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Page 21 of 26 <br />FORM 4.05 CERTIFICATION REGARDING LOBBYING BY CONTRACTOR (150K & ABOVE) <br />Pursuant to 40 CFR Part 20 (which is by this reference incorporated herein), the undersigned certifies, to the best <br />of his or her knowledge and belief, that: <br />A.No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any <br />person for influencing or attempting to influence an officer or employee of an agency, a Member of <br />Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection <br />with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal <br />loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, <br />amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. <br />B.If any funds other than Federal appropriated funds have been paid or will be paid to any person for <br />influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an <br />officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal <br />contract, grant, loan, or cooperative agreement, the undersigned must complete and submit Standard <br />Form-LLL Disclosure Form to Report Lobbying, in accordance with its instructions. <br />C.The undersigned must require that the language of this certification be included in the award documents <br />for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and <br />cooperative agreements) and that all subrecipients must 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 must be <br />subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. <br />The Contractor, ___________________, certifies or affirms the truthfulness and accuracy of each statement of its <br />certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 <br />U.S.C. A 3801, et seq., apply to this certification and disclosure, if any. <br />____________________________ <br />Signature of Contractor <br />____________________________ <br />Print Name <br />____________________________ <br />Title <br />_____________________________ <br />Date <br />_____________________________ <br />Address <br />_____________________________ <br />City, State, ZIP <br />NOTE: The penalty for making false statements in offers is prescribed in 18 U.S.C. 1001. RFP