Sample Contract for a Loan to a Family Member

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Sample Contract for a Loan to a Family Member Powered By Docstoc
					FORM INFORMATION
Form Name / Title         Certification Regarding Lobbying
Form Number               CD-511
Version Number
Version Date              8-Aug-06
Description               Legal statements to which the applicant representative certifies the organization will comply.
OMB Control Number
OMB Expiration Date
Form Family              SF424
                           X
(select all that apply)  SF424 R&R
                           X
                         SF424 Individual
                         SF424 Mandatory
                       X SF424 Short Organizational
Form Category            Cover Sheet
                       X Certification and Assurance
                         Survey
                         Budget Form
                         Key Contacts and Personal Data
                         Attachments
                         Miscellaneous
ADDITIONAL FORM REQUIREMENTS (not indicated on the FORM DAT)
FORM TITLE:                                         Certification Regarding Lobbying
    [1]                       [2]                             [3]             [4]            [5]            [6]                [7]              [8]                  [9]                          [10]                 [11]              [12]            [13]           [14]           [15]             [16]            [17]

                                                                                                                                                                                                                                                                  Min # of Chars     Max # of
                             Field                        Short Field                      Minimum       Maximum           Agency Field                         Global Library                 Field Type                                               List of         or           Chars or         Field
  Field #                    Label                          Label         Required?     Occurrences    Occurrences            Name           Field Type          Field Name                      Source           Business Rules      Data Type         Values       Min Value      Max Value    Implementation       Help Tip
00-00          FORM                                 n/a                 n/a            n/a            n/a            n/a                  n/a             n/a                    n/a                        n/a                    n/a            n/a             n/a            n/a            Label           n/a
00-01          CD-511                               n/a                 n/a            n/a            n/a            n/a                  n/a             n/a                    n/a                        n/a                    n/a            n/a             n/a            n/a            Label           n/a
00-02          U.S. DEPARTMENT OF                   n/a                 n/a            n/a            n/a            n/a                  n/a             n/a                    n/a                        n/a                    n/a            n/a             n/a            n/a            Label           n/a
               COMMERCE
00-03          CERTIFICATION                        n/a                 n/a            n/a            n/a            n/a                  n/a             n/a                    n/a                        n/a                    n/a            n/a             n/a            n/a            Label           n/a
               REGARDING LOBBYING
00-04          (REV 1-05)                           n/a                 n/a            n/a            n/a            n/a                  n/a             n/a                    n/a                        n/a                    n/a            n/a             n/a            n/a            Label           n/a
00-05          Applicants should also review        n/a                 n/a            n/a            n/a            n/a                  n/a             n/a                    n/a                        n/a                    n/a            n/a             n/a            n/a            Label           n/a
               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.




01-00          LOBBYING                          n/a                    n/a            n/a            n/a            n/a                  n/a             n/a                    n/a                        n/a                    n/a            n/a             n/a            n/a            Label           n/a
01-01          Statement for Loan                n/a                    n/a            n/a            n/a            n/a                  n/a             n/a                    n/a                        n/a                    n/a            n/a             n/a            n/a            Label           n/a
               Guarantees and Loan
               Insurance
01-02          As required by Section 1352, n/a                         n/a            n/a            n/a            n/a                  n/a             n/a                    n/a+J15+J19                n/a                    n/a            n/a             n/a            n/a            Label           n/a
               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:



01-03          The undersigned states, to the n/a                       n/a            n/a            n/a            n/a                  n/a             n/a                    n/a                        n/a                    n/a            n/a             n/a            n/a            Label           n/a
               best of his or her knowledge
               and belief, that:
01-04          (1) No Federal appropriated     n/a                      n/a            n/a            n/a            n/a                  n/a             n/a                    n/a                        n/a                    n/a            n/a             n/a            n/a            Label           n/a
               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.




