Citizens’ Voice Project
Pre-award Certifications, Assurances and other statements of apparently successful applicant/ recipient
These are not required to be submitted with the application but are only provided for information of the applicants that in the event of short-listing for a subaward, these will be required. TDEA will contact apparently successful, short-listed applicants for provisions of these certifications, assurances and other statements.
Section – D: Pre-award Certifications, Assurances and other statements of applicant/ recipient
Apparently successful applicants will be required to submit Pre-award Certifications, Assurances and other Statements of the Recipient as listed in this section.These Pre-award Certifications, Assurances and other Statements of the Recipient shall not be submitted as part of the initial application.
In order to receive a grant, every applicant will be required to obtain a number from the website of Data Universal Numbering System (DUNS). Guidelines for the process of obtaining this number are provided in this RFA.
The timing of submission of each certification is mentioned with the text of certifications. Certifications required with the application must be provided with it. For certifications required before the award TDEA will notify the apparently successful applicant(s) to submit these documents after evaluation of proposals.These are mandatory conditions precedent to a subaward. A list is provided below:
- Certification regarding terrorist financing implementing EO 13224
- Certification regarding debarment, suspension, ineligibility and voluntary exclusion
- Certification regarding Narcotics offense and drug trafficking by key individuals
- Certification regarding Narcotics offense and drug trafficking by participants
- Certification regarding drug free workplace
- Certification regarding Lobbying
- Certification Regarding Prohibition On Assistance To Drug Traffickers
- Initial environmental examination form
- Certification regarding Voluntary Population Planning Activities
- Certification that the subawardee and its key employees have never been convicted by a court of competent jurisdiction in Pakistan.
- Declaration about the family relationships within management and governance structure of the subawardee organization.
- Certification regarding local cost financing.
- Disclosure and Certification Regarding Political Leadership/ Management of the Subawardee
- Requirement and Guidelines for obtaining DUNS number
- FSRS Subaward Reporting form
- Certification Regarding No profit element in the grant
- Assurance regarding no increment above actual cost
- Certification Regarding Trafficking In Persons
- Prohibition on contracting with entities that require certain internal confidentiality agreements-representation
These certifications and assurances are given in consideration of and for the purpose of obtaining any and all Federal grants, loans, contracts, property, discounts, or other Federal financial assistance extended after the date hereof to the recipient by the Agency, including installment payments after such date on account of applications for Federal financial assistance which was approved before such date. The recipient recognizes and agrees that such Federal financial assistance will be extended in reliance on the representations and agreements made in these assurances, and that TDEA will have the right to seek judicial enforcement of these assurances. These assurances are binding on the recipient, its successors, transferees, and assignees, and the person or persons whose signatures appear below are authorized to sign these assurances on behalf of the recipient.
Solicitation Number:______
Grant Agreement Number (if applicable): ______
Date of Application: ______
Name of Grantee Organization: ______
Name and Title of authorized representative: ______
Signature: ______Date: ______
I.Certification Regarding Terrorist Financing Implementing EO 13224
(To be submitted with the subaward application)
By signing and submitting this application, the prospective recipient provides the certification set out below:
1. The Recipient, to the best of its current knowledge, did not provide, within the
previous ten years, and will take all reasonable steps to ensure that it does not and will not knowingly provide, material support or resources to any individual or entity that commits, attempts to commit, advocates, facilitates, or participates in terrorist acts, or has committed, attempted to commit, facilitated, or participated in terrorist acts, as that term is defined in paragraph 3.
