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Contract #68-200b <br />Triangle Home Health Care, Inc. <br />ATTACHMENT G <br />CERTIFICATION REGARDING LOBBYING <br />Orange County Department of Social Services <br />The undersigned certifies, to the best of his or her knowledge and belief, that: <br />1. No Federal appropriated funds have been paid or will be paid by or on behalf of the undersigned, <br />to any person for influencing or attempting to influence an officer or employee of any agency, a <br />Member of Congress, an officer or employee of Congress, or an employee of a Member of <br />Congress in connection with the awarding of any Federal contract, continuation, renewal, <br />amendment, or modif cation of any Federal contract, grant, loan, or cooperative agreement. <br />2. If any funds other than Federal appropriated funds have been paid or will be paid to any person <br />for influencing or attempting to influence an officer or employee of any agency, a Member of <br />Congress, an officer or employee of Congress, or an employee of a Member of Congress in <br />connection with this Federally funded contract, grant, loan, or cooperative agreement, the <br />undersigned shall complete and submit Standard Form SF-LLL, "Disclosure of <br />Lobbying Activities," in accordance with its instructions. <br />3. The undersigned shall require that the language of this certification be included in the award <br />• document for subawards at all tiers (including subcontracts, subgrants, and contracts under grants, <br />loans, and cooperative agreements) who receive federal funds of $100,000.00 or more and that all <br />subrecipients shall certify and disclose accordingly. <br />This certification is a material representation of fact upon which reliance was placed when this <br />transaction was made or entered into. Submission of this certification is a prerequisite for making <br />or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who <br />fails to file the required certification shall be subject to a civil penalty of not less than $10,000.00 <br />and not more than $100,000.00 for each such failure. <br />Signature <br />~~U2~~V <br />Title <br />Agency/~ ganization ~ Date <br />(Certification signature should be same as Contract signature.) <br />• <br />Federal Certification -Lobbying (06/04) Page 1 of 1 <br />