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FORM TITLE:                                     Certification Regarding Lobbying
    [1]                      [2]                        [3]                 [4]          [5]            [6]                [7]              [8]                  [9]                  [10]                 [11]              [12]            [13]           [14]           [15]             [16]            [17]

                                                                                                                                                                                                                                                      Min # of Chars     Max # of
                              Field               Short Field                          Minimum       Maximum           Agency Field                         Global Library         Field Type                                               List of         or           Chars or         Field
  Field #                    Label                  Label            Required?      Occurrences    Occurrences            Name           Field Type          Field Name              Source           Business Rules      Data Type         Values       Min Value      Max Value    Implementation       Help Tip
01-05          In any funds have been paid or n/a                  n/a             n/a            n/a            n/a                  n/a             n/a                    n/a                n/a                    n/a            n/a             n/a            n/a            Label           n/a
               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.


01-06          Submission of this statement is n/a                 n/a             n/a            n/a            n/a                  n/a             n/a                    n/a                n/a                    n/a            n/a             n/a            n/a            Label           n/a
               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.



01-07          (2) If any funds other than      n/a                n/a             n/a            n/a            n/a                  n/a             n/a                    n/a                n/a                    n/a            n/a             n/a            n/a            Label           n/a
               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.



01-08          (3) The undersigned shall         n/a               n/a             n/a            n/a            n/a                  n/a             n/a                    n/a                n/a                    n/a            n/a             n/a            n/a            Label           n/a
               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.




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FORM TITLE:                                    Certification Regarding Lobbying
    [1]                       [2]                       [3]                 [4]         [5]            [6]                   [7]                [8]                         [9]                             [10]                                      [11]                    [12]                [13]                    [14]           [15]             [16]                         [17]

                                                                                                                                                                                                                                                                                                                    Min # of Chars     Max # of
                              Field                  Short Field                      Minimum       Maximum             Agency Field                                 Global Library                      Field Type                                                                              List of                  or           Chars or         Field
  Field #                     Label                    Label         Required?     Occurrences    Occurrences              Name           Field Type                  Field Name                           Source                              Business Rules             Data Type              Values                Min Value      Max Value    Implementation                   Help Tip
01-09          This certification is a material  n/a               n/a            n/a            n/a            n/a                    n/a             n/a                                n/a                                          n/a                             n/a            n/a                           n/a            n/a            Label           n/a
               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.




