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Washington Military Department Contract Number: U18-090
<br /> Debarment, Suspension, Ineligibility or Voluntary Exclusion Certification Form
<br /> NAME Doing business as(DBA)
<br /> City of Everett
<br /> ADDRESS +f �3ti'�8 Applicable Procurement WA Uniform Business Federal Employer Tax
<br /> ���
<br /> 2930 Wetmore Ave L L or Solicitation#,if any: Identifier(UBI) Identification#:
<br /> Everett, WA 98201 313-000-656 91-6001248
<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 and
<br /> 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 fact upon which reliance was placed when this
<br /> transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an
<br /> erroneous certification, in addition to other remedies available to the Federal Government the department or agency
<br /> with which this 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 department, institution or office to
<br /> which this proposal is submitted if at any time the prospective lower tier participant learns that its certification was
<br /> 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 meaning
<br /> set out in the Definitions and 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 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 excluded
<br /> from participation in this covered transaction, unless authorized by the department or agency with which this
<br /> 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 all 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 covered
<br /> transaction that it is not proposed for debarment under applicable CFR, debarred, suspended, ineligible, or voluntarily
<br /> excluded from covered transactions, unless it knows that the certification is erroneous. A participant may decide the
<br /> method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required
<br /> to, check the List of Parties Excluded from Federal Procurement and Non-procurement 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 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 applicable
<br /> CFR, 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
<br /> pursue available remedies, including suspension and/or debarment.
<br /> Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion--Lower Tier
<br /> Covered Transactions
<br /> The prospective lower tier participant certifies, by submission of this proposal or contract, 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. Where the prospective lower tier
<br /> participant is unable to certify to any of the statements in this certification, such prospective participant shall
<br /> attach an explanation to this form.
<br /> Bidder or Contractor Signature: A. 441, Date: ql
<br /> Print Name and Title: -Ra ! nSa AL`.. or-
<br /> II r-T . ST.
<br /> City Clerk
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