Application and Reports for the Direct Component and the Centers of Excellence Research Grants Program of the Gulf RESTORE Program

RESTORE Act Direct Component Applicant Certifications
Department of the Treasury
OMB Approval No. 1505-0250
Directions: These certifications are required by federal law and Department of the Treasury (Treasury) regulations to be submitted
with each application to Treasury for financial assistance under the RESTORE Act Direct Component. The certifications must be
signed by an authorized senior official of the Applicant who can legally bind the entity and has oversight for the administration and
use of the Direct Component funds.

A. RESTORE Act Certification
Pursuant to the RESTORE Act, I certify that for any award Agreement
resulting from this application:
1. Each activity funded under this Agreement has been primarily
designed to restore and protect [select all that are appropriate: the
natural resources, ecosystems, fisheries, marine and wildlife habitats,
beaches, coastal wetlands, or economy] of the Gulf Coast region.
2. Each activity funded under this Agreement is designed to carry out
one or more of the eligible activities for the Direct Component.
3. Each activity funded under this Agreement was selected after
consideration of all meaningful input from the public, including broadbased participation from individuals, businesses, Indian tribes, and
nonprofit organizations, as described in the grant application.
4. Each activity funded under this Agreement that protects or restores
natural resources is based on the best available science, as that term
is defined in 31 C.F.R. Part 34.
5. This recipient has procedures in place for procuring property and
services under this award that are consistent with the procurement
standards applying to Federal grants. This recipient will not request
funds under this award for any contract unless this certification remains
true and accurate.
6. Pursuant to 2 C.F.R. § 200.303, this recipient will establish and
maintain effective internal control over any award made based on this
application that provides reasonable assurance that this recipient is
managing the award in compliance with Federal statutes, regulations,
and the terms and conditions of the award. No material deficiencies in
this recipient’s internal controls are known.
7. A conflict of interest policy consistent with 2 C.F.R. § 200.318(c) is in
effect and covering each activity funded under this Agreement.
8. This recipient will comply with Title VI of the Civil Rights Act of 1964,
the Rehabilitation Act of 1973, and all other applicable federal laws and
regulations concerning anti-discrimination.
I make each of these certifications based on my personal knowledge
and belief after reasonable and diligent inquiry, and I affirm that this
Applicant maintains written documentation sufficient to support each
certification made above, and that this Applicant’s compliance with
each of these certifications is a condition of this Applicant’s initial and
continuing receipt and use of the funds provided under this Agreement.

B. Certification Regarding Debarment, Suspension,
and Other Responsibility Matters -- Primary Covered
Transactions
Instructions: The inability of an applicant to provide the certification
required below will not necessarily result in the denial of participation in

this covered transaction. The prospective Applicant shall submit an
explanation of why it cannot provide the certification set out below. The
certification or explanation will be considered in connection with
Treasury’s approval of the proposed Application. However, failure of
the Applicant to furnish a certification or an explanation shall disqualify
such person/entity from participation in this transaction. Please be
advised of the following:

1. This certification is a material representation of fact upon which
reliance is placed when Treasury determines to enter into this
transaction. If it is later determined that the Applicant knowingly
rendered an erroneous certification, in addition to other remedies
available to the Federal government, Treasury may terminate this
transaction for cause or default.
2. The Applicant shall provide immediate written notice to Treasury if at
any time the Applicant learns that its certification was erroneous when
submitted or has become erroneous by reason of changed
circumstances.
3. The terms “covered transactions,” “debarred,” “suspended,”
“ineligible,” “lower tier covered transaction,” “participant,” “person,”
“primary covered transaction,” “principal,” “proposal”, and “voluntarily
excluded,” as used in this clause (certification), have the meanings set
out in the Definitions and Coverage sections of the rules implementing
Executive Order 12549. You may contact Treasury for assistance in
obtaining a copy of those regulations (31 C.F.R. Part 19).
4. The Applicant agrees by submitting this Application that, should the
proposed covered transaction be entered into, it shall not knowingly
enter into any lower tier covered transaction with a person who is
debarred, suspended, declared ineligible, or voluntarily excluded from
participation in this covered transaction, unless authorized by
Treasury.
5. The Applicant further agrees by submitting this Application that it will
include the clause titled “Certification Regarding Debarment,
Suspension, Ineligibility and Voluntary Exclusion-Lower Tier Covered
Transaction,” to be provided by Treasury, without modification, in all
lower tier covered transactions and in all solicitations for lower tier
covered transactions (see 31 C.F.R. Part 19, Appendix).
6. A participant in a covered transaction may rely upon a certification of
a prospective participant in a lower tier covered transaction that it is not
debarred, suspended, ineligible, or voluntarily excluded from the
covered transaction, unless it knows that the certification is erroneous.
A participant may decide the method and frequency by which it
determines the eligibility of its principals. Each participant may, but is
not required to, check the Nonprocurement List.
7. Nothing contained in the foregoing shall be construed to require
establishment of a system of records in order to render in good faith
the certification required by this clause. The knowledge and
information of a participant is not required to exceed that which is
normally possessed by a prudent person in the ordinary course of
business dealings.
8. Except for transactions authorized under paragraph 4 of this
certification, if a participant in a covered transaction knowingly enters
into a lower tier covered transaction with a person who is suspended,

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it
displays a valid OMB control number. The valid OMB control number for this information collection is 1505-0250. The time required
to complete this information collection is estimated to average 10 hours, including the time to review instructions, search existing
data resources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Comments
concerning the accuracy of the time estimate and suggestions for reducing this burden should be directed to the Department of the
Treasury, RESTORE Act Program, 1500 Pennsylvania Ave., NW, Washington, DC 20005.

