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_. CITY OF SANTA ANA <br />PROJECT NO. 11-7508; LACY NEIGHBORHOOD SEWER AND WATER. MAIN <br />IMPROVEMENTS <br />PROPOSAL AND CONTRACT AGREEMEIV I' <br />CERTIFICATION FOR FEDFR wi -AID CONTRACTS <br />The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or <br />her loaowledge and belief; that: <br />(1) No Federal appropriated fiords have been paid. or will be paid, by or on behalf of the undersigned, <br />to .any person for influencing or attempting to influence an officer or employee of any Federal <br />Agency,. a Member of Congress, an officer or employee of Congress, or an employee of a Member <br />of Congress in connection with the awarding of any Federal contract, the making of any Federal <br />grant, the making of any Federal loan, the entering into of any cooperative agreement, and the <br />extension, continuation, renewal, amendment, or modification of an Federal contract, grant, loan, <br />or cooperative agreement. <br />(2) If any funds other Federal appropriated funds have been paid or will be paid 'to aay person for <br />influencing or attempting to influence an officer m employee of any Federal agency, a Member of <br />- Congress, an officer or employee of Congress, or an employee- of a Member . of Congress in <br />connection with Federal contract, grant, loan, or cooperative agreement, the .undersigned shall <br />_ complete and submit Standard Form-LLL*, "Disclosure of Lobbying Activities" in .accordance <br />with its instructions. - <br />This certification. is a material representation of fact upon which reliance was placed when .this transaction <br />was made or entered into. .Submission of this certification is a prerequisite for malting or entering into this - <br />t?ansaction unposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification <br />shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. <br />The prospective participant also agrees by submitting his or her proposal that he or she shall require that <br />the lan this certification be included in all lower tier subcontracts, which exceed $100,000 and that all <br />such reci en certify and disclose accordingly. <br />D /f??ureG <br />Firm <br />ai/.? ?i <br />Date <br />TO BE INCLUDED IN BID PACKAGE <br />BP 26 of 31