R2001-205 AUTHORIZING SUBMISSION OF GRANT APPLICATION

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Altemate I. (Grantees Other Than Individuals) A. The grantee certifies that it will or continue to provide a drug-free workplace by: (a)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; (b) Establishing an ongoing drug-free awareness program to inform employees about-- (1) The dangers of drug abuse in the workplace; (2) The grantee's policy of 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 occumng in the workplace; (c) Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement 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-- (1) Abide by the tertns 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 ten calendar days after receiving notice under subparagraph(d)(2) from an employee or otherwise receiving actuai notice of such conviction. Employers of convicted employees must provide notice,including position title, to every grant officer on whose grant activity the convicted employee was working,unless the Federal agency has designated a central point for the receipt of such notices. Notice shall include the identification numbers(s)of each affected grant; (� 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 and including termination, consistent widi the requirements of the Rehabilitation Act of 1973,as amended;or . (2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal,State,or local health,law enforcement,or other appropriate agency; (g) Making a good faith effort to continue to maintain a drug-free workplace tivough implementation of paragraphs(a)(b),(c),(d),(e) and(�. 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 Perfortnance(Street address,ciry,counry,state,zip code) Decatur Club 1 West Prairie venue ]).pr�t„r Tl l�pni,�_�S� Check_if there are workplaces on file that are not identified here. PART D: Certi6cation Regarding Drug-Free Workplace Requirements CHECK IF THIS CERTIFlCATION IS FOR AN APPLICANT WHO IS ANINDl�lDUAL. Altemate(I. (Grantees Who Are Individuals) (a) The grantee certifies that, as a condition of the grant, he or she will not engage in the unlawful manufacture, distribution, dispensing, possession,or use of a controlled substance in conducting any activity with the grant; (b) If convicted of a criminal drug offense resulting from a violadon occurring during the conduct of any grant activity,he or she will repoR the conviction,in writing,within 10 calendar days of the conviction,to the grant officer or other designee,unless the Federal agency designates a central point for the receipt of such notices. When notice is made to such a central point,it shall include the identification number(s)of each affected grant DI-2010June 1995 (Thls form rcplaca DI-1953,DI-19S1, � DI-1955,DI-1956 and DId963)