Certification-regarding-lobbying~6.pdf
PDF 120 KB Posted
- Attached to
- Non-Emergency Transportation (NET)
- Solicitation number
- 41NHA-S3848
- Issued by
- Nevada
About this file
This is a Certification Regarding Lobbying form issued by the Nevada State Purchasing Division, Department of Administration, on behalf of the Nevada Health Authority for the Non-Emergency Transportation (NET) Brokerage Services solicitation. The form serves as a federal compliance document required for all contract awards involving federal appropriated funds. The certification requires the undersigned vendor to attest that no federal appropriated funds have been paid or will be paid to influence federal contract awards, grants, loans, or cooperative agreements. The form includes standard language that must be incorporated into all subaward documents at all tiers, including subcontracts and subgrants, with all subrecipients required to certify and disclose accordingly.
The certification represents a material representation of fact required under section 1352, U.S. Code, and submission is a prerequisite for contract execution. Any person failing to file the required certification is subject to civil penalties ranging from $10,000 to $100,000 for each failure. The form requires completion with the solicitation number, vendor name, authorized signer name, authorized signature, and date. Vendors must also disclose any non-federal funds used to influence government officials by submitting Standard Form-LLL if applicable. This document is mandatory for all vendors responding to the Nevada Health Authority's Non-Emergency Transportation Brokerage Services solicitation.
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Other files
| File | Type | Posted |
|---|---|---|
| 41NHA-S3848-Reference-Questionnaire~1.docx | DOCX document | |
| 41NHA-S3848 - Cost Schedule.xlsx | XLSX spreadsheet | |
| 41NHA-S3848-Vendor-Information-Response.pdf | ||
| Terms-and-conditions-for-services~6.pdf | ||
| 41NHA-S3848 - Business Associate Addendum 07.01.25.docx | DOCX document | |
| 41NHA-S3848 Technical Proposal Questions- Attachment A.docx | DOCX document | |
| 41NHA-S3848-Request-for-Proposals.docx | DOCX document | |
| 41NHA - S3848 - Insurance Schedule - RFP.doc | DOC document | |
| Standard-form-contract~4.docx | DOCX document | |
| 41NHA-S3848 - Business Continuity Agreement 12.01.25.docx | DOCX document | |
| 41NHA-S3848 - SOW.docx | DOCX document | |
| 41NHA-S3848-Request-for-Proposals - Updated 5-21.docx | DOCX document |
Show all 12
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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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