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APPENDIX <br />ATTACHMENT 4 _ NON-L.C?L3Si3 ING CERTIFICATION <br />The facemxu+re praduipeot certifies", by signing and snb➢n uffig this bid or proposal, to the, bestof his or her knowledge and <br />belief, dial: <br />4No federal appropriated fiends leave been paid or will be paid, by area behalf of the undersigned, to any <br />person for iaf7aencing or anwapting to iniiucirua mt otYlcer or employee bf any ivdsral age�rcy, a Ntcnnbar of <br />Comes", an officer or cirresm ee of Congress, or an employee of a Member of Congress in contraction with <br />the awarding of any federal umtraat, tine making many federal gmrse the making ofany fademi loan, the <br />entering into of any cooperative agreement, and the extension, connnuation, retuiwal, amendment, or <br />modification of any federal contract, grunt, burn, or cooperative agreement. <br />2; If any funds other than federal appropriated funds have been paid or will he paid to any person for <br />influencing or attempting to influence any officer or employee of ary federal agency, a filember of Congress, <br />an o€Iicer ar etnphoyre of Congress, or nn employee of a lvombcr of Ca egress in connection with this tederei <br />eontrau, grant loan, loan err sooperarivo agrmunant, dire undersigned obeli Damp€ate and submit a °`Disciasurh <br />of l abhying Activities". <br />This certificati0n is a material representation of Fact umet which reliance Nn5 placed when rhii transaction Was crude or <br />entered into. Submission of this canificatlon is a is crequisite, for looking or entering into this transaction impsed by Section <br />1332, Tide 31, U.S. Code. Any parson who fails to file the required scrtiiic.a nin shall be subject to a civil penalty of oat leas <br />than $10,000 and not more than 5100,00D for seen such fndurc. <br />The prespactive poricifead also agrees by submitting his or her bid or proposal that he or 6 a shah require data the lnnguagc of <br />this certification be included in ail Mover her subcontracts, which escecd S100,000 and that all such sub recipients shall certify <br />and disclose accordingly. <br />Finn 1jmVsrsa1 <br />Sig cdand front d Name: <br />Title President <br />LLC dba Allied Universal janitorial Services <br />Mark Ii. olivas <br />THIS F dE COMP E D AND BNCL€JDED WITH THE PROPiPaAL. <br />PROPOSALS THAT DO NOT CONTAIN THIS rORM WILL HE CONSIDERED NONRESPONSIVE� <br />City of Santa Ana RFP 19.074 <br />Attachment 4 <br />ALLIED UNIVERSAL JAN]TO RIALSERVICES 25B-66 Page34 <br />