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CITY ON SANTA ANA <br />Project No. 13-6796: Chestnut Avenue Class 11 Bikeway from Standard Avenue to <br />Grand Avenue; CM -5063(148) <br />PROPOSAL AND CONTRACT AGREEMENT <br />CERTIFICATION FOR FEDERAL AID CONTRACTS <br />The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or <br />her knowledge and belief; that: <br />(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, <br />to any person for influencing or attempting to influence an officer or employee of ally Federal <br />Agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member <br />of Congress in connection with the awarding of any Federal contract, the making of any Federal <br />grant, the making of any Federal loan, the entering into of any cooperative agreement, and the <br />extension, continuation, renewal, amendment, or modification of an Federal contract, grant, loan, <br />or cooperative agreement. <br />(2) If any funds other Federal appropriated fiends 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 Federal contract, grant, loan, or cooperative agreement, the undersigned shall <br />complete and submit Standard Form -LLL*, "Disclosure of Lobbying Activities" in accordance <br />with its instructions. <br />This certification is a material representation of fact upon which reliance was placed when this transaction <br />was made or entered into. Submission of this certification is a prerequisite for making or entering into this <br />transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification <br />shatl be 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 proposal that lie or slip shall require that <br />the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all <br />such sub -reel' i ras s all certify and disclose accordingly, <br />BID E Signature Ro�-{ <br />B � � E� _ I/► i (A t til <br />t CV1—mnir_t S CA ifb 11I�LL� <br />Firm <br />��►y <br />Datil <br />s,� <br />�1.,t�itkattt;Wt..'f�'J?i`d(?µ'¢d�,��i _..�� �1t��!.1i �li��*;x�iftl°� a gRi4yiK't"t�ttfrsNy�YeT,.� a r k. nNia <br />TO BE INCLUDED IN BID PACKAGE <br />BP 23 of 27 <br />