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Print Application Page 18 of 24 • <br /> Certifications Regarding Lobbying; Debarment, Suspension and Other Responsibility Matters; and Drug-Free <br /> Workplace Requirements. <br /> Attachments <br /> CityofEverett Form112-0-3C 20150727.pdf <br /> Section 17.630 of the regulations provide that a grantee that is a State may elect to make one certification in <br /> each Federal fiscal year.A copy of which should be included with each application for FEMA funding. States <br /> and State agencies may elect to use a Statewide certification. <br /> I, Sarah LaVelle, hereby sign this form as of 07-27-2015. <br /> 176 <br />