Laserfiche WebLink
Attachment E <br /> Certification Regarding <br /> Debarment„Suspension,=ineligibility <br /> And Vohm `Exclusion <br /> Contractor Covered Transactions <br /> ( 1 ) The prospective contractor of the Recipient, certifies, by <br /> submission of this document, that neither It nor its principals is presently debarred, suspended, <br /> Proposed for debarment, declared ineligible, or voluntarily excluded from participation in this <br /> transaction by any Federal department or agency. <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 /> CONTRACTOR: <br /> By: <br /> Signature Recipient's Name <br /> Name and Title Division Contract Number <br /> Street Address <br /> City, State , Zip <br /> Date <br /> 38 <br />