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N , AND OTHER RESPONSIBILITIY
<br /> CERTIFICATION REGARDING LOBBYING ; DEBARMENT, SUSPENSIO
<br /> MATTERS ; AND DRUG -FREE WORKPLACE REQUIREMENTS T121111 ; COPY
<br /> Edward By me Memorial Justice Assistance Granit-Program
<br /> J . R. SMITHt LERR
<br /> Form Provided by the U . S . DEPARTMENT OF JUSTICE , OFFICE OF JUSTICE PROGRAMS ,
<br /> OFFICE OF THE COMPTROLLER
<br /> CERTIFICATIONS REGARDING LOBBYING ; DEBARMENT, SUSPENSION , AND OTHER RESPONSIBILITY
<br /> MATTERS , AND DRUG-FREE WORKPLACE REQUIREMENTS
<br /> Applicants should refer to the regulations cited below to determine the certification to which they are required to
<br /> attest . Applicants should also review the instructions for certification included in the regulations before completing this
<br /> form . Signature of this form provides for compliance with certification requirements under 28 CFR Part 69 , " New
<br /> Restrictions on Lobbying" and 28 CFR Part 67 , "Government-wide Debarment and Suspension (Non-procurement) and
<br /> Government-wide Requirements for Drug-Free Workplace (Grants)" . The certifications shall be treated as a material
<br /> representation of fact upon which reliance will be placed when the Department of Justice determines to award the
<br /> covered transaction , grant , or cooperative agreement.
<br /> (b) Have not within a three-year period preceding this application
<br /> 1 . LOBBYING been convicted of or had a civil judgement rendered against them for
<br /> commission of fraud or a criminal offense in connection with
<br /> As required by Section 1352, Title 31 of the U .S. Code, and implemented at 28 obtaining, attempting to obtain, or performing a public
<br /> (Federal, State,
<br /> CFR Part 69, for persons entering into a grant or cooperative agreement over or local) transaction or contract under a public transaction
<br />; violation of
<br /> $ 100 , 000 , as defined at 28 CFR Part 69, the applicant certifies that: Federal or State antitrust statutes or commission of embezzlement,
<br /> theft forgery , bribery , falsification or destruction of records, making
<br /> (a) No federal appropriated funds have been paid or will be paid , by or on behalf false statements , or receiving stolen property;
<br /> of the undersigned , to any person for influencing or attempting to influence an
<br /> officer or employee of any agency, a member of Congress, an officer or employee (c) Are not presently indicted for or otherwise criminally
<br /> or civilly
<br /> of Congress, or an employee of a Member of Congress in connection with the charged by a governmental entity (Federal, State, or local)
<br /> with
<br /> making of any federal grant, the entering into of any cooperative agreement, and commission of any of the offenses enumerated in paragraph
<br /> ( 1 ) (b) of
<br /> the extension , continuation , renewal, amendment, or modification of any federal this certification; and
<br /> grant or cooperative agreement;
<br /> (d) Have not within athree-year period preceding this application
<br /> (b) If any funds other than federal appropriated funds have been paid or will be had one or more public transactions (Federal , State,
<br /> or local)
<br /> paid to any person influencing or attempting to influence an officer or employee of terminated for cause or default; and
<br /> any agency, a member of Congress, an officer or an employee of Congress, or an
<br /> employee of a member of Congress in connection with this federal grant or B. Where the applicant is unable to certify to any of the
<br /> statements in
<br /> cooperative agreement, the undersigned shall complete and submit Standard this certification , he or she shall attach an explanation to this
<br /> Form - LLL, " Disclosure of Lobbying Activities", in accordance with its instructions; application.
<br /> (c) The undersigned shall require that the language of this certification be
<br /> included in the award documents for all subawards at all tiers (including subgrants, 3. DRUG-FREE WORKPLACE
<br /> contracts under grants and cooperative agreements, and subcontracts) and that all (GRANTEES OTHER THAN INDIVIDUALS)
<br /> subrecipients shall certify and disclose accordingly.
<br /> As required by the Drug-Free Workplace Act of 1988 , and
<br /> implemented at 28 CFR Part 67 , Subpart F , for grantees, as defined
<br /> 2. DEBARMENT, SUSPENSION, AND OTHER at 28 CFR Part 67 Sections 67 . 615 and 67. 620-
<br /> RESPONSIBILITY MATTERS
<br /> ( DIRECT RECIPIENT) A. The applicant certifies that it will or will continue to provide a drug-
<br /> free workplace by:
<br /> As required by Executive Order 12549, Debarment and Suspension , and
<br /> implemented at 28 CFR Part 67 , for prospective participants in primary covered (a) Publishing a statement notifying employees that the
<br /> unlawful
<br /> transactions, as defined at 28 CFR Part 67 , Section 67. 510 - manufacture, distribution , dispensing , possession , or use of
<br /> a
<br /> controlled substance is prohibited in the grantee' s workplace and
<br /> A. The applicant certifies that it and its principals: specifying the actions that will be taken against employees for
<br /> violation of such prohibition ,
<br /> (a) Are not presently debarred , suspended , proposed for debarment, declared
<br /> ineligible, sentenced to a denial of federal benefits by a State or Federal court, or (b) Establishing an on-going drug-free awareness
<br /> program to inform
<br /> voluntarily excluded from covered transactions by any federal department or employees about-
<br /> agency;
<br /> (•I ) The dangers of drug abuse in the workplace;
<br /> (2) The grantee's policy of maintaining a drug-free workplace,
<br /> (3) Any available drug counseling , rehabilitation , and employee
<br /> assistance programs, and
<br /> (4) The penalties that may be imposed upon employees for drug
<br /> abuse violations occurring in the workplace,
<br /> F®LE JAG Grant Application Package Lobbying, Debarment , Suspension, and Drug-Free Workplace Certification
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