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CERTIFICATION REGARDING LOBBYING , DEBARMENT, SUSPENSION , AND OTHER RESPONSIBILITIY MgtTERS•_AND-DRU-G EREEMORKPLACE_RE_QUIREMEFlorlua- Depart "I Of-Law rw NCS -- - - -- - dwarcLU me-Mqmor al Justica_A_asi nee Grant_ F t a requirement that each employee to be engaged in the performance be given a copy of the statement required by paragraph (a) ; the employee in the statement required by paragraph (a) that, as a mployment under the grant, the employee will- the terms of the statement; and (2) Notify the employer in writing of his or her conviction for a violation of a Check here _ If there are workplaces on file that are not identified criminal drug statute occurring in the workplace no later than five calendar days here. after the conviction; Section 67.630 of the regulations provides that a grantee that is a (e) Notifying the agency, in writing , within 10 calendar days after receiving notice State may elect to make one certification in each Federal fiscal year. under subparagraph (d) (2) from an employee or otherwise receiving actual notice A copy of which should be included with each application for of such conviction. Employers of convicted employees must provide notice Department of Justice funding. States and State agencies may elect including position title, to: Department of Justice, Office of Justice Programs, to use OJP Form 4061 /7. ATTN: Control Desk, 633 Indiana Avenue, N .W. , Washington , D. C. 20531 . Notice shall include the identification number(s) of each affected grant; Check here _ If the State has elected to complete OJP Form 406117 . (f) Taking one of the following actions, within 30 calendar days of receiving notice under subparagraph (d) (2) , with respect to any employee who is so convicted- (1 ) Taking appropriate personnel action against such an employee, up to and DRUG-FREE WORKPLACE including termination, consistent with the requirements of the Rehabilitation Act of (GRANTEES WHO ARE INDIVIDUALS ) 1973 , as amended; or As required by the Drug-Free Workplace Act of 1988, and (2) Requiring such employee to participate satisfactorily in a drug abuse implemented at 28 CFR Part 67 , Subpart F , for grantees, as defined assistance or rehabilitation program approved for such purposes by a Federal , at 28 CFR Part 67; Sections 67.615 and 67.620. State, or local health , law enforcement, or other appropriate agency; A. As a condition of the grant, 1 certify that I will not engage in the (g) Making a good faith effort to continue to maintain a drug-free workplace unlawful manufacture, distribution, dispensing, possession, or use of through implementation of paragraphs (a) , (b) , (c) , (d), (e) , and (f) . a controlled substance in conducting any activity with the grant; and B. The grantee may insert in the space provided below the site(s) for the B. If convicted of a criminal drug offense resulting from a violation performance of work done in connection with the specific grant: occurring during the conduct of any grant activity, I will report the Place of Performance Street address, city, county, state, zip code conviction , in writing, within 10 calendar days of the conviction, to: ( ty ty, P ) Department of Justice, Office of Justice Programs, ATTN : Control Desk, 633 Indiana Avenue, N.W. , Washington , D. C. 20531 . As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the above certifications . 1 . Grantee Name and Address : Indian River County Sheriff s Office — 4055 41 st Avenue Vero Beach Florida 32960 2 , Project Name : Mulit-Agencv Criminal Enforcement Unit 2012/2013 3 . Typed Name and Title of Authorized Representative : Dervl Loar, Sheriff 4 . Signature : 0115 . Date : June 29 , 2012 FDLE JAG Grant Application Package Lobbying, Debarment , Suspension, and Drug-Free Workplace Certification Page 2