|
<br />~ertifications
<br />lQI..E: You mus~he "Accept" button at the bottom of the page before closing this window
<br />
<br />Page 1 of 2
<br />
<br />I.S. DEPARTMENT OF JUSTICE
<br />ÞFFICE OF JUSTICE PROGRAMS
<br />ÞFFICE OF THE COMPTROLLER
<br />
<br />:ERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY MATTERS; AND
<br />IRUG-FREE WORKPLACE REQUIREMENTS
<br />
<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 regulations 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.
<br />
<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 />,to a grant or cooperative agreement over $100,000, as defined at 28 CFR Part 69, the applicant certifies that:
<br />
<br />3) No Federal 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;
<br />
<br />b) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to
<br />,fluence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a
<br />Aember of Congress in connection with this Federal grant or cooperative agreement, the undersigned shall complete and submit
<br />;tandard Form - LLL, "Disclosure of Lobbying Activities," in accordance with its instructions;
<br />
<br />c) The undersigned shall require that the language of this cer-tification 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.
<br />
<br />!. DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS (DIRECT RECIPIENT)
<br />
<br />~s required by Executive Order 12549, Debarment and Suspension, and implemented at 28 CFR Part 67, for prospective
<br />>articipants in primary covered transactions, as defined at 28 CFR Part 67, Section 67.510
<br />
<br />~. The applicant certifies that it and its principals:
<br />
<br />a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, sentenced to a denial of Federal benefits
<br />>y a State or Federal court, or voluntarily excluded from covered 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 civil judgment rendered against them
<br />'or commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal,
<br />,tate, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of
<br />~mbezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;
<br />
<br />c) Are not presently indicted for or otherwise criminally or civîlly charged 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 />)receding this application had one or more public transactions (Federal, State, or local) terminated for cause or default; and
<br />
<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 />3pplication.
<br />
<br />3. DRUG-FREE WORKPLACE (GRANTEES OTHER THAN INDIVIDUALS)
<br />
<br />~s required by the Drug-Free Workplace Act of 1988, and implemented at 28 CFR Part 67, Subpart F, for grantees, as defined at
<br />28 CFR Part 67 Sections 67.615 and 67.620
<br />
<br />b.ttps:/ /grants.ojp. usdoj .gov/gmsextemal/GenCertifications.j sp?certified N &certify ID= 1320
<br />
<br />3/11/2005
<br />
|