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U.S. DBPARTMENT OF HOUSING AND U1tBAN DEVELOPMENT <br />COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM <br />CONTRACTOR'S CERTIFICATION <br />CONCERNING LABOR STANDARDS AND PREVAILING WAGE REQUIREMENTS <br />TO (Appropriate Recipient): DATE <br />PROJECT NUMBER (!f any) <br />C/O PROJECT NAME <br />l. The undersigned, having eacecuted a contract with <br />for the construction of the above-identified project, acknowledges that: <br />(a) The Labor Stendards Provisions of The Conttact For Construction are included in the aforesaid contract. <br />(b) Correction of any infractions ofthe aforesaid conditions, including infractions by eny of his subcontractors and gny lower tier <br />subcontractors, is his responsibility; <br />2. He certifies that: <br />(a) Neither he nor any firm, corporation, parmership or association in which he has s substantial interest is designated as an ineligible <br />cantractor by tht Comptcollcr General of the United States pursuant to Section 5.6(b) of the Regulations of the 5ecrotary of Labor, <br />Part 5 (29 CFR, Part 5), or pursuani to Section 3(a) of the Davis-Bacon Act, as amended (40 U.S.C. 27602(a)). <br />(b) No part of the aforementioned contract has been or will be subcontracted to any subcontractor if such subconiractor or any firm, <br />eorpotation, parcnership or association in which such subcont:actor has a substantial interest is designated as en ine)igiblc contractor <br />pursuant to the aforesaid regulat4ry or statutory provisions. <br />He agrees to obtain and forward to the contractor, for transmittal to the reeipient, within ten days after the execution of any lower <br />subcontract, a SubconVactor's Certification Concerning Labor Standards and Prevailing Wage Requirements, executed by the lower tier <br />subcantractor, in duplicate. <br />4. He certifies that: <br />(a) The legal name and tho business address of the undersigned arc: <br />b) The <br />(1) A SINGLE PROPRIETORSHIP: (3) A CORPORATION ORGANiZBD IN THE STATE OF: <br />(2) A P.4RTNERSHiP: (4) OTHER ORGANIZATION (Descrrbe) <br />(c) The name title and address of the owner partners or officers of the undersianed are: <br />NAME TITLE ADDRESS <br />lillal421(6-75) <br />24 <br />