Compliance Attestations

Compliance Attestations (Attachment 1)
The Whole Person
This packet contains all required compliance forms. It includes:
- 1. Certification Regarding Debarment & Suspension
- 2. Byrd Anti-Lobbying Amendment Certification
- 3. Conflict of Interest Disclosure
- 4. Equal Opportunity & Nondiscrimination Compliance Statement
- 5. Supplier Diversity Disclosure
- 6. Disability Representation (Voluntary Aggregate Data)
- 7. Insurance Compliance Attestation
- 8. Cybersecurity Compliance Attestation
- 9. Data Privacy & Confidentiality Compliance Statement
Each section includes fillable tables and signature fields for the completion.
Organization Name:*
Address:*
City/State/ZIP:*
Phone:*
Format: (000) 000-0000.
1. Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion
(2 CFR 200.214; 2 CFR Part 180)
I. The Company certifies that it and its principals are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in federal transactions.
II. The Company further certifies compliance with all requirements listed under 2 CFR Part 180.
Legal Business Name:*
Authorized Representative:*
Signature:*

Clear
Date:*

MonthDayYear
Date

2. Byrd Anti-Lobbying Amendment Certification
(31 U.S.C. 1352)
The Company certifies that no federally appropriated funds have been paid or will be paid to influence or attempt to influence any federal employee or Member of Congress.
Organization Name:*
Authorized Representative:*
Signature:*

Clear
Date:*

MonthDayYear
Date
3. Conflict of Interest Disclosure
(2 CFR 200.112)
YesNo
If yes, describe:
Authorized Representative:*
Signature:*

Clear
Date:*

MonthDayYear
Date
4. Equal Opportunity & Nondiscrimination Compliance Statement
The Company certifies compliance with:
- Title VI of the Civil Rights Act
- Title VII
- Section 504 of the Rehabilitation Act
- ADA
- Age Discrimination Act
- All applicable EEO laws
Signature:*

Clear
Date:*

MonthDayYear
Date

5. Supplier Diversity Disclosure (MBE/WBE/DBE/SBE)
YesNo
Certification Type:
Certifying Agency:
Certification Number:
Expiration Date:

MonthDayYear
Date
6. Disability Representation (Voluntary Aggregate Data)
Approximate % of employees who self-identify as having a disability:*
Approximate % of board members who self-identify as having a disability:*
(Disclosure is voluntary and non-identifying.)
7. Insurance Compliance Attestation
Professional LiabilityErrors & OmissionsCommercial General LiabilityAuto Liability (if applicable)
Insurance Carrier:*
Policy Number:*
Signature:*

Clear
Date:*

MonthDayYear
Date

8. Cybersecurity Compliance Attestation
The Company certifies it maintains reasonable cybersecurity safeguards, including:
- Multi-factor authentication (MFA)
- Encryption of sensitive data
- Secure password protocols
- Data breach notification procedures
Signature:*

Clear
Date:*

MonthDayYear
Date
9. Data Privacy & Confidentiality Compliance Statement
The Company agrees to protect all data, maintain confidentiality, and comply with all applicable privacy laws.
Signature:*

Clear
Date:*

MonthDayYear
Date
This packet is designed for use by The Whole Person.
Should be Empty:

Compliance Attestations (Attachment 1)