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DocuSign Envelope ID: A07C4620 -D9F0- 4228- 9B2F- lD499E5F8796 <br />H. The site(s) for the performance of work done in connection with the specific agreement are listed <br />below: <br />I. <br />2. <br />(Street address) <br />(City, county, state, zip code) <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 <br />45 C.F.R. Section 82.510. Section 4 CFR Part 85, Section 85.615 and 86.624. <br />CERTIFICATION REGARDING NONDISCRM41NATION <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 />I Dacu5igned by, <br />6V'b{{�.t.u. h. 1�aVlr'46tn. <br />73BC2FODOAA.94BE... <br />Signature <br />Agency director <br />Title <br />Personalized Patient Home Assistance 722/2018 <br />Agency /Organization Date <br />(Certification signature should be same as Contract signature.) <br />Federal Certification - Drug -Free Workplace & Nondiscrimination rev. 06 -2015 <br />Page 2 of 2 <br />