EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION
The undersigned understands and agrees that it is the "applicant" within the meaning of 38 CFR 36.4391.
To induce the Department of Veterans Affairs (VA) to act on any request submitted by or on behalf of the
undersigned for establishment by VA of reasonable value(s) relating to proposed construction, the undersigned hereby
agrees that it will incorporate or cause to be incorporated into any contract for construction work or modification thereof,
as defined in the rules and regulations of the Secretary of Labor relating to the land or housing included in its request to
VA, the equal opportunity clause contained in 38 CFR 36. 4392 and printed on the reverse of this form.
The undersigned further agrees that it will be bound by the equal opportunity clause in any federally assisted
construction work which it performs itself other than through the permanent work force directly employed by an agency
The undersigned agrees that it will cooperate actively with the administering agency and the Secretary of Labor in
obtaining the compliance of contractors and subcontractors with the equal opportunity clause and the rules, regulations
and relevant orders of the Secretary, that it will furnish the administering agency and the Secretary of Labor such
information as they may require for the supervision of such compliance, and that it will otherwise assist the administering
agency in the discharge of the agency’s primary responsibility for securing compliance. The undersigned further agrees
that it will refrain from entering into any contract or contract modification subject to Executive Order 11246 with a
contractor debarred from, or who has not demonstrated eligibility for, Government contracts and federally assisted
construction contracts pursuant to Part II, subpart D of Executive Order 11246 and will carry out such sanctions and
penalties for violation of the equal opportunity clause as may be imposed upon the contractors and subcontractors by the
administering agency or the Secretary of Labor pursuant to Part II, subpart D of Executive Order 11246.
In addition, the undersigned agrees that if it fails or refuses to comply with these undertakings such failure or refusal
shall be a proper basis for cancellation by VA of any outstanding master certificates of reasonable value or individual
certificates of reasonable value relating to proposed construction, except in respect to cases in which an eligible veteran
has contracted to purchase a property included on such certificates, and for the rejection of future requests submitted by
the undersigned or on his or her behalf for appraisal services, until satisfactory assurance of future compliance has been
received from the undersigned, and for referral of the case to the Department of Justice for appropriate legal proceedings.
NAME OF FIRM
ADDRESS OF FIRM
EXISTING STOCKS OF VA FORM 26-421, SEP 1985,
WILL BE USED.