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Page 10 of 13 <br />shalt complete and submit Standard Form - LLL, "Disclosure Form #o Report Lobbying," in <br />accordance with its instrucfions. <br />No part of any appropr€ation contained in this contract shall be used to pay the salary or <br />expenses of any grant or contract recipient, or agent acting for such recipient, related to any <br />activity designed to influence legislation or appropriation pending before the Congress. <br />(This certification Is a material representation of fact upon which reliance was placed when this <br />Agreement was made or entered into. This certification is a requirement far making or entering <br />Into this Agreement imposed by Section 1352,Title 31, U.S. Code.} <br />25. Drug Free Workplace. By signing this contract the Agency certifies #hat It will provide a drug <br />free workplace by implementing the provisions at 29 CFR 98.630, Appendix C, pertaining to the <br />Drug Fres Workplace. In accordance with these provisions, a list of places where performance <br />of work will take place in connection with this specific grant must be maintained at the project <br />office and available for Federal inspection. <br />26. Audit and Audit/Assessment Resolutions and Disallowed Casts. The Agency agrees to have an <br />annual independent audit in accordance with North Carolina General Sfakutes, North Carolina <br />Local Government Commission requirements, Division of Aging and Adult Services Program Audit <br />Guide for Aging Services and Federal Office of Budget and Management (OMB) Circular A-133. <br />Community service providers must provide a copy of their audit and/or year end financial <br />statemenfs to the Area Agency on Aging. Community service providers, as specified in <br />paragraph one (1) are subject to audit and fiscal reporting requ[rements as stated in 2003 <br />revisions to OMB Circular A-133 and NC General Statute 143-6.1, where applicable. <br />information on audit and fiscal reporting requirements can be found at <br />http:/lwww. ncauditor. net/webprojectldefault.asp?non profit. <br />If the contractor is a governmental entity, such entity is subject to the provisions of the requirements of <br />OMB Circular A-133 and Ehe NC Single Aud[t Implementation Act of 1987. Non-government agencies must <br />comply with GS 143C-6-23 as outlined in the chart below. <br />NON PROFIT ONLY <br />Required State Grants Reporting <br />$1 - $24,999. $25;440;= $499;999 $500tj00+in State $50b,a00+-_in;State less than $500;000" <br />= _ , `Furids`AND Federal ~ finis AND.;~~0~400 i~ State funds AND. <br />_ ?pass tirough,funds in- ; in Federal Pass ' $500,000in Federal <br /> an'arna~nt legs than ,' ~ through funds .: ~ :pass ~hru funds. T <br /> _ _ <br />_ <br />. "" _ <br />, - <br />Certifica#ion Certification Form Certification Form Certification Form Certification Form <br />Form <br />Brief More detailed Audit and Audit and Audit and <br />accounting and accounting (schedule Schedule of Awards Schedule of Awards Schedule of Awards <br />program of receipts and (usually included in (usually included in (usuai[y ir~~,{f},u ber <br />activities and ex enditures audit audif au~d' a 81 of 362 <br />