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DocuSign Envelope ID: D442B3A4-5DOF-49D2-ABA8-60AB45788486 <br /> CERTIFICATION REGARDING DEBARMENT AND SUSPENSION <br /> The undersigned applicant certifies to the best of his or her knowledge and belief, that the applicant and <br /> its principals: <br /> (a) are not presently debarred, suspended, proposed for debarment, declared ineligible or <br /> voluntarily excluded from covered transactions by any Federal Department or agency; <br /> (b) have not within a 3-year period preceding this proposal been convicted of or had a civil <br /> judgment rendered against them for commission of fraud or a criminal offense in connection <br /> with obtaining, attempting to obtain, or performing a public (Federal, State, or local) <br /> transaction or contract under a public transaction; violation of Federal or State antitrust <br /> statutes or commission of embezzlement,theft, forgery,bribery, falsification or destruction of <br /> records,making false statements, or receiving stolen property; <br /> (c) are not presently indicted or otherwise criminally or civilly charged by a governmental entitle <br /> (Federal, State, or local)with commission of any of the offenses enumerated in paragraph(b) <br /> of this certification; and <br /> (d) have not within a 3-year period preceding this application/proposal had one or more public <br /> transactions(Federal, State,or local)terminated for cause or default. <br /> Where the prospective participant is unable to certify to any of the statements in this certification, such <br /> prospective participant shall attach an explanation to this proposal. <br /> Business Name: Marcus & Milli chap <br /> Address: 201 S. Tryon St. Suite 1220 <br /> City/State/Zip: charlotte, NC 28202 <br /> KSign5'g eg by: <br /> ature: y" (Seal if Corporation) <br /> C <br /> Title: Regional Manager <br /> Date: 2/8/2021 1 09:01:42 PST <br /> 13 <br />