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HomeMy WebLinkAbout2004-003 Addendum - Task Forcewww. dea.gov U. S. Department of Justice Drug Enforcement Administration Medford Resident Office 1225 Crater Lake Avenue, Suite 201 Medford, Oregon 97504 October 21, 2003 i~'U~ Rich Walsh, Lieutenant Interim Chief of Police Ashland Police Department 1155 E. Main, Ashland, Oregon 97520 Attached is a second amended addendum to the Task Force Agreement for Task Force Agent Randy Snow. The prior addendum, dated September 2003, increased the amount of overtime reimbursement. This attached addendum, dated October 2003, moves the effective date back one day, to September 30, 2003 (through September 30, 2004). Once again,, please sign the amended version and return to the DEA Medford Resident Office for processing, i Acting Resident Agent in Charge Attachment U. S. Department of Justice Drug Enforcement Administration Medford Resident Office 1225 Crater Lake Avenue, Suite 201 Medford, Oregon 97504 October 2003 Ashland Police Department 1155 East Main Street Ashland, Oregon 97520 ADDENDUM to Task Force Agreement (2nd Update) This agreement is an addendum to the Agreement, dated September 2002, between the United States Department of Justice, Drug Enforcement Administration (DEA), and the Ashland Police Department. 1. The term of the Agreement shall be from the date of signature by representatives of both parties through September 30, 2004. Except as modified by this addendum, and addendum dated september 2003 increasing the reimbursement rate to $14,115.75, the September 2002 Agreement between DEA and the Ashland Police Department shall remain in full force and effect. MODIFICATIONS: Paragraph 1/Agreement effective September 30, 2003 through 2004. For the Drug Enforcement Administration: John M. Bott Special Agent in Charge Seattle Field Division Date: For the Ashland Police Department: Rich Walsh, Lieutenant Interim Chief of Police Ashland Police Department Date: U. S. Department of Justice Drag Enforcement Administration Medford Resident Office 1225 Crater Lake Avenue Suite 201 Medford, Oregon 97504 www. dea. gov September 18, 2003 Rich Walsh, Lieutenant Interim Chief of Police Ashland Police Department 1155 E. Main, Ashland, Oregon 97520 Attached is an amended Addendum to Task Force Agreement for Task Force Agent Randy Snow. The overtime reimbursement rate has been increased to $14,115.75 for the fiscal year beginning October 1, 2003. Please sign the amended version and remm to the Medford Resident Office for processing. · R~ald S. W~ Acting Resident Agent in Charge U. S. Department of Justice Drug Enforcement Administration Medford Resident Office 1225 Crater Lake Avenue, Suite 201 Medford, Oregon 97504. September 2003 Ashland Police Department 1155 East Main Street Ashland, Oregon 97520 ADDENDUM to Task Force Agreement (Annual Update) This agreement is an addendum to the Agreement, dated September 2002, between the United States Department of Justice, Drug Enforcement Administration (DEA), and the Ashland Police Department. 1. The term of the Agreement shall be from the date of signature by representatives of both parties through September 30, 2004. 2. Except as modified by this addendum, the September 2002 Agreement between DEA and the Ashland Police Department shall remain in full force and effect. MODIFICATIONS: Paragraph 6/annual overtime reimbursement rate is changed to $14,115.75. For the Drug Enforcement Administration: John M. Bott Special Agent in Charge Seattle Field Division Date: For the Ashland Police Department: Rich Walsh, Lieutenant Interim Chief of Police Ashland Police Department Date: MEDFORD RESDIDENT OFFICE STATE AND LOCAL TASK FORCE AGREEMENT This agreement is made this first day of October, 2002, between the United States Department of Justice, Drug Enforcement Administration (hereinafter "DEA"), and the Ashland Police Department (hereinafter "APD"). WHEREAS there is evidence that trafficking in narcotics and dangerous drugs exists in the Southern Oregon area and that such illegal activity has a substantial and detrimental effect on the health and general welfare of the people of Southern Oregon, the parties hereto agree to the following: 1. The Medford Resident Office Task Force will perform the activities and duties described below: a. disrupt the illicit drug traffic in the Southern Oregon area by immobilizing targeted violators and trafficking organizations; b. gather and report intelligence data relating to trafficking in narcotics and dangerous drugs; and c. conduct undercover operations where appropriate and engage in other traditional methods of investigation in order that the Task Force's activities will result in effective prosecution before the courts of the United States and the State of Oregon. d. the APD Task Force Officer will primarily be responsible for developing Federal drug cases in Ashland. 