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--- APPENDIX <br />ATTACHMENT D-2: NON -LOBBYING CERTIFICATION <br />CERTIFICATIONS <br />CITY OF SANTA ANA <br />REQUEST FOR PROPOSALS <br />FOR <br />ON -CALL ENGINEERING SERVICES <br />RFP NO.: 14-037 <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 <br />undersigned, to any person for influencing or attempting to influence an officer or employee <br />of any federal agency, a Member of Congress, an officer or employee of Congress, or an <br />employee of a Member of Congress in connection with the awarding of any federal <br />contract, the making of any federal grant, the making of any federal loan, the entering into <br />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 funds other than federal appropriated funds have been paid or will be paid to any <br />person for influencing or attempting to influence any officer or employee of any federal <br />agency, a Member of Congress, an officer or employee of Congress, or an employee of a <br />Member of Congress in connection with this federal contract, grant loan, loan or <br />cooperative agreement, the undersigned shall complete and submit a "Disclosure of <br />Lobbying Activities". <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 <br />certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each <br />such failure. <br />The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require <br />that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and <br />that all such sub recipients shall certify and disclose accordingly. <br />Firm Name Kimley-Horn�and Associates, Inc. <br />Signed and Printed <br />Title: Vice President <br />11-17-2014 <br />Darren Adrian, P.E. <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 14-037 <br />Page 27 <br />