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<br />U.S.. Department of Justice
<br />Office of Community Oriented Policing Services
<br />CeMcafions
<br />Regarding La"; Bedarmen% Suspe Win and i> Mr Respufflsiti ty Maft m; iii„ g4m iN *#ace
<br />Requiremmu coordimWon Mfti Mfecw Agencies; HarSupNanMng; and Retud im
<br />Although the Department of Justice has made every effort to simplify die application process, other provisions of Federal law
<br />require us to seek your certification regarding certain matters. Applicants should read the regulations cited below and the
<br />instructions for certification included in the regulations to understand the requirements and whether they apply to a particular
<br />applicant. 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, "Governrnent•wide Debarment and Suspension (Nonprocurement) and
<br />Government -wide Requirements for iDwg-Free Workplace (Grants)," and die coordination and non -supplanting requirements
<br />of the Public Safety Partnership and Community Policing Act of 1994. The certifications shall be treated as a material represen-
<br />tation of fact upon which reliance will be placed when the Department of justice determines to award the covered grant.
<br />1. Lobbying
<br />As required by Section 1352, Title 31 of the U 5. Code, and imple-
<br />mented at 28 CFR Part 69, for persons entering into a grant or coop-
<br />erative agreement over *0100,000, as defined at 28 CFR Pan 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 the undersigned, to arty person for tnflu-
<br />encing or attempting to influence an officer oremployee of any
<br />agency, a Member of Congress, an officer or employeeof
<br />Congress, or an employee of a Member of Congress in connection
<br />with the making of any Federal grant; the entering into of any
<br />cooperative agreement; and the extension, continuation, renewal,
<br />amendment or modification 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 influencing or attempting
<br />to influence an officer a employee of any agency, a Member 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 agreement, the undersigned shall complete and sub-
<br />mit Standard Form — LLL, "Disclosure of Lobbying Activities," in
<br />accordance with its instructions;
<br />C. The undersigned shall require that the language of this certifi-
<br />cation be included in the award documents for all subawards at
<br />all tiers (including subgranLs, contracts under grants and coopera-
<br />tive agreements, and subcontracts) and that all sub -recipients
<br />shall certify and disclose accordingly.
<br />2. Debarment, Suspension and Other Responsibility Matters
<br />(Direct Recipient)
<br />As required by Executive Order 12549. Debarment and Suspension,
<br />and Implemented at 28 CFR Part67, for prospective participants in
<br />primary covered transactions, as defined at 28 CFR Part 67, Section
<br />67,510—
<br />A.Tie applicant certifies that it and Its principals:
<br />(i) Are not presently debarred, suspatcled, proposed for
<br />debarrnent, declared ineligible, sentenced to a Aerial of
<br />Federal benefits by a state or Federal court, or voluntarily
<br />excluded from covered transactions by any Federal depart-
<br />ment or agency;
<br />(ii) Have not within a three-year period preceding this appli-
<br />cation been convicted of or had a civil judgment rendered
<br />against them for commission of fraud or a criminal offense in
<br />connection with obtaining, attempting to obtain, or perform-
<br />ing public (Federal, state or local) transaction or contract under
<br />a public transaction;. violation of Federal or state antitrust
<br />statutes or commission of embezzlement, theft, forgery,
<br />bribery, falsification or destruction of records, making false
<br />statements, or receiving stolen property;
<br />(iii) Are riot presently indicted for or otherwise criminally or
<br />civilly charged by a governmerital entity (Federal, slate or
<br />local) with conunission of any of the offereses enumerated in
<br />paragraph (A)(0) of this certification; and
<br />(iv) Have not within a three-year period preceding lhis appli-
<br />cation had one or more public transactions (Federal, state or
<br />local) terminated for rause or default; and
<br />B. Where the applicant is unable to certify to any of the state-
<br />ments in this certification, he or she shall attach an explanation to
<br />this application.
<br />3. Drug -Free Workplace (Grantees Cather -Than Individuals)
<br />As required by the Drug -Free Workplace Act of 1998, and imple-
<br />menled at 28 Chit Part 67, Subpart F, for grantees, as defined at 28
<br />CFR Part 67, Sections 67.615 and 67.620 —
<br />A. The applicant certifies that it whl1, or will continue to, provide
<br />a drug-frm workplace by.
<br />(i) Publishing a statem art notifying employees that the
<br />unhawfuI manufacture, thstribution, dispensing, possession or
<br />use of a controlled substance is prohibited in the grantees
<br />workplace and specifying the actions that will be taken against
<br />employees for violation of r,uch prohibition;
<br />(ii) Establishing an on-going drug-free awareness program to
<br />inform employees about ---
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