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<br />City of Everett REQUEST FOR QUALIFICATIONS <br />RFQ No. 2023-164 <br />Walter E. Hall Park Community Connections Path <br /> <br />CERTIFICATE OF NONDEBARMENT / SUSPENSION <br />• To be completed by the Prime Contractor of this bid and any Subcontractors that will be <br />affiliated with the work in this bid. <br />• Return the completed form with the original bid package. <br /> <br /> CERTIFICATION REGARDING DEBARMENT, SUSPENSION AND OTHER <br /> INELIGIBILITY AND VOLUNTARY EXCLUSION <br /> LOWER TIER COVERED TRANSACTIONS <br /> <br /> <br />The Lower Tier Participant (Applicant for a third party subcontract or subgrant under an FTA project), <br /> hereinafter referred to as Vendor, certifies, by <br />submission of this document, that neither it nor its principals is presently debarred, suspended, <br />proposed for debarment, declared ineligible or voluntarily excluded from participation in this <br />transaction by any federal department or agency. <br /> <br />Where the Vendor is unable to certify to any of the statements in this certification, such Vendor shall <br />attach an explanation to this submittal. <br /> <br />The Vendor, , certifies or affirms the truthfulness and <br />accuracy of the contents of the statements submitted on or with this certification and <br />understands that the provisions of 31 U.S.C. Section 3801 et seq. are applicable thereto. <br /> <br /> <br /> <br /> <br /> _______________________________________ <br /> Signature of Authorized Official <br /> <br /> <br /> <br /> <br /> _______________________________________ ____________________________________ <br /> Title of Authorized Official Date <br /> <br /> <br /> <br /> <br />THIS FORM SHALL BE COMPLETED BY THE PRIME CONTRACTOR AND ANY <br />SUBCONTRACTORS THAT WILL BE AFFILIATED WITH THE WORK IN THIS BID. RETURN ALL <br />COMPLETED FORMS WITH ORIGINAL BID PACKAGE. <br />Board & Vellum <br />Board & Vellum <br />Principal February 14, 2024