The undersigned certifies, to the best of his
or her 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 an 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 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 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.
(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 section 1352, title
31, 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.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or
her knowledge and belief, that:
If any 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 in connection with this commitment
providing for the United States to insure or guarantee a loan, the undersigned
shall complete and submit Standard Form-LLL, ``Disclosure Form to Report
Lobbying,'' in accordance with its instructions. Submission of this statement
is a prerequisite for making or entering into this transaction imposed
by section 1352, title 31, U.S. Code. Any person who fails to file the
required statement shall be subject to a civil penalty of not less than
$10,000 and not more than $100,000 for each such failure.
Signature
Title
Organization