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ATTACHMENT A <br />CERTIFICATION REGARDING LOBBYING <br />(To be submitted with all bids or offers exceeding $100,000; must be executed prior to Award) <br />13- The undersigned ,) I�_ c , t e best of his or her knowledge and belief, that: <br />(Contractor) <br />1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any <br />persons for influencing or attempting to influence an officer or employee of any agency, a Member of <br />Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection <br />with the awarding to any Federal contract, the making of any Federal grant, the making of any Federal <br />loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, <br />amendment, or 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 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 this Federal <br />contract, grant loan, or cooperative agreement, the undersigned shall complete and submit Standard <br />Form -LLL, "Disclosure Form to Report Lobbying ", in accordance with its instructions [as amended by <br />"Government wide Guidance for New Restrictions on Lobbying," 61 Fed. Reg. 1413 (1119196). Note: <br />language in paragraph (2) herein has been modified in accordance with Section 10 of the Lobbying <br />Disclosure Act of 1995 (P.L. 104 -65, to be codified at 2 U.S.C. 1601, et seq .)] <br />3. The undersigned shall require that the language of this certification be included in the award documents <br />for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and <br />cooperative agreements) and that all subrecipients shall certify and disclose accordingly. <br />This certification is a material representation of fact upon which reliance is placed when this transaction <br />was made or entered into. Submission of this certification is a prerequisite for making or entering into this <br />transactions imposed by 31, U.S.C. 1352 (as amended by the Lobbying Disclosure Act of 1995). Any <br />person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 <br />and not more than $100,000 for each such failure. <br />[Note: Pursuant to 31 U.S.C. 1352(c)(1)- (2)(A), any person who makes a prohibited expenditure or fails to file <br />or amend a required certification or disclosure form shall be subject to a civil penalty of not less than $10,000 <br />for each such expenditure or failure.] <br />The Contractor, 13 Is rftl 1WORPOWI Qertifies or affirms the truthfulness and accuracy of each statement <br />of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions <br />1 31 U.S. Section A 3801 et seq., apply to this ertification and disclosure, if any. <br />Date Signature ofQdntractoes Authorized Official <br />AQ 9 <br />Name and Title of Contractors Authorized Official <br />Subscribed and swoW to before me this -Edgy of 204 in the State of ; <br />and the County of <br />Notary Public' <br />AMBER A. SAFRIT My Appointment Expires' <br />Notary Public, North Carolina <br />Cabarrus County <br />my commission Expires <br />±�?_J rILi - - - - -- <br />46 <br />Attachment number 2 <br />F -4 Page 152 <br />