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U.S. OEPARl"MENT 0,. COMMERCE
ECONOMIC DEVELOPMENT ADMINISTRATION
o.u.n. No. 4J.H2lJuJ;
Appro,'" Elphu D.cemtler 31, 1979
. CERTIFICATION BY CONTRACTOR OR SUBCONTRACTOR REGARDING
EQUAL EMPLOYMENT OPPORTUNITY
'.
GARY CONTRACTING & TRUCKINC COMPANY
Nm..f Prim. Contr.c:tor or $ubc:ontr.c:tor
06-01-01629
ED^ ProJ.ct No.
606 4th Avenue North West, New Brighton; Minnesota 55112
Address
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Internal Rev..ue Service Employer Id..Ullc.Uon Number 41-0947757
GENERAL
In .ceordlltlce with Executive Order 11246 (30 F.R. 12319-25), the implemenUng rules and regulstions thereol, and orders of
the Secret.ry 01 L.bor, . Certilic.tion regarding Equal Opportunity i. required 01 bidder. or prospective eoDll.ctor. and their
proposed lube>>ntractoul prior to the award of contracts or subcontracts. '
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CONTRACTOR'S CERTIFICATION
1. Participation in . previous contract or lubcontrlillct.
I, Contr.ctor has p.rticip.ted in . previous coDtr.ct or subcontr.ct subject to the
Equal Opportunity d"yse ........................................... g Yes
ONo
b. Compli&llce rcporti were required to be med in connection with such contr.ct
or subcontract. . .... ....... . I ..... 1.1. .. . . . . .. . . .. . . . . . . .... . .... 0.,Yes
ONo
c, Contractor has filed all compliance reports required by Executive Order 11246 or
by regul.tions 01 the Olfic. or Federal Contr.ct Compll&llce Programs issued
pursu&llt to TiUe VII 01 the Civil Richls Act 01 1964. . . . . , , . . . . . . , , . . . . . . . . . ... [A, V..
ONo
d. If answer to ileEn C is HNo," pJeas!! explain in detail on reverse side of this certification.
2. Oollar amount of proposed contr.ct $
/=3 501.)
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3. Nonsegregated laciliU.s.
a. Notice to ProspecUv. Federolly-Assisted Construction Contractors
(1) A CertificaUon 01 Nonsegregated F.cilitles, as required by the May 9, 1967, order (32 F.R. 7439, May 19, 1967) on
Elimination 01 Segregated F.cilities, by the Secretary 01 L.bor, must be submitted to the recipient prior to the .ward
01 · federally-a.sisted construction contract exceeding $10,000 which is not exempt lrom the provisions 01 the Equal
Opportunity clause.
(2) Contr.ctors receiving lederally,.sslsted construction contract .words .xceeding $10,000 which .re not exempt Irom
the provisions 01 the Equ.1 Opportunity clouse will be required to provide lor the rorwordinc 01 the lollowing notice to
prospective subcontr.ctors lor supplle. &lid construction contr.ct. where the subcontr.cts .xceed $10,000 and .re not
.xempt lro.. the provisions 01 the Equ.1 Oprr"'onlty clause:
b. Notic. to Prospective Subcontractors 01 Requir.ment lor Certification or Nonsecrec.ted F.ci!ities
. . (1) A C.rtification or NODsecrecat.d F.ciliti.s, .s r.qulred by the M.y 9, 1967, order (32 F.R. 7439. May 19, 1967) on
Elimln.tion or S'Cr.c.ted Facilitl.s. by the Secretary 01 L.bor, Dlust b. submitt.d to the eontractor prior to the .w.rd
of a subconll.ct ..c..dl~C S10.OOO which is not .xempt rrom the provi.iona 01 tb. Equal Opportunity cl.....
No o..l..otlll.1I h .wlldld ..1... Ihl. "p.rt I. "c.lnd. 42 U.l.C. ZOoo..2OO00017:
E.O. IU~, he. 203(bl: 41 C.'.R. 'OoI.I(b'.
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Y.:'. OE.:P'ARTM!NT 0' COMMERCe:
IIlGONOt.4.IC: OEVEL.OPMENT ACMINIITA4TfON
CERTIFICATION OF COMPLIANCE WITH THE CLEAN AIR
ACT AND THE FEDERAL WATER POLLUTION CONTROL ACT
Name 01 Projecn
COLUMBIA HEIGHTS PARKING FACILITIES, PLAZA CONNECTION 06-01-01629
Project Number:
.Loc:ation:
COLUMBIA HEIGHTS, ANOKA, MINNESOTA
(a If,., . ."n/,., _,. ,.)
The UNDERSIGNED Certifies cr.u,
Ca) it is .ither (1) an applicant for financial assisranc. from th. Economic O....lopm.nt Administration,
(;1) a bidder fot a construction, s.rvic. or supply contraCt to be .ntered into ~y th. r.cipi.nt o( EDA
..sisranc. for th. purpose of accomplishins the project no,ed above, or (3) a bidder lor a subcontract
under the lauer cCMlcrac:t;
(b) 8S such, those laciHdes under its ownership. lease or supervision ..,hic:h will be utilized in the
accomplishment of the project noted above ace not listed on the Environmental Protecdon Agency',
(EPA) ,List 01 Violotins Faciliti.s, pursuant to Section 15.200140 CFR, Pa" 15: and
Cc) it will nodly the Economic D.vclopm.nt Administradon, if the UNnERSIGNED is on applicant, or
notify ,h. recipien, 01 the EDA linancial assistance, il ,he UNDERSIGNED is a bidder, o( the rec.ipt
of any communication (rom the Director of the EPA Q((iee o( Federal Actjvides indicating that a
lacility to b., utilized in ,he project is unde, consideracion lor listins on th. EPA Ust 01 Viola tins
FaciIicies. ~- L
(J '"
~'7/ c: ' _ OWNER November 4, 1982
MjN'~. .n" Tit .f ApplIC4Int' D.,.
Contr.c'fWl./lub ontt..,,,,l. Aut <<t..d R.pr..."'."".-
for
GARY CONTRACTING & TRUCKING COMPANY
A Pl'Ue.nt/ C _Ir.c tor/Subconl,. c Icw-
ACKNOWl.EDGEMENT
I,
GARY BORYCZKA
, as
OWNER
rUlo
of
GARY CONTRACTING & TRUCKING CO
. IC .. 1$ . N .' do hereby cettily that the lotesoing oflicer who ex.culed the
Appllc.nt 0 onl,..,. 0 U'COIIt,.C'_. .mo
cecrification haa lull aUlhorilY 10 bind thaI endty.In wilness whereof I .el my hand and aliillhe (corporate,
. . h' 4th ! November In 82
statc, county. Of mwuC:Jpal)' .ca! t 11 _day 0 . 7_.
.~
/
Owner
SEAL
NOTE. The above acknowledg.m.nt must be ex.cuced by a'differen' corporat. officer than che person who
si8n~d aboY~ lot th~ entity. HOWEVER. if such entity represents a single owner. or a proprietor-
ship, or B partnership, then the acknowled8cment need not be executed.
ql:!~':- nUT INAPPROPRIATE RF.FF.I1FtlrC(