R2013-68 ACCEPTING THE BID AND AUTHORIZING THE EXECUTION OF A CONTRACT

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REVISED JUNE 17, 2013 RETURN WITH BID EPA Project Control#: L17-4873 United States Environmental Protection Agency Washington,DC 20460 Certification Regarding Debarment,Suspension and Other Responsibility Matters The prospective participant to the best of its knowledge and belief that it and its principles: (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any 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 of records,making false statements,or receiving stolen property. (c) Are not presently indicted for or otherwise criminally or civilly charged by a government 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. I understand that a false statement on this certification may be grounds for rejection of this proposal or termination of the award. In addition, under 18 USC Sec. 1001, a false statement may result in fine of up to $10,000 or imprisonment for up to 5 years, or both. Denise Carroll, Assistant Secretary (Typed ame Title of Authorized Representative) June 21, 2013 (Signature of Authorized el r sentative) (Date) ❑ I am unable to certify the above statements. My explanation is attached. ' EPA FORM 5700-49(11-88) CITY 2012-06/BGM 12-043 PROP-14