HomeMy WebLinkAboutR16-044 Eagle County (CDOT/FHWA) Title VI Plan Commissioner AOLAt . —02.ti moved adoption
of the following Resolution:
BOARD OF COUNTY COMMISSIONERS
COUNTY OF EAGLE, STATE OF COLORADO
RESOLUTION No.
RESOLUTION ADOPTING THE EAG yt t;k TY'I DOT/FHWA) TITLE VI PLAN
A 44 xt,
WHEREAS, Eagle County is the recipie 'A = al Highway Administration
("FHWA") funds administered or directed through the Colorado Department of
Transportation("CDOT"); and
WHEREAS, compliance with Title VI is a condition of receipt of federal funds;
and
WHEREAS,the Eagle County Board of Commissioners (hereinafter the
"Board") desires to formally adopt a Title VI Plan including a non-discrimination policy,
complaint procedure and language assistance plan; and
WHEREAS, the Board desires to approve and authorize its Chair to sign United
States Department of Transportation's Standard Title VI Assurances; and
WHEREAS, through its Annual Appointment Resolution(Resolution 2016-
007), the Board appointed the Assistant County Manager as the County's Title VI/Civil
Rights Coordinator.
NOW, THEREFORE, be it resolved by the Board of County Commissioners
of the County of Eagle, State of Colorado:
THAT, the Board hereby adopts the Eagle County Government Title VI Plan,
(CDOT/FHWA)which is attached hereto and incorporated herein as Exhibit A. The plan sets
forth Eagle County's Title VI and Non-Discrimination Policy Statement, Title VI Complaint
Procedures and Language Assistance Policy.
THAT, the Board hereby approves and authorizes the Chair to sign United States
Department of Transportation's Standard Title VI Assurances which are included as Attachment
1 to the Title VI Plan.
THAT, the Board, having the authority, in its sole discretion, may revise, modify,
replace and readopt the Title VI Plan from time to time.
�A,PPRO'JE S TO FORM
By: /�.4'`-C &i///`e/6
agle C °nty Attorney's Office
By:
Eagle County Commissioners' Office
MOVED, READ and ADOPTED by the Board of County commissioners of the
County of Eagle, State of Colorado, at its regular meeting held the i4 day
of 144v10e-t , 2016.
eAate COUNTY OF EAGLE, STATE OF
41Y 4 qt COLORADO,by and Through Its
ATTEST: `° (f BOARD OF COUNTY COMMISSIONERS
By: {�
Teak J. Simonton anne McQuee
Clerk to the Board of Chair
County Commissioners /
Jillian H. Ryan
Co ssioner //
Wikcathy C ae r-Henry
Commissioner
Commissioner A)-4 seconded adoption of the foregoing resolution. The
roll having been called, the vote was as follows:
Commissioner McQueeney N
Commissioner Ryan ILLASR
Commissioner Chandler-Henry •
This Resolution passed by2(0 vote of the Board of County Commissioners of the County
of Eagle, State of Colorado.
EXHIBIT A
EAGLE COUNTY GOVERNMENT
TITLE VI PLAN
AND
LANGUAGE ASSISTANCE PLAN
(CDOT/FHWA)
APRIL, 2016
1
TITLE VI AND NON-DISCRIMINATION POLICY STATEMENT
Eagle County, Colorado is committed to compliance with Title VI of the Civil Rights Act of
1964 and related statutes. It is the policy of Eagle County, Colorado that no person shall, on the
grounds of race, color, gender, national origin, religion, sex, sexual orientation, disability or age,
be excluded from participation in,be denied the benefits of, or be subjected to discrimination in
any operation of Eagle County Government as provided by Title VI of the Civil Rights Act of
1964 and related statutes.
This policy applies to Eagle County Government, including its contractors and anyone who acts
on behalf of Eagle County. This policy also applies to the operations of any department or
agency to which Eagle County, Colorado extends federal financial assistance. Federal financial
assistance includes grants, training, and use of equipment, donations of surplus property, and
other assistance.
Prohibited discrimination may be intentional or unintentional. Seemingly neutral acts that have
disparate impacts on individuals of a protected group and lack a substantial legitimate
justification are a form of prohibited discrimination. Harassment and retaliation are also
prohibited forms of discrimination.
Examples of prohibited types of discrimination based on race, color, gender, national origin,
religion, sex, sexual orientation, disability, or age may include: denial to an individual of any
lawfully required service, lawfully required financial aid or other lawfully required benefit;
distinctions in the quality, quantity, or manner in which a benefit is provided; segregation or
separate treatment; restriction in the enjoyment of advantages, privileges, or other benefits
provided; discrimination in activities related to highway and infrastructure or related facilities
built or repaired; and discrimination in employment.
