Resolution 2025-027 - Laserfiche WebLink

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Docusign Envelope lD: CCD36BBF-645D-4579-9C75-F803991 1CF89 2. lf any funds other than Federally appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Gongress in connection with this Federal contract, grant, loan, or cooperative Contract, the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying Activities," in accordance with its instructions. (lf needed, Standard Form-LLL, "Disclosure of Lobbying Activities," its instructions, and continuation sheet are included at the end of this application form.) 3. The undersigned shall require that the language of this certification be included in the award documents for all subcontracts at all tiers (including subcontracts, subcontracts, and contracts under grants, loans and cooperative Contracts) and lhat all sub- recipients shall certify and disclose accordingly. This certiflcation is a materialrepresentation of fact upon which reliance was placed when this transaction was made or entered into. $ubmission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, U.S. Code. Any person who fails to file the required certlfication shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. d. GERTIFIGATION REGARDING PROGRAM FRAUD CIVIL REMEDIES ACT (PFGRA): The undersigned (authorized official signing for the contacting organization) certifies that the statements herein are true, complete, and accurate to the best of his or her knowledge, and that he or she is aware that any false, fictitious, or fraudulent statements or claims may subject him or her to criminal, civil, or administrative penallies. The undersigned agrees that the contracting organization will comply with the Public Health Seruice terms and conditions of award if a contract is awarded. e. CERTIFICATION REGARDING ENVIRONMENTALTOBAGCO SMOKE: Public Law 1O3-227, also known as the Pro-Children Act of 1994 (AcQ, requires that smoking not be permitted in any portion of any indoor facility owned or leased or contracted for by an entity and used routinely or regularly for the provision of health, day care, early childhood development services, education or library services to children under the age of 18, if the services are funded by Federal programs either directly or through State or local governments, by Federal grant, contract, loan, or loan guarantee, The law also applies to children's services that are provided in indoor facilities that are constructed, operated, or maintained with such Federalfunds. The law does not apply to childrenls services provided in private residence, portions of facilities used for inpatient drug or alcohol treatment, service providers whose sole source of applicable Federalfunds is Medicare or Medicaid, or facilities where WIC coupons are redeemed. Failure to comply with the provisions of the law may result in the imposition of a civil monetary penalty of up to $1,000 for each violation and/or the imposition of an admlnistrative compliance order on the responsible entity. By signing the certification, the undersigned certifies thatthe contracting organization will comply with the requirements of the Act and will not allow smoking within any portion of any indoorfacility used for the provision of services for children as delined by the Act. The contracting organization agrees that it will require that the language of this certification be included in any subcontracts which contain provisions for children's services and that all sub- recipients shall certify accordingly. Washington State Health Care Authority 21 HCA Contract #R7843