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• <br />FWC Agreement No. 13127 <br />Attachment F <br />CERTIFICATION REGARDING DEBARMENTS, SUSPENSION, INELIGIBILITY AND <br />VOLUNTARY EXCLUSION -LOWER TIER FEDERALLY FUNDED TRANSACTIONS <br />Required for all contractors and subcontractors on procurement (vendor) contracts of $100,000 or more, and for all <br />contracts and grants with sub -recipients regardless of amount, when funded by a federal grant. <br />1 The undersigned hereby certifies that neither it nor its principals is presently debarred, suspended, proposed <br />for. debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any <br />Federal department or agency. <br />2. The undersigned also certifies that it and its principals: <br />(a) Have not within a three-year period preceding this response been convicted of or had a criminal offense <br />In connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) <br />transaction or contract under a public transaction; violation of Federal or State anti-trust statutes or <br />commission of embezzlement theft forgery, bribery, falsification or destruction of records, making <br />false statements, or receiving stolen property. <br />(b) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity <br />(Federal, State or local) with commission of any of the offenses enumerated in paragraph 2.(a) of this <br />Certification; and <br />(c) Have not within a three-year period preceding this certification had one or more public transactions <br />(Federal, State or local) terminated for cause or default. <br />3. Where the undersigned is unable to certify to any of the statements in this certification, an explanation shall <br />be attached to this certification. <br />Dated this <br />day of , 20_ <br />By: <br />Authorized Signature/Contractor <br />Typed Name/Title <br />Grantee Name/Contractor Name <br />Street Address <br />Building, Suite Number <br />City/State/Zip Code <br />Area Code/Telephone Number <br />debar.226/rev.12/00 <br />Ver. December 2013 <br />Attachment F, Page 1 of 2 <br />