009
(COMPANY – MAR 2009, Rev 1)
B&W Y -12
NOTICE: By signing below, the Offeror /Subcontractor represents and certifies that this certification is
accurate, current, and complete and that the signer is duly authorized to make such certification on behalf of
the Offeror /Subcontractor.
1. CENTRAL CONTRACTOR REGISTRATION.
It El is, E] is not registered in the Central Contractor Registration database.
2. DUNS NUMBER. (Show as it appears in CCR.)
Its DUNS number is ________—
Its DUNS Plus 4 number is _ _ _ _ or ❑ a DUNS Plus 4 number is not applicable.
3. PARENT DUNS NUMBER.
It 0 does, ❑ does not have a parent company.
If it has a parent company, the parent company's DUNS number is _ _ _ _ _ _ _ _ —
4. LEGAL BUSINESS NAME. (Show as it appears in CCR.)
Its legal business name by which it is incorporated and pays taxes is
5. DOING BUSINESS AS (DBA). (Show as it appears in CCR.)
It ❑ commonly uses another name, n does not commonly use another name.
If it commonly uses another name, the name is
6. SUBCONTRACTOR'S PHYSICAL ADDRESS. (P. O. Box or c% may not be used. Show as it appears
in CCR.)
Street Aridracc•
City: .
State:
UCN- 22179(6 -09)
Zip Code (nine digits required):
Congressional district (required if in the United States):
7. PRIMARY PERFORMANCE LOCATION OF THE SUBCONTRACT WORK.
(P. O. Box or clo may not be used.)
Street Address:
City:
State-
Zip Code (nine digits required):
Congressional district (required if in the United States):
8. EXECUTIVE COMPENSATION. ('Total Compensation "means the complete pay package of
subcontractor employees, including all forms of monthly, benefits, services, and in -kind payments,
consistent with the regulations of the Securities and Exchange Commission at 17 CFR 229.402.)
A. Names and total compensation of each of the five most highly compensated officers for the calendar
year in which the subcontract is awarded if-
(i) in its preceding fiscal year, it received —
(1) 80 percent or more of its annual gross revenues in Federal contracts (and subcontracts),
loans, grants (and sub - grants), and cooperative agreements; and
(2) $25,000,000 or more in annual gross revenues from Federal contracts (and subcontracts),
loans, grants (and sub - grants), and cooperative agreements; and
(ii) the public does not have access to information about the compensation of the senior executives
through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of
1934 (15 U.S.C. 78M(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986.
TOTAL
ON
The compensation for senior executives shown above is for calendar year 20_
Its fiscal year end date is
B. If compensation of senior executives is not provided in 8.A above, complete the following:
In its preceding fiscal year, it Odid, ❑ did not receive —
(A) 80 percent or more of its annual gross revenues in Federal contracts (and subcontracts),
loans, grants (and sub - grants), and cooperative agreements; and
(B) $25,000,000 or more in annual gross revenues from Federal contracts (and subcontracts),
loans, grants (and sub - grants), and cooperative agreements.
The public ❑ does, 0 does not have access to information about the compensation of the senior
executives through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934
(15 U.S.C. 78M(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986.
UCN -22179 (6 -09)
LEGAL BUSINESS NAME:
9. GROSS INCOME.
Its gross income in the previous tax year ❑ did, ❑ did not exceed $300,000.
By:
Printed/Typed Name
Signature
Title:
Date:
UCN -22179 (6 -09)
Wage and Hour Division (WHD)
Instructions For Completing Payroll Form, WH -347
• WH -347 (PDF)
OMB Control No. 1215 -0149, Expires 12/31/2011.
Persons are not required to respond to the collection of information unless it
displays a currently valid OMB control number.
General: Form WH- 347has been made available for the convenience of contractors and
subcontractors required by their Federal or Federally -aided construction -type contracts and
subcontracts to submit weekly payrolls. Properly filled out, this form will satisfy the
requirements of Regulations, Parts 3 and 5 (29 C.F.R., Subtitle A), as to payrolls submitted in
connection with contracts subject to the Davis -Bacon and related Acts.
While completion of Form WH -347 is optional, it is mandatory for covered contractors and
subcontractors performing work on Federally financed or assisted construction contracts to
respond to the information collection contained in 29 C.F.R. §§ 3.3, 5.5(a). The Copeland Act
(40 U.S.C. § 3145) requires contractors and subcontractors performing work on Federally
financed or assisted construction contracts to "furnish weekly a statement with respect to the
wages paid each employee during the preceding week." U.S. Department of Labor (DOL)
Regulations at 29 C.F.R. § 5.5(a)(3)(ii) require contractors to submit weekly a copy of all
payrolls to the Federal agency contracting for or financing the construction project, accompanied
by a signed "Statement of Compliance" indicating that the payrolls are correct and complete and
that each laborer or mechanic has been paid not less than the proper Davis -Bacon prevailing
wage rate for the work performed. DOL and federal contracting agencies receiving this
information review the information to determine that employees have received legally required
wages and fringe benefits.
Under the Davis -Bacon and related Acts, the contractor is required to pay not less than prevailing
wage, including fringe benefits, as predetermined by the Department of Labor. The contractor's
obligation to pay fringe benefits may be met either by payment of the fringe benefits to bona fide
benefit plans, funds or programs or by making payments to the covered workers (laborers and
mechanics) as cash in lieu of fringe benefits.
This payroll provides for the contractor to show on the face of the payroll all monies to each
worker, whether as basic rates or as cash in lieu of fringe benefits, and provides for the
contractor's representation in the statement of compliance on the payroll (as shown on page 2)
that he /she is paying for fringe benefits required by the contract and not paid as cash in lieu of
fringe benefits. Detailed instructions concerning the preparation of the payroll follow:
Contractor or Subcontractor: Fill in your firm's name and check appropriate box.
Address: Fill in.your firm's address.
Payroll No.: Beginning with the number "I", list the payroll number for the submission
For Week Ending: List the workweek ending date.
Project and Location: Self - explanatory.
Project or Contract No.: Self - explanatory.
Column 1 - Name and Individual Identifying Number of Worker: Enter each worker's full
name and an individual identifying number (e.g., last four digits of worker's social security
number) on each weekly payroll submitted.
Column 2 - No. of Withholding Exemptions: This column is merely inserted for the employer's
convenience and is not a requirement of Regulations, Part 3 and 5.
Column 3 - Work Classifications: List classification descriptive of work actually performed by
each laborer or mechanic. Consult classification and minimum wage schedule set forth in
contract specifications. If additional classifications are deemed necessary, see Contracting
Officer or Agency representative. An individual may be shown as having worked in more than
one classification provided an accurate breakdown or hours worked in each classification is
maintained and shown on the submitted payroll by use of separate entries.
