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CERTIFICATION
I , the offic ia l named below, CERTIFY UNDER PENALTY OF PE RJURY that I am dul y
authorized to lega ll y bind the prospective Contractor to the clause(s) li sted below. This
certificatio n is made unde r the laws of th e State of Cali forn ia.
Contractor/Bidder Firm Name (Prin t ed)
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Federal ID Number
I By r1 c r r ignature)
Pritzted Na~e and Title °t Person Signing
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oL +-V\ o n1.u"' o '-~ irP c:.. \r\ f"I
Date Executed
...., I Executed in the County of h-e.s no
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CONTRACTOR CERTIFICATION CLAUSES
1. STATEMENT OF COMPLIANCE: Contracto r has, unl ess exempted , complied with
the nondiscrimination program requirements. (Gov. Code §12990 (a-f) and CCR, Title 2,
Section 1 11 02) (Not applicab le to public e ntiti es.)
2. DRUG-FREE WORKPLACE REQUIREMENTS: Contracto r will comply with t he
requirements of the Drug-Free Workplace Act of 1990 and w ill provide a drug-free
workplace by taking the fo ll owing actions:
a. Publish a statement notifying e mployees that unlawful m a nufacture, distribution,
dispensation , possession or use of a contro lled substance is prohibited and sp ecify in g
actions to be taken against emp loyees fo r v io latio ns.
b . Establ ish a Drug-Free Awaren ess Program to inform employees a bout:
1) the dangers of drug abus e in the workplace;
2) the person's or organ ization's policy of maintaining a drug-free workp lace;
3) any avai lab le counse lin g, rehabilitation and empl oyee assistance programs; and,
4) penalties that may be imposed upon e mpl oyees for drug abus e v io lations .
c . Every empl oyee who works on the proposed Agreement wi ll :
1) receive a copy of the company 's drug -free workplace policy s tatement; and,
2) agree to a bid e by the term s of the compa ny's statem e nt as a condition of e mpl oyment
on t he Agreem e nt.
Failure to compl y w ith these requirements may res ult in suspe ns ion of payments under
th e Ag reement or termi nation of the Agreement or both and Contractor may be ineligible
for award of a ny fu ture State agreements if th e department determines that any of th e
fol lowing has occurred : the Contractor h as made false certification, or v io lated the
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STATE OF CALIFORNIA
CALIFORNIA CIVIL RIGHTS LAWS ATTACHMENT
DGS OLS 04 (Rev. 01/17)
DEPARTMENT OF GENERAL SERVIC E S
OFFICE OF LEGAL SERVIC ES
Pursuant to Public Contract Code section 2010, a person that submits a bid or proposal to, or
otherwise proposes to enter into or renew a contract with, a state agency with respect to any
contract in the amount of $100,000 or above shall certify, under penalty of perj ury, at the time
the bid or proposal is submitted or the contract is renewed , all of the following:
1. CALIFORNIA CIVIL RIGHTS LAWS : For contracts executed or renewed after
January 1, 2017, the contractor certifies compliance with the Unruh Civil Rights Act (Section
51 of the Civil Code) and the Fair Employment and Housing Act (Section 12960 of the
Government Code); and
2. EMPLOYER DISCRIMINATORY POLICIES: For contracts executed or renewed after
January 1, 2017, if a Contractor has an internal policy against a sovereign nation or
peoples re cogn ized by the United States government, the Contractor certifi es that such
policies are not used in vio lation of the Unruh Civil Rights Act (Sectio n 51 of the Civil Code)
or the Fair Employment and Housing Act (Section 12960 of the Government Code).
CERTIFICATION
I, the official named below, certify under penalty of perjury under the la ws of the State of
California that the foregoing is true and correct.
Proposer/Bidder Firm Name (Printed) Federa l ID Number
~~~ ob f'.r-eSY"\O ·· l)e,pcvM'fY'\ errv-\-
_o_b_~_eh __ CL_v_·•_o-f"_cJ __ ~ ________ AnEsT:
By (Authorized Signature) BERN ICE E. SEIDEL
Clerk to the Board of Supervisors
County of Fresno, State of California {L ~,i__
___________________ By ~ ~&\Cbp Deputy
Printed Name and Title of Perso n Signing
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1
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Ob ~e. ~~ ob rreS,nO
Executed in the County of ,-,,
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Date Executed
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Executed in the State of
STATE OF CA LI FORNIA DE PARTMENT OF RE HABI LI TATION
GRANT/CONTRACT SIGNATURE AUTHORIZATION
DR 325 (Rev . 12/98) Compute r Generated
G RA NTEE/CO NT RAC T O R:
STATE OF CALIFORNIA
Department of Rehabilitation
721 Capitol Mall
S UBG RA NTEE/C O NT RACT EE :
(Legal Corpora t io n/Pub lic Agency Name & A ddress )
Sacram e nto , California 95814
The following persons are authorized to request reimbursement of
expenses incurred as a result of the agreement between the
Grantee/Contractor and Subgrantee/Contractee named above :
Signa t ure Na me (Please T ype or Print) T itle (Pleas e T ype or Print)
£S ~ ~ 1)t£WtUl-ll--fedd-Oi'rec:f-o-y-
Signature Name (Pl ease T ype or Print) T itle (Please Type or Print)
£S
Signature Name (P lease T ype or Pri nt) Ti tl e (Please Type or Print)
£S
Signature Name (Please Ty pe o r Print) Ti tl e (Please Type or Print)
£S
I hereby delegate authority to request reimbursement of expenses
as shown above .
Authorized Signature per Board Resolution
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ATTEST:
BE RN ICE E. SE IDEL
Cl e r k to t he Bo ard o f Supervisors
Cou nty of Fre sn o, State o f Cal ifornia
By ~~3-sho-p De puty
Name (Please Type or Print) Brian Pache co ,
Ch a irman of the Board of Super visors
Date Sig ned
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