Orange County NC Website
Browse       Search
28 <br />FEDERAL CERTIFICATIONS Contract Number 00027858 /Page 25 of 33 <br />The undersigned states that: <br />1 He or she is the duly authorized representative of the Provider named below; <br />2, He or she is authorized to make, and does hereby make, the following certifications on behalf of the Provider, as set <br />out herein: <br />a. The Certification Regarding Nondiscrimination; <br />b. The Certification Regarding Drug -Free Workplace Requirements, <br />c The Certification Regarding Environmental Tobacco Smoke; <br />d, The Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered <br />Transactions; and <br />e, The Certification Regarding Lobbying; <br />3 He or she has completed the Certification Regarding Drug -Free Workplace Requirements by providing the addresses <br />at which the contract work will be performed; <br />4 [Check the applicable statement] <br />[ ] He or she has completed the attached Disclosure Of Lobbying Activities because the Provider has made, or <br />has an agreement to make, a payment to a lobbying entity for influencing or attempting to influence an officer or <br />employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a <br />Member of Congress in connection with a covered Federal action; <br />OR <br />[X] He or she has not completed the attached Disclosure Of Lobbying Activities because the Provider has not <br />made, and has no agreement to make, any payment to any lobbying entity for influencing or attempting to <br />influence any officer or employee of any agency, any Member of Congress, any officer or employee of Congress, <br />or any employee of a Member of Congress in connection with a covered Federal action, <br />5. The Provider shall require its subcontractors, if any, to make the same certifications and disclosure, <br />Signature <br />Orange County, NC <br />Provider Name <br />(!� ,. f f ° /Z--_ <br />Date <br />[This Certification Must be Signed by the Same Individual Who Signed the Proposal Execution Page] <br />In Certification Regarding Nondiscrimination <br />The Provider certifies that it will comply with all Federal statutes relating to nondiscrimination. These include but are not <br />limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88 -352) which prohibits discrimination on the basis of race, color <br />or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S C, § §1681 -1683, and 1685- <br />1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended <br />(29 U S.0 §794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as <br />amended (42 U S. C. § §6101 - 6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and <br />Treatment Act of 1972 (P..L. 92 -255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the <br />Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91 -616), as <br />amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) Title VIII of the Civil Rights Act of <br />1968 (42 U.S C § §3601 et seq ), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (h) <br />the Food Stamp Act and USDA policy, which prohibit discrimination on the basis of religion and political beliefs; and (i) <br />the requirements of any other nondiscrimination statutes which may apply to this Agreement <br />