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Certification Regarding Debarment, Suspension, Ineligibility and Voluntary <br /> Exclusion Primary Covered Transactions <br /> The Bidder certifies that, the firm or any person associated therewith in the capacity of <br /> owner, partner, director, officer, principal , investigator, project director, manager, auditor, and/or <br /> position involving the administration of federal funds : <br /> ( a ) are not presently debarred , suspended , proposed for debarment , declared ineligible , or <br /> voluntarily excluded from covered transactions , as defined in 49 CFR s29 . 110 ( a ) , by any federal <br /> department or agency; <br /> ( b ) have not within a three-year period preceding this certification been convicted of or had <br /> a civil judgment rendered against it for commission of fraud or a criminal offense in connection <br /> with obtaining , attempting to obtain , or performing a federal , state , or local government transaction <br /> or public contract, violation of federal or state antitrust statutes ; or commission of embezzlement , <br /> theft , forgery , bribery , falsification or destruction of records , making false statements , or receiving <br /> stolen property <br /> (c) are not presently indicted for or otherwise criminally or civilly charged by a federal <br />, <br /> state , or local governmental entity with commission of any of the offenses enumerated in <br /> paragraph ( b ) of this certification ; and <br /> (d ) have not within a three-year period preceding this certification had one or more federal , <br /> state , or local government public transactions terminated for cause or default. <br /> The Bidder certifies that it shall not knowingly enter into any transaction with any <br /> subcontractor, material supplier, or vendor who is debarred , suspended , declared ineligible , or <br /> voluntarily excluded from participation in this project by any federal agency unless authorized by <br /> the Florida Department of Transportation . " <br /> Company Name:GODA'!:0n <br /> Authorized By : <br /> ( Print Name ) <br /> Title : U � uz' C ,rvv Date :_ 5 /912 % % <br /> 00476 <br /> F:1Publfc Works\ENGINEERING DIVISION PROJECTS10845-Old Dixie Hwy Sidewalk US1 _69th (LAI` )\ Wdrnlmlbrd documents100476 - <br /> Certification Regarding Debarment.doc <br />