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i <br /> the extension, continuation, renewal, amendment, or modification of any Federal <br /> <br /> ' contract, grant, loan, or cooperative agreement. <br /> (2) If any funds other than Federal appropriated funds have been paid or will be paid <br /> to any person for influencing or attempting to influence an officer or employee of <br /> any Federal agency, a Member of Congress, an officer or employee of Congress, <br /> or an employee of a Member ofiCongress in connection with this Federal <br /> contract, grant, loan, or cooperative agreement, the undersigned shall complete <br /> and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in <br /> accordance with its instructions. <br /> B. This certification is a material representation of fact upon which reliance was placed <br /> when this transaction was made or entered into. Submission of this certification is a <br /> prerequisite for making or entering into this transaction imposed by 31 U.S.C. 1352. Any. <br /> person who fails to file the required certification shall be subject to a civil penalty of not <br /> less than $10,000 and not more than $100,000 for each such failure. <br /> C. The prospective participant also agrees by submitting his or her bid or proposal the he or <br /> she shall require that the language of this certification be included in all lower tier <br /> subcontracts; which exceed $100,000 and that all such recipients shall certify and <br /> disclose accordingly. <br /> XX. 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 sub- <br /> recipients, consultants, and contractors on the basis of age, disability, gender, race, color, <br /> national origin, age income status and religion may bring forth a complaint of discrimination <br /> under Title VI and related statutes to the Oregon Department of Transportation, Office of Civil. <br /> Rights, 800 Airport Road SE, Salem, Oregon, 97301, (503)986-4350. <br /> CITY OF EUGENE PBS- ENGINEERING + <br /> ,Q~.~ ~ ~ ENVIRONMENTAL <br /> y <br /> Mark Schoening .E. Rex Wallace <br /> City Engineer Director of Operations <br /> Date: o Date: a G <br /> <br />