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ATTACHMENT E <br />Debarment, Suspension, Ineligibility or Voluntary Exclusion - <br />Certification Form <br />Grant # E05-071 <br />NAME <br />Doing business as (DBA) <br />CITY OF EVERETT <br />ADDRESS <br />2930 Wetmore Avenue <br />Applicable Procurement <br />or Solicitation #, if any: <br />WA Uniform Business <br />Identifier (UBI) <br />Federal Employer Tax <br />Identification #: <br />Everett, WA 98201 <br />313009341 <br />91-6001248 <br />Instructions For Certification Regarding Debarment, Suspension, Ineligibility and <br />Voluntary Exclusion --Lower Tier Covered Transactions <br />READ CAREFULLY BEFORE SIGNING THE CERTIFICATION. Federal regulations require <br />contractors and bidders to sign and abide by the terms of this certification, without modification, in order <br />to participate in certain transactions directly or indirectly involving federal funds. <br />By signing and submitting this proposal, the prospective lower tier participant is providing <br />the certification set out below. <br />2. The certification in this clause is a material representation of fact upon which reliance was <br />placed when this transaction was entered into. If it is later determined that the prospective <br />lower tier participant knowingly rendered an erroneous certification, in addition to other <br />remedies available to the Federal Government, the department or agency with which this <br />transaction originated may pursue available remedies, including suspension and/or <br />debarment. <br />3. The prospective lower tier participant shall provide immediate written notice to the <br />department, institution or office to which this proposal is submitted if at any time the <br />prospective lower tier participant learns that its certification was erroneous when submitted <br />or had become erroneous by reason of changed circumstances. <br />4. The terms covered transaction, debarred, suspended, ineligible, lower tier covered <br />transaction, participant, person, primary covered transaction, principal, proposal, and <br />voluntarily excluded, as used in this clause, have the meaning set out in the Definitions and <br />Coverage sections of rules implementing Executive Order 12549. You may contact the <br />person to which this proposal is submitted for assistance in obtaining a copy of those <br />regulations. <br />5. The prospective lower tier participant agrees by submitting this proposal that, should the <br />proposed covered transaction be entered into, it shall not knowingly enter into any lower tier <br />covered transaction with a person who is proposed for debarment under the applicable <br />CFR, debarred, suspended, declared ineligible, or voluntarily excluded from participation in <br />2-� <br />J <br />