Disadvantaged Bus Ent Cert ProMEMORANDUM
February 13, 2002
TO:
FROM:
SUBJECT:
The Honorable Mayor and City Council Members
Michael C. Van Milligen, City Manager
Adoption of a Statewide Disadvantaged Business Enterprise (DBE)
Certification Program
The Federal Register 49 CFR Part 26 included a requirement for a "one-stop"
certification process for approval of contractors and suppliers as Disadvantaged
Business Enterprises. This will be a comprehensive statewide listing of approved
DBE's instead of several agencies having their own approved lists of DBE's. Failure to
approve this agreement will result in the loss of US DOT funding.
Public Works Director Mike Koch is recommending approval of the statewide Unified
Certification Program for Disadvantaged Business Enterprises.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
MiChael C. Van Milligen
MCVM/jh
Attachment
cc: Barry Lindahl, Corporation Counsel
Cindy Steinhauser, Assistant City Manager
Michael A. Koch, Public Works Director
CITY OF DUBUQUE, IOWA
MEMORANDUM
February 12, 2002
TO:
FROM:
SUBJECT:
Michael C. Van Milligen, City Manager
Michael A. Koch, Public Works Director
Adoption of a Statewide Disadvantaged Business Enterprise (DBE)
Certification Program
INTRODUCTION
The Federal Register 49 CFR Part 26 included a requirement for a "one-stop"
certification process for approval of contractors and suppliers as Disadvantaged
Business Enterprises.
DISCUSSION
The federal regulation requires the development and approval of such a
certification process by the end of February, 2002. Enclosed is a Unified
Certification Program (UCP) which has been prepared and adopted by the Iowa
Department of Transportation for the entire State of Iowa.
This will be a comprehensive statewide listing of approved DBE's instead of
several agencies each having their own approved lists of DBE's. Failure of the
City to approve the attached UCP agreement will result in the loss of US DQT
funding.
RECOMMENDATION
I recommend City Council approval of the attached Unified Certification Program
agreement through adoption of the enclosed resolution.
ACTION TO BE TAKEN
The City Council is requested to adopt the enclosed resolution approving the
statewide Unified Certification Program for Disadvantaged Business Enterprises.
MAK/vjd
RESOLUTION NO.. 75-02
RESOLUTION APPROVING
TRANSPORTATION UNIFIED
AGREEMENT
IOWA DEPARTMENT OF
CERTIFICATION PROGRAM
Whereas, the Federal Register 49 CFR Part 26 requires the development
of a "one-stop" process for DBE certification, to be developed by the end of
February, 2002; and
Whereas, the Iowa Department of Transportation has developed a
statewide Disadvantaged Business Enterprise (DBE) directory; and
Whereas, all recipients of US DOT funding are required to ratify and
comply with the attached Unified Certification Program (UCP) Agreement as
developed by the Iowa Department of Transportation.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF
THE CITY OF DUBUQUE, IOWA:
Section 1. That the Iowa Department of Transportation's Unified
Certification Program (UCP) agreement is required to be ratified and executed by
any recipient of US DOT funding.
Section 2. That the City Council approves of the requirements as
outlined in the attached UCP.
Section 3. That the Mayor be authorized and directed to execute the
UCP on behalf of the City Council.
Passed, approved and adopted this 18th day of February, 2002.
Attest:
Ann E. Michalski, Mayor Pro-Tem
Jeanne F. Schneider, City Clerk
RESOLUTION NO. -02
RESOLUTION APPROVING
TRANSPORTATION UNIFIED
AGREEMENT
IOWA DEPARTMENT OF
CERTIFICATION PROGRAM
Whereas, the Federal Register 49 CFR Part 26 requires the development
of a "one-stop" process for DBE certification, to be developed by the end of
February, 2002; and
Whereas, the Iowa Department of Transportation has developed a
statewide Disadvantaged Business Enterprise (DBE) directory; and
Whereas, all recipients of US DOT funding are required to ratify and
comply with the attached Unified Certification Program (UCP) Agreement as
developed by the Iowa Department of Transportation.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF
THE CITY OF DUBUQUE, IOWA:
Section 1. That the Iowa Department of Transportation's Unified
Certification Program (UCP) agreement is required to be ratified and executed by
any recipient of US DOT funding.
Section 2. That the City Council approves of the requirements as
outlined in the attached UCP.
Section 3. That the Mayor be authorized and directed to execute the
UCP on behalf of the City Council.
