Federal Pre-Award Certifications_2018.pdf

FEDERAL PRE-AWARD CERTIFICATIONS

DBE LETTER OF INTENT FROM BIDDER/OFFEROR AND/OR SUBCONTRACTORS

(TO INCLUDE COPIES OF DBE CERTIFICATIONS)

Name of Bidder’s/Offeror’s Firm: ________________________________________________________

Address: ____________________________________________________________________________

City: _____________________________________________________ State: _________ Zip: _____

Name of DBE Firm: ____________________________________________________________________

Address: ____________________________________________________________________________

City: _____________________________________________________ State: _________ Zip: _____

Telephone: __________________________________________________________________________

Description of work to be performed by DBE Firm: ___________________________________________

The Bidder/Offeror is committed to utilizing the above-named DBE firm for the work described above.

The estimated dollar value of this work is $ ___________.

Affirmation: The above-named DBE firm affirms that it will perform the portion of the contract for the estimated dollar value as stated above.

By: ________________________________________________________________ Date: _______ (Signature/Title)

If the Bidder/Offeror does not receive award of the contract, any and all representations made in this Letter of Intent and Affirmation shall be null and void.

(Submit this page for each DBE subcontractor.)

Each DBE firm must also submit a copy of its DBE Approval Certification

DEBARMENT AND SUSPENSION CERTIFICATION (LOWER TIER COVERED TRANSACTION)

The Bidder certifies, by submission of this Bid, that neither it nor its “principals” as defined at 49 CFR § 29.105(p) are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency.

If the Bidder is unable to certify to the statement above, it shall attach an explanation, and indicate that it has done so, by placing an “X” in the following space ________.

THE BIDDER, ___________________________________________________, CERTIFIES OR AFFIRMS THE TRUTHFULNESS AND ACCURACY OF EACH STATEMENT OF ITS CERTIFICATION AND EXPLANATION, IF ANY.

IN ADDITION, THE BIDDER UNDERSTANDS AND AGREES THAT THE PROVISIONS OF 31 U.S.C. §§ 3801 ET

SEQ. APPLY TO THIS CERTIFICATION AND EXPLANATION, IF ANY.

Signature of the Bidder’s Authorized Official

Name and Title of Bidder’s Authorized Official

Date

LOBBYING CERTIFICATION

The Bidder certifies, to the best its knowledge and belief, that:

1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of a Federal department or agency, a Member of the U.S. Congress, an officer or employee of the U.S.

Congress, or an employee of a Member of the U.S. 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 thereof.

2. If any funds other than Federal appropriated funds have been paid or will be paid to any person for making lobbying contacts to 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 Form to Report Lobbying," in accordance with its instructions (as amended by "Government-wide Guidance for New Restrictions on Lobbying," 61 Fed. Reg. 1413 (1/19/96). Note: Language in paragraph (2) herein has been modified in accordance with Section 10 of the Lobbying Disclosure Act of 1995 (P.L. 104-65, to be codified at 2 U.S.C. 1601, et seq.))

3. The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients 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 31, U.S.C. § 1352 (as amended by the Lobbying Disclosure Act of 1995). 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.

THE BIDDER, __________________________________________________________, CERTIFIES OR

AFFIRMS THE TRUTHFULNESS AND ACCURACY OF EACH STATEMENT OF ITS CERTIFICATION AND

DISCLOSURE, IF ANY. IN ADDITION, THE BIDDER UNDERSTANDS AND AGREES THAT THE PROVISIONS OF

31 U.S.C. §§ 3801 ET SEQ. APPLY TO THIS CERTIFICATION AND DISCLOSURE, IF ANY.

____________________________________________ Signature of the Bidder’s Authorized Official

____________________________________________ Name and Title of Bidder’s Authorized Official

____________________________________________ Date