Common use of Certification Regarding Use of State Funds Clause in Contracts

Certification Regarding Use of State Funds. In the case that Party is an employer and this Agreement is a State Funded Grant in excess of $1,001, Party certifies that none of these State funds will be used to interfere with or restrain the exercise of Party’s employee’s rights with respect to unionization. State of Vermont – Attachment C Revised AHS – 9-3-2014 ATTACHMENT F AGENCY OF HUMAN SERVICES’ CUSTOMARY CONTRACT PROVISIONS

Certification Regarding Use of State Funds. In the case that Party is an employer and this Agreement is a State Funded Grant in excess of $1,001, Party certifies that none of these State funds will be used to interfere with or restrain the exercise of Party’s employee’s rights with respect to unionization. State of Vermont – Attachment C Revised AHS – 6-9-3-2014 ATTACHMENT F AGENCY OF HUMAN SERVICES’ CUSTOMARY CONTRACT PROVISIONS

Certification Regarding Use of State Funds. In the case that Party is an employer and this Agreement is a State Funded Grant in excess of $1,001, Party certifies that none of these State funds will be used to interfere with or restrain the exercise of Party’s employee’s rights with respect to unionization. State of Vermont – Attachment C Revised AHS – 911-37-2014 2012 ATTACHMENT F AGENCY OF HUMAN SERVICES’ CUSTOMARY CONTRACT GRANT PROVISIONS

Certification Regarding Use of State Funds. In the case that Party is an employer and this Agreement is a State Funded Grant in excess of $1,001, Party certifies that none of these State funds will be used to interfere with or restrain the exercise of Party’s employee’s rights with respect to unionization. State of Vermont – Attachment C Revised AHS – 911-37-2014 2012 ATTACHMENT D MODIFICATION OF CUSTOMARY PROVISIONS OF ATTACHMENT C OR ATTACHMENT F AGENCY OF HUMAN SERVICES’ CUSTOMARY CONTRACT PROVISIONS1. The insurance requirements contained in Attachment C, Section 7 are hereby modified:

Certification Regarding Use of State Funds. In the case that Party is an employer and this Agreement is a State Funded Grant in excess of $1,001, Party certifies that none of these State funds will be used to interfere with or restrain the exercise of Party’s employee’s rights with respect to unionization. (End of Standard Provisions) State of Vermont – Attachment C Revised AHS – 9-3-2014 ATTACHMENT F AGENCY OF HUMAN SERVICES’ CUSTOMARY CONTRACT PROVISIONS2014

Certification Regarding Use of State Funds. In the case that Party is an employer and this Agreement is a State Funded Grant in excess of $1,001, Party certifies that none of these State funds will be used to interfere with or restrain the exercise of Party’s employee’s rights with respect to unionization. State of Vermont – Attachment C Revised AHS – 9-3-2014 ATTACHMENT F AGENCY OF HUMAN SERVICES’ CUSTOMARY CONTRACT GRANT PROVISIONS

Certification Regarding Use of State Funds. In the case that Party is an employer and this Agreement is a State Funded Grant in excess of $1,001, Party certifies that none of these State funds will be used to interfere with or restrain the exercise of Party’s employee’s rights with respect to unionization. State of Vermont – Attachment C Revised AHS – 6-9-3-2014 ATTACHMENT F AGENCY OF HUMAN SERVICES’ CUSTOMARY CONTRACT GRANT PROVISIONS

Certification Regarding Use of State Funds. In the case that Party is an employer and this Agreement is a State Funded Grant in excess of $1,001, Party certifies that none of these State funds will shall be used to interfere with or restrain the exercise of Party’s employee’s rights with respect to unionization. State of Vermont – Attachment C Revised AHS – 911-37-2014 2012 ATTACHMENT F AGENCY OF HUMAN SERVICES’ CUSTOMARY CONTRACT D OTHER PROVISIONS

Certification Regarding Use of State Funds. In the case that Party is an employer and this Agreement is a State Funded Grant in excess of $1,001, Party certifies that none of these State funds will be used to interfere with or restrain the exercise of Party’s employee’s rights with respect to unionization. State of Vermont – Attachment C Revised AHS – 911-37-2014 2012 ATTACHMENT D MODIFICATION OF CUSTOMARY PROVISIONS OF ATTACHMENT C OR ATTACHMENT F AGENCY OF HUMAN SERVICES’ CUSTOMARY CONTRACT PROVISIONS1. The requirements contained in Attachment C, Paragraph 1, are modified to add the following sentence:

Certification Regarding Use of State Funds. In the case that Party is an employer and this Agreement is a State Funded Grant in excess of $1,001, Party certifies that none of these State funds will be used to interfere with or restrain the exercise of Party’s employee’s rights with respect to unionization. State of Vermont – Attachment C Revised AHS – 9-3-2014 ATTACHMENT F AGENCY OF HUMAN SERVICES’ CUSTOMARY CONTRACT PROVISIONSD

Certification Regarding Use of State Funds. In the case that Party is an employer and this Agreement is a State Funded Grant in excess of $1,001, Party certifies that none of these State funds will be used to interfere with or restrain the exercise of Party’s employee’s rights with respect to unionization. State of Vermont – Attachment C_9/2/2014 ATTACHMENT D MODIFICATION OF CUSTOMARY PROVISIONS OF ATTACHMENT C Revised AHS – 9-3-2014 OR ATTACHMENT F AGENCY OF HUMAN SERVICES’ CUSTOMARY CONTRACT PROVISIONS1. The requirements contained in Attachment C, Paragraph 1, are modified to add the following sentence:

