12-Municipal Lobbying Oridnance Bidder Certification CEC Form 50.PDF

Revised February 2022 Los Angeles Municipal Code § 48.09(H), Los Angeles Administrative Code § 10.40.1 Page 1 of 1 ethics.lacity.org

This form must be submitted with your bid or proposal to the City department that is awarding the contract noted below. If you have questions about this form, please contact the Ethics Commission at (213) 978-1960.

Certification

I certify the following on my own behalf or on behalf of the entity named above, which I am authorized to represent:

A. I am applying for one of the following types of contracts with the City of Los Angeles:

1. A goods or services contract with a value of more than $25,000 and a term of at least three months;

2. A construction contract with any value and duration;

3. A financial assistance contract, as defined in Los Angeles Administrative Code § 10.40.1(h), with a value of at least $100,000 and a term of any duration; or

4. A public lease or license, as defined in Los Angeles Administrative Code § 10.40.1(i), with any value and duration.

B. I acknowledge and agree to comply with the disclosure requirements and prohibitions established in the Los Angeles Municipal Lobbying Ordinance if I qualify as a lobbying entity under Los Angeles Municipal Code § 48.02.

I certify under penalty of perjury under the laws of the City of Los Angeles and the state of California that the information in this form is true and complete.

Name Signature

Title Date

Original Filing Amendment: Date of Signed Original ________________. Date of Last Amendment _________________.

Email Address Phone Number

Address

Reference Number (Bid, Contract, or RAMP) Awarding Authority (Department awarding the contract)

Bidder Name

FORM

Bidder Certification https://codelibrary.amlegal.com/codes/los_angeles/latest/lamc/0-0-0-133681 https://codelibrary.amlegal.com/codes/los_angeles/latest/laac/0-0-0-40211 http://ethics.lacity.org/