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21
<br />Revised 12/2021
<br />APPENDIX A, 44 C.F.R. PART 18 – CERTIFICATION
<br />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.
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<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
<br />of Congress in connection with this Federal contract, grant, loan, or cooperative
<br />agreement, the undersigned shall complete and submit Standard Form- LLL,
<br />“Disclosure Form to Report Lobbying,” in accordance with its instructions.
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<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 and
<br />disclose accordingly.
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<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 or
<br />entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails
<br />to file the required certification shall be subject to a civil penalty of not less than $10,000 and not
<br />more than $100,000 for each such failure.
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<br />The Provider, Spicy Green Gourmet, LLC, certifies or affirms the truthfulness and accuracy of
<br />each statement of its certification and disclosure, if any. In addition, the Provider understands
<br />and agrees that the provisions of 31 U.S.C. Chap. 38, Administrative Remedies for False
<br />Claims and Statements, apply to this certification and disclosure, if any.
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<br />_________________________________________
<br />Signature of Provider’s Authorized Official
<br />Ashlyn Smith, Printed Name and Title of Provider’s Authorized Official
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<br /> Date
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<br />DocuSign Envelope ID: 9BA2C3AD-E8A9-4A4A-9498-D9E0BBD728C4
<br />1/13/2022
<br />Owner
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