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State Fiscal Year 2013 Public Transportation Programs <br />Federal and State Assistance Certifications and Assurances <br />(Required of all Applicants) <br />CERTIFICATION AND RESTRICTIONS ON LOBBYING <br />I, Bernadette Pelissier , on behalf of <br />Name of Authorized Official <br />Orange County <br />Legal Name of Applicant ' <br />Hereby certifies that: <br />No Federal/State appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any <br />person for influencing or attempting to influence an officer or employee of any Federal/State agency, a Member <br />of Congress or State Legislature, an employee. of a member of Congress or State Legislature, or an officer or <br />employee of Congress or State Legislature in connection with the awarding of any Federal/State contract, the <br />making of any Federal/State grant, the making of any Federal/State loan, the entering into of any cooperative <br />agreement, and the extension, continuation, renewal, amendment, or modification of any Federal/State contract, <br />grant, loan, or cooperative agreement. <br />If any funds other than Federal/State appropriated funds have been paid or will be paid to any person <br />influencing or attempting to influence an officer or employee of any Federal/State agency, a Member of <br />Congress or State Legislature, an employee of a member of Congress or State Legislature, or an officer or <br />employee of Congress or State Legislature in connection with the Federal/State contract, grant, loan, or <br />cooperative agreement, the undersigned shall complete and submit Standard Form - LLL, "Disclosure Form to <br />Report Lobbying," in accordance with its instructions. <br />The undersigned shall require that the language of this certification be included in the award documents for all <br />sub-awards at all tiers (including sub-contracts, sub-grants and contracts under grants, loans, and cooperative <br />agreements) and that all sub-recipients shall certify and disclose accordingly. <br />This certification is a material I°epresentation of fact upon which I°eliance lwas placed tivhen this t~~ansaction was <br />made or entered into. Submission of this certification is a prerequisite for making oh entering into this <br />transaction imposed by 31 U.S. C. ,~ 1352 (as amended by the Lobbying Disclosure Act of 1995). Any person <br />who fails to file the required certification shall be subject to a civil penalty of not less than X10, ODO and not <br />mor°e than $100, 000 for each such failztre. <br />The undersigned certifies or affirms the truthfulness and accuracy of the contents of the statements submitted on <br />or 1~~ith this cel°tification and zrnderstands that the provisions of 31 U. S. C. Section 3801, et seq., are applicable <br />thel°eto. <br />Signature of Authorized O~ci 9 E <br />Seal Subscribed and sworn to me (date) p~ ~ ~ - ~~ l <br />~ ~2 ~~~,~ <br />Notary Public y ~ ~ ~C, ~J ~e~ l <br />`~1~..~~~ G 2,~21a3 <br />Printed Name and Address <br />My commission expires (date) f Q - l3 -- ~ Q <br />Affrx Notes ~eat;,~Iere <br />~~ ~~ <br />` 1'~s~ P~~Y ~ <br />,,.~ ~... <br />,, ,, <br />24 <br />