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CITY OF SANTA ANA <br />PROJECT NO. 10-6704: TRAFFIC SIGNAL INSTALLATION ON CIVIC CENTER DR 8c PACIFIC ST <br />PROJECT NO. 10-6705: TRAFFIC SIGNAL INSTALLATION ON 17TH ST 8r KING ST <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 his or her <br />knowledge and belief; that: <br />(1) No Federal appropriated funds have been paid or will be paid, by or on be half of the undersigned, to any <br />person for 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 Congress in <br />connection with the awarding of any Federal contract, the making of any Federal grant, the making of <br />any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, <br />renewal, amendment, or modification of an Federal contract, 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 Member of <br />Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection <br />with Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit <br />Standard Form-LLL*, "Disclosure of Lobbying Activities" in accordance with its instructions. <br />This certification is a material representation of f ct upon which reliance was placed when this transaction was <br />made or entered into. Submission of this certificatio is a prerequisite for making or entering into this transaction <br />imposed by Section 1352, Title 3 1, U.S. Code. Any p rson who fails to file the required certification shall be subject to <br />a civil penalty of not less than $10,000 and not mor than $100,000 for each such failure. <br />The prospective participant also agrees y submitting his or her proposal that he or she shall require that the <br />language of this certifi tion be included in all ower tier subcontracts, which exceed $100,000 and that all such sub- <br />recipients shall certify a?idl?dissncP ascordingl <br />BIDDER Signature `? <br />Ca It?r???ct ?'ro-F?-s?c?v.c:? E??t?er?rc? <br />Firm <br />5/?3/.-z <br />Date <br />TO BE INCLUDED IN BID PACKAGE <br />BP 28 of 32