Laserfiche WebLink
SECTION 00640 — CERTIFICATION REGARDINEBARMENTS9 SUSPENSION <br /> INELIGIBILITY AND VOLUNTARY EXCLUSIO — LOWER TIER FEDERALLY FUNDED <br /> ' TRANSACTIONS <br /> REQUIRED FOR ALL CONTRACTORS AND SUBCONTRACTORS <br /> 1 . <br /> The undersigned hereby certifies that neither it nor its principals is presently debarred , <br /> suspended , proposed for debarment , declared ineligible , or voluntarily excluded from <br /> 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 response been convicted of <br /> or had a criminal offense in connection with obtaining , attempting to obtain , or <br /> performing a public ( Federal , State or local ) transaction or contract under a <br /> public transaction ; violation of Federal or State anti-trust statutes or commission <br /> 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 <br /> governmental entity (Federal , State or local ) with commission of any of the <br /> 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 <br /> public transactions ( Federal , State or local ) terminated for cause or default . <br /> 3 . Where the undersigned is unable to certify to any of the statements in this certification , <br /> an explanation shall be attached to this certification . <br /> Dated this day of , 20 <br /> BY <br /> Authorized Signature/Contractor <br /> Typed Name/ I itle <br /> Contractor's Firm Name <br /> Street Address <br /> Building , Suite Number <br /> City/State/Zip Code <br /> DEP FORM 11 -043 Rev(05/95) Area Code/Telephone Number <br /> 00640- 1 <br /> 0060 Debarments , Suspension , <br /> upnBI dd Ineligibility, etc.FAPublic Works\KeithM\Stormwater Projects\Gifford East\Constructio hBiContract <br /> mennts\ nonrat <br /> Documents\00640 - Debarments, Suspension , Ineligibility, etc.doc <br />