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U.S. DEPARTM ENT OF JUSTICE
<br />OFFICE OF JUS TICE PROGRAMS
<br />OFFICE OF THE COMPTROLLER
<br />CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND
<br />OTHER RESPONSIBILITY MATTERS; AND DRUG-FREE WORKPLACE REQUIREMENTS
<br />Applicants should refer to the regulations cited below to determine the certification to which they are required to
<br />attest. Applicants should also review the instructions for certification included in the regulations before completing this
<br />form. Signature of this form provides for compliance with c ertification requirements under 28 CFR Part 69, "New
<br />Restrictions on Lobbying" and 28 CFR Part 67, "Governme nt-wide Debarment and Suspension (Nonpro-curement) and
<br />Government-wide Requirements for Drug-Free Workplace ( Grants)." The certifications shall be treated as a material
<br />representation of fact upon which reliance will be placed w hen the Department of Justice determines to award the
<br />covered transaction, grant, or cooperative agreement.
<br />1. LOBBYING
<br />As required by Section 1352
<br />Title 31 of the U.S. Code
<br />and public (Federal, State, or total) transaction or contract under a
<br />,
<br />,
<br />implemented at 28 CFR Part 69, for persons entering into a public transaction; violation of Federal or State antitrust statutes
<br />grant or cooperative agreement over $100
<br />as defined at
<br />000 or commission of emhezzlement, theft, forgery,
<br />,
<br />,
<br />28 CFR Part 69, the applicant certifies that: bribery, falsification or destruction of records, making false
<br /> statements, or receiving stolen property;
<br />(a) No Federal appropriated funds have been paid or will be (c) Are not presently indicted for or otherwise criminally or
<br />paid, by or on behalf of the undersigned, to any person for in- civilly charged by a governmental entity (Federal
<br />State
<br />or
<br />fluencing or attempting to influence an officer or employee of any ,
<br />,
<br />local) with commission of any of the offenses enumerated in
<br />agency, a Member of Congress, an officer or employee of paragraph (1)(b) of this certification; and
<br />Congress, or an employee o(a Member of Congress in con-
<br />nection with the making of any Federal grant, the entering into (tl) Have not within athree-year period preceding this applica-
<br />o(any cooperative agreement, and the extension, continuation, lion had one or more public transactions (Federal, State, or
<br />renewal, amendment, or modification of any Federal grantor local) terminated for cause or default; and
<br />cooperative agreement;
<br /> B. Where the applicant is unable to certify to any of the
<br />(b) If any funds other than Federal appropriated funds have statements in this certification, he or she shall attach an
<br />been paid or will be paid to any person for influencing or at- explanation to this application.
<br />tempting to influence an officer or employee of any agency, a
<br />Member of Congress, an officer or employee of Congress, or
<br />an employee of a Member of Congress in connection with this 3. DRUG-FREE WORKPLACE
<br />Federal grant or cooperative agreement, [he undersigned shall
<br />" (GRANTEES OTHER THAN INDIVIDUALS)
<br />complete and submit Standard Form - LLL,
<br />Disclosure of
<br />Lobbying Activities," in accordance with its instructions; As required by fhe Drug-Free Workplace Act of 1988, and
<br />(c) The undersigned shall require that the language of this ter- implemented at 28 CFR Part 67, Subpart F, for grantees, as
<br />tification be included in the award documents for all subawards defined at 28 CFR Part 67 Sections 67.615 and 67.620-
<br />atall tiers (including subgrants, contracts under grants and A. The applicant certifies that i[ will or will continue to provide
<br />cooperative agreements, and subcontracts) and that all sub- a drug-free workplace by:
<br />recipients shall certify and disclose accordingly.
<br /> (a) Publishing a statement noli(ying employees that the
<br /> unlawful manufacture, distribution, dispensing, possession, or
<br />2. DEBARMENT, SUSPENSION, AND OTHER use of a controlled substance is prohibited in the grantee's
<br /> workplace antl specifying the actions that will be taken against
<br />RESPONSIBILITY MATTERS employees for violation of such prohibition;
<br />(DIRECT RECIPIENT) (b) Establishing an on-going drug-free awareness program to
<br />As requiretl by Executive Order 12549, Debarment and inform employees aboul-
<br />Suspension, and implemented at 28 CFR Par[ fi7, for prospec- (1) The dangers of drug abuse in the workplace;
<br />live participants in primary covered transactions, as defined at
<br />28 CFR Part 67, Section 67.510-
<br />(2) The grantee's policy of maintaining adrug-tree workplace;
<br />
<br />A. The applicant certifies [hat it and its principals: (3) Any available drug counseling, rehabilitation, and employee
<br /> assistance programs; and
<br />(aj Are not presently debarred, suspended, proposed for debar- (4) The penalties that may be imposed upon employees for
<br />men[, declared ineligible, sentenced to a denial of Federal drug abuse violations occurring in the workplace;
<br />henefits by a State or Federal court, or voluntarily excluded
<br />from covered transactions by any Federal department (c) Making it a requirement that each employee to be engaged
<br />or agency; in the performance of the grant be given a copy of the state-
<br /> ment required by paragraph (a);
<br />(b) Have not within athree-year period preceding this applica-
<br />tion been convicted of or had a civil judgment rendered against (d) Notifying the employee in the statement required by para-
<br />them for commission of fraud or a criminal offense in connec- graph (a) that, as a condition of employment under the grant,
<br />lion with obtaining, attempting to obtain, or performing a the employee will-
<br />OJP FORM dOfi1/6 (3-91) REPLACES OJP FORMS dOfitl2, 4061/3 ANO d06tIG WHICH ARE OBSOLETE.
<br />
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