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A PPIrND IN <br />ATTACII1' ENT 3 -2. N[[+�y}N- yC.itiBBYI:NG CERTIFICATION <br />CITY OF SANTA .ANA <br />RE, QUE, STFOR PROPOSALS <br />FOR <br />WALNUT PUMP STATION OPERATIONAL PLAN AND SYSTENT TESTTiNC <br />R P NO_ 15_105 <br />The prospective parierpant eertifim,, by signing and subn>itring [his bid or propra:ad, to the best of his other knowledge and <br />belief, that: <br />I. No federal appropriated funds have been paid or will be paid, by or on bclalf oClhc undersigucxl, to any <br />person lbr influencing. or allcmpting to influence an officer or employee oCiny federal ngency, a Member of <br />Congress, an officer or employee oiCoagruss, or an employee of a Member of Congress hi cotnxuction wilh <br />the awarding of tiny tideral contrast, tile making of any Went gunnt, [lie making of any federal loan, [lie <br />entering into of any and lheextension, continuation, renewal, amendment, or <br />modification orany federal contrac4, grant, loam, or coopondivc afmcerncnt. <br />I If any fiends other dawn federal appropriated, funds have been paid or will be paid to any person for <br />iutiuencing car uttcrvrpking to in€lrreus;e nttY' nflicer en° employee of nrry fedeml agecccy, a Polenaber of C"ongiress, <br />an o Ificer or employee of Congress, or an cnsploycc of a htemher of Congress ill corxneauou with this tedeinl <br />cortl.racl, gratrt lottn, lartra or cnnpetntive agreenresrB, theunilersigncd shall enstrplwnc and srrl7rnrit a ` "L)isclosurc <br />o f lobby i ng Activities ". <br />This certification is a material rcpresentafion of fact upon which reliance was placed when this transactio=n was made or <br />entered Into. Submis non of this certification is a prerequisite for making or entering into this transaotion imposed by Section <br />1 352, Title 31, U S. Code. ltrty person who .fails to file tile required. certification shall he subject to a civil penalty of not less <br />than S 10,000 and not more Chan S1 00,000 for caelt such fitilure. <br />The prospective particlpant also agnecas by submitting! his or her bid or proposal that he ur she shaft require that the lnn�T.rage of <br />this ccrtifioation be included in nil lower tier subcontracts, which excoxt $100,000 and dint all such cub recipients shall certify <br />and disclose accordingly, <br />Firm. <br />Signed and Printed Name: <br />Title <br />Date <br />— -- City of Srran_ ta Ana R P 16 -105 <br />