CERTIFICATION REGARDING LOBBYING 

FORM CD-511

(REV 1-05)

U.S. DEPARTMENT OF COMMERCE

Applicants should also review the instructions for certification included in the regulations before completing this form. Signature on this form provides for 

compliance with certification requirements under 15 CFR Part 28, 'New Restrictions on Lobbying.' The certifications shall be treated as a material representation 

of fact upon which reliance will be placed when the Department of Commerce determines to award the covered transaction, grant, or cooperative agreement.

LOBBYING

As required by Section 1352, Title 31 of the U.S. Code, and implemented 

at 15 CFR Part 28, for persons entering into a grant, cooperative 

agreement or contract over $100,000 or a loan or loan guarantee over 

$150,000 as defined at 15 CFR Part 28, Sections 28.105 and 28.110, the 

applicant certifies that 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 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 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 

occurring on or before October 23, 1996, and of not less than $11,000 and 

not more than $110,000 for each such failure occurring after October 23, 

1996.

Statement for Loan Guarantees and Loan Insurance

The undersigned states, to the best of his or her knowledge and belief, 

that: 

In 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 Form to Report 

Lobbying,' 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 

occurring on or before October 23, 1996, and of not less than $11,000 and 

not more than $110,000 for each such failure occurring after October 23, 

1996.

As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the above applicable certification.

* NAME OF APPLICANT

* AWARD NUMBER * PROJECT NAME

Prefix: * First Name: Middle Name:

* Last Name: Suffix:

* Title:

* SIGNATURE: * DATE:

Company Name

YEAR-NIST-SBIR-01 Proposal Title

FName

LName

CEO, President, Founder, Tc.

(NOFO Number)