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COOPERATIVE AGREEMENT NO. ATC020223
<br />° making it a requirement iha[ each employee to be enga8cd in the
<br />perfomiance of the grant be given a copY of the stammcm requircd by
<br />puagraph (a):
<br />(d) Noli(ying the rniploy<e in the stammrnt requircd by paragraph (a) Nat,
<br />as a cofMition of cmployment under the granl, the employee will-
<br />( q Abide by the Iemu o( the statcmenr, and
<br />(2) Notify the employ<r in writing of his or h<r conviclian for
<br />a violation of a criminal dmg sutute occurring in the warkplace no later
<br />than five calerWar days afmr such <onviaion; (e) Notifying the agarcy in writing, withim mn calendar days aRer
<br />receiving natice uMcr pua&mPh (2) from an employee or otherwise
<br />rcceiving actuai noiice of such eonviction. Employcrs of convicted
<br />employees must provide mtice, including posilion title, lo every gram
<br />activity the mnvic[ed employee wu working, unless the Federal agrncy
<br />has designatN a central point for the receipt of such notices. Notice shall
<br />incluAe the identification number(s) of each af(eaeA grm[;
<br />(Q Taking an af the follawing actions within 30 calendu days of receiving
<br />notitt under paragraph (d)(2), with respect lo any employee who is so
<br />canvicttd-- (1) Taking aDPropriatt perzonncl action against such an
<br />employee, up to and including temiimeian, consismnt with the
<br />r<quiremrnts of the Rehabilitation Aa of 1973, as ameiMed; or
<br />(2) Requiring such employre to participate satisfazlorily in a
<br />dm& abusc assismncc or rehabiliution pmgram approvM for such purposes
<br />by a Fcdenl, Smie, or iocal health, law rnforcement, ar aiher appmprime
<br />agency:
<br />(g) Making a good faith effortm continue m mainmin a dmg-free
<br />workplace thmugh implemen[ation of paragraphs (a), (b), (c), (d), (e) and
<br />m.
<br />B. Thc grantee may inscr[ in the space provided 6elow the site(s) for the
<br />pcr(ortnance of work done in connection with the specific grant: Place a(
<br />PerPormance (SVea address, ciry, counry, sm(e, zip code)
<br />Chcck if thue are workplaces on fde that a¢ not identified here.
<br />Alt<rtute 11. (Granmes Who Are Individmis)
<br />(a) The gnnme <ertifies thaz, as a coiWition of the grant, he or she will mt
<br /><ngage in the uNawNi manufauurc, disaribution, dispensine, posaeuion,
<br />or use af a comrollcd substance in conducting any aetivity with the gnm;
<br />(b) If conviacd of a<riminal drug ofknse resulting from a violation
<br />accurring during th<conduci of any yram aceiviry, he or she will report the
<br />conviction, in writing, within 10 calendar days of the conviction, lo every
<br />grant officer or aiher designee, unless the Federal agrncy desigmtes a
<br />centnl point for the receipt of such notices. W hen notice is made lo such a
<br />centnl point, it shall include Lhe iden[ification numbv(s) of ach aH<eted
<br />grent.
<br />1. CERTIFICATION FOR CONTRACTS, GRANTS, LOANS, AND
<br />COOPERATIVE AGREEMENTS
<br />The unJersigned certifies, w the best oFhis or her knowledge and b<lief, thac
<br />(q No Federal appmpriatN Ponds have bcen paid or will be paid, by or on behal( of the undersigned, to any person for intluencing or attempling ro iniluena
<br />an offcer or cmployee of an agency, a hlember of Congrtss, an offset or employee of Congress, or un employee of a Member of Congrcss in connection wilh the
<br />awaNing of any Federal contract, the making of any Federal Ioan, the rntering into any coopermive agrcemrnt, and the exiension, continuation, renewai,
<br />amendmern, or malificuion of any Fcderal contnct, gnnt, loan, or coopeneive agreement.
<br />(2) If any fu`Ms o(her than Federal appropriated furMs have been paid or will be paid m any person for in0uencing or avempling to influence an officer or
<br />empluyee of any agency, a Member of Cong¢ss, an offittr of employ<e of Congrcss, or an employ<e of a Member of Congress in <onnection with this Fcdenl
<br /><onvazt, granq loan, or coopcn(ive agreemmt, the undcrsign shall complete afM submit Standud Form-LLL, 'Disclosure Form io Report Lobbying,' in
<br />accordance wiih its ins[mctions.
<br />(7) The undenigned shall require [hu the language of this certification be included in the award docum<nts Por all subawuds a1 all tiers (induding
<br />submntnerors, subgrants, and mntnct under grants, loans, aM cooperativt agreements) and Ihat all subrccipiems shall certity and disclose accordingiy. This cenificatian is a material represrnution of faa upon which rcliarce was placed wh<n Ihis tronsaaian was made or entered into. Submission o( this
<br />certifwtion is a pmrequisite (or makine or entering into this Iransaztion imposed by sttlion 1352, litle 3 1, U.S. Code. Any person who fails ta file Ili< requirM
<br />mrtifmaiion shall be subject lo a civil penahy of noUess than $10.000 aM not mort thon $ 100,000 for ea<h such failure.
<br />Summent for Loan Gmrontees anl Loan Imunnce
<br />The undersignnl states, lo the best of his or her knowleAge and belief, Ihat
<br />If any Ponds have been paid or will be paid ro any person Por in0uencing or aUempting lo inllurnce an o(ficer or employtt of an agarcy, a Member of
<br />Cangress, an off¢er ar employee of Congr<ss, or an employee of a Member of Congmss in connection with Ihis <ommionrnt providiny (or the United Sutes to
<br />irtsure or gvaranme a loan, the undenigned shall <ampkte and submit Slandard Farm-LLL,'Disclosure Fortn to Repart Lobbying,' in accordance with ilc
<br />inslmctions.
<br />Submission of lhif statement is a prerequisim for making or entering into Ihis lransaction impostd by seclian 1352, title 31, U.S. Code. Any person who (ails
<br />to file the required swmment shail be subjmt to a civil penaity af not I<ss Nan SI0,000 and not more Ihan $100,000 for each such failure.
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