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CITY OF SANTA ANA <br />RFP NO.: 16 -141 <br />ON -CALL RIGHT OF WAY COORDINATOR <br />NON-LOBBYING CERTIFICAJ'ION <br />CITY OF SANTA ANA <br />REQUEST FOR PROPOSALS <br />FOR <br />ON-CALL RIGHT OF WAY COORDINATOR <br />RFP NO.. I6 -I41 <br />The prospective participant certifies, by signing and submitting this bid or proposal, to the best <br />of his or her knowledge and belief, that: <br />(1) 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 <br />employee of any Federal agency, a Member of Congress, an officer or employee of <br />Congress, or an employee of a Member of Congress in connection with the awarding of <br />any Federal contract, the making of any Federal grant, the making of any Federal loan, <br />the entering into of any cooperative agreement, and the extension, continuation, renewal, <br />amendment, or modification of any Federal contract, grant, loan, or cooperative <br />agreement, <br />(2) if any funds other than Federal appropriated finds have been paid or will be paid to any <br />person for influencing or attempting to influence an 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, or cooperative <br />agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure <br />of Lobbying Activities' in conformance with its instructions. <br />This certification is a material representation of fact upon which reliance was placed when this <br />transaction was made or entered into. Submission of this certification is a prerequisite for <br />making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any <br />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 <br />shall require that the language of this certification be included in all lower tier subcontracts, <br />which exceed $100,000 and that all such subrecipients shall certify and disclose accordingly. <br />Signed: <br />Title: Sr. Vi(L ?YtSidbA4- <br />Firm: *JnnL• <br />Date: 1 .)..a 1 'Lot1� <br />Page 1 of 1 <br />25M -20 <br />