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CERTIFICATION REGARDING LOBBYING <br /> CERTIFICATION 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 connection 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) 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 off~cer 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-Ill, "Disclosure Form to Report Lobbying," in accordance with it's <br /> 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, <br /> and contracts under grants, loans and cooperative agreements) and that all <br /> subrecipients shall certify and disclose accordingly. <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 impose, 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 /> les~~n $1_00,000 for each such failure. <br />'e Date <br /> Print Name of Authorized Individual <br /> <br /> 7560022067 2004-02 <br /> Application or Contract Number <br /> <br /> PARIS-LAMAR COUNTY HEALTH DEPARTMENT <br /> Organization Name and Address <br /> <br /> 740 SOUTHWEST 6TH <br /> <br /> PARIS, TX 75460-0000 <br /> <br /> <br />