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Certifications and Assurances
<br />NCDA&CS Certifications & Assurances Page 1 of 3
<br />Rev 9/12, 10/12, 11/13;1/17
<br />CERTIFICATIONS REGARDING LOBBYING, NONPROCUREMENT, DEBARMENT,
<br />SUSPENSION AND DRUG-FREE WORKPLACE
<br />Applicants should refer to the regulations cited below to determine the certification to which they are
<br />required to attest. Signature of this form provides for compliance with certification requirements under 2
<br />CFR, Subtitle B, Chapter IV, Part 417, "Nonprocurement Debarment and Suspension," Part 418, "New
<br />Restrictions on Lobbying,” and Part 421, “Requirements for Drug-Free Workplace (Financial Assistance),"
<br />and 2 CFR Part 180. The certifications shall be treated as a material representation of fact upon which
<br />reliance will be placed when the Department of Agriculture & Consumer Services determines to award the
<br />covered transaction, grant, or cooperative agreement.
<br />1. LOBBYING
<br />As required by authority: 31 U.S.C. 1352 and U.S.C. 301 and implemented at 2 CFR Part 180, for persons
<br />entering into a grant or cooperative agreement over $100,000, as defined at 2 CFR Section 418.110, the
<br />applicant certifies that to the best of their knowledge and belief, that:
<br />1)No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned,
<br />to any person for influencing or attempting to influence an officer or employee of an agency, a
<br />Member of Congress, an officer or employee of Congress, or an employee of a Member of
<br />Congress in connection with the awarding of any Federal contract, the making of any Federal
<br />contract, the making of any Federal loan, the entering into of any cooperative agreement, and the
<br />extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan,
<br />or cooperative agreement.
<br />2)If any funds other than Federal appropriated funds have been paid or will be paid to any person for
<br />influencing or attempting to influence an officer or employee of any agency, a Member of
<br />Congress, an officer or employee of Congress, or an employee of a Member of Congress in
<br />connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall
<br />complete and submit Standard Form -LLL, “Disclosure Form to Report Lobbying” in accordance
<br />with its instructions.
<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 />This certification is a material representation of fact upon which r eliance was placed when this transaction
<br />was made or entered into. Submission of this certification is a prerequisite for making or entering into this
<br />transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required
<br />certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for
<br />each such failure.
<br />2.NONPROCUREMENT DEBARMENT AND SUSPENSION
<br />As required by Executive Order 12549, Debarment and Suspension, and implemented at 2 CFR Part 180
<br />and 2CFR Part 417, for prospective participants in primary covered transactions, as defined at 2 CFR
<br />180.435 and Subpart C, 417.332, the applicant certifies that it and its principals:
<br />a)Are not presently debarred, suspended, proposed for debarment, declared ineligible, or v oluntarily
<br />excluded from covered transactions by any Federal department or agency;
<br />b)Have not within a three-year period preceding this application been convicted of or had a civil
<br />judgment rendered against them for commission of fraud or a criminal offense in connection with
<br />obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or
<br />contract under a public transaction; violation of Federal or State antitrust statutes or commission of
<br />embezzlement, theft, forgery, briber y, falsification or destruction of records, making false
<br />statements, or receiving stolen property;
<br />Attachment C
<br />DocuSign Envelope ID: F8ACCDE8-686F-4083-B46D-486310D8A869
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