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CITY OF SANTA ANA <br />RFP NO.: 22-133 <br />CN-CALL ENGINEERING DESIGN SERVICES FOR PFAS TRF-ATME14T SYSTEMS <br />NON-L0BBYING CERTIFICATION <br />The prospeotive parlicipant cerlies, by signing and submllling Ihis bid or proposal, to the <br />best of his or her Knowledge and belief, that: <br />{1) No Federar appropriated funds have been paid or will be paid, by or on behalf of <br />the undersigined, to any person for Influendrig ar allerripting to influence an officer <br />©remployeie of any Federal agency, a Member ofCongress, an officer or employee <br />of Congress„ or an employee of a Member of Congress in connection with the <br />awarding of any Federal contract, the masking of any Federal grant, the making of <br />any Federal loan, the entering Into of any caaperatNe agrearn"t, and the <br />extension, continualion, renewal, amendment, or modification of afly Federal <br />contract, grant, hart, or Cooperative agreement, <br />(2) If any funds other than Federal appropriated Funds have been paid or will be pairs <br />to any person for i4ftuendng or anampifng to influence an officer or employee of <br />any Federal agency, a Member of Congress, an officer or employee of Congress, <br />or an employee of a Member of Congress in conneclio-n with this Federal contracl, <br />grant, loan, or cooperative agreement, the undersigned shad complete and submit <br />5tandtrvd Forrn�LL, "disclosure of Lobbying Aawlies,' W Conformance with its <br />instructions. <br />This cerilfilcabion W a material re.presentabanof fact upon which reliance was placed whin <br />this transaction was made orentefed into_ Skibmission of this certification Is a prerequisite <br />for making or entering into this transaction imposed by Section 1352. Title 31, U.S. Code. <br />Any person who fails to file the required certification shall he subject to a civil penalty of <br />not less than $10,ON and not more than $140,r]Qp for each such #allure. <br />The prospective participant also agrees by submitting his or her hid or proposal that he <br />or she shall require that the language of this certification be included in all lower tier <br />subcontracts, which exceed $100,000 and that all such subrecipiants shall certify and <br />disclose accordingly. <br />r <br />Title: <br />Firm: <br />Date: f '1— <br />City of Santo Ana RFP Pi<.'-i:1 <br />On -Calf Enginsefing Design ServiCe% for PEAS Ir almenl Systems <br />Page 3u <br />City Council 19 — 277 4/4/2023 <br />