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U.S. DEPARTMENT OF JUSTICE l <br /> � � '�j OFFICE OF JUSTICE PROGRAMS <br /> „ ,f' OFFICE OF THE COMPTROLLER <br /> Certification Regarding <br /> Debarment, Suspension, Inetigibility and Voluntary Exciusion <br /> Lower Tier Covered Transactions <br /> (Sub•Recipient) <br /> This certification is required by the regulations implementing Executive Order 12549, Debarment and <br /> Suspension, 28 CFR Part 67, Section 67.510, Participants' responsibilities. The regulations were published <br /> as Part VII of the May 26, 1988 Federa/ Register(pages 19160-19211). � <br /> (BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS ON REYERS� <br /> , (1} The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its <br /> principals are presently debarred, suspended, proposed for debarment,declared ineligible,orvoluntarily <br /> excluded from participation in this transaction by any Federal department or agency. <br /> (2) Where the prospective lower tier participant is unable to certify to any of the staternents in this certifi- <br /> cation, such prospective participant shall attach an explanation to this proposal. <br /> .TamP� A_ AnderSOII C'hi Pf nf Pnl i r_t� <br /> Name and Title of Authorized Representative <br /> � 3 <br /> Signa re D te <br /> ecatur Police Department (City of Decatur) <br /> Name of Organization <br /> 333 S. Franklin Street, Decatur, I1. 62523 <br /> Address of Organization <br /> OJP FORM 4061f1 (REV.2/69)Previous editions are obsolete. <br />