AG 06-117 - WSDOT
- ------------~ ------- -
DATE IN: DATE OUT:
MENT
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REQUEST FOR CONTRACT PREPARATIONIDOCUMENT REVIEW/SIGNATURE ROUTING SLIP
1. ORIGINATING DEPT.IDIY: tv\6
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2. ORIGINATING STAFF PERSON: \\NUl \^J~ EXT: d0LtL 3. DATE REQ. BY: ~~
4. TYPE OF DOCUMENT REQUESTED (CHECK ONE)
D PROFESSIONAL SERVICE AGREEMENT D SECURITY DOCUMENT (E.G. AGREEMENT &
D MAINTENANCE/LABOR AGREEMENT PERFIMAIN BOND; ASSIGNMENT OF FUNDS IN LIEU OF BOND)
D PUBLIC WORKS CONTRACT D CONTRACTOR SELECTION DOCUMENT
D SMALL PUBLIC WORKS CONTRACT (E.G., RFB, RFP, RFQ) AG#: 06 -117
(LESS THAN $200,000) D CONTRACT AMENDMENT
D PURCHASE AGREEMENT) D CDBG _ ~Y~1V1DXl+- Wsto\
(MATERIALS, SUPPLIES, EQUIPMENT) ~THER lAt\
D REAL ESTATE DOCUMENT
5. PROJECT NAME: Nm-- tiB"YlrY\\Y'lt11.OO :f\g refAY\eYtt-
6. NAME OF CONTRACTOR: \N~'
ADDRESS: . TELEPHONE
SIGNATURE NAME: TITLE
7. ATTACH ALL EXHIBITS AND CHECK BOXES D SCOPE OF SERVICES D ALL EXHIBITS REFERENCED IN DOCUMENT
D INSURANCE CERTIFICATE D DOCUMENT AUTHORIZING SIGNATURE
8. o PLETIONDATE'~ ~
9. TOTAL COMPENSATION $
(INCLUDE EXPENSES AND SALES TAX, IF ANY)
(IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES)
REIMBURSABLE EXPENSE: DYES D NO IF YES, MAXIMUM DOLLAR AMOUNT: $
IS SALES TAX OWED DYES D NO IF YES, $ PAID BY: D CONTRACTOR D CITY
10. CONTRACT REVIEW INITIALIDATE APPROVED INITIALIDATE APPROVED
D PROJECT MANAGER 7~olo
'~IRECTOR ~
D RI8K MAn\GIIMENT 2l \I? lAL-
~w2ltJiDb
11. CONTRACT SIGNATURE ROUTING INITIALIDATE APPROVED INITIAL/DATE APPROVED
D LXiv'DE.flAltTMENT @ ~
~ITY MANAGER ! ~ 2./llolo~
!:l CITY CLBRK >C.
~IGN COPY BACK TO ORGINATlNG DEPT. ~ 1i1/tIt
)lCASSIGNEDAG# Ob"'117
D PURCII}.~U>TG: PI P A C::P CJIARCr:: TO.
COMMENT~ ~ ~ ~1 lo b W .
~
07/05
L
------~. ---
~ '\ RECEiVED
JUL 3 1 lO06
~ &iHi~:V at FeUEf1AL 'WAY
ilj Washington State Transportation Buil . *' . IC~
~'I Department of Transportation 310 Maple Park Aven~~ Y4tMGEA'S OFF
Douglas B. MacDonald P.O. Box 47300
Secretary of Transportation Olympia, WA 98504-7300
360-705-7000
TTY: 1-800-833-6388
www.wsdot.wa.gov
July 17, 2006
CERTIFIED MAIL RECEIPT REQUESTED
Mr. Derek Matheson
Interim City Manager
33324 8th A venue South
Federal Way, WA 98063-9718
Re: Title VI Non-Discrimination Agreement Approval
Dear Mr. Matheson:
The Washington State Department of Transportation (WSDOT) Office of Equal
Opportunity received the City of Federal Way's Non-Discrimination Agreement on
April 5, 2006.
WSDOT has reviewed the Non-Discrimination Agreement to ensure adherence with
Title VI of the Civil Rights Act of 1964 and related federal regulations. The City of
Federal Way's Non-Discrimination Agreement is approved as it sufficiently addresses
the requirements under Title 23, Code of Federal Regulations (CFR), Part 200 and 49
CFR 21, as well as the provisions of Executive Order 12898 on Environmental Justice
and Executive Order 13166 on Limited English Proficiency. Enclosed you will find
the signed Non-Discrimination Agreement.
WSDOT appreciates your efforts in developing the required document for the
implementation of your Title VI Program. The City of Federal Way will be required
to submit an Annual Title VI Accomplishment and Update Report each year. The
report for Federal Fiscal Year 2006 is due July 31, 2007.
