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DEPARTMENT OF HEALTH AND HUMAN SERVICES <br /> DMSION OF PUBLIC HEALTH <br /> CERTIFICATION REGARDING ENVIRONMENTAL TOBACCO SMOKE <br /> Certification for Contracts,Grants,Loans and Cooperative Agreements <br /> Public Law 103-227,Part C-Environmental Tobacco Smoke,also known as the Pro-Children Act of 1994 <br /> (Act),requires that smoking not be permitted in any portion of any indoor facility owned or leased or <br /> contracted for by an entity and used routinely or regularly for the provision of health,day care,education, <br /> or library services to children under the age of 18,if the services are funded by Federal programs either <br /> directly or through State or local governments,by Federal grant,contract,loan,or loan guarantee.The law <br /> does not apply to children's services provided in private residences,facilities funded solely by Medicare or <br /> Medicaid funds,and portions of facilities used for inpatient drug or alcohol treatment.Failure to comply <br /> with the provisions of the law may result in the imposition of a civil monetary penalty of up to$1,000.00 <br /> per day and/or the imposition of an administrative compliance order on the responsible entity. <br /> By signing and submitting this application,the Contractor certifies that it will comply with the <br /> requirements of the Act.The Contractor further agrees that it will require the language of this certification <br /> be included in any subawards that contain provisions for children's services and that all subgrantees shall <br /> certify accordingly. <br /> df,L�� Health Director <br /> Signature 0 <br /> / /Title <br /> Orange County Health Dept. 'T <br /> Agency/Organization Date <br /> (Certification signature should be same as Contract signature.) <br />