BOX ONLY Clause Samples

BOX ONLY. The undersigned certifies that within the past 10 years the Contractor has NOT been the subject of a complaint or pending action in a legal administrative proceeding alleging that Contractor discriminated against its employees, subcontractors, vendors or suppliers. The undersigned certifies that within the past 10 years the Contractor has been the subject of a complaint or pending action in a legal administrative proceeding alleging that Contractor discriminated against its employees, subcontractors, vendors or suppliers. A description of the status or resolution of that complaint, including any remedial action taken and the applicable dates is as follows: Contractor Name: Certified By Title Equal Opportunity Contracting Sole Source Contracts, Cooperative Procurement Contracts Goods/Services Contracts Under $150,000 Revised 1/1/16 OCA Document No. 1208377 The objective of the Equal Employment Opportunity Outreach Program, San Diego Municipal Code Sections 22.3501 through 22.3517, is to ensure that contractors doing business with the City, or receiving funds from the City, do not engage in unlawful discriminatory employment practices prohibited by State and Federal law. Such employment practices include, but are not limited to unlawful discrimination in the following: employment, promotion or upgrading, demotion or transfer, recruitment or recruitment advertising, layoff or termination, rate of pay or other forms of compensation, and selection for training, including apprenticeship. Contractors are required to provide a completed Work Force Report (WFR). Type of Contractor: Construction Vendor/Supplier Financial Institution Lessee/Lessor Consultant Grant Recipient Insurance Company Other Name of Company: ADA/DBA: Address (Corporate Headquarters, where applicable): City: County: State: Zip: Telephone Number: Fax Number: Name of Company CEO: Address(es), phone and fax number(s) of company facilities located in San Diego County (if different from above): Address:

BOX ONLY. The undersigned certifies that within the past 10 years the Consultant has NOT been the subject of a complaint or pending action in a legal administrative proceeding alleging that Consultant discriminated against its employees, subcontractors, vendors or suppliers. The undersigned certifies that within the past 10 years the Consultant has been the subject of a complaint or pending action in a legal administrative proceeding alleging that Consultant discriminated against its employees, subcontractors, vendors or suppliers. A description of the status or resolution of that complaint, including any remedial action taken and the applicable dates is as follows: DATE OF CLAIM LOCATION DESCRIPTION OF CLAIM LITIGATION (Y/N) STATUS RESOLUTION/REMEDIAL ACTION TAKEN 12/31/15 Los Angeles, CA Allegation of racial discrimination Y Resolved None necessary Consultant Name Psomas Certified By ▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇ Title Vice President Equal Opportunity Contracting Program Page 6 of 12 12/2015 City of San Diego EQUAL OPPORTUNITY CONTRACTING PROGRAM (EOCP) ▇▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇ • Suite 200 • ▇▇▇ ▇▇▇▇▇, ▇▇ ▇▇▇▇▇ Phone: (▇▇▇) ▇▇▇-▇▇▇▇ • Fax: (▇▇▇) ▇▇▇-▇▇▇▇ WORK FORCE REPORT ADMINISTRATIVE The objective of the Equal Employment Opportunity Outreach Program, San Diego Municipal Code Sections 22.3501 through 22.3517, is to ensure that contractors doing business with the City, or receiving funds from the City, do not engage in unlawful discriminatory employment practices prohibited by State and Federal law. Such employment practices include, but are not limited to unlawful discrimination in the following: employment, promotion or upgrading, demotion or transfer, recruitment or recruitment advertising, layoff or termination, rate of pay or other forms of compensation, and selection for training, including apprenticeship. Contractors are required to provide a completed Work Force Report (WFR).

