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REV: 03-01-23 RL <br />Page 27 <br />contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard <br />Form-LLL, “Disclosure Form to Report Lobbying,” in accordance with its instructions. <br />3. The undersigned shall require that the language of this certification be included in the award documents <br />for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and <br />cooperative agreements) and that all subrecipients shall certify and disclose accordingly. <br />This certification is a material representation of fact upon which reliance was placed when this transaction <br />was made or entered into. Submission of this certification is a prerequisite for making or entering into this <br />transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required <br />certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for <br />each such failure. <br />Grantee certifies or affirms the truthfulness and accuracy of each statement of its certification and <br />disclosure, if any. In addition, the Grantee understands and agrees that the provisions of 31 U.S.C. Chap. <br />38, Administrative Remedies for False Claims and Statements, apply to this certification and disclosure, if <br />any. <br />___________________________________________ <br />Signature of Grantee’s Authorized Official <br />___________________________________________ <br />Name and Title of Grantee’s Authorized Official <br />___________________________________________ <br />Date <br />ATTY/AGR.2023.031/County of San Mateo (Agreement for Homeless Outreach) (Page 27 of 27) <br />DocuSign Envelope ID: 6F079F33-00E9-42D4-A508-A3B82FC663F4 <br />3/27/2023 | 4:37 PM PDT <br />City ManagerMelissa Stevenson Diaz