ALL AMERICAN ASPHALT (MID-CITY NEIGHBORHOOD IMPROVEMENT (WEST OF BRISTOL))

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j , CITY OF SANTA ANA Project No. 10-7554 Mid-City Neighborhood Improvement (west of Bristol St.) Project No. 07-7577 Edinger Ave. Improvement from Mohawk St. to 400' e/o Mohawk St. PROPOSAL AND CONTRACT AGREEMENT CERTIFICATION FOR FEDERAL AID CONTRACTS The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her lrnowledge and belief; that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any Federal Agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of an Federal contract, grant, loan, or cooperative agreement. (2) If any funds other Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL*, "Disclosure of Lobbying Activities" in accordance with its instructions. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The prospective participant also agrees by submitting his or her proposal that he or she shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such sub-recipients shall certify and disclose accordingly. .?~ B ER Signature (2. C~-~'R~' ~ U. , ~G~ ~~t~c> ~P~~~ Firm ~lA~. ~- 201.0 Date ~~ d ~ Form LI.L mar be ~ht ~ ~ -~ 'y.. l ~r ct_' o t Caltra~ or P.H cesv ~ -" ~ ~°' e - ~ ...~ o • TO BE INCLUDED IN BID PACKAGE BP 27 of 31