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<br />CERTIFICA TIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND OTHER
<br />RESPONSIBILITY MA TTERS; AND DRUG-FREE WORKPLACE REQUIREMENTS
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<br />Applicants should refer to the regulations cited below to determine the certification to which they
<br />are required to attest. Applicants should also review the instructions for certification included in
<br />the regulations before completing this form. Acceptance of this form provides for compliance with
<br />certification requirements under 28 CFR Part 69, "New Restrictions on Lobbying" and 28 CFR
<br />Part 67, "Government-wide Debarment and Suspension (Nonpro-curement) and Government-
<br />wide Requirements for Drug- Free Workplace (Grants)." The certifications shall be treated as a
<br />material representation of fact upon which reliance will be placed when the Department of Justice
<br />determines to award the covered transaction, grant, or cooperative agreement.
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<br />1. LOBBYING 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 $100,000, as
<br />defined at 28 CFR Part 69, the applicant certifies that:
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<br />(a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the
<br />undersigned, to any person for influencing or attempting to influence an officer or employee of
<br />any agency, a Member of Congress, an officer or employee of Congress, or an employee of a
<br />Member of Congress in connection with the making of any Federal grant, the entering into of any
<br />cooperative agreement, and the extension, continuation, renewal, amendment, or modification of
<br />any Federal grant or cooperative agreement;
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<br />(b) If any funds other than Federal appropriated funds have been paid or will be paid to any
<br />person for influencing or attempting to influence an officer or employee of any agency, a Member
<br />of Congress, an officer or employee of Congress, or an employee of a Member of Congress in
<br />connection with this Federal grant or cooperative agreement, the undersigned shall complete and
<br />submit Standard Form - LLL, "Disclosure of Lobbying Activities," in accordance with its
<br />instructions;
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<br />(c) The undersigned shall require that the language of this certification be included in the award
<br />documents for all subawards at all tiers (including subgrants, contracts under grants and
<br />cooperative agreements, and subcontracts) and that all sub-recipients shall certify and disclose
<br />accordingly.
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<br />2. DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS (DIRECT
<br />RECIPIENT)
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<br />As required by Executive Order 12549, Debarment and Suspension, and implemented at 28 CFR
<br />Part 67. for prospective participants in primary covered transactions, as defined at 28 CFR Part
<br />67, Section 67.510
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<br />A. The applicant certifies that it and its principals:
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<br />(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible,
<br />sentenced to a denial of Federal benefits by a State or Federal court, or voluntarily excluded from
<br />covered transactions by any Federal department or agency;
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<br />(b) Have not within a three-year period preceding this application been convicted of or had a civil
<br />judgment rendered against them for commission of fraud or a criminal offense in connection with
<br />obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or
<br />contract under a public transaction; violation of Federal or State antitrust statutes or commission
<br />of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false
<br />statements, or receiving stolen property;
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