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B. The grantee must provide the location site(s)for the performance of work done in connection with the <br /> specific grant. <br /> Place(s)of Performance(Street address, city,county, state,zip code) <br /> DRUG-FREE WORKPLACE-(GRANTEES WHO ARE INDIVIDUALS) <br /> As required by the Drug-Free Workplace Act of 1988, and implemented at 7 CFR Part 3021, Subparts <br /> A, C, and E,for grantees, as defined at 7 CFR Part 3021: <br /> A. As a condition of the grant, I certify that I will not engage in the unlawful manufacture, distribution, <br /> dispensing, possession, or use of a controlled substance in conducting any activity with the grant; <br /> and <br /> B. If convicted of a criminal drug offense resulting from a violation occurring during the conduct of any <br /> grant activity, I will report the conviction, in writing, within 10 calendar days of the conviction, to the <br /> agency. <br /> Notice shall include the identification number(s)of each affected grant. <br /> As the duly authorized representative of the Grantee, I hereby certify that the Grantee will <br /> comply with the above certifications. <br /> o16 �] 6 <br /> Grantee Orbkinization Na <br /> Signature of Authorized RepresentoWe Date <br /> Cow <br /> 2�4_M <br /> Printed Name of Authorized Representative Title <br /> NCDA&CS Certifications&Assurances Page 3 of 3 <br /> Rev.7114 <br />