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<br />Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-Lower Tier <br />Covered Transactions <br />(1) .The prospective lower tier participant certifies, by submission of this document, that neither it nor its <br />principals is presently debarred, suspend, proposed for debarment, declared ineligible, nor voluntarily <br />excluded from participation in this transaction by any Federal deparanent or agency. <br />(2) Where the prospective lower tier participant is unable to certify to any of the statements in this <br />certification, such prospective participant shall attach an explanation to this proposal. <br />~M ,, J <br />/~~17 ~1'/1?1.~~~~ Health Director <br />Signature V Title <br />Orange Couty Health Department ~'" / ~ / O <br />Agency/Organization Date -T~ <br />(Certification signature should be same as Contract signature.) <br />