Title VI compliance is a condition of receipt of federal funds. The Title VI Coordinator is
authorized to ensure compliance with this policy, Title VI of the Civil Rights Act of 1964, 42
U.S.C. § 2000d and related statutes, and the requirements of 23 Code of Federal Regulation
(CFR)pt. 200 and 49 CFR pt. 21.
I. STANDARD ASSURANCES
US Department of Transportation's Standard Title VI Assurances have been executed by the
Chair of the Eagle County Board of County Commissioners and are attached hereto as
Attachment 1. Eagle County shall ensure that the applicable appendices of the Standard
Assurance are included in each federally-assisted contract. The appendices include the
following: (a) general contract provisions; (b) clauses for deeds transferring U.S. property; (c)
clauses for transfer of real property acquired or improved under a FHWA activity, facility or
program; (d) clauses for construction/use/access to real property acquired under a FHWA
activity, facility or program; and (e)pertinent nondiscrimination authorities. The Standard Title
2
VI Assurances and related appendices may be amended from time to time by the federal
government, and such amendments are considered approved as if set forth herein,without further
action by the Board of County Commissioners.
II. TITLE VI COORDINATOR AND RELATED DUTIES
The Eagle County Manager or Assistant County Manager is ultimately responsible for assuring
full compliance with the provisions of Title VI of the Civil Rights Act of 1964 and related
statutes and has directed that non-discrimination is required of all agency employees, contractors,
and agents pursuant to 23 CFR Part 200 and 49 CFR Part 21.
Eagle County Government has appointed the Assistant County Manager to perform the duties of
the Title VI Coordinator and ensure implementation of its Title VI program. The Title VI
Coordinator is located within the office of Administration.
The Title VI Coordinator is responsible for:
1. Submitting a Title VI plan and annual reports on behalf of Eagle County;
2. Developing procedures for prompt processing and disposition of complaints;
3. Investigating complaints, compiling a complaint log, and reporting to other public
agencies as required;
4. Developing procedures for the collection and analysis of statistical data;
5. Developing a program to conduct Title VI reviews of program areas;
6. Conducting annual Title VI assessments of pertinent program areas;
7. Developing Title VI information for dissemination; and
8. Establishing procedures for resolving deficiencies and reducing to writing remedial
action agreed to be necessary.
III. PROGRAM AREA DESCRIPTIONS AND REVIEW PROCEDURES
A. Program Area Descriptions
1. Eagle County Engineering Department. The Eagle County Engineering Department
oversees the planning and design of public works projects. The Engineering Department
staff review development applications, oversee County floodplain administration and
issue flood plain development,road cut, grading and access permits.
2. Eagle County Regional Transportation Authority("Eco Transit"). Eco Transit maintains
a separate Title VI Plan in compliance with Federal Transportation Authority
requirements.
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3. Eagle County Road & Bridge Department. The Eagle County Road & Bridge Department
generally provides maintenance and snow removal on certain county roads to provide
safe, efficient roadways.
B. Review Procedures
On an annual basis, the Civil Rights Coordinator will, using the form attached as Attachment 2,
communicate with the directors of the above-referenced program areas to identify any areas of
discrimination or potential for discrimination. In the event of discrimination or an identified
deficiency, the Civil Rights Coordinator will together with the appropriate individuals within an
affected program area, work to timely implement a corrective plan or take such other action as
may be appropriate. Further, in instances where the County is a sub-recipient of federal aid, the
program area team shall be responsible for monitoring contractors and subcontractors for
compliance with Title VI.
IV. NOTICE OF RIGHTS
A. Dissemination of Title VI Information to Eagle County Employees
Eagle County's Title VI information shall be disseminated to Eagle County employees annually
via the Employee Handbook. The current Title VI Employee Handbook language is attached as
Attachment 3. Such language may be amended from time to time and such amended language
shall be considered approved and set forth herein without further action by the Eagle County
Board of County Commissioners. This information reminds employees of the Eagle County
Title VI and Nondiscrimination Policy Statement, and of their Title VI responsibilities in their
daily work duties. Employees actively acknowledge receipt of the Eagle County Employee
Handbook on an annual basis.
During new employee orientation, new employees shall be informed Eagle County's Title VI
Policy, and Eagle County's expectations to perform their duties accordingly. There may be
alternative, specific complaint policies for employees, contractors, inmates, etc. The Eagle
County Employee Handbook governs employment-related complaints of discrimination.
B. Dissemination of Title VI Information to the Public
Title VI information posters will contain the notice set forth below and shall be prominently
displayed on the Eagle County campus. The notice and the Title VI Plan are available on the
Eagle County website at www.eaglecounty.us. Questions relating to nondiscrimination
obligations can be obtained from Eagle County's Title VI Coordinator.
The Title VI Notice is available in Spanish on the Eagle County website and as Attachment 5.
