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DocuSign Envelope ID:6640lB51-89A1-4507-BCA8-FE809341297F <br /> R. 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 <br /> 45 C.F.R.Section 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 VIE 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 /> GocuSigned by, <br /> : <br /> ��I{r President <br /> 05COC•14C66FF,4C8. -- — <br /> Signature Title <br /> Premier Home Health Care Services, inc.9/30/2019 <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 />