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Certification Regarding <br />_Debarment, Suspension lneligibilit3T and �7oluntary Exclusion <br />Lower 'Pier Covered Transactions <br />This certification is required by the regulations implementing Executive Order 12549, <br />Debannent and Suspension, 29 CFR Part 98, Section 95.510, Participants' Responsibilities. <br />The regulations were published as Part V11 of the May 16. 1988, Federal Register (Pages <br />19160-19211). <br />(Before completing certification, read instructions which are an integral part of certification) <br />1. The prospective primary participant. (i.e. grantee) certifies to the best of its knowledge <br />and belief, that it and its principals: <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 />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 of records.. making false statements. or receiving <br />stolen property. <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 (1)(b) of this certification: and <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 />?. Where the prospective primary participant is unable to certi�° to any of the statements in <br />this certification.. such prospective participant shall attach an explanation to this proposal. <br />yi i7a �2 IL 0/�'f� }SiC1f� <br />Grante Contractor Organization <br />Name and Title of Official Authorized to CertI6 <br />On Behalf of the Grantee <br />r <br />L-' <br />Date <br />32 <br />