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LATINO HEALTH ACCESS (4)
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LATINO HEALTH ACCESS (4)
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Last modified
1/12/2023 11:29:15 AM
Creation date
5/19/2022 8:54:18 AM
Metadata
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Template:
Contracts
Company Name
LATINO HEALTH ACCESS
Contract #
A-2022-069-09
Agency
Parks, Recreation, & Community Services
Council Approval Date
5/3/2022
Expiration Date
6/30/2023
Destruction Year
2028
Notes
For Insurance Exp. Date see Notice of Compliance
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DocuSign Envelope ID; 098D4B61-B495-429F-BABC-OAF46D368454 <br />EXHIBIT D <br />DEBARMENT <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 <br />and Suspension, 29 CFR Part 98, Section 98.510, Participants' responsibilities. The regulations were <br />published as Part VII of the May 26,1988 Federal Register (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 <br />proposal, that neither it nor its principals are presently debarred, suspended, proposed for <br />debarment, declared ineligible, or voluntarily excluded from participation in this transaction <br />by any 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 <br />this proposal. <br />flancz.{ Wei iek , GP -e- <br />Name and Title of <br />Signature I ( I Date <br />27 <br />
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