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Attachment G <br /> iY }r r �r t`P i� s4i`y �" , '��A 3 t?• �, f" ." "G 'f eN w:ral <br /> IIIr r kw. ¢ s Ff ,� y' ,ri`. <br /> JI <br /> "¢N01 rp , <br /> p r r R^ *N�f t g �f� �'Aa° u�`�sp .r"'�j� ' � � "w ." k ✓ a <br /> u e £ frixvtwyM s <br /> ,oaf �Yk�x' <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 /> 1 ODB-4X- 10 -4O-01 -F 13 <br /> (Print Name and Title) (DCA Contract Number) <br /> ( Street Address ) <br /> (City , State, Zip) <br /> 24 <br />