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CITY OF SANTA ANA <br />RFP NO : 22.133 <br />ON -CALL ENGINEERING DESIGN SERVICIES FOR PFAS TREATMENT SYSTEMS <br />foci LQBBYIfaf9_C2RTIFtCATIO <br />The prospective parliclpant cardufi ss, by signing and submitting lhis bld or proposal, jo the <br />best of Ills or her knowledge and boffor, Iliat <br />(I) No Federal appropriated FuriAl haVe been paid or wvlll he paid„ by a on behalf of <br />the undersigned, to any person. for Influencing or Mtempting to Influence art officer <br />or employee ofany Federal augenuy, as Member ofCongress, aun officer or employee <br />of Congress, or an eatspfayee of a Menrtaor of Congress in connection with the <br />awarding of any Federal contract, the making or any Federal grant, the making of <br />any Federal loan, the eastering into of any cooperative agreement, and the <br />extension, ccntlnatalton, rnne4wel, amendment. or modification of any Federal <br />bonlract, grant, Iran, or cooperaative wg,reomonl. <br />(2) if any fonds other than Federal approprietod' larnds have been paid or will be paid <br />to any person for Irstttron In or altempUng to in0kienoe 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 Congrees lei connectinn with lhis Fe4erail contract, <br />grant, loan, or cooperative agreaartent, the unrtersignecl shall complete and submit <br />Standard Fbrrarn-LLL, "Disclosure of Lobbying Ac1t5attios," in conformance with its <br />instructions. <br />Thlq carkJfcatiorn is a material representation of fact+upon which rellaince was placed wwtion <br />this transaction was made or entered into, Submi Won of US cortifidatdon Is a p romquiMte <br />for making or entering into this truansaactlou Imposed by Section 1352, Title 3'1, U.S, Code, <br />Any person who fails to Pilo the required certification 811,011 be subject to a civil penalty of <br />not lrau than $10,t 00 and not snore, then $1013,000 for each such failure. <br />The prospective par icipatnt anrrso agrees by submitting his or her bid or proposal that ho <br />or she shall retpudre that lira language of this aorUllcalion bet Included to all lower tier <br />subcontracts, rwhlcli exceed $100,000 and flat all such s tbreclplents shall cerlify and <br />disclose accordingly. r <br />Signed: _. <br />Title; ,r ' C <br />r <br />City of Santa Ana R P 22-133 <br />On-Coir Engineering Design Servims for PrA ' Irt"Imeni Systems <br />Patio 39 <br />