U.S. Government-Funded Acquisition Subawards
Required Certifications and Representations

SUBAWARDEE:

DUNS Number:COUNTRY:

FHI 360 ID No.: FCO No.:

Subaward Project Title:

Certification Regarding Restrictions on Lobbying:

As a condition of entering into the referenced subaward, the undersigned hereby certifies on behalf of the Subawardee that to the best of his/her knowledge and belief:

(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.

(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 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 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 and is imposed by Title 31, U.S. Code Section, 1352. 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.

C&G rev. 2011-08
Certificate – USG Acquisition
Lobbying

Transparency Act

In accordance with the U.S. Government’s Federal Funding Accountability and Transparency Act (FFATA), FHI 360 is required to ask the following questions:

Does 80% or more of your organization’s annual gross revenue come from US Government sources (either as prime- or sub-awards)?

Yes—continue to next question

No—skip to signature section

If yes, do these revenues total at least $25,000,000 annually?

Yes—continue to next question

No—skip to signature section

If yes, is information on the names and total compensation of the five highest-compensated individuals in your organization already reported to the public through periodic reports filed with the SEC or IRS?

Yes—continue to signature section

No—complete the following table for the five highest compensated individuals in your organization:

Name and Title / Total Annual Compensation (USD Value including cash and non-cash compensation)

These certifications and statements are an express term and condition of the subaward and any violation shall be grounds for immediate unilateral termination of the subaward by FHI 360 prior to the end of its term.

SignatureDate

Type or print name

Title

C&G rev. 2011-08
Certificate – USG Acquisition
Transparency Act Certificate

Representations

Is your organization based in the United States?

Yes – complete the following representations

No – skip to signature section

As a condition of entering into the referenced subaward, the undersigned hereby represents that:

Per FAR 52.222-22Previous Contracts and Compliance Reports

The offeror represents that—

(a)It has has not participated in a previous contract or subcontract subject to the Equal Opportunity clause of this solicitation;

(b)It has has not filed all required compliance reports; and

(c)Representations indicating submission of required compliance reports, signed by proposed subcontractors, will be obtained before subcontract awards.

Per FAR 52.222-25Affirmative Action Compliance

The offeror represents that –

(a)It has developed and has on file, has not developed and does not have on file, at each establishment, affirmative action programs required by the rules and regulations of the Secretary of Labor (41CFR 60-1 and 60-2); - or -

(b)It has not previously had contracts subject to the written affirmative action programs requirement of the rules and regulations of the Secretary of Labor.

Per FAR 52.222-38 Compliance with Veterans’ Employment Reporting Requirements

By submission of its offer, the offeror represents that, if it is subject to the reporting requirements of 38 U.S.C. 4212(d) (i.e., if it has any contract containing Federal Acquisition Regulation clause 52.222-37, Employment Reports on Special Disabled Veterans, Veterans of the Vietnam Era, and Other Eligible Veterans), it has submitted the most recent VETS-100 Report required by that clause.

These certifications and representations are an express term and condition of the subaward and any violation shall be grounds for immediate unilateral termination of the subaward by FHI 360 prior to the end of its term.

SignatureDate

Type or print name

Title

C&G rev. 2011-08
Certificate - USG Acquisition
Representations