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Home My WebLink AboutAgreement A-17-416 with CDPH for PHEP Funds.pdfCCC 04/2017 CERTIFICATION I, the official named below, CERTIFY UNDER PENALTY OF PERWRY that I am duly authorized to legally bind the prospective Contractor to the clause(s) listed below. This certification is made under the laws of the State of California. Contractor/Bidder Firm Name (Printed) Federal ID Number County of Fresno 946000512 I By .el!ized Signature) ATTEST: BERNICE E. SEIDEL, Clerk Board of Supervisors Printed Name and Title of Person Signing By d. liD.' • e .. ~ Brian Pacheco, Chairman, Board of Supervisors R y \ ! Date Executed Executed in the County of II ~ .l e, '!'.\.. cg J.()\\ Fresno ...., CONTRACTOR CERTIFICATION CLAUSES 1. STATEMENT OF COMPLIANCE: Contractor has, unless exempted, complied with the.nondiscrimination program requirements. (Gov. Code §12990 (a-f) and CCR, Title 2, Section 11102) (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 manufacture, 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: 1) the dangers of drug 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 a 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 department determines that any of the following has occurred: the Contractor has made false certification, or violated the I Exhibit F Federal Terms and Conditions STATE OF CAliFORNIA CALIFORNIA DEPARTMENT OF PUBLiC HEALTH CERTIFICATION REGARDING LOBBYING The undersigned certifies, to the best or his or her knowledge and bsiief. that; (1) No Federal approprialc~d runds have been pa!d or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress. an officer or employee or Congress, or an employee of a Member of Congress in connection with the making. a·,...,arding or entering into of this Federal contract, Federal grant, or cooperative agreement, and the extension, contimlalion, renewal, amendment, or modification of lhis 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 an officer or employee of any agency of the United States Government, a Member of Congress, an officer or empfoyee of Congress. or an employee of a Member of Congress in connection with !his Federal contract, grant, or cooperative agreement, the undersigned shall complete and submit Standard Form LLL. "Disclosure of Lobbying Activities" in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tlers {including subcontractor's. subconlrac!s, and contracts under cooperative agreements) of $100,000 or more, and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of lttis certincatlon is a prerequisite for making or entering into this transaction imposed by Section 1352, Tille 3i. U.S.C., any person who falls to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. -------------·-··------··------- County of Fresno Nsme of Contractor #17-10153 Cor.tracl l·lilmlro1 Aiter execution by or on behalf of Contractor, please return to: California Department of Public Heaith Brian Pacheco Chairman, Board of SupeNisors AlTEST: BERNICE E. SEIDEL, Clerk Board of Supervisors By cf\~ ~puty CDPH reserves the right to nolifiy llle Contractor in writing of an alternate submission address. (Rev 04/16) Page 10 of 12 STATE OF CALIFORNIA CALlFORNIA CIVIL RIGHTS LAWS ATTACHMENT DGS OLS 04 {Rev. 01/17) DEPARTMENT OF GENERAL SERVICES OFFICE OF LEGAL SERVICES 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 perjury, 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 recognized by the United States government, the Contractor certifies that such policies are not used in violation of the Unruh Civil Rights Act (Section 51 of the Civil Code) or the Fair Employment and Housing Act (Section 12960 of U1e Government Code). CERTIFICATION r--------------------------------------------------------r----------------------, 1 I, the official named below, certify under penalty of perjury under Federa/ID Number ' ! the laws of the State of California that the foregoing is true and I I j correct. I 946000512 f I I l I Proposer/Bidder Firm Name (Pn'nted) I '1 I I I County of Fresno I I I ! I r-------------------------------------------------------· ---------------~ I I By (Au~~riief Signature) ATTEST: V.t:.._l1 ~ BERNICE E. SEIDEL, Clerk 1-Board of Supervisors 1 ~~ted-Nan1eanCTr#lio7~if.Son-s~ning--------------------~ .J\ • n 1 By UJ•_O. , ~ 1 Brian Pacheco, Chairman, Board of Supervisors§i'uty 1-------------------------------r---------------------j.~-ic.+~-;;F-----==--.----- J Date Executed 1 Executed in t11e County and State of 1 I I I ! ~~.~ g W\\ I Fresno California I L ___ :__.:_.:...:-u----+-------------L---------------------------------------------J ATTACHMENT 19 2017-2022 Public Health Emergency Preparedness (PHEP), General Fund Pandemic lnfluenza (GF Pan Flu) and Hospital Preparedness Program (HPP) Funding NON-SUPPLANTATION CERTIFICATION FORM ~-•• "•• ••-"•'"-'' ~· ••••• • ••••• ••·-~ -••,,••• ~··••R ,'"' ·-:•-•'••• Name of Local Entity: County of Fresno As the duly authorized representative of the above-named County, I hereby certify as follows: 1. The funds allocated by the California Department of Public Health (CDPH) under the Contract wilf not be used to supplant funding for existing levels of service and shall only be used for the purposes specified in the Contract. 2. Upon receipt, the funds will be deposited into an interest-bearing local public health preparedness trust fund established solely for this purpose before the funds are transferred or expended for any of the purposes allowed in the Application Work Plan and Budget, as approved by the CDPH. Chairperson, Board of Supervisors, Mayor of a City or designee: Signature: Printed Name: Brian Pacheco i Title: Chairman, Board of Supervisors Phone: 559-600-1000 Date: ~'-~,~,.., __ ATTEST: BERNICE E. SEIDEL, Clerk Board of Supervisors By~~ \__ De uty Please return the original signed certification with your FY 2017-22 PHEP, GF Pan Flu and HPP Funding Agreement to: California Department Public Health Emergency Preparedness Office Attn: Local Management Unit MS 7002 P.O. Box 997377 Sacramento, CA 95899-7377 Page I ofl