RFP_26V-1029_Anti-Lobbying_Certification_Form.pdf
PDF 79 KB Posted
- Solicitation number
- 26V-1029
- Issued by
- Maricopa County, Arizona
About this file
This is an Anti-Lobbying Certification Form associated with RFP 26V-1029, a Request for Proposal issued by Mohave (the Municipal Emergency Services Consortium) on behalf of approximately 488 public agencies across Arizona. The RFP solicits sources for various grocery, household, kitchen, health and beauty, and general use products for in-store purchasing or direct online order. The contract will be awarded for an initial one-year term with four potential one-year extensions available through contract modification. Eligible members as of August 31, 2026 are specified in the supporting documentation, though additional members may be added during the contract term at their own discretion regarding volume impact. Offerors are permitted to propose alternate solutions and manufacturers provided they meet the specified quality and performance characteristics, with Mohave serving as the final arbiter of acceptance.
The Anti-Lobbying Certification Form functions as a compliance document requiring certification that no federal appropriated funds will be used to pay any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, or an employee of a member of Congress in connection with the award of this contract. This certification is a standard requirement for federal funding compliance and must be completed and submitted by all bidders as part of the proposal process.
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Other files
| File | Type | Posted |
|---|---|---|
| Grocery:_In-Store_Purchasing_or_Direct_Online_Order.pdf | ||
| 26V-1029_Grocery_In-store_or_Online.xlsx | XLSX spreadsheet | |
| RFP_26V-1029_Offer_and_Acceptance_Form.pdf | ||
| RFP_26V-1029_Offer_and_Acceptance_Form.docx | DOCX document | |
| RFP_26V-1029_EDGAR_Certification.pdf | ||
| RFP_26V-1029_EDGAR_Certification.docx | DOCX document | |
| RFP_26V-1029_Specifications.docx | DOCX document | |
| RFP_26V-1029_Current_Mohave_Members.pdf | ||
| RFP_26V-1029_USDA_Form_AD-1048.pdf | ||
| RFP_26V-1029_USDA_Form_AD-1048.docx | DOCX document | |
| RFP_26V-1029_Contract_Information_for_Firm.pdf | ||
| RFP_26V-1029_Contract_Information_for_Firm.docx | DOCX document | |
| RFP_26V-1029_Anti-Lobbying_Certification_Form.docx | DOCX document |
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Text version
Anti-Lobbying Certification Form
RFP 26V-1029
ANTI-LOBBYING CERTIFICATION
Certification and Disclosure Regarding Payments to Influence Certain Federal Transactions
In accordance with the Byrd Anti-Lobbying Amendment 31 U.S. Code § 1352, 2 CFR § 200.450 and Federal Acquisition Regulation 52.203-11:
(A) The definitions and prohibitions contained in the clause, at FAR 52.203-12, Limitation on
Payments to Influence Certain Federal Transactions, included in this solicitation, are hereby incorporated by reference in paragraph (B) of this certification.
(B) The offeror, by signing its offer, hereby certifies to the best of his/her knowledge and belief that:
(1) No Federal appropriated funds have been paid, or will 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 on his or her behalf in connection with the awarding of this 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 Federal appropriated funds have been paid, or will 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 on his or her behalf in connection with this solicitation, the offeror shall complete and submit, with its offer, OMB standard form LLL, Disclosure of Lobbying Activities, to the Contracting Officer in accordance with its instructions; and
(3) The undersigned shall require that the language of this certification be included in the award documents for all subcontract awards at all tiers and require that all recipients of subcontract awards in excess of $100,000 shall certify and disclose accordingly.
(C) Submission of this certification and disclosure is a prerequisite for making or entering into this contract imposed by 31 U.S. Code § 1352. Any person who makes expenditure prohibited under this provision or who fails to file or amend the disclosure form to be filed or amended by this provision shall be subject to a civil penalty of not less than $10,000, and not more than $100,000, for each such failure.
(Firm Name)
(Signature)
(Print Name)
(Print Title)
(Date Certified)
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