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The prospective participant certifies, byslgningand submittingthis-bid or proposal, to the nest ofhis or her <br />lonowlodge and W110f., that: <br />1. NofoderalapproprlstedflmdsbavoboenpaidorwrUbepstidbysronbehelfofthoundersiped,to <br />auyporaonfor influaneingoraUemptingto in8uenes aoofficer or employee of any Aderal agency, a <br />MomborofCotwess,anoffioeror.emptoyesofess oranemployeeoroMembarofCongrryes <br />In connection with the awarcihtgofsoy fe MI contract, the maldrg3 ofany£odeaztl grant, the ra tdog <br />ofmWfederal l6rn, the entering lotoofGnycooprerwvea utom;attdINoxtenslen,continuation, <br />renewal, amendment, or moOontion of faderai contract, grant; loan, or amperat[w agreement. <br />2. <br />This certification is amaterlatroprresemation of ihot upon which reliance was placed when this transaction was made <br />oreatmWInto, Submission ofthis certification Is aprerauupehe formalongor entering him this; 'iransaotion7mposed <br />byScotto IJs2,fiitloSl, U S. Code, Any person who hilstofile the, req ulrodcertiflcat ion aivaiib0aubjecttoaovlI <br />penalty of less Own $10,000 and not morethanVI06,606for maltsucbfaUur , <br />The piospootive partiolpaut'also agrees by subinitting his or her bld or proposal that he or she shall require, that the <br />language of this eartlfrcation be Included In all lower tier subcontracts, which oxoced $100,000 and that all such stab <br />rsolp#ants Omit cartlfr and disolose accordingly, <br />Firm s�/rTf7 <br />$itpzed and Printed Nom <br />��AFf� ,} •[�i ,+91¢l �aM' 'm. rt �. h,, i..". t'�•S.'�.G4 "'.�.%' �4rw'4tY�•-;r• vFi,.} <br />"�l'�"t'.�`.�'x�{3r�r,'.+'�.''i-�.'-0t•.�')u�.A�uix�9��*.;''�'�'X'e+%J.�a�ir'��•'r;�'��F''�s..�''�r x5.,:�:�ra :o,�;'i�k�t4't'�k;A�.�`'�`irr$ <br />{'a2,.., 4u.:, �: u"ti w� w4.w..�..�.._:r.+'vt„•��'� 'tut,.,.,v.5'isu rw. <br />25E-414 <br />