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Local Assistance Procedures Manual CXIIIBJT 10-K <br />Consultant Certification of Contract Costs and Financial Management System <br />1. Compliant with Generally Accepted Accounting Principles (C,AA ) and standards promulgated <br />by the Cost Accounting Standards Board (when applicable). l ) d ✓ <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 172 - Administration of Fngineering 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 file& <br />Subconsultants (if applicable) <br />Proposed Contract Amount (or amount not to exceed if on-call contract): $ <br />Prime Consultants (if applicable) <br />Proposed Total Contract Amount (or amount not to exceed if on-call contract): $ <br />Prime, list all subconsultants and proposed subcontract dollar amounts (attach additional page if necessary): <br />Consultant Certifying (Print Name and Title): n� <br />Name: aA L�.tr (? 1 \ (XU)6I)6 <br />Title: <br />Consultant Certification Signature **: <br />Date of Certification (mmtcldlyyyy): b G t t2 6 ( ")o t � <br />Consultant Contact Information: <br />Email: M,Vv1aA\C u,Y & &tv\ VCa_ , Cut VIA <br />Phone number: -� (0 , rY (6 ' (L/ e) C) <br />**An 'Individual executive or financial officer of the consultant's organization ata 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 USC. 112(6)(2)(B), Sttbcowultarts nni a comply etdth tie PW R Cost Pr inciples contolned in 43 CFR Port 31. <br />23 CFR Part 172.3 Definitions states Cunsxltaxt arsons the individsmlar fxtaiprovidttag etgrtmering and desigrz re7atedservics nv a1Yr+'ty <br />ro the contract. Therefore, sabeansulmnty as parttes of a contract must complete a ceralpeatton and send originals to A&I and keep copies <br />in Local Agency Pralect Piles. <br />Disailoi ion: ])Original to Caltrans Audits and Investigations <br />2) Retained in Local Agency Prgieut Has <br />Page 2 of 2 <br />1.111P last .January 14, 2015 <br />