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Contract#68-2004 <br /> Personalized Patient Home Assistance,Inc.. <br /> I1. The site(s)for the performance of work done in connection with the specific agreement are listed <br /> below: <br /> 1. loo <br /> (Street address) <br /> pic,114, 1 j� 0 r4l n�j a) A) C .2 7 <br /> (City,county, state,zip c ) <br /> 2. <br /> (Street address) <br /> (City,county,state,zip code) <br /> Contractor will inform the County of any additional sites for performance of work under this agreement. <br /> False certification or violation of the certification shall be grounds for suspension of payment,suspension <br /> or termination of grants,or government-wide Federal suspension or debarment(45 C.F.R. Section <br /> 82.510. Section 4 CFR Part 85, Section 85.615 and 86.620). <br /> CERTIFICATION REGARDING NONDISCRIMINATION <br /> The Vendor certifies that it will comply with all Federal statutes relating to nondiscrimination.These <br /> include but are not limited to: (a)Title VI of the Civil Rights Act of 1964(P.L. 88-352)which prohibits <br /> discrimination on the basis of race,color or national origin; (b)Title IX of the Education Amendments of <br /> 1972,as amended(20 U.S.C. §§1681-1683,and 1685-1686),which prohibits discrimination on the basis <br /> of sex;(c)Section 504 of the Rehabilitation Act of 1973,as amended(29 U.S.C. §794),which prohibits <br /> discrimination on the basis of handicaps;(d)the Age Discrimination Act of 1975, as amended(42 U.S.C. <br /> §§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 <br /> abuse;(f)the Comprehensive Alcohol Abuse and Alcoholism Prevention,Treatment and Rehabilitation <br /> Act of 1970(P.L.91-616), as amended,relating to nondiscrimination on the basis of alcohol abuse or <br /> alcoholism;(g)Title VIII of the Civil Rights Act of 1968(42 U.S.C. §§3601 et seq.),as amended, <br /> relating to nondiscrimination in the sale,rental or financing of housing; (h)the Food Stamp Act and <br /> USDA policy,which prohibit discrimination on the basis of religion and political beliefs; and(i)the <br /> requirements of any other nondiscrimination statutes which may apply to this Agreement. <br /> a- � c�CJZiZ <br /> Signature Title <br /> Agency/Orgamzation Date <br /> (Certification signature should be same as Contract signature.) <br /> Federal Certification-Drug-Free Workplace(07/10) Page 2 of 2 <br />