Fillable Form 1.: Long-Term Loan or Guarantee Application (Export-Import Bank of the United States)

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Form 1.: Long-Term Loan or Guarantee Application (Export-Import Bank of the United States)

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OMB No. 3048-0013
Expires 08/31/2022
Long-Term Loan or Guarantee Application
ATTACHMENT D: Anti-lobbying Declaration/Disclosure
The provisions of this Attachment D apply to the following, as applicable: direct loans, medium-
term insurance policies and final commitments for medium or long-term guarantees.
1.
Anti-Lobbying Law.
Under a U.S. law (31 U.S.C. 1352), recipients of U.S. government loans (which includes direct
loans from EXIM), grants, contracts, and cooperative agreements, are prohibited from
spending Federally appropriated funds to influence certain U.S. government employees,
including EXIM employees, in connection with the awarding of any such Federal award.
Recipients of U.S. government loans, grants, contracts and cooperative agreements may
spend non- Federally appropriated funds for such lobbying purposes; however, they are
required to declare and disclose such lobbying expenditures related to a specific
transaction.
The law also requires recipients of EXIM guarantees and insurance to declare and disclose
any lobbying activities in connection with the particular guarantee or insurance policy.
Declaration and Disclosure Forms are to be filed by applicants and recipients, including
certain exporters and suppliers, as defined below.
2.
Compliance Procedures. 2a. Who Must File.
All applicants for direct loans, medium-term insurance policies and final commitments for
medium or long-term guarantees must file the appropriate Declaration, in the form
annexed to this Attachment D, regardless of whether any funds have been spent for
lobbying purposes.
For applicants for direct loans, if any funds have been spent for lobbying purposes in
connection with this direct loan, a Disclosure Form must also be filed as directed in the
annexed Declaration. The Disclosure Form is OMB Standard Form LLL, “Disclosure Form
to Report Lobbying,” (http://exim.gov/sites/default/files/forms/lll.pdf).
For applicants for medium-term insurance policies and for final commitments for
medium-term and long-term guarantees, if any funds have been spent for lobbying
purposes in connection with the insurance policy or guarantee that is the subject of the
transaction, a Disclosure Form must also be filed as directed in the annexed Declaration.
The Disclosure Form is OMB Standard Form LLL, “Disclosure Form to Report Lobbying,”
(http://exim.gov/sites/default/files/form/lll.pdf).
The Declaration and/or Disclosure Forms must be received by EXIM from the applicant
before EXIM will consider the application for a final commitment.
All recipients under EXIM programs, who are not the applicant for a final commitment, must
file the appropriate Declaration and, if they have spent funds for lobbying purposes in
connection with the EXIM transaction, a Disclosure Form. Recipients include borrowers who
receive EXIM direct loans, exporters who receive EXIM insurance and lenders who receive
EXIM insurance or guarantees.
The Declaration and/or Disclosure Forms must be received by EXIM from the recipients
before EXIM will enter into a loan, or issue an insurance policy or guarantee.
All suppliers who have entered into a contract in excess of $100,000 with the recipient of an Ex-Im
Bank direct loan or grant must file a Declaration and, if funds have been spent for lobbying
purposes, a Disclosure Form.
EIB 95-10 |Attachment D (Rev. 3/2019) Page 1 of 4
OMB No. 3048-0013
Expires 08/31/2022
Such suppliers must file the Declaration and/or Disclosure Forms upon being awarded the
supply contract.
2b. Exemptions.
The law has been interpreted so that it does not apply to foreign governments, their
instrumentalities or their wholly-owned companies. Therefore, these entities are exempt
from filing both the Declaration and Disclosure Forms.
The law’s disclosure requirements do not apply to loan, insurance or guarantee transactions where the
U.S. Government-financed portion is $150,000 or less.
2c. How To File.
Complete the appropriate Declaration Form on the following page. If you are required to
file a Disclosure Form, it will be provided by EXIM upon request. Any person who fails to
file the required forms shall be subject to a civil penalty of not less than $10,000 and not
more than $100,000 for each such failure.
EIB 95-10 |Attachment D (Rev. 3/2019) Page 2 of 4
OMB No. 3048-0013
Expires 08/31/2022
Long-Term Loan or Guarantee Application
ATTACHMENT D: Anti-lobbying Declaration
3.
Certification for Contracts, Grants, Loans and Cooperative Agreements.
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 behalf of the
undersigned, to any person for influencing or attempting to influence an officer or
employee of an agency, a Member of
Congress, an officer or employee of Congress, or an employee of 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.
Applicant/Recipient Company
Signature
Name Title
EIB 95-10 |Attachment D (Rev. 3/2019) Page 3 of 4
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OMB No. 3048-0013
Expires 08/31/2022
Long-Term Loan or Guarantee Application
ATTACHMENT D: Anti-lobbying Declaration
4. Statement for Loan Guarantees and Loan Insurance.
The undersigned certifies, to the best of his or her knowledge and belief, that:
If 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 a
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.
Applicant/Recipient
Company
Signature
Name Title
EIB 95-10 |Attachment D (Rev. 3/2019) Page 4 of 4
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signature
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Form 1.: Long-Term Loan or Guarantee Application (Export-Import Bank of the United States)

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Completed 4 October 2021

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