2. To accomplish the objectives of the Medford Resident Office Task Force, the APD agrees to detail one (1) experienced officer to the Task Force for a period of not less than two years. During this period of assignment, the APD officer will be under the direct supervision and control of DEA supervisory personnel assigned to the Task Force. 3. The APD officer assigned to the Task Force shall adhere to DEA policies and procedures. Failure to adhere to DEA policies and procedures shall be grounds for dismissal from the Task Force. 4. The APD officer assigned to the Task Force shall be deputized as a Task Force Officer of DEA pursuant to 21 U.S.C. 878. 5. To accomplish the objectives of the Medford Resident Office Task Force, DEA will assign two (2) Special Agents to the Task Force. DEA will also, subject to the availability of annually appropriated funds or any continuing resolution thereof, provide necessary funds and equipment to support the activities of the DEA Special Agents and the APD officer assigned to the Task Force. This support will include: office space, office supplies, travel funds, funds for the purchase of evidence and information, investigative equipment, training, and other support items. 6. During the period of assignment to the Medford Resident Office Task Force, the APD will remain responsible for establishing the salary and benefits, including overtime, of the officer assigned to the Task Force, and for making all payments due the officer. DEA will, subject to availability of funds, reimburse the APD for overtime payments made by it to the APD officer assigned to the Medford Resident Office Task Force for overtime, up to a sum equivalent to 25 percent of the salary of a GS-10, step 1, Federal employee (currently $9,801.00), per officer. 7. In no event will the APD charge any indirect cost rate to DEA for the administration or implementation of this agreement. 8. The APD shall maintain on a current basis complete and accurate records and accounts of all obligations and expenditures of funds under this agreement in accordance with generally accepted accounting principles and instructions provided by DEA to facilitate on-site inspection and auditing of such records and accounts. 9. The APD shall permit and have readily available for examination and auditing by DEA, the United States Department of Justice, the Comptroller General of the United States, and any of their duly authorized agents and representatives, any and all records, documents, accounts, invoices, receipts or expenditures relating to this agreement. The APD shall maintain all such reports and records until all audits and examinations are completed and resolved, or for a period of three (3) years after termination of this agreement, whichever is sooner. 10. The APD shall comply with Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act (as incorporated in the Civil Rights Act of 1991) and all requirements imposed or pursuant to the regulations of the United States Department of Justice implementing those laws, 28 C.F.R. Part 42, Subparts C, D, and F. 11. The APD agrees that an authorized officer or employee will execute and return to DEA the attached OJP Form 4061/6, Certification Regarding Lobbying; Debarment, Suspension and Other Responsibility Matters; and Drug-Free Workplace Requirements. The APD acknowledges that this agreemenE will not take effect and no Federal funds will be awarded to the APD by DEA until the completed certification is received. 12. When issuing statements, press releases, requests for proposals, bid solicitations, and other documents describing projects or programs funded in whole or in part with Federal money, the APD shall clearly state: (1) the percentage of the total cost of the program or project which will be financed with Federal money and (2) the dollar amount of Federal funds for the project or program. 