Laserfiche WebLink
Attachment G <br /> Certcation Regarding <br /> Debarment, Suspension, Ineligibility <br /> And Voluntary Exclusion <br /> Contractor Covered Transactions <br /> ( 1 ) The prospective contractor of the Recipient, certifies, by <br /> submission of this document, that neither it nor its principals is presently debarred, suspended, <br /> proposed for debarment, declared ineligible, or voluntarily excluded from participation in this <br /> transaction by any Federal department or agency. <br /> (2) Where the Recipient's contractor is unable to certify to the above statement, the prospective <br /> contractor shall attach an explanation to this form. <br /> CONTRACTOR: <br /> By: <br /> Signature Recipient's Name <br /> Name and Title DEM Contract Number <br /> Street Address <br /> City, State, Zip <br /> Date <br /> 36 <br />