Effective Date 10/01/2014

Posted 4/08/2015

The United States Department of Transportation (USDOT)

Standard Title VI/Non-Discrimination Assurances

DOT Order No. 1050.2A

The (agency, city, county name) (hereinreferredtoasthe"Recipient"),HEREBYAGREESTHAT,asaconditionto receivinganyFederal financialassistancefromtheU.S.DepartmentofTransportation(DOT),throughthe Federal Highway Administration issubject toandwillcomply withthefollowing:

Statutory/RegulatoryAuthorities

  • TitleVIoftheCivil RightsActof1964(42U.S.C.§2000d etseq.,78stat.252),(prohibits discriminationonthebasisof race,color,national origin);
  • 49C.F.R.Part21(entitledNon-discriminationInFederally-AssistedPrograms OfTheDepartmentOf Transportation-EffectuationOfTitleVIOfTheCivilRightsActOf1964);
  • 28C.F.R.section50.3(U.S. DepartmentofJustice GuidelinesforEnforcementofTitleVIoftheCivil Rights Actof1964);

Theprecedingstatutoryandregulatoryciteshereinafterarereferredtoasthe"Acts"and"Regulations," respectively.

General Assurances

InaccordancewiththeActs,theRegulations,andotherpertinentdirectives,circulars,policy,memoranda, and/or guidance,theRecipienthereby givesassurancethatitwillpromptlytakeanymeasuresnecessaryto ensurethat:

"NopersonintheUnitedStatesshall,onthegroundsofrace,color,ornationalorigin,be excludedfromparticipationin,bedeniedthebenefitsof,orbeotherwisesubjectedto discriminationunderanyprogramoractivity," forwhichtheRecipientreceivesFederal financialassistancefromDOT,includingthe Federal Highway Administration.

TheCivilRightsRestorationActof1987 clarifiedtheoriginalintentofCongress,withrespecttoTitleVIand otherNon-discriminationrequirements(TheAgeDiscriminationActof1975, andSection504ofthe RehabilitationActof1973),byrestoringthebroad,institutional-widescope andcoverageofthesenon­discriminationstatutesandrequirementstoinclude allprogramsandactivitiesof theRecipient,solongasany portion oftheprogram isFederallyassisted.

SpecificAssurances

Morespecifically,andwithoutlimitingtheabovegeneral Assurance,theRecipient agrees withandgivesthe followingAssuranceswithrespecttoitsFederallyassisted Federal-Aid Highway Program.

1. TheRecipientagreesthateach"activity,""facility,"or"program,"asdefinedin §§21.23(b)and21.23 (e)of49C.F.R. §21willbe(with regardtoan"activity")facilitated,orwillbe(with regard toa"facility")operated,orwillbe(withregardtoa"program") conductedincompliance withall requirementsimposedby,orpursuanttotheActsandtheRegulations.

2. TheRecipientwillinsertthefollowing notificationin allsolicitationsforbids,RequestsforProposals forwork,ormaterialsubjecttotheActsandtheRegulationsmadeinconnection withallFederal-Aid Highway Programand,inadaptedform,inallproposalsfornegotiatedagreementsregardlessof fundingsource:

"The(agency, city, county name),inaccordance withtheprovisionsofTitleVIoftheCivilRightsAct of1964(78Stat.252,42US.C.§§2000dto2000d-4)andtheRegulations, herebynotifiesall biddersthatitwillaffirmatively ensurethatanycontractenteredintopursuanttothis advertisement, disadvantaged businessenterpriseswillbeaffordedfullandfairopportunityto submitbidsinresponsetothisinvitationandwillnotbediscriminated againstonthegrounds ofrace,color,ornationalorigininconsiderationforanaward."

3. TheRecipientwillinserttheclausesofAppendixAandEofthisAssurance ineverycontractor agreementsubjecttotheActsandtheRegulations.

