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12 <br />CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND OTHER <br />RESPONSIBILITY MATTERS; AND DRUG-FREE WORKPLACE REQUIREMENTS <br />Applicants should refer to the regulations cited below to determine the certification to which they are <br />required to attest. Applicants should also review the instructions for certification included in the <br />regulations before completing this form. Acceptance of this form provides for compliance with certification <br />requirements under 28 CFR Part 69, "New Restrictions on Lobbying," 2 CFR Part 2867, "DOJ <br />Implementation of OMB Guidance of Nonprocurement Debarment and Suspension," and 28 CFR Part'83, <br />"Government -wide Debarment and Suspension," and Government -wide Requirements for Drug -Free <br />Workplace (Grants).".The certifications shall be treated as a material representation of fact upon which <br />reliance will be placed when the Department of Justice determines to award the covered transaction, <br />grant, or cooperative agreement. <br />1. LOBBYING As required by Section 1352, Title 31 of the U.S. Code, and implemented at 28 CFR Part <br />69, for persons entering into a grant or cooperative agreement over $100,000, as defined at 28 CFR Part <br />69, the applicant certifies that: <br />(a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to <br />any person for influencing or attempting to influence an officer or employee of any agency, <br />a Member of <br />Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection <br />with the making of any Federal grant, the entering into of any cooperative agreement, and the extension, <br />continuation, 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 person for <br />influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an <br />officer or employee of Congress, or an employee of a Member of Congress in connection with this <br />Federal grant or cooperative agreement, the undersigned shall complete and submit Standard Form - <br />LLL, "Disclosure of Lobbying Activities," in accordance with its instructions; <br />(c) The undersigned shall require that the language of this certification be included in the award <br />documents for all subawards at all tiers (including subgrants, contracts under grants and cooperative <br />agreements, and subcontracts) and that all sub -recipients shall certify and disclose accordingly. <br />2. DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS (DIRECT RECIPIENT) <br />As required by Executive Order 12549, Debarment and Suspension, and implemented at 2 CFR Part <br />2867, for prospective participants in primary covered transactions, as defined at 2 CFR Section <br />2867.20(a): <br />A. The applicant certifies that it and its principals: <br />(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, sentenced to a <br />denial of Federal benefits by a State or Federal court, or voluntarily excluded from covered transactions <br />by any Federal department or agency; <br />(b) Have not within a three-year period preceding this application .been convicted of or had a civil <br />judgment rendered against them for commission of fraud or a criminal offense in connection with <br />obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract <br />under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, <br />theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen <br />property; <br />111 <br />