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DocuSign Envelope ID: 1582AE24-D793-4A66-9311-4472000BOEC3 <br /> Contract#68-2004 <br /> Personalized Patient Home Assistance, Inc.. <br /> II. The site(s)for the performance of work done in connection with the specific agreement are listed <br /> below: <br /> 1. <br /> (Street address) <br /> (City, county, state,zip code) <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 /> Docu�'Slrigned by: <br /> �w6f(,c a <br /> Agency director <br /> BG2F-0DOAA94BE... <br /> Signature Title <br /> Personalized Patient Home Assistance 7/14/2015 <br /> Agency/Organization Date <br /> (Certification signature should be same as Contract signature.) <br /> Federal Certification-Drug-Free Workplace(07/10) Page 2 of 2 <br />