Common use of SUBSCRIBED AND SWORN TO before Clause in Contracts

SUBSCRIBED AND SWORN TO before. me this day of , 2016 NOTARY PUBLIC My commission expires The Town of Ashland City follows all Title VI policy not to discriminate on the basis of race, color, national origin, age, sex, or disability in its hiring and employment practices, or in admission to, access to, or operation of its programs, services, and activities. It is also the policy of the Town of Ashland city to follow the City’s written complaint procedures for employees and all contracted workers and to comply with any LEP, Limited English Proficiency guidelines. With regard to all aspects of this contract, contractor certifies and warrants it will comply with these policies. Signature of Contractor Name of Contractor (printed) Date Subcontractor Date APPLICATION FORMS & INFORMATION COLLECTION REQUIREMENTS: All recipients, other than those using guarantee programs, are required to collect data on race/ethnic and gender of users or beneficiaries. Application form must include below the signature and date block the following disclosure statements: (rev. 1/2001 as per Fed. Register Vol. 62 No. 210) “The following information is requested by the Federal Government in order to monitor compliance with Federal Laws prohibiting discrimination against applicants seeking to participate in this program. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, we are required to note the race/national origin of individual applicants on the basis of visual observation or surname.” Ethnicity: Hispanic or Latino Not Hispanic or Latino Race: (Mark one or more) White Black or African American American Indian/Alaska Native Asian Native Hawaiian or Other Pacific Islander Gender: Male Female POLICY OF NONDISCRIMINATION The Town of Ashland City does not discriminate on the basis of race, color, religion, national origin, sex, age or handicapped status in the admission or access to, or treatment or employment in, its federally assisted programs or activities. Xxxxxx Xxxx PO Box 36 Ashland City, TN 00000 (000)000-0000 Has been designated to coordinate compliance with the nondiscrimination requirements contained in the Department of Housing and Urban Development’s (HUD) regulations implementing Section 504 (24 CFR Part 8, dated June 2, 1988), Section 3 (24 CFR Part 135, dated October 23, 1973, Use of Small and Disadvantaged Businesses and Hiring Lower Income Residents of the Project Area), Equal Employment Opportunity Act of 1978 (In House Equal Employment Opportunity), Executive Order 11246 as amended by Executive Order 11375 (Equal Employment Opportunity on Federal Assisted Construction Contracts), and Executive Order 11625 (Minority Entrepreneurship). LIMITED ENGLISH PROFICIENCY

SUBSCRIBED AND SWORN TO before. me this day of , 2016 NOTARY PUBLIC My commission expires The Town of Ashland City follows all Title VI policy not to discriminate on the basis of race, color, national origin, age, sex, or disability in its hiring and employment practices, or in admission to, access to, or operation of its programs, services, and activities. It is also the policy of the Town of Ashland city to follow the City’s written complaint procedures for employees and all contracted workers and to comply with any LEP, Limited English Proficiency guidelines. With regard to all aspects of this contract, contractor certifies and warrants it will comply with these policies. Signature of Contractor Name of Contractor (printed) Date Subcontractor Date APPLICATION FORMS & INFORMATION COLLECTION REQUIREMENTS: All recipients, other than those using guarantee programs, are required to collect data on race/ethnic and gender of users or beneficiaries. Application form must include below the signature and date block the following disclosure statements: (rev. 1/2001 as per Fed. Register Vol. 62 No. 210) “The following information is requested by the Federal Government in order to monitor compliance with Federal Laws prohibiting discrimination against applicants seeking to participate in this program. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, we are required to note the race/national origin of individual applicants on the basis of visual observation or surname.” Ethnicity: Hispanic or Latino Not Hispanic or Latino Race: (Mark Xxxx one or more) White Black or African American American Indian/Alaska Native Asian Native Hawaiian or Other Pacific Islander Gender: Male Female POLICY OF NONDISCRIMINATION The Town of Ashland City does not discriminate on the basis of race, color, religion, national origin, sex, age or handicapped status in the admission or access to, or treatment or employment in, its federally assisted programs or activities. Xxxxxx Xxxx PO Box 36 Ashland CityXX Xxx 00 Xxxxxxx Xxxx, TN XX 00000 (000)000615)792-0000 4211 Has been designated to coordinate compliance with the nondiscrimination requirements contained in the Department of Housing and Urban Development’s (HUD) regulations implementing Section 504 (24 CFR Part 8, dated June 2, 1988), Section 3 (24 CFR Part 135, dated October 23, 1973, Use of Small and Disadvantaged Businesses and Hiring Lower Income Residents of the Project Area), Equal Employment Opportunity Act of 1978 (In House Equal Employment Opportunity), Executive Order 11246 as amended by Executive Order 11375 (Equal Employment Opportunity on Federal Assisted Construction Contracts), and Executive Order 11625 (Minority Entrepreneurship). LIMITED ENGLISH PROFICIENCY

