|
Cl 18
<br />FEDERAL EMERGEONCY HOMELAND
<br />ANAGEMENT AGENCY
<br />O.M.B. No. 166MO25
<br />CERTIFICATIONS REGARDING LOBBYING DEBARMENT SUSPENSION AND Expires August3l, 2011
<br />OTHER RESPONSIBILITY MATTERS; AND DRUB -FREE WORWPLACE REQUIREMENTS
<br />PAPERWORK BURDEN DISCLOSURE NOTICE
<br />Public reporting burden for this form is estimated to average 1.7 hours per response. The burden estimate includes the time for reviewing instructions and
<br />searching existing data sources, gathering and maintaining the data needed and completing, and submitting the form. You are not required to respond to
<br />this collection of information unless a valid OMB control number appears in the upper night corner of this form. Send comments regarding the accuracy of
<br />the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal
<br />Emergency Management Agency, 500 C Street, SW, Washington, DC 20472, Paperwork Reduction Project (1660- 0001). NOTE: Do not send your
<br />completed form to this address.
<br />Applicants should refer to the regulations cited below to determine the certification to which they are required to attest. Applicants should also review the
<br />instructions for certification included in the regulations before completing this form. Signature of this form provides for compliance with certification
<br />requirements under 44 CFR Part 18, "New Restrictions on Lobbying" and 28 CFR Part 17, "Government -wide Debarment and Suspension
<br />(Nonprocurement) and Government -wide Requirements for Drug -Free Workplace (Grants)." The certifications shall be treated as a material representation
<br />of fact upon which reliance will be placed when the Federal Emergency Management Agency (FEMA) determines to award the transaction, grant, or
<br />1. LOBBYING
<br />As required by section 1352, Title 31 of the U.S. Code, and implemented
<br />at 44 CFR Part 18, for persons entering into a grantor cooperating
<br />agreement over S 100,000, as defined at 44 CFR Part 18, the applicant
<br />certifies that:
<br />(a) No Federal appropriated funds have been paid or will be paid, by or on
<br />behalf of the undersigned, to any person for influencing or attempting to
<br />influence an officer or employee of any agency, a Member of Congress, an
<br />officer or employee of Congress, or an employee of a Member of Congress
<br />in connection with the making of any Federal grant, the entering into of any
<br />cooperative agreement, and the extension, continuation, renewal,
<br />amendment, or modification of any Federal grant or cooperative
<br />agreement.
<br />(b) If any other funds than Federal approprated funds have been paid or will be
<br />paid to any other person for influencing or attempting to influence an officer
<br />or employee of any agency, a member of Congress, an officer or an
<br />employee of Congress, or employee of a member of Congress in
<br />connection with this Federal Grant or cooperative agreement, the
<br />undersigned shall complete and submit Stand Fofm-LLL, "Disclosure of
<br />Lobbying Activities," in accordance with its instructions.
<br />c) The undersigned shall require that the language of this certification be
<br />included in the award documents for all subawards at all tiers (including
<br />subgrants, contracts under grants and cooperative agreements, and
<br />subcontracts) and that all subrecipients shall certify and disclose
<br />accordingly.
<br />R Standard Form -LLL "Disclosure of Lobbying Activities" attached
<br />(This form must be attached to certification B nonappropriated funds are to
<br />be used to influence activities.)
<br />2. DEBARMENT,SUSPENSION, AND OTHER RESPONSIBILITY
<br />MATTERS (DIRECT RECIPIENT)
<br />As required by Executive Order 12549, Debarment and Suspension, and
<br />implemented at 44 CFR Part 67, for prospective participants in primary
<br />covered transactions, as defined at 44 CFR Part 17, Section 17.510 -A.
<br />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 or
<br />Federal court, or voluntarily excluded from covered transactions by any
<br />Federal Department or agency;
<br />(b) Have not within a three -year period preceding this application been
<br />convicted of a or had a civilian judgment rendered against them for
<br />commission of fraud or a criminal offense in connection with obtaining,
<br />attempting to obtain, or perform a public a public (Federal ,State, or local)
<br />transaction or contract under a public transaction; violation of Federal or
<br />State antitrust statutes or Commission of embezzlement, theft, forgery,
<br />bribery, falsification or destruction of records, making false statements, or
<br />receiving stolen property;
<br />(c) Are not presently indicted for otherwise criminally or civilly charged by a
<br />governmental entity (Federal, State, or local) with commission of any of the
<br />offenses enumerated in paragraph (1) (b) of this certification; and
<br />(d) Have not within a three -year period preceding this application had one or
<br />more public transactions (Federal, State, or local) terminated for cause of
<br />default; and
<br />B. Where the applicant is unable to certify to any of the statements In this
<br />certification, he or she shall attach an explanation to this application.
<br />3. DRUG -FREE WORKPLACE
<br />(GRANTEE OTHER THAN INDIVIDUALS)
<br />As required by the Drug -Free Workplace AG of 1988, and implemented at
<br />44 CFR Part 17, Subpart F, for grantees, as defined at 44 CFR Part 17.615
<br />and 17.620 -
<br />A. The applicant certifies that it will continue to provide a drug -free
<br />workplace by;
<br />(a) Publishing a statement notifying employees that the unlawful
<br />manufacture, distribution, dispensing, possession, or use of a controlled
<br />substance is prohibited in the grantee's workplace and specifying the
<br />actions that will be taken against employees for violation of such
<br />prohibition;
<br />(b) Establishing an on -going drug free awareness program to inform
<br />employees about-
<br />(1) The dangers of drug abuse in the workplace;
<br />(2) The grantee's 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
<br />for drug abuse violations occurring in the workplace;
<br />(c) Making it a requirement that each employee to be engaged in the
<br />performance of the grant to be given a copy of the statement required by
<br />paragraph (a);
<br />(d) Notifying the employee in the statement required by paragraph (a) that,
<br />as a condition of employment under the grant, the employee will.
<br />(1) Abide by the term of the statement; and
<br />(2) Notify the employee in writing of his or her conviction for a
<br />violation of a criminal drug statute occurring Ion the workplace no
<br />later than five calendar days after such convictions;
<br />rcnua rorm cv -tor., uc I uo PKEVIOU5 EUITION OBSOLETE
<br />
|