Passed, approved and adopted this __ day of
,2002.
Attest:
Terrance M. Duggan, Mayor
Jeanne F. Schneider, City Clerk
IOWA DEPARTMENT OF TRANSPORTATION (Iowa DOT)
UNIFIED CERTIFICATION PROGRAM (UCP) AGREEMENT
Development & Proposal
The new Disadvantaged Business Enterprise (DBE) requirements contained in 49 CFR Part 26
included a provision for a "one-stop" certification process. The process must be defined and
submitted to the Secretary of Transportation for approval within 3 years of publication of the
regulations, February 2002. (Attachment A) Failure to develop and execute a UCP agreement
will result in a loss of USDOT funding.
Impact on Recipient Programs
Federal regulations, 49 CFR Part 26, require all USDOT fund recipients implement a UCP
within three years. The statewide UCP must establish a single uniform process or "one stop-
shopping" for DBE applications, certifications, and development of a single point DBE
Directory. All USDOT recipients will be required to ratify the UCP agreement and all DBE
certifications by the Iowa DOT will be binding.
The UCP will not establish, recommend or alter any agencies' overall DBE Program, other than
to supplement an approved program submittal, DBE goal, or goal methodology. DBE goal
development, administration, monitoring, and reporting remains the soul responsibility of the
agency with a USDOT approved DBE Program in accordance with 49 CFR Part 26, subject to
any oversight requirements of the lead agency. Any agency that elects not to establish a DBE
Program as set forth in 49 CFR Part 26 will be required to adopt and implement the lead
agency's program. The lead agency in Iowa is the Iowa DOT for the majority of the recipient's
USDOT federal funds.
Reciprocity
The Iowa DOT may elect to enter into a written reciprocity agreement; with UCPs in other states
or regions.
Process Review
The Iowa DOT has developed an application letter, approval letter, and certificate of approval.
(Attachments B, C, & D) The current DBE application will be used due to the impending
application under development by the USDOT.
Ratification Process
All recipients of federal funds administered b.y the USDOT, either directly or indirectly, must
ratify and comply with the UCP agreement. Failure to ratify the agreement may result in the loss
of federal funds from the Iowa DOT and/or the USDOT.
Pagel
Initial Consolidation
The Iowa DOT will review all firms that make a written request to determine eligibility under 49
CFR Part 26. The Iowa DOT will review any investigative information, the certification file, and
any other documentation provided. The Iowa DOT will then make a determ'mation as to whether
or not the firm meets the eligibility requirements. The fi:rm may appeal this decision to the
Appeals Committee.
After the effective date of this Agreement, only firms certified based on guidelines prescribed in
49 CFR Part 26 and provisions of this agreement, shall be recognized as certified by the Iowa
DOT.
Appeals Process
The Appeals Committee will consist of 5 members. The Appeals Committee will give the firm
the oppommity for administrative re-consideration of the eligibility determ'mation. As required
inthe DBE regulations, a fn'rn may appeal directly to the USDOT, however, if they choose to
appeal to the Iowa DOT Appeals Committee, they do not forfeit the fight to appeal to the
USDOT, within the time frame provided in 49 CFR Part 26.
Initial Certification Applicant Denials - When a frrrn is denied certification, a certified letter is
sent in which they are given the opportunity to appeal that decision, to an internal DBE Appeals
Committee. To do this, they must request an appeal, in writing, within 15 days of their receipt of
the letter. If an appeal is requested the firm is contacted within 3 days to schedule the appeal. If
the denial is upheld by the Committee, the DBEfirm has the right to appeal to the USDOT
within 180 days of the notice.
Denial of Re-Certification and De-Certifications - When a certified firm is decertified or
denied recertification, they are sent a certified letter in which they are given the opportunity to
appeal that decision, to an internal DBE Appeals Committee. To do this, they must request an
appeal, in writing, within 15 days of their receipt of the letter.
Administrative Removal~of Eligibility - In circumstances where a certified firm, or a new
applicant fern, has failed to submit required documentation or exceeded Personal Net Worth
thresholds, there will be no administrative re-consideration. Those circumstances include:
· Any certified firm that does not submit the annual update required in 49 CFR Part 26 will
have certification removed for failure to comply after 45 days fi:om the date the update
was due. The update is due March 1st of every year. Failure to submit the update is not
appealable.
