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W <br />CERTIFICATION REGARDING LOBBYING <br />Certification for Contracts, Grants, Loans, <br />and Cooperative Agreements <br />The undersigned certifies, to the best of his or her knowledge and <br />belief, that: <br />(1) No Federal appropriated funds have been paid or will be <br />paid, by or on behalf of the undersigned, to any person <br />for influencing or attempting to influence an officer <br />or employee of Congress, or an employee of a Member of <br />Congress in connection with the awarding of any Federal <br />contract, the making of any Federal grant, the making <br />of any Federal loan, the entering into of any <br />cooperative agreement, and the extension, continuation, <br />renewal, amendment, of modification of any Federal <br />contract, grant loan, or cooperative agreement. <br />(2) If any funds other than Federal appropriated funds have <br />been paid or will be paid to any person for influencing <br />or attempting to influence an officer or employee of <br />any agency, a Member of Congress in connection with <br />this Federal contract, grant, loan, or cooperative <br />agreement, the undersigned shall complete and submit <br />Standard Form -LLL, "Disclosure Form to Report <br />Lobbying," in accordance with its instructions. <br />(3) The undersigned shall require that the language of this <br />certification be included in the award documents for <br />all* sub - awards at all tiers (including subcontracts, <br />sub - grants and contracts under grants, loans, and <br />cooperative agreements) and that all* subrecipients <br />shall certify and disclose accordingly. <br />This certification is a material representation of fact upon which <br />reliance was placed when this transaction was made or entered <br />into. Submission of this certification is a prerequisite for <br />making or entering into this transaction imposed by Section 1352, <br />Title 31, U.S. Code. Any person who fails to file the required <br />certification shall be subject to a civil penalty of not less than <br />$10,000 and not more that $100,000 for each such failure. <br />Orange County Department of Social Services WIA Youth Programs <br />CONTRACTOR WIA ORGANIZATION PROGRAM TITLE <br />SIGNATURE OF CERTIFYING OFFICIAL DATE <br />*NOTE: In these instances, "All," <br />clarified to show that it applies to <br />over $100,000 (per OMB). <br />in the Final Rule is expected to be <br />covered contract /grant transactions <br />Local Workforce Area Contract Agreement Page 27 of 29 <br />Amended 7/14 <br />