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<br />Fonn 20-16C
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<br />You must read and sign these assurances by providing your password and checking the box at the bottom of
<br />this page.
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<br />Note: Fields marked with an . are required.
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<br />Certifications Regarding Lobbying, Debarment, Suspension and Other Responsibily Matters and Drug-Free Workplace
<br />Requirements.
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<br />Applicants should refer to the regulations cited below to determine the certification to which they are required to attest.
<br />Applicants should also review the instructions for certification included in the regulations before completing this form.
<br />Signature on this form provides for compliance with certification requirements under 44 CFR Part 18, "New Restrictions
<br />on Lobbying; and 28 CFR Part 17, "Government-wide Debarment and Suspension (Non-procurement) and Government-
<br />wide Requirements for Drug-Free Workplace (Grants)." The certifications shall be treated as a material representation of
<br />fact upon which reliance will be placed when the Department of Homeland Security (DHS) determines to award the
<br />covered transaction, grant, or cooperative agreement.
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<br />1. Lobbying
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<br />A. As required by the section 1352, Title 31 of the US Code, and implemented at 44 CFR Part 18 for persons(entering)
<br />into a grant or cooperative agreement over $100,000, as defined at 44CFR Part 18, the applicant certifies that:
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<br />(a) No Federal appropriated funds have been paid or will be paid by or on behalf of the undersigned to any
<br />person for influencing or attempting to influence an officer or employee of any agency, a Member of
<br />Congress, an officer or employee of congress, or an employee of a Member of Congress in connection
<br />with the making of any Federal grant, the entering into of any cooperative agreement and extension,
<br />continuation, renewal amendment or modification of any Federal grant or cooperative agreement.
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<br />(b) If any other funds than Federal appropriated funds have been paid or will be paid to any person for
<br />influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an
<br />officer or employee of congress. or an employee of a Member of Congress in connection with this Federal
<br />grant or cooperative agreement, the undersigned shall complete and submit Standard Form LLL,
<br />"Disclosure of Lobbying Activities", in accordance with its instructions.
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<br />(c) The undersigned shall require that the language of this certification be included in the award documents
<br />for all the sub awards at all tiers Qncluding sub grants, contracts under grants and cooperative agreements
<br />and sub contract(s» and that all sub recipients shall certify and disclose accordingly.
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<br />2. Debarment, Suspension and Other Responsibility Matters (Direct Recipient)
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<br />A. As required by Executive Order 12549, Debarment and Suspension, and implemented at 44CFR Part 67, for
<br />prospective participants in primary covered transactions, as defined at 44 CFR Part 17, Section 17.510-A, the applicant
<br />certifies that it and its principals:
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<br />(a) Are not presently debarred, suspended, proposed for debarment, declared ineHgible, sentenced to a
<br />denial of Federal benefits by a State or Federal court, or voluntarily exctuded from covered transactions by
<br />any Federal department or agency.
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<br />(b) Have not within a three-year period preceding this appHcation been convicted of or had a civilian
<br />judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining,
<br />attempting to obtain or perform a pubic (Federal, State, or local) transaction or contract under a public
<br />transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery,
<br />bribery, falsification or destruction of records, making false statements, or receiving stolen property.
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<br />(c) Are not presently indicted for or otherwise criminally or civilly charged by a government entity (Federal,
<br />State, or local) with commission of any ofthe offenses enumerated in paragraph (1){b) ofthis certification:
<br />and
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<br />(d) have not within a three-year period preceding this appication had one or more public transactions
<br />(Federal, State, or local) tenrinated for cause or default; and
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