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<br />COOPERATIVE AGREEMENT NO. ATC020223
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<br />o making it a requirement that each employee to be engaged in the
<br />perfonllance of the grant be given a copy of the statement required by
<br />paragraph (a);
<br />(d) Notifying the employee in the statement requircd by paragraph (a) that,
<br />as a condition of employment under the grant, the employee will-
<br />(I) Abide by the tenns of the statement; and
<br />(2) Notify the employer in writing of his or her conviction for
<br />a violation of a criminal drug statute occurring in the workplace no later
<br />than five calendar days after such conviction;
<br />(e) Notifying the agency in writing, within ten calendar days after
<br />receiving notice undcr paragraph (2) from an employee or otherwise
<br />receiving actual notice of such conviction. Employers of convictcd
<br />employees must provide notice, including position title. to every grant
<br />activity the convicted employee was working. unless the Federal agency
<br />has designated a central point for the receipt of such notices. Notice shall
<br />include the identification number(s) of each affected grant;
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<br />(0 Taking on of the following actions within 30 calendar days of receiving
<br />notice under paragraph (d)(2), with respect to any employee who is so
<br />convicted-- .
<br />(I) Taking appropriate personnel action against such an
<br />employee. up to and including termination, consistent with the
<br />requirements of the Rehabilitation Act of 1973, as amended; or
<br />(2) Requiring such employee to participate satisfactorily in a
<br />drug abusc assistance or rehabilitation program approved for such purposes
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<br />by a Federal, State, or local health, law enforcement, or other appropriate
<br />agency;
<br />(g) Making a good faith effort to continue to maintain a drug-free
<br />workplace through implementation of paragraphs (a). (b), (c), (d), (e) and
<br />(t).
<br />B, The grantee may insert in the space provided below the site(s) for the
<br />performance of work done in connection with the specific grant: Place of
<br />Performance (Street address, city, county, state, zip code)
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<br />Check [ ] if there are workplaces on file that are not identified here.
<br />Alternate II. (Grantees Who Are Individuals)
<br />(a) The grantee certifies that, as a condition of the grant, he or she will not
<br />engage in the unlawful manufacture, distribution, dispensing. possession.
<br />or use of a controlled substance in conducting any activity with the grant;
<br />(b) If convicted of a criminal drug offense resulting from a violation
<br />occurring during the conduct of any grant activity, he or she will report the
<br />conviction, in writing, within 10 calendar days of the conviction. to every
<br />grant officer or other designee. unless the Federal agency designates a
<br />central point for the receipt of such notices. When notice is made to such a
<br />central point, it shall include the identification number(s) of each affected
<br />grant.
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<br />1. CERTIFICATION FOR CONTRACTS, GRANTS, LOANS, AND
<br />COOPERATIVE AGREEMENTS
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<br />The undersigned certifies, to the best of his or her knowledge and belief, that:
<br />(I) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for innuencing or attempting to innuence
<br />an officer or employee of an agency. a Mcmber of Congress. an officer or employee of Congress, or an employee of a Member of Congress in connection with the
<br />awarding of any Federal contract. the making of any Federal loan, the entering into any cooperative agreement, and the extension, continuation, renewal,
<br />amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.
<br />(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for innuencing or attempting to innuence an officer or
<br />employee of any agency. a Member of Congress, an officer of employee of Congress, or an employee of a Member of Congress in conncction with this Federal
<br />contract, grant, loan. or cooperative agreement. the undersign shall complete and submit Standard Form-lll, "Disclosure Form to Report lobbying, " in
<br />accordance with its instructions.
<br />(3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including
<br />subcontractors, subgrants, and contract under grants. loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.
<br />This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this
<br />certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31. U,S. Code. Any person who fails to file the required
<br />certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
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<br />The undersigned states, to the best of his or her knowledge and belief, that:
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<br />Statement for loan Guarantees and loan Insurance
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<br />If any funds have been paid or will be paid to any person for innuencing or attempting to innuence an officer or employee of an agency. a Member of
<br />Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this conunitment providing for the United States to
<br />insure or guarantee a loan, the undersigned shall complete and submit Standard Form-lll, "Disclosure Fonn to Report lobbying," in accordance with its
<br />instructions,
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<br />Submission of this statement is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U,S, Code. Any person who fails
<br />to file the required statement shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure,
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