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9/14/23, 1:00 PM Grant Package <br /> Name Category Created by Applic Date <br /> ' - <br /> Applicant Disclosures and Janice Frankovich ation Added <br /> Disclosure of Assurances Numbe <br /> Duplication in r 08/24/2 <br /> Cost Items C-BJA- -- 023 <br /> 2023-171790.pdf <br /> Declaration and Certification to the U.S. Department of Justice as to this Application Submission <br /> By[taking this action], I -- <br /> 1. Declare the following to the U.S. Department of Justice(DOJ), under penalty of perjury: (1) 1 <br /> have authority to make this declaration and certification on behalf of the applicant; (2) 1 <br /> have conducted or there was conducted (including by the applicant's legal counsel as <br /> appropriate,and made available to me)a diligent review of all requirements pertinent to <br /> and all matters encompassed by this declaration and certification. <br /> 2.Certify to DOJ, under penalty of perjury,on behalf of myself and the applicant,to the best of <br /> my knowledge and belief,that the following are true as of the date of this application <br /> submission: (1) 1 have reviewed this application and all supporting materials submitted in <br /> connection therewith (including anything submitted in support of this application by any <br /> person on behalf of the applicant before or at the time of the application submission and <br /> any materials that accompany this declaration and certification); (2)The information in this <br /> application and in all supporting materials is accurate,true,and complete information as of <br /> the date of this request;and (3) 1 have the authority to submit this application on behalf of <br /> the applicant. <br /> 3. Declare the following to DOJ, under penalty of perjury, on behalf of myself and the <br /> applicant: (1) 1 understand that, in taking(or not taking)any action pursuant to this <br /> declaration and certification, DOJ will rely upon this declaration and certification as a <br /> material representation; and (2) 1 understand that any materially false,fictitious,or <br /> fraudulent information or statement in this declaration and certification(or concealment or <br /> omission of a material fact as to either) may be the subject of criminal prosecution <br /> (including under 18 U.S.C. §§ 1001 and/or 1621,and/or 34 U.S.C. §§ 10271-10273), and also <br /> may subject me and the applicant to civil penalties and administrative remedies under the <br /> federal False Claims Act(including under 31 U.S.C. §§3729-3730 and/or§§3801-3812)or <br /> https://justgrants.usdoj.gov/prweb/PRAuth/app/JGITS_/3yZ6Bxxi_1pDExTOT4XnAjzjAXmVNevW*/!TABTHREAD6?pyActivity=%40baseclass.pzPro... 18/19 <br />