Laserfiche WebLink
I <br /> I <br /> Local Agency Certification for Federal-Aid Contracts <br /> IThe prospective participant certifies by signing and submitting <br /> this bid or proposal, to the best of his or her knowledge and <br /> belief, that: <br /> I (1) No Federal appropriated funds have been paid or will be paid, by or on <br /> behalf of the undersigned,to any person for influencing or attempting to <br /> I influence an officer or employee of any Federal agency, a Member of Congress, <br /> an 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 any <br /> I Federal grant,the making of any Federal loan, the entering into of any <br /> cooperative agreement, and the extension, continuation, renewal,amendment, <br /> or modification of any Federal contract,grant, loan or cooperative agreement. <br /> I (2) If any funds other than Federal appropriated funds have been paid or will be <br /> paid to any person for influencing or attempting to influence an officer or <br /> employee of any Federal agency, a Member of Congress, an officer or <br /> 1 employee of Congress, or an employee of a Member of Congress in connection <br /> with this Federal contract, grant, loan, or cooperative agreement,the <br /> undersigned shall complete and submit Standard Form-LLL, "Disclosure Form <br /> to Report Lobbying," in accordance with its instructions. <br /> This certification is material representation of the fact upon which reliance was <br /> placed when this transaction was made or entered into. Submission of this <br /> 111 certification is a prerequisite for making or entering into this transaction imposed <br /> by Section 1352, Title 31, U.S.Code. Any person who fails to file the required <br /> certification shall be subject to a civil penalty of not less than$10,000 and not <br /> Imore than$100,000 for each failure. <br /> The prospective participant also agrees by submitting his or her bid or proposal <br /> I that he or she shall require that the language of this certification be included in <br /> all lower tier subcontracts,which exceed$100,000 and that all such <br /> subreclpients shall certify and disclose accordingly. <br /> I <br /> III SR DOT Form 272-040A EF <br /> QL2011 <br /> ILOCAL AGENCY CERTIFICATION FOR FEDERAL-AID CONTRACTS <br /> I 2023 FEDERAL OVERLAY <br /> FEDERAL AIDI!STBGUL-2715(011) <br /> WO#3788 March 2,2023 119 <br /> IIProvided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal <br />