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debarred, ineligible, or voluntarily excluded from participation in this
transaction, in addition to other remedies available to the Federal
government, Treasury may terminate this transaction for cause or
default.
By signing and submitting this Application, the prospective primary
participants (the Applicant) is providing the certification set out below.
The prospective primary participant (the Applicant) certifies to the
best of its knowledge and belief, that it and its principals:
1. Are not presently debarred, suspended, proposed for debarment,
declared ineligible, or voluntarily excluded from covered transactions
by any Federal department or agency;
2. Have not within a three-year period preceding this Application been
convicted of or had a civil judgment rendered against them for
commission of fraud or a criminal offense in connection with obtaining,
attempting to obtain, or performing 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;
3. Are not presently indicted for or otherwise criminally or civilly
charged by a governmental entity (Federal, State or local) with
commission of any of the offenses enumerated in paragraph (1)(b) of
this certification; and
4. 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.
Where the Applicant is unable to certify to any of the statements in this
certification, such Applicant shall attach an explanation to this
proposal.

C. Certification Regarding Drug-Free Workplace
Requirements
The Applicant certifies that it will provide a drug-free workplace
by:
1. Publishing a statement notifying employees that the unlawful
manufacture, distribution, dispensing, possession, or use of a
controlled substance is prohibited in the Applicant’s workplace and
specifying the actions that will be taken against employee for violations
of such prohibition;
2. Establishing a drug-free awareness program to inform employees
about:
a. The dangers of drug abuse in the workplace;
b. The Applicant’s policy of maintaining a drug-free workplace;
c. Any available drug counseling, rehabilitation, and employee
assistance program;
d. The penalties that may be imposed upon employees for drug
abuse violations occurring in the workplace
3. Making it a requirement that each employee to be engaged in the
performance of the award be given a copy of the statement required by
paragraph (1) of this certification;
4. Notifying the employee in the statement required by paragraph (1) of
this certification that, as a condition of employment in such grant, the
employee will:
a. Abide by the terms of the statement; and
b. Notify the employer of any criminal drug use statute conviction
for a violation occurring in the workplace no later than five
calendar days after such conviction;

5. Notifying the granting agency in writing, within ten calendar days
after receiving notice of a conviction under paragraph (4)(b) of this
certification from an employee or otherwise receiving actual notice of
such conviction;
6. Taking one of the following actions, within 30 days of receiving
notice under paragraph (4)(b) of this certification, with respect to any
employee who is so convicted:
a. 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
b. 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; and
7. Making a good faith effort to continue to maintain a drug-free
workplace through implementation of paragraphs 1 through 6 above.

D. Certification Regarding Lobbying
The Applicant certifies, to the best of his or her knowledge and belief,
that:
1. No Federal appropriated funds have been paid or will be paid, by or
on behalf of the Applicant, to any person for influencing or attempting
to influence an officer or employee of an agency, a Member of
Congress, an officer or employee of Congress, or an employee of a
Member of Congress in connection with the awarding of any Federal
contract, the making of any Federal grant, the making of any Federal
loan, the entering into of any cooperative agreement, and the
extension, continuation, renewal, amendment, or modification of any
Federal contract, grant, loan, or cooperative agreement.
2. If any funds other 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 contract, grant, loan, or
cooperative agreement, the undersigned shall complete and submit
Standard Form-LLL, ‘‘Disclosure Form to Report Lobbying,’’ in
accordance with its instructions.
3. The Applicant shall require that the language of this certification be
included in the award documents for all subawards at all tiers
(including subcontracts, subgrants, and contracts under grants, loans,
and cooperative agreements) and that all sub-recipients shall certify
and disclose accordingly. This certification is a material representation
of fact upon which reliance was placed when this transaction was
made or entered into. Submission of this certification is a prerequisite
for making or entering into this transaction imposed by title 31 U.S.
Code section 1352. Any person who fails to file the required
certification shall be subject to a civil penalty of not less than $10,000
and not more than $100,000 for each such failure.
This certification is a material representation of fact upon which
reliance was placed when this transaction was made or entered into.
Submission of this certification is a prerequisite for making or entering
into this transaction imposed by section 1352, title 31, U.S. Code. Any
person who fails to file the required certification shall be subject to a
civil penalty of not less than $10,000 and not more than $100,000 for
each such failure.

Signature of Authorized Senior Official:

Name:

Date:

Title:

Organization: