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NAME
<br />County of Kittitas
<br />Doing business as (DBA)
<br />Kittitas County
<br />ADDRESS
<br />205 West Sth Ste 105
<br />Ellensburg, WA 98926
<br />Applicable Procurement
<br />or Sollcltation #, if any:
<br />WA Uniform Business
<br />ldentilier (UBl)
<br />192002673
<br />Federal Employer Tax
<br />ldentilication #:
<br />91 -6001 349
<br />Washington Military Department Contract Number E21-187
<br />Debarment, Suspension, Ineligibility or Voluntary Exclusion Certification Form
<br />lnstructions For Gertification Regarding Debarment, Suspension, lneligibility and Votuntary Exclusion--Lower
<br />Tier Covered Transactions
<br />1. By signing and submitting this proposal, the prospective lower tier participant is providing the certification set out
<br />below.2. The certification in this clause is a material representation of fact upon which reliance was placed when this
<br />transaction was entered into. lf it is later determined that the prospective lower tier participant knowingly rendered an
<br />erroneous certification, in addition to other remedies available to the Federal Government the department or agency
<br />with which this transaction originated may pursue available remedies, including suspension and/or debarment.3. The prospective lower tier participant shall provide immediate 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 cerlification was
<br />erroneous when submitted or had become erroneous by reason of changed circumstances.4. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person,
<br />primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meaning
<br />set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the
<br />person to which this proposal is submitted for assistance in obtaining a copy of those regulations.5. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered
<br />transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is
<br />proposed for debarment under the applicable CFR, debarred, suspended, declared ineligible, or voluntarily excluded
<br />from participation in this covered transaction, unless authorized by the department or agency with which ihis
<br />transaction originated.6. The prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled"Certification Regarding Debarment, Suspension, lneligibility 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.7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered
<br />transaction that it is not proposed for debarment under applicable CFR, debarred, suspended, ineligible, or voluntarily
<br />excluded from covered transactions, unless it knows that the certification is erroneous. A participant may decide the
<br />method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required
<br />to, check the List of Parties Excluded from Federal Procurement and Non-procurement Programs.L Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to
<br />render in good faith the certification required by this clause. The knowledge and information of a participant is not
<br />required to exceed that which is normally possessed by a prudent person in the ordinary course of business activity.9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transaition
<br />knowingly enters into a lower tier covered transaction with a person who is proposed for debarment under applicable
<br />CFR, suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other
<br />remedies 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 />Gertification Regarding Debarment, Suspension, Ineligibility 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 presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded
<br />from participation in this transaction by any Federal department or agency. Where the prospective lower tier
<br />participant is unable to certify to any of the statements ln this certification, such prospective participant shall
<br />attach an explanation to this
<br />Bidder or Contractor S
<br />READ CAREFU LLY BEFORE SIGN ING THE CERTIF tcA TION Federal regu lations requ re contractors an d bi dders to st gn and
<br />ab ide by the terms of this certification,wlthout modification,tn order to participate tn certa tn transactio ns di rectly
<br />ndl fede ral funds
<br />Print Name and Title:Judy ud Finance Manager
<br />DarJ 4t2t2021
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