Attachments for 06-07 RFCR for WorkSource contractors



|Contractor: |      |

| |Completion Status |Guidelines |

|Form 1 | |Please include completed checklist with RFCR submission |

|RFCR Document Checklist |Completed: | |

|Form 2 | |Please include the completed Contractor General |

|Contractor General Information |Completed: |Information Form with RFCR submission. |

|Corporate Documents |No Change: |If there have been any changes to your Agency’s Legal |

| | |Name, Corporate Status, City Business License Number, IRS|

| |Revised and attached: |Taxpayer Identification Number, Articles of |

| |Agency Legal Name |Incorporation, or Corporate Bylaws, or DUNS number, |

| |Corporate Status |submit the revised documents with this RFCR or select No |

| |City Business License Number |Change. |

| |IRS Taxpayer Identification Number | |

| |Articles of Incorporation | |

| |Corporate Bylaws | |

| |DUNS# | |

|Code of Conduct | | |

| |Adopted the Code of Conduct provided| |

| |by the City of Los Angeles; or | |

| | | |

| |Agency has own Code of Conduct | |

| |Approved by the City | |

| | | |

| |Submitting Code of Conduct | |

|Form 5 |Completed: | |

|Budget Forms | | |

|Form 6 |Completed: | |

|Budget Narrative Form | | |

|Budget Support Documentation |Completed: | |

|(See Section X) | | |

|Form 7A |Form 50 Attached: |Please include original Certification Compliance Form |

|Bidder Certification Certificate of Compliance | |with wet signatures |

|Form 50 | | |

| | |CEC Form 50 can be downloaded at |

| | | |

|Form 7B |Form 55 Attached: |Please include original Certification Compliance Form |

| | |with wet signatures |

|Bidder Contributions | | |

|CEC Form 55 | |CEC Form 55 can be found on the Ethics Commission's |

| | |website, on the Forms page, or by clicking this link: |

| | |

| | |df |

|Form 8 |Attached: |Please include original Certification of Authorities with|

|Certification of Authorities | |wet signatures |

|Form 9 |Attached: |Please include Board Resolution and Certification |

|Board Resolution and Certification (sample) | | |

|Form 10 |Updated list |Please include updated list of |

|Resolution Identifying Members of Board of |Attached: |Board Members along with Certification of Board |

|Directors (sample) |Resolution Attached: |Resolution. |

|Form 11 |Attached: |Please attach completed Inventory Form if applicable. |

|Equipment Inventory Form | | |

|Form 12 |Attached: |Please attach a completed CRO Questionnaire. |

|Contractor Responsibility Ordinance (CRO) | | |

|Service Questionnaire | |The CRO Service Questionnaire can be downloaded at |

| | |

| | |ionnaire%20Rev%201-20-12.pdf |

|Form 13 |Attached: |Please attach a completed and signed CRO Pledge of |

|CRO Pledge of Compliance | |Compliance. |

| | | |

| | |The CRO Pledge can be downloaded at |

| | |

| | |mpliance.PDF |

|Forms 11 |Attached: |Please refer to the attached LWO Submission Guidelines, |

|Living Wage Ordinance (LWO) | |complete and attach the appropriate LWO forms. |

|Submission Guidelines | | |

| | |LWO forms can be downloaded at |

|Guideline 1 |Registered: |Please refer to the attached instructions to register on |

|Los Angeles Business Assistance Virtual Network| |BAVN. Upload the applicable ordinance forms: EEP, AA, |

|(BAVN) “Download Templates” Instructions | |EBO, and SDO (Guidelines 1a—1d). |

| | | |

| | |IMPORTANT: If you have uploaded and received approvals on|

| | |the above referenced ordinance forms within the last 12 |

| | |months, no action is necessary. Instead, please select |

| | |the “Uploaded” boxes on Guidelines 1a-1d, wherever |

| | |applicable. Approved BAVN ordinance forms remain in |

| | |effect for 12 months for any number of contracts. |

| | | |

| | |For more details please go to |

|Guideline 1a |Uploaded: |Please upload the completed EBO/FHSO form at |

|Equal Benefits Ordinance (EBO) and First Source|Date Uploaded:______ | if you have not done so within the last 12|

|Hiring Ordinance (FSHO) Compliance Affidavits | |months. |

|Guideline 1b |Uploaded: |Please upload the completed SDO form at if|

|Slavery Disclosure Ordinance (SDO) Affidavit |Date Uploaded:______ |you have not done so within the last 12 months. |

|Guideline 1c |Uploaded: |Please upload the completed EBO/FHSO form at |

|Affirmative Action Program Affidavit |Date Uploaded:______ | if you have not done so within the last 12|

| | |months. |

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