Laserfiche WebLink
Exhibit D <br />CERTIFICATIOI\T REGARDING LOBBZ'1NG <br />CERTIFICATION FOR CONTRACTS GRANTS LOANS <br />and COOPERATNE AGREEMENTS <br />The undersigned certifies, to 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 <br />the undersigned, to any person for influencing or attempting to influence an <br />officer or employee of an agency, a Member of Congress, an officer or employee <br />of Congress, or an employee of a Member of Congress iri connection with the <br />awarding of any Federal contracts, 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 an_y person for influencing or attempting to influence an officer or employee of <br />any agency; a Member of Congress, an officer or employee of Congress, or an <br />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 Form to Report Lobbying," in accordance <br />with its instructions. <br />3) The undersigned shall require that the language of this certification be included in <br />the award documents for all subawards at all tiers (including agreements) and that <br />all subrecipients shall certify and disclose accordingly. <br />Tlus certification is a material representation of fact upon v,~hich reliance v,~as placed <br />when this transaction was made or entered into. Submission of this certification is a <br />prerequisite for making or entering into this transaction imposed by 31 U.S.C. 1352. Any <br />person who fails to file the required certification shall be subject to a civil penalty of not <br />less than ~ 10,000 and not more that ~ 100,000 for each such failure. <br />Grantee/Contractor Organization <br />William M. Dickerson <br />Executive Director <br />CSII F[JLLERTON AIJ%ILIARY SERVICES CORPORATION <br />Print Name of Certifying Official <br />..~/~~~~ <br />Date <br />Signature <br />25N-64 <br />