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loan, the entering into of any cooperative agreement, and the extension, <br /> continuation, renewal, amendment, or modification of any Federal <br /> contract, grant, loan, or cooperative agreement. <br /> (2) If any funds other than Federal appropriated funds have been paid or will <br /> be paid to any person for influencing or attempting to influence an officer <br /> or employee of any Federal agency, a Member of Congress, an officer or <br /> employee of Congress, or an employee of a Member of Congress in <br /> connection with this Federal gontract, grant, loan, or cooperative , <br /> agreement, the undersigned shall complete and submit Standard Form- <br /> LLL, "Disclosure Form to Report Lobbying," in accordance with its <br /> instructions. <br /> B. This certification is a material representation of fact upon which reliance was <br /> placed when this transaction was made or entered into. Submission of this <br /> certification is a prerequisite for making or entering into this transaction imposed <br /> by 31 U.S.C. 1352. Any person who fails to file the required certification shall be <br /> subject to a civil penalty of not less than $10,000 and not more than $100,000 for <br /> each such failure. <br /> C. The prospective participant also agrees by submitting his or her bid or proposal <br /> the he or she shall require that the language of this certification be included in all <br /> lower tier subcontracts, which exceed $100,000 and that all such recipients shall <br /> certify and disclose accordingly. <br /> Any person who believes that he/she has been excluded from participation in, denied <br /> benefits or services of any program or activity administered by the Department or its <br /> sub-recipients, consultants, and contractors on the basis of age, disability, gender, <br /> race, color, national origin, age income status and religion may bring forth a <br /> complaint of discrimination under Title VI and related statutes to the Oregon <br /> Department of Transportation, Office of Civil Rights, 800 Airport Road SE, Salem, <br /> Oregon, 97301, (503)986-4350. <br /> <br /> ' CITY OF UGENE ENVIRONMENTAL SOLUTIONS, LLC <br /> K rt Corey, P. E Nancy Holzh user <br /> Public Warks Di ctor Owner <br /> Date: / 2 - Z 2 Date: 10~ • I 0 $r <br /> <br />