2022/10/26 Council Agenda Packet

FORM 4.04 CERTIFICATE OF NON-DEBARMENT/SUSPENSION REQUEST FOR PROPOSAL #2022-074 LANDSCAPE MAINTENANCE SERVICES CERTIFICATION REGARDING DEBARMENT, SUSPENSION AND OTHER INELIGIBILITY AND VOLUNTARY EXCLUSION LOWER TIER COVERED TRANSACTIONS THIS FORM MUST BE COMPLETED BY THE PRIME SUPPLIER AND ANY SUB -TIER SUPPLIERS THAT WILL BE AFFILIATED WITH THE WORK IN THIS QUOTE. RETURN ALL COMPLETED FORMS WITH ORIGINAL QUOTATION PACKAGE. \\) The Lower Tier Participant (Applicant for a third -party subcontract or subgrant under a federal funded project), hereinafter referred to as Supplier, certifies, by submission of this document, 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 Supplier is unable to certify to any of the statements in this certification, such Supplier must attach an explanation to this submittal. The Supplier, , certifies or affirms the truthfulness and accuracy of the contents of the statements submitted on or with this certification and understands that the provisions of 31 U.S.C. Section 3801 et seq. are applicable thereto. Signature of Authorized Official Title of Authorized Official Date