Common use of Sites for Work Performance Clause in Contracts

Sites for Work Performance. The Applicant shall list (on separate pages) the site(s) for the performance of work done in connection with the HUD funding of the program/activity shown above: Place of Performance shall include xxx xxxxxx xxxxxxx, xxxx, xxxxxx, Xxxxx, and zip code. Identify each sheet with the Applicant name and address and the program/activity receiving grant funding.) Check here 0if there are workplaces on file that are not identified on the attached sheets. I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate. Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U .S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802) Name of Authorized Official Title Signature X Xxxxxx Xxxxxxx CEO Families Forward Date 3/23/2019 form HUD-50070 (3/98) ref. Handbooks 7417.1 , 7475.13, 7485.1 & .3 SERVICE PLANNING AREAS DocuSign Envelope ID: XX00X0X0-0X0X-0000-XXXX-00X000XX0XX0 XxxxxXxxxxxxxxxxx X0 Xx Xxxxx Xxxx Xxxxxxxxx Placentia Xxxxx Xxxxx Buena Park La Palma Cypress Los Alamitos Xxxxxxx Anaheim Garden Grove Orange Villa Park Unincorporated Seal Beach Westminster Santa Xxx Xxxxxx Fountain Valley Cities of North Region ANAHEIM BREA BUENA PARK CYPRESS FULLERTON LA HABRA Huntington Beach Costa Mesa Newport Beach Irvine Laguna Xxxxx Lake Forest Rancho Santa Xxxxxxxxx Mission Viejo LA PALMA LOS ALAMITOS ORANGE PLACENTIA ROSSMOOR CDP XXXXXXX XXXXX PARK XXXXX XXXXX Region Cities of Central Region COSTA MESA FOUNTAIN VALLEY GARDEN GROVE HUNTINGTON BEACH MIDWAY CITY CDP NEWPORT BEACH NORTH TUSTIN CDP SANTA XXX XXXX BEACH TUSTIN WESTMINSTER Cities of South Region ALISO VIEJO COTO DE CAZA CDP XXXX POINT IRVINE LADERA RANCH CDP LAGUNA BEACH LAGUNA HILLS LAGUNA NIGUEL LAGUNA XXXXX LAKE FOREST LAS XXXXXX CDP Laguna Hills Aliso Viejo Laguna Beach Laguna Niguel San Xxxx Xxxxxxxxxx Xxxx Point San Clemente North Region Central Region South Region MISSION VIEJO RANCHO SANTA XXXXXXXXX SAN XXXXXXXX SAN XXXX CAPISTRANO

Sites for Work Performance. The Applicant shall list (on separate pages) the site(s) for the performance of work done in connection with the HUD funding of the program/activity shown above: Place of Performance shall include xxx xxxxxx xxxxxxx, xxxx, xxxxxx, Xxxxx, and zip code. Identify each sheet with the Applicant name and address and the program/activity receiving grant funding.) Check here 0if there are workplaces on file that are not identified on the attached sheets. I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate. Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U .S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802) Name of Authorized Official Xxxx Xxxx Xxxxxx Title Executive Director Signature Date X Xxxxxx Xxxxxxx CEO Families Forward Date 3/23/2019 4/2/2019 form HUD-50070 (3/98) ref. Handbooks 7417.1 , 7475.13, 7485.1 & .3 SERVICE PLANNING AREAS DocuSign Envelope ID: XX00X0X0A9A95B9A-7FB7-0X0X-00004FA9-XXXX-00X000XX0XX0 XxxxxXxxxxxxxxxxx X0 Xx Xxxxx BC3C-CE4A507DB101 AttacEhxmheibnitt G3 La Habra Xxxx Xxxxxxxxx Placentia Xxxxx Xxxxx Buena Park La Palma Cypress Los Alamitos Xxxxxxx Anaheim Garden Grove Orange Villa Park Unincorporated Seal Beach Westminster Santa Xxx Xxxxxx Fountain Valley Cities of North Region ANAHEIM BREA BUENA PARK CYPRESS FULLERTON LA HABRA Huntington Beach Costa Mesa Newport Beach Irvine Laguna Xxxxx Lake Forest Rancho Santa Xxxxxxxxx Mission Viejo LA PALMA LOS ALAMITOS ORANGE PLACENTIA ROSSMOOR CDP XXXXXXX XXXXX PARK XXXXX XXXXX Region Cities of Central Region COSTA MESA FOUNTAIN VALLEY GARDEN GROVE HUNTINGTON BEACH MIDWAY CITY CDP NEWPORT BEACH NORTH TUSTIN CDP SANTA XXX XXXX BEACH TUSTIN WESTMINSTER Cities of South Region ALISO VIEJO COTO DE CAZA CDP XXXX POINT IRVINE LADERA RANCH CDP LAGUNA BEACH LAGUNA HILLS LAGUNA NIGUEL LAGUNA XXXXX LAKE FOREST LAS XXXXXX CDP Laguna Hills Aliso Viejo Laguna Beach Laguna Niguel San Xxxx Xxxxxxxxxx Xxxx Point San Clemente North Region Central Region South Region MISSION VIEJO RANCHO SANTA XXXXXXXXX SAN XXXXXXXX SAN XXXX CAPISTRANO

