Form 4a - Labor Standards Compliance
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1FORM 4A
LABOR STANDARDS COMPLIANCE
(Contracts over $2,000 and 8 or more units)
Subrecipient: __________________________________________________________________________________
Project Number: _______________________________
Project Title: __________________________________
Estimated Amount of Contract: $___________________
Project Award: _______________________________
Approximate Date Project will be advertised for bid: ____/____/20___
Authorization to Incur Grant Costs Date: ____/____/20___
INCORPORATED IN DOCUMENT SPECIFICATIONS
X
Davis-Bacon Wage Determination (To be requested from HUD 60 days in advance of award of
contract.
Date Wage Determination Received:
Labor Standards Provisions (covering Davis-Bacon Act and Copeland Anti-Kickback Act)
( )
Contract Work Hours and Safety Standards Act Provisions
( )
EQUAL EMPLOYMENT OPPORTUNITY - Contracts over $10,000
In Specifications
Certification of Bidder regarding Equal Employment Opportunity
Equal Employment Opportunity Notice, Clauses and Specification
SECTION 3
Section 3 Clause
OTHER PROVISIONS (If applicable)
Clean Air Act of 1970 and the Federal Water Pollution Control Act Provisions (if contract is
estimated to exceed $100,000)
Architectural Barriers Act of 1968 Provisions (if contract is for construction of a facility i.e.
recreation center)
NOTE: Cook County approval is based upon review of federally required documents. Because of
limitations in any plan review, errors and irregularities may nevertheless occur and not be
detected. Our plan review would not necessarily disclose design or technical omissions
which are the responsibility of the licensed architect or the licensed engineer for the project.
☐
Check here to indicate that a copy of the bid documents has been sent to:
Name: ________________________________________________________________________
Date:
____/____/20___
CITY/VILLAGE OF:
____________________________________________
Cook County, Illinois
Signed by: __________________________________________________________
Date: ____/_____/20____
Title: _______________________________________________________________
Approved by Cook County: ____________________________________________
Date: ____/_____/20____
Revised 03/13/2014
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Parent category: Business