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<br />0: Corr .:r.:J n1:\ U:1e i\ :.:-:: t'0. ....l..:. .) ::-\-.~~-~ <br />. .... <br /> <br />..... . ~ <br /> <br />~-r- <br />~. <br /> <br />tificatiOns <br /> <br />nq 1..DbIJyqJ; Debarment, QISfe Son.n Other ~JSUity MiAltM; ~ ~ <br />.. en'al~ eoo.ci.ation wtth Aflected Ageldes; tbr~~'&ig; end ~,tiOI\. <br /> <br />, <br /> <br />ugh the Department of Justice has made every effort to simplify the appliatia\ process, other provisions of Federal law <br />:e us to ~ your certificaticl\ regarding certain 1Nltters. Applicants should read the regulations cited below and the <br />lc:ticns for certi.6catioo included in the regulations to und~tand the requirements ANi whether they apply to a particu1a: <br />:ant. Signature of this form provides for canpliance with oerti6alia\ requireI:nents under 28 CFR Part 69, "Ne..... <br />ictia\s CI'\ 1.obbying,- and 28 CFR Part 61, -Government-wide [)ebanne:nt ANi Suspensia\ (Na\procurement) and <br />~t.wide ~ts for Drug-Free Workplace (Grants): and the coordinatioo and nro-supplanting requirements <br />!! Public Safety Partnenhip and Cotnrnunity Policing Act of 1994. The a:rti&at:ia\s shall be treated as a 1Nlteria1 represen- <br />;'\ of fact upc:I" whid\ ~ ",ill be placed .....hen the Depa.:1ment of Justice det:e:rmines to award the covered grant <br /> <br />-bbying Feden.1 benefics b). . state or Federal court. or YoluntlJi1~ <br />exduckod from covered tn.nSAcbons by atly feden.1 depa:t- <br />ment or age-q"; <br /> <br />(il) Have not within a three-ye:ar period preceding this appli- <br />ation been cawicted of or had a dvil judgment rendered <br />against them for c:ornmission of fraud or a cri.mina1 offense in <br />connection with obtaining. attempting to obtain. or perform- <br />ing public (Fede:-al. state or 1001) tranSlcbOn or contra:t undr. <br />a publ1c tra:\Saction.; violation of Feden.1 or state antitNS~ <br />statutes or c:om:ni9sior. of embez;zlement. tt-eft. forger)'. <br />bribery. b1sificatlon or destruCtion of n!COf'ds. avJcing false <br />staterne:nCS. or ft!Cei'.-ing stolen propert)"; <br /> <br />(ill) M not presently iNiicted for or ~"ise ~~. o~ <br />&.illy charged by a governmental entit'j (Fed~1. state or <br />~) ....ith commissior. of alW of the offenses en\UMnted in <br />pa.-agn?h (A)(u) of this ricatlon; and <br /> <br />(IV) Have net ....ithin a thn!e-yea." period prea<hng this appti. <br />c:a~on had one or rr&:ln! public tranSactions (Federal. state or <br />local; trmiNtrd for cause or default; I1'\d <br /> <br />B w~ the a??uca....: is unable to ce:rti.~. to any of the state- <br />rne:"I:s iI" tru.s c:r~.i':a :'0:-. he or ~ sNl1 l:tach an exp1aN tion to <br />t."'..:.s I?ph:a:!o:-. <br /> <br />~ by Se<:t1on 1352. Tltle 31 of the t.:.5. Code. and imp\e- <br />ted at 28 CFR Pa:169. for persons entering into a grant or coo;:- <br />ve aSiee::ment oyer Sl00.oco. as defined at 2S CFR Part 69. the <br />.leant certi.6es tha: <br /> <br />I.. No federal appropNted fur.ds have been paid or will be <br />,aid. b~' or on behalf of the und~. to an~. pe~ for inf1~ <br />rong or attempting to influera an office: or employee of an~' <br />Ig-e:-..:'. a Merr.ber of Congress. a."