.............. .................................................... CJD Grant Application - Page 14
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<br /> CERTIFICATIONS
<br /> 1. The applicant certifies that it will provide a drug-free workplace by:
<br /> a. Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of
<br /> a controlled substance is prohibited in the grantee's workplace and specifying the actions that will be taken against
<br /> employees for violation of such prohibition,
<br /> b. Establish a drug-free awareness program to inform employees about:
<br /> i. the dangers of drug abuse in the workplace;
<br /> ii. the applicent's poticy of maintaining a drug-free workptace;
<br /> iii. any available drug counseling, rehabilitation, and employee assistance programs; and
<br /> iv. the penalties that may be imposed upon employees for drug abt~se violations.
<br /> c. Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the
<br /> statement required by paragraph (a),
<br /> Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the grant, the
<br /> employee will:
<br /> I. abide by the terms of the statement, and
<br /> ii. notify the employer of any criminal drug stsfuts conviction for a violation occurring in the workptace not later than five
<br /> days after such conviction.
<br /> e. Notifying the agency within ten days after receiving notice under subparagraph (d)(ii) from an employee or otherwise
<br /> receiving actual notice of such conviction.
<br /> f. Taking one of the following actions with respect to any employee who is so convicted:
<br /> i. Taking appropriate personnel action against such an employee, up to and including termination; or
<br /> ii. Requiring such employee to participats satisfactorily in a drug abuse assistance or rehabilitation program appr°ved f°r
<br /> such purposes by a federal, state, or local health, law enforcement, or other appropriate agency.
<br /> g. Making a good faith effort to continue to maintain a drug-free workplace through the implementation of paragraphs (a), (b),
<br /> (c), (d), (e), and (0.
<br /> If application is in excess of $'100,000, I certify to the best of my knowledge and belief to the following:
<br /> 1. No federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer
<br /> or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a member of
<br /> Congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal
<br /> loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of
<br /> any federal contract, grant, loan, or cooperative agreement.
<br /> [~] Check here if any non-federal funds have been paid or will be paid to any person for influencing or attempting to
<br /> influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an
<br /> employee of a member of Congress in connection with this federal contract, grant, loan, or cooperative agreement. You
<br /> must also notify the Criminal Justice Division (CJD} or your local council of governments for the "Disclosure Form to
<br /> Report Lobbying'.
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<br /> 2. The undersigned shall require that the language of this certification be included in the award documents for all sub-awards at
<br /> all tiers and that alt sub-recipients shall certify accordingly.
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<br /> AUDIT CERTIFICATION (SELECT THE APPROPRIATE CHOICE) I certify:
<br /> ] The applicant agency currently expends combined federal funding of $300,000 or more and, therefore, is
<br /> required to submit an annual single audit by an independent auditor made in accordance with the Single Audit
<br /> Act Amendments of 1996 and OMB Circular A-133.
<br /> ] The applicant agency currently expends combined federal funding of less than $300,000 and, therefore, is
<br /> exempt from the Single Audit Act and cannot charge audit costs to a CJD grant. I understand, however, that
<br /> CJD may require a limited scope audit as defined in OMB Circular A-133.
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<br /> EQUAL EMPLOYMENT OPPORTUNITY PLAN (EEOP) CERTIFICATION (SELECT THE APPROPRIATE CHOICE)
<br /> Definitions:
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<br /> Tvoe I Entity
<br /> Educational/medical/non-profit institution/Native American Tribe - certification required (select appropriate choice below};
<br /> EEOP NOT required.
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<br /> Tyoe II Entitl/
<br /> All other recipients receiving more than $25,000, but not more the $500,000 - certification required (select the appropriate
<br /> choice below); organizations must maintain EEOP on file for possible audit if the organization has more the 50
<br /> employees.
<br /> Type III Entity
<br /> For profit entities and state and local governments receiving $500,000 or more - certification requ[rad (select the
<br /> appropriate choice below); the organization must submit an EEOP to the Office for Civil Rights (OCR) for approval.
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<br /> Issue Date: October 2002
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