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IRC-2025—ITB—FLEET FACILITY GAS ISLAND CANOPY REFURBISHMENT <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, JSR Fueling Technologies, LLC. certifies or affirms the truthfulness and accuracy of <br />each statement of its cer' ' ation re, if any. In addition, the Contractor understands and agrees that <br />the provisions o 01 et s, apply to this certification and disclosure, if any. <br />Sign of.Aff6--ntractorr �oT d Official <br />Joshua Ghiz - Contractor <br />Name and Title of Contractor's Authorized Official <br />05.24.2021 <br />Date <br />Page 23 of 39 <br />