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APPENDIX C.1 <br />LOWER TIER PARTICIPANT DEBARMENT CERTIFICATION <br />being duly <br />(Name of certifying official) <br />sworn or under penalty of perjury under the laws of the United States, certifies that neither <br />nor its principals <br />(Name of lower tier participant) <br />are presently: <br />• debarred, suspended, proposed for debarment, <br />• declared ineligible, <br />• or voluntarily excluded from participation in this transaction <br />by any federal department or agency. <br />Where the above identified lower tier participant is unable to certify to any of the above statements in <br />this certification, such prospective participant shall indicate below to whom the exception applies, the <br />initiating agency, and dates of action. <br />Exceptions will not necessarily result in denial of award but will be considered in determining <br />contractor responsibility. Providing false information may result in criminal prosecution or <br />administrative sanctions. <br />EXCEPTIONS: <br />Signature of Certifying Official <br />Title <br />Date of Certification <br />Form 1734 <br />Rev. 10-91 <br />TPFS <br />EXHIBIT D <br />CERTIFICATION REGARDING LOBBYING <br />Memorandum of Understanding Page 2 <br />