3631 Enterprise QRTP Certification-regarding-lobbying.pdf
PDF 130 KB Posted
- Attached to
- QRTP
- Solicitation number
- 40DHHS-S3631
- Issued by
- Washoe County, Nevada
About this file
This is a Certification Regarding Lobbying form issued by the Nevada State Purchasing Division, Department of Administration, in coordination with Federal procurement requirements. The document establishes compliance standards for vendors and contractors engaging in state and federally-funded transactions. The certification requires vendors to affirm that no Federal appropriated funds have been or will be used to influence Federal agency officers, Members of Congress, or Congressional employees in connection with the awarding of Federal contracts, grants, loans, or cooperative agreements. Additionally, vendors must commit to including identical certification language in all sub-award documents at every tier, including subcontracts, sub-grants, and contracts under grants and loans, with all sub-recipients required to certify and disclose accordingly.
The form identifies Solicitation Number 40DHHS-S3631 and requires completion by the vendor's authorized representative, including submission of the vendor name, authorized signer name, authorized signature, and date. This certification constitutes a material representation of fact upon which the state and Federal government rely when entering into the transaction. Failure to file the required certification subjects the responsible party to civil penalties ranging from $10,000 to $100,000 for each violation, as established under Section 1352, U.S. Code. The form serves as a prerequisite for contract award and establishes ongoing compliance obligations throughout the contract term.
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Text version
Nevada State Purchasing Division Department of Administration 515 E Musser St Ste 300 Carson City, NV 89701 purchasing.nv.gov nevadaepro.com
Revised 2024-10 Page 1 of 1
Certification regarding lobbying
The undersigned certifies, to the best of his or her knowledge and belief, that:
1. No Federal appropriated funds have been paid or shall 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 Federally appropriated funds have been paid or shall 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 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, 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.
Date
Solicitation number
Vendor Name
Authorized signer name
Authorized signature https://purchasing.nv.gov/ https://nevadaepro.com/
| Date: |
| Solicitation number: 40DHHS-S3631 |
| Vendor name: |
| Authorized signer name: |
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