4a Certification Regarding Lobbying Form.pdf
PDF 12 KB Posted
- Attached to
- Insurance Worksite Products
- Solicitation number
- RFP 23-06-WP
- Issued by
- Santa Rosa County, New Port Richey City, Florida
About this file
This document is a Certification Regarding Lobbying form associated with the Santa Rosa County School Board's Request for Proposal (RFP 23-06-WP) for Insurance Worksite Products in Milton, Florida. The certification form requires the prospective contractor to affirm that no federal appropriated funds have been or will be paid to influence or attempt to influence any government officials in connection with the awarding of a federal grant, loan, cooperative agreement, or contract modification.
The form outlines strict compliance requirements, including the potential submission of a Standard Form-LLL if non-federal funds are used for lobbying activities, and mandates that this certification language be included in all sub-award documents. Failure to file the required certification can result in civil penalties ranging from $10,000 to $100,000 for each violation. The document provides space for the organization's details, authorized representative's signature, and title, serving as a critical compliance document for the insurance worksite products procurement process.
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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 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 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," in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award documents of 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, title 31, United States 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.
Organization:
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CERTIFIED BY:
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TITLE:
(signature) (date)
File details come from the government source that posted it. Updated .