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<br />FEDERAL DEBARMENT CERTIFICATION <br /> <br />BID ON BLEACHER, PARK AND PLAYGROUND EQUIPMENT, 11-0014-MR <br /> <br />CERTIFICATION REGARDING DEBARMENT, SUSPENSION <br />INELIGIBILITY AND VOLUNTARY EXCLUSION - LOWER TIER COVERED <br />TRANSACTIONS <br /> <br />This certification is required by the regulations implementing Executive Order 12549, Debarment and <br />Suspension, 7 CFR Part 3017, Section 3017.510, Participants responsibilities. The regulations were <br />published as Part IV of the January 30,1989, Federal Register (pages 4722-4733) <br /> <br />*** BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS ON NEXT PAGE *** <br /> <br />(1) The prospective lower tier participant certifies, by submission of this proposal, that neither it nor <br />its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or <br />voluntarily excluded from participation in this transaction by any Federal department or agency. <br /> <br />(2) Where the prospective lower tier participant is unable to certify to any of the statements in this <br />certification, such prospective participant shall attached an explanation to this proposal. <br /> <br />Organization Name <br /> <br />PRlAward Number or Project Name <br /> <br />Name(s) and Title(s) of Authorized Representative(s) <br /> <br />Signature(s) <br /> <br />Date <br /> <br />Form AD-1048 (1/92) <br /> <br />Page 35 of37 <br /> <br />... <br /> <br />..., -\ <br /> <br />., <br />. <br /> <br />~ <br />