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/ <br /> Attachment 2 L ` ) AD J cO L , <br /> ( Required of all Applicants ) <br /> CERTIFICATION AND RESTRICTIONS ON LOBBYING j <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 k <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, f <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 r <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 /> I <br /> The undersigned certifies or affirms the truthfulness and accuracy of the contents of the statements submitted on or with <br /> c <br /> this certification and understands that the provisions of 31 U. S. C. Section 3801, et seq . , are applicable thereto . <br /> Signature of A horiz Official Affix NotgU Seal Here <br /> .•�` ap JEN '#�, <br /> Seal Subscribed and sworn to me ti �" .• �,� <br /> NOTARY •� �s <br /> ( d <br /> E <br /> ) ` (� � ® TAR Z <br /> PUBLIC <br /> Notary <br /> Publ c <br /> • <br /> y <br /> f <br /> �o <br /> • . . . . . • <br /> LDS IL <br /> NC AIAI8 <br /> Printed Name a d Address .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> My commission expires <br /> ( date ) ® C) A (a <br />