R2001-92 AUTHORIZING SUBMISSION OF GRANT APPLICATION

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Project Number 17-01-000014 U.S.Deparhnent of the Interior Certifications Regarding Debarment,Suspension and Other Responsibility Matters,Drug-Free Workplace Requirements and Lobbying Persoas signing this form should refer to the regulations referenced below Certification Regarding Debarment, Suspension, Ineligibiliry and for complete inswctions: Voluntary Exclusion-Lower Tier Covered Transacdons-(See Appendix B of Subpart D of 43 CFR Part 12.) Certificadon Regarding Debarment,Suspeasion,and Other Respoasibility Matters - Primary Covered Transactions - The prospective primary Certification Regarding Drug-Free Workplace Requirements-Alternate I. participant further agrees by submitting this proposal that it will (Grantees Other Than Individuals) and Alternate II. (Grantees Who aze include the clause tifled, "Certifiration Regarding Debarment, Individuals)-(See Appendix C of Subpart D of 43 CFR Par[12) Suspensioa, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transaction," provided by the deparnnent 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 18. 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 t6e Department of the Interior determines to award the for certification and sign. (See Appendix A of Subpart D of 43 CFR Part covered�ansaction,grant,cooperative ageement or loan. 12.) PART A:Certificarion Regarding Debarment,Suspension,and Other Respoasibility Matters- Primary Covered Transactions CHECIdC!F THIS CERTlFICATION lS FOR A PRIMARY COVERED TRANSACTION AND 1S APPLICABLE. (1) The prospective primary participant certifies to the best of its knowledge and belief,that it and iu principals: (a) Are not presendy debarred,suspended,proposed for debarment,declared ineligibie,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 performing a public(Federal,State or local)transaction or contract under a public transacdon;violation of Federal or State antitrust statutes or commission of embezzlement,theft,forgery, bribery, falsificadon or descrucdon of records,making false statements,or receiving stolen property; (c) Are not presendy indicted for or otherwise criminally or civilly charged by a governmental entiry(Federal,State or local)with commission .. of any of the offeases enumerated ia paragraph(1)(b)of this certificadon;and (d) Have not witlrin a three-year period preceding this applicatiodproposal had one or more public transacdons (Federal, State or local) terminated for cause or defaul� (2) Where the prospective primary par[icipant is unable to certify to any of the statements in this certifcation,such prospective participant shall attach an explanadon to this proposal. PART B: Certification Regarding Debarment,Suspension,Ineligibility and Voluntary Exclusion- Lower Tier Covered Transactions CHECK IF THlS CERTIFICATlON IS FOR A LOWER TIER COVERED TRANSAGTlON AND!S APPLlCABLE. (1) The prospecdve lower tier participant certifies,by submission of this proposal, that neither it nor its principals is presendy debarred, suspeaded, proposed for debarment,declared ineligible,or voluntarily excluded from participation in this rransaction by any Federal department or agency. (2) Where the prospective lower tier participant is unable to certify to any of the statements in this certificadon,such prospective participant shall attach an explanation to this proposal. DI•2010 )une 1995 (This form replac�s DI-1953,DI•1953, D41955,DI-1956 a�DI•1%3) PART C:Cert�cation Regarding Drug-Free Workplace Requirements CHECK IF THIS CERTIFICAT/ON!S FOR AN APPLICANT WHO lS NOT AN/NDIVIDUAL