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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 18-6906 <br />EDINGER AVE, AND BRISTOL ST. CLASS II BICYCLE LANES <br />FEDERAL PROJECT NO: HSIPL 5063(180) <br />NON -LOBBYING CERTIFICATION FOR FEDERAL AID CONTRACTS <br />The prospective participant certifies, by signing and submitting this bid or proposal, to the best of <br />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 influence or attempting to influence an officer or <br />employee of Congress, or an employee of a Member of Congress in connection <br />with the awarding of any Federal contract, the making of any Federal grant, the <br />making of any Federal loan, the entering into of any cooperative agreement, and the <br />extension, continuation, renewal, amendment or modification of any Federal <br />contract, grant, loan, or cooperative agreement. <br />(2) If any funds other than Federal appropriate 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 />Federal agency, a Member of Congress, an officer or employee of Congress, or an <br />employee of a Member of Congress in connection with this Federal contract, grant, <br />loan, or cooperative agreement, the undersigned shall complete and submit Standard <br />Form-LLL, "Disclosure of Lobbying Activities,' in accordance with its instructions. <br />This certification is a material representation of fact upon which reliance was placed when <br />this transaction was made or entered into. Submission of this certification is a prerequisite for <br />making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person <br />who fails to file the required certification shall be subject to a civil penalty of not less than $ 10,000 <br />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 <br />she shall require that the language of this certification be included in all lower tier subcontracts, <br />which exceed $100,000 and that all such sub -recipients shall certify and disclose accordingly. <br />Signed <br />Title Edward J. Carlson, Vice President <br />Firm All American Asphalt <br />Date /b-ZZ-1 q <br />• Standard Form LLL may be obtained from Caltrans and FHWA offices. <br />P-23 of P-40 <br />20D-37 <br />