HomeMy WebLinkAbout32258CCC-307
CERTIFICATION
I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that I am duly
authorized to legally bind the prospective Contractor to the clause(s) listed below. This
certification is made under the Jaws ofthe State of California.
Contractor/Bidder Firm Name (Printed) Federal JD Number
4-6000-512
. Executed in the County of ATTEST:
BERNICE E. SEIDEL, Clerk
Fresno Board of Supervisors
B~,"-~t:t CONTRACTOR CERTIFICATION CLAUSES . eputy
1. STATEMENT OF COMPLIANCE: Contractor has, unless exempted, complied with
the nondiscrimination program requirements. (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 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 ofthe
following has occurred: the Contractor has made false certification, or violated the
Slale of Califomia-Heallh and Human Services Agency California Deparlmenl of Public Heallh
Conlracls and Purchasing Services Seclion
Darfur Contracting Act
Pursuant to Public Contract Code (PCC) sections 10475-10481, 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 10477(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. DAP
Initials
2.
Initials
3.
Initials
CERTIFICATION
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
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
10477(b) or submit a contracUpurchase order. A copy of the written permission from
DGS is included with our bid, proposal or contracUpurchase order.
OR
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 10476.
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)
CDPH 9067 (4/09)
Federa/10 Number
94-6000-512
ATIEST:
BERNICE E. SEIDEL, Clerk
Board of Supervisors
Board of Supervisors s& l ,:,t , (_~
Executed in the County and State of
Fresno, CA