Column 4 - Hours worked: List the day and date and straight time and overtime hours worked
in the applicable boxes. On all contracts subject to the Contract Work Hours Standard Act, enter
hours worked in excess of 40 hours a week as "overtime ".
Column 5 - Total: Self - explanatory
Column 6 - Rate of Pay (Including Fringe Benefits): In the "straight time" box for each
worker, list the actual hourly rate paid for straight time worked, plus cash paid in lieu of fringe
benefits paid. When recording the straight time hourly rate, any cash paid in lieu of fringe
benefits may be shown separately from the basic rate. For example, "$12.25/.40" would reflect a
$12.25 base hourly rate plus $0.40 for fringe benefits. This is of assistance in correctly
computing overtime. See "Fringe Benefits" below. When overtime is worked, show the overtime
hourly rate paid plus any cash in lieu of fringe benefits paid in the "overtime" box for each
worker; otherwise, you may skip this box. See "Fringe Benefits" below. Payment of not less than
time and one -half the basic or regular rate paid is required for overtime under the Contract Work
Hours Standard Act of 1962 if the prime contract exceeds $100,000. In addition to paying no less
than the predetermined rate for the classification which an individual works, the contractor must
pay amounts predetermined as fringe benefits in the wage decision made part of the contract to
approved fringe benefit plans, funds or programs or shall pay as cash in lieu of fringe benefits.
See "FRINGE BENEFITS" below..
Column ,7 - Gross Amount Earned: Enter gross amount earned on this project. If part of a
worker's weekly wage was earned on projects other than the project described on this payroll,
enter in column 7 first the amount earned on the Federal or Federally assisted project and then
the gross amount earned during the week on all projects, thus "$163.00/$420.00" would reflect
the earnings of a worker who earned $163.00 on a Federally assisted construction project during
a week in which $420.00 was earned on all work.
Column 8 - Deductions: Five columns are provided for showing deductions made. If more than
five deductions are involved, use the first four columns and show the balance deductions under
"Other" column; show actual total under "Total Deductions" column; and in the attachment to
the payroll describe the deduction(s) contained in the "Other" column. All deductions must be in
accordance with the provisions of the Copeland Act Regulations, 29 C.F.R., Part 3. If an
individual worked on other jobs in addition to this project, show actual deductions from his/her
weekly gross wage, and indicate that deductions are based on his gross wages.
Column 9 - Net Wages Paid for Week: Self- explanatory.
Totals - Space has been left at the bottom of the columns so that totals may be shown if the
contractor so desires.
Statement Required by Regulations, Parts 3 and 5: While the "statement of compliance" need
not be notarized, the statement (on page 2 of the payroll form) is subject to the penalties provided
by 18 U.S.C. § 1001, namely, a fine, possible imprisonment of not more than 5 years, or both.
Accordingly, the party signing this statement should have knowledge of the facts represented as
true.
Items land 2: Space has been provided between items (1) and (2) of the statement for describing
any deductions made. If all deductions made are adequately described in the 'Deductions"
column above, state "See Deductions column in this payroll." See "FRINGE BENEFITS" below
for instructions concerning filling out paragraph 4 of the statement.
Item 4 FRINGE BENEFITS - Contractors who pay all required fringe benefits: If paying
all fringe benefits to approved plans, funds, or programs in amounts not less than were
determined in the applicable wage decision of the Secretary of Labor, show the basic cash hourly
rate and overtime rate paid to each worker on the face of the payroll and check paragraph 4(a) of
the statement on page 2 of the WH -347 payroll form to indicate the payment. Note any
exceptions in section 4(c).
Contractors who pay no fringe benefits: If not paying all fringe benefits to approved plans,
funds, or programs in amounts of at least those that were determined in the applicable wage
decision of the Secretary of Labor, pay any remaining fringe benefit amount to each laborer and
mechanic and insert in the "straight time" of the "Rate of Pay" column of the payroll an amount
not less than the predetermined rate for each classification plus the amount of fringe benefits
determined for each classification in the application wage decision. Inasmuch as it is not
necessary to pay time and a half on cash paid in lieu of fringe benefits, the overtime rate shall be
not less than the sum of the basic predetermined rate, plus the half time premium on basic or
regular rate, plus the required cash in lieu of fringe benefits at the straight time rate. In addition,
check paragraph 4(b) of the statement on page 2 the payroll form to indicate the payment of
fringe benefits in cash directly to the workers. Note any exceptions in section 4(c).
Use of Section 4(c), Exceptions
Any contractor who is making payment to approved plans, funds, or programs in amounts less
than the wage determination requires is obliged to pay the deficiency directly to the covered
worker as cash in lieu of fringe benefits. Enter any exceptions to section 4(a) or 4(b) in section
4(c). Enter in the Exception column the craft, and enter in the Explanation column the hourly
amount paid each worker as cash in lieu of fringe benefits and the hourly amount paid to plans,
funds, or programs as fringe benefits. The contractor must pay an amount not less than the
predetermined rate plus cash in lieu of fringe benefits as shown in section 4(c) to each such
individual for all hours worked (unless otherwise provided by applicable wage determination) on
the Federal or Federally assisted project. Enter the rate paid and amount of cash paid in lieu of
fringe benefits per hour in column 6 on the payroll. See paragraph on "Contractors who pay no
fringe benefits" for computation of overtime rate.
Public Burden Statement: We estimate that it will take an average of 55 minutes to complete
this collection of information, including time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection
of information. If you have any comments regarding these estimates or any other aspect of this
collection of information, including suggestions for reducing this burden, send them to the
Administrator, Wage and Hour Division, ESA, U.S. Department of Labor, Room 53502, 200
Constitution Avenue, N.W.,Washington, D.C. 20210.
Note: In -order to view, fill out, and print PDF forms, you need Adobe® Acrobat® Reader®
version 5 or later, which you may download for free at
www.adobe.com/products/acrobat/readstep2.htm]. To save the completed forms on your
workstation, you need to use the "Save As" method to save the file.
For example, move your mouse curser over the PDF link and click on your "RIGHT" mouse
button. This will cause a menu to be displayed, from which you will select the proper save option
-- depending upon which browser you are using:
• For Microsoft IE users, select "Save Target As"
• For Netscape Navigator users, select "Save Link As"
Once you've selected the proper save option for your browser, and have saved the file to a
location you specified, go to your program menu and start the Adobe Acrobat® Reader. Once
open, locate the PDF file you saved and open it directly in Acrobat.
