4-Form - Lobbying.pdf
PDF 68 KB Posted
- Solicitation number
- 2027003
- Issued by
- Indian River County, Florida
About this file
This is a Certification Regarding Lobbying form required for submission with bids or offers exceeding $100,000 or those that may be paid under a FEMA PA Grant in connection with the RFQ for 82nd Avenue Utility Corridor Consulting Services in Florida. The form certifies that no federal appropriated funds have been or will be paid to influence federal officials or members of Congress in connection with the awarding of the contract. The contractor must disclose any non-federal funds used for lobbying purposes by completing Standard Form-LLL and must include identical certification language in all subaward documents at all tiers, requiring all subrecipients to certify and disclose accordingly.
The certification constitutes a material representation of fact required by 31 U.S.C. § 1352 as a prerequisite for entering into the transaction. Any person failing to submit the required certification faces civil penalties ranging from $10,000 to $100,000 for each failure. The contractor's authorized official must sign and date the form, certifying the truthfulness and accuracy of all statements and acknowledging that provisions under 31 U.S.C. § 3801 et seq. apply to the certification and disclosure requirements.
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| 3-Form - Foreign Entity Ownership.pdf | ||
| 1-Form - Debarment.pdf | ||
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Text version
CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans, and Cooperative Agreements
(This form MUST be submitted with each bid or offer exceeding $100,000, as well as with any bid or offer that may be paid for under FEMA PA Grant)
The undersigned Contractor certifies, to the best of his or her knowledge, 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 an 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 Form to Report Lobbying,” in accordance with its instructions.
3. The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients 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 31, U.S.C. § 1352. 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 Contractor, , certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. § 3801 et seq., apply to this certification and disclosure, if any.
Signature of Contractor’s Authorized Official
Name and Title of Contractor’s Authorized Official
Date
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