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HomeMy WebLinkAboutGRANTEE-SUBGRANTEE FOR DOMESTIC PREPAREDNESS 911 YR 2004 $225,000.00 HOMELAND SECURITY GEORGIA EMERGENCY MANAGEMENT AGENCY SONNY PERDUE GOVERNOR CHARLEY ENGLISH DIRECTOR May 15, 2008 .. RE: FIPS #245-04196-01 GAN #2004-GE-T4-0012 Budget Worksheet #-1098-EQU Augusta-Richmond County Emergency Management Agency Mr. Howard Willis Director Augusta-Richmond County Emergency Management Agency 911 4th Street Augusta, Georgia 30901 Dear Mr. Willis: Enclosed is the Grantee-Subgrantee, Office for Domestic Preparedness (ODP) State Homeland Security Grant Program FY04 Agreement. This agreement governs the procurement and use of equipment being funded by ODP, to help your agency to prepare for and react to acts of terrorism. The amount of this agreement is $225,000.00. You may not exceed in either quantity nor total dollar amount the items expressly approved for you to purchase, as shown on the accompanying detailed budget worksheet(s). Attached to the Grantee-Subgrantee Agreement are Exhibits A-G. Please review and return signed originals of the Grantee-Subgrantee Agreement, Exhibit F, and Exhibit G, to the attention of your grants manager with in 14 days of receipt of th is letter. Keep a copy of each form for your records. If you require further information as to the grantee package, please contact Pat Craig, Grants Manager, at 404-635-7511. Thank you for your work on behalf of the citizens of Georgia. Angi Ford Public Assistance Director af/dm Enclosures Post Office Box 18055 . Atlanta, Georgia 30316-0055 Phone (404) 635-7000 or toll-free in Georgia 1-800-TRY-GEMA . Fax (404) 635-7205 www.gema.state.ga.us FISCAL YEAR 2004 HOMELAND SECURITY GRANT PROGRAM GRANTEE-SUB GRANTEE AGREEMENT The United States Department of Homeland Security, Office of Justice Programs, Office for Domestic Preparedness (ODP) approved the application and awarded funding for homeland security and law enforcement terrorism prevention to the Georgia Emergency Management Agency (GEMA) on behalf of the State of Georgia, in accordance with the Fiscal Year 2004 Homeland Security Appropriations Act. GEMA will maintain overall responsibility and accountability to the federal government for the duration of the project. GEMA, as Grantee, has awarded the amount of $225,000.00 to Augusta-Richmond County Emergency Management Agency, as Subgrantee, in accordance with the Fiscal Year 2004 Homeland Security Grant Program (HSGP). Under this Agreement, GEMA will execute the interests and responsibilities of the Grantee. The individual designated to represent the State is Charley English, Authorized Grantee Official. The State has designated Ralph Reichert as the Program Manager of this program. The Subgrantee's Authorized Official has authority to legally bind the Subgrantee and will execute the interests and responsibilities of the Subgrantee. The Subgrantee's Authorized Official is the person whose name appears on page four (4) of this agreement and whose signature appears on page four (4) of this agreement. 1. The following exhibits are attached or attainable via the internet and made a part of this agreement: Exhibit A Exhibit B Exhibit C Exhibit D Exhibit E Exhibit F Exhibit G United States Department of Homeland Security, Office of Justice Programs, Office of the Comptroller's Financial Guide, found on OJP's Web site: http://www.ojp.usdoj.gov. United States Department of Homeland Security, Office of Justice Programs, Office of Domestic Preparedness Grant Solicitation and Application Guide for Fiscal Year 2004 Homeland Security Grant Program, a copy of which is available on the OJP Web site: http://www .ojp. usdoj .gov/ docs/fy04hsgp. pdf. Georgia Emergency Management Agency FY 04 ODP/Georgia Homeland Security Grant Instructions for the State Homeland Security and Law Enforcement Terrorism Prevention Program 11-07-03, a copy of which is available on the GEMA Web site: http://www.gema.state.ga.us. Approved Detailed Budget Worksheet. Payment Request Form. Assurances - OJP Assurance Form 4000/3. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions. Drug- Free Workplace Certification. Lobbying Certification OJP Form 4061/6. 