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Attached wt G, <br /> . • InY <br /> Subtontratter Covered T r=wd.*.' <br /> (I) The prospective subcontractor.-of.the'Recipient, • __,certifc'es,by <br /> subnussion of this document,that neither it nor its principals is,prescnthy debarred, <br /> suspended,.proposed for debarment,declared.ideligible,or voluntarily excluded from <br /> participation in this transaction by any Pedcral.dept or agency ; <br /> (2) Where the Contractor's subcontractor is unable to certify to the above statement;the . - <br /> prospective contractor shall attach an explanation to this form. <br /> eA <br /> (Sub-Contructor's.Name) (Recipient's Natne)' ; <br /> Daic: <br /> (Authorized.Signature) <br /> _ I ODD-4X-10.40-01=E'13. .. <br /> (Print Name wwritle) (DCA-Contract Number) ' <br /> (Street"Address) <br /> (City,State,;Zip)" <br /> ' .24 rt. <br /> tib? .. - - .. w. .. -- _•. _ -. •- .' - '•.iSi�~ tra.'�Y�:r <br /> p±i <br /> t. o- <br /> •ms:F•.=..r, a <br /> »L11 tt Y; <br /> :nxa;,gtFc(:v�Rn.:.+:a]uula,5a''�i-t,. .u. - - - - <br />