R99-117 APPROVING SPECIFICATIONS AND AUTHORIZING REQUEST FOR PROPOSALS

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. .�.2 • CERTIFICATION OF PRIMARY PARTIClPANT REGARD/NG DISBARMENT, � SUSPENSION, AND OTHER RESPONSIBILITY MATTERS Tne Primary Participant (potential contractor for a major third-party contract) I certifies to the best of its knowledge and belief that it and its principals: � 1. Are not presently disbarred, suspended, proposed for debarment, decfared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; 2. Have not within a three-year perioc� preceding this proposal been convicted of or had a civil judgment rendered against therri 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (Federal, State or locai) with commission or any of the offenses � enumerated in paragraph 2 of this certification; and - 4. Have not within a three-year period preceding this application/proposal had one or mcre public transactions (Federal, State, or local) terminated for cause or default. (If the primary participant ((potential third-party contractor)) is unable to certify to any of the statements in this certification, the participant shall attach an explanation to this certification.) THE PRIMARY PARTICIPANT (POTENTIAL CONTRACTOR FOR A MAJOR THIRD-PARTY CONTRACT) CERTIFIES OR AFFIRMS THE TRUTHFULNESS AND ACCURACY OF THE CONTENTS OF THE STATEMENTS SUBMI�ED ON OR WITH THIS CERTIFICATION AND UNDERSTANDS THAT THE PROVISIONS OF 31 U.S.C. SECTION 3801 ET. SEQ. ARE APPLICABLE THERETO. Sionature and Title of Authorized Official � -14-