Minutes - 11-3-14 Reg. Meeting - Laserfiche WebLink

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BK - 00027 PG (Required of all Applicants) CERTIFICATION AND RESTRICTIONS ON LOBBYING I, Charles T. Parks Name of Authorized Ofth , on behalf of County of Lee , Legal Name of Applicant Hereby certifies that: No Federal /State appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any Federal /State agency, a Member of Congress or State Legislature, an employee of a member of Congress or State Legislature, or an officer or employee of Congress or State Legislature in connection with the awarding of any Federal/State contract, the making of any Federal /State grant, the making of any Federal /State loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal /State contract, grant, loan, or cooperative agreement. If any funds other than Federal/State appropriated funds have been paid or will be paid to any person influencing or attempting to influence an officer or employee of any Federal/State agency, a Member of Congress or State Legislature, an employee of a member of Congress or State Legislature, or an officer or employee of Congress or State Legislature in connection with the Federal /State contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form — LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. The undersigned shall require that the language of this certification be included in the award documents for all sub - awards at all tiers (including sub - contracts, sub -grants and contracts under grants, loans, and cooperative agreements) and that all sub - recipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31 U.S.C. § 1352 (as amended by the Lobbying Disclosure Act of 1995). Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10, 000 and not more than $100, 000 for each such failure. The undersigned certifies or affirms the truthfulness and accuracy of the contents of the statements submitted on or with this certification and understands that the provisions of 31 U.S. C. Section 3801, et seq., are applicable thereto. - -Signature 6f Authorizid Official C /i ) Affix Notary Seal Here N SnOLD N ", 00"4(7W" cow* My commission expires (date) /Z • 9� /g