4
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CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any
person for influencing or attempting to influence an officer or employee of an agency, a Member of
Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with
the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the
entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or
modification of any Federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an
officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal
contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard
Form -LLL, "Disclosure of Lobbying Activities;' in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award documents
for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and
cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification
is a material representation of fact upon which reliance was placed when this transaction was made or
entered into. Submission of this certification is a prerequisite for making or entering into this transaction
imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be
subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
The undersigned states, to the best of his or her knowledge and belief, that:
If any funds have been paid or will be paid to any person for influencing or attempting to influence an officer
or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of
a Member of Congress in connection with this commitment providing for the United States to insure or
guarantee a loan, the undersigned shall complete and submit Standard Form -LLL, "Disclosure of Lobbying
Activities," in accordance with its instructions. Submission of this statement is a prerequisite for making or
entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the
required statement shall be subject to a civil penalty of not less than $10,000 and not more than $100,000
for each such failure.
* APPLICANT'S ORGANIZATION
* PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE
Prefix: -First Name: Middle Name:
• Last Name: Suffix:
• Title:
* SIGNATURE: * DATE:
Certification Regarding Debarment, Suspension, and Other Responsibility Matters
Primary Covered Transactions
This certification is required by the regulations implementing Executive Order 12549, Debarment and
Suspension, 13 CFR Part 145. The regulations were published as Part VII of the May 26, 1988 Federal
Register (pages 19160 - 19211). Copies of the regulations are available from local offices of the U.S. Small
Business Administration.
(BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS ON REVERSE)
1. The prospective primary participant certifies to the best of its knowledge and belief that it and
its principals:
a. Are not presently debarred, suspended, proposed for disbarment, declared ineligible, or
voluntarily excluded from covered transactions by any Federal department or agency;
b. Have not within a three -year period preceding this application been convicted of or had a
civil judgment rendered against them for commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain, or performing a public (Federal, State, or
local) transaction or contract under a public transaction; violation of Federal or State
antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental
entity (Federal, State, or local) with commission of any of the offenses enumerated in
paragraph (1)(b) of this certification; and
d. Have not within a three -year period preceding this application had one or more public
transactions (Federal, State, or local) terminated for cause or default.
2. Where the prospective primary participant is unable to certify to any of the statements in this
certification, such prospective primary participant shall attach an explanation to this proposal.
Business Name:
Date:
By:
Name & Title of Authorized Representative
Signature of Authorized Representative
INSTRUCTIONS FOR CERTIFICATION
1. By signing and submitting this proposal, the prospective primary participant is providing the certification
set out below.
2. The inability of a person to provide the certification required below will not necessarily result in denial of
participation in this covered transaction. The prospective participant shall submit an explanation of why it
cannot provide the certification set out below. The certification or explanation will be considered in
connection with the department or agency's determination whether to enter into this transaction. However,
failure of the prospective primary participant to furnish a certification or an explanation shall disqualify
such person from participation in this transaction.
3. The certification in this clause is a material representation of fact upon which reliance was placed when
the department or agency determined to enter into this transaction. If it is later determined that the
prospective primary participant knowingly rendered an erroneous certification, in addition to other
remedies available to the Federal Government, the department or agency may terminate this transaction
for cause or default.
4. The prospective primary participant shall provide immediate written notice to the department or agency
to which this proposal is submitted if at any time the prospective primary participant learns that its
certification was erroneous when submitted or has become erroneous by reason of changed
circumstances.
5. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction,"
participant, person, primary covered transaction, principal,' proposal, and voluntarily excluded,
as used in this clause, have the meanings set out in the Definitions and Coverage sections of the rules
implementing Executive Order 12549. You may contact the department or agency to which this proposal
is submitted for assistance in obtaining a copy of those regulations (13 CFR Part 145).
6. The prospective primary participant agrees by submitting this proposal that, should the proposed
covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction
with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation
in this covered transaction, unless authorized by the department or agency entering into this transaction.
7. The prospective primary participant further agrees by submitting this proposal that it will include the
clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - -Lower
Tier Covered Transactions," provided by the department or agency entering into this covered transaction,
without modification, in all lower tier covered transactions and in all solicitations for lower tier covered
transactions.
8. A participant in a covered transaction may rely upon a certification of a prospective participant in a
lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from
the covered transaction, unless it knows that the certification is erroneous. A participant may decide the
method and frequency by which it determines the ineligibility of its principals. Each participant may, but is
not required to, check the Nonprocurement List.
9. Nothing contained in the foregoing shall be construed to require establishment of a system of records
in order to render in good faith the certification required by this clause. The knowledge and information of
a participant is not required to exceed that which is normally possessed by a prudent person in the
ordinary course of business dealings.
10. Except for transactions authorized under paragraph 6 of these instructions, if a participant in a
covered transaction knowingly enters into a lower tier covered transaction with a person who is
suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to
other remedies available to the Federal Government, the department or agency may terminate this
transaction for cause or default.
Certification of Cost Sharing By
Name of Third Party
Address of Third Party
Salaries and Benefits
This is to certify that during the period
employees of
indicated:
to
the following
spent time and effort in support of the
activities /program on an in -kind basis and in the percentages
Name
Title
Percent
effort*
Value of Effort
Value of
Benefits
The effort was an integral and necessary part of the activities /program. The time and effort
was not charged to the respective program and was otherwise paid from qualifying and
non - federal sources pursuant to Office of Management and Budget (OMB) Circular A -110.
The value of effort represents the actual amounts paid to the respective individuals at their
regular rate of pay. The value for fringe benefits does not include an overhead component and
reflect reasonable, allowable and allocable amounts. Documentation of the time spent by the
individual is available if necessary.
*If the subcontracting institution monitors hours of work instead of percent effort, please
include hours devoted to the activities /program in this space.
Supplies, Equipment Space Service Fees Other
This is to certify that during the period to
expenditures were incurred in support of the
_, the following
activities /program:
W TIT R1
The expenditures listed above were not charged to the respective program and were otherwise
paid from qualifying and non - federal sources pursuant to Office of Management and Budget
Circular A -110. The expenditures are necessary and reasonable for accomplishment of the
project/program objectives. Documentation of these expenditures is available if necessary.
• For tangible items (supplies, equipment), the values represent the cost of those items
and the cost does not exceed the fair market value of the items. If the cost of a tangible item
is not determinable, the amount reported does not exceed the fair value of the item as of the
date of donation.
• Any equipment purchased and reported as a cost shared expenditure is fully dedicated to
the activities /project.
