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Local Assistance Procedures Manual EXHIBIT 10-K <br />Consultant Certification of Contract Costs and Finemcial Management System <br />I. Compliant with Generally Accepted Accounting Principles (GAAP) and standards promulgated <br />by the Cost Accounting Standards Board (when applicable). �r 6+ A-O'F'Wc'y 64�e <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 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 />Snbeonsultants (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): <br />Name: <br />Title: <br />Consultant Certification Signature **: <br />Date of Certification (rnmlddtyyyy): <br />Consultant Contact Information: <br />b ja(,/,;)Lgcs <br />Email: �CtiA.}' CS1 (�/.s`t\a Vct (Ue ' C- m° <br />Phone number: {� t9 �1 in� o <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 />Nate: Per 23 U.S.C. 112(b)(2)(6), Subconsaltants must comply with the FAR Cast Principles contained in 48 CFR, Part 31. <br />23 CFR Part 172.3 Dcfnitions state: Considtant means the individual or firm providing engineering and design related services as a party <br />to (he ctouract, Therefore, subcons chants as parties of a contract must complete a certification and send originals to A&1 and keep copies <br />in Local Agency Project Files. <br />Distribution: 1) 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 />