GG_LOBBYINGFORM-V1.1_COMBINED.PDF

Certification for Contracts, Grants, Loans, and Cooperative Agreements
  
(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 
contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard 
Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award documents 
for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and 
cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification 
is a material representation of fact upon which reliance was placed when this transaction was made or 
entered into. Submission of this certification 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 certification shall be  
subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. 
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 of Lobbying 
Activities,'' 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.
* APPLICANT'S ORGANIZATION
* SIGNATURE:
* DATE:
* PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE
Suffix:
Middle Name:
* Title:
* First Name:
* Last Name:
Prefix:
CERTIFICATION REGARDING LOBBYING
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any  
person for influencing or attempting to influence an officer or employee of an agency, a Member of 
Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with 
the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the  
entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or 
modification of any Federal contract, grant, loan, or cooperative agreement.
The undersigned certifies, to the best of his or her knowledge and belief, that:
Statement for Loan Guarantees and Loan Insurance 
The undersigned states, to the best of his or her knowledge and belief, that:
Maricopa County on behalf of Maricopa Cnty Sheriff's Office
Bill
Chairman
Gates

HIDTA CY23 Application GG Lobbying Form 
 
 
 
 
 
       
 
19a 
 
 
 
Maricopa County 
 
 
 
ATTEST: 
 
 
 
 
 
 
 
 
 
 
 
 
 Juanita Garza                                 Date 
 Clerk of the Board of Supervisors 
 
 
 
APPROVED AS TO FORM 
 
 
 
This ____ day of ____________________, 2022 
 
 
By: ___________________________________ 
      Deputy Maricopa County Attorney