2. The Subgrantee agrees to use allocated funds only as approved, to comply with the terms, conditions and guidelines as stated within this agreement, and to request reimbursement only for expenditures made in accordance with the Approved Detailed Budget Worksheet (Exhibit D). Any change to this worksheet must be requested in writing by the Subgrantee and must be approved by the Program Manager prior to the execution of that change. 3. Federal funds provided under this program are for 100% reimbursement of all eligible expenditures. 4. No elected or appointed official or employee of the Subgrantee shall be admitted to any share or part of any benefit, directly or indirectly, from this agreement or from the grant or sub grant awards. This provision shall not be construed to extend to any contract made with a corporation for its general benefit. 5. If the Subgrantee violates any of the conditions of this agreement, including all exhibits hereto, or of applicable federal and state law or regulation, GEMA shall notify the Subgrantee that additional funds for the grant in connection with which the violation occurred will be withheld until such violation has been corrected to the satisfaction of GEMA. In addition, GEMA may also withhold or require repayment of all or any portion of the financial award which has been or is to be made available to the Subgrantee for other projects under this program, this or other agreements, and applicable federal and state regulations until adequate corrective action is taken. 6. The Subgrantee agrees that federal or state officials and auditors or their duly authorized representatives may conduct required audits and examinations. The Sub grantee further agrees that such officials, auditors or representatives shall have access to any books, documents, papers and records of any recipients of this funding and of any persons or entities which perform any activity which is reimbursed to any extent with federal or state funds distributed under the authority of the Fiscal Year 2004 Homeland Security Appropriations Act and this Agreement. 7. Subgrantee shall complete and submit reports as requested by GEMA and cooperate and assist GEMA in complying with ODP's tracking and reporting requirements. Specifically, without limitation, Subgrantee shall: (a) Submit updated information as requested by GEMA to assist the state in completing the Initial Strategy Implementation Spending Plan to show how the grant funds have been expended and how the funds will support the goals and objectives outlined in the State's Homeland Security Strategy. (b) Submit information at GEMA's request and direction to assist GEMA in submitting Biannual Strategy Implementation Reports and Categorical Assistance Program Reports in accordance with ODP's requirements as outlined in the ODP Guide (Exhibit B). 2 8. Subgrantee agrees to comply with all applicable terms and conditions of the ODP Guide (Exhibit B), which includes the requirements to: (a) Institutionalize the use of the incident command system (ICS), as taught by the United States Department of Homeland Security (US DHS), by the end of the grant's two-year performance period. (b) Adopt the National Incident Management System (NIMS) as mandated by the Homeland Security Presidential Directive 5 (HSPD-5), beginning no later than fiscal year 2005. ODP suggests that subgrantees begin utilizing NIMS . concepts, principles, terminology, and technologies as they are made available by the US DHS. (c) Adhere to the State's Homeland Security Strategy. (d) Sign and comply with the terms and conditions of GEMA's Statewide Mutual Aid and Assistance Agreement and sign any other Mutual Aid Agreements GEMA or ODP shall deem necessary to fulfill the Subgrantee's obligations under this Agreement to render mutual aid for a suspected or real attack or in the case of a weapons of mass destruction event. 9. The Sub grantee agrees that all purchases and expenditures authorized under this program will be completed by June 27, 2008. 10. Payments to the Subgrantee will be made only upon presentation of the approved Payment Request Form (Exhibit E). Reimbursements from invoices and applicable canceled checks (or other justifying documentation) will only be made for eligible equipment, materials, expenses and costs upon approval of the Program Manager. Noncompliance by Subgrantee with the terms or conditions of this agreement will constitute justification for non-payment of any amounts submitted on the Payment Request Forms. 