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<br />.-~ <br />f~~.:::.('~~~: <br />\,)~~J <br />'---.:.,:...,. <br /> <br />u.s. DEPARTMENT OF JUSTICE <br />orneE OF J1.'SllCE PROGRAMS <br />OFneE or TIlE COMPTROLLER <br /> <br />Dehannent, <br /> <br />Certification Regarding <br />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 Suspension, <br />2-;;: CFR Part 67. Section 67.5iO, Participants' respon~jbjlities. The regulations were published as Part VI[ of the <br />~hy 26, ]988 Frderal RegL<ler (pages 19160-192(1). <br /> <br />(BEFORE COMPLFTING CERTIFICATION, READ INSTRUCTIONS ON REVERSE) <br /> <br />( ) The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals <br />ti;': presently debarred, suspended, proposed. for debarment, declared ineligible, or voluntarily excluded from <br />F':.r1icipation in this transaction by any Federal department or agency. . <br /> <br />(:) v.'bere the prospective lower tier participant is unable to certify to any of the statements in this certification, such <br />p:-o~pective participant shall attach an explanation to this proposal. <br /> <br />/lII,'c.("..~( E./JIJ"/ONf!... C:,y /l1""c.~-tr <br /> <br />';m~::;~ <br /> <br /> <br />5;c"Tlature ) <br /> <br /> <br />~;E,:t6rga.~i!iont.r :? <br /> <br />3-f)--73 <br />Date <br /> <br />___13;;;.. '(OJ'? <br />;;;;.css of Organi7...ation <br /> <br />A.r .' s- <br />o <br /> <br />~ <br />I x. 7..>V~o <br /> <br />71 <br /> <br />.,..-.;,.'t;_.-"oo:r;<':s,... <br /> <br />.- <br /> <br />.-J. <br />