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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 />5. The terms covered transaction, civil judgment, debarment, suspension, ineligible, participant, person,
<br />principal, and voluntarily excluded, as used in this clause, are defined in 2 CFR parts 180 and 1200. You may
<br />contact the department or agency to which this proposal is being submitted for assistance in obtaining a copy of
<br />those regulations.
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