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Docusign Envelope ID: B576D624-E16E-4D9F-BC67-5703DE54A6F8 <br /> SUBMIT WITH PROPOSAL <br /> CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY and <br /> VOLUNTARY EXCLUSION LOWER TIER COVERED TRANSACTION <br /> (To be submitted with all bids exceeding $25,000.) <br /> (1) The prospective Applicant certifies, by submission of this proposal, that neither it nor <br /> its principals is presently debarred, suspended, proposed for debarment, declared <br /> ineligible, or voluntarily excluded from participation in this transaction by any Federal <br /> department or agency. <br /> (2) The prospective Applicant also certifies by submission of this proposal that all <br /> subcontractors and suppliers (this requirement flows down to all subcontracts at all <br /> levels) are not presently debarred, suspended, proposed for debarment, declared <br /> ineligible, or voluntarily excluded from participation in this transaction by any Federal <br /> department or agency. <br /> (3) Where the prospective Applicant is unable to certify to any of the statements in this <br /> certification, such prospective participant shall attach an explanation to this bid or <br /> proposal. <br /> The Applicant, IEM International, Inc. certifies or affirms <br /> the truthfulness and accuracy of this statement of its certification and disclosure, if any. <br /> DATE October// , 2024 <br /> SIGNATURE <br /> NAME Keith Reynolds <br /> TITLE Manager of Contract Admnisitration <br /> COMPANY IEM International, Inc. <br /> State of Louisana <br /> County of ,fie ( <br /> Subscribed and sworn to before me this day of October 2024. <br /> Notary Public <br /> My Appointment Expires= <br /> WEND16T J.DAIGLE <br /> NOTAiiY FUMIG <br /> ST.TMIMANY PARISH <br /> LOUESIANA <br /> NOTARY ID NO,024GG4 <br /> my comwaSION EXPIRES AT DEATH <br />