10.Exhibit 13.pdf

Corvallis Road Waterline Improvements

PN: 2023-13

Keller Project: 223055-007

CITY OF INDEPENDENCE PAGE 1 OF 2 DEBARMENT

EXHIBIT 13 – Debarment Certification Form

TO: CITY OF INDEPENDENCE, a Municipal Corporation in the State of Oregon

PROJECT

NAME: Corvallis Road Waterline Improvements

Government requirements for non-procurement suspension and debarment are contained in the OBM guidance in 2 CFR part 180, which implements Executive Orders 12549 and 12689, Debarment and Suspension. This certification is required by those regulations since the total contract award is expected to equal or exceed $25,000.

The Contractor certifies that, neither the Contractor firm nor any owner, partner, director, officer, or principal of the Contractor, nor any person in a position with management responsibility or responsibility for the administration of federal funds:

Are presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by any federal or state department/agency;

Has within a three (3)-year period preceding this certification been convicted of or had a civil judgment rendered against it for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public transaction or contract (federal, state, or local); violation of federal or state antitrust statutes; or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;

Are presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in item (2) above; or

Has, within a three (3)-year period preceding this certification, had one (1) or more public transactions or contracts (federal, state, or local [other than the City of Independence]) terminated for cause or default.

Has, within a five (5) year period preceding this certification, had one (1) or more public contracts with the City of Independence terminated for cause or default.

The contractor is “Actively” registered with SAMS (Service for Award Management) and has been assigned the following DUNS Number: __________________________.

The Contractor further certifies that it shall not knowingly enter into any transaction with any subcontractor, material supplier, or vendor who is debarred, suspended, declared ineligible, or voluntarily excluded from covered transactions by any federal or state department/agency. Where the prospective recipient of Federal assistance funds is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this Response.

ATTESTATION

Signed (Contractor) Firm

Title Date

Corvallis Road Waterline Improvements

PN: 2023-13

Keller Project: 223055-007

CITY OF INDEPENDENCE PAGE 2 OF 2 DEBARMENT

Debarment Certification Form (CONTINUED)

Instructions for Certification

1) By signing and submitting this form, the prospective recipient of Federal assistance funds is providing the certification as set out below.

2) The certification in this class is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective recipient of Federal assistance funds knowingly rendered an erroneous certification, the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment.

3) The prospective recipient of Federal assistance funds shall provide immediate written notice to the person to which this Response is submitted if at any time the prospective recipient of Federal assistance funds learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.

4) The terms “covered transaction,” “debarred,” “suspended,” “ineligible,” “lower-tier covered transaction,” “participant,” “person,” “primary covered transaction,” “principal,” “proposal” and “voluntarily excluded,” as used in this clause, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the offices to which this proposal is submitted for assistance in obtaining a copy of those regulations.

5) The prospective recipient of Federal assistance funds agrees by submitting this Response that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency with which this transaction originated.

6) The prospective recipient of Federal assistance funds further agrees by submitting this Response that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-Lower Tier Covered Transactions," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.

7) A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may but is not required to check the Nonprocurement List.

8) Nothing contained in the foregoing shall be construed to require the establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.

9) Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment.