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ttiUECOPY <br />dfRTla KATION ON LAST PAGE <br />J.R. SMITH. CLERK <br />Attachment G <br />Subcontractor Covered Transactions <br />(1) - The prospective subcontractor of the Sub -Recipient, <br />certifies, by submission of this document, that neither it nor its principals is presently debarred, <br />suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation <br />in this transaction by any Federal department or agency. <br />(2) Where the Sub -Recipient's subcontractor is unable to certify to the above statement, the <br />prospective subcontractor shall attach an explanation to this form. <br />SUBCONTRACTOR: <br />By: <br />Name <br />«SUBRECIPIENT» <br />Signature <br />Sub -Recipient's <br />«ADDRESS 1», «CITY STATE ZIP» <br />Name and Title Street Address <br />Street Address Date <br />City, State, Zip <br />Date <br />