Flowers Baking Company of Tyler - Region 10 Education Service ...

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Clean Air and Water Act. l, the Vendor, am in compliance with all applicable standards, orders or regulations issued6gpsusnlASEnvironmental Pioteotion Agency Regulatlon; 4O CFR" Parf'15- as required' under OMBCircular A-102,Attachment O, Paragraph 14 (1) regarding reporting violations to the grantor agency andto the United Statel Environment Protection Agency Assistant Administrator for theEnforcement.potential Vendor Name:Flowers Baking Co of Tyler, LLC.Title of Authorized Representatiu"' PresidentMailing OOOr"rr'1200 West En'vin' Tyler' TX 75702Complete and return with proposalFresh Bread RFP # 2012-09Page 20 of 30
Certification Regarding LobbyingSubmission ol this certification is a prerequisite for making or entering into this transaction and is imposed bysection 13S2, Title 31, U.S. Code. This certification is a material representation of fact upon which reliancewas placed when this transaction was made or entered into. Any person who fails to file the requiredcertification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for eachsuch failure.The undersigned certifies, 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 behaff of the undersigned, toany person for influencing or attempting to influence an officer or employee of any agency, a Member ofCongress, an officer or employee of congress, or an employee of a Member of Congress in connection withthe awarding ol a Federal contrao!.the making of a Federal grant, the making of a_Federal loan, the enteringinto a coop6rative agreement, and the elttenlion, continuation, renewal, amdnOment, or modification ol aFederal contract, grant, loan, or cooperative agreement'(2) lf any lunds other than Federal appropriated funds have been paid or will be paid to any person lorinfluencing or attempting to influence an officer or employee of any agency, a Member of Congress, anofficer or -employee ol congress, or an employee of a Member of Congress in connection with this Federalgrant or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "disclosureForm to Report Lobbying," in accordance with its instructions.(3) The undersigned shall require that the language ol this certification be included in the awarddocuments for all covered subawards exceeding $100,000 in Federal funds at all appropriate tiers and that allsubrecipients shall certfy and disclose accordingly.Flowers Baking Co of Tyler, LLC.Name/Add ress of Organ izationJohn Gilmer/PresidentMav 16,2012DateComplete and return with prooosalFresh Bread RFP # 2012-09Page 21 of30
Page 2 and 3: FELONY CONVICTION NOTIFICATIONState
Page 6 and 7: f n stru cti onEf o r Ce rtlf l c-a
Page 8 and 9: **Flowers Baking Co of Tyler, LLC.
Page 10 and 11: Reouest for BldATTACHMENT ATo:From:
Page 12 and 13: CONFLICT OF INTEREST QUESTIONNAIREF
Page 14: TO: Education Service Center Region

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