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<br />. ~~. <br /> <br />t TTFICATION RESAROING LOBBYING <br />CERTIFICATION FOR CONTRACTS. GrtANTS. LOANS AND COOPERATIVE AGrtEEMENTS <br /> <br />The undersigned c~rtifies, to the best of his or her knowledge and belief <br />that: <br /> <br />(1) No federal appropriated funds have been paid or will be paid, by <br />or on behalf of the undersigned, to any person for influencing or <br />attempting to influence an officer or an ~loyee of any agency, <br />a member of congress, an officer or employee of congress, or an <br />employee of a member of congress in connection with the awarding <br />of any federa 1 contract, the mak i ng of any federa 1 grant, the <br />making of any federal loan, the entering into of any cooperative <br />agreement, and the extension, continuation, renewa I, amendment, <br />or modification of any federal contract, grant, loan, or <br />cooperative agreement. <br /> <br />(2) If any funds other than federal appropriated funds have been paid <br />or will be paid to any person for influencing or attempting to <br />influence an officer or employee of any agency, a member of <br />congress, an officer or employee of congress, or an employee of a <br />member of congress in connection with this federal contract, <br />grant, loan, or cooperative agreement, the undersigned shall <br />complete and submit Standard Form-Ill, "Disclosure Form to Report <br />Lobbying," in accordance with its instructions. <br /> <br />(3) The undersi gned sha 11 requ ire that the 1 anguage of thi s <br />certifi cati on be i nc 1 uded in the award documents for a 11 <br />subawards at all tiers (including subcontracts, sub grants , and <br />contracts under grants, loans and cooperati ve agreements) and <br />that all subrecipients sha'l1 certify and disclose accordingly. <br /> <br />This certification is a mat~rial representation of fact upon which reliance <br />was placed when this transaction was made or entered into. Submission of <br />this certification is a prerequisite for making or entering into this <br />transaction imposed by Section 1352, Title 31, U.S. Code. Any person who <br />fails to file the required certification shall be subject to a civil <br />penalty of not less than SlO,OOO and not more than S100,000 for each su~i <br /> <br />failure~ <br />~ - r-.<o -7/. <br />Sig~ature Date <br /> <br />ANTHONY BETHEL, ADMINISTRATOR <br />Name OT Au~norizea InQlvlduai <br /> <br />r-Sf,(JO'J..-:)..(Jbl ,,,/-o?- <br />App lcatlon or Contract Numoer <br /> <br />PARIS-LAMAR CO. HEALTH DEPT. 740 S.W. 6TH, PARIS, TEXAS 75460 <br />Name ana Address OT Organlzation <br />