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EXHIBIT F <br /> ALT H 4 <br /> c~ ti~ CERTIFICATION REGARDING LOBBYING <br /> r DEPARTMENT OF HEALTH AND HUMAN SERVICES <br /> ~ FAMILY SUPPORT ADMINISTRATION <br /> <br /> 2 <br /> ~ <br /> r a'" <br /> bay ,,~~c PROGRAM: Community Services Block Grant/ARRA <br /> °•ust~•e <br /> PERIOD: JUIy 1, 2009 through September 30, 2010 <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 <br /> behalf of the undersigned, to any person for influencing or attempting to <br /> influence an officer or employee of any agency, a Member of Congress, an <br /> officer or employee of Congress, or an employee of a Member of Congress in <br /> connection with the awarding of any Federal contract, continuation, renewal, <br /> amendment, or modification of any Federal contract, grant, loan, or <br /> cooperative agreement. <br /> (2) If any funds other than Federal appropriated funds have been paid or <br /> will be paid to any person for influencing or attempting to influence an officer <br /> or employee of any agency, a Member of Congress, an officer or employee of <br /> Congress, or an employee of a Member of Congress in connection with this <br /> Federal contract, grant, loan, or cooperative agreement, the undersigned shall <br /> complete and submit Standard Form LLL, "Disclosure Form to Report <br /> Lobbying," in accordance with its instructions. <br /> (3) The undersigned shall require that the language of this certification be <br /> included in the award document for subawards at all tiers (including <br /> subcontracts, subgrants, and contracts under grants, loans, and cooperative <br /> agreements) and that all subrecipients shall certify and disclose accordingly. <br /> This certification is a material representation of fact upon which reliance was <br /> placed when this transaction was made or entered into. Submission of this <br /> certification is a prerequisite for making or entering into this transaction <br /> 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 <br /> $10,000 and not more than $100,000 for each such failure. <br /> Title Signature <br /> Agency/Organization Date <br /> 25L~-37 <br /> <br />