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<br />Fonn RA 10 <br /> <br />NONPROCUREMENT DEBARMENT CERTIFICATION <br /> <br />Instructions: <br />First, read the instructions and guidelines on the following two pages. Then, complete this certification form <br />and return it to CJD. <br /> <br />U.S. DEPARTMEl\'T OF JUSTICE <br />OFFICE OF JUSTICE PROGRAMS <br />OFFICE OF THE COMPTROLLER <br /> <br />Certification Regarding <br />Debarment, Suspension, Ineligibility and Voluntary Exclusion <br />Lower Tier Covered Transactions <br />(Sub-Recipient) <br /> <br />This certification is required by the regulations implementing Executive Order 12549, Debarment and <br />Suspension, 28 CFR Part 67, Section 67.5l0, Participants' responsibilities. The regulations were published as <br />Part VII of the May 26, 1 988 Federal Register (pages 19160- 1921l). <br /> <br />(1) The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its <br />principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily <br />excluded from participation in this transaction by any federal department or agency. <br /> <br />(2) Where the prospective lower tier participant is unable to certify to any of the statements in this certification, <br />such prospective participant shall attach an explanation to this proposal. <br /> <br />Mi chae 1 E. Ma lone <br />Name of Authorized Official <br /> <br />City Manager <br />Title of Authorized Official <br /> <br />'S~~~ <br /> <br />11-26-97 <br />Date <br /> <br />City of Paris <br />Name of Organization <br /> <br />P. O. Box 9037, Paris, Texas 75461-9037 <br />Address of Organization <br /> <br />21 <br />em Forms Packet <br />Revised: September. 1997 <br />