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ATTACHMENT C CERTIFICATION REGARDING DEBARMENTS , SUSPENSION , INELIGIBILITY AND VOLUNTARY EXCLUSION- LOWER TIER FEDERALLY FUNDED TRANSACTIONS DEP CONTRACT NO : RM026 1. The undersigned hereby certifies that neither it nor its principals is presently debarred , suspended , proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. 2. The undersigned also certifies that it and its principals: (a ) Have not within a three-year period preceding this certification been convicted of or had a civil judgment 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 anti-trust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property. ( b) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity ( Federal , State or local ) with commission of any of the offenses enumerated in paragraph 2 . (a ) of this Certification ; and (c) Have not within a three-year period preceding this certification had one or more public transactions ( Federal, State or local) terminated for cause or default. 3. Where the undersigned is unable to certify to any of the statements in this certification , an explanation shall be attached to this certification . Dated this day of 20 By Authorized Signature/Contractor Typed Name/Title Contractor's Firm Name Street Address Building, Suite Number City/State/Zip Code Area Code/Telephone Number Form DEP 55-220 (01/01) DEP Contract No , RM026 , Attachment C, Page 1 of 2