09-207.00 Spokane County: Clement Street Improvements GrantQ
Certification Regarding Lobbying For
Grants and Cooperative Agreements
Submission of this certification is required by Section 1352, Title 3l of the U.S. Code and is a
prerequisite for making or entering into a grant or cooperative agreement over $100,000.
The undersigned certifies, to the best of his or her knowledge and belief, that
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or employee
of any agency, a Member of Congress, an officer or employee of Congress, or an employee of
a Member of Congress in connection with the making of any Federal grant, the entering into
of any cooperative agreement, and the extension, continuation, renewal, amendment, or
modification of any Federal grant or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any
person for influencing or attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with this Federal grant or cooperative agreement, the undersigned
shall complete and submit Standard Form — LLL, "Disclosure Form to Report Lobbying," in
accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award
documents for all subawards at all tiers (including subgrants, contracts under grants and
cooperative agreements, and subcontracts) and that all subrecipients shall certify and disclose
accordingly.
This certification is a material representation of fact on which the Spokane County, Housing and
Community Development Department relied when it made or entered into this grant or cooperative
agreement. Any person who fails to file the required certification shall be subject to a civil penalty of not
less than $10,000 and not more than $100,000 for each such failure.
Name ff PR/Award (or Application) Number
Or Project Name
de
Name and Title of
C01- 2611
DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 0348 -0046
See reverse for public burden disclosure.
1. Type of Federal Action:
2. Status of Federal Action:
3. Report Type:
Fb a. contract
b] a. bid /offer /application
� a. initial filing
b. grant
b. initial award
b. material change
c. cooperative agreement
c. post -award
For Material Change Only:
d. loan
year quarter
e. loan guarantee
date of last report
f. loan insurance
4. Name and Address of Reporting Entity:
5. If Reporting Entity in No. 4 is a Subawardee, Enter Name
❑ Prime 0 subawardee
and Address of Prime:
Tier if known:
Spokane County Community Services, Housing, and Community
Development Department
312 W 8th Ave 4th Floor
Spokane, WA 99204
Con ressional- District'; if known: '4c
Congressional District, ifknown: -
6. Federal Department/Agency:
7. Federal Program Name /Description:
Housing and Urban Development
CDBG
CFDA Number, if applicable: 14.218
8. Federal Action Number, if known:
9. Award Amount, if known:
$ 220,526.00
10. a. Name and Address of Lobbying Registrant
b. Individuals Performing Services (including address if
(if individual, last name, first name, Ml):
different from No. 1Oa)
Greg McCormick
(last name, first name, Ml):
City of Spokane Valley
11707 E Sprague Suite 106
Spokane Valley, WA 99206
Information requested through this form is authonzed by tine 31 U.S.C. section
11 . 1352.
Signature:
This disclosure of lobbying activities is a material representation of fact
Print Name:
upon which reliance was placed by the for above when this transaction was made
or entered into. This disclosum is mwirsd pursuant W 31 U.S.C. 1352. This
Title:
information will be available for public inspection. Any person who fails to file the
required disclosure shall be subject to a civil penalty of not less than S1o,000and
not more then $1 Keep for each such failure.
Telephone No.: Date:
FederalUsii'Only a l s II < 3
Authorize Local d for Ll Re roduction
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Standard Form LLL (Rev. 7 -57)
INSTRUCTIONS FOR COMPLETION OF SF -LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal
action, or a material change to a previous fling, pursuant to title 31 U.S.C. section 1352. The fling of a form is required for each payment or agreement to make
payment to any lobbying entity 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 employeeof a Member of Congress in connection with a covered Federal action. Complete all items that apply for both the initial filing and material
change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.
1. Identify the type of covered Federal action for which lobbying activity is and /or has been secured to influence the outcome of a covered Federal action.
2. Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report. If this is a followup report caused by a material change to the information previously reported, enter
the yearand quarterin which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal
action.
4. Enterthe full name, address, city, State and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification
of the reporting entilythat designates if it is, or expects to be, a prime or subaward recipient. Identify the tierof the subawardee,e.g., the first subawardee
of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.
5. If the organization fling the report in item 4 checks "Subawardee, "then enter the full name, address, city, State and zip code of the prime Federal
recipient. Include Congressional District, if known.
6. Enterthe name of the Federal agency making the award or loan commitment. Include at least one organizationallevel below agencyname, if known. For
example, Department of Transportation, United States Coast Guard,
7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance
(CFDA) number for grants, cooperative agreements, loans, and loan commitments.
8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number,
Invitation for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application /proposal control number
assigned by the Federal agency). Include prefixes, e.g., "RFP -DE -90 -001."
9. For a covered Federal action where there has been an award or lean commitment by the Federal agency, enter the Federal amount of the award /loan
commitment for the prime entity identified in item 4 or 5.
10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting
entity identified in item 4 to influence the covered Federal action.
(b) Enter the full names of the individual(s) performing services, and include full address if different from 10 (a). Enter Last Name, First Name, and
Middle Initial (MI).
11. The certifying official shall sign and date the form, print his/her name, title, and telephone number.
According to the Paperwork Reduction Act, as amended,no persons are required to respond to a collection of information unless it displays a valid OMB Control
Number. The valid OMB control number for this information collection is OMB No. 0348 -0046. Public reporting burden for this collection of information is
estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to the Office of Managementand Budget, Paperwork Reduction Project (0348 - 0046), Washington,
DC 20503.
M
ill sr_� o a �-oos
August 19, 2009
i
CHRISTINE BARADA
SERVICES, HOUSING, AND COMMUNITY DEVELOPMFNT DEPARTMENT
DIRECTOR
M]r, Greg McCormick
City of Spokane Valley
11707 East Sprague Ave. Suite 106
Spokane Valley, WA 99206
Dear Mr. McCormick;
According to Federal Regulations as outlined in 24 CFR 87, Subrecipients of $100,000 or more in
federal funding must certify that Federal funds will not be used for lobbying or other attempts to
influence agency employees or officers, or Members or employees of Congress in connection
with the making of federal loans, grants or agreements. During the 2009 -2010 program year you
will receive $100,000 or more in CDBG or HOME Investment Partnership funds and arc
therefore affected by this compliance requirement.
To comply with this regulation we are forwarding a copy of a Certification Regarding Lobbying
for Grants and Cooperative Agreements for your review and signature. Please read the
certification, sign and return the document to the Spokane County Housing and Community
Development Department before August 31, 2009
In addition to the certification, Subrecipients must also report their lobbying efforts (supported
by non - federal funds) by completing a Disclosure of Lobbying Activities, Standard Form LLL and
LLL -A. Copies of this form are also enclosed for your use if your organization is involved in
lobbying Federal agencies, personnel, Members of Congress or Congressional Employees.
If you have any questions regarding the Certification or Disclosure in regard to lobbying please
contact Tim Crowley, Department manager at 477 -4488.
Sincerely, RECEIVED
Al s i )'1 2
Christine Barada
.,POI<nn!E vALLer
Director DEPART MINT OF
,OA1l:turdjTY nFVI;LO?edFAIT
Eno: Certification Regarding Lobbying For Grants and Cooperative Agreements
Standard Forms LLL and LLL -A, Disclosure of Lobbying Activities
312 WEST 8 AVENUE • FOURTH FLOOR • SPOKANE WA 99204
PHONE:(509)477 -5722 • FAX:(509)477 -6827 • RELAY SERVICE OFWASHINGTON: 1- 800 - 833.6384 • R'ww.SPOKANE000NrY.ORG a
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