Who may sign on behalf of the organization

An authorized officer or a person with written delegated authority should sign. Maintain a corporate resolution or delegation document that evidences signatory authority in case the agency requests verification.

Is an electronic signature acceptable

Yes, electronic signatures are generally valid under the ESIGN Act (15 U.S.C. §7001) and UETA where adopted. Confirm agency policy for any required additional authentication or notarization.

When is notarization required

Notarization depends on state or agency rules. Some states or specific solicitations require notarized attestations; check the solicitation or agency instructions before submitting.

How to correct an error after signing

Do not alter the signed copy. Prepare an amended certification signed by an authorized representative and submit with an explanatory statement referencing the original submission.

How long must we keep signed copies

Retain copies per applicable federal or state retention requirements; IRS records typically require a minimum of three years (IRC §6501(a)), and HIPAA has a six year rule where PHI applies.

What if disclosure changes after submission

Submit an updated certification or supplemental disclosure as required by the agency solicitation or contract terms. Document and date the update to preserve an audit trail.

Electronic Signature
Templates
Miscellaneous
Government Lobbying Certification Form

Government Lobbying Certification Form

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

GOVERNMENT LOBBYING CERTIFICATION FORM

WHEREAS

WHEREAS, Certifying Entity: has submitted an application or proposal in connection with Contract/Grant/Agreement Number:

WHEREAS, the Certifying Entity acknowledges that certain laws and regulations govern lobbying, the use of public funds and disclosures related to efforts to influence governmental decision-making for the period: From To ; and

WHEREAS, the Certifying Entity must certify the veracity of representations about lobbying activities, lobbying expenditures, and related disclosures in connection with the referenced procurement, agreement or grant.

IDENTIFICATION

Certifying Entity Legal Name Principal Office Address

Contact Person

Telephone

Email

CERTIFICATION OF LOBBYING ACTIVITIES

Has the Certifying Entity engaged persons or made expenditures for the purpose of influencing legislative or executive action, administrative rulemaking, political decision-making or procurement outcomes during the certification period?

No — The Certifying Entity affirms that no lobbying activities or expenditures were undertaken in connection with the referenced matter. Yes — The Certifying Entity discloses the lobbying activities and expenditures below and attaches supporting documentation as required. If Yes, describe lobbying activities and identify persons or firms retained to lobby

Total Lobbying Expenditures

Dates of Activity (From)

Dates of Activity (To)

DISCLOSURE OF THIRD-PARTY PAYMENTS

Did the Certifying Entity use third-party contractors, consultants or subrecipients to perform lobbying on its behalf?

No Yes — List each third party, the nature of work performed, and amounts paid Third-Party Details

SCOPE OF SERVICES SUBJECT TO CERTIFICATION

Scope of Work

LEGAL ACKNOWLEDGEMENTS AND CERTIFICATIONS

The Certifying Entity certifies, under penalty of law, that the representations set forth herein are true, complete and accurate to the best of its knowledge. The Certifying Entity further certifies that:

It has complied with all applicable registration and reporting requirements applicable to lobbyists and lobbying firms for the jurisdiction(s) identified above.
No federal, state or local public funds have been used in violation of law for purposes of political contributions or prohibited lobbying activities in connection with the referenced matter.
It will promptly update this certification if any material facts change during the term of the contract or grant, and will cooperate with any audit or inquiry concerning lobbying expenditures or disclosures.

Consequences of False Statement: Any false statement, omission, or misrepresentation in this certification may constitute fraud and result in civil or criminal penalties, termination of the contract or grant, and recovery of funds expended as a result of such misrepresentation.

TERM, TERMINATION AND REMEDIES

This certification remains effective for the duration of the referenced agreement. The awarding government entity may terminate the agreement and seek all available remedies if the Certifying Entity is found to have materially misrepresented lobbying activities or failed to disclose required information.

Agreement Start Date

Agreement End Date

Notice Period for Termination (days)

CONFIDENTIALITY AND PUBLIC RECORDS

The Certifying Entity acknowledges that information submitted in connection with this certification may be subject to public records laws. The Certifying Entity must clearly identify any information claimed to be confidential and provide a statutory basis for such confidentiality. The government entity may disclose records as required by law.

GOVERNING LAW; ENTIRE AGREEMENT

This certification shall be governed by the laws of the state of: . This document, together with any attachments and disclosures submitted contemporaneously, constitutes the entire certification regarding lobbying activities for the referenced matter and supersedes all prior written or oral statements on that subject.

ATTESTATION

I hereby attest, under penalty of perjury, that I am duly authorized to execute this certification on behalf of the Certifying Entity, that the information contained herein is true and correct, and that I understand the legal consequences of knowingly providing false information.

Printed Name:

Title:

Signature:

Date Signed:

Business/Employer:

What the Government Lobbying Certification Form Is

The Government Lobbying Certification Form is a signed declaration used by contractors, grant recipients, and vendors to confirm compliance with federal and state lobbying restrictions when bidding for government contracts or receiving public funds. It documents whether the signer used federal or state funds to influence legislative or executive actions, identifies any paid lobbyists, and discloses related expenditures. Agencies commonly require this certification as part of procurement, grant application, or contract execution processes to ensure transparency and to enforce anti‑lobbying statutes and administrative rules.

