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<br />:ertifications
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<br />I.S. DEPARTMENT OF JUSTICE
<br />IFFICE OF JUSTICE PROGRAMS
<br />IFFICE OF THE COMPTROLLER
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<br />:ERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY MATTERS; AND
<br />IRUG-FREE WORKPLACE REQUIREMENTS
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<br />,pplicants should refer to the regulations cited below to determine the certification to which they are required to attest. Applicants
<br />hould also review the instructions for certification included in the reguiations before completing this form. Signature of this form
<br />rovides for compliance with certification requirements under 28 CFR Part 69, "New Restrictions on lobbying" and 28 CFR Part
<br />7, "Government-wide Debarment and Suspension (Nonpro-curement) and Government-wide Requirements for Drug- Free
<br />Vorkplace (Grants)." The certifications shall be treated as a material representation of fact upon which reliance will be placed
<br />Ihen the Department of Justice determines to award the covered transaction, grant, or cooperative agreement.
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<br />. lOBBYING As required by Section 1352, Title 31 of the U.S. Code, and implemented at 28 CFR Part 69, for persons entering
<br />1tO a grant or cooperative agreement over $1 00,000. as defined at 28 CFR Part 69, the applicant certifies that:
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<br />3) No Federai appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for in-
<br />uencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of
<br />;ongress, or an employee of a Member of Congress in con-nection with the making of any Federal grant, the entering into of any
<br />ooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal grant or cooperative
<br />Igreement;
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<br />b) If any funds other than Federal appropriated funds have boen paid or will be pai~ to any person for infiuencing or attempting to
<br />lfluence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a
<br />nember of Congress in connection with this Federal grant or COof'f,.-ative agreement, the undersigned shall complete and submit
<br />;tandard Form - lll, "Disclosure of lobbying Activities," in accorCl;'"Ce with its instructions;
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<br />c) The undersigned shall require that the language of this cer-tificalion be included in the award documents for all subawards at
<br />III tiers (including subgrants, contracts under grants and cooperative agreements, and subcontracts) and that all sub-recipients
<br />,hall certify and disclose accordingly.
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<br />!, DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS (DIRECT RECIPIENT)
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<br />Is required by Executive Order 12549, Debarment and Suspension, and implemented at 28 CFR Part 67, for prospective
<br />larticipants in primary covered transactions, as defined at 28 CFR Part 67, Section 67.510
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<br />I. The applicant certifies that it and its principals:
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<br />a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, sentenced to a denial of Federal benefits
<br />lY a State or Federal court, or voluntarily excluded from covered transactions by any Federal department or agency;
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<br />b) Have not within a three-year period preceding this applbJtion been convicted of or had a civil judgment rendered against them
<br />or commission of fraud or a criminal offense in connection with ot,taining, attempting to obtain, or performing a public (Federal,
<br />3tate, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of
<br />1mbezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;
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<br />c) Are not presently indicted for or otherwise criminally or civilly cildrged by a governmental entity (Federal, State, or local) with
<br />:ommission of any of the offenses enumerated in paragraph (1)(b) of this certification; and (d) Have not within a three-year period
<br />Jreceding this application had one or more public transactions (Federal, State, or local) terminated for cause or default; and
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<br />3. Where the applicant is unable to certify to any of the statements in this certification, he or she shall attach an explanation to this
<br />lpplication.
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<br />3, DRUG-FREE WORKPLACE (GRANTEES OTHER THAN INDIVIDUALS)
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<br />I\s required by the Drug-Free Workplace Act of 1988, and implemented at28 CFR Part 67, Subpart F, for grantees, as defined at
<br />28 CFR Part 67 Sections 67.615 and 67.620
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<br />attps :11 grants .ojp. usdoj. gov 1 gmsexternall Gen Certifications.j sp ?certified= N &certify rD= 13 2 0
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<br />3/1112005
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