Rd 400-6

USDA
Form RD 400-6
(Rev.12-09)

Form Approved
OMB No. 0575-0018
COMPLIANCE STATEMENT

This statement relates to a proposed contract with
,
(Name of borrower or grantee)

who expects to finance the contract with assistance from either the Rural Housing Service (RHS),
Rural Business-Cooperative Service (RBS), or the Rural Utilities Service (RUS) or their successor
agencies, United States Department of Agriculture (whether by a loan, grant, loan insurance,
guarantee, or other form of financial assistance). I am the undersigned bidder or prospective
contractor, I represent that:
have not, participated in a previous contract or subcontract subject to Executive
have,
1. I
Order 11246 (regarding equal employment opportunity) or a preceding similar Executive Order.
have not, filed all
have,
2. If I have participated in such a contract or subcontract, I
compliance reports that have been required to file in connection with the contract or subcontract.
If the proposed nonconstruction
If the proposed contract is for $50,000 or more: or
contract is for $50,000 or more and I have 50 or more employees, I also represent that:
3. I
have not previously had contracts subject to the written affirmative action
have,
programs requirements of the Secretary of Labor.
4. If I have participated in such a contract or subcontract,
I have,
have not developed and
placed on file at each establishment affirmative action programs as required by the rules and
regulations of the Secretary of Labor.
I understand that if I have failed to file any compliance reports that have been required of me, I am not
eligible and will not be eligible to have my bid considered or to enter into the proposed contract unless
and until I make an arrangement regarding such reports that is satisfactory to either the RHS, RBS or RUS,
or to the office where the reports are required to be filed.
I also certify that I do not maintain or provide for my employees any segregated facilities at any of my
establishments, and that I do not permit my employees to perform their services at any location, under my
control, where segregated facilities are maintained. I certify further that I will not maintain or provide for
my employees any segregated facilities at any of my establishments, and that I will not permit my employees
to perform their services at any location, under my control, where segregated facilities are maintained. I
agree that a breach of this certification is a violation of the Equal Opportunity clause in my contract. As
used in this certification, the term ''segregated facilities'' means any waiting rooms, work areas, restrooms
and wash rooms, restaurants and other eating areas time clocks, locker rooms and other storage or dressing
areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities
provided for employees which are segregated by explicit directive or are in fact segregated on the basis of
race, creed, color, or national origin, because of habit, local custom, or otherwise. I further agree that
(except where I have obtained identical certifications for proposed subcontractors for specific time periods)
I will obtain identical certifications from proposed subcontractors prior to the award of subcontracts exceeding
$10,000 which are not exempt from the provisions of the Equal Opportunity clause; that I will retain such
certifications in my files; and that I will forward the following notice to such proposed subcontractors (except
where the proposed subcontractors have submitted identical certifications for specific time periods):
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information
unless it displays the valid OMB control number. The valid OMB control number for this information collection is 0575-0018. The time required to complete this
information collection is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the collection of information.

Position 6

RD 400-6 (Rev. 12-09)

NOTICE TO PROSPECTIVE SUBCONTRACTORS OF REQUIREMENTS FOR
CERTIFICATIONS OF NON-SEGREGATED FACILITIES

A certification of Nonsegregated Facilities, as required by the May 9, 1967, order (32F.R. 7439, may 19, 1967) on
Elimination of Segregated Facilities, by the Secretary of Labor, must be submitted prior to the award of a subcontract
exceeding $ 10,000 which is not exempt from the provisions of the Equal Opportunity clause. The certification may be
submitted either for each subcontract or for all subcontracts during a period (i.e., quarterly, semiannually, or annually).

NOTE: The penalty for making false statements in offers is prescribed in 18 U.S.C. 1001.

DATE
(Signature of Bidder or Prospective Contractor)

Address (including Zip Code)