HomeMy WebLinkAboutWestern Municipal_Certificatin Regarding Debarment Section 00900 January 2021
SRF Project Number
United States Environmental Protection Agency
Washington, DC 20460
Certification Regarding Debarment, Suspension, and
Other Responsibility Matters
The prospective participant certifies to the best of its knowledge and belief that it and its principals:
(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily
excluded from covered transactions by any Federal department or agency;
(b) Have not within a three year period preceding this proposal been convicted of or had a civil
judgment rendered against them for commission of fraud or a criminal offense in connection with
obtaining, attempting to obtain, or performing a public(Federal, State, or local) transaction or contract
under a public transaction; violation of Federal or State antitrust statutes or commission of
embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements,
or receiving stolen property;
(c) Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(Federal, State, or local)with commission of any of the offenses enumerated in paragraph (1)(b) of
this certification; and
(d) Have not within a three-year period preceding this application/proposal had one or more public
transactions (Federal, State, or local)terminated for cause ordefault.
understand that a false statement on this certification may be grounds for rejection of this proposal or
termination of the award. In addition, under 18 USC Sec. 1001, a false statement may result in a fine
of up to $10,000 or imprisonment for up to 5 years, or both.
Jock Clause, President
Typed Name &Title of Authorized Representative
Z Zjftc-,� 7/20/21
Signature of Aut rized Representative Date
I am unable to certify to the above statements. My explanation isattached.
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