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Certification Ige ardin <br /> Qebar ent Sus erasion Ineligibility an 1,VoluntarV Exclusion <br /> Lower Tier Covered Transactions <br /> This certification is required by the regulations Implementing Executive Order 12549,Debarment and <br /> Suspension,29 CFR Part 98,Section 98.510,Participants' Responsibilities. The regulations were <br /> published as Part VIE 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 belief, <br /> that it and Its principals: <br /> a. Are not presently debarred,suspended, proposed for debarment,declared ineligible,or <br /> Voluntarily excluded from covered transactions by any federal department or agency; <br /> b. Have not within a three-year period preceding this proposal been convicted or had a civil <br /> Judgment Tendered against them for commission of fraud or a criminal offense in connection <br /> with obtaining, attempting to obtain,or performing a public(federal,state or local)transaction <br /> or contract under a{public transaction;violation of federal or state antitrust statues or <br /> commission of embezzlement,theft,forgery, bribery,falsification or destruction of records, <br /> making false statements,or receiving stolen property. <br /> c. Are not presently indicted for or otherwise criminally or civilly charged by a government <br /> entity(federal,state or local) with commission of any of the offenses enumerated in paragraph <br /> (1)(b)of this certification;and <br /> d. Have not within a three-year period preceding this application/proposal had one or more <br /> 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 /> certlfi t' n, such prospective rticipantIsh- tth an explanation to this proposal. <br /> _ ✓i <br /> Gr me /Contractor Organization <br /> ANAh 6�i�R__ / LVAk <br /> Name and Title of Official Authorized to erti <br /> On Behalf of the Grantee <br /> �40_ <br /> Date <br /> EXHIBIT IF <br />