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Washington Military Department Contract Number:fl
<br />Debarment, Suspension, lneligibility or Voluntary Exclusion Certificatign Form
<br />lnstructions For cerfification Regarding Debarment, suspension, lneligibility and Voluntary Exclusion-'Lower
<br />Tler Covered Transactions
<br />NAME
<br />County of Kittitas
<br />Dolng business as (DBA)
<br />Kittitas CountY
<br />ADDRESS
<br />205 W Sth Ave Suite 105
<br />Applicable Procur€ment
<br />or Sollcltation #, if any:
<br />WA Uniform Business
<br />ldentifier (UBl)
<br />192-002-673
<br />Federal Employer Tax
<br />ldentification #:
<br />-6001 349
<br />ts aa
<br />READ CAREF ULLY BEFORE SIGN ING THE CERTIFICA TION.Federal rcgulations requrre contractons and bidders to sign and
<br />abide by the tetms of this certiflcation without modificatlon,in order to participate in certain transactions directly
<br />ind federel funds.
<br />1. By signing and submitting this proposal, the prospective lower tier participant is providing the certification set out
<br />below.
<br />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 determinid that the prospective lower tier participant knowingly rendered en
<br />erroneous certification, in addition to other remedies available to ihe Federal Government the department or agency
<br />with which this transaition originated may pursue available remedies, including suspension and/or debarment'
<br />3. The prospective lower tier participant srrarr piovioe immediate written notice to the department, institution or office to
<br />which this proposal is submitted if al any t'irne me 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 lier covered transaction, participant' person,
<br />primary covered transaction, piincipal, propo-"i,
<br />"nO
<br />voluntirily excluded, as used in this clause, have the meaning
<br />set out in the Definitions and Coverage ,"!tion, of rules implementing Executive Order 12549. You may contact the
<br />p;ir* to which this pioposat is submltted for assistance in obtaining a copy of those regulations.
<br />5. The prospective tower tier participant ag-rees by Jubmitting ttris proil-osal that, should the proposed covered
<br />transaction oe entered into, it shalt'not rnJwintty 6nter into aiy towei tirir covered transaction with a person who is
<br />proposed for debarment under the applicabl" ifn, debarred, suspended, declared ineligible, or voluntarily excluded
<br />from participation in this covered trinsaction, unl"". authorized by the department or agency with which this
<br />transaction originated.
<br />6. The prospective tower tier participant further agrees by submiliing this proposal that it will include this clause titled
<br />..certification n"gaidi;g bJuarment, suspEisiJn, inetigibility-and'Voluntary Exclusion-Lower Tier covered
<br />Transaction,,, without modification, in att nildrlier-covereoiransactions and in ail solicitations for lower tier covered
<br />transactions.
<br />T. A participant in a covered transaclion may rely upon a certification of a prospective participant in a lower tier covered
<br />transaction ttrat it is notlroposea for oeoirment under applicable cFR, debarred, suspended, ineligible, or voluntarlly
<br />excluded from covered transactions, unless it knows tnat'tne certification is erroneous. A participant may decide the
<br />method ano rrequency nv wrriCrr it determines the eligibility of its principals. Each participant may, but is not required
<br />to, check the Lisiot pirti6s Excluded from Federal Procurement and Non-procurement Programs'
<br />g. 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 requiieo-ny this clause..The knowledge and information of a participant is not
<br />required to exceed that which is normally posseised by a prudent person in th.e ordinary course of business activity'
<br />g. Except for transactions authorizeo uno6rparaliapn-s ot'ttrese instructions, if a participant in a covered transaction
<br />knowingly enters into a lower tier covered iraniaciion with a person who is proposed for debarment under applicable
<br />CFR, suspended, debarred, ineligible, or vJluntarity excluded from participation in.this transaction, in addition to other
<br />remedies available to the Federal Government, tne department or bgency with which this transaction originated may
<br />pursue available remedies, including suspension and/or debarment.
<br />Certification Regarding Debarment, Suspension, lneligibility and Voluntary Excluslon-Lower Tier
<br />Covered Transactions
<br />The pros pective 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 />to certify to any of the statements in this certification,such prosPective participant shallparticipant is unable
<br />attach an exPlanation to this form.
<br />Bidder or Contractor Signature:
<br />Print Name and Title:Zack ,B et and Finance Director
<br />Date L@
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