Okaloosa County BOCC — August 5, 2014 — Debar-Lobbying-SFY-2012

CERTIFICATION REGARDING LOBBYING; DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITIY MATTERS; AND DRUG-FREE WORKPLACE REQUIREMENTS Florida Department of Law Enforcement Edward Byrne Memorial Justice Assistance Grant Program Form Provided by the 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 (Non-procurement) 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. (b) Have not within a three-year period preceding this application 1. LOBBYING been convicted of or had a civil judgement rendered against them for commission of fraud or a criminal offense in connection with As required by Section 1352, Title 31 of the U.S. Code, and implemented at 28 obtaining, attempting to obtain, or performing a public (Federal, State, CFR Part 69, for persons entering into a grant or cooperative agreement over or local) transaction or contract under a public transaction; violation of $100,000, as defined at 28 CFR Part 69, the applicant certifies that: Federal or State antitrust statutes or commission of embezzlement, theft forgery, bribery, falsification or destruction of records, making (a) No federal appropriated funds have been paid or will be paid, by or on behalf false statements, or receiving stolen property; of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee (c) Are not presently indicted for or otherwise criminally or civilly of Congress, or an employee of a Member of Congress in connection with the charged by a governmental entity (Federal, State, or local) with making of any federal grant, the entering into of any cooperative agreement, and commission of any of the offenses enumerated in paragraph (1) (b) of the extension, continuation, renewal, amendment, or modification of any federal this certification; and grant or cooperative agreement; (d) Have not within a three-year period preceding this application (b) If any funds other than federal appropriated funds have been paid or will be had one or more public transactions (Federal, State, or local) paid to any person influencing or attempting to influence an officer or employee of terminated for cause or default; and any agency, a member of Congress, an officer or an employee of Congress, or an employee of a member of Congress in connection with this federal grant or B. Where the applicant is unable to certify to any of the statements in cooperative agreement, the undersigned shall complete and submit Standard this certification, he or she shall attach an explanation to this Form - LLL, “Disclosure of Lobbying Activities”, in accordance with its instructions; application. (c) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subgrants, 3. DRUG-FREE WORKPLACE contracts under grants and cooperative agreements, and subcontracts) and that all (GRANTEES OTHER THAN INDIVIDUALS) subrecipients shall certify and disclose accordingly. As required by the Drug-Free Workplace Act of 1988, and implemented at 28 CFR Part 67, Subpart F, for grantees, as defined 2. DEBARMENT, SUSPENSION, AND OTHER at 28 CFR Part 67 Sections 67.615 and 67.620- RESPONSIBILITY MATTERS (DIRECT RECIPIENT) A. The applicant certifies that it will or will continue to provide a drug- free workplace by: As required by Executive Order 12549, Debarment and Suspension, and implemented at 28 CFR Part 67, for prospective participants in primary covered (a) Publishing a statement notifying employees that the unlawful transactions, as defined at 28 CFR Part 67, Section 67.510 - manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the grantee’s workplace and A. The applicant certifies that it and its principals: specifying the actions that will be taken against employees for violation of such prohibition; (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, sentenced to a denial of federal benefits by a State or Federal court, or (b) Establishing an on-going drug-free awareness program to inform voluntarily excluded from covered transactions by any federal department or employees about- agency; (1) The dangers of drug abuse in the workplace; (2) The grantee’s policy of maintaining a drug-free workplace; (3) Any available drug counseling, rehabilitation, and employee assistance programs; and (4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; FDLE JAG Grant Application Package Lobbying, Debarment , Suspension, and Drug-Free Workplace Certification Page 1  CERTIFICATION REGARDING LOBBYING; DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITIY MATTERS; AND DRUG-FREE WORKPLACE REQUIREMENTS Florida Department of Law Enforcement Edward Byrne Memorial Justice Assistance Grant Program (c) Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement required by paragraph (a); (d) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the grant, the employee will- (1) Abide by the terms of the statement; and (2) Notify the employer in writing of his or her conviction for a violation of a Check here If there are workplaces on file that are not identified criminal drug statute occurring in the workplace no later than five calendar days here. after the conviction; Section 67.630 of the regulations provides that a grantee that is a (e) Notifying the agency, in writing, within 10 calendar days after receiving notice State may elect to make one certification in each Federal fiscal year. under subparagraph (d) (2) from an employee or otherwise receiving actual notice A copy of which should be included with each application for of such conviction. Employers of convicted employees must provide notice Department of Justice funding. States and State agencies may elect including position title, to: Department of Justice, Office of Justice Programs, to use OJP Form 4061/7. ATTN: Control Desk, 633 Indiana Avenue, N.W., Washington, D.C. 20531. Notice shall include the identification number(s) of each affected grant; Check here If the State has elected to complete OJP Form 4061/7. (f) Taking one of the following actions, within 30 calendar days of receiving notice under subparagraph (d) (2), with respect to any employee who is so convicted- (1) Taking appropriate personnel action against such an employee, up to and DRUG-FREE WORKPLACE including termination, consistent with the requirements of the Rehabilitation Act of (GRANTEES WHO ARE INDIVIDUALS) 1973, as amended; or As required by the Drug-Free Workplace Act of 1988, and (2) Requiring such employee to participate satisfactorily in a drug abuse implemented at 28 CFR Part 67, Subpart F, for grantees, as defined assistance or rehabilitation program approved for such purposes by a Federal, at 28 CFR Part 67; Sections 67.615 and 67.620- State, or local health, law enforcement, or other appropriate agency; A. As a condition of the grant, I certify that I will not engage in the (g) Making a good faith effort to continue to maintain a drug-free workplace unlawful manufacture, distribution, dispensing, possession, or use of through implementation of paragraphs (a), (b), (c), (d), (e), and (f). a controlled substance in conducting any activity with the grant; and B. The grantee may insert in the space provided below the site(s) for the B. If convicted of a criminal drug offense resulting from a violation performance of work done in connection with the specific grant: occurring during the conduct of any grant activity, I will report the conviction, in writing, within 10 calendar days of the conviction, to: Place of Performance (Street address, city, county, state, zip code) Department of Justice, Office of Justice Programs, ATTN: Control Desk, 633 Indiana Avenue, N.W., Washington, D.C. 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: Okaloosa County Board of County Commissioners 1804 Lewis Turner Boulevard, Suite 206 Fort Walton Beach, FL 32547 2. Project Name: Family Violence Prevention Project 3. Typed Name and Title of Authorized Representative: Charles K. Windes, Jr., Chairman 4. Signature: ___________________________________________________ 5. Date:_____________________________ FDLE JAG Grant Application Package Lobbying, Debarment , Suspension, and Drug-Free Workplace Certification Page 2