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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 aff 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 />G� o�c,fa.rw {iie? <br />The lower tier participant (Bidder/Contractor), KgX23er-t�5 -T"�L , certifies or affirms the truthfulness <br />and accuracy of this statement of its certification and disclosure, if any. <br />DATE S t/ - <br />SIGNATURE d"1 �--� 4'/�✓�-'� <br />COMPANY_ A��°sN^{tdCLXGca33�rw .f`,n/r✓ <br />NAME �%ra^/ �- �pWC- C <br />/� <br />TITLE <br />State of /`�. \ ,, ) C�a( � m <br />l <br />County of l L Clx J, n <br />Subscribed and swom to before me this L day of�i 1Q r, 20.1-00 <br />Notary Public <br />My Appointment ExpiresI-FT--21C)- a"2, <br />24 <br />F-3 Page 142 <br />1 <br />