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CITY OF SANTA ANA <br />R F P NO.- 22-133 <br />ON -CALL ENGINEE RING DESIGN SERVICE FOR PFAS TR A7 ENT SYSTEMS <br />NON-1-013E3YING CEPTfFiCATION <br />The prospac1We padidpant certifies. by signing and subrnruiing thFs bid or proposaE, to the <br />best -of his or her R-nawied!ge and I}efief, Ihal: <br />(1� No Federal appropriated funds have been paid or will be paid, by or on behalf of <br />the undlarsi!gnsd, to any pet n for jnOueiaoing of atteMpbrig to influence a n officer <br />or emproyee of any Fe-deral agericy. a Membe r of Congress, an officer or employee <br />of Congress, or an emplayee of a Mamber of Congress in oonneation with the <br />;@warding of eny Federal contract, the mai ing of any Federal grani, the making of <br />any Federal Icaa, the entering into of any ooaperatiVe agreeMer~t. and the <br />extension, continuation, renewal, amendment. or modification of arty Federal. <br />aantract, graril, load, OF ecoperaUve agreement. <br />(2) If any funds oilier than federal appropriat@d funds have Wen paid or will be paid <br />to any parson for iaffuencieg ar attempling to influence an offs-er or employee of <br />array Faderar agency. a Member of Dori -grass, ar) offiCer or ermpfcyee of Gongrer;s, <br />4or no employee of a Member of Congress in conoaction with lhis Federal ritFar-t, <br />(jrant. loan, or cooperative a 9raen neat, the u ridersigned shall -complete and submit <br />Slandard Forin-LLL, "Disclosure of Lobbyin-U Acl:Mhas." fn cGnlomiaince wily its <br />instructions_ <br />'f h is certification is a m ale vial representation of fact upon vwh ichti reliance was placed when <br />this Iransaclion was made or entered into, ubmission of this certification is a prerequisite <br />for making or enleiing into W5 transacbDn imposed by Section 1352, Title 31, U. S, Gode. <br />Any person who fails to file the regLtited rtifiealia-n shall tie !subjeat to a civil penalty of <br />riot lest thlarr $10,000 and rlol more than $1OUG-1) for each such feature. <br />The prospective paTlicipani also agrees by submitting hip, or her bid Qr proposal that he <br />or she s tkall require that the language of this certificafion be included in all lower ties <br />su bcontracls_ which exceed 1 ChD,0-DG and MW all such subreclpients shall certify and <br />diselo ardhrly, <br />ti <br />Signed, <br />Title,. <br />Firm: C+1*1 C.Ay. 7-4t kks <br />Date: fed /z <br />Oily cyr Santa Aria 1�Fp 22-133 <br />On_(�,atr 1Engiriebrji7q Design Cervices for PF,4S Treatment Sy !jrem!j <br />Page 39 <br />