State of Washington Dept of Commerce 12/10/2018

ATTACHMENT C CERTIFICATION FORM Compliance with the Equal Employment Opportunity Plan(EEOP)Requirements Please read carefully the Instructions(see below)and then complete Section 4 or Section B ar Section C,not all three Recipient's Name:Everett Police Department Address:3002 Wetmore,Everett,WA 98201 Is agency a ❑Direct or®Sub recipient of OJP,OVW or COPS fundin.g? Law Enforcement Agency?®Yes❑No DUNS Number:608909156 Vendor Number(only if direct recipient):N/A Name and Title of Contact Person:Jeny Strieck,Lieutenant Telephone Number:(425)2574447 E-Mail Address:jstdeck@ci.everett.wa.us Section A Declaration Claiming Complete-Exemption:from`the EEOP Requirement...:;- ;:•.. .. Please check all the following boxes that apply_ :- ❑ Less the fifty employees. ❑ 1naian tribe."" MeeCcal Insetution ❑Nonprofit Organization. •❑ 1=ducational institution . . ❑Receiving an-waia leis'thali$25.000 • T, • .[responsible official j; certifythat rec• ie nt isnot [ tp ] re aired to prepare an EEOP for the reason(s)checked above 4 P eP pursuit to 28 C.F.R. 42302. O , § I further certifythat [ rec' lent] will comply with all applicable federal civil rights laws that prohibit discrimination in employment and in the delivery of services. Print or Type Name and Title Signature Date Section S--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 award or.subaward of 525,000 or more,but less than 5500,000,then the recipient agency does not have to submit an EEOP to the OCR for review as long as it certffies thefollowbig(42 C.F.R.§42.305): L Brian Jones [responsible official], certify that City of Everett,Washington [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 CFR 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.Department of Justice.The EEOP is on file at the following office: City of Everett,Human Resources [organization], 2930 Wetmore Ave,Everett,WA 98201 [address]. \'\ • Brian Jones,HR Manager , – - /? — Prinz or Type Name and Title Signature `' Date Section C Declaration.Stating that an=ESOP:Short:Form Has Been'Submitted:'to`the•_ leffe foi',Civil . Rights for Review • If a rrecitpiem agency has ffj*or rirore employeees and is i eceivirig a single award orsubcneard ofSS00,000 or-mote,-riria ire recp:Ent agency must send an EEO?Short Form to the OCR for review :••- ponsible`offcial],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 CFR pt 42,subpt.E,,and sent it for review on ..... [date]to'tfie Office for Civil Rights,•Office of Justice-Programs,.U.S.Department of Justice. - Print or Type Name and Tale Signature Date