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CITY OF SANTA ANA PROJECT 13 -7516: MADISON PARK COMMUNITY GARDEN AND BASKETBALL COURT PROJECT 10 -7564: GARFIELD STREET AT BROWN STREET PARKING LOT EXTENSION PROJECT 13 -7512: MABURY PARK SECURITY LIGHTING PROPOSAL AND CONTRACT AGREEMENT CERTIFICATION FOR FEDERAL AID CONTRACTS The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any Federal Agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of an Federal contract, grant, loan, or cooperative agreement. (2) If any funds other Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form -LLL *, "Disclosure of Lobbying Activities" in accordance with its instructions. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The prospective participant also agrees by submitting his or her proposal that he or she shall require that the language of this certif ation be included in all lower tier subcontracts, which exceed $100,000 and that all such sub- recipients all c rtify and disclose accordingly. BIDDER Signatu K�6 lJ� Firm Date *Standard Form LLL maybe obtained from Cattrans or FHWA offices. TO BE INCLUDED IN BID PACKAGE BP 29 of 33