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CITY OF SANTA ANA <br />REQUEST FOR PROPOSALS <br />FOR <br />ON-CALL RIGHT OF WAY SPECIALTY SERVICES <br />RFP NO.: 13-075 <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 />No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to <br />any 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 <br />Congress in connection with the awarding of any federal contract, the making of any federal grant, <br />the making of any federal loan, the entering into of any cooperative agreement, and the extension, <br />continuation, renewal, amendment, or modification of any federal contract, grant, loan, or <br />cooperative agreement. <br />2. If any funds other than federal appropriated funds have been paid or will be paid to any person for <br />influencing or attempting to influence any 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, loan or cooperative agreement, the undersigned <br />shall complete and submit a "Disclosure of Lobbying Activities". <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 <br />to 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 bid or 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 shall certify and disclose accordingly. <br />Firm <br />I <br />Title e— o <br />Date <br />