U.S. DEPARTMENT OF TRANSPORTATION

EXHIBITS TO FHWA GRANT AGREEMENTS UNDER THE

FISCAL YEARS 2022-2023 WILDLIFE CROSSINGS PILOT PROGRAM

January 5, 2024 
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EXHIBIT A 

APPLICABLE FEDERAL LAWS AND REGULATIONS

By entering into this agreement for a FY 2022-2023 Wildlife Crossings Pilot Program 

(WCPP) Grant, the Recipient assures and certifies, with respect to this Grant, that it will comply 

with all applicable Federal laws, regulations, executive orders, policies, guidelines, and 

requirements as they relate to the application, acceptance, and use of Federal funds for this 

Project. Performance under this agreement shall be governed by and in compliance with the 

following requirements, as applicable, to the type of organization of the Recipient and any 

applicable sub-recipients. The applicable provisions to this agreement may include, but are not 

limited to, the following: 

General Federal Legislation

a. Davis-Bacon Act – 40 U.S.C. 3242, et seq., as applicable under 23 U.S.C. 313 

b. Federal Fair Labor Standards Act – 29 U.S.C. 201, et seq. 

c. Hatch Act – 5 U.S.C. 1501, et seq. 

d. Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 – 42 

U.S.C. 4601, et seq. 

e. Section 106 of the National Historic Preservation Act of 1966 – 54 U.S.C. 306108 

f. Archeological and Historic Preservation Act of 1974 – 54 U.S.C. 312501, et seq.

g. Native American Graves Protection and Repatriation Act – 25 U.S.C. 3001, et seq. 

h. Clean Air Act, Pub. L. No. 90-148, as amended – 42 U.S.C. 7401, et seq. 

i. Section 404 of the Clean Water Act, as amended – 33 U.S.C. 1344 

j. Section 7 of the Endangered Species Act, Pub. L. No. 93-205, as amended – 16 U.S.C. 

1536 

k. Coastal Zone Management Act, Pub. L. No. 92-583, as amended – 16 U.S.C. 1451, et 

seq. 

l. Section 102 of the Flood Disaster Protection Act of 1973 – 42 U.S.C. 4012a 

m. Age Discrimination Act of 1975 – 42 U.S.C. 6101, et seq. 

n. American Indian Religious Freedom Act, Pub. L. No. 95-341, as amended.

o. Drug Abuse Office and Treatment Act of 1972, as amended – 21 U.S.C. 1101, et seq. 

p. The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and 

Rehabilitation Act of 1970, Pub. L. No. 91-616, as amended – 42 U.S.C. 4541, et seq. 

q. Sections 523 and 527 of the Public Health Service Act of 1912, as amended – 42 U.S.C. 

290dd through 290dd-2 

r. Architectural Barriers Act of 1968 – 42 U.S.C. 4151, et seq. 

s. Contract Work Hours and Safety Standards Act – 40 U.S.C. 3701, et seq. 

t. Copeland Anti-kickback Act, as amended – 18 U.S.C. 874 and 40 U.S.C. 3145 

u. National Environmental Policy Act of 1969 – 42 U.S.C. 4321, et seq. 

v. Wild and Scenic Rivers Act, Pub. L. No. 90-542, as amended – 16 U.S.C. 1271, et seq. 

w. Federal Water Pollution Control Act, as amended – 33 U.S.C. 1251-1376 

x. Single Audit Act of 1984 – 31 U.S.C. 7501, et seq. 

y. Americans with Disabilities Act of 1990 – 42 U.S.C. 12101, et seq. 

z. Title IX of the Education Amendments of 1972, as amended – 20 U.S.C. 1681 through 

1683 and 1685 through 1687 

aa. Section 504 of the Rehabilitation Act of 1973, as amended – 29 U.S.C. 794 
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bb. Title VI of the Civil Rights Act of 1964 – 42 U.S.C. 2000d, et seq.

cc. Title IX of the Federal Property and Administrative Services Act of 1949 – 40 U.S.C. 

1101-1104, 541 et seq. 

dd. Freedom of Information Act – 5 U.S.C. 552, as amended. 

ee. Magnuson-Stevens Fishery Conservation and Management Act – 16 U.S.C. 1855 

ff. Farmland Protection Policy Act of 1981 – 7 U.S.C. 4201, et seq.

gg. Fish and Wildlife Coordination Act of 1956 – 16 U.S.C. 661, et seq.

hh. Section 9 of the Rivers and Harbors Act and the General Bridge Act of 1946 – 33 U.S.C. 

401 and 525 

ii. Section 4(f) of the Department of Transportation Act of 1966 – 49 U.S.C. 303 and 23 

U.S.C. 138 

jj. Comprehensive Environmental Response, Compensation, and Liability Act of 1980 

(CERCLA), as amended – 42 U.S.C. 9601, et seq.

kk. Safe Drinking Water Act – 42 U.S.C. 300f to 300j-26 

ll. Wilderness Act – 16 U.S.C. 1131-1136 

mm.Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act 

of 1976 – 42 U.S.C. 6901, et seq. 

nn. Migratory Bird Treaty Act – 16 U.S.C. 703, et seq.

oo. The Federal Funding Accountability and Transparency Act of 2006, as amended (Pub. 

L. No. 109–282, as amended by section 6202 of Pub. L. No. 110–252) 

pp. Cargo Preference Act of 1954 – 46 U.S.C. 55305 

qq. Section 889 of the John D. McCain National Defense Authorization Act for Fiscal Year 

2019, Pub. L. No. 115-232 

rr. Build America, Buy America Act, Pub. L. No. 117-58, div. G §§ 70901–70927 

Executive Orders

a. Executive Order 11246 – Equal Employment Opportunity 

b. Executive Order 11990 – Protection of Wetlands

c. Executive Order 11988 – Floodplain Management

d. Executive Order 12372 – Intergovernmental Review of Federal Programs

e. Executive Order 12549 – Debarment and Suspension

f. Executive Order 12898 – Federal Actions to Address Environmental Justice in Minority 

Populations and Low-Income Populations 

g. Executive Order 13166 – Improving Access to Services for Persons With Limited 

English Proficiency

h. Executive Order 13985 – Advancing Racial Equity and Support for Underserved 

Communities Through the Federal Government 

i. Executive Order 14005 – Ensuring the Future is Made in All of America by All of 

America’s Workers

j. Executive Order 14008 – Tackling the Climate Crisis at Home and Abroad

k. Executive Order 14025 – Worker Organizing and Empowerment 

l. Executive Order 14052 – Implementation of the Infrastructure Investment and Jobs Act

Presidential Policy Directives and Memorandums

a. Presidential Policy Directive 21 – Critical Infrastructure Security and Resilience
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b. National Security Presidential Memorandum on Improving Cybersecurity for Critical 

Infrastructure Systems

General Federal Regulations

a. Uniform Administrative Requirements, Cost Principles, and Audit Requirements for 

Federal Awards – 2 C.F.R. Parts 200, 1201 

b. Non-procurement Suspension and Debarment – 2 C.F.R. Parts 180, 1200 

c. Procedures for predetermination of wage rates – 29 C.F.R. Part 1 

d. Contractors and subcontractors on public building or public work financed in whole or 

part by loans or grants from the United States – 29 C.F.R. Part 3 

e. Labor standards provisions applicable to contracts governing federally financed and 

assisted construction (also labor standards provisions applicable to non-construction 

contracts subject to the Contract Work Hours and Safety Standards Act) – 29 C.F.R. 

