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Deryl Loar
<br /> Date:
<br /> 06/11/2015
<br /> Signature of Government Executive/Financial Official(For your electronic signature, please type in your name)Kelly
<br /> Goodwin
<br /> Kelly Goodwin
<br /> Date:
<br /> 06/11/2015
<br /> SECTION 15B: CERTIFICATIONS
<br /> Regarding Lobbying; Debarment,Suspension and Other Responsibility Matters; Federal Taxes and Assessments;
<br /> Drug-Free Workplace Requirements;and Coordination with Affected Agencies.
<br /> Although the Department of Justice has made every effort to simplify the application process,other provisions of federal law
<br /> require us to seek your agency's 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.Signing this form complies with certification requirements under 28 C.F.R. Part 69,"New Restrictions on Lobbying,"2
<br /> C.F.R. Part 2867,"Nonprocurement Debarment and Suspension,"the applicable appropriations Acts,28 C.F.R. Part 83,
<br /> "Government-Wide Requirements for Drug-Free Workplace(Grants),"and the coordination requirements of the Public Safety
<br /> Partnership and Community Policing Act of 1994.The certifications shall be treated as a material representation of fact upon
<br /> which reliance will be placed when the Department of Justice determines to award the covered grant.
<br /> 1. Lobbying
<br /> As required by 31 U.S.C.§ 1352, implemented at 28 C.F.R. Part 69,for persons entering into a grant or cooperative agreement
<br /> over$100,000,and 2 C.F.R. §200.450 as adopted by the Department of Justice in 2 C.F.R.§2800.101,the applicant certifies
<br /> that:
<br /> A. No federal appropriated funds have been paid or will be paid,by or on behalf of the undersigned,to any person for influencing
<br /> or attempting to influence an officer or employee of any agency,a member of Congress,an officer or employee of Congress,or
<br /> an employee of a member of Congress in connection with the making of any federal grant;the entering into of any cooperative
<br /> agreement;and the extension,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 any person for influencing or attempting to
<br /> influence an officer or 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 complete and submit
<br /> Standard Form-LLL,"Disclosure of Lobbying Activities,"in accordance with its instructions;and
<br /> C. If applicant is a nonprofit organization or an institution of higher education, it will comply with the additional lobbying restrictions
<br /> set forth in 2 C.F.R. §200.450(c) as adopted by the Department of Justice in 2 C.F.R. §2800.101; and
<br /> D.The undersigned shall require that the language of this certification be included in the award documents for all subawards at all
<br /> tiers(including subgrants,contracts under grants and cooperative agreements, and subcontracts)and that all sub-recipients shall
<br /> certify and disclose accordingly.
<br /> 2.Debarment,Suspension and Other Responsibility Matters(Direct Recipient)
<br /> Pursuant to Executive Order 12549,Debarment and Suspension,as implemented at 2 C.F.R. Part 2867,for prospective
<br /> participants in primary covered transactions, as defined at 2 C.F.R.§2867.20(a),and other requirements,the applicant certifies
<br /> that it and its principals:
<br /> A.Are not presently debarred,suspended,proposed for debarment,declared ineligible,sentenced to a denial of federal benefits
<br /> by a state or federal court,or voluntarily excluded from covered transactions by any federal department or agency;
<br /> B. Have not within a three-year period preceding this application been convicted of a felony criminal violation under any Federal
<br /> law,or been convicted or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection
<br /> with obtaining,attempting to obtain,or performing a public(federal,state or local)or private agreement or transaction;violation of
<br /> federal or state antitrust statutes or commission of embezzlement,theft,forgery,bribery,falsification or destruction of records,
<br /> making false statements,tax evasion or receiving stolen property, making false claims,or obstruction of justice,or commission of
<br /> any offense indicating a lack of business integrity or business honesty that seriously and directly affects your present responsibility;
<br /> C.Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity(federal,state or local)with
<br /> commission of any of the offenses enumerated in paragraph(B)of this certification; and
<br /> D. Have not within a three-year period preceding this application had one or more public transactions(federal,state or local)
<br /> terminated for cause or default.
<br /> 3.Mandatory Disclosure
<br /> Pursuant to the Uniform Administrative Requirements,Cost Principles,and Audit Requirements for Federal Awards,2 C.F.R.§
<br /> 200.113 as adopted by the Department of Justice in 2 C.F.R. §2800.101,the applicant certifies that it:
<br /> A.Has not violated any federal criminal law involving fraud,bribery,or gratuity that may potentially affect the federal grant or 100
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