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Certification For Contracts, Grants, Loans and Cooperative Agreements <br /> <br />The undersigned certifies, to the best of his or her knowledge and belief, that: <br /> <br />(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to <br />any person 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 of any Federal contract, the making of any cooperative agreement, and the extension, <br />continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative <br />agreement. <br /> <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, or <br />an officer or employee of Congress, or an employee ora Member of Congress in connection with this <br />Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit <br />Standard Form LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. <br /> <br />(3) The undersigned shall require that the language of this certification be included in the award <br />documents for all subawards at all tiers (including subcontractors, subgrants, and contracts under grants, <br />loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. <br /> <br />This certification is a material representation of fact upon which reliance was placed when this <br />transaction was made or entered into. Submission of this certification is a prerequisite for making or <br />entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file <br />the required certification shall be subject to a civil penalty of not less than $10,000 and not more than <br />$100,000 for each such failure. <br /> <br />Organization Name <br /> <br />Name and Title of Authorized Representative <br /> <br />Signature Date <br /> <br /> <br />