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Certification Re~ardin~ - <br />Debarment Suspension InelieibilitY and Vo{untary- Exclusion - - - <br />-LowerTier Covered Transactions <br />This certification is required by the regulations implementing Executive Order 12549, Debarment <br />and Suspension, 29 CFR Part 98, Section 98.510, Participants' Responsibilities.-The regulations <br />were published as Part VII of the May 16, 1988, Federal Register {Pages 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 and <br />belief, that it and its principals: <br />a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, <br />orvoluntarily excluded from covered transactions by any federal department or agency; <br />- <br />b. Have not within athree-year period preceding this proposal been convicted or had a <br />civil judgment rendered against them for commission offraud or a criminal offense in <br />connection with obtaining, attempting to obtain, or performing a public {federal, state or <br />local) transaction or contract under a public transaction; violation of federal or state <br />antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or <br />destruction of records, making false statements, or receiving 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 athree-year period preceding this application/proposal had one or <br />more public transactions (federal, state or local) terminated for cause or default. <br />2. Where the prospective primary participant is unable to certify to any of the statements in this <br />certification, such prospective participant shall attach an explanation to this proposal. <br />~~ <br />~.~ ~-~+~. ~ ~/tee <br />Grantee/Contractor Organization <br />e- <br />!• <br />Name and Title of Official Authorized to C i / <br />On I3ehalf of the Grantee <br />~ d p <br />Date <br />