Laserfiche WebLink
A-T'i.Lr ?e'zck <br />33 <br />Attachment C <br />CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY <br />and VOLUNTARY EXCLUSION <br />Contractor Covered Transactions <br />(1) The prospective subcontractor of the Sub -recipient, , certifies, by submission of <br />this document, that neither _it nor Its principals is presently debarretl, suspended, proposed for <br />debarment, declared lriellglble, or voluntarily excluded from part'icipat'or in this transaction by any - <br />Federal department or agency. <br />(2) Where the Sub -recipient's subcontractor is unable to certify to the above statement, the'prospective <br />contract shall attach an explanation to this form. <br />p1�1� <br />110FArift—Nam <br />wgnatur <br />1511) NW IN A . <br />Street Address <br />Doirkl I IPL- -5 31 1)(o <br />City, State, Zi <br />Date <br />C4 & ( _-",Jpj.r lSI�S &C�CI� <br />Sub-ftipie�Name I <br />DEM.Contract Number <br />FEMA Project Number <br />