# FTA C4702.1 Page 1

## APPENDIX A

**FEDERAL TRANSIT ADMINISTRATION CIVIL RIGHTS ASSURANCE**

The **[GRANTEE]{.underline}** HEREBY CERTIFIES THAT; as a condition of
receiving Federal financial assistance under the Federal Transit Act of
1964, as amended, it will ensure that:

1.  No person on the basis of race, color, or national origin will be
    subjected to discrimination in the level and quality of
    transportation services and transit-related benefits.

2.  The City of North Bend will compile, maintain, and submit in a
    timely manner Title VI information required by FTA Circular 4702.1
    and in compliance with the Department of Transportation's Title VI
    regulation, 49 CFR Part 21.9.

3.  The **[GRANTEE]{.underline}** will make it known to the public that
    those person or persons alleging discrimination on the basis of
    race, color, or national origin as it relates to the provision of
    transportation services and transit-related benefits may file a
    complaint with the Federal Transit Administration and/or the U.S.
    Department of Transportation.

The person or persons whose signature appears below are authorized to
sign this assurance on behalf of the grant applicant or recipient.

Date\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Kenneth G. Hearing, Mayor

> FTA C4702.1 Page 1

### APPENDIX B

> DEPARTMENT OF TRANSPORTATION TITLE VI ASSURANCE

The City of North Bend (hereinafter referred to as the "recipient")
HEREBY AGREES THAT as a condition to receiving any Federal financial
assistance from the Department of Transportation, it will comply with
Title VI of the Civil Rights Act of 1964, 78 Stat.252, 42 U.S.C.
2000d-42 U.S.C. 2000d-4 (hereinafter referred to as the Act), and all
requirements imposed by or pursuant to Title 49, Code of Federal
Regulations, Department of Transportation, Subtitle A, Office of the
Secretary , Part 21, Nondiscrimination in Federally-Assisted Programs of
the Department of Transportation-Effectuation of Title VI of the Civil
Rights Act of 1964 (hereinafter referred to as the Regulations) and
other pertinent directives, to the end that in accordance with the Act,
Regulations, and other pertinent directives, no person in the United
States shall, on the grounds of race, color, or national origin, be
excluded from participation in, be denied the benefits of, or be
otherwise subjected to discrimination under any program or activity for
which the Recipient receives Federal financial assistance from the
Department of Transportation, including the Federal Transit
Administration and HEREBY GIVES ASSURANCE THAT it will promptly take any
measures necessary to effectuate this agreement. This assurance is
required by subsection 21.7 (a) of the Regulations.

> More specifically and without limiting the above general assurance,
> the Recipient hereby gives the following specific assurances with
> respect to any FTA program:

1.  That the Recipient agrees that each "program" and each "facility" as
    defined in subsections 21.23(e) and 21.23(b) of the Regulations,
    will be (with regard to a "program") conducted, or will be (with
    regard to a "facility") operated in compliance with all requirements
    imposed by, or pursuant to, the Regulations.

2.  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 U.S. Department of
    Transportation Programs and, in adapted form in all proposals for
    negotiated agreements:

> The City of North Bend, in accordance with the Title VI of the Civil
> Rights Act of 1964, 78 Stat. 252, 42 U.S.C. 2000d to 2000d-4 and Title
> 49, Code of Federal 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 insure that in any contract entered into pursuant to
> this advertisement, minority business enterprises will afforded full
> opportunity to submit bids in response to this invitation and will not
> be discriminated against on the grounds of race, color, or national
> origin in consideration for an award.

#### FTA C 4702.1 Page 2

3.  That the Recipient shall insert the clauses of Appendix A of this
    assurance in every contract subject to this Act and the Regulations.

4.  That the Recipient shall insert the clauses of Appendix B of this
    assurance, 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.

5.  That where the Recipient receives Federal financial assistance to
    construct a facility, or part of a facility the assurance shall
    extend to the entire facility and facilities operated in connection
    therewith.

6.  That where the Recipient receives Federal financial assistance in
    the form, or for the acquisition of real property or an interest in
    real property, the assurance shall extend to rights to space on,
    over, or under such property.

7.  That the Recipient shall include the appropriate clauses set forth
    in Appendix C of this assurance, 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
    any FTA program: and (b) for the construction or use of or access to
    space on, over, or under real property acquired or improved under
    any FTA program.

8.  That this assurance obligates the Recipient for the period during
    which Federal financial assistance is extended to the program,
    except where the Federal financial assistance is to provide, or is
    in the form of, personal property, or real property or interest
    therein or structures or improvements thereon, in which case the
    assurance obligates the Recipient or any transferee for the longer
    of the following periods: (a) the period during which the property
    is used for a purpose for which the Federal financial assistance is
    extended, or for another purpose involving the provision of similar
    services or benefits; or (b) the period during which the Recipient
    retains ownership or possession of the property.

