EV11-0065 GSC MARICOPA COUNTY AQD EXECUTED.PDF

C S s° • .onz.
ADE() CONTRA( T NO. EVII-0065
TERMINATION DATE: JUNE 30.2011
igitftititil4Agg ISIWOW
GOVERNMENTAI SERVICES CONTRACT
Iletwceig
ARIZONA •PARTMENT OF ENVIRONMENTAL QUALITY
MAR1COPA (OUNI V AIR QUALITY DEPARTMENT
THIS CON ] RACT, is between the State of Arizona Department of i'mvironmoltal Quillity [hereinafter sometimes
referre.ia hc "Department" or 11ADFQ1, located at 1110 W. Washinrton Street, Phoenix., Ariiona 5OO. and
Nlaricop; located al 1001 N, Central AN•c, Phoenix, Arizona 85004 [hereinafter sometimes reiirred to as the
"Contractor" -Count ,y 1.
of this Contract is to provide fundn copa County ion Prinin (1 Prequired by
AR",-; I throw+ ARS §49-593.
dudi Agreement Terms, Scope of Work, IHNhibits , Attachments and any Amendments approved in
with shall constitute the entire Contract between the parties and supersede all other understandings, oral
Of ,
• I I I A KIZONA H 1 E IRONMIN \
Slk ,-10. H AI. SICri Or-Al II( )R11.1,1) INDIVIDUA
DON STAPLEY Y 1) NAME: LRIC C. MASSEY
CHAIRMAN BOARD OF SUP )RS DIRECTOR, AN I( DIVTU
Y OE/114
(40
DAM:
0 V 04 2010
101A,,
No/ 3 c3-a/e•

GOVERNMENTAL SERVICES CONTRACT
AGREEMENT TERMS
EV I 1-0065
I. Definitions: The following definitions shall apply to the terms used in this Agreement, except where the context necessarily
requires otherwise,
1,1 "Department" or "ADEQ" means the Arizona Department of Environmental Quality.
1.2 "Agreement" or "Contract" means this written document between ADEQ and the Contractor.
1.3 "Contractor" or "AICAQ1)" means the Maricopa County Air Quality Department.
1,4 "Project" or "Program" means the work, or any portion thereof described in this Contract.
1.5 "Shall - means that which is mandatory.
1.6 "Subcontract" or "Subcontractor" means any contract between the Contractor and a third party to provide all or a specified
part of the activities which the. Contractor has contracted with the Department to provide.
1.7 "State" means the State of Arizona,
2. Access to Information:
Subject to statutory confidentiality requirements of the Contractor and ADEQ, both parties to this Agreement shall have full,
complete and equal access to data and information prepared under this Agreement on a no-charge basis.
3. Amendment:
'Ibis Agreement may be modified only by written Contract Amendment signed by the Director or his/her designee, of the
ADEQ and the person duly authorized to act on behalf of the Contractor. Contract Amendments shall be executed with the
same formalities as this Agreement. Executed copies of any Amendment shall be provided to both parties.
3.1 Changes: ADFQ reserves the right to add or delete related services and make other changes within the general Scope of
Work as may be deemed necessary to best serve the interests of the Stale. All changes shall be documented in advance by
Contract Amendment signed by the ADF,Q designated authority and the Contractor.
4. Amount of Agreement:
The total amount of reimbursement from ADEQ to the Contractor for expenses incurred under this Agreement shall not
exceed $678,800.00, unless otherwise in accordance with the Amended Section of this Contract.
5. Applicable Law:
5,1 Arizona Law. The law of Arizona applies to this contract including, where applicable, the Uniform Commercial Code as
adopted by the State of Arizona
5.2 implied Consent Terms. Each provision of law and any terms required by law to be in this Contract are a part of this Contract
as if fully stated in it.
6. Assignment:
Neither Party may assign any rights to this Contract without the express, written, prior consent of the other Party.
7. Audit of Records:
Pursuant to ARS §35-214, al any time during the term of this Contract, and five years thereafter, the Contractor's or any
subcontractor's books and records shall be subject to audit by the State and, where applicable, the Federal Government, to
the extent that the books and records relate to the performance of the contract or subcontract,

