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CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY
<br />EXCLUSION — LOWER TIER COVERED TRANSACTIONS
<br />This page must be filled out and returned with your application. Failure to do so may subject your application to rejection. Unsigned
<br />applications will NOT be considered.
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<br />INSTRUCTIONS:
<br />1. By signing and submitting this document, the prospective lower tier participant is providing the certification set out
<br />below.
<br />2. The certification in this clause is a material representation of the fact upon which reliance was placed when this
<br />transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an
<br />erroneous certification, in addition to other remedies available to the State and /or federal government, the department or
<br />agency with which this transaction originates may pursue available remedies, including suspension and /or debarment.
<br />3. The prospective lower tier participant shall provide immediate written notice to the person to which this application is
<br />submitted if at any time the prospective lower tier participant learns that its certification was erroneous when submitted or
<br />has become erroneous by reason of changed circumstances.
<br />4. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "participant,"
<br />"person," "primary covered transaction," "principal," "proposal," and "voluntarily excluded," as used in this clause, have the
<br />meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549, 45 CFR Part 76.
<br />5. The prospective lower tier participant agrees by submitting this application that, should the proposed covered
<br />transaction be entered into, it shall not knowingly enter any lower tier covered transaction with a person who is debarred,
<br />suspended, determined ineligible or voluntarily excluded from participation in this covered transaction unless authorized
<br />by the department or agency with which this transaction originated.
<br />6. The prospective lower tier participant further agrees by submitting this document that it shall include the clause titled
<br />"Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion — Lower Tier Covered Transaction,"
<br />without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.
<br />7. A participant in a covered transaction shall rely upon a certification of a prospective participant in a lower tier covered
<br />transaction that is not debarred, suspended, ineligible, or voluntarily excluded from covered transaction, unless it knows
<br />that the certification is erroneous. A participant may decide the method and frequency of which it determines the eligibility
<br />of its principals. Each participant may, but is not required to, check the Non - procurement List.
<br />8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to
<br />render in good faith the certification required by this clause. The knowledge and information of a participant is not required
<br />to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.
<br />9. Except for transactions authorized in paragraph 5 of these instructions, if a participant in a covered transaction
<br />knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily
<br />excluded from participation in this transaction, in addition to other remedies available to the State and /or federal
<br />government, the department or agency with which this transaction originated may pursue available remedies, including
<br />suspension, and /or debarment.
<br />The government department or agency with which this transaction originated may pursue available remedies, including
<br />suspension, and /or debarment. See http:/ /www.pandc.nc.gov /actions.asp for the N.C. list and https: / /www.epls.gov/ for
<br />the federal list of suspended and debarred organizations.
<br />CERTIFICATION:
<br />1. The prospective lower tier participant certifies, by submission of this document, that neither it nor its principals is
<br />presently debarred, suspended, proposed for debarment, declared ineligible, nor voluntarily excluded from participation in
<br />this transaction by any State and /or federal department or agency.
<br />2. Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such
<br />prospective participant shall attach an explanation to this application.
<br />SIGNED: DATE:
<br />TITLE: ORGANIZATION:
<br />Solicitation No. 2011WXSSP
<br />Page 24 of 53
<br />Attachment number 1
<br />F -4 Page 136
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