9.  The Recipient shall provide for such methods of administration for
    the program as are found by the Secretary of Transportation or the
    official to whom he/she delegates specific authority to give
    reasonable guarantee that it, other recipients, sub grantees,
    contractors, subcontractors, transferees, successors in interest,
    and other participants of Federal financial assistance under such
    program will comply with all the requirements imposed or pursuant to
    the Act, the Regulations and this assurance.

10. 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 assurance.

> FTA C4702.1 Page 3
>
> Appendix B
>
> THIS ASSURANCE is 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 Department of Transportation under
> any Federal Transit Administration program and is binding on it, other
> recipients, contractors, subcontractors, transferees, successors in
> interest and other participants in any FTA program. The person or
> persons whose signatures appear below are authorized to sign this
> assurance on behalf of the Recipient.
>
> Dated \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

by
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

> Kenneth G. Hearing, Mayor
>
> City of North Bend
>
> Attachments:
>
> Appendices A, B, C
>
> FTA C4702.1 Page 4
>
> (APPENDIX A TO TITLE VI ASSURANCE)

During the performance of this contract, the contractor, for itself, its
assignees and successors in interest (hereinafter referred to as the
"contractor") agrees as follows:

(1) [Compliance With Regulations:]{.underline} The contractor shall
    comply with the Regulations relative to nondiscrimination in
    federally assisted programs of the Department of Transportation
    (hereinafter, "DOT") 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 incorporated by reference and
    made a part of this contract.

(2) [Nondiscrimination]{.underline}: The contractor, with regard to the
    work performed by it during the contract, shall not discriminate on
    the grounds of race, color, or national origin in the selection and
    retention of subcontractors, including procurements of materials and
    leases of equipment. The contractor 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 Subcontracts, Including Procurement for Materials
    and]{.underline}

> [Equipment]{.underline}: In all solicitations either by competitive
> bidding or negotiation made by the contractor for work to be performed
> under a subcontract, including procurements of materials or leases of
> equipment, each potential subcontractor or supplier shall be notified
> by the contractor of the contractor's obligations under this contract
> and the Regulations relative to nondiscrimination on the grounds of
> race, color, or national origin.

(4) [Information and Reports]{.underline}: The contractor shall provide
    all information

> reports required by the Regulations or directives issued pursuant
> thereto, and shall permit access to its books, records, accounts, or
> other sources of information, and its facilities as may be determined
> by the City of North Bend or the Federal Transit Administration 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 furnish this
> information this contractor shall so certify to the City of North
> Bend, or the Federal Transit Administration as appropriate, and shall
> set forth what efforts it has made to obtain the information.

(5) [Sanctions for Noncompliance]{.underline}: In the event of the
    contractor's

> noncompliance with nondiscrimination provisions of this contract, the
>
> City of North Bend shall impose contract sanctions as it or the
> Federal Transit Administration may determine to be appropriate,
> including
>
> but not limited to:

FTA C4702.1 Page 5

Appendix B

(a) withholding of payments to the contractor under the contract

> until the contractor complies; and/or

(b) cancellation, termination, or suspension of the contract, in

> whole or in part

(6) [Incorporation of Provisions]{.underline}: The contractor shall
    include the provisions

> of paragraph (1) through (6) in every subcontract, including
> procurements 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 subcontract or procurement
> as the City of North Bend or the Federal Transit Administration may
> direct as a means of enforcing such provisions including sanctions for
> noncompliance. Provided, however, that in the event a contractor
> becomes involved in, or is threatened with, litigation with a
> subcontractor or supplier as a result of such direction, the
> contractor may request the City of North Bend to enter into such
> litigations to protect the interests of the City of North Bend, and in
> addition, the contractor may request the United States to enter into
> such litigation to protect the interests of the United States.

FTA C4702.1 Page 6

Appendix B

(APPENDIX B TO TITLE VI ASSURANCE)

The following clauses shall be included in any and all deeds effecting
or recording the transfer of real property, structures or improvements
thereon, or interest therein from the United States.

(GRANTING CLAUSE)

NOW THEREFORE, the Department of Transportation, as authorized by law,
and upon the condition that the City of North Bend will accept title to
the lands and maintain the project constructed thereon, in accordance
with Title VI of the 1964 Civil Rights Act, the Regulations for the
Administration of the Federal Transit Administration's programs and the
policies and procedures prescribed by the Federal Transit Administration
of the Department of Transportation and, also in accordance with and 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, Nondiscrimination in Federally
--Assisted Programs of the Department of Transportation (herein 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 U.S. C. 2000d
to 2000d-4), does hereby remise, release, quitclaim and convey unto the
City of North Bend all the right, title and interest of the Department
of Transportation in and to said lands described in Exhibit "A" attached
hereto and made a part hereof.

