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12 <br /> <br /> <br />APPENDIX A, 44 C.F.R. PART 18 – CERTIFICATION REGARDING LOBBYING <br />Certification for Contracts, Grants, Loans, and Cooperative Agreements <br />The undersigned certifies, to the best of his or her knowledge and belief, that: <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 of <br />an agency, a Member of Congress, an officer or employee of Congress, or an employee of a <br />Member of Congress in connection with the awarding of any Federal contract, the making of <br />any Federal grant, the making of any Federal loan, the entering into of any cooperative <br />agreement, and the extension, continuation, renewal, amendment, or modification of any <br />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, a <br />Member of Congress, an officer or employee of Congress, or an employee of a Member of <br />Congress in connection with this Federal contract, grant, loan, or cooperative agreement, <br />the undersigned shall complete and submit Standard Form-LLL, “Disclosure Form to <br />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 under <br />grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose <br />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 and <br />not more than $100,000 for each such failure. <br /> <br />The Provider, Quality Inn Chapel Hill, certifies or affirms the truthfulness and accuracy of each <br />statement of its certification and disclosure, if any. In addition, the Provider understands and <br />agrees that the provisions of 31 U.S.C. Chap. 38, Administrative Remedies for False Claims and <br />Statements, apply to this certification and disclosure, if any: <br /> <br /> <br />_________________________________________ <br />Signature of Provider’s Authorized Official <br /> <br /> <br /> <br />Printed Name and Title of Provider’s Authorized Official <br /> <br /> <br />Date <br /> <br />DocuSign Envelope ID: B6010608-C906-474E-854E-CEDF89A70F76 <br />12/7/2020 <br />Martina Brooks