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CERTIFICATION REGARDING LOBBYING ; DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITIY MATTERS ; AND DRUG-FREE WORKPLACE REQUIREMENTS Florida Department of Law Enforcement Edward Byrne Memorial Justice Assistance Grant Program FNufify ing it a requirement that each employee to be engaged in the performance ant be given a copy of the statement required by paragraph (a); fying the employee in the statement required by paragraph (a) that, as a n of employment under the grant, the employee will- e by the terns of the statement, and fy the employer in writing of his or her conviction for a violation of a Check here If there are workplaces on file that are not identified drug statute occurring in the workplace no later than five calendar days here. 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 he 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 title, to: Department of Justice, Office of Justice Programs, to use OJP Form 4061 R. ATTN: Control Desk, 633 Indiana Avenue, N.W., Washington, D.C. 20531 . Notice shall include the identification numbers) of each affected grant; Check here _ If the State has elected to complete OJP Forth (f) Taking one of the following actions, within 30 calendar days of receiving notice 4061/7. 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 As required by the Drug-Free Workplace Act of 1988, and (2) Requiring such employee to participate satisfactorily, in a drug abuse 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 faith effort to continue to maintain adrug-free workplace A. As a condition of the grant, I certify that I will not engage in the through implementation ofparagraphs a , b , c , a controlled manufacture, distribution, dispensing, possession, or use of ( ) ( ) ( ) (d), (e), and (f). a controlled substance in conducting any activity with the grant; and B. The grantee may insert in the space provided below the site(s) 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 conviction, in writing, within 10 calendar days of the conviction, to: Place of Performance (Street address, city, county, state, zip code) 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 County Commissioners 1840 25th Street , Vero Beach , F1 32960 2. Project Name: Administration 3. Typed Name and Title of Authorized Representative: Gary C Wheelert Vice Chairman 4. Signature: ro e 5. Date: June 13 , 2006 FDLE JAG Grant Ap fication Package Lobb in , Debarment , Sus enslon, and Dru - Free Wor face Certification