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					                                     ARRA SITE REVIEW CHECKLIST
SECTION I – PRE-INSPECTION REPORT
Complete at State Office prior to the onsite review.

 A. General Project Information
 Applicant Name:                                                                                               DEH#:
 P&S Serial #:
 Project Description:

 Yes   No
            Green Reserve Status:

            Project is categorically qualified for the Green Reserve.

            Project required a business case.




 B. Status of Ongoing Reporting
 Assistance recipients must submit job created/retained number to the State quarterly, and certification of Davis-Bacon for
 compliance for each week at intervals defined by the State. Complete Section I-B by reviewing State files.

 Yes   No
            1. A comprehensive Buy American certification has been submitted and is on file.

            2. Job creation/retention number has been submitted for all required reporting periods.


               Most recent quarter in which report is available:
               Year: 201_            July-Sept.          Oct.-Dec.           Jan.-Mar.           Apr.-June
               Jobs reported in most recent quarter:

           3. Regular certifications have been submitted by the assistance recipient to the State as part of request(s)
 for reimbursement and are on file stating that the project has remained in compliance with Davis-Bacon based on a
 review of weekly payroll records.
           N/A, request for reimbursement has not yet been made.



         Print Inspector Name                                         Signature                                          Date




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                                    ARRA SITE REVIEW CHECKLIST
SECTION II – ONSITE INSPECTION CHECKLIST
To be completed during onsite review of project.

This Checklist is used to review and document compliance steps being taken by the Applicant and Contractors, including their sub-
contractors, to meet the ongoing requirements for a project financed (at least in part) by American Reinvestment and Recovery Act
(ARRA) funding.
 A. Inspection Summary
 Applicant Name:                                                          %:        10 50 90 extra        DEH#:
 Location:                                                                Date:                           Time:
                                          Individuals Present at Inspection Review
                             Name                                                       Organization




 Notes:




                                                                                                              YES
 Does the inspected project match the PWS-financed project?
                                                                                                              NO



          Print Inspector Name                                     Signature                                        Date




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                                   ARRA SITE REVIEW CHECKLIST
 Applicant Name:                                                                                         DEH#:


 B. Davis-Bacon and Related Acts Compliance

 Yes    No
             1. Received payroll records utilize either the federal Department of Labor (DOL) Wage and Hour Division
             form WH-347 or a comparable report, which contains essential data elements represented by WH-347 and
             has statement of compliance as modeled by the reverse side of form WH-347.

             2. Verified weekly payroll records have been submitted by the Prime Contractor, including sub-contractor
             payrolls, and are on file with the ARRA funding recipient and/or with the consulting engineer.

             3. Verified that weekly signed certification statements of compliance (as modeled by the reverse of form
             WH-347), as submitted by the Prime Contractor and each sub-contractor, are on file with the ARRA funding
             recipient and/or with the consulting engineer.

             4. Interviews have been conducted with at least one employee per contract (mechanics and laborers)
             covered under Davis-Bacon Act provisions, by the ARRA funding recipient, as evidenced by use and
             completion of GSA Standard Form 1445 or equivalent, within two weeks of the first payroll and periodically
             throughout the life of the project.

             5. Davis-Bacon wage poster (WH-1321) is posted at the construction site in a conspicuous place protected
             from the weather in all relevant languages with designated Contracting Officer.

             6. Applicable Davis-Bacon wage rate determinations are displayed at the construction site in a location
             accessible to laborers and mechanics.

             7. Weekly payroll records indicate that employees are being compensated (pay + fringe benefits) at or
             above the Davis-Bacon wage rates determinations for their classification.

             8. If fringe benefits are critical to meeting or exceeding the applicable Davis-Bacon wage rate determination,
             contractor fringe contributions have been verified.
             N/A, if fringe benefits were not critical.

             9. If apprentices or trainees are being used, documentation is available certifying compliance with or proving
             registration with a DOL or State program.
             N/A, if apprentices and trainees not used.

             10. If apprentices or trainees are being used, it has been verified that the ratio of apprentices/trainees
             working on the project is consistent with the ratios prescribed in a DOL or State program.
             Ratio: ____ to ____
             N/A, if apprentices and trainees not used.

             11. Wage rate violations of the 29 CFR 5.5 requirements were found by the ARRA funding recipient and had
             been reported to the DOL Wages and Hour District Office.
             N/A, if no wage rate violations found.


I certify that:

12.       I completed Employee Interview(s) to verify the use and completion of GSA Standard Form 1445, or
          No workers on site on the date of inspection.

13.      I verbally notified the ARRA funding recipient that they are required to maintain records pertaining to Davis-
         Bacon wage requirement for a period of three years following the completion of the ARRA funded project.


