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<br />CA
<br />U.S. Department of Justice
<br />Office of Community Oriented Policing Services
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<br />Although the Department o0ustice has madeevery effort to simplify the application process, other provisions of Federal law
<br />require us toseekyour certification Ilegarding certain matters. Applicants should read the regulations cited below and the
<br />instructions for certification included in the regulations to tutderstand the nauirements and whether they apply to a particular
<br />applicant, Signature of Otis fon-n provides for compliance with certification requirements under 26 CFR Sart 69, "New
<br />Restrictionson Lobbying," and 28 CFR tart67, "Government -wide Debarment and Suspension (Nonprocurement) and
<br />Government -wide Requirements for Drug -Free Workphce (Grants)," and the coordination and iron -supplanting requirements
<br />of the i'ublicSafety partnership anti Community Policing Act of 1994. The c+ertificatiortsshall be treated as a material represen-
<br />tation of fact upon whidt reliance twill be placed when the Department of f ustice determines to award the covered grant.
<br />3, Lobbying
<br />As mquired'by Section 7352 73tie 31 of the US. Code, and imple-
<br />mented at 28 CFR Part 69, for persons entering into n grant cr coop-
<br />erative agreement over $ll]OX0, as defined at 28 CI• -R Part 69, the
<br />applicant certifies that:
<br />A. No Federal appropriated funds have been paid or will be
<br />paid, by or on behalf of" undersigned, to any person for influ-
<br />encing or aIle. rnpting to influence all officer or ernployce of any
<br />agency, a Member of Congress, an officer or employee of
<br />Conpmss, cr an employee of a hfennlxr of Congressin connection
<br />with the making of any Federal grant, the entering inlo of any
<br />cooperative,igmcanenl; and dte exlenssion, continuation, renewal,
<br />amendment or modif!Uion of any Federal grant or cooperative
<br />agreement;
<br />B. If any funds other than Federal appropriated funds have been
<br />paid or will be paid to any person for infMencing or attempting
<br />to influence an officer or employee of any agency, a Memtyrr of
<br />Congress, an officer or employee of Congress, or an employee of
<br />A Member of Congress In connection with this Federal grant or
<br />cooperative agreemcnl, the !undersigned sliall compltte and sub-
<br />mit Standard Form -- LLL,-Disdosure of Lobbying Activities," in
<br />accordance with its instructions;
<br />C. The undersigned shall require: that the language of thisconifi-
<br />cation be included in the award donrmeats for all subawards at
<br />All tiers (including subgranls, contracts tuufer grants and coopera-
<br />live agreements, and aut>mttracls) and that all sub -recipients
<br />shall certify and dhsckrse accordingly.
<br />2. Debarmerik5trspenaion and OflrerReoponaibitity Matters
<br />(Direct Recipient)
<br />As required b)° Executive Order !2549, Debarment and Suspension,
<br />and implemented at 28 CFR Fart 67, for prospective participants in
<br />primary covered transattiotts, as defvted at 28 CFR Part A7, Section
<br />67.510—
<br />A, i'he applicant certlRes that it and its principals:
<br />(t} Arrnotpreic5r0ydetuneci,suspended,pmpos+.ttfor
<br />debarment declared ineligible, sernterrad to a denial at
<br />Federal benefits by a stale or Federal court, or voluntarily
<br />excluded from covered transactions by any Federal clepart-
<br />nrent or agency;
<br />(ii) Have not within a three-year period preceding ihts appli-
<br />cation been Convicted of or had a civil judgment rendered
<br />against them for mmm654on of fraud or a criminal offense in
<br />connection with obtaining, attempting to obtain or perform-
<br />ing public (Federal, stl[Cor local) transaction c
<br />erform-ingpublic(Federal,staleorlocal)transactiona cntractunder
<br />a public transaction; violation of Federal or str..e antitnrst
<br />slatules or rommissien of embe;celernenl, theft.. forgery,
<br />bribery, falsification or destruction of records, making false
<br />statemen is, o r receiving s tolen p mperty;
<br />(iii} Are not presently indicted for or otherwise nirnirtally or
<br />civilly charged try a governmental entity (Federal, stale or
<br />iomll with commission of any of the offenses enumerated in
<br />paragraph W6 this cercif-ication; and
<br />(iv) Have not within a t}uee-year period preceding this appli-
<br />cation had one or more pub)!c Iransactiols We&rat shite or
<br />total) terminated for cause or default at td
<br />D. Where the applicant is unable to certify to any of the slate-
<br />ments in this certification, fee or she shall atlaelt an explanation to
<br />this application.
<br />3. brig -Free Workplace IGranites Other7`7nan In dividual9)
<br />As required by Dae Drug -Free Workpi ane Act of 19W and intple<
<br />men teti at 28 C'R d'art 67, Subpar F, for grantees, as defined at 28
<br />CFI! Pari 67, sections 67.615 and 67.620 —
<br />A- The applicant certifies that it will, or will continue to, provide
<br />A dmg•free Workplace by:
<br />Ii) f ubllsltang a statement rotifybag employees that the
<br />unlawful manufacture, distributior6 dispensing, possession or
<br />use of a txmtrolied sobstaru : is prohibited in the grantees
<br />workplace and specifyirg the actions that will be taken against
<br />employees for violation of suds proltibitiom
<br />(ii) Fslablislunganon-going dnrg-freeawarenessProgram to
<br />inform employees absxit --
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