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ADORESS
<br />205 W Sth Ave Suite 105
<br />Ellonsbury WA 98926
<br />Appllcable Procurunrnt
<br />orsollcltrdon t lfsny:
<br />WA Uniform Businos$
<br />Henffi€I (Ugl)
<br />192002673
<br />Federal Em/oyur Tax
<br />ldenlltlcallofl f:
<br />91-8001349
<br />Thl. cedmc.ilon
<br />Washington Milltary Department Contrsct Number: j331
<br />Debarment Suspension, lneliglblllty or Voluntary Excluslon Certlflcatlon Form
<br />of Kittitas
<br />Odng h'nlnew ar (DBA)
<br />Kittitas
<br />lnstructlons For Csrtlllcatlon Regardlng Debarrnant, Surpenclon,lnellgiblllty and Voluntary Excluslon-LoyyBr
<br />Tler Govered Tranractlona
<br />CAREFULLY BEFORE THE ERTIFICAilON. Fed€ta
<br />eblde by
<br />lndlnctlv
<br />the tgrmt of lhlr cerllflcl$on, wlthout modlficlllon, ln ordcr b pa
<br />lnyolvlng federel fundr.
<br />rcqulre
<br />rfclpete
<br />contraciorc and to sign
<br />ln ceitaln tnnlacfona dircctly
<br />1' By signing and submitting this proposal, the prospective lower tier participant is providing the cerUfication set outbelow
<br />2. The cartiltcalion ln this clause is a malerial representatlon ol fect upon wtrich rslianco uas placed when thie
<br />trensEdion was sntered into. lf it is later determined thal the prospeclive lovrrer tier porlicipant knondngly rendered an
<br />erroneous certification, ln addltlon lo olher remedies available lo the Federal Government lhe rtepailmtnt or agency
<br />with which this trenssction originated may pursue aveilable remedles, including susponsion and/or dabarmenl,3. The prospectlve lower tler participant shall provide immediate wrifien notice to thadepaftment, inslitulion or office to
<br />which lhis proposal is submitted lf at any tlme the prospsctivo lower tis participant ieams that its certification was
<br />€ronsous when submitted or had become enoneous by reason of changed circumstances,4. The terms covered transaction, dabaned, suspended, lnellgible, loweitier covered transaction, participant, pergon,
<br />primary covered lransaction,_princlpal, proposal, and voluntarily excluded, as used in this clause, nave'the nieanlng
<br />s€l out in the Definitlons end Coverage sec'tlons of rules imptemcnling Execulive Order 12549. You may contacl thiperson to which this proposal is submitted for asslstsnce in obtaining a copy of thoee regulations.5' The prospective lounr tier participant agrees by eubmitling tris pro-pbsal that, siould the proposed covered
<br />transaclion be €ntored into, it ehall not knowingly enter into any lourer tier covered transaction wiitr d person who isproposedlor debarment. under the. applicable CFR, debaned, suspended, declared lneligible, or voluniarily excludedfron participation in this covered transaclion, unless authorized by lhe departmentlr agency witn -ntrich
<br />ttris
<br />traneaction odginated.6. The prospeclive lowar tier participant further agr€es by submitting his proposal that lt will include this clause ililed*Certificatlon Regarding Debarment, Suspension, lneligibility and
<br />-Voiuntary
<br />Exclusion-Lourer Tier Govered
<br />Trangaclion," without modiftcation, in all lower lier coveredlransactions and in ali solicitations for lower tier covergd
<br />transaclion6.7. A psrticipant in a covered transaction may rely upon a cortificalion of a proepective participant in a low€r tier covered
<br />transac{ion that ii is not propos€d for debarment und€r appliceble CFR, debaned, suspended, ineligible, or volunlarily
<br />excluded from covered lransactions, unless at knows that the certilication is enoneoub. A participant may decide lhi
<br />melhod and lrequency by which il determlnes the eligibility of lls principals. Each participant ma|, Uut is hot required
<br />lo, check the List of Partlos Excluded from Federal Proarsment and Non-procurement piograms.
<br />0. Nothing conlsined in lhe forsgoing shall be construed to requira eEleblishment of e sysiem of records in order torender in good faith the cerlification rcquired by lhis clause. The knowledge and lnfoniraffon of a participant ls not
<br />_ requlr€d to exceed that which is normally possessed by a prudent person in ihe ordinary oourEs of buiinesi activity,9. Excepl for ltansaclions aulhorized under paragnph 5 of these instructions, if a participant in a coverEd transa(iion
<br />knowingly enter8 into a lowgr tier covered lransaction with a person who is proposed for debarment unrhr applicable
<br />CFR, suspended, debaned, insllglble, or voluntrarily excluded from participalion in lhis transaclion, in addition io other
<br />remedies available to the Federal Govemmant, the department or agency with which lhis lrangsc-flon originated may
<br />puraue avellable remedies, including suspension and/or debarmenl.
<br />Gertiflcrtion Regardlng Debarment, $uspenrlon, lneliglblllty and Voluntary Excluslon-Lower Tier
<br />Govered Tranracdons
<br />Biddsr or Contriactor Signature:
<br />Prinl Name and Title:Judy & Finance Manager
<br />oate: 0915-2020
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