Part 5 

f. Office of Federal Contract Compliance Programs, Equal Employment Opportunity, 

Department of Labor (Federal and federally assisted contracting requirements) – 41 

C.F.R. Parts 60, et seq. 

g. New Restrictions on Lobbying – 49 C.F.R. Part 20

h. Nondiscrimination in Federally Assisted Programs of the Department of Transportation –

Effectuation of Title VI of the Civil Rights Act of 1964 – 49 C.F.R. Part 21 

i. Uniform relocation assistance and real property acquisition for Federal and Federally 

assisted programs – 49 C.F.R. Part 24 

j. Nondiscrimination on the Basis of Sex in Education Programs or Activities Receiving 

Federal Financial Assistance – 49 C.F.R. Part 25 

k. Nondiscrimination on the Basis of Handicap in Programs and Activities Receiving or 

Benefiting from Federal Financial Assistance – 49 C.F.R. Part 27 

l. DOT’s implementation of DOJ’s ADA Title II regulations compliance procedures for all 

programs, services, and regulatory activities relating to transportation under 28 C.F.R. 

Part 35 

m. Enforcement of Nondiscrimination on the Basis of Handicap in Programs or Activities 

Conducted by the Department of Transportation – 49 C.F.R. Part 28 

n. Denial of public works contracts to suppliers of goods and services of countries that deny 

procurement market access to U.S. contractors – 49 C.F.R. Part 30 

o. Governmentwide Requirements for Drug-Free Workplace (Financial Assistance) – 49 

C.F.R. Part 32

p. DOT’s implementing ADA regulations for transit services and transit vehicles, including 

the DOT’s standards for accessible transportation facilities in Part 37, Appendix A – 49 

C.F.R. Parts 37 and 38 

q. Participation by Disadvantaged Business Enterprises in Department of Transportation 

Financial Assistance Programs – 49 C.F.R. Part 26 (as applicable under section 18.2 of 

this agreement)

Highway Federal Legislation 

a. Highway – Title 23, U.S.C. 

b. Brooks At (this incorporates Title IX of the Federal Property and Administrative Services 

Act of 1949) – 40 U.S.C. 1101-1104; 23 U.S.C. 112(b)(2) 
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c. Letting of Contracts, 23 U.S.C. 112 

d. Highway Design and Construction Standards, 23 U.S.C. 109 

e. Prevailing Rate of Wage, 23 U.S.C. 313 

f. Planning, 23 U.S.C. 134 and 135 

g. Tolls, 23 U.S.C. 301 (to the extent the recipient wishes to toll an existing free facility that 

has received Title 23 funds in the past); except as authorized by 23 U.S.C. 129 and 166. 

h. Size, Weight, and Length Limitations – 23 U.S.C. 127, 49 U.S.C. 31101 et seq. 

i. Buy America – 23 U.S.C. 313 

j. Nondiscrimination – 23 U.S.C. 140

k. Efficient Environmental Reviews - 23 U.S.C. 139 

Federal Highway Regulations 

a. Highways – Title 23, C.F.R. 

b. Planning – 23 C.F.R. Part 450 

c. National Highway System Design Standards – 23 C.F.R. Part 625 

d. Preconstruction Procedures – 23 C.F.R. Part 630 Subparts A and B 

e. Construction and Maintenance – 23 C.F.R. Part 635 

f. Manual on Uniform Traffic Control Devices – 23 C.F.R. Part 655 

g. Environmental Impact and Related Procedures – 23 C.F.R. Part 771 

h. Procedures for Abatement of Highway Traffic and Construction Noise – 23 C.F.R. Part 

772 

i. Procedures Implementing Section 4(f) of the Department of Transportation Act – 23 

C.F.R. Part 774 

j. Permitting Requirements under the National Pollutant Discharge Elimination System – 

40 C.F.R. Part 122 

k. Required Contract Provisions – 23 C.F.R. Prat 633 (Form 1273) 

l. External Programs – 23 C.F.R. Part 230 

Specific assurances required to be included in the FY 2022-2023 WCPP Grant agreement by any 

of the above laws, regulations, or circulars are hereby incorporated by reference into this 

agreement. 
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EXHIBIT B 

ADDITIONAL STANDARD TERMS
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TERM B.1 

TITLE VI ASSURANCE

(Implementing Title VI of the Civil Rights Act of 1964, as amended)

ASSURANCE CONCERNING NONDISCRIMINATION IN FEDERALLY-ASSISTED 

PROGRAMS AND ACTIVITIES RECEIVING OR BENEFITING FROM FEDERAL 

FINANCIAL ASSISTANCE

(Implementing the Rehabilitation Act of 1973, as amended, and the Americans With Disabilities 

Act, as amended)

49 C.F.R. Parts 21, 25, 27, 37 and 38 

The United States Department of Transportation (USDOT)

Standard Title VI/Non-Discrimination Assurances

DOT Order No. 1050.2A 

By signing and submitting the Technical Application and by entering into this agreement under 

the FY 2022-2023 WCPP, the Recipient HEREBY AGREES THAT, as a condition to 

receiving any Federal financial assistance from the U.S. Department of Transportation (DOT), 

through the Federal Highway Administration (FHWA), it is subject to and will comply with the 

following:

Statutory/Regulatory Authorities

• Title VI of the Civil Rights Act of 1964 (42 U.S.C. § 2000d et seq., 78 stat. 252), 

(prohibits discrimination on the basis of race, color, national origin); 

• 49 C.F.R. Part 21 (entitled Non-discrimination In Federally-Assisted Programs Of The 

Department Of Transportation—Effectuation Of Title VI Of The Civil Rights Act Of

1964); 

• 28 C.F.R. section 50.3 (U.S. Department of Justice Guidelines for Enforcement of Title 

VI of the Civil Rights Act of 1964); 

The preceding statutory and regulatory cites hereinafter are referred to as the “Acts” and 

“Regulations,” respectively.

