Attachment F

**NATIONAL SCIENCE FOUNDATION**

**Small Business Innovation Research (SBIR)**

**SBIR PHASE II PROPOSAL COVER PAGE**

<table>
<tbody>
<tr class="odd">
<td><p>Phase I Award No.</p></td>
<td><p>Topic No.</p></td>
<td><p>SubTopic Letter (if any)</p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><p>Proposal Title</p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><p>Company Name:</p></td>
<td><p>Employer Identification Number (EIN) or</p>
<p>Taxpayer Identification Number (TIN)</p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><p>Address (including address of Company Headquarters and zip code
plus four digit extension)</p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><p>Requested Amount</p>
<p>$</p></td>
<td><p>Proposed Duration</p></td>
<td><p>Period of Performance</p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><p><strong>THE SMALL BUSINESS CONCERN CERTIFIES
THAT:</strong></p></td>
<td><p><strong>Y/N</strong></p></td>
<td><p>1<span id="Text11">. It is a small business as difined Section
2.12.</span></p></td>
<td></td>
<td><p>2. It qualifies as a socially and economically disadvantaged
business as defined Section 2.14. (FOR</p>
<p>STATISTICAL PURPOSES ONLY)</p></td>
<td></td>
<td><p>3<span id="Text13">. It qualifies as a women-owned business as
defined in Section 2.17. (FOR STATISTICAL PURPOSES ONLY)</span></p></td>
<td></td>
<td><p>4<span id="Text14">. NSF is the only Federal agency that has
received this proposal (or an overlapping or equivalent proposal ) from
the small business concern. If </span><strong>No</strong>, you must
disclose overlapping or equivalent proposals and awards as defined in
Section 3.1.12</p></td>
<td></td>
<td><p>5<span id="Text15">. A minimum of one-half of the research will
be performed by this firm in Phase II.</span></p></td>
<td></td>
<td><p>6<span id="Text16">. The primary employment of the Principal
Investigator will be with this firm at the tiime of award and</span></p>
<p>during the conduct of the research.</p></td>
<td></td>
<td><p>7<span id="Text17">. It will permit the government to disclose
the title and technical abstract page, plus the name, address and
telephone number of a corporate official, if the proposal does not
result in an award, to parties that may be interested in further
information or possible investment.</span></p></td>
<td></td>
<td><p>8. It will comply with the provisions of the Civil Rights Act of
1964 (P.L. 88-352) and the regulations pursuant thereto.</p></td>
<td></td>
</tr>
<tr class="odd">
<td><p><strong>PRINCIPAL INVESTIGATOR /PROFECT
DIRECTOR</strong></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><p>Name</p></td>
<td><p>Title</p></td>
<td><p>Social Security No.</p></td>
<td><p>Telephone Number</p></td>
<td><p>E-Mail Address</p></td>
<td><p>Fax Number</p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><p><strong>COMPANY OFFICER (FOR BUSINESS AND FINANCIAL
MATTERS)</strong></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><p>Name</p></td>
<td><p>Title</p></td>
<td><p>Telephone Number</p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><p><strong>OTHER INFORMATION</strong></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><p>President’s Name</p></td>
<td><p>Year Firm</p>
<p>Founded</p></td>
<td><p>Number of Employees</p>
<p>Average Previous 12 Mo.:</p>
<p>Currently:</p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
</tbody>
</table>

**PROPRIETARY NOTICE: **See Section 5.5 for instructions concerning
proprietary information.

**Check here if proposal contains proprietary information.**

**NOTE: **The signed Certification Page must be included immediately
following this Cover Page with the original

copy of the proposal only.

