HomeMy WebLinkAboutAgenda - 10-05-94 - VIII-A-1 23
APPENDIX D
22.4 The Grantee agrees:
22.4. 1 To comply with the provisions of the Privacy
Act of 1974, 5 U.S.C. § 552A and regulations adopted thereunder,
when performance under the program involves the design,
development, or operation of any system of records on
individuals to be operated by the Grantee, its third-party
contractors, subcontractors, subgrantees, or their employees to
accomplish a DOT function;
22 .4.2 To notify DOT when the Grantee or any of its
third-party contractors, subcontractors, subgrantees,
subrecipients, or their employees anticipate operating a system
of records on behalf of DOT in order to implement the program,
if such system contains information about individual's name or
other identifier assigned to the individual. A system of
records subject, to the Act may not be used in the performance of
this Agreement until the necessary and applicable approval and
publication requirements have been met.
22 .4.3 To include in every solicitation and in every
third-party contract, subgrant, and when the performance of work
under that proposed third-party contract, subgrant, or
subagreement may involve the design, development, or operation
of a system of records on individuals to be operated under that
third-party contract, subgrant, or to accomplish a DOT function,
a Privacy Act notification informing the third-party contractor,
or subgrantee, that it will be required to design, develop, or
operate a system of records on individuals to accomplish a DOT
function subject to the Privacy Act of 1974, 5 U.S.C. § 552a,
and applicable DOT regulations, and that a violation of the Act
may involve the imposition of criminal penalties; and
22 .4.4 To include the text of Subsections 22 .4. 1
through 22 .4 .4 in all third-party contracts, and subgrants under
which work for this Agreement is performed or which is awarded
pursuant to this Agreement or which may involve the design,
development, or operation of such a system of records on behalf
of DOT.
DATE
(Recipient)
by
(Signature of Authorized Official)
24
APPENDIX E
CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS
(GRANTEES OTHER THAN INDIVIDUALS)
This certification is required by the regulations implementing the Drug-Free Workplace Act of 1988, 44 CFR Part 17,
Subpart F. The regulations, published in the January 31, 1989 Federal Register, require certification by grantees,
prior to award, that they will maintain a drug-free workplace. The certification set out below is a material
representation of fact upon which reliance will be placed when the agency determines to award the grant. False
certification or violation of the certification shall be grounds for suspension of payments, suspension or termination of
grants,or government-wide suspension or debarment,(See 44 CFR Part 13,Subpart C 13.300 and Subpart D 13.400).
The grantee certifies that it will 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 a 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 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 employer of any criminal drug statute conviction for a violation occurring in the workplace no later
than five days after such conviction;
(e) Notifying the agency within ten days after receiving notice under subparagraph (d)(2), from an employee or
otherwise receiving actual notice of such conviction;
(f) Taking one of the following actions,within 30 days of receiving notice under subparagraph (d)(2),with respect to
any employee who is convicted
(1) Taking appropriate personnel action against such an employee,up to and including termination; 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 through implementation of
paragraphs(a),(b)(c),(d),(e)and(g).
Place(s)of Performance: The grantee shall insert in the space provided below the site(s)for the performance of
work done in connection with the specific grant(street address,city,county,state,zip code):
Organization Name (As appropriate) Application Number
Printed Name
•
Signature Date
•