There are Title VI compliance areas that will require special attention as you
implement the provisions of Title VI. Executive Order 12898 on Environmental
Justice and Executive Order 13166 on Limited English Proficiency have identified
issues of discrimination on the basis of national origin, which require more specific
administrative measures to prevent such forms of discrimination from recipients and
sub-recipients of federal funds.
'-.
Mr. Derek Matheson
July 17,2006
Page 2
The implementation of Title VI requires you to incorporate the provisions of
Environmental Justice and Limited English Proficiency policies and practices into all
aspects of the transportation process. Your update will need to include the following
information:
. Gather and maintain the most current demographics data on minority, low
income and Limited English Proficiency populations in the City of Federal
Way's jurisdiction (using a variety of sources such as Office of Financial
Management, school districts, and the Washington State Department of Social
and Health Services). This information is to be analyzed to develop special
outreach for underserved populations impacted by the City of Federal Way's
federal-aid highway activities;
. How those demographics were obtained and analyzed;
. Outline in the Title VI Update and Accomplishment Report the process that
was developed for evaluating and documenting the effectiveness of
Environmental Justice and Limited English Proficiency public involvement
strategies. WSDOT will review the methodologies utilized to maximize
public involvement activities. Examples include but are not limited to:
1) Advertising in alternate languages in minority or other publications even
though there may not be a minority newspaper of record in the City of Federal
Way's jurisdiction, and 2) developing other methods to advise the public of
the activities such as notices in organizations and establishments that provide
services or assistance to persons that may be low-income or have Limited
English Proficiency.
On-line resources regarding Limited English Proficiency and public participation
requirements and regulations may be found at the following Internet addresses:
http://www.fhwa.dot. gov / civilrights/2004workshops/04Iepsandiego.htm and at
http://www.hhs. gov / ocr/lepfina1.htm.
The WSDOT Local Agency Guidelines Manual Chapter 28, Appendix 28.73 has a
template for the Title VI Annual Accomplishment and Update Report. There is also a
template on http://www.wsdot.wa.gov/TA/Operations/LAG/Lagchap.htm as well as
on our web site at http://www.wsdot.wa.gov/oeo. The report is available in Microsoft
Word@ and in Adobe PDF@ formats.
WSDOT is committed to providing any assistance you may need with your Title VI
Program implementation process.
------------
Mr. Derek Matheson
July 17, 2006
Page 3
If you have any questions concerning your Title VI Program, please contact Liane
Carlson, Title VI Coordinator, at (360) 705-7098 or email her at
carlsol@wsdot.wa. gov.
Sincerely,
q)~ 1<. NftMtW~
Brenda R. Nnambi
Director, Office of Equal Opportunity
Enclosure
cc: Dave Mounts, WSDOT Highways and Local Programs
File
- ----
. .
Appendix 28.72 Non-Discrimination Agreement
Population Under 100,000
Washington State Department of Transportation
and Name of Recipient Policy Statement
The City of Federal Way . hereinafter referred to as the "Recipient" assures that no person shall on the grounds of race, color,
national origin, or sex, as provided by Title VI of the Civil Rights Act of 1964, and the Civil Rights Restoration Act of 1987
(PL 100.259) be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any
program or activity. The Recipient further assures every effort will be made to ensure non-discrimination in all of its programs
and activities, whether those programs and activities are federally funded or not.
The Civil Rights Restoration Act of 1987, broadened the scope of Title VI coverage by expanding the definition of terms
"programs or activities" to include all programs or activities of Federal Aid recipients, sub-recipients, and contractors/consultants,
whether such programs and activities are federally assisted or not (Public Law 100259 (S.557] March 22, 1988.)
In the event the Recipient distributes federal aid funds to a sub-recipient, the Recipient will include Title VI language in all
written agreements and will monitor for compliance.
The Recipient's Human Res~urces Manager is responsible for initi~ng-and monitoring Iitle VI acti,vities, preparing reports
and other responsibilities as required by 23 Code of Federal Re~lation(CFR) 200 an f Federal Regulation 21.
Interim City Manager
<2-/lla IOf;
Date
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Local Agency Guidelines M 36-63 28-19
April 2005
General Project Development
Appendix 28.72 Non-Discrimination Agreement Population Under 100,000
Title VI Program
Organization and Staffing
Pursuant to 23 CFR 200, the City of Federal Way has appointed a Title VI Specialist who is responsible for Attachment I, which
describes the hierarchy for the City of Federal Way's Title VI Program, including an organization's chart illustrating the level and
placement of Title VI responsibilities.