4. TheRecipientwillinserttheclausesofAppendixBofthisAssurance,asacovenant runningwiththe land,in anydeedfromtheUnitedStateseffectingorrecordingatransferofrealproperty,structures, use, orimprovementsthereonorinterestthereintoaRecipient.

5. ThatwheretheRecipientreceivesFederalfinancialassistancetoconstructafacility,orpartofafacility, theAssurancewillextendtotheentirefacilityandfacilitiesoperatedinconnectiontherewith.

6. ThatwheretheRecipientreceivesFederalfinancialassistanceintheform,orfortheacquisitionofreal propertyoraninterestinrealproperty,theAssurancewillextendtorightstospaceon,over,orunder suchproperty.

7. ThattheRecipientwillincludetheclausessetforthinAppendixCandAppendixDofthisAssurance, asacovenantrunningwiththeland,inanyfuturedeeds,leases,licenses,permits,orsimilarinstruments enteredintobytheRecipientwithotherparties:

a.forthesubsequenttransferofrealpropertyacquiredorimprovedundertheapplicableactivity, project,orprogram;and

b. fortheconstruction oruseof,oraccessto,spaceon,over,orunderrealpropertyacquiredor improvedundertheapplicableactivity,project,orprogram.

8. ThatthisAssuranceobligatestheRecipientfortheperiodduringwhichFederalfinancialassistanceis extendedtotheprogram,exceptwheretheFederalfinancialassistanceistoprovide,orisintheformof, personalproperty,orrealproperty,orinteresttherein,orstructuresorimprovementsthereon,inwhich casetheAssuranceobligatestheRecipient,oranytransfereeforthelongerofthefollowingperiods:

a. theperiodduringwhichthepropertyisusedforapurposeforwhichtheFederalfinancial assistanceisextended,orforanotherpurposeinvolvingtheprovisionofsimilarservicesor benefits;or

b. theperiodduringwhichtheRecipientretainsownershiporpossession oftheproperty.

9. TheRecipientwillprovideforsuchmethodsofadministrationfortheprogram asarefoundby the SecretaryofTransportation ortheofficialtowhomhe/shedelegatesspecificauthoritytogive reasonableguaranteethatit,otherrecipients,sub-recipients,sub-grantees, contractors, subcontractors, consultants,transferees, successorsininterest,andotherparticipantsofFederalfinancialassistanceundersuchprogramwillcomplywithallrequirements imposedorpursuanttotheActs,theRegulations, andthisAssurance.

10.TheRecipientagreesthattheUnitedStateshasarighttoseekjudicialenforcement withregardtoany matterarisingundertheActs,theRegulations,andthisAssurance.

BysigningthisASSURANCE, the (agency, city, county name)alsoagreestocomply(andrequireanysub-recipients, sub-grantees,contractors, successors,transferees,and/orassigneestocomply)withallapplicable provisions governingthe Federal Highway Administration’s accesstorecords,accounts,documents,information,facilities,andstaff. Youalsorecognizethatyoumustcomplywithanyprogramorcompliancereviews,and/orcomplaint investigationsconducted bythe Federal Highway Administration. Youmustkeeprecords,reports,andsubmitthematerial forreviewuponrequestto the Federal Highway Administration,oritsdesigneeinatimely,complete,andaccurateway. Additionally,youmustcomplywithallotherreporting,datacollection,andevaluationrequirements,as prescribedbylawordetailedinprogramguidance.

The (agency, city, county name) givesthisASSURANCEinconsideration ofandforobtaininganyFederalgrants,loans, contracts,agreements, property,and/ordiscounts,orotherFederal-aidandFederalfinancialassistanceextended afterthedatehereoftotherecipientsbytheU.S.Department ofTransportation underthe Federal-Aid Highway Program.ThisASSURANCE isbindingon(agency, city, county name),otherrecipients,sub-recipients,sub-grantees, contractors,subcontractorsandtheirsubcontractors',transferees,successorsininterest,andanyother participantsinthe Federal-Aid Highway Program.Theperson(s)signingbelowisauthorizedtosignthis ASSURANCEonbehalfoftheRecipient.

