Local Assistance Procedures Manual Exhibit 10-K

Consultant Annual Certification of Indirect Costs and Financial Management System

EXHIBIT10-KCONSULTANTANNUALCERTIFICATIONOF

INDIRECTCOSTSANDFINANCIALMANAGEMENTSYSTEM

(Note:Ifa SafeHarbor IndirectCostRate isapproved,thisformisnot required.)

Consultant’sFullLegalName:

Important:Consultantmeanstheindividualorconsultantprovidingengineeringanddesignrelatedservicesasaparty ofacontractwitharecipientorsub-recipientofFederalassistance.Therefore,theIndirectCostRate(s)shall notbecombinedwithitsparent companyorsubsidiaries.

IndirectCost Rate:

Combined Rate % OR

HomeOffice Rate% andFieldOfficeRate(ifapplicable)%

FacilitiesCapital Costof Money%(ifapplicable)

Fiscal period*

* Fiscal period is annual one year applicable accounting period that the Indirect Cost Rate was developed (not the contract period). The Indirect Cost Rate is based on the consultant’s one-year applicable accounting period for which financial statements are regularly prepared by the consultant.

Ihave reviewedtheproposal toestablish anIndirectCostRate(s) forthefiscalperiodas specifiedaboveandhavedeterminedto the best of my knowledge and belief that:

  • Allcosts includedinthe costproposal toestablishtheindirect cost rate(s)areallowable inaccordancewiththe costprinciplesof theFederalAcquisitionRegulation(FAR)48,CodeofFederalRegulations(CFR),Chapter1, Part31(48 CFRPart31);
  • The cost proposal doesnot include anycostswhichareexpresslyunallowableunder the costprinciplesof48 CFRPart 31;
  • Theaccountingtreatment andbillingofprevailingwage deltacosts areconsistentwithourprevailingwage policyas eitherdirect labor,indirectcosts,or other directcostsonallfederally-fundedA&EConsultantContracts.
  • Allknownmaterialtransactionsorevents thathave occurredsubsequent to year-end affectingthe consultant’sownership,organization,andindirectcostrateshavebeendisclosedasofthedateofthiscertification.

Iamprovidingtherequiredand applicabledocuments as instructedonExhibit10-A.

FinancialManagementSystem:

Our laborcharging,jobcosting, andaccountingsystemsmeet the standards for financialreporting,accountingrecords,andinternalcontroladequate to demonstratethat costs claimed havebeenincurred,appropriatelyaccountedfor,are allocabletothe contract,and complywiththefederalrequirementsassetforthinTitle23United StatesCode (U.S.C.) Section112(b)(2); 48 CFRPart31.201-2(d);23CFR,Chapter1,Part172.11(a)(2);andallapplicable state andfederalrules andregulations.

Ourfinancial managementsystemhasthefollowingattributes:

  • Accountnumbersidentifyingallowable direct,indirect,andunallowable cost accounts;
  • Abilitytoaccumulate andsegregate allowabledirect,indirect,andunallowable costsintoseparate costaccounts;
  • Abilitytoaccumulate andsegregate allowabledirect costsbyproject,contract andtypeofcost;
  • Internal controls tomaintainintegrityoffinancialmanagement system;
  • Abilitytoaccount andrecordcostsconsistentlyandtoensurecostsbilledareincompliance with FAR;
  • Abilitytoensureanddemonstratecostsbilledreconciletogeneralledgers andjobcostingsystem;and
  • Abilitytoensurecosts are incompliance withcontractterms andfederalandstaterequirement

Cost ReimbursementsonContracts:

Ialsounderstandthatfailure tocomplywith48 CFRPart16.301-3 orknowinglychargeunallowable costs toFederal-Aid HighwayProgram(FAHP)contracts mayresult inpossible penalties andsanctions as provided bythefollowing:

  • SanctionsandPenalties-23CFRPart172.11(c)(4)
  • FalseClaimsAct-Title31U.S.C.Sections3729-3733
  • Statementsorentriesgenerally-Title18U.S.C.Section1001
  • MajorFraudAct -Title18U.S.C.Section1031

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March 2018

Local Assistance Procedures Manual Exhibit 10-K

Consultant Annual Certification of Indirect Costs and Financial Management System

AllA&EContract Information:

  • Total participation amount$______on all State and FAHP contracts for Architectural Engineeringservices thattheconsultantreceivedinthelastthreefiscal periods.
  • Thenumberofstates inwhichthe consultant doesbusiness is.
  • Yearsofconsultant’sexperience with48 CFRPart 31 is.
  • Audithistoryoftheconsultant’s current and prior years(if applicable)

I,the undersigned,certifyalloftheabovetothebestof myknowledge andbelief andthatIhave reviewedtheIndirect Cost Rate Schedule to determinethatanycosts whichare expresslyunallowableundertheFederalcost principleshavebeenremovedandcomplywithTitle23U.S.C.Section112(b)(2),48CFRPart31,23CFRPart172,andallapplicable state andfederal rulesandregulations.IalsocertifythatIunderstandthat alldocumentationofcompliancemustberetainedbytheconsultant. Iherebyacknowledge thatcoststhatare noncompliant withthefederalandstaterequirementsarenoteligibleforreimbursementandmustbereturnedto Caltrans.

Name**:_Title**:

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March 2018

Local Assistance Procedures Manual Exhibit 10-K

Consultant Annual Certification of Indirect Costs and Financial Management System

Signature: Email**:

Date ofCertification(mm/dd/yyyy): PhoneNumber**:

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March 2018

Local Assistance Procedures Manual Exhibit 10-K

Consultant Annual Certification of Indirect Costs and Financial Management System

**Anindividualexecutiveorfinancialofficeroftheconsultant’s orsubconsultant’s organizationatalevel nolowerthanaVicePresident,aChiefFinancialOfficer,orequivalent, whohasauthoritytorepresent thefinancialinformationusedtoestablishtheindirectcostrate.

Note:BothprimeandsubconsultantsaspartiesofacontractmustcompletetheirownExhibit10-Kforms.Caltranswillnot processlocalagency’sinvoicesuntilacompleteExhibit10-KformisacceptedandapprovedbyCaltransAuditsandInvestigations.

Distribution: 1)Original- LocalAgencyProjectFile

2)Copy-Consultant

3)Copy-CaltransAuditsandInvestigations

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March 2018