06. Appendix E - Lobbying Cert Form.pdf

This is a Lobbying Certification Form required for state and local contract opportunities. The form serves as a certification document that contractors and bidders must complete to comply with federal lobbying disclosure requirements and restrictions. The form applies to organizations receiving federal funding through grants or contracts and requires certification that no federally appropriated funds have been or will be used to pay any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with obtaining federal assistance.

The certification requires authorized representatives of the contracting organization to attest under penalty of perjury that the organization understands and will comply with restrictions on lobbying activities. The form must be signed and dated by an official with authority to bind the organization legally. Contractors are required to disclose any lobbying activities undertaken using non-federal funds related to the federal award and to provide detailed lobbying activity reports if applicable. The form emphasizes that providing false certifications may result in civil penalties and criminal prosecution, and contractors must ensure all subcontractors and lower-tier participants also comply with lobbying certification requirements.