GOVERNMENTAL SERVICES CONTRACT
AGREEMENT TERMS
EV I 1-0065
8. Cancellation of State Contracts:
Both parties may cancel this Contract, without penalty of further obligation, pursuant to ARS §38-511.
9. Conflict Resolution Procedures:
Should a confliet arise between the parties to this contract, resolution shall be through arbitration by a mutually
acceptable third party. Uniform Rule or Arbitration 4 (d) and (e) shall apply to such an arbitration. Each party shall
bear its own arbitration fees, attorney's fees and costs. The decision of the arbitrator is final and binding upon the
parties.
10. Contract Term:
This Agreement shall remain in effect until June 30, 2011 unless previously terminated pursuant to the terms on the
contract. The agreement may be renegotiated for additional periods, by formal Contract Amendment, subject to the
requirements and/or limitations by Federal or State regulations.
11. Effective Date:
This Agreement shall become effective on the date signed by the ADEQ Air Quality Director or his/her designated
representative.
12. Non -Availability of Funds:
Every payment obligation of the State under this Contract is conditioned upon the availability of funds appropriated
or allocated for the payment of such obligation. If funds are not allocated and available for the continuance of this
Contract, this Contract may be terminated by the State at the end of the period for which funds are available. No
liability shall accrue to the State in the event this provision is exercised, and the State shall not be obligated or
liable for any future payments or for any damages as a result of termination under this paragraph.
13. NON -DISCRIMINATION:
CONTRACTOR agrees to comply with all provisions and requirements of Arizona Executive Order 2009 -09
including flow down of all provisions and requirements to any subcontractors. Executive Order 2009 -09
supersedes Executive order 99-4 and amends Executive order 75-5 and may be viewed and downloaded at the
Governor of the State of Arizona's website httpillwww.azgovernor.govidmstupload/E0 ,2009 99,0f which is
hereby incorporated into this contract as if set forth in full herein. During the performance of this contract,
CONTRACTOR shall not discriminate against any employee, client or any other individual in any way because of
that person's age, race, creed, color, religion, sex, disability or national origin,
14. Notices,Correspondence, Reports and Invoices:
14.1 Notices, correspondence, reports and invoices from the Contractor shall be sent to;
David Biddle, Project Manager
Arizona Department of Environmental Quality
Air Quality Division
1110 W. Washington Street
Phoenix, Arizona 85007
Phone; (602) 771-2376 Direct(602) 771-2366 Fax
dab v

GOVERNMENTAL SERVICES CONTRACT
AGREEMENT TERMS
EVI I-0065
14.2 Notices, correspondence, reports and payments from the Arizona Department of Environmental Quality shall he
sent to:
Neil Yockey
Maricopa County AQD
1001 N. Central Ave., Ste 400
Phoenix, Arizona 85004
Phone: (602) 506-6750 Direct(602) 506-6669 Fax
nyeekey@mail.mtirieopti,goy
14.3 Either party to this Agreement may designate a new Project Manager/Director by filing a notice to the other party
in accordance with these notice requirements.
14.4 Reports shall be reported on a quarterly basis:
September 30 — I" quarter
December 31 — quarter
March 31 — 3ra quarter
June 30 -- 4 1h quarter
15. Ownership or Information:
Title to all documents, reports and other materials prepared by the Contractor in performance of this Agreement
shall rest in the ADEQ, except for copyrighted material prepared in advance of this Agreement by the Contractor at
the expense of the Contractor. The ADEQ shall have full and complete rights to reproduce, duplicate, disclose,
perform and otherwise use all information prepared under this Agreement except for copyrighted material as
provided in this section. The Contractor shall have full and complete rights to reproduce, duplicate, disclose,
perform and otherwise use all information prepared under this Contract with the provision that all reproduction,
duplication, disclosures and literature shall contain acknowledgement to ADEQ.
16. Payment:
16.1 All requests for reimbursement shall be accompanied by reasonable assurance that the goods and services for which
reimbursement is requested were actually received and performed, and payments were made during the period for
which reimbursement is requested,
16.2 The Contractor shall submit a monthly invoice of charges to the Project Manager identified in Section 16.1 of this
contract. Each payment for thee contract will be made Net 30 Days after approval of the Project Manager.
Payments to the Contractor shall be made in accordance with the requirements of the Scope of Work of this
Agreement.
16.3 The Contractor shall submit an invoice of expenditures which shall include the following:
Title of Project
Contractor' name and Contract number
Time period covered
Whether an interim of final report
Total expense to date
Total reimbursement due
The final report shall state any unexpected funds
4

