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Attachment G <br /> Certification Regarding <br /> Debarment, Suspension, Ineligibility <br /> And Voluntary Exclusion <br /> Subcontractor Covered Transactions <br /> ( 1 ) The prospective subcontractor of the Recipient , certifies , by <br /> submission of this document, that neither it nor its principals is presently debarred, <br /> suspended, proposed for debarment, declared ineligible, or voluntarily excluded from <br /> participation in this transaction by any Federal department or agency . <br /> ( 2) Where the Contractor ' s subcontractor is unable to certify to the above statement, the <br /> prospective contractor shall attach an explanation to this form. <br /> ( Sub - Contractor ' s Name) (Recipient ' s Name) <br /> Date : <br /> ( Authorized Signature) <br /> l ODB -4X- 10-40 - 01 -F 13 <br /> (Print Name and Title) ( DCA Contract Number) <br /> ( Street Address ) <br /> ( City , State , Zip ) <br /> 24 <br />