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STATE OF WASHINGTON JUSTICE ASSISTANCE GRANT <br /> DEPARTMENT OF COMMERCE FORM 2 <br /> U.S. DEPARTMENT OF JUSTICE <br /> OFFICE OF JUSTICE PROGRAMS <br /> OFFICE OF THE COMPTROLLER <br /> CERTIFICATION REGARDING <br /> DEBARMENT,SUSPENSION,INELIGIBILITY AND VOLUNTARY EXCLUSION <br /> LOWER TIER COVERED TRANSACTIONS <br /> (SUB-RECIPIENT) <br /> This certification is required by the regulations implementing Executive Order 12549, Debarment and <br /> Suspension, 28 CFR Part 67, Section 67.510, Participants' responsibilities. The regulations were <br /> published as Part VII of the May 26, 1988 Federal Register(pages 19160-19211). <br /> (BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS ON REVERSE) <br /> (1) The prospective lower tier participant certifies by submission of this proposal that neither it nor its <br /> principals are presently debarred, suspended, proposed for debarment, declared ineligible, or <br /> voluntarily excluded from participation in this transaction by any Federal department or agency. <br /> (2) Where the prospective lower tier participant is unable to certify to any of the statements in this <br /> certification, such prospective participant shall attach an explanation to this proposal. <br /> Name and Title of Authorized Representative <br /> Signature Date <br /> Name of Organization <br /> Address of Organization <br /> 7 <br />