**NSF FORM 12O7-PII (SBIR) (2/97) Proposal Page No. 1 **

Attachment F

**CERTIFICATION PAGE**

+-------------+-------------+-------------+-------------+---+---+
| Ce          |             |             |             |   |   |
| rtification |             |             |             |   |   |
| for         |             |             |             |   |   |
| Principal   |             |             |             |   |   |
| In          |             |             |             |   |   |
| vestigators |             |             |             |   |   |
|             |             |             |             |   |   |
| I certify   |             |             |             |   |   |
| to the best |             |             |             |   |   |
| of my       |             |             |             |   |   |
| knowledge   |             |             |             |   |   |
| that:       |             |             |             |   |   |
|             |             |             |             |   |   |
| \(1\) the   |             |             |             |   |   |
| statements  |             |             |             |   |   |
| herein      |             |             |             |   |   |
| (excluding  |             |             |             |   |   |
| scientific  |             |             |             |   |   |
| hypotheses  |             |             |             |   |   |
| and         |             |             |             |   |   |
| scientific  |             |             |             |   |   |
| opinions)   |             |             |             |   |   |
| are true    |             |             |             |   |   |
| and         |             |             |             |   |   |
| complete,   |             |             |             |   |   |
| and         |             |             |             |   |   |
|             |             |             |             |   |   |
| \(2\) the   |             |             |             |   |   |
| test and    |             |             |             |   |   |
| graphics    |             |             |             |   |   |
| herein are  |             |             |             |   |   |
| as well as  |             |             |             |   |   |
| any         |             |             |             |   |   |
| a           |             |             |             |   |   |
| ccompanying |             |             |             |   |   |
| p           |             |             |             |   |   |
| ublications |             |             |             |   |   |
| or other    |             |             |             |   |   |
| documents,  |             |             |             |   |   |
| unless      |             |             |             |   |   |
|             |             |             |             |   |   |
| otherwise   |             |             |             |   |   |
| indicated,  |             |             |             |   |   |
| are the     |             |             |             |   |   |
| original    |             |             |             |   |   |
| work of the |             |             |             |   |   |
| signatories |             |             |             |   |   |
| or          |             |             |             |   |   |
| individuals |             |             |             |   |   |
| working     |             |             |             |   |   |
| under their |             |             |             |   |   |
| s           |             |             |             |   |   |
| upervision. |             |             |             |   |   |
|             |             |             |             |   |   |
| I agree to  |             |             |             |   |   |
| accept      |             |             |             |   |   |
| res         |             |             |             |   |   |
| ponsibility |             |             |             |   |   |
| for the     |             |             |             |   |   |
| scientific  |             |             |             |   |   |
| conduct of  |             |             |             |   |   |
| the project |             |             |             |   |   |
| and to      |             |             |             |   |   |
| provide the |             |             |             |   |   |
| required    |             |             |             |   |   |
| progress.   |             |             |             |   |   |
|             |             |             |             |   |   |
| I           |             |             |             |   |   |
| understand  |             |             |             |   |   |
| that the    |             |             |             |   |   |
| willful     |             |             |             |   |   |
| provision   |             |             |             |   |   |
| of false    |             |             |             |   |   |
| information |             |             |             |   |   |
| of          |             |             |             |   |   |
| concealing  |             |             |             |   |   |
| a material  |             |             |             |   |   |
| fact in     |             |             |             |   |   |
| this        |             |             |             |   |   |
| proposal or |             |             |             |   |   |
| any other   |             |             |             |   |   |
| co          |             |             |             |   |   |
| mmunication |             |             |             |   |   |
| submitted   |             |             |             |   |   |
| to NSF is a |             |             |             |   |   |
| criminal    |             |             |             |   |   |
| offense     |             |             |             |   |   |
| (U.S. Code, |             |             |             |   |   |
| Title 18,   |             |             |             |   |   |
| Section     |             |             |             |   |   |
| 1001)       |             |             |             |   |   |
+-------------+-------------+-------------+-------------+---+---+
| **Name      | **          | **Date**    | **PI/PD**   |   |   |
| (Typed)**   | Signature** |             |             |   |   |
+-------------+-------------+-------------+-------------+---+---+
| **Ce        |             |             |             |   |   |
| rtification |             |             |             |   |   |
| for         |             |             |             |   |   |
| Authorized  |             |             |             |   |   |
| Org         |             |             |             |   |   |
| anizational |             |             |             |   |   |
