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DocuSign Envelope ID: D37C6C9E-3CC6-4586-B782-34070527DC90 <br /> (3)are not presently indicted for or otherwise criminally or civilly charged by a governmental entity(Federal, <br /> State, or local)with commission of any of the offenses enumerated in paragraph a 2 of this certification; and <br /> Y OO <br /> (4)have not within a 3-year period preceding this application/proposal had one or more public transactions <br /> (Federal, State, or local)terminated for cause or default. <br /> Should the applicant not be able to provide this certification, an explanation as to why should be placed under <br /> the assurances page in the application package. <br /> (b)Lower Tier Covered Transactions <br /> The applicant agrees by submitting this proposal that it will include,without modification,the following clause titled <br /> "Certification Regarding Debarment, Suspension,Ineligibility,and Voluntary Exclusion--Lower Tier <br /> Covered Transaction"(Appendix B to 45 CFR Part 76)in all lower tier covered transactions(i.e.,transactions with <br /> subgrantees and/or contractors)and in all solicitations for lower tier covered transactions: <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 proposal,that neither it nor its <br /> principals is presently debarred, suspended,proposed for debarment, declared ineligible,or voluntarily <br /> excluded from participation in this transaction by any Federal department 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 /> Signature of Authorized Certifying Official Title <br /> DDocuSigned by <br /> AdiLlGt. Department Director <br /> B7E962D1 BF454FA._ <br /> Grantee Name Date Submitted <br /> Orange County,North Carolina 11/30/2015 <br /> l <br /> Page 16 of 16 <br />