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<br />C fIFICA TION REGARDING LOBi .NG <br />CERTIFICA TION FOR CONTRACTS. GRANTS. <br />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 influencing or attempting to influence an officer or an <br />employee of any agency, a member of Congress in cO,nnection with the awarding of any <br />federal contract, the making of any federal grant, the making of any federal loan, the <br />entering into of any cooperative agreement, and the extension, continuation, renewal, <br />amendment, or modification of any federal contract, grant, loan, or cooperative <br />agreement. <br /> <br />(2) <br /> <br />If any funds other than federal appropriated funds have been paid or will be paid to <br />any person for influencing or -attempting to influence an officer or employee of any <br />agency, a member of Congress, an officer or employee of Congress, or an <br />employee of a member of Congress in connection with this federal contract, grant, <br />loan, or cooperative agreement, the undersigned shall complete and submit Standard <br />Form-ll1, "Disclosure Form to Report Lobbying," i~ accordance with it's <br />instructions. .1 <br /> <br />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, <br />and contracts under grants, loans and cooperative agreements) and that all <br />sub recipients shall certify and disclose accordingly. <br /> <br />(3) <br /> <br />This certification is a material representation of fact upon which reliance was placed when <br />this transaction was made or entered into. Submission of this certification is a prerequisite <br />for making or entering into this transaction impos~d by Section 1352, Title 31, U.S. Code. <br />Any person who fails to file the required certification shall be subject to a civil penalty of not <br />less than $10,000 and not more than $100,000 for each such failure. <br /> <br />4iJ/j;?~ . <br /> <br />~nat re I <br /> <br />fIJ/Y} h n h/v/ fJ e/~g/ <br /> <br />Print Name of Auth6rized Individual <br /> <br />f- 2 -ot/ <br /> <br />, <br /> <br />Date <br /> <br />7560022067 2005-03 <br />Application or Contract Number <br /> <br />PARIS-LAMAR COUNTY HEALTH DEPARTMENT <br />Organization Name and Address <br /> <br />740 6TH ST SW <br /> <br />PARIS, TX 75460-8530 <br />