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w ' � <br /> ATTACHMENT H <br /> CERTIFICATION REGARDING DEBARMENTS, SUSPENSION, INELIGIBILITY AND <br /> VOLUNTARY EXCLUSION-LOWER TIER FEDERALLY FUNDED TRANSACTIONS <br /> DEP AGREEMENT NO: G0061 <br /> 1 . The undersigned hereby certifies that neither it nor its principals is presently debarred, suspended, proposed for <br /> debarment, <br /> declared ineligible, or voluntarily excluded from participation in this transaction by any 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 certification been convicted of or had a civil judgment rendered <br /> against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, <br /> or <br /> performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or <br /> State anti-trust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, <br /> malting false statements, or receiving stolen property. <br /> (b) Are not presently indicted for or otherwise criminally or civilly charged by a govemmental entity (Federal, State or <br /> local) with commission of any of the offenses enumerated in paragraph 2. (a) of this Certification; and <br /> (c) Have not within a three-year period preceding this certification had one or more public transactions (Federal , State or <br /> 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 be attached <br /> to this <br /> certification. <br /> Dated this 1 0th day of June 20 0 3 <br /> By <br /> � —AW40e; <br /> Authorized Signature/Contractor <br /> � . <br /> Typed ame/Title <br /> CU . <br /> t <br /> n <br /> Contractor' s Firm e ` <br /> SAW I <br /> NU <br /> Street Address a <br /> Q <br /> a <br /> .r <br /> Building, Suite Number <br /> o � <br /> ' U o a= <br /> a) Y W w W- <br /> ' C CU W <br /> City/State/Zip dode M cn o E c <br /> 1JG C CD d= <br /> *�-' o <br /> 12 <br /> Q m U it O <br /> Area Code/Telephone Number p <br /> Form DEP 55-220 (01/01) <br /> DEP Agreement No . G00619 Attachment H, Page 1 of 2 <br />