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Local Assistance Procedures Manual <br />PS&E Checklist Instructions <br />DEBARMENT AND SUSPENSION CERTIFICATION <br />TITLE 49, CODE OF FEDERAL REGULATIONS, PART 29 <br />EXHIBIT 12-E <br />Attachment E <br />The bidder, under penalty of perjury, certifies that, except as noted below, he/she or any other person associated <br />therewith in the capacity of owner, partner, director, officer, and manager: <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 />within the past 3 years; <br />• Does not have a proposed debarment pending; and <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 />If there are any exceptions to this certification, insert the exceptions in the following space. <br />N/A <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 />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 />40a <br />Pat Somerville, PE, Vice President <br />Page 12-83, <br />LPP 01-04 March 15, 2001 <br />