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a <br /> I <br /> ' t�t <br /> Attachment H j <br /> Contractor Covered Transactions <br /> ( 1 ) The prospective 'contractor of the Recipient, Indian River County, certifies, by submission of this j <br /> document, that neither it nor its principals Is presently debarred, suspended, *Proposed for <br /> debarment, declared ineligible, or voluntarily excluded from Oarticipation in this transaction by any <br /> Federal department or agency. i <br /> I <br /> i <br /> (2) Where the Recipient's contractor is unable to certify to the above statement, the prospective <br /> contractor shall attach an explanation to this form. <br /> A-ssoo4•rt vice P:2xs� �rm,- Indian River County <br /> Contractor's Name and Title Recipient's. Name ; <br /> 06DB-3C-10-40-01 -W 14 <br /> Signature DCA Contract Number i <br /> 1 <br /> Firm <br /> s `1 � :✓ PP/J-cuciG /3L✓Jy S✓ / Fe y <br /> Street Address <br /> City, State, Zip <br /> d2- - za - oG� <br /> Date <br /> i <br /> - i <br /> i <br /> i <br /> 1 <br /> - - 1 <br /> NOTE: SUBMISSION OF THIS. FORM DOES NOT PRECLUDE RECIPIENTS COMPLETION AND <br /> SUBMISSION OF THE " BIDDING;INFORMATION AND CONTRACTOR ELIGIBILITY FORM." ' <br /> i <br /> 8 <br /> ii <br /> S <br /> 1i <br /> q <br /> i <br /> i <br /> a <br /> 33 3 <br /> 3 <br />