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STATE OF INDIANA <br />DRUG-FREE WORKPLACE CERTIFICATION <br />Pursuant to Executive Order No. 90-5, April 12, 1990, issued by Governor Evan Bayh, the Indiana Department of <br />Administration requires the inclusion of this certificate in all contracts with and grants from the State of Indiana in <br />excess of $25,000. No award of a contract or grant shall be made, and no contract, purchase order or agreement, the <br />total amount of which exceeds $25,000, shall be valid unless and until this certification has been fully executed by the <br />Contractor or Grantee and attached to the contract or agreement as part of the contract documents. False certification <br />or violation of the certification may result in sanctions including, but not limited to, suspension of contract payments, <br />termination of the contract or agreement and/or debarment of contracting opportunities with the State for up to three <br />(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 unlawful <br />manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the Contractor's <br />workplace and specifying the actions that will be taken against employees for violations of such prohibitions; and <br />(b)Establishing a drug-free awareness program to inform employees about (1) the dangers of drug <br />abuse in the workplace; (2) the Contractor's policy of maintaining a drug-free workplace; (3) any available drug <br />counseling, rehabilitation, and employee assistance programs; and (4) the penalties that may be imposed upon an <br />employee for drug abuse violations occurring in the workplace; <br />(c)Notifying all employees in the statement required by subparagraph (a) above that as a condition of <br />continued employment the employee will (1) abide by the terms of the statement; and (2) notify the employer of any <br />criminal drug statute conviction for a violation occurring in the workplace no later than five (5) days after such <br />conviction; <br />(d)Notifying in writing the contracting State Agency and the Indiana Department of Administration <br />within ten (10) days after receiving notice from an employee under subdivision (c) (2) above, or otherwise receiving <br />actual notice of such conviction; <br />(e)Within thirty (30) days after receiving notice under subdivision (c) (2) above of a conviction, <br />imposing the following sanctions or remedial measures on any employee who is convicted of drug abuse violations <br />occurring in the workplace: (1) take appropriate personnel action against the employee, up to and including <br />termination; or (2) require such employee to satisfactorily participate in a drug abuse assistance or rehabilitation <br />program approved for such purposes by a Federal, State or local health, law enforcement, or other appropriate agency; <br />and <br />(f)Making a good faith effort to maintain a drug-free workplace through the implementation of <br />subparagraphs (a) through (c) above. <br />THE UNDERSIGNED AFFIRMS, UNDER PENALTIES OF PERJURY, THAT HE OR SHE IS <br />AUTHORIZED TO EXECUTE THIS CERTIFICATION ON BEHALF OF THE DESIGNATED ORGANIZATION. <br />Printed Name of Organization Contract/Grant ID Number <br />X <br />Signature of Authorized Representative Date <br />Printed Name and Title