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{ <br /> ATTACHMENT C <br /> CERTIFICATION REGARDING DEBARMENTS , SUSPENSION, INELIGIBILITY AND <br /> VOLUNTARY EXCLUSION-LOWER TIER FEDERALLY FUNDED TRANSACTIONS <br /> DEP AGREEMENT NO : LW475 <br /> 1 . The undersigned hereby certifies that neither it nor its principals is presently debarred, suspended, proposed <br /> for 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 /> making false statements, or receiving stolen property. <br /> (b) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State <br />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 day of 20 <br /> By <br /> Authorized Signature/Contractor <br /> Typed Name/Title <br /> Contractor's Firm Name <br /> Street Address <br /> Building, Suite Number <br /> City/State/Zip Code <br /> Area Code/Telephone Number <br /> Form DEP 55-220 (01/01 ) Page i of 2 <br /> DEP Agreement No. LW475, Attachment C, Page 1 of 2 <br />