• Amounts related to loaned equipment do not exceed the fair rental value of such
equipment.
• Amounts related to donated space do not exceed the fair rental value of comparable
space.
• Service fees reported as cost sharing reflect arms - length amounts that would otherwise
be billed to a third party.
If the activities /programs are fully completed, please check one of the following:
_ The amount of certified cost share expenses equals or exceeds the amount of
committed cost sharing.
_ The amount of certified cost share expenses is less than the amount of committed cost
sharing
Explanation:
Signature of Program Official
Date
Print Name and Title
Signature of Financial Representative
Date
Print Name and Title
Instructions
Use this template when negotiating a subcontract whereby the third party subcontractor is
agreeing to cost share. The template helps to explain how to properly value committed cost
share activity. Additionally, it allows the subcontractor to anticipate the associated
representations that will be requested during the program, if it is awarded.
Template Purpose
• To properly value cost share activity during the proposal process
• To provide a consistent format for acceptable cost sharing certification by a third party
• To facilitate the closeout process when subcontracts with cost sharing exist
Use of Template
')riming
During the life of the subcontract, periodically (ie, quarterly, semi - annually, in conjunction
with the time period of the subcontractor's invoices, et cetera) print this template on your
letterhead.
The appropriate wording should be cut -and -pasted from the template into a customized letter,
using Microsoft WORD application software. Enter the third party's legal name and its
address at the top of the letter under the heading "Certification of Cost Sharing."
Mechanics
If only salaries and benefits are cost shared, do not include the "supplies, equipment, space,
service fees, other" section of the letter. Likewise, if expenses other than salaries and
benefits are cost shared, do not include the "salaries and benefits" section.
If a separate spreadsheet with the required information is attached, instruct the subcontractor to
write "See Attached Detail" in the appropriate section and attach the spreadsheet. The letter
(on letterhead) must be signed by the contractor representatives.
The form allows third party subcontractors to identify when cost sharing is fully satisfied, or to
indicate that cost sharing is behind what was anticipated. This is useful to fulfill the
contractor's requirement to monitor the subcontractor's technical and financial progress.
Appropriate Signatories
The letter must be signed by the third party contact who is responsible for overseeing the
program
The letter must be signed by the third party financial representative who is in a position to verify
that the valuation of the expenses is in accordance with federal regulations (which are
summarized in the two sections of the template).
NETL F 451.1 -1/3
(11/2007) OPI =320
(Previous Editions Obsolete) U.S. DEPARTMENT OF ENERGY
ENVIRONMENTAL, QUESTIONNAIRE
BACKGROUND
The Department of Energy (DOE) National Environmental Policy Act (NEPA) Implementing Procedures (10 CFR 102 1)
require careful consideration of the potential environmental consequences of all proposed actions during the early planning
stages of a project or activity. DOE policy directs at the earliest possible stage in a project whether such actions will require
preparation of an Environmental Assessment, an Environmental Impact Statement, or a Categorical Exclusion. To comply
with these requirements, an Environmental Questionnaire (NETL Form 451.1 -1/3) must be completed for each proposed
action to provide DOE with the information necessary to determine the appropriate level ofNEPA review and
documentation. If the proposed project qualifies for Categorical Exclusion designation, a Categorical Exclusion Designation
Form (NETL Form 451..1 -1/1) will also be completed in addition to the Environmental Questionnaire.
II. INSTRUCTIONS
Separate copies of the Environmental Questionnaire and Categorical Exclusion Designation Form (if required) should be
completed by the principal proposer and principal subcontractor(s). In addition, if the proposed project includes activities at
different locations, an independent questionnaire should be prepared for each location. Supporting information can be
provided as attachments.
In completing this Questionnaire, the proposer is requested to provide specific information and quantities, when applicable,
regarding air emissions, wastewater discharges, solid wastes, etc., to facilitate the necessary review. The proposer should
identify the location of the project and specifically describe the activities that would occur at that location. In addition, the
proposer will be required to submit an official copy of the project's statement of work (SOW) or statement of project
objective (SOPO) that will be used in the contract/agreement between the proposer and DOE.
III. QUESTIONNAIRE
A. PROJECT SUMMARY.
1. Solicitation/Project Number:
2. Proposer and Subcontractor(s):
3. Principal Investigator:
Telephone Number:
4. Project Title:
5. Duration:
6. Location(s) of Performance (City/Township, County, State):
7. Identify and select the checkbox with the predominant project work activities under Group A -7a, A -7b, or A -7c.
Group A -7a
❑ Categorical Exclusion CX -A: Routine administrative, procurement, training, and personnel actions. Contract
activities /awards for management support, financial assistance, and technical services in support of agency business,
programs, projects, and goals. Literature searches and information gathering, material inventories, property surveys;
data analysis, computer modeling, analytical reviews, technical summary, conceptual design, feasibility studies,
document preparation, data dissemination, and paper studies. Technical assistance including financial planning,
assistance, classroom training, public meetings, management training, survey participation, academic contribution,
technical consultation, and stakeholders surveys. Workshop and conference planning, preparation, and
implementation which may involve promoting energy efficiency, renewable energy, and energy conservation.
NETL F 451.1 -1/3
(11/2007) OPI =320 U.S. DEPARTMENT OF ENERGY
(Page 2)
ENVIRONMENTAL QUESTIONNAIRE
Group A -7b
Categorical Exclusion CX -B: Laboratory Scale Research, Bench Scale Research, Pilot Scale Research, Proof -of-
Concept Scale Research, or Field Test Research. Work DOES NOT involve new building/facilities construction and
site " excavation/groundbreaking activities. This work typically involves routine operation of existing laboratories,
commercial buildings /properties, offices and homes, project test facilities, factories /power plants, vehicles test stands
and components, refueling facilities, utility systems, or other existing structures /facilities. Work will NOT involve
major change in facilities missions and operations, land use planning, new /modified regulatory/operating permit
requirements. Includes work specific to routine DOE Site operations and Lab research work activities, but NOT
building construction and site preparation. DOE work typically involves laboratory facilities and lab equipment
operations, buildings and grounds management activities; and buildings and facilities maintenance, repairs,
reconfiguration, remodeling, equipment use and replacement.
