Laserfiche WebLink
CERTIFICATION REGARDING LOBBYING <br />CERTIFICATION FOR CONTRACTS GRANTS LOANS <br />and COOPERATIVE AGREEMENTS <br />The undersigned certifies, to the best of his or her knowledge and belief, that: <br />1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the <br />undersigned, to any person for influencing or attempting to influence an officer or <br />employee of any agency, a Member of Congress in connection with the awarding of any <br />Federal contract, the making of any Federal grant, the making of any Federal loan, the <br />entering into of any cooperative agreement, and the extension, continuation, renewal, <br />amendment, or modification of any Federal contract, grant, loan, or cooperative <br />agreement. <br />2) If any funds other than Federal appropriated funds have been paid or will be paid to any <br />person for influencing or attempting to influence an officer or employee of any agency, a <br />Member of Congress, an officer or employee of Congress, or an employee of a member of <br />Congress in connection with this Federal contract, grant, loan, or cooperative agreement, <br />the undersigned shall complete and submit Standard Form -LLL, "Disclosure Form to <br />Report Lobbying." in accordance with its instructions. <br />3) The undersigned shall require that the language of this certification be included in the <br />award documents for all subawards at all tiers (including agreements) and that all <br />subrecipients shall certify and disclose accordingly. <br />This certification is a material representation of fact upon which reliance was placed when this <br />transaction was made or entered into. Submission of this certification is a prerequisite for making <br />or entering into this transaction imposed by 31 U.S.C. 1352. <br />Any person who fails to file the required certification shall be subject to a civil penalty of not less <br />than $10,000 and not more than $100,000 for each such failure occurring on or before October <br />23, 1996, and of not less than $11,000 and not more than $110,000 for each such failure. <br />OCZAu ,-G [ --W4't Y AS,,AV4 A <br />Grantee/ Contractor Organization <br />Signature <br />ilA� -`� RANK �vo <br />Name of Certifying Official Signature <br />IL S Aye a��C'2 ¢o A,� <br />S, A\3 <br />Date <br />+jl ,7 TU <br />28 <br />