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,5 yy Attachment G <br /> X <br /> #aa r „ f Cgi7chon� 'agar ung $ � <br /> s <br /> g <br /> t rtC ja, kati7�v �nta "Ll7��lUS�Ora7 ' e 'r � yY � <br /> �E <br /> tN .v^, „ <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 /> lODB4X= 1040-01 -F 13 <br /> (Print Name and Title) (DCA Contract Number) <br /> ( Street Address ) <br /> ( City , State, Zip) <br /> 24 <br />