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<br />Account # <br /> <br />GENERAL SERVICES COMMISSION <br />INTER-GOVERNMENTAL PROGRAMS <br />FEDERAL SURPLUS PROPERTY PROGRAM <br /> <br />, NONDISCRIMINATION ASSURANCE I <br /> <br />LEGAL NAME & MAILING ADDRESS OF APPLICANT ORGANIZATION: <br /> <br />Name of Organization <br /> <br />Sueel AddresS/Location <br /> <br />Met/Ing Address fP. O. Box .. Slreel. City & Statel <br /> <br />(9 digit ZIp Codel <br />I <br /> <br />County <br /> <br />Teleonone " <br /> <br />(Name 01 OrganlZal/On) <br /> <br />, the donee. <br /> <br />agrees that the program for or In connection with which any propeny is donaIed to the donee will <br />be conducted in compliance with. and the donee will comply with and will require any other per- <br />son (any legal enIlty) who througn contractual or other arrangements w,th the donee IS authorized <br />10 provide servIces or benefits under said program to comply wIth all requirements Imposeo by or <br />pursuant to the regulations of the General Services AdmlnlSIraIlon 141 C.F.R. 101-6.2 ana 101-8) <br />issued under Ihe provIsions of Tille VI of the Civil Rights Act of 1964. as amended. section 606 of <br />Tille VI of the Federal Propeny and AdmlnlStraI,ve ServIces Act of 1949. as amenoed. section 504 <br />of the RehabilitaIion Act of 1973. as amended. Tille IX of the Education Amenoments Of 1972. as <br />amended. section 303 at the Age Discnmlnatlon Act of 1975. ana the Civil Right Restoration Act ot <br />1987. to the end thaI no person In the United SlaIes shall on the ground of race. color. nallonal <br />orrgln. sex. or age. or Ihat no otherwise qualified handicllllped person shall soiely by reason of <br />the handicap. be excluded from panlcipation in. be denied beneflls of. or be suolected to <br />discnmination under any program or activity 10r which the donee received Federal assistance trom <br />the General Services Administration: and hereby gives assurance that II will immediately take any <br />measures necessary to effectuate this agreement. <br /> <br />The aonee funher agrees II) that this agreement shall be subject In all respeclS to the orovlslons <br />of saId Federal staIutes and reguJatlons (2) that this agreemenI obligates the donee for the oerlod <br />dUring which it retaIns ownershio or possessIon of the propeny. (3) thaI the United Stales snail <br />have the nghI to seek Judicial enforcement of this agreement. and (4) thaI thiS agreement shall be <br />binding upon any successor In Interest at the donee and the wore "donee' as used herein in- <br />cludes any such successor In Interest. <br /> <br />(Dale) <br /> <br />(Prinrea Name of Authonzea Officlai) <br /> <br />(Signature of Aulhonzed Official) <br /> <br />MAIL COMPlETED FORMS 10: GENERAL SERVICES COMMISSION. FEOERAL SURPLUS PROPERTY PROGRAM. <br />? O. BOX 13OD. AlI!:T1N TY "1R'7t1_"VW.7 <br />