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� PART C: Certification Regarding Drug-Free Workplace Requirements
<br /> CHECK✓IF THIS CERTIFICATION IS FOR AN APPUCANT WHO IS NOT AN INDIVIDUAL.
<br /> Alternate I. (Grantees Other Than Individuals)
<br /> 1
<br /> A. The grantee certifies that it will or continue to provide a drug-free workplace by:
<br /> (a) Publishing a statement notifying employees that the unlawfut manufactu�e,distribution,dispensing, possession,or use of
<br /> a controlled substance is prohibited in the grantee's workplace and specifying the actions that will be take� against
<br /> employees for violabon of such prohibition;
<br /> (b) Establishing an ongoing drug-free awareness program to inform employees about—
<br /> (1) The dangers of drug abuse in the workplace;
<br /> � (2) The grantee's policy of maintaining a drug-free workplace;
<br /> (3) Any available drug counseling,rehabilitation,and employee assistance programs;and
<br /> (4) The penatties that may be imposed upon employees for drug abuse violations occurring in the workplace;
<br /> (c) Maldng R a requirement that each employee to be engaged in the pe�formance of the grant be given a copy of the statement
<br /> requi�ed by paragraph(a); ` <
<br /> (d) Notirying the employee in the statement required by paragraph(a)that, as a condition of employment under the grant,the
<br /> employee will—
<br /> (1) Abide by the terms of the statemen�and
<br /> (2) Notiy the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace
<br /> no later than five calendar days after such conviction;
<br /> (e) Notiying the agency in writing,within ten cale�dar days after receiving notice under subparagraph(d)(2)from an employee
<br /> or othervuise receiving actual notice of such conviction. Employers of convicted employees must provide notice,induding
<br /> position title,to every grant officer on whose grant activity the convicted employee was working, unless the Federal agency
<br /> has designated a central point for the receipt of such notices. Notice shall indude the identification numbers(s)of each
<br /> affected gran�
<br /> (� Taking one of the following actions,within 30 calendar days of receiving notice under subparagraph(d)(2),with respect to
<br /> any employee who is so convicted—
<br /> (1) Taking appropriate personnel action against such an employee, up to and including termination,consistent with the
<br /> requirements of the Rehabilitation Act of 1973,as amended; or
<br /> (2) Requiring such employee to partiapate satisfactorily in a drug abuse assistance or rehabilitation program app�oved for
<br /> � such purposes by a Federal,State,or local heatth,law enforcement,or other appropriate agency;
<br /> (g) Making a good faith effort to continue to maintain a dntg-free workplace through implementation of paragraphs(a)(b),(c),
<br /> (d),(e)and(�.
<br /> B. The grantee may insert in the space provided below the site(s for the performance of work done in connection with the specific
<br /> grant
<br /> Place of Performance(Street address,city,county,state,zip code)
<br /> I C'�y�� l� �1-✓�d�so n I�l u�.
<br /> �c a,-t-i,ly', l l. (o a-�'a 'L �'l�t.co v� �'c�v•��,,�
<br /> Check✓if there are�vorkplaces on file that are not identified here.
<br /> PART D: Certification Regarding Drug-Free Workplace Requirements
<br /> CHECK IF THIS CERTIFICATION/S FOR AN APPUCANT WHO 1S AN INOIVIDUAL.
<br /> Altemate II. (Grantees Who Are Individuals)
<br /> (a) The grantee certifies that, as a condi6on of the grant, he or she will not engage i�the unlawful manufacture, distribution,
<br /> dispensing, possession,or use of a controlled eubstance in conducting a�y activity with the grant;
<br /> (b) If convided of a criminal drug offense resutting from a violation occurri�g during the conduct of any grant activity,he or she
<br /> 1 wiq report the conviction,in writing,within 10 calendar days of the conviction,to the grant officer or other designee, unless
<br /> the Federal agency designates a central point for the receipt of such notices. When notice is made to such a central point,
<br /> it shall include the identification number(s)of each affected grant.
<br /> D42010
<br /> Juiw 1986
<br /> (TN�form rplw��OI-1969.DI-1B64, .
<br /> 01�1966,DI-1Y36�nd DI-196�1
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