11. There shall be no changes to this Agreement unless mutually agreed upon by both parties to the Agreement. 12. Termination. This agreement may be terminated for the following reasons: Cause/Default. This agreement may be terminated for cause, in whole or in part, at any time by the State for failure of the Sub grantee to perform any of the provisions or to comply with a~y terms and conditions herein. If the State exercises its right to terminate this agreement under the provisions of this paragraph, the termination shall be accomplished in writing and specify the reason and termination date. The Subgrantee will be required to submit the final invoice not later than 30 days after the effective date of written notice of termination. Upon termination of this agreement, the State shall not incur any new obligations after the effective date of the termination and shall cancel as many outstanding obligations as possible. The above remedies are in addition to any other remedies provided by law or the terms of this agreement. 3 Convenience. This agreement may be cancelled or terminated by either of the parties without cause; however, the party seeking to terminate or cancel this agreement must give written notice of its intention to do so to the other party at least 30 days prior to the effective date of cancellation or termination. Non-Availability of Funding. Notwithstanding any other provision of this agreement, in the event that either of the sources of reimbursement for services under this agreement (appropriations from the General Assembly of the State of Georgia or the Congress of the United States of America) no longer exist or in the event the sum of all obligations of GEMA incurred under this and all other agreements entered into for this program exceeds the balance of such agreement sources, then this agreement shall immediately terminate without further obligation of GEMA as of that moment. The certification by the Director of GEMA of the occurrence of either of the events stated above shall be conclusive. 13. Sub grantee will follow procurement standards as stated in the Financial Guide. Subgrantee's name and mailing address: Augusta-Richmond County Emergency Management Agency, 911 4th Street, Augusta, Georgia 30901. 14. GEMA's mailing address: Georgia Emergency Management Agency, P.O. Box 18055, Atlanta, Georgia 30316-0055. AGREED: ~/ By: (jL;;e~ . SUbgrrntee'l AuthOrized Official -> VI ,,~ Signature Date By: 17Avj::" 1> ~. C6 Fe; vi 1-114 ~ "- Printed or Typed Name of Subgrantee's Authorized Official AG~ 4 Exhibit 0 >c u :z; r"l ~ -< Eo< :z; r"l ~ r"l ~ -< :z; ~ >c u :z; r"l ~ r"l ~ r"l :$~ Co-' Q,l ~ ~ 0= r"l Q,l Co-'~ .... rn rn = ~ "<t o o M >c ~ ~ I: .. ... < ... I: .. e .. ... to ; :iE ~ I: .. ... .. .. e to ~ ~,e. Q 3 "B8 5 ~ ~. I: $] E-< '" ~~ u d. ~1n ~ ::l ~ ~ << .,. r- N .,. Q N N ob trl ~ z \OJ~ "N en u :~ ~ N gf 0-....:1 'g ~~ "'~~ ~ ~CQ lii~() ~.~ '" C) ~ - . ~ ..- or,:21~ ~8$ c 5 s:: ~ ll's o r.s .~ o~~ ~~~ E-<CQ 8 u G' .-& - ~ e:::i .g ~ tl ..:l 0 II ~ ~~ ^t:~ ~" . rJ'.l 8. s: ~.~~ 1:l ~ :'S '" .... d:! ~ ~ ""0 0 .:S a ~ 1:l -fi S .tj, ~i5'<r; ~w~ ~:iE,-., ~rJ'.l '" - B~~ roi ~.~ 0" ~ e o ~ ~ ~:a"" N ~ a ~ <= ~ . 0 ~ ~'B ~ z g, c= 0 Ul "u.s 8 ~ . ";- B ~ $sC;; .. () ~ :> " ~ 'B 00 ~ 00 .~ ~ f=;'~ -;;;~- 8 B.~ ~5~ ~ 8 ~ ,-., ~ .~ ~ Q, "'0' "" .~ ~ 6:' .~ ~.2 C ~ Q t) c: ~ _ ~.2 ~ ~ IU c= ~ ~ ~ ~ or- ~8 ~ ,.....:::, p... -' 60'~", J ~.~ p ~I~~ 8 e ~ roi S ~ .i ~ "-@ Ol ,13 ::r: ~ ~ 8 ~ ~ c:i e ~~ ~ 0 ~ 0 I:U]"'. '"'"" iU IU ..- , ~ :> ;j i:'...." ~ g,g.~'g ~ ... 0.. 0.. =~~g. u_~ci5 .. o ... '" .. .. is or S ~ 'C .. to ~ o ::r: ~ ~ Z E-< U < E-< Z o u .... Q '" Q ...., ~ t '" ::l ... ~ ... .. .. .. ... '" ,s .,. .... .... '" '" '" ~ ~ Q Q < E-< '" o U ....:i < E-< o E-< Q Q Q Q o 0 o Q Q Q lIj" 'If '" N '" N ::r: u < ~ E-< '" o u fA "" o o o g ....:i or,- < '" E-< '" 0 fA E-< ,f o CJ oz, a :21 - ~ ~ () '60 " .... .):j CI.l E CI.l ~ () " fEo .s ..... o .... ~ g .s ~ o " ..0 ] a ,!l "" " 1;; " " 0' " .... ..