EIB 95-10 Application for Long-Term Loan or Guarantee, Attachment

OMB No. 3048-0013
Expires 1/31/2005

Long-Term Loan or Guarantee Application
ATTACHMENT D: Anti-lobbying Declaration/Disclosure
This attachment applies only to applications for final commitments.
1.

Anti-Lobbying Law.

Under a U.S. law (31 U.S.C. 1352), recipients of U.S. government loans, grants, contracts, and cooperative agreements are
prohibited from spending Federally appropriated funds to influence certain U.S. government employees, including Ex-Im Bank
employees, in connection with the awarding of those Federal awards.
Recipients of Federal loans, grants, guarantees, insurance, contracts and cooperative agreements may spend non-Federally
appropriated funds for such lobbying purposes; however, they are required to report such lobbying expenditures.
The law applies to Ex-Im Bank loan, guarantee and insurance transactions. Declaration and Disclosure Forms are to be filed by
applicants and recipients and certain exporters and suppliers, as defined below.
2.

Compliance Procedures. 2a. Who Must File.

All applicants for final commitments from Ex-Im Bank must file a Declaration regardless of whether non-Federally
appropriated funds have been spent for lobbying purposes. If non-Federally appropriated funds have been spent, a
Disclosure Form must also be filed. Applicants include borrowers and lenders who are applicants for final commitments
for medium-term and long-term direct loans and guarantees.
The Declaration and/or Disclosure Forms must be received by Ex-Im Bank from the applicant before Ex-Im Bank will
consider the application for a final commitment.
All recipients under Ex-Im Bank programs, who are not the applicant for a final commitment, must file a Declaration and, if
they have spent funds for lobbying purposes, a Disclosure Form. Recipients include borrowers who receive Ex-Im Bank direct
loans and lenders who receive Ex-Im Bank guarantees.
The Declaration and/or Disclosure Forms must be received by Ex-Im Bank from the recipients before Ex-Im Bank will
enter into a loan or guarantee agreement.
All suppliers who have entered into a contract in excess of $100,000 with the recipient of an Ex-Im Bank direct loan or grant
must file a Declaration and, if funds have be en spent for lobbying purpose s, a Disclosure Form.
Such suppliers must file the Declaration and/or Disclosure Forms upon being awarded the supply contract.
2b. Exemptions.

The law has been interpreted so that it does not apply to foreign governments, their instrumentalities or their wholly-owned
companies. Therefore, these entities are exempt from filing both the Declaration and Disclosure Forms.
The law’s disclosure requirements do not apply to loan or guarantee transactions where the U.S.
Government-financed portion is $150,000 or less.
2c.

How To File.

Complete the appropriate Declaration Form on the following page. If you are required to file a Disclosure Form, it
will be provided by Ex-Im Bank upon request. Any person who fails to file the required forms shall be subject to a
civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

EIB Form 95-10 (attachment D)
Revised 1/05 2

OMB No. 3048-0013
Expires 1/31/2005

Long-Term Loan or Guarantee Application
ATTACHMENT D: Anti-lobbying Declaration/Disclosure
3. Certification for Contracts, Grants, Loans and Cooperative Agreements.

The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal 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 an agency, a Member of
Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with
the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the
entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or
modification of any Federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an
officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal
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.
(3) The undersigned shall require that the language of this certification be included in the award documents
for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and
cooperative agreements) and that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction
was mad e or entered into. Submission of this certification is a prerequisite for making or entering into this
transaction imposed by section 1352, title 31, U.S. Cod e. Any person w ho 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.
Applicant/Recipient Company
Signature
Name

EIB Form 95-10 (attachment D)
Revised 1/05 2

Title

OMB No. 3048-0013
Expires 1/31/2005

Long-Term Loan or Guarantee Application
ATTACHMENT D: Anti-lobbying De claration/Disclosure
4. Statement for Loan Guarantees and Loan Insurance.
The undersigned certifies, to the best of his or her knowledge and belief, that:
If any funds have been paid or will be pa id to an y person for influencing or attempting to influence an
officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an
employee of a Member of a Congress in connection with this commitment providing for the Unit ed
States t o insure o r guarantee a loan, the undersigned shall complete an d submit Standard Form-LLL,
“Disclosure Form to Report Lobbying”, in accordance with its instructions.
Submission of this statement is a prerequisite for making or entering into this transaction imposed by
section 1352, title 31, U.S. Code. Any person who fails to file the required statement shall be subject to a
civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
Applicant/Recipient Company
Signature
Name Title

EIB Form 95-10 (attachment D)
Revised 1/05