BOX ONLY. The undersigned certifies that within the past 10 years the Consultant has NOT been the subject of a complaint or pending action in a legal administrative proceeding alleging that Consultant discriminated against its employees, subcontractors, vendors or suppliers. The undersigned certifies that within the past 10 years the Consultant has been the subject of a complaint or pending action in a legal administrative proceeding alleging that Consultant discriminated against its employees, subcontractors, vendors or suppliers. A description of the status or resolution of that complaint, including any remedial action taken and the applicable dates is as follows: DATE OF CLAIM LOCATION DESCRIPTION OF CLAIM LITIGATION (Y/N) STATUS RESOLUTION/REMEDIAL ACTION TAKEN Consultant Name Nasland Engineering Certified By ▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇, PE Title Principal City of San Diego EQUAL OPPORTUNITY CONTRACTING PROGRAM (EOCP) ▇▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇ • Suite 200 • ▇▇▇ ▇▇▇▇▇, ▇▇ ▇▇▇▇▇ Phone: (▇▇▇) ▇▇▇-▇▇▇▇ • Fax: (▇▇▇) ▇▇▇-▇▇▇▇ WORK FORCE REPORT ADMINISTRATIVE The objective of the Equal Employment Opportunity Outreach Program, San Diego Municipal Code Sections 22.3501 through 22.3517, is to ensure that contractors doing business with the City, or receiving funds from the City, do not engage in unlawful discriminatory employment practices prohibited by State and Federal law. Such employment practices include, but are not limited to unlawful discrimination in the following: employment, promotion or upgrading, demotion or transfer, recruitment or recruitment advertising, layoff or termination, rate of pay or other forms of compensation, and selection for training, including apprenticeship. Contractors are required to provide a completed Work Force Report (WFR).

BOX ONLY. The undersigned certifies that within the past 10 years the Design Professional has NOT been the subject of a complaint or pending action in a legal administrative proceeding alleging that Design Professional discriminated against its employees, subcontractors, vendors or suppliers. X The undersigned certifies that within the past 10 years the Design Professional has been the subject of a complaint or pending action in a legal administrative proceeding alleging that Design Professional discriminated against its employees, subcontractors, vendors or suppliers. A description of the status or resolution of that complaint, including any remedial action taken and the applicable dates is as follows: 12/11/2015 Jacksonville, FL Employment - related claims of age discrimination Yes Case settled w/prejudice in March of 2016 Settled in mediation in March of 2016

BOX ONLY. The undersigned certifies that within the past 10 years the Design Professional has NOT been the subject of a complaint or pending action in a legal administrative proceeding alleging that Design Professional discriminated against its employees, subcontractors, vendors or suppliers. The undersigned certifies that within the past 10 years the Design Professional has been the subject of a complaint or pending action in a legal administrative proceeding alleging that Design Professional discriminated against its employees, subcontractors, vendors or suppliers. A description of the status or resolution of that complaint, including any remedial action taken and the applicable dates is as follows: Consultant is a large international engineering and consulting firm with more than 80 offices spread out across more than 30 states nationwide. Consultant does not have a centralized repository that tracks the subject of this request dating back 10 years. Notwithstanding the foregoing, however, and upon reasonable investigation and belief, Consultant is aware of the following complaints or pending actions in a legal or administrative proceeding over the past 7 years alleging that Consultant discriminated against its employees, subcontractors, vendors, or suppliers: 2015 FL Former employee filed a charge and lawsuit alleging wrongful termination and age discrimination. Y Closed Design Professional denies the allegations and any wrongdoing, but the parties were able to reach an amicable settlement at mediation. 2016 SC Former employee filed a charge with the EEOC/SCHAC alleging constructive termination and race discrimination Y Closed Design Professional denies the allegations and any wrongdoing, but the parties were able to amicably resolve the matter. 2016 PA Former employee filed a charge with the EEOC alleging race and sex discrimination. Y Closed Design Professional denies the allegations and any wrongdoing, but the parties were able to amicably resolve the matter. 2016 CA Former employee filed a complaint with the Department of Fair Employment and Housing alleging wrongful termination, retaliation and age/ sex discrimination. Y Closed Design Professional denies the allegations and any wrongdoing, but the parties were able to amicably resolve the matter. 2017 VA Former employee filed a charge with the EEOC alleging wrongful termination and discrimination. Y Closed Design Professional denies the allegations and any wrongdoing, but the parties were able to amicably re...

