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DEPARTMENT OF HEALTH AND HUMAN SERVICES <br />DIVISION OF PUBLIC HEALTH <br />25 <br />CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND <br />VOLUNTARY EXCLUSION-LOWER TIER COVERED TRANSACTIONS (Note: The phrase <br />"prospective lower tier participant," means providers under contract with the Division of Public <br />Heatth.) <br />1. By signing and submitting this document, the prospective lower tier participant is <br />providing the certification set out below. <br />1. The certification in this clause is a material representation of the fact upon which reliance <br />was placed when this transaction was entered into. If it is later determined that the <br />prospective lower tier participant knowingly rendered an erroneous certification, in <br />addition to other remedies available to the Federal Government, the department or agency <br />with which this transaction originate may pursue available remedies, including <br />suspension and/or debarment. <br />3. The prospective lower tier participant will provide immediate written notice to the person <br />to which this proposal is submitted if at any time the prospective lower tier participant <br />leazns that its certification was erroneous when submitted or has become erroneous by <br />reason of changed circumstances. <br />4. The teens "covered transaction, debarred, suspended, ineligible, lower tier <br />covered transaction, participant, person, primary covered transaction, princrpa, <br />"proposal," and "voluntarily excluded," as used in this clause, have the meanings set out <br />in the Definitions and Coverage sections of Hiles implementing Executive Order 12549, <br />45 CFR Part 76, You may contact the person to which this proposal is submitted for <br />assistance in obtaining a copy of those regulations. <br />5. The prospective lower tier participant agrees by submitting this proposal that, should the <br />proposed covered transaction be entered into, it shall not knowingly enter any lower tier <br />covered transaction with a person who is debarred, suspended, determined ineligible or <br />voluntarily excluded from participation in this covered transaction unless authorized by <br />the department or agency with which this transaction originated. <br />6. The prospective lower tier participant further agrees by submitting this document that it <br />will include the clause titled "Certification Regarding Debarment, Suspension, <br />Ineligibility and Voluntary Exclusion -Lower Tier Covered Transaction," without <br />modification, in all lower tier covered transactions and in all solicitations for lower tier <br />covered transactions. <br />DPH Debarment 1/OZ <br />Page 1 oI 2 <br />