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And Voluntar✓Exclusion <br />Contractor Covered Transactions <br />(1) The prospective contractor of the Recipient, Indian River County, certifies, by submission of this <br />document, that neither it nor its principals is presently debarred, suspended, proposed for <br />debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any <br />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 />Indian River Countv <br />Contractor's Name and Title Recipient's Name <br />OBDB-D3-10-40-01- 12 <br />Signature DCA Contract Number <br />Street Address <br />City, State, Zip <br />Date <br />NOTE: SUBMISSION OF THIS FORM DOES NOT PRECLUDE RECIPIENT'S COMPLETION AND <br />SUBMISSION OF THE "BIDDING INFORMATION AND CONTRACTOR ELIGIBILITY FORM." <br />33 <br />