HomeMy WebLinkAbout1999-07840
40
U.S. Department of Housing
. ation of Payments and Urban Development
to Influence Federal Transactions Office of Public and Indian Housing�9
qc)
Apolicant Name
INDTAN PINIFR COUNTY BOARD OF COUNTY C0tiMTSST01`1F.R5
p(ogram/Activity Receiving Federal Grant Funding
SECTION 8 TENANT BASED RENTAL ASSTSTANCF PROGRAM
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be
paid, by or on behalf of the undersigned, to any person for
influencing or attempting to influence an officer or employee of
an agency, a Member of Congress, an officer or employee of
Congress. or an employee of a Member of Congress in connec-
tion with the awarding of any Federal contract, the making of any
Federal grant. the making of any Federal loan, the entering into
of any cooperative agreement, and the extension, continuation.
renewal. amendment, or modification of any Federal contract,
grant. loan. or cooperative agreement.
t_) 1f any funds other than Federal appropria[ed funds have
been paid or will be paid to any person for influencing or
attempting to influence an officer or employee of an agency, a
Member of Congress, an officer or employee of Congress. or an
employee of a Member of Congress in connection with this
Federal contract, grant, loan, or coopera[ice agreement, the
undersigned shall complete and submit Standard Form -LLL.
Disclosure Form to Report Lobbying. in accordance with its
instructions.
(3) The undersigned shall require that the language of thi,
certification be included in the award documents for all subaward-
at all tiers (including subcontracts, subgrants, and contracz>
under grants, loans, and cooperative agreements) and that all
subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which
reliance was placed when this transaction was made or entcre,'.
into. Submission of this certification is a prerequisite for makin--
or entering into this transaction imposed by Section 135=. Titl:
31, U.S. Code. Any person who fails to file the require.:
certification shall be subject to a civil penalty of not less th_-
510.000 and not more than 5100.000 for each such failure.
d herein. as well as any
I hereby certify that all the information stateinformation provided in the accompaniment herewith. is true and accurac.
Warning: HUD will prosecute
051012ms and $ 3729` 3802) Conviction may result in criminal and/or civil penalties.
(18 U.S.C. I Tele:
Name of A°tnonted Otlicial:
X
KENNETH R. MACHT
c9'IAIRMAN
3/a,/`/'
form HUD 50071 i-'
,.
715 , .16 , ..
40
0
Disclosure of Lobbying Activities
Approved by OMB 03,18.0c."
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 -
(See reverse side for Instructions.)
the
me for reviewing
Public` Reporting Burden for this collection of ma n awning the data estimated
average
and completingreand rev ewingethe colllection of information. Send comcmens;
searching existing data sources, gathering g suggestions for reducing this burden, to the Office of Managemenr
regarding this burden estimate or any other aspect of this collection of information, includin sugg
and Budget. Paperwork Reduction Project (094"046), Washington, D.C. 20503. i 3 Report Type:
1. Type of Federal Action: 2. Status of Federal Act a, initial filing
a. contract a. bZottedapplication b, material change
b. grant ❑ b. initial award N/ A
c. post -award For Material Change Onl� / A
c. cooperativeagreemenl/A Po year quarter
d. loan
date of last repo
e. loan guarantee
report �----
.re _ .'a . anrt Address of
9. Award Amount, if known:
6. Federal Action Number, if known: $ N/A
N/A
b. Individualaperforming Services (indueingaddressitdifferent from Nc '�_
first name. MI):10a. Name and Address of Lobbying Registrant (last name,
(if individual, last name, first name. MI):
N/A
_------
11. Information requested through this form is authorized by Sec.
3119
Pub. L.101.121,103 Stat. 750, Th amended lsure of lobby ng activities
65, Stat. 700 (31 U.S.C. 1352). which reliance was placed
is a material representation of fact upon
by the above when this transaction was made or entered into. This
disclosure is required pursuant to 31 U.S.C. 1352. This information
will be reported to the Congress rson who fails to fsemiannually and ileilthe requirel be d
for public inspection. Any p
disclosure shall be subject to a civil penalty of not less than 510,000
and not more than S100,0001or each such failure.
Fndor,d Uc^ Only: _
N/A
Signature:
Print Name: _—x�-
CHAIRMAN
Title:
(j'(p/)5C7 - YO CO Date: �-
TelephoneNo.___
Authorized for local Reproaucn
Stand,,d Form -U L 0
5. if Reporting Entity in NO- 413
4. Name and Address of Reporting Entity:
Prime 7 Subawardee Tier
;t known: Prime:
I N/A
N; A
i
Congressional District, it known:
congressional District, it known:
7. Federal Program Name/Descriptlon:
I
6. Federal Department/Agency:
N/A
N/A
CFDA Number. it applicable:
9. Award Amount, if known:
6. Federal Action Number, if known: $ N/A
N/A
b. Individualaperforming Services (indueingaddressitdifferent from Nc '�_
first name. MI):10a. Name and Address of Lobbying Registrant (last name,
(if individual, last name, first name. MI):
N/A
_------
11. Information requested through this form is authorized by Sec.
3119
Pub. L.101.121,103 Stat. 750, Th amended lsure of lobby ng activities
65, Stat. 700 (31 U.S.C. 1352). which reliance was placed
is a material representation of fact upon
by the above when this transaction was made or entered into. This
disclosure is required pursuant to 31 U.S.C. 1352. This information
will be reported to the Congress rson who fails to fsemiannually and ileilthe requirel be d
for public inspection. Any p
disclosure shall be subject to a civil penalty of not less than 510,000
and not more than S100,0001or each such failure.
Fndor,d Uc^ Only: _
N/A
Signature:
Print Name: _—x�-
CHAIRMAN
Title:
(j'(p/)5C7 - YO CO Date: �-
TelephoneNo.___
Authorized for local Reproaucn
Stand,,d Form -U L 0