13. The term of this agreement shall be from the date of signature by representatives of both parties to September 30, 2003. This agreement may be terminated by either party on thirty days' advance written notice. Billings for all outstanding obligations must be received by DEA within 90 days of the date of termination of this agreement. DEA will be responsible only for obligations incurred by the APD during the term of this agreement. For th~~ Enforcement Administration: ~ ~J ~-- Date: /~ ~- Special' Agent in Charge Seattle Field Division For the Ashland Police Department: Police Chief Ashland Police Department Date: U.S. DEPARTMENT OF JUSTICE OFFICE OF JUSTICE PROGRAMS OFFICE OF THE COMPTROLLER 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 from, Signature of this form provides for compliance with certification requirements under 28 CFR Part 69, "New Restrictions on Lobbying" and 28 CFR Part 67, "Government-wide Department and Suspension (Nonprocurement) and Government-wide Requirements for Drug-Free Workplace (Grants)." The certifications shall be treated as a material representation of fact upon reliance will be placed when the Department of Justice 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 28 CFR Part 69, for persons entedng into a grant or cooperative agreement over $100,000, as defined at 28 CFR Part 69, the applicant certifies that: la) No Federal, appropriate fun,ds have been paid or will be paid, by or on behalf of the unoersigned, to any person for in- fluencing or attempting to influence an officer or employee of any agency a Member of Co.ngress an officer or employee of Congress, or an employee or a Member of Congress in con- nect~on with the making of any Federal grant, the entering into of any cooperative agreement, and extension, continuation, renewal, amendment, or modification of any Federal grant or cooperative agreement; bb) If any, funds other than Federal appr?priat.ed funds hav,e een pa~a or _will be paid .to any perso, n for in. nuencing or al- tempting to intluence an othcer or emp~o, yee or 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 grant or coog, erative agreement, the undersigned shall complete and submIt Standard Form - LLL, "Disclosure of Lobbying Activities," in accordance with its instructions; lc) The undersigned shall require that the language of this cer- ification be included in the award documents-for all subawards at all tiers (including subgrants, contracts under grants and cooperative agreements and subcontracts) and that all sub- recipients shall certify and disclose accord ng y. 2. DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS (DIRECT RECIPIENT) As requiCed by Executive Order 12549, Debarment and Suspension, and implemented at 28 CFR Prt 67, for prospec- tive participants in pdmary covered transactions, as defined at 28 CFR Part 67, Section 67.510- A. The applicant certifies that it and its principals: la) Are not pre,sently debarred, suspended, proposed for de,bar- merit, declared ineligible, sentenced to a denial of Federal benefits by a State or Federal court, or voluntarily excluded from covered transactions by any Federal department or agency; lb) Have not within, a.thre, e-y, ear pe, riod, preceding,this,applica- tion been convictea or or nad a c[vi~ juogment renoereo against them for commission of fraud or a crim nal offense in connec. tion 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, bdbery, falsification or destruction of records, making false statements, or receiving stolen property; lc) Are,not presently indicted for or ,o.,therwise criminally Or ,civill~ cnarged by a gov. emmental end~ (Federal, Sta,te, or ~ocau with commission or any of the offenses enumera[ed in paragraph (1)lb) of this certification; and Id) Have not within a three-year period preceding this applica- ion had one or more public transactions (Federal, State, or local) terminated for cause or default; and B. Where the applicant is unable to certify to any of the statements in th~s certification, he or she shall attach an explanation to this application. 3. DRUG-FREE WORKPLACE (GRANTEES OTHER THAN INDIVIDUALS) As required by the Drug-Free Workplace Act of 1988, and implemented at 28 CFR~art 67 Subpart F, for grantees, as defined at 28 CFR Part 67 Sectons 67.615 and 67.620- A. The applicant certifies that it will or will continue to provide a drug-free workplace by: la) 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; lb.) Establis, hing an, on;going drug-free awareness program to ~nform employees aoou[- (1) The dangers of drugs abuse in the workplace; (2) The grantee's policy o['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; {c) Making it a requirement that each employee to be engaged ~n the performance of the grant be given a copy of the state- ment required by paragraph la); (d) Notifying the employee in the statement requir,ed by paragraph la) that, as a condition of employment under the grant, the employee will- OJP FORM 4061/6 (3-91) REPLACES OJP FORMS 4061/2, 4062/3 AND 4061/4 WHICH ARE OBSOLETE. (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 s'uch convic- tion. Employers of convicted employees must provide notice; including position title, to: Department of Justice, Office or Justice Pro,rams, ATTN: Control Desk, ,633 Indiana Avenue, N.W. Washington, D.C. 20531. Notice snail include the iden- t fication 