4
Your Rights Against Discrimination under Title VI of the Civil Rights Act of 1964
Eagle County operates its programs and services without regard to race, color, gender, national
origin, religion, sex, sexual orientation, disability or age. Anyone who believes they have been
excluded from participation in, denied the benefits of, or otherwise subjected to discrimination
under any Eagle County program or activity because of their race, color, gender, national origin,
religion, sex, sexual orientation, disability or age may file a discrimination complaint with Eagle
County or the Colorado Department of Transportation.
Eagle County's Title VI Plan is available at www. eaglecounty.us
Eagle County's Title VI Coordinator is the Assistant County Manager.
To file a Title VI discrimination complaint, contact:
Attn: Assistant County Manager
500 Broadway
Post Office Box 850
Eagle, CO 81631
(970) 328-8604
Email: Eagleadmin @eaglecounty.us
Complaints may also be filed directly with:
Colorado Department of Transportation
Civil Rights &Business Resource Center
4201 East Arkansas Avenue, Room 150
Denver, CO 80222
(303) 757-9234
dot civilrights @state.co.us
Federal Highway Administration, Colorado Division
12300 West Dakota Avenue, Suite 180
Lakewood, CO 80228
Phone: 720-963-3000
Fax: 720-963-3001
V. TITLE VI COMPLAINT PROCEDURES
This Plan, including these complaint procedures is available on the Eagle County website at
www.eaglecounty.us. The procedures are also available in Spanish on the Eagle County website
and as Attachment 6.
5
A. Discrimination Complaint Procedure for Eagle County
Federal and state law prohibit discrimination on the basis of race, color, gender,national origin,
religion, sex, sexual orientation, disability, or age in any Eagle County program or activity.
Federal law requires that Eagle County investigate, track and report discrimination complaints.
Complaints must be filed in writing and will be investigated within sixty(60) days of
submission. If you need assistance to file your complaint or need interpretation services,please
contact the Assistant County Manager, Eagle County's Title VI Coordinator.
Who is eligible to file a complaint?
Anyone who believes they have been excluded from participation in, denied the benefits of, or
otherwise subjected to discrimination under any Eagle County program or activity because of
their race, color, gender, national origin,religion, age, sex, sexual orientation or disability may
file a complaint. The Eagle County Employee Handbook governs employment-related
complaints of discrimination.
Discrimination includes unlawful lack of access, harassment, retaliation and disparate impacts
from a program or activity. Harassment includes a wide range of abusive or humiliating verbal
or physical behaviors. Retaliation includes intimidating, threatening, coercing, or engaging in
other discriminatory conduct against anyone because they filed a complaint or otherwise
participated in a discrimination investigation.
How do you file a complaint?
Complaints must be filed within one hundred eighty(180) days from the last date of the alleged
discrimination. However, contact Eagle County's Title VI Coordinator if you believe your
complaint may fall outside this deadline.
Reasonable efforts will be made to assist persons with disabilities, non-English speakers, and
others unable to file a written complaint. For assistance in filing a complaint, please contact
Eagle County's Title VI Coordinator.
Complaints may be submitted via mail, email, fax or in person to:
Attn: Assistant County Manager
Eagle County Title VI Coordinator
500 Broadway
Post Office Box 850
Eagle, CO 81631
Telephone: (970) 328-8604
Fax: (970) 328-8629
Email:Eagleadmin @eaglecounty.us
6
Complaints may also be filed directly with the following agencies:
Colorado Department of Transportation
Civil Rights &Business Resource Center
4201 East Arkansas Avenue, Room 150
Denver, CO 80222
dot civilrights @state.co.us
Phone: 800-925-3427
Fax: 303-952-7088
Federal Highway Administration, Colorado Division
12300 West Dakota Avenue, Suite 180
Lakewood, CO 80228
Phone: 720-963-3000
Fax: 720-963-3001
What happens after a complaint is filed?
Title VI complaints will be investigated within sixty(60) days. Investigating a complaint
includes interviewing all parties involved and key witnesses. The investigator may also request
relevant information such as books, records, electronic information, and other sources of
information from all involved parties. You may specify if there is a particular individual or
individuals that you feel should not investigate your complaint due to conflict of interest or other
reasons.
Complaints related to employment with Eagle County will be addressed in accordance with the
Eagle County Handbook and related policies and procedures.
In some cases, complaints will be forwarded to either the Colorado Department of Transportation
or Federal Highway Administration for investigation. If your complaint is forwarded to one of
these agencies, you will be provided the name and contact information of the employee handling
your complaint.
Federal law prohibits retaliation against individuals because they have filed a discrimination
complaint or otherwise participated in a discrimination investigation. Any alleged retaliation
should be reported in writing to the investigator.
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Title VI Complaint Form
Please complete this form to the best of your ability. If you need translation or other assistance, contact
the Assistant County Manager.
Name
Address City Zip
Phone: Home Work Mobile
Email:
Basis of Complaint(circle all that apply):
Race Color
National Origin Gender
Sex Sexual Orientation
Age Disability
Retaliation Religion
Other:
Who discriminated against you?
