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Local Assistance Procedures Manual EXH1l31T 10•K <br />Consultant Certification of Contract Costs and Financial Management System <br />1. Compliant with Generally Accepted Accounting Principles (GAAP) and standards promulgated <br />by the Cost Accounting Standards Board (when applicable), <br />2, Compliant with the terms of the contract and is incurred specifically for the contract. <br />3, Not prohibited by 23 CFR, Chapter 1, Part -l72 —Administration of Engineering and Design <br />Related Service Contracts to the extent requirements are applicable to Consultant. <br />All costs must be applied consistently and fairly to all contracts, All documentation of compliance must be <br />retained in the project files, <br />Subconsultants (if applicable) / <br />Proposed Contract Amount (or amount not to exceed if on-call contract): $/ r <br />Prime Consultants (if applicable) <br />Proposed Total Contract Amount (or amount not to exceed if on-call contract): $2001000 <br />Prime, list all subconsultants and proposed subcontract dollar amounts (attach additional page if necessary): <br />Consultant Certifying (Print Name and Title): <br />Name: <br />Title; <br />Consultant Certification Signature *In:_ �)) C�'V11 (__ <br />Date of Certification (mm/dd/yyyy): a//$ /,J— <br />Consultant Contact Information: <br />Email: Q , YaD Lrivi, <br />Phone nrunber: q � q _ <br />-Source. <br />6-35-- 0� 7� <br />**An individual executive or financial officer of the consultant's organization at a level no lower than a Vice <br />President or Chief Financial Officer, or equivalent, who has authority to represent the financial information <br />utilized to establish the Indirect Cost Rate proposal submitted in conjunction with the contract, <br />Note: Per 23 U.S.C. 112(b)(2)(6), Subconsultants must comply with the FAR Cost Pelnciptes contained in 48 CFR, Part 3l, <br />23 CFR Part 1723Deja ittons slate: Consultant means the individual or firm providing engineering and destgn related.rervtces as a party <br />to the contract. Therefore, subcomultants asparties ofa contraai must complete a carttricadon and send originals toA&[and keep copies <br />in Local Agency Project Files. <br />mistribution: I) Original to Caltrans Audits and Investigations <br />2) Retained in Local Agency Project Files <br />Page 2 of 2 <br />UP 15-01 January 14, 2015 <br />