Certification-regarding-lobbying~22.pdf
PDF 120 KB Posted
- Attached to
- Medical Staff Credentialing
- Solicitation number
- 40DHHS-S3757
- Issued by
- Churchill County, Nevada
About this file
This is a Certification Regarding Lobbying form issued by the Nevada State Purchasing Division, Department of Administration, applicable to federal contract awards and related transactions. The document serves as a mandatory certification for vendors and contractors engaging with Nevada state purchasing in connection with federal funding. The form requires the authorized representative of the bidding organization to certify compliance with federal lobbying restrictions and disclosure requirements under 31 U.S.C. Section 1352. The certification applies to the Medical Staff Credentialing Services contract opportunity in Nevada and must be completed and submitted as part of the proposal submission process, with fields provided for the solicitation number, vendor name, authorized signer name, authorized signature, and date.
The certification establishes three primary obligations for the undersigned: first, affirming that no federal appropriated funds have been or will be used to influence federal officers, members of Congress, or their employees in connection with the federal award; second, committing to complete and submit Standard Form-LLL disclosing any lobbying activities funded by non-federal sources; and third, requiring that all subcontractors and sub-recipients at all tiers include identical certification language in their award documents and certify accordingly. Failure to file the required certification subjects any person to civil penalties ranging from $10,000 to $100,000 per violation. This certification is identified as a material representation of fact and a prerequisite for executing the transaction, with submission required before the contract award can be finalized.
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Other files
| File | Type | Posted |
|---|---|---|
| 40DHHS-S3757 - Questions and Answers.docx | DOCX document | |
| Standard-form-contract~20.docx | DOCX document | |
| 40DHHS-S3757 - reference-questionnaire.docx | DOCX document | |
| Terms-and-conditions-for-services~27.pdf | ||
| 40DHHS-S3757 - Vendor-Information-Response.pdf | ||
| 40DHHS-S3757 - request-for-proposals.docx | DOCX document | |
| Quote Instructions.pdf | ||
| 40DHHS-S3757 - Insurance Schedule.docx | DOCX document | |
| Cost Schedule~13.xlsx | XLSX spreadsheet |
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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: |
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