Agmt11 Ca. Department of Public Health- Project LEAN

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Callfornia Department of Public Health - Special Terms and Conditions Exhibit D(F) Attachment 1 STATE OF CALIFORNIA CALIFORNIA DEPARTMENT OF PUBLIC HEALTH � CERTIFICATION REGARDING LOBBYING The undersigned certifies, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to inFluence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the making, awarding or entering into of this Federal contract, Federal grant, or cooperative agreement, and the extension, continuation, renewal, amendment, or modification of this Federal contract, grant, 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 of the United States Government, 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, or cooperative agreement, the undersigned shall complete and submit Standard Form LLL, "Disclosure of Lobbying Activities" in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards a: all tiers (including subcontractors, subgrants, and contracts under grants and cooperative agreements) of $100,000 or more, 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 intc. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S C., ar,y person who fails to file the required certification shall be subject to a civi� penalty of not less than $10,OOC ar�d not more than $100,000 for each such failure. Name of Conhactor Printed Name of Person Signing for Contractor � Contract! Grant Number Signature of Person Signin9 for Contractor � Date Title After execution by or on behalf of Contractor, please return to: Cali�ornia Departmeni of Public Health CDPH reserves the right to notifiy the contractor in writing of an alternate submission address. CDPH Exhibit D(F) (8/10) Page 23 of 25