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22 <br /> DEPARTMENT OF HEALTH AND HUMAN SERVICES <br /> DIVISION OF PUBLIC HEALTH <br /> CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND <br /> VOLUNTARY EXCLUSION-LOWER TIER COVERED TRANSACTIONS (Note: The phrase <br /> "prospective lower tier participant," means providers under contract with the Division of Public <br /> Health.) <br /> I. By signing and submitting this document, the prospective lower tier participant is <br /> providing the certification set out below. <br /> 2. The certification in this clause is a material representation of the fact upon which reliance <br /> was placed when this transaction was entered into. If it is later determined that the <br /> prospective lower tier participant knowingly rendered an erroneous certification, in <br /> addition to other remedies available to the Federal Government,the department or agency <br /> with which this transaction originate may pursue available remedies, including <br /> suspension and/or debarment. <br /> 3. The prospective lower tier participant will provide immediate written notice to the person <br /> to which this proposal is submitted if at any time the prospective lower tier participant <br /> learns that its certification was erroneous when submitted or has become erroneous by <br /> reason of changed circumstances. <br /> 4. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier <br /> covered transaction," "participant," "person," "primary covered transaction," "principal," <br /> "proposal," and "voluntarily excluded," as used in this clause, have the meanings set out <br /> in the Definitions and Coverage sections of rules implementing Executive Order 12549, <br /> 45 CFR Part 76. You may contact the person to which this proposal is submitted for <br /> assistance in obtaining a copy of those regulations. <br /> 5. The prospective lower tier participant agrees by submitting this proposal that, should the <br /> proposed covered transaction be entered into, it shall not knowingly enter any lower tier <br /> covered transaction with a person who is debarred, suspended, determined ineligible or <br /> voluntarily excluded from participation in this covered transaction unless authorized by <br /> the department or agency with which this transaction originated. <br /> 6. The prospective lower tier participant further agrees by submitting this document that it <br /> will include the clause titled "Certification Regarding Debarment, Suspension, <br /> Ineligibility and Voluntary Exclusion - Lower Tier Covered Transaction," without <br /> modification, in all lower tier covered transactions and in all solicitations for lower tier <br /> covered transactions. <br /> Debarment 5/00 <br /> Page 1 of 2 <br />