Laserfiche WebLink
<br />CERTIFICATION FORM <br />CIVIL RIGHTS REQUIREMENTS <br /> <br />lederal regulatIOns reqUire recipients of tinancial assistance lrom the Ollice of Justice Programs. or Its component agencies. to prepare, maintain on tile. <br />and Implement an Equal Employment Opportunity Plan WEDP) in aeeordanee with 28 eFR 99 42.301 - .308, The regulations exempt some reCipients <br />(rom the EEOP requirements, Recipients must complete either Section A or B below, <br /> <br />I'll'ase complete the following: <br /> <br />I. <br />2. <br /> <br />Grantee Name: LtA~<;' (,0 '^'~ <br />Number of Person Employed: ~ ~ 0 <br /> <br />6-o\J ~,(\I\~~ <br /> <br />3. Grant Award Amount: <br /> <br />4. Grant Number: <br /> <br />5. Civil Rights Contact Person: ~ D ~""'\ e... .:!O "'~O '^ <br />Address: '?O. ~t)'J. ~b I -t= f.LV"~O I ~ e> s<6108 <br />Telephone Number: --=t t) l- d.-Y. \ -~ i. ~ ()____,_ <br /> <br />Section A - CERTIFICATION (EEOP ON FILE) <br /> <br />Agencics that cmploy 50 or more persons and that receive $25.000 or more III tcderallunds are reqUIred to have an EEOP that complies with 28 CFR Part <br />42. Subpart E, <br /> <br />For agenclcs that have an EEOP. complete the following certification statement: <br /> <br /> <br />I. ~O"''''''~ €... -:s- D~~v-.. IAuthorized Official/, certif).' that the <br />C.CA. ~ c 0 "^-""'~, b~\J~V'V\ \N'\."t.."".;r lagell~YI hasj;mllulate~ an E~~al Employment <br />Opportunity Plan in accordance with 28 CFR 42,]01, !il. ~" Subpart E, that It has heen Signed Into ~fject by the proper <br />authorily and disseminated to all employees. and thaI it is on.file at agellcYI <br />lowted at \....:-\-.c;.. Iluldress/. or review or audit by officials <br />oj'the ,,,'Iate planning agency or the Office for Civil Rig ts, <?tfice oj./ustice Programs as required by relevant laws and <br />regulations, <br /> <br />Date and effective duration ofEEOP: <br /> <br />Lo "'+ \. \;\.. ""'- (') I..L~ <br /> <br />-~ <br /> <br />Isigllllturel <br /> <br />'cr- <br /> <br />~ (~tttA <br />Itltlel <br /> <br />\ \ -.}~-D!c <br />IdateJ <br /> <br />D <br /> <br />If the agency does not have an appropriate EEOP. check the box and attach an addendum outlining what steps the agency is currently <br />taking to develop an EEOP that complies with the requiremcnts state above. and when it is expected the plan will be completed, <br /> <br />Section B - CERTIFICATION (NO EEOP REQUIRED) <br /> <br />D Fllr agencies not required to have an fEDP, cheek the box and completc thc tbllowlng certiticatllln: <br /> <br />I HEREBY ('ERTIFY THA T THE FUNDED ENTlTL <br />HAS LESS THAN 50 EMPLOYEES OR AWARD IS LESS THAN $25.0()O IN FEDERAL FUNDS PER YEAR AND <br />THEREFORE IS NOT REQUIRED TO MAINTAIN AN EEOP. PURSUANT TO 28 CFR 42,]01, ETSEo.; <br /> <br />IS AN EDUCATIONAL, MEDICAL, NON-PROFIT INSTITUTION OR INDIAN TRIBE THAT IS EXEMPT FRUAl <br />THE EEOP REQUIREMENTS OF 28 CFR 42,]01, ET SEQ,; <br /> <br />f...igllllturej <br /> <br />Ititlej <br /> <br />Idate} <br />