|
Instructions for Certification Regarding Debarment,
<br /> Suspension and other Responsibility Matters
<br /> 1. By signing and submitting this proposal,the prospective primary proposal that,should the proposed covered transaction be entered into,it
<br /> participant is providing the certification set out below. shall not knowingly enter into any lower tier covered transaction with a
<br /> 2.The inability of a person to provide the required certification will
<br /> person who is debarred.suspended,declared ineligible,or voluntarily
<br /> not necessarily result in denial of participation in this covered transaction. excluded from participation in this covered transaction.unless authorized
<br /> The prospective participant shall submit an explanation of why it cannot in writing by ACTION.
<br /> provide the certification. The certification or explanation will be consid- 7. The prospective primary participant further agrees by submitting
<br /> cred in connection with ACTION'S determination whether to enter into this proposal that it will include the clause titled"Certification Regarding
<br /> this transaction.However,failure of the prospective primary participant to Debarment,Suspension,Ineligibility,and Voluntary Exclusion—Lower
<br /> furnish a certification or explanation shall disqualify such person from TicrCovered Transactions."providedby ACTION,without modification,
<br /> participation in this transaction. in all lower tier covered transactions and in all solicitations for lower tier
<br /> 3. The certification in this clause is a material representation of fact covercd transactions'
<br /> upon which reliance was placed when the department or agency deter- 8.A participant in a covered transaction may rely upon a certification
<br /> mined to enter into this transaction. If it is later determined that the of a prospective participant in a lower tier covered transaction that it is not
<br /> prospective primary participant knowingly rendered an erroneous certify- debarred,suspended,ineligible,or voluntarily excluded from the covered
<br /> cation,in addition to other remedies available to the Federal Government, transaction,unless it knows that the certification is erroneous. A panici-
<br /> ACTION may terminate this transaction for cause or default. pant may decide the method and frequency by which it determines the
<br /> 4. The prospective primary participant shall provide immediate eligibility of its principals. Each participant may,but is not required to,
<br /> written notice to ACTION if at any time the prospective partici-
<br /> pant
<br /> check'he Nonprocurement List.
<br /> Y � Pr°� primary p
<br /> learns that its certification was erroneous when submitted or has 9. Nothing contained in the foregoing shall be construed to require
<br /> become erroneous by reason of changed circumstances. establishment of a system of records in order to render in good faith the
<br /> 5.The terms"covered transaction,"debarred,"'suspended,""ineli-
<br /> certification required by this clause.The knowledge and information of a
<br /> giblet"'lower tier covered transaction;"'participant;'"person,""primary participant is not required to exceed that which is normally possessed by
<br /> covered trans acti on.""principal;"'proposal,"and"voluntarily excluded," a prudent person in the ordinary course of business dealings.
<br /> as used in this clause,have the meanings set out in the Definitions and 10. Except for transactions authorized under paragraph 6 of these
<br /> Coverage sections of the rules implementing Executive Order 12549.You instructions,if a participant in acovered transaction knowingly enters into
<br /> may contact ACTION for assistance in obtaining a copy of those regula- alowcr tier covered transaction with aperson who is suspended,debarred,
<br /> ti ineligible,orvoluntarily excluded from participation in this transaction,in
<br /> 6. The prospective primary participant agrees by submitting this addition to other remedies available to the Federal Government,ACTION
<br /> may terminate this transaction for cause or default.
<br /> Certification Regarding Debarment,Suspension, charged by a Federal, State or local government entity with
<br /> and Other Responsibility Matters commission of any of the offenses enumerated in paragraph lb
<br /> (Primary Covered Transactions) of this certification;and
<br /> This certification is required by the regulations implementing Executive d. Have not,within a three-year period preceding this application/
<br /> Order 12549, Debarment and Suspension,45 CFR Part 1229,Section proposal,had one or more public transactions(Federal,State or
<br /> 1229.510,Participants'responsibilities. The regulations were published local)terminated for cause or default.
<br /> as Part VII of the May 26,1988,Federal Register(pages 19160-19211). 2. Where the prospective primary participant is unable to certify to any
<br />(Before completing certification,read instructions above) of the statements in this certification,such prospective participant
<br /> 1. 'The prospective primary participant certifies,to the best of its knowl- shall attach an explanation to this proposal.
<br /> edge and belief,that it and its principals:
<br /> a. Are not presently debarred,suspended,proposed for debarment, Orange–Chatham Comprehensive Health Services,Inc.
<br /> declared ineligible,or voluntarily excluded from covered trans- Applicant Organization
<br /> actions by any Federal department or agency;
<br /> Moses Carey, Jr., Executive Director
<br /> b. Have not.within a three-year period preceding this proposal,
<br /> been convicted of or had a civil judgment rendered against them Name and Title of Authorized Representative
<br /> for commissionof fraud ora criminal offense inconncctionwith
<br /> obtaining,attempting to obtain.or performing a public(Federal, � / / ,
<br /> State or local)transaction or contract under a public transaction;
<br /> violation of Federal or State antitrust statutes or commission of Signature of Authorized Certifying Offici
<br /> embezzlement,theft,forgery,bribery,falsification or destruc-
<br /> tion V/�
<br /> of records,making false statements,or receiving stolen /3o/ O
<br /> Pn opa'y;
<br /> Date
<br /> c. Are not presently indicted for or otherwise criminally or civilly
<br /> ACTION Form 424-F (12/89)
<br />
|