Group A -7e
El Categorical Exclusion CX -B, Environmental Assessment (EA), Environmental Impact Statement (EIS): Pilot Test
Facilities Construction, Pilot Scale Research, Field Scale Demonstration, or Commercial Scale Application. Work
typically involves facility construction, site preparation /excavation/groundbreaking, and/or demolition. This work
would include construction, retrofit, replacement, and/or major modifications of laboratories, test facilities, energy
system prototypes, and power generation infrastructure. Work may also involve construction and maintenance of
utilities system right -of -ways, roads, vehicle test facilities, commercial buildings /properties, fuel refinery/mixing
facilities, refueling facility, power plants, underground wells, and pipelines, and other types of energy research related
facilities. This work may require new or modified regulatory permits, environmental sampling and monitoring
requirements, master planning, public involvement, and environmental impact review. Includes work specific to DOE
Site Operations and Lab operation activities involving building and facilities construction, replacement,
decommissioning /demolition, site preparation, land use changes, or change in research facilities mission or operations.
Other (please describe):
If all work activities related to this project can be classified and described within categories under item A- 7a, it is a
categorically excluded action. Proceed directly to Section IV CERTIFICATION BYPROPOSER, completing
information and signatures as requested. The questionnaire is now complete and no additional information is
required.
Ifproject work activities are described under either items) A -7b, or A -7c.; then continue filling out questionnaire
,starting below with Question A.8.
Summarize the objectives of the proposed work. List activities planned at the location as covered by this
Environmental Questionnaire.
9. List all other locations where work would be performed by the primary contractor of the project and primary
subcontractor(s). (Note: An environmental questionnaire may be required for each new location after reviewing the
SOW /SOPO, project scope, tasks, and environmental affects).
NETL F 451.1 -1/3
(11/2007) OPI =320
(Page 3) U.S. DEPARTMENT OF ENERGY
ENVIRONMENTAL QUESTIONNAIRE
10. Identify major materials that would be used and produced by the project when projects are larger than lab or bench
scale.
�Mater,�als�sec� °(in ut) . „�Eshmafe Quantity` Mater,�als�P�r�a�duced,;(pu�nt) �zEst►matesQnanhty � 1.
❑ Coal ❑ Wastewater
❑ Natural Gas ❑ Air Emissions
❑ Oil ❑ Solid Waste
❑ Electricity ❑ Hazardous Waste
❑ Water ❑ Others -- List:
❑ Others -- List:
B. - PROPOSED PROJECT ALTERNATIVES
If applicable, list any project alternative considered to achieve the project objectives.
C. PROJECT LOCATION
1. Provide a brief description of the project location (physical location, surrounding area, adjacent structures).
2. Attach a project site location map of the project work area. Project site photos and topographical maps may be
requested for further review.
D. ENVIRONMENTAL IMPACTS
This section is designed to obtain information concerning environmental impacts and regulatory compliance of a proposed
project. NEPA procedures require evaluations of possible effects (including land use, energy resource use, natural, historic
and cultural resources, and pollutants) from proposed projects on the environment. The Environmental Virtual Campus
website has valuable information concerning environment impacts and regulatory compliance.
1. Land Use
a. Characterize present land use where the proposed project would be located.
❑ Urban ❑ Industrial ❑ Commercial ❑ Agricultural
❑ Suburban ❑ Rural ❑ Residential ❑ Research Facilities
Forest ❑ University Campus ❑ Other:
b. Identify the total size of the facility, structure, or system and what portion would be used for the proposed project.
3
NETL F 451.1 -1/3
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(Page 4) U.S. DEPARTMENT OF ENERGY
ENVIRONMENTAL QUESTIONNAIRE
C. Describe planned construction, installation, and/or demolition activities, i.e., roads, utilities system right -of -ways,
parking lots, buildings, laboratories, storage tanks, fueling facilities, underground wells, pipelines, or other structures.
❑ No construction would be anticipated for this project.
d. Describe how land use would be affected by operational activities associated with the proposed project.
❑ No land areas would be affected.
e. Describe any plans to reclaim areas that would be affected by the proposed project.
❑ No land areas would be affected.
f. Would the proposed project affect any unique or unusual landforms (e.g., cliffs, waterfalls, etc.)?
❑ No ❑ Yes (describe)
g. Would the proposed project be located in or near local, state, or federal parks; forests; monuments; scenic waterways;
wilderness; recreation facilities; or tribal lands? ❑ No ❑ Yes (describe)
If project work activities falls under item A -7b; then proceed directly to question D. 6 (Atmospheric Conditions /Air
Quality) and continue to fill out questionnaire..
Ifproject work falls under item A -7c.; thenproceed directly below to question D.2 (Construction Activities and/or
Operations) and continue to fill out questionnaire,
2. Construction Activities and/or Operation
a. Identify project structure(s), power line(s), pipeline(s), utilities system(s), right -of- way(s) or road(s) that will be
constructed and clearly mark them on a project site map or topographic map as appropriate. ❑ None
b. Would the proposed project require the construction of waste pits or settling ponds?
❑ No ❑ Yes (describe and identify location, and estimate surface area disturbed)
C. Would the proposed project affect any existing body of water? ❑ No ❑ Yes (describe)
d. Would the proposed project impact a floodplain or wetland? ❑ No ❑ Yes (describe)
e. Would the proposed project cause runoff/sedimentation/erosion? ❑ No ❑ Yes (describe)
4
NETL F 451.1 -1/3
(11/2007) OPI =320
(Page 5) U.S. DEPARTMENT OF ENERGY
ENVIRONMENTAL QUESTIONNAIRE
f. Describe any instability (e.g., subsidence, perma- frost, erosion, faulting/fracturing) affecting building construction, site
development, and/or project operation.
3. Vegetation and Wildlife Resources
a. Identify any State or Federal - listed endangered or threatened plant or animal species affected by the proposed project.
❑ None
b. Would any threatened or endangered species habitat be affected by the proposed project? ❑ No ❑ Yes (describe)
C. Describe any impacts that construction would have on any other s of sensitive or unique habitats.
❑ No planned construction ❑ No habitats 6 None ❑ Impact (describe)
d. Would any unnatural substances /materials be introduced into ground or surface waters, soil, or other earth/geologic
resource because of project activities? How would these foreign substances /materials affect the water, soil, and
geologic resources? ❑ No ❑ Yes (describe)
e. Would any migratory animal corridors be impacted or disrupted by the proposed project? ❑ No ❑ Yes (describe)
4. Socioeconomic and Infrastructure Conditions
a. Would local socio- economic changes result from the proposed project? ❑ No ❑ Yes (describe)
b. Would the proposed project generate increased traffic use of roads through local neighborhoods, urban or rural areas?
