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CITY OF SANTA ANA <br />REQUEST FOR PROPOSALS j <br />FOR <br />ON -CALL ENGINEERING SERVICES — PART B <br />RFP NO.: I4-037B <br />The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and <br />belief, that: <br />1. No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any <br />person for 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 connection with <br />the awarding of any 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, amendment, or <br />modification of any federal contract, grant, loan, or cooperative agreement. <br />2. If any fiords other than federal appropriated fiords 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 Congress, <br />an officer or employee of Congress, or an employee of a Member of Congress in connection with this federal <br />contract, grant loan, loan or cooperative agreement, the undersigned shall complete and submit a "Disclosure <br />of Lobbying Activities". <br />This certification is a material representation of fact upon which reliance was placed when this transaction was made or <br />entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section <br />1352, Title 31, U. S. Code. 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. <br />The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require that the language of <br />this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such sub recipients shall certify <br />and disclose accordingly. <br />Firm <br />Signed and Printed Name: <br />Title <br />Date <br />