2006/06/14 Council Agenda Packet

15 .EPA EPA Project Control Number United States Environmental Protection Agency Washington,DC 20460 Certification Regarding Debarment, Suspension, and Other Responsibility Matters The prospective participant certifies to the best of its knowledge and belief that it and its principals: (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; (b) Have not within a three year period preceding this proposal been convicted of or had a civi judgement rendered against them for commission of fraud or a criminal offense in connection with o t g, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (c) Are not presently indicted for or otherwise criminally or civilly charged by a government entity(Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this certification;and (d) Have not within a three-year period preceding this application/proposal had one or more public transactions(Federal,State,or local)terminated for cause or default. I understand that a false statement on this certification may be grounds for rejection of this proposal or termination of the award. In addition, under 18 USC Sec. 1001, a false statement may result in a fine of up to$10,000 or imprisonment for up to 5 years,or both. Typed Name&Title of Authorized Representative Signature of Authorized Representative Date I am unable to certify to the above statements. My explanation is attached. EPA Form 5700-49 (11-88) kr Printed on Recycled Paper 91