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<br />C .aIFICA TION REGARDING LOBB\ .. ~G <br /> <br />CERTIFICATION FOR CONTRACTS. GRANTS. LOANS AND COOPERATIVE AGREEMENTS <br /> <br />The undersigned certifies, to the best of his or her knowledge and belief that: <br /> <br />(1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, <br />to any person for influencing or attempting to influence an officer or an employee of any agency, <br />a member of congress 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 cooperative agreement, and <br />the extension, continuation, renewal, amendment, or modification of any federal contract, grant, <br />loan, or cooperative agreement. <br /> <br />(2) If any funds other than federal appropriated funds have been paid or wiIl be paid to any person for <br />influencing or attempting to influence an officer or employee of any agency, a member of congress, <br />an officer or employee of congress, or an employee of a member of congress in connection with this <br />federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit <br />Standard Form-Ill, "Disclosure Form to Report Lobbying," in accordance with its instructions. <br /> <br />(3) The undersigned shall require that the language of this certification be included in the award <br />documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under <br />grants, loans and cooperative agreements) and that all subrecipients shall certify and disclose <br />accordingly. <br /> <br />This certification is a material representation of fact upon which reliance was placed when this transaction was made <br />or entered into. Submission of this 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 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 /> <br />Si,,;;.,re ,4, /~/~ <br /> <br /> <br />ANTHONY BETHEL, ADMINISTRATOR <br />Print Name of Authorized Individual <br /> <br />09-22-97 <br />Date <br /> <br />7560022067 98-02 <br />Application or Contract Number <br /> <br />PARIS-LAMAR COUNTY HEALTH DEPARTMENT <br />Organization Name <br /> <br />P. O. BOX 938 <br /> <br />PARIS, TX 75460-0938 <br />