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<br /> WASHINGTON
<br /> City of Everett Coronavirus Local Fiscal Recovery Fund
<br /> Everett Forward Grant Beneficiary Agreement—Exhibit 5
<br /> LOBBYING CERTIFICATION FORM
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<br /> The undersigned certifies,to the best of the undersigned's knowledge and belief,that:
<br /> (1) No Federal appropriated funds have been paid or will be paid,by or on behalf of the undersigned, to any
<br /> ya person for influencing or attempting to 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 in connection with the awarding of any
<br /> Federal contract,the making of any Federal grant,the making of any Federal loan,the entering into of any
<br /> cooperative agreement,and 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 appropriated funds have been paid or will be paid to any person for influencing
<br /> or attempting to influence an officer 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 this Federal contract,grant,loan,or
<br /> cooperative agreement,the undersigned shall complete and submit Standard Form-LLL,"Disclosure Form to
<br /> Report Lobbying,"in accordance with Its instructions,as attached.
<br /> (3)The undersigned shall require that the language of this certification be included in the award documents for all
<br /> u subawards at all tiers(including 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 placed when this transaction was
<br /> made or entered into.Submission of this 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 required certification shall be subject
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<br /> to a civil penalty of not less than$10,000 and not more than$100,000 for each such failure.
<br /> I hereby certify that I have read the above certification,and that the information and my statements provided herein
<br /> by me are true and correct to the best of my knowledge,and by my signature on this document,acknowledge my
<br /> understanding that any intentional or negligent misrepresentation or falsification of any of the information in this
<br /> document could subject me to punishment under federal and/or civil liability and/or in criminal penalties,including
<br /> M but not limited to fine or imprisonment or both under Title 18,United States Code,Sec.1001,et seq.and punishment
<br /> under federal law.
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<br /> .5 Printed Name Sig ure
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<br /> EFG Agreement Exhibit 5—Lobbying Certification
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