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C~ CITY OF SANTA ANA • PROJECT NO. 08-5017: TRAFFIC SIGNAL INSTALLATION ON WII,LITS ST & SULLIVAN ST PROJECT NO. 08-5021: TRAFFIC SIGNAL INSTALLATION ON RAITT ST & GLENWOOD AVE PROJECT NO. 08-5022: TRAFFIC SIGNAL INSTALLATION ON HARBOR BLVD & KENT AVE PROJECT NO. 08-5023: TRAFFIC SIGNAL MODIFICATION ON SANTA ANA BL & FLOWER ST PROPOSAL AND CONTRACT AGREEMENT CERTIFICATION FOR FEDERAL AID CONTRACTS The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief; that: (l) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any Federal Agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of an Federal contract, grant, loan, or cooperative agreement. (2) If any funds other Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL*, "Disclosure of Lobbying Activities" in accordance with its instructions. • This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 3l, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The prospective parti tpa t also agrees by submitting his or her proposal that he or she shall require that the language of this certification be ' cluded in all lower tier subcontracts, which exceed $100,000 and that all such sub- recipients 11 certi n ~ c se accordingly. a- Bidder S~ nature LINCOLN PACIFlC BUIU?ERS, INC Firm Date %Standard Form LLL may be obtained from Caltrans or FHWA offices. • TO BE INCLUDED IN BID PACKAGE BP 30 of 34