Appendix A to Part 1200 - Certification and Assurances for Highway Safety Grants (23 U.S.C. Chapter 4)
23:1.0.2.13.1.9.1.1.33 : Appendix A
Appendix A to Part 1200 - Certification and Assurances for Highway
Safety Grants (23 U.S.C. Chapter 4) State: Fiscal Year:____
Each fiscal year the State must sign these Certifications and
Assurances that it complies with all requirements including
applicable Federal statutes and regulations that are in effect
during the grant period. (Requirements that also apply to
subrecipients are noted under the applicable caption.)
In my capacity as the Governor's Representative for Highway
Safety, I hereby provide the following certifications and
assurances:
GENERAL REQUIREMENTS
To the best of my personal knowledge, the information submitted
in the Highway Safety Plan in support of the State's application
for Section 402 and Section 405 grants is accurate and complete.
(Incomplete or incorrect information may result in the disapproval
of the Highway Safety Plan.)
The Governor is the responsible official for the administration
of the State highway safety program through a State highway safety
agency that has adequate powers and is suitably equipped and
organized (as evidenced by appropriate oversight procedures
governing such areas as procurement, financial administration, and
the use, management, and disposition of equipment) to carry out the
program. (23 U.S.C. 402(b)(1)(A))
The State will comply with applicable statutes and regulations,
including but not limited to:
• 23 U.S.C. Chapter 4 - Highway Safety Act of 1966, as
amended
• 49 CFR Part 18 - Uniform Administrative Requirements for
Grants and Cooperative Agreements to State and Local
Governments
• 23 CFR Part 1200 - Uniform Procedures for State Highway Safety
Grant Programs
The State has submitted appropriate documentation for review to
the single point of contact designated by the Governor to review
Federal programs, as required by Executive Order 12372
(Intergovernmental Review of Federal Programs).
FEDERAL FUNDING ACCOUNTABILITY AND TRANSPARENCY ACT (FFATA)
The State will comply with FFATA guidance, OMB Guidance on
FFATA Subward and Executive Compensation Reporting, August 27,
2010,
(https://www.fsrs.gov/documents/OMB_Guidance_on_FFATA_Subaward_and_Executive_Compensation_Reporting_08272010.pdf)
by reporting to FSRS.gov for each sub-grant awarded:
• Name of the entity receiving the award;
• Amount of the award;
• Information on the award including transaction type, funding
agency, the North American Industry Classification System code or
Catalog of Federal Domestic Assistance number (where applicable),
program source;
• Location of the entity receiving the award and the primary
location of performance under the award, including the city, State,
congressional district, and country; and an award title descriptive
of the purpose of each funding action;
• A unique identifier (DUNS);
• The names and total compensation of the five most highly
compensated officers of the entity if:
(i) the entity in the preceding fiscal year received -
(I) 80 percent or more of its annual gross revenues in Federal
awards;
(II) $25,000,000 or more in annual gross revenues from Federal
awards; and
(ii) the public does not have access to information about the
compensation of the senior executives of the entity through
periodic reports filed under section 13(a) or 15(d) of the
Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or
section 6104 of the Internal Revenue Code of 1986;
• Other relevant information specified by OMB guidance.
NONDISCRIMINATION (applies to subrecipients as well as States)
The State highway safety agency will comply with all Federal
statutes and implementing regulations relating to
nondiscrimination. These include but are not limited to: (a) Title
VI of the Civil Rights Act of 1964 (Pub. L. 88-352), which
prohibits discrimination on the basis of race, color or national
origin (and 49 CFR Part 21); (b) Title IX of the Education
Amendments of 1972, as amended (20 U.S.C. 1681-1683 and 1685-1686),
which prohibits discrimination on the basis of sex; (c) Section 504
of the Rehabilitation Act of 1973, as amended (29 U.S.C. 794), and
the Americans with Disabilities Act of 1990 (Pub. L. 101-336), as
amended (42 U.S.C. 12101, et seq.), which prohibits
discrimination on the basis of disabilities (and 49 CFR Part 27);
(d) the Age Discrimination Act of 1975, as amended (42 U.S.C.
