Laserfiche WebLink
Rear Braise Overhaul (Both Sides) <br />Q Yes <br />❑ No <br />Minor EVAC and Recharge R134 AC System <br />[ Yes <br />❑ No <br />Alignment <br />2 Yes <br />❑ No <br />Battery Replacement <br />© Yes <br />[] No <br />Fuel Injection Flush <br />©' Yes <br />❑ No <br />Alternator <br />Fuel Pump Module <br />® Yes <br />❑ No <br />❑✓ Yes <br />❑ No <br />Window Motors <br />2 Yes <br />❑ No <br />Shock Absorbers <br />Z Yes <br />❑ No <br />Transmission 1 Engine Oil Cooler Lines <br />0 Yes <br />❑ No <br />Tires <br />Yes <br />[:1 No <br />Towing Services <br />❑ Yes <br />[Z No <br />Accident Repair 1 Body Work <br />❑Yes <br />©No <br />This information is true and accurate to the best of my knowledge and ability, <br />Typed Name of Person Completing this Form: <br />Title: \I _ -,a <br />Signature: �c C'�' k C-f Kw Date: r _� - f I <br />• Contractors and consultants will need to provide the required information for their own workforce <br />as well as the workforce of all subcontractors that were active on their ARRA funded project(s) for <br />the reporting month. These reports are required monthly until the contract is completed or <br />September 2012 whichever occurs first. <br />The Contractor hereby agrees to comply with the Contract Provisions and Reporting Requirements as <br />indicated in the American Recovery and Reinvestment Act of 2009 and any amendments thereto. The <br />Contractor also agrees to comply with any additional reporting requirements that may be requested by NC <br />Department of Transportation, FTA, U. S. Department of Transportation, the Inspector General (IG), the <br />Government Accountability Office (GAO), or other entities, for example Congressional committees or <br />individual members of Congress. The Contractor hereby agrees to inspections or audits that may occur at <br />any time from the any of the above referenced federal or state agencies. Contractors are requested to provide <br />a copy of any such reports to NC Department of Transportation on any responses to such requests for <br />information or as a result of an inspection or audit. <br />By the submission of this proposal or bid, the Contractor hereby certifies and affirms to the truthfulness and <br />accuracy of each of the above statements of this certification. <br />54 <br />Attachment number 1 <br />F -5 Page 204 <br />