| Rep         |             |             |             |   |   |
| resentative |             |             |             |   |   |
| or          |             |             |             |   |   |
| Individual  |             |             |             |   |   |
| Applicant** |             |             |             |   |   |
|             |             |             |             |   |   |
| By signing  |             |             |             |   |   |
| and         |             |             |             |   |   |
| submitting  |             |             |             |   |   |
| this        |             |             |             |   |   |
| proposal,   |             |             |             |   |   |
| the         |             |             |             |   |   |
| individual  |             |             |             |   |   |
| applicant   |             |             |             |   |   |
| or the      |             |             |             |   |   |
| authorized  |             |             |             |   |   |
| official of |             |             |             |   |   |
| the         |             |             |             |   |   |
| applicant   |             |             |             |   |   |
| institution |             |             |             |   |   |
| is: (1)     |             |             |             |   |   |
| certifying  |             |             |             |   |   |
| that        |             |             |             |   |   |
| statements  |             |             |             |   |   |
| made herein |             |             |             |   |   |
| are true    |             |             |             |   |   |
| and         |             |             |             |   |   |
| complete to |             |             |             |   |   |
| the best of |             |             |             |   |   |
| his/her     |             |             |             |   |   |
| knowledge;  |             |             |             |   |   |
| and (2)     |             |             |             |   |   |
| agreeing to |             |             |             |   |   |
| accept the  |             |             |             |   |   |
| obligation  |             |             |             |   |   |
| to comply   |             |             |             |   |   |
| with NSF    |             |             |             |   |   |
| award terms |             |             |             |   |   |
| and         |             |             |             |   |   |
| conditions  |             |             |             |   |   |
| if an award |             |             |             |   |   |
| is made as  |             |             |             |   |   |
| a result of |             |             |             |   |   |
| this        |             |             |             |   |   |
| a           |             |             |             |   |   |
| pplication. |             |             |             |   |   |
| Further,    |             |             |             |   |   |
| the         |             |             |             |   |   |
| applicant   |             |             |             |   |   |
| is hereby   |             |             |             |   |   |
| providing   |             |             |             |   |   |
| ce          |             |             |             |   |   |
| rtification |             |             |             |   |   |
| regarding   |             |             |             |   |   |
| Federal     |             |             |             |   |   |
| debt        |             |             |             |   |   |
| status,     |             |             |             |   |   |
| debarment   |             |             |             |   |   |
| and         |             |             |             |   |   |
| suspension, |             |             |             |   |   |
| drug free   |             |             |             |   |   |
| workplace,  |             |             |             |   |   |
| and         |             |             |             |   |   |
| lobbying    |             |             |             |   |   |
| activities  |             |             |             |   |   |
| (see        |             |             |             |   |   |
| below), as  |             |             |             |   |   |
| set forth   |             |             |             |   |   |
| in the      |             |             |             |   |   |
| *Grant      |             |             |             |   |   |
| Policy      |             |             |             |   |   |
| Manual,     |             |             |             |   |   |
| (GPG)*, NSF |             |             |             |   |   |
| 98-2.       |             |             |             |   |   |
| Willful     |             |             |             |   |   |
| provision   |             |             |             |   |   |
| of false    |             |             |             |   |   |
| information |             |             |             |   |   |
| in this     |             |             |             |   |   |
| application |             |             |             |   |   |
| and its     |             |             |             |   |   |
| supporting  |             |             |             |   |   |
| documents   |             |             |             |   |   |
| or in       |             |             |             |   |   |
| reports     |             |             |             |   |   |
| required    |             |             |             |   |   |
| under an    |             |             |             |   |   |
| ensuring    |             |             |             |   |   |
| award is a  |             |             |             |   |   |
| criminal    |             |             |             |   |   |
| offense     |             |             |             |   |   |
| (U.S. Code, |             |             |             |   |   |
| Title 18,   |             |             |             |   |   |
| Section     |             |             |             |   |   |
| 1001).      |             |             |             |   |   |
|             |             |             |             |   |   |
| In          |             |             |             |   |   |
| addition,   |             |             |             |   |   |
| if the      |             |             |             |   |   |
| applicant   |             |             |             |   |   |
| institution |             |             |             |   |   |
| employs     |             |             |             |   |   |
| more than   |             |             |             |   |   |
| fifty       |             |             |             |   |   |