General Assurances

In accordance with the Acts, the Regulations, and other pertinent directives, circulars, policy, 

memoranda, and/or guidance, the Recipient hereby gives assurance that it will promptly take any 

measures necessary to ensure that: 
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“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 DOT, including the FHWA.

The Civil Rights Restoration Act of 1987 clarified the original intent of Congress, with respect to 

Title VI and other Non-discrimination requirements (The Age Discrimination Act of 1975, and 

Section 504 of the Rehabilitation Act of 1973), by restoring the broad, institutional-wide scope 

and coverage of these non-discrimination statutes and requirements to include all programs and 

activities of the Recipient, so long as any portion of the program is Federally assisted. 

Specific Assurances

More specifically, and without limiting the above general Assurance, the Recipient agrees with 

and gives the following Assurances with respect to its Federally assisted FY 2022-2023 WCPP: 

1. The Recipient agrees that each “activity,” “facility,” or “program,” as defined in §§ 21.23 

(b) and 21.23 (e) of 49 C.F.R. § 21 will be (with regard to an “activity”) facilitated, or 

will be (with regard to a “facility”) operated, or will be (with regard to a “program”) 

conducted in compliance with all requirements imposed by, or pursuant to the Acts and 

the Regulations. 

2. The Recipient will insert the following notification in all solicitations for bids, Requests 

For Proposals for work, or material subject to the Acts and the Regulations made in 

connection with the FY 2022-2023 WCPP Grant and, in adapted form, in all proposals 

for negotiated agreements regardless of funding source: 

“The Recipient, in accordance with the provisions of Title VI of the Civil Rights 

Act of 1964 (78 Stat. 252, 42 U.S.C. §§ 2000d to 2000d-4) and the Regulations, 

hereby notifies all bidders that it will affirmatively ensure that for any contract 

entered into pursuant to this advertisement, disadvantaged business enterprises 

will be afforded full and fair 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.” 

3. The Recipient will insert the clauses of Appendix A and E of this Assurance in every 

contract or agreement subject to the Acts and the Regulations. 

4. The Recipient will insert the clauses of Appendix B of this Assurance, as a covenant 

running with the land, in any deed from the United States effecting or recording a transfer 

of real property, structures, use, or improvements thereon or interest therein to a 

Recipient. 

5. That where the Recipient receives Federal financial assistance to construct a facility, or 

part of a facility, the Assurance will extend to the entire facility and facilities operated in 

connection therewith. 
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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 will extend to 

rights to space on, over, or under such property. 

7. That the Recipient will include the clauses set forth in Appendix C and Appendix D of 

this Assurance, as a covenant running with the land, in any future deeds, leases, licenses, 

permits, or similar instruments entered into by the Recipient with other parties:

a. for the subsequent transfer of real property acquired or improved under the 

applicable activity, project, or program; and 

b. for the construction or use of, or access to, space on, over, or under real property 

acquired or improved under the applicable activity, project, or 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 will 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-recipients, contractors, 

subcontractors, consultants, transferees, successors in interest, and other participants of 

Federal financial assistance under such program will comply with all requirements 

imposed or pursuant to the Acts, 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 Acts, the Regulations, and this Assurance.

By signing this ASSURANCE, the Recipient also agrees to comply (and require any subrecipients, contractors, successors, transferees, and/or assignees to comply) with all applicable 

provisions governing the FHWA’s access to records, accounts, documents, information, 

facilities, and staff. You also recognize that you must comply with any program or compliance 

reviews, and/or complaint investigations conducted by the FHWA. You must keep records, 

reports, and submit the material for review upon request to FHWA, or its designee in a timely, 

complete, and accurate way. Additionally, you must comply with all other reporting, data 

collection, and evaluation requirements, as prescribed by law or detailed in program guidance. 
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The Recipient gives this ASSURANCE in consideration of and for obtaining any Federal grants, 

loans, contracts, agreements, property, and/or discounts, or other Federal-aid and Federal 

financial assistance extended after the date hereof to the recipients by the U.S. Department of 

Transportation under the FY 2022-2023 WCPP. This ASSURANCE is binding on the Recipient, 

other recipients, sub-recipients, contractors, subcontractors and their subcontractors’, transferees, 

successors in interest, and any other participants in the FY 2022-2023 WCPP. 
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APPENDIX A

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: The contractor (hereinafter includes consultants) will 

comply with the Acts and the Regulations relative to Non-discrimination in Federallyassisted programs of the U.S. Department of Transportation, Federal Highway 

Administration (FHWA), as they may be amended from time to time, which are herein 

incorporated 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, will 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 will not participate directly or indirectly in the discrimination 

prohibited by the Acts and the Regulations, including employment practices when the 

contract covers any activity, project, or program set forth in Appendix B of 49 C.F.R. Part 

21. 

3. Solicitations for Subcontracts, Including Procurements of Materials and Equipment:

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 will be notified by the contractor of 

the contractor’s obligations under this contract and the Acts and the Regulations relative to 

Non-discrimination on the grounds of race, color, or national origin. 

4. Information and Reports: The contractor will provide all information and reports 

required by the Acts, the Regulations, and directives issued pursuant thereto and will 

permit access to its books, records, accounts, other sources of information, and its facilities 

as may be determined by the Recipient or the FHWA to be pertinent to ascertain 

compliance with such Acts, Regulations, and instructions. Where any information required 

of a contractor is in the exclusive possession of another who fails or refuses to furnish the 

information, the contractor will so certify to the Recipient or the FHWA, as appropriate, 

and will set forth what efforts it has made to obtain the information.

5. Sanctions for Noncompliance: In the event of a contractor’s noncompliance with the 

Non-discrimination provisions of this contract, the Recipient will impose such contract 

sanctions as it or the FHWA may determine to be appropriate, including, but not limited to: 

a. withholding payments to the contractor under the contract until the contractor 

complies; and/or

b. cancelling, terminating, or suspending a contract, in whole or in part. 

