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<br />- <br /> <br />:;enitication for <br />:;ontracts, Grants, Loans & <br />:::ooperative Agreements <br /> <br />"ublic Housing Agency I Indian Housing Authority <br /> <br />u.s. uepartment C?t Housing <br />and Urt:an.Oevelopment <br />Office of Public and Indian Housing <br /> <br />~ <br /> <br />'t'\A!lHA Nam.: <br /> <br />If o\h.r than Opera ling Subsidy or Sec- <br />tion 23. en"" lho Foderal Fiscal Yoar In <br />which lho funds aro oxpoClod to be <br />reserved : <br /> <br />II ep.ratlng Subaldy or S.ctlon 23, <br />enter PHA'sJ1HA', FtscaJ Year Ending <br />date In whk:h func!s alB expeded lo be <br />obngated; <br /> <br />P",gramlAcIMty ReceivIng Fode..1 Grant ovor $100.000: (marllono) <br />~ Operating Subsidy ~CGP <br />. Development ClAP <br />Drug Elimination Grants MROP <br />880.23 Leased Housing Other: (dKC1be) <br />Adjustments <br /> <br />Acting on behalf of the above nam~ PHNlHA as its Authoriud Official. I make the following <br />certifications to the Deparonent of Housing and Urban Development (HUD): <br /> <br />(I) No F~eraI appropria1ed funds have been paid or will be paid. by or on behalf 9f the <br />undersign~. to any person for influencing or attempting to influence an officer or employee <br />of any agency, a Member of Congress in connection with the awardiJig of any F~eraI <br />contract. the rna1:ing of any F~eraI grant. the making of any FMeraI loan. the entering into <br />of any cooperative agreement, and the extension, continuation, rene\\'al. amendment, or <br />modification of any F~eraJ contraCt. grant. loan, or cooperative agreemenL <br /> <br />(2) If any funds other than F~eraI appropriat~ funds have been paid or will be paid to any <br />person for influencing or anempting to influence an officer or employee of any agency. a <br />Member of Congress, an officer or employee of Congress, or any employee of a Member <br />of Congress in connection with this F~eraJ contraCt. grant. loan, or cooperative agreement, <br />the IUldersign~ shall complete and submit Standard Form.llL. Disclosure of Lobbying <br />Activities, in accordance with its instructions. <br /> <br />(3) The undersigned shall require thai the language of this certification be included in the award <br />documents for all subawards at all tiers (including subcontracts. subgrants, and contraCts <br />IUlder grants, loans, and cooperative agreemenlS) and thaI all subrecipients shall certify and <br />disclose accordingly. <br /> <br />'This certification is anwerial representation offact upon which reliance was plac~ when this transaction <br />was made orentu~ into. Submission of this certification is a prerequisite for making or entering into this <br />tranSaction imposed by Section 1352, Title 31, U.S. Code. My pel'Son who fails 10 file t1ie required <br />certification shall be subject to a civil penalty of not less than SIO,OOOand not more than SI 00,000 for each <br />such iailu:~. <br /> <br />I certify under penalty of perjury that the foregoing is true and corrett <br />AulhorizC'C: PHAIIHA Official: Na.>n. J,n,.: <br /> <br />Si~natur. & Oal': <br /> <br />x <br /> <br />lonn HUD 50071 (1/92) <br />lot HoodOOooks 7417.1. 7475.13. 748S.1. & 7485.3 <br />