= ~ " .... o ~ II o Z -; o '"' '" 'Q, .. .... to bÚ'" Exhibit E EXHIBIT E Date: Georgia Emergency Management Agency State Homeland Security Grant Program Payment Request Form Instructions: All requests for payments must be supported by documentation supporting actual expenditures, Itemize each . expenditure below to the fullest detail possible. Attach documentation that supports this payment request, such as copies of bills of sale, invoices, receipts, and canceled checks evidencing payment. Do not send originals. Attach a continuation sheet if necessary. * Please refer to Budget Worksheet for information needed in the following section * Budget Worksheet Number: Name of Jurisdiction: GAN Number: FIPs Number: Area: Item Number From Budget Worksheet Requested Item to be Reimbursed Requested Quantity Requested Cost Description of Documentation Attached in Support of this Pa ent Ruest Under penalty of peIjury, I certify that to the best of my lmowledge and belief the data above are correct and that all outlays were made in . accordance with the grant conditions or other agreements, comply with procurement regulations contained within the Financial Guide, and that payment is due and has not been previously requested. I understand that any part of this payment request that is not supported by cost documents and/or expended within the scope of the approved project will be refunded to the State of Georgia within 30 days of receiving the deobligation notice. Signature of Subgrantee' s Authorized Representative Printed Name Contact Phone Number . ! .: Exhibit F . ASSURANCES OMB APPROVAL NO. Jl2.1'()140 The Applicant hereby assures and certifies compliance with all Federal statutes, regulations, policies, guidelines and requirements, including OMB Circulars No. A-21, A-87, A-1l0, A-122, A-133; B.O. 12372 and Uniform Administrative Requirements for Grants and Cooperative Agreements 28 CPR, Part 66, Common rule, that govern the application, acceptance and use of Federal funds for this federally-assisted project. Also the Applicant assures and certifies that: 1. It possesses legal authority to apply for the grant; that a resolution, motion or I o. similar action has been duly adopted or passed as an official act of the applicant's governing body, authorizing the filing of the application, including all understandings and assurances containedtherein, and directing and authorizing the person identified as the official representative of the applicant to act in connection with the application and toprovide such additional information may be required. 2. It wiD comply with requirements of the provisions of the Uniform Relocation Assistance and Real Property Acquisitions Act of 1970 (p.L. 91-646) which provides for fair and equitable treatment of persons displaced as a result of Federal and federally - assisted programs. 11. It will comply with provisions of Federal law which limit certain political activities of employees of a State or local unit of government whose principal employment is in connection with an activity fmanced in whole or in part by Federal grants. (5 USC 1501, etseq.) 3. 4. It will comply with the minimum wage and maximum hours provisions of the Federal Fair Labor Standards Act if applicable. . 12. It will establish safeguards to prohibit employees from using their positions for a purpose that is or gives the appearance of being motivated by a desire for private gain for themselves or others, particularly those with whom they have family, business, or other ties. 5. 6. It will give the sponsoring agency or the Comptroller General, through any authorized representative, access toand the right to examine all records, books, papers, or documents related to the grant 7. It wiD comply with all requirements imposed by the Federal sponsoring agency concerning special requirements of law, program requirements, and o.ther 13. administrative requirements. . 