Certification Regarding Lobbying Template printable pdf download

CERTIFICATION REGARDING LOBBYING

Certification for Contracts, Grants, Loans, and Cooperative Agreements

Appendix A - 49 CFR Part 20

The undersigned (Contractor) certifies, to the best of his or her knowledge and belief, that:

No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned,

to any person for influencing or attempting to influence an officer or employee of an agency, a

Member of Congress, an officer or employee of Congress, or an employee of a Member of

Congress in connection with the awarding of any Federal contract, the making of any Federal

grant, the making of any Federal loan, the entering into of any cooperative agreement, and the

extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan,

or cooperative agreement.

If any funds other than Federal appropriated funds have been paid or will be paid to any person

for making lobbying contacts to an officer or employee of any agency, a Member of Congress, an

officer or employee of Congress, or an employee of a Member of Congress in connection with

this Federal contract, grant, loan or cooperative agreement, the undersigned shall complete and

submit Standard Form--LLL, “Disclosure Form to Report Lobbying,” in accordance with its

instructions [as amended by “Government wide Guidance for New Restrictions on Lobbying,” 61

Fed. Reg. 1413 (1/19/96). Note: Language in paragraph (2) herein has been modified in

accordance with Section 10 of the Lobbying Disclosure Act of 1995 (P.L. 104-65, to be codified

at 2 U.S.C. 1601, et seq.)]

The undersigned shall require that the language of this certification be included in the award

documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under

grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose

accordingly.

This certification is a material representation of fact upon which reliance was placed when this transaction

was made or entered into. Submission of this certification is a prerequisite for making or entering into this

transaction imposed by 31, U.S.C. § 1352 (as amended by the Lobbying Disclosure Act of 1995). Any

person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000

and not more than $100,000 for each such failure. [Note: Pursuant to 31 U.S.C. § 1352(c)(1)-(2)(A), any

person who makes a prohibited expenditure or fails to file or amend a required certification or disclosure

form shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such

expenditure or failure.]

The Contractor, _______________________________, certifies or affirms the truthfulness and

accuracy of each statement of its certification and disclosure, if any.

In addition, the Contractor

understands and agrees that the provisions of 31 U.S.C. A 3801, et seq., apply to this certification and

disclosure, if any.

Signature of Contractor’s Authorized Official ____________________________________________

Name and Title of Contractor’s Authorized Official________________________________________

Date ________________________________

Certification Regarding Lobbying Template