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Certification ReaardinR <br />Debarment, Suspension, Ineligibility and Voluntary 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 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 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 organization; <br />b. Have not within a three -year period preceding this proposal been convicted or had a civil <br />judgment rendered 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) <br />transaction or contract under a public transaction; violation of federal or state antitrust <br />statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of <br />records, 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 <br />paragraph (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 />certification, such prospective participant shall attach an explanation to this proposal. <br />Grantee /Contractor Organization <br />Name and Title of Official Authorized to Certify <br />On Behalf of the Grantee <br />Date <br />19D-33 29 <br />