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CITY OF SANTA ARIA <br />RFP NC.� 22-133 <br />ON -CALL ENGINEERING DESIC3N SERVICES FOR PEAS TREATMENT SYSTEMS <br />NON-1-038YING CE IRTIFICAT I ON <br />The prospective participant certifps_ by signinu and submrtting this bid or proposal, to the <br />besl ref his Dr her knowledge and belief, thal: <br />)1) No Federal appropriated funds have been paid or will be paid, by or on behalf of <br />the undersigned, to any person for In0ue4tcing of attempting to influence an affcer <br />or employee of 2 ny Federal agency, a Membe r of Cang ress, an office ror employee <br />of Congress, or an employee of a Member of Congress in connection with the <br />awardrntg of any Federal contra4nt, the making of any Federal grant, the making of <br />any Federal loan, the entering into of any cooperative agreement. and the <br />extension, conlinualion, renewal, amendment, or modification of any Federail <br />contract, grant, 10an, or cooperative agreement. <br />(2) If any funds other than Federal appropriated funds have been paid or will be paid <br />to any person for influencing or attempting to influence an rffaeer or employee of <br />any Federal agency, a Member of Congress, an officer or employee of Congress, <br />or ain employee of a Member of Congress in connection with this Federal contract, <br />grant, loan, or cooperative agreement, the a ndersigned shall complete and submit <br />Standard Form-LLL, 'Disclosure of Lobbying Aclrviliesa" in conformance with its <br />instructions. <br />This certification is a male vial representation of fact upon which reliance was, placed when <br />this transaction was made or entered into. Sulam isslon of this certition is a prerequisite <br />far makrng or enlering into W5 transaction imposed by Section 1352, Title 31, U.S. Code. <br />Any person who fails to file the required certification shall be subject to a civil penalty of <br />not less than 510,000 and not more than $100,OW for each such failure_ <br />The prospective parlicipanl also agrees by submitting his or her bid or proposal that he <br />or she shall require that the language of this certification be included in air lower tier <br />subcontracts_ which exceed $11W,000 and that all such subreclpients shall certify and <br />disclose accordingly. � <br />Signed: 1 — <br />Title, 'Ur`rcC +rCSr��h! <br />Firm: <br />❑are: fr �'� ?.� z <br />wiry coi Santa Ana R FP 22-133 <br />Can -Calf Engir Ornig betign Services for PFAS Tresiw-,ro. <br />City Council -' 19 — 282 4/4/2023 <br />