74BAI-S3470 Certification-regarding-lobbying.pdf

PDF 120 KB Posted

Attached to
2025 Nevada Workers Compensation Medical Fee Schedule Study
Solicitation number
74BAI-S3470
Issued by
Churchill County, Nevada

About this file

This document is a Certification Regarding Lobbying form from the Nevada State Purchasing Division, Department of Administration, located in Carson City, Nevada. The form is a standard federal certification that requires vendors to disclose and certify that no federal appropriated funds have been or will be paid to influence or attempt to influence government officials in connection with federal contracts, grants, loans, or cooperative agreements.

The certification requires vendors to complete and submit Standard Form-LLL if any non-federal funds are used for lobbying activities. Vendors must also include this certification language in all sub-award documents at all tiers. Failure to file the required certification can result in civil penalties ranging from $10,000 to $100,000 for each violation. The form provides blank spaces for the date, solicitation number, vendor name, authorized signer name, and signature, indicating it is to be completed by a vendor as part of a procurement process.

View the file

Other files

File Type Posted
74BAI-S3470 Cost Schedule.xlsx XLSX spreadsheet
74BAI-S3470 Insurance Requirements.pdf PDF
74BAI-S3470 SOW.docx DOCX document
74BAI-S3470 reference-questionnaire.docx DOCX document
74BNAI-S3403 RFP~1.docx DOCX document
Terms-and-conditions-for-services.pdf PDF
74BAI-S3470 Standard Form Contract.docx DOCX document
74BAI-S3470 Vendor-Information-Response.pdf PDF
Quote Instructions.pdf PDF
74BNAI-S3470 RFP.docx DOCX document

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file

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:
Vendor name:
Authorized signer name:

File details come from the government source that posted it. Updated .