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CERTIFICATION REGARDING LOBBYING ; DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITIY MATTERS ; AND DRUG-FREE WORKPLACE REQUIREMENTS Florida Department of Law Enforcement Edward B me Memorial Justice Assistance Grant Program (c) Making tt a requirement Mat each employee to De 7h (a) ; e performanceof the grant be given a copy of the statement required by (a) ;(d) Notifying the employee in the statement required by a) that, as acondition of employment under the grant, the employee(1 ) Abide by the terms of the statement; and (2) Notify the employer in writing of his or her conviction on of a Check here If there are workplaces on file that are not identified criminal drug statute occurring in the workplace no later tentlar 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 its, to: Department of Justice, Office of Justice Programs, to use OJP Form 41 ATTN: Control Desk, 633 Indiana Avenue, N.W., Washington, D.C. 20531 . Notice shall include the idenflfication numbers) of each affected grant; Check here _ If the State has elected to complete OJP Form 4061/7. (ITaking 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 (2) Requiring such employee to participate satisfactorily in a tlru abuse As required by the Drug-Free Workplace Am of 1988, and Y 9 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; (g) Making a good faitheffort to continue tomaintain a dru -free wor lace A. As a condi ion of the grant, I certify that I will not engage in the 9 kP unlawful manufacture, distribution, dispensing, possession, or use of through implementation of paragraphs (a), (b), (c), (d), (a), and (q. a controlled substance in conducting any activity with the grant; and B. The grantee may insert in the space provided below the sites) 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 wilting, within 10 calendar days of the conviction, to: 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 Board of Commissioners 1640 25th Street , Vero Beach , FL 32960 2. Project Name: Indian River County Planning 3. Typed Name and Title of Authorized Representative: Gary C . wheeler , Chairperson 4. Signature : 5 . Date :_ (rite �l V FDLE JAG Grant Application Package Lobbying Debarment Suspension and Drug-Free Workplace Certification Page 2