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Page 16 of 17 <br /> <br />EXHIBIT D <br /> <br /> <br />SELF-CERTIFICATION LETTER <br /> <br />Debarment and Suspension Certifications <br /> <br />a. The Landlord certifies to the best of its knowledge and belief that: <br /> <br />i.the Landlord and/or any of its principals are ___ are not ___ [INDICATE ONE] presently debarred, suspended, <br />proposed for debarment, or declared ineligible for the award of contracts by any Federal agency or instrumentality <br />of the Senate; <br /> <br />ii.the Landlord and/or any of its principals have ___ have not ___ [INDICATE ONE], within a three (3) year period <br />preceding this offer, been convicted of or had a civil judgment rendered against them for: commission of fraud or <br />criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, state, or <br />local) contract or subcontract; violation of Federal or state antitrust statutes relating to the submission of offers; or <br />commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false <br />statements, or receiving stolen property; <br /> <br />iii.the Landlord and/or any of its principals are ____ are not ___ [INDICATE ONE], currently indicted for or <br />otherwise criminally or civilly charged by any federal, state or municipal agency with commission of any of the <br />offenses enumerated in paragraph (a)(ii) of this provision. <br /> <br />iv.the Landlord and/or any of its principals has ____ has not ____ [INDICATE ONE] within a three (3) year period <br />preceding this offer had one or more contracts terminated by default by any federal, state or municipal <br />agency. <br /> <br />(b)For purposes of this provision, principals is defined as officers, directors, owners, partners, and persons having primary <br />management or supervisory responsibilities within a business entity. <br /> <br />(c)The Landlord shall provide immediate written notification to the Sergeant at Arms State Office Operations if, at any time <br />prior to the lease execution, the Landlord learns that its certification was erroneous by reason of changed circumstances. <br /> <br />(d)A certification that any of the items in paragraph (a) above exists will not necessarily result in withholding of award. The <br />certification will be used in connection with a determination of the Landlord’s responsibility. <br /> <br /> <br /> <br />_____________________________________ <br /> <br />_____________________________________ <br /> <br />PAUL MCKEE, REAL PROPERTY MANAGER Date <br /> <br /> <br /> <br /> <br />_______________________________ <br /> <br />Signature <br /> <br /> <br />