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<br /> - DSHS Contract Number 0364-32126
<br /> NAME Doing business as(DBA)
<br /> City of Everett Camp Patterson
<br /> ADDRESS WASHINGTON UNIFORM FEDERAL EMPLOYER
<br /> 802 East Mukilteo Blvd BUSINESS IDENTIFIER(UBI) IDENTIFICATION NUMBER
<br /> Everett,WA 98203 916001248
<br /> This certification is submitted as part of a request to contract. The applicable Procurement or Solicitation Number, if any,is .
<br /> Instructions For Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion--
<br /> Lower Tier Covered Transactions
<br /> READ CAREFULLY BEFORE SIGNING THE CERTIFICATION. Federal regulations require contractors and bidders to sign
<br /> and abide by the terms of this certification,without modification, in order to participate in certain transactions directly or
<br /> indirectly 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 this
<br /> • 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 person to which this proposal is
<br /> submitted if at any time the prospective lower tier participant learns that its certification was erroneous when submitted or
<br /> 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 out
<br /> in the Definitions and Coverage sections of rules implementing Executive Order 12549.You may contact the person to which
<br /> 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 48 CFR part 9, subpart 9.4, 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 Transaction,"
<br /> without modification,in all lower tier covered transactions and in all solicitations for lower tier covered 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 48 CFR part 9, subpart 9.4,debarred, suspended, ineligible,or
<br /> voluntarily excluded from covered transactions, unless it knows that the certification is erroneous.A participant may decide
<br /> the 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 Nonprocurement 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 dealings.
<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 48 CFR part 9,
<br /> subpart 9.4,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 pursue
<br /> available remedies, including suspension and/or debarment.
<br /> Certification Regarding Debarment, Suspension, Ineligibility and
<br /> Voluntary Exclusion--Lower Tier Covered Transactions
<br /> (1)The prospective lower tier participant certifies, by submission of this proposal, 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.
<br /> (2)Where the prospective lower tier participant is unable to certify to any of the statements in this certification,
<br /> such prospective participant shall attach an explanation to this proposal.
<br /> Bidder or Contractor Signature Date
<br /> Print Name and Title
<br /> t.9
<br /> DSHS Central Contract Services
<br /> Debarrment Certification(12-13-00)
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