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INDIANA HOUSING AND COMMUNITY DEVELOPMENT AUTHORITY <br />STATE OF INDIANA <br />DRUG-FRFIX WORIaLAOE CERTIFICATION <br />Pursuant to Executive Order No, 90-5, April 12, 1994, issued by Governor Evan Bayh, the Indiana <br />Department of Administration requires the inclusion of this certification in all contracts with and grants <br />from the State of Indiana in excess of $25,000. No award of a contract or grant shall be made, and no <br />contract, purchase order or agreement, the total of which amount exceeds $25,000, shall be valid unless and <br />until this certification has been fully executed by the Contractor of Grantee and attached to the contract or <br />agreement as part of the contract documents. False certification or violation of the certification may result <br />in sanctions including, but not limited to, suspension of contract payments, termination of the contract <br />payments, termination of the contract or agreement and/or debarment of contracting opportunities with the <br />State for up to three (3) years. <br />The Contractor/Grantee certifies and agrees that it will provide a drug -free workplace by: <br />(a) Publishing and providing to all of its employees a statement notifying employees that the <br />unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in <br />the Contractor's workplace and specifying the actions that will be taken against employees for violations of <br />such prohibition; and <br />(b) Establishing a drug-fi-ee awareness program to inform employees about (1) the dangers of <br />drug abuse in the workplace; (2) the Contractor's policy of maintaining a drug -free workplace; (3) any <br />available drug counseling, rehabilitation, and employee assistance programs; and (4) the penalties that may <br />be imposed upon an employee for drug abuse violation occurring in the workplace; <br />(c) Notifying all employees in the statement required by subparagraph (a) above that as a <br />condition of continued employment the employee will (1) abide by the terms of the statement; and (2) <br />notify the employer of any criminal drug use conviction for a violation occurring in the workplace no later <br />than five (5) days after such a conviction; <br />(d) Notifying in writing the contracting State Agency and the Indiana Department of <br />Administration within ten (10) days after receiving notice from an employee under subdivision (c)-(2) <br />above, or otherwise receiving actual notice of a conviction; <br />(e) Within thirty (30) days after receiving notice under subdivision (c)-(2) above of a <br />conviction, imposing the following sanctions or remedial measures on any employee who is convicted of <br />drug abuse violations occurring in the workplace: (1) tape appropriate personnel action against the <br />employee, up to and including termination; or (2) require such employee to satisfactorily participate in a <br />drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State or local <br />health, law enforcement, or other appropriate agency; and <br />(f) Making a good faith effort to maintain a drug -free workplace through the implementation <br />of subparagraphs (a) through (e) above. <br />THE UNDERSIGNED AFFIRMS, UNDEiR PENALTIES OF PERJURE', TIIAT ITE OR SHE IS <br />AUTHORIZED TO EXECUTE THIS CERTIFICATION ON BEHALF OF THE DESIGNATED' <br />ORGANI7 WON. <br />Ci of South Bend <br />Printed Name of Organization <br />Signature ofAthorizedRePresentative <br />Printed Narne and Title <br />DR20R-018-003 <br />Reqursition/Coniract/Grant ID Number <br />Date <br />STATE FORM 44260 (R/4-91) <br />