Assurances
49 CFR Part 21.7
The City of Federal Way hereby gives assurances:
l. That no person shall on the grounds of race, color, national origin, and sex, be excluded from participation in, be denied the
benefits of, or be otherwise subjected to discrimination under any program or activity conducted by the recipient regardless of
whether those programs and activities are Federally funded or not. Activities and programs which the recipient hereby agrees
to carry out in compliance with Title VI and related statutes include but are not limited to:
. List all major programs and activities of the recipient and Title VI responsibilities for each one of them. Include
information as Attachment 2 to this Nondiscrimination Agreement.
2. That it will promptly take any measures necessary to effectuate this agreement.
3. That each program, activity, and facility as defined at 49 CFR 21.23(b) and (e), and the Civil Rights Restoration Act of 1987
will be (with regard to a program or activity) conducted, or will be (with regard to a facility) operated in compliance with the__
nondiscriminatory requirements imposed by, or pursuant to, this agreement.
4. That these assurances are given in consideration of and for the purpose of obtaining any and all Federal grants, loans,
contracts, property, discounts or other Federal financial assistance extended after the date hereof to the recipient by the
Washington State Department of Transportation (WSDOT) under the Federally-Funded Program and is binding on it, other
recipients, subgrantees, contractors, sub-contractors, transferees, successors in interest and other participants. The person
or persons whose signatures appear below are authorized to sign these assurances on behalf of the Recipient.
5_ That the Recipient shall insert the following notification in all solicitations for bids for work or material subject to the
Regulations and made in connection with all Federally-Funded programs and, in adapted form all proposals for negotiated
agreements.
The Recipient, in accordance with Title VI of the Civil Rights Act of 1964, 79 Stat. 252,42 U,S.C. 2000d to 2000d-4
and Title 49, Code ofFederaJ Regulations, Department of Transportation, Subtitle A, Office of the Secretary, Part 21,
Nondiscrimination in Federally-assisted programs of the Department of Transportation issued pursuant to such Act,
hereby notifies all bidders that it will affirmatively ensure that in any contract entered into pursuant to this advertisement.
disadvantaged business enterprises as defined at 49 CFR Part 23 will be afforded full opportunity to submit bids in response
to this invitation and will not be discriminated against on the grounds of race, color, national origin, or sex in consideration
for an award.
6. That the Recipient shall insert the clauses of Appendix I of this Agreement in every contract subject to the Act and
the Regulations.
7. That the Recipient shall insert the clauses of Appendix 2 of this Agreement, as a covenant running with the land, in any
deed from the United States effecting a transfer of real property, structures, or improvements thereon, or interest therein.
8, That the Recipient shall include the appropriate clauses set forth in Appendix 3 of this Agreement, as a covenant running
with the land, in any future deeds, leases, permits, licenses, and similar agreements entered into by the Recipient with other
parties: (a) for the subsequent transfer of real property acquired or improved under a Federal Aid Program; and (b) for the
construction or use of or access to space on, over or under real property acquired, or improved under a Federal Aid Program.
9. The Recipient agrees that the United States has a right to seek judicial enforcement with regard to any matter arising
under the Act, the Regulations, and this agreement.
--~---,~~-~-------- ____~_..___ _ .___m__.~__.,___.__.______ ~---- ------.
28-20 Local Agency Guidelines M 36-63
April 2005
____n_______
General Project Development
Appendix 28.72 Non-Discrimination Agreement Population Under 100,000
Implementation Procedures
This agreement shall serve as the recipient's Title VI plan pursuant to 23 CFR 200 and 49 CFR 21.
For the purpose of this agreement, "Federal Assistance" shall include:
I. grants and loans of Federal funds,
2, the grant or donation of Federal property and interest in property,
3. the detail of Federal personnel,
4. the sale and lease of, and the permission to use (on other than a casual or transient basis), Federal property or any interest
in such property without consideration or at a nominal consideration, or at a consideration which is reduced for the purpose of
assisting the recipient, or in recognition of the public interest to be served by such sale or lease to the recipient, and
5. any Federal agreement, arrangement, or other contract which has as one of its purposes, the provision of assistance.
The recipient shall:
I. Issue a policy statement, signed by the head of the recipient, which expresses it's commitment to the nondiscrimination
provisions of Title VI. The policy statement shall be circulated throughout the recipient's organization and to the general
public. Such information shall be published where appropriate in languages other than English.
2. Take affirmative action to correct any deficiencies found by WSDOT or the United States Department of Transportation
(US DOT) within a reasonable time period, not to exceed 90 days, in order to implement Title VI compliance in accordance
with this agreement. The head of the recipient shall be held responsible for implementing Title VI requirements.
