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FROM.:CITY OF SANTA FlNA FAX NO. 71 7-6736 4 C ct. 13 2005 04:10PM P4 <br />I, <br />a,' <br />��' <br />I lie and to the best Of hi id that: <br />F l <br />+ <br />behatrof the <br />cer o: <br />oG cmiid C dlfCongress, or <br />7 empl i Congress in. iaf any Federal <br />a ;f it ry •'S700pExr, I' <br />'ter,. i '?3. ^, {• Jl •.1 N "..,.. � ','kl., " ."� <br />(2) if any funds other than Federal appropriated funds have been paid or will be -:laid to <br />any person for influencing or attempting to influence an officer or employee of airy <br />agency, a Member of Congress, an officer or employee of Congress, or an emplo ,,ee of a <br />Member of Congress in connection with this Federal contract, grant, loan, or cool: crative <br />agreement, the undersigned shall complete and submit Standard Form -LLL, "Dis,.losure <br />Form to Report Lobbying," in accordance with its instructions. <br />(3) The undersigned shall require that the Ia4a9c of this certification be uu lud d in the <br />award documents for all subawards at all tiers (including su + tact, subgrants, :md <br />contracts under gr6rits, lotlns, and eooperWU tai EL'subrecipients shall <br />certify and disclose accordingly. <br />This ccrtificatiat', a nuatcrial rcprescatat fact,i wI teliance was plw:ed <br />b 1 a v hen this' E, cation iii a <br />' rcreytts i%' �C iteriitg tti 'on 1352, Title <br />fly 31, tl. S. }' ivfio, fails to i tliall be su: +jert to <br />z ry <br />a civil penalty onvt less than $10,000 antiiparo than each such failure. <br />4 )a } dl <br />c:. "K.t� <br />Orante on actor Organization Pm,gr<m Title <br />Name of Certifying Officer signature Date <br />pp t <br />