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DocuSign Envelope ID: 262ABA18-5354-4F41-9508-9B13C8ACBA6D
<br />i. Taking appropriate personnel action against such an employee, up to and including termination,
<br />consistent with the requirements of the Rehabilitation Act of 1973, as amended; or
<br />ii. Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program
<br />approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate
<br />agency;
<br />6. Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs
<br />(1) through (V).
<br />For purposes of paragraph (V) regarding agency notification of criminal drug convictions, Authority has designated
<br />the following central point for receipt of such notices:
<br />Legal Services Manager
<br />WA State Health Care Authority
<br />PO Box 42700
<br />Olympia, WA 98504-2700
<br />c. CERTIFICATION REGARDING LOBBYING: Title 31, United States Code, Section 1352, entitled "Limitation on use
<br />of appropriated funds to influence certain Federal contracting and financial transactions," generally prohibits
<br />recipients of Federal grants and cooperative Contracts from using Federal (appropriated) funds for lobbying the
<br />Executive or Legislative Branches of the Federal Government in connection with a SPECIFIC grant or cooperative
<br />Contract. Section 1352 also requires that each person who requests or receives a Federal grant or cooperative
<br />Contract must disclose lobbying undertaken with non -Federal (non appropriated) funds. These requirements apply
<br />to grants and cooperative Contracts EXCEEDING $100,000 in total costs (45 CFR Part 93).
<br />The undersigned (authorized official signing for the contracting organization) certifies, to the best of his or her
<br />knowledge and belief, that:
<br />1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person
<br />for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer
<br />or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any
<br />Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any
<br />cooperative Contract, and the extension, continuation, renewal, amendment, or modification of any Federal
<br />contract, grant, loan, or cooperative Contract.
<br />2. If any funds other than Federally appropriated funds have been paid or will be paid to any person for influencing
<br />or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee
<br />of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or
<br />cooperative Contract, the undersigned shall complete and submit Standard Form -LLL, "Disclosure of Lobbying
<br />Activities," in accordance with its instructions. (If needed, Standard Form -LLL, "Disclosure of Lobbying Activities,"
<br />its instructions, and continuation sheet are included at the end of this application form.)
<br />3. The undersigned shall require that the language of this certification be included in the award documents for all
<br />subcontracts at all tiers (including subcontracts, subcontracts, and contracts under grants, loans and cooperative
<br />Contracts) and that all sub -recipients shall certify and disclose accordingly.
<br />This certification is a material representation of fact upon which reliance was placed when this transaction was
<br />made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction
<br />imposed by Section 1352, U.S. Code. Any person who fails to file the required certification shall be subject to a
<br />civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
<br />d. CERTIFICATION REGARDING PROGRAM FRAUD CIVIL REMEDIES ACT (PFCRA): The undersigned
<br />(authorized official signing for the contracting organization) certifies that the statements herein are true, complete,
<br />and accurate to the best of his or her knowledge, and that he or she is aware that any false, fictitious, or fraudulent
<br />statements or claims may subject him or her to criminal, civil, or administrative penalties. The undersigned agrees
<br />that the contracting organization will comply with the Public Health Service terms and conditions of award if a contract
<br />is awarded.
<br />Washington State Page 29 of 53 HCA IAA K4649
<br />Health Care Authority Revised 10/2020
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