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U.S. Department of Transportation

Federal Railroad Administration

Certifications Regarding Debarment, Suspension and Other Responsibility Matters, 

Drug-Free Workplace Requirements and Lobbying

PART A: Certification Regarding Debarment, Suspension and Other Responsibility Matters – Primary Covered Transactions 

(Pursuant to 2 CFR Part 180)

(1) The grantee certifies to the best of its knowledge and belief, that it and its principles:

(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 application 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 of 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 had one or more public

transactions (Federal, State or local) terminated for cause or default.

(2) Where the grantee is unable to certify to any of the statements of this certification, he or she

shall attach an explanation to this application.

PART B: Certification Regarding Drug-Free Workplace Requirements (Pursuant to 49 CFR Part 32)

A. The grantee certifies that it will or 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);

Paperwork Reduction Act Burden Statement A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be 

subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of 

information displays a currently valid OMB Control Number. The OMB Control Number for this information collection is 2130-0615. Public reporting for 

this collection of information is estimated to be approximately .25 hours per response, including the time for reviewing instructions, searching existing data 

sources, gathering and maintaining the data needed, completing and reviewing the collection of information. All responses to this collection of information are 

mandatory. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this 

burden to: Information Collection Clearance Officer (RAD-20), Federal Railroad Administration, 1200 New Jersey Avenue, Washington, DC. 20590.

OMB Control No. 2130-0615

Expires 01/31/2025

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(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 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

subparagraph (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 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

subparagraph (d)(2), with respect to any employee 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), (e) and (f).

B. The grantee may insert in the space below the site(s) for the performance of work done in

connection with the specific grant:

Place of Performance (Street address, city, county, state, zip code)

_____________________________________________________________________

_____________________________________________________________________

____________________________________________________________________

Check if there are workplaces on file that are not identified here.

PART C: Certification Regarding Lobbying (Pursuant to 49 CFR Part 20)

CHECK IF APPLICABLE

CERTIFICATION IS FOR THE AWARD OF A GRANT OR COOPERATIVE AGREEMENT EXCEEDING 

$100,000

OR

A FEDERAL LOAN EXCEEDING $150,000

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 an 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.

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(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

document for all subawards at all tiers (including subcontracts, subgrants, and contracts under

grants, loans, and cooperative agreements) and that all subrecipients shall certify accordingly.

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 31 USC 1352. 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.

As the authorized certifying official, I hereby certify that the certifications in Parts A, B, and C (if C is 

applicable) are true.

SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL

TYPED NAME AND TITLE

DATE

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