Orange County NC Website
Browse       Search
C I41 VoJQ95 ) wbol � J ���� <br /> Attachment 1 <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 Government <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 subs, <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 /> SignotL#e of A horized Offi 1 Affix Notary Seal Here <br /> Seal Subscribed and sworn to me oboe•" "'•••.•F.y '%, <br /> ( date $ :' NOTARY <br /> SIR <br /> AMP <br /> • s <br /> PUBLIC <br /> XP ES: <br /> Notary Publicr <br /> ,'•. �O •'•• • . .. .••',lr C �••• <br /> q SI- v-� <br /> Printed Name and Address U ......... . . . . . . . . . . ... .. . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . ..... . . . . . . . ..... . . . . . . .... . . . . .. . . . <br /> My commission expires <br /> ( date ) <br /> 1 <br />