Appendix_C_CERTIFICATION_REGARDING_DEBARMENT.pdf

CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY

and VOLUNTARY EXCLUSION

The Contractor certifies, to the best of its knowledge and belief, that it and its principals:

1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency;

2. Have not within the five-year period preceding entering into this Agreement had one or more public transactions (Federal, State, or Local) terminated for cause or default; and

3. Have not within the five-year period preceding entering into this proposal been convicted of or had a civil judgment rendered against them for:

a) the commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or Local) transaction or a contract under public transaction, or b) 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.

The Contractor understands and agrees that the language of this certification must be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, contracts under grants, loans, and cooperative agreements) and that all contractors and sub-contractors must certify and disclose accordingly.

The Contractor further understands and agrees that this certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into.

Signature:

Name: Contractor’s Name:

Title:

Street Address:

City, State, Zip:

Date:

APPENDIX C