**ASSURANCES: NON-CONSTRUCTION PROGRAMS**

As the duly authorized representative of the applicant, I certify that
the applicant:

1\. Has the legal authority to apply for Federal assistance, and the
institutional, managerial, and financial capability (including funds
sufficient to pay the non-Federal share of project costs) to ensure
proper planning, management and completion of the project described in
this application.

2\. Will give the awarding agency, the Comptroller General of the United
States, and, if appropriate, the State, through any authorized
representative, access to and the right to examine all records, books,
papers, or documents related to the award; and will establish a proper
accounting system in accordance with generally accepted accounting
standards or agency directives.

3\. Will establish safeguards to prohibit employees from using their
positions for a purpose that constitutes or presents the appearance or
personal or organizational conflict of interest, or personal gain.

4\. Will initiate and complete the work within the applicable time frame
after receipt of approval of the awarding agency.

5\. Will comply with all applicable Federal statutes. These include but
are not limited to: (a) Title VI of the Civil Rights Act of 1964, (P.L.
88-352), (42 U.S.C. 2000d-2000d-6), which prohibits discrimination on
the basis of race, color or national origin: (b) Title IX of the
Education Amendments of 1972 (20 U.S.C. 1681-1688), which prohibits
discrimination on the basis of sex and blindness; (c) Section 504 of the
Rehabilitation Act of 1973 (29 U.S.C. 794), which prohibits
discrimination on the basis of disability; (d) the Age Discrimination
Act of 1975, 42 U.S.C. 6101-6107, which prohibits discrimination on the
basis of age; and (e) the requirements of any other nondiscrimination
statute(s) which may apply to the application.

6\. Will comply, if applicable, with insurance purchase requirements of
42 U.S.C. 4012a that requires recipients in a special flood hazard area
to participate in the program and to purchase flood insurance.

7\. Will comply with environmental standards which may be prescribed
pursuant to the following: (a) institution of environmental quality
control measures under the National Environmental Policy Act of 1969, 42
U.S.C. 4321-4347; (b) Coastal Zone Management Act of 1972 (16 U.S.C.
1451 et seq.); and (c) the Clear Air Act of 1955, (42 U.S.C. Chapter 85,
7401 et seq.).

8\. Will assist the awarding agency in assuring compliance with Section
106 of the National Historic Preservation Act of 1966, (16 U.S.C. 470f),
and the Service Award Act of 1974 (16 U.S.C. 469a-1).

9\. Will cause to be performed the required financial and compliance
audits in accordance with the Single Audit Act of 1984, (31 U.S.C.
7501-75).

**CERTIFICATIONS: NON-CONSTRUCTION PROGRAMS**

The certifications below are executed with the signing of the
certification signature page and submission with the grant application
or modification package.

**CERTIFICATION REGARDING LOBBYING**

The undersigned certifies, to the best of his or her knowledge and
belief, that:

\(1\) No Federal appropriated funds have been paid or will be paid, by
or on behalf 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 of Congress, or an employee of a
Member of Congress in connection with the awarding of any Federal
contract, the making of any Federal grant, the making of any Federal
loan, the entering into of any cooperative agreement, and the extension,
continuation, renewal, amendment, or modification of any Federal
contract, grant, loan, or cooperative agreement;

\(2\) If any funds other than Federal appropriated funds have been paid
or will be paid to any person for influencing or attempting to influence
an officer or employee of any agency, a Member of Congress, an officer
or employee of Congress, or an employee of a Member of Congress in
connection with this Federal contract, grant, loan or cooperative
agreement, the undersigned shall complete and submit Standard Form-LLL,
\`\`Disclosure Form to Report Lobbying,\'\' in accordance with its
instructions;

\(3\) The undersigned shall require that the language of this
certification be included in the award documents for all sub-awards at
all tiers (including subcontracts, sub-grants, and contracts under
grants, loans, and cooperative agreements) and that all sub-recipients
shall certify and disclose accordingly; and this certification is a
material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification
is a prerequisite for making or entering into this transaction imposed
by section 1352, title 31 U.S. Code. Any person who fails to file the
required certification shall be subject to a civil penalty of not less
than \$10,000 and not more than \$100,000 for each such failure.

