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CITY OF SANTA ANA <br />PROJECT NO. 12 -6758: TRAFFIC SIGNAL INSTALLATION ON FAIRVIEW ST & EDNA DR <br />PROJECT NO. 12 -6759: TRAFFIC SIGNAL MODIFICATION ON MCFADDEN AVE & EUCLID 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 behalf 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 fact upon which reliance was placed when this transaction was <br />made or entered into. Submission of this 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 required certification shall be subject to <br />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 the <br />language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such sub- <br />recipients_shalLeellify and disclose accordingly. <br />ignZt a n: Fl ASr -t,u S-0�--N3 <br />Firm I <br />Date <br />*Standard Form LLL may be obtained from Caltrans or FHWA offices. <br />TO BE INCLUDED IN BID PACKAGE <br />BP 26 of 30 <br />