8. It will insure that the facilities under its ownership, lease or supervision which shall be utilized in the accOmplishment of the project are not listed on the Environmental Protection Agency's (EP A)list of Violating Facilities and that it will notifY the Federal grantor agency of the receipt of any communication from the Directorofthe EPA OfficeofFedeial Activities indicating thatafacilitr to be used in the project is under consideration for listing by the EP A. It wiD comply with the flood insurance purchase requirements of Section 102( a) of the Flood Disaster Protection Act of 1973, Public Law 93-234, 87 Stat 975,14. approved December 31, 1976, Section 102(a) requires, on and after March 2, 1975; the purchase of flood insurance m communities where such insurance is available as a condition for the receipt of any Federal financial assistance for construction or acquisition purposes for usein any area that has been identified by the Secretary of the Department of Housing and Urban Development as an area having special flood hazards. The phrase "Federal financial assistance" 15. includes any form ofloan, grant, guaranty, insurancepayment, rebate, subsidy, disaster assistance loan or grant, or any other form of direct or indirect Federal assistance. 16. 9. Signature UL~-4 - Y A /111 ---' It will assist the Federal grantor agency in its compliance with Section 106 of the National Historic Preservation Act of 1966 as amended (16 USC 470), Executive Order 11593, and the Archeological and Historical Preservation Act of 1966 (16 USC 569 a-I et seq.) by (a) consulting with the State Historic Preservation Officer on the conduct of investigations, as necessary, to identifY properties listed in or eligible for inclusion iri the National Register of Historic Places that are subject to adverse effects (see 36 CPR Part 800.8) by the activity, and notifYing the Federal grantor agency of the existence of any such properties, and by (b) complying with ail requirements established by the . Federal grantor agency to avoid or mitigate adverse effects upon such properties. It will comply, and assure the compliance of all its subgrantees and contractors, with the applicable provisions of Title I of the Omnibus Crime Control and Safe Streets Act of 1968, as amended, the Juvenile Justice and Delinquency Prevention Act, or the Victims of Crime Act, as appropriate; the provisions of the current edition of the Office of Justice Programs Financial and Administrative Guide for Grants, M71 00.1; and all other applicable Federal laws, orders, cireulars, or regulations. It will comply with the provisions of28 CFR applicable to grants and cooperative agreements including Part 18, Administrative Review Procedure; Part 20, Criminal Justice Information Systems; Part 22, Confidentiality of IdentifIable Resesrch and Statistical Information; Part 23, Criminal Intelligence Systems Operating Policies; Part 30, Intergove-rrimental Review of Department of Justice Programs and Activities; Part 42, NondiscriminationlEqual Employment Opportunitr Policies and Procedures; Part 61, Procedures for Implementing the National Environmental Policy Act; Part 63, Floodplain Management and Wetland Protection Procedures; and Federal laws or regulations applicable to Federal Assistance Programs. It will comply, and all its contractors will comply, with the nondiscri-mination requirements of the Omnibus Crime Control and Safe Streets Act of 1968, as amended, 42 use 3789(d), or Victims of Crime Act (as appropriate); Title VI of the Civil Rights Act of 1964, as amended; Section 504 of the Rehabilitation Act of 1973, as amended; Subtitle A, Title II of the Americans with Disabilities Act (ADA) (1990); Title IX of the Education Amendments of 1972; the Age Discrimination Act of 1975; Department of Justice Non-Discrimination Regulations, 28 CPR Part 42, Subparts C, D, E, and G; and Department of Justice regulations on disability discrimination, 28 CFR Part 35 and Part 39. In the event a Federal or State court or Federal or State administrative agency makes a finding of discrimination after a due process hearing on the grounds of race, cOlor, religion, national origin, sex, or disability against a recipient of funds, the recipient will forward a copy of the rmding to the Office for Civil Rights, Office of Justice Programs. It will provide an Equal Employment Opportunity Program if required to maintain one, where the application is for ~500,000 or more. It will comply with the provisions of the Coastal Barrier Resourees Act (p.L. 97-348) dated October I 9, 1982 (16 USC 3501 et seq.) which prohibits the expenQiture of most new Federal funds within the units of the Coastal Barrier Resources System. 