Laserfiche WebLink
Exhibit G-2 Certification Regarding Deba: ment, Suspension and Other <br />Responsibility Miatirers - Primary Covered Transactions <br />I. The prospective primary participant certifies to the best of its knowledge and belief, that it and its principals: <br />A. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily <br />excluded from covered transactions by any Federal department or agency; <br />B. Have not within a three (3) year period preceding this proposal been convicted of or had a civil judgment <br />rendered against them for commission of fraud or a criminal offense in connection with obtaining, <br />attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under <br />a public transaction; violation of Federal or State anti-trust statues or commission of embezzlement, <br />theft, forgery. bribery, falsification or destruction of records, making false statements, or receiving <br />stolen property; <br />C. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity <br />(Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1)(b) <br />of this certification; and <br />D. Have not within a three (3) year period preceding this application f proposal had one or more public <br />transactions (Federal. State and local) terminated for cause or default. <br />11. Where the prospective primary participant is unable to certify to any of the statements in this certification, <br />such prospective participant shalt attach an explanation to this proposal. <br />Intermountain Materials Testing <br />Consultant (firm Name) <br />Signatujo `uthorized Official of 6gnsultant) <br />WSAOT Form 140-089 EF Exhibit G <br />Revised 1013012014 <br />January 30, 2017 <br />Date <br />Agreement Number: KCPW 17-19GE02 <br />Page 1 of 1 <br />