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Attachment G <br /> Cie � wifica�I14 Q ega" ing .K,f� a <br /> k e <br /> barmen � , us erasion ne ibin R <br /> < Y F , y „F1ild 4Q Un a �EeIU I <br /> u , <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 pro pective <br /> contractor shall attach an explanation to this form . <br /> CONTRACTOR : <br /> By : <br /> Signature Recipient ' s Name <br /> Name and Title DCA Contract Number <br /> Street Address <br /> City, State , Zip <br /> Date <br /> 35 <br />