Laserfiche WebLink
CITY OF SANTA ANA <br />RFQ No. 22-005 State Legislative Advocacy Services Page 27 of 29 <br /> <br /> <br /> <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) No Federal appropriated 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 Congress in connection 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 Form-LLL, "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 for 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 $100,000 for <br />each such failure. <br />The prospective participant also agrees by submitting his or her bid or statement of qualificationsthat he <br />or she shall require that the language of this certification be included in all lower tier subcontracts, which <br />exceed $100,000 and that all such subrecipients shall certify and disclose accordingly. <br />Signed: <br /> <br />Title: <br /> <br />Firm: <br /> <br />Date: <br /> <br /> <br /> <br /> <br /> <br /> <br />THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE STATEMENT OF QUALIFICATION. <br />STATEMENT OF QUALIFICATIONS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED <br />NONRESPONSIVE. <br /> <br /> <br />ATTACHMENT D <br /> <br />NON-LOBBYING CERTIFICATION