Name (Type/print)Recipient: (agency, city, county name)

Signature/Title/Mayor/Co. Commis.Chair/Exec.Dir.Date

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Effective Date 10/01/2014

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(Insert agency, city, county name), RECIPIENT

APPENDIXA OF THE TITLE VI ASSURANCES

Duringtheperformanceofthiscontract,theContractor,foritself,itsassignees,andsuccessorsininterest(hereinafter referredtoastheContractor)agreesasfollows:

1. Compliancewith Regulations:TheContractor(hereinafter includesconsultants)willcomplywiththe ActsandtheRegulations relativetoNon-discriminationinFederally-assisted programsoftheU.S. DepartmentofTransportation, the Federal Highway Administration, astheymaybeamended fromtimetotime,whicharehereinincorporatedbyreferenceandmadeapartofthiscontract.

2. Non-discrimination:TheContractor,withregardtotheworkperformedbyitduringthecontract,will notdiscriminateonthegroundsofrace,color,ornationaloriginintheselectionandretentionof subcontractors,includingprocurementsofmaterialsandleasesofequipment. TheContractor willnot participatedirectlyorindirectlyinthediscriminationprohibited bytheActsandtheRegulations, includingemployment practiceswhenthecontractcoversanyactivity,project,orprogramsetforthin AppendixBof49CFRPart21.

3. SolicitationsforSubcontracts,IncludingProcurementsofMaterialsandEquipment:Inall solicitations,eitherbycompetitivebidding,ornegotiationmadebytheContractorforworktobe performedunderasubcontract, includingprocurementsofmaterials,orleasesofequipment,each potentialsubcontractororsupplierwillbenotifiedbytheContractoroftheContractor'sobligations under thiscontractandtheActsandtheRegulationsrelativetoNon-discrimination onthegroundsof race, color,ornationalorigin.

4. Information and Reports:The ContractorwillprovideallinformationandreportsrequiredbytheActs, theRegulations,anddirectivesissuedpursuanttheretoandwillpermitaccesstoitsbooks,records, accounts,othersourcesofinformation,anditsfacilitiesasmaybedeterminedbytheRecipientorthe Federal Highway Administration tobepertinenttoascertaincompliancewithsuchActs, Regulations,andinstructions. WhereanyinformationrequiredofaContractorisintheexclusive possessionofanotherwhofailsorrefusestofurnishtheinformation, theContractorwillsocertifytothe Recipientorthe Federal Highway Administrationasappropriate,andwillsetforthwhat effortsithasmadetoobtaintheinformation.

5. SanctionsforNoncompliance:Intheeventofacontractor'snoncompliancewiththeNondiscrimination provisionsofthiscontract,theRecipientwillimposesuchcontractsanctionsasitorthe Federal Highway Administration maydeterminetobeappropriate,including,butnotlimited to:

a. withholdingpaymentstotheContractorunderthecontractuntiltheContractorcomplies;and/or

b. cancelling,terminating,orsuspendingacontract,inwholeorinpart.

6. IncorporationofProvisions:TheContractorwillincludetheprovisionsofparagraphsonethroughsix ineverysubcontract,includingprocurementsofmaterialsandleasesofequipment,unlessexemptbythe Acts,theRegulationsanddirectivesissuedpursuantthereto. TheContractorwilltakeactionwithrespect toanysubcontractorprocurementastheRecipientorthe Federal Highway Administrationmaydirectasameansofenforcingsuchprovisionsincludingsanctionsfornoncompliance.Provided, thatiftheContractor becomesinvolvedin,oristhreatenedwithlitigationbyasubcontractor, orsupplier becauseofsuchdirection,theContractormayrequesttheRecipienttoenterintoanylitigationtoprotect theinterestsoftheRecipient. Inaddition,theContractor mayrequesttheUnitedStatestoenterintothe litigationtoprotecttheinterestsoftheUnitedStates.