01-10          As the duly authorized          n/a                 n/a            n/a            n/a            n/a                    n/a             n/a                                n/a                                          n/a                             n/a            n/a                           n/a            n/a            Label           n/a
               representative of the
               applicant, I hereby certify
               that the applicant will
               comply with the above
               applicable certification.
02-01          NAME OF APPLICANT               Organization Name   Yes            1              1              OrganizationName       Forward-        globLib:OrganizationNameDataType   SF424V2-Block8-LEGAL_NAME or                 User is unable to edit field.   AN             n/a                           1              60             Field           Enter legal name of applicant, which will
                                                                                                                                       populated                                          SF424RR-block5-Legal Name or                                                                                                                                            undertake the assistance activity.
                                                                                                                                                                                          SF424Short-block5-Legal Name
02-02          AWARD NUMBER                    Award Number        No             0              1              AwardNumber            Agency-specific n/a                                n/a                                          Required if PROJECT NAME is AN                 n/a                           0              25             Field           Enter the project award number.
                                                                                                                                                                                                                                       blank.
02-03          PROJECT NAME                    Project Name        No             0              1              ProjectName            Global          globLib:ProjectNameDataType        n/a                                          Required if AWARD NUMBER AN                    n/a                           0              60             Field           Enter the name of the project.
                                                                                                                                                                                                                                       is blank.
02-04          Prefix:                         Prefix              No             0              1              PrefixName             Forward-        globLib:PrefixName                 SF424V2-block21-prefix or SF424RR-           User is unable to edit field. LIST             Mr.&&Mrs.&&Miss&&Ms.&&Dr.&&   0              10             Combobox        Select the Prefix from the provided list or
                                                                                                                                       populated                                          block19-prefix or SF424Short-block9-                                                        Rev.&&Prof.                                                                 enter a new Prefix not provided on the list.
                                                                                                                                                                                          prefix or SF424INDV-block5-prefix
02-05          First Name:                     First Name          Yes            1              1              FirstName              Forward-        globLib:FirstName                  SF424V2-block21-first name or SF424RR-       User is unable to edit field.   AN             n/a                           1              35             Field           Enter the First Name. This field is required.
                                                                                                                                       populated                                          block19-first name or SF424Short-block9-
                                                                                                                                                                                          first name or SF 424INDV-block5-first
                                                                                                                                                                                          name
02-06          Middle Name:                    Middle Name         No             0              1              MiddleName             Forward-        globLib:MiddleName                 SF424V2-block21-middle name or               User is unable to edit field.   AN             n/a                           0              25             Field           Enter the Middle Name.
                                                                                                                                       populated                                          SF424RR-block19-middle name or
                                                                                                                                                                                          SF424Short-block9-middle name or SF
                                                                                                                                                                                          424INDV-block5-middle name
02-07          Last Name:                      Last Name           Yes            1              1              LastName               Forward-        globLib:LastName                   SF424V2-block21-last name or SF424RR-        User is unable to edit field.   AN             n/a                           1              60             Field           Enter the Last Name. This field is required.
                                                                                                                                       populated                                          block19-last name or SF424Short-block9-
                                                                                                                                                                                          last name or SF 424INDV-block5-last
                                                                                                                                                                                          name
02-08          Suffix:                         Suffix              No             0              1              SuffixName             Forward-        globLib:SuffixName                 SF424V2-block21-suffix or SF424RR-           User is unable to edit field.   LIST           Jr.&&Sr.&&M.D.&&Ph.D          0              10             Combobox        Select the Suffix from the provided list or
                                                                                                                                       populated                                          block19-suffix or SF424Short-block9-suffix                                                                                                                              enter a new Suffix not provided on the list.
                                                                                                                                                                                          or SF 424INDV-block5-suffix
02-09          Title:                          Title               Yes            1              1              Title                  Forward-        globLib:HumanTitleDataType         SF424V2-block21-title or SF424RR-            User is unable to edit field.   AN             n/a                           1              45             Field           Enter in the Position Title.
                                                                                                                                       populated                                          block19-position/title or SF424Short-
                                                                                                                                                                                          block9-title
02-10          SIGNATURE:                      n/a                 Yes            1              1              Signature              Post-Populated globLib:SignatureDataType           n/a                                          n/a                             AN             n/a                           1              144            Label           It is the organization's responsibility to
                                                                                                                                                                                                                                                                                                                                                                  assure that only properly authorized
                                                                                                                                                                                                                                                                                                                                                                  individuals sign in this capacity and/or
                                                                                                                                                                                                                                                                                                                                                                  submit the application to Grants.gov. If this
                                                                                                                                                                                                                                                                                                                                                                  application is submitted through
                                                                                                                                                                                                                                                                                                                                                                  Grants.gov leave blank. If a hard copy is
                                                                                                                                                                                                                                                                                                                                                                  submitted, the AOR must sign this block.



02-11          DATE:                           n/a                 Yes            1              1              SubmittedDate          Post-Populated globLib:DateSignedDataType          n/a                                          n/a                             DATE           n/a                           n/a            n/a            Label           If this application is submitted
                                                                                                                                                                                                                                                                                                                                                                  through Grants.gov, the system will
                                                                                                                                                                                                                                                                                                                                                                  generate this date. If submitting a
                                                                                                                                                                                                                                                                                                                                                                  hard copy, enter the date the AOR
                                                                                                                                                                                                                                                                                                                                                                  signed the application.




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DOCUMENT INFO
Description: Sample Contract for a Loan to a Family Member document sample