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 an_d i,ncJu,d.!ng te.rm!nation, consistent .wit, h the requirements of the t~enaoi~kat~on ,~ct of 1973, as amenaeo; or d) Requiring such employee to participate satisfactorily in a rug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforce- ment, or other appropriate agency; tg)Making a good faith effort to continue to maintain a drug- roe 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, country, state, zip code) Check ,FI if there are workplace on file that are not identified here. SectiOn 67; 630 of the regulations provides that a grantee that is a State may elect to make one certification in each Federal fiscal year: A copy of which should be included with each ap- plication for Department of Justice funding. States and State agencies may elect to use OJP Form 4061/7. Check [] if the State has elected to complete OJP Form 4061/7. D RU G-FREE WORKPLACE (GRANTEES WHO ARE INDIVIDUALS) As required by the Drug-Free Workplace Act of 1988, and implemented at 28 CFRPart 67 SubDart F, for .qrantees as defined at 28 CFR Part 67; Sect or~s 67'.615 and 67.B20- A. As a condition of the grant I certify that I will not engage in the unlawful .manufacture, distribution dispensing, posses- sion, or use of a contro ed substance in condition any activity with the grant; and B. If convinced 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: Department of Justice, Office of Justice Programs, ATTN: Control Desk, 633 Indiana Avenue, N.W. Washington, D.C. 20531. ' As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the above certifications. 1. Grantee Nameand Address: Ashland Police Department 1155 East Main Ashland, Oregon 97520 2. Application Number and/or Project Name 3. Grantee IRSNendor Number DEA Medford Resident office Task Force APD ~93 -6002117 4. Typed Name and Title of Auth°dzed Representative Scott Pleuter,- Chief of Police Signature Date 7-/2-o'2 Medford Resident Office and Local Task Force State and Local Task Force Agreement This agreement is made this day of September 1999, between the United States Department'of Justice, Drug Enforcement Administration (hereinafter "DEA"), and the Ashland Police Department (hereinafter "APD"). WHEREAS there is evidence that trafficking in narcotics and dangerous drugs exists in the Southern Oregon area and that such illegal activity has a substantial and detrimental effect on the health and general welfare of the people of Oregon, the parties hereto agree to the following: 1. The Medford Resident Office State and Local Task Force will perform the activities and duties described below: a. disrupt illicit drug traffic in the area by immobilizing targeted violators and trafficking organizations; b. gather and report intelligence data relating to trafficking in narcotics and dangerous drugs; and c. conduct undercover operations where appropriate and engage in other traditional methods of investigation in order that the Task Force's activities will result in effective prosecution before the courts of the United States and the State of Oregon. d. The APD Task Force Officer will primarily be responsible for developing Federal drug cases in Ashland. 2. To accomplish the objectives of the Medford Resident Office State and Local Task Force, the APD agrees to detail an experienced officer to the Medford Resident Office State and Local Task Force for a period of not less than two years. During this period of assignment, the officer will be under the direct supervision and control ofDEA superv-isory personnel assigned to the Task Force. 3. The APD officer assigned to the Task Force shall adhere to DEA policies and procedures. Failure to adhere to DEA policies and procedures shall be grounds for dismissal from the Task Force. 4. The APD officer assigned to the Task Force shall be deputized as a Task Force Officer of DEA pursuant to 21 U.S.C. 1878. 5. To accomplish the objectives of the Medford Resident State and Local Task Force, DEA will assign two Special Agents to the Task Force. DEA will also, subject to the availability of annually appropriated funds or any continuing resolution thereof5 provide necessary funds and equipment to support the activities of the DEA Special Agents and Officers assigned to the Task Force. This support will include: office space, office supplies, travel funds, funds for the purchase of evidence and information, investigative equipment, training and other support items. 6. During the period of assignment to the Medford Resident Office State and Local Task Force, the APD will remain responsible for establishing the salary and benefits, including overtime, of the officer assigned to the Task Force, and for making all payments due him/her. DEA will, subject to availability of funds, reimburse APD for overtime payments made by it to officers assigned to the Medford Resident Office State and Local Task Force for overtime, up to a sum equivalent to 25 percent of the salary of a GS-10, step 1, Federal employee (currently $8,875.00, per officer). 