|
A TRUE COPY
<br />CERTIFICATION ON LAST PAGE
<br />RYAN L. BUTLER, CLERK
<br />EX HIBIT — 3
<br />CERTIFICATION REGARDING LOBBYING
<br />Check the appropriate box:
<br />❑ This Certification Regarding Lobbying is required because the Contract, Grant, Loan, or
<br />Cooperative Agreement shall exceed $100,000 pursuant to 2 C.F.R. Part 200, Appendix II(I); 31 U.S.C. §
<br />1352; and 44 C.F.R. Part 18.
<br />❑ This Certification is not required because the Contract, Grant, Loan, or Cooperative Agreement shall be
<br />equal to or less than $100,000.
<br />APPENDIX A, 44 C.F.R. PART 18 — CERTIFICATION REGARDING LOBBYING
<br />Certification for Contracts, Grants, Loans, and Cooperative Agreements
<br />The undersigned certifies, to the best of his or her knowledge and belief, that:
<br />1. No federal appropriated funds have been paid or shall be paid, by or on behalf of the undersigned, to any person
<br />for influencing or attempting to influence an officer or employee of an agency, a member of Congress, an officer
<br />or employee of Congress, or an employee of a member of Congress in connection with the awarding of any
<br />federal contract, the making of any federal grant, the making of any federal loan, the entering into of any
<br />cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal
<br />contract, grant, loan, or cooperative agreement.
<br />2. If any funds other than federal appropriated funds have been paid or shall 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.
<br />3. The undersigned shall require that the language of this certification be included in the award documents for all
<br />subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative
<br />agreements) and that all Sub -Recipients shall certify and disclose accordingly.
<br />This certification is a material representation of fact upon which reliance was placed when this transaction was made or
<br />entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by
<br />section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of
<br />not less than $10,000 and not more than $100,000 for each such failure.
<br />The Sub -Recipient or subcontractor, , certifies or affirms the truthfulness and
<br />accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees
<br />that the provisions of 31 U.S.C. Ch. 38, Administrative Remedies for False Claims and Statements, apply to this
<br />certification and disclosure, if any.
<br />Signature of Sub-Recipient/subcontractor's Authorized Official
<br />Name and Title of Sub-Recipient/subcontractor's Authorized Official
<br />Date
<br />ATTACHMENT A
<br />Program Budget
<br />29
<br />
|