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<br />U.s. DEPARTMENT OF THE INTERIOR CERTIFICAnONS, continued
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<br />Page 2. of 2.
<br />(Rev. 8/95)
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<br />(g) Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragrap~s (a), (b), (c), (d), (e) and (t).
<br />B. The grantee may insert in the space provided below the site(s) far the performance of work done in connection with the specific grant;
<br />Place for Performance (Street address, city, county, state, zip code)
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<br />Checlc _ If there are workplaces on file that are not Identlfled here.
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<br />PART 0: Certification Reaardlna Orua-Free WorkDlace. A1temate II. Applies to grantees who are Individuals.
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<br />this certification Is required by the regulations Implementing the drug-free workplace reqUirements for Federal grant recipients under the Orug-Free Workplace
<br />Ad. of 1988 (43 CFR Part 12, Subpart 0).. A copy of the regulation Is available from the .Issulng office.
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<br />(a) The grantee certifies that, as a condition of the grant, he or she will not engage in the unlawful manufad.ure, distribution, dispensing, possession, or
<br />use of a controlled substance In cond~ctIng any activity with the grant;
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<br />(b) If convicted of a criminal drug offense resulting from a violation occurring during the condud. of any grant activity, he or she will report the conviction,
<br />in writing, within 10 calendar days of the convidlon, to the grant officer or other designee, unless the Federal agency designates a central point far the receipt of
<br />such notices. When notice is made to such a central point, it shall include the Identification number(s) of each affected ~ranl .
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<br />PART E: Certlflcatlon Reoardina Lobbvlno - Certification far Contracts. Grants. Loans. and CooDeratlve Aoreements. Applies to recipients of awards
<br />exceeding $100,000. '
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<br />This certification Is required by Section 1352, title 31, U.S. Code, entitled "Limitation on use of appropriated funds to Influence certain Federal contracting and
<br />financial transactions..
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<br />The undersigned certifies, to the best of his or her knowledge and belief, that:
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<br />(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person far Influencing or attempting to
<br />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
<br />connection with the awarding of any Federal contract, the making of any Federal grant, the making of'any Federal loan, the entering into of any cooperative
<br />agreement, and the extenslonl continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement
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<br />(2) If any funds other than Federal appropriated funds have been paid or wUl be paid to any person far Influencing or attempting to Influence an officer or
<br />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 this Federal
<br />contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-Lll, "Disclosure Form to Report Lobbying,. in
<br />accordance with its instructions. .
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<br />(3) The undersigned shall require that the language of thle (;8rtif1cat1on be included in the award documents for all subawards to all tiers (Including
<br />subcontracts, subgrants, and contrads under grants, loans, and cooperative agreements) and that all subrecipients shall certify accordingly.
<br />This certification Is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this
<br />certification Is a prerequisite far making or entering into this transaction imposed by Section 1352, t1Ue 31 U.S. Code. Any person who fails to file the required
<br />certification shall be subject to a civil penalty of not less that $10,000 and not more that $100,000 for each such failure.
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<br />As the authorized certifying official, I hereby certify that the above specified certifications are true.
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<br />Signature
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<br />JOl6eri (.
<br />Typed name and Title
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<br />fl-e ('( (1 ,cry MmJ~./
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<br />City of La Porte
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<br />Applicant/Recipient
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