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CITY OF SANTA ANA <br />RFP NO.: 24-003 <br />CLOSED CIRCUIT TELEVISION (CCTV) INSPECTION OF SANITARY SEWERS <br />NON -LOBBYING CERTIFICATION <br />The prospective participant certifies, by signing and submitting this bid or proposal, to the <br />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 <br />the undersigned, to any person for influencing or attempting to influence an officer <br />or employee of any Federal agency, a Member of Congress, an officer or employee <br />of Congress, or an employee of a Member of Congress in connection with the <br />awarding of any Federal contract, the making of any Federal grant, the making of <br />any Federal loan, the entering into of any cooperative agreement, and the <br />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 <br />to any person for influencing or attempting to influence an officer or employee of <br />any Federal agency, a Member of Congress, an officer or employee of Congress, <br />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 <br />Standard Form-LLL, "Disclosure of Lobbying Activities," in conformance with its <br />instructions. <br />This certification is a material representation of fact upon which reliance was placed when <br />this transaction was made or entered into. Submission of this certification is a prerequisite <br />for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. <br />Any person who fails to file the required certification shall be subject to a civil penalty of <br />not less 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 <br />or she shall require that the language of this certification be included in all lower tier <br />subcontracts, which exceed $100,000 and that all such subrecipients shall certify and <br />disclose accordingly. <br />Signed: <br />Title: <br />Firm: <br />Date: <br />City of Santa Ana RFP 24-003 <br />Closed Circuit Television (CCTV) Inspection of Sanitary Sewers <br />Page 39 <br />