The undersigned certifies, to the best of his or Federal contract, grant, loan, or cooperative her knowledge and belief, that: agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to (1) No Federal appropriated have been Report Lobbying," in accordance with its paid or will be paid, by or on behalf of the instructions; undersigned, to any person for influencing or attempting to influence an officer or employee of (3) The undersigned shall require that the any agency, a Member of Congress, an officer language of this certification be included in the or employee of Congress, or an employee of a award documents for all subawards at all tiers Member of Congress in connection with the (including subcontracts, subgrants, and awarding of any Federal contract, the making of contracts under grants, loans, and cooperative any Federal grant, the making of any Federal agreements) and that all subrecipients shall loan, the entering into of any cooperative certify and disclose accordingly. agreement, and the extension, continuation, renewal, amendment, or modification of any This certification is a material representation of Federal contract, grant, loan or cooperative fact upon which reliance was placed when this agreement; transaction was made or entered into. Submission of this certification is a prerequisite (2) If any funds other than Federal for making or entering into this transaction appropriated funds have been paid or will be imposed by section 1352, title 31, U.S. Code. paid to any person for influencing or attempting Any person who fails to file the required to influence an officer or employee of any certification shall be subject to a civil penalty of agency, a Member of Congress, an officer or not less than $10,000 and not more than employee of Congress, or an employee of a $100,000 for each such failure. Member of Congress in connection with this Organization Name Number or Project Name Name and Title of Authorized Representative Signature Date Date
The undersigned certifies, to the best of his or her knowledge and belief, that: (1) No Federal appropriated 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; (2) If any funds other than Federal appropriated funds have been paid or will be paid 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 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; (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards 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 was 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. Organization Name Number or Project Name Name and Title of Authorized Representative Signature Date Date
2017_NRAC_RFA_Full_Proposals.docx