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Certification Regarding <br />Debarment, Suspension, Ineligibility and Voluntary Exclusion <br />Lower Ter 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 />or 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 <br />civil judgment rendered against them for commission of fraud 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 a three -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 />O tLNV -C-F no AC5 %Aa ,� 1"Q?- t T`Y A <br />1 <br />1 <br />4� 011A ZA��L �0 <br />Grante /Contr or Organization <br />i <br />4 tT <br />Name and Title of Official Authorized to Certify <br />On Behalf of the Grantee <br />Date <br />1 <br />26 <br />