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<br />CERTIFICATION REGARDING LOBBYING
<br />Certification for Contracts, Grants, Loans, and Cooperative Agreements
<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 behaff of the undersigned, to any
<br />person for influenclng or attempting to influence an officer or employee of an agency, a Member of
<br />Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with
<br />the awarding of any Federal contrail, the making of any Federal grant, the making of any Federal loan, the
<br />entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or
<br />modification of any Federal contract,, grant, ioan, or cooperative agreement
<br />(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for
<br />influenclng or attempting to influence an officer or employee of any agency, a Member of Congress, an
<br />officer or employee of Congress, or an empbyee of a Member of Congress in conneclion with this Federal
<br />contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard
<br />Form-LLL, "Disclosure of Lobbying Activities; ` in acwrdance with its instructions.
<br />(3) The undersigned shall require that the language of this certification be included in the award documents
<br />for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and
<br />cooperative agreements} and that all subredpients shalt certify and disclose accordingly, This certfication
<br />is a material representation of fact upon which reliance was placed when this transaction was made or
<br />entered into. Submission of this certification is a prerequisite for making or entering into this transaction
<br />imposed by section 1352, title 31, U.S. Code. Any person who fails to fife the required certification shall be
<br />subjectto a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
<br />The undersigned states, to the best of his or her knowledge and belief, that
<br />If any funds have been paid or will be paid to any person for influencing or attempting to influence an officer
<br />or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of
<br />a Member of Congress in connection with this commitment providing for the United States to insure or
<br />guarantee a loan, the undersigned shalt complete and submit Standard Form-LLL, "Disclosure of Lobbying
<br />Activities;' in accordance with its instructions. Submission of this statement is a prerequisite for making or
<br />entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the
<br />required statement shall be subject to a civil penalty of not less than $10,000 and not more than $100,D00
<br />for each such failure.
<br />'APPLICANTS ORGANIZATION
<br />`PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE
<br />Prefix: 'First Name: ~ ~ Middle Name:
<br />Last Name: Suffix:
<br />Title:
<br />SIGNATURE: `DATE: ~!
<br />
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