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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 18-6918 <br />MAIN ST & 15TH ST TRAFFIC SIGNAL INSTALLATION <br />FEDERAL PROJECT NO: HSIPL 5063 (189) <br />department or agency with which Oils Imnsocim originated <br />may pursue am8ablo mnndios. Including susponslon andito <br />debarment <br />Cerlllcallm Regarding DobamwM, Suspension, <br />Ineligibility and Voluntary Exclusion -tower Tier <br />Participants: <br />1. The pmspadbe Wwg Ilorpofacipaat corgfne, by <br />submission of this pwpusal, UM nolher it not is pdrelpnis Is <br />pmsongy debaaod, susponded. poposod fordebomsont. <br />doclnmd Inulgblo, a voluntarily excluded from pnrlldpalinO In <br />covered transactions by any Federal depadmotil a effoncy. <br />2. Whore IhoWospoclim lower ON pa Ong Is unable to <br />cerlly to nary N Inc slatommis in this coNimibn such <br />prospWWO Podldpmt Mail Much fo explanation to his <br />proposal. <br />XL CERTIFICATION REGARDING USE OF CONTRACT <br />FUNDS FOR LOBBYING <br />This provision is applicablo to all Fateratroid construction <br />coobncts and to all related subcontracts which exceed <br />$10000(49 CFR 20) <br />1. The pmspocllvo pulcpanl cD Wos, by signing and <br />submitting this bid or proposal, to ma best of his or Inn <br />kwwledge ant hell of, that: <br />a. Na Federal appropriated funds have bam paid orwll be <br />paid, liver on bohalfol the undersigned, to ary person for <br />NOuonchg or allanptina toinlivaao an offhgf or ompteyao a <br />any Federal agahuy, a Member of Confirms, to officer or <br />employee of Congress, or an employee of a Mamba of <br />Congress in cmnecllm „ on the Molding of my Federal <br />contract, the me" crony Fodaralgrarl. Ihemefdng of any <br />Fodeml Icon, the ontorig kilo of my coopormwo ogroanom, <br />coil the extension, continuation, mcexel, anenament or <br />modfpationof any Federal contract, grant, tom, or <br />cooparauw mgmomaa. <br />b. If any funds other than Fetleml appropriated funds have <br />been paid or will be pad to any person for Imumdngor <br />attempting to in luenco an officer or employee of any Federal <br />agency, a Mombor of Conamss, an ofrRa err employee of <br />Congress, or an employee of a Mamba of Congress In <br />comocuon with this Federal cooked. grant, lam, or <br />cooperative agmomari, the urdomignod shol compWo an <br />submit Standard Fame LLL, "Disclosure Form to Repro <br />Lobbying.' In accordance with Its Instructions. <br />2. This codlkalbn Is a material mpmsuntalon of fact upon <br />which mlanco we placed when Oils Imnmclim was mode a <br />uttered into. Submission ofthl9 cedli'.Olbn is a premgdegp <br />for making a Offering into Nis transaction Imposed by 31 <br />U.S.C. IM Any person wholails b fie No required <br />codification; shag be autjecltoe NA penalty of net lase than <br />54000 and not ma, than S100,000 fa each such failure. <br />3. The pmspectivo participant also agrees by submitting is <br />NO prop000l gat Oic participant still require that coo <br />luoguage of this certification be included In al I bswr Ina <br />subcoftmcls, which exceed $100.0110 and that of each <br />radplefis shol codify foul disclose aaordingly. <br />P-29 of P-52 <br />