R2001-205 AUTHORIZING SUBMISSION OF GRANT APPLICATION

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U.S.Department of the Interior Certifications Regarding Debarment,Suspension and Other Responsibility Matters,Drug-Free Workplace Requirements and Lobbying Persons signing this form should refer to the regulations referenced below Certification Regarding Debarment, Suspension, Ineligibility and for complete instructions: Voluntary Exclusion-Lower Tier Covered Transactions-(See Appendix B of Subpart D of 43 CFR Part 12.) Certification Regarding Debarment,Suspension,and Other Responsibility Matters - Primary Covered Transactions - The prospecdve primary Certification Regarding Drug-Free Workplace Requirements-Altemate I. ', participant further agrees by submitting this proposai that it will (Grantees Other Than Individuals) and Altemate II. (Grantees Who are j include the clause titled, "Certificadon Regarding Debarment, Individuals)-(See Appendix C of Subpart D of 43 CFR Part 12) I Suspension, Ineligibility and Voluntary Exclusion - Lower Tier � Covered Transacdon," provided by the department or agency Signature on this form provides for compliance with certification entering into this covered transaction, without modification, in all requirements under 43 CFR Parts 12 and l8. The certifications shall be lower tier covered transactions and in all solicitations for lower tier treated as a material representation of fact upon which reliance will be covered transactions. See below for language to be used or use this form placed when the Department of the Interior determines to award the for certification and sign. (See Appendix A of Subpart D of 43 CFR Part covered transaction,grant,cooperative agreement or loan. 12.) PART A:Certification Regarding Debarment,Suspension,and Other Responsibility Matters- Primary Covered Transactions CHECK�IF TH/S CERTlFICATION/S FOR A PRIMARY COVERED TRANSACTlON AND IS APPLICABLE. (1) The prospective primary participant certifies to the best of its knowledge and belief,that it and its principals: (a) Are not presently debarred,suspended,proposed for debartnent,declared ineligible,or voluntarily excluded 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 perfornvng 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 presendy indicted for or otherwise criminally or civilly charged by a govertunental 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 (2) Where the prospective primary participant is unable to certify W any of the statements in this certificarion,such prospective participant shall attach an explanation to this proposal. PART B: Certificallon Regarding Debarment,Suspension,Inellgibility and Voluntary Exclusion- Lower Tier Covered Transactions CHECK !F TKIS CERTlFlCATION/S FOR�LOWER TlER COVERED TRANSACTION AND IS APPLICABLE. (1) The prospective lower tier participant certifies,by submission of this proposal,that neither it nor its principals is presently debartrd,suspended, proposed for debarment,declared ineligible,or voluntarily excluded from participation in this transaction by any Federal departrnent or agency. (2) Where the prospective lower tier participant is unable to certify to any of the statemeets in this certification,such prospective participant shall attach an explanation to this proposal. DF2010 .lme 1995 (Thls form rcplaca DI-l953,DI-1954, _- DId955.DI-1956 and D41963) PART C:Certification Regarding Drug-Free Workplace Requirements CHECK /F THIS CERTlFICATION/S FOR AN APPLICANT WHO IS NOT AN INDIVIDUAL.