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23A - PROJ - STREET REPAIR
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23A - PROJ - STREET REPAIR
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Last modified
6/29/2017 2:54:33 PM
Creation date
6/29/2017 2:48:12 PM
Metadata
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Template:
City Clerk
Doc Type
Agenda Packet
Agency
Public Works
Item #
23A
Date
7/5/2017
Destruction Year
2022
Document Relationships
GENTRY GENERAL ENGINEERING, INC.,
(Message)
Path:
\Contracts / Agreements\ PROJECTS
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EXIIIBIT 16 <br />FEDERAL LOBBYIST REQUIREMENTS CERTIFICATION <br />Name of Firm: Date: 'i &12=:L)i-q <br />Address: 6l ^� Ard/r7' L M_, 1 t <br />330.11 ag <br />State: Zip Code: r�310 Telephone: <br />Acting on behalf of the above-named firm as its Authorized Official, I make the following Certification to the <br />Department of Housing and Urban Development (HUD) and the Community Development Commission, County of <br />Los Angeles: <br />1) No Federal appropriated funds have been paid, by or on behalf of the above-named firm to any person for <br />influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an <br />officer or employee of Congress, or an employee of a Member of Congress in connection with the <br />awarding of any Federal contract, the making of any Federal grant, loan, or cooperative agreement, and any <br />extension, continuation, renewal, amendment, or modification thereof; and <br />2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for <br />influencing or attempting to influence an officer or employee or any agency, a Member of Congress, an <br />officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal <br />contract, grant, loan, or cooperative agreement, the above-named firm shall complete and submit Standard <br />Form—LLL, "Disclosure Form to Report Lobbying" in accordance with its instructions; and <br />3) The above-named firm shall require that the language of this certification be included in the award <br />documents for all sub -awards at all tiers (including subcontracts, sub -grants, and contracts under grants, <br />loans, and cooperative agreements) and that all sub -recipients shall certify and disclose accordingly. <br />This certification is a material representation of fact upon which reliance was placed when this transaction was <br />made or entered into. Submission of this certification is a prerequisite for making or entering into the transaction <br />imposed by Section I352 Title 31 U.S. Code. Any person who fails to file the required certification shall be subject <br />to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. <br />Authorized Official: <br />Name: tS� "" �' "'\ Title: <br />Signature: 7P,�,,Zz Vcn Date: `I AQ/�aq- <br />F:10DCS1PRDPSVCSIHUDFORM MBU5004AMB-S..U0n3S"=D0C <br />23A-50 <br />
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