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