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CERTIFICATION POR CONTRACTS, ~RANTS~ LOA~S, AND COOPE~ATIV~ AG~EHEMT$ <br /> <br /> The undersigned certifies, to the best of his or her knowledge and belief, <br /> that~ <br /> <br />(1). No Federal appropriated funds have been paid or will be paid, by or on <br />behalf of the undersigned, tm any person for influencing or attempting to <br />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 <br />connection with the awarding of any Federal contract, the making of any <br />cooperative agreement, and the extension, continuation, renewal, amendment, or <br />modification of any Federal contract, grant, loan, or cooperative agreement. <br /> <br />(2) If any funds dther than Federal appropriated funds ha~e been paid or will <br />be paid to any person for influencing or attempting to influence an officer or <br />employee of any agency, a Member of Congress, or an officer or employee of <br />Congress, or an employee of a Member of Congress in connection with this <br />Federal contract, grant, loan, or cooperative agreement, the undersigned shall <br />complete and submit Standard Form-LLL, 'Disclosure Form to Report Lobbying," <br />in accordance with its instructions. <br /> <br />(3) The undersigned shall require that the language of this certification be <br />included in the award documents for all suhawards at all tiers (including <br />subcontracts, aubgrante, and contracts under grants, loans, and cooperatiye <br />agreements) and that all subreciptents shall certify and disclose accordingly. <br /> <br />This certification is a material representation of fact upon which reliance <br />was placed when this transaction was made or entered into. Submission of this <br />certification is a prerequisite for making or entering into this transaction <br />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 <br />than $10,000 and not more than $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 />