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<br />, Print Application <br /> <br />Page 12 of 13 <br /> <br />applicant certifies that it and its principals: <br /> <br />(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, sentenced <br />to a denial of Federal benefits by a State or Federal court, or voluntarily excluded from covered <br />transactions by any Federal department or agency. <br /> <br />(b) Have not within a three-year period preceding this application been convicted of or had a <br />civilian judgment rendered against them for commission of fraud or a criminal offense in <br />connection with obtaining, attempting to obtain or perform a public (Federal, State, or local) <br />transaction or contract under a public transaction; violation of Federal or State antitrust statutes or <br />commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making <br />false statements, or receiving stolen property. <br /> <br />(c) Are not presently indicted for or otherwise criminally or civilly charged by a government entity <br />(Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1 )(b) of <br />this certification: and <br /> <br />(d) have not within a three-year period preceding this application had one or more public <br />transactions (Federal, State, or local) terminated for cause or default; and <br /> <br />B. Where the applicant is unable to certify to any of the statements in this certification, he or she shall attach an <br />explanation to this application. <br /> <br />3. Drug-Free Workplace (Grantees other than inpividuals) <br /> <br />As required by the Drug-Free Workplace Act of 1988, and implemented at 44CFR Part 17, Subpart F, for <br />grantees, as defined at 44 CFR part 17, Sections 17.615 and 17.620: <br /> <br />(A) The applicant certifies that it will continue to provide a drug-free workplace by: <br /> <br />(a) Publishing a statement notifying employees that the unlawful manufacture, <br />distribution, dispensing, possession, or use of a controlled substance is prohibited in <br />the grantee's workplace and specifying the actions that will be taken against <br />employees for violation of such prohibition; <br />(b) Establishing an on-going drug free awareness program to inform employees <br />about: . <br /> <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 employee <br />assistance programs; and <br />(4) The penalties that may be imposed upon employees for drug abuse <br />violations occurring in the workplace; <br /> <br />(c) Making it a requirement that each employee to be engaged in the performance of <br />the grant to be given a copy of the statement required by paragraph (a); <br />(d) Notifying the employee in the statement required by paragraph (a) that, as a <br />condition of employment under the grant, the employee will: <br /> <br />(1) Abide by the terms of the statement and <br />(2) Notify the employee in writing of his or her conviction for a violation <br />of a criminal drug statute occurring in the workplace no later than five <br />calendar days after such conviction. <br /> <br />(e) Notifying the agency, in writing within 10 calendar days after receiving notice <br />under subparagraph (d)(2) from an employee or otherwise receiving actual notice of <br /> <br />hnps:/ /portal. fema.goy/firegrant/j sp/fire/print_ app.j sp?print=true& app _number= <br /> <br />4/1 012003 <br />