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Wash ington M ilitary Department Contract 1.1r t 5"r E25-224
<br />Debarment, Suspension, lneligibility or Voluntary Exclusion Gertification Form
<br />lnstructions For Certification Regarding Debarment, Suspension, lneligibility and Voluntary Exclusion*Lower
<br />Tler Govered Transactlons
<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. If 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 />w1h which this transaction originated may pursue available remedies, including suspension and/or debarment.
<br />3, The prospective lower tier participant shall provide immediate written notice to the department, institution or office to
<br />wnictr tfrii proposal is submitted-if at any time the prospective lower tier participant learns that its certification was
<br />erroneous when submitted or had become erroneous by reason of changed circumstances.
<br />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 />bet oui in the Definitions and Coveraga 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,
<br />S. The pr.ospective lower'tier participant agrees by submitting this proposal that, should the proposed covered
<br />transiction 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 />irom participatisn in this covered iransaction, unless authorized by the department or agency with which this
<br />ransaction-origi
<br />6. The prospective lowor tier participant further agrees by submitting this that it will include this clause titled
<br />"Certification
<br />Transaction,"
<br />transactions,
<br />Regardi ng Debarment, Suspension, lneligibility and
<br />proposal
<br />Volunta ry Exclusion-Lower Tier Covered
<br />without modification, in all lower tier covered transactions and in all solicitations for lower tier covered
<br />attach an explanation to this form.
<br />Bidder or Contractor Signature:
<br />7. Aparticipantinacoveredtransactionmayrelyupon.acertificationofaprospectiveparticipant.inalowertiercovered
<br />transactibn that it is not proposed for debirmdnt under applicable CFR, debarred, suspended, ineligible, or voluntarily
<br />excluded from covered iransactions, 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.
<br />O. 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 ordina.ry course of business activity.
<br />9. Exiept for transactions authorized und6r paragraph 5 of these instructions, if a participant in a covered transaction
<br />knowingly enters into a lower tier covered transaction with a person who is proposed for debarment under applicable
<br />CFR, suipended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other
<br />remedies'availabie to the Federal Government, the department or agency with which this transaction originated may
<br />pursue available remedies, including suspension and/or debarment.
<br />Certiflcation Regarding Debarment, Suspension, lneligibility and Voluntary Exclusion"Lower Tier
<br />Covered Transactions
<br />The prospective lower tier particlpant certifies, by submlsslon of this proposal or contract, that neither it nor its
<br />priniipali is presently debarred, suspended, profosed for debarment, declared ineligible, or voluntarily excluded
<br />irom participbtion 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 in this certlfication, such prospective participant shall
<br />c
<br />NAME
<br />County of Kittitas
<br />Dolng buslness as (DBA)
<br />Kittitas County
<br />ADDRESS
<br />205 W 5th Ave #105
<br />Ellensburg, WA 98926
<br />Appllcable Procurement
<br />or Sollcltatlon fi if any:
<br />WA Unlform Buslness
<br />ldentlfler (UBl)
<br />WQ23XPBSAU44
<br />Federal Employer Tax
<br />ldentlllcatlon #:
<br />91 -6001 349
<br />This'certlllcatlon ls submlttsd as p
<br />READ CAREFULLY BEFORE StGNING THE CERTIFICATION. Federa
<br />abide by the terms of this certlflcation, without modificatlon' ln
<br />involvi federal funds.
<br />I regulations require contractors and bidders to sign and
<br />order to partlclpate in certain transactlons dlrectly or
<br />Print Name and Title:
<br />ii
<br />Date:a l,t /t"
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