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CITY
<br /> OF EVERETT PUBLIC WORKS
<br /> SPECIAL PROVISIONS
<br /> Debarment, Suspension, Ineligibility or Voluntary Exclusion Certification Form
<br /> NAME Doing business as(DBA)
<br /> Kassel & Associates, Inc.
<br /> ADDRESS Applicable Procurement NH Uniform Business Federal Employer Tax.
<br /> 7126 180th Avenue NE #0-103 or Solicitation#,if any: Identifier(UBI) Identification#:
<br /> Redmond, WA 98052 602 944 979 27-0765921
<br /> This certification is submitted as part of a request to contract.
<br /> Instructions For Certification Regarding Debarment,Suspension, Ineligibility and Voluntary Exclusion—Lower
<br /> 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
<br /> below.
<br /> 2. The certification in this clause is a material representation of factupon which reliance was placed when this
<br /> transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered
<br /> an erroneous certification, in addition to other remedies available to the Federal Government the department or
<br /> agency with which this 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 department, institution or office
<br /> to which this proposal is submitted if at anytime the prospective lower tier participant learns that its certification
<br /> was erroneous when submitted or 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
<br /> meaning set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may
<br /> contact the person to which 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
<br /> transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is
<br /> proposed for debarment under the applicable CFR, debarred, suspended, declared ineligible, or voluntarily
<br /> excluded from participation in this covered transaction, unless authorized by the department or agency with which
<br /> this transaction 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
<br /> Transaction,"without modification, in ali lower tier covered transactions and in all solicitations for lower tier covered
<br /> transactions.
<br /> 7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier
<br /> covered transaction that it is not proposed for debarment under applicable CFR, debarred, suspended, ineligible,
<br /> or voluntarily excluded from covered transactions, unless it knows that the certification is erroneous. A participant
<br /> may decide the method and frequency by which it determines the eligibility of its principals. Each participant may,
<br /> but is not required to, check the List of Parties Excluded from Federal Procurement and Non-procurement
<br /> Programs.
<br /> 8: Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to
<br /> render in good faith the certification required by this clause. The knowledge and information of a participant is not
<br /> required to exceed that which is normally possessed by a prudent person in the ordinary course of business
<br /> activity.
<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
<br /> applicable CFR, suspended, debarred, ineligible, or voluntarily-excluded from participation in this transaction, in
<br /> 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 /> Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion--Lower Tier
<br /> Covered Transactions
<br /> WFP Operations Building Seismic Retrofit-Rebid January 6,2017
<br /> WO#UP3600 004556-2
<br /> Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal
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