Michigan Department ofl Transportation 2068 (08/19)  PUBLIC ACT 51, SECTION 18j, MCL 247.668j Annual Certification of Employee-related CERTIFICATION YEAR 2023  Conditions  CITY OR VILLAGE NAME  City of Melvindale  Beginning September 30, 2015, and annually each September 30 thereafter, certification must be made for compliance to Section 18j(1) of Public. Act 51 of 1951, MCL 247.668j(1). A local road agency must certify that it has (a) developed an employee compensation plan for its employees as described OR (b) the local road agency must certify that medical benefits are offered to its employees or elected public officials in compliance with the publiclly funded health insurance contribution act, 2011 PA 152, MCL 15.561 to 15.569, or, that it does not offer medical benefits to its  employees or elected public officials. Compliance with(1)(a)  Icertify compliance with MCL247.668X1)a).  Our compensation plan for employees meets the minimum criteria of MCL 247.668j (a)(i-iv).  Compliance with (1)(b)  Icertify compliance with! MCL 247.668J(1)(b), and as such, offer one oft the following:  Icertify that medical benefits are offered to employees ore elected public officials in compliance with the publically Icertify thatt the local road agency has exemptedi itself from thep publically funded health insurance contribution act,  funded! health insurance contribution act, 2011 PA 152; or  2011 PA 152; or  Icertify thatr medical benefits are not offered to employees or elected public officials.  Non-compliance with (1)(a) or (1)(b)  Icertify that we are noti inc compliance with MCL 247. 668j(1).  lunderstand that failure to comply with certification of (a) or (b) OfMCL247.6681) may resulti int the withholding of all or  part of the distributions made to this local road agency from the Michigan Transportation Fund. This form must be signed byt the Street Administrator and the Treasurer or Financial Director.  SIGNATURE PRINTED1 NAME Richard S. Ortiz TITLE Street Administrator  Ahler PRINTED NAME Michel Belch TITLE Treasurer  DATE 09/26/23  DATE 09/26/23  Due Each September 30 Return the completed form to: E-mail to: MDOT-Outreach@Michigan.gov, OR Fax to: (517)335-1828  Michigan Department of Transportation, Financial Operations Division, P.O. Box 30050, Lansing, MI 48909,OR