❑ No ❑ Yes (describe)
C. Would the proposed project require new transportation access (roads, rail, etc.)? Describe location, impacts, costs.
❑ No ❑ Yes (describe)
d. Would the proposed project create a significant increase in local energy usage? ❑ No ❑ Yes (describe)
5
NETL F 451.1 -1/3
(11/2007) OPI =320
(Page 6) U.S. DEPARTMENT OF ENERGY
ENVIRONMENTAL QUESTIONNAIRE
5. Historical/Cultural Resources
a. Describe any historical, archaeological, or cultural sites in the vicinity of the proposed project; note any sites included
on the National Register of Historic Places. ❑ None
b. Would construction or operational activities planned under the proposed project disturb any historical, archaeological,
or cultural sites? ❑ No planned construction ❑ No historic sites ❑ Yes (describe) ❑ No Impact (discuss)
C. Has the State Historic Preservation Office been contacted with regard to this project? p No ❑ Yes (describe)
d. Would the proposed project interfere with visual resources (e.g., eliminate scenic views) or alter the present
landscape? ❑ No ❑ Yes (describe)
For allproposedproject work activities identified under item A -7b, respond to item D6 directly below and continue
filling out environmental questionnaire.
6. Atmospheric Conditions /Air Quality
a. Identify air quality conditions in the immediate vicinity of the proposed project with regard to attainment of National
Ambient Air Quality Standards (NAAQS). This information is available under the Green Book Non - Attainment Areas
for Criteria Pollutants located at hLtp: / /epa.gov.oar /oggps /zreenbk or hLtp: / /www.epa.gov /air /oMps /2reenbk/astate.htmi
b. Would proposed project require issuance of new or modified local, state, or federal air permits to perform project
related work and activities? ❑ No 0 Yes (describe)
C. Would the proposed project be in compliance with local and state air quality requirements? ❑ No (explain) ❑ Yes
d. Would the roposed project be classified as either a New Source or a major modification to an existing source?
F1 No Yes (describe)
J
NETL F 451.1 -1/3
(11/2007) OPI =320
(Page 7) U.S. DEPARTMENT OF ENERGY
ENVIRONMENTAL QUESTIONNAIRE
e. What types of air emissions, including fugitive emissions, would be anticipated from the proposed project, and what
would be the maximum annual rate of emissions for the project?
1Vlaxtnm peYYear , ,Total for roJect On
❑ so.
❑ NOX
❑ PM - 2.5
❑ PM - 10
❑ CO
❑ co,
❑ Lead
❑ H2S
❑ Organic solvent vapors or other volatile organic compounds - -List:
❑ Hazardous air pollutants -- List:
❑ Other -- List:
❑ None
f. Would any types of emission control or particulate collection devices be used?
❑ No ❑ Yes (describe, including collection efficiencies)
g. If no control devices are used, how would emissions be vented?
7. Hydrologic Conditions/Water Quality
a. What is the closest body of water to the proposed project area and what is its distance from the project site?
b. What sources would supply potable and process water for the proposed project?
C. Quantify the daily or annual amount of wastewater that would be generated by the proposed project.
'� `�Galloans
❑ Non - contact cooling water
❑ Process water
❑ Sanitary and/or grey water
❑ Other -- describe:
❑ None
7
NETL F 451.1 -1/3
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(Page 8) U.S. DEPARTMENT OF ENERGY
ENVIRONMENTAL QUESTIONNAIRE
d. What would be the major components of each type of wastewater (e.g., coal fines)? ❑ No wastewater produced
e. Identify the local treatment facility that would receive wastewater from the proposed project.
❑ No discharges to local treatment facility
f. Describe how wastewater would be collected and treated.
g. Would any run -off or leachates be produced from storage piles or waste disposal sites? ❑ No ❑ Yes (describe source)
h. Would project require issuance of new or modified water permits to perform project work or site development
activities? ❑ No ❑ Yes (describe)
L Where would wastewater effluents from the proposed project be discharged? ❑ No wastewater produced
j. Would the proposed project be permitted to discharge effluents into an existing body of water?
❑ No ❑ Yes (describe water use and effluent impact)
k. Would a new or modified National Pollutant Discharge Elimination System (NPDES) permit be required?
❑ No ❑ Yes (describe)
Would the proposed project adversely affect the quality or movement of groundwater? ❑ No ❑ Yes (describe)
m. Would the proposed project require issuance of an Underground Injection Control (UIC) permit?
❑ No ❑ Yes (describe)
8. Solid and Hazardous Wastes
a. Identify and estimate major non - hazardous solid wastes that would be generated from the project. Solid wastes are
defined as any solid, liquid, semi - solid, or contained gaseous material that is discarded or has served its intended
purpose, or is a manufacturing or mining by- product (See EPA Municipal Solid Waste and Municipal Solid by State).
❑ Municipal solid waste, i.e., paper, plastic, etc.
annual Qiant�ty�
❑ Coal or coal by- products
❑ Other -- Identify:
❑ None
NETL F 451.1 -1/3
(11/2007) OPI =320
(Page 9) U.S. DEPARTMENT OF ENERGY
ENVIRONMENTAL QUESTIONNAIRE
b. Would project require issuance of new or modified solid waste and/or hazardous waste related permits to perform
project work activities? ❑ No ❑ Yes (explain)
C. How and where would solid waste disposal be accomplished?
❑ On -site (identify and describe location)
❑ Off -site (identify location and describe facility and treatment)
d. How would wastes for disposal be transported?
e. Identify hazardous wastes that would be generated, used, or stored under this project. Hazardous waste information
can be found at EPA Hazardous Waste website. ❑ None
f. How would hazardous or toxic waste be collected and stored? ❑ None used or produced
g. If hazardous wastes would require off -site disposal, have arrangements been made with a certified TSD (Treatment,
Storage, and Disposal) facility?
❑ Not Required ❑ Arrangements not yet made ❑ Arrangements made with a certified TSD facility (identify)
9. Health/Safety Factors
a. Identify hazardous or toxic materials that would be used in the proposed project.
❑ None ❑ Hazardous or toxic materials that would be used (identify):
b. What would be the likely impacts of these project related hazardous materials on human health and the environment?
❑ None ❑ Yes (explain)
C. Would there be any special physical hazards or health risks associated with the project? ❑ No ❑ Yes (describe)
d. Does a worker safety program exist at the location of the proposed project? ❑ No ❑ Yes (describe)
e. Would safety training be necessary for any laboratory, equipment, or processes involved with the project?
❑ No ❑ Yes (describe)
6
NETL F 451.1 -1/3
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(Page 10) U.S. DEPARTMENT OF ENERGY
ENVIRONMENTAL QUESTIONNAIRE
f. Describe any increases in ambient noise levels to the public from construction and operational activities.
❑ None ❑ Increase in ambient noise level (describe)
g. Would project construction result in the removal of natural barriers that act as noise screens?
