AG 2011 06 20 - Laserfiche WebLink

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CERTIFICATION REGARDING LOBBYING The undersigned certifies, to the best of his or her knowledge and belief, that: 1. No Federal appropriated funds have been paid or will be paid by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. 2. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federally funded contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form SF -LLL, "Disclosure of Lobbying Activities," in accordance with its instructions. 3. The undersigned shall require that the language of this certification be included in the award document for subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) who receive federal funds of $100,000.00 or more and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000.00 and not more than $100,000.00 for each such failure. SIGNED: DATE: TITLE: ORGANIZATION: OFFICE FOR HISTORICALLY UNDERUTILIZED BUSINESSES INSTRUCTIONS: Non -State recipients should complete this certification for all State funds received. The completed and signed form should be provided to the State agency funding the grant to be attached to the contract for the grant funds. A copy of this form, along with the completed contract, should be kept by the funding agency and available for review by the Office of State Budget and Management. If you have questions, contact: Grants Reporting, Office of State Budget and Management, 919- 807 -4795. CERTIFICATION: Please check the following: Is your organization registered with the Office for Historically Underutilized Businesses (HUB)? ❑ YES ❑ NO Are your organization minority contractors, small contractors, physically handicapped contractors, ❑ YES women contractors, disabled business enterprises and nonprofit work centers for the blind and severely ❑ NO disabled? SIGNED: TITLE: Solicitation No. 2011WXSSP DATE: ORGANIZATION: F -4 Page 25 of 53 Attachment number 1 Page 137