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<br />U.S. DEPARTMENT OF HOMELAND SECURITY
<br />CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND
<br />OTHER RESPONSIBILITY 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 attest. Applicants
<br />should also review the instructions for certification included in the regulations before completing this form. Signature on this
<br />form provides for compliance with certification requirements under 44 CFR Part 18, "New Restrictions on Lobbying; and 28 CFR
<br />Part 17, "Government-wide Debarment and suspension (Nonprocurement) and Government-wide Requirements for Drug-Free
<br />Workplace (Grants)." The certifications shall be treated as a material representation of fact upon which reliance will be placed
<br />when the Federal Emergency Management Agency (FEMA) determines to award the covered transaction, grant, or cooperative
<br />agreement.
<br />A. As required by section 1352, Title 31 of the U.S. Code, and
<br />implemented at 44 CFR Part 18, for persons entering into a grant
<br />or cooperative agreement over $100,000, as defined at 44 CFR
<br />Part 18, the applicant certifies that
<br />(a) No Federal appropriated funds have been paid or will be paid,
<br />by 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 />(b) If any other funds than Federal appropriated funds have been
<br />paid or will be paid to any person for influencing or attempting to
<br />influence an officer or employee of any agency, a Member of
<br />Congress, an officer or an employee of Congress, or employee
<br />of a 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 />(c) The undersigned shall require that the language of this certification
<br />be included in the award documents for all subawards at all tiers
<br />(including subgrants, contracts under grants and cooperative
<br />agreements, and subcontract(s) and that all subrecipients shall
<br />certify and disclose accordingly.
<br />Standard Form LLL, "Disclosure of Lobbying Activities" attached.
<br />(This form must be attached to certification ifnonappmpriated funds
<br />are to be used to influence activities.)
<br />2. DEBARMENT, SUSPENSION, AND OTHER
<br />RESPONSIBILITY MATTERS
<br />(DIRECT RECIPIENT)
<br />(b) Have not within a three-year period preceding this application been
<br />convicted of ar had a civilian judgment rendered against them for
<br />commission of fraud or a criminal offense in connection with
<br />obtaining, attempting to obtain, or perform a public (Federal, State,
<br />or local) transaction or contract under a public transaction; violation
<br />of Federal or State antitrust statutes or commission of embezzlement,
<br />theft, forgery, bribery, falsification or destruction of records,
<br />making 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)
<br />of this certification; and
<br />(d) Have not within a three-year period preceding this application
<br />had one or more public t ransactions (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
<br />in this certification, he or shall shall attached 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 44 CFR Part 17, Subpart F, for grantees, as defined
<br />at 44 CFR Part 17, Sections 17.615 and 17.620:
<br />A. The applicant certifies that it will continue to privide 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 thl will be taken against employees for
<br />violation of such prohibition;
<br />As required by Executive Order 12549, Debarment and Suspension,
<br />and implemented at 44 CFR Part 67, for prospective participants in
<br />primary covered transactions, as defined at 44 CFR Part 17,
<br />Section 17.510-A. The applicant certifies that it and its principals:
<br />(a) Are 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 />Form 20-1 aC JI IN Gd
<br />(b) Establishing an on-going drug free awareness program to
<br />inform empoyees about:
<br />(1) The dangers of drug abuse in the workplace;
<br />(2) The grantees policy of maintaining a drug-free workplace;
<br />(3) Any available drug counseling, rehabilitation, and
<br />employee assistance programs; and
<br />(4) the penalties that may be imposed upon employees for
<br />drug abuse violations occurring in the workplace;
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