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7. CERTIFICATION REGARDING <br />DEBARMENT, SUSPENSION, AND <br />OTHER RESPONSmILITY MATTERS <br />--PRIMARY COVERED <br />TRANSACTIONS <br />I) The prospective contractor certifies to the <br />best of its knowledge and belief, that it and <br />its principals: <br />a) Are not presently debarred, suspended, <br />proposed for debarment, declared <br />ineligible, or voluntarily excluded from <br />covered transactions by any Federal <br />department or agency; <br />b) Have not within a three-year period <br />preceding this contract been convicted <br />of or had a civil judgment rendered <br />against them for commission of fraud or <br />a criminal offense in connection with <br />obtaining, attempting to obtain, or <br />performing a public (Federal, State or <br />local) transaction or contract under a <br />CONTRACTOR SIGNATURE l U)UTRED <br />SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL <br />Please also print or type name : <br />n b I'V) RDtul <br />ORGANIZATION NAME: (if applicable) <br />'II~~~~ C\1~ <br />2015-2017 Consolidated Contract <br />DOH CONTRACT #: C17114 <br />public transaction; violation of Federal <br />or State antitrust statutes or commission <br />of embezzlement, theft, forgery, bribery, <br />falsification or destruction of records, <br />making false statements, or receiving <br />stolen property; <br />c) Are not presently indicted for or <br />otherwise criminally or civilly charged <br />by a governmental entity (Federal, State <br />or local) with commission of any of the <br />offenses enumerated in paragraph (I )(b) <br />ofthis certification; and <br />d) Have not within a three-year period <br />preceding this contract had one or more <br />public transactions (Federal, State or <br />local) terminated for cause or default. <br />2) Where the prospective contractor is unable <br />to certify to any of the statements in this <br />certification, such prospective contractor <br />shall attach an explanation to this proposal. <br />TITLE <br />DATE <br />Page 15 of 17