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Local Assistance Procedures Manual <br />Exhibit 12-H <br />NONLOBBYING CERTIFICATION <br />FOR FEDERAL -AID CONTRACTS <br />Sample Bid <br />The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and <br />belief, that: <br />(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for <br />influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an <br />officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any <br />Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any <br />cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal <br />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 influencing or <br />attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or <br />employee of Congress, or an 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 Form-LLL, "Disclosure of <br />Lobbying Activities," in conformance with its instructions. <br />This certification is a material representation of fact upon which reliance was placed when this transaction was made or <br />entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section <br />1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less <br />than $10,000 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 she shall require that the language <br />of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such subrecipients shall <br />certify and disclose accordingly. <br />LPP 18-01 <br />20E-41 <br />Page 11 of 22 <br />January 2019 <br />