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A TRUE COPY
<br />CERTIFICATION ON LAST -AGE
<br />RYAN L. BUTLER, CLERK
<br />Criminal Justice Grants
<br />LOBBYING, DEBARMENT, AND DRUG
<br />FREE WORKPLACE CERTIFICATION
<br />Email completed form to: CJgrants@fdle.state.fl.us
<br />Instructions: Before completing this form, applicants should refer to the regulations cited below to determine which
<br />certifications are required. Using this form, applicants may certify their compliance with the following requirements:
<br />28 CFR Part 69, "New Restrictions on Lobbying;" 28 CFR Part 67, "Government -wide Debarment and Suspensions
<br />(Non -procurement);" and 28 CFR 83, "Government -wide Requirements for Drug Free Workplace (Grants)," as
<br />applicable. The certifications attested to on this form shall be treated as a material representation of fact and will
<br />be relied upon as such when Criminal Justice Grants makes award determinations for a covered transaction,
<br />grant, or cooperative agreement.
<br />1. Lobbying
<br />As required by Section 1352, Title 31 of the U.S. Code, and implemented at 28 CFR Part 69, for persons
<br />entering into a grant or cooperative agreement over $100,000, as defined at 28 CFR Part 69, the applicant
<br />certifies that:
<br />a) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any
<br />person for influencing or attempting to influence an officer or employee of any agency, a member of
<br />Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with
<br />the making of any federal grant, the entering into of any cooperative agreement, and the extension,
<br />continuation, renewal, amendment, or modification of any federal grant or cooperative agreement.
<br />b) If any funds other than federal appropriated funds have been paid or will be paid to influence an officer or
<br />employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a
<br />member of Congress in connection with this federal grant or cooperative agreement, the undersigned shall
<br />complete and submit Standard Form LLL — "Disclosure of Lobbying Activities", in accordance with its
<br />instructions.
<br />c) The undersigned shall require that the language of this certification be included in the award documents for
<br />all subawards at all tiers (including subgrants, contracts under grants and cooperative agreements, and
<br />subcontracts) and that all subrecipients shall certify and disclose accordingly.
<br />2. Debarment, Suspension and Other Responsibility Matters
<br />As required by Executive Order 12549, Debarment and Suspension, and implemented at 28 CFR Part 67 -
<br />a) The applicant certifies that it and its principals:
<br />i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, sentenced to
<br />a denial of federal benefits by a State or Federal court, or voluntarily excluded from covered
<br />transactions by any federal department or agency;
<br />ii. Have not within a three-year period preceding this application been convicted of or had a civil
<br />judgement rendered against them for commission of fraud or a criminal offense in connection with
<br />obtaining, attempting to obtain, or performing a public transaction; violation of Federal or State
<br />antitrust statutes or commission of embezzlement, theft forgery, bribery, falsification or destruction
<br />of records, making false statements, or receiving stolen property;
<br />iii. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity
<br />(Federal, State, or local) with commission of any of the offenses enumerated in paragraph (a)(ii) of
<br />this certification; and
<br />iv. Have not within a three-year period preceding this application had one or more public transactions
<br />(Federal, State or local) terminated for cause or default.
<br />b) Where the applicant is unable to certify to any of the statements in this certification, he or she shall attach an
<br />explanation to this application.
<br />3. Drug Free Workplace
<br />As required by the Drug -Free Workplace Act of 1988, and implemented at 28 CFR Part 67, Subpart F, as defined
<br />at 28 CFR Part 67 Sections 67.615 and 67.620 —
<br />a) The applicant certifies that it will or will continue to provide a drug-free workplace by:
<br />UGJG-001 Page 1 of 2
<br />Lobbying, Debarment, and Drug Free Workplace Certification rev. 07/25
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