· Any firm previously certified and denied certification due to exceeding the Personal Net
Worth cap by the disadvantaged owner is not appealable.
· If any certified firm's disadvantaged owner's Personal Net Worth exceeds the cap within
the 3 year period of certification, the eligibility of the firm will be removed. Removal of
certification for exceeding Personal Net Worth is not appealable.
Page 2
SIC/NAIC Codes
The Iowa DOT agrees to certify all firms in compliance with 49 CFR Part 26, including
designating specific work types. The Iowa DOT agrees to use the SIC/NAIC codes for those
designations.
Any firm may request modification and/or additions to their approved codes by making a written
request to the Iowa DOT. The request must include the equipment and experience indicating the
firm's ability to perform the particular work type. In addition, the firm must submit
documentation of past contracts on which the firm has performed the specific type of work. A
sample request application is set out in Attachment E.
3ra Party Challenges
The Iowa DOT shall accept written complaints from any person alleging that a certified finm is
ineligible. The complaint must state specific reasons for ineligibility and submit any
documentation in support of the complaint. The firm being challenged will be notified by the
Iowa DOT, in writing, of the challenge, the basic grounds, and relevant regulations. The Iowa
DOT shall thoroughly investigate the complaint, within a reasonable time, not to exceed 60 days.
The agency shall notify the DBE in writing, by certified mail, of the preliminary findings. If
reasonable cause to remove certification eligibility is found, the Iowa DOT will notify the
complainant of the specific grounds and inform the finn of the right to appeal the preliminary
finding to the Iowa DOT.
The Appeals Committee will be the hearing board for all challenges to currently certified frans.
This does not include denial of re-certifications or new certification requests.
The firm may request an appeal to the Iowa DOT, in writing, of the intent to remove certification
within 15 days of the date of the notice.
The USDOT may notify the Iowa DOT of reasonable cause to find a certified DBE fn-m to be
ineligible and the Iowa DOT shall immediately removed the certification eligibility of that firm.
Supportive Services
Assistance is provided to all DBE certified firms in the following areas.
· preparation of the certification application
· information about how to obtain bidding documents and plans
· plan reading
· dealing with contractors
· information about dealing with the Iowa DOT
· assistance in developing loan packages and fmancial statements
Page 3
ATTACHMENTS
Attachment A
49 CFR Part 26
§26.81 What are the requirements for Unified Certification Programs?
(a) You and all other DOT recipients in your state must participate in a Unified Certification
Program(UCP).
(1) Within three years of [insert date 30 days after date of publication in Federal Register],
you and the other recipients in your state must sign an agreement establishing the UCP
for that state and submit the agreement to the Secretary for approval. The Secretary may,
on the basis of extenuating circumstances shown by the recipients in the state, extend this
deadline for no more than one additional year.
(2) The agreement must provide for the establishment ofa UCP meeting all the requirements
of this section. The agreement must specify that the UCP will follow all certification
procedures and standards of this part, on the same basis as recipients; that the UCP shall
cooperate fully with oversight, review, and monitoring activities of DOT and its
operating administrations; and that the UCP shall implement DOT directives and
guidance concerning certification matters. The agreement shall also commit recipients to
ensuring that the UCP has sufficient resources and expertise to carry out the requirements
of this part. The agreement shall include an implementation schedule ensuring that the
UCP is fully operational no later than 18 months following the approval of the agreement
by the Secretary.
(3) Subject to approval by the Secretary, the UCP in each state may take any form acceptable
to the recipients in that state.
(4) The Secretary shall review the UCP and approve it, disapprove it, or remand it to the
recipients in the state for revisions. A complete agreement which is not disapproved'hr
remanded wittdn 180 days of its receipt is deemed to be accepted.
(5)
If you and the other recipients in your state fall to meet the deadlines set forth in this
paragraph (a), you shall have the opportunity to make an explanation to the Secretary
why a deadline could not be met and why meeting the deadline was beyond your control.
If you fall to make such an explanation, or the explanation does not justify the failure to
meet the deadline, the Secretary shall direct you to complete the required action by a date
certain. If you and the other recipients fttil to carry out this direction in a timely manner,
you are collectively in noncompliance with this part.
(b) The UCP shall make all certification decisions on behalf of all DOT recipients in the state
with respect to participation in the DOT DBE Program.
Page 4
(1) Certification decisions by the UCP shall be binding on all DOT recipients Mt[fin the
state.
