74BAI-S3531 Certification-regarding-lobbying.pdf

PDF 120 KB Posted

Attached to
Workers Compensation Claims Third Party Administrator (TPA)
Solicitation number
74BAI-S3531
Issued by
Nevada

About this file

The document is a Certification regarding Lobbying form from the Nevada State Purchasing Division, Department of Administration, located in Carson City, Nevada. The form requires vendors to certify that they have not used federal appropriated funds to influence or attempt to influence government officials in connection with federal contracts, grants, loans, or cooperative agreements.

The certification requires vendors to disclose any non-federal funds used for lobbying activities by completing Standard Form-LLL and mandates that this certification language be included in all sub-awards and contracts. Failure to file the required certification can result in civil penalties ranging from $10,000 to $100,000 for each violation. The form provides space for vendors to enter the date, solicitation number, vendor name, authorized signer name, and signature.

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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:
Vendor name:
Authorized signer name:

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