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(Insert agency, city, county name)

APPENDIX B OF THE TITLE VI ASSURANCES

CLAUSESFORDEEDSTRANSFERRINGUNITEDSTATESPROPERTY

Thefollowingclauseswillbeincludedindeedseffectingorrecordingthetransferofrealproperty,structures,or improvementsthereon,orgrantinginterestthereinfromtheUnitedStatespursuanttotheprovisionsof Assurance4:

NOW,THEREFORE,theU.S.Department ofTransportationasauthorized bylawandupontheconditionthat the (agency, city, county name)willaccepttitletothelandsandmaintaintheprojectconstructedthereoninaccordance withTitle 23, United States Code,theRegulationsfortheAdministration of the Federal-Aid Highway Program,andthepoliciesandproceduresprescribedbythe Federal Highway AdministrationoftheU.S.Department of Transportationin accordanceandincompliancewithallrequirements imposedby Title49,CodeofFederalRegulations,U.S.DepartmentofTransportation,SubtitleA,Officeofthe Secretary,Part21,Non-discriminationinFederally-assisted programsoftheU.SDepartmentofTransportation pertainingtoandeffectuating theprovisionsofTitleVIoftheCivilRightsActof1964(78Stat.252;42U.S.C.§ 2000dto2000d-4),doesherebyremise,release,quitclaimandconveyuntothe (agency, city, county name)alltheright, titleandinterestoftheU.S.Department ofTransportationin andtosaidlandsdescribedinExhibitAattached heretoandmadeaparthereof.

(HABENDUM CLAUSE)

TOHAVEANDTOHOLDsaidlandsandintereststhereinunto the (agency, city, county name)anditssuccessorsforever, subject,however,tothecovenants,conditions,restrictionsandreservations hereincontainedasfollows,which willremainineffectfortheperiodduringwhichtherealpropertyorstructuresareusedforapurposeforwhich Federalfinancialassistance isextendedorforanotherpurposeinvolvingtheprovisionofsimilarservicesor benefitsandwillbebindingonthe (agency, city, county name),itssuccessorsandassigns.

The (agency, city, county name),inconsideration oftheconveyanceofsaidlandsandinterestsinlands,doeshereby covenantandagreeasacovenantrunningwiththelandforitself,itssuccessors andassigns,that(1)nopersonwillonthegroundsofrace,color,ornationalorigin,beexcludedfromparticipation in,bedeniedthebenefitsof,orbe otherwisesubjectedtodiscrimination withregardtoanyfacilitylocatedwhollyorinparton,over,orundersuchlandsherebyconveyed[,][and]*(2)thatthe (agency, city, county name)willusethelandsandinterestsinlandsand interestsinlandssoconveyed, incompliancewithallrequirementsimposedbyorpursuanttoTitle49,Codeof FederalRegulations,U.S.Department ofTransportation,SubtitleA,OfficeoftheSecretary,Part21,Non­ discriminationinFederally-assistedprogramsoftheU.S.DepartmentofTransportation,EffectuationofTitleVI oftheCivilRightsActof1964,andassaidRegulationsandActsmaybeamended[, and(3)thatin theeventof breachofanyoftheabove-mentionednon-discrimination conditions,theDepartment willhavearighttoenteror re-entersaidlandsandfacilitiesonsaidland,andthatabovedescribed landandfacilitieswillthereonreverttoandvestin andbecometheabsolutepropertyoftheU.S.Departmentof Transportationanditsassignsassuchinterestexistedpriortothisinstruction].*

(*Reverterclauseandrelatedlanguagetobeusedonlywhenitisdetermined thatsuchaclauseisnecessaryin ordertomakeclearthepurposeofTitleVI.)

