Certification-regarding-lobbying~5.pdf
PDF 120 KB Posted
- Attached to
- Medicaid Third Party Liability (TPL), Recovery Audit Contracting (RAC), and Medicaid Estate Recovery
- Solicitation number
- 41NHA-S3818
- Issued by
- Nevada
About this file
This is a Certification Regarding Lobbying form issued by the Nevada State Purchasing Division, Department of Administration, for use in state and local contract opportunities in Nevada. The document is associated with a formal RFP issued by the Nevada Health Authority for Medicaid Third Party Liability (TPL), Recovery Audit Contracting (RAC), and Medicaid Estate Recovery (MER) Services. The form serves as a compliance document that must be completed and submitted by vendors as part of their proposal response.
The certification requires the authorized signer to attest that no Federal appropriated funds have been or will be paid to influence officers or employees of any agency, members of Congress, or congressional employees in connection with the awarding of Federal contracts, grants, loans, or cooperative agreements. Vendors must also disclose any non-Federal funds used for lobbying activities by submitting Standard Form-LLL if applicable. The form mandates that vendors include identical certification language in all subaward documents at all tiers, requiring all subrecipients to certify and disclose accordingly. Failure to file the required certification subjects violators to civil penalties ranging from $10,000 to $100,000 for each failure. The form includes fields for the solicitation number, vendor name, authorized signer name, and date, which must be completed prior to submission.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| RFP Attachment - SLA TPL Vendor Checklist.xlsx | XLSX spreadsheet | |
| RFP Attachment - TPL Comparision Report Sample.xlsx | XLSX spreadsheet | |
| 41NHA-S3818 SOWs Final 06.08.26.docx | DOCX document | |
| RFP Attachment - 213 MCO Subrogation Sample.xlsx | XLSX spreadsheet | |
| Standard-form-contract~3.docx | DOCX document | |
| RFP Attachment - Vendor Recovery Recoup Checklist.xlsx | XLSX spreadsheet | |
| 41NHA-S3818-Request-for-Proposals.docx | DOCX document | |
| 41NHA-S3818-Reference-Questionnaire.docx | DOCX document | |
| 41NHA-S3818 - Insurance Schedule - RFP.docx | DOCX document | |
| Terms-and-conditions-for-services~5.pdf | ||
| 41NHA-S3818 - Cost Schedule Final 06.09.26.xlsx | XLSX spreadsheet | |
| 41NHA-S3818 - Business Associate Addendum.docx | DOCX document | |
| RFP Attachment - 210 MCO TPL Report Sample.xlsx | XLSX spreadsheet |
Show all 13
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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 .