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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO. 14,6799: New TrAH1c Signal on Newhope St and Camille St <br />PROJECT NO, 14-6800: Traffic Signal Mod if kation on Segerstrom Ave and Bear St <br />NON -LOBBYING CERTIFICATION FOR FEDERAL AID CONTRACTS <br />The prospective participant certifies, by signing and submitting this bid or proposal, to the best <br />of his or her knowledge and belief, that: <br />(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of <br />the undersigned, to any person for influence or attempting to Influence an officer <br />or employee of Congress, or an employee of a Member of Congress in connection <br />with the awarding of any Federal contract, the making of any Federal grant, the <br />making of any Federal loan, the entering into of any cooperative agreement, and <br />the extension, continuation, renewal, amendment or modification of any Federal <br />contract, grant, loan, or cooperative agreement. <br />(2) If any funds other than Federal appropriate funds have been paid or will be paid to <br />any person for influencing or attempting to influence an officer or employee of any <br />Federal agency, a Member of Congress, an officer or employee of Congress, or an <br />employee of a Member of Congress in connection with this Federal contract, <br />grant, loan, or cooperative agreement, the undersigned shall complete and submit <br />Standard Form -LLL, "Disclosure of Lobbying Activities," in accordance with its <br />Instructions. <br />This certification is a material representation of fact upon which reliance was placed <br />when this transaction was made or entered into. Submission of this certification is a <br />prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. <br />Code, Any person who fails to file the required certification shall be subject to a civil penalty of <br />not less than $10,000 and not more than $100,000 for each such failure. <br />The prospective participant also agrees by submitting his or her bid or proposal that he <br />or she shall equire that the language of this certification be included in all lower tier <br />subcontract which exceed $100,000 and that all such sub -recipients shall certify and disclose <br />according) . <br />Eii£dbeth H. Mendoza de McRae <br />President/CFO <br />Signature <br />PTM General Enaneerina Services, Inc <br />Firm <br />10.05.2015 <br />Date <br />• Standard Form UL may W obtained 61,m Calvans and P`JIWA ni'Nra� <br />ESP -24 <br />