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a5 <br />NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES <br />DIVISION OF PUBLIC HEALTH <br />CERTIFICATION REGARDING ENVIRONMENTAL TOBACCO SMOKE <br />Certification for Contracts, Grants, Loans and Cooperative Agreements <br />Public Law 103-2~7, Part C-Environmental Tobacco Smoke, also known as the Pro-Children Act <br />of 1994 (Act), requires that smoking not be permitted in any portion of any indoor facility owned <br />or leased or contracted for by an entity and used routinely or regulazly for the provision of health, <br />day care, education, or librazy services to children under the age of 18, if the services are funded <br />by Federal programs either directly or through State or local governments, by Federal grant, <br />contract, loan. or loan guarantee. The law does not apply to children's services provided in <br />private residences, facilities funded solely by Medicare or Medicaid funds, and portions of <br />facilities used for inpatient drug or alcohol treatment, Failure to comply with the provisions of <br />the law may result in the imposition of a civil monetary penalty of up to $1,000 per day and/or <br />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. Zhe Contractor further agrees that it will require the language of this <br />certification be included in any subawazds that contain provisions for children's services and that <br />all subgrantees shall certify accordingly. <br />Authorized Agency Official Signature Title <br />Official Agency Name Date <br />(Signature should be same as Contract signature) <br />Smoke 5/00 <br />