Sites for Work Performance. The Applicant shall list (on separate pages) the site(s) for the performance of work done in connection with the HUD funding of the program/activity shown above: Place of Performance shall include xxx xxxxxx xxxxxxx, xxxx, xxxxxx, Xxxxx, and zip code. Identify each sheet with the Applicant name and address and the program/activity receiving grant funding.) Alameda County Health Care Services Agency Community Assessment, Planning and Evaluation (CAPE) Unit/Epidemiology Support and Program Evaluation Services 0000 Xxx Xxxxxxx Xxxxxxxxx, 0xx Xxxxx Xxx Xxxxxxx, XX 00000 (See attached page) Check here 0if if there are workplaces on file that are not identified on the attached sheets. I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate. Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U .S.C. U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802) Name of Authorized Official Xxxxx Xxxxxx Title President of the Board of Supervisors Signature X Xxxxxx Xxxxxxx CEO Families Forward Date 3/23/2019 form HUD-50070 (3/98) ref. Handbooks 7417.1 7417.1, 7475.13, 7485.1 & .3 SERVICE PLANNING AREAS DocuSign Envelope ID: XX00X0X0-0X0X-0000-XXXX-00X000XX0XX0 XxxxxXxxxxxxxxxxx X0 Xx Supplement for US HUD Certification of a Drug‐Free Workplace Site for Work Performance Community Assessment, Planning and Evaluation (CAPE) Unit Epidemiology Support and Program Evaluation Services Alameda County Health Care Services Agency 0000 Xxx Xxxxxxx Xxxxxxxxx, 0xx Xxxxx Xxxx Xxxxxxxxx Placentia Xxxxx Xxxxx Buena Park La Palma Cypress Los Alamitos Xxx Xxxxxxx, (Xxxxxxx Anaheim Garden Grove Orange Villa Park Unincorporated Seal Beach Westminster Santa Xxx Xxxxxx Fountain Valley Cities Xxxxxx) XX 00000 CAPE Unit May 2021 To be completed by Contractor/Vendor Form EBO-1 CITY OF BERKELEY CERTIFICATION OF COMPLIANCE WITH EQUAL BENEFITS ORDINANCE If you are a contractor, return this form to the originating department/project manager. If you are a vendor (supplier of North Region ANAHEIM BREA BUENA PARK CYPRESS FULLERTON LA HABRA Huntington Beach Costa Mesa Newport Beach Irvine Laguna Xxxxx Lake Forest Rancho Santa Xxxxxxxxx Mission Viejo LA PALMA LOS ALAMITOS ORANGE PLACENTIA ROSSMOOR CDP XXXXXXX XXXXX PARK XXXXX XXXXX Region Cities goods), return this form to the Purchasing Division of Central Region COSTA MESA FOUNTAIN VALLEY GARDEN GROVE HUNTINGTON BEACH MIDWAY CITY CDP NEWPORT BEACH NORTH TUSTIN CDP SANTA XXX XXXX BEACH TUSTIN WESTMINSTER Cities of South Region ALISO VIEJO COTO DE CAZA CDP XXXX POINT IRVINE LADERA RANCH CDP LAGUNA BEACH LAGUNA HILLS LAGUNA NIGUEL LAGUNA XXXXX LAKE FOREST LAS XXXXXX CDP Laguna Hills Aliso Viejo Laguna Beach Laguna Niguel San Xxxx Xxxxxxxxxx Xxxx Point San Clemente North Region Central Region South Region MISSION VIEJO RANCHO SANTA XXXXXXXXX SAN XXXXXXXX SAN XXXX CAPISTRANOthe Finance Dept.

