CERTIFICATIONS AND ASSURANCES

	ASSURANCES AND CERTIFICATIONS SIGNATURE PAGE

The Department of Labor will not award a grant or agreement where the grantee/recipient has failed to accept the ASSURANCES AND CERTIFICATIONS contained in this section.  By signing and returning this signature page, the grantee/recipient is providing the certifications set forth below:

A.	Certification Regarding Lobbying, Debarment, Suspension, Other Responsibility Matters - Primary Covered Transactions and Certifications Regarding Drug-Free/Tobacco-Free Workplace,

B.	Certification of Release of Information

C.	Assurances - Non-Construction Programs

D.	Applicant is not a 501(c)(4) organization

APPLICANT NAME and LEGAL ADDRESS:

If there is any reason why one of the assurances or certifications listed cannot be signed, please explain. Applicant need only submit and return this signature page with the grant application. All other instruction shall be kept on file by the applicant.

   SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL		TITLE

   APPLICANT ORGANIZATION					DATE SUBMITTED

Please Note:	This signature page and any pertinent attachments which may be required by these assurances and certifications shall be attached to the applicant's Cost Proposal.