TA Attachment F

Certification Regarding Lobbying for Contracts, Grants, Loans, and Cooperative Agreements

U.S. Department of Agriculture
Broadband Initiatives Program

We, _________________________________ (the Applicant) the undersigned certify, to the best of our
knowledge and belief, that:
(1)

No Federal appropriated funds have been paid or will be paid, by or on our behalf, 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 the awarding of any Federal contract, the making of any Federal grant or 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, we shall complete
and submit Standard Form-LLL, Disclosure Form to Report Lobbying, in accordance with its
instructions. See http://www.whitehouse.gov/omb/grants/sflllin.pdf for Disclosure Instructions.

(3)

We 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 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. 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.

Date

(Authorized Representative’s Signature)
Name:
Title: