Common use of Statement for Loan Guarantees and Loan Insurance Clause in Contracts

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 20-066-006-C038 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx SIGNATURE DATE * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Glo Contract

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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 Noah Arc Community Development Corporation Inc. 20-066063-006018-C038 B939 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx SIGNATURE DATE * Xxxx Xxxx Director 2/7/2020 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- SIGNATURE DATE appA. Published Apr. 1, 2011. Accessed Aug. 1, 2018. Disclosure of Lobbying Activities In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx d. loan e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Glo Contract

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 20TRT Development Company d/b/a/Omni Corpus Christi Hotel 25-066010-006000-C038 E594 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx Xxxxxxx Xxxxxxxx General Manager 6/5/2024 SIGNATURE DATE * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 02/28/2025 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx d. loan e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Form Agreement

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 20Xxxx, Xxxxxxx & Associates, Inc. 00-066000-006-C038 000 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx Xxx Xxxxx Executive Vice President 11/18/2021 SIGNATURE DATE * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx d. loan e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Professional Services Contract

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 20Galveston Bay Foundation 19-066041-006000-C038 B075 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx SIGNATURE DATE * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material changeApproved by OMB

Appears in 1 contract

Samples: Subrecipient Grant Agreement

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-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 [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 duly authorized representative 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 applicantMay 26, I hereby certify that the applicant will comply with the above applicable certification1988 Federal Register (pages 19160 – 19211). NAME (BEFORE SIGNING CERTIFICATION, READ ATTACHED INSTRUCTIONS WHICH ARE AN INTEGRAL PART OF APPLICANT AWARD NUMBER AND/OR PROJECT NAME Fort Bend County 20-066-006-C038 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx SIGNATURE DATE * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material changeTHE CERTIFICATION)

Appears in 1 contract

Samples: Primary Services Contract Agreement

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 Maple Park Senior Village, L.L.C. 20-066063-006014-C038 B935 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE _Will Xxxxxx XX Xxxxxx SIGNATURE DATE * 8/17/2020 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- SIGNATURE DATE appA. Published Apr. 1, 2011. Accessed Aug. 1, 2018. Disclosure of Lobbying Activities In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx d. loan e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Glo Contract

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 20CARE INNS OF TEXAS, LTD 21-066119-006002-C038 C764 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx SIGNATURE DATE * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx d. loan e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Reimbursement Agreement

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 20Touchstone Veterans Management, Ltd. 21-066119-006004-C038 C834 through its General Partner, Touchstone Veterans GP, Inc. PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx E. Xxxx Xxxxxxxx CEO SIGNATURE DATE 12/8/2020 * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx d. loan e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Reimbursement Agreement

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 Nueces County 20-066065-006091-C038 C254 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx SIGNATURE DATE * Xxxxxxx Xxxxxxx Nueces County Judge 3/3/2020 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- SIGNATURE DATE appA. Published Apr. 1, 2011. Accessed Aug. 1, 2018. Disclosure of Lobbying Activities In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Glo Contract

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 2018-066523-006000-C038 B264 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material changeApproved by OMB

Appears in 1 contract

Samples: Glo Contract

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 20Wood Environment & Infrastructure Solutions, Inc. 21-066145-006000-C038 C845 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx Xxxxx Xxxxx Central Gulf Coast Region Manager SIGNATURE DATE 2/5/2021 * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Project Management Services

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 20San Antonio Bay Partnership, Inc. 22-066045-006017-C038 D114 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxx Xxxxxx Chair of Board of Directors 9/27/2021 SIGNATURE DATE * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx d. loan e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Subrecipient Grant Agreement

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 20Ernst & Young U.S. LLP 00-066000-006-C038 000 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx Xxxxx Xxxxxxxxx Authorized Signatory 12/5/2019 SIGNATURE DATE * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Professional Services Contract

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 20Care Inns of Texas, LTD. 21-066214-006002-C038 C982 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx SIGNATURE DATE * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Response Agreement

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 20Galveston Bay Foundation 22-066045-006005-C038 D102 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxx Xxxxxx President SIGNATURE DATE 9/16/2021 * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx d. loan e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Subrecipient Grant Agreement

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 20GrantWorks, Inc. 21-066064-006001-C038 C847 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx Xxxxx Xxxxxxxxxx President SIGNATURE DATE 2/8/2021 * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Program Implementation Services Contract

