APPENDIX B
CERTIFICATION OF RESTRICTIONS ON LOBBYING
(1)
(2)
(3)
fac: Shep her Ellis, ” hereby certify on behalf ofthe
Bis aads\ lane that:
No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned,
to any person for influencing or attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with the awarding of any Federal contract, the making of any Federal
grant, the making of any Federal loan, the entering into of any cooperative agreement, and the
extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan,
or cooperative agreement.
lf any funds other than Federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence and officer or employee of any agency, a Member of
Congress, an officer or employee of Congress, or an employee of a Member of Congress in
connection with this Federal contract, grant, loan or cooperative agreement, the undersigned shall
complete and submit Standard Form-LLL, “Disclosure Form to Report Lobbying," in accordance
with its instructions,
The undersigned shall require that the language of this certification be included in the award
documents for all sub awards at all tiers (including subcontracts, subgrants, and contracts under
grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose
accordingly.
This certification is a material representation of fact upon which reliance is placed when this
transaction was made or entered, into. Submission of this certification is a prerequisite for making or
entering into this transaction imposed by section 1352, title 31, U.S.Code. Any person who fails
to file the required certification shall be subject to a civil penalty of not less than $10,000 and
not more than $100,000 for each such failure.
' ZOeN
Executed this _[¢*» day of une 2048
By:
Pee
(Signature of authorized official)
Contracting offres
(Title of authorized official)
