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CERTIFICATIONS REGARDING (A) DEBARMENT, SUSPENSION AND OTIiER RESPONSIBILITY ~ 3
<br />~,r a mmc•'o c. rn~ nvrir2_>u~uFr. wnRKPT.A('.F. RF.niTIREMENTS: AND (C) LOBBYING
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<br />Applicants should refer to the regulations cited below to determine which certifications(s) apply to their grant, and review the instructions included in the
<br />regulations, Signing this form complies with certification requirements under "Govemment-wide Debarment and Suspension (Non-procurement)",
<br />"Government-wide Requirements for Dmg-Free Workplace (Grants)" in 45 CFR Part 1229, and "New Restrictions on Lobbying" in 45 CFR Par[ 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 />M DEBARMENT, SUSPENSION, AND OTAER RESPONSRILITIES
<br />As required by Executive Order 12549, Debarment and Suspension, and implemented at 45 CFR Part 1229, for prospective participants in primary covered transactions. as
<br />defined at 45 CFR Pan 1229, Sections 1229105 and 1229.1 t0 -
<br />1. The applicant certifies that it and its principals:
<br />(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Fedeml department or
<br />agency;
<br />(b) Have oot, 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 connection with obtaining, attempting to obtain, or performing a public (Fedeml, Smte or local) vansacdon or contract under a public transaction;
<br />violation of Federal or Smte antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or deswction of records, making false
<br />statements, or receiving stolen property;
<br />(c) Are not presently indicted for or otherwise criminally or civilly charged by a Fedeml, Smte or local government entity with commission of any of dre offenses
<br />enumerated in paragraph t(b) of this cerditcation;
<br />(d) Have not, within a 3-year period preceding this applicadon, had one or more public transactions (Fedeml, State or local) terminated for cause or default.
<br />2. Where the applicant is unable to certify to any of the statements in this certificadon, he or she shall attach an explanation to this application.
<br />B. DRUG-FREE WORKPLAN (GRAN'T'EES OTI~R IIiAN WDNmUAL S)
<br />As required by the Drug-Free Workplace Ac[ of 1986, 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 pzovide a drub-Gee workplace, and will -
<br />(a) Publish a statement notifying employees that unlawful manufacture, distribution, dispensing, possession or use of a convolled sub-stance is prohibited in the
<br />grantee's workplace and specifying the actions drat will be Wkcn against employees for violation of such prohibidon;
<br />(b) Establish an on-going drug-free awareness program to inform employees about -
<br />(1) The dangers of drug abuse in the workplace;
<br />(2) The grantee's policy of maintaining a drag-free workplace;
<br />(3) Any available drag counseling, rehabilitndon, and employee assistance programs; and
<br />(4) The penalties that may be imposed upon employees for drug abuse violations occumng in dre workplace.
<br />(c) Require that each employee to be engaged in dre performance of the grant be given a copy of the statement required by paragraph t (a);
<br />(d) Nadfy the employee in dte smtement required by subparagraph 1(a) Ihat, as a condcdon of employment under the grant, employee will -
<br />(t) Abide by the terms of the smtement; and
<br />(2) Notify the employer in writing of any convicdon for a violation of a criminal drug smlute which occurred in the workplace, no later than 5 calendar days after
<br />such convicdon;
<br />(c) Notify the cognizant Carpomdon Grants Officer widrin ]0 calendar days after receiving notice of such conviction under subparagraph (d)(2) from the employee, or
<br />otherwise receiving actual notce. The notice shall include the title of the employee's posidon and the identification number(s) of the affected grant;
<br />(t) Take one of the following actions, widrin 30 calendar days of receiving nodce with respect to any employee who is so convicted -
<br />(I) Take appropriate personnel action against such an employee up [o and including terminadon consistent with the requirements of the Rehabilimdon Act of 1973,
<br />as amended; or
<br />(2) Require such employee to participate satisfactorily in a drug abuse assistance oz rehabilitation program approved (ar such purposes by a Fedeml, State or local
<br />health, law enforcement, or other appropriate agency;
<br />(g) Make a good faith effort to continue to mainmin a drug-free workplace dvough implementation of paragraphs 1(a) through 1(f).
<br />C. LOBBYWG
<br />As required by Secdon 1352, Title 31 of the US. Code, and implemented at 45 CFR Part 1230, for organiwtions entering into a gram or cooperative agreement over
<br />$IOO,000, as defined at 45 CFR Pan 1230, Sections 1230 105 and 1230 110, [he applicant certifies drat:
<br />i No Fedeml appropriated funds have been paid or will be paid, by or on behalf of dre undersigned, to any person for influencing or attempting to influence an officer or
<br />employee of any agency, a Member of Congress, an officer ar employee of Congress, or an employee of a Member of Congress in connection with the awarding of any
<br />Fedeml contract, the malting of any Fedeml grant, the making of any Fedeml loan, the entering into of any cooperative agreement, or the extension, condnuadon,
<br />renewal, amendment, or modiPicadon of any Fedeml contract, gmn6 loan, or cooperative agreement.
<br />2. If any funds other than Fedeml appropriated funds have been paid or will be paid to any person far influencing or attempting to influence an officer or employee of any
<br />agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connecdon with this Fedeml contract, grant, loan, or
<br />cooperative agreement, the undersigned shall complete and submit Standard Forth-LLL, "Disclosure Form to Report Lobbying;' in accordance with its inswctions.
<br />3. The undersigned shall require that dre language of this cerdfication be included in the award documents for all subcanvacts at all tiers (including subconvacts, sub-
<br />grants, and contracts under grants, loans, and eooperadve agreements) and That all sub-recipients shall certify and disclose accordingly.
<br />As the duly authorized represenradve of the applicant. 1 hereby certify that the applicant will comply with the above certification(s) (A copy of [he governing body's
<br />authorization forme to sign this certification as official represenmtive is on file in the applicant's office)
<br />Oran a Count Govemment Board of Commissioners Ba 7acobs Chair
<br />Applicant Organizrdon Printed Name and Title of Authorized Represenmtive
<br />-April 16, 2006
<br />Signature of Authorized Certifying Official Date
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