4._Certification_Regarding_Debarment_Form.pdf

Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion Lower-tier

Covered Transactions

NOTE: Before completing the certification, please read the instructions on the second page, as they are an essential component of the certification process.

The regulations implementing Executive Order 12549, Debarment and Suspension, 29 CFR Part 98, Section 98.510, and the participant's responsibilities require this certification. The regulations were published as Part VII of the May 26, 1988, under the Federal Register on pages 19160 through 19211.

By submitting this bid, the prospective recipient of Federal assistance funds certifies that neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency.

Where the prospective recipient of Federal assistance funds cannot certify any of the Statements in this certification, such prospective participant shall attach an explanation to this Proposal.

Printed Name and Title of Authorized Representative

Signature Date

DUNS Number or Cage Code

Instructions for Certification

By signing and submitting this proposal, the prospective recipient of Federal assistance funds will provide the certification as set out below.

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 and other remedies available to the Federal Government, the Department of Labor (DOL) may pursue available remedies, including suspension and/or debarment.

The prospective recipient of Federal assistance funds shall provide immediate written notice to the person to whom this Proposal 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 due to changed circumstances.

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 person to whom this Proposal is submitted for assistance obtaining a copy of those regulations.

The prospective recipient of Federal assistance funds agrees by submitting this Proposal 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 DOL.

The prospective recipient of Federal assistance funds further agrees by submitting this Proposal 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.

A participant in a covered transaction may rely upon a prospective participant in a lower-tier covered transaction's certification 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 List of Parties Excluded from Procurement or Non-procurement Programs.

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

Except for transactions authorized under paragraph five (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 DOL may pursue available remedies, including suspension and/or debarment.