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Certification Regarding Lobbying <br />Certification for Contracts Grants Loins and Cooperative A regiments <br />The undersigned certifies, to the best of his or her knowledge and belief, that: <br />(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the <br />undersigned, to any person for influencing or attempting to influence an officer or <br />employee of any agency, a Member of Congress, an officer or employee of Congress, or <br />an employee of a Member of Congress in connection with the awarding of any Federal <br />contract, the making of any cooperative agreement, and the extension, continuation, <br />renewal, amendment, or modification of any Federal contact, grant, loan or cooperative <br />agreement. <br />(2.) If any funds other than Federal appropriated funds have been paid or will be paid to <br />any person for influencing or attempting to influence an officer or employee of any <br />agency, a Member of Congress, an officer or employee of Congress, or an employee of a <br />Member of Congress in connection with this Federal contract, grant, loan, or cooperative <br />agreement, the undersigned shall complete and submit Standard Form -LLL, "Disclosure <br />Form to Report Lobbying," in accordance with its instructions. <br />(3) The undersigned shall require that the language of this certification be included in the <br />award documents for all subawards at all tiers (including subcontract, subgrants, and <br />contracts under grants, loans, and cooperative agreements) and that all subrecipients shall <br />certify and disclose accordingly. <br />This certification is a material representation of fact upon which reliance was placed <br />when this transaction was made or entered into. Submission of this certification is a <br />prerequisite for making or entering into this transaction imposed by Section 1352, Title <br />31, U. S. Code. Any person who fails to file the required certification shall be subject to <br />a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. <br />Community Health Initiative of Orange County <br />Grantee/Contactor Organization <br />Georgina Maldonado, Execuitve Director <br />Name of Certifying Officer <br />EXHIBIT D <br />Page I of 2 <br />