\ office: or employee o! <br />:on.g:ress, 0: a.~ employee of a Me:::nbe of Cor\gres6 in connectio:- <br />...,t.", the rr.ak."\~ of a....y Fede:-a! gn."\:: the en~ into of a..,y <br />~:!ve Ig:eeme:"t; a."': the ex:te:\Slor.. cont.nuatlo:'.. ~'a.: <br />nendme:lt or m:xii.ficat1on of ...,y Federal gra."\t or cooperative <br />a~eeme:'\t; <br /> <br />B Ii a."\ y funds other than Fede:-a: I ??lO? ria ~ Nnds have bee:- <br />paid or .....ill be paid to .....y ~. for i..'\fi~"\f 0: a~"\f <br />to tnfl~ a."\ of:i~ or ~ioy~ of 1.:'1. age:'\~'. a Member 0: <br />Cor~. a.-" of5ce:' O~ ~-?ioyet' of Ccr.~ or a."'I employee 0: <br />...a Me::nbe:' of Congress 1."'1 cor.."leC':lor. ....,th tr.1S Federal gn....t or <br />coope;otl....e I~ee;ne;-.t. the unde:"Si~ shall complete anc s~ <br />r:"'J: Sta.~-c Fo:T:' - LLL "D.sclos-..:.."t' of Lobb)'lnf A:t1\itl~: l:". <br />a::::or:i.a...-.:e '^~~. 1:S t.~~~~~..: <br /> <br />Co. l/"Ie ur'\.:!e.-s:~ shall req~"t' t:-..1~ t."..,e la.....F..;.!~ ::>~ t:us c:e-..5.. <br />c:a:JO~ be u-.clIJded L:': ti-.e a.....a:d doc-.1.-ne:"I:S fo: a!.: s".lba.....a.-d.s a: <br />L oe:'S (m.:JUcllng subgra....t!.. c:on~~ ur'\.:ie~ ~...:s a."'IC roope.1T <br />o....e a~eerre;"'.:s, a."'Id subcont:'a:t'Sl a."\d tha: L; S'..>reaple=l:S <br />si"..ili c:r<:..~" a....::I d1sdos.e a.::::::l rd.!,!". E=\ <br /> <br />. i>e b L."lI'I en t. S us ?CN i 0:\ L.... d Oth r. Res ?ON i b ilJt':o 1'wU t:tn!. <br />Dtrect R.tci pi roll <br /> <br />\s reo=- ~ -eo: b.... Ex eo:-.J t....e <>.d e:' l:'~;. t:K-...a.. ~: a. ~ SI.1S?e':":S::-:"_ <br />..._..: l.~I~tE-j a~ 2.5 C'FR Pa~ 6-:'. to: p~""e pa."tlo.F'a....~ l."' <br />':-""'1"..1:: CO\~ tra."\So1:t~:-~, ~ def.-.eC a: 2.S CFi< Pa.~ 6-. ~:':". <br />;:".51(', - <br /> <br />r. T:"-t a?~:';.:.a.-.~ ce:-':I~ ~.J~ 1~ a...-.': l~ !==-_-..=?i.: <br /> <br />(: A...~ n:-: F~~~:- der-...a.-;e-.: s'..lS~:"\de-.: t'~?,-~': ::~ <br />C:?':.l..~ll?7"',: c..::a:-e-.: l."",::~:.. sc:'.~:e-.: ::. a ce:-~ :. <br /> <br />3 Or.1g.F~ Won..7~~ IGrwtc'a Other ll\.1.."\ lnciividu.alsl <br /> <br />As reqw:'eC by the I>.\lg..Fre-; Workpla~ At:t of 19S5. and imple- <br />rne:".:e.:! a~ 2.S CFR Pa..'"t 67. Subpa:t F. for S!'&nteeS. as defined It 2.S <br />CFi\ Pa.~ 67. Se<t1o:\S 67.6:5 a.-...d 67.6ZJ-< <br /> <br />A Tr.e a?pl1:::a....: ~e; that it will. or....'ill c:on:ir\ue to. p!O\ide <br />a d.-.1g"~ .....::r.-icplace b>~ <br /> <br />(I; P\:b tls. '--.i.--.g a SO;3~: notifY\r\g employees t:N t the <br />u."'\la....+.Jl ma.....u.~""tu."'e. d1stributlOl'\. d1spel'\Smg. possession or <br />USe? 0: I c:onr:roll~ s~ is prohibited i.n the grantee' 5 <br />.....ork?la::r a.rd ~ the ac:tior6 that ....ill be taken against <br />employees for ",olatlon of such prohibioor.. <br /> <br />(l:: ~lls~ il.."\ ~~ dr.1g'~ a.....a..~ program to <br />i.:-_~;.;-. e:'":"'-?:oyees a':>.:o-.;! - <br />