3. Establish a civil rights unit and designate a coordinator who has a responsible position in the organization and easy access to
the head of the recipient. This unit shall contain a Title VI Specialist, who shall be responsible for initiating and monitoring
Title VI activities and preparing required reports.
4. Adequately staff the civil rights unit to effectively implement the civil rights requirements.
5. Process complaints of discrimination consistent with the provisions contained in this agreement. Investigations shall be
conducted by civil rights personnel trained in discrimination complaint investigation. Identify each complainant by race,
color, national origin or sex, the nature of the complaint, the date the complaint was filed, the date the investigation was
completed, the disposition, the date of the disposition, and other pertinent information. A copy of the complaint, together
with a copy of the recipient's report of investigation, will be forwarded to WSDOT's Office of Equal Opportunity (OEO)
within 10 days of the date the complaint was received by the recipient.
6. Collect statistical data (race, color, national origin, sex) of participants in, and beneficiaries of the programs and activities
conducted by the recipient.
7. Conduct Title VI reviews of the recipient and sub-recipient contractor/consultant program areas and activities. Revise
where applicable, policies, procedures and directives to include Title VI requirements.
8, Conduct training programs on Title VI and related statutes.
9. Prepare a yearly report of Title VI accomplishments for the last year and goals for the next year.
a) Annual Work Plan
Outline Title VI monitoring and review activities planned for the coming year; state by which each activity will be
accomplished and target date for completion.
b) Accomplishment Report
List major accomplishments made regarding Title VI activities. Include instances where Title VI issues were identified
and discrimination was prevented. Indicate activities and eff0l1s the Title VI Specialist and program area personnel have
undertaken in monitoring Title VI. Include a description of the scope and conclusions of any special reviews (internal
or external) conducted by the Title VI Specialist. List any major problem(s) identified and corrective action taken.
Include a summary and status report on any Title VI complaints filed with the recipient.
. ~------_._--------_._--------- --------_.~~,--._._-_._~---- .._--~-- --~------_._---- -- - .-.. -------~-._~--
Local Agency Guidelines M 36-63 28-21
April 2005
-
--- -----
General Project Development
Appendix 28.72 Non-Discrimination Agreement Population Under 100,000
Discrimination Complaint Procedure
l. Any person who believes that he or she, individually, as a member of any specific class, or in connection with any
disadvantaged business enterprise, has been subjected to discrimination prohibited by Title VI of the Civil Rights Act
of 1964, the American with Disabilities Act of 1990, Section 504 of the Vocational Rehabilitation Act of 1973 and the
Civil Rights Restoration Act of 1987, as amended, may file a complaint with the recipient. A complaint may also be
filed by a representative on behalf of such a person. All complaints will be referred to the recipient's Title VI
Specialist for review and action,
2. In order to have the complaint consideration under this procedure, the complainant must file the complaint no later
than 180 days after;
a) The date of alleged act of discrimination; or
b) Where there has been a continuing course of conduct, the date on which that conduct was discontinued.
In either case, the recipient or hislher designee may extend the time for filing or waive the time limit in the interest
of justice, specifying in writing the reason for so doing.
3. Complaints shall be in writing and shall be signed by the complainant and/or the complainant's representative. Complaints
shall set forth as fully as possible the facts and circumstances surrounding the claimed discrimination. In the event that a
person makes a verbal complaint of discrimination to an officer or employee of the recipient, the person shall be interviewed
by the Title VI Specialist. If necessary, the Title VI Specialist will assist the person in reducing the complaint to writing and
submit the written version of the complaint to the person for signature. The complaint shall then be handled according to
the recipient's investigative procedures.
4. Within 10 days, the Title VI Specialist will acknowledge receipt of the allegation, inform the complainant of action taken
or proposed action to process the allegation, and advise the complainant of other avenues of redress available, such as
WSDOT and USDOT.
5. The recipient will advise WSDOT within 10 days of receipt of the allegations. Generally, the following information
will be included in every notification to WSDOT;
a) Name, address, and phone number of the complainant.
b) Name(s) and address(es) of alleged discriminating official(s).
c) Basis of complaint (i.e.; race, color, national origin or sex)
d) Date of alleged discriminatory act(s).
e) Date of complaint received by the recipient.
f) A statement ofthe complaint.
g) Other agencies (state, local or Federal) where the complaint has been filed,
h) An explanation of the actions the recipient has taken or proposed to resolve the issue raised in the complaint.
6, Within 60 days, the Title VI Specialist will conduct an investigation of the allegation and based on the information obtained,
will render a recommendation for action in a report of findings to the head of the recipient. The complaint should be resolved
by informal means whenever possible. Such informal attempts and their results will be summarized in the report of findings.
