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<br /> � 1►1"T�,'`�•T A '
<br /> � ��7CATIV.: OF P�IJ�.�' FF,WZCIPh*Tl'
<br />�'� �#,�TNC: T'F�.`t�NT Si_15Pt]�'SIQ� A','D �Ih'F� FtESPCY7STRTiTTY K�7'ImS .
<br /> 'lhe Pri.maiy Farticiparrt (applica.�rt ic� a� LY.TA giarrt or oovperative ,
<br /> •agr�eeaer�t car �tinl ocertsactor far a s�j or third oc�tract), '
<br />, , , pUte, P�Y .
<br />' �� '��--�� oertifies to the best of its �le3ge ar�d belief� that it e.r�d
<br /> . 1ts pri��pals: I
<br />' 1. Ar�e not prese.-�t.ly c3e�arraj� c�'�'d, P� for ��,,�+t� I
<br /> declarer� ineligible, or wlurrtarily excluded fr� cwered ' ��
<br /> ' transacti�s by arry Federal de�artr��t or age�y;
<br /> . �• Iiave nc�t vithin a �S p�Tiod preoeding thi.s prcposal been I
<br /> � 000�vict�d of or ha� a civil iu3�ent rer�aez�era against t� to� �
<br /> oa�an,issim of fraud o� a csi�inal offense in�oa�ectim vith -
<br /> _ cbta.ining, ett�ting to obtain, at Perfarm.i��g a public (Fladesal, �
<br /> � State or local) trar�actiu�a� omtract tmder a public trarsact.im: .
<br /> violatian of flede.ral o� stete antrtrvst �tat�ut�ss cz� �-���ia� of
<br /> �nbeial�rrt, theft, ica�esy, b�ribei]', falsificatim o�destruction
<br /> of rec�ords, �k,ing talse atate��rts, o�r z�eiving stolm pQvp�ext.y;
<br /> 3. Are no�t pr�se�tly irdiete9 tc� o�r o�tAen�ise cri�cinally ca dvilly
<br /> c3�n�ed�by a rt,3tY (F�desal• State, ar loc�l) vith ,.
<br /> . oa�nir�sian oi any of the cif�ses ��*ate3 in p�ragr�h (2) of this
<br /> c�ert.ificatian; e.nd , , �
<br /> 4. Iiave mt vithin e thrE+e'ya3r period p� thia •
<br /> . applicatiar�rq.�al La� ane oQ snc�+e public transactiar� �flederal, '
<br /> • b't�ete at local) t�-a.inated iar ta�sse oc- default.
<br /> � (If the primary ��rtscipartt (4�Plicarit tor an iY.TA giar:t, cr cooperative ,
<br /> . � egrae�nestt, or poterrtiel third pariy tu�ractos-) is Zn-,able to oertify tc any . .
<br /> of the stet�mJrts in this oeitifica'�ian, the participant c`�all atta� an '
<br /> e�lnr�tion to this oes�tificatim.) .
<br /> � �Fd' pFJ�lC'IFANT (�F'PI.TQIN7'�t A'� U�► GRANT CR O�OP�TVE '
<br /> . • � 1'0'I'f?�I'IAL CU�il+..'''!CR�'P.11 ?:l.TC�t '�i�'� pAFaY QTtIR�'T).
<br /> �' �,�.�=-s. �.u-,z�� , �'IF�S OR 1►Ff� Zl-� I1.��ACY OF
<br /> • '!}� a?rI�TTIS OFi'1}� bTl��?�'I'S �JS'.TlTfD QZ Gt 1+�3�i Z?iIS t�TFICATICt1 �TD
<br /> 'I?�,T � pR�JISIQ3 OF �l U.S.C. b�CIZCt1S 3BD1 €7'�. �IRE �
<br /> AF'F'1.SG�S;E ��Tp, �
<br /> .�', c,a
<br /> ' . , aig�t�ue and itle of �utln�ized Oif cinl. �
<br /> '� �ersig.'�ed dzief legal ov�a�e1 tar the .�1�68,��v��u�-.r�� �
<br /> . • oertities tT�at the �„�'�'��-�3��-�"�a�s`'a rity ta�c3es btete and local
<br /> law to oQ;g,1y vith the cubject a�.�uar�es ar� tha oertificatim above
<br /> has b�+en le�g�aliy �3e. • �
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