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CITY OF SANTA ANA <br />RFP NO.; 22.09E <br />ON CALL EMERGENCY ASPHALT & PCC <br />NON-LQBBYINC CERTIFICATION <br />The prospective participant certifies, by signing and submitting this bid or proposal, to the befit of <br />his or her knowledge and belief, that: <br />(1) No Federal appropriated funds .)lave been paid or will be paid, by or on behalf of the <br />undersigned, to any person for influencing or attempting to influence an officer or <br />employee of any Federal agency, a Member of Congress, an officer or employee of <br />Congress, or an employee of a Member of Congress in connection with the awarding of <br />any Federal contract, the making of any Federal grant, the malting of any Federal loan, the <br />entering into of any cooperative agreerent, and the extension, continuation, renewal, <br />amendment, or modification ofany Federal contract, grant, loan, or cooperative agreement. <br />(2) if any fonds other than Federal appropriated funds have been paid or will be paid to any <br />person for influencing or attempting to influence an officer or employee of any Federal <br />agency, a Member of Congress, an officer or employee of Congress, or an ernpioyce of a <br />Member o€ Congress in connection with this Federal contract, grant, loan„ or cooperative <br />agreement; the undersigned shall complete and submit Standard Form-LLL, "Disclosure <br />of Lobbying Activities," in conformance with its instructions, <br />This certification is a material representation of fact upon which reliance was placed when this <br />transaction was made or entered into. Submission of this certification is a prerequisite for making <br />or entering into this transaction imposed by Section 1352, Title 3 t, U.S, Code. Any person who <br />fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and <br />not more than $160,000 for each such failure, <br />The prospective participant also agrees by submitting his or her bid or proposal that he or she shall <br />require that the language of this certification be included in all lower tier subcontracts, which <br />exceed S i 00,000 all t all such sut ipients shall certify and disclose accordingly. <br />Signed: <br />Jo§epit Nark! <br />'title; Vice Went) <br />Firm: ESS General Engineering, Inc <br />Date; _2/1/2023 <br />Page $ of 10 <br />