us/form/irs/ty2026/p1101/page-45

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us/form/irs/ty2026/p1101/page-45 — Page 45 · Axiom

17 Will cause to be performed the required financial and

compliance audits in accordance with the Uniform Administrative

Requirements, Cost Principles, and Audit Requirements for Federal

Awards (2 CFR Part 200) (formerly found in the Single Audit Act

Amendments of 1996 and OMB Circular No. A-133, “Audits of

States, Local Governments, and Non-Profit Organizations”).

18 Will comply with all applicable requirements of all other Federal

laws, executive orders, regulations, and policies governing this

program.

19. Will comply with the requirements of Section 106(g) of the

Trafficking Victims Protection Act (TVPA) of 2000, as amended,

(22 U.S.C. § 7104) which prohibits a grantee that is a private

entity and any sub-recipient that is a private entity from engaging

in, or using labor recruiters, brokers, or other agents who engage in

(1) severe forms of trafficking in persons; (2) the procurement

of a commercial sex act during the period of time that the grant,

contract, or cooperative agreement is in effect; (3) the use of forced

labor in the performance of the grant, contract, or cooperative

agreement; or (4) acts that directly support or advance trafficking

in persons. B. Additional Certifications In addition to the assurances and certifications provided by the Applicant pursuant to OMB Standard Form 424B, the Applicant hereby assures and certifies that:

1. It is duly organized and validly existing under the laws of the

jurisdiction in which it was incorporated or otherwise established,

and is (or within 30 days will be) authorized to do business in

any jurisdiction in which it proposes to undertake activities specified

in this Application;

2. Its Board of Directors (or similar governing body) has by proper

resolution or similar action authorized the filing of this Application,

including all understandings and assurances contained herein, and

directed and authorized the person identified as the authorized

representative of the Applicant to act in connection with this

Application and to provide such additional information as may be

required; and

3. It has not knowingly and willfully made or used a document

or writing containing any false, fictitious or fraudulent statement or

entry as part of this Application or any related document,

correspondence or communication. (The Applicant and its

authorized representative should be aware that, under 18 U.S.C.

1001, whoever knowingly and willfully makes or uses such

document or writing shall be fined or imprisoned for not more than

five years, or both); and

4. The information in this Application, and in these assurances and

certifications in support of the Application, is true and correct to the

best of the Applicant’s knowledge and belief and the filing of this

Application has been duly authorized. C. Certification Regarding Debarment, Suspension, and Other Responsibility Matters – Primary Covered Transactions

1. The prospective primary participant (the Applicant) certifies to

the best of its knowledge and belief, that it and its principals:

(a)are not presently debarred, suspended, proposed#

(a) are not presently debarred, suspended, proposed

for debarment, declared ineligible, or voluntarily excluded

from covered transactions by any Federal department

or agency;

(b)have not within a three-year period preceding#

(b) 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;

(c)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

(d)Have not within a three-year period preceding this#

(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.

2. Where the Applicant is unable to certify to any of the statements

in this certification, such Applicant shall attach an explanation to

this proposal.

D. Certification Regarding Drug-Free Workplace

Requirements

1. The Applicant 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 Applicant’s workplace and specifying the actions

that will be taken against employee for violations of such

prohibition;

(b) establishing a drug-free awareness program to

inform employees about:

(i)the dangers of drug abuse in the workplace;#

(i) the dangers of drug abuse in the workplace;

(ii)the Applicant’s policy of maintaining a#

(ii) the Applicant’s policy of maintaining a

drug-free workplace;

(iii) any available drug counseling,

rehabilitation, and employee assistance

program;

(iv) the penalties that may be imposed upon

employees for drug abuse violations occurring

in the workplace

engaged in the performance of the award be given a

copy of the statement required by subparagraph (a);

(d) notifying the employee in the statement required

by subparagraph (a) that, as a condition of employment in

such grant, the employee will:

(i) abide by the terms of the statement; and

(ii) 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; Appendix A - Federal Grant Certifications Exhibit 2: List of Assurances and Certifications - page 2