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WashingtortMilitaryDepartmentContractNumber:E23-116Debarment,Suspension,IneligibilityorVoluntaryExclusionCertificationFormNAMEDoingbusinessas(DBA)Kittitas,TheCountyofKittitasCountyADDRESSApplicableProcurementWAUniformBusinessFederalEmployerTax205W5thAveSte105orSolleitation#,Ifany:Identiner(UBI)Identiñcation#:Ellensburg,WA9892619200267391-6001349Thiscertificationissubmittedaspartofarequesttocontract.InstructionsForCertificationRegardingDebarment,Suspension,IneligibilityandVoluntaryExclusion--LowerTierCoveredTransactionsREADCAREFULLYBEFORESIGNINGTHECERTIFICATION.Federalregulationsrequirecontractorsandbidderstosignandabidebythetermsofthiscertification,withoutmodification,InordertoparticipateIncertaintransactionsdirectlyorindirectlyInvolvingfederalfunds.1.Bysigningandsubmittingthisproposal,theprospectivelowertierpadicipantisprovidingthecertificationsetoutbelow.2.Thecedificationinthisclauseisamaterialrepresentationoffactuponwhichreliancewasplacedwhenthistransactionwasenteredinto.Ifitislaterdeterminedthattheprospectivelowertierparticipantknowinglyrenderedanerroneouscertification,inadditiontootherremediesavailabletotheFederalGovernmentthedepadmentoragencywithwhichthistransactionoriginatedmaypursueavailableremedies,includingsuspensionand/ordebarment.3.Theprospectivelowertierparticipantshallprovideimmediatewrktennoticetothedepadment,institutionorofficetowhichthisproposalissubmittedifatanytimetheprospectivelowertierpanicipantlearnsthatitscedificationwaserroneouswhensubmittedorhadbecomeerroneousbyreasonofchangedcircumstances.4.Thetermscoveredtransaction,debarred,suspended,ineligible,Iowertiercoveredtransaction,participant,person,primarycoveredtransaction,principal,proposal,andvoluntarilyexcluded,asusedinthisclause,havethemeaningsetoutintheDefinitionsandCoveragesectionsofrulesimplementingExecutiveOrder12549.Youmaycontactthepersontowhichthisproposalissubmittedforassistanceinobtainingacopyofthoseregulations.5.Theprospectivelowertierparticipantagreesbysubmittingthisproposalthat,shouldtheproposedcoveredtransactionbeenteredinto,itshallnotknowinglyenterintoanylowertiercoveredtransactionwithapersonwhoisproposedfordebarmentundertheapplicableCFR,debarred,suspended,declaredineligible,orvoluntarilyexcludedfromparticipationinthiscoveredtransaction,unlessauthorizedbythedepartmentoragencywithwhichthistransactionoriginated.6.Theprospectivelowertierparticipantfurtheragreesbysubmittingthisproposalthatitwillincludethisclausetitled'CertificationRegardingDebarment,Suspension,IneligibilityandVoluntaryExclusion-LowerTierCoveredTransaction,"withoutmodification,inalllowertiercoveredtransactionsandinallsolicitationsforlowertiercoveredtransactions.7.AparticipantinacoveredtransactionmayrelyuponacertificationofaprospectiveparticipantinalowertiercoveredtransactionthatitisnotproposedfordebarmentunderapplicableCFR,debarred,suspended,ineligible,orvoluntarilyexcludedfromcoveredtransactions,unlessitknowsthatthecertificationiserroneous.Aparticipantmaydecidethemethodandfrequencybywhichitdeterminestheeligibilityofitsprincipais.Eachparticipantmay,butisnotrequiredto,checktheListofPartiesExcludedfromFederalProcurementandNon-procurementPrograms.8.Nothingcontainedintheforegoingshallbeconstruedtorequireestablishmentofasystemofrecordsinordertorenderingoodfaiththecertificationrequiredbythisclause.Theknowledgeandinformationofaparticipantisnotrequiredtoexceedthatwhichisnormallypossessedbyaprudentpersonintheordinarycourseofbusinessactivity,9.Exceptfortransactionsauthorizedunderparagraph5oftheseinstructions,ifaparticipantinacoveredtransactionknowinglyentersintoalowertiercoveredtransactionwithapersonwhoisproposedfordebarmentunderapplicableCFR,suspended,debarred,ineligible,orvoluntarilyexcludedfromparticipationinthistransaction,inadditiontootherremediesavailabletotheFederalGovernment,thedepadmentoragencywithwhichthistransactionoriginatedmaypursueavailableremedies,includingsuspensionand/ordebarment.CertificationRegardingDebarment,Suspension,IneligibilityandVoluntaryExclusion-LowerTierCoveredTransactionsTheprospectivelowertierparticipantcertifies,bysubmissionofthisproposalorcontract,thatneitheritnoritsprincipalsIspresentlydebarred,suspended,proposedfordebarment,declaredineligible,orvoluntarilyexcludedfromparticipationinthistransactionbyanyFederaldepartmentoragency.Wheretheprospectivelowertierparticipantisunabletocertifytoanyofthestatementsinthiscertification,suchprospectiveparticipantshallattachanexplanationtothisform.BidderorContractorSignature:Date:PrintNameandTitle:A&Ç-
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