6. Incorporation of Provisions: The contractor will include the provisions of paragraphs one 

through six in every subcontract, including procurements of materials and leases of 

equipment, unless exempt by the Acts, the Regulations and directives issued pursuant 
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thereto. The contractor will take action with respect to any subcontract or procurement as 

the Recipient or the FHWA may direct as a means of enforcing such provisions including 

sanctions for noncompliance. Provided, that if the contractor becomes involved in, or is 

threatened with litigation by a subcontractor, or supplier because of such direction, the 

contractor may request the Recipient to enter into any litigation to protect the interests of 

the Recipient. In addition, the contractor may request the United States to enter into the 

litigation to protect the interests of the United States.
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APPENDIX B

CLAUSES FOR DEEDS TRANSFERRING UNITED STATES PROPERTY

The following clauses will be included in deeds effecting or recording the transfer of real property, 

structures, or improvements thereon, or granting interest therein from the United States pursuant to 

the provisions of Specific Assurance 4:

NOW, THEREFORE, the U.S. Department of Transportation as authorized by law and upon the 

condition that the Recipient will accept title to the lands and maintain the project constructed 

thereon in accordance with the Infrastructure Investment and Jobs Act, Pub. L. No. 117-58 (Nov. 

15, 2021), 49 U.S.C. § 6702, the Regulations for the Administration of the FY 2022-2023 WCPP,

and the policies and procedures prescribed by the Federal Highway Administration (FHWA) of 

the U.S. Department of Transportation in accordance and in compliance with all requirements 

imposed by Title 49, Code of Federal Regulations, U.S. Department of Transportation, Subtitle A, 

Office of the Secretary, Part 21, Non-discrimination in Federally-assisted programs of the U.S. 

Department of Transportation 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 Recipient all the right, title and interest of the U.S. 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 Recipient 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 is extended or for another 

purpose involving the provision of similar services or benefits and will be binding on the 

Recipient, its successors and assigns.

The Recipient, 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 will 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 wholly or in part on, over, or under such lands hereby conveyed [,] [and]* (2) that the 

Recipient will use the lands and interests in lands and interests in lands so conveyed, in 

compliance with all requirements imposed by or pursuant to Title 49, Code of Federal 

Regulations, U.S. Department of Transportation, Subtitle A, Office of the Secretary, Part 21, Nondiscrimination in Federally-assisted programs of the U.S. Department of Transportation, 

Effectuation of Title VI of the Civil Rights Act of 1964, and as said Regulations and Acts may be 

amended[, and (3) that in the event of breach of any of the above-mentioned non-discrimination 

conditions, the Department will have a right to enter or re-enter said lands and facilities on said 

land, and that above described land and facilities will thereon revert to and vest in and become the 

absolute property of the U.S. Department of Transportation and its assigns as such interest existed 

prior to this instruction].*
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(*Reverter clause and related language to be used only when it is determined that such a clause is 

necessary in order to make clear the purpose of Title VI.) 
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APPENDIX C

CLAUSES FOR TRANSFER OF REAL PROPERTY ACQUIRED OR IMPROVED 

UNDER THE ACTIVITY, FACILITY, OR PROGRAM

The following clauses will be included in deeds, licenses, leases, permits, or similar instruments 

entered into by the Recipient pursuant to the provisions of Specific Assurance 7(a):

A. The (Recipient, lessee, permittee, etc. as appropriate) for himself/herself, 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:

1. In the event facilities are constructed, maintained, or otherwise operated on the 

property described in this (deed, license, lease, permit, etc.) for a purpose for which a 

U.S. Department of Transportation activity, facility, or program is extended or for 

another purpose involving the provision of similar services or benefits, the (Recipient, 

licensee, lessee, permittee, etc.) will maintain and operate such facilities and services 

in compliance with all requirements imposed by the Acts and Regulations (as may be 

amended) such that no person on the grounds of race, color, or national origin, will be 

excluded from participation in, denied the benefits of, or be otherwise subjected to 

discrimination in the use of said facilities. 

B. With respect to licenses, leases, permits, etc., in the event of breach of any of the above Nondiscrimination covenants, Recipient will have the right to terminate the (lease, license, 

permit, etc.) and to enter, re-enter, and repossess said lands and facilities thereon, and hold 

the same as if the (lease, license, permit, etc.) had never been made or issued.*

C. With respect to a deed, in the event of breach of any of the above Non-discrimination 

covenants, the Recipient will have the right to enter or re-enter the lands and facilities 

thereon, and the above described lands and facilities will there upon revert to and vest in and 

become the absolute property of the Recipient and its assigns.*

(*Reverter clause and related language to be used only when it is determined that such a clause is 

necessary to make clear the purpose of Title VI.) 
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APPENDIX D

CLAUSES FOR CONSTRUCTION/USE/ACCESS TO REAL PROPERTY ACQUIRED 

UNDER THE ACTIVITY, FACILITY OR PROGRAM

The following clauses will be included in deeds, licenses, permits, or similar 

instruments/agreements entered into by Recipient pursuant to the provisions of Specific 

Assurance 7(b):

A. The (Recipient, licensee, permittee, etc., as appropriate) for himself/herself, 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 (1) no person on the ground of race, color, or national origin, 

will be excluded from participation in, 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 of services thereon, no person on the ground 

of race, color, or national origin, will be excluded from participation in, denied the benefits 

of, or otherwise be subjected to discrimination, (3) that the (Recipient, licensee, lessee, 

permittee, etc.) will use the premises in compliance with all other requirements imposed by 

or pursuant to the Acts and Regulations, as amended, set forth in this Assurance. 

B. With respect to (licenses, leases, permits, etc.), in the event of breach of any of the above 

Non-discrimination covenants, Recipient will have the right to terminate the (license, permit, 

etc., as appropriate) and to enter or re-enter and repossess said land and the facilities thereon, 

and hold the same as if said (license, permit, etc., as appropriate) had never been made or 

issued.* 

C. With respect to deeds, in the event of breach of any of the above Non-discrimination 

covenants, Recipient will there upon revert to and vest in and become the absolute property 

of Recipient and its assigns.*

(*Reverter clause and related language to be used only when it is determined that such a clause is 

necessary to make clear the purpose of Title VI.) 
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APPENDIX E

During the performance of this contract, the contractor, for itself, its assignees, and successors in 

interest (hereinafter referred to as the “contractor”) agrees to comply with the following nondiscrimination statutes and authorities; including but not limited to: 

Pertinent Non-Discrimination Authorities:

• Title VI of the Civil Rights Act of 1964 (42 U.S.C. § 2000d et seq., 78 stat. 252), 

(prohibits discrimination on the basis of race, color, national origin); and 49 C.F.R. Part 

21. 

