|
2.
<br />3.
<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 />4,4 /r rc fl
<br />The undersigned fr['�.smfl SWcertifies, 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, to any
<br />persons 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 with
<br />the awarding to any Federal contract, the making of any Federal grant, the making of any Federal loan,
<br />the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or
<br />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 influencing or
<br />attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of
<br />Congress, or an employee of a Member of Congress in connection with this Federal contract, grant loan, or
<br />cooperative agreement, the undersigned shall complete and submit Standard Form -LLL, "Disclosure Form to
<br />Report Lobbying", in accordance with its instructions [as amended by "Government wide Guidance for New
<br />Restrictions on Lobbying," 61 Fed. Reg. 1413 (1119196). Note: language in paragraph (2) herein has been
<br />modified in accordance with Section 10 of the Lobbying Disclosure Act of 1995 (P.L. 10465, to be codified at 2
<br />U.S.C. 1601, at 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, sub -grants, and contracts under grants, loans, and
<br />cooperative agreements) and that all sub -recipients shall certify and disclose accordingly. This certification is
<br />a material representation of fact upon which reliance is placed when this transaction was made or entered
<br />into. Submission of this certification is a prerequisite for making or entering into this transactions imposed by
<br />31, U.S.C. 1352 (as amended by the Lobbying Disclosure Act of 1995). Any person who fails to file the
<br />required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000
<br />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 to
<br />file or amend a required certification or disclosure form shall be subject to a civil penalty of not less than
<br />$10,000 for each such expenditure or failure.]
<br />G.n ��,k.
<br />The Contractor, 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.C. Section A 3801 at seq., apply to this certification and disclosure, if any.
<br />Signature of Contractors Authorized Official
<br />Date/� n /1��
<br />Name an) neo loin�rrac orsut onzzz�ffcial
<br />//ice P�es�a°QN �
<br />Subscribed and swom to before me this 1 day of OS , 20JS_in the State of NL
<br />and the County Iq offCcbarc . s _
<br />NotaryPubli �l �A--L3.-/ My Appointment Expires1�,
<br />Notory Public
<br />25 = stanly County
<br />Attachment number 1 \n
<br />F-3 'Will 111111— Page 143
<br />
|