Statement for Loan Guarantees and Loan Insurance. The undersigned states, to the best of his or her knowledge and belief, that: If any 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 commitment providing for the United States to insure or guarantee a loan, the undersigned shall complete and 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. As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the above applicable certification. NAME OF APPLICANT AWARD NUMBER AND/OR PROJECT NAME City of Houston, Housing and Community Develop1m9e-n1t47-001-B489 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE Xxx XxXxxxxxx 1/4/2019 SIGNATURE DATE 1 24 C.F.R. 87 App. A, available at xxxxx://xxx.xxx.xxx/fdsys/granule/CFR-2011-title24-vol1/CFR-2011-title24-vol1-part87-
Statement for Loan Guarantees and Loan Insurance. The undersigned states, to the best of his or her knowledge and belief, that: If any 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 commitment providing for the United States to insure or guarantee a loan, the undersigned shall complete and 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. As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the above applicable certification. NAME OF APPLICANT AWARD NUMBER AND/OR PROJECT NAME Fort Bend County 18-523-000-B264 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE Xxxxxx Xxxxxx SIGNATURE DATE 8/28/2018 *24 C.F.R. 87 App. A, available at xxxxx://xxx.xxx.xxx/fdsys/granule/CFR-2011-title24-vol1/CFR-2011-title24-vol1-part87- appA. Published Apr. 1, 2011. Accessed Aug. 1, 2018. Disclosure of Lobbying Activities Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) Approved by OMB
Statement for Loan Guarantees and Loan Insurance. The Contractor certifies, to the best of the Contractor’s knowledge and belief, that if any 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 commitment providing for the United States to insure or guarantee a loan, the Contractor shall complete and 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.
Statement for Loan Guarantees and Loan Insurance. The undersigned states, to the best of his or her knowledge and belief, that: If any 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 commitment providing for the United States to insure or guarantee a loan, the undersigned shall complete and 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. Name of Agency Administrator Title of Individual Signing
Statement for Loan Guarantees and Loan Insurance. The undersigned certifies on behalf of the Subrecipient that:
Statement for Loan Guarantees and Loan Insurance. The undersigned states, to the best of his or her knowledge and belief, that: If any 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 commitment providing for the United States to insure or guarantee a loan, the undersigned shall complete and 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. Signature and Title 🗹 Date 🗹 Printed Name and Address: �� (Name of Organization) 🗹 (Address) 🗹 (City)
Statement for Loan Guarantees and Loan Insurance. The undersigned states, to the best of its knowledge and belief, that: If any 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 commitment providing for the United States to insure or guarantee a loan, the undersigned shall complete and submit Standard Form-LLL, “Disclosure Form to Report Lobbying,” in accordance with its instructions.
Statement for Loan Guarantees and Loan Insurance. The undersigned states, to the best of his or her knowledge and belief, that: If any 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 commitment providing for the United States to insure or guarantee a loan, the undersigned shall complete and 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. [55 FR 6754, Feb. 26, 1990, as amended at 81 FR 61565, Sept. 6, 2016] Name and Title of Authorized Representative, Name of Contractor Signature Date *NOTE: - In these instances, “All” in the Final Rule is expected to be clarified to show that it applies to covered Contract/Grant transactions over $100,000 (per OMB). THIS SPACE LEFT BLANK INTENTIONALLY CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS PRIMARY COVERED TRANSACTIONS This certification is required by the regulations implementing Executive Order 12549 and 12689, Debarment and Suspension, 29 CFR Part 98, Section 98.510, Participants Responsibilities and implemented at 45 CFR Part 85. The regulations were published as Part VII of the May 26, 1988 Federal Register (pages 19160 – 19211). (BEFORE SIGNING CERTIFICATION, READ ATTACHED INSTRUCTIONS WHICH ARE AN INTEGRAL PART OF THE CERTIFICATION)
Statement for Loan Guarantees and Loan Insurance. The undersigned states, to the best of his or her knowledge and belief, that: In any 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 commitment providing for the United States to insure or guarantee a loan, the undersigned shall complete and 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 occurring on or before October 23, 1996, and of not less than $11,000 and not more than $110,000 for each such failure occurring after October 23, 1996. As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the above applicable certification. * NAME OF APPLICANT Pacific Fishery Management Council * AWARD NUMBER * PROJECT NAME NOAA-NMFS Pacific Fishery Management Council Administrative Xxxxx Prefix: * First Name: Middle Name: Xx. Xxxxxxx A * Last Name: Suffix: Xxxxx * Title: Deputy Director * SIGNATURE: * DATE: XXXXXXX XXXXX 12/19/2014 Budget Narrative File(s) REVISED_PFMC_BudgetNarrativeCover_2015_Budget.pdf
Statement for Loan Guarantees and Loan Insurance. The undersigned states, to the best of its knowledge and belief, that: If any 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 commitment providing for the United States to insure or guarantee a loan, the undersigned shall complete and 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. SUBRECIPIENT: SAISD By: _ Name: Title: Date:
