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<br />. , , <br /> <br />CERTIFICATION REGARDING LOBBYING <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 <br />undersigned, to any person for intluencing or attempting to influence an officer or an <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 federal <br />contract, the making of any federal grant, the making of any federal loan, the entering <br />into of any cooperative agreement, and the extension, continuation, renewal, <br />amendment or modification of any federal contract, grant, loan, or copperative <br />agreement. <br /> <br />(2) If any funds other than federal appropriated funds have been paid or will be paid to any <br />person for influencing or attempting to influence an officer or employee of any agency, <br />a member of congress, an officer or employee of congress, or an employee of a <br />member of congress in connection with this federal contract, grant, loan, or cooperative <br />agreement, the undersigned shall complete and submit Standard Form-Ill, "Disclosure <br />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 <br />award documents for all subawards at all tiers (including subcontracts, subgrants, and <br />contracts under grants, loans and cooperative agreements) and that all subrecipients <br />shall certify and disclose accordingly. <br /> <br />This certification is a material representation of fact upon which reliance was placed when this <br />transaction was made or entered into. Submission of this certification is a prerequisite for making or <br />entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails <br />to file the required certification shall be subject to a civil penalty of not less that $10,000 and not more <br />than $100,000 for each such failure. <br /> <br />. <br /> <br />d-~____ <br /> <br />Date <br /> <br />ANTHONY BETHEL, ADMINISTRATOR <br />Name of Authorized Individual <br /> <br />'IS (,00 '''J.. d- 061 q 1- 6 '3 <br />Application or Contract Number <br /> <br />PARIS-LAMAR COUNTY HEALTH DEPARTMENT, 740 S.W. 6TH, PARIS, TEXAS 75460 <br />Name and Address of Organization <br />