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North Carolina Department of Agriculture and Consumer Services
<br />State Certifications and Assurances Section
<br />CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND OTHER
<br />RESPONSIBILITY MATTERS; AND DRUG -FREE WORKPLACE REQUIREMENTS
<br />The certifications shall be treated as a material representation of fact upon which reliance will be placed when the
<br />Department of Agriculture determines to award the covered transaction, grant, or cooperative agreement.
<br />1. LOBBYING
<br />The applicant certifies that:
<br />A. No Federal, State or local government 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 employee of any Federal,
<br />State or local government agency, a Member of Congress, North Carolina's General Assembly or local
<br />government body; an officer or employee of Congress, North Carolina's General Assembly or local government
<br />body or an employee of a Member of Congress, North Carolina's General Assembly or local government body in
<br />connection with the making of any Federal, State or local government grant, the making of any Federal, State or
<br />local government loan, the entering into of any cooperative agreement, and the extension, continuation, renewal,
<br />amendment, or modification of any Federal, State, or local government contract, grant, loan or cooperative
<br />agreement;
<br />B. If any funds other than Federal, State or local government appropriated funds have been paid or will be paid to
<br />any person for influencing or attempting to influence an officer or employee of any agency, a Member of
<br />Congress, North Carolina's General Assembly or local government body; an officer or employee of Congress,
<br />North Carolina's General Assembly or local government body; or an employee of a Member of Congress, North
<br />Carolina's General Assembly or local government body in connection with the Federal, State or local government
<br />contract, grant, loan or cooperative agreement, the undersigned shall complete and submit Standard Form - LLL,
<br />"Disclosure Form to Report Lobbying," in accordance with its instructions;
<br />2. DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS
<br />A. The applicant certifies that it and its principals:
<br />a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily
<br />excluded from covered transactions by any Federal, State or local government agency;
<br />b) Have not within a three -year period preceding this application been convicted of or had a civil judgment
<br />rendered against them for commission of fraud or a criminal offense in connection with obtaining,
<br />attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a
<br />public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft,
<br />forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen
<br />property;
<br />c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal,
<br />State, or local) with commission of any of the offenses enumerated in paragraph 2. (A) (b) of this
<br />certification; and.
<br />d) Have not within a three -year period preceding this application had one or more public transaction
<br />(Federal, State, or local) terminated for cause or default.
<br />B. Where the applicant is unable to certify to any of the statements in this certification, he or she shall attach an
<br />explanation to this certification.
<br />Page 2 of 4
<br />Attachment number 3
<br />F -6 Page 150
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