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ATTACHMENT A4 <br /> y Certificat on� Regard ng, z s r y Jr <br /> u xi bDebarment, xSus ension ,ineli ibilit An°d„ �ol'unta <br /> Contractor Covered Transactions <br /> ( 1 ) The prospective contractor of the Subrecipient , certifies , by <br /> submission of this document , 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 ) Where the Subrecipient'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 Subrecipient 's Name <br /> Name and Title Department Grant Number <br /> Street Address <br /> City, State , Zip <br /> Date <br /> 26 <br />