Orange County NC Website
25 <br /> Attachment 2 <br /> (Required of all Applicants) <br /> CERTIFICATION AND RESTRICTIONS ON LOBBYING <br /> I, Jamezetta Bedford, Chair,Orange County Board of County Commissioners , on behalf of <br /> Name of Authorized Official <br /> Orange County <br /> Legal Name of Applicant <br /> Hereby certifies that: <br /> No Federal/State appropriated funds have been paid or will be paid, by or on behalf of the undersigned,to any person <br /> for influencing or attempting to influence an officer or employee of any Federal/State agency, a Member of Congress or <br /> State Legislature, an employee of a member of Congress or State Legislature, or an officer or employee of Congress or <br /> State Legislature in connection with the awarding of any Federal/State contract,the making of any Federal/State grant, <br /> the making of any Federal/State loan, the entering into of any cooperative agreement, and the extension, continuation, <br /> renewal, amendment, or modification of any Federal/State contract, grant, loan, or cooperative agreement. <br /> If any funds other than Federal/State appropriated funds have been paid or will be paid to any person influencing or <br /> attempting to influence an officer or employee of any Federal/State agency, a Member of Congress or State Legislature, <br /> an employee of a member of Congress or State Legislature, or an officer or employee of Congress or State Legislature in <br /> connection with the Federal/State contract, grant, loan, or cooperative agreement, the undersigned shall complete and <br /> submit Standard Form—LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. <br /> The undersigned shall require that the language of this certification be included in the award documents for all sub- <br /> awards at all tiers (including sub-contracts, sub-grants and contracts under grants, loans, and cooperative agreements) <br /> and that all sub-recipients shall certify and disclose accordingly. <br /> This certification is a material representation of fact upon which reliance was placed when this transaction was made or <br /> entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31 <br /> U.S.C. .§ 1352 (as amended by the Lobbying Disclosure Act of 1995).Any person who fails to file the required certification <br /> shall be subject to a civil penalty of not less than$10,000 and not more than$100,000 for each such failure. <br /> The undersigned certifies or affirms the truthfulness and accuracy of the contents of the statements submitted on or with <br /> this certification and understands that the provisions of 31 U.S.C. Section 3801, et seq., are applicable thereto. <br /> ....................................................................................... <br /> Signature of Authorized Official Affix Notary Seal Here <br /> Seal Subscribed and sworn to me <br /> (date) <br /> Notary Public <br /> Printed Name and Address ................................................................................................ <br /> My commission expires <br /> (date) <br />