Contract Template For Use With Private Sector Contracts Page 3

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12. Federal Certifications:
Individuals and Organizations receiving federal funds must ensure compliance with certain certifications required
by federal laws and regulations. The contractor is hereby complying with Certifications regarding
Nondiscrimination, Drug-Free Workplace Requirements, Environmental Tobacco Smoke, Debarment,
Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions, and Lobbying. These
assurances and certifications are to be signed by the contractor’s authorized representative.
13. Specific Language Not Previously Addressed:
( can be delted if not needed)
14. Signature Warranty: The undersigned represent and warrant that they are authorized to bind their principals to the
terms of this agreement.
The Contractor and the County have executed this contract in duplicate originals, with one original being retained by each
party.
__________________________________________________________________________________________________
Signature
Date
____________________________________________________________________
_______________
Printed Name
Title
COUNTY
___________________________________________________________________________________________________
Signature
(must be legally authorized to sign contracts for County DSS)
Date
Vickie K Smith______________________________________________________________Director_______________
Printed Name
Title
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act.
________________________________________________________________________________________________
Signature of County Finance Officer
Date
Contract-General (07/13)
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