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<br />CERTIFICATIONS REGARDING (A) DEBARMENT, SUSPENSION
<br />AND OTHER RESPONS113ILITY MATTERS;
<br />(B) DRUG -FREE WORKPLACE REQUMEEMENTS; AND (C) LOBBYING
<br />Applicants should refer to the regulations cited below to determine which certincauion(s) apply to their grant, and
<br />review the instructions included in the regulations. Signing going this form complies with certification requirements under
<br />Government -wide Debarment and Suspension (Nonprocurement)" and "Government -wide Requirements for Drug -
<br />Free Work -place (Grams)" (under 45 CFR Part 1229), and New Restrictions on Lobbying" (under 45 CFR Part 1230).
<br />The certifications) shall be treated as a material representation of fact upon which reliance will be placed when
<br />ACTION determines to award the covered transaction, grant, or cooperative agreement.
<br />A. DEBARMENT, SUSPENSION, AND OTHER
<br />RESPONSIBILITY MATTERS
<br />As required by Executive Order 12549, Debarment and
<br />Suspension, and implemented at 45 CFR Pan 1229, for
<br />prospective participants in primary covered transactions,
<br />as defined at 45 CFR Part 1229, Sections 1229.105 and
<br />1229.110—
<br />1. The applicant certifies that it and its principals=
<br />(a) Are not presently debarred, susuended, proposed
<br />for debarment, declared ineligible, or voluntarily
<br />excluded from covered transactions by any Fed-
<br />eral department or agency;
<br />(b) Have not, within a three-v= period preceding
<br />this application, been convicted of or had a civil
<br />judgment rendezed against them for commission
<br />of fraud or a criminal offense in connection with
<br />obtaining, artempting to obtain, or performing a
<br />public (Federal, Stare or local) transaction or
<br />contract under a public transaction; violation of
<br />Federal or Stare antitrust statutes or commission
<br />of embezzlement. theft, forgery, bribery, fals7n-
<br />cation or destruction of records, making false
<br />statements, or receiving stolen propery;
<br />(c) Are not presently indicted for or otherwise crimi-
<br />nally orcivilly charged by aFederal, State orlocal
<br />government entity with commission of any of the
<br />offenses enumerated in paragraph 1(b) of this
<br />cerpfication;
<br />(d) Have not, within a Three -year period preceding
<br />this application, had one or more public transac-
<br />tions (Federal, State orlocal) terminated forcause
<br />or default; and
<br />B. DRUG- FREEWORKPLACE
<br />(GRANTEES OTHER THAN INDIVIDUALS)
<br />As required by the Drug -Free Workplace Act of 1988,
<br />and implemented at 45 CFR Part 1229, Subpart F, for
<br />grantees, as defined at 45 CFR Part 1229, Sections
<br />1229.605 and 1229.610—
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<br />2. Where the applicant is unable to certify to any of the
<br />statements in this certification, he or she shall attach
<br />an explanation to this application.
<br />ACTION Form 424 -E,F,G (1191) Page lU
<br />The applicant certifies that it will or will continue to
<br />provide a drug -free workplace, and will:
<br />(a) Publish a statement notifying employees that the
<br />unlawful manufacture, distribution, dispensing,
<br />possession or use of a controlled substance is
<br />prohibited in the grantee's workplace and speci-
<br />fying the actions that will be taken agai= em-
<br />ployees for violation of such prohibition;
<br />(b) Establish an on -going drug -uee awareness uro-
<br />gram to inform em-olovees about —
<br />(1) The dangers of drug abuse in the workplace;
<br />(2) The grantee's policy of maintaining a drug -
<br />free workplace;
<br />(3) Any available drug counseling, rehabiiita-
<br />aon, and employee assistance proag-ams; and
<br />(4) The penalties that may be imposed upon
<br />employers for drug abuse violations occur-
<br />ring in the workplace.
<br />(c) Make it a reouirement that each employee to be
<br />engaged in the performance of the grant be given
<br />a copy of the statement required by paragraph
<br />1(a);
<br />(d) Notify the employee in the statement required by
<br />subparagraph 1(a) that, as acondition of employ-
<br />ment under the grant, the employee will
<br />(1) Abide by the term of the statement; and
<br />(2) Notify the employerin writing of any convic-
<br />tion for a violation of a criminal drug statute
<br />which occurred in the workplace, no later
<br />than five calendar days after such conviction;
<br />19.
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