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CERTIFICATIONS REGARDING (A) DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY ss
<br />MATTERS; (B) DRUGFREE WORKPLACE REQimtF>~N'rS; AND (C) LOBBYING
<br />A- -'icants should refer to the regulations cited below to detemvne which certifications(s) apply to their grant, and review the instructions included in the
<br />r'. lions. Signing this form complies with certification requirements under "Government-wide Debarment and Suspension (Non-procurement)",
<br />"Government-wide Requirements for Drug-Free Workplace (Grants)" in 45 C,FR Part 1229, and "New Restrictions on Lobbying" in 45 (,'FR Part 1230.
<br />The certification(s) shall be treated as a material representation of fact upon which reliance will be placed when the Corporation determines to award the
<br />covered transaction, grant, or cooperative agreement ;
<br />A. DEBARMENT, SUSPENSION, AND OTHER RESPONSIBLITI~S
<br />As required by Executive Order 12549, Debarment and Suspension, and implemented at 45 CFR Part 1229, for prospective participants is primacy covered transactions, as
<br />defined at 45 CFR Part 1229, Sections 1229.105 and 1229.110 -
<br />1. The applicant certifies that it and its principals:
<br />(a) Are not presently debanrd, suspended, proposed for debarment, declared ineligtble, or voluntarily excluded from covered transactions by any Federal department or
<br />agency;
<br />(b) Have not, within a 3-year period preceding this application, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal
<br />offense in coffiection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or c~tract under a public transaction;
<br />violation of Federal or State antitrust statutes or commission of embezzlcmant theft, forgery, bribery, falsification or destruction of records, malting false
<br />statements, or receiving stolen property;
<br />(c) Are not presently indicted for or otherwise criminally or civilly charged by a Federal, State or local government entity with coanaission of any of the offenses
<br />enumerated in paragraph 1(b) of this certification;
<br />(d) Have not, within a 3-year period preceding this application, had one or more public transactions (Federal, State or local) terminated for cause or default.
<br />2. Where the applicant is unable to certify to any of the statements is this certification, he or she shall attach an explanation to this application.
<br />B. DRUGI?REE WORKPLAN (GRANTEES OTHER THAN INDIVIDUALS)
<br />As required by the Drug-Free Workplace Act of 1988, and implemented at 45 CFR Part 1229, Subpart F, for grantees, as defined at 45 CFR Part 1229, Sections 1229.605
<br />and 1229.610 -
<br />1. The applicant certifies that it will or will continue to provide adrub-free workplace, and wdl -
<br />(a) Publish a statement notifying employees that unlawful manufi-cture, distribution, dispensing, possession or use of a controIled sub-stance is prohibited in the
<br />grantee's workplace and specifying the actions that wr71 be taken against employees for violation of such prohibition;
<br />(b) Establish an ~-going drug-free awareness program to inform employees about -
<br />(1) The dangers of drug abuse m the workplace;
<br />(2) The grantee's policy of mainlsiniag adrug-free workphace; .
<br />~ (3) Any available drug counseling, rehabiliffition, and employee assistance programs; and
<br />(4) The penalties that may be imposed upon employees for drug abuse viohations occurring in the workplace.
<br />(c) Require that each employee to be engaged in the performance of the grant be given a copy of the statement required by paragraph 1(a); .
<br />(d) Notify the employee in the statement required by subpazagraph 1(a) that as a condition of employment under the grant, employee will -
<br />(1) Abide by the terms of the sffitearent; and
<br />(2) Notify the employer in writing of any conviction for a violation of a criminal drug statute which occurred in the workplace, no hater their 5 calendar days after
<br />such conviction;
<br />(e) Notify the cognizant Corporation Chants Officer within 10 calendar days after receiving notice of such conviction under subparagraph (d)(2) from the employee, or
<br />otherwise receiving actual notice. The notice shall include the title of the employee's position and the identification number(s) of the affected grant;
<br />(f) Take one of the following actions, within 30 calendar days of r~eiving noiice with respect to any employee who is so convicted -
<br />(1) Take appropriate persomrel action against such an employee up to and including termination consistent with the requirements of the Rehabilitation Act of 1973,
<br />as amended; or
<br />(2) Require such employee to participate satisfactorily in a drug abuse assist~ce or rehabilitation program approved for such purposes by a Federal, Sffite or local
<br />health, law enforcanent or other appropriate agency;
<br />(g) Make a good faith effort to c~tinue to maintain a ding-free workplace through implementation of paragraphs 1(a) though 1(f1.
<br />C. LOBBYING
<br />As required by Section 1352, Title 31 of the U.S. Code, and implemetnted at 45 CFR Part 1230, for organizations entering into a grant or cooperative agreement over
<br />$100,000, as defined at 45 CFR Part 1230, Sections 1230.105 and 1230.110, the applicant certifies that
<br />1. No Federal appropriated fiords have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing air attempting to influence an officer or
<br />employee of any agency, a Member of Congress, an officer ar employee of Congress, ~ an employee of a Member of Congress is oormection with the awarding of any
<br />Federal contract the malting of any Federal giant the making of nay Federal hoar, the entering into of any cooperative agreetncat or the extension, continuation,
<br />renewal, ar~ndment or modification of any Federal contract Brant loan, or cooperative agreement.
<br />2. ]f any fiords other than Federal appropriated fiords have been paid or will be paid to any person for influencing or attempting to influence an office or employee of any
<br />agency, a Member of Congress, as officer or employee of Congress,. or an employee of a Member of Congress in co-mection with this Federal contract, great loan, ar
<br />~~ coopciativa agreement the undersigned shall complete and submit Standard Form-LLL, `Disclosure Form to,Report Lobbying," in accordance with its instructions: --
<br />3. The undersigoed shall require that the language of thus certification be included in the award documents for all subcontracts at all tiers (including subcontracts, sub-
<br />grants, and contracts ands grants, loans, and cooperative agreements) sad that eIl sub-recipients shall certify and disclose accordingly.
<br />As the duly authorized representative of the applicant I hereby certify that the applicant will comply with the above certification(s). (A copy of the governing body's
<br />au'" rtion for me to sign this certification as official representative is on file in the applicant's office)
<br />Omuue County Government Board of Coaanissioners Margaret Brown. Chair
<br />Applicant Organization Printed Name and Title of Authorized Representative
<br />April 1, 2003
<br />Signature of Authorized Certifying Official Date
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