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<br />Contract Number <br />County„ ,~ <br />DEBARMENT CERTIFICATION <br />The Contractor certifies to the best of his knowledge and belief, that he and his principals: <br />Rev 7-20-08 <br />a. Are ~t presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily <br />excluded from covered transactions by any Federal department or agency; <br />b. Have not within athree-year period preceding this proposal been convicted of or had a civil <br />judgment rendered against them for commission of fraud or a criminal offense in connection with <br />obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or <br />contract under a public transaction; violation of Federal or State antitrust statutes or commission of <br />embezzlement, thei}, forgery, bribery, falsification or destruction of records; making false <br />statements; or receiving stolen property; <br />c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity <br />(Federal, State or local) with commission of any of the offenses enumerated in paragraph b. of this <br />certification; and <br />d. Have not within athree-year period preceding this proposal had one or more public transactions <br />(Federal, State or local) terminated for cause or default. <br />e. If status changes, will submit a revised Debarment Certification immediately. <br />If the Contractor cannot certify that he is rwt debarred, he shall provide an explanation with this <br />submittal An explanation will not necessarily result in denial of participation in a contract. <br />Faihue to submit anon-collusion affidavit and debarment certification will result in the Contractor's <br />bid being considered non-responsive. <br />Check here if an explanation is attached to this <br />certification. <br />73 <br />