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FULL PACKET_ 2012-06-04
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FULL PACKET_ 2012-06-04
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7/22/2016 2:16:57 PM
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5/31/2012 5:52:30 PM
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City Clerk
Agency
Clerk of the Council
Date
6/4/2012
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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 published as <br />Part VII of the May 16, 1988, Federal Register (Pages 19160 - 19211). <br />(Before completing certification, read instructions which are an integral part of certification) <br />1. The prospective primary participant, (i.e. grantee) certifies to the best of its knowledge and belief, that it <br />and its principals: <br />a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily <br />excluded from covered transactions by any federal department or agency; <br />b. Have not within a three -year period preceding this proposal been convicted or had a civil judgment <br />rendered against them for commission of fraud or a criminal offense in connection with obtaining, <br />attempting to obtain, or performing a public (federal, state or local) transaction or contract under a <br />public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, <br />forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen <br />property. <br />c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity <br />(federal, state or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this <br />certification; and <br />d. Have not within a three -year period preceding this application /proposal had one or more public <br />transactions (federal, state or local) terminated for cause or default. <br />2. Where the prospective primary participant is unable to certify to any of the statements in this certification, <br />such prospective participant shall attach an explanation to this proposal. <br />Grantee /Contractor Organization <br />Name and Title of Official Authorized to Certify <br />On Behalf of the Grantee <br />Date <br />EXHIBIT F <br />Page 49 of 54 <br />25K -71 <br />
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