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B. The grantee must provide the location site(s) for the performance of work done in connection with the <br />specific grant. <br />Place(s) of Performance (Street address, city, county, state, zip code) <br />DRUG-FREE WORKPLACE - (GRANTEES WHO ARE INDIVIDUALS) <br />As required by the Drug -Free Workplace Act of 1988, and implemented at 7 CFR Part 3021, Subparts <br />A, C, and E, for grantees, as defined at 7 CFR Part 3021: <br />A. As a condition of the grant, I certify that I will not engage in the unlawful manufacture, distribution, <br />dispensing, possession, or use of a controlled substance In conducting any activity with the grant; <br />and <br />B. If convicted of a criminal drug offense resulting from a violation occurring during the conduct of any <br />grant activity, I will report the conviction, in writing, within 10 calendar days of the conviction, to the <br />agency. <br />Notice shall include the identification number(s) of each affected grant. <br />As the duly authorized representative of the Grantee, I hereby certify that the Grantee will <br />comply with the above certifications. <br />Grantee Organization Name <br />Signature of Authorized Representative Date <br />Printed Name of Authorized Representative Title <br />Attachment number 2 \n <br />NCDA&CS Certifications & Assurances Page 3 of 3 <br />Rev, 7/14 F-10 Page 264 <br />