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APPENDIX <br />EXHIBIT 11i NON-LOBBYING CERTIFICATION <br />CERTIFICATIONS <br />CITY OF SANTA ANA <br />REQUEST FOR PROPOSALS <br />FOR <br />ON -CALL DEMOLITION SERVICES <br />RFP NO.: 14.026 <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, <br />a 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 <br />subject 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 <br />sub recipients shall certify and disclose accordingly. <br />Firm <br />Signed and Printed Name: <br />ON -CALL <br />Date <br />DEMOLITION <br />SERVICES <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 14 -D26 <br />Page 25 <br />251 -37 <br />