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Washington Military Department Contract Number: E20-156
<br />Debarment, Suspension, lneligiblJity or Voluntary Exclusion Certification Form
<br />NAME Doing business as (DBA)
<br />County of Kittitas Kittitas County
<br />ADDooss Applicable Procurement WA Unifomi Business Federal Employer Tax 205 . 5th Ave Sta. 105 or Solicitation #, If any: ldenlifier (UBI) Identification #:.
<br />Ellensburg, WA 98926 192002673 91-6001349
<br />This certification Is submitted as part of a niquaat to contract.
<br />Instructions For Certification Regarding Debarment, Suspension, lnellglblllty and Voluntary Excluslon--Lower
<br />Tier Covered Transactions
<br />READ C-AREFlJLL Y BEFORE SIGNING THE CERTIFICATION. Federal regulations require contractors and bidders to sign and
<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 submitting this proposal, the prospective lower tier participant Is providing the certification set out
<br />below.
<br />2. The certification In this clause is a material representation of faGl' upor.i Which rellance . was placed when this
<br />transaction was entered into. If it is later determined that the ptosp_eoUve lower tier participant knowingly rendered an
<br />erroneous certification, In addition to other remedies available to the Fedetal Gc;>Vernment the department or agency
<br />with which this transaction origlnateC, may pursue available remedies, Including suspension and/or debarment.
<br />-3. The _prospecUve lower lier participant shall provicte Immediate wrflten-no0ce -fo lhe depai1m-enl~ Tnslltullon~ or offlcato
<br />Whleh this proposal Is submitted If at any time Iha prospeoUve lower tier participant 'learns that its -certiflcatjon was
<br />erroneous ·Whei'I submltted or had becom& erroneous by reason of changed circumstances.
<br />4. The terms covered ~a11sacUon, deb~rred, suspended, lneflglbte, lower lier covered trans~ctlon, participant, person,
<br />primary, covered transaction , prlnofpal, proposal, and voluntarily excluded , as used In this clause, ~ave lh:e meaning
<br />set out In the. Definitions and Coverage sectic,ms of rules lmplementlng Executive Order 12549 . You may contact U,e
<br />person to which this proposal Is submitted for assistance In obt~lnlng a copy of those regula\lons.
<br />5. The prospective lower tier participant agre.es by submitting th is proposal that, shollfd the proposed covered
<br />transaction be entered Jnto, It shall not kr,i~wlngty e.nter Into any lower tier covered transaction with a person who Is
<br />proposed for debarment under the applicable CFR, debarred, suspended , declared lnellglbfe, ot voluntarUy excluded
<br />from partlcfpatfon In this covered transaction . unless authorized by the department or agency with wnlch this
<br />transaction originated.
<br />6. The prospective lower tier partltlpant fu rther agrees by submitting this proposal U,at It will Include this clause titled
<br />"Certification Regarding Debarment, Suspension, lnellgiblllty and Voluntary Exclusion-Lower Tier Covered
<br />Transaction," without modification, In all lower lier covered transactions and In all sollcllations for lower tier cove re d
<br />transactions.
<br />7. A partlclpant In a covered tr1:1nsaction may rely upon a certification of a prosp.e.c~ve partlcipaht In ~ lower tler ·covered
<br />transaction that It Is not proposed for deb"arr:nent un.der appllcable CFR , debarred , suspended , Ineligible, or voluntarily
<br />excluded from covered transactions, unless It kno~ that the certification Is erroneous. A part icipant may declde ·1he
<br />method and frequency by which It determines the eligibility ot Its prlnCIP.ats. !=ach participant may, but Is not required
<br />to, check the List of Parties Excluded from Federal Procurement and Non-procurement Programs.
<br />8. Nothing contained In the foregoing shall be construed to require establishment of a system of re.cords In order to
<br />render In good faith the certlflcallon required by this claus_e. The knowledge and Information of a participant Is not
<br />required to exceed that which Is normally possessed by a prugen ( person In the ordinary course of business actlvlty.
<br />9. Except for transactions authorized under paragraph 6 of these Instru ctio ns, If a participant In a covered transaction
<br />knowingly enters Into a low~r tier covered transaction with a person who Is proposed fQr debarment under applicable
<br />CFR, suspended, debarred, ineligible, at voluntarily excluded from partiolpaflon In this transaction, In ~ddltlon to other
<br />rernedl8$ available to the Federal Government, the department or agency with which this transaction originated may
<br />pursue available remedies, Including suspension and/or debarment.
<br />Certification Regarding Debarment, Suspension, lnellgibllity and Voluntary Excluslon--Lower Tier
<br />Covered Transactions
<br />The prospective-lower tter participant certifies, by submission of this proposal or contract, that neither It nor Its
<br />principals Is presently debarred, suspended, proposed for d.eb~rment, declared lnellglble, or voluntatlly excluded
<br />from participation In this transactron by any Federal department or ,gency. Where the prospective tower tier
<br />participant I$ unable to certify to any of the statements In this certlflcatlon, such prospective participant shall
<br />attach an explanation to this form.
<br />J ') ' I l ,""{, I I Bidder or Contractor Signature: ___ ct-,-_,,,,+--'----.;-"-:---------
<br />Print Name and Title: Judy Pless f ., t ' I if:
<br />Date:
<br />.
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