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<br />Appendix C: Certification Of Restrictions On Lobbying
<br />(To be submitted with all bids or offers exceeding $100,000, must be executed prior to Award)
<br />The undersigned aAa 4mevvrictertifies, to the best of his or her knowledge and belief, that:
<br />(Contractor " '
<br />No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned,
<br />to any persons for influencing or attempting to influence an officer or employee of any agency, a
<br />Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in
<br />connection with the awarding to any Federal contract, the making of any Federal grant, the making of
<br />any Federal loan, the entering into of any cooperative agreement, and the extension, continuation,
<br />renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.
<br />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 Form -
<br />LLL, "Disclosure Form to Report Lobbying ", in accordance with its instructions [as amended by "Government
<br />wide Guidance for New Restrictions on Lobbying," 61 Fed. Reg. 1413 (1/19196). Note: language in
<br />paragraph (2) herein has been modified in accordance with Section 10 of the Lobbying Disclosure Act of
<br />1995 (P.L. 104 -65, to be codified at 2 U.S.C. 1601, et seq .)]
<br />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. This
<br />certification is a material representation of fact upon which reliance is placed when this transaction was
<br />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
<br />$10,000 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
<br />to file or amend a required certification or disclosure form shall be subject to a civil penalty of not less
<br />than $10,000 for each such expenditure or failure.]
<br />The Contractor, Xcuac r ;ear ♦ - rnc . , certifies or affirms the truthfulness and accuracy of each statement of
<br />its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of
<br />31 U.S.G. Section A 3801 et seq., apply to this certification and disclosure, if any.
<br />— 1 7 — Signatur of Contra ctor's / A thorized Official
<br />�,J'/
<br />Date
<br />Name and Title of Contractors Authorized Official
<br />Subscribed and sworn to before me this a day of � ' T 20k4 in the State of Et L
<br />and the County of .�r�.s .
<br />Notary Public My Appointment Expires 1 )I b1ti`t
<br />Donna M Cosh
<br />Notary Public
<br />Union County, NC
<br />25
<br />F -5
<br />Attachment number 1
<br />Page 179
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