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GITY OF SA NTA A NA <br />R F R NO-: 22-133 <br />ON-QAl_L i*NQ I NEE R I NG DESIGN 6r:RVIGES FOR PFAS TREATM ENT 8 Y5 TEM S <br />NON-LOSRYIN G C E RT I Fi AXON <br />The prospeol+we paslicipant cerl'rfies, hV signing ai}d sUbM111log Ihie bid a proposal, to the <br />bust of his -or her k ri.owledge and belief, lha t. <br />(1) No Federal appropriated funds haYa been paid or will be paid_ by cr on behalf of <br />the un de mrgned , to an y perso n For io flqje rx Ing or altemptirng to influence a re officer <br />or emplo�e'e of any Fede,el ;apeney, a Member of Congress, an officer or employee <br />of C�ongrens, or an employee -o# s Member of Congress in Dne-clan with the <br />8Wi9fdlF1!y of acy Federa l car tracl , the makirng of a ily FedeFaM grant, the ma k ing 0 f <br />any Federal loan, the iebtefi n g into of any coaparative agreema rr , and the <br />exle nsion, ccntintjakion. re riewva I, a mend me Dt, or modification of any Federal <br />e. wracl, -grant, foan, or cooperative agreement, <br />(2) 1 f a n y fu nds other III an Fedeia I a pproprts ted funds have bee a pa id or will be laid <br />ie any pe-rS00 for Influerleing or atteniplirig to inflvence an officer cr emplDyee of <br />any Federal agency- a Member of Congress, i3i1 officer or amplcyee of Congress, <br />or an employee of a Member of C Cong ress in -corknectean with Ibis Federal -conlract, <br />grant, loan, or cooperabye agreement, the undersigns shall Complete and submit <br />,Standard Fom°,-LLL, "Dmr-losure of Lobbying AClivilies," in eertiform;Nnce with ils <br />irlstrUoko s. <br />Thrs -cer#Ifir..alion is a material representaban of fa-Gt upor1 which reliance was placed when <br />thFs transac6un Was made or entered into_ Subrnissrort -of tYrir, Certification is a preraquisike <br />for making or entering into this transa-cfion imposed by Section 1352, Titre 31, U,s. Code. <br />Any person who fails to fRe the rewired certificaticR shall be subjecl tO a civE1 pertialty of <br />riot 1$:59 0011 S 10. 000 erld not More thar) $90,00 for each such #aLIlure. <br />The pFoapeCtiVe participant of-s-@ ag reez, by submitting his or her bid or proposal! that he <br />or she sha Il requ ire that I h e la n-qu age of this cortificelian be Precluded in all lowar tier <br />5uhcoritracts, which exceed $100,000 and that all such subrecipients shall Qertity and <br />disclose accordingly. <br />Signed: _ <br />Title; w- <br />Finn: <br />Date, <br />C t} of Santa Ana kFP 22-133 <br />On-Calr En$inewing D.@4igrL &@wipe% for PFAS Treatimetnl SyrsL$me <br />Page '113 <br />