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J:\Contracts\Environmental\Everett\PHIV 41st Environ Cont 1-9-04.doc <br /> 1. 1J <br /> Exhibit D-3 <br /> Certification Regarding The Restrictions of The use of Federal Funds for <br /> Lobbying <br /> The prospective participant certifies,by signing and submitting this bid or proposal,to the best of his or her <br /> 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 person <br /> for influencing or attempting to influence an officer or employee of any federal 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 cooperative <br /> agreement,and the extension,continuation,renewal,amendment,or modification of any federal contract,grant,loan, <br /> 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 or <br /> attempting to influence an officer or employee of any federal 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 Report <br /> Lobbying,"in accordance with its instructions. <br /> This certification is a material representation of fact upon which reliance was placed when this transaction was made <br /> or entered into. Submission of this 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 certification shall be subject to a civil <br /> penalty of not less than$10,000 and not more than$100,000 for each such failure. <br /> The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require that the <br /> language of this certification be included in all lower tier subcontracts which exceed$100,000 and that all such <br /> subrecipients shall certify and disclose accordingly. <br /> Consultant: (Firm): <br /> Date I q � Sign. e <br /> 3O <br />