6101-6107), which prohibits discrimination on the basis of age; (e)
the Civil Rights Restoration Act of 1987 (Pub. L. 100-259), which
requires Federal-aid recipients and all subrecipients to prevent
discrimination and ensure nondiscrimination in all of their
programs and activities; (f) the Drug Abuse Office and Treatment
Act of 1972 (Pub. L. 92-255), as amended, relating to
nondiscrimination on the basis of drug abuse; (g) the comprehensive
Alcohol Abuse and Alcoholism Prevention, Treatment and
Rehabilitation Act of 1970 (Pub. L. 91-616), as amended, relating
to nondiscrimination on the basis of alcohol abuse or alcoholism;
(h) Sections 523 and 527 of the Public Health Service Act of 1912,
as amended (42 U.S.C. 290dd-3 and 290ee-3), relating to
confidentiality of alcohol and drug abuse patient records; (i)
Title VIII of the Civil Rights Act of 1968, as amended (42 U.S.C.
3601, et seq.), relating to nondiscrimination in the sale,
rental or financing of housing; (j) any other nondiscrimination
provisions in the specific statute(s) under which application for
Federal assistance is being made; and (k) the requirements of any
other nondiscrimination statute(s) which may apply to the
application.
THE DRUG-FREE WORKPLACE ACT OF 1988 (41 U.S.C. 8103)
The State will provide a drug-free workplace by:
• 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;
• Establishing a drug-free awareness program to inform employees
about:
○ The dangers of drug abuse in the workplace.
○ The grantee's policy of maintaining a drug-free workplace.
○ Any available drug counseling, rehabilitation, and employee
assistance programs.
○ The penalties that may be imposed upon employees for drug
violations occurring in the workplace.
○ Making it a requirement that each employee engaged in the
performance of the grant be given a copy of the statement required
by paragraph (a).
• Notifying the employee in the statement required by paragraph
(a) that, as a condition of employment under the grant, the
employee will -
○ Abide by the terms of the statement.
○ Notify the employer of any criminal drug statute conviction
for a violation occurring in the workplace no later than five days
after such conviction.
• Notifying the agency within ten days after receiving notice
under subparagraph (d)(2) from an employee or otherwise receiving
actual notice of such conviction.
• Taking one of the following actions, within 30 days of
receiving notice under subparagraph (d)(2), with respect to any
employee who is so convicted -
○ Taking appropriate personnel action against such an employee,
up to and including termination.
○ 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.
• Making a good faith effort to continue to maintain a drug-free
workplace through implementation of all of the paragraphs
above.
BUY AMERICA ACT (applies to subrecipients as well as States)
The State will comply with the provisions of the Buy America Act
(49 U.S.C. 5323(j)), which contains the following requirements:
Only steel, iron and manufactured products produced in the
United States may be purchased with Federal funds unless the
Secretary of Transportation determines that such domestic purchases
would be inconsistent with the public interest, that such materials
are not reasonably available and of a satisfactory quality, or that
inclusion of domestic materials will increase the cost of the
overall project contract by more than 25 percent. Clear
justification for the purchase of non-domestic items must be in the
form of a waiver request submitted to and approved by the Secretary
of Transportation.
POLITICAL ACTIVITY (HATCH ACT) (applies to subrecipients as well as
States)
The State will comply with provisions of the Hatch Act (5 U.S.C.
1501-1508) which limits the political activities of employees whose
principal employment activities are funded in whole or in part with
Federal funds.
CERTIFICATION REGARDING FEDERAL LOBBYING (applies to subrecipients
as well as States)
Certification for Contracts, Grants, Loans, and Cooperative
Agreements
The undersigned 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 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 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 undersigned shall require that the language of this
certification be included in the award documents for all sub-award
at all tiers (including subcontracts, subgrants, and contracts
under grant, loans, and cooperative agreements) and that all
subrecipients 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 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.
