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A TPUE COPY <br />CERTI!zICATION ON L! FT PAGE <br />L. 3J i LER, CLL,<K <br />ATTACHMENT G <br />CERTIFICATION REGARDING <br />DEBARMENT, SUSPENSION, INELIGIBILITY <br />AND VOLUNTARY EXCLUSION <br />Subcontractor Covered Transactions <br />The prospective subcontractor, , of the <br />Sub -Recipient certifies, by submission of this document, that neither it, its principals, nor its affiliates are <br />presently debarred, suspended, proposed for debarment, declared ineligible, voluntarily excluded, or <br />disqualified from participation in this transaction by any federal department or agency. <br />By: <br />SUB -CONTRACTOR: <br />Signature <br />Sub -Recipient's Name <br />Name and Title FDEM Agreement Number <br />Street Address <br />City, State, Zip <br />Date <br />65 <br />