• The Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, 

(42 U.S.C. § 4601), (prohibits unfair treatment of persons displaced or whose property 

has been acquired because of Federal or Federal-aid programs and projects); 

• Federal-Aid Highway Act of 1973, (23 U.S.C. § 324 et seq.) (prohibits discrimination on 

the basis of sex);

• Section 504 of the Rehabilitation Act of 1973, (29 U.S.C. § 794 et seq.), as amended, 

(prohibits discrimination on the basis of disability); and 49 C.F.R. Part 27; 

• The Age Discrimination Act of 1975, as amended, (42 U.S.C. § 6101 et seq.), (prohibits 

discrimination on the basis of age); 

• The Civil Rights Restoration Act of 1987, (PL 100-209), (Broadened the scope, coverage 

and applicability of Title VI of the Civil Rights Act of 1964, The Age Discrimination Act 

of 1975 and Section 504 of the Rehabilitation Act of 1973, by expanding the definition of 

the terms “programs or activities” to include all of the programs or activities of the 

Federal-aid recipients, sub-recipients and contractors, whether such programs or activities 

are Federally funded or not); 

• Titles II and III of the Americans with Disabilities Act, which prohibit discrimination on 

the basis of disability in the operation of public entities, public and private transportation 

systems, places of public accommodation, and certain testing entities (42 U.S.C. §§ 

12131 – 12189) as implemented by Department of Transportation regulations at 49 

C.F.R. Parts 37 and 38; 

• Executive Order 12898, Federal Actions to Address Environmental Justice in Minority 

Populations and Low-Income Populations, which ensures nondiscrimination against 

minority populations by discouraging programs, policies, and activities with 

disproportionately high and adverse human health or environmental effects on minority 

and low-income populations; 

• Executive Order 13166, Improving Access to Services for Persons with Limited English 

Proficiency, and resulting agency guidance, national origin discrimination includes 

discrimination because of limited English proficiency (LEP). To ensure compliance with 

Title VI, you must take reasonable steps to ensure that LEP persons have meaningful 

access to your programs (70 Fed. Reg. at 74087 to 74100); 

• Title IX of the Education Amendments of 1972, as amended, which prohibits you from 

discriminating because of sex in education programs or activities (20 U.S.C. § 1681 et 

seq).
B-13 

TERM B.2 

CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER 

RESPONSIBILITY MATTERS -- PRIMARY COVERED TRANSACTIONS

2 C.F.R. Parts 180 and 1200 

These assurances and certifications are applicable to all Federal-aid construction contracts, 

design-build contracts, subcontracts, lower-tier subcontracts, purchase orders, lease agreements, 

consultant contracts or any other covered transaction requiring FHWA approval or that is 

estimated to cost $25,000 or more – as defined in 2 C.F.R. Parts 180 and 1200. 

By signing and submitting the Technical Application and by entering into this agreement under 

the FY 2022-2023 WCPP, the Recipient is providing the assurances and certifications for First 

Tier Participants and Lower Tier Participants in the FY 2022-2023 WCPP Grant, as set out 

below. 

1. Instructions for Certification – First Tier Participants: 

a. The prospective first tier participant is providing the certification set out below.

b. The inability of a person to provide the certification set out below will not necessarily 

result in denial of participation in this covered transaction. The prospective first tier participant 

shall submit an explanation of why it cannot provide the certification set out below. The 

certification or explanation will be considered in connection with the department or agency’s 

determination whether to enter into this transaction. However, failure of the prospective first tier 

participant to furnish a certification or an explanation shall disqualify such a person from 

participation in this transaction.

c. The certification in this clause is a material representation of fact upon which reliance was 

placed when the contracting agency determined to enter into this transaction. If it is later 

determined that the prospective participant knowingly rendered an erroneous certification, in 

addition to other remedies available to the Federal Government, the contracting agency may 

terminate this transaction for cause of default.

d. The prospective first tier participant shall provide immediate written notice to the

contracting agency to whom this proposal is submitted if any time the prospective first tier 

participant learns that its certification was erroneous when submitted or has become erroneous 

by reason of changed circumstances.

e. The terms “covered transaction,” “civil judgment,” “debarred,” “suspended,” “ineligible,” 

“participant,” “person,” “principal,” and “voluntarily excluded,” as used in this clause, are 

defined in 2 C.F.R. Parts 180 and 1200. “First Tier Covered Transactions” refers to any covered 

transaction between a Recipient or subrecipient of Federal funds and a participant (such as the 

prime or general contract). “Lower Tier Covered Transactions” refers to any covered transaction 

under a First Tier Covered Transaction (such as subcontracts). “First Tier Participant” refers to 
B-14 

the participant who has entered into a covered transaction with a Recipient or subrecipient of 

Federal funds (such as the prime or general contractor). “Lower Tier Participant” refers to any 

participant who has entered into a covered transaction with a First Tier Participant or other 

Lower Tier Participants (such as subcontractors and suppliers). 

f. The prospective first tier participant agrees by submitting this proposal that, should the 

proposed covered transaction be entered into, it shall not knowingly enter into any lower tier 

covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily 

excluded from participation in this covered transaction, unless authorized by the department or 

agency entering into this transaction.

g. The prospective first tier participant further agrees by submitting this proposal that it will 

include the clause titled “Certification Regarding Debarment, Suspension, Ineligibility and 

Voluntary Exclusion-Lower Tier Covered Transactions,” provided by the department or 

contracting agency, entering into this covered transaction, without modification, in all lower tier 

covered transactions and in all solicitations for lower tier covered transactions exceeding the 

$25,000 threshold. 

h. A participant in a covered transaction may rely upon a certification of a prospective 

participant in a lower tier covered transaction that is not debarred, suspended, ineligible, or 

voluntarily excluded from the covered transaction, unless it knows that the certification is 

erroneous. A participant is responsible for ensuring that its principals are not suspended, 

debarred, or otherwise ineligible to participate in covered transactions. To verify the eligibility of 

its principals, as well as the eligibility of any lower tier prospective participants, each participant 

may, but is not required to, check the System for Award Management website 

(https://www.sam.gov/), which is compiled by the General Services Administration. 

i. Nothing contained in the foregoing shall be construed to require the establishment of a 

system of records in order to render in good faith the certification required by this clause. The 

knowledge and information of the prospective participant is not required to exceed that which is 

normally possessed by a prudent person in the ordinary course of business dealings. 

j. Except for transactions authorized under paragraph (f) of these instructions, if a participant 

in a covered transaction knowingly enters into a lower tier covered transaction with a person who 

is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, 

in addition to other remedies available to the Federal Government, the department or agency may 

terminate this transaction for cause or default.

Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion – 

First Tier Participants:

a. The prospective first tier participant certifies to the best of its knowledge and belief, that it 

and its principals:
B-15 

(1) Are not presently debarred, suspended, proposed for debarment, declared ineligible, 

or voluntarily excluded from participating in covered transactions by any Federal department 

or agency; 

(2) Have not within a three-year period preceding this proposal been convicted of or had 

a civil judgment, including a civil settlement, rendered against them for commission of fraud 

or a criminal offense in connection with obtaining, attempting to obtain, or performing a 

public (Federal, State or local) transaction or contract under a public transaction; violation of 

Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, 

falsification or destruction of records, making false statements, or receiving stolen property;

(3) Are not presently indicted for or otherwise criminally or civilly charged by a 

governmental entity (Federal, State or local) with commission of any of the offenses 

enumerated in paragraph (a)(2) of this certification; and

(4) Have not within a three-year period preceding this application/proposal had one or 

more public transactions (Federal, State or local) terminated for cause or default.

b. Where the prospective participant is unable to certify to any of the statements in this 

certification, such prospective participant shall attach an explanation to this proposal. 

2. Instructions for Certification - Lower Tier Participants:

(Applicable to all subcontracts, purchase orders and other lower tier transactions requiring prior 

FHWA approval or estimated to cost $25,000 or more - 2 C.F.R. Parts 180 and 1200) 

a. The prospective lower tier participant is providing the certification set out below.

b. The certification in this clause is a material representation of fact upon which reliance was 

placed when this transaction was entered into. If it is later determined that the prospective lower 

tier participant knowingly rendered an erroneous certification, in addition to other remedies 

available to the Federal Government, the department, or agency with which this transaction 

originated may pursue available remedies, including suspension and/or debarment. 

c. The prospective lower tier participant shall provide immediate written notice to the person 

to which this proposal is submitted if at any time the prospective lower tier participant learns that 

its certification was erroneous by reason of changed circumstances.

d. The terms “covered transaction,” “civil settlement,” “debarred,” “suspended,” “ineligible,” 

“participant,” “person,” “principal,” and “voluntarily excluded,” as used in this clause, are 

defined in 2 C.F.R. Parts 180 and 1200. You may contact the person to which this proposal is 

submitted for assistance in obtaining a copy of those regulations. “First Tier Covered 

Transactions” refers to any covered transaction between a Recipient or subrecipient of Federal 

funds and a participant (such as the prime or general contract). “Lower Tier Covered 

Transactions” refers to any covered transaction under a First Tier Covered Transaction (such as 

subcontracts). “First Tier Participant” refers to the participant who has entered into a covered 
B-16 

transaction with a Recipient or subrecipient of Federal funds (such as the prime or general 

contractor). “Lower Tier Participant” refers any participant who has entered into a covered 

transaction with a First Tier Participant or other Lower Tier Participants (such as subcontractors 

and suppliers). 

e. The prospective lower tier participant agrees by submitting this proposal that, should the 

proposed covered transaction be entered into, it shall not knowingly enter into any lower tier 

covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily 

excluded from participation in this covered transaction, unless authorized by the department or 

agency with which this transaction originated. 

f. The prospective lower tier participant further agrees by submitting this proposal that it will 

include this clause titled “Certification Regarding Debarment, Suspension, Ineligibility and 

Voluntary Exclusion-Lower Tier Covered Transaction,” without modification, in all lower tier 

covered transactions and in all solicitations for lower tier covered transactions exceeding the 

$25,000 threshold. 

g. A participant in a covered transaction may rely upon a certification of a prospective 

participant in a lower tier covered transaction that is not debarred, suspended, ineligible, or 

voluntarily excluded from the covered transaction, unless it knows that the certification is 

erroneous. A participant is responsible for ensuring that its principals are not suspended, 

debarred, or otherwise ineligible to participate in covered transactions. To verify the eligibility of 

its principals, as well as the eligibility of any lower tier prospective participants, each participant 

may, but is not required to, check the System for Award Management website 

(https://www.sam.gov/), which is compiled by the General Services Administration. 

h. Nothing contained in the foregoing shall be construed to require establishment of a system 

of records in order to render in good faith the certification required by this clause. The 

knowledge and information of participant is not required to exceed that which is normally 

possessed by a prudent person in the ordinary course of business dealings. 

i. Except for transactions authorized under paragraph e of these instructions, if a participant 

in a covered transaction knowingly enters into a lower tier covered transaction with a person who 

is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, 

in addition to other remedies available to the Federal Government, the department or agency 

with which this transaction originated may pursue available remedies, including suspension 

and/or debarment. 

Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion --

Lower Tier Participants:

1. The prospective lower tier participant certifies, by submission of this proposal, that neither 

it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, 

or voluntarily excluded from participating in covered transactions by any Federal department or 

agency. 
B-17 

2. Where the prospective lower tier participant is unable to certify to any of the statements in 

this certification, such prospective participant shall attach an explanation to this proposal. 
B-18 

TERM B.3 

REQUIREMENTS REGARDING DELINQUENT TAX LIABILITY OR A FELONY 

CONVICTION UNDER ANY FEDERAL LAW

As required by sections 744 and 745 of Title VII, Division E of the Consolidated Appropriations 

Act, 2022, Pub. L. No. 117-103 (Mar. 15, 2022), and implemented through USDOT Order 

4200.6, the funds provided under this award shall not be used to enter into a contract, 

memorandum of understanding, or cooperative agreement with, make a grant to, or provide a 

loan or loan guarantee to, any corporation that: 

(1) Has any unpaid Federal tax liability that has been assessed, for which all judicial and 

administrative remedies have been exhausted or have lapsed, and that is not being paid in 

a timely manner pursuant to an agreement with the authority responsible for collecting 

the tax liability, where the awarding agency is aware of the unpaid tax liability, unless a

Federal agency has considered suspension or debarment of the corporation and made a 

determination that suspension or debarment is not necessary to protect the interests of the 

Government; or 

(2) Was convicted of a felony criminal violation under any Federal law within the preceding 

24 months, where the awarding agency is aware of the conviction, unless a Federal

agency has considered suspension or debarment of the corporation and made a 

determination that suspension or debarment is not necessary to protect the interests of the 

Government. 

The Recipient therefore agrees:

1. Definitions. For the purposes of this exhibit, the following definitions apply:

“Covered Transaction” means a transaction that uses any funds under this award and that is 

a contract, memorandum of understanding, cooperative agreement, grant, loan, or loan 

guarantee.

“Felony Conviction” means a conviction within the preceding 24 months of a felony 

criminal violation under any Federal law and includes conviction of an offense defined in a 

section of the United States Code that specifically classifies the offense as a felony and 

conviction of an offense that is classified as a felony under 18 U.S.C. 3559. 

