UNITED STATES DEPARTMENT OF JUSTICE, DRUG ENFORCEMENT ADIMINSTARTION (DEA)

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(1) Abide by the terms of the statement; and (2) Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace no later than five calendar gave after such conviction: VNotifying the agency, in writing, within 10 calendar days er receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such convic- tion. Employers of .convicted employees must provide notice includin0 position title to: Department of Justice, Office of Justice Programs, ATtN: Control Desk, 633 Indiana Avenue, N.W. Washington D.C. 20531. Notice shall include the iden- tification number(sj of each affected grant; (f) Taking one of the following actions, within 30 calendar days of receiving notice under subparagraph (d)(2), with respect to any employee who is so convicted - Check ❑ if there are workplace on file that are not identified here. Section 67, 630 of the regulations provides that a grantee that is a State may elect to make one certification in each Federal fiscal year. A copy of which should be included with each ap plica8on for Department of Justice funding. States and Stale agencies may elect to use OJP Form 406117. Check ❑ if the State has elected to complete OJP Form 4061n. (1) Taking apppropriate personnel action against such an employee, up to and including termination consistent with the DRUG -FREE WORKPLACE requirements of the Rehabilitation Act of 19�3, as amended; or (GRANTEES WHO ARE INDIVIDUALS) (2) Requiring such employee to, ,participate satisfactorily in a As required by the Druq Free Workplace Act of 1988, and drug abuse assistance or rehabilitation program approved for Implemented at 28 CFR Part 67, Subpart F, for ggrantees, as such purposes by a Federal, State, or local health, law enforce- defined at 28 CFR Part 67; Sections 67.615 and 67.620- ment, or other appropriate agency; Ig) Making a good faith effort to confinue to maintain a drugg- ffree workpplace through implementation of paragraphs (a), (b), (c), (d), (e), and (1). B. The grantee may insert in the space provided below the site(s) for the performance of work done in connection with the specific grant: Place of Performance (Street address, city, country, state, zip code) A. As a condition of the grant I certify that I will not engage in the unlawful manufacture rtsbibution, dispensing,.posses- sion, or use of a controlled substance in condition any activity with the grant; and B. If convinced of a criminal drug offense resulting from a violation occurring during the conduct of any grant acW I wlll report the conviction, in wdtinlq, within 70 calendar days of the conviction to: Department of Justice, Office of Justice Programs, ATTIC: Control Desk, 633 Indiana Avenue, N.W., Washington, D.C. 20531. As the duly authorized representative of the applicant. I hereby certify that the applicant will comply with the above certifications. 1. Grantee Name and Address: Santa Ana Police Department 2. Application Number and/or Project Name 4. Typed Name and Title of Authorized Representative David Valentin, Chief of Police 3. Grantee IRSNendor Number 0