          Print Inspector Name                                     Signature                                       Date


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                                     ARRA SITE REVIEW CHECKLIST
 Applicant Name:                                                                                           DEH#:

 C. Buy American Compliance / Project-Specific Waiver
 The number of components to be reviewed during each inspection should be determined by the State SRF program managers and
 staff assigned to the project (see Reference Guide for more information on making this decision). Additional copies of this page
 should be made and completed for each component reviewed.

 1. Description of component(s) reviewed:


 2. a) Component was entirely assembled in the U.S. using U.S.-made subcomponents and raw materials.
 OR
 2. b) Description of substantial transformation process:


 3. Location where substantial transformation occurred:

 4. Documentation of origin and / or the substantial transformation process is provided by:

       Certification from manufacturer

       Print-outs from manufacturer’s website

       Shipping manifest or bill of lading

       Cut sheet(s) or invoice(s)

       Federal Register notice of approved project-specific waiver

       Other:

 Yes     No
                5. Component(s) is (are) the same general character and type as described in the documentation.

                6. Country-of-origin and general component labeling is consistent with the documentation (e.g., labeling
                does not indicate foreign origin, manufacturer and model are same as documented, etc.)



          Print Inspector Name                                      Signature                                        Date




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                                   ARRA SITE REVIEW CHECKLIST
 Applicant Name:                                                                                        DEH#:

 D. De Minimis Buy American Waiver Compliance
       N/A – No incidental components have yet been                  N/A – Project does not require a waiver for any
             ordered for this project                                      incidental components

 Yes    No
             1. An itemized list of all materials, including incidental manufactured goods, is being maintained.

             2. Receipts or invoices are kept to show total value of exempted items.

             3. The de minimis waiver is only applied to incidental project components that are generally miscellaneous,
             small, and low-cost.
             4. Items exempted under the de minimis waiver make up 5% or less of total materials cost.

 5. Value of exempted incidental goods:
 6. Estimate/final cost of materials (to be) procured:
 7. Percentage of material costs exempted:

 E. Green Reserve Compliance
                                     N/A – Green components                       N/A – Current stage of construction does
       N/A – Not a Green
                                           satisfactorily reviewed in                   not allow for review of green
             Reserve Project
                                           previous inspection                          components
 1. Description of component(s) reviewed:



 Yes    No
             2. Project is categorically qualified for the Green Reserve, or the recipient maintains a copy of an approved
             business case.

             3. Green design and/or equipment is incorporated into the project as described in the project plans and/or
             business case.

             4. The green components used in the project are the same character and type as described in the project
             plans and/or business case.

 F. Compliance with Remaining ARRA Requirements

 Yes    No
             1. Recipient maintains documentation supporting job creation/retention reports that have been submitted to
             the State.
             2. Job creation/retention reports were submitted for each consultant and (sub)contractor that submitted
             payroll reports for at least one week and/or participated in a labor standards interview during the quarter.
             3. Job creation/retention reports are developed according to methods described in EPA and State guidance.

             4. Documentation matches the number of jobs reported as created or retained.

             5. Project sign with ARRA and NC Jobs Now logos is posted at the construction site.

             6. ARRA whistleblower poster and OERI Management Directive #5 are posted at the construction site.



         Print Inspector Name                                     Signature                                        Date


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                                   ARRA SITE REVIEW CHECKLIST
 Applicant Name:                                                                                                DEH#:

 G. Contract Document Compliance
 Additional copies of this page should be made and completed for each additional contract reviewed as applicable.
       N/A – The applicant is using a Force Account labor and for construction.
       N/A – The contract documents have been previously reviewed.
 Contractor:                                                                                             Contract No.:
 Scope of Work:
 Do the executed contract documents contain the following items?:
 Yes    No   N/A
                   1. Bonds

                        (a) ≥ 5% Bid Bond
                            Only required if contract > $500k (State) or $100k (Federal).
                        (b) ≥ 100% Performance Bond
                            Only required if contract > $50k on construction > $300k (State) or if contract > $100k (Federal).
                        (c) ≥ 100% Payment Bond
                            Only required if contract > $50k on construction > $300k (State) or if contract > $100k (Federal).
                   2. Liability Insurance

                   3. DWSRF Special Conditions Package (DWSRF SCP)

                   4. State Special Conditions Package (State SCP)

                        (a) Is a verifiable percentage goal specified?

                        (b) Is the Owner’s resolution date specified?

                   5.   (a) Davis-Bacon Terms and Conditions (7/14/09)
                   OR
                   5.   (b) Dept of Labor Davis-Bacon Contract Provisions (text of law)

                   6. Department of Labor Wage Tables for Davis-Bacon Compliance

                        (a) Are the wage categories applicable to the project?

