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Appendix B: Certification of Primary Participants Regarding Debarment, Suspension, and Other <br />Responsibility Matters <br />CERTIFICATION REGARDING DEBARMENT, SUSPENSION, <br />INELIGIBILITY and VOLUNTARY EXCLUSION <br />LOWER TIER COVERED TRANSACTION <br />(To be submitted with all bids /proposals or offers exceeding $25,000.) <br />(1) The prospective lower tier participant (Bidder/Contractor) certifies, by submission of this bid or proposal, <br />that neither it nor its principals is presently debarred, suspended, ; proposed for debarment, declared <br />ineligible, or voluntarily excluded from participation in this transaction by any Federal department or <br />agency. <br />(2) The prospective Bidder/Contractor also certifies by submission of this bid or proposal that all <br />subcontractors and suppliers (this requirement flows down to all subcontracts at all levels) are not <br />presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from <br />participation in this transaction by any Federal department or agency. <br />(3) Where the prospective lower tier participant (Bidder/Contractor) is unable to certify to any of the <br />statements in this certification, such prospective participant shall attach an explanation to this bid or <br />proposal <br />Gm Ar x' C r'K- . v-. 1" � <br />The lower tier participant (Bidder /Contractor), certifies or affirms the truthfulness <br />and accuracy of this statement of its certification and disclos re, if any. <br />DATE <br />SIGNATURE <br />COMPANY �' R %Aa ,,n V, u-e. an A Xcr- so n a f z.t\c <br />NAME 1 �z I 141 <br />TITLE <br />State of ' AN u � �C <br />County of __ <br />Subscribed and sworn to before me this, day of #ti 20 . <br />0 Notary Public -�_1 <br />on" cwjrft My Appointment Expires <br />24 <br />Attachment number 1 <br />F -5 Page 178 <br />