HomeMy WebLinkAbout29694Agreement No. 17-638
California Department of Public Health -Federal Terms and Conditions
STATE OF CALIF.ORNIA
CALIFORNIA DEPARTMENT OF'PUBLICHEALTH
'
CERTIFICATION REGARDING LOBBYING
The un·dersigned certifies, to the best of his or her knowledge arid li.>elief, that:
Exhibit F
Attachment 1
(1) No Federal appr,opriated funds have been paid or will be paid, by or on behalf of the undersigned, to
any p~~son for influencing cir attempting to influence an officer or employee of an agency, a Mernber of Congress,
ari officer or employe~ of Congress, or an ernployee of a· Member of Congress in connection with the making,
awarding or entering into of fhis Fe_deral cohtracCFederal grant, or cooperative agreement, and the extension,
continuation, renewal, arnendment, or.modification of this·Federal contract, grant, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have. been paid or will be paid to any person for
influencing or attempting to influence a.n officer or employee of any agency of the United States Government, a
Member of Congress, an officer or Elmployee of Corigr~ss, or ah_ employee of a Memoer of CongrE;)SS iri
connection with this Federal contract, grant; or cooperative ~greement, the unaersigned shall com·pIete and submit
Standard Form LLL, "Disclosure of Lobbying Activities" in accordance with its instructions.
(3) The under.signed shall require that the lang4age of t.his cE;)rtification be inc.ludel;I in the award
d_ocumerits for all. subal(\/ar,ds at• alJ tiers (i11c:luding subC3r~ntee~, subgrants, arid contracts Linder grant~ ana
cooperative agreements) of $1 oo;ooo or more, and that all subtec:ipierit~ shall certify arid dis¢Ibse accordiAgly:
This certification is a material representation of. fact upon which rel,ancewas placed wheh this transaction was
made or entered into. Submission of this certification is a prereqi.ii~ite f0r making or enfering into this transaction
imposed by Section 1352, Title 31, U.S.C_., any person whqj;iiils t'? file the require~ certification shall be subject to
a c.ivil penalty of not less than $1G,OOO anq not more than $10Q,OOO.for.each ·such failure.
County of Fresno
Name c:,f Granlao
#17~10306
Contract I Grant Number
~ ,';).,~n
After execution by or on behalf of GrantE;)e, pJease return tc:i:
Caiifornia Qepartrnent of Public Health
Program
P.O. Box 997371,MS XX·X
Sacramento, CA 95899-XXXX
Brian Pacheco
· Prinle.d l'JP!)iP. 01 Persoh.Signln1fro(Gran1ee
·· ~ignaturc of Person Signing for Grnn1ee
l:iUe
ATTEST:
Chairma_n Qf. tf:le Board of
Supervisors of t_he County of Fresno
BERNICE E. SEIDEL
CDPH reserves the right to notifiy the Grantee in writing of an alternate submission address.
CrJPH (rev. 07116) Page.! •f 1-1
/ CERTIFICAttON REGAROING L0$BY'ING
O:of'liplS,te this f<YrrilJOJ;Ji~Clcise'.Jolli::iyfritl,~C~VitiespUfsL(an.t,to'31 U,~;C.1352
{Se~ reveJse for publicburcfen disclosure}
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D $v~wart.4~e .
11er ......,. ff ~nol',TI;
iO,~. ~lririW_~j1dAdpr¢s1tf!H.obby.tig ,F~e9is1ra111
flNricfiviaaa./, iii~t na;'1ie1 fif§t: nBrrift: Mi.l:
ATTEST:
BERNICE E. SEIDEL
Clerk to the Board of Supervisors
County of Fresno, State of California
By d\,~ ~ Deputy
,Repor:tType;
[ f S: , ·fnft]af fifff1!1
b, [ll~fe_nal. t&.mge.
Fo, ~Tatenal Ghti~~~Only;
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cf ale. of ,ast i'~PW! _. __ ..
5, mRi;)i)otJJrig EntJtY-ri,N.9; <tla $utiawari.r~1 i;nJ::ir Name
and Addre:s~ i:Jr Prl,~e:
· .9, Aw.atd ~mounl,
$
~. ln(;ilvJ~µ~ls P!.lrfmrning (lnc{udirl~;arf,:i~£s ff qt(f.c;,(cmt frprrt.
Ula. .
(L;i;~t name, /=!r(tfnif¢e; MQ:
STATE OF CALIFORNIA
CALIFORNIA CIVIL RIGHTS LAWS ATTACHMENT
DGS OlS 04 (Rev, 01/17) . . .
DEPARTMENT OF GENERAL SERVICES
OFFICE OF LEGALSERVICES
Pursuant to Public Contract Code sectio11 2010, a person that s1,1bmlts 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 o.r above shall certify, under pen'alty perjury, at ~he~time the
bid or proposal is submitted or the-contract is renewed, all df the following, ·
1. GALIFORNIA GIVlL RIGHTS LAWS: Forcontracts executed or renewed after .:January 1,
2017, the contractor.certifies complic::incewith the Unru,h CivHRights Act (Section 51 of the Civil
Gode) and ttie Fair Employment and. Housing Ac\ (Section 12960 of the Government Code); ahd · ·
2. EMPLOYER DISCRIMINATORY POLICIES: For contracts executed or renewed after
January 1, 2017, if a Gonfrador has, ari internal jlOlicy agairisJ a sovereign nation or peo11les
recognized by the United States government, the Gontractor certifies !hat such policies are not
used in violation of the Unruh CMI Rights Act (Section 51 of the Civil Code) or the Fair
Em11loyment and Housing Act (Section 12960 of the Government Code), ·
CERTIFICATION
r1 ·. t. he o·.ffic·j_·al. nam .. e.d be· I. ow, _certijy u. ~0.; er pepajty .?f .. p~rJyry under TFedera/10 M11i1ber .-----1· I the laws of the State of.Galiforn1a tha.t the foregomg·1.s true.:ti.nd · ·
l~~d . . I 94.eooos12 •
I Proposer/Bfd-,(Jr Firm Name (Printed) ·
1 i County of Fresno ·,
r --------------·---· ------------------------! Bi(Autwri~·edSignature) . . ATTEST:
I . \ BERNICE E. SEIDEL
1 . . ... r..J-. . . ,, . Clerk to the Board of Supervisors
'" -----.,.·.--·· ·----.------·---,-·· '··-..,.;~-' -----------··
Printed Nam.e and TitiEJ of Person· S .. 1gr···Jfi1'g. · · ... · co""ty of ''~'"4 ca111om1,
Brian Pacheco, Chairman, Board ef Supervisors \ By cR,/yJ. . Deputy
· -. · ·-• -. ··· -----------------·""-· · ·-r·-· ·· --------. ---------. ---. ------------------1 Date Executed I Ex~cuteg in the County and State of I
~~ Q ol'DM I Fresno .. California !
L----------. . -. ---• . ·-'· -. . -------L-··--------------------------------------------J