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CITY OF SANTA ANA <br />RFP NO.: 16-074 <br />DEVELOPMENT IMPACT FEES <br />NON-LOBBYtIvc CrRTIFICATYON <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 funds have been paid or will be paid to ally <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 lvhioh 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 />i <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 allsuchsubrecipients shall certify and disclose accordingly. <br />Signed: <br />Title:Y1UQinG Dt(eGkv� <br />Firm: a LtYI r� "CduSS( F SSpCi 0.)tei <br />V -- <br />Date: '� 2J J' (D <br />Page 1 of 1 <br />