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(e) Notify the cognizant ACTION Grants Officer
<br /> within ten calendar days after receiving notice of C. LOBBYING
<br /> such conviction under subparagraph(d)(2)from As required by Section 1352,Title 31 of the U.S. Code,
<br /> the employee, or otherwise receiving actual no- and implemented at 45 CFR Part 1230,for organizations
<br /> tice. The notice shall include the title of the
<br /> employee's position and the identification entering into a grant or cooperative agreement over
<br /> $100,000, as defined at 45 CFR Part 1230, Sections
<br /> number(s)of each affected grant; 1230.105 and 1230.110,the applicant certifies that:
<br /> (f) Take one of the following actions, within 30
<br /> calendar days of receiving notice under 1. No Federal appropriated funds have been paid or will
<br /> subparagraph 4b, with respect to any employee be Paid, by or on behalf of the undersigned, to any
<br /> who is so convicted— person for influencing or attempting to influence an
<br /> officer or employee of any agency, a Member of
<br /> (1) Take appropriate personnel action against Congress,an officer or employee of Congress,or an
<br /> such an employee up to and including termi-
<br /> nation consistent with the requirements of the employee of a Member of Congress in connection
<br /> with the awarding of any Federal contract,the making
<br /> Rehabilitation Act of 1973,as amended; or of any Federal grant,the making of any Federal loan,
<br /> (2) Require such employee to participate satis- the entering into of any cooperative agreement,or the
<br /> factorily in a drug abuse assistance or reha- extension, continuation, renewal, amendment, or
<br /> bilitation program approved for suchpurposes modification of any Federal contract,grant,loan, or
<br /> by a Federal, State or local health, law en- cooperative agreement.
<br /> forcement,or other appropriate agency;
<br /> 2. If any funds other than Federal appropriated funds
<br /> (g) Make a good faith effort to continue to maintain have been paid or will be paid to any person for
<br /> a drug-free workplace through implementation influencing or attempting to influence an officer or
<br /> of paragraphs 1(a) through 1(f). employee of any agency,a Member of Congress,an
<br /> 2. The grantee shall insert in the space provided below officer or employee of Congress,or an employee of a
<br /> the site(s) for the performance of work done in Member of Congress in connection with this Federal
<br /> connection with the specific grant: contract, grant, loan, or cooperative agreement, the
<br /> Place of Performance(Street address,city,county,state, undersigned shall complete and submit Standard
<br /> zip code): Forth-LLL,"Disclosure Form to Report Lobbying,"
<br /> in accordance with its instructions.
<br /> 3. The undersigned shall require that the language of
<br /> this certification be included in the award documents
<br /> for all subcontracts at all tiers (including subcon-
<br /> tracts, subgrants, and contracts under grants, loans,
<br /> Check here if there are grantee workplaces that are and cooperative agreements)and that all subrecipients
<br /> not identified above. 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
<br /> certification(s). (A copy of the governing body's authorization for me to sign this certification as official represen-
<br /> tative is on file in the applicant's office.)
<br /> faaze Z�
<br /> Applicant Organization
<br /> A PS f Romd O- ,6115 S�d7ll�C�S
<br /> Printed Name and Title of utho ' Representative
<br /> Signaturf of Authorized Certifying Official Date
<br /> Page 11
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