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EXHIBIT B <br />CERTIFICATION REGARDING DEBARMENT, SUSPENSION AND OTHER <br />RESPONSIBILITY MATTERS <br />Applicants should refer to the regulations cited below to determine the certification to which they are required <br />to attest. Applicants should also review the instructions for certification included in the regulations before <br />completing this foim. Signature of this forin provides for compliance with certification requirements under <br />the applicable CFR covering New Restrictions on Government-wide Debarment and Suspension <br />(Nonprocurement). The certification shall be treated as a material representation of fact upon which reliance <br />will be placed when the Agency determines to award the covered transaction or cooperative agreement. <br />As required by Executive Order 12549, Debarinent and Suspension, and implemented under the applicable <br />CFR, for prospective participants in covered transactions, as defined in the applicable CFR <br />A. The applicant certifies that it and its principals: <br />(a) Are not presently debarred, suspended, proposed for debamient, declared ineligible, sentenced to <br />a denial of Federal benefits by a State or Federal court, or voluntarily excluded firom covered <br />transactions by any Federal department or agency; <br />(b) Have not within a three-year period preceding this application been convicted of or had a civil <br />judgment rendered against them for commission of '6audor a criminal offense in connection with <br />obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or <br />contract under a public transaction; violation of Federal or State antitrust statutes or cotnmission <br />of embezzlement, the:it, forgery, bribery, falsification or destniction of records, making false <br />statements, or receiving stolen property; ,. <br />(c) Are not presently indicted for or otherwise criminally or civilly.charged by a government entity <br />(Federal State or local) with commission of any of these offenses enumerated in paragraph (1) <br />(b) of this certification; and <br />(d) Have not within a ffiree-year period preceding this application had one or more public transactions <br />(Federal, State or local) teririinated for cause or default; and <br />B. Where the applicant is unable to certify to any of the statements in this certification, he or she shall <br />attach an explanation to this application. <br />Authorized Agent Signature <br />Printed or Typed Name <br />Title <br />address:S""'l m 9ovtg "km-tt-sm <br />(,)C) CiVtc cwThR PLh7'A <br />€urA A/\jA,(2A gllC))