WA State Deptartment of Commerce 1/12/2023

Attachment C ________________________________________________________________________________________________________ Page 25 of 30 Attachment C: EEOP Compliance Certification Form Recipient’s Name: Everett Police Department Address: 3002 WETMORE , EVERETT, WA 98201 Is agency a  Direct or  Sub recipient of OJP, OVW or COPS funding? Law Enforcement Agency?Yes  No UEI Number: D5JNURKQWE76 Vendor Number (only if direct recipient): N/A Name and Title of Contact Person: Tracey Landry, Police Services Program Manager Telephone Number: (425) 257-8447 E-Mail Address: tlandry@everettwa.gov Section A—Declaration Claiming Complete Exemption from the EEOP Requirement Please check all the following boxes that apply: Less than fifty employees. Indian tribe. Medical Institution. Nonprofit Organization. Educational Institution. Receiving an award less than $25,000 I, ______________________________________________________________________________ [responsible official], certify that [recipient] is not required to prepare an EEOP for the reason(s) checked above, pursuit to 28 C.F.R. § 42.302. I further certify that ________________________________________________________________________ [recipient] will comply with all applicable federal civil rights laws that prohibit discrimination in employment and in the delivery of servic es. Print or Type Name and Title Signature Date Section B—Declaration Claiming Exemption from EEOP Submission Requirement and Certifying That an EEOP Is on File for Review If a recipient has fifty or more employees and is receiving a single awar d or, subaward of $25,000 or more, but less than $500,000, then the recipient agency does not have to submit an EEOP to the OCR for review as long as it certifies the following (42 C.F.R. § 42.305): I, [responsible official], certify that [recipient] Which has fifty or more employees and is receiving a single award for $25,000 or more, but less than $500,000, has formulated an EEOP in accordance with 28 C.F.R. pt. 42, subpt E. I further certify that within the last twenty -four months, the proper authority has formulated and signed into effect the EEOP and, as required by applicable federal law, it is available for review by the public, employees, the appropriate state planning agency, and the Office for Civil Rights, Office of Justice Programs, U.S. Dep artment of Justice. The EEOP is on file at the following office: [organization], [address]. Print or Type Name and Title Signature Date Section C—Declaration Stating that an EEOP Short Form Has Been Submitted to the Office for Civil Rights for Review If a recipient agency has fifty or more employees and is receiving a single award or subaward of $500,000 or more, then the r ecipient agency must send an EEOP Short Form to the OCR for review. I, [responsible official], certify that [recipient], which has fifty or more employees and is receiving a single award of $500,000 or more, has formulated an EEOP in accordance with 28 C.F.R. pt. 42, subpt. E, and sent it for review on [date] to the Office for Civil Rights, Office of Justice Programs, U.S. Department of Justice. Print or Type Name and Title Signature Date DocuSign Envelope ID: 527E3FBE-EEE5-4411-9E63-6055BC6B456C Michael Duerr The City of Everett Police Department City of Everett 2930 Wetmore Ave, 5th Floor Michael Duerr, Human Resources Manager 1/11/2023 DocuSign Envelope ID: 16D40C5D-636D-4982-811A-C1204A727F71