The undersigned states, to the best of his or her knowledge and belief,
that:

If any funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with this commitment
providing for the United States to insure or guarantee a loan, the
undersigned shall complete and submit Standard Form-LLL A Disclosure
Form to Report Lobbying, in accordance with its instructions.

Submission of this statement is a prerequisite for making or entering
into this transaction imposed by section 1352, Title 31, U.S. Code. Any
person who fails to file the required statement shall be subject to a
civil penalty of not less than \$10,000 and no more than \$100,000 for
each such failure.

#  

**CERTIFICATION REGARDING DEBARMENT, SUSPENSION,**

**AND OTHER RESPONSIBILITY MATTERS**

**INSTRUCTIONS FOR CERTIFICATION\--PRIMARY COVERED TRANSACTIONS**

1\. By signing and submitting the certification signature page, the
prospective primary participant is providing the certification set out
below.

2\. The inability of a person to provide the certification required
below will not necessarily result in denial of participation in this
covered transaction. The prospective participant shall submit an
explanation of why it cannot provide the certification set out below.
The certification or explanation will be considered in connection with
the department or agency\'s determination whether to enter into this
transaction. However, failure of the prospective primary participant to
furnish a certification or an explanation shall disqualify such person
from participation in this transaction.

3\. The certification in this clause is a material representation of
fact upon which reliance was placed when the department or agency
determined to enter into this transaction. If it is later determined
that the prospective primary participant knowingly rendered an erroneous
certification, in addition to other remedies available to the Federal
Government, the department or agency may terminate this transaction for
cause or default.

4\. The prospective primary participant shall provide immediate written
notice to the department or agency to which this proposal is submitted
if at any time the prospective primary participant learns that its
certification was erroneous when submitted or has become erroneous by
reason of changed circumstances.

5\. The terms covered transaction, debarred, suspended, ineligible,
lower tier covered transaction, participants, person, primary covered
transaction, principal, proposal, and voluntarily excluded, as used in
this clause, have the meanings set out in the Definitions and Coverage
sections of the rules implementing Executive Order 12549. You may
contact the department or agency to which this proposal is being
submitted for assistance in obtaining a copy of those regulations.

6\. The prospective primary participant agrees by submitting this
proposal that, should the proposed covered transaction be entered into,
it shall not knowingly enter into any lower tier covered transaction
with a person who is proposed for debarment under 48 CFR part 9, subpart
9.4, debarred, suspended, declared ineligible, or voluntarily excluded
from participation in this covered transaction.

7\. The prospective primary participant further agrees by submitting
this proposal that it will include the clause titled A Certification
Regarding Debarment, Suspension, Ineligibility and Voluntary
Exclusion-Lower Tier Covered Transaction,\'\' provided by the department
or agency entering into this covered transaction, without modification,
in all lower tier covered transactions and in all solicitations for
lower tier covered transactions.

8\. A participant in a covered transaction may rely upon a certification
of a prospective participant in a lower tier covered transaction that is
not proposed for debarment under 48 CFR part 9, subpart 9.4, debarred,
suspended, ineligible, or voluntarily excluded form the covered
transaction, unless it knows that the certification is erroneous. A
participant may decide the method and frequently by which it determines
the eligibility of its principals. Each participant may, but is not
required to, check the List of Parties Excluded from Federal Procurement
and Non-Procurement programs.

9\. Nothing contained in the foregoing shall be construed to require
establishment of a system of records in order to render in good faith
the certification required by this clause. The knowledge and information
of a participant is not required to exceed that which is normally
possessed by a prudent person in the ordinary course of business
dealings.

10\. Except for transactions authorized under paragraph 6 of these
instructions, if a participant in a covered transaction knowingly enters
into a lower tier covered transaction with a person who is proposed for
debarment under 48 CFR part 9, subpart 9.4, suspended, debarred,
ineligible, or voluntarily excluded from participation in this
transaction, in addition to other remedies available to the Federal
Government, the department or agency may terminate this transaction for
cause or default.

