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Local Assistanee 1'rocedmes Manual IExhibit 104, Consultant Annual ;Certification of Indirect Costs and Financial Management System accounts; • Ability to accumulate and slegregate allowable direetcosts by project; contract and type of cost • Internal controls to maintain integrity of financial management system; • Ability to account and record, costs consistently and to ensure costs billed are in compliance with FAR; • Ability to ensure and demonstrate costs billed reeoncileto general ledgers and job costing system, and • Ability to ensure costs are in compliance with confraa t terars and federal and state requirement Cost Reimbursolgenj on Cantr6ots I also understand that failure to comply with48.CFRPark 16:301-3 or'lmowingly dhargem allowable costs to Federal -Aid iiigltway' rograin (FAIN') contracts amy'result n possible penalties and umetions as provided by` the following: + Sanctions and penalties - 7B CFR part 1 2.1 I. c 4 • FalseClinms Act --jute 311I:S.C. SqrtiopOL29-3713 * Statements or entries generally —Title 18 U.S.C. Section 1001 io Major frond Act - Title 18 U.S,t1 Section 1031 All A&E Lgift •nit Information: Total. participationatuotmt $ $50M on all State and FAHP contracts for Atcbdteetural & Engineering services that the consultant received in the last three felcal periods, • The number of Sipes itt whiclrthe consul atit does business is Years of consultant's experience with 48 CER Part 31 is s Audithistdryoftheconstiltant'scurertatulptiorgears(ifapplicable) O Cognizant IMAndit ❑ Local Gov't ICR Audit- ❑ Caltrans ICR Audit l] CPA ICR Audit ❑ Federal Gov't ICR Audit 1, of the alcove to the hest of all applicable state and federal rules and regulatior compliance must be retained by the consultant. I"lrt federal and state requirelpents are not eligible for.rt 'Name**, Meuric o Argent "y Signature: Email**: Mauricio.A gente to ratch.com mill elief and that I have reviewed the which are expresslyttnaffowableunder the Federal cost O.S.C.Seetionl.t2 2 A8C"Ftipart3l?3C1Rpare372 and dso certify thatl itnderstandthat all doetimentatiot of acknowledge that costs that are noncompliant with the ursemont,and must be returned to Caltrans. T;11.**. vice.Pmident Date of Cold Ovation (mm(ddlyyyy): 11112/201€3 Plione Number**: 805-542-9052 "Asladividaal execa$ve or Isadat offieer of cous•ttttaafs or cadsiiltatri's orgauiza6 at, a Vdoo4oNva than aViCe Prv4deut;a 'Clilefkioaucnl Officer: or eynidaleut who hasainiiotiiytq to tsiabli-b theardirwwsfotte; Note: Both prime and subconsrrltams as parties of a contract roast complete ibeip otvn Exhibit 10,Kf #,= Caltrrans will not pracesslocal agency's invoices.towl a complete TtW?ibit 1 P-Kform is accepted and approved by CcdlransAudttr and Investigations. Distribution: 1) Olig19ial- J,&alAgencyPMj=t File S) Copy - Consultant. 3) Copy- Calowis Aud tsan4 Invesfigations CSJ.Lr.11