(2) The UCP shall provide "one-stop shopping" to applicants for certification, such that an
applicant is required to apply only once for a DBE certification that will be honored by
all recipients in the state.
(c)
(3) All obligations of recipients with respect to certification and nondiscrimination must be
carried out by UCPs, and recipients may use only UCPs that comply with the certification
and nondiscrimination requirements of this part.
Ail certifications by UCPs shall be pre-certifications; i.e., certifications that have been made
final before the due date for bids or offers on a contract on which a fmu seeks to participate
as a DBE.
A UCP is not required to process an application for certification fi:om a firm having its
principal place of business outside the state if the firm is not certified by the UCP in the state
in which it maintains its principal place of business. The "home state" UCP shall share its
information and documents concerning the firm with other UCPs that are considering the
firm's application.
Subject to DOT approval as provided in this section, the recipients in two or more states may
form a regional UCP. UCPs may also enter into written reciprocity agreements with other
UCPs. Such an agreement shall outline the specific responsibilities of each participant. A
UCP may accept the certification of any other UCP or DOT recipient.
(f)
Pending the establishment of UCPs meeting the requirements of this section, you may enter
into agreements with other recipients, on a regional or inter-jurisdictional basis, to perform
certification functions required by this part. You may also grant reciprocity to other
recipient's certification decisions.
(g)
Each UCP shall maintain a unified DBE directory containing, for all firms certified by the
UCP (including those fi:om other states certified under the provisions of this section), the
informatiov~required by §26.31. The UCP shall make the directory avallabl..e to the public
electronically, on the interact, as well as in prim. The UCP shall update the electronic
version of the directory by including additions, deletions, and other changes as soon as they
are made.
(h) Except as otherwise specified in this section, all provisions of this subpart and subpart D of
this part pertaining to recipients also apply to UCPs.
Page 5
Attachment B
Thank you for your interest in the Iowa Department of Transportation's Disadvantaged Business
Enterprise Program.
The certification process is perhaps the most critical single element of DBE program
administration, since it is to determine eligibility for participation in the program. As such, it is a
state's first line of protection against program abuse.
In order to be certified, a fnma must be:
· A small business as defined by Section 8(d) of the Small Business Act and as amended by
TEA-21of 1998. (13 CFR, paragraph 121.3-8, lists definitions for small businesses by
industry type.). TEA-21 of 1998 restricts the size of small businesses to $17.42 million
three-year average gross income.
· Owned (at least 51 percent) by a socially and economically disadvantaged person or
persons; and
· Controlled by a socially and economically disadvantaged person or persons.
To qualify as a Disadvantaged Business Enterprise (DBE) your firm must meet the eligibility
standards established in Part 26, Title 49 of the Code of Federal Regulations, published February
2, 1999. Additional requirements were also passed in the Transportation Equity Act for the 21~t
Century (TEA-21).The Congress directed the U.S. Secretary of Transportation to establish
minimum uniform criteria for state governments to use in certifying that a firm qualifies for
participation in the DBE program. As a minimum, according to the Act, the criteria include on-
site visits, field interviews, licenses, analysis of stock ownership, listing of equipment, analysis
of bonding capacity, listing of work completed, resumes of principal owners, financial capacity,
type of work performed, and notarized statement of personal net worth and that each DBE owner
is, in fact, socially and economically disadvantaged. A copy of the rules are available upon
request fxom the Iowa Department of Transportation's Office of Contracts.
.~oOn receipt of the completed Certification Application, the Department will evaluate the
rmation submitted to determine compliance with the above criteria. It is, therefore,
imperative that your application and any attached documentation provide evidence of the
ownership and control of your firm. You shall also show that your firm has the resources
necessary to perform the work you indicated. Only those firms which have been certified under
this process can be considered for participation in the Department's DBE Program.
To ensure a timely review of your application, you must answer all questions and submit all
requested documentation. If yours is a recently established firm, and portions of the application
do not seem applicable, please place (NA) on the questions that do not apply. Failure to complete
portions of the application and to submit the requested documentation will delay the certification
process.
Sincerely,
EEO Administrator
Page 6
Certificate No.
Disadvantage Business Enterprise
Certification
This Certifies That
Has met the requirements under the rules promulgated by the U.S. Department of Transportation pursuant to 49
Code of Federal Regulations, Part 26, and is eligible to participate as a Disadvantaged Business Enterprise in the
Iowa Department of Transportation DBE Program
Issue Date:
Expiration Date:
Craig J. Russell, EEO Administrator Roger E. Bierbaum, P.E., Contracts Engineer
This certification may be revoked by the department upon finding of ineligibility and said company is subject to examination at any
time and maybe required to supply additi6nal information for review notwithstanding the issuance of this certificate.
