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Appendix B: Certi~caticn of Primary Partiaipants Regarding Qebarment, Suspension, and Other <br />Responsibiiity IUlatters <br />CERTiFICATiON REGARDING DEBARMENT, SU5PENSION, <br />tNELIGI~(LITYand V~LUNTARY EXCLUSION <br />LOWER T1ER GOVERED TRAN5ACTlON <br />(To be submitted with all bids) <br />{1 } The prospective tawer tier participant (BidderlContractor} certifies, by submission of this bid vr prapasal; <br />that nei#her it nar its principa#s is presently debarred, suspended, prapased far debarment, declared <br />ineligible, ar voluntarily excluded from participa#ion in this transaction by any FederaE department ar agency. <br />{2} The prospective Bi~lder/Contractor also certifies by submissian of this bid ar praposal that all subcontractors <br />and suppliers {fhis requirement flows down to all subcantracts at all (evels) are not presently debarred, <br />suspended, proposed for debarment, declaeed ineligible, or voluntarily ~xcluded from participation in fl~is <br />transaction by any Federal deparfinent ar agency. <br />(3) Where the prospective lower tier participant (Bidder/Contractor) is unable to certify to any of the statements <br />in this certificatian, such prospective par~icipan# shall attach an explanation to this bid ar pronosai. <br />The lower ti~r participant (BidderlContrac#or}, ~~,.,~ ,`~~ ~,~~~~, ~,~;~, ~~{~~~s or af~rms the truthfulness <br />and accuracy of this statemerit of its cerfification and disclosure, i# any. ~ <br />~l; /~ <br />Stafe of _ 1 ~1CkI~~-, d C~ ~t ~~ i'~ <br />Gauntypf ~~i~,t~~~ <br />~ATE ~~....~`'~1~ ~l~ ;2. <br />----, --- <br />SIGNATU ~ <br />COMPANY ~~. 4 ti.~ ~~ 1~C-''~ Clt`" t i~.i t~ <br />r~aM~ 1~.~~'~1-~ k`~ . ~i~~ ~C. <br />rir~.E ~U~ q`~ ~;v~ ~ ~Y~'~~ ~ ~n~" <br />Subscrbed and sworn to before me this ~ day of _~~~'c~.~~ , 20~, <br />~~ <br />.~~~\~`~~~~ ~fi~,Jf l,'~~ <br />~ ~~~ ~C~~~ ~ <br />=' N~?TARY ~ ~ <br />' ~ PUB~.l~ = <br />:~ ..y~ ~U,~~ <br />,~ <br />'l~~~~~ c ~ C O U N ~ ; ~ .' ' ~~ ~ <br />MAR-07-2012 1ac~9 From: <br />Notary Pubiic f ~: ~~-~'"~. ,~d ~,/L-'-~--^----- <br />My Appaintment~~xpir~s f~-- ~~;,-- ~ '~ <br />IQ:1111 <br />Pase:016 R=93% <br />