Certification-regarding-lobbying~28.pdf
PDF 120 KB Posted
- Attached to
- Record Storage
- Solicitation number
- 40DHHS-S3965
- Issued by
- Nevada
About this file
This is a Certification Regarding Lobbying form issued by the Nevada State Purchasing Division, Department of Administration, applicable to a Record Storage services solicitation for Southern Nevada Adult Mental Health Services. The form serves as a mandatory certification document for vendors participating in this state and local contract opportunity in Nevada. While specific details regarding project scope, quantities, response deadlines, site visits, or bidder meetings are not contained within this certification form itself, this document represents a prerequisite requirement that must be completed and submitted by authorized signatories as part of the bid process.
The certification requires vendors to affirm that no Federal appropriated funds have been or will be paid to influence government officials in connection with contract award, and mandates disclosure of any non-Federal funds used for lobbying activities via Standard Form-LLL if applicable. Vendors must also ensure identical certification language is included in all subaward documents and that subrecipients provide corresponding certifications and disclosures. Failure to submit the required certification subjects vendors to civil penalties ranging from $10,000 to $100,000 for each failure. The form requires completion of fields for date, solicitation number, vendor name, authorized signer name, and authorized signature, with these same fields repeated at the bottom of the document for record-keeping purposes.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 40DHHS-S3965 - Cost Schedule.docx | DOCX document | |
| 40DHHS-S3965 - Insurance Schedule.docx | DOCX document | |
| 40DHHS-S3965 - request-for-proposal~1.docx | DOCX document | |
| Terms-and-conditions-for-services~34.pdf | ||
| 40DHHS-S3965 -Standard-form-contract.docx | DOCX document | |
| Quote Instructions.pdf | ||
| 40DHHS-S3965 - Reference Questionnaire.docx | DOCX document | |
| 40DHHS-S3965 - Vendor-Information-Response.pdf |
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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 .