HomeMy WebLinkAboutExhibit 6•
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INSTRUCTIONS FOR COMPLETION OF SF.LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at
the initiation or receipt of ■ covered Federal action, or a material change to a previous filing, pursuant to title 31
U.S.C. uctlon 1352. The filing of a form is required for each payment or agreement to make payment to any
lobbying entity 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 a covered
Federal action. Complete all items that apply for both the initial fling and material change report. Refer to the
implementing guidance published by the Office of Management and Budget for additional information.
1. Identify the type of covered Federal action for which lobbying activity is and/or hu been secured to
influence the outcome of a covered Federal action.
2. Identity the status of the covered Federal action.
3. Identify the appropriate classification of this report. If this Is a followup report caused. by a material
change to the information previously reported, enter the year and quarter in which the change occurred.
'Enter the daleof'the. ttfhhtilttlit"riltoM;brthotor Ale Covered Nora]
action.
4, Enter the full name, address, city, state and zip code of the reporting entity, Include Congressional
Dia rkt, If known. Check the appropriate classification of the reporting entity that designates If It is or
expects to be, a prime or, subaward recipient. Identify the tier of the subawarde e. g., the first
subewardee of the prime is the 1st tier. Subs wards include but are not limited o subcontracts,
subgrants and contract awards under grants.•
S. If the organization filing the report In Item 4 checks "Subawardee", then enter the full name, address,
city, state and zip code.of the prime.FederaI recipient. Include Congressional District, If known.
6. Enter the name of the Federal agency making the award or loan commitment. Include at°leut one
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organizational level below agency name, If know, For example, Department of Transportation, United
States Coast Guard.
7. Enter the Federal program name or description for the covered Federal action (hem 1). If known, inter
the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, .
loans, and loan commitments. •
11. Enter the most appropriate Federal Identifying number available for the ,Federal action identified In
item1 (e.g., Request for Proposal (RFP) number; Invitation for Bid (IFB) number; grant announcement
number; the contract, grant, or loan award number; the applicationlproposai control number assigned
by the Federal agency). Include prefixes, e.g., "RFP•DE•90.001."
4. For a covered Federal action where there has been an award or loan commitment by the Federal agency,
enter the Federal amount of the awardiloan commitment (or the prime entity identified in item 4 or S.
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10. (a) Enter the full name, address city, state and zip code of the lobbying entity engaged by the reporting
entity identified In item 4 to Influence the covered Federal action.
(b) Enter the hull name% of the individuals) performing srrvlces, and include full addrcs If different
from 10 (a). Enter Last Name, First Name, and Middle Initial (MI).
11. The certifying official shall sign and date the form, print his/her name, title and telephone number,
According to the Paperwork Reduction Act, as emended, no persons are
required to deploy' a vend OMB Control lklumber. The valid OM contrl number for this lntormetionncolle tiecollection
is OOel No. 0341.Pubyc reporting burden for this collection of Information is estimated to average 30 minutes per rnpoan, Inch
ding inoirurdims, marching existing data sources, gathering end nsaintataing the data needed, and co reviewing
collection
lnformetion. Send comments regarding the burden estimate or any other aspect of this collection ofnffe� �e� tin eo llama of
for reducing this burden, to the Once of !denotement and Budget. Paperwork ReductlsnJroiert {pytg.0W6}, � tinduodlag eugestioat
Form DEP '55.221(Oirui) i
DEP Agreement No. L►V462, Attachment 3, l'uge 2 of 2
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INSTRUCTIONS FOR CERTIFICATION REGARDING DEBARMENT,
SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION.
LOWER TIER FEDERALLY FUNDED TRANSACTIONS
1. By signing and subm[ttini Ode form, the certifying party is providing the certification let out below.
2. The certification in this clause is a material repncntstion of fact upon which reliance was placed when this transaction was
entered into.. If it 1a later determined that the certifying party knowingly rendered en erroneous certification, in addition to other
remedies available to the Federal Oovemment, the Department of Environmental Protection (DEP) or agencies with which this
trtnsaction originated may pursue available remedies, including suspension andlor debarment„
hi** ih:it��iis::'cenlficall�ti• i�ii" erriineotii< when 'ubibl to which this contract is submitted if at any time the
3. The certifying. party shin provide immediate written notice to the person
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c fyitiep�i' tied'or his becdriie "eiioneotii.
circumstances.
4. The terms covered irarrsactian, debarred. suspended, ineligible., lower tier covered transaction, participant, person, printery
covered transaction, principal, proposal, and voluntarily excluded, m used in this clause,' have the meanings sat out in the
Defnitlons and Coverage sections of'rules implementing Executive Order 12549. You may caner the person to which this
contract is submitted for auiitance in obtaining a copy of those regulations.
5. The cenitying parry agrees by submitting this contract that. should the proposed covered transaction be entered into, it Shall not
knowingly enter into any lower tier contract, or other covered uanuction with a person who,is proposed for debarment under.48
CFR 9,. subpan 9.4. debarred. suspended, declared ineligible, • or voluntarily excluded from participation in this covered
. transaction, unless authorized ythe°DEP_orjency.with.which this transactionorisinitedr.
6. The ceniying parry funher agrees by exceuting this contract that it will include this clause titled "Certification Regarding
Debarment, Suspension, Ineligibility and Voluntary Exclusion -Lower Tier Covered Transaction," without modification in all
contracts or lower, tier covered transactions and in all solicitations for lower tier covered transacdons.
a.
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A participant In a covered transaction may rely.upon a certification of a prospective participant in slower tier eovered transaction
that it finial is proposed for debarment- under-48 CFR 9; subpart 9.4, debarred, suspended ineligible, or voluntarily excluded
from the covered transaction. unless it knows that the certification is erroneous. A participant may decide the method and
frequency by which it determines the eligibility of its ,principals. Each participant may, but 11 not required to, check the
Nonprocurement List (Telephone No. (202) 501 "4740 or (202) 501.4873.)
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Nothing coritairied In the foregoing shall be consuved to require establishment of a system of nand, in order to render in good
faith the 'certification required by this clause. The. knowledge and information of a participant is not required' to exceed that
which is normally possessed by a prudent person in the ordinary course ofbusiness dealings.
9. Except for transactions authorized under paragraph 3 of these instructions, if a participant in a covered transaction knowingly
enter into a lower der covered transaction with a person who is proposed for debarment under 48 CPR 9, subpart 9.4,
suspendril, debarred, Ineligible, or voluntarily excluded from participation in this tr,erssetfon, in addition to other remedies
available to the Federal Government, the DEP or agency with which thb transaction originated may pursue available remedies,
Including suspension and/or debarment.
DEP FORM n723001101) Page 2 of 1
EP Agtwmeot Ne.,1,1462, Attach neat Page 2 of 2 -