HomeMy WebLinkAboutE26-350 Kittitas County 25SHSP Debarment signedWashington Military Department Contract Number: E26-350
Debarment, Suspension, Ineligibility or Voluntary Exclusion Certification Form
NAME
Doing business as (DBA)
County of Kittitas
Kittitas County
ADDRESS
Applicable Procurement
WA Uniform Business
Federal Employer Tax
205 W 5th Ave Suite 105
or solicitation #, if any:
Identifier (UBI)
Identification #:
192-002-673
91-6001349
This certification Is submitted as Rart,of a request to contract.
Instructions For Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion --Lower
Tier Covered Transactions
READ CAREFULLY BEFORE SIGNING THE CERTIFICATION, Federal regulations require contractors and bidders to sign and
abide by the terms of this certification, without modification, In order to participate In certain transactions directly or
indirectly involving federal funds,
1. By signing and submitting this proposal, the prospective lower tier participant is providing the certification set out
below,
2. The certification in this clause is a material representation of fact upon which reliance was placed when this
transaction was entered into, If it is later determined that the prospective lower tier participant knowingly rendered an
erroneous certification, in addition to other remedies available to the Federal Government the department or agency
with which this transaction originated may pursue available remedies, including suspension and/or debarment,
3. The prospective lower tier participant shall provide immediate written notice to the department, institution or office to
which this proposal is submitted if at any time the prospective lower flier participant learns that Its certification was
erroneous when submitted or had become erroneous by reason of changed circumstances,
4. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person,
primary covered transaction, principal,_ proposal, and voluntarily excluded, as used in this clause, have the meaning
set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the
person to which this proposal is submitted for assistance in obtaining a copy of those regulations.
5. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered
transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is
proposed for debarment under the applicable CFR, debarred, suspended, declared ineligible, or voluntarily excluded
from participation in this covered transaction, unless authorized by the department or agency with which this
transaction originated,
6. The prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled
"Certification Regarding Debarment, Suspension, ineligibility and Voluntary Exclusion -Lower Tier Covered
Transaction," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered
transactions,
7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered
transaction that it is not proposed for debarment under applicable CFR, debarred, suspended, ineligible, or voluntarily
excluded from covered transactions, unless it knows that the certification is erroneous, A participant may decide the
method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required
to, check the List of Parties Excluded from Federal Procurement and Non -procurement Programs,
8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to
render in good faith the certification required by this clause. The knowledge and information of a participant is not
required to exceed that which is normally possessed by a prudent person in the ordinary course of business activity.
9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transaction
knowingly enters into a lower tier covered transaction with a person who is proposed for debarment under applicable
CFR, suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other
remedies available to the Federal Government, the department or agency with which this transaction originated may
pursue available remedies, including suspension and/or debarment,
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion --Lower Tier
Covered Transactions
The prospective lower tier participant certifies, by submission of this proposal or contract, that neither it nor its
principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded
from participation in this transaction by any Federal department or agency. Where the prospective lower tier
participant is unable to certify to any a statements In this certification, such prospective partl ipant shalt
attach an explanation to this form,
a� 2C
Bidder or Contractor Signature: Date: C
Print Name and Title: ABC e�lVe Ud e & Finance Director