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EXHIBIT 12-E Local Assistance Procedures Manual <br />Attachment B PS&E Checklist Instructions <br />I. Nothing contained in ft foregoing shall be con-strusd to <br />require the establishment of a system orrecords in order to <br />render in good faith the cerdficOon required by this clause. <br />The knowledge and information of the prospective participant <br />is not required In exceed Shat which is normally possessed by <br />a prudent person in the ordinary course of business dealings - <br />1. Except for transactions authorized under paragraph (f) of <br />these instructions, if a participant al a covered transaction <br />knowingly enters into a lower tier covered transaction with a <br />person Me is suspended, debarred, ineligible, or voluntarily <br />excluded from participation in this transaction, in addition to <br />other remedies available to the Federal Government, the <br />department or agency may terminate this transaction for cause <br />ordefault. <br />2. Certification Regarding Qabarmard, Suspension, <br />Ineligibility, and Voluntary Exctuston — First Tier <br />Participants: <br />a. The prospective first Her participant certifies to the best of <br />its knowledge and belief, that it and its principals; <br />(1) Are not presently debarred, suspended, proposed for <br />debarment, declared ineligible, or voluntarily excluded from <br />participating in covered transactions by any Federal <br />department or agency; <br />(2) Have not within a thnea-year period preceding this <br />proposal been convicted of or had a civil judgment rendered <br />against them for commission of fraud or a. criminal offense in <br />connection with obtaining, attempting to obtain, or performing <br />a public (Federal, State or local) transaction or contract under <br />a public tmnsadioa, vlotabon of Federal or State anfiaust <br />suedes or commission of'embemlament, that, forgery, <br />bribery, falsification ordestmdion of records, making false <br />statements, or receiving skrlen property; <br />(0) Are not presently indicted for m otherwise criminally or <br />civilly charged bya governmental entity (Federal, State or <br />local with commission of any of the offenses enumerated in <br />paragraph (a)(2) of this cartificatton; and <br />(4) Have not within a thma-year period preceding this <br />appllcaDonfproposal had one or more public transactions <br />(Federal, State or local) terminated for cause or default <br />b. Where the prospective participant is unable to cerfify to <br />any of the stalemates in this certification, such prospective <br />participant shall attach an explanation to this proposal. <br />2 Instructions for Certification - Lower Tier Participants: <br />(Applicable to all subcommets, purchase orders and other <br />lowerfiertramsacUmns requiring prior FHWA approval nor <br />estimated to rust $25,000 or mom -2 CFR Parts 190 and <br />1200) <br />a. By signing and submitting this proposal, the prospective <br />lower der is providing the certification set out below. <br />It. The cetification in this clause is a material representation <br />of fact upon which reliance was placed when this transaction <br />was entered into. If It Is later determined thatthe prospective <br />lower Der participant knowingly rendered an emoneaus <br />cenifimficn, in addition to other remedies available to the <br />Federal Government, the department, or agency with which <br />io <br />Page 12-20 <br />July 31, 2012 <br />this transaction originated may pulli available remedies, <br />including suspension andlor debarment. <br />c. The prospective lower Derparttppant shall provide <br />immediatewdtten notice to the person to which this proposal is <br />submitted if at anytime the prospective lower Der participant <br />teams that its certification was emameous by reason of <br />changed circumstances. <br />d. The teems "covered transaction."' "debarren,d;' <br />"suspended; "fineligibfe," "participant ° ^perso"principal" <br />and "Vduntadly excluded," as used inti this clause, are defined <br />in 2 CFR Parts 100 and 1200. You rruay contactthe person to <br />which this proposal is submified for assistance in obtaining a <br />oopyofihoseregulations. "FfrstTier Coversd Transactions" <br />l eters, to any covered transaction betVreen a gredea or <br />subgrantee or Federal funds and a participant (such as the <br />primeorgeneralconlmet). "LowerTrar Covered Tmnsacfions <br />refers to any covered transaction undler2 First Tier Cowered <br />Transaction (such as sur contrads). "First Tier ParficipaW <br />refersth the participant who has entered into a covered <br />transaction with a granteo or subgrantee of Fedand funds <br />(such as the prime orgeneral contmctark "Lower per <br />Pamolloanf'refras any Pargcill cilia has entered into <br />covered transaction with a First Tiler Parttelpant or other Lower <br />Ter Participants (such as subcontractors. and suppliers), <br />e. The prospective lower Der participant agrees by <br />submitting this proposal that should the proposed covered <br />transaction be entered: into; it strait not knowingly erder into <br />any lower tier covered transaction with a person who is <br />debarred, suspended, declared ineligible, or voluntarily <br />excluded from parlidpation in this covared transaction, unless <br />authorized by the department or agency with which this <br />transaction originated. <br />E The prospective lower tier participant further agrees by <br />submitting this proposal that it will include this clause titled <br />"Certification Regarding 0ebarment, Suspension, Ineligfb lily <br />and Voluntary Exclusion -Lower Tier Covered Transarficn," <br />without modification, in all lower tier covered transactions and <br />in all solciations for tower Der corseted transactions exceeding <br />the $.25,000 threshold. <br />g. A participant h a covered transaction imay rely upon a <br />certification of a prospective participant in a lower tier covered <br />transaction that is not debarred, suspended, inefi9ibte, or <br />voluntarily excluded from the covered transaction, unless it <br />knows that the cenificatidn is erroneous. A. participant is <br />responsible for ensuring that its prsndipals are net suspended, <br />debarred, or otherwise ineligible to participate in covered <br />transactions. To verify five eligibility of its principals, as well as <br />the eltgDmlftyofany lower tier prospective participants, each <br />particlpant may, but is not required to, check the Excluded <br />Parties List System websds (httos:ff .eels govt), whidh is <br />compiled by the General Services Administration. <br />h. Nothing contained in the foregoing shall be construed to <br />require esta6fishment of a system of records in orderto render <br />in good faith the certification required by this clause. The <br />knowledge and information of padiapant is not required to <br />exceed that which is normally possessed by a prudent person <br />in the ordinary course of business dealings. <br />1. Except for transactions authorized order paragraph a of <br />these instructions, if a participant In a covered trarmcttun <br />knowingly enters into a lower tier covered fransacikn with a <br />person who is suspended, debarred, ineligible, or voluntarily <br />excluded from participation in this transaction, in addition to <br />other remedies available to the Federal Governmemi, the <br />OB 12-05 <br />