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C] <br />i <br />i <br />ATTACHMENT B <br />CERTURICATION REGARDING DEBARMENTS, SUSPENSION, INFLIGIBILITY AND VOLUNTARY <br />EXCLUSION -LOWER TIER FEDERALLY FUNDED TRANSACTIONS <br />Required for all contractors unit subrontractors under <br />DFP GRANT AGREEMENT: OFMAS-122 <br />1, The undersigned hereby certifies that neither it nor its principals is presently debarred, suspended, proposed <br />for debarment, declared ineligible, or voluntarily excluded front 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 hada criminal <br />offense in connection witls obtaining, allempting to obtain, or perfonning a public (Federal, Stale or <br />local) transaction or contract under a public transaction; violation of'Fcderal or State anti-trust statutes <br />or commission of ornbeazlement, theft, forgery, bribery, falsification or destruction of records, making <br />false statements, or receiving stolen properly. <br />(b) Are not presently indicted for or olhenvise criminally or civilly charged by a governmental catily <br />(Federal, State or local) with commission of any of the offenses cnunrcrated 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 derault. <br />3. Where the undersigned is unable to certify to any of the stnteinenls in this certification, an explanation shall <br />be attached to this certification. <br />r <br />Dated this -6 ay of 19 <br />�- Authorized ignature Conlractor <br />Cityfslato zip <br />Area Cndefrefcphone Number <br />DI, 1' FORM l 144.1 Rcv(0195) <br />DEP Grant Agrivnitnt No. OFMAS-122, Attachment II, Payr 1 of 2 <br />