“Participant” means the Recipient, an entity who submits a proposal for a Covered 

Transaction, or an entity who enters into a Covered Transaction. 

“Tax Delinquency” means an unpaid Federal tax liability that has been assessed, for which 

all judicial and administrative remedies have been exhausted, or have lapsed, and that is not 

being paid in a timely manner pursuant to an agreement with the authority responsible for 

collecting the tax liability.
B-19 

2. Mandatory Check in the System for Award Management. Before entering a Covered 

Transaction with another entity, a Participant shall check the System for Award Management 

(the “SAM”) at http://www.sam.gov/ for an entry describing that entity.

3. Mandatory Certifications. Before entering a Covered Transaction with another entity, a 

Participant shall require that entity to:

(1) Certify whether the entity has a Tax Delinquency; and

(2) Certify whether the entity has a Felony Conviction. 

4 Prohibition. If

(1) the SAM entry for an entity indicates that the entity has a Tax Delinquency or a 

Federal Conviction; 

(2) an entity provides an affirmative response to either certification in section 3; or 

(3) an entity’s certification under section 3 was inaccurate when made or became 

inaccurate after being made

then a Participant shall not enter or continue a Covered Transaction with that entity unless 

the USDOT has determined in writing that suspension or debarment of that entity are not 

necessary to protect the interests of the Government.

5. Mandatory Notice to the USDOT. 

(a) If the SAM entry for a Participant indicates that the Participant has a Tax Delinquency or 

a Felony Conviction, the Recipient shall notify the USDOT in writing of that entry.

(b) If a Participant provides an affirmative response to either certification in section 1, the 

Recipient shall notify the USDOT in writing of that affirmative response.

(c) If the Recipient knows that a Participant’s certification under section 1 was inaccurate 

when made or became inaccurate after being made, the Recipient shall notify the USDOT 

in writing of that inaccuracy. 

6. Flow Down. For all Covered Transactions, including all tiers of subcontracts and subawards, 

the Recipient shall:

(1) require the SAM check in section 2;

(2) require the certifications in section 3;

(3) include the prohibition in section 4; and
B-20 

(4) require all Participants to notify the Recipient in writing of any information that 

would require the Recipient to notify the USDOT under section 5. 
B-21 

TERM B.4 

RECIPIENT POLICY TO BAN TEXT MESSAGING WHILE DRIVING

(a) Definitions. The following definitions are intended to be consistent with the definitions in 

DOT Order 3902.10, Text Messaging While Driving (Dec. 30, 2009) and Executive Order 

13513, Federal Leadership on Reducing Text Messaging While Driving (Oct. 1, 2009). For 

clarification purposes, they may expand upon the definitions in the executive order. 

For the purpose of this Term B.4, “Motor Vehicles” means any vehicle, self-propelled or drawn 

by mechanical power, designed and operated principally for use on a local, State or Federal 

roadway, but does not include a military design motor vehicle or any other vehicle excluded 

under Federal Management Regulation 102-34-15.

For the purpose of this Term B.4, “Driving” means operating a motor vehicle on a roadway, 

including while temporarily stationary because of traffic congestion, a traffic signal, a stop sign, 

another traffic control device, or otherwise. It does not include being in your vehicle (with or 

without the motor running) in a location off the roadway where it is safe and legal to remain 

stationary. 

For the purpose of this Term B.4, “Text messaging” means reading from or entering data into 

any handheld or other electronic device (including, but not limited to, cell phones, navigational 

tools, laptop computers, or other electronic devices), including for the purpose of Short Message 

Service (SMS) texting, e-mailing, instant messaging, obtaining navigational information, or 

engaging in any other form of electronic data retrieval or electronic data communication. The 

term does not include the use of a cell phone or other electronic device for the limited purpose of 

entering a telephone number to make an outgoing call or answer an incoming call, unless this 

practice is prohibited by State or local law. The term also does not include glancing at or 

listening to a navigational device that is secured in a commercially designed holder affixed to the 

vehicle, provided that the destination and route are programmed into the device either before 

driving or while stopped in a location off the roadway where it is safe and legal to remain 

stationary. 

For the purpose of this Term B.4, the “Government” includes the United States Government and 

State, local, and tribal governments at all levels.

(b) Workplace Safety. In accordance with Executive Order 13513, Federal Leadership on 

Reducing Text Messaging While Driving (Oct. 1, 2009) and DOT Order 3902.10, Text 

Messaging While Driving (Dec. 30, 2009), the Recipient, subrecipients, contractors, and 

subcontractors are encouraged to:

(1) adopt and enforce workplace safety policies to decrease crashes caused by distracted

drivers including policies to ban text messaging while driving— 

(i) Company-owned or -rented vehicles or Government-owned, leased or rented

vehicles; or

(ii) Privately-owned vehicles when on official Government business or when 

performing any work for or on behalf of the Government. 
B-22 

(2) Conduct workplace safety initiatives in a manner commensurate with the size of the

business, such as— 

(i) Establishment of new rules and programs or re-evaluation of existing programs 

to prohibit text messaging while driving; and 

 (ii) Education, awareness, and other outreach to employees about the safety risks 

associated with texting while driving.

(c) Subawards and Contracts. To the extent permitted by law, the Recipient shall insert the 

substance of this exhibit, including this paragraph (c), in all subawards, contracts, and 

subcontracts under this award that exceed the micro-purchase threshold, other than contracts and 

subcontracts for the acquisition of commercially available off-the-shelf items.
C-1 

EXHIBIT C 

QUARTERLY PROJECT PROGRESS REPORTS AND RECERTIFICATIONS:

FORMAT AND CONTENT

1. Purpose. The purpose of the Quarterly Project Progress Reports and Recertifications 

under this agreement for the FY 2022-2023 WCPP are to ensure that the project scope, schedule, 

and budget will be maintained to the maximum extent possible. 

2. Format and Content. The Recipient shall produce a quarterly cost, schedule, and status 

report that contains the sections enumerated in the following list. At the discretion of the 

USDOT, modifications or additions can be made to produce a quarterly reporting format that 

will most effectively serve both the Recipient and the USDOT. Some projects will have a more 

extensive quarterly status than others. For smaller projects, the USDOT may determine that the 

content of the quarterly reports will be streamlined and project status meetings will be held on a 

less-frequent basis. The first quarterly progress report should include a detailed description and, 

where appropriate, drawings of the items funded. 

(a) Project Overall Status. This section provides an overall status of the project’s scope, 

schedule and budget. The Recipient shall note and explain any deviations from the 

scope of work, the schedule, or the budget that are described in this agreement. 