2. The following steps may enable the Recipient to comply with its obligations under paragraph 1:
a. Before providing any material support or resources to an individual or entity, the Recipient will verify that the individual or entity does not (i) appear on the master list of Specially Designated Nationals and Blocked Persons, which is maintained by the U.S. Treasury’s Office of Foreign Assets Control (OFAC), or (ii) is not included in any supplementary information concerning prohibited individuals or entities that may be provided by USAID to the Recipient.
b. Before providing any material support or resources to an individual or entity, the Recipient also will verify that the individual or entity has not been designated by the United Nations Security (UNSC) sanctions committee established under UNSC Resolution 1267 (1999) (the “1267 Committee”) [individuals and entities linked to the Taliban, Usama bin Laden, or the Al Qaida Organization]. To determine whether there has been a published designation of an individual or entity by the 1267 Committee, the Recipient should refer to the consolidated list available online at the Committee’s website: .
c. Before providing any material support or resources to an individual or entity, the Recipient will consider all information about that individual or entity of which it is aware and all public information that is reasonably available to it or of which it should be aware.
d. The Recipient also will implement reasonable monitoring and oversight
procedures to safeguard against assistance being diverted to support terrorist activity.
3. For purposes of this Certification-
a. “Material support and resources” means currency or monetary instruments or financial securities, financial services, lodging, training, expert advice or assistance, safehouses, false documentation or identification, communications equipment, facilities, weapons, lethal substances, explosives, personnel, transportation, and other physical assets, except medicine or religious materials.”
b. “Terrorist act” means-
(i) an act prohibited pursuant to one of the 12 United Nations Conventions and Protocols related to terrorism (see UN terrorism conventions Internet site: ); or
(ii) an act of premeditated, politically motivated violence perpetrated against noncombatant targets by subnational groups or clandestine agents; or
(iii) any other act intended to cause death or serious bodily injury to a civilian, or to any other person not taking an active part in hostilities in a situation of armed conflict, when the purpose of such act, by its nature or context, is to intimidate a population, or to compel a government or an international organization to do or to abstain from doing any act.
c. “Entity” means a partnership, association, corporation, or other organization, group or subgroup.
d. References in this Certification to the provision of material support and resources shall not be deemed to include the furnishing of USAID funds or USAID-financed commodities to the ultimate beneficiaries of USAID assistance, such as recipients of food, medical care, micro-enterprise loans, shelter, etc., unless the Recipient has reason to believe that one or more of these beneficiaries commits, attempts to commit, advocates, facilitates, or participates in terrorist acts, or has committed, attempted to commit, facilitated or participated in terrorist acts.
e. The Recipient’s obligations under paragraph 1 are not applicable to the
procurement of goods and/or services by the Recipient that are acquired in the ordinary course of business through contract or purchase, e.g., utilities, rents, office supplies, gasoline, etc., unless the Recipient has reason to believe that a vendor or supplier of such goods and services commits, attempts to commit, advocates, facilitates, or participates in terrorist acts, or has committed, attempted to commit, facilitated or participated in terrorist acts.
This Certification is an express term and condition of any agreement issued as a result of this application, and any violation of it shall be grounds for unilateral termination of the agreement by TDEA/USAID prior to the end of its term.
Solicitation Number:______
Grant Agreement Number (if applicable): ______
Date of Application: ______
Name of Grantee Organization: ______
Name and Title of authorized representative: ______
Signature: ______Date: ______
II.Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion
(To be submitted with the subaward application)
(a)Instructions for 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, has the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. 1/ You may contact the person to which 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 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 this clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary ExclusionLower Tier covered Transaction," 2/ without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.
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 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 Non procurement List.
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 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.
1/See ADS Chapter 303, 22 CFR 208.
2/For USAID, this clause is entitled "Debarment, Suspension, Ineligibility, and Voluntary Exclusion (March 1989)" and is set forth in the USAID grant standard provision for U.S. nongovernmental organizations entitled "Debarment, Suspension, and Related Matters" (see ADS Chapter 303), or in the USAID grant standard provision for nonU.S. nongovernmental organizations entitled "Debarment, Suspension, and Other Responsibility Matters" (see ADS Chapter 303).
(b)Certification Regarding Debarment, Suspension, Ineligibility and Voluntary ExclusionLower 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.
Solicitation Number:______
Grant Agreement Number (if applicable): ______
Date of Application: ______
Name of Grantee Organization: ______
Name and Title of authorized representative: ______
Signature: ______Date: ______
III.Certification Regarding Narcotics Offense and Drug Trafficking By Key Individuals
(To be submitted with the subaward application)
I hereby certify that within the last ten years:
1. I have not been convicted of a violation of, or a conspiracy to violate, any law or regulation of the United States or any other country concerning narcotic or psychotropic drugs or other controlled substances.
2. I am not and have not been an illicit trafficker in any such drug or controlled substance.
3. I am not and have not been a knowing assistor, abettor, conspirator, or colluder with others in the illicit trafficking in any such drug or substance.
Signature: ______
Date: ______
Name: ______
Title/Position: ______
Organization: ______
Address: ______
______
Date of Birth: ______
NOTICE:
1. You are required to sign this Certification under the provisions of 22 CFR Part 140, Prohibition on Assistance to Drug Traffickers. These regulations were issued by the Department of State and require that certain key individuals of organizations must sign this Certification.
2. If you make a false Certification you are subject to U.S. criminal prosecution under 18 U.S.C. 1001.
IV.Certification Regarding Narcotics Offense and Drug Trafficking By Participants
(To be submitted with the subaward application)
1. I hereby certify that within the last ten years:
a. I have not been convicted of a violation of, or a conspiracy to violate, any law or regulation of the United States or any other country concerning narcotic or psychotropic drugs or other controlled substances.
b. I am not and have not been an illicit trafficker in any such drug or controlled substance.
c. I am not or have not been a knowing assistor, abettor, conspirator, or colluder with others in the illicit trafficking in any such drug or substance.
2. I understand that USAID may terminate my training if it is determined that I engaged in the above conduct during the last ten years or during my USAID training.
Signature: ______
Date: ______
Name: ______
Title/Position: ______
Organization: ______
Address: ______
______
Date of Birth: ______
NOTICE:
1. You are required to sign this Certification under the provisions of 22 CFR Part 140, Prohibition on Assistance to Drug Traffickers. These regulations were issued by the Department of State and require that certain participants must sign this Certification.
2. If you make a false Certification you are subject to U.S. criminal prosecution under 18 U.S.C. 1001.
V.Certification Regarding Drug Free Workplace
(To be submitted with the subaward application)
The grant beneficiary of this Grant Agreement hereby certifies the following:
1That this certification is a material representation of fact from the grant beneficiary upon which reliance was placed when TDEA awarded the grant;
2That the grant beneficiary understands that if it is later determined that the grant beneficiary knowingly rendered a false certification, or otherwise violated the requirements of the Drug-Free Workplace Act, TDEA , in addition to any other remedies available, may take action authorized under the Drug-Free Workplace Act; and
3That the Beneficiary currently maintains and will continue to maintain and provide throughout the life of the grant 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 grant beneficiary'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 grant beneficiary’s policy of maintaining a Drug-Free Workplace;
- Any available drug counseling, rehabilitation, and employee assistance programs; and
- The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace;
- Making it a requirement that each employee to be 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; and
- 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 TDEA within ten days after receiving notice under subparagraph (d) (3) 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) (3), with respect to any employee who is so convicted:
- Taking appropriate personnel action against such an employee, up to and including termination; or
- Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by local health law enforcement, or other appropriate agency;
- Making a good-faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (a), (b), (c), (d), (e) and (f).
The grant beneficiary further certifies that the site(s) for the performance of work to be done in connection with the grant is:
Street address:
City, postal code:
The grant beneficiary certifies that, as a condition of the grant, it will not engage in the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance in conducting any activity with the grant.
Certified by: ______
(Authorized official)
Name: ______
Title: ______
Date:______
VI.Certification Regarding Lobbying
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 Cooperative Agreement, 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.