Annual Certification and Disclosure Regarding Payments to Influence Certain Federal Transactions | ITC-0110

ITC-0110 2021-05-12.008

Seiler Instrument & Manufacturing Company, Inc. (“SEILER”) is required, as a prime and subcontractor for the United States Government, to certify compliance with the Federal Acquisition Regulations (FARs), Executive Orders, and other laws and regulations. Further, these certification requirements apply to SEILER subcontractors providing materials or services related to a United States Government contract.

Accordingly, we request that you complete and submit the following certification.

This certification shall be part of all purchase orders placed with your company by SEILER INSTRUMENT COMPANY to the extent required by the applicable FAR, Executive Order, Rule, or Regulation.


The undersigned certifies, to the best of his or her knowledge and belief, that no 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 on his or her behalf in connection with the awarding of any Federal contract.

If any registrants under the Lobbying Disclosure Act of 1995 have made a lobbying contact on behalf of the undersigned with respect to this contract, the Supplier shall complete and submit OMB Standard Form LLL, Disclosure of Lobbying Activities to the authorized Seiler Instrument Company Purchasing representative to provide the name of the registrants. The Supplier need not report regularly employed officers or employees of the Supplier to whom payments of reasonable compensation were made.

The Supplier will include the language of this certification in all subcontract awards at any tier and require that all recipients of subcontract awards in excess of $150,000 shall certify and disclose accordingly.

Submission of this certification and disclosure is a prerequisite for making or entering into any contract imposed by section 1352, title 31, United States Code. Any person who makes expenditure prohibited under this provision or who fails to file or amend the disclosure form to be filed or amended by this provision shall be subject to a civil penalty of not less than $10,000.

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