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2018-038A
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Last modified
12/21/2020 12:43:43 PM
Creation date
3/15/2018 11:23:59 AM
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Template:
Official Documents
Official Document Type
Agreement
Approved Date
02/20/2018
Control Number
2018-038A
Agenda Item Number
8.S.
Entity Name
Johnson-Davis, Inc.
Subject
Culvert Replacement
Area
74th Avenue and 1st Street SW
Project Number
1737
Bid Number
2018024
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RFP IRC1737-74th Ave and 1st Street SW v2 <br />CERTIFICATION REGARDING LOBBYING <br />Certification for Contracts, Grants, Loans, and Cooperative Agreements <br />(This form MUST be submitted with each bid or offer exceeding $100,000) <br />The undersigned Contractor certifies, to the best of his or her knowledge, that: <br />1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any <br />person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, <br />an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding <br />of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of <br />any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any <br />Federal contract, grant, loan, or cooperative agreement. <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, an officer or <br />employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, <br />loan, or cooperative agreement, the undersigned shall complete and submit Standard Form -LLL, "Disclosure <br />Form to Report Lobbying," in accordance with its instructions. <br />3. The undersigned shall require that the language of this certification be included in the award documents for <br />all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative <br />agreements) and that all subrecipients shall certify and disclose accordingly. <br />This certification is a material representation of fact upon which reliance was placed when this transaction was <br />made or entered into. Submission of this certification is a prerequisite for making or entering into this <br />transaction imposed by 31, U.S.C. § 1352 (as amended by the Lobbying Disclosure Act of 1995). Any person who <br />fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more <br />than $100,000 for each such failure. <br />The Contractor, , certifies or affirms the truthfulness and accuracy of <br />each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that <br />the provisions of 31 U.S.C. § 3801 et seq., apply to this certification and disclosure, if any. <br />Signature of Contractor's Authorized Official <br />Name and Title of Contractor's Authorized Official <br />Date <br />Page 14 of 14 <br />
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