SUBSCRIBED AND SWORN TO before. me this day of , 2016 2020 NOTARY PUBLIC My commission expires The Town of Ashland City follows all Title VI policy not to discriminate on the basis of race, color, national origin, age, sex, or disability in its hiring and employment practices, or in admission to, access to, or operation of its programs, services, and activities. It is also the policy of the Town of Ashland city to follow the City’s written complaint procedures for employees and all contracted workers and to comply with any LEP, Limited English Proficiency guidelines. With regard to all aspects of this contract, contractor certifies and warrants it will comply with these policies. Signature of Contractor Name of Contractor (printed) Date Subcontractor Date APPLICATION FORMS & INFORMATION COLLECTION REQUIREMENTS: All recipients, other than those using guarantee programs, are required to collect data on race/ethnic and gender of users or beneficiaries. Application form must include below the signature and date block the following disclosure statements: (rev. 1/2001 as per Fed. Register Vol. 62 No. 210) “The following information is requested by the Federal Government in order to monitor compliance with Federal Laws prohibiting discrimination against applicants seeking to participate in this program. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, we are required to note the race/national origin of individual applicants on the basis of visual observation or surname.” Ethnicity: Hispanic or Latino Not Hispanic or Latino Race: (Mark Xxxx one or more) White Black or African American American Indian/Alaska Native Asian Native Hawaiian or Other Pacific Islander Gender: Male Female POLICY OF NONDISCRIMINATION The Town of Ashland City does not discriminate on the basis of race, color, religion, national origin, sex, age or handicapped status in the admission or access to, or treatment or employment in, its federally assisted programs or activities. Xxxxxx Xxxx PO Box 36 Ashland CityXX Xxx 00 Xxxxxxx Xxxx, TN XX 00000 (000)000615)792-0000 4211 Has been designated to coordinate compliance with the nondiscrimination requirements contained in the Department of Housing and Urban Development’s (HUD) regulations implementing Section 504 (24 CFR Part 8, dated June 2, 1988), Section 3 (24 CFR Part 135, dated October 23, 1973, Use of Small and Disadvantaged Businesses and Hiring Lower Income Residents of the Project Area), Equal Employment Opportunity Act of 1978 (In House Equal Employment Opportunity), Executive Order 11246 as amended by Executive Order 11375 (Equal Employment Opportunity on Federal Assisted Construction Contracts), and Executive Order 11625 (Minority Entrepreneurship). LIMITED ENGLISH PROFICIENCY

SUBSCRIBED AND SWORN TO before. me this day of , 2016 NOTARY PUBLIC My commission expires The Town of Ashland City follows all Title VI policy not to discriminate on the basis of race, color, national origin, age, sex, or disability in its hiring and employment practices, or in admission to, access to, or operation of its programs, services, and activities. It is also the policy of the Town of Ashland city to follow the City’s written complaint procedures for employees and all contracted workers and to comply with any LEP, Limited English Proficiency guidelines. With regard to all aspects of this contract, contractor certifies and warrants it will comply with these policies. Signature of Contractor Name of Contractor (printed) Date Subcontractor Date APPLICATION FORMS & INFORMATION COLLECTION REQUIREMENTS: All recipients, other than those using guarantee programs, are required to collect data on race/ethnic and gender of users or beneficiaries. Application form must include below the signature and date block the following disclosure statements: (rev. 1/2001 as per Fed. Register Vol. 62 No. 210) “The following information is requested by the Federal Government in order to monitor compliance with Federal Laws prohibiting discrimination against applicants seeking to participate in this program. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, we are required to note the race/national origin of individual applicants on the basis of visual observation or surname.” Ethnicity: Hispanic or Latino Not Hispanic or Latino Race: (Mark one or more) White Black or African American American Indian/Alaska Native Asian Native Hawaiian or Other Pacific Islander Gender: Male Female POLICY OF NONDISCRIMINATION The Town of Ashland City does not discriminate on the basis of race, color, religion, national origin, sex, age or handicapped status in the admission or access to, or treatment or employment in, its federally assisted programs or activities. Xxxxxx Xxxx PO Box 36 Ashland CityXX Xxx 00 Xxxxxxx Xxxx, TN XX 00000 (000)000615)792-0000 4211 Has been designated to coordinate compliance with the nondiscrimination requirements contained in the Department of Housing and Urban Development’s (HUD) regulations implementing Section 504 (24 CFR Part 8, dated June 2, 1988), Section 3 (24 CFR Part 135, dated October 23, 1973, Use of Small and Disadvantaged Businesses and Hiring Lower Income Residents of the Project Area), Equal Employment Opportunity Act of 1978 (In House Equal Employment Opportunity), Executive Order 11246 as amended by Executive Order 11375 (Equal Employment Opportunity on Federal Assisted Construction Contracts), and Executive Order 11625 (Minority Entrepreneurship). LIMITED ENGLISH PROFICIENCY