(b) Project Significant Activities and Issues. This section provides highlights of key 

activities, accomplishments, and issues occurring on the project during the previous 

quarter. Activities and deliverables to be reported on should include meetings, audits 

and other reviews, design packages submitted, advertisements, awards, construction 

submittals, construction completion milestones, submittals related to any applicable 

Recovery Act requirements, media or Congressional inquiries, value 

engineering/constructability reviews, and other items of significance. 

(c) Action Items/Outstanding Issues. This section should draw attention to, and track 

the progress of, highly significant or sensitive issues requiring action and direction in 

order to resolve. The Recipient should include administrative items and outstanding 

issues that could have a significant or adverse effect on the project’s scope, schedule, 

or budget. Status, responsible person(s), and due dates should be included for each 

action item/outstanding issue. Action items requiring action or direction should be 

included in the quarterly status meeting agenda. The action items/outstanding issues 

may be dropped from this section upon full implementation of the remedial action, 

and upon no further monitoring anticipated. 

(d) Project Scope Overview. The purpose of this section is to provide a further update 

regarding the project scope. If the original scope contained in the grant agreement is 

still accurate, this section can simply state that the scope is unchanged.

(e) Project Schedule. An updated master program schedule reflecting the current status 

of the program activities should be included in this section. A Gantt (bar) type chart is 

probably the most appropriate for quarterly reporting purposes, with the ultimate 
C-2 

format to be agreed upon between the Recipient and the USDOT. It is imperative that 

the master program schedule be integrated, i.e., the individual contract milestones tied 

to each other, such that any delays occurring in one activity will be reflected 

throughout the entire program schedule, with a realistic completion date being 

reported. Narratives, tables, and/or graphs should accompany the updated master 

program schedule, basically detailing the current schedule status, delays and potential 

exposures, and recovery efforts. The following information should also be included: 

• Current overall project completion percentage vs. latest plan percentage. 

• Completion percentages vs. latest plan percentages for major activities such as 

right-of-way, major or critical design contracts, major or critical construction 

contracts, and significant force accounts or task orders. A schedule status 

description should also be included for each of these major or critical 

elements. 

• Any delays or potential exposures to milestone and final completion dates. 

The delays and exposures should be quantified, and overall schedule impacts 

assessed. The reasons for the delays and exposures should be explained, and 

initiatives being analyzed or implemented in order to recover the schedule 

should be detailed. 

(f) Project Cost. An updated cost spreadsheet reflecting the current forecasted cost vs. 

the latest approved budget vs. the baseline budget should be included in this section. 

One way to track project cost is to show: (1) Baseline Budget, (2) Latest Approved 

Budget, (3) Current Forecasted Cost Estimate, (4) Expenditures or Commitments to 

Date, and (5) Variance between Current Forecasted Cost and Latest Approved 

Budget. Line items should include all significant cost centers, such as prior costs, 

right-of-way, preliminary engineering, environmental mitigation, general engineering 

consultant, section design contracts, construction administration, utilities, 

construction packages, force accounts/task orders, wrap-up insurance, construction 

contingencies, management contingencies, and other contingencies. The line items 

can be broken-up in enough detail such that specific areas of cost change can be 

sufficiently tracked and future improvements made to the overall cost estimating 

methodology. A Program Total line should be included at the bottom of the 

spreadsheet. Narratives, tables, and/or graphs should accompany the updated cost 

spreadsheet, basically detailing the current cost status, reasons for cost deviations, 

impacts of cost overruns, and efforts to mitigate cost overruns. The following 

information should be provided: 

• Reasons for each line item deviation from the approved budget, impacts 

resulting from the deviations, and initiatives being analyzed or implemented 

in order to recover any cost overruns. 

• Transfer of costs to and from contingency line items, and reasons supporting 

the transfers. 
C-3 

• Speculative cost changes that potentially may develop in the future, a 

quantified dollar range for each potential cost change, and the current status of 

the speculative change. Also, a comparison analysis to the available 

contingency amounts should be included, showing that reasonable and 

sufficient amounts of contingency remain to keep the project within the latest 

approved budget. 

• Detailed cost breakdown of the general engineering consultant (GEC) services 

(if applicable), including such line items as contract amounts, task orders 

issued (amounts), balance remaining for tasks, and accrued (billable) costs. 

• Federal obligations and/or disbursements for the project, compared to planned 

obligations and disbursements. 

(g) Federal Financial Report (SF-425). The Federal Financial Report (SF-425) is a 

financial reporting form used throughout the Federal Government Grant system.

Recipients shall complete this form and attach it to each quarterly Project Progress 

and Monitoring Report. The form is available at

https://www.grants.gov/forms/post-award-reporting-forms.html.

(h) Certifications.

i. A certification that the Recipient is in compliance with 2 C.F.R. 200.303 

(Internal Controls) and 2 C.F.R. Part 200, Subpart F (Audit Requirements).

ii. The certification required under 2 C.F.R. 200.415(a).
D-1 

EXHIBIT D 

FORM FOR SUBSEQUENT OBLIGATION OF FUNDS

The FHWA and [recipient name] entered a grant agreement for the [project name] that was 

executed by the FHWA on [date of FGWA signature on original agreement] (the 

“Agreement”). 

As described in section 10.2(f) of the General Terms and Conditions, this instrument obligates 

[$XXX] for [insert portion of project listed in the Obligation Condition Table in Section 

2.3]. 

[Recipient name] states that:

(1) Section 3.1 of the Agreement accurately describe the Project’s activities;

(2) for each completion date listed in Section 3.2 of the Agreement, the Recipient’s 

estimate for that milestone is not more than six months after the date listed in 

Section 3.2 of the Agreement; 

(3) comparing the Project’s current budget with the amounts listed in Section 3.4 of 

the Agreement, the “Non-Federal Funds” amount has not decreased and the total 

eligible project costs amount has not decreased; and

(4) under the terms of Article 11 of the General Terms and Conditions, the Recipient 

is not presently required to request a modification to the Agreement.

[Recipient name] acknowledges that FHWA is acting in reliance on the Recipient’s statements 

above. 

Date

By:

Signature of Recipient’s Authorized Representative

[insert name]

Name

[insert title]

Title

The FHWA has determined that: 

(1) all conditions described in the Obligation Condition Table in Section 2.3 for this 

portion of the Project are satisfied; and
D-2 

(2) all applicable Federal requirements for obligating these funds are satisfied.

Date

By:

Signature of FHWA’s Authorized Representative

[insert name]

Name

[insert title]

Title