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0 <br />C:: <br />ATTACHMENT B <br />CERTIFICATION REGARDING DEBARMENTS. SUSPENSION, INELIGIBILITY AND VOLUNTARY <br />EXCLUSION -LOWER TIER FEDERALLY FUNDED TRANSACTIONS <br />Required for all contractors and subcontractors under <br />DEP GRANT AGREEMENT: OFMAS-122 <br />I . The undersigned hereby certifies 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. The undersigned also certifies that it and its principals: <br />(a) Have not within a three-year period preceding this response been convicted of or had a criminal <br />offense in connection with obtaining, attempting to obtain, or performing a public (Federal. State or <br />local) transaction or contract under a public transaction, violation of Federal or State anti-trust statutes <br />or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making <br />false statements, or receiving stolen property. <br />(b) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity <br />(Federal, State or local) with commission of any of the offenses enumerated in paragraph 2. (a) of this <br />Certification; and <br />(c) Have not within a three-year period preceding this certification had one or more public transactions <br />(Federal, State or local) terminated for cause or default. <br />3. Where the undersigned is unable to certify to any of the statements in this certification, an explanation shall <br />be attached to this certification. <br />i <br />Dated this __&_day of rr t✓ I9�• <br />By _ <br />Authorized ignatme/Contractor <br />i«tirtirt rif R /,//9 ­,A11 -Z; c> 1C141&,4I A4J <br />Typed Name/Title <br />inc an R ver County f Ar.croven I )ate i <br />ACministrat,o:i _ <br />I Contractor's Firm/Name <br />Legal I <br />-- �— Street Address <br />Deoartmoni <br />Division <br />Building, Suite Number <br />City/State/Zip Code <br />Area Coderrelephone Number <br />DEP FORM It -043 Rev(05/95) <br />DEP Grant Agreement No. 0FMAS-122, Attachment B, Pat!r 1 fit 2 <br />