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ATTACHMENT <br />CERTIFICATION REGARDING DEBARMENTS, SUSPENSION, INELIGIBILITY AND <br />VOLUNTARY EXCLUSION -LOWER TIER FEDERALLY FUNDED TRANSACTIONS <br />DEP AGREEMENT NO: 60182 <br />The undersigned hereby certifies that neither it nor its principals is presently debarred, suspended, proposed for debarment, <br />declared ineligible, or voluntarily excluded from 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 certification been convicted of or had a civil judgment rendered <br />against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or <br />performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or <br />State anti-trust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, <br />making false statements, or receiving stolen property. <br />(b) <br />Are not presently <br />indicted for <br />or otherwise criminally or civilly charged by a governmental entity <br />(Federal, State or <br />local) with commission of any <br />of the offenses enumerated <br />in paragraph 2.(a) of this Certification; and <br />(c) Have not within a three-year period preceding this certification had one or more public transactions (Federal, State or <br />local) terminated for cause or default. <br />Where the undersigned is unable to certify to any of the statements in this certification, an explanation shall be attached to this <br />certification. <br />Dated this day of , 20 <br />0 <br />Form DEP 55-220 (01/01) <br />Authorized Signature/Contractor <br />Typed Name/Title <br />Contractor's Fimt Name <br />Street Address <br />Building, Suite Number <br />City/State/Zip Code <br />Area Code/Telephone Number <br />DEP Agreement No. G0182, Attachment 1, Page 1 of 2 <br />Page 1 of 2 <br />