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9 <br /> Exhibit D-3 <br /> Certification Regarding the Restrictions <br /> of the use of Federal Funds for Lobbying <br /> The prospective participant certifies, by signing and submitting this bid or proposal, to the best of <br /> his or her knowledge and belief,that: <br /> 1. No federal appropriated funds have been paid or will be paid, by or on behalf of the <br /> undersigned,to any person for influencing or attempting to influence an officer or <br /> employee of any Federal agency, a member of Congress, an office or employee of <br /> Congress, or an employee of a member of Congress in connection with the awarding of <br /> any Federal contract,the making of any Federal grant, continuation, renewal, <br /> amendment, or modification of any Federal contract, grant, loan, or cooperative <br /> agreement. <br /> 2. If any funds other than Federal appropriated funds have been paid or will be paid to any <br /> person for influencing or attempting to influence an officer or employee of any Federal <br /> agency, a member of Congress, an officer or employee of Congress, or an employee of a <br /> member of Congress in connection with this Federal contract, grant, loan, or cooperative <br /> agreement,the undersigned shall complete and submit Standard Form-LL, "Disclosure <br /> Form to Report Lobbying," in accordance with its instructions. <br /> This certification is a material representation of fact upon which reliance was placed <br /> when this transaction was made or entered into. Submission of this certification is a <br /> prerequisite for making or entering into this transaction imposed by Section 1352,Title <br /> 31, U.S. Code. Any person who fails to file the required certification shall be subject to a <br /> civil 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 <br /> she shall require that the language of this certification be included in all lower tier <br /> subcontracts which exceed $10,000 and that all such subrecipients shall certify and <br /> disclose accordingly. <br /> Consultant(Firm): BHC Consultants, LLC <br /> 6 -z#—e8 <br /> (Date) (Signature)President or Authorize fficial of Consultant <br /> 1 <br /> 12 <br />