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subcontract(s)] and that all subrecipients shall certify and disclose <br />accordingly. <br />DEBARMENT, SUSPENSION, AND OTHER RESPONSI]]ILITY MATTERS -- <br />applies to federally funded grants only <br /> <br />As required by Executive Order 12549, Debarment and Suspension, and <br />implemented at 28 CFR, Part 67, for prospective participants in primary covered <br />transactions, as defined at 28 CFR, Part 67, Section 67.510, the applicant certifies <br />that it and its principals: <br /> <br />Are not presently debarred, suspended, proposed for debarment, declared <br />ineli~ble, sentenced to a denial of federal benefits by a State or Federal <br />Court, or voluntarily excluded from covered transactions by any federal <br />department or agency. <br /> <br />Have not, within a three-year period preceding this application, been <br />convicted of or had a civil jud~,gment rendered against them for commission <br />of fraud or a criminal offense in connection with obtaining, attempting to <br />obtain, or performing a public (federal, state, or local) transaction or <br />contract under a public trans~ction; violation of federal or state antitrust <br />statutes or commission of embezzlement, theft, forgery, bribery, falsification <br />or destruction of records, making false statements, or receiving stolen <br />property. ~ <br /> <br />Are not presently indicted for, or otherwise criminally, or civilly, charged by <br />a governmental entity (federal, state, or local) ~vith commission of m~y of the <br />offenses enumerated above. <br /> <br />Have not, ~vithin a three-year period preceding this application, had one or <br />more public transactions (federal, state, or local) terminated for cause or <br />default. <br /> <br />Where the applicant is unable to certify to any of the statements in this <br />certification, he or she shall attach an explanation to this application. <br /> <br />O[fice of Criminal Justice Planning 19 <br /> <br /> <br />