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<br /> <br /> Local Assistance Procedures Manual EXHIBIT 12-E <br /> PS&E Checklist Instructions Attachment E <br /> <br /> DEBARMENT AND SUSPENSION CERTIFICATION <br /> <br /> TITLE 49, CODE OF FEDERAL REGULATIONS, PART 29 <br /> <br /> <br /> The bidder, under penalty of perjury, certifies that, except as noted below, he/she or any other person associated <br /> <br /> therewith in the capacity of owner, partner, director, officer, and manager: <br /> <br /> • Is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by <br /> any federal agency; <br /> • Has not been suspended, debarred, voluntarily excluded or determined ineligible by any federal agency <br /> <br /> within the past 3 years; <br /> • Does not have a proposed debarment pending; and <br /> <br /> • Has not been indicted, convicted, or had a civil judgment rendered against it by a court of competent <br /> jurisdiction in any matter involving fraud or official misconduct within the past 3 years. <br /> <br /> <br /> If there are any exceptions to this certification, insert the exceptions in the following space. <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> Exceptions will not necessarily result in denial of award, but will be considered in determining bidder <br /> responsibility. For any exception noted above, indicate below to whom it applies, initiating agency, and dates of <br /> action. <br /> <br /> <br /> <br /> Notes: Providing false information 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 /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> Page 12-83 <br /> LPP 01-04 ~ March 15, 2001 <br />