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9828 <br />00131-4 <br />DEBARMENT AND SUSPENSION CERTIFICATION (LOWER TIER COVERED TRANSACTION) <br />(To be submitted with a bid or Offer exceeding the small pur+chase threshold fo~ Federal assistance <br />Pro9~~~ ~urrerrtly $100~000.) <br />The prospedive lower tier participant (Offero~ certifies, by submission of this Offer, that neither it nor its <br />`prinapals' as defined at 49 C.F.R. § 29.105(p) is p~+esently debamed, suspended, proposed for debarmerrt, <br />dedared inet'~gible, or volurrtarily exduded from participation in this transaction by any Federal departmerrt <br />or agency. <br />if the prospective Iower tier partiapant (Offeror) is u~able to certify to the statemerrt above. it shall attach <br />an explanation, and indicate that it has done so, by placing an 'X' in the foilowing space , <br />THE BIDDER OR OFFEROR, , CERTIFIES OR AFFIRMS THE TRUTHFUWESS AND <br />ACCURACY OF EACH STATEMENT OF ITS CERTIFICATION AND EXPLANATION, IF ANY. IN <br />ADDI710N, THE BIDDER OR OFFEROR UNDERSTANDS ANO AGREES THAT THE PROVISIONS OF <br />31 U.S.C §§ 3801 ET SEQ. APPLY TO THIS CERTIFICATION AND EXPLANqT10N, IF ANY. <br />Signature of the Bidder or Offero~'s Authorized Official <br />Name and Tdie of the Bidder o~ Offeror's Authorized Official <br />Date <br />LOBBYING CERTIFICATION <br />(To be submitted with a bid or Offer exceeding $100.000.) <br />The Bidder or Offeror ce~tifies, to fhe best its knowledge and belief. that: <br />No Federal appropriated funds have been paid or wili be paid by o~ on behaif of the <br />u~dersigned~ to any person for influerx;ing or attempting to influence an officer o~ empioyee <br />of a Federal departmerrt or agency~ a Member of the U.S. Congress~ an officer or employee <br />of the U.S. Congress, or an employee of a Membe~ of the U.S. Congress in oonnedion witM <br />the awarcling of any Federal contract, the making of any Federal grarrt, the making of any <br />Federal loan, 'the errtering into of any oooperative agreemerrt, and the extension, <br />continuation. renewal~ amendmerrt~ or modification thereof. <br />2. If any funds othe~ than Federal appropriated funds have been paid or wili be paid to any <br />person for making lobbying corrtacts to an officer o~ employee of any agency, a Member of <br />Congr~ess, an officer or employee of Congre.ss, or an employee of a Member of Cong~ess <br />in connection with this Federal contract, grarrt, loan, or cooperative agneemerrt, ttie <br />undersigned shall complete and submit Standarci Form - LLL, •Disclosure Fonn to Report <br />Lobbying; in aoco~dance with its instrudion~ as amended by'Govemmerrt Wide Guidance <br />for New Restrictions on Lobbying,' 61 Fed. Reg. 1413 (1M9/96) <br />3. The undersigned shall r~equire that the langu~e of this certiflcatio~ be included in the award <br />documents for all subawarYis at all tiers (inGuding subco~acts, subgrarrts, and contracts <br />undergraMs, loans, and oooperative agreemerrts) and that all subrec~pients shall certify and <br />disciose accordingly. This certification is a material~ represe~rtation of fact upon which <br />reliance was placed when this transaction was made or errtered irrto. Submission of this <br />certification shall be subjed to a civil penalty of not less than $10.000 and not more than <br />$100,000 fo~ each such failure. <br />