RESTRICTION ON STATE LOBBYING (applies to subrecipients as well as
States)
None of the funds under this program will be used for any
activity specifically designed to urge or influence a State or
local legislator to favor or oppose the adoption of any specific
legislative proposal pending before any State or local legislative
body. Such activities include both direct and indirect (e.g.,
“grassroots”) lobbying activities, with one exception. This does
not preclude a State official whose salary is supported with NHTSA
funds from engaging in direct communications with State or local
legislative officials, in accordance with customary State practice,
even if such communications urge legislative officials to favor or
oppose the adoption of a specific pending legislative proposal.
CERTIFICATION REGARDING DEBARMENT AND SUSPENSION (applies to
subrecipients as well as States)
Instructions for Primary Certification
1. By signing and submitting this proposal, the prospective
primary participant is providing the certification set out
below.
2. The inability of a person to provide the certification
required below will not necessarily result in denial of
participation in this covered transaction. The prospective
participant shall submit an explanation of why it cannot provide
the certification set out below. The certification or explanation
will be considered in connection with the department or agency's
determination whether to enter into this transaction. However,
failure of the prospective primary participant to furnish a
certification or an explanation shall disqualify such person from
participation in this transaction.
3. The certification in this clause is a material representation
of fact upon which reliance was placed when the department or
agency determined to enter into this transaction. If it is later
determined that the prospective primary participant knowingly
rendered an erroneous certification, in addition to other remedies
available to the Federal Government, the department or agency may
terminate this transaction for cause or default.
4. The prospective primary participant shall provide immediate
written notice to the department or agency to which this proposal
is submitted if at any time the prospective primary participant
learns its certification was erroneous when submitted or has become
erroneous by reason of changed circumstances.
5. The terms covered transaction, debarred, suspended,
ineligible, lower tier covered transaction, participant, person,
primary covered transaction, principal, proposal, and voluntarily
excluded, as used in this clause, have the meaning set out in
the Definitions and coverage sections of 49 CFR Part 29. You may
contact the department or agency to which this proposal is being
submitted for assistance in obtaining a copy of those
regulations.
6. The prospective primary participant agrees by submitting this
proposal 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 proposed for debarment under 48
CFR Part 9, subpart 9.4, debarred, suspended, declared ineligible,
or voluntarily excluded from participation in this covered
transaction, unless authorized by the department or agency entering
into this transaction.
7. The prospective primary participant further agrees by
submitting this proposal that it will include the clause titled
“Certification Regarding Debarment, Suspension, Ineligibility and
Voluntary Exclusion-Lower Tier Covered Transaction,” provided by
the department or agency entering into this covered transaction,
without modification, in all lower tier covered transactions and in
all solicitations for lower tier covered transactions.
8. 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 proposed for debarment under 48 CFR Part
9, subpart 9.4, 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 list of
Parties Excluded from Federal Procurement and Non-procurement
Programs.
9. 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.
10. Except for transactions authorized under paragraph 6 of
these instructions, if a participant in a covered transaction
knowingly enters into a lower tier covered transaction with a
person who is proposed for debarment under 48 CFR Part 9, subpart
9.4, suspended, debarred, ineligible, or voluntarily excluded from
participation in this transaction, in addition to other remedies
available to the Federal Government, the department or agency may
terminate this transaction for cause or default.
Certification Regarding Debarment, Suspension, and Other
Responsibility Matters-Primary Covered Transactions
(1) The prospective primary participant certifies to the best of
its knowledge and belief, that its principals:
(a) Are not presently debarred, suspended, proposed for
debarment, declared ineligible, or voluntarily excluded by any
Federal department or agency;
(b) Have not within a three-year period preceding this proposal
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 record, 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
application/proposal had one or more public transactions (Federal,
State, or local) terminated for cause or default.
(2) Where the prospective primary participant is unable to
certify to any of the Statements in this certification, such
prospective participant shall attach an explanation to this
proposal.
