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................................. CJD Grar, pplication- Page 14
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<br />CERTIFICATIONS
<br />1. The applicant certifies that it will provide a drug-free workplace by:
<br /> Publ[shlng a statement noticing 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 applicant's policy of maintaining' a drug-free workplace;
<br /> iii. any available drug counseling, rehabilitation, and employee assistance programs; and
<br /> iv. the penaIfies that may be imposed upon employees for drug abuse violations.
<br /> c. Making it a requirement that each employee to be engaged tn the performance of the grant be given a copy of the
<br /> statement required by paragraph (a).
<br /> d. NotiCing the employee in the statement required by paragraph (a) that, as a condition of employment under the grant, the
<br /> employee w[Ih
<br /> i. abide by the terms of the statement, and
<br /> ii. noti~ the employer °f anycriminal drug statute c°nvict[°n f°r a vi°lati°n °ccurring In the w°rkplace n°t later than five
<br /> days after such conviction.
<br /> e. Notifying the agency with[n ten days after recelv[ng notice under subparagraph (d)(ii) from an employee dr othe~vise
<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 /> re nate ersonnel action aga ns such an employee, up to and including termination; or
<br /> i. Taking app p ' P _ ,._,__,~.=,. =~ ~ ,4,.,~ abuse ass s ance or rahab [itation program approved for
<br /> such purposes by a federal, state, or local health, law enforcement, or other appropriate agency.
<br /> g. Making a good fa[th effort to continue to maintain a drug-free workplace through the implementation of paragraphs (a), (b),
<br /> (c), (d), (e), and
<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 /> n connection with this federa contract, grant, loan, or cooperative agreement. You
<br /> employee of a membe! o! Congm. ss ............. ,~f novernments for the "Disclosure Form to
<br /> must also notify the Cr~mma Jus ~ce D~ws~on
<br /> Report Lobbying',
<br />
<br /> 2. The undersigned shaft require that the language of this certification be included in the award documents for ail sub-awards at
<br /> all tiers and that ail sub-recipients shall certify accordingly.
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<br /> AUDtT CERTIFICATION (SELECT THE APPROPRIATE CHOICE).
<br /> 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 deflced tn OMB Circular A~133.
<br /> EQUAL EMPLOYMENT OPPORTUNITY PLAN {EEOP) CERTIFICATION (SELECT THE APPROPRIATE CHOICE) Defin lions.'.
<br />
<br /> Type Ent[~
<br /> Educationa'l~/medical/non.proflt institution/Native American Tdbe - certification required (select appropriate choice below);
<br /> EEOP NOT required.
<br />
<br /> Type II Entit~
<br /> All ether recipients rece[vlng more than $25,000, but not more the $500,000 - certil~cation 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 /> e Il En ' ' required (selectthe
<br /> ~YP ~ nd local overnments receiving $500,000 or more - cert[ficahon
<br /> For pro~t enbt~es and state a g
<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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