HomeMy WebLinkAboutAgreement A-13-712-2 with CDPH.pdfCCC-307
CERTIFICATION
I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that 1 am duly
authorized to legally bind the prospective Contractor to the clause(s) listed below. This
certification is made under the Jaws of the State of California.
·-·~.
Contractor/Bidder Firm Name (Printed) Federal ID Number
County of Fresno 94-6000-512 --........... ~ .. , ... -=· --~--
By (Authorized Signature)
F~ /3. .. I .L ~~--<-... ~ .... .,., __ -, ....
Printed Name and Title of Per.f(m Signing ATTEST:
""' '·
. -·
Ernest Buddy Mendes, Chairman, Boar~_o3 S~p:rvisors BERNICE E SEIDEL, -· -Clerk Board of Supervisors Date Executed Executed in the Coun~y of B{:fu,.}~· < (\ !}.: ~~~ ·1 a01 v Fresno
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CONTRACTOR CERTlFICATlON CLAUSES
l. STA TEMEN'l' OF COMPLIANG.'!;.: Contractor has, unless exempted, complied with
the nondiscrimination program ret]Uirements. (Gov. Code§ 12990 (a-f) and CCR, Title 2,
Section 81 03) (Not applicable to public entities.)
2. DRUG-FREE WORKPLACE REQUIREMENTS: Contractor will comply with the
requirements of the Drug-Free Workplace Act of 1990 and will provide a drug-free
workplace by taking the following actions:
a. Publish a statement notifying employees that unlawful tmmufacture, distribution,
dispensation, possession or use of a controlled substance is prohibited and specifYing
actions to be taken against employees for violations.
b. Establish a Drug-Free Awareness Program to inform employees about:
I) the dangers of dmg abuse in the workplace;
2) the person's or organization's policy of maintaining a drug-free workplace;
3) any available counseling, rehabilitation and employee assistance programs; and,
4) penalties that may be imposed upon employees for drug abuse violations.
c. Every employee who works on the proposed Agreement will:
1) receive u copy ofthe company's drug-free workplace policy statement; and,
2) agree to abide by the terms of the company's statement as a condition of employment
on the Agreement.
Failure to comply with these requirements may result in suspension of payments under
the Agreement or termination of the Agreement or both and Contractor may be ineligible
for award of any future State agreements if the depa1tment determines that any of the
following has occurred: the Contractor has made false certification, or violated the
Page 1 of 4
C•ltfo/'11l., ll<>t'811mentof PubliC ll•.>lth
Canlram and Purc:ha11110 SnfVIGOI SeC-tion
Darfur Contracting Act
Pursuant to Public Contract Code (PCC) sections 104 75-10481, the Darfur Contracting Act's intent is to
preclude State agencies from contracting with scrutinized companies that do business in the African nation of
Sudan. A scrutinized company is a company doing specified types of business in Sudan as defined in PCC
section 10476. Scrutinized companies are Ineligible to, and cannot, contract with a State agency for goods or
services (PCC section 10477(a)) unless obtaining permission from the Department of General Services
according to the criteria set forth in PCC section 1 0477(b).
Therefore, to be eligible to contract with the California Department of Public Health, please Initial one of the
following three paragraphs and complete the certification below:
1.
2.
EBM
Initials
We do not currently have, or we have not had within the previous
three years, business activities or other operations outside. of the United States.
OR
We are a scrutinized company as defined in Public Contract Code
Initials section 10476, but we have received written permission from the Department of General
Services (DGS) to submit a bid or proposal pursuant to Public Contract Code section
1 0477(b) or submit a contract/purchase order. A copy of the written permission from
OGS is included with our bid, proposal or contract/purchase order.
OR
3. We currently have, or we have had within the previous three years,
business activities or other operations outside of the United States,
but we certify below that we are not a scrutinized company
as defined in Public Contract Code section 104 76.
CERTIFICATION
I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that I am duly authorized to legally bind this
company to the clause listed above. This certification is made under the laws of the State of California.
Company Name (Printed)
County of Fresno
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By (Authorized Signawre)
~a, ...... '-. ~1--.-.J-1-J~'>-~-A _______ _
Printed Name and Title of Person ~gning
Federai/D Number
94-6000-512
E Ernest Buddy Hcndes, Chairman, Board of Supervisors
":}";: J aD tv -J Ex•!:::~~~;• c~:::~~::··~ Oi
-~ ~ -~ ..... ~ ..... ~--.... ,.# ... ~-~&· ... -· .. s=:;;-~-ap~.;:o
ATTEST:
BERNICE E. SEIDEL, Clerk
Board of Supervisors
1:
CDPH 9067 (4/09) .,:j(_ti'r .. C'.L~
Dep
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