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NAME
<br />County of Kittitas
<br />Doing busin€ss as (DBA)
<br />Kittitas Coung
<br />ADDRESS
<br />205 W, Sth Ste. 105
<br />Ellensburg, WA 98926
<br />Thls cerllllcallon
<br />Appllcable Procurement
<br />or Sollcltallon #, lf any:
<br />WA Unifom Business
<br />ldentifier (UBl)
<br />192002673
<br />Federal Employer Tax
<br />ldentification *.
<br />91-6001349
<br />Wahington Mililary Department Contract 11ur6"r E22-260
<br />Debarment, Suspension, lneligibility or Voluntary Exclusion Certification Form
<br />Instructions For Certification Regarding Debarment, Suspension, lnetigibility and Voluntary Exclusion--Lowsr
<br />Tier Govsred Transactions
<br />Bidder or Gontraclor Signature:
<br />1. By signing and submitting this proposal, tFre prospecl*ve lower tier parlicipant is providing the certification set out
<br />below.2. The certlf{cation in this clause is a malerial representation of fact upon which reliance was placed when thistransaction was entered into. lf it is later determined that the prospeclive lower tier participant knowingty rendered an
<br />erroneous certification, in addilion to other remedies available to lhe Federal Goveinment the departirlnt or agency
<br />with which this transaction originated may pursue available remed{es, including suspension and/or debarment.3. The prospective lower tier participant shall provide immediate written notice fo tha deparlment, inslitution or office towhich this proposal is submitted if at any time the prospective lower tier participant iearns that its certification was
<br />erroneous when submitted or had become erroneous by reason of changed circumstances.4. The tems covered transaction, debarred, suspended, ineligible. lower tier covered transaction, participant, penion,
<br />primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, nave'the meaning
<br />set out in the Definil{ons and Coverage sections of rules implementing Executive Order 12549. You rnay contact theperson to whbh thls proposal is submitted for asslstance in obtaining Jcopy of those regulalions.5. The prospective lower tier participant agrees by submitting thG proil6sat that, siould the proposed covered
<br />transaction be entered into, it shall not knowlngly enter into any towei tier covered transaction wiin a person who isproposed for debarment under the applicable CFR, debaned, suspended, declared ineligible, or voluniarily excludedfrom participalion in this covered transaction, unless authorized by the department or agency wittr which ttris
<br />transaction originated.6' The prospective lower tier participant further agrees by submitting this proposal lhat it will include this clause tifled"Certification Regardtrng .Debarment, Suspension, lneligiblllty and
<br />-Voiuntary
<br />Exclusion-Lower Tier Covered
<br />Transaction," wilhout modification, in all lower tier covered transactions and in ali solicitations for lower tier covered
<br />tsansactions.
<br />7. A padicipant in a covered transaction may rely upon a certificalion of a prospective participanl in a lower tier covered
<br />transacl{on that it is nol proposed for debarment under applicable CFR, debirred, suspended, ine1gible, or voluntarily
<br />excluded from covered transactions, unless it knows that the certilication is erroneous. A participait may decide thi
<br />method and frequency by which it delermines the eliglbility of ils principals, Each participanl may, but is nol required
<br />to, check the List of Partles Excluded from Federal Procurement aho ttdn-procurement piograms.8. Nothing contained.in lhe foregoing shall be construed to require establishmenl of a system of records in order torender in good faith. the certification requhed by this clause. The knowledge and information of a padicipant is not
<br />required to exceed thai which is normally possessed by a prudent person in ihe ordinary course of bu'siness activity.9. Except for transactions authorized under paragraph 5 of these instruclions, if a participant in a covered transactionknouingly enters into a lower tier covered transaction with a person who is propoied for debarment under apfti""Ute
<br />GFR, suspended, debarred, ineligible, or voluntadly excluded fiom participation'in lhis transaction, in additiori io other
<br />remedies available to lhe Federal Government, the department or agency with which this transaction originated maypursue available remedles, including suspenslon and/or debarment.
<br />Certllication Regarding Debarment, Suspension, lneligibility and Voluntary Exclusion--Lower Tier
<br />Covered Transactions
<br />The prospective lower tier participant certlfles, by submission of this proposal or contract, that neither it nor itsprlncipals_ is presently_debarred, suspended, ploposed for debarment, decjared ineligible, or voluntarlly excludedfrom participation ln this transaction by any Federal department or ag€ncy. Wheie thi prospectiv; lo;;r tierparticipant is unable to ce-rtify to any of the statements in this certiflcation, such prospective participant shallaftach an explanation to this form.
<br />READ CAREFULL Y BEFORE stc NING THE CERTIFICATION. Federat rugulations
<br />urlthout modificaUon, ln order to pa
<br />req utre contractors and bldderc to slgnabldethetermsofthigcertification,rllclpate tn ee ilaln transactions dlrectlylndfederalfundg.
<br />Print Name and Tltle:Jerry Auditor
<br />aae, 4#/erz?
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