7. Within 90 days of receipt of the complaint, the head of the recipient will notify the complainant in writing of the final
decision reached, including the proposed disposition of the matter. The notification will advise the complainant ofhis/her
appeal rights with WSDOT, or USDOT, if they are dissatisfied with the final decision rendered by the Recipient. The
Title VI Specialist will also provide WSDOT with a copy of this decision and summary offindings upon completion
of the investigation.
~--~---~-----------------_.-._. --.--- ---------_..---- - --- ----.------.----..-------.--.------
28-22 Local Agency Guidelines M 36-63
April 2005
General Project Development
Appendix 28.72 Non-Discrimination Agreement Population Under 100,000
8. Contacts for the different Title VI administrative jurisdictions are as follows:
Washington State Department of Transportation
Office of Equal Opportunity, Title VI Program
PO Box 47314
Olympia, WA 98466
(360) 705-7098
Federal Highway Administration
Washington Division Office
711 Capitol Way South, Suite 501
Olympia, WA 98501
(360) 534-9325
Sanctions
In the event the recipient fails or refuses to comply with the terms ofthis agreement, the WSDOT may take any or all of
the following actions:
1. Cancel, terminate, or suspend this agreement in whole or in part;
2. Refrain from extending any further assistance to the recipient under the program from which the failure or refusal occurred
until satisfactory assurance of future compliance has been received from the recipient.
3. Take such other action that may be deemed appropriate under the circumstances, until compliance or remedial action has
been accomplished by the recipient.
4. Refer the case to the Department of Justice for appropriate legal proceedings.
WASHINGTON STATE
DEPARTMENT OF TRANSPORTATION:
q3~ g. N~~
Signature
Director of the Office of Equal Opportunity
Title
Date 7/!7/DG
~:;:n~
Derek Matheson
Interim City Manager
2-/110 ( 010
Date. {
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Local Agency Guidelines M 36-63 28-23
April 2005
--,
General Project Development
Appendix 28.72 Non-Discrimination Agreement Population Under 100,000
Appendix 1
During the performance of this contract, the contractor/consultant, for itself, its assignees and successors in interest (hereinafter
referred to as the "contractorfl) agrees as follows:
1. Compliance with Regulations
The contractor shall comply with the Regulations relative to non-discrimination in federally assisted programs of United
States Department of Tmnsportation (USDOT), Title 49. Code of Federal Regulations, part 21, as they may be amended
from time to time, (hereinafter referred to as the Regulations), which are herein incorpomted by reference and made a
part of this contract,
2. Non-discrimination
The contractor, with regard to the work performed by it during the contract, shall not discriminate on the grounds of race,
color, sex, or national origin in the selection and retention of sub-contractors, including procurement of materials and
leases of equipment. The contmctor shall not participate either directly or indirectly in the discrimination prohibited
by Section 21.5 of the Regulations, including employment practices when the contract covers a program set forth in
Appendix B of the Regulations.
3. Solicitations for Sub-contracts, Including Procurement of Materials and Equipment
In all solicitations either by competitive bidding or negotiations made by the contractor fur work to be pertbimed under
a sulK:ontract, including procurement of materials or leases of equipment, each potential sub-contractor or supplier
shall be notified by the contractor of the contractor's obligations under this contract and the Regulations relative to
nolNfiscrimination on the grounds of race, color, sex, or naliona. origin.
4. Information and Reports
The contractor shall prQvide all information and reports required by the Regulations or directives issued pursuant thereto,
and shall permit access to its books, records, accounts, other sources of information, and its facilities as may be determined
by the contracting agency or the appropriate federal agency to be pertinent to ascertain compliance with such Regulations,
orders and instructions. Where any information required of a contractor is in the exclusive possession of another who fails
or refuses to fIlmisb this information, the contractor shall so certify to WSDOT or the USDOT as appropriate, and shall set
forth what efforts it has made to obtain the information.
5. Sanctions for Non-compliance
In the event of the contractor's non-compliance with the non-discrimination provisions of this contract, the contracting
agency shall impose such contract sanctions as it or the USOOT may determine to be appropriate, including, but not
limited to:
. Withholding of payments to the contractor under the contract until the contractor complies. and/or;
. Cancellation, termination, or suspension of the contract, in whole or in part
6. Incorporation of Provisions
The contractor shall include th.e provisions of paragraphs (I) through (5) in every sulK:ontract, including procurement of
materials and leases of equipment, unless exempt by the Regulations, or directives issued pursuant thereto. The contractor
shall take such action with respect to any sub-contractor or procurement as the Contracting agency or USDOT may direct
as a mean.s of enforcing such provisions including sanctions for non-compliance.
