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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 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-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 />thi~ 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 Title 31, U.§. 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 mo e than $ 0,000 <br />?i~ta~re 1 /~., ~~/~, for each such failure. Date <br /> <br />Print Name of Authorized Individual <br /> <br />7560022067 2004-01 <br />Application or Contract Number <br /> <br />PARIS-LAMAR COUNTY HEALTI{ DEPARTMENT <br /> <br />Organization Name and Address <br /> <br />740 SOUTHWEST 6TH <br /> <br />PA~I$, TX 75460-0000 <br /> <br /> <br />