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• <br /> 3 <br /> 7570.1 <br /> Appcndbc <br /> APPENDIX I. FORM BUD-50071, CERTIFICATION FOR CONTRACTS, GRANTS, <br /> LOANS AND COOPERATIVE AGREEMENTS <br /> Certification for V t.0epe t"'"y'' Housing <br /> btNal Contracts, Grants, Loans & otre•dfPuble°rtrhlen►lou.inp 11? <br /> Cooperative Agreements <br /> Pubic Hovtinq Agency/indtan Housing Authorty <br /> rw.s rt Nemo If sew *AA Oc.r,try&am se s Op-Ire Ini tkbatly w t+ouow:a, <br /> Main it brw IIIAIAHA>a nem,Yew E1dry <br /> VW M Fiodrd FI•461 Yraar b v1 Ann In stash ar.*err•wowd b be <br /> M trek ere topoeft4 b be nrw.sd etipIUt <br /> .q M.*Mv Federal Ores ow 11100.000:Iowa orb) <br /> CD*ctthQ <br /> 34.041?y COP <br /> De ebpmM CLAP <br /> Drug Elkninasixt Owes l.YioP <br /> Sec 23 l staid Flaxinp Other:*eau) <br /> • <br /> Acting co Weill of the above named P$WDIA as its A urFwri ed Oftiic ia1,1 nuke die Mowing cent lleatiom <br /> to the Mormon of Housing end Urban Devekrrrnaht(FOJD) <br /> (1) No Federal appropriated funds have bees pad or will be paid.by or co behalf d tbs <br /> undersigned,to any person kw influencing or w erscsng to influence an officer or employee <br /> of any agency,s Member of Congress is cooaacnon*ills the awarding of any Federti <br /> eontrict,the muting of any Federal grant,the mains deny Federal loan,the entering Imo <br /> of any cooperative agreement,and the extension,taotinwtton,fences!,amendment,cr <br /> anodifratioa of any Federal contract,grant.loos,cr cooperative specmeas. <br /> (2) irony Finds cater than Federal oppropistal faros brie been paid or will be paid to say perms <br /> • Sox influencing ce atlemptung as influence an afScer err employee of airy agency,a Master <br /> d Congress,as officer er employee of Calms,Or soy employee Oa Member d CA:are n <br /> is connection with this Fc feral contract,gent,loan,or cooperative agreement„the odor- <br /> Opal dull complete and submit Standard Fares-111,Disclosure of ltebyiag Activities, <br /> Is accordance with its kastrvctione. <br /> (3) The undoijgned sFuiil require that the Iarguge of this certifxstices be labeled is the sward <br /> P documents nor all;Amuds at sin titre(-secluding s,aboo uracu,subgrsz u,and castrate <br /> wader pints,loam,and cooperative agreements)rid that st1 abeeopirnb shall citify and <br /> erode accordingly. <br /> TbIJ oenilkaoon is s materiel representadoo of fact altos stick reliance was placed when this trsnsscdes <br /> wu mask Of entered into. Submission d this certification it a prerequisite for making a entering Ina this <br /> transomioo Imposed by Section 1351,71de 31,US.Code. Any person Oa(sits to Ale the repaired <br /> cue f icatics shall be subject to s civil penalty of not less des 510,000 sod not more than 3100,003 for esc! <br /> Inch fultss. <br /> certify under penalty of perjury that the foregoing is true and cornet <br /> Authorirsd PHMHA Otrcial: *MP acts: <br /> X <br /> torn HUD 1.0071 (111) <br /> qr KaxtomU 7117 1.WS 13.1us i l 14.5 3 <br /> 1 <br />