Name
Name of Organization
Address City Zip
Telephone
How were you discriminated against?(Attach additional pages if more space is needed)
8
II
Where did the discrimination occur?
Dates and times discrimination occurred?
Were there any other witnesses to the discrimination?
Name Organization/Title Work Telephone Home Telephone
9
How would you like to see this situation resolved?
Have you filed your complaint, grievance, or lawsuit with any other agency or court?
Who When
Status(pending, resolved,etc.) Result, if known
Complaint number, if known
Do you have an attorney in this matter?
Name Phone
Address City Zip
Signed Date
VI. DOCUMENTING TITLE VI COMPLAINTS AND INVESTIGATIONS
All Title VI complaints will be entered and tracked in the Civil Rights Coordinator's log. Active
investigations will be monitored for a timely response on the part of all parties. The Complaint
Log shall include the following for each complaint:
Date Complaint Filed
Complainant
Basis of Complaint(i.e. race, color, national origin, etc...)
Summary of Allegation
Pending Status of Complaint
Actions Taken
VII. DATA COLLECTION
The program areas will provide to the Civil Rights Coordinator on an annual basis, data to assist
the Civil Rights Coordinator in identifying potential problem areas to ensure non-discrimination
and for reporting in the Annual Goals and Accomplishments report. See Attachment 4.
10
VIII. PUBLIC PARTICIAPTION
Eagle County has engaged the public in its planning and decision making processes, as well as
its marketing and outreach efforts. The public is consistently invited to participate in these
activities through notice in the local newspapers,posting on the Eagle County website, audio and
video recordings of meetings.
Eagle County strives to coordinate with the public including implementing community-based
public involvement strategies to reach out to members in the affected minority and/or low-
income communities.
The Eagle County Board of County Commissioners generally hold meetings each week and the
public is invited to attend and participate. Citizens may contact county commissioners and
county staff. Contact information is available on the Eagle County website at
www.eaglecounty.us. Questions and comments are distributed to relevant staff for timely
response to citizens.
IX. LANGUAGE ASSISTANCE PLAN
Limited English Proficient("LEP") individuals are those individuals for whom English is not
their primary language and have a limited ability to speak, read, write, or understand English.
Failure to provide language assistance for LEP persons may result in national origin
discrimination. Pursuant to Executive Order 13166, Eagle County as a FHWA sub-recipient has
performed an LEP analysis of the County and has developed a plan for providing language
assistance and outreach to LEP populations.
The following is the four-factor analysis was used to determine the measures necessary for
providing meaningful access for LEP individuals:
A. Identify the number or proportion of LEP persons likely to be encountered.
1. Permanent Population
The U.S. Census provides information to assist in estimating the number of limited
English speakers in the permanent population. For small urban areas and rural counties,
the best available data is from the U.S. Census 2010. In Eagle County 30.7% of the
population speaks a language other than English at home. This percentage is based upon
persons age 5 years or older for the period of 2010-2014. Of that 30.7% approximately
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89% (or 27.4%of the entire population) were Spanish speaking. Eagle County is
committed to monitoring LEP needs among the permanent population over time.
2. Visitors
There may be a potential need for special services for LEP individuals in our visitor
population. As a year round resort community, Eagle County attracts individuals from all
over the world. Eagle County is therefore sensitive to LEP needs among visitors to the
County.
B. Determine the frequency with which LEP persons come into contact with Eagle
County.
Various Eagle County employees have daily contact with Spanish speaking individuals.
Therefore, strategies to address this need have been developed and will continually be
reviewed, and improved where needed.
C. Determine the importance of a program, activity or service provided.
The nature and importance of LEP contact is high for Eagle County particularly in areas
where services and County staff interact directly with the public.
D. Identify the resources available.
Eagle County is committed to addressing the on-going need to assist LEP individuals.
Eagle County has and will contract with entities to provide verbal translation services by
telephone or other appropriate formats. Eagle County employs bilingual staff in key
program areas.
E. Plans for Future LEP Efforts
In order to identify potential future LEP needs with respect to services offered by Eagle
County, we will undertake the following:
i. Review census updates as they become available;
ii. Periodically review LEP needs with appropriate Eagle County staff;
iii. Make periodic contacts with school districts and other community agencies that
may know of LEP persons or groups; and
iv. Review surveys as they occur.
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F. Language Assistance Measures
Eagle County will implement the following to respond to LEP needs:
i. Provide information in Spanish, as needed;
ii. Obtain"I Speak Cards"to have on hand, if needed;
iii. Develop Spanish versions of materials, complaint forms, and notices as
appropriate and in accordance with applicable law; and
iv. Identify other community resources such as agencies serving LEP persons which
may have resources to share.
G. Staff Training
Eagle County will conduct staff training as needed on topics that may include:
i. Federal LEP requirements, LEP Plan and Title VI;
ii. Documenting language assistance requests; and
iii. Use of any language assistance measures as described above.
