HomeMy WebLinkAboutExhibit 11Attachment E
Contractor Covered Transactions
(1) The prospective contractor of the Recipient, , certifies, by
submission of this document, that neither it nor its principals is presently debarred, suspended,
proposed for debarment, declared ineligible, or voluntarily excluded from participation in this
transaction by any Federal department or agency.
(2) Where the Recipient's contractor is unable to certify to the above statement, the prospective
contractor shall attach an explanation to this form.
CONTRACTOR:
By:
Signature Recipient's Name
Name and Title Division Contract Number
Street Address
City, State, Zip
Date
47