7. In no event will the APD charge any indirect cost rate to DEA for the administration or implementation of this agreement. 8. The APD shall maintain, on a current basis, complete and accurate records and accounts of all obligations and expenditures of funds under this agreement, in accordance with generally accepted accounting principles and instructions provided by DEA to facilitate on-site inspection and auditing of such records and accounts. 9. The APD shall permit and have readily available for examiniation and auditing by DEA, the United States Department of Justice, the Comptroller General of the United States, and any of their duly authorized agents and representatives, any an all records, documents, accounts, invoices, receipts or expenditures relating to this agreement. APD shall maintain all such reports and records until all audits and examinations are complete and resolved, or for a period of three (3) years after termination of this agreement, whichever is sooner. 10. APD shall comply with the Title VI of the Civil Rights Act of 1964, Section of the Rehabilitation Act of 1973, the American With Disabilities Act (as incorporated in the Civil Rights Act of 1991) and all requirments imposed by or pursuant to the regulations of the United States Department of Justice implementing that law 28 CFR. Part 42, Subparts C, D, and F. 11. The APD agrees that an authorized officer or employee will execute and return to DEA the attached OIP form 4061/6, Certification Regarding Lobbying; Debarment, Suspension and Other responsibility Matters; and Drug-Free Workplace Requirements. The APD acknowledges that this agreement wil not take effect and no Federal funds will be awarded to them by DEA until the completed certification is recieved. 12. When issuing statements, press releases, request for proposals, bid solicitations, and other documents describing projects or programs funded in whole or in part with Federal money, APD shall clearly'state: (1) the percentage of the total cost of the program or project which will be 2 financed with Federal money and (2) the dollar amount of Federal funds for the project or program. 13. DEA acknowledges that the United States is liable for the wrongful or negligent acts or omissions of its officers and employees, including Task Force Officers duly sworn pursuant to 21 U.S.C. Section 878, while on duty and acting within the scope of their Federal employment, to the extent permitted by the Federal Tort Claims Act. 14. Assets seized during task force investigations will be forfeited under 21 U.S.C. 881 and will be shared equitably among the parties to this agreement in accordance with the Attorney General's Guidlines on Seized and forfeited Property. 15. The term of this agreement shall be from the date of signature by representatives of both parties, to September 30, 2000. This agreement may be terminated by either party on thirty days advanced written notice. Billings for all outstanding obligations must be received by DEA within 90 days of the date of termination of this agreement. DEA will be responsible only for obligations incurred during the term of this agreement. For the Drug Enforcement Administration: Spepial A~,ent in Charge Sea~ttte Field Division Date: For Ashland Police Department Name Date: Title U.S. DEPaRTMENt Of JUSTICE OFFICE OF JUSTICE PROGRAMS OFFICE OF THE COMPTROLLER 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 this form provides for compliance with certification requirements under 28 CFR Part 69, "New Restrictions on Lobbying" and 28 CFR Part 67, "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 Justice 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 28 CFR Part 69, for persons entering into a grant or cooperative agreement over $100,0OO, as defined at 28 CFR Part 6g, the applicant certifies that: la) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for in- fluencing or a~tempting 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 con- nection 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; lb) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or tempting 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 this Federal grant or cooperative agreement, the undersigned shall complete and submit Standard Form * LLL, '°Disclosure of Lobbying Activities," in accordance with its instructions; lc) The undersigned shall require that the language of this cer- tification be included in the award documents for all subawards at all tiers (including subgrants, contracts under grants and cooperative agreements, and subcontracts) and that all sub- recipients shall certify and disclose accordingly. 2. DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS (DIRECT RECIPIENT) As required by Executive Order 12549, Debarment and Suspension, and implemented at 28 CFR Part 67, for prospec- rive participants in primary covered transactions, as defined at 28 CFR Part 67, Section 67.510-- A. The applicant certifies that it and its principals: la} Are not presently debarred, suspended, proposed for debar- ment, declared ineligible, sentenced to a denial of Federal benefits by a State or Federal court, or voluntarily excluded from covered transactions by any Federal department or agency; lb} Have not within a three-year period preceding this applica- tion been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connec- tion 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; (c) Are not presently indicted for or otherwise criminally or civilly charged by a 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 applica- tion had one or more pub}ic transactions (Federal, State, or local) terminated for cause or default; and 8. Where the applicant is unable to certify to any of the statements in this certification, he or she shall at'tach an explanation to this application. 3. DRUG-FREE WORKPLACE (GRANTEES OTHER THAN INDIVIDUALS) As required by the Drug-Free Workplace Act of 1988, and implemented at 28 CFR Part 67, Subpart F, for grantees, as defined at 28 CFR Part 67 Sections 67.615 and 67.62.0-- A. The applicant certifies that it will or will continue to provide a drug-free workplace by: la) 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; lb) Establishing an on-going drug-free awareness program to inform employees about-- (1) The dangers of drug abuse in the workplace; (2) The grantee's po(icy of maintaining a drug, ~ree 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; (c) Making it a requirement that ~ach employee to be engaged in the performance of the grant be given a copy of the state- ment 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-- OJP FORM 4061/a (3'9ll REPLACES OJP FORMS 406)/2. 4061/3 ANO 4061/4 WHICH ARE: OE)SOLETE. tl) Abide by the '.arms 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 [han five calendar days after such conviction; (e) Notifying the agency, in writing, within 10 calendar days ah:er receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such convic- tion. Employers of convicted em01oyees mus~ provide notice, including position title, to: Department of Justice, Office of Justice Programs, ATTN: Control Desk, 633 Indiana Avenue, N,W., Washington, D.C. 20531. Notice shall include the iden- tification 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- {I) 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 pa~icipate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforce- ment, or other appropriate agency; (g) Making a good faith effor~ to continue to maintain a drug- free workplace [hrough impiementation of paragraphs (a), (c), (d), (e), and (f). B. The grantee may inser~ 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) Check ~ if there are workplaces on file that are not indenti~ed here. Section 67, 630 of the regulations provides that a grantee [hat is a State may elect to make one codification in each Federal fiscal year. A copy of which should be included with each ap- plica~on for Department of Justice funding. States and State agencies may elect to use OJP Form 4061/7. Check ~ if the State has elected to complete OJP Form 4061/7. DRUG-FREE WORKPLACE (GRANTEES WHO ARE INDIVIDUALS) As required by the Drug-Free Workplace Act of 1988, and implemented at 28 CFR Part 67, Subpan: F, for grante~s, as defined at 28 CFR Par~ 67; Sections 67.615 and 67.620-- A. As a condition of the grant, I cer+Jfy that I will not engage in the unlawful manufacture, distribution, dispensing, posses- sion, or use of a controlled substance in conducting any activity with the grant; and B. tf convicted of a criminal drug offense resulting from a violation occurring during the conduct of any grant activity, l will repor~ the conviction, in writing, within 10 calendar days of the conviction, to: Depa~ment of Justice, Office of Justice Programs, ATT, N: Control Desk, 633 indiana Avenue, N.W., Washington, D.C. 20531. As the duly authorized representative o~ the applicant, I hereby certify that [he applicant will comply with the above certifications. 1. Grantee Name and Address: 2. Application Number and/or Project Name 3. Grantee IRS/Vendor Number Typed Name and Title of Authorized Representative 5. Signature Date