GOVERNMENTAL SERVICES CONTRACT
AGREEMF',NT TERMS
EV11-0065
17. P rsonnel:
17.1 The Contractor represents that it employs, or shall through subcontract, secure all personnel required for the
performance of the services under this Agreement. Such personnel shall not be employees of, nor have any
contractual relationship with ADEQ unless otherwise specified herein,
17,2 Unless otherwise specified, all the services required hereunder shall be performed by the Contractor or under their
supervision, and all personnel eng Led in the work shall be fully qualified and shall be authorized under applicable
law to perform such services. It is further agreed that the Contractor warrants that it is fully qualified and
authorized under applicable law to perform the services contemplated under this Agreement.
Printing Credit:
Promotional materials such as brochures, advertisements, videos and other printed materials, developed by the
Contractor, which are funded with ADEQ monies, shall show credit to ADEQ. All promotional materials shall be
printed to the extent possible on recycled paper with the statement "Printed on Recycled Paper" printed on the
cover sheet.
19. Project Review:
19.1 It is the responsibility of ADEQ to review and observe the progress of this project. Therefore, ADEQ reserves the
right to meet with the Contractor or its subcontractors at reasonable intervals for purposes of review of the work
and progress of the Project.
19,2 Additionally, ADEQ reserves the right to review and approve any and all forms, questionnaires, brochures, and
other special purpose documents developed by the Contractor or its subcontractors for use in the Project.
20. eyerability:
The provisions of this Agreement are severable to the extent that any provision or application held to be invalid
shall not affect any other provision or application of the Agreement, which shall remain in effect without the
invalid provision or application,
21. Termination:
21.1 ADEQ or the Contractor may terminate this Contract at any time, with or without cause, atler giving (30) days
written notice of termination to the Contractor or ADEQ, as appropriate. The notice shall specify the effective date
of termination, In the event this Contract is terminated, with or without cause, the equipment, instruments, housing,
supplies and other materials prepared or purchase wider this Contract, except for copyrighted materials prepared in
advance of this Agreement by the Contractor at the Contractor's expense as provided in the Scope of Work of this
Agreement, shall become property of ADEQ.
21.2 In the event the Contract is terminated with or without cause, the Contractor shall deliver all finished or unfinished
documents, data and reports prepared as a result of this Contract to ADEQ.
21.3 If the Contract is terminated, the Contractor shall be paid for allowable costs incurred prior to the date of
termination, subject to audit verification by ADEQ or its duly authorized representative,
22. Third Party Antitrust Violations:
The Contractor assigns to the State any claim for overcharges resulting from antitrust violations to the extent that
those violations concern materials or services supplied by third parties to the Contractor, toward fulfillment of this
Contract.

GOVERNMENTAL SERVICES CONTRACT
AGREEMENT TERMS
EV11-0065
23. Offshore Performance of Work Prohibited:
Due to security and identity protection concerns, all services under this Contract shall be performed within the
borders of the United States, All information storage and processing shall be performed within the borders of the
United States. This provision applies to work performed by subcontractors at all tiers.
24. ADEQ shall be notified in writing (within seven (7) days), if the prime Contractor terminates a Disadvantaged
Business Enterprise (DBE) subcontractor for convenience or performance issues, The prime Contractor shall
provide ADEQ with written information regarding a replacement subcontractor or if thc prime Contractor will
perform the work themselves. Furthermore, when a DBE subcontractor is terminated or fails to complete its work
under the subcontract, A DEQ requires that the prime contractor make good faith efforts to hire DBEs if they choose
to hire a new subcontractor.
24,1 Utilize:
Exhibit B EPA FORM 6100-2 (DBE Subcontractor Participation Form)
Exhibit C EPA FORM 6100-3 (DBE Subcontractor Performance Form)
Exhibit D EPA FORM 6100-4 (DBE Subcontractor Utilization For
25. Compliance Requirements for A.R.S. §41-4401 Government Procurement: E-Verifv Requirement:
25.1 The Contractor warrants compliance with all Federal immigration laws and regulations relating to employees and
warrants its compliance with Section A.R.S. §23-214, Subsection A. (That subsection reads: "After December 31,
2007, every employer, after hiring an employee, shall verify the employment eligibility of the employee through
the E- Verify program.)
25.2 A breach of a warranty regarding compliance with immigration laws and regulations shall be deemed a material
breach of the contract and the contractor may be subject to penalties up to and including termination of the
Contract.
25.3 Failure to comply with a State audit process to randomly verify the employment records of contractors and
subcontractors shall be deemed a material breach of the contract and the contractor may be subject to penalties up
to and including termination of the contract.
25.4 The State Agency retains the legal right to inspect the papers of any employee who works on the contract to ensure
that the Contractor or Subcontractor is complying with the warranty under paragraph 25,
6

