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Washington Military Department Contract Number: E2 0·168
<br />Debarment, Suspension, Ineligibility or Voluntary Exclusion Certification Form
<br />NAME Doing business as (OBA)
<br />County of Kittitas Kittitas County
<br />ADDOO,SS Appllcable Procurement WA Uniform Business Federal Employer Tax
<br />205 . 5th Ave Ste. 105 or Solicitation#, If any: lden tifi8f' (UBI) Identification #:
<br />Ellensburg, WA 98926 192002673 91-6001349
<br />This cartlflca,tlon Is submltlod as oart of a reques t to contract.
<br />Instructions For Certification Regard ing Debarment, Suspension , lnellglbllity and Voluntary Excluslon--Lower
<br />Tier Covered Transactions
<br />READ CAREFULLY BEFORE SIGNING THE CERTIFICATION. Fed eral regulations require contractors and bidders to sign an d
<br />abide by the terms of this certification, without modification, In order to participate In certain transactions directly or
<br />Indirectly Involving federal funds.
<br />1. By signing and subm itting this proposal, the prospective lower tier participant Is providing the certification set out
<br />below.
<br />2. The certificallor;i In this clause Is a mc!lerlal representation of fact upon which reliance was plaeed when thi s
<br />transaction was entered Into . If It Is later determined that the prospective · 1ower tier participant knowlngly rendered an
<br />erro neous certificatron, In addition to other remedies avallable to the Federal Govemment the department or agehcy
<br />wll'1 whlcti th .is [f'ansaction originated may pursue available" remedies, inc luding suspension and/or debarment.
<br />3. The prospective lower tier partlclpaAl shall provide Imme diate written notice to the department , Institution or office to
<br />which this proposal Is submitted if at any time the prospective lower tier participant learns that its certification was
<br />erroneous when subm itted or had become erroneous by reason of changed circumstances.
<br />4. The terms covered tran saction, debarred, suspended, inel!gible, lower tier covered ~nsactlon, partic ipant, person,
<br />primary covered transaction, principal, proposal , and voluntarlly excluded, as used In this claus e, have the meaning
<br />set out In th1:1 Dennltlons and Coverage .sections of ru1e·s lmpfl;lmentlng Executive Order 125.49. Yo u may contact the
<br />person to which this proposa l Is submitted for asslstanc~ in obtaining a copy of those regulations.
<br />5. The prospective lower tier participant agrees · by submlttlng this prop osal that, should the proposed coverEid
<br />transaction be entered Into, It shall not knowlngly enter Into any lower lier covered transaction With a per,;on who Is
<br />proP.osed for debarment under the applicab le CFR, debarred, suspen ded, declare d lnellglble, or volu ntarily exc luded
<br />from participation in this covered transaction, unless autho rized by the departtnen t or agency with which this
<br />transaction originated .
<br />6. The prospective lower tier participant further agrees by submitting this proposal that it will Include this clause titled
<br />--certification Regarding Debarment, Suspension, lnellglblllty and Voluntary Exclusion-Lower Tier Covered
<br />Transaction," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered
<br />transactions.
<br />7. A participant in a covered transaction may rely upon a certification of a prospective participant In a lower tier covered
<br />transa~lon tnat It Is not prc,pesed for debarment Under applicab le CF R, debarred, suspended, lnetlglble, or voluntarily
<br />excluded from covered transactions, unless it knows that the certincatlon Is erroneous . A participa nt may deci de tne
<br />method an d fre quency by which it determines the eli gibility. of Its principa l~. Each partfclpant may, but Is not required
<br />to, check the List of Parties Excluded from Federal Pro cureme nt and Non-procureme nt Programs.
<br />8. Noth ing co ntained In the foregoing shall be construed to require establishment of a system of records in order to
<br />r~nder In good faith the certrfl.catlon required b}( this clause. The knewle dge and lnformatiori of a participant Is not
<br />required to exceed that which Is normally possessed by a prudent person In the ord inary course of business actlV!ty.
<br />9. Except fo r transactions auth orized under paragrap h 5 of these · Instructions, If a partlcip~nt In a CQVered transaction
<br />knowingly enters Into a lower tier covered transaction with a person who Is proposed for debarm ent under ~ppli cable
<br />CFR, sus pended , debarre d, Inelig ible , or voluntarily exc luded from participation in this tra nsa cti on , in addition to other
<br />remedies ~wailab le to the Federal Government, the depa rtment or agency with which this transaction originated may
<br />pursue available remedies, including suspension and/or debarment.
<br />Certification Regarding Debarment, Suspension, lnellglbilfty and Voluntary Exclusion--Lower Tier
<br />Covered Transactions
<br />The prospective lower tier participant certifies, by submission of this proposal or contract, that neither It nor Its
<br />principals Is pre sently debarred, suspended, proposed fo r debarment, declared Ineligible, or voluntarlly excluded
<br />from parti cipation In t his tr.ansactlon by any Federal dep artment or agency. Where the prospective lower tier
<br />partlc l pah t Is una ble to ce rt ify t o any of the stateme nts In this certification, such prospective participant shall
<br />attach an explanation to this form.
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<br />Date : -'-"/!_ft_t-'-1 __
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