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Attachment G <br /> Certification Regarding <br /> Debarment, Suspension , Ineligibility <br /> And Voluntary Exclusion <br /> Contractor Covered Transactions <br /> ( 1 ) The prospective contractor of the Recipient, certifies, by <br /> submission of this document, that neither it nor its principals is presently debarred, suspended, proposed <br /> for 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 contractor <br /> shall attach an explanation to this form . <br /> CONTRACTOR : <br /> By: <br /> Signature Recipient ' s Name <br /> Name and Title DCA Contract Number <br /> Street Address <br /> City, State, Zip <br /> Date <br /> 36 <br />