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 20Xxxxxx and Xxxxxxx, Inc. 00-066000-006-C038 000 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx Xxxxxxxx Vice President SIGNATURE DATE 8/13/2020 * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Environmental Services Contract

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 20Information Strategies, Inc. ("InfoStra2t0"-0)75-066-006-C038 000 -B969 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx Xxxxx X. Xxxxxxxx President SIGNATURE DATE 2/19/2020 * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Ongoing Technology Enhancement and Support Services Contract

Statement for Loan Guarantees and Loan Insurance. The undersigned states, to the best of his or her 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. As the duly authorized representative of the applicant[SUBRECIPIENT’S NAME], 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 20-066-006-C038 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx SIGNATURE DATE * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Numbera nonprofit corporation By: 4040-0013 Expiration Name: «Sig_Auth First_Name» «Sig_Auth_Last_name» Title: «Sig_Auth_title» Date: 02/28/2022 1TEXAS DEPARTMENT OF HOUSING AND COMMUNITY AFFAIRS CONTRACT NUMBER 6119000XXXX FOR THE FY 2019 COMMUNITY SERVICES BLOCK GRANT PROGRAM (“CSBG”) CFDA#93.569 ADDENDUM B CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS This certification is required by the regulations implementing the Drug-Free Workplace Act of 1988: 45 CFR Part 76, Subpart, F. Sections 76.630(c) and (d)(2) and 76.645 (a)(1) and (b) provide that a Federal agency may designate a central receipt point for STATE-WIDE AND STATE AGENCY-WIDE certifications, and for notification of criminal drug convictions. *Type For the Department of Federal ActionHealth and Human Services, the central point is: a. contract x. xxxxx c. cooperative agreement x. xxxx e. loan guarantee f. loan insurance 2Division of Grants Management and Oversight, Office of Management and Acquisition, Department of Health and Human Services, Room 000-X, 000 Xxxxxxxxxxxx Xxxxxx, XX Xxxxxxxxxx, XX 00000. *Status of Federal Action: a. bid/offer/application b. initial award c. postThe undersigned certifies that it will or will continue to provide a drug-award 3. *Report Type: a. initial filing b. material changefree workplace by:

Appears in 1 contract

Samples: Housing and Community Affairs

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 20Xxxxxx and Xxxxxxx, Inc. 00-066000-006-C038 000 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx X. Xxxxx VP, Division Manager SIGNATURE DATE 8/10/2020 * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Professional Services Contract

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 20Aptim Environmental & Infrastructure, LLC 00-066000-006-C038 000 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx Xxxx Xxxxxxxxxxx Vice President 11/19/2021 SIGNATURE DATE * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Professional Services Contract

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 20PRDG, LLC 00-066000-006-C038 000 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx Xxxx Xxxxxxxxx Managing Principal SIGNATURE DATE 11/17/2021 * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx d. loan e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Professional Services Contract

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 20-066-006-C038 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx County Judge SIGNATURE DATE 11/22/2022 * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 02/28/2025 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx d. loan e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Glo Contract

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 2018-066523-006000-C038 B264 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx Xxxxxx SIGNATURE DATE * *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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material changeApproved by OMB

Appears in 1 contract

Samples: Glo Contract

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 Nueces County 20Public Health District 00-066000-006-C038 000 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx Xxxxxxx Xxxxxxxxx Health Director SIGNATURE DATE * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: destinyhosted.com

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-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 [ 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 duly authorized representative 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 applicantMay 26, I hereby certify that the applicant will comply with the above applicable certification1988 Federal Register (pages 19160 – 19211). NAME (BEFORE SIGNING CERTIFICATION, READ ATTACHED INSTRUCTIONS WHICH ARE AN INTEGRAL PART OF APPLICANT AWARD NUMBER AND/OR PROJECT NAME Fort Bend County 20-066-006-C038 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx SIGNATURE DATE * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material changeTHE CERTIFICATION)

Appears in 1 contract

Samples: Appendix A

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 20Galveston Bay Foundation 23-066020-006002-C038 D596 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxx Xxxxxx President 10/3/2022 SIGNATURE DATE * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 02/28/2025 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx d. loan e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Subrecipient Grant Agreement

