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NAME
<br />Coun$ of Kittitas
<br />Ooing business a$ (DBA)
<br />Kittitas Coun$
<br />ADDRESS
<br />205 W Sth Ste 105
<br />Ellensburg, WA 98926
<br />Appllcable Procurement
<br />or SollclCatlon #, lf any:
<br />WA Unilorm Business
<br />ldentifier (UBl)
<br />192002673
<br />Federal EmployerTax
<br />ldentification #:
<br />91-600'1349
<br />submlttsd es
<br />Washhrgton Military Department Contract Nlum6gr E22'217
<br />Debarm ent, Suspens ion, Ineligibility or Vol untary Exclusion Certlflcatlon Form
<br />lnstructions For Certilication Regarding Debarment, Suspension, lnellglbility and Voluntary 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 lhis clause is a material representalion of fact upon which reliance was placed when this
<br />transaclion 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 nolice to the deparlment, institution or office to
<br />which lhis proposal is submitted if at any time the prospeclive lower tier participant learns lhat its certification was
<br />erroneous when submitted or had become enoneous by reason ol changed circumstances.4. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaciion, parlicipant, person,
<br />primary covered transaclion, principal, proposal, and voluntarily excluded, as used in this clause, have'the nieaning
<br />set out in the Definitions and Coverage seclions of rules implementing Execulive Order 12549. You may contact the
<br />person lo which lhis proposal is submitted for assistance in obtaining a copy of those regulations.5. The prospective lower tier participant agrees by submitting this propbsal thai, should the proposed covered
<br />transaction be entered into, it shall not knowingly enter into any lower tier covered transaction wiin a person who is
<br />proposed for debarment under the applicable CFR, debarred, suspended, declared ineligible, or voluniarily excluded
<br />from participation in this covered lransaction, unless authorized by lhe department or agency with tvhich this
<br />transaction orig{nated.6. The prospective lower tier participant further agrees by submitting this proposal that it will include this clause tifled*Certification Regarding Debarment, Suspenslon, lneligibility and Voluntary Exclusion-Lower Tier Covered
<br />Transaction." wfthout modlfication, in all lower tier covered transactions and in all soticitations for lower tier covered
<br />transactions.7. A participant in a covered transactlon 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 />exduded from covered lransactions, unless it knows that the certificalion is erroneous. A participant may decide th6
<br />melhod and freguency by which it delermines the eligibility of its principals. Each participant may, nut is not required
<br />lo, check the List of Parties Excluded from Federal Procurement and Non-procuremenl Piograms.L Nothing contained in the foregoing shall be conslrued to require establishment of a sysiem of records in order to
<br />render in good faith the certification required by this clause. The knowledge and information of a padicipant is not
<br />required to exceed lhal which Is normally possessed by a prudent person in the ordinary course of business activity,9. Except for lransactions authorized under paragraph 5 of these instruclions, if a partiiipant in a covered transaition
<br />knorvingly enters into a lower tier covered lransaction with a person who is proposed for debarment under applicable
<br />GFR" suspended" debarred, ineligible, or voluntarily excluded from participation in this transaction, in additbri io other
<br />remedles available to the Federal Government, lhe department or agency with which this transaction originated may
<br />pursue available remedies, induding suspension and/or debarment.
<br />Certification Regarding Debarment, Suspenslon, lneligibility and Voluntary Exclusion-Lower Tier
<br />Covered Transactions
<br />The prospective lower tier participant certifies, by submission of thls proposal or contract, that neither it nor itsprinclpals is presently dcbarred, suspended, proposed for debarmsnt, declared ineligible, or voluntarily excluded
<br />from participatlon in this transaction by any Federal department or agency. Where the prospective lower tier
<br />particlpant ls unabte to certify to any of the statements ln this certifiCation, such prospectlve participant shall
<br />attach an explanation to thls form.
<br />Bidder or Contractor Signature:
<br />READ CAREFULLY AEFORE SIGNING THE CERTIFICA TION.Federa regulatlons rtquire contraclo ns and bldders to slgn and
<br />ablde by the te rms of thls certification,wlthout modlflcatlon,n order to partlclpate ln cerlain tran sactrlone dt rectly
<br />federal funds.
<br />print Name and Tile: Jerry Peftit,itor
<br />Date:irrfu,
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