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19 <br />DEPARTMENT OF HEALTH AND HUMAN SERVICES <br />DMSION OF PUBLIC HEALTH <br />CERTIFICATION REGARDING ENVIRONMENTAL TOBACCO SMOKE <br />Certification !or Contracts, Grants, Loans and Cooperative Agreement <br />Public Law 103-227, Part C-Environmental Tobacco Smoke, also known as the Pro-Children Act of 1994 <br />(Act), requires that smoking not be permitted m any portion of any indoor facdity owned or leased or <br />contracted for by an entity and used routinely or regularly for the provision of health, day care, education, <br />or Lbruy services to children under the age of 18, if the services are funded by Federal programs either <br />directly or through State or local governments, by Federal grant, contract, loan, or loan guarantee. The law <br />does not apply to children's services provided in private residences, facilities fimded solely by Medicare or <br />Medicaid funds, and portions of facilities used far inpatient drug or alcohol treatment. Failure to comply <br />with the provisions of the law may resuh in the imposition of a civil monetary penalty of up to S 1,0.00 <br />per day and/or the imposition of an administrative compliance order on the responsible entity. <br />By signing and submitting this application, the Contractor certifies that h will comply with the <br />requirements of the AcK. The Contractor further agrees that it will require the language of this certification <br />be included is any subawards that contain provisions for children's services and that all subgrantees shall <br />certify accordingly. <br />Signature <br />Title <br />Agency/Organization Date <br />(Certification signature should be same as Contract signature.) <br />