Provided, however, that in the event a contractor becomes involved in, or is threatened with. litigation with a sub-contractor
or supplier as a result of such direction, the contractor may request WSDOT cnt<< into such litigation to protect the interests
of the state and, in addition, the contractor may request the USOOT enter into such litigation to protect the interests of the
United States.
-_.~-
28-24 Locat Ag<imcy Guidelines M 36-63
Apnl 2005
-
General Proje<;t Development
Appendix 28.72 Non-Discrimination Agreement Population Under 100,000
Appendix 2
The following clauses shall be included in any and all deeds affecting or recording the transfer of real property, structures
or improvements thereon, or interest therein from the United States.
GRANTING CLAUSE
NOW TIiEREFORE, Department of Transportation, as authorized by law. and upon the condition that the state of
Washington will accept title to the lands and maintain the project constructed thereon, in accordance with Title 23, United
States Code, the Regulations for the Administration QfFederal Aid for Highways and the policies and procedures prescribed
by the United States Department of Transportation and, also in accordan.ce with and in compliance with all requirements
imposed by or pursuant to TItle 49, Code of Federal Regulations, Department of Transportation, Subtitle A, the Department
ofTransportation WSDOT (hereinafter referred to as the Regulations) pertaining to and effectuating the provisions of TItle VI
of the Civil Rights Act of 1964 (78 Stat. 252: 42 USC 2000d to 2000d - 4) does hereby remise, release, quitclaim, and coovey
unto the state of Washington all the righ.t, title, and interest of the Department of Transportation in and to said land described
in Exhibit A attached hereto and made a part thereof.
HABENDUM CLAUSE
TO HAVE AND TO HOLD said lands and interests therein unto the state of Washington, and its successors forever, subject,
however, to the covenants. conditiQns, restrictions and reservations herein contained as foHows, which will remain in effect
for the period during which the real property or structures are used for a purpose for which the federal financial assistance is
extended or for another purpose involving the provisiQIlS of similar services or benefits and shall be binding on the state of
Washington, its successors, and assigns.
The state of Washington. in consideration of the conveyance of said lands and interests in lands, does hereby covenant and
agree as a covenant running with the land for itself. its successors and assigns, that (I) no person shall on the grounds of
race, color, sex or nationaJ origin, be exciuded from participation in, be denied tbe benefits of. or be otherwise subject to
discrimination with regard to any facility located wholly or in part on, over, or under such lands hereby oonveyed (,)(and)*
(2) that the state of Washington. shall use the lands and interests in lands so conveyed, in compliance with all requirements
imposed by or pursuant to TItle 49, Code of Federal Regulations, Department of Transportation, Subtitle A, Office of the
Secretary, part 21, Non-discrimination of federally assisted programs of the Department of Transportation. Effectuation
of TItle VI of the Civil Rights Act of 1964, and as said Regulations may be amended (.) and (3) that in the event of breach
of any of the above mentioned non-discrimination conditions, the department shall have a right to reenter said lands and
facilities on said land, and the above described land and facilities shall thereon revert to and vest in and become the absolute
property of the Department of Transportation and its assigns as such interest existed. prior to this instruction.
Local Agency GuIdelines M 36-63 211-26
April 2005
~
.
General Project Development
Appendix 28.72 Non.Discrimlnatlon AglWmeot Population Under 100,000
Appendix 3
The following clauses shaU be included in all deeds, licenses, leases, penults, or similar instruments entered into by (Recipient)
pursuant to the provisions of Assurance 8,
The LESSEE, for himself or herself, his or hcr heirs, personal representatives, successors ill interest, and assigns, as a part of the
consideration hereof. does hereby covenant and agree as a covenant running with the land that in the event facilities are
constructed, maintained, or otherwise operated on the said property described in this lease, for a purpose of which a Department
of Transportation program or activity is extended or for another purpose involving the provision of similar services or bene1its,
the LESSEE shall maintain and opemle such fucilities and services in compliance with all other requirements imposed pursuant to
TItle 49, Code of Federal Regulations, Department of Transportation. Subtitle A, Office of the Secretary, part 21,
Non-discrimination in federally assisted programs of the Department ofTram;portation - Effectuation of Title VI of the Civil
Rights Act of 1964, as said Regulations may be amended.
That in the event of breach of any of the above non-discrimination covenants, the STATE shall have the right to terminate
the lease, and to reenter and repossess said land and the facilities thereon, and hold the same as if said lease has never
been made or issued.
The following shall be included in all deeds, licenses, leases, permits, orsirnilar agreements entered illto by the Washington State
Department ofTransportation pursuant to the provisions of Assurance 8.