| persons,    |             |             |             |   |   |
| the         |             |             |             |   |   |
| authorized  |             |             |             |   |   |
| official of |             |             |             |   |   |
| the         |             |             |             |   |   |
| applicant   |             |             |             |   |   |
| institution |             |             |             |   |   |
| is          |             |             |             |   |   |
| certifying  |             |             |             |   |   |
| that the    |             |             |             |   |   |
| institution |             |             |             |   |   |
| has         |             |             |             |   |   |
| implemented |             |             |             |   |   |
| a written   |             |             |             |   |   |
| and         |             |             |             |   |   |
| enforced    |             |             |             |   |   |
| conflict of |             |             |             |   |   |
| interest    |             |             |             |   |   |
| policy that |             |             |             |   |   |
| is          |             |             |             |   |   |
| consistent  |             |             |             |   |   |
| with the    |             |             |             |   |   |
| provisions  |             |             |             |   |   |
| of *Grant   |             |             |             |   |   |
| Policy      |             |             |             |   |   |
| Manual,*    |             |             |             |   |   |
| Section     |             |             |             |   |   |
| 510; that   |             |             |             |   |   |
| to the best |             |             |             |   |   |
| of his/her  |             |             |             |   |   |
| knowledge,  |             |             |             |   |   |
| all         |             |             |             |   |   |
| financial   |             |             |             |   |   |
| disclosures |             |             |             |   |   |
| required by |             |             |             |   |   |
| that        |             |             |             |   |   |
| conflict of |             |             |             |   |   |
| interest    |             |             |             |   |   |
| policy have |             |             |             |   |   |
| been made;  |             |             |             |   |   |
| and that    |             |             |             |   |   |
| all         |             |             |             |   |   |
| identified  |             |             |             |   |   |
| conflicts   |             |             |             |   |   |
| of interest |             |             |             |   |   |
| will have   |             |             |             |   |   |
| conflict of |             |             |             |   |   |
| interest    |             |             |             |   |   |
| policy.     |             |             |             |   |   |
| conflicts   |             |             |             |   |   |
| which       |             |             |             |   |   |
| cannot be   |             |             |             |   |   |
| sat         |             |             |             |   |   |
| isfactorily |             |             |             |   |   |
| managed,    |             |             |             |   |   |
| reduced or  |             |             |             |   |   |
| eliminated  |             |             |             |   |   |
| must be     |             |             |             |   |   |
| disclosed   |             |             |             |   |   |
| to NSF.     |             |             |             |   |   |
|             |             |             |             |   |   |
| **Debt and  |             |             |             |   |   |
| Debarment   |             |             |             |   |   |
| Cer         |             |             |             |   |   |
| tifications |             |             |             |   |   |
| **(If       |             |             |             |   |   |
| answer      |             |             |             |   |   |
| "yes" to    |             |             |             |   |   |
| either,     |             |             |             |   |   |
| please      |             |             |             |   |   |
| provide     |             |             |             |   |   |
| ex          |             |             |             |   |   |
| planation.) |             |             |             |   |   |
+-------------+-------------+-------------+-------------+---+---+
| I[s         | Yes No      |             |             |   |   |
| o           |             |             |             |   |   |
| rganization | Yes No      |             |             |   |   |
| delinquent  |             |             |             |   |   |
| on any      |             |             |             |   |   |
| Federal     |             |             |             |   |   |
| debt        |             |             |             |   |   |
| ?]{#Check2} |             |             |             |   |   |
|             |             |             |             |   |   |
| [Is the     |             |             |             |   |   |
| o           |             |             |             |   |   |
| rganization |             |             |             |   |   |
| or its      |             |             |             |   |   |
| principals  |             |             |             |   |   |
| presently   |             |             |             |   |   |
| debarred,   |             |             |             |   |   |
| suspended,  |             |             |             |   |   |
| proposed    |             |             |             |   |   |
| for         |             |             |             |   |   |
| debarment,  |             |             |             |   |   |
| declared    |             |             |             |   |   |
| ineligible, |             |             |             |   |   |
| or          |             |             |             |   |   |
| voluntarily |             |             |             |   |   |
| excluded    |             |             |             |   |   |
| from        |             |             |             |   |   |
| covered     |             |             |             |   |   |
| t           |             |             |             |   |   |
| ransactions |             |             |             |   |   |
