HomeMy WebLinkAboutAgreement A-17-521 with CDPH.pdf$TATE OF,OALIFORf\l.IA
CALI.FORI'JIADEPARTMENT 0F PlJr:ILIC li~ALTH
CEB:TIFICAJJON REGAR.DING LOBBYIN(;
Exlliolt.F
Attachment 1
(1) No Fedl3~1.approprl?teo fi:J~ds h~Y~ S~.er1 pal~ or vv)ll ey~ paid, ·by or.·on !)~h~tf pf the underS,ign~d, to
any person for fnfiL!ehCfng or :sttempt!hg 'tq)t:Jfl~en~ ~n ()fflce:r:.or eir)p!.oye~ of an ~ger'!cy, a Member of Congress,
ar'( officer Or ~mploy?e-of Congress, pran eh)piQy~e Q[.a 1\ilefri!)!'lr·of Cohgress 1n connecti9n with the maKin§,
awa(dihg . .or entering i.nto of this Federaj cc:mfra.ct; F.e9~ral gra~t, or cooperatiVI!i ~greement, and lh!!! eX:tension,
contl'tlllation, .re.ne\val; amendm€!nt, or mod.ificatio!Yoffh.i~ Federal cqntracti .grant, orpooperative agreement
r2) If any·fuQds other than Feder<1!j ~pproprfated fund,!; .hav~ !;>~en pa1d or Will be. paid to aqy person for
infhi.enqihg .Cir attempting to frifl4ence an :9ffi¢er' or' employee of at:Jy. agency o1 the LJnited Stafes GoV.ernflletit, a
ME;Jrnb.er of r;>ong(es~. an ciffi~er or. employee ~f Congre,ss, or ~111 iilJrlployee' 'Of a Member ol congress in
connectloh .With this Federal contra.ct, grant. or coop:§!rCJtiV!3 ag,rt::?€/rhen.t, tne uhde{slglietl shall conipl.ete and submit
standard Forrfl. LL!-, "btsc;loS\Jre of Lo.bbyiqg f;~Hi/f!ie$" \n aqcoidance with lfs lhstrudlons. .
(3) T)le undersigned sh~lll. require that the ran:gUB!ff<!! of this certifi'catib~ be Included in the :award
obl='unients, tor all sub~wards at· aU tler~ (inqfudingsuqcontr:?Jctqf's; ~u~c!Ontracts, iiihti contracts uqder cooperative
agrr:;em~nts} OT $1 00;0(10 or rriqre; aniJ that ·(:Iii S,lfDrecJplef'lts Sh<'Jll. c·ertifY arid di$clbse accordilfgly.
This c~til.~G:§Ition is a matenal representatio.n efta;ct URQn V.<l:lich relianpe: was placed ~'111311 tl1is tr;alisac:tlon was
made or entered jn<to. SJ.tbmji:.siqr'l of this~certificatidn· is a -preteqtff~1te J6r rl'ia~itig pr .ent~rlng lpt9 thi$ 'tr~n~~ction
it)Jpp~ecj l:ly $¢ctl on 1352, Title; 3t1 U.S;~ .• ·an)' perso~ 'Nhb fail S:Jh fil.e th·t? re.q Uire ~ c~ttifiJ;Etipn· s.h~ll be su t5Ject to
a c.lvil p:e'nalfy ofrfot l.ess tharr §to;ooe and nqt more tnancS1.0%POOJor eacn such failure,
Brian Pacheco
~rtntlld r-,;at'lle~rt.:Jn Sigl'li~g !i Con!rn~ ·
After execution by or on.behalf of Contractor, pleasereturnto:
Calif9mia D~paqmer:~t<::!f Public Health
Ch~lrman, Board. of.Su pervisors
ATTEST:
BERNICE E. SEIDEL, Clerk
Board of Supervisors
By~~d
eputy
CDPH reserves the< righHo notifly the Gohtractor in writing of analternat:e submission adclress~ .. ·' . . . ' .. ~ ' .
(rev: 1oll4i
$TA:TE OF CA:l:.IFORNIA
CALIFORNIA CIVIL RIGHTS. LAWS ATTACHMENT
l:iG,S<;JL:S.04:(R;eiJ. O.i{i7.) .
tiEPARTMETf( OF !3B'JERA\l S.ERVIC~S
OFfLbE CiF'LEG'ALSI::RVICES
Pursu~nt to Pul;)trc Golitr?¢ Cqde e;~gtlon ,2~10ra per~on that s~bmits a 1?1d 9r prcppo~l to~ or
otherwise pro(Dbses to entet" in.te . .Or~new~aconttactwtth, 'a st~te agencywfth·•r~sf?ecttq any
cohtract In the amoutit·of:}l100,000 or above ~haf!·~ttTfy •. Vndffirpeflatty perjury, alth(Hime·tl9e
bid or proposal It:; s1.1bm.itte:d qr:tne ~;;ontri3ct is·tehewep, ~1Fof·1tlefollowing~
' ' ' ' >, ",-' ' '',. '
1, CAUFORNIA CJV.IL RIGHTS LAWS: Fo,rcolltMgts ex13goted or r:enew.ed afier Jafluary 1.
20·ft the oontr9otorcel\ifres tqlliplianr;;~ with. tne Unnil;tPMI,.RigbtsAct (~ect!on 51' ofth~. Cfvil
C9de) and the Fair Employment and Hbt!sfngA~t-.(Section 12960 ofthe Government Code};
a~ . .· .. .
4-EMRhQYER DISCRIMINATORY POliCIES: For contr~ctsexacuted ont;;oewed afte~
Jani.:rary l, 2017 ,rr a· Contractor na·s·ari interttal policy against· a sovereign nation or peoples
recogpize~ by th~Unlted.Sl9.~sggvemrm~~t, the,Contrac~or>C9rtiflesij1atsuch. pqliciE?s are not
used In violation of the· Unruh Clvil Rights Act {SS,ction 51 or-tile Civl.l Code) .orthe Fair
Erilployrnent and Housing A!;:t {S~c~iori 1.2960 Of ti:Je Gqv~rtn'llent Oeide).
CERTHfJCATION
rl,tne o~ici~J nam~d belo~,pettlf.Y u~der;~·ell~Jty ofp~rJwytf~der:
I the.: ra~vs qf the· State of Calrfqrnia tha.t :ttu~ fpregolr)g I~ tOJe ~net
1 correct.
I
·.1· Proposer!Bklde. r ~~rrn·.N<ime (Pifnted)·
1
County of Fresrw
r"".,;.__.;;..;.~-.. -· ·;.....;--.. ~·· .·~_.,;._;....,;. __________ . ·---· -· .
1. By·(r. C1./f1o{iz$cJ ·Signature) . . . ATTEST:
I • ,\ \ BERNICE E. SEIDEL, Clerk l . P~ . Board of Supervisors
t1itffiffirTName ahdTTtTi'Ot£=iets6n-:siinlfrQ_..,.,._,.~....,.-:-~ By cR~ ~
! .. Bria.h 8~checoi :Chainnal'!1 Board of Siipervfsor:S \ ~ oJ#5
fb~t~':'E8§¢ute-J-~--~-=-~-,.. .. ~~fEx~tu(~& rn7hi;:c¢u~(y$iili$T~te bf~ ----.-~-i
l~~-ale .. ~rl-----,--L-~~r.:_~~~:_--"-~~~----~_8~lf<ir~~:_~----.,;._-.-J
f Pe(/eral JCiNbmbe.i · ·· -. -~
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