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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 20AECOM Technical Services, Inc. 21-066064-006002-C038 C858 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx Xxxx Xxxxxxxx Vice President, USWest Water SIGNATURE DATE 2/2/2021 * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Program Implementation Services Contract

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 20Metric Engineering Inc. 21-066168-006000-C038 C906 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxxx Xxxxxx Executive Vice President SIGNATURE DATE 3/1/2021 * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx d. loan e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Services Contract

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 AECOM Technical Services, Inc. 20-066088-006000-C038 C015 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxxxxxxx Xxxxxx VP SIGNATURE DATE 11/25/2019 * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Glo Contract

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 20SWCA, Inc. 00-066000-006-C038 000 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxx Xxxxxx Vice President SIGNATURE DATE 8/19/2020 * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx d. loan e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material changeaward

Appears in 1 contract

Samples: Environmental Services Contract

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 20Xxxx, Xxxxxx, Elstner Associates, Inc. 00-066000-006-C038 000 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx Xxxxxxx Xxxxxxx Unit Manager and Principal 11/9/2021 SIGNATURE DATE * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx d. loan e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Professional Services Contract

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 20CrowderGulf, LLC 21-066169-006000-C038 C907 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx Xxxxxx-Xxxxx President 3/2/2021 SIGNATURE DATE * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx d. loan e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Services Contract

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 20Care Inns of Texas - Temple, LTD. 21-066119-006003-C038 C835 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx E. Xxxx Xxxxxxxx CEO SIGNATURE DATE 12/8/2020 * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx d. loan e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Reimbursement Agreement

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 20Texas VSI, LLC 21-066119-006001-C038 C763 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx SIGNATURE DATE * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx d. loan e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Reimbursement Agreement

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 20Care Inns of Texas, LTD. 21-066214-006002-C038 C982 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx SIGNATURE DATE * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx d. loan e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Response Agreement

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 20AECOM Technical Services, Inc. 00-066000-006-C038 000 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx Xxxxxxx Vice President, Disaster Recovery SIGNATURE DATE 11/17/2023 * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 02/28/2025 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx d. loan e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: s3.glo.texas.gov

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 20AECOM Technical Services, Inc. 00-066000-006-C038 000 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx Xxxx Xxxxxxxx Vice President, Central Water SIGNATURE DATE 8/9/2020 * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Professional Services Contract

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 20Ernst & Young U.S. LLP 00-066000-006-C038 000 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx Xxxxx Xxxxxxxxx Authorized Signatory 12/3/2019 SIGNATURE DATE * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Professional Services Contract

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 DR Sienna Villas Investments, LP 20-066063-006019-C038 B940 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx SIGNATURE DATE * Xxx Xxx Manager 1/31/2020 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- SIGNATURE DATE appA. Published Apr. 1, 2011. Accessed Aug. 1, 2018. Disclosure of Lobbying Activities In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx d. loan e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Glo Contract

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 Delta Manor GP LLC 20-066063-006004-C038 B926 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx SIGNATURE DATE * Xxxxx Vice President 6/8/2020 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- SIGNATURE DATE appA. Published Apr. 1, 2011. Accessed Aug. 1, 2018. Disclosure of Lobbying Activities In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx d. loan e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Glo Contract

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 20Xxxxxxxxxx Engineering Corporation 00-066000-006-C038 000 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxx Xxxxxx Division Manager SIGNATURE DATE 8/10/2020 * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Professional Services Contract

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 20AECOM Technical Services, Inc. 00-066000-006-C038 000 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx SIGNATURE DATE * 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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx d. loan e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material change

Appears in 1 contract

Samples: Professional Services Contract

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 20Xxxxxxx Construction Company, Inc. 19-066087-006000-C038 B409 PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE XX Xxxxxx Xxxxx Xxxxxxx president SIGNATURE DATE * 11/3/2018 *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 In Process Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) OMB Number: 4040-0013 Expiration Date: 02/28/2022 1. *Type of Federal Action: a. contract x. xxxxx c. cooperative agreement x. xxxx e. loan guarantee f. loan insurance 2. *Status of Federal Action: a. bid/offer/application b. initial award c. post-award 3. *Report Type: a. initial filing b. material changeApproved by OMB

Appears in 1 contract

Samples: Major Construction Contract

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