LOBBYING CERTIFICATION-EXHIBIT G.pdf
PDF 56 KB Posted
- Attached to
- Transit-ADA Compliant Van Procurement
- Solicitation number
- BD-27-1030-0T100-0T100-132631
- Issued by
- Massachusetts
About this file
This is a Lobbying Certification form (Exhibit G) required for proposal submission to MassDOT Rail and Transit Division in Massachusetts for the procurement of ADA-compliant transit vans. The certification serves as a pre-award self-certification document that proposers must complete and submit as part of their bid package. The form requires the proposer's authorized representative to certify that no federal appropriated funds have been or will be paid to influence federal officers, members of Congress, or Congressional staff in connection with the awarding of this federal contract, grant, loan, or cooperative agreement.
The certification document mandates that proposers disclose any non-federal funds used for lobbying contacts and requires submission of GSA Standard Form LLL if applicable. The proposer must also ensure that all subcontractors and sub-recipients at all tiers include identical certification language in their award documents and certify accordingly. Failure to comply with this certification requirement carries civil penalties ranging from $10,000 to $100,000 per violation. The form requires signature, date, printed name, and title of the proposer's authorized representative and is governed by 31 USC 1352, as amended by the Lobbying Disclosure Act of 1995, with additional provisions under 31 USC 3801 et seq.
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| EXHIBIT F - BUSINESS REFERENCE FORM 2026.doc | DOC document | |
| BUY AMERICA CERTIFICATION-EXHIBIT G.pdf | ||
| EXHIBIT B - PROPOSAL DEVIATION 2026.docx | DOCX document | |
| NON-COLLUSION AFFIDAVIT - EXHIBIT G.pdf | ||
| ADA Compliant Van RFP~2.pdf | ||
| DEBARMENT AND SUSPENSION CERTIFICATION-EXHIBIT G.pdf | ||
| FEDERAL MOTOR VEHICLE SAFETY STANDARDS-EXHIBIT G.pdf | ||
| EXHIBIT I - CONTRACTOR AUTHORIZED SIGNATURE FORM.doc | DOC document | |
| EXHIBIT A - ACKNOWLEDGMENT OF RECEIPT OF ADDENDA 2026.docx | DOCX document | |
| EXHIBIT H - CONFLICT OF INTEREST 2026.docx | DOCX document | |
| CERTIFICATION OF COMPLIANCE WITH VEHICLE TESTING REQUIREMENT- EXHIBIT G.pdf | ||
| TRANSIT VEHICLE MANUFACTURER DBE - EXHIBIT G.pdf | ||
| EXHIBIT E - CONTRACTOR SERVICE AND PARTS SUPPORT DATA FORM 2026.doc | DOC document | |
| EXHIBIT C - PRE-AWARD EVALUATION DATA 2026.docx | DOCX document | |
| Price Proposal 2026.docx | DOCX document | |
| Appendix A - COMMBUYS INFORMATION.docx | DOCX document | |
| EXHIBIT D - GENERAL VEHICLE DATA SHEET 2026.docx | DOCX document |
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Text version
REQUIRED PROPOSAL SUBMISSION FORM
LOBBYING CERTIFICATION
PROPOSER PRE-AWARD SELF-CERTIFICATION
The Proposer certifies, to the best of 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 instruction, as amended by “Government-wide Guidance for New Restrictions on Lobbying,” 61 Fed. Reg.
1413 (1/19/96).
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 31, USC §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 PROPOSER, _______________________________________________________, CERTIFIES OR AFFIRMS THE TRUTHFULNESS AND ACCURACY OF EACH STATEMENT OF ITS CERTIFICATION AND DISCLOSURE, IF ANY. IN ADDITION, THE PROPOSER UNDERSTANDS AND AGREES THAT THE PROVISIONS OF 31 USC §§ 3801 ET SEQ.
APPLY TO THIS CERTIFICATION AND DISCLOSURE, IF ANY.
Name of the Proposer’s authorized representative:
Title: ________________________________________________________________________________________________________________________________
Signature Date
Per paragraph 2 of the included form Lobbying Certification, add GSA Standard Form LLL, “Disclosure Form to Report Lobbying,” if applicable.
| REQUIRED PROPOSAL SUBMISSION FORM |
| LOBBYING CERTIFICATION |
| PROPOSER PRE-AWARD SELF-CERTIFICATION |
File details come from the government source that posted it. Updated .