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FORM D: ADMINISTRATIVE INFORMATION continued 4 411 R At DSHS 1 QI 40 91 4 9 t P that aFe submitted and ma h y --at . , - . .. A. , . . . , onto diS etinn reien 4 o,mrlo of the Feo t the r?rnnno?/ nn the GF 8 w finanGiaPGapabditv- 8. Is respondent or any member of respondent's executive management, project management, board members or principal officers: • Delinquent on any state, federal or other debt; • Affiliated with an organization which is delinquent on any state, federal or other debt; or • In default on an agreed repayment schedule with any funding organization? ? YES ? NO If YES, please explain. (Attach no more than one additional page.) 9. Has the respondent had a contract suspended or terminated prior to expiration of contract or not been renewed under an optional renewal by any local, state, or federal department or agency or non- profit entity? ? YES ? NO If YES, indicate the reason for such action that includes the name and contact information of the local, state, or federal department or agency, the date of the contract and a contract reference number, and provide copies of any and all decisions or orders related to the suspension, termination, or non-renewal by the contracting entity. 10. Does this proposal include financial participation by a person or entity that has been convicted of violating federal law, or been assessed a penalty in a federal civil administrative enforcement action, in connection with a contract awarded by the federal government for relief, recovery or reconstruction efforts as a result of Hurricanes Rita or Katrina or any other disaster occurring after September 24, 2005, under Government Code §2155.006 and 2161.053? ? YES ? NO If YES, please explain. (Attach no more than one additional page.) Page 33 RFP# EMS/LPG - 0328.1