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Contract#68-2004 <br /> Personalized Patient Home Assistance,Inc. <br /> ATTACHMENT G <br /> CERTIFICATION REGARDING LOBBYING <br /> Orange County Department of Social Services and Orange County Department on Aging <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 modification 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 Title <br /> c <br /> Agency/Orga tion Date <br /> (Certification signature should be same as Contract signature.) <br /> Federal Certification—Lobbying(06/04) Page 1 of 1 <br />