Instructions for Lower Tier Certification
1. By signing and submitting this proposal, the prospective
lower tier participant is providing the certification set out
below.
2. The certification in this clause is a material representation
of fact upon which reliance was placed when this transaction was
entered into. If it is later determined that the prospective lower
tier participant knowingly rendered an erroneous certification, in
addition to other remedies available to the Federal government, the
department or agency with which this transaction originated may
pursue available remedies, including suspension and/or
debarment.
3. The prospective lower tier participant shall provide
immediate written notice to the person to which this proposal is
submitted if at any time the prospective lower tier participant
learns that its certification was erroneous when submitted or has
become erroneous by reason of changed circumstances.
4. The terms covered transaction, debarred, suspended,
ineligible, lower tier covered transaction, participant, person,
primary covered transaction, principal, proposal, and voluntarily
excluded, as used in this clause, have the meanings set out in
the Definition and Coverage sections of 49 CFR Part 29. You may
contact the person to whom this proposal is submitted for
assistance in obtaining a copy of those regulations.
5. The prospective lower tier participant agrees by submitting
this proposal 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 proposed for debarment
under 48 CFR Part 9, subpart 9.4, debarred, suspended, declared
ineligible, or voluntarily excluded from participation in this
covered transaction, unless authorized by the department or agency
with which this transaction originated.
6. The prospective lower tier participant further agrees by
submitting this proposal that it will include the clause titled
“Certification Regarding Debarment, Suspension, Ineligibility and
Voluntary Exclusion - Lower Tier Covered Transaction,” without
modification, in all lower tier covered transactions and in all
solicitations for lower tier covered transactions. (See below)
7. 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 proposed for debarment under 48 CFR Part
9, subpart 9.4, 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 List of
Parties Excluded from Federal Procurement and Non-procurement
Programs.
8. 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.
9. Except for transactions authorized under paragraph 5 of these
instructions, if a participant in a covered transaction knowingly
enters into a lower tier covered transaction with a person who is
proposed for debarment under 48 CFR Part 9, subpart 9.4, suspended,
debarred, ineligible, or voluntarily excluded from participation in
this transaction, in addition to other remedies available to the
Federal government, the department or agency with which this
transaction originated may pursue available remedies, including
suspension and/or debarment.
Certification Regarding Debarment, Suspension, Ineligibility
and Voluntary Exclusion - Lower Tier Covered Transactions:
1. The prospective lower tier participant certifies, by
submission of this proposal, that neither it nor its principals is
presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from participation in this
transaction by any Federal department or agency.
2. Where the prospective lower tier participant is unable to
certify to any of the statements in this certification, such
prospective participant shall attach an explanation to this
proposal.
POLICY ON SEAT BELT USE
In accordance with Executive Order 13043, Increasing Seat Belt
Use in the United States, dated April 16, 1997, the Grantee is
encouraged to adopt and enforce on-the-job seat belt use policies
and programs for its employees when operating company-owned,
rented, or personally-owned vehicles. The National Highway Traffic
Safety Administration (NHTSA) is responsible for providing
leadership and guidance in support of this Presidential initiative.
For information on how to implement such a program, or statistics
on the potential benefits and cost-savings to your company or
organization, please visit the Buckle Up America section on NHTSA's
Web site at www.nhtsa.dot.gov. Additional resources are
available from the Network of Employers for Traffic Safety (NETS),
a public-private partnership headquartered in the Washington, DC
metropolitan area, and dedicated to improving the traffic safety
practices of employers and employees. NETS is prepared to provide
technical assistance, a simple, user-friendly program kit, and an
award for achieving the President's goal of 90 percent seat belt
use. NETS can be contacted at 1 (888) 221-0045 or visit its Web
site at www.trafficsafety.org.
