FEMA Form 20-16C
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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
on this form provides for compliance with certification requirements
under 44 CFR Part 18, "New Restrictions on Lobbying; and 28 CFR
Part 17, "Government-wide Debarment and suspension (Non-procurement)
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 Federal Emergency
Management Agency (FEMA) determines to award the covered transaction,
grant, or cooperative agreement. |
1. LOBBYING
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A. As required by the section 1352, Title 31 of the US Code, and implemented
at 44 CFR Part 18 for persons entering into a grant or cooperative agreement
over $100,000, as defined at 44 CFR Part 18, the applicant certifies
that:
(a) No Federal appropriated funds have been paid or will be paid,
by or on behalf of the undersigned, to any person for influencing
or attempting 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 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;
(b) If any other funds than Federal appropriated funds have been
paid or will be paid to any person for influencing or attempting
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;
Standard Form LLL Disclosure of Lobbying Activities Attached
(c) The undersigned shall require that the language of this certification
be included in the award documents for all the sub awards at all
tiers (including subgrants, contracts under grants and cooperative
agreements, and subcontract(s)) and that all subrecipients shall
certify and disclose accordingly.
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2. DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY MATTERS (DIRECT RECIPIENT)
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As required by Executive Order 12549, Debarment and Suspension,
and implemented at 44 CFR Part 67, for prospective participants in primary covered
transactions, as defined at 44 CFR Part 17, Section 17.510-A. The
applicant certifies that it and its principals:
(a) Are not presently debarred, suspended, proposed for debarment,
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;
(b) Have not within a three-year period preceding this application
been convicted of or had a civilian judgment rendered against
them for commission of fraud or a criminal offense in connection
with obtaining, attempting to obtain, or perform 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 locally)
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 application
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 this certification, he or she shall attach an explanation to
this application.
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Explanation:
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3. DRUG-FREE WORKPLACE (GRANTEES OTHER THAN INDIVIDUALS)
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As required by the Drug-Free Workplace Act of 1988, and implemented
at 44 CFR Part 17, Subpart F, for grantees, as defined at 44 CFR
part 17, Sections 17.615 and 17.623:
(A) The applicant certifies that it will 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 on-going 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 occurring in the workplace;
(c) Making it a requirement that each employee to be engaged in
the performance of the grant to 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 terms of the statement; and
(2)Notify the employee 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 such conviction. Employers
of convicted employees must provide notice, including position
title, to the applicable FEMA awarding office, i.e. regional office
or FEMA office.
(f) Taking one of the following actions against such an employee,
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 with
the requirements of the Rehabilitation Act of 1973, as amended;
or
(2) Require 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 effort to continue to maintain a drug free 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:
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Section 17.630 of the
regulations provide 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
application for FEMA funding. States and State agencies may elect to use a
Statewide certification.
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