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The prospective participant cerfifles, by signing and submitting this bid or proposal, to the best of his or her <br />knowledge and belief, that: <br />1. No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to <br />any person for Influencing or attempting to influence an officer or employee of any federal agency, a <br />Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress <br />in connection with the awarding of any federal contract, the making of any federal grant, the making <br />of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, <br />renewal, amendment, or modification of any federal oontraet, grant, loan, or cooperative agreement, <br />2, if any funds other than federal appropriated funds have been paid or will be paid to any person for <br />Influencing or attempting to influence any officer or employee of any federal agency, a Member of <br />Congress, an officer or employee of Congress, or an employee of a Member of Congress in <br />connection with this federal contract, grant loan, loan or cooperative agreement, the undersigned <br />shall complete and submit a "Disclosure of Lobbying Activitles", <br />This certification 1s a material representation of fact upon which reliance was placed when this transaction was made <br />or antared Into. Submission of this certification Is a prerequisite for making or entering into this transaction imposed <br />by Section 1352, Title 31, U. S. Code. Any person who fails to file the required certification shall be subject to a civil <br />penalty of not less than $10,000 and not more than $100,000 for each such failure. <br />The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require that the <br />language of this certification be Winded in all lower tier subcontracts, which exceed $106,000 and that all such sub <br />recipients shall certify and disclose accordingly. <br />Signed and Printed Name: <br />Title <br />Date March <br />City of Santa Ana RFP <br />Page A3-2 <br />