POLICY ON BANNING TEXT MESSAGING WHILE DRIVING
In accordance with Executive Order 13513, Federal Leadership On
Reducing Text Messaging While Driving, and DOT Order 3902.10, Text
Messaging While Driving, States are encouraged to adopt and enforce
workplace safety policies to decrease crashed caused by distracted
driving, including policies to ban text messaging while driving
company-owned or -rented vehicles, Government-owned, leased or
rented vehicles, or privately-owned when on official Government
business or when performing any work on or behalf of the
Government. States are also encouraged to conduct workplace safety
initiatives in a manner commensurate with the size of the business,
such as establishment of new rules and programs or re-evaluation of
existing programs to prohibit text messaging while driving, and
education, awareness, and other outreach to employees about the
safety risks associated with texting while driving.
ENVIRONMENTAL IMPACT
The Governor's Representative for Highway Safety has reviewed
the State's Fiscal Year highway safety planning document and hereby
declares that no significant environmental impact will result from
implementing this Highway Safety Plan. If, under a future revision,
this Plan is modified in a manner that could result in a
significant environmental impact and trigger the need for an
environmental review, this office is prepared to take the action
necessary to comply with the National Environmental Policy Act of
1969 (42 U.S.C. 4321, et seq.) and the implementing
regulations of the Council on Environmental Quality (40 CFR Parts
1500-1517).
SECTION 402 REQUIREMENTS
The political subdivisions of this State are authorized, as part
of the State highway safety program, to carry out within their
jurisdictions local highway safety programs which have been
approved by the Governor and are in accordance with the uniform
guidelines promulgated by the Secretary of Transportation. (23
U.S.C. 402(b)(1)(B))
At least 40 percent (or 95 percent, as applicable) of all
Federal funds apportioned to this State under 23 U.S.C. 402 for
this fiscal year will be expended by or for the benefit of the
political subdivision of the State in carrying out local highway
safety programs (23 U.S.C. 402(b)(1)(C), 402(h)(2)), unless this
requirement is waived in writing.
The State's highway safety program provides adequate and
reasonable access for the safe and convenient movement of
physically handicapped persons, including those in wheelchairs,
across curbs constructed or replaced on or after July 1, 1976, at
all pedestrian crosswalks. (23 U.S.C. 402(b)(1)(D))
The State will provide for an evidenced-based traffic safety
enforcement program to prevent traffic violations, crashes, and
crash fatalities and injuries in areas most at risk for such
incidents. (23 U.S.C. 402(b)(1)(E))
The State will implement activities in support of national
highway safety goals to reduce motor vehicle related fatalities
that also reflect the primary data-related crash factors within the
State as identified by the State highway safety planning process,
including:
• Participation in the National high-visibility law enforcement
mobilizations;
• Sustained enforcement of statutes addressing impaired driving,
occupant protection, and driving in excess of posted speed
limits;
• An annual statewide seat belt use survey in accordance with 23
CFR Part 1340 for the measurement of State seat belt use rates;
• Development of statewide data systems to provide timely and
effective data analysis to support allocation of highway safety
resources;
• Coordination of Highway Safety Plan, data collection, and
information systems with the State strategic highway safety plan,
as defined in 23 U.S.C. 148(a).
(23 U.S.C. 402(b)(1)(F))
The State will actively encourage all relevant law enforcement
agencies in the State to follow the guidelines established for
vehicular pursuits issued by the International Association of
Chiefs of Police that are currently in effect. (23 U.S.C.
402(j))
The State will not expend Section 402 funds to carry out a
program to purchase, operate, or maintain an automated traffic
enforcement system. (23 U.S.C. 402(c)(4))
I understand that failure to comply with applicable Federal
statutes and regulations may subject State officials to civil or
criminal penalties and/or place the State in a high risk grantee
status in accordance with 49 CFR 18.12.
I sign these Certifications and Assurances based on personal
knowledge, after appropriate inquiry, and I understand that the
Government will rely on these representations in awarding grant
funds.
Signature Governor's Representative for Highway Safety Date Date
Printed name of Governor's Representative for Highway Safety