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BID NUMBER: RFP/DF-09/10-47 OPENING DATE: FEBRUARY 12, 2010 @ 2:00 P.M.
<br />ATTACHMENT C
<br />.F".�is trw
<br />Florida Department of agriculture and Consumer Services
<br />C6 i
<br />Division of Administration
<br />�~ CERTIFICATION REGARDING LOBBYING,
<br />DEBARMENT, SUSPENSION AND OTHER
<br />CHARLES H. BRONSON RESPONSIBILITY MATTERS
<br />COMMISSIONER FOR EXPENDITURE OF FEDERAL FUNDS
<br />LOBBYING
<br />As required by 7 CFR Part 3016, far persons entering into a contract, grant or cooperative agreement over $100,000 involving the expenditure of
<br />Federal funds, the undersigned certifies for Itself and its principals that:
<br />(a) No Federal appropriated funds have been paid or will be paA, by or on behalf of the unders`gred, to any person for influencing or
<br />attempt'ng to influence an o`rcer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an
<br />employee of a Member of Congress in connection with the making of any Federal grant, the entering into of any cooperative
<br />agreement, and the extension, continuation, renewal, amendment, or modification of any Federal grant or cooperative agreement;
<br />(b) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to
<br />Influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress or an employee of a
<br />Mernber of Congress, m connection with this Federal grant or cooperative agreement, the undersigned shall complete and submit
<br />Standard Form - LLL, `Disclosure Form to Report Lobbying,' in accordance with its instructions; and
<br />(c) The unders`gned shall require that the language of this certification be included in the award documents for all subawards at all tiers
<br />(including subgrants, contracts under grants and cooperative agreements, and subcontracts) and that a] subrec-pier:ts shall certify
<br />and disc'ose accordingly.
<br />This cerjFcaiion is a material representation of fact upon which reliance was paced when this transaction was made or entered into.
<br />Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, fit'e 31, U.S. Code. Any
<br />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 5100,000 for each
<br />such failure.
<br />Charlene Glancy, Mayor
<br />PRINTED NAMEITITLE OF REPRESENTATIVE
<br />j � 3
<br />j r
<br />SIGNATURE OF REPRESENTATI T_ I DIfiJE
<br />RFP/DF-09/10-47
<br />CONTRACT I PURCHASE ORDER NUMBER
<br />DEBARMENT. SUSPENSION AND OTHER RESPONSIBILITY MATTERS
<br />As required by 7 CFR Part 3017, for persons entering into a contract, grant crcooperalive agreement over $25,000 involving the expenditure of
<br />Federal funds, the undersigned certifies for'tself and its principals that
<br />(a) Are not presently debarred.. suspended, proposed for debarment, deCared inelig.ble, or voluntarily excluded from covered transactions
<br />by any Federal department or agency;
<br />,b) Have not within a three-year period preceding this applicat=on been convicted of or had a civil;udgment rendered against then) for
<br />commission of fraud or a criminal offense In correction with obtaining, attempting to obtain, or performing a public (Federal, Slate, or
<br />`ocal) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of
<br />embezzlement, thert, forgery, bribery, falsification or destruction of records, making fa'se statements, or receiving stolen property;
<br />(c) Are not presently lnd cted for or otherwise criminally or civi€Iy charged by a Government entity (Federal, State, o, :`ocal) with
<br />commission, of any offenses enumerated in paragraph (b) of this certification; and
<br />(d) Have not within a three-year period preced-ng this application had one or more public transaction (Federal, Slate; or local) terminated
<br />for cause or default; and
<br />%^.here the applicant is unable to certify to any of the statements in :his certification, he or she shall attach an explanation to this
<br />appl`cation.
<br />Charlene Glancy, Mayor RFP/DF-09/10-47
<br />PRINTED NAMEITITLE OF REPRESENTATIVE CONTRACT I PURCHASE ORDER NUMBER
<br />r
<br />SIGNATURE OF REPRESENTATIVEt`1jDATE
<br />DAC S-01522 03109
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