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I <br />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 />I (a) are not presently debarred, suspended, proposed for debarment, declared ineligible, or <br />voluntarily excluded from covered transactions, as defined in 49 CFR s29.1 10(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 />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 athree-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 Na <br />Authorized B <br />Title: <br />(Sign) (Print Name) <br />eS <br />00476 <br />Date:_ 081 (ArI t I <br />C <br />F:\Public Works\ENGINEERING DIVISION PROJECTS\1024-17th Street and IR Blvd Intersection\Admim\Contract Documents\00476 - <br />Certification Regarding Debarment.doc <br />