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STATE OF WASHINGTON JUSTICE ASSISTANCE GRANT <br />DEPARTMENT OF COMMERCE FORM 3 <br />U.S. DEPARTMENT OF JUSTICE <br />OFFICE OF JUSTICE PROGRAMS <br />OFFICE OF THE COMPTROLLER <br />CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, <br />SUSPENSION AND OTHER RESPONSIBILITY MATTERS <br />AND <br />DRUG -FREE WORKPLACE REQUIREMENTS <br />Applicants should refer to the regulations cited below to determine the certification to which they <br />are required to attest. Applicants should also review the instructions for certification included in <br />the regulations before completing this form. Signature of this form provides for compliance with <br />certification requirements under 28 CFR Part 69, "New Restrictions on Lobbying" and 28 CFR <br />Part 67, "Government -wide Debarment and Suspension (Non -procurement) and Government - <br />wide Requirements for Drug -Free Workplace (Grants)." The certifications shall be treated as a <br />material representation of fact upon which reliance will be placed when the Department of <br />Justice determines to award the covered transaction, grant, or cooperative agreement. <br />1. LOBBYING <br />As required by Section 1352, Title 31 of the U.S. Code, and implemented at 28 CFR Part 69, for <br />persons entering into a grant or cooperative agreement over $100,000, as defined at 28 CFR <br />Part 69, the applicant certifies that: <br />(a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the <br />undersigned, to any person for influencing or attempting to influence an officer or <br />employee of any agency, a Member of Congress, an officer or employee of Congress, or <br />an employee of a Member of Congress in connection with the making of any Federal <br />grant, the entering into of any cooperative agreement, and the extension, continuation, <br />renewal, amendment, or modification of any Federal grant or cooperative agreement; <br />(b) If any funds other than Federal appropriated funds have been paid or will be paid to any <br />person for influencing or attempting to influence an officer or employee of any agency, a <br />Member of Congress, an officer or employee of Congress, or an employee of a Member <br />of Congress in connection with this Federal grant or cooperative agreement, the <br />undersigned shall complete and submit Standard Form - LLL, "Disclosure of Lobbying <br />Activities," in accordance with its instructions; <br />(c) The undersigned shall require that the language of this certification be included in the <br />award documents for all subawards at all tiers (including subgrants, contracts under <br />grants and cooperative agreements, and subcontracts) and that all sub -recipients shall <br />certify and disclose accordingly. <br />2. DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS <br />(DIRECT RECIPIENT) <br />As required by Executive Order 12549, Debarment and Suspension, and implemented at 28 <br />CFR Part 67, for prospective participants in primary covered transactions, as defined at 28 CFR <br />Part 67, Section 67.510 <br />A. The applicant certifies that it and its principals: <br />9 <br />