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Attachment G <br /> fix fry \ ' , � <br /> r S f rr +t e2 u'W` L��. StC i`i'`` f''i cx`?S N 1Y� s r - :r'tni rc„?".rT�z• s ^'+rar�71Y '� .$ .n f'e ,;,."3 <br /> ,! t r 4 1 Ft e § Mrs y,, �e"»F � E� ..sy. ..;.ac`s- rx `a F. .E! T7k 1. r�4�� �:c"'s'�t <br /> , , y � r i f Cerauticatdoar Itepard►naa"� " � � � <br /> 'E r'r �t g— t b ' b " '' ' Gs'-moi;>� <br /> s xr an, xt . <br /> l�tk �C�+"ni'S9 <br /> y,�l rx'�t4 r �'m>-.rye kms' r u=�ta„7.W� t��t'.2 wr'�s>f"eY' iC'S''2� ..w�`s7' ��ti P~''}'.�s;.`� r 3�✓,`C�' f','cdi t "a <br /> r �y ��`f :. � `���c�F � � h � * nx- $\ t' <br /> Jfn nvr IA M� > r2ae�i�^, y3 Ft zt�.� rfi }ys nik nir.Y' �`r4+ss . - n 2i7 'sd 2` '.' f'sr� . '°"'7"4 e f <br /> Fa nn' a �.:.ril <br /> '} r "s �h 3� a f7� ', . ' m vw�` ;$��4..Rte"s f*fr,Yx ,�: }�St,.F�i'eV � F''hi k H �y �S p4 �y'3 � , v{'. �+5 r �!t d xY E ,y��i�fi`.S'u"+� <br /> � N� r �i .y Sits{ ^�+ ° y��'• x <br /> ° a, ,�& �i .:afl m5 e .q.v�'LfP ws hrr {. ,„ ♦ ! t3rs .t`n'•'�� P t? of .^ x.:C „��ry <br /> a <br /> ak S � F n'' t u r 'i ''y� ; � .�j';�{ydti ,,t xiyAnoYntar�i4�jcduOlonz\!' '.i} �lv SIE. 4C6Gr �`'�BYu� Fr � ti,.� Y <br />'Sc 4+k <br /> : ii�nu^ L7 <br /> x s � Xf, n. 5 > N.u'�.k a 7�FStt k- 4 s ; � �Y3s�tTt_ .:�.,r ,.Y. .F,��.A,iF ti. l��>..=.pF �c3 �.ii•.-zJ <br />�w3fi..^„s. S.. Y <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 /> lODB -4X- 10 -40- 01 -F 13 <br /> (Print Name and Title) (DCA Contract Number) <br /> ( Street Address) <br /> ( City , State, Zip) <br /> 24 <br />