Non_Debarment_or_Suspension_Certification.docx

KENTON COUNTY AIRPORT BOARD CINCINNATI/NORTHERN KY INTERNATIONAL AIRPORT

PROJECT NAME

NON-DEBARMENT OR SUSPENSION CERTIFICATION

In accordance with the CODE OF FEDERAL REGULATIONS, Part 49, CFR Section 29.510, the Bidder, being duly sworn (or under penalty of perjury under the laws of the United States), certifies to best of his/her knowledge and belief, that 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 a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of record, making false statements, or receiving stolen property;

3. are not 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 the above paragraph of this certification; and

4. have not within a three-year period preceding this proposal had one or more public transactions (federal, state, or local) terminated for cause or default.

Where the Bidder is unable to certify to any of the statements in this certification, such Bidder shall list exceptions below. Exceptions will not necessarily result in denial of award, but will be considered in determining contractor responsibility. For any exception noted, indicate below to whom it applies, the initiating agency, and the dates of the action. Providing false information may result in criminal prosecution or administrative sanction. If an exception is noted, the Bidder must contact the Sponsor to discuss the exception prior to award of the Contract.

The Bidder certifies under penalty of perjury under the laws of the Commonwealth of Kentucky that the foregoing is correct and true.

Name: Bidding contractor ___________________________________________________

By _________________________________Date:_______________

(SIGNATURE)

Name and Title ____________________________________________________

(PRINT OR TYPE)

Subscribed and sworn before me this date: Month _________ Day ______ Year __________

Notary Public's signature: ____________________________________________________

Commission expires: _________________________________________________________

END OF SECTION