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(Insert agency, city, county name)

APPENDIX C OF THE TITLE VI ASSURANCES

CLAUSESFORTRANSFEROFREALPROPERTYACQUIREDORIMPROVEDUNDER THEACTIVITY,FACILITY,ORPROGRAM

Thefollowingclauseswillbeincludedindeeds,licenses,leases,permits,orsimilarinstrumentsenteredintoby (agency, city, county name)pursuanttotheprovisionsofAssurance7(a):

A.The(grantee,lessee,permittee,etc.asappropriate)forhimself/herself,his/herheirs,personal representatives,successors ininterest,andassigns,asapartoftheconsiderationhereof,doeshereby covenantandagree[inthecaseofdeedsandleasesadd"asacovenantrunningwiththeland"]that:

1. Intheeventfacilitiesareconstructed, maintained,orotherwiseoperated onthepropertydescribedin this(deed,license,lease,permit,etc.)forapurposeforwhichaU.S.Department ofTransportation activity,facility,orprogramisextendedorforanotherpurposeinvolvingtheprovisionofsimilar servicesorbenefits,the(grantee, licensee,lessee,permittee,etc.)willmaintainandoperatesuch facilitiesandservices incompliancewithallrequirementsimposed bytheActsandRegulations(as maybeamended)suchthatnopersononthegroundsofrace,color,ornationalorigin,willbe excludedfromparticipationin,deniedthebenefitsof,orbeotherwisesubjectedtodiscrimination in theuseofsaidfacilities.

B. Withrespecttolicenses,leases,permits,etc.,intheeventofbreachofanyoftheaboveNon-discrimination covenants, (agency, city, county name)willhavetherighttoterminatethe(lease,license,permit,etc.)andtoenter, re-enter,andrepossesssaidlandsandfacilitiesthereon,andholdthesameasifthe(lease,license,permit, etc.)hadneverbeenmadeorissued.*

C. Withrespecttoadeed,intheeventofbreachofanyoftheaboveNon-discriminationcovenants,(agency, city, county name) willhavetherighttoenterorre-enterthelandsandfacilitiesthereon,andtheabovedescribed landsandfacilitieswillthereuponreverttoandvestinandbecometheabsolute propertyofthe (agency, city, county name) anditsassigns.*

(*Reverterclauseandrelatedlanguagetobeusedonlywhenitisdetermined thatsuchaclauseisnecessaryto makeclearthepurposeofTitleVI.)

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(Insert agency, city, county name)

APPENDIX D OF THE TITLE VI ASSURANCES

CLAUSESFORCONSTRUCTION/USE/ACCESSTOREALPROPERTYACQUIRED UNDERTHEACTIVITY,FACILITYORPROGRAM

Thefollowingclauseswillbeincludedindeeds,licenses,permits,orsimilarinstruments/agreementsentered intoby (agency, city, county name)pursuanttotheprovisionsofAssurance7(b):

A. The(grantee,licensee,permittee,etc.,asappropriate)forhimself/herself,his/herheirs,personal representatives,successorsininterest,andassigns,asapartoftheconsideration hereof,doeshereby covenantandagree(inthecaseofdeedsandleasesadd,"asacovenantrunningwiththeland")that(1)no persononthegroundofrace,color,ornationalorigin,willbeexcludedfromparticipation in,deniedthe benefitsof,orbeotherwisesubjectedtodiscrimination intheuseofsaidfacilities,(2)thatinthe constructionofanyimprovements on,over,orundersuchland,andthefurnishingofservicesthereon,no persononthegroundofrace,color,ornationalorigin,willbeexcludedfromparticipationin,deniedthe benefitsof,orotherwise besubjected todiscrimination,(3)thatthe(grantee,licensee,lessee,permittee, etc.)willusethepremisesincompliance withallotherrequirementsimposedbyorpursuanttotheActsand Regulations,asamended,setforthinthisAssurance.

B. Withrespectto(licenses,leases,permits,etc.),intheeventofbreachofanyoftheaboveNon­ discriminationcovenants, (agency, city, county name) willhavetherighttoterminatethe(license,permit,etc.,as appropriate)andtoenterorre-enterandrepossesssaidlandandthefacilitiesthereon,andholdthesameas ifsaid(license,permit,etc.,asappropriate)hadneverbeenmadeorissued.*

C. Withrespecttodeeds,intheeventofbreachofanyoftheaboveNon-discriminationcovenants, (agency, city, county name) willthereuponreverttoandvestinandbecometheabsolutepropertyof (agency, city, county name)and itsassigns.*

(*Reverterclauseandrelatedlanguagetobeusedonlywhenitisdeterminedthatsuchaclauseisnecessaryto makeclearthepurposeofTitleVI.)

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(Insert agency, city, county name)

APPENDIX E OF THE TITLE VI ASSURANCES

Duringtheperformanceofthiscontract,thecontractor,foritself,itsassignees,andsuccessorsininterest (hereinafterreferredtoastheContractor)agreestocomplywiththefollowingnon-discriminationstatutesand authorities;includingbutnotlimitedto:

Pertinent Non-Discrimination Authorities:

•TitleVIoftheCivilRightsActof1964(42U.S.C.§2000detseq.,78stat.252),(prohibits discrimination onthebasisofrace,color,nationalorigin);and49CFRPart21.

•TheUniformRelocation AssistanceandRealPropertyAcquisitionPoliciesActof1970,(42U.S.C.§4601),(prohibits unfairtreatmentofpersonsdisplacedorwhosepropertyhasbeenacquiredbecauseof FederalorFederal-aid programsandprojects);

•Federal-AidHighway Actof1973,(23U.S.C.§324etseq.),(prohibitsdiscrimination onthebasisof sex);

•Section504of the RehabilitationActof1973,(29U.S.C.§794etseq.),asamended,(prohibits discriminationonthebasisofdisability);and49CFRPart27;

•TheAgeDiscriminationActof1975,asamended,(42U.S.C.§6101etseq.),(prohibitsdiscrimination onthebasisofage);

•AirportandAirwayImprovement Actof1982,(49USC§471,Section47123),asamended,(prohibits discrimination basedonrace,creed,color,nationalorigin,orsex);

•TheCivilRightsRestorationActof1987,(PL100-209),(Broadenedthescope,coverageand applicabilityofTitleVIoftheCivilRightsActof1964,TheAgeDiscriminationActof1975and Section504oftheRehabilitation Actof1973,byexpanding thedefinitionoftheterms"programs or activities"toincludealloftheprogramsoractivitiesoftheFederal-aidrecipients,sub-recipientsand contractors,whether suchprogramsoractivitiesareFederallyfundedornot);

•TitlesIIandIIIoftheAmericanswithDisabilitiesAct,whichprohibitdiscrimination onthebasis of disabilityintheoperationofpublicentities,publicandprivatetransportationsystems,placesofpublic accommodation,andcertaintestingentities(42U.S.C.§§12131-12189)asimplemented by DepartmentofTransportation regulationsat49C.F.R.parts37and38;

•TheFederalAviation Administration'sNon-discriminationstatute(49U.S.C.§47123)(prohibits discrimination onthebasisofrace,color,nationalorigin,andsex);

•ExecutiveOrder12898,FederalActionstoAddressEnvironmental JusticeinMinorityPopulations and Low-IncomePopulations,whichensuresnon-discrimination againstminoritypopulationsbydiscouraging programs,policies,andactivitieswithdisproportionatelyhighandadversehumanhealthor environmental effectsonminorityandlow-incomepopulations;

•ExecutiveOrder13166,ImprovingAccesstoServicesforPersonswithLimitedEnglishProficiency, andresultingagencyguidance,nationalorigindiscrimination includesdiscrimination becauseoflimited Englishproficiency(LEP). ToensurecompliancewithTitleVI,youmusttakereasonablestepsto ensurethatLEPpersonshavemeaningfulaccesstoyourprograms(70Fed.Reg.at74087to74100);

•TitleIXoftheEducation Amendmentsof1972,asamended,whichprohibitsyoufromdiscriminating becauseofsexineducationprogramsoractivities(20U.S.C.1681etseq).

E