The LESSEE, or himself or herself: his or her personal representatives, successors in interest, and assigns, as a part of the
consideration hereof, does hereby COvenant and agree as a covenant running with the land that (I) no person. on the grounds
of race, color, sex, or national origin, shall be excluded from participation in, be denied the benefits of, or be otherwise subjected
todiscrimination in the use of said facilities, (2) that in the construction of any improvements on, over or under such land and
furnishing of services thereon, no person on the grounds of race, color, sex, and national origin shall be excluded from
participation in, denied the benefits ot; or otherwise be subjected to discrimination, (3) that the LESSEE shall use the premises in
compliance with all requirements imposed by or pursuant to Title 49, Code ofFedera1 Regulations, Department of Transportation,
Subtitle A. Office of the Secretary, part 21, Non..discrimination in federally assisted programs of the Department of Transportation
- Effectuation of Title VI of the Civil Rights Act of 1964, and as said Regulations may be amended.
That in the event of breach of any of the above non..discrimination covenants, the STATE shall have the right to terminate
the lease, and to reenter and repossess said land and the facilities thereon, and hold the same as if said lease had never been
made or issued.
I Reverter Clause and related language to be used only when it is determined that such a clause is necessary in
order to effectuate the purpose of Title VI of the Civil Rights Act of 1964.
Z8-2G Local Agency GuidelInes M 36-63
April 2005
i
..
Appendix 28.73 Annual Title VI Update Questionnaire
ANNUAL TITLE VI UPDATE ACCOMPLISHMENT REPORT
In responding to this questionnaire, the agency is to only identify changes that
have occurred since they submitted their previous questionnaire or since their Title
VI Plan or Nondiscrimination Agreement was approved. The questionnaire is to be
submitted by the due date each year to the Region Local Programs Engineer for
transmittal to Highways and Local Programs (H&LP) for submittal to WSDOT's
Office of Equal Opportunity (OEO).
I. POLICY STATEMENT
Describe any changes to your approved policy statement that have resulted
from changes in legislation, local ordinances, etc., or a change in Chief
Executive Officer. Submit a copy of the policy statement with the new CEO's
signature.
II. ORGANIZATION, STAFFING, STRUCTURE
a. Organization: Describe any changes in the agency's organization
that modify the Title VI Program reporting relationship of the Title VI
Coordinator to the CEO.
b. Staffing: Provide all changes in descriptions of duties, names, race
and gender of the support staff responsible for Title VI compliance
monitoring.
c. Structure: Provide all changes in supervisory staff (their names, race
and gender) responsible for Title VI compliance for each of the
agency's program areas (e.g., Planning, Design, Construction,
Maintenance, etc.).
III. TITLE VI MONITORING AND REVIEW PROCESS
Describe actions that have been taken to promote internal (within the agency)
and external (sub recipient of the agency's federal funds) compliance with
Title VI. List any Title VI compliance reviews the agency has conducted and
the results and/or conclusion of each review.
IV. COMPLAINTS
Describe each Title VI complaint, if any, its basis (race, gender, etc.), and its
resolution. Provide a copy of the investigative report(s).
V. ACCOMPLISHMENT REPORT FOR EACH PROGRAM AREA
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Appendix 28.73 Annual Title VI Update Questionnaire
A. Planning
1) How many consultant projects for planning were awarded and
their dollar value?
2) Describe efforts made to utilize minority and female consultants
and subcontractors in federally funded contracts.
3) Describe any studies conducted to provide data relative to
minority persons, neighborhoods, income levels, physical
environments, and travel habits. What assistance did the Title
VI Coordinator provide to ensure that Title VI considerations
were included in the planning stage?
4) Identify the number of planning hearings held. Describe efforts
to ensure citizen participation in the hearings, particularly by
minorities and women. How many minorities and women both
individually and through their organizations were represented,
and their role(s) in the citizen participation effort?
B. Research (Generally not a local agency reporting area)
1) How many research projects are currently underway?
2) List of universities and/or consultants currently conducting
research projects.
a) Universities
b) Consultants
c) Federal
3) Provide a summary of actions taken to encourage universities to
utilize minority and women students to participate on highway
research projects.
4) Provide a summary of actions taken to increase minority and
women consultant firms in obtaining research projects.
5) List any significant actions to be taken during the ensuing year.
c. Location
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Appendix 28.73 Annual Title VI Update Questionnaire
1) Describe complaints filed, if any, resulting from the choice of
highway location decisions, or the procedure used for arriving at
the decisions.
2) Identify the titles, ethnicity and gender of employees, and any
vacancies, in the Location Program area. Describe efforts of
the Title VI Coordinator to increase the representation of
minorities and women if they are under-represented. Describe
efforts to encourage adequate representation of minorities and
women on boards and committees involved in the development
of transportation projects.
