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TION
<br />ING• DEBARMENT SUSP
<br />AnutrUm twBBY , , _.._._..1 _ _- __ OTHER RESPONSIBI
<br />MATTERS; AND DRUG-FREE WORKPLACE REQUIREMENTS
<br />Florida Department of Law Enforcement
<br />Edward Bvrne Memorial Justice Assistance Grant Program
<br />Form Provided by the U.S. DEPARTMENT OF JUSTICE, OFFICE OF JUSTICE PROGRAMS,
<br />OFFICE OF THE COMPTROLLER
<br />CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY
<br />MATTERS; AND DRUG-FREE WORKPLACE REQUIREMENTS
<br />Applicants should refer to the regulations cited below to determine the certification to which they are required to
<br />attest. Applicants should also review the instructions for certification included in the regulations before completing this
<br />form. 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, "Government -wide Debarment and Suspension (Non -procurement) and
<br />Government -wide Requirements for Drug -Free Workplace (Grants)". The certifications shall be treated as a material
<br />representation of fact upon which reliance will be placed when the Department of Justice determines to award the
<br />covered transaction, grant, or cooperative agreement.
<br />1. LOBBYING
<br />As required by Section 1352, Title 31 of the U.S. Code, and implemented at 28
<br />CFR Part 69, for persons entering into a grant or cooperative agreement over
<br />$100,000, as defined at 28 CFR Part 69, the applicant certifies that:
<br />(a) No federal appropriated funds have been paid or will be paid, by or on behalf
<br />of the undersigned, to any person for influencing or attempting to influence an
<br />officer or employee of any agency, a member of Congress, an officer or employee
<br />of Congress, or an employee of a Member of Congress In connection with the
<br />making of any federal grant, the entering into of any cooperative agreement, and
<br />the extension, continuation, renewal, amendment, or modification of any federal
<br />grant or cooperative agreement;
<br />(b) It any funds other than federal appropriated funds have been paid or will be
<br />paid to any person influencing or attempting to influence an officer or employee of
<br />any agency, a member of Congress, an officer or an employee of Congress, or an
<br />employee of a member of Congress in connection with this federal grant or
<br />cooperative agreement, the undersigned shall complete and submit Standard
<br />Form - LLL, 'Disclosure of Lobbying Activities", in accordance with its instructions;
<br />(c) The undersigned shall require that the language of this certification be
<br />included in the award documents for all subawards at all tiers (including subgrants,
<br />contracts under grants and cooperative agreements, and subcontracts) and that all
<br />subrecipients shall certify and disclose accordingly.
<br />2. DEBARMENT, SUSPENSION, AND OTHER
<br />RESPONSIBILITY MATTERS
<br />(DIRECT RECIPIENT)
<br />As required by Executive Order 12549, Debarment and Suspension, and
<br />Implemented at 28 CFR Part 67, for prospective participants in primary covered
<br />transactions, as defined at 28 CFR Part 67, Section 67.510 -
<br />A. The applicant certifies that it and its principals:
<br />(a) Are not presently debarred, suspended, proposed for debarment, declared
<br />Ineligible, sentenced to a denial of federal benefits by a State or Federal court, or
<br />voluntarily excluded from covered transactions by any federal department or
<br />agency;
<br />(b) Have not within a three-year period preceding this application
<br />been convicted of or had a civil judgement rendered against them for
<br />commission of fraud or a criminal offense in connection with
<br />obtaining, attempting to obtain, or performing a public (Federal, State,
<br />or local) transaction or contract under a public transaction; violation of
<br />Federal or State antitrust statutes or commission of embezzlement,
<br />theft forgery, bribery, falsification or destruction of records, making
<br />false statements, or receiving stolen property;
<br />(c) Are not presently indicted for or otherwise criminally or civilly
<br />charged by a governmental entity (Federal, State, or local) with
<br />commission of any of the offenses enumerated in paragraph (1) (b) of
<br />this certification; and
<br />(d) Have not within a three-year period preceding this application
<br />had one or more public transactions (Federal, State, or local)
<br />terminated for cause or default; and
<br />B. Where the applicant is unable to certify to any of the statements in
<br />this certification, he or she shall attach an explanation to this
<br />application.
<br />3. DRUG-FREE WORKPLACE
<br />(GRANTEES OTHER THAN INDIVIDUALS)
<br />As required by the Drug -Free Workplace Act of 1988, and
<br />implemented at 28 CFR Part 67, Subpart F, for grantees, 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-
<br />free workplace by:
<br />(a) Publishing a statement notifying employees that the unlawful
<br />manufacture, distribution, dispensing, possession, or use of a
<br />controlled substance is prohibited in the grantee's workplace and
<br />specifying the actions that will be taken against employees for
<br />violation of such prohibition;
<br />(b) Establishing an on-going drug-free awareness program to inform
<br />employees about -
<br />(1) The dangers of drug abuse In the workplace;
<br />(2) The grantee's policy of maintaining a drug-free workplace;
<br />(3) Any available drug counseling, rehabilitation, and employee
<br />assistance programs; and
<br />(4) The penalties that may be imposed upon employees for drug
<br />abuse violations occurring in the workplace;
<br />and
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