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~.'~T~.' OF ~AI~1 T A ANA <br /> PROJECT NO. OS-3195 <br /> PROPOSAL AND CONTRACT AGREEMENT <br /> CERTIFICATION FOR FEDERAL AID CONTRACTS <br /> The prospective participant certifies, by signing and submitting this bid or proposal, to the best of <br /> 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 the <br /> undersigned, to any person for influencing or attempting to influence an off ter or employee <br /> of any Federal Agency, a Member of Congress, an officer or employee of Congress, or an <br /> employee of a Member of Congress in connection with the awarding of any Federal contract, <br /> the malting of any Federal grant, the making of any Federal loan, the entering into of any <br /> cooperative agreement, and the extension, continuation, renewal, amendment, or modification <br /> of an Federal conhact, grant, loan, or cooperative agreement. <br /> (2) If any funds other Federal appropriated funds have been paid or will be paid to any person for <br /> influencing or attempting to influence an officer or employee of any Federal agency, a <br /> Member of Congress, an officer or employee of Congress, or an employee of a Member of <br /> Congress in connection with Federal contract, grant, loan, or cooperative agreement, the <br /> • undersigned shall complete and submit Standard Form-LLL'x, "Disclosure of Lobbying <br /> Activities" in accordance v~~ith its instructions. <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 making or <br /> entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the <br /> required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 <br /> for each such failure. <br /> The prospective participant also agrees by submitting his or her proposal that he or she shall require <br /> that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and <br /> that all such sub-recipients shall certify and disclose accordingly. <br /> B d ignature <br /> F.T. ZIEBARTH COMPANY <br /> Firm <br /> 04/22/10 <br /> Date <br /> *Standard Form LLL ma be obtained from Caltrans or FHWA offices. <br /> Y <br /> <br /> • <br /> TO BE INCLUDED 1N BID PACKAGE <br /> BP 2 ( of 26 <br /> <br />