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Certification for Contracts, Grants, Loans, and Cooperative Agreements <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 undersigned, to any <br />person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, <br />an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding <br />of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of <br />any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any <br />Federal contract, 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 an officer or employee of any agency, a Member of Congress, an officer <br />or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, <br />grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, <br />"Disclosure 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 award documents for <br />all sub -award at all tiers (including subcontracts, subgrants, and contracts under grant, loans, and cooperative <br />agreements) and that all subrecipients shall certify and disclose accordingly. <br />This certification is a material representation of fact upon which reliance was placed when this transaction was <br />made or entered into. Submission of this certification is a prerequisite for making or entering into this <br />transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification <br />shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. <br />RESTRICTION ON STATE LOBBYING <br />(applies to subrecipients as well as States) <br />None of the funds under this program will be used for any activity specifically designed to urge or influence a <br />State or local legislator to favor or oppose the adoption of any specific legislative proposal pending before any <br />State or local legislative body. Such activities include both direct and indirect (e.g., "grassroots") lobbying <br />activities, with one exception. This does not preclude a State official whose salary is supported with NHTSA <br />funds from engaging in direct communications with State or local legislative officials, in accordance with <br />customary State practice, even if such communications urge legislative officials to favor or oppose the adoption <br />of a specific pending legislative proposal. <br />CERTIFICATION REGARDING DEBARMENT AND SUSPENSION <br />(applies to subrecipients as well as States) <br />Instructions for Primary Tier Participant Certification (States) <br />1. By signing and submitting this proposal, the prospective primary tier participant is providing the certification <br />set out below and agrees to comply with the requirements of 2 CFR parts 180 and 1200. <br />2. The inability of a person to provide the certification required below will not necessarily result in denial of <br />participation in this covered transaction. The prospective primary tier participant shall submit an explanation of <br />why it cannot provide the certification set out below. The certification or explanation will be considered in <br />connection with the department or agency's determination whether to enter into this transaction. However, <br />failure of the prospective primary tier participant to furnish a certification or an explanation shall disqualify such <br />person from participation in this transaction. <br />3. The certification in this clause is a material representation of fact upon which reliance was placed when the <br />department or agency determined to enter into this transaction. If it is later determined that the prospective <br />primary tier participant knowingly rendered an erroneous certification, in addition to other remedies available to <br />the Federal Government, the department or agency may terminate this transaction for cause or default or may <br />pursue suspension or debarment. <br />4. The prospective primary tier participant shall provide immediate written notice to the department or agency to <br />which this proposal is submitted if at any time the prospective primary tier participant learns its certification was <br />erroneous when submitted or has become erroneous by reason of changed circumstances. <br />20D-16 <br />