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Last modified
3/26/2021 10:56:32 AM
Creation date
3/26/2021 10:54:05 AM
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Contracts
Company Name
FAMILIES FORWARD
Contract #
A-2021-021-03
Agency
Community Development
Council Approval Date
2/16/2021
Expiration Date
9/30/2021
Insurance Exp Date
7/1/2021
Destruction Year
2026
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DocuSign Envelope ID: DB57E193-19OC-45B4-AD94-OE87F2337591 <br />EXHIBIT E <br />RIN1,11 ►11'�1►Y:Y <br />Certification Regarding <br />Debarment, Suspension, Ineligibility and Voluntary Exclusion <br />Lower Tier Covered Transactions <br />This certification is required by the regulations implementing Executive Order 12549, Debarment and <br />Suspension, 29 CFR Part 98, Section 98.510, Participants' responsibilities. The regulations were <br />published as Part VII of the May 26,1988 Federal Re ig ster (pages 19160-19211). <br />(BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS FOR CERTIFICATION - <br />Attached) <br />(1) The prospective recipient of federal assistance funds certifies, by submission of this proposal, <br />that neither it nor its principals are presently debarred, suspended, proposed for debarment, <br />declared ineligible, or voluntarily excluded from participation in this transaction by any <br />federal department or agency. <br />(2) Where the prospective recipient of federal assistance funds is unable to certify to any of the <br />statements in this certification, such prospective participant shall attach an explanation to this <br />proposal. <br />nladelynn Hirneise CEO <br />Name and Title of Authorized Representative <br />wmkm % 3/9/2021 <br />Signature Date <br />23 <br />
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