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CERTIFICATIONS REGARDING (A) DEBARMENT, SUSPENSION AND OTHER RESPONSIBILIT
<br />MATTERS; (B) DRUG-FREE WORKPLACE REQUIREMENTS; AND (C) LOBBYING 3
<br />Applicants should refer to the regulations cited below to determine which certifications(s) apply to their grant, and revie.v
<br />instructions included in the regulations. Signing this form complies with certification requirements under "Government-wide Debarm
<br />and Suspension (Non-procurement)", "Govemment-wide Requirements for Drug-Free Workplace (Grants)" in 45 CFR Part 1229,
<br />"New Restrictions on Lobbying" in 45 CFR Part 123U. The certification(s) shall be treated as a material representation of fact ul
<br />which reliance will be placed when the Corporation determines to award the covered transaction, grant, or cooperative agreement.
<br />A. DEBARMENT, 5USPENSION, AND OTHER RE$PONSIIBLITIES
<br />As required by Executive Order 13549, Debarment and Suspension, and implemented at 43 CFR Part 1229, for prospective participants in prin
<br />covered transactions, as defined at 45 CFR Part 1229, Sections 1229.105 and 1229.1 1D -
<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
<br />Federal department or 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 commissioi
<br />fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction
<br />contract under a public transaction; violation of Federal or State antitrust statutes or commissron of embezzlement, theft, forgery, brib
<br />falsification or destruction of records, making false 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 commission of
<br />of the offenses 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 caus~
<br />default:
<br />2. Where the applicant, is unable to certify to any of the statements in this certification, he or she shall attach an explanation to this application.
<br />B. DRUG-FREE WORKPLAN (GRANTEES OTHER THAN INDIVIDUALS)
<br />As required by'the Drug-Free Workplace Act of 1988, and implemented at 45 CFR Part 1239, Subpart F, for grantees, as defined at d5 CFR Part 1:
<br />Sections 1229.605 and 1229.610 -
<br />1. The applicant certifies that it will or will continue to provide adrub-free workplace, and will -
<br />(a) Publish a statement notifying employees that unlawful manufacture, distribution, dispensing, possession or use of a controlled sub=stone
<br />prohibited in the grantee's workplace and specifying the actions that will be taken against employees for violation of such prohibition;
<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 polity of maintaining a drug-free workplace;
<br />(3) Any available drug counseling, rehabilitation, and employee assistance programs; and
<br />(4) The penalties that may be imposed upon employees for drug abuse violations 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 subparagraph 1(a) that, as a condition of employment under the grant employee will -
<br />(1) Abide by the terms of the statement; 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 Lauer the
<br />calendar days after such conviction;
<br />(e) Notify the coenizant Corporation Grants Officer within 10 calendar.days after receiving notice of such conviction under subparagraph (d
<br />from the employee, or otherwise receiving actual notice. The notice shall include the title of the employee's position and the idvntafica
<br />number(s) of the affected grant;
<br />(fl Take one of the following actions, within 30 calendar days of receiving notice with respect to any employee who is so convicted -
<br />(1) Take appropriate personnel action against such an employee up to and including termination consistent with the requirements of
<br />Rehabrlrtation Act of 1973, as amended; or
<br />(2) Require such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes i
<br />Federal, State or local health, law enforcement, or other appropriate agency;
<br />(g) Make a good faith effort to continue to maintain adrug-Free workplace through implementation of paragraphs 1(a) through 1(fl.
<br />C. LOBBYING
<br />As required by Section 1352. Title 31 of the U.S. Code, and implemented at 45 CFR Part 1230, for organizations entering into a grant or cooper2
<br />agreement over SI00,000, as defined at 45 CFR Part 1230, Sections 1230.105 and 1230.110, the applicant certifies that:
<br />1. No Federal appp_ropriated funds have been paid or will be paid, by or on behalf of the undersigned to any person for influencing or attemptin
<br />influence an o#Iicer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Membe
<br />Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the cote
<br />iota of any cooperative agreement, or the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan
<br />cooperative agreement.
<br />2. if any funds other than Federal aapppropriated funds have been paid or will be paid to any person for influencing or attempting to influence an otl
<br />or em layee of any agency_.a.lvtember of Congress, an otlicer or employee of Congress, or an employee of a Member of Congress in connec
<br />with this Federal contract, grant, loan, ar cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure F
<br />to Report Lobbying," in accordance with its mstrucdons.
<br />3. The undersigned shall require that the language of this certification be included in the award documents for all subcontracts at all tiers (inclu~
<br />subcontracts, sub-grants. and contracts under grants, loans, and cooperative agreements) and that all sub-recipients shall certify and disc
<br />As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the above certrrrcatron(s).
<br />copy of the governing body's authorization for me to sign this certification as official representative is on file in the applicant's office;
<br />Applicant Organization
<br />Printed Name and Title of Authorized Representative
<br />Signature of Authorized Certifying Official Date
<br />424C (1
<br />per: tti
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