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(3) The undersigned shall require that the language of this certification be included in the award documents for all <br />subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative <br />agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material <br />representation of fact upon which reliance was placed when this transaction was made or entered into. <br />Submission of this certification is a prerequisite for making or entering into this transaction imposed by <br />section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a <br />civil penalty of not less than $10,000 and not more than $100,000 for each such failure. <br />Statement for Loan Guarantees and Loan Insurance <br />The undersigned states, to the best of his or her knowledge and belief, that: <br />If any funds have been paid or will be paid to any person for influencing or attempting to influence an officer or <br />employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member <br />of Congress in connection with this commitment providing for the United States to insure or guarantee a loan, the <br />undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in <br />accordance with its instructions. Submission of this statement is a prerequisite for making or entering into this <br />transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required statement shall <br />be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. <br />2. DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS (DIRECT RECIPIENT): <br />As required by Executive Order 12549, Debarment and Suspension, and implemented at 44 CFR, Part 17: <br />A. The applicant certifies that it and its principals: <br />(1) Are not presently debarred, suspended, proposed for debarment, declared ineligible, sentenced to a <br />denial of Federal benefits by a State or Federal court, or voluntarily excluded from covered transactions <br />by any Federal department or agency; <br />(2) Have not within a three-year period preceding this application been convicted of or had a civil judgment <br />rendered against them for commission of fraud or a criminal offense in connection with obtaining, <br />attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a <br />public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, <br />forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen <br />property; <br />(3) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity <br />(Federal, State, or local) with commission of any of the offenses enumerated in paragraph (A)(2) of this <br />certification; and <br />(4) Have not within a three-year period preceding this application had one or more public transactions <br />(Federal, State, or local) terminated for cause or default; and <br />B. Where the applicant is unable to certify to any of the statements in this certification, he or she shall attach an <br />explanation to this application. <br />3. CERTIFICATIONS REGARDING DRUG-FREE WORKPLACE REQUIREMENTS: This certification <br />commits the applicant to compliance with the certification requirements under 44 CFR, Part 17 Government- <br />wide Requirements for Drug-Free Workplace (Grants). See Article IX. <br />A-1 2