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Attachment H <br /> Certification Regarding <br /> Debarment, Suspension, Ineligibility <br /> And Voluntary 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 /> Firm <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 />