OTHER-2020-009 Instructions for Debarment Certifications - Wet Signature

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Federal Government, the department or agency with which this transaction originated may pursue available remedies including suspension and /or debarment CERTIFICATIONS REGARDING DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY MATTERS Applicants should refer to the regulations cited on page 67 . Applicants should also review the instructions for certification included in the regulations before completing this form , signature on this form provides for compliance with certification requirements implementing Federal Executive Order 12549 and guidance issued in the Federal Register, Volume 70, No . 168 , pages 51863 through 51880 for " Government wide Debarment and Suspension ( Non - procurement ) . " The certification shall be treated as a material representation of fact upon which reliance will be placed when the Rural Economic Development Division determines to award the covered transaction , grant, or cooperative agreement . As required by Executive Order 12549 , Debarment and Suspension , for prospective participants in primary covered transactions : 1 ) The prospective primary participant certifies to the best of its knowledge and belief, that it and its principals : a . Are not presently debarred , suspended , proposed for debarment, declared ineligible , or voluntarily excluded from covered transactions by a Federal department or agency; b . Have not within a three -year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining , attempting to obtain , or performing a public ( Federal , State or local ) transaction or contract under a public transaction ; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction or records , making false statements, or receiving stolen property : c . Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity ( Federal , State , or local ) with commission of any of the offenses enumerated in paragraph ( 1 ) ( b ) of this certification ; and d . Have not within a three -year period preceding this application / proposal had one or more public transactions ( Federal , State , or local ) terminated for cause or default . 2 ) Where the prospective primary participant is unable to certify to any of the statements in this certification , such prospective participant shall attach an explanation to this proposal . As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the above applicable certification ( s ) . Name of Applicant/Grantee : Grant Number and Project Name : Orange County, North Carolina Emergency Housing Assistance Printed Namnhr, d Title of Authori epr entative . Penny Rich , Orange County oa d ofC mmissioners Signature f Date "At# 4,Z, w l lzt #_ tom; 52 ` `' 'psi t IVS