HomeMy WebLinkAboutExhibit 11A •
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Attachment
Certification Regarding
Debarment, Suspension, Ineligibility
and Voluntary Exclusion
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 Recipient's Name
By:
Signature DEM Contract Number
Name and Title
Street Address
City, State, Zip
Date
36