Why this certification matters for government contracts

Completing the Government Lobbying Certification Form safeguards eligibility for awards, demonstrates regulatory compliance, and creates an auditable record for contracting officers. Accurate certification reduces risk of bid rejection, post‑award withholding, or penalties tied to false statements. The form supports agency oversight and helps recipients avoid conflicts with statutes that bar certain lobbying activities when federal or state funds are involved.

Who typically completes the Government Lobbying Certification Form

Agencies, proposers, grantees, and subcontractors each rely on this certification at different stages of solicitation and contract administration.

Prime contractors submitting bids or contract proposals under federal or state procurement rules.
Nonprofit grantees and recipients of federal assistance during grant application or award acceptance.
Subcontractors and consultants whose activities could affect prime contractor compliance.

Ensure the form is completed by an authorized representative who understands organizational lobbying activities and can attest to accuracy.

Stepwise completion checklist

Follow these core steps to prepare and submit a correct Government Lobbying Certification Form.

01

Gather documents: Collect award details and lobbying expense records.
02

Confirm authority: Ensure signer has delegated signature authority.
03

Complete fields: Enter identifiers, dates, and disclosure amounts.
04

Submit and retain: Send to the agency and save a signed copy.

Typical filing flow for agencies and vendors

The certification travels through defined points in procurement or grant workflows; each step creates an auditable event.

Preparation: Requester prepares form with contract details.
Signature: Authorized signer executes the certification.
Submission: Form submitted to contracting officer or grants portal.
Recordkeeping: Agency and recipient retain the signed form.

Configuring an online workflow for this form

Design an electronic workflow that enforces signer order, captures attestations, and stores the signed record securely.

Field	Configuration
Authentication	Email plus SMS code for signer verification
Routing	Sequential routing: preparer → approver → signer
Retention	Set secure retention and export settings
Notifications	Automate reminders and completion notices

Technical considerations for electronic submission

Use a platform that captures audit trails, supports required authentication, and retains records in tamper-evident form.

Audit Trail: Timestamp, IP, and action log
Authentication: Email, SMS, or knowledge‑based verification
File Formats: PDF/A recommended for long term

Ensure the chosen system can export signed PDFs and meet agency retention or production requests without altering the signed record.

Common timing and processing expectations

Agencies set specific submission checkpoints tied to solicitations, award execution, or invoice milestones; missing deadlines can affect eligibility.

Pre‑award submission:

Often required with initial proposal or bid submission

Post‑award execution:

May be required before contract kickoff or funds disbursement

Periodic updates:

Some awards require periodic recertification or updated disclosures

Agency requests:

Respond to agency audits within specified days

Record production:

Provide copies within agency timeline for review

Common preparation pitfalls to avoid

Entering trade names instead of the legal entity name, which can fail crosschecks and delay processing.
Failing to report small consultant payments because of unclear internal accounting, causing later audit findings.
Allowing an unauthorized individual to sign without documented delegation, risking invalidation of the certification.
Using inconsistent dates or mismatched contract numbers between the certification and related procurement documents.

Consequences of incorrect or missing certification

Bid rejection: Possible disqualification

Withholding: Funds may be suspended

Contract termination: Breach can trigger termination

Civil penalties: Fines or administrative sanctions

Criminal risk: False statements may have criminal exposure

Audit findings: Increased oversight and corrective action

What a complete Government Lobbying Certification Form should include

A professional form combines identity, contract details, disclosure fields, an attestation statement, signature block, and retention instructions to meet agency expectations.

Entity ID

Unique identifiers such as UEI or DUNS plus tax identification to ensure accurate vendor matching and eligibility verification.

Contract Details

Precise contract or grant number, agency name, and award amount to tie the certification to the correct procurement record.

Lobbying Disclosure

Fields to list paid lobbyists, specific activities, and amounts expended to influence government decision makers.

Attestation Text

A clear, signed statement declaring the truthfulness of disclosures and compliance with applicable anti‑lobbying provisions.

Signature Block

Authorized representative name, title, signature, and date, including a statement of authority to bind the organization.

Retention Note

Recordkeeping instructions specifying how long and where the signed form will be stored for audit and production.

eSignature vendor comparison for submitting and storing the form

Common platform capabilities relevant to the Government Lobbying Certification Form include price, trial availability, bulk send, audit trail, HIPAA compliance, and envelope limits.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Trial or limited	Trial or limited	Trial available	Trial available
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Frequently asked questions about completing the form

Answers address common points of confusion about authority, formats, e‑signatures, notarization, updates, and record retention.

Need help? Contact support

Who may sign on behalf of the organization
An authorized officer or a person with written delegated authority should sign. Maintain a corporate resolution or delegation document that evidences signatory authority in case the agency requests verification.
Is an electronic signature acceptable
Yes, electronic signatures are generally valid under the ESIGN Act (15 U.S.C. §7001) and UETA where adopted. Confirm agency policy for any required additional authentication or notarization.
When is notarization required
Notarization depends on state or agency rules. Some states or specific solicitations require notarized attestations; check the solicitation or agency instructions before submitting.
How to correct an error after signing
Do not alter the signed copy. Prepare an amended certification signed by an authorized representative and submit with an explanatory statement referencing the original submission.
How long must we keep signed copies
Retain copies per applicable federal or state retention requirements; IRS records typically require a minimum of three years (IRC §6501(a)), and HIPAA has a six year rule where PHI applies.
What if disclosure changes after submission
Submit an updated certification or supplemental disclosure as required by the agency solicitation or contract terms. Document and date the update to preserve an audit trail.

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