GOVERNMENTAL SERVICES CONTRACT
EV11-0065
EXHIBIT A
Maricopa County
Air Quality Departnaent
Travel Reduction Program / MARICOPA COUNTY TRAVEL REDUCTION PROGRAM
Voluntary Vehicle Retrofit
& Repair Division
1001 North Central Avenue, SCOPE OF WORK
Suite 550 FY 2010-2011
Phoenix, Arizona 85004
Phone: 602-506-6750
Fax: 602-506-6669 PROGRAM OVERVIEW
in April 1985 the Center for Law and Public Interest filed suit against the State of Arizona and Maricopa
County for failure to meet the Ambient Air Quality Standards for carbon monoxide. The federal court
ordered the State of Arizona to write a State Implementation Plan (SIP) to comply with the standards. In
response, the Arizona Legislature passed the 1988 Air Quality Bill (ARS 49-581 et seq.) which mandated a
Travel Reduction Program (TRP) for employers and schools in Maricopa County. The original county
ordinance affected employers and schools with 100 or more employees and/or driving-age students.
There have since been two ordinance revisions which have reduced the required number of employees
and/or students from 100 down to 50.
Metropolitan area employers and media have pointed out that they see little difference in the objectives of
the Travel Reduction Program and the Clean Air Campaign as both are rooted in legislation intended to
reduce vehicle miles traveled (VMT) in Maricopa County, especially travel by single occupancy vehicles.
The Clean Air Campaign continues as a year-round public relations/education effort supporting the
efforts of employers to encourage commuters to use alternative modes of transportation, and to educate
the general public. While the campaign will continue to place heavy emphasis on the winter carbon
monoxide season, as required by statute, ozone and particulates will also be addressed.
The Maricopa County Regional Travel Reduction Program staff will continue to operate the research,
planning, coordinating and regulatory aspects of the Travel Reduction Program. Public relations,
employer training, technical assistance and the Clean Air Campaign will be carried out through a contract
with the Regional Public Transportation Authority/Valley Metro and under direction of County staff.
SCOPE OF WORK
Continue implementation of the Regional Travel Reduction Program pursuant to Arizona Revised
Statutes, Title 49, Chapter 3, Article 8 (49-581 through 49-593) and the Regional Voluntary No-Drive Day
Campaign pursuant to Arizona Revised Statute, Tide 49, Chapter 3, Article 3 (49-506) and the Maricopa
County Travel Reduction Ordinance (P-7).
Comply with all tasks and items listed in the Special Tarns and Conditions of the Grant Agreement.
#
Administer the TRP to major employers within Maricopa County who have 50 or more employees.
Issue paper/Intemet/intranct surveys to employers taking part in the 1RP during the fiscal year.
Process and analyze the TRP surveys for participating employers.
Research and identify new major employers that are legally required to take part in the TRP.
Provide summary analyses to employers participating in the TRP rewarding their employee commuting
habits based on the employee survey results. With this information, employers are able to formulate a
plan that will reduce single occupancy vehicle (SOV) trips.
0 Submit completed plans to the Maricopa County Regional Travel, Reduction Task Force for approval.
Review and monitor employer TRP annual plans.
Protecting our most vita!, natural resource; air.
W,rumiyypa.gov
7

