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6.D. - Page 68 of 170 Request for Qualifications: General Park Building Construction, Retrofit, Maintenance, and/or Repairs LW -13 L'UIWO —DEPARTMENTAL EXEMPTION APPLICATION EXEMPTIONS THAT REQUIRE AWARDING DEPARTMENT APPROVAL This application for exemption trust be submitted along with your bid or proposal to the AWARDING DEPARTMENT. INCOMPLETE SUBMISSIONS WILL BE RETURNED. Los Angeles Administrative Code 10.37. the Living Wage Ordinance (12WO), presumes all City contractors (including service oontractors, subcontractors, financial assistance red Eipsientslessees. licensees„ sublessees and subluaensees) arm subject to the LVM unnleess an exemption aaollies. TO BE FILLED Our BY THE CONTRACTOR-- 1. Company Name: Phone Number 2. C 3mpanyAddress: 3. Are you a Subdontractcr2 nYes n No Iff YES, state the name a+fyour Prime Contractor 4.Type of Service Provided: EXEMPT11011 INFORMATION: CHECKOFF ONE BOX BELOWTHATBEST DESS-RIBESTHETYPE OFE1SEMPTiON Y041 AREAPPLYING FOR AND ATTACH THE SUPPORTING DOCUMENTATION LISTED ON, THE R GHT1 - EXEMPTION SUPPORTFNG DOCUMENTATION REQUIRED ❑ 601(o)(3) Non-Prout Org3rid actions: 1_ ATTACH a copy of your 5D1(c)(3) Ieaw from the IRS. A corporation organized under 501(o)(3) of One, IRS:,Cagle 2_ A11SWER the follawing questions: quaf foes for an exemption frrbn the LVQTI if the highest paid A. STATE the hourly wage of HI GHIE ST paW �emoeyee employee makes less than Eight times the hourly wage of in the organization: $ the lowest paid employee. fee B. STATE the hourly wage of LOWEST paid employee Theexempfiion is �. alfid for all employees except Child Care in due- organization: $ Workers. ___ , C. MULTIPLY 8 by S: $ 'I7 Therefore, even if a 6131Ic)(3) organization meets the salary test. Child Care Workers performing work on the 3- Based on Quest on 2 ab ow. is A less than C? City agreement must still be provided with the LINO ❑ YES ❑ NO required wage and time off benefits. It NO. your company is NOT eligible for an exemption - Under the LVffs Rules and Regulations„ a Child Cane It YES. sign and submit this applb ;atian fix final approval Worker is an employee 'whose work on an agffeennentt 4_ 'Will there be any Chid Care Workers (ars defined by the involves the cars or supeMsian of a ildren 12 years of LV90 Regulations) wo&ng on this Agreement? age and under.' ❑ YES; IJ No This is read broadlp so that the teras mmuild inr.,ludle, far 5. Fill & Submit LW -18 Subcontractor Information Form. exarrTle. tutors working with children 12 or under. ❑ One -Person Contractors: Contractors drathanve no ennplayees are exempt from the LVVO. tf you have employees Fill aril Submit the LW -18 Farm. in the future, you must damply with the Ordinance. 1 deciam under parially orpsqury undert M leave, art* Stolle ar 6arfurnila that (1)1 aro aullmnUed 6u blind tits snllty Noted RUM t2} tW minnotlon pFoviaod an trite. form is true and o rroct ID the but armyluMbdgw and p) fibs entity qualmes for axiamptlon !mm tW LWO on the, bawls bidlciowd above. By signing belaw.1 ladher agree that shoWd me Entity Tisted above cease to quality" Ric an exemption because of a e nange In saury structure. non-pront stains. theming ad em gbyaes,, ar amy vuitrerreasrDn. the entity well notify the Awarding Deparurent and the CCC of such change and comply Wth the EWO%wage and time off requirements_ Print Name of Person: Completing This Form SNpature of Person Completing This Form Title Phone* hate ANYAE'PROVAL OF THIS APPLICATION EXEMPTS ONLY THE LIS i ED CONTRACTOR FROM THE LUNO CURING THE PERFORMANCE OF THIS CONTRACT. ASLIECOf ITRACI-OR PERFORMING 4IiOW ON TFIS CONTRACT IS NOT EXEMPT LINLESS THE OFFICE OF CONTRACT COMPLIANCE Wis APPROVED A SEPARATE EXEMPTION FOR THE INDPA DUAL SUECONrRACTOR. AWARDING DEPARTNMW USE ONLY: Di!pt wcoritaat Conbophone: conlradtill: Approved lWAppNoved-Reason - ByAnahmt Date: Fenn occiim-13, Rev. GrJoe OFFICE OF CONTRACT OOMPLMNCE, EEGE SECMN:1213) 1147-2623 IMPORTANT — RESPONDERS MUST SUBMIT ALL REQUIRED FORMS (COMPLETELY FILLED OUT) BY RFQ SUBMITTAL DEADLINE. Page 62 of 103 151