Certification Regarding Use of State Funds. In the case that Party is an employer and this Agreement is a State Funded Grant in excess of $1,001, Party certifies that none of these State funds will be used to interfere with or restrain the exercise of Party’s employee’s rights with respect to unionization. State of Vermont – Attachment C Revised AHS – 97-31-2014 ATTACHMENT F AGENCY OF HUMAN SERVICES’ CUSTOMARY CONTRACT PROVISIONS2012

Certification Regarding Use of State Funds. In the case that Party is an employer and this Agreement is a State Funded Grant in excess of $1,001, Party certifies that none of these State funds will be used to interfere with or restrain the exercise of Party’s employee’s rights with respect to unionization. (End of Standard Provisions) State of Vermont – Attachment C Revised AHS – 9-3-2014 ATTACHMENT F AGENCY OF HUMAN SERVICES’ CUSTOMARY D: MODIFICATIONS TO CONTRACT PROVISIONSREQUIREMENTS AND ATTACHMENTS

Certification Regarding Use of State Funds. In the case that Party is an employer and this Agreement is a State Funded Grant in excess of $1,001, Party certifies that none of these State funds will be used to interfere with or restrain the exercise of Party’s employee’s rights with respect to unionization. State of Vermont – Attachment C Revised AHS – 9-3-2014 ATTACHMENT F AGENCY STATE OF HUMAN SERVICES’ CUSTOMARY CONTRACT PROVISIONSVERMONT PAGE 7 OF 9 AMENDMENT TO PERSONALSERVICES XXXXXXXX XXXXXXXX #00000 BLUE CROSS AND BLUE SHIELD OF VERMONT AMENDMENT #2 Exhibit I Exhibit 1 (continued)

Certification Regarding Use of State Funds. In the case that Party is an employer and this Agreement is a State Funded Grant in excess of $1,001, Party certifies that none of these State funds will be used to interfere with or restrain the exercise of Party’s employee’s rights with respect to unionization. State of Vermont – Attachment C Revised AHS – 97-31-2014 2012 ATTACHMENT F AGENCY OF HUMAN SERVICES’ CUSTOMARY CONTRACT GRANT PROVISIONS

Certification Regarding Use of State Funds. In the case that Party is an employer and this Agreement is a State Funded Grant in excess of $1,001, Party certifies that none of these State funds will be used to interfere with or restrain the exercise of Party’s employee’s rights with respect to unionization. State of Vermont – Attachment C Revised AHS – 9-3-2014 ATTACHMENT D MODIFICATION OF CUSTOMARY PROVISIONS OF ATTACHMENT C OR ATTACHMENT F AGENCY OF HUMAN SERVICES’ CUSTOMARY CONTRACT PROVISIONS1. The insurance requirements contained in Attachment C, Section 7 are hereby modified:

Certification Regarding Use of State Funds. In the case that Party is an employer and this Agreement is a State Funded Grant in excess of $1,001, Party certifies that none of these State funds will be used to interfere with or restrain the exercise of Party’s employee’s rights with respect to unionization. State of Vermont – Attachment C Revised AHS – 9-3-2014 ATTACHMENT D MODIFICATION OF CUSTOMARY PROVISIONS OF ATTACHMENT C OR ATTACHMENT F AGENCY OF HUMAN SERVICES’ CUSTOMARY CONTRACT PROVISIONS1. Requirements of Sections in Attachment C are hereby deleted and replaced:

Certification Regarding Use of State Funds. In the case that Party is an employer and this Agreement is a State Funded Grant in excess of $1,001, Party certifies that none of these State funds will be used to interfere with or restrain the exercise of Party’s employee’s rights with respect to unionization. State of Vermont Vermont– Attachment C Revised AHS AHS– 9-3-2014 ATTACHMENT F AGENCY OF HUMAN SERVICES’ CUSTOMARY CONTRACT PROVISIONSExhibit I

Certification Regarding Use of State Funds. In the case that Party is an employer and this Agreement is a State Funded Grant in excess of $1,001, Party certifies that none of these State funds will be used to interfere with or restrain the exercise of Party’s employee’s rights with respect to unionization. State of Vermont – Attachment C Revised AHS – 9-3-2014 ATTACHMENT F AGENCY This amendment consists of 6 pages. Except as modified by this amendment all provisions of this agreement, (#03410-1315-15) dated August 29, 2014 shall remain unchanged and in full force and effect. STATE OF HUMAN SERVICES’ CUSTOMARY CONTRACT PROVISIONSVERMONT SUBRECIPIENT

Certification Regarding Use of State Funds. In the case that Party is an employer and this Agreement is a State Funded Grant in excess of $1,001, Party certifies that none of these State funds will be used to interfere with or restrain the exercise of Party’s employee’s rights with respect to unionization. State of Vermont – Attachment C Revised AHS – 9-3-2014 ATTACHMENT D MODIFICATION OF CUSTOMARY PROVISIONS OF ATTACHMENT C OR ATTACHMENT F AGENCY OF HUMAN SERVICES’ CUSTOMARY CONTRACT PROVISIONS1. The insurance requirements contained in Attachment C, Section 7 are hereby modified: N/A