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<br />Crime Victim Services Division Office of the Attorney General
<br />COMPREHENSIVE CERTIFICATION FORM
<br />
<br />(" "ified Assurances:
<br />certification is a material representation of fact upon which reliance was placed with the agency detennined to award the grant. If it is later
<br />mined that the grantee knowingly rendered an erroneous certification, the agency, in addition to any other remedies available to the federal/state
<br />5- , .rnment or state agency, may take available action.
<br />
<br />I certify to the best of my knowledge and belief:
<br />1. No federal/state appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or
<br />employee of any agency, a member of Congress or the Texas Legislature, or an employee of a member of Congress or the Texas Legislature in
<br />connection with the awarding of any federal/state contract, the making of any federal/state grant, the making of any federal/state loan, the
<br />entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal/state contract,
<br />grant, loan, or cooperative agreement; and
<br />2. If any non-federal/state funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of
<br />any agency, a member of Congress or the Texas Legislature, an officer or employee of Congress or the Texas Legislature, or an employee of a
<br />member of Congress or the Texas Legislature in connection with this federal/state contract, grant, loan, or cooperative agreement, the
<br />undersigned shall contact the Grants Coordinator ofthe Office ofthe Attorney General for the "Disclosure Form to Report Lobbying."
<br />
<br />I certify that to the best of my knowledge and belief:
<br />I. The applicant certifies that it will provide a drug-free workplace by:
<br />A Publishing a statement notifying employees/assignees that the unlawful manufacture, distribution, dispensing, possession, or use of a
<br />controlled substance is prohibited in the applicant's workplace and specifying the actions that will be taken against employees for
<br />violation of such prohibition.
<br />B. Establishing a drug-free awareness program to inform employees/assignees about:
<br />1. The dangers of drug abuse in the workplace;
<br />2. The applicant's policy of maintaining a drug-free workplace;
<br />3. Any available drug counseling, rehabilitation, and employee assistance programs; and
<br />4. The penalties that may be imposed upon employees/assignees for drug abuse violations.
<br />C. Making it a requirement that each employee/assignee to be engaged in the performance of the grant be given a copy of the statement
<br />required by paragraph (A).
<br />D. Notifying the employee/assignee in the statement required by paragraph (A) that, as a condition employment/assignment under the
<br />grant, the employees/assignee will:
<br />1. Abide by the terms ofthe statement, and
<br />2. Notify the applicant agency and Grants Coordinator tor the Office of the Attorney General of any criminal drug statute
<br />conviction tor a violation occurring in the workplace not later than five days after such conviction.
<br />E. Notifying the agency within ten days after receiving notice under subparagraph (D)(2) from an employee/assignee or otherwise
<br />receiving actual notice of such conviction.
<br />F. Taking one ofthe following actions with respect to any employee/assignee so convicted:
<br />1. Taking appropriate personnel action with respect to any employee/assignee so convicted;
<br />2. requiring such employee/assignee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved
<br />for such purposes by a federal, state, or local health, law enforcement, or other appropriate agency.
<br />G. Making a good taith effort to continue to maintain a drug-free workplace through the implementation of paragraphs (A), (B), (C), (D),
<br />(E), and (F).
<br />
<br />I certify to the best of my knowledge and belief that one of the following applicable requirements will be met:
<br />1. The applicant agency currently expends combined federal/state funding of $500,000 or more, and, therefore, is required to submit an annual
<br />single audit by an independent auditor made in accordance with the Single Audit Act Amendments of 1996 and OMB Circular A-B3.
<br />2. The applicant agency currently expends combined state funding of $500,000 or more, and, therefore, is required to submit an annual single audit
<br />by an independent auditor made in accordance with the Uniform Grant Management Standards (UGMS).
<br />3. The applicant agency currently expends no federal/state funding or combined federal/state funding of less than $500,000 and therefore is exempt
<br />from the Single Audit Act and cannot charge audit costs to an OV AG AND VCLG grant. I understand, however, that OAG may require a
<br />limited scope audit as defined in OMB Circular A-B3.
<br />
<br />If this application is for funds in excess of $25,000, I certify the following;
<br />By submission of this proposal, that neither the applicant agency nor its principals are presently debarred, suspended, proposed for debarment, declared
<br />ineligible, or voluntarily excluded from participation in this transaction by any federal department or state agency.
<br />
<br />If I am unable to certify the above statement I have attached an explanation to his application.
<br />
<br />I certify that to the best of my knowledge and belief:
<br />That the applicant entity will follow the guidelines in the Uniform Grant Management Standards (UGMS) as required for all governmental entities. Both
<br />governmental entities as well as non-profit entities are required to follow all UGMS guidelines.
<br />
<br />COMPREHENSIVE CERTIFICATION FORM CON'T.
<br />
<br />06-07 OAG Application Kit v20
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<br />10/11/2005
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