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Local Assistance Procedures Manual <br />PS&E Checklist Instructions <br />department or agency with which this transacbm originated <br />may pursue available remedies, including suspension andfor <br />debarment <br />Certification Regarding Debarment, Suspension, <br />Ineligibility and Voluntary Exclusion -Lower Tier <br />participants: <br />1. The prospectiue lawertierpanitdpant oerlifles, by <br />submission of this:timposa€, that nei0ner it nor He principals B <br />presently debarred, suspended, proposed for debarment, <br />declared ineligible, or voluntarily excluded from participating in <br />covered transaoiions by any Federal department or agency. <br />2. Where ft prospective lowartierparicipant is unableta <br />codify to arty ofthe statements In this cediFieatian, such <br />prospective participant shall attach anertirianation to this <br />proposal. <br />711. CERTIFICATION REGARDING USE OF CONTRACT <br />FUNDS FOR LOBBYING <br />This provision is applicable to all Federal aid construction <br />contracts and to all related subcontracts which exceed <br />$100,000 (49 CFR 20)- <br />I . <br />0). <br />1. The prospective participant certifies, by signing and <br />submitting We bid or proposal, to the best of his a her <br />Knowledge and belief, that <br />a. No Federal appropriatedfunds have been paid or will be <br />paid, by or on behalf of the undersigned, to any person for <br />influencing or attempting to influence an officeror employee of <br />any Federal agency, a Member of Coitress, an ofaceror <br />employee of Congress, or an employee of a Member of <br />Congress in connection vath the awarding of any Federal <br />contract, the making of any Federal grant the making of any <br />Federal loan, the entering irhb of any cooperative agreement, <br />and the extension, continuation, renewal, amendment, or <br />modification of any Federal contract, grant, faun, or <br />cooperative agreement <br />b. if any funds other than Federal appropriated funds have <br />been paid or Wil be paid to arty perm fa influencing or <br />adempfing to influence an officer or employee of any Fedemi <br />agency, a Mendher of Congress, an officer or employee of <br />Congress, oar employee of a Member of Congress in <br />conneclion with this Federal contract, grant, loan, or <br />cooperative agreement, the undersigned shag comylete and <br />submit Standard ForntLLL, "Disclosure Form to Report <br />Lobbying," in accordance with its instructions. <br />2. This certiflcaron is a material representation of fact upon <br />which reliancewas placed when this transaction was made or <br />entered into. Submission of this certification is a prerequisite <br />for making or entering into this transaction imposed by 31 <br />U.S.C. 1352 Any person who fails to file the required <br />certi0caflon stall be subject to a civil penalty of not less than <br />$10,000 and not more than $i00,00D for each such faikue. <br />3. The prospective participant also agrees by submhting its <br />bid or proposal that the participant shall require that the <br />language of this certification be included in all tower tier <br />soticontracts, which exceed $1DO,000 and that all such <br />recipients shall certify and discbse accordingly. <br />11 <br />OB 12-05 <br />EXHIBIT 12-E <br />Attachment B <br />Page 12-21 <br />July 31, 2012 <br />