HomeMy WebLinkAbout32184STATE OF CALIFORNIA
CALIFORNIA DEPARTMENT OF PUBLIC HEALTH
CERTIFICATION REGARDING LOBBYING
The undersigned certifies, to the best of his or her knowledge and belief, that:
Exhibit F
Attachment 1
(1) No Federal appropriated funds have been paid 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 of Congress, or an employee of a Member of Congress in connection with the making,
awarding or entering into of this Federal contract, Federal grant, or cooperative agreement, and the extension,
continuation, renewal, amendment, 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 an officer or employee of any agency of the United States Government, a
Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in
connection with this Federal contract, grant, or cooperative agreemen~ 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 tiers (including subGrantees, subgrants, and contracts under grants and
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 this certification is a prerequisite for making or entering into this transaction
imposed by Section 1352, Title 31, U.S.C., any person who fails 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
Name of Grantee
t/15-10419
Contract I Grant Number
D~ J.A, ~15
After execution by or on behalf of Grantee, please return to:
California Department of Public Health
Immunization Branch
850 Marina Bay Pkwy., Bldg. P, 2nd Floor
Richmond, CA 94804
Chairman, Board of
Tille
ATTEST:
BERNICE E. SEIDEL, Clerk
Board of Supervisors ~ . (\ B(Jlf\c\.<~ ._ D , ty
CDPH reserves the right to notifiy the Grantee in writing of an alternate submission address.
(Rev. 7/14) Page 6 of 8
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CCC-307
CERTIFICATION
I, the official named below, CERTIFY UNDER PENALTY OF PER.JUR Y 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)
County of Fresno
Printed Name and Title of Person Signin
Deborah A. Poochigian, Chairman, oard of Supervisors I Executed in the County of
Fresno
CONTRACTOR CERTIFICATION CLAUSES
Federal ID Number
94-6000-512
ATIEST:
BERNICE E. SEIDEL, Clerk
Board of.
I. STATEMENT OF COMPLIANCE: Contractor has, unless exempted, complied with
the nondiscrimination program requirements. (Gov. Code §12990 (a-f) and CCR, Title 2,
Section 8103) (Not applicable to public entities.)
2. DRUG-FREE WORKPLACE REQUIREMENTS: Contractor will comply with the
requirements ofthe 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 infonn 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:
I) receive a copy ofthe company's drug-free workplace policy statement; and,
2) agree to abide by the tenns of the company's statement as a condition of employment
on the Agreement.
Fl:l.ilure to comply with these requirements may result in suspension of payments under
the Agreement or tennination 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