Sites for Work Performance. The Applicant shall list (on separate pages) the site(s) for the performance of work done in connection with the HUD funding of the program/activity shown above: Place of Performance shall include xxx xxxxxx xxxxxxx, xxxx, xxxxxx, Xxxxx, and zip code. Identify each sheet with the Applicant name and address and the program/activity receiving grant funding.) Check here 0if there are workplaces on file that are not identified on the attached sheets. I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate. Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U .S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802) Name of Authorized Official Title Signature X Xxxxxx Xxxxxxx CEO Families Forward Xxxxx Xxxx Title Associate Director Date 3/23/2019 4/2/2019 form HUD-50070 (3/98) ref. Handbooks 7417.1 , 7475.13, 7485.1 & .3 SERVICE PLANNING AREAS DocuSign Envelope ID: XX00X0X04AE69EF4-0X0X-0000176F-453C-820B-XXXX-00X000XX0XX0 XxxxxXxxxxxxxxxxx X0 E148B2708041 SERVICE XXXXXXXX XXXXX XxxxXxxxxxxxxxxxx 0X Xx Xxxxx Xxxx Xxxxxxxxx Placentia Xxxxx Xxxxx Buena Park La Palma Cypress Los Alamitos Xxxxxxx Anaheim Garden Grove Orange Villa Park Unincorporated Seal Beach Westminster Santa Xxx Xxxxxx Fountain Valley Cities of North Region ANAHEIM BREA BUENA PARK CYPRESS FULLERTON LA HABRA Huntington Beach Costa Mesa Newport Beach Irvine Laguna Xxxxx Lake Forest Rancho Santa Xxxxxxxxx Mission Viejo LA PALMA LOS ALAMITOS ORANGE PLACENTIA ROSSMOOR CDP XXXXXXX XXXXX PARK XXXXX XXXXX Region Cities of Central Region COSTA MESA FOUNTAIN VALLEY GARDEN GROVE HUNTINGTON BEACH MIDWAY CITY CDP NEWPORT BEACH NORTH TUSTIN CDP SANTA XXX XXXX BEACH TUSTIN WESTMINSTER Cities of South Region ALISO VIEJO COTO DE CAZA CDP XXXX POINT IRVINE LADERA RANCH CDP LAGUNA BEACH LAGUNA HILLS LAGUNA NIGUEL LAGUNA XXXXX LAKE FOREST LAS XXXXXX CDP Laguna Hills Aliso Viejo Laguna Beach Laguna Niguel San Xxxx Xxxxxxxxxx Xxxx Point San Clemente North Region Central Region South Region MISSION VIEJO RANCHO SANTA XXXXXXXXX SAN XXXXXXXX SAN XXXX CAPISTRANO

Sites for Work Performance. The Applicant shall list (on separate pages) the site(s) for the performance of work done in connection with the HUD funding of the program/activity shown above: Place of Performance shall include xxx xxxxxx xxxxxxx, xxxx, xxxxxx, Xxxxx, and zip code. Identify each sheet with the Applicant name and address and the program/activity receiving grant funding.) Check here 0if there are workplaces on file that are not identified on the attached sheets. I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate. Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U .S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802) Name of Authorized Official Xxxx Xxxxxxxxxx Title President/Executive Director Signature Date 3/19/2019 X Xxxxxx Xxxxxxx CEO Families Forward Date 3/23/2019 form HUD-50070 (3/98) ref. Handbooks 7417.1 , 7475.13, 7485.1 & .3 SERVICE PLANNING AREAS DocuSign Envelope ID: XX00X0X0D09FA73E-8838-0X0X-000047F9-XXXX-00X000XX0XX0 XxxxxXxxxxxxxxxxx X0 Xx Xxxxx AEFA-521CF593E926 AtEtaXcHhmIBeInTt E3 La Habra Xxxx Xxxxxxxxx Placentia Xxxxx Xxxxx Buena Park La Palma Cypress Los Alamitos Xxxxxxx Anaheim Garden Grove Orange Villa Park Unincorporated Seal Beach Westminster Santa Xxx Xxxxxx Fountain Valley Cities of North Region ANAHEIM BREA BUENA PARK CYPRESS FULLERTON LA HABRA Huntington Beach Costa Mesa Newport Beach Irvine Laguna Xxxxx Lake Forest Rancho Santa Xxxxxxxxx Mission Viejo LA PALMA LOS ALAMITOS ORANGE PLACENTIA ROSSMOOR CDP XXXXXXX XXXXX PARK XXXXX XXXXX Region Cities of Central Region COSTA MESA FOUNTAIN VALLEY GARDEN GROVE HUNTINGTON BEACH MIDWAY CITY CDP NEWPORT BEACH NORTH TUSTIN CDP SANTA XXX XXXX BEACH TUSTIN WESTMINSTER Cities of South Region ALISO VIEJO COTO DE CAZA CDP XXXX POINT IRVINE LADERA RANCH CDP LAGUNA BEACH LAGUNA HILLS LAGUNA NIGUEL LAGUNA XXXXX LAKE FOREST LAS XXXXXX CDP Laguna Hills Aliso Viejo Laguna Beach Laguna Niguel San Xxxx Xxxxxxxxxx Xxxx Point San Clemente North Region Central Region South Region MISSION VIEJO RANCHO SANTA XXXXXXXXX SAN XXXXXXXX SAN XXXX CAPISTRANO