EV11-0065
EXHIBIT A
ADEQ - 'FRP Scope of Work 1 1Y11 r2 082710.doc
ilogut4 27, 2010
Page 2 of 2
ci Negotiate Intergovernmental Agreement with the RPTA/Valley Metro regarding training, technical
assistance, collateral materials for TRP and promotion of all alternative transportation modes and
strategies.
Task 2; Subcontract° • RPTA/VaUcy Metro :- Travel Reduction Program Training and Assistancc
o Provide training, technical assistance, develop collateral materials, on-line support, e-newsletters,
webinars and in-person training. Develop promotional kits for employers and associated collateral
pieces - up to four times per year that promote the use of alternative tnodes,
o Produce brochures, informational materials, collateral materials and promotional items pursuant to
established guidelines for promotional items as necessary, to promote trip reduction strategies.
o Provide technical assistance to TRP employers in achieving the prescribed reductions in single
occupant vehicle trips or single occupant vehicle miles traveled through one-on-one assistance,
promotion and materials as available.
o Provide training to TRP employer transportation coordinators on the requirements of the law
including the survey process, plan writing and documentation; types of alternative modes; and trip
reduction strategies.
o Form and facilitate TRP Transportation Coordinator Associations.
o Monitor and track activities to evaluate the effectiveness of the training, promotions and collateral
materials as part of the Annual On-line Transportation Coordinator Survey.
Conduct a year round campaign for Valley employees that encourage weekly use of trip reduction
solutions through integrated campaigns which may include print materials, paid media, public and
media relations, public affairs, and events.
PROGRAM OBJECTIVES
Encourage TRP employer promotion of alternative modes of transportation, including carpooling,
vanpooling, taking the bus, bicycling, walking, and alternative fueled vehicles, as well as alternative work
schedules including telecommuting and compressed work schedules.
Provide training and assistance to TRP employers in all aspects of the Travel/Trip Reduction Program
requirements such as conducting surveys, writing, and implementing a TRP plan.
Use brochures and conduct presentations and training to promote alternative modes of transportation and
work schedules to employer management, TRP organization committees, and Transportation Coordinator
Associations, and facilitate and assist with the marketing and promotion of Clean Air Campaign events and
transportation fair events.
Increase the number of TRP employers that implement strategies to promote the use of alternative modes
of transportation and work schedules, such as subsidized bus and vanpool fares, preferential parking, and
guaranteed ride home, and who offer or expand telecommuting and compressed work schedules.
Encourage and assist employers in establishing a "commuter choice tax benefit" program through
education, workshops, and outreach.
Increase the annual number of TRP employers utilizing the electronic, c-survey version of the annual TRP
survey. The e-survey is available in either the Intranet or the Internet version.

EV11-0065
EXHIBIT A
Maricona County Air quality.Deortment
Trip Reduction Program
ADEQ Contract No.; EV11.8065
FY 2011 Budget
Costs and Hour By Tkmk
1C01,1iTtR (JR --- -1% t)/ isk -r.zziagonesost
1Poric:3 July 1,2010 - June 30, 2011
Raw Direct 1 2
Labor Trip Reduction Training & Total Total
Person Hourly Rate Prooggram Hours Cost
ummings Phil $27.96 1044.00 4 00 $29,190.24
Duffy Vera $16.00 1044.00 1044,00 $16,704.00
John $14.97 1044.00 1044,00 $15,628,68
Harlsock Brad $27.96 1044.00 1044.00 $29,190.24
Herb Patrice $14.73 1044.00 1044.00 $15,376.12
Jannett Ernie $21.31 1044.00 1044,00 $22,247,84
rtinez Sylvia $18.94 1044.00 1044.00 $19,773.36
er Greg $19.82 1044.00 1044.00 $20,692,08
O'Rourke Linda $17,93 1044.00 1044.00 $18,718,92
Starr Sheila $18.84 1044.00 1044.00 $19,668.96
Yockey Neil $32.50 1044.00 1044,00 $33,930.00
eosin - Office Asst. Specialist $16.00 1044.00 1044.00 $16,704.00
scant - Grant Contract Adm, $25.46 0.00 0.00 $0.00
Subtotal 0257,828.24
Total Hours 12,528.00 12,528.00
Total Hourly Cost $257,826.24 $25782624
Fringe Benefit (34.00%) 34.00% $87,860.92 $87,680,92
Fotal Labor with Fringe $345,487.16 $345,487.16
REIMBURSABLE EXPENSE
Expenses by Task Total
Description Task 1 Cost
$2,400.00
Rent; E hipping, Purchases, R&M, Other) $23,216.17
bursabte Exneases $25,616.17
UBCONTRACTON RPTAIValley 1Vtetro Hours by Personnel & TO(
eriori: July 1, 2010 - June 30, 2011
Raw Direct 2
Labor Training & Total
nnel Hourly Rate Assi floe Hours
nt - Project Manager $44.50 626.40 626.40 $27,074.8
Day Suzanne $29.44 522.00 522.00 $35,367.
uarte Lillian $29.46 522.00 522.00 $15,378.
hneider CJ (Cheri) $25.54 522.00 522.00 $13,331.8
Tracts $21.61 522.00 522.00 $11,280.4
me Eddie $37.14 432.00 432.00 $16,044.4
Reid Jeff $22.14 522.00 522,00 $11,557.0
'acant $28.60 0.00 0.00 $0.
ubtotal 0,834.4
Total Hours 3,668.40 .40
Total Hourly Subcontractors Cost $110,834.46 $110,834.4
Fringe (38.04%) 38.04% $42,181.43 $42,161.4
Overhead (45,36%) 45.38% $50,274.51 $50,274.51
RPTA Consultants $31,729.60 $31,729.6
Reimbursable Expense (Meetings & Mileage $20,000.00 n00.0
$255,000.00
MI Labor with Erin_ $345,487.16
imbursable Expenses $25,616.17
verhead (14.20%) 14.20% $52,696.67
Subcontractor RPTAIVaII 255000.00 $255000.00
TOTAL 678,800.00
ACILQ RR FY11 Budget IR11.v2 08-18.10.vlsx 8411/2010
9

