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HomeMy WebLinkAboutCertifications.pdfCERTIFICATION OF NON-DISCRIMINATION AND AFFIRMATIVE ACTION As suppliers of goods or services to the City of Diamond Bar, the firm listed below certifies that it does not discriminate in its employment with regards to race, religion, sex, or national origin; that it is in compliance with all federal, state, and local directives and executive orders regarding non-discrimination in employment; and that it will pursue an affirmative course of action as required by the affirmative action guidelines. We agree specifically: 1.To establish or observe employment policies which affirmatively promote opportunities for minority persons at all job levels. 2.To communicate this policy to all persons concerned including all company employees, outside recruiting services, especially those serving minority communities, and to the minorit y communities at large. 3.To take affirmative steps to hire minority employees within the company. FIRM Key Code Media, Inc. TITLE OF OFFICER SIGNING President ....,...-------------------------- SIGNATURE � � Please include any additional information available regarding equal opportunity employment programs now in effect within your company: 35 1293492.1 CERTIFICATION WITH REGARD TO THE PERFORMANCE OF PREVIOUS CONTRACTS OR SUBCONTRACTS SUBJECT TO THE EQUAL OPPORTUNITY CLAUSE AND THE FILING OF REQUIRED REPORTS The bidder ___ , proposed subcontractor ___ , hereby certifies that he has ___ has not X , participated in a previous contract or subcontract subject to the Equal Opportunity Clause, as required by Executive Orders 10925, 11114, or 11246, and that he has ___ , has not , filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance, a Federal Government contracting or administering agency, or the former President's Cammi ttee on Equal Employment Opportunity, all reports due under the applicable filing requirements. DATE: (TITLE) �ftf-"--11--/l�l _2-_� __ , 2 o a. NOTE: The above certification is required by the Equal Employment Opportunity Regulations of the Secretary of Labor (41 CFR 60-1.7 (b) (1), and must be submitted by bidders and proposed subcontractors only in connection with contracts and subcontracts which are subject to the Equal Opportunity Clause. Contracts and subcontracts which are exempt from the Equal Opportunity Clause are set forth in 41 CFR 60-1.5. (Generally, only contracts or subcontracts of $10,000 or under are exempt). Currently, Standard Form 100 (EEO-1) is the only report required by the Executive Orders or their implementing regulations. Proposed prime contractors and subcontractors who have participated in a previous contract or subcontract subject to the Executive Orders and have not filed the required reports should note that 41 CFR 60-1.7 (b) (1)prevents the award of contracts and subcontracts unless such contractor submits a report covering the delinquent period of such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor.36 1293492.1 X X NON-COLLUSION AFFIDAVIT TO: THE CITY OF DIAMOND BAR: STATE OF CALIFORNIA COUNTY OF Los Angeles ss Michael Cavanagh , being first duly -------�-------------------- sworn, deposes and says that he or she is President --------------of Key Code Media Inc. , the party making the foregoing bid, that the bid is not made in the interest of or on behalf of, any undisclosed person, partnership, company association, organization, or corporation; that the bid is genuine and not collusive or sham; that the bidder has not directly or indirectly induced or solicited another bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other bidder, or to secure any advantage against the public body awarding the contact or anyone interested in the proposed contract; that all statements contained in the bid are true; and further, that the bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. STATE OF CALIFORNIA )SS COUNTY OF LOS ANGELES ) Subscribed and sworn to before me this __ day of ,20 ------ Notary Public in and for the County of � attaehed cerflftcat,-, State of California --------------------------37 1293492,1 CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE § 8202 · 'f/See Attached Document (Notary to cross out lines 1-6 below) D See Statement Below (Lines 1-6 to be completed only by document signer[s], not Notary) 2_,_ -. -----------� - Signature of Document Signer No. 1 Signature of Document Signer No. 2 (if any) A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California Countyof Lo3 �l � �--······� NATHANIEL HORNE Notary Public -California z Los Angeles County !Commission# 2303507 My Comm. Expires Aug 30, 2023 Place Notary Seal and/or Stamp Above Subscribed and sworn to (or affirmed) before me on this J:t1+b day of Afr�! , 2ol2._, by Date ., Month Year c11 AA1Jiacl C.n,tn�� � (and (2) _____________ ), Namepff of Signer{;i( proved to me on the basis of satisfactory evidence to be the person�ho appeared before me. Signature �t!� Signature of Notary Public .--- ---------------OPTIONAL-----------------, Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: hl (9V\ � Co\\ \l\.n "1 0 l\ �l b ,f,\ Document Date: __ f)�lf .......... f_tH_.....,/_Jf)�J-:.�3 _____ Number of Pages: _____ _l Signer(s) Other Than Named Above: _______________________ _ ©2017 National Notary Association