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Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion --Primary Covered Transactions The Bidder certifies that the firm or an person associated therewith in the capacity of owner, partner , director , officer, principal , investigator , project director , manager, auditor , and/or position involving the administration of federal funds : (a ) are not presently debarred , suspended , proposed for debarment , declared ineligible , or voluntarily excluded from covered transactions , as defined in 49 CFR s29 . 110 (a ) , by any federal department or agency ; ( b ) have not within a three-year period preceding this certification been convicted of or had a civil judgment rendered against it for: commission of fraud or a criminal offense in connection with obtaining , attempting to obtain , or performing a federal , state , or local government transaction or public contract; violation of federal or state antitrust statutes ; or commission of embezzlement , theft , forgery , bribery , falsification or destruction of records , making false statements , or receiving stolen property (c) are not presently indicted for or otherwise criminally or civilly charged by a federal , state , or local governmental entity with commission of any of the offenses enumerated in paragraph ( b ) of this certification ; and (d ) have not within a three-year period preceding this certification had one or more federal , state , or local government public transactions terminated for cause or default . / The Bidder certifies that it shall not knowingly enter into any transaction with any subcontractor , material supplier, or vendor who is debarred , suspended , declared ineligible , or voluntarily excluded from participation in this project by any federal agency unless authorized by the Florida Department of Transportation . " Company Name : l Vvtc4tLV Vu c' � . Authorized �y — ` ' 0 cam' (Sign ) ( Print Name ) Title : S e Date : 0 00476 F :\PublicWorks\ENGINEERING DIVISION PROJECTS\0745-Indian River Blvd Sidewalk Imp . Proj 12th_17th St. (LAP )\Admim\bid documents\00476 - Certification Regarding Debarment. doc