❑ No construction planned ❑ No ❑ Yes (describe)
h. Would hearing protection be required for workers? ❑ No ❑ Yes (describe)
10. Environmental Restoration and/or Waste Management
a. Would the proposed project include CERCLA removals or similar actions under RCRA or other authorities?
❑ No ❑ Yes (describe)
b. Would the proposed project including siting, construction, and operation of temporary pilot -scale waste collection and
treatment facilities or pilot -scale waste stabilization and containment facilities? ❑ No ❑ Yes (describe)
C. Would the proposed project involve operations of environmental monitoring and control systems?
❑ No ❑ Yes (describe)
d. Would the proposed project involve siting, construction, operation, and decommissioning of a facility for storing
packaged hazardous waste for 90 days or less? ❑ No ❑ Yes (describe)
E. REGULATORY COMPLIANCE
1. For the following laws, describe any existing permits, new or modified permits, manifests, responsible authorities or
agencies, contacts, etc., that would be required for the proposed project (Information on the following environmental
laws can be found at Major Enviromnental Law website):
a. Resource Conservation and Recovery Act (RCRAI: ❑ None ❑ Required (describe)
b. Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA):
❑ None ❑ Required (describe)
C. Toxic Substance Control Act (TSCA): ❑ None ❑ Required (describe)
10
NETL F 451.1 -1/3
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(Page 11) U.S. DEPARTMENT OF ENERGY
ENVIRONMENTAL QUESTIONNAIRE
d. Clean Water Act (CWA): ❑ None ❑ Required (describe)
e. Underground Storage Tank Control Program (UST): E] None E] Required (describe)
f. Underground Injection Control Program UIC): ❑ None ❑ Required (describe)
g. Clean Air Act (CAA): ❑ None ❑ Required (describe)
h. Endangered Species Act (ESA): ❑ None ❑ Required (describe)
i. Floodplains and Wetlands Regulations: ❑ None ❑ Required (describe)
j. Fish and Wildlife Coordination Act (FWCA): ❑ None ❑ Required (describe)
k. National Historic Preservation Act (NHPA): ❑ None ❑ Required (describe)
1. Coastal Zone Management Act (CZMA): ❑ None ❑ Required (describe)
2. Identify any other environmental laws and regulations (Federal, state, and local) for which compliance would be
necessary for this project, and describe the permits, manifests, and contacts that would be required.
F. DESCRIBE ANY ISSUES THAT WOULD GENERATE PUBLIC CONTROVERSY REGARDING THE
PROPOSED PROJECT. ❑ None
G. WOULD THE PROPOSED PROJECT PRODUCE ADDITIONAL DEVELOPMENT, OR ARE OTHER
MAJOR DEVELOPMENTS PLANNED OR UNDERWAY, IN THE PROJECT AREA?
❑ No ❑ 'Yes (describe)
H. SUMMARIZE THE SIGNIFICANT IMPACTS THAT WOULD RESULT FROM THE PROPOSED
PROJECT. ❑ None (provide supporting detail) ❑ Significant impacts (describe)
NETL F 451.1 -1/3
(11/2007) OPI =320
(Page 12) U.S. DEPARTMENT OF ENERGY
ENVIRONMENTAL QUESTIONNAIRE
W. CERTIFICATION BY PROPOSER
I hereby certify that the information provided herein is current, accurate, and complete as of the date shown immediately
below.
SIGNATURE:E DATE ( mm/dd/yyyy):
TYPED NAME:
TITLE:
ORGANIZATION:
REVIEW AND APPROVAL BY DOE
I hereby certify that I have reviewed the information provided in this questionnaire, have determined that all questions have
been appropriately answered, and judge the responses to be consistent with the efforts proposed. Based on the information in
the questionnaire, I conclude the following (check the appropriate box):
❑ The proposed action falls under one or more of the categorical exclusions (CXes) listed in Appendix A or B of
Subpart D of the DOE NEPA Implementing Procedures and would not (1) violate' applicable ES &H requirements,
(2) require siting of waste transportation, storage and disposal or recovery facilities, (3) disturb hazardous materials
(excluding naturally occurring petroleum and natural gas), thus producing uncontrolled or unpermitted releases, and
(4) adversely affect environmentally sensitive resources.
Additionally, the proposed action (1) would not present any extraordinary circumstances such that the action might
have a significant impact upon the human environment, (2) is not connected to other actions with potentially
significant impacts, and (3) is not related to other actions with cumulatively significant impacts.
Based on the Environmental Questionnaire and these conclusions, Categorical Exclusion of the proposed action
would be appropriate.
❑ The proposed action does not qualify as a CX as identified in Subpart D of DOE's NEPA Implementing Procedures;
therefore, the proposed action may require further documentation in the form of an Environmental Assessment of
Environmental Impact Statement.
PROJECT MANAGER
SIGNATURE: DATE (mm/dd/yyyy):
TYPED NAME:
12
U.S. DEPARTMENT OF ENERGY ' _ff JU05
FINANCIAL ASSISTANCE
PROPERTY CLOSEOUT CERTiFiCATinN
Award Number
Recipient (Name and address)
The purpose of this report is to facilitate the closeout of the Award. Based on the records' maintained by the Recipient in accordance
with the Property Management standards set forth in the Award, the following data reflects' the Recipient's' closeout inventory of real and
personal property that was provided by the Department of Energy (DOE) or partially or wholly acquired with project funds.'
I. EQUIPMENT
A. Federally- Owned: (Government Furnished Equipment): (10 CFR 600.133(a), 600.232, 600.322, or Federal Demonstration
Partnership ( FDP) General Terms and Conditions No. 33, as applicable): ❑ No ❑ Yes
(If yes, attach property inventory list that includes item description, manufacturer, model, serial number, original acquisition
date, original acquisition cost and disposal condition code per the Federal Management Regulation 102 - 36.240)
B. Equipment Acquired with Award Funds where Title Vests in the Recipient with further obligations to DOE:
(10 CFR 600.133, 600.134, 600.232, or 600.321, as applicable)
❑ No ❑ Yes
If yes, does the equipment have a per unit fair market value of $5,000 or more? ❑ No ❑ Yes
(If yes, attach a property inventory list that includes item description, manufacturer, model, serial number, original acquisition
date, original acquisition cost, disposal condition code per the Federal Management Regulation 102 -36 -240 and one of the
disposition codes listed below)
(1) The property will continue to be used for the purposes authorized in the Award.
(2) The property is no longer needed for the purposes of the Award, and will be used on another Federally sponsored
activity (List Activity and Federal Agency):
(3) The Recipient wishes to retain the property and compensate DOE for its share of the current per unit fair market value.