# **CERTIFICATION REGARDING** 

**DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS**

**PRIMARY COVERED TRANSACTIONS**

The prospective primary participant certifies to the best of its
knowledge and belief, that it and its principals:

> \(a\) Are not presently debarred, suspended, proposed for debarment,
> declared ineligible, or voluntarily excluded by any Federal department
> or agency;
>
> \(b\) Have not within a three-year period preceding this proposal been
> convicted of or had a civil judgment rendered against them for
> commission of fraud or a criminal offense in connection with
> obtaining, attempting to obtain, or performing a public (Federal,
> State or local) transaction or contract under a public transaction;
> violation of Federal or State antitrust statutes or commission of
> embezzlement, theft, forgery, bribery, falsification or destruction of
> records, making false statements, or receiving stolen property;
>
> \(c\) Are not presently indicted for or otherwise criminally or
> civilly charged by a governmental entity (Federal, State or local)
> with commission of any of the offenses enumerated in paragraph (1)(b)
> of this certification; and
>
> \(d\) Have not within a three-year period preceding this
> application/proposal had one or more public transactions (Federal,
> State or local) terminated for cause or default.
>
> Where the prospective primary participant is unable to certify to any
> of the statements in this certification, such prospective participant
> shall attach an explanation to this proposal.

**CERTIFICATIONS REGARDING DRUG-FREE/TOBACCO-FREE**

**WORKPLACE REQUIREMENTS**

1\. By signing and/or submitting the certification signature page, the
grantee is providing the certification set out below.

2\. The certification set out below is a material representation of fact
upon which reliance is placed when the agency awards the grant. If it is
later determined that the grantee knowingly rendered a false
certification, or otherwise violates the requirements of the Drug-Free
Workplace Act, the agency, in addition to any other remedies available
to the Federal Government, may take action authorized under the
Drug-Free Workplace Act.

3\. For grantees other than individuals, Alternate I applies.

4\. For grantees that are individuals, Alternate II applies.

5\. Workplaces, under grants, for grantees other individuals, need not
be identified on the certification. If known, they may be identified in
the grant application. If the grantee does not identify the workplaces
at the time of application, upon award, the grantee must keep the
identity of the workplace(s) on file in its office and make the
information available for Federal inspection. Failure to identify all
known workplaces constitutes a violation of the grantee\'s drug-free
workplace requirements.

6\. Workplace identifications must include the actual address of
buildings (or parts of buildings) or other sites where work under the
grant takes place. Categorical descriptions may be used (e.g. all
vehicle; of a mass transit authority or State highway department while
in operation, State employees in each local unemployment office
performers in concert halls or radio studios).

7\. If the workplace identified to the agency changes during the
performance of the grant, the grantee shall inform the agency of the
change(s), if it previously identified the workplaces in question (see
5., above).

8\. Definitions of terms in the Non-procurement Suspension and Debarment
common rule and Drug Free Workplace common rule apply to this
certification. Grantees\' attention is called, in particular, to the
following definitions from these rules:

> a\) Controlled substance means a controlled substance in Schedules I
> through V of the Controlled Substances Act (21 U.S.C. 812) and as
> further defined by regulation (21 CFR 1308.11 through 1308.15).
>
> b\) Conviction means a finding of guilt including a plea of Anolo
> contendere or imposition of sentence, or both, by any judicial body
> charged with the responsibility to determine violations of the Federal
> or State criminal drug statutes.
>
> c\) Criminal drug statute means a Federal or non-Federal criminal
> statute involving the manufacture, distribution, dispensing, use or
> Possession of any controlled substance.
>
> d\) Employee means the employee of a grantee directly engaged in the
> performance of work under a grant, including: (i) All direct charge
> employees; (ii) All indirect charge employees unless their impact or
> involvement is insignificant to the performance of the grant; and,
> (iii) Temporary personnel and consultants who are directly engaged in
> the performance of work under the grant and who are on the grantee\'s
> payroll. This definition does not include workers not on the payroll
> of the grantee (e.g., volunteers, even if used to meet matching
> requirement; consultants or independent contractors not on the
> grantee\'s payroll; or employees of sub-recipients or subcontractors
> in covered workplaces).

**CERTIFICATION REGARDING DRUG- FREE**

**WORKPLACE REQUIREMENTS**

The grantee certifies that it will or will continue to provide a
drug-free workplace by:

\(a\) Publishing a statement notifying employees that the unlawful
manufacture, distribution, dispensing, possession, or use of a
controlled substance is prohibited in the grantee\'s workplace and
specifying the actions that will be taken against employees for
violation of such prohibition.

