Form Rd 400 6 PDF Details

Form Rd 400-6 is an asphalt pavement mix design used by the Iowa Department of Transportation. It is a 6-inch thick mix that uses Type I base, stone screenings, and course aggregate. The mix also includes a binder and mineral filler. This design is generally used on low volume roads. The Iowa DOT has been using this particular asphalt pavement mix design for many years and has found it to be durable and perform well under a variety of weather conditions. In fact, Form Rd 400-6 was recently tested in a research project that showed it to be more resilient to rutting than other mixes currently being used in the state. If you're looking for an asphalt pavement mix that performed well in colder climates or are dealing with some steep grades, then Form Rd 400-6 may be the right choice for you. Contact your local Iowa DOT office to learn more.

Form NameForm Rd 400 6
Form Length2 pages
Fillable fields0
Avg. time to fill out30 sec
Other namesform rd certifications, form 400 6, proposed form rd, form rd 400 6 compliance statement

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FORM RD 400-6


Form Approved

Form RD 400-6

OMB No. 0575-0018

(Rev. 12-09)


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


Order 11246 (regarding equal employment opportunity) or a preceding similar Executive Order.


If I have participated in such a contract or subcontract, I


have not, filed all


compliance reports that have been required to file in connection with the contract or subcontract.



If the proposed construction contract is for $50,000 or more: or

If the proposed nonconstruction


contract is for $50,000 or more and I have 50 or more employees, I also represent that:




have not previsouly had contracts subject to the written affirmative action


programs requirements of the Secretary of Labor.




If I have participated in such a contract or subcontract, I


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 a 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)

To be used to reveal whether the bidder or prospective Contractor is in default with respect to Compliance reports required under any previously covered contract or subject to the “Affirmative Action Program” and to provide for certification regarding the maintenance or use of non-segregated facilities.



: RD Instruction 1901-E.



Community Development Managers.



Original and two.


: Original and two by each Bidder or



prospective Contractor.



Original to Bidder or prospective Contractor;



copy to borrower or grantee;



copy retained by Local Office.

(03-17-10) PN437

-2- (Form Manual Insert - Form RD 400-6)




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.


(Signature of Bidder or Prospective Contractor)

Address (including Zip Code)