(Identify the fair market value on the attached property inventory list and describe how the value was determined).
(4) The property is no longer needed for the purposes of the Award or other Federally sponsored activities and the Recipient
requests DOE disposition instructions.
II. SUPPLIES (10 CFR 600.135, 600.233, 600.324, or FDP General Terms and Conditions No. 35, as applicable)
Does the residual inventory of unused supplies exceed $5,000 in total aggregate value? ❑ No ❑ Yes (if yes,check block below)
❑ The supplies will be used on another Federally sponsored activity (List Activity and Federal Agency).
❑ The supplies will be sold or retained for use on non- Federally sponsored activities and the Recipient will compensate DOE for
its share of the sales proceeds (or estimate of current fair market value). Attach a list of the supplies and complete the
following Worksheet:
Sale proceeds or estimate of current fair market value .............................. $
Percentage of Federal participation
Federalshare .......................................... ............................... $
Selling and handling allowance ......................... ............................... $
Amount to be remitted to DOE ......................... ............................... $
Page 1 of 3
U.S. DEPARTMENT OF ENERGY
FINANCIAL ASSISTANCE
PROPERTY CLOSEOUT CERTIFICATION
111. REAL PROPERTY: (Real Estate - 10 CFR 600.132, /600.231, 600.321, or FDP General Terms and Conditions No. 32, as
applicable) Fl No FlYes (lf ves. complete A —C)
A. Description of Real Property:
B. Complete Address of Real Property:
C. Period of Federal Interest in the Property: From To (Unless the award specifies otherwise, the
Federal Interest in the property ends when the award project period ends. )
D. Disposition Preference Request. If the period of Federal Interest in the property exceeds the project period, check one of
the following blocks to indicate your disposition preference:
❑ Transfer property to another Federal award.
❑ Sell and compensate DOE.
❑ Return to DOE.
❑ Retain title and compensate DOE for its share of the current fair market value of the property.
Certification: I certify to the best of my knowledge and belief that all information presented in this report is true, correct and
complete, and constitutes a material representation of fact upon which the Federal government may rely.
Name I Signature I Title I Date
Page 2of3
U.S. DEPARTMENT OF ENERGY
FINANCIAL ASSISTANCE
PROPERTY CLOSEOUT CERTIFICATION
To be completed by the Department of Energy:
DOE PROPERTY DISPOSITION
❑ Negative Report
❑ Real Property:
❑ Equipment:
❑ Supplies:
Property Management Official Name Signature Date
Page 3 of 3
Page 1 of 3
General Decision Number: NC100051 03/12/2010 NC51
Superseded General Decision Number: NC20080051
State: North Carolina
Construction Type: Building
Counties: Chatham and Orange Counties in North Carolina.
BUILDING CONSTRUCTION PROJECTS (does not include single family
homes and apartments up to and including 4 stories)
Modification Number Publication Date
0 03/12/2010
* SUNC1995 -001 09/29/1995
Rates Fringes
Bricklayer .....................$ 15.30
Carpenter
_includes batt insulation
and drywall hanging ...... $ 11.33
Cement mason /concrete
finisher .....................$ 10.00
Electrician ....................$ 10.67
Ironworker, reinforcing ........ $ 10.00
Laborers:
—General .................... $ 7.42
Mason tender ...............$ 9.17
Painter
_does not include drywall
finishing ................$ 10.00
Pipefitter
includes HVAC piping ....... $ 13.27
Plumber ........................$ 11.56
Power equipment operators:
_Backhoe ....................$
10.80
1.87
_Loader .....................$
10.00
1.25
Roller .....................$
10.00
1.25
Roofer .........................$
9.40
Sprinkler fitter ...............$
12.50
1.71
Tile setter ....................$
13.75
Truck driver ...................$
9.00
2.50
http: / /www.wdol.gov /wdol /scafiles /davisbacon/NC51.dvb 4/19/2010
Page 2 of 3
Drywall Finisher /Taper....: ...... $ 12.00
HVAC Mechanic Duct
HVAC duct work only ........ $ 11.00 2.80
---------------------------------------------------------- - - - - --
WELDERS - Receive rate prescribed for craft performing
operation to which welding is incidental.
Unlisted classifications needed for work not included within
the scope of the classifications listed may be added after
award only as provided in the labor standards contract clauses
(29CFR 5.5 (a) (1) (ii)).
In the listing above, the "SU" designation means that rates
listed under the identifier do not reflect collectively
bargained wage and fringe benefit rates. Other designations
indicate unions whose rates have been determined to be
prevailing.
WAGE DETERMINATION APPEALS PROCESS
1.) Has there been an initial decision in the matter? This can
be:
• an existing published wage determination
• a survey underlying a wage determination
• a Wage and Hour Division letter setting forth a position on
a wage determination matter
• a conformance (additional classification and rate) ruling
On survey related matters, initial contact, including requests
for summaries of surveys, should be with the Wage and Hour
Regional Office for the area in which the survey was conducted
because those Regional Offices have responsibility for the
Davis -Bacon survey program. If the response from this initial
contact is not satisfactory, then the process described in 2.)
and 3.) should be followed.
With regard to any other matter not yet ripe for the formal
process described here, initial contact should be with the
Branch of Construction Wage Determinations. Write to:
Branch of Construction Wage Determinations
Wage and Hour Division
U.S. Department of Labor
200 Constitution Avenue, N.W.
Washington, DC 20210
2.) If the answer to the question in 1.) is yes, then an
interested party (those affected by the action) can request
review and reconsideration from the Wage and Hour Administrator
(See 29 CFR Part 1.8 and 29 CFR Part 7). Write to:
http:// www. wdol. gov/ wdol /scafiles /davisbacon/NC51.dvb 4/19/2010
Page 3 of 3
Wage and Hour Administrator
U.S. Department of Labor
200 Constitution Avenue, N.W.
Washington, DC 20210
The request should be accompanied by a full statement of the
interested party's position and by any information (wage
payment data, project description, area practice material,
etc.) that the requestor considers relevant to the issue.
3.) If the decision of the Administrator is not favorable, an
interested party may appeal directly to the Administrative
Review Board (formerly the Wage Appeals Board). Write to:
Administrative Review Board
U.S. Department of Labor
200 Constitution Avenue, N.W.
Washington, DC 20210
4.) All decisions by the Administrative Review Board are final.
END OF GENERAL DECISION
http:// www. wdol. gov/ wdol /scafiles /davisbacon/NC51.dvb 4/19/2010
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