H. Outreach Efforts
Eagle County will:
i. Identify agencies that may serve LEP populations;
ii. Provide information on services, as appropriate; and
iii. Provide opportunities for LEP participation at public meetings, through
advertising and conduct of meetings, as appropriate.
I. Monitoring and Updating Plan
Eagle County will monitor and update the LEP Plan as needed. This will include:
i. Reviewing the LEP Plan with staff and making adjustments, as needed; and
ii. Pay particular attention to demographic changes in Eagle County and to any LEP-
related complaints received.
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J. Dissemination of Our LEP Plan
This document will be posted on the Eagle County website.
X. ADHERENCE TO ENVIORNMENTAL JUSTICE PRINCIPLES
Executive Order 12898 directs federal agencies to identify and address the disproportionately
high and adverse human health or environmental effects of their actions on minority and low-
income populations to the greatest extent practicable and permitted by law. As a recipient of
federal funding, Eagle County complies with the federal government's Environmental Justice
Policy.
To help ensure fair distribution of the benefits and burdens associated with Eagle County
programs and activities, Eagle County is guided by the following: (i)to avoid,minimize, or
mitigate disproportionately high and adverse human health and environmental effects, including
social and economic effects, on minority populations and low-income populations; (ii) to ensure
the full and fair participation by all potentially affected communities; and(iii) to prevent the
denial of, reduction in, or significant delay in the receipt of lawful benefits by minority and low-
income populations.
Eagle County will analyze demographic data from the U.S. Census and American Community
Survey to aid in identifying the locations and characteristics of the population in Eagle County
including minority and low-income populations. Eagle County will seek guidance from the
Colorado Department of Transportation and Federal Highway Administration for additional
guidance, if needed. Eagle County will consider whether an adverse effect is disproportionately
high for minority and low-income populations.
Eagle County will engage low income and minority populations in the decision-making process.
Effective communication will include traditional public outreach, including providing any
required notice to the public. Eagle County will work to hold public meetings at convenient and
accessible times, and will make information available on its website. Eagle County may
implement non-traditional outreach methods including, social media, direct mail and partnerships
with community groups.
XI. ANNUAL GOALS AND ACCOMPLISHMENT REPORT
Eagle County's Civil Rights Officer will complete CDOT's sub-recipient Annual Goals and
Accomplishments Report on an annual basis. This report will describe its Title VI compliance
efforts from the previous year. This report will include a summary of Title VI complaints
received during the prior year.
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ATTACHMENT 1
STANDARD TITLE VIINON-DISCRIMINATION ASSURANCES
DOT ORDER NO. 1050.2A
Eagle County, Colorado (herein referred to as the"Recipient"), hereby agrees that, as a condition
to receiving any federal financial assistance from the U.S. Department of Transportation (DOT)
Federal Highway Administration ("FHWA") through the Colorado Department of
Transportation, 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); and
•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:
"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 received Federal
financial assistance from the DOT, including the FHWA through the Colorado Department of
Transportation".
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.
15
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 FHWA assisted
programs:
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
all FHWA programs and, in adapted form, in all proposals for negotiated agreements regardless
of funding source:
"The County of Eagle, State of Colorado, in accordance with the provisions of Title VI of
the Civil Rights Act of 1964 (78 Stat. 252, 42 U.S.C. §,' 2000d-4) and the Regulations, hereby
notifies all bidders that it will affirmatively ensure that 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, a part of
a facility, the Assurance will extend to the entire facility and facilities operated in connection
therewith.
6. That where the Recipient receives Federal financial assistance in a 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:
16
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 extGndetl, 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, sub-grantees, 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, Eagle County, Colorado also agrees to comply and require any sub-
recipients, sub-grantees, contractors, successors, transferees, and/or assignees to comply with all
applicable provisions governing the FHWA and Colorado Department of Transportation 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 or Colorado Department of Transportation. You must keep records,
reports, and submit the material for review upon request to the FHWA or Colorado Department
of Transportation, 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.
Eagle County, Colorado 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 FHWA. This Assurance is binding on the State of Colorado, other
17
recipients, sub-recipients, sub-grantees, contractors, subcontractors and their subcontractors',
transferees, successors in interest, and any other participants in FHWA funded programs. The
person(s) signing below is authorized to sign this Assurance on behalf of the Recipient.
Eagle County, Colorado
by and through its
Board of County Commissioners
By: . {� � 4.
�
eanne McQueeeny, air
Date: S Z 6 t(o
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APPENDIX A
TO
STANDARD ASSURANCES
GENERAL CONTRACT PROVISIONS
Eagle County will include the following, as applicable, in federally assisted contracts:
During the performance of this Agreement, 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 Regulations relative to non-discrimination in Federally-assisted
programs of the U.S. Department of Transportation, [Insert Title of Modal Operating
Administration], as they may be amended from time to time, which are herein incorporated and
made a part of this Agreement.
