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U.S.Department of Homeland Security <br /> Headquarters <br /> 500 C St SW <br /> Washington,D C.20042 <br /> 3��. FEMA <br /> i.v <br /> influence an officer or employee of an agency, a Member of Congress, an <br /> officer or employee of Congress, or an employee of a Member of Congress <br /> in connection with the awarding of any Federal contract,the making of <br /> any Federal grant, the making of any Federal loan, the entering into of any <br /> cooperative agreement, and the extension, continuation, renewal, <br /> amendment, or modification of any Federal contract, grant, loan, or <br /> cooperative agreement. <br /> 2. If any funds other than Federal appropriated funds have been paid or will <br /> be paid to any person for influencing or attempting to influence an officer <br /> or employee of any agency, a Member of Congress, an officer or employee <br /> of Congress, or an employee of a Member of Congress in connection with <br /> this Federal contract, grant, loan, or cooperative agreement,the <br /> undersigned shall complete and submit Standard Form-LLL, "Disclosure <br /> Form to Report Lobbying," in accordance with its instructions. <br /> 3. The undersigned shall require that the language of this certification be <br /> included in the award documents for all subawards at all tiers (including <br /> subcontracts, subgrants, and contracts under grants, loans, and cooperative <br /> agreements) and that all subrecipients shall certify and disclose accordingly. <br /> This certification is a material representation of fact upon which reliance was <br /> placed when this transaction was made or entered into. Submission of this <br /> certification is a prerequisite for making or entering into this transaction <br /> imposed by section 1352, title 31, U.S. Code. Any person who fails to file the <br /> required certification shall be subject to a civil penalty of not less than $10,000 <br /> and not more than $100,000 for each such failure. <br /> The Contractor, 0141 verer , certifies or <br /> affirms the truthfulness and accuracy of each statement of its certification and <br /> disclosure, if any. In addition,the Contractor understands and agrees that the <br /> provisions of 31 U.S.C.Chap.38, Administrative Remedies for False Claims and <br /> State s, app y o this certification and disclosure, if any. <br /> Ignaturec or's Authorized Official <br /> /(4 t\itt OYL cI <br /> Name and Title of Contractor's Authorized Official <br /> / D/V/4) <br /> Date <br /> n 1,' <br /> Page 14 of 19 www.fema.qov/procurement-disaster-assistance-team <br /> �iti <br />