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A EPA Project Control Number ®fir® E PA United States Environmental Protection Agency Washington, DC 20460 Certification Regarding . Debarment , Suspension , and Other Responsibility Matters The prospective participant certifies to the best of its knowledge and belief that it and its principals: (a) : Are not presently debarred , suspended , proposed . for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; (b) Have not within a three year period preceding this proposal been convicted of or had a civil judgement rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain , or performing a public (Federal , State, or local) transaction or contract under a public transaction ; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (c) Are not presently indicted for or otherwise criminally or civilly charged by a government ent' (Federal , State, or local) with commission of any of the offenses enumerated in paragraph (1b) of this certification ; and (d) -Have not --within a --three-year period -preceding this - application/proposal had one or more public transactions (Federal ; State , or local ) terminated for cause or default. I understand that a false statement on this certification may be grounds for rejection of this proposal or termination of the award : In addition , under 18 -USC Sec . 1001 , a false statement may result in a fine of up to $ 10 ,000 or imprisopment_ for up to 5 years, or both. - t Kew k hairman Typed Name & Titlef utt� � p sfiit s; ' r Signa re o Authorized � ,re, tiki 1 ,4v+ Date ❑ 1 am unable to certify to the above statements . My explanation is attached . EPA Form 5700-49 (11 -88) Page 21