HomeMy WebLinkAboutCertification U.S.DEPARTMENT OF JUSTICE
OFFICE OF JUSTICE PROGRAMS
OFFICE OF THE COMPTROLLER
CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND
OTHER RESPONSIBILITY MATTERS; AND DRUG-FREE WORKPLACE REQUIREMENTS
Applicants should refer to the regulations cited below to determine the certification to which they are required to attest.
Applicants should also review the Instructions for certification Included in the regulations before completing this form.
Signature of this form provides for compliance with certification requirements under 28 CFR Part 69,"New
Restrictions on Lobbying"and 28 CFR Part 67,"Government-wide Debarment and Suspension(Nonpro-curement)and
Government-wide Requirements for Drug-Free Workplace(Grants)."The certifications shall be treated as a material
representation of fact upon which reliance will be placed when the Department of Justice determines to award the
covered transaction,grant,or cooperative agreement.
1.LOBBYING
public(Federal,State,or local)transaction or contract under a
As required by Section 1352,Title 31 of the U.S.Code,and public transaction;violation of Federal or State antitrust statutes
or commission of embezzlement,theft,forgery,
implemented at 28 CFR Part 69,for persons entering into a •
grant or cooperative agreement over$100,000,as defined at bribery,falsification or destruction of records,making false
28 CFR Part 69,the applicant certifies that: statements,or receiving stolen property;
(a)No Federal appropriated funds have been paid or will be (c)Are not presently indicted for or otherwise criminally or
cipaid,by or on behalf of the undersigned,to any person for cl)withcha commissionod by a governmental any of the entityf n(Federal,Slate,dor
local)with of any of offenses enumerated in
influencing or attempting to influence an officer or employee paragraph(1)(b)of this certification;and
of any agency,a Member of Congress,an officer or
employee of Congress.or an employee of a Member of (d)Have not within a three-year period preceding this applica-
Congress in connection with the making of any Federal lion had one or more public transactions(Federal.State,or
grant,the entering Into of any cooperative agreement,and local)terminated for cause or default;and
the extension,continuation, renewal,amendment,or
modification of any Federal grant or cooperative agreement; B.Where the applicant is unable to certify to any of the
(b)If any funds other than Federal appropriated funds have statements In this certification,he or she shall attach
been paid or will be paid to any person for influencing or at-
tempting an explanation to this application.
to influence an officer or employee of any agency,a
Member of Congress.an officer or employee of Congress,or 3.DRUG-FREE WORKPLACE
an employee of a Member of Congress in connection with this (GRANTEES OTHER THAN INDIVIDUALS)
Federal grant or cooperative agreement,the undersigned shall
complete and submit Standard Form-LLL,"Disclosure of As required by the Drug-Free Workplace Act of 1988,and
Lobbying Activities,"in accordance with Its Instructions; implemented at 28 CFR Part 67,Subpart F,for grantees,as
(c)The undersigned shall require that the language of this cer- defined al 28 CFR Part 67 Sections 67.615 and 67.620-
tification be included in the award documents for all subawards A.The applicant certifies that it will or will continue to provide
at all tiers(including subgranla,contracts under grants and a drug-free workplace by:
cooperative agreements,and subcontracts)and that all sub-
recipients shall certify and disclose accordingly. (a)Publishing a statement notifying employees that the
unlawful manufacture,distribution,dispensing,possession,or
use of a controlled substance is prohibited in the grantee's
2. DEBARMENT,SUSPENSION,AND OTHER workplace and specifying the actions that will be taken against
RESPONSIBILITY MATTERS employees for violation of such prohibition;
(DIRECT RECIPIENT) (b)Establishing an on-going drug-free awareness program to
inform employees about—
As required by Executive Order 12549,Debarment and
Suspension,and implemented at 28 CFR Part 67,for prospect (1)The dangers of drug abuse In the workplace;
live participants In primary covered transactions,as defined at
28 CFR Part 67,Section 67.510— (2)The grantee's policy of maintaining a drug-free workplace;
A.The applicant certifies that it and its principals: (3)Any available drug counseling,rehabilitation,and employee
assistance programs;and
(a)Are not presently debarred,suspended,proposed for debar-
ment,declared ineligible,sentenced to a denial of Federal (4)The penalties that may be Imposed upon employees for
benefits by a State or Federal court,or voluntarily excluded drug abuse violations occurring in the workplace;
from covered transactions by any Federal department
or agency; (c)Making it a requirement that each employee to be engaged
in the performance of the grant be given a copy of the statement
(b)Have not within a three-year period preceding this applica- required by paragraph(a);
lion been convicted of or had a civil judgment rendered against
them for commission of fraud or a criminal offense in connec- (d)Notifying the employee in the statement required by pare-graph
Lion with obtaining,attempting to obtain,or performing a (a)that,as a condition of employment under the grant,
the employee will—
!
