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<br />Form 275.021-04 <br />E u.r 0 rtunitv Office 312004 <br /> <br />~: Access www.mvflcndacom/ecuaIOODOrtunilV.lolflCe/lo reylew the policy and plan cited herein. Complete and submit the original of this loon 10: <br />FOOT Equal Opportunity OfIlce. 605 Suwannee St-Mail Station 65, Tallahassee. FI 3Zl!l~5lJ. . <br /> <br />CONTRACTOR CERTIFICATION OF07 0r:p '."'J <br />EEOJAA POLICY AND PLAN ADOPTION'" -;, 9: 2 <br /> <br />, U.I <br />Select one (:): This Certification of EEO Policy Zlnd Plan Is for ;;~; ii <br />)(Adoptlon 0 Update of Co. address, phone number, approving officer ~ 5 <br />~ ~;= <br /> <br />Contractor's Company Name: S ....,e~2-~.LOOz...f O-L\- d~N ~~ ~ <br />FEIN# or FDOTVendor#: ~~ - e S-3.~ l~0 '- Lg~ <br />~, <br />. 0:. ~ <br />Flonda Home Office Address: CE ;;! <br />Street address (required) .)-;)-ee> 2--\ W d-- s. 1\uL P.O. Box [If used) ~ ~ 9 0 <br />f ~w :> a: <br />City: l-tSL ~ t. . Florida 3. ~ (4<- ZIp Code: ~ I 4 L ~ 0 &: ~ <br /> <br />Phone' ~~. ~-=1-{.-<:::'7C. 7 FAX; ~~. ~~-.{..,-,c'Jl\.(~iJ <. <br />. ~Q~ <br />am code C'" /) .rna co. <br />Name (printed) of Company Official Signing below: ~A:-( ~s.<:; l (fulJlirst& I.1stname) <br /> <br />Official's Title rinted c.~ ~( (c....U~Exeeutlv.OtII...r,PfllSidcnt,orChail)le...onrnquired) <br /> <br />The signature of this Company's cial is notification to the U.S. Federal Highway AdminIstration <br />(FHWA), the Florida Department of Transportation (FOOT), our employees, applicants for employment, <br />contractors, other businesses, other Federal, State or Local government agencies, and any other <br />parties of interest, that this Company has wholly adopted the following model policy and plan <br />pertaining to employment, civil rights, and associated FOOT contractual obligations: <br />EQUAL EMPLOYMENT OPPORTUNITY/AFFIRMATIVE ACTION ('EEO/AA Policy & Plan') <br />This company acknowledges its responsibility for on-going communication and dissemination of the <br />policy and plan as outlined therein, both verbally and in writing, internally and externally, to the public, <br />contractors, employees and other interested parties. This Company will input the name and contact <br />infonnation of the EEO Officer to the FOOT Equal Opportunity Reporting System within 30 days of this <br />Initial Certification of Policy and Plan Adoption, and within 30 days of subsequent Officer Changes. <br />This Company is responsible for development and maintenance of an affirmative action program ,and <br />for exhibiting with good faith, specific and results-oriented actions to transfonn this policy and plan <br />from commitments on paper to actual equal employment practices and opportunities. Records will be <br />maintained and made available to FOOT recording our EEOJAA program and actions. <br /> <br /> <br /> <br />Date q (s-t~ ~daylyrl <br />- - - .., <br />"\..~~~I~Z~,,.. MARIA VALDES I <br />t>\N~!.\I~Atate or flo/l(fq --". <br />~ 17 l?-L-=- <br />g 1:!<l0et14.ZCl;l entification. <br /> <br />Bonded By Nallonal Norory Assn. <br /> <br />@ THIS SECTION <br />Registered by <br />UPDATE ACTION: <br />DISlRIBtJTICN: ORlGIlJAl.; <br />COPY; <br /> <br />(M'D/YR) <br /> <br />1 . d <br /> <br />16Sv-vBl.-lS5 <br /> <br />mO..lij u>:qo(:l <br /> <br />Bl.O:Ol l.D 50 daS <br /> <br />STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION <br />NOTIFICATION TO FOOT OF EEO OFFICER <br /> <br />275-021-13 <br />EQUAL OPPORTUNITY <br />01/07 <br /> <br />FDOT Equal 0 <br /> <br /> <br />Mail signed original to: <br />605 Suwannee Street-MS 65, <br /> <br />Tallahassee, FI 32399-0450 <br />