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<br />Applicant r; t-y n-f $~n M~rC'o~ <br />Attachment G <br /> <br /> <br />Debarment Certification <br />(Negotiated Contracts) <br /> <br /> <br />(1) The CONTRACTOR certifies to the best of its knowledge and belief, that it and its <br />princi pals: <br /> <br />(a) Are not presently debarred, suspended, proposed for debannent, declared <br />ineligible or voluntarily excluded from covered transactions by any federal <br />department or agency; <br /> <br />(b) Have not within a three-year period preceding this proposal been convicted <br />of or had a civil judgment rendered against them for commission of fraud or a criminal <br />offense in connection with obtaining, attempting to obtain, or performing a public* <br />transaction or contract under a public transaction; violation of federal or state <br />antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification <br />or destruction of records, making false statements, or receiving stolen property; <br /> <br />(c) Are not presently indicated for or otherwise criminally or civilly charged by <br />a governmental entity* with commission of any of the offenses enumerated in <br />paragraph (1)(b) of this certification; and <br /> <br />(d) Have not within a three-year period preceding this application/proposal had one or <br />more public transactions* tenninated for cause or default. <br /> <br />(2) Where the CONTRACTOR is unable to certify to any of the statements in <br />this certification, such CONTRACTOR shall attach an explanation to this <br />certification. <br /> <br /> <br />*federal, state or local <br /> <br /> <br /> <br />ß'i;1 U Jf <br />f,/! r ,,- 'I!/j <br />Signature o(Certi{y'i,ng ¡cial ~ <br />. \'j <br />City Manager <br />Title <br /> <br />September 25. 1989 <br />Date <br /> <br /> <br />io'orm 17a4-^ <br />4-89 <br />