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Attachment G <br /> 01-014 �0� <br /> y!^aicLy'#rn ' sj 3 <br /> . sr��•"''�`� ,�.� ���,, � � .� ebarmrmen S �, . , <br /> , ¢ a01 ntary �xcluslon e g <br /> fhYr , '}rro. ii •'ht"F PrcfS �° ` "KSvRr� �^'�CSr^ ; 7 o itii°_�. �:. j. o_k$:.'c -.i;.i°' �` 4 .. <br /> �?4u'� <br /> Subcontractor Covered Transactions <br /> ( 1 ) The prospective subcontractor of the Recipient, , certifies , by <br /> submission of this document, 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) Where the Contractor' s subcontractor is unable to certify to the above statement, the <br /> prospective contractor shall attach an explanation to this form. <br /> ( Sub-Contractor ' s Name) (Recipient' s Name) <br /> Date: <br /> (Authorized Signature) <br /> IODB4X- 10-40-01 -F 13 <br /> (Print Name and Title) (DCA Contract Number) <br /> (Street Address) <br /> (City , State, Zip) <br /> 24 <br />