5:> (Z?r {~ Date , . ! Exhibit G , .. U,S. Df;PARTMENT OF JUSTICE OFFICE OF JUSTICE PROGRAMS OFFICE OF THE COMPTROLLER CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND OlHER RESPONSIBIUTY MAITERS; AND DRUG-FREE WORKPLACEREQUIREMENrs Applicants should refer to the reg'ulatlons 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 fOf compliance with certification requlre~ents under 28 CFR Part 69, -New Restrictions on Lobbying- an9 28 CFR Part 67, -GQvernment-wlde Debarment and Suspens!on (Nonpro-curement) and Govemm~nt-wlde 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 oovered transact/on, grant, or coopera(lve agreement. .. 1. LOBBYING , A.$ required by Section 1352, Title 31 of the U.S. CQde, and Implemented at 28 .CFR Part 69, for persons entering Into a grant or cooperative agreement over $100,000, as defined at 28 CFR Part 69, the applicant cerUfles that: (a).No Federal appropriated funds have been paid or will be paId, by or on' behalf of the undersigned, to any person for In- fluencIng or attempUng to Influence an officer or employee of any agency,' a Member. of Congr6S1!, an officer or employee of Congress, or an employee of a MelT!ber of Congress In con- ne<ltIon wtth the making of any Federal grant, the entering Into of any cooperative agreement, and the extension, conl/nuatlon, re~wal, amendment, or modification of any Federal grant or cooperative 'agreement; . .(b) If any funds other ttlan Federal appropriated funds have been paid or will be paid to any person for InfluencIng or at- tempOng to ~nftuencean officer or employee of any agency, a Member of COngress, 8,n officer or employee 'of Congress. or an employee of a Member of Congress In connection with thIs . Federal grant or COoperatiVe agreement, the undersigned shall COmplete and submit Standard Form - LLL, .Olsolosure of Lobbying Actlv/Ues: In acoordanoe wIth Its Instructions; (e) The undersigned shaU require that the larigu~e of th.1s cer- tification be Included mthe award documents for all subawards at aU tlenl (IncludIng subgrants, contraots under 'grants al'!d cooperative at1f'Gements, and subcontracts) and that aU SUb- recipients shaD certify and dIsclose aCCOrdingly. . . 2. DEBARMENT, SUSPENSION, ANP OTHER RESPONSIB/U1Y MAneRS (DIRECT RECIPIENT) As requIred by Exeoutlve Order 12549,Debarment and Suspension, and Implemented at 28 CFR Part 67, 'for prospec- tive partiCipants In primary covered transactions. as defined at 28 CFR Part 67, Section 67.510- A. The applicant certifies that It and Its prInCipals: (a) Are not pr_sently debarred, 8ullPended, proposed for debar- ment, declared 'nellglble, sentenced to a denial of Federal benefits by a State or Federal court, or voluntarily excluded from covered transactions by any Federal department or agency; (b) Have not withIn a three-year perIod preceding this applica- tion bee" convlQted of or had a olvll Judgm~nt rendered against them for commission of fraud ot a criminal offense In. conneo. Uon wIth obtaining, attempting to obtaIn, or performing a publlo (Federal, State, or local) transaction or contract under a pUblic: transaction; violation of Federal or State antitrust statutes or commission. of embezzlement, theft, forgery, brfbery, falsification or destnJoOon of records, makIng false statements,or re~lvlng s~olen property; (c) Are not .presently Indicted' for or otherwIse crimInally or ciVilly charged by a governmental entity (Federal, State, or 10caQ with con1mlsslon of any of the offenses enumerated In paragraph (1)(b) 'of this certlflcatlon;"and (d) Have not within a three-year periOd preoodtng thIs applica- tion had one or more pubQo transacUons (Federal, State, or IocaQ termInated for cause or default; and B. Where the applicant Is unable to cerUfy to any of the statements In this certlfIcaUon, he or she shall attach an explanation to this application. 