ATTM 003.docx

DOCX document 27 KB Posted

Attached to
Pharmacy Benefit Services (PBS)
Solicitation number
5400029905
Issued by
Richland County, South Carolina

About this file

This is a certification document regarding debarment, suspension, ineligibility, and voluntary exclusion for lower tier covered transactions, as defined by 45 CFR Part 76. The document serves as a prerequisite certification that prospective lower tier participants must complete and submit with their proposals. By signing and submitting this certification, the prospective participant confirms to the best of its knowledge and belief that neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in federal transactions by any federal department or agency.

If a prospective lower tier participant is unable to certify compliance with the above conditions, the participant must attach a detailed explanation to its proposal. The prospective lower tier participant further agrees that upon submission of this certification, it will include this clause in all subsequent lower tier covered transactions and in all solicitations for lower tier covered transactions without modifications. An authorized signature is required to validate the certification.

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Text version

ATTM 003 Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion – Lower Tier Covered Transactions

(To Be Supplied to Lower Tier Participants)

By signing and submitting this lower tier proposal, the prospective lower tier participant, as defined in 45 CFR Part 76, certifies to the best of its knowledge and belief that it and its principals:

a) are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency.

b) where the prospective lower participant is unable to certify to any of the above, such prospective participant shall attach an explanation to this proposal.

The prospective lower tier participant further agrees by submitting this proposal that it will include this clause entitled Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion-Lower Tier Covered Transactions without modifications in all lower tier covered transactions and in all solicitations for lower tier covered transactions.

Authorized Signature

File details come from the government source that posted it. Updated .