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EXHIBIT J <br />CITY OF SANTA ANA <br />REQUEST FOR PROPOSALS FOR <br />SECURE BIKE PARKING FACILITIES <br />Installation and Service Agreement <br />RFP #13-019 <br />The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or <br />her knowledge and beliefy that: <br />(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to <br />any person for influence or attempting to influence an officer or employee of Congress, or an <br />employee of a Member of Congress in connection with the awarding of any Federal contract, the <br />making of any Federal grant, the making of any Federal loan, the entering into of any cooperative <br />agreement, and the extension, continuation, renewal, amendment or modification of any Federal <br />contract, grant, loan, or cooperative agreement. <br />(2) If any funds other than Federal appropriate 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 <br />connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall <br />complete and submit Standard Form-LLL, "Disclosure of lobbying Activities," in accordance with <br />its instructions. <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 or entering <br />into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required <br />certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each <br />such failure. <br />The prospective participant also agrees by submitting his or her bid or proposal that he or she shall <br />me -fig tlanguage of this certification be included in all lower tier subcontracts, which exceed $100,000 <br />that a ch sub-regipj(nt"hall certify and disclose accordingly. <br />C 1 Ve J plc . <br />Firm <br />THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL. <br />PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE. <br />City of Santa Ana RFP 13-019 <br />Page 29 <br />