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A TRUE COPY
<br />CERTIFICATION ON LAST PAGE
<br />ATTACHMENT III RYAN L. BUTLER, CLERK
<br />XXX COUNTY HEALTH DEPARTMENT
<br />CIVIL RIGHTS COMPLIANCE AND NON-DISCRIMINATION CERTIFICATE
<br />The CHD agrees to completethe Civil Rights Compliance Questionnaire, DH Forms 946 A and B (orthe subsequent
<br />replacement if adopted during the contract period), if so requested by the Department.
<br />2. The CHD assures that itwill comply with the Omnibus Budget Reconciliation Act of 1981, P.L. 97-35, which prohibits
<br />discriminationon the basis of sex and religion in programs and activities receiving orbenefiting f romfederal financial
<br />assistance.
<br />Assurance of Civil Rights Compliance: The CHID hereby agrees that it will comply with Title VI of the Civil Rights
<br />Act of 1964 (42 U.S.C. 2000d et seq.); Title IX of the Education Amendments of 1972 (20 U.S.C. 1681 et seq.);
<br />Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794); the Age Discrimination Act of 1975 (42 U.S.C. 6101
<br />et seq.); Title II and Title III of the Americans with Disabilities Act (ADA) of 1990, as amended by the ADA
<br />Amendment Act of 2008 (42 U.S.C. 12131-12189) and as implemented by Department of Justice regulations at 28
<br />CFR Parts 35 and 36; Executive Order 13166, "Improving Access to Services for Persons with Limited English
<br />Proficiency" (August 11, 2000); all provisions required by the implementing regulations of the U.S. Department of
<br />Agriculture (7 CFR Part 15 et seq.); and FNS directives and guidelines to the effect that no person shall, on the
<br />ground of race, color, national origin, age, sex, or disability, beexcluded from participation in, be denied the benefits
<br />of, orotherwise be subjected to discrimination under any program oractivity forwhich the agency receives Federal
<br />financial assistance from FNS; and hereby gives assurance that it will immediately take measures necessary to
<br />effectuate this agreement.
<br />By providing this assurance, the CHD agrees to compile data, maintain records and submit records and reports
<br />as required to permit effective enforcement of the nondiscrimination laws, and to permit Department personnel
<br />during normal working hours to review and copy such records, books and accounts, access such facilities, and
<br />interview such personnel as needed to ascertain compliance with the non-discrimination laws. If there are any
<br />violations of this assurance, the Department of Agriculture shall have the right to seek judicial enforcement of this
<br />assurance.
<br />This assurance is given in consideration of and for the purpose of obtaining any and all Federal financial
<br />assistance, grants, and loans of Federal funds, reimbursable expenditures, grant or donation of Federal property
<br />and interest in property, the detail of Federal personnel, the sale and lease of, and the permission to use Federal
<br />property or interest in such property or the furnishing of services without consideration or at a nominal
<br />consideration, or at a consideration that is reduced for the purpose of assisting the recipient, or i n recognition of
<br />the public interest to be served by such sale, lease, or furnishing of services to the recipient, or any improvements
<br />made with Federal financial assistance extended to the Program applicant by USDA. This includes any Federal
<br />agreement, arrangement, or other contract that has as one of its purposes the provision of cash assistance for the
<br />purchase of food, and cash assistance for purchase or rental of food service equipment or any other financial
<br />assistance extended in reliance on the representations and agreements made in this assurance.
<br />This assurance is binding on the CHD, its successors, transferees, and assignees as long as it receives or retains
<br />possession of any assistance from the Department. The person or persons whose signatures appear below are
<br />authorized to sign this assurance on the behalf of the CHD.
<br />Confidentiality of Data, Files, and Records: The CHD agrees to restrict the use and disclosure of confidential USDA,
<br />Women, Infant, and Children (WIC) applicant and participant information as specified in 7 CFR § 246.26(d)(1)(i) in
<br />accordance with 7 CFR § 246.26(d)(1)(ii), as applicable.
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