                        (b) Do the wages apply to the project location?

                   7. “Implementation of Buy American Provisions…” Memo from EPA (4/28/09)

                        (a) Contract language-Appendix 3 (modified for specific project)

                        (b) Certification language-Appendix 5 (modified for specific project)
                            Note: Certification of Compliance with ARRA Buy American Provisions from CG&L is also acceptable.
                   8. EPA Buy American Provisions—Questions and Answers—Part 1 (7/2/09)

                   9. (a) Supplemental Contract Provisions For DWSRF/ARRA Funding (Pages 1-3)
                   OR
                   9. (b) OERI Contract Provisions + Sheet 3 from 9(a)
                   OR
                   9. (c) “Estimates of Job Creation…” Memo from Council of Economic Advisors (5/09)
                          + Sheet 3 from 9(a)
                   10. Executed Agreement



          Print Inspector Name                                        Signature                                           Date


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                                    ARRA SITE REVIEW CHECKLIST
APPENDIX A – JOBS REPORTING INSPECTION GUIDANCE
This is a procedure for determining the completeness and accuracy of the reported number of jobs supported by project funding.

 Step 1: Determine if Jobs Reports, especially that for the latest fiscal quarter, have been submitted by the recipient.

 Jobs Reports are to be submitted to Tony Patnode at the end of each fiscal quarter for a given PWSS project with ARRA funding
 until the project has been closed out. As a result, it is expected that recipients will report zero Full-Time Equivalent jobs (FTEs)
 during periods of inactivity. Tony should provide a spreadsheet that summarizes these reports after each quarterly reporting period.
 If a Jobs Report is found to be missing, then I.B.2 should be marked “No” and a Jobs Report is to be submitted for PWSS records.
 Otherwise, mark I.B.2 “Yes”.

 Step 2: Record the number of FTEs that the recipient reported for the latest quarter.

 Jobs Reports may be submitted by multiple consultants, contractors and subcontractors to the recipient. The number of jobs
 (FTEs) reported for a given project for a given fiscal quarter is the sum total of these reports. Tony Patnode should provide a
 spreadsheet that summarizes these reports after each quarterly reporting period. Record the latest quarter reported and the
 number of jobs reported in I.B.2.

 Step 3: Determine if the recipient maintains copies of each Jobs Report and supporting documentation.

 The funding recipient should maintain copies of each Jobs Report that has been submitted for their project. This includes reports
 from every consultant, contractor and subcontractor. Similarly, the recipient should be able to produce a copy of Payroll Reports,
 hourly billing records or similar supporting documentation (of how much time has been spent work on the project) for each of these
 reports. If any of this material is found to be missing, then II.F.1 should be marked “No” and it should be submitted for PWSS to
 review. Otherwise, mark II.F.1 “Yes”.

 Step 4: Determine if each consultant and/or (sub)contractor that has performed work on the project during the latest
 fiscal quarter has submitted a Jobs Report.

 Payroll Reports and Labor Standards Interviews record consultant and (sub)contractor activity on the project. These reports should
 be cross-referenced with the latest Jobs Reports in order to ensure that, if employees of a given contractor or (sub)contractor have
 been documented as working on the project during the latest fiscal quarter, their organization has submitted a Jobs Report for that
 quarter. The recipient should be able to provide copies of each of these reports. If it is found that a consultant or (sub)contractor
 has not submitted a Jobs Report reflecting their activity on the project, then II.F.2 should be marked “No” and a Jobs Report is to be
 submitted for PWSS records. Otherwise, mark II.F.2 “Yes”.

 Step 5: Determine if the reported number of FTEs was developed according to EPA guidelines.

 In order to determine the number of jobs (FTEs) to report, the man hours recorded in the supporting documentation for the fiscal
 quarter must be summed up. This sum is then divided by 520, which is the number of hours one would accumulate by working 13
 weeks at a rate of 40 hours per week, to produce the resulting number of FTE jobs.


 It may be noted that this method does not account for holidays, sick days, vacation, or any other interruption of the normal work
 week. Nonetheless, if there is any deviation found between this result and that shown in the submitted Jobs Report, then II.F.3
 should be marked “No” and a revised report is to be submitted for PWSS records. Otherwise, mark II.F.3 “Yes”.

 Step 6: Determine if the number of FTEs that was reported for the latest quarter matches provided documentation.

 In addition to the guidance provided for Step 5, if the number of jobs (FTEs) that were reported differs from the provided
 documentation for any reason that does not involve the calculation methodology, such as previous omission of a weekly Payroll
 Report, then II.F.4 should be marked “No” and a revised Jobs Report is to be submitted for PWSS records. Otherwise, mark II.F.4
 “Yes”.




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