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Washington Military Department Contract Number: U23-040 .
<br />Debarment, Suspension, Ineligibility or Voluntary Exclusion Certification Form
<br />NAME
<br />City of Everett
<br />Doing business as (DBA)
<br />
<br />ADDRESS
<br />2930 Wetmore Ave, Everett, WA
<br />98201
<br />Applicable Procurement
<br />or Solicitation #, if any:
<br />
<br />WA Uniform Business
<br />Identifier (UBI)
<br />
<br />Federal Employer Tax
<br />Identification #:
<br />This certification is submitted as part of a request to contract.
<br />Instructions For Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion--Lower
<br />Tier Covered Transactions
<br />READ CAREFULLY BEFORE SIGNING THE CERTIFICATION. Federal regulations require contractors and bidders to sign and
<br />abide by the terms of this certification, without modification, in order to participate in certain transactions directly or indirectly
<br />involving federal funds.
<br />1. By signing and submitting this proposal, the prospective lower tier participant is providing the certification set out below.
<br />2. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction
<br />was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous
<br />certification, in addition to other remedies available to the Federal Government the department or agency with which
<br />this transaction originated may pursue available remedies, including suspension and/or debarment.
<br />3. The prospective lower tier participant shall provide immediate written notice to the department, institution or office to
<br />which this proposal is submitted if at any time the 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 tier covered transaction, participant, person,
<br />primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meaning set
<br />out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the person
<br />to which this proposal is submitted for assistance in obtaining a copy of those regulations.
<br />5. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered transaction
<br />be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is proposed for
<br />debarment under the applicable CFR, debarred, suspended, declared ineligible, or voluntarily excluded from
<br />participation in this covered transaction, unless authorized by the department or agency with which this transaction
<br />originated.
<br />6. The prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled
<br />``Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-Lower Tier Covered
<br />Transaction,'' without modification, in all lower tier covered transactions and in all solicitations for lower tier covered
<br />transactions.
<br />7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered
<br />transaction that it is not proposed for debarment under applicable CFR, debarred, suspended, ineligible, or voluntarily
<br />excluded from covered transactions, unless it knows that the certification is erroneous. A participant may decide the
<br />method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to,
<br />check the List of Parties Excluded from Federal Procurement and Non-procurement Programs.
<br />8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render
<br />in good faith the certification required by this clause. The knowledge and information of a participant is not required to
<br />exceed that which is normally possessed by a prudent person in the ordinary course of business activity.
<br />9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transaction
<br />knowingly enters into a lower tier covered transaction with a person who is proposed for debarment under applicable
<br />CFR, suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other
<br />remedies available to the Federal Government, the department or agency with which this transaction originated may
<br />pursue available remedies, including suspension and/or debarment.
<br />Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion--Lower Tier
<br />Covered Transactions
<br />The prospective 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 />participant is unable to certify to any of the statements in this certification, such prospective participant shall
<br />attach an explanation to this form.
<br />Bidder or Contractor Signature: _______________________________________ Date: _____________
<br />Print Name and Title: _Cassie Franklin, Mayor_________________________________
<br />
<br />Cassie Franklin 06/12/2023
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