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DocuSign Envelope ID: E51E535C-r71e-44A8-80o0eEAe7rrA0A81 <br /> . ' <br /> D. The site(s) for the performance of work done in connection with the specific agreement are listed <br /> below: <br /> l. <br /> (Street <br /> zip <br /> (City, county, uV�� 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 certUfiuod000r violation of the certification shall hm grounds for suspension of payment, suspension <br /> or termination of grants, or government-wide Federal suspension or debarment <br /> 45 C.F.R. Section 82.510. Section 4 CFR Part 85,Section 85.615 and 86.620. <br /> CERTIFICATION REGARDING NONDIS <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 1904 (Y.L. 88-352)which prohibits <br /> discrimination on the basis of race, color ornational origin; (b) Title IX of the Education Amendments of <br /> 1972, as amended (20 U.S.C. §O168l'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 /> G80101'6107)` 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; ([) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation <br /> Act of 1970 (P.[. 91'616)` as amended, relating to nondiscrimination on the basis of alcohol abuse or <br /> alcoholism; (g) Title VIII of Civil Rights Act of 1968 (42 U.S.C. 8�30O| et seq.), as amended, <br /> ` ` ' = — (42 ^^ ' <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 /> DocuSigned by: <br /> Agency di rector <br /> 7—r.~^~~~~B` <br /> SiAouUuo: Title <br /> personalized Patient Home Assistance 7/21/2017 <br /> Agency/Organization Date <br /> (Certification signature should benuooeuaCoutcmutoiguuk/ru.) <br /> Federal Certification Drug-Free Workplace&Nondiscrimination rev. 06-2015 <br /> Page 2o[2 <br />