BOX ONLY. The undersigned certifies that within the past 10 years the Contractor has NOT been the subject of a complaint or pending action in a legal administrative proceeding alleging that Contractor discriminated against its employees, subcontractors, vendors or suppliers. The undersigned certifies that within the past 10 years the Contractor has been the subject of a complaint or pending action in a legal administrative proceeding alleging that Contractor discriminated against its employees, subcontractors, vendors or suppliers. A description of the status or resolution of that complaint, including any remedial action taken and the applicable dates is as follows: Contractor Name: Kosmont & Associates, Inc., dba Kosmont Companies Certified By ▇▇▇▇▇ ▇ ▇▇▇▇▇▇▇ Name Title CEO Signature

BOX ONLY. The undersigned certifies that within the past 10 years the Design Professional has NOT been the subject of a complaint or pending action in a legal administrative proceeding alleging that Design Professional discriminated against its employees, subcontractors, vendors or suppliers. The undersigned certifies that within the past 10 years the Design Professional has been the subject of a complaint or pending action in a legal administrative proceeding alleging that Design Professional discriminated against its employees, subcontractors, vendors or suppliers. A description of the status or resolution of that complaint, including any remedial action taken and the applicable dates is as follows: Date of Claim Location Description of Claim Litigation (Y/N) Status Resolution/Remedial Action Taken Design Professional Name Certified By Title The objective of the Equal Employment Opportunity Outreach Program, San Diego Municipal Code Sections 22.3501 through 22.3517, is to ensure that contractors doing business with the City, or receiving funds from the City, do not engage in unlawful discriminatory employment practices prohibited by State and Federal law. Such employment practices include, but are not limited to unlawful discrimination in the following: employment, promotion or upgrading, demotion or transfer, recruitment or recruitment advertising, layoff or termination, rate of pay or other forms of compensation, and selection for training, including apprenticeship. Contractors are required to provide a completed Work Force Report (WFR). Type of Contractor:  Construction  Vendor/Supplier  Financial Institution  Lessee/Lessor  Consultant  Grant Recipient  Insurance Company  Other Name of Company: ADA/DBA: Address (Corporate Headquarters, where applicable): City: County: State: Zip: Telephone Number: Fax Number: Name of Company CEO: Address(es), phone and fax number(s) of company facilities located in San Diego County (if different from above): Address: City: County: State: Zip: Telephone Number: Fax Number: Email: Type of Business: Type of License: The Company has appointed: As its Equal Employment Opportunity Officer (EEOO). The EEOO has been given authority to establish, disseminate and enforce equal employment and affirmative action policies of this company. The EEOO may be contacted at: Address:

BOX ONLY. The undersigned certifies that within the past 10 years the Contractor has NOT been the subject of a complaint or pending action in a legal administrative proceeding alleging that Contractor discriminated against its employees, subcontractors, vendors or suppliers. The undersigned certifies that within the past 10 years the Contractor has been the subject of a complaint or pending action in a legal administrative proceeding alleging that Contractor discriminated against its employees, subcontractors, vendors or suppliers. A description of the status or resolution of that complaint, including any remedial action taken and the applicable dates is as follows: Contractor Name: ▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇ & ▇▇▇▇▇▇▇ Certified By ▇▇▇▇▇ ▇. ▇▇▇▇▇▇ Name Title President Signature Equal Opportunity Contracting Sole Source Contracts, Cooperative Procurement Contracts Goods/Services Contracts Under $150,000 Revised 1/1/16 OCA Document No. 1208377 ▇▇▇▇▇ ▇. ▇▇▇▇▇▇ WORK FORCE REPORT – Pge 2 NAME OF FIRM: DATE: OFFICE(S) or BRANCH(ES): ▇▇▇ ▇. ▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇ ▇▇▇▇▇, ▇▇▇ ▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ COUNTY: INSTRUCTIONS: For e6ch occup6▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇▇e number of m61es 6nd fem61es in every e▇▇▇▇ ▇▇▇▇▇. ▇▇▇▇ co1umns in row provided. Sum of 611 ▇▇▇▇ ▇▇▇▇▇▇ be equ61 ▇ ▇▇▇▇ ▇▇▇ work force. Inc1ude 611 hose emp1oyed by your comp6ny on ei▇▇▇ ▇ ▇▇▇▇ ▇▇ ▇▇▇- ime b6sis. The fo11owing groups 6re o be inc1uded in e▇▇▇▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇ed in co1umns be1ow:

BOX ONLY. The undersigned certifies that within the past 10 years the Contractor has NOT been the subject of a complaint or pending action in a legal administrative proceeding alleging that Contractor discriminated against its employees, subcontractors, vendors or suppliers.