10-Lobbying Certification Form.pdf
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- Attached to
- Bagged De-Icing Materials (50 lb. bags)
- Solicitation number
- 6100046155
- Issued by
- Bradford County, Pennsylvania
About this file
This document is a Lobbying Certification Form that must be completed by entities seeking federal contracts, grants, loans, or cooperative agreements. The certification states that the undersigned organization has not and will not use federal funds to influence government officials or employees in connection with the federal funding opportunity. The form also requires the organization to disclose any non-federal funds that may have been used for lobbying activities and to include this certification language in any sub-awards. Failure to complete and submit this form can result in civil penalties of $10,000 to $100,000. The form must be signed by an authorized representative of the organization.
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Text version
Exhibit 12
BOP-1307
Revised 11/7/2013
LOBBYING CERTIFICATION FORM
Certification for Contracts, Grants, Loans, and Cooperative Agreements
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 any agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection 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.
(2) If any funds other than federal appropriated funds have been paid or will be paid to 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 this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, Disclosure of Lobbying Activities, which can be found at:
http://www.whitehouse.gov/sites/default/files/omb/assets/omb/grants/sflllin.pdf
(3) The undersigned shall require that the language of this certification be included in the award documents for all sub-awards at all tiers (including subcontracts, sub-grants, and contracts under grants, loans, and cooperative agreements) and that all sub-recipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed under Section 1352, Title 31, U. S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for such failure.
SIGNATURE: ______________________________________________________________
TITLE: _____________________________________________ DATE: ________________
http://www.whitehouse.gov/sites/default/files/omb/assets/omb/grants/sflllin.pdf
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