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<br />U.S. Department of Justice
<br />Office of Community Oriented Policing Services
<br />
<br />Certifications
<br />
<br />
<br />Regarding Lobbying; Debarment, Suspension and Other Responsibility Matters; rug-Free Workplace
<br />Requirements Coordination with Affected Agencies.
<br />
<br />Although the Department of Justice has made every effort to simplify the application process, other provisions of federal law require us to
<br />seek your agency's certification regarding certain matters. Applicants should read the regulations cited below an the instructions for
<br />certification included in the l"Cgulations to understand the requirements and whether they apply to a particular a plicant. Signing this form
<br />complies with certification requirements under 28 CFR Part 69, "New Restrictions on Lobbying," 28 CFR Part )7, "Government-\Vide
<br />Debarment and Suspension (Nonprocurement)," 28 CFR Part 83 Government-\'(Iide Requirements for Drug-F ee Workplace (Grants)."
<br />and the coordination requirements of the Public Safety Partnership and Community Policing Act of 1994. The certifications shall be
<br />treated as a material representation of fact upon which reliance will be placed when the Department of Justice etermines to award the
<br />covered grant,
<br />
<br />1. Lobbying
<br />
<br />As re<juired by Section 1352, Title 31 of the U.S. Code, and
<br />implemented at 28 CFR Part 69, for persons entering into a grant or
<br />cooperative agreement over $100,000. as defined at 28 CFR Part 69,
<br />the applicant certifies that:
<br />
<br />A. No federal appropriated funds have been paid or will he paid. hy
<br />or on behalf of the undersigned, to any person for influencing or
<br />attempting to influence an officer or employee of any agency, a
<br />member of Congress, an officer or employee of Congress. or an
<br />employee of a member of Congress in connection with the making
<br />of any federal grant; the entering into of any cooperative agreement;
<br />and the extension, continuation, renewal, amendment or modification
<br />of any federal grant or cooperative agreement;
<br />
<br />B. I f any funds other than federal appropriated funds have been paid
<br />or will be paid to any person for influencing 01' attempting to
<br />influence an officer or employee of any agency, a member of
<br />Congress. an officer or employee of Congress, or an employee of a
<br />member of Congress in connection with this federal grant or
<br />cooperative agreement, the undersigned shall complete and submit
<br />Standard Form - LLL, "Disclosure of Lobbying Activities." in
<br />accordance with its instructions;
<br />
<br />C The undersi!-,'1led shall re<juire that the language of this
<br />certification be included in the award documents for all suhawards at
<br />all tiers (including subgrants, contracts und(,r grants and cooperative
<br />agreements, and subcontracts) and that all sub-recipients shall certify
<br />and disclose accordingly.
<br />
<br />2. Debarment. Suspension and Other Responsibility i\'latters (Direct
<br />Recipient)
<br />
<br />As required by I:xecutive Order 125~9, Debarment and Suspension,
<br />and implemented at 28 CFR Part 67, for prospective participants in
<br />primary covered transactions. as defined at 28 CFR Part 67, Section
<br />67.440 -
<br />
<br />A. The applicant certifies that it and its principals:
<br />
<br />(i) ,\re not presently debarred, suspended, proposed for debarment.
<br />declared ineligible, sentenced to a denial of federal benefits by a state
<br />or federal court. or voluntarily excluded from covered transactions by
<br />any federal department or agency;
<br />
<br />(ii) 1 lave not within a three-year perio preceding this application
<br />been convicted of or had a civil judg ent rendered against them
<br />for commission of fraud or a criminal offense in connection with
<br />obtaining, attempting to obtain, or per orming a public (federal,
<br />state or local) or private agreement or ransaction; violation of
<br />federal or state antitrust statutes or co mission of
<br />embezzlement, theft, forgery, bribery, a1sification or destruction
<br />of records, making false statements, ta evasion or receiving
<br />stolen property, making false claims. 0 obstruction of justice, or
<br />commission of any offense indicating lack of business integrity
<br />or business honesty that sel~ously and irectly affects your
<br />present responsibility.
<br />
<br />(iii) Are not presently indicted for or 0 herwise criminally or
<br />civilly charged by a governmental enti I (federal, state or local)
<br />with commission of any of the offens 's enumerated in paragraph
<br />(i\)(ii) of this certification; and
<br />
<br />(iv) Have not within a tluee-year pel~o preceding this application
<br />had one or more public transactions ( deral, state or local)
<br />terminated for cause or default; and
<br />
<br />B. W'here the applicant is unable to celtify to any of the
<br />statements in this certification, he or s e shall attach an
<br />explanation to this application.
<br />
<br />3. Drug-Free Workplace (Grantees Ot er Than Individuals)
<br />
<br />As re<juired by the Drug-Free Workpl e /\ct of 1988, and
<br />implemented at 28 CFR Part 83, for g antees, as defmed at 28
<br />CFR Part 83, Sections 83 and 83,510 -
<br />
<br />A The applicant certifies that it will, o' will continue to, provide
<br />
<br />a drug-free workplace by:
<br />
<br />(i) Publishing a statement notifying em loyees that the unlawful
<br />manufacture, distribution, dispensing, (lSsession or use of a
<br />controlled substance is prohibited in tl e grantee's workplace and
<br />specifying the actions that will be take against employees for
<br />violation of such prohibition;
<br />
<br />(ii) Establishing an em-going drug-free awareness program to
<br />
<br />inform employees about -
<br />
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