Orange County NC Website
DocuSign Envelope ID:A6134E61D-095E-4A51-9823-BOEE0861F374 <br /> Contract Number 00041435, Amendment Number 4/ Page 13 of 20 <br /> FEDERAL CERTIFICATIONS <br /> The undersigned states that: <br /> 1. He or she is the duly authorized representative of the Contractor named below; <br /> 2. He or she is authorized to make, and does hereby make, the following certifications on behalf of the Contractor, as set <br /> out herein: <br /> a. The Certification Regarding Nondiscrimination; <br /> b. The Certification Regarding Drug-Free Workplace Requirements; <br /> c. The Certification Regarding Environmental Tobacco Smoke; <br /> d. The Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered <br /> Transactions; and <br /> e. The Certification Regarding Lobbying; <br /> 3. He or she has completed the Certification Regarding Drug-Free Workplace Requirements by providing the addresses <br /> at which the contract work will be performed; <br /> 4. [Check the applicable statement] <br /> [ ] He or she has completed the attached Disclosure Of Lobbying Activities because the Contractor has made, <br /> or has an agreement to make, a payment to a lobbying entity for influencing or attempting to influence an officer <br /> or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a <br /> Member of Congress in connection with a covered Federal action; <br /> OR <br /> [X] He or she has not completed the attached Disclosure Of Lobbying Activities because the Contractor has not <br /> made, and has no agreement to make, any payment to any lobbying entity for influencing or attempting to <br /> influence any officer or employee of any agency, any Member of Congress, any officer or employee of Congress, <br /> or any employee of a Member of Congress in connection with a covered Federal action. <br /> 5. The Contractor shall require its subcontractors, if any, to make the same certifications and disclosure. <br /> DocuSigned by: <br /> &ivl bt.A. skway- Health Director <br /> 999E3445 .. <br /> Signature Title <br /> Orange County Health Department 1/28/2022 <br /> Contractor Name Date <br /> [This Certification Must be Signed by the Same Individual Who Signed the Proposal Execution Page] <br /> I. Certification Regarding Nondiscrimination <br /> The Contractor certifies that it will comply with all Federal statutes relating to nondiscrimination. These include but are <br /> not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, <br /> color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §§1681-1683, and <br /> 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as <br /> amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of <br /> 1975, as amended (42 U.S.C. §§6101-6107), which prohibits discrimination on the basis of age; (e)the Drug Abuse Office <br /> and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the <br /> Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as <br /> amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) Title VIII of the Civil Rights Act of <br /> 1968 (42 U.S.C. §§3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (h) <br /> the Food Stamp Act and USDA policy, which prohibit discrimination on the basis of religion and political beliefs; and (i) <br /> the requirements of any other nondiscrimination statutes which may apply to this Agreement. <br />