3. DRUG-FREE WORKPLACE (GRANTEES OntER 1liAN INDIVIDUALs) h required by the Drug-Free Worf<place Act of 1968, and . Implemented at 28 <?FR Part 67, Subpart Fe for grantees, as defined aU8 CFR Part 87 Sections 67.615 and 67_~ A. The appDcant certlftes that It will or WRl. continue to provlde a drug-free workplace by: . . . (a) PUblishing a statement notIfying employees that the unlaWful manufacture, distribution, dispensing, possess/on, or use of a controlled substance Is prohibited In the grantee's workplace and specifying the actions that will be taken against employees for vlolaOon of such Prohlbltl~ . (b) establishing an on-golng drug..free awareness program to Inform employees about- (1) .The dangers of drug abuse In the workplace; (2) The grantee's polloy of maintaining a drug-free workplace; (3) Any.avallable drug counseling, rehabllltatlon, and employee. assistance programs; and (4) The penalties that may be Imposed upon employees for drug abUse violations OCCUtrlng In the workplace; . (0) Making It a requirement that each employee to be engaged In /he performance olthe grant be given a copy of /he Jtate- . ment required by paragraph (8); (d) Notifying the employee In the statement required by para- graph (a) thai, as a condition of employment under the grant, the employee will- 01' ~M ~11e (3091) REPLACES OJP ,"ORMS ~06112. Ml61f3 ANO""oe1/~ WHICH ARE OBSOLETe. (1) Abide by the terms of the statement; and (2) Notlfy the employer In wrrtlng of his or her oonvlotlon for a violation of a orlmlnal drug statute ooourri"g In Iheworkplace no later than fl,ve oalendar days after such oonvIctlon; (e) Notifying the agency, In. writIng, within 10 calendar days after receiving notice under SUbparagraph (d)(2) from an employee or otherwise receiving actual notice of such conv/o-tlon. Employers of convicted employees must provide notloe,lne/ud/ng pOSition title, to: Department of Justice, Office of' . Jusllce Programs, ATTN: Control Desk, 633 Indiana Avenue. N.W., Washington, D.C. 20531. Notice shalllne/ude th~ Iden- tification numb~r(s) of each affected gmnt (t) Taklng one of the following actions. within 30 celendar daYs ,of r.ecelvlng notice under subparagraph (d)(2), wlth . respect to any emplOyee who Is so oonv/cted- (i) Taking appropriate peraonnel aotlon against such an .' employee, up to and Including termJnatlon, consistent wlth the requirements of the Rehabilitation Act of 1973, as amendea; or (2) Requiring such employee to partlolpate satisfactorily In 8 drug abuse assistance or rehabUltatlon progmm apJ1roved for such purposes by 8. Fedeml, State. or local health, law enforce- ment, 'or other appropriate a~enoy; (g) Making a good ft!1th effort to continue to maintain a drug- free workplace through Implementatlon.of pamgraphs (a), (b), (e), (d), (e), and (t). B. The grantee may Insert In the space Provided beloW the slte(s) for the performance of work done In connection with the speolflc grant Place of PerformanCe (Street address, city; county, state, zip code) Check O'1f there are workplaces on file that are not Indent/fled here. Seollon 67, 630 of the regulations provides that a grantee that Is a 'State may elect to make one certification In eaoh Federal fiscal year. A oOPY of which should be Included with each ap- plication for Department of Justice funding. States and State agenoles may elect to use OJP Form 4061/7. , CheQk 0 If the State hl1s elected to complete OJP Form 4061n. DRUG-FREE WORKPLACE (GRANTEES WHO AftE INDMDUALS) As required by the Drug-Free Workplace Act of 1988. and Implemented at 28 CFR Part 67, Subpart F, for gmntees, as defined at 28 CFR Part 67; Sections 67.615 and 67.620- A.. As a condition of the grant, I certify that I wlil not.engage In the unlawfut manufacture, distribution, dispensIng, posses- sion, or use of a controlled substance In conduotlng allY activity with the grant; and . B. If convlcted of a ortmlnal dr\lg offense resulting from 8 violation ooourrlng during the conduct of any grant activity, I will report the conviction, In writing, wIthin 10 calendar d8y$, of the convlotlon, to: Department of Justice, OffIce of Justice Progran1S. ATTN: Control Des1<.' 633 tndi~08 Avenue, N.W.. Was,hlngton. D.C. 20531. As the duly authorized representative of the applicant, I hereby certify that the applk:ant will comply with the above certifications. 1. G~ntee Name and Address: 2. Application NU!l1ber and/or Project Name. 3. Grantee IRSNendor Number 4. l)'ped Name and TItle of Authorized RepresentatIve ~v ~6f4 g--- r I--- 5. SIgnature . . -s ('Sot DO 6. Date 4t?PPf 'U.s. OoYemment Prln81lCJ 0IIlQ8: 1998 -405-03Tf.4001<l