2. Non-discrimination: The Contractor, with regard to the work performed by it during the
Agreement, 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 CFR Part 21. [Include Modal Operating
Administration specific program requirements]
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 Agreement and the Acts and Regulations relative to
on the grounds of race, color, or national origin.[Include Modal Operating
Administration specific program requirements].
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[Title of Modal Operating Administration] 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[Title of Modal Operating
19
Administration], 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[Inset Title of Modal Operating Administration] may determine to be appropriate,
including but not limited to:
a. withholding payments to the Contractor under the Agreement 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 thereto.
The Contractor will take action with respect to any subcontract or procurement as the Recipient
or the[Title of Modal Operating Administration]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.
20
APPENDIX B
TO
STANDARD ASSURANCES
CLAUSES FOR DEEDS TRANSFERRING UNITED STATES
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 Assurance 4:
NOW,THEREFORE, the U.S. Department of Transportation as authorized by law and upon
the condition that Eagle County, Colorado, will accept title to the lands and maintain the project
constructed thereon in accordance with[name appropriate legislative authority],the
Regulations for the Administration of[name appropriate program],and the policies and
procedures prescribed by 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 Eagle County,
Colorado 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 Eagle County, Colorado and
its successors forever, subject, however, to the covenants, conditions, restrictions and
reservations herein contained as follows, which will remain in effect for a 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 Eagle County, Colorado, it successors and assigns.
Eagle County, Colorado, 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 subject to discrimination with regard
to any facility located wholly or in part on, over, or under such lands hereby conveyed[,] [and *]
(2) that Eagle County, Colorado 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, Cody 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,
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-
21
discrimination conditions, the Department will have the 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.]*
(* 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).
22
APPENDIX C
TO
STANDARD ASSURANCES
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 County of Eagle, State of Colorado pursuant to the provisions of Assurance
7(a):
A. The (grantee, lessee, permittee, etc. as appropriate) for himself/herself,his/her heirs,
personal representatives, successors in interest, and assigns, as 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 even 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 (grantee, 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
Non-discrimination covenants, County of Eagle, State of Colorado, 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 of 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 County of Eagle, State of Colorado, 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 County of Eagle, State of Colorado 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.)
23
APPENDIX D
TO
STANDARD ASSURANCES
CLAUSES FOR CONSTURCTION/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 County of Eagle, State of Colorado pursuant to the
provisions of Assurance 7(b):
A. The(grantee, licensee,permittee, etc., as appropriate) for himself/herself,his/her heirs,
personal representatives, successors in interest, and assigns, as 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(grantee, 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, permits, etc.), in the event of breach of any of the above Non-
discrimination covenants, County of Eagle, State of Colorado 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, County of Eagle, State of Colorado will there upon revert to and vest in and become
the absolute property of County of Eagle, State of Colorado 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.)
24
APPENDIX E
To
STANDARD ASSURANCES
PERTINENT NON-DISCRIMINATION AUTHORITIES
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 non-
discrimination 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 CFR 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 CFR Part 27;
- The Age Discrimination Act of 1975, as amended, (42 U.S.C. §6101 et seq.), (prohibits
discrimination on the basis of age);
- Airport and Airway Improvement Act of 1982, (49 U.S.C. §471, Section 47123), as
amended, (prohibits discrimination based on race, creed, color, national origin, or sex);
- The Civil Rights Restoration Act of 1987, (PL 100-209), (Broadened 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);
- Title 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:
- The Federal Aviation Administration's Non-discrimination statute(49 U.S.C. §47123)
(prohibits discrimination on the basis of race, color, national origin, and sex);
- Executive Order 12898, Federal Actions to Address Environmental Justice in Minority
Populations and Low-Income Populations, which ensures against discrimination of
minority populations by discouraging programs,policies, and activities with
25
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.).
26
ATTACHMENT 2
Title VI/Non- Review Procedures for
Program Area General Description Discrimination Concerns Ensuring Non-
and Responsibilities Discrimination
Engineering Planning and design of public Public Participation Determine and verify manner
works projects including engagement of and type of public notice and
low income and minority out-reach for public meetings
populations and hearings
Right of Way Acquisitions Ensure relocation,if Evaluate any acquisitions to
applicable,occurs in a determine if minorities were
nondiscriminatory manner treated unfairly through
appraisal,relocation etc.