OMB Control No: 2090-0030
Approved: 05/01/2008
Approval Expires 0 1/31/2011
Environmental
Protection Agency
Disadvantaged Business Enterprise Program
DBE Subcontractor Utilization Form
The public reporting and recordkeeping burden for this collection of information is estimated to
average fifteen (15) minutes. Burden means the total time, effort, or financial resources expended
by persons to generate, maintain, retain, or disclose or provide information to or for a Federal
agency. This includes the time needed to review instructions; develop, acquire, install, and utilize
technology and systems for the purposes of collecting, validating, and verifying information,
processing and maintaining information, and disclosing and providing information; adjust the
existing ways to comply with any previously applicable instructions and requirements; train
personnel to be able to respond to a collection of information; search data sources; complete and
review the collection of information; and transmit or otherwise disclose the information. An
agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB control number.
Send comments on the Agency's need for this information, the accuracy of the provided burden
estimates, and any suggested methods for minimizing respondent burden, including the use of
automated collection techniques to the Director, Collection Strategies Division, U.S.
Environmental Protection Agency (2822), 1200 Pennsylvania Ave., NW, Washington, D.C.
20460. Include the OMB control number in any correspondence. Do not send the completed EPA
DBE Subcontractor Participation Form to this address.
EPA FORM 6100-4 (i)BE Subcontractor Utilization Form)
15

EXHIBIT B
OMB Control No:
Approved:
Approval Expires
Environmental
Protection Agency
Disadvantaged Business Enterprise Program
DBE Subcontractor Participation Form
NAME OF SUBCONTRATOR PROJECT NAME
ADDRESS CONTRACT NO.
TELEPHONE NO. E-MAIL ADDRESS
PRIME CONTRACTOR NAME
Please use the space below to report any concerns regarding theEPA-funded project (e.g., reason for termination
by prime contractor, late payment, etc.).
CONTRACT TEM OF WORK OR DESCRPTION OF SERVICE AMOUNT SUBCONTRACTOR
ITEM NO. RECEIVED FROM THE PRIME CONTRACTOR WAS PAID BY PRIME
CONTRACTOR
Subcontractor Signature Title/ a
'Subcontractor is defined as a company, firm, joint venture, or individual who enters into an agreement with a contractor to
provide services pursuant to an EPA award of financial assistance.
EPA FORM 6100-2 (DBE Subcontractor Participation Form)
10

