Attachment_E-_Certificate_Regarding_Lobbying_-_FAR_3.804.pdf

CERTIFICATION REGARDING LOBBYING

The undersigned certifies, to the best of his or her knowledge and belief, that in accordance with Federal Acquisition Regulation at FAR 52.203-11, Certification and Disclosure Regarding Payments to Influence Certain Federal Transactions (Sept 2007):

(1) The offeror, by signing its offer, hereby certifies to the best of its knowledge and belief that no 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 on its behalf in connection with the awarding of this contract.

(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,'' in accordance with its instructions.

(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 the contract award (this transaction) was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 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 each such failure.

The undersigned states, to the best of his or her knowledge and belief, that:

If any 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 commitment providing for the United States to insure or guarantee a loan, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with its instructions. Submission of this statement is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required statement shall be subject t to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

ORGANIZATION: _________________________________________________________

PRINT NAME AND TITLE OF AUTHORIZED REPRESENTATIVE

First Name: ________________________ Middle Name: ______________________________

Last Name: ______________________________________

Title: ____________________________________________

CERTIFICATION REGARDING LOBBYING

I have read and understand the Certification set forth above. I accept the consideration stated above and agree to be bound by the terms of this Certification in accordance with Federal Acquisition Regulation at FAR 52.203-11, Certification and Disclosure Regarding Payments to Influence Certain Federal Transactions (Sept 2007).

SIGNATURE: ____________________________________ DATE: ______________________

State of:

County of:

On the ______ day of ______________________ 2017, ____________________________ personally appeared before me and acknowledged that he/she executed this Certification with a full understanding of its terms and of his/her own free will and accord.

Notary Public