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<br />Certification Rel!:ardinl!: <br />Debarment, Suspension, Ineligibilitv and Voluntary Exclusion <br />Lower Tier Covered Transactions <br /> <br />This certification is required by the regulations implementing Executive Order 12549, <br />Debarment and Suspension, 29 CPR Part 98, Section 98.510, Participants' Responsibilities. <br />The regulations were published as Part VII ofthe May 16, 1988, Federal Register (Pages <br />19160-19211). <br />(Before completing certification, read instructions which are an integral part of certification) <br /> <br />I. The prospective primary participant, (i.e. grantee) certifies to the best of its knowledge <br />and belief, that it and its principals: <br /> <br />a. Are not presently debarred, suspended, proposed for debarment declared <br />ineligible, or voluntarily excluded from covered transactions by any federal <br />department or agency; <br /> <br />b. Have not within a three-year period preceding this proposal been convicted or <br />had a civil judgment rendered against them for commission of fraud or a criminal <br />offense in connection with obtaining, attempting to obtain, or performing a public <br />(federal, state or local) transaction or contract under a public transaction; violation <br />of federal or state antitrust statues or commission of embezzlement, theft, forgery, <br />bribery, falsification or destruction ofrecords, making false statements, or receiving <br />stolen property. . <br /> <br />c. Are not presently indicted for or otherwise criminally or civilly charged by a <br />government entity (federal, state or local) with commission of any of the offenses <br />enumerated in paragraph (I )(b) of this certification; and <br /> <br />d. Have not within a three-year period preceding this application/proposal had one <br />or more public transactions (federal, state or local) terminated for cause or default <br /> <br />2. Where the prospective primary participant is unable to certify to any ofthe statements in <br />this certification, such prospective participant shall attach an explanation to this proposal. <br /> <br />Ov-&~ <br /> <br /> <br />Grantee/Contractor Orgarnzation <br /> <br />1/12-. ",,"r-JC-> :T1l/1E-f'it:.. L - 1-\/:>.1.11 E x.r:t ~, v.;:- D. u C 'c "- <br />Name and Title of Official Authorized to Certify <br />On Behalf of the Grantee <br /> <br />~ <br />Date <br />