Certification-regarding-lobbying~8.pdf
PDF 120 KB Posted
- Attached to
- Nevada State Pharmacy Benefit Manager
- Solicitation number
- 41NHA-S3992
- 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 connection with a Nevada State Pharmacy Benefits Manager procurement on behalf of the Nevada Health Authority. The form serves as a prerequisite certification document that vendors must complete and submit 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 any Federal agency officials, members of Congress, or congressional staff in connection with the award of this Federal contract, grant, loan, or cooperative agreement.
The form requires vendors to disclose any non-Federal funds that may have been paid for lobbying purposes by completing and submitting Standard Form-LLL in accordance with its instructions. Additionally, the vendor must ensure that identical certification language is included in all sub-award documents at all tiers, including subcontracts and sub-grants, with all sub-recipients required to certify and disclose accordingly. Failure to submit the required certification subjects the vendor to civil penalties ranging from $10,000 to $100,000 for each failure. The form includes blank fields for the solicitation number, vendor name, authorized signer name, authorized signature, and date, which must be completed at the time of submission.
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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/
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