OMB Control No: 2990-0030
Approved: 05/01/2008
Approval Expires 01/31/2011
Environmental
Protection Agency
Disadvantaged Business Enterprise Program
DBE Subcontractor Participation Form
The public reporting and recordkeeping burden for this collection of information is estimated to average
fifteen (15) minutes. Burden means the total time, effort, or financial resources expended by persons to
generate, maintain, retain, or disclose or provide information to or for a Federal agency. This includes
the time needed to review instructions; develop, acquire, install, and utilize technology and systems for
the purposes of collecting, validating, and verifying information, processing and maintaining
information, and disclosing and providing information; adjust the existing ways to comply with any
previously applicable instructions and requirements; train personnel to be able to respond to a collection
of information; search data sources; complete and review the collection of information; and transmit or
otherwise disclose the information. An agency may not conduct or sponsor, and a person is not required
to respond to, a collection of information unless it displays a currently valid OMB control number.
Send comments on the Agency's need for this information, the accuracy of the provided burden
estimates, and any suggested methods for minimizing respondent burden, including the use of automated
collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection
Agency (2822), 1200 Pennsylvania Ave„ NW, Washington, D.C. 20460. Include the OMB control
number in any correspondence. Do not send the completed EPA DBE Subcontractor Participation Form
to this address.
EPA FORM 6100-2 (DBE Subcontractor Participation Form
11

EXHIBIT C
[OMB Control No: 2090-0030 – —1
Approved: 05/01/2008
Approval Expires 01/31/2011
Environmental
Protection Agency
Disadvantaged Business Enterprise Program
DBE Subcontractor Performance Form
NAME OF SUBCONTRATOR' PROJECT NAME
ADDRESS BID/PROPOSAL NO.
TELEPHONE NO. E-MAIL ADDRESS
PRIME CONTRACTOR NAME
CONTRACT TEM OF WORK OR DESCRPTION OF SERVICE PRICE OF WORK SUBMITTED
ITEM NO. D TO PRIME PRIME CONTRACTOR
Currently certified as an MBE or WBE under EPA's DBE Program' No
Siunature of Prime Contracto] Date
Print Name
Signature of Subcontractor Date
int Name Title
'Subcontractor is defined as a company, firm, joint venture, or individual who enters into an agreement with a contractor to
provide services pursuant to an EPA award of financial assistance.
EPA FORM 6100-3 (DBE Subcontractor Performance Form)
12

OMB Control No: 2090-00
Approved: 5/01/2008
Approval Expires 01/31/20
Environmental
Protection Agency
Disadvantaged Business Enterprise Program
DBE Subcontractor Performance Form
The public reporting and recordkeeping burden for this collection of information is estimated to average
fifteen (15) minutes. Burden means the total time, effort, or financial resources expended by persons to
generate, maintain, rctain, or disclose or provide information to or for a Federal agency. This includes
the time needed to review instructions; develop, acquire, install, and utilize technology and systems for
the purposes of collecting, validating, and verifying information, processing and maintaining
information, and disclosing and providing information; adjust the existing ways to comply with any
previously applicable instructions and requirements; train personnel to be able to respond to a collection
of information; search data sources; complete and review the collection of information; and transmit or
otherwise disclose the information. An agency may not conduct or sponsor, and a person is not required
to respond to, a collection of information unless it displays a currently valid OMB control number.
Send comments on the Agency's need for this information, the accuracy of the provided burden
estimates, and any suggested methods for minimizing respondent burden, including the use of automated
collection techniques to the Director, Collection Strategies Division, U.S, Environmental Protection
Agency (2822), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control
number in any correspondence. Do not send the completed EPA DBE Subcontractor Participation Form
to this address.
EPA FORM 6100-3 (DBE Subcontractor Performance Form)
13

EXHIBIT I)
I OMB Control No: 2090-0030
Approved: 05/01/2008
A I oval Ex ires 01/31/2011
Environmental
Protection Agency
Disadvantaged Business Enterprise Program
DBE Subcontractor Utilization Form
D/PROPOSAL NO. PROJECT NAME
NAME OF PRIME DER/PROPOSER E-MAIL ADDRESS
ADDRESS
TELEPHONE NO. FAX NO.
The following subcontractors' will be used on this project:
COMPANY NAME, ADDRESS, PHONE TYPE OF WORK TO BE ESTIMATED CURRENTLY CERTIFIED
NUMBER, AND E-MAIL ADDRESS PERFORMED DOLLAR AS AN MBE
AMOUNT OR WBE?
;ertify under penalty of perjury that the forgoing statements are true and correct. In the event of a replacement
'a subcontractor, I will adhere to the replacement requirements set forth in 40 CFR Part 33 Section 33,302(c).
Signature of Prime Contractor Date
Pri Name Title
Subcontractor is defined as a company, firm, joint venture, or individual who enters into an agreement with a contractor to
provide services pursuant to an EPA award of financial assistance.
EPA FORM 100-4 (DBE, Subcontractor Utilization Form)
14