\(b\) Establishing an ongoing drug-free awareness program to inform
employees about:

> \(1\) 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.

\(c\) 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 criminal drug statute occurring in the workplace no
> later than five calendar days after such conviction.

\(e\) Notifying the agency in writing, within ten calendar days after
receiving notice under paragraph (d)(2) from an employee or otherwise
receiving actual notice of such conviction. Employers of convicted
employees must provide notice, including position title, to every grant
officer or other designee on whose grant activity the convicted employee
was working, unless the Federal agency has designated a central point
for the receipt of such notices. Notice shall include the identification
number(s) of each affected grant.

\(f\) Taking one of the following actions within 30 calendar days of
receiving notice under paragraph (d)(2) with respect to any employee who
is so convicted:

> \(1\) Taking appropriate personnel action against such an employee, up
> to and including termination consistent with the requirements of the
> Rehabilitation Act of 1973, as amended; or
>
> \(2\) Requiring such employee to participate satisfactorily in a drug
> abuse assistance or rehabilitation program approved for such purposes
> by a Federal, State, or local health, law enforcement, or other
> appropriate agency.

\(g\) Making a good faith effort to continue to maintain a drug-free
workplace through implementation of paragraphs (a), (b), (c), (d), (e)
and (f).

**CERTIFICATION REGARDING**

**ENVIRONMENTAL TOBACCO SMOKE**

Public Law 103-227, Part C\--Environmental Tobacco Smoke, also known as
the Pro-Children Act of 1994 (Act), requires that smoking not be
permitted in any portion of any indoor routinely owned or leased or
contracted for by an entity and used routinely or regularly for
provision of health, day care, education, or library services to
children under the age of 18, if the services are funded by Federal
programs either directly or through State or local governments, by
Federal grant, contract, loan, or loan guarantee. The law does not apply
to children\'s services provided in private residences, facilities
funded solely by Medicare or Medicaid funds, and portions of facilities
used for inpatient drug or alcohol treatment. Failure to comply with the
provisions of the law may result in the imposition of a civil monetary
penalty of up to \$1000 per day and/or the imposition of an
administrative compliance order on the responsible entity.

By signing and submitting the certification signature page (Enclosure
VI. D.) with this application the applicant/ grantee certifies that it
will comply with the requirements of the Act. The applicant/grantee
further agrees that it will require the language of this certification
be included in any sub-awards which contain provisions for the
children\'s services and that all sub-grantees shall certify
accordingly.

**CERTIFICATION OF RELEASE OF INFORMATION**

Each grantee must indicate the Federal Share of the grant and the
percentage of the grant financed by the Federal share. In this regard,
the Certificate for Release of Information is cited below for this
purpose. The submission of a signed application containing a copy of
this Certification for Release of Information shall constitute the
necessary certification.

The grantee agrees that when issuing statements, press releases,
requests for proposals, bid solicitations or other documents describing
the grant project or program, the grantee shall clearly state (1) the
percentage of the total cost of the program or project which will be or
is being financed with Federal money, and (2) the dollar amount of
Federal funds for the project or program; except when, the project or
program is competitive.

**ASSURANCES AND CERTIFICATIONS - SIGNATURE PAGE**

The Department of Labor will not award a grant or agreement where the
grantee/recipient has failed to accept the ASSURANCES AND CERTIFICATIONS
listed above. By signing and returning this signature page, the
grantee/recipient is accepting the certifications set forth below:

A. Assurances - Non-Construction Programs

B. Certifications Regarding Lobbying, Debarment, Suspension, and Other

Responsibility Matters and Drug-Free/Tobacco-Free Workplace Requirements

C. Certification of Release of Information

APPLICANT NAME and LEGAL ADDRESS:

     

     

     

If there is any reason why one of the assurances or certifications
listed cannot be signed, please explain. Applicant need only submit and
return this signature page with the grant application or funding
request. All other instructions shall be kept on file by the applicant.

          

SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE

           

APPLICANT ORGANIZATION DATE SUBMITTED

**Please Note: This signature page and any pertinent attachments which
may be required by these assurances and certifications shall be attached
to the grant application.**