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13 <br /> <br /> <br />APPENDIX A, 44 C.F.R. PART 18 – CERTIFICATION REGARDING LOBBYING <br />Certification for Contracts, Grants, Loans, and Cooperative Agreements <br /> <br />The undersigned certifies, to the best of his or her knowledge and belief, that: <br /> <br />1. No Federal 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 <br />of an agency, a Member of Congress, an officer or employee of Congress, or an employee <br />of a Member of Congress in connection with the awarding of any Federal contract, the <br />making of any Federal grant, the making of any Federal loan, the entering into of any <br />cooperative agreement, and the extension, continuation, renewal, amendment, or <br />modification of any Federal contract, grant, loan, or cooperative agreement. <br /> <br />2. If any funds other than Federal appropriated funds have been paid or will be paid to any <br />person for influencing or attempting to influence an officer or employee of any agency, <br />a Member of Congress, an officer or employee of Congress, or an employee of a <br />Member of Congress in connection with this Federal contract, grant, loan, or <br />cooperative agreement, the undersigned shall complete and submit Standard Form- <br />LLL, “Disclosure Form to Report Lobbying,” in accordance with its instructions. <br /> <br />3. The undersigned shall require that the language of this certification be included in the award <br />documents for all subawards at all tiers (including subcontracts, subgrants, and contracts <br />under grants, loans, and cooperative agreements) and that all subrecipients shall certify <br />and disclose accordingly. <br /> <br />This certification is a material representation of fact upon which reliance was placed when this <br />transaction was made or entered into. Submission of this certification is a prerequisite for making <br />or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who <br />fails to file the required certification shall be subject to a civil penalty of not less than $10,000 <br />and not more than $100,000 for each such failure. <br /> <br />The Provider, , certifies or affirms the truthfulness and accuracy of each statement of its <br />certification and disclosure, if any. In addition, the Provider understands and agrees that the <br />provisions of 31 U.S.C. Chap. 38, Administrative Remedies for False Claims and Statements, <br />apply to this certification and disclosure, if any. <br /> <br /> Signature of Provider’s Authorized Official <br /> <br /> _____________________________________________________ __________________ <br /> Printed Name and Title of Provider’s Authorized Official Date <br /> <br /> <br />DocuSign Envelope ID: 1C0795C4-E5F5-4D2B-A734-9175427D7278