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1 <br /> Local Agency Certification for Federal Aid Contracts <br /> I <br /> ' The 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 /> (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 /> 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 /> 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 /> (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 /> ' 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 /> 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 /> more than $100,000 for each failure. <br /> ' The prospective participant also agrees by submitting his or her bid or proposal <br /> 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 /> subrecipients shall certify and disclose accordingly. <br /> ' SR <br /> DOT Form 272-040A EF <br /> 07/2011 <br /> 31 164 Local Agency Certification for Federal-Aid Contracts <br /> ovided to Builders Exchanae of WA. Inc. For usaae Conditions Aareement see www.bxwa.com-Always Verify Scale <br />