Construction oversight Ensure oversight of Verify FHWA/CDOT
contractors and contracts contain non-
subcontractors for Title VI discrimination language and
compliance related citations
Permitting Ensure equal access to Consider minority
permitting process populations served and
implement LAP plan as
needed
Road and Bridge Maintenance of certain county Seek to ensure non- Verify roads and bridges are
roads and bridges discrimination through maintained on a uniform basis
uniform maintenance and determine how
practices emergency maintenance and
repairs occur
27
ATTACHMENT 3
EMPLOYEE HANDBOOK INFORMATION
Eagle County, Colorado is committed to compliance with Title VI of the Civil Rights Act of
1964 and related statutes. It is the policy of Eagle County, Colorado that no person shall on the
grounds of race, color, gender, national origin, sex, sexual orientation disability or age,be
excluded from participation in,be denied the benefits of, or be subjected to discrimination in any
operation of Eagle County Government as provided by Title VI of the Civil Rights Act of 1964
and related statutes. The complete Title VI Plan and policy statement appear on the Eagle County
website.
All employees of Eagle County are expected to consider, respect, and observe this policy in their
daily work and duties. If a citizen approaches you with a question or complaint, direct him or
her to the Assistant County Manager and Eagle County Civil Rights Coordinator.
28
Attachment 4
Data Collection Form1
Program Type of Data Collected&Process Intended Outcome of Data Analysis
Area for Collecting (i.e.Title VI Purpose for Collecting the Data)
Engineering
Road and
Bridge
1 Describe Eagle County's process for collecting and analyzing data on the race,color,national origin,sex of
participants and beneficiaries of program activities. Examples might include tracking residents relocated through a
right of way program,residents impacted by road maintenance or snow removal and collecting US Census data on
populations impacted by programs
29
ATTACHMENT 5
TITLE VI NOTICE
(SPANISH)
Sus Derechos Contra la Discriminacion de Conformidad con el Titulo VI de la Ley de
Derechos Civiles de 1964
El condado de Eagle administra sus programas y servicios independientemente de criterios tales
como raza, color, genero, origen nacional, religion, sexo, orientacion sexual, discapacidad o
edad. Cualquier persona que considere que ha sido excluida de la participacion de, que se le han
negado los beneficios de, o que ha sido victima de discriminacion de alguna otra forma en algnn
programa o actividad del condado de Eagle en funcion de su raza, color, origen nacional,
religion, sexo, orientacion sexual, discapacidad o edad puede presentar una queja por
discriminacion ante el condado de Eagle o el Department of Transportation(Departamento de
Transporte) de Colorado.
El Plan del Titulo VI del condado de Eagle se publica en www.eaglecounty.us.
El Coordinador del Titulo VI (Title VI Coordinator) del condado de Eagle es el Subdirector del
Condado (Assistant County Manager).
Para presentar una queja por discriminacion en virtud del Titulo VI, dirijase a:
Atn.: Subdirector del Condado (Assistant County Manager)
500 Broadway
Post Office Box 850
Eagle, CO 81631
(970) 328-8604
Email:Eagleadmin @eaglecounty.us
Las quejas tambien se pueden presentar directamente ante:
Colorado Department of Transportation(Departamento de Transporte de Colorado)
Civil Rights &Business Resource Center(Centro de Recursos de Negocios y Derechos Civiles)
4201 East Arkansas Avenue, Room 150
Denver, CO 80222
(303) 757-9234
dot civilrights@state.co.us
Federal Highway Administration, Colorado Division
(Administracion Federal de Autopistas, Division de Colorado)
12300 West Dakota Avenue, Suite 180
Lakewood, CO 80228
Telefono: 720-963-3000
Fax: 720-963-3001
30
ATTACHMENT 6
TITLE VI COMPLAINT PROCEDURES AND COMPLAINT FORM
(SPANISH)
I. PROCEDIMIENTOS PARA QUEJAS EN RELACION CON EL TITULO VI
Para consultar este plan,junto con los procedimientos para presentar quejas, dirijase al sitio web
del condado de Eagle: www.eaglecountv.us. Los procedimientos tambien se publican en espafiol
en el sitio web del condado de Eagle y como Anexo 6.
A. Procedimiento para quejas por discriminacion del condado de Eagle
Las leyes federales y estatales prohiben la discriminacion en funcion de criterios tales como
raza, color, genero, origen nacional,religion, sexo, orientacion sexual, discapacidad o edad en
todas las actividades y programas del condado de Eagle. La ley federal exige que el condado de
Eagle investigue, lleve a cabo un seguimiento y comunique las quejas por discriminacion. Las
quejas deben presentarse por escrito y seran investigadas dentro de los sesenta(60) dias de su
presentation. Si necesita ayuda para presentar una queja o precisa servicios de interpretation,
comuniquese con el Subdirector del Condado (Assistant County Manager), el Coordinador del
Titulo VI (Title VI Coordinator) del condado de Eagle.
i.Quien es elegible para presentar una queja?
Cualquier persona que considere que ha sido excluida de la participation de, que se le han
negado los beneficios de, o que ha sido victima de discriminacion de alguna otra forma en algµn
programa o actividad del condado de Eagle en funcion de su raza, color, origen nacional,
religion, sexo, orientacion sexual, discapacidad o edad puede presentar una queja. El manual del
empleado del condado de Eagle regula las quejas por discriminacion relacionadas con el empleo.
