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……..The pro forma contract detailed in this attachment contains some “blanks” (signified by descriptions in capital letters) that will be completed with appropriate information in the final contract resulting from this RFP/RFQ.. The Institution: The Contractor: NAME AND TITLE OF INSTITUTION CONTACT PERSON INSTITUTION NAME ADDRESS TELEPHONE NUMBER FACSIMILE NUMBER EMAIL ADDRESS NAME AND TITLE OF CONTRACTOR CONTACT PERSON CONTRACTOR NAME ADDRESS TELEPHONE NUMBER FACSIMILE NUMBER EMAIL ADDRESS All instructions, notices, consents, demands, or other communications shall be sent in a manner that verifies proof of delivery.. The Contractor certifies, to the best of its knowledge and belief, that: No federally appropriated funds have been paid or will be paid, by or on behalf of the Contractor, to any person for influencing or attempting to influence an officer or employee of any agency, 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, and entering into any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement.. If 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 Congress in connection with this Contract, grant, loan, or cooperative agreement, the Contractor shall complete and submit Standard Form-LLL, “Disclosure Form to Report Lobbying,” in accordance with its instructions.. have not within a three (3) year period preceding this Contract been convicted of, or had a civil judgment rendered against them from commission of fraud, or a criminal offence in connection with obtaining attempting to obtain, or performing a public (Federal, State, or Local) transaction or grant
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