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DOH CONTRACT #: CLH18249 <br />4) Have not within a three-year period preceding this contract had one or more public transactions (Federal, <br />State or local) terminated for cause or default. <br />B. Where the prospective contractor is unable to certify to any of the statements in this certification, such <br />prospective contractor shall attach an explanation to this contract. <br />AUTHORIZED SIGNATURE REQUIRED <br />SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL <br />TITLE <br />PLEASE PRINT OR TYPE NAME: <br />ORGANIZATION NAME: (if applicable) <br />DATE <br />2018-2020 Consolidated Contract Page 15 of 17 <br />