Page 7
Attachment D
Date
Co. Name
Address
City, ST Zip
Dear:
The Iowa Department of Transportation (Iowa DOT) has approved the eligibility of COMPANY
NAME for credit on Iowa DOT contracts performing a commemially useful function in the
area(s) of: WORK TYPES CERTIFIED FOR. For record-keeping purposes Iowa DOT is
counting COMPANY NAME. as a Woman/Disadvantaged Business Enterprise (WfDBE). If
the firm should develop the resources, including equipment and personnel, to become involved
in other areas, you should notify our office before quoting contracts in those other areas.
The certification of eligibility is valid for three years from Month Day, 200? to March 1,200?.
Enclosed with this approval letter is your DBE Certification Certificate. Your tim's name will
be retained on our list of certified DBE's.
This determination is based on information provided to the Iowa DOT on the Schedule A Form
Application for Determining Disadvantaged Business Enterprise, and the Social and Economic
Disadvantaged Forms. Should this information change, you must complete a new application
within 10 days of the change. In addition, Iowa DOT reserves the fight to rescind this
certification, should the information upon which it is based is proven false, inaccurate, or
misleading.
You will be required to submit a Recertification Form to renew certification every three years,
with Personal Financial Statements each year. These forms will be supplied by the Office of
Contracts, EEO Section.
-Iowa DOT has the responsibility for providing technical assistance to DBE firms for our
highway projects. These services are currently being provided by the Office of Contracts at
515-239-1422. Certified firms are encouraged to utilize this office for assistance.
If you have any questions, please feel free to contact this office.
Sincerely,
Compliance Officer
Page 8
Attachment E
DISADVANTAGED BUSINESS ENTERPRISE
Request for Standard Industry Classification (SIC) Code Review
Name of Firm:
Street Address:
City: State: Zip:
Description of SIC Code
i Addition Requested
List and attach documentation of the 5 largest contracts or supply invoices completed for the SIC code
requested.
Owner/Contractor Phone Contract Project Name/Location Type of Work Perfomaed
Amount
List all equipment you own or lease used to perform the work for the SIC code requested. Copies of
current lease agreements or proof of payment must be attached.
Type of Equipment Make Model Year Date Acquired Present Value
Please attach any other documentation or information relevant to the review of the SIC code your firm
requested. This can include documentation of technical licenses, leases of property or facilities, training
or expertise.
Signature
Printed name
Title
Date
P~e9
State of Iowa Recipients
CITIES
Ackley
Albia
Algona
Allison
Altoona
Ames
Anamosa
Ankeny
Asbury
Atlantic
Bellevue
Bettendorf
Blakesburg
Bloomfield
Bonaparte
Boone
Burlington
Carroll
Casey
Cedar Falls
Cedar Rapids
Centerville
Charles City
Cherokee
Clear Lake
Clinton
Clive
Coin
Conrad
Coralville
Council Bluffs
Creston
Davenport
De Witt
Decorah
Delmar
Denison
Denver
Des Moines
Dubuque
Dyersville
Dysart
Eagle Grove
Eldon
Eldridge
Estherville
Waterloo
Fairfield
Forest City
Fort Dodge
Fort Madison
Fredericksburg
George
Greenfield
Grinnell
Grundy Center
Guthrie Center
Harlan
Hiawatha
Hinton
Hudson
Hull
Ida Grove
Independence
Indianola
Iowa City
Iowa Falls
Johnston
Keokuk
Kiron
Knoxville
La Porte City
Lansing
LeMars
Leon
Madrid
Manchester
Manning
Maquoketa
Marion
Marshalltown
Mason City
Maxwell
Milford
Monona
Mt. Pleasant
Mount Vernon
