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Last modified
8/19/2024 4:06:55 PM
Creation date
7/5/2023 10:45:50 AM
Metadata
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Template:
Contracts
Company Name
HELPMATES STAFFING
Contract #
A-2023-122-03
Agency
Human Resources
Council Approval Date
6/20/2023
Expiration Date
6/30/2026
Insurance Exp Date
2/13/2025
Destruction Year
2031
Notes
For Insurance Exp. Date see Notice of Compliance
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Docu&gn Envelope ID: 49380AED-6969-4l D5-8269-7OD86a62F795 <br />CITY OF SANTA ANA <br />ATTACHMENT E <br />NON -LOBBYING CERTIFICATION <br />The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or <br />her knowledge and belief, that: <br />(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, <br />to any 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 employee of a Member <br />of Congress in connection with the awarding of any Federal contract, the making of any Federal <br />grant, the making of any Federal loan, the entering into of any cooperative agreement, and the <br />extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, <br />or cooperative agreement. <br />(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person <br />for influencing or attempting to influence an officer or employee of any Federal agency, a Member <br />of Congress, an officer, or employee of Congress, or an employee of a Member of Congress in <br />connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned <br />shall complete and submit Standard Form-LLL, "Disclosure of lobbying Activities," in <br />conformance with its instructions. <br />This certification is a material representation of fact upon which reliance was placed when this transaction <br />was made or entered into. Submission of this certification is a prerequisite for making or entering into <br />this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required <br />certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for <br />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 exceed <br />$100,000 and that all such subrecipients shall certify and disclose accordingly. <br />Signed: _°01 V nk✓ <br />Title: ?Wknk <br />Firm: (44e yo,ks shklt_tft(T��I�I((GGSi <br />Date: 41 / g 12 ) <br />THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL. <br />PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE. <br />
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