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flppettciix <br />A'I"I"A.C:Y�iV�tst�'1 -I; I�lQ7N••L,DI�IiS'TiV4� �'is;i?.Ttti'fCat'i"��['I <br />CXRT(FICA'LT10JN <br />CON STRUC" PABILFPY REVIE V <br />The prospective, Wuticipaol cci4i f ics, by sigui ng and subs n{I I ins this biii or proposed, to the best of Itis or hcs <br />laxnSdge mid belief, that: <br />I. No federal appropriated Rats have been paid err will be paid, by or on behallbfthc undersigned, to <br />ally person for influenciIM or attempting la influence an alliceror employee orally feclet I agency, a <br />h4ember orCougress, an officer nr employes orCangress, or an englnyee of a NkWwr of Congress <br />in connection with tile, m Whig ortnty federal ronh'nct, Te oiakbng of ally nxinral grant, the making <br />of any fedeml loan, the entering into ofany cooperative a„greennent, and the extension, continuation, <br />renewal, aiuenehnent, or modification oramy federal contract, gnat, loan, or coaperativc agreement. <br />2. Irany Funds other than fedeml appropriated funds have been paid or will be paid to any person bar <br />hnfluencing or attempting to influence any oil Nor or employee ofany federal agency, a Meriberof <br />Cangm,anofficeroremployceorCongress,oranemployeeoraMemberofCongressin <br />culn echo" wilb this fecle`ad caniml, grant loan, loan or cooperative agreement, the undersigned <br />shall mmvicte and submit a "Disclosure of Lobbying Activifies". <br />This certification is a material representation of' Met upon which reliance was placed when this transaction was made <br />or entered. into. Submission orthis certification is a prerequisite for making or entering into this transaction imposed <br />by Sectioln 13552, Title 3I, It. S. Code. Any person who bills to file (he required certification shall be sulrjcc( to a civil <br />pmr<lty ornot less than $ I OM00 and not more Own 5;100100 For each such litilum <br />The prospective participant also agrees by submitting his or hot, bid or proposal that lie or she shall require that the <br />language orchis cerlitieation be included in all lower tier subcoi n icls, which exceed S1004100 and Ihnt all such sub <br />mcipieurs shall Coldly and disclose accordingly. <br />Pit m 1 .� <br />Siviled and printed \111111o:f 76— <br />talcI <br />_l--T"-�.)�L/nf-�Y.LL.::.,J...._..._.. <br />Date ...�..... C..s( t_p <br />City of Santa Ana RFP <br />Page A3-2 <br />25G-23 <br />