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DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E <br /> City, State, Zip Code <br /> Street <br /> City, State,Zip Code <br /> 3. Contractor will inform the Department of any additional sites for performance of work under this agreement. <br /> 4. False certification or violation of the certification may be grounds for suspension of payment, suspension or <br /> termination of grants, or government-wide Federal suspension or debarment. 45 C.F.R. 82.510. <br /> III. Certification Regarding Environmental Tobacco Smoke <br /> Public Law 103-227, Part C-Environmental Tobacco Smoke, also known as the Pro-Children Act of 1994 (Act), requires <br /> that smoking not be permitted in any portion of any indoor facility owned or leased or contracted for by an entity and used <br /> routinely or regularly for the provision of health, day care, education, or library services to children under the age of 18, if <br /> the services are funded 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 private residences, facilities <br /> funded solely by Medicare or Medicaid funds, and portions of facilities used for inpatient drug or alcohol treatment. <br /> Failure to comply with the provisions of the law may result in the imposition of a civil monetary penalty of up to <br /> $1,000.00 per day and/or the imposition of an administrative compliance order on the responsible entity. <br /> The Contractor certifies that it will comply with the requirements of the Act. The Contractor further agrees that it will <br /> require the language of this certification be included in any subawards that contain provisions for children's services and <br /> that all subgrantees shall certify accordingly. <br /> IV. Certification Regarding Debarment, Suspension,Ineligibility and Voluntary Exclusion Lower Tier <br /> Covered Transactions <br /> Instructions <br /> [The phrase "prospective lower tier participant" means the Contractor.] <br /> 1. By signing and submitting this document, the prospective lower tier participant is providing the certification set out <br /> below. <br /> 2. The certification in this clause is a material representation of the fact upon which reliance was placed when this <br /> transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an <br /> erroneous certification, in addition to other remedies available to the Federal Government, the department or agency <br /> with which this transaction originate may pursue available remedies, including suspension and/or debarment. <br /> 3. The prospective lower tier participant will provide immediate written notice to the person to whom this proposal is <br /> submitted if at any time the prospective lower tier participant learns that its certification was erroneous when <br /> submitted or has become erroneous by reason of changed circumstances. <br /> 4. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "participant," <br /> "person," "primary covered transaction," "principal," "proposal," and "voluntarily excluded," as used in this clause, <br /> have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549, 45 <br /> CFR Part 76. You may contact the person to whom this proposal is submitted for assistance in obtaining a copy of <br /> those regulations. <br /> 5. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered transaction <br /> be entered into, it shall not knowingly enter any lower tier covered transaction with a person who is debarred, <br />