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CITY OF SANTA ANA <br />ATTACHMENT E <br />NON -LOBBYING CERTIFICATION <br />The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or <br />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 proposal that he or she shall <br />require that the language of this certification be included in all lower tier subcontracts, which exceed <br />$100,000 and that all such subrecipients shall ce ' and disclose accordingly. <br />Signed: Tim Burgess <br />Title: President <br />Firm: Inland Moving and Storage Co., Inc., DBA Burgess Moving and Storage <br />Date: ,� 3 <br />THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL. <br />PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE <br />RFP No. 23-058 Library Moving and Storage Services Page 38 of 40 <br />