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APPENDIX D <br /> is <br /> Subcontractor Covered Transactions <br /> ( 1 ) The prospective subcontractor of the Recipient, <br /> certifies, by 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 Recipient's subcontractor is unable to certify to the above statement, the <br /> prospective subcontractor shall attach an explanation to this form . <br /> SUBCONTRACTOR: <br /> By: <br /> Signature Recipient's Name <br /> 10DB-4X- 1040-01 -F 13 <br /> Name and Title DCA Contract Number <br /> Street Address <br /> City, State , Zip <br /> Date <br /> 43 <br />