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U.S. DEPARTMENT OF JUSTICE
OFFICE OF JUSTICE PROGRAMS
OFFICE OF THE COMPTROLLER
CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY
MATTERS; AND DRUG -FREE WORKPLACE REQUIREMENTS
Applicants should refer to the regulations cited below to determine the certification to which they are required to
attest. Applicants should also review the instructions for certification included in the regulations before completing
this form, Signature of this form provides for compliance with certification requirements under 28 CFR Part 69,
"New Restrictions on Lobbying" and 28 CFR Part 67, "Government -wide Debarment and Suspension (Nonpro-
curement) and Government -wide Requirements for Drug- Free Workplace (Grants)." The certifications shall be
treated as a material representation of fact upon which reliance will be placed when the Department of Justice
determines to award the covered transaction, grant, or cooperative agreement.
1, LOBBYING As required by Section 1352, Title 31 of the U.S. Code, and implemented at 28 CFR Part 69, for
persons entering into a grant or cooperative agreement over $100,000, as defined at 28 CFR Part 69, the
applicant certifies that:
(a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any
person for in-fluencing or attempting to influence an officer or employee of any agency, a Member of Congress,
an officer or employee of Congress, or an employee of a Member of Congress in con-nection with the making of
any Federal grant, the entering into of any cooperative agreement, and the extension, continuation, renewal,
amendment, or modification of any Federal grant or cooperative agreement;
(b) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing
or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of
Congress, or an employee of a Member of Congress in connection with this Federal grant or cooperative
agreement, the undersigned shall complete and submit Standard Form - LLL, "Disclosure of Lobbying Activities,"
in accordance with its instructions;
(c) The undersigned shall require that the language of this cer-tification be included in the award documents for all
subawards at all tiers (including subgrants, contracts under grants and cooperative agreements, and
subcontracts) and that all sub -recipients shall certify and disclose accordingly,
2. DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS (DIRECT RECIPIENT)
As required by Executive Order 12549, Debarment and Suspension, and implemented at 28 CFR Part 67, for
prospective participants in primary covered transactions, as defined at 28 CFR Part 67, Section 67.510
A. The applicant certifies that it and its principals:
(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, sentenced to a denial of
Federal benefits by a State or Federal court, or voluntarily excluded from covered transactions by any Federal
department or agency;
(b) Have not within a three-year period preceding this application been convicted of or had a civil judgment
rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to
obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation
of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, or receiving stolen property;
(c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal,
State, or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this certification; and (d)
Have not within a three-year period preceding this application had one or more public transactions (Federal,
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State, or local) terminated for cause or default; and
B. Where the applicant is unable to certify to any of the statements in this certification, he or she shall attach an
explanation to this application.
3. DRUG -FREE WORKPLACE (GRANTEES OTHER THAN INDIVIDUALS)
As required by the Drug -Free Workplace Act of 1988, and implemented at 28 CFR Part 67, Subpart F, for
grantees, as defined at 28 CFR Part 67 Sections 67.615 and 67.620
A, The applicant certifies that it will or will continue to provide a drug -free workplace by:
(a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing,
possession, or use of a controlled substance is prohibited in the grantee's workplace and specifying the actions
that will be taken against employees for violation of such prohibition;
(b) Establishing an on -going drug -free awareness program to inform employees about
(1) The dangers of drug abuse in the workplace;
(2) The grantee's policy of maintaining a drug -free workplace;
(3) Any available drug counseling, rehabilitation, and employee assistance programs; and
(4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace;
(c) Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of
the statement required by paragraph (a);
(d) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under
the grant, the employee will
(1) Abide by the terms of the statement; and
(2) Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the
workplace no later than five calendar days after such conviction;
(e) Notifying the agency, in writing, within 10 calendar days after receiving notice under subparagraph (d)(2) from
an employee or otherwise receiving actual notice of such convic-tion. Employers of convicted employees must
provide notice, including position title, to: Department of Justice, Office of Justice Programs, ATTN: Control Desk,
633 Indiana Avenue, N.W., Washington, D.C. 20531. Notice shall include the identification number(s) of each
affected grant;
(f) Taking 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 including termination, consistent
with the requirements of the Rehabilitation Act of 1973, as amended; or
(2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program
approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency;
(g) Making a good faith effort to continue to maintain a drug -free workplace through implementation of paragraphs
(a), (b), (c), (d), (e), and (f).
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As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the
above certifications.
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