0JP FORM 4061r6(3.91)REPLACES OJP FORMS 4061/2.4051/3 AND 4061/4 WHICH ARE OBSOLETE
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(1)Abide by the terms of the statement;and
(2)Notify the employer In writing of his or her conviction for a SeaTac HIDTA Task Force(Group D-22)
violation of a criminal drug statute occurring in the workplace 300 51h Ave,Suite 1300
no later than five calendar days after such conviction;
Seattle,WA 98104
(e)Notifying the agency,in writing,within 10 calendar days
after receiving notice under subparagraph(d)(2)from an Check• if there are workplaces on file that are not lndentified
employee or otherwise receiving actual notice of such convic-tion. here.
Employers of convicted employees must provide notice,including
position title,to:Department of Justice,Office of Section 67,630 of the regulations provides that a grantee that
Justice Programs,ATTN:Control Desk,633 Indiana Avenue. is a State may elect to make one certification in each Federal
N.W.,Washington,D.C.20531.Notice shall include the iden- fiscal year.A copy of which should be Included with each ap-
Ification number(s)of each affected grant; plication for Department of Justice funding.States and State
(f)Taking one of the following actions,within 30 calendar agencies may elect to use OJP Form 4061/7.
days of receiving notice under subparagraph(d)(2),with Check E] if the State has elected to complete OJP Form
respect to any employee who is so convicted— 4061/7.
(1)Taking appropriate personnel action against such an
employee,up to and including termination,consistent with the DRUG-FREE WORKPLACE
requirements of the Rehabilitation Act of 1973,as amended;or (GRANTEES WHO ARE INDIVIDUALS)
(2)Requiring such employee to participate satisfactorily in a As required by the Drug-Free Workplace Act of 1988,and
drug abuse assistance or rehabilitation program approved for implemented at 28 CFR Part 67,Subpart F,for grantees,as
such purposes by a Federal,State,or local health,law enforce- defined at 28 CFR Part 67;Sections 67.615 and 67.620—
ment,or other appropriate agency;
(g)Making a good faith effort to continue to maintain a drug- A As a condition of the grant.I certify that I will not engage
free workplace through implementation of paragraphs(a),(b), in the unlawful manufacture,distribution,dispensing,posses-
(c),(d),(e),and(i). sion, or use of a controlled substance In conducting any
activity with the grant;and
B.The grantee may insert in the space provided below the
sites)for the performance of work done in connection with B. If convicted of a criminal drug offense resulting from a
the specific grant: violation occurring during the conduct of any grant activity,I
will report the conviction,in writing,within 10 calendar days
Place of Performance(Street address,city,county,state,zip of the conviction,to:Department of Justice.Office of Justice
code) Programs,ATTN:Control Desk,810 Seventh Street NW.,
Washington,DC 20531.
As the duly authorized representative of the applicant.I hereby certify that the applicant will comply with the above certifications.
1.Grantee Name and Address:
Renton Police Department
1055 South Grady Way
Renton,WA 98057
2.Application Number and/or Project Name 3.Grantee IRSNendor Number
DEA SeaTac HIDTA Task Force(Group D-22)
4.Typed Name and Title of Authorized Representative
Kevin Milosevich,Chief of Police—Renton Police Department
5.Signature , 6.Date l �
y - 40At61- /_ /'J
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'US Government Pnnling Office 1998.405-037/40014