| by a        |             |             |             |   |   |
| Federal     |             |             |             |   |   |
| Department  |             |             |             |   |   |
| or          |             |             |             |   |   |
| agency      |             |             |             |   |   |
| ?]{#Check2} |             |             |             |   |   |
+-------------+-------------+-------------+-------------+---+---+
| **Ce        |             |             |             |   |   |
| rtification |             |             |             |   |   |
| Regarding   |             |             |             |   |   |
| Lobbying**  |             |             |             |   |   |
|             |             |             |             |   |   |
| This        |             |             |             |   |   |
| ce          |             |             |             |   |   |
| rtification |             |             |             |   |   |
| is required |             |             |             |   |   |
| for an      |             |             |             |   |   |
| award of a  |             |             |             |   |   |
| Federal     |             |             |             |   |   |
| contract,   |             |             |             |   |   |
| grant or    |             |             |             |   |   |
| cooperative |             |             |             |   |   |
| agreement   |             |             |             |   |   |
| exceeding   |             |             |             |   |   |
| \$100,000   |             |             |             |   |   |
| and for an  |             |             |             |   |   |
| award of a  |             |             |             |   |   |
| Federal or  |             |             |             |   |   |
| a           |             |             |             |   |   |
| commitment  |             |             |             |   |   |
| providing   |             |             |             |   |   |
| for the     |             |             |             |   |   |
| United      |             |             |             |   |   |
| States to   |             |             |             |   |   |
| insure or   |             |             |             |   |   |
| guarantee a |             |             |             |   |   |
| loan        |             |             |             |   |   |
| exceeding   |             |             |             |   |   |
| \$150,000.  |             |             |             |   |   |
|             |             |             |             |   |   |
| **Ce        |             |             |             |   |   |
| rtification |             |             |             |   |   |
| for         |             |             |             |   |   |
| Contracts,  |             |             |             |   |   |
| Grants,     |             |             |             |   |   |
| Loans and   |             |             |             |   |   |
| Cooperative |             |             |             |   |   |
| A           |             |             |             |   |   |
| greements** |             |             |             |   |   |
|             |             |             |             |   |   |
| The         |             |             |             |   |   |
| undersigned |             |             |             |   |   |
| certifies,  |             |             |             |   |   |
| to the best |             |             |             |   |   |
| of his or   |             |             |             |   |   |
| her         |             |             |             |   |   |
| knowledge   |             |             |             |   |   |
| and belief, |             |             |             |   |   |
| that:       |             |             |             |   |   |
|             |             |             |             |   |   |
| \(1\) No    |             |             |             |   |   |
| Federal     |             |             |             |   |   |
| a           |             |             |             |   |   |
| ppropriated |             |             |             |   |   |
| funds have  |             |             |             |   |   |
| been paid   |             |             |             |   |   |
| or will be  |             |             |             |   |   |
| paid, by or |             |             |             |   |   |
| on behalf   |             |             |             |   |   |
| of the      |             |             |             |   |   |
| u           |             |             |             |   |   |
| ndersigned, |             |             |             |   |   |
| 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    |             |             |             |   |   |
| 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,  |             |             |             |   |   |
| co          |             |             |             |   |   |
| ntinuation, |             |             |             |   |   |
| renewal,    |             |             |             |   |   |
| amendment,  |             |             |             |   |   |
| or          |             |             |             |   |   |
| m           |             |             |             |   |   |
| odification |             |             |             |   |   |
| of any      |             |             |             |   |   |
| Federal     |             |             |             |   |   |
| Contract,   |             |             |             |   |   |
| grant,      |             |             |             |   |   |
| loan, or    |             |             |             |   |   |
| cooperative |             |             |             |   |   |
| agreement.  |             |             |             |   |   |
|             |             |             |             |   |   |
| \(2\) If    |             |             |             |   |   |
| any funds   |             |             |             |   |   |
| other than  |             |             |             |   |   |
| Federal     |             |             |             |   |   |
| a           |             |             |             |   |   |
| ppropriated |             |             |             |   |   |
| 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,   |             |             |             |   |   |
| and 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 |             |             |             |   |   |
| A           |             |             |             |   |   |
| ctivities," |             |             |             |   |   |
| in          |             |             |             |   |   |
| accordance  |             |             |             |   |   |
