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0 CITY OF SANTA ANA <br />ATTACHMENT D <br />NON -LOBBYING CERTIFICATION <br />The prospective participant certifies, by signing and submitting this bid or statement of qualification, to <br />the best of his or her knowledge and belief, that: <br />(1) N61-6dtl61 appr6prated funds have been paid or will be paid, by or on behalf of the undersigned, <br />to any person for influencing or attempting to influence an officer or employee of any Federal <br />agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member <br />of Congrcaa in connectfon with the awarding of any federal contract, the making of any federal <br />grant, the making of any Federal loan, the entering Into of any cooperative agreement, and the <br />extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, <br />or cooperative agreement <br />(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person <br />for Influencing or attempting to influence an officer or employee of any Federal agency, a Member <br />of Congress, an officer or employee of Congress, or an employee of a Member of Congress in <br />connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned <br />shall complete and submit Standard FomrLLL, "Disclosure of Lobbying Activities," in <br />conformance with its instructions. <br />This certification is a material representation of fact upon which reliance was placed when this transaction <br />was made or entered into. Submission of this certification is a prerequisite fnr making or entering into <br />this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required <br />certification shall be subject to a civil penalty of not less than $10,000 and not more than $1110,000 for <br />each such failure. <br />The prospective papipant also agrees by submitting his or her bid or statement of qualifications that he <br />or she shall requi t he language of this certification be included in all lower tier subcontracts, which <br />oxoccd $100.00 a at such a ell certify and disclose accordingly. <br />Signed: <br />Title: President <br />Firm- �Tlownsend Public Affairs, Inc. <br />Date: J'I 2D?• <br />THIS FORM MUST RE COMPLETED AND INCLUDED WITH THE STATEMENT OF QUALIFICATIONS. <br />STATEMENT OF QUALIFICATIONS THAT DO NOT CONTAIN THIS FORM WILL RE CONSIDERED <br />NONRESPONSIVE. <br />RFQ No. 21-016 State Legislative Advocacy Services Page 27 of 29 <br />Q Statement of Qualifications for State Legislative Advocacy Services I City of Santa Ana Page 25 <br />