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STATE OF CALIFORNIA <br />DRUG-FREE WORKPLACE <br />®K ACE C®TIFICATION <br />STD. 21 (REV. 12.93) <br />CERTIFICATION <br />I, the official named below, hereby swear that I am duly authorized legally to bind the contractor or <br />grant recipient to the certification described below. I am fully aware that this certification, executed <br />on the date below, is made under penalty of perjury under the laws of the State of California. <br />CONTRACTORIBIDDER FIRM NAME I FEDERAL ID NUMBER <br />SAjn�S' es�,l SerV� tro �eu� �iI/, ` ,Z/—&&)05-3 <br />BY (Authorized Sign t B DATE EXE UTED <br />.✓ 07� / ECJ <br />PRINTED AND TITLE OF PERSOkSLGNING TELE ONE NU BER (Include Area Code) <br />L ' <br />_ <br />V.1 rb ) r0. ►_ v n__ �C44 — -- - - <br />CONTRACTOR/BIDDE FIRM'S MAILING ADDRESS ' ' l <br />co, � �x 3Ss�, J�aL K-�h C14 �1520038' <br />The contractor or grant recipient named above hereby certifies compliance with Government Code Section 8355 <br />in matters relating to providing a drug-free workplace. The above named contractor or grant recipient will: <br />1. Publish a statement notifying employees that unlawful manufacture, distribution, dispensation, possession, <br />or use of a controlled substance is prohibited and specifying actions to be taken against employees for <br />violations, as required by Government Code Section 8355(a). <br />2. Establish a Drug -Free Awareness Program as required by Government Code Section 8353(b), to inform <br />employees about all of the following: <br />(a) The dangers of drug abuse in the workplace, <br />(b) The person's or organization's policy of maintaining a drug-free workplace, <br />(c) Any available counseling, rehabilitation and employee assistance programs, and <br />(d) Penalties that may be imposed upon employees for drug abuse violations. <br />3. Provide as required by Government Code Section 8355(c), that every employee who works on the proposed <br />contract or grant: <br />(a) Will receive a copy of the company's drug-free workplace policy statement, and <br />(b) Will agree to abide by the terms of the company's statement as a condition of employment on <br />the contract or grant. <br />4. At the election of the contractor or grantee, from and after the "Date Executed" and until <br />(NOT TO EXCEED 36 MONTHS), the state will regard this certificate as valid for all contracts or gra tsentered <br />into between the contractor or grantee and this state agency without requiring the contractor or grantee to <br />provide a new and individual certificate for each contract or grant. If the contractor or grantee elects to fill <br />in the blank date, then the terms and conditions of this certificate shall have the same force, meaning, effect <br />and enforceability as if a certificate were separately, specifically, and individually provided for each contract <br />or grant between the contractor or grantee and this state agency. <br />