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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 />p rop osal. <br />The lower tier participant (Bidder/Contractor), aim , certifies or affirms the truthfulness <br />and accuracy of this statement of its certification and disclosure, if any. <br />DATE ,,r_ <br />SIGNATURE <br />COMPANY GOfff A196/r' .e v'- X Ced �S��rt� <br />NAME // �� 16 l� <br />TITLE 1� <br />State of 4 y L <br />County of Comrals <br />Subscribed and sworn to before me this 13 day of 20�. <br />Notary Public <br />My Appointment Expires <br />26 <br />Attachment number 1 <br />F -5 Page 96 <br />