Orange County NC Website
CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND OTHER <br /> RESPONSIBILITY MATTERS; AND DRUG-FREE WORKPLACE REQUIREMENTS <br /> The certifications shall be treated as a material representation of fact upon which reliance will be placed when the <br /> Department of Agriculture determines to award the covered transaction, grant, or cooperative agreement. <br /> 1. LOBBYING <br /> The applicant certifies that: <br /> A. No Federal, State or local government appropriated funds have been paid or will be paid, by or on behalf of the <br /> undersigned, to any person for influencing or attempting to influence an officer or employee of any Federal, <br /> State or local government agency, a Member of Congress, North Carolina's General Assembly or local <br /> government body; an officer or employee of Congress, North Carolina's General Assembly or local government <br /> body or an employee of a Member of Congress, North Carolina's General Assembly or local government body in <br /> connection with the making of any Federal, State or local government grant,the making of any Federal, State or <br /> local government loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, <br /> amendment, or modification of any Federal, State, or local government contract, grant, loan or cooperative <br /> agreement; <br /> B. If any funds other than Federal, State or local government appropriated funds have been paid or will be paid to <br /> any person for influencing or attempting to influence an officer or employee of any agency, a Member of <br /> Congress, North Carolina's General Assembly or local government body; an officer or employee of Congress, <br /> North Carolina's General Assembly or local government body; or an employee of a Member of Congress, North <br /> Carolina's General Assembly or local government body in connection with the Federal, State or local government <br /> contract, grant, loan or cooperative agreement, the undersigned shall complete and submit Standard Form -LLL, <br /> "Disclosure Form to Report Lobbying," in accordance with its instructions; <br /> 2. DEBARMENT, SUSPENSION,AND OTHER RESPONSIBILITY MATTERS <br /> A. The applicant certifies that it and its principals: <br /> a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily <br /> excluded from covered transactions by any Federal, State or local government agency; <br /> b) Have not within a three-year period preceding this application been convicted of or had a civil judgment <br /> rendered against them for commission of fraud or a criminal offense in connection with obtaining, <br /> attempting to obtain, or performing a public(Federal, State, or local)transaction or contract under a <br /> public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, <br /> forgery, bribery,falsification or destruction of records, making false statements, or receiving stolen <br /> property; <br /> c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity(Federal, <br /> State, or local)with commission of any of the offenses enumerated in paragraph 2. (A) (b)of this <br /> certification; and. <br /> d) Have not within a three-year period preceding this application had one or more public transaction <br /> (Federal, State, or local)terminated for cause or default. <br /> B. Where the applicant is unable to certify to any of the statements in this certification, he or she shall attach an <br /> explanation to this certification. <br /> 1/12 Rev 7/12, 9/12 Page 6 of 11 <br />