(HABENDUM CLAUSE)

> TO HAVE AND TO HOLD said lands and interests therein unto City of
> North Bend and its successors forever, subject, however, to the
> covenants, conditions, restrictions and reservations herein contained
> as follows, which will remain in effect for the period during which
> the real property or structures are used for a purpose for which
> Federal financial assistance as extended or for another purpose
> involving the provision of similar services or benefits and shall be
> binding on the City of North Bend, its successors and assigns.

The City of North Bend, 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 (1)
no person shall on the grounds of race, color, or national origin, be
excluded from participation in, be denied the benefits of, or be
otherwise subjected to discrimination with regard to any facility
located or wholly or in part on, over or under such lands hereby
conveyer \[,\] \[and\] \* (2) that the City of North Bend shall use the
lands and interest in 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 Secretary.

FTA C4702.1 Page 7

Appendix B

> Part 21, Nondiscrimination in Federally-Assisted Programs of the
> Department of Transportation Effectuation of Title VI o f 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
> nondiscrimination conditions, the Department shall have a right to
> re-enter 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 to this instruction.\*

\*Reverter clause and related language to be used only when it is
determined that such a clause is necessary in order to effectuate the
purposes of Title VI of the Civil Rights Act of 1964.

FTA C4702.1 Page 8

Appendix B

(APPENDIX C TO TITLE VI ASSURANCE)

The following clauses shall be included in all deeds, licenses, lease,
permits, or similar instruments entered into by the City of North Bend
pursuant to the provisions of Assurance 7(a).

The (grantee, licensee, lessee, permitee, etc., as appropriate) for
herself/himself, his/her heirs, personal representatives, successors in
interest, and assigns, as a part of the consideration hereof, does
hereby covenant, and agree \[in the case of deeds and leases add "as a
covenant running with the land\] that in event facilities are
constructed, maintained, or otherwise operated on the said property
described in this (deed, license, permit, etc.) for a purpose for which
a Department of Transportation program or activity is extended or for
another purpose for involving the provision of similar services or
benefits, the (grantee, licensee, lessee, permitee, etc.) shall maintain
and operate such facilities 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, Nondiscrimination 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.

\[Include in license, leases, permits, etc.\]\*

That in the event of breach of any of the above nondiscrimination
covenant, City of North Bend shall have the right to terminate the
\[license, lease, permit, etc.\] and to re-enter and reposes said land
and the facilities thereon, and hold the same as if said \[licenses,
lease, permit, etc.\] had never been made or issued.

\[Include in deeds\]\*

That in the event of breach of any of the above nondiscrimination
covenants, the City of North Bend shall have the right to re-enter said
lands and facilities thereon, and the above described lands and
facilities shall thereupon revert to and vest in and become the absolute
property of the City of North Bend and its assigns.

FTA C4702.1 Page 9

Appendix B

The following shall be included in all deeds, licenses, leases, permits,
or similar agreements entered into by the City of North Bend pursuant to
the provisions of Assurance 7(b).

The (grantee, licensee, permitee, etc., as appropriate) for
herself/himself, his/her personal representatives, successors in
interest, and assigns, as a part of the consideration hereof, does
hereby covenant and agree (in case of deeds and leases add "as a
covenant running with the land") that (1) no persons on the grounds of
race, color, or national origin shall be excluded from participation in,
be denied the benefits of, or be otherwise subjected to discrimination
in the use of said facilities, (2) that in the construction of any
improvements on, over or under such land and the furnishing services
thereon, no person on the grounds of race, color, or national origin
shall be excluded from the participation in, be denied the benefits of,
or be otherwise subjected to discrimination, and (3) that the (grantee,
licensee, lessee, permitee, etc.) shall use the premises in compliance
with all other requirements imposed by or pursuant to Title 49, Code of
Federal Regulations, Department of Transportation, Subtitle A, Office of
the Secretary, Part 21, Nondiscrimination 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.

\[Include in licenses, leases, permits, etc.\]\*

That in the event of breach of any of the above nondiscrimination
covenants, (Name of Recipient) shall have the right to terminate the
\[license, lease, permit, etc.\] and to re-enter and repossess said land
and the facilities thereon, and hold the same as if said \[license,
lease, permit, etc.\] had never been made or issued.

\[Include in deeds\]\*

That in the event of breach of any of the above nondiscrimination
covenants, (Name of Recipient) shall have the right to re-enter said
land and facilities thereon, and the above described lands and
facilities shall thereupon revert to and vest in and become the absolute
property of (Name of Recipient) and its assigns.

\*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.