Microsoft Word - Certifications Regarding Lobbying.doc

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Certifications Regarding Lobbying; Debarment, Suspension, and Other Responsibility Matters; and Drug-Free Workplace Requirements

Applicants should refer to the regulations cited below to determine the certification to which they are required to attest. Applicants should also review the

instructions for certification included in the regulations before completing this form. Signature of the form provides for compliance with certification requirements

under 34 CFR Part 82, "New Restrictions on Lobbying," and 34 CFR Part 85, "Government-wide Debarment and Suspension (Nonprocurement) and

Government-wide Requirements for Drug-Free Workplace (Grants)." The certifications shall be treated as a material representation of fact upon which reliance

will be placed when the Department of Education determines to award the covered transaction, grant, or cooperative agreement.

1. Lobbying

As required by Section 1352, title 31 of the U.S. Code, and implemented at 34

CFR Part 82, for persons entering into a grant or cooperative agreement over

$100,000, as defined at 34 CFR Part 82, Sections 82.105 and 82.110, the

applicant certifies that:

(a) No Federal appropriated funds have been paid or will be paid, by or on

behalf of the undersigned, to any person for influencing or attempting to

influence an officer or employee of any agency, a Member of Congress in

connection with the making of any Federal grant, the entering into of any

cooperative agreement, and the extension, continuation, renewal, amendment,

or modification of any Federal grant or cooperative agreement;

(b) If any funds other than Federal appropriated funds have been paid or will

be paid to any person for influencing or attempting to influence an officer or

employee of any agency, a Member of Congress, an officer or employee of

Congress, or an employee of a Member of Congress in connection with the

Federal grant or cooperative agreement, the undersigned shall complete and

submit Standard Form - LLL, "Disclosure Form to Report Lobbying," in

accordance with its instructions;

included in the award documents for all subawards at all tiers (including

subgrants, contracts under grants and cooperative agreements, and

subcontracts) and that all subrecipients shall certify and disclose accordingly.

Debarment, Suspension, and Other Responsibility Matters

As required by Executive Order 12549, Debarment and Suspension, and

implemented at 34 CFR Part 85, for prospective participants in primary

covered transactions, as defined at 34 CFR Part 85, Sections 85.105 and

85.110 --

The applicant certifies that it and its principals:

(a) Are not presently debarred, suspended, proposed for debarment, declared

ineligible, or voluntarily excluded from covered transactions by any Federal

department or agency;

(b) Have not within a three-year period preceding this application been

convicted of or had a civil judgment rendered against them for commission of

fraud or a criminal offense in connection with obtaining, attempting to obtain, or

performing a public (Federal, State, or local) transaction or contract under a

public transaction; violation of Federal or State antitrust statutes or commission

of embezzlement, theft, forgery, bribery falsification or destruction of records,

making false statements, or receiving stolen property;

governmental entity (Federal, State, or local) with commission of any of the

offenses enumerated in paragraph (1)(b) of this certification; and

(d) Have not within a three-year period preceding this application had one or

more public transactions (Federal, State, or local) terminated for cause or

default; and

Where the applicant is unable to certify to any of the statements in this

certification, he or she shall attach an explanation to this application.

Drug-Free Workplace (Grantees Other Than Individual)

As required by the Drug-Free Workplace Act of 1988, and

implemented at 34 CFR Part 85, Subpart F, for grantees, as defined

at 34 CFR Part 85, Sections 85.605 and 85.610--

The applicant certifies that it will or will continue to provide a drug-free

workplace by:

(a) Publishing a statement notifying employees that the unlawful manufacture,

distribution, dispensing, possession, or use of a controlled substance is

prohibited in the grantee's workplace and specifying the actions that will be

taken against employees for violation of such prohibition;

(b)

Establishing an on-going drug-free awareness program to inform

employees about--

(1) The dangers of drug abuse in the workplace;

(2) The grantees policy of maintaining a drug free workplace;

(3) Any available drug counseling, rehabilitation, and employee assistance

programs; and

(4) The penalties that may be imposed upon employees for drug abuse

violations occurring in the workplace;

performance of the grant be given a copy of the statement required by

paragraph (a);

(d) Notifying the employee in the statement required by paragraph (a) that, as

a condition of employment under the grant, the employee will--

(1) Abide by the terms of the statement; and

(2) Notify the employer in writing of his or her conviction for a violation of a

criminal drug statute occurring in the workplace no later than five calendar

days after such conviction;

(e) Notifying the agency, in writing, within 10 calendar days after receiving

notice under subparagraph (d)(2) from an employee or otherwise receiving

actual notice of such conviction. Employers of convicted employees must

provide notice, including position title, to: Director, Grants and Contracts

Service, U.S. Department of Education, 400 Maryland Avenue, S.W. (room

3124, GSA Regional Office Building No. 3), Washington, D.C. 20202-4571.

Notice shall include the identification number(s) of each affected grant;

(f)

Taking one of the following actions within 30 calendar days of receiving

notice under subparagraph (d)(2), with respect to any employee who is so

convicted --

(1) Taking appropriate personnel action against such an employee, up to and

including termination, consistent with the requirements of the Rehabilitation Act

of 1973, as amended; or

(2) Requiring such employee to participate satisfactorily in a drug abuse

assistance or rehabilitation program approved for such purposes by a Federal,

State, or local health, law enforcement, or other appropriate agency;

(g) Making a good faith effort to continue to maintain a drug-free workplace

through implementation of paragraphs (a), (b), (c), (d), (e), and (f).

B. The grantee may insert in the space provided below the site(s) for the

performance of work done in connection with the specific grant:

Place of Performance (street address, city, county, state, zip code)

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Check

if there are workplaces on file that are not identified here.

Drug-Free Workplace (Grantees who are Individuals)

As required by the Drug-Free Workplace Act of 1988, and implemented at 34

CFR Part 85, Subpart F, for grantees, as defined at 34 CFR Part 85, Sections

85.605 and 85.610 --

As a condition of the grant, I certify that I will not engage in the unlawful

manufacture, distribution, dispensing, possession, or use of a controlled

substance in conducting any activity with the grant; and

If convicted of a criminal drug offense resulting from a violation occurring

during the conduct of any grant activity, I will report the conviction, in writing,

within 10 calendar days of the conviction, to: Director, Grants and Contracts

Service, U.S. Department of Education, 400 Maryland Avenue, S.W. (room

3124, GSA Regional Office Building No. 3), Washington, D.C. 20202-4571.

Notice shall include the identification number(s) of each affected grant.

As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the above certifications.

NAME OF APPLICANT

PRINTED NAME AND TITLE OF AUTHORIZED CHARTER SCHOOL REPRESENTATIVE

SIGNATURE

DATE SIGNED