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� 5.1 CERTIF/CAT10N OF RESTRICTIONS ON LOBBYING <br /> �� , hereby certify on behalf <br /> (Name of official) <br /> of that: <br /> (Name of Proposer) <br /> 1. No Federaliy-appropriated funds have been paid or will be paid on behalf of the <br /> undersigned to any person for influencing or attempting to influenre an officer or <br /> employee of any agency, a Member of Congress, an officer or employee of Congress, <br /> 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 Federai loan, the <br /> entering into of any cooperative agreement� and the extension, continuation, renewal, <br /> amendment, or modification of any Federal contract, grant, loan or cooperative <br /> agreement � <br /> 2. If any funds other than Federally appropriated funds have been paid or will be paid to <br /> any person for influencing or attempting to influence an cfficer or employee of any <br /> agency, a Member of Congress, an officer or employee of Congress, or an employee of <br /> a Member of Congress in connection with this Federal contract, grant, loan or <br /> cooperative agreement, the Contractor shall complete and submit Office of <br /> Management and Budget Standard Form-LLL, "Disclosure Form to Report Lobbying," in i <br /> accordance with its instructions. - - <br /> 3. The undersigned shall require that the language of this certification be included in the <br /> award documents for sub-awards at all tiers (incfuding subcontracts, sub-grants, and <br /> contracts under grants, loans and cooperative agreements) and that all sub-recipients <br /> shall certify and disclose accordingly. <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 certicfication is a <br /> prere�uisite 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 <br /> a civii penalty of not less than �10,000 and not more than �100,000 for each such <br /> failure. <br /> Executed this day of , �g <br /> By: <br /> Signature and Title of Authorized Official. <br /> -13- <br />