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<br />EXHIBIT G <br /> <br />CONTRACT NO: <br /> <br />CERTIFICATION REGARDING LOBBYING <br /> <br />CERTIFICATION FOR CONTRACTS. GRANTS. LOANS. <br />AND COOPERATIVE AGREEMENTS <br /> <br />The undersigned certifies, to the best of his or her knowledge and belief, that: <br /> <br />(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the <br />undersigned, to any person for influencing or attempting to influence an officer or employee of <br />an agency, a member of Congress, an officer or employee of Congress, or an employee of a <br />Member of Congress in connection with the awarding of any Federal contract, the making of any <br />Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, <br />and the extension, continuation, renewal, amendment, or modification of any Federal contract, <br />grant, loan, or cooperative agreement. <br /> <br />(2) If any funds other than Federal appropriated funds have been paid or will be paid to any <br />person for influencing or attempting to influence an officer or employee of any agency, a <br />Member of Congress, an officer or employee of Congress, or an employee of a member of <br />Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the <br />undersigned shall complete and submit Standard Form-LLL,"Disclosure Form to Report <br />Lobbying," in accordance with its instructions. <br /> <br />(3) The undersigned shall require that the language of this certification be included in the award <br />documents for all* subawards at all tiers (including subcontracts, subgrants and contracts under <br />grants, loans, and cooperative agreements) and that all* subrecipients shall certify and disclose <br />accordingly. <br /> <br />This certification Is a material representation of fact upon which reliance was placed when this <br />transaction was made or entered into. Submission of this certification is a prerequisite for <br />making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any <br />person who fails to file the required certification shall be subject to a civil penalty of not less than <br />$10,000 and not more than $100,000 for each such failure. <br /> <br />FORMULA <br /> <br />Citv of Santa Ana <br />Grantee/Contractor Organization <br /> <br />Dislocated Worker Mortaaae <br />ProgramlTitle <br /> <br />David N. Ream. Citv Manaaer <br />Name and Title of Authorized Signatory <br /> <br />C-S~~~ f D.~ <br /> <br />8f' ~lffi <br />Dat <br /> <br />*Note: <br /> <br />In these instances, "All," in the Final Rule is expected to be clarified to show that It <br />applies to covered contracUgrant transactions over $100,000 (per OMS). <br />