La discriminacion incluye la denegacion de acceso de catheter ilegal, el acoso, las represalias y
los impactos desiguales derivados de un programa o actividad. El acoso abarca un amplio rango
de conductas fisicas o verbales de catheter abusivo o humillante. Entre las represalias, cabe
mencionar la intimidation, las amenazas, la extorsion o la adoption de otras conductas
discriminatorias dirigidas a alguna persona por haber presentado una queja o participado de
alguna otra forma en una investigation por discriminacion.
i.Como se presenta una queja?
Las quejas deben presentarse dentro de los ciento ochenta(180) dias de la iiltima fecha del
incidente de discriminacion alegado.No obstante, comuniquese con el Coordinador del Titulo VI
(Title VI Coordinator) del condado de Eagle si tree que su queja no entra dentro de este periodo.
31
Se tomaran medidas razonables para ayudar a aquellos con discapacidades, que no hablen ingles
o que no puedan presentar una queja por escrito por algun otro motivo. Si necesita ayuda para
presentar una queja, comuniquese con el Coordinador del Titulo VI (Title VI Coordinator) del
condado de Eagle.
Las quejas pueden enviarse por correo postal, email o fax, o entregarse en persona ante:
Atn.: Subdirector del Condado (Assistant County Manager)
Coordinador del Titulo VI (Title VI Coordinator) del condado de Eagle
500 Broadway
Post Office Box 850
Eagle, CO 81631
Telefono: (970) 328-8604
Fax: (970) 328-8629
Email:Eagleadmin@eaglecounty.us
Las quejas tambien pueden presentarse directamente ante alguna de las siguientes agencias.
Colorado Department of Transportation(Departamento de Transporte de Colorado)
Civil Rights &Business Resource Center(Centro de Recursos de Negocios y Derechos Civiles)
4201 East Arkansas Avenue, Room 150
Denver, CO 80222
clot civilrights @state.co.us
Telefono: 800-925-3427
Fax: 303-952-7088
Federal Highway Administration, Colorado Division
(Administracion Federal de Autopistas, Division de Colorado)
12300 West Dakota Avenue, Suite 180
Lakewood, CO 80228
Telefono: 720-963-3000
Fax: 720-963-3001
;.Que ocurre despues de que se presenta una queja?
Las quejas relacionadas con el Titulo VI se investigaran dentro de los sesenta(60) dias. La
investigacion de una queja conlleva interrogar a todos los involucrados y testigos clave. El
investigador tambien puede solicitar informacion pertinente, como libros, registros e informacion
electronica y de otras fuentes, a todos los involucrados. Si cree que cierta persona o personas no
deben participar de la investigacion de la queja por algun conflicto de interes u otro motivo,
usted puede indicarlo.
32
Las quejas relacionadas con el empleo en el condado de Eagle se abordaran de conformidad con
el manual del condado de Eagle, y las politicas y procedimientos pertinentes.
En algunos casos, las quejas se remitiran al Department of Transportation(Departamento de
Transporte) de Colorado o a la Federal Highway Administration(Administracion Federal de
Autopistas)para su debida investigacion. Si su queja se remite a alguna de estas agencias, se le
proporcionara el nombre y la informacion de contacto de la persona a cargo de su queja.
La ley federal prohibe la toma de represalias contra personas por haber presentado una queja por
discriminacion o participado de alguna otra forma en una investigacion por discriminacion.
Cualquier represalia alegada ha de informarse por escrito al investigador.
33
Formulario de quejas en virtud del Titulo VI
Complete este formulario de la mejor manera posible.Si necesita una traduccion o cualquier otro tipo
de ayuda, comuniquese con el Assistant County Manager(Subdirector del Condado).
Nombre y apellido
Direccion Ciudad Codigo postal
Telefono: Particular Laboral Celular
Email:
Motivo de queja(marque con un circulo todo to que corresponda):
Raza Color
Origen nacional Genero
Sexo Orientacion sexual
Edad Discapacidad
Represalias Religion
Otro:
Quien to/a discrimino?
Nombre y apellido
Nombre de la organizacion
Direccion _ Ciudad Codigo postal
Telefono
Como to/a discriminaron?(Agregue mos paginas si precisa mos espacio)
34
eDonde ocurrio el incidente/ocurrieron los incidentes de discriminacion?
dFechas y horas del incidente/de los incidentes de discriminacion?
cHubo testigos?
Nombre Organizacion/Cargo Telefono laboral Telefono particular
dComo le gustaria que se resolviera esta situacion?
35
Presentd esta queja, reclamo o denuncia ante alguna otra agencia o tribunal?
Ante quien Fecha
Estado(pendiente, resuelta, etc.) Resultado, si to sabe
Numero de queja o reclamo, si to sabe
dPuso un abogado?
Nombre Telefono
Direccion Ciudad Codigo postal
Firma Fecha
36