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Contract Number 00027858 / Page 25 of 33 <br /> FEDERAL CERTIFICATIONS <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 /> . M 4Z A-e�� <br /> Signature Title <br /> Orange County, NC G f fl - z-- <br /> Provider Name Date <br /> [This Certification Must be Signed by the Same Individual Who Signed the Proposal Execution Page] <br /> L 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 (R.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 />