| with its    |             |             |             |   |   |
| in          |             |             |             |   |   |
| structions. |             |             |             |   |   |
|             |             |             |             |   |   |
| \(3\) The   |             |             |             |   |   |
| undersigned |             |             |             |   |   |
| shall       |             |             |             |   |   |
| require     |             |             |             |   |   |
| that the    |             |             |             |   |   |
| language of |             |             |             |   |   |
| this        |             |             |             |   |   |
| ce          |             |             |             |   |   |
| rtification |             |             |             |   |   |
| be included |             |             |             |   |   |
| in the      |             |             |             |   |   |
| award       |             |             |             |   |   |
| documents   |             |             |             |   |   |
| for all     |             |             |             |   |   |
| subawards   |             |             |             |   |   |
| at all      |             |             |             |   |   |
| tiers       |             |             |             |   |   |
| including   |             |             |             |   |   |
| su          |             |             |             |   |   |
| bcontracts, |             |             |             |   |   |
| subgrants,  |             |             |             |   |   |
| and         |             |             |             |   |   |
| contracts   |             |             |             |   |   |
| under       |             |             |             |   |   |
| grants,     |             |             |             |   |   |
| loans, and  |             |             |             |   |   |
| cooperative |             |             |             |   |   |
| agreements  |             |             |             |   |   |
| and that    |             |             |             |   |   |
| all         |             |             |             |   |   |
| su          |             |             |             |   |   |
| brecipients |             |             |             |   |   |
| shall       |             |             |             |   |   |
| certify and |             |             |             |   |   |
| disclose    |             |             |             |   |   |
| a           |             |             |             |   |   |
| ccordingly. |             |             |             |   |   |
|             |             |             |             |   |   |
| This        |             |             |             |   |   |
| ce          |             |             |             |   |   |
| rtification |             |             |             |   |   |
| is a        |             |             |             |   |   |
| material    |             |             |             |   |   |
| rep         |             |             |             |   |   |
| resentation |             |             |             |   |   |
| of fact     |             |             |             |   |   |
| upon which  |             |             |             |   |   |
| reliance    |             |             |             |   |   |
| was placed  |             |             |             |   |   |
| when this   |             |             |             |   |   |
| transaction |             |             |             |   |   |
| was made or |             |             |             |   |   |
| entered     |             |             |             |   |   |
| into.       |             |             |             |   |   |
| Submission  |             |             |             |   |   |
| of this     |             |             |             |   |   |
| ce          |             |             |             |   |   |
| rtification |             |             |             |   |   |
| is a        |             |             |             |   |   |
| p           |             |             |             |   |   |
| rerequisite |             |             |             |   |   |
| for making  |             |             |             |   |   |
| or entering |             |             |             |   |   |
| into this   |             |             |             |   |   |
| transaction |             |             |             |   |   |
| imposed by  |             |             |             |   |   |
| section     |             |             |             |   |   |
| 1352, title |             |             |             |   |   |
| 31, U.S.    |             |             |             |   |   |
| Code. Any   |             |             |             |   |   |
| person who  |             |             |             |   |   |
| fails to    |             |             |             |   |   |
| file the    |             |             |             |   |   |
| required    |             |             |             |   |   |
| ce          |             |             |             |   |   |
| rtification |             |             |             |   |   |
| shall be    |             |             |             |   |   |
| subject to  |             |             |             |   |   |
| a civil     |             |             |             |   |   |
| penalty of  |             |             |             |   |   |
| not less    |             |             |             |   |   |
| than        |             |             |             |   |   |
| \$10,000    |             |             |             |   |   |
| and not     |             |             |             |   |   |
| more than   |             |             |             |   |   |
| \$100,000   |             |             |             |   |   |
| for each    |             |             |             |   |   |
| such        |             |             |             |   |   |
| failure.    |             |             |             |   |   |
+-------------+-------------+-------------+-------------+---+---+
| *           | **          | **Date**    | *           |   |   |
| *Authorized | Signature** |             | *Name/Title |   |   |
| Company     |             |             | (Typed)**   |   |   |
| Officer**   |             |             |             |   |   |
+-------------+-------------+-------------+-------------+---+---+
| **Telephone | *           | **Fax       |             |   |   |
| Number**    | *Electronic | Number**    |             |   |   |
|             | Mail        |             |             |   |   |
| () -        | Address**   | () -        |             |   |   |
+-------------+-------------+-------------+-------------+---+---+