Muscatine
Nevada
New Hampton
Newton
North Liberty
0elwein
0nawa
Osage
Oskaloosa
Ottumwa
Pella
Peosta
Perry
Pleasant Hill
Red Oak
Redfield
Bettendorf
Rudd
Sergeant Bluff
Shelby
Sheldon
Shell Rock
Shenandoah
Sioux Center
Sioux City
Spencer
Storm Lake
Story City
Strawberry
Point
Tiffin
Iowa City
Urbandale
Van Home
Vinton
Wash'mgtun
Waterloo
Waverly
Webster City
West Liberty
Wheatland
Windsor Hgts
AIRPORT
Ames
Ankeny
Atlantic
Audubon
Belle Pla'me
Bloomfield
Boone
Burlington
Carroll
Cedar Rapids
Centerville
Chafiton
Charles City
Cherokee
Clarinda
Clarion
Clinton
Council Bluffs
Creston
Davenport
Connell Flying
Service
Deulson
Des Moines
Dubuque
Emmetsburg
Estherville
Fairfield
Forest City
Fort Dodge
Fort Madison
Greenfield
Grinnell
Guthfie County
Hampton
Harlan
Humboldt
Independence
Knoxville
Iowa City
Iowa Falls
Jefferson
Keokuk
Lamoni
LeMars
Mapletun
Maquoketa
Marshalltown
Mason City
Monticello . _
Mount Pleasant
Muscatine
Newton
0elwein
Orange City
0sceola
Oskaloosa
Ottumwa
Pella
Perry
Pocahontas
Red Oak
Rockwell City
Sac City
Sheldon
Shenandoah
Sioux City
Spencer
Spirit Lake
Storm Lake
Vinton
Washington
Waterloo
Waverly
Webster City
West Union
P~el0
TRANSITS
Ames Transit Agency
City of Bettendorf
Burlington Urban Service
Five Seasons Transportation
(Cedar Rapids)
Clinton Municipal Transit
City of Council Bluffs
Davenport CitiBus
Des Moines METRO
Keyline Transit
Iowa City Transit
U of I, Dept. of Parking &
Transportation
City of Mason City
Muscatine City Transit
Ottumwa Transit Authority
Northeast Iowa Community
Action Corp. (Decorah)
Spencer Regional Transit
Siouxland Regional Transit
(Sioux City)
MIDAS (Fort Dodge)
Region 6 Planning Comm.
(Marshalltown)
Iowa Northland Regional
Transit (Waterloo)
Dubuque Regional Transit
Great River Bend Service
(Davenport)
East Central Iowa Council
of Governments
(Cedar Rapids)
Region 12 Council of
Governments (Carroll)
SW Iowa Planning Council
(Atlantic)
Area XIV Agency on Aging
(Creston)
SE Iowa Community
Action Org. (Burlington)
Sioux City Transit
Heart of Iowa Regional
Transit (Des Moines)
Dart - City of Fort Dodge
Coralville Transit System
Marshalltown Municipal
Transit
Metropolitan Transit
(Waterloo)
U ofI - Transit Manager
City of Albia
City of Algona
COUNTIES Clay Hardin Marion Sioux
Adair Clayton Harrison Marshall Story
Adams Clinton Henry Mills Tama
Allamakee Crawford Howard Mitchell Taylor
Appanoose Dallas Humboldt Monona Union
Audubon Davis Ida Monroe Van Buren
Benton Decatur Iowa Montgomery Wapello
Black Hawk Delaware Jackson Muscatine Warren
Boone Des Moines Jasper O'Brien Washington
Bremer Dickinson Jefferson Osceola Wayne
Buchanan Dubuque Johnson Page Webster
Buena Vista Emmet Jones Palo Alto Winnebago
Butler Fayette Keokuk Plymouth Winneshiek
Calhoun Floyd Kossuth Pocahontas Woodbury
Carroll Franklin Lee Polk Worth
Cass Fremont Linn Pottawattamie Wright
Cedar Greene Louisa Poweshiek
Cerro Gordo Grundy Lucas Ringgold
Cherokee Guthrie Lyon Sac
Chickasaw Hamilton Madison Scott
Clarke Hancock Mahaska Shelby
Page 11
Recipient Signature(s)
Federal Regulations 49 CFR Part 26 requires o11 recipients in the state to sign this agreement
establishing this document as the UCP for the State of Iow~
By your signatures, you are completing that agreement. Please obtain all necessary signatures
and return this page only to the Iowa Department of Transportation, Office of Contracts, 800
Lincoln Way, Ames, Iowa 50010.
Recipient Name (i.e. City/County/Transit)
(Name & Title)
(Name & Title)
(Name & Title)
(Name & Title)
(Name & Title)
(Name & Title)
(Name & Title)
(Name & Title)
,~ame & Title)
Page 12