Certification-regarding-lobbying~4.pdf
PDF 120 KB Posted
- Attached to
- Specialty Managed Care Plan
- Solicitation number
- 41NHA-S3708
- Issued by
- Clark County, Fish Springs CDP, Nevada
About this file
This is a Certification Regarding Lobbying form issued by the Nevada State Purchasing Division, Department of Administration, applicable to federal contracts, grants, loans, and cooperative agreements. The form serves as a mandatory certification document that must be completed and submitted by vendors and contractors bidding on or entering into transactions involving federal appropriated funds.
The certification requires the authorized signer to attest that no federal appropriated funds have been or will be paid to influence federal officers, Congress members, or their employees in connection with the award or modification of federal contracts, grants, loans, or cooperative agreements. If non-federal funds have been or will be used for lobbying activities, the signatory must complete and submit Standard Form-LLL, "Disclosure of Lobbying Activities," in accordance with its instructions. The form mandates that vendors include identical certification language in all sub award documents at every tier, including subcontracts and sub grants, with all sub recipients certifying and disclosing accordingly. Submission of this certification is a material prerequisite for transaction entry, and false certification carries civil penalties ranging from $10,000 to $100,000 per violation under Section 1352 of the U.S. Code.
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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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