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<br />CERTIFICATION REGARDING <br />DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION <br />FOR COVERED CONTRACTS <br /> <br />Federal Executive Order 12549 requires the General SSMess CommiSSion to screen eacn ApPlicant Organtzatlon to cetermine wl181her the <br />appllcam has a rlgnt 10 obtain finanClal &sslstanc8IPropeny In acccraance with feaera! regulations on aebarment. susoenSlon. ineligibility and <br />vOluntary exClusion. Each applicant organazatlcnlc0V8reo contractor must alSO screen eacn of its coverea succontractars. In this C8rtlficallon <br />q:ontractor" reters 10 both contraaor ana SUbcontractOr. "contract" reters to bOth contract ana SUOCOmract. <br /> <br />3y sIgning and SUbmitting this CBniticallOn II1S Applicam OrganrzaIion acceots Ihe follOWing terms: <br /> <br />- 1. The certification herein beiow is "mateoal representation of fact upon wnich reliance was olacea woen thiS comract was emlll1H:l into. It <br />II is later determrneo that the OrganlZ8IIOn renoerea an erroneous cenlficauan, In addition 10 otner remeale, available to Ihe teoera. govern. <br />ment, the General Services CommiSSIon. the United States General Services Administration or OIner teaeral depanmenr or agency may pur- <br />sue avaIlable remeaies. Induding SuspenSion anaJcr debarment. <br />2. The Organization shaJl PRMdelmmeai818 wnnen notice to the Agency to wnich this centticauon IS SUDmltted if at any time the Organazatlon <br />iearns that the Csntfication was erroneous wnen SUDmmed or has become erroneous oy reason at changea Circumstances. <br />3. The wores "C0V8l1Ki contract." "debarrea." "suspenaeci." "inaligible:' "panlcio8m." ".,erson;' ";Jrinoo81:' "proposcu:' and '"Voluntarily ex. <br />cludBCI:' as usea in Ihis cendieanon have meaMlngs Da.seo upon matenaJ in tne Oetinnrons and Coverage Sections at feoeral rules Imptement. <br />Ing ExecutIve Order 12549. <br />4 The OrganIzation agrees by submming this csnlficatlon thaI. ShOUld eligibility 10 aCQUire orooerty De granted. it shall not knOWIngly enler <br />IntO any SUDCOmraa wllh a person who IS oeDarrea. susoenOed. declareo Ineligible. or vOiuntanly eXCluoBQ tram panlCloauon In Ihis COWtntc:2 <br />'ransamon. Unless autnonzea by the Genenu SeMC8S CommISSIOn. Ihe Unrtea States Generar SeMCSS Admlnlstranon or Clner federal deQllrtmem <br />:r agency. <br />The Organization further agrees Dy SUbmlnlnq this certlficanon tnal It Will inclUde thiS certificatIon lltled "Certification Aegarainq Cebar- <br />-am. Susoenslon. IneligIbility, ana Voluntarv ExclUSion 10r Coverea ContraCtS" WllOOUt moadicanon, In aU Coverea sUbcontraClS In SOIlcuaUon <br />'or all COV8r8Q SubCOntractS. <br />0, The Organlzauon may rety upon a cenlficauon at a pOIamlal SUDComractor tnal IS nor debarrea. susoenOed. ineligible. or vOluntanty axclud- <br />.;0 from lOe coverea COntracl. unless II knows tnatlne certification IS erroneous. A OrganlZ8llon must. at a minImum OOtalO cenlficabone from <br />lIS covered subcontraaors upon 8ach suDcontracfs innialion and upon eacn renewal. <br />7. Nothing contalnea In all Ihe fOregolng snall be construea to reqUIre estaDlishmem Of a system of recoras In order 10 render in good faith <br />the cenlficallOn required by this cenrficarlon dQCume,... The knowtedge and Informallon of a comractor IS not requlrea to eXCMd tnII Whtch <br />IS normally posseasea by . prudent person In the oralnary course of bUSiness dealings. <br />a ExcePl for ContraClS aulhonzea Uncler paragraph 4 of these lemus. It an OrganlzalJOn In a coverea comract knOWingly enters IntO . CCMmtd <br />'5ubCOmraa: with a person who IS luaQenGBd. d8batred. ineUgible. or votuntanly excluded from panlciPAUon In this Iran.sacIion. in addttion <br />:.1 other remediel avaJlablelO Ih. federaJ government. the Uniled Sla1el GeneraJ SeMce. Administration. or otner tederal deaanm8nl or .gen. <br />cy, as appllCaDle. andJQr Ihe Genetal S8Mces CommiSSIOn may pursue available remeales. inCluding susoenSlon anoJor deOalllwW. <br /> <br />CEflTIFlCATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOWNTARY <br />EXCWSION FOR COVERED CONTRACTS <br /> <br />YOU MUST CHECK THE BOX WHICH APPLIES TO YOUR ORGANIZATION OR' <br />THIS FORM IS INCOMPLETE. <br /> <br />~ <br />----: The App41C8n1 OR)anlDbon canities. by subrl'nSSlOn of this CenIficanon. that nBlther If nor lis onnctDalS is Dresemty detlamtd. ~~. <br />~tOoos8Cl for clebarmenl. declareo Ineligible or VOluntanly excluded from panlClpallon 1M this Contract by any federal deoanme" or agency <br />or Dy the Slale of Texas. <br /> <br />I I .. <br />~ The ApPlicant OrganlZabOn IS unable 10 candy 10 one or more of the terms In tn,s cenlticauon. and the Applicanl OrgarllZlllOn ~Ult <br />lllaCn an explanation for eactl of the at)Qw terms to whICh he IS unaoJe to make cenlficallon. AnaCh tn. eJCplanatlon(s' to thll C81aftc:1tion. <br /> <br />Name of Applicant OrglllUZlWOn <br /> <br />Printed Name at Aulhanzea OfflciaJ <br /> <br />Dale <br /> <br />SignarureiTiUe af Autnonzaa OfficiaJ <br /> <br />MAlL COUPlETED FORMS TO; GENERAL SERVtCES COMMISSION. FEDERAL SURPLUS PROPERTY PROGRAM. <br />P.O."SOX 130C7.AUS11N. TX 7B7'ff.3OQ <br />