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~IT~ flF SAN~'A A~;~~ <br /> • PP.OPOSAL AND CONTRACT AGREEIVIENT <br /> V~TEST PUMP STATION FACILITIES UPGRADES; PROTECT NO- OS-3195 <br /> TITLE 49, CODE OF FEDERAL, REGULATIONS, PART 29 <br /> DEBARIVIENT ASTD SUSPENSION CERTIFICATION <br /> The bidder under penalty of perjury, certifies that except as noted below, he/she or any person <br /> associated therewith in the capacity of owner, partner, director, officer, manager: <br /> Is not currently under suspension, debarment, voluntary exclusion, or determination of <br /> ineligibility by any federal agency; <br /> Has not suspended, debarred, voluntarily excluded, or determined ineligible by any federal <br /> agency within past three years; <br /> Has not been indicted, convicted, or had a civil judgment rendered against it by a court of <br /> competent jurisdiction in any matter involving fraud or official misconduct within the past 3 <br /> years. <br /> If there are any exceptions to this certification, insert the exceptions in the following space. <br /> Exceptions will not necessarily result in denial of award, but will be considered in determining bidders <br /> responsibility. For any exception noted above, uZdicate below to whom it applies, initialing agency, <br /> and dates of action. <br /> I~To#e. Providing false infoaznation may result in criminal prosecution or administrative sanctions. <br /> The above certification is part of the Proposal. Signing this Proposal on the signature portion thereof <br /> shall also constitute signature of this Certification. <br /> Name of Bidder: F.T. ZIEBARTH COMPANY <br /> <br /> I Signature of Bidder: <br /> ZIEBARTH, PRESIDENT <br /> • Date: 04/22/2010 <br /> FED.8-22-8 <br /> TO BE INCLUDED IN BID PACK_ACE <br /> BP ~ 6 of 26 <br /> <br />