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<br />
<br />Exhibit D
<br />APPENDIX A, 44 C.F.R. PART 18 – CERTIFICATION REGARDING
<br />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
<br />employee of an agency, a Member of Congress, an officer or employee of Congress, or
<br />an employee of a Member of Congress in connection with the awarding of any Federal
<br />contract, the making of any Federal grant, the making of any Federal loan, the entering
<br />into of any cooperative agreement, and the extension, continuation, renewal,
<br />amendment, or modification of any Federal contract, grant, loan, or cooperative
<br />agreement.
<br />
<br />2. If any funds other than Federal appropriated funds have been paid or will be paid to
<br />any person for influencing or attempting to influence an officer or employee of any
<br />agency, a Member of Congress, an officer or employee of Congress, or an employee
<br />of a 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
<br />award documents for all subawards at all tiers (including subcontracts, subgrants, and
<br />contracts under grants, loans, and cooperative agreements) and that all subrecipients
<br />shall certify and disclose accordingly.
<br />
<br />This certification is a material representation of fact upon which reliance was placed
<br />when this transaction was made or entered into. Submission of this certification is a
<br />prerequisite for making or entering into this transaction imposed by section 1352, title
<br />31, U.S. Code. Any person who fails to file the required certification shall be subject to a
<br />civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
<br />
<br />The Subrecipient, White Cross Volunteer Fire Department, certifies or affirms the
<br />truthfulness and accuracy of each statement of its certification and disclosure, if any. In
<br />addition, the Subrecipient understands and agrees that the provisions of 31 U.S.C.
<br />Chap. 38, Administrative Remedies for False Claims and Statements, apply to this
<br />certification and disclosure, if any.
<br />
<br />
<br />
<br />_______________________________________________ _________________
<br />Signature of Subrecipient’s Authorized Official Date
<br />
<br />
<br />_________________,_____________________________
<br />Print Name, Title of Subrecipient’s Authorized Official
<br />DocuSign Envelope ID: E9696229-2C10-4E21-876A-3D5C1D00DF70
<br />Tony Blake
<br />11/3/2022
<br />Tony Blake - President WCVFD
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