3) How many Environmental Impact Statements were reviewed?
Summarize comments provided on the EIS about adverse
impacts on minority, handicapped, elderly, etc., communities.
4) How many consultants currently have contracts involving project
development activities and their dollar value? How many are
minority consultants and their dollar value? Where minorities
and women participation is low, describe efforts to increase
their participation.
5) How many project location public hearings were held? Describe
how these hearings were advertised, including efforts to provide
notification to minorities.
6) Describe efforts to identify minority leaders and encourage them
to provide suggestions and ask questions about the location of
highways.
7) Was there a need to utilize bilingual advertisements,
announcements, notices, etc.?
D, Design
1) How many consultant firms currently have design contracts and
their dollar value? How many of these are held by minority and
women owned firms and their dollar value?
2) Describe efforts to increase minority and female participation in
consultant contracts. Does the agency maintain a list of
minority and woman consultants? If so, how many firms are on
the list? How many are receiving contracts?
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Appendix 28.73 Annual Title VI Update Questionnaire
3) How many highway design phase public hearings were held?
Describe minority individuals, groups and organizations that
participated in the hearings, including efforts to involve them.
Provide a summary of concerns and issues raised, if any,
related to minority communities. Describe actions taken by the
Title VI Coordinator to facilitate and/or address these concerns.
4) Identify the Design Program employees by title, ethnicity, and
gender, and identify any vacant positions. Describe efforts to
increase minority and female representation where it is low.
5) Identify Title VI complaints filed, if any, in the Design Program
area. Provide a summary of each with basis, status, actions
proposed and actions taken.
6) Identify any significant Title VI problem areas,
accomplishments, and actions to take during the ensuing year.
E. Right of Way
1) Identify the number of civil rights complaints filed, if any, in each
of the following Right-of-Way functional areas:
a) Appraisals
b) Negotiations
c) Relocation Assistance and Payments
d) Property Management
2) How many appraisers were utilized and how many were
minority and women? What efforts were made by the Title VI
Coordinator to increase minority and women representation if
they were low?
3) Identify the number of negotiations. Does the negotiator's log
reflect any disparity in negotiations with minorities as compared
to non-minorities?
4) Explain concerns, if any, raised by minorities or women about
their options in the negotiation phase.
5) Identify the number of relocations.
6) Describe concerns, if any, raised by minorities or women on
replacement housing, referral housing and advisory services.
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Appendix 28.73 Annual Title VI Update Questionnaire
7) Identify the number of contracts awarded for providing
relocation assistance, the opportunities given to minorities and
women to obtain these, and how many they received.
8) Describe special efforts made to comply with Title VI
regulations?
9) Identify Right-of-Way staff by name, job title, race and gender.
F. Construction and Maintenance
1) Describe civil right complaints, if any, the agency received on
their competitive bidding procedures, and the corrective action,
if any was needed, that the agency has taken. Provide a
summary of any concerns raised by MWBE about licensing,
pre-qualifications, lack of sub-contracting opportunities, etc.
2) Summarize the efforts of the Title VI Coordinator to encourage
the use of minority individuals, firms, or agencies for
maintenance agreements or construction contracts.
3) Describe any agency procedures that were reviewed to assure
Title VI compliance in subcontract agreements, first and second
tier, material supply and equipment lease agreements.
4) List any significant accomplishment goals and/or action items to
be taken during the ensuing year.
G. Education and Training
1) Describe efforts made to encourage participation by minorities
and women in National Highway Institute (NHI) educational and
training program(s).
2) Identify the types of NHI programs the agency staff attended,
whether the agency sponsored or co-sponsored the programs,
the number of agency staff that attended, and how many of
these were minorities and women.
3) Identify agency staff responsible for training by job title, ethnicity
and gender.
4) Describe civil rights complaints filed, if any, concerning training
and educational opportunities, and the corrective actions.
Provide a summary of concerns raised, complaints filed, status,
etc.
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Appendix 28.73 Annual Title VI Update Questionnaire
H. Administration
1) Provide a summary list of employees by ethnicity, gender and
title in each of the Title VI program areas.
2) Describe activities undertaken to assure Title VI compliance
with contractors and by contractors. (Title VI requirements are
to be included in all contracts, subcontracts, and consultant
agreements.) Describe reviews made to ensure contractors
and consultants are apprised of Title VI requirements and to
ensure that contractors and/or consultants are adhering to Title
VI requirements.
3) Describe Title VI training, if any, that was provided, and how
many participants attended, their titles, etc. Describe
participation in any other kind of civil rights training (e.g., title
and course content), and provide a list of participants by job title
(e.g. supervisor, manager, etc.)
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