HomeMy WebLinkAboutLobbying CertificateCERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies to the best of his or her knowledge 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 an 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 any Federal contract, grant, loan, or
cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid to any person for influencing or
attempting to influence an officer or employee of any agency, a Member of Congress, an officer or
employee of Congress, or an employee of a Member of Congress in connection with this Federal
contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard
Fonn-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
This undersigned shall require that the language of this certification be included in the award
documents for "All" sub -awards at all tiers (including subcontracts, sub -grants, and contracts under
grants, loans, and cooperative agreements) and that all sub -recipients shall certify and disclose
accordingly.
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 3 1, 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.
(3)
Aliapattah Community Action, Inc,
Name of Applicant
Ardo Mesa, Chairman
Print name of Certifying Official
Signature of Certifying Official Date
43
City of WV"
STATE OF FLORIDA
The foregoing instrument was acknowledged before me this day of / 1209,5.
by�b� '� s/� who ispersonally known to me or who
(name of person whose signature is being notarized)
produced
(Type of Identification)
OTARY UBLICC::
„/"1,7(,/,177,4all
as identification, and